AGREEMENT FOR THE USE OF CITY GENERAL FUNDS

This Agreement is entered into between the City of Lawrence, Kansas, a municipal corporation (hereafter “City”) and Health Care Access, Inc. (hereafter the “Independent Agency”), on this ___________ day of _______________________ 2006, for the purpose of establishing certain conditions on the receipt, expenditure and  use of City funds received by the Independent Agency.

I. Use of City Funds

As a condition of the receipt of City funds amounting to $28,000 during City budget year 2007, the Independent Agency hereby agrees to use and expend all such funds pursuant to:

A. All applicable federal, state, and local laws;

B. The application for funds, as approved and amended by the City Commission, which states the funds will be used to support our Clinical and Medication Programs;

C. The Independent Agency’s mission statement to help facilitate access to health services for Douglas County residents with limited financial means who are not covered by private or governmental insurance programs.

II. Independent Contractor

The Independent Agency further agrees that it is an independent contractor of the City, and that the employees, agents, and vendors of the Independent Agency are not employees of the City.

III. Reporting Requirements

The Independent Agency shall provide written reports to the City as follows:

A. A six month progress report shall be due no later than July 15, 2007 that provides in a narrative form a description of the progress made towards meeting the goals and outcomes described in the Independent Agency’s Application for Funding.

B. The following documents shall be due to the City by March 31, 2008:

1. IRS Form 990 (i.e. copy of Federal Tax Return for 2006) as well as a copy of the corporate annual report filed with the Kansas Secretary of State – FORM NP (not-for-profit) filing.

2. A copy of the agency’s financial audit.  It is suggested that the agency adopt SFAS No. 117. This standard has been adopted by the Financial Accounting Standards Board as a preferred accounting method for non-profit corporations.

3. A copy of the Agency’s Annual Report that includes a summary of how the funds were used, to include an assessment of the agency’s annual accomplishments and outcomes.

IV. Access to Financial Records

In addition, the Independent Agency shall provide the City with reasonable access to financial records concerning the expenditure of City Funds. 

V.   Withholding of Payment

The City shall retain the authority to withhold any and all payments to the Independent Agency if, in the sole judgment of the City, the proposed or continued use of the funds violates the terms of this Agreement, any applicable law, or is contrary to the appropriate use of public funds.

THE UNDERSIGNED, DULY REPRESENTING HEALTH CARE ACCESS, INC., THE INDEPENDENT AGENCY OF THIS AGREEMENT, HEREBY AGREES TO THE CONDITIONS OF THIS AGREEMENT FOR THE RECEIPT, EXPENDITURE AND USE OF CITY FUNDS:

Signature:      _________________________________________________________________

Print Name and Title: ___________________________________________________________

STATE OF KANSAS      )

COUNTY OF DOUGLAS )

The foregoing Agreement was acknowledged before me this ___________ day of ____________, 2006 by __________________________________, representing ____________________________________ as the Independent Agency of this Agreement.  In testimony whereof, I have hereunto set my hand and affixed my official seal on the day and year last above written.

                     ________________________

                     Notary Public                  

 My commission expires: ______________

THE UNDERSIGNED FOR THE CITY OF LAWRENCE, KANSAS:

Signature:   _______________________________________________________________

Printed Name and Title:  _____________________________________________________

STATE OF KANSAS       )

COUNTY OF DOUGLAS  )

The foregoing Agreement was acknowledged before me this ___________ day of _____________, 2006 by ____________________, representing the City of Lawrence, Kansas.  In testimony whereof, I have hereunto set my hand and affixed my official seal on the day and year last above written.

____________________________

Notary Public          

My commission expires: _______________