HomeMy WebLinkAboutContract 47279 CITY SECRETAW
STATE OF TEXAS §
COUNTY OF TARRANT §
This contract ("Contract") is made and entered into by and between the City of Fort
Worth (hereafter "City") and YWCA Fort Worth and Tarrant County (hereafter "Agency"), a
Texas non-profit corporation. City and Agency may be referred to individually as a "Party" and
jointly as "the Parties".
The Parties state as follows:
WHEREAS, City receives grant monies from the United States Department of Housing
and Urban Development ("HUD") through Emergency Solutions Grant Program ("ESG"),
Program No. S-15-MC-48-0006, Catalog of Federal Domestic Assistance No. 14.231;
WHEREAS, the ESG program is intended to provide homeless persons or persons at risk
of becoming homeless with financial assistance, basic shelter, essential supportive services,
and/or operations, as applicable;
WHEREAS, Agency submitted a proposal to use ESG funds for an eligible program
under the ESG Regulations whereby Agency will provide services to low and moderate income
City citizens;
WHEREAS, City citizens, the Community Development Council, and the City Council
have determined that ESG programs are needed by the City's citizens;
NOW, THEREFORE,the Parties understand and agree as follows:
1. INCORPORATION OF RECITALS.
City and Agency hereby agree that the recitals set forth above are true and correct and
form the basis upon which the Parties have entered into this Contract.
2. DEFINITIONS.
In addition to terms defined in the body of this Contract, the terms set forth below shall
have the definitions ascribed to them as follows:
Area Median Income or AMI means the median family income for the Fort Worth-Arlington
metropolitan statistical area as established annually by HUD. The 2014 income limits are
attached hereto as EXHIBIT "A-1"—2015 HUD Income Limits.
Business Diversity Enterprise Ordinance or BDE means the City's Business Diversity
Ordinance, Ordinance No. 20020-12-2011.
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Complete Documentation means the following documentation as applicable:
• Attachments I,11, and 111, with supporting documentation including:
• Proof of expense: copies of timesheets, invoices, leases, service contracts
or other documentation showing that payment is due by Agency.
• Proof of payment: cancelled checks, bank statements, or wire transfers
necessary to demonstrate that amounts due by Agency were actually paid
by Agency.
• Proof of client eligibility: Source Documentation sufficient to show that
clients participating in the Program are ESG Eligible Clients as described
in Section 6.
• Complete Documentation shall meet the standards described in the attached
EXHIBIT "F"- Standards for Complete Documentation.
• Any other document or record reasonably necessary to verify costs spent and
client eligibility for the Program.
Continuum of Care means the Tarrant Area Continuum of the Care.
DBE means disadvantaged business enterprise in accordance with 49 CFR Part 26.
Director means the Director of the City's Neighborhood Services Department.
Effective Date means October 1, 2015.
ESG means Emergency Solutions Grant.
ESG Eligible Client means an individual or household that meets the definition of"homeless"
or "at risk of homelessness" as defined in the Heath Act.
ESG Funds means the ESG grant funds supplied by City to Agency under the terms of this
Contract.
ESG Regulations means regulations found at 24 CFR Part 576 et seq.
HEARTH Act means the Homeless Emergency Assistance and Rapid Transition to Housing Act
of 2009,42 U.S.C. 11302 etseq.
HMIS means Homeless Management Information System required by HUD for client data
collection.
HUD means the United States Department of Housing and Urban Development.
IDIS means Integrated Disbursement Information System,HUD's project tracking system.
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Neighborhood Services Department means the City's Neighborhood Services Department.
OMB means the Office of Management and Budget.
Program means the services described in EXHIBIT "A"—Program Summary.
Reimbursement Request means all reports and other documentation described in Section 9.
Source Documentation means documentation sufficient under ESG Regulations to establish an
individual or household as an ESG Eligible Client
Unduplicated Clients means a count of ESG Eligible Clients served at least once in the Contract
Term. ESG Eligible Clients served more than once in the Contract Term will only be counted
the first time they are served when determining the total count of Unduplicated Clients.
3. TERM.
The term of this Contract begins on October 1, 2015 and terminates on September 30,
2016 unless earlier terminated as provided in this Contract.
4. DUTIES AND RESPONSIBILITIES OF CITY.
4.1 Provide ESG Funds.
City shall provide up to $79,435.00 of ESG Funds under the terms and conditions herein.
4.2 Monitor.
City will monitor the activities and performance of Agency and any of its contractors,
subcontractors or vendors as necessary, but no less than annually. Monitoring by City will
include determining whether Agency is meeting the requirements of the ESG Regulations
during the term of this Contract.
5. DUTIES AND RESPONSIBILITIES OF AGENCY.
5.1 Required Services.
Agency shall perform the services described in EXHIBIT "A"—Program Summary in
accordance with the terms and conditions of this Contract.
5.2 Use of ESG Funds.
5.2.1. Compliance with ESG Regulations and Contract..
Agency shall be reimbursed for eligible Program costs with ESG Funds only if City
determines in its sole discretion that:
5.2.1.1 Costs are eligible expenditures in accordance with ESG Regulations.
5.2.1.2 Costs are in compliance with this Contract and are reasonable and
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consistent with industry norms.
5.2.1.3 Complete Documentation, as applicable, is submitted to City by
Agency.
5.2.2 Bu gct.
5.2.2.1. The ESG Funds will be paid on a reimbursement basis in accordance
with EXHIBIT `B"-Budget.
5.2.2.2 During the term of this Contract, Agency may submit written requests
to increase or decrease line-item amounts in the Budget, including an
explanation of why such increases or decreases are necessary. All
such requests must be approved by the Director in writing, with such
approval being in the Director's sole discretion. If Director approves
the Agency's proposed Budget amendment (as approved, the
"Amended Budget"), then the Amended Budget will take effect on
the first day of the month following the month in which it was
approved by Director, unless otherwise specified in the amendment.
All requests for Budget amendments must be submitted by June 1,
2016.
5.2.3 Change in Program Budget.
5.2.3.1 Agency will notify City promptly of any additional funds it receives
for operation of the Program, and City reserves the right to amend this
Contract in such instances to ensure compliance with HUD regulations
governing cost allocation.
5.2.3.2 Agency agrees to utilize funds the ESG Funds to supplement rather
than supplant funds otherwise available for the Program.
5.2.4 Payment of ESG Funds to Agency.
ESG Funds will be disbursed to Agency upon City's approval of Reimbursement
Requests including submission of Complete Documentation to City in compliance with Section
9. If Agency expends all funds budgeted for the Program prior to September 30, 2016, City
may hold back a small amount of the ESG Funds until the end of the term. During this interim
period, Agency must continue to submit Reimbursement Requests with an invoiced amount of
$0. It is expressly agreed by the Parties that any ESG Funds not spent or not approved for
reimbursement to Agency shall remain with City.
5.3 Program Performance Milestones.
5.3.1 Agency represents that the Program will achieve the following milestones in
accordance with EXHIBIT "A"—Program Summary and the table below:
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Unduplicated Clients as
specified in EXHIBIT
Program
Month Ex enditures Summary
3 25% 25%
6 50% 50%
8 75% 75%
12 1 100% 100%
5.3.2 Failure of Agency to meet these milestones or a material deviation from
them as outlined in this Section 5.3 is a breach of this Contract. For the purpose of this Section,
"material deviation" shall mean more than 10% lower than the specified goal. In the event of
such breach, City reserves the right in its sole option to delay or withhold payment of
Reimbursement Requests, to lower Agency's allocation of ESG Funds, or to terminate this
Contract.
5.3.3 Failure to meet at least 80% of its performance milestones or serve 60
Unduplicated Clients under this Contract will automatically disqualify Agency for consideration
under the City's Request for Proposals for the 2016-2017 Program Year for ffederal grant funds.
5.3.4 Amendments to performance milestones must be approved by the Director in
writing, with such approval being in the Director's sole discretion. If Director approves the
Agency's proposed amended performance milestones (as approved, the "Amended
Performance Milestones"), then the Amended Performance Milestones will take effect on the
first day of the month following the month in which it was approved by Director, unless
otherwise specified in the amendment. All requests for amendments to performance milestones
must be submitted by June 1, 2016. Notwithstanding the above, any amendments to this
Contract shall not reduce the number of Unduplicated Clients stated in Section 5.3.3 and in
EXHIBIT "A"—Program Summary.
5.4 Identify Program Expenses Paid with ESG Funds.
Agency will keep accounts and records in such a manner that City may readily identify
and account for Program expenses reimbursed with ESG Funds. These records shall be made
available to City for audit purposes and shall be retained as required hereunder.
5.5 Match.
Agency must match ESG Funds dollar for dollar with other funding sources. Potential
sources of match include any sources described at 42 U.S.C. 11375(a). Some common sources
include: (i) Agency funding from non-federal sources and eligible federal grants, (ii) volunteer
time, which may valued at$5/hour of time; and (iii)the value or fair rental value of any donated
materials or space. The monetary values Agency assigns to all sources of match are subject to
review and approval by City.
5.5.1 Prior to October 1,2015, Agency must submit to City a completed Match Report
on the form attached hereto as EXHIBIT "H"- Match Report detailing actual and anticipated
match sources.
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5.5.2 With each Reimbursement Request, Agency must submit a log of funds expended
to date on the form provided in EXHIBIT "H" - Match Report, plus documentation of any
match expenditures first reported in that month's Reimbursement Request.
5.5.3 Records regarding match funds must be kept by Agency in accordance with
Section 8.
5.5.4 If the expenditure of match funds and ESG Funds is not happening at
approximately the same pace on a quarterly basis, then the City shall withhold ESG Funds until
match expenditures are substantially the same as ESG Funds reimbursed to date.
5.6 Program Subcontracts.
Agency shall not enter into a subcontract with another agency, contractor, or vendor to
provide a service to clients for any part of the Program that will be paid with ESG Funds without
City's written consent.
6. CLIENT ELIGIBILITY VERIFICATION.
6.1 Client Eligibility.
Agency will document the eligibility of all prospective clients. Agency may redact the
client's personal information and substitute a client number. Agency may use form attached
hereto as EXHIBIT "I" — Staff ESG Certification Form to document the eligibility of all
prospective clients that receive direct financial assistance as more particularly described as
follows.
6.1.1 Agencies Receiving ESG Funds.
6.1.1.1 Coordination of Services. Agency must participate in the local
Continuum of Care and enter data in HMIS.
6.1.1.2 Homelessness Status. Agency must verify that all new clients meet
the definition of homeless or at risk of homelessness in the HEAR I`H
Act, as amended from time to time. Acceptable forms of verification
include:
i. For emergency persons (shelter services for homeless including
childcare for homeless clients):
A signed, dated statement from the client stating that the client is
homeless, or that the client is homeless by virtue of fleeing
domestic violence.
ii. For homelessness prevention- financial assistance services:
1. Documentation that the individual or family has an annual
income at or below 30% of AMI,
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2. Evidence documenting that the client does not have
sufficient resources or support networks immediately
available to prevent them from moving to an emergency
shelter or another place defined in Category 1 of the
"homeless" definition under the HEARTH Act,
3. Documentation of client's reasonable prospects of
resuming payment of rent or utilities, as applicable, within
a reasonable time, and
4. Documentation supporting the type and amount of
assistance provided, including, but not limited to, invoices,
past due notices, and/or executed leases, as applicable, and
proof of payment by Agency.
iii. For rapid re-housing services-financial assistance:
1, Documentation that the individual or family meets the
homeless definition in the HEARTH Act and that the client
is eligible consistent with the definition of homelessness in
24 CFR Part 576.2,paragraphs 1 and 4,
2. Documentation of habitability of the housing unit,
3. Documentation of rent reasonableness,
4. Documentation of client's reasonable prospects of
resuming payment of rent and/or utilities, as applicable,
within a reasonable time,
5. Evidence documenting that the client is not receiving
assistance from other rapid re-housing/homelessness
prevention agencies or funding sources, and
6. Documentation supporting the type and amount of
assistance provided, including, but not limited to, invoices,
past due notices, and/or executed leases, as applicable, and
proof of payment by the agency.
iv. For housing relocation and stabilization services:
1. Documentation that services are provided for eligible
homeless and at risk of homelessness clients as defined in
the HEARTH Act, and
2. Documentation that any staff costs and or
relocation/stabilization services directly benefit the eligible
individual and families and are clearly distinguished from
the general administration of the Program.
6.1.2 Performance Standards.
Agency must verify that the Program is tracking ESG activities and outcomes in
accordance with the City's performance standards as described in EXHIBIT "J" - ESG
Performance Standards.
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6.1.3 Written Standards for ESG Assistance.
Agency must verify that the Program is documenting Client Eligibility in accordance
with the City's written standards as described in EXHIBIT "J-1" — Written Standards for
ESG Assistance. Agency must maintain all records in accordance with Section 8.
6.2 Submission of Complete Documentation.
Agency must submit copies of documentation of client eligibility described in Section 6.1
with Attachment III in each month's Reimbursement Request for all Unduplicated Clients.
6.2 Maintain Documentation.
Agency must maintain copies of all documentation required by this Section 6 for 5 years
following the expiration of the Contract tern1. This Section shall survive the earlier terminations
or expirations of this Contract.
7. ADDITIONAL ESG REQUIREMENTS.
Agency agrees to comply with all requirements of the ESG Program as stated in the ESG
Regulations, including but not limited to the following:
7.1 Environmental Review.
ESG Funds will not be paid, and costs cannot be incurred until City has conducted an
environmental review and an Environmental Review Record as required by 24 CFR Part 58. The
environmental review may result in a decision to proceed with, modify, or cancel the funding for
the Program. Further, Agency will not undertake or commit any funds to physical or choice
limiting actions as described in any applicable federal regulations. Any violation of this
provision will (i) cause this Contract to terminate immediately; and (ii) require Agency to repay
City the ESG Funds it has already received and forfeit any future payments of ESG Funds.
7.2 Contract Not Constitutine Commitment of Funds.
Notwithstanding any provision of this Contract, the Parties agree and acknowledge that
this Contract does not constitute a commitment of funds, and that such commitment of funds or
approval may occur only upon (i) satisfactory completion of environmental review and receipt
by City of an authorization to use grant funds from HUD under 24 CFR Part 58, (ii) approval of
City's 2015-2016 Action Plan, and(iii)receipt by City of grant agreement from HUD.
7.3 Monitoring.
7.3.1 Agency understands and agrees that it will be subject to monitoring by City for
compliance with terms and provisions of this Contract and the ESG Regulations for the term of
this Contract. Agency is subject to such monitoring during the term of this Contract and for 5
years after the Contract term ends. Agency will provide reports and access to Program files as
requested by City during this 5 year period. For purposes of this Contract, this 5 year period for
monitoring is deemed to begin on October 1, 2016 and end on September 30, 2021 regardless
of whether or not this Contract is earlier terminated.
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7.3.2 Representatives of City, HUD, HUD Office of Inspector General, and the United
States Comptroller General shall have access during regular business hours, upon 48 hours prior
notice, to Agency's offices and records pertaining to the use of the ESG Funds, and to Agency's
officers, directors, agents, employees, contractors, subcontractors and vendors for the purpose of
such monitoring.
7.3.3 In addition to other provisions of this Contract regarding frequency of monitoring,
City reserves the right to perform desk reviews or on-site monitoring of Agency's compliance
with the temps and conditions of this Contract. City shall provide Agency with a written report
of the monitor's findings after each monitoring visit. If the monitoring report notes deficiencies
in Agency's performance, the report shall include requirements for the timely correction of said
deficiencies by Agency. Failure by Agency to take the action specified in the monitoring report
may be cause for suspension or termination of this Contract as provided herein.
7.3.4 Subsections 7.3.1 through 7.3.3 shall be applicable for the Contract term and for 5
years thereafter and shall survive the earlier termination or expiration of this Contract.
7.3.5 Agency shall provide City amlually the results of any state or federal monitoring.
Such results shall be submitted within 60 days of receipt of such state or federal monitoring
report, or with the January Reimbursement Request,whichever is earlier.
7.4 Agency Procurement Standards.
Agency shall comply with all applicable federal, state and local laws, regulations, and
ordinances for making procurements under this Contract. In addition to the conflict of interest
provisions in Section 14.13.3, Agency shall establish written procurement procedures to ensure
that materials and services are obtained in a cost effective manner and that provides for full and
open competition. When procuring materials and services for this Contract, Agency shall
comply at a minimum with the procurement standards in 2 CFR Part 200.317 through 2 CFR
Part 200.326.
7.4.1 Contracts in excess of $10,000.00 made by Agency using ESG Funds must
address termination for cause and convenience including the manner by which such termination
shall be effected and the basis for settlement of the terminated contract, if any, as required by
Appendix II (B),2 CFR Part 200.
7.4.2 Agency shall not make any contract with parties listed on the governmentwide
System for Award Management, www.sam.gov (`'SAM"). Agency must confirm by search of
SAM that all contractors paid with ESG Funds are not listed by SAM as being debarred, both
prior to hiring and prior to submitting a Reimbursement Request which includes invoices from
any such contractor. Failure to submit such proofs of search shall be an event of default.
7.5 Cost Principles/Cost Reasonableness.
Agency shall administer its use of ESG Funds in compliance with 2 CFR Part 200, as
applicable. The eligibility of costs incurred for performance rendered shall be determined in
accordance 2 CFR Part 200.400 through 2 CFR Part 200.475.
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7.6 Accounting Standards.
Agency agrees to comply with 2 CFR Part 200, as applicable. Agency also agrees to
adhere to the accounting principles and procedures required therein, utilize adequate internal
controls, and maintain necessary supporting and back-up documentation for all costs incurred in
accordance with 2 CFR Part 200.302 and Part 200.303.
7.7 Uniform Administrative Requirements, Cost Principles, and Audit
Requirements.
Agency will comply with the Uniform Administrative Requirements, Cost Principles, and
Audit Requirements for Federal Awards in 2 CFR Part 200, as applicable, or any reasonably
equivalent procedures and requirements that City may require.
