AGREEMENT FOR COMMUNITY OUT OF SCHOOL TIME - COSTAGREEMENT
Between
THE JUVENILE WELFARE BOARD
and
City of Clearwater (AGN274)
Community Out of School Time (COST)
1. PURPOSE
The Juvenile Welfare Board of Pinellas County, hereinafter referred to as "JWB", and City of Clearwater
(AGN274), hereinafter referred to as "Provider", enter into this mutual Agreement, including all attachments
referred to herein, for the period commencing October 1, 2014 and extending tlrough September 30, 244
2015. This Agreement does not take effect and JWB has no responsibility for any of its obligations hereunder
until this Agreement is fully and completely executed by all parties to this Agreement.
IL STAFF
Provider agrees to employ staff, at its expense, to execute services provided in accordance with this Agreement.
Such individuals shall not be considered employees of JWB, and are subject to the supervision, personnel
practices and policies of the Provider. Unless otherwise approved by JWB, all staff shall meet qualifications as
stated in the approved job descriptions on file at JWB and any approved revisions which are submitted for FY
14-15 funding.
SERVICES
Provider agrees to deliver services as stated in the currently approved program methodology on file at JWB and
to accomplish performance measures stated in Attachment 2, as determined by JWB, in service areas stated in
Attachment 3, and pursuant to the General Conditions listed in Attachment 1, and any special conditions as
stated in Section I, subsection VIII of this Agreement.
W. FUNDS
The program budget for both JWB and other funds (if any) for accomplishing the above stated services shall be
as set forth in Attachment 4. JWB agrees to reimburse up to $402,442 for Community Out of School Time
(COST) for services rendered pursuant to this Agreement.
V. METHOD OF PAYMENT
1. JWB issues reimbursements in accordance with the schedule listed on Attachment 5 (or on the preceding
working day in case of a holiday). The Provider shall select to submit a request for payment either every
other week or once a month. Reimbursement Requests shall be submitted timely and only for amounts
that should properly be reimbursed per this Agreement within reasonably needed amounts based on the
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budget and other funding sources. Request for payment must be accompanied by the appropriate
documentation as prescribed by JWB.
2. Requests for advance funds may be made, consistent with JWB policy.
VI. TERMINATION
1. It is the intent of the JWB to assure a consistent and orderly delivery of children's services. It is the
further intent of JWB to terminate Agreements in those situations where such action is essential to
protection of its interests and the interests of children, as determined solely by JWB.
2. In the event funds to finance this Agreement become unavailable, JWB may terminate the Agreement
upon no less than twenty -four (24) hours' notice in writing to the Provider. Said notice shall be delivered
by certified mail, return receipt requested, or in person with proof of delivery.
3. JWB shall endeavor, whenever possible and consistent with its legal obligations and principles of
prudent management to provide thirty (30) days' notice for termination for lack of funds. JWB shall be
the final authority as to the availability of funds and extension of notice beyond the minimum time
herein stated.
4. In addition to the rights as set forth in paragraph VI. 2 above, this Agreement may be terminated by
JWB for any reason whatsoever upon twenty -four (24) hours written notice. Said notice shall be
delivered by certified mail, return receipt requested, or in person with proof of delivery.
5. Provider will only be compensated for services performed prior to the termination date. Provider may
only terminate this Agreement upon thirty (30) days written notice to JWB delivered in person, by
facsimile or by US mail, return receipt requested.
6. The above provisions shall not limit JWB's right to remedies at law or to damages.
VII. COMMENCEMENT OF PAYMENT
Unless specifically authorized by JWB, payment for services rendered under this Agreement shall not
commence prior to the effective date of this Agreement.
VIII. SPECIAL CONDITIONS
The following condition(s) applies to the following program(s):
- -- Community Out of School Time (COST)
PROGSC122- Provider approved COST program shall adhere to JWB quality standards for Out of School Time
programming, develop community partnerships and work with JWB in the planning and implementation of a
quality model for COST program(s).
PROGSC123- Provider approved COST program site shall cooperate with the JWB regarding policies and
procedures related to the delivery of enrichment overlays and incorporate JWB funded enrichment overlays
with the JWB approved quality COST Model Program Components.
PROGSC124- Provider approved COST program site will complete the Florida Afterschool Network Quality
Self- Assessment & Improvement Guide at the beginning of the JWB Fiscal Year and subsequent Program
Improvement Guide as applicable.
PROGSC125 -JWB may report performance information such as, but not limited to: FCAT scores/DSS, GPA, or
school disciplinary information. This data is reported as dashboard, baseline, or pilot information intended to
gain a better understanding of the program's impact on specific community indicators.
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The following condition(s) applies to the following Agency(AGN274):
- -- City of Clearwater
PROVSC10- General Condition #2E - The last sentence is waived: Provider is not required to submit a
Continuity of Operations Plan to JWB.
PROVSC12- General Condition #3 - Audit and Management Letter are waived.
PROVSC14- General Condition #8 - Publicizing of JWB Support- Endorsements is waived.
PROVSC15- General Condition #11 - Confidential Information- The last sentence of paragraph 4 is replaced
with the following: "Provider shall defend, indemnify, and hold harmless JWB from any and all damages
caused by the improper disclosure of any information including, but not limited to, Protected Health
Information under HIPAA and any and all costs associated with remedying the disclosure subject to the doctrine
of sovereign immunity and limitations set forth in F.S. 768.28."
PROVSC25- General Condition #24 - Indemnification is replaced with "The Provider agrees to be fully
responsible for all claims arising out of its own acts of negligence or its respective employees' acts of
negligence when acting within the scope of their employment and agrees to be liable for any damages
proximately caused thereby; provided, however, that the Provider's liability is subject to the monetary
limitations and defenses imposed by section 768.28, F.S. Nothing herein is intended to serve as a waiver of
sovereign immunity by the Provider, nor shall anything herein be construed as consent by the Provider to be
sued by any third party for any cause or matter arising out of or related to this Agreement except to the extent
provided by 768.28, F.S."
PROVSC13- General Condition #6 - Board Members, Meetings, and Financial Review are waived.
PROVSC133- General Condition #23 - All insurance requirements are waived.
PROVSC11- General Condition #2F - Merit Plan is waived.
