Opportunity Connect Burial Assistance Request Form

The Office of Youth and Young Adult Opportunities through the Opportunity Connect program links local communities to empowering resources and services designed to mitigate the impacts of violence, drugs, or gang participation while addressing unresolved trauma and supporting returning citizens.

The goals of the program are to:

· End the cycle of insufficient resources to meet the necessities of life and sustainability

· Mitigate the cycle of trauma for individuals, families, and the community

· Stop the needless loss of life by reducing drug, gang, and gun related violence;

· Help individuals transitioning from incarceration identify support

The purpose of this document is to establish the Scope of Work for a service or resource provided through the Opportunity Connect Program.

Terms

• A relative is requesting Burial Assistance to offset the cost of interment as a result of gun violence for a Hampton Youth or Young Adult.
• The Burial Assistance Program provides support in defraying the cost of a standard burial assitance and cremation services. 
• Assistance is provided based on availablitity of funds and general practices observed by Youth and Young Adult Opportunities. 

• If a contract is entered into with the applicant requesting support the applicant agrees to attend one counseling session paid for by the Office of Youth and Young Adult Opportunities up to an additional seven (7) sessions to receive burial assistance. Upon receiving funding, the applicant will have up to 14 days after the memorial services to coordinate grief counseling with the Senior Family Services Coordinator.

• The applicant understands the Office of Youth and Young Adult Opportunities reserves the right to request the return of any funds provided and may initiate legal action by the city to collect such funds for failure to attend a counseling session.

• However, if the session is delayed the recipient may request an extension from the OYYAO Director prior to 30 days after the initial date of submitted request.

• The City of Hampton or any of its Departments reserves the right to cancel this Proposal for Services with no liability.

• This Proposal for Services DOES NOT constitute a written agreement, contract, nor promise to initiate a contract between the Office of Youth and Young Adult Opportunities and the applicant, for performance of services for the interment cost.

• Hold Harmless/Indemnification: Should a contract be entered, it is understood and agreed that the recipient hereby assumes the entire responsibility and liability for any and all damages to persons or property caused by, resulting from, or arising out of any act or omission on the part of the applicant, its subcontractors, agents, volunteers, or employees, under or in connection with, this scope of work or the performance or failure to perform any connection with this scope of work or the performance or failure to perform any work required by this scope of work. The applicant agrees to indemnify and hold harmless the City of Hampton, its agents, volunteers, servants, employees, and officials from and against any and all claims or suits due to, arising out of, or in connection with (a) any and all damages, real, or alleged; (b) the violation of any law applicable to this Agreement; and (c) the performance of the work by the applicant or those for whom the applicant is legally liable. Upon written demand by the City of Hampton, the applicants shall assume and defend at the applicant’s sole expense, any and all such suits or defense claims made against the City of Hampton, its agents, volunteers, servants, employees, or officials.

• Modification: Should a contract be entered into with the applicant, there may be no modification to the contract, except in writing, executed by the authorized representatives for the Office of Youth and Young Adult Opportunities and the applicant.

• Non-Assignment: Should a contract be entered into with the applicant there will be no assignment of its rights and duties under the contract, without the prior, written consent of the Office of Youth and Young Adult Opportunities.

• All payments under this Scope of Work SHALL NOT be made directly to the applicant but to the designated services provider to whom is a local business registered with the City of Hampton’s Commission of Revenue and the State Corperation Commission.

This Proposal for Services DOES NOT constitute a written agreement, contract, nor promise to initiate a contract between the Office of Youth and Young Adult Opportunities and the applicant for payments rendered for interment services.