SCHOOL READINESS AGREEMENT 2011 - 2012SCHOOL. READINESS AGREEMENT 2011 - 2012
SUMMER SCHOOL AGE CARE
1. PARTIES
1. THIS AGREEMENT is made and entered into this 1s' day of May, 2011, by and
between the Early Leaming Coalition of Pinellas County, Inc., with its principal offices
located at 5735 Rio Vista Drive, Clearwater, Florida 33760 (Hereinafter referred to as
"Coalition") and C i f? o? Of, wa-4(- , with its principal offices located at
too S_ r?l 1 l,r f?vc rcefir wa'1 e"
(hereinafter referred to as the "Provider").
II. TERMS OF THE AGREEMENT
2. This Agreement applies to the School Readiness Program. The Agreement shall
begin on May 1. 2011 or the date on which the Agreement is signed by the last party
required to sign the Agreement, which ever occurs last, and expires upon September
30. 2011. The Coalition is not obli ated to-pay for costs incurred b the Provider
before the Agreement's beginning date or after the ending date.
3. The Provider must complete and sign a new Agreement each subsequent program
year to remain eligible to deliver School Readiness services.
4. The child care services purchased by this Agreement will be provided at the
location(s) shown on page 1 or the approved child care locations for
Administrative/Corporate entities. When moving to another location or adding
locations and services Providers are not eligible for payment until the new or
changed location has been licensed and a new School Readiness Agreement has
been signed by the Provider and the Coalition. A monitoring visit to the new location
is required prior to the execution of a new Agreement.
5. This Agreement shall bind the successors and assignees. If the ownership or
corporate structure of the Provider changes, the current Provider shall notify the
Coalition within 10 calendar days before the change.
6. In addition, whenever a signatory to the executed Agreement changes, a new
Agreement must be executed. The Coalition has reviewed the School Readiness
Provider Application submitted by the Provider and based on the information
submitted, has determined that the Provider is eligible to deliver the School
Readiness program during the time period specified in Paragraph 2 above.
7. Although the Coalition has determined that the Provider is eligible to deliver the
School Readiness program, the Provider understands that the Coalition has an
ongoing duty to verify the Provider's compliance with the Florida Statutes, state
rules, and procedures of the Coalition and the Agency for Workforce Innovation.
SUMMER School Age/City of Clearwater
Agreement 2011/2012
Rev April 2011
c r
i
III. NONDISCRIMINATION
8. The Provider understands that, in accordance with 45 CFR, Part 98.46, the Provider
may not discriminate against a parent or child, including the refusal to admit a child
for enrollment in the SR program, on the ground of race, color, or national origin. See
Attachment 3 paragraph 1.
IV. MAINTENANCE OF RECORDS
9. The Provider agrees to maintain records and documents as follows:
a. Record of payments received from the Coalition or contracted designee and
attendance records of all children who receive scholarships through the Coalition
or other funders; to maintain the sign-in/sign-out sheets with the time of student
drop-off and the time of student pick-up recorded. This must be completed and
signed daily by parent/guardian or other authorized persons. Inaccurate,
incomplete and/or problematic attendance records may result in delay or loss of
payment. Com late parent signatures are required,
b. To ensure that these records are available at all reasonable times for inspection,
review, or audit by the Coalition, State, and Federal personnel and other
personnel duly authorized by the Coalition.
c. To allow public access to all documents, papers, assessments, letters or other
material subject to the provisions of s. 411.011, F.S. and Chapter 119, F.S., and
made or received by the Provider in conjunction with this Agreement.
V. CONFIDENTIALITY AND RETENTION OF RECORDS
110. The Provider agrees to keep all SR records of a child for at least 5 years after the
child's last day of attendance or, to the extent required, in accordance with the
retention schedules and disposal process adopted under section 119.021(2), Florida
Statutes, whichever is greater.
11. The Provider understands that, in accordance with Florida Statutes, records of
children enrolled in the SR program are confidential. The Provider shall keep all SR
records confidential and disclose the records only in accordance with law. The
Provider shall follow s. 411.011, F.S. and the Florida Public Records Act (Chapter
119, Florida Statutes) where applicable and other applicable laws regarding
disclosure of any confidential information received by the State of Florida, the
Agency for Workforce Innovation, or the Coalition.
