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2011-2012 Miami-Dade County Public Schools Supplemental Educational Services Contractual Agreement

No Child Left Behind Act of 2001 Supplemental Educational Services Contractual Agreement

2011-2012

This Contract is made and entered between The School Board of Miami-Dade County, Florida, (“School Board”) and _______________________________________________________________ (“Provider”) for the purpose of providing Supplemental Educational Services (“SES”) to eligible students pursuant to the No Child Left Behind Act of 2001 (“NCLB”). “Eligible students” are those students identified by the School Board who meet specific requirements under NCLB Parental Choice Options, pursuant to the NCLB, and as otherwise specified herein. I. School Board Responsibilities:

A. PARENT NOTIFICATION The School Board agrees to notify parents of eligible students annually (during years when it

is required by NCLB to offer SES) of the opportunity to obtain SES and provide them with a list of State-approved SES providers.

B. ASSIST PARENTS

1. The School Board agrees to assist parents, if requested by them, in obtaining additional information regarding State-approved SES providers that are available to serve their child(ren);

2. The School Board agrees to develop an agreement, in consultation with each eligible

student’s parent/guardian and the Provider, as described in Section II. J. For the purpose of this Contract, a parent is the natural or adoptive parent, legal guardian, or a surrogate parent as defined by Florida law or pursuant to a court order assigning or determining parental rights.

C. STUDENT CONTACT INFORMATION The School Board agrees to notify the Provider of the student’s name, school, address and

telephone on record, and allow the Provider to initiate contact with the student’s parents for the exclusive purpose of providing SES for the current school year, once parents select a Provider for their child(ren).

D. PROVIDER COMPENSATION

1. The School Board agrees to provide compensation to the Provider upon receipt of a complete and correct invoice as described in Section II. AA at a rate of $_________ per hour for each student. An instructional session shall be _________ minutes in length.

2. The 2011-2012 State-approved SES per pupil allocation for Miami-Dade County is

$1,369.00. This amount will be reduced by an annual fee of $85.80 (the per pupil cost of the pre and post assessment) for a net maximum per pupil payout of $1,283.20. In no event, shall the total cost per year for any individual student exceed the maximum per pupil payout.

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E. PAYMENTS

1. The School Board shall process payments to the Provider within forty-five (45) to sixty (60) business days of submission of complete and accurate invoices. Invoices submitted more than sixty (60) days after services are rendered are subject to non-payment.

2. No payment shall be authorized for services provided to any eligible student without a fully approved SLP, Tutoring Schedule and Monthly Progress Report, completed online by the Provider.

3. The School Board shall notify the Provider in writing if any modification to the date for

final invoicing is established. 4. The School Board reserves the right to withhold payment if a review reveals that

overcharges have been submitted by the Provider. Pre-assessments and post-tests are not billable. Payment of an invoice shall not foreclose the School Board’s right to recover erroneous, excessive, or illegal payments.

II. Provider Responsibilities:

A. APPROVED STATUS

1. The Provider certifies that it is on the Florida Department of Education’s current list of State-approved SES providers for Miami-Dade County and will provide services in accordance with the requirements of the 2011-2012 No Child Left Behind Supplemental Educational Services Request for Applications issued by the Florida Department of Education;

2. The Provider certifies that it has a demonstrated record of effectiveness in increasing the

academic achievement of students in subjects relevant to meeting the state’s academic content and student achievement standards;

3. The Provider certifies that it is capable of providing SES that are consistent with the

instructional program of the School Board and the State in both content and achievement standards;

4. The Provider certifies that it will deliver tutorial services consistent with the information

provided to the State in its application to become a State-approved SES provider, including grades served and minimum students to be served at a location; and

5. The Provider certifies that it is financially sound and otherwise capable of fulfilling its

requirements to the School Board, students and parents during the term of this Contract.

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B. MINIMUM STUDENT REQUIREMENT PER SITE

1. The Provider agrees to provide services to students from any school where at least ______ students have selected services from said Provider and been assigned to same. Failure to deliver services to students from any school that has met the minimum number of students established above will constitute a default on the part of the Provider.

2. The Provider agrees to electronically notify the District on or before September 26, 2011,

of its intent not to serve students assigned to their company from any school where the minimum number of students per site has not been met.

C. MAXIMUM STUDENT REQUIREMENT IN THE DISTRICT

The Provider agrees to provide services to a maximum of __________ students in the District. Failure to deliver services to all students assigned to the Provider without documentation to the School Board, as agreed upon in Section II. H. of this agreement, will constitute a default on the part of the Provider.

D. MEETINGS

The Provider must attend any and all School Board mandatory meetings including; Provider Orientation, Technical Assistance, End-of-Year, or any other meetings as may be required from time to time. The School Board will notify the Provider of the meeting times and dates at least five (5) calendar days in advance of the scheduled meeting by the School Board. Failure to attend such meeting shall result in default.

E. MARKETING MATERIALS

1. The Provider agrees that all marketing materials including posted materials used by providers to promote SES in Miami-Dade County shall be translated into Spanish and Haitian-Creole and include a disclaimer specifying that, “Distribution of this information does not imply endorsement or recommendation by the District”. Additionally, the Provider agrees that all SES marketing materials distributed to parents by the Provider will include a notice advising parents that, “In order for your child to be eligible for free tutoring, your child must attend a Title I School that has been designated as a ‘School In Need of Improvement (SINI)’ and must be eligible for Free or Reduced Price Meals for the 2011-2012 school year.”

2. Any marketing materials found by the District on school board property and/or at District

sponsored events that do not include the aforementioned disclaimer will be seized and disposed of by District personnel. Failure to comply with all marketing requirements will result in this Contract becoming null and void.

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F. STUDENT ENROLLMENT

1. Only SES eligible students may enroll in SES. An SES Eligible Student is defined as a student from a low-income family, as determined by the School Board, who is attending a Title I funded school that has been identified as a School in Need of Improvement (SINI), corrective action, or restructuring.

2. Only the official, district-issued SES application shall be processed for student

assignment by the School Board. It is the parent’s sole responsibility to complete the SES application. The Provider agrees that it shall not modify, replicate, or complete the SES application. Any SES application completed and/or altered by a Provider, or Provider’s agent, shall be declared void and will not be processed for student assignment.

3. Eligible students may only be registered for the Provider’s services by the District. The

Provider agrees that it shall not encourage students, or parents to enroll in its SES program once a student is enrolled in another provider’s SES program.

4. Recruitment of students on behalf of any specific Provider by School Board employees is

strictly prohibited. School Board employees may only answer questions and provide factual information to parents regarding SES, Providers, and/or Choice Options, for the purpose of assisting parents, as described in Section I.B., to select the best and most appropriate option for the student’s specific needs. School Board employees shall not be offered incentives and bonuses for recruiting students for the Provider.

G. INCENTIVES

The Provider agrees to limit student incentives as follows: a. Must not exceed a total of fifty dollars ($50.00) during the 2011-2012 school year per

student for all incentives;

b. Incentives must be earned by achievement and/or attendance;

c. Provider may not use/announce the availability of achievement and/or attendance incentives in its marketing efforts prior to student sign-up; and

d. Only students that have been assigned to a Provider may be informed of achievement

and/or attendance incentives.

e. The Provider shall not provide parent incentives.

H. RESSIGNMENT OF STUDENTS 1. The Provider agrees to make at least three (3) attempts to contact the parent of an assigned

student. The Provider shall document such attempts in writing before the Provider indicates the student cannot be served and requests that the student be removed from their

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list of assigned students. Such documentation shall be made available to the District upon request. 2. The School Board may, at its discretion, remove a student from a Provider’s list of assigned student if

the Provider has failed to deliver services to said student in a timely fashion, provided that a timely fashion shall be defined as at least twenty (20) days beyond the date of assignment of students.

I. PRE/POST ASSESSMENTS

1. The Provider agrees that the School Board shall determine the pre and post assessment for measuring learning gains of students enrolled in Supplemental Educational Services for the 2011-2012 school year.

2. The Provider further agrees that the third party assessment contractor selected by the School Board shall conduct the pre and post assessment of all students assigned to the Provider by the District.

3. The Provider also agrees to adhere to all district established timelines for the pre and post assessment of students.

4. The Provider shall be responsible for the cost associated with the pre and post assessment of all students assigned to the Provider by the School Board for the 2011-2012 school year, as stated in Section I.D.

J. STUDENT LEARNING PLAN

1. Student Learning Plan (SLP) - NCLB requires each District to enter into an agreement with the State-

approved SES provider selected by a parent. This agreement is recognized in Florida as the SLP and must be developed in consultation with the student’s parents and the Provider. The plan must include a statement of specific achievement goals for the student, how the student’s progress will be measured, and a timetable for improving achievement. In the case of a student with disabilities, these goals must be consistent with the student’s Individualized Education Program (IEP) under the Individuals with Disabilities Education Act (IDEA) or the student’s Section 504 Plan. The SLP must also describe how the student’s parents and teachers will be regularly informed of the student’s progress.

2. The Provider agrees to provide SES for the 2011-2012 school year to students assigned to the Provider

by the District. Parents of students assigned to the Provider must be contacted within 15 days by the Provider to schedule the completion of the SLP.

3. The Provider agrees to complete an SLP online for each student assigned and submit all required

documentation to the NCLB Parental Choice Options office for approval, prior to the commencement of services. Any student without an approved SLP within twenty (20) days of assignment to a Provider is subject to removal from that Provider’s list and reassignment to another Provider. The School Board reserves the right to require modification to the SLP.

4. The Provider agrees to submit to the District the original Parent Signature Page, signed by the parent or if the Provider is unable to contact the parent after three different attempts, the Provides agrees to submit the Evidence of Attempt to Obtain a Parent Signature on the SLP Form.

5. A Provider may not invoice the District for any tutoring services that commence before the student has a

fully approved SLP. A student’s SLP shall terminate if the student ceases to be enrolled in the District or a Title I SES eligible school.

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6. Disapproved SLPs shall be corrected and resubmitted via the M-DCPS SES Web-Based System within five (5) business days of the disapproval date.

7. The SLP is incorporated herein as Appendix A and shall become a term of this Contract. Such SLP agreement shall include and address:

a. The subject area(s) in cases where the parent, school, or SES Provider disagree, the

school shall have final authority to decide which subject area will be given priority;

b. A description of how the student’s progress will be measured;

c. A timetable for improving student achievement;

d. A description of the post-assessment that will be administered and an expected percentage of mastery of goals.

e. Procedures approved by the School Board for regularly informing the student’s

parents, teachers, and the District of the student’s progress;

f. Provision for the termination of the SLP and this Contract if the Provider fails to meet the goals and timetables specified in the agreement (this shall not limit the School Board’s right to terminate the agreement and/or Contract as provided elsewhere in this Contract);

g. Goals and timetables developed are consistent with the students’ Individualized

Education Plan (IEP), or Section 504 Plan, or English Language Learners Plan (ELL), if applicable;

8. Changes to a student’s SLP may only be made with the written consent of the School

Board and in consultation with parents/guardians. In the event that a student misses a scheduled SES session, a make-up session may be scheduled. The parent/guardian must be notified in writing 72 hours prior to the make-up session date(s) and the make-up session date(s) shall be reflected in the student’s Progress Report. Any make-up session must be scheduled within 21 calendar days of the missed session and may not occur after the last day to provide services as specified in Section III. A. The Provider shall not unilaterally terminate an SLP. The Provider must obtain written authorization from the School Board before terminating an SLP. The parents/guardians shall not be charged for any services rendered under the SLP unless such services and charges are clearly identified in writing as additional services independent of this Contract and agreed upon in advance and in writing by the parents/guardians. The District shall not be considered a party to such an agreement. Such arrangements shall be completely separate and apart from any agreement between the Provider and the School Board. In no event shall the agreed upon charges for additional services obligate the School Board financially, nor shall the School Board incur any obligations or expense in excess of the State/Federal reimbursement amount as identified in Section I. D.

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K. TUTORING SCHEDULE

The Provider agrees to maintain in the SES Web-based System an up-to-date tutoring schedule for each assigned student, in order to ensure continuity of services, the safety of students, and the efficient monitoring of services and program implementation. The Provider agrees to communicate all changes in the student tutoring schedule to the parent and the student’s school prior to implementing the new schedule.

L. PROGRESS REPORT

1. The Provider agrees to complete the District’s online Student Progress Report, incorporated herein as Appendix M. The Student Progress Report shall become a term of the contract, in order to ensure that parents are provided with information on the student’s progress at least monthly in an understandable and uniform format. The Provider further agrees to provide the parents with a printed version of the Student Progress Report which has been completed online by the Provider. The School Board and the student’s teachers may be provided with electronic reports unless written documentation is specifically requested. The Provider’s agrees to maintain a printed copy of each progress report generated for a student in the individual student’s file; and

2. The Provider agrees to be responsible for providing translation services whenever practicable, in the event that a parent requires translation of the Student Progress Report. However, translation of the information contained in the Progress Report into Spanish and/or Haitian-Creole shall always be “practicable”. The Provider further agrees to maintain written proof of such translations.

M. COMMENCEMENT OF TUTORING SERVICES

Services to students for the 2011-2012 school year must commence as soon as practicably possible but in no event later than October 15, 2011 (contingent upon Provider receipt of the District-approved student enrollment list at least 20 days prior to start date). Commencement of services is defined as the delivery of at least one unit of tutoring to the students assigned to the Provider as of September 23, 2011. In the event that assigned students are not being served by October 15, 2011, those students may be assigned to another SES Provider. Further, in the event that at least one hundred percent (100%) of assigned students are not being served by October 15, 2011, the District may terminate the Provider’s Contract and assign all students to other SES Providers.

