HomeMy WebLinkAboutExhibit• Officers/Executive Committee
Marla A. Alonso
Chair
Chet Zerlin
Vice Chair -
William Diggs
Secretary
Hon. Isaac Salver.
Treasurer
Dr. William E. Pelham, Chair
Program Services
Lily de Moya, Chair
Childhood Health and
Development
Laurie W. Nuell, Chair
Human Resources
Dr. Miguel BaIsere, At -Large
The Board of Directors
Donald I. Bierman
Kadie R. Black
Alberto M. Carvalho
Bryan Cuadra
Carlos L. Curbelo
Rep. Manny Diaz Jr.
Gilds Ferradaz
Terrla Flakes
Inson Klm
Dr. Thresia B. Gambon
Thomas V. Gammon
Claudia Grillo
Dr, Nora Hernandez -Hendrix
Nelson Hincaple
Matisse Leichter
Dr. Rosa Martin
Roymi Membiela
Dr. Susan Neimand
Trudy Novicki
Hon. Orlando A. Prescott
Manoucheka Thermitus
Evelio Torres
Sharon G. Watson
Com. Juan Zapata
David Lawrence Jr.
Founding Chair
Charles M. Auslander
President & CEO
County Attorney's Office
Legal Counsel
The
Childn'sTu
July 31, 2014
Mr. Daniel J. Alfonso
City Manager
City of Miami Parks and Recreation Department
444 SW 2nd Avenue, loth Floor
Miami, Florida 33130
RE: Out -of -School Program; Contract #1510-1440
Dear Mr. Alfonso:
The Children's Trust is issuing this Service Authorization to allow City
of Miami Parks and Recreation Department, to provide Out -of -School
services beginning August 1, 2014, while contract negotiations
continue. However, please be aware that this service authorization is
only valid for a maximum of 60 days. It will expire not later than
October 1, 2014, or when the contract is executed, whichever first
occurs.
During the period covered by this Service Authorization letter, City of
Miami Parks and Recreation Department, must comply with all
requirements of the core contract, including those of all relevant
attachments as emailed to your agency and/or posted on The
Children's Trust's website (www.thechiidrenstrust,org). The Children's
Trust requires all applicable certificates of insurance be filed with and
approved by The Children's Trust prior to or commencing with the
service authorized by this letter. In addition, all background screening
for direct services staff must be completed prior to employment, as
mandated by Florida law; and, you must submit a current financial
audit or obtain an audit extension from us.
Program activities are expected to be provided In accordance with your
draft Scope of Services, and only expenditures for allowable expenses
directly related to the services will be considered for future
reimbursement. Your agency will be responsible for any costs incurred
that are not allowable and included in the final approved budget. Any
applicable data reporting, outcome assessments, satisfaction surveys,
etc. will also need to be submitted by the contractual due dates. The
Children's Trust reserves the right to withhold payment until proper
documentation has been submitted.
ieJ'J# l4f- 193+f1..
3150 SW 311i Avenue, 8th Floor, Miami, Florida 33129 • Tel: 305-571-5700 / Fax: 305-857-9592• www.thechlidrenstrvrst.org
.10
Page 2
City of Miami Parks and Recreation Department
Contract #1510- .440
It is critically important to execute timely contracts. You will not be paid on any
invoice submitted until a final budget is approved in SAMIS as part of your executed
contract: SAMIS training are ongoing and if your agency has not been trained it must
be In order to commence the process to submit an approved budget. Your assigned
Contract Manager is available to assist you with whatever technical assistance you
may need to successfully negotiate your contract and forward it to The Children's
Trust for execution.
Please sign and ieturn this Service. Authorization within ten days of this letter's date.
If you have questions about the negotiation- or contract execution process, please
contact your .. 'assigned Contract Manager., Patricia Leal via email at
patricia@thechifdrenstrust.org or by telephone to (305) 571-5700.
We look forward'to our continued relationship with you and appreciate the work your
agency does on: behalf of the children and families of Miami -Dade County.
Sincerely.,
Charles M. Auslander
President & CEO
I agree to the terms and conditions described in this Service Authorization.
Signature of Authorized Representative Print Name
2014
Date
cc: Contract file
See Attached
City 0f Miami
Signature page.
r
•
Acceptance of Authorization Letter for 2014-2015 Out -of -School Program Services
CITY OF MIAMI, a Florida Municipal Corporation
: '-•.:
By. ,
rlianny Alfonso,. City Manager
1 .
Date:
., 44.-- f .
:77
Attest:
• Todd T1nnoii, CityClerk
Date: 115.1t1(
Ap roved as F,:grarraid rrectness:
Victoria Mende,4 -C-ITY'Attorney
cf4A,
Date:
Approved as to I
By:
quirements:
Aim -Marie Sharp sk anagernent
Date:
12.e, Atvist
F/ait.C.t-d t s 73uait
FY 2014-2015
Professional Services Agreement with
In connection with
CONTRACT NO.
BETWEEN THE CHILDREN'S TRUST
AND CITY OF MIAMI
Department:
Program:
THIS PROFESSIONAL SERVICES AGREEMENT ("Agreement") is between the City of Miami, a
Florida municipal corporation whose address is 3500 Pan American Drive, Miami, Florida
33133 ("City"), and , a Florida whose
address Is ("Provider") in connection with
the CONTRACT ("Contract" attached and incorporated hereby as Exhibit 1) between The
Children's Trust whose address is 3150 S.W. 3rd Avenue, 8th 'Floor, Miami, Florida 33129
("Trust" or "The Children's Trust") and the City.
In consideration of the mutual covenants herein, City and Provider (sometimes hereafter
referred to as "Parties") agree as follows:
A. EFFECTIVE TERM
The effective term of this Agreement shall be the same as the effective term of the
Contract which shall be from through , subject
to funding availability and Provider's performance.
B. TERMS OF RENEWAL, if applicable
In their respective sole discretion, the City and The Children's Trust in connection with the
Contract, may renew this Agreement with the acknowledgement of Provider. In
considering the exercise of any agreement/contract renewal, and in accordance with
the Request for Proposal (RFP) and Board authorization of the Trust and any City
Commission approvals, if necessary, renewal of this Agreement may not exceed a term
equal to the term of the initial Trust Contract for a total maximum of three (3) terms. The
City in consultation with The Children's Trust in their sole discretion will consider, but are
not limited to, the following:
1. Provider meeting the performance requirements specified in this Agreement in
relation to the Contract.
2. Continued demonstrated and documented need for the services funded.
3. Program performance, fiscal performance, and compliance by Provider that are
deemed satisfactory in the City and The Children's Trust, in their respective sole discretion.
4. The availability of funds. The City and The Children's Trust are prohibited from
creating obligations in anticipation of budgeted revenues from one fiscal year to another
without year to year extension provisions in the agreement/contract.
5. If applicable, The Children's Trust in its sole discretion will initiate re -negotiation of this
Agreement through renegotiation of the Contract before the agreement and contract
term expires.
6. Provider's performance under any other agreement with the City.
396391 FY 2013-2014 Form of Provider Agreement in connection with
Children's Trust Contract # for
City Program:
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le 77 iy q3
C. SCOPE OF SERVICES,
1. Provider agrees to render services in accordance with the Scope of Services,
Attachment A, hereafter "Services", to this Agreement and the Contract. Provider shall
implement the Services in a manner deemed satisfactory to the City and The Children's
Trust. Any modification to the Services shall not be effective until approved, in writing, by
the City, The Children's Trust and Provider.
2. The Services' activities and performance measures, as well as complete and
accurate data and programming information will be used in the evaluation of Provider's
overall performance:
3. Provider agrees. That all funding provided by the City from The Children's Trust,
pursuant to this Agreement and the Contract will be used exclusively for services in and
for the benefit of City and Miami -Dade County residents. -
D. TOTAL FUNDING
Subject to the availability of funds, the maximum amount payable for Services rendered
under this Agreement and the Contract shall not exceed $ , with a required cash
match of $ and a required in -kind match of $ . Provider agrees that
should available funding to the City and/or The Children's Trust be reduced, the amount
payable under this Agreement and the Contract will be reduced at the sole option of
The Children's Trust. Provider agrees to adhere to Other Fiscal Requirements, Budget and
Method of Payment outlined in Attachment B to this Agreement and the Contract.
E. FISCAL MANAGEMENT
1. Double Billing and Payments
Provider costs or earnings claimed under this Agreement and the Contract may not also
be claimed under any other contract or grant from the City and/or The Children's Trust or,
unless such claim is denied by The Children's Trust, from any other agency. Any claim for
double payment by Provider shall be a material breach of this Agreement and of
Provider's portion of the Contract.
2. No Supplanting of Existing Public Funds
The Children's Trust funding through the City under this Agreement and the Contract may
not be used as a substitute for existing resources or for resources that would otherwise be
available for children's services, or to replace funding previously provided by, and
currently available from, local and state funding sources for the same purpose. A
violation of this section by Provider shall be considered a material breach of this
Agreement and of Provider's portion of the Contract.
