HomeMy WebLinkAboutContract 49728 CITY SECRETARY (;
CONTRACT NO. `1
AGREEMENT FOR COMMUNITY BASED PROGRAM
SafeHaven of Tarrant County
FISCAL YEAR 2018
In consideration of the mutual covenants, promises and agreements contained herein, THIS
AGREEMENT ("Agreement") is made and entered into between CITY OF FORT WORTH, a
home rule municipal corporation of the State of Texas, ("City")acting by and through Valerie R.
Washington, its duly authorized Assistant City Manager, and SafeHaven of Tarrant County, a
Texas non-profit corporation ("Contractor") acting by and through Kathryn R. Jacob,
President/CEO, its duly authorized representative.
RECITALS
WHEREAS, City has determined that Community-Based Programs are necessary to
support crime prevention in City during Fiscal Year 2018 to meet one or more of the Crime Control
and Prevention District ("CCPD") goals, which are (1) to support efforts to reduce violent crime
and gang-related activities through enhanced enforcement activities and crime prevention
programs,(2)to support efforts to increase the safety of residents and to decrease crime throughout
Fort Worth neighborhoods, and (3) to support efforts to increase the safety of youth and reduce
juvenile crime through crime prevention and intervention programs; and
WHEREAS, Contractor has agreed to operate a Community-Based Program called
SafeKids in Fort Worth, which will support the police department's crime prevention efforts
throughout the community; and
WHEREAS, City desires to enter into an agreement with Contractor to operate the
SafeKids in Fort Worth Program and
WHEREAS, City, as consideration for the performance of Contractor, has appropriated
monies in the CCPD Budget in the amount of $43,750.00 ("Program Funds") to provide to
Contractor on a reimbursable basis for the operation of the SafeKids Program subject to and in
accordance with this agreement;
NOW, THEREFORE, in consideration of the mutual covenants herein expressed, the
parties agree as follows:
AGREEMENT DOCUMENTS t' w. A
ON
The Agreement documents shall include the following: C6
1. This Agreement between City and Contractor q m
2. Exhibit A—Proposal Abstract and Narrative M - < ".i
p
3. Exhibit B—Budget
4. Exhibit C—Request for Reimbursement
5. Exhibit D—Program Activities Repoi
g p OFFICIAL RECORD
CITY SECRETARY
FY 2018 Community Based Program FT.WORTH, TX I
SafeHaven of Tarrant County Page 1 of 14
6. Exhibit E—Program Effectiveness Measurement Report
7. Exhibit F—Request for Budget Modification
Exhibits A through F, which are attached hereto and incorporated herein, are made a part of this
Agreement for all purposes. In the event of any conflict between the terms and conditions of
Exhibits A through F and the terms and conditions set forth in the body of this Agreement, the
terms and conditions of this Agreement control.
DEFINITIONS
The term"City" shall include City, and its officers,agents, employees,and representatives.
The term "Contractor" shall include Contractor, and its officers, agents,employees,
representatives, servants, contractors,and subcontractors.
The term "Party" shall refer to either City or Contractor.
The term"Parties" shall refer to both City and Contractor.
AGREEMENT
1. Responsibilities of Contractor.
Contractor covenants and agrees to fully perform,or cause to be performed,with good faith
and due diligence,all work and services described in Exhibit"A"—Proposal Narrative. Contractor
shall be responsible for day-to-day administration of the SafeKids program. Contractor agrees to
expend the Program Funds in accordance with the Budget as described in Exhibit`B". Program
activities shall be reported in accordance with Exhibit "D"- Program Activities Report and
effectiveness measures shall be reported in accordance with Exhibit "E"- Program Effectiveness
Measures Report.
2. Program Funds.
2.1 In no event shall the total distribution from City made to the Contractor during the Term
of this Agreement exceed $43,750.00 ("Program Funds").
2.2 Payment of the Program Funds from City to Contractor shall be made on a cost-
reimbursement basis following receipt by City from Contractor of a signed Request for
Reimbursement (RFR), as described in Exhibit "C" along with copies of all receipts and other
supporting documentation. Contractor shall deliver to City a written detailed Program Activities
Report and Program Effectiveness Measures Report as described in Section 4.2 below with each
RFR to support expenditure of Program Funds. Such reports shall be signed by the Contractor or
duly authorized officer of the Contractor. The RFR and monthly Program Activities Report shall
be submitted to City no later than the 15th day following the end of the month. Submittal of a
monthly RFR and Program Activities Report is required even if services are not provided.
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The monthly RFR, with an original signature by an authorized representative, must be submitted
to the Grants and Program Management Section of the Fort Worth Police Department,
ATTENTION: Contract Compliance Specialist,Financial Management Division,Bob Bolen
Public Safety Complex,505 W. Felix St.,Fort Worth,Texas,76115. Reimbursements will not
be made until after receipt of an acceptable and approved RFR and a monthly Program Activities
Report from the Contractor.Additionally,a quarterly Program Effectiveness Measurement Report
from Contractor is required as described in section 4.2 and must be approved prior to
reimbursements. Reimbursements shall be made within 30 days receipt of said documents.
2.3 Contractor is authorized to modify up to five (5) percent of any budgeted line-item in the
original approved budget without prior written permission from City. However, Contractor must
submit the Request for Budget Modification Form (Exhibit "F") to City, with the monthly RFR,
during the month the modification took place. The new modified budget cannot exceed the total
amount of Program Funds.
2.4 Any modifications of more than five (5)percent of any budgeted line-item in the original
approved budget must have prior written permission from City before the modifications are made.
The Budget Modification Form(Exhibit"F")must be submitted,and request must be approved by
City,before any money is moved to the line-item. Once the Budget Modification is approved,the
modified budget will take effect on the first day of the following month. The new modified budget
shall not exceed the total amount of Program Funds.
2.5 Any modifications to zero line-items in the original approved budget must have prior
written permission from City before the modifications are made. The Budget Modification Form
(Exhibit"F") must be completed and approved by City before money is transferred into the new
line-item. Once the Budget Modification is approved,the modified budget will take effect on the
first day of the following month. The new modified budget shall not exceed the total amount of
Program Funds.
2.6 Budget modification can only occur within the Direct and Indirect costs. Funds may not
be moved from a Direct line-item into an Indirect line-item, or vise versus. Modification of Direct
and Indirect approved budgets must follow the guidelines outlined in sections 2.3, 2.4. and 2.5.
Budget adjustments shall be submitted to the Contract Compliance Specialist, Financial
Management Division, the Fort Worth Police Department at Bob Bolen Public Safety
Complex at 505 W. Felix St., Fort Worth,Texas, 76115.
