HomeMy WebLinkAboutR-1992-147 I .1
RESOLUTION NO-
OF 1 : 7 -92
A RESOLUTION OF THE CITY OF DANIA, FLORIDA,
APPROVING THAT CERTAIN AGREEMENT BETWEEN
TBROARD O W AFTER COSCHOOL NDCARE,
THE CIAND PROVIDINGTY OF DIA RELATING FOR AN
EFFECTIVE DATE.
COMMISSION OF THE CITY OF DANIA,
BE IT RESOLVED BY THE CITY
FLORIDA:
section_ 1_ That that certain Agreement between Broward f
1 ter school care, a copy
County and the City of Dania relating to af
I of which is attached hereto as Exhibit "A" , be and the same is
hereby approved, and the appropriate city officials are hereby
directed to execute same.
} Section 2 . That Michael W. Smith, as Personnel Director, and a
tor, are hereby authorized to sign
Tim Tapp, as Recreation Direc
invoices and certification statements as required by said
monthly
"a
A
agreement.
Sect_ i�3_ This resolution shall be in force and take effect
i immediately upon its passage and adoption.
PASSED and ADOPTED this 27th day of
October 1992.
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MAYOR - ISSIONER
ATTEST:
rCITY CLERK - AUDITOR
APPROVED AS TO FORM AND CORRECTNESS
By: � 1 -
FRANK C. ADLER, City Attorney !f,
147-92 "
Resolution No.
444
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A G R E E M E N T
between
BROWARD COUNTY
and
CITY OF DANIA, FLORIDA
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Contract #93-6
Af to rschool Care
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between
BROWARD COUNTY
and
CITY OF DANIA, FLORIDA
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" ;
$ I AND
CITY OF DANIA, FLORIDA, a political subdivision of the State of
Florida , hereinafter referred to as "PROVIDER" . t
WHEREAS, this funding agreement will enable PROVIDER to
provide afterschool care services, not otherwise funded by any
other public and private funding source; and
WHEREAS , expenditures given to the PROVIDER have been found,
I determined and declared to be a county and public purpose by the
Boar] of County Commissioners of COUNTY;
NOW, THEREFORE, the parties agree as follows:
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1'Hki PROVIDER ag rcv ; L i
r -•;:�_ on nthiy basis the rt?Of-
Set forth in Exhibit A attathvu her,:to a;1tl ^.auc d part hereof .
ARTICLE II
j FUNDING AND NE'IHOD OF PAYMENT
2 . 1 The maximu reimbursable to
amount the PROVIDER by the
'.Y1 COUNTY under this Agreement shall be thirty thousand dollars
( $ 30,000.00) .
2 . 2 COUNTY agrees to reimburse for units actually delivered,
orret:tly invoiced and documented at unit price specified in
Exhibit A. Original invoice plus one copy are due on or
1 fifteenth of the following month, beginning on
before theonth
I the fifteenth COUNTY. COUNTY magrees fotoowreimburseemthe
execution by
PROVIDER on a monthly billing basis. No monthly bill shall
exceeunt
d that amount obtained by dividing
umber of lmonthsoset
payable under this agreement thin Y "TERM OF SERVICES" ,
forth in ARTICLE III of this Agreement, varies
except for those agencies whose cttold monthly wpayment
i funding period and the COUNTY agrees ment Schedule in
schedule as specified in the Activity/Pay
Exhibit A, if applicable .
in order to be deemed proper as def ined m the Florida
st comp
Prompt Payment Act, all invoices mu ly with the
requirements set forth in this Agreement and must be
j submitted on the form and pursuant to instructions
prescribed by the COUNTY, attached hereto and incorporated
i herein.
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1 COUNTY shall pay PROVIDER within thirty ( 30) calendar days
of receipt of PROVIDER' s properly submitted invoice in
accordance with the provisions of the COUNTY' s Prompt
payment Ordinance 89-49. All amounts not paid within thirty
( 30) days after the due date shall bear interest at a rate
of one percent per month on the unpaid amount .
