Contract No. 1821-1090 The Children's Trust ( 0/9 - 02-9 -3
CONTRACT NO. 1821-1090
BETWEEN THE CHILDREN'S TRUST
AND City of Miami Beach
FOR Place-based/Countywide Community Partnerships
THIS CONTRACT is between The Children's Trust whose address is 3150 S.W.3rd Avenue,8th Floor,Miami,
Florida 33129 and City of Miami Beach hereafter"Provider"whose address is 1700 Convention Center
Drive,,Miami Beach,FL 33139.
In consideration of the mutual covenants herein,The Children's Trust and Provider(sometimes hereafter
referred to as "Parties") agree as follows:
A. EFFECTIVE TERM
The effective term of this Contract shall be from 8/1/2017 through 7/31/2018,subject to funding
availability and Provider's performance.
B. TERMS OF RENEWAL, if applicable
In the sole discretion of The Children's Trust,this Contract may be renewed with the acknowledgement of
Provider. In considering the exercise of any Contract renewal,and in accordance with the Request for
Proposal (RFP) and Board authorization,renewal may not exceed a term equal to the term of the initial
Contract for a total maximum of three (3) terms. The Children's Trust,in its sole discretion,will consider,but is
not limited to,the following:
1. Provider meeting the performance requirements specified in this Contract.
2. Continued demonstrated and documented need for the services funded.
3. Program performance,fiscal performance,and compliance by Provider that is deemed satisfactory
in The Children's Trust's sole discretion.
4. The availability of funds.The Children's Trust is prohibited from creating obligations in anticipation of
budgeted revenues from one fiscal year to another without year to year extension provisions in
the Contract.
5. If applicable,The Children's Trust,in its sole discretion,will initiate re-negotiation of this Contract
before the Contract term expires.
C. SCOPE OF SERVICES
1. Provider agrees to render services in accordance with the Scope of Services,Attachment A,
hereafter"Services",to this Contract. Provider shall implement the Services in a manner deemed
satisfactory to The Children's Trust. Any modification to the Services shall not be effective until
approved,in writing, by The Children's Trust and Provider.
2. The Services' activities and performance measures,as well as complete and accurate data and
programming information will be used in the evaluation of Provider's overall performance.
3. Provider agrees that all funding provided by The Children's Trust,pursuant to this Contract will be used
exclusively for services in and for the benefit of Miami-Dade County residents.
D. TOTAL FUNDING
Subject to the availability of funds,the maximum amount payable for Services rendered under this Contract
shall not exceed$400,000.00,with a required match of$100,000.00.Provider agrees that should
available funding to The Children's Trust be reduced,the amount payable under this Contract will be
reduced at the sole option of The Children's Trust. Provider agrees to adhere to Attachment B of this
Contract: Other Fiscal Requirements, Budget and Method of Payment.
E. FISCAL MANAGEMENT
1. Double Billing and Payments
Provider costs or earnings claimed under this Contract may not also be claimed under any other
Contract or grant from The Children's Trust or,unless such claim is denied by The Children's Trust,from
any other agency. Any claim for double payment by Provider shall be a material breach of this
Contract.
2. No Supplanting of Existing Public Funds
The Children's Trust's funding may not be used as a substitute for existing resources or for resources that
would otherwise be available for children's services,or to replace funding previously provided by,and
currently available from,local and state funding sources for the same purpose. A violation of this
section is a material breach of this Contract.
3. Capital Equipment
Capital equipment is included in the definition of "property"under Florida Statutes,Chapter 274,and
Florida Administrative Code,Section 691-73.002,and is defined as individual items with a value of
$1,000 or greater which have a life expectancy of more than one year.
All capital equipment acquired by Provider less than$10,000,and reimbursed by The Children's Trust,
shall be capitalized by the Provider and Provider shall retain all rights and possession of equipment
unless this Contract is subject to termination or early cancellation. Should this Contract be terminated
or not renewed,The Children's Trust may acquire rights and possession of all reimbursed capital
equipment that is not fully depreciated.
All capital equipment acquired by Provider equal to or greater than$10,000,and reimbursed by The
Children's Trust,shall be capitalized by The Children's Trust and The Trust shall retain all rights to
equipment until the item is fully depreciated. Should this Contract be subject to termination or early
cancellation,The Children's Trust may acquire possession of all reimbursed capital equipment that is
not fully depreciated.
Any or all such qualifying capital equipment shall be returned to The Children's Trust,or its designee(s)
upon request. Provider is to maintain proof of Property Coverage in accordance with the insurance
requirements prescribed in section K of this Contract.
4. Assignments and Subcontracts
Provider shall not assign this Contract to another party. Provider shall not subcontract any Services
under this Contract without prior written approval of The Children's Trust. In any subcontract, Provider
shall incorporate appropriate language from this Contract into each subcontract and shall require
each subcontractor providing services to be governed by the terms and conditions of this Contract.
Provider shall submit to The Children's Trust a copy of each subcontract to this Contract within 30 days
of its execution. All subcontracts with Provider must be executed within 30 days of Provider's execution
date. All subcontractors are subject to monitoring by Provider and/or The Children's Trust,in the same
manner as Provider under the terms of this Contract. Provider acknowledges and agrees that The
Children's Trust and any subcontractor to this Contract have authority to communicate and exchange
information about Contract,program,and/or fiscal issues. Provider waives any and all claims,
demands,and/or legal action based upon any such communications.
Provider shall be responsible for all Services performed,and all expenses incurred,under this Contract,
including services provided and expenses incurred by any and all subcontractors. The Children's Trust
shall not be liable to any subcontractor for any expenses or liabilities incurred under any subcontract.
Provider shall be solely liable for any expenses or liabilities incurred under any subcontract. Provider
shall hold harmless and defend,at Provider's expense,The Children's Trust against any claims,
demands or actions related to any subcontract.
The Children's Trust shall not provide funds to any subcontractor unless specifically agreed to in writing
by The Children's Trust with notification to the Provider. All payments to any contracted subcontractor
shall be paid directly by Provider to the subcontractor.The Children's Trust reserves the right to require
verification from Provider and/or subcontractor of payment due for satisfactory work performed by
the subcontractor.
Provider and any subcontractor must be currently qualified to conduct business in the State of Florida
at the time that a subcontractor agreement is entered into and services are rendered.
5. Religious Purposes
Providers and/or their faith-based community partners shall not use any funds provided under this
Contract to support any inherently religious activities,including but not limited to,any religious
instruction,worship,proselytization,publicity or marketing materials. Any such use by Provider shall be
a material breach of this Contract.
6. Lobbying
Provider shall not use any funds provided under this Contract or any other funds provided by The
Children's Trust for lobbying any federal,state or local government or legislators. Any such use by
Provider shall be a material breach of this Contract.
7. Adverse Action or Proceeding
Provider shall not use any funds under this Contract,or any other funds provided by The Children's Trust,
for any legal fees,or for any action or proceeding against The Children's Trust,its agents,employees
or officials. Any such use by Provider shall be a material breach of this Contract.
8. Compliance
Provider agrees to maintain and ensure its compliance,as applicable,with federal,state,county,and
local laws. This includes,but is not limited to,adherence to IRS rules and regulations requiring timely
filing of tax returns to retain tax-exempt status and payment of payroll taxes,as applicable,throughout
the term of the Contract.
Provider further agrees to provide agency and site(s) information to the Jewish Community Services of
South Florida,Inc.211 Helpline,The Children's Trust 24 hour helpline.
F. INDEMNIFICATION BY PROVIDER
1. Government Entity
Subject to the limitations and sovereign immunity provisions of Florida Statute,Sec.768.28, Provider
shall indemnify and hold harmless The Children's Trust and its officers,employees,agents and
instrumentalities from any and all liability,losses or damages,including attorneys'fees and costs of
defense,which its officers,employees,agents or instrumentalities may incur as a result of claims,
demands,suits,causes of actions or proceedings of any kind or nature arising out of,relating to or
resulting from the performance of this Contract by Provider or its employees,agents,servants,
partners,principals or subcontractors.
Subject to the limitations and sovereign immunity provisions of Florida Statutes,Sec.768.28,Provider
shall pay all claims and losses in connection therewith and shall investigate and defend all claims,suits
or actions of any kind or nature in the name of The Children's Trust,where applicable,including
appellate proceedings,and shall pay all costs,judgments,and reasonable attorney's fees which may
issue thereon.
2. All Other Providers
Provider shall indemnify and hold harmless The Children's Trust and its officers,employees,agents and
instrumentalities from any and all liability,losses or damages,including reasonable attorneys'fees and
costs of defense,which The Children's Trust or its officers,employees,agents or instrumentalities may
incur as a result of claims,demands,suits,causes of action or proceedings of any kind or nature arising
out of,relating to or resulting from the performance of this Contract by Provider or its employees,
agents,servants,partners,principals or subcontractors,except to the extent arising from The Children's
Trust's willful or wanton acts or omissions.
To the extent arising from a liability that is covered by the foregoing indemnification, Provider shall pay
all claims and losses in connection therewith and shall investigate and defend all claims,suits or actions
of any kind or nature in the name of The Children's Trust,where applicable,including appellate
proceedings,and shall pay all costs,judgments,and reasonable attorney's fees which may issue
thereon. Provider agrees that any insurance protection required by this Contract or otherwise
provided by Provider shall in no way limit the responsibility to indemnify, keep and save harmless and
defend The Children's Trust or its officers,employees,agents.
The provisions of this section on indemnification shall survive the expiration or termination of this
Contract.
G. COPYRIGHTS AND RIGHT TO DATA/MATERIALS
Where activities supported by this Contract produce original writing,data,sound recordings,pictorial
reproductions,drawings or other graphic representations and works of similar nature,The Children's Trust
has a license to reasonably use,duplicate and disclose such materials in whole or in part in a manner
consistent with the purposes and terms of this Contract,and to have others acting on behalf of The
Children's Trust to do so,provided that such use does not compromise the validity of any copyright,
trademark or patent.If the data/materials so developed are subject to copyright,trademark or patent,
legal title and every right,interest,claim or demand of any kind in and to any patent,trademark or
copyright,or application for the same,will vest in Provider or with any applicable third party who has
licensed or otherwise permitted Provider to use the same. Provider agrees to allow The Children's Trust and
others acting on behalf of The Children's Trust to have reasonable use of the same consistent with the
purposes and terms of this Contract,at no cost to The Children's Trust,provided that such use does not
compromise the validity of such copyright,trademark or patent.
H. PUBLIC RECORDS
This Contract is subject to the provisions,limitations and exceptions of Chapter 119,Florida Statutes,
regarding public records. The Provider shall allow public access to all documents,papers,letters,or other
material subject to the provisions of Chapter 119,Florida Statutes,made or received by the Provider in
connection with this Contract,except that public records which are made confidential or exempt from
public record disclosure by law must be protected from disclosure and include,but is not limited to criminal
history information derived from the U.S.Department of Justice. Failure of the Provider to allow such public
access shall result in the immediate termination of this Contract or any renewal.The Provider shall maintain
public records stored in electronic record keeping systems in accordance with Chapter 119, Florida
Statutes,and Rule IB-26.003 of the Florida Administrative Code.
Pursuant to section 119.0701 of the Florida Statutes,the Provider shall:
a. Keep and maintain public records required by The Children's Trust to perform the services under this
Contract;
b. Upon request from The Children's Trust's custodian of public records,provide The Children's Trust with
a copy of the requested records or allow the records to be inspected or copied within a reasonable
time 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 for the duration of the Contract term
and following completion of the Contract if the Provider does not transfer the records to The
Children's Trust;and
d. Meet all requirements for retaining public records and transfer to The Children's Trust,at no cost to
The Children's Trust,all public records created,received, maintained and or directly related to the
performance of this Contract that are in possession of the Provider upon termination of this Contract.
Upon termination of this Contract,the Provider shall 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 Children's Trust,upon request from The Children's Trust's
custodian of public records,in a format that is compatible with The Children's Trust's information
technology systems.
For purposes of this Section,the term "public records"shall mean all documents,papers,letters,maps,
books,tapes,photographs,films,sound recordings,data processing software,or other material,regardless
of the physical form,characteristics,or means of transmission,made or received pursuant to law or
ordinance or in connection with the transaction of The Children's Trust official business.
IF THE PROVIDER HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES,
TO THE PROVIDER'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT
THE CUSTODIAN OF PUBLIC RECORDS AT (305) 571-5700 EXT. 292,
MURIEL.JEANTY@THECHILDRENSTRUST.ORG, 3150 SW 3RD AVENUE, 8TH FLOOR, MIAMI, FLORIDA
33129.
In the event the Provider does not comply with the public records disclosure requirement set forth in section
119.0701 of the Florida Statutes and this Section H of this Contract,The Children's Trust shall avail itself of the
remedies set forth in,Sections J. Breach of Contract and Remedies and K. Termination By Either Party—of
this Contract.Additionally,a Provider who fails to provide the public records as required by law,within a
reasonable time,may be subject to penalties under section 119.10 of the Florida Statutes.
I. OWNERSHIP AND LICENSING OF INTELLECTUAL PROPERTY
To the extent permitted by Chapter 119, Florida Statutes, Provider retains sole ownership of intellectual
property developed under this Contract. Provider is responsible for payment of required licensing fees if
intellectual property owned by other parties is incorporated by Provider into the services required under this
Contract. Such licensing should be in the exclusive name of Provider. Payment for any licensing fees or
costs arising from the use of others'intellectual property shall be at the sole expense of Provider.
J. BREACH OF CONTRACT AND REMEDIES
1. Breach
A material breach by Provider shall have occurred under this Contract if Provider through action or
omission causes any of the following:
a. Fails to comply with Background Screening,as required under this Contract.
b. Fails to provide the Services outlined in the Scope of Services Attachment A within the effective
term of this Contract;
c. Fails to correct an imminent safety concern or take acceptable corrective action;
d. Ineffectively or improperly uses The Children's Trust's funds allocated under this Contract;
e. Does not furnish and maintain the certificates of insurance required by this Contract or as
determined by The Children's Trust;
f. Does not meet or satisfy the conditions of award required by this Contract;
g. Fails to submit,or submits incorrect or incomplete proof of expenditures to support Services &
Activities Management System (SAMIS) disbursement requests or advance funding
disbursements;or,fails to submit,or submits incomplete or incorrect,detailed reports of
requests for payment,expenditures or final expenditure reports;included,but not limited to
budgets,invoices,and amendments in SAMIS.
h. Does not submit or submits incomplete or incorrect required reports pursuant to the Scope of
Services Attachment A in this Contract;
i. Refuses to allow The Children's Trust access to records or refuses to allow The Children's Trust to
monitor,evaluate and review Provider's program,including required client data;
j. Fails to comply with child abuse and incident reporting requirements;
k. Attempts to meet its obligations under this Contract through fraud,misrepresentation or material
misstatement;
I. Fails to correct deficiencies found during a monitoring,evaluation or review within a specified
reasonable time;
m. Fails to meet the terms and conditions of any obligation or repayment schedule to The
Children's Trust or any of its agencies;
n. Fails to maintain the confidentiality of client files,pursuant to Florida and federal laws;
o. Fails to fulfill in a timely and proper manner any and all of its obligations,covenants,Contracts
and stipulations in this Contract.
p. Fails to submit an Annual Financial Statement Audit and a Program-Specific Audit,as applicable,
in accordance with Section P and Attachment D of this Contract.
q. Fails to submit an Audit Engagement Letter for either the Annual Financial Statement Audit or the
Program Specific Audit within thirty (30) days after Provider's fiscal year end.
r. Fails to notify The Children's Trust within thirty (30) days of nonpayment of payroll or other
required taxes imposed by the federal government,State of Florida,Miami-Dade County or
other authorized taxing entity.
Waiver of breach of any provisions of this Contract shall not be deemed to be a waiver of any other
breach and shall not be construed to be a modification of the terms of this Contract.
2. Remedies
If Provider fails to cure any breach within thirty (30) days after receiving written notice from The
Children's Trust identifying the breach,The Children's Trust may pursue any or all of the following
remedies:
a. The Children's Trust may,at its sole discretion,enter into a written performance improvement
plan (PIP) Attachment F,if applicable,with Provider to cure any breach of this Contract as may
be permissible under state or federal law. Any such remedial plan shall be an addition to this
Contract and shall not affect or render void or voidable any other provision contained in this
Contract,costs,or any judgments entered by a court of appropriate jurisdiction.
b. The Children's Trust may suspend payment in whole or in part under this Contract by providing
written notice of suspension to Provider of such suspension and specifying the effective date of
suspension,at least five business days before the effective date of suspension.On the effective
date of suspension Provider may (but shall not be obligated to) continue to perform the Services
in this Contract,but Provider shall promptly cease using The Children's Trust logo and any other
reference to The Children's Trust in connection with such Services. All payments to Provider as of
the date of suspension shall cease,except that The Children's Trust shall continue to review and
pay verifiable requests for payment for Services that were performed and/or for deliverables
that were substantially completed,at the sole discretion of The Children's Trust,prior to the
effective date of such suspension. The Children's Trust may also suspend any payments in whole
or in part under any other Contracts entered into between The Children's Trust and Provider by
providing separate written notice to Provider of each such suspension and specifying the
effective date of suspension,which must be at least five business days before the effective
date of such suspension,in any event The Children's Trust shall continue to review and pay
verifiable requests for payment as provided for in such other Contracts for services that were
performed and/or for deliverables that were substantially completed,at the sole discretion of
The Children's Trust prior to the effective date of such suspension. Provider shall be responsible
for all direct and indirect costs associated with such suspension including reasonable attorney's
fees.
c. The Children's Trust may terminate this Contract by giving written notice to Provider of such
termination and specifying the date of termination at least five (5) business days before the
effective date of termination. In the event of such termination,The Children's Trust may (a)
request Provider to deliver to The Children's Trust clear and legible copies of all finished or
unfinished documents,studies,surveys,reports prepared and secured by Provider with Trust
funds under this Contract subject to the rights of Provider as provided for in Paragraphs G and
I above; (b) seek reimbursement of any Trust funds which have been improperly paid to Provider
under this Contract; (c) terminate further payment of Trust funds to Provider under this Contract,
except that The Children's Trust shall continue to review and pay verifiable requests for payment
for services that were performed and/or deliverables that were substantially completed,at the
sole discretion of The Children's Trust prior to the effective date of such termination;and/or (d)
terminate or cancel,without cause,any other Contracts entered into between The Children's
Trust and Provider by providing separate written notice to Provider of each such termination and
specifying the effective date of termination,which must be at least five business days before
the effective date of such termination,in which event The Children's Trust shall continue to
review and pay verifiable requests for payment as provided for in such other Contracts for
services that were performed and/or for deliverables that were substantially completed,at the
sole discretion of The Children's Trust prior to the effective date of such termination. Provider
shall be responsible for all direct and indirect costs associated with such termination,including
reasonable attorney's fees.
d. The Children's Trust may seek enforcement of this Contract including but not limited to filing an
action with a court of appropriate jurisdiction. Provider shall be responsible for all direct and
indirect costs associated with such enforcement,including reasonable attorney's fees,costs,
and any judgments entered by a court of appropriate jurisdiction,including all direct and
indirect costs and reasonable attorneys'fees through conclusion of all appellate proceedings,
and including any final settlement or judgment.
e. The provisions of this Paragraph J shall survive the expiration or termination of this Contract.