12. The Provider understands that a parent of a SR child has the right to inspect and
review the individual records of his or her child and obtain a copy of the records. The
child and parent/guardian information should only be shared with the Coalition, a
Child Protection Investigator (CPI), Foster Care and Protective Services staff from
the Department of Children and Families or their contracted designee, or appropriate
law enforcement agencies as well as any other contracted designee. Nothing
contained in this paragraph shall be construed to prevent or preclude a Provider from
Summer School Age 2 of 18
Agreement 201112012
Rev Feb 2011
sharing or disclosing any such information, if such sharing or disclosing of
information is required by Chapter 119, Florida Statutes, or applicable laws.
VI. COMPLIANCE VERIFICATION
13. The Provider shall cooperate with and permit the Coalition, or the Agency for
Workforce Innovation, at any reasonable time, to enter the Provider's SR program
site to verify the Provider's compliance with this Agreement and with the
requirements of the SR program as set forth in the Florida Statutes, state rules,
and Board approved procedures of the Coalition and the Agency for Workforce
Innovation.
14. The Provider shall cooperate and allow the Coalition or the Agency for Workforce
Innovation, to inspect and copy the records maintained by the Provider concerning
the SR program, instructors, directors, and children.
15. The Coalition may require the Provider to submit corrective action plans for
noncompliance under this Agreement as appropriate.
16. The Provider's noncompliance with any term in this Agreement may result in the
Coalition withholding funds.
VII. TERMINATION
17. The Provider and the Coalition may agree to terminate this Agreement by mutual
agreement. Notice of termination must be given, and alternative arrangements for
uninterrupted services shall be made for children enrolled with the Provider in the
SR program, at least 30 calendar days before the termination date.
18. If the Provider withdraws as a provider from the SR program, the Provider must
give notice to the Coalition, and alternative arrangements for uninterrupted
services shall be made for children enrolled with the Provider in the SR program, at
least 30 calendar days before the termination date.
19. If the Provider fails to comply with all terms and conditions of this Agreement and
with all requirements of the SR program as set forth in the Florida Statutes, state
rules, and Board approved procedures of the Coalition and the Agency for
Workforce Innovation, the Coalition shall notify the Provider in writing and develop
a Service Improvement Agreement outlining goals and time frames to achieve
compliance as appropriate. Lack of liability insurance is not subject to a Service
Improvement Agreement.
20. If funds required to finance this Agreement become unavailable, the Coalition may
terminate this Agreement with prior written notice of at least 24 hours before
termination. This Notice of Termination due to lack of funds must be delivered in
person with proof of delivery or by certified mail with return receipt requested. The
Coalition is the final authority as to the availability of funds. In the event of
termination of this Agreement, the Provider shall be paid for the hours completed
through the termination date.
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t
21. Any obligation for payment under this Agreement is contingent upon an annual
appropriation by the Florida Legislature. If the funds upon which this Agreement
depends are withdrawn or redirected, the Agreement is terminated and the
Coalition has no further liability to the Provider beyond payment for the hours of
care provided through the termination date.
Vlll. DISPUTE RESOLUTION
22. The Provider agrees to submit any disputes or disagreements concerning this.
Agreement in writing to the Coalition. The Coalition agrees to respond to the
dispute or disagreement within 10 business days after receiving the dispute or
disagreement. If the Provider is dissatisfied with the response, the Coalition agrees
to allow the Provider to bring the dispute or disagreement before a standing
committee of the Coalition Board.
IX. SEVERABILITY
23. If any provision of this Agreement is held to be unenforceable by a court of
competent jurisdiction, the remaining terms and conditions remain in full force and
effect.
X. AMENDMENTS
24. An amendment will not be made to this Agreement unless the amendment is
provided in writing, and signed by both the Coalition and the Provider.
XI. SUBCONTRACTS
25. The Provider will not enter into subcontracts/agreements/assignments for any of
the work contemplated under this Agreement.
XII. ELECTRONIC COMMUNICATION
26. The Coalition's Prima rv method for communicating with Providers is electronically
(email). The Provider is required to maintain and monitor a working email address
for sending and receiving communications from the Coalition or contracted
designee. Failure to do so will result In termination Qf_this Agreement. This is
of subiect to a Service Improvement reement
XIII. OTHER CHILD CARE SCHOLARSHIP FUNDED PROGRAM'S
27. Providers serving scholarship children from the Teen Parent Program, Refugee
and JWB Low Income Employed Families (LIEF) will be required to comply with the
terms and conditions of the associated funders relating to these scholarship
programs in addition to those conditions contained herein.
