AGREEMENT BETWEEN THE JUVENILE WELFARE BOARD - AGN274 - COST (3)AGREEMENT
Between
THE JUVENILE WELFARE BOARD
and
City of Clearwater (AGN274)
City of Clearwater (COST)
I. 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, 2018 and extending through September 30, 2019. This
Agreement does not take effect and JWB has no responsibility for any of its obligations hereunder until this
Agreement is executed by all parties to this Agreement.
II. STAFF
Provider agrees to employ staff, at its own 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 position profile on file at JWB and any approved revisions which are
submitted for FY19 funding.
III. SERVICES
Provider offers after school programs for youth in North Pinellas County. The Ross Norton and North
Greenwood Recreation Complexes serve children aged 6 through 18 year round. The program incorporates
enrichment activities that promote school success and healthy lifestyles, improve social skills, increase athletic
abilities, and develop leadership skills. All activities include aspects of positive character development
including courage, teamwork, compassion and community service.
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, according to service areas
stated in Attachment 3, and pursuant to the General Conditions stated in Section VIII and Special Conditions
listed in Attachment 1. A program methodology update, or certification that no updates are needed, is due for
submission thirty (30) days after the effective date of this Agreement (see Attachment 5 for an outline of all
document submittals). The Provider shall cooperate with JWB on the process for approval of program
methodology updates by no later than January 11th, 2019. Any proposed changes in service delivery after
January 1 1th must be approved in writing by JWB in advance of making those changes and program
methodologies shall subsequently be updated within 30 days of that approval.
IV. FUNDS
The program budget for both JWB and other funds (if any) for accomplishing the above stated services must be
approved in the JWB data system or other designated format before payment will commence. JWB agrees to
reimburse up to $453,032 for City of Clearwater (COST) for services rendered pursuant to this Agreement.
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V. METHOD OF PAYMENT
1. JWB issues reimbursements in accordance with the schedule listed on Attachment 4 (or on the preceding
working day in case of a holiday). The Provider shall elect to submit a request for payment at a
minimum either every other week or once a month. Reimbursements shall be made on pace throughout
the fiscal year in order to allow for a consistent and orderly delivery of services. Reimbursement
requests shall be submitted timely and only for amounts actually incurred that should properly be
reimbursed per this Agreement within reasonably needed amounts based on the 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 JWB to ensure a consistent and orderly delivery of services. It is the further intent of
JWB to terminate Agreements in those situations where such action is essential to the protection of its
interests and the interests of children and families served by JWB, 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 due to 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 shall 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 shall not be made for services rendered prior to the effective
date of this Agreement.
VIII. GENERAL CONDITIONS
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
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amendment 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 the approved budget on file at JWB.
b. Provider agrees to submit Program Statement of Financial Activities reports within thirty (30) days
following the end of each quarter of JWB's fiscal year. 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 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 Recover Pinellas. This period may be extended at
the discretion of the Board upon recommendation of the Chief Executive Officer. Provider must file an
insurance and FEMA claim and shall reimburse JWB for any amounts received from FEMA and
insurance that have previously been funded by JWB. The Provider must submit to JWB a copy of the
Provider's Continuity of Operations Plan within thirty (30) days of the effective date of this Agreement.
f. Provider shall provide supporting documentation (Board meeting minutes, etc.) for all salary
adjustments. JWB shall not reimburse more than two weeks of accrued leave for terminating employees.
JWB shall 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 eighty (180) calendar 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.
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 Provider is required to engage an audit firm that follows Government /Non -Profit Audit Standards when
conducting the financial audit and that shows evidence of a peer review report completed every three years.
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4. Other Financial Support
a. Provider shall report within ninety (90) calendar days any major changes in non-JWB revenue which
would impact targeted service levels in JWB funded programs during the fiscal year.
b. JWB funds shall 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 monitoring, site visit, accreditation and licensing reports supplied by funding,
accreditation and licensing entities, as applicable, to JWB upon Provider receipt. 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, JWB Secure Portals and Provider specific data collection systems), and to cooperate
in monitoring activities including, but not limited to, access to sites, staff, fiscal and participant records, logs,
participant rights and responsibilities policies, participant handbooks, grievance and complaint procedures and
the provision of related participant and participant rights information. Provider shall maintain and have
available for audit inspection participant records for five years post termination of services. Provider agrees to
cooperate with the JWB Funded Program Monitoring 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.
Program staff shall adhere to JWB's Data Quality Manual and JWB's Financial Policies and Procedures for
Funded Programs, and all staff who have any responsibility (supervisory or direct) for data entry shall 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 Secure Portal User Access to ensure that all users are active employees with access to
appropriate data systems and modules. The Provider shall notify support@mosaic-network.com for GEMS
support and help@jwbpinellas.org for JWB Secure Portal support. Provider shall notify the JWB Program
Consultant and complete the designated form immediately upon involuntary termination and within five (5)
business days upon voluntary separation or whenever a Provider staff person's access must be inactivated due to
the reasons outlined in JWB's Data Quality Manual. 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.