K. TERMINATION BY EITHER PARTY
The parties agree that this Contract may be terminated by either party by written notice to the other party
of intent to terminate at least thirty (30) calendar days prior to the effective date of such termination.
L. INSURANCE REQUIREMENTS
Prior to,or on the date commencing the effective term of this Contract, Provider's insurance agent(s) shall
provide to The Children's Trust the following,as applicable: 1) Certificates of Insurance naming The
Children's Trust as an additional insured and the certificate holder on all applicable policies;and all
applicable policies shall be maintained in full force and effect for the entire term of this Contract.
Or,2) A letter of self-insurance indicating coverage applicable to a Florida municipal corporation required
under this section or as determined by The Children's Trust,except as required by Florida law for
government entities.
Failure by Provider to comply with Section L,shall be a material breach of this Contract. The Children's Trust
will not disburse any funds under this Contract until all required Certificates of Insurance,or letter(s) of self-
insurance have been provided to and have been approved by The Children's Trust.
Provider will carry insurance policies in the amounts and with the requirements indicated below:
1. 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 Provider is no longer exempt
from obtaining Worker's Compensation insurance,the Provider must notify The Children's Trust 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.
2. 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 Provider can provide financial statements to
support a higher deductible.The Children's Trust 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:
a. Bodily Injury;
b. Property Damage;
c. No exclusions for Abuse,Molestation or Corporal Punishment;
d. No endorsement for premises only operations.
3. Automobile liability coverage for all owned and/or leased vehicles of Provider and non-owned
coverage for their employees and/or subcontractors and transportation companies transporting
program participants. The amount of coverage is $1,000,000 combined single limit per occurrence
for bodily injury and property damage. The Children's Trust must be designated and shown as an
additional insured and the certificate holder with respects to this coverage.Coverage can be
purchased as non-owned without hired auto coverage when the cost is prohibitive for hired
automobile coverage such as the case with the Florida Automobile Joint Underwriting Association;
but rental cars cannot be used in the course of Provider's regular operations.Rental cars may be used
for travel to attend conferences outside the tri-county area.Transportation companies used by the
Provider for the funded program must list The Children's Trust as a certificate holder and as an
additional insured.
4. Automobile liability coverage for all owned and/or leased vehicles of Provider and non-owned
coverage for their employees and/or subcontractors not transporting program participants. The
minimum amount of coverage is$300,000 combined single limit per occurrence for bodily injury and
property damage.The Children's Trust must be designated and shown as an"Additional Insured as
Their Interest May Appear"with respects to this coverage. Coverage can be purchased as non-
owned without hired auto coverage when the cost is prohibitive for hired automobile coverage such
as the case with the Florida Automobile Joint Underwriting Association;but rental cars cannot be used
in the course of Provider's regular operations. Rental cars may be used for travel to attend
conferences outside the tri-county area.
5. If applicable,Special Events Coverage,as determined by The Children's Trust. The liability coverage
will be the same as the coverage and limits required for comprehensive general liability and The
Children's Trust must be designated and shown as "Additional Insured as Its Interest May Appear."
Special Events policies are for short term functions and not meant to replace annual liability policies.
The coverage is for the day or days of the event and must provide coverage the day prior and the
day following the event.
6. If applicable,Professional Liability insurance,as determined by The Children's Trust,with coverage
amounts determined by The Children's Trust but 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 Children's Trust 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.
7. Proof of Property Coverage is required for all capital equipment greater than or equal to$10,000,
and when Provider has capital equipment owned by The Children's Trust and said capital equipment
is under the care custody and control of Provider. The Children's Trust must be shown on the evidence
of property coverage as a Loss Payee. Property coverage shall survive the expiration or termination
of this Contract until such time the ownership of the capital equipment is transferred to Provider or
such capital equipment is returned to The Children's Trust.
Certificate Holder
Certificate holder must read:
The Children's Trust
3150 SW 3rd Avenue, 8th Floor
Miami, Florida 33129
Classification and Rating
All insurance policies required above shall be issued by companies authorized to do business under
the laws of the State of Florida,with the following qualifications:
The company must be rated no less than "B"as to management,and no less than"Class V"as the
financial strength,by the latest edition of Best's Insurance Guide,published by A.M.Best Company,
Oldwick,New Jersey,or its equivalent,subject to the reasonable approval of The Children's Trust.
Provider and or Provider's insurance agent,as applicable,shall notify The Children's Trust,in writing,of
any material changes in insurance coverage,including,but not limited,to any renewals of existing
insurance policies,not later than thirty (30) days prior to the effective date of making any material
changes to the insurance coverage except for ten (10) days for lack of payment changes. Provider
shall be responsible for ensuring that all applicable insurances are maintained and submitted to The
Children's Trust for the duration of this Contract.
In the event of any change in Provider's Scope of Services,Attachment A,The Children's Trust may
increase,waive or modify,in writing any of the foregoing insurance requirements. Any request by a
Provider to decrease,waive or modify any of the foregoing insurance requirements shall be
approved,in writing,by The Children's Trust prior to any such decrease,waiver or modification.
In the event that an insurance policy is canceled,lapsed or expired during the effective period of this
Contract,The Children's Trust shall withhold all payments to Provider until a new Certificate of Insurance
required under this section is submitted and approved by The Children's Trust. The new insurance
policy shall cover the time period commencing from the date of cancellation of the prior insurance
policy.Provider shall submit required Certificate of Insurance within thirty (30) days cancellation,lapse
or expiration. Failure to provide said Certificate of Insurance will be considered a material breach of
the Contract and The Children's Trust may waive payment or terminate the Contract.
The Children's Trust may require Provider to furnish additional and different insurance coverage,or
both,as may be required from time to time under applicable federal or state laws or The Children's
Trust's requirements. Provision of insurance by Provider,in no instance,shall be deemed to be a
release,limitation,or waiver of any claim,cause of action or assessment that The Children's Trust may
have against Provider for any liability of any nature related to performance under this Contract or
otherwise.
All insurance required hereunder may be maintained by Provider pursuant to a master or blanket
policy or policies of insurance.
M. PROOF OF TAX STATUS
Provider is required to keep on file the following documentation for review by The Children's Trust:
• The Internal Revenue Service (IRS) tax status determination letter,if applicable;and
• The most recent(two years) IRS form 990 or applicable tax return filing within six (6) months after
Provider's fiscal year end or other appropriate filing period permitted by law;and
• IRS form 941:employer's quarterly federal tax return.If required by The Children's Trust, Provider
agrees to submit form 941 within thirty (30) calendar days after the quarter ends and if applicable,
any state and federal unemployment tax filings.If form 941 and unemployment tax filings reflect a tax
liability,then proof of payment must be submitted within sixty (60) calendar days after the quarter
ends.
N. NOTICES
Written notices pursuant to this Contract shall be sent to the addresses for each Party appearing on the first
page of this Contract.Notices to The Children's Trust shall be marked to the attention of its President/CEO. It
is each Party's responsibility to advise the other Party in writing of any changes in responsible personnel for
accepting Notices under this Contract,mailing address,and/or telephone number.
O. AUTONOMY
The Parties agree that this Contract recognizes the autonomy of,and stipulates or implies no affiliation
between,the contracting parties. Provider is only a recipient of funding support and is not an employee,
agent or instrumentality of The Children's Trust,and Provider's agents and employees are not agents or
employees of The Children's Trust.
P. RECORDS, REPORTS, AUDITS AND MONITORING
The provisions of this section shall survive the expiration or termination of this Contract,consistent with
Florida laws.
1. Accounting Records
Provider shall keep accounting records that conform to generally accepted accounting principles
(GAAP).All such records will be retained by Provider for not less than five years beyond the last date
that all applicable terms of this Contract have been complied with,final payment has been received
and appropriate audits have been submitted to and accepted by The Children's Trust. However,if any
audit,claim,litigation,negotiation or other action involving this Contract or modification hereto has
commenced before the expiration of the retention period,then the records shall be retained until
completion of the action and resolution of all issues which arise from it,or until the end of the regular
retention period,whichever is later.
2. Financial Statement Audit
Within one-hundred eighty (180) days from the close of its fiscal year, Provider's independent certified
public accounting firm (CPA) must submit all of the following documents,electronically,to The
Children's Trust,which together comprise an annual financial statement audit conducted in
accordance with GAAP and standards contained in Government Auditing Standards issued by the
Comptroller General of the United States (The Yellow Book).The required items are:
a. An annual financial statement audit,performed by a CPA firm that is licensed and registered to
conduct business with the Florida Department of Business and Professional Regulation;
b. An annual financial statement audit conducted in accordance with auditing standards generally
accepted in the United States of America and the standards applicable to financial audits
contained in Government Auditing Standards;
c. Written communication encompassing the requirements of AU-C section 265, "Communicating
Internal Control Over Financial Reporting and on Compliance and Other Matters Based on an
Audit of Financial Statements Performed in Accordance With Government Auditing Standards;"
d. Written communication encompassing the requirements of AU-C section 260, "The Auditor's
Communication With Those Charged With Governance;"
e. A Single Audit conducted in accordance with OMB Circular A-133,Audit of States, Local
Government and Non-Profit Organizations or the Florida Single Audit Act,Florida Statutes 215.97,
if applicable;and
f. A Management Letter;if no Management Letter is prepared by Provider's CPA firm,then the
CPA firm must expressly confirm,in writing,that no Management Letter was issued.
g. If Provider's annual financial statement audit is prepared by the Florida Auditor General,then the
due date for submitting the annual financial statement audit,as defined,is two-hundred seventy
(270) days after the close of Provider's fiscal year.
Electronic filing of the annual financial statement audit,as defined,must be sent by Provider's CPA
firm to the following e-mail address:audits@thechildrenstrust.org.
Providers that are required to have a Single Audit agree to have their CPA firm submit the schedule of
expenditures pertaining to awards,summary schedule of prior audit findings,applicable auditor's
reports and the corrective action plan,if applicable.
3. Program Specific Audit
Within 180 days of the close of its fiscal year,all Providers are required to have their CPA firm submit a
program specific audit related to The Children's Trust's Contracts,electronically,in addition to the
annual financial statement audit.The program-specific audit shall be performed by an independent
CPA firm that is licensed and registered to conduct business with the Florida Department of Business
and Professional Regulation,has performed audits under Government Auditing Standards and is either
a member of the AICPA or FICPA peer review program to include government engagement reviews.
This program-specific audit must encompass an audit of The Children's Trust's Contract(s) as specified
in Attachment D:Program Specific Audit Requirements.
4. Audit Extensions
Audit extensions may be granted by The Children's Trust upon receipt,in writing,of such request with
appropriate justification by Provider and for a period of time not to exceed sixty (60) days after the
initial due date. A copy of the engagement letter,along with the anticipated audit completion date
and any concerns from Provider's CPA firm related to the audit must accompany the request.
Approved audit extension requests allow for the continuation of payment until such time that the
extension expires.
In the event that either the annual financial statement audit or the program specific audit is not
received in a timely manner and in accordance with the previously stated due dates;and an audit
extension has not been approved,then The Children's Trust shall withhold all payments to Provider until
the documents are received and determined to be acceptable by The Children's Trust.
5. Engagement Letters
Audit Engagement Letters are due to The Children's Trust thirty (30) days after provider's fiscal year
end. Provider agrees to submit an Engagement Letter for both the annual financial statement audit
and the program specific audit,electronically,to audits@thechildrenstrust.org Failure to submit an
engagement letter may result in a breach of contract,or other remedy,as deemed appropriate by
The Children's Trust.
6. List of Approved Certified Public Accounting Firms
To receive reimbursement for the preparation of the program specific audit,as defined,Provider must
choose from a list of approved Certified Public Accountants or approved CPA,which are posted on
The Children's Trust website. Inclusion in this pre-approved CPA vendor pool requires a CPA firm to
meet three (3) criteria,which are enumerated in Attachment B:Other Fiscal Requirements,Budget and
Method of Payment.
7. Access to Records
Provider shall permit access to all records including subcontractor records,which relate to this Contract
at its place of business during regular business hours. Provider agrees to deliver such assistance as
may be necessary to facilitate a review or audit by The Children's Trust to ensure compliance with
applicable accounting,financial and programmatic standards.This would include access by The
Children's Trust,or its designee,to Provider's independent auditor's work papers for complying with
federal,state and local requirements. The Children's Trust reserves the right to require Provider to
submit to an audit by an auditor of The Children's Trust's choosing and at The Children's Trust's
expense.
8. Monitoring
Provider agrees to permit The Children's Trust personnel or contracted agents to perform random
scheduled and/or unscheduled monitorings,reviews and evaluations of the program which is the
subject of this Contract,including any subcontracts under this Contract,using The Children's Trust
approved monitoring tools.The Children's Trust or contracted agents shall monitor both
fiscal/administrative and programmatic compliance with all the terms and conditions of the Contract.
Provider shall permit The Children's Trust or contracted agents to conduct site visits,client interviews,
client assessment surveys,fiscal/administrative review and other assessments deemed reasonably
necessary at The Children's Trust's sole discretion to fulfill the monitoring function. A report of
monitoring findings will be delivered to Provider and Provider will remedy all deficiencies cited within
the period of time specified in the report.
9. Client Records
Pursuant to Florida Statute 119.071(5),The Children's Trust collects the last four digits of social security
numbers of child participants of funded programs and services for the following purposes: (a) to
research,track and measure the impact of The Children's Trust's funded programs and services in an
effort to maintain and improve such programs and services for the future (individual identifying
information will not be disclosed);and (b) to identify and match individuals and data within and
among various systems and other agencies for research purposes.The Children's Trust does not collect
social security numbers for adult participants.
Provider shall maintain a separate file for each participant.This file shall include all pertinent
information regarding program enrollment and participation.At a minimum,the file will contain
enrollment information (including parent registration consents and child demographics),service plans
(as applicable),outcome measures (as set forth in Attachment A),and notes documenting referrals,
special needs,or incident reports.These files shall be subject to the monitoring/review and inspection
requirements under this Contract,subject to applicable confidentiality requirements.All such records
will be retained by Provider for not less than five calendar years after the participant is no longer
enrolled.Provider agrees to comply with all applicable state and federal laws on privacy and
confidentiality.
10. Internal Documentation/Records Retention
Provider agrees to maintain and,upon request by The Children's Trust,provide for inspection to The
Children's Trust,during regular business hours the following as may be applicable,subject to
applicable confidentiality requirements: (1) personnel files of employees which include hiring records,
background screening affidavits,job descriptions,verification of education and evaluation
procedures;and (2) authorized time sheets,records and attendance sheets to document the staff
time billed to provide Services pursuant to this Contract;and (3) daily activity logs and monthly
calendars of the provision of Services pursuant to this Contract;and (4) training modules;and (5) pre
and post session questionnaires;and (6) all participant attendance records;and (7) participant
consent and information release forms;and (8) agency policies and procedures;and (9) such other
information related to Service provision as described in Attachment A and as required by this
Contract. Provider shall retain all records for not less than five years beyond the last date that all
applicable terms of this Contract have been complied with and final payment has been received,and
appropriate audits have been submitted to and accepted by The Children's Trust and/or other
appropriate agency.
11. Confidentiality
Provider and The Children's Trust understand that during the course of performing the Services
hereunder,each party may have access to certain confidential and proprietary information and
materials of the other party in order to further performance of the Services.The Parties shall protect
confidential information and comply with applicable federal and state laws on confidentiality to
prevent unauthorized use,dissemination or publication of confidential information as each party uses
to protect its own confidential information in a like manner.The Parties shall not disclose the
confidential information to any third party (except that such information may be disclosed to such
Party's attorneys),or to any employee of such Party who does not have a need to know such
information,which need is related to performance of a responsibility hereunder. However,this
Contract imposes no obligation upon the Parties with respect to confidential information which
(a) was lawfully known to the receiving party before receipt from the other, (b) is or becomes a matter
of public knowledge through no fault of the receiving party, (c) is rightfully received by the receiving
party from a third party without restriction on disclosure, (d) is independently developed by or for that
party, (e) is disclosed under operation of law, (f) is disclosed by the receiving party with the other
party's prior written approval or (g) is subject to Chapter 119 of the Florida Statutes or is otherwise
required to be disclosed by law. The confidentiality provision of this Contract shall remain in full force
and effect after the termination of this Contract. Provider shall specifically require all subcontractors to
comply with this paragraph.
12. Data Security Obligation
Data Security Definitions are defined and specified in Attachment G:Data Security Definitions
attached to this Contract.
a. Standard of care
1. Provider acknowledges and agrees that,in the course of its Contract with The Children's
Trust, Provider may,directly or indirectly,receive or have access to Highly-Sensitive
Personal information or Personal Information. Provider shall comply with the terms and
conditions set forth in this Contract in its collection,receipt,transmission,storage,disposal,
use and disclosure of such Highly-Sensitive Personal Information or Personal Information
and shall be responsible for the unauthorized collection,receipt,transmission,access,
storage,disposal,use and disclosure of Personal Information under its control or in its
possession.Furthermore,Provider shall be responsible for the actions and omissions of all
Authorized Persons that are not Authorized Employees concerning the treatment of such
Highly-Sensitive Personal Information or Personal Information as if they were Provider's
own actions and omissions.
2. Personal Information is deemed to be property of The Children's Trust and is not property
of Provider. The Children's Trust will not collect Highly-Sensitive Personal Information.The
Provider should not collect Client Highly-Sensitive Personal Information.
3. In recognition of the foregoing,Provider agrees and covenants that it shall:
a. keep and maintain all such Highly-Sensitive Personal Information or Personal
Information strictly confidential;
b. use and disclose Personal Information solely and exclusively for the purposes for
which the Personal Information,or access to it,is provided pursuant to the terms
and conditions of this Contract,and shall not divulge,communicate,use,misuse,
sell,rent,transfer,distribute,or otherwise disclose or make available Personal
Information for Provider's own purposes or for the benefit of anyone other than The
Children's Trust,in each case,without The Children's Trust's prior written consent,
which may be withheld in its sole and absolute discretion;and
c. not,directly or indirectly,disclose Personal Information to any person other than
Authorized Persons (an"Unauthorized Third Party"),without express written consent
from The Children's Trust,which may be withheld in its sole and absolute discretion.
If any person or authority makes a demand on Provider purporting to legally
compel it to divulge any Personal Information, Provider shall (i) immediately notify
The Children's Trust of the demand before such disclosure so that The Children's
Trust may first assess whether to challenge the demand prior to Provider's divulging
of such Personal Information; (ii) be responsible to The Children's Trust for the
actions and omissions of such Unauthorized Third Party concerning the treatment of
such Personal Information as if they were Provider's own actions and omissions;
and (iii) require the Unauthorized Third Party that has access to Personal Information
to execute a written Contract agreeing to comply with the terms and conditions of
this Contract relating to the treatment of Personal Information. Provider shall not
divulge such Personal Information until The Children's Trust either has concluded not
to challenge the demand,or has exhausted its challenge,including appeals,if any.
b. Personal information security
Provider shall protect and secure data in electronic form containing such Highly-Sensitive Personal
Information or Personal Information.