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Agreement 2011/2012
Rev Feb 2011
XIV. INDEMNIFICATION
28. The provider is fully liable for the actions of its agents, employees, partners,
contractors, and subcontractors and shall indemnify, defend, and hold harmless
the Coalition, the Agency for Workforce Innovation, and their officers, agents,
employees, contractors, and subcontractors from suits, actions, damages, and
costs of every name and description, including reasonable attorney's fees, arising
from or relating to personal injury and damage to real or personal tangible property
to the extent caused by the Provider, its agents, employees, partners, contractors,
or subcontractors. If the Provider is a county government, municipal government,
public school, or school district, this paragraph is limited to the extent required by
section 768.28, Florida Statutes.
XV. LIABILITY INSURANCE
29. The Provider will maintain Child Care Liability Insurance in the amounts of $500,000
per each occurrence and $1,000,000 for general aggregate for the term of this
Agreement and will ensure the Coalition has a current "Certificate of Insurance with
a ten 10 day notice to the Coalition' throughout the year.
Without adequate liability Insurance, this Agreement will be canceled.
See
This Is not applicable to ovemment administered Programs.
Attachment 4
XVI. COUNTERTERRORISM COMPLIANCE
30. The Provider certifies that the program is not on any federal terrorism "watch lists,"
and that it does not, will not and has not knowingly provided financial, technical, in-
kind or other material support or resources to any individual or entity that is a
terrorist or terrorist organization, or that supports or funds terrorism.
The following websites can be accessed to determine if an individual or
organization is on such a list:
a. The Treasury Department's "master list" of specially designated nationals
and blocked persons: htt ://www.treas. o /officer,/enforcementlofactsdn/.
b. The State Department's list of foreign terrorist organizations:
httr):www.state.oov/s/ct/c4291.htm.
c. The list of persons and entities designated under Executive Order 13224:
htt ://www.treas. ov/offices/enforce ent/ofac/s c ionsttl lter. df.
XVII. SANCTIONS
31. Failure to comply with the requirements listed within this Agreement may result in
sanctions as published in the Coalition's "School Readiness Compliance Policy
for Child Care Centers and Licensed Family Child Care Homes Providers"
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Agreement 2011/2012
Rev Feb 2011
developed and approved by the Coalition. Said policies can be found at
www,elcpinellas.net.
The level of sanction may include but are not limited to; verbal warning,
suspension of payment, rate reduction (if Gold Seal), notification of parents or
termination of this Agreement resulting In discontinuance of funding for School
Readiness services or other sanctions as approved by the Coalition.
XVIII. REPORTING CHILD ABUSE
32. As a mandated reporter, child care Providers must immediately report any known
or suspected abuse or neglect to the Abuse Hotline (1-800-962-2873) via the
Child Abuse Registry. This should also be reported to the Coalition as an Incident
Report after notification to proper authorities.
XIX. RILYA WILSON ACT
33. Not applicable for school age care.
XX. REPORTING INCIDENTS
34. The Provider will be responsible for reporting unusual incidents (i.e. incidents that
involve the Provider, parents, or children and may cause negative public reaction
against the Provider, Coalition or contracted designee or other funders within one
(1) hour of learning of the incident and to submit a written report on Coalition
forms within three (3) workdays. Incident reports can be faxed to the Coalition at
727-548-1509 attention Lisa Zawistowski or emailed to
Izawistowski@elcpinellas.net. Email is preferred.
XXI. MONITORING AND REPORTING
35. The Provider will furnish reports, as requested by the Coalition or contracted
designee, Including all reporting required for monthly reimbursement and
attendance monitoring as outlined in the School Readiness Provider Manual.
(can be found on the Coalition website www.elcpinellas.net.)
36. The Provider will cooperate and allow access to staff of the Coalition and/or their
authorized designee, AWI or other funders to conduct unannounced monitoring of
the summer SR program.
37. The Provider must provide access to whatever applicable information (i.e.
children's records, parent sign intout sheets, attendance rosters) is necessary to
facilitate this monitoring.
38. The Provider agrees to supply, upon request, relevant financial information as
requested by the AWI/Coalition or contracted designee for the purpose of justifying
present or future reimbursement rates. However, when funding allows, rate
justification may be based on the market rate survey in each district, county, or
neighborhood, the maximum allowable rate, and the Provider's published rates for
the general public.
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Agreement 2011/2012
Rev Feb 2011
XXI. NOTICE OF CONTACT
39. The representative for the Coalition for this Agreement is Lisa Zawistowski who
can be contacted at the Early Learning Coalition of Pinellas County, Inc. 5735
Rio Vista Drive, Clearwater, FL 33760, telephone 727-548-1439, email
Izawistowski elc inellas.net.