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IX. SIGNATURES
Executive Director: Juvenile Welfare Board
of Pinellas County
/Weir /9. avvi_b--"44/
9 /i7�i�
See attached city signature page
Authorized Representative, Provider
Please Print or Type Name
Date Date
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09/16/2014 08:26:49 AM
City Signature Page for Agreement between
The Juvenile Welfare Board and
City of Clearwater
Community Out of School Time (COST)
Countersigned:
---"Ct eo rte (\Cr tWes:11
George N. Cretekos
Mayor
Approved as to form:
Laura Lipowski Mahony
Assistant City Attorney
CITY OF CLEARWATER, FLORIDA
By:
Attest:
W.QP,.w,d -4G.4.5'---zr
William B. Horne, II
City Manager
Rosemarie CaII
City Clerk
4
Attachment 1
General Conditions of the Agreement
1. Agreement Revisions
This Agreement, and its attachments constitute the contractual relationship between the Provider and JWB. If
there is any discrepancy between program- related documents, this agreement preempts all other documents. No
amendments to this Agreement or its attachments may be made without the prior written approval of JWB and
Provider, except as may be provided in General Condition #4.
2. Fiscal Responsibility
a. Provider agrees to maintain books, records and documents in accordance with generally accepted
accounting principles and practices which accurately and appropriately reflect all expenditures of funds
listed in Attachment 4.
b. Provider agrees that all financial records and supporting documentation shall be subject at all times to
inspection, review, or audit by JWB personnel or its duly authorized agent.
c. Provider agrees to maintain and file with JWB in a timely fashion reports related to services provided
under this Agreement.
d. Provider agrees to retain all financial records, supporting documentation, statistical records, and any
other documents pertinent to this Agreement for a period of five (5) years after termination of this
Agreement. If an audit has been initiated and audit findings have not been resolved at the end of five (5)
years, all records shall be retained until resolution of audit findings.
e. Payments during Disaster Recovery: JWB agrees to support previously approved funded programs that
are unable to provide normal services for a period of at least sixty (60) days after a disaster has been
declared, provided the program agrees to comply with requests of JWB and the Human Services
Disaster Recovery Leadership Network. This period may be extended at the discretion of the Board
upon recommendation of the Executive Director. Provider must file an insurance and FEMA claim and
will reimburse JWB for any amounts received from FEMA and insurance. The Provider must submit to
JWB a copy of the Provider's Continuity of Operations Plan (see Attachment 6 for an outline of all
document submittals) within thirty (30) days of the effective date of this Agreement.
f. The Provider agrees to provide prior to their budget submission or subsequent amendment, Board
meeting minutes that show explanation and approval of a compensation plan, if JWB funds are to be
utilized to pay merit increases, cost of living adjustments bonuses, incentives or retention payments of
any kind, or if annualized salary or benefit changes may impact future budgets. JWB will not reimburse
more than two weeks of accrued leave for terminating employees. JWB will not reimburse expenses not
previously approved by JWB.
3. Audit and Management Letter
The Provider agrees to submit to JWB an independent audit of the financial statements of the entity in its
entirety and any accompanying management letter(s) immediately upon receipt by the Provider's board, but
within a period not to exceed one hundred and fifty (150) days of the close of the Provider's fiscal year. The
audit must be performed by a firm licensed to perform audits in the State of Florida and conducted in
accordance with generally accepted auditing standards and standards established by the American Institute of
Certified Public Accountants.
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The Provider's auditor shall not provide any non -audit service to an issuer contemporaneously with the audit,
including:
(1) bookkeeping or other services related to the accounting records or financial statements of the audit client;
(2) financial information systems design and implementation; (3) appraisal or valuation services, fairness
opinions, or contribution -in -kind reports; (4) actuarial services; (5) internal audit outsourcing services; (6)
management functions or human resources; (7) broker or dealer, investment adviser, or investment banking
services; (8) legal services and expert services unrelated to the audit. The audit will separately identify JWB
revenues, fees and donations, and expenditures by program.
The Provider is required to engage an audit firm which follows Government Audit Standards when conducting
the financial audit and which shows evidence of a peer review report completed every three years.
4. Other Financial Support
a. Provider will report within ninety (90) calendar days any major changes in non -JWB revenue which
would impact contracted service levels in JWB funded programs during the fiscal year.
b. JWB funds will not be used for expenditures also funded by other sources. JWB funds shall not be used
to supplant other sources of revenue.
c. Generally, JWB encourages use of its funds as financial match for securing funds from other sources.
However, in such instances, Provider is required to obtain prior written approval to submit an
application with JWB committed funds.
d. Revenues earned in a JWB funded program must remain in that program as a condition of funding.
5. Program Monitoring
Provider agrees to submit progress reports and other information in such format and at such times as may be
prescribed by JWB (including JWB Databases, SharePoint and Provider specific data collection systems), and
to cooperate in site visits and other on -site monitoring (including, but not limited to, access to sites, staff, fiscal
and participant records, and logs and the provision of related information). Provider agrees to cooperate with
Monitoring JWB Funded Program policy and procedures. Provider agrees to provide JWB representatives
access, without presence of the Provider supervisor, to staff or program participants during any monitoring with
or without advance notice. Programs charging a fee for services supported by JWB funding must forward a
copy of the fee schedule to JWB. Lead agencies are responsible for monitoring subcontracts funded by JWB
unless otherwise specified in a Special Condition of this Agreement. Governmental entities are exempt from
fiscal and personnel file review.
Program staff will adhere to JWB's Data Business Rules and Fiscal Guidelines for Funded Programs and all
staff who have any responsibility (supervisory or direct) for data entry will be trained within thirty (30) calendar
days of hire. The Provider is responsible for maintaining written policies and procedures for providing data to
JWB in a timely manner. The Provider is responsible for reviewing JWB Database and JWB SharePoint User
Access to ensure that all users are active employees with access to appropriate data systems and modules. The
Provider will notify the support@mosaic - network.com for GEMS support and help @jwbpinellas.org for
SharePoint support. Provider shall notify JWB within two (2) business days whenever a Provider staff person's
access must be inactivated due to the reasons outlined in JWB's Data Business Rules. The Provider is
responsible for implementing appropriate procedures into their data policies to protect data and prevent
accidental or malicious disclosure of participant information. The Provider is responsible for maintaining fiscal
workflow approval prior to creation of a program budget.