3. Term. This Agreement shall commence upon October 1, 2017 ("Effective Date"), and
shall end on September 30, 2018 ("End Date"). All of Contractor's expenditures under this
Agreement must be completed no later than September 30, 2018.
4. Program Performance.
4.1 Contractor agrees to maintain full documentation supporting the performance of the work
and fulfillment of the objectives set forth in Exhibit"A."
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4.2 Contractor agrees to provide a monthly Program Activities Report and quarterly Program
Effectiveness Measurement Report to document the performance of the work described in Exhibit
"D" and Exhibit "E," respectively. The Program Activities and Effectiveness Measures shall
document the program activity names, numbers of participants attending, details of the activities,
and a description of the goals achieved in support of the CCPD goals. Program Effectiveness
Measures shall be reported on a quarterly basis and included in the January, April, July, and
October RFR and Program Activities Report submittals. Additionally,the Program Effectiveness
Measurement Report must include descriptions of any realized successes. The monthly Program
Activities and quarterly Program Effectiveness Measurement Reports shall be submitted to City
no later than the 15th day after the end of each month.
4.3 Contractor agrees that the monthly Request for Reimbursement and Program Activities
Report and quarterly Program Effectiveness Measurement Report will be submitted to City no
later than the 151h day after the end of each month. Should Contractor not meet these requirements,
Contractor will be given an additional 15 days to submit the required reports to City. If,at the end
of this 15-day extension period, Contractor has not submitted the required reports, City will send
a non-compliance letter notifying Contractor's duly authorized representative of a possible
suspension of program funding.
4.4 A representative of the program shall attend quarterly meetings of the Crime Control and
Prevention District Board as requested.
5. Default and Termination.
5.1 This Agreement is wholly conditioned upon the actual receipt by City of Program Funds
from the CCPD. All monies distributed to Contractor hereunder shall be exclusively from monies
received from the CCPD, and not from any other monies of City. In the event that funds from the
CCPD are not received in whole or in part, City may, at its sole discretion, terminate this
Agreement and City shall not be liable for payment for any work or services performed by
Contractor under or in connection with this Agreement.
5.2 In the event no funds or insufficient funds are appropriated by the City in any fiscal year for
any payments due hereunder, City will notify Contractor of such occurrence and this Agreement
shall terminate on the last day of the fiscal period for which appropriations were received without
penalty or expense to the City of any kind whatsoever,except as to the portions of payments herein
agreed upon for which funds have been appropriated.
5.3 The City may terminate this Agreement at any time and for any reason by providing the
other party with thirty(30) days' written notice of termination.
5.4 Termination will be effected by delivering to Contractor written notice of termination.
Upon Contractor's receipt of notice of termination, Contractor shall:
(a) Stop work under the Agreement on the date and to the extent specified in the notice of
termination;
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(b) Place no further order or subcontracts, except as may be necessary for completion of the
work not terminated;
(c) Terminate all orders and contracts to the extent that they relate to the performance of the
work terminated by the notice of termination; and
(d) Cease expenditures of Program Funds, except as may be necessary for completion of the
work not terminated.
5.5 In the event City suspends or terminates this Agreement, Contractor expressly waives any
and all rights to monetary damages,including but not limited to actual,consequential,and punitive
damages, court costs and attorney's fees.
5.6 Within thirty(30)days following the date of termination of this Agreement,Contractor shall
return to City any property provided hereunder. City will have no responsibility or liability for
Contractor's expenditures or actions occurring after the effective date of termination of the
Agreement.
6. Equipment and Maintenance. All equipment purchased with Program Funds must meet
all eligibility requirements of City. Contractor shall maintain all equipment used in the
administration and execution of the SafeKids program. Contractor shall maintain, replace, or
repair any item of equipment used in support of SafeKids program or for use under the terms of
this Agreement that no longer functions or is lost or stolen. The cost for maintenance,replacement
or repair of any equipment used in support of SafeKids program and/or for use under the terms of
this Agreement is the sole responsibility of Contractor. Contractor shall not use Program Funds
to repair or replace said equipment. Contractor shall use any and all equipment purchased with
Program Funds exclusively in support of the SafeKids program. Within 10 days following the
purchase of equipment, Contractor shall submit to City a detailed inventory of all equipment
purchased with Program Funds to the Grants and Program Management Section at the address set
forth in paragraph 2.2 above. The equipment inventory shall include an itemized description of
each piece of equipment,the date each piece of equipment was purchased,the cost of purchase for
each piece of equipment, and the location of each piece of equipment.
7. Administrative Requirements.
7.1
Contractor agrees to keep sufficient records to document its adherence to applicable local, state, and
federal regulations,along with documentation and records of all receipts and expenditures of Program
Funds. All records shall be retained for three (3) years following the termination or completion of
this Agreement. City or its representatives shall have the right to investigate, examine, and audit at
any time any and all such records relating to operations of Contractor under this Agreement.
Contractor, its officers,members,agents,employees,and subcontractors,upon demand by City, shall
make such records readily available for investigation, examination, and audit. In the event of such
audit by City, a single audit of all Contractor's operations will be undertaken and may be conducted
either by City or an independent auditor of City's choice. Contractor shall submit a copy of any audit
performed by their independent auditor within 30 days of receipt of the final audit report.
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7.2 If any audit reveals a questioned practice or expenditure, City shall notify Contractor as
soon as reasonably practical. Contractor shall have fifteen(15)days to provide City with a written
explanation and any supporting documentation regarding the practice or expenditure.If Contractor
fails to resolve or cure the questioned practice or expenditure,to the City's satisfaction,within the
fifteen(15)day period,City reserves the right to withhold further Program Funds under this and/or
future agreement(s)with Contractor.
7.3 If, as a result of any audit, it is determined that Contractor misused, misapplied or
misappropriated all or any part of the Program Funds, Contractor agrees to reimburse City the
amount of such monies so misused, misapplied or misappropriated, plus the amount of any
sanction, penalty, or other charge levied against City because of such misuse, misapplication or
misappropriation.
7.4 Contractor's obligation to City shall not end until all closeout requirements are completed.
The closeout requirements shall include,but are not limited to: providing final Program Activities
Report and Program Effectiveness Measurement Reports, making final payments, and disposing
of SafeKids assets as appropriate, if deemed required by the City in its sole discretion.
7.5 Contractor covenants and agrees to fully cooperate with City in monitoring the
effectiveness of the services and work to be performed by Contractor under this Agreement, and
work to be performed by Contractor under this Agreement and City shall have access at all
reasonable hours to offices and records of Contractor, its officers, members, agents, employees,
and subcontractors for the purpose of such monitoring.