6. Board Members, Training, and Financial Review
Within thirty (30) calendar days of approval or a change of Board composition, Provider shall submit to JWB
an updated list of Board Members to include the e-mail and physical address, phone number and place of
employment of the Board Chair.
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Submission of Provider policies and procedures regarding Board review of Provider finances shall be required
within thirty (30) calendar days of this Agreement and upon revision and approval by the Provider's Board.
Training of new board members 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 that are
governmental entities, higher education institutions, and hospitals are exempt from this policy.
7. Nondiscrimination
Providers 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, pregnancy, and genetic information, or any other legally protected
category except that programs may target services for specific participant groups as defined in the application.
Additionally, Providers 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 shall be submitted to the JWB Board
for its consideration. However, endorsements, which do not require JWB resources may be given to those
Providers that support the focus and priorities of the JWB Board, at the discretion of the JWB Chief Executive
Officer. JWB's logo must be present on the following Provider materials as an acknowledgement of support:
• Annual Report
• Program Brochures
• Program stationery
JWB's logo may not be used on any other publications requiring JWB resources without JWB 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 Chief Executive Officer.
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 and Provider will be notified by JWB when this occurs.
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 the approved budget on file at JWB, 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 this Agreement. All such assignments or subcontracts shall be subject as applicable to the
General Conditions of this Agreement and to any conditions of approval that JWB shall deem necessary.
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Subcontracts shall be submitted to JWB within thirty (30) calendar days of the effective date of this Agreement
and upon revision, amendment and execution thereafter.
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 shall 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. Once executed, this signed statement does not require subsequent renewal.
The Provider shall 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 shall 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. JWB has full discretion as to the use
of data and JWB owns all data once transferred to JWB.
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 shall inform JWB of the
improper disclosure and extent thereof within two (2) business days of becoming aware of the improper
disclosure. Provider shall 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 shall
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. Provider shall defend, indemnify and
hold harmless JWB from any and all damages caused by the improper disclosure as defined by law of any
information including but not limited to personally identifiable information (PII) and protected health
information (PHI) as required under HIPAA, HITECH and FIPA regulations or other information that is
confidential and/or exempt from disclosure per F.S. 119. This provision shall survive the termination of this
Agreement.
Likewise, in the event of an improper disclosure of Provider's participant information by JWB, JWB shall
inform Provider of the improper disclosure and extent thereof within two (2) business days of becoming aware
of the improper disclosure. JWB shall 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 shall
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defend, indemnify and hold harmless Provider from any and all damages caused by JWB's 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. Public Records
JWB is a public entity subject to Florida's Public Records Law, which includes provisions relating to records
retention, production and confidentiality. For purposes of this section, Provider is also referred to as Contractor.
IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119,
FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS
RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT:
Juvenile Welfare Board of Pinellas County
14155 58th St. No., Ste. 100
Clearwater, FL 33760
(727) 453-5600
communications(&jwbpinellas.org
Contractors acting on behalf of JWB must comply with 119.0701 and must:
a. Keep and maintain public records required by JWB to perform the service.
b. Upon request from JWB's custodian of public records, provide JWB with a copy of the requested
records or allow the records to be inspected or copied within a reasonable time at a cost that does not
exceed the cost provided in F.S. 119 or as otherwise provided by law.
c. Ensure that public records that are exempt or confidential and exempt from public records disclosure
requirements are not disclosed except as authorized by law for the duration of the contract term and
following completion of the contract if the contractor does not transfer the records to the public agency.
d. Upon completion of the contract, transfer, at no cost, to JWB all public records in possession of
Contractor or keep and maintain public records required by JWB to perform the service. If the
Contractor transfers all public records to JWB upon completion of the contract, Contractor shall destroy
any duplicate public records that are exempt or confidential and exempt from public records disclosure
requirements. If Contractor keeps and maintains public records upon completion of the contract, the
Contractor shall meet all applicable requirements for retaining public records. All records stored
electronically must be provided to JWB, upon request from JWB's custodian of public records, in a
format that is compatible with the information technology systems of JWB.
In addition, Contractors should be aware that social security numbers are confidential and exempt from
disclosure (119.071(5)) and personal identifying information of a child or the parent or guardian of the child
held by JWB or service provider under contract with JWB is exempt from disclosure (125.901(11)). There are
many other exemptions in the law that Provider should be cognizant exist. However, for all Providers, any and
all contracts between JWB and Provider, program methodology, budgets, requests for reimbursements, emails,
other written correspondence and any other documents exchanged between the Provider and JWB are generally
public records and will be disclosed in the sole discretion of JWB and must be retained in accordance with
Florida's record retention policy. Providers should not provide any documents to JWB containing Trade Secrets,
as defined by F.S. 812.08, or exempt or confidential and exempt information to JWB without specifically
marking such document. By submitting any documents or information whatsoever to JWB, Provider agrees that
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JWB may use and disclose all information and documents submitted for any purpose JWB sees fit and that it is
within JWB's sole discretion to determine if any information submitted is exempt from disclosure.