At a minimum, Provider's safeguards for the protection of Personal Information shall include:
1. encrypting,securing,or modifying such Personal Information by any method or technology
that removes elements that personally identify an individual or that otherwise renders the
information unusable.
2. limiting access of Personal Information to Authorized Employees and Authorized Persons;
3. securing business facilities,data centers,paper files,servers,back-up systems and
computing equipment,including, but not limited to,all mobile devices and other
equipment with information storage capability;
4. implementing network,device application,database and platform security;
5. securing information transmission,storage and disposal;implementing authentication and
access controls within media,applications,operating systems and equipment;
6. encrypting Highly-Sensitive Personal Information stored on any mobile media;
7. encrypting Highly-Sensitive Personal Information transmitted over public or wireless
networks;
8. implementing appropriate personnel security and integrity procedures and practices,
including, but not limited to,conducting backgrounds checks consistent with applicable
law,as required by The Children's Trust from time to time;
9. providing appropriate privacy and information security training to Provider's employees,
as required by The Children's Trust from time to time;and
10. purchasing and maintaining cyber insurance coverage,if The Children's Trust deems
necessary in its sole and absolute discretion.
a. Provider shall dispose,or arrange for the disposal,of customer records containing
Personal Information within its custody or control when the records are no longer to
be retained.Such disposal shall involve shredding,erasing,or otherwise modifying
Personal Information in its control or possession to make it unreadable or
undecipherable through any means.
b. During the term of each Authorized Employee's employment by Provider, Provider
shall at all times cause such Authorized Employees to abide strictly by Provider's
obligations under this Contract. Provider further agrees that it shall maintain a
disciplinary process to address any unauthorized access,use or disclosure of
Personal Information by any of Provider's officers,directors,partners,principals,
employees,agents or contractors.Upon The Children's Trust's request,Provider shall
promptly identify for The Children's Trust in writing all Authorized Employees as of the
date of such request.
c. Upon The Children's Trust's written request, Provider shall provide The Children's Trust
with a network diagram that outlines Provider's information technology network
infrastructure and all equipment used in relation to fulfilling its obligations under this
Contract,including,without limitation: (i) connectivity to The Children's Trust and all
third parties who may access Provider's network to the extent the network contains
Personal Information; (ii) all network connections including remote access s and
wireless connectivity; (iii) all access control devices (such as (solely by way of
example),firewall,packet filters,intrusion detection and access-list routers); (iv) all
back-up or redundant servers;and (v) permitted access through each network
connection.
c. Security breach procedures
1. Provider shall:
a. provide The Children's Trust with the name and contact information for an
employee of Provider who shall serve as The Children's Trust's primary security
contact and shall be available to assist The Children's Trust twenty-four(24) hours
per day,seven (7) days per week as a contact in resolving issues associated with a
Security Breach;
b. notify The Children's Trust of a Security Breach immediately,but no later than forty-
eight (48) hours after Provider becomes aware of it;and
c. notify The Children's Trust of any Security Breaches by telephone at the following
number: (305)571-5700/e-mailing The Children's Trust with a read receipt at
datasecurity@thechildrenstrust.org and with a copy by e-mail to Provider's contract
manager at The Children's Trust.The notice shall include,at a minimum: (1) the date,
estimated date,or estimated date range of the Breach of security;and (2) a
description of the Personal Information that was accessed or reasonably believed
to have been accessed as a part of the Breach of security.
2. Immediately following Provider's notification to The Children's Trust of a Security Breach,
the parties shall coordinate with each other to investigate the Security Breach. Provider
shall fully cooperate with The Children's Trust in The Children's Trust handling of the matter,
including,without limitation: (i) assisting with any investigation; (ii) providing The Children's
Trust with physical access to the facilities and operations affected; (iii) facilitating
interviews with Provider's employees and others involved in the matter;and (iv) making
available all relevant records,logs,files,data reporting and other materials required to
comply with applicable law,regulation,industry standards or as otherwise required by The
Children's Trust,in its sole and absolute discretion.
3. Provider shall take steps to immediately remedy any Security Breach and prevent any
further Security Breach at Provider's expense in accordance with applicable privacy
rights,laws,regulations and standards,or as otherwise required by The Children's Trust in
its sole and absolute discretion. Provider shall reimburse The Children's Trust for all costs
incurred in providing individuals affected by a Security Breach with notice of the breach
and complimentary access for credit monitoring services.
4. Provider agrees that it shall not inform any third party of any Security Breach without first
obtaining The Children's Trust's prior written consent,other than to inform a complainant
that the matter has been forwarded to The Children's Trust's legal counsel.Further,
Provider agrees that The Children's Trust shall have the sole right to determine: (i) whether
notice of the Security Breach is to be provided to any individuals,regulators,law
enforcement agencies,consumer reporting agencies or others as required by law or
regulation,or otherwise in The Children's Trust's discretion;and (ii) the contents of such
notice,whether any type of remediation may be offered to affected persons,and the
nature and extent of any such remediation.
13. Withholding of Payment
At the sole discretion of The Children's Trust,payment may be withheld for non-compliance of
contractual terms. The Children's Trust will provide payment upon satisfactory compliance with the
contractual terms as solely determined by The Children's Trust.
Q. MODIFICATIONS
Any alterations,variations,modifications,extensions or waivers of provisions of this Contract including but
not limited to amount payable and effective term shall only be valid when they have been reduced to
writing,duly approved and signed by both Parties.
R. GOVERNING LAW & VENUE
This Contract shall be interpreted and construed in accordance with and governed by the laws of the State
of Florida without regard to its conflicts of law provisions. Any controversies or legal problems arising out of
the terms of this Contract and any action involving the enforcement or interpretation of any rights hereunder
shall be submitted to the jurisdiction of the state courts of the Eleventh Judicial Circuit,in and for,Miami-
Dade County, Florida.
S. STAFF AND VOLUNTEER BACKGROUND CHECK REQUIREMENTS
All employees,volunteers and subcontracted personnel who work in direct contact with children or who
may come into direct contact with children at the site in question must complete a Level 2 background
screening and comply with the requirements thereto prior to commencing work pursuant to this Contract.
This requirement applies to all volunteers who provide more than 10 hours of service,in any given calendar
year,to children,youth and their families.Occasional or transient repair or maintenance persons,vendor
representatives,contractors or subcontractors who have not completed a Level 2 background screening
and appear on the site should be escorted to their work areas and supervised the entire time they are
present to conduct their work.
All providers are required to review annually,at minimum,The Dru Sjodin National Sex Offender Public
Website.
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 from 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 the MDCPS Office of Employment Standards
indicating the person has successfully completed a Level 2 screening will be accepted.
In addition:
• The Provider shall complete Attachment E-1:Affidavit for Level 2 Background Screenings,the Affidavit
shall 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.
• The Provider shall complete Attachment E-2:Child Care Affidavit of Good Moral Character,
Attachment E-3:Child Abuse &Neglect Reporting Requirements and Attachment E-4:Background
Screening &Personnel File Requirements.
• Provider shall maintain AttachmentE-1:Affidavit for Level 2 Background Screenings,Attachment E-2:
Child Care Affidavit of Good Moral Character,Attachment E-3:Child Abuse &Neglect Reporting
Requirements and Attachment E-4: Background Screening &Personnel File Requirements in Provider's
personnel,volunteers,and subcontractors'files.
• Provider shall re-screen each employee,volunteer and subcontractor every five years.
T. CHILDREN WITH DISABILITIES AND THEIR FAMILIES
Provider understands that The Children's Trust expects Provider to meet the federal standards under the
Americans with Disabilities Act. By policy of The Children's Trust,providers must also implement reasonable
programmatic accommodations to include children with disabilities and their families,whenever possible.
Notwithstanding anything to the contrary, Provider shall not be required to make any alteration to any public
school building or other building or structure which is not owned by Provider.
U. REGULATORY COMPLIANCE
1. Non-discrimination and Civil Rights
Provider shall not discriminate against an employee,volunteer,or client of Provider based on the
individual's protected class status,which includes race,color,religion,ancestry,national origin,sex,
pregnancy,age,disability,marital status,familial status,gender identity,gender expression,sexual
orientation,source of income,or actual or perceived status as a victim of domestic violence,dating
violence or stalking,except that programs may target services for specific target groups as may be
defined in the competitive solicitation.Additionally,Provider shall demonstrate that it has standards,
policies,and practices necessary to render services in a manner that respects the worth of the
individual and protects and preserves an individual's dignity without regard to the individual's
protected class status.
Provider agrees to abide by Chapter 11A of the Code of Miami-Dade County ("County Code'),as
amended,which prohibits discrimination in employment,housing and public accommodations;Title VII
of the Civil Rights Act of 1968,as amended,which prohibits discrimination in employment and public
accommodation;the Age Discrimination Act of 1975,42 U.S.C.Section 6101 as amended,which
prohibits discrimination in employment because of age;Section 504 of the Rehabilitation Act of 1973,
29 U.S.C.§ 794,as amended,which prohibits discrimination on the basis of disability;and the
Americans with Disabilities Act,42 U.S.C.§12101 et seq.,which,among other things, prohibits
discrimination in employment and public accommodations and by local governments on the basis of
disability.
It is expressly understood that upon receipt of evidence of discrimination under any of these laws,The
Children's Trust shall have the right to terminate all or any portion of this Contract. If Provider or any
owner,subsidiary,or other firm affiliated with or related to Provider,is found by the responsible
enforcement agency or the courts to be in violation of these laws,said violation will be a material
breach of this Contract and The Children's Trust will conduct no further business with Provider.
2. Public Entities Crime Act
Provider will not violate the Public Entities Crimes Act Section 287.133,Florida Statutes,which essentially
provides that a person or affiliate who is a Provider,consultant or other provider and who has been
placed on the convicted vendor list following a conviction for a Public Entity Crime may not submit a
bid on a Contract to provide any goods or services to The Children's Trust,may not submit a bid on a
Contract with The Children's Trust for the construction or repair of a public building or public work,may
not submit bids on leases of real property to The Children's Trust,may not be awarded or perform work
as a Provider supplier,sub Provider,or consultant under a Contract with The Children's Trust,and may
not transact any business with The Children's Trust in excess of the threshold amount provided in Section
287.017, Florida Statutes,for category two purchases for a period of thirty-six (36) months from the date
of being placed on the convicted vendor list. Violation of this section shall result in cancellation of this
Contract and recovery of all monies paid hereto,and may result in debarment from The Children's
Trust competitive procurement activities.
3. Conflict of Interest
Provider represents that the execution of this Contract does not violate Miami Dade County's Conflict
of Interest and Code of Ethics Ordinance,and Florida Statutes §112 as amended,which are
incorporated herein by reference as if fully set forth herein. Provider agrees to abide by and be
governed by these conflict of interest provisions throughout the course of this Contract and in
connection with its obligations hereunder. (Refer to
http://www.miamidadeethics.com/Publications/code_of_ethics2010.pdf for the Code of Ethics
Ordinance).
4. Compliance with Sarbanes-Oxley Act of 2002
Provider shall comply with the following applicable provisions of the Sarbanes-Oxley Act of 2002,
including:
Provider agrees not to alter,cover up,falsify,or destroy any document that may be relevant to an
official investigation.
Provider agrees not to punish whistleblowers or retaliate against any employee who reports suspected
cases of fraud or abuse.
5. Licensing
Provider (and subcontractor,as applicable,) shall obtain and maintain in full force and effect during
the term of this Contract any and all licenses,certifications,approvals,insurances,permits and
accreditations,required by the State of Florida,Miami-Dade County,relevant municipalities, The
Children's Trust or the federal government. Provider must be qualified and registered to do business in
the State of Florida both prior to and during the Contract term with The Children's Trust.
6. Incident Reporting
An incident is defined as any actual or alleged event or situation that creates a significant risk of
substantial or serious harm to the physical or mental health,safety or well-being of a child participating
in the program.Reportable incidents include,but are not limited to,allegations of abuse, neglect or
exploitation of a child,injury of a participant,missing child or abandoned child,loss of property use for
the program,or destruction of property used in the program.
Provider shall immediately report knowledge or reasonable suspicion of abuse, neglect,or
abandonment of a child,aged person,or disabled adult to the Florida Abuse Hotline on the statewide
toll-free telephone number (1-800-96-ABUSE).As required by Chapters 39 and 415,Florida Statutes,this
is binding upon both Provider and its employees.
Provider shall notify the contract manager of any incident as defined within three (3) days after
Provider is informed of such incident.Provider shall provide written notification of the incident together
with a copy of the incident report.The report must contain the following:
(1) Name of reporter (person giving the notice)
(2) Name and address of victim and guardian
(3) Phone number where the reporter can be contacted
(4) Date,time,and location of incident
(5) Complete description of incident and injuries,if any
Police report and actions taken shall be submitted to The Children's Trust within fifteen (15) days of the
incident. Provider shall provide written notification to The Children's Trust,within seven (7) days of any
legal action related to the incident.
7. Sexual Harassment
Provider shall complete an incident report in the event a program participant,client or employee
makes an allegation of sexual harassment,sexual misconduct or sexual assault by a Provider
employee,volunteer or anyone arising out of the performance of this Contract and Provider has
knowledge thereof. Provider shall provide written notification to The Children's Trust within three (3)
business days after Provider is informed of such an allegation. Provider shall provide written
notification to The Children's Trust,within seven (7) business days,if any legal action which is filed as a
result of such an alleged incident.
8. Proof of Policies
Provider and subcontractor,as applicable,shall keep on file copies of its policies including but not
limited to confidentiality,incident reporting,sexual harassment,non-discrimination,equal opportunity
and/or affirmative action,Americans with Disabilities Act,and drug-free workplace.
V. CONSENT
Provider must obtain parental/legal guardian consent for all minor participants to participate and/or for
adult participants in the program for services;and to share information with The Children's Trust for
monitoring and evaluation purposes.
Provider will ask participants to sign a voluntary Consent to Photograph form.The form is available in English,
Spanish,and Creole and can be downloaded from www.thechildrenstrust.org.The signed consent form for
photography will be maintained at the program site,with a copy filed in the participant's record.The
consent shall be part of the participants' registration form,and signed by parent/guardian before services
commence or assessments are administered.Any refusal of consent must be properly documented and
signed by the parent or legal guardian on the consent form.
W. PROGRAMMATIC DATA REPORTING
Demographic and service information on program participants will be provided to The Children's Trust as
part of The Children's Trust's research mission. Provider agrees to comply and participate in any data
collection reporting,including participant data as required by The Children's Trust and described in
Attachment C to this Contract,Programmatic Data and Reporting Requirements,subject to confidentiality
requirements. In addition,Provider agrees to furnish The Children's Trust with complete and accurate reports
in the timeframe and format to be reasonably specified by The Children's Trust,and as described in
Attachment C.
Provider must participate and provide agency (agency profile) and site(s) information to the Jewish
Community Services of South Florida,Inc.211 Helpline,The Children's Trust's 24 hour helpline,as applicable
and as defined in Attachment C:Programmatic Data Reporting Requirements.
X. PUBLICITY
Provider agrees that activities,services and events funded by this Contract shall recognize The Children's
Trust as a funding source. Provider shall ensure that all publicity,public relations,advertisements and signs
within its control recognize The Children's Trust for the support of all contracted activities. The use of the
official Children's Trust logo is permissible.
Provider shall use its best efforts to ensure that all media representatives,when inquiring with Provider about
the activities funded by this Contract,are informed that The Children's Trust is a funding source. Provider
shall,if it possesses the appropriate technology,provide a link between the website and The Children's
Trust's website.
Y. PUBLICATIONS
Provider agrees to supply The Children's Trust,without charge,up to three copies of any publication
developed in connection with implementation of programs addressed by this Contract. Such publications
will state that the program is supported by The Children's Trust. Provider agrees that The Children's Trust will
have use of copyrighted materials developed under this Contract to the extent provided in,and subject to,
the provisions of Paragraphs G and I above.
To the extent permitted by the applicable journal or other publication source,Provider shall include The
Children's Trust logo and the following paragraph in all materials featuring programs funded by The
Children's Trust,including but not limited to newsletters,press releases,brochures,fliers,homepage of
websites or any other materials for dissemination to the media or general public:
English:
Provider Program Name is funded by The Children's Trust. The Children's Trust is a dedicated source of
revenue established by voter referendum to improve the lives of children and families in Miami-Dade
County.
Espanol:
Provider Program Name esta financiado por El Fideicomiso de los Ninos (The Children's Trust).El
Fideicomiso de los Ninos es una fuente de financiacion,establecida por referendum para mejorar las vidas
de ninos y familias en el Condado de Miami-Dade.
Kreyol:
Provider Program Name Se Children's Trust ki finanse (pwogram sa-a). Children's Trust se yon sous
finansman elekte Miyami-Dade to kreye nan yon referandom. Rnansman sa a dedye you pwogram k'ap
amelyore lavi ti moun ak fanmi yo.
Note: In cases where funding by The Children's Trust represents only a percentage of Provider's overall
funding,the above language can be altered to read"The (organization) is funded in part by The Children's
Trust..."
Z. HEADINGS, USE OF SINGULAR AND GENDER
Paragraph headings are for convenience only and are not intended to expand or restrict the scope or
substance of the provisions of this Contract. Wherever used herein,the singular shall include the plural and
plural shall include the singular,and pronouns shall be read as masculine,feminine or neuter as the context
requires.
-THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK -
AA. TOTALITY OF CONTRACT/SEVERABILITY OF PROVISIONS
This Contract with its attachments as referenced below contains all the terms and conditions agreed upon
by the parties:
Attachment A: Scope of Services
Attachment B: Other Fiscal Requirements,Budget,and Method of Payment
Attachment C: Programmatic Data and Reporting Requirements
Attachment D: Program Specific Audit Requirements
Attachment E-1: Affidavit for Level 2 Background Screenings,if applicable
Attachment E-2: Child Care Affidavit of Good Moral Character,if applicable
Attachment E-3: Child Abuse &Neglect Reporting Requirements,if applicable
Attachment E-4: Background Screening &Personnel File Requirements,if applicable
Attachment F: Performance Improvement Plan,if applicable
Attachment G: Data Security Definitions
No other Contract,oral or otherwise,regarding the subject matter of this Contract shall be deemed to exist
or bind the Parties. If any provision of this Contract is held invalid or void,the remainder of this Contract shall
not be affected thereby if such remainder would then continue to conform to the terms and requirements
of applicable law.
Ci /
ty Children's Trust
of Mi.mi Beach
MIAMI-DADE COUNTY,FLORIDA
1
By: -441111111 By:
(si4 ature of A horized Representative) (signature)
James R. Haj
President and CEO
Date: ( 3 I Ifl) Date:
Provider Federal ID# 59-6000372
Provider Vendor ID# CITYO109
This Contract is not valid until signed by both parties.