N. TUTORING CONTENT

The Provider agrees to ensure that: 1. The content and instruction provided as part of the SES to be delivered shall be:

a. Research-based;

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b. Specifically designed to increase the academic achievement of eligible students as measured by the No Child Left Behind Act of 2001 under the state’s assessment system;

c. Sufficient to enable eligible students to make reasonable progress, given their

academic skills when services began, toward attaining proficiency in meeting state academic achievement standards;

d. Consistent with the School Board and State curriculum content and instruction; e. Aligned with School Board and State achievement standards; f. Secular and neutral with reference to matters of religious, political and social

ideology; and g. Consistent with federal and state law, Florida Administrative Code, and as specified by

the terms of this Contract.

2. Tutoring sessions must be related to each student’s goals. If it is found that tutoring is not in conformity with the Provider’s State-approved application, and the student’s SLP, the tutoring session will not be paid by the School Board and the Provider must submit a written plan to the School Board to revise the tutoring sessions to bring them into compliance with the Provider’s State-approved application and the student’s SLP, before tutoring may continue.

O. TUTORING LIMITS

1. The Provider agrees to limit the maximum number of hours of tutoring per week to six (6)

hours.

2. The Provider shall not tutor more than two (2) hours per day Monday through Friday. 3. The Provider shall not tutor more than four (4) hours on Saturday or Sunday, not to exceed six (6) hours for the week. 4. The School Board will not compensate the Provider for any tutoring which occurs beyond

the maximum number of hours of tutoring per week (6) hours. A week shall be considered Sunday through Saturday.

P. USE OF DISTRICT DESIGNATED ONLINE SYSTEMS

1. The Provider agrees to utilize the District’s SES Web-based System to develop SLPs, develop and maintain Student Tutoring Schedules, develop Student Progress Reports, and record and certify attendance. The Provider agrees to keep the District’s SES Web-based System up to date within one week of services rendered. The Provider shall enter actual hours of service into the District’s SES Web-based System within one week of services

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rendered. The District must be notified via email within ten (10) calendar days from the date the student became ineligible. The Provider will not be compensated for hours that have not been entered into the SES Web-based System within one week of services rendered for students who become ineligible. The School Board agrees to provide adequate training to Providers in the features and use of the District’s SES Web-based System;

2. The intentional and deliberate falsification of service hours entered into the SES Web-

based System by a provider will constitute a violation of the Providers’ obligations under the Contract and will be sufficient to place the provider in default. The District may, at its sole discretion, terminate the Contract.

Q. FEDERAL/STATE/LOCAL LAWS

1. The Provider agrees to comply with all applicable federal, State Board of Education, and

local statutes, laws, ordinances, rules and regulations, including any requirements of the State Board of Education or as specified in the Florida Administrative Code, relating to the provision of SES, including securing and maintaining in force such permits and licenses as are required by law in connection with the furnishing of services pursuant to and during the term of this Contract.

2. The Provider agrees to ensure that the SES are in compliance with federal/state laws and

School Board Policies regarding health, safety, and civil rights including, but not limited to, the Americans with Disabilities Act (ADA), Individuals with Disabilities Education Act (IDEA), and Section 504 of the Rehabilitation Act.

3. The Provider agrees to maintain all appropriate licenses that are required to provide SES

and inform the School Board immediately if any licenses are revoked or suspended. R. STUDENT CONFIDENTIALITY The Provider understands and agrees that it shall comply with the Family Educational Rights

and Privacy Act (“FERPA”) and all state and federal laws relating to the confidentiality of student records. The Provider further agrees to maintain the confidentiality of all students receiving SES and not disclose the identity of any student who is eligible for or receiving SES without the prior written permission of the student’s parents/guardians, except as authorized by School Board personnel.

S. CONTROL OF STUDENTS/STUDENT SAFETY

The Provider, while providing services, agrees to be solely responsible for the control and safety of all students from the time the student arrives until the student is placed under the control of the parent/guardian or other approved caregiver, at the end of the service. The Provider agrees to escort all students to the proper caregiver or approved means of transportation at the end of service. The Provider agrees to check the ID of the person picking up the child to make sure that it matches an individual allowed to care for that child if the

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person is unknown to the Provider. The Provider further agrees that it shall not release the student to any individual other than the parent/guardian, unless the parent/guardian has authorized that individual, in writing, to take custody of the student. The Provider also agrees to keep student emergency contact information at hand while providing services to students. An in-home Provider shall only provide services if the parent/guardian is present in the home during tutoring sessions. The Provider agrees to maintain a plan of action or provisions for substitutes, inclusive of tutors, instructional materials and supplies, in the event a tutor is absent. In the case of in-home tutorial, the Provider agrees to notify the parent of cancellation of a previously scheduled tutoring session at least twenty (24) hours prior to the beginning of the tutoring session.

T. QUALIFICATIONS OF TUTORS 1. The Provider agrees to ensure and certify that all tutors meet the minimum qualifications

for Title I paraprofessionals, as specified in requirements outlined in the 2011-2012 No Child Left Behind Supplemental Educational Services Request for Application issued by the Florida Department of Education.

2. The Provider is required to retain records of tutors’ qualification for each tutor and such

records shall be made available upon request. U. BACKGROUND SCREENING

1. The Provider agrees that as a condition of entering into this Contract, it will ensure that all staff members, including any administrative personnel who may have contact with students or visit school facilities while students are present, have undergone background checks with the Florida Department of Law Enforcement. The Provider further agrees that any person representing their organization entering school grounds or having direct contact with students shall meet Level 2 screening requirements as described in §1012.32 and 1012.465 Florida Statutes and School Board Policy 3121.01, attached herein as Appendix B. The name of each staff member must appear on the most current SES Provider Tutor Clearance Report prior to the time they have contact with students.

2. The Provider agrees to complete, for any new applicants who are not currently listed on

the most current SES Tutor Clearance Report, the SES Request for Fingerprinting of Non-M-DCPS Employees Form, incorporated herein as Appendixes F and F-1, as appropriate. The appendixes shall be electronically submitted to the NCLB Parental Choice Options office prior to the commencement of services.

3. The School Board agrees to perform the processing of each applicant’s fingerprints, except

in the case of a Provider that is delivering tutorial services online and whose firm and employees are located outside of the State of Florida. In the event that a Provider is providing online services, and is located outside the State of Florida, that Provider’s employees may undergo a background check and fingerprint screening conducted by a law enforcement agency or other entity approved by the School Board located in their home state. The results of the background check and fingerprint screening must be forwarded to

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the M-DCPS NCLB Parental Choice Options office for review and approval. All results must be forwarded on the letterhead of the law enforcement agency or other School Board approved entity that conducted the screening. The cost of fingerprinting will be borne by the Provider or the applicant.

4. The Provider agrees that applicants shall not be hired prior to the School Board’s receipt,

review, and approval of the fingerprint results of the Provider’s applicants from the Florida Department of Law Enforcement and the Federal Bureau of Investigation or School Board authorized entity, if the Provider is outside of the State of Florida. The Provider agrees not to hire applicants whose fingerprint check results reveal non-compliance with standards of good moral character and to ensure that no employee of the Provider working with students of the School Board has been convicted of a violent or serious felony, or a felony involving the abuse or neglect of children, as defined by statutes.

5. The Provider acknowledges and agrees that no payment will be made by the District

to the Provider for SES delivered by a tutor prior to the tutor receiving fingerprint screening clearance from the NCLB Parental Choice Options office.

6. The Provider agrees that it bears the responsibility to maintain a list of all cleared

employees, to immediately notify the District of any new hires and to ensure that they have completed the background screening process before they are given any access to students.

7. The Provider agrees to notify the District immediately upon becoming aware that one of its

employees, who were previously cleared through the background screening process, is subsequently arrested or convicted of any disqualifying offense. Failure by the Provider to notify the District of any such arrest or conviction within 48 hours of being put on notice and within five (5) business days of the occurrence of qualifying arrest or conviction shall constitute grounds for immediate termination of this agreement.

8. The School Board reserves the right to prohibit any employee of the Provider from having

contact with students on district property if the District has reason to believe that the safety or health of the students might be in jeopardy.

V. COMPLIANCE WITH CODE OF ETHICS/CONFLICT OF INTEREST

1. The Provider agrees to act in accordance with the Code of Ethics for Public Officers and

Employees and all School Board Policies regarding conflicts of interest. The Provider shall not act in a manner that is an actual or potential conflict of interest on behalf of itself or its employees providing services hereunder, including but not limited to, employment with the School Board.

2. The Provider agrees not to compensate school district employees by monetary payment, nor in-kind contributions, nor promise of future employment in exchange for access to facilities, (except as customary for facility utilization fees in accordance with Board Policies), to obtain student lists, unauthorized access to student or parent information

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and/or to obtain other similar benefits for their SES program or for any improper or illegal purpose.

3. In addition, the Provider agrees to comply with the requirements stipulated by M-DCPS’

Guidelines for Professional Conduct and Ethics regarding SES and incorporated herein as Appendix I. Further, the Provider agrees to ensure that all employees and contracted entities are informed about their obligations in meeting the M-DCPS’ Guidelines for Professional Conduct. Any violations of the ethics rules will be reported to the District’s Office of the Inspector General and/or the Office of Management and Compliance Audits for investigation and/or any other authorities as appropriate.

4. Further, as reflected in the Assurances section of the Provider’s state application, the

Provider agrees to adhere to the SES Provider Code of Ethics of the Education Industry Association (EIA) as revised January 8, 2008, a copy of which is incorporated herein as Appendix K.

W. DUAL EMPLOYMENT OF DISTRICT PERSONNEL

1. The Provider may hire school district employees for direct instructional purposes; however, tutors may also receive compensation for the completion of paperwork and documentation that are customarily associated with the task of tutoring. Additionally, Providers may also provide compensation to no more than one tutor per site who may perform the duties customarily associated with those of a Lead Tutor/Teacher. In the event that the Provider hires School Board employees to perform any services for the Provider, said services must be performed outside of the employee’s M-DCPS workday.

2. The Provider agrees to request a background check waiver for current School Board

employees by completing and submitting the 2011-2012 Background Check Waiver Form, incorporated herein as Appendix D for any new applicants who are not currently listed on the SES Tutor Clearance Report prior to the commencement of service. Waivers will be approved if the employee has met and cleared all background check requirements under Section II. U. of this agreement. The Provider further agrees not to allow District employees to engage in tutoring services until their names appear on the SES Tutor Clearance Report.

3. The Provider agrees to retain a completed and signed 2011-2012 Dual Employment Disclosure Form, incorporated herein as Appendix E, for each district employee hired to work with their company. Such employment by the Provider of School Board employees must be in accordance with School Board Policies 1129.01 and 3129.01, attached herein as Appendix J.

4. Further, any employee of the District which holds a position within the ownership

structure of the company and listed on the Florida Department of State Division of Corporations (Sunbiz) must either divest themselves of their interest in the Provider organization or resign their position with the District.

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5. All teachers who are employed by the Provider remain subject to the Code of Ethics of the Education Profession in Florida. No Provider may request that teachers engage in any activity that is not permitted under the Code of Ethics of the Education Profession in Florida.

X. TRAINING LOG

1. The Provider agrees to complete the Miami-Dade County Public Schools SES Provider

Staff Training Acknowledgement Form and the SES Provider Training Assurance Form, attached herein as Appendix L, and maintain copies of both forms in addition to all training meeting agendas, sign-in sheets, and training materials for District and State monitoring compliance. The Training Acknowledgement Log will be used to record the completion of all required training by each staff and shall be retained on file at the Provider’s facility. The Provider agrees to submit the SES Provider Staff Training Assurance Form to the District by October 21, 2011. Submission of this form acknowledges that the Provider has trained all current staff and will continue to provide training to all new staff hired within the contractual year.

2. The Provider agrees to ensure that all staff members, including volunteers, have been trained, are familiar with and agree to adhere to child abuse and/or missing children reporting obligations and procedures under Florida law, including but not limited to, Florida Statutes 39.201. The Provider agrees that all staff members will abide by such laws in a timely manner.

3. The Provider agrees that all personnel will be trained in appropriate procedures for

handling and reporting accidents or incidences when a student has suffered an injury, injured another individual, or has been involved in an activity requiring notification of law enforcement or emergency personnel.

4. The Provider agrees to sign the Provider Staff Training Acknowledgement Form, and

ensure that each staff member also sign the form verifying that they have been trained in the administration of the Provider’s SES program, its curriculum, pre and post assessment and student data reporting, District SES procedures, and all State mandated training.

5. The Provider agrees that by signing the Provider Staff Training Assurance Form, the

Provider is verifying that all current employees have been provided with all appropriate tutoring materials and supplies necessary to implement the Provider’s SES program as documented on the Provider’s State-approved application. The Provider also agrees to abide by these procedures when training new employees throughout the year.

Y. ACCIDENT/INCIDENT REPORTING

1. The Provider agrees to notify the School Board immediately (within one hour) of accident or incidence when a student has suffered an injury, or injured another individual, or has been involved in an activity requiring notification of law enforcement or emergency personnel.

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2. The Provider agrees to provide a written incident report within four (4) to six (6) hours of

an accident or incident when a student has suffered an injury, or injured another individual, or has been involved in an activity requiring notification of law enforcement or emergency personnel.

3. The Provider agrees to report all accidents or incidents to appropriate authorities with a

copy to the School Board when it is notified or otherwise becomes aware of circumstances including, but not limited to: all allegations of molestation, child abuse, or missing children under the Provider’s supervision. The Provider agrees to submit a written summary report of the occurrence to the School Board within three (3) days of original notification.

4. The Provider agrees to notify the School Board immediately of any information that may be

detrimental to the health or safety of any students or that may inhibit the Provider’s performance of this Contract.

Z. ACCESS TO RECORDS/FACILITIES/PERSONNEL

1. The Provider agrees to provide the School Board and/or its representatives with access to all facilities and records as may be necessary for the School Board to monitor compliance with this Contract. The Provider agrees to notify the School Board and provide the address of the location, and any change in location, along with all required permits, certificates of occupancy, or other approvals as may be required for the intended facility, in which it will provide SES to eligible students at least ten (10) days prior to the commencement of services. The Provider agrees to provide access to the School Board representatives to its SES facilities for periodic monitoring of each student’s instructional program.

