HomeMy WebLinkAboutContract 44032 (2)CITY SECRETARY
CONTRACT NO.
PROFESSIONAL SERVICES AGREEMENT
This PROFESSIONAL SERVICES AGREEMENT ("Agreement") is
made and entered into by and between the CITY OF FORT WORTH (the
"City"), a home rule municipal corporation organized under the laws of the State
of Texas, acting by and through Fernando Costa, its duly authorized Assistant
City Manager, and NORTHSIDE INTER -COMMUNITY AGENCY, INC.
("Consultant"), a Texas Non -Profit Corporation authorized to do business in and
in good standing with the State of Texas, acting by and through Connie
Nahoolewa, its duly authorized Executive Director.
1. SCOPE OF SERVICES.
1.1. Consultant's Services.
Consultant hereby agrees to provide the City's Housing and
Economic Development Department ("HED") with professional
consulting services to assist HED in increasing awareness of and access to
HED's Lead -Safe Program ("LSP") among Fort Worth residents living in
central city zip codes (76104, 76105, 76106, 76110, 76111, 76164) by
conducting targeted community outreach; educating the public on how to
protect young children from lead -based paint hazards; and other activities
that will assist in increasing the volume of LSP applicants (collectively the
"Project"). The Project is described in detail in Exhibit "A", attached
hereto and hereby made a part of this Agreement for all purposes. The
City and Consultant may change the scope of the Project by substituting
an amended Exhibit "A", signed by both the City and Consultant, which
shall then be attached to this Agreement and made a part of this
Agreement for all purposes.
1.2. City's Duties.
The City shall provide Consultant access on a reasonably timely
basis to various City personnel for consultation, interviews, questions,
document reviews and other forms of participation necessary to the
Project. The City shall also provide Consultant with reasonable facilities
and equipment in order to allow Consultant to perform its duties and
obligations under this Agreement when it is necessary for Consultant to be
on -site.
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1.3. Work Schedule.
A written work schedule applicable to the Project ("Work
Schedule") has been completed by the City and Consultant. This Work
Schedule establishes timetables and milestones relating to and in
accordance with each step of work referenced in Exhibit "A".
1.4. Work Product.
All work produced by Consultant under this Agreement
(collectively the 'Work Product '), specifically including, but not limited
to, Presentation Cover Sheets, Attendance Certification Forms
Canvassing Documentation Forms, and supporting documentation such as
sign -in sheets, confirmation e-mails, and pictures, shall be owned, at all
times, by the City. Consultant shall deliver any undelivered Work Product
to the City upon the termination or expiration of this Agreement. The City
shall have access to and be entitled to review and copy any portion of the
Work Product at any time. Consultant may retain a copy of the Work
Product except as to any portion thereof that is proprietary or otherwise
confidential.
2. TERM.
This Agreement shall commence upon the date that both the City and
Consultant have executed this Agreement (` Effective Date") and shall continue
in full force and effect for a term of 18 months thereafter unless (i) terminated
earlier in accordance with the provisions of this Agreement or (i1) when the City
has provided Consultant with written notice that Consultant has fulfilled its
obligations under this Agreement and that Consultant's services are no longer
required.
3. COMPENSATION.
Subject to the provisions of Section 4.2 of this Agreement, the City shall
pay Consultant a sum not to exceed $10,000 in services provided and expenses
incurred in the carrying out and fulfillment of Consultant's duties and obligations
under this Agreement. The specific services and expenses involved in each step
of the Project are described in Exhibit "A". Notwithstanding anything herein to
the contrary, in no event shall Consultant be compensated any sum greater than
$10,000 for services provided pursuant to this Agreement unless this Agreement
is amended in writing by both the City and Consultant.
4. TERMINATION.
4.1. Written Notice.
The City may terminate this Agreement at any time and for any
reason by its pi oviding the other party with written notice of termination.
