MOU with Borinquen Health Care Center, Inc. � qM 00.2c
MEMORANDUM OF UNDERSTANDING BETWEEN
THE CITY OF MIAMI BEACH AND BORINQUEN HEALTH CARE CENTER, INC.
TO IMPLEMENT A FLU PROGRAM FOR SCHOOL YEAR 2019/2020
This is a Memorandum of Understanding ("MOU" or "Agreement") made and
entered into this 2yday of S413 , 2020, by and between the City of Miami
Beach ("CMB") and the BORINQUEN HEALTH CARE CENTER, INC. ("PROVIDER")
(collectively, the "Parties"), to provide for funding and for the implementation of a Flu Shot
Program as provided herein, and as to be provided in an agreement between Provider
and The Children's Trust ("TCT").
WITNESSETH
WHEREAS, the Parties have determined that a program to provide Flu
immunizations attending public schools is in the best interest of the health and public
welfare of the City of Miami Beach; and
WHEREAS, Provider, through contract with The Children's Trust (and in
collaboration with Miami Dade County Public Schools and the DOH) has implemented a
school health program that provides comprehensive and coordinated on-site health
services- including first aid, nursing assessment and counseling to public school children.
Staffed by registered nurses, licensed practical nurses, medical assistants, social
workers, and mental health professionals. Borinquen Medical Centers is operating 31
school sites in Central Miami-Dade County; and
WHEREAS, the School Health Program, through funding and partnership with the
City of Miami Beach and Borinquen Medical Centers, has also implemented the provision
of additional services in the form of flu vaccines; and
WHEREAS, as the school health provider, Borinquen Medical Centers of Miami-
Dade will be providing flu vaccines on-site at Miami Beach Public School locations, as
provided in Exhibit A, to those students who have not received their flu shot, and funded
by the City of Miami Beach in an amount not to exceed $15,000.
NOW, THEREFORE, in consideration of the mutual terms, conditions, promises,
covenants, and payments hereinafter set forth, the Parties agree to provide for a Flu Shot
Program for the participating City of Miami Beach Public School as follows:
1. Provider shall furnish all materials, labor and services required for the
administration of the Flu Shot Program, as set forth in Exhibit A, which Flu Shot
Program shall be funded by the City directly to Provider. The term for the Flu Shot
Program shall be from March 1, 2020 to October 31, 2020.
2. Provider agrees to comply with all the terms and conditions contained in the
Agreement between Provider and The Children's Trust, Contract No. 2017-6920,
attached hereto as Exhibit B. Provider understands that the City shall only be
providing the funding for the services described in this Agreement, and Provider
warrants and represents to the CITY that Provider has the authority and consent
from the TCT to administer the services described in this Agreement.
3. City shall provide funding to TCT for the Flu Shot Program in the amount not to
exceed $15,000. Subject to the availability of funds, the maximum amount payable
for Services rendered under this Agreement shall not exceed $15,000. Provider
agrees that the amount payable under this Contract may be reduced at the sole
option of City with a proportional reduction in services. Provider agrees to adhere
to City billing procedures. Provider shall submit an invoice for the services
described in Exhibit A to the City which shall be paid by the City within 30 Days
following the City's approval of the invoice.
4. In the event that any of the provisions in this MOU are not performed after the City
contribution has been dispersed to Provider, then Provider shall reimburse to the
City any and all unused funds.
5. Provider shall indemnify and hold harmless the City and their respective officers
employees, agents and instrumentalities from any and all liability, losses, or
damages, including attorneys' fees and costs of defense, which the City or their
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 MOU by Provider or its
employees, agents, servants, partners, principals, or subcontractors. Provider
shall pay 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 City,
where applicable, including appellate proceedings, and shall pay all costs,
judgments, and attorney's fees which may issue thereon.
6. In the event that any of the provisions in this MOU are not performed, or if the
services described herein are terminated after funds have been dispersed to
Provider as provided in paragraphs 3 and 4, then Provider shall promptly
reimburse City its proportionate share of unused funds.
7. This MOU shall be construed in accordance with the laws of the State of Florida.
This MOU shall be enforceable in Miami-Dade County, Florida, and if legal action
is necessary by either party with respect to the enforcement of any or all of the
terms or conditions herein, exclusive venue for the enforcement of this MOU shall
lie in Miami-Dade County, Florida. By entering into this MOU, Provider and the City
expressly waive any rights either party may have to a trial by jury of any civil
litigation related to or arising out of this MOU.
8. Provider agrees that all program services, activities and events funded by this
Agreement shall recognize City as a funding source in any and all publicity, public
relations and marketing efforts/materials created under its control on behalf of the
program.
9. Inspector General Audit Rights
a. Pursuant to Section 2-256 of the Code of the City of Miami Beach, the City
has established the Office of the Inspector General which may, on a random
basis, perform reviews, audits, inspections and investigations on all City
contracts, throughout the duration of said contracts. This random audit is
separate and distinct from any other audit performed by or on behalf of the
City.
b. The Office of the Inspector General is authorized to investigate City affairs
and empowered to review past, present and proposed City programs,
accounts, records, contracts and transactions. In addition, the Inspector
General has the power to subpoena witnesses, administer oaths, require
the production of witnesses and monitor City projects and programs.
Monitoring of an existing City project or program may include a report
concerning whether the project is on time,within budget and in conformance
with the contract documents and applicable law. The Inspector General
shall have the power to audit, investigate, monitor, oversee, inspect and
review operations, activities, performance and procurement process
including but not limited to project design, bid specifications, (bid/proposal)
submittals, activities of the Provider, its officers, agents and employees,
lobbyists, City staff and elected officials to ensure compliance with the
Contract Documents and to detect fraud and corruption. Pursuant to
Section 2-378 of the City Code, the City is allocating a percentage of its
overall annual contract expenditures to fund the activities and operations of
the Office of Inspector General.
c. Upon ten (10) days written notice to the Provider, the Provider shall make
all requested records and documents available to the Inspector General for
inspection and copying. The Inspector General is empowered to retain the
services of independent private sector auditors to audit, investigate,
monitor, oversee, inspect and review operations activities, performance and
procurement process including but not limited to project design, bid
specifications, (bid/proposal) submittals, activities of the Provider, its
officers, agents and employees, lobbyists, City staff and elected officials to
ensure compliance with the contract documents and to detect fraud and
corruption.
d. The Inspector General shall have the right to inspect and copy all
documents and records in the Provider's possession, custody or control
which in the Inspector General's sole judgment, pertain to performance of
the contract, including, but not limited to original estimate files, change order
estimate files, worksheets, proposals and agreements from and with
successful sub Providers and suppliers, all project-related correspondence,
memoranda, instructions, financial documents, construction documents,
(bid/proposal) and contract documents, back-change documents, all
documents and records which involve cash, trade or volume discounts,
insurance proceeds, rebates, or dividends received, payroll and personnel
records and supporting documentation for the aforesaid documents and
records.
e. The Provider shall make available at its office at all reasonable times the
records, materials, and other evidence regarding the acquisition (bid
preparation) and performance of this contract, for examination, audit, or
reproduction, until three (3) years after final payment under this contract or
for any longer period required by statute or by other clauses of this contract.
In addition:
f. If this contract is completely or partially terminated, the Provider shall make
available records relating to the work terminated until three (3) years after
any resulting final termination settlement; and
g. The Provider shall make available records relating to appeals or to litigation
or the settlement of claims arising under or relating to this contract until such
appeals, litigation, or claims are finally resolved.
h. The provisions in this section shall apply to the Provider, its officers, agents,
employees, sub Providers and suppliers. The Provider shall incorporate the
provisions in this section in all subcontracts and all other agreements
executed by the Provider in connection with the performance of this
contract.
i. Nothing in this section shall impair any independent right to the City to
conduct audits or investigative activities. The provisions of this section are
neither intended nor shall they be construed to impose any liability on the
City by the Provider or third parties.
REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
IN WITNESS THEREOF, the Parties hereto have caused this MOU to be executed '
by their respective and duly authorized'officers as:of the day and year. first written above.
:.. : ATTEST
: Borinquen Health Care Center:Inc. CITY OF MIAMI BEACH,
a Florida not for profit Corporation a Municipal Corporation of the:State of
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:By' C-A A��, : . By av�'`_
Paul Carl Velez Jimmyllorale
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EXHIBIT A
Borinquen Medical Centers, through contract with The Children's Trust (and in
collaboration with MDCPS and DOH) has implemented a school health program that
provides comprehensive and coordinated on-site health services- including first aid,
nursing assessment and counseling to public school children. Staffed by registered
nurses, licensed practical nurses, medical assistants, social workers, and mental health
professionals. Borinquen Medical Centers is operating 31 school sites in Central Miami-
Dade County.
The School Health Program, through funding and partnership with the City of Miami
Beach and Borinquen Medical Centers, has also implemented the provision of additional
services in the form of flu vaccines. As the school health provider, Borinquen Medical
Centers (BMC) will be providing flu vaccines on-site to those students who have not
received their flu shot.
Miami Beach public school sites for flu shot administration:
Miami Beach Senior High School
Miami Beach Nautilus Middle School
Miami Beach Fienberg Fisher K-8
Miami Beach South Pointe Elementary
North Beach Elementary
Biscayne Beach Elementary
Flu shot range per administration:
Cost of Fluarix per box of 10 prefilled syringes is $160.00 (Fluarix covers 3yrs and up)
Cost of Flucelvax per box of 10 prefilled syringes $179.58 (also 3yrs and up)
Additional Supply Cost of supply per unit per
supporting administration administration
Spot Bandaid $0.01
Eclipse Needle with Safety $0.22
Gloves (1 pair) $0.13
Alcohol Pad $0.01
Total $0.37
Administration fee per child at the school site clinic: $5.00.
Range of cost per shot: $16.37 to $23.33.
Activity Description
Flu Vaccination Provision of health-related services in the school setting.
Flu vaccination is provided to support student health and to promote a healthy school
environment that is conducive to student well-being.
Flu Vaccination Consents will be disseminated through coordination with MDCPS.
Coordination
Parents will be informed via use of"ConnectEd" messaging and notification sent home
with student.
Parents will also be informed via promotion/advertisement by City of Miami Beach
partners.
Flu vaccination supplies with be purchased by City of Miami Beach partner.
Flu vaccination supplies will be ordered by BMC.
Flu Vaccination Flu vaccination will be administered to students with a signed consent form.
Administration
BMC provider (SHP APRN) will be on site to order and document vaccine
administration.
Nurse will administer vaccine to student.
EXHIBIT"B"
CONTRACT NO. 2017-6920
BETWEEN THE CHILDREN'S TRUST
AND Borinquen Health Care Center, Inc.
FOR School-based Health
Agency's address: 3601 Federal Highway
Miami, FL 33137
Agency's federal identification number: 59-1417397
Vendor's identification number: BORIN692
Effective term: 7/1/2019 through 6/30/2020
Contract amount shall not exceed: $3,481,000.00
Required match amount(if applicable): $348,100.00
Approved by resolution number: ,2019-54
Agency's authorized official for notices Controller
Agency's custodian of public records (applicable if Grants Manager
Agency is subject to Chapter 119, Florida Statutes):
THIS CONTRACT is between The Children's Trust, whose address is 3150 SW 3rd Avenue, 8th Floor, Miami, FL 33129,
and Borinquen Health Care Center, Inc., hereafter referred to as "Provider," whose address is listed above.
•
In consideration of the mutual covenants herein, The Children's Trust and Provider (hereafter collectively referred
to as "Parties")agree as follows:
This Contract is subject to funding availability and Provider's performance.
A. TERMS OF RENEWAL, if applicable
In the sole discretion of The Children's Trust, this Contract may be renewed with Provider's authorization. Contract renewals
will be contingent upon The Children's Trust's board ("board") approval and in accordance with applicable solicitation
documents for services provided. Such renewal may not exceed five (5) terms. In determining whether to renew Provider's
contract, The Children's Trust will consider factors that include, but are not limited to the following:
1. Continued demonstrated and documented need for the services.
.2. Provider's satisfactory program performance, fiscal performance, and compliance with the terms of the Contract,
as determined by The Children's Trust in its sole discretion.
3. Availability of funds.
B. SCOPE OF SERVICES
All Providers
1. Provider agrees to render services in accordance with Attachment A: Scope of Services (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, as appropriate, will be used in the evaluation of Provider's overall performance.
3. Provider agrees that all funding for direct community services 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. Direct
community services refer to services or programs such as after-school, summer and parenting services offered to
children and families in Miami-Dade County.
School-based Health Providers only
In addition to the three requirements above, the school-based health providers must abide by the following:
4. Services under this Contract shall be available to all students, upon referral, at the designated school sites
regardless of financial status or social/economic background. Provider is responsible for the clinical supervision of all
direct staff.
5. Provider is solely responsible for securing compliance with any applicable state and federally mandated
requirements for consents for health services, including medical treatment, and compliance with notification of
privacy practices. Provider shall secure parental consent for health services. All consents for treatment shall
specifically state that all treatment is being rendered by Provider and not by The Children's Trust.
6. Provider shall comply with applicable state and federal laws and Miami-Dade County Public Schools' (M-DCPS)
policies and regulations relating to the confidentiality of student records and information. Provider assures it shall
provide the parents, or the student who is beyond the age of eighteen (18), the right of access to medical records,
as specified in section 228.093, Florida Statutes, and Rule 6A-1.0955, F.A.C.
7. Upon request from the Florida Department of Health, Provider shall provide evidence of appropriate credentials
and/or licenses of all direct staff assigned to the schools.
8. Where applicable, Provider shall comply with the Health Insurance Portability and Accountability Act of 1996
(HIPAA), as well as, all regulations promulgated thereunder (45 CFR Parts 160,162, and 164).
9. Provider may apply for Medicaid reimbursement, third party billing or any type of reimbursement available to
patients. Provider is solely responsible for compliance with, and adherence to, all state and federal laws and
regulations for health care related services, including, but not limited to, privacy and confidentiality.
C. TOTAL FUNDING
Subject to the availability of funds, the maximum amount payable for Services rendered under this Contract shall not
exceed the amount stated above. Provider agrees that the amount payable under this Contract may be reduced at the sole
option of The Children's Trust with a proportional reduction in services. Provider agrees to adhere to Attachment B: Other
Fiscal Requirements, Budget and Method of Payment, of this Contract.
D. 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 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 individual items with a value of$1,000.00 or greater which have a life expectancy of more than
one (1) year.
All capital equipment acquired by Provider valued at less than $10,000.00 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, in its sole discretion, acquire rights
and possession of all reimbursed capital equipment that is not fully depreciated.
All capital equipment acquired by Provider valued as equal to or greater than $10,000.00 and reimbursed by The
Children's Trust shall be capitalized by The Children's Trust, and The Children's Trust shall retain all rights to that
equipment until the item is fully depreciated. Should this Contract be subject to termination or early cancellation,
The Children's Trust, in its sole discretion, 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: Insurance Requirements 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.
For contracts involving direct community services, Provider and subcontractor must be qualified to conduct
business in the state of Florida at the time that a subcontractor agreement is executed.
In any subcontract, Provider shall incorporate 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 (thirty) calendar days of its
execution. Subcontractors are only entitled to reimbursement for services rendered upon receipt of executed
subcontracts. 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 the
Contract, the 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. Provider, not The Children's Trust, shall be
solely liable to any subcontractor and for all expenses or liabilities incurred under any subcontract.
All payments to any contracted subcontractor shall be paid directly by Provider to the subcontractor. The Children's
Trust shall not pay any subcontractor unless specifically agreed to in writing by The Children's Trust with notification
to the Provider. In such instances, 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.
5. Religious Purposes
Provider and/or its faith-based community partner 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 awarded by The Children's Trust, under this Contract or otherwise for legal fees, or
any legal or other such actions, including, but not limited to, active investigations that Provider is a party or witness.
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 documents to
maintain tax-exempt status and payment of payroll taxes, as applicable, throughout the term of the Contract and
any such renewals thereof.
Provider further agrees to maintain a current listing of its agency, program(s) and site(s) in the HELPPages resource
directory available online and used by 211, Miami-Dade County's health and human services information and referral
helpline, managed by Jewish Community Services of South Florida, Inc.
