CPC PROGRAM (please check one):

___Hockomock ___Sachem

___Project SHARE ___CDS

___Cross Community Provider (name of CPC

Program)

FY ’06 Provider Agreement/Authorization Form

Program Name:

Director’s Name:

Address: City: Zip:

Mailing Address (if different):

Phone Number: Fax : Email Address:

Billing Contact Person:

Council Contact Person:

(Please check one) � Public School � Center-based � Family Child Care (please check one ○ independent ○ system )

Accreditation Status (PLEASE CHECK all that apply):

___NAEYC Certificate (expires___________) ___CDA Credential (expires______________)

___NAFCC Certificate (expires___________) ___Degreed/Exempt Family Childcare Provider

SELF HELP INC., CPC MUST HAVE A COPY OF A

CURRENT DEEC (OCCS) LICENSE(EXPIRES__________________)

CHECKLIST FOR YOUR CONVENIENCE: you must return all forms from this checklist to Self Help Inc.

Self Help Inc./CPC Forms Enclosed (all originals) Copies of Forms to be provided by Childcare Program/Provider

Provider Agreement Authorization Program Brochure/Parent Manual

CPC Provider Agreement Copy of Current Published Rates

Holiday/Vacation Closure Verification and all Fees charged to families

Agreement as an Independent Contractor NAEYC Certificate (if applicable)

RFR Authorization Form CDA Credential (if applicable)

Late Pick-up Policy NAFCC Certificate (if applicable)

Abuse & Neglect Policy Snow/inclement weather policy

FY ’06 Rate Agreement Copy of DEEC (OCCS) license ________

CPC Provider Participation/Responsibilities

W-9 Form

Please check Corporation or Non-Corporation

 A: Corporation (please check appropriately)

 Non-profit as defined by the Internal Revenue Service  Profit (Proprietary)

Non-Massachusetts Corporation: You are required to register with the

Massachusetts Secretary of State to obtain authorization to do business within

Massachusetts. (please attach copy of authorization)

 B. Type of Non-Corporation Provider Entitles (please check appropriately)

Partnership: A partnership is a verbal or written agreement between two or more persons. It includes organizations where profits and losses are shared between persons, including husbands and wives. List names and addresses of all partners (or attach a list):

 Municipal Government (or similarly elected bodies): The Provider Agreement must be signed by all members of the stature to make contracts, or such authorizations may be delegated to an appropriate employee. If it is delegated, a copy of the delegation of the authority must be appended to this form. The person named in the delegation must be the one who actually signs the contract.

Sole Proprietorship: If your business is not incorporated, is not a partnership and is not a government body, it is a sole proprietorship. A sole proprietor must sign all agreements with her/him.

 Trust: List names and addresses of all trustees below (or attach a list)

__________________________________ ________________________________ ____________________________

COMMUNITY PARTNERSHIPS FOR CHILDREN

FY’06 PROVIDER AGREEMENT

This agreement is made between_____________________________________________, herein after referred to as the Provider and having a usual place of business at:

(street)_________________________________(city/town)___________________________________

(state)___________(zip code)___________________(phone)_________________________________

and Self Help, Inc., hereinafter referred to as SHI. This program is supported by a grant from the Department of Early Education Care (DEEC) to the lead agency, Self Help, Inc. The material within this contract does not necessarily reflect the views or policies of the DEEC or the Federal Government. The activities are financed under the DEEC project, Community Partnerships for Children Program, pursuant to a Standard Contract - Long Form between Self Help, Inc. and the DEEC.

Section I: General Purpose

This Agreement is for:

1. The provision of preschool childcare services hereinafter referred to as CPC scholarships to eligible families with children ages 2.9 to 5 years who are not yet eligible for kindergarten.
2. The pursuit of/maintenance of NAEYC Accreditation for group childcare centers; the pursuit of/ maintenance of a Child Development Associate (CDA) credential or National Association of Family Child Care Association (NAFCC) Accreditation for family child care providers according to the DEEC Early Childhood Program Standards and Preschool Learning Guidelines.
3. These services must be provided in compliance with the CPC program guidelines and regulations as described herein and in the DEEC’s Technical Assistance Manual dated October 2001.