4.2. Duties and Obliizations of the Parties.
In the event that this Agreement is terminated prior to its
expiration, as provided in Section 2, the City shall pay Consultant for
services actually rendered as of the effective date of termination and
Consultant shall continue to provide the City with services requested by
the City and in accordance with this Agreement up to the effective date of
termination
5. DISCLOSURE OF CONFLICTS AND CONFIDENTIAL
INFORMATION.
Consultant hereby warrants to the City that Consultant has made full
disclosure in writing of any existing or potential conflicts of interest related to
Consultant's .services and proposed services with respect to the Project. In the
event that any conflicts of interest arise after the Effective Date of this
Agreement, Consultant hereby agrees immediately to make frill disclosure to the
City in writing
The City acknowledges that Consultant may use products, materials or
methodologies proprietary to Consultant. The City agrees that Consultant's
provision of services under this Agreement shall not be grounds for the City to
have or obtain any rights in such proprietary products materials or methodologies
unless the parties have executed a separate written agreement with respect thereto.
Notwithstanding the foregoing, Consultant under stands and agrees that the City is
subject to various public information laws and regulations, including, but not
limited to the Texas Open Records Act. Consultant, for itself and its officers
agents and employees, further agrees that it shall treat all information provided to
it by the City as confidential and shall not disclose any such information to any
third party without the prior written approval of the City.
I
6. AUDITS.
The City shall have, for three (3) years following the termination of this
Agreement and upon reasonable advance notice, access to and the right to
examine and audit any books, documents, papers, records or other data of
Consultant that involve transactions relating to this Agreement. Accordingly,
Consultant shall provide the City with access during normal working hours to all
of Consultant's facilities and with appropriate workspace at Consultant's facilities
necessary foi the City to conduct examinations and audits in accordance with this
Agreement.
7. INSURANCE.
During the term of this Agreement, Consultant shall procure and maintain
at all times, in full force and effect, a policy or policies of insurance that provide
the specific coverage set forth in this Section 7 as well as any and all other public
risks related to Consultant's performance of its obligations under this Agreement.
Consultant shall specifically obtain the following types of insurance at the
following limits:
• Commercial General Liability:
$1,000,000 per occurrence; providing blanket contractual liability -
insurance products and completed operations; independent
Consultant's liability; and coverage for pioperty damage to City
facilities; and
• Automobile Liability:
$1,000,000 per occurrence or accident; including, but not limited to,
all vehicles whether owned or hired, in use by Consultant, its
employees, agents or subconsultants; and
• Worker's Compensation/Employer's Liability:
Worker's compensation coverage as required by applicable law; and
Employer's Liability at $100,000 per accident
Prior to the Effective Date, Consultant shall provide the City with
certificates of insurance that verify Consultant's compliance with the insurance
requirements of this Agreement. The City's Risk Manager shall have the right to
review and evaluate Consultant's insurance coverage and to make reasonable
requests or revisions pertaining to the types and limits of that coverage
Consultant shall comply which such requests or revisions as a condition precedent
to the effectiveness of this Agreement.
8. INDEPENDENT CONSULTANT.
It is expressly understood and agreed that Consultant shall operate as an
independent Consultant as to all rights and privileges granted herein, and not as an
agent, representative or employee of the City. Subject to and in accordance with
the conditions and provisions of this Agreement, Consultant shall have the
exclusive right to control the details of its operations and activities and shall be
solely responsible for the acts and omissions of its officers, agents, servants,
employees, Consultants and subconsultants. Consultant acknowledges that the
doctrine of respondent superioi shall not apply as between the City its officers,
agents, servants and employees, and Consultant, its officers, agents, employees,
Consultants and subconsultants Consultant further agrees that nothing herein
shall be construed as the creation of a partnership or joint enterprise between the
City and Consultant.
