Service Agreement (Part C) (V1 Inputs)– Specifications for Disability Services

Disability Services Act 2006

Director-General for the Department of Communities

Name of Funded Organisation		
ABN		
Funded Organisation number		

Date of Commencement of Service Agreement:	[INSERT DATE]
Date of Expiration of Service Agreement:		[INSERT DATE]

1	Formation of Service Agreement
1.1	Parts of the Service Agreement 
The following documents form the Service Agreement:
(i)	
(i)	The Service Agreement (Part A) - Standard Terms of Funding http://www.communityservices.qld.gov.au/department/funding/resources/documents/service-agreement-part-a-v1.pdf , current as at 09 April 2010;                       
(ii)	the Service Agreement (Part B) - Specific Terms of Funding http://www.communityservices.qld.gov.au/department/funding/resources/documents/service-agreement-part-b-disability-v1.pdf current as at 09 April 2010 that specify those terms and conditions specific to the Disability Services Act 2006; 
(i)	
(iii)	this part referred to as the Service Agreement (Part C) - Specifications; and
(iv)	any other document agreed in writing by the parties varying or extending the Service Agreement.
1.2	Term of Service Agreement

Date of Commencement of Service Agreement:	[INSERT DATE]
Date of Expiration of Service Agreement:		[INSERT DATE]

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2	General
2.1	Funded organisation/service provider contact details

Contact Officer		
Position		
Postal address		
Telephone number		
Fax number		
E-mail address		

2.2	Service Outlet details 
Service Outlet details are contained in the table in item 6.1.
1	
3	Services
3.1	Description of Services

The Services include funded activities specified in Item 6.1.

3.2	Funding area

Not applicable, intentionally deleted

3.3	Target Group/Service Users
Not applicable, intentionally deleted.

1	
4	Delivery of Services (one-off funding only)
4.1	Service Commencement Date
[Insert Service Commencement Date or if Not Applicable insert the words “Not applicable, intentionally deleted]

4.2	Milestones 

Tasks	Timeframe	

		

5	Exit Strategy
Not applicable, intentionally deleted.

6	Funded outputs, performance measurement and reporting	
6.1 	Details of Funding
	Service Provider Name	____________________________________________________________________	Service Provider Reference No____

Region	Service Outlet Reference Number	Location and Address of Service	Funding Source	Funding (Grant) ID	Funding Type	Funding period/ frequency	Service Type	Effective Start
Date	End date	Amount	Service User(s)	No. of Service users	

													

													

													

6.2	Performance reports
You must submit to Us the reports as specified in Item 10.

7	Funding Details

The Funding Details for the Services are described in item 6.

8	Assets

Refer to separate assets agreement, if applicable.

9	Timing of Payments  

Payments of the Funding will be made in advance subject to the lodgement of all statements and reports as required by Us under the Service Agreement.

Payment	Payment Due	
We will make payments to You on a quarterly basis when You have provided Your quarterly financial acquittal reports 	Payment occurs within 28 days after receipt of the quarterly financial acquittal reports	

10	Financial statements and reports  

10.1 Financial statements and reports
You must submit the following statements and reports to Us at the following address, during the Term of the Service Agreement. Statements and reports will be required for the following periods for each year by the following due dates:

Financial Acquittal Reports must contain the information in the form required by Us.

A Service may have been funded for part of the reporting period, either at the Date of Commencement or Date of Expiration. Where this is the case, the Financial Acquittal Reports should still be submitted for the relevant part of that reporting period.

Report	Period	Due date	To	
Service performance report	Annual	Annually from the date of the commencement of the Service Agreement	Departmental Officer	

DS NMDS transmissions	Quarterly	1 month after the end of the quarter	•	On-line (ODC) – Website: https://odc.disability.qld.gov.au
•	Electronic (own system) – Email: cstdanmdsdata@disability.qld.gov.au
•	Paper forms – Mail: 
Reply Paid 430
Department of Communities
GPO Box 806
BRISBANE QLD 4001	

Financial Acquittal Report 	Quarterly	31 October
31 January
30 April
31 July	As specified in item 10.2	
Financial statements as specified in Service Agreement (Part A) – Standard Terms of Funding clause  8.1 (a) (ii)	Annual	Within 6 months of the end of Your financial year	As specified in item 10.2	
Financial statements as specified in Service Agreement (Part B) – Specific Terms of Funding clause  9 (a) & 9 (b)	Annual	Within 6 months of the end of Your financial year	As specified in item 10.2	

10.2 Address for financial statement and reports  
Financial statements or reports are to be submitted to Us, by the dates shown in the above table, at the following address:- 

Grants Administration Branch
Disability Services, Department of Communities
GPO Box 806
BRISBANE QLD 4001

OR
Faxed to: 
Grants Administration Branch on 32248037

OR

Emailed to: 
dsqgrants@communities.qld.gov.au 

11	Additional conditions
Where Funding is provided under any of the programs specified below You must ensure that the Services provided are in accordance with the specific program guidelines as advised.

•	<List relevant programs for example PSS, ALSP, etc>

12 	Departmental Officer

Name	[Insert name]	
Position	[Insert position]	
Postal address	[Insert postal address]	
Telephone number	[Insert telephone number]	
Fax number	[Insert fax number]	
E-mail address	[Insert email address (if any)]	

EXECUTED as an Agreement

SIGNED by  [insert name]   [insert position]  as delegate for the Director-General of the Department of Communities 
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____________________________________
		Signature

____________________________________
		Signature of Witness
		
____________________________________
		Date

____________________________________
		Name of Witness

			
(This EXECUTION CLAUSE is to be used for any NGSP that is NOT a company delete this instruction when printing)
 
(Delete the entire clause if the annexure clause on the next page is to be used- delete this instruction when printing)

SIGNED by [insert name] [insert position] for and on behalf of [insert name of Service Provider] as its duly authorised officer:
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____________________________________
		Signature

	

____________________________________
		Signature of Witness
		
____________________________________
		Date

____________________________________
		Name of Witness

(This EXECUTION CLAUSE is for use by companies only -
delete this instruction when printing)

(delete entire clause if the other annexure clause is used
- delete this instruction when printing)

SIGNED for and on behalf of 
[NAME OF CORPORATION]
in accordance with section 127 of the Corporations Act 2001		

	

____________________________________
(signature of director/secretary)		

____________________________________
(signature of director)	

______________________________________
(name of director/secretary)
		
______________________________________
(name of director)

______________________________________
(date)