HomeMy WebLinkAboutC-1777 - Senior Citizens surveyC(*JNTY OF ORANGE
GENERAL SERVICES AGENCY
o` PURCHASE ORDER
VENDOR
rPURCHASE
ORDER N0. � 4 ? >09
CONTROL NO. 24G81
SHIPTO
CITY OF NEWPORT BEACH SENIOR CITIZENS PROGRAM OFFICE
3300 NEWPORT BOULEVARD 801 -C N. BROADWAY
NEWPORT BEACH, CALIFOR14IA 92663 SANTA ANAL CALIFORNIA 92701
NOT TO EXCEED
FUND B/U
OBJECT
SUB GREW
RESP. CT0.
CATEGORY
JOB NUMBER
GRHNT
DATE MHILED
COMMODITY
TOTAL AMOUNT
0148
190
003
LH
1 -20 -76
19958
RED NO.
PRI-CD
FOB DEST
PLUS FRT
TERMS
ORDER DATE
DELIVERY WITHIN
2634
1
YES
NO
NET
AS REQUIRED DAYSARO
I,560I 00
ITEM
NO.
°"
k
UNIT
DESCRIPTION
UNIT PRICE
AMOUNT
1
1 �
I
I
AGREEMENT FOR IMPLEMENTATION OF SSI
I
ALERT PHASE II PER ATTACHED AGREEMENT
WITH MONETARY LIMIT AND TIME PERIOD
INDICATED.
PER BOARD RESOLUTION 975 -1512.
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ACKNOWLEDGED Receipt of Material
AUTHORIZED _
THE ABOVE ITEPO$ WERE RECEIVED BY
XXXXXX?CXXXx %l
V j - I SIGNATURE OF COUNTY EMPLOYEE DATE
NOTE: Report any damage or irregular itieS to the BUYER: ROBERT J. MERSHON
Office of Procurement. IMMEDIATELY PHONE: (714) 834 -3400
,.
' _ a
AGREEMENT FOR SOCIAL SERVICES
FOR
ELDERLY PERSONS IN ORANGE COUNTY
This AGREE14ENT is made and entered into this 23rd day of December,
1975, by and between the COUNTY OF ORANGE, hereinafter referred to
as "County" and the CITY OF NEWPORT BEACH, 3300 Newport Blvd.,
.Newport Beach, CA 92663, hereinafter referred to as "Contractor ".
WHEREAS, the Congress of the United States through
the Administration on Aging of the Department of Health, Educa-
tion and Welfare (hereinafter referred to as "HEW "), through
j. the State of California Office on Aging (hereinafter referred to
as "State•'), has made certain funds available under Title III
of the Older Americans Act of 1965, as amended (hereinafter
referred to as "Act "), Title 42, Section 3021 et seer. of the
United States Code, for providing social services to elderly
persons;
WHEREAS, pursuant to the Burton Act for the Aging,
California Welfare and Institutions Code Section 9000 et seq.,
the California Legislature has designated State as the single
j' state agency for supervision of all programs under the Act;
WHEREAS, pursuant to the provisions of the Act, State
has designated County's Senior Citizens Program Office as the
'Area, Agency on Aging for Orange County, and County has adopted
an Area Plan for Program on Aging to provide said services;
WHEREAS, pursuant to the provisions of the Act, State
has approved County's Area Plan for Programs on Aging;
WHEREAS, State and County have entered into a written
agreement, which incorporates by reference County's Area Plan
for Programs. on Aging, whereby State is to provide County with
i
federal funds to implement County's Area Plan for Programs on
Aging in accordance with the Act and all regulations and.
directives relating thereto which are promulgated by HEW and
by State;
t
WHEREAS, pursuant to the provisions of said written
agreement, County has agreed to enter into written agreements
with other. public and private agencies or organizations which
shall provide certain of said services;
WHEREAS, Contractor is equipped, staffed and pre-
pared to provide certain of said services; j
WHEREAS, pursuant to the provisions of California
Government Code Section 53703, County may contract with other
public and private agencies or organizations and do all acts
necessary to participate in federal programs, such as this
program under the Act, whereby federal funds are provided to
County for purposes of public health, safety or welfare; and
WHEREAS, the Administration on Aging has approved
the use of certain Model Project funds, authorized under Title
III, Section 308 of the Older Americans Act of 1965 as amended,
to implement Phase II of SSI- Alert;
WHEREAS, for purposes of this Agreement, the term
"SSI" and the eligibility for SSI are explained as follows:
On January 1, 1974, under Public Law 92 -603 enacted by
Congress, a new income maintenance program for low- income per-
sons went into effect nationwide. This new program, called
Supplemental Security Income (SSI) , completely replaced Cali-
fornia's previously existing federal - state- county public as-
sistance programs for the aged (Old .Age Security) , blind (Aid
to the Blind) , and disabled (Aid to the Totally Disabled)..
Under. SSI, the federal government guarantees a minimum
income level - -as of July, 1975, $157.70 per month for an el-
igible individual, and $236.60 per month for an eligible couple.
The federal government also sets eligibility requirements which
are uniform throughout the country.
Basically there are four separate requirements that each
claimant for SSI benefits must meet. The first requirement is
that he or she have certain "special characteristics" as defined
by federal statutes and regulations. These characteristics are
that the person is either aged (i.e., at least 65 years of age);
or blind or disabled of any age. Second, he must have certain
"common characteristics "; that is, he must be a U.S. and Cali -
fornia resident, and be a U.S. citizen or have certain resident
alien status. Third, his income must be within certain speci=
Pied limits. Fourth, his resources (assets) must also be with-
in certain.specified limits.
SSI ELIGIBILITY: THE FOUR BASIC REQUIREMENTS
An'applicant must have:
11 certain special characteristics: that is, he must
be either:
a) aged (65 or over);
or b) blind. (any age); ,
or c) disIbled (any age).-
and 2) certain common characteristics, such as U.S. and
California residency, and citizenship or permanent
alien status;
and 3) limited income; -
and 4) limited resources.