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6. Board Members, Meetings, and Financial Review
Within thirty (30) calendar days of approval or a change of Board composition, Provider will submit to JWB an
updated list of Board Members. Submission of Provider policies and procedures regarding Board review of
Provider finances will be required within thirty (30) calendar days of this Agreement and upon revision and
approval by the Provider's Board. Board training by an external trainer is required prior to issuance of a funding
contract or by August 1st of the current fiscal year, whichever occurs first. Training must consist of the
following topics: non - profit governance, fiduciary risks, and liabilities. Documentation of this training shall
include an outline of topics covered, the Board members in attendance and who provided the training. Providers
who are governmental entities, higher education institutions, and hospitals are exempt from this policy.
7. Nondiscrimination
Programs receiving funding from JWB shall not discriminate against an employee, volunteer, or participant of
the Provider on the basis of race, color, gender, religion, national origin, citizenship, disability, marital status,
age, veteran status, sexual orientation or any other legally protected category except that programs may target
services for specific participant groups as defined in the application. Additionally, agencies receiving funds
shall demonstrate the 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, and ethnic backgrounds.
8. Publicizing of JWB Support — Endorsements
Requests for endorsements that require a commitment of JWB resources will be submitted to the JWB Board
for its consideration. However, endorsements, which do not require JWB resources, may be given to those
Providers which support the focus and priorities of the JWB Board, at the discretion of the JWB Executive
Director. JWB's logo must be present on the following Provider materials as an acknowledgement of support:
• Annual Report
• Program Brochures
• Stationery
JWB's logo may not be used on any other publications requiring JWB resources without JWB Board approval.
However, if a publication does not require a monetary commitment or indicate sponsorship, use of the JWB
logo may be authorized at the sole discretion of the JWB Executive Director.
9. Publications
Provider agrees to supply JWB, without charge, up to three (3) copies of any publication developed in
connection with implementation of programs addressed by this Agreement. Such publications will state that the
program is supported by JWB. Provider agrees that JWB will have unlimited use of copyrighted materials
developed under this Agreement.
10. Assignments and Subcontracts
Provider shall not assign the responsibility of this Agreement to another party nor subcontract for any of the
work contemplated under this Agreement, unless so specified in Attachment 4, without prior written approval of
JWB. No such approval by JWB of any assignment or subcontract shall be deemed in any event or in any
manner to provide for the incurrence of any obligation by JWB in addition to the total dollar amount stated in
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this Agreement. All such assignments or subcontracts shall be subject to the conditions of this Agreement and to
any conditions of approval that JWB shall deem necessary.
11. Confidential Information
Provider must follow all laws regarding confidentiality of information including, but not limited to, HIPAA.
Provider shall not use or disclose any information which specifically identifies a recipient of services under this
Agreement, and shall adopt appropriate procedures for employees' handling of confidential data with the
following exceptions: a) such information may be revealed as may be necessary to conform to Fiscal
Responsibility and Program Monitoring requirements as stated in the General Conditions of this agreement; b)
such information may be revealed as may be necessary pursuant to applicable federal, state, or local law and
related regulations; and c) such information may be revealed with the written consent (authorization) of the
recipient, or the recipient's responsible parent or guardian, where authorized by law. Provider is responsible to
adopt appropriate policies, notifications, authorizations, and other relevant information that allows for the
sharing of confidential information with JWB.
Providers will adhere to JWB's written statement of purpose for collection of confidential data in compliance
with Section 119.071(5), Florida Statutes. Provider must distribute a copy of this statement to recipients of
JWB - funded programs and services and obtain the signature of the recipient or recipient's responsible parent or
guardian. A copy of this signed statement must be maintained in case files for each participant for whom
confidential data is collected. This statement does not require renewal.
The Provider will also maintain in participant files a completed copy of a JWB- approved form for authorizing
client consent to release information for each participant receiving services. As allowed by law and Provider
policy, the Provider will add JWB to consent forms including HIPAA consent forms to facilitate data sharing
and implement the Fiscal Responsibility and Program Monitoring requirements as stated in the General
Conditions of this agreement and advise JWB within two (2) business days if a participant has withdrawn
consent to share data and note this withdrawal of consent in the case file. In no event should participant
identifying information ever be emailed or faxed to JWB.
In the event of an improper disclosure of participant information by Provider, Provider will inform JWB of the
improper disclosure and extent thereof within two (2) business days of becoming aware of the improper
disclosure. In accordance with JWB Breach Procedures, Provider will cooperate fully with JWB and take all
necessary steps to correct and remedy any damage caused by the Provider's improper disclosure and to prevent
future improper disclosure. Provider will defend, indemnify and hold harmless JWB from any and all damages
caused by the improper disclosure of any confidential information as defined by law including, but not limited
to, Protected Health Information under HIPAA and any and all costs associated with remedying the disclosure.
Likewise, in the event of an improper disclosure of Provider's participant information by JWB, JWB will inform
Provider of the improper disclosure and extent thereof within two (2) business days of becoming aware of the
improper disclosure. In accordance with JWB Breach Procedures, JWB will cooperate fully with Provider and
take all necessary steps to correct and remedy any damage caused by JWB's improper disclosure and to prevent
future improper disclosure. JWB will defend, indemnify and hold harmless Provider from any and all damages
caused by the improper disclosure and any and all costs associated with remedying the disclosure subject to the
doctrine of sovereign immunity and limitations set forth in F.S. 768.28.
12. Return of Funds
Provider agrees to return to JWB any overpayment due to unearned funds or funds disallowed pursuant to the
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terms of this Agreement that were disbursed to Provider by JWB, and such funds shall be considered JWB
funds and shall be refunded to JWB in accordance with its instructions. Should Provider fail to return said
funds, Provider will be responsible for all costs and fees of collection incurred by JWB, including, but not
limited to attorney fees and court costs including any pre -suit collections fees and costs.