APPROVED AS TO
FORM & LANGUAGE
& FOR EXECU ION
AAL;41X
C Attorne \v____ Dat
AA. TOTALITY OF CONTRACT/SEVERABILITY OF PROVISIONS
This Contract with its attachments as referenced below contains all the terms and conditions agreed upon
by the parties:
Attachment A: Scope of Services
Attachment B: Other Fiscal Requirements,Budget,and Method of Payment
Attachment C: Programmatic Data and Reporting Requirements
Attachment D: Program Specific Audit Requirements
Attachment E-1: Affidavit for Level 2 Background Screenings,if applicable
Attachment E-2: Child Care Affidavit of Good Moral Character,if applicable
Attachment E-3: Child Abuse &Neglect Reporting Requirements,if applicable
Attachment E-4: Background Screening &Personnel File Requirements,if applicable
Attachment F: Performance Improvement Plan,if applicable
Attachment G: Data Security Definitions
No other Contract,oral or otherwise,regarding the subject matter of this Contract shall be deemed to exist
or bind the Parties. If any provision of this Contract is held invalid or void,the remainder of this Contract shall
not be affected thereby if such remainder would then continue to conform to the terms and requirements
of applicable law.
City of Miami Beach The Children's Trust
MIAMI-DADE COUNTY,FLORIDA
SOL
By: By:By:
(signature of Authorized Representative) (signature)
Judy Hoanshelt for Jimmy L. Morales James R. Haj
Grants Management Division Director President and CEO
Date: 11/13/2017 Date: 11/13/2017
Provider Federal ID# 59-6000372
Provider Vendor ID# CITYO109
This Contract is not valid until signed by both parties.
Attachment A-Scope of Services
FAMILY&NEIGHBORHOOD SUPPORT PARTNERSHIPS
1. PROGRAM DESCRIPTION
The City of Miami Beach Service Partnership/Success University is a place-based coalition of human service
providers collaborating to provide coordinated services to families and communities where children are at risk of
child maltreatment and chronic absenteeism,or display disruptive behavior in school or in the community.Family
and Neighborhood supports also provide engagement activities that bring residents together around the issues
facing their communities.
Success University is an integrated Care Coordination-based human services program that provides
comprehensive and accessible family supports within the community,including homes,to address family and
youth challenges.The program offers an array of educational,human services,physical,health,mental health,
income,and housing supports provided through a coordinated and collaborative delivery system that contributes
to the overall wellbeing of high-risk children,youth and families.The program provides children and youth with
personal and academic supports while providing their families with holistic services to ensure stability and child
success.Service components include:Family Assessments,Care Coordination,Family Team Conferences,Teen
Employment Services,Counseling,Tutoring,Transportation accessibility,credit counseling,legal services,
mentoring and targeted referrals to community-based services not available within the Family and Neighborhood
Support framework.
2.TARGET AREAS: Miami Beach
3. ACTIVITIES
This table specifies the unduplicated number of participants expected to complete the program.
Type of Participant Number of Participants Percent CWD
Youth_Children 135 10%
Parents 126
10%
Families 126
10%
Activity Name ACTIVITY DESCRIPTION
Referral Adopting a holistic view of program participants, providers are required to make and
Coordination receive referrals to and from other agencies and program partners.Families and youth
referred for services should be contacted and engaged as soon as possible.
Partnerships are required to maintain an organized referral process between program
partners, Together for Children agencies, community-based service providers and
informal support networks. Staff should document referrals, follow-up on referrals and
provide partners with ongoing feedback on the status of referrals.Partnerships working
with Together for Children,delinquency and/or dependency partners are expected to
provide regular (at least monthly) updates on services to the appropriate personnel,
with necessary parental consent. These are considered two-way relationships where
partnerships receive referrals from as well as make referrals to the groups noted,since
high-risk families will have multiple support needs. Partnerships should also have the
capacity to make referrals for services not readily available through the partners in the
collaborative.
Activity Name ACTIVITY DESCRIPTION
Eligibility Every participant will receive a standard screening to determine care coordination
Screening eligibility based on risk factors related to absenteeism, maltreatment, and disruptive
behavior. Based on degree of concern yielded by screening, participants will be
&Intake referred for a family assessment. Eligibility are determined through a standard
screening and assessment that incorporates geographic area and significant risk
factors. A majority of those enrolled should meet one of the following place-based
criteria; others from nearby the contracted geographic area or schools may be
served,but only if enrollment risk factors are met:
• Child abuse or neglect:current or prior history of involvement with the child
welfare system that did not result in a court-order into foster care,shelter care or
protective supervision
• Child attendance,chronic absenteeism or truancy:child has been absent 6% or
more days in the current or previous school year,or the child has dropped out of
school
• Child behavior problems:child has symptoms or diagnosis of a behavioral,social
or emotional problems that have resulted in difficulty at home,school and/or the
community;this may include (but is not limited to) fighting,school suspension,
and/or arrest or involvement in the juvenile justice system
• Child academic performance:child has failed one or more academic subjects
• Child exposure to violence:child has experienced domestic violence in the
home
• Child risk for abuse or neglect:suspected history or observed risk for child abuse
or neglect but without involvement with the child welfare system (i.e.,harsh
parenting,lack of parent/caregiver understanding of child needs,development
and/or parenting skills)
• Parental functioning and supports:one or more parents/caregivers of the child
have symptoms or diagnosis of mental health,stress or substance abuse
problems that have impacted their parenting and/or family functioning
• Concrete Supports:family has difficulty meeting their basic needs,such as
adequate housing,access to food,clothing and transportation
For providers of population-specific participants:
• Child of incarcerated parent(s):child in need of supports as result of their
parent(s)/caregiver(s) being imprisoned
• Gay,lesbian,bisexual,transgender,questioning youth:youth who identifies
his/her sexual orientation as gay,lesbian,or bisexual or who identifies as
transgendered or questioning
• Unaccompanied,immigrant minor:child who is an immigrant at risk of
deportation or removal or who is in the custody of the Office of Refugee
Resettlement(ORR) and eligible for release
• Child exposure to high family conflict and domestic violence:child has
experienced intensive family conflict or domestic violence in the home.
• Families with children with disabilities who require supports to care for their family
member(i.e.,individuals with disabilities who are unable to perform
developmentally appropriate self-care or daily living tasks).
Family All participants determined to be eligible for care coordination through the Screening
Assessment will receive an Assessment to confirm eligibility.The Assessment will define protective
factors/family strengths and service needs; including the need for Health Insurance
and medical home. Based on degree of concern and service needs yielded by the
Assessment, participants will be enrolled in Care Coordination. A comprehensive tool
must be used to further assess the risk factors noted in the screening
Activity Name ACTIVITY DESCRIPTION
Care Within the first 14 days,the family and Care Coordinator will work to complete a Care
Coordination Plan which is unique to each family, and which establishes the framework upon which
the family will achieve its goals. Target and completion dates are addressed in the
Care Plan, which guides and projects target dates for meeting their goals and
objectives. Families receive a copy of the Care Plan goals once signed along with
referrals of community partners that the client and parent or guardian is referred to.
The client/parent or guardian are asked to return the referral form with a signature of
any representative that assisted the client to the referred agency,so that staff have a
record and can follow up with review (through authorization of release forms) to
gather relevant data. Progress notes are typed by the Care Coordinator to document
and capture the intake, assessment, sessions, performance measurements, care plan,
and referrals into the online case management system at each session. When
appropriate, Natural Helper Supports could be used to help families identify resources
they can utilize to further strengthen their parent/child relationships, support treatment
engagement and skill acquisition,stabilize their families and reduce their at-risk status.
Follow up sessions must take place at least once a month during the time participant is
enrolled in care coordination. Care Coordinator conducts scheduled visits/contacts
with family;determines if referrals have been successful;reviews and assists the family
in pursuit of their goals in the Care Plan; amends the care plan as necessary; holds
multidisciplinary staffing as necessary. When the family and the care coordinator
determine the goals of the care plan have been met, and that no additional services
are needed,the care coordinator will close out the case.
Services To Partnerships working with families should include multiple services and/or activities
Support The Family designed to reduce the impact of familial risk factors that contribute to negative
Strengthening child/youth outcomes. Using a strengths-based, solution-focused approach, providers
Framework can leverage protective factors to address issues threatening family stability. The
Center for the Study of Social Policy's Strengthening Families approach identifies five
(5) specific protective factors: 1) parental resilience; 2) social connections; 3)
concrete support in times of need;4) knowledge of parenting and child development;
and 5) social and emotional competence of children. Services should focus on
improving parent and child/youth knowledge, attitudes and beliefs that will influence
these protective factors and the target outcomes to reduce youth violence/disruptive
behavior,chronic absenteeism and maltreatment.
Activity Name ACTIVITY DESCRIPTION
Partnerships Family and neighborhood support partnerships are designed to more effectively
Coordination coordinate high quality community services through an integrated network of formal
and informal supports. Community partners must operate within a shared governance
structure to actively collaborate and coordinate an array of broad, flexible services.
As part of this initiative, providers are expected to leverage partners' resources to
address the needs of families and improve outcomes for children through access to
high quality services. Coordination and integration of services is facilitated by cross-
agency data-sharing regarding common participants. Partnerships are formalized
through executed memoranda of understanding among participating organizations
and individuals.
Partnerships are expected to:
• lead a collaborative of diverse system partners toward a common goal;
• cultivate a partnership based on trust, reciprocity, shared ownership and
accountability for all partners;
• coordinate frequent and meaningful training for members;
• use creative thinking, effective problem-solving and communication to
coordinate with key partners to make good decisions and overcome barriers
that arise;
• actively involve members in developing action plans with goals and objectives;
and
• achieve success working with children, youth, families and local communities in
the targeted geographic areas or special populations.
4. QUALITY MEASURES
Performance Statement Target Associated Activity
Number/percentage of participants The number and percentage of Family Assessment
who were assessed within 72 hours of participants assessed will be
referral analyzed to determine the outcome
target percentage in the second
year of the funding cycle.
Number/percentage of participants The number and percentage of Care Coordination
who have a care plan initiated within participants who have a care plan
14 days of the assessment will be analyzed to determine the
outcome target percentage in the
second year of the funding cycle.
Percentage of parents/caregivers and 85% of parents/caregivers and Survey Administration
youth satisfied with program youth satisfied with program
(satisfaction surveys) (satisfaction surveys)
5. PARTICIPANT OUTCOMES
Required Outcomes Data Source/Measurement Tool Timing Meaningful Improvement
Parents/caregivers report an Parents'Assessment of Protective Factors-SC Pretest should be The assessment scores,as well as the number
increase in social administered at enrollment and percentage of parents demonstrating
connections Social Connections(SC)Subscale(items 20- and posttestevery6 months increased scores will be analyzed after the
28).Scoring:9 Items;sum the numerical thereafter or during the first posttest to determine the specific criteria
Associated Activity:Care values of the responses for the Social closing session. to be used for contracted meaningful
Coordination Connections(SC)subscale(items 20-28) improvement and outcome target
Service Component: and record the total on the line for"Social percentage in the second year of the
Parents-Care Coordination Connections Total"on the PAPF Scoring funding cycle.
Sheet.Compute the SC Subscale Score as
the average(mean)of the response values.
Record the score on the line for"Social
Connections Average Score"on the score
sheet.PAPF Strength Level:Low(score range
0.00-1.99),Moderate(2.00-2.99),High(3.00-
3.99),Maximum(4.00).
%of children/youth who School Records:EWS indicators Pretest data based on the A decrease of one or more early warning
decrease number of early latest school year records indicators
warning system(EWS) The early warning system indicators(EWS) should be reported at
indicators include:attendance(18+),suspensions(1*), enrollment.Posttest data
reading course failure.math course failure, based on the end of school
Associated Activity:Care below grade level on reading/math year records should be
Coordination assessment(FCAT,FSA,SAT);Scoring:Total# reported in July
Service Component: of early warning indicators;Data provided
Parents-Care Coordination by Miami-Dade County Public Schools with
parental consent
%of children/youth referred Delinquency System Records:Offenses Data should be reported Number of delinquent offenses should equal
from delinquency system who once a year in July zero
do not commit delinquent Scoring:Total#of delinquent offenses for
offense during program children/youth referred from the delinquency
participation system;Data provided byjuvenile justice
system with parental consent
Associated Activity:Care
Coordination
Service Component:
Parents-Care Coordination
Parents/caregivers report an Parents'Assessment of Protective Factors-SE Pretest should be The assessment scares,as well as the number
increase in their child's administered at enrollment and percentage of parents demonstrating
social emotional Social Emotional Competence of Children and posttest every 6 months increased scores will be analyzed after the
competence (SE)Subscale(items 38-46).Scoring:9 Items; thereafter or during the first posttest to determine the specific criteria
sum the numerical values of the responses for closing session. to be used for contracted meaningful
Associated Activity:Care the Social Emotional Competence of improvement and outcome target
Coordination Children(SE)subscale(items 38-46)and percentage in the second year of the
Service Component: record the total on the line for"Social and funding cycle.
Parents-Care Coordination Emotional Competence Total"on the PAPF
Scoring Sheet.Compute the SE Subscale
score as the average(mean)of the response
values.Record the score on the line for
"Social and Emotional Competence of
Children Average Score"on the score sheet.
PAPF Strength Level:Low(score range 0.00-
1.99),Moderate(2.00-2.99),High(3.00-3.99),
Maximum(4.00).
Parents/caregivers will Strengths&Difficulties Questionnaire(SDQ) Pretest should be Posttest score must be below 17
report a decrease in their administered by the second
child's problem behavior Strengths and Difficulties Questionnaire care coordination session
(SDQ).Scoring:20 item;sum of scores in all and posttest every 6 months
Associated Activity:Care of the items of the 4 scales;range:0-40 thereafter or during the
Coordination (higher scores indicate greater difficulty) closing session.
Service Component:
Parents-Care Coordination
Required Outcomes Data Source/Measurement Tool Timing Meaningful Improvement
%of children/youth referred Dependency System Records:DCF Incidents Data should be reported Number of subsequent incidents involving
from dependency system with once a year in July DCF should equal zero
no further involvement in DCF Scoring:Total#of subsequent incidents
involving DCF for children/youth referred
Associated Activity:Care from the dependency system.Data provided
Coordination by child welfare system with parental consent
Service Component:
Parents-Care Coordination
Parents/caregivers report an Parents'Assessment of Protective Factors-CS Pretest should be The assessment scores,as well as the number
increase in concrete administered at enrollment and percentage of parents demonstrating
supports Concrete Supports(CS)Subscale(items 29- and posttest every 6 months increased scores will be analyzed after the
37).Scoring:9 Items;sum the numerical thereafter or during the first posttest to determine the specific criteria
Associated Activity:Care values of the responses for the Concrete closing session. to be used for contracted meaningful
Coordination Supports(CS)subscale(items 29-37)and improvement and outcome target
Service Component: record the total on the line for"Concrete percentage in the second year of the
Parents-Care Coordination Supports Total"on the PAPF Scoring Sheet. funding cycle.
Compute the PR Subscale score as the
average(mean)of the response values.
Record the score on the line for"Concrete
Supports Average Score"on the score sheet.
PAPF Strength Level:Low(score range 0.00-
1.99),Moderate(2.00-2.99),High(3.00-3.99),
Maximum(4.00).
Parents/caregivers report an Parents'Assessment of Protective Factors-PR Pretest should be The assessment scores,as well as the number
increase in parental administered at enrollment and percentage of parents demonstrating
resilience Parental Resilience(PR)Subscale(items 11- and posttest every 6 months increased scores will be analyzed after the
19).Scoring:9 Items:sum the numerical thereafter or during the first posttest to determine the specific criteria
Associated Activity:Care values of the responses for the Parental closing session. to be used for contracted meaningful
Coordination Resilience(PR)subscale(items 11-19)and improvement and outcome target
Service Component: record the total on the line for"Parental percentage in the second year of the
Parents-Care Coordination Resilience Total"on the PAPF Scoring Sheet. funding cycle.
Compute the PR Subscale score as the
average(mean)of the response values.
Record the score on the line for"Parental
Resilience Average Score"on the score
sheet.PAPF Strength Level:Low(score range
0.00-1.99),Moderate(2.00-2.99),High(3.00-
3.99),Maximum(4.00).
6. SUBCONTRACTORS/IN-KIND AGENCY(IES)
Subcontractor Agency Street City Zip Contact Information Associated Activity
or In-Kind Name Address Code
In-Kind CCDH 7990 SW Miami 33183 Helene Good hgood@ccdh.org Disability Advocate
117th 305-596-1160
Avenue,Ste
200
Subcontractor Ayuda 7144 Byron Miami 33141 Cecilia De Loof Care Coordination&Counseling
Avenue Beach ceciliadl,@ayudamiami.org 305-864-
6885
In-Kind Catalyst Miami 3000 Miami 33137 Gretchen Beesing Advocacy
Biscayne gretchenb@catalystmiami.org 305-
Blvd.,Suite 576-5001
210
Subcontractor Agency Street City Zip Contact Information Associated Activity
or In-Kind Name Address Code
In-Kind Educate 1717 N Miami 33132 Brett McNaught Mentoring&College Prep
Tomorrow Bayshare mcnaught@educatetomarrow.org
Dr,Ste 203 305-111-2222
Subcontractor ICFH 15490 NW Miami 33169 Annette Naranjo Functional Family Therapy&
7th Avenue anaranjo@icfhinc.org 305-235-8105 Individual Counseling
Suite 201
In-Kind Parent to Parent 7990 SW Miami 33183 Isabel C.Garcia Autism/Disability Advocate
117th igarcia@PtoPMiami.org 305-271-
Avenue,Ste 9797
200
Subcontractor C.O.G. 199 Ocean Key 33149 Catalina Ortiz Care Coordination&Counseling
Counseling,LLC Lane Dr. Biscayne catalina@cogcounseling.com
#901 (786)234-0160
In-Kind UM/NSU Center for 5665 Ponce Miami 33146 Jennifer Durocher Disability Advocate
Autism and de Leon jstella@miami.edu(305)284-6563
Related
Disabilities
In-Kind Advocate 1150 NW Miami 33126 Althea Birch Child/Family Services for Domestic
Program 72nd Althea B@ ad vo ca tep rog ra m.o rg Violence
Avenue, 305-704-0116
Suite 200
Subcontractor Choices Et AI,Inc P.O.Box Miami 33269 Cheryl Polite-Eaford Care Coordination&Family Team
695409 choices724@gmail.com(305)332- Conferencing
2074
Subcontractor Cuban American 1223 SW 4th Miami 33135 Jessica Buitrago Teen Employment
National Council Street jbuihago@cnc.org(305)642-3484,
(CNC) Ext.172
In-Kind DOUGLAS 1680 Miami 33139 Mary Eleanor Lanser Counseling/Domestic Violence&
GARDENS Meridian Beach Elanser@dgcmhc.org(305)531-5341 Substance Abuse for Adults
COMMUNITY Ave#501
MENTAL HEALTH
CENTER OF MIAMI
BEACH,INC.