3. Capital Equipment
Capital equipment is included in the definition of "property" under Florida Statutes,
Chapter 274, and Florida Administrative Code, Section 691-73.001, and is defined as
individual items with a value of $1,000 or greater which have a life expectancy of more
than one year. Provider is to maintain proof of Property Coverage in accordance with
the insurance requirements prescribed in this Agreement and the Contract (see Section
K. Insurance).
396391 FY 2013-2014 Form of Provider Agreement in connection with
Children's Trust Contract # for
City Program:
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Capital equipment .purchased with Trust funds by Provider become assets of The
Children's Trust; are intended for The Children's Trust funded programs; are owned by The
Children's Trust; and must be tagged at the time of purchase as an asset of The
Children's Trust. The City and The Children's Trust will work with Provider to tag the asset
and receive all information regarding the capital equipment. Provider must maintain a
record of any capital equipment purchased with funds provided by The Children's Trust
through the City pursuant to this Agreement and the Contract. When Provider is no
longer funded by The Children's Trust through the City under this Agreement and the
Contract, the equipment will be returned to The Children's Trust unless it is fully
depreciated. Ownership of capital equipment will be transferred to Provider and
removed from .The Children's Trust's fixed asset system if_ thecapital equipment is fully
depreciated and in the possession of Provider. Provider can purchase the equipment at
the depreciated cost -with the approval of The Children's Trust. If capital equipment is not
purchased by Provider prior to the equipment being fully depreciated, Provider must
return such capital equipment to The Children's Trust before submission of the final
invoice tolhe City for'approval by the Trust.
In the event that property of The Children's Trust is either damaged, lost, or stolen, while in
Provider's possession, Provider is to perform all of the following: a) within 5 business days
provide written notification to the City program manager and The Children's Trust
contract manager that the capital equipment has been either damaged, lost or stolen;
b) provide a police report for lost or stolen items; or provide a written statement as to how
the capital equipment was damaged; and c) reimburse The Children's Trust for the value,
as determined by The Children's Trust.
4. Assignments and Subcontracts
Provider shall not assign this Agreement in connection with the Contract to another party.
Provider shall not subcontract any Services under this Agreement in connection with the
Contract without prior written approval of the City and The Children's Trust. In any
subcontract, Provider shall incorporate appropriate language from this Agreement and
the Contract into each subcontract and shall require each subcontractor providing
services to be governed by the terms and conditions of this Agreement and the
Contract. Provider shall submit to the City and The Children's Trust a copy of each
subcontract to this Agreement and the Contract within 30 days of its execution. All sub-
contracts with Provider must be executed within 90 days of Provider's execution date. All
subcontractors must agree to be monitored by Provider, the City and/or The Children's
Trust, in the same manner as Provider under the terms of this Agreement and the
Contract. Provider acknowledges and agrees that the City, The Children's Trust and any
subcontractor to this Agreement in connection with the Contract have authority to
communicate and exchange information about Agreement, Contract, program, and/or
fiscal issues. Provider waives any and all claims, demands, and/or legal action based
upon any such communications.
Provider shall be responsible for all Services performed, and all expenses incurred, under
this Agreement and the Contract, including services provided and expenses incurred by
any and all subcontractors. The City and The Children's Trust shall not be liable to any
subcontractor for any expenses or liabilities incurred under any subcontract. Provider
shall be solely liable for any reimbursable expenses or liabilities incurred under any
subcontract. Provider shall hold harmless and defend, at Provider's expense, the City
and The Children's Trust, and their respective officials, officers, employees, and agents
against any claims, demands or actions related to any subcontract.
396391 FY 2013-2014 Fonn of Provider Agreement in connection with
Children's Trust Contract # for
City Program:
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The City and Children's Trust shall not provide funds to any subcontractor unless
specifically agreed to in writing by the City and The Children's Trust with notification to the
Provider. All payments to any contracted subcontractor shall be paid directly by
Provider to the subcontractor. The City and The Children's Trust both reserve the right to
require verification from Provider and/or subcontractor of payment due for satisfactory
work performed by the subcontractor.
Provider and any Subcontractor must be currently qualified to do business in the State of
Florida and must have the required licenses and permits required to do business in the
City of Miami at the time that this Agreement and at the time that any subcontractor:.::
agreement is entered into and services are rendered.
5. Religious Purposes
Providers and/or their faith -based community partners shall not use any funds provided
Under this Agreement and the Contract to support any inherently religious activities,
including but not limited to, any religious instruction, worship, proselytization, publicity or
marketing materials. Any such use by Provider shall be a material breach of this
Agreement and of Provider's portion of the Contract.
6. Lobbying
Provider shall not use any funds provided under this Agreement and the Contract or any
other funds provided by the City through The Children's Trust for lobbying any federal,
state or local government or legislators. Any such use by Provider shall be a material
breach of this Agreement and Provider's portion of the Contract.
7. Adverse Action or Proceeding
Provider shall not use any funds under this Agreement and the Contract, or any other
funds provided by the City from The Children's Trust, for any legal fees, or for any action
or proceeding against the City and/or The Children's Trust, their respective agents,
employees, officers, or officials. Any such use by Provider shall be a material breach of
this Agreement and of Provider's portion of the Contract.
8. Compliance
Provider agrees to maintain and ensure its compliance, as applicable, with federal, state,
county, and local laws. This includes, but is not limited to, adherence to IRS rules and
regulations requiring timely filing of tax documents to maintain tax-exempt status and
payment of payroll taxes, licenses, permits, and any other governmental fees, as
applicable, throughout the term of this Agreement and the Contract.
Provider further agrees to provide agency and site(s) information to Switchboard of
Miami 2-1-1, The Children's Trust 24 hour helpline, and to the City's program manager.
F. INDEMNIFICATION BY PROVIDER
1. Government Providers
Subject to the limitations and sovereign immunity provisions of Florida Statute, Sec. 768.28,
Provider shall indemnify and hold harmless the City, The Children's Trust, and their
respective officials, officers, employees, agents and instrumentalities from any and all
liability, losses or damages, including attorneys' fees and costs of defense, which its
officials, officers, employees, agents or instrumentalities may incur as a result of claims,
396391 FY 2013-2014 Form of Provider Agreement in connection with
Children's Trust Contract ti for
City Program:
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demands, suits, causes of actions or proceedings of any kind or nature arising out of,
relating to or resulting from the performance of this Agreement and Provider's portion of
the Contract by Provider or its officials, officers, employees, agents, servants, partners,
principals or subcontractors.
Subject to the limitations and sovereign immunity provisions of Florida Statutes, Sec.
768.28, Provider shall pay all claims and losses in connection therewith and shall
investigate and defend all claims, suits or actions of any kind or nature in the name of the
City and The Children's Trust, where applicable, including appellate proceedings, and
shall pay all costs, judgments, and reasonable attorney's fees which may issue thereon.
2. All Other Providers
Provider shall indemnify and hold harmless the City and The Children's Trust and their
respective officials, officers, employees, agents and instrumentalities, from any and all
liability, losses or damages, including reasonable attorneys' fees and costs of defense,
which the City, The Children's Trust, and/or their respective officials, officers, employees,
agents or instrumentalities may incur as a result of claims, demands, suits, causes of
action or proceedings of any kind or nature arising out of, relating to or resulting from the
performance of this Agreement and Provider's portion of the Contract by Provider or its
employees, agents, servants, partners, principals or sub contractors, except to the extent
arising, as applicable, from the City's and/or The Children's Trust's willful or wanton acts or
omissions:
To the extent arising from a liability that is covered by the foregoing indemnification,
Provider shall pay all claims and losses in connection therewith and shall investigate and
defend all claims, suits or actions of any kind or nature in the names of the City and The
Children's Trust, where applicable, including appellate proceedings, and shall pay all
costs, judgments, and reasonable attorney's fees which may issue thereon. Provider
agrees that any insurance protection required by this Agreement in connection with the
Contract or otherwise provided by Provider shall in no way limit the responsibility to
indemnify, keep and save harmless and defend, as applicable, the City, The Children's
Trust, and their respective officials, officers, employees, agents and instrumentalities.
The provisions of this section on indemnification shall survive the expiration or termination
of this Agreement and the Contract.
G. COPYRIGHTS AND RIGHT TO DATA/MATERIALS
Where activities supported by this Agreement through the Contract produce original
writing, data, sound recordings, pictorial reproductions, drawings or other graphic
representations and works of similar nature, the City and The Children's Trust both have a
license to reasonably use, duplicate and disclose such materials in whole or in part in a
manner consistent with the purposes and terms of this Agreement and the Contract, and
to have others acting on behalf of the City and/or The Children's Trust to do so, provided
that such use does not compromise the validity of any copyright, trademark or patent. If
the data/materials so developed are subject to copyright, trademark or patent, legal
title and every right, interest, claim or demand of any kind in and to any patent,
trademark or copyright, or application for the same, will vest in Provider or with any
applicable third party who has licensed or otherwise permitted Provider to use the same.
Provider agrees to allow the City, The Children's Trust and others acting on behalf of the
City and/or The Children's Trust to have reasonable use of the same consistent with the
396391 FY 2013-2014 Fonn of Provider Agreement in connection with
Children's Trust Contract # for
City Program:
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purposes and terms of this Agreement and the Contract, at no costs to the City and The
Children's Trust, provided that such use does not compromise the validity of such
copyright, trademark or patent.
H. OWNERSHIP AND LICENSING OF INTELLECTUAL PROPERTY
This Agreement and the Contract are subject to the provisions, limitations and exceptions
of Chapter 119, Florida Statutes, regarding public records. Accordingly, to the extent
permitted by Chapter 119, Florida Statutes, Provider retains sole ownership of intellectual
property developed under this Agreement and Provider's portion of the Contract.