NOW THEREFORE, the parties hereto mutually agree as
follows:
1. Scope of Services. Contractor shall perform, in
a manner satisfactory to the County, the duties as set forth
in the following paragraphs hereof which state for such services:
'(A). Statement of Goals
(1) To develop a pilot program to locate
i and identify senior citizens who may
be eligible for the Supplemental Security
Income Program (SSI).
f
(2) To conduct a needs assessment survey,
i.e., "Action Survey" to determine
the needs of the pilot area senior
citizens.
(B) Responsibilities
i (1) Orange County Senior Citizens Program
Office's responsibilities are:
i. To secure cooperation and partici-
pation from local cities, non - profit
private agencies and volunteers.
3 -
ii. To monitor the program and assist in
i
analyzing the collected data.
To coordinate with Social Security
Administration Office in analyzing
and planning better services for
seniors.
i:v. To prepare questionnaire forms (see
attachments)
needed materials and
training sessions.
(2) Sub- contractor's responsibilities are:
i. To provide or utilize a centrally
accessible office with dependable
voluntary or paid personnel and suf-
ficient in -house equipment to be able
to support SSI Suryey in their pilot
areas.
ii. To recruit volunteers from their areas
to conduct the survey.
To identify the location of the pilot
area senior citizens.
iv. To coordinate with SCPO, CRIS, SSA
and other public and private agencies
in developing a cooperative network
of information and referral service
to persons in their areas.
V. To develop and maintain records of
'its transactions. The records should
include the number of senior citizens
contacted, method of contact, number'
of SSI referrals and names of organi-
zations or agencies where volunteers
were recruited. The records should
be kept in a confidential manner so
that no individual will be identified
by the public.
vi To submit invoices for payment to the
County of Orange for staff (if appli-
cable) and volunteer expenses and to
keep travel vouchers and time sheets
_.. 8�g.: 1'�n_ka:vn.. .f�.r .a_ewv�i..n e. .. .. ...• -. ,
2. Time of Performance. The term of this Agree-
ment shall commence on any date but not to exceed 8 weeks from
January 1, 1976 to March 31, 1976.
This Agreement may be terminated by either party at any time as
described in Paragraph 7 and 8 with written notice to the other
party. County may also terminate this' Agreement immediately
upon written notice to Contractor if County receives communica-
tion from State that funds are not available for this Agreement
or for any portion hereof.
3. Location of Performance. During the term of
this Agreement, Contractor shall continuously manage and operate
the service site(s) at the following location(s) to provide the
services set forth in Paragraph l hereof:
CITY OF NEWPORT BEACH, 3300 Newport Blvd., Newport Beach, CA 92663.
The service site(s) listed hereinabove may be eliminated from
and or other service site(s) may be added to this Agreement as
mutually agreed upon by the parties hereto in accordance with
Paragraph 9 hereof. The service area is within Orange County.
4. Compensation. (Budget, pay scale, allowable expense,
and terms of payment)
County agrees to pay Contractor. for the performance of the duties
set forth herein as follows:
A. Total Budget: $1,560.00
Total Staff Cost $ 560.00
Total Volunteer Cost $1,000.00
B. Allowable expenses are as follows:
i. All volunteer transportation and parking
expense related to the SSI -Alert "Action
Survey ": traveling expenses reimbursable
at 17 cents a mile for the first 150 miles
and 15 cents for the remaining miles.
i
ii. One (1) staff member is an allowable cost
at.$3.50 per hour, 20 hours per week,
- 5 -
to act as the project manager for the
term of the SSI -Alert Action Program for
each sponsor..
iii. Meals are allowable, but will be left to
the discretion of the contractor who
should receive meal reimbursement.
•C. Terms of Payment - By Invoice
The Contractor will submit staff time every
two weeks and volunteer travel and meal expense
once a month.
5. Contacts for Responsibility. The Director of the
the Orange County Senior Citizens Program Office, or his desig-
nee; is the County's representative for purposes of monitoring
this Agreement. He or. his staff will provide technical assist-
ance, training sessions and will analyze the collected data as
indicated in paragraph 1 (A). Contractor shall make available
to County a list of all persons by name, job title and duties,
experience, and professional degrees, if any, who are to per -
form services hereunder. All personnel shall be qualified in
accordance with the Act and all federal, state and local laws,
ordinances, regulations., and directives applicable thereto.
6. Audit and Inspection of Records. At any time
during normal business hours and as often as County may deem
necessary, Contractor shall make available to County, State and
Federal officials for examination all of its records with re-
spect to all matters covered by this Agreement and will permit
County, State and Federal officials to audit, examine and make
excerpts or transcripts from such records, and to make audits
of all invoices, materials, payrolls, records of personnel and
I
other data relating to all matters covered by this Agreement.
Contractor shall maintain all such records for a minimum
of three years if audit has occurred, and five years if
audit has not occurred, and. in the case of audit exception
.until such exception has been cleared. Contractor fur-
ther agrees to submit such reports of its activities
and expenditures as may be required by the State and the County.
Exclusion: Client matters identified or designated as confi-
dential by Contractor.
7. Changes.. County may from time to time request
changes in the scope of the services of Contractor to be per -
formed hereunder. Such changes, including any increase or
decrease in the amount of Contractor's compensation, which
are mutually agreed upon by and between County and Contractor
shall be effective when incorporated in written amendments to
the Agreement. No oral understanding or agreement, not incor-
porated herein, shall be binding on the parties hereto.
8. Assignability. Contractor shall not assign any
interest in this Agreement and shall not transfer any interest
in the same, whether by assignment or novation, without the
prior written consent of County thereto; provided, however,
that claims for money due or to become due to Contractor from
County under this Agreement, may be assigned to a bank, trust
company, or other financial institution without such approval.
Notice of any such assignment or transfer shall be furnished
promptly to .County.