Any Provider who receives a Public Records request for records pertaining to JWB or services funded by JWB,
must advise JWB within two (2) business days of the records request and JWB and Provider will work together
to respond to any such request. This provision shall survive termination of this Agreement.
13. Return of Funds
Provider agrees to return to JWB any overpayment due to costs not incurred or costs disallowed pursuant to the
terms of this Agreement 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 shall 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. This provision survives termination of this Agreement and
return of funds for overpayment or disallowance will be required even if the overpayment or disallowance is
discovered after this Agreement is terminated.
14. 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. Participant 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.
Breach of Information -Sensitive, protected or confidential data has potentially been viewed, stolen or used by
an individual unauthorized to do so.
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.
Investigation or Lawsuit -Any formal investigation or legal action brought against Provider which relates to the
services funded by JWB or which may reasonably be considered to jeopardize its capability to continue to meet
its obligations under the terms of this Agreement.
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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 Death - The death of any participant receiving JWB services, regardless if the death occurred while
under Provider's care.
Participant Illness - An illness of a participant requiring a response by Emergency Medical Services AND
transport to a medical facility due to the severity of the illness while participant is attending the program.
Participant Injury - A medical condition of a participant requiring a response by Emergency Medical Services
AND transport to the hospital due to the severity of the injury while the participant is attending the program.
Note in both instances of Participant Illness and Participant Injury the parents may use Emergency Medical
Services as transportation to the hospital - if it is used solely for this purpose an incident report is not required.
In the event that the participant leaves the program and requires emergency care due to an injury or illness
incurred at the program, an incident report should be complete when the program becomes aware.
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.
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.
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
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. In the event of a participant death please contact by phone
the JWB Chief Operating Officer within three (3) hours of knowledge of the incident.
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.
Provider must adhere to the reporting requirements hereunder after the termination of this Agreement if
Provider becomes aware of a Critical Incident after the termination of the Agreement if the Critical Incident
occurred during the term of the Agreement and/or relates to the services funded by JWB.
15. Provider Staff Membership on Board
Provider agrees that Provider staff shall not serve as voting members of the Provider's governing board.
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16. Waiver
JWB reserves the right to waive requirements of this Agreement and General Conditions where warranted by
special circumstances. Any waiver shall be in writing and signed by JWB.
17. 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.
18. Provider Staff Background Checks
All program staff 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 and subcontractors who may have
access to youth. Volunteers and subcontractors who assist on an intermittent basis for less than ten (10) hours
per month do not have to be screened if a person who meets the screening requirement of this section is always
present and has the volunteer and subcontractor 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.
The Florida Department of Children and Families provides an exemption process under this statute. JWB does
not provide an exemption or waiver process.
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. Only in the event the Provider does not qualify to receive a national Level 2 background
check in accordance with F.S. 435 and is not eligible to participate in VECHS, then the Provider must engage a
third party vendor to conduct a national background check and must comply with the standards as set forth in
F.S. 435.
Providers using VECHS, or any other third party vendor which does not allow the release of background
screening results to JWB, must sign and provide to JWB an affidavit which ensures compliance with the
entirety of this section. This affidavit must be renewed and submitted annually within thirty (30) days of the
effective date of this Agreement and upon change of staff in this position. Provider must also provide a written
procedure within thirty (30) days of the effective date of this Agreement which outlines the process by which
compliance is ensured with the entirety of this section.
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Provider agrees to submit to monitoring of personnel and volunteer files and other required documents to ensure
compliance with this section. Monitoring will include, but not be limited to, review of training logs, position
descriptions, applications, resumes and Provider verification of staff credentials. Providers shall not release PHI
to JWB and shall keep this information separated from personnel and volunteer files. Parental consent for JWB
monitoring activities must be evident in the personnel and volunteer files of minor children.
19. Attendance
Provider is 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.
20. Link to JWB's Websites
Provider website shall include links to the JWB website (www.jwbpinellas.org) and include the JWB logo.
21. Drug -Free Workplace
The Provider shall have and enforce a Drug and Alcohol Free Workplace Policy. This policy shall be submitted
to JWB within thirty (30) calendar days of the execution of this Agreement.
22. 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.
23. 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, JWB Financial Policies and Procedures for Funded
Programs, research policies, security policies, JWB Data Quality Manual 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 thirty (30) calendar days' notice to the
Provider and it is the responsibility of the Provider to be in compliance with 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.
Agency: City of Clearwater (AGN274) 07/11/2018 10:23:03 AM
Page 11 of 27
24. Conflict of Interest
The Provider must have no interest and shall acquire no interest, either direct or indirect, which would conflict
in any manner with the performance or services required hereunder. The Provider further represents that no
person having any such interest shall be employed by the Provider during the Agreement term and any
extensions.