The representative of the Provider responsible for the administration of the
program under this Agreement is:
Name A 4La hrZo,
Address O & [ l -ear L z F
Telephone 72- 7- 7 z. 9 Z ys
Email u4G . I??er , a l a r
In the event that either party designates different representatives after execution of
this Agreement, notice of the name and address of the new representative will be
rendered via electronic email to the other party and said notification attached to
originals of this Agreement.
XXIII. TERMS AND CONDITIONS
40. This Agreement constitutes the only Agreement, and supersedes all prior
Agreements and understandings both written and oral, among the parties with
respect to the subject matter hereof. All Attachments hereto are a material part of
this Agreement and are incorporated by reference. This Agreement, including any
Attachments hereto, may not be amended or modified, except in writing and signed
by all parties to this Agreement.
XXIV. COMMITMENT OF INTENT
41. It is understood that by signing this Agreement, the Provider acknowledges
awareness of the importance of quality care and education; and affirms that it will
provide a developmentally appropriate School Readiness program for all children
entrusted to care.
42. The failure of the Coalition to exercise any of its rights or to enforce any of the
provisions of this Agreement on any occasion shall not be a waiver of such right or
provision, nor affect the Coalition's rights thereafter to enforce each and every
provision of this Agreement.
43. This Agreement will be binding on the parties and their respective successors and
assigns. This Agreement may not be assigned by the Provider unless it obtains the
Coalition's prior written consent.
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Agreement 2011/2012
Rev Feb 2011
44. The parties each acknowledge that it is acting as an independent contractor.
Neither party, nor any of their respective representatives, employees or agents
shall be construed to be the agent, employee, servant or representative of the
other, and neither party shall have the power and authority to act on behalf of or
bind the other party.
45. The parties acknowledge that this contract shall be construed and enforced in
accordance with the laws of the State of Florida. The parties further agree that any
litigation brought arising out of this contract will be brought in Pinellas County,
Florida, and not in any other state or county. In the event of any litigation arising
out of this contract then the prevailing party shall be entitled to reasonable attorney
fees and costs, including those on appeal.
46. This Agreement may be executed in counterparts, each of which shall be deemed
an original, but all of which shall constitute one and same instrument. Faxed
signatures shall be deemed to be originals and effective to bind the party who's
authorized representative signs below.
IN WITNESS THEREOF, the parties have caused this 18 page Agreement including
accompanying Attachments 1, 2, 3 and 4 to be executed by their undersigned officials as
duly authorized.
EARLYYLL A?RNING COALITION of
PINE S COUNJY,.INC.
Provider
Signature
Janet Chapman
Print Name
See attached signature age.
Authorized Signature
Print Name
Executive Director
Tit e
Date
Summer School Age
Agreement 201112012
Rev Feb 2011
Title
Date
Federal Identification Number
8of18
Countersigned:
Frank V. Hibbard
Mayor
Approved as to form:
ly?
Laura Lipowski Mahony 61
Assistant City Attorney
CITY OF CLEARWATER, FLORIDA
1 cep
By: ta& 4?L4
William B. Horne, II
City Manager
Attest:
'04-0
Rosemarie Call
City Clerk
OF r/I,,C?
vim- /
cl,
ATTACHMENT 1
MANNER AND SCOPE OF SERVICES
1. To provide quality education and care services in Pinellas County, Florida for children
of families who meet the eligibility and enrollment requirements of the Coalition, and
other funders and whose parents/guardians have chosen their facility.
2. All Child Care Centers and School Age Programs: To maintain availability of a
minimum of ten (10) hours of child care service five (5) days per week. Before and
after school programs do not have to meet the ten (10) hours per day requirement
when school is in session. Exception may be given to specified programs meeting
the needs of specified families. Any program needing such exceptions must be
approved in writing by the Coalition. Holidays and staff development days are
allowed up to 12 days per year and prorated to 3 a year for summer programs.
3. The Provider must utilize a curriculum or schedule of daily events approved by the
Coalition.
4. Character Development Program: The Provider must identify, and implement an
approved character development program. Such program must be approved by the
Coalition (411.01 (5)(c)2.b, Florida Statutes).
5. Program Assessment: The Provider is required to participate in the Program
Assessment Process and to correct all identified deficiencies In order to remain in
compliance with this Agreement. The Coalition will provide technical assistance to
assist with required improvements (411.01(4xd)8., Florida Statutes).
6. Parental access and family involvement: The Provider must allow parents or
guardians unlimited access to their children in the School Readiness Program.
Parents and families must be provided with information and activities that involve
them in decisions about their child's growth and development.
7. Professional Development Requirements: The Provider must meet all training and
education requirements and participate in the professional development registry.
a. Completion of twenty (20) hours of in-service training during July 1, 2011 and June
30, 2012 year. Training must include at least four of the seven competency areas.