2 . 3 t4onthly in submitted by PROVIDER shall include a
certification statement signed by an authorized person as
referenced in Exhibit B attached hereto and made a part
se rved by the PROVIDER is eligible
hereof , that each client
under this agreement. � t a notarized ome necessary
Of the
rized copy
PROVIDER to replace signators
authorizing resolution as passed by PROVIDER's Commissioners
shall be submitted to COUNTY's Contract Administrator for
this Agreement. A letter from the City Commission setting N
forth the reason for the action must accompany the notarized
copy , Both items must be submitted to COUNTY' s Contract
Administrator for
this Agreement on or before the fifteenth
of the following month.
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All :,tC ^ :nLatiy^. rcl:: it•r:: ! / this sa, Gion shall ne
rcl,ort ., a. yt.yinct: ana pt'ct;onto,: t:pon f ms prest ribcu by
r appr ;:•r.: !)I COUNTY Contra, L A:^intstraL.; r.
Invoit.e5 shall be ,cbmittct7 on Broward County Form i609C-2
revs in : xhibit C and calendar
ied 1992 as shown -
revoL sentation shall be submitted on Broward County Form
11 A609C-3 bearing the appropriate fisL.al year designation on
its face as shown in Exhibit D attached and made a part I ,
{ hereof , or other such form pre-approved by the Contract
I
1 Administrator. ( '
2 .4 PROVIDER may choose to document units delivered in excess of
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contracted levels and not paid by any other source. Units
I of service so documented may be used to augment subsequent
months' billings when service levels are lower than
contracted amounts. [4riGten iustification for failing to
deliver contracted service levels must be submitted with
billing whenever this deficit ocutrs . 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
i requirements for delivery of services specified in Exhibit
A.
2 . 5 Invoices not acceptably submitted within forty-five (45) t
days of the closing date of this Agreement shall not be
reimbursable.
j2 . 6 PROVIDER shall provide signature authorization to COUNTY as
shown in Exhibit B- I attached hereto and made a part hereof .
2 .7 Submission of accurate, timely documentation , and other
s requested information as required by COUNTY shall be
Lonsidered 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
of funding , including banked units and COUNTY has relied
upon that representation.
2 .9 PROVIDER shall keep accurate and complete records of any
a a,.
I 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 Y3
all such records available to the COUNTY upon demand.
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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
extant such total payments exceed the actual cost per unit. 4 :
This reimbursement may be deducted from PROVIDER's invoices. � W
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A;.TICLE III
1
TEiL'•S Or jE2'r Il'r:
Services shall b-_- provided under this Agreement from October, 1 ,
1992 through September 30, 1993 .
ARTICLE IV
MONITORING
The PROVIDER agrees: I
4 . 1 To provide the COUNTY with an overview of their agency' s �IIII
activities including goals, outcome objectives, number of
clients served, demographic, statistics , as set forth in
Exhibit A . PROVIDER agrees to submit a mid-term progress
report to the Children' s Services Section staff , due within f`
thirty ( 30) days after March 31 and an annual statistical
demographic report due thirty (30) days after September 30.
4 .2 To assign appropriate staff as necessary to attend meetings
with COUNTY staff to assess the quality of service and make '
recommendations for improvement.
4 . 3 COUNTY and PROVIDER shall maintain the confidentiality of
client services and records infull accord with any Federal
or State laws or regulations mandating such confidentiality
and in full accord with any applicable professional
standards of ethics requiring confidentiality .
4 .4 To make all records pertaining to eligible clients subject
at all times to inspection, review and/or audit by the
COUNTY. Required internal documentation may consist of, but
j not be limited to, the items shown in Exhibit E attached
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.