Section 7 shall survive the expiration or termination of this Agreement.
8. Independent Contractor,
8.1 Contractor shall operate hereunder as an independent contractor and not as an officer,
agent,or servant or employee of City. Contractor shall have exclusive control of,and the exclusive
right to control, the details of the work and services performed hereunder, and all persons
performing same, and shall be solely responsible for the acts and omissions of its officers,
members,agents,servants,employees,subcontractors,program participants,licensees,or invitees.
The doctrine of respondeat superior shall not apply as between City and Contractor, its officers,
members,agents,servants,employees,subcontractors,program participants,licensees,or invitees,
and nothing herein shall be construed as creating a partnership or joint enterprise between City and
Contractor.No federal,state,or local income tax,nor any payroll tax of any kind,shall be withheld
or paid by City on behalf of Contractor.Contractor shall not be treated as an employee with respect
to the services performed pursuant to this Agreement for federal or state tax purposes. It is
expressly understood and agreed that officers, members, agents, employees, subcontractors,
licensees, or invitees of Contractor, and any program participants hereunder are not eligible for,
and shall not participate in any employer pension, health, or other fringe benefit plan provided by
City. It is expressly understood and agreed that City does not have the legal right to control the
details of the tasks performed hereunder by Contractor, its officers, members, agents, employees,
subcontractors,program participants, licensees, or invitees.
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8.2 City shall in no way nor under any circumstances be responsible for any property belonging
to Contractor, its officers, members, agents, employees, subcontractors, program participants,
licensees or invitees, which may be lost, stolen,destroyed, or in any way damaged.
9. Liability and Indemnification.
CONTRACTOR SHALL BE LL9BLEAND RESPONSIBLE FOR ANYAND ALL PROPERTY
LOSS, PROPERTY DAMAGE AND/OR PERSONAL INJURY, INCLUDING DEATH, TO
ANY AND ALL PERSONS, OF ANY KIND OR CHARACTER, WHETHER REAL OR
ASSERTED, TO THE EXTENT CAUSED BY THE NEGLIGENT ACT(S) OR OMISSION(S),
MALFEASANCE OR INTENTIONAL MISCONDUCT OF CONTRACTOR,ITS OFFICERS,
AGENTS,SERVANTS OR EMPLOYEES.
CONTRACTOR AGREES TO DEFEND, INDEMNIFY, AND HOLD THE CITY, ITS
OFFICERS,AGENTS, SERVANTS,AND EMPLOYEES HARMLESSAGAINS TANYAND
ALL CLAIMS, LAWSUITS, ACTIONS, COSTS, AND EXPENSES OF ANY KIND,
INCLUDING, BUT NOT LIMITED TO, THOSE FOR PROPERTY DAMAGE OR LOSS
(INCLUDING ALLEGED DAMAGE OR LOSS TO OWNER'S BUSINESS AND ANY
RESULTING LOST PROFITS) AND/OR PERSONAL INJURY (INCLUDING DEATH)
THAT MAYRELATE TO,ARISE OUT OF, OR BE OCCASIONED BY(I) CONTRACTOR'S
BREACH OF ANY OF THE TERMS OR PROVISIONS OF THIS AGREEMENT OR (II)
ANY NEGLIGENT ACT OR OMISSION OR INTENTIONAL MISCONDUCT OF
CONTRACTOR,ITS OFFICERS,AGENTS,ASSOCL9TES,EMPLOYEES, CONTRACTORS
(OTHER THAN THE CITY), OR SUBCONTRACTORS RELATED TO THE
PERFORMANCE OF THISAGREEMENT;EXCEPT THAT THE INDEMNITYPROVIDED
FOR IN THIS SECTION SHALL NOT APPLY TO ANY LL9BILITY RESULTING FROM
THE SOLE NEGLIGENCE OF THE CITY OR ITS OFFICERS, AGENTS, EMPLOYEES,
OR SEPARATE CONTRACTORS, AND IN THE EVENT OF JOINT AND CONCURRENT
NEGLIGENCE OF BOTH CONTRACTOR AND CITY,RESPONSIBILITY,IFANY,SHALL
BE APPORTIONED COMPARATIVELY IN ACCORDANCE WITH THE LAWS OF THE
STA TE OF TEXAS. NOTHING HEREIN SHALL BE CONSTRUED ASA WAIVER OF THE
CITY'S GOVERNMENTAL IMMUNITY AS FURTHER PROVIDED BY THE LAWS OF
TEXAS.
Contractor shall require all of its subcontractors to include in their subcontracts a release and
indemnity in favor of City in substantially the same form as above.
This section shall survive the expiration or termination of this Agreement.
10. Non-Assignment. No assignment or delegation of duties under this Agreement by
Contractor shall be effective without City's prior written approval.
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11. Prohibition Against Interest.
11.1 No member, officer, or employee of City, or its designees or agents; no member of the
governing body of the locality in which the SafeKids program is situated; and no other public
official of such locality or localities who exercises any functions or responsibilities with respect to
the SafeKids program during his tenure or for one year thereafter, shall have any interest,direct or
indirect, in any contract or subcontract, or the proceeds thereof, for work to be performed
hereunder.Contractor shall incorporate,or cause to be incorporated,like language prohibiting such
interest, in all contracts and subcontracts hereunder.
11.2 No officer,employee,member, or program participant of Contractor shall have a financial
interest,direct or indirect, in this Agreement or the monies transferred hereunder,or be financially
interested, directly or indirectly, in the sale to Contractor of any land, materials, supplies, or
services purchased with any funds transferred hereunder, except on behalf of Contractor, as an
officer, employee, member, or program participant. Any willful violation of this paragraph with
the knowledge, expressed or implied, of Contractor or its subcontractors, shall render this
Agreement voidable by City of Fort Worth.
12. Nondiscrimination.
12.1 In accordance with the federal, state, and local laws and ordinances, Contractor
covenants that neither it nor any of its officers,members,agents,employees,program participants,
or subcontractors, while engaged in performing this Agreement shall in connection with the
employment, advancement, or discharge of employees, in connection with the terms, conditions
or privileges of their employment,discriminate against persons because of their age,except on the
basis of a bona fide occupational qualification, retirement plan, statutory requirement,or statutory
or ordinance exception.
12.2 Contractor will not unlawfully discriminate against any person or persons because of
age, race, color, religion, sex,disability,national origin, or sexual orientation, nor will Contractor
permit its officers,members,agents,employees,subcontractors,or program participants to engage
in such discrimination.
