The Community Development Ministerial Body

THE COMMUNITY DEVELOPMENT MINISTERIAL BODY

and

SERVICE PROVIDER

for the

SERVICE

SERVICE AGREEMENT

THIS SERVICE AGREEMENT is made the day of 20

BETWEEN

THE PERSON DESCRIBED IN ITEM 1 OF SCHEDULE 1 ("Principal")

and

THE PERSON DESCRIBED IN ITEM 3 OF SCHEDULE 1 ("Service Provider")

Operative provisions

1The parties hereto hereby enter into the Service Agreement.

2The Service Agreement comprises the provisions and stipulations set out in:

(a)this document;

(b)the Indexation version of the General Provisions for the Purchase of Community Services by Government Agencies;

(c)the service proposal as described in the Service Provider’s Preferred Service Provider or Request for Proposal Application; and

(d)the 6 schedules to the documents referred to in clause 2(b) above and which schedules are annexed to this document.

3The Service Provider hereby acknowledges having received a full copy of the applicable document referred to in clause 2(b) above.

Executed by the parties hereto:

SIGNED for and on behalf of the

COMMUNITY DEVELOPMENT MINISTERIAL BODY

by the Executive Director Service Standards and Contracting ______

of the Department for Child Protection Signed

duly authorised, in the presence of:

______

(Witness)

THE COMMON SEAL of the Service Provider

was hereunto affixed in accordance with its Constitution in the presence of

______

FULL NAME OF OFFICE BEARERSIGNATURE OF OFFICE BEARER

POSITION OF OFFICE BEARER

______

FULL NAME OF OFFICE BEARERSIGNATURE OF OFFICE BEARER

POSITION OF OFFICE BEARER

SCHEDULE 1

GENERAL INFORMATION ABOUT THE SERVICE PROVIDER

Principal: THE COMMUNITY DEVELOPMENT MINISTERIAL BODY

Principal’s Service Agreement Manager

Name:

Position:

Office:

Service Provider

Organisation Name: SERVICE PROVIDER

Service Name: SERVICE

ABN:

Registered for GST:

Service Provider's Service Agreement Manager

Name:

Position:

Insurances

[NOTE: Where it applies, the following represents the minimum insurance requirements in relation to the provision of the Service. The Service Provider should not rely solely on these minimum requirements when determining the overall insurance requirements for the Service Provider organisation. A risk assessment should also be undertaken to determine the appropriate type and level of insurance that will be required under the Service Agreement. Reference should also be made to the Waiver of Insurances process administered by the State Supply Commission and outlined in a Buyer Alert dated April 2004.]

(a)Workers Compensation

Workers’ Compensation insurance in accordance with the provisions of the Workers’ Compensation and Injury Management Act 1981 (WA), including cover for common law liability for an amount of not less than $50 million for any one occurrence in respect of workers of the Service Provider. The insurance policy must be extended to indemnify the Principal for claims and liability under section 175 of the Workers’ Compensation and Injury Management Act 1981 (WA).

(b)Public Liability

A public and products liability insurance policy covering the legal liability of the Service Provider, its employees and volunteer workers arising out of the Services provided in connection with the Service Agreement for an amount of not less than $5 million for any one occurrence, unlimited in the aggregate except for products liability limited in the aggregate to the sum insured.

(c)Professional Indemnity (Applicable/Not Applicable)

A professional indemnity insurance policy for any breach of duty owed in a professional capacity by the Service Provider or any volunteer worker engaged by or on behalf of the Service Provider in respect of the Services provided in connection with the Service Agreement. The insurance policy must be for an amount of not less than $1 million for any one claim with a provision of one automatic reinstatement of the full sum insured in any one period of insurance and must be extended to include claims made under the Trade Practices Act 1974 or the Fair Trading Act 1987. The insurance policy must be maintained for at least 6 years after termination of this Service Agreement.

(d)Personal Accident Insurance for Volunteers

A personal accident policy covering volunteers while undertaking voluntary duties for the Service Provider. The coverage is to provide a capital sum of not less than $50,000 per person for death or permanent total disablement and weekly compensation entitlements for employed and self employed volunteers of an amount up to 1% of the capital sum, but not exceeding in any case the normal weekly remuneration of the volunteer.

(e)Motor Vehicle Liability

A motor vehicle third party insurance policy covering legal liability against property damage and bodily injury to or death of persons caused by motor vehicles used in connection with the Services provided in the Service Agreement for an amount of not less than $10 million for any one occurrence, unlimited in the aggregate.

[NOTE: A comprehensive Motor Vehicle Insurance policy will include Motor Vehicle Third Party Liability Insurance.]

