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398 ESSEX STREET - BUILDING JACKET
� �9� �,S,S�X S�r��7' :_-_ -,� r (� 9 SENDER: Complete items 1 and 2. > Add your address in the "RETURN TO" space on reverse. 1. The following service is requested (check one). t Show to whom and date delivered-----....... 15¢ Show to whom, date, & address of delivery.. 35; u ❑ DELIVER ONLY TO ADDRESSEE and show to whom and date delivered..---------. 65¢ ❑ DELIVER ONLY TO ADDRESSEE and show to whom, date, and address of delivery -----------..---------------------------------- 854 al 2. ARTICLE ADDRESSED TO: El C _Erika Malloy M 398 Essex St. m Salem, MA 01970 _m 3. ARTICLE DESCRIPTION: 21 REGISTERED NO. CERTIFIED NO. INSURED NO. p 1945102 rn (Always obtain signature of addressee or agent zI have received the article described above. t, mm SIGNATURE rp C z (L!tn C ; v n N C 4. a m DATE OF DELIVERY POST 0 D D 5. ADDRESS (Complete only if requested) tail � S a O INI 6. UNABLE 7'O DELIVER BECAUSE: CL l I LS 3 D r a GPO:194 � � �3 UNITED STATES POSTAL SERVICE OFFICIAL BUSINESS PENALTY FOR PRIVATE USE TO AVOID PAYMENT SENDER INSTRUCTIONS OF POSTAGE, $300 Print your name,address,and ZIP Cade in the space below. U.S.MAIL • Complete items 1 and 2 oreverse side. • Moisten gummed ends and attach tach to bath of article. RETURN TO Building Inspector John B. Powers 5 Broad Street Salem, MA 01970 OTRU II4 �tlpm, MSStIC.�1iSP## OTRU PX1TpertV Pgadment =� rn T Pnilaing PP�7t1Z rind 3Jo4n P. Polvers rJ Proub $frref 745-11213 August 6, 1975 Erika Malloy 398 Essex Street Salem, MA 01970 Dear Madam, Complaints received in this office from the Board of Health of your property at 398 Essex Street reveal that this property is being used as a rooming house and that there is only one exit from the second floor apartment; a second egress being bolted or nailed shut. You are hereby instructed to take immediate action to discontinue this violation of the Building Code by either empting the apartment or providing the egress required. Failure to comply with this order will be sufficient cause to seek a complaint in the Distric Court of Essex. Very truly yours, Inspector of Buildings CERTIFIED,MAIL RETURN RECEIPT REQUESTED #945102 JBP:cc cc: City Solicitor Board of Health p<,c m.aa CITY Of SALEM �l�`� 'Q �. r' ,� ' •nnc i, ��'` .. BUILDING DEPARTMENT a AUG 12 ` i.. Ci#y Hall Annex `E _�-- N o _ I Salem Green Tp PQ J975 ��,� n •�—��, ff< SALEM, MASSACHUSETTS 91970 SENpcRI V REn.S;r• Doffice DO is r, .:;rte t `. ,. \l,M�f A_/✓ not re in This enP Erika oy N -398 e reet Sa , MA 01970 D / rffNo- 945192 DIM & 5 u _p, r 1. . .. ... . . . .. .. ... :. .. .... S �... ; 3 � fig»' 7r rr� r f2�: .;"iyED � „�.i-t� tiz �,c;,.,_etti ,�,.�c..�5�.�..�iLi�2'ita f3'R I FEBRUARY 24, 1976 CITY CL',J,e:°S U:FICE SALE;9, MASS. VM_LIA'M F. ADMT - JOSE'H F. DOM _ AUHUR E. LAM-CgJZ DECISION ON PETITION OF WILLIAM F. WHITE TO CONVERT THE FIRST FLOOR JA: - T. Lu4D.R :>AN OF 398 ESSEX STP.IsET TO A DENTAL OFFICE AND TO CONTIME THE USE OF EM Ey P. TAt4JM THE PRESENT OFF-STREET PARKING FACILITY. Hearing on this petition was held on February 24, 1976 with Chairman John M. Gray Sr. , and members Jane T. Lundregan, William Abbott, Arthur LaBrecque and Associate Member Donald Eames present. Notices were duly mailed to abutters and others in accordance with Massachusetts Law, Chapter 808. Atty. Timothy Davern appeared for the petitioner. The petitioner desires to convert the premises located at 398 Essex_ Street so that the fir t'floor thereof` may be used for his dental office with the continued use of the second floor as an apartment. In order to use said premises for such purpose the petitioner requires a Special Permit under the provisions of Section V of the Salem Zoning COrdinance, and he needs a variance in so far as the provisions of Article V, Paragraph IA-2 since he will not reside in the dwelling. He also requests permission to continue the use of the present off-street parking facilities. Atty. Davern pointed out that the premises in question, which is located in an R-2 Zone is in close proximity to an existing B-1 District where the use sought is a permitted use. Atty. Davern also pointed out that the structure has been used in the past as a medical office. There is parking in the rear of the building for 3 cars, and parking is permitted along this section of Essex Street, The Board voted unanimously to grant the Special Permit. with the condition that the dentist office and the apartment on the second floor be the only occupancy allowed in the building, and that the facilities for three boarders would not be used. The Board found that the intended use would be in harmony with the surrounding neighborhood, and would not derogate from the intent and purpose of the Zoning Ordinance of the City of Salem. SPECIAL PEWMIT AND VARIANCE GRANTED 1CF.P IN SHALL NOT TAKE EFFECT UNTIL A COPY OF THE DECISION BEARING THE CERTIFICATION OF TUE CITY CLERK THAT T[dEiiTY DAYS HAVE ELAPSED AND NO APPEAL HAS BEEN FILED, OR THAT IF SUCH AN APPEA7, HAS BEEN FILED IT HAS BEEN DISMISSED OR DENIED AS RECORDED IN THE SOUTH ESSEX REGISTRY OF DEEDS AND INDEXED IN THE GRANTOR INDEX UNDER THE MME OF THE OWNER OF RECORD, OR RECORDED X.:) ED O ; T:r O;r;ERIS CF;UrlFlcr:: . e= :: r. SALEM BOiRD OF APPZAL BY f Secretary i' bass river day activity program, inc. 0Ijjt 1mG DEPT 437 Essex Street, Beverly; Massachusetts 01915 (617) 927-5326 DEC �O 84 RFCFIVED CITY OF SALEM,MASS. December 18, 1979 City of Salem One Salem Green Salem, Massachusetts 01970 Attention Mr. Mansur, Building Inspector Dear Mr. Mansur: Please find enclosed our 501(c)(3) non-profit status for the Bass River Day Activity Program, Inc. We are presently under contract with the Department of Mental Health to supply residential services for ten tetarded adults located at 136 Federal Street, Salem. Due to programmatic issues, we find it necessary to vacate that property and are now requesting your assistance in assessing property at 398 Essex Street for the possibility of having four mentally retarded adults with two live-in staff reside at this location. Your assistance in this matter would be greatly appreciated. Very truly yours, Edward A. Potvin, Executive Director BASS RIVER DAY ACTIVITY PROGRAM, INC. EAP/glo Attachment B � OAP A NEW WAY OF LIFE FOR MENTALLY RETARDED ADULTS THROUGH COMMUNITY PROGRAMING H` Bos.—EO-74-823 ; .._�.- Internal Revenue Service Department of the Treasu y`-A - District Director Date: APR 9 Nr 6Jl 4 Advance Ruling Period Ends: 12-31-74 APR J person to Contact•. AU:EO:JD Contact Telephone Number. 223-4241 Bass River Day Activity Program, Inc , c/o Centerville Community Center 437 Essex Street Beverly, Mass. 01915 Gentlemen: Eased on information supplied, and assuming your operations will be as stated in your application for recognition of exemption, we have determined you are exempt from Federal income tax under section 501(c)(3) of the Internal Revenue Code. You are not liable for social security (FICA) taxes unless you file a waiver of exemption certificate as provided in the Federal Insurance Contributions Act. You are not liable for the taxes imposed under the Federal Unemployment Tax Act (FUTA) . Donors,may deduct contributions to you as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to or for your use are deductible under sections 2055, 2106, and 2522 of the Code. ,ge have evaluated your foundation status notification and based on the infor— mation you submitted, we have determined you can reasonably be expected to be a publicly supported organization of the type described in section 509(x)(1) &, 170(b)(1)(A)(vi). Accordingly, you will be treated as a publicly supported organization, and not as a private foundation, during an advance ruling period. This advance ruling period begins on the date of your inception and ends on the date referred to above. Within 90 days after the end of your advance ruling period, you must submit to your key District Director information needed to determine whether you have met the requirements of the applicable support test during the advance ruling period. If you establish that you have been a publicly supported organization, you will be classified as a section 509(a)(1) or 509(a) (2) organization so long as you continue to meet the requirements of the applicable support test. If however, you do not meet the public suprort requirements during the advance ruling period, ,you will be classified as a private founda— tion 'for future periods. ,Also, in the event you are classified as a private NAR For, EOS 337 (}74 1-ii'` foundation, you will be treated as a private foundation from the date of _ your inception for purposes of sections 507(d) and 4940. Grantors and donors may rely on the determination that you are not a private foundation until 90 days after the end of your advance ruling period. In addition, if you submit the required information within 90 days grantors and. donors may continue to rely on the advance determination until the Service makes a final determination of your foundation status. However, if notice that you will no longer be treated as a section 509(a)(1) organization is published in the Internal Revenue Bulletin, grantors and donors may not rely on this determination after the date of such publication. Also, a grantor or donor may not rely on this determination if he was in part responsible for, or was aware of; the act or failure to act that resulted in your loss of section 509(a)(1) status, or acquired knowledge that the Internal Revenue Service had given notice that you would be removed from classification as a section_ 509(a)(1) organization. Organizations that are not private