9. Interest of Contractor. Contractor convenants
that he presently has no interest and shall not acquire any
interest, direct or indirect, which would conflict in any.
manner or degree with the performance of services required
to be performed under this Agreement. Contractor further
covenants that in the performance. of this Agreement, no person
having any such, interest shall be employed.
10. Indemnity. Contractor agrees to maintain and
'provide evidence of such insurance as will fully protect both
Contractor and County from any and all claims under any Workers'
Compensation Act or employer's liability laws, and from any and
all other claims of whatsoever kind or nature for the damage
to property or for personal injury, including death, made by
anyone whomsoever which may arise from operations carried on
under this Agreement, either by Contractor, any sub - contractor
or by anyone. directly or indirectly engaged or employed by
i
either of them. It is necessary that the County of Orange
be shown as an additional assured and that 30 days written
notice of cancellation be provided. Contractor shall exonerate,
indemnify and .hold harmless County from and against, and
shall assume full responsibility for payment of all Federal,
- 7 -
State and local taxes or contributions imposed "or required
under Unemployment Insurance, Social Security, and Income Tax
Laws, with respect to Contractor and Contractor's employees
engaged in performance of this Agreement. County, and its
agents and employees, shall not be, nor be held liable for
any liabilities, penalties, or forfeitures, or for any damage .
to the goods, properties or effects of Contractor, or of any
other persons whatsoever, not for personal injury to or death
of them, whether caused by or resulting from any negligent act
or omission of Contractor. Contractor further agrees to
indemnify and hold harmless County and County's agents and•
employees, against and from any and all of the foregoing
liabilities, and any and all costs or expenses incurred by
County foregoing obligations and liabilities, by which it is
intended by both parties that Contractor shall indemnify and
hold County harmless from all claims arising by reason of any
act or omission of Contractor. It is understood that there will
be consultants and volunteers involved in "this service. They
should be liable for themselves. Neither the County nor the
Contractor are responsible for their liabilities.
11. Confidentiality. Contractor agrees and shall
insure that no information about or obtained from any elderly
person receiving services hereunder shall be voluntarily dis-
closed in any form identifiable with such elderly person without
first obtaining the written consent of such elderly person.
The provisions of this section shall not, however, restrict
the Contractor's obligations to provide required information
under this or its other County, State or Federal contracts.
12. Independent Contractor. It is agreed that
Contractor shall perform as an independent contractor under
this Agreement. Contractor is, for all purposes arising out
of this-Agreement, an independent contractor and it shall not
be deemed an employee of the County. It is expressly under-
stood and agreed that Contractor shall in-no event be entitled
to any benefits to which County employees are entitled, including+
but not limited to, overtime, any retirement benefits, Workmen's
Compensation benefits, and injury leave or other leave benefits.
13. Affirmative-Action. Contractor performing under
this Agreement, shall comply with the Affirmative Action and Equal
Opportunity Regulations of the State of California.
14. Authority to Contract. Contractor shall have no
authority to contract for or on behalf of, or incur obligations
on behalf of, the State of California or the County of Orange.
15. Fair Employment. Contractor shall not discrimi-
nate in the hiring of personnel to perform the services hereunder
on the basis of race, color, religion, sex, age, .national origin
or ancestry. In addition, Contractor, shall not discriminate in
its delivery of services hereunder to elderly persons on the
basis of race, color, religion, sex, national origin or ancestry.
Contractor shall further comply with the Civil Rights Act of 1964,
as amended, and all regulations applicable thereto and has executed
the Assurance of Compliance with said Act which is attached herein
by reference.
16. Notice. Any notice or notices required or per-
mitted to be given pursuant to this Agreement may be personally
served on the other party by the party giving such notice, or
may be served by certified mail, return receipt requested, to
i
the following addresses:
County: Contract Designee:
Director CITY OF NEWPORT BEACH
Senior Citizens Program Office 3300 Newport Blvd.
801 -C North Broadway Newport Beach, CA 92663
Santa Ana, CA 92701
17. Conflict or Disagreement. To the extent that
there exists any conflict between the language of this Agree-
ment and the exhibits attached hereto, the former shall govern
and prevail.
IN WITNESS WHEREOF, the Board of Supervisors of
the County of Orange has caused this Agreement to be subscribed
byx its Chairman and the seal of said Board to be hereto affixed,
and attested by the County Clerk and ex- officio Clerk thereof,
and Contractor has caused this Agreement to be subscribed in its
behalf by its duly authorized officers, the day, month, and
year first above written.
i
Contractor: CITY OF NEWPORT BEACH
Mayor \. \�.
/TTEST:
! City Clerk / =�
APPR TED •
LPLrchasing
Agent for the County of Oranae
i
AGREEMENT FOR SOCIAL SERVICES
FOR
ELDERLY PERSONS IN ORANGE COUNTY
This AGREEMENT is made.and entered into this 23rd day of December,
1975, by and between the COUNTY OF ORANGE, hereinafter referred to
as "County" and the CITY OF NEIgPORT BEACH, 3300 Newport Blvd.,
Newuort Beach, CA 92663, hereinafter referred to as "Contractor ".