Section II: The Provider agrees to:

A. Licensing/ Registration

1. Maintain a current DEEC (OCCS) (or other, as applicable) license or letter from the DEEC and provide child care services that shall comply at all times with the DEEC standards for the licensure or approval of group day care centers.

2. Care for no more children than the DEEC registration certificate allows at any one time.

B. Pursuit/Maintenance of NAEYC/CDA/NAFCC

1. Group Child Care Centers:

Maintain or be in the process of NAEYC Accreditation or submit for validation according to DEEC Guidelines and in accordance with current council guidelines.

2. Family Child Care Providers:

CDA/NAFCC candidate must follow set goals established between the Family Child Care Provider and the Family Child Care Support Specialist. The CDA/NAFCC Candidate must submit the Direct Assessment Application Form according to DEEC guidelines and in accordance with current CPC council guidelines.

3. All providers must keep SHI updated on accreditation status with any pertinent information to be submitted upon request.
4. As established by the DEEC, all center-based early childhood programs, that are part of Community Partnerships for Children, must follow the EARLY CHILDHOOD PROGRAM STANDARDS and GUIDELINES.

C. Operations

1. Maintain for pre-school programs, staff-child ratios and group size as stipulated under DEEC licensure standards.

2. Services may only be provided to children from age 2.9 through 5 years of age, but not kindergarten eligible.
3. Maintain and distribute to CPC program consumers, a written policy defining procedures to be followed when children are not picked up on time.
4. Remain open, whenever possible, despite inclement weather, with a skeleton crew, except in the case of declared snow emergency as indicated by the local Department of Public Works. A written copy of the snow day policy shall be distributed to all CPC program consumers.

D. Referrals/Eligibility

1. Accept families referred by SHI for a CPC scholarship that meet the eligibility requirements established by DEEC and the CPC Council without discrimination with regard to race, color, national origin, ancestry, age, sex, sexual orientation, religion, or disability.

E. Fee Collection

2. Collect only the fee as indicated on the consumer's child care authorization form, one week prior to the week to which payments apply.

3. Fees will be collected for days listed on the Holiday/Vacation Closure Verification form, if private consumers are charged for these days. A maximum of 14 holidays is allowed as indicated on the holiday closure listing along with scheduled vacation(s) listed.

4. Maintain a ledger of all fees collected from CPC program consumers; provide receipts to consumers for fees paid. Providers must maintain documentation of bank deposits of parent fees intact.
5. In the case of non-payment of fees, initiate termination, using the advanced notice of termination form and standard procedures, provided by SHI. (included)

F. Reporting

1. Notify SHI thirty (30) days in advance of any change in information in program name, address, telephone and fax number.
2. Notify SHI immediately if a child has more than three (3) unexplained absences within one (1) month. Any billing in excess of this will be disallowed if notification is not given on the fourth day of absence.
3. Notify SHI immediately if a child has more than ten (10) explained absences within one (1) month. Any billing in excess of this will be disallowed if notification is not given on the eleventh (11^th) day of absence.
4. Notify SHI immediately if a consumer terminates from CPC childcare Program before the end date authorized on the childcare authorization form.
5. Notify SHI and the consumer at least fourteen (14) days in advance of termination of services, using the advanced notice of termination form and standard procedures, provided by SHI.
6. Complete, sign, and deliver the Request for Reimbursement (RFR) to SHI/CPC on the Last day of Each Month. Payments will be mailed out based on the SHI Accounts Payable Schedule for FY 06. The Request for Reimbursement must be completed in compliance with the approved rates, assessed fees and service period as specified on the consumer's childcare authorization form. Late, incomplete or incorrect submission of the RFR will delay payment for that billing cycle. Two consecutive late billings may result in termination of contract.

7. No reimbursement for childcare provided through the Community Partnerships for Children Program will be honored beyond 60 days of the service month. Therefore, all RFR’s whether it be corrections; deletions or additions must be brought to SHI 's attention immediately.