E. INDEMNIFICATION BY PROVIDER
1. Government Entity
Subject to the limitations set forth in section 768.28, Florida Statutes, both parties agree to be fully responsible for
their own acts of negligence, or their agents' negligence when acting within the scope of their employment, and
agree to be liable for any damages resulting from said negligence. Nothing herein is intended to serve as a waiver of
sovereign immunity to any party to which sovereign immunity may be applicable. Nothing herein shall be
construed as consent by a state agency or political subdivision of the State of Florida to be sued by third parties in
any matter arising out of any agreement, as defined in section 768.28, Florida Statutes.
2. All Other Providers
Provider shall indemnify, defend, and hold harmless The Children's Trust and its officers, employees, agents and
instrumentalities from any and all liability, losses or damages, including reasonable attorney 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 matters arising from The Children's Trust's negligence, willful or wanton acts or omissions.
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 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 and
agents.
The provisions of this section on indemnification shall survive the expiration or termination of this Contract
F. INTELLECTUAL PROPERTY AND RIGHT TO DEVELOPED MATERIALS
Where funding from this Contract is used to produce original or non-minor alterations and/or enhancements to
software designs or methods or techniques, writing, data, sound recordings, pictorial reproductions, drawings or
other graphic representations and works of similar nature (hereinafter "developed materials"), legal title and every
right, interest, claim or demand of any kind in and to any copyright, trademark or patent, or application for the
same, in such developed materials will vest in Provider. Notwithstanding the foregoing, Provider agrees to grant The
Children's Trust a worldwide, perpetual, royalty-free and non-exclusive license, for The Children's Trust to use,
duplicate and/or disclose such developed materials, in whole or in part, to others acting on behalf of The Children's
Trust, and other providers funded by The Children's Trust, provided that such use, duplication, or disclosure does not
compromise the validity of any developed materials or any copyright, trademark or patent rights thereto. Such
license shall not extend to scientific publications. In the event of a dispute, both parties agree to participate in
meditation to resolve the matter.
G. INTELLECTUAL PROPERTY LICENSING FEES AND COSTS
If Provider incorporates Intellectual Property, third party software, to provide Services required under this Contract,
Provider is solely responsible for payment of required licensing fees and costs. Such licensing should be in the exclusive
name of Provider.
H. PUBLIC RECORDS
For purposes of this section, the term "public records" shall mean all documents, papers, letters, electronic
communications, maps, books, tapes, photographs, films and video recordings, 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.
Pursuant to section 119.0701, Florida Statutes, if the Provider meets the definition of "Contractor" as defined in
Section 119.0701(1)(a), the Provider shall:
1. Keep and maintain public records required by The Children's Trust to perform the services under this
- Contract.
2. 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 Chapter 119, Florida Statutes, or as otherwise provided by
law.
3. Ensure that public records that are exempt and/or confidential 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.
4. Upon completion of the Contract, transfer, at no cost, to The Children's Trust all public records in possession
of Provider or keep and maintain public records required by The Children's Trust to perform the service. If
Provider transfers all public records to The Children's Trust upon completion of the Contract, Provider shall
destroy any duplicate public records that are exempt and/or confidential from public records disclosure
requirements. If Provider keeps and maintains public records upon completion of the Contract, Provider shall
meet all applicable requirements for retaining public records. 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.
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 Provider does not comply with the public records requirements set forth in Chapter 119, Florida Statutes, and
Section H of this Contract, The Children's Trust may avail itself of the remedies set forth in Sections I: Breach of
Contract and Remedies and J: Termination By Either Party of this Contract. Additionally, a Provider who fails to
provide the public records as required by law within a reasonable amount of time may be subject to penalties under
section 119.10, Florida Statutes.
I. BREACH OF CONTRACT AND REMEDIES
1. Breach
A material breach by Provider shall have occurred under this Contract as specified in other Sections of this Contract,
and also if Provider, through action or omission, causes any of the following:
a. Fails to comply with Background Screening, as required under this Contract or applicable law.
b. Fails to provide the Services outlined in the Scope of Services, Attachment A, within the effective term of
this Contract and to the satisfaction of the Children's Trust.
c. Fails to correct an imminent safety concern or take acceptable corrective action, as determined by The
Children's Trust.
d. Improperly uses The Children's Trust's funds allocated under this Contract as defined in Attachment B:
Other Fiscal Requirements, Budget and Method of Payment and/or Attachment A: Scope of Services.
e. Fails to furnish or maintain the certificates of insurance required by this Contract or as determined by The
Children's Trust.
f. Fails to 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, including, but not limited to, budgets, invoices and amendments in SAMIS or any other
format prescribed by The Children's Trust.
h. Fails to 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 site visit/observation, 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 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 0: Records, Reports, Audits and Monitoring and Attachment D: Program-
Specific Audit Requirements 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) calendar days after Provider's fiscal year end.
r. Fails to notify The Children's Trust within thirty (30) calendar 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.
s. Fails to comply with Section T: Regulatory Compliance, #9: Mandatory Disclosure.
The Children's Trust's decision not to enforce a breach of any of the provisions of this Contract does not entail waiver
of such breach unless expressly provided in writing by The Children's Trust. Additionally, waiver 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) calendar 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), 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 and specifying its effective date, at least five (5) business days before said
date. On the effective date of suspension, Provider may, at risk of nonpayment from The Children's Trust,
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 at the sole discretion of The Children's Trust,
verified requests for payment for Services that were performed and/or for deliverables that were
substantially completed prior to the effective date of such suspension shall be rendered. 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 (5) business days before the
effective date of such suspension. In this 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 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 and
reports prepared and secured by Provider with Trust funds under this Contract, subject to the rights of
Provider as provided in Sections F: Intellectual Property and Rights to Developed Materials and G:
Intellectual Property Licensing Fees and Costs; (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 (5) 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 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 fees, costs and any judgments entered by
a court of appropriate jurisdiction, including all direct and indirect costs and reasonable attorney fees
through conclusion of all appellate proceedings, and including any final settlement or judgment.
J. TERMINATION OF THE CONTRACT
The Parties agree that this Contract may be terminated by either party with written notice to the other party of intent to
terminate at least thirty (30) calendar days prior to the effective date of such termination. Notwithstanding any other
provision in this Contract, in the event The Children's Trust determines that Provider engaged in fraud, misrepresentation
or material misstatement, or that it is in the best interest of The Children's Trust to terminate this Contract, The Children's
Trust may do so by giving written notice to Provider of such termination and specifying the effective date thereof at least
twenty-four (24) hours before the effective date of termination. The provisions of Section G: Intellectual Property
Licensing Fees and Costs and Section 0: Records, Reports, Audits and Monitoring shall survive the expiration or
termination of this Contract.
K. INSURANCE REQUIREMENTS
All Providers, Except State Agencies or Subdivisions
Upon execution of this Contract, or on the date commencing the effective term of this Contract, whichever is earlier,
Provider's insurance agent(s) shall submit the following, as may be applicable, to insurance@thechildrenstrust.org:
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.
Provider's failure to comply with this section 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. Workers' compensation insurance covering all employees, non-incorporated independent contractors or
consultants, and incorporated independent contractors or consultants that do not have workers' compensation
coverage or a valid state of Florida exemption on file with the Department of Labor, as required by Florida Statutes,
Chapter 440. Provider must notify The Children's Trust and provide the necessary certificate of insurance upon the
termination of the exemption. In the event that the Provider is no longer exempt from obtaining workers'
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 a minimum of
$500,000.00/$500,000.00/$500,000.00.
2. Comprehensive general liability insurance, which shall include a rider or separate policy for sexual molestation
liability, in an amount not less than $500,000.00 combined single limit per occurrence and $1,000,000.00
aggregate in a policy year. 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 its
employees and/or subcontractors and transportation companies transporting program participants. The
amount of coverage is $1,000,000.00 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 respect
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 its
employees and/or subcontractors not transporting program participants. The minimum amount of coverage is
$300,000.00 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 Its Interests May Appear" with respect 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 Interests 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 $250,000.00 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. 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. If applicable, cyber security insurance with coverage amounts determined by The Children's Trust, but not less
than $1,000,000.00 for the effective term of the Contract and any renewals.
8. Proof of property coverage is required for all capital equipment greater than or equal to$10,000.00, 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.
9. All required coverages may be afforded via commercial insurance, self-insurance, a captive or some combination
thereof.
Certificate Holder
Certificate holder must read:
The Children's Trust
3150 SW 3rd Avenue, 8th Floor
Miami, FL 33129
Classification and Rating
If the coverage will be provided via commercial insurance, all required policies listed above shall be issued by
companies authorized to do business under the laws of the state of Florida, with the following qualifications:
1. 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.
2. 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) calendar days prior to the effective date of making any material changes
to the insurance coverage except for 10 (ten) calendar 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.
3. 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 must be approved, in
writing, by The Children's Trust prior to any such decrease, waiver or modification.
4. In the event that an insurance policy is canceled, lapses or expires during the effective period of this
Contract, The Children's Trust shall withhold all payments to Provider until a new certificate of insurance, as
required under this Contract, 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 the required certificate of insurance within thirty (30) calendar days of cancellation, lapse or
expiration. Failure to provide said certificate of insurance will be considered a material breach of the
Contract, which may result in The Children's Trust waiving payment or terminating the Contract.
5. 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.
Insurance Requirements for State of Florida Agencies or Political Subdivisions
As an agency or political subdivision of the State of Florida, Provider agrees it is subject to the express provisions and
limitations of section 768.28, Florida Statutes.
L. PROOF OF TAX STATUS
Provider is required to keep and have the following documentation readily available for review by The Children's Trust:
1. An Internal Revenue Service (IRS) tax status determination letter, if applicable.
2. The two (2) most recent IRS form 990 or applicable tax return filing within six (6) months of the end of Provider's
fiscal year or other appropriate filing period permitted by law.
3. IRS form 941: employer's quarterly federal tax return. If required by The Children's Trust, Provider agrees to
submit form 941 within the timeframe established by IRS Publication 15, and if applicable, all 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.
M. NOTICES
Written notices pursuant to this Contract shall be sent via electronic mail or postal mail 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. Notices to
Provider shall be marked to the authorized official identified on page 1 of this contract. Each party is responsible for
advising the other party, in writing, of any changes to responsible personnel for accepting notices under this Contract,
electronic address, mailing address, and/or telephone number.
N. 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.
O. RECORDS, REPORTS, AUDITS AND MONITORING
1. Accounting Records
Provider shall keep accounting records that conform to generally accepted accounting principles (GAAP). In addition to any
requirements for retaining records pursuant to Section H, Public Records, all such records will be retained by Provider for
not less than five (5) 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) calendar days from the close of its fiscal year, Provider's independent certified public
accounting firm (CPA) must electronically submit to The Children's Trust all the following documents, 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
Related Matters Identified in an Audit."
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 "Uniform Administrative Requirements, Cost Principles, and
Audit Requirements for Federal Awards" or the Florida Single Audit Act, Florida Statutes 215.97, if applicable.
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.
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)calendar days after the close of Provider's
fiscal year.
If Provider is required to have a Single Audit, it agrees to have its 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 one hundred eighty (180) calendar days of the close of its fiscal year, Provider is required to provide a Program-
Specific Audit related to the Contract to The Children's Trust, 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. Audits Submission Method
The Provider's CPA firm must transmit Provider's annual financial statement audit and the required Program-Specific Audit
related to the Contract to The Children's Trust, within the timeframe specified above in Section 0, subsections 2 and 3, via
electronic mail or through another online system identified by The Trust, unless otherwise previously agreed upon, in
writing, by the Trust and Provider.
5. 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) calendar 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 deemed by The Children's
Trust.
6. Engagement Letters
Audit engagement letters are due to The Children's Trust thirty (30) calendar days after the end of Provider's fiscal year.
Provider agrees to submit an audit engagement letter electronically to engagementletters@thechildrenstrust.org,. Failure to
submit an audit engagement letter may result in a breach of Contract, or other remedy, as deemed appropriate by The
Children's Trust.
7. 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 CPA firms, which are posted on The Children's Trust's 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.
8. Access to Records
Provider shall permit access to all records, including subcontractor records, as per the Supporting Documentation
Requirements in Attachment B: Other Fiscal Requirements, Budget and Method of Payment, which relate to this
Contract at its place of business during regular business hours at a date and time mutually agreed upon by Provider and
The Children's Trust.
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.
9. Program Metrics
Provider agrees to permit The Children's Trust personnel or The Children's Trust contracted agents/consultants to perform
random scheduled and/or unscheduled site visits, reviews and evaluations of the program which is the subject of this
Contract, including any subcontracts under this 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 sole discretion of The
Children's Trust. Program Metrics reports, which provides real time data can be accessed through Trust Central.
Administrative or Fiscal findings will be discussed with Provider and, in accordance with specifications provided by The
Children's Trust, Provider will remedy all deficiencies cited in the report from Trust Central as described in Section I:
Breach of Contract and Remedies.
To the extent permitted by law, school-based health Providers shall permit public health authorities and health oversight
agency (ies), that are charged with supervising health services program in schools, to conduct oversight and regulatory
activities authorized by law.
10. Client Records
School-based Health Providers only
School Health Programs are comprehensive services and shall be provided to in accordance with section 381.0056, Florida
Statutes. Provider agrees and shall require all sub-contractors to comply with all applicable state and federal privacy and
confidentiality laws, as relevant to the services provided under this contract.
The Florida Department of Health is statutorily authorized to review school health records of all students enrolled in the
public-school system, regardless of the form in which these records are kept, at all reasonable times for as long as records
are retained and in accordance with applicable law.
All other Providers
Provider shall make available to The Children's Trust expects all required information, as provided in Attachment A:
Scope of Services and Attachment C: Data Requirements and Program Metrics, to be entered directly in the
electronic data reporting system. If the Provider chooses to maintain physical records for participants, Provider agrees to
comply with all applicable state and federal laws on privacy and confidentiality.
All Providers
Safeguards of Electronic Protected Health Information (ePHI)
The Children's Trust and Provider agree to use appropriate safeguards to prevent use or disclosure of protected health
information (PHI), covered under Health Insurance Portability and Accountability Act of 1996 (HIPAA) security regulations,
that is produced, saved, transferred or received in an electronic form. The parties shall maintain a comprehensive written
information security program that includes administrative, technical, and physical safeguards appropriate to the size and
complexity of their respective operations. Provider maintains that it will use appropriate safeguards to protect the
confidentiality, integrity, and availability of the PHI and ePHI that are created, received, maintained, or transmitted.
11. Internal Documentation/Records Retention
Provider agrees to maintain and, upon request of The Children's Trust, provide for inspection by The Children's Trust during
regular business hours the following, as may be applicable and 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; (2) authorized time sheets, records and attendance sheets to document the staff
time billed to provide Services pursuant to this Contract; (3) daily activity logs and monthly calendars of the provision of
Services pursuant to this Contract; (4) training modules; (5) pre- and post-session questionnaires; (6) all participant
attendance records; (7) participant consent and information release forms; (8) agency policies and procedures; and (9)
such other information related to Services provision as described in Attachment A: Scope of Services and as required
by this Contract. In addition to any requirements for retaining records pursuant to Section H, Public Records, Provider shall
retain all records for not less than five (5) 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.
12. 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, comply with applicable federal and state
laws on confidentiality, and engage in measures to prevent unauthorized use, dissemination or publication of confidential
information regardless of the source of such information. Any information determined to be confidential must be clearly
marked as such. The Parties shall not disclose 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. In any event, Provider shall be responsible for defending its claim that any information submitted to The
Children's Trust is confidential, trade secret, or otherwise exempt from inspection and copying under Florida's Public
Records Law, including, but not limited to, defending or indemnifying The Children's Trust in the event that a claim or case
is brought against The Children's Trust, subject to the limitations set forth in section 768.28, Florida Statutes. Provider shall
specifically require all subcontractors to comply with this paragraph. The confidentiality provision of this Contract shall
remain in full force and effect after the termination of this Contract.
13. Data Security Obligation
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 Sensitive Personal Identifiable Information (Sensitive
PII) or Personal Identifiable Information (PII).
Sensitive PII is defined as 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.
PII is defined as Sensitive PII 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, PII 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.
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 Sensitive PII or PII, and shall be responsible for the unauthorized collection,
receipt, transmission, access, storage, disposal, use and disclosure of Sensitive PII or PII under its control or in its
possession. Furthermore, Provider shall be responsible for the actions and omissions of all Authorized Persons concerning
the treatment of such Sensitive PII or PII as if they were Provider's own actions and omissions.
