HomeMy WebLinkAboutContracts & Agreements_145-2005_CCv0001.pdf Attachment A-1
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Additional Terms and Conditions to Title IIIB Programs Purchase Order
Amendment 1 — Effective July 19, 2005
THIS CONTRACT is entered into in the State of California by and between the County of San Bernardino,
Department of Aging and Adult Services, hereinafter called the County, and
Name
City of Redlands hereinafter called "Contractor"
Address
P.O. Box 3005
Redlands, CA 92373
Phone
(909) 798-7579
Federal ID No.or Social Security No.
95-6000766
IT IS HEREBY AGREED AS FOLLOWS:
AMENDMENT NO. 1
It is hereby agreed to amend this Contract as follows: Section VIII.TERM(A)is amended to read:
This Contract is effective as of July 19, 2005 and expires June 30, 2006, but may be terminated earlier in
accordance with provisions of Article IX of the Contract.
All other terms and conditions of this Contract shall remain the same and are incorporated herein by this
reference.
This amendment shall become effective upon execution by both parties.
COUNTY OF SAN BERNARDINO CONTRACTOR
PURCHASING DEPARTMENT
By: By:
LEO T09EZ Su4n Peppler, -Mafo�
Deputy Purchasing Agent
Dated: Dated: July 19, 2005
Attest:
By .
o He Poyz r C ty Clerk
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Attachment B
City of Redlands
WORK PLAN
FY 2005 - 2006
This work plan contains the measurable objectives mandated by DAAS of the service provider. The
work plan specifies and establishes time frames either on an annual basis or, where required by state
regulations, on a quarterly basis. The work plan constitutes the primary document for ongoing
monitoring, Annual Program Performance Review/Fiscal Audit and will be used to measure the
provider's efforts toward providing quality Transportation services.
I. Scope of Work
A. Geographic Area/Clientele and Eligibility Criteria
1. The geographic area served by this provider covers City of Redlands.
2. The clientele served by this agreement consists of seniors 60 and over.
B. Program Description
1. Purpose: Transportation services assist people who cannot transport
themselves to remain independent and active in community services.
2. Definition: Provide a means of transportation for a person who requires
help in going from one location to another, using a vehicle. Does not
include any other activity.
C. Intended Outcomes
1. Provide 3,466 one-way trips annually to seniors who are not eligible for
these services from any other resource and who cannot afford to pay for
these services.
2. Staff and/or volunteers providing services must be trained and qualified in
the safe provision of Transportation services. Transportation must be
provided to at least 74 unduplicated seniors of which at least 7 are to be
minority low-income seniors.
11. Service Delivery Activities
A. Staffing
Sufficient personnel shall be available to carry out the needs of the program. This
includes a Director and additional personnel as determined by the size of the service
area and the method and level of service provision needed to fully comply with the
terms of this work plan and agreement.
L:\At,.iii�2"Pro-raiiis\Scope,s of Work anti Protide Budgets\05-t)6, WPs&
B. Volunteer Staff
1. Volunteers are individuals who work without pay in the performance of essential
duties to conduct the program. In some cases, the Director may be a volunteer.
2. Volunteers shall not replace paid personnel.
C. Clients will be given priority for services who are socially and/or economically needy and
who are not eligible for services from any other source.
Further, individuals referred by DAAS staff shall be given first priority for services under
this agreement.
Definitions: Economically Needy: Seniors whose income is at or below the SSI/SSP
level.
Socially Needy: Seniors who have at least two of the following characteristics:
Disabled, Language/Communication Barrier, Lives Alone, Age 75+.
D. Training Activities
1 Provide training both on the job and in formal training sessions, as appropriate, to
improve the understanding of paid staff about the service(s) being provided.
Wherever required by law and/or ordinance, licensed staff must be trained to
carry out assigned duties. In addition, annually evaluate paid staff performance
to determine his/her effectiveness, skill development and understanding of tasks
they are assigned. Documentation of training shall be kept on file at the
provider's main office for review by DAAS during program monitoring to be
scheduled and conducted by DAAS.
2. Volunteers should be provided on-the-job training and opportunities for formal
training to improve skills and understanding of the service being provided.