foundations are not subject to the excise taxes under Chapter U of the Code. However, you are not automatically exempt from other Federal excise taxes. If your sources of support, or your.purposes, character, or method of opera- tion is changed, you should let your key District Director know so he can consider the effect of the change on your status. Also, you must inform him of all changes in your name or address. If your gross receipts each year are normally more than $5,000, you are required to file Form 990, Return of Organization Exempt From Income Tax, by the 15th day of the fifth month after the and of your annual accounting period. The law imposes a penalty of $10 a day, up to a maximum of $.5,000, for failure to file a return-on time. You are not required to file Federal income tax returns unless you are subject to the tax on unrelated business income under section 511 of the Code. If you are subject to this tax, you must file an income tax return on Form 990-T. In this letter we are not determining whether any of your present or proposed, . activities are unrelated trade or business as defined in section 513 of the Code. You need an employer identification number even if you have no employees. If an employer identification number was not entered on your application, a number will be assigned to you and you will be advised of it. Please use that number on all returns you file and in all correspondence with the Internal Revenue Service. Please keep this determination letter in your permanent records. Sincerely yours, JOHN E. FORISTALL Acting District Director This exemption is granted on the condition that you amend your articles of organization to delete all references to section 501(c)(4) organizations. A conformed copy of the amendmer must be submitted to thi3 office within 90 days from the date of this letter. �i c P A y P Salem Historical Commission ONE SALEM GREEN,SALEM, MASSACHUSETTS 01970 (508)745-9595 EXT. 311 NOTICE OF DENIAL OF APPLICATION FOR A CERTIFICATE OF APPROPRIATENESS RE : 398 Essex St. On Wednesday, May 3, 1995, the Salem Historical Commission denied an application for a Certificate of Appropriateness from William White for door replacement at 398 Essex Street by a vote of five in favor and one opposed to a motion to deny the door proposed. I attest that this is an accurate record of the vote taken, not amended or modified in any way to this date. May 4 , 1995 ) Jane Al. Guy Clerk,of the Co ission cc: Building Inspector City Clerk JG\JG\DENIAL47 V V fi_ fG�E Saiem -H storical Commission ONE SALEM GREEN.SALEM, MASSACHUSETTS 01970 (508)715-9595 EXT. 311 CERTIFICATE OF APPROPRIATENESS It is herebv certified that the Salem Historical Commission has determined that the proposed ❑ Construction ❑ Moving ❑ Reconstruction ❑ Alteration ❑ Demolition ® Painting ❑ Signage ❑ Other work as described below will be appropriate to the preservation of said Historic District, as per the requirements set forth in the Historic District's Act (M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance. District: McIntire Address of Property: 398 Essex St. Name of Record Owner: William white Description of Work Proposed: Paint colors: Bodv: Pittsbury Blue HC-159 Foundation Bricks: as per paint chip Trim: Monterey White HC-27 Trim includes around windows, cornerboards, water table, rake board (including dormers) , door frames, face of dormers (but not sides) , front door brackets. Bays: Shingles on bays to be body color, panels on first floor to be body color (including recess) with trim of recess to be trim color. Commission member Lance Kasparian (H) 7455975 or (W) 508 458-7653 has been delegated to approve door color(s) and rear porch post alteration and paint color. (Post violation will need to be resolved prior to painting rear porch.) Dated: 5/4/95 SALEM HISTORIICAL COMMISSION By: // 211 t erg The homeowner has the option not to commence the work (unless it `relates to resolving an outstanding violation). All work commenced must be completed within one year from this date unless otherwise indicated. THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of Buildings (or any other necessary permits or approvals) prior to commencing work. RECEIPT FOR CERTIFIE1 MAIL-300 (plus postage) SENT TO POSTMARK Erika Malloy OR DATE STREET AND NO. 0�ys� 398 Essex Street P.O., STATE AND ZIP CODE cm to Salem, MA 01970 =COQ^, OPTIONAL SERVICES FOR ADDITIONAL FEES ^ �1 RETURN 1. Shows to whom and date delivered ...........: IS : With delivery to addressee only............650 RECEIPT E, Shows to whom,date and where delivered..350 SERVICES With delivery to addressee only............850 e DELIVER TO ADDRESSEE ONLY ..............:....................................... 50d ZSPECIAL 3800NO Y (extra 9INSURANCE COVERAGE PROVIDED— (See o PS Form 3800 cher side) Apr. 1971 NOT FOR INTERNATIONAL MAIL STICK POSTAGE STAMPS TO ARTICLE TO COVER POSTAGE (first class or airmail), CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED-OPTIONAL SERVICES.(see front) 1. If you want this receipt postmarked, stick the gummed stub on the left portion of the address side of the article,leaving the receipt attached,and present the article at a post office service window or hand it to your rural carrier. (no extra charge) 2. If you do not want this receipt postmarked, stick the gummed stub on the left portion of the address side of the article, date, detach and retain the receipt, and mail the article. 3. If you want a return receipt, write the certified-mail number and your name and address on a return receipt card, Form 3811, and attach it to the back of the article by means of the gummed ends. Endorse front of article RETURN RECEIPT REQUESTED. 4. I,you want the article delivered only to the addressee, endorse it on the front DELIVER TO ADDRESSEE ONLY. Place the same endorsement in line 2 of the return receipt card if that service is-requested. 5. Save this receipt and present it if you make inqui lot � to �� U QTitui of '$ttlrm, 'fflassar4uu is �r • 3 Vuhlit Vro extU pepadment g Hila-inttrtrum# john �. �3otners S mail �freef 7454213 August 6, 1975 Erika Malloy 398 Essex Street Salem, MA 01970 Dear Madam, Complaints received in this office from the Board of Health of your property at 398 Essex Street reveal that this property is being used as a rooming house and that thlre is only one exit from the second floor apartment; a second egress being bolted or nailed shut. You are hereby instructed to take immediate action to discontinue this violation of the Building Code by either empting the apartment or providing the egress required. Failure to comply with this order will be sufficient cause to seek a complaint in the Distric Court of Essex. Very truly yours, Inspector of Buildings CERTIFIED MAIL RETURN RECEIPT REQUESTED $945102 JBP:cc cc: City Solicitor Board of Health C c s �l 11>�� ZSR 1 u5 P Kk tJo owe a� Iwwe July 319 1975 398 Essex Street �. 00 M "ille^al m Roomer who just moved out of e m k rooming house with only one exit from 2nd floor" y CD M called ----- says he knew Health Department was i down on this before. Owner Eri]Ka Malloy lives there ----- he says one exit is nailed or bolted shut leaving only one way out* Exits are now under domain of Bldg. Inspector. � ---- eliminaz,ed from the Sanitary o e. e er to Bldg. Inspector n L C= �m F v a = r m o m Cn ! CJ7 r 5 9 r S�CLRYE�. Salem Historical CommiSs1®n CITY HALL. SALEM. MASS. 01970 745-0215 December 29, 1983 REGISTERED RETURN RECEIPT Dr. William F. White 13 Mohawk Drive Danvers, MA 01923 Dear Dr. White: With reference to the Historical Commission's letter of November 1, 1983, copy enclosed, you should understand that since the shutter installation was specifically denied in your application for painting, failure to remove them constitutes a violation of the Salem Historic District Ordinance. As such, the Commission expects that the shutters will be removed from the building within a reasonable period, after which the matter would be referred to the City Solicitor. Sincerely,'" � tEhzabeth B. WheantonX� Chairman EBW:ngk enc. cc: Building Inspector City Solicitor s - S Salem Historical Commission CITY HALL. SALEM, MASS. 01970 - - 745-0215 November 1, 1983 Dr. William F. White 13 Mohawk Drive Danvers, MA 01923 Dear Dr. White; Thank you for your application for painting and shutter installation at - 398 Essex Street, McIntire Historic District. At its meeting of October 13, the Commission unanimously approved the color tones selected for your property. Serious concern was, however, expressed regarding the install- ation of vinyl shutters, resulting in a vote to deny this aspect of the -- -- application. In Salem's historic districts, the Commission generally applies the standards of the Secretary of Interior with regard to renovation and construction. These call for retention or replacement of original con- struction materials wherever possible. The vinyl material fails to adequately simulate the appearance of wooden shutters. This difficulty is compounded ,by their inappropriate size and manner of non-operable install- ation. The Commission finds, therefore, that the shutters produce an - incongruous .element and detract from the historic aspects of both your property and the district in general.. - Should you have any questions about this application, please feel free to contact the Commission. Very truly .yours, Elizabeth B. Wheaton Chairman EBW:ngk C�OAMMOVWEALTFI OF MASSACHUSETTS ��r. + ._ �rIF�IP'rvt9S7R OF S A L E M �1 WLTCjff y� WJJ CERTIFICATE OF INSPECTIO.d UG RECEIVED Date l0/( /�— CITY DF SAI-Fg,miASS. (g ) Fee Required ( Amount 25.00 ( ) No Fee . Required In accordance with the provisions of