13. Special Situations and Incidents
Provider agrees to inform JWB within one (1) business day of any circumstances or events which may
reasonably be considered to jeopardize its capability to continue to meet its obligations under the terms of this
Agreement. Incidents are required to be reported for situations that occur only while under the Provider's care
and includes anything that may reflect negatively or critically upon JWB. Certain personnel are mandated by
law to report their suspicions of child abuse, neglect, or abandonment to the Florida Abuse Hotline (1- 800 -96-
ABUSE). All concerns regarding suspected abuse, neglect, or abandonment of a child or vulnerable adult by the
Provider shall first be reported to the Florida Abuse Hotline and then reported to JWB. Incident reporting does
not preclude mandated reporting requirements
Critical Incidents are defined as follows:
Abduction - An incident in which an individual who does not have care and custody of a child has taken the
child. Concerns of child abductions shall immediately be reported to the appropriate law enforcement personnel.
Abuse or Neglect - reasonable cause to suspect that a child has been harmed or is believed to be threatened with
harm from a person responsible for the care of the child.
Participant Death - The death of any participant receiving JWB services.
Media Coverage or Public Inquiry - Media coverage or public reaction that may have an impact on the Provider
or JWB's ability to protect and serve its participants, or other significant effect on the Provider or JWB.
Participant Illness - An illness of a participant receiving services determined by a licensed health care
professional to be life - threatening or the result of apparent abuse or neglect.
Participant Injury - A medical condition of a participant determined by a licensed health care professional to be
life - threatening or the result of apparent abuse or neglect.
Employee Arrest - Employee conduct or activity that results in potential liability to the Provider or JWB; death
or harm to a participant; or results in a law violation, including falsification of official records. If an arrest is
made for a potentially disqualifying offense under Level 2 background screening requirements, or if the arrest
occurred while in the performance of an employee's official duties, the incident should be reported immediately.
Suicide Attempt - An act which clearly reflects the physical attempt by an active participant to cause his or her
own death, which results in bodily injury requiring medical treatment by a licensed health care professional.
Sexual Battery - An allegation of sexual battery involving a participant or employee as evidenced by medical
evidence or law enforcement involvement. Sexual battery includes participant on participant incidents,
employee on participant, and participant on employee.
In addition, the Provider shall notify JWB immediately upon knowledge of any action or incident involving
Provider staff or volunteers that could potentially jeopardize the terms of this Agreement which includes
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misconduct, malfeasance during working hours, or any conduct that results in the arrest of a staff member or
volunteer after hours.
Within one (1) business day, the Provider must submit electronically a completed Incident Report to
IRreviewteam @jwbpinellas.org with full details and disposition of the incident, excluding identifying
information such as name, date of birth, and address. All e -mail communications made or received by JWB
members or staff are considered public records and are retained and, upon request, made available to the public
and media in accordance with Chapter 119, Florida Statutes.
14. Provider Staff Membership on Board
Provider agrees that Provider staff shall not serve as members of the Provider's governing board.
15. Waiver
JWB reserves the right to waive requirements of this Agreement and General Conditions where warranted by
special circumstances. Any waiver will be in writing and signed by JWB.
16. Provider & Program Data Maintained In 2 -1 -1 Database
Provider agrees to maintain accurate and up -to -date Provider and program data in the 2 -1 -1 Tampa Bay Cares
database. The Provider will review and update (as necessary) this data at least once annually. The Provider will
list data for newly funded program(s) within thirty (30) calendar days of the date that JWB funds the program.
This requirement applies to all programs accepting 2 -1 -1 referrals.
17. Funded Provider Staff Background Checks
All program and Provider staff (including employees, independent contractors and staff of subcontractors),
volunteers and those who may have access to youth participants supported through JWB funding are required to
undergo and pass a national Level 2 background check that complies with the standards set forth in F.S. 435.
Those individuals must have no disqualifying offenses listed in Florida Statute 435.04. for which they have not
received an exemption in accordance with Florida law. All staff and volunteers must continue to qualify to pass
a Level 2 screening at all times and must notify their employer if at any time they no longer qualify to pass a
Level 2 screening. Proof of Level 2 background clearance, including current executed affidavits /attestations of
good moral character, must be maintained at all times in the appropriate files and the screening repeated every
five (5) years or more often in accordance with law or as requested by JWB. This requirement applies to
employees regardless of the funder supporting the position and all volunteers who may have access to youth. A
volunteer who assists on an intermittent basis for less than ten (10) hours per month does not have to be
screened if a person who meets the screening requirement of this section is always present and has the volunteer
within his or her line of sight. The Provider is required to clearly document which volunteers meet the criteria
for a Level 2 background screening and affidavits of good moral character, and which are exempt according to
the terms of this Agreement. The Provider's policy and practice for background screening must provide for
adequate protection and must comply with all applicable laws and implementing regulations including, but not
limited to F.S. 435. Should a Provider not be statutorily authorized to receive a national Level 2 background
check in accordance with F.S. 435, the Provider must still comply with the standards set forth in F.S. 435
through VECHS background screening. The Florida Department of Children and Families provides an
exemption process under this statute. JWB does not provide an exemption process.
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18. Attendance
All Programs are required to keep attendance records. If Attachment 2 requires a program to track participant
attendance, attendance may be tracked in the JWB Database or other approved data system.
19. Link to JWB's Websites
Providers with an Provider website will include links on their website to the JWB website
(www.jwbpinellas.org) and include the JWB logo.
20. Drug -Free Workplace
As applicable, the Provider will comply with the Drug -Free Workplace Act, Section 440.101, Florida Statutes.
21. Public Entity Crimes
Per Section 287.133, Florida Statutes, a person or affiliate 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 a public entity, may not submit a bid on a contract with a public entity for the construction or repair
of a public building or public work, may not submit bids on leases of real property to a public entity, may not be
awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with a public
entity, and may not transact business with a public entity in excess of the threshold amount provided in Section
287.017, for CATEGORY TWO for a period of thirty six (36) months from the date of being placed on the
convicted vendor list.
22. JWB Policies and Procedures
Provider agrees to follow all JWB policies and procedures which can be located on the JWB website at
www.jwbpinellas.org / and which are incorporated into this Agreement in their entirety. Said policies include,
but are not limited to, all Board policies, funding policies, Fiscal Guidelines for Funded Programs, JWB Breach
Procedures, research policies, security policies, JWB Data Business Rules and policies that may be promulgated
by JWB within its sole discretion from time to time. JWB reserves the right to change these policies from time
to time within its sole discretion. JWB will provide a minimum of ten (10) business days' notice to the Provider
and it is the responsibility of the Provider to be in compliance will all policies and procedures at all times.