Wherever required by law or ordinance, volunteers must be trained and/or
licensed to carry out assigned duties. Documentation of training shall be kept on
file at the provider's main office for review by DAAS during program monitoring to
be scheduled and conducted by DAAS staff.
111. Other Service Requirements
A. Physical Set-Up
1 Where services are provided in a care center, office or any setting outside the
client's home, the environment must be attractive, clean and free from obstacles
which could cause injury.
2. Post floor plans identifying emergency exits, assembly areas, etc. and conduct
evacuation drills at least twice a year. Proof of evacuation drills will be kept on
file duly signed by the Fire Marshal or other authorized agency within the
community where the service site is located.
L:\A,I,iti�\Pi-ozraTYIs\SCOpe',Of WOrk and Provider Budgets\05-06 WPs&Budgets
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B. Donations and Confidentiality
1 Encourage seniors to donate by notifying them verbally that donations are
accepted and are important to maintaining the service(s) provided. Post signs
where appropriate stating that donations are accepted. The provider shall not in
any way employ tactics which could be viewed as coercion, embarrassing, and/or
obligatory to the service being provided.
2. All contributions shall be used to increase the amount of service being provided
in the program(s) funded by DAAS.
C. Coordination Activities
1. Provider shall participate within appropriate coordination bodies established by
state law and/or county ordinance.
2. Provider shall include the following statement on all advertising, posters and
brochures, etc.:
"Funding for this service has been provided by the San Bernardino County
Department of Aging and Adult Services through a grant award from the
California Department of Aging."
3. Provider shall coordinate service with other County departments and local
agencies by providing time within the facility during parrticipant meetings, staff
meetings and volunteer meetings, etc., for presentations on special activities that
promote a Community Based System of Care for elderly clients. All coordination
activities must be documented and kept on file for review by DAAS.
4. Provider shall coordinate service with other County departments and local
agencies by providing time for presentations or special activities that promote a
Community Based System of Care for the elderly participants attending their
sites. All such activities must be documented and kept on file for review by
DAAS.
D. Reporting Requirements
Contractor, at such times and in such forms as DAAS may require, shall furnish
statements, records, reports, data and information requested by DAAS
pertaining to Contractor's performance of services hereunder and other matters
covered by this Contract. The forms shall be reviewed for timeliness,
completeness, and correctness of the information submitted, by the Program
Director or his/her designee, prior to submission to DAAS. Incomplete forms
shall be returned to the Contractor for completion. (in the event of changes in
these forms, DAAS shall advise the Contractor via written notice.) The Contractor
shall develop and implement a process for ensuring quality control.
a. Contractor shall meet the following standard for its financial management
LAging',,Pi,o�rairis\Scopet of'Work and Provider Budgets\05-06 WPs&Budgets
systems, as provided in the CDA PM Title III Program Manual:
I. Financial Reporting (CDA PM, Section G, Paragraph 93.5a)
Accurate, current and complete disclosure of the financial
results of the Supportive Services Program shall be made in
accordance with the financial reporting requirements of this
Contract. The following reports are to be submitted to DAAS
when indicated:
1) Monthly (Due by 5th working day of each month)
a. Monthly Expenditure Report/Request for
Reimbursement
2) Semi-Annually
a. Budget Revision #1 (Due November 1)
b. Budget Revision # 2 (Due May 15)
3) Annually
a. Financial Close-Out Report (Due August 1)
b. Periodic Inventory (Due August 1 with Close-out)
c. Audit Report (Due October 31)
d. Revised Financial Close-out Report (Due October 31)
with Audit Report.
11. Program Reporting
The following reports are to be submitted to DAAS when indicated:
1) Monthly (Due by the 5th working day of each month)
a. 11113 Monthly Service Unit Report
2) Quarterly
a. Program modification request in writing to DAAS.
Contractor shall describe, in detail, necessary program
changes and the reasons for the requested
modification.
3) Upon request
a. Completion of Client Intake Sheets provided by DAAS.
4) DAAS may require financial reports more frequently than
indicated above or with more detail (or both), upon written notice
to the Contractor, until such time as DAAS determines that the
financial management standards are met.