atherMassachusettstificate of State Buil tion for Code , Section 108 ,15 , I hereby apply forthe below-named premises located at the following address : Street and Number39$ Essex Street Name of Premises Doctors Office Purpose for Which Premises is Used License( s ) or Permit ( s ) Required for the Premises by Other Governmental Agencies : Agency License or Permit Certificate to be Issued to Address Owner of Record of Building Address Name of Present Holder of Certificate Name of Agent , if any ^ ,, 1 A --- TITLE SIGNATURE OF PERSON TO WHOb1 CERTIFICATE IS ISSUED OR HIS AUTHORIZED AGENT DATE INSTRUCTIONS : 1) Make check payable to : Cit of qniprA John B. Powers - Insp. of Bldi 2) Return this application with your check to : 01970 1 Salem Green lem PLEASE NOTE : 1 ) Application form with accompanying fee must be s bTf:itted for each built p thereon to be certified . Ing or structure or art be . � 2 ) Application and fee must be received be_ore the cert_. iea ( } ays o= any ch official shall be notified wit 3 ) The building :, r. ter: 10 in the above information . CERTIFiC +TF.. _ 4_47� WORCESTER INSURANCE COMPANY 120 Front Street, Suite 500 * Worcester, MA 01608-1408 DATE: 11/09/99 TO: Building Commissioner or Board of Selectmen or Inspector of Buildings Board of Health City Hall City Hall Salem, MA 01970 Salem, MA 01970 RE: Insured: William F. White DDS Property Address: 398 Essex Street Policy Number: BO 870009 Loss of: 11/03/99 File or Claim Number: F60-363691 Claim has been made involving loss, damage or destruction of the above captioned *property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6, to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. David G. Vincent Senior Claims Adjuster On this date, I caused copies of this notice to be sent to the p ons named above at the addresses indicated above by first class mail. Signature 11/9/99 Date A Member of The Harleysville Insurance Companies WNS-251 CL(Ed. 5-95) ' f I DMH -- EOHS 1-1 10 FY 80 UNIT - RP REGION' III : AF-7 SEQUENCE 11 RATE FILING• AGREEMENT This Agreement made. and entered into by and between the DEPARTMENT OF MENTAL HEALTH (AGENCY) of, the COMMONWEALTH OF MASSACHUSETTS and Baas River Day Activity Program Inc. ,v (PROVIDER) a community residence_ having its principal offices at 437 Essex Street Beverly, Massachusetts 01915 WHEREAS; the AGENCY is authorized under G.L.c19 sec.l to provide Community Mental 11 dealth Services and wishes to purchase these services from the provider; and WHEREAS.;' the PROVIDER represents itself as able and prepared to provide such services; Now,' therefore, in consideration of the undertakings specified herein, the AGENCY and PROVIDER hereby agree as follows& 1 . ENC6 ,L'MENT The AGENCY hereby engages the PRPVIDER to provrEIe, and the PROVIDER ,shall provide, the services :and 'fitl.e XX eligibility det�,rmination, if applicable, specified in the STATE1U".NT OF WORK Al1�) OBJECTIVES 'f.onatituting ATTACHMENT A hereto. 2. QUANT OF SERV) ,ES _, The number of units of other quantity of seryfces to be provided and the location of facilities to be used in pZovoding services shall be as specified in the STATEMENT OF WORK AND OBJECTIVES. 3, PERIOD OF PERFO1ql,4NCE Performance hereunder shall commence, on or about the First day of July 197 9 in accordance with a written notice to proceed from the AGENCY to the PROVIDER which specifies the date on which services are to commence and which represents that a properly completed Commonwealth of Massachusetts Form �F-7 . governing this Agreement has been approved by the Secretary of Human Se£vices and filed with the Comptroller of the Commonwealth. Said notice shall be considered a part of this Agreement. Performance shall continue until the 30th day of June 199 80 4. COMPENSATION The AGENCY shall reimburse the PROVIDER for services rendered in accordance with the rate per unit ($�1[1:BQJ- ) therefore as time to time established by the Rate Setting Commission of the �l:oQonwealth of Massachusetts. Maximum payment hereunder shall not exceed Seventy Nine Thousand Eight Hundred Dollars and 00/100 — ($79,800.00 )• The source of funds hereunder shall be appropriation account The PROVIDER shall not charge or accept a fee for service from a recipient of services under this Agreement. AFFIDAVIT OF COMPLIANCE v _ _ - EY,ECiTIVE OFFICE of ADMINISTRATION AND FINANCE FORM AF-4A _ THE COMMONWEALTH OF MASSACHUSF.'!`T!; - - - E-1 M7VSSACHUSETTS BUSINESS CORPORATION Q FOREIGN (non-Massachusetts) CORPORATION - © NON-PROFIT CORPORATION - I,_wBrgaret T. Reilly , (A President ® Clerk of Bass River Day Activity Prozram, Inc. t-ped name name of corporation where principal office is located at 437 Essex Street , Beverly, Bassachusetts 01915 do har=7g certify that the above named corporati :n has filed with the State Secretary all certificates and annual reports required.by chapter 13x8, Section 109 (business corporation) , by Chapter 161, Section 4 (foreign corporations) , or by Chapter 180, Section 26A (non-profit corporations) of the Massachusetts Genera'_ Laws. - - SIGNED UNDER THE PENALTIES OF PERJURY this 30th day of Nay - , 1979 Sirnature of responsible corporate officer^ _ _ j S. Mir: 1107) OF PAYMENT . S0hMISSION AI4D PAYMENT OF INVOICES: No later than thirty (30) days after the close of each calendar month during the period of performance hereunder, the PROVIDER shall submit an invoice, in a form approved by the AGENCY, for the units of service rendered during the month just ended. The AGENCY shall use its best efforts to forward each properly completed invoice to the Comptroller of the Commonwealth within fifteen days of receipt and to assure payment thereon within thirty (30) days of receipt. Unless the AGENCY has initiated the process set out in Article 9 of the General Conditions (ATTACHMENT C) , non-payment by the Commonwealth of a properly completed invoice within forty-five (45) days of receipt thereof shall constitute cause for termination pursuant to Article 13, sec. A of the General Conditions (ATTACEIIENT Q . B. ADJUSTMENT OF INVOICES: The AGENCY may, with the consent of the PROVIDER, adjust any invoice of the PROVIDER. A copy of any adjusted invoice shall be , promptly sent to the, PROVIDER. C. NOTICE: If the AGENCY expects payment to be delayed beyond the payment period specified herein, it shall promptly notify the PROVIDER. 6. INTEGRATION Attached to and hereby. made a part of this Agreement are the following: 1, EOHS GENERAL CONDITIONS (ATTACHMENT C) 2. , ATTACHMENT A - Statement of Work and Objectives 3: ATTACHMENT B - Statement of Fiscal Condition/Program Budget 4. ATTACHMENT D - Statement of Reports and Applicable Statutes, Regulations and Pianuals ' S. Financial Interest Statement 6. Financial. Disclosure Statement 7. Certificate of Corporate Vote 8. Affidavit of Compliance (Commonwealth of Massachusetts Form AF-4A) 9. Listof members of board of directors of the PROVIDER 10. Copy of PROVIDER' S Articles of Organization (in the case where the , PROVIDER has not been under contract within the last year) The entire Agreement of the parties is contained herein and this Agreement supersedes all other Agreements, negotiations and representations pertaining to the services for the period of performance specified herein. In Witness Whereof, the parties hereto have caused this Agreement to be executed by their duly authorized officers. FOR THE DEPARTMENT FOR THE PROVIDER REGIONAL SERVICES ADMINISTRATOR DATE DATEp•„y 30, 1979 APPROVED: AREA DIRECTOR DATE Norp,: ALL FUfDS ARE SUBJECT TO APPROPRIATION 51t !Pont ran'.', n'.' of VAIN IWA ob,je tvow i. 4t- Unit it definad . .. '%ollm ;.(i. . !E.E�TL;:!'�I �PI d !;5-7t1 : . 0 un'.r, 9i: OAKS 00 &WJ . K'ttY,t 1w¢,'i �. ) :7om ay of rxr,t"1 c e 1:'0060d it r r. : c l.lhr t .. b. 'DAY P1 OCRA}f n v , uP ........ 1tr (: } r yr o!' t ervice Q:n'V'1•.'_'.^C. tt1 ..i�ut. 1, I 1 t l:i.t§1 71 75' a 11'0 fr �,. ,.', (1 ) houyn per ) - 2, A client in deflmd v2 WAWA '00 : "+ 40',.. . LN 1:14,^. j) ^..I't:Plt] T1'7.L 1;"i.C:,1111',:}•. � iq In referrcd 1 o the J x t"'.7;Il R UY tOr I'C?=O ] �.`p.rvices )1:dmiist.rat n to e.l 1. t l'I C>:'. 7J1 tS-L _iC'C14L. ,. i � f 44. : The FR MM ru l t 1-: re1.sident i;l r 4 t e ^ 7 , i e d net ehe 4'�f l.i1: IJ lift f _. P _I'J,y: I c. '`+',�)i vl r, 10) ", � , 4'.}I! Y f..f1; LI L. ..F:T:ili t{.h!! "ns act f�7".'ti'i kl rile �ry, r( .& RI1 %sit ,.rn lw ., �_,u Thr cone llil'lq"e. T),7i( 't. ' PROMER ER ht ,:] )l t n. Usciel. Wpm now for o:onm All Via . t} .evalint,i l.M ' noWyMat nf -COCK • ; 001 '1:C!S' X..l S'V;l,wt7i'..1 t" Ce T'j" .:7I a t.'`'.?_(. ,Y..i17.'tr 117".. ) . 1CL tL ,l 'l l' V: SO,r'� tin ,aV^1 ja Sll'. C. arrmagemsm toy.- lir(i r'7 '} lila? m''.!vviank, :: t 11T!. C':I,. (tl tt.a'iGl Gy ja`vg] ,B.iu Ex5 r+CQ0.=0 in ti" :'. .( alt .':.".t ! 10016val -(•:, x010 T,l(.Y", Ci. trismin in f0.ncr 1 .'ns? P" lie ""We" r:°e" EOnl A''J:iu `.7.' G 11'. vl 'dc`Y( : i 40 i.: Ll;t'., :'Iv Lug, Iivinr skit I , , r,(. 1 pi ; Wr t n I £. rjr.e-Ilrrvire ',.Irl !.r r .. , ', i :, COCOA t :, „ ( ,r MtW ;r.r,' c a UN Its: n.' 'rv.nt . ve OWE. a a The PAOVIDUR vhul '1 'pr,. Irtri' thy NU ,p O it 1W 0 , t; r r,,. &' , I SAW, Masmhuse,ttv,,01970. ._..,...,.._. ....,.... n 1 r YPr I Ono! ]i. In t:C. �L. ,Th,. EWF `I'� r"�� I'�I _, � I r;:'e;!: ,r d';r:" I I ;rr ,,. r • 1 Irt; ",ride cervices in Lin n ',t��ct ltu;nI,I I ..UVAn ':-t'. {rL(, Ir rr..'n it 0001vP QBW1 r ,D:9. L pn6;!.hlz for thr 61W -,'Md Weryinn"ry, ,,:.r r I r' pa_WW W t l 'y 1ti •pr.nrle `L functlon5.n? it rho• ! : jrsLriom of t r:c nonnuOtS, 7. 