Authorized Persons is defined as (i) Provider's employees who have a need to know or otherwise access PII to enable
Provider to perform its obligations under this Contract. ; or (ii) Provider's subcontractors approved by The Children's Trust
who have a need to know or otherwise access PII to enable Provider to perform its obligations under this Contract, and who
are bound in writing by confidentiality obligations sufficient to protect PII in accordance with the terms and conditions of
this Contract.
2. All data collected on behalf of The Children's Trust is deemed to be property of The Children's Trust and is not
property of Provider.
3. In recognition of the foregoing, Provider agrees and covenants that it shall:
a. Keep and maintain all such Sensitive PII or PII strictly confidential.
b. Use and disclose Sensitive PII or PII solely and exclusively for the purposes for which the Sensitive
PII or PII, or access to it, is provided pursuant to the terms and conditions of this Contract, and
shall not divulge, communicate, use, sell, rent, transfer, distribute, or otherwise disclose or make
available Sensitive PII or PII for Provider's own purposes or for the benefit of anyone other than The
Children's Trust, without The Children's Trust's prior written consent, which may be withheld in The
Children's Trust's sole and absolute discretion.
c. Not, directly or indirectly, disclose Sensitive PI1 or PII to an Unauthorized Third Party, without
express written consent from The Children's Trust, which may be withheld in its sole and absolute
discretion. An Unauthorized Third Party is any person other than an Authorized Person. If any
person or authority makes a demand on Provider purporting to legally compel it to divulge any
Sensitive PII or PII, 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 Sensitive PII or PII; (ii) be responsible to The Children's Trust for
the actions and omissions of such Unauthorized Third Party concerning the treatment of such
Sensitive PII or PII as if they were Provider's own actions and omissions; and (iii) require the
Unauthorized Third Party that has access to Sensitive P11 or PII to execute a written Contract
agreeing to comply with the terms and conditions of this Contract relating to the treatment of
Sensitive PII or PII. Provider shall not divulge such Sensitive PII or PII until The Children's Trust has
concluded not to challenge the demand, has exhausted its challenge, including appeals, if any.
B. Sensitive Personal Identifiable Information or Personal Identifiable Information Security
Provider shall protect and secure data in electronic form containing such Sensitive P11 or PII.
At a minimum, Provider's safeguards for the protection of Sensitive PII or P11 shall include:
1. Encrypting, securing or modifying such Sensitive PII or PII by any method or technology that removes
elements that personally identify an individual or that otherwise renders the information unusable.
2. Limiting access of Sensitive PII or PII to 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; and implementing authentication and access
controls within media, applications, operating systems and equipment.
6. Encrypting Sensitive PII or PII stored on any mobile media.
7. Encrypting Sensitive PII or PII transmitted over public or wireless networks.
8. Implementing appropriate personnel security and integrity procedures and practices, including, but not
limited to, conducting background checks consistent with applicable law, as required by The Children's
Trust from time to time.
9. Providing written copies of appropriate privacy and information security training to Provider's employees, as
required by and to The Children's Trust.
10. Purchasing and maintaining cyber insurance coverage, as The Children's Trust deems necessary in its sole
and absolute discretion.
a. Provider shall dispose, or arrange for the disposal, of customer records that contain
Sensitive PII or PII within its custody or control when the records are no longer
required to be retained pursuant to Sections H and 0. Such disposal shall involve
shredding, erasing or otherwise modifying Sensitive P11 or PII in its control or
possession to make it unreadable or undecipherable.
b. During the term of each Authorized Person's employment by Provider, Provider shall
at all times cause such Authorized Persons 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 Sensitive PII or PII
by any of Provider's officers, directors, partners, principals, employees, agents or
contractors. Upon The Children's Trust's request, Provider shall promptly identify all
Authorized Persons as of the date of such request to The Children's Trust in writing.
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 Sensitive PII or PII; (ii) all network connections including remote
access s and wireless connectivity; (iii) all access control devices, such as (solely by
way of example) firewalls, 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
For purposes of this Contract, "Security Breach" is defined as unauthorized access of data in electronic form containing
Sensitive PII or PII or a breach or alleged breach of this Contract relating to such privacy practices. Good faith access of
Sensitive PII or PII by an employee or agent of the covered entity shall not constitute a breach of security under this
Contract, 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. In the event of a Security Breach, Provider shall:
1. Notify The Children's Trust of a Security Breach immediately, but not later than forty eight (48) hours, after
Provider becomes aware of it by emailing The Children's Trust with a read receipt at
datasecurity@thechildrenstrust.org; and with a copy of such email 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 Security
Breach; and (2) a description of the Sensitive PII or PII that was accessed or reasonably believed to have been
accessed as a part of the Security Breach.
2.To the extent legally permissible, confer with The Children's Trust prior to informing any third party of any Security
Breach related to this Contract. Provider and The Children's Trust shall communicate regarding: (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 regulation, or otherwise; 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.
3. 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 be solely responsible for all costs associated with a Security Breach and The Children's Trust may seek
to recover any costs it expends as a result of such breach from Provider.
14. Withholding of Payment
At the sole discretion of The Children's Trust, payment may be withheld if Provider or Subcontractor fail to comply with the
terms of this Contract. The Children's Trust will only make payment upon satisfactory compliance with the contractual
terms as solely determined by The Children's Trust.
P. 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.
Q. GOVERNING LAW AND 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, to the exclusion of all others, be
submitted to the jurisdiction of the state courts of the Eleventh Judicial Circuit, in and for, Miami-Dade County, Florida.
R. STAFF AND VOLUNTEER BACKGROUND CHECK REQUIREMENTS
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 Florida Department of Children and Families
(DCF), the Florida Department of Juvenile Justice (DJJ) or Miami-Dade County Public Schools (M-DCPS).
In addition:
1. 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.
2. 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.
3. Provider shall maintain Attachment E-1: Affidavit for Level 2 Background Screenings, Attachment E-2:
Child Care Attestation 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.
4. Provider shall ensure that all employees, volunteers and/or subcontractors complete Level 2 background screening
no later than every five (5) years.
Provider is required to review annually, at minimum, the Dru Sjodin National Sex Offender Public Website (NSOPW).
School-based Health Providers only
All school staff members or sub-contracted agency personnel assigned to work at a site where they have access to children
must satisfy Level 2 background screening requirements and comply with all necessary school procedures prior to
commencing services within M-DCPS or doing any work for The Children's Trust related to this contract. Pursuant to
section 1012.32, Florida Statutes, non-instructional school district employees or contractual personnel who are permitted
access on school grounds when students are present, have direct contact with students or have access to or control of
school funds must meet Level 2 background screening requirements.
All of Provider's employees who work in a school must satisfy Level 2 background screening requirements as provided in
section 1012.32, Florida Statutes. All employees who work in a school must inform their employer within 48 hours if
convicted of any disqualifying offenses included in M-DCPS's Employee Manual, while he or she is employed or under
contract in that capacity.
If Provider employs a person, under this contract or with The Children's Trust's funds, to work in a school who does not
satisfy Level 2 background screening requirements, the employee shall be immediately suspended from working in that
capacity. A clearance letter or an identification badge issued by M-DCPS will be accepted as proof that the employee
satisfactorily completed background screening. A copy of said clearance letter or identification badge must be on file for
each employee hired to work within the school setting.
All other Providers
Subject to the provisions, limitations and exceptions of all relevant statutory provisions, including sections 1012.465 and
1012.468, Florida Statutes, 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 for the entire time they are present on the site by a member of Provider's staff who has
satisfactorily completed a Level 2 background screening.
S. CHILDREN WITH DISABILITIES AND THEIR FAMILIES
Provider understands that The Children's Trust expects Provider to comply with all relevant provisions of the Americans
with Disabilities Act and other state, federal or local laws that mandate the accessibility of programs, services and benefits
for persons with disabilities. The Children's Trust also requires Provider implement reasonable programmatic
accommodations to include children with disabilities and their families, whenever possible.
T. REGULATORY COMPLIANCE
1. Nondiscrimination and Civil Rights
Provider shall not discriminate against an employee, volunteer or client of Provider based on an individual's
protected class, 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.
Provider shall have 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.
Additionally, 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 applies to a person
or affiliate who is a Provider, consultant or other direct service provider and who has been placed on the convicted
vendor list following a conviction for a public entity crime. Such person or affiliate may not: (a) submit a bid on a
Contract to provide any goods or services; (b) submit a bid for the construction or repair of a public building or
public work; (c) submit bids on leases of real property; (d) be awarded or perform work as a Provider supplier,
subcontractor or consultant; and (e) transact any business in excess of the threshold amount provided in section
287.017, Florida Statutes, for certain statutorily defined purchases for a period of 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's 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 or Chapter 112, Part III, Florida Statutes, as amended, which are incorporated 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://ethics.miamidade.gov/library/2016-publications-rqo/sec%20 2 11-
1 conflict of interest and code of ethics ordinance jan16.pdf). In addition, Provider agrees to:
• Prohibit members of the Provider's board of directors from directly or indirectly receiving any funds paid by
The Children's Trust to the Provider under this Contract.
• Prohibit members of the Provider's board of directors from voting on matters relating to this Contract which
may result in the board member directly or indirectly receiving funds paid by the Provider under this
Contract.
• Prohibit members of the Provider's board of directors from voting on any matters relating to this Contract if
they are related to the person or entity seeking a benefit as 1) an officer, director, partner, of counsel,
consultant, employee, fiduciary, beneficiary, or 2) a stockholder, bondholder, debtor, or creditor.
• Prohibit employees of the Provider from directly or indirectly receiving any funds paid by The Children's
Trust to the Provider under this Contract, with the exception of the employee's salary and fringe benefits or
portion of the employee's salary and fringe benefits included in Attachment B.
• Maintain a written nepotism and conflict of interest policy that applies to hiring, providing services to
clients, and procuring supplies or equipment.
• Immediately disclose and justify in writing to The Children's Trust any business transactions between the
Provider on one side, and its board member(s) or its staff on the other side, as well as all related-party
transactions with shareholders, partners, officers, directors, or employees of any entity that is doing
business with the Provider that are funded, partially or entirely, under the Contract with The Children's
Trust, or are in any way related to The Children's Trust-funded program.
4. Compliance with Sarbanes-Oxley Act of 2002
Provider shall comply with applicable provisions of the Sarbanes-Oxley Act of 2002, including the following:
a. Provider agrees not to alter, cover up, falsify, or destroy any document that may be relevant to an official
investigation.
b. 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. Incident definitions can be found on the sample incident report form located on The Children's Trust
website.
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
(800.962.2873), as required by Chapters 39 and 415, Florida Statutes, Provider and its employees are mandated to
report any such suspicions.
Provider shall notify the contract manager of any incident as defined within three (3) calendar days after Provider is
informed of such incident. The notification must be in writing and include 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 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) calendar days of the
incident. Provider shall provide written notification to The Children's Trust, within seven (7) calendar 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
involved with service 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 submit written notification to The Children's Trust within seven (7) business days of
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 their policies, including, but not limited to,
confidentiality, incident reporting, sexual harassment, nondiscrimination, equal opportunity and/or affirmative
action, Americans with Disabilities Act, and drug-free workplace.
9. Mandatory Disclosure
Provider shall disclose to The Children's Trust all administrative proceedings, active investigations and legal actions
(collectively referred to as "Actions") that it is a party to or witness related to any program funded by The Children's
Trust. Provider shall notify its assigned Contract Manager within five (5) days of the Provider becoming aware of such
Actions. Failure to comply with this requirement could be deemed a material breach of this Contract, as determined
in the sole discretion of The Children's Trust. Additionally, The Children's Trust, in its sole discretion, will determine
whether such Actions could have an adverse impact on the Provider's ability to deliver the contractual services and
whether to terminate this Contract.
U. 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.
Additionally, prior to taking or using still photographs, digital photographs, motion pictures, television transmissions and/or
videotaped recordings (collectively referred to as "Recordings") of participants, Provider shall ask participants to sign a
voluntary Authorization for PhotographNideo form located on The Children's Trust's website. The form is produced in
English, Spanish and Haitian Creole and shall be made available to Provider. Any refusal of consent must be properly
documented and signed by the parent or legal guardian on the consent form.
V. 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: Data Requirements and Program
Progress Metrics, are 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 Attachments A: Scope of Services and C: Data Requirements and Program Progress Metrics.
W. MARKETING &PUBLICITY
Provider or its contracted departments shall distribute a news release to local news media outlets announcing it has been
awarded funding by The Children's Trust.
Provider shall prominently place a Children's Trust program sign decal on the main entry door or front window of each of its
Trust-funded site locations (unless such placement of signage is specifically prohibited by Provider's lease).
Provider shall display the official Children's Trust logo on the home page of its website (if Provider maintains a website) and
link it to The Children's Trust website (www.thechildrenstrust.org); or, if Provider maintains another page on its website
that displays the names and logos of its funding partners, Provider shall include the official Children's Trust logo on that
page and link it to The Children's Trust website (www.thechildrenstrust.org,). If the funded program is part of a larger
entity, such as a university, the logo may be placed on the web page dedicated to that program on the Provider's website.
Provider shall in addition include the following paragraph, along with the logo, on the web page dedicated to the program
funded by this Contract, or elsewhere on its website (in English/Spanish or English/Haitian Creole or all three languages,
depending upon population served):
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:
El [Provider Program Name] este financiado por The Children's Trust. The Children's Trust es una fuente de
financiacion, creada por los votantes en referendum para mejorar la vida de los ninos y las familias en Miami-Dade.
Kreyol:
Se Children's Trust ki finanse[Pwogram Sa-a]. Children's Trust se yon sous finansman elekte Miyami-Dade to kreye
nan yon referandom. Finansman 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 "[Provider Program Name] is funded in part by The Children's Trust..." OR "El
[Provider Program Name] este financiado en parte por The Children's Trust..." OR "Se Children's Trust ki finance yon
pati nan[Pwogram Sa-a]..."
Provider agrees that all program services, activities and events funded by this Contract shall recognize The Children's Trust
as a funding source in any and all publicity, public relations and marketing efforts/materials created under its control on
behalf of the program.
1. COMMUNICATION WITH MEDIA/NEWS OUTLETS
Provider shall request that all media representatives, when inquiring with Provider about the program services,
activities and events funded by this Contract, recognize The Children's Trust as a funding source.
2. VIDEO
Provider agrees that any video it produces that depicts activities, services and events funded by this Contract shall
include a full-screen graphic at its end recognizing The Children's Trust as a funding source.
3. SOCIAL MEDIA
If Provider or its contracted departments maintains social media accounts, they shall:
a. Post an update on its social media accounts (e.g., Facebook, Twitter, Instagram, etc.) announcing it
has been awarded a funding contract by The Children's Trust, and tag The Children's Trust's profile
on those social media networks. If The Trust does not have a profile on a particular social media
network, the post should link back to www.thechildrenstrust.org,.
b. State it is funded by The Children's Trust on all of its social media networks' 'About" sections.
c. Tag and/or mention The Children's Trust on all posts related to services, activities and events funded
by this Contract.
d. List The Children's Trust's fan page under "Liked by This Page" on its Facebook page (if Provider
maintains a Facebook page).
e. Follow The Children's Trust Twitter account (if Provider maintains a Twitter account).
4. PRINTED MATERIALS
a. Provider or its contracted departments shall ensure that any and all printed materials it creates for
program services, activities and events funded by this Contract, including, but not limited to,
newsletters, news releases, brochures, fliers, advertisements, signs/banners, letters to program
participants and/or their parents/guardians, or any other materials released to the media or general
public, shall state that these program services, activities and events are funded by The Children's
Trust.
b. Further, Provider shall also employ the use of the appropriate Children's Trust logo and/or language
as stated above when recognizing said funding in any and all printed materials.
c. Proofs of all printed material referenced herein must be submitted to The Children's Trust
communications department (communicationscompliance@thechildrenstrust.org) for approval prior
to production/printing and release/distribution.
d. Provider agrees to deliver to The Children's Trust, without charge, at least three (3) copies of any
and all printed materials it creates for program services, activities and events funded by this
Contract.
e. 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 Sections F: Intellectual
Property and Rights to Developed Materials and H: Intellectual Property Licensing Fees
and Costs.
5. TERMINATION OF CONTRACT
Upon termination of this Contract by either party or its expiration and nonrenewal, Provider shall remove all
references to The Children's Trust from its site(s), website, social media accounts, advertisements and promotional
materials, to coincide with the effective date of such termination or expiration.