9. LIABILITY AND INDEMNIFICATION.
CONSULTANT SHALL BE LIABLE AND RESPONSIBLE FOR ANY
AND ALL CLAIMS, DEMANDS, LAWSUITS OR OTHER ACTIONS FOR
DAMAGES OF ANY KIND, INCLUDING, BUT NOT LIMITED TO,
PROPERTY LOSS, PROPERTY DAMAGE AND/OR PERSONAL INJURY,
INCLUDING DEATH, TO ANY AND ALL PERSONS, OF ANY KIND OR
CHARACTER, WHETHER REAL OR ASSERTED, TO THE EXTENT
CAUSED BY THE NEGLIGENT ACT(S) OR OMISSION(S),
MALFEASANCE OR INTENTIONAL MISCONDUCT OF CONSULTANT,
ITS OFFICERS, AGENTS, SERVANTS OR EMPLOYEES.
CONSULTANT COVENANTS AND AGREES TO, AND DOES
HEREBY, INDEMNIFY, HOLD HARMLESS AND DEFEND THE CITY, ITS
OFFICERS, AGENTS SERVANTS AND EMPLOYEES, FROM AND
AGAINST ANY AND ALL CLAIMS OR LAWSUITS FOR DAMAGES OF
ANY KIND, INCLUDING, BUT NOT LIMITED TO, PROPERTY DAMAGE
OR LOSS (INCLUDING ALLEGED DAMAGE OR LOSS TO
CONSULTANT'S BUSINESS AND ANY RESULTING LOST PROFITS)
AND/OR PERSONAL INJURY, INCLUDING DEATH, TO ANY AND ALL
PERSONS, OF ANY KIND OR CHARACTER, WHETHER REAL OR
ASSERTED, ARISING OUT OF OR IN CONNECTION WITH THIS
AGREEMENT, TO THE EXTENT CAUSED BY THE NEGLIGENT ACTS
OR OMISSIONS OR MALFEASANCE OF CONSULTANT, ITS OFFICERS,
AGENTS, SERVANTS OR EMPLOYEES.
10. ASSIGNMENT AND SUBCONTRACTING.
Consultant shall not assign or subcontract any of its duties, obligations or
rights under this Agreement without the prior written consent of the City If the
City grants such consent, the assignee or subconsultant shall execute a written
agreement with the City under which the assignee of subconsultant agrees to be
bound by the duties and obligations of Consultant under this Agreement.
11. COMPLIANCE WITH LAWS, ORDINANCES, RULES AND
REGULATIONS.
Consultant agrees to comply with all federal, state and local laws,
ordinances, rules and regulations. If the City notifies Consultant of any violation
of such laws, ordinances, rules or regulations, Consultant shall immediately desist
from and correct the violation
12. NON-DISCRIMINATION COVENANT.
Consultant, for itself, its personal representatives, assigns, subconsultants
and successors in interest, as part of the consideration herein, agrees that in the
performance of Consultant's duties and obligations hereunder, it shall not
discriminate in the treatment or employment of any individual or group of
individuals on the basis of race color national origin, religion, handicap, sex,
gender expression, gender identity, transgender, sexual orientation or familial
status. If any claim arises from an alleged violation of this non-discrimination
covenant by Consultant, its personal representatives, assigns, subconsultants or
successors in interest, Consultant agrees to assume such liability and to indemnify
and defend the City and hold the City harmless from such claim.
13. LICENSES AND PERMITS.
Consultant shall, at its sole expense, obtain and keep in effect all licenses
and permits necessary for it to carry out its duties and obligations hereunder.
14. NOTICES.
Notices required pursuant to the provisions of this Agreement shall be
conclusively determined to have been delivered when (1) hand -delivered to the
other party, its agents, employees, servants or representatives, (2) delivered by
facsimile with electronic confirmation of the transmission, or (3) received by the
other party by United States Mail, registered, return receipt requested, addressed
as follows:
To THE CITY:
City of Fort Worth
Housing and Economic Development
Joe Cordova
Lead -Safe Program Manager
1000 Throckmorton
Fort Worth, TX 76102-6311
Facsimile: (817) 392- 5436
15. GOVERNMENTAL POWERS.
To CONSULTANT:
Northside Inter -Community Agency
Connie Nahoolewa
Executive Director
1600 Circle Park Blvd.
Fort Worth, TX 76164
Facsimile: (817) 626-9043
It is understood and agreed that by execution of this Agreement, the City
does not waive or surrender any of its governmental powers.
