PROVIDE HEALTH CARE SERVICES FOR THOSE IN NEED
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AGREEMENT
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This Funds Agreement is made and entered into this J q day of ~ between
the City of Clearwater, hereinafter referred to as the aty, and G~MMUNITY
HEALTH RESOURCE CENTER hereinafter referred to as the Agency.
WHEREAS, it has been determined to be highly desirable and socially responsible to provide
health care services to those who would not otherwise have health care services; and
WHEREAS, the City desires to help those in need of health care services by providing funding for
such services; and
WHEREAS, the Agency provides health care services and operates in the City;
NOW, THEREFORE, the parties agree as follows:
ARTICLE I. TERM
The term of this agreement shall be for a period of 12 months commencing on the 1st day
of October, 1997, and continuing through the 30th day of September, 1998, (the
Tennination Date), unless earlier terminated under the terms of this agreement.
ARTICLE ll. RESPONSffiILITIES OF THE AGENCY
1. Services to be Provided. The Agency shall provide health care services in accordance
with the proposal submitted by the Agency and approved by the City, which is incorporated
herein by reference.
2. Area to be Served. Services rendered through this agreement shall be provided within
the corporate limits of the City as it now exists and as its boundaries may be changed during
the term of this agreement.
3. Scheduled Reports of Agency Activities. The Agency shall furnish the City Human
Relations Department, Grants Coordinator, with an annual report of activities conducted
under the provisions of this agreement within sixty days, of the end of the Agency's fiscal
year. Each report is to identify the number of clients served, the costs of such service, and
commentary on the viability, effectiveness, and trends affecting the program.
4. Use and Disposition of .Funds Received. Funds received by the Agency from the City
shall be used to pay for health care services. Funds existing and not used for this purpose at
the end of the term of this agreement term shall be deemed excess to the intended purpose
and shall be returned to the City.
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5. Creation, Use and Maintenance of Financial Records.
a. Creation of Records. Agency shall create, maintain and make accessible to
authorized City representatives such financial and accounting records, books,
documents, policies, practices, and procedures necessary to reflect fully the financial
activities of the Agency. Such records shall be available and accessible at all times
for inspection, review, or audit by authorized City personnel.
b. Use of Records. Agency shall produce such reports and analyses that may be
required by the City and other duly authorized agencies to document the proper and
prudent stewardship and use of the monies received through this agreement.
c. Maintenance of Records. All records created hereby are to be retained and
maintained for a period not less than five (5) years from the termination of this
agreement.
6. Non-discrimination. Notwithstanding any other provision of this agreement, during the
term of this agreement, the Agency for itself, agents and representatives, as part of the
consideration for this agreement, does covenant and agree that:
a. No Exclusion from Use. No person shall be excluded from participation in,
. denied the benefits of, or otherwise be subjected to discrimination in the operation
of this program on the grounds of race, color, religion, sex, handicap, age, or
national origin.
b. No Exclusion from Hire. In the management, operation, or provision of the
program activities authoFized and enabled by this agreement, no person shall be
excluded from participation in or denied the benefits of or otherwise be subject to
discrimination on the grounds of, or otherwise be subjected to discrimination on the
grounds of race, color, religion, sex, handicap,age, or national origin.
c. Inclusion in Subcontracts. The Agency agrees to include the requirement to
adhere to Title VI and Title VII of the Civil Rights Act of 1964 in all approved sub-
contracts.
d. Breach of Nondiscrimination Covenants. In the event of conclusive evidence
of a breach of any of the above non-discrimination covenants, the City shall have
the right to terminate this agreement.
7. Liability and Indemnification. The Agency shall act as an independent contractor and
agrees to assume all risks of providing the program activities and services herein agreed and
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all liability therefore, and shall defend, indemnify, and hold harmless the City, its officers,
agents, and employees from and against any and all claims of loss, liability, and damages of
whatever nature, to persons and property, including, without limiting the generality of the
foregoing, death of any person and loss of the use of any property, except claims arising
from the negligence or willful misconduct of the City or City1s agents or employees. This
includes, but is not limited to, matters arising out of or claimed to have been caused by or
in any manner related to the Agency's activities or those of any approved or unapproved
invitee, contractor, subcontractor, or other person approved, authorized, or permitted by the
Agency in or about its premises whether or not based on negligence.