2. The Provider agrees to maintain a file folder for each student which shall include at a

minimum each student’s SLP, Student Progress Reports, attendance, work samples, emergency contact and release instructions. Each student file must be made available for review to the School Board upon request. The School Board’s representatives must have access to observe each student at work during the SES sessions, observe the instructional setting, interview the tutor and provider, and review each student’s progress, including a behavior intervention plan, if any.

AA. INVOICING

1. The Provider agrees to submit to the District (on or before the 5th of each month) monthly

invoices for services rendered the previous month. Monthly invoices submitted to the District shall include; a completed M-DCPS Invoice Template, the original M-DCPS Monthly SES Student Attendance Form, attached herein as Appendix N, for all students listed on the Certified End of Month (EOM) Report, and the M-DCPS Certified EOM Report. The Provider also agrees to provide this information in aggregate form. Such invoices shall be submitted within sixty (60) days of the rendering of services. The Provider agrees to maintain Monthly SES Student Attendance Forms for all students receiving services. Any invoice submitted without the required documentation may be

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subject to non-payment. The Provider is only paid for the sessions students attend and that have been initialed by the student and the parent for in-home tutoring. Online Providers shall also submit a computerized log. The computerized log must include the students’ names and log-in IDs, as well as the log-in and log-out times for all of the invoiced students. The Provider shall indicate on the log, the total number of billable hours of service per day and the total number of billable hours for the month, for each student listed, in lieu of the student’s initials on the Monthly SES Attendance Form.

2. (a) Late Invoices

Invoices submitted after the 15th of the month will be assessed a fee of $60.00. For

invoices submitted after the 28th of the month, a fee of $10.00 per day for each day after the 15th shall be assessed.

(b) Deficient Invoices

Invoices returned to the Provider for corrections shall be assessed an administrative fee of 1% of the total corrected invoiced amount and resubmitted to the District within five (5) business days; otherwise, the Provider shall be assessed a fee of $100.00 per day beyond the 5th day. For all deficient invoices not submitted within ten (10) business days, the District shall deduct the appropriate fees delineated above and any other amount related to the unresolved discrepancy(ies) from the total invoiced amount. The invoice will then be submitted to Accounts Payable for payment.

3. Final invoices shall be submitted no later than May 5th of any calendar year, or as otherwise established by the District’s NCLB Parental Choice Options office.

BB. RECORDED ATTENDANCE FOR STUDENTS

Recorded attendance cannot be submitted for increments of less than 30 minutes. Time

reported between 30 minutes and 59 minutes shall be compensated as 30 minutes of service. The School Board shall not compensate the Provider for a full hour of services when time is reported for less than 60 minutes.

CC. SCHOOL BOARD POLICIES

The Provider agrees to follow all School Board Policies, regulations and guidelines associated with all aspects of SES including marketing to parents and students, recruitment and enrollment of students for the SES program; and to work at the School Board’s direction regarding the selection of those students that are to receive SES from the Provider in the event there are more students requesting SES from the Provider than can be accommodated.

DD. SUPPLIES/MATERIALS

The Provider agrees to be solely responsible for the provision of all appropriate supplies, equipment, materials and facilities for each student as required in his/her SLP.

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EE. USE OF DISTRICT FACILITIES

1. A Provider who desires to use the District’s facilities to implement its SES must make a

separate application for use of facilities through the School Board’s facilities usage procedures, as outlined in School Board Policy 7510, Use of District Facilities, and current Rental Charges established for SES Providers. Any Provider who has an outstanding charge for use of District facilities whose account is thirty (30) days or more delinquent, as determined by the District’s Office of Facilities Operations, Maintenance, Finance, shall be prohibited from using any District facility until such time as the outstanding balance is brought current.

2. Any Provider with an outstanding/unpaid balance for the use of District facilities from the

preceding year will be prohibited from:

a. entering into a new SES Contract for the following year; and

b. renting any District facility for any purpose until such time as the delinquent facilities account is brought current.

3. In the event that the outstanding balance is disputed, the District’s Office of Facilities

Operations, Maintenance, Finance, shall review the SES student attendance records for the dates and locations that are in dispute and make a determination as to the amount owed. In accordance with Section III. F. of this agreement, the School Board may withhold payment to the Provider when the School Board determines that there is an outstanding balance due for the use of school facilities.

4. In the event that a Provider has entered into a Facilities Usage Agreement for more classrooms and/or other spaces than will be utilized based on the Provider’s assigned number of students, those excess rooms must be released by the Provider. In as much as 1008.331(2)(g) Florida Statutes requires that “A school district with a student population in excess of 300,000 may only charge a State-approved supplemental educational services provider facility rental fees for the actual hours that the classrooms are used for tutoring by the provider”, any room retained by a Provider which fails to be used by said Provider for any two weeks in a four week period may be removed from the Facilities Usage Agreement and made available for use by the District or any other entity.

5. The Provider agrees to abide by School Board Policies 3124 and 4124, Drug Free Workplace, incorporated herein as Appendix C.

The School Board does not guarantee the use of the school facilities.

FF. RECORDS

1. The Provider agrees to maintain student records and provide the School Board access to

these records. All SES student records, including but not limited to attendance,

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assessments, and any other progress reports, shall be kept by the Provider in a secure location which prohibits access by unauthorized individuals. The Provider agrees to maintain an access log delineating date, time, agency, and identity of any individual accessing SES student records. The Provider shall not forward to any person, other than the parents/guardians, any student record without the written consent of the parents/guardian or the School Board.

2. The Provider agrees to provide access to and copies of all SES student records to the School Board upon the School Board’s request. Upon completion or termination of a student’s SLP, or termination of this Contract, the Provider agrees to provide all SES student records under its custody or control to the School Board.

3. The School Board shall have the right to inspect and audit the Provider’s facilities and

records and to observe services being rendered.

4. The Provider agrees to inform the District ten (10) days prior to administering post-assessments of when and where the test will take place to give the District the option to monitor or be present during the administration of the post-assessment.

5. The Provider agrees to provide access to all records, reports, logs or other matters relating

to this Contract for the current school year immediately upon request by the School Board. Fiscal records created pursuant to this Contract and records related to prior school years relating to SES shall be maintained by the Provider for five (5) years and shall be available for audit upon twenty-four (24) hours notice. In addition, the Provider understands and agrees that it is subject to the provisions of Chapter 119, Florida Statutes.

6. The Provider agrees to maintain daily records of student services provided, (i.e. portfolio)

including the name/address of the student, the name of the Provider’s employee who rendered the service, and the amount of time of such service. Said records shall be maintained in M-DCPS SES Web-based System, Tutoring Schedule for each student. Such records are subject to the inspection requirements delineated herein. The Provider shall permit access to and/or a copy of such records to School Board upon request.

GG. INDEMNIFICATION

1. The Provider agrees to indemnify, hold harmless and defend the School Board, its officers, agents and employees individually and collectively from and against all liabilities,

obligations, losses, damages, penalties, interest, claims, actions, assessments fines, suits demands, investigations, proceedings, judgments, orders or injuries, including death to any, or damage, of whatever nature, to any property and all costs including court costs and attorneys’ fees, and disbursements, whether suit is instituted or not, and if instituted, at all tribunal levels (wherever raised by the parties hereto or a third party) imposed on, or incurred by or asserted against the Board or any of them arising out of or in connection with or based directly or indirectly upon (a) the Provider’s directors, officers employees, agents, subcontractors, or representatives, performance or non-performance of their duties and obligations under or pursuant to this agreement, including without limitations, the

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failure to maintain insurance or notify the School Board; (b) any material breach of this agreement by the Provider(s); (c) false or inaccurate representation or warranty made by or on behalf of the Provider(s); and (d) any act or omission, negligence, or intentional acts of the Provider(s) or any of the Provider’s directors officers, employees agents, subcontractors or other representatives.

2. The Provider further agrees that it will not attempt to, purport to, or actually lend the full

faith and credit of the School Board to any third person or entity.

3. If the Provider is the State of Florida, or an agency or political subdivision of the State as defined by Section 768.28, Florida Statutes, the Provider shall furnish the School Board upon request, written verification of liability protection in accordance with Section 768.28, Florida Statutes.

HH. INSURANCE

At all times during the Agreement Term, the Provider(s) shall, at its sole cost and expense,

procure and maintain in full force and effect, the insurance policies as described below. The Provider(s) shall include the School Board and its members, officers and employees as “certificate holder” on all insurance policies. The insurance carriers must be duly authorized to do business in the State of Florida, with a general Best’s rating of “A-” or better and a financial size category of “IV” or better according to the A.M. Best’s Rating Guide and acceptable to the Board, the following types of insurance:

COMMERCIAL GENERAL LIABILITY INSURANCE Except as otherwise provided, the commercial General Liability Insurance provided by the Provider(s) shall conform to the requirements hereinafter set forth:

a. The Provider’s insurance shall cover the Provider(s) for those sources of liability

(including, but not by way of limitation, coverage for operations, Products/Completed Operations, independent Contractors, and liability Contractually assumed) which would be covered by the latest occurrence form edition of the standard Commercial General Liability Coverage Form (ISO Form CG 00 01), as filed for use in the State of Florida by the Insurance Services Office;

b. The minimum limits to be maintained by the Provider(s) (inclusive of any amounts provided by an umbrella or excess policy) shall be $1 million per occurrence/annual aggregate;

c. Except with respect to coverage for Property Damage Liability, the Commercial

General Liability coverage shall apply on a first dollar basis without any application of a deductible or a self-insured retention. The coverage for Property Damage Liability shall be subject to a maximum deductible of $1,000 per occurrence; and

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d. The Provider(s) shall include the School Board and its members, officers and

employees as “additional insured” on the required Commercial General Liability Insurance. The coverage afforded such Additional Insured shall be no more restrictive than that which would be afforded by adding the Board as Additional Insured using the latest Additional Insured Owners, Lessees or Contractors (Form B) Endorsement (ISO Form CG 20 10). The Certificate of Insurance shall be clearly marked to reflect “The School Board of Miami-Dade-County, Florida, its members, officers, employees and agents as additional insured.”

AUTOMOBILE LIABILITY INSURANCE The Automobile Liability Insurance shall conform to the following requirements:

a. The Provider’s Insurance shall cover the Provider(s) for those sources of liability

which would be covered by Section II of the latest occurrence edition of the standard Business Auto Policy (ISO Form CA 00 01), including coverage for liability Contractually assumed, as filed for use in the State of Florida by the Insurance Services Office;

b. Coverage shall be included on all owned, non-owned and hired autos used in

connection with his agreement; and

c. The minimum limits to be maintained by the Provider(s) (inclusive of any amounts provided by an umbrella or excess policy) shall be $1 million per occurrence/an annual aggregate.

WORKERS’ COMPENSATION/EMPLOYERS’ LIABILITY The Workers’ Compensation/Employers’ Liability Insurance provided by the Provider(s) shall conform to the following requirements:

a. The Provider’s insurance shall cover the Provider(s) (and to the extent its sub-

Contractors and sub-subcontractors are not otherwise insured), for those sources of liability which would be covered by the latest edition of the standard Workers’ Compensation Policy, as filed for use in Florida by the National Council on Compensation Insurance, without restrictive endorsements. In addition to coverage for the Florida Workers’ Compensation Act, where appropriate, coverage is to be included for the Federal Employer’s Liability Act and any other applicable federal or state law; and

b. Subject to the restrictions found in the standard Workers’ Compensation Policy,

there shall be no maximum limit on the amount of coverage for liability imposed by the Florida Workers’ Compensation Act or any other coverage customarily insured under Part One of the standard Workers’ Compensation Policy. The minimum amount of coverage for those coverages customarily insured under Part

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Two of the standard Workers’ Compensation Policy shall be: EL Each Accident: $500,000; EL Disease- Policy Limit: $500,000; EL Disease- Each Employee: $500,000.

c. In the event the Provider is not required to provide Workers’ Compensation

Insurance, as outlined in Section 440, Florida Statutes, and chooses not to provide Workers’ Compensation Insurance for its employees, the Provider shall provide, on company letterhead, a letter indicating that the Provider is not required to provide Workers’ Compensation Insurance under Section 440, Florida Statutes and elects not to provide said coverage for any employees.

PROFESSIONAL LIABILITY INSURANCE 1. The Professional Liability Insurance provided by the Provider(s) shall conform to the

following requirements:

a. The Provider’s Professional Liability insurance shall be on a form acceptable to the Board and shall cover those sources of liability typically insured by Professional Liability Insurance, arising out of or the rendering or failure to render professional services in the performance of this agreement, including all provisions of indemnification which is part of this agreement;

b. The insurance shall be subject to a maximum deductible not to exceed $25,000;

c. If on a claims-made basis, The Provider shall maintain without interruption, the

Professional Liability Insurance until (3) years after this agreement; and

d. The minimum limits to be maintained by The Provider (inclusive of any amounts provided by an umbrella or excess policy) shall be $1 million per claim/annual aggregate.

2. By appropriate rider or endorsements to such policies, the Board shall be included as an

additional insured under such policies, which endorsements or riders shall further provide that coverages there under shall be primary without right of contribution of any insurance carried by the Board. Prior to commencement of services hereunder, the Provider shall provide to the Board’s Office of Risk and Benefits Management, via the NCLB Parental Choice Options office, copies of the riders or endorsement described above.

3. Each insurance policy evidencing the insurance required hereunder shall bear the

appropriate endorsements whereby the insurance carrier waives any rights of subrogation acquired against the Board and the students by reason of any payment under such policy and shall provide that such insurance carriers shall notify the Board in writing at least (30) days prior to any cancellation, termination, non-renewal, or modification to the Provider’s policy(ies) required under this agreement.