16. NO WAIVER.
The failure of the City or Consultant to insist upon the performance of any
term or provision of this Agreement or to exercise any right granted herein shall
not constitute a waiver of the City's or Consultant s respective right to insist upon
appropriate performance or to assert any such right on any future occasion.
17. VENUE , JURISDICTION AND EXPENSES.
This Agreement shall be construed in accordance with the laws of the
State of Texas If any action, whether real or asserted, at law or in equity, is
brought on the basis of this Agreement, venue for such action shall lie in state
courts located in Tarrant County, Texas or the United States District Court for the
Northern District of Texas, Fort Worth Division. In any such action, the
prevailing party shall be entitled to recover from the other party reasonable
attorneys' fees incurred in the bringing or defending of the action
18. SEVERABILITY.
If any provision of this Agreement is held to be invalid, illegal or
unenforceable, the validity, legality and enforceability of the remaining provisions
shall not in any way be affected or impaired.
19. FORCE MAJEURE.
The City and Consultant shall exercise their best efforts to meet their
respective duties and obligations as set foith in this Agreement, but shall not be
held liable for any delay or omission in perfonnance due to force majeure or other
causes beyond then reasonable control, including, but not limited to, compliance
with any government law, ordinance or regulation acts of God acts of omission,
fires, strikes, lockouts national disasters, wars riots, material or labor restrictions
by any governmental authority, transportation problems and/or any other similar
causes.
20. HEADINGS NOT CONTROLLING.
Headings and titles used in this Agreement are for reference purposes only
and shall not be deemed a part of this Agi eement.
21. ENTIRETY OF AGREEMENT.
This Agreement, including the schedule of exhibits attached hereto and
any documents incorporated herein by reference, contains the entire
understanding and agreement between the City and Consultant their assigns and
successors in interest, as to the matters contained herein Any prior or
contemporaneous oral or written agreement is hereby declared null and void to the
extent in conflict with any provision of this Agreement. This Agieement shall not
be amended unless agreed to in writing by both parties and, if required, approved
by the City's City Council.
IN WITNESS hereto have executed this
ter the parties
Agreement in multiples as ofthe la date below:
NORTITSIDE INTER -
UNITY AGENCY
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By:
Date:
ATTEST
Fernando Costa
Assistant City
Manager
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Connie NahO°
Executive Director
Date: i"
OFFIUAL RECORD
CITY SECRETARY
FT. WORTH, TX
STATE OF TEXAS §
COUNTY OF §
BEFORE ME, the undersigned authority, a Notary Public in and for the
State of Texas, on this day personally appeared Connie Naholeewa known to me to
be the person whose name is subscribed to the foregoing instrument, and
acknowledged to me that the same was the act of Northside Inter -Community
Agency and that she executed the same, and had authorization to execute the same,
as the act of Northside Inter -Community Agency for the purposes and
consideration therein expressed and in the capacity therein stated.
GIVEN UNDER MY HAND AND SEAL OF OFFICE this Pday of
est
UUA AURORA ESOOBEDO
MY COMMISSION EXPIRES _ Febnjaty 8, 2015 Notary Public in and for the State of Texas
STA'i'E OF TEXAS
COUNTY OF TARRANT §
BEFORE ME, the undersigned authority, a Notary Public in and for the
State of Texas, on this day personally appeared Fernando Costa, known to me to be
the person whose name is subscribed to the foregoing instrument, and acknowledged
to me that the same was the act of the City of Fort Worth and that he executed the
same as the act of the City of Fort Worth for the purposes and consideration therein
expressed and in the capacity therein stated.
GIVEN UNDER MY HAND AND SEAL OF OFFICE this At day of
20l ..3
batnytW
Notary Public in and for the State of Texas
1 . 1
EVONIA DANIELS
MY COMMISSION EXPIRES
July 10,2013
EXHIBIT "A"
I. Purpose
The purpose of all community outreach activities is to increase Lead -Safe
Program participation, awareness, and access among target audiences (income
eligible Fort Worth families living in pre-1978 housing with children under
the age of six who live or spend extended periods of time in a lead -
contaminated residence).
