HomeMy WebLinkAboutR-1991-107 • 6i
RESOLUTION NO. 107-91
A RESOLUTION OF THE CITY OF DANIA, FLORIDA,
APPROVING THAT CERTAIN AGREEMENT BETWEEN
BROWARD COUNTY AND THE CITY OF DANIA RELATING
TO AFTER SCHOOL CARE; AND PROVIDING FOR AN
EFFECTIVE DATE.
BE IT RESOLVED BY THE CITY COMMISSION OF THE CITY OF DANIA,
FLORIDA:
Section 1. That that certain Agreement between Broward
County and The City of Dania relating to after school care, a copy
1' of which is attached hereto as Exhibit "A", be and the same is
hereby approved, and the appropriate city officials are hereby
j directed to execute same.
Section 2. That Michael W. Smith, as Personnel Director, and
Mardie Holloway, as Recreation Coordinator, are hereby authorized
N to sign monthly invoices and certification statements as required
by said agreement.
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j Section 3. That this resolution shall be in force and take
effect immediately upon its passage and adoption.
PASSED and ADOPTED this 24th day of September 1991.
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MAYOR - COMMISSIONER
ATTEST:
'CITY CLERK - AUDITOR
APPROVED AS TO FORM AND CORRECTNESS:
A" c. �
FRANK C. ADLER, City Attorney
107-91
Resolution No.
. '. A G R E E M E N T
between
�^ BROWARD COUNTY
e
and
k
CITY OF DANIA, FLORIDA
Contract Number 92-12
After School Care
EXHIBIT "A"
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AGREEMENT
between
BROWARD COUNTY
and
CITY OF DANIA, FLORIDA
si
1 This Agreement,. entered into this day of
19 , by and between BROWARD COUNTY, a political subdivision of
the State of Florida, hereinafter referred to as "COUNTY" ;
AND
CITY OF DANIA, FLORIDA, a political subdivision of the State of
N+, Florida, hereinafter referred to as "PROVIDER" .
WHEREAS, this funding agreement will enable PROVIDER to
provide after school care services, not otherwise funded by any
I
other public and private funding source ; and
WHEREAS, expenditures given to the PROVIDER have been found,
determined and declared to be a county and public purpose. by the
Board of County Commissioners of COUNTY;
NOW, THEREFORE, the parties agree as follows:
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ARTICLE I
SCOPE OF SERVICES
rovide on a mnthly basis the services
• THE PROVIDER agrees to p o
art hereof'.
• set forth in Exhibit "A" attached hereto and made a p
ARTICLE
UfJDING AND METHOD OF PAYMENT.
F
maximum amount reimbursable to the PROVIDER by the
.
2. 1 The reement shall be thirty thousand dollars
COUNTY under this Ag
($30,000. 00) . delivered,
invoiced and documented at unit price specified in
2. 2 COUNTY agrees to reimburse for units actually
correctly plus one copy are due on or
Ori original invoice p month, beginning on .
Exhibit A. gthe A reement
before the fifteenth Of the firstolmonthg following 9
the fifteenth Of COUNTY agrees to reimburse the
. ,
execution by COUNTY. basis. No monthly bill shall
� PROVIDER on a monthly billing dividing the maximum amount
exceed that amount obtained by the number of months set
1' payable under this agreement by "TERM OF SERVICES
forth in ARTICLE III of this Agreement, the
I except for those agencies whose client flow varies wlhment
funding period and the COUNTY agrees to a monthly pa
Y
schedule as specified in the Activity/Payment Schedule in
did Exhibit A, attached hereto and made a part hereof .
In order to be deemed proper as defined in the Florida
ith
Prompt Payment Act, all invoices must
reeme
requirements set ntcomply
and wmust the
forth in this
urs to inst
submitted on the
guant ructions
form and p
prescribed by the COUNTY, attached hereto and incorporated
II herein.