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4. Prior to the execution of this agreement, the Provider shall furnish to the Board’s Office of Risk and Benefits Management, via the NCLB Parental Choice Options office, Certificates of Insurance evidencing that the Provider’s insurance coverage is consistent with the terms of the agreement. The Provider shall also provide to the School Board, via the NCLB Parental Choice Options office, renewal or replacement Certificates of Insurance no less than (30) days prior to cancellation, termination or modification. The Provider shall be in material breach of this agreement if the Provider fails to obtain replacement insurance coverage prior to the date in which coverage is terminated or expires. In this event the Board may terminate this agreement without further liability to the Provider. Additionally, the Provider shall be liable to the Board for any and all damages incurred due to the Provider’s failure to perform the agreement terms.

II. ASSURANCES

The Provider agrees to abide by all assurances provided to the Florida Department of

Education in the Provider’s State-approved Supplemental Educational Services Application, notify the School Board immediately if at any time the Provider can no longer certify or meet these assurances, and comply with all State of Florida legislative requirements associated with the delivery of SES.

JJ. EQUAL OPPORTUNITY The Provider agrees that it will not discriminate on the basis of race, religion, sex, age,

handicap, or sexual orientation in employment or in the operation of its program(s). KK. CORPORATE DOCUMENTS/PARTNERSHIP AGREEMENTS

1. The Provider agrees to furnish to the District a copy of the most recent registration with The Florida Department of State showing evidence that the Provider is legally qualified to do business in Florida. The document must be submitted at the time of Contract submission and within seven (7) days of any change to such documents or qualifications, including but not limited to a change of name for the Provider, and/or a change of any member of the Board of Directors, Trustees, Partners or other Principal of the Provider Organization. Additionally, no owner or principal of any Provider organization may be an active employee of the District.

2. The Provider agrees to complete and provide the District with the SES Provider Authorized Representative Form for Documentation, incorporated herein as Appendix H, listing all employees authorized to sign on behalf of the company upon the submission of the Contract to the NCLB Parental Choice Options office. If the Provider will not authorize any additional individuals to sign on behalf of the company, except those indicated on page 27 of this contract, the Provider shall indicate Not Applicable on the space provided for authorized representative(s) name.

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LL. STATE OF EMERGENCY

The Provider agrees to follow the District’s direction as to the status of school openings in the event that a State of Emergency is declared in Miami-Dade County and the Superintendent or other designated authority closes the public schools. In so much as the public schools remain closed to ensure the safety and security of M-DCPS students and the community, the Provider will not engage in tutoring services unless such services are ordinarily provided on-line in the student’s home.

MM. ID BADGES

1. The Provider agrees that all employees of the Provider shall wear a photo ID badge which clearly displays the employee’s name, current school year, the Provider’s name, and the employee’s role, i.e. Tutor, Lead Tutor, Area Manager, etc., while that employee is on District grounds and/or engaged in activities on behalf of the Provider, at any other location. In the event tutoring services are delivered in a student’s home or community location, the tutor must also display the required ID Badge. No Provider may issue an ID Badge to an employee for the current school year until such time as that employee has passed the District background check as required in Section II. U. of this agreement. The Provider shall provide the District with a sample ID Badge for its records for the current school year.

2. In the event the District creates a uniform SES ID Badge, the Provider agrees to switch to

the District’s uniform badge for all employees. The Provider further agrees that the District may charge a processing fee for each badge in an amount to be determined but which shall not exceed $5.00 per badge.

3. Failure of a Provider employee to properly display a valid SES ID Badge may require that

the employee discontinue tutoring and leave the premises until such time as a current valid SES ID Badge can be produced.

NN. VENDOR APPLICATION

The Provider agrees to complete and submit to the NCLB Parental Choice Options office, the M-DCPS Vendor Application Form incorporated herein as Appendix G. Complete and correct Vendor Applications will be forwarded to the Procurement Management Services Department for processing. Each company’s assigned vendor number will appear on the electronic version of their End-of-Month Report.

III. The Parties agree that:

A. TERM, RENEWAL, MODIFICATION AND AMENDMENT

1. The period of this Contract shall be July 1, 2011 through June 30, 2012, and shall become effective upon full execution of the Contract by both parties. No payment shall be authorized for services provided prior to the full execution of this Contract.

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2. The final date to provide SES tutorial services to any eligible student during the 2011-2012

school year shall be Monday, April 30, 2012. This Contract may be renewed for up to two (2) additional one year terms by mutual agreement of the Parties and upon the terms and conditions agreeable for such renewal.

3. This Contract may be modified or amended during its initial term or any renewal term

upon the approval of both parties, and such modifications shall be in writing and executed by the parties. No change in this Contract or a student’s SLP shall result in a per student School Board financial obligation to the Provider in excess of the School Board’s annual Title I SES per pupil allocation as determined by the Florida Department of Education.

B. SOURCE OF FUNDS AND LIMITATIONS

Nothing in this Contract shall be construed to require the School Board to meet its financial

obligations with funds or sources of funding that are not specifically provided pursuant to, and available for expenditure under, the No Child Left Behind Act of 2001 nor does this Contract create a multiple fiscal year obligation. Any financial commitment on the part of the School Board contained in this Contract is subject to annual appropriation by the School Board, federal and/or state governments, as applicable. The Parties agree that the School Board has no obligation to fund the financial obligations under this Contract other than for the then-current year of the Contract term and subject to the requirements of the No Child Left Behind Act of 2001, or until the Contract is terminated, if terminated during the term of the Contract.

C. TRANSPORTATION

1. Transportation arrangements and costs for students receiving services under this Contract

are between the Provider and the eligible student’s parents. The School Board has no obligations to provide transportation in connection with the Provider’s responsibility to provide services under this Contract.

2. If the Provider agrees to provide transportation to students, the Provider shall provide

transportation consistent with the requirements of Part I. E. of Chapter 1006, Florida Statutes. If the Provider utilizes private transportation providers, said transportation providers must meet all applicable State and School Board safety and transportation standards. The Provider shall provide the name of the private transportation provider with the name and a copy of the signed transportation contract at least ten (10) working days prior to the start of the transportation service.

3. If the Provider owns vehicles, they shall comply with the terms of Section II. HH. “Automobile Liability Insurance.” If the Provider does not own any vehicles, the Provider shall provide, if commercially available, evidence of Hired and Non-owned Automobile Liability Coverage in the amounts and limits outlined is Section II. HH. “Automobile Liability Insurance.” If Hired and Non-owned coverage is not commercially available, the

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Provider shall provide, on the Provider’s letterhead, a letter stating the required insurance is not commercially available.

D. DISPUTE RESOLUTION

Disputes between the School Board and the Provider concerning the interpretation of, requirements, or performance of this Contract shall be submitted in writing, delivered in person, or by certified mail, to the Accountability Officer, NCLB Parental Choice Options, at 1501 Northeast Second Avenue, Room 336R, Miami, Florida 33132 for review. The Accountability Officer’s decision shall be final and conclusive unless ten (10) days from the date of receipt of its copy, the Provider furnishes a written appeal of the decision to the Superintendent/Designee. In connection with any such appeal, the Provider shall be afforded an opportunity to be heard and to offer evidence in support of its position. The decision of the School District shall be binding upon the Provider and the Provider shall abide by the decision. The School Board reserves the right to take any actions it deems necessary during the dispute resolution process to protect the health, safety and welfare of the students.

E. SUBCONTRACT AND ASSIGNMENT

The Provider agrees that it shall not subcontract or assign any of the work contemplated

under this Contract.

F. DEFAULT

1. Failure on the part of the Provider to comply with or fulfill any term, condition, or timeline as specified in this Contract, or the SLP, will be sufficient to place the Provider in Default of its obligations under this Contract. If the School Board determines that the Provider is in Default as described above, the School Board shall notify the Provider in writing immediately and shall have the right to withhold payment of outstanding invoices. The Provider shall have seven (7) days from receipt of Default Notification from the School Board to cure said default. If the default is not cured within seven (7) days of School Board notification to the Provider, the District may, at its sole discretion, terminate the Contract.

2. If the Contract is terminated under this Default provision, the School Board shall only be liable for payment for services satisfactorily provided and properly invoiced in accordance with the requirements and time frames established in Section II. AA. of this agreement through the termination date, at the sole discretion of the School Board. If it is determined that the cause of the default will endanger the health, safety, or welfare of students of Miami-Dade County Public Schools receiving SES from the Provider, then this Contract may be terminated immediately.

3. In addition, in the event of a default, which may include, but is not limited to non-

performance and/or poor performance, the Provider shall lose eligibility to transact new business with the School Board for a period of 14 months from date of termination of the

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Contract by the School Board. Providers that are determined ineligible may request a hearing pursuant to §120.569, Fla. Statute, and School Board Policy 0133.

G. TERMINATION

1. During the term of this Contract, the School Board shall retain the right to terminate this

Contract with or without cause, provided that such termination shall comply with federal and state law, upon twenty (20) days prior written notice, except under circumstances as identified in Section III. F. of this Contract, which outlines the provisions for termination as a result of a default by the Provider or, Section II. E., which outlines marketing requirements or, Section II. U. which outlines the requirements for Provider employee background screening requirements. In the event of a termination for default, the seven (7) day notice of default and subsequent seven (7) day response period will be counted as part of the twenty (20) calendar day written notice.

2. Further, if the District must present the Provider with more than two (2) Notices of Default, upon the third default notice, the District will notify the Provider of intent to terminate this Contract.

3. The Provider may also elect to terminate this Contract upon twenty (20) days written

notice; however, in no event shall the Provider’s exercise of its right to terminate this Contract relieve the Provider of its responsibilities to complete any existing SLPs. Upon termination that is not occasioned by Provider’s default, the School Board shall pay, without duplication, for all services satisfactorily performed and properly invoiced in accordance with the requirements and time frames established in Section II. AA. of this agreement, up to the date of termination. In consideration of this payment, the Provider waives all rights to any further payment from School Board including, without limitation, any compensation for lost or unearned profits or costs and expenses incurred as result of the termination.

4. In the event of termination, the School Board shall reassign students remaining in need of

services to another Provider.

H. INDEPENDENT CONTRACTOR

1. This Contract is by and between two independent agents and is not intended to and shall not be construed to create an agent, servant, employee, partnership, joint venture, or association relationship between the parties hereto. The Provider understands and agrees that it shall be responsible for providing its own salaries, payroll taxes, withholding, insurance, workers compensation coverage, and all other benefits of any kind, as required by law for its own employees, and assumes the full responsibility for the acts, and/or omissions of his/her employees or agents as they relate to the services to be provided under this Contract.

2. The parties shall in no event be construed to be partners, joint ventures or associates of

the other in the conduct of each party’s business, nor shall the School Board be liable for

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the debts of the Provider in the conduct of the Provider’s business. The Provider and any person working for or on behalf of the Provider shall at all times be regarded as, independent contractors, and in no manner shall be considered employees, servants, or agents of the School Board. The Provider and any person working for or on behalf of the Provider shall provide all necessary materials to effectively perform their duties. The Provider agrees to comply with all applicable laws, including but not limited to state, federal and local tax laws; local and state laws concerning the licensing and operation of a business of the nature contemplated herein; local and state laws relating to health and safety; state and federal laws relating to nondiscrimination in employment; workers’ compensation laws; and state and federal wage and hour laws.

I. APPLICABLE LAW

The Provider agrees to be bound by any amendments to any state or federal laws referenced in this Contract or which impact the SES described herein upon the effective date of such amendments.

J. NON-EXCLUSIVITY This Contract does not grant to the Provider any exclusive privileges or rights; the School

Board may contract with other Providers for the procurement of comparable services. The School Board makes no commitment to request from Provider any minimum or maximum amount of services hereunder, except as otherwise set forth in this Contract.

K. SEVERABILITY

If any provision of this Contract is determined to be unenforceable or invalid by a court of competent jurisdiction, the remainder of the Contract shall remain in full force and effect.

L. GOVERNING LAW ATTORNEY’S FEES The terms and conditions of this Contract shall be governed by the laws of the State of

Florida with venue in Miami-Dade County, Florida. Nothing contained in this Contract shall give or allow any claim or right of action whatsoever to any other party or third party. It is the express intent of the parties to this Contract that any person receiving services or benefits hereunder shall be deemed an incidental beneficiary only. Each party shall be responsible for its own attorney’s fees.

M. ENTIRE AGREEMENT

1. This Contract represents the entire agreement between the parties. No other promises or agreements have been made other than those in the Contract. This Contract supersedes any prior agreements, understandings, promises, or representations, whether claimed to be oral or in writing.

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2. The parties have incorporated into this Contract their entire understanding of the requirements under this agreement. Each party acknowledges that it has read this Contract carefully, fully understands the meaning of the terms of this Contract, and is signing this Contract knowingly and voluntarily.

3. The failure of either party to insist in any one or more instances upon the strict

performance of any one or more of the provisions of this Contract shall not be construed as a waiver or relinquishment for the failure of any such term or provision, and the same shall continue in full force and effect. No waiver or relinquishment of any rights or privileges established by this Contract shall be deemed to have been made by either party unless in writing and signed by the parties.

4. Upon submission of this Contract to the District, the Provider shall provide the District

with the required documents, inclusive of this Contract and Appendixes A-N, which constitutes the entire Agreement between the School Board and the Provider. Failure to provide any of the documentation required under this Contract by the established deadline may result in default and termination as specified in Sections III. F. and G. of this Contract.