IF ANY CLAIM ARISES FROM AN ALLEGED VIOLATION OF THIS NON-
DISCRIMINATION COVENANT BY CONTRACTOR, ITS PERSONAL
REPRESENTATIVES, ASSIGNS, SUBCONTRACTORS OR SUCCESSORS IN
INTEREST, CONTRACTOR AGREES TO ASSUME SUCH LIABILITY AND TO
INDEMNIFY AND DEFEND THE CITY AND HOLD THE CITY HARMLESS FROM
SUCH CLAIM.
This section shall survive the expiration or termination of this Agreement.
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13. Compliance.
13.1 Contractor, its officers, members, agents, employees, program participants, and
subcontractors, shall abide by and comply with all laws, federal, state and local, including all
ordinances, rules and regulations of City. If City calls to the attention of Contractor in writing to
any such violation on the part of Contractor or any of its officers, members, agents, employees,
subcontractors or program participants,then Contractor shall immediately desist from and correct
such violation.
13.2 Contractor shall utilize Program Funds strictly for those purposes and goals intended under
the terms and conditions of this Agreement. If City calls the attention of Contractor in writing to
any such violations on the part of Contractor or any of its officers, members, agents, employees,
program participants or subcontractors,then Contractor shall immediately desist from and correct
such violation.
14. Governmental Powers. It is understood that by execution of this Agreement, the City does
not waive or surrender any of it governmental powers.
15. Waiver of Immunity. If Contractor is a charitable or nonprofit organization and has or
claims an immunity or exemption (statutory or otherwise) from and against liability for damages
or injury, including death,to persons or property; Contractor 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.
16. Insurance Requirement.
16.1 Coverages and Limits. Contractor shall provide the City with certificate(s) of insurance
documenting policies of the following minimum coverage limits that are to be in effect prior to
commencement of any work pursuant to this Agreement:
(a) Commercial General Liability (CGL): $1,000,000 per occurrence, with a $2,000,000.00
annual aggregate limit, in a form that is acceptable to the City's Risk Manager.
(b) Non-Profit Organization Liability or Directors & Officers Liability: $1,000,000 per
occurrence, with a $1,000,000 annual aggregate limit, in a form that is acceptable to the
City's Risk Manager.
(c) Automobile Liability: $1,000,000 each accident on a combined single limit basis OR split
limits are acceptable if limits are at least $250,000 Bodily Injury per person, $500,000
Bodily Injury per accident and $100,000 Property Damage.
(d) Any other insurance the City may reasonably require to protect the interest of the City.
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16.2 Contractor's insurer(s)must be authorized to do business in the State of Texas for the lines
of insurance coverage provided and be currently rated in terms of financial strength and solvency
to the satisfaction of the City's Risk Manager. All insurers must have a minimum rating of A-VII
in the current A.M. Best Key Rating Guide, or have reasonably equivalent financial strength and
solvency to the satisfaction of Risk Management. If the rating is below that required, written
approval of Risk Management is required.
16.3 Each insurance policy required herein shall be endorsed with a waiver of subrogation in
favor of the City. Each insurance policy required by this Agreement, except for policies of
worker's compensation or accident/medical insurance shall list the City as an additional
insured. City shall have the right to revise insurance coverage requirements under this Agreement.
16.4 Contractor further agrees that it shall comply with the Worker's Compensation Act of
Texas and shall provide sufficient compensation insurance to protect Contractor and City from and
against any and all Worker's Compensation claims arising from the work and services provided
under this Agreement.
16.5 The commercial general liability policy shall name the City as an additional insured thereon,
as its interests may appear.
16.6 A minimum of Thirty (30) days' notice of cancellation or reduction in limits of coverage
shall be provided to the City. Ten(10)days' notice shall be acceptable in the event of non-payment
of premium. Notice shall be sent to the Risk Manager, City of Fort Worth,200 Texas Street, Fort
Worth,Texas 76102, with copies to the City Attorney at the same address.
16.7 Any failure on the part of the City to request required insurance documentation shall not
constitute a waiver of the insurance requirement.
16.8 Certificates of Insurance evidencing that the Contractor has obtained all required insurance
shall be delivered to the City prior to Contractor proceeding with any work pursuant to this
Agreement.
17. Miscellaneous Provisions.
17.1 The provisions of this Agreement are severable, and, if for any reason a clause, sentence,
paragraph,or other part of this Agreement 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.
17.2 City's failure to insist upon the performance of any term or provision of this Agreement or
to exercise any right herein conferred shall not be construed as a waiver or relinquishment to any
extent of City's right to assert or rely upon any such term or right on any future occasion.
17.3 Should any action, whether real or asserted, at law or in equity, arise out of the execution,
performance,attempted performance or non-performance of this Agreement,venue for said action
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shall lie in state courts located in Tarrant County, Texas or the United States District Court for the
Northern District of Texas, Fort Worth Division.
17.4 Contractor 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 Agreement
and to perform the responsibilities herein required.
17.5 This written instrument and Exhibits A through F constitute the entire agreement between
the parties concerning the work and services to be performed hereunder, and any prior or
contemporaneous,oral or written agreement which purports to vary from the terms hereof shall be
void.
17.6 Any amendments to the terms of this Agreement must be in writing and must be signed by
authorized representatives of each Party.
17.7 None of the performance rendered under this Agreement shall involve, and no portion of
the Program Funds received hereunder shall be used, directly or indirectly, for the construction,
operations,maintenance or administration of any sectarian or religious facility or activity,nor shall
said performance rendered or funds received be utilized so as to benefit,directly or indirectly, any
such sectarian or religious facility or activity.
17.8 The parties acknowledge that each party and its counsel have reviewed this Agreement and
that the normal rules of construction to the effect that any ambiguities are to be resolved against
the drafting party shall not be employed in the interpretation of this Agreement or exhibits hereto.
17.9 Captions and headings used in this Agreement are for reference purposes only and shall
not be deemed a part of this Agreement.
17.10 The provisions and conditions of this Agreement are solely for the benefit of City and
Contractor and are not intended to create any rights, contractual or otherwise,to any other person
or entity.
17.11 Contractor certifies that it has obtained a 501(c)(3) Certificate from the Internal Revenue
Service. Contractor shall notify City in writing of any changes to its 501(c)(3)tax-exempt status
during the term of this Agreement.