Provider is responsible for payment of required licensing fees if intellectual property
owned by other parties is incorporated by Provider into the services required under this
Agreement pursuant to the Contract. Such licensing should be in the exclusive name of
Provider. Payment for any licensing fees or costs arising from the use of others'
intellectual property shall be at the sole expense of Provider.
For Governmental Providers: As applicable for Provider, the City and The Children's Trust
under Fla. Stat. Section 768.28, and to the extent permitted by and within the limitations
of Fla. Stat. Section 768.28, the Parties shall indemnify and hold each other and The
Children's Trust harmless from liability of any nature or kind, including costs and expenses
for or on account of third party allegations that use of any intellectual property owned by
the third party and provided, manufactured or used by the indemnifying Party and/or
The Children's Trust, as applicable, in the performance of this Agreement and the
Contract violates the intellectual property rights of that third party.
All Other Providers: Provider shall indemnify and hold the City and The Children's Trust
harmless from liability of any nature or kind, including costs and expenses for or on
account of third party allegations that use of any intellectual property owned by the third
party and provided, manufactured or used by the indemnifying Provider, the City and/or
The Children's Trust, as applicable, in the performance of this Agreement and the
Contract violates the intellectual property rights of that third party.
I. BREACH OF CONTRACT AND REMEDIES
1. Breach
A material breach by Provider shall have occurred under this Agreement and under
Provider's portions of the Contract if Provider through action or omission causes any of
the following:
a. Fails to comply with Background Screening, as required under this Agreement and
the Contract.
b. Fails to provide the Services outlined in the scope of services (Attachment A)
within the effective term of this Agreement and the Contract;
c. Fails to correct an imminent safety concern or take acceptable corrective action;
d. Ineffectively or improperly uses The Children's Trust funds and any funds allocated
by the City under this Agreement and the Contract;
e. Does not furnish and maintain the certificates of insurance required by this
Agreement and the Contract or as determined by the City and/or The Children's
Trust;
f. Does not meet or satisfy the conditions of award required by this Agreement and
the Contract;
396391 FY 2013-2014 Fonn of Provider Agreement in connection with
Children's Trust Contract # for
City Program:
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k.
n.
laws;
o.
g. 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 requests for payment,
expenditures or final expenditure reports; included, but not limited to budgets,
invoices, and amendments in Services & Activities Management System (SAMIS).
h. Does not submit or submits incomplete or incorrect required reports pursuant to
the scope of Services in this Agreement and the Contract;
Refuses to allow the City and/or The Children's Trust access to records or refuses to
allow the City and/or The Children's Trust to monitor, evaluate and review
Provider's program, including required client data;
Fails to comply with child abuse and incident reporting requirements;
Attempts. to meet its obligations under this Agreement and the Contract through
fraud, misrepresentation or material misstatement;
Fails to correct deficiencies found during a monitoring, evaluation or review within
a specified reasonable time;
Fails to meet the terms and conditions of any obligation or repayment schedule to
the City, The Children's Trust or any of their respective agencies;
Fails to maintain the confidentiality of client files, pursuant to Florida and federal
Fails to fulfill in a timely and proper manner any and all of its obligations,
covenants, contracts and stipulations in this Agreement and the Contract.
p. Fails to submit an Annual Financial Statement Audit Package and Program
Specific Audit, as applicable, in accordance with Section 0 and Attachment D of
this Agreement and the Contract.
q. Fails to submit an Annual Financial Statement Audit and Program Specific Audit
Engagement Letter within thirty (30) days after Provider's fiscal year end.
Waiver of breach of any provisions of this Agreement and of any related provisions of the
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 Agreement nor of the Contract.
2. Remedies
If Provider fails to cure any breach within thirty (30) days after receiving written notice
from the City and/or The Children's Trust identifying the breach, the City and/or The
Children's Trust may pursue any or all of the following remedies:
a. The City and/or The Children's Trust may, at their sole discretion, enter into a
written performance improvement plan with Provider to cure any breach of this
Agreement and any related provisions of the Contract as may be permissible under state
or federal law. Any such remedial plan shall be an addition to this Agreement and the
Contract and shall not affect or render void or voidable any other provision contained in
this Agreement and the Contract, costs, or any judgments entered by a court of
appropriate jurisdiction.
b. The City and The Children's Trust may suspend payment in whole or in part under
this Agreement and any related provisions of the Contract by providing written notice of
suspension to Provider of such suspension and specifying the effective date of
suspension, at least five business days before the effective date of suspension. On the
effective date of suspension Provider may (but shall not be obligated to) continue to
perform the Services in this Agreement and the Contract, but Provider shall promptly
396391 FY 2013-2014 Form of Provider Agreement in connection with
Children's Trust Contract # for
City Program:
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cease using the City logo, The Children's Trust's logo andany other reference to the City
and The Children's Trust in connection with such Services. All payments to Provider as of
the date of suspension shall cease, except that the City and The Children's Trust shall
continue to review and pay verifiable requests for payment for Services that were
performed and/or for deliverables that were substantially completed at the sole
discretion of the City and The Children's Trust, prior to the effective date of such
suspension.. The City and/or The Children's Trust may also suspend any payments in whole
or in part under any other contracts entered into between the City and Provider and
under any other contracts entered into between The Children's Trust and Provider by
providing separate written notice to Provider of each such suspension and specifying the
effective date- of suspension, which must be at least: five business days before .the
effective date of such suspension, in any event the City and The Children's-Trust -shall
continue to review and pay verifiable requests for payment as provided for in such other
contracts for services that were performed and/or for deliverables that were substantially
completed at the sole discretion of the City and/or The Children's Trust prior to the
effective date of such suspension. Provider shall be responsible for all directand indirect
costs associated with such suspension including reasonable attorney's fees.
c. The City may terminate this Agreement and The Children's Trust may terminate
Provider's portions of the Contract by giving written notice to Provider of such termination
and specifying the date of termination at least five (5) business days before the effective
date of termination. In the event of such termination, the City and/or The Children's Trust
may (a) request Provider to deliver to the City and The Children's Trust clear and legible
copies of all finished or unfinished documents, studies, surveys, reports prepared and
secured by Provider with Trust funds under this Agreement and the Contract subject to
the rights of Provider as provided for in Paragraphs G and H above; (b) seek
reimbursement of any Trust funds which have been improperly paid to Provider under this
Agreement and under the Contract; (c) terminate further payment of Trust funds to
Provider under this Agreement and the Contract, except that the City and The Children's
Trust shall continue to review and pay verifiable requests for payment for services that
were performed and/or deliverables that were substantially completed at the sole
discretion of the City and The Children's Trust prior to the effective date of such
termination; and/ -or (d) terminate or cancel, without cause, any other contracts entered
into between The Children's Trust and Provider; and/or (e) terminate or cancel, without
cause, any other agreements entered into between the City and Provider, by providing
separate written notice to Provider of each such termination and specifying the effective
date of termination, which must be at least five business days before the effective date
of such termination, in which event the City and/or The Children's Trust, as applicable,
shall continue to review and pay verifiable requests for payment as provided for in such
other contracts for services that were performed and/or for deliverables that were
substantially completed at the sole discretion of the City and/or The Children's Trust, as
applicable, prior to the effective date of such termination. Provider shall be responsible
for all direct and indirect costs associated with such termination, including reasonable
attorney's fees.
396391 FY 2013-2014 Fonn of Provider Agreement in connection with
Children's Trust Contract # for
City Program:
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d. The City and/or The Children's Trust may seek enforcement of this Agreement
and of Provider's portions of the Contract, as applicable, including but not limited to filing
an action with a court of appropriate jurisdiction. Provider shall be responsible for all
direct and indirect costs associated with such enforcement, including reasonable
attorney's fees, costs, and any judgments entered by a court of appropriate jurisdiction,
including all direct and indirect costs and reasonable attorneys' fees through conclusion
of all appellate proceedings, and including any final settlement or judgment.
e. The provisions of this Paragraph I shall survive the expiration or termination of this
Agreement and the Contract.
J. TERMINATION BY EITHER PARTY
The parties agree that this Agreement and the Provider's portions of the Contract may be
terminated by either party by written notice to the other party of intent to terminate at
least thirty (30) calendar days prior to the effective date of such termination.
K. INSURANCE REQUIREMENTS
Prior to, or on the date commencing the effective term of this Agreement in connection
with the Contract, Provider's insurance agent(s) shall provide to the City and The
Children's Trust the following, as applicable: 1) Certificates of Insurance naming both the
City and The Children's Trust as an additional insureds and both as certificate holders on
all applicable policies; and all applicable policies shall be maintained in full force and
effect for the entire term of this Agreement and the Contract.
Or, 2) A letter of self-insurance indicating coverage applicable to a Florida municipal
corporation required under this section or as determined by the City and The Children's
Trust, except as required by Florida law for government entities.
Failure by Provider to comply with Section K, shall be a material breach of this Agreement
and of Provider's portions of the Contract. The City and The Children's Trust will not
disburse any funds under this Agreement and under Provider's portions of the Contract
until all required Certificates of Insurance, or letter(s) of self-insurance have been
provided to and have been approved by the City and The Children's Trust.
Provider will carry insurance policies in the amounts and with the requirements indicated
below:
1. Worker's Compensation Insurance covering all employees, non -incorporated
independent contractors or consultants, and incorporated independent contractors or
consultants that do not have worker's compensation coverage or a valid State of Florida
exemption on file with the Department of Labor, as required by Florida Statutes, Chapter
440. In the event that the Provider is no longer exempt from obtaining Worker's
Compensation insurance, the Provider must notify The Children's Trust and provide the
necessary certificate of insurance upon the termination of the exemption. The employer's
liability portion will be $500,000/$500,000/$500,000 as a minimum.
