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HomeMy WebLinkAboutRequirements Emergency Hotel Motel PlacementAttachment A The City of Miami Scope of Services Requirements of the Emer«ency Hotel/Motel Placement Program: The Provider agrees to provide emergency hotel/motel placements of homeless families with children for a period of up to seven (7) days in area hotels/motels. Families may be provided food vouchers on an as -needed basis of up to $20.00 per diem while residing in hotels/motels. Families with more than four (4) members may be provided an additional $5.00 per person per day. Reimbursements will only he made for properly documented disbursement of food vouchers. . All reimbursements must be submitted to the County by the 15t day of each month following the month of service. All reimbursement requests must be approved by the County prior to the disbursement of funds. Requirements of the Feeding Coordination Program: The Provider shall coordinate feeding programs for the homeless in the City of Miami to ensure feeding is conducted in a clean, convenient and humane environment. The Community Liaison/Feeding Coordinator shall develop and maintain a list of all participating organizations and homeless individuals no later that thirty (30) days prior to the end of each quarter; distribute correspondence as needed to participating organizations; and ensure the coordination of outreach activities at the feeding sites listed below: is Camillus House, Inc. 726 NE l"Avenue Miami, Florida 33136 • Miami Rescue Mission 2020 NE 1' Avenue Miami, Florida 33127 • Mount Zion Baptist Church 301 NW 9`h Street Miami., Florida 33136 Rey uirements of the HMIS Staffing Program: The Provider shall provide a dedicated HMIS Outreach staff person. The purpose of this staff position is to maintain data current in the 1-iMIS and includes, but is not limited to input of client data upon intake, updates of client files, compilation of reports and entering data for statistical purposes. Failure to maintain this data current, as evidenced by HMIS generated Monthly Progress Reports (MPR) submitted to the County each month under the United States Housing and Urban Developnment (USHUD) sub -recipient Agreement between the Provider and the County may result in the termination of this Agreement. • Attachment B, Page 1 of 3 The City of Miami Emergency Hotel/Motel Placement — PC-1011-HTMT-1 CITY OF MIAMI HOMELESS ASSISTANCE PROGRAM Emergency Hotel/Motel Placement 2010-2011 Contract Amendment BUDGET Object Class Cost MDHT % City of Miami % Justification Emergency Housing, Hotel/Motel 1400 days/units @ $50.00 per day $100,000.00 100% Emergency Hotel/Motel placements for eligible families due to unavailability of beds within the continuum of care Food Vouchers 250 vouchers @ $20.00 per voucher $12,500.00 100% Food vouchers for eligible families. TOTAL $112,500.00 1 Attachment B-Page 2 of 3 The City of Miami Feeding Coordinator Program-PC-1011-FC CITY OF MIAMI HOMELESS ASSISTANCE PROGRAM Feeding Coordinator 2010-2011 Contract Amendment BUDGET Object Class Cost MDHT % Feeding Contract MDHT % MOA Justification 1. Staffing Personnel -Salary 1 FT Homeless Program Feeding Coordinator @ $14.49/h $32,445 46 % 54% Salaries for the City of Miami Homeless Program Feeding Coordinator TOTAL $32,445 $15,000 $17,445 1 Attachment B The City of Miami HMIS Staffing — PC-1011-HMIS-1 CITY OF MIAMI HOMELESS ASSISTANCE PROGRAM Homeless Management Information System 2010-2011 Contract Amendment BUDGET Object Class Cost MDCHT HMIS Contract % MDCHT MOA Contract % Justification 1. Supportive Service Costs Personnel -Salary 1 FT Homeless Program Clerk. HMIS Administrator @$14.49/h $32,445 76 % 24 % Salaries for the City of Miami Homeless Program HMIS Administrator • TOTAL $24,600 $7,845 1 MIAM COL Nf f Carlos Alvarez, Mayor October 15, 2010 Mr. Carlos Migoya, City Manager c/o Sergio Torres, Program Director City of Miami 1490 NW 3rd Avenue, Suite 103 Miami, FL 33130 Homeless Trust 111 NW 1st Street • 27th Floor • Suite 310 Miami, Florida 33128-1930 T 305-375-1490 F 305-375-2722 RE: 2010-2011Primary Care Program — The City of Miami Extension and Amendment of the Grant Agreement for the HMIS, Emergency Hotel/Motel Placement and Feeding Coordination Program Dear Mr. Migoya: miamidade.gov Enclosed, please find for your review, the Amendment of the Agreement between Miami -Dade County, through the Miami -Dade County Homeless Trust and The City of Miami to provide housing and services to the homeless individuals in Miami -Dade County. Please review the Agreement thoroughly, as well as the attachments and become familiar with the amended contract language. In addition, please include an updated Attachment A, Scope of Services, and Attachment B, Budget for the 2010-2011 contract year. Please sign and complete all three (3) copies of the Extension and Amendment Agreement and return it to our office, attention Terrell T. Ellis, Contract Monitoring and Management Supervisor no later than Tuesday, October 26, 2010. One fully executed Agreement will be returned to your agency for your files. Mimi -Dade County requires that the President/Chairman of the Board execute the Agreement on behalf of the agency. However, the Executive Director may execute the Agreement if approved by a resolution of the agency's Board. A copy of the applicable Board resolution(s) must be submitted with the Ageement. In addition, the corporate seal must be affixed to the signature page of the document. The Miami -Dade County Homeless Trust looks forward to continuing work with your agency in implementing this project. If you have any . estio:s, please contact me or Tenell T. Ellis, Contract Monitoring and Management Supervis. •-at 305) 37 David Raymo d Executive Director Enclosures I have received the Agreements for the abovementioned grants. Signature of Authorized Agency Representative Printed Name of Agency Representative Date EXTENSION AND AMENDMENT #1 OF THE AGREEMENT BETWEEN MIAMI-DARE COUNTY AND THE CITY OF MIAMI HOTEL/MOTEL PLACEMENT PROGRAM/CONTRACT #PC-1011-HTMT-1 FEEDING COORDINATION PROGRAM/CONTRACT #PC-1011-FC HMIS STAFFING PROGRAM/CONTRACT #PC-1011-HMIS-1 THIS AMENDMENT OF AGREEMENT (the "Agreement Amendment") is made as of by and between Miami -Dade County, through the Miami -Dade County Homeless Trust (the "County") and The City of Miami, a provider of services to homeless individuals, hereinafter referred to as the "Provider". WITNESSETH: WHEREAS, On February 1, 2010, the County and the Provider entered into an Agreement ("Agreement") which provides funding for the provision of housing and services to homeless individuals in Miami -Dade County. WHEREAS, this Agreement provides for certain rights and responsibilities of the County; and WHEREAS, the Agreement allows for amendments and extensions at the sole discretion of the County; and WFIFREAS, the County is desirous of amending the Agreement pursuant to the terms of the Agreement; NOW, THEREFORE, BE IT RESOLVED, for and consideration of the mutual agreements between the County and the Provider, which are set forth in this Amendment of the Agreement, the receipt and sufficiency of which are acknowledged, the County and the Provider amend this Agreement as follows: ARTICLE I — Recitals The foregoing recitals are true and correct and constitute a part of this Amendment of the Agreement. ARTICLE II — Ratification of the Agreement Other than expressly modified or amended herein, all other terms and conditions of the Agreement shall remain in full force and effect. The City of Miami agency Hotel/Motel Placement Program (PC-10 11-HTMT-1), Feeding Coordination (PC-)O11-FC), HM1S Staffing (PC-1011-HMIS-1) ARTICLE III — Amendments reement is hereby amended as follows: 2 is replaced as follows: 'LE 2. AMOUNT PAYABLE. t to available funds, the maximum amount payable for services rendered under this shall not exceed: 1. Emergency Hotel/Motel Placement Program 2. Feeding Coordination Program 3. HMIS Staffing Program $ 112,500.00 $ 15,000.00 $ 24,666.00 Total Contract Amount $152,166.00 arties agree that should available County funding be reduced, the amount payable under ntract may be proportionately reduced at the sole discretion and option of the County. vices undertaken by the Provider before the County's execution of this Contract shall be at vider's risk and expense. e responsibility of the Provider to maintain sufficient financial resources to meet the 3s incurred during the period between the provision of services and payment by the .unty, at its sole discretion, may allow Provider an advance of N/A once the Provider emitted an appropriate request and submitted an invoice in the form required by the 3 is replaced as follows: LE 3. SCOPE OF SERVICES The Provider shall render services in accordance with the 2010-2011 Scope of Services rated herein and attached hereto as Attachment A. The Provider shall implement the Scope of Services as described in Attachment A in a deemed satisfactory to the County. Any modification or amendment to the Scope of s shall not be effective until approved by the County and Provider in writing. 2 The City of Miami Emergency Hotel/Motel Placement Program (PC-1011-HTMT-1), Feeding Coordination (PC-I0I I-FC), HMIS Staffing (PC-I011-HMIS-1) Article 4 is replaced as follows: ARTICLE 4. BUDGET SUMMARY The Provider agrees that all expenditures or costs shall be made in accordance with the 2010-2011 Budget, which is attached hereto and incorporated herein as Attachment B. The parties agree that the Provider may, with the County's prior written approval; revise the schedule of payments or the line item budget, and such revision shall not require an amendment to this Contract. Article 5 is replaced as follows: ARTICLE 5. EFFECTIVE TERM Both parties agree that the Effective Term of this Contract shall commence on October 1, 2010 and terminate at the close of business on September 30, 2011. Contingent of the existence of sufficient funding and the approval of the County, this Contract may be extended for one (1) additional one (1) year term, at the County's sole discretion. SIGNATURES APPEAR ON THE FOLLOWING PAGE 3 The City of Miami Emergency Hotel/Motel Placement (PC10-11-HTMT-1), Feeding Coordination (PC1011-FC), HMIS Staffing (PC1011-HMIS-1) IN WITNESS WHEREOF, the parties have caused this five (5) page Amendment of the Agreement to be executed by their respective and duly authorized officers the day and year first above written. THE CITY OF MIAMI By: Name: CARLOS A. MIGOYA Title: CITY MANAGER Date: By: Name: PRISCILLA A. THOMPSON Titie: CITY CLERK Date: Approved as to Form and Correctness: By: Name: JULIE O. BRU Title: CITY ATTORNEY Date: 4 MIAMI-DADE COUNTY, FLORIDA By: Name: Title: Date: Attest: HARVEY RUVIN, Clerk Board of County Commissioners By: Print Name: Attachment A The City of ?Miami Scope of Services Requirements of the Emerfjency Hotel/Motel Placement Program: The Provider • agrees to provide emergency hotel/motel placements of homeless families will children for a period of up to seven (7) days in area motels/motels. Families may be provided food vouchers on an as -needed basis of up to $20.00 per diem while residing in hotels/motels. Families with more than four (4) members may be provided an additional $5.00 per person per day. Reimbursements will only he made for properly documented disbursement of food vouchers. All reimbursements must be submitted to the County by the 154 day of each month following the month of service. All reimbursement requests must be approved by the County prior to the disbursement of funds. Requirements of the Feeding Coordination Program: The Provider shall coordinate feeding programs for the homeless in the City of Miami to ensure feeding is conducted in a clean, convenient and humane environment. The Community Liaison/Feeding Coordinator shall develop and maintain a list of all participating, organizations and homeless individuals no later that thirty (30) days prior to the end of each quarter; distribute correspondence as needed to participating organizations; and ensure the coordination of outreach activities at the feeding sites listed below: • Camillus House, Inc. 726 NE l ' Avenue Miami, Florida 33136 a . Miami Rescue Mission 2020 NE 151 Avenue Miami, Florida 33127 • Mount Zion Baptist Church 301 NW 9th Street Miami, Florida 33136 Requirements of the HMIS Staffing Program: The Provider shall provide a dedicated HMIS Outreach staff person. The purpose of this staff position is to maintain data current in the HMIS and includes, but is not limited to input of client data upon intake, updates of client files, compilation of reports and entering data for statistical purposes. Failure to maintain this data current. as evidenced by HMiS generated Monthly Progress Reports (MPR) submitted to the County each month under the United States Housing and Urban Development (L]SHUD) sub -recipient Agreement between the Provider and the County may result in the termination of this Agreement. Attachment B, Page 1 of 3 The City of Miami Emergency Hotel/Motel Placement — PC-1011-HTMT-1 CITY OF MIAMI HOMELESS ASSISTANCE PROGRAM Emergency Hotel/Motel Placement 2010-2011 Contract Amendment BUDGET Object Class Cost MDHT % City of Miami . % Justification Emergency Housing, Hotel/Motel 1400 days/units @ $50.00 per day $100,000.00 100% Emergency Hotel/Motel placements for eligible families due to unavailability of beds within the continuum of care Food Vouchers 250 vouchers @ $20.00 per voucher $12,500.00 100% Food vouchers for eligible families. TOTAL $112,500.00 1 Attachment B-Page 2 of 3 The City of Miami Feeding Coordinator Program-PC-1011-FC CITY OF MIAMI HOMELESS ASSISTANCE PROGRAM Feeding Coordinator 2010-2011 Contract Amendment BUDGET Object Class Cost MDHT % Feeding Contract MDHT % MOA Justification 1. Staffing Personnel -Salary 1 FT Homeless Program Feeding Coordinator @ $14.49/h $32,445 46 % 54% Salaries for the City of Miami Homeless Program Feeding Coordinator TOTAL $32,445 $15,000 $17,445 1 Attachment B The City of Miami HMIS Staffing — PC-1011-HMIS-1 CITY OF MIAMI HOMELESS ASSISTANCE PROGRAM Homeless Management Information System 2010-2011 Contract Amendment BUDGET Ob'ect Class Cost MDCHT HMIS Contract % MDCHT MOA Contract % Justification 1. Supportive Service Costs Personnel -Salary 1 FT Homeless Program Clerk. HMIS Administrator @$14.49/h $32,445 76 % 24 % Salaries for the City of Miami Homeless Program HMIS Administrator TOTAL $24,600 $7,845 Homeless Trust t 11 NW 1st Street • 27th Floor • Suite 310 Miami, Florida 33128-1930 T 305-375-1490 F 305-375-2722 Carlos Alvarez, Mayor October 15, 2010 Mr. Carlos Migoya, City Manager c/o Sergio Torres, Program Director City of Miami 1490 NW 3`d Avenue, Suite 103 Miami, FL 33130 RE: 2010-2011Primary Care Program — The City of Miami Extension and Amendment of the Grant Agreement for the IIMIS, Emergency Hotel/Motel Placement and Feeding Coordination Program Dear Mr. Migoya: miamidade.gov Enclosed, please find for your review, the Amendment of the Agreement between Miami -Dade County, through the Miami -Dade County Homeless Trust and The City of Miami to provide housing and services to the homeless individnals in Miami -Dade County. Please review the Agreement thoroughly, as well as the attachments and become familiar with the amended contract language. In addition, please include an updated Attachment A, Scope . of Services, and Attachment B, Budget for the 2010-2011 contract year. Please sign and complete all three (3) copies of the Extension and Amendment Agreement and return it to our office, attention Terrell T. Ellis, Contract Monitoring and Management Supervisor no later than Tuesday, October 26. 2010. One fully executed Agreement will be returned to your agency for your files. Miami -Dade County requires that the President/Chairman of the Board execute the Agreement on behalf of the agency. However, the Executive Director may execute the Agreement if approved by a resolution of the agency's Board. A copy of the applicable Board resolution(s) must be submitted with the Agreement. In addition, the corporate seal must be affixed to the signature page of the document. The Miami -Dade County Ho u, - Trust looks forward to continuing work with your agency in implementing this project. If you have any . estio:s, please contact me or Terrell T. Ellis, Contract Monitoring and Management Supervise¢ 305) 37 David Raymo d Executive Director Enclosures I have received the Agreements for the abovementioned grants. Signature of Authorized Agency Representative Printed Name of Agency Representative Date EXTENSION AND AMENDMENT #1 OF THE AGREEMENT BETWEEN MIAMI-DADE COUNTY AND THE CITY OF MIAMI HOTEL/MOTEL PLACEMENT PROGRAM/CONTRACT #PC-1011-1ITMT-1 FEEDING COORDINATION PROGRAM/CONTRACT #PC-1011-FC HMIS STAFFING PROGRAM/CONTRACT #PC-1011-HAMS-1 THIS AMENDMENT OF AGREEMENT (the "Agreement Amendment") is made as of by and between Miami -Dade County, through the Miami -Dade County Homeless Trust (the "County") and The City of Miami, a provider of services to homeless individuals, hereinafter referred to as the "Provider". WITNESSETH: WHEREAS, On February I, 2010, the County and the Provider entered into an Agreement ("Agreement") which provides funding for the provision of housing and services to homeless individuals in Miami -Dade County. WHEREAS, this Agreement provides for certain rights and responsibilities of the County; and WHEREAS, the Agreement allows for amendments and extensions at the sole discretion of the County; and WHEREAS, the County is desirous of amending the Agreement pursuant to the terms of the Agreement; NOW, THEREFORE, BE IT RESOLVED, for and consideration of the mutual agreements between the County and the Provider, which are set forth in this Amendment of the Agreement, the receipt and sufficiency of which are acknowledged, the County and the Provider amend this Agreement as follows: ARTICLE I — Recitals The foregoing recitals are true and correct and constitute a part of this Amendment of the Agreement. ARTICLE II — Ratification of the Agreement Other than expressly modified or amended herein, all other terms and conditions of the Agreement shall remain in full force and effect. The City of Miami Emergency Hotel/Motel Placement Program (PC-1011-HTMT-1), Feeding Coordination (PC-1011-FC), HMIS Staffing (PC-1011-HMIS-1) ARTICLE III — Amendments The Agreement is hereby amended as follows: Article 2 is replaced as follows: ARTICLE 2. AMOUNT PAYABLE. Subject to available funds, the maximum amount payable for services rendered under this contract shall not exceed: 1. Emergency Hotel/Motel Placement Program 2. Feeding Coordination Program 3. HMIS Staffing Program $ 112,500.00 $ 15,000.00 $ 24,666.00 Total Contract Amount $152,166.00 Both parties agree that should available County funding be reduced, the amount payable under this Contract may be proportionately reduced at the sole discretion and option of the County. All services undertaken by the Provider before the County's execution of this Contract shall be at the Provider's risk and expense. It is the responsibility of the Provider to maintain sufficient financial resources to meet the expenses incurred during the period between the provision of services and payment by the County. The County, at its sole discretion, may allow Provider an advance of N/A once the Provider has submitted an appropriate request and submitted an invoice in the form required by the County. Article 3 is replaced as follows: ARTICLE 3. SCOPE OF SERVICES The Provider shall render services in accordance with the 2010-2011 Scope of Services incorporated herein and attached hereto as Attachment A. The Provider shall implement the Scope of Services as described in Attachment A in a manner deemed satisfactory to the County. Any modification or amendment to the Scope of Services shall not be effective until approved by the County and Provider in writing. 