18. Notice.
Notices to be provided hereunder shall be sufficient if forwarded to the other party by hand-delivery or via
U.S. Postal Service certified mail,postage prepaid,to the address of the other party shown below:
CITY: Valerie R. Washington,Assistant City Manager
City Manager's Office
City of Fort Worth
200 Texas Street
Fort Worth,TX 76102
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Copies To: Financial Management Division
Bob Bolen Public Safety Complex
505 West Felix St.
Fort Worth,TX 76115
City Attorney's Office
Attn: Police Contracts
200 Texas Street
Fort Worth,TX 76102
CONTRACTOR: Stephanie Storey
Chief Operating Officer
1100 Hemphill St., Suite 303
Fort Worth,TX 76104
19. IMMIGRATION NATIONALITY ACT.
City actively supports the Immigration & Nationality Act (INA) which includes provisions
addressing employment eligibility, employment verification, and nondiscrimination. Contractor
shall verify the identity and employment eligibility of all employees who perform work under this
Agreement. Contractor shall complete the Employment Eligibility Verification Form (I-9),
maintain photocopies of all supporting employment eligibility and identity documentation for all
employees, and upon request,provide City with copies of all I-9 forms and supporting eligibility
documentation for each employee who performs work under this Agreement. Contractor shall
establish appropriate procedures and controls so that no services will be performed by any
employee who is not legally eligible to perform such services. Contractor shall provide City with
a certification letter that it has complied with the verification requirements required by this
Agreement. Contractor shall indemnify City from any penalties or liabilities due to violations of
this provision. City shall have the right to immediately terminate this Agreement for violations of
this provision by Contractor.
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[SIGNATURE PAGE FOLLOWS]
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IN WITNESS WHEREOF,the parties hereto have executed this gre m t in multip e- in Fort
Worth,Tarrant County, Texas,to be effective this -f�day of --- , 20
APPROVED AND AGREED FOR APPROVED AND AGREED FOR
CITY OF FORT WORTH SAFEHAVEN OF TARRANT
COUNT
Valerie R. Washington Kathryn . Jacob
Assistant City Manager President/CEO
Date: I r Date: q A•14
APPROVED AS TO FORM AND
LEGALITY FOR SafeHaven of
APPROVAL RECOMMENDED Tarrant County
Joel F. Fitzgerald
Chief of Police SafeHaven of Tarrant County
Date: 27
Date:
APPROVED AS TO FORM AND
LEGALITY FOR CITY OF FORT
WORTH
ATTEST
ZAAnn ate
Assistant City Attorney Mary J. Ka serr'
City Secretary
Date:
�— f — Date:
M&C No.NOT RE P�^
X.
1295 CERTIFICATION:
C
OFFICIAL RECORD
CITY SECRETARY
FY 2018 Community Based Program FT• WORTH, TX
SafeHaven of Tarrant County Page 13 of 14
Contract Compliance Manager:
By signing I acknowledge that I am the person responsible
e monitoring and administration of this contract, including
ens ring all er ormance and re ort' equirements.
i
Title CG 56—
FY 2015 Community Based Program
Camp Fire First Texa Page 14 of 14
Exhibit A
Proposal Abstract and Narrative
SafeHaven of Tarrant County: SafeKids RFP No. 17-0237
SafeKids Project Abstract
SafeHaven of Tarrant County's SafeKids program is intended to break the cycle of domestic violence by
providing school-age children and youth with the knowledge,skills,and resources to recognize and
respond appropriately to abusive,controlling behaviors in their family and dating/intimate relationships.
Domestic violence is a crime that affects families of all ethnic and cultural backgrounds and every
socioeconomic category.
In 2015,there were 12,548 family violence incidents reported in Tarrant County, and the youngest person
to lose her life in an intimate partner homicide was only 16 years old. Girls and women between 16 and
24 experience the highest rates of intimate partner violence,and nearly half of all adult sex offenders
report committing their first sexual assault offense prior to the age of 18. SafeKids is a school-based
program using evidence-based curriculum designed to prevent domestic/dating violence by giving
students the information and skills necessary to avoid becoming either a perpetrator or victim.
SafeHaven of Tarrant County:SafeKids RFP No. 17-0237
Narrative Responses
1) In one sentence,describe the purpose of your proposed program.
SafeHaven's SafeKids program is intended to break the cycle of domestic violence by providing school-age
children and youth with the knowledge, skills, and resources to recognize and respond appropriately to
abusive,controlling behaviors in their familial and dating/intimate relationships.
2) Who will the program benefit? How many people? What age group?
SafeKids will be available to all students in grades 3-12 in selected traditional schools, alternative schools,
or juvenile probation programs within the corporate limits of Fort Worth. Generally, the PALS curriculum
is offered to students in grades 3-4,and the SafeDates curriculum is utilized for students in grades 6-12. The
specific style or method of presenting these curricula will be tailored to "meet students where they are."
This will allow SafeHaven staff to address the unique needs of any special populations (at-risk students,
students in Pregnant and Parenting programs, those in juvenile probation programs, etc.) as they facilitate
program sessions. SafeHaven's goal is to have 1,750 students participate in the SafeKids program within
the 2018 program year. Ultimately, however, it is not just the students in the program who will benefit.
Their families will benefit from the students' increased awareness,knowledge, and skills related to healthy
relationships and violence reduction. Also, the greater Fort Worth community will benefit as the cycle of
domestic violence is broken and future violent crimes are prevented.
3) What geographic area will it serve? Please describe if it will be city wide,a specific council district,
or a specific zip code?Please include geographic boundaries and a map.
SafeHaven's SafeKids program will be made available to students attending selected traditional schools or
receiving juvenile probation services within the corporate limits of the City of Fort Worth. Given the city's
geographic boundaries,services may be provided in multiple school districts,and services will not be limited
to a specific council district or zip code. A map showing the City's corporate limits is attached.
4) Describe in detail the problem that your program addresses.
Domestic violence is a pattern of abusive behavior characterized by the intent to gain or maintain power and
control over an intimate partner or other family members. It affects families of all ethnic and cultural
backgrounds and every socioeconomic category. In 2015,the Texas Department of Public Safety reported
12,548 family violence incidents in Tarrant County. That same year Tarrant County ranked fifth in the state
for intimate partner homicides.The youngest person to lose her life in an intimate partner homicide in Texas
in 2015 was only 16 years old. It is also important to note that domestic violence does not limit its victims
to intimate partners. Domestic violence affects the entire community. In 2015, when intimate partner
violence fatalities occurred, 9 family members and friends were injured, 19 family members and friends
were killed, and 101 bystanders were present(Texas Council on Family Violence, 2015 Honoring Texas
Victims Report).
Girls and women between the ages of 16 and 24 experience the highest rates of intimate partner violence
overall,almost triple the national average(www.loveisrespect.org). Teen dating violence includes physical,
sexual, and psychological abuse usually involving control or coercion. It can be inflicted face-to-face or
SafeHaven of Tarrant County:SafeKids RFP No. 17-0237
through technology. One in three teen girls is a victim(National Council on Crime and Delinquency). Teen
intimate partner violence is associated with increased risk of substance abuse, unhealthy weight control
behaviors, sexually risky behaviors, pregnancy, and suicide (National Center for Injury Prevention and
Control).