(f)Compulsory Motor Vehicle Liability

Compulsory third party insurance as required under any statute relating to motor vehicles used in connection with the Services provided in the Service Agreement.

[NOTE: Any motor vehicle that is appropriately licensed and registered by the Western Australian Department of Planning and Infrastructure will automatically have Compulsory Third Party Liability Insurance in force upon registration.]

Term: –

Financial Period: –

Address for Notices

(a)Principal

Postal Address:

Facsimile:

Email:

(b)Service Provider

Postal Address:

Facsimile:

Email:

SCHEDULE 2

SCHEDULE 3

QUALITY STANDARDS

1.The Service Provider must meet the requirements and standards set out in Schedule 2 - Service Specifications.

2.Where email, the Internet and other web-based services are accessed the Service Provider shall ensure:

(a)That all usage is monitored.

(b)That procedures are developed and implemented to manage the legal, ethical and responsible use of these and other on-line services.

(c)The procedures include a code of conduct which clearly articulate:

-the permitted use of such on-line services, and

-the monitoring and audit compliance processes to be used by the Service Provider.

(d)The Principal is provided access to these procedures on request.

A breach of these procedures constitutes a Serious Incident, refer General Provisions – Indexation Version, clauses 3.7(b) and 3.8.

3.In relation to the Services described in Schedule 2 of this Service Agreement, and in accordance with Section 21(d) Functions of Chief Executive Officer, Children and Community Services Act 2004, to establish procedures for dealing with complaints about social services, a Service Provider shall establish and implement procedures to deal with client grievances and/or complaints (complaints). The Service Provider shall ensure that complaints are resolved in a fair, prompt and accountable manner, which ensures natural justice and is free of charge.

Complaints procedures include making clients aware of the complaints process and ensuring it is easily accessible to clients. The complaints process also includes recording the details, actions and outcomes of complaints lodged. All information gathered must be treated and maintained in a confidential manner.

The complainant also needs to be made aware that if the complaint cannot be resolved with the service provider the matter can be referred to the Principal (funder) for further consideration. If appropriate the Principal will work with the service provider and the complainant to resolve the matter.

The Principal is to be provided access to these procedures on request.

SCHEDULE 4

PAYMENT SCHEDULE

1.The Service Payment is the maximum annual amount of funding that the Principal will contribute towards the cost of the funded service during the Term of this Service Agreement. The Service Payment includes an Annual Funding Level payment of plus provision for indexation as appropriate under the Service Agreement, an amount to cover any liability for GST and other such allowances as applicable.

2.Payments will be made quarterly on the first days of July, October, January, and April in each year subject to the provision/receipt of reports set out in, and in accordance with, the terms set out in Schedules 5 and 6.

3.The first payment for a new service will reflect commencement of the Term and the proportion of quarter payment in the quarter it is paid.

4.Pursuant to clause 2.2(b) of the General Provisions for the Purchase of Community Services by Government Agencies, the Service Provider must not without the prior written approval of the Principal use or expend the Service Payment or any part thereof upon:

.Costs relating to any industrial or legal action.

.Payment of pre-existing debts not relevant to the provision of the Service.

5.Capital costs and capital equipment are non-recurrent or significant long-term outlays incurred by the Service Provider. Expenditure in these areas should be clearly identified in all financial statements as a capital cost or acquisition of assets if it satisfies all of the following tests:

(i)The total cost of each item is over $1,000.

(ii)The equipment has a useful economic life of 2 years or more.

(iii)The equipment would reasonably expect to have a resale value.

6.Expenditure in relation to Depreciation should be clearly identified in all financial statements. Australian Accounting Standards AAS4 would apply in reporting on Depreciation.

7.Pursuant to clauses 9.2 and 9.3 of the General Provisions for the Purchase of Community Services by Government Agencies, the Principal may withhold payment of the Service Payment in an Event of Default and may recommence payment in the Principal's discretion when the Principal is satisfied that the Service Provider has rectified the Event of Default.

SCHEDULE 5

FINANCIAL OBLIGATIONS AND REPORTS

Financial Accountability Requirements

In order for the Principal to monitor and review purchased activities, a range of accountability mechanisms are required to ascertain how an organisation is functioning. This schedule outlines the financial accountability requirements that are required of the Service Provider.

Please note that the less onerous reporting requirements for services with an Annual Funding Level (AFL) up to and including $35,000 has been granted by the Principal. This exemption may be reviewed by the Principal as required.