• Health, Safety, and Nutrition
• Child Development and Learning
• Building Family and Community Relationships
• Teaching and Learning Environments and Interactions
• Curriculum
• Observing, Documenting, Screening, and Assessing to Support Young
Children and Their Families
• Professionalism
Summer School Age Providers do not need to meet the 20 hours but must show
documentation of training for staff.
Summer School Age 9 of 18
Agreement 2011/2012
Rev Feb 2011
b. Providers that serve school-age children must ensure staff that work with school
age children complete Coalition approved training on "Brain Research for School-
age Children". Summer school age providers may apply for an exemption.
c. Training hours may be pro rated if the duration of this Agreement is less than (12)
months.
8. Health and Safety requirements: The Provider must meet and maintain state and
local health and safety requirements in accordance with federal, state, and local
requirements, statute, and rules. The Provider must adhere to all pertinent state and
local health and safety requirements, including Level 2 Background Screening,
prevention and control of infectious diseases, childhood immunizations, building and
physical premises safety, and minimum health and safety training. Section
411.01(5)(c)2.f., Florida Statutes, requires all federally-funded School Readiness
programs to provide a "healthy and safe environment." To implement this
requirement, the Coalition is required to adopt local health and safety requirements
that may meet but not exceed state and local licensing standards. This requirement
is applicable to all School Readiness Providers, including unlicensed or license-
exempt providers.
Refer to Coalition "School Readiness Compliance Policy for Child Care Centers
and Licensed Family Child Care Homes"
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ATTACHMENT 2
REIMBURSEMENT AND PAYMENT
1. Reimbursement for School Readiness services will be based upon a proposed
rate per child per day, but will not exceed the maximum Coalition approved rate
or the Provider's current published rate schedule for the general public,
whichever is lower.
2. Reimbursement for School Readiness services will be conducted by the Coalition
or contracted designee. Programs that have obtained Gold Seal status and
submitted appropriate documentation to the Coalition are eligible for up to 20%
higher differential rate, as funding and funder policy allows. Published rates must
be supported by the actual rate charged to the general public or full fee-paying
families.
3. The Provider is required to utilize the Electronic Funds Transfer (EFT) system for
direct deposit for reimbursement of all funds within the dates and manner
prescribed by funders.
4. The Coalition or designee shall notify the Provider in writing of any financial
penalties. The Coalition or designee may deduct the amount of the penalty from
invoices submitted by the Provider.
5. The Provider agrees to return any disallowed funds pursuant to the terms of this
Agreement that were disbursed to the Provider as applicable. Such funds are
considered funds belonging to the funder and will be remitted to the Coalition or
contracted designee upon request in accordance with its instructions. The
Coalition or contracted designee reserves the right to withdraw funds through
reverse Electronic Fund Transfer (EFT) within five (5) days if overpayment of any
type is made. In the event reverse EFT is needed to recover disallowed funds,
every effort will be made to contact the Provider prior to withdrawal of funds.
6. Should a Provider increase the rates/fees charged to parents/guardians, the
parent/guardian must be given a minimum of thirty-day (30) notification during
which time the parent/guardian may choose to keep their child in care or make
other arrangements for the care of their child.
7. The Provider agrees to comply with all terms and conditions contained in the
School Readiness Provider Manual and that if at any time during the agreement
period is found to be out of compliance with any of the requirements stated
within, reimbursement for services provided may not be allowed. A copy of this
manual can be accessed on ELC's website www_elcpinelles.net.
8. The Provider is responsible for complying with policies and procedures related to
eligibility determination, redetermination, termination, parent fees, process for
notification of any changes related to eligibility per the Coalition and other funder
requirements. Payment will be made only for those services specified In this
Agreement as authorized by the Coalition or other funders for families who have
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Agreement 2011/2012
Rev Feb 2011
been properly certified as eligible and authorized in advance. No payment can be
made for those families who have been determined ineligible. It Is the Provider's
responsibility to help ensure families have the proper eligibility documentation or
certification prior to enrollment.
9. PARENT FEES
a. The Provider will collect parent fees assessed in compliance with the
Coalition and other funder current regulations. The provider reimbursement
claimed under this Agreement will be reduced by the assessed amount (See
"School Readiness Provider Manual" for further requirements regarding
parent fees.)
b. The Provider will comply with all requirements related to the assessment and
non-payment of parent fees as described in the "School Readiness Provider
Manual".
c. The Provider agrees to obtain a signed provider/parent rate/fee agreement
for all families, private as well as those receiving a child care scholarship.
d. The Provider agrees to make a copy of this agreement available to Coalition
staff upon request. These forms may be monitored by Coalition personnel
when making site visits.