2.3 Monthly invoices submitted by PROVIDER shall include certification t signed by an authorized person as
statemenand
referenced in Exhibit B, Page 1 attached hd it become the oPRO necVIDERseis
served by
part hereof, that each client s
eligible under this agreement. Should it
for PROVIDER to replace signators, a notarized copy
authorizing resolution as passed by PROVIDER' S Commissionefor
rs
shall be submitted to COUNTY' s Contract CommissionAdministrs setting
this Agreement. A letter from the City an the notarized
forth the reason for the action must accompanyContract
copy . Both items must submitted
or before the fifteenth
Administrator for this Agreement
of the following month.
documentation required by this sectionshall
be
All by
reported, maintained
and presented upon forms prescribed
or approved by COUNTY Contract Administrator.
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Invoices shall be submitted on Broward County Form #609C-2
revised 1991 as shown in Exhibit C and calendar
documentation shall be submitted on Broward County Form
#609C-3 bearing the appropriate fiscal year designation on
its face as ,shown in Exhibit D attached and made a part
hereof, or other such form pre-approved by the Contract
Administrator.
2 .4 PROVIDER may choose to document units delivered in excess of -
contracted levels and not paid by any other source. Units
of service so documented may be used to augment subsequent
months' billings when service levels ' are lower than
contracted amounts. Written iustification for failing to
deliver contracted service levels must be submitted with
billing whenever this deficit occurs . Adjustments enabling
PROVIDER to collect maximum monthly payment (s) for the
month(s) showing unit shortages will be made so long as
written justification for uneven service delivery is
submitted and justification is not in violation of the
requirements for delivery of services specified in Exhibit
A.
2.5 Invoices not acceptably submitted within forty-five (45)
days of the closing date of this Agreement shall not be
reimbursable.
2 .6 PROVIDER shall provide signature authorization to COUNTY as
{' shown in Exhibit B, page one ( 1 ) attached hereto and made a
part hereof.
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2 .7 Submission of accurate, timely documentation , and other
requested information as required by COUNTY shall be
considered a factor in evaluating future funding requests.
Invoices and/or documentation returned to PROVIDER for
corrections shall be cause for delay in receipt of
reimbursement .
2.8 PROVIDER represents to COUNTY that no other funds are used
for services invoiced to the COUNTY constituting duplication
j of funding, including banked units and COUNTY has relied
upon that representation.
2.9 PROVIDER shall keep accurate and complete records of any
fee, reimbursement, or compensation of any kind, assessed
against or collected from any client or other third party,
for any service covered by this Agreement, and shall make
all such records available to the COUNTY upon demand.
PROVIDER shall report such fee, reimbursement, compensation,
and funding to COUNTY for any such payments received for
each unit from all sources ( including the COUNTY) to the
extent such total payments exceed the actual cost per unit.
This reimbursement may be deducted from PROVIDER's invoices .
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2. 10 Reimbursements and notices shall be sent or given to the
PROVIDER at the following address:
City of Dania, Florida
Post Office Box 1708
Dania, Florida 11044
ARTICLE
TERM OF SERVICE
this A ement from October
Services shall be provided under gre 1 ,
1991 through September 30, 1992 .
ARTICLE IV
HON I�N�
The PROVIDER agrees:
4. 1 To provide the COUNTY with an overview of their agency ' s
,., objectives, number of
II ', activities including goals, outcome
clients served, demographic statistics, set forth in
to suu
Exhibit "A" Part II . PROVIDER agrees set
a mid-term
9
progress report to the daysd after march Services Section
S and lan annual
u due within thirty (30) day days
statistical statistical demographic report due thirty (30) day
September 30 (Form #609C-7) .
attend
4 . 2 To assign appropriate staff as ess the neualitry o meetings
Of service and make
for imp
with COUNTY staff to improvement.
recommendations
q Y
recommendations
Of
ent
4 .3 To maiainaccordntwith thany o Federal la or y State lllaws services
or regulations
with any
mandating suc la standardslity and
of ul ethics rd requiring
applicable professional
confidentiality -
ct
4 .4 To make all records pertaining to eligible clients by the
at all times to inspection, review and/or audit by
of , but
COUNTY. Required intmenta
theaitemsu shown ion Exhibits E tattached
not be limited to,
hereto and made a part hereof . Client case files shall not
be accessible to the COUNTY to the extent such access is in
violation of federal and state law.