ARTICLE ID. RFSPONSffiILITIES OF THE CITY
1. Grant of Funds. The City agrees to provide a total grant of $6,920.00 to fund the
program in accordance with this agreement. .
2. Payments. The total amount requested will be paid by the City to the Agency within 30
days after execution of this agreement by the City and the Agency but no earlier than
October 1 of the budget year for which the funds are authorized.
ARTICLE IV. DISCLAIMER OF WARRANTIFS
This Agreement constitutes the entire Agreement of the parties on the subject hereof and
may not be changed, modified or discharged except by written Amendment duly executed
by both parties. No representations or warranties by either party shall be binding unless
expressed herein or in a duly executed Amendment hereof.
ARTICLE V. TERMINATION
1. For Cause. Failure to adhere to any of the provisions of this agreement in material
respect shall constitute cause for termination. This agreement may be terminated with 30
day notice.
2. Disposition of Fund Monies. In the event of termination for any reason, monies made
available to the Agency but not expended in accordance with this agreement shall be
returned to the City.
ARTICLE VI. NOTICE
Any notice required or permitted to be given by the provisions of this agreement shall be
conclusively deemed to have been received by a party hereto on the date it is hand-delivered
to such party at the address indicated below (or at such other address as such party shall
specify to the other party in writing), or if sent by registered or certified mail (postage
prepaid), on the fifth (5th) business day after the day on which such notice is mailed and
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properly addressed.
l.~to: ~~~
1 tn:>/ ""n, ~ .
a.~ a., -;;... () ~"L \ 4- -:J--
0~-o-J!hAA~~ 35;zs'~
2. If ~~dd;~s;edto: . / Grants Coordinator
Human Relations Department
P.O. Box 4748
Clearwater, FL 34618-4748
ARTICLE VII. EFFECTIVE DATE
The effective date of this agreement shall be as of the first day of October, 1997.
IN WITNESS WHEREOF, the parties hereto have set their hands and seals this
,qPaay of ~..... , 1997.
CITY OF CLEARWATER, FLORIDA
By:
City Manager
Approved as to form and legal sufficiency:
Attest:
~c ~
John Carassas, Assistant City Attorney
r,~ :>.,Li.. ,fJ.n~_
Cy a E. G()t(dfau, CltyClerk
Witnesses as to Agency:
~S"~
~u(/~
By:
President
Attest:
?I~tA:Z~~c/
~~ A' -c-r/9,/C/
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CITY OF CLEARWATER
SOC~ SERVICES GRANT
PROJECT APPLICATION FORM
Phone:
(813) 562-4060 for assistance
Due: May 29, 1997
A. Application Information
Will~ Carson- Chairman
Applicant:
(Sponsor/Developer)
Organization Name:
(If different)
Greenwood Community Health
Resource Center
Bldg. 22 Apts. 1&2
1001 Greenwood Ave. Bldg. 2201
Address:
City; State; Zip
Clearwater, Fl 34615
Telephone Number:
None at this writing
Contact Person:
Willa Carson
Title:
Chairman, Board of Directors
Telephone Number:
(813) 447-6993
Period for which funds
are being requested:
October 1, 1997 - Sept. 30, 1998
Sig~atur;;;dj~r(: ~
~)~/s. f!.~
Board of D~rectors Chairperson
Date d- - cJ 7 - '17
NOTE :
The city of Clearwater reserves the right to fund applicants at a
level lower than requested.
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B. Activity (Check One)
Adult Crime
Child Abuse
Elderly
Hunger
Juvenile Crime
Physical Illness
~..-
Parenting
Adolescents
Substance Abuse
Unsupervised
Children
Youth Development
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Other
(Describe Below)
x
Elderly and Citizens in the Greenwood
Community.
This health facility is badly needed in the Greenwood area. The elderly
and the sickly children can walk to the clinic for service. Should a patient
need immediate service, we will then be in a position to secure additional
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services for the patient. The facility will offer Blood Pressure checks,
Sickle Cell Anemia checks, and many other clinical services that will be
needed. We will have doctors on duty in the evening to carry out details
a nurse cannot do. Also, the Health Mobile will be at the facility one d~
a week for about~ hours.
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C. AMOUNT OF FUNDING CURRENTLY REQUESTED:
(Not to exceed $10,000)
$8,500.00 . .