N. NOTICES

Every notice, approval, consent or other communication authorized or required by this Contract shall not be effective unless same shall be in writing and sent postage prepaid by United States Certified Mail, directed to the other party at the address hereinafter provided or such other address that from time to time either party may designate upon notice and agreement of both parties in accordance herewith shall be directed to the parties at their respective address as follows:

As to the Provider: The Provider’s Name and Address As to the School Board: Superintendent of Schools

Miami-Dade County Public Schools 1450 Northeast Second Avenue, Suite 912 Miami, Florida 33132

With a copy to: Accountability Officer, NCLB Parental Choice Options Miami-Dade County Public Schools

1501 Northeast Second Avenue, Room 336R Miami, Florida 33132

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Signed and effective this _______day of ___________________________________, 2011 Provider Authorized Representative: I, THE UNDERSIGNED, CERTIFY that I am an officer of _______________________________ (provider’s name) and therefore authorized to act on behalf of the organization. I further certify that the organization will comply with all of the terms set forth herein. Failure to comply with the terms may result in termination of this Contract and the reassignment of students remaining in need of services to another provider. By signing this contract, the Provider also certifies that it: a) Is not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily

excluded by any federal department or agency;

b) Has not, within a three-year period preceding this contract, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;

c) Is not presently indicted for, or otherwise criminally or civilly charged by a government entity

(Federal, State, or local) with, commission of any of the offenses enumerated in paragraph b. (above) of this section, and

d) Has not within a three-year period preceding this contract had one or more public transactions

(Federal, State, or local) terminated for cause or default. _____________________________________________________________________________ Name (Print) Title Signature Name of Supplemental Educational Service Provider: _________________________________ ____________________________________________________________________________ Tax Identification Number: ______________________________________________________ Additional Supplemental Educational Service Provider Authorized Representative(s): _____________________________________________________________________________ Name (Print) Title of Representative

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School Board Authorized Representative: Alberto M. Carvalho Superintendent of Schools Signature Signed and effective this ______ day of _____________________________________, 2011

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RNING PLAN (Sy not be assig

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Appendix A

____________________ __________

parent decide

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Appendix B

3121.01 - EMPLOYMENT STANDARDS AND FINGERPRINTING OF ALL EMPLOYEES

The School Board shall employ only individuals of good moral character. Employees not found to be of good moral character will not be eligible for continued employment. This policy applies to all employees whether full-time, part-time, or temporary.

Good moral character means exemplifying the acts and conduct that would cause a reasonable person to have confidence in an individual's honesty, fairness and respect for the rights of others and for the laws of the State and nation.

A. Fingerprinting

1. Periodic re-fingerprinting of employees is required to remain

employed. Personnel who have had a break in service shall also be required to be re-fingerprinted in order to be re-employed. Upon re-fingerprinting, any new criminal history that was not previously reported and appropriately addressed may result in non-reemployment, or disciplinary action up to and including dismissal.

2. Current employees who are seeking instructional positions and

who are required to be re-fingerprinted as part of the certification process may be subject to disciplinary action, up to and including dismissal, for any new criminal history that was not previously disclosed/discovered and appropriately addressed. Any records of criminal offenses that were properly disclosed and previously cleared by the Office of Professional Standards will not be a cause for disciplinary action upon subsequent review of the employee’s history.

3. Employees found through the re-fingerprinting process to have been convicted of a crime (regardless of adjudication or guilty plea, no contest plea and Pretrial Intervention) may be subject to disciplinary action up to, and including dismissal. However, if the prior criminal offense or conviction was related to or involved child abuse or child neglect, including sexual assault/sexual battery, the prior criminal offense or conviction shall be considered for the purpose of taking appropriate employment or disciplinary action, regardless of whether it was previously disclosed by the employee or previously cleared by the Office of Professional Standards.

4. Once an employee has previously disclosed his/her criminal

history record and is cleared for employment with the District, the criminal history may not be used as an impediment to promotion if the employee applied, fulfilled all the requirements, and is otherwise qualified for promotion.

5. The School District shall not be precluded, however, from

considering a current employee’s criminal history background when making future employment/placement decisions, such as

_____Initials Page 1 of 5

Appendix B

whether an employee with a prior conviction may be prohibited from holding a position of trust. Accordingly, the Superintendent has the discretion to review an employee applicant’s prior criminal history when making placement decisions.

6. The cost of the fingerprinting and the fingerprint processing shall

be borne by the District.

B. Disqualifying Criminal Offenses

Criminal offenses, which may result in disciplinary action up to, and

including dismissal include, but are not limited to,:

1. adult abuse, neglect or exploitation of aged persons or disabled

adults (F.S. 825.103)

2. aggravated assault (F.S. 784.021)

3. aggravated battery (F.S. 784.045)

4. arson (F.S. 806.01)

5. child abuse or child neglect (F.S. 827.03)

6. contributing to the delinquency or dependency of a child

(F.S. 827.04)

7. currently has a pending case for driving under the influence of

alcohol (DUI) (F.S. 316.193)

8. domestic violence (felony) (F.S. 741.28)

9. exhibiting a firearm or weapon within 1,000 feet of a school

(F.S. 790.115)

10. extortion (F.S. 836.05)

11. felony battery/assault (F.S. 784.041)

12. felony drug possession, sale or distribution (F.S. 893.13) 13. incest (F.S. 826.04)


Appendix B

14. indecent exposure (F.S. 800.03)

15. kidnapping/false imprisonment (F.S. 787.01, 787.02) 16. killing of an unborn child by injury to the mother (F.S. 782.09)

17. lewd and lascivious behavior (F.S. 798.02, 800.04) 18. manslaughter (F.S. 782.07)

19. murder (F.S. 782.04)

20. distribute or possess to sell obscene material (F.S. 847.011) 21. prostitution/solicitation of prostitution (F.S. 796.07) 22. removing children from the State or concealing children contrary

to court order (F.S. 787.04)

23. robbery (F.S. 812.13)

24. sexual assault/sexual battery (F.S. 794.011)

25. sexual performance by a child (F.S. 827.071)

26. vehicular homicide (F.S. 782.071)

27. burglary (F.S. 810.02)

28. counterfeiting (F.S. 831.28)

29. forgery (F.S. 831.01)

30. fraud (F.S. 817.03)

31. grand larceny (F.S. 812.014)

32. grand theft (F.S. 812.014)


Appendix B

33. possession of a concealed weapon (felony) (F.S. 790.01) 34. sale of alcohol to a minor (F.S. 562.11)

35. welfare/unemployment/workers' compensation fraud

(F.S. 443.071, 440.105)

36. battery/assault (F.S. 784.03, 784.011)

37. drug and/or paraphernalia (misdemeanor) (F.S. 893.13)

38. possession of a concealed weapon (misdemeanor) (F.S. 790.01)

39. resisting arrest with violence (F.S. 843.01)

40. currently on probation or community control (F.S. 948) 41. disorderly conduct (F.S. 870.01)

42. domestic violence (misdemeanor) (F.S. 741.28)

43. driving under the influence/driving while intoxicated (F.S. 316.193)

44. loitering (F.S. 856.021)

45. other criminal traffic offenses (various statutes)

46. petty theft/larceny/theft to deprive/retail theft/shoplifting

(F.S. 812.014, 812.015)

47. resisting arrest without violence (F.S. 843.02); with violence

(F.S. 843.01)

48. trespassing (F.S. 810.08)

49. worthless checks (F.S. 831.09, 831.02)

50. any crime involving moral turpitude (F.S. 1012.32, 1012.33)

Any omissions, changes, or typographical errors in the statutory citations

shall not be a defense for the employee.


Appendix B

The District will not retain employees within the School Police

Department who have received a dishonorable discharge from any of the Armed Forces of the United States, or with a conviction of a misdemeanor involving perjury, or a false statement.

C. Appeal Process

Employees who are disqualified from continued employment because of

criminal history will receive written notification by regular and certified mail. Disqualified employees may request an appeal conference. A written request for an appeal conference must be submitted to the Office of Professional Standards no later than fifteen (15) calendar days from receipt of notification by U.S. Mail or return receipt post office notification, whichever occurs first. An appeal conference will be conducted by the Office of Professional Standards within thirty (30) workdays of the receipt of a timely request from the applicant/employee. The period of time for holding an appeal conference may be extended upon agreement of the employee and the Office of Professional Standards.

The District administrator conducting the appeal may consider the

specific facts, which led to the conviction, and may consider mitigating factors. It is the employee's burden to provide verifiable documentation in support of his/her mitigation claim. The decision of the District administrator conducting the appeal will be final with the approval of the Superintendent.

F.S. 435.09, 943.0585(4)(a), 943.059(4)(a), 1001.10(5), 1012.27(6), 1012.315 F.S. 1012.32, 1012.56


Appendix C

3124 - DRUG-FREE WORKPLACE

The purpose of this policy is to:

A. promote a healthy, safe working environment;

B. seek the rehabilitation of permanent employees with a self-admitted or detected substance

abuse problem;

C. eliminate substance abuse problems in the workplace;

D. provide a consistent model of substance-free behavior for students;

E. provide a clear standard of conduct for District employees;

F. communicate that persons who violate the standards of conduct cited in this policy and who

refuse or cannot be assisted by rehabilitation or who have negatively impacted students and/or staff shall be dismissed; and

G. hire drug-free employees.

Illegal Drugs

A. Employees on duty or on Board property shall not manufacture, distribute, dispense, possess

or use illegal drugs, or be under the influence of such drugs.

B. Employees on or off duty shall not influence students to use illegal drugs or abuse legal drugs.

C. Employees convicted, adjudicated guilty, or who have entered a plea of guilty for any criminal

drug statute violation occurring in the workplace shall notify the District within forty-eight (48) hours after final judgment.

One time only, prior to testing, the District shall provide all job applicants and part-time employees transitioning to full-time employment a written statement of its policy on a drug-free workplace.

Alcohol and Prescription Drugs

A. Employees on duty or on Board property shall not be under the influence of alcohol. Employees in safety sensitive positions, will be free of measurable alcohol concentrations. Safety sensitive positions are defined in the Drug-Free Workplace Technical Guide, incorporated by reference into this rule. Employees shall not manufacture or use alcoholic beverages while on Board property or on duty.


Appendix C

B. Employees on duty shall not use or take prescription drugs above the level recommended by the prescribing physician on use prescribed drugs for purposes other than what the prescribed drugs were intended. In addition, the employee shall not distribute or dispense such drugs, except as provided in Policy 5330.

Pre-Employment Drug Screening

A. The District shall require pre-employment drug screening of applicants according to the Drug-

Free Workplace Technical Guide.

B. Applicants will be referred to Board approved, independent, certified laboratories using

recognized techniques and procedures, as described in the Drug-Free Workplace Technical Guide.

C. Specimens collected shall not be used to conduct any other analysis or test unless otherwise

authorized by law.

D. The validity period for pre-employment drug screening is one (1) year.

E. Applicants will be informed in advance of the requirement of a negative drug screen as a condition of employment. Applicants testing positive will not be eligible for employment for three (3) years from the date of the test. Applicants for designated positions will be informed of the requirement for a random drug screening test, without prior notification, after employment, under existing labor contracts, statutes, OTETA, and Board policies.

Employee Physical Examinations/Screening/Health Services

A. Drug screening shall be included in all physical examinations; current employees and contracted persons in covered positions will be screened under the Omnibus Transportation Employee Testing Act of 1991 (OTETA), and as required under existing labor contracts, statutes, State Board rules, and Board policies.

B. Circumstances under which testing may be considered include, but are not limited to, the

following:

1. observed use of illegal drugs and/or abuse of alcohol during work hours;

2. apparent physical state of impairment of motor functions;

3. marked changes in personal behavior on the job not attributable to other factors;

4. employee involvement in serious or repetitive accidents on the job causing personal

injury to self or others and/or significant property damage;


Appendix C

5. employee involvement in an accident requiring the vehicle to be towed or medical

treatment away from the scene of the accident; and

6. any vehicular fatality.

C. Drug and/or alcohol screening shall be conducted by Board approved, independent, certified laboratories using recognized techniques and procedures as described in the Drug-Free Workplace Technical Guide. The Technical Guide shall be located in the Board Office, Citizen Information Center, and the Office of the Board Clerk.

D. Medical records and related information shall be maintained in strict confidentiality, with the highest regard for employee privacy consistent with Florida's Public Records laws and the purpose of achieving and maintaining a drug-free workplace. Any laboratory contract shall provide that the contractor's records are to be kept confidential. The District shall establish a system of maintaining records to include both the District's and the contractor's record of applicant and employee urinalysis and blood alcohol results.

E. Chemical dependency is an illness that can be successfully treated and where possible, the

District will seek rehabilitation of permanent employees with a self-admitted or detected drug problem.

Disciplinary Sanctions

Employees who violate these standards of conduct and who the Board determines will not be assisted by rehabilitation or who have negatively impacted students and/or staff shall be dismissed. A refusal to submit to a drug test or a second violation of this policy shall constitute an inability to be assisted by rehabilitation. Nothing precludes the Board from seeking criminal prosecution for violation of this policy where the Board deems appropriate.

F.S. 440.101, 440.102 20 U.S.C. 3224A 20 U.S.C. Omnibus Transportation Testing Act of 1991 20 U.S.C. 701-706 Rehabilitative Act 1973 20 U.S.C. 86-201 20 U.S.C. 3171 et seq. 29 U.S.C. 705(2), 794, 794a 34 C.F.R. Parts 85, 86, 104 34 C.F.R. 34-86.201 41 U.S.C. 701 et seq., Drug-Free Workplace Act of 1988 Vocation Rehabilitation Act of 1973 Drug-Free Schools and Communities Act of 1986


Appendix C

4124 - DRUG-FREE WORKPLACE

The purpose of this policy is to:

A. promote a healthy, safe workplace.

B. seek the rehabilitation of permanent employees with a self-admitted or detected substance

abuse problem.

C. eliminate substance abuse problems in the workplace.

D. provide a consistent model of substance-free behavior for students.

E. provide a clear standard of conduct for District employees.

F. communicate that persons who violate the standards of conduct cited in this rule and who

refuse or cannot be assisted by rehabilitation or who have negatively impacted students and/or staff shall be dismissed.