Ill. Report service and client data by the 5th working day of the month
on DAAS Monthly Service Report which will be verified by DAAS
during the annual program audit. Additionally, establish audit files
of Work and Provider Hud«et.'M5-06 WPs&, Bu&,ets 4
which include but are not limited to a copy of the Monthly
Service Report
IV. Report monthly expenditures to DAAS by the 5th working day of the
month. Maintain support files including but not limited to invoices,
payroll, and other supporting documents, all of which will be
attached to a copy of the expenditures report and kept on file by
month for review during the Annual Audit.
V. Maintain records, by month, that support claimed in-kind
expenditures.
In the event additional funds become available, the provider will use the funds to increase the
Transportation services provided to elderly clients by either increasing the number of individuals
served or by increasing the units of service provided or both. Exceptions to this requirement, for
instance the use of additional funds to purchase equipment, must be fully documented in writing and
submitted to the department for prior approval. Failure to abide by this work plan will constitute just
cause for sanctions being imposed.
L:"A,-,iii,,\IlroLr�itiis\Scopes ol'Work and Provider BUdget.,,\05-06 WPs&Budgets
[County of San Bernardino -Department of Aging and Adult Services Attachment C
Original [X
BUDGET DISPLAY Revised [ ]
Contract Agency Name: City of Redlands Budget for Fiscal Year: 2005-2006 Contract P.O.No.: Date: duly 19, 2005
Contractor Information Performance Information Budget Information
JDAAS
E ONLY
Seniors Minorities Units Project MATCH
ToBe To Be Of
Prc► am # Served Served Service Title III Funds Income Cash In-Find Total CRC Codes
Transportation 10 74 7 3,466 one $5,200.00 $578.00 $5,778.00
way trips
L:\AGING SERVICES\Programs\Scopes of Work and Provider Budgets\05-06 WPs&Budgets
07/12/2005
Attachment D
County of Sain!.Bernardino
Department of Agfirg &Adult Services
VENDOR COMPLAINT FORM
Date: Program:
Name of person completing form: Phone #
Address: Phone #
Staff name (if it applies) Phone #
Office Location
Contractor/Vendor.
Has issue been brought to the attention of vendor? (Circle one) YES NO
Do you wish to remain anonymous? (Circle one) YES NO
Issue:
j
i
FACTS:
1
I
Resolution:
f
I
i
Admin Staff Assigned Date Assigned Date Resolved }
DAAS VEND 1 (11/02)
kttacnment rz
INFORMATION SHEET
CONTRACTOR SHALL COMPLETE SECTION I OF THIS FORM AND RETURN TO:
SAN BERNARDINO,COmy
Department of Agindtbbo j4,,qqA Services
Attn: GNTRACTS
SECTION 1: CONTRACTOR INFORMATION
Contractor Name:
Cled, 10. od S hciq)-�w,--I 157�L
Address(including City,State and Zip Code): Phone:
56 P
() e
_)Dy
_ 3005 P
Calon 2)+. Od
Web Site: 1-1 Email: Fax:
Site Name for Senices(IfDifferentfrom Contractor):
Address(including Cit},State and Zip Code), Phone:
q
_q D
Po 80
Web Site Email: Fax:
o
Clinic Contact: Title:
t t'LA- f
k,
Contract Signature Authoritv:
Name: Name:
'j
Title: f"J Title:
Sig latu f Signature:
Pfiaue 5`, E-4Rai V Phone P: E-Mail:
Claim Signature Authority:
Name: Name:
ci n-
Title!
ra'r kv
S'grla re: Signature:
Phone 41: k.nc it: E-Mail:
------------
SECTION 11: DAAS INFORMATION
Contract Mailing Address: Contracts Unit:
San Bernardino Countv Leslie Dunn, Contracts Management
Department of Aging and Adult Services 909-891-3930
Contracts Unit
686 E. Mill Street E-Mail: Ldunn,ii�liss,sb,:ouiitv,,Ll,c)v
San Bernardino, CA 92415-0920 twit Fax#: 909-891-3919
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