2. Comprehensive General Liability insurance, to include sexual molestation, in an
amount not less than $500,000 combined single limit per occurrence and $1,000,000
aggregate in a policy year. Deductibles exceeding $1,000 are discouraged, unless
Provider can provide financial statements to support a higher deductible. The Children's
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Trust and the City of Miami must both be designated and shown as an additional insured
and as certificate holders with respects to this coverage. The general liability policy must
contain coverage for the following:
a. Bodily Injury;
b. Property Damage;
c. No exclusions for Abuse, Molestation or Corporal Punishment;
d. No endorsement for premises only operations.
3. Automobile liability coverage for all owned and/or leased vehicles of Provider
and non -owned coverage for their employees and/or sub -contractors and transportation
companies transporting program participants. The amount of coverage is $1,000,000
combined single limit per occurrence for bodily injury and property damage. The
Children's Trust and the City of Miami must both be designated and shown as an
additional insured and as certificate holders with respect to this coverage. Coverage
can be purchased as non -owned without hired auto coverage when the cost is
prohibitive for hired automobile coverage such as the case with the Florida Automobile
Joint Underwriting Association; but rental cars cannot be used in the course of Provider's
regular operations. Rental cars may be used for travel to attend conferences outside the
tri-county area. Transportation companies used by the Provider for the funded program
must list both The Children's Trust and the City of Miami as a certificate holder and as an
additional insured.
4. Automobile liability coverage for all owned and/or leased vehicles of Provider
and non -owned coverage for their employees and /or sub -contractors not transporting
program participants. The minimum amount of coverage is $300,000 combined single
limit per occurrence for bodily injury and property damage. The Children's Trust and the
City of Miami must both be designated and shown as an "Additional Insured as Their
Interests May Appear" with respect to this coverage. Coverage can be purchased as
non -owned without hired auto coverage when the cost is prohibitive for hired
automobile coverage such as the case with the Florida Automobile Joint Underwriting
Association; but rental cars cannot be used in the course of Provider's regular operations.
Rental cars may be used for travel to attend conferences outside the tri-county area.
5. If applicable, Special Events Coverage, as determined by the City and The
Children's Trust. The liability coverage will be the same as the coverage and limits
required for comprehensive general liability and The Children's Trust and the City of
Miami must both be designated and shown as "Additional Insured as Their Interests May
Appear." Special Events policies are for short term functions and not meant to replace
annual liability policies. The coverage is for the day or days of the event and must
provide coverage the day prior and the day following the event.
6. If applicable, Professional Liability insurance, as determined by the City and The
Children's Trust, with coverage amounts determined by the City and The Children's Trust
but not less than $250,000 per claim and in the aggregate. Defense costs may be inside
the limits of liability and the policy can be written on claims made form. The City and The
Children's Trust are both required to be named as an Additional Insured. Professional
liability insurance is generally required when the scope of services uses professional
services that require certification or license(s) to provide direct services to program
participants.
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7. Proof of Property Coverage is required when Provider has capital equipment
owned by The Children's Trust and said capital equipment is under the care custody and
control of Provider. The Children's Trust must be shown on the evidence of property
coverage as a Loss Payee. Property coverage shall survive the expiration or termination
of this Agreement and the Contract until such time the ownership of the capital
equipment is transferred to Provider or such capital equipment is returned to The
Children's Trust.
Certificate Holders
Certificate holders must read:
The Children's Trust -
3150 SW 3rd Avenue, 8th Floor
Miami, Florida 33129
And
The City of Miami
c/o Department of Risk Management
444 S.W. 2nd Avenue, 9th Floor
Miami, Florida 33130
Classification and Rating
All insurance policies required above shall be issued by companies authorized to do
business under the laws of the State of Florida, with the following qualifications:
The company must be rated no less than "B" as to management, and no less than "Class
V" as the financial strength, by the latest edition of Best's Insurance Guide, published by
A.M. Best Company, Oldwick, New Jersey, or its equivalent, subject to the reasonable
approval of the City and The Children's Trust.
Provider and or Provider's insurance agent, as applicable, shall notify The Children's Trust
and the City of Miami, in writing, of any material changes in insurance coverage,
including, but not limited, to any renewals of existing insurance policies, not later than
thirty (30) days prior to the effective date of making any material changes to the
insurance coverage except for ten (10) days for lack of payment changes. Provider shall
be responsible for ensuring that all applicable insurances are maintained and submitted
to the City and The Children's Trust for the duration of this Agreement and the Contract.
In the event of any change in Provider's Scope of Services, Attachment A, the City and
The Children's Trust may increase, waive or modify, in writing any of the foregoing
insurance requirements. Any request by a Provider to decrease, waive or modify any of
the foregoing insurance requirements shall be approved, in writing, by the City and The
Children's Trust prior to any such decrease, waiver or modification.
In the event that an insurance policy is canceled, lapsed or expired during the effective
period of this Agreement and the Contract, the City and The Children's Trust shall
withhold all payments to Provider until a new Certificate of Insurance required under this
section is submitted and approved by the City and The Children's Trust. The new
insurance policy shall cover the time period commencing from the date of cancellation
of the prior insurance policy.
The City and/or The Children's Trust may require Provider to furnish additional and
different insurance coverage, or both, as may be required from time to time under
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applicable federal or state laws or the City's requirements or The Children's Trust
requirements. Provision of insurance by Provider, in no instance, shall be deemed to be a
release, limitation, or waiver of any claim, cause of action or assessment that the City
and/or The Children's Trust may have against Provider for any [ability of any nature
related to performance under this Agreement, the Contract, or otherwise.
All insurance required hereunder may be maintained by Provider pursuant to a master or
blanket policy or policies of insurance.
L. PROOF OF TAX STATUS
Provider is required to keep on file the following documentation for review by the City
and The Children's Trust:
■ The Internal Revenue Service (I.R.S.) tax status determination letter, if applicable;
■ The most recent (two years) I.R.S. form 990 or applicable tax return filing within six
(6) months after Provider's fiscal year end or other appropriate filing period
permitted by law;
■ If required by applicable law to be filed by Provider,_IRS 941 - quarterly federal tax
return reports within thirty-five (35) calendar days after the quarter ends and if
applicable, state and federal unemployment tax filings and if the 941 and
unemployment tax filings reflects a tax liability, proof of payment must be
submitted within sixty (60) calendar days after the quarter ends.
M. NOTICES
Written notices pursuant to this Agreement and the Contract shall be sent to the
addresses for each Party appearing on the first_page of this Agreement and of the
Contract. Notices to the City shall be marked to the attention of the City Manager.
Notices to The Children's Trust shall be marked to the attention of its President/CEO.
Notices to Provider shall be marked to the attention of . It is
each Party's responsibility to advise the other Party in writing of any changes in
responsible personnel for accepting Notices under this Agreement and under the
Contract; mailing address, and/or telephone number.
N. AUTONOMY
The Parties agree that this Agreement as it relates to the Contract recognizes the
autonomy of, and stipulates or implies no affiliation between, the contracting parties.
Provider is only a recipient of funding support and is not an employee, agent or
instrumentality of the City nor of The Children's Trust, and Provider's agents and
employees are not agents or employees of the City nor of The Children's Trust.
O. RECORDS, REPORTS, AUDITS AND MONITORING
The provisions of this section shall survive the expiration or termination of this Agreement
and the Contract, consistent with Florida laws.
1. Accounting records
Provider shall keep accounting records which conform to generally accepted
accounting principles (GAAP). All such records will be retained by Provider for not less
than five (5) years beyond the last date that all applicable terms of this Agreement and
the Contract have been complied with and final payment has been received and
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appropriate audits have been submitted to and accepted by the appropriate entity.
However, if any audit, claim, litigation, negotiation or other action involving this
Agreement and Contract or modification hereto or thereto has commenced before the
expiration of the retention period, the records shall be retained until completion of the
action and resolution of all issues which arise from it or until the end of the regular
retention period, whichever is later.
2. Financial Statement Audit
Within 180 days of the close of its fiscal year, Provider agrees to electronically submit the
following documents to the City and The Children's Trust, which together comprise an
Annual Financial Statement Audit Package; they are: (a). An annual financial statement
audit, performed by an independent certified public accounting firm that is registered to
conduct business with the Florida Department of Business and Professional Regulation;
(b). Written communication encompassing the requirements in AU-C section 265,
Communicating Internal Control Related Matters Identified in an Audit (AICPA,
Professional : Standards, vol.1); (c). Written communication encompassing the requirements in AU-C section 260, The Auditor's Communication With Those Charged With
Governance (AICPA, Professional Standards, vol.1) (d). A Management Letter; if no
Management Letter is prepared by the independent certified public accounting firm,
then Provider must confirm in writing to the City and The Children's Trust that no such
Management Letter was submitted to Provider; (e). A Single Audit conducted in
accordance with OMB Circular A-133, Audit of States, Local Government and Non -Profit
Organizations or the Florida Single Audit Act, Florida Statutes 215.97, if applicable;
If a Provider's financial statement audit is prepared by the Florida Auditor General, then
the due date for submitting an Annual Financial Statement Audit Package, as defined, is
270 days after the close of a Provider's fiscal year.
The annual financial statement audit shall be conducted in accordance with auditing
standards generally accepted in the United States of America (GAAP) and standards
contained in Government Auditing Standards issued by the Comptroller General of the
United States (The Yellow Book).