7 Ie i Plan\ lI1 '? Fh ,l ?. !'rotiryOn Alen i1J. r _ hitilrl U Wr: (;) onys ear:al vacet.r_y fundind thi luji' I c'. ui Y ,' ar. c, ,r:. j' _r r I..;te. warot h. . . _ I r with written napkKon, ofOw Ma I i1i.r arlo i ( r A;pin" from v WLo "'pernan : cllp5iln 1.n ;WoNnnt. All jOrr"01 W , I ��_I r'�-, 'vOw .CS fr i.i;;: I '8nAr 4 fF..)".°n of !'.1H Winval Srrvif = 0001 t,l I ; , .(.C.J:.. - P. The DEPA.\1F ,c.131" .r.]'1:,1 asmI[At:i' Wit U).rC.! i .v Fi i'•{ ! rr gS'firr6 which! F`L'f1 fiE!Yv7iIIg the eam(r c1..e,tlt yvat r r , r I . ,ri,r ze -r;s_r c:"(r. r iu' 'ivn vf`" efLrrrCu in lm}lk,v•- mer.tinr Up 0 K. ;,' ra W1100W sUvEnrl CA. }G Fy,Lfr..t CI, t+ c;ot:° f,Aj-rQM p:ru..rr,i-I p:'l. ,ll ! :ct r. I ,;r:[e in 2u:al cr.: .. Wrtl n tl <;_wi ,•. mn any 1.o-. :e jWv& !I t.:':r. l l r'1..1' !'MiOW . !n But.f.i.on, z! 2eaK one full -time la.i :�u. Cock rnI _ e ? e (n. p ;iorre: 1i as Pay. lic j0prQUan . . r :cq I: ry hj the i. ai•.t Pit , i:.tl : or FoginvinAl. :; v .'t:8 1C . A RPW.cl"rnC iL!?,. Mery t .'t(;A PrNo ...i 5-.I Ll:` r[i'I. tll ,` NOWIC! -L': c) twL)oltG L:Q 'titer I,W.f B ' w CCiCWlU:71Ey LE*59..r rr�1L 1111 Spy Vinod rt4 f . ... I r r'.ia , fl �.r. .r ;:it ;BCEit').t.}' .ht, i \,n:..r. ._ , t . ....r".+ ;.r:r,M Q !.!t)'o ,1:. i`}.2'. (JOXti.t',:Cr . iJ]1't"B.:i, and tf, L he j`:API 11', Ae I Y.`: f ( , rva . . At! 0 U �0". r Shfa tered l Ir!ii' I''.�'r .d" . � I I'..:�,.' „{ -10" win V1 IV. '111.,1 lli i,r l „f:'<'1.',1 ,:.I htl Unna', L .a;r.f'. Cr1),yI 4, 1'"1 I p 1 q p TA f:� , TV She! I r,l_,`,.r lL. ho DUKRI' FIT M11 p cunt_ t. o 1 10001, VOW nPIVII.I; r Uny U... M 1 '"r f or,set�t. '4'c,il. rn 5, rcVAUW00 of Ito l;rcn (rFt .iCO3 r 12. client l. ,corcls t1L'l}.Jl Cf:rl.yr' .aril 7 { ',I I�,. <Ib I". i , Tho PROW T H 1! ";h'1'1 I,,;' I 7"''! I '; i ' i."t:. i, :It 1: , 1.,... r '� '..I. :., .. „ I .Li7:. •rl J;eueiv,i.vi)', ,Wild 4100.1W 1 1 r•r•_ ,..�i�' -ni .Rf;il1 ' 1 nui 'd?: ' - rim ri i:.i. t to .:{ not .�.}Itli.t:ud 'L i, ttt, t'.(: ... it..i' 7 , . I .. ., x quirN I as .r})��r'vt 1 1, I 'lkpi II - �.n"U "•r:' W!1echer, "_tt.numin '.1. ir n i, -tp" 1h, A➢ t :fin i s t':.n ...I �.I..i . Winn, Vi S. .�'R 1 ' r r��, ' f , . and u4l `. Li,:: r( n, 7 it-I at' I'; J)1 tiny (h ,. . tn : �.I! , i ar,.. ' b I, rr,cr-,,I 10 ribor:!ci n:rp. t rn.rr:l.:; i.'19at LI w.lj.;. w 1 .':i:'r' .r 7":!I'rl t r;' .::. ' ir'.n: tr'v' i„ r'.;. Oily Li ''00 1, 't71"r: , Ni)'.'J::.1... I.irTa or ccinndavd;: . 13. 111 par�f 1 Q). 1 1 ;��,.-; 'I Wit " ,, t 1.., r;l 'I I r raylim"I',t "?:i .:v r ;;ll}L tP u, 7 , .� I.. J ':' i +:'I' .i n 'r(, t,r I'.'' i o. , I ,r . ' .lo' 1 'B1'.all,JW9l t.,. r r m _ .. : ' ... t fe. li I !�' 1.i. inl;., in'. 7 . tlnl; "1)tw nol. i 7l:n+ r:if 1.'.) '.... .. .. hnt:."'''.I;i ll$., 10 1AW TiQ1 to 1 I'1}:i.. and Motu t.i I; 'r Y¢. 4 ails; C) I:lSV. T ,;lu 1'f• l' tVs};.C'. srounp, or l. iv:ivCZ ,.;T"om 10 1sy, cly, t \.!i.l:L! Qt);f.:' ji:.l , r9i.qY UasLh;l.J- OWN �. - f,•1 i.t'( ?!i 1. to Wi!"t'?. Ok TO GI'll + t 15no t�l:9iT�,IL . - .. . ' t,t c:"t,r tI ,; ... .;.i' no'V or 0 t ..mc.. . Any INNAW9 i,Qn 1 'f 1 on hP 00 10 ir. . '1 UC I !& 1CIi r '.S-OL inc Ind ill;. .,;,n not mnr I j 0 inr. '. I ':i:` ) . ,t:'Q„ r ,..I ,c'97 por Spoal li.i.e. 6Y du t'J 0r;:' t,li%•':: i :I�.: n ,.7 ,! 'r.-') or o'.) ilr,•:n:,e: :,I 1' j UNIT 'COST AGREEMENT ATTACHMENT B - PART I (to be used in EOHS standard unit-type agreement) BUT)G 7,CATFC'ORY (a) ANNUAL (b) AMOUNT (c) OTHER (d) ANNUAL (e) ( ) ' PROGRAM EXPFNSF. PAID FROM SOURCE. CODE DMH EXPENSE MONTH EXPENSE OTHER SOURCE A. LIREc:'r SERVICE 1. PERSONNEL Director/Manager $15.0Q0.00 2 Staff Counselors 20-OOn.00 _2n nnn nn 2 ,Skill Tnstructor�j9.� 19 ,000.00= Belief 2.200,00 2.200.00 " TOTAL PERSONNEI. , 56.20-0.00 $ _ $ 56 200.00 $�� 2. FRINGE BENEFITS (159 Of' ABOVE COSTS) (1) FICA $ 3-445.06_ $ _ $ 3,445.06 $ FUTA ;' ' STATE UNEMPLOYMENT�t57.40 2.187 .40 WORKMEN'S COMP3 — GROUP HEALTH 3.684.00 3-68 .00 GROUP LIFE. TOTAL FRINGE $ 9.421. 34 $ $ 9 42 $ 3. GENERAL 6 ADMINISTRATIVE COST (SEE CONTRACT MANUAL AS AMENDED FOR INSTRUCTIONS— ' SPECIFY: 1 Office P�3'Honnel _ S2 514-66 �2 5'i4.66 4. CONFULTA,NT $i 000.00 (SPECIFY By TYPE AND RATE) gej)av n - S 5.@m/ho r (;pperh - S18.00/hour__, 5. TRANSPORTATION 70n.00 gi. Oho 6. TRAVEL son-no 5nn_n0 7. TELEPHONE $ 400.00SL 400.00 / 8. OTHER DIRECT SERVICE COSTS (SPECIFY B'' TYPE AND REIMBURSEMENT RATE) Prpyr'i u2R ie $1.000.00 �1,000,OU Liability TnsuEa $ 964.00 $ ,964.00- 7D2,.oo TOTAL OTHER DIRECT SERVICE $ - - $ TOTAL DIRECT SERVICE $_Z2.220.00 $ $ 73.220.00 $ (Al through A8)' ---------------------------------------------------------------------------------------------- B. MAINTENANCE COSTS 1. RF?JT 9.180.00 5.r>QQ.QO C (3) $ 3.690.001 $ 2.. UTILITIES , S 5'000.00 2,800.00 C 3. FOOD $10,000.00 $10,000.00 C (4) _ '.4. OTHER (SPECIFY BY TYPE) I Custodian Maintanro s 4.000.00 SC 2 . i00.n0 S 700_.00 MatariatA -noo.o� y � .��D.•S4Y. TOTAL OTHER MAIN. S $ $ S TOTAL MAINTENANCF. COSTS i . . �..v.^..� (B1 through B4) $ 28,180.00 }21,600.00 $ 6,580.00 $ --------------------------------------------- ------------..--- -------------------------------- TOTAL 0:' U: ^CT :I'RVICF. AND MAINTENANCE ( A + B) SI07 [ 0.�0 $21 . ,00.00 $79 60 00 $ UNTT COST AOREPMENT ATTACAIMXNT il 1,L wl—1 in Ftlli!; !.t .krhdard unit-type agreement) C Client Contribution B = Lx-,nations frcm lkqen•-".es or Individuals DePaTlmc'n : (,I. -(Tvqnu-ty E, "te.ff.' !),'!,.,(!lo-pmenta'l 0 OTHEP;- ---------- --------------------------------- Fr>0"-N0TES (1) DMH SHARE FRINGE 159 OF Al. IF COSTS ABOVE 159 CAN BE DETAILED, A COPY OF THAT DLTA.IT, TO THIS 13ODGrT FOR RATE SETTING COMMISSION RE,.'tr.I. (2) E-enoral. 'K Administrative, aro limiced in the DMH Contract Manual as amended. Please check hefnre flltilq out.. (3) D" reimbursemf!nt for PENT :end IJTr�jqql.S is limited to programs which do NOT charge staff for those rost,.",. ine;triictions in Contract Manual) (4) Food costs acre not 1)y !1.1411 except in cases noted in Division Instructions in manual. ---------------------------------------7�---------------------------------------------------- COST DZ-FRMI1LIT1d4 JF BATF. A $TC �ffOS00T a. total DMH lir-,ct service o.xpr�,isa (ro f (A) page 1) h. number of rlierAt- co ba qr.,v(-d 'Fvom ATTACHMINT A) 10 C. numher of se.cvice rl-lyri in Zis.ill III() d. total units of s;>rvic,! ( b x c) -77-1-0 .q. DMH DTP-"C,' .13FT; UJJJIA' $ -949-.4004 f. total DMH maintenance (!X0"J1!`c (I[ (B) Page 1) $ •5, 5210.00 U. total units of. service 01 h.- DMH MAINTENANCE SERV.-CE 111I.I.T C'OSq' COST THIS AGREEMENT I. :number of clients above: 10 j. number of sL—rjc> 3()b k. total. units',of :3nrvico ( J, 136o0 1. DMH DTRT-'(7T SFRVTr7j?, 11N7,V -r) A.ovo) ri. DMH DIRECT SERVICE COST CREFMI", ;IV n, total units ( k above.) 1660 0. DMH MAINTENA17CP. FTNIT COST h aj,ove) $ 1_79S 172 P. DMH MAINTENANCE COST Tjll': AGREi' I 'DwIll $ 6 b6 'I. TOTRI, (70FIf, (DIRECT- i- THTF AOPFFM2NT 79,521 ,qD POR J'LSCAL' 1,01RO Prs] nrm'rAi, PROGRAMS 366 DAYS, FOR DAY PROGRAM: 251 DAYS (j.11i:A11 YL'Ajc) THIS TOTAT, CQ.-.1 ON FOR T'Y-A]: OB111GATION OF THE CONTRACT ON YELLOW PAGES CONSTi'TUTING PAGE f. Ari(d of -hf, AGRFY Mj-j;T. Attac)ht& A — vitler " m1p6wilx TISfS EK ecaQa-s""S-s 701 r MAL M,PN'CIAT. 'AR'lKCi'.'.ATTYC I. GOMYA ??WHIMS: . Sha follovin` General Pr:x!sicns shall be adhered to by all Contractors aperatfag ■ Sltla Zx rejrbutssbLa pro g:c. A a:la II reinbursable progra= is sssectla117 any pco- gram that provides a service vhlai cor:esponds to a Title S3 service defrwicioa. tf (a) program fsds come di-e=:17 l:a: a faderal service or; (b) if sty oftheJ 3 fundiag is to be used as a match for faderal !,_ds, then the program is not elisibla for Title rc rainberseceac. A. She Contract shall aL:ain and provide all information necessary to substantiate s cl"2 foe federal :ei_Sursenaat for services under Title SS on euch, forms and In such mannan as. required by the Department of Public Welfare DM and the Department of Xaatal 2ea1th 0:3); mud. upon request, allow authorized tepresenea- tives of DPW, and suck other federal azkd staca agencies, es any require such La- formation, to have atcass to such records as may be necessary to confirm rho Contractor's eouplice vi:h the specifications of the Agraeoear. a. Consent Danuirameats and protection of Client Confidea[lalfty: She Contractor shall assure thac infor^stion which ideattfias a clieac indivi- dually be cafntainad anis at the service providar Laval and not be dessa imaced beyond that !evil. Tnfar_acion As CO fL-ACC131 rendition'o' persons applying r for or tece/vi=g sarxicas sha'l'l be used oma for the purpose of Leta:niniag Title S% oliglb!lit7. in -he event chat-laformation or ev!dacce !s required for verification of the Clirt's scacaneats about her/his lacoce, it cost be secured vi:h: a) tie cliec:'s pciar �Cowledge and written tone=r: b) with a clear ex- planation to clues as to (1) *what information is iesi:ed_, (2) ch7 it is needed. and (3) how, is w'!1 be used. C. ?izht to Fel: 'mean'=g: :'ie Contrutoz ahiL' 3nfora each individual or her/his authorised representative of bar/his right to a tai: hearing before DPW if services are desks-ed, reduced, ter_aa ed, or not !*!!