WHEREAS, the Congress of the United States through
the Administration on Aging of the Department of Health, Educa-
tion and Welfare (hereinafter referred to as "HEW "), through
the State of California Office on Aging (hereinafter referred to
as "State "), has made certain funds available under Title III
of the Older Americans Act of 1965, as amended (hereinafter
referred to as "Act "), Title 42, Section 3021 et sec. of the
United States Code, for providing social services to elderly
persons;
WHEREAS, pursuant to the Burton Act for the Aging,
California Welfare and Institutions Code Section 9000 et seq.,
the California Legislature has designated State as the single
state agency for supervision of all programs under the Act;
WHEREAS, pursuant to the provisions of the Act, State
.has designated County's Senior Citizens Program Office as the
Area Agency on Aging for Orange County, and County has adopted
an Area Plan for Program on Aging to provide said services;
WHEREAS, pursuant to the provisions of the Act, State
has approved County's Area Plan for Programs on Aging;
WHEREAS, State and County have entered into a written
agreement, which incorporates by reference County's Area Plan
for Programs on Aging, whereby State is to provide County with
federal funds to implement County's Area Plan for Programs on
Aging in accordance with the Act and all regulations and
directives relating thereto which are promulgated by HEW and
by State;
WHEREAS, pursuant to the provisions of said written
agreement, County has agreed to enter into written agreements
with other public and private agencies or organizations which
shall provide certain of said services;
WHEREAS, Contractor is equipped, staffed and pre-
pared to provide certain of said services;
WHEREAS, pursuant to the provisions of California
Government Code Section 53703, County may contract with other
public and private agencies or organizations and do all acts
necessary to participate in federal programs, such as this
program under the Act, whereby federal funds are provided to
County for purposes of public health, safety or welfare; and
WHEREAS, the Administration on Aging has approved
the use of certain Model Project funds, authorized under Title
III, Section 308 of the Older Americans Act of 1965 as amended,
to implement Phase II of SSI- Alert;
WHEREAS, for purposes of this Agreement, the term
"SSI" and the eligibility for SSI are explained as follows:
On January 1, 1974, under Public Law 92 -603 enacted by
Congress, a new income maintenance program for low- income per-
sons went into effect nationwide. This new program, called
Supplemental Security Income (SSI) , completely replaced Cali-
fornia's previously existing federal- state - county public as-
sistance programs for the aged (Old Age Security) , blind (Aid
to the Blind) , and disabled (Aid to the Totally Disabled) .
Under SSI, the federal government guarantees a minimum
income level - -as of July, 1975, $157.70 per month for an el-
igible individual, and $236.60 per month for an eligible couple.
The federal government also sets eligibility requirements which
are uniform throughout the country.
Basically there are four separate requirements that each
claimant for SSI benefits must meet. The first requirement is
that he or she have certain "special characteristics" as defined
by federal statutes and regulations. These characteristics are
that the person is either aged (i.e., at least 65 years of age);
or blind or disabled of any age. Second, he must have certain
r
WHEREAS, pursuant to the provisions of said written
agreement, County has agreed to enter into written agreements
with other public and private agencies or organizations which
shall provide certain of said services;
WHEREAS, Contractor is equipped, staffed and pre-
pared to provide certain of said services;
WHEREAS, pursuant to the provisions of California
Government Code Section 53703, County may contract with other
public and private agencies or organizations and do all acts
necessary to participate in federal programs, such as this
program under the Act, whereby federal funds are provided to
County for purposes of public health, safety or welfare; and
WHEREAS, the Administration on Aging has approved
the use of certain Model Project funds, authorized under Title
III, Section 308 of the Older Americans Act of 1965 as amended,
to implement Phase II of SSI- Alert;
WHEREAS, for purposes of this Agreement, the term
"SSI" and the eligibility for SSI are explained as follows:
On January 1, 1974, under Public Law 92 -603 enacted by
Congress, a new income maintenance program for low- income per-
sons went into effect nationwide. This new program, called
Supplemental Security Income (SSI) , completely replaced Cali-
fornia's previously existing federal- state - county public as-
sistance programs for the aged (Old Age Security) , blind (Aid
to the Blind) , and disabled (Aid to the Totally Disabled) .
Under SSI, the federal government guarantees a minimum
income level - -as of July, 1975, $157.70 per month for an el-
igible individual, and $236.60 per month for an eligible couple.
The federal government also sets eligibility requirements which
are uniform throughout the country.
Basically there are four separate requirements that each
claimant for SSI benefits must meet. The first requirement is
that he or she have certain "special characteristics" as defined
by federal statutes and regulations. These characteristics are
that the person is either aged (i.e., at least 65 years of age);
or blind or disabled of any age. Second, he must have certain
I
"common characteristics ";
fornia resident, and be a
alien status. Third, his
fied limits. Fourth, his
in certain specified limi
that is, he must be a U.S. and Cali -
U.S. citizen or have certain resident
income must be within certain speci=
resources (assets) must also be with -
ts.
SSI ELIGIBILITY: THE FOUR BASIC REQUIREMENTS
An applicant must have:
1) certain special characteristics: that is, he must
be either:
a) aged (65 or over);
or b) blind, (any age);
or c) disabled (any age).
and 2) certain common characteristics, such as U.S. and
California residency, and citizenship or permanent
alien status;
and 3) limited income;
and 4) limited resources.
NOW THEREFORE, the parties hereto mutually agree as
follows:
1. Scope of Services. Contractor shall perform, in
a manner satisfactory to the County, the duties as set forth
in the following paragraphs hereof which state for such services:
(A) Statement of Goals
(1) To develop a pilot program to locate
and identify senior citizens who may
be eligible for the Supplemental Security
Income Program (SSI).
(2) To conduct a needs assessment survey,
i.e., "Action Survey" to determine
the needs of the pilot area senior
citizens.
(B) Responsibilities
(1) Orange County Senior Citizens Program
Office's responsibilities are:
i. To secure cooperation and partici-
pation from local cities, non - profit
private agencies and volunteers.
-'3 -
ii. To monitor the program and assist in
analyzing the collected data.
i iii. To coordinate with Social Security
Administration Office in analyzing
and planning better services for
seniors.
iv. To prepare questionnaire forms (see
attachments), needed materials and
training sessions.
(2) Sub - contractor's responsibilities are:
i. To provide or utilize a centrally
accessible office with dependable
voluntary or paid personnel and suf-
ficient in -house equipment to be able
to support SSI Survey in their pilot
areas.
ii. To recruit volunteers from their areas
to conduct the survey.
iii. To identify the location of the pilot
area senior citizens.
iv. To coordinate with SCPO, CRIS, SSA
and other public and private agencies
in developing a cooperative network
of information and referral service
to persons in their areas.