2 The City of Miami Emergency HoteVMotel Placement Program (PC-1011-HTMT-1), Feeding Coordination (PC-loll-FC), HMIS Staffing (PC-1011-HM►S-I) Article 4 is replaced as follows: ARTICLE 4. BUDGET SUMMARY The Provider agrees that all expenditures or costs shall be made in accordance with the 2010-2011 Budget, which is attached hereto and incorporated herein as Attachment B. The parties agree that the Provider may, with the County's prior written approval; revise the schedule of payments or the line item budget, and such revision shall not require an amendment to this Contract. Article 5 is replaced as follows: ARTICLE 5. EFFECTIVE TERM Both parties agree that the Effective Term of this Contract shall commence on October 1, 2010 and terminate at the close of business on September 30, 2011. Contingent of the existence of sufficient funding and the approval of the County, this Contract may be extended for one (1) additional one (1) year term, at the County's sole discretion. SIGNATURES APPEAR ON THE FOLLOWING PAGE 3 The City of Miami Emergency Hotel/Motel Placement (PC10-11-HTMT-1), Feeding Coordination (PC1011-FC), HMIS Staffing (PC1011-HMIS-1) IN WITNESS WHEREOF, the parties have caused this five (5) page Amendment of the Agreement to be executed by their respective and duly authorized officers the day and year first above written. THE CITY OF MIAMI By: Name: CARLOS A. MIGOYA Title: CITY MANAGER Date: By: Name: PRISCILLA A. THOMPSON Title: CITY CLERK Date: Approved as to Form and Correctness: By: Name: JULIE O. BRU Title: CITY ATTORNEY Date: MIAMI-DADE COUNTY, FLORIDA By: Name: Title: Date: Attest: HARVEY RUVIN, Clerk Board of County Commissioners By: Print Name: Approved as to Insurance Requirements: By: Name: GARY RESHEFSKY Title: RISK MANAGEMENT Date: Attest: Print Name: Title: Authorized Person OR Notary Public Corporate Seal OR Notary Seal/Stamp: 5 Attachment .4 The City of Miami Scope of Services Requirements of the Emergency Hotel/Motel Placement Program: The Provider agrees to provide emergency hotel/motel placements of homeless families with children for a period of up to seven (7) days in area hotels/motels. Families may be provided food vouchers on an as -needed basis of up to 520.00 per diem while residing in hotels/motels. Families with more than four (4) members may be provided an additional $5.00 per person per day. Reimbursements will only be made for properly documented disbursement of food vouchers. . All reimbursements must be submitted to the County by the 15th day of each month following the month of service. All reimbursement requests must be approved by the County prior to the disbursement of funds. Requirements of the Feeding Coordination Program: The Provider shall coordinate feeding programs for the homeless in the City of Miami to ensure feeding is conducted in a clean, convenient and humane environment. The Community Liaison/Feeding Coordinator shall develop and maintain a list of all participating, organizations and homeless individuals no later that thirty (30) days prior to the end of each quarter; distribute correspondence as needed to participating organizations; and ensure the coordination of outreach activities at the feeding sites listed below: ® Camillus House, Inc. 726 NE I' Avenue Miami, Florida 33136 • Miami Rescue Mission 2020 NE 151 Avenue Miami, Florida 33127 • Mount Zion Baptist Church 301 NW 9th Street Miami, Florida 33136 Requirements of the HI\2JS Staffing Program: The Provider shall provide a dedicated HMIS Outreach staff person. The purpose of this staff position is to maintain data current in the HMiS and includes, but is not limited to input of client data upon intake, updates of client files, compilation of' reports and entering data for statistical purposes. Failure to maintain this data current, as evidenced by HMIS generated Monthly Progress Reports (MPR) submitted to the County each month under the United States 1-lousing and Urban Development (USHLID) sub -recipient Agreement between the Provider and the County may result in the termination of this Agreement. Attachment B, Page 1 of 3 The City of Miami Emergency Hotel/Motel Placement — PC-1011-HTMT-1 CITY OF MIAMI HOMELESS ASSISTANCE PROGRAM Emergency Hotel/Motel Placement 2010-2011 Contract Amendment BUDGET Object Class Cost MDHT % City of Miami % Justification Emergency Housing, Hotel/Motel 1400 days/units @ $50.00 per day $100,000.00 100% Emergency Hotel/Motel placements for eligible families due to unavailability of beds within the continuum of care Food Vouchers 250 vouchers @ $20.00 per voucher $12,500.00 100% . Food vouchers for eligible families. TOTAL $112,500.00 Attachment B-Page 2 of 3 The City of Miami Feeding Coordinator Program-PC-1011-FC CITY OF MIAMI HOMELESS ASSISTANCE PROGRAM Feeding Coordinator 2010-2011 Contract Amendment BUDGET Object Class Cost MDHT % Feeding Contract MDHT % MOA Justification 1. Staffing Personnel -Salary 1 FT Homeless Program Feeding Coordinator @ $14.49/h $32,445 46 % 54% Salaries for the City of Miami Homeless Program Feeding Coordinator TOTAL $32,445 $15,000 $17,445 1 Attachment B The City of Miami HMIS Staffing — PC-1011-HMIS-1 CITY OF MIAMI HOMELESS ASSISTANCE PROGRAM Homeless Management Information System 2010-2011 Contract Amendment BUDGET Object Class Cost MDCHT HMIS Contract % MDCHT MOA Contract % Justification 1. Supportive Service Costs Personnel -Salary 1 FT Homeless Program Clerk. HMIS Administrator @$14.49/h $32,445 76 % 24 % Salaries for the City of Miami Homeless Program HMIS Administrator TOTAL $24,600 $7,845 1 Carlos Alvarez, Mayor February 1, 2010 ORIGINAL CONTRACT Mr. Pedro Hernandez, City Manager c/o Sergio Torres, Program Director The City of Miami 1490 NW 3rd Avenue Miami, FL 33136 Homeless Trust 111 NW 1st Street • 27th Floor • Suite 310 Miami, Florida 33128-1930 T 305-375-1490 F 305-375-2722 RE: Feeding Coordination Program PC-0910-FC Emergency Hotel/Motel Placement Program PC-0910-HTMT-1 HMIS Staffing Program PC-09] 0-HMIS-1 Dear Mr. Hernandez: miamidade.gov Enclosed, please find for your file, one fully executed original of the Agreement between Miami - Dade County, through the Miami -Dade County Homeless Trust and The City of Miami, for the above referenced grant. Please feel free to contact us at (305) 375-1490 if you have any questions or require additional information. Thank you for your continued efforts with addressing the needs of the homeless of our community. Sincerely, a/1. avid Raymond tive Director Enclosures I have received one fully executed Agreement for each of the above -referenced programs. Signature of Authorized Agency Representative Date Printed Name of Agency Representative The City of Miami Feeding Coordination (PC0910-FC), Emergency Hotel/Motel Placement (PC0910-HTMT-1) HMIS Staffing (PC0910-HMIS-1) CONTRACT This Contract made and entered into as of this /5 r— day of 20 (C� by and between Miami -Dade County, a political subdivision of the State of Florida (the "County"), having its principal office at 111 N.W. 1st Street, 27th Floor, Miami, • Florida 33128 and The City of Miami/FEIN#: 59-6000375, a corporation organized and existing under the laws of the State of Florida, having its principal office at 444 SW 2"d Avenue, Miami, Florida 33130 ("Provider"), states conditions and covenants for the rendering of human and social services ("Services") for the County. WHEREAS, the Home Rule Charter authorizes the County to provide for the uniform health and welfare of the residents throughout the County and further provides that all functions not otherwisespecifically assigned to others under the Charter shall be performed under the supervision of the Mayor or the Mayor's designee; and WHEREAS, the Provider provides or will develop services of value to the County and has demonstrated an ability or desire to provide these services; and WHEREAS, the County is desirous of assisting the Provider in providing those services and the Provider is desirous of providing such services; and WHEREAS, the County has appropriated funds for the proposed services; NOW, THEREFORE, in consideration of the mutual covenants and agreements herein contained, the parties hereto agree as follows: ARTICLE 1. DEFINITIONS The following words and expressions used in this Contract shall be construed as follows, except when it is clear from the context that another meaning is intended: a) The words "Agreement" "Contract" or "Contract Documents" shall mean collectively these terms and conditions, the Scope of Services Attachment A and the Budget Documents Attachment B and all other attachments hereto, as well as all amendments or budget revisions issued hereto. b) The words "Contract Manager" shall mean Miami -Dade County's Director of the Homeless Trust ("County") or the Director's designee, or the duly authorized representative designated to manage the Contract. c) The word "Days —shall mean Calendar Days, unless otherwise specifically noted. d) The word "Deliverables" shall mean all documentation and any items of any nature submitted by the Provider to the County for review and approval pursuant to the terms of this Contract. e) The words "directed", "required", "permitted", "ordered", "designated", "selected", "prescribed" or words of like import to mean respectively, the direction, requirement, permission, order, designation, selection or prescription of the County's Contract Page 1 of 26 The Cite of Miami Feeding Coordination (PC09I0-FC), Emergency Hotel/Motel Placement (PC0910-HTMT-1) HMIS Stang (PC091 0-HMIS- 1 ) Manager; and similarly the words "approved", acceptable", "satisfactory", "equal", "necessary", or words of like import to mean respectively, approved by, or acceptable or satisfactoryto, equal or necessary in the sole discretion of the County's Contract Manager. f) The words "Effective Term" shall mean the date on which this Contract is effective, including start date and end date. g) The words "Extra Work" or "Change Order" or "Additional Work" shall mean resulting in additions or deletions or modifications to the amount, type or value of the Work and Services as required in this Contract, as directed and/or approved by the County. h) "HIPAA" means Health Insurance Portability and Accountability Act of 1996. i) The words "Scope of Services" shall mean the document appended hereto as Attachment A, which details the work to be performed by the Provider. j) The word "subcontractor" or "sub consultant" shall mean any person, entity, firm or corporation, other than the employees of the Provider, who furnishes labor and/or materials, in connection with the Work, whether directly or indirectly, on behalf and/or under the direction of the Provider and whether or not in privities of contract with the Provider. k) The words 'Work", "Services" "Program", or "Project" shall mean all matters and things required to be done by the Provider in accordance with the provisions of this Contract. ARTICLE 2. AMOUNT PAYABLE. Subject to available funds, the maximum amount payable for services rendered under this contract shall not exceed: 1. Emergency Hotel/Motel Placement Program $75,000.00 2. Feeding Coordination Program $15,000.00 3. HMIS Staffing Program $24,666.00 Total Contract Amount: $114,666.00 Both parties agree that should available County funding be reduced, the amount payable under this Contract may be proportionately reduced at the sole discretion and option of the County. All services undertaken by the Provider before the County's execution of this Contract shall be at the Provider's risk and expense. It is the responsibility of the Provider to maintain sufficient financial resources to meet the expenses incurred during the period between the provision of services and payment by the County. . The County, at its sole discretion, may allow Provider an advance of N/A once the Provider has submitted an appropriate request and submitted an invoice in the form required by the County. Page 2of26 The City of Miami Feeding Coordination (PC0910-FC), Emergency Hotel/Motel Placement (PC0910-HTMT-1) HMIS Staffing (PC0910-HMIS-1) ARTICLE 3. SCOPE OF SERVICES The Provider shall render services in accordance with the Scope of Services incorporated herein and attached hereto as Attachment A. The Provider shall implement the Scope of Services as described in Attachment A in a manner deemed satisfactory to the County. Any modification or amendment to the Scope of Services shall not be effective until approved by the County and Provider in writing. ARTICLE 4. BUDGET SUMMARY The Provider agrees that all expenditures or costs shall be made in accordance with the Budget, which. is attached hereto and incorporated herein as Attachment B. The parties agree that the Provider may, with the County's prior written approval; revise the schedule of payments or the line item budget, and such revision shall not require an amendment to this Contract. ARTICLE 5. EFFECTIVE TERM Both parties agree that the Effective Term of this Contract shall commence on October 1, 2009 and terminate at the close of business on September 30, 2010. Contingent of the existence of . sufficient funding and the approval of the County, this Contract may be extended for two (2) additional one (1) year terms, at the County's sole discretion. ARTICLE 6. INDEMNIFICATION BY PROVIDER A. Government Entity. Government entity shall indemnify and hold harmless the County and its officers, employees, agents and instrumentalities from any and ail liability, losses .or damages, including attorneys' fees and costs of defense, which the County or its officers, employees, agents or instrumentalities may incur as a result of claims, demands, suits, causes of actions or proceedings of any kind or nature arising out of, relating to or resulting from the performance of this Contract by the government entity or its employees, agents, servants, partners, principals or subcontractors. Government entity 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 County, where applicable, including appellate proceedings, and shall pay all costs, judgments, and attorney's fees which may issue thereon. Provided, however, this indemnification shall only be to the extent and within the limitations of Section 768.28, Fla. Stat., subject to the provisions of that Statute whereby the government entity shall not be held liable to pay a personal injury or property damage -claim or judgment by any one person which exceeds the sum of $100,000, or any claim or judgment or portions thereof, which, when totaled with all other claims or judgment paid by the government entity arising out .of the same incident or occurrence, exceed the sum of $200,000 from any and all personal injury or property damage claims, liabilities, losses or causes of action which may arise as a result of the negligence of the government entity. B. All Other Providers. Provider shall indemnify and hold harmless the County and its officers, employees, agents and instrumentalities from any and all liability, losses or Page 3 of 26 The City of Miami Feeding Coordination (PC0910-FC), Emergency Hotel/Motel Placement(PC0910-HTMT-1) HMIS Staffing(PC0910-HMIS-1) damages, including attorneys' fees and costs of defense, which the County or its officers, employees, agents or instrumentalities may incur as a result of claims, demands, suits, causes of actions or proceedings of any kind or nature arising out of, relating to or resulting from the performance of this Contract by the Provider or its employees, agents, servants, partners principals or subcontractors. 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 County, where applicable, including 'appellate proceedings, and shall pay all costs, judgments, and attorneys fees which may issue thereon. Provider expressly understands and 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 County or its officers, employees, agents and instrumentalities as herein provided. C. Term of Indemnification. The provisions of Article 6 shall survive the expiration or termination of this Contract. ARTICLE 7. INSURANCE If the total dollar value of all County contracts with the Provider exceeds $25,000 then the following insurance coverage is required: A. Government Entity. If the Provider is the State of Florida or an agency or political subdivision of the State as defined by section 768.28, Florida Statutes, the Provider shall furnish the County, .upon request, written verification of liability protection in accordance with section 768.28, Florida Statutes. Nothing herein shall be construed to extend any party's liability beyond that provided in section 768.28, Florida Statutes. The provider shall also furnish the County, upon request, written verification of Workers Compensation protection in accordance with Florida Statutes, Chapter 440. B. All Other Providers. 1. Minimum Insurance Requirements: Certificates of Insurance. The Provider shall submit to Miami -Dade County, c/o Miami Dade County Homeless Trust (COUNTY), 111 -N.W. 1' Street, 27th Floor, Miami, Florida 33128-1994, original Certificate(s) of Insurance indicating that insurance coverage has been obtained which meets the requirements as outlined below: A All insurance certificates must list the County as "Certificate Holder" in the following manner: Miami -Dade County 111 N.W. 1" Street, Suite 2340 Miami, Florida 33128 B. Worker's Compensation Insurance for all employees of the Provider as required by Florida Statutes, Chapter 440. Commercial General Liability Insurance in an amount not less than $300,000 combined single limit per occurrence for bodily injury and property damage. Miami -Dade County must be shown as an additional insured with respect to this coverage. Page 4 of 26 The City of Miami Feeding Coordination (PC0970-FC), Emergency Hotel/Motel Placement (PC0910-HTMT-I) HMIS Staffing (PC0910-HMIS- I ) D. Automobile Liability Insurance covering all owned, non -owned, and hired vehicles used in connection with the Work provided under this Contract, in an amount not less than $300,000* combined single limit per occurrence for bodily injury and property damage. *NOTE: For Providers supplying vans or mini -buses with seating capacities of fifteen (15) passengers or more, the limit of liability required for Auto Liability is $500, 000. Professional Liability Insurance in the name of the Provider, when applicable, in an amount not less than $250,000. All insurance policies required above shall be issued by companies authorized to do business under the laws of the State of Florida, with the following qualifications: 1. The company must be rated no less than "B" as to management, and no Tess than "Class V" as to financial strength, according to the latest edition of Best's Insurance Guide published by A.M. Best Company, Oldwick, New Jersey, or its equivalent, subject to the approval of the County's Risk Management Division. OR 2. The company must hold a valid Florida Certificate of Authority as shown in the latest 'List of All Insurance Companies Authorized or Approved to Do Business in Florida," issued by the State of Florida Department of Insurance, and must be a member of the Florida Guaranty Fund. Certificates will indicate that no modification or change in insurance shall be made without thirty (30) days advance written notice to the Certificate Holder. Compliance with the foregoing requirements shall not relieve the Provider of its liability and obligations under this Section or under any other section of this Contract. I. The County reserves the right to inspect the Provider's original insurance policies at any time during the term of this Contract. J. Applicability of this Article Providers whose combined total award for all services funded under this Contract exceed a $25,000 threshold. In the event that the Provider whose original total combined award in less than $25,000, but receives additional funding during the contract period which makes the total combined award exceed $25,000, then the requirements in this Article shall apply. • K. Failure. to Provide Certificates of Insurance. The Contractor shall be responsible for assuring that the insurance certificates required in conjunction with this Section remain in force for the duration of the effective term of this Contract. If insurance certificates are scheduled to expire during the effective term, the Provider shall be responsible for submitting new or renewed insurance certificates to the County prior to expiration. Page 5 of 26 The City of Miami Feeding Coordination (PC0910-FC), Emergency Hotel/Motel Placement (PC0910-HTMT-1) HMIS Staffing (PC0910-HMIS-1) In the event that expired certificates are not replaced with new or renewed certificates which cover the effective term, the County may suspend the Contract until such time as the new or renewed certificates are received by the County in the manner prescribed herein; provided, however, that this suspended period does not exceed thirty (30) calendar days. Thereafter, the County may, at its sole discretion, terminate this Contract. ARTICLE 8. PROOF OF LICENSURE/CERTIFICATION AND BACKGROUND