Nearly half of adult sex offenders report committing their first sexual assault offenses prior to the age of 18
(Criminal Justice and Behavior, 1998). A 2002 study of juvenile sexual assault offenders across the U.S.
indicated that only about 33%of the juveniles perceive sex as a way to demonstrate love or caring for another
person. Rather,24%perceive sex as a way to feel power and control,and others consider it a way to handle
anger or punish the other person(California Coalition Against Sexual Assault).
Intimate partner violence/dating violence are not isolated issues that just suddenly appear. For children and
youth, such violence often manifests in their relationships because it is what they have seen modeled at
home. Multiple studies have found that the single best predictor of children becoming either perpetrators or
victims of domestic violence later in life is whether or not they grow up in a home where there is domestic
violence(UNICEF, 2006). If the primary parental relationship at home teaches a child that a man's role is
to control and a woman's role is to please, he/she will not learn about healthy relational roles. Likewise,
when familial relationships model the notion that violence is the primary way to solve problems and resolve
conflicts, it is violence the child will learn to employ or expect. The lack of skills to resolve differences in
healthy ways and the lack of positive role models for healthy relationships put youth at risk of becoming
either victims or perpetrators. Murray Strauss reported in Criminology that the severity of violence among
intimate partners is shown to increase if the pattern is established in adolescence(1989). Thus teen dating
violence ultimately endangers the safety of the entire community.
SafeKids addresses these issues in a way that traditional,and even alternative school curricula cannot. The
program provides facilitators with expertise and experience working with children and youth for the specific
purpose of increasing knowledge and awareness about intimate partner violence, domestic violence, dating
violence,appropriate conflict resolution skills,and other social skills in which students should be literate to
avoid becoming a perpetrator or victim.
5) Describe what your program does to support efforts to increase the safety of youth and reduce
juvenile crime through crime prevention and intervention programs and to address a literacy
element as required by the CCPD Board.
In a 2010 report, Preventing Intimate Partner Violence and Sexual Violence Against Women, the World
Health Organization concluded that "there is currently only one strategy for the prevention of intimate
partner violence that can be classified effective at preventing actual violence. This is the use of school-
based programs to prevent violence within dating relationships." SafeKids provides a combination
prevention-intervention services approach to develop critical knowledge and skills through evidence-based
curricula. The group and individual activities involved in both the Safe Dates(grades 6-12)and Peer Abuse
Learning(grades 3-4) programs inform students about bullying behavior, domestic/family violence, and
dating violence. These lessons are conveyed in a variety of activities ranging from group discussion and
art projects to role-play and writing exercises,all of which help develop students'reading,writing,listening,
speaking and viewing skills. The chosen curricula are interactive in their application,which allows staff to
tailor the messages to the specific audience, e.g., pregnant/parenting teens, juvenile offenders or more
general at-risk populations as appropriate.
SafeHaven of Tarrant County:SafeKids RFP No. 17-0237
The Peer Abuse Learning, SafeHaven (PALS) program is a curriculum SafeHaven created for third and
fourth grade students. The curriculum has been successfully delivered in numerous school districts in
Tarrant County and is currently undergoing a research project in the hope of PALS being designated as an
evidence-based curriculum program in The National Registry of Evidence-Based Programs and Practices.
Effective participation and completion of the programs within the SafeKids context positively impacts the
safety of not only dating teens and elementary age students,but their current and future families. If families
are safer in their homes and students are safer in school and social settings,then Fort Worth neighborhoods
are safer as well. If relationships and attitudes change, then relationship violence will decrease, thus
decreasing crime in Fort Worth.
6) Does your program address the CCPD priority/special emphasis of the prevention or intervention
of youth violence and/or family violence or incorporate literacy instruction or skills for children
ages 0-9? Describe how your program addresses this priority?
SafeKids incorporates the Peer Abuse Learning(PALS)program created by SafeHaven specifically for third
and fourth grade students(typically 7-9 year olds). The program is intended to prevent and reduce youth
peer abuse and bullying behavior that are often precursors to or indicators of more significant,even criminal
behaviors. Program curriculum is taught in an interactive style, utilizing games and role-play to allow
students to practice the seven social skills that are the program's focus. Communication skills are a key
element in the curriculum,,and students are given the opportunity to increase their related literacy and
experience throughout the program's seven sessions. This development all occurs while students learn how
to identify,avoid,and seek appropriate help regarding peer abuse and bullying.
7) How will you measure the effectiveness of the program? You must include specific performance
measures within the Activities and Outcomes Summary and describe evaluation tools and the
method of data collection that you will use. If awarded funding,these performance measures will
be included as an exhibit in the contract,and you will be required to report progress towards these
measures,which will be reported to the CCPD Board.
After participation in the SafeKids program:
• 75%of participants will be able to correctly identify types of abuse
• 75%of participants will exhibit increased knowledge of support systems and resources
• 70%of participants will demonstrate increased understanding of healthy communication styles
SafeKids staff will administer pre/post-program evaluations to measure participants' knowledge and skills
related to each curriculum. The Prevention Specialists examine the pre/post-program evaluation scores to
determine behavioral and knowledge changes in the indicated categories. The outcomes, along with the
total number served,are tracked in the agency's database.
At the conclusion of the last session, SafeKids program staff is also evaluated by the classroom teacher or
group leader using a survey that measures answers on a 5-point Likert Scale. In addition to the survey,
teachers have the option of adding comments at the end of the form, one of which asks about areas for
improvement. These methods provide an accurate evaluation of the program from the teachers/leaders' and
students/participants' points of view.
SafeHaven of Tarrant County:SafeKids RFP No. 17-0237
8) What makes this program unique from any other crime prevention program in Fort Worth?
SafeHaven is the only service provider in Tarrant County whose primary mission is to end domestic
violence. The organization's prevention initiatives, including SafeKids through schools in Fort Worth, are
designed to address the root causes and behaviors that lead to domestic violence incidents and deaths, and
equip the community's youth with the skills they need to break the cycle of domestic violence. The program
utilizes evidence-based and evidence-informed curricula to connect with students at the critical point when
they are forming their expectations about healthy relationships, appropriate behavior, and healthy
boundaries. Students who develop the relationship and communication skills taught in the SafeKids program
are more likely to avoid abusive relationships and become stable, contributing members of the Fort Worth
community.
9) Is the program already in operation? If so, how long have you operated the program? What
resources are currently used to operate the program? Why are CCPD funds necessary at this
time?