7.8 Terms Applicable to Contractors, Subcontractors and Vendors.
Agency understands and agrees that all terms of this Contract, whether regulatory or
otherwise, shall apply to any and all contractors, subcontractors and vendors of Agency which
are in any way paid with ESG Funds or who perform any work in connection with the Program.
Agency shall cause all applicable provisions of this Contract to be included in and made a part of
any contract or subcontract executed in the performance of its obligations hereunder including its
obligations regarding the ESG Regulations. Agency shall monitor the services and work
performed by its contractors, subcontractors and vendors on a regular basis for compliance with
the ESG Regulations and Contract provisions. Agency must cure all violations of the ESG
Regulations committed by its contractors, subcontractors or vendors. City maintains the right to
insist on Agency's full compliance with the terms of this Contract and the ESG Regulations and
Agency is responsible for such compliance regardless of whether actions taken to fulfill the
requirements of this Contract are taken by Agency or by Agency's contractors, subcontractors or
vendors. Agency acknowledges that the provisions of this Section shall survive the earlier
termination or expiration of this Contract and shall be applicable for 5 years after the termination
of the Contract.
7.9 Copyright and Patent Rights.
No reports, maps, or other documents produced in whole or in part under this Contract
shall be the subject of an application for copyright by or on behalf of Agency. HUD and City
shall possess all rights to invention or discovery, as well as rights in data, which may arise as a
result of Agency's performance under this Contract.
7.10 Conflict of Interest Disclosure.
In accordance with the requirements of Section 14.13.2.1 and 14.13.4, Agency shall
establish conflict of interest policies for federal awards. Agency shall disclose to City in writing
any potential conflict of interest.
7.11 Compliance with FFATA and Whistleblower Protections.
Agency shall comply with the requirements of 2 CFR 300(b), including provisions of the
Federal Funding Accountability and.Transparency Act ("FFATA") governing requirements,on
executive compensation and provisions governing whistleblower protections contained in 10
U.S.C. 2409, 41 U.S.C. 4712, 10 U.S.C. 2324, 41 U.S.C. 4304 and 41 U.S.C. 4310.
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7.11.1 Agency shall provide City with its DUNS number.
7.12 Internal Controls.
In compliance with the requirements of 2 CFR Part 200.303,Agency shall:
7.12.1 Establish and maintain effective internal control over the ESG Funds that
provides reasonable assurance that Agency is managing the ESG Funds in compliance with
federal statutes, regulations, and the terms and conditions of this Contract. These internal
controls shall be in compliance with guidance in "Standards for Internal Control in the Federal
Government" issued by the Comptroller General of the United States or the "Internal Control
Integrated Framework" issued by the Committee of Sponsoring Organizations of the Treadway
Commission("COSO");
7.12.2 Comply with federal statutes, regulations, and the terms and conditions of this
Contract;
7.12.3 Evaluate and monitor Agency's compliance with statutes, regulations and the
terms and conditions of this Contract;
7.12.4 Take prompt action when instances of noncompliance are identified including
noncompliance identified in audit findings; and
7.12.5 Take reasonable measures to safeguard protected personally identifiable
information and other information that HUD or City designates as sensitive or Agency considers
sensitive consistent with applicable federal, state, local and tribal laws regarding privacy and
obligations of confidentiality.
8. RECORD KEEPING; REPORTING AND DOCUMENTATION
REQUIREMENTS; AUDIT.
8.1 Record Keepins.
Agency shall maintain a record-keeping system as part of its performance of this Contract
and shall promptly provide City with copies of any document City deems necessary for the
effective fulfillment of City's monitoring and evaluation responsibilities. Specifically, Agency
will keep or cause to be kept an accurate record of all actions taken and all funds spent, with
supporting and back-up documentation. Agency will maintain all records and documentation
related to this Contract for 5 years after the Contract term ends. If any claim, litigation, or audit
is initiated before the expiration of the 5 year period, the relevant records and documentation
must be retained until all such claims, litigation or audits have been resolved. For purposes of
this Contract, this 5 year period for record retention is deemed to begin on October 1, 2016 and
end on September 30,2021 regardless of whether or not this Contract is earlier terminated.
8.2 Access to Records.
Representatives of City, HUD and any duly authorized officials of the federal
government will have full access to, and the right to examine, audit, copy, excerpt and/or
transcribe any of Agency's records pertaining to all matters covered by this Contract for 5 years
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after the Contract term ends. Such access shall be during regular business hours and upon at
least 48 hours prior notice. For purposes of this Contract,this 5 year period for access to records
is deemed to begin on October 1,2016 and end on September 30,2021 regardless of whether or
not this Contract is earlier terminated.
8.3 Reports.
Agency will submit to City all reports and documentation described in this Contract in
such form as City may prescribe. Agency may also be required to submit a final performance
and/or final financial report if required by City at the termination of this Contract in such form
and within such times as City may prescribe. Failure to submit to City any report or
documentation described in this Contract shall be an event of default of this Contract and City
may exercise all of its remedies for default under this Contract.
8.3.1 Additional Information.
Agency shall provide City with additional information as may be required by state or
federal agencies to substantiate Program activities and/or expenditure eligibility.
8.4 Change in Reporting Requirements and Forms.
City retains the right to change reporting requirements and forms at its discretion. City
will notify Agency in writing at least 15 days prior to the effective date of such change, and the
Parties shall execute an amendment to the Contract reflecting such change if necessary.
8.5 Audit.
8.5.1 Entities that Expend $750,000 or more in Federal Funds Per Year.
All non-federal entities that expend $750,000 or more in federal funds within 1 year,
regardless of the source of the federal award, must submit to City an annual audit prepared in
accordance with specific reference to 2 CFR Part 200.501 through Part 200.521. The audit
shall cover the Agency's fiscal years during which this Contract is in force. The audit must
be prepared by an independent certified public accountant, be completed within 6 months
following the end of the period being audited and be submitted to City within 30 days of its
completion. Agency's audit certification is attached hereto as EXHIBIT "C" — "Audit
Certification Form" and "Audit Requirements". The Audit Certification Form must be
submitted to City prior to or with the first Reimbursement Request. Entities that expend less
than $750,000 a year in federal funds are exempt from federal audit requirements for that
year, but records must be available for review or audit by appropriate officials of the federal
agency, City, and General Accounting Office.
8.5.2 City Reserves the Right to Audit.
City reserves the right to perform an audit of Agency's Program operations and finances
at any time during the term of this Contract and for 5 years after the Contract Term ends if City
determines that such audit is necessary for City's compliance with the ESG Regulations or other
City policies. Agency agrees to allow access to all pertinent materials as described herein for
such audit. For purposes of this Contract, this 5 year period for City audit is deemed to begin on
October 1, 2016 and end on September 30, 2021 regardless of whether or not this Contract is
earlier terminated. If such audit reveals a questioned practice or expenditure, such questions
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Rev. 10.022015
must be resolved within 15 business days after notice to Agency of such questioned practice or
expenditure. If questions are not resolved within this period, City reserves the right to withhold
further funding under this Contract and/or any other contracts with Agency. IF AS A RESULT
OF ANY AUDIT IT IS DETERMINED THAT AGENCY HAS FALSIFIED ANY
DOCUMENTATION OR MISUSED, MISAPPLIED OR MISAPPROPRIATED
FUNDS OR SPENT ESG FUNDS ON ANY INELIGIBLE ACTIVITIES, AGENCY
AGREES TO REIMBURSE
CTIONS THE
PENMLOTY ORF MNIES PLUS
AMOUNT OF ANY SAN HARGELEV ED
AGAINST CITY BY HUD BECAUSE OF SUCH ACTIONS.
9, REIMBURSEMENT REQUIREMENTS.
9.1 Deadline for Submitting Reimbursement Requests.
9.1.1 Reimbursement Requests shall be submitted monthly to the City and must be
received by the City on or before the 15t" day of the month following the month expenses were
paid by Agency. For example, the Reimbursement Request for June expenses must be received
by July 15. In the event the 15th falls on a weekend or City holiday, Reimbursement Requests
shall be due the next day that the City is open for business. Failure to submit a Reimbursement
Request in a timely fashion will result in City taking the actions outlined in Section 10.1.
NOTWITHSTANDING ANYTHING ABOVE, THE REIMBURSEMENT REQUEST
FOR EXPENSES INCURRED FOR SEPTEMBER 2016 MUST BE RECEIVED BY
OCTOBER 1, 2016. COMPLETE DOCUMENTATION FOR ALL SEPTEMBER 2016
EXPENSES MUST BE SUBMITTED BY OCTOBER 15,2016. FAILURE TO SUBMIT A
FINAL REIMBURSEMENT�SQLT IN AUTOMATIC DOCUMENTATION
OCTOBER 15, 2016 WILL IC FORFEITURE OF PAYMENT
OF THE SEPTEMBER REIMBURSEMENT REQUEST.
9.1.2 City will notify Agency by e-mail within 20 calendar days if a Reimbursement
Request is lacking Complete Documentation or corrections are needed. Agency will have 10
business days from the date of the e-mail notice to submit any requested information or missing
documentation. Agency will be penalized in the Request for Proposal for the 2016-2017
Program Year for any notifications received under this Section. If Agency fails to submit all the
required information or missing documentation within 30 calendar days from the first e-mail,
Agency shall forfeit any payments n cult at as outlined in Section 10.1 submit any requested
information will be considered a event of de
9.2 Submission of Reimbursement Requests.
Agency shall provide City with Complete Documentation and the following
reports as shown in EXHIBIT "D" — Reimbursement Forms with each Reimbursement
Request:
9.2.1 Attachment I—Invoice.
This report shall contain the amount requested for reimbursement each month, the
cumulative reimbursement requested to date (inclusive of that month's request), and must be
signed by an authorized signatory of Agency. By signing Attachment I, Agency is certifying
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that the costs are valid, eligible, consistent with the terms and conditions of this Contract, and the
data contained in the report is true and correct. This report must be submitted even if Agency is
requesting$0 for a particular month.
9.2.1.1 Agency must submit a separate invoice for each activity type, i.e.
Shelter Operations, Homeless Prevention, Rapid Rehousing, and
HMIS.
9.2.2 Attachment II—Expenditure Worksheet.
This report shall itemize each expense requested for reimbursement by Agency and shall
include the Account corresponding the expense to a Budget line item. In order for this report to
be complete the following must be submitted:
9.2.2.1 For payroll expenses, timesheets signed by employees and approved
by supervisor for all payroll expenses listed. Timesheets must
distinguish between ESG-funded time and non-ESG funded time and
reflect actual time spent on ESG-funded activities. Agency may not
submit payroll expenses dated 60 calendar days prior to the date of the
Reimbursement Request.
9.2.2.2 For non-payroll expenses, invoices for each expense listed with an
explanation as to how the invoiced expense pertains to the Program.
Agency may not submit invoices dated 60 calendar days prior to the
date of the Reimbursement Request.
9.2.2.3 Proof that each expense was paid by Agency, which proof can be
satisfied by canceled checks, wire transfer documentation, paid
receipts or other appropriate banking documentation.
9.2.3 Attachment III—Client Data Report.
This report shall list each Unduplicated Client served during the month along with his or
her demographic information. The Client Data Report must maintain a list of all clients
served during the Contract term. If Agency, receives funds from the United States
Department of Justice, then Agency is prohibited from submitting the Client Data Report
to the City. However, Agency must complete all required forms under this Section 9.2.3
and maintain in client files in accordance with Section 8. In order for this report to be
complete the following must be submitted:
9.2.3.1 Documentation of income verification for each Unduplicated Client
the first time the client is served, which either will be the completed
form attached hereto as EXHIBIT "E"- Form of Income Self
Certification or Source Documentation.
9.2.3.2 Agency may use the form attached hereto as EXHIBIT "I" — Staff
ESG Certification Form to verify client eligibility as described in
Section 6.1.
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9.2.4 Delivery of Reimbursement Repuest.
Reimbursement Requests can be mailed or delivered in person to Neighborhood
Services Department, 908 Monroe Street, Fort Worth, Texas 76102. In addition, Agency can
submit Reimbursement Requests via email to psa fortworthtexas.tiov, but Agency must
submit a signed original of Attachment I by the deadline in Section 9.1.1.
9.2.5 Match Report.
This report shall document actual expenditure of match funds, as further described in
Section 5.5.
9.2.6 ESG Quarterly HMIS Report.
Agency shall submit the ESG Quarterly HMIS Report, attached hereto as EXHIBIT "K"
— Quarterly Report, with the January 15, April 15, July 15 and October 15 Reimbursement
Requests to document Agency's participation in the local Continuum of Care's HMIS. A paper
copy must be submitted with the Reimbursement Request, and an electronic copy must also be
emailed to psa @fortworthtexas.gov.
9.3 Withholding Payment.
CITY SHALL HAVE NO OBLIGATION TO PAY ON ANY REIMBURSEMENT
REQUEST THAT IS NOT RECEIVED BY THE DUE DATE. Failure to timely submit
Reimbursement Requests and Complete Documentation along with any required reports
shall be an event of default.
10. DEFAULT AND TERMINATION.
10.1 Failure to Submit Reimbursement Re nest or Required Documentation.
10.1.1 If Agency fails to submit a Reimbursement Request in accordance with
Section 9,Agency shall be in default of this Contract. City will notify Agency in writing of such
default and the Agency will have 10 business days from the date of the written notice to submit
such Reimbursement Request to cure the default. If Agency fails to cure the default within such
time,Agency shall forfeit any payments otherwise due that month.
10.1.2 If Agency fails to submit requested information or missing documentation as
set forth in Section 9.1.2, then Agency shall forfeit payment due that month and the failure to
submit shall be considered an event of default that shall not be cured.
10.1.3 NOTWITHSTANDING THE PROVISIONS OF SECTION 10.1.1 OR
10.1.2, IF AGENCY FAILS TO SUBMIT THE REIMBURSEMENT REQUEST DUE
OCTOBER 1, 2016, OR IF THE SUBMITTED REIMBURSEMENT REQUEST FOR
OCTOBER 1,2016 IS LATE,INCOMPLETE OR OTHERWISE NOT IN COMPLIANCE
.WITH THIS CONTRACT OR THE ESG
WILL BEREGULATIONS
NO CURE DETERMINED
PERIOD AND ANY
IN ITS SOLE DISCRETION, THERE
REIMBURSEMENT WILL BE FORFEITED.
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10.1.4 In the event of (i) an uncured default under Section 10.1.1 or an event of
default under 10.1.2 (ii) or more than 2 instances of default, cured or uncured, under these
Sections, City reseives the right at its sole option to terminate this Contract effective
immediately upon written notice of such intent with no penalty or liability to City.
10.1.5 Notwithstanding anything to the contrary herein, City will not be required to
pay any ESG Funds to Agency during the period that any Reimbursement Request, report or
documentation is past due or is not in compliance with this Contract or the ESG Regulations, or
during any period during which Agency is in default of this Contract.
10.1.6 In the event of termination under this Section 10.1, all ESG Funds awarded
but unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency shall
have no further right to such funds.
10.2 Failure to Maintain Records or Submit Reports and Documentation.
If Agency fails to maintain all records and documentation as required in Section 8, or if
the maintained or submitted report or documentation is not in compliance with this Contract or
the ESG Regulations as determined by City in its sole discretion, City will notify Agency in
writing and Agency will have 30 calendar days from the date of the written request to obtain or
recreate the missing records and documentation or submit or resubmit any such report or
documentation to City. If Agency fails to maintain the required reports or documentation, or
fails to submit or resubmit any such report or documentation within such time, City shall have
the right to terminate this Contract effective immediately upon written notice of such intent with
no penalty or liability to City.
10.2.1 In the event of termination under this Section 10.2, all ESG Funds awarded
but unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency shall
have no further right to such funds, and any ESG Funds paid to Agency must be repaid to City
within 30 days of termination. If such ESG funds are not repaid to City within the 30 day period,
City shall exercise all legal remedies available under this Contract.
10.3 In General.
10.3.1 Subject to Section 10.2, and unless specifically provided otherwise in this
Contract, Agency shall be in default under this Contract if Agency breaches any term or
condition of this Contract. In the event that such a breach remains uncured after 30 calendar
days following written notice by City (or such other notice period as may be specified herein) or,
if Agency has diligently and continuously attempted to cure following receipt of such written
notice but reasonably requires more than 30 calendar days to cure, as determined by both Parties
mutually and in good faith, City shall have the right to elect in City's sole discretion to (i) extend
Agency's time to cure, (ii) terminate this Contract effective immediately upon written notice of
such intent to Agency, or (iii) pursue any other legal remedies available to City under this
Contract.
10.3.2 City's remedies may include:
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10.3.2.1 Direct Agency to prepare and follow a schedule of actions for
carrying out the affected activities, consisting of schedules,
timetables and milestones necessary to implement the affected
activities.
10.3.2.2 Direct Agency to establish and follow a management plan that
assigns responsibilities for carrying out the remedial activities.
10.3.2.3 Reprogram ESG Funds that have not yet been expended from
affected activities to other eligible activities or withhold ESG
Funds.
10.3.2.4 Any other appropriate action including but not limited to any
remedial action legally available such as declaratory judgment,
specific performance, damages, temporary or permanent
injunctions,termination of this Contract or any other contracts with
Agency, and any other available remedies.
10.3.3 In the event of termination under this Section 10.3, all ESG Funds awarded
but unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency shall
have no further right to such funds, and any ESG Funds already paid to Agency must be repaid
to City within 30 days of the termination. Failure to repay such ESG Funds within the 30 day
period will result in City exercising all legal remedies available under this Contract.
10.4 No Funds Disbursed while in Breach.
Agency understands and agrees that no ESG Funds will be paid to Agency until all
defaults are cured to City's satisfaction.
10.5 No Compensation After Date of Termination.
Agency shall not receive any compensation for work undertalcen after the date of the
termination.
10.6 Rights of City Not Affected.
Termination shall not affect or terminate any of the existing rights of City against
Agency, or which may thereafter accrue because of Agency's default and this provision shall be
in addition to any and all other rights and remedies available to City under the law. Such
termination does not terminate any provisions of this Contract that have been expressly noted as
surviving the term or termination of the Contract. No delay or omission by City in exercising
any right or remedy available to it under this Contract shall impair any such right or remedy or
constitute a waiver or acquiescence in any Agency default.