•tared •rith reasonable prompc_ess,.unless it wi11 be pro- vided fro= non-T!t!a .a sources. D. Standards: The Contractor .hal- ?:oxide mad keep current any license, cert!ficatlon, part. or acersditationa :e,cira: by local, state or federal stature Or regalactcas and shall, upon request of t`e :spar-=*tz, submit to the 2eparteenc }too_` of say such license, cer:tfica:ica, pathic or accradicacion. Psilura to ptccure or keep tor- :mc m7 such I!ca=sa, :e-:ificata, parait or accreditation shit be suff_'-dent srouade for a' this Asrea:.ne upon aotificacion to the Comzraztar. So fees for serviea =7 Se ch.s:ged by Title 'a Contractors. II. ov!'17T_: 0? MCMC A. :ecaeatar is.: he Contac:it,ah■!! =ci_i:a' :ha 7Y_'i Title £( (Doc__tn:a'ant "lea for Cat:r,a- henaive Arnuai•Sa ti a: Ser:i_as and aisndaents the:eta. 1. C112!S SIir� ?meed tr "_atone: a. Dena^._.scion of21iLibility Dader Title !S: 1) The Caccrac:oz shall deteraine eligtbil!r7 !or federal rs+_burseoent of costs , of senricas provided to persons ty rhe Coatractor' in accordance with the all;'r biltry standards and procedurca, established by :be Depart--mt. The Ca_t=xcta: a::Ai1, •ri:hie SO calendar days of :he c_/ant's :equest nor service to data='aa vhather u applicant is rel=bursecenc eligible in accordance v'_;S such 011%1- Siit7 criteria And aotif7 the applicant :rich reasonable peagt-m"s (!.Z-LS Says' that 2) The C.,..t-actor'shall requtizAall apPL'cants for services ca --==Place a i_i:rsm ragnes: fa: aerrlCa an ! fora prescrlbod by the ]tpc-ant- a applicsct sis:.' s!gc and !ata uhf :aquest And shall. rerti_`y that the Laforaa ti=n t`ern's is :c: rec:. 3e Cont:pec roe shall accept ;he request frim the applicant or his suz-..- , orirad represenco-ive, or where appl!csat is a _nor, inrepeer�nr, ��tapaci:A:: .: Im. as azeegengy. by someone, actiAt r09ponsi`_17, for " - iac�ud3g 41anc7 ac_. 4S aAll doacaen:s nfered io la 5chadu'_a D are availabl4 at Ustonal office . Attachment T. .. '1'x t'•.n n}' A)'rr�c;��;$.'" i;.'ott c.l':Ue+.:�f) 3) pm 'L!. .tach applicaat •for purchased rsarvicss eichar aligib or inelLgibla to recai.9t ot:c. services ffi 'ateorda%ca With its eapactt7 to ;rr. vide purchased serK.ce s. :.ubla to provide such services, the Contractor alsall mks app•opr:.*.te 7eerra:.. . 'b. Verification of Intoes = Y_5111-:. cn'ler Title SS: 1) Trcoew %?ttnttnazcs Cl,.etas art rocipiaats of AFDC. SSI-CAA, or SSI-A3, SSI-DA Suppore Lrg rioeuzsctaz!a: w'.2.1 Sa a Current Jfodieaid Card. 1) Haditald Only Clients t! rrcece Sligibilicy Cilentai FLnatcial Eli&IbULty it!o.:1t!on required for applications based on Income meatus will crdiaaril.y ba based on the clients' declaration when such •_forma: is eouplata, C.onsistaat, and vitbeut coatrtdictory evidence. Such decLaratio• vi11 include:. a) the amal: of gross =mthly income; b) the sourca(a) of sue Lacuna; c) the tyre of !acr=e. Tf the -icforaecion is incacpleto or iaccasis-, then varilieation :ay to secght, consistonc with ptovislons under ly, above. C. ledatar inac!on of rncoce T_1ix!S il'_cy Under r!tle ESC -rhe Coocraetot -s Fal: of'Iftcoce 41igibit'ry !ar aich ;4. son mho is furnished purchasad services in aeeordaaea with this Agrae:eet: '1) when raquired on tie basis of Laforzati.on tha Contractor tax obcaiaed abou anticipated changes i_ t`-a !-'_ividual's situation; 2) u.chin thirt7 (3D) days racaipc of tnfor-_zc inn :e ga:di:g changes in the rircu"tanres of a porsoa -vz which nay make such :e:s= _er ii}isle fox fe.'.ecal ralnbvraaaaac; 3) periodic, • and u.yon tarai:aciot; c::ca A Tear ic:r 25s" raclpieres and sat lass !vaquantl7 than every six (f) t._tha •!a: all athoto; 4) when rtquested bf Cho Depart_ea DPA. 2., Elis�i_billty Lased in feed for Seniles: _ a. Daterzitation of Need: The Cootraccor shall d r+e lap at.d cocplets en Lnd 7.•:Ld;al service plan for etc? r:ec!pieet of Tirle ?2 san`_:os on facts ;rovided by the Depa,-.�oenc. b. ieassesseent of Need !ar -en-!-es: The eontzactar abs__ vac ia6ics11.7 but at least every six caatSs reaasess aa?„'�r{ Title Z< :ec ipleo c's tae'- fV se:•v!Caa Cn fora$ ?rcvided by cha De�atc=arc_ Con.ractCr shay- alsa :.ice ^a ass aaaaaats -:hen there is a algai!tdrat change Lha sarv't.ce the '-.d i:!! is rec.aivicg and when the iadivldal :a. .a cos f, the program.' j, it St!bil_'ev 3a*gad c+t Grn,n ye ,ac'=�_: CSinnc nllgibll'.^_- f-: sa^`_cel under "itis IQT Way be Qece^_icec0 :7 v_rruo 4! =*a borsltip '.a dtjc:t:a, pre-dmf'.ed group~ (}Coup aLigibi'_ic7) !Z Liass it th, ' Ieogchitr processes :! (a), al!;3 iii-v )lased an incoca, mei ;b), *2_g'aill:p- t`+,basad as need !or se-ices. The Ca^.::actor shall ut li i:e cht ytaup aJ,ig ib ill p'racess when Zh4 'a;e:t;av sa Laaltraces. =3e CanttAc-or sLola. on a awachLy basis, r_b_c a Service leci?ient 7olivor7 3apovc sits hie .equest for pa7mane for ae^!ess :andored is alder to receive Co- for sarvites. The Daparr=ant stall-* ptavids fares. for this rapor_izg. C. rho Cace^aetor shall allow auchorizad ra,;c es e_taeb:vs ftm:: Who w!i_ uri?ttn the : -DT; eT 'IIO Gnc:act :°cnito:!ng 'Ish, ea __tor `,erl`his p=ograce. "•Ile :CL 3esoutte %vents:'I: no Crtrae:or sk:all utilize the D.`2 'itle G Uscu:ca Tn:•encary Cod!nx Yanuat and a=corn is !:era^.o and upon request by 'he :oOa=t wn: scall prav de iafor-=sc an as del3ea:ed co c`_e "Aasout^.a raveccor7 Data 3beets." M ATTACHMENT A - PART IT i. CONSULTANTS : All consultants hired by the PF.OVIDFR under t-FAb�ment shall he paid rates not. to exceeri those e:>tablished by the Fxr-rcutive Office of Administration and Finence or the Rate Setting Commission where established and -.Iw_.l. nee.t standards promulgated and dis- tributed by t:he Department for f.A,nfiar state positions . 2 . ALLOWABLY' COTS : 'i'he! 0ROV0"R api:ees that: no Funds under this s tegr ement. sL all be expended for costs incurred or services rendered pri.oi to the effective date of this Agreement . The P Rt'VTDF.R further af;rees not to expend funds UndeX this As,:+.-eemenT: for payment to state , federal , local. or muni.cipa1. ,m :l.oyee fo)- Services norrial.ly paid for by such employee ' s rc4ular salary or wage. . The I'P.f'VIDFR. further- as;rees tc :.ubi ,it: inJo;.ces for payment of only t1_ns, est:; :9ncur.c :f in(, se;-v:cos -I-endered in accordance with Attachment: A rind At ; aclm:ent, R. Part: I . 3 INCON -EXI'f:NSI.:/IPNENI ToRY STATE NTS : iaithin (60) days a'1ner�":crrpfet:z�on 0.3' ni�r,"ornranc`e, innTer this Afireement , the N•.OVIDEIR stere; a ,ub>= is to t:he DI?I'APT111?NT an Income and t'',:i)Ense report and w luvento, t ofequlpmert purchased on fc.r ;us nrovidecl by the DF.PARTMF.NT which reflects the period covered by t1u-s Agreement. 4. UNTTF;;'TMW!RSliil'1?N'r: .went t1c3r: tT)e T'ROVIDER is rciTm}JUr^ -c', 7�Or uery tc:'8 on a unit of service bt,sis the following,, provisions rha _l also be applicable : Day and Residential Program: If the total number of units of service in any month is 80'! or more of program capacity, the DI'PA.RTMF'.NT, at Che discretion of the Contract Officer , r e y reinahurse the l''ROVIDER at: It Oi rate. Tf the total units of service provided is less than 807, the Provider shall be reimbursed for the actual number or service units provided. in the event that the number of clients served is consistently less than 80% of capacity, this Agreement shall he :,object to review and renPgoti.ation. Payments may i)e_• a.utlorized for additional units of service pro- vided by the PROVIDER if the total nT.tmber of clients ser%-t—d .S below 807. becausa of one cr more of the following: a) Medical. Absence of Client - maximum of 14 days per c:Lint per f'isca'l year . b) Reimbur•seable Vacation - maximum 1.4 days r)er client per fiscal year . c) Re:;erved for 'i DI NT'.IFItsD Client in 3tate Schnol - ma.tirnwn o : 60 days per client per fiscal- year . d) Reserved fnr TDENTI.FII,D Client in ' tial Community Placement: - maximum 6!1 days per client: per fiscal vear . e) Other progranmiat-ic masons as defined t'y the OFFICER - maximum 14 rlays per client: per fiscal year . ' 4 AMIVINIUITT 47 SYF' G-neral. Conditions .. :rr'-{i1W�r Lnlpat lOn in The provider shall not deny cny sn>vlces io or otherwise d:rscrlmi.nate in the delivery of aerricos against, any per xxn Olio otherwise n is the eligibility criteria for the progrwn ai the t+asis of race, coilor, relipzle.«, sex, age, national origin, anceatry, uhysic:a.l or mental handicxt c-• !xcv.;e such person is a recipiratt „'' feroxai, state ur bccal public as„rstance o.: housing subsidies, TTIo-a Prwici;ar I.vith 9-11 applicable nrovis::onm of: (a) Title VI of the Civil 8.i ht?ts 1ct of p3Fi (42 rac Sec. ""1Kld poblhlts da Z.7:riminat-.inn oo rhe :iasis of r.,r: colr.�; m:meal x;ti,ixn in � -,:'aur.; .t„?C'ri nR t-Ae,:,a !'i... r•:,. .::J. %sSis'tanCe: and (b) Sw-tlor, hO4 .I ch.- 4.h h;Jibrt.i,rn drat of ,.9^(?. (^a ;S” Ste:. ^11.•x. Ind 1ho �Ilgnt l.ICi:,I: ll .''r:'et0, i 1, ra: pl rrdLits ix.;cr inv nxrii o, -=:x[;x. yu:_il.fled handicaprwd inAi viduats @ on Llai a:L:.is i>I h7ncti,:a.n ;n any pn;g-ram or act±,vLi3' rf. eiv).pg or `xxlefi tting firm tedenil "uiancii a::s is cailxxi and rmui.xes pz•oglaurE' :ird WT .VITInes, when vicrxni in their entirety, to bx re2dily (c) N.,;.:.. 1J.7, SFr;. a ri,)) -' '..PTrib:.'Cs d stir?_nSRatioD, !P .rit •j.ndiv.utra.i is rir;r.L, �1 1e, or 1!� L ;J:+L i.c r istapce �r ho'u r$ alt+su.f.?a. '? vim--74 se:^!mi raulnn - , Snnlaw;z�nt ^..e ;rmvider sn rl 1:.i: dim r j au..ate (42' _. :,ny ,;;a ta.Lic-v, erre lcyIi:. .. pl_xue r: or �rnl();rvn' .Acapf , 1)r, nstion»i origin :K!1, se.<. �i l.•gic'm ;x ,ir ,r�::. -a n•nta: i•:.di,:ap. :he provider shall Cmply .vi,th i!', nppR i xi:'le _:rxs'r,xon of: iu) '.Yt;u V'Il. ci the C,:"I RiphtS .act ' r 1J&d (62 '.W' 3ee. -.7(YA, ' t-o n>h r It ;t r:ral.racl�u .tp r,+qi lovrxlnt on �- iia,i�: u coj-,r, rel=x-.on :;es, :x 1.1:u,na_ nrir;in{ ase r 021 ec eT1.l. 1 - p;r;n.ibns .'iis.:r ir.:!na.:c i�,.;: L. •:r:io:Tlenr �n �''e tui A ave .a:, , ..,k ar.= is ,<; it ii, c!utls :stn 'o'•' 'e:4.• 40 Ye.u'= np;e t.] !z.:•s .:.n .;5 v�ar. �: a.sl ,nd ^g?'+ Cc) 3ecu.o: .4&4 of the Sec. 79v •rd thr, •t i.: .a� '^rx?ax'.p:L .rtt eursauz ^re::. (45 ilal f(: m,'i'lblLs „].aCI'L'Glna rl.... aga1 z4t 'qual_:te,', Nandi ciGl>.:u l ^..ivi,:,:a.: •)n the of -a Cucap ]nd rngt.:res e.rloeers to mike rea•.ngaf)].e kcCrnrndaz inns G� 'rrrn _)lays n:: or 'r�Ta.i. l]mi.cat:.ons of ;therat.";e goal a.fied !:mdicapi. applicants and =,q)1ny�•er;; s:'i„ : (d' N.,i.i. C. 15iB, .