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HomeMy WebLinkAbout23360AGREEMENT INFORMATION AGREEMENT NUMBER 23360 NAME/TYPE OF AGREEMENT AGE FRIENDLY INITIATIVE DESCRIPTION MEMORANDUM OF UNDERSTANDING/MIMI-DADE AGE - FRIENDLY 2020-2021 MINI-GRANT/#31 EFFECTIVE DATE February 17, 2021 ATTESTED BY TODD B. HANNON ATTESTED DATE 3/9/2021 DATE RECEIVED FROM ISSUING DEPT. 3/24/2021 NOTE CITY OF MIAMI DOCUMENT ROUTING FORM 0_33,0 ORIGINATING DEPARTMENT: Dept. of Human Services DEPT. CONTACT PERSON: Michael Roman NAME OF OTHER CONTRACTUAL PARTY/ENTITY: Age Friendly Initiative EXT. IS THIS AGREEMENT A RESULT OF A COMPETITIVE PROCUREMENT PROCESS? ❑ YES 0 NO TOTAL CONTRACT AMOUNT: $ 250o FUNDING INVOLVED? 0 YES TYPE OF AGREEMENT: ❑ MANAGEMENT AGREEMENT ❑ PROFESSIONAL SERVICES AGREEMENT 0 GRANT AGREEMENT ❑ EXPERT CONSULTANT AGREEMENT ❑ LICENSE AGREEMENT ❑ PUBLIC WORKS AGREEMENT ❑ MAINTENANCE AGREEMENT ❑ INTER -LOCAL AGREEMENT ❑ LEASE AGREEMENT ❑ PURCHASE OR SALE AGREEMENT ❑ NO OTHER: (PLEASE SPECIFY) PURPOSE OF ITEM (BRIEF SUMMARY): To review and accept the attached MOU for grant funded civic engagement program COMMISSION APPROVAL DATE: / / FILE ID: NA ENACTMENT NO.: NA IF THIS DOES NOT REQUIRE COMMISSION APPROVAL, PLEASE EXPLAIN: Funds only $2500 -ROUTING INFORMATION ° Date PLEASE PRINT AND SIGN APPROVAL BY DEPARTMENTAL DIRECTOR Feb 18 2021 PRINT: William Porro SIGNATURE: William Porro SUBMITTED TO RISK MANAGEMENT PRINT: ANN-MARIE SHARPE l GTvMi5netl MTvryM SIGNATURE: ,aT�T.,A�. SUBMITTED TO CITY ATTORNEY 3/4/2021 PRINT: VICTORIA MENDEZ Min, Digitally signed by Min, SIGNATURE: Barnaby 1—°4:0958jj 4 APPROVAL BY ASSISTANT CITY MANAGER 3-5 ' 262,1 PRINT: /VGibii4 a%bface-k4 SIGNATURE: �1�„.,ts RECEIVED BY CITY MANAGER PRINT: ART N6RIEGA SIGNATURE: PRINT: SIGNATURE: PRINT: SIGNATURE: PRINT: SIGNATURE: 1) ONE, ORIGINAL TO CITY CLERK, 2) ONE COPY TO CITY ATTORNEYS, OFFICE; _. 3) REMAINING ORIGINAL(S) TO ORIGINATING DEPARTMENT _. PLEASE ATTACH THIS ROUTING FORM TO ALL DOCUMENTS THAT REQUIRE EXECUTION BY THE CITY MANAGER AGE FRIENDLY INITIATIVE Miami -Dade County Miami -Dade Age -Friendly 2020-2021 Mini -Grant Memorandum of Understanding Congratulations! Please complete the following to receive your Miami -Dade Age -Friendly Mini Grant. By completing this form and accepting this grant, you agree that the Miami -Dade Age -Friendly Initiative can use information regarding your project in the promotion of the Mini Grant program and other areas of work. Please submit this agreement by February 17, 2021. Please do not disclose to anyone outside of your organization that you have received this grant until the time of the announcement in late -February. You will be sent an announcement date and materials. GRANTEE INFORMATION Date: 2/22/21 Name of Contact Person: Michael Roman Email of Contact Person: mroman@miamigov.com _ Phone number: (305) 416-1618 Payable to organization name: City of Miami Department of Human Services Address where check will be sent: C/O Michael Roman or Susana Penaranda 444 S.W. 2nd Avenue, 10th Floor Miami, FL 33160 Street or PO Box City State Zip Code MINI -GRANT INFORMATION The Miami -Dade Age -Friendly Initiative is a collaborative, collective impact effort to make Miami -Dade a place for older adults of all ages to stay active and healthy with dignity and enjoyment. We work with community residents, leaders, stakeholders, organizations, and municipalities toward a more age -friendly community. The Miami -Dade Age -Friendly Initiative is proud to have selected your organization as one of its Age -Friendly Mini -Grant Program awardees. The goal of the mini -grant program is to jump-start age -friendly projects across the County. Amount of Mini -Grant Award: $2,500.00 Mini -Grant Timeline: February 10, 2021: Announcement to winners & MOU's will be provided to recipients February 17, 2019: Deadline to submit this agreement... February 17 - July 31, 2021: Mini -Grant -Implementation April 30, 2021: Check -in Update Due 1 • August 13, 2021: Final Mini -Grant Recipient Reports Due Grant funds will be used for the following proposed project: The City of Miami is looking at building and enhancing civic leadership and community liaisons in our older adult communities. The Department of Human Services is looking at kicking off CITY OF