V. To develop and maintain records of
its transactions. The records should
include the number of senior citizens
contacted, method of contact, number
of SSI referrals and names of organi-
zations or agencies where volunteers
were recruited. The records should
be kept in a confidential manner so
that no individual will be identified
by the public.
vi To submit invoices for payment to the
County of Orange for staff (if appli-
cable) and volunteer expenses and to
keep travel vouchers and time sheets
as backup for invoices.
2. Time of Performance. The term of this Agree-
ment shall commence on any date but not to exceed 8 weeks from
January 1, 1976 to March 31, 1976.
This Agreement may be terminated by either party at any time as
described in Paragraph 7 and 8 with written notice to the other
party. County may also terminate this Agreement immediately
upon written notice to Contractor if County receives communica-
tion from State that funds are not available for this Agreement
or for any portion hereof.
3. Location of Performance. During the term of.
this Agreement, Contractor shall continuously manage and operate
the service site(s) at the following location(s) to provide the
services set forth in Paragraph 1 hereof:
CITY OF NEWPORT BEACH, 3300 Newport Blvd., Newport Beach, CA 92663.
The service site(s) listed hereinabove.may be eliminated from
and or other service site(s) may be added to this Agreement as
mutually agreed upon by the parties hereto in accordance with
Paragraph 9 hereof. The service area is within Orange Coen *x.
4. Compensation.(Budget, pay scale, allowable expense,
and terms of payment)
County agrees to pay Contractor for the performance of the duties
set forth herein as follows:
A. Total Budget: $1,560.00
Total Staff Cost $ 560.00
Total Volunteer Cost $1,000.00
B. Allowable expenses are as follows:
i. All volunteer transportation and parking
expense related to the SSI -Alert "Action
Survey ": traveling expenses reimbursable
at 17 cents a mile for the first.150 miles
and 15 cents for the remaining miles.
ii. One (1) staff member is an allowable cost
at $3.50 per hour, 20 hours per week,
5 -
to act as the project manager for the
term of the SSI -Alert Action Program for
each sponsor..
Meals are allowable, but will be left to
the discretion of the contractor who
should receive meal reimbursement.
C. Terms of Payment - By Invoice
The Contractor will submit staff time every
two weeks and volunteer travel and meal expense
once a month.
5. Contacts for Responsibility. The Director of the
the Orange County Senior Citizens Program Office, or his desig-
nee; is the County's representative for purposes of monitoring
this Agreement. He or.his staff will provide technical assist-
ance, training sessions and will analyze the collected data as
indicated in paragraph 1 (A). Contractor shall make available
to County a list of all persons by name, job title and duties,
experience, and professional degrees, if any, who are to per-
form services hereunder. All personnel shall be qualified in
accordance with the Act and all federal, state and local laws,
ordinances, regulations, and directives applicable thereto.
6. Audit and Inspection of Records. At any time
during normal business hours and as often as County may deem
necessary, Contractor shall make available to County, State and
Federal officials for examination all of its records with re-
spect to all matters covered by this Agreement and will permit
County, State and Federal officials to audit, examine and make
excerpts or transcripts from such records, and to make audits
of all invoices, materials, payrolls, records of personnel and
other data relating to all matters covered by this Agreement.
Contractor shall maintain all such records for a minimum
of three years if audit has occurred, and five years if
audit has not occurred, and.in the case of audit exception
until such exception has been cleared. Contractor fur-
ther agrees to submit such reports of its activities
and expenditures as may be required by the State and the County.
Exclusion: Client matters identified or designated as confi-
dential by Contractor.
7. Changes. County may from time to time request
changes in the scope of the services of Contractor to be per-
formed hereunder. Such changes, including any increase or
decrease in the amount of Contractor's compensation, which
are mutually agreed upon by and between County and Contractor
shall be effective when incorporated in written amendments to
the Agreement. No oral understanding or agreement, not incor-
porated herein, shall be binding on the parties hereto.
8. Assignability. Contractor shall not assign any
interest in this Agreement and shall not transfer any interest
in the same, whether by assignment or novation, without the
prior written consent of County thereto; provided, however,
that claims for money due or to become due to Contractor from
County under this Agreement, may be assigned to a bank, trust
company, or other financial institution without such approval.
Notice of any such assignment or transfer shall be furnished
promptly to.County.
9. Interest of Contractor. Contractor convenants
that he presently has no interest and shall not acquire any
h'
interest, direct or indirect, which would conflict in any
manner or degree with the performance of services required
to be performed under this Agreement. Contractor further
covenants that in the performance of this Agreement, no person
having any such interest shall be employed.
10. Indemnity. Contractor agrees to maintain and
'provide evidence of such insurance as will fully protect both
Contractor and County from any and all claims under any Workers'
Compensation Act or employer's liability laws, and from any and
all other claims of whatsoever kind or nature for the damage
to property or for personal injury, including death, made by
anyone whomsoever which may arise from operations carried on i
under this Agreement, either by Contractor, any sub - contractor
or by anyone directly or indirectly engaged or employed by
either of them. It is necessary that the County of Orange
be shown as an additional assured and that 30 days written
notice of cancellation be provided. Contractor shall exonerate,
indemnify and hold harmless County from and against, and
shall assume full responsibility for payment of all Federal,
7 -
State and local taxes or contributions imposed or required
under Unemployment Insurance, Social Security, and Income Tax
Laws, with respect to Contractor and Contractor's employees
engaged in performance of this Agreement. County, and its
agents and employees, shall not be, nor be held liable for
any liabilities, penalties, or forfeitures, or for any damage
to the goods, properties or effects of Contractor, or of any
other persons whatsoever, not for personal injury to or death
of them, whether caused by or resulting from any negligent act .
or omission of Contractor. Contractor further agrees to
indemnify and hold harmless County and County's agents and
employees, against and from any and all of the foregoing
liabilities, and any and all costs or expenses incurred by
County foregoing obligations and liabilities, by which it is
intended by both parties that Contractor shall indemnify and
hold County harmless from all claims arising by reason of any
act or omission of Contractor. It "is' understood that there will
be consultants and volunteers involved in this service. They
should be liable for themselves. Neither the County nor the
Contractor are responsible for their liabilities.