The prevention initiatives described in this application have been in operation for more than seven years.
Both government and private funding streams currently support similar programs. The Office on Violence
Against Women(OVW) supports targeted prevention efforts in the Everman I.S.D. Additionally, school-
based prevention efforts are supported with United Way funding and Community Development Block Grant
(CDBG)funding through Tarrant County Community Development. The CDBG funded activities target a
specific population of Title I schools in districts outside of Fort Worth. CCPD funds are necessary to support
programming in the city of Fort Worth, specifically to increase capacity and ensure the impact on crime
reduction efforts in Fort Worth.
10) Is this a new program? If so,what other funds have you applied for? Also, please describe the
sequence of steps needed to implement your program and the timeframe in which this will occur.
SafeKids has operated since 2009. The program's original funding was through the Office of the Governor's
Criminal Justice Division, but funding for prevention programs was subsequently eliminated. CCPD
funding in FY 2015, combined with other funding resources allowed SafeHaven to provide violence
prevention education to a special population of at-risk students in Fort Worth. SafeHaven offers a
comparable program in a specific school district outside of Fort Worth with funding through the Office on
Violence Against Women. Even though SafeHaven was ineligible for CCPD funding in PY 2017, the
agency was able to provide some prevention programming in Fort Worth schools through private funding
sources.Because the curricula to be used in the SafeKids program is already in use by SafeHaven staff,and
the school year will already be underway at the beginning of the program year, the organization will be
positioned to begin providing services immediately upon execution of a contract with the CCPD.
11) Briefly describe the specific expenditures planned for CCPD funding. You MUST fully complete
attached budget forms.
CCPD funding will be used for salary and benefits for one full-time equivalent position (Prevention
Specialist) providing direct service in the SafeKids program. The Prevention Specialist will lead/facilitate
SafeKids instructional sessions and coordinate program schedules with the schools/juvenile justice facilities
served.
Exhibit B
Budget Narrative and Summary
BUDGET SUMMARY
Amount
Requested
A. Direct Personnel $36,010
B. Direct Fringe Benefits $ 5,089
C. Direct Travel $2,651
D. Direct Equipment 0
E. Direct Supplies 0
E Direct Contracts/Consultants 0
G. Indirect Cost up to 10% 0
TOTAL $43,750
BUDGET DETAIL
A. Direct-Personnel
Name Position Rate of Pay x#of Hours Cost
Amy Dossett Prevention Services-.25 FTE 20.75/hr.x 520 hrs. $10,790
Rundee Thomas Prevention Services-.25 FTE 16.50/hr.x 520 hrs. $ 8,580
Felicia Hernandez Prevention Services-.50 FTE 16.00/hr. x 1,040 hrs. $16,640
TOTAL Personnel $36,010
B. Direct- Fringe Benefits
Name Position Description of Benefits Cost
Amy Dossett Prevention Services-.25 FTE FICA $ 825
Life/ADD/LTD Ins $ 108
Workers Comp $ 108
403b Retirement $ 215
Rundee Thomas Prevention Services-.25 FTE FICA $ 656
Health Ins $ 1,232
Life/ADD/LTD Ins $ 85
Workers Comp $ 85
403b Retirement $ 171
Felicia Hernandez Prevention Services-.50 FTE FICA $ 1,272
Life/ADD/LTD Ins $ 166
Workers Comp $ 166
TOTAL Fringe Benefits $ 5,089
RFP No. 17-0237,FY2018 Community Based Programs
Page 22 of 27
C. Direct-Travel
Personnel Purpose of Travel Location Item Cost
Amy Dossett Prevention Services Local Mileage .53/mile x 1,250 miles $ 663
Rundee Thomas Prevention Services Local Mileage .53/mile x 1,250 miles $ 663
Felicia Hernandez Prevention Services Local Mileage .53 mile x 2,500 miles $1,325
TOTAL Travel $2,651
D. Direct—Equipment Not applicable
Item Cost per Item Quantity Cost
TOTAL Equipment $N/A
E. Direct-Supplies
Item Cost per Item Quantity Cost
TOTAL Supplies $N/A
F. Direct-Contracts/Consultants Not applicable
Description of the Service Cost
TOTAL Contracts/Consultants $N/A
* The program budget may use up to 10 percent of the funds requested towards indirect/non-
program related expenses. Indirect costs include but are not limited to administrative staff salary,
rent or lease payments for administrative offices, utility costs for administrative offices,audit costs
and insurance premiums.
G. Indirect—Personnel Not applicable
Name Position Rate of Pay x#of Hours Cost
TOTAL Personnel $N/A
H. Indirect—Fringe Benefits Not applicable
Name Position Description of Benefits Cost
TOTAL Fringe Benefits $N/A
I. Indirect-Other Costs Not applicable
Item Cost per Item Quantity Cost
TOTAL Other Cost $N/A
RFP No. 17-0237,FY2018 Community Based Programs
Page 23 of 27
BUDGET NARRATIVE
Please attach a detailed budget narrative that explains the need for all proposed expenditures by individual
item. The budget narrative should clearly explain how funds will be used and why expenditures are
necessary for successful implementation of your program. Please explain how costs are calculated.
A. Direct—Personnel
Prevention Specialists provide educational and intervention programming that increases the safety of
youth and reduces juvenile crime, especially as relates to family violence. Requesting funds for one total
FTE(three staff allocated at.25, .25 and .50 percentage of time spent providing programming). Wages for
staff based on hourly rate by position, multiplied by the estimated number of services hours to be provided
by each employee.
B. Direct-Fringe
Fringe benefits to include employer cost for Social Security/Medicare at 7.65%of charged taxable wages
for each funded program position. Company portion of cost for health insurance charged for staff that
enrolls in the benefit, charged at same percentage of total wages charged to the award. Example, 25%of
total wages,25%of employer cost of benefit. Company cost for long term disability insurance,accidental
death and dismemberment, life insurance, and workers compensation allocated in the same manner as
noted above. Company cost of retirement(403b)match for employees enrolled in the benefit.
C. Direct-Travel
Cost for approved travel mileage for staff providing prevention services at schools and juvenile probation
facilities in Fort Worth. Mileage charged at .53/mile traveled and allocated to award based on the same
percentage of wages charged for each employee. Example, 25% of total wages charged to award for
services,25%of allocated mileage charged to the award.