X. MISCELLANEOUS
1. 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.
2. NO THIRD PARTIES
There are no intended or unintended third party beneficiaries to this Contract.
Y.JOINT PREPARATION
The parties hereto acknowledge that they have sought and received whatever competent advice and counsel as was
necessary for them to form a full and complete understanding of all rights and obligations herein and that the preparation
of this Contract has been their joint effort. The language agreed to expresses the parties' mutual intent and the resulting
document shall not, solely as a matter of judicial construction, be construed more severely against one of the parties than
the other.
Z. 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: Data Requirements and Program Metrics
Attachment D: Program-Specific Audit Requirements
Attachment E-1: Affidavit for Level 2 Background Screenings, if applicable
Attachment E-2: Child Care Attestation 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: Additional Insurance Requirements, if applicable
Attachment G: Other Matters, if applicable
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.
[REMAINDER OF PAGE INTENTIONALLY BLANK]
Borinquen Health Care Center, Inc. The Children's Trust
MIAMI-DADE COUNTY, FLORIDA
By: By: ei "4—
(signature of Authorized Representative) (signature)
Deborah Gracia James R. Haj,
Chief Medical Officer President and CEO
Date: 5/2/2019 Date: 5/3/2019
Provider Federal ID# 59-1417397
Provider Vendor ID# BORIN692
This Contract is not valid until signed by both Parties.
Attachment A-Scope of Services
School-based Health
GENERAL
AGENCY SIGNER
Deborah Gracia Bohorquez
INITIATIVE
School-based Health
CONTRACT TIM EF RAM E
School Year
PROGRAM NAME
Borinquen School Health
PROGRAM DESCRIPTION
The school health program provides comprehensive and coordinated on-site health services- including first aid, nursing
assessment and counseling -to public school children. Staffed by registered nurses, licensed practical nurses, social
workers, health aide/medical assistance and mental health professionals. The teams work collaboratively to identify,
prevent, or remedy students' physical and behavioral health problems, as well as provide linkage to appropriate
community care. The program goal is to promote a healthy school environment that is conducive to student wellbeing,
fosters positive behavior, and supports higher academic achievement. Borinquen Health Care Center is operating 31 sites
in Central Miami-Dade County.
SITES
r
Site Name MD PA ! ARNP MSN BSN RN ; LPN LCSW HA MHP
` I -1
Fienberg/Fisher K-8 Center i 0.00 0.00 0.00 0.00 0.00 0.20 1.00 0.50 0.00 ! 0.00
1420 Washington Ave.
Miami Beach 33139
Miami Beach Senior High School 0.00 0.00 1.00 0.00 1.00 0.00 1.00 0.00 0.40 • 0.00 I
2231 Prairie Ave. •
Miami Beach 33139
Nautilus Middle School 0.00 0.00 0.00 0.00 ; 0.00 1.00 I 0.00 0.50 0.30 0.00
4301 N. Michigan Ave.
� I '
Miami Beach 33140
North Beach Elementary School ! 0.00 10.00 0.00 ; 0.00 0.00 ' 0.20 1.00 0.00 0.30 0.00
4100 Prairie Ave.
Miami Beach 33140
Ruth K. Broad/Bay Harbor K-8 Center 0.00 i 0.00 0.00 0.00 0.00 1.00 0.00 0.00 0.60 0.00
115593rd St. j
Bay Harbor Islands 33154
South Pointe Elementary School 0.00 ! 0.00 0.00 0.00 0.00 0.20 1.00 0.00 0.00 j 0.00
1050 4th St.
Miami Beach 33139
Treasure Island Elementary School ; 0.00 0.00 10.00 0.00 0.00 0.20 1.00 0.00 0.00 ' 0.00
7540 E. Treasure Dr.
, North Bay Village 33141
Coral Gables Senior High School 0.00 0.00 0.00 0.00 1.00 0.00 1.00 0.50 0.20 : 0.00
' 450 Bird Rd.
Coral Gables 33146
- -' - ----- -- --- - ---- ---,- ---r--- �- -- - - '-`--- -- -,- --�- -- '-' -:
. Biscayne Elementary School | 0.00 ! 0.00 � 0.00 0.00 � 0.00 0.20 | 1.00 0.00 0.00 0.00
1 � � ` ! ' � !
800St. |
77th � ! '
! Miami Beach 3sz4z | | | | !
, -_ - � _
| Coconut Grove Elementary School ! 0.00 O�O0 O.00 ' 0.00 0.00 0.20 1.00 / 0.50 | 0.0
o '� 0.00
! -
|!!
| 335lMatilda St.
| � | \ | �
Miami 33133 ` | ' i
� ` . |
_ ____- -____-'-~-__- _-_- __-_--~-__ - __
�� �� i l / |
|
Fra S. Tucker Elementary School / 0.Oo O.O0 / O.00 | o�no O.U0 O.�O � z�nu 0.50 � 0.00 0.00
| '
| 35OOoougla /sRd� ) )| �`��mias�ss �
! | � | | `
| Georgew�sh|ngtonCarverBeme�arySchmd ! n�oO O.O0 n.uu 0.00 O.On . �.on | o.00 ' 0.50 i 0.00 0.00
| � ! / i
Z38Grand / . �
1 Ave.e- !
/ Coral Gables 33133 I
Ponce De Leon Middle School ' 0.00 0.00 0.00 0.00 1.00 0.20 1.00 0.00 0.00 0.00
: 5801 Augusto St.
i Coral Gables 33146
I Silver Bluff Elementary School 0.00 0.00 0.00 0.00 0.00 0.20 1.00 0.00 0.00 0.00
Miami 33133 ,
Sunset Elementary School 0.00 0.00 0.00 0.00 0.00 1.00 0.00 0.00 0.10 0.00 :
' 5120 SW 72nd St.
Unincorp Miami-Dade 33143 i
Miami 33127 . .
Miami 33127 ,
Miami 33135 ' '
Unincorp Miami-Dade 33126 , | ' - -
E.W.F. Stirrup Elementary School 0.00 | 0.00 0.00 ' 0.00 0.00 / 0.10 1.00 0.50 ' 0.00 0.00
/ | ' i |
97thssowvvAve. � | . � i
'
Unincorp Miami-Dade 33172 { . / !
�- _--_- _'- -__ -_ '---__-- ___-_---_-- - ��___'^'_ � _- -_ ^__ _�_-_-.__
Ruben
/! oahoMiddleSchoo 0.00 i 0.00 �| 0.00 n.nO 0.00 0.20 1.00 i 0.000.00 0.00
350 NW 97th Ave. ' |!
UnincorpMiami-Dade 33172 . �
-'-- ----------- '- -�' --'- - -- --1- --.--- -� --� - -''- -r- �- ---�- ' -
Palm Springs Middle Schoo0.00 0.00 0.00 0.00 0.00 | l.00 / O�0O 0.50! 0.40 0.00
1025 W. 56th St. '
�
Hialeah ]3ol3
!
- '__-__- -_-- .i__-___--^_
Santa Clara Elementary School � 0.00 | 0.00 0.00 � 0.00 / 0.00 | 0.20 / 1.00 0.00 0.00 I.00
� . ' |
, 1051 mW2�hTern ' ! /
Miami � i | ! ' � / | |
/ i | � / / � •
`
Holmes Elementary School 0.00 0.00 . 0.00 i0.00 ' 0.00 0.10 1.00 0.00 0.00 1.00
)
1I75 NW 67tSt.
Miami 33150
Lenora Braynon Smith Elementary School 0.00 0.00 0.00 0.00 0.00 0.20 1.00 0.00 0.00 1.00
, 4700 NW 12th Ave.
; Miami 33127
Liberty City Elementary School 0.00 0.00 0.00 0.00 0.00 0.10 1.00 0.00 0.00 1.00
1855 NW 71st St.
Unincorp Miami-Dade 33147
Riverside Elementary School 0.00 0.00 0.00 0.00 0.00 , 0.20 1.00 0.00 0.70 1.00
1190 SW 2nd St.
Miami 33130
Comstock Elementary School 0.00 0.00 0.00 0.00 0.00 0.10 1.00 0.00 0.00 1.00
2420 NW 18th Ave.
Miami 33142
Riviera Middle School 0.00 0.00 0.00 0.00 0.00 1.00 0.00 0.00 0.00 0.00
10301 SW 48th St.
Unincorp Miami-Dade 33165
Rockway Middle School 0.00 0.00 0.00 0.00 0.00 0.20 1.00 0.00 0.00 0.00
9393 SW 29th Terr.
Unincorp Miami-Dade 33165
Tropical Elementary School 0.00 0.00 0.00 0.00 ; 0.00 0.10 1.00 0.00 0.00 0.00
4545 SW 104th Ave.
, Unincorp Miami-Dade 33165
STAFFING TABLE
.-- ----- ---' - '---- - - -' - ---- ------ -.�- ..-- - - - - - - - -' -'-- --'---- - -
'-- ---' �---- -----T - --- - --'---�-----------'--' --- --------- -- -------
Position
Status:
Classiciation,
Positionnoinim�m In Ratio,
/ ` |
lDmefnamuo(s) Position Title | Qualifications ` Related Program Responsibilities i Supervision
�---'------- -- ---- -/-------------�----' -------- ------- -'--------+ -----'-- '1
School Year . \ Current licensure by Provides direct nursing care, primary care services, Classification: .
ANRPsusun � s�teboards or | and � Full-Time
! '
Category: ARNP / Professional included in the position job description. ) In ratio:
Positions:1# of { Regulation and } Position ma�hedatInn96 ' Y�s
(
Education, with ' Superv�ion:
(
. | current CPR/ First Aid | NO
! '
Certification.
� ! � ! � |
School Year Master's degree in Provides behavioral health services and prevention Classification:
LCSW 38574 psychology, social activities- per program model and assigned duties Full-Time
Category: work, marriage and ! included in the position job description. ; In ratio:
Mental family therapy, ; YES
Health/Social ; mental health Supervision:
Services counseling or related NO
Professional ;field.
# of Positions:1
School Year Current licensure by Assists registered nurses in the provision of direct Classification:
LPN (POOLED) state boards of nursing care and health prevention activities per Full-Time
38531 ; Professional assigned duties included in the position job In ratio:
Category: Regulation and description. YES
LPN/Medical Education, with a Supervision:
Assistant/Health ! current CPR/First Aid NO
Aid Certification.
# of
Positions:23
School Year Current licensure by ' Assists registered nurses in the provision of direct Classification:
LPN 38586 state boards of ; nursing care and health prevention activities per Full Time
Category: Professional assigned duties included in the position job In ratio:
LPN/Medical Regulation and description. YES
Assistant/Health Education, with a Supervision:
Aid current CPR/ First Aid NO
# of Positions:1 ; Certification.
School Year - Current licensure by Assists registered nurses in the provision of direct Classification:
Medical ' state boards of I nursing care and health prevention activities per Full Time
Assistant 38535 Professional ' assigned duties included in the position job In ratio:
Category: Regulation and description. YES
LPN/Medical Education, with a Supervision:
Assistant/Health current CPR/ First Aid NO
Aid Certification.
# of Positions:1
School Year A high school ' Performs other duties related to program delivery. ! Classification:
Program diploma or General ; May be responsible for a variety of assignments such Full Time
Assistant 38579 I Equivalency Diploma as bus driver, cook, and maintenance worker, etc. In ratio:
Category: (GED). ! YES
Support Staff Supervision:
# of Positions:1 NO
School Year Current licensure by Provides direct nursing care and health prevention ; Classification:
Registered state boards of activities per assigned duties included in the position Full-Time
Nurse Manager Professional job description. In ratio:
38577 Regulation and 1 RN staff is a BSN YES
Category: Education, with a Supervision:
Registered current CPR/First Aid YES
Nurse Certification. A
# of Positions:1 i bachelor of science
in nursing (BSN) is
required for nurses
assigned to high
schools.
School Year Current licensure by Provides direct nursing care and health prevention I Classification:
RN (POOLED) state boards of activities per assigned duties included in the position Full Time
38536 j Professional job description. In ratio:
Category: Regulation and 2 RN staff are BSN YES
• Registered Education, with a ; Supervision:
Nurse current CPR/ First Aid i NO
# of Positions:5 Certification. A
bachelor of science
in nursing (BSN) is
required for nurses
I t assigned to high
schools.
School Year Current licensure by Provides direct nursing care and health prevention Classification:
RN (POOLED) state boards of ! activities per assigned duties included in the position Full Time
38572 Professional job description. In ratio:
Category: Regulation and i 1 RN staff is a BSN (provides .60 coverage at 1 site) YES
Registered Education, with a Supervision:
Nurse current CPR/ First Aid NO
# of Positions:5 ; Certification. A
bachelor of science
in nursing (BSN) is
required for nurses
assigned to high
schools.
School Year Current licensure by Provides direct nursing care and health prevention Classification:
RN 38537 state boards of ; activities per assigned duties included in the position Full-Time
Category: Professional job description. In ratio:
Registered Regulation and 1 RN staff is a BSN YES
Nurse Education, with a j Supervision:
# of Positions:1 current CPR/ First Aid NO
Certification. A
bachelor of science
in nursing (BSN) is
required for nurses
assigned to high
schools.
School Year Current licensure by Provides direct nursing care and health prevention Classification:
RN 38573 state boards of activities per assigned duties included in the position Full Time
Category: Professional job description. In ratio:
r i
Registered , Regulation and YES
Nurse Education, with a Supervision:
# of Positions:1 current CPR/First Aid NO
Certification. A i I
bachelor of science
in nursing (BSN) is
required for nurses
assigned to high
schools.
i i
•
School Year ' Current licensure by Provides direct nursing care and health prevention Classification:
RN 38703 ' state boards of activities per assigned duties included in the position i Full Time
Category: l Professional job description. ! In ratio:
I f Registered Regulation and YES
j = Nurse ; Education, with a Supervision:
#of Positions:1 current CPR/First Aid NO
IJ ! Certification. A 1 j
! ! bachelor of science
{ in nursing (BSN) is
required for nurses ;• i
assigned to high
schools. I I
School Year Current licensure by Provides direct nursing care and health prevention ! Classification:
RN 38704 state boards of activities per assigned duties included in the position Full Time
Category: Professional job description. In ratio:
Registered Regulation and i 1 RN staff is a BSN j YES
Nurse j Education, with a Supervision:
II # of Positions:1 j current CPR/First Aid ; ! NO
Certification. A
bachelor of science
in nursing (BSN) is
required for nurses
assigned to high •
(' I
schools.
School Year I Master's degree in I Provides behavioral health services and prevention Classification:
MSW (POOLED) psychology, social I activities- per program model and assigned duties Full-Time
38533 work, marriage and ! included in the position job description. In ratio:
Category: family therapy, 14 MSW staff provide mental health and behavioral YES
Mental mental health I health services Supervision:
Health/Social counseling or related 4 MSW staff provide school social work services NO
f f
Services field.
Professional i 1
# of Positions:8
School Year � Bachelor Degree or Provides direction for the program's day to day Classification:
School Program j equivalent ! operations, supervision, direction and guidance for Full Time
Coordinator ! experience in I staff, assures implementation of evidence based In ratio:
38578 program curriculum or program protocols with fidelity. i YES
! I Category: management. Supervision:
Program I YES
I I Management
# of Positions:1
School Year AA/AS degree Provides Technical guidance and support to staff in Classification:
IT TECHNICIAN required. BS/BA I operation of automated practice management Full-Time
38581 degree preferred or i systems and financial management systems, In ratio:
Category: Other equivalent work including problem resolution. Plans, coordinates and YES
#of Positions:1 experience. A+ oversees technical support for telecommunications Supervision:
certification required. network(equipment, software, etc.)Manage and I NO
3 to 5 years maintain network infrastructure. Install/Configure and
experience in IT or support computer and printer hardware. Oversees
Help Desk equipment inventory, repair, replace and advises in
environment. purchasing in order to achieve maximum economies
of scale.
School Year Master's degree in Provides behavioral health services and prevention Classification:
LCSW 38576 psychology, social activities- per program model and assigned duties Full Time
Category: j work, marriage and included in the position job description. Provides In ratio:
Mental family therapy, guidance and monitors SW/MHP staff. YES
Health/Social mental health ! Supervision:
Services counseling or related ° YES
Professional field.