`,w.,7. 4 rl1 ._ �,�-,:;iUi is :!]x;rinic]tvn! In : PIOYM- nt on elm :L Is )f rake, taiar, tieK, .-_.(ism, rianonal or7.eirj, a:;e. ...e p:Y;v:,:et' a:a_: decr.Icu 'std 'bser-.'e a ::: :t.� 'i-S']i Ek:'.5 :)1' �A't�;1lJ:h+nt S,(leI' .-h`S Y'nC. .n.3.�'.C-'.:xi, L: "a'u.'rvr., -;(Xf7ka1G1t1U1:' fav:3n:e. :mder :I;,q is mp. mindL+!u rho,lsr•;::'. zo .ars :i'_[0,')00) :r :n:>n+. -.he ;),r eider snail'_ de�e!op :mtl aint.a]n :r. scu)rdanee ll'h gu]delines :::alv�-r:l'.:�Ki l,}' ratey{encv to rhe ?tr>v]c4=a". u: Alf:arsL t-':e actic;n i:ut 'and :jhai: .eutsm'c :;aid n:.m to -.be Agencc'. ;rtiou ♦Munistraror. -10 dgenc'; _tall, s{xm rw!uest. -ec:n.;:al assistance .tthe ?:,Dvi.der _:I ^.0^.=,:coirµ{ paid p1.^+r.. , � :!. O:np t:.ance '.vL^.n dpP u;'ai;lc• atnn;!e�. :n uldi.Llun -o cne statlaos ar:d :?.w,'r.at:pRs atcd in Arc:c. *: ant: .. :i c:]ese -:>enera! G>nd Cr,:�.;ns, cqr• P�';vt der :;na;l .. c.er!.o[marw ;qre.,-nenc rce4:l.v a'i.[h -tnf.LiaW.-, cn+ ')-ars a .-razates : a]]:i '.::uncia c1C!:•d '.:: -_e za;,sneni -,�' ':ie[a n^s :end app!lcat:ie iitatt_t a5'.: 'iFgmlatCons and 1, Statute and P,egttlat]ors. Mi;:h :'granin srscmal data ra.inta:ne': puPssuar.r. _o [his .4Trt'[Y1 nt, rre Provider is a .'balder of c. TtXmal ::ata .As telnl is, ']Sed In ii.L. C. IEA. the Fair inf Ctrrar10n ?mct;ces .Ac`., anC .. s;lail •:crrp!j".vxrh the provis]ons n; c;.,,. .. 136A, Sec. '2. 1.e !trnvider ra._ i!so '_oe.'oz^n its !andiinS of ;)e,•r.:oaai. ;fate. vicer this Agreement n the rxc r.•._ 'n=nts or agencies set :wt Cn bi '-vTN 'Laptera; ';i:i, 405 and and iac. 404.010 rlirctapn 4C-4,056 of Chaycer 4014 the regular ions zf -.he ze::'reta : of Htubim Se]vanes governing the sa2f%u -cl;]lg, usa and acress -c :+ersa alai dal^. d. Information Svsran. 'ihe Provider stall furnish to the *encv, within thirty (30) daps follrwing request n3' the +Agency, a written des- criptioq of ttae Provider's systar. ror gather nog, storing and releas i:g . personal data. 6. Maintenance of Records .1:e Provider shill pn1pare and maintain, and snall retain for a period of six (6) years, such shorter period as the ,Agency mal' specify ' or suet: longer period as any appiicah,, iirxnsing standards nay require, followiug CaMletionof Perfonmhce of the Services, the following; A. Such data as are necessary -o satisfy applicab Le reporting re- quirements of the. Haze Setting Cnmeussiai of the iimnonwealth of Nass- ' achuse Lts and, Lf payntest 1,iereender is on i. �sL-C'e imhUlSenIFY1L basis, financial books and recoras whici; ref.ec: ,;osis incurred in and allocated to performnce of the Ser fees. .hese arks and records shall be r-,,.u1r.- . twined in acoorcimce witli generaliv accepted a,cow!t:.dg princip:es. D. Personnel Policies, - c. Personnel records, - D. An inventory of equfPM111: .O'..1en UurehaSLd With funds Prnviaec :•tereunder and has a useful .i.e :)f Tyre r.han one year and a cost v1 exrrss of xne hundred :tollars 5100.1. I:i_s inve:nrory v::i:.l inc_'ude, with -respecL to earli item. 1. A brief description. 2. ,Manufacturer's serial number or m ..centifier assigned ov he provider. 3. Acquisition date and cost q. Location and uae. G. Client casework files. !%eee files s,ali oe mintained in actor- ' dmCa with applicable statutes, regulations or nmhuals cited M Article 4 of these ,eneral Conditions and any specifications set in the state- . wuz of 'Work and Ob,ectives. In tlr. cases ?f a client cormitted by court to, or otherwise in the are or %ustofy �j', the Agency, the Provider �ml1. upon the request of the Agency, forwaM ro the Agency a ^ropy �f Stich aiient's �aseworn f_se. C 7. Inspection, Review and Audit of Returns A. Fiscal and Administrative Reu)rds. The provider shall hold avail- able alt all reasonable 'Lies during the business day at the premises where nonna.11y kept the fiscaland aLninistrative records specified in Article 6, sections A, H, C and D of these General conditions for inspection, rr- view or audit by the United States Depax=lent et Health, Education and Welfare, the lfassacinusetts Departnent of Pablic welfare, the Rate Setting Cc-mission, the Agency and their authorized representatives. J. Client Casework Files. The ptnvider shall 'acid available it all reasonable times during the business day at the praises where annually -:sept the client casework Piles specified ir. Article 6, Section E of :hese General Conciiti-ons for inspection or review by persons ;not mcludi.g rtemUers of citizen-review or advisory wards) who are efnplo5ed or engaged as independenr contractors by the ilnited States DeparCrent ,f llealtn, Education and welfare, tie Massachuserts Deparnaent of ?tblic 'Welfare or :he .Agency to monitor :he maintenance of sim files or evaluate the Services provided nereunder; orovided, however, that. 1. Material in any such file containing unique client indentifying information my be inspected or reviewed by the .Agency only; +� a) as and to the extent required by statue or :eg+ilation in order for :be Comonwealth of Massaclluset:s :o obtain fade' ran re- imbtu'.sement with respect w _.ands provided :o the provider her-2- under; or b) as a part of a engram of the Agency ipproved by the �xnaissioner of the .agency or his designee to assure that Services a_re bei.g provided as specified herein ana to evaluate the quality and effectiveness of ttrese Seriires. 2. Client casework files arty not In the course cf any such inspection or 'review be physically rent,ved frcr the provider's premises by . the Agency; nor, except with respect '.o files of clients committed Dy court to, or otherwise :n the care or �'.nstody or, the Agency or except with respect to the nanes a. clients whose elin_bilccy for Ser,;ices is deteirined by :;e Agency, coy su,= flies be ;%ctoccpied or transcribed in any respect. C. Procedures. Ins , review or audit ,f mrurd,� �cu:cnrevi ' by the A.tenc:• under the preceding secticns of this Ar'rcle !nav be :oQCL•c-_, oily ) in accordance with the following procedures: 1. Except when the .Agency has reasonable grounds to sarspect fraudulent , or criminal activity or material breach cf this Agreement, it shah - give advance written notice of at least ren (10) days of the purpose. scope, expected diaration, written instrsrent (s) to •..sed in and Person (s) conducting any inspection, review or audit. 2• 'lie .Agency shall conduct all 'nspections, reviews and audits wl-h i the.inimal Possible disription to the prmiaion of Sen aces here- .� rider. 3. At or soon after the close of inspection, rcn•iew or audit, :he Agency shall afford rhe P ovlder an exit conference :or the Provider to di$cu. `:S he inspection,. review or audit process ,self, to ;.current !Pon any observations thea formulated by the !:rspec*ing nffi:er (,) and to offer additional cert'nent information. 4. ;Wn its ccaPl.etion of a preluninary report on any inspect icn, review or audit, the Agency shall forward a copy thereof to the Provider for carmen. Any cChi nts submitted within fifteen '1 ' days thereafter shall be considered by the .agency in its Proparatrcn Of, and shal1'1be attached to, the final report. 8. Site Visits forProgram nitoring, Review and Eval 01n A. Inforral Site Visits.. The ,.agency ,may from time to tune ,hake informil visits of reasonable frequencv and duration to the site or sites where Services are being provided to annitor the provision of Services- Such visits may, subject to Arr.icle. 713, include examination Of a reasonable number of client casework files. S. P- am Evaluation. On-site Program review or evaluation, other than visits under Section 4 of this Article, shat` be conducted in accordance with the procedures set forth in Article 7, Section C )f these General Conditions. r w A. i�-� Til lie k�Vlj,[L �A—Ilnncw Procell, cue "-ovlcl r am act, pc)v,(jc .he .r'y togs 21i rhe ehTanl: billed, nas tilled for 3ervicea to any per,,11; nj, T, i.:: ?xw ;r shuuld have :moon wrn rbe, Innorm'AtIon tc 11v h'cl L!'*,kT!,I', j$ c-Ie client qr by a: :Iierefor under Lice rearm of KIIIS *M' rc'rt tW has J,plJ ,arc �r excess day�x�ar tnrcugh error of rlie lgem 0 P-- %qency shall so ':Le rmv:Lder' scall ixec end - allow 4 U :1,T 'ess than "en (75)) lays, 'Or —e A: "mance sliou., not ce provider ajgx�' To :'L w lny ;:111. or l'be. :"sallowance the -Agency shat; '.ec,n)p n;�yqm'nc in lcuX=ce, a rn 3ection .1) ?�. vider objp.cr *.c' 111 or any ?an'. ^i T.he 1q.1 should -ae .49'ricV levernH.iess xi�jjj ,.o pm'�Cf ! !v a_pvncy 'u&'.- 30 rctt_y rae. Provizior ctu: Shall stay -kny acn:"n irlj- . 9"n PrOOrdOzce with, azy review -.ind ;r. 7arrer by the -Imvidor under Sec,.,gin C 11.erwor.. I Payment- In Vie 'Ie-erva!.es t!la- !Zin, Provi'�V'r -w� -'al-�d :'r; Lu • 3r l.cle 10 spec.'f"" ti::fj —e .Agesiry ,ayncrxy T.:e !:hac i:voice soli Snal-; ail(n' a reasollal!.O ; :rd :,µL :.'Of days, !:,r .zie Provider --o ;!�"w st:'mild I --he Agency nay, ,nLj,. •.he i,jjv payment -n 6Wn vouchcr mI.I.1 it recpJves -;I,! ilt.ov-'der J%;ect sU-% de-ay, and should the A,1sh ',c 'rjere.- 7ne Agency shall so jor4 fy rhe :Vcvider. '.hu 6ge cy mall �cj. in IcCOfc4mm- w;L' any review end -..Ie aught ty r.he ?Mvicer vniter 5ecr).cAj C ' , r -7- ore 7- bre enc•. rtv Prvx• d r >t.al: upon .:ling ,vr,t•en . notice withr n. ren ( ] ) dSys .7C.er r•r •;r. ;t x) ?Ce under __'er., inn d or S r)ereof, ne entitled to an intoxcai hextring hef.)re the hemi of the emcv .. .or his des!gnee. with respect to the proPos^°d i{{.sallowance or dela;. ;f the agency head nukes such a disi.gnatior: the cies ignee slm!1 not be the Person or one of the people :vho mae or participated in the ntkinq of the decision ender review• N'J.rh in Cer, (10) days-oi notice the CrxmLissioner or his clesi?