G. hire drug-free employees.

Illegal Drugs

A. Employees on duty or on Board property shall not manufacture, distribute, dispense, possess

or use illegal drugs, or be under the influence of such drugs.

B. Employees on or off duty will not influence students to use illegal drugs or abuse legal drugs.

C. An employee convicted, adjudicated guilty, or who has entered a plea of guilty for any criminal

drug statute violation occurring in the workplace shall notify the District within forty-eight (48) hours after final judgment.

One time only, prior to testing, the District shall give all job applicants and part-time employees going to full-time employment a written statement of its policy on a drug-free workplace.

Alcohol and Prescription Drugs

A. Employees on duty or on Board property shall not be under the influence of alcohol. Employees in safety sensitive positions will be free of measurable alcohol concentrations. Safety-sensitive positions are defined in the Drug-Free Workplace Technical Guide, incorporated by reference. Employees shall not manufacture or use alcoholic beverages while on Board property or on duty.


Appendix C

B. Employees on duty will not use or take prescription drugs above the level recommended by the prescribing physician, and will not use prescribed drugs for purposes other than what the prescribed drugs were intended. In addition, the employee will not distribute or dispense such drugs, except as provided in Policy 5330.

Pre-Employment Drug Screening

A. The District shall require pre-employment drug screening of applicants according to the Drug-

Free Workplace Technical Guide.

B. Applicants will be referred to Board approved, independent, certified laboratories utilizing

recognized techniques and procedures as described in the Drug-Free Workplace Technical Guide.

C. Specimens collected shall not be used to conduct any other analysis or test unless otherwise

authorized by law.

D. The validity period for pre-employment drug screening is one (1) year.

E. Applicants will be informed in advance of the requirement of a negative drug screen as a condition of employment. Applicants testing positive will not be eligible for employment by the District for three (3) years from the date of the test. Applicants for designated positions will be informed of the requirements for a random drug screening test, without prior notification, after employment, under existing labor contracts, statutes, OTETA, and Board policies.

Employee Physical Examinations/Screening/Health Services

A. Drug screening shall be included in all physical examinations; existing employees and contracted persons in covered positions will be screened under the Omnibus Transportation Employee Testing Act of 1991 (OTETA), and as required under existing labor contracts, statutes, State Board rules, and Board policies.

B. Circumstances under which testing may be considered include, but are not limited to, the

following:

1. observed use of illegal drugs and/or abuse of alcohol during work hours;

2. apparent physical state of impairment of motor functions;

3. marked changes in personal behavior on the job not attributable to other factors;

4. employee involvement in serious or repetitive accidents on the job causing personal

injury to self or others and/or significant property damage;


Appendix C

5. employee involvement in an accident requiring the vehicle to be towed or medical

treatment away from the scene of the accident; and

6. any vehicular fatality.

C. Drug and/or alcohol screening shall be conducted by Board approved, independent, certified laboratories utilizing recognized techniques and procedures as described in the District's Drug-Free Workplace Technical Guide which shall be located in the Board Office, Citizen Information Center, and the Office of the Board Clerk.

D. Medical records and related information shall be maintained in strict confidentiality, with the highest regard for employee privacy consistent with Florida's Public Records Act and the purpose of achieving and maintaining a drug-free workplace. Any laboratory contract shall provide that the contractor's records are to be kept confidential under provisions of Florida laws. The District shall establish a system of maintaining records to include both the District's and the contractor's record of applicant and employee urinalysis and blood alcohol results.

E. Chemical dependency is an illness that can be successfully treated. It is the policy of the

District, where possible, to seek rehabilitation of permanent employees with a self-admitted or detected drug problem.

Disciplinary Sanctions

Employees who violate these standards of conduct and who the Board determines will not be assisted by rehabilitation or who have negatively impacted students and/or staff shall be dismissed. A refusal to submit to a drug test or a second violation of this policy shall constitute an inability to be assisted by rehabilitation. Nothing precludes the Board from seeking criminal prosecution for violation of this policy where the Board deems appropriate.

F.S. 440.101, 440.102 20 U.S.C. 3224A 20 U.S.C. Omnibus Transportation Testing Act of 1991 20 U.S.C. 701-706 Rehabilitative Act 1973 20 U.S.C. 86-201 20 U.S.C. 3171 et seq. 29 U.S.C. 705(2), 794, 794a 34 C.F.R. Parts 85, 86, 104 34 C.F.R. 34-86.201 41 U.S.C. 701 et seq., Drug-Free Workplace Act of 1988 Vocation Rehabilitation Act of 1973 Drug-Free Schools and Communities Act of 1986


SES Provider Name:

SES Provider Code:

LAST NAME FIRST NAME *Res

ubm

ittal

M-DCPS Employee #

Date of Birth (MM/DD/YYYY) Social Security #

District Office Use Only

* Mark for all "Resubmittals". Please do not send a new form.

M-DCPS EMPLOYEE

2011-2012 SES Background Check Waiver for M-DCPS EMPLOYEES

Page 1 of 2

Appendix D

This form will only be accepted if it is submitted electronically to: [email protected]. Changes/modifications to this form are strictly prohibited and will be considered a violation of the SES contract.Incomplete and/or altered Appendix D will not be processed.

Pursuant to Section II. U. of the 2011-2012 SES Contractual Agreement: "The Provider agrees that as a condition of enteringinto this Contract, it will ensure that all staff members, including any administrative personnel who may have contact withstudents or visit school facilities while students are present, have undergone background checks with the Florida Departmentof Law Enforcement. The Provider further agrees that any person representing their organization entering school grounds orhaving direct contact with students shall meet Level 2 screening requirements as described in §1012.32, Florida Statutes."

The staff listed below is currently employed by the District for the school year 2011-2012 and have completed and signed anSES Provider/School Board Dual Employment Disclosure (Appendix E), which shall be retained on file at the provider's facility.Our agency understands that no staff member will be allowed to work directly with students until their name appearson the "most current SES Provider Tutor Clearance Report".

______Initials

SES Provider Name:

SES Provider Code:

LAST NAME FIRST NAME Res

ubm

ittal

M-DCPS Employee #

Date of Birth (MM/DD/YYYY) Social Security #

District Office Use Only


This form will only be accepted if it is submitted electronically to: [email protected]/modifications to this form are strictly prohibited and will be considered a violation of the SES contract.Incomplete and/or altered Appendix D forms will not be processed.

M-DCPS EMPLOYEES

Page 2 of 2

Appendix D

M-DCPS EMPLOYEE

2011-2012 SES Background Check Waiver for

______Initials

SES P

Original witCopy to EmCopy to Wo

20

School B

engaging

to tutor f

The rule

regular w

________

acknowle

an empl

Educatio

2011-201

activity c

Board ho

the Prov

governin

Policies

with Sch

Each Pr

(Append

Provider

who is al

Emplo

rovider

h Provider ployee ork Site

011-2012 S

Board Policie

g in independ

for a fee, no

further requ

working hour

__________

edges that it

oyee of Mi

nal Services

12 SES Con

conducted b

ours. M-DCP

vider and e

ng the condu

1129.01 and

ool Board P

ovider listed

dix D) shal

r/School Bo

lso employe

oyee’s Name

SES Provid

es 1129.01 a

dent tutoring

r solicit for

uires that th

rs of the emp

___________

t has engage

iami-Dade C

s (SES) to el

ntractual Ag

by the emplo

PS shall not

employee; h

uct of Schoo

d 3129.01 m

olicies and a

d on the 20

ll be respo

oard Dual E

ed by the Pr

e

Name &

der/Schoo

and 3129.01

g for a fee of

a private sc

e District em

ployee nor o

__________

ed the servic

County Pub

ligible stude

greement ent

oyee on beh

t be conside

however, the

ol Board emp

may subject

any governin

11-2012 Bac

onsible for

Employmen

rovider.

Title of Prov

ol Board D

: TUTORI

f any student

hool, any st

mployee sha

on public sch

___________

ces of _____

blic Schools

ents on beha

tered into be

half of the P

ered a party

e employee

ployees at a

the employ

ng labor con

ckground C

retaining

nt Disclosur

Employee’

vider Repres

Dual Empl

ING require

t enrolled in

tudent curren

all not tutor

hool premise

__, an a

___________

s (M-DCPS

lf of the Pro

etween the P

Provider sha

to any emp

e must conf

all times. An

yee to discip

ntracts.

Check Waiv

the origin

re form for

’s Signature

sentative

oyment D

es that any D

the District

ntly enrolled

any student

es.

approved

__________

), to provid

ovider in ass

Provider and

all occur du

ployment agr

form to all

ny violation

plinary actio

ver for M-D

nal signed

r each M-D

Appen

Date

isclosure

District empl

shall not arr

d in his/her c

t for a fee du

SES Prov

___________

de Supplem

sociation wit

d M-DCPS.

uring non-Sc

reement betw

l Board Pol

of School B

on in accord

DCPS Emplo

2011-2012

DCPS empl

Date

ndix E

loyee

range

class.

uring

vider,

____,

mental

th the

Any

chool

ween

licies

Board

dance

oyees

SES

loyee

______Initials

SES Provider Name:

SES Provider Code:


ubm

ittal

Date of Birth (MM/DD/YYYY) Social Security # District Office Use Only


NON M-DCPS EMPLOYEE

Appendix F

This form will only be accepted if it is submitted electronically to: [email protected]. Changes/modifications to this form are strictly prohibited and will be considered a violation of the SES contract.Incomplete and/or altered Appendix F will not be processed.

Pursuant to Section II. U. of the 2011-2012 SES Contractual Agreement: The Provider agrees that as a condition of enteringinto this Contract, it will ensure that all staff members, including any administrative personnel who may have contact withstudents or visit school facilities while students are present, have undergone background checks with the Florida Department ofLaw Enforcement. The Provider further agrees that any person representing their organization entering school grounds orhaving direct contact with students shall meet Level 2 screening requirements as described in §1012.32, Florida Statutes."

Our agency understands that no staff member will be allowed to work directly with students until their name appearson "the most current SES Provider tutor Clearance Report".

NON-M-DCPS SES STAFF 2011-2012 SES Background Check for

_______Initials

SES Provider Name:

SES Provider Code:


ubm

ittal

Employee #Date of Birth

(MM/DD/YYYY) Social Security #District Office

Use Only


CHARTER SCHOOL EMPLOYEE

Appendix F-1

This form will only be accepted if it is submitted electronically to: [email protected]. Changes/modifications to this form are strictly prohibited and will be considered a violation of the SES contract.Incomplete and/or altered Appendix F-1 will not be processed.

Pursuant to Section II. U. of the 2011-2012 SES Contractual Agreement: "The Provider agrees that as a condition of enteringinto this Contract, it will ensure that all staff members, including any administrative personnel who may have contact withstudents or visit school facilities while students are present, have undergone background checks with the Florida Departmentof Law Enforcement. The Provider further agrees that any person representing their organization entering school grounds orhaving direct contact with students shall meet Level 2 screening requirements as described in §1012.32, Florida Statutes."

Our agency understands that no staff member will be allowed to work directly with students until their name appearson "the most current SES Provider tutor Clearance Report".

CHARTER SCHOOL EMPLOYEES2011-2012 SES Background Check Waiver for

_____Initials

Vendor Application

Interested vendors should fill out the Vendor Application Forms and refer to the Procurement website, at http://procurement.dadeschools.net for current solicitations. The completed Vendor Application Forms should be sent by fax or mail to the number or address listed below:

MIAMI-DADE COUNTY PUBLIC SCHOOLS PROCUREMENT MANAGEMENT SERVICES

1450 Northeast Second Avenue Room 352

Miami, Florida 331 32 (305) 995 - 4288

(305) 995 - 2642 FAX

FM-3921 Rev. (07-1 1)

Appendix G

______Initials

of 3 FM-3921 Rev. (07-1 1)

Miami-Dade County Public Schools Procurement Management Services

1 A. Federal Employer Identification Number

If none Owner's Social Security Number

1 B. Name of Business This name will be used on purchase orders and checks issued to your company.

Name of Firm, Individual(s), Partners or Corporation

Doing Business As (if same as above, leave blank)

6. Tvpe of Business

Corporation (State Incorporated)

(Date Incorporated)

Partnership

Sole Proprietorship (One individual owner)

Non-Profit Organization

Joint venture

Other

Street Address

City State Zip Code

2. Mailinq Address (If same as above, leave blank)

Street Address

City State Zip Code

7. Licenses

Occupational License No. (Attach copy of license to application)

Issued by

Certificate of Competency (if applicable)

Other Licenses

3. Invoice Remittance Address(where check should be mailed) (If same as mailing address, leave blank)

Street Address

City State Zip Code

4. TelephonelFax NumberlContact Person

Tel. Number

800 Number

Fax Number I Contact Person

E-Mail

5. Affiliated Companies (Parent company, subsidiary, joint venture, etc.) Use separate sheet if necessary.

Name of Company

Street Address

City State Zip Code

Tel. Number b l

8. Primary Business Classification (Check appropriate type)

Manufacturer/Producer General Contractor

Dealer or Distributor Subcontractor (Type)

Retailer Broker (Type)

MaintenanceIRepair Other (Type)

Professions Services (Type)

9. OwnerlGender Classification (Check those that apply)

Caucasian

African American

Hispanic

Female

Male

Other

Appendix G

______Initials

of 3 FM-3921 Rev. (07-1 1)

Stock Ownership

10. Ownership Disclosure If the contract or business transaction is with a corporation, partnership, sole proprietorship, or joint venture, the full legal name and business address shall be provided for each officer, director, and stockholder or owner who holds, directly or indirectly, five percent (5%) or more of the stock or ownership. If the contract or business transaction is with a trust, the full legal name and address shall be provided for each trustee and each beneficiary. Post Office addresses are not acceptable.