4 .5 That monitoring reports originated periodically by
designated COUNTY staff and all the performance requirements
of this Agreement and timeliness of requested information
shall be considered a factor in evaluating future funding
requests .
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4 .6 To give representatives of the COUNTY full access to
PROVIDER's facilities for announced and unannounced site
visits for the purpose of observation of services and
examination of all records and data covered by this
Agreement, provided, however, client services shall not be
accessible to the COUNTY to the extent such access is in
violation of federal or state law.
4 .7 To make available, for review and evaluation by the COUNTY,
reports that measure the quality of services provided
pursuant to this Agreement. The aggregate reports shall be
compiled in a form mutually agreed upon by the parties and
shall contain a description of the methodology and necessary
instruments/tools used in its creation.
ARTICLE V
TERMINATION OF AGREEMENT
5. 1 This Agreement may be terminated by either party upon thirty
(30) days written notice.
5.2 COUNTY' s Board of County Commissioners shall be the final
ti authority as to the availability of funds and the allocation
j of available funds among social service providers. The
COUNTY reserves the right to terminate the services covered
by this Agreement in the event funds are unavailable.
5.3 If the PROVIDER fails to provide services called for by this
Agreement within the time specified herein or any extension
thereof, or if the PROVIDER fails to perform any of the
other provisions of this Agreement the COUNTY may , by
written notice of breach of the PROVIDER, terminate this
Agreement.
5.4 Termination, pursuant to Section 5 . 2 or 5. 3 shall be upon no
less than twenty-four (24) hours notice, in writing ,
delivered by certified mail, or in person, to the address
specified in Section 2.9 .
ARTICLE VI
RETENTION OF RECORDS
The PROVIDER shall preserve and make available all financial
records, supporting documents, statistical records, and any other
documents pertinent to this Agreement for a period of three (3)
years after termination of the term of service specified in
Section 2.9 , or, if an audit has been initiated and audit
findings have not been resolved at the end of those three (3 )
years, the records shall be retained until resolution of the
audit findings .
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ARTICLE VII
INDEPENDENT CONTRACTOR
The PROVIDER is an, independent contractor under this Agreement.
Services provided by the PROVIDER shall be by employees of the
PROVIDER and subject to supervision by the PROVIDER, and not as
officers, employees, or agents of COUNTY. Employee compensation,
personnel policies, tax responsibilities, social security and health
insurance, employee benefits, travel, per diem policies and other
similar administrative procedures applicable to services rendered
under this Agreement shall be those of the PROVIDER.
ARTICLE VIII
FINANCIAL STATEMENT
8. 1 The CONTRACTOR shall provide the COUNTY a special report by a
Certified Public Accountant, or by the entity's internal auditor
on the elements specified in the financial presentation
described in Section 8 . 3 below.
8 . 2 If the special report is prepared by an independent Certified
�y Public Accountant, it shall be in accordance with Section 623 of
the Codification of Statements on Auditing Standards as
promulgated by the American Institute of Certified Pubic
Accountants. If the special report is prepared by an internal
auditor, it shall be as nearly in accordance with that Section
as the status of the internal auditor permits, realizing that
?, the internal auditor may not issue the opinions required
' f therein.
,!
8 . 3 The Financial presentation shall show all revenues, by source
and all expenditures to include the classification set forth in
Exhibit "A" for each specific PROGRAM/PROJECT for which grant
funds were provided. The financial presentation shall
specifically disclose any funds received which were not expended
in accordance with the AGREEMENT (or with any regulations
incorporated by reference therein) . It shall specifically
disclose the interest computed as earned on these funds. It
shall identify the total of noncompliant expenditures and
interest earned as due back to the COUNTY.