8. At the end of the fiscal year (June 30th) the fiscal books will close for the year as of the 14th of July. No corrections or RFR’s will be honored beyond that date.

G. Record Keeping

1. In addition to the record keeping requirements of the DEEC (OCCS), the subcontractor must maintain a daily attendance record for each enrolled CPC child.
2. Maintain all source documents used to complete the Request for Reimbursement Form.
3. Maintain books, records and other data in such detail as shall properly substantiate receipt of funds from the lead agency and parent fees, if applicable; claims for payment; verification of participants’ eligibility, and program accomplishments (i.e., program goals achieved) under any funding award. These records must be made available to SHI, the DEEC and its authorized representatives, and representatives of the Office of the State Auditor and the Inspector General at reasonable times upon reasonable requests.
4. All records must be retained for seven years from the termination date of the subcontract.

H. Site Visits

1. Allow for site visits by SHI, DEEC and the CPC Council with reasonable notice.
2. Encourage the parent and the child to visit the program prior to acceptance.
3. Encourage consumer involvement, allow parental access, and enhance consumer knowledge about the child's program activities.

I. Title to Equipment and Furnishings.

1. The subcontractor must keep a record of the equipment and furnishings purchased under the contract. Self Help, Inc. and the Provider may be required to return equipment or furnishings purchased with grant funds upon completion or termination of a funding award or upon leaving the Partnership (see the attached Provider Responsibilities for details). The DEEC retains the right to verify that the equipment and furnishings are used in programs for young children.
2. The Provider agrees to use all CPC materials in a developmentally appropriate manner within their pre-school curriculum to meet the criteria presented in the Early Childhood Classroom observation.
3. The provider will return or incur the cost to return all CPC materials in the event that the Provider is no longer in business as an Early Childhood Provider.
4. Equipment & Furnishings are awarded on individual council policies, and all equipment/materials purchased through the grant must be marked in permanent marker with SHI/CPC.

J. Health & Safety

1. Develop and familiarize all staff with written procedures for maintaining clean, safe, and sanitary conditions for staff, children and the program environment. These conditions shall include, but not be limited to: hand washing, cleaning of bathroom fixtures, removal of trash, washing equipment and toys, and availability of staff trained in CPR and emergency first aid.

2. Immediately notify the local Board of Health in the case of an outbreak of any contagious disease including but not limited to; meningitis, H flu, hepatitis, giardia, salmonella, shingella, and follow the Board of Health's required procedures.

3. Disseminate to families the information sheet regarding lead screening developed by the Childhood Lead Poison Prevention Program, Department of Public Health.
4. Within 3 months of intake, encourage families to obtain lead screening tests as recommended and defined by the Child Lead Poison Prevention Program, Department of Public Health. Documentation of results shall be maintained in each child's case records.
5. Maintain logs regarding incidents such as injuries, health concerns and safety issues, which occur during the course of the day. These logs shall be used to share pertinent information between shifts and to monitor and improve health and safety conditions with the program on a routine basis, as need.

K. Institutional Child Abuse and Neglect

1. Adhere to all applicable Government State and/ or adopted Federal requirements pertaining to checking criminal records of employees.

2. Provide each staff member with a statement clearly defining child abuse and neglect.

3. Outline an employee's responsibility to report all incidents of child abuse or neglect to DSS and to the chief administrator of the facility.

4. Report any suspected or alleged incident immediately by telephone and in writing within forty-eight (48) hours to the DSS Area Director as mandated by the Massachusetts General Law -Chapter 119, Section 51 A-F and cooperate fully in the investigation of any incident. All suspected child abuse must also be reported to DEEC.

6. Maintain written procedures for handling any suspected incident of child abuse including:

- A procedure for ensuring that a staff member named in the report of suspected abuse does not work directly with the children until the investigation is completed.

- A procedure for disciplining any staff member who has been formally determined to be involved in an incident of child abuse.