Provider is encouraged to provide certification of current accreditation by a recognized national accrediting
body appropriate to the programming funded by JWB.
Regardless of accreditation, the Provider must meet the highest professional standards established through its
specific field.
23. Insurance, Public Liability, Bodily Injury, and Property Damage
The Provider will procure, pay for, and maintain, throughout the period of this Agreement, on behalf of the
Provider and JWB, the following MINIMUM limits of insurance coverage with responsible companies, eligible
to do business in the State of Florida, which maintain a rating of A -IX or higher with AM Best.
Commercial General Liability
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Each occurrence
Personal Injury
General Aggregate
Property Damage
Products & Completed Operations
Fire Legal Liability
Professional Liability
$1,000,000
$1,000,000
$1,000,000
$1,000,000
$1,000,000
$50,000
Each occurrence $1,000,000
Sexual Abuse and Molestation:
Each occurrence $1,000,000
Automobile (to include owned, hired and non -owned autos):
Bodily Injury and Property damage $500,000
Directors and Officers Liability $1,000000
with Employment Practices Liability Insurance: ,
Recommended, but not presently required coverage:
CyberLiability $1,000,000
JWB must be listed as an additional insured for the operations of the Provider on all coverage except Directors
and Officers Liability. The Provider will submit to JWB a certificate of insurance which describes the insurance
maintained by the Provider. Provider will give JWB written notice within three (3) business days of it becoming
aware that any of its insurance coverage will be cancelled, decreased or changed in any way.
24. Indemnification
The Provider will defend, indemnify, and hold harmless the JWB, its agents, and employees from and against
any and all liabilities, claims, judgments, or actions including court costs and attorney's fees that may hereafter
at any time be made or brought by any person or entity on account of any claim including but not limited to,
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personal injury, property damage, loss of monies, civil rights violation, or discrimination allegedly caused in
whole or part by any act or omission, including but not limited to, breach of contract, negligent act, wrongful
act, intentional act, omission, and any acts of fraud or defalcation, of the Provider, its agents, employees, or
subcontractors, during performance under this Agreement. In no event will the Provider be liable for or have
any obligation to defend JWB against such liability, claims, judgments, or actions, including costs and
attorney's fees, arising out of the sole negligent acts of JWB.
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Attachment 2
City of Clearwater (AGN274)
Community Out of School Time (COST) (PROG478)
Performance Measurements & Service Levels
FY 2014 -2015
Participant Level Performance Measurements
All Primary Participants will be measured through the Performance Measurement reporting module in GEMS
within the contract period. Measured is defined as each participant having all the appropriate administration
points required during the fiscal year based on the language of each Performance Measurement.
Targets Information for PROG478
TargetDefinitionId
Target(Measurable): Annual participation - child
TRGT1211
ShortTargetTitle
Annual participation - child
TargetText
Number of Participants who continue in the afterschool program for more than one year. (Baseline)
TargetType
Milestone Based Target
ProjectedValue
ProjectedStartDate
10/01/2014
ProjectedEndDate
09/30/2015
Notes
Target(Measurable): Number of children receiving OST Survey
TargetDefinitionId
TRGT932
ShortTargetTitle
Number of children receiving OST Survey
TargetText
Number of currently enrolled participants will be given the OST Survey during the administration
windows (October 2014 and May 2015) and captured with JWB database milestone. (Baseline)
TargetType
Milestone Based Target
ProjectedValue
ProjectedStartDate
10/01/2014
ProjectedEndDate
09/30/2015
Notes
TargetDefinitionId
ShortTargetTitle
TargetText
Target(Measurable): OST Quality Matrix Level
TRGTI 147
OST Quality Matrix Level
Funded program sites will maintain a Quality Matrix Level 4, as documented in site visit reports.
Agency: City of Clearwater (AGN274)
Page 14 of 30
09/16/2014 08:26:49 AM
TargetType
Milestone Based Target
ProjectedValue
4
ProjectedStartDate
10/01/2014
ProjectedEndDate
09/30/2015
Notes
ProjectedValue
TargetDefinitionId
Target(ititeasurable): Percent of days attended
TRGT945
ShortTargetTitle
Percent of days attended
TargetText
The program will have 70% of the youth attend 70% of the program days tracked on a monthly basis as
demonstrated by JWB database attendance report. (Baseline)
TargetType
Milestone Based Target
ProjectedValue
ProjectedStartDate
10/01/2014
ProjectedEndDate
09/30/2015
Notes
Services Not Associated with Any Targets in Program's SOW
Milestones Not Associated with Any Targets in Program's SOW
R & R Definitions Information for PROC478
Agency: City of Clearwater (AGN274) 09/16/2014 08:26:49 AM
Page 15 of 30
Attachment 3
Geographical Service Area
Provider agrees whenever possible to maintain service sites which are accessible by public transportation and
convenient to the target participant group. Provider will advise JWB of any changes made in service sites.
The geographical service area for this agreement is as follows:
Program Name
Community Out of School Time (COST)
Service Will be Provided
Countywide
Services will be provided Tess than countywide.
Services will be provided in the following zip
codes or the following geographical areas
(list all zip codes of the target area or describe the geographical area)
33755,33756
Agency: City of Clearwater (AGN274) 09/16/2014 08:26:49 AM
Page 16 of 30
y � T
Attachment 4: BUDGET(S)
The provider will deliver services according to the budget(s) following this page.
Revised budgets should be submitted by the provider in accordance with JWB policies and procedures.
Provider may make budget amendments during the fiscal year in accordance with JWB forms and procedures as
delineated in the Fiscal Guidelines for Funded Programs found on the JWB website at www.jwbpinellas.org.
For all amendments, the following guidelines apply:
A. Funded programs shall make adjustments in accordance with forms and procedures as established by
JWB staff.
B. Equipment purchased will be considered the inventory of the Provider. Equipment purchased will be
accounted for and controlled by the Provider. Inventory reports shall be made available to JWB upon
request. JWB may physically inspect equipment at their discretion. Once equipment is fully depreciated
it becomes the property of the Provider. JWB will accept the depreciation schedule of the Provider's
auditor.
C. Any adjustments made by funded agencies which are not in accordance with JWB policy shall be
subject to reimbursement of JWB at the discretion of JWB.
No adjustment may be made after the budget amendment closing date.