Electronic filing of the Annual Financial Statement Audit Package, as defined, must be
sent to the following e-mail address: audits@thechildrenstrust.orq and to the City's
program manager at his/her City email address.
Providers that are required to have a Single Audit agree to submit the schedule of
expenditures pertaining to awards, summary schedule of prior audit findings, applicable
auditor's reports and the corrective action plan. In the event that the independent
auditor does not disclose audit findings, Provider shall submit written notification to the
City and The Children's Trust that an audit of Provider was conducted in accordance
with applicable laws and regulations and that the findings and questioned costs
disclosed no audit findings related to this Agreement and the Contract; and, that the
summary schedule of prior audit findings did not report on the status of any audit findings
relating to awards that the City and/or The Children's Trust provided.
3. Program Specific audit
Within 180 days of the close of its fiscal year, a Provider who is contracted for a combined
total of $100,000 or more from the City and/or The Children's Trust from this or any other
City or Children's Trust contract(s), related to the fiscal year under audit, must
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electronically submit a Program Specific Audit (PSA) related to City contracts and The
Children's Trust contract(s), in addition to the Annual Financial Statement Audit Package.
The Program Specific Audit shall be performed by an independent certified public
accounting firm that is registered to conduct business with the Florida Department of
Business and Professional Regulation, can perform audits under Government Auditing
Standards i.e. "Yellow Book", and is either a member of the AICPA or FICPA Peer Review
Program to include engagement reviews. This Program Specific Audit is to encompass an
audit of The Children's Trust contract(s) as specified in Attachment D: Program Specific
Audit Requirements.
A;provider that does not meet the Program Specific Audit threshold requirement will be
exempt from the Program Specific Audit requirement in the fiscal year that the audit
threshold is not met.
Program Specific Audits must be conducted in compliance -..with Statement on Auditing
Standards No. 117 (SAS 117) and are required to include performing tests of controls over
compliance. Beyond the requirements of SAS 117, an auditors risk assessment must include an
expectation of the operating effectiveness of controls over compliance; and in doing so; the
assessed control risk must be set at low.
Electronic filing of the Program Specific Audit must be sent to the following e-mail
address: audits@thechildrenstrust.org
4. Audit Extensions
Audit extensions may be granted in writing by the City and The Children's Trust upon
receipt in writing of such request with appropriate justification by Provider and for a
period of time not to exceed sixty (60) days after the initial due date. A copy of the
engagement letter, along with the audit completion date and any concerns from the
independent certified public accounting firm in relation to the audit, must accompany
the request. Approved extension requests allow for the continuation of payment until
such time that the extension expires.
The Annual Financial Statement Audit Package and other financial information will be
used in the evaluation of Provider's performance and Provider's overall fiscal health.
In the event that either the Annual Financial Statement Audit Package or the Program
Specific Audit is not received in a timely manner and in accordance with the previously
stated due dates, and an audit extension has not been approved, then the City and The
Children's Trust shall withhold all payments to Provider until said documents are received
and determined to be acceptable by the City and The Children's Trust.
5. Engagement Letters
Audit Engagement Letters are due to the City and The Children's Trust thirty (30) days
after a provider's fiscal year end. Provider agrees to submit an Engagement Letter for
both the Audited Financial Statements and the Program Specific Audit, electronically, to
audits@thechildrenstrust.orq and to the City's program manager at his/her City email
address. Failure to submit an Engagement Letter may result in breach of contract or other
remedy as deemed appropriate by the City and The Children's Trust.
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6. List of Trust Approved Certified Public Accounting Firms
To receive reimbursement for the preparation the Annual Financial Statement Audit
Package and the Program Specific Audit, as defined, Provider must choose from a list of
approved Certified Public Accountants or approved Certified Public Accounting Firms,
which are posted to The Childern's Trust website. Inclusion on this pre -approved list
requires a Certified Public Accountant or Certified Public Accounting Firm to meet three
(3) criteria , which are enumerated in attachment B:
7. Access to records
Provider shall provide access to all records including subcontractor(s) which relate to this
Agreement and the Contract at its place of business during -regular business hours.
Provider agrees to provide such assistance as may be necessary to facilitate their review
or: audit by the City and/or The Children's Trust to insure compliance with applicable
accounting, financial, and programmatic standards. This would include access by the
City, The Children's Trust, or their respective designees, to Provider's independent auditor's
working papers for complying with federal, state and local requirements. The City and
The Children's Trust reserve the right to require Provider to submit to an audit by an
auditor of The Children's Trust's choosing at The Children's Trust's expense.
8. Monitoring
Provider agrees to permit the City's personnel or contracted agents and The Children's
Trust personnel or contracted agents to perform random scheduled and/or unscheduled
monitorings, reviews, and evaluations of the program which is the subject of this
Agreement and the Contract, including any subcontracts under this Agreement and the
Contract, using The Children's Trust approved monitoring tools. The City, The Children's
Trust and/or contracted agents shall monitor both fiscal/administrative and
programmatic compliance with all the terms and conditions of this Agreement in relation
to the Contract. Provider shall permit the City, The Children's Trust and/or contracted
agents to conduct site visits, client interviews, client assessment surveys,
fiscal/administrative review and other assessments deemed reasonably necessary in the
City's and The Children's Trust's sole discretion to fulfill the monitoring function. A report of
monitoring findings will be delivered to Provider and Provider will rectify all deficiencies
cited within the period of time specified in the report,,
9. Client Records
Pursuant to Florida Statute 119.071(5), The Children's Trust collects the last four digits of
social security numbers of child participants of funded programs and services for the
following purposes: (a) to research, track and measure the impact of The Children's Trust
funded programs and services in an effort to maintain and improve such programs and
services for the future (individual identifying information will not be disclosed); (b) to
identify and match individuals and data within and among various systems and other
agencies for research purposes. The Children's Trust does not collect social security
numbers for adult participants.
Provider shall maintain a separate file for each participant. This file shall include all
pertinent information regarding program enrollment and participation. At a minimum,
the file will contain enrollment information (including parent registration consents and
child demographics), service plans (as applicable), outcome measures (as set forth in
Attachment A), and notes documenting referrals, special needs, or incident reports.
These files shall be subject to the monitoring/review and inspection requirements under
this Agreement and the Contract, subject to applicable confidentiality requirements. All
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such records will be retained by Provider for not less than five (5) calendar years after the
participant is no longer enrolled. Provider agrees to comply with all applicable state and
federal laws on privacy and confidentiality.
8 . Internal Documentation/Records Retention
Provider agrees to maintain and provide for inspection to the City and The Children's
Trust, during regular business hours the following as may be applicable, subject to
applicable confidentiality requirements: (1) personnel files of employees which include
hiring records, background screening affidavits, job descriptions, verification of
education, and evaluation procedures; (2) authorized time sheets, records, and
attendance sheets to. document the staff time billed to provide Services pursuant to this
Agreement in connection with Provider's portions of the Contract; (3)_-daily activity logs
and monthly calendars of the provision of Services pursuant to this Agreement and
Provider's portions of the Contract; (4) training modules; (5) pre and post session
questionnaires; (6) all, participant attendance records; (7) participant consent and
information release forms; (8) agency policies and procedures; and (9) such -other
information related to Service provision as described in Attachment A and as required by
this Agreement and the Contract; all upon request by the City and/or The Children's Trust.
Provider shall retain all records for not less than five (5) years beyond the last date that all
applicable terms of this Agreement and the Contract have been complied with and final
payment has been received, and appropriate audits have been submitted to and
accepted by the appropriate entity.
9. Confidentiality
Provider, the City, and The Children's Trust understand that during the course of
performing the Services hereunder, each party may have access to certain confidential
and proprietary information and materials of the other party in order to further
performance of the Services. The Parties shall protect confidential information and
comply with applicable federal and state laws on confidentiality to prevent unauthorized
use, dissemination or publication of confidential information as each party uses to protect
its own confidential information in a like manner. The Parties shall not disclose the
confidential information to any third party (except that such information may be
disclosed to such Party's attorneys), or to any employee of such Party who does not have
a need to know such information, which need is related to performance of a
responsibility hereunder. However, this Agreement and the Contract impose no
obligation upon the Parties with respect to confidential information which (a) was lawfully
known to the receiving party before receipt from the other, (b) is or becomes a matter of
public knowledge through no fault of the receiving party, (c) is rightfully received by the
receiving party from a third party without restriction on disclosure, (d) is independently
developed by or for that party, (e) is disclosed under operation of law, (f) is disclosed by
the receiving party with the other party's prior written approval or (g) is subject to
Chapter 119 of the Florida Statutes or is otherwise required to be disclosed by law. The
confidentiality provision of this Contract shall remain in full force and effect after the
termination of this Agreement and the Contract. Provider shall specifically require all sub-
contractors to comply with this paragraph.
10. Data Security Obligation
Provider shall maintain an appropriate level of data security for the personally identifiable
information (PII) Provider is collecting or using in the performance of this Agreement in
relation to Provider's portions of the Contract. PII is information that can uniquely identify,
contact, or locate a single person or can be used with other sources to uniquely identify
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individuals. Provider shall maintain and adhere to a written Data Security Policy that
addresses requirements regarding the protection of PII from unauthorized access and
protection against data breaches and ensures Provider is in compliance with applicable
federal and state standards with respect to transmission, receipt and storage of PII on
Provider's computing network and as paper records. This policy shall address the topics of
computer passwords, screensavers that lock computers, securing physical facilities,
storing data, data use, data confidentiality agreements, and staff training related to the
policy. Additionally, Provider is responsible for approving and tracking all Provider
employees who request system or information access and ensuring that user access has
been removed from all terminated employees of Provider.