11. Aqent. Representative or Employee Authorized to Transact Business on Behalf of the EntitvlFirm

Name Title Name Title

Name of company, if other than applicant Name of company, if other than applicant

Street Address Street Address

City State Zip Code City State Zip Code

Te l Number Tel. Number

12. Please use Attachment " A and type the appropriate categories you would like to receive bid information on. The attachment can be found at http://procurement.dadeschools.netlpdf/vendorlist.pdf

Name

lC;tero;iJoil llt',"IN;I

I D

Gender Title RacelEthnicity

Under penalties of perjury, I certify that:

1. The number shown on this vendor application is my correct taxpayer identification number (or I am waiting for a number to be issued to me)

2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding. Vendor must cross out ltem 2 above if helshe has been notified by the IRS that helshe is currently subject to backup withholding because of failure to report all interest and dividends on hislher tax return, and

3. 1 agree with The School Board of Miami-Dade County , Florida, Business Code of Ethics and agree to comply with this Code and all applicable School Board contracting and procurement policies and procedures. (School Board Policy 6460)

Pursuant to School Board Policy 6460, which may be accessed at http://www2.dadeschools.netlschoolboardlrules all bidders, proposers, consultants, and contractors are required to disclose the names of any of their employees who serve as agents or principals for the bidder, proposer or contractor, and who within the last two years, have been or are employees of the School Board. Such disclosures will be in accordance with current School Board rules, but will include, at a minimum, the name of the former School Board employee, a list of the positions the employee held in the last two years of his or her employment with the School Board, and the dates the employee held those positions.

Pursuant to Florida State Statute 11 9.071 (5) (2) (a), we are notifying you that the Division of Procurement Management is collecting your social security number or taxpayer identification number inasmuch as the Internal Revenue Service requires that we obtain this information to report income paid to you.

Category No. I ,ltemlNo.,

UIIm , Category I No. I I I Item No.

m m , Category I No. I Item I No. , m m

Appendix G

______Initials

(Corporate Seal, i f appropriate)

CONE OF SILENCE

BOARD POLICY 1129

The School Board of Miami-Dade County, Florida, enacts a Cone of Silence from issuance of a solicitation and shall terminate at the time the School Board acts on a written recommendation from the Superintendent to award or approve a contract, to reject all bids or responses, or to take any other action which ends the solicitation and review process. All provisions of School Board Policy 1129.

LOBBYISTS

BOARD POLICY 81 50

School Board Policy 8150, delineates the policy regarding lobbyists. Pursuant to this rule, lobbyists shall complete annually, a Lobbyist Registration Form, and pay the annual registration fee.

Pursuant to this rule, every person required to register shall list all individuals who may make a presentation when the person appears as a representative for an individual or firm for an oral presentation before a site administrator, or instructional personnel, or certification, evaluation, selection, technical review or similar oral presentation committee. This listing shall include the Clerk's form, the list of presenters, and the indication of fee receipt, prior to the oral presentation. No person shall appear before any employee or committee on behalf of any individual or firm unless he or she has been listed as part of the firm's presentation team or unless he or she is registered with the Clerk's office and has paid all applicable fees.

The Board rule may be accessed at:

http://www2.dadeschools.net/schoolboard/rules/

(Signature) (Date)

Page 3 of 3 FM-3921 Rev. (07-1 1 )

Appendix G

______Initials

Appendix H

6/01/11

SES PROVIDER AUTHORIZED REPRESENTATIVE FORM FOR DOCUMENTATION*

________________________________________________

Provider Name

Document

Representative Name

Title

Student Learning Plans (SLPs)

Monthly SES Student Attendance Reports as Supervisor

Invoice & Title I SES EOM Report

Authorized to Sign Page 1 of the Provider Staff Training Assurance Form

Any and All SES Related Documents

(Attach additional forms if necessary)

I, the undersigned, certify that I am the Principal of the Provider Agency and hereby give permission for the above-named individuals to sign the designated documents.

_______________________________________________________________________________________ Name (Print) Title Signature Date

Changes to this form must be emailed to [email protected].

*No changes will be accepted to this form until after the contract has been fully executed.

______Initials

Appendix I

MIAMI-DADE COUNTY PUBLIC SCHOOLS’ GUIDELINES FOR PROFESSIONAL CONDUCT AND ETHICS FOR STATE-APPROVED SUPPLEMENTAL EDUCATIONAL SERVICES PROVIDERS

Please be reminded that State-Approved Providers servicing Miami-Dade County Public Schools (M-DCPS) and their staff must adhere to the following M-DCPS’ Guidelines for Professional Conduct and Ethics regarding Supplemental Educational Services (SES):

• SES Providers shall not compensate district employees personally in exchange for providing access to facilities, providing student lists, assisting with marketing or student recruitment to promote enrollment in a provider’s program. • SES Providers shall not request from district employees a list of students eligible to receive

services, as this information would identify a student as eligible for Free and Reduced Price Meals, which is in violation of the Family Educational Rights and Privacy Act (FERPA). • SES Providers shall not employ district employees in the capacity of principal, district

administrator or SES Coordinator. • SES Providers shall not hire school personnel for any purpose other than instruction-related

services (Tutor) or program coordination (Lead Tutor). • SES Providers shall not offer a parent or student any form of incentive for signing-up to receive

Services (simple door prizes of a nominal value (approximately $5 per prize) and refreshments to potential students and their families can be offered, while attending informational sessions. • SES Providers shall not distribute or make arrangements with school administrators, teachers or

school support staff to send home, via backpack or mail, the M-DCPS’ SES Enrollment Form that has a Provider’s name preprinted as part of the form or flyers endorsing a specific SES Program. • SES Providers shall not use school staff to market or promote their program to parents or

students. • SES Providers shall not modify any SES enrollment form completed by a parent. • SES Providers shall not post signs, pass out flyers or implement any other marketing strategies on

school ground or district’s property, as this creates disruption, which prevents the school from operating in a safe and orderly manner. • SES Providers shall not encourage students/parents to switch Providers once enrolled. A student is

considered enrolled once the District has issued the formal student / Provider selection list. • SES Providers shall not implement a rewards program for attendance and/or achievement that is

not part of the provider’s state-approved program (rewards for student’s performance up to $50.00 can be offered per student per year). • SES Providers shall not misrepresent to anyone, including parents (during student recruitment), the

location of a Provider’s program, principal, district or state’s approval of a Provider, or the likelihood of becoming so approved. • SES Providers shall not interact with each other in unprofessional manner in the presence of

students and parents, particularly during M-DCPS’ sponsored activities. M-DCPS’ sponsored activities are not appropriate venues for confrontations between providers.

____________________________________________________________________________ ACKNOWLEDGEMENT OF RECEIPT OF M-DCPS’ GUIDELINES FOR PROFESSIONAL CONDUCT AND ETHICS FOR STATE-APPROVED SES PROVIDERS By signing this form I acknowledge that I have received and read the M-DCPS’ Guidelines for Professional Conduct and Ethics regarding SES and agree to comply with these requirements. I will also ensure that all employees and contracted entities are informed about their obligations in meeting the above Guidelines for Professional Conduct and Ethics and provided with a copy of these guidelines. __________________________ __________________________ _______________ Provider Name Provider Signature Date

_____Initials

Appendix J

1129.01 - TUTORING

Administrators engaging in independent tutoring for a fee of any student enrolled in the District shall:

A. not arrange to tutor for a fee, nor solicit for a private school, any student currently enrolled in

his/her classes;

B. not tutor any student for a fee during regular working hours of the employee nor on public

school premises;

C. if a fee will be charged for tutoring students other than those enrolled in the tutor's classes, then the tutor must make arrangements with the parents for fee to be charged.

3129.01 - TUTORING

Instructional staff engaging in independent tutoring for a fee of any student enrolled in the District shall:

A. not arrange to tutor for a fee, nor solicit for a private school, any student currently enrolled in

his/her classes;

B. not tutor any student for a fee during regular working hours of the employee nor on public

school premises;

C. if a fee will be charged for tutoring students other than those enrolled in the tutor's classes, the tutor must make arrangements with the parents for the fees to be charged.

_____Initials

Code of Professional Conduct and Business Ethics For

Supplemental Educational Services Providers

Amended January 8, 2008

This revised code of ethics, as adopted by the EIA Board of Directors, shall become effective January 8, 2008. SES Providers (and other education service providers) operate in an environment that touches communities, school officials, parents, students and other providers. The importance of the activities and complexity of the interactions make it paramount that EIA member organizations adhere to the highest standards of professional conduct and business ethics. In its role of providing critical leadership to the education industry, both public and private, EIA has adopted this voluntary code to describe key organizational behaviors and policies that will guide its member companies and others. High quality educational programs delivered by trained professionals represent the core value that is to be reflected throughout all of our partnerships with schools, parents and students. The following structure represents the collective judgment of what constitutes ethical behavior. EIA members are committed to using it to guide decision-making and performance at all levels of their organizations—from the CEO to the employee in the classroom. Accountability for achieving desired results consistent with these guidelines and standards is the ultimate benchmark upon which EIA member service providers will be judged. We encourage States and Local School Districts to adopt these guidelines into their governance, contractual and oversight systems and apply all appropriate sanctions when the guidelines have been breached. EIA Compliance Procedures:

1. EIA will develop educational materials on these standards for use by providers, States and school district personnel. These materials will be distributed to members and non-members alike for their incorporation into their internal staff development procedures.

2. All EIA members will sign a statement acknowledging their acceptance of these standards. EIA will maintain a list of signers on its website for the public to review.

3. When a State or School District completes an investigation and has a finding that a breach of these guidelines has occurred, EIA may issue its own censure, suspend or terminate the membership status of the Member. Before EIA acts, it will discuss the matter with the party and offer the party the opportunity to present its information to an ad hoc committee of the Board of Directors.

General Guidelines

In the conduct of business and discharge of responsibilities, Providers commit to:

Appendix K


1. Conduct community outreach and student recruitment and to serve students fully consistent with the terms of their state-approved application and all state and local policies.

2. Conduct business honestly, openly, fairly, and with integrity. 3. Comply with applicable laws, statutes, regulations and ordinances. 4. Avoid known conflict of interest situations. 5. Never offer or accept illegal payments for services rendered. 6. Apply these guidelines and standards throughout the company by insuring all employees understand

them and act accordingly. 7. Refrain from publicly criticizing or disparaging other providers. 8. In the case of any conflict, first attempt resolution directly with each other. However, the parties involved

may ask EIA to help mediate potential disputes. 9. Comply with the confidentiality and non-disclosure provisions of all applicable federal, state and local

laws, including those relating to student identity, records, reports, data, scores and other sensitive information.

10. Be factual and forthright in reporting and documenting attendance rates, effectiveness of their programs, and in explaining the theoretical/empirical rationale behind major elements of its program, as well as the link between research and program design.

11. Take appropriate corrective action against provider employees, consultants or contractors who act in a manner detrimental to the letter or spirit of this code. 12. Take immediate steps to correct any actions on its part that willfully or inadvertently violate of the letter or spirit of this code.

Standards Specific to SES

EIA Members will consistently implement the NCLB Supplemental Services provisions and promote full access to SES services. To that end, Providers Shall: 1. Not compensate school district employees personally in exchange for access to facilities, to obtain

student lists, to assist with marketing or student recruitment, to promote enrollment in a provider’s program at the exclusion of other providers, to obtain other similar benefits for their SES program, or for any illegal purpose.

2. Not employ any district employees who currently serve the districts in the capacity of Principal, Assistant Principal, or school or district SES Coordinator.

3. Not employ any individuals, including teachers, parents or community leaders, who have any governing authority over a school district or school site. The sole exception shall be in school districts that are considered rural and where there are few providers.

4. Not hire school-employed personnel for any purpose other than instruction-related services or program coordination, as described in item #3 in the next section below.

5. Not make payments or in-kind contributions to schools or school personnel, exclusive of customary fees for facility utilization in exchange for access to facilities, to obtain student lists, to increase student enrollment, to obtain other similar benefits for their SES program or for any illegal purpose.

6. Not misrepresent to anyone, including parents (during student recruitment), the location of a provider’s program, principal/district or state’s approval of a provider, or the likelihood of becoming so approved.

7. Not offer a student, parent or teacher any form of incentive for signing-up a student with a provider. This includes restricting the promotion of any allowable attendance or performance incentives to the period following student enrollment. Only then may the provider inform the student of any incentives that are directly linked to attendance or performance in SES.

8. Not sponsor promotional events including pizza parties on school grounds for student recruitment that are for the sole benefit of a single provider. The preferred practice is for the school to organize such

Appendix K


recruitment events that are for the benefit of all providers, accepting voluntary sponsorship from providers.

9. Not employ any SES-enrolled student. 10. Not use a district enrollment form that has the selected provider’s name pre-printed as part of the form.

Any facsimile of the enrollment form used to demonstrate how to accurately complete it must be clearly marked as “SAMPLE” and this facsimile shall in no way be used to actually enroll the student.

11. Not encourage students/parents to switch providers once enrolled. A student is considered enrolled once the District has issued the formal student / Provider selection list.

Providers MAY: 1. Provide simple door prizes of a nominal value (approximately $2 per prize) and refreshments to

potential students and their families, while attending informational sessions. 2. Offer enrolled students performance rewards with a maximum value of $50 that are directly linked to

documented meaningful attendance benchmarks and/or the completion of assessment and program objectives. These incentives shall not be advertised in advance of actual enrollment.

3. Employ a parent of an SES-eligible student subject to the following conditions. Each parent of an eligible student who is hired by a provider must have a written job description and must be compensated on the same basis as all other employees of the provider who perform similar work. No parent may receive any commission or other benefit related to the enrollment of his or her child in a provider’s program, nor may a parent be subject to any employment action by the provider on account of the parent’s selection of an SES program for his or her child.

