Queensland Government
Department of Communities

Service Agreement (Part C) – Specifications for Disability Services		

The Department of Communities (Disability Services) Service Agreement comprises three sections:
•	Service Agreement (Part A) - Standard Terms of Funding
•	Service Agreement (Part B) - Specific Terms of Funding
•	Service Agreement (Part C) - Specifications

The Service Agreement (Part C) - Specifications is designed to document:
•	Organisation and service details; 
•	Service descriptions;
•	Funded outputs;
•	Service specific additional conditions (if applicable);and 
•	Reporting requirements. 

Service Agreement (Part C) – 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)	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  [INSERT DATE];                       
(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 [INSERT DATE] that specify those terms and conditions specific to the Disability Services Act 2006; 
(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]
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.
3	Services
3.1	Description of Services
The Services to be provided under the Service Agreement are [Insert description of Services]
The Services include the matters specified in Items 3.2 and 3.3 and the funded outputs / activities specified in Item 6.1.
3.2	Funding area
[Insert Funding area or if Not Applicable insert the words “Not applicable, intentionally deleted]

3.3	Target Group/Service Users
[Insert description of Target Group / Services Users]

4	Delivery of Services
4.1	Service Commencement Date
[Insert Service Commencement Date or if Not Applicable insert the words “Not applicable, intentionally deleted]
4.1	Milestones 
Tasks	Timeframe	

		

5	Exit Strategy
Not applicable, intentionally deleted.

6. Funded outputs, performance measurement and reporting	
6.1	Funding, Outputs, Output measures and Output reporting (Only to be used for output based service delivery)

Total Recurrent Funding per Financial Year $.........
(Includes all recurrent individual and block funding allocations )	
Region	Service Outlet number	Output
(DS NMDS code)	Output Measure	Quantity (per annum)	Minimum number of service users 	Service Report Required

							

Service Users with Individual Funding Allocations 
	
Region	Service Outlet number	First name	Surname	Output
(DS NMDS code)	Output Measure	Quantity (per annum)	Service Report Required

								

Service Users with Block Specified Funding Allocations 
	
Region	Service Outlet number	First name	Surname	Output (DS NMDS code)	Output Measure	Quantity (per annum)	Service Report Required

								

Initiative Specific Block Funding Allocations
	
Region	Service Outlet number	Initiative Name 	Output (DS NMDS code)	Output Measure	Quantity (per annum)	Minimum number of service users	Service Report Required

								

Initiative Specific Individual Funding Allocations	
Region	Service Outlet number	First Name	Surname	Initiative Name	Output (DS NMDS code)	Output Measure	Quantity (per annum)	Service Report Required

									

One-off Block Funding Allocations	
Region	Service Outlet number	Start Date	End Date	Funding	Output (DS NMDS code)	Output Measure	Quantity (per one-off period)	Minimum number of service users	Service  Report Required

										

One-off Individual Funding Allocations	
Region	Service Outlet number	First Name	Surname	Start Date	End Date	Funding	Output
(DS NMDS code)	Output Measure	Quantity (per one-off period)	Service Report Required 	

6.1 	Details of Funding (Only to be used for input-based service delivery & reporting)
	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	Reports (Only to be used for output based service delivery)
You must submit to Us the reports as specified in Item 10.

6.2 	Performance reports (Only to be used for input-based service delivery & reporting)
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 in accordance with the table below, 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 (Only to be used for output based service delivery)
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:

Report	Period	Due date	To	
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	
Director’s certificate			•	POQ@communities.qld.gov.au
•	Fax: 
•	Purchasing, Outputs and Quality 
GPO Box 806
BRISBANE QLD 4001	
Service Report (only if required in Item 6.1)			•	POQ@communities.qld.gov.au
•	Fax: 
•	Purchasing, Outputs and Quality 
GPO Box 806
BRISBANE QLD 4001
	
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	

10.1 Financial statements and reports (Only to be used for input-based service delivery & reporting)
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 documents for example PSS manual 2009/10
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

			
EXECUTION CLAUSE A (delete 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

EXECUTION CLAUSE – B (delete 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)