10. REPAYMENT OF FUNDS
a. Upon the Coalition's final determination of overpayments or disallowed costs
under federal or state law, regulation or rule, the Provider shall return any
overpayments or disallowed costs within 30 calendar days of issuance of written
notice by the Coalition or contracted designee. Should repayment not be made
in a timely manner, the Coalition or contracted designee shall be entitled to
charge a lawful rate of interest on the outstanding balance.
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ATTACHMENT 3
GENERAL ASSURANCE CERTIFICATION
The Coalition will not award a grant where the Provider has failed to accept the
Assurances and Certifications contained in this section. In performing its responsibilities
under the Agreement, the Provider hereby certifies and assures that it will fully comply
with the following if applicable:
a. Nondiscrimination & Egual Oppodunity Assurance 29 CFR Part 37 an 45
CFR Part 801
b. Debarment and Suspension Certification 29 CFR Part 98 and 45 CFR Part
c. Dru -free Workplace Certification 29 CFR Sub Pa 98 and 45 CFR Part 82,
29 CFR 94, and Subpart B Part 82)
d. Certification Re rdin Public Entity Crimes section 287.133 Florida
Statutes
e. Departments of Labor. Health and Human Services and Education and
Related encies Appropriations of 1995 section 507, P.L. 103-333
f. TrafFckina Victims Protection Act of 2000, as amended (section 106 (sa) and
(22 U.S.C. 7104)
g. Pro-Children Act of 1994 art C P.L. 1 3-227
h. Federal Child Care Development Funds Laws 45 Code of Federal
Re ulations 98):
hftp:/ANww.access.noo.gov/nara/cfrtwaisidx 02/45cfr98 02.html
i. Coalition Plan and Board a roved policies (www.elcolnellas,
J. Clean Air And Water Act
By signing the Agreement, the Provider is providing the above Assurances and
Certifications as detailed below,
1. NONDISCRIMINATION & EQUAL OPPORTUNITY ASSURANCE
The Provider will comply with all Federal statutes relating to nondiscrimination. These
include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352)
which prohibits discrimination on the basis of race, color, or national origin; (b) Title IX of
the Education Amendments of 1972, as amended (20 U.S.C. 1681-1683, and 1685-1686
to include discrimination based on sex/gander), which prohibits discrimination on the
basis of disabilities; (c) section 504 of the Rehabilitation Act of 1973, as amended (29
U.S.C. 794), which prohibits discrimination on the basis of handicaps; (d) the Age
Discrimination Act of 1975, as amended (42 U.S.C. 6101-6107), which prohibits
discrimination on the basis of age; (e) sections 523 and 527 of the Public Health Service
Act of 1912 (42U.S.C. 290 dd.3 and 290 ee-3), as amended, relating to confidentiality of
alcohol and drug abuse patient records; (f) Title VIII of the Civil Rights Act of 1968 (42
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Agreement 2011/2012
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U.S.C. 3601 at seq.), as amended, relating to nondiscrimination in the sale, rental, or
financing of housing; (g) any other nondiscrimination provisions in the specific statute(s)
under which application for Federal assistance is being made; and (h) Title VI of the Civil
Rights Act of 1964 as amended, 42 U.S.C. 2000d at seq. , which prohibits
discrimination on the basis of race, color or national origin (i) the requirements of any
other non-discrimination statute(s) which may apply to the application.
a. The Provider will comply with the provisions of the Hatch Act (5 U.S.C. 1501-
1508 and 7328) which limit the political activities of employees whose principal
employment activities are funded in whole or in part with Federal funds.
b. The Provider will comply, as applicable, with the provisions of the Davis-Bacon
Act (40 U.S.C. 276a to 2760), the Copeland Act (40 U.S.C. 276c and 18 U.S.C.
874), and the Contract Work Hours and Safety Standards Act (40.327-333)
regarding labor standards for federally assisted construction sub agreements.
c. The Provider will cause to be performed the required financial and compliance
audits in accordance with the Single Audit Act Amendments of 1996 and OMB
Circular No. A-133, "Audits of States, Local Governments, and Non-Profit
Organizations."
d. The Provider will comply with Executive Order (EO) No. 11246, Equal
Employment Opportunity, as amended by EO No.11375, and as supplemented
in Department of Labor regulation 29 CFR parts 33 and 37 as well as 41 CFR
part 60 and 45 CFR part 80 if applicable.
e. The Provider will comply with all applicable requirements of all other Federal
laws, executive order, regulations and policies governing this program.
2. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS - PRIMARY COVERED TRANSACTION.
The Provider, through the duly appointed undersigned representative, certifies to the
best of its knowledge and belief, that it and its principals:
a. Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by any Federal
Department or the Coalition;
b. Have not, within a three-year period preceding the Agreement, been convicted or
had a civil judgment rendered against them for commission of fraud or a criminal
offense in connection with obtaining, attempting to obtain, or performing a public
(Federal, State, or local) transaction or contract under a public transaction;
violation of Federal or State antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
c. Are not presently indicted or otherwise criminally or civilly charged by a
government entity (Federal, State or local) with commission of any of the
offenses enumerated in paragraph B.2. of this certification; and/or
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d. Have not, within a three-year period preceding the Agreement, had one or more
public transactions (Federal, State, or local) terminated for cause of default.
Where the Provider is unable to certify to any of the statements in this certification,
such prospective PROVIDER shall attach an explanation to the Agreement.
3. CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS.
Pursuant to the Drug-Free Workplace Act of 1988 and its implementing regulations
codified at 29 CFR 98, Subpart F., the Provider, through the duly appointed undersigned
representative, attests and certifies that the Provider will provide a drug-free workplace
by the following actions.
a. Publishing a statement notifying employees that the unlawful manufacture,
distribution, dispensing, possession or use of a controlled substance is
prohibited in the Provider's workplace and specifying the actions that will be
taken against employees for violation of such prohibition.
b. Establishing an ongoing drug-free awareness program to inform employees
concerning:
• The dangers of drug abuse in the workplace.
• The policy of maintaining a drug-free workplace.
• Any available drug counseling, rehabilitation and employee
assistance programs.
• The penalties that may be imposed upon employees for drug
abuse violations occurring in the workplace.
c. Making it a requirement that each employee to be engaged in the
performance of the Agreement be given a copy of the statement required by
paragraph 1.
d. Notifying the employee in the statement required by paragraph 1 that, as a
condition of employment under the Agreement, the employee will:
• Abide by the terms of the statement.
• Notify the employer, in writing, of his or her conviction for a
violation of a criminal drug statute occurring in the workplace no
later than five (5) calendar days after such conviction.
e. Notifying the Coalition in writing ten (10) calendar days after receiving notice
under subparagraph 5.b. from an employee or otherwise receiving actual
notice of such conviction. Provide such notice of convicted employees,
including position title, to every Grant officer on whose Grant activity the
convicted employee was working. The notice shall include the identification
number(s) of each affected Grant(s).
f. Taking one of the following actions, within thirty (30) calendar days of
receiving notice under subparagraph 4.b., with respect to any employee who
is so convicted.
• Taking appropriate personnel action against such an employee,
up to and including termination, consistent with the requirements
of the Rehabilitation Act of 1973, as amended.
• Requiring such employee to participate satisfactorily in a drug
abuse assistance or rehabilitation program approved for such
Summer School Age 15 of 18
Agreement 201112012
Rev Feb 2011
purposes by a Federal, State or local, health, law enforcement,
or other appropriate Provider.
g. Making a good faith effort to continue to maintain a drug-free workplace
through implementation of this entire certification.
The following are the sites for the performance of work done in connection with the
specific Agreement including street address, city, county, state, and zip code:
work address of Provider.
Check ( ) if there are workplaces on file that are not identified here.
Check) if an additional page was required for the listing of the workplaces.
The Provider will inform the Coalition or designee of any changes relevant to the
provisions of this section.
4. TRAFFICKING VICTIMS PROTECTION ACT OF 2000
In accordance with the Terms and Conditions of the Health and Human Services
Administration for Children and Families Child Care and Development Fund, the
Provider shall comply with section 106(g) of the Trafficking Victims Protection Act of
2000. In each Provider award (i.e., grant or cooperative agreement) under which
funding is provided to a private entity, section 106(g) of the Trafficking Victims Protection
Act of 2000, as amended, requires the Provider to include a condition that authorizes the
Provider to terminate the award, without penalty, if the recipient or a sub recipient (a)
Engages in severe forms of trafficking in persons during the period of time that the
award is in effect; (b) Procures a commercial sex act during the period of time that the
award is in effect; or (c) Uses forced labor in the performance of the award or sub
awards under the award.
5. PRO-CHILDREN ACT OF 1994
The Contractor agrees to comply with the Pro-Children Act of 1994, 20 U.S.C. 6083.