D. SPECIFICALLY FOR WHAT WILL THIS MONEY BE USED.
(Line item budget for this amount)
1. Rent
2. Electricity
3. Telephone
4. Medical Supplies
5. Books for counselin2 & teaching
6. Misc. services that we will nppn RA 'lJp C:PT"P nllT I'li9UtlO
E. BRIEF DESCRIPTION OF PROJECT YOU WISH TO FUND UTILIZING THIS
GRANT.
The project is the Greenwood Community Henlth RpRnllrrp r.Ant9r Wg UQQd
additional funds for the daily oneration. he~nll~p it iQ R ~r~.. ~liuic
No salary is paid to anyone, All services are nnnRtprl
F"pryt-h1ng r,yg
have to-date has been ~ratis, inc1udin{1: donations from thp pllhl1r
F. BRIEF DESCRIPTION OF YOUR OVERALL ORGANIZATION.
The composition of the orRanization is:
1. A Board of Directors
2. Community Support Group
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G. NUMBER OF CLIENTS SERVED BY THIS PROGRAM.
The weekly estimated number of adults 125
The weekly estimated number of children 50
H. PERCENTAGE OF THESE CLIENTS WHO .ARE CITIZENS OF cLtARWATER.
99%
I. CURRENT OVERALL ORGANIZATION BUDGET (PLEASE ATTACH) .
$ 21 , 101. 00
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J. IF THIS IS START UP OR MATCHING MONEY, SPECIFY THE DETAILS ie:
WHICH AGENCY OR ORGANIZATION WILL PROVIDE THE MATCH, THE
REQUIREMENTS .AND THE AMOUNT OF THE MATCH.
This program will not have matching funds. All of our funds will come
from grants and other donations from the
Pinellas County.
l K. IS YOUR AGENCY A REGISTERED 501 (C) (3) NON-PROFIT AGENCY OR IN
THE PROCESS OF BECOMING ONE.
We are a 501 (c) 3 agency
L. DOES YOUR FACILITY HAVE OR IS IT IN THE PROCESS OF ACQUIRING
THE APPROPRIATE LICENSURE FOR THE DELIVERY OF THE SERVICES
DESCRIBED IN THIS APPLICATION.
Yes. we have all licences necessary for operation.
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GREENWOOD COMMUNITY HEALTH RESOURCE CENTER INC.,
1001 N. GREENWOOD AVE. BLDG. 22. APT. 1 & 2.
. CLEARWATER, FLORIDA 34615
GREENWOOD COMMUNITY HEALTH RESOURCE CENTER
BUDGET FISCAL YEAR ENDING DECEMBER 31, 1997
MAy-DEcEMBER ( B MONTHS )
ACCT. 1/ T l1LE
INCOME
3610
3690
AMOUNT
INTEREST
FISH FRY
T-SHIRT SALES
GRANTS
CLIENT CONTRIB.
DONATIONS
TOTAL INCOME
EXPENSES
OFFICE EXPENSES
4110 SALARIES
LEGAL
4140 PRINTING/PROMO
4150 TRAINING ~
4170 AUDIT/ACCT.
41BO RENT
4190 SUPPLIES
4190.1 POSTAGE
4190.2 TELEPHONE
4190.3 LONG DISTANCE
4190.4 EDucATIONAL
TOTAL OFFICE EXPENSE
UTILITIls
4310 WATER & SEWER
4320 ELECTRICITY
TOTAL UTILITIES
MAINTANCE
4410 LABOR
4420 MATERIALS
4430 CONTRACTS
TOTAL MAINTANCE
INSURANCE \
4510 INSURANCE-
COMMENTS
50.00
500.00
BOO.OO
B,OOO.OO
1. 500.00
13,251.00
24, 1 01 . 00
MINIMAL INVESTMENTS
IN-KIND
61.00
500.00
1. 000 . 00
1, 500.00
3,120.00
5,000.00
400.00
1. 500 . 00
120.00
1. 700 . 00
14 , 901. 00
ANNUAL RECORDING FEE
SOME DONATIONS
IN-KIND
1,800.00
1. 800 .00
INCLUDED IN RENT
EST. @ 225/MONTH
IN-KIND
600.00
BOO.OO
1. 400.00
INCLUDES ALARM SYSTEM
2,000.00
LIABILITY $500/0FFICIALS
1,500.00