8 .4 The reporting period for the financial disclosure information
described in 8. 1 and 8 . 2 above shall be the CONTRACTOR' s fiscal
year. The information shall be filed with the COUNTY within
sixty (60) days after the close of each of the CONTRACTOR' s
fiscal years in which the CONTRACTOR accounts for funds under
this Agreement .
8.5 Late submission of the financial statement shall result in
suspension of payment under this Agreement until the financial
statement is received and accepted by COUNTY, and shall be a
factor in evaluating future funding requests. Suspension of
payment shall not excuse PROVIDER from continued delivery of
services although COUNTY will not accept invoices until
financial statements are received and accepted by COUNTY.
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ARTICLE .IX
MANAGEMENT LETTERS
9. 1 PROVIDER shall provide to COUNTY' s Contract Administrator
for this Agreement any and all management letters arising
from audited financial statements• within ten ( 10) days of
receipt by PROVIDER.
9.2 PROVIDER shall provide to COUNTY's Contract Administrator
for this Agreement the schedule of corrections developed in
response to said management letter(s ) within thirty (30)
days of development.
9. 3 PROVIDER shall provide to COUNTY' s Contract Administrator
for this Agreement any compliance audits required by law
within one hundred twenty ( 120) days after the close of each
of the PROVIDER's fiscal years in which PROVIDER accounts
for funds under this Agreement.
ARTICLE X
EQUAL OPPORTUNITY FOR EMPLOYMENT AND SERVICES
10. 1 PROVIDER shall not discriminate against any employee or
applicant for employment because of race, age, religion,
a color, gender, national origin, marital status, physical or
mental handicap. PROVIDER shall take affirmative action to
insure applicants are employed and employees treated during
7 employment without regard to race, age, religion, color,
gender, national origin, marital status, physical or mental
handicap. Such actions shall include, but not be limited to
the following: employment, upgrading, demotion, transfer,
recruitment or recruitment advertising, layoff, termination,
rates of pay, other forms of compensation, terms and
conditions of employment and training, including
If apprenticeship.
10. 2 Decisions regarding client eligibility shall be made without
regard to, or consideration of race, age, religion, color,
gender, national origin, marital status, physical or mental
handicap or other factors which cannot be lawfully or
appropriately used as basis for service delivery.
ARTICLE XI
INDEMNIFICATION CLAUSE
11 . 1 PROVIDER shall indemnify and save harmless and defend
COUNTY, its agents, servants and employees from and against
any claim, demand or cause of action of whatsoever kind or
nature arising out of error, omission, or negligent act of
PROVIDER, its agents, servants or employees in the
performance of service under this Agreement.
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11. 2 PROVIDER further agrees to indemnify, save harmless and
defend COUNTY, its agents, servants and employees from and
against any claim, demand or 'cause of action of whatsoever
kind or nature arising out of any conduct or misconduct of
the PROVIDER not included in Paragraph 11. 1 above, and for
which the COUNTY, its agents, servants or employees are
alleged to be liable.
ARTICLE X1I
DESIGNATED REPRESENTATIVES.
The Contract Administrator for the 'COUNTY for this Agreement is
the Director of Broward County's Human Services Division or
designee. The representative of the PROVIDER responsible for the
administration of the program under this Agreement is the
k n Director, Personnel and Community Development.
ARTICLE XIII
,
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INSURANCE
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PROVIDER will maintain in force for tern of this Agreement,
y in the minimum amount c three
comprehensive general liabilit
hundred thousand dollars ($300,000 .00) per occurrence combined
^'. single limit of bodily injury and property damage liability.
,. , Such policy will name Broward County Board of County
Commissioners as additional insured. Further, the PROVIDER will
maintain professional liability insurance in the minimum amount
of three hundred thousand dollars ($300,000. 00) , subject to
insurance market availability. Such policies as required will be
evidenced to the COUNTY by ce ifica e(s)written of insurance
n u ance which will
reflect thirty (30) day prior
on
and/or non renewal.