SCREENING A. Licensure. If the Provider is required by the State of Florida or Miami -Dade County to be licensed or certified to provide the services or operate the facilities outlined in the Scope of Services (Attachment A), the Provider shall maintain a copy of all required current licenses or certificates. This documentation should remain on file at the Provider's agency and shall be made available to the County for on -site review and audit. Examples of services or operations requiring such licensure or certification include .but are not limited to residential substance abuse centers, child care, day care, nursing homes, and boarding homes. If the Provider fails to fumish the County with the licenses or certificates requested under this Section, the County shall not disburse any funds until it is provided with such licenses or certificates. Failure to provide the licenses or certificates within forty-five (45) days of the County's request may result in termination of this Contract. B. Background Screening. In the event criminal background screening is required by law, the State of Florida and/or the County, only employees and subcontracted personnel with a satisfactory national criminal background check through an appropriate screening agency (i.e., the Florida Department of Juvenile Justice, Florida Department of Law Enforcement or Federal Bureau of Investigation) may work in direct contact with juveniles. Unless specifically requested by the County in writing, the Provider is not required to submit any background screening information to the County. This documentation should remain on file at the Provider's agency and shall be made available to the County for on -site review and audit. When applicable, if the Provider fails to furnish the County with proof of the satisfactory background screening required under this Article, the County shall not disburse any funds until the County is provided with documented proof that the required background screening was initiated. The County requires that only employees and subcontracted personnel with a satisfactory background check as described in Section 39.001 (2), Florida Statutes and through an appropriate screening agency (i.e., the Florida Department of Juvenile Justice, Florida Department of Law Enforcement, Federal Bureau of Investigation) work with direct contact with juveniles. Pursuant to Section 985.012(a) Florida Statutes, "each contract entered into...for services delivered on an appointment or intermittent basis by a provider that does not have regular custodial responsibility for children... must ensure that the owners, operators, and all personnel who have direct contact with children are of good moral character..." In order to ensure this condition "(b) The Department of Juvenile Justice... shall require employment screening Page 6 of 26 The City of Miami Feeding Coordination (PC0910-FC), Emergency Hotel/Motel Placement (PC0910-HTMT-1) HMIS Staffing (PC0910-HMIS-1) pursuant to chapter 435, using the level 2 standards set forth in that chapter for personnel in programs for children or youths." Pursuant to the above passages from Florida Statutes, it is required that all provider agency personnel working directly with children must have a completed Level 1 Screening response from the Florida Department of Law Enforcement that indicates that there has been no prior involvement in any of the disallowed conditions, before beginning work with client youths. Level 1 Screenings can be accomplished electronically on line with the Florida Department of Law Enforcement: www.fdle.state.fl.us/CriminalHistory/. In addition, recognizing that Level 2 Screening can take several weeks, Level 2 Screening must be initiated prior to beginning work directly with clients. Any employee receiving positive response(s) to any of the enumerated charges as defined in Level 1 and Level 2 background checks must immediately cease working with children or youths. All employee personnel files shall reflect the initiation and completion of the required background screening checks. From the date of execution of this Contract, Provider shall furnish the County with proof that background screening Level 1 was completed. If the Provider fails to furnish to the County proof that background screening Level 1 was completed and Level 2 was initiated prior to working directly with client youths, the County shall not disburse any further funds and this Contract may be subject to termination at the sole discretion of the County. The County requires that only employees and subcontracted employees with a satisfactory background check as described in Section 435.03(3)(a), and through an appropriate screening agency (i.e. Florida Department of Law Enforcement, Federal Bureau of Investigation) work in direct contact with the elderly, disabled and persons with mental illness, in settings such as but not limited to adult day care center, assisted living facilities, home equipment screening nursing homes, home health agencies, facilities for developmentally disabled, and mental health treatment facilities. Within thirty (30) days of execution of this Contract, Provider shall furnish the County with proof that background screening was initiated. If the Provider fails to furnish to the County proof that background screening was initiated within thirty (30) days of execution of this contract, the County shall not disburse any further funds and this Contract may be subject to termination at the sole discretion of the County. ARTICLE 9. CONFLICT OF INTEREST A. The Provider agrees to abide by and be governed by Miami -Dade County Ordinance No. 72-82 (Conflict of Interest Ordinance codified at Section 2-11.1 et al. of the Code of Miami -Dade County), as amended, which is incorporated herein by reference as if fully set forth herein, in connection with its contract obligations hereunder. B. No person under the employ of the County, who exercises any function or responsibilities in connection with this Contract, has at the time this Contract is entered into, or shall have during the term of this Contract, any personal financial interest, direct or indirect, in this Contract. Page 7 of 26 The City of Miami Feeding Coordination (PC0910-FC), Emergency Hotel/Motel Placement (PC0910-HTMT-1) .HMI S Staffing (PC0910-HMIS-1) C. Nepotism. Notwithstanding the aforementioned provision, no relative of any officer, board of director, manager, or supervisor employed by the Provider shall be employed by the Provider unless the employment preceded the execution of this Contract by one (1) year. No family member of any employee may be employed by the Provider if the family member is to be employed in a direct supervisory or administrative relationship either supervisory or subordinate to the employee. The assignment of family members in the same organizational unit shall be discouraged. A conflict of interest in employment arises whenever an individual would otherwise have the responsibility to make, or participate actively in making decisions or recommendations relating to the employment status of another individual if the two individuals (herein sometimes called "related individuals") have one of the following relationships: 1. By blood or adoption: Parent, child, sibling, first cousin, uncle, aunt, nephew, or niece; 2. By marriage: Current or former spouse, brother- or sister-in-law, father- or mother-in-law, son- or daughter-in-law, step-parent, or step -child; or 3. Other relationship: A current or former relationship, occurring outside the work setting that would make it difficult for the individual with the responsibility to make a decision or recommendation to be objective, or that would create the appearance that such individual could not be objective. Examples include, but are not limited to, personal relationships and significant business relationships. For purposes of this section, decisions or recommendations related to employment status include decisions related to hiring, salary, working conditions, working responsibilities, evaluation, promotion, and termination. An individual, however, is not deemed to make or actively participate in making decisions or recommendations if that individual's participation is limited to routine approvals and the individual plays no role involving the exercise of any discretion in the decision -making processes. If any question arises whether an individual's participation is greater than is permitted by this paragraph, the matter shall be immediately referred to the Miami -Dade County Commission on Ethics and Public Trust. This section applies to both full-time and part-time employees and voting members of the Provider's Board of Directors. D. No person, including but not limited to any officer, board of directors, •manager, or supervisor employed by the Provider, who is in the position of authority, and who exercises any function or responsibilities in connection with this Contract, has at the time this Contract is entered into, or shall have during the term of this Contract, received any of the services, or direct or instruct any employee under their supervision to provide such services as described in the Contract. Notwithstanding the before mentioned provision, any officer, board of directors, manager or supervisor employed by the Provider, who is eligible to receive any of the services described herein may utilize such services if he or she can demonstrate that he or she does not have direct supervisory responsibility over the Provider's employee(s) or service program. Staff members, or their immediate family members (spouse, children, siblings, mother or father) of Homeless Trust funded programs, who are eligible for and wish to receive services from a Homeless Trust funded program must receive the approval of the Executive Director of their employer (i.e. the Provider) prior to applying for and receiving those services. This approval Page 8 of 26 The City of Miami Feeding Coordination (PC0910-FC), Emergency Hotel/Motel Placement (PC0910-HTMT-1) HMIS Staffing (PC0910-HMIS-1) must be in writing and accompany any referral for such services. Any Provider knowingly accepting a referral of an employee of a Homeless Trust funded program, and providing services without the written approval of the Executive Director of the Provider, will be subject to the recoupment/disallowance of any funds paid for services to this individual and/or their 'immediate family member. When the services are to be provided at the same agency the employee works for, this information must be disclosed in writing to the director of the Homeless Trust, which shall be reviewed for eligibility determination and a sign off must come from the County. This provision does not apply to staff members seeking emergency shelter, medical or legal services. Providers must complete a Client Services Authorization Form (Attachment P) for staff members seeking services. ARTICLE 10. CIVIL RIGHTS The 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 on the basis of race, creed, religion, color, sex, familial status, marital status, sexual orientation, pregnancy, age, ancestry, national origin or handicap; 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. §6101, as amended, which prohibits discrimination in .employment because of age; the Rehabilitation Act of 1973, 29 U.S.C. §794, as amended, which prohibits discrimination on the basis of disability; the Americans with Disabilities Act, 42 U.S.C. §12101 et seq., which prohibits discrimination in employment and public accommodations because of disability; the Federal Transit Act, 49 U.S.C. §1612, as amended; and the Fair Housing Act, 42 U.S.C. §3601 et seq. It is expressly understood that the Provider must submit an affidavit attesting that it is not in violation of the Acts. If the Provider or any owner, subsidiary, or other firm affiliated with or related to the Provider is found by the responsible enforcement agency, the Courts or the County to be in violation of these acts, the County will conduct no further business with the Provider. Any contract entered into based upon a false affidavit shall be voidable by the County. If the Provider violates any of the Acts during the term of any contract the Provider has with the County, such contract shall. be voidable by the County, even if the Provider was not in violation at the time it submitted its affidavit. The Provider agrees that it is in compliance with the Domestic Violence Leave, codified as § 11A-60 et seq. of the Miami -Dade County Code, which requires an employer, who in the regular course of business has fifty (50) or more employees working in Miami -Dade County for each working day during each of twenty (20) or more calendar work weeks to provide domestic violence leave to its employees. Failure to comply with this local law may be grounds for voiding or terminating this Contract or for commencement of debarment proceedings against Provider. ARTICLE 11. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT; Any person or entity that performs or assists Miami -Dade County with a function or activity involving the use or disclosure of "individually identifiable health information (IIHI)" and/or "Protected Health Information (PHI)" shall comply with the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the Miami -Dade County Privacy Standards Administrative Order. HIPAA mandates for privacy, security and electronic transfer standards, Page 9 of 26 The City of Miami Feeding Coordination (PC0910-FC), Emergency Hotel/Motel Placement (PC0910-HTMT- 1) HMIS Staffing (PC0910-HMIS-1) include but are not limited to: 1. Use of information only for performing services required by the contract or as required by law; 2. Use of appropriate safeguards to prevent non -permitted disclosures; 3. Reporting to Miami -Dade County of any non -permitted use or disclosure; 4. Assurances that any agents and subcontractors agree to the same restrictions and conditions that apply to the Provider and reasonable assurances that IIHI/PHI will be held confidential; 5. Making Protected Health Information (PHI) available to the customer; 6. Making PHI available to the client for review and amendment; and incorporating any amendments requested by the client; 7. Making PHI available to Miami -Dade County for an accounting of disclosures; and 8. Making internal practices, books, and records related to PHI available to Miami -Dade County for compliance audits. PHI shall maintain its protected status regardless of the form and method of transmission (paper records and/or electronic transfer of data). The Provider must give its clients written notice of its privacy information practices, including specifically, a description of the types of uses and disclosures that would be made with protected health information. Provider must post, and distribute upon request to service recipients, a copy of the County's Notice of Privacy Practices. ARTICLE 12. NOTICE REQUIREMENTS Notice under this Contract shall be sufficient if made in writing, delivered personally or sent via U.S. mail, electronic mail, facsimile, or certified mail with return receipt requested and postage prepaid, to the parties at the following addresses (or to such other party and at such other address as a party may specify by notice to others) and as further specified within this Contract.. If notice is sent via electronic mail or facsimile, confirmation of the correspondence being sent will be maintained in the sender's files. If to the COUNTY: If to the PROVIDER: Miami -Dade County Homeless Trust 111 N.W. 15t Street, 27th Floor Miami, Florida 33128 Attention: David Raymond, Executive Director Electronic mail: dray@miamidade.gov Pedro Hernandez City Manager The City of Miami 444 SW 2"d Avenue Miami, Florida 33130 Electronic mail: pgh@miamigov.com Either party may at any time designate a different address and/or contact person by giving written notice as provided above to the other party. Such notices shall be deemed given upon Page 10 of 26 The City of Miami Feeding Coordination (PC0910-FC), Emergency Hotel/Motel Placement (PC0910-HTMT-I) HMIS Staffing (PC09I0-HMIS-I) receipt by the addressee. ARTICLE 13. AUTONOMY Both parties agree that this Contract recognizes the autonomy of the contracting parties and implies no affiliation between the contracting parties. It is expressly understood and intended that the Provider. is only a recipient of funding support and is not an agent or instrumentality of the County. Furthermore, the Provider's agents and employees are not agents or employees of the County. ARTICLE 14. SURVIVAL • The parties acknowledge that any of the obligations in this Contract, including but not limited to Provider's obligation to indemnify the County, will survive the term, termination, and cancellation hereof. Accordingly, the respective obligations of the Provider under this Contract, which by nature would continue beyond the termination, cancellation or expiration thereof, shall survive termination, cancellation or expiration hereof. ARTICLE 15. BREACH OF CONTRACT: COUNTY REMEDIES A. Breach. A breach by the Provider shall have occurred under this Contract if: (1) the Provider fails to provide the services outlined in the Scope of Services (Attachment A) within the effective term of this Contract; (2) the Provider ineffectively or improperly uses the County funds allocated under this Contract; (3) the Provider does not fumish the Certificates of Insurance required by this Contract or as determined by the County's Risk Management Division; (4) if applicable, the Provider does not fumish upon request by the County proof of licensure/certification or proof of background screening required by this Contract; (5) the Provider fails to submit, or submits incorrect or incomplete, proof of expenditures to support disbursement requests or advance funding disbursements or fails to submit or submits incomplete or incorrect detailed reports of expenditures or final expenditure reports; (6) the Provider does not submit or submits incomplete or incorrect required reports; (7) the Provider refuses to allow the County access to records or refuses to allow the County to monitor, evaluate and review the Provider's program; (8) the Provider discriminates under any of the laws outlined in Article 10 of this Contract; (9) the Provider, attempts to meet its obligations under this Contract through fraud, misrepresentation, or material misstatement; (10) the Provider fails to correct deficiencies found during a monitoring, evaluation, or review within the specified time as described and defined in its Performance Improvement Plan (PIP); (11) the Provider fails to issue prompt payments to small business subcontractors or follow dispute resolution procedures regarding a disputed payment; (12) the Provider fails to submit the Certificate of Corporate Status, Board of Directors requirement, or proof of tax status; and (13) the Provider fails to fulfill in a timely and proper manner any and all of its obligations, covenants, agreements, and stipulations in this Contract; (14) the Provider fails .to meet any of the terms and conditions of the Miami -Dade County Affidavits (Attachment C) and the State Affidavits (Attachment D) fl Applicable E. Not Applicable or (15) the Provider fails to fulfill in a timely and proper manner any and all of its obligations, covenants, agreements and stipulations in this Contract. Waiver of breach of any provisions of this Contract shall not be deemed to be a waiver of any other breach and shall not be construed to be a modification of the terms of this Contract. Page 11 of 26 The City of Miami Feeding Coordination (PC0910-FC); Emergency Hotel/Motel Placement (PC0910-HTMT-1) HMIS Staffing (PC0910-HMIS-1) In the event that the County determines certain Contract goals (as defined in the Scope of Services) are not being met then the County, in its sole discretion may place the Provider on a Performance Improvement Plan (PIP). The following is a delineation of the instances where a PIP may be required: a. HMIS- Based on Provider's past performance on prior contracts in the area of Homeless Management Information System compliance it is subject to a PIP during this contract term. The Provider is required to submit a Monthly Progress Report and an HMIS-generated Monthly Progress Report for each month of the contract. Compliance will be determined when it is deemed that the two (2) reports are in substantial conformity with each other for a period of two