AFFILIATE AGREEMENT WITH EAST VALLEY RSVP.PDF

East Valley RSVP 1
Affiliate Agreement with Maricopa County Head Start
Affiliate Agreement
Between
East Valley RSVP
and
Maricopa County
The Agreement is a non-financial agreement between East Valley RSVP (hereinafter
referred to as “RSVP”), a community based organization and Maricopa County administered
by its Human Services Department Head Start Program (hereinafter referred to as the
“County”, “Head Start Program” or the “Volunteer Station”). RSVP and the County, Head
Start Program or the Volunteer Station are collectively referred to herein as the “Parties”
and individually as the “Party”.
Purpose of the agreement is to have the Head Start Program to host RSVP volunteers in the
Head Start office. Volunteers will help to enhance the services provided by Head Start
program.
“RSVP” “Volunteer Station”1
East Valley RSVP and Maricopa County Head Start
East Valley Adult Resources, Inc. 2150 S. Country Club Drive
45 W. University Drive, Unit B Ste. 7
Mesa, Arizona 85201-5831 Mesa, AZ 85210-6878
This Affiliate Agreement contains basic provisions, which will guide the working relationship
between both parties between the dates2:
Agreement
4/1/2015 and 3/31/2018
Affiliate
This Affiliate Agreement may be amended, in writing, at any time with concurrence of both
parties and may be renegotiated at the end of the current RSVP grant period.
Chapter:
1 Also enter the name and physical address of any additional “locations” in or at which RSVP Volunteer will serve if such an address or
addresses is different from that of the Volunteer station.
2 One, two or three year periods are per Senior Corps regulations.
1

East Valley RSVP 2
Affiliate Agreement with Maricopa County Head Start
BASIC PROVISIONS
A. East Valley RSVP Responsibilities:
1. Recruit, interview, and enroll RSVP volunteers to be placed in the Volunteer Station.
2. Provide RSVP orientation to Volunteer Station staff prior to placement of volunteers,
and at other times, in coordination with the Volunteer Station.
3. Provide for adequate safety of volunteers and submit an annual assurance email upon
request by the project sponsor.
4. Collect and validate reports as requested by the Corporation for National and
Community Services (CNCS) including collecting and validating appropriate volunteer
reports for submission to RSVP office on a monthly basis and supplying data
measuring volunteer impact on community needs and other data as requested, to the
RSVP project.
5. Furnish accident, personal liability, and excess automobile insurance coverage as
required by program policies. Insurance is secondary coverage and is not primary
insurance. A complete description of the supplementary insurance provided for each
and every East Valley RSVP volunteer is described in Addendum F.
6. Monitor volunteer activities monthly at Volunteer Station to assess and/or discuss
needs of volunteers and Volunteer Stations.
7. RSVP volunteers are provided with assistance with the cost of transportation to and
from volunteer assignments and official project activities, including orientation,
training, and recognition events, within the limits of the project's available resources.
8. Develop publicity for RSVP such as radio, TV, print or verbal presentations
highlighting volunteers’ service, accomplishments, and impact on the community.
9. Annually assess volunteer placements to ensure the safety of volunteers as follows:
Throughout the annual duration of this Affiliation Agreement an annual safety
assessment will be conducted, including a required email assurance of safety from the
Volunteer Stations covered by this agreement.
B. Volunteer Station Responsibilities
1. As required by the Volunteer Station, each Volunteer will be required to have a
criminal background check and fingerprint screen prior to participating in the program. Agreement
2. Implement orientation, in-service instruction, or special training of volunteers to
include one hour of training and one hour of orientation. Interview and make final decision
on assignment of volunteers Affiliate
3. Provide supervision of volunteers on assignments.
4. Instruct RSVP volunteers in proper use of monthly reports, reimbursement guidance, Chapter:
and program procedures.
2