Failure to comply with the provisions of the law may result in the imposition of civil
monetary penalty up to $1,000 for each violation and/or the imposition of an
administrative compliance order on the responsible entity. This clause is applicable to all
approved sub-contracts. The Contractor shall comply with Public Law 103-277, which
requires that smoking not be permitted in any portion of any indoor facility used for the
provision of federally funded services including health, day care, early childhood
development, education or library services on a routine or regular basis, to children up to
age 18.
6. CLEAN AIR AND WATER ACT
The Provider will comply with environmental standards which may be prescribed
pursuant to the following: (a) Institution of environmental quality control measures under
the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO)
11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of
wetlands pursuant to EO 11990; (d) evaluation of flood hazards in flood plains in
accordance with EO 11988; (e) assurance of project consistency with the approved
State management program developed under the Coastal Zone Management Act of
1972 (16 U.S.C. 1451 et. seq.); (f) conformity of Federal actions to State (Clear Air)
Implementation Plans under section 176(c) of the Clear Air Act of 1955, as amended (42
Summer School Age 16 of 18
Agreement 2011/2012
Rev Feb 2011
U.S.C. 7401 et seq.); (g) protection of underground sources of drinking water under the
Safe Drinking Water Act of 1974, as amended, (P.L. 93-523); and (h) protection of
endangered species under the Endangered Species Act of 1973, as amended, (P.L. 93-
205).
7. AMERICANS WITH DISABILITIES ACT
The American with Disabilities Act of 1990, P.L. 101-336, which prohibits discrimination
on the basis of disability and requires reasonable accommodation for persons with
disabilities.
The American with Disabilities Act of 1990, P.L. 101-336, prohibits discrimination in all
employment practices, including job application procedures, hiring, firing, advancement,
compensation, training, and other terms, conditions, and privileges of employment. It
applies to recruitment, advertising, tenure, layoff, leave, fringe benefits, and all other
employment related activities.
8. WORKFROCE INVESTIMENT ACT
Section 188 of the Workforce Investment Act of 1998 (WIA), 29 U.S.C. 2801 at seq.,
which prohibits discrimination against all individuals in the United States on the basis of
race, color, religion, sex, national origin, age, disability, political affiliation, or belief, and,
for beneficiaries only, on the basis of citizenship/status as a lawfully admitted immigrant
authorized to work in the United States or participation in any WIA Title 1-financially
assisted program or activity. Applicable to USDOL-financially assisted programs under
WIA. See 29 CFR part 37.
By signing below, the Provider, through the duly appointed undersigned representative,
certifies and assures that it will fully comply with the applicable assurances outlined in
parts A through J, above.
3. 1" -u- _ :5/2,z
Name and Title of Authorized Representative Date
-17
Print Name
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Summer School Age 17 of 18
Agreement 2011/2012
Rev Feb 2011
ATTACHMENT 4
Government Entities and Insurance
LIABILITY INSURANCE
The provider Is a state agency or subdivision as defined by section 768.28, F.S., and
the provider accepts responsibility for identifying and determining the type(s) and
extent of liability insurance necessary to provide reasonable financial protections for
the provider and the clients to be served under this Agreement. Upon executive of
this Agreement, the provider shall furnish the Coalition written verification supporting
existence of such insurance coverage. Such coverage may be provided by a self-
insurance program established and operating under the laws of the State of Florida.
The remainder of this page was left intentionally blank.
Summer School Age 18 of 18
Agreement 201112012
Rev Feb 2011
CITY OF CLEARWATER- CAMP CHAKA II
N. GREENWOOD REC CENTER
900 N MLK JR AVE
CLEARWATER, FL 33755
CITY OF CLEARWATER- CAMP FUN IN THE SUN
THE LONG CENTER
1501 N BELCHER RD
CLEARWATER, FL 33765
CITY OF CLEARWATER- COUNTRYSIDE REC
COUNTRYSIDE REC
2640 SABAL SPRINGS DR
CLEARWATER, FL 33761
CITY OF CLEARWATER- N GREENWOOD REC
N. GREENWOOD REC CENTER
900 N MLK JR AVE
CLEARWATER, FL 33755
CITY OF CLEARWATER- ROSS NORTON REC
ROSS NORTON REC
1426 S MLK JR AVE
CLEARWATER, FL 33756
CITY OF CLEARWATER- SCIENCE AND NATURE CAMP
MOCCASIN LAKE NATURE PARK
2750 PARK TRAIL LN
CLEARWATER, FL 33759
CITY OF CLEARWATER- THE LONG CENTER
THE LONG CENTER
1501 N BELCHER RD
CLEARWATER, FL 33765