# of Positions:1
School Year Master's degree in ! Provides behavioral health services and prevention Classification:
LCSW 38575 psychology, social activities- per program model and assigned duties Full Time
Category: work, marriage and included in the position job description. ; In ratio:
Mental family therapy, YES
Health/Social mental health ! Supervision:
Services counseling or related NO
Professional field.
# of Positions:1
School Year Master's degree in Provides behavioral health services and prevention Classification:
LCSW 38584 j psychology, social activities- per program model and assigned duties Full Time
Category: j work, marriage and included in the position job description. In ratio:
Mental family therapy, j YES
Health/Social ; mental health Supervision:
+ ! Services counseling or related ; NO
Professional field.
# of Positions:1
School Year Current licensure by Assists registered nurses in the provision of direct Classification:
Medical state boards of nursing care and health prevention activities per Full Time
Assistant 38700 Professional assigned duties included in the position job In ratio:
Category: Regulation and ! description. YES
LPN/Medical Education, with a Position matched at 100% Supervision:
Assistant/Health ; current CPR/First Aid NO
Aid Certification. I
# of Positions:1
School Year , Current licensure by Assists registered nurses in the provision of direct Classification:
Medical state boards of nursing care and health prevention activities per Full-Time
Assistant 38701 Professional assigned duties included in the position job j In ratio:
Category: ; Regulation and description. YES
LPN/Medical Education, with a Position matched at 100% Supervision:
Assistant/Health i current CPR/First Aid NO
Aid ; Certification.
# of Positions:1
I__------------ , ---- ---- ---- {-- -. ---- -------- _.._�----. -- --- -----_.-___----------------- --------
School Year Current licensure by Provides direct nursing care and health prevention Classification:
RN 40580 ; state boards of activities per assigned duties included in the position Full Time
Category: Professional !job description. In ratio:
Registered Regulation and YES
Nurse Education, with a Supervision:
# of Positions:1 current CPR/ First Aid NO
Certification. A
bachelor of science
in nursing (BSN) is
required for nurses
assigned to high
� I I
schools.
Attachment A-Scope of Services
School Health Program
2. NURSING ACTIVITIES
Activity Description
Grade-level screenings of students are central to identifying health problems that may adversely impact
health and school performance.
• Vision screenings are required for all students in kindergarten (k), 1st, 3rd and 6thgrades and
new to state in grades k through 5th
Grade Level Screenings • Growth and development screenings are required for students in 1st, 3rd 6th and 9th grades.
• Student's growth and development are evaluated with BMI according to current CDC
recommendations. BMI results are graphed and calculated using the student's height, weight,
age or birth date, and gender.
• Oral health screenings are required for all students in 1st, 3rd, and 6thgrades.
Hypertensive Screening Students who are at or above the 95th percentile for BMI must receive a hypertension screening.
Pediculosis/ Provide visual examination of the scalp or skin to screen for head lice or scabies infestation, referral,
Scabies Screening and follow-up services to students, siblings, and classmates.
Developmental/Social/ Perform screenings for developmental, social, emotional and behavioral well-being for early
Emotional/ Behavioral identification and primary prevention of challenges, and to coordinate referrals for timely and
Health Screening and ESE responsive assessment or intervention services needed for at-risk students. Assist with screenings for
Supports Exceptional Student Education (ESE) and attend staffing meetings for students being considered for the
ESE programs.
Complete review and assessment of student records, such as the cumulative health record, emergency
health information, and incoming medications, to determine immunization, health status and identify
Record Review any significant health risks or problems. The record review consists of review of: 1) Florida Certificate of
Immunization DH Form 680; 2)School Entry Physical Examination DH Form 3040; 3) Emergency health
information; and, 4) Health screening information.
Nursing assessments are conducted to identify the health needs and resources of students and their
families. This primary and ongoing process includes health history, observation, physical assessment,
Nursing Assessment and monitoring patient and family reactions, interviewing to ascertain social and emotional stability, and
Counseling identification of risk factors arising from social, physical, or environmental conditions. This assessment
provides the basis for nursing diagnoses and helps to determine the need for an Individualized Health
Care Plan (IHCP).
Medication administration includes the school health program staff member verifying the identity of the
student, the medication, the medication dose, route of administration and time for administration, and
Medication Administration matching these data with the medication order written by the child's physician. It also includes assisting
the student in the ingestion, injection and application or monitoring the self-administration of the
medication, and contacting the child's primary care physician when necessary. The documentation on
the medication log and in the students' health record is considered part of medication administration.
The provision of first aid and/or cardiopulmonary resuscitation (CPR)should include an evaluation of the
First Aid or CPR student's condition, the administration of first aid and/or CPR, and documentation in the student's
health record. Staff members should be currently certified by nationally recognized, certifying agencies
in the administration of first aid and CPR.
Provision of health-related services required by the student to function in the school setting. Complex
Complex Medical medical procedures include but are notlimited to: cardiac monitoring, carbohydrate counting, glucose
Procedures monitoring, oxygen therapy, specimen (urine or blood)collection or testing, nebulizer treatment, and
intervention through administration of emergency medications.
Review and/or follow-up of student Florida Certificates of Immunization to verify that age-appropriate
immunization requirements are current and documented, and assist school's officials with downloading
Immunization Follow-up records as needed through Florida Shots. Students' immunization status must be periodically reviewed
to ascertain if the student is age-appropriately immunized. Targeted groups include, at a minimum: 1)
Newly enrolled students in State; and 2) Students in kindergarten and 7th grade.
School Health Staff Coordinate health services with other school activities and advise and/or assist school personnel,
Consultation parents/guardians and other health care providers in health related matters.
Provide support and guidance to family members; secure parent consents to maximize utilization of the
Family Engagement health suites; ensure participant's families have the opportunity to be actively engaged with the school
health program; and provide regular, ongoing communication to parents and caregivers about the
program and their child's health status
Development, review, or revision of individualized student health care plans (IHCP) by a registered
nurse for students with chronic or acute health problems. These students may need specific
individualized health-related services to maintain their health status, stay in school, and optimize their
educational opportunities, as identified by school health staff. The written IHCP must be followed to
Individualized Health provide services in a safe and efficient manner.
Care Plan (IHCP) The Emergency Action Plan (EAP) is a component of the IHCP. All students who have a life threatening
Emergency Action Plan condition or chronic condition that may result in complications causing serious life altering or life
(EAP) threatening events should have an EAR The plan should always include emergency contact
information, the medical diagnosis and nursing plan of care, individual student information such as
medications, goals, and who is delegated, trained and authorized to provide care in the absence of the
nurse. The EAP should be easy for unlicensed assistive personnel (UAP) or school staff persons to
understand and follow. It should be written so that laypersons can follow student-specific emergency
procedures in case of an emergency.
Obesity Intervention This intervention requires completion of all four of the following components: student-parent
consultation, completion of an IHCP, health counseling and case management.
The provision and documentation of counseling services by a nurse educator concerning identified risk
Health Education factors and behavioral changes to reduce risks. The purpose is to facilitate the voluntary adaptation of
healthy behavior. Some health education topics provided to students, such as human sexuality, are
subject to parental approval.
Oral Health Services Provide oral health risks assessment, education, and counseling and fluoride varnish application to pre-
k and k students and make referrals for further treatments when appropriate.
A planned education session with one or more participants, conducted by an authorized health
Child-Specific Training professional, to provide child-specific training to school personnel performing child-specific health-
related services as specified in the student's IHCP.
Chronic Disease Provide education, management and support of students with chronic conditions. This includes objective
Management assessment and monitoring; physical examination; review of student health history and parent report in
(for Asthma, Diabetes, order to assess the characteristics and severity of the condition and to ensure adequate control is
Severe Allergies and achieved and maintained.
Seizures)
3. SOCIAL WORK ACTIVITIES
Activity Description
Developmental/Social/ Perform screenings for developmental, social, emotional and behavioral well-being for early
Emotional/ Behavioral identification and primary prevention of challenges, and to coordinate referrals for timely and
Health Screening and ESE responsive assessment or intervention services needed for at-risk students. Assist with screenings for
Supports Exceptional Student Education (ESE) and attend staffing meetings for students being considered for the
ESE programs.
Perform assessments such as psychosocial/developmental history, adaptive behavior measurements,
Assessment and classroom observations. Prepare individualized assessments and incorporate parents', students'
and teachers' perspectives and performance objectives into final assessments.
Implement interventions aimed at improving students' behavioral health, social-emotional development,
Intervention and and academic achievement. Provide individual, group and family counseling to address targeted
Counseling Services problems interfering with students' functioning and well-being. Identify obstacles to success while
building on strengths and resiliencies. Offer the opportunity to explore different ways of understanding
and perceiving the environment and facilitate effective ways of coping.
Assist schools in creating and maintaining a safe school environment that promotes learning and the
Crisis Intervention development of cognitive, academic, emotional, and social growth among students. Participate in
reducing risk for vulnerable students by promoting awareness, responding to crises and assisting
schools in reinstating a state of functional safety and security.
4. BEHAVIORAL HEALTH ACTIVITIES
Activity Description
Primary prevention involves schoolwide interventions aimed at decreasing the number of new cases
of problem behaviors. These interventions include the use of effective school-wide disciplinary
School-wide Preventative practices, classroom-wide behavior management strategies, and effective instructional practices.
Services Secondary prevention involves interventions with at-risk students. Interventions at this level include
more focused individual or small group interventions, such as anger management or problem-solving
skills training. Strategies developed should be based on the needs of each individual school.
5. PERFORMANCE MEASURES
Programmatic Performance measures are grouped into measures of quantity, quality and participant outcomes.
Performance accountability at the contract level requires collecting ongoing measures of progress on the quantity and
quality of service efforts and effects.
Targeted Measures:
Performance Performance Statement Goal Measurement Tool Timing Associated
Type Activity
Percentage of BMI screenings ° Program data reported Grade Level
conducted for grades 1, 3, & 6 95/° in school health 12/31 Screenings (BMI)
database
Percentage of students who Program data reported
demonstrate concerns in BMI 100% in school health 12/31 Grade Level
screenings are referred for database Screenings (BMI)
Quality additional services
Percentage of vision screenings ° Program data reported Grade Level
conducted for grades K, 1, 3, & 6 95/° in school health 12/31 Screenings (Vision)
database
Percentage of students who fail Program data reported
the vision screenings are 100% in school health 12/31 Grade Level
referred for comprehensive database Screenings (Vision)
screenings
Percentage of students who
return to class following health 85% School health database ongoing Nursing assessment
suite encounter
Percentage of students who are Immunization
compliant with their age 95% School health database ongoing Follow-
Participant appropriate immunizations up/Administration
Outcomes Percentage of students referred Nursing Notes/Written
for weight-related concerns who 20% documentation from ongoing CompletedBMI
receive services physician referrals
Percentage of students referred Nurse observation/ Completed vision
for vision concerns who receive 50% written documentation ongoing referral
services from vision provider
Additional Measures:
Performance Measure Statement Timing
Type
Quantity Number of students with chronic conditions 12/31
Number of BM! Screenings completed for grade 9 05/31
Number of oral health screenings, risks assessment, and education 05/31
conducted for grades 1, 3, and 6
Number of screenings, risks assessment, education, and fluoride 05/31
varnish applications for grades pre-k and K
Number of Record Reviews completed 05/31
Number of behavioral health screenings conducted 05/31
Number of social histories competed by LCSWs 05/31
Number of weight management counseling sessions completed ongoing
Number of care plans completed for students with asthma, ongoing
diabetes, severe allergies and/ or seizures
Number of health educations completed ongoing
Number of students utilizing the health services ongoing
•
Number of intervention and counseling services by LCSWs ongoing
Number of crisis intervention conducted by LCSWs ongoing
Number of children referred for health insurance benefits ongoing
application
Percentage of parent consents collected ongoing
Percentage of affirmative parent consents collected ongoing
Quality Percentage of child specific trainings conducted for students with ongoing
care plans
Percentage of school staff, students, and parents satisfied with the ongoing
services provided
Percentage of students with weight-related concerns who increase 12/31
physical activity (baseline)
Percentage of students referred for weight-related concerns who 05/31
show improvement on BMI
Percentage of students with care plans (IHCPs)who meet their 05/31
goals
Percentage of students who successfully manage 05/31
their diabetes
Percentage of students with asthma with less than two asthma- 05/31
Participant related emergency room visits during the school year.
Outcomes Percentage of students who engage in preventative oral health 05/31
care (brushing)
Percentage of students referred for oral health concerns who 05/31
receive services
Percentage of students who maintain or improve their knowledge 05/31
of health education topic covered
Percentage of students who demonstrate their knowledge of 05/31
appropriate health behaviors(e.g., hand washing, dental hygiene)
Percentage of students referred for behavioral health concerns 05/31
who receive services
ATTACHMENT B
OTHER FISCAL REQUIREMENTS, BUDGET and METHOD OF PAYMENT
Budget amendments/revisions
Budget amendments/revisions require written approval from the designated Contract Manager and The Children's Trust's
Chief Financial Officer or their designees. Requests for budget amendments/revisions must be submitted to the 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 the Contract.
Once approved, all budget amendments/revisions will be incorporated into the Contract.
Invoice/Request for Payment Requirements
Provider or Seller shall submit an original request for payment, utilizing the format prescribed by The Children's Trust and
in accordance with the approved budget or approved budget revision(s). This format may entail the electronic submission
of a request for payment in the SAMIS system in accordance with the approved budget or budget amendments/revisions,
paper invoice, spreadsheet, or other submission method. The Children's Trust will notify the Provider and/or Seller the
method of submittal. Invoices not submitted in the SAMIS system shall be submitted by the Provider and/or Seller to The
Children's Trust at: accountspayable@thechildrenstrust.org and to the Provider and/or Seller's Trust staff member assigned
to this contract. The invoice must include The Children's Trust's issued Purchase Order (PO) number. Submissions to
accountspayable@thechildrenstrust.org,must contain only the invoice and no additional correspondence. Attachments and
other documentation included with the invoice submitted to accountspayable@thechildrenstrust.org" will render the
invoice as being not properly submitted. 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
and/or Seller on a monthly basis, provided that the Contract utilizes a cost reimbursement method of payment. Any
expense included on an invoice relating to a reimbursement request that pertains to a 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, and the invoices are to be submitted using SAMIS, then Form D: Attestation of
Payment must be uploaded to The Children's Trust's electronic system Document Repository no later than thirty (30) days
after payment to subcontractor. If invoices are submitted using SAMIS, upon the close of this Contract, Provider and/or
Seller is required to complete Form E: Close-out Attestation of Payment, which must be uploaded to The Children's Trust's
electronic system 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 and/or Seller 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 and/or Seller will be accepted by The
Children's Trust up to forty-five (45) days after the expiration of this Contract. If Provider and/or Seller fails to comply, then
all rights to payment shall be forfeited.
If The Children's Trust determines that Provider or Seller has been paid funds, which are not in accordance with this
Contract, and to which it is not entitled, then Provider and/or Seller 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 and/or Seller 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 or Seller, its independent CPA firm or The Children's Trust discovers that an overpayment has
been made, Provider or Seller shall repay the overpayment within thirty (30) calendar days of discovery of the event by the
Provider or Seller or notification of overpayment by the Provider's or Seller's independent CPA firm or The Children's Trust.
If Provider or Seller fails to serve the contracted number of participants and/or fails to utilize the funds in accordance with
the Contract, The Children's Trust may amend the Contract to reduce the amount funded. 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 request for payment will be deemed proper as defined by the Florida Prompt Payment Act, Chapter 218, Part VII, Florida
Statutes, 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 and/or Seller for corrections may
be cause for delay in the receipt of payment. Late submission may result in delay in the receipt of payment. Upon receipt
of Provider's or Seller's properly submitted Request for Payment (i.e., invoice) and/or other required documentation, The
Children's Trust shall pay Provider or Seller in accordance with the Florida Prompt Payment Act.
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.
Indirect Administrative Costs
In no event shall The Children's Trust fund indirect administrative costs in excess of (10%) percent of the total Contract
amount. This includes operational costs that support the performance of programmatic functions but are not directly
incurred as a result of the program (i.e. insurance costs).
Match Requirement $348,100.00
Programs requiring a match, if provided in the respective solicitation, which 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 must be another funding
source other than The Children's Trust.
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 and/or Seller'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 or Seller agree that prior to, on the date commencing
the effective term of this Contract, or when direct deposit functionality is made available, Provider or Seller 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 or Seller's designated bank account held in a United States
financial institution.