In-Kind Family Recovery 9350 Sunset Miami 33173 Ray Estefania Substance Abuse for Youth
Specialists Dr#175 restefania@bellsouth.net 305-595-
7378
In-Kind Florida 401 NW 2nd Miami 33128 Bronwyn Stanford Child/Family Services
Department of Avenue, Bronwyn.Stanford@mytfamilies.com
Children and South (305)520-0050
Families Tower,10th
Floor
In-Kind Fun Paw Care 900 16th Miami 33139 Russell Hartstein Dog Training
Sheet Beach info@funpawcare.com(786)372-
0299
Subcontractor Get Credit 8411 W Sunrise 33351 Elizabeth Korwowski Credit Counseling&Finances
Healthy,Inc. Oakland info@getcredithealthy.com 877-850-
Park Blvd 3444
#202
Subcontractor Agency Street City Zip Contact Information Associated Activity
or In-Kind Name Address Code
In-Kind Miami Dade 22722nd Miami 33139 Bryant Capleycapleyb@mdpls.org Technology/Education/Educational
County Public Street 305-535-4219 Resources&Tutoring
Library System
In-Kind Pridelines 6360 NE 4th Miami 33138 Marsharee Chronicle LGBTQ Youth Services
Court marsharee@pridelines.org(305)
571-9601
Subcontractor The Sunshine 325 S. Miami 33131 Jasmine Khilnani Tutoring
Method Biscayne jasmine@ thes u ns h inemetho d.com
Blvd#3321 (786)266-5513
Subcontractor Advocate2Create 7380 South Miami 33161 Patricia Timerman Counseling
West 107th patricia@advocate2create.com
Avenue (305)482-3366
Suite 1208
In-Kind Empowering 1031 Ives Miami 33179 Andrew Wanza Counseling
Youth Dairy Road, empowermenttutoring@hotmail.com
Suite 228 (305)654-7251
7.STAFFING TABLE
Position Position Details Qualifications and Responsibilities
Title
Qualifications:Associate's degree or equivalent in college credits with major course work in Social Work,Business,
Criminal Justice,Sociology,or Psychology Some experience working in social service,youth program,or related field
Experience can substitute for education on a year-for-year basis Driver's License bilingual(English/Spanish)or(English/
Creole).Valid driver's license.
Number of staff: 1 Responsibilities:Data entry,assistance with client contact and care coordination,provides client transportation,
Key Position:Yes
conduct client home visits/intakes,filing and any other necessary support or direct service provision of program
Case Worker Position Status:Full- activities.Interviews clients with problems such as personal and family adjustments,school attendance finances,
employment,food,clothing,housing,and physical needs to determine nature and degree of problem,confers with
Time and teachers regarding clients,visits families of clients to resolve truancy
Percent Effort: 100 principals g g yproblems and makes referral to
applicable agency,helps client to modify attitudes and patterns of behavior by referral to social agency as necessary,
refers clients to community resources,attends staff meetings,workshops,conferences,and parents meetings,compiles
records and prepares reports,reviews service plans and performs follow-up to determine quantity and quality of
service provided to client and status of client's case,accesses and records client and community resource information,
secures supplementary information such as employment,medical records,or school reports,any other necessary
support or direct service provision of program activities.
Qualifications:Associate's degree or equivalent in college credits with major course work'n Social Work,Business,
Criminal Justice,Sociology,or Psychology Some experience working in social service,youth program,or related field
Experience can substitute for education on a year-for-year basis Driver's License bilingual(English/Spanish)or(English/
Creole).Valid driver's license.
Number of staff: 1 Responsibilities:Data entry,assistance with client contact and care coordination,provides client transportation,
Key Position:Yes conduct client home visits/intakes,filing and any other necessary support or direct service provision of program
Case Worker Position Status:Full- activities.Interviews clients with problems such as personal and family adjustments,school attendance finances,
employment,food,clothing,housing,and physical needs to determine nature and degree of problem,confers with
Time principals and teachers regarding clients,visits families of clients to resolve truancy problems and makes referral to
Percent Effort:60
applicable agency,helps client to modify attitudes and patterns of behavior by referral to social agency as necessary,
refers clients to community resources,attends staff meetings,workshops,conferences,and parents meetings,compiles
records and prepares reports,reviews service plans and performs follow-up to determine quantity and quality of
service provided to client and status of client's case,accesses and records client and community resource information,
secures supplementary information such as employment,medical records,or school reports,any other necessary
support or direct service provision of program activities.
Number of staff: 1
Key Position:Yes Qualifications:Bachelor Degree or equivalent experience in program management.
Office
Position Status:Full-
Associate IV Time Responsibilities:Provides direction for the program's day to day operations,supervision,direction and guidance
Percent Effort: 100 for staff,assures implementation of evidence based curriculum or program protocols with fidelity.
Number of staff: 1
Senior Key Position:Yes Qualifications:Bachelor Degree or equivalent experience in program management.
Program Position Status:Full-
Coordinator Time Responsibilities:Provides direction for the program's day to day operations,supervision,direction and guidance
Percent Effort:50 for staff,assures implementation of evidence based curriculum or program protocols with fidelity.
Position
Title Position Details Qualifications and Responsibilities
Number of staff: 1
Department
Key Position:No Qualifications:Bachelor Degree or equivalent experience in program management.
Director Position Status:Full- Responsibilities:Oversees the administration and management oforgranization including all program activities
Time and staff.
Percent Effort:S
Number of staff: 1
Assistant Key Position:No Qualifications:Bachelor Degree or equivalent experience in program management.
Department Position Status:Full- Responsibilities:Oversees the administration and management oforgranization including all program activities
Director Time and staff.
Percent Effort:5
Number of staff: 1
Case Worker II Key Position:No Qualifications:Ahigh school diploma or General Equivalency Diploma(GED).
-Payroll Position Status:Full-
Coordinator Time Responsibilities:Performs office duties of a routine nature thatmayinvolve a variety of tasks and work methods.
Percent Effort:5
Qualifications:Associate's degree or equivalent in college credits with major course work in Social Work,Business,
Criminal Justice,Sociology,or Psychology Some experience working in social service,youth program,or related field
Experience can substitute for education on a year-for-year basis Driver's License bilingual(English/Spanish)or(English/
Creole).Valid driver's license.
Number of staff:1 Responsibilities:Data entry,assistance with client contact and care coordination,provides client transportation,
Key Position:No conduct client home visits/intakes,filing and any other necessary support or direct service provision of program
Case Worker Position Status:Full- activities.Interviews clients with problems such as personal and family adjustments,school attendance finances,
employment,food,clothing,housing,and physical needs to determine nature and degree of problem,confers with
Time and teachers regarding clients,visits families of clients to resolve truant
Percent Effort: 1 principals g g truancy problems and makes referral to
applicable agency,helps client to modify attitudes and patterns of behavior by referral to social agency as necessary,
refers clients to community resources,attends staff meetings,workshops,conferences,and parents meetings,compiles
records and prepares reports,reviews service plans and performs follow-up to determine quantity and quality of
service provided to client and status of client's case,accesses and records client and community resource information,
secures supplementary information such as employment,medical records,or school reports,any other necessary
support or direct service provision of program activities.
All persons delivering the services required by this contract must have the knowledge and skills,either by training,
experience,education,or a combination thereof,to adequately and competently perform the duties,
obligations,and services set forth and to provide and perform such services to The Children's Trust's satisfaction.
All persons delivering the services described herein must be included in the Position Management module of
SAMIS.
ATTACHMENT B
OTHER FISCAL REQUIREMENTS, BUDGET and METHOD OF PAYMENT
Advance payment requests
The Children's Trust offers advance payments up to 15% of the total Contract value.The Children's Trust will
only approve advance requests that are equivalent to the total amount of the first two (2) months
programmatic expenditures and up to 15% of the total Contract value. Determinations of programmatic
expenditures will be supported by the immediate prior year's performance or a detailed listing of
estimated expenditures. Advance requests shall be limited to governmental entities and not-for-profit
corporations,in accordance with subsection 216.181(16)(b),F.S.Advance requests must include the amount
requested and a justification for the request.Advance requests must be submitted using the designated
form and must be approved in writing by The Children's Trust's Contract Manager and Chief Financial
Officer or their designee.Advance payments are made at and within the sole discretion of The Children's
Trust.
Advance repayment
Advance repayment is due within sixty (60) calendar days of receipt of the advance. Provider shall report
the amount of the advance repayment in SAMIS using the "advances/adjustments"button on the SAMIS
reimbursement screen. If a provider does not use SAMIS,the provider is required to deduct its advance
repayment from each invoice,consecutively,until the advance is repaid in full.
Budget amendments/revisions
Budget amendments/revisions require written approval from the Contract Manager and The Children's
Trust's Chief Financial Officer or their designees.Request for budget amendments/revisions must be
submitted to a Contract Manager using SAMIS,or the appropriate form,as designated by The Children's
Trust. All budget amendments/revisions are subject to final approval by The Children's Trust.Budget
amendments/revisions cannot be used to increase the total Contract amount or to modify the Scope of
Services. No more than two budget amendments/revisions may be approved during the Contract term.
Budget amendments/revisions will be disallowed if they seek to revise retroactive costs not previously
budgeted.All amendments/revisions must adjust for operational activity effective as of the previously
billed period. Budget amendment/revision requests must be submitted sixty (60) days prior to the expiration
of Contract. Budget amendments/revisions will be incorporated into the Contract.
Indirect Administrative Costs
In no event shall The Children's Trust fund indirect administrative costs in excess of ten (10%) percent of the
total Contract amount.
List of Approved Certified Public Accountants or Certified Public Accounting Firms
To receive reimbursement for the preparation of the program specific audit,as defined,provider must
choose from a list of approved independent Certified Public Accounting (CPA) firms,which are posted on
The Children's Trust website. Inclusion in this pre-approved vendor pool requires that a CPA firm meet the
following three criteria:
(a) participation in either the American Institute of Certified Public Accountants (AICPA) or the Florida
Institute of Certified Public Accountants (FICPA) peer review program as evidenced by submitting a triennial
System Review Report with a passing score to The Children's Trust;
(b) providing documentation that a CPA firm,or one of its associates,has adequate experience in
governmental accounting and/or nonprofit accounting with the application of GovernmentAuditing
Standards;and
(c) completion of an annual CPA training session sponsored by The Children's Trust finance department.
Match Requirement
Programs may be required to provide programmatic matching funds in satisfaction with the amount
disclosed within the contract and conditions disclosed within the respective solicitation. A match is defined
as cash or in-kind contributions including non-federal cash dollars,donated items,and/or services that are
part of the overall cost of operating the program,should be reasonable,necessary,and/or required for the
program.Matching funds do not include The Children's Trust funds.
The Children's Trust reserves the right to ask for substantive documentation to support the match at any time
and such documentation must be presented to Provider's independent auditors as part of their annual
financial statement audit.
Direct Deposit of Payment
As a requirement of this Contract with The Children's Trust,Provider agrees that prior to,or on the date
commencing the effective term of this Contract, Provider will enroll in The Children's Trust direct deposit
program.The direct deposit program requires that all reimbursements received from The Children's Trust
are directly deposited into the Provider's designated bank account held in a United States financial
institution.The format,including the terms and conditions for the direct deposit of payment,can be found at
http://www.thechildrenstrust.org/providers/forms/direct-deposit-enrollment.
Cost Reimbursement Method of Payment
The parties agree that this is a cost reimbursement method of payment Contract;Provider shall be paid in
accordance with the approved budget and/or approved budget amendments/revisions as set forth in this
attachment. Provider also agrees to pay its subcontractors,vendors and employees for the fulfillment of
services provided in this Contract,on a timely basis.
Invoice Requirements
Provider shall submit an electronic request for payment in the SAMIS system in accordance with the
approved budget or budget amendments/revisions.The request for payment is due on or before the
fifteenth (15th) day of the month following the month in which expenditures were paid (exclusive of legal
holidays or weekends). The Children's Trust will consider all invoices received after the fifteenth (15th) of
each month as late,even if the cause of a late submission is due to the delayed approval of a budget or
amendment in the SAMIS system. The Children's Trust agrees to reimburse Provider on a monthly basis. Any
expense,included on a SAMIS reimbursement that is check dated greater than two months prior to the
invoice period will not be approved. The Children's Trust reserves the right to request any supporting
documentation related to this Contract.
If there are subcontractors to this Contract,then the Form D:Attestation of Payment must be uploaded to the
SAMIS Document Repository no later than thirty (30) days after payment to subcontractor. Upon the close of
this Contract,Provider is required to complete Form E:Close-out Attestation of Payment,which must be
uploaded to the SAMIS Document Repository no later than thirty (30) days after payment to subcontractor.
These forms may be downloaded from The Children's Trust website. For the purpose of payment only,a
subcontractor is defined as an independent agency that has entered into agreement with Provider to
perform services pertaining to The Children's Trust funded programs identified in this Contract.
A final request for payment(last monthly invoice of the Contract term) from Provider will be accepted by
The Children's Trust up to forty-five (45) days after the expiration of this Contract. If Provider fails to comply,
then all rights to payment shall be forfeited.
If The Children's Trust determines that Provider has been paid funds,which are not in accordance with this
Contract,and to which it is not entitled,then Provider shall return such funds to The Children's Trust or submit
appropriate documentation to support the payment within thirty (30) days of notification by The Children's
Trust. After thirty (30) days,The Children's Trust may recapture amounts due to The Children's Trust,from this
or any Contract by reducing amounts requested to be reimbursed less the amount owed to The Children's
Trust. The Children's Trust shall have the sole discretion in determining if Provider is entitled to such funds in
accordance with this Contract.The Children's Trust decision on this matter shall be binding.
In the event that Provider,its independent CPA firm or The Children's Trust discovers that an overpayment
has been made,Provider shall repay the overpayment within thirty (30) calendar days without prior
notification from The Children's Trust.
If Provider fails to serve the number of participants and/or fails to utilize the funds in accordance with the
Contract,then The Children's Trust may amend the Contract to reduce the amount of dollars. Any delay in
amendment by The Children's Trust is not deemed a waiver of The Children's Trust right to amend or seek
reimbursement for under-serving participants in accordance with the Contract.
A SAMIS request for payment will be deemed proper as defined by the Florida Prompt Payment Act,if the
request complies with the requirements set forth in this Contract and is submitted on the forms prescribed by
The Children's Trust. Requests for payment and/or documentation returned to Provider for corrections may
be cause for delay in the receipt of payment. Late submission may result in delay in the receipt of
payment. The Children's Trust shall pay Provider within thirty (30) calendar days of receipt of Provider's
properly submitted Request for Payment (i.e.,SAMIS invoice) and/or other required documentation.
The Children's Trust may retain any payments due until all required reports,deliverables or monies owed to
The Children's Trust are submitted and accepted by The Children's Trust.
Supporting Documentation Requirements
Provider shall maintain original records documenting actual expenditures and services provided according
to the approved budget and Scope of Services.Supporting documentation shall be made available and
provided to The Children's Trust upon request.
Provider shall keep accurate and complete records of any fees collected,reimbursement or compensation
of any kind received from any client or other third party,for any service covered by this Contract,and shall
make all such records available to The Children's Trust upon request. Provider shall maintain a cost
allocation methodology that is used to allocate its costs to ensure that The Children's Trust is paying only its
fair share of costs for services,overhead and staffing devoted to the program funded by this Contract.
Such methodology shall be made available to The Children's Trust upon request.
-THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK -
Budget Summary Report
City of Miami Beach-SPB XX21-1090-City of Miami Beach
Fiscal Year 17-18(8/01/17-7/31/18)
Contract#: 1821-1090
CSC Program Allocation: $400,000
Budget Status:Approved
Salary Accounts
Original Original Amended
Program CSC CSC
Account# Title Budget Budget Budget
511 Regular Salaries and Wages 164,227.00 147,396.00 147,396.00
521 FICA/MICA 2,382.00 2,138.00 2,138.00
522 Retirement Contributions 41,054.00 8,843.00 8,843.00
523 Life and Health Insurance 26,850.00 25,624.00 25,624.00
524 Workers Compensation 493.00 442.00 442.00
525 Unemployment Compensation 0.00 0.00 0.00
Salary Totals: 235,006.00 184,443.00 184,443.00
Expense Accounts
Original Original Amended
Program CSC CSC
Account# Title Budget Budget Budget
531 Travel(other than participants) 1,833.00 0.00 0.00
532 Travel (participants) 7,829.00 4,163.00 4,163.00
533 Meals(participants) 1,676.00 1,676.00 1,676.00
534 Space 0.00 0.00 0.00
535 Utilities 7,250.00 0.00 0.00
536 Supplies(office) 3,350.00 1,200.00 1,200.00
537 Supplies(program) 840.00 840.00 840.00
540 Non-Capital Equipment 0.00 0.00 0.00
550 Capital Equipment 0.00 0.00 0.00
591 Indirect Cost 0.00 0.00 0.00
611 Subcontractor 236,947.00 202,457.00 202,457.00
711 Professional Services(instructors) 0.00 0.00 0.00
721 Professional Services(certified teachers) 0.00 0.00 0.00
731 Professional Services(tutors) 0.00 0.00 0.00
741 Professional Services(consultants) 0.00 0.00 0.00
791 Professional Services(other) 0.00 0.00 0.00
811 Other(advertising) 0.00 0.00 0.00
821 Other(background screening) 0.00 0.00 0.00
831 Other(admission to field trips) 0.00 0.00 0.00
891 Other(other) 2,000.00 2,000.00 2,000.00
529 Fringe Benefits(other) 0.00 0.00 0.00
841 Program Specific Audit 1,500.00 1,500.00 1,500.00
751 Professional Services(Evaluation) 0.00 0.00 0.00
Expense Accounts
Original Original Amended
Program CSC CSC
Account# Title Budget Budget Budget
851 Other(Volunteers) 0.00 0.00 0.00
852 Other(Special Events) 6,500.00 0.00 0.00
853 Other(Required Staff Training) 0.00 0.00 0.00
854 Other(Discretionary Funds) 1,721.00 1,721.00 1,721.00
855 Other(conference registration) 0.00 0.00 0.00
2000 Salary Summary 0.00 0.00 0.00
2005 EBP Trainings 0.00 0.00 0.00
Expense Totals: 271,446.00 215,557.00 215,557.00
Salary and Expense Totals: 506,452.00 400,000.00 400,000.00
Program Funders
Summary Funders
Funder Type Funder Total Comment
In-Kind Contributions In-Kind Contributions(Summary) 106,452.00 Program Funder
In-kind contributions provided by
City of Miami Beach Match, State
Attorney's Office, Pridelines and
Catalyst Miami.