6. Inform SHI when any staff member, assistant or household member (for FCC Providers) has been alleged to be involved in any 51A reports to the Department of Social Services.

7. Give permission for SHI to access any information from DSS or DEEC that pertains to the ability to care for children.

L. Indemnification, Non-Discrimination, Insurance, Certification...

Indemnification. Unless otherwise exempted by law, the subcontractor shall indemnify and hold harmless SHI against any and all liability, loss damages, penalties, costs or expenses for personal injury or damage to real or tangible personal property which the lead agency may sustain, incur or be required to pay, resulting from, arising out of, or in connection with any services or activities performed under this Agreement or any funding award by reason of acts, inactions, omissions, negligence, reckless or intentional misconduct of the subcontractor provided that the subcontractor is notified by SHI of any claim within a reasonable time after SHI becomes aware of it. The subcontractor is afforded an opportunity to participate in the defense of such claim and any negotiated settlement

agreement or final judgment. If applicable, indemnification by or of the subcontractors shall be determined in accordance with the provisions of M.G.L. c. 258.

1. This includes all suits and claims against the Provider, by its staff members, children served by their program, or third parties arising out of the care and education of the children. Including, and without limitations, and injury or illness sustained as a result of caring for, treating, or educating the children.

2. Center-based programs shall carry liability in commercially reasonable amounts. The Provider shall, upon request by SHI, provide SHI with evidence of such coverage.
3. The provider understands and certifies herein that the Provider enters into this Agreement as an independent contractor and may in no way be considered an employee of SHI, the Commonwealth or Federal Government.

M. Non-Discrimination in Employment and Affirmative Action

The subcontractor shall not discriminate against any qualified employee or applicant for employment because of race, color, national origin, ancestry, age, sex, religion, disability, handicap or sexual orientation.

N. Conflict of Interest and Undue Influence Prohibited

The subcontractor may not use any funds, programs or services funded under the Agreement or any funding award for any partisan political activity or to further the election or defeat of any candidate for public office.

0. Assignments

The subcontractor may not assign or delegate, in whole or in part, or otherwise transfer any liability, responsibility, obligation, duty or rights, including present and prospective claims for money, under a funding award, provided however, that present and prospective claims for money due and owing to the subcontractor from the lead agency hereunder may be assigned to a bank, trust company, or other financial institution insured by the Federal Deposit Insurance Corporation (FDIC) provided the, subcontractor provides written notice of the intent to make such assignment and the subcontractor complies with any additional DEEC requirements for effectuating such assignments.

P. Severability, Headings and Interpretation, Integration

All subcontracts by the parties must be in writing and consistent with the Commonwealth of Massachusetts Standard Contract and in compliance with the agreement between the lead agency and the DEEC. If any conflict arises, the provisions of the agreement between the DEEC and the lead agency take precedence.

Q. Execution and Certifications Required of Subcontractors

1. Provide ongoing technical assistance to providers, at a minimum in the areas of billing procedures, fees collection, record Employment Security Contribution and Workers' Compensation Insurance: The subcontractor has complied and shall continue to comply with all laws of the Commonwealth relating to contributions and payments in lieu of the contributions to the employment Security System, and relating to compulsory workers' compensation insurance covering all employees of the subcontractor.

2. Provision of Child Care: If the subcontractor has 50 or more full-time employees, it is required to establish a dependent care assistance program, childcare tuition assistance, or on-site or near- site child care placements, or is an “exempt employer". A subcontractor shall be considered an exempt employer if the subcontractor receives a funding award or other financial assistance from the Commonwealth that qualifies as a “grant-in-aid”.

3. Debarment: The subcontractor certifies that it is not currently debarred or suspended by the Commonwealth of Massachusetts, or the federal government under any Commonwealth or federal law or regulation.

4. Internal Revenue Service (IRS): The IRS requires Form W9 to be completed by all self-employed individuals and retained by the subcontractor, e.g., independent family childcare provider. The IRS requires that Form 1099 must be issued to any self- employed individual who is paid $600 or more in a calendar year. Forms can be downloaded from the IRS web site (www.irs.ustres.gov).