11. Withholding of payment
At the sole discretion of the City and/or The Children's Trust, payment may be withheld for
non-compliance of contractual terms. The City and The Children's Trust will provide
payment upon satisfactory compliance of the contractual terms as solely determined by
the City under this Agreement and by The Children's Trust under the Provider's portions of
the Contract.
P. MODIFICATIONS
Any alterations, variations, modifications, extensions or waivers of provisions of this this
Agreement and any related portions of the 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 hereto and by the Trust under the Contract.
Except for changes to the total not to exceed amount payable and changes to the
length of the effective term, the City Manager is authorized pursuant to City Commission
Resolution No. , adopted , as Provider's authorized representative
for approving and executing alterations, variations, modifications, extensions, or waivers
of the provisions of this Agreement and any related provisions of the Contract. Any
changes to this Agreement and to any related provisions of the Contract to change the
total not to exceed amount payable and/or to change the length of the effective term
shall require further City Commission approval(s).
Q. GOVERNING LAW & VENUE
This Agreement and the Contract shall be interpreted and construed in accordance with
and governed by the laws of the State of Florida without regard to its conflicts of law
provisions. Any controversies or legal problems arising out of the terms of this Agreement
and/or the Contract and any action involving the enforcement or interpretation of any
rights hereunder shall be submitted to the jurisdiction of the state courts of the Eleventh
Judicial Circuit, in and for, Miami -Dade County, Florida.
R. BACKGROUND SCREENING
In accordance with Sections 943.0542, 984.01, Chapter 430, 435, 402, 39.001, and
1012.465 Florida Statutes, as applicable, employees, volunteers and subcontracted
personnel who work in direct contact with children or who come into direct contact with
children must complete a satisfactory Level 2 background screening prior to
commencing work pursuant to this Agreement in connection with the Contract.
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For purposes of this section, the term "direct service provider" means a person 18 years of
age or older, including a volunteer, who provides services to children, youth and their
families. The term does not include volunteers who assist on an intermittent basis for less
than 20 hours per month.
Level 2 Background screenings must be completed through the Florida Department of
Law Enforcement (FDLE) VECHS (Volunteer & Employee Criminal History System) Program.
Satisfactory background screening documentation will be accepted for those agencies
that already conduct business with either the Department of Children and Families (DCF)
or the Department of Juvenile Justice (DJJ) or the Miami Dade County Public School
System (MDCPS). A clearance letter from MDCPS Office of Employment Standards
indicating the person has successfully completed a Level 2 screening will be accepted.
If background screenings are completed with VECHS, then Provider shall complete
Attachment E: "Affidavit for Level 2 Background Screenings" each for contract term. The
Affidavit will cover employees, volunteers, and subcontractors performing services .under
this Agreement in connection with the Contract who are required to complete a Level 2
background screening as defined in this section. Provider shall keep Attachment E:
"Affidavit for Level 2 Background Screenings" in Provider's personnel, volunteers, and sub-
contractors files. Provider shall re -screen each employee, volunteer and/or
subcontractor every five years.
S. CHILDREN WITH DISABILITIES AND THEIR FAMILIES
Provider understands that the City and The Children's Trust expect Provider to meet the
federal standards under the Americans with Disabilities Act. By policy of The Children's
Trust, providers must also implement reasonable programmatic accommodations to
include children with disabilities and their families, whenever possible. Notwithstanding
anything to the contrary, Provider shall not be required to make any alteration to any
public school building or other building or structure which is not owned by Provider.
T. REGULATORY COMPLIANCE
1. Non-discrimination and Civil Rights
Provider shall not discriminate against an employee, volunteer, or client of Provider on
the basis of race, color, gender, pregnancy, marital status, familial status, sexual
orientation, religion, ancestry, national origin, disability, or age, except that programs
may target services for specific target groups as may be defined in the competitive
solicitation.
Provider shall demonstrate that it has standards, policies, and practices necessary to
render services in a manner that respects the worth of the individual and protects and
preserves the dignity of people of diverse cultures, classes, races, religions, sexual
orientation, and ethnic backgrounds.
Provider agrees to abide by Chapter 11 A of the Code of Miami -Dade County ("County
Code"), as amended, which prohibits discrimination in employment, housing and public
accommodations; Title VII of the Civil Rights Act of 1968, as amended, which prohibits
discrimination in employment and public accommodation; the Age Discrimination Act of
1975, 42 U.S.C. Section 6101, as amended, which prohibits discrimination in employment
because of age; Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. § 794, as
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amended, which prohibits discrimination on the basis of disability; and the Americans
with Disabilities Act, 42 U.S.C. § 12101 et seq., which prohibits discrimination in employment
and public accommodations because of disability.
It is expressly understood that upon receipt of evidence of discrimination under any of
these laws, the City shall have the right to terminate all or any portion of this Agreement
and The Children's Trust shall have the right to terminate all or any portion of Provider's
portions of the Contract. If Provider or any owner, subsidiary, or other firm affiliated with
or related to Provider, is found by the responsible enforcement agency or the courts to
be in violation of these laws, said violation will be a material breach of this Agreement, of
Provider's portions of. the Contract and The Children's Trust and the City will conduct no
further business with Provider.
2.Public Entities Crime Act
Provider will not violate the Public Entities Crimes Act (Section 287.133, Florida Statutes),
which essentially provides that a person or affiliate who is a Provider, consultant or other
provider and who has been placed on the convicted vendor list following a conviction
for a Public Entity Crime may not submit a bid on a contract to provide any goods or
services to the City or The Children's Trust, may not submit a bid on a contract, as
applicable, with the City and/or The Children's Trust for the construction or repair of a
public building or public work, may not submit bids on leases of real property to the City
and/or The Children's Trust, as applicable, may not be awarded or perform work as a
Provider supplier, sub Provider, or consultant under a contract with the City and/or The
Children's Trust, as applicable, and may not transact any business with the City and/or
The Children's Trust, as applicable, in excess of the threshold amount provided in Section
287.017, Florida Statutes, for category two purchases for a period of thirty-six (36) months
from the date of being placed on the convicted vendor list. Violation of this section shall
result in cancellation of this Agreement and of Provider's portions of the Contract and
recovery of all monies paid hereto, and may result in debarment from the City's and The
Children's Trust's competitive procurement activities.
3. Conflict of Interest
Provider represents that the execution of this Agreement in connection with Provider's
portions of the Contract does not violate Miami Dade County's Conflict of Interest and
Code of Ethics Ordinance, and Florida Statutes §112 as amended, which are
incorporated herein by reference as if fully set forth herein. Provider agrees to abide by
and be governed by these conflict of interest provisions throughout the course of this
Agreement and Provider's portions of the Contract and in connection with its obligations
hereunder.
(Refer to http://www.miamidadeethics.com/Publications/code of ethics2010.pdf for the
Code of Ethics Ordinance).
4. Compliance with Sarbanes-Oxley Act of 2002
Provider shall comply with the following applicable provisions of the Sarbanes-Oxley Act
of 2002, including:
• Provider agrees not to alter, cover up, falsify, or destroy any document that may
be relevant to an official investigation.
• Provider agrees not to punish whistleblowers or retaliate against any employee
who reports suspected cases of fraud or abuse.
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5. Licensing
Provider (and subcontractor, as applicable,) shall obtain and maintain in full force and
effect during the term of this Agreement and the Contract any and all licenses,
certifications, approvals, insurances, permits and accreditations, required by the State of
Florida, Miami -Dade County, the City, other relevant municipalities, The Children's Trust or
the federal government. Provider must be qualified and registered to do business in the
State of Florida and in the City of Miami both prior to and during the contract term with
City and with The Children's Trust.
6. Incident Reporting
An incident - is defined as any actual or alleged event. or .situation that creates a
significant risk of substantial or serious harm to the physical or mental health, safety or
wellbeing of: a child participating in the program. Reportable incidents include, but are
not limited to, allegations of abuse, neglect or exploitation of a child, injury of a
participant, missing child or abandoned child, loss of property use for the program, or
destruction of property used in the program.
Provider shall immediately report knowledge or reasonable suspicion of abuse, neglect,
or abandonment of a child, aged person, or disabled adult to the Florida Abuse Hotline
on the statewide toll -free telephone number (1-800-96-ABUSE). As required by Chapters
39 and 415, Florida Statutes, this is binding upon both Provider and its employees.
Provider shall notify the City's program manager and The Children's Trust contract
manager of any incident as defined within three (3) days after Provider is informed of
such incident. Provider shall provide written notification of the incident together with a
copy of the incident report. The report must contain the following:
(1) Name of reporter (person giving the notice)
(2) Name and address of victim and guardian
(3) Phone number where the reporter can be contacted
(4) Date, time, and location of incident
(5) Complete description of incident and injuries, if any
Police report and actions taken shall be submitted to the City and to The Children's Trust
within fifteen (15) days of the incident. Provider shall provide written notification to the
City and to The Children's Trust, within seven (7) days of any legal action related to the
incident.
7. Sexual Harassment
Provider shall complete an incident report in the event a program participant, client or
employee makes an allegation of sexual harassment, sexual misconduct or sexual assault
by a Provider employee, volunteer or anyone arising out of the performance of this
Agreement in connection with the Contract and Provider has knowledge thereof.