Summary Funder Totals: 106,452.00
Comprehensive Budget/Amendment Report
City of Miami Beach-SPB XX21-1090-City of Miami Beach
Fiscal Year 17-18(8/01/17-7/31/18)
Contract#:1821-1090
Original Budget
Salary Data
Position Ong Amend Orig Amend Orig Amend Orig Amend Orig Amend Orig Amend
Salary Salary FICA FICA Retire Retire Insur Insur WC WC Unemp Unemp
Assistant Department Director(37977)
Staff: Tarre,Alba(32109)
Gross: 98,315.00 98,315.00 7,521.00 7,521.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Program: 4,916.00 4,916.00 71.00 71.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
CSC: 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Original Distribution
Program Allocation CSC Allocation Match Allocation
Time Period #Of People Rate Wks Funded HrslWeek Amt HrslWeek Amt Amt
Year Round 1.00 46.94 46.80 2.00 4,394.00 0.00 0.00
Year Round 1.00 48.35 5.40 2.00 522.00 0.00 0.00
Total Distribution to Program Salary 5% 4,916.00 0% 0.00 100% 4,916
Percentage of Distribution to Gross Salary 5% 0% 5%
Original Budget Narratives:
Assistant Department Director
Work status:Full-time
Frequency of payment:Bi-weekly
Source of Match:City of Miami Beach
Salary based on a rate of$46.94/hour x 40 hours/week x 46.8 weeks x 5%dedication to program
On September 14,2016 the Mayor and City Commission of the City of Miami Beach adopted a resolution providing for cost-of-living adjustments(COLA)for all unclassified employees;effective the first pay
period ending in July 2018,there shall be an across-the-board cost-of-living adjustment of 3%.
COLA effective date is June 25,2018.
6/25/18-7/31/18=27 days=5.4 weeks
$46.94+3%=$48.35
$48.35/hour x 40 hours/week x 46.8 weeks x 5%dedication to program
'Calculation included is an average of total hours worked per person per week.Actual hours worked per week will vary depending on case load and parenting groups facilitated.
The City of Miami Beach does not contribute towards FICA for unclassified employees.The City of Miami Beach calculates the rate for MICA at 1.45%of employee salary.
$98,315.28 x 5%x 1.45%=$71.28
Budget Amendment Narratives:
Approved Date: -
Position Orig Amend Orig Amend Orig Amend Orig Amend Orig Amend Orig Amend
Salary Salary FICA FICA Retire Retire Insur Insur WC WC Unemp Unemp
Case Worker(36104)
Stag: Mendoza,Nashely(44165)
Gross: 39,608.00 39,608.00 3,030.00 3,030.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Program: 39,608.00 39,608.00 575.00 575.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
CSC: 39,608.00 39,608.00 575.00 575.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Original Distribution
Program Allocation CSC Allocation Match Allocation
Time Period 8 Of People Rate Wks Funded HrslWeek Amt Hrs/Week Amt Amt
Year Round 1.00 18.91 46.80 40.00 35,400.00 0.00 0.00
Year Round 1.00 19.48 5.40 40.00 4,208.00 0.00 0.00
Year Round 1.00 18.91 46.80 0.00 0.00 40.00 35,400.00
Year Round 1.00 19.48 5.40 0.00 0.00 40.00 4,208.00
Total Distribution to Program Salary 100% 39,608.00 100% 39,608.00 0% 0
Percentage of Distribution to Gross Salary 100% 100% 0%
Original Budget Narratives:
Work status:Full-time
Frequency of payment:Bi-weekly
Salary based on a rate of$18.92/hour x 40 hours/week x 46.8 weeks
On September 14,2016 the Mayor and City Commission of the City of Miami Beach adopted a resolution providing for cost-of-living adjustments(COLA)for all unclassified employees;effective the first pay
period ending in July 2018,there shall be an across-the-board cost-of-living adjustment of 3%.
COLA effective date is June 25,2018.
6/25/18-7/31/18=27 days=5.4 weeks
$18.92+3%=$19.49
$19.49/hour x 40 hours/week x 5.4 weeks
The City of Miami Beach does not contribute towards FICA for unclassified employees.The City of Miami Beach calculates the rate for MICA at 1.45%of employee salary.
$39,628 x 1.45%=$574.61
Budget Amendment Narratives:
-
Approved Date:
Position Orig Amend Orig Amend Orig Amend Orig Amend Orig Amend Orig Amend
Salary Salary FICA FICA Retire Retire Insur Insur WC WC Unemp Unemp
Case Worker(36106)
Staff: Marcia,Jessica(42972)
Gross: 39,628.00 39,628.00 3,032.00 3,032.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Program: 23,777.00 23,777.00 345.00 345.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
CSC: 23,777.00 23,777.00 345.00 345.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Original Distribution
Program Allocation CSC Allocation Match Allocation
Time Period S Of People Rate Wks Funded Hrs/Week Amt Hrs/Week Amt Amt
Year Round 1.00 18.92 46.80 0.00 0.00 24.00 21,251.00
Year Round 1.00 19.49 5.40 0.00 0.00 24.00 2,526.00
Year Round 1.00 18.92 46.80 24.00 21,251.00 0.00 0.00
Year Round 1.00 19.49 5.40 24.00 2,526.00 0.00 0.00
Total Distribution to Program Salary 60% 23,777.00 100% 23,777.00 0% 0
Percentage of Distribution to Gross Salary 60% 60% 0%
Original Budget Narratives:
Work status:Full-time
Frequency of payment:8i-weekly
Source of Match:Position is shared between this contract and Parent-Child Program
Salary based on a rate of$18.92/hour x 40 hours/week x 46.8 weeks x 60%
On September 14,2016 the Mayor and City Commission of the City of Miami Beach adopted a resolution providing for cost-of-living adjustments(COLA)for all unclassified employees;effective the first pay
period ending in July 2018,there shall be an across-the-board cost-of-living adjustment of 3%.
COLA effective dale is June 25,2018.
6/25/18-7/31/18=27 days=5.4 weeks
$18.92+3%=$19.49
$19.49/hour x 40 hours/week x 5.4 weeks x 60%
The City of Miami Beach does not contribute towards FICA for unclassified employees.The City of Miami Beach calculates the rate for MICA at 1.45%of employee salary.
$23,777 x 1.45%=$344.77
Budget Amendment Narratives:
Approved Date: -
Position Orig Amend Orig Amend Orig Amend Orig Amend Orig Amend Orig Amend
Salary Salary FICA FICA Retire Retire Insur Insur WC WC Unemp Unemp
Case Worker(37978)
Staff: Chiovaro,Carmela(45004)
Gross: 63,797.00 63,797.00 4,880.00 4,880.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Program: 638.00 638.00 9.00 9.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
CSC: 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Original Distribution
Program Allocation CSC Allocation Match Allocation
Time Period #Of People Rate Wks Funded HrsfWeek Amt HrslWeek Amt Amt
Year Round 1.00 30.46 46.80 0.40 570.00 0.00 0.00
Year Round 1.00 31.37 5.40 0.40 68.00 0.00 0.00
Total Distribution to Program Salary 1% 638.00 0% 0.00 100% 638
Percentage of Distribution to Gross Salary 1% 0% 1%
Original Budget Narratives:
Carmela
Work status:Full-time
Frequency of payment:Bi-weekly
Source of Match:City of Miami Beach
Salary based on a rate of$30.46/hour x 40 hours/week x 46.8 weeks x1%dedication to program
On September 14,2016 the Mayor and City Commission of the City of Miami Beach adopted a resolution providing for cost-of-living adjustments(COLA)for all unclassified employees;effective the first pay
period ending in July 2018,there shall be an across-the-board cost-of-living adjustment of 3%.
COLA effective date is June 25,2018.
6/25/18-7/31/18=27 days=5.4 weeks
$30.46+3%=$31.37
$31.37/hour x 40 hours/week x 5.4 weeks x 1%dedication to program
*Calculation included is an average of total hours worked per person per week.Actual hours worked per week will vary depending on case load and parenting groups facilitated.
The City of Miami Beach does not contribute towards FICA for unclassified employees.The City of Miami Beach calculates the rate for MICA at 1.45%of employee salary.
$63,797 x 1%x 1.45%=$9.25
Budget Amendment Narratives:
Approved Date: -
Position Orig Amend Orig Amend Orig Amend Orig Amend Orig Amend Orig Amend
Salary Salary FICA FICA Retire Retire Insur Insur WC WC Unemp Unemp
Case Worker II-Payroll Coordinator(30428)
Staff: Nunez,Jose E(32058)
Gross: 50,414.00 50,414.00 3,857.00 3,857.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Program: 2,521.00 2,521.00 37.00 37.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
CSC: 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Original Distribution
Program Allocation CSC Allocation Match Allocation
Time Period #Of People Rate Wks Funded HrslWeek Amt HrslWeek Amt Amt
Year Round 1.00 24.07 46.80 2.00 2,253.00 0.00 0.00
Year Round 1.00 24.79 5.40 2.00 268.00 0.00 0.00
Total Distribution to Program Salary 5% 2,521.00 0% 0.00 100% 2,521
Percentage of Distribution to Gross Salary 5% 0% 5%
Original Budget Narratives:
Work status:Full-time
Frequency of payment:Bi-weekly
Source of Match:City of Miami Beach
Salary based on a rate of$24.07/hour x 40 hours/week x 46.8 weeks x 5%dedication to program
On September 14,2016 the Mayor and City Commission of the City of Miami Beach adopted a resolution providing for cost-of-living adjustments(COLA)for all unclassified employees;effective the first pay
period ending in July 2018,there shall be an across-the-board cost-of-living adjustment of 3%.
COLA effective date is June 25,2018.
6/25/18-7/31/18=27 days=5.4 weeks
$24.07+3%_$24.79
$24.79/hour x 40 hours/week x 5.4 weeks x 5%dedication to program
'Calculation included is an average of total hours worked per person per week.Actual hours worked per week will vary depending on case load and parenting groups facilitated.
The City of Miami Beach does not contribute towards FICA for unclassified employees.The City of Miami Beach calculates the rate for MICA at 1.45%of employee salary.
$48,947.76 x 5%x 1.45%_$36.55
Budget Amendment Narratives:
Approved Date: -
Position Orig Amend Orig Amend Orig Amend Orig Amend Orig Amend Orig Amend
Salary Salary FICA FICA Retire Retire Insur Insur WC WC Unemp Unemp
Department Director(37931)
Staff: Ruiz,Maria(44767)
Gross: 175,120.00 175,120.00 13,397.00 13,397.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Program: 8,756.00 8,756.00 127.00 127.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
CSC: 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Original Distribution
Program Allocation CSC Allocation Match Allocation
Time Period #Of People Rate Wks Funded HrslWeek Amt HrslWeek Amt Amt
Year Round 1.00 83.61 46.80 2.00 7,826.00 0.00 0.00
Year Round 1.00 86.12 5.40 2.00 930.00 0.00 0.00
Total Distribution to Program Salary 5% 8,756.00 0% 0.00 100q 8,756
Percentage of Distribution to Gross Salary 5% 0% 5%
Original Budget Narratives:
Work status:Full-time
Frequency of payment:Bi-weekly
Source of Match:City of Miami Beach
Salary based on a rate of$83.61/hour x 40 hours/week x 46.8 weeks x 5%dedication to program
On September 14,2016 the Mayor and City Commission of the City of Miami Beach adopted a resolution providing for cost-of-living adjustments(COLA)for all unclassified employees;effective the first pay
period ending in July 2018,there shall be an across-the-board cost-of-living adjustment of 3%.
COLA effective date is June 25,2018.
6/25/18-7/31/18=27 days=5.4 weeks
$83.61+3%=$86.12
$86.12/hour x 40 hours/week x 5.4 weeks x 5%dedication to program
'Calculation included is an average of total hours worked per person per week.Actual hours worked per week will vary depending on case load and parenting groups facilitated.
The City of Miami Beach does not contribute towards FICA for unclassified employees.The City of Miami Beach calculates the rate for MICA at 1.45%of employee salary.
$175,119.84 x 5%x 1.45%=$126.96
Budget Amendment Narratives:
Approved Date: -
Position Orig Amend Orig Amend Orig Amend Orig Amend Orig Amend Orig Amend
Salary Salary FICA FICA Retire Retire Insur Insur WC WC Unemp Unemp
Fringe Benefits(30340)
Staff: Benefits,Fringe(31330)
Gross: 0.00 0.00 0.00 0.00 41,054.00 41,054.00 26,850.00 26,850.00 493.00 493.00 0.00 0.00
Program: 0.00 0.00 0.00 0.00 41,054.00 41,054.00 26,850.00 26,850.00 493.00 493.00 0.00 0.00
CSC: 0.00 0.00 0.00 0.00 8,843.00 8,843.00 25,624.00 25,624.00 442.00 442.00 0.00 0.00
Original Budget Narratives:
Health&Dental
Senior Program Coordinator:$439.87(medical)+$7.27(dental)x 24 pay periods=$10,731.36 x 50%=$5,365.68
Office Associate IV:$233.27(medical)+$10.98(dental)x 24 pay periods=$5862
Case Worker$233.27(medical)+$10.98(dental)x 24 pay periods=$5862 x 60%_$3517.20
Case Worker:$439.87(medical)+$7.27(dental)x 24 pay periods=$10,731.36
$5,365.68+$5862+$3517.20+$10,731.36=$25,476.24
City of Miami Beach-In-kind staff
Department Director:$233.27(medical)+$4.15(dental)x 24 pay periods=$5698.08 x 5%=284.90
Assistant Department Director:$233.27(medical)+$4.15(dental)x 24 pay periods=55698.08 x 5%=284.90
Case Worker II(Payroll Coordinator):$439.87(medical)+$4.15(dental)x 24 pay periods=$10,656.48 x 5%_$532.82
Case Worker$439.87(medical)+$4.15(dental)x 24 pay periods=$10,656.48 x 1%=$106.56
$284.90+5284.90+$532.82+106.56=01209.18
Life
Life Insurance-The City of Miami Beach contributes 0.1%towards Life Insurance for all employees Full-Time Employees.Total Program&CSC Allocation:$164.22(0.1%of$164,215.00)
Total CSC Allocation:$147.38(0.1%of$147,384.00)
Retirement-The City of Miami Beach contributes towards a pension plan for FT employees.The City's contribution is calculated two times in the fiscal year based on how its market contributions are faring.
This range is typically 6%-25%depending on market conditions.The 6%charged is a conservative estimate and the City will contribute whatever difference is determined at the time of the actuarial reviews.
Total Program&CSC Allocation:$41,053.75(25%of total FT salaries$164,215.00)
Total CSC Allocation:$8,843.03(6%of total FT salaries$147,384.00)
Worker's Comp
Workers Compensation-The City of Miami Beach contributes 0.3%towards Worker's Compensation Insurance for all employees.
Total Program&CSC Allocation:$492.65(0.30%of total Salaries$164,215.00)
Total CSC Allocation:$442.15(0.30%of total Salaries$147,384.00)
Unemployment Compensation
The City of Miami Beach is self-insured and does not fund Unemployment Insurance separately.
Source of Match:City of Miami Beach
Budget Amendment Narratives:
Approved Date: -
Position Orig Amend Orig Amend Orig Amend Orig Amend Orig Amend Orig Amend
Salary Salary FICA FICA Retire Retire Insur Insur WC WC Unemp Unemp
Office Associate IV(30734)
Staff: Montenegro,Bianca(37826)
Gross: 49,913.00 49,913.00 3,818.00 3,818.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Program: 49,913.00 49,913.00 724.00 724.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
CSC: 49,913.00 49,913.00 724.00 724.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Original Distribution
Program Allocation CSC Allocation Match Allocation
Time Period 8 Of People Rate Wks Funded HrslWeek Amt Hrs/Week Amt Amt
Year Round 1.00 23.83 46.80 40.00 44,610.00 0.00 0.00
Year Round 1.00 24.55 5.40 40.00 5,303.00 0.00 0.00
Year Round 1.00 24.55 5.40 0.00 0.00 40.00 5,303.00
Year Round 1.00 23.83 46.80 0.00 0.00 40.00 44,610.00
Total Distribution to Program Salary 100% 49,913.00 100% 49,913.00 0% 0
Percentage of Distribution to Gross Salary 100% 100% 0%
Original Budget Narratives:
Work status:Full-time
Frequency of payment:Bi-weekly
Source of Match:None
Salary based on a rate of$23.83/hour x 40 hours/week x 46.8 weeks
On September 14,2016 the Mayor and City Commission of the City of Miami Beach adopted a resolution providing for cost-of-living adjustments(COLA)for all unclassified employees;effective the first pay
period ending in July 2018,there shall be an across-the-board cost-of-living adjustment of 3%.
COLA effective date is June 25,2018
6/25/18-7/31/18=27 days=5.4 weeks
$23.83+3%=$24.55
$24.55/hour x 40 hours/week x 5.4 weeks
The City of Miami Beach does not contribute towards FICA for unclassified employees.The City of Miami Beach calculates the rate for MICA at 1.45%of employee salary.
$49,913 x 1.45%_$723.74
Budget Amendment Narratives:
Approved Date: -
Position Orig Amend Orig Amend Orig Amend Orig Amend Orig Amend Orig Amend
Salary Salary FICA FICA Retire Retire Insur Insur WC WC Unemp Unemp
Senior Program Coordinator(37928)
Staff: Cabrera,Cristina(31388)
Gross: 68,196.00 68,196.00 5,217.00 5,217.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Program: 34,098.00 34,098.00 494.00 494.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
CSC: 34,098.00 34,098.00 494.00 494.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
• Original Distribution
Program Allocation CSC Allocation Match Allocation
Time Period #Of People Rate Wks Funded HrslWeek Amt Hrs/Week Amt Amt
Year Round 1.00 32.56 46.80 20.00 30,476.00 0.00 0.00
Year Round 1.00 33.54 5.40 20.00 3,622.00 0.00 0.00
Year Round 1.00 32.56 46.80 0.00 0.00 20.00 30,476.00
Year Round 1.00 33.54 5.40 0.00 0.00 20.00 3,622.00
Total Distribution to Program Salary 50% 34,098.00 100% 34,098.00 0% 0
Percentage of Distribution to Gross Salary 50% 50% 0%
Original Budget Narratives:
Work status:Full-time
Frequency of payment:Bi-weekly
Source of Match:Position is shared between this contract and Parent-Child Program
Salary based on a rate of$32.56/hour x 40 hours/week x 46.8 weeks x 50%
On September 14,2016 the Mayor and City Commission of the City of Miami Beach adopted a resolution providing for cost-of-living adjustments(COLA)for all unclassified employees;effective the first pay
period ending in July 2018,there shall be an across-the-board cost-of-living adjustment of 3%.
COLA effective date is June 25,2018.
6/25/18-7/31/18=27 days=5.4 weeks
$32.56+3%=$33.54
$33.54/hour x 40 hours/week x 5.4 weeks x 50%
The City of Miami Beach does not contribute towards FICA for unclassified employees.The City of Miami Beach calculates the rate for MICA at 1.45%of employee salary.