consecutive months. (Substantial conformity as meaning a minimum of 95% accuracy on all elements). At the time of compliance, the Provider shall only be required to submit the HMIS-generated Monthly Progress Report. O Applicable Q Not Applicable b. Utilization — Based on Provider's past performance on prior contracts in the area of utilization compliance, this contract is subject to a PIP. During this contract term, the Provider must submit all invoices in a timely manner. The Provider shall invoice at a rate of 95% of targeted expenditures for the invoicing period. If the Provider fails to comply, all rights to payments will be forfeited if the County so chooses. Failure to submit accurate invoices for appropriately documented and eligible expenditures at a rate of 95% • of targeted expenditures by the end of the third quarter of this contract term may result in the termination of this contract by the County. O Applicable Q Not Applicable c. Program Performance — Based on Provider's past performance on prior contracts in the area of program goals and outcome objectives, this Contract is subject to a PIP. During this Contract term, the Provider must achieve those goals specified in the Contract. Performance against these annual goals shall be evaluated on a quarterly basis, and if by the end of the third quarter of the contract period substantial compliance (meeting the targeted goals) is not achieved, it may result in the termination of this contract with the County. O Applicable U✓ Not Applicable The above is subject to the review and approval of the County B. County Remedies. If the Provider breaches this Contract, the County may pursue any or all of the following remedies: 1. The County may terminate this Contract by giving written notice to the Provider of such termination and specifying the effective date thereof. In the event of termination, the County may: (a) request the return of finished or unfinished documents, data studies, surveys, drawings, maps, models, photographs, reports prepared and secured by the Provider with County funds under this Contract; (b) seek reimbursement of County funds allocated to the Provider under this Contract; (c) terminate or cancel any other contracts entered into between the County and the Provider. The Provider shall be responsible for all direct and indirect costs associated with such termination, including attorney's fees; 2. The County may suspend payment in whole or in part under this Contract by providing written notice to the Provider of such suspension and specifying the effective date Page 12 of 26 The City of Miami Feeding Coordination (PC0910-FC), Emergency Hotel/Motel Placement (PC091 0-HTMT-1 ) HMIS Staffing (PC0910-HMIS-1) thereof. If payments are suspended, the County shall specify in writing the actions that must be taken by the Provider ascondition precedent to resumption of payments and shall specify a reasonable date for compliance. The County may also suspend any payments in whole or in part under any other contracts entered into between the County and the Provider. The Provider shall be responsible for all direct and indirect costs associated with such suspension, including attorneys fees; 3. The County may seek enforcement of this Contract including but not limited to filing an action in a court of appropriate jurisdiction. The Provider shall be responsible for all direct and indirect costs associated with such enforcement, including attomey's fees; 4. The County may debar the Provider from future County contracting; 5. If, for any reason, the Provider should attempt to meet its obligations under this Contract through fraud; misrepresentation or material misstatement, the County shall, whenever practicable terminate this Contract by giving written notice to the Provider of such termination and specifying the effective date. The County may terminate or cancel any other contracts which such individual or entity has with the County. Such individual or entity shall be responsible for all direct and indirect costs associated with such termination or cancellation, including attorney's fees. Any individual or entity who attempts to meet its contractual obligations with the County through fraud, misrepresentation, or material misstatement may be debarred from county contracting for up to five (5) years; 6. Any other remedy available at law or equity. C. Authorization to Terminate Contract. The Mayor or the Mayor's, designee is authorized to terminate this Contract on behalf of the County. D. Failures or waivers to insist on strict performance of any covenant, condition, or provision of this Contract by the County shall not be deemed a waiver of any rights or remedies, nor shall it relieve the Provider from performing any subsequent obligations strictly in accordance with the term of this Contract. No waiver shall be effective unless in writing and signed by the parties. Such waiver shall be limited to provisions of this Contract specifically referred to therein and shall not be deemed a waiver of any other provision. No waiver shall constitute a continuing waiver unless the writing states otherwise. E. Damages Sustained. Notwithstanding the above, the Provider shall not be relieved of liability to the County for damages sustained by the County by virtue of any breach of the Contract, and the County may withhold any payments to the Provider until such time as the exact amount of damages due the County is determined. The County may also pursue any remedies available at law or equity. to compensate for any damages sustained by the breach. The Provider shall be responsible for all direct and indirect costs associated with such action, including attorney's fees. ARTICLE 16. TERMINATION FOR CONVENIENCE The County may terminate this Contract, in whole or part, when both parties agree that the continuation of the activities would not produce beneficial results commensurate with further expenditure of the funds. Both parties shall agree upon the termination conditions, including the effective date and in the case of partial termination, the portion to be terminated. However, if the County determines in the case of partial termination that the reduced or modified portion of the Page 13 of 26 The City of Miami Feeding Coordination (PC0910-FC), Emergency Hotel/Motel Placement (PC09I0-HTMT-I) HMIS Staffing (PC0910-HMIS-1) grant will not accomplish the purposes for which the grant was made it may terminate the grant in its entirety. The Provider understands and acknowledges that if the County determines in its sole discretion that termination of the Contract is necessary for the healthy, safety, or welfare of the County then it may due so upon twenty-four (24) hours notice to the Provider. ARTICLE 17. PAYMENT PROCEDURES The County agrees to pay the Provider for services rendered under this Contract based on the payment schedule, timely provision by the Provider of required reports and of supporting documentation of expenses and activities as described in this Contract, and the line item budget (Attachment B). Payment shall be made in accordance with procedures outlined below and if applicable, the Sherman S. Winn Prompt Payment Ordinance (Ordinance 94-40). 1. Performance Based Contract: How payment will be made. Payment requests shall be made to the County on a monthly basis and shall be signed by the Executive Director and the Financial Officer of the Provider, unless otherwise approved in writing, on the form incorporated herein as Attachment E "Primary Care Invoice for Services". The payment request for the previous month is due by the 15th of the month following the month for which payment is invoiced. 2. Any reimbursement may be . withheld pending the receipt and approval by the County of all reports and documents required herein. 3. Maximum monthly reimbursements are limited to N/A. a. Hotel/motel placement cost amounts may vary from month to month depending on the service need. Requests in excess of $6.250.00/monthly must be approved by the County prior to any such expenditure. b. HMIS staffing costs are paid on a quarterly basis. The maximum quarterly reimbursement is limited to $3.083.25. c. The maximum monthly reimbursement amount for feeding coordination is limited to $1,250.00. 4. As applicable, during the period of N/A through N/A the Provider.will submit a record of those individuals served utilizing Social Security Administration repayments as specified in the Scope of Services. The Provider will utilize these funds to serve those clients as specified and authorized in the Scope of Services 5. N/A Providers with cumulative utilization rates greater than ninety-five percent (95%) during the first nine (9) months of this Contract may exceed this maximum number of billable bed days during the last quarter of the Contract term, up to the total Contract award amount, with the prior approval of the Executive Director of the Homeless Trust. 6. N/A Providers with cumulative utilization rates lower than ninety-five percent (95%) may be subject to a reduction in funding. 7. Within thirty (30) days of the termination or expiration of this Contract, a final report of expenditures shall be submitted to the County. If after the receipt of such final report, the County determined that the Provider has been paid funds not in compliance with the Contract, and to which it is not entitled, the Provider will be required to return such funds to the County or submit documentation demonstrating that the expenditure was in compliance with this Contract. The County shall have the sole and absolute discretion to determine if the Provider is entitled to such funds and the County's decision in this matter shall be final and binding. Page 14 of 26 The City of Miami Feeding Coordination (PC0910-FC), Emergency Hotel/Motel Placement (PC0910-HTMT-1) HMIS Staffing (PC0910-Ii.MIS-I ) 8. Monies Owed to the County: The County reserves the right, in its sole discretion, to reduce payments to the Provider in order to recapture any monies owed to the County. In accordance with County Administrative Order No. 3-29, the Provider that is in arrears to the County is prohibited from obtaining new County contracts or extensions of contracts until such time as the arrearage has been paid in full or the County has agreed in writing to an approved payment plan_ The County reserves the right, at its sole discretion to convert this Contract to a cost -based Contract in which the Provider shall be paid through reimbursement payment based on the budget approved under this Contract and when documentation of completed and satisfactory service delivery is provided. Thus, it is imperative that the Provider maintain appropriate supporting documentation for all expenditures from the beginning of the Contract term (i.e., receipts, bank statements, cancelled checks, employee timesheet, etc.). Once the County, in itssole discretion has made the determination to convert to a cost -based method, the Provider shall submit to the Contract Manager, the Monthly Reimbursement form provided by the County on a monthly basis. Monthly reimbursement requests (both retroactive and current) and accompanying supporting documentation must be received by the County no later than the 251h of the month following the month for which reimbursement is requested. C. No Payment of Subcontractors. In no event shall County funds be advanced or paid by the County directly to any subcontractor hereunder. Payment to approved subcontractors shall be made by the Provider following requirements and limitations as detailed in Article 21 of this Contract. D. Processing the Request for Payment. After the County staff reviews the payment request, the County will submit a payment request to the County's Finance Department. The County's Finance Department will issue payment via Automated Clearing House (ACH) or mail the check directly to the Provider at the address listed in .Article 12 of this Contract, unless otherwise directed by the Provider in writing. The parties agree that the processing of a payment request from date of submission by the Provider shall take a maximum of thirty (30) days from receipt of a complete and accurate payment request, pursuant to the County's Sherman S. Winn Prompt Payment Ordinance (Ordinance 94-40), Section 2-8.1.4 of the Code of .Miami -Dade County, Administrative Order No. 3-19, and the Florida Prompt Payment Act, if supporting documentation/invoices are properly documented as determined by the County in its sole discretion. It is the responsibility of the Provider to maintain sufficient financial resources to meet the expenses incurred during the period between the provision of services and payment by the County. E. Reporting Requirements. Failure to submit to the County the reports listed below in a manner deemed correct and acceptable by the County by the 15th day after the end of the month in which the service was delivered, or failure to submit to the County supporting documentation of Contract expenditures or activities within fourteen (14) days of any County request, shah be considered -a-breach of this • Contract and -may_ result .in -withholding. payment,_.. non-payment, or termination of this Contract. Applicable as indicated 1. Monthly Payment Requests (Attachment F). Q 2. Monthly Performance Reports (Attachment G) 3. Outcome Performance Measurements Monthly Report (Attachment H) ❑ 4. Client Contribution Report (Attachment I) ❑ 5. Client Attendance Roster (Attachment J) ❑ 6. Quarterly Vacancy / Permanent Housing Placement Report(Attachment K) ❑ Page 15 of 26 The City afMiami Feeding Coordination (PC0910-FC), Emergency Hotel/Motel Placement (PC0910-HTMT-1) HMIS Staffing (PC0910-HMIS-I) Performance Reports. The Provider agrees to participate in the Homeless Management Information System (HMIS) selected and. established by the County. Participation will include, but is not limited to, input of client data upon intake, daily updates of bed availability information, as well as updates of client files upon client contact, and maintaining current data for statistical purposes. The Provider understands that they are responsible for any ongoing cost to access the HMIS system. The Provider shall furnish the County with Monthly, Quarterly, and Annual Performance Reports in accordance with the activities and goals detailed in the Scope of Services. The reports shall explain the Provider's progress for the quarter. The data should .be quantified when appropriate. The final progress report shall be due no later than thirty (30) days after the expiration or termination of this Contract. Continuation of this Contract and future funding is contingent upon meeting established performance goals. Progress reports, produced through the Homeless Management Information System (HMIS) invoices for services and client attendance rosters signed by the Executive Director of the agency shall by submitted by the Provider, as required. F. Final Report/Recapture of Funds. Upon the expiration or termination of this Contract, the Provider shall submit the final Annual Performance Report and Annual Actual Expenditure Report (Attachment L) to the County no later than thirty (30) days after the expiration or termination of this Contract after receipt of such final reports, the County determines that the Provider has been paid funds not in accordance with the Contract, and to which it is not entitled, the Provider shall return such funds to the County, or the County may reduce, by the amount of such funds, from any subsequent payment to which the Provider is entitled, or the Provider may submit appropriate documentation within seven (7) days of notice from the County. The County shall have the sole discretion in determining if the Provider is • entitled to such funds and the County's decision on this matter shall be final and binding. Additionally, any unexpended or unallocated funds shall be recaptured by the County. Additionally, the Provider agrees to assign any proceeds to the County. from any contract, including this Contract, between the County, its agencies or instrumentalities and the Provider or any firm, corporation, partnership or joint venture in which the Provider has a controlling financial interest in order to secure repayment of any reimbursements for services provided under this or any other contract for which the County discovers was not reimbursable through its inspection, review and/or audit pursuant to this Contract. ARTICLE 18. PROHIBITED USE OF FUNDS A. Adverse Actions or Proceeding. The Provider shall not utilize County funds to _retain legal counsel for any action or proceeding against the County or any of its agents, instrumentalities, •employees, or officials. The Provider shall not utilize County funds to provide legal representation, advice, or counsel to any client in any action or proceeding against the County or any of its agents, instrumentalities, employees, or officials. B. Religious Purposes. County funds shall not be used for religious purposes. C. Commingling Funds. The Provider shall not commingle funds provided under this Contract with funds received from any other funding sources. The Provider shall establish a Page 16 of 26 The City of Miami Feeding Coordination (PC0910-FC), Emergency Hotel/Motel Placement (PC0910-HTMT-1) HMIS Staffing (PC09 10-HMIS- 1 ) separate account exclusively for receipt of the funds received pursuant to this Contract. D. Double Payments. Provider costs claimed under this Contract may not also be claimed under another contract or grant from the County or any other agency. Any claim for double payment by Provider shall be considered a material breach of this -Contract. ARTICLE 19. REQUIRED DOCUMENTS, RECORDS, REPORTS, AUDITS, MONITORING AND REVIEW A. Certificate of Corporate Status. The Provider must submit to the Contract Manager, within thirty (30) days from the date of execution of this Contract, a certificate of corporate status in the name of the Provider, which certifies the following: that the Provider is organized under the laws of the State of Florida; that all fees and penalties have been paid; that the Providers most recent annual report has been filed; that its status is active; and that the Provider has not filed Articles of Dissolution. B. Board of Director Requirements. The Provider shall ensure that . the Provider's Board of Directors is apprised of the programmatic, fiscal, and administrative obligations under this Contract funded through County Funds by passage of a formal resolution authorizing execution of this Contract with the County. A copy of this corporate resolution must be submitted to the County prior to contract execution. A current list of the Provider's Board of Directors and officers must be included with the submission. The Provider acknowledges and understands that all contract documents shall be signed by either the Provider's President or Vice President. The Provider's resolution shall at a minimum: list the name(s) of the Board's President, Vice President and, only in the event that the President or Vice President is not available to execute the contract documents, any other persons authorized to execute this Contract on behalf of the Provider; affirmatively state that a quorum was present at the time of adoption of the resolution; and reference the service categories and dollar amounts in the award, as may be amended. C. Proof of Tax Status. The Provider is required to submit to the County the following documentation: (a) W-9 Form (Attachment M); (b) The I.R.S. tax exempt status determination letter; (c) the most recent I.R.S. form 990; (d) the annual submission of I.R.S. form 990 within (6) months after the Provider's fiscal year end; (e) IRS form 941 - Quarterly Federal Tax Return Reports within thirty-five (35) days after the quarter ends and if the form 941 reflects a tax liability, proof of payment must be submitted within forty-five (45) days after the quarter ends. D. Conflicts of Interest. Section 2-11.1(d) of Miami -Dade County Code as amended, requires any County employee or any member of the employee's immediate family who has a controlling financial interest, direct or indirect, with Miami -Dade County or any person or agency acting for Miami -Dade County competing or applying for any such contract as it pertains to this solicitation, to first request a conflict of interest opinion from the County's Ethic Commission prior to their or their immediate family member's entering into any contract or transacting