11. Confidentiality. Contractor agrees and shall
insure that no information about or obtained from any elderly
person receiving services hereunder shall be voluntarily dis-
closed in any form identifiable with such elderly person without
first obtaining the written consent of such elderly person.
The provisions of this section shall not, however, restrict
the Contractor's obligations to provide required information
under this or its other County, State or Federal contracts.
12. Independent Contractor. It is agreed that
Contractor shall perform as an independent contractor under
this Agreement. Contractor is, for all purposes arising out
of this Agreement, an independent contractor and it shall not
be deemed an employee of the County. It is expressly under-
stood and agreed that Contractor shall in no event be entitled
to any benefits to which County employees are entitled, including,
but not limited to, overtime, any retirement benefits, Workmen's
Compensation benefits, and injury leave or other leave benefits.
_ g _
J
I
County of Orange, a political sub -
division of the State of California
By
Chairman of the Board of Supervisors
ATTEST:
WILLIAM E. ST. JOHN
County Clerk and ex- officio Clerk
of the Board of Supervisors of
Orange County, California
By
Deputy
Approved as to Form:
ADRIAN KUYPER, COUNTY COUNSEL
Orange County, California
By
Contractor: CITY OF NEWPORT BEACH
By: ,
Mayor
ATTEST: ) /A'/i.a�
I
APPROVED:
Nathan A. Cherry, Purchasing
Agent for the Countv of Orange
13. Affirmative Action. Contractor performing under
this Agreement, shall comply with the Affirmative Action and Equal
Opportunity Regulations of the State of California.
14. Authority to Contract. Contractor shall have no
authority to contract for or on behalf of, or incur obligations
on behalf of, the State of California or the County of Orange.
15. Fair Employment. Contractor shall not discrimi-
nate in the hiring of personnel to perform the services hereunder
on the basis of race, color, religion, sex, age, national origin
or ancestry. In addition, Contractor shall not discriminate in
its delivery of services hereunder to elderly persons on the
basis of race, color, religion, sex, national origin or ancestry.
Contractor shall further comply with the Civil Rights Act of 1964,
as amended, and all regulations applicable thereto and has executed
the Assurance of Compliance with said Act which is attached herein
by reference.
16. Notice. Any notice'or notices required or per-
mitted to be given pursuant to this Agreement may be personally
served on the other party by the party giving such notice, or
may be served by certified mail, return receipt requested, to
the following addresses:
County: Contract Designee:,
Director CITY OF NEWPORT BEACH
Senior Citizens Program Office 3300 Newport Blvd.
801 -C North Broadway Newport Beach, CA 92663
Santa Ana, CA 92701
17. Conflict or Disagreement. To the extent that
there exists any conflict between the language of this Agree-
ment and the exhibits attached hereto, the former shall govern
and prevail.
IN WITNESS WHEREOF, the Board of Supervisors of
the County of Orange has caused this Agreement to be subscribed
by its Chairman and the seal of said Board to be hereto affixed,
and attested by the County Clerk and ex- officio Clerk thereof,
and Contractor has caused this Agreement to be subscribed in its
behalf by its duly authorized officers, the day, month, and
year first above written.
- 9 -
L
PROJECT SSI ALERT
-Name
Social Security No.
Address
f
Telephone Number
Code
No.
1. Do you or your spouse receive Gold- colored
Supplemental Security Income checks?
Yes
No
Declines
2. Have you applied for these checks?
Yes
No
Declines
3. Are you 65 or older?
Yes
No
Declines -
Are you disabled?
Yes
No
Declines '
Are you blind?
Yes
No
Declines
i
If you are married, answer these questions:
Is your spouse age 65 or older?
Yes
No
Declines .
Is your spouse disabled?
Yes
No
Declines
Is your spouse blind?
Yes
No
Declines
4. Are you a U.S. citizen?
Yes
No
Declines
5. What amount did you receive last month from
Social Security, other pensions, or other
kinds of payments? $
If other than English language, contact should be
made by someone who speaks
' language
I understand that this form will protect my
right's to any Supplemental Security Income
payments which may be due me from the Social
Security Administration.
Your Signature
Date
Volunteer's Name Date
INTERVIEW /QUESTIONNAIRE
PILOT PROJECT
Social Organizations
1. Are you a member of any service club or social
organization that have programs specifically for
senior citizens in your community?
la. If yes, how often do you attend these club
functions?
Often
Very Often { )
Rarely ( )
Never ( )
lb. If no, would you join if such organizations were
formed in your community?
ic. Do you know of any programs for senior persons in
your community?
If yes, how frequently do you participate in these
programs?
Daily ( )
Weekly { )
Once a month ( )
Other
Id. Would you participate in programs for senior persons
if they were available?
le. Do you feel there is a need for facilities for senior
citizens in Newport Beach?
lf. 4tould you use a public facility providing recreational
programs?
Ig. (or) service -type programs (counseling, healti:, or
legal advice) for seniors if they were available?
lh. 'v:ouid you use a central facility?
li. (or) would you prefer smaller facilities dispersed
roughp_it the City?
li. .,;uld y o j use such a facility?
i'ornings ( }
Afterr.:;oos
venin9s ( }
Yes No Declines
Yes No Declines
Yes No Declines
Yes No Declines
Yes No Declines
Yes No Declines
Yes
No
Declines
Yes
No
Declines:
Yes
No
Declines
Yes No Declines
Ye No Declines
Health
2. Do you have a health - insurance plan now?
2a. If yes, what kind?
Nedi - cal ( )
Medicare ( )
Kaiser ( )
Other
2b. If no, have you applied for a public - health insurance
plan?