Cost Reimbursement Method of Payment
The parties agree that this is a cost reimbursement method of payment Contract. Provider and/or Seller shall be paid in
accordance with the approved budget and/or approved budget amendments/revisions as set forth in this attachment, as
well as based on the actual costs incurred. Provider or Seller will be paid in accordance with the approved budget, typically
after expenses are incurred. Provider and/or Seller also agrees to pay their subcontractors, vendors and employees for the
fulfillment of services provided on a timely basis. The Trust expects that Provider and/or Seller maintain sufficient funds in
the amount of at least 15%of their operating budget. Adequate working capital is considered a best practice and is
necessary when managing a cost reimbursement contract. Provider and/or Seller are expected to possess the funds
necessary to cover initial program expenses, and then request reimbursement from The Trust.
Deliverable-Based Method of Payment
The parties agree that this is a deliverable based Contract, and Provider or Seller will be paid based on acceptance by The
Children's Trust of deliverables as outlined in Attachment A and/or the flat project fee or fee per deliverable as stated in
Attachment B. Provider or Seller will submit required reports and/or deliverables in accordance with the deliverable
schedule set forth in Attachment A or in Attachment B if not included in Attachment A. If Provider or Seller fails to submit
approved deliverables in accordance with the Contract, The Children's Trust may amend the Contract to reduce the
amount of dollars representing the deliverables not provided. Any delay in amendment by The Children's Trust is not
deemed a waiver of The Children's Trust's right to amend or seek reimbursement for deliverables not provided in
accordance with the Contract.
Timely Payment by Provider or Seller
Provider or Seller also agree to timely pay subcontractors, vendors, and employees for the fulfillment of services provided in
this Contract. Every request by Provider or Seller for payment for services provided, work performed, or costs incurred
pursuant to this Contract, except for any advanced payments by The Trust, shall be accompanied by a Request for
Payment from The Children's Trust. If there are subcontractors to this Contract, the 'Attestation of Payment' form must be
included in the Request for Payment.These forms may be downloaded from The Trust's website. For the purpose of
payment only, a subcontractor is defined as an independent agency that has entered into agreement with Provider and/or
Seller to perform services pertaining to The Children's Trust funded programs identified in this Contract.
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 section 216.181(16)(b), Florida Statutes. 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
Upon receipt of an advance, repayment must be credited to proceeding reimbursement requests within sixty (60)
calendar days. Provider or Seller shall report the amount of the advance repayment in The Trust electronic system using
the "advances/adjustments" button on the reimbursement screen. If a Provider or Seller does not use the specified Trust
electronic system, the Provider or Seller is required to deduct its advance repayment from each invoice, consecutively,
until the advance is repaid in full.
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 and/or Seller 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 Government Auditing Standards_and (c) completion of an
annual CPA training session sponsored by The Children's Trust finance department.
Alternatively, Provider or Seller may also receive reimbursement if Provider or Seller is subject to audit by a federal, state or
local Office of Inspector General and such Office of Inspector General conducts an audit and charges Provider or Seller for
said audit services.
Supporting Documentation Requirements
Provider and/or Seller 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 and/or Seller 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 and/or Seller shall maintain a cost allocation methodology
that is used to allocate its costs to ensure that The Children's Trust is only paying its fair share of costs for services,
overhead and staffing devoted to the program or services 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
Borinquen Medical Ctr-HSB XX17-6920 Borinquen Health Care Center
Fiscal Year 19-20(7/01/19-6/30/20)
Contract#:2017-6920
CSC Program Allocation:$3,481,000
Budget Status:Approved
Salary Accounts
Original Original Amended
Program CSC CSC
Account# Title Budget Budget Budget
511 Regular Salaries and Wages 2,683,553.00 2,486,099.00 2,486,099.00
521 FICA/MICA 205,294.00 190,188.00 190,188.00
522 Retirement Contributions 0.00 0.00 0.00
523 Life and Health Insurance 507,905.00 418,080.00 418,080.00
524 Workers Compensation 10,439.00 9,671.00 9,671.00
525 Unemployment Compensation 5,003.00 4,655.00 4,655.00
Salary Totals: 3,412,194.00 3,108,693.00 3,108,693.00
Expense Accounts
Original Original Amended
Program CSC CSC
Account# Title Budget Budget Budget
531 Travel(other than participants) 4,860.00 0.00 0.00
532 Travel(participants) 0.00 0.00 0.00
533 Meals(participants) 0.00 0.00 0.00
534 Space 0.00 0.00 0.00
535 Utilities 6,240.00 0.00 0.00
536 Supplies(office) 15,246.00 11,159.00 11,159.00
537 Supplies(program) 34,059.00 13,048.00 13,048.00
540 Non-Capital Equipment 0.00 0.00 0.00
550 Capital Equipment 0.00 0.00 0.00
591 Indirect Cost 348,100.00 348,100.00 348,100.00
611 Subcontractor 0.00 0.00 0.00
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) 2,400.00 0.00 0.00
831 Other(admission to field trips) 0.00 0.00 0.00
891 Other(other) 0.00 0.00 0.00
529 Fringe Benefits(other) 0.00 0.00 0.00
841 Program Specific Audit 6,000.00 0.00 0.00
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) 0.00 0.00 0.00
853 Other(Required Staff Training) 0.00 0.00 0.00
854 Other(Discretionary Funds) 0.00 • 0.00 0.00
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: 416,905.00 372,307.00 372,307.00
Salary and Expense Totals: 3,829,099.00 3,481,000.00 3,481,000.00
Program Funders
Summary Funders
Funder Type Funder Total Comment
Cash Agency Cash Revenue(Summary) 348,100.00 Borinquen Matching Funds consists
of Agency Cash Revenue derived
from Patient Fees. Borinquen Match
Funding is Matching Salaries and
fringe benefits; Utilities, Program
and office supplies,program
specific audit and other through
General Funds.
Summary Funder Totals: 348,100.00
Comprehensive Budget/Amendment Report
Borinquen Medical Ctr-HSB XX17-6920 Borinquen Health Care Center
Fiscal Year 19-20(7/01/19-6/30/20)
Contract#:2017-6920
Original Budget and Approved/Unapproved Amendments
Salary Data
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
ANRP(38580)
Staff: Williams,Morreen (47819)
Gross: 95,014.00 95,014.00 7,269.00 7,269.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Program: 95,014.00 95,014.00 7,269.00 7,269.00 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 HrsNVeek Amt Amt
Year Round 1.00 45.68 52.00 40.00 95,014.00 0.00 0.00
•
Total Distribution to Program Salary 100% 95,014.00 0% 0.00 100% 95,014
Percentage of Distribution to Gross Salary 100% 0% 100%
Original Budget Narratives:
ARNP Position#38580
Employee Status:Full Time
Gross Salary:$95,014($45.68/hr'40hrs/wk"52Weeks)
Payment frequency:Biweekly
Position actually work 42 weeks of School Year but paid over a 52 week period
Start date 8/5/2019 to 6/5/2020(Excluding 1 week for Winter&1 Week for Spring Break)
%Time dedicated to the program:100% .
CSC Allocation:$0.00
Match Allocation:$95,014
Source of the match:Borinquen Unrestricted funds such as Patient fee's Allocation.
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(38546)
Staff: Benefits,Fringe(36551)
Gross: 0.00 0.00 0.00 0.00 0.00 0.00 507,905.00 507,905.00 10,439.00 10,439.00 5,003.00 5,003.00
Program: 0.00 0.00 0.00 0.00 0.00 0.00 507,905.00 507,905.00 10,439.00 10,439.00 5,003.00 5,003.00
CSC: 0.00 0.00 0.00 0.00 0.00 0.00 418,080.00 418,080.00 9,671.00 9,671.00 4,655.00 4,655.00
Original Budget Narratives:
FICA/MICA:Program Cost:Total Salaries,$2,683,553 x 7.65%=$205,294 ROUNDUP
CSC Allocation:Total Salaries$2,486,099 X 7.65%=$190,188 ROUNDUP
Source of Match:Borinquen General Funds
Health,Life,ADD,Disability Insurance:Program Cost:Total Salaries$2,683,553 x 18.9266%=$507,905
CSC Allocation:Total Salaries($2,486,099 X 16.8167%)=$418,080,
Source of Match:Borinquen General Funds.
Worker's Compensation:Program Cost:Total Salaries$2,683,553 x 0.389%_$10,439
CSC Allocation:Total Salaries$2,486,099 X 0.389%=$9,671,
Match Allocation:$768.00
Source of Match:Borinquen General Funds
Unemployment Compensation:Program Cost $5,003
Calculations
$7000 Maximum Taxable Earnings X 1.24%Tax rate=$87.00 per Staff roundedup.
CSC Allocation:$4,655
53 Staff @ 100% and 1 Staff @ 50%=$87*53=$4,611.plus($87'50%=$44.00(roundup))=$4,655.00
Match Allocation: $348
3 staff @ 100%_$87`3= $261.00
2 staff @ 50% _$43.50*2= $87.00 roundup
Source of Match:Borinquen General Funds
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
IT TECHNICIAN(38581)
Staff: Marroquin,Josse R(45884)
Gross: 53,040.00 53,040.00 4,058.00 4,058.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Program: 26,520.00 26,520.00 2,029.00 2,029.00 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 HrsNVeek Amt Amt
Year Round 1.00 25.50 52.00 20.00 26,520.00 0.00 0.00
Total Distribution to Program Salary 50% 26,520.00 0% 0.00 100% 26,520
Percentage of Distribution to Gross Salary 50% 0% 50%
Original Budget Narratives:
IT TECHNICIAN Position#38581
Employee Status:Full Time
Gross Salary:$53,040($25.50/hr*40hrs/wk'52Weeks)
Payment frequency:Biweekly
Position actually work 42 weeks of School Year but paid over a 52 week period
Start date 8/5/2019 to 6/5/2020(Excluding 1 week for Winter&1 Week for Spring Break)
%Time dedicated to the program:50%
CSC Allocation:$0.00
Match Allocation:$26,520
Source of the match:Borinquen Unrestricted funds such as Patient fee's Allocation
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
LCSW(38574)
Staff: Curia,Nora(42913)
Gross: 58,011.00 58,011.00 4,438.00 4,438.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Program: 58,011.00 58,011.00 4,438.00 4,438.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
CSC: 58,011.00 58,011.00 4,438.00 4,438.00 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 HrsNVeek Amt HrslWeek Amt Amt
Year Round 1.00 27.89 52.00 40.00 58,011.00 0.00 0.00
Year Round 1.00 27.89 52.00 0.00 0.00 40.00 58,011.00
Total Distribution to Program Salary 100% 58,011.00 100% 58,011.00 0% 0
Percentage of Distribution to Gross Salary 100% 100% 0%
Original Budget Narratives:
LCSW Position#38574
Employee Status:Full Time
Gross Salary:$58011($27.89/hr`4ohrs/wk`52Weeks)
Payment frequency:Biweekly
Position actually work 42 weeks of School Year but paid over a 52 week period
Start date 8/5/2019 to 6/5/2020(Excluding 1 week for Winter&1 Week for Spring Break)
Time dedicated to the program:100%
CSC Allocation:$58,011
Match Allocation:$0.00
Budget Amendment Narratives:
Approved Date: -
Position Orig Amend Orig Amend Orig Amend Orig Amend Orig Amend Orig Amend
Salary Salary FICA FICA Retire Retire Insur Insur WC WC Unemp Unemp
LCSW(38575)
Staff: Zuccaro,Alejandro(34065)
Gross: 60,008.00 60,008.00 4,591.00 4,591.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Program: 60,008.00 60,008.00 4,591.00 4,591.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
CSC: 60,008.00 60,008.00 4,591.00 4,591.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Original Distribution
Program Allocation CSC Allocation Match Allocation
Time Period #Of People Rate Wks Funded HrslWeek Amt HrslWeek Amt Amt
Year Round 1.00 28.85 52.00 0.00 0.00 40.00 60,008.00
Year Round 1.00 28.85 52.00 40.00 60,008.00 0.00 0.00
Total Distribution to Program Salary 100% 60,008.00 100% 60,008.00 0% 0
Percentage of Distribution to Gross Salary 100% 100% 0%
Original Budget Narratives:
LCSW Position#38575
Employee Status:Full Time
Gross Salary:$($28.85/hr`40hrs/wk`52Weeks)
Pay Rate Rounded to 2 decimal places
Payment frequency:Biweekly
Position actually work 42 weeks of School Year but paid over a 52 week period
Start date 8/5/2019 to 6/5/2020(Excluding 1 week for Winter&1 Week for Spring Break)
%Time dedicated to the program:100%
CSC Allocation:$60,008
Match Allocation:$0.00
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
LCSW(38576)
Staff: Holdeman,Lori(34067)
Gross: 65,000.00 65,000.00 4,973.00 4,973.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Program: 65,000.00 65,000.00 4,973.00 4,973.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
CSC: 65,000.00 65,000.00 4,973.00 4,973.00 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 Hrs/Week Amt Hrs/Week Amt Amt
Year Round 1.00 31.25 52.00 40.00 65,000.00 0.00 0.00
Year Round 1.00 31.25 52.00 0.00 0.00 > 40.00 65,000.00
Total Distribution to Program Salary 100% 65,000.00 100% 65,000.00 0% 0
Percentage of Distribution to Gross Salary 100% 100% 0%
Original Budget Narratives:
LCSW Position#38576
Employee Status:Full Time
Gross Salary:$65,000($31.25/hr4ohrs/wk*52Weeks)
Pay Rate Rounded to 2 decimal places
Payment frequency:Biweekly
Position actually work 42 weeks of School Year but paid over a 52 week period
Start date 8/5/2019 to 6/5/2020(Excluding 1 week for Winter&1 Week for Spring Break)
%Time dedicated to the program:100%
CSC Allocation:$65,000
Match Allocation:$0.00
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
LCSW(38584)
Staff: Lozano,Rodrigo(36557)
Gross: 58,011.00 58,011.00 4,438.00 4,438.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Program: 58,011.00 58,011.00 4,438.00 4,438.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
CSC: 58,011.00 58,011.00 4,438.00 4,438.00 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 Hrs/Week Amt HrslWeek Amt Amt
Year Round 1.00 27.89 52.00 40.00 58,011.00 0.00 0.00
Year Round 1.00 27.89 52.00 0.00 0.00 40.00 58,011.00
Total Distribution to Program Salary 100% 58,011.00 100% 58,011.00 0% 0
Percentage of Distribution to Gross Salary 100% 100% 0%
Original Budget Narratives:
LCSW Position#38584
Employee Status:Full Time
Gross Salary:$58,011($27.89/hr*40hrs/wk*52Weeks)
Pay Rate Rounded to 2 decimal places
Payment frequency:Biweekly
Position actually work 42 weeks of School Year but paid over a 52 week period
Start date 8/5/2019 to 6/5/2020(Excluding 1 week for Winter&1 Week for Spring Break)
Time dedicated to the program:100%
CSC Allocation:$58,011
Match Allocation:$0.00
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
LPN(38586)
Staff: Elzey,Carla(42853)
Gross: 35,360.00 35,360.00 2,705.00 2,705.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Program: 35,360.00 35,360.00 2,705.00 2,705.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
CSC: 17,680.00 17,680.00 1,353.00 1,353.00 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 Hrs/Week Amt Hrs!Week Amt Amt
Year Round 1.00 17.00 52.00 0.00 0.00 20.00 17,680.00
Year Round 1.00 17.00 52.00 40.00 35,360.00 0.00 0.00
Total Distribution to Program Salary 100% 35,360.00 50% 17,680.00 50% 17,680
Percentage of Distribution to Gross Salary 100% 50% 50%
Original Budget Narratives:
LCSW Position#38586
Employee Status:Full Time
Gross Salary:$35,360($17/hr*4ohrs/wk*52Weeks)
Pay Rate Rounded to 2 decimal places
Payment frequency:Biweekly
Position actually work 42 weeks of School Year but paid over a 52 week period
Start date 8/5/2019 to 6/5/2020(Excluding 1 week for Winter 8 1 Week for Spring Break)
%Time dedicated to the program:100%
CSC Allocation:$17,680,50%
Source of Match Allocation:Borinquen$17,680,50%
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
LPN(POOLED)(38531)
Staff: Alonso,Antonio(34140);Arias,Martha (45759);Celestin-Martinez,Marie(34143);De Leon,Aleyda (47115);Del Socorro Ruiz,Jasmine (45393);
Desroches,Maguedala(34146);Ducatel,Rodna (44436);Duval,Joubert (44554);Escalona,Dina(34147);Grant,Nadia(34150);Gustave,Cristina
(44514);Irizarry,Tamara(34153);Lyman,Lilian (45376);Montes,Christian(41436);Pardo,Claudia (45758);Parra,Kathryn M(45757);Peraza,
Milagros (47787);Pierre,Omara (47106);Preval,Amber (47105);Rodriguez,Elder(34159);Rodriguez,Yareline(34160);Rosales,Luisalberto
(47107);Vigil,Yisset(34161)
Gross: 813,280.00 813,280.00 62,216.00 62,216.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Program: 813,280.00 813,280.00 62,216.00 62,216.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
CSC: 813,280.00 813,280.00 62,216.00 62,216.00 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 23.00 17.00 52.00 0.00 0.00 40.00 813,280.00
Year Round 23.00 17.00 52.00 40.00 813,280.00 0.00 0.00
Total Distribution to Program Salary 100% 813,280.00 100% 813,280.00 0% 0
Percentage of Distribution to Gross Salary 100% 100% 0%
Original Budget Narratives:
LPN POOLED Position#38531(23 STAFF)