D. Direct—Equipment—N/A
E. Direct—Supplies—N/A
F. Direct-Contracts/Consultants-N/A
G. Indirect Cost up to 10%-N/a
H. Indirect Cost—Personnel—N/A
I. Indirect Cost—Fringe Benefits-N/A
J. Indirect Cost—Other Costs-N/A
RFP No. 17-0237,FY2018 Community Based Programs
Page 24 of 27
Exhibit C
Request for Reimbursement
FORT WORTH Exhibit C
Request for Reimbursement(RFR)
FY 2018
CRINiF.CO\I'R01
AND PREvt-fnoN DISTRICT'
Submit To: Submitting Agency: SafeHaven of Tarrant County
Bob Bolen Public Safety Complex Contact Name: Stephanie Storey
Attn:Brittany Taylor Phone Number: 817.502-7151
Financial Management Division Email: sstorevldsafehaventc.ora
505 West Felix St.
Fort Worth,TX 76115 Remit Address:
Invoice Number:
Month of Request:
DIRECT COSTS(90%Minimum)
A B C D E
Total of Previous B+ A-jftla..This Month's
Budget Category Budget Amount Reimbursements Request Total Requested RemaininRequested q To-Date AvailA Personnel S 36,010.00 $ - $
B Fri nge Benefits $ 51111,89.00 S $ 5,O89.00
C Travel&Training $ 2,651.00 S $ 2,651.00
D Equipment $ S - $
E Supplies $ S
F Contracts/Consultants $ $
G Other Approved $ S
Total Direct Costs Is 43 750.00 1$ $ s S 43 750.00
INDIRECT COSTS(10%Maximum)
A B C D
E
B+C A-DTote)of Previous This Mouth's iBud et Category Budget Amount Reimbursements Request Total Requested Reineg
Balsam
Requested Ta-Date
A Personnel S
B Fringe Benefits S $
C Travel$Training S $
D Equipment S - $ -
E Supplies S $
F Contracts/Consultants S - $
G Other Approved $ S S
Total In Direct Costs S $ $ $ s
Supporting documents required with monthly requests. Summary:
This includes,timesil depicting CCPD funded activities, Total Budget: S 43,750.00
copy or psychmics,invoices and receipts detailing all CCPD Previous Requests: S
funded expenditures,
This Request: S
Total Requested To-Date S
Remaining Funds S 43,750.00
1 have reviewed this request and certify that these listed expenses and support documentation are accurate.
Authorized Signatory Signatory Title Date
Fiscal Agent Use Only
Purchase Order# Fund Dept fD Accounf
RFR Approved For Payw t
Grant Staff Signature Date
Finance Received Stamp Placed Below
118 Interlocal Agreement After School Program
BFort Worth SafeHaven of Tarrant County
Exhibit D
Activity Report
FORT WORTH
Cxrwc CorrrwL
&Pwwwnon DmmxT
Exhibit D
Fiscal Year 2018
Monthly Program Activities Report
Current Reporting Month
Submitting Agency SafeHaven of Tarrant County
Contact Name Stephanie Storey
Phone Number and Email 817-502-7151 sstoreyasafehaventc.org
Remit Address
Activity Current To Date Year
Month Total End
Total Goal
1 Number of 5th- 12th grade students attending Family Violence Prevention 1,300
classroom presentations
2 Number of 3rd-4th grade students attending Violence Prevention classroom 450
presentations
3 Number of 3rd-12th grade students successfully completing all 7 sessions 875
of Family Violence Prevention programming
4
5
6
7
8
I have reviewed this report and certify that the measures provided are accurate and appropriately reflect the
CCPD goals set forth in the contract.
Authorized Signatory Signatory Title Date
FY 2018 Interlocal Agreement After School Program
City of Fort Worth&SafeHaven of Tarrant County
Exhibit E
Quarterly Program
Effectiveness Measurement
Report
FART WORTH
'14�✓
cam coKneoi.
&Pw-mann DL"vxr
Exhibit E
Fiscal Year 2018
Quarterly Program Effectiveness Measurement Report
Current Reporting Quarter
Submitting Agency SafeHaven of Tarrant County
Contact Name Stephanie Storey
Phone Number and Email 817-501-7151 sstorey@safehaventc.org
Remit Address
Please include outcome narrative that describes how measure was accomplished for each quarter.
Effectiveness Measures and Quarterly Outcomes
Measure 1 75%of program participants will be able to identify types of abuse.
Outcome
Measure 2 75%of program participants will exhibit increased knowledge of support systems& resources.
Outcome
Measure 3 70%of program participants will demonstrate increased understanding of healthy community
styles.
Outcome
Measure 4 85%of classroom teachers will indicate a positive impact on the classroom students.
Outcome
Measure 5
Outcome
I have reviewed this report and certify that the measures provided are accurate and appropriately reflect the
CCPD goals set forth in the contract.
Authorized Signatory Signatory Title Date
Report due each quarter: 1"Quarter(Oct-Dec)due January 15 2"'Quarter(Jan-Mar)due April 15
3r'Quarter(Apr-June)due July 15 4t"Quarter(Jul-Sep)due October 15
FY 2018 Interlocal Agreement After School Program
City of Fort Worth&SafeHaven of Tarrant County
Exhibit F
Request for Budget
Modification
FORT WORTH
**O�
CRIME
&Pwwwncm Damcr
• Up to 5%of any budgeted line-item does not need prior approval but form must be sent to City with monthly RFR
• More than 5%of any budgeted line-item must have prior City approval
• An increase in a zero line-item must have prior City approval
• Modifications cannot be made between Direct and Indirect costs
Exhibit F
Request for Budget Modification
Fiscal Year 2018
Date
Submitting Agency SafeHaven of Tarrant County
Contact Name Stephanie Store
Phone Number and Email 817-501-7151 sstore safehaventc.or
Remit Address
DIRECT COSTS 90% minimum
Budget Category Approved Budget Change Requested Revised Budget
Personnel
Fringe Benefits
Travel and Training
Equipment
Supplies
Contracts/Consultants
Other Approved
Total Direct Costs
INDIRECT COSTS 10% maximum
Budget Category Approved Budget Change Requested Revised Budget
Personnel
Fringe Benefits
Travel and Training
Equipment
—Supplies
Contracts/Consultants
Other Approved
Total Indirect Costs
Modification Narrative describe in detail what change is for
I have reviewed this request and certify that the listed modifications are correct.
Authorized Signatory Signatory Title Date
FWPD STAID'1u:ONLY
0 Modification Approved Q Modification NOT Approved
CERTIFICATE OF INTERESTED PARTIES FORM 1295
1 Of.1,
Complete Nos.1-4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos.1,2,3,5,and 6 if there are no interested partes. CERTIFICATION OF FILING
1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business.
12017-264424
SafeHaven of Tarrant County
Fort Worth,TX United States Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 09/22/2017
being filed.
City Of Fort Worth