10.7 . . Waiver of Breach Not Waiver of Subsequent Breach.
The waiver of a default or breach of any term, covenant, or condition of this Contract
shall not operate as a waiver of any subsequent default or breach of the same or any other term,
covenant or condition hereof.
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10.8 Civil Criminal and Administrative Penalties.
Failure to perform all the Contract terms may result in civil, criminal or administrative
penalties, including,but not limited to those set out in this Contract.
10.9 Termination for Cause.
10.9.1 City may terminate this Contract in the event of Agency's default, inability, or
failure to perform subject to notice, grace and cure periods. In the event City terminates this
Contract for cause, all ESG Funds awarded but unpaid to Agency pursuant to this Contract shall
be immediately rescinded and Agency shall have no further right to such funds and any ESG
Finds already paid to Agency must be repaid to City within 30 days of termination. Failure to
repay such ESG Funds within 30 days will result in City exercising all legal remedies available
to City under this Contract. AGENCY ACKNOWLEDGES AND AGREES THAT IF CITY
TERMINATES THIS CONTRACT FOR CAUSE, AGENCY OR ANY AFFILIATES OF
AGENCY SHALL NOT BE CONSIDERED FOR ANY OTHER CITY CONTRACT FOR
ESG FUNDS FOR A MINIMUM OF 5 YEARS FROM THE DATE OF TERMINATION.
10.9.2 Agency may terminate this Contract if City does not provide the ESG Funds
substantially in accordance with this Contract.
10.10 Termination for Convenience.
In terminating in accordance with 2 CFR Part 200, Appendix 11, this Contract may be
terminated in whole or in part only as follows:
10.10.1 By City with the consent of Agency in which case the Parties shall agree upon
the termination conditions, including the effective date and in the case of partial termination, the
portion to be terminated; or
10.10.2 By Agency upon at least 30 days written notification to City, setting forth the
reasons for such termination, the effective date, and in the case of partial termination,the portion
to be terminated. In the case of a partial termination, City may terminate the Contract in its
entirety if City determines in its sole discretion that the remaining portion of the Contract to be
performed or ESG Funds to be spent will not accomplish the purposes for which the Contract
was made.
10.11 Dissolution of Ageney Terminates Contract.
This Contract shall terminate in the event Agency is dissolved or ceases to exist. In the
event of termination under this Section, all ESG Funds are subject to repayment and/or City may
exercise all of its remedies under this Contract.
10.12 Reversion of Assets.
In the event this Contract is terminated with or without cause, all assets acquired by
Agency with the ESG Funds including cash, interest payments from loans or otherwise, all
outstanding notes, mortgages or other security instruments, any accounts receivable attributable
to the use of the ESG Funds, and any real or personal property owned by Agency that was
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improved with the ESG Funds shall automatically transfer to City or to such assignee as City
may designate.
11. REPAYMENT OF ESG Fi1NDS.
All ESG Funds are subject to repayment in the event the Program does not meet the
requirements of this Contract or in the ESG Regulations. If Agency takes any action that
results in the City being required to repay all or any portion of the ESG Funds to HUD,
Agency agrees it will reimburse City for such repayment. If Agency takes any action that
results in City receiving a finding from HUD about the Program, whether or not
repayment of all or any portion of the ESG Funds is required of City, Agency agrees it will
pay City 10% of the ESG Funds as liquidated damages. The Parties agree that City's
damages in the event of either repayment to HUD being required or receiving a finding from
IIUD are uncertain and would be difficult to ascertain and may include an impact on City's ESG
grant or other federal grant funds, in addition to the finding by HUD or a required repayment of
funds to HUD by City. Therefore, the Parties agree that payment under this Section of 10% of
the ESG Funds by Agency to City is liquidated damages and not a penalty.
12. CHANGE IN NON-PROFIT STATUS.
Agency must provide City with written notification of any changes to its non-profit status
within 15 calendar days of being notified of the change. If the non-profit status of Agency
changes after the date of this Contract, City may but is not obligated to, terminate this Contract.
City has 30 calendar days to make such determination after receipt of written notice from
Agency and failure to make such determination will constitute a waiver. In the event of
termination under this Section 12, all ESG Funds awarded but not yet paid to Agency pursuant to
this Contract shall be immediately rescinded and Agency shall have no further right to such
funds. Any ESG Funds already paid to Agency must be repaid to City within 30 calendar days
of termination under this Section.
13. SURVIVAL.
Any provision of this Contract that pertains to auditing, monitoring, client income
eligibility, record keeping and reports, City ordinances, or applicable ESG requirements, and any
default and enforcement provisions necessary to enforce such provisions, shall survive the
termination of this Contract for 5 years after the Contract term ends and shall be enforceable by
City against Agency. For purposes of this Contract, this 5 year period for survival of certain
Contract provisions is deemed to begin on October 1, 2016 and end on September 30, 2021
regardless of whether or not this Contract is earlier terminated.
14. GENERAL PROVISIONS
14.1 Agency an Independent Contractor.
Agency shall operate hereunder as an independent contractor and not as an officer, agent,
servant or employee of City. Agency shall have exclusive control of, and the exclusive right to
control, the details of the work and services performed hereunder, and all persons performing
ESG PSA CONTRACT 2015-2016 Page 19
YWCA Fort Worth and Tarrant County Rev. 10.02.2015
same, and shall be solely responsible for the acts and omissions of its officers, members, agents,
servants, employees, contractors, subcontractors,vendors, clients, licensees or invitees.
14.2 Doctrine of Respondeat Superior.
The doctrine of respondeat superior shall not apply as between City and Agency, or its
officers, members, agents, servants, employees, contractors, subcontractors, vendors, clients,
licensees or invitees, and nothing herein shall be construed as creating a partnership or joint
enterprise between City and Agency. City does not have the legal right to control the details of
the tasks performed hereunder by Agency, its officers, members,agents, employees, contractors,
subcontractors,vendors, clients, licensees or invitees.
14.3 Agency Property.
City shall under no circumstances be responsible for any property belonging to Agency,
or its officers, members, agents, employees, contractors, subcontractors, vendors, clients,
licensees or invitees that may be lost, stolen or destroyed or in any way damaged and AGENCY
HEREBY INDEMNIFIES AND HOLDS HARMLESS CITY AND ITS OFFICERS,
AGENTS, AND EMPLOYEES FROM ANY AND ALL CLAIMS OR SUITS
PERTAINING TO OR CONNECTED WITH SUCH PROPERTY.
14.5 Religious Organization.
No portion of the ESG Funds shall be used in support of any sectarian or religious
activity. In addition, there must be no religious or membership criteria for clients of a ESG-
funded service.
14.6 Venue.
Venue shall lie in Tarrant County, 'Texas for any action, whether real or asserted, at law
or in equity, arising out of the execution, performance, attempted performance or
non-performance of this Contract.
14.7 Governing Law.
This Contract shall be governed by and construed in accordance with the laws of the
State of Texas. If any action, whether real or asserted, at law or in equity, arises out of the
execution, performance or non-performance of this Contract or on the basis of any provision
herein, for any issue not governed by federal law,the choice of law shall be the laws of the State
of Texas.
14.8 Severability.
The provisions of this Contract are severable, and if for any reason a clause, sentence,
paragraph or other part of this Contract shall be determined to be invalid by a court or federal or
state agency, board or commission having jurisdiction over the subject matter thereof, such
invalidity shall not affect other provisions which can be given effect without the invalid
provision.
14.9 Written Agreement Entire Contract.
This written instrument and the Exhibits, Attachments, and Addendums attached hereto,
which are incorporated by reference and made a part of this Contract for all purposes, constitute
the entire agreement by the Parties concerning the work and services to be performed under this
ESG PSA CONTRACT 2015-2016 Page 20
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Contract. Any prior or contemporaneous oral or written agreement which purports to vary the
terms of this Contract shall be void. Any amendments to the terms of this Contract must be in
writing and executed by the Parties.
14.10 Paraeraph Headings for Reference Only, No Legal Significance; Number
and Gender.
The paragraph headings contained herein are for convenience in reference to this
Contract and are not intended to define or to limit the scope of any provision of this Contract.
When context requires, singular nouns and pronouns include the plural and the masculine gender
shall be deemed to include the feminine or neuter and the neuter gender to include the masculine
and feminine. The words"include" and"including"whenever used herein shall be deemed to be
followed by the words"without limitation".
14.11 Compliance With All Applicable Laws and Regulations.
Agency agrees to comply fully with all applicable laws and regulations that are currently
in effect or that are hereafter amended during the performance of this Contract. Those laws
include,but are not limited to:
➢ ESC Regulations found in 24 CFR Part 576
➢ SubtitleB of Title IV of the McKinney-Vento Homeless Assistance Act, as amended,
(42 USC 11371)
➢ Title VI of the Civil Rights Act of 1964 (42 U.S.C. Sections 2000d et seq.) including
provisions requiring recipients of federal assistance to ensure meaningful access by
person of limited English proficiency
➢ The Fair Housing Act, Title VIII of the Civil Rights Act of 1968 (42 U.S.C. Sections
3601 et seq.)
➢ Executive Orders 11063, 11246 as amended by 11375 and 12086 and as
supplemented by Department of Labor regulations 41 CFR Part 60
➢ The Age Discrimination in Employment Act of 1967
➢ The Age Discrimination Act of 1975 (42 U.S.C. Sections 6101 et seq.)
➢ The Uniform Relocation Assistance and Real Property Acquisition Policies Act of
1970 (42 U.S.C. Sections 4601 et seq. and 49 CFR Part 24) ("URA")
➢ Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. Sections 794 et seq.) and 24
CFR Part 8 where applicable
➢ National Environmental Policy Act of 1969, as amended, 42 U.S.C. Sections 4321 et
seq. ("NEPA") and the related authorities listed in 24 CFR Part 58.
➢ The Clean Air Act, as amended, (42 U.S.C. Sections 1251 et seq.) and the Clean
Water Act of 1977, as amended (33 U.S.C. Sections 1251 el seq.) and the related
Executive Order 11738. In no event shall any amount of the assistance provided
under this Contract be utilized with respect to a facility that has given rise to a
conviction under the Clean Air Act or the Clean Water Act.
➢ Immigration Reform and Control Act of 1986 (8 U.S.C. Sections 1101 et seq.)
specifically including the provisions requiring employer verifications of legal status
of its employees
➢ The Americans with Disabilities Act of 1990 (42 U.S.C. Sections 12101 et seq.), the
Architectural Barriers Act of 1968 as amended (42 U.S.C. Sections 4151 el seq.) and
the Uniform Federal Accessibility Standards,24 CFR Part 40,Appendix A
ESG PSA CONTRACT 2015-2016 Page 21
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YWCA Fort Worth and Tarrant County
➢ Regulations at 24 CFR Part 87 related to lobbying, including the requirement that
certifications and disclosures be obtained from all covered persons
➢ Drug Free Workplace Act of 1988 (41 U.S.C. Sections 701 et seq.) and 24 CFR Part
23, Subpart F
➢ Executive Order 12549 and 24 CFR Part 5.105(c) pertaining to restrictions on
participation by ineligible, debarred or suspended persons or entities
➢ Section 6002 of the Solid Waste Disposal Act, as amended by the Resource
Conservation and Recovery Act
➢ Guidelines of the Environmental Protection Agency at 40 CFR Part 247
➢ For contracts and subgrants for construction or repair, Copeland "Anti-Kickback" act
(18 U.S.C. 874) as supplemented in 29 CFR Part 5
➢ For construction contracts awarded by Agency in excess of$2,000, and in excess of
$2,500 for other contracts which involve the employment of mechanics or laborers,
Sections 103 and 107 of the Contract Work Hours and Safety Standards Act (40
U.S.C. 327A 300) as supplemented by 29 CFR Part 5
➢ Lead-Based Paint Poisoning Prevention Act (42 U.S.C. 4801 et seq.), as amended by
the Residential Lead-Based Paint Hazard Reduction Act of 1992 (42 U.S.C. 4851 et
seq.) and implementing regulations at 24 CFR Part 35, subparts A, B,M, and R
➢ Urdform Administrative Requirements, Cost Principles, and Audit Requirements for
Federal Awards,2 CFR Part 200 et seq.
➢ Federal Funding Accountability and Transparency Act of 2006 ("FFATA") (Pub.L.
109-282, as amended by Section 6205(a) of Pub.L. 110-252 and Section 3 of Pub.L.
113-101)
➢ Federal Whistleblower Regulations, as contained in 10 U.S.C. 2409, 41 U.S.C. 4712,
10 U.S.C. 2324, 41 U.S.C. 4304 and 41 U.S.C. 4310,
14.11 HUD-Assisted Pro'ects and Em to ment and other Economic
Opportunities; Section 3 Requirements.
14.11.1 Requirement that Law Be Quoted in Covered Contracts. — Certain
Requirements Pertaining to Section 3 of the Housing and Urban
Development Act of 1968 as Amended (12 U.S.C. Sections 1701 et seg.
and its Related Regulations at 24 CFR Part 135.
If the Program results in the creation of new employment, training, or contracting
opportunities on a contractor or subcontractor level resulting from the expenditure of the ESG
Funds, Agency shall comply with the following and will ensure that its contractors also comply.
If the work performed under this Contract is on a project assisted under a program providing
direct federal financial assistance from HUD, Section 3 of 24 CFR Part 135.38 ("Section 3")
requires that the following clause, shown in italics,be inserted in all covered contracts ("Section
3 Clause"):
Section to be quoted in covered contracts begins:
"A. The work to be performed under this contract is subject to the
requirements of Section 3 of Housing and Urban Development Act of 1968, as
amended, 12 U.S.C. section 1701 a (Section 3). The purpose of Section 3 is to
ensure that employment and other economic opportunities generated by HUD
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assisted or HUD-assisted programs covered by Section 3, shall to the greatest
extent feasible, be directed to low- and very-low income persons, particularly
persons who are recipients of HUD assistance for housing.
B. The parties to this contract agree to comply with HUD's regulations in 24
CFR Part 135, which implement Section 3. As evidenced by their execution of
this contract, the parties to this contract certify that they are under no contractual
or other impediment that would prevent them from complying with the Part 135
regulations.
C. The contractor agrees to send to each labor organization or
representative of workers with which it has a collective bargaining agreement or
other understanding, if any, a notice advising the labor organization or workers'
representatives of the contractor's commitments under this Section 3 clause and
will post copies of the notice in conspicuous places at the work site where both
employees and applicants for training and employment positions can see the
notice. The notice shall describe the Section 3 preference, shall set forth
minimum number and job titles subject to hire, availability of apprentice and
training positions, the qualifications for each; and the name and location of the
person(s) taking applications for each of the positions; and the anticipated date
the work shall begin.
D. The contractor agrees that it will include this Section 3 clause in every
subcontract to comply with regulation in 24 CFR Part 135, and agrees to take
appropriate action, as provided in an applicable provision of the subcontract or
in this Section 3 clause, upon finding that the subcontractor is in violation of the
regulations in 24 CFR Part 135. The contractor will not subcontract with any
subcontractor where it has notice or knowledge that the subcontractor has been
found in violation of regulations in 24 CFR Part 135.
E, The contractor will certify that any vacant employment positions,
including training positions that are filed: (1) after the contractor is selected but
before the contract is executed, and(2) with persons other than those to whom the
regulations of 24 CFR Part 135. The contractor will not subcontract with any
subcontractor where it has notice or knowledge that the subcontractor has been
found in violation of regulations in 24 CFR Part 135.
F Noncompliance with HUD's regulation in 24 CFR Part 135 may result in
sanctions, termination of this contract for default, and debarment or suspension
f om future HUD assisted contracts.
G. With respect to work performed in connection with Section 3 covered
Indian housing assistance, section 7(b) of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. Section 450(e) also applies to the work to be
performed under this Contract. Section 7(b) requires that to the greatest extent
feasible (i) preference and opportunities for training and employment shall be
given to Indians, and (ii)preference in the award of contracts and subcontracts
shall be given. to Indian organizations and Indian-owned Economic Enterprises.
Parties to this contract that are subject to the provisions of Section 3 and Section
7(b) agree to comply with Section 3 to the maximum extent feasible, but not in
derogation of compliance with Section 7(b). "
Section to be quoted in covered contracts ends.
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14.11.2 Agency Responsibilities for Section 3 Requirements.
City and Agency understand and agree that compliance with the provisions of Section 3,
the regulations set forth in 24 CFR Part 135, and all applicable rules and orders of HUD shall be
a condition of the federal financial assistance provided to the Program binding upon City and
Agency and their respective successors, assigns, contractors and subcontractors. Failure to fulfill
these requirements shall subject Agency and its contractors and subcontractors and their
respective successors and assigns to those sanctions specified by the grant agreement through
which federal assistance is provided and to such sanctions as are specified by 24 CFR Part 135.
Agency's responsibilities include:
14.11.2.1 Implementing procedures to notify Section 3 residents and
business concerns about training, employment, and contracting
opportunities generated by Section 3 covered assistance;
14.11.2.2 Notifying potential contractors working on Section 3 covered
projects of their responsibilities;
14.11.2.3 Facilitating the training and employment of Section 3 residents and
the award of contracts to Section 3 business concerns;
14.11.2.4 Assisting and actively cooperating with the HED Department in
making contractors and subcontractors comply;
14.11.2.5 Refraining from entering into contracts with contractors that are in
violation of Section 3 regulations;
14.11.2.6 Documenting actions taken to comply with Section 3; and
14.11.2.7 Submitting Section 3 Annual Summary Reports (Form HUD-
60002) in accordance with 24 CFR Part 135.90.
14.11.3 Section 3 Reporting Requirements. must submit the forms
In order to comply with the Section 3 requirements, Agency
attached hereto as EXHIBIT "G" - Section 3 Reporting Forms.
14.11.3.1 Report to the City on a quarterly basis all applicants for
employment, and all applicants for employment by contractor and
subcontractor. This shall include name, address, zip code, date of
application, and status (hired/not hired) as of the date of the report.