any business through a firrri, corporation, partnership or business entity in which the employee or any member of the employee's immediate family has a controlling financial interest, direct or indirect, with Miami -Dade County or any person or agency acting for Miami - Dade County. Further, any such contract, agreement or business engagement entered in violation of this subsection, as amended, shall render this Contract voidable. Page 17 of 26 The City of Miami Feeding Coordination (PC0910-FC), Emergency Hotel/Motel Placement (PC09 10-HTMT- 1 ) HM'S Staffing (PC0910-HMIS-1) E. Accounting Records. The Provider shall keep accounting records which conform to generally accepted accounting principles. All such records will be retained by the Provider for no less than three (3) years beyond the term of this Contract, and shall be made available for review upon request from County authorized personnel. F. Financial Audit. If the Provider has or is required to have an annual certified public accountant's opinion and related financial statements, the Provider agrees to provide these documents to the County no later than one hundred eighty (180) days following the end of the Provider's fiscal year, for each year during which this Contract remains in force or until all funds received pursuant to this Contract have been so audited, whichever is later. G. Access to Records: Audit. The County reserves the right to require the Provider to submit to an audit by an auditor of the County's choosing or approval- The Provider shall provide access to all of its records which relate to this Contract at its place of business during regular business hours. The Provider agrees to provide such assistance as may be necessary to facilitate their review or audit by the County to ensure compliance with applicable accounting and financial standards. H. Quarterly Reviews. of Expenditures and Records. The County Commission Auditor may perform quarterly reviews of Provider's expenditures and records. Subsequent payments to the Provider shall be subject to a satisfactory review of Provider's records and expenditures by the County Commission Auditor, including but not limited to, review of supporting documentation for expenditures and the existence of sufficient documentation to support eligible expenditures. The Provider agrees to reimburse the County for ineligible expenditures as determined by the County Commission Auditor. Quality Assurance / Recordkeeping. The Provider shall maintain, and shall require that the Provider's subcontractors and suppliers maintain, complete and accurate program and -fiscal records to substantiate compliance with the requirements set forth in the Attachment A, Scope of Services, of this Contract. The Provider and its subcontractors and suppliers, shall retain such records, and all other documents relevant to the Services furnished under this Contract for a period of Q three (3) years or 0 years (for State contracts) from the expiration date of this Contract. The Provider agrees to participate in evaluation studies, quality management activities, Corrective Action Plan activities, and analyses carried out by or on behalf of the County to evaluate the effectiveness of client service(s) or the appropriateness and quality of care/service delivery. Accordingly, the Provider shall allow authorized County staff involved in such efforts to examine and review the Provider's -premises and records. J. Confidentiality Requirements. To establish and implement policies and procedures which ensure compliance with- the -following security -standards -and any -and all applicable State and Federal statutes and regulations for the protection of confidential client records and electronic exchange of confidential information. The policies and procedures must ensure that: (1) There is a controlled and secure area for storing and maintaining active confidential information and files, including but not limited to medical records; Page 18 of 26 The City of Miami Feeding Coordination (PC0910-FC), Emergency Hotel/Motel Placement (PC0910-HTMT-l) HMIS Staffing (PC0910-HMIS-1) (2) Confidential records are not removed from the Provider's premises, unless otherwise authorized by law or upon written consent from the County; (3) Access to confidential information is restricted to authorized personnel of the Provider, the County, the United States Department of Health and Human Services, the United States Comptroller General, and/or the United States Office of the Inspector General; (4) Records are not left unattended in areas accessible to unauthorized individuals; (5) Access to electronic data is controlled; (6) • - Written authorization, signed by the client, is obtained for release of copies of client records and/or information. Original documents must remain on file at the originating Provider site; (7) (8) An orientation is provided to new staff persons, employees, and volunteers. All employees and volunteers must sign a confidentiality pledge, acknowledging their awareness and understanding of confidentiality laws, regulations, and policies; Procedures are developed and implemented that address client chart and medical record identification, filing methods, storage, retrieval, organization and maintenance, access and security, confidentiality, retention, release of information, copying, and faxing. K. Monitoring: Management Evaluation and Performance Review. The Provider agrees to permit County authorized personnel to monitor, review and evaluate the program/work which is the subject of this Contract. The County shall monitor fiscal, administrative, and programmatic.compliance with all the terms and conditions of the Contract. The Provider shall permit the County to conduct site visits, client assessment surveys, and other techniques deemed reasonably necessary to fulfill the monitoring function. A report of the County's findings will be delivered to the Provider and the Provider will rectify all deficiencies cited within the period of time specified in the report. If such deficiencies are not corrected within the specified time the County may suspend payments or terminate this Contract. The County may conduct one or more formal management evaluation and performance reviews of the Provider. Continuation of this Contract or future funding is dependent upon the County being satisfied with the results of the evaluations. L. Client Records. The Provider shall maintain a separate individual client chart for each client/family served, where appropriate. This client chart shall include all pertinent information regarding case activity. At a minimum, the client chart shall contain referral and intake information, treatment plans, and case notes documenting the dates services were provided and the type of service provided. These client charts shall be subject to the audit and inspection requirements under Article 19, Sections F, G and H of this Contract. M. Disaster Plan/Continuity of Operations Plan (COOP). The Provider shall develop and maintain an Agency Disaster Plan/COOP. At a minimum, the Plan will describe how the Provider establishes and maintains an effective response to emergencies and Page 19 of 26 The City of Miami Feeding Coordination (PC09I0-FC), Emergency Hotel/Motel Placement (PC0910-HTMT-1) HMIS Staffing (PC0910-HMIS-1) disasters, and must comply with any Florida Statutes related to Emergency Management that are applicable to the Provider. The Disaster Plan/COOP must be submitted to the County no later than April 1st of the contract term and is also subject to review and approval of the County in its sole discretion. The Provider will review the Plan annually, revise it as needed, and maintain a written copy on file at the Provider's site. ARTICLE 20. Office of Miami -Dade County Inspector Genera! and the Commission Auditor The Provider understands that it may be subject to an audit, random or otherwise, by the Office of Miami -Dade County Inspector General or an Independent Private Sector Inspector General retained by the Office of the Inspector General, or the County Commission Auditor. Independent Private Sector Inspector General Reviews. The attention of the Provider is hereby directed to the requirements of Miami -Dade County Code Section 2-1076; in that the Office of the Miami -Dade County Inspector General (IG) shall have the authority and power to review past, present and proposed County programs, accounts, records, contracts and transactions. The IG shall have the power to subpoena witnesses, administer oaths and require the production of records. Upon ten (10) days written notice to the Provider from IG, the Provider shall make all requested records and documents available to the IG for inspection and copying. The IG shall have the power to report and/or recommend to the Board of County Commissioners whether a particular project, program, contract or transaction is or was necessary and, if deemed necessary, whether the method used for implementing the project or program is or was efficient both financially and operationally. Monitoring of an existing project or . program may include reporting whether the project is on time, within budget and in conformity with plans, specifications, and applicable law. The IG shall have the power to analyze the need for, and reasonableness of, proposed change orders. The IG may, on a random basis, perform audits on all County contracts throughout the duration of said contract (hereinafter "random audits"). This random audit is separate and distinct from any other audit by the County. To pay for the functions of the Office of the Inspector General, any and all payments to be made to the Provider under this contract will be assessed one quarter (1/4) of one percent of the total amount of the payment, to be deducted from each progress payment as the same becomes due unless this Contract is federally or state funded where federal or state law or regulations preclude such a charge. The Provider shall in stating its agreed prices be mindful of this assessment, which will not be separately identified, calculated or adjusted in the proposed budget form. The IG shall have the power to retain and coordinate the services of an independent private sector inspector general (1PSIG) who may be engaged to perform said random audits, as well as audit, investigate, monitor, oversee, inspect, and review the operations, activities and perforrriance and procurement process including, but not limited to, project design, . establishment of bid specifications, bid submittals, activities of the contractor, its officers, agents and employees, lobbyists, County staff and elected officials in order to ensure compliance with contract specifications and detect corruption and fraud. ARTICLE 21. SUBCONTRACTORS and ASSIGNMENTS A. Subcontracts. The parties agree that no assignment or subcontract will be . Page 20 of 26 The City of Miami Feeding Coordination (PC091 D-FC), Emergency Hotel/Motel Placement (PC09I0-HTMT-1) HMIS Staffing (PC0910-HM1S-1) made or let in connection with this Contract without the prior written approval of the County in its sole discretion, which shall not be unreasonably withheld, and that all subcontractors or assignees shall be govemed by all of the terms and conditions of this Contract. 1) If the Provider will cause any part of this Contract to be performed by a Subcontractor, the provisions of this Contract wit apply to such Subcontractor and its officers, agents and employees in all respects as if it and they were employees of the Provider; and the Provider will not be in any manner thereby discharged from its obligations and liabilities hereunder, but will be liable hereunder for all acts and negligence of the Subcontractor, its officers, agents, and employees, as if they were employees of the Provider. The services performed by the Subcontractor will be subject to the provisions hereof as if performed directly by the Provider. 2) The Provider, before making any subcontract for any portion of the services, will state in writing to the County the name of the proposed Subcontractor, the portion of the Services which the Subcontractor is to perform, the place of business of such Subcontractor, and such other information as the County may require. The County will have the right to require the Provider not to award any subcontract to a person, firm, or corporation disapproved by the County in its sole discretion. 3) Before entering into any subcontract hereunder, the Provider will inform the Subcontractor fully and completely of all provisions and requirements of this Contract relating either directly or indirectly to the Services to be performed. Such Services performed by such Subcontractor will strictly comply with the requirements of this Contract. 4) In order to qualify as a Subcontractor satisfactory to the County in its sole discretion, in addition to the other requirements herein provided, the Subcontractor must be prepared to prove to the satisfaction of the County that it has the Tiecessary facilities, skill and experience, and ample financial resources to perform the Services in a satisfactory manner. To be considered skilled and experienced, the Subcontractor must show to the satisfaction of the County in its sole discretion that it has satisfactorily performed services of the same general type which is required to be performed under this Contract. 5) The County shall have the right to withdraw its consent to a subcontract if it appears to the County that the subcontract will delay, prevent, or otherwise impair the performance of the Contractor's obligations under this Contract. All Subcontractors are required to protect the confidentiality of the County's and County's proprietary and confidential information. Provider shall furnish to the County copies of all subcontracts between Provider and Subcontractors and suppliers hereunder. Within each such subcontract, there shall be a' clause for the benefit of the County permitting the County to request completion of performance by the Subcontractor of its obligations under the subcontract, in the event the County- finds the Contractor in breach of its obligations, the option to pay the Subcontractor directly for the performance by such subcontractor. Page 21 of 26 The City of Miami Feeding Coordination (PC091 0-FC), Emergency.Hotel/Motel Placement (PC09]0-HTMT-1) HMIS Staffing (PC091 0-HMIS- 1) Notwithstanding, the foregoing shall neither convey nor imply any obligation or liability on the part of the County to any subcontractor hereunder as more fully described herein. B. Prompt Payments to Subcontractors. The Provider shall issue prompt payments to subcontractors that are small businesses (annual gross sales of $750,000 or Tess with its principal place of business in Miami -Dade County) and shall have a dispute resolution procedure in place to address disputed payments. Pursuant to the County's Sherman S. Winn Prompt Payment Ordinance (Ordinance 94-40), Section 2-8.1.4 of the Code of Miami -Dade County, Administrative Order No. 3-19, and the Florida Prompt Payment Act, payments must be made within thirty (30) days of receipt of a proper invoice. Failure to issue prompt payments to small business subcontractors or adhere to dispute resolution procedures may be grounds for suspension or termination of this Contract or debarment. ARTICLE 22. LOCAL, STATE, AND FEDERAL COMPLIANCE REQUIREMENTS Provider agrees to comply, subject to applicable professional standards, with the provisions of any and all applicable Federal, State and the County's orders, statutes, ordinances, rules and regulations that may pertain to the Services required under this Contract, including but not limited to: a) Miami -Dade County Florida, Department of Business Development Participation Provisions, as applicable to this Contract. b) Miami -Dade County Code, Chapter 11A, including but not limited to Articles III and IV. All Providers and subcontractors performing work in connection with this Contract shall provide equal opportunity for employment and services without regard to race, creed, religion, color, sex, familial status, marital status, sexual orientation, pregnancy, age, ancestry, national origin or handicap. The aforesaid provision shall include, but not be limited to, the following: employment, upgrading, demotion or transfer, recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The Provider agrees to post in a conspicuous place available for employees and applicants for employment, such notices as may be required by the, Dade County Equal Opportunity Board or other authority having jurisdiction over the work setting forth the provisions of the nondiscrimination law. Conflict of Interest and Code of Ethics Ordinance, Section 2-11.1 et seq. of the Code of Miami -Dade County, as amended. d) Miami -Dade County Code Section 10-38, Debarment of contractors from County work. e) Miami -Dade County Ordinance 99-5, codified at 11A-60 et seq. Code of Miami - Dade County pertaining to complying with the County's Domestic Leave Ordinance. f) Miami -Dade County Ordinance 99-152 codified at Section 21-255 et seq. prohibiting the presentation, maintenance, or prosecution of false or fraudulent claims against Miami -Dade County. Page 22 of 26 The City of Miami Feeding Coordination (PC09 10-FC), Emergency Hotel/Motel Placement (PC0910-HTMT-1) HMIS Staffing {PC0910-HMIS-1) Notwithstanding any other provision of this Contract, Provider shall not be required pursuant to this Contract to take any action or abstain from taking any action if such action or abstention would, in the good faith determination of the Provider, constitute a violation of any law or regulation to which Provider is subject, including but not limited to laws and regulations requiring that Provider conduct its operations in a safe and sound manner_ ARTICLE 23. MISCELLANEOUS A. Publicity. It is understood and agreed between the parties hereto that this Provider is funded by Miami -Dade County. Further, by the acceptance of these funds, the Provider agrees that events funded by this Contract shall recognize and adequately reference the County as a funding source. The Provider shall ensure that all publicity, public relations, advertisements and signs recognizes and references the County (by inserting the Miami -Dade County Homeless Trust Logo on all materials) for the support of all contracted activities. This is to include, but is not limited to, all posted signs, pamphlets, wall plaques, cornerstones, dedications, notices, flyers, brochures, news releases, media packages, promotions, and stationery. The use of the official Miami -Dade County Homeless Trust logo is permissible for the publicity purposes stated herein. Provider shall submit sample or mock up of such publicity or materials to the County for review and approval. The Provider shall ensure that all media representatives, when inquiring about the activities funded by this Contract, are informed that the County is its funding source. B. Governing Law and Venue. This Contract is made in the State of Florida and shall be governed according to the laws of the State of Florida. Venue for this Contract shall be Miami -Dade County, Florida. C. 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 and attached to the original of this Contract. The County and Provider mutually agree that modification of the Scope of Services, schedule of payments, billing and cash payment procedures, set forth herein and other such revisions may be made as a written amendment to this Contract executed by both parties. The Mayor or the Mayor's designee is authorized to make modifications to this Contract as described herein on behalf of the County. The Office of the Inspector General shall have the power to analyze the need for, and the reasonableness of proposed modifications to this Contract. D. Counterparts. This Contract is executed in three (3) counterparts, and each counterpart shall constitute an original of this Contract. E. 