The Provider shall promptly notify JWB, in writing, by certified mail, of all potential conflicts of interest for
any prospective business association, interest, or other circumstance, which may influence or appear to
influence the Providers judgment or quality of services being provided hereunder. Such written notification
shall identify the prospective business association, interest or circumstance, the nature of work that the Provider
may undertake and request an opinion of JWB as to whether the association, interest or circumstance would, in
the opinion of JWB, constitute a conflict of interest if entered into by the Provider. JWB agrees to notify the
Provider of its opinion, by certified mail, within thirty (30) days of receipt of notification by the Provider.
25. Insurance Requirements - Basic Provisions
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 basic insurance coverage with responsible companies,
eligible to do business in the State of Florida, which maintain a rating of A -(IX) or higher with A.M. Best.
a. Worker's Compensation
Part One: "Statutory"
Part Two: Each Accident $500,000
Disease - Policy Limit $500,000
Disease - Each Employee $500,000
Such insurance shall be no more restrictive than that provided by the latest edition of the standard Workers'
Compensation Policy, as filed for use in Florida by the National Council on Compensation Insurance (NCCI),
without any restrictive endorsements other than any endorsements required by NCCI or the State of Florida. In
addition to coverage for the Florida Workers' Compensation Act, where appropriate, coverage is to be included
for the Federal Employer's Liability Act and any other applicable Federal or State law.
b. Commercial General Liability
General Aggregate
Products/Completed Operations Aggregate
Personal and Advertising Injury
Each occurrence
$3,000,000
$3,000,000
$3,000,000
$3,000,000
Such insurance shall be no more restrictive than that provided by the latest edition of the standard Commercial
General Liability Form (Form CG 00 01) as filed for use in the State of Florida by the Insurance Services Office
(ISO) without any restrictive endorsements other than any endorsements specifically required by ISO or the
State of Florida.
Agency: City of Clearwater (AGN274) 07/11/2018 10:23:03 AM
Page 12 of 27
JWB and its officials, officers and employees shall be included as an "Additional Insured" on the Commercial
General Liability coverage a form no more restrictive than ISO form CG 20 10 (Additional Insured - Owners,
Lessees, or Provider).
c. Automobile
Combined Single Limit $5,000,000
Such insurance shall be no more restrictive than that provided by Section II (Liability Coverage) of the most
recent version of the standard Business Auto Policy (ISO Form CA 00 01) without any restrictive
endorsements, including coverage for liability contractually assumed, and shall cover all owned, non -owned,
and hired autos used in the performance of the work under this Agreement.
d. Excess or Umbrella Insurance:
All required limits of insurance may be satisfied by the use of any combination of primary and excess/umbrella
liability insurance coverages. All Certificates of Insurance for umbrella and excess liability policies should
clearly indicate which underlying policies such excess or umbrella liability policies are applicable to on an
excess basis.
e. Evidence of Insurance:
Provider shall not commence work until the required insurance is in force and evidence of insurance meeting all
of the requirements set forth herein has been provided to JWB.
JWB at all times reserves the right to request such additional documentation and evidence of insurance as in its
sole discretion it may require and the Provider hereby agrees to provide same. An appropriate Certificate of
Insurance signed by an authorized representative of the insurer shall be satisfactory evidence of insurance. With
respect to the Commercial General Liability, an appropriate Certificate of Insurance signed by an authorized
representative of the insurer, and copies of the actual additional insured endorsement(s) as issued on the
policy(ies), shall be satisfactory evidence of such insurance.
The evidence of insurance provided by Provider must include a disclosure of the amount(s) of all deductibles or
self-insured retentions applicable to any policy of insurance required under this section.
Until such insurance is no longer required by this Agreement, Provider shall provide JWB with renewal or
replacement evidence of insurance at least fifteen (15) days prior to the expiration or termination of such
insurance.
Notwithstanding the prior submission of a Certificate of Insurance, copies of endorsements, or other evidence
initially acceptable to JWB, if requested by JWB, Provider shall, within thirty (30) days after receipt of a
written request from JWB, provide JWB with a certified copy(ies) of the policy(ies) providing the coverage
required herein. Provider may redact or omit, or cause to be redacted or omitted, those provisions of the policy
or policies which are not relevant to the insurance required herein.
Agency: City of Clearwater (AGN274) 07/11/2018 10:23:03 AM
Page 13 of 27
f. Notice of Cancellation:
All required policies must be endorsed to provide JWB with 30 days prior notice of cancellation.
Primary and Non -Contributory: The insurance provided by the Provider shall apply on a primary basis to and
shall not require contribution from, any insurance maintained by JWB. Any insurance or self-insurance
maintained by JWB shall be in excess of, and shall not contribute with, the insurance provided by Provider.