14.11.3.2 Advertise available positions to the public for open competition,
and provide documentation to City with the quarterly report that
demonstrates such open advertisement in the form of printout of
Texas Workforce Commission posting, copy of newspaper
advertisement, copy of flyers and listing of locations where flyers
were distributed, and the like.
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14.113.3 Report to the City on a quarterly basis all contracts awarded by
contractor and subcontractor. This shall include name of
contractor and/or subcontractor, address, zip code, and amount of
award as of the date of the report.
14.12 Prohibition Against Discrimination,
14.12.1 General Statement.
Agency shall comply in the execution, performance or attempted performance of this
Contract, with all non-discrimination requirements of 24 CFR Part 5 as modified by 24 CPR Part
576.57(a) and Chapter 17, Article III, Division 4—Fair Housing of the City Code. Agency may
not discriminate against any person because of race, color, sex, gender, religion, national origin,
familial status, disability or perceived disability, sexual orientation, gender identity, gender
expression, or transgender, nor will Agency permit its officers, members, agents, employees, or
clients to engage in such discrimination.
This Contract is made and entered into with reference specifically to Chapter 17, Article
I11, Division 3 - Employment Practices of the City Code, and Agency hereby covenants and
agrees that Agency, its officers, members, agents, employees and contractors, have fully
complied with all provisions of same and that no employee, or applicant for employment has
been discriminated against under the terms of such ordinances by either or its officers, members,
agents, employees or contractors.
14.12.2 No Discrimination in Employment durin2 the Performance of This
Contract.
During the performance of this Contract Agency agrees to the following provision, and
will require that its contractors and subcontractors also comply with such provision by including
it in all contracts with its contractors:
[Contractor's Subcontractor's or Vendor's name] will not unlawfully discriminate
against any employee or applicants for employment because of race, color, sex, gender, religion,
national origin, familial status, disability or perceived disability, sexual orientation, gender
identity, gender expression or transgender. [Contractor's Subcontractor's or Vendor's name]
will take affirmative action to ensure that applicants are hired without regard to race, color, sex,
gender, religion, national origin, familial status, disability or perceived disability, sexual
orientation, gender identity, gender expression or transgender and that employees are treated
fairly during employment without regard to their race, color, sex, gender, religion, national
origin, familial status, disability or perceived disability, sexual orientation, gender identity,
gender expression or transgender. Such action shall include, but not be limited to,the following:
employment, upgrading, demotion or transfer, recruitment or recruitment advertising, layoff or
termination, rates of pay or other forms of compensation, and selection for training, including
apprenticeship. [Contractor's Subcontractor's or Vendor's name] agrees to post in conspicuous
places, available to employees and applicants for employment, notices setting forth the
provisions of this nondiscrimination clause.
[Contractor's Subcontractor's or Vendor's name] will, in all solicitations or
advertisements for employees placed by or on behalf of [Contractor's Subcontractor's or
ESG PSA CONTRACT 2015-2016 Rev. 10.02.2015
YWCA Fort Worth and Tarrant County
Vendor's name], state that all qualified applicants will receive consideration for employment
without regard to race, color, sex, gender, religion, national origin, familial status, disability or
perceived disability, sexual orientation, gender identity, gender expression or transgender.
[Contractor's Subcontractor's or Vendor's name] covenants that neither it nor any of its
officers, members, agents, employees, or contractors, while engaged in performing this Contract,
shall, in connection with the employment, advancement or discharge of employees or in
connection with the terms, conditions or privileges of their employment, discriminate against
persons because of their age or because of any disability or perceived disability, except on the
basis of a bona fide occupational qualification,retirement plan or statutory requirement.
[Contractor's Subcontractor's or Vendor's name] further covenants that neither it nor its
officers, members, agents, employees, contractors, or persons acting on their behalf, shall
specify, in solicitations or advertisements for employees to work on this Contract, a maximum
age limit for such employment unless the specified maximum age limit is based upon a bona fide
occupational qualification,retirement plan or statutory requirement.
14.12.3 Atiency's Contractors and the ADA.
In accordance with the provisions of the Americans With Disabilities Act of 1990
("ADA"), Agency warrants that it and any of its contractors will not unlawfully discriminate on
the basis of disability in the provision of services to the general public, nor in the availability,
terms and/or conditions of employment for applicants for employment with, or employees of,
Agency or any of its contractors. AGENCY WARRANTS IT WILL FULLY COMPLY
WITH THE ADA'S PROVISIONS AND ANY OTHER APPLICABLE FEDERAL,
STATE AND LOCAL LAWS CONCERNING DISABILITY AND WILL DEFEND,
INDEMNIFY AND HOLD CITY HARMLESS AGAINST ANY CLAIMS OR
ALLEGATIONS ASSERTED BY THIRD PARTIES, CONTRACTORS
SUBCONTRACTORS, VENDORS OR AGENTS AGAINST CITY ARISING OUT OF
AGENCY'S AND/OR ITS CONTRACTORS', SUBCONTRACTORS', VENDORS' OR
AGENTS' OR THEIR RESPECTIVE EMPLOYEES' ALLEGED FAILURE TO
COMPLY WITH THE ABOVE-REFERENCED LAWS CONCERNING DISABILITY
DISCRIMINATION IN THE PERFORMANCE OF THIS CONTRACT.
14.13. Conflicts of Interest and Violations of Criminal Law.
14.13.1 Agencv Safeivards.
Agency shall establish safeguards to prohibit its employees, board members, advisors and
agents from using positions for a purpose that is or gives the appearance of being motivated by a
desire for private gain for themselves or others, particularly those with whom they have family,
business or other ties. Agency shall disclose to City any such conflict of interest or potential
conflict of interest, immediately upon discovery of such.
14.13.2 General Prohibition Against Conflicts of Interest.
No employees, agents, consultants, officers or elected officials or appointed officials of
City or of Agency who exercise or have exercised any functions or responsibilities with respect
to activities assisted with ESG funds or who are in a position to participate in a decision-making
process or gain inside information with regard to these activities may utilize ESG services, may
ESG PSA CONTRACT 2015-2016 Page 26
Rev. 10.02.2015
YWCA Fort Worth and Tarrant County
obtain a financial interest or benefit from a ESG-assisted activity, or have an interest in any
contract, subcontract or agreement with respect thereto, or the proceeds thereunder, either for
themselves or those with whom they have family or business ties, during their tenure or for 1
year thereafter, unless they are accepted in accordance with the procedures set forth at 24 CFR
Part 576.57(d).
14.13.2.1 Agency shall establish conflict of interest policies for federal
awards including the ESG Funds and shall disclose in writing
potential conflicts of interest to City as authorized by 2 CFR Part
200.112.
14.13.3 Conflicts of Interest Involving Procurement.
The conflict of interest provisions of 24 CFR Part 85.36 and 24 CFR Part 84.42,
respectively, shall apply in the procurement of property and services by Agency. In all cases not
governed by those Sections, the provisions of 24 CFR Part 576.57(d) of the ESG Regulations
shall apply.
14.13.3.1 As more particularly described in 2 CFR Part 200.318, Agency
shall maintain and submit to City written standards of conduct
covering conflicts of interest and governing the performance of its
employees engaged in the selection, award, and administration of
contracts. No employee, officer, or agent may participate in the
selection, award, or administration of a contract supported by a
federal award if he or she has a real or apparent conflict of interest.
The standards of conduct must provide for disciplinary actions to
be applied for violations of such standards by officers, employees,
or agents of Agency.
14.13.3.2 The officers, employees, and agents of Agency shall neither solicit
nor accept gratuities, favors, or anything of monetary value from
contractors or parties to subcontracts.
14.13.3.3 Notwithstanding the prohibition contained in Section 14.13.3.2,
Agency may set standards of conduct for situations in which the
financial interest is not substantial or the gift is an unsolicited item
of nominal value. Such standards of conduct must provide for
disciplinary actions to be applied for violations of such standards
by Agency's officers, employees or agents.
14.13.3.4 Agency shall maintain written standards of conduct covering
organizational conflicts of interest. Organizational conflicts of
interest means that because of relationships with a parent company,
affiliate, or subsidiary organization, Agency is unable or appears to
be unable to be impartial in conducting a procurement action
involving a related organization.
14.13.3.5 Agency must maintain records sufficient to detail the history of
procurement. These records will include, but are not necessarily
Page 27
ESG PSA CONTRACT 2015-2016 Rev. 10.02.2015
YWCA Fort Worth and Tarrant County
limited to the following: rationale for the method of procurement,
selection of contract type, contractor selection or rejection, and the
basis for the contract price.
14.13.4 Disclosure of Conflicts of Interest.
In compliance with 2 CFR Part 200.112, Agency is required to timely disclose to City in
writing any potential conflict of interest.
14.13.5 Disclosure of Texas Penal Code Violations.
Agency affirms that it will adhere to the provisions of the Texas Penal Code which
prohibit bribery and gifts to public servants.
14.13.6 Disclosure of Federal Criminal Law Violations.
In compliance with 2 CFR Part 200.113, Agency is required to timely disclose to City all
violations of federal criminal law involving fraud, bribery or gratuity violations potentially
affecting the Agency.
14.14 Subcontracting with Small and Minority Firms, Women's Business
Enterprises and Labor Surplus Areas.
14.14.1 For procurement contracts $50,000.00 or larger that are paid for, in part of in
full, with ESG Funds, Agency agrees to abide by City's policy to involve Minority Business
Enterprises and Small Business Enterprises and to provide them equal opportunity to compete
for contracts for construction, provision of professional services, purchase of equipment and
supplies and provision of other services required by City. Agency agrees to incorporate the
City's BDE Ordinance, and all amendments or successor policies or ordinances thereto, into all
contracts and subcontracts for procurement larger than $50,000.00 or larger that are paid for, in
part or in full, with the ESG Funds and will further require all persons or entities with which it so
contracts to comply with said ordinance.
14.14.2 It is national policy to award a fair share of contracts to disadvantaged
business enterprises ("DBEs"), small business enterprises ("SBEs"), minority business
enterprises ("MBEs"), and women's business enterprises ("WBEs"). Accordingly, affirmative
steps must be taken to assure that DBEs, SBEs, MBEs, and WBEs are utilized when possible as
sources of supplies, equipment, construction and services.
14.14.2.1 In order to comply with federal reporting requirements, Agency
must submit the form attached hereto as EXHIBIT "L" — MBE
Reporting Form for each contract or subcontract with a value of
$10,000.00 or more paid or to be paid with the ESG Funds.
Agency shall submit this form by the date specified in EXHIBIT
"L"—MBE Reporting Form.
14.15 Other Laws.
The failure to list any federal, state or City ordinance, law or regulation that is applicable
to Agency does not excuse or relieve Agency from the requirements or responsibilities in regard
to following the law, nor from the consequences or penalties for Agency's failure to follow the
law,if applicable.
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ESG PSA CONTRACT 2015-2016 Rev. 10.02.2015
YWCA Fort Worth and Tarrant County
14.16 Assignment.
Agency shall not assign all or any part of its rights, privileges, or duties under this
Contract without the prior written approval of City. Any attempted assigmnent of same without
approval shall be void, and shall constitute a breach of this Contract.
14.17. Right to Inspect Agency Contracts.
It is agreed that City has the right to inspect and approve in writing any proposed
contracts between Agency and any contractor or vendor engaged in any activity in conjunction
with this ESG-funded Program prior to any charges being incurred.
14.18 Force Maieure
If Agency becomes unable, either in whole or part, to fulfill its obligations under this
Contract due to acts of God, strikes, lockouts, or other industrial disturbances, acts of public
enemies, wars, blockades, insurrections, riots, epidemics, earthquakes, fires, floods, restraints or
prohibitions by any court, board, department, commission or agency of the United States or of
any States, civil disturbances, or explosions, or some other reason beyond Agency's control
(collectively, "Force Majeure Event"),the obligations so affected by such Force Majeure Event
will be suspended only during the continuance of such event. Agency will give City written
notice of the existence, extent and nature of the Force Majeure Event as soon as reasonably
possible after the occurrence of the event. Failure to give notice will result in the continuance of
Agency's obligation regardless of the extent of any existing Force Majeure Event. Agency will
use commercially reasonable efforts to remedy its inability to perform as soon as possible.
15. INDEMNIFICATION AND RELEASE.
AGENCY COVENANTS AND AGREES TO INDEMNIFY, HOLD HARMLESS
AND DEFEND, AT ITS OWN EXPENSE, CITY AND ITS OFFICERS, AGENTS,
SERVANTS AND EMPLOYEES FROM AND AGAINST ANY AND ALL CLAIMS OR
SUITS FOR PROPERTY LOSS OR DAMAGE AND/OR PERSONAL INJURY,
INCLUDING DEATH, TO ANY AND ALL PERSONS, OF WHATSOEVER KIND OR
CHARACTER, WHETHER ERg�AEXECi1TIONRTPERFORMANCOUTO
CONNECTION W ATTEMPTED
PERFORMANCE OR NONPERFORMANCE OF THIS CONTRACT AND/OR THE
OPERATIONS, ACTIVITIES AND SERVICES OF THE PROGRAM DESCRIBED
HEREIN, WHETHER OR NOT CAUSED IN WHOLE OR IN PART, BY ALLEGED
NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES,
CONTRACTORS OR SUBCONTRACTORS OF CITY; AND AGENCY HEREBY
ASSUMES ALL LIABILITY AND RESPONSIBILITY OF CITY AND ITS OFFICERS,
AGENTS, SERVANTS, AND EMPLOYEES FOR ANY AND ALL CLAIMS OR SUITS
FOR PROPERTY LOSS OR DAMAGE AND/OR PERSONAL INJURY, INCLUDING
DEATH, TO ANY AND ALL PERSONS, OF WHATSOEVER KINDS OR
CHARACTER, WHETHER REAL OR ASSERTED, ARISING OUT
ATTE OR IN
M
CONNECTION WITH THE EXECUTION, PERFORANCE,
PERFORMANCE OR NONPERFORMANCE OF THIS CONTRACT AND/OR THE
OPERATIONS, ACTIVITIES AND SERVICES OF THE PROGRAM DESCRIBED
HEREIN, WHETHER OR NOT CAUSED IN WHOLE OR IN PART BY ALLEGED
Page 29
ESG PSA CONTRACT 2015-2016 Rev. 10.02.2015
YWCA Fort Worth and Tarrant County
NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES,
CONTRACTORS OR SUBCONTRACTORS OF CITY.
AND HOLD
COVENANTS AND AGREES TO AND DOE S
HARMLESS CITY FROM AND AGAINST ANY AND ALL INJURY, DAMAGE OR
DESTRUCTION OF PROPERTY OF CITY, ARISING OUT OF OR IN CONNECTION
WITH ALL ACTS OR OMISSIONS OF AGENCY, ITS OFFICERS, MEMBERS,
AGENTS, EMPLOYEES, INVITEES
CONTRACTORS, SUBCONTRACTORS,
LICENSEES, OR CLIENTS, OR CAUSED, IN WHOLE OR IN PART, BY ALLEGED
NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES,
CONTRACTORS OR SUBCONTRACTORS OF CITY.
IT IS THE EXPRESS INTENTION OF THE PARTIES, BOTH AGENCY AND
CITY, THAT THE INDEMNITY PROVIDED FOR THIS SECTION INCLUDES
INDEMNITY BY AGENCY TO INDEMNIFY AND PROTECT CITY FROM THE
NEGLIGE
NCE I SALLEGED TO'BE THE SOLENEGLIGENCE,
OR CONCURRING CAUSE OF THE
NEGLIGENCE IS
INJURY,DAMAGE OR DEATH.
AGENCY AGREES TO AND SHALL RELEASE CITY, ITS AGENTS,
EMPLOYEES, OFFICERS AND LEGAL REPRESENTATIVES FROM ALL
LIABILITY FOR INJURY, DEATH, DAMAGE OR LOSS TO PERSONS OR
PROPERTY SUSTAINED IN CONNECTION WITH OR INCIDENTAL TO
PERFORMANCE LOS THIS CAUSED CONTRACT,
CITY'S SOLE OR INJURY,OR CONC URRFNT
DAMAGE OR
NEGLIGENCE.
AGENCY SHALL REQUIRE ALL OF ITS CONTRACTORS AND
SUBCONTRACTORS TOCI I I FTSS Y T
A RELEASE AN DIND �rYNFAVOR O CIY IN SUBSTANTIALLY HE
SAME FORM AS ABOVE.
16. WAIVER OF IMMUNITY BY AGENCY.
If Agency, as a charitable or nonprofit organization, has or claims an immunity or
exemption (statutory or otherwise) from and against liability for damages or injury, including
death, to persons or property, Agency hereby expressly waives its rights to plead defensively
such immunity or exemption as against City. This Section shall not be construed to affect a
governmental entity's immunities under constitutional, statutory or common law.
17. INSURANCE AND BONDING.
Agency will maintain coverage in the form of insurance or bond in the amount of
$79,435.00 to insure against loss from the fraud, theft or dishonesty of any of Agency's officers,
agents, trustees, directors or employees. The proceeds of such insurance or bond shall be used to
reimburse City for any and all loss of ESG Funds occasioned by such misconduct. To effectuate
such reimbursement, such fidelity coverage shall include a rider stating that reimbursement for
any loss or losses shall name the City as a Loss Payee.
Page 30
ESG PSA CONTRACT 2015-2016 Rev. 10.02.2015
YWCA Fort Worth and Tarrant County
Agency shall furnish to City in a timely manner,but not later than the Effective Date,
certificates of insurance as proof that it has secured and paid for policies of commercial
insurance as specified herein. If City has not received such certificates by the Effective Date,
Agency shall be in default of the Contract and City may, at its option,terminate the Contract.