$34,098.48 x 1.45%=$494.43
Budget Amendment Narratives:
Approved Date: -
Salary Totals
Percentage of Program Distribution to Gross Salary: 28% Percentage of CSC Distribution to Gross Salary: 25%
Orig Amend Orig Amend Orig Amend Orig Amend Orig Amend Orig Amend
Salary Salary FICA FICA Retire Retire Insur Insur WC WC Unemp Unemp
Gross: 584,991.00 584,991.00 44,752.00 44,752.00 41,054.00 41,054.00 26,850.00 26,850.00 493.00 493.00 0.00 0.00
Program: 164,227.00 164,227.00 2,382.00 2,382.00 41,054.00 41,054.00 26,850.00 26,850.00 493.00 493.00 0.00 0.00
CSC: 147,396.00 147,396.00 2,138.00 2,138.00 8,843.00 8,843.00 25,624.00 25,624.00 442.00 442.00 0.00 0.00
Expense Data
Account S Account Name Orig CSC Budget Amend CSC Budget Orig Prog Budget Amend Prog Budget
529 Fringe Benefits(other) 0.00 0.00 0.00 0.00
Original Budget Calculation:
Original Budget Narratives:
Budget Amendment Narratives:
Approved Date: -
Account R Account Name Orig CSC Budget Amend CSC Budget Orig Prog Budget Amend Prog Budget
531 Travel(other than participants) 0.00 0.00 1,833.00 1,833.00
Original Budget Calculation:
152.77'12
Original Budget Narratives:
Program Staff has access to a City,Fleet maintained sedan.$152.77 x 12 months=$1,833.33
Budget Amendment Narratives:
Approved Date: -
Account# Account Name Orig CSC Budget Amend CSC Budget Orig Prog Budget Amend Prog Budget
532 Travel(participants) 4,163.00 4,163.00 7,829.00 7,829.00
Original Budget Calculation:
4162.5+3666.48
Original Budget Narratives:
3 months(maximum)emergency bus passes issued in accordance with TCT budget guidelines(1 p/household).$56.25 per monthly pass(discounted rate)x 70 estimated instances of need=
$3,937.50+Single trip one use tickets;$2.25 each ticket x 100 instances of need for transportation and ineligible for MDT Transportation Disadvantaged Program=$225.
Program Staff has access to two City,Fleet maintained passenger vans to provide transportation to Participants needing to and/or from service activities such as FTC.$152.77 x 12 months x 2
vans=$3,666.48
Budget Amendment Narratives:
Approved Date: -
Account# Account Name Orig CSC Budget Amend CSC Budget Orig Prog Budget Amend Prog Budget
533 Meals(participants) 1,676.00 1,676.00 1,676.00 1,676.00
Original Budget Calculation:
85`4`4.93
Original Budget Narratives:
85 FGC x average of 4 people attending x 4.93 per individual meal=1,676.20
Budget Amendment Narratives:
Approved Date: -
Account# Account Name Orig CSC Budget Amend CSC Budget Orig Prog Budget Amend Prog Budget
534 Space 0.00 0.00 0.00 0.00
Original Budget Calculation:
Original Budget Narratives:
Budget Amendment Narratives:
Approved Date: -
Account# Account Name Orig CSC Budget Amend CSC Budget Orig Prog Budget Amend Prog Budget
535 Utilities 0.00 0.00 7,250.00 7,250.00
Original Budget Calculation:
104.16'12+500'12
Original Budget Narratives:
Property Maintenance$104.16 x 12 months=$1250
Telecommunications services and technical support(including hardware,software and peripherals)$500 x 12 months=$6,000
Budget Amendment Narratives:
Approved Date: -
Account# Account Name Orig CSC Budget Amend CSC Budget Orig Prog Budget Amend Prog Budget
536 Supplies(office) 1,200.00 1,200.00 3,350.00 3,350.00
Original Budget Calculation:
1200+875+1275
Original Budget Narratives:
Requested amount of$1,200 is 0.30%of TCT contract value(within limitation of 2%of the contract value as per Budget Guidelines).
$875 costs for copier&remote file storage(Source Match:In-kind contributions provided by City of Miami Beach)
$1,275 toner and machine maintenance.(Source Match:In-kind contributions provided by City of Miami Beach)
Budget Amendment Narratives:
Approved Date: -
Account# Account Name Orig CSC Budget Amend CSC Budget Orig Prog Budget Amend Prog Budget
537 Supplies(program) 840.00 840.00 840.00 840.00
Original Budget Calculation:
60`14
Original Budget Narratives:
Annual fee for SamePage software to enable client tracking by all partners$60 x 14 log-ins=$840
Budget Amendment Narratives:
Approved Date: -
Account# Account Name Orig CSC Budget Amend CSC Budget Orig Prog Budget Amend Prog Budget
611 Subcontractor 202,457.00 202,457.00 236,947.00 236,947.00
Original Budget Calculation:
30933.00+40491.36+15759+6828.90+5750+19800+1845+24570+3584+896+2000+5000
0+10000+14850+9640
Original Budget Narratives:
Care Coordination Services Provided by C.O.G.Counseling,Ayuda and Choices et al.
CC Assessment:$245.50 each x 126 clients=$30,933
CC Follow Ups:$80.34 each x 504 sessions=$40,491.36
Family Team Conference(FTC):
$185.40 each x 85 clients=$15,759.00
FTC follow-up$80.34 each x 85 clients=$6,828.90
Mental Health Services
MH Assessment:$250 each x 23 clients=$5,750
MH Sessions:$90 each x 20 clients x 11 sessions=$19,800
Tutoring Services
Tutoring Assessment:$45 each x 41 clients=1,845
Tutoring Sessions:$45 each x 39 clients x 14 sessions=$24,570
Youth Employment
Employment Session Stipend:$14 x 256 hours=$3,584
Employee Training:$224 x 4 Clients=$896
Credit Counseling
$500 per family x 4 Families=$2,000
Functional Family Therapy
Please see the uploaded ICFH budget.
Salary:$17.60/hr x 40/hrs wk x 52.00 wks(12 months,paid biweekly)
Travel:Staff travel to appointments in client homes.Reimbursement rate of$0.50/mile @ approximately 200 miles/month. 200 .50*12=$1,200
Supplies(Program):Approximately$12.50/month x 12 months(Program books/manuals).
8-12 sessions x 25 Families
$50,000
In-Kind Services
Legal Assistance—State Attomey's Office
(Child Support,Seal and Expunge,Wage Gamishment)
$1,000 per family x 10 families=$10,000
LGBT Support Services—Pridelines
(Counseling,HIV testing,Support Groups,Free Technology for Homework Support)
$350 per person x 30 people=$10,500(LQBT cultural competency training)
$87 per program visit x 50 visits=$4,350
$10,500+$4,350=$14,850
Leadership and Advocacy Training,Family Empowerment Training—Catalyst Miami
(Step-Up Miami,People Empower People,Parent Leadership Training Institute)
$332 per training course x 20 families=$6,640(This estimate is for a 12 week course)
$75 per training program supplies x 20 families x 2(average)people per family=$3,000
$10,000+$14,850+$9,640=$34,490$6,640+$3,000=$9,640
Budget Amendment Narratives:
Approved Date: -
Account# Account Name Orig CSC Budget Amend CSC Budget Orig Prog Budget Amend Prog Budget
841 Program Specific Audit 1,500.00 1,500.00 1,500.00 1,500.00
Original Budget Calculation:
1500
Original Budget Narratives:
The cost of program-specific audit is$1,500
Budget Amendment Narratives:
Approved Date: -
Account# Account Name Orig CSC Budget Amend CSC Budget Orig Prog Budget Amend Prog Budget
852 Other(Special Events) 0.00 0.00 6,500.00 6,500.00
Original Budget Calculation:
6500
Original Budget Narratives:
Family Service Day is a community engagement event designed to galvanize members of the Miami Beach community in a call for public service.The event is sponsored by The City of Miami Beach.
$2,500 for Family Service Day T-Sh iris for Volunteers(300-500 expected volunteers)
$3,000 for Supplies and materials for service projects for Family Service Day.(Gloves,Trash bags,mulch,various plants,etc.)
$500 for Reserved Parking Spaces
$500 for Various food for volunteers with special dietary needs.
Budget Amendment Narratives:
Approved Date: -
Account# Account Name Orig CSC Budget Amend CSC Budget Orig Prog Budget Amend Prog Budget
854 Other(Discretionary Funds) 1,721.00 1,721.00 1,721.00 1,721.00
Original Budget Calculation:
1721
Original Budget Narratives:
$1,721 is 0.43%of the total grand fund of$400,000
Budget Amendment Narratives:
Approved Date: -
Account# Account Name Orig CSC Budget Amend CSC Budget Orig Prog Budget Amend Prog Budget
891 Other(other) 2,000.00 2,000.00 2,000.00 2,000.00
Original Budget Calculation:
2000
Original Budget Narratives:
$500 emergency funds x 4 clients=$2000
Budget Amendment Narratives:
Approved Date: -
Expense Totals Orig CSC Budget Amend CSC Budget Orig Prog Budget Amend Prog Budget
215,557.00 215,557.00 271,446.00 271,446.00
Salary,Expense,and Subcontractor Totals Orig CSC Budget Amend CSC Budget Orig Prog Budget Amend Prog Budget
400,000.00 400,000.00 506,452.00 506,452.00
Subcontractor Budget
Organization Name: City of Miami Beach
Subcontractor Name: Institute for Child&Family Health
Contract
Period: August 1.2017-July 31.2018 12 months Areas in Blue to be completed by the Agency
PROGRAM BUDGET Insert Program Period Insert Program Period
Requested Funding Matching Funds Justification
SALARIES: % Amount ^/o Amount
List Full-Time Employees
Annual
Salary
Position (12 mths)
Therapist 36,611.00 100% 36,611.00 0.00 $17.60/hr x 40/hrs wk x 52.00 wks(12 months,paid biweekly)
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
Full-Time Total 1.00 36,611.00 0.00 0.00
List Part-Time/Seasonal Employees
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
Part-Time Total 0.00 0.00 0.00 0.00
TOTAL FTEs/SALARIES 1.00 $36,611.00 .00 $0.00
FRINGE BENEFITS
Fica/Mica Rate: 7.65% 2,801.00 0.00 Total salaries$36,611*.0765=$2,800.74
W-Comp's Rate: 0.88% 322.00 0.00 Total salaries$36,611*.0088=$322.17
Unemploy Rate: 1.14% 80.00 0.00$7,000*.00114=$79.80
Retirement Rate: 0.00% 0.00 0.00
Other Specify&provide calculations
Health Ins. Cost per Staff $398.00 4,776.00 $398.00 per month/staff
Life Ins. Rate: 0.17% 62.00 Total salaries*.0017
Rate:
TOTAL FRINGE BENEFITS $8,041.00 $0.00 TCT Fringe is 21.9633443500587%of TCT Requested Salarie
PROGRAM OPERATING EXPENSES: Requested Matching Funds
Funding Amount Amount
Travel(other than participants) 1,200.00 Staff travel to appointments in client homes.Reimbursement rate
of$0.50/mile @ approximately 200 miles/month. 200*.50*12
=$1.200
Travel(participants)
Meals(participants)
Space(rent of a building)
Utilities(e.g.telephone,utilities) 420.00 Cellular phone for use in the field.$35 x 1 person x 12 months
Supplies-office (e.g.paper,printing,postage) 300.00 Approximately$25.00/month x 12 months(Includes general office
supplies,copier costs,postage,etc.)
Supplies-program(e.g.curricula,books) 150.00 Approximately$12.50/month x 12 months(Program books/
manuals).
Non-Capital Equipment(less than$1,000)(List each) 0.00 0.00
Capital Equipment(greater than$1,000)(List each) 0.00 0.00
Subcontractor Budget Rev 4/13
Subcontractor Budget
Subcontractors (List each) 0.00 0.00
Professional Services 0.00 0.00
Instructor(List each) 0.00 0.00
Certified Teacher(List each) 0.00 0.00
Tutor(List each) 0.00 0.00
Professional Services/Independent Contractor- 0.00 0.00
Additional(List each)
0.00
Other 0.00 0.00
Volunteers
Advertising
Background screening
Admission to field trips
Program Specific Audit
Other-Additional(List each) 0.00 0.00
TOTAL OPERATING EXPENSES: $2,070.00 $0.00
Administrative/Indirect Costs
(Can not exceed 10%) 7% 3,278.00 Staff supervision,as contractually required per Evidence-Based
Practice guidelines
TOTAL BUDGET $50,000.00 0%u $0.00
Subcontractor Budget Rev 4/13
Attachment C: Data Requirements and Program Progress Metrics
FAMILY AND NEIGHBORHOOD SUPPORT
The Children's Trust requires collecting ongoing measures of progress on the quantity,quality and effects of
service efforts.The purpose of data collection,reporting and analysis is to promote continuous
improvements in program quality and outcome achievement.Successful programs regularly monitor the
quality of their own implementation at the site level,offer staff training and coaching on program
components,and incorporate feedback from participants and staff.Program progress metrics may be
revised throughout the funding cycle depending on the initiative needs and additional program data.For
specific details,please refer to the latest version of the Program Progress Metrics tool on the Children's
Trust website.Contract-specific reporting requirements can be found in Attachment A-Scope of Services.
Satisfaction Survey:Providers are expected to administer satisfaction surveys to all parents upon
completion of services or at the end of the contract year if the family is rolling over into the next year.The
Trust's satisfaction survey guidelines can be found at The Children's Trust website.
Providers are required to submit a summary of their satisfaction survey results through a web-based
reporting system.
Trust-sponsored/facilitated Trainings:Providers must ensure appropriate staff and subcontractors attend
various initiative-specific trainings provided by The Trust's program and professional development
providers annually as specified on The Children's Trust website.At a minimum,staff will be required to
attend the following annually:
• New and renewal contract development;
• Contract management trainings;
• The Children's Trust provider meetings;
• SAMIS training for budgets,amendments,invoices,SAMIS programmatic and reports trainings.
• Content-specific trainings related to program quality and performance measures (e.g.,Injury Free,
ACT,and Project RISE).
Compliance Items:Provider shall comply with all applicable compliance items specified in the core
contract,related contract attachments,and the "Required Documentation Checklist"posted on The
Children's Trust website.
Program Narrative Report:The Program Narrative Report captures a brief report of the program's
successes,challenges,and support needed.The report will be submitted to The Trust via the web-based
reporting system and following the guidelines provided in the Data Reporting Timeline below.
Accurate Timely Data Entry:Providers are expected to enter demographic,attendance,screening,and
assessment data in a timely manner,contributing to data accuracy and real time use of data.Providers are
expected to have processes in place to ensure data quality and integrity.Providers are expected to collect
and report outcome and screening data on all participants in our data reporting system.
Data Reporting Timeline:Provider shall comply with the web-based reporting requirements set forth in the
tables below. With each submission, Provider shall attest,based on his/her best knowledge,information and
belief,that all data submitted in conjunction with the reports are accurate,truthful and complete.Providers
will report individual participant attendance for each month by the 15th of the following month at the latest.
Due Date* What to Report in the Web-Based Reporting System
15th Day Each • Prior month's new participant demographics,activity data,screening data,and
Month any testing data
15th
• Program Narrative Report(For services and activities rendered in August,
November 15 September,and October)
15th • Program Narrative Report(For services and activities rendered in November,
February 15 December,and January)
15th
• Program Narrative Report(For services and activities rendered in February,March,
May 15 and April)
• Aggregated satisfaction survey responses
August 15th • Program Narrative Report(For services and activities rendered in May,June,and
July)
*NOTE:If a reporting due date falls on a weekend or holiday,the document shall be due on the following
business day.
ATTACHMENT D
Program Specific Audit Requirements
The Program Specific Audit must encompass an audit of The Children's Trust Contracts in accordance with
section P3:Program Specific Audit of this Contract.The comprehensive nature of auditing performed in
accordance with the standards set forth below places on the independent certified public accounting firm
(CPA) the responsibility for ensuring that(1) the audit is conducted by personnel who have the necessary
skills; (2) independence is maintained; (3) applicable standards are followed in planning and conducting
audits and reporting the results; (4) the organization has an appropriate internal quality control system in
place;and (5) the organization undergoes an external quality control review.
Program Specific Audits must be conducted in compliance with AU-C 935 and are required to
include performing tests of controls over compliance.
An auditor's risk assessment must include an expectation of the operating effectiveness of
controls over compliance; and in doing so; the assessed control risk must be assessed at low
during the planning stage. If the auditor determines a lack of controls and identifies risk of
material noncompliance that demonstrates internal controls do not exist or are not effective
regarding the compliance requirement, a response to such risks should be developed, and a
finding (significant deficiency or material weakness) should be reported.
The auditor's test work and sample size of each compliance requirement should be the result of
the assessed level of inherent risk and control risk as it relates to each compliance requirement
as stated in The Children's Trust Contracts.
The Program Specific Audit requires the following components (a sample format may be found on The
Children's Trust website):
a. Independent Auditor's Report on the Schedule of Expenditures of The Children's Trust Contracts;
b. Schedule of Expenditures of The Children's Trust Contracts;
c. Notes to Schedule;
d. Independent Auditor's Report on Compliance for each of The Children's Trust Contracts and Report
on Internal Control over Compliance;and
e. Schedule of Findings and Questioned Costs.
At a minimum,the auditor must include the following tests in their audit program to ensure that the
compliance requirements set forth in The Children's Trust compliance supplement are met. They are:
The Children's Trust Compliance Supplement to the Program Specific Audit:
Compliance Requirements:
a. Internal Controls
Program Specific Audit Implication
1. An auditor's risk assessment must include an expectation of the operating effectiveness of
controls over compliance;and in doing so;the assessed control risk must be assessed at low
during the planning stage. If the auditor determines a lack of controls and identifies risk of
material noncompliance that demonstrates internal controls do not exist or are not effective
regarding the compliance requirement,a response to such risks should be developed,and a
finding (significant deficiency or material weakness) should be reported.
The auditor's test work and sample size of each compliance requirement should be the result of
the assessed level of inherent risk and control risk as it relates to each compliance requirement as
stated in The Children's Trust Contracts.
Example
A. Controls tested during the financial statement audit may not consider compliance as it relates to
the Children's Trust Contracts. Overall control risk must consider each compliance requirement
tested during the program specific audit. Separate risk assessment procedures and materiality
should be performed and generated for a program specific audit.
b. Budget vs. Actual Expenditures
Program Specific Audit Implication
1. The approved budget is to include the original approved Contract as well as any approved
budget amendments/revisions.
Example
A. Testwork should include a schedule identifying each Contract and its original/amended budget,
monthly billings,Contract utilization and any analytical expectations that may identify any
overbillings.
i. SAMIS does not allow providers to overbill any budgeted line item or Contract
allocation,however,if Contract utilization is greater or less than expected,this could
indicate that a budgeted salary rate is not the employee's actual rate. Provider
must compensate employees at the rate stated on the budget. Any difference in
rate would warrant a finding in the Program Specific Audit Report.
c. Allowable/Unallowable Activities and Costs
Common unallowable costs:
1. Salary rates,payroll methods and hours billed do not match original or amended budgets.
2. The amount of fringe benefits billed to the Trust is actually for employees not included in Contract
budget and unrelated to the program.
3. Professional services are billed within regular salaries and wages.
4.Capital purchases disguised as repairs.
5. Sales taxes and tips.
6. Fuel
7. Food and beverage costs for parties,celebrations,end-of-program events,and conferences or
conventions,unless while attending an out-of-town conference or convention.