Provider shall provide written notification to the City and to The Children's Trust within
three (3) business days after Provider is informed of such an allegation. Provider shall
provide written notification to the City and to The Children's Trust, within seven (7)
business days, if any legal action which is filed as a result of such an alleged incident.
8. Proof of Policies
Provider and subcontractor, as applicable, shall keep on file copies of its policies
including but not limited to confidentiality, incident reporting, sexual harassment, non-
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discrimination, equal opportunity and/or affirmative action, Americans with Disabilities
Act, and drug -free workplace.
U. CONSENT
Provider must obtain parental/legal guardian consent for all minor participants to
participate and/or for adult participants in the program for services; and to share
information with The Children's Trust for monitoring and evaluation purposes.
Provider will ask participants to sign a voluntary Consent to Photograph form. The form is
available in. English, Spanish, and Creole and can be. downloaded _ from
www.thechildrenstrust.org. The signed consent form for photography will be maintained -
at..the program site, .with a copy filed in the participant's record. The consent shall be
part of the participants' registration form, and signed by parent/guardian before services
commence or assessments are administered. Any refusal of consent must be properly
documented and signed by the parent or legal guardian on_the_consent form.
V. PROGRAMMATIC DATA REPORTING
Demographic and service information on program participants will be provided to the
City and The Children's Trust as part of The Children's Trust's research mission. Provider
agrees to comply and participate in any data collection reporting, including participant
data as required by The Children's Trust and described in Attachment C to this
Agreement and the Contract, Programmatic Data and Reporting Requirements, subject
to confidentiality requirements. In addition, Provider agrees to furnish the City and The
Children's Trust with complete and accurate reports in the timeframe and format to be
reasonably specified by The Children's Trust, and as described in Attachment C.
Provider must participate and provide agency (agency profile) and site(s) information to
Switchboard of Miami 2-1-1, The Children's Trust 24 hour helpline, as applicable and as
defined in Attachment C: Programmatic Data Reporting Requirements.
W. PUBLICITY
Provider agrees that activities, services and events funded by this Agreement through the
Contract shall recognize the City and The Children's Trust as funding sources. Provider
shall ensure that all publicity, public relations, advertisements and signs within its control
recognize the City and The Children's Trust for the support of all contracted activities. The
use of the official Children's Trust logo is permissible. Provider shall contact the City's
program manager regarding uses of the City 's logo.
Provider shall use its best efforts to ensure that all media representatives, when inquiring
with Provider about the activities funded by this Agreement and the Contract, are
informed that The Children's Trust is a funding source and that the City is a funding source
in cooperation with The Children's Trust for Services within the City. Provider shall, if it
possesses the appropriate technology, provide a link between the website and The
Children's Trust's website. Provider shall coordinate with the City's program manager
regarding links between Provider's website and the City's website.
X. PUBLICATIONS
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Provider agrees td supply both the City and The Children's Trust, without charge, up to
three copies each of any publication developed in connection with implementation of
programs addressed by this Agreement and the Contract. Such publications will state
that the program is supported by the City and The Children's Trust. Provider agrees that
the City and The Children's Trust will have use of copyrighted materials developed under
this Agreement in connection with the Contract to the extent provided in, and subject to,
the provisions of Paragraphs G and H above.
To the extent permitted by the applicable journal or other publication source, Provider
shall include the City's logo, The Children's Trust logo and the following paragraph in all
materials featuring programs funded by the City and The Children's Trust, including but
not limited to newsletters, press releases, brochures, fliers, homepage of websites or any
other materials for dissemination to the media or general public_
English:
City of Miami's Program Name is funded by The Children's Trust The Children's Trust is a
dedicated source of revenue established by voter referendum to improve the lives of
children and families in Miami -Dade County.
Espanol:
City of Miami's Program Name esta financiado=por El Fidecomiso de los Ninos (The
Children's Trust). El Fidecomiso de los Ninos es una fuente de financiacion, establecida
por referendum para mejorar las vidas de ninos y families en el Condado de Miami -
Dade.
Kreyol:
City of Miami's Program Name finanse_pa "The Children's Trust". Trust la, se you sous lajan
ke gouvenman amerikin vote an referandom you ke' li investi byen nan pwogram kap
ameliore la Vi Ti Moun ak fanmi yo nan Myami Dade.
Note: In cases where funding by The Children's Trust represents only a percentage of
Provider's overall funding, the above language can be altered to read "The
(organization) is funded in part by The Children's Trust in cooperation with the City of
Miami,..."
Y. 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 Agreement or of the 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.
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Z. TOTALITY OF CONTRACT/SEVERABILITY OF PROVISIONS
This Agreement with its attachments as referenced below contains all the terms and
conditions agreed upon by the parties:
Exhibit 1: The Contract with its attachments
Attachment A: Scope of Services
Attachment B: Other Fiscal Requirements, Budget, and Method of Payment
Attachment C: Programmatic Data and Reporting Requirements
Attachment D: Program Specific Audit Requirements
Attachment E: Affidavit for Level 2 Background Screenings, if applicable
Attachment F: Provider's Corporate Authorization and Insurance Requirements
No other contract, oral or otherwise, regarding the subject matter of this Agreement in
connection with the Contract shall be deemed to exist or bind the Parties. If any
provision of this Agreement and/or any applicable provision of the Contract is held
invalid or void, the remainder of this Agreement and any applicable provision of the
Contract shall not be affected thereby if such remainder would then continue to
conform to the terms and requirements of applicable law.
PROVIDER:
A Florida
Provider Federal ID#
CITY OF MIAMI,
A Florida municipal corporation
By: By:
Print Name:
Title: City Manager
Date: Date
Attest: Attest:
By: By:
Print Name: Todd Hannon, City Clerk
Title: Date:
Date:
Approved as to Form and Correctness:
By:
City Attorney
Date:
Approved as to Insurance Requirements:
By:
Director of Risk Management
Date:
This Agreement is not valid until signed by both parties.
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Attachment A Place Holder
(replace this page with the revised Attachment A and
remove all references to this place holder)
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ATTACHMENT B
OTHER FISCAL REQUIREMENTS, BUDGET and METHOD OF PAYMENT
Advance payment requests
The Children's Trust offers advance payments up to 15% of the total contract amount.
Advance requests shall be limited to governmental entities and not -for -profit
corporations, in accordance with subsection 216.181 (16) (b), F.S. The advance request is
to include the amount requested and the justification. Advance payment requests must
be submitted using the designated form and must be approved in writing by The
Children's Trust Contract Manager and Chief Financial Officer or their designee(s).
Advanced funds, if not used, shall be invested by Provider in an insured interest bearing
account, in accordance with subsection 216.181 (16) (b), F.S. Interest earned on
advanced funds shall be returned to The Children's Trust on a quarterly basis or applied
against the amount of the contract owed by The Children's Trust.
The City shall not advance any funds unless such funds are advanced by The Children's
Trust under the Contract in relation to this Agreement.
Advance repayment
Advance repayment is due within 60 calendar days of receipt of an advance. Provider
shall report the amount of the advance repayment in SAMIS using the
"advances/adjustments" button on the SAMIS reimbursement screen. If a Provider does
not use SAMIS, then they are required to deduct their advance repayment from each
invoice, consecutively, until the advance is repaid in full.
Budget revisions
Budget revision(s) require written approval from the City's program manager, the Trust's
the Contract Manager and The Children's Trust's Chief Financial Officer or their
designee(s). Request for budget revisions must be submitted to the Contract Manager
using the appropriate form and/or entered into SAMIS. All budget revisions are subject to
final approval by the City and The Children's Trust. Provider must request a budget
revision to add, delete, and/or modify any line item(s). Budget revisions cannot be used
to modify the total contracted amount nor can they be used to modify the Scope of
Services. No more than two (2) budget revisions may be approved during the contract
term. Budget revision requests must be submitted sixty (60) days prior to the expiration of
this Agreement and the Contract. Budget revisions will be incorporated into this
Agreement and the Contract.
Indirect Administrative Costs/No Unfunded Costs
In no event shall The Children's Trust fund indirect administrative costs in excess of ten
(10%) percent of the total contract amount. In no event shall the City fund any costs
whatsoever unless such costs have been funded by The Children's Trust.
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Cost Reimbursement Method of Payment
The parties agree that this is a cost reimbursement method of payment contract; Provider
shall be paid in accordance with the approved budget and/or approved budget
revision as set forth in this Attachment. Provider also agrees to timely pay its
subcontractors, vendors, and employees for the fulfilment of services provided in this
Agreement and the Contract.
Invoice Requirements
Provider shall submit an original request for payment, utilizing the format prescribed by
The Children's Trust and in accordance with the approved budget or approved budget
revision(s) The Children's Trust will notify the Provider if the request for payment is to be
submitted electronically using SAMIS or by using a reporting "invoice" form/ spreadsheet.
The request . for payment is due on or before the fifteenth (15th) day of the month
following the month in which expenditures were incurred (exclusive of legal holidays or
weekends). The City agrees to reimburse Provider in accordance with The Children's Trust
requirements. Generally, The Children's Trust agrees to reimburse on a monthly billing
basis. Every request by Provider for payment for services provided, work performed, or
costs incurred pursuant to this Agreement and the Contract, except for any advanced
payments by The Trust, shall be accompanied by a Request for Payment in the format
that is prescribed by The Children's Trust. If there are subcontractors to this Agreement if
permitted by the Contract, then the Form D-Attestation of Payment- must be either
uploaded to the SAMIS Document Repository or included in the Request for Payment no
later than 30 days after payment to subcontractor(s). These forms may be downloaded
from The Children's Trust's website. For the purpose of payment only, a subcontractor is
defined as an independent agency that has entered into agreement with Provider to
perform services pertaining to The Children's Trust funded programs identified in this
Agreement and the Contract.