Such insurance shall cover all insurable risks incident to or in connection with the
execution, performance, attempted performance or nonperformance of this Contract. Agency
shall maintain the following insurance coverage and limits:
Commercial General Liability(COL)Insurance
$ 500,000 each occurrence
$1,000,000 aggregate limit
Non Profit Orzanization Liability or Directors & Officers Liabilit
$1,000,000 Each Occurrence
$1,000,000 Annual Aggregate Limit
Business Automobile Liability Insurance
$1,000,000 each accident on a combined single-limit basis, or
$ 250,000 Property Damage
$ 500,000 Bodily Injury per person per occurrence
$2,000,000 Aggregate
Insurance policy shall be endorsed to cover"Any Auto", defined as autos owned,hired,
and non-owned. Pending availability of the above coverage and at the discretion of
City,the policy shall be the primary responding insurance policy versus a personal
auto insurance policy if or when in the course of Agency's business as contracted
herein.
Workers' Compensation Insurance
Part A: Statutory Limits
Part B: Employer's Liability
$100,000 each accident
$100,000 disease-each employee
$500,000 disease-policy limit
Note: Such insurance shall cover employees performing work on any and all projects
including but not limited to construction, demolition, and rehabilitation. Agency or its
contractors shall maintain coverages, if applicable. In the event the respective contractors
do not maintain coverage, Agency shall maintain the coverage on such contractor, if
applicable, for each applicable contract.
Additional Requirements
Such insurance amounts shall be revised upward at City's reasonable option and no more
frequently than once every 12 months, and Agency shall revise such amounts within 30 days
following notice to Contractor of such requirements. Page 31
ESG PSA CONTRACT 2015-2016 Rev. 10.02.2015
YWCA Fort Worth and Tarrant County
Agency will submit to City documentation that it has obtained insurance coverage and has
executed bonds as required in this Contract prior to payment of any monies provided hereunder.
Where applicable, insurance policies required herein shall be endorsed to include City as an
additional insured as its interest may appear. Additional insured parties shall include employees,
officers, agents, and volunteers of City.
Any failure on part of City to request certificate(s) of insurance shall not be construed as a
waiver of such requirement or as a waiver of the insurance requirements themselves.
Insurers of Agency's insurance policies shall be licensed to do business in the state of Texas by
the Department of Insurance or be otherwise eligible and authorized to do business in the state of
Texas. Insurers shall be acceptable to City insofar as their financial strength and solvency and
each such company shall have a current minimum A.M. Best Key Rating Guide rating of A-: VII
or other equivalent insurance industry standard rating otherwise approved by City.
Deductible limits on insurance policies shall not exceed $5,000 per occurrence unless otherwise
approved by City.
In the event there are any local, federal or other regulatory insurance or bonding requirements for
the Program, and such requirements exceed those specified herein,the former shall prevail.
Agency shall require its contractors to maintain applicable insurance coverages, limits, and other
requirements as those specified herein; and Agency shall require its contractors to provide
Agency with certificate(s) of insurance documenting such coverage. Also, Agency shall require
its contractors to have City and Agency endorsed as additional insureds (as their interest may
appear) on their respective insurance policies.
Directors and Officers Liability coverage shall be in force and may be provided on a claims-
made basis. This coverage may also be referred to as Management Liability, and shall protect
the insured against claims arising out of alleged errors in judgment, breaches of duty and
wrongful acts arising out of their organizational duties. Coverage shall protect not only the
entity, but all past, present and future directors, officers, trustees, employees, volunteers and
committee members.
Notwithstanding any provision in this Contract to the contrary, when applicable, Agency
shall comply with the requirements of 2 CFR 200.310 and shall, at a minimum, provide the
equivalent insurance coverage for real property and equipment acquired or improved with
ESG Funds as provided to property owned by Agency.
18. CERTIFICATION REGARDING LOBBYING.
The undersigned representative of Agency hereby certifies, to the best of his or her
knowledge and belief,that:
Page 32
ESG PSA CONTRACT 2015-2016 Rev. 10.02.2015
YWCA Fort Worth and Tarrant County
No federal appropriated funds have been paid or will be paid, by or on behalf of Agency,
to any person for influencing or attempting to influence an officer or employee of any
agency, a member of Congress, an officer or employee of Congress in connection with
the awarding of any federal contract, the making of any federal grant, the making of any
federal loan, the entering into of any cooperative agreement and the extension,
continuation, renewal, amendment, or modification of any federal contract, grant, or
cooperative agreement.
If any funds other than federally appropriated funds have been paid or will be paid to any
person for influencing or attempting to influence an officer or employee of any agency,
member of Congress in connection with this federal contract, grant, loan or cooperative
agreement, Agency shall complete and submit Standard Form-LLL, "Disclosure Form to
Report Lobbying,"in accordance with its instructions.
This certification is a material representation of fact upon which reliance was placed
when this Contract was made or entered into. Submission of this certificate is a
prerequisite for making or entering into this Contract imposed by 31 U.S.C. Section
1352. Any person who fails to file the required certification shall be subject to a civil
penalty of not less than$10,000.00 and not more than$100,000.00 for each such failure.
Agency shall require that the language of this certification be included in all subcontracts
or agreements involving the expenditure of federal funds.
19. LITIGATION AND CLAIMS.
Agency shall give City immediate notice in writing of any action, including any
proceeding before an administrative agency, filed against Agency in conjunction with this
Contract or the Program. Agency shall furnish immediately to City copies of all pertinent papers
received by Agency with respect to such action or claim. Agency shall provide a notice to City
within 10 days upon filing under any bankruptcy or financial insolvency provision of law.
20. NOTICE.
All notices required or permitted by this Contract must be in writing and are deemed
delivered on the earlier date of the date actually received or the third day following deposit in a
United States Postal Service post office or receptacle; with proper postage, certified mail return
receipt requested; and addressed to the other Party at the address set out below or at such other
address as the receiving Party designates by proper notice to the sending Party.
City:
City Attorney's Office
1000 Throckmorton Street
Fort Worth, TX 76102
Telephone: 817-392-7600
Page 33
ESG PSA CONTRACT 2015-2016 Rev. 10.02.2015
YWCA Fort Worth and Tarrant County
Copy to:
Neighborhood Services Department
1000 Throckmorton Street
Fort Worth,TX 76102
Attention: Assistant Director
Telephone: 817-392-7540
Copy to:
Neighborhood Services Department
1000 Throckmorton Street
Fort Worth,TX 76102
Attention: Program Coordinator
Telephone: 817-392-6342
Aenc :
YWCA Fort Worth and Tarrant County
Carol Klocek
512 W. 4th Street
Fort Worth, Texas 76102
Telephone: 817-332-6410
21. AGENCY HAS LEGAL AUTHORITY TO ENTER INTO CONTRACT.
Agency represents that it possesses the legal authority, pursuant to any proper,
appropriate and official motion, resolution or action passed or taken, to enter into this Contract
and to perform the responsibilities herein required.
22. COUNTERPARTS.
This Contract may be executed in multiple counterparts, each of which shall be
considered an original, but all of which shall constitute one instrument whicb may be sufficiently
evidenced by one counterpart.
[SIGNATURES APPEAR ON NEXT PAGE]
ESG PSA CONTRACT 2015-2016 Page 33-1
YWCA Fort Worth and Tarrant County Rev. 10.02.2015
IN WITNESS WHEREOF,the Parties hereto have executed 4 duplicate originals of this
Contract in Fort Worth, Tarrant County, Texas.
ATTEST: CITY OF FORT WORTH
By:
City Secretary Fernando Costa, Assistant City Manager
M&C: G-18521
Date: August 4,2015
APPROVED AS TO FORM AND LEGALITY:
Assistant City Attorney
YWCA FORT WORTH AND TARRANT
COUNTY
By: �®
Name:
Title:
d
" 0 c 5A, L,R EC
11-Y SECRETARV
F i1, IIIfT I'll�'1 7
ESG PSA CONTRACT 2015-2016 Page 34
YWCA Fort Worth and Tarrant County Rev.09.01.2015
IN WITNESS WHEREOF,the Parties hereto have executed 4 duplicate originals of this
Contract in Fort Worth, Tarrant County, Texas.
�+T: CITY OF FORT WORTH
AT EST: y� 1 � C?r+p��ea �......,,�_....._._.........,.
ity Se i 1 . ; Fernando Costa, Assistant City Manager
M&C. -�X18521
Date: August 4, 2015
APPROVED AS TO FO SAND LEGALITY:
X 4�
Assistant City Attorney
YWCA FORT WORTH AND TARRANT
COUNTY
By:
Name: Carol Klocek
Title: CEO
6E)FFI C 0 AL R E i'l()111
CITY SECRETARY
ESG PSA CONTRACT 2015-2016 Page 34
YWCA Fort Worth and Tarrant County Rev. 10.02.2015
EXHIBITS:
EXHIBIT"A"—Program Summary
EXHIBIT "A-1"—2015 HUD Income Limits
EXHIBIT "B"—Budget
EXHIBIT "C"—Audit Certification Form
EXHIBIT "D" —Reimbursement Forms
EXHIBIT"E"—Form of Income Self-Certification
EXHIBIT "F"—Standards for Complete Documentation
EXHIBIT "G"—Section 3 Reporting Forms
EXHIBIT "H"—Match Report
EXHIBIT "I"—ESG Staff Certification Form
EXHIBIT "J" -ESG Performance Standards
EXHIBIT "J-1"—Written Standards for ESG Assistance
EXHIBIT "K"—ESG Quarterly HMIS Report
EXHIBIT "L"—MBE Reporting Form
ESG PSA CONTRACT 2015-2016 Page 35
YWCA Fort Worth and Tarrant County Rev. 10.02.2015
YWCA FORT WORTH AND TARRANT EXHIBIT"A"
COUNTY
YWCA Rapid Rehousing PROGRAM SUMMARY
PROGRAM SUMMARY
(ESG)
October 1, 2015 to September 30,2016 $79,435.00
AMOUNT
PERIOD
Capitalized terms not defined herein shall have meanings assigned them in the Contract.
PROGRAM:
The Program provides housing relocation and stabilization services including case management,
housing placement services, family stabilization, employment and education assistance, and
other life skills training to homeless households. These services must be provided in support of
and in conjunction with any rental and utility support that is provided through other funding
sources. Clients will receive re-housing within 30 days of contacting the Agency. Agency will
verify and document all client and housing unit eligibility as defined in 24 CFR 576.2 paragraphs
I and 4 (definition of homelessness) and 24 CFR 576.104 (Rapid-rehousing Component).
ESG Funds will be used to pay for the salaries and fringe benefits for Program employees.
Agency's Program office and services will be available at 512 E. 4th Street, Fort Worth, TX
76102,Monday through Friday, during regular business hours.
REGULATORY CLASSIFICATION:
Service Category (if more than one category, specify amount for each): ESG Relocation and
Stabilization Services in Support of Rapid Rehousing
Regulatory Citation(s): 24 CFR 576.104, 24 CFR 576.105, and 24 CFR 576.106
Agency will maintain documentation that 100% of clients served are homeless at the time of
Program entry in accordance with the ESG Regulations and that the client lacks sufficient
resources and support network to obtain housing. Agency will also maintain documentation on
eligibility for the housing unit for which financial assistance is provided, including rental
amounts and compliance with ESG Minimum Habitability Standards.
ESG PSA CONTRACT 2015-2016—EXHIBIT"A"—PROGRAM SUMMARY Page l
YWCA Fort Worth and Tarrant County
PROGRAM GOALS:
Minimum Number of Fort Worth Clients to be Served: The Program must serve a minimum
of 75 unduplicated households from Fort Worth as shown by the monthly reports on Attachment
III.
ESG PSA CONTRACT 2015-2016—EXHIBIT"A"—PROGRAM SUMMARY Page 2
YWCA Fort Worth and Tarrant County
EXHIBIT "A-1"
2015 HUD INCOME LIMITS
2015 Median Family Income-Fort Worth/Arlington,"1'X*
1 Person —T—Persons 3 Persons 4 Persons 5 Persons 6 Persons 7 Persons 8 Persons
30%AMI $14,650 $16,750 $20,090 $24,250 $28,410 $32,570 $36,730 $40,890
50%AM1 $24,400 $27,900 $31,400 $34,850 $37,650 $40,450 $43,250 $46,050
80% AMI $39,050 $44,600 $50,200 $55,750 $60,250 $64,700 $69,150 $73,600
*Income limits are published at least annually by HUD.
ESG PSA CONTRACT 2015-2016--EXHIBIT"A-l"-2015 HUD INCOME LIMITS Page 1
YWCA Fort Worth and Tarrant County
EXHIBIT"B"-BUDGET
Aceount.� Grant`,,.
"` .. Bad et
EMERGENCY SHELTER .
ESSENTIAL SERVICES
1001
Salaries
1002
Life Insurance
Health Insurance 1003
unemployment 1004
Worker's Compensation 1005
Retirement FICA/Medicare 1006 11007 1,Office Su lies
Postage 1008
Printing 1009
Craft lies 1110 1,200
1111 1,200
Food Su lies 1,521 1,521
Insurance 7112
Accounting 1113 3,896
Contract Labor
1114 3,896
SHELTER OPERATIONS 8 788 gV2,772
Maintenance 1115
Rent 1116 203
security 1117
Insurance 1118 1119 2,772 Utilities 1120 418
Supplies
Hotel/Motel Vouchers 1121
RENOVATIONS 20,525 20,525
SUBTOTAL EMERGENCY SHELTER
--7 77777777777
HLUSING IEI OCAION.AND
STABILIZATION
Salaries-Prevention 2001
FICA-Prevention 2002
Life Insurance-Prevention 2003
Health Insurance-Prevention 2004
Disabilitv Insurance-Prevention 200'
Unem to ment-State-Prevention 2006
2007 75,000 57,020 132,020
Salaries-ReHousin 6 273 10,708
FICA-ReHousing 2008 4,435
WInsurance-ReHousing ce-ReHousin C2009 18,437 rance-ReHousin 1 8,437
surance-ReHousin 1,578
1,578
eat-State-ReHousing 79,435 83,308 162,743
SUBTOTAL-ASSISTANCE stance-Prevention 319,260
Rental Assistance-ReHousin 319,260
Utli Payments-Prevention 3003 4,000
3004 4,000
Utility Deposits-ite"ousing 11,000 11,000
Movin Costs-ReHousin 3005
Motel/Hotel Vouchers-ReHousing 3006
Security Deposits-ReHousing 3001 334,260 334,260
SUBTOTAL-FINANCIAL ASSISTANCE
HMIS-Prvvention 4001
HMIS-ReHousing 4002
SUBTOTAL-HMIS 517,528 .
TQTALESrCONTIAC AMOUNT' :` 179,435 , '103,833 .334260
FUNDING A: PRIVATE DONATIONS AND GRANTS(YWCA)
FUNDING B: GOVERNMENT GRANT FUNDING
FUNDING C:
ESG PSA CONTRACT 2015-2016-EXHIBIT`B"-BUDGET
Page 1
YWCA Fort Worth and Tarrant County
The following tables were created for the purpose of preparing, negotiating, and determining the
cost reasonableness and cost allocation method used by the Agency for the line item budget
represented on the first page of this EXHIBIT "B" —Budget. The information reflected in the
tables is to be considered part of the terms and conditions of the Contract. Agency must have
prior written approval by the City to make changes to any line item in the Budget as outlined in
Section 5.2.2 in the Contract. The deadline to make changes to EXHIBIT`B"—Budget is June
1, 2016.
SALARY DETAIL
Cost Type(Admin or Hourly Annual Percent Amount to
Position Housing Relocation I Rate Hours to Grant Grant
Stabilization Services
Case Manager Stabilization Services 16.83 2080 100% 35,000
Lead Case Manager Stabilization Services 19.23 2080 100% 40,000
75,000 100% 75,000
TOTAL
FRINGE DETAIL
Percent to Amount to Grant
Percent of Payroll Amount Grant
FICA
8% 10,708 41% 4,435
Life Insurance
Health Insurance
Unemployment
Workers Cornl2ensation
Retirement 10,708 41% 4,435
TOTAL
SUPPLIES AND SERVICES
=TotalBud7Perc771M
OTOTAL Supplies
ment Rental
MISCELLANEOUS
Total Budget Percent to Grant Amount to Grant
Conference&Seminars
Construction/Building
Materials
Contract Labor
Craft Su plies
Credit Reports
Facility Fees
Field Tri Costs
Food Supplies
Mileage
Teaching Aids 0
TOTAL
ESG PSA CONTRACT 2015-2016—EXHIBIT`B"—BUDGET
Page 2
YWCA Fort Worth and Tarrant County
FACILITY AND UTILITIES
Total Bud et Percent to Grant Amount to Grant
Tele hone
Electric
Gas
Neater and Wastewater
Solid Waste Dis osal
Rent _
Custodial Services
Repairs ---
Cleaning Sup lies 0
TOTAL
LEGAL,FINANCIAL AND INSURANCE mount to Grant
Total Bud et
Fidelity Bond(or
E uivalent)
General Commercial
Liabilit
Directors and Officers
Legal Fees —
Contract Accounting 0
TOTAL
FINANCIAL ASSISTANCE Amount to Grant
Total Bud et Percent to Grant
Ra id Re-Housin
Homelessness Prevention 0
TOTAL
HMIS
Total Budget Percent to Grant Amount to Grant
*Homelessness usin
Prevention 0
ESG PSA CONTRACT 2015-2016—EXHIBIT`B"—BUDGET
Page 3
YWCA Fort Worth and Tarrant County
EXHIBIT"C"
AUDIT CERTIFICATION FORM
ESG PSA CONTRACT 2015-2016—EXHIBIT"C"—AUDIT CERTIFICATION FORM Page 1
YWCA Fort Worth and Tarrant County
AUDIT CERTIFICATION FORM AND AUDIT REQUIREMENTS
Agency: YWCA Fort Worth and Tarrant County
Fiscal Year Ending: September 30,2016
During the fiscal year in which funds will be received, we will exceed the federal
expenditure threshold of $750,000. We will have our Single Audit or Program Specific
Audit completed and will submit the audit report described in 2 CFR Part 200 within 7
months after the end of the audited fiscal year or 30 days within its completion, whichever
is the earlier date.