East Valley RSVP 3
Affiliate Agreement with Maricopa County Head Start
5. Accept volunteers to the extent that East Valley RSVP volunteers agree to be matched
to this assignment.
6. Investigate and report any accidents and injuries involving RSVP volunteers
immediately to the RSVP office. All reports will be submitted in writing.
C. Other provisions:
1. Separation from Volunteer Service: The Volunteer Stations may request the removal
of an RSVP volunteer at any time. The RSVP volunteer may withdraw from service at
the Volunteer Stations or from RSVP at any time. Discussion of individual separations
will occur among RSVP staff, Volunteer Stations staff, and the volunteer to clarify the
reasons, resolve conflicts, or take remedial action, including placement with another
Volunteer Stations.
2. Prohibited Activities: The Volunteer Stations will not request or assign RSVP
volunteers to conduct or engage in religious, sectarian, or political activities.
Participating in a voter registration drive is a prohibited activity for all AmeriCorps
members and Senior Corps volunteers.
3. Displacement of Employees: The Volunteer Station will not assign RSVP volunteers to
any assignment which would displace employed workers or impair existing contracts
for services.
4. Accessibility and Reasonable Accommodation: The Volunteer Station will maintain the
programs and activities to which RSVP volunteers are assigned accessible to persons
with disabilities (including mobility, hearing, vision, mental, and cognitive impairments
or addictions and diseases) and/or limited English language proficiency and provide
reasonable accommodation to allow persons with disabilities to participate in programs
and activities.
5. Prohibition of Discrimination: The Volunteer Stations will not discriminate against
RSVP volunteers or in the operation of its program on the basis of race; color; national
origin, including limited English proficiency; sex; age; political affiliation; sexual
orientation; religion; or on the basis of disability, if the volunteer is a qualified
individual with a disability.
6. Indemnification. Each party (as ‘Indemnitor’) agrees to defend, indemnify, and hold
harmless the other party (as ‘Indemnitee’) from and against any and all claims, losses,
liability, costs, or expenses (including reasonable attorney’s fees) (hereinafter
Agreement
collectively referred to as “Claims”) arising out of bodily injury of any person
(including death) or property damage, but only to the extent that such negligence,
misconduct, or other fault of the Indemnitor, its officers, officials, agents, employees
or volunteers. Affiliate
7. Conflict of Interest. Participation in this Agreement is subject to Section 38-511 of the
Arizona Revised Statutes which provides that this Agreement may be cancelled if any
Chapter:
person significantly involved in initiating, negotiating, securing, drafting or creating this
Agreement on behalf of the County is, at any time while this Agreement, or any
3

East Valley RSVP 4
Affiliate Agreement with Maricopa County Head Start
extension thereof, is in effect, an employee or agent of the other party to this
Agreement in any capacity or a consultant to any other party with respect to the
subject matter of this Agreement.
8. Notice of Arbitration Statutes. Pursuant to Arizona Revised Statutes Section 12-1518,
the parties acknowledge and agree that they will be required to make use of mandatory
arbitration of any legal action that is filed in the Arizona superior court concerning a
controversy arising out of this Agreement if required by Section 12-133 of the Arizona
Revised Statutes.
9. Specify, either by written information or verbally, that RSVP volunteers are
participants in the Volunteer Station’s program in all publicity featuring such
volunteers, whether it be radio, TV, print or verbal presentation. Display an RSVP
placard where it may be viewed by the public.
10. Conditions of this Affiliate Agreement may be amended or terminated in writing at any
time at the request of either party. It will be reviewed annually to permit needed
changes.
11. This Affiliate Agreement contains all the terms and conditions agreed upon by the
agreeing parties.
12. This Affiliate Agreement will be in effect upon dated signature of the Volunteer
Station’s Representative and the RSVP Project Director.
The Volunteer Station’s representative who will serve as liaison with RSVP and who will be
responsible for volunteer orientation and supervision is:
Ms. Sylvia Gradillas Family and Community Volunteer
Assistant
(480)464-9669 X221 gradillass@mail.maricopa.gov
The East Valley RSVP staff member who will serve as liaison with the Volunteer Station is:
Mr. Gene van den Bosch RSVP Project Director
480-775-1466 x 3512 gvandenbosch@evadultresources.org
Agreement
Affiliate
Chapter:
4