II. Definitions
"Target Lead -Safe Program (LSP) Zip Codes"- Shall mean six central city
zip codes where Lead -Safe Program outreach activities will be focused so as
to reach Foit Worth residents living in central city zip codes, specifically zip
codes 76104, 76105, 76106 76110, 7611, and 76164.
"Presentation"- Shall mean an activity where the Consultant has an
opportunity to present to the public on 1) the lead -hazard seduction services
that are available to income -eligible families through the Lead -Safe Program,
2) the program's eligibility criteria, 3) explain how interested residents can
apply for the program and 4) distribute LSP brochures and program referral
cards to interested residents Presentations must be made in person, and
documented using an "Activity Cover Sheet" (See Exhibit B) or "Attendance
Certification Form" (See Exhibit C). Visual aides are recommended but not
required in presentations.
"Canvassing"- Shall mean an activity where the Consultant has an
opportunity to leave a LSP brochure or flyer in the entryway, doorstep, yard,
or door of 100 single-family residential units located in every Target LSP Zip
Code. The Consultant's employees and volunteers must comply with Section
23-15 of the City of Fort Worth's Code of Ordinances, "Posting of handbills,
signs, posters, or advertisements in certain places- Prima facie evidence of
violation" (Ord. No 9741, § 1 10-14-86; Ord. No. 17829, § 2, 10-9-07, Ord.
No. 18359-11-2008, § 1, 11-11-08). The Consultant shall not leave LSP
brochures in properties where a "No Soliciting", 'No Handbills" or "No
Trespassing" sign is posted; on or in mailboxes, os in properties where the
property owner, during the time of placement, orally insts ucts that no such
material be placed on the property Consultant must not knock on residents'
doors. Canvassing activities must be documented using a "Canvassing
Documentation Form" (See Exhibit D).
"Event"- Shall mean a one -hour period of time during which the Consultant
1) sets up a table or booth display containing LSP brochures or flyers, 2)
distributes LSP brochures and referral cards to interested event participants, 3)
helps interested residents complete a referral card, and 4) collects any
completed program referral cards. Whenever feasible, the Consultant will
verbally inform event participants of the lead -hazard reduction services that
are offered through the Lead -Safe Program; review the program's eligibility
criteria; and explain how interested residents can apply for the program
Events must be documented using an "Attendance Certification Form" (See
Exhibit C).
"Referral Screening"- Shall mean an activity where the Consultant has an
opportunity to 1) identify 'at risk' Fort Worth residents (see definition) who
may be 'at risk for lead exposure during the Consultants' daily intake
interviews, 2) inform 'at risk' clients of the lead -hazard reduction services that
are offered through the LSP, and 3) provide `at -risk' clients who are interested
in completing a LSP application with a referral card.
"At -risk Resident"- Shall mean any Fort Worth resident who discloses that
1) he/she lives in a pre-1978 residence where one or more children under the
age of six (6) reside or spend at least 60 hours a year and/or that 2) that a child
under the age of six (6) who lives with them or in their care has received an
elevated blood lead level test result within the past 12 months.
' Lead -Safe Poster Contest"- Shall mean an activity where the Consultant
develops entry rules, a selection process, and publicity for an art poster contest
(tentatively titled "Prevent Lead Poisoning") on lead hazards and lead
poisoning prevention open to Fort Worth students in grades K-8. The content
of all participating poster entries will focus on lead, how childhood lead
poisoning can occur, and/or how it can be prevented The poster contest will
feature prizes such as gift cards, certificates of recognition /participation,
and/or medals that will be awarded to the winning entries in each of the
following divisions• Division I (K-2°d grade), Division II (3-5th grade),
Division III (6-8th glade).