Deductibles/Self-Insured Retentions: Except as otherwise specifically authorized in this Agreement, no
deductible or self-insured retention for any insurance required of Provider pursuant to this Agreement will be
allowed. To the extent any required insurance is subject to any deductible or self-insured retention (whether
with or without prior approval of JWB), Provider shall be solely responsible for paying any such deductible or
self-insured retention.
Non-Waiver/Remedies: Compliance with these insurance requirements shall not limit the liability of Provider,
its subcontractors, sub -subcontractors, employees or agents. Any remedy provided to JWB or JWB's officials,
officers or employees by the insurance provided by Provider shall be in addition to and not in lieu of any other
remedy (including, but not limited to, as an indemnitee of Provider) available to JWB under this Agreement or
otherwise.
Neither approval nor failure to disapprove insurance furnished by Provider shall relieve Provider from the
responsibility to provide insurance as required by this Agreement.
Provider shall provide JWB with renewal or replacement evidence of insurance at least fifteen (15) days prior to
the expiration or termination of such insurance.
26. Insurance Requirements - Additional Coverages
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 additional insurance coverage with responsible
companies, eligible to do business in the State of Florida, which maintain a rating of A -(IX) or higher with
A.M. Best.
a. Professional Liability
Each Claim
Annual Aggregate
Deductible or Self Insured Retention
$500,000
$500,000
$25,000
Such insurance shall be on a form acceptable to JWB and shall cover Provider for those sources of liability
arising out of the rendering or failure to render professional services in the performance of the services required
in the Agreement including any hold harmless and/or indemnification agreement.
If the Professional Liability is provided on a Claims Made Form, the retroactive date must be no later than the
first date of this Agreement and such claims -made coverage must respond to all claims reported within three
years following the period for which coverage is required.
Agency: City of Clearwater (AGN274) 07/11/2018 10:23:03 AM
Page 14 of 27
b. Cyber Liability
Each Claim N/A
Annual Aggregate N/A
Deductible or Self Insured Retention N/A
The Cyber Liability insurance shall be on a form acceptable to JWB and shall cover Security & Privacy
Liability and Breach Response Coverage, including Notification Expenses.
If the Cyber Liability is provided on a Claims Made Form, the retroactive date must be no later than the first
date of this Agreement and such claims -made coverage must respond to all claims reported within three (3)
years following the period for which coverage is required.
The required Cyber Liability coverage may be included as part of the Professional Liability coverage and limits
required above.
c. Abuse and Molestation Liability
Each Claim
Annual Aggregate
Deductible or Self Insured Retention
$1,000,000
$1,000,000
$25,000
Such insurance shall be on a form acceptable to JWB and shall cover Provider and its employees for liability
arising out of any occurrence of abuse or molestation in relation to the work provided by Provider under the
Agreement.
If the Abuse and Molestation coverage is provided on a Claims Made Form, the retroactive date must be no
later than the first date of this Agreement and such claims -made coverage must respond to all claims reported
within three (3) years following the period for which coverage is required.
d. Directors and Officers/Employment Practices Liability
Each Claim
Annual Aggregate
Deductible or Self Insured Retention
$1,000,000
$1,000,000
$25,000
Such insurance shall be on a form acceptable to JWB and shall cover Provider and its directors, officers and
employees for liability arising out of "Wrongful Acts" in the performance of their duties as directors, officers
and employees of Provider. In addition, coverage shall be included for "Wrongful Acts" of Provider arising out
of Provider's employment practices.
If, the coverage is provided on a Claims Made Form, the retroactive date must be no later than the first date of
this Agreement and such claims -made coverage must respond to all claims reported within three (3) years
following the period for which coverage is required.
Agency: City of Clearwater (AGN274) 07/11/2018 10:23:03 AM
Page 15 of 27
e. Crime Insurance
Such insurance shall be on a form acceptable to JWB and shall provide the following coverages in the following
amounts:
Employee Dishonesty: $300,000
Forgery or Alteration: $300,000
Robbery (on or off premises): $300,000
Computer Fraud: $300,000
Funds Transfer Fraud: $300,000
f. Watercraft Liability
To the extent watercraft are utilized, Provider shall purchase and maintain insurance which shall, at a minimum,
cover Provider for injuries or damage arising out of the use of all owned, non -owned and hired watercraft.
The insurance shall include JWB and its officials, officers and employees as additional insureds.
The limits applicable to watercraft liability shall be:
Each Occurrence/Annual Aggregate $300,000
g. Pollution Legal Liability
Such insurance shall cover Provider for liability resulting from pollution or other environmental impairment
arising out of, or in connection with, work performed under this Agreement, or which arises out of, or in
connection with this Agreement, including coverage for clean-up of pollution conditions and third party bodily
injury and property damage claims arising from pollution conditions. Such insurance shall also include
transportation coverage and non -owned disposal site coverage.