ARTICLE XIV
AMENDMENTS, ASSIGNMENTS
14. 1 No modification, amendment or alteration in the terms or
conditions contained herein shall be effective unless
contained in a written document executed with the same
formality and of equal dignity herein.
14. 2 The PROVIDER shall not transfer or assign the performance of
services called for in the Agreement without the prior
written consent of the COUNTY.
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ARTICLE XV
WAIVER OR BREACH
Waiver or breach of any provision of this Agreement shall hot -be
deemed to be a waiver of any other subsequent breach and shall
not be construed to be a modification of the terms of this
Agreement .
ARTICLE XVI
REPRESENTATIONS AND ACKNOWLEDGMENTS
16. 1 PROVIDER acknowledges that:
a) There have been no irregularities involving its
management or employees that could have a material
affect on PROVIDER' s operations or stability.
b) There are no violations or possible violations of laws
li or regulations the effects of which should be
considered.
,{ {
{ c) There are properly recorded einat-he appropriate document(s ) .l transactions that have been
d) Related party transactions and related amounts
1'j receivable or payable have been properly recorded or
disclosed.
16 . 2 PROVIDER acknowledges that:
a) In order to obtain execution of this Agreement by the
Board of County Commissioners , PROVIDER's most recent
audited financial statements , compliance audit as
required by law, and management letter, if generated,
must be provided to, and reviewed and accepted by
COUNTY.
b) Submission of audited financial statements, compliance
audit as required by law and management letter( s) if
generated to any Department, Division, Office or other
entity of Broward County as a requirement for any
transaction or agreement with that Department, Division,
Office or other entity does not constitute compliance
with the requirements of this Agreement insofar as
submission of material to the Contract Administrator for
this Agreement is concerned.
c) The certificate of insurance, the Authorized Invoice
Signators and the Certification of Empowerment, as shown
in Exhibit "B" , pages one ( 1 ) and two ( 2) shall
accompany the Agreement upon execution of said contract
by PROVIDER.
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d) Information, guidance and technical assistance offered
by COUNTY's Contract Administrator for this Agreement,
the Contract• monitor and any other staff, whether
written .or verbal, in no way constitutes a guarantee of
execution of this . Agreement' by the Board of County
Commissioners.
e) Information guidance and technical assistance provided
prior to contract execution at the Contract Workshop
should not be relied upon as a basis for doing business,
delivering service, expending financial resources or
expectation of reimbursement or receipt of payment.
ARTICLE XVII
RENEWAL
A,II PROVIDER understands and acknowledges that, although its
successful and scrupulous performance under this Agreement will be
a factor considered by the COUNTY in evaluating future funding
1 requests , COUNTY funding under this Agreement relates exclusively
to the term of service specified in ARTICLE III herein and that
3 !� the COUNTY, by entering into this Agreement with the PROVIDER,
9
assumes no obligation whatsoever with respect to further or future
u � funding to this PROVIDER. Notice of renewal shall be given to
PROVIDER in writing no later than thirty (30) days before the
expiration of the initial term.
ARTICLE XVIII
RENEGOTIATION
The parties agree to renegotiate this Agreement if COUNTY
revisions of any applicable laws, regulations or increase/decrease
in allocations makes changes in this Agreement necessary.
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IN WITNESS WHEREOF , the parties hereto have made and executed
this Agreement on the respective dates under each signature : BROWARD
COUNTY through its BOARD OF COUNTY COMMISSIONERS, signing by and
through the County Administrator, authorized to execute same by Board .
action on the day of 19__ and PROVIDER signing
by and through its duly authorized
to execute same.
COUNTY
BROWARD COUNTY, through its
WITNESS : Broward County Administrator
County Administrator
day of 19_
Approved as to form and legality by
Office of County Attorney
Broward County, Florida
l JOHN J. COPELAN, JR.