Agency: City of Clearwater (AGN274) 09/16/2014 08:26:49 AM
Page 17 of 30
y
Form 1
Community Out of School Time (COST) (PROG478)
Current & Proposed Operating Budget
Category Subcategory
Salaries Salaries
-Subtotal
Salaries
Prior
Fiscal
Year
$0
Total
Current
Fiscal
Year
$168,272
Program Budget
Difference from
Prior Year ($)
$168,272
Difference from
Prior Year ( %)
100%
Prior
Fiscal
fear
$0
Current
Fiscal
Year
$0
JW'B Budget
Difference from
Prior Year ($)
Difference from
Prior Year ( %)
$0
--
$0
$168,272
$168,272
100%
$0
$0
$0
--
Benefits
-
-
-
FICA
$0
$6,155
$6,155
100%
$0
$0
$0
--
Retirement
$0
$26,006
$26,006
100%
$0
$0
$0
--
Group Insurance
$0
$25,211
$25,211
100%
$0
$0
$0
--
Workers Comp
$0
$0
$0
--
$0
$0
$0
--
Unemployment
Comp
-Subtotal
Benefits
$0
$0
$0
--
$0
$0
$0
""
$0
$57,372
$57,372
100%
$0
$0
$0
--
Total Salary and Benefits
$0
$225,644
$225,644
100%
$0
$0
$0
--
Profession
al Services
-Audit/Accountin
-
Professional
Services
g
$0
$81,100
$81,100
100%
$0
$25,600
$25,600
100%
$0
$0
$0
--
$0
$0
$0
--
Court/Legal
Services
$0
$0
$0
--
$0
$0
$0
--
-
Other Services
$0
$0
$0
--
$0
$0
$0
--
Investigations
$0
$0
$0
--
$0
$0
$0
--
Subtotal
Professional
Services
$0
$81,100
$81,100
100%
$0
$25,600
$25,600
100%
Rent
Expense
Rental & Leases
$0
$0
$0
--
$0
$0
$0
--
-Subtotal
Rent
Expense
$0
$0
$0
--
$0
$0
$0
--
Repairs /M
aintenance
Repairs &
Maintenance
$0
$0
$0
--
$0
$0
$0
--
Subtotal
Repairs /Mainte
nance
$0
$0
$0
--
$0
$0
$0
--
Utilities
-
-Subtotal
Communications
$0
$0
$0
--
$0
$0
$0
--
Utilities
Utilities
$0
$0
$0
--
$0
$0
$0
--
$0
$0
$0
--
$0
$0
$0
--
Operating
Expenses
Freight and
Postage
$0
$0
$0
--
$0
$0
$0
--
Printing &
Binding
$0
$0
$0
--
$0
$0
$0
Advertising
$0
$0
$0
--
$0
$0
$0
--
-
Office Supplies
$0
$2,200
$2,200
100%
$0
$0
$0
--
Agency: City of Clearwater (AGN274)
Page 18 of 30
09/16/2014 08:26:49 AM
Category
Subcategory'
g 3
Operating
Supplies
Prior
fiscal
Year
$0
Total
Current
Fiscal
Year
$49,472
Program Budget
Difference from
Prior Year (S)
$49,472
Difference from
Prior Year ( %)
100%
Prior
Fiscal
Year
$0
Current
Fiscal
Year
JV B Budget
Difference from
Prior Year (y)
Difference from
Prior Year (' /o)
$0
$0
Subtotal
Operating
Expenses
$0
$51,672
$51,672
100%
$0
$0
$0
--
Participan
t Expenses
Participant
Transportation
$0
$21,800
$21,800
100%
$0
$0
$0
-'
Participant
Expense
$0
$67,550
$67,550
100%
$0
$0
$0
-"
Participant Food
& Nutrition
$0
$56,450
$56,450
100%
$0
$0
$0
""
Participant
Books
$0
$0
$0
--
$0
$0
$0
""
Participant Educ.
Materials
$0
$10,000
$10,000
100%
$0
$0
$0
'
Subtotal
Participant
Expenses
$0
$155,800
$155,800
100%
$0
$0
$0
--
Education
al
Books,
Subscriptions
Dues &
Memberships
$0
$0
$0
--
$0
$0
$0
""
Training
$0
$2,500
$2,500
100%
$0
$0
SO
--
Subtotal
Educational
$0
$2,500
$2,500
100%
$0
$0
$0
--
Travel/Co
nference
Travel & Per
Diem
$0
$0
$0
--
$0
$0
$0
--
Conference
$0
$0
$0
--
$0
$0
$0
--
Subtotal
Travel /Confere
nce
$0
$0
$0
--
$0
$0
$0
--
Promotion
al
Promotional
$0
$0
$0
--
SO
$0
$0
-"
Subtotal
Promotional
$0
$0
$0
--
$0
$0
$0
--
Administr
ative Cost
Administrative
Cost
$0
$27,572
$27,572
100%
$0
$0
$0
-
Subtotal
Administrative
Cost
$0
$27,572
$27,572
100%
$0
$0
$0
--
Depreciati
on
Depreciation
Expense
$0
$0
$0
--
$0
$0
$0
'"
Subtotal
Depreciation
$0
$0
$0
--
$0
$0
$0
--
Insurance
Insurance
Expense
$0
$0
$0
--
$0
$0
$0
Subtotal
Insurance
$0
$0
$0
--
$0
$0
$0
--
Miscellane
ous
Bank Service
SO
$0
$0
--
SO
$0
SO
--
Agency: City of Clearwater (AGN274)
Page 19 of 30
09/16/2014 08:26:49 AM
Category
Subcategory -
Other/Miscellan
eons
Prior
Fiscal
Year
$0
Total
Current
Fiscal
Year
$0
Program Budget
Difference from
Prior Year (5)
$0
Prior
Difference from
o Fiscal
Priori Year ( /o)
fear
-- $0
Current
Fiscal
Year
$0
lWB Budget
Difference from Difference from
„
Prior Year (S) Prior Year ( /u)
$0
Subtotal
Miscellaneous
$0
$0
$0
— $0
$0
$0 --
Capital
Machinery &
Equipment-
Capital
$0
$0
$0
--
$0
$0
$0
--
-Subtotal
Capital
$0
$0
$0
--
$0
$0
$0
--
Unit of
Costs
Out of School
Time (OST)
$0
$0
$0
--
$0
$376,842
$376,842
100%
Grand Total
$0
$544,288
$544,288
100%
$0
$402,442
$402,442
100%
Agency: City of Clearwater (AGN274)
Page 20 of 30
09/16/2014 08:26:49 AM
Form 2
Community Out of School Time (COST) (PROG478)
Salary and Fringe Preparation
FY 2014 -2015
Position
POS1709 - Rec
Coordinator
Staff
PRSNL1924 - Kathy
LaTerza
FTE
o
s
0.1
Staff
0.1
Sala'
PRG
$6,971
ies
JWB
$0
FICA
PRG
$101
JWB
$0
Retirement
PRG
$1,673
JWB
$0
Group Insurance
PRG
$1,004
JWB
$0
Workers
PRG
$0
Comp
JWB
$0
Unemployment
PRG
$0
Comp
JWB
$0
Total S & Benefits efits
PRG
$9,749
JWB
$0
POS1725 - Recreation
Leader
PRSNL1938 Sawang
