<Only use for output funding>

Service Agreement (Part C) – Specifications for Disability Services		

The Department of Communities, Child Safety and Disability Services (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, Child Safety and Disability Services

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 version 2, current as at 3 April 2012  available on Our website, currently (www.communities.qld.gov.au);  
(ii)	the Service Agreement (Part B) - Specific Terms of Funding Disability Services (Part B) version 2, current as at 3 April 2012 that specify those terms and conditions specific to the Services and the Disability Services Act 2006, available on Our website, currently (www.communities.qld.gov.au);  

(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 specified in Item 6.1.

3.2	Funding area

Not applicable, intentionally deleted]

3.3	Target Group/Service Users

Not applicable, intentionally deleted]

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	Funding, Outputs, Output measures and Output reporting

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 	

6.2 	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	Month of Payment	
We will make payment to You on a quarterly basis when You have provided Your:
•	Directors Certification; and
•	DS NMDS quarterly transmissions for each of Your service outlets	Payment occurs within 28 days after receipt of the Directors Certification and DS NMDS quarterly transmissions for each of Your service outlets 	

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:

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, Child Safety and Disability Services
GPO Box 806
BRISBANE QLD 4001	
Director’s certification	Quarterly	1 month after the end of the quarter	
As specified in item 10.2	
Service Report (only if required in Item 6.1)	Annual	1 month after the Annual General Meeting	•	POQ@communities.qld.gov.au
•	Fax: 3836 0924
•	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	

10.2 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:- 
Statewide Funding Branch
Disability Services, Department of Communities, Child Safety and Disability Services
GPO Box 806
BRISBANE QLD 4001

OR
Faxed to: 
Statewide Funding 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 >

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, Child Safety and Disability Services 
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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 -
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(delete entire clause if the other annexure clause is used
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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)