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. Page 23 of 26 The City of Miami Feeding Coordination (PC0910-FC), Emergency Hotel/Motel Placement (PC0910-HTMT-I) HMIS Staffing (PC09I0-HMIS-1) F. Review of this Contract. Each party hereto represents and warrants that they have consulted with their own attorney concerning each of the terms contained in this Contract. No inference, assumption, or presumption shall be drawn from the fact that one party or its attorney prepared this Contract. It shall be conclusively presumed that each party participated in the preparation and drafting of this Contract. G. The County's Consultant. The County understands that in order to facilitate the implementation of this Contract, the County may from time to time designate a development consultant to work with the Provider. The County's consultant shall be considered the County's designee with respect to all portions of this Contract with the exception of those provisions relating to payment of the Provider for services rendered. The County shall provide written notification to the Provider of the name, address, and employees of the County's consultant. H. Contracts with Municipalities or Counties Outside Miami -Dade County to Provide Homeless Housing in Miami -Dade County. The Provider desiring to transact business or enter into a Contract with the County for the provision of homeless housing and/or . services swears, verifies, affirms and agrees that (1) it has not entered into any current contract, arrangement of any kind, or understanding with any municipality outside of Miami -Dade County or any County (collectively "locality") to provide housing and services for homeless persons in Miami=Dade County who are transported to Miami -Dade County by or at the behest of such locality and (2) during the term of this Contract, it will not enter into any such contract, arrangement of any kind, or understanding; provided, however, upon the written request of the Contractor prior to entering into such contract, understanding that the County may, in its sole and absolute discretion, find and determine within sixty (60) days of such request that a proposed contract should not be prohibited hereby, as the best interests of the homeless programs undertaken by and on behalf of Miami -Dade County would not be negatively affected by such contract, arrangement, or undertaking. Incident Reports. The Provider must report to the Miami -Dade County Homeless Trust information related to any critical incidents occurring during the administration of its programs. The Provider is to utilize the "incident Report" form attached as Attachment N. In addition to reporting this incident to the appropriate authorities, the Provider must within twenty-four (24) hours of any incident, submit in writing a detailed account of the incident. This incident report should be addressed to the County. This incident report should be addressed to Miami -Dade County Homeless Trust, 111 NW First Street, 27th Floor, Suite 310, Miami, Florida 33128; telephone (305) 375-1490 and facsimile (305) 375-2722. J. Totality of Contract / Severability of Provisions. This Contract and Attachments, with it recitals on the first page of the Contract and with its attachments as referenced below contain all the terms and conditions agreed upon by the parties: K. Property. This section applies to equipment with an acquisition cost of $5,000 or more per unit and all real property. a. Any real property under the Provider's control that was acquired/improved in whole or in part with funds from the Homeless Trust and any equipment purchased for $5,000 or more shall be disposed of, at the expiration or termination of this contract, in accordance with instruction from the Homeless Trust. Real Property is defined as land, including land Page 24 of 26 The City of Miami Feeding Coordination (PC0910-FC), Emergency Hotel/Motel Placement (PC0910-HTMT-1) HMIS Staffing (PC0910-HMIS-I) improvements, structures, and appurtenances thereto, including movable machinery and equipment. Equipment means tangible, nonexpendable, personal property having a useful life of more than one year and an acquisition cost of $5,000 or more per unit. All equipment with an acquisition cost of $5,000 or more per units and all real property purchased in whole or .in part with funds from this and previous contracts with the Homeless Trust, or transferred to the Provider t after being purchased in whole or in part with funds from the Homeless Trust shall be listed in the property records of the Provider and shall include a legal description, size, date of acquisition, value at time of purchase, owner's name if different from the Provider, information on the transfer or disposition of the property, and map indicating whether property is in parcels, lots or blocks and showing adjacent streets and roads. • Notwithstanding documentation required for reimbursement purposes, a copy of the purchase receipt for any asset described above purchased with Homeless Trust funds must also be included in the Provider's monthly reimbursement package submitted to the Homeless Trust in the month in which the item was purchased along with the "Provider Asset Inventory" (Attachment 0). c. All equipment with an acquisition cost of $5,000 or more per unit and all real property shall be inventoried annually by the Provider and an inventory report shall be submitted to the Homeless Trust. This report shall include the elements listed in the paragraph listed above. Attachment A: Scope of Services Attachment B: Budget Attachment C: Miami Dade County Affidavits Attachment D: State Affidavits (not applicable) Attachment E:. Primary Care invoice for Services (not applicable) Attachment F: Monthly Payment Requests Reports Attachment G: Monthly Performance Reports (not applicable) Attachment H: Outcome Performance Measurements Monthly Report (not applicable) Attachment I: Client Contribution Report (not applicable) Attachment J: Client Attendance Roster (not applicable) Attachment K: Vacancy/Permanent Housing Placement Report (Quarterly) (not applicable) Attachment L: Annual Performance Report & Annual Actual Expenditure Report Attachment M: W-9 Form Attachment N: Incident Report Attachment 0: Provider Asset Inventory Report Attachment P: Client Services Certification Form No other agreement, oral or otherwise, regarding the subject matter of this Contract shall be deemed to exist or bind any of the parties hereto. 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 and ordinance. Page 25 of 26 The City of Miami Feeding Coordination (PC0910-FC), Emergency HoteVMotel Placement (PC0910-HTMT-1) HMIS Staffing (PC0910-HMIS-1) IN WITNESS WHEREOF, the parties have executed this. Contract, along with all of its Attachments, effective as of the contract date herein above set forth. THE CITY OF Ml,Afl14h_ MIAMI-DADE COUNTY, FLORIDA By. Name: PEDRORNANDEZ Title: CITY MANAGER Name: — PRIS ILLA A. THO PSON Title: CITY CLERK Date: Approved as to Form and Correctness: By: Name: Title: Date: By: Name: Title: Date: Attest: HARVEY RUVIN, Clerk Page 26 of 27 Board of County Commissioners Approved as to Insurance Requirem-rits: By: Name: LEE AN : - ' HM Title: Date: Attest: Print Name: Title: RISK MANAGEMENT Authorized Person OR Notary Public Corporate Seal OR Notary Seal/Stamp: Page 27 of 27 Attachment A The City of Miami Scope of Services Requirements of the Emergency Hotel/Motel Placement Program: The Provider agrees to provide emergency hotel/motel placements of homeless families with children for a period of up to seven (7).days in area hotels/motels. Families may be provided food vouchers on an as -needed basis of up to $20.00 per diem while residing in hotels/motels. Families with more than four (4) members may be provided an additional $5.00 per person per day. Reimbursements will only be made for properly documented disbursement of food vouchers. All reimbursements must be submitted to the County by the 15th day of each month following the month of service. All reimbursement requests must be approved by the County prior to the disbursement of funds. Requirements of the Feeding Coordination Program: The Provider shall coordinate feeding programs for the homeless in the City of Miami to ensure feeding is conducted in a clean, convenient and humane environment. The Community Liaison/Feeding Coordinator shall develop and maintain a list of all participating organizations and homeless individuals no later that thirty (30) days prior to the end of each quarter; distribute correspondence as needed to participating organizations; and ensure the coordination of outreach activities at the feeding sites listed below: • Camillus House, Inc_ 726 NE lst Avenue Miami, Florida 33136 • Miami Rescue Mission 2020 NE 151 Avenue Miami, Florida 33127 • Mount Zion. Baptist Church 301 NW 9th Street Miami, Florida 33136 Requirements of the HMIS Staffing Program: The Provider shall provide a dedicated HMIS Outreach staff person. The purpose of this staff position is to maintain data current in the HMIS and includes, but is not limited to input of client data upon intake, updates of client files, compilation of reports and entering data for statistical purposes. Failure to maintain this data current, as evidenced by HMIS generated Monthly Progress Reports (MPR) submitted to the County each month under the United States Housing and Urban Development (USHUD) sub -recipient Agreement between the Provider and the County may result in the termination of this Agreement. Attachment B, Page 1 of 3 The City of Miami Emergency Hotel/Motel Placement —PC-0910-HTMT-1 CITY OF MIAMI HOMELESS ASSISTANCE PROGRAM Emergency Hotel/Motel Placement 2009-2010 Contract BUDGET Object Class Cost MDHT % City of Miami % Justification Emergency Housing, Hotel/Motel 1400 days/units @ $50.00 per day $70,000 100% Emergency Hotel/Motel placements for eligible families due to unavailability of beds within the continuum of care Food Vouchers 250 vouchers @ $20.00 per voucher $5,000 100% Food vouchers for eligible families. TOTAL $75,000 1 Attachment B-Page 2 of 3 The City of Miami Feeding Coordination Program-PC-0910-FC CITY OF MIAMI HOMELESS ASSISTANCE PROGRAM Feeding Coordinator 2009-2010 Contract BUDGET Object Class Cost MDHT % MCH % City of Miami % Justification 1. Staffing Personnel -Salary 1 FT Homeless Program Feeding Coordinator @ $14.49/h $32,445 46 % 31 % 23% Salaries for the City of Miami Homeless Program Feeding Coordinator TOTAL • $32,445 $15,000 $10,000 $7,445 Attachment B The City of Miami HMIS Staffing — PC-0910-HMIS-1 CITY OF MIAMI HOMELESS ASSISTANCE PROGRAM Homeless Management Information System 2009-2010 Contract BUDGET Object Class Cost MDHT % City of Miami % Justification 1. Supportive Service Costs Personnel -Salary 1 FT Homeless Program Clerk. HMIS Administrator @$14.49/h $32,445 76 % 24 % Salaries for the City of Miami Homeless Program HMIS Administrator TOTAL $24,666 $7,779 1 ATTACHMENT C NMIAMI-DADE COUNTY AFFIDAVITS The contracting individual or entity (government or otherwise) shall indicate by an "X" all affidavits that pertain to this contract and shall indicate by an "N/A" at affidavits that do not pertain to this contract. All blank spaces must be filled. The MIAMI-DADE COUNTY OWNERSHIP DISCLOSURE AFFIDAVIT; MIAMI-DADE COUNTY EMPLOYMENT DISCLOSURE AFFIDAVIT; MIAM1-DADE CRIMINAL RECORD AFFIDAVIT; DISABILITY NON-DISCRIMINATION AFFIDAVIT; and the PROJECT FRESH START AFFIDAVIT shall not pertain to contracts with the United States or any of its departments or agencies thereof, the State or any political subdivision or agency thereof; it shall however, pertain to municipalities of the State of Florida. All other contracting entities or individuals shall read carefully each affidavit to determine whether or not it pertains to this contract. Sergio Torres Affiant , being first duly swom state: The full legal name and business address of the person(s) or entity contraction or transacting business with Miami -Dade County are (Post Office addresses are not acceptable): 59-6000375 Federal Employer identification Number (If none, Social Security) City of Miami Homeless Assistance Program Name of Entity, Individual(s), Partners, or Corporation Doing Business As (If same as above, leave blank) 1490 NW 3rd Ave Suite 105 Miami Florida 33136 Street Address City State Zip Code 1. MIAMI-DADE COUNTY OWNERSHIP DISCLOSURE AFFIDAVIT (Sec. 2-8.1 of the County Code) 1. If the contract or business transaction is with a corporation, the full legal name and business address shall be provided for each officer and director and each stockholder who holds directly or indirectly five percent (5%) or more of the corporation's stock. If the contract or business transaction is with a partnership, the foregoing information shall be provided for each partner. It the contract or business transaction is with a trust, the full legal name and address shall be provided for each trustee and each beneficiary. The forgoing requirements shall not pertain to contracts with publicly -traded corporations or to contracts with the United States or any department or names and addresses are (Post Offices addresses are not acceptable): Full Legal Name Address Ownership NONE Page 1 of 5 2. The full legal names and business address of any other individual (other than subcontractors, material men, supplies, laborers, or enders) who have, or will have, any interest (legal, equitable beneficial or otherwise) in the contract or business transaction with Dade County are (Post Office addresses are not acceptable): 3. Any person who willfully fails to disclose the information required herein, or who knowingly discloses false information in this regard, shall be punished by a fine of up to five hundred dollars ($500.00) or imprisonment in the County jail for up to sixty (60) days or both. iL MiAMi-DADE COUNTY EMPLOYMENT DISCLOSURE AFFIDAVIT (County Ordinance No. 90-133, amending Sec. 2:8-1; Subsection (d)(2) of the County Code). Except where precluded by federal or State laws or regulations, each contract or business transaction or renewal thereof which involves the expenditure of ten thousand dollar ($10,000) or more shall require the entity contracting or transacting business to disclose the following information. The foregoing disclosure requirements do not apply to contracts with the United States or any department or agency thereof, the State or any political subdivision or agency or any municipality of this State. 1. Does your firm have a collective bargaining agreement with its employees? X Yes No 2. Does your firm provide paid hearth care benefits for its employees? X Yes No 3. Provide a current breakdown (number of persons) of your firm's work force and ownership as to race, national origin and gender. White: 1 Males: 0 Females:Asian: Males: Females: Black: 9 Males: 8 Females: American Indian: Males: Females: Hispanics: 12 Males: 4 Females: Aleut (Eskimo): Males: Females: Males: Females: Males: Females: iII. AFFIRMATIVE ACTION/NON-DISCRIMINATION OF EMPLOYMENT, PROMOTION AND PROCUREMENT PRACTICES (County Ordinances 98-30 codified at 2-8.1.5 of the County Code) In accordance with County Ordinance No. 98-30, entities with annual gross revenues in excess of $5,0D0,000 seeking to contract with the County shall, as condition receiving a County contract, have I) a written affirmative action plan which sets forth the procedures the entity utilizes to assure- that it does not discriminate in its employment and promotion practices; and ii) a written procurement policy which sets forth the procedures the entity utilizes to assure that it does not discriminate against minority and women - owned businesses in its own procurement of goods, supplies and services. Such affirmatives action plans and procurement policies shall provide for periodic review to determine their effectiveness in assuring the entity does not discriminate in its employment, promotion and procurement practices. The foregoing notwithstanding, corporate entities whose boards of directors are representatives of the population make- up of the nation shall be presumed to have non-discriminatory employment and procurement policies, and shall not be required to have written affirmative action plans and procurement policies in order to receive a County contract. The foregoing presumption may be rebutted. The requirements of County Ordinance No. 98-30 may be waived upon the written recommendation of the County Manager that it is in the best interest of the County. to do so and upon approval of the Board of County Commissioners by majority vote of the members present. Page 2 of 5 —' ti The firm does not have annual gross revenues in excess of $5,000,000. The firm does have annual revenues in excess of $5,000,000; however, its Board of Directors is representative of the population make-up of the nation and has submitted a written, detailed listing of its Board of Directors, including the race of ethnicity of each board member, to the County's Department of Business Development, 175 NW 1s' Avenue, 28'h Floor, Miami, Florida 33128. The firm has annual gross revenues in excess of $5,000,000 and the firrn does have a written affirmative action plan and procurement policy as described above, which includes periodic review to determine effectiveness, and has submitted the plan and policy to the County's Department of Business Development, 175 NW 151 Avenue, 2B'h Floor, Miami, Florida 33128. The fin-n does not have an affirmative action plan and/or a procurement policy as described above, but has been granted a waiver. IV. MIAMI-DADE COUNTY CRIMINAL RECORD AFFIDAVIT (Section 2-8.6 of the County Code) The individyal or entity entering into a contract or receiving funding from the County has ye has not of the date of this affidavit been convicted of a felony during the past ten (10) years. V. MIAMI-DARE EMPLOYMENT DRUG -FREE WORKPLACE AFFIDAVIT (County Ordinance no. 92-15 codified as Section 2-8.1.2 of the County Code) That in compliance with Ordinance No. 92-15 of the Code of Miami -Dade County, Florida, the above named person or entity is providing a drug -free workplace. A written statement to each employee shall, inform the employee about: 1. Danger of drug abuse in the workplace 2. The firm's policy of maintaining a drug -free environment at all workplaces 3. Availability of drug counseling, rehabilitation and employee assistance programs 4. Penalties that may be imposed upon employees for drug abuse violations The person or entity shall also require an employee to sign a statement, as a condition of employment, that the employee will abide by the terms and notify the employer of any criminal drug conviction occurring no later than five (5) days after receiving notice of such conviction and impose appropriate personnel action against the employee up to and including termination. Compliance with Ordinance No. 92-15 may be waived if the special characteristics of the product or service offered by the person or entity make it necessary for the operation cif the County or for the health, safety, welfare, economic benefits and well-being of the public. Contracts_.invol.ving funding. which is .provided in whole or in part by the United States of the State of Florida shall be exempted from the provisions of this ordinance in those instances where those provisions are in conflict with the requirements of those government entities. VI. MIAMI-DADE EMPLOYMENT FAMILY LEAVE AFFIDAVIT (County Ordinances No. •142-91 codified as Section 11A-29 et. Seq of the County Code) That in compliance with ordinance No. 142-91 of the Code of Miami -Dade County, Florida, an employer with fifty (50) or more employees working in Dade County for each working day during each of twenty (20) or more calendar workweeks, shall provide the following information in compliance with all items in the aforementioned ordinance: Page 3 of 5 An employee who has worked for the above firm at least one (1) year shall be entitled to ninety (90) days of family leave during any twenty-four (24) month period, for medical reasons, for the birth or adoption of a child, or for the care of a child, spouse or other close relative who has serious health condition without risk of termination of employer retaliation. The foregoing requirements shall not pertain to contracts with the United States or any department or agency thereof, or the State of Florida or any political subdivision or agency thereof. It shall, however, pertain to municipalities of this State. VII. DISABILITY NON-DISCRIMINATION AFFIDAVIT (County Resolution R385-95) --- That the above names firm, corporation or organization is in compliance with the agrees to continue to comply with and assure that any subcontractor, or third party contractor under this project complies with all applicable requirements of the laws listed below including, but not limited to, those provisions pertaining to employment provisions of programs and services, transportation, communications, access to facilities, renovations, and