Phommaleuth
1
1
$22916
$0
$332
$0
$5,500
$0
$7,794
$0
$0
$0
$0
$0
$36,542
$0
POS1729 - Recreation
Leader
PRSNL1942 - Marcia
Terry
0.6
0.6
$14,624
$0
$1,119
$0
$0
$0
$0
$0
$0
$0
$0
$0
$15,743
$0
POS1732 - Recreation
Leader -lw
PRSNL1943 vacant
nglw
0.25
0.25
$6,142
$0
$470
$0
$0
$0
$0
$0
$0
$0
$0
$0
$6,612
$0
POS1731 - Recreation
Leader -PPT
PRSNL1947 - vacant
ngppt
0.6
0.6
$14,624
$0
$1,119
$0
$0
$0
$0
$0
$0
$0
$0
$0
$15,743
$0
POS1730 - Recreation
Leader -PPT
PRSNL1945 - vacant
rnppt
0.6
0.6
$14,624
$0
$1,119
$0
$0
$0
$0
$0
$0
$0
$0
$0
$15,743
$0
POS1734 - Recreation
Leader -seas
PRSNL1946 vacant
rnseas
0.2
0.2
$4,950
$0
$379
$0
$0
$0
$0
$0
$0
$0
$0
$0
$5,329
$0
POS1733 - Recreation
Leader -seas
PRSNL1944 - vacant
ngseas
0.2
0.2
$4,950
$0
$379
$0
$0
$0
$0
$0
$0
$0
$0
$0
$5,329
$0
POS1727 - Recreation
Programmer
PRSNL1940 -Freda
Dixon
1
1
$31,130
$0
$451
$0
$7,471
$0
$7,819
$0
$0
$0
$0
$0
$46,871
$0
POS1726 - Recreation
Specialist
PRSNL1939 Kevin
Whitlow
1
0.8
$31,252
$0
$453
$0
$7,501
$0
$6,244
$0
$0
$0
$0
$0
$45,450
$0
POS1728 - Recreation
Supervisor
PRSNL1941 - Karen
Sowada
0.3
0.3
$16,089
$0
$233
$0
$3,861
$0
$2,350
$0
$0
$0
$0
$0
$22,533
$0
TOTAL
$168,272
$0
$6,155
$0
$26,006
$0
$25,211
$0
$0
$0
$0
$0
$225,644
$0
Agency: City of Clearwater (AGN274)
Page 21 of 30
09/16/2014 08:26:49 AM
Form 3
Community Out of School Time (COST) (PROG478)
Operational Narratives
Category Subcategory Line Items Amount Narrative
Professional
Services
Professional
Services
Professiona
1 services
$81,10
0
Enrichment Overlay Services at $400 per number of assigned participant scholarships (64).
$400 x 64 participants = $25,600 annually
Summer Instructors
Fitness /nutrition $5000 x 2 centers
Youth development $5,000 x 2 centers
STEM $5,000 x 2 centers
Speakers $3,000
Afterschool
Leagues: $35/hr x 4 hrs x 2 centers x 5 wk/session x 7 sessions (6wk ea) = $9,800
Fitness $25/hr x 42 wks x 2 centers x 2 hr /wk = $4,200
Journaling/spoken word $5,000
Step /dance $5,000
STEM $5,000 x 2 centers
Skateboard lessons $25/hr x 42 wks x 2 hr /wk = $2,100
Gender specific $5,000
Tennis lessons $2,000
Golf lessons $2,000
Misc speakers $3,000
Operating
Expenses
Office
Supplies
office
supplies
$2,200
150 Notebooks / dividers 500
Pencils /Pens /Paper /3x5 cards and holders 700
20 x $50 Color Printer Cartridges 1,000
Agency: City of Clearwater (AGN274) 09/16/2014 08:26:49 AM
Page 22 of 30
Category Subcategory Line Items Amount Narrative
Operating operating
Supplies supplies
$49,47 T -shirts
2
board games
6 card tables x $250
Sports equipment
Awards
Movies 40 x $20
Swim gear
photo paper, supplies
tablets and storage cabinet
Fitness equipment
Sports equipment
Games -video
Uniforms
Storage cabinets
Game consoles
Furniture - sofas, chairs, desks
Book bags /school /homework supplies
5,000
3,000
1,000
1,500
3,172
2,500
800
2,000
1,500
5,000
5,000
6,000
5,000
3,000
5,000
2,000
10,000
Participant
Expenses
Participant
Transportat
ion
Transportati
on
$21,80
0
Summer 35 buses x $350 ave each = $14,000
Afterschool van /bus rental 18 trips x $300 ea = $5,400
Holiday camp van /bus rental = $2400
Agency: City of Clearwater (AGN274)
Page 23 of 30
09/16/2014 08:26:49 AM
Agency: City of Clearwater (AGN274)
Page 24 of 30
09/16/2014 08:26:49 AM
Participant
Expense
Field trips
$67,55
0
Busch Gardens $95 x 105 kids = $9,975
Celebration station$30 x 105 kids = $3,150
Skating $10 x 105 = $1050
Weeki Wachee /Buccaneer Bay $13 x $1,365
Movies $10 x 105 = $1,050
Game time $17 x 105 = $1,785
MOSI $8 x 105 = $840
Threshers $7 x 105 = $735
Adventure Island $80 x 105 = $8400
Paintball $30 x 105 = $3150
Bowling $12 x 105 = $1260
Afterschool -1 trips /mo x 9 mo x $15 ea x 70 kids /staff
= $18,900
holiday and spring break camps
movies x 3 x 70 kids x $10 = $2,100
paintball x 2 x 70 x $30 = $4,200
busch gardens $95 x 70 = $6,650
Bowling $12 x 70 = $840
Agency: City of Clearwater (AGN274)
Page 24 of 30
09/16/2014 08:26:49 AM
Y
Category
Subcategory
Line Items
Amount
Narrative
celebration station $30 x 70 = $2,100
Participant
Food and
$56,45
Food &
Nutrition
nutrition
0
hot dogs $1,000
pizza $2,000
Ice Cream Sundae makings $1,500
Chips / Potato Salad / Baked Beans $1,500
Chicken Wings $2,000
Drinks $5,000
Snacks $200 /wk x 10 wks = $2,000
Summer Parent banquet 150 kids + 2 guests ea x $15= $6,750
Lunches /snack when food program ends $10,000
Snacks $100 wk/site x 42 wks = $ 4200
Nutrition class supplies $50 /wk x 30 wks = $1,500
Holiday celebrations $5,000
Drinks - afterschool $4,000
Lunches for school out days/holidays $10,000
Participant
Educational
$10,00
Educational materials
Educ.