County Attorney
�I
?, Governmental Center, Suite 432
115 South Andrews Avenue
Ii Fort Lauderdale, Florida 33301
R'.l( By
Assistant County Attorney
PROVIDER
City Name
Mayor
APPROVED AS TO LEGAL FORM:
City Manager City Clerk
City Attorney
(CITY SEAL)
day of 19_
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EXHII3I'r A
I. Scope of Service : (Reference Article I, Page .'. )
The PROVIDER agrees to provide a variety of structured supervised ' .
after school day care activities which will focus on enhancing and .
increasing academic and life skills and various recreational
activities to Broward County eligible children/siblings Pre-K through
five (5) enrolled in any City of Dania elementary schocl( s) .
II. Definition of Units of Service:
.A) A unit of service is defined as attendance to a session of one ( 1 )
to four ( 4) hours of daily after school day care by an eligible
child and his/her sibling (s) if enrolled in area schools in grades
K-5 or in a Pre-K program.
B) Subject to the deductions provided for in Subsection (C ) below,
the COUNTY agrees to reimburse the PROVIDER for each unit of
service during TERM OF SERVICE set forth in ARTICLE III of this
Agreement at a cost not to exceed $3 .75 per unit/session at a
�- maximum of $3, 000. 00 monthly or one tenth ( 1/10) the amount of
this Agreement.
l C) In the event the PROVIDER collects any fee or collects any
d reimbursement from a third party for services provided under this
Agreement, PROVIDER shall keep accurate and complete records of
all such fees collected and report such collection to COUNTY, and
1� reimbursement to PROVIDER.
D) It is understood that per unit cost from PROVIDER is $3 .75.
In residential placements, the COUNTY agrees to pay for the day of
admission but not for day of departure if departure occurs before
noon.
III. Project Program Information (as defined in Application
609C-1B, Pages 5 of 8, Item #17 )
IV. Internal Documentation Required for ttonitorinq ,
(see Exhibit E)
V. Monthly Invoices: (Reference Funding and Method of Payment ARTICLE II,
Pages 3, 4, and 5)
VI . Other Requirements:
Client Case Files: The PROVIDER agrees to maintain updated case files
on all clients. Files shall include, but not be limited to: name ,
date of birth, entry date, statement verifying client eligibility for
service, exit date and exit time .
Tracking System: The PROVIDER agrees to maintain a formal Tracking
System ( if applicable) of all clients referred to and from program,
identifying services referred for, services received, unavailability
of services, and feedback from agency client was referred to.
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PROJECTIPROGRAM INFORMATION
17
• PROJECT/PROGRAM TITLE: City of Dania - After School Care
Note:Then obleetiveemeybe ueed at part of the criteria in the monitoring of your organization.
Obisaiwlz) Af waty Componenthl Units of Service Outcome/9e.efit
IMeeturable•if eooheeblel
A. Educational 1 . Homework 1 . 50 children 1. Quarterly Pro-
Enrichment Helper at 1 unit per Gress Report
day. through School
system.
' Week to week
contact with
pupil and
teacher.
2 . Arts & Crafts 2 . All 60 chil- 2 • Each child will
Special/Holi- dren. complete one
day project a week .1
30-45 mins . Best will be
_q kW 23 kept for dis-
play.
I
3 . Reading Club 3 . 40 children 3 • Child will im-
` Grades 1-5 prove his/her
Twice weekly reading and
comprehension
skills.
Monthly report
from School
Teachers on
improvement or
I
progress .
4 ^ Drama Club 4 . 24 children 4 . Develop self-
' twice weekly expression and
learn to cope
with others.
Christmas and
Easter Holiday
programs .
B. Skills 5 . Dance 5 . All 60 chil- 5 . Develop motor
Athletics dren. skills and co-
operation with
others .
- 6 . Sewing Club 6 . 30 children. 6 . Build self-
reliance and
ability to
complete pro-
jects .