Financial Reporting Requirement / AFL
Up to and including $35,000 pa / AFL
Greater than $35,000 pa
A.Statement of Receipts and Payments for each purchased service Form 5 (a)
-12 months ended 30 June – Due date 31 October (xx) / Yes / Yes
B.(*) The 12 month funded service reports ended 30 June must be accompanied by:

Statement of Financial Position (Balance Sheet) – Form 5(b) (required for the whole of organisation)

/ No / Yes

Statement of Financial Performance – Form 5(c)

(required for the whole of organisation ) / No / Yes

Management Board Certification Statement – Form 5(d) part 1 (only one Certification to cover all funded services)

/ Yes / Yes

Auditor’s Certification Statement – Form 5(d) part 2

(only one Certification to cover all funded services) / No / Yes

Notes to Financial Statements (whole of organisation)

/ No / Yes

Management Board Certification Statement – Form 5(e) part 1 (required for the whole of organisation)

/ No / Yes

Auditor’s Certification – Form 5(e) part 2 for recommended content (required for the whole of organisation)

/ No / Yes

Note:* Information relating to the whole of organisation may be provided by submitting one copy of the Organisation’s published Annual Report.

Local Government Authorities (LGAs)

For LGAs the due date for submission of the above financial reporting requirements is 31 January.

In addition, an Unaudited Form 5(a) Statement of Receipts and Payments for each purchased Service for the 12 months ended 30 June, is required by 31 October. (This is NOT required to be audited, nor certified by the Management Board). However, the form should be signed by a LGA management representative.

LGAs need only submit extract copies of the Annual Report pages that meet the requirements of Forms 5(b), 5(c) and 5(e) part 1 & 2 for the whole of organisation.

The following pages contain sample statements provided as guidelines for the preparation and submission of financial statements. The categories shown are minimum requirements for completion. The financial reporting statements and certificates should be forwarded to:

Contract Officer

Non-Government Policy and Funding

Department for Child Protection

PO Box 6334

EAST PERTH WA 6892

Form 5(a)

STANDARD FORM

STATEMENT OF RECEIPTS AND PAYMENTS

Please provide a separate statement for each service purchased by the Principal

For 12 months ending 30 June, 20__

SERVICE PROVIDER

SERVICE

This Reporting Period / Same Period Last Year
Ended: / /20.. / Ended: / /20..
OPENING BALANCE
RECEIPTS / $______ / $______
RECEIPTS FROM THE PRINCIPAL
(1) ______/ $ / $
(2) ______/ $ / $
(3) ______/ $ / $
(4) ______/ $ / $
TOTAL RECEIPTS FROM THE PRINCIPAL / $ / $
Fees and Charges / $ / $
Other (for example, fundraising and donations, interest received) / $ / $
TOTAL RECEIPTS / $ / $
PAYMENTS
Salaries and Related Costs / $ / $
Administration Costs / $ / $
Operational Costs / $ / $
Motor Vehicle Costs / $ / $
Depreciation Costs (refer to Schedule 4 point 6) / $ / $
Interstate Travel Costs / $ / $
Overseas Travel Costs / $ / $
Capital Costs (refer to Schedule 4 point 5) / $ / $
Repairs and Maintenance Costs / $ / $
Other / $ / $
$ / $
TOTAL PAYMENTS / $ / $
CLOSING BALANCE / $ / $

Notes:

No expenditure or provision for expenditure may contravene “prohibited purposes” (refer schedule 4, item 4)
Organisations using accounting software such as MYOB may be permitted to substitute the equivalent report produced by the software, provided that it includes all requisite information. Before proceeding, please check with the Principal to ensure that this is accepted.

Form 5(b)

STANDARD FORM - ANNUAL AUDITED STATEMENT

The audited Statement of Financial Position for the organisation should include, as a minimum, the following disclosures (as applicable)

STATEMENT OF FINANCIAL POSITION

for whole of organisation

for year ending 30 June, 20__

This Year / Last Year
Ended: / /20.. / Ended: / /20..
ASSETS
CURRENT
Cash Assets / $ / $
Investments (Short Term) / $ / $
Receivables / $ / $
Inventories / $ / $
Other / $ / $
Total Current Assets / $ / $
NON-CURRENT
Land / $ / $
Buildings / $ / $
Motor Vehicles / $ / $
Plant and Equipment / $ / $
Investments (Long Term) / $ / $
Total Non-Current Assets / $ / $
TOTAL ASSETS / $ / $
LIABILITIES
CURRENT
Grants Received in Advance / $ / $
Interest Bearing Liabilities / $ / $
Payables / $ / $
Provisions- Employee Entitlements / $ / $
- Other / $ / $
Other / $ / $
Total Current Liabilities / $ / $
NON-CURRENT
Interest Bearing Liabilities / $ / $
Other (including non-current payables and provisions) / $ / $
Total Non-Current Liabilities / $ / $
TOTAL LIABILITIES / $ / $
NET ASSETS / $ / $
EQUITY
Accumulated Surplus (Deficiency) as at 30 June, 20__ / $ / $
Reserves / $ / $
$ / $
TOTAL EQUITY / $ / $

Form 5(c)

STANDARD FORM - ANNUAL AUDITED STATEMENT

The audited Statement of Financial Performance for the organisation should include as a minimum the following disclosures (as applicable).