❑ During the fiscal required funds will
e exceed c $750,000
federal expenditure threshold for a S be ingle received,
dit or Program Specific be
performed this fiscal year. (Fill out schedule below)
Federal Ex endituxe I?isclpsure
WS Aaxdit or 'ro rani Audit xs TOT rqutred,
Pass Through progralrn l*Tatne& Contract Ependtr �s
Fderal Grtttor Qrantor : . CFUAul,
ex ' , �Iuinber, =3
Total Federal Expenditures for this Fiscal Year:
Date
NignAatorVp6nd Title
Failure to submit this or a similar statement or failure to submit a completed single audit package
as described in the federally required audit requirements described in 2 CFR Part 200, as
applicable, by the required due date may result in suspension of funding and may affect
eligibility for future fundonmeetNotwithstanding o er financial reporting�sfinan�al statements,certification
and other
agency's commitment t
audit requirements as may be set forth in the Contract.
ESG PSA CONTRACT 2015-2016—EXHIBIT"C"—AUDIT CERTIFICATION FORM Page 2
YWCA Fort Worth and Tarrant County
EXHIBIT"D"
REPORTING FORMS
ESG PSA CONTRACT 2015-2016—EXHIBIT"D"—REPORTING FORMS
Page 1
YWCA Fort Worth and Tarrant County
ATTACHMENT 1
Invoice
INVOICE
Relocation and Stabilization Services L
� I
Agency: YWCA Fort Worth and Tarrant County '
Address:
City, State, Tp:'
YWCA Rapid Rehousing
Program:' ,
Period of Service:
Amount
Program.` This invoice,. ' C0'M 'Dative to Date
Ra id Rehousin
i
enc
lA g y's Certification: By signing this report, I certify to the best of my
l knowledge and belief that the report is true, complete, and accurate, and
!the expenditures, disbursements and cash receipts are for the purposes
and objectives set forth in the terms and conditions of the Federal award.
I am aware that any false, fictitious or fraudulent information, or the I
omission of any material fact, may subject me to criminal, civil, or ,
administrative penalties for fraud, false statements, false claims, or
;otherwise. U.S. Code Title 18, Sec. 1001 and Title 31, Sec. 3729-3730
land 3801-3812.
I �
Signature and Date:
Name:
Title:
ESG PSA CONTRACT 2015-2016—EXHIBIT"D"—REPORTING FORMS
Page 2
YWCA Fort Worth and Tarrant County
ATTACHMENT II
Expenditure Worksheet
Relocation and Statilization Services
Salaries&Fiinge Benefits -
City of Fort Worth
Neighborhood Seniees DZamnen(.
Expcnditune\Vorlahect
Agend, YNC4Fart Northa IT ,t COUnn
Progcvn-. riVCA Rn id Rchous�n Highlightcdare tine—IYrolesvnt miles for this Program.
Plense you I I oust codes-
re '.
AnQourtC dj�Sey:: ,',EslrsrnoLi Ii 'Account
` P. iJosori -oqs'.' .Ae'toRi EMERGENCYSI 3E1.'l-R .
Mi ta. Ctkcl:No.'
I ESSFa�R7AI.SERVlCES 1001
Salaries
3
oo
Life L.swmee 1003
4 ,e.lth bawance 100a
5 Unem plc onem 1005
6 Worker's Com'nsntion loot,05
7 Retirement '1CAlMcdiaoe-) L07
- 8 Office
So ies - 1008
9 - Postn a 1009
10 Priori 1110
II - IY fl R4 I'es 1111
I2 FocdS lies 1112
- 13 lasuraru:e 1113
l4 Accomli
15 Comatet Lobar City ds ofcommot lufom es 1114
16 SHEGIER OPER47TON5 - '
hfaimenanne 1115
17 lllfi
1117
19 Secwi 1118
20 huumroc
21 l ltilities 1120
22 S lies
23 Hntel/IVlotel Vouclers 7121
24 HDI75iNGREL0CATl0N AND STADIL7ZATION',
25 Salones-P—enliod 2001
26 FICA-Pretention 2002
27 Life lmwvnce-Pretenlion 2003
28 _ Heatd.hrswawc-Presomion 2004
29 Disobilitr L.surnnce-Pretention 2005
30 Ude i ant Sm: n
P-1-li 2006
31 Sal es R 11— 2007
32 :.FICA ReHuusiri r: 2008
33 Life h.—.-ReF--m 2009
34 Health lrswarce-ReHousio 2010
35 Disebilit-inswmce-ReHousln 2011
36 Uoem to ment-Stale Reliouin 2072
7
FlliiILIC41IrASS1SPA1\CE
3 Rentnl Assismnce-Yr r•.nlion 3001
38 002
39 Remnl Assismncc-ReHousine
40 Unit-Payments-Pretenlion 3003
"41 Utili'De sits-ReIT-1a 3003
4 -. Mo.in Costs-IteHousin 3005
'12 2 Motel/Llotel Vauohers-ReHousin 3005
44 Secure De siLC-Re}iousi 3007
45
U_[I tv Pm�nents-Relws.sm 3008
a6 4001
47 I-IMIS P 'noon
1-AA[S-RaHous' 4002
48
49 _..
50
51 '..
52
53
54
55
56
57 _...
58
59
60
Total _..
sP yroll must identify mployee.R nt must identify tewnt.Other".menu slmuldidemify irnb.idu'Js if orvliaable. -
ESG PSA CONTRACT 2015-2016—EXHIBIT"D"—REPORTING FORMS Page 3
YWCA Fort Worth and Tarrant County
ATTACHMENT III
Client Data Report
Agency. ril'CA Fnrt\5'arm and l'zrnnt County•
Pmgmm: 1M1YC,\lie WRrhous'ne_..
Ab M1 ry
Tutu ri i °$� .Ar+ea•a 1P•iWnr+n+Jmre m6atnWifief+rn+1 rehM •nl t,
llulNCliotu: tlJ it N1 NxP IJ In P++tn,.mrw so.dW�nam. bP;m'tteunNS,+W aVPNhfafN! r}wm p[. p+N,anaup+ei+;m�Png. ,
ncaeme[Imnhnx trt d�.nn.sls :. '.'
' c.a.`ea,YOrCUAR TDtO\9i :'Ple+ [nwanl,m•nr,m m>mn
a
s to xvo,
a
2. Y
7;7 � � 946 T spy scN
-------------
a
'� y�.. NAilY�`Aaea nix 'of., N t rbsnx'•[�xb
NgZ'Aa tYA�.2NartEexe2 'aatn mnmNSa€NnWa+'iF3 s oe 4 ifY6�ro
bc+, wLU.a.
ESG PSA CONTRACT 2015-2016—EXHIBIT"D"—REPORTING FORMS Page 4
YWCA Fort Worth and Tarrant County
EXHIBIT "E"
INCOME CERTIFICATION FORMS
ESG PSA CONTRACT 2015-2016--EXHIBIT"E"--INCOME CERTIFICATION FORMS Page 1
YWCA Fort Worth and Tarrant County
YWCA Fort Worth and Tarrant County
CERTIFICATION OF INCOME STATEMENT
Applicant Name:
Current Address: Phone :
Household Members and Income
(Includin A plicant)
Last Name First Name Age Monthly Source/Employer Name
Income
**PERSONAL INFORMATION:(Check one in each item. Optional Information for Federal Reporting Purposes)
a ❑MALE b.❑WHITE ❑BLACK/AFRICAN AMERICAN ❑BLACK/AFRICAN AMERICAN&WHITE
❑FEMALE ❑AMERICAN INDIAN/ALASKAN NATIVE ❑ASIAN
❑AMERICAN INDIAN/ALASKAN NATIVE&WHITE ❑ASIAN&WHITE
El NATIVE F1 O ❑
AMERICAN INDIAN/ I
ALASKAN NATIVE&BLACK/AFRICANAAMERICOAN R
c. ETHNICITY d. DISABLED e. IS CLIENT WOMEN HEAD OF HOUSEHOLD
r]HISPANIC F-1 S S
F1 NON-HISPANIC ❑NO ❑NO
* TOTAL NUMBER OF HOUSEHOLD MEMBERS
(Include Yourself AND everyone who lives in the house.)
Total Anticipated Annual household Income:
Certification:
I certify that the information I am providing is true and could be subject to verification at any time by a third
party. I also acknowledge that the provision of false information could leave me subject to the penalties of
Federal, State and local law.
WARNING: TITLE 18,SECTION 1001 OF THE U.S.CODE STATES THAT A PERSON IS GUILTY OF A FELONY
FOR KNOWINGLY AND WILLINGLY MAKING FALSE OR FRAUDULENT STATEMENTS TO ANY DEPARTMENT OF
THE UNITED STATES GOVERNMENT.
Signature of Applicant Date
-----------------For use Py Agency sta ff only-----------------
Household Size: Gross Annual Income:
Applicable Income Limit: Is Applicant Eligible?
Check if Applicant refused to provide demographic information: ❑
Staff Assessment of
Demographics:
Person Making Determination: Date:
NOTE: Address, income amounts and sources for ALL household members are required
ESG PSA CONTRACT 2015-2016--EXHIBIT"E"--INCOME CERTIFICATION FORMS Page 2
YWCA Fort Worth and Tarrant County
YWCA Fort Worth and Tarrant County
CERTIFICACION DE DECLARACION DE INGRESOS
Nombre del Solicitante:
Domicilio Actual: Nlimero de Telefono:
Miembros en el Ilogar e Ingresos
(Incluir el/la solicitante)
Ingreso Fuente de In resos/Nombre de Empleador
Apellido Nombre Edad Mensual g
**INFORMACION PERSONAL:(Seleccione uno en cada categoria. informaci6n optional para prop6sitos de informaci6n Federal)
a. ❑MASCULINO b.❑CAUCASICO ❑NEGRO/AFRICANO AMERICANO
❑NEGRO/AFRICANO AMERICANO&CAUCASICO
❑FEMININO ❑INDIO AMERICANO/NATIVO DE ALASKA ❑ASIATICO
❑INDIO AMERICANO/NATIVO DE ALASKA&CAUCASICO ❑ASIATICO&CAUCASICO
❑NATIVO HAWAIANO/OTRO DE LAS ISLAS PACIFICAS ❑BALANCE/OTRO
❑INDIO AMERICANO/NATIVO DE ALASKA&NEGRO/AFRICANO AMERICANO
c. ETNICIDAD d.DISCAPACITADO e.DES EL SOLICITANTE UNA MU O S CABECERA DEL HOGAR?
❑HISPANO ❑SI F1 NO
El NO-HISPANO F]NO
NUMERO TOTAL DE MIEMBROS EN EL IIOGAR (Incluye a si mismo y a todos los que viven en la casa)
Ingreso total del hogar anual anticipado:
Certificaci6n:
Certifico que la informaci6n que proporciono es verdad y podria ser susceptible a la comprobaci6n a
cualquier tiempo por terceros.Yo tambien reconozco que la provisi6n de informaci6n falsa me podria dejar
sujeto a las penalidades Federales, Estatales y locales.
ADVERTENCIA:TITULO 18,SECCION 1001 DEL CODIGO DE EE.UU.QUE UNA PERSONA ES CULPABLE DE
UN DELITO POR SABER Y VOLUNTARIAMENTE RACER DECLARACIONES FALSAS O FRAUDULENTAS A
CUALQUIER DEPARTAMENTO DEL GOBIERNO ESTADOUNIDENSE.
Firma del Solicitante Fecha
----- -Para use de em leados de la a encia-----------------
#De Miembros de Familia: Ingreso Anual:
Limite de Ingreso: �Es solicitante elegible?
Compruebe si el solicitante se neg6 a dar su informaci6n personal: ❑
Evaluaci6n del empleado sobre informaci6n personal:
Persona haciendo la determinaci6n: Fecha:
Note: La direction de la casa y los ingresos(y sus origenes) para todos miembros del hogar son requeridos.
ESG PSA CONTRACT 2015-2016--EXHIBIT"E"--INCOME CERTIFICATION FORMS Page 3
YWCA Fort Worth and Tarrant County
EXHIBIT"F"
STANDARDS OF DOCUMENTATION
ESG PSA CONTRACT 2015-2016--EXHIBIT"F"--STANDARDS OF DOCUMENTATION Page I
YWCA Fort Worth and Tarrant County
2016-2016 Documentation Standards for
ESG Public Service Contract Expenses
. ..
e " =Cl "ill reimburse the"sala�yand b"enefits of atty;employee(s)who wo"rk direc#lywith ffie ESG Progr Qiti Au at d consls#eittl e*th he ESG
Employee;Salari'e's and Ben alts ,ty y+
to the execution of ESG Contract:,'Agenoles must shoW;calculatlon'on how Elie ESG poftlon of employee salaries and peiteflfs wer ,sale I " , Y
t o11 �,<. .
Prior to the execution of the ESG Contract the Agency will priovide the City with a written statement on how each employee's time will be
allocated. If an employee works 1D0%of their time directlywith the ESG-funded Program,then 100%of the employee's salary may be
eligible for reimbursement. Agency must submit a written statement that 100%of the employee's time is spent working directly with the
ESG-funded Program. Statements must be signed by a person authorized to sign on behalf of the Agency and will be submitted with the
October invoice.
Reimbursement requests must include a timesheet and work log that reflects the hours worked by the employee(s)working directly on the
Salaries X X ESG-funded Program. For employees who are paid with multiple funding sources,timesheets must reflect all funding sources. If separate
timesheets are kept for each funding source,all such timesheets must be submitted to City. Timesheets must be signed by employee and
supervisor. Agency must show a calculation and documentation of how the employee's salary was calculated and invoiced to City. The
duties for administrative personnel defined by the job descriptions must reflect eligible administrative costs.
`If employees are paid by direct deposit rather than check,then the agency must submit both the direct deposit payment company's report
(such as an ADT report)and a bank statement or check showing payment to the direct deposit company.
FICR/Medicare X X
Life Insurance X X
Health X X If the City pays gross salary,this is already included.If the City pays the employer portion,the Agency must provide proof that the
Insurance employee is enrolled in the benefit plan,must show a calculation and documentation of how the invoiced amount was calculated,and must
Disability X X provide documentation showing payment.
Insurance
Unemployment X X
insurance
If the City pays gross salary,this is already included.If the City pays the employer portion,the Agency must provide proof that the
Retirement X X employee is enrolled in the benefit plan,must show a calculation and documentation of how the invoiced amount was calculated,and must
provide documentation showing payment
Materials,Equipment,Gootls and Supplies"-Citywill oply reimburse for the amount spenct°Bohn ort hoNthe ES,G por#idn otthese expettses'werge caiculatetl co Slsfently with
reifRbursementforfheseitemswIUrequfre.priorClh approval Agenefesmustshowca) ula
the ESG`Contract. s
Office Supplies X X X
Office
Equipment X X X X
Rental
Posts e X X X
Pnnting/Copies X X X
.. .. - ,
e't` Utilities"and'Mairitenaoce=Cltywill only"payfor a pottI h of-these,explanses The portion wail be defermine�bey ehex"ensQs fray oniybebin ssupport of the ESG funtled
R n
Program and shalt be cost=allocated in accordance With the atnoirnt,bf space"used fort e, SG fundedprogr��,- h N .
pro"iam.:The items listed below require prlorCity approval and the'Agency tsYegui�,ed.to ldetltify art�f Je'caiculated consisten#lyhwith the ESGtCont actses that is not,"�
9.
%paid with:City ESG funtls, Ager2cies mustshoW cafculation on how"the ESG por#ion of these experts
Telephone X X
Gas X X
Water/ X X
Wastewater
Electric X X
Solid Waste X X
Dis osai
Facility This item requires approval by the City prior to the execution of the ESG Contract. Repairs may be categorized as major/minor
Maintenance X X X X rehabilitation projects and must be approved through the full HUD Environmetal Review.
and Reoairs
City will pay for a portion of the rent for the Program facility so long as its in proportion to the square footage attributable to the ESG-funde
Rent X X X rogram
Homeless Prevention Clien#rEfigibilitya�ocumentatlon Agency wlll`subinit documetftatlor).ipolcat]ng ihet(��Client is atrisk Or-rnminentrisk of,horlte�essness,(2),Ciient."
lacks resources and support networks;and{3)Clients!,income isunder30°I AM1t etc
Demograhic Client documentation provided must reflect demographic&household/family composition.
Information
HMIS Report A a will submit HMIS re ort for all Homeless Prevention Clients or comparable report for Domestic Violence A e a
Lead-Based If Clients stay in housing longer than 100 days,Agency will be required to comply with Lead-Based Compliance. Lead-Based compliance
Paint will be triggered if the unit is built prior to 1978,and a child under the age of 6 lives in the unit.
Compliance
Habitability Inspection or Housing Quality Standard(HQS)Inspection: Agency will submit documentation that reflects that units were
Unit Inspection inspected and are in Compliance.
Rent Agency will submit documentation that reflects that unit rents were calculated and are reasonable. Agency will submit documentation that
Reasonableness/ eflects that unit rents are under the local FMR for unit size.
IF Rents
1
ESG PSA CONTRACT 2015-2016 Exhibit"F"—STANDARDS FOR COMPLETE DOCUMENTATION
Rental
Agreement, Agency will submit a(ease agreement or documentation that reflects the rental assistance agreement with the owner/properly manager of
Lease,and/or X X X the unit. Full lease agreements must be submitted.
Eviction Notice
If clients are assisted by other types of financial assistance such as application fees,security deposits,utility deposits,last month's rent(if
Other Financial X X X required by lease),or moving costs,Agency will be required to submit supporting documentation that includes but is not limited to
Assistance agreements,leases,invoices,checks,proof of payments etc
Rapid Re•housing:Client,Ellgibility Documentation-Agencywill submit documentatlomindlgating that,(1)Client ts,homeless-Ityl�tg in shatter or on the stieets,,and(2)lacks
resources and support networks,etc,:-%
Demograhic Client documentation provided must reflect demographic&household/family composition.
Information
Agencywill submit HMIS report for all Homeless Prevention Clients or comparable report for Domestic Violence Agencies.
HMIS Report
Lead-Based If Clients stay in housing longer than 100 days,Agencywill be required to comply with Lead-Based Compliance. Lead-Based compliance
Paint will be triggered if the unit is built prior to 1978,and a child underthe age of 6 lives in the unit.