material
0
STEM materials $3,000 x 2 centers
Materials
Language arts supplies $2,000 x 2 centers
Educational
Training
Staff
trainng
$2,500
Staff training
10 staff x $250 = $2,500
Administrat
Administrat
Faciltiy use
$27,57
Based on square footage costs at facilities.
ive Cost
ive Cost
2
Unit of
Out of
FY 2014-
$0
Scholarship allocations for FY 14 -15
Costs
School Time
2015
22.56 daily per diem rate times 64 participant scholarships times up to 261 reimbursable days.
(OST)
Scholarship
$22.56 x 64 participants x 261 days = $376,842
Allocation
Total
$318,6
Operating
44
Cost
Agency: City of Clearwater (AGN274)
Page 25 of 30
09/16/2014 08:26:49 AM
s R )
Form 4
Community Out of School Time (COST) (PROG478)
Other Program Funding
Funder Type/Funder
City Government (in Pinellas)
Grand Total
Other Program Funding Fiscal %ear Comparison
FY 2013 -2014 Total
$0
$0
FY 2014 -2015 Total
$141,846
$141,846
% Increase/Decrease
100%
100%
Total Budget Summary
Total JWB Allocations
$402,442
Total Other Funding
$141,846
Total Program Funding:
$544,288
Total Program Budget
$544,288
Difference
$0
Agency: City of Clearwater (AGN274)
Page 26 of 30
09/16/2014 08:26:49 AM
1
Form 5
Community Out of School Time (COST) (PROG478)
Other Program Funding Narrative
Funding Amount: Other Funding Source:
$141,846
City Government (in
Pinellas)
Narrative:
City of Clearwater contribution to program. Parks and Recreation Dept budget is primarily from the
General Fund which comes from Ad Velorem taxes. salary & benefits $114,274 facility use
$27,572
Agency: City of Clearwater (AGN274) 09/16/2014 08:26:49 AM
Page 27 of 30
< 1 A
END OF PROGRAM BUDGET FOR
Community Out of School Time (COST) (PROG478)
Agency: City of Clearwater (AGN274) 09/16/2014 08:26:49 AM
Page 28 of 30
•
Attachment 5
JWB Reimbursement Schedule
Pay#
Juvenile Welfare
F1' 2014
Accounts Payable
Submission
Due Date
Board
-2015
Schedule
Reimbursement
Date
1
10 -03 -14
10 -10 -14
2
10 -17 -14
10 -24 -14
3
10 -31 -14
11 -07 -14
4
11 -14 -14
11 -21 -14
5
11 -28 -14
12 -05 -14
6
12 -12 -14
12 -19 -14
7
12 -26 -14
01 -02 -15
8
01 -09 -15
01 -16 -15
9
01 -23 -15
01 -30 -15
10
02 -06 -15
02 -13 -15
11
02 -20 -15
02 -27 -15
12
03 -06 -15
03 -13 -15
13
03 -20 -15
03 -27 -15
14
04 -03 -15
04 -10 -15
15
04 -17 -15
04 -24 -15
16
05 -01 -15
05 -08 -15
17
05 -15 -15
05 -22 -15
18
05 -29 -15
06 -05 -15
19
06 -12 -15
06 -19 -15
20
06 -26 -15
07 -03 -15
21
07 -10 -15
07 -17 -15
22
07 -24 -15
07 -31 -15
23
08 -07 -15
08 -14 -15
24
08 -21 -15
08 -28 -15
25
09 -04 -15
09 -11 -15
26
09 -18 -15
09 -25 -15
27
10 -02 -15
10 -09 -15
28
10 -16 -15
10 -23 -15
Agency: City of Clearwater (AGN274)
Page 29 of 30
09/16/2014 08:26:49 AM
Attachment 6
Document Submittal Chart
Provider Document
COOP
Time Frame
Within thirty (30) days of effective date of agreement
Submit To
Waived
Most Recent Audit
Immediately upon receipt by the Provider's Board or not to exceed
150 days of the close of the Provider's fiscal year
Waived
Board Member List
Within thirty (30) calendar days of approval or a change of Board
composition
Waived
Policy and procedure regarding Board
review of Provider finances
Within thirty (30) calendar days of effective date of agreement and
upon revision and approval by the Provider's board
Waived
Board Approved Merit Compensation Plan
(Board minutes showing approval)
If applicable, then prior to budget submission or subsequent
amendment
Waived
Board Training
(Outline of topics, members in attendance
and who provided training)
Prior to issuance of subsequent year's contract or August 1st of
current fiscal year, whichever occurs first
Waived
Incident Reports
Within one (1) business day of occurrence
IRreviewteam @jwbpinellas.org
Liability Insurance Documentation
Throughout the period of the agreement.
Waived
User Access
Notify within two (2) business days when a staff person's access
must be inactivated
support @mosaic- network.com
Agency: City of Clearwater (AGN274)
Page 30 of 30
09/16/2014 08:26:49 AM