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. _
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COUNTY,
4 :7 To 1 nvaila:, iv, r prnvi::ed
.. 5cru Chu qua lit} of ervL,:
r.L;r:iva11� that v_'t
purscant tv a I( M r`:to 1t1 s hrecd33 by rthe partihets lan d
�'.r,^.tpiled in a Leer ( 3
shall l.Onta In a IIISL, rl[)titin Of
the CeL lJQp 10:J}' an'•7 nel.e59a P(
instruments/tools used in its creation.
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ARTICLE V
TERMINATION OF AGREEMENT
5 . 1 This Agreement may be terminated by either party upon thirty
( 30) days written notice .
i 5. 2 COUNTY' s hoard of County Commissioners shall be the final
j authority as to the availability of funds and the allocation
of available Funds among social service providers. The
terminate the services covered
COUNTY reserves the right to
by this Agreement in the event funds are unavailable.
5 . 3 IE the PROVIDER fails to provide services called for by this j
Agreement within the time specified herein or any extension I
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
Ag reement.
5 .4 Termination, pu
rsuant to Section 5 . 2 or 5. 3 shall be upon no ;
lesss than twenty-Four (24 ) hours notice, in writing ,
delivered by certified mail , or in person, to the address
specified in Article XIX.
ARTICLE VI
RETENTION OF RECORDS
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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
Article III , 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 .
ARTICLE VII
INDEPENDENT CONTRACTOR
F;
The PROVIDER is an independent contractor under this Agreement. I
Services provided by the PROVIDER shall be by employees of the l
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
t
and other similar administrative procedures applicable tom, +.
services rendered under this Agreement shall be those of thet :; x
PROVIDER.
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ARTICI-F VI II
PINANCIA1, ;TATrMEr,
8 . 1 The CONTRACTOR shall provide the COUNTY a special report by
r ''�` a Cc rt if icd Pub1 it AL ountant, or by the entity's internal
auditor cn the elements specified in the Financial
presentation dCSL. ribed in Section 8. 3 below .
8 . 2 If the special report is prepared by an independent
Certified 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 therein.
l8 . 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.
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.
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9 . 2 PROVIDER : ,itl i�r`;vi�e t` COUNTY' s Contract Adr..inistrator
d in
fur this Agreement the schedule of correWithin ctions dthirty„ ( 30)
response to said management letters)
days of development.
9 . 3 PROVIDER shall provide to COUNTY' s Contract Administrator
for this Agreement any compliance audits required within one hundred twenty ( 120) days after the close off
each
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of the PROVIDER' s fiscal years in which PROVIDER accounts
for funds under this Agreement. I
ARTICLE Y
EQUAL OPPORTUNITY FOR EMPLOYMENT AND SERVICES
10 . 1 PROVIDER shall not discriminate against any employee or
applicant for employment because of race, age, religion,
ational origin,color, gender, ngin,
marital status, physical or
i mental handicap. PROVIDER shall take affee a[reatedve tduring
ion to
{ insure applicants are employed and employ reli ion, color,
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employment with regard to race, age' or mental
gender, national origin, marital status, physical
handicap. Such actions shall in upgrading,,b demotion,ut not be ltransfer�
the following: employment, up9 g
recruitment or recruitment�rmeformsVeofisc mpensation, te ermstiand
rates of pay' and training, including
conditions of employment
apprenticeship. The PROVIDER agrees to furnish COUNTY upon
request , a copy of its Affirmative Action Policy.
client eligibility shall be made without
10 .2 Decisions regarding religion, color,
regard to, or consideration of race, age' 9
rital status, physical sical or mental
gender, national origin, ma
which cannot be lawfully or
handicap or other factors
appropriately used as a basis for service delivery .
ARTICLE XI
INDEMNIFICATION CLAUSE
R shal indemnify and
11 . 1 To savet� harmless pandldefendy COUNTY its agentsl servants and
` employees from and against any claim, demand or cause of
{
action of whatsoever kind or nature arising out of error.
ants
omission, or negligent a of PROVIDER,
serviits ce
tunder�this
or employees in the per
Agreement. Neither PROVIDER nor the COUNTY waives any
immunity it may have by law .