Employee Status:Full Time
Gross Salary:$35,360($17/hr'40hrs/wk*52Weeks)
Pay Rate Rounded to 2 decimal places
Payment frequency:Biweekly
Position actually work 42 weeks of School Year but paid over a 52 week period
Start date 8/5/2019 to 6/5/2020(Excluding 1 week for Winter&1 Week for Spring Break)
%Time dedicated to the program:100%
CSC Allocation:$35,360'23=$813,280
Match Allocation:$0.00
Budget Amendment Narratives:
Approved Date: -
Position Orig Amend Orig Amend Orig Amend Orig Amend Orig Amend Orig Amend
Salary Salary FICA FICA Retire Retire Incur Insur WC WC Unemp Unemp
Medical Assistant(38535)
Staff: Granera,Nancy T(45608)
Gross: 29,120.00 29,120.00 2,228.00 2,228.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Program: 29,120.00 29,120.00 2,228.00 2,228.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
CSC: 29,120.00 29,120.00 2,228.00 2,228.00 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 14.00 52.00 0.00 0.00 40.00 29,120.00
Year Round 1.00 14.00 52.00 40.00 29,120.00 0.00 0.00
Total Distribution to Program Salary 100% 29,120.00 100% 29,120.00 0% 0
Percentage of Distribution to Gross Salary 100% 100% 0%
Original Budget Narratives:
Medical Assistant Position#38535
Employee Status:Full Time
Gross Salary:$29,120($14/hr*40hrs/wk*52Weeks)
Pay Rate Rounded to 2 decimal places
Payment frequency:Biweekly
Position actually work 42 weeks of School Year but paid over a 52 week period
Start date 8/5/2019 to 6/5/2020(Excluding 1 week for Winter&1 Week for Spring Break)
%Time dedicated to the program:100%
CSC Allocation:$29,120
Match Allocation:$0.00
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
Medical Assistant(38700)
Staff: Almonor,Myriam (47116)
• Gross: 29,120.00 29,120.00 2,228.00 2,228.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Program: 29,120.00 29,120.00 2,228.00 2,228.00 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 Hrs!Week Amt Hrs!Week Amt Amt
Year Round 1.00 14.00 52.00 40.00 29,120.00 0.00 0.00
Total Distribution to Program Salary 100% 29,120.00 0% 0.00 100% 29,120
Percentage of Distribution to Gross Salary 100% 0% 100%
Original Budget Narratives:
Medical Assistant Position#38700
Employee Status:Full Time
Gross Salary:$29,120($14/hr*40hrs/wk*52Weeks)
Pay Rate Rounded to 2 decimal places
Payment frequency:Biweekly
Position actually work 42 weeks of School Year but paid over a 52 week period
Start date 8/5/2019 to 6/5/2020(Excluding 1 week for Winter&1 Week for Spring Break)
%Time dedicated to the program:100%
CSC Allocation:$0.00
Source of Match Allocation:Borinquen$29,120
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
Medical Assistant(38701)
Staff: Flores,Urania (47117)
Gross: 29,120.00 29,120.00 2,228.00 2,228.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Program: 29,120.00 29,120.00 2,228.00 2,228.00 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 Hrs!Week Amt HrslWeek Amt Amt
Year Round 1.00 14.00 52.00 40.00 29,120.00 0.00 0.00
Total Distribution to Program Salary 100% 29,120.00 0% 0.00 100% 29,120
Percentage of Distribution to Gross Salary 100% 0% 100%
Original Budget Narratives:
Medical Assistant Position#38701
Employee Status:Full Time
Gross Salary:$29,120($14/hr'40hrs/wk"52Weeks)
Pay Rate Rounded to 2 decimal places
Payment frequency:Biweekly
Position actually work 42 weeks of School Year but paid over a 52 week period
Start date 8/5/2019 to 6/5/2020(Excluding 1 week for Winter&1 Week for Spring Break)
%Time dedicated to the program:100%
CSC Allocation:$0.00
Source of Match Allocation:Borinquen$29,120
•
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
MSW(POOLED)(38533)
Staff: Brown,Lopez (45448);Cooke,Jessica M(47124);De Leon,Katherine Sofia (47125);Ferguson,Jessica K(47123);Ferro,Diana M(47122);Gomez,
Jenna L(47121);Marimon,Mayra (47120);Rios,Celeste C(47119)
Gross: 384,051.00 384,051.00 29,380.00 29,380.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Program: 384,051.00 384,051.00 29,376.00 29,376.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
CSC: 384,051.00 384,051.00 29,376.00 29,376.00 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 Hrs/Week Amt HrsNVeek Amt Amt
Year Round 8.00 23.08 52.00 40.00 384,051.00 0.00 0.00
Year Round 8.00 23.08 52.00 0.00 0.00 40.00 384,051.00
Total Distribution to Program Salary 100% 384,051.00 100% 384,051.00 0% 0
Percentage of Distribution to Gross Salary 100% 100% 0%
Original Budget Narratives:
MSW POOLED Position#38533(8 STAFF)
Employee Status:Full Time
Gross Salary:$48,006($23.08/hr*40hrs/wk•52Weeks)
Pay Rate Rounded to 2 decimal places
Payment frequency:Biweekly
Position actually work 42 weeks of School Year but paid over a 52 week period
Start date 8/5/2019 to 6/5/2020(Excluding 1 week for Winter 8 1 Week for Spring Break)
%Time dedicated to the program:100%
CSC Allocation:$48,006*8=$384,051
Match Allocation:$0.00
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
Program Assistant(38579)
Staff: Goins,Kevia(39996)
Gross: 35,027.00 35,027.00 2,680.00 2,680.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Program: 35,027.00 35,027.00 2,680.00 2,680.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
CSC: 35,027.00 35,027.00 2,680.00 2,680.00 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 Hrs!Week Amt HrslWeek Amt Amt
Year Round 1.00 16.84 52.00 0.00 0.00 40.00 35,027.00
Year Round 1.00 16.84 52.00 40.00 35,027.00 0.00 0.00
Total Distribution to Program Salary 100% 35,027.00 100% 35,027.00 0% 0
Percentage of Distribution to Gross Salary 100% 100% 0%
Original Budget Narratives: ,
Program Assistant Position#38579
Employee Status:Full Time
Gross Salary:$35,027($16.84/hr•4ohrs/wk*S2Weeks)
Pay Rate Rounded to 2 decimal places
Payment frequency:Biweekly
Position actually work 42 weeks of School Year but paid over a 52 week period
Start date 8/5/2019 to 6/5/2020(Excluding 1 week for Winter&1 Week for Spring Break)
%Time dedicated to the program:100%
CSC Allocation:$35,027
Match Allocation:$0.00
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
Registered Nurse Manager(38577)
Staff: Herrera,Karina(34048)
Gross: 70,512.00 70,512.00 5,394.00 5,394.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Program: 70,512.00 70,512.00 5,394.00 5,394.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
CSC: 70,512.00 70,512.00 5,394.00 5,394.00 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 33.90 52.00 0.00 0.00 40.00 70,512.00
Year Round 1.00 33.90 52.00 40.00 70,512.00 0.00 0.00
Total Distribution to Program Salary 100% 70,512.00 100% 70,512.00 0% .0
Percentage of Distribution to Gross Salary 100% 100% 0%
Original Budget Narratives:
Registered Nurse Manager Position#38577
Employee Status:Full Time
Gross Salary:$70512($33.90/hr*40hrs/wk*52Weeks) •
Pay Rate Rounded to 2 decimal places
Payment frequency:Biweekly
Position actually work 42 weeks of School Year but paid over a 52 week period
Start date 8/5/2019 to 6/5/2020(Excluding 1 week for Winter&1 Week for Spring Break)
%Time dedicated to the program:100%
CSC Allocation:$70,512
Match Allocation:$0.00
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
RN(38537)
Staff: Raymonvil,Musa(34051)
Gross: 61,818.00 61,818.00 4,729.00 4,729.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Program: 61,818.00 61,818.00 4,729.00 4,729.00 0.00 0.00 0.00 0.00 0.00 •
0.00 0.00 0.00
CSC: 61,818.00 61,818.00 4,729.00 4,729.00 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 Firs/Week Amt HrslWeek Amt Amt
Year Round 1.00 29.72 52.00 0.00 0.00 40.00 61,818.00
Year Round 1.00 29.72 52.00 40.00 61,818.00 0.00 0.00
Total Distribution to Program Salary 100% 61,818.00 100% 61,818.00 0% 0
Percentage of Distribution to Gross Salary 100% 100% 0%
Original Budget Narratives:
RN Position#38537
Employee Status:Full Time
Gross Salary:$61,818($29.72/hr*4Ohrs/wk*52Weeks)
Pay Rate Rounded to 2 decimal places
Payment frequency:Biweekly
Position actually work 42 weeks of School Year but paid over a 52 week period
Start date 8/5/2019 to 6/5/2020(Excluding 1 week for Winter&1 Week for Spring Break)
%Time dedicated to the program:100%
CSC Allocation:$61,818
Match Allocation:$0.00
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
RN(38573)
Staff: De Los Rios,Suset(34145)
Gross: 55,016.00 55,016.00 4,209.00 4,209.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Program: 55,016.00 55,016.00 4,209.00 4,209.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 .
CSC: 55,016.00 55,016.00 4,209.00 4,209.00 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 26.45 52.00 0.00 0.00 40.00 55,016.00
Year Round 1.00 26.45 52.00 40.00 55,016.00 0.00 0.00
Total Distribution to Program Salary 100% 55,016.00 100% 55,016.00 0% 0
Percentage of Distribution to Gross Salary 100% 100% 0%
Original Budget Narratives:
RN Position#38573
Employee Status:Full Time
Gross Salary:$55,016($26.45/hr•40hrs/wk•52Weeks)
Pay Rate Rounded to 2 decimal places
Payment frequency:Biweekly
Position actually work 42 weeks of School Year but paid over a 52 week period
Start date 8/5/2019 to 6/5/2020(Excluding 1 week for Winter&1 Week for Spring Break)
%Time dedicated to the program:100%
CSC Allocation:$55,016
Match Allocation:$0.00
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
RN(38703)
Staff: Mejia,Felicia(44063)
Gross: 55,016.00 55,016.00 4,209.00 4,209.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Program: 55,016.00 55,016.00 4,209.00 4,209.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
CSC: 55,016.00 55,016.00 4,209.00 4,209.00 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 Hrs!Week Amt HrslWeek Amt Amt
Year Round 1.00 26.45 52.00 40.00 55,016.00 0.00 0.00
Year Round 1.00 26.45 52.00 0.00 0.00 40.00 55,016.00
Total Distribution to Program Salary 100% 55,016.00 100% 55,016.00 0% 0
Percentage of Distribution to Gross Salary 100% 100% 0%
Original Budget Narratives:
RN Position#38703
Employee Status:Full Time
Gross Salary:$55,016($26.45/hr•40hrs/wk*52Weeks)
Pay Rate Rounded to 2 decimal places
Payment frequency:Biweekly
Position actually work 42 weeks of School Year but paid over a 52 week period
Start date 8/5/2019 to 6/5/2020(Excluding 1 week for Winter&1 Week for Spring Break)
•
%Time dedicated to the program:100%
CSC Allocation:$55,016
Match Allocation:$0.00
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
RN(38704)
Staff: Rodriguez,Barbara(34058)
Gross: 61,818.00 61,818.00 4,729.00 4,729.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Program: 61,818.00 61,818.00 4,729.00 4,729.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
CSC: 61,818.00 61,818.00 4,729.00 4,729.00 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 29.72 52.00 0.00 0.00 40.00 61,818.00
Year Round 1.00 29.72 52.00 40.00 61,818.00 0.00 0.00
Total Distribution to Program Salary 100% 61,818.00 100% 61,818.00 0% 0
Percentage of Distribution to Gross Salary 100% 100% 0%
Original Budget Narratives:
RN Position#38704
Employee Status:Full Time
Gross Salary:$61,818($29.72/hr4ohrs/wk*52Weeks)
Pay Rate Rounded to 2 decimal places
Payment frequency:Biweekly
Position actually work 42 weeks of School Year but paid over a 52 week period
Start date 8/5/2019 to 6/5/2020(Excluding 1 week for Winter&1 Week for Spring Break)
%Time dedicated to the program:100%
CSC Allocation:$61,818
Match Allocation:$0.00
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
RN(40580)
Staff: Collado,Suzette (47327)
Gross: 55,016.00 55,016.00 4,209.00 4,209.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Program: 55,016.00 55,016.00 4,209.00 4,209.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
CSC: 55,016.00 55,016.00 4,209.00 4,209.00 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 26.45 52.00 40.00 55,016.00 0.00 0.00
Year Round 1.00 26.45 52.00 0.00 0.00 40.00 55,016.00
Total Distribution to Program Salary 100% 55,016.00 100% 55,016.00 0% 0
Percentage of Distribution to Gross Salary 100% 100% 0%
Original Budget Narratives:
RN Position#40580
Employee Status:Full Time
Gross Salary:$55,016($26.45/hr40hrs/wk•52Weeks)
Pay Rate Rounded to 2 decimal places
Payment frequency:Biweekly
Position actually work 42 weeks of School Year but paid over a 52 week period
Start date 8/5/2019 to 6/5/2020(Excluding 1 week for Winter&1 Week for Spring Break)
%Time dedicated to the program:100%
CSC Allocation:$55,016
Match Allocation:$0.00
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
RN(POOLED)(38536)
Staff: Armenteros,Nigelia M(39995);Aycart,Nicole(34049);Cuellar,Caridad(34057);Garcia,Livia(34149);Martinez,Baltazar(36558)
Gross: 300,040.00 300,040.00 22,953.00 22,953.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Program: 300,040.00 300,040.00 22,955.00 22,955.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
CSC: 300,040.00 300,040.00 22,955.00 22,955.00 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 Hrs/Week Amt Hrs/VVeek Amt Amt
Year Round 5.00 28.85 52.00 40.00 300,040.00 0.00 0.00
•
Year Round 5.00 28.85 52.00 0.00 0.00 40.00 300,040.00
Total Distribution to Program Salary 100% 300,040.00 100% 300,040.00 0% 0
Percentage of Distribution to Gross Salary 100% 100% 0%
Original Budget Narratives:
RN POOLED Position#38536(5 STAFF)
Employee Status:Full Time
Gross Salary:$60,008($28.85/hr•40hrs/wk•52Weeks)
Pay Rate Rounded to 2 decimal places
Payment frequency:Biweekly
Position actually work 42 weeks of School Year but paid over a 52 week period
Start date 8/5/2019 to 6/5/2020(Excluding 1 week for Winter&1 Week for Spring Break)
%Time dedicated to the program:100%
CSC Allocation:$60,008•5=$300,040
Match Allocation:$0.00
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
RN(POOLED)(38572)
•
Staff: Juste,Elumene(34052);Lioe-A-Tjam,Irama(34050);Lora,Ahnie(34059);Quintero,Adriana(34064)
Gross: 226,637.00 226,637.00 17,338.00 17,338.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Program: 226,637.00 226,637.00 17,338.00 17,338.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
CSC: 226,637.00 226,637.00 17,338.00 17,338.00 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 4.00 27.24 52.00 40.00 226,637.00 0.00 0.00
•
Year Round 4.00 27.24 52.00 0.00 0.00 40.00 226,637.00
Total Distribution to Program Salary 100% 226,637.00 100% 226,637.00 0% 0
Percentage of Distribution to Gross Salary 100% 100% 0%
Original Budget Narratives:
RN POOLED Position#38572(4 STAFF)
Employee Status:Full Time
Gross Salary:$56,659($27.24/hr*40hrs/wk*52Weeks)
Pay Rate Rounded to 2 decimal places
Payment frequency:Biweekly
Position actually work 42 weeks of School Year but paid over a 52 week period
Start date 8/5/2019 to 6/5/2020(Excluding 1 week for Winter&1 Week for Spring Break)
•
%Time dedicated to the program:100%
CSC Allocation:$56,659.20'4=$226,637
Match Allocation:$0.00
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
School Program Coordinator(38578)
Staff: Anderson,Guerline(34061)
Gross: 80,038.00 80,038.00 6,123.00 6,123.00 0.00 0.00' 0.00 0.00 0.00 0.00 0.00 0.00
Program: 80,038.00 80,038.00 6,123.00 6,123.00 0.00. 0.00 0.00 0.00 0.00 0.00 0.00 0.00
CSC: 80,038.00 80,038.00 6,123.00 6,123.00 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 Hrs!Week Amt HrslWeek Amt Amt
Year Round 1.00 38.48 52.00 40.00 80,038.00 0.00 0.00
Year Round 1.00 38.48 52.00 0.00 0.00 40.00 80,038.00
Total Distribution to Program Salary 100% 80,038.00 100% 80,038.00 0% 0
Percentage of Distribution to Gross Salary 100% 100% 0%
Original Budget Narratives:
Program Coordinator Position#38578
Employee Status:Full Time
Gross Salary:$80,038($38.48/hr*40hrs/wk*52Weeks)
Pay Rate Rounded to 2 decimal places
Payment frequency:Biweekly
Position actually work 42 weeks of School Year but paid over a 52 week period
Start date 8/5/2019 to 6/5/2020(Excluding 1 week for Winter&1 Week for Spring Break)
%Time dedicated to the program:100%
CSC Allocation:$80,038
Match Allocation:$0.00
Budget Amendment Narratives:
Approved Date: -
Salary Totals
Percentage of Program Distribution to Gross Salary: 99% Percentage of CSC Distribution to Gross Salary: 92%
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: 2,710,073.00 2,710,073.00 207,325.00 207,325.00 0.00 0.00 507,905.00 507,905.00 10,439.00 10,439.00 5,003.00 5,003.00
Program: 2,683,553.00 2,683,553.00 205,294.00 205,294.00 0.00 0.00 507,905.00 507,905.00 10,439.00 10,439.00 5,003.00 5,003.00
CSC: 2,486,099.00 2,486,099.00 190,188.00 190,188.00 0.00 0.00 418,080.00 418,080.00 9,671.00 9,671.00 4,655.00 4,655.00
Expense Data
Account# Account Name Orig CSC Budget Amend CSC Budget Orig Prog Budget Amend Prog Budget
531 Travel(other than participants) 0.00 0.00 4,860.00 4,860.00
Original Budget Calculation:
(30*12*25*0.54)
Original Budget Narratives:
TCT Staff reimbursement for travel expenses to and from designated site locations for meetings,etc.throughout grant period.Travel for work or to attend any training or meeting that is at a location
that differs from their assigned or scheduled work site.BMC uses the Miami Dade County Mileage reimbursement rate for BMC related travel.