8. Monetary gift cards as incentives.
(A detailed listing of all costs and activities considered allowed and un-allowed can be viewed in the
Budget Guidelines form on the Children's Trust website,www.thechildrenstrust.org/providers/forms.)
Program Specific Audit Implication
1. Requires that the nature of services and type of costs paid are in agreement with the
contractual budget and/or budget amendment/revision's Scope of Services and budget
guidelines.
AND/OR
Requires that activities performed or costs paid with The Children's Trust funds are listed in the
contractual budget narrative or a contractual budget amendment/revision narrative.
2. Any cost or service billed that is not approved in the Contract budget is a finding and reported
as a questioned cost on the Program Specific Audit Report.
3. If any cost or service is billed in more than one Contract,and the billings are in excess of the total
disbursement,or approved allocation,the expense has been overbilled or doubled billed and
should be considered a finding.
4. The Children's Trust funds must supplement a program,supplanting is unallowable. A provider
may not use Contract funds to defray any costs that the recipient already is obligated to pay.
(See example F)
Example
A. If Provider asks to be reimbursed for 6 field trips to teach children social skills,only field trips
enumerated in either the contractual budget narrative or the contractual Scope of Service will
be reimbursed.
B. If the Contractual budget,lists a Program Coordinator position at$25.00/hour,the provider must
pay the Program Coordinator and charge The Children's Trust$25.00/hour.The provider cannot
substitute funding identified for the Program Coordinator to any other position.
C. If the Contractual budget,lists a Program Coordinator's position,with dedicated time charged
to The Children's Trust program of 25%,the provider must keep records of an employee's time
to substantiate that 25% of time was in fact earned and charged to The Children's Trust program.
D. If 3 Contracts list a Program Coordinator's total budgeted salary as $100,000 and each Contract
will reimburse $35,000 (35%),then a possible overbilling of$5,000 may have occurred
($35,000*3=$105,000 or 35%*3=105% Children's Trust salary allocation).
E. If an invoice is submitted to The Children's Trust that includes food charges for end of the year
parties and celebrations,those costs are NOT allowable per The Children's Trust budget
guidelines and cannot be paid by The Children's Trust.
F. If a provider,prior to applying to participate in the contracted program,committed to purchase
10 new computers for another program,the provider must purchase those 10 computers in
addition to any other computers requested for The Children's Trust program.
d. Cash Management
Program Specific Audit Implication
1. With the exception of the last month of the Contract period,do monthly invoices represent cost
actually paid during the Contract period (cash basis),rather than costs incurred or accrued.
Example
A. If payroll is paid on 3/31,it should be disclosed in March's reimbursement.
B. If payroll is paid on 4/1,but represents time charged in March,it should be disclosed in April's
reimbursement.
e. Period of Availability
Program Specific Audit Implication
1. Requires Provider to charge The Children's Trust grant with only allowable costs resulting from
obligations incurred during the funding period.
Example
A. If the active Contract period extends from 8/1 through 7/31,and Provider expends $250.00 for
office supplies on 9/30,during said Contract period,that expenditure must support program
services performed during the Contract term.
B. The following items warrant the most attention at the beginning and end of Contract periods:
i. Payroll from expired Contracts is not allowed to be billed in the first month of the
renewed Contract if it was paid during the invoiced month but was incurred in prior
Contract. Reporting requirements for final invoice allow this payroll to be expensed
and reimbursed in prior Contract. Only the portion of payroll incurred during the
Contract period may be billed.
ii. Utilities
iii. Insurances
f. Special Provisions
Program Specific Audit Implication
1. Eligibility requirements related to Contract expectations such as type of participants served,
number of participants served and background checks should NOT be tested as part of The
Children's Trust program specific audit. The program specific audit is meant to test the fiscal
viability of the provider. Therefore,certain core Contract provisions that support the fiscal
viability of the provider should be tested.
Example
Each of the following special provisions must be tested:
A. Insurance requirements (further description in Section L of the Core Contract)
i. Auditor should determine if all applicable insurance policies were carried during the
fiscal year.
B. Proof of tax status (further description in Section M of the Core contract)
ii. Auditor should vouch to applicable documents verifying that all incurred payroll and
unemployment taxes have been paid.
C. Data security obligation (further description in Section 12 of the Core Contract)
i. Auditor should obtain and/or understand the Provider's data security policy.
D. Subcontractor agreements (if applicable)
i. Auditor should obtain and understand any agreements made with subcontracted
parties. Additionally,the auditor should obtain an understanding of any Provider
monitoring procedures.
E. Matching Funds
i. In some cases,a required match is contracted. This will be indicated in Section D of
the Core Contract. Verify the applied method the provider uses to satisfy match
requirements. Also,verify that provider maintains documentation to backup match
requirements.
The independent auditor's report shall state that the audit was conducted in accordance with auditing
standards generally accepted in the United States of America;the standards applicable to financial audits
contained in Government Auditing Standards,issued by the Comptroller General of the United States,and
the Program Specific Audit requirements listed in The Children's Trust Contract.
ATTACHMENT E-1
Affidavit under Penalty of Perjury for Level 2 Background Screenings
Affidavit under Penalty of Perjury Affirming Compliance with Background Screening for Provider
Personnel, Volunteers, and Subcontracted Personnel, as applicable.
In accordance with Sections 943.0542, 984.01, Chapter 430, 435, 402, 39.001, and 1012.465 Florida
Statutes,and pursuant to the requirements of Paragraph R. Background Screening of this Contract,
the undersigned affiant makes the following statement under oath and under penalty of perjury,
which is a first degree misdemeanor, punishable by a definite term of imprisonment not to exceed
one year and/or a fine not to exceed $1,000, pursuant to Sections 837.012 and 775.082, Florida
Statutes.
All full-time, part-time, contracted staff and volunteers, along with the staff and volunteers
provided to the program by a subcontractor have been checked against The Dru Sjodin National
Sex Offender Public Website http://www.nsopw.gov/eng (Check must have taken place within 30
calendar days prior to the signing of this document.)
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
Before me, the undersigned authority, personally appeared (CEO/Executive Director) Authorized
Provider
Representative of (Provider Name) , who being by me first duly sworn, deposes
and says:
I swear and affirm that the nbave-named contracted_Provider is compliant with the requirements
for personnel background screening detailed in Sections 943.0542, 984.01,Chapter 435,402,39.001,
and 1012_465_Elork-ia Statut.ec as applicable,for all personnel having-direct-contact with children.
(Signature of CEO/Executive Director/HR Director) Date
Sworn to and subscribed before me at Miami-Dade County, Florida this_day of , 20_by
Who is personally known to me
Who produced identification:
Type of identification
Signature of Notary Public
State of Florida at Large
Print, type or stamp name of notary public
My Commission Expires:
tic Zr41r
th
ATTACHMENT E-2
r °ANc34°: CHILD CARE
Mv"Famrrr"")M AFFIDAVIT OF GOOD MORAL CHARACTER
State of Florida County of
Before me this day personally appeared who, being duly sworn, deposes and says:
(Applicant's/Employee's Name)
As an applicant for employment with, an employee of, a volunteer for, or an applicant to volunteer with
, I affirm and attest under penalty of perjury that I meet the moral character
requirements for employment, as required by Chapter 435 Florida Statutes in that:
I have not been arrested with disposition pending or found guilty of, regardless of adjudication, or entered a
plea of nolo contendere or guilty to, or have been adjudicated delinquent and the record has not been sealed
or expunged for,any offense prohibited under any of the following provisions of the Florida Statutes or under any
similar statute of another jurisdiction for any of the offenses listed below:
Relating to:
Section 393.135 sexual misconduct with certain developmentally disabled clients and reporting of such sexual misconduct
Section 394.4593 sexual misconduct with certain mental health patients and reporting of such sexual misconduct
Section 415.1 1 1 adult abuse,neglect,or exploitation of aged persons or disabled adults or failure to report of such abuse
Section 741.28 criminal offenses that constitute domestic violence,whether committed in Florida or another jurisdiction
Section 777.04 attempts,solicitation,and conspiracy
Section 782.04 murder
Section 782.07 manslaughter,aggravated manslaughter of an elderly person or disabled adult,or aggravated
manslaughter of a child
Section 782.071 vehicular homicide
Section 782.09 killing an unborn child by injury to the mother
Chapter 784 assault, battery,and culpable negligence,if the offense was a felony
Section 784.fJ11 ussautt,if the victim of uffensewasa-minar
Section 784.03 battery,if the victim of offense was a minor
Section 787.01 kidnapping
Section 787.02 false imprisonment
Section 787.025 luring or enticing a child
Section 787.04(2) taking,enticing,or removing a child beyond the state limits with criminal intent pending custody
proceeding
Section 787.04(3) carrying a child beyond the state lines with criminal intent to avoid producing a child at a custody hearing
or delivering the child to the designated person
Section 790.1 15(1) exhibiting firearms or weapons within 1,000 feet of a school
Section 790.1 15(2) (b) possessing an electric weapon or device,destructive device,or other weapon on school property
Section 794.011 sexual battery
Former Section 794.041 prohibited acts of persons in familial or custodial authority
Section 794.05 unlawful sexual activity with certain minors
Chapter 796 prostitution
Section 798.02 lewd and lascivious behavior
Chapter 800 lewdness and indecent exposure
Section 806.01 arson
Section 810.02 burglary
Section 810.14 voyeurism,if the offense is a felony
Section 810.145 video voyeurism,if the offense is a felony
Chapter 812 theft and/or robbery and related crimes,if a felony offense
Section 817.563 fraudulent sale of controlled substances,if the offense was a felony
Section 825.102 abuse,aggravated abuse,or neglect of an elderly person or disabled adult
Section 825.1025 lewd or lascivious offenses committed upon or in the presence of an elderly person or disabled adult
Section 825.103 exploitation of disabled adults or elderly persons,if the offense was a felony
Section 826.04 incest
Section 827.03 child abuse,aggravated child abuse,or neglect of a child
Section 827.04 contributing to the delinquency or dependency of a child
Former Section 827.05 negligent treatment of children
Section 827.071 sexual performance by a child
Section 843.01 resisting arrest with violence
Section 843.025 depriving a law enforcement,correctional,or correctional probation officer means of protection or
communication
Section 843.12 aiding in an escape
Section 843.13 aiding in the escape of juvenile inmates in correctional institution
Chapter 847 obscene literature
Section 874.05(1) encouraging or recruiting another to join a criminal gang
drug abuse prevention and control only if the offense was a felony or if any other person involved in the
offense was a minor
Section 916.1075 sexual misconduct with certain forensic clients and reporting of such sexual conduct
Section 944.35(3) inflicting cruel or inhuman treatment on an inmate resulting in great bodily harm
Section 944.40 escape
Section 944.46 harboring,concealing,or aiding an escaped prisoner
Section 944.47 introduction of contraband into a correctional facility
Section 985.701 sexual misconduct in juvenile justice programs
Section 985.711 contraband introduced into detention facilities
I understand that I must applicable acknowledge the existence of any criminal record relating to the above
lists of offenses including those under any similar statute of another jurisdiction, regardless of whether or not
those records have been sealed or expunged. Further, I understand that, while employed or volunteering at
in any position that requires background screening as a
condition of employment, I must immediately notify my supervisor/employer of any arrest and any changes in
my criminal record involving any of the above listed provisions of Florida Statutes or similar statutes of another
jurisdiction whether a misdemeanor or felony.This notice must be made within one business day of such arrest
or charge. Failure to do so could be grounds for termination.
I attest that I have read the above carefully and state that my attestation here is true and correct that my
record does not contain any of the above listed offenses. I understand, under penalty of perjury,all employees
in such positions of trust or responsibility shall attest to meeting the requirements for qualifying for employment
and agreeing to inform the employer immediately if arrested for any of the disqualifying offenses. I also
understand that it is my responsibility to obtain clarification on anything contained in this affidavit which I do
not understand prior to signing. I am aware that any omissions, falsifications, misstatements or
misrepresentations may disqualify me from employment consideration and, if I am hired, may be grounds for
termination or denial of an exemption at a later date.
SIGNATURE OF AFFIANT:
Sign Above OR Below, DO NOT Sign Both Lines
To the best of my knowledge and belief, my record contains one or more of the applicable disqualifying acts or
offenses listed above. I have placed a check mark by the offense(s) contained in my record. (If you have
previously been granted an exemption for this disqualifying offense, please attach a copy of the letter granting
such exemption.) (Please circle the number which corresponds to the offense(s) contained in your record.)
SIGNATURE OF AFFIANT:
Sworn to and subscribed before me this day of , 20
SIGNATURE OF NOTARY PUBLIC,STATE OF FLORIDA
(Print,Type,or Stamp Commissioned Name of Notary Public)
(Check one)
Affiant personally known to notary
OR Affiant produced identification
ATTACHMENT E-3
yiF pk,
v` •
m Child Abuse & Neglect Reporting Requirements
All child care personnel are mandated by law to report their suspicions of child abuse, neglect, or
abandonment to the Florida Abuse Hotline in accordance with s. 39.201 of the Florida Statutes(F.S.).
* Child care personnel must be alert to the physical and behavioral indicators of child abuse and
neglect.
"Child Abuse or Neglect" is defined in s.39.201, F.S.,as "harm or threatened harm" to a child's health
(mental or physical) or welfare by the acts or omissions by a parent, adult household member, other
person responsible for the child's welfare, or for purposes of reporting requirements by any person.
Categories include:
- Physical Abuse or Neglect (i.e. unexplained bruises, hunger, lack of supervision...)
- Emotional Abuse or Neglect (i.e. impairment in the ability to function, depression...)
-Sexual Abuse (i.e.withdrawal, excessive crying, physical symptoms...)
* Reports must be made immediately to the Florida Abuse Hotline Information System by
-Telephone at 1-800-96-ABUSE (1-800-962-2873), or
- Fax at 1-800-914-0004, or
-Online at http://www.dcf.state.fl.us/abuse/report/.
* Failure to perform duties of a mandatory reporter pursuant to s.39.201, F.S. constitutes a violation of
the standards in ss. 402.301-319, F.S. and is a felony of the third degree. Remember, it is each child
care personnel's responsibility to report suspected abuse and/or neglect.
* All reports are confidential. However, persons who are mandated reporters (child care personnel) are
required to give their name when making a report.
* It is important to give as much identifying and factual information as possible when making a report.
* Any person,when acting in good faith, is immune from liability in accordance with s.39.203(1)(a), F.S.
* For more information about child abuse and neglect, visit the Department's website at
www.myflorida.com/childcare and select "Training Requirements." The Department offers a 4-hour
Identifying and Reporting Child Abuse and Neglect course for child care providers.This course is an
overview of the various types of abuse and neglect, indicators that may be observed, the legal
responsibility of mandatory reporters, and the proper procedure for reporting abuse and neglect, as
required by ss. 402.305(2) and 402.313(1), F.S. The course is offered both online and instructor-based
throughout Florida.
This statement is to verify that on , 20 , I,
Date Print Name of Employee
Read and understood the information and my mandated reporting requirements.
Signature of Employee for facility or large family child care home) Signature of Operator
`'x ATTACHMENT E-4
A NO
M.VFLFAMM u ass-c z M
BACKGROUND SCREENING
& PERSONNEL FILE REQUIREMENTS
Place in employee file and attach all background screening documentation.
Authority: s. 402.301-319, F.S., and s. 435, F.S.
Name of Employee:
Name of Facility:
*Social Security #: Date of Birth: Employment Date:
*Pursuant to Chapter 435.05, F.S.,the Department's license/registration application requires personnel to give their Social Security
number for the purposes of background screening.Social security numbers are used by the Department for identity verification only.
Position Classification Position Type Age Group Assigned Education Level
(check one) (check all that apply) (check one) (check one)
Child Care Personnel Owner 0- 12 Months No High School/GED
Intermittent Volunteer Director 1 Year High School Student
Other Personnel Lead Teacher 2 Years High School/GED
(must select age group) 3 Years National Early Childhood Credential
VPK Instructor 4 Years Birth Through Five Child Care Credential
Assistant Teacher 4 Years VPK School-Age Child Care Credential
Substitute 5+Years Associates Degree
Mixed Bachelor's Degree
Not Applicable Master's Degree or Higher
SCREENING DOCUMENTATION
All child care personnel are required by law to be screened pursuant to Chapter 435, F.S.,
as a condition of employment and continued employment.
Initial Screen
Date Livescanned Date completed
FINGERPRINT FDLE/FBI FDLE/FBI
Affidavit of Good Moral Character N/A
(due on or before employment,following a 90
break,or when changing employers)
5 Year Re-screen
Date Livescanned Date completed
FINGERPRINT
FINGERPRINT
FINGERPRINT
OTHER REQUIREMENTS
Date Employment References Checked:
Names of References (attach additional documentation if necessary):
Leave of Absence Documentation from Employer (if applicable):
ATTACHMENT G
Data Security Definitions
"Authorized Employees" means Provider's employees who have a need to know or otherwise access
Personal Information to enable Provider to perform its obligations under this Agreement.
"Authorized Persons" means (i) Authorized Employees;or (ii) Provider's subcontractors approved by The
Children's Trust who have a need to know or otherwise access Personal Information to enable Provider to
perform its obligations under this Agreement,and who are bound in writing by confidentiality obligations
sufficient to protect Personal Information in accordance with the terms and conditions of this Agreement.
"Unauthorized Third Party" means any person other than Authorized Employee or Authorized Person(s).
"Highly-Sensitive Personal Information" means an individual's (i) government-issued identification
number(including,without limitation,social security number,driver's license number or state-issued
identified number); (ii) financial account number,credit card number,debit card number,credit report
information,with or without any required security code,access code,personal identification number or
password,that would permit access to an individual's financial account;or(iii) biometric or health data.
"Personal Information" includes Highly-Sensitive Personal Information or any of the following:
i. An individual's first name or first initial and last name in combination with any one or more of the
following data elements for that individual:
1. A social security number;
2. A driver license or identification card number,passport number,military identification number,
or other similar number issued on a government document used to verify identity;
3. A financial account number or credit or debit card number,in combination with any required
security code,access code,or password that is necessary to permit access to an individual's
financial account;
4. Any information regarding an individual's medical history,mental or physical condition,or
medical treatment or diagnosis by a health care professional;or
5. An individual's health insurance policy number or subscriber identification number and any
unique identifier used by a health insurer to identify the individual.
ii. User name or e-mail address,in combination with a password or security question and answer that
would permit access to an online account.
Notwithstanding the foregoing,the term "Personal Information"shall not include information (1) about an
individual that has been made publicly available by a federal,state,or local governmental entity;or(2) that
is encrypted,secured,or modified by any other method or technology that removes elements that
personally identify an individual or that otherwise renders the information unusable.
"Security breach" or"breach" means unauthorized access of data in electronic form containing
personal information,or a breach or alleged breach of this Agreement relating to such privacy practices.
Good faith access of Personal Information by an employee or agent of the covered entity shall not
constitute a breach of security under this Agreement,so long as the information is not used for a purpose
unrelated to the business of The Children's Trust,or as a result of any other unauthorized use.