4. Employ school district employees (subject to items #2, #3 and #4 in the previous section above) for instruction-related services or program coordination purposes as long as the person does not restrict the marketing or enrollment opportunities of other providers, subject to District policies governing conflict of interests and other District-imposed requirements. However, tutors who are currently employed by the school district may not recruit students.

5. Include in tutor compensation, incentives for student achievement consistent with a company’s written policy.

For more information about the Education Industry Association, contact Steve Pines, Executive Director, 800-252-3280, [email protected], www.educationindustry.org.

Appendix K


Miami- Dade County Public Schools (M-DCPS) Supplemental Educational Services (SES)

Provider Staff Training Assurance Form Please print or type the following information: Name of Provider: _____________________________________________________________________

As the authorized representative for this Provider, I certify that all the staff have been trained in the following areas:

1. M-DCPS Procedures and Guidelines for the Implementation of SES Program

2. M-DCPS Code of Ethics and Conduct

3. Child Abuse Reporting

4. Accident/Incident Reporting

5. Confidentiality of Student Information

6. M-DCPS Emergency Procedures

7. Student Emergency Contact Information

8. Student Dismissal Procedures

9. Student Sign In/Sign Out Procedures

10. Student Attendance Recording

11. Student Learning Plan (SLP) and Progress Report

12. Pre-and Post-Assessment Procedures and Reporting

13. Provider’s SES Program and Curriculum

14. Usage of Supplies and Equipment

15. Instructional Materials and Supplies

16. District Requirements and Procedures for Fingerprinting/Background Screening Clearance

17. All State Mandated Training

I also acknowledge that:

No SES will be delivered by a tutor prior to the tutor receiving background and drug screening clearance from the NCLB Parental Choice office.

Instructional materials for program implementation were provided for all tutors.

I certify that I am an individual authorized to act on behalf of the organization named or referenced above in submitting this Assurance as indicated on Appendix H, and that all the information provided herein is true and accurate to the best of my knowledge. I verify that the attached list contains the name and title of all staff members that have been trained in all areas indicated above. I understand that the staff will not begin offering services until approval is received from the M-DCPS NCLB Parental Choice office. I further certify that this organization will continue complying with all staff training requirements during the duration of the services stipulated in the contractual agreement with M-DCPS, and that newly hired staff will be trained within 30 days of employment with this organization. _________________________________ ________________________ ______________

Provider Representative Name & Title (print or type) Signature Date

Appendix L


Miami- Dade County Public Schools (M-DCPS) Supplemental Educational Services (SES)

Provider Staff Training Acknowledgement Please print or type the following information: Name of Provider: _____________________________________________________________________ Name of Staff: __________________________________, _____________________________________ Last First Job Title: ____________________________________________________________________________ I have been trained in:

M-DCPS Procedures and Guidelines for the Implementation of SES Program M-DCPS Code of Ethics and Conduct Child Abuse Reporting

Accident/Incident Reporting

Confidentiality of Student Information

M-DCPS Emergency Procedures

Student Emergency Contact Information

Student Dismissal Procedures Student Sign In/Sign Out Procedures

Student Attendance Recording

Student Learning Plan (SLP) and Progress Report

Pre-and Post-Assessment Procedures and Reporting

Provider’s SES Program and Curriculum

Usage of Supplies and Equipment – I will only use supplies or equipment that belongs to the provider or myself.

Instructional Materials and Supplies

District Requirements and Procedures for Fingerprinting/Background Screening Clearance All State Mandated Training

I acknowledge that I have received training in all areas listed above. Yes No I meet the educational requirements to work for this company under the capacity of: Employee Tutor Volunteer Other _________________________________________ I have received instructional materials for program implementation (tutors only). Yes No ________________________________________ __________________________________________ Staff Signature Date Staff Phone Number: _______________________ Email: ____________________

Provider Use Only:

I verify that the staff member named above has been properly trained in all areas checked. I understand that the staff will not begin offering services until approval is received from the M-DCPS NCLB Parental Choice Options office. ___________________________________ ________________________ ____________ Provider Representative Name & Title (print or type) Signature Date

Place Copy of SES Staff Identification Badge

Here

Badge must include:

Name Title Photo Name of the Company Current School Year


Stud SES Comprov - Ear

Ass - Ha

En Nam Nam

Loca Scho Freq Leng

NCL

dent:

Provider:

mpany’s Namvide SES tuto

rned a high sociate Degre

as undergoneforcement or

e of Tutor Co

e of Provide

ation of Tuto

ool / room # (

uency of Pro

gth of Sessio

LB Parenta

me confirms oring:

school diplomee, or has pa

e a required other entity a

ompleting th

er's Represen

Tutoring

ring:

)

ogress Repo

ons:

Miamal Choice O

R

ID#

that the ab

ma and has ssed a local p

background approved by t

his Report:

ntative Enter

g Schedule f

orting:

Pa

mi-Dade CoOptions - S

Student P

Reporting P

#:

Tutor(s

bove-named

completed twprofessional a

screening, ithe School Bo

ring Report O

for This Rep

Type of

Total N

Day(s):

age 1 of 3

ounty PubSupplemenProgress R

Period:

Grade:

s):

tutor(s) hav

wo (2) years academic ass

nclusive of foard, prior to t

Online:

Date:

porting Per

f Instruction:

umber of Tu

lic Schoolsntal EducatReport

to

S

ve met the f

of college esessment.

fingerprinting,the time they

riod (_____

:

toring Hours

Time of D

s tional Serv

School:

following mi

quivalent to

, with the Flbegan tutorin

____ to ____

s to be Delive

Day:

vices (SES

inimum qua

60 semester

lorida Departng students.

____)

ered This Sc

Appendix M

)

lifications to

r hours, or an

tment of Law

chool Year:

M

o

n

w

_____Initials

Num Num

Ident Meas Pre-A Com How Reco Stude

NCL

mber of Days

mber of Tutor

tified Deficie

surable Goal

Assessment

mments on St

Progress wa

ommendatio

ent:

LB Parenta

Absent:

ring Hours Re

ency - The stu

l(s) - The stud

Score:

tatus of Goal

as Determine

ns for Next P

Miamal Choice O

eceived for t

udent does no

dent will be a

l(s):

ed:

Progress Per

Pa


Student P

At

this Period:

Make-u

StudeReading

ot:

ble to:

riod:

age 2 of 3


ttendance

up Sessions

nt's Progreg/Math/Scie

Post


s(s)

ess ence

t-Assessmen

s tional Serv

Status

nt Score:

vices (SES

s of Goal

Appendix M

)

M

_____Initials

Fina Tota Reco If yo Si us Si w nan

NCL

l Date of Tut

l Number of

ommendatio

u have any q

sted tiene alg

genyen nen

LB Parenta

oring Servic

Tutoring Ho

ns for furthe

questions or

guna pregun

pòt kesyon o

Miamal Choice O

ces:

ours Actually

er Academic

concerns ab

nta sobre est

oubyen sous

Pa


Student P

Final Ev

y Delivered fo

Improvemen

bout this Pro

te Informe de

si sou Rapò

age 3 of 3


valuation Re

or this Schoo

nt:

ogress Repo

e Progreso A

Pwogrè sa a


eport

ol Year:

rt, please ca

Académico, p

a, silvouplè re

s tional Serv

ll

por favor llam

ele

vices (SES

me

Appendix M

S)

at

a

M

_____Initials

Information on this form must be typed and signed in blue ink by the Principal of the Provider Agency or authorized representative as substantiated by affidavit on file with the District.

Company Name:

Invoice Number: ‐ Purchase Order #:

To: Miami‐Dade County Public SchoolsNCLB Parental Choice Options1501 Biscayne Boulevard, Suite 336Miami, FL 33132Phone: 305 995‐7638

Vendor Number:

Provider Phone: (_____)_________________

Service Period

(Month / Year)

Services Rendered

Miami‐Dade County Public SchoolsSupplemental Educational Services

2011‐2012

NCLB Parental ChoiceOptions use only

SES tutoring for _______ hours of service at per hour

Invoice Amount: $_________________________

Total Invoice Amount:

$___________________

AdjustmentsHours of services will be removed and the invoice adjusted, if the tutor(s) listed on the Monthly SES Student Attendance Form was/were not cleared prior to providing services, students' or parents' initials (required for in‐home tutoring) are missing or wrong, and/or whiteout wasused on student's Dates/Hours/Initials, and/or on Tutor's Name or Signature. In addition, as perthe 2011‐2012 SES Contractual Agreement, the fees outlined below will be deducted from theinvoice amount, if applicable. The District reserves the right to withhold payment if a review reveals that overcharges havebeen submitted by the Provider.

Less Total Adjustment(s):

$_____________________

Total Amount to Be Paid:

$_____________________

NCLB Parental Choice Options use onlyIf applicable, per the 2011‐2012 SES Contractual Agreement the following fees will be assessed:

Adjustment(s) Fee(s)Invoice submitted after the 15th of the month

Please remit payment to: (Must be the remit to address listed with Procurement)

Provider Name:

Address:

Name___________________________ Title: ______________________ Signature:___________________________ Date: ________

Invoice submitted after the 5th business day of notification

Invoice returned for corrections

Invoice submitted after the 28th of the month

$60.00

$10.00 per day for each day after the 15th (10x ____= $_______)

1% of the total invoice amount (1%x _____= $_______)

$100.00 per day for each day after the 5th business day ($100x___ =____)

Total Invoice $ Total

Directions:

Day(s) Total

Day(s) Total

Only Provider's RepresentativesListed on Appendix H:

Invoice Template

Appendix N


SES Provider Name: ____________________________________________ Monthly SES Attendance Form Month/Year____________ Supervisor Name: ____________________________________________ Signature:_______________________________ Date:___________

Tutor Name:

____________________________Student Name

(Last, First) 1 2 3 4 5 6 7 8 9 10Sch

Code Student ID # 11 12 13 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 16 15 14

# of Hours

Print Student's Initials

Tutor Name: Tutor Name: _________________________Signature: Signature: Signature:________________________________

___________________________________________________________________________________

Certification of Provision of Services: I hereby certify that SES have been provided to the students named below on the dates and for the times indicated herein. I understand that any material misrepresentation may subject me to criminal, civil and/or administrative

action. I further certify that the tutor(s) listed on this form have met the minimum qualifications established as the Title I standards for paraprofessionals, or has obtained an Associate's Degree, have met Level 2 screening requirements as described in Section 1012.32, Florida Statutes, received background screening clearance by M‐DCPS, and have received official clearance notification from the NCLB Parental Choice Options Office prior to the time they began working with students.Note: Hours of service will be removed if the tutor(s) listed have not been cleared prior to providing services, if students' initials are missing or wrong, or if whiteout was used on: hours, dates, or signatures.

# of Hours


# of Hours


# of Hours


# of Hours


# of Hours


# of Hours


# of Hours


# of Hours


# of Hours


Date:________Date:__________Date:__________

Check one: _____School‐Site or Provider Location _____ Library/Community Center _____ Library

DOB:_____/_____ Month/Day



Appendix N


Tutor Name:

____________________________

Student Name (Last, First)

1 2 3 4 5 6 7 8 9 10Sch Code

Student ID # 11 12 13 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 16 15 14

# of Hours

PrintStudent's Initials

Tutor Name: Tutor Name: _________________________

Signature: Signature: Signature:________________________________

_______________________________________________________

____________________________

Note: Hours of service will be removed if the tutor(s) listed have not been cleared prior to providing services, if students' initials are missing or wrong, or if whiteout was used on: hours, dates, or signatures.

PrintParent's Initials

# of Hours

PrintStudent's Initials

Date:___________Date:__________Date:_________

Certification of Provision of Services: I hereby certify that SES have been provided to the students named below on the dates and for the times indicated herein. I understand that any material misrepresentation may subject me to criminal, civil and/or administrative

action. I further certify that the tutor(s) listed on this form have met the minimum qualifications established as the Title I standards for paraprofessionals, or has obtained an Associate's Degree, have met Level 2 screening requirements as described in Section 1012.32, Florida Statutes, received background screening clearance by M‐DCPS, and have received official clearance notification from the NCLB Parental Choice Options Office prior to the time they began working with students.

SES Provider Name: ____________________________________________ Monthly SES Attendance Form Month/Year____________ Supervisor Name: ____________________________________________ Signature: ____________________________________ Date: _________

Individual/In‐Home Tutoring Only

DOB:____/____ Month/Day

DOB:____/____ Month/DayDOB:____/____

Month/Day

Appendix N


Tutor Name:

____________________________

Student Name (Last, First)

1 2 3 4 5 6 7 8 9 10Sch Code

Student ID # 11 12 13 30 29 28 27 26 25 24 23 22 21 20 19 18 17 16 15 14

Tutor Name: Tutor Name: _________________________

Signature: Signature: Signature:________________________________

_______________________________________________________

____________________________

# of Hours

*PrintStudent's

Initials

Date:________Date:_________Date:_________

SES Provider Name: ____________________________________________ Monthly SES Attendance Form Month/Year____________ Supervisor Name: __________________________________________

Signature:__________________________________ Date:__________

Online Tutoring Only

DOB:____/____

DOB:____/____

DOB:____/____

31

Provision of Services: I hereby certify that SES have been provided to the students named below on the dates and for the times indicated herein. I understand that any material misrepresentation may subject me to criminal, civil, and/or administrative action. I further certify that the tutor(S) listed on this form have met the minimum qualifications established as the Title I standards for paraprofessionals, or has obtained an Associate's Degree, have met Level 2 screening requirements as described in Section 1012.32, Florida Statutes, received background screening clearance by M‐DCPS, and have received official clearance notification from the NCLB Parental Choice Options Office prior to the time they began working with students.Note: Hours of service will be removed if the tutor(s) listed have not been cleared prior to providing services, if student's initials are missing or wrong, or if whiteout was used on hours, dates, or signatures.

* Online Providers are required to submit a computerized log in lieu of student's initials on the Monthly SES Attendance Form

Appendix N