MIAMI — EMPOWER60, a 4-week academy in each of the five (5) districts in the City of Miami designed for older adults to learn the best practices of engaging and working with local government. Every 4 weeks, a cohort of classes will be offered in a different district focusing on the resources specific to that district. The City will offer 4 classes per district for a total of 5 cohorts, with each cohort having 5 participants. Participants will be given the tools, information and resources to become more knowledgeable members of the community resulting in effective neighborhood leaders advocating for healthier, thriving neighborhoods. The end of this course will result in older adults putting the information learned over the 4-week course into practice at community and city events. EMPOWER60 requires residents ages 60 and older to attend a once a week virtual course for two hours. The course is facilitated by local leaders to help participants increase resident engagement; educate neighbors about local government's role and impact; and promote engagement and service deliveries of governmental services. Topics will include public safety, clean and beautiful neighborhoods, growth and development, education and economic access, culture and recreation, and efficient and effective government. After successfully completing the program, participants will be invited to a virtual City Commission meeting where they are not only awarded and acknowledged for the completion of the academy and receive a stipend for completion but will have the opportunity to put the skills learned into practice. The City of Miami will also work closely with these participants to identify other avenues for additional civic engagement. Deliverables and Project Sustainability: • Deliverable 1: Recruit 25 City of Miami residents (5 from each district) to participate and complete the 4-week academy in their respective district. • Deliverable 2: Administer a pre and post survey to evaluate the amount of knowledge and practice learned throughout the academy. • Deliverable 3: Provide stipends and financial literacy and services to participants to continue promoting wealth equity in our older adult populations. • Deliverable 4: Work with participants to develop their own civic engagement strategy project. • Deliverable 5: Provide opportunities to civic engagement strategies into practice. • Deliverable 6: Evaluate success of program and create a guide for other local governments The City of Miami engages the community and involved older adults in the process. The Neighborhood Service Centers are satellite City hubs that engage community. Some of the Service Centers have offered programming to older adults. The Service Centers become an essential tool to engaging older adults since these Centers become a trusted municipal 2 partner. Through the City's Department of Human Services, community partners (Leon Medical Centers, Simply healthcare, etc), we are able to offer resources and engage older adults. However, we are advocating for more two-way communication, and hoping to receive greater insight from this population. The desired outcome is that through this effort, the 25 graduates of EMPOWER60 will use their newfound advocacy skills to engage other residents in their communities. EMPOWER60 graduates will be asked to engage 3-5 friends and neighbors, and actively mentor them to become community liaisons. While This gives EMPOWER60 the potential to impact up to 100 residents. This project will serve as a pilot that DHS will use as a platform to bring resident voices into programmatic planning processes. DHS will use the results of EMPOWER60 as a case study to get support from established community partners for additional workshops. AGREEMENT & MATERIALS Additional Materials Required Please submit the following with this completed agreement by February 17, 2021: • Copy of your organization's W9 • Proof of organization's not for profit status (if applicable), OR if a government agency or educational institution, the website address of agency or institution • Organization and/or Project Logo • Description of your organization and the project (100 word maximum). This description will be used in the official announcement of the mini -grant and other publicity materials by the Miami -Dade Age -Friendly Initiative. By signing below, you attest that the information on this form is correct and agree that: • Your organization can execute the above project by the implementation deadline date (July 31, 2021) • Your organization can provide an informal mid -point update to the Initiative (April 30, 2021). • Your organization can attend one Age -Friendly Initiative Meeting (June TBD) to share an update about this project. • Your organization can complete the required report by the deadline date (August 13, 2021). • Your organization is committed to partnering with the Age -Friendly Initiative toward creating a more livable community for'faII ages.. Signature of Grantee: Title: £ ► I\+ \ 0v‘ 452 ✓ Please submit this form and other required materials via email to Isabel Rovira, Urban Health Partnerships, at isabel@urbanhp.org by February 17, 2021. 3 Form _9 (Rev. October 2018) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification ► Go to www.irs.gov/FormW9 for instructions and the latest information. Give Form to the requester. Do not send to the IRS. 0 m a c 0 ai c a.o Z `02 C N ` c a 0 .v Q cn an 1 Name (as shown on your income tax retum). Name is required on this line; do not leave this line blank. City of Miami 2 Business name/disregarded entity name, if different from above 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the following seven boxes. ❑ IndividuaVsole proprietor or ❑ C Corporation ❑ S Corporation ❑ Partnership ❑ Trust/estate single -member LLC ❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ► Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner. ❑✓ Other (see instructions) ► Municipality 4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3): Exempt payee code (if any) Exemption from FATCA reporting code (if any) (Applies to accountsmaintaned outside the U.S.) 5 Address (number, street, and apt. or suite no.) See instructions. 444 SW 2nd Avenue; 6th Floor 6 City, state, and ZIP code Miami, FL 33130 Requester's name and address (optional) 7 List account number(s) here (optional) Part. I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later. Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter. Social security number or Employer identification number 5 9 6 0 0 0 3 7 5 Part II Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. I am not subject to backup withholding because: (a) 1 am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. I am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax retum. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not requird`(o sign the certification, but you must provide your correct TIN. See the instructions for Part II, later. Sign Here Signature of U.S. person ► General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information retum with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information retum. Examples of information returns include, but are not limited to, the following. • Form 1099-INT (interest earned or paid) Date ! /o// q • Form 1099-DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-6 (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. if you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Cat. No. 10231X Form W-9 (Rev. 10-2018) ATTEST: Todd B. Hann City Clerk APPROVED AS TO FORM AND CORRECTNESS Min, By: Barnaby De aw.ntte1MM«` Danube Date : mn 03.041410:3 mar Victoria Mendez City Attorney (21-425 - JCP) SPONSORING AGENCY THE CITY OF MIAMI, a municipal Corporation of the State of Florida By: Arthur Norlega City Manager APPROVED AS TO INSURANCE REQUIREMENTS M. Digitally d by Terry M.Quevedo Date: 2021.02.26 09:41:03 By: -05'00' Ann -Marie Sharpe, Director Department of Risk Management Counterparts and Electronic Signatures. This Agreement may be executed in any number of counterparts, each of which so executed shall be deemed to be an original, and such counterparts shall together constitute but one and the same Agreement. The parties shall be entitled to sign and transmit an electronic signature of this Agreement (whether by facsimile, PDF or other email transmission), which signature shall be binding on the party whose name is contained therein. Any party providing an electronic signature agrees to promptly execute and deliver to the other parties an original signed Agreement upon request.