2c. Have you experienced difficulty in obtaining
medical or dental care? If yes, what type?
3. Where do you go for medical care?
Private doctor ( }
Community Health Clinic ( j
County hospital ( )
Other - Location
3a. Do you have a twice- yearly health check?
3b. Have you experience any problem in obtaining
prescription medicines? If yes, explain.
4. Have you experienced any problems in getting to
medical facilities, due to transportation?
Transportation
5. Do you drive a car?
6. Do you own a car?
7. Do you have a valid driver's license?
8. If no, do you have access to a car?
9. Whose?
10. Do you pay this person for the use of his car?
10a. If yes, what amount do you pay this person?
11. iuw often do you use this person's car?
Very often ( )
Occasionally ( )
Rarely ( 1
72. there a bus route within walking distance of
Ur meidE'n ce?
-3-
Yes No Decline
Yes No Decline
Yes No Decline
Yes No Decline
Yes No Decline!
Yes No Decline!
Yes
No
Declines
Yes
No
Declines
Yes
No
Declines
Yes
No
Declines
Yes No Declines.
IYes No Declines;
12a.
Do you know that free bus service for senior persons
over 65 is now available?
Yes No
Declines
I
13.
If yes, how did you find out about this service?
Newspaper (name)
s
_
A friend
i
Community Center (name)
I
_
Other
i
—
14_
'fill you take advantage of this service?
Yes No
Decline:
15.
If yes, hour often will you use this service?
Very often ( )
Occasionally ( )
Hardly ever ( )
Never ( )
16.
Are you less active now due to problems with
transportation?
Yes No
Decline
Comments
16a.
If you had a need for legal advice, were you able
to obtain it? If not, why?
Yes No
Decline
Job
Opportunities
17.
What type of work did you do at the time of your
retirement?
18.
Are you working now?
Yes No
Decline
18a.
If no, are you seeking employment now?
Yes No
Decline.
18h.
If yes, do you feel that you have been discriminated
f
against when seeking employment because of your age?
Yes No
Decline
19.
Mould you be interested in doing volunteer work? I
Yes No
Decline
i9a.
Would you be interested in participating in the RSVP
program? (Retired Senior Volunteers Program)
Yes No
Decline
Info:-,.:
—
a ti or, i
s
20.
o:r d you receive you; information concerning pro -
gram,s and activities that effect you and other senior
i
p :'. i'S C11 s?
I
-
:
C0 r.', a il y Ce ra tar D']11ci1:'1S f
Otn�Pr
i
I
r
20a. Do you read a newspaper regularly?
21. Would you like to receive a newsletter informing you
about senior citizen activities, legislation and
services?
21a. Would you like to receive a free newspaper that
includes senior citizens information?
Educational Opportunities
22. Several area colleges offer special programs for
senior citizens. Have you taken any of these
courses?
22a. If no, would you be interested in taking some of
these courses?
22b. Has lack of transportation kept you from partici-
pating in these classes?
Nutritional
23. How many meals a day do you normally eat?
23a. Do you have access to cooking facilities?
23b. Would you be interested in receiving nutritional
information?
23c. Would you participate in a lunch program if it were
offered in a school close to your home?
24. Have you ever participated in the Transportation,
Lunch, and Counseling Program (TLC)?
24a. Do you regularly participate in the TLC program?
tab. If yes, how did you find out about TLC?
Newspaper. (name)
R friend ( )
Community Center bulletins ( )
Other
Personal Data
25. 'hat is your age?
60 or below ( )
61 - 63 ( )
64 - 66 ( )
67 - 69 ( )
- 5-
Yes No Decline
Yes No Decline
Yes No Decline
Yes No .Decline
Yes No Decline
Yes No Decline!
Yes No Declin(
Yes No Decli
Yes No Deciin
Yes No Decline
Yes No Decline
k
26. Are you:
iii arried ( )
single ( )
divorced ( )
widowed ( )
27 ldhat is your present liviny arrangements?
living alone ( )
living with spouse ( }
living with relatives ( }
29. Do you feel your neighborhood is safe?
28a. If no, why not?
29.
Do
you
own your home?
30.
What
is
your approximate monthly costs for:
31
32
3u
Z =.
Pent
Utilities
Tares
Total
Do you receive Social Security?
Do you receive income from:
Railroad Retirement ( ).
Teacher's Retirement ( )
Civil Service
Private Retirement Funds ( )
Stocks or bonds ( )
Interest from savings ( )
Insurance annuities ( )
InCorlle property ! )
Support roln, family
eteran s pension ( )
Uther ( )
haf is your approximate monthly income fror.1
all sources? S
,;!iat do you feel is :ne ,Yost pressing prrjhlen(s)
,Id ;'Ou .JC abr) "i s0 v.n,l the pr0bi._i'i
6-
Yes No Declines!
Yes No Declines
Yes No Declines
Thank you
( ) Refused to answer questions.
Name of Volunteer
Date
ASSURANCE Or COMPLIANCE 'WITH THE DEPARTMENT OF
HEALTH, EDUCATION AND WPLFARE REGULATIONS UNDER
TITLE VI OF THE CIVIL RIGHTS ACT or 1964
City of Newport $parh (hereinafter
(Name of Grantee or Contractor)
called the "Recipient of Award ") HEREBY AGREES THAT it will comply with
Title VI of the Civil Rights Act- of 1969 (P.L. 88-352) and all requirements
imposed by or pursuant to the Regulation of the Department- of Health, Educa-
tion and Welfare (95 CFR Part 80) issued pursuant to that title, to the end
that, in accordance with Title VI of that Act and the regulation, no person
in the United States shal.l., on the ground of race, color, or national origin,
be excluded from participation in, be denied the benefits of, or be other-
wise subjected to discrimination under any program or activity for which the
Recipient of Ac•:ard receives Federal financial assistance from ^
Orange Count
Senior Citizens Pr_ogr.jm Office_, a recipient of Federal financial assistance
(Name of Area Agency)
from th3 Department; and HEREBY GIVES ASSURANCE THAT it will immediately take
any measures necessary to effectuate this agreement.