Coverage must either be on an occurrence basis; or, if on a claims -made basis, the coverage must respond to all
claims reported within three (3) years following the period for which coverage is required and which would
have been covered had the coverage been on an occurrence basis.
The minimum limits (inclusive of any amounts provided by an umbrella or excess policy) shall be:
Each Claim
Annual Aggregate
Deductible or Self Insured Retention
$500,000
$500,000
$25,000
JWB and JWB's officials, officers, and employees shall be included as an "Additional Insureds" on the policy.
27. Indemnification
Provider shall defend, indemnify, and hold harmless JWB, its agents, and employees from and against any and
all liabilities, claims, judgments, or actions including, but not limited to, attorney's fees and all costs that may
Agency: City of Clearwater (AGN274) 07/11/2018 10:23:03 AM
Page 16 of 27
hereafter at any time be made or brought by any person or entity on account of any claim including but not
limited to, 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, arising out of or relating to its performance of this Agreement or for Provider's
improper disclosure of confidential and/or exempt information, or failure to comply with F.S. 119 or any other
applicable law, rule or regulation. 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. This provision survives termination of the Agreement.
28. Certification that Provider is legally able to contract with JWB
In compliance with F.S. 287.135(a), a Provider is ineligible to and may not enter into a contract with JWB if the
Provider is on the Scrutinized Companies that Boycott Israel List, created pursuant to s. 215.4725 or is engaged
in a boycott of Israel. In compliance with F.S. 287.135(b), for contracts of $1 million or more, a Provider is
ineligible to and may not enter into a contract with JWB if the Provider (1) is on the Scrutinized Companies
with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Section
List, created pursuant to s. 215.473 or, (2) is engaged in business operations in Cuba or Syria. By entering into
this Agreement, you are certifying that you are eligible to contract with JWB and are not participating in a
boycott of Israel, are not on the Scrutinized Companies with Activities in Sudan List, are not on the Scrutinized
Companies with Activities in the Iran Petroleum Energy Sector List and that you do not have business
operations in Cuba or Syria. In addition, this Agreement may be terminated if Provider (1) has found to have
submitted a false certification, (2) has been placed on the Scrutinized Companies that Boycott Israel List, or is
engaged in a boycott of Israel, (3) has been placed on the Scrutinized Companies with Activities In Sudan List
or the Scrutinized Companies with Activities in The Iran Petroleum Energy Sector List; or (4) has been engaged
in business operations in Cuba or Syria.
Agency: City of Clearwater (AGN274) 07/11/2018 10:23:03 AM
Page 17 of 27
IX. SIGNATURES
Dr. Marcie A. Bidd eman
Chief Executive Officer: Juvenile Welfare Board
of Pinellas County
b72///,
Date
Countersigned:
ct?Arktr1Cf sktc43
George N. Cretekos
Mayor
App ved as to form:
441/ 114e1
Owen Kohler
Assistant City Attorney
Agency: City of Clearwater (AGN274)
William B. Horne, II
City Manager: City of Clearwater
r. , k) 13, I
Date
Rosemarie Call
City Clerk
Page 18 of 27
07/11/2018 10:23:03 AM
Attachment 1
Special Conditions of the Agreement
The following condition(s) applies to the following program(s):
--- City of Clearwater (COST)
Provider approved COST program shall adhere to the JWB approved Program Service Matrix Model Program
Components for Out of School Time Programming.
The Provider will complete and submit the Florida Afterschool Network (FAN) Quality Self- Assessment and
Improvement Guide within 30 days of the effective date of this Agreement including specific information for all
sites regarding Categories 3, 4, 6, and 7. In addition, Provider will submit the required Program Improvement
Plan identifying strategies towards progress to JWB within 30 days following the due date according to the
FAN assessment timeline.
The Provider and all facilities legally required to be licensed must maintain valid licensure. Facilities not
required to be licensed must maintain a Certificate of Substantial Compliance issued by the Pinellas County
License Board (PCLB). Should any Provider or facility's license or certification be revoked, not renewed, or
suspended during the time services are being provided hereunder, the Provider must immediately notify JWB
within twenty-four (24) hours in writing and said Provider or facility is no longer qualified to provide services
to the Recipients under the terms of this Agreement. Provider or facility's license must be considered in Good
Standing, which is defined as having no probationary license status within the preceding twelve (12) months.
Provider authorizes JWB to speak with PCLB and any other entity regulating the Provider about anything
relevant to Provider's child care license, history of providing care or anything else deemed relevant by JWB.
General Condition #18- Provider is waived from personnel file monitoring with JWB wherein the Provider has
no non -compliances on PCLB's most recent monitoring report/inspection checklist/complaint investigation in
the area of Personnel and at the time of JWB monitoring is in full compliance with all PCLB regulations
pertaining to Personnel, including, but not limited to, personnel records and background screening. JWB
reserves the right to monitor personnel files at any time, including if a non-compliance is noted during PCLB's
monitoring/inspection/investigation and at any time JWB deems necessary. Provider will give JWB staff access
to all PCLB monitoring reports/inspection checklist/complaint investigations. All other provisions of the
Condition remain.
