HomeMy WebLinkAboutCAG2019-090 - Amendment - Exibit A-1 - Children's Therapy Center - Special Needs Program - 12/22/2022Ap
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Originator:Department:
Date Sent:Date Required:
Authorized to Sign:
Director or Designee Mayor
Date of Council Approval:
Grant? Yes No
Type:
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Date Received by City Attorney:
Comments:
Date Routed to the Mayor’s Office:
Date Routed to the City Clerk’s Office:
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Vendor Name:Category:
Vendor Number:Sub-Category:
Project Name:
Project Details:
Agreement Amount:
Start Date:
Basis for Selection of Contractor:
Termination Date:
Local Business? Yes No*
Business License Verification: Yes In-Process Exempt (KCC 5.01.045)
If meets requirements per KCC 3.70.100, please complete “Vendor Purchase-Local Exceptions” form on Cityspace.
Notice required prior to disclosure?
Yes No
Contract Number:
Agreement Routing Form
For Approvals, Signatures and Records Management
This form combines & replaces the Request for Mayor’s Signature and Contract Cover Sheet forms.
Visit Documents.KentWA.gov to obtain copies of all agreementsadccW22373_1_20
Budget Account Number:
Budget? Yes No
Dir Asst:
Sup/Mgr:
Dir/Dep:
rev. 20200218
FOR CITY OF KENT OFFICIAL USE ONLY
(Optional)
* Memo to Mayor must be attached
N/A
N/A
1/6/2023
Amended Exhibit A - 1
Scope and Schedule of Work
2019-2022 Consultant Services Agreement
Agency: Children's Therapy Center
Program: Pediatric Therapy for Children with Special Needs
This funding will
provide:
The Special Needs program includes patient centered physical, occupational, speech and
feeding therapy.
2019 Funding $44,710.83
2020 Funding: $42,045.52
2021 Funding: $44,667.32
2022 Funding: $18,576.33
Total: $150,000
Revised December 22, 2022 - Funds unspent from one year, may carry over to another year, or the budget
otherwise redistributed between each year of this four-year Agreement. This budget alteration or carryover will
be documented through an amended Scope and Schedule of Work signed by the parties.
Consultant shall provide the approximate number of City of Kent clients with the following services each year
of the CSA
Annual Program Service Units: Program Outcome:
2019-2020
Unduplicated Kent Residents
184
At least 75% of children aged birth to 3 who receive at
least 6 months of CTC services and children aged 3 to
18 who receive at least 12 weeks of CTC services will
make “good” or “great” progress toward their
treatment goals.
Medical Care (individual visit)
2021-2022
Unduplicated Kent Residents
Medical Care (individual visit)
368
92
184
Contract Administration
• The Consultant shall notify the City, in writing, within ten (10) days of any changes in program
personnel or board membership.
• The Consultant shall provide the City with a current list of its board of directors, general or limited
partners, as applicable.
• All records related to the CSA must be retained for three (3) years plus the current year.
Reporting Requirements
Service Unit Report - Data from this form will be used to track each program’s progress toward meeting
the goals stipulated in the Scope of Work. It shall be submitted quarterly through Share1app, no later than
the 15th of the month following the end of the quarter (i.e. April 15, July 15, Oct 15, Jan 15).
Reimbursement Request - The Consultant shall submit quarterly payment invoices to Public Health –
Seattle & King County (“PHSKC”), along with all documentation that may be required by PHSKC. Once
invoices are received by PHSKC, PHSKC will certify their eligibility for reimbursement under the Medicaid
Administrative Claiming (“MAC”) Program. Once that certification process is complete, PHSKC then invoices
the City for Consultant’s services. The City remits payment on those invoices to PHSKC who then remits
payment to Consultant.
Demographic Data Report - The agency shall collect and retain the data requested on this form from the
persons served through this contract. Data should be tracked in an ongoing manner and submitted annually
(by January 15).
Annual Outcome Data Report - Outcome data shall be submitted no later than the 15th following the end
of the year). Data should demonstrate the program’s progress toward Outcomes specified in the Scope of
Work.
The scope of work is amended to allow for the redistribution of funds between years of the
contract.
Merina Hanson
Human Services Manager
City of Kent
Janet Bliss
CFO
Children’s Therapy Center
Merina Hanson (Dec 22, 2022 13:48 PST)
Janet Bliss (Dec 23, 2022 10:42 PST)
Janet Bliss
2019-2022 CTC-Amended Scope
Final Audit Report 2022-12-23
Created:2022-12-22
By:KateLynn Jennings (kjennings@kentwa.gov)
Status:Signed
Transaction ID:CBJCHBCAABAA9dHk_jl84_KlU3b4BeWU3wbgTdFlymH9
"2019-2022 CTC-Amended Scope" History
Document created by KateLynn Jennings (kjennings@kentwa.gov)
2022-12-22 - 6:54:52 PM GMT- IP address: 146.129.252.126
Document emailed to mhanson@kentwa.gov for signature
2022-12-22 - 6:55:34 PM GMT
Email viewed by mhanson@kentwa.gov
2022-12-22 - 9:47:43 PM GMT- IP address: 174.204.75.170
Signer mhanson@kentwa.gov entered name at signing as Merina Hanson
2022-12-22 - 9:48:15 PM GMT- IP address: 24.18.250.253
Document e-signed by Merina Hanson (mhanson@kentwa.gov)
Signature Date: 2022-12-22 - 9:48:17 PM GMT - Time Source: server- IP address: 24.18.250.253
Document emailed to janet@ctckids.org for signature
2022-12-22 - 9:48:18 PM GMT
Email viewed by janet@ctckids.org
2022-12-23 - 6:42:14 PM GMT- IP address: 50.236.51.154
Signer janet@ctckids.org entered name at signing as Janet Bliss
2022-12-23 - 6:42:31 PM GMT- IP address: 50.236.51.154
Document e-signed by Janet Bliss (janet@ctckids.org)
Signature Date: 2022-12-23 - 6:42:33 PM GMT - Time Source: server- IP address: 50.236.51.154
Agreement completed.
2022-12-23 - 6:42:33 PM GMT