R. Obligation in Event of Termination or Suspension

If a subcontract is terminated or suspended, a timetable for meeting any stated requirements and a description of any allowable activities and approved costs incurred before termination or during suspension period must be included in the notice of termination or suspension.

Section III: Self Help, Inc. (SHI) Agrees to:

A. Referrals

Maintain a CPC Program Provider Resource File, which shall be available to all eligible consumers, which contains pertinent, up-to-date information, including the Provider's published brochures, rate information, and provider policies.

B. Training/Technical Assistance

Provide ongoing technical assistance to providers, at a minimum in the areas of billing procedures, fee collection, record keeping and CPC Program child care policies and procedures, and in other areas as SHI and the provider deem appropriate or as the DEEC may require.

Provide CDA/NAFCC/NAEYC Accreditation Support and training for the achievement and maintenance CDA/NAFCC/NAEYC Accreditation as agreed upon by the provider, SHI and the CPC Council.

C. Fee Assessment

SHI will assess the CPC Program’s consumer fees in accordance with the Commonwealth of Massachusetts Subsidized Childcare Sliding Fee Scale, based on the following: Quarter-day=less than 3 hrs.; half-day=3 hours-less than 6 hours per day; full-day=6 hours or more per day

D. Reimbursement

1. Review and approve each properly completed and duly submitted Request for Reimbursement (RFR) form within 10 days of receipt of the RFR, or inform the provider of reasons of disallowance.
2. Reimburse the provider within three weeks of receipt of the properly completed RFR from the provider.

E. Communications

1. Inform the provider of any change or termination of the consumer’s authorization for care.
2. Assist and, if possible, rectify consumer complaints regarding a specific provider or complaints regarding an enrolled consumer.
3. Make available to the provider all information contained in the provider's resource file, upon written request.
4. Inform the provider of DEEC standard contract requirements regarding non-profit providers.

Section IV: All Parties agree to:

A. Termination and Suspension:

A Subcontract may be terminated if one of the parties fails to complete any term, condition or material obligation of the subcontract (a notice to terminate must be given in writing 7 days prior to the recommended termination date.) A subcontract may also be suspended if an unanticipated emergency condition exists. This is limited to rare and extreme circumstances and further limited to the period of emergency. A subcontract may be terminated or the funding reduced if funding is reduced in the contract or grant received by SHI (Notice must be given and 14 days notice is recommended). Neither party will be expected to complete the provisions of the subcontract if they are unable to do so due to causes beyond their control, such as floods, fires, wars, quarantines, strikes, or unusually severe weather ("force majeure").

B. Obligation in the Event of Termination or Suspension

1. If a subcontract is terminated or suspended, a timetable for meeting any stated requirements and a description of any allowable activities and approved costs incurred before termination or suspension period must be included in the notice of termination or suspension. Regular payments will be delivered on schedule.

2. The subcontractor shall return any unspent funds to SHI no later than 7 days after the termination date of the subcontract. Payments may be withheld for non-performance or unsatisfactory performance.

C. Rates

1. The agreed upon rate(s) are in effect for the duration of this Agreement. All rates are subject to the approved policies of SHI, the CPC Council and the DEEC.

2. The CPC Program rate(s) are not higher than the rate(s) charged to private consumers for the same program type.

3. The agreed upon rates do not include registration/enrollment and other fees, such as field trip costs.

4. The provider may not charge a CPC Program consumer more than the fee assessed on the childcare authorization form. No deposits, no registration/enrollment fees, field trip fees, enrichment fees or other special event fees. Late fees charged after the established closing hours are the only exception.

5. For purposes of enrollment and billing, 6 or more hours is considered a full day. Less than 6 hours is considered a half day. Less than 3 hours is considered ¼ day.

D. Reimbursement Policy

1. Childcare services, as provided under this CPC Agreement, are considered properly authorized when a CPC authorization form has been issued and remains current. The provider will not be paid for services that are provided before the start date of a CPC authorization or beyond the end date of the CPC scholarship.