The following condition(s) applies to the following Agency(AGN274):
--- City of Clearwater
General Condition #2E - The last sentence is waived: Provider is not required to submit a Continuity of
Operations Plan to JWB.
General Condition #27 - 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."
Agency: City of Clearwater (AGN274) 07/11/2018 10:23:03 AM
Page 19 of 27
General Condition #11 - Confidential Information- paragraph 4, the sentence that states, "Provider shall 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." is stricken and replaced with the
following: "Provider shall defend, indemnify, and hold harmless JWB from any and all damages caused by the
provider's 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."
General Condition #6 - Board Members, Training, and Financial Review are waived.
General Conditions #25 and #26- Insurance Requirements are waived wherein the Provider maintains
responsibility for the delivery of services. Should the Provider assign or subcontract any of the work
contemplated under this Agreement to a non-governmental entity, or to a non -Florida governmental entity, this
Insurance Requirements waiver is no longer applicable. Provider is solely responsible for ensuring
subcontractors of the Agreement are in compliance with the minimum insurance requirements as described in
General Conditions #25 and #26.
Agency: City of Clearwater (AGN274) 07/11/2018 10:23:03 AM
Page 20 of 27
Attachment 2
City of Clearwater (AGN274)
City of Clearwater (COST) (PROG478)
Performance Measurement
FY 2018-2019
Participant Level Performance Measurements
All 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 1'I2OC478
1 nr_et ('Icasnrable): Percent of eligible participants rcccising the O 1 stirs t:
TargetV2Definitionld
2905
ShortTargetTitle
Percent of eligible participants receiving the OST survey
TargetText
Percentage of eligible participants who will be given the OST Survey during the administration window
(May 2019).
TargetType
Milestone Data
ProjectedValue
0
ProjectedStartDate
10/01/2018
ProjectedEndDate
09/30/2019
Notes
Baseline
TargetV2Definitionld
1 ar et (Measurable): [RC 1 1211::knnual participation - child
1297
ShortTargetTitle
TRGT1211: Annual participation - child
TargetText
Percent of Participants who continue in the afterschool program for more than one year.
TargetType
Roster Data
ProjectedValue
65
ProjectedStartDate
10/01/2018
ProjectedEndDate
09/30/2019
Notes
Agency: City of Clearwater (AGN274)
Page 21 of 27
07/12/2018 02:10:21 PM
TargetV2Definitionld
1 arnet (Measurable): "I12(.1'1360: Percent ofdas attended
2549
ShortTargetTitle
TRGT1360: Percent of days attended
TargetText
Percent of youth attend 70% of the program days tracked on a monthly basis as demonstrated by JWB
database attendance report.
TargetType
Milestone Data
ProjectedValue
70
ProjectedStartDate
10/01/2018
ProjectedEndDate
09/30/2019
Notes
Notes
1
irget (Measurable): 112671516: Improved FS:k score - Reading
TargetV2Definitionld
2633
ShortTargetTitle
TRGT1516: Improved FSA score - Reading
TargetText
% of students with an improved score on the Florida Standardized Assessment (FSA) English Language
Arts (ELA).
TargetType
Milestone Data
ProjectedValue
0
ProjectedStartDate
10/01/2018
ProjectedEndDate
09/30/2019
Notes
Baseline
TargetV2Definitionld
1 aroet (Measurable): I RG 1 1517: Improved 1 score - Math
2634
ShortTargetTitle
TRGT1517: Improved FSA score - Math
TargetText
% of students with an improved score on the Florida Standardized Assessment (FSA) Mathematics.
TargetType
Milestone Data
ProjectedValue
0
ProjectedStartDate
10/01/2018
ProjectedEndDate
09/30/2019
Notes
Baseline
Target (\Icasurable): TRGT1519: Less than 10'%0 of school dans unattended
TargetV2Definitionld
2636
ShortTargetTitle
TRGT1519: Less than 10% of school days unattended
TargetText
% of students who miss less than 10% of unexcused school days.
TargetType
Milestone Data
ProjectedValue
0
ProjectedStartDate
10/01/2018
ProjectedEndDate
09/30/2019
Notes
Baseline
Sers ices .Not :associated with .ins 1 argots in Program's SOW
Agency: City of Clearwater (AGN274)
Page 22 of 27
07/12/2018 02:10:21 PM
\liilestones Not lssociated with Targets in Program's SO\C
Sin•NeDefinitions Information for 1'ROO.478
Agency: City of Clearwater (AGN274) 07/12/2018 02:10:21 PM
Page 23 of 27
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:
Participants are
Program Name eligible
('otinty idc
City of Clearwater
(COST)
Participants arc eligible IN Ito reside in the following zip
codes or the follow ing geographical areas
(list all zip codes of the target area or describe the geographical arca)
Participants will primarily reside in high risk zone 2: 33755, and 33756. However, participants can also
reside in the following zip codes: 33763, 33764, 33765, 33770, 33778, 34677, 34695, and 34698.