STATEMENT OF FINANCIAL PERFORMANCE

for whole of organisation

for year ending 30 June, 20__

This Year / Last Year
Ended: / /20.. / Ended: / /20..
REVENUE
RECEIPTS FROM THE PRINCIPAL
(1) ______/ $ / $
(2) ______/ $ / $
(3) ______/ $ / $
(4) ______/ $ / $
TOTAL RECEIPTS / $ / $
Fundraising and Donations / $ / $
Fees and Charges / $ / $
Interest Revenue / $ / $
Other revenue from ordinary activities / $ / $
TOTAL REVENUE FROM ORDINARY ACTIVITIES / $ / $
EXPENSES
Employee Expenses / $ / $
Administration Expenses / $ / $
Operational Expenses / $ / $
Motor Vehicle Expenses / $ / $
Depreciation Costs (refer to Schedule 4 point 6) / $ / $
Repairs and Maintenance Expenses / $ / $
Accruals and Leave Entitlements / $ / $
TOTAL EXPENSES FROM ORDINARY ACTIVITIES / $ / $
SURPLUS/(DEFICIENCY) / $ / $

Form 5(d) part1

STANDARD FORM

ANNUAL MANAGEMENT BOARD CERTIFICATION OF

STATEMENT OF RECEIPTS AND PAYMENTS

(to accompany Form 5(a) report as at 30 June)

For Year Ending 30 June 20__

I hereby certify to the best of my/our knowledge, information and beliefthat:

the information reported in the accompanying Statement/s of Receipts and Payments for the following services/s

……………………………………………………………………………………..

has been prepared from proper accounts to present fairly the financial transactions for the period 1 July 20__ to 30 June 20__ and the payments in the Statement are in accordance with the terms and conditions of the Service Agreement with THE COMMUNITY DEVELOPMENT MINISTERIAL BODY; and

the Management Board and the Service Provider have complied with the obligations imposed by the Constitution of the Service Provider and the terms and conditions of the Service Agreement.

Office Bearer Signature:
Office Bearer Name:
Office Bearer Position:
Organisation Name:
Date:

Form 5(d) part2

STANDARD FORM

AUDITOR’S CERTIFICATION OF

STATEMENT OF RECEIPTS AND PAYMENTS

(to accompany Form 5(a) report as at 30 June 20__

for services where AFL is greater than $35,000)

The Auditor, who must be a member of CPA Australia, the Institute of Chartered Accountants in Australia or the National Institute of Accountants, may determine the wording of this certification as required. The following is a suggestion for general content.

I hereby certify that, in my opinion, the information reported in the attached Statement/s of Receipts and Payments forthe following service/s:

……………………………………………………………………………………..

is based on proper accounts and presents fairly the financial transactions for the period 1July 20__ to 30 June 20__, and the payments in the Statement are in accordance with the terms and conditions of the Service Agreement with THE COMMUNITY DEVELOPMENT MINISTERIAL BODY.

AUDITOR

Signature:
Full Name:
Name of Organisation (if applicable)
Membership: / (CPA/ICA/NIA)
Date:

Form 5(e) part1

STANDARD FORM

ANNUAL MANAGEMENT BOARD CERTIFICATION STATEMENTS (WHOLE ORGANISATION)

For Year Ending 30 June 20__

Management Board Certification

I/We hereby certify to the best of my/our knowledge, information and beliefthat:

the accompanying financial statements of SERVICE PROVIDER comprising the Statement of Financial Performance, Statement of Financial Position, Statement of Cash Flows and the Notes to the Financial Statements for the period 1 July 20__ to 30 June 20__ have been prepared in accordance with Accounting Standards and other mandatory professional reporting requirements in Australia, from proper accounts to present fairly the financial transactions for the period 1July 20__ to 30 June 20__ and the financial position; and

the Management Board and the Service Provider have complied with the obligations imposed by the Constitution of the Service Provider and the terms and conditions of the Service Agreement.

Office Bearer Signature:
Office Bearer Name:
Office Bearer Position:
Organisation Name:
Date:

Form 5(e) part2