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l,,w , PROVIDER crtaer cn; rves t.
11 . 2 To th e cx.t•ar:t n rri tt...: . ,' aents ,
indemnify, save harTrless and defend COUNTY, its
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i :in Nan tS and employees fro-r. an:1 against any claim, demand Or
C al;sC Of acC lOn Of whatsGever kind Or nature arising Out Of
any conduct or misconduct of the PROVIDER not included in
I Paragraph 11 . 1 above, and fors re alleged to which the COUNTY, its agents ,
servants PROVIDER orer
employee
cthe oCOUNTYa waives any immun�ityiabl may have by
law .
j ARTICLE XII
1
1 DESIGNATED REPRESENTATIVES
i{ I•he Contract Administrator for the COUNTY for this Agreement is
the Director of Broward County's Social Services Division or
the
designee. The representat=oe Of ram tundehe ROVshEs responsible
is the
administration of the p 9
d Community Development.
Director, Personnel an
ARTIC_ 1_ F XIII j
INSURANCE
PROVIDER shall submit a certification of to su ancinvoie to rbei g
rd
County' s Risk Management Division prior
paid .
ARTICLE XIV
AMENDMENTS, ASSIGNMENTS
14 . 1 No modification, amendment nor alteration in the terms or
j: conditions contained he shall be effective unless
contained in a written document executed with t e same
f' formality and of equal dignity herein.
1 .1 . 2 The PROVIDER shall not transfer nor assign the performance
of services called for in the Agreement without the prior
written consent of the COUNTY.
3 ARTICLE XV
WAIVER OR BREACH
t7aiver or breach of any provision of this Agreement shall not be
deemed to be a waiver of any other subsequent breach and shall
of this
not be construed to be a modification of the terms
Agreement .
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116. 1 PROVIDER acknowledges that: f
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a) There have been no irregularities involving its f
'i management or employees that coulu have a material
affect on PROVIDER' s operations or stability.
b) There are no violations or possible violations of laws
or regulations the effects of which should be
considered .
c ) There are no material transactions that have not been
properly recorded in the appropriate document( s) .
l (1 ) Related party transactions and related amounts
receivable or payable have been properly recorded or
t 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
requi red 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-1 and/or B-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
I verbal, in no way constitutes a guarantee of execution of
j this Agreement by the Board of County Commissioners .
i
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
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
requests, COUNTY funding under this Agreement relates exclusively
to the term of service specified in ARTICLE III herein and that
the COUNTY, by entering into this Agreement with the PROVIDER,
assumes no obligation whatsoever with respect to further or
future funding to this PROVIDER. NOTICE of renewal shall be
l given to PROVIDER in writing no later than thirty (30) days
before the expiration of the initial term.
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ARTICLE XVIII
RENEGOTIATION
The parties agree to renegotiate this Agreement if COUNTY
revisions of any applicable law, regulations or increase/
decrease in allocations make changes in this Agreement
necessary.
ARTICLE XIX
REIMBURSEMENTS AND NOTICES
The parties agree that whenever either party desires to give
notice unto the other under the terms of this Agreement, it must
be given by written notice, sent by registered United States mail ,
with return receipt requested, addressed to the party for whom it
j is intended, at the place last specified and the place for giving
of notice shall remain such until it shall have been changed by
written notice in compliance with the provisions of this
paragraph. For the present, the parties deFignate the following
as the respective places for reimbursements ana giving of notice,
to-wit:
COUNTY: Children's Services Section
Broward County Governmental Center
115 South Andrews Avenue, Room 324-A
Fort Lauderdale, Florida 33301
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PROVIDER: City of Dania I
Post Office 1708 '
Dania, Florida 33044 j
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ARTICLE XX f
ATTORNEY FEES
F
The PROVIDER understands and acknowledges that if COUNTY incurs any
expenses in enforcing the terms of this Agreement, whether suit be
brought or not, PROVIDER agrees to pay all such costs and expenses
including, but not limited to, court costs, interest and reasonable
attorney's fees.