Agency: City of Clearwater (AGN274)
Page 24 of 27
07/12/2018 02:10:21 PM
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Agency: City of Clearwater (AGN274) 07/12/2018 02:10:21 PM
Page 25 of 27
Pay#
1119
kccounts Payable Schedule
Submission
Due Date
Reimbursement
Date
1
09/28/18
10/05/18
2
10/12/18
10/19/18
3
10/26/18
11/02/18
4
11/09/18
11/16/18
5
11/23/18
11/30/18
6
12/07/18
12/14/18
7
12/21/18
12/28/18
8
01/04/19
01/11/19
9
01/18/19
01/25/19
10
02/01/19
02/08/19
11
02/15/19
02/22/19
12
03/01/19
03/08/19
13
03/15/19
03/22/19
14
03/29/19
04/05/19
15
04/12/19
04/19/19
16
04/26/19
05/03/19
17
05/10/19
05/17/19
18
05/24/19
05/31/19
19
06/07/19
06/14/19
20
06/21/19
06/28/19
21
07/05/19
07/12/19
22
07/19/19
07/26/19
23
08/02/19
08/09/19
24
08/16/19
08/23/19
25
08/30/19
09/06/19
26
09/13/19
09/20/19
27
09/27/19
10/03/19 (September business)
28
10/11/19
10/17/19 (September business)
29
10/25/19
10/31/19 (September business)
Agency: City of Clearwater (AGN274)
Page 26 of 27
07/12/2018 02:10:21 PM
Attachment 5
Document Submittal Chart
Provider Document
Program methodology update or
certification that no updates are
needed.
1 imc 1 r,nnc
Submit lo
Agency Specific JWB Secure
Portal Site
Within thirty (30) days of effective date of Agreement
Approved program methodology
January 11th, 2019
Agency Specific JWB Secure
Portal Site
COOP - WAIVED
Within thirty (30) days of effective date of Agreement
Agency Specific JWB Secure
Portal Site
Salary Adjustment Approval
If applicable, then prior to budget submission or subsequent amendment
Agency Specific JWB Secure
Portal Site
Quarterly Program Statement of
Financial Activities
Within thirty (30) days following the end of each quarter ofJWB's fiscal
year.
Agency Specific JWB Secure
Portal Site ,
Most Recent Audit
Immediately upon receipt by the Providers Board or not to exceed 180 days
of the close of the Provider's fiscal year
Agency Specific JWB Secure
Portal Site
Monitoring, Site Visit,
Accreditation and Licensing
Reports
Upon receipt
Agency Specific JWB Secure
Portal Site
User Accessupon
Notify the JWB Program Consultant and complete the designated form
immediately upon involuntary termination and within five (5) business days
voluntary separation or whenever a Provider staff person's access must
be inactivated due to the reasons outlined in JWB's Data Quality Manual.
JWB Program Consultants
Board Member List WAIVED
Within thirty (30) calendar days of approval or a change of Board
composition
Agency Specific JWB Secure
Portal Site
Policy and procedure regarding
Board review of Provider
finances - WAIVED
Within thirty (30) calendar days of effective date of Agreement and upon
revision and approval by the Provider's board
Agency Specific JWB Secure
Portal Site
Board Training
(Outline of topics, members in
attendance and who provided
training) - WAIVED
For new board members, prior to issuance of subsequent year's contract or
August 1n of current fiscal year, whichever occurs first
Agency Specific JWB Secure
Portal Site
Subcontracts
Within thirty (30) calendar days of the effective date of this Agreement and
upon revision, amendment and execution thereafter.
Agency Specific JWB Secure
Portal Site
Incident Reports
Within one (1) business day of occurrence
IRreviewteam@jwbpinellas.org
Executive Director Affidavit
(Providers using VECHS)- Not
Applicable
Within thirty (30) calendar days of the effective date of this Agreement and
upon change of staff in this position.
Agency Specific JWB Secure
Portal Site
Procedure for General Condition
#18 (Provider Staff Background
Checks) - Not Applicable
Within thirty (30) calendar days of the effective date of this Agreement
Agency Specific JWB Secure
Portal Site
Drug -Free Workplace policy
Within thirty (30) calendar days of effective date of Agreement and upon
revision and approval by the Provider's board
Agency Specific JWB Secure
Portal Site
Insurance Documentation —
WAIVED- Unless services are
subcontracted
Throughout the period of the Agreement and with renewal or replacement at
least fifteen (15) days prior to the expiration or termination of such
insurance.
Agency Specific JWB Secure
Portal Site
Agency: City of Clearwater (AGN274)
Page 27 of 27
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