Compliance
Habitability Inspection or Housing Quality Standard(HOS)Inspection: Agency will submit documentation that reflects that units were
Unit Inspection inspected and are in Compliance.
Rent Agency will submit documentation that reflects that unit rents were calculated and are reasonable. Agency will submit documentation that
Reasonableness! reflects that unit rents are under the local FMR for unit size.
FMR Rents
Rental X X X Agency will submit a lease agreement or documentation that reflects the rental assistance agreement with the owner/property manager of
Agreements the unit. Full lease agreements must be submitted.
If clients are assisted by other types of financial assistance such as application fees,security deposits,utility deposits,last month's rent(if
Other Financial X X X required by lease),or moving costs,Agency will be required to submit supporting documentation that includes but is not limited to
Assistance agreements,leases,invoices,checks proof of payments,etc.
Miscellaneous., „
t,
City-required X X City will only pay for a percentage of the City-required insurance solong as it is in proportion to the square footage attributable to the ESG-
funded program.
This Item requires prior approval by the City. Prior to the execution of the ESG Contract,the Agency must submit a written statement that
Insurance
lists the contract labor services to be used during the Contract term. Agency will submit a memo related to the procurement of such
Procurement- X X X X X services and will forward any information pertaining to the procurement process to City. This requirement applies to,but is not limited to,
Contract Labor services retained for security services,legal,accounting,transportation providers,educational facilitators,custodial services,etc.
Agencies may not use the contract services of any City of Fort Worth Department.
If an audit is required because federal funds exceed$750,000,then the cost should be split evenly by all grant funding sources. Agency
must show calculation on how the CDBG portion of the accounting services were calculated. For example,if the CDBG grant is 10%of
Audit Services X X X X your Agency's budget,then invoice shall not exceed 10%of the overall cost. Agency must show a calculation and documentation of how
the invoiced amount was calculated,and must provide documentation showing payment.
Match Report/ X X X X X X Agency must submit a monthly match report. All match must be ESG eligibile and documentation standards apply.
Invoice
'Proof of payment effective October 1,2013: Payments or Expenses must be documented in the following manner:
A)Image of the check AND bank statement showing the check cleared the bank;OR,
B)Image of the cancelled check(ex.At end of bank statement);OR,
C)Payroll Check Stub,"Advice",or Statement AND Bank Statement indicating payroll;OR,
D)For wire or e-transfers:Reciept or statement from payee/vendor OR bank statement. Finar as or 062620151hr
t
ESG PSA CONTRACT 2015-2016 Ehibit"F"—STANDARDS FOR COMPLETE DOCUMENTATION
EXHIBIT"G"
SECTION 3 REPORTING FORMS
ESG PSA CONTRACT 2015-2016--EXHIBIT"G"--SECTION 3 REPORTING FORMS Page 1
YWCA Fort Worth and Tarrant County
EXHIBIT "G11
Section 3 Summery Report U.S.Department of Housing OMB Approval No: 2529-0043
Economic Opportunities for
and Urban Development (exp.11/3012010)
Low—and Very Low-Income Persons Office of Fair Housing iuD Fieldofr�:
And Equal Opportunity
Section back of page for Public Reporting Burden statement
3. Total Amount of Award:
1.Recipient Name&Address: (street,city,state,zip) 2.Federal Identification: (grant no.)
4.Contact Person 5.Phone: (Include area code)
6.Length of Grant: 7.Reporting Period:
9.Program Code: (Use separate sheet 10. Program Name:
8.Date Report Submitted: for each program code)
Part I: Em to me and Trainin "Columns B,C and F_arre mandatory fiields.Dlnclude New Hires in E&E F
A
Number of Number of New %of Aggregate Number %of Total Staff Hours Number of Section 3
Job Category New Hires Hires that are of Staff Hours of New Hires for Section 3 Employees Trainees
Sec.3 Residents that are Sec.3 Residents and Trainees
Professionals
Technicians
Office/Clerical
Construction by Trade(List)
Trade
Trade
Trade
Trade
Trade
Other List
Total
3=Publiandian Housing 4=Homeless Assistance 6-CDBG State Administered
*Program Codes A=Development, 5=HOME 9=Other CD Programs
1=Flexible Subsidy
2=Section 202/811 B=Operation 6=HOME State Administered 1D=Other Housing Programs
C-Modernization 7=CDBG Entitlement
Page 1 of 2 form HUD 60002(6/2001)
Ref 24 CFR 135
Part It: Contracts Awarded
1. Construction Contracts:
A. Total dollar amount of all contracts awarded on the project $
B. Total dollar amount of contracts awarded to Section 3 businesses $
C. Percentage of the total dollar amount that was awarded to Section 3 businesses
D. Total number of Section 3 businesses receiving contracts
2. Non-Construction Contracts:
A. Total dollar amount all non-construction contracts awarded on the project/activity $
B. Total dollar amount of non-construction contracts awarded to Section 3 businesses $
C. Percentage of the total dollar amount that was awarded to Section 3 businesses
D. Total number of Section 3 businesses receiving non-construction contracts
Part III: Summary
Indicate the efforts made to direct the employment and other economic opportunities generated by HUD financial assistance for housing
and community development programs,to the greatest extent feasible,toward low-and very low-income persons,particularly those who
are recipients of government assistance for housing. (Check all that apply.)
Attempted to recruit low-income residents through: local advertising media,signs prominently displayed at the project site,
contracts with the community organizations and public or private agencies operating within the metropolitan area(or
nonmetropolitan county)in which the Section 3 covered program or project is located,or similar methods.
Participated in a HUD program or other program which promotes the training or employment of Section 3 residents.
Participated in a HUD program or other program which promotes the award of contracts to business concerns which meet the
definition of Section 3 business concerns.
Coordinated with Youthbuild Programs administered in the metropolitan area in which the Section 3 covered project is located.
Other;describe below.
Public reporting for this collection of information is estimated to average 2 hours per response,including the time for reviewing instructions,
searching existing data sources,gathering and maintaining the data needed,and completing and reviewing the collection of information.
This agency may not collect this information,and you are not required to complete this form,unless it displays a currently valid OMB
number.
Section 3 of the Housing and Urban Development Act of 1968,as amended,12 U.S.C.1701 u,mandates that the Department ensures that
employment and other economic opportunities generated by its housing and community development assistance programs are directed
toward low-and very-low income persons,particularly those who are recipients of government assistance housing. The regulations are
found at 24 CFR Part 135. The information will be used by the Department to monitor program recipients'compliance with Section 3,to
assess the results of the Department's efforts to meet the statutory objectives of Section 3,to prepare reports to Congress,and by
recipients as self-monitoring tool. The data is entered into a database and will be analyzed and distributed. The collection of information
involves recipients receiving Federal financial assistance for housing and community development programs covered by Section 3. The
information will be collected annually to assist HUD in meeting its reporting requirements under Section 808(e)(6)of the Fair Housing Act
and Section 916 of the HCDA of 1992. An assurance of confidentiality is not applicable to this form. The Privacy Act of 1974 and OMB
Circular A-108 are not applicable. The reporting requirements do not contain sensitive questions. Data is cumulative;personal identifying
information is not included.
form HC f2 )
Ref 24 CFR 135
Form HUD-60002,Section 3 Summary Report,Economic Opportunities for Low-and Very Low-Income Persons.
Instructions: This form is to be used to report annual 8. Program Code: Enter the appropriate program code as listed at
the bottom of the page.
accomplishments regarding employment and other economic g Program Name: Enter the name of HUD Program corresponding
opportunities provided to low-and very low-income persons under with the"Program Code"in number 8.
Section 3 of the Housing and Urban Development Act of 1968. The
Section 3 regulations apply to any public and Indian housing Part I: Employment and Training opportunities
programs that receive: (1)development assistance pursuant to Column A: Contains various job categories. Professionals are
Section 5 of the U.S.Housing Act of 1937;(2)operating assistance defined as people who have special knowledge of an occupation(i.e.
pursuant to Section 9 of the U.S.Housing Act of 1937;or(3) supervisors,architects,surveyors,planners,and computer
modernization grants pursuant to Section 14 of the U.S.Housing Act o yammers For construction positions,list each trade and provide
of 1937 and to recipients of housing and community development data in columns B through F for each trade where persons were
assistance in excess of$20tion a expended for: (1)housing employed. The category of"Other'includes occupations such as
rehabilitation(including reduction and abatement public c con lead-based paint service workers.
hazards);(2)housing construction;or(3)other public construction Column B: Mandator Field Enter the number of new hires for
projects;and to contracts and subcontracts in excess of$100,000 each category of workers identified in Column A in connection with
awarded in connection with the Section-3-covered activity. this award. New hire refers to a person who is not on the contractor's
Form HUD-60002 has three parts,which are to be completed for or recipient's payroll for employment at the time of selection for the
all programs covered by Section 3. Part I relates to employment Section 3 covered award or at the time of receipt of Section 3 covered
and training.The recipient has the option to determine numerical assistance.
employment/training goals either on the hasis of the number of hours Column C: (Mandatory Field) Enter the number of Section 3 new
worked by new hires(columns B,D,E and F). Part II of the form hires for each category of workers identified in Column A in
relates to contracting,and Part III summarizes recipients'efforts to connection with this award. Section 3 new hire refers to a Section 3
comply with Section 3. resident who is not on the contractor's or recipient's payroll for
Recipients or contractors subject to Section 3 requirements must
maintain appropriate documentation to establish that HUD financial employment the time of selection for the Section 3 covered award or
r
at the time of receipt of Section 3 covered assistance.
assistance for housing and community development programs were Column D: Enter the percentage of all the staff hours of new hires
directed toward low-and very low-income persons.' A recipient of Section 3 residents)in connection with this award.
Section 3 covered assistance shall submit one copy of this report to Column E: Ender the percentage of the total staff hours worked for
HUD Headquarters,Office of Fair Housing and Equal Opportunity. Section 3 employees and trainees(including new hires)connected
Where the program providing assistance requires an annual with this award. Include staff hours for part-time and full-time
performance report,this Section 3 report is to be submitted at the positions.
same time the program performance report is submitted. Where an Column F: Mandator Field) Enter the number of Section 3
annual performance report is not required,this Section 3 report is to be residents that were trained in connection with this award.
submitted by January 10 and,if the project ends before December 31, Part II: Contract Opportunities
within 10 days of project completion. Only Prime Recipients are Block 1: Construction Contracts
required to report to HUD. The report must include A: Enter the total dollar amount of all contracts awarded on the
accomplishments of all recipients and their Section 3 covered Item m tlprogram.
contractors and subcontractors. Item B: Enter the total dollar amount of contracts connected with this
HUD Field Office: Enter the Field Office name. ro ect/ ro ram that were awarded to Section 3 businesses.
1. Recipient: Enter the name and address of the recipient Iproject/program
em C P Enter the percentage of the total dollar amount of contracts
submitting this report. connected with this project/program awarded to Section 3 businesses.
2. Federal Identification: Enter the number that appears on the Item D: Enter the number of Section 3 businesses receiving awards.
award form(with dashes). The award may be a grant, Block 2: Non-Construction Contracts
cooperative agreement or contract.
3. Dollar Amount of Award: Enter the dollar amount,rounded to the Item A: Enter the total dollar amount of all contracts awarded on the
projecUprogram.
nearest dollar,received by the recipient. Item B: Enter the total dollar amount of contracts connected with this
4&5. Contact Person/Phone: Enter the name and telephone number ro ect awarded to Section 3 businesses.
of the person with knowledge of the award and the recipient's Item C: Enter the percentage of the total dollar amount of contracts
implementation of Section 3. connected with this project/program awarded to Section 3 businesses.
6. Reporting Period: Indicate the time period(months and year) Item D: Enter the number of Section 3 businesses receiving awards.
this report covers. Part III: Summary of Efforts—Self-explanatory
7. Date Report Submitted: Enter the appropriate date.
Submit one(1)copy of this report to the HUD Headquarters Office of The Secretary may establish income ceilings higher or lower than 80 percent
Fair Housing and Equal Opportunity,at the same time the of the median for the area on the basis of the Secretary's findings such that
performance report is submitted to the program office. The Section 3 variations are necessary because of prevailing levels of construction costs
report is submitted by January 10. Include only contracts executed or unusually high-or low-income families. Very low-income persons mean
during the period specified in item 8. PHAsiIHAs are to report all low-income families(including single persons)whose incomes do not
contracts/suhcontracts. exceed 50 percent of the median family income area,as determined by the
' The terms"low-income persons"and very low-income persons"have Secretary with adjustments or smaller and larger families,except that the
the same meanings given the terms in section 3(b)(2)of the United Secretary may establish income ceilings higher or lower than 50 percent of
States Housing Act of 1937. Low-income persons mean families the median for the area on the basis of the Secretary's findings that such
(including single persons)whose incomes do not exceed 80 percent of variations are necessary because of unusually high or low family incomes.
the median income for the area,as determined by the Secretary,with
adjustments for smaller and larger families,except that
form HUD 60002(1112010)
Page i
Ref 24 CFR 135
EXHIBIT "H"
MATCH REPORT
ESG PSA CONTRACT 2015-2016—EXHIBIT"H"—MATCH REPORT Page 1
YWCA Fort Worth and Tarrant County
CITY OF FORT WORTH
NEIGHBORHOOD SEVICES DEPARTMENT
EMERGENCY SOLUTIONS GRANT
This attachment is designed to document proposed sources and to assess compliance with the
required Emergency Shelter Grant (ESG) match portion at 24 CFR 576.51. ESG funds are
matched dollar-for-dollar for each program year allocation.
City of Fort Worth ESG Funds$ Agency ESG Match $
1. SOURCES OF LOCAL MATCH:
Other Federal(including pass-through funds,e.g., City CDBG, County FEMA,etc.)
MATCH SOURCE MATCH AMOUNT
$
TOTAL MATCH
2. STATE/LOCAL GOVERNMENT FUNDING: (e.g., State Housing Trust Funds,Local
Assessment, etc.)
MATCH AMOUNT
MATCH SOURCE
TOTAL MATCH $
3.PRIVATE (including recipient)FUNDING:
MATCH SOURCE MATCH$AMOUNT
Fund Raising/Cash $
Loans $
Building Value or Lease $
Donated Goods $
ESG PSA CONTRACT 2015-2016—EXHIBIT"H"—MATCH REPORT Page 2
YWCA Fort Worth and Tarrant County
Donated Computers $
New Staff Salaries $
Volunteers($5/hr)
Volunteer Medical/Legal $
TOTAL MATCH $
Comments:
CERTIFICATION• The undersigned, hereby, gives assurance that to the best of my knowledge and belief,the data
included in this report is true and accurate,and if submitted by a non-profit agency,has been approved by the governing
body of the organization prior to submission.The match funds identified in this report are not included as contribution
for any other federally assisted project or program as required by 24 CFR 84.23(a)(2)
Date: Submitted by: Phone Number:
F.SG PSA CONTRACT 2015-2016—EXHIBIT"H"—MATCH REPORT
Page 3
YWCA Fort Worth and Tarrant County
EXHIBIT"I"
ESG STAFF CERTIFICATION FORM
ESG PSA CONTRACT 2015-2016—EXHIBIT"I"—ESG STAFF CERTIFICATION FORM Page 1
YWCA Fort Worth and Tarrant County
City of Fort Worth
STAFF CERTIFICATION OF ELIGIBILITY FOR ESG FINANCIAL ASSISTANCE
of income(source documentation or
Instructions:In order for City to approve reimbursement for any client,agency must submit:(1)client documentation
submitted upon initial reimbursement
self-certification);(2)documentation of homelessness;(3)copy of lease;and(4)this completed to rm.(1)-(4)niust
request for assistance for each client.
HOMELESS PREVENTION ONLY:(1)-(4)upon agency request for reimbursement for the 0'month of rent for a client(excluding arrears).
1. General Information
Age:
Head of Household Name: Age:
Names of other Household Members: Age:
Age:
Age:
Age:
Household Income is less than 30%AMI? Yes❑ No❑ N/A(Rapid Rehousing Initial Evaluation Onl), ❑
Client Lacks Resources/Support Networks? Yes❑ No❑
Type(s)of ESG Financial Assistance:
Rent❑ Rent Arrears El utility
❑ Deposit(s)❑
Unit Address(mast be in City of Fort Worth):
2. Other ESG Re uirements
Lease in agency file? Yes❑ No❑
Client receives NO other rental subsidy(ie.Housing Choice Voucher)? Yes❑ No❑
Rental Assistance Agreement between landlord and agency in agency file? Yes❑ No❑
Unit Number of Bedrooms:
Fair:Market Rent(FMR)&Rent Reasonableness: Area FMR Limit(as published by HUD):
Unit Rent per lease:
Unit meets Habitability Standards? Yes❑ No❑ Date of Inspection:
r1q Safe Housing: re-1978 housing unit,AND(3)child under 6 in household.
hen(1)provtdmg ESG rental assistance for more than 3 months excluding arrears,(2)p g
plicable ❑f Months Rental As sistance Provided(excluding arrears):
Visual Inspection Indicates Unit and Property Free of Deteriorated Paint?
ing Unit Built: yes❑ No❑
Name of Visual Assessor*:
*For named,agency must have on file a certificate of completion of HUD's Visual Assessment Course(http://www hud vov/offices ofm)
/15ad training/visualassessmentAr00100.
Required certifications: Each person signing below certifies to the following: (1)To the best of my knowledge, the program participant named above meets all
fi
requirements to receive assistance under the Emergency Solutions Grant(ESG).(2)To the best of my knowledge and ability,all of the information used in making this
eligibility determination is true and complete.(3)I am not related to the program participant throuhe best of my
gh family,business or other personal ties.(4)To t
knowledge, neither I nor anyone related to me has received or will receive any financial benefit for this eligibility determination. (5)I understand that fraud is
investigated by the Department of Housing and Urban Development,Office of Inspector General,and may be punished under Federal laws to include,but not limited
to, 18 ti-S.C. L001 and]8 U.S.C.641 (6)I understand that if any of these certifications is found to be false,I will be subject to criminal,civil and administrative
penalties and sanctions.