East Valley RSVP 5
Affiliate Agreement with Maricopa County Head Start
This Agreement contains all the terms and conditions agreed to by the Parties. No other understanding,
oral or otherwise, regarding the subject matter of this Agreement shall be deemed to exist or to bind any
Party hereto. Nothing in this Agreement shall be construed as consent to any lawsuit or waiver of any
defense in a lawsuit brought against the State of Arizona, County, or the District in any State or federal
court.
IN WITNESS THEREOF, the Parties have signed this Agreement:
Approved by:
_____________________________________________ ____________________________________________
Maricopa County East Valley RSVP
_____________________________________________ _____________________________________________
Signature Signature
Gene van den Bosch
___________________________________________ _____________________________________________
Printed Name Printed Name
Chairman, Board of Supervisors Project Director, East Valley RSVP
Title Title
Date: _______________________________________ Date: ______________________________________
Attested to:
______________________________________
Clerk, Board of Supervisors
______________________________________
DATE
IN ACCORDANCE WITH A.R.S. §§ 11-201 AND 11-251. THIS AGREEMENT HAS BEEN REVIEWED BY
THE UNDERSIGNED DEPUTY COUNTY ATTORNEY WHO HAS DETERMINED THAT THIS AGREEMENT
IS PROPER IN FORM AND WITHIN THE POWER AND AUTHORITY GRANTED UNDER THE LAWS OF
THE STATE OF ARIZONA.
APPROVED AS TO FORM:
Deputy County Attorney
Agreement
_______________________________
DATE
Affiliate
Definitions
 RSVP: RSVP is a Senior Corps program and one of the largest volunteer networks in Chapter:
the nation for people 55 and over.
5

East Valley RSVP 6
Affiliate Agreement with Maricopa County Head Start
 RSVP Volunteer: an individual, age 55 and over, who serves with either a non-profit
organization or public agency, and whose talents and skills to perform service address
various local community needs. This individual is subject to the RSVP legislation,
codified at 42 U.S.C. § 5001, and the RSVP implementing regulations at 45 CFR Part
2553.
 Senior Corps: A set of CNCS programs connecting people age 55 and older with the
people and organizations that need them most. Programs within Senior Corps allow
these individuals to volunteer to become mentors, coaches or companions to people in
need, or contribute their job skills and expertise to community projects and
organizations. Senior Corps was created pursuant to and is governed by 42 U.S.C. §§
5000 et seq.
 Volunteer Coordinator: A staff member of the volunteer site who will provide logistical
support and oversight of the RSVP volunteer.
 Volunteer Insurance: Free supplementary insurance provided to each and every East
Valley RSVP through THE CIMA COMPANIES, INC as described in Addendum F.
 Volunteer Station: An organization receiving RSVP and other Senior Corps volunteer
positions from a Senior Corps grantee of CNCS.
 Volunteer Location: Name and physical address of location for RSVP volunteer service
if such a name or address is different from that of the Volunteer Station.
Agreement
Affiliate
Chapter:
6

East Valley RSVP 7
Affiliate Agreement with Maricopa County Head Start
Addendum A
The total number of RSVP volunteer assignments projected to be available with the
Volunteer Station on an annual basis is:
Number of RSVP Volunteers
The average number of people served by this station is estimated or projected to be:
Per Day Per Week Per Month / Year
The average number of people served by each RSVP Volunteer at this station is estimated or
projected to be:
Per Hour Or Per Week Or Per Month / Year
A
Addendum
Chapter:
7

East Valley RSVP 8
Affiliate Agreement with Maricopa County Head Start
Addendum B - Program Accessibility
Note: If the answer to the question below is yes, there is no need to complete the
Accessibility Checklist on Addendum B.
Please use this form to provide us with your program accessibility assurance.
Section 504 of the Rehabilitation Act3 prohibits recipients of Federal financial assistance
from discriminating against a qualified person with disabilities in any of their programs or
activities. In general, no qualified individual with disabilities shall, on the basis of disability,
be denied the benefits of, be excluded from participation in, or otherwise be subjected to
discrimination under any program or activity conducted by a Corporation for National Service
(i.e. Senior Corps and RSVP) grantee or sub-grantee.
Volunteer Station and Address: Maricopa County Head Start
2150 S. Country Club Drive, Ste. 7
Mesa, AZ 85210-6878
Volunteer Location Address: Maricopa County Head Start
2150 S. Country Club Drive, Ste. 7
Mesa, AZ 85210-6878
Ms. Sylvia Gradillas, Family and
Volunteer Station Contact Person: Community Volunteer Assistant
Our organization certifies it has completed paperwork with the Federal government for
compliance with Section 504 of the Rehabilitation Act.
YES (completes this process and you may skip to Addendum C for this MOU).
No (complete the One-Time Senior Corps Accessibility Checklist on Addendum B and
the Annual Safety Checklist on Addendum C for each location or facility at which the
RSVP volunteer will be serving). Accessibility
I certify the above to be true.
Program
-
B
Signature Name Typed / Printed Title Date
Note: It is not required that your facility be accessible to, or usable by RSVP volunteers who are disabled. Nor can East Valley RSVP take Addendum
any action that could result in a fundamental alteration in the nature of the program, project, or activity – or result in any undue financial or
administrative burdens.
Chapter:
3 http://www.hhs.gov/ocr/civilrights/resources/factsheets/504.pdf
8