If any real property or structure thereon is ,provided or improved with the
aid of Federal financial assistance extended to the Recipient of Award by
the Area F.gency, this assurance shcl.l obligate the recipient of Award or
in die case of any transfer of such prroperty, any transferee, for the poriod
during t: ?ii.ch the real property or structure is used for. a purpose for which
the Federal financial assistance is extended or for another purpose involving
thn pru,,ision of.sicilai Gervices or benefits. If any personal. property
is so prnvrned, tlis assurance shall obligate the Recipiont of Award for the
per.iol duri.n•g which the Federal financial assistance. is extended to it by
the Psrea Agency.
THIS ASS'UIn" CL is give:: in consideration of and for the purpose of obtain-
ing any and all Federal grants, loans, contracts, pr:onerty, discounts or
other FuGeral fin n.cial. assistance extended after: the date hereof to the
Recipient of i..:ar by the Area Agency, inca.uci.i.nq instal.l::•ent payments after
such date on a co.isrt of ape >lieati_ons for Federal fi.rre:nci.al ass.is.ancr.
which .hare ap;,roved be,`.ore such date. The Recipient. of A•,.,ard reconni.zes
and agrees ti:at such federal financial. assistance will be extended -in re-
liance on, the re?::esentaT. ion acrd agrecnents made in this assurance, and
that Ule Area Tqe: ?i:y or the United States or both .;hall have tj're right: to
see}: judicial en:orce::.cnt of this assurance. This aF; %ur.n;ce. is binlinq on
the Jecipient of Award, its successors, transferees: and assignees, and
the person or persone whose signatures a;,pcar belowr are authorized to
sign this assurance on behalf of the 1iecipicr.t of Award.
Dated _ December 23_2 1975 CITY OF NE14PORT BEACH _
(Recipiclit- of Award)
3300 Newport Boulevard (President, Chairman of Boara, or
comparable authorized official)
Newport Beach, CA 92633 .
Ti
(Recipient's mailing adclress)
ATI
(Attn- Tim ,_.
Agxeemant with ty for
Senior Citizens Su funds
d— 1777c;
Enclosed are the original and one copy of subjaot agreement which
have been duly aiyned by the City. Please tranaedt to the appropriate
Cbmty agency for ftrther execution.
t,ben the agreement has been fully eiTied by the Ot mty, Please return
a copy to my office for inclusion in the official reooxds.
I
? Ii
3I
4�
S
G,
7
8
9
t0
11
l2
13
14 j
15
16
17
'18
19
20
21
22
23
24
25
26
27
28
29
30
31
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15
3_
RESOLUTION OF THE BOARD OF SUPERVISORS
Y"
RECEIVED
COmm�nity
Devewpment
Dept.
NQV � 1976x►
CITY or
NEWPORT BEACH,�
OF ORANGE COUNTY, CALIFORNIA
T � is
November 4, 1975
I
On motion of Supervisor Schmit, duly seconded and carried, the fol-
lowing Resolution was adopted:
BE IT RESOLVED as follows:
1. The amendment to the SSI Alert Program Contract between the
County of Orange and the California Office on Aging, extending the term
of the agreement from October 14, 1974, to December 31, 1975, is hereby
--
approved.
2. The Director of the Orange County Senior Citizens Program Offic(
is authorized to negotiate subcontracts for this service, where applicable
r
AYES: SUPERVISORS LAURENCE J. SCHMIT, RALPH B. CLARY, ROBERT W.
BATTIN, THOMAS F. RILEY, and RALPH A. DIEDRICH
NOES: SUPERVISORS NONE
ABSENT: SUPERVISORS NONE
STATE OF CALIFORNIA )
ss.
COUNTY OF ORA11GE )
I, WILLIAM E. ST JOHN, County Clerk and ex- officio Clerk of the
Board of Supervisors of Orange County, California, hereby certify that
the above and foregoing Resolution was duly and regularly adopted by the
said Board at a regular meeting thereof held on ti.e 4th day of
November 1975 , and passed by a ur,ani_r.:ons vote of
said Boar
IN WI'NESS WHEREOF, I have hereunto set my, harid`And seal this
A +h day of A?rn,nmhn,- 19 ..
Resolution No. 75 -1512 WILLIA:i E. ST JOHN
r SSI Alert Cati, ?i_y. C3cx:: crl : er- o£zicio Clerk
Extension n of tht Bo< -rd of Supervisors of
Program Contract Orange County, California
By
• f _ Deputy -
• 1
i
Contractor: CITY OF NEUMORT BEACH
p
Y Mayor
/TTEST: 2261 ,,- 0-C',
! City Clerk
HquuL zor the County of oranae
RESOLUTION NO. 8 6 5 R
A RESOLUTION OF THE CITY COUNCIL OF THE CITY
OF NEWPORT BEACH AUTHORIZING THE EXECUTION OF
AN AGREEMENT BETWEEN THE CITY OF NEWPORT BEACH
AND THE COUNTY OF ORANGE FOR FUNDS TO BE USED
IN CONNECTION WITH THE SENIOR CITIZENS SURVEY
WHEREAS, there has been presented to the City Council
of the City of Newport Beach a certain agreement between
the City of Newport Beach and the County of Orange for funds
to be used in connection with the Senior Citizens Survey; and
WHEREAS, the City Council has considered the terms
and conditions fo said agreement and found them to be fair
and equitable, and in the best interests of the City;
NOW, THEREFORE, BE IT RESOLVED by the City Council
of the City of Newport Beach that said agreement above - described
is approved, and the Mayor and City Clerk are hereby authorized
and directed to execute the same on behalf of the City of
Newport Beach.
ADOPTED this 22nd day of December
ATTEST:
City Clerk
i,
1975.
DDO /bc
12/19/75