III.Scope of Work
During the contract period, the Consultant will perform 113 outreach
activities, consisting of Presentations, Canvassing, Events, Referral Screening,
and a Lead -Safe Poster Contest. The Consultant will inform LSP staff of the
days, times, and locations of scheduled Presentations and Events the first
week of every month.
A. Presentations
i. Consultant will conduct 89 Presentations specifically:
1. Sixty (60) Presentations to participants enrolled in the
Consultant's ongoing programs, such as ESL, GED and
computer classes, nutrition education programs, and
gardenmg programs;
2. Sixteen (16) Presentations at faith -based organizations
located in the City of Fort Worth;
3. Three (3) Presentations to participants enrolled in the
Consultant's 2013 summei reading programs;
4. Four (4) Presentations featuring a health/nutrition
expert, Texas AgriLife, and/or Tarrant Area Food Bank
staff member that will educate participants enrolled in
NICA's ongoing programs on foods that help reduce
the absorption of lead into the body and
5. Six (6) Presentations to participants enrolled in the
Consultant's 2013 Thanksgiving and Christmas
programs.
B. Canvassing
i. Consultant will conduct 16 Canvassing activities, and reach
1 600 unduplicated single-family, residential units
ii. The Consultant will notify LSP staff of the day time and
the street blocks that will be canvassed at least two (2)
weeks before each month s scheduled Canvassing activity
takes place.
C. Events
i. Consultant will participate in six (6) Events, specifically:
1. National Night Out held at the Northside
Community Center;
2. Cinco de Mayo celebration held at All Saint's
Catholic Church in May 2013 and
3. Four (4) additional Events, such as health fairs,
community center festivals, neighborhood block
parties, special school events, etc.
D. Referral Screening
i. The Consultant will identify and refer At -Risk residents to
the Lead -Safe Program during their daily intake interviews
occurring every Tuesday to Friday from 9:00 a m. to 3:30
p.m. and every Saturday from 9:30 a m to 12:00 p m.
E. Lead -Safe Poster Contest
i. The Consultant will sponsor one Lead -Safe Poster Contest
during July 2013 that will be announced to children
enrolled in Consultants' programs, and with flyers posted
in at least two (2) other public venues, such as a public
libiaiy branch or community center.
ii. Consultant will partner with a public agency to publicly
display select poster entries for at least one week.
IV. LOCATIONS OF ACTIVITIES
The locations where contracted activities will take place are as follows:
A. Presentations
i. All Presentations, except those to faith -based organizations,
will take place at 1600 Circle Park Boulevard, Fort Worth,
TX, 76164.
ii. At least 12 out of 16 Presentations at faith -based
organizations must take place in all Target LSP Zip Codes.
The remaining 4 presentations may take place outside these
zip codes, but at locations within the City of Fort Worth.
B. Canvassing
i. All Canvassing must take place in all Target LSP Zip Codes.
C. Events
i. Two (2) Events will take place in zip codes 76164, and the
remaining four (4) Events may take place in any of the
following zip codes: 76102, 76103, 76104, 76105, 76106,
76107, 76110, 76111, 76112, 76114, 76115, and 76119.
D. Referral Screening
i. All Referral Screening activities will occur at the
Consultant's facilities (1600 Circle Park Boulevard, Fort
Worth TX, 76164).
E. Lead -Safe Poster Contest
i. Flyers announcing the Lead -Safe Poster Contest will be
placed in the Consultant s facilities (1600 Circle Park
Boulevard Fort Worth, TX, 76164) and two (2) other public
venues located within a Target LSP Zip Code.
ii. Select entries will be displayed in at least one (1) other public
venue located within a Target LSP Zip Code.
V. Woi k Product Deliverables
The deliverables and submission due dates for Presentations, Canvassing, Events,
Referral Screening, and the Lead -Safe Poster Contest (collectively the "Work
Product") are listed below.
A. Presentation Deliverables
i. One "Activity Cover Sheet" (See Exhibit B) for every
Presentation conducted, except for Presentations at faith -
based organizations.
ii. For every Presentation made at a faith -based organization,
one "Attendance Certification Fonn (see Exhibit C). The
Attendance Certification Form must be signed and dated by
the hosting organization's authorized representative after the
Presentation has been completed.