East Valley RSVP 9
Affiliate Agreement with Maricopa County Head Start
Addendum C: Senior Corps Accessibility Checklist
Volunteer Station and Address: Maricopa County Head Start
2150 S. Country Club Drive, Ste. 7
Mesa, AZ 85210-6878
Volunteer Location Address: Maricopa County Head Start
2150 S. Country Club Drive, Ste. 7
Mesa, AZ 85210-6878
Ms. Sylvia Gradillas, Family and
Volunteer Station Contact Person: Community Volunteer Assistant
Parking
Y N N/A
X Adequate number of accessible parking spaces available closest to the
nearest entrance? (One accessible space per 25 non-accessible spaces?)
X Are accessible parking spaces marked?
X Is there a level approach to the building from the parking lot area or
street?
X Is the parking lot well lit at night?
X Are snow and ice adequately removed from parking areas during winter
months?
Entrance and Hallways
Y N N/A
X Is there a ramp or level entrance to a main door? Accessibility
X Are ramps non-slip and equipped with handrails?
Program
X Are there directional signs clearly directing persons to ramps / accessible
entrances? -
B
X Are Braille signs provided at appropriate places?
Addendum
X Are fountains / /bulletin boards, etc. accessible to persons in
wheel chairs?
Chapter:
X Do open stairways have means of warning for sight impaired individuals?
9

East Valley RSVP 10
Affiliate Agreement with Maricopa County Head Start
X Are there ramps or elevators to all levels?
Doors
Y N N/A
X Are exterior and interior doors easy to open without much force?
X Vertical door handles or horizontal door bars can be opened with a closed
fist?
Restrooms
Y N N/A
X Do restrooms (especially toilet areas) have handrails?
X Are toilet stalls large enough to accommodate a wheelchair?
X Are the sinks, soap, towels, hand-drier, and mirrors wheelchair accessible?
X Are faucet controls operable with a closed fist?
X Are restrooms accessible from main building areas?
Main Building Areas and Offices
Y N N/A
X Can rooms accommodate wheelchairs (spaces between desks, chairs, and
tables are wide enough)?
X In auditoriums/meeting rooms, are several places provided for wheelchairs?
X Is there adequate lighting on speakers face to facilitate speech/lip reading?
Accessibility
X Are guide dogs permitted in the building?
X Is there a temperature controlled heating and cooling system? Program
Staff Knowledge -
B
Y N N/A
X Staff recognize the importance of making people with disabilities feel
Addendum
welcome.
X Staff provided basic awareness training to meet the needs of those with
disabilities. Chapter:
10

East Valley RSVP 11
Affiliate Agreement with Maricopa County Head Start
X Staff understand requirements re: reasonable accommodations to
volunteers with disabilities unless an accommodation would cause undue
hardship.
Y N N/A
X Staff recognize people with disabilities have the same rights as anyone to
access Program and become volunteers.
X Services / Programs are as integrated as possible (meaning that volunteers
with Disabilities serve alongside volunteers who do not have disabilities).
X Emergency evacuation procedures are in place for persons with disabilities,
Including those with mobility impairments.
X Staff are knowledgeable of procurement for equipment for those with
hearing disabilities such as TT/TTY/TTD.
X Staff understand that documented permission must be granted prior to
discussing someone’s disability with another person and only as needed.
X Private space is available for discussion of disability related issues.
X Discussions about a disability are made in private, in person or by phone.
X Policies and procedures are in place, known to all, and in dissemination to
ensure staff do not disclose information about a person’s disability to others
without permission.
X Organization/Center/Agency has documented procedures and guidelines to Accessibility
handle requests for reasonable accommodation requests.
X Organization/Center/Agency posts procedures for requesting reasonable
Program
accommodations/modifications.
-
B
Recruitment and Orientation
Y N N/A
X Persons are offered assistance completing forms if needed. Addendum
X Persons are asked if they need assistance or accommodations to
participate. Chapter:
X Information is provided slowly and clearly with reasonable time for
11