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IN wi,r1ESS WHEREOF , the parties hereto have made and executed i
this Agreement on the respective dates under each signature : COUNTY
� '.<. through its BOARD OF COUNTY COMMISSIONERS, signing by and through its
Chairman or Vice Chairman, authorized to execute same by Board action
on the day of 19 and PROVIDER, signing by
and through its duly authorized to execute same.
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COUNTY
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BROHARD COUNTY, through its I
ATTEST:
BOARD OF COUNTY COMMISSIONERS
Deputy Administrator and
Ex-Officio Clerk of the Chairman
Board of County Commissioners
of Broward County, Florida
Approved as to form and legality
by the Office of County Attorney
Browara County, Florida
JOHN J. COPELAN, JR.
County Attorney
Governmental Center, Suite 423
115 South Andrews Avenue
Fort Lauderdale, Florida 33301
By
Assistant County Attorney
PROVIDER
CITY OF DANIA
City Name
Mayor `{
APPROVED AS TO LEGAL FORM: Bill Hyde , Mayor
Print Name and Title I
I '
City Manager City Clerk j
Robert F. Flatley Wanda Mullikin
City Attorney
Frank Adler (CITY SEAL)
day of 19_
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I . :mope of Servii , ( Refs- nrn� o Artie 1 I , Pa 3 )
7 The PROVIDER agree; to prcJi.i•_ a variety of structured afCarschool i
day care activities which will fO, CS on enhancing and increasing
a C ad en it. and Iif•; skills and various recreational activities to
Prcward County eligible children/siblings, Pre-K through five ( 5 )
enrolled in any City of Dania elementary schools)
I �
IT . 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 afterschool day care by an eligible
child and his/her sibliny ( s) if enrolled in area schools in grades
K-5 or in a Pre-K program. f "
D . Subject to the deductions provided for in Subsection (C) below,
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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 fff
maximum of $3, 000. 00 monthly or one tenth ( 1/10) the amount of
this Agreement .
C . In the event the PROVIDER collects any fee or collects any
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
reimbursement to PROVIDER.
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D. It is understood that per unit cost from PROVIDER is $3 J5 .
III . Project Program Information (as defined in Application
609C- 111, Pages 5 of 8, Item 17 )
IV. Internal Documentation Required for Monitoring
( see Exhibit E)
V. Monthly Invoices: (Reference Funding and Method of Payment ARTICLE II,
Pages 3, 4 , and 5)
V1 . 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, f
date of birth, entry date, statement verifying client eligibility for < 4'
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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City of Dania - Afterschool Care
ii:r�,c ,.!; }cct ]vc•, .-a•: urcd ❑s part .+t the criteria In the mnn'.torin}: of i -
3 Outcome/Benefit
--- -- uhiv Live(-O Activ itv (:o v:p un e n t I sl Cnits of Service (?Je:u:urable if
appl h i
. � 1 . Educational Homework 50 children at 1 unit a. Quarterly progress
per day. Report through
Enrichment Helper School system.
Week to week con-
Minumum of one tact with pupil and
hour of strut- teacher.
tured homework
time. b. Measure Report card
improvement from is
report to last of
the year. r;
c. Attendance per
child.
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d. Attrition per child
e. Demographics
t � rafts a. All 60 children a. Each child will cum
Skills a. Arts S C plete one project
Special/Holiday a week. Beat will
30-45 minutes be kept for display
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b. Reading Club. b. 40 children b. Child will improve
Grades 1-5 his/her reading and
Twice weekly comprehension skill:
Monthly report from
School Teachers on
improvement or pro-
gress.
C. 24 children
c. Drama Club C.