The City and The Children's Trust reserve the right to request any supporting
documentation. A final request for payment (last monthly invoice of the contract term)
from Provider will be accepted by The Children's Trust up to forty-five (45) days after the
expiration of this Agreement and the Contract. If Provider fails to comply, all rights to
payment shall be forfeited.
If the City and/or The Children's Trust determines that Provider has been paid funds not in
accordance with this Agreement in relation to the Contract, and to which it is not
entitled, Provider shall return such funds to the City and/or The Children's Trust, as
applicable, or submit appropriate documentation to support the payment within thirty
(30) days of notification by the City and/or The Children's Trust. After thirty (30) days, The
City and/or Children's Trust, as applicable, may recapture amounts due to the City
and/or The Children's Trust, as applicable, from this or any other The Children's Trust
contract or any other applicable City agreement by reducing amounts requested to be
reimbursed less the amount owed to The Children's Trust and/or to the City, as
applicable. The Children's Trust and the City shall have the sole discretion in determining
if Provider is entitled to such funds in accordance with this Agreement and the Contract
and the City's decision and The Children's Trust's decision on this matter shall be binding.
In the event that Provider, its independent auditor, the City, or The Children's Trust
discovers that an overpayment has been made, Provider shall repay said overpayment
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within thirty (30) calendar days without prior notification from The Children's Trust or from
the City, as applicable.
If Provider fails to serve the number of participants and/or fails to utilize the funds in
accordance with this Agreement and the Contract, the City may amend this Agreement
and The Children's Trust may amend the Contract to reduce the amount of dollars. Any
delay in amendment by The Children's Trust is not deemed a waiver of The Children's
Trust's right to amend or seek reimbursement for under -serving participants in
accordance with the Contract. Any delay in amendment by the City is not deemed a
waiver of the City's right to amend or seek reimbursement for under -serving participants
in accordance with this Agreement.
In order for a request for payment to be deemed proper as defined by the Florida
Prompt Payment Act, all requests for payment must comply with the requirements set
forth in this Agreement and the Contract and must be submitted on the forms as
prescribed by The Chi►dren's Trust. Requests for payment and/or documentation returned
to Provider for corrections may be cause for delay in receipt of payment. Late
submission may result in delay in receipt of payment. The Children's Trust shall pay
Provider within thirty (30) calendar days of receipt of Provider's properly submitted
Request for Payment and/or other required documentation.
The City and/or Children's Trust, as applicable, may retain any payments due until all
required reports, deliverables or monies owed to the City and/or The Children's Trust, as
applicable are submitted and accepted by The Children's Trust and/or the City, as
applicable.
Supporting Documentation Requirements
Provider shall maintain original records documenting actual expenditures and services
provided according to the approved budget and scope of services as required.
Supporting documentation shall be made available and provided to the City and The
Children's Trust upon request.
Provider shall keep accurate and complete records of any fees collected,
reimbursement, or compensation of any kind received from any client or other third
party, for any Service covered by this Agreement and the Contract, and shall make all
such records available to the City and The Children's Trust upon request. Provider shall
maintain a cost allocation methodology that it uses to allocate its costs. Provider shall
use a cost allocation methodology which assures that The Children's Trust is paying only its
fair share of costs for services, overhead, and staffing not solely devoted to the program
funded by this Agreement and the Contract. Such methodology shall be made available
to the City and The Children's Trust upon request.
THE REMAINDER OF THIS PAGE IS INTENTIONALLY BLANK.
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Attachment C Place Holder
(replace this page with the revised Attachment C and
remove all references to this place holder)
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Attachment D
Program Specific Audit Requirements
The Program Specific Audit is to encompass an audit of this Agreement in connection
with The Children's Trust Contract(s) in accordance with section 0.3. Program Specific
Audit. The comprehensive nature of auditing performed in accordance with the
standards set forth below places on the audit organization the responsibility for ensuring
that (1) the audit is conducted by personnel who have the necessary skills, (2)
independence is maintained, (3) applicable standards are followed in planning and
conducting audits and reporting the results, (4) the organization has an appropriate
internal quality control system in place, and (5) the organization undergoes an external
quality control review. Individuals assigned to these audits are to complete at least 2.4 of : _
the 80 hours of continuing education required for licensure, and every two years, in
subjects directly related to the government environment and to government auditing as
required by Governmental Auditing Standards.
The Program Specific Audit requires the following (a sample may be found on The
Children's Trust website):
Submission of:
a. Independent Auditor's Report on the Schedule of Expenditures of The Children's Trust
Contract(s)
b. Schedule of Expenditures of The Children's Trust Contract(s)
c. Notes to Schedule(s)
d. Independent Auditor's Report on Compliance with Requirements That Could Have a
Direct Material Effect on The Children's Trust Contracts and on Internal Control Over
Compliance in Accordance With the Program Specific Audit Requirements of The
Children's Trust Contract(s)
e. Schedule of Findings and Questioned Costs
f. Supplemental Information, which includes a Schedule of Budget to Actual Expenditures
of The Children's Trust Contract(s)
The auditor must include the following tests in their audit program:
a. testing of the budget versus actual expenditures. The approved budget is to include the
original approved contracted budget as well as any approved budget revisions and
budget amendments.
b. double billing i.e. billing under The Children's Trust contract the same expenditure that is
billed under another contract and/or revenue source
c. testing for unallowable expenditures e.g. costs not included in the approved budget or
budget revision and unallowable costs identified in the budget guidelines included on
The Children's Trust website
d. testing for questioned costs
e. testing that the Provider billed and was reimbursed by The Children's Trust in accordance
with the method of payment identified in the contract and within the contract period
f. testing for the supplanting of funds
g. testing of match requirements, if required
h. testing of the cost allocation plan to verify that The Children's Trust is paying only its fair
share of costs for services, overhead and staffing
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i. testing that advanced funds, if not used, shall be invested by Provider in an insured
interest bearing account and that any interest earned on advanced funds is returned to
The Children's Trust.
j. testing the controls over compliance beyond the Statement on Auditing Standards No.
1 17, which means that an auditors risk assessment must include an expectation of the
operating effectiveness of controls over compliance; and in doing so, the assessed
control risk must be set at low.
The independent auditor's report shall state that the audit was conducted in accordance
with auditing standards generally accepted in the United States of America; the
standards applicable to financial audits contained in Government Auditing Standards,
issued by the Comptroller General of the United States, and the Program Specific Audit
requirements listed in The Children's Trust contract(s). The report shall include the
following:
• An opinion (or disclaimer of opinion) as to whether the Schedule of Expenditures of The
Children's Trust Contract)s) of Provider, is presented fairly in all material respects in
conformity with accounting principles generally accepted in the United States of
America, An opinion (or disclaimer of opinion) as to whether Provider maintained
compliance with requirements that could have a direct material effect on The Children's
Trust Contract(s) and on internal control over compliance in accordance with the
program specific audit requirements of The Children's Trust Contract(s) which shall
describe the scope of testing of internal control and the results of the tests; and
• A schedule of findings and questioned costs for The Children's Trust contract(s) that
includes a summary of the auditor's results relative to The Children's Trust contract(s) and
findings and questioned costs.
• Required supplemental schedule(s) of budget to actual expenditures of The Children's
Trust Contract(s)
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ATTACHMENT E
Affidavit for Level 2 Background Screenings
Affidavit Affirming Compliance with Background Screening for Provider Personnel,
Volunteers, and Subcontracted Personnel, as applicable.
In accordance with Sections 943.0542, 984.01, Chapter 430, 435, 402, 39.001, and
1012.465 Florida Statutes, and pursuant to the requirements of Paragraph R. Background
Screening of this Agreement and the related Children's Trust Contract, the undersigned
affiant makes the following statement under oath, under penalty of perjury, which is a first
degree -misdemeanor, punishable by a definite term of imprisonment not to exceed one
year and/or a fine not to exceed $1,000, pursuant to Sections 837.012 and 775.082,
Florida Statutes.
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
Before me, the undersigned authority, personally appeared (CEO/Executive Director)
Authorized Provider
Representative of (Provider Name) , who being by me first duly sworn,
deposes and says:
Name of Contracted Provider
(Signature of CEO/Executive Director/HR Director) Date
I swear and affirm that the above -named contracted Provider is compliant with the
requirements for personnel background screening detailed in Sections 943.0542, 984.01,
Chapter 435, 402, 39.001, and 1012.465 Florida Statutes, as applicable, for all personnel
having direct contact with children.
Sworn to and subscribed before me at Miami -Dade County, Florida this day of
, 2012/2013 by
Who is personally known to me
Who produced identification:
Type of identification
Signature of Notary Public
State of Florida at Large
Print, type or stamp name of notary public
My Commission Expires:
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Attachment F
(Replace this Page with Provider's Corporate
Authorization and Insurance Requirements)
396391 FY 2013-2014 Form of Provider Agreement in connection with
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Attachment G Place Holder
(replace this page with the Performance Improvement
Plan, if necessary and remove all references to this
place holder. If not needed delete this page)
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