East Valley RSVP 12
Affiliate Agreement with Maricopa County Head Start
questions or answers.
X The disability status (when known) of all volunteers is stored in a way that
ensures confidentiality.
Last Question
Y N N/A
X The station representative is willing and able to make accommodations for
a volunteer with a disability so that the volunteer may participate in station
programming?
Comments
I certify the above to be true.
Sylvia Gradillas Family and Community
Volunteer Assistant 2/18/2015
Signature Name Typed / Printed Title Date Accessibility
Program
-
B
Signature Name Typed / Printed Title Date
Addendum
Chapter:
12

East Valley RSVP 13
Affiliate Agreement with Maricopa County Head Start
Addendum D: Senior Corps Safety Checklist (Annual)
Volunteer Station and Address: Maricopa County Head Start
2150 S. Country Club Drive, Ste. 7
Mesa, AZ 85210-6878
Volunteer Location Address: Maricopa County Head Start
2150 S. Country Club Drive, Ste. 7
Mesa, AZ 85210-6878
Ms. Sylvia Gradillas, Family and Community
Volunteer Station Contact Person: Volunteer Assistant
Parking
Y N N/A
Does the workplace appear clean and tidy?
Is there enough light for people to do each task safely and without eye glare?
Is there enough fresh air and ventilation to ensure good air quality?
Is there proper storage for equipment?
Is the volunteer site kept at a comfortable working temperature?
Are toilets, rest and eating areas of a good standard?
Are walkways and stairways clear and safe?
Is it easy to get in and out of the buildings and worksites safely?
Are there visible lighted exit signs?
Accessibility
Are there procedures to cover emergencies and accidents?
Are noise levels appropriate to complete volunteer tasks comfortably? Program
Are there alarms to indicate when an evacuation is needed? -
B
Are trainings available to volunteers about proper usage of equipment to prevent
injury? Addendum
I certify the above to be true.
Chapter:
Signature Name Typed / Printed Title Date
13

East Valley RSVP 14
Affiliate Agreement with Maricopa County Head Start
Addendum E: East Valley RSVP Volunteer Station’s Volunteer Service Description
Volunteer Station Name: Maricopa County Head Start
Station Mission:
Family and
Community
Volunteer Position Title: Volunteer Reports to:
Volunteer
Assistant
Location where volunteers will
2150 S. Country Club Drive, Ste. 7
serve (Name & Address):
City: Mesa State: AZ Zip: 85210-6878 County: Maricopa
Business Phone: (480) 464-9669 X221 Fax: (480) 655-1154
Description
Ms. Sylvia Gradillas
Volunteer Supervisor’s Name: Email: gradillass@mail.maricopa.gov
# of Volunteers Requested:
Service
List responsibilities of position:
List skills
Maintain confidentiality and security (see attached) Volunteer
required:
Days and times volunteers needed: Approx. 8 hours per week
Minimium/Maximum time requirements (if applicable): N/A
Station’s
Do you conduct background checks for this position? X Yes No
If so, do you pay for the screening or does the volunteer? X Volunteer Station Pays Volunteer Pays
Do you provide training for volunteers in this position? X Yes No Volunteer
If yes, what
kind of training Volunteer handbook (policies, rules, benefits), 30 hours of training
is available:
RSVP
Who benefits as a result of the RSVP volunteer’s service
Classroom of 3-5 year old children.
in this position (i.e. demographic served)?
How do you measure the impact of this position’s efforts Valley
on the community/clients?
Which Focus Area does this position fit in? East
Healthy Futures: Food Security; Companionship; Abuse Prevention; Other Services to Prolong
Independent Living | X Education: X School Readiness (Head Start); K-12 Tutoring/School Engagement E:
Veterans and/or Military Families | Disaster Preparedness / Prevention
Capacity Building for nonprofit organization or government agency | Other Community Priorities: Describe:
Addendum
Partner Agency Volunteer Coordinator / Manager Signature: Date:
Partner Agency Program Manager / Director Signature: Date:
2/25/2015
Chapter:
H:VOLUNTEER Applications, Forms, Manuals, Referrals\RSVP Volunteer Position Description (MOU Addendum D).docx | Last Updated: 2/4/2015
14