Develop self-expre-
Twice weekly
scion and learn to
cope with others.
Christmas and
Easter Holiday pro-
grams.
d. Dance Athletics d. All 60 children. d. Devandlop motor skill
cooperation witl
others.
e. 30 children e. Build self-reliance
e. Sewing Club
and ability to com-
plete projects.
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Outcome/Benefit
(lh lcct !vc(r;) Activity Compunent (s) l'nits of Service (Mear,urable if
.1
3. Other Misc. Daily: Games-Movies
Free Play - All children Activity Schedule j
I posted daily.
I 4. Networking Collaboration Referrals a. 0 of referrals
Activities Efforts b. Type of referrals
c. Outcome of
� referral
5. Client Administer a satis- 1001 of the parents A mimimum if 90% of
Satisfaction faction survey to of the children en- the parents will re-
parents. rolled during 3/93 fleet satisfaction
will complete a with after school care
client satisfaction in client satisfaction
survey in 9/93. survey.
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AUTHORIZEDINVOICE. SIGNATORS FOR MUNICIPALITIES
t"
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Appoarin•� below are samples of signatures authorized by the City j
the City of Dania,
Commission of �
as required by Browa rd County.
Signature
Signature
Michael W. Smith Tim Tapp
Type Name
Type Name
STATE OF FLORIDA
Browa d
COUNTY OF
' Before me personally appeared
Michael W. Smith as Personnel Director
Name and Title
Tim Tapp as Recreation Director
and
Name and Title
to me well known and known to me to
be the person described in and who
executed the foregoing instrument,
and acknowledged to and before me that
they
-arcd-
Executed said instrument for the
purpose therein expressed.
WITNESS my hand and official seal ,
(NOTARY SEAL) j
I this day of ,A.D. , 19_ [
1 !.
4
Notary Public
State of Florida
F
9.
_ Name of Notary printed typed
Commis (?n No. 3
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NmTa of Clounty CovutuN BX Ifs.!#owdfA County.Honda
CONTRACTED SERVICES INVOICE SOCIAL SERVICES DIVISIOWChlldren's Services Section
2 Federal Identification Number
1. Non•Prold Organization or Govmnmunlal Entity
Addtoss
9. Contract Number 4. Name of Contracted Program
mayy:.F
R J
6. For the Month and Year ? .Mnual Maximum Contract Amounts.,
" 5. Funding Category �s.;.
6b. monthly Maximum units of Service 9. Total Units of Service Provided This Month
Y +�
ea. Monthly Maximum Contract Amount
6'
C
4
Uni
10. Total Fees Collected Divided by Unit Cost Equals 11. Total Units of Sees Minus Converted Units from 12. Banked Units To Dale 13. TTh sked Month Is Applied
Service _
Converted Units of Service Fees Collected (d applicable) ^.
i
15. Reimbursement Requested 16. Comments: Explanation of Under Performance or rs
14. Total Lints for Raunbutsomenl This Month Over Performance + or - 5%
Co
1 e
FOR COUNTY USE ONLY CERTIFICATION: The undersigned, as an authorized ' F.
signature for this contract between Broward County,
and
- Fund _ _ Agency .------ -- --- — -- — 17. tt
hereby affirms and certifies that the service billed here- t
Organization _- _ __ Object _ _——_—____------ with has been rendered on behalf of Broward County, t
that all clients served have met program eligibility
Date Invoice Received by County Contract Administrator: ___—_ — requirements, that all fees collected have been duly
deducted, and that sufficient written Information is
',ate or Inaccuracy Penalty Applied: ❑ Yes ❑ No available to document services and fees reported___,--_ -
2oico Received By —.— Date Approved Signature: —
18.
Invoice Reviewed By Date Type dame
Date 19. i
Invoice Approved By ------ ---- Type Toe
Signature: 20.
Date Forwarded to Accounting
Date: ?I —_
609C 2lRev.711,921 - --------^^���^
EXHIBIT C, PAGE 2
Hu:z+ui Services Departeent/Social Services Di•:ision
Children's Services Section
Instructions for Contracted Services Invoice -- Form 609C-2
name/legal address of agency under contract with Broward County. -
2 Agency's Federal Identification number.
`.� 3. Ageiic/'c: contract number, as Ltated on title pale ui contract.
{ 4. Name of contracted pru6rc:,. is
5. Funding category, i.e. coutinufng, one-time/capital, one-time/emergency and NPO. [l
6. Month and year for reiLiuuraement request only. f
7 . Maximum contract dollar ::mount, is stated In the contract.
8. a) Monthly maximum contract amount.
{� b) Monthly maximum units of service. ;
' III 9. Total units of service provided this month, (including banked units)
10. Total fees collected divided by unit cost to equal converted units of service,
i (if applicable)
11 . Total units of service minus converted units from fees collected (if applicable) .
12. Banked units Y-T-D. (cumulative total) .
13. Banked units applied this month.
14. Total units for reimbursement this month including banked units. (not to exceed
monthly Maximum units of service) .
15. Reimbursement request in dollars not to exceed monthly maximum contract amount.
{ 16. Comments: Explanation of under performance or over performance for the current
month, "!" or " five percent (5%). Attach explanation on additional
sheet/sheets to monthly invoice.
17. Certification: Legal name of agency under contract with Broward County. i
18. Name of authorized signator as stated in Exhibit B-1 of contract. C'
f. .
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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SOCIAL SERVICES DIVISIONICHILDREN'S SERVICES SECTION Loc ltron of ServlCes 4a-
LENDAR DOCUMENTATIONJ •.
F.Y. 19
10 11 12 13 14 15 16 17 1 19 20 21 22 23 24 25 26 27 28 29 30 31 x �,
1 2 3 4 5 6 7 8 9 Y
rrir+tl r'n Comments Total Units: _ Fees Collected:
E _ ____-------
IIuVWalc -
1
Fni D:dre CerLbed Ely { `
5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 213 ,21 22 23 24 25 28 27 2 29
1 2 3 4
1 I '
-- .- — Fees Collected:.--------------
ilni,a:Im Entry D110 _ Comments Total Units:
I,
CaAhed BY
6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 2 24 2 2 27 2 29 0
r lamo 1
fiuthd.de Entry Darin Comments Total Units: -------
Fees Collected:._.-----
I.%II Date CerGtred Ely -...,.
1 2 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1
3 4 5
de Comments _ Fees Collected:
Fnlry D.
tlnud;rto Total Units:
F.,I D.nv Certdwd By
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Name
r:
nnndna, Entry Date Comments Total Units: _.._ _ ... . ._.
Fees Collected:_.. .
Grand Total Fees Collected:
I q DaW Cerldbed BY Grand Total Units:
r, .•, (TIC 1 in•..; ;•,a
u�
EXHIHiT D, PAGE 2
y Human Services Department/Social Services Division f
Children's Services Section
k.,
Instructions for Calendar Documentation -- Form 609C-3
�^E
1 . Invoice Month and year.
2 . Location of Service.
3 . Name of client (or confidential code number of participant) .
I'
A . Date of birth of c. lient .
5. Date of client' s entry into contracted program. 4
6. Exit date of client (only if terminated or discharged ) .
7 . Original initials of authorized signator for certification.
4<'
i
8. Each block represents a day of the month. Indicate days or hours, per
{ 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 REQUIRED FOR MONITORING
F
Days/Hours/Sessions of child day and after school care
- Client/parent (authorized) signature daily sign in and sign out
attendance sheets
Client file as required; client registration form, and any other
pertinent information
Hiring records (personnel files; personnel education requirements,
staff medical statements, criminal records clearance, and any other
pertinent information)
is
Daily routine and program log
- Occupational license and license displayed !�
- Unannounced site visits t
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