One piece of supporting documentation for every
Presentation conducted, except for Presentations at faith -
based organizations. Examples include sign -in sheets,
meeting agendas, e-mail correspondence, or pictures taken at
the Presentation. Submission of supporting documentation
for Presentations made at faith -based organizations is
optional.
B. Canvassing Deliverables
i. One "Canvassing Documentation Form" (See Exhibit D) for
each Canvassing activity that takes place.
C. Event Deliverables
i. One "Attendance Certification Form" (see Exhibit C) for
each completed Event.
1±. One piece of supporting documentation must be submitted
for each Event, such as pictures of the Consultant's
table/booth at the Event, Event registration forms, and e-mail
correspondence between the Event's sponsor and the
Consultant.
D. Referral Screening Deliverables
i. Referral cards collected by the Consultant during Referral
Screenings must be delivered to LSP staff within five (5)
business days of a resident filling out the referral card.
Lead -Safe Poster Contest Deliverables
i. Flyer used to publicize the Lead -Safe Poster Contest.
ii. Lead -Safe Poster Contest's entry rules.
iii. Pictures of select Lead -Safe Poster Contest entries publicly
on display at Consultant's facilities and one other venue.
iv. Pictures of the winning Poster Contest entries in each
division.
F. Deliverable Due Dates
i. Consultant will submit deliverables to LSP staff for all
Presentations, Events, Canvassing, Referral Screening, and
the Lead -Safe Poster Contest on a quarterly basis (see Table
Period of
Performance:
Deliverables
Due On:
Referral
Cards Due:
1). Deliverables are due to LSP staff by 5 p.m. via mail, e-
mail, fax, or in person on the following dates:
1 Deliverables for all Presentations, Events, and
Canvassing taking place from Monday, Januaiy 1 to
Sunday, March 31, 2013 are due on Monday, April
1, 2013.
2. Deliverables for all Presentations, Events, and
Canvassing taking place from Monday, April 1 to
Sunday, June 30, 2013 are due on Monday, July 1,
2013.
3. Deliverables for all Presentations, Events,
Canvassing and Lead -Safe Poster Contest taking
place from Monday, July 1 to Monday, September
30, 2013 are due on Tuesday, October 1, 2013.
4. Deliverables for all Presentations, Events, and
Canvassing taking place from Tuesday, October 1,
2013 to Tuesday, December 31, 2013 are due on
Thursday, January 2, 2014.
5. Deliverables for all Presentations, Events, and
Canvassing taking place from Wednesday, January
1, 2014 to Monday March 31, 2014 are due on
Tuesday, April 1, 2014.
6. Deliverables for all Presentations, Events, and
Canvassing taking place from Tuesday, April 1,
2014 to Sunday, June 29, 2014 are due on Monday,
June 30, 2014.
7. All referral cards completed at Presentations,
through daily Referral Screening, and Events must
be delivered to LSP staff within five (5) business
days of a resident filling out the referral card via
mail, e-mail, fax, or in person.
Table 1: Summary of Work Product Deliverables
Q4 Q5
10/1/13- 1/1/14-
12/31/13 3/31/14
1/2/14 4/1/14
Q1
1/1/13-
3/31/13
4/1/13
Ongoing
Basis
Q2
4/1/13-
6/30/13
7/1/13
Q3
7/1/13-
9/30/13
10/1/13
Q6
4/1/14-
6/29/14
6/30/14
VI. COSTS
Outreach Activity
Presentations
Canvassing
Events
Referral Screening
Lead -Safe Poster
Contest
Total
Note: Costs include
Unit Cost
$57.30
$100
$100
$2500
$200
Quantity
89
16
6
1
1
all reimbursable expenses.