C. Other Misc . 7 . Daily: 7 . All children 7 . Activity sche-
Games - Movies dule posted
- Free Play daily.
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eerm no. 609-C-1 B Pap 5 of B
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EXHIBIT B
AUTHORIZED INVOICE SIGNATORS FOR :HUNICIPALITIES
Appearing below are samples of signatures authorized by the City ,
Commission of the City of nania , pinriria
as required by Broward County .
Signature Signature
MICHAEL W. SMITH, as MARDIE HOLLOWAY, as
Type Name Type Name
Personnel Director Recreation Coordinator
STATE OF FLORIDA
COUNTY OF BROWARD
Before me personally appeared
ji
j MICHAEL W. SMITiI, as Personnel Director
Name
and MARDIE HOLLOWAY, as Recreation Coordinator
Name
_w
r
to me well known and known to me to
be the person described in and who
executed the foregoing instrument,
I and acknowledged to and before me that
i
MICHAEL W. S:•iITH, as Personnel Director
and MARDIE HOLLOWAY . as Recreation Coordinator
Executed said instrument for the
purpose therein expressed .
(NOTARY SEAL) WITNESS my hand and official seal ,
this day of ,A.D. , 19al
Notary Public
State of Florida
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EXHIBIT C, PAGE 2
Public Services Department/Human Services Division .
Children's Services Section
Instructions for Contracted Services Invoice -- Form 609C-2
1. Legal name/legal address of agency under contract with Broward County.
2. Agency' s Federal Identification number.
3. Agency's contract number, as stated on page of contract .
4 . Name of contracted program.
5. Funding category .
1 6. Month and year for reimbursement request only .
7 1
7. Maximum contract dollar amount, as stated in the contract.
8. a) Monthly maximum contract amount.
b) tlonthly maximum units of service.
9. Total units of service provided this month not to exceed maximum.
10. Total fees collected divided by unit cost to equal converted units of
service. Indicate total amount of dollars collected also.
11. Total units of service minus converted units from fees collected ( if
applicable) .
12. Banked units to date.
13. Banked units applied this month.
14. Total units for reimbursement this month including banked.
15. Reimbursement request in dollars nct to exceed monthly maximum cap.
16. Comments: Explanation of under performance or over performance for the
current month, "+" or "-" five percent ( 5% ) only .
17. Certification: Legal name of agency under contract with Broward
County.
18. [dame of authorized signator as stated in Exhibit B-1 of contract.
19. Title of authorized signator.
20. Signature of person, as authorized in Exhibit B- 1 of contract.
21. Date invoice was signed by authorized signator.
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EXHIBIT D, PAGE 2
Public Services Department/Human Services . Division
Children' s Services Section
Instructions for Calendar Documentation -- Form 609C-3
L. Invoice Month and year.
2. Location of Service.
3. Name of client (or confidential code number of participant),
4. Date of birth of client .
7' 5. Date of client' s entry into contracted program. WK
6 Exit date of client (only if terminated or discharged) .
7. Original initials of authorized signator for certification.
8. Each block represents a day of the month. Indicate days or hours, per
n � day, that services were rendered (as per Contractual Agreement -
Exhibit A) .
9. Total units (for the month) .
10. Fees collected ( for the month) .
11. Grand total units ( for the whole page) .
12. Grand total fees collected ( for the whole page) .
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EXHIBIT E
INTERNAL DOCUMENTATION RFQUIRED FOR MONITORING
Days/[lours/Sessions of child day and after school care
- Client/parent (authorized) Gignature daily sign 'in and sign out
attendance sheets
- Hiring records (personnel files; personnel education requirements,
staff medical statements, criminal records clearance, and any other
pertinent information
- Daily routine and program log
- Meal and snack records
- Occupational license and license displayed
- Client billing and payment records to include third party
reimbursement, if applicable
q - Agency policy and procedures handbook
s - Unannounced site visits
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