East Valley RSVP 15
Affiliate Agreement with Maricopa County Head Start
Addendum F: Free Supplementary Insurance for all East Valley RSVP Volunteers as Provided by THE CIMA COMPANIES,
INC. (page 1 of 2)
Chapter:
15

East Valley RSVP 16
Affiliate Agreement with Maricopa County Head Start
Addendum F: Free Supplementary Insurance for all East Valley RSVP Volunteers as Provided by THE CIMA COMPANIES,
INC. (page 2 of 2)
Chapter:
16

East Valley RSVP 17
Affiliate Agreement with Maricopa County Head Start
Letter of Agreement – Addendum G
Between
“RSVP” “Volunteer Station”
East Valley RSVP Maricopa County Head Start
and
East Valley Adult Resources, Inc. 2150 S. Country Club Drive
45 W. University Drive, Unit B Ste. 7
Mesa, Arizona 85201-5831 Mesa, AZ 85210-6878
This addendum is to our Letter of Agreement (LOA) for the period:
4/1/2015 and 3/31/2018
With my signature below I certify that our Volunteer Station is a:
Non-profit Organization
X Private Non-Profit
Proprietary Healthcare Organization
Public Agency or Tribal Government
… and thus eligible to serve as a RSVP Volunteer Station.
Date
Print / Type Name and Title:
Date
Chapter:
17

East Valley RSVP 18
Affiliate Agreement with Maricopa County Head Start
MARICOPA COUNTY
VOLUNTEER ACKNOWLEDGMENT FORM
By signing this form I, __________________________________________, acknowledge the following:
1. The Maricopa County Volunteer Program (the “Program”) is approximately ______ weeks, for a minimum of
____ hours per week (not to exceed ____ hours per week), beginning __________, 20__ and concluding
__________, 20___.
2. I understand that I may be working with individuals from diverse backgrounds and I will treat all individuals
with the utmost respect.
3. I understand that I may be exposed to confidential information while participating in the Program and I agree
to respect the confidential nature of all information whether in hardcopy or electronic form which may be
revealed in me in any manner. I also agree not to remove such information via copies or by other recording
means from the County work locations.
4. I acknowledge that any information that I encounter as a result of my participation in this program may be
confidential or sensitive and therefore may not be posted to social media, blogs, or otherwise shared publicly
without written consent from the department director or appointing authority.
5. If I fail to comply with any rules, regulations, policies, or procedures of the County, such failure may result in
disciplinary action, up to and including dismissal from the Program.
6. Transportation to and from the Volunteer Station is my sole responsibility, and shall not be the responsibility of
the County.
7. I am responsible for maintain my own health insurance throughout the entire term of my participation in the
Program.
8. I am not an employee of the County and therefore I will not be entitled to any benefits normally associated with
employment with the County, such as, but not limited to, wellness programs, paid leave accrual, commuter
benefits, and health, behavioral health, pharmacy, vision, dental, life, and short term disability insurance
program. Also I will not be entitled to enroll in the Arizona State Retirement System or the County’s deferred
compensation retirement plan as a result of my participation in the Program.
9. I am not entitled to any wages from the County and I will not be eligible for unemployment compensation
benefits when my volunteering term ends, even if the County terminates my services.
10. My participation in the Program is at will, terminable at any time, and participation in or completion of the
Program does not entitle me to a job with the County or any of the protections afforded by A.R.S. § 11-351 et
seq. (Arizona laws governing county employee merit systems) or the Maricopa County Employee Merit System.
Signature:_________________________________________ Date:__________________
Print Name: ____________________________________ Chapter:
18