ESG Staff Signature: Date:
ESG Supervisor Signature: Date:
ESG PSA CONTRACT 2015-2016—EXHIBIT"I"—ESG STAFF CERTIFICATION FORM Page 2
YWCA Fort Worth and Tarrant County
EXHIBIT"J"
ESG PERFORMANCE STANDARDS
Em er enc Solutions Grant Performance Standards
Activi Out ut/Outcome'
Street Outreach Number of persons:
- Placed in shelter or safe havens
- With more non-cash benefits at program exit
- Receiving case management
Emergency Shelter Number of persons:
- Exiting to temporary/transitional housing destinations
- Exiting to permanent housing destinations
- Receiving case management
Homelessness Number of persons:
Prevention - Who maintained their permanent housing for 3 months
- Exiting to permanent housing destinations
- With higher income at program exit
- With more non-cash benefits at program exit
- Receiving case management
Rapid Re-Housing Number of persons:
- Who maintained their permanent housing for 3 months
- Exiting to permanent housing destinations
- With higher income at program exit
- With more non-cash benefits at program exit
- Receiving case management
In order to successfully record performance outcomes,the CoC system requires that once
a household is enrolled in an ESG program, non-domestic violence agencies must
complete an initial HUD Intake Assessment within the HMIS system (ETO), the HUD
Mid-Program Assessment, and the HUD Exit Assessment upon program. Performance
outcomes will be reported to the City using the HMIS generated ESG reports.
Domestic Violence Organizations will provide the same data utilizing their similar data
systems.
Reassessments are required for program participants receiving homelessness prevention
assistance and rapid re-housing assistance. Participants receiving homeless prevention
must be reassessed monthly; rapid re-housing participants must be reassessed at least
quarterly. All participants must receive an exit assessment and enter it into HMIS or a
comparable-level database.
ESG PSA CONTRACT 2015-2016—EXHIBIT"J"—ESG PERFORMANCE STANDARDS Page 1
YWCA Fort Worth and Tarrant County
EXHIBIT "J-1"
Written Standards for ESG Assistance
Individuals and families eligibility. Households receiving either emergency shelter or rapid re-housing
assistance must meet HUD's revised definition of homelessness. Households receiving homelessness
prevention assistance must meet the definition of"at risk of homelessness", have incomes at or below
30% AMI, and lack sufficient resources and support networks to retain housing. Eligible ESG-assisted
individuals and households must reside in the City of Fort Worth. Individuals receiving rapid re-housing
assistance must be housed to a unit located in the City of Fort Worth. Agencies will conduct initial
evaluation of clients to determine program eligibility, and kind of assistance needed. Agencies will re-
evaluate quarterly the assistance provided to homelessness prevention recipients, and yearly, to rapid re-
housing clients. Re-evaluation will ascertain that: i) annual incomes do not exceed 30%AMI; ii) clients
lack resources and support networks to retain housing without ESG assistance. Annual incomes are
established per 24 CFR 5.609. All clients must receive an exit assessment that will then be entered into
HMIS or comparable database.
Coordination among emergency shelter, homelessness prevention, rapid re-housing, and other
homeless assistance and housing providers. To receive ESG funds, an agency has to be an active
member of the Continuum of Care (CoC). The CoC leads the coordination among agencies to assist the
homeless and prevent homelessness. It also engages and coordinates resources to improve current
programs and funding strategies.
Determining and prioritizing homelessness prevention and rapid re-housing assistance. Rapid re-
housing and homelessness prevention providers will determine prioritization among eligible clients. This
should be based on a risk assessment. Prioritization should take into account: 1) families with children,
and elderly and disabled persons who do not require permanent supportive housing; and 2) the share of
rent and utilities costs that each client must pay, if any,while receiving homelessness prevention or rapid
re-housing assistance. The City recommends that clients share in rent and utility costs, unless there are
reasons for receiving 100%ESG-assistance.
Duration of rental assistance. Per §576.103 and §576.104, agencies shall provide clients for no more
than 24 months, during any 3-year period with short-term rental assistance, medium-term rental
assistance, payment of rental arrears, or any combination thereof. Short-term rental assistance is limited
to 3 months. Medium-term rental assistance extends over 3 months but not more than 24 months.
Payment of rental arrears consists of a one-time payment for up to 6 months of rent in arrears, including
any late fees on those arrears.
Type, amount, and duration of housing stabilization and/or relocation assistance. Agencies will
establish standards for the type, amount, and duration of housing stabilization and/or relocation services
provided, acknowledging that services may not extend for more than 24 months within a 3-year period.
Housing relocation and stabilization services include financial assistance(moving costs,rental application
fees, security deposits, last month's rent, utility deposits and utility payments), and services (housing
search and placement, housing stability and case management, mediation, legal services, and credit
repair.) The amount and type of assistance provided shall aim at clients becoming self-sufficient. The
City shall have access to documentation that supports the amount and type of assistance provided.
ESG PSA CONTRACT 2015-2016—EXHIBIT"J-1"—Written Standards for ESG Assistance Page 1
YWCA Fort Worth and Tarrant County
EXHIBIT "K"
ESG QUARTERLY HMIS REPORT
ESG PSA CONTRACT 2015-2016--EXHIBIT"K"—ESG QUARTERLY HMIS REPORT Page 1
YWCA Fort Worth and Tarrant County
City of Fort Worth
Emergency Solutions Grant(ESG)
Quarterly HMIS Report
Agency Name: Reporting Period: From
Contact Person: To
This report is meant to collect data that is required for the HUD Consolidated Annual Performance and Evaluation Report
(CAPER). This report is due each quarter,on January 15,April 15, July 15 and September 30 of each Contract year. Please
fill out the report according to your Agency's accomplishments. If a particular activity does not apply to your Agency (for
example, a shelter does not perform homeless prevention) please fill in all zeros for that particular column. This information
should be collected from HMIS and the total number of persons should match comparable figures on the City's Attachment III
Report. If this report does not match the City's Attachment III Report, the Agency may be required to resubmit the report and
provide an explanation for the discrepancy.
Total Persons Served Total Persons Total Persons
Homelessness Rapid Re- Emergency Served This Served
Prevention Housing Shelters Quarter (Cumulative)
Special Populations Served-All Activities
Veterans —�7�
Victims of Domestic Violence
Elder)
HIV/AIDS
Chronically Homeless
Persons with Disabilities
Severely Mentally III
Chronic Substance Abuse(Drug,
Alcohol
Other Disabilities(Physical,
Developmental)
Total
Number of Persons in Household
Adults
Children
Don't Know/Refused/Other
Missing Information
Total
Gender-Ali Activities
Male
Female
Trans ender
Don't Know/Refused/Other
Missing Information
Prepared by: D.C.and C.A.
Page 1 of 2
Updated:2/1112015
Total Persons Served Total Persons Total Persons r
Homelessness Rapid Re- Emergency Served This Served
Prevention Housing' Shelters Quarter ::.(Cumulative)
Total
Age-All Activities
Under 18
18-24
25 and over
Don't Know/Refused/Other
Missing Information
Total
Shelter Utilization
Number of New Units-
Rehabilitation
Number of New Units-Conversion
Total Number of Bed-Nights
Available*
Total Number of Bed-Nights
Provided**
Performance Standards
Received Case Management
Exited to transitional or permanent
housing
With higher cash income at exit
With non-cash benefits at exit
Exited to or maintained permanent
housing at exit
Did not enter CoC Shelter or
Transitional Housing during
remainder of ESG year
*The total number of beds that are available in a year. For example, if they are all year-round beds, it would be 365 multiplied by the
number of emergency shelter beds;if some are seasonal as well(e.g.,only winter)then add in the number of nights each bed is available.
Count all emergency shelter beds,whether or not they are ESG-funded.
**The number of beds that were filled each night. Count all emergency shelter beds,whether or not they are ESG-funded.
Prepared by: D.C.and C.A. Page 2 of 2
Updated: 8/3112015
EXHIBIT"L"
MBE REPORTING FORM
ESG PSA CONTRACT 2015-2016--EXHIBIT"L"--MBE REPORTING FORM Page 1
YWCA Fort Worth and Tarrant County
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Contmcts/zubcommets rflessthws 510,000 need be reportzd onlyifsvch commets repressntn orpmsidessubcon[,ding or Wsivess development apWrtunities to businesses usancd Ly lary or Srbmitnan(2l copies ofihis report to}nurlo<nI RHD Ofliee Iithin tell(10)days¢de,the end of
dgnificnnt portion of yaurlotd eontracti,lg aalisily.Imlud,only<omm<tseucuj dwring this lo+s-income resilents.Lo d,gbm in .nere4de.M include participles in Yvu[hboild oerreNd,g penodynuehecked in item JO:r theCmnt.Completx item 7h.Only Ill for each
rcWUing PC^od pmgrvmsestablizhed underSUbdtle Dof Tide lV uflLe Cranston-Gr:rnlcz Natirnd Aff.Mkle m<mrlmRnntmc[or on inch semi-vnnuel re port.
Horsing All
Thistoms h.been rnndified le captum Section3contra,!dataiucllu:nns7g and]i.Section3 Thelenns-lulain,rmcµ:sou"ald',e,y!.sjr,ome pzrsons'hnse the same nteaningsngill' Erne,Ihe pnme conim<tofs Illinilen]f.for Ill rontmers mdsuhontructs.Include only
slant We ri 1 d other ecunon.e epFnmrnr ee generate y eted du' he d.PHAOILill mlorep-11
require <r prym<n:o:l Ah f{Up hnenc the termsinseedon3(by2)Ifthetinned Slmes HOasl sv ACtu[dgo Lossln,Ifthenm mean coo[ cape nngt rcFnningperio
sistmce far housing mdeemmunity dca'ellpment programs sl,dl,mthegrcvtestoete.tln GIdie.(in:ludin_single p<r9,ns)nh.,incomes do not estted 80 per centum of the median mcis/subcumm<ts.
me tr lh.wea,ssdchrmn<db the-I,,..ssith adjustmems for m,vller an lasgerf iliei
feuible, Ifg.ctedt rt loss-and veryln,.g.RempilIne 6 9thio bi-those sstio¢re .n y cntu
rccipien sotgos<mmentnwatw cef rho:sing.W02Iennrongthis(wmt end Section3 pt
dt.f.nl the Secretary m¢ycstafths incomeecilinii,plint wehl r,lti gn pert mnfthc
ontrxtdrt¢nmst also usePM ln(fortn llUDbW02 to report emp:Iyment and!mining me. for the wevc Ii"b,If ofthe Secrctasys fiWings shat such rarirlians are nccersary
opportunities data Fa r.HUD-2516 is In he because ofpres'oiling Imels of consvucrion
Commerdty Deselnple-Pregnnss MIldfamip!lousing Programs Public tllwing vnd Indivn Housing L'rognns
I*Gra,t 11,rljn onn,r:Enterthe nmoeoftto unit nfgosemmend agency or mortgagor entity PHAs/IHAS are to report dl eomv<is'subeomnct>Ind.d<enly contracts xaecuted during this
1.Granlee E.1,r the.rate efthe unit ofgasemnsmt zrbmining Ibis rcpon. svbmillirag this report. rcpuning period.
3.Contact Person:Ente,rame vnd phone ntparmn asWnsible 6r mainteining and submitting 3.-Ill Person:Snorew item 3"rack:CPD Pmgmmx I.Projed thin r:n.Chhe none ofihe pri,l,gos mment,agency or mortgagor entity
submitting raprn.Check boa as apprrpdaie.
<ontm<VSObcanrm<[data 7v.Grant\umber.billet the ElUD Community Dzvelopment ID.J rm:Identirratirn 3.Canm[t Person:Same e,hero 3 under CPU Pm
Number(yith dashes).For a ple:II-32-MC-25U034 F,,Enti:tenter:Fm Irrc and Smell J.IbporK.g Period:Ch,ll, one perinJ_ grams'
City multi-y'eme.rnprehensive pm2mm.5 znterthe I nter.,,p ,ed grm,l number.
Hn Amount of Cnrs dJSubconln,h Enter the d.Heru ovnt rounded tr the nearest dollar.If 4.Re Penal:Check only one period.
subcummctrr
ID numb,,is pnvided in 7f the dollw 5gurc rsoIld befnrlEesublelt"t only S.Program Code:Enterthe vppreprime pmas¢et code. parting
end not far the prime canumt
7e Type nf't'nde:Euterthe n.me f<mdea•vhi<h best mdiletzs the 7a.Gr yproje.l,l'wnber:Enter the HUD Pmje<t Number er l{ousin3 Deve!opmert Grant or S.Program Crl Enrer the eppl.11i¢le pmgmm cod..
metofersubcr rhnclofs ser Ce.It.bco.l 1 lDnumber is pv+idcd in 7f,the 7R of number assigned.
cord.code mould be for He snb<nntrn tnrnnly and not for the pri me ell-tor.
-
The"Itlr'emegory includes supply.pn E,s onnl seni,cs and all aIhe etmtie,except 76.Anseimt ofConlnet/Slbeontreet:Same usI—76.under CPD Pr ...ns no.GrvndPra)eet Numher.Enter the llUD Pmje.t Number nr Housing DeselopmentGmnt nr
umber nzsigned.
cons„ICUOn rod educanonrtmining nctivities.
7d.R iness RacivVEdmierGender CWe:Enter the nvmcrie code which indi....sbe 7,Type of Tnde:Same¢s item 7e.under CPD Pmgmns. 7h.Amount of CrnlractlSlLcantn<u Semeasitem 76,underCPD Pmgmms.
meidl.thnis/ge,der character ofthz runeKs)end ennwller(s)ofSl°:ofthe 6usinasx.
When 51!op ore s aid emrtmlled byany single mciN/elhnic/genler carcgmy' as rte
r the cola.hkh sre of nppo pri It,Ifthe suhonlmcmr lD nuosEer is pmsided,the 7d.7?usvners Rld.1ElMidGender Code:San:e¢s IT—7d.under CPD Pmgrwnz 7e Type ofTnde:Son. m]o,nder CPU Pmgmnrc
toles Id Ipply to the ubcammc[ur wrd not to the P:im<contrvclI,
7e.\l'oman Gsrned Business:Enter Yes or He. 7..\\'omen Dsnsed Husiness:Enter Yes Or No. 7d.Business ItaeiaVEllWr/Gender Code:Sm:e asinn:7d..nder CPD Programs.
7f.Con actor ldentificadnn(11))Nuntb<r.En:crlbe Enlpl05Yr(1RS)NUmbzroflhc Prime 7e.tt'omnn 0,a Bruineas:Enter Yes nr N.
Con os Jm pique identificrlbr prime rccipienl of FiUD Curds.Note thnt thn£.mplo}er 7f.Contractor ldendficadon(IU)Ntunher.S¢m<as item 7f Ind.r CPD Programs.
(IRS)Number srurt be pmsided far exh<ammcVsuMlmma anarJcJ.
7g Se<don 3 Cant belor:Enter Yes or NI. 7&Seedon 3 Contra<mr:Enter Yes nr No. 71.Conhacmr ldenftrrealirn(1D)Nmnher:Sanm u aem 7f underCPD pergnm..
71.Subeantneror Idendfi<atirn g 1l)Nun,ber.Enter Ihn Frnpioyer(IRS)Number of the
su-Irremr ns tbe!rigre idenlide,16,.h svbconlme[mneded from H UU funds.When the 71,SU6conlra,tor ldenlifenlio HE)Nwsher.Same¢s item 7h.under CPD Pmgmms ]g.5e<don3 Contractor:Entelyesor Nr.
subcommclor ID Number is Fm.idcd,the respeetixe k'rime Conimetor ID Nnmher roan dv bx
pmsided.
7i.Section3 Conhaefor:F.nhr Yes or No. 7i.Seed.3 Contractor.Enter Yes nr Nn. 7h SUhcon[reetor ldendlleadon(ID)Nwnber;Sanse ns i:cm 7h.uuderCPD Programs.
7j.COnlracmr/Subconln<torNeme vnd Address:Enter thisinf,nation torexh firm 7j,Contractor/SubconfnclrrNemeand Address:Samsssitem 7j.unJcs CPD Pmgrvn,x 7L Section 3 Contnclrr:Enter yes or Nn.
re<e,ins crnwcusubromrn<I ne'mty only one tine on each report for each fiml.
7j.Cantroclor/SlMOnlnctar Nense vuJ Addl.;Ssmc m item]j.under CPD Pngmnss.
Agency
Camp Fire
Camp Fire
Girls Inc
Girls Inc
Girls Inc
Women's Center
YMCA
REACH
Salvation Army
Salvation Army
Several agencies
Several agencies
Issue
On current certificate for D&0, has "To Whom It May Concern" as certificate holder.
Had $1M per occurrence and $1M aggregate on D&O for 2014-2015, now have$1M
limit.
D&O is for$50,000 with$1,000 deductible; contract is for$75,000; does grantee need
to have D&O in the same amount of the contract?Contract seems to indicate this.
Current auto policy has$1M bodily injury per person and $1M bodily injury per accident
but no property damage; not according to contract.
Statutory limit not marked on current worker's comp insurance
Does Business and Management Ind.take the place of D&O?They are not showing any
D&O or Prof. Liability, but do have Business and Management Ind.
On General Commercial Liability, medical expense per person dropped from$10,000 on
previous policy to $5,000 on most recent policy. Is this okay?
No certificate holder for Crime or D&O insurance. Do we need that?
No D&O or Prof. Liability showing on any certificate.
Auto insurance shows$500K per personal injury,$1M per accident injury and $100K
property damage per occurrence; does not appear to be according to contract.Contract
requires$1M each accident combined single limit OR$250K property damage, $500K
bodily injury per person and $2M aggregate.
Contract says"Insurance policy shall be endorsed to cover"Any Auto" defined as autos
owned, hired and non-owned." Does this mean that"Any Auto" must be marked on the
policy?What about"owned," "hired," and "non-owned"? Must those be marked on
every policy?
Does the Social Service Liability Endorsement take the place of D&0?
Response