�ea+ shall hold a hearing and allow th PrpvJ.del:' to presentall relevant inf0mation. The QOmnissiores or his designee sha.11, with i.ri ren (10) days thereafter, reach a deci stun on ;titch disa.L'cw.u)re orde Lay ;silt shall a5'aawira ae such decision in .vri.ting W the FrovLder. D. Method of Disallovrarce. itiY di sa,louance by the :1Re,cY ..^.wde it accordance with ect ion hero, and with the :eci.sion order irtitall. C fron an if any, shall be with the out by .:1? deduction of such disallowance Eny on invoice, Pending with the Agency or set-off of ;ucn disallowance °roti any armies rr�ed U) the Provider by the enc Provided, that the .lgency PrcmPrtY sti6rntt. to the Provider a ATxrtrn acwuntir:g of such ii.sa.lowance ;r settft; or (2) repayrn nt by :he PrJvider ir: the ama,mr oT sud) :isal;.caarce vii Chin (60) days follavting resuest„ or such longr-,r xr..od as the :wenm: and P^:;vider r'ety nrzctua!=y detena!ne.. . 7.0.___fie�ons he Prcvi der shall. subn;t u) the ap;rncv the 1,FWE is epeci'ied '.n .ltrarlynent C «• t,hin t . 7. he tura per.ods indi.cater! ir, said atacaanent or, if an Period is cr) indicated, within a rea:x)nab!e CmG after reg::est. :n addition to the reports bPPri=ied in :ald .Atraria:ec:t, Che ]`l'ovider -nil .oilanit to the Agency rich other reports as ase "r:gnixvci by .he `.Ren�f, ,o asMly u^ith state nr :ec1r_.t,t! sta RrtE?s ?r re lat:.ons or :oleral i 1 ::nes and ;uch specitci repots �nta.ij} fiscal, ariinxstrat i�-e or�pn:g:-err-a';,• , '.ata as the .lgencY 'av infra tine to tt116 reasonahly request in orderto con itor and , valuate the _ertiices or to Wbsta,tiat c. irs c_aiirs to 'edea: reimhurs,�.rent :'or funding prtwtded hereunder. In Ch^ =vent that the toxrat Or any )f the reports sPecif[.ed in ittacrvren^ C is to Lk ,:hanged significantly or n the event -hat •,he ;gencY ='�luesr:s It .;Praia! :epor- in accordance xdthaht.s drticle, :he + :rev shall cnnsxlt with -he Pm%'Irier to advance as t:o the nattue of 3r.;, arch Change .)r . ?•'port, and .Ile ,:ire ceriod for v:rplEr:rentnr.ion or sutmi sfon -hereof, and she!t., if roiluested by the Provider, assist the Provider In cMpli:uice. 11. 4epmduct:on of ReM,-s The Provi.der shall not ;ltaseninate, rep o.hcca` „r, publ:.si) any -qr• asap, ;nfot^.cttion, luta or other docu:ent Cr)ducc:d to -vYa le r,)r in car , U pursuant to Article 10 01 knew General C-�nditioas eithcut L7e prior ; written consent of the Agency; nor snail any such report, map, ;afotmetiot?.. data or other doraaent be the subject of an application for copyright by or on behalf of the Provider without the prior written consent of the Agency. 1 , 1 Assigrauent and Suhca_utract the Provider shall not assign or cthetwtse transfer any interest �n ; this Agreement without the prior written o>tseat of the Agency, which consent i shall act be unreasonably withheld or delayed; provided, however• that claire � for money due or to became due to the Provider frro the agency hereunder my be assigned to a 6enir, trust ccngxtny or other financial institution without such consent and that notice of any sura essigntent is fu.-nished p.^cmprly to the Agency. `lone of The Services to be provided by the Provider pursuant to this Agrernut±tt shall be subcontracted to any other organization, association, individual, partnership or group of individuals without the prior written cons-ent of the ,agency which snail not be unreasonably with- held or delayed. rhe Provider sha11 be trsponsible to the .agency for he Perforn'snoe of any subcontractor and any subcontract shall be bubyect to the terms and conditions of this .A •rnt, ,,,77 i 13. Ear1Teimination A. For Cause. Ia the event d)ft Pit7,er para, fails to fulfill its obligation s hereunder in a timely and proper auncr, the othor may, after speci.fyiug nay alleged default or breach in writing and allowing a reason- able cure, but not less than fifteen (15) days, for correction thereof, terminate this ,Agreement by sending written rotit•e of termination, contain- ing specification of reasons, at least fifteen (15) days before its effective date: provided, however, that either party Amy teraunate this Agreement by notice effective immediately, and without uPPO=urity for correction LY the other, in the avant that any default or bmC ch by the other or any other intervening casualty poises rmslinte. threat to the life, health or safari of a client, In rite =ase of s'u:1tarrdiata termination by the Provider, ,Were any of the affected clients is cxxmLitted by court to or cther vise to t:-e care Or custttxiy r,f the 1,60ncy, the :'mvider snall use its i best eiforts to Provide for the health Md aafetp Cf such clients for the health and safety oC,-uch 'clients for a ^e:vsonable Period of tss to , I I ati.ow Lhe Agency to etc^ani eor rhelr trati.;er {nus•,>a.nt Lo Article 14, Section D, in the arae of Urneuiate resrrinat iol] the terminaticg party shall hold a conference with the, other, and if it has not cone so before, provide a written statement as :'.n its reascrt)s for temi.narion, rVrthia tllree (3) days of terrnnation. . 3. Without r�a�use- Either pa1'tY :ray terminate th.Ls .agre Lent ')Ur cal se 'upon pIpV1510r of '.N"Itten notice to the other at je,St sLxty loo) (Says 'DeZIre its Lf'_'ectivp Date. :he "vent that any ';ta[ute or •yh rc❑ by ire; own ;?ra or 'Dy dreicles 4 :-,r 19 of -;ese Genera: ' ,-'CnnitiOn govern, p,+rformance hereunder :s changed, .:i'ferenU•; Lnterpreced by a �-.ourt :r other comperent suthor:;y, or newly enacted, adopted �r promu,lgatsd, as t'le case may be, so as 0 ., increase the `,urdens on either pall— i.,. come lyln gV . .ih ne Terns of this Agreement si-gni.:icanti.y beyond ;hose ax_sting at '.:11e Llnle J: exe Cl't'I11, be:'eOI , Bi tier such .Dar'lv may [er^:na-e 'h:,:i Agreement ;.p,)n pnn,j,lotl 'Jf aTi'.tBr. ❑OL'Ce Ll' ]h PJi::Pr at :east '.nry ,30) days bef;re 1s effective Sate, ur0vlded, hC%evBr, Thai any , I aot.l ce ut ctsr..inar.icn recer:ed '.arer than sirry (60) jars after sue.. rhnago. V lnre:arerat'Ion or enac vert. .,hill not !:,a valid tinder -,bis Sect+on and shall Oe •"eated as a nCtice. ): termanariOn pursuant LO above. D. Temination.of FMciinw. ,n the e,7ent :hat funding to the 7gency by State appropriation clic V grsnrs or contracts free: an agency Df L;e federal goverynent :or payment 'or the Sorvlces is r", c,�d _Dr tertnirated ny '.he rpneral Crnss of the (:rn)ronrvealrh ')i Naaeacl usPt or unilaterally reduced by such 3r1 agency .)i the federa.t gLverm -,jt, w 28 -o prevent Donti.cued ftnldirg of all service contracts entered into ul!der the appropriation item governing this dgreenent or under any applic'abie f !era: nr contract, the .Agency ^ay *es.^inare this +LdreHr It u4s)n provlalcn )f wrtit'en ^CLice COI%taz❑ing meCl fl Cat iO❑ ,7` reas),S 1t :east t:Ur •; Its er"fect:ve date. 1 . ld. !XP..i,` tions i:rv•n ^^t^�:: aticn_ Spon tecr.:inaricn of this dR:'eH^eri, ar,other -pon c(xq).yr_on Tf per fomarcr, ,r ;;;' early -er-.caation ]ndr?r A_rt'.I•'P ;; these ::Nn.;lr^.1 Condi-:ors: ' I .si M1 l� —lo- A. Reports and Other Ikxanents. All documents, data, studies and reports prepared by the Provider tar the Agency hereunder shall, unless the Agency ocheiwise dir�,,;t:s, be sutmitted to the Agency. B. Client ;;eso files. Cliant case files maintained pursuant to this agreerrent shall ranain the property of the Provider. , I C. moment. The Provider shall be paid for all Services performed . LT-- to she date of tenlinacion plus, it the Agency is required by Section ,! D of this Article to rem,.v clients turn a facility operated by the Provider. ; and fails x, to remove ;,aid clients, all cast reasonable incurred in :rain- - 5 :i tarnl.ng :inch ;Aients in such tacilt',y after the date of termination and F lnti.l such clients Are so rrnuved; provided, that properly completed invoices for all such payrAnts are' s:tmirted within ninety (90) days of web removal. • D. Transfer or Clients_ if fj:encs are conmitted by court to or Otherwise in the�cRiM or miswdv of the agency, the Agency shall unless the Provider is t1j +nntinua Servipjj;s -ander a sucressor, renewed pr extended i Agreement, pnxpr.l,y take all steps?pecessary to provide alternate services I for :hem or otharprfse -«rnrne then �rcm facilities, if any, maintained by the Provider hereugdcr.. d 1 Recla'�mp_ion of @Zuipment Title to all, ,equipcebt rhe cosi,of ,,tdch is fully reimbursed by funds provided hereunder and which has a gefui life of more than one �).) year and a cost in e' s of one hundred,to Lars (15100.) shall vest in the agency. i 'tpmecaplerion of performance hereunder, rhe Provider shall retain such equipavnt for its use in perfonnauce of social services unless and until, following rnsonahle advance aoriee, the Agency re o%vs such equipment. Renewal scall be at the Agency's expense. IC, Waiver of Default 10 waiver by either party of any default or breach hereunder by the f. orher shall constitute a wa.i�ver of -coy subsequent default or breach. 17. Amendnent '"his kK eem t :nay be amended only by 'written document signed by authorized to :cind in contract the .Agency and the Provider. 18. G:ntract ?fticer_a with :_keen 15) dayss lirer r^e execution of this Agre". nt, the A.gencc :cad 'he ?.•n._,ler sural: s'u•h, by Nr..Ceh rot ice tc the other, designate. Y 1 I � 1 • 1 one it rwre t:otract otrt!,rri', , SZWcI P4.'?h": Such designstlnn may hn chunged •:Pl1:rau4 cno ;.wrr.:<'. oY :hi:; :%gr"Wr llt...!y r ; written notice. :1 de61!plated I%'wrw'tl hff.Xer stml.l l>-, .x!rl]PrlZv:! and9f¢X.)we[..P. ' : to represent and Jlnd -th, n.6m} f;r, -r1r1Yl:;Yn):t !