Total$4,860(25 STAFF @ approx 30.00miles/mc x 0.54 per mile X 12 MOS)
CSC Allocation:$0.00
Match allocation:$4,860
Source of Match:Borinquen
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 6,240.00 6,240.00.
Original Budget Calculation:
(2`85`12)+(7`50'12)
Original Budget Narratives:
Cell phone reimbursement expenses:
Program Cost:$6,240
$50 X 12 months X 7 staff=$4,200
$85 X 12 months X 2 Managerial Staff=$2,040
Amount Funded by CSC $0.00
Match allocation:$6,240
Source of Match-Borinquen
Budget Amendment Narratives:
Approved Date: -
Account# Account Name Orig CSC Budget Amend CSC Budget Orig Prog Budget Amend Prog Budget
536 Supplies(office) 11,159.00 11,159.00 15,246.00 15,246.00
Original Budget Calculation:
(40.963'12'31)
Original Budget Narratives:
Office Supplies-On average$40.983 dollars per Site per Month for 12 Months.
$40.983 average per month'31 schools'12 months=$15,246 roundedup
Expense Calculation $15,246
Calculation Result $15,246 Program Budget
Amount Funded by CSC $11,159
Match allocation :$4,087
Source of Match:Borinquen
Budget Amendment Narratives:
Approved Date: -
Account# Account Name Orig CSC Budget Amend CSC Budget Orig Prog Budget Amend Prog Budget
537 Supplies(program) 13,048.00 13,048.00 34,059.00 34,059.00
Original Budget Calculation:
(91.557'31'12)
Original Budget Narratives:
Program Supplies including:
Various Medical Supplies:
Calculation:31 schools x$91.557/month x 12months=$34,059
Program Supplies including:
Gloves,sanitizer,soap,gauze,bandaids,hot/cold packs,ear probes,pads
Program Cost$34,059
CSC Allocation:$13,048
Match Allocation:$21,011
Source of Match:Borinquen
Budget Amendment Narratives:
Approved Date: -
Account# Account Name Orig CSC Budget Amend CSC Budget Orig Prog Budget Amend Prog Budget
540 Non-Capital Equipment 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
591 Indirect Cost 348,100.00 348,100.00 348,100.00 348,100.00
•
Original Budget Calculation:
3481000'0.10
Original Budget Narratives:
The amount funded by TCT is representative of 10%Percent Administrative Cost-$348,100.
Expense Calculation $348,100
Calculation Result $348,100 Program Budget
Amount Funded by CSC $348,100
Budget Amendment Narratives:
Approved Date: -
Account# Account Name Orig CSC Budget Amend CSC Budget Orig Prog Budget Amend Prog Budget
791 Professional Services(other) 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
821 Other(background screening) 0.00 0.00 2,400.00 2,400.00
Original Budget Calculation:
200`12
Original Budget Narratives:
Program Cost:$2,400
$200 X 12 months=$2,400
Amount Funded by CSC $0.00
Match allocation:$2,400
Source of Match-Borinquen
Budget Amendment Narratives:
Approved Date: -
Account# Account Name Orig CSC Budget Amend CSC Budget Orig Prog Budget Amend Prog Budget
841 Program Specific Audit 0.00 0.00 6,000.00 6,000.00
Original Budget Calculation:
6000
Original Budget Narratives:
PSA$6000
Source of Match-Borinquen
Expense Calculation 6000
Calculation Result 6,000.00 Program Budget
Amount Funded by CSC $0.00
Budget Amendment Narratives:
Approved Date: -
Expense Totals Orig CSC Budget Amend CSC Budget Orig Prog Budget Amend Prog Budget -
372,307.00 372,307.00 416,905.00 416,905.00
Salary,Expense,and Subcontractor Totals Orig CSC Budget Amend CSC Budget Orig Prog Budget Amend Prog Budget
3,481,000.00 3,481,000.00 3,829,099.00 3,829,099.00
ATTACHMENT C: Data Requirements and Program Metrics
The Children's Trust requires collecting ongoing measures on the quantity, quality and impact of service efforts. The
purpose of data collection, reporting and analysis is to promote continuous improvement in program quality and
participant outcome achievement. Contract-specific reporting requirements are identified in Attachment A-Scope of
Services.
The Program Metrics tool can be found on the Children's Trust website and it details the components that are regularly
reviewed by Trust staff or approved contractors. These components—as well as the way they are rated—are specific to the
initiative and can be revised throughout the funding cycle.
•
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.
Data requirements:
As applicable, provider is expected to collect and enter demographic, attendance, screening, and assessment data in a
timely manner, while incorporating practices that ensure data quality and integrity. Data must be collected using the
appropriate tools (e.g., required demographic fields can be found in the Child and Adult Information Forms found on
The Children's Trust website) and entered in a timely manner into the Trust' approved data system. All data entered must
be reviewed and validated by the provider no later than the 15th of month following the month in which services were
delivered.
As applicable, provider may also be expected to complete a Program Narrative Report (see initiative specific requirements—
including timing—in the Initiative Specific Reporting Requirements on The Children's Trust website) that captures a
brief account of the program's successes, challenges, and supports needed.
With each submission, the provider attests, based on his/her best knowledge, information and belief, that all data
submitted in conjunction with the reports are accurate, truthful and complete. The trust and approved partners shall use
and analyze this data for evaluation and strategic planning purposes.
Program Metrics:
• Compliance Items: Provider shall fulfill all applicable compliance items specified in the safety, administrative and
fiscal compliance component in the Program Metrics tool, as well as in the Required Documentation Checklist
posted on The Children's Trust website.
• Quarterly or Yearly Growth Plan: In partnership with the Contract Manager, the provider will develop and
implement Growth Plans up to four times per contract year. A Growth Planning Guidance Document with
additional information can be found on The Children's Trust website.
Additional Program Continuous Quality Improvement Requirements:
Provider must ensure appropriate staff and subcontractors attend various Trust-sponsored or facilitated trainings. Training
requirements by initiative are detailed on The Children's Trust website. At a minimum, staff will be required to attend
the following annually:
• 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, Project
RISE, evidence-based programs, and measurement tools).
Attachment D
Program-Specific Audit Requirements
The Program-Specific Audit must encompass an audit of The Children's Trust Contracts in accordance with Section 0:
Records, Reports, Audits and Monitoring 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):
1. Independent Auditor's Report on the Schedule of Expenditures of The Children's Trust Contracts
2. Schedule of Expenditures of The Children's Trust Contracts
3. Notes to Schedule
4. Independent Auditor's Report on Compliance for each of The Children's Trust Contracts and Report on Internal
Control over Compliance
5. Schedule of Findings and Questioned Costs
At a minimum, the auditor must include the following tests in its 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 Program-Specific Audit Example
Requirement Implication
a) Internal Controls 1)An auditor's risk assessment A) Controls tested during the financial
must include an expectation of statement audit may not consider
the operating effectiveness of compliance as it relates to The
controls over compliance, and in Children's Trust's Contract. Overall
doing so, the assessed control control risk must consider each
risk must be assessed at low compliance requirement tested during
during the planning stage. If the the Program-Specific Audit. Separate
auditor determines a lack of risk assessment procedures and
controls and identifies risk of materiality should be performed and
material noncompliance that generated for a Program-Specific
demonstrates internal controls Audit.
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
b) Budget vs. Actual 1)The approved budget is to A)Test work should include a schedule
Expenditures include the original approved identifying each Contract and its
Contract as well as any original/amended budget, monthly
approved budget billings, Contract utilization and any
amendments/revisions. analytical expectations that may
identify any overbillings.
i. The current Children's Trust
electronic system 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) 1) Requires that the nature of A) If Provider asks to be reimbursed
Allowable/Unallowable services and type of costs paid for six (6)field trips to teach children
Activities and Costs are in agreement with the social skills, only field trips
contractual budget and/or enumerated in either the contractual
Common unallowable budget amendment/revision's budget narrative or the contractual
costs: Scope of Services and budget Scope of Service will be reimbursed.
guidelines.
1. Salary rates, payroll AND/OR B) If the contractual budget, lists a
methods and hours Requires that activities program coordinator position at
billed that do not match performed or costs paid with The $25.00/hour, the provider must pay
original or amended Children's Trust funds are listed the program coordinator and charge
budgets. in the contractual budget The Children's Trust$25.00/hour. The
narrative or a contractual budget provider cannot substitute funding
2. Fringe benefits billed amendment/revision narrative. identified for the program coordinator
to The Children's Trust to any other position.
for employees not 2)Any cost or service billed that
included in Contract is not approved in the Contract's C) If the contractual budget, lists a
budget and are budget is a finding and reported program coordinator's position, with
unrelated to the as a questioned cost on the dedicated time charged to The
program. Program-Specific Audit Report. Children's Trust program of 25%, the
provider must keep records of an
3. Professional services 3) If any cost or service is billed employee's time to substantiate that
billed within regular in more than one Contract, and 25%of time was in fact earned and
salaries and wages. the billings are in excess of the charged to The Children's Trust
total disbursement or approved program.
4. Capital purchases allocation, the expense has been
disguised as repairs. overbilled or double billed D) If three Contracts list a program
and should be considered a coordinator's total budgeted salary as
5. Sales taxes and tips. finding. $100,000.00 and each Contract will
reimburse $35,000.00 (35%), then a
6. Fuel. 4)The Children's Trust funds possible overbilling of$5,000 may
must supplement a program; have occurred
7. Food and beverage supplanting of funds is ($35,000.00*3=$105,000.00 or
costs for parties, unallowable. A provider may 35%*3=105%Children's Trust salary
celebrations, end-of- not use Contract funds to defray allocation).
program events, and any costs that the recipient
conferences or already is obligated to pay. (See E) If an invoice is submitted to The
conventions, unless example F.) Children's Trust that includes food
while attending an out- charges for end-of-year parties and
of-town conference or celebrations, those costs are NOT
convention. allowable per The Children's Trust
budget guidelines and cannot be paid
S. Monetary gift cards by The Children's Trust.
as incentives.
F) If a provider, prior to applying to
A detailed listing of all participate in the contracted program,
costs and activities committed to purchase 10 new
considered allowed and computers for another program, the
unallowed can be provider must purchase those 10
viewed in the Budget computers in addition to any other
Guidelines form on The computers requested for The
Children's Trust Children's Trust program.
website.
d) Cash Management 1)With the exception of the last A) If payroll is paid on 3/31, it should
month of the Contract period, be disclosed in March's
monthly invoices must represent reimbursement.
costs actually paid during the
Contract period (cash basis), B) If payroll is paid on 4/1, but
rather than costs incurred or represents time charged in March, it
accrued. should be disclosed in April's
reimbursement.
e) Period of Availability 1) Requires provider to charge A) If the active Contract period extends
The Children's Trust grant with from 8/1 through 7/31, and provider
only allowable costs resulting expends $250.00 for office supplies on
from obligations incurred during 9/30 during said Contract period, that
the funding period. 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 1) Eligibility requirements related Each of the following special provisions
to Contract expectations such as must be tested:
type of participants served,
number of participants served A) Insurance requirements (further
and background checks should described in Section K: Insurance
NOT be tested as part of The Requirements of this Contract)
Children's Trust Program-Specific
Audit. The Program-Specific i. Auditor should determine if all
Audit is meant to test the fiscal applicable insurance policies
viability of the provider. were carried during the fiscal
Therefore, certain-Contract year.
provisions that support the fiscal
viability of the provider should
be tested. B) Proof of tax status (further
described in Section L: Proof of Tax
Status of this Contract)
ii. Auditor should vouch that
applicable documents
verifying that all incurred
payroll and unemployment
taxes have been paid.
C) Data security obligation (further
described in Section 0: 12 of this
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 and
understand any provider
monitoring procedures.
E) Matching Funds
i. In some cases, a required
match is contracted. This will
be indicated in Section C:
Total Funding of this
Contract. Verify the applied
method the provider uses to
satisfy match requirements.
Also, verify that provider
maintains documentation to
back up match requirements.
The independent auditor's report shall state that the audit was conducted in accordance with: (1) auditing standards
generally accepted in the United States of America; (2) the standards applicable to financial audits contained in
Government Auditing Standards, issued by the Comptroller General of the United States; and (3) 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 above-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 Florida Statutes, 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:
r.0ErA p.
Or ® L41 �
ATTACHMENT E-2
4fAi AND Vt. CHILD CARE
61vFLFnMnIFs.COM 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 415.111 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 784.011 assault,if the victim of offense was a minor
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 790.115(1) exhibiting firearms or weapons within 1,000 feet of a school
Section 790.115(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
o° Child Abuse & Neglect Reporting Requirements
All child care personnel are mandated by law to report their ;usoicions 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. Jtemember, 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
vs.rAni.
rah
i ! N
° nI ATTACHMENT E-4
MYF L FAM I LI ES.COM
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.