Cost
$5100
$1,600
$600
$2,500
$200
$10,000
-SAFE PROGRAM
Date:
EXHIBIT "B"
Activity Cover Sheet
City of Fort Worth
Lead -Safe Program
Activity Cover Sheet
Type of Outreach Activity (Presentation, Event, Marketing! PubIicity):
Start Time.
Location:
Staff Contact:
Attendance Estimate:
End Time:
it Referrals Generated:
Target Audience:
Health 8 Child Care Providers
Schools. Parent Groups. Places of Worship
Landtords:'Landlord Groups. Tenants Tenant Groups' Housing Cotporations
Conununity or Target Area Wide
Real Estate Professionals
Other (specify)
Please provide a brief description of the outreach activity:
I am providing one or more of the following types of supporting documentation to this form (check
all that apply):
Sign- in sheet
Coirespondence related to activity
Pictures
Meeting Agenda
Other (specify)
I certify that the information I am providing is true and correct and subject to verification at any
time. I also acknowledge that if I provide false information, I will be subject to the penalties of
perjury under Federal, State, and local law. Warning: Title 18, Section 1001 of the L.S. Code States
that Person is Guilty of a felony for knowingly and willingly snaking false or fraudulent statements
to any department of the United States Government.
Authorized Consultant Representative Date
EXHIBIT "C"
Attendance Certification Form
City of Fort Worth
Lead -Safe Program
Attendance Certification Form
Date of Event/ Presentation:
Start Time:
Location:
Staff Contact:
Attendance Estimate:
Target Audience:
This Section To Be Filled out by MCI
End Time:
# of Referrals Generated:
Please provide a brief description of the event/ presentation:
This Section To Be Filled out by Sponsoring Otgani_atiot
Name of Sponsoring Organization:
Name of Authorized Representative:
Phone Number:
E-mail:
I, (print name) hereby certify
that during the day and time listed above. one or more representatives of North Side Inter -
Agency Community Agency (MICA) provided information on lead. how to protect young
children fore lead poisoning, and the lead -hazard reduction services that are available to
income -eligible residents through the Lead -Safe Program to the members of my organization.
AuthoriredRepresentative Signature
Date
17-"
»-
tEAO SAEE FROEB60i
EXHIBIT "D"
Canvassing Documentation Form
City of Fort worth Lead -Safe Program
Canvassing Documentation Form
Date of Canvassing: Start Time: End Time:
Staff Contact: Ntunber of homes canvassed:
hUnit No.- IStreet No.
1
1
1
1
1
1
1
Name ilip Code -_
I certify that the information I am providing is true and correct and subject to verification at any time. I also acknowledge
that if I provide false information, I will be subject to the penalties of perjury under Federal, Sta te, and local law.
Signature of Staff Contact Date
Scope of Work
Presentations, at
Consultant's
Onooing proerams
Presentations, at
Falls -Baud
Omanizatons
Presentations, at
Consultant's Summer
Reading fir Yams
Presentations. feat a
heaWnh4n5nn erped
Presentations, at
Consuhant's 2013
Thanksgiving and
Xmas programs
Canvassing
Events, at Nabonal
Night Out 2013
Events, at A9 Sant's
Cexo de Mayo 2013
Events, at health fairs,
community centers, etc
Referral Screening
-Lead-sate
Poster Contest
TOTAL
Mo.1
JAt1
4
EXHIBIT "E"
WORK SCHEDULE
Table depicting Consultant's work product milestones over 18 month contract period.
Mo. 2
FEB
4
Mo.3
MAR
4
1
Mo_4 Mo.5
APR MAY
4 3
1 1
1
Mo. 6
JUN
3
1
Mo.7 Mo.8
JUL AUG
3 3
1
3
Mo.9 Mo.10
SEP OCT
4
4
1
1
Mo.11 Mo.12
NOV DEC
3
Mo. 13 Mo. 14
JAB FEB
4 4
1
1 I1
Mo.15
MAR
4
1
Mo. 16
APR
4
Mo. 17 Mo. 18 Tot
MAY JUN
3 2 60
16
3
4
6
I I 1 11 11 16
1
1 4
3 1
1
t13