•..t!t :•e.41'N.:±,'.Y. rr, yl: 'mtzs::vs •, . : within Ruch area of ;uGQX) 'ity rft' vri u, Ag e"'rir, 1 • provided, chat stlGt C;Gn R:1rl. ;ifficr:r ,ha 11 nuz. i>e i'Itrµrrne,cvl *..:> aimod 't:u.; y,• - Agmemen•, : 1N._..-•S4.f ::nless otherwise 'lrset n. na' :nt: r.•r :4r4'"Hien.. 'n!jaa;. r } .fe!tard hereunder frm elr:hpx ?nrtp !Ste .lthor shoal, '.e 'n •..r.:.taz1. '1 be Signet! `ly the 01ntract ':'diner )f •�v+ n,)-.)yir¢; ,Ut .;, 1,1 -dta:.: x leaned 'o have ':)eat givorr "1*11 rt.ti.,•. 'el':v. x:1 n- :lr xi:4:-ext :n . t a '•nited .Stares -rn1 !box In i"1�.•:,rago t•t'(y"•..:r1 .:.ri"P 1'npe :;1L1+1?!iY#! f'!t- i•:'.rr. ' . he Provider 'Hu—.. xs, tept+'S'a`n r::1 'Ind µtt +•"y ':!'w at:Tl,A ttN3 dgreenent is In offw,t .e t!:2r p,'r 4ay '.l. 'S . y,r,h'! rC.r:banY, iS 'Y rea::Nf defined, participates :.n ,r 4ry)(e rd ia?.t .�l,r tr :v:.fl:`n.U; 'S;:.i 'ply x,rt, as 'defined in sec. 399 !u l :31 :utd ! :.i •tr. n r>.^ra'. iira".?nl�A i;mP !95.; : as xrendedr or engag'e� :n ^:mdu•• dr^!yry:1 in :r •m!aur.tl. -y sec., 3 :f �.. .r rbapter. 151k, Nasse.:hturrry xeral !nu' 1: •,!•f:nr aha Ll or"A% in '.re. ... waxr$ntY. rePmNP.ntat;rm :Ind Igrexirnv j-ftmiml l :n this ;rarafiraph, r.h«n . nvithotrt Limiting such -rh, r-g?;t:> ,It; :: auy '.Iv •.::F :.:an:rutwea.; .. be entitled to resctnn :his ;+)rr ., 15 s.9 ).ere ul,. a` tt`i'.n.:rd Sar• arl, , + . . 'Snell. IN! MY businrA; ?n1 ;S. f '.hire it . Interests are 't1lYCt:y =, .ttd.i.rh".Ly 1wn.47 L, n. "•.C' i,: .0 .:}, . '•a'3ai i :)f pP.rsons OT !ab LnfciS ..nrJ['! t' n}'3.')•"i ,' Tt.".iti .r 3 +;;.!.'i •A,Tl llyj Y. 51P or 'he mer-Anp !!aer s i 'rtn 1."'}^' I ':!:�'.': 44. 1..9 . ;ndirectly :;, ns at :.easr Iia°. of 'Jv «.rnm•sn r ', res: 'Le arts. 2mvi.der shah :u'.t: lU:nwr:W;',;: ",„t,',,r, cr.1[.wpyi'.y or .Irr31*.e c"nopensate anY eeMl OSlee ;1 t1e .4tenr; }•:t^•k «: ...:--t d 'Rina L3r...*Iwnt without the ;;Tier .. .rna` , .,r•l ll. . ...o r � 4 „ l rsido L'.(.11t.i.tyi,ng Number }'INtlNLiA1. 1Lli";'fa5`I Sf r","!-[iARt?I'i 1. war�r, . k'otvi person _ lrecutive Dirmctor sninga reement position in urgaklMlLion Bass Rfver Day Activit,/ I'roLnini, Inc. hereby certify ulikicr the pains aw naII1C UorgI anizationn penalties of perjury that the following sets forth the names and addresses of persons having a financial interest in the attached ,agreement: 4' 2 NONE 4. 5. r Executive Director - :�1,Ll-=--- Nky 30, 1979 'Delete if agreer=ivor with individual *In the case of m--n-profit orgartizations, insert "NONE". Unlyuq xdentifyI"g N[i:nt,ee FINANC1A1, USCIAXURE STAT:'.ME-N"l' Name of Contractor _Bass River Day Activity Pro, raw, Address 437 Essex Street , Beverly, Nassachusetts 01915 F. E. 1. #/S.S. # 04 251 2466 _ Tax exempt numbcr (if applicable) E-000-077-035 1, Edward A. Putvin Executive Director name o person signingagrerlleni pc}sitiutiiin organizati-on Bass River Day Ar_tivit, rop,raw, Lug , hereby certify that [lie following, se;.' name of orfranizati.:n T —' forth all income dc°rivol from the federal government, the Commonwealth or any of its political subdivisions: GOVERNMENT ACFNCX _AMOUNT 1 Department of Mental� liealtii - Danvers/Salem Area X30 clients. $119, 342.00 2,Department of Mental Health - Danvers/Salem Area . 3 clients. $ 3,3135.50 $.Department of Mental Health - Cape Ann Area 5 clients. $ 22,372.00 CSpecializod Home Care - Cape Ann Area $ 12 ,000.0,P S-Specialized Home Care - Greater Lynn Area $ 1 ,!;75 .0 , 6.North Shore Consortium - 2 clients - 766 - $ 11 , 176.00 7.City of. Reverly - 1 client - 766 - R.City of Duuvers - 1 client - 7GG - $5,50.00 Ei iture 9.Ci( y of Peabody - 2 clients - 766 - $11 ,176.00 Executivo Ultoctor O:P!asconomet - ] client - 766, - $5 ,'t13.00 11 .City of Beverly - I!ealth Dept. - $61 ,100.0() ra=y 3n, 1970 '.2.City of Salem - health Dept. - $1,000,00 'Delete if agreement with individual '. 3.Cuntracts - $2,500.()0 II 3 I F bass` river: day activity program, inc. ti. r 4.37,Emx SMeel, Beverly; Massachusetts 01915 ..4617) 927-5326 BOARD OF DIRECTORS - 1978 -1979 Ralph Parisella - PRESIDENT Attorney John Kriegel 3 Sargent,Avenue - 927-2323 P.O. Box 456 - 462-2252 Beverly, Massachusetts 01915 Byfield, Massachusetts 01922 Neoey Rice - VICE-PRESIDENT Kathy Kriegel' 25 Millbrook Road '- 927-4419 '`} P.O. Box 456 - 462-2252 Bevorly, Massachusetts 01915 Byfield, Massachusetts 01922 s Sophie Fowler John Monahan North Shore Community College 8 Edgewood Road - 927-3563 3 sea" Street - 927-4850 x181 Beverly, Massachusetts 01915 Beverly, Massachusetts 01915 Margaret. Reilly - -TREAc9t3R£R Charles Papuchis 44 Hale Street .- 922-2717 G��k 12 Daniel Terrace - 531-8151 Beverly,_ Massachusetts 01915 ��t/1�7� Peabody, Massachusetts 01940 � >> Blele'Brochu Margaret Brennan- Z SO Hillside Avenue -` 922-0228 - 3 West Terrace - 744-6924 ` Beverly, Massachusetts 01915 Salem, Massachusetts 01970 Nsrgara't' Byrne.' to Colon Street =, 922-7640 Bedogly,. Massachusetts 01915 Mary 3MsQerthq 42 Wallis Street = 922-3828 Beverly, Massachusetts 01915 ' Pa�Yiciat sisib,- 30,Xi.11brook Road -:922-1407 Beverly, Massachusetts 01915 Carob (lroaley':,; 8 Rowell Avenue - 927-3640 86vsrly; tiassachusetts 01915 Mary Miishand 4 12 Savoy Street -"744-7988 Salem,,Massachusetts 01970 A NEW WAY OF LIFE FOR MENTALLY RETARDED ADULTS THROUGH COMMUNITY PROGRAMING F Unique ldeneifylrg Number CENTIFICATE OF VOTE ° 1, Narj;aret r. &-my do hereby certify that 1, the duly name of c erk/secre[ary elected Clerk Of $ qs- i �'T secretary/clerk - Inc of organi7 ati0n at a duly called meeting of the B(mrd of Directors, Board of Selectmen, Aldermen, qr City Council Of Bass Paver Dig activity Proi;rani, Le. held on � t natrte o, ori;anizatian date tie following vote was passed and is still in fall force and eff:2ct: VOTED: that Edgard A. Potvin _, Executive Director of name of fr)l'rSOn signing agreem :: titjtc .r141y. Activt YY ninc.ro,raIand PC, "ng, m. Ytri _.�i_ , name of organization b ehdf, b:: and hereby is authorizea to enter into an agreeme rat to provide services to the Ccmmonwealrh of Massachusetts Department of Mental Health; and is further VOTIED: that said Edward A. Potvi,it or his djf..signvc be atxl is hereby authorized to execute and deliver anY and tall documents necessary and inciri<-nial t',,,,reto. Witness my hand this IOti, day of _^ May 1979 '0mit i f agreement with i.n�+i'aidu.al \ The Commonwealth of Massachusetts CITY OF Board of Building Regulations and Standards Massachusetts State Building Code,780 CMR SA Revised Mar Mar 2011 Building Permit Application To Construct,Repair,Renovate Or Dem 'sh a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number. lbte Applied: Building Official(Print Name) Signa Date SECTION 1:SITE INFORMA ON 1.Pro perty dress: 1.2 Assessors Parcel Numbers 2S SS>c`C �-r� l.a Is this an accepted street yes no Map Number Parcel Number : l �'' 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq R) Frontage(it) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Requited Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: — Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' [New Own 'of Record: EF ALEK1 Ol9'�U e�t City,State,ZIP and Street T Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Altetation(s) ❑ Addition ❑ olition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ o 1. Building Permit Fee:$ Indicate how fee is determined: 2 Electrical $ ❑Standard City[rown Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fees:$ Suppression) Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ ❑Paid in Full ❑Outstanding Balance Due: �0 i SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSC Type(see below) No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft. R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covenn WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Tele hone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street Email address City/Town,City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .......... ❑ No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject ro hereby authorize to act onq ative to work authorized by this building permit application. ro-w- -� Not Owner' am 'c Si ) Date SECTIONW.OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor Li!!nT be found at www.mass.gov/dos 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,fi i asement/attics,decks or porch) Gross living area(sq.ft.) Habitable r m count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" Salem Historical Commission 98 WASHINGTON STREET, SALEM,MASSACHUSETTS 01970 (978)619-5685 CERTIFICATE OF APPROPRIATENESS It is hereby certified that the Salem Historical Commission has determined that the proposed: ❑ Construction ❑ Moving ❑ Reconstruction ✓ Alteration ❑ Demolition ❑ Painting ❑ Signage 0 Other work as described below will be appropriate to the preservation of said Historic District, as per the requirements set forth in the Historic District's Act(M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance. District: McIntire Address of Property 199 F.csex Street Name of Record Owner: QMH Realty LLC (Jeffrey Casiglia) Description of Approval of Work: ■ Install Timberline architectural roof shingles on rear roof slope(after the fact). Dated: September 7, 2018 ZSA HISTORICAL 0 MIS ION The homeowner has the option not to commence the work(unless it relates to resolving an outstanding violation). All work commenced must be completed within one year from this date unless otherwise indicated. THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of Buildings (or any other necessary permits or approvals)prior to commencing work.