2. Children are considered enrolled, and services reimbursable, on the first day of actual program attendance, as verified by SHI.

3. Providers are reimbursed only from the time that children are authorized by SHI and scheduled to attend, according to the childcare authorization form.

4. The provider must immediately notify SHI after three (3) days of unexplained absence or ten (10) days of explained absence in one month. Billing for days in excess of this will be disallowed if notification is not given, as stated in Section I.E., 2-3. Repeated billing errors may be grounds for termination of this agreement.

5. If advance notification is given, the consumer may take a maximum of two (2) weeks vacation per year. (This is considered an explained absence).

6. The provider may bill up to ten (10) authorized service days in a fourteen (14) calendar day period if a consumer terminates services (before the end dates of the childcare authorization) without giving fourteen (14) calendar days notice, as long as the slot remains un-enroIled.

7. The number of days notice received will determine the additional days for which the provider who receives eight (8) calendar days notice may bill for all scheduled/ authorized service days within the following six (6) calendar days (as long as the slot remains opened).

8. SHI will reimburse the provider the full-reimbursed rate if the parent fee portion is not collected due to inadequate termination notice (less than 14 calendar days.)Otherwise, SHI will reimburse the provider for only the portion of the reimbursed rate as indicated on the authorization form. This payment will be made only if the slot remains un-enrolled. SHI will not be responsible for reimbursing the provider for any uncollected parent fees other than as described.

9. No billing under the fourteen (14) calendar days provision shall be allowed if the provider has received sufficient notice of termination by the consumer or SHI.

10. No billing under the fourteen (14) calendar days provision shall be allowed in the case of:

· provider-initiated termination,

· a child leaving a program due to an age-related transfer,

· a child is transferring from CPC Program services to a contracted/income eligible slot with the same provider, or

· the end date of the Program.

E. Notices

All written notices as required within the contract herein shall be deemed deliverable and received when given in person or mailed to the Provider and SHI, or when delivered by any other appropriate method evidencing actual receipt by the addressee.

F. Confidentiality

The lead agency and the subcontractor will comply with all laws and regulations relating to confidentiality and privacy. The lead agency and subcontractors shall at all times recognize DEEC’s ownership of data related to program operation: including the numbers of children served, ages, whether or not children have an Individualized Education Plan (IEP), first language of the children, type and duration of services, and income level of families of children served.

G. Subcontracting

Subcontractors may not subcontract with other agencies for services they are committed to provide without the consent of the lead agency.

H. Forum and Choice of Law

The laws of the Commonwealth of Massachusetts shall govern this Agreement, any funding award, award attachments, and any performance herein, and all actions arising therein, shall be brought and maintained in a state or federal district court of competent jurisdiction within the Commonwealth which shall have exclusive jurisdiction thereof. This paragraph shall not be construed to limit any other legal or equitable right of the parties.

I. Waivers

Forbearance or indulgence in any form or manner by a party shall not be construed as a waiver, nor in any way limit the legal or equitable remedies available to that party. No waiver by either party of any default or breach shall constitute a waiver of any subsequent default or breach.

J. Amendments

An amendment to a funding award shall not be effective unless authorized representatives of both parties in accordance with all applicable laws, regulations and procedures, execute it and filed with the original funding award at the Office of the Comptroller.

K. Effective Dates of the Provider Agreement

1. The provisions of this Agreement, including program rates, are subject to the review and approval of SHI, the CPC Council and the DEEC as indicated in Section IV.
2. This Agreement is not effective until signed by both parties.
3. This Agreement shall become effective on July 1, 2005 and shall be terminated no later than June 30, 2006.
4. This Agreement is subject to funding by the DEEC.

In Witness whereof, SHI and the Provider have caused this Agreement to be executed by their duly authorized representatives

Program Name Program Authorized Representative Signature Date (printed name and title)

Self Help Inc. Mary Donnellan, Director

Lead Agency Name Lead Agency Authorized Representative Signature Date

(printed name and title)