new construction in the following laws: The Americans with Disabilities Act of 1990 (ADA), Pub. L. 101-336, 104 Stat 327.42 U.S.C. 12101-12213 and 47 U.S.C. Section 1612; The Fair Housing Act as amended, 42 U.S.C. Section 3601-3631. The foregoing requirements shall not pertain to contracts with the United States or any department or agency thereof, the State or any political subdivision or agency thereof or any municipality of this State. VIII. MIAMI-DADE COUNTY REGARDING DELIQUENT AND CURRENTLY DUE . FEES OR TAXES (Sec. 208.1 (c) of the County Code) Except for small purchase orders and sole source contracts, that above. named firm, corporation, organization or individual desiring to transact business or enter a contract with the County Verifies that all delinquent and currently due fees or taxes — including but not limited to real and property taxes, utility taxes and occupational licenses — which are collected in the normal course by the Dade County Tax Collector as well as Dade County issued parking tickets for vehicles registered in the name of the firm, corporation, organization or individual have been paid. IX. CURRENT OR ALL COUNTY CONTRACTS, LOANS AND OTHER OBLIGATIONS The individual entity seeking to transact business with the County is current in all its obligations to the County and is .not otherwise in default or any contract, promissory note or other loan documents with the County or any of its agencies or instrumentalities. X. PROJECT FRESH START (Resolution R-702-98 and 358-99) Any firm that has a contract with the County that results in actual payment of $500,000 or more shall contribute to Project Fresh Start, the County's Welfare to Work Initiative. However, if five percent (5%) of the-firm's work -force consists of.individuals. who..reside.in Miami -Dade - County and who have lost or will loose cash assistance benefits (formerly Aid to Families with dependent Children) as a result of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, the firm may request waiver from the requirement of R-702098 and R-358-99 by submitting a waiver request affidavit. The foregoing requirement does not pertain to government entities, not for profit organizations or recipients of grant awards. Page 4 of 5 XI. DOMESTIC VIOLENCE LEAVE (Resolution 185-00; 99-5 Codified at 11A-60 Et. Seq. of the Miami -Dade County Code). The firm desiring to do business with the County is in compliance with Domestic Leave Ordinance, Ordinance 99-5, codified at 11A-60 et. Seq. of the Miami -Dade County Code, which requires an employer which has in the regular course of business fifty (50) or more employees working in Miami -Dade County for each working day during each of twenty (20) or more calendar work weeks in the current or proceeding calendar years, to provide Domestic Violence Leave to its employees. I have carefully read this entire five (5) page document entitled Miami -Dade County Affidavits and have indicated by an "X" all affidavits that pertain to his contract and have indicated by an "N/A" all affidavits that do not pertain to this contract. By. Ci 2S ! �c''�td. (Signore o Affiant) ate) SUBSCRIBED AND SWORN TO (or affirmed) before me this , 5 day of/7t . `rti 20 /0 by .5eisio ,;rr- s . Cabe is personally known to me or has presentedF%/,CCivsr' 780— A'7-?99C as identification. (Type of Identification) re °Ng rarcowl Do&7192 EXPIRES: February 2, 2013 f,,pF Balled'Pon Notary Pubic Uirkimik,s (Serial Number) i/ trV a, aa/! (Print of Stamp of Notary) {Expiration Date) Notary Public — State of �GreirA (State) Page 5 of 5 . SWORN STATEMENT PURSUANT TO SECTION 287.133 (3) (a) FLORIDA STATUTES ON PUBLIC ENTITY CRIMES THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL . AUTHORIZED TO ADMINISTER OATHS 1. This form statement is submitted to Miami -Dade County Homeless Trust Sergio Torres, Program Administrator by (Print individual's name and title) City of Miami Homeless Assistance Program for (Print name of entity submitting swam statement) whose business address is 1490 NW 3rd Ave Suite 105 Miami, FL 33136 and if applicable its Federal Employer Identification Number (FEIN) is 59-600037 f the entity has not FEIN, include the Social Security Number of the individual signing this sworn statement. 2. I understand that a "public entity crime" as defined in paragraph 287.133(1)(g), Florida Statues, means a violation of any state or federal taw by a person with respect to an directly related to the transactions of business with any public entity or with an agency or political subdivision of any other state or with the United States, including, but not limited to any bid or contract for goods or services to be provided to public entity or agency or political subdivision of any other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misinterpretation. 3. i understand that "convicted" or "conviction" as defined in' Paragraph 287.133(1)(b), Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in an federal or state trial court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, non -jury trial, or entry of a plea of gutty or nolo contendere. 4. 1 understand that an "Affiliate" as defined in paragraph 287.133(1)(a), Florida Statutes means: 1. A predecessor or successor of a person convicted of a public entity crime, or • 2. An entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes those officers , directors, executives, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a. controlling interest in another person, or a pooling of equipment or income among persons when not for fair market value under an arm's length agreement, shall be a prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted -of a public entity crirne in Florida during the preceding •36 months shall be considered an affiliate. 5. I understand that a "person" as defined in Paragraph 287.133(1)(e), Florida Statues, means any natural person or entity organized under the laws of any state or of the United States within the legal power to enter into a binding contract and which.bids or applies to bid on contracts for the provision of goods or entity. The term "person" includes those officers, executives, partners, shareholders, employees, members, and agents who are active in management of an entity 6_ Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement. (Please indicate which statement applies.) Neither the entity submitting sworn statement, nor any of its officers, director, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, nor any affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. The entity submitting this swom statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who 'are active in the management of the entity, or an affiliate of the entity, or an affiliate of the entity had been charged with and convicted of a public entity crime subsequent to July 1, 1989, AND (please indicate which additional statement applies. The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, nor any affiliate of the entity has been charged with and convicted of a public entity crime subsequent proceeding before a Hearing Officer of the State of the State of Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer determined that it was not in the public interest to place the entity submitting this swom statement on the convicted vendor list. (attach a copy of the final order). 1 UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND THAT THIS FORM IS VALID THROUGH DECEMBER 31 OR THE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THAT PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN . SECTION 287.017 FLORIDA STATUTES FOR A CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM. Sworn to and subscribed before me this 25 nature) day of ..70 NJQI't7/ , 20/0.. Personally known Or produced identification Notary Public -State of ,fOry ila My commission expires T bii2Yy ,3, a0/3 (Type of identification) I : <Q '.Pi' NATAUA D. FIGUEROA :- MY COMMISSION # DD 857192 EXPIRES:Febma 2,2013 (Print " +:" °F° ItMtN'rrt11 'P4FfWf jc ed name of notary public) ATTACHMENT D NOT APPLICABLE ATTACHMENT E NOT A]PIPLICABLE Attachment F Miami -Dade County Homeless Trust Invoice For Services NAME OF AGENCY: The Citv of Miami SERVICE PERIOD: TO NAME OF GRANT: Emereencv Hotel/Motel Placement GRANT NUMBER: PC-0910-HTMT-1 TOTAL AWARD AMOUNT: $ 75.000.00 AMOUNT OF FUNDS REQUESTED THIS MONTH: $ AMOUNT OF FUNDS RECEIVED TO DATE: $ BALANCE REMAINING ON GRANT: $ (following payment of this request) Signature of Agency Representative Date Printed Name of Agency Representative Miami -Dade County Homeless Trust Invoice For Services Attachment F ( ) NAME OF AGENCY: The Citv of Miami SERVICE PERIOD: TO NAME OF GRANT: HMIS Staffing Program GRANT NUMBER: PC-0910-HMIS-1 TOTAL AWARD AMOUNT: $ 24.666.00 AMOUNT OF FUNDS REQUESTED THIS MONTH: $ AMOUNT OF FUNDS RECEIVED TO DA 1E: $ BALANCE REMAINING ON GRANT: (following payment of this request) Signature of Agency Representative Date Printed Name of Agency Representative Attachment F Miami -Dade County Homeless Trust Invoice For Services NAME OF AGENCY: The City of Miami SERVICE PERIOD: TO NAME OF GRANT: Feeding Coordination Program GRANT NUMBER: PC-0910-FC TOTAL AWARD AMOUNT: $ 12.500.00 AMOUNT OF FUNDS REQUESTED THIS MONTH: $ AMOUNT OF FUNDS RECEIVED TO DATE: $ BALANCE REMAINING ON GRANT: $ (following payment of this request) Signature of Agency Representative Date Printed Name of Agency Representative ATTACHMENT G NOT A]P]PLICABLE ATTACHMENT H NOT APPLICABLE ATTACHMENT I NOT APPLICABLE ATTACHMENT J NOT APPLICABLE ATTACHMENT K NOT APPLICABLE ATTACHMENT L °i') Miami -Dade County Homeless Trust Annual Actual Expenditure Report The City of Miami Contract Period: October 1, 2009 - September 30, 2010 Name of Agency Contract Number: The City of Miami PC-0910-HTMT-1 $ 75,000.00 Month of Services Amount Paid October-09 November-09 December-09 January-10 February-10 March-10 April-10 May-10 June-10 July-10 August-10 September-10 Total Requested Balance Remaining 75,000.00 ATTACHMENT L (= ..j• Miami -Dade County Homeless Trust Annual Actual Expenditure Report The City of Miami I Contract Period: October 1, 2009 - September 30, 2010 Name of Agency Contract Number: The City of Miami PC-0910-FC 12,500.00 Month of Services Amount Paid October-09 November-09 December-09 January-10 February-10 March-10 April-10 May-10 June-10 July-10 August-10 September-10 Total Requested Balance Remaining 0 $ 12,500.00 ATTACHMENT L A.5 ;j Miami -Dade County Homeless Trust Annual Actual Expenditure Report The City of Miami I Contract Period: October 1, 2009 - September 30, 2010 Name of Agency Contract Number: The City of Miami PC-0910-HMIS-1 24,666.00 Month of Services Amount Paid October-09 November-09 December-09 January-10 February-10 March-10 April-10 May-10 June-10 July-10 August-10 September-10 Total Requested Balance Remaining 0 $ 24,666.00 p r,euast ;or Taxpayer � ar_ �r Identification Number and Ce,rtirication City of Miami E._.,n_ __ _ _, :iheir n frOn: s u c,1F.: !' �o::.'O:�r;ale r,�::� I I!IJiI'Id"JJ��:,✓Ig rXG:,:,etc L '.•D:�c aftac ✓� Peitre!: nip hm;teci imbitity compare Erne vie ion e:z:n.iiccaiior, ID=d;reparoed en! ‘;. C=e rperancn, P-o Ot'r�, 1=ee in;trutiien:i Pddrecs numbs,, axe/a. and apt. or tune nc.i LT,, 444 SW 2nd Ave. Miami, FL .31] 9Q City. crate. and JP toile Request• Give form to the requester. Do not send tc the IRS, IX' naver name and aod,ec:; (optional) Lett ac:cour mrie ter t ere Irpkonar, Taxpayer Identification Number (Tits) Enter your TIN in the appropriate box. The TIN provided must match the name given on Line t to avoid backup withholding. For individuals, this is your social security number (SSN). However, fora resident alien, sole proprietor. or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (2I1J). If you do not have a number, see How to ger e TIN on page 3. Note. If the account is in more than one name. see the chart on page_ 4 for guidelines on whose number to enter. ' Social security number or Employer identification number 5.9 6_110 017 5 !ball Certification Under penalties of perjury. I certify that: 'I. The number shown on this 'form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to 'backup withholding as a result of a failure to report al: interest or dividends. or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. I am a U.S. citizen or other U.S. person (defined below). Certrtrcafion instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report at interest and dividends on your tax return. For real estate transactions. item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancefafion of debt, contributions to an individual retirement . arrangement (iFiA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct T1N. See the instructions on pace Sign I signature Here U.S. person F Genera! Instructions 'J Section references are to the Internal Revenue Code unless otherwise noted. Purpose of Form A person who is required to file an information return with the IRS must obtain your correcl taxpayer identification number (YIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment -of secured property, cancellation of debt, or contributions you made to an RA. Use Form W-9 only if you are a U.S. person (including a resident alien), to provide. your correct TIN to the person requesting it (the requester) and. when app;icable. to: 1. Certify that the TIN you are giving is correct (or you are waiting for number to be issued), _. Cerrtify, that you are nni subiecf to backup v.r;lnito:ding, or a Clain- fixer,In1.io11 from m backup withhoidinc; i1 you are a U.S. ectpl pot,=_. I'• applicable: you are asa certityina that as 2 per Eton, your all.oc-bie share.o', any r crtnerthip income from a U.S. traile ar busrne_s is not subieci to tine withhoiding ter,: on or=Y;n partners' snare of effectively _•:=fin: -pled income. Note. !* reoue.sier gives, you a icrrr other than Form Yir'• to feDLtertt vaur TIN 31 LiCe the reouast_. s form d r I_ aubu.rsnr,ait, : imiser to ti'.:r Fora: e.-g.. Date ` co Definition of a U.S. person. For federal taknurposes, you are • considered a U.S. person if you are: e An individual who is a U.S. citizen or U.S. resident alien, 6 A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, An estate (other than e foreign estate), or A domestic trust (as defined in Regulations section 301.7701-71. Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax on any foreign partners' share of income from such business. Further, in certain case: where a Form w-g has not been received, a partnership is required to presumes that corner is a foreign person, and pay the withholding tax. Therefor. if ,you are a U.S person that is e partner in a • partnership conduct'mg a trade or busrricss in the United States provide Form Pd-9 TO the partnership to establish your U.S. aratu.. and avoid rrithholc inc or, your share of partnership income The pea:on who give , Forma trir•t! to Ihn ct:finer :hlr inr purpose:, o`. establishing its U.S. status and avoiding v;ahi;t,i;hnq on is a1%-,:a is share o' fie:; income from the cartne.rchta conductln..: 2 trade el' business ir, the Jn1ieU Stales 13 in lee f3.ioviiN: canes: The. U.S. ovine. :of a sae _ rrett P01011 ..rill no! tri_ enth_,; Lai 111.. '•-• .,. 'Pm Ud-9 Ci • The Imo.-. ?:'a":or Dr :trier owner ca grantor trust ono. .._....e Puss. aria • The L rust io-ther than a _minor trust, ells not frees Foreign person. If you are a tore,gr, person, Cc rig` use Form i4'•9. Ir:si=_aa: use, the apero?hate Form V•i-2 des Fus!icalion 515, Vrithholding of Tax or. hlonrecicent Aiiens ant Foreign Entities), Nonresident alien who becomes a resident alien. (Generality, Only a nonresident alien indvidual may use the terms of a tax Treaty to reduce or eliminate U.S. tax on certain types of income. However. most tax treaties contain a provision known as a 'saving clause." Exceptions specified in the saving clause may permit an exemption from tax; to continue for certain types of income even atter the payee has otharwise become a U.S. resident alien for tax: purposes. If you are a U.S. resident alien who is relying on an exception contained in the saving clause of e tar, treaty to claim en exemption from U.S. tax on certain types of .income, you must attach a statement to Form W-9 that specifies the following five items: 1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien. 2. The treaty article addressing the income. 3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions. 4. The type and amount of income that qualifies for the exemption from tax. 5. Sufficient facts to justify the exemption from tax under the. terms of the treaty article. Example. ;ride 20 of the U.S.-China income tax treaty allows -an exemption from tax for scholarship income received by a Chinese student temporarily present in the United States. Under U.S. law, this student will become a resident alien for tax purposes if his or her stay in the United States exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the. first protocol) and is relying on this exception to claim an exemption from tax on his or her scholarship or fellowship ' income would attach to Form W-9 a statement that includes the information described above to support that exemption. If you are a nonresident alien or a foreign entity not subject to backup.withholding, give the requester the appropriate completed Form W-8. What is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS 28% of such payments. This is called "backup withholding." Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends. broker and barter exchange transactions, rents, royalties, nonemployee pay. and certain payments from fishing boat operators. Real estate ,transections,are not subject to backup withholding. You will not be subject 10 backup withholding on payments you receive if you give the requester your correct TIN. make the proper certifications, and repon all your taxable interest and . dividends on your tar. return. Payments you receive will be subject to backup withholding if: - 1. You do not iurnish your TIN ic. the r :gii•ester, ":Cu2. d•,-; not certify your TIN when rep lured ices the Par; II IrsiructiOns on page 3 tor OeiaC3j. The -IRS tell;. The.. esie! that you furn:sa__ a.n. in _'T.,. TIN. • yr ❑r:gloms c:SL:_ _D,O . epnr' ,: u: in._ _s: enc, I:if:le.nts on ysur lefi return' (io:' .:soma. = in.. =rea: an, dividend!. ore. ;. Or riCG r'AI :- the requester that '>' .. are not £ - _. se:�:UO w:tnnaidirro Tinder - assive :Tor reponzoie Interea; a•.o divideno,socnlnta opened a:': 1g2 pnryr. Ce ;air: payees ano payments -are ezem,:it iron-, ca_ rug v.'ithhoidln0. See tht. InztruG1000 below any the seperai=_ instructions for the Requester o' Form W-9. Also sees Special rule_ for.ca^Ine'chia. on page 1. Penalties Failure to furnish TIN. It you fail to furnish your correct Till to a requester, you are subject 10 a penalty of 5.50 for each such failure unless your failure is due 10 reasonable cause ano not to willful neglect. Civil penalty for false information with respect to withholding. 11 you make a false statement with no reasonable . basis that results in no backup withholding, you are subject to a 5penalty Crimi500nal per•,.atty for falsifying information. Willtully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment. Misuse of TINs. If the requester discloses or uses TINS in violation of federal law, the requester may be subject to civil and criminal penalties. Specific Instructions. Name If you are an individual, you must generally enter the name shown on your income tax return. However, if you have changed your lasl name, for instance, due to marriage without informing the Social Security Administration of the name_ change, enter your firs name, the last name shown on your social security card, and your new last name. If the account is in joint names. list first, and then circle, the name of the person or entity whose number you entered in Part I of the form. Sole proprietor. Enter your individual name as shown on your incorne fax return on the "Name" line. You may enter your business, trade, or `doing business as (DSA)" name on the "Business name' Inc. Limited liabiiity company (LLC). Check the "Limited Cabiliiy company" box orily and enter the appropriate code for the tax; classification ("D" for disregarded entity, "C" for corporation, 'P" for partnership) in the space provided. For a single -member LLC (including a foreign LLC with a dotnestic owner) that is disregarded as an entity separate from its owner under Regulations section 301.7701-3, enter the owner's name on the "Name" inc.IEnter the LLC's name on the "Business name" inc.I For an LLC classified as a partnership or a corporation, enter the LLC's name on the "Name" line and any business, trade, or DB! name on the "Business nan'le" line. Other entities. Enter your business name- as shown on required :eaeroi tax documents on the "Name" tine. This name should matcn the name shown -on the charter or other legal document creating Ile entity. You may enter any business, trade, or UBA name on the 'Business name' Ina. Note. YOU are re0U501ed to chacu the sl:Ip roost: figs: ic;, you' .,talus ilndhbduai'soie proaneto;. cor0or:lion. etc.). Exempt Payee If you a - -mpt from backup wiir, otdinc enter 0o.:. name de„cribeo ancvc and chest the appropriate no:.: jot your :tiat:!r.. ;ne> crect. tree Exerlp: - be in the lin i.l;Ow;nr. the uusine-_ name. r,nc O ... tot form. proprietors, are. act et:en-tat inor'. _ '.i�t-,,,oi71- . dr5.c - c _ ,::tnf:,lz:"rofor :area:r, caaerrierts. sucit a_ .. r._ ant,' : i. ens':. Note. If !co ere et:00101 !r00 arrouittr mot: _110100.E t'1.S too .- C7ct:2,'c tn:root ,.:_r:C: tr,,:,nnoid rsq. The fafowinci pa, _:_ are ei:emp' tram Pa0i:u0 1. An arcani:aiion e..a^Ipt from tar: under section 501tat. any IF;:., or a cu1Lrd:al account under section 403(b)(7) if the aceounl soli: ie., the reouirementt of section :U1(1)(21, 2. The United States or any of its agencies. or instrumentalities, 3. A state, the District of Columbia, a possession of the United Stales, or any of their political subdivisions or instrumentalities, 4. A foreign government or any of its political subdivisions, agencies, or instrumentalities, or 5. An international organization or any of its agencies or instrumentalities. Other payees that may be exempi from backup withholding inelude: 6. A corporation, 7. A foreign central bank of issue, E. A dealer in securities or commodities required to register in the United States, the District of Columbia, or a possession of the United States, 9. A futures commission merchant registered with the Commodty Futures Trading Commission, 10. A real estate "investment trust, 11. An entity registered at all times during the tax year under the investment Company Act of 1940, 12. A common trust fund operated by a bank under section 5a4(a), 13. A financial institution. 14. A middleman known in the investment community as a nominee or custodian, or 15. A trust exempt from tax under section 664 or described in section 4947. The char', below shows types of payments that may be exempt from backup withholding. The chart applies to the exempt payees listed above, 1 through 15. 1F the payment is for .. THEN the payment is exempt for Interest and dividend payments All exempt payees except for 9 Broker transactions Exempt payees 1 through 13. Also, a person registered under the Investment Advisers Act of 1940 who regularly acts as a broker Barter exchange transactions exempt payees 1 through 5 and patronage dividends r . uir to be reported and direct 001:r ) •_......rally, ^airy of r0tyee.s tnrough 7 ;•ee rt...., i(9?0-1.,.,,.., l-4 - l meet..: ins:,,. v.. err tluwernsi. i:ll' irtanw.rrr: l: arrf`.errs IC, i! c?roorasoP GO::In.SMr 11 0:1 rwDcetvls rein 1v, an attorney tidier Si:clici. 111.-5ifi. even :1 i 11- uii0rney is :. Frtrrn m m.lit :ate 2.e t:' C:Irr etrem.'. 51;err ;rN:' navelemt ra• ;rr0'tC.'c r i.. i `'.!^.OPrai 1r:Caln1' b(r2n.a•. ttc.:rtme .t.ne:. Part I. iv;:p0y r ic�ri ric_var, \lurn!Der (TIN) ) Enter you; TIN in the appropriate box. I` yo: are ; resioeni 3r r ins. you ot. itot 7 c'.'_ e.ne are OM t. 051-: tlr TI!'! e VDu' PE, ,,Crd[$:0 35'.Sr identification n; mile. (ITN). Erter In the azicial security n:.r..b_. b:,.. If you zr_ isct nave an ITIN. isee Rota to get a (1 beiou:! If you area sole ,proprietor and y:ru have an EIN: you may, ernes erghar your SSN or 2111. However. the If -IS preters that you tce your SSN, li you are a 5iliole-member LLC that is ois.rer arded as an entity separate tom 1(11 owner (see Limited liability company (LLG) on pace 2i, enter the owner's SSW (or EIN, if the Owner has one). Do not enter the disregarded entity's EIN. If the LLC :c ciassiiied e.s a corporation or partnership, enter the entity's c9ll•I. Note. See the chart on pane 4 for further clarification of name and TIPS combinations. How to get a TIN. If you do not have a TIN, apply for one immedialeiy. To apply for an SSN, get Form SS-5, Application fora Social Security Card, from your local Social Security Administration office or oat this form online al. www.sa.gov. You may also get this form by calling 1-600-77 2-1213. Use Form W-7, Application for IRS Individual Taxpayer Identification Number, to apply for an ITIN, or Form SS-4, Application Tor Employer Identification Number, to apply for an EIN. You can apply for an EIN online by accessing the IRS website at wNw.irsoovlbusinesses and clicking on Employer Identification Number (EIN) under Staring a Business. You can get Forms W-7 and SS-4 from the IRS by visiting www.irs.go: or by calling 1-800-TAX-FORM (1-800-629-3676). If you are asked to complete_ Form W-9 but do not have a TIN, write ".Applied For" in the space for the TIN, sion and date the form, and give it to the requester. For interest and dividend payments, and certain payments made with respect to readily tradable instruments, gen=_rally you will have 60 days to gel a TIN and give it to the requester before you are subject to backup withholding on payments. The 60-day ruie does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester. Not:. Entering "Applied For" means that you have, already applied for a TIN or that you intend to apply for one soon. Caution: A disregarded domestic entity that has a foreign owner must use the appropriate Fo„;r W-8. Part II: CerttficatiDfi To establish to the withholding agent that you are a U.S. person, or'resideni alien, sion Form W-9. You may be requested to sign by the withholding agent even if items 1, 4, and 5 below 'indicate otherwise. For a joint account, only the person whose TIN is shown in Part I should sign ((when required). Exempt payees, see Exempt Payee on page 2. Signature requirements. Complete the certification as indicated in 1 through 5 below. 1. interest, dividend, and barter exchange accounts opened before 1984 and broker accounts considered active dur1nt.q 199yrou must give. your correct TIN. but ,u do not - nave to sign the certification. 2. Interest, dividend, broker. and barter exchange account; opened after 19E33 and broker accounts considered inactive during 1963. You ri111$1 sign the: celtifioalion or bnclalr: withholdno will easily. I) yo:i ore SUCnec1 to backuci..ithhn:dinrl and you art: merely providing your correct TIN to the recues1el, ',sou moil crass out Item 2 in hie:.:. t natation before signing tit fort-.. 20:7- "01111 4 2.. Peal estate. transactions. You musif fr.gr: Yoj rr, ar-DSE ou: nen.. 3. the certicatiori. 4. other payments. rnuc: gise. you, .titiPe:i 00. no: paie 13 sior. 105 cerfificsticr. Jri!eF'.5 have beeri nozified thai, you have prewoushi 000r. ar, income:1 TIN. —Direr nayments" inciusie payme.ms rriacie tri11 course the. reouecter S trade 50 tir,055 01 rents. rOyallieS. 931005 Ic-Arier than bills for merchandise), medical and health care senncez (including payments to corporations), payments to a nonemployee for SeiviCh.rt, payments lo ceriain fishing DC31 crew members arid fisherme.n, and grecs proceeds paid to attorneys (including payments to corporations). 5. Mortgage interest paid by you, acquisition or abandonment of secured property, cancellation of debt, qualified tuition program payments (under section 529), IRA, Coverdell ESA, Archer MSA or HSA contributions or distributions, and pension distributions. You must give your correct TIN, but you do not have to sign the certification What Name and Number To Give the Requester For this type of account Give name and SSN of: 1. Individual 2. Two or more individuals (joint account) 3. Cutilodian accovnl 01 a minor (Uniform Gift to Minors Act) 4. a. The usual revocable savings trust (grantor is also trustee) b. So-called trusi account that is not a legal or valid trus-, under state law S. Sole proprietorship or disregarded entity owned by an individual The individual The actual owner of the account or. i! combined tunes, the first individual Ihe account The minor The grantor -trustee The actual Owner Tne owner For this type of account Give name and SIN of: 6. Disregarded entity nOI owned by ar, individual 7. A valid trust estate, or pension trust B. Corporate or LLC electing corporate status on Form 8832 S. Assodathon, club, religious, charitable, educational, or other tax-exempt organization 10, Partnership or multi -member LLC it. A brokei or registered nominee. 12. Account with the Department of Agriculture in the name ot a public entity fsuch as a state or local government, school district or prison! that receives agricultural program payments The owner Le.oal entity 4 The corporation The organization The partnership Tne broker or nernine.e , T00 public entity flan arc) cirde Ihe nxne ol the person whose number you furnish. 11 only one person on a pint encounl hasscx. 'hat porson'v, number mull Pirolo the minor, name ond lurrush the minor's SSW. Yoo munt rhow your incitvidual name onrf yOu 1,13 3I50 er110, yme bum., m' "DOW name on 11K, second name Imo. You may tine chi ,cr your E5N EIN 01 you hlyn one:. bol ins mcourage, you lo unr. you SSW. List Ns/ onclmrelry 1114 norn, 111 the 111141, cv.ato, tar oenm. Iron!. roc. nol /t/rn,,b rho TI14 of Ihr Mr.on,l,olvonentolivD or 'Tuner, wk.,. VV. 101101 an!) 11. not 101450100011 Ifl tho oocouni sec Spo..val punn0r1:111p., pn/v. 1. N11.7.7t..e: if 10 nanne is circled whien more than ono 005519 listed. the number will be considered to be that 01 the first nomeilisted. Secure Your Tel): Re:---ord.s from Identity Thet idfantit; trier. ()C.:IX! ,.•.,fier, someone 07v51 5017:71 EL nUrrta,,r other i011n1iiying intormatich. witnotri your psmnission. 53T.Cirnriil trZuit Cir ciitner crJrnes, ,frf ioentny thief ma.; t:Se P:a7 a Pia of rriai, file: a 1E): reiurri 5„),SN E Tr, reduce your rish: • Protecl your SST:, a Ensure ryji employe: 1.1; prolaciiric, your S'Stil. arid • Be careful v.,heri choosing' a tax preperer. Call the IRE-, at 1-503-'629-1040 if you think your identity has been uses inaPicroVialelY ior ISO PurPosf5- Victims of identity theft who are experiencing economic ham, or a system problem, or are seeking heip in resolving ta;: problems that have not been resolved through normal channels, may be eligible for Taxpayer Advocate Service, TAS) assistance. You can reach TAS by calling the TAS toll -free case intake line ai 1-877-777-4778 or 7TY/TDD 1-800-E29-4059.. Protect yourself from suspicious &nails or phishing schemes. Phishing is the creation and use of email and websites designed to mimic legitimate business emails and website.s. The most common act is sending an email to a user falsely claiming to be an established legitimate enterprise in an attempt to scam the user into surrendering private, information that will be used for identity theft. The IRS does not initiate contacts with taxpayers via emalis, Also, the IRS does not request personal detailed information through email or ask taxpayers for the PIN numbers, passwords, or similar secret access information for their credit card, bank, or other financial accounts. If you receive an unsolicited email claiming to beitrom the IRS, forward this message 0 phishingqiirs.gov. You may also report misuse of the IRS name, logo, or other IRS personal property to the. Treasury Inspector General for Tar. Administration at 1-800-366-44E4. You can forward suspicious emails to the Federal Trade Commission at: :-..pamuce.gov or contact them at www.consumer.govhdthefl or 1-877-IDTHEFT(.432-4338). . Visit the IRS we.bsite t www.irs..gov to learn more about identity theft and how to reduce your risk, Privacy Aci Notice Sect rti Inv irsarmei Fitch:ante; Ctirietiv rec,nrits Lice. le: provoe VOYO, :;051'44.71 111 on,7,orrvinci awe: filev,MII Int:. OlweienCIS. thrtain otter interne tied In vine. rhortc.zicK. !mores: yeiu oaicli the abnndorrneric sena:cr.:I propene. cant.:crenr. CV. dent. or contrinoticre. yen r,115z. o, A;zreoi or I-155 I553 uses It, norrotyy ant iri }!* VOr Mt" Zic.,..:1,,CZy CJI yfni• 1 ne 19.11 rintai aisai tnie. Iniormatiori lf- UV' (..cpzinmi•r1I jot 155 CA,27., LT:f::. CI! Ctolurerva. anti Valtreertniert n tri sarr,i op, Iro,r t j11 04104 intormaitivi to ottie couninein tediiirri' rind trIalf, V.• !if elm, c..rwrmaI lawn. ix IC: 10dCIt3,.. aoonoicii 517n11)31 ItYrroo:oy, rrotho;! 11.10 genie, rarer onyrnarat 0,511 rrnen :IV pre& 1. TIC< cnneer. 4.1%' INCIDENT REPORT TTAC2-IN.YFT CHECK IF CRITICAL x IDENTIFYING INFORMATION Reponing Pally Phone. Reportirv2 Pany Name., Contract Provider Name Progr. am Name Provider Location Date of Incident / Tin -it of )ncident arn'/pn-1 Specific Prograin: (chech all that apply) 0 HT LI Primary Care 1 SHP 0 Emergency 0 Challenge Specific location/ address -where incident occurred: TYPE OF INCIDENT • El ALTERCATION E CLIENT DEATH D CLIENT INjUILY OR ILLNESS D THEFT 0 SEXUAL BATTERY 0 SUICIDE ATTEMPT D PROPERTY DAMAGE u" OTHER INCIDENT Spz:cifv PARTICIPANT (S) WITNESS (ES). • (Please \ V or f' for either \Vim est, or Participant) LAST NAM E. FIRST I DENTIFIER ;-`f CLIENT EMPLOyEE OTHER 0 0. 0 I of 3 ATTLCEME'NT ' DESCRIPTION OF INCIDENT Give detailed account — who. What. where. when. why. Ii( — add nags if nectssar i CORRECTIVE ACTION AND FOLLOW OF Immediate corrective action taken Is follow up action needed? ❑ Yes ❑ No if yes, specify IND1VIDTJALS NOTIFIED Abuse Registry 1-800-962 2;73 Applicable Law Enforcement Department Indicate name. of person contacted, if report was accepted, the date and time if called or copy of report Incident Reports — The Suhrecipicnt n11.1Si reporl 1(1 1\1ktmi-Dade: County' Rornclese Trust information related to :an, critical incidents occurring duringi the administration term of its programs, In addition in repon.inC this incident to the cipproprietc authorities the Subrecipient must is ilhin 1Nrcnry-four C41 hours of ant• incident. submit in writinc ti derailed aecouni of the incident. This incident report should be addressed to the Cowan Officer or Administrative Officer assigned. This incident repoin should h addressccl to (Miami -Dade Count' 1-lomcless Tru.¢t. I II NW First Street. „' Floor. Salle ;1 Q. Miami. Florida ;31"S: telephone t= (hi 75-1;00 and facsmilir(i) 75-2 _2 of 3 ATT.A.CHIAENT Definitions of Reportable Incidents a. Altercation. A physical confrontation occurring bervreen a client and employee or two or more clients at the time services are being rendered, or when a client is -in the physical custodv.of the department, which results in one or more clients or employees receiving medic;,] treatment by a licensed health care professional, b, Client Death. A person whose life terminates due to or allegedly due to an accident, act of abuse, neglect or other incident occurring while in the presence of an employee. in Homeless Trust contracted program facility. e. Client Injury or Illness. A medical condition of a client requiring medical treatment by a licensed health care professional sustained or allegedly sustained due to an accident, act of abuse, neglect or other incident occurring, while in the presence of an employee, in a Homeless Trust contracted program. d. Other Incident. An unusual occurrence or circumstance initiated by something other than natural causes or out of the ordinary such as a tornado, kidnapping, riot, or hostage situation, which jeopardizes the health, safety and welfare of clients. e. Sexual Battery. An allegation of sexual battery by a client on a client, employee on a client, or client on an employee as evidenced by medical evidence or law enforcement involvement. •Suicide Attempt. An act which- clearly reflects the physical attempt by a. client to cause his or her own death while in the physical custody of the department or a departmental contracted or certified provider, which results in bodily injury requiring medical treatment by a licensed health care professional. Property Damage .An incident involving damage to property procured with Homeless Trust funding. c,f Provi(ftr Name: Program Name.: Funding ‘'.30tirce.: • Reporting Desk:110ml u1 Pitwel • ;eiitl / Numbcr MIAMI-DADE COUNTY HOMELESS TRUST PROVIDER ASSET INVENTORY Acquisition Date Acquisition Cost 'Vendor Name "70 of Pitrchase Cost front Locntion of Property /V11.1\c.111\ Llsc mut Condiiion or Propculy Attneli hi \ vices for nil-ptirclinses this grniit reporting period. . . tioilis Title of MIAMI DARE COUNTY HOMELESS TRUST CLIEI",7 SERViCES CERTIFICATION REFERRAL FORM FOR EMPLO1'EES OF HOMELESS TRUST FUNDED PROGRAMS INSTRUCTIONS: . Provider ma king referral must complete iris rWo-page form, including signatures by Applicant and Provider Representatives. 'Fax completed forms to Provider Receiving Referral for Huusin and or Services. Date: Referrine Provider: Contact Person Name IJNNFORMATJON ON HEAD OF HOUSEHOLD: Last Name: Date of Binh: First Name: SS: Title Prime: Number INFORMATION ON OTi-iER HOUSEHOLD MiEMBERS: Name Age Sex Relationship Employer T5 ANY MEMBER OF THE HOUSEHOLD EMPLOYED BY, OR RELATED TO AN EMPLOYEE OF,.4 HOMELESS TRUST FUNDED PROGRAM? Yes No ] f yes: Name ofEmu loyee: Ern ployinQ Provider: Relationship to Applicant: CERTIFICATION I_ the undersigned. do iterehv certify this the above information prro idcd.hv me is true and spruce t, the hest of my knowledire: Applicant's Name `;i!tnaturc. [)arc: • l:rferrino Provideri tahoriyied Representative Wants: SiL'ncturC bate s PROVIDER REFEI;FAL FOR11 P.kGE T\V-o lithe Applicant or <: memhcr urihcir iousehold is 1-in employe:: of the referring proviucr, tile• approyal of the fruyider Executive Director is hereby indicated hysi^narurc: • Name/Title Date J f the Applicant or a mc+mbcr their househoid is an employee °rot provider ovider where services will he provided, the approval of The Provider Executive Director, the Homeless Trust Executive Director, and the Homeless Trust Board Chair are hereby indicated by signature: Provider Executive Director Date Miami -Dade County Homeless Trust Chairperson Date Miami -Dade County Homeless Trust Executive Director Date ADDITIONAL HOUSEHOLD INFORMATION_ Where is the household iivin_ now? (Facility name, exact address) Date of present homelessness: Explain the homeless situation, and what caused the current homelessness: NOTE TO REFERRING PROVIDER: PROVIDING THE ABOVE INFORMATION DOES NOT ENSURE APPROVAL FOR HOUSING OR OTHER SERVICES REQUESTED. A DETERMINATION WILL BE MADE FOLLOWING A COMPLETE ASSESSMENT OF THE APPLICANT'S CASE. THIS SECFIONFOR SERVICE .PROVIDER STAFF CI.i£ ;rIVLI': fleets Eligibility Criteria: 1'£S' _ NO rnnrc uj f"rrrririer.cc .,:—'m n' i'j7- ['LEASE MAINTAIN THE ENCC;TEI) COPY OF THIS DOCUMENT IN' TI-IE CLIENT FILE OF THE SERVICING PROVE ER AND T'Ef:SONNEL FILE OF REFERRING PROVIDER. Date: To: November 30, 2009 Mandana Dashtaki, Assistant County Attorney Miami -Dade County Attorney's Office Memorandum From: 1 D,a`vid Raymond, Executive Director rMiami -Dade County Homeless Trust Subject: Approval of Agreement 0 Sub -recipient 0 U.S. HUD Grant Agreement 0 State Q Other: Primary Care Attached, please find for your review and approval, three (3) originals of the referenced Grant Agreement between Miami -Dade County, through the Miami -Dade County Homeless Trust and the agency listed below: Agency: The City of Miami Contract Number / Name: PC-0910-HTMT-1 Emergency Hotel/Motel Placement PC-0910-FC Feeding Coordination PC-0910-HMIS-1 HMIS Staffing Contract Amount: S114,666.00 SHP: ❑ F&B Emergency Hotel/Motel Placement S75,000.00 Feeding Coordination HMIS Staffing / S24,666.00 .STATE: 0 OTHER ❑ Authorized by Resolution: 0 (Specify): New ❑ Renewal Authorized by A) 3-38: E'1 ❑ II New Renewal We are requesting your assistance with reviewing and approving the Agreement as to form and legal sufficiency as soon as possible. Please contact our office once the Agreements have been signed at (305) 375-1490. As always, thank you for your assistance. I approve the above referenced agreement for form and legal sufficiency. Mandana Dashfaki. Assistant County Attorney I do not approve the above referenced agreement for form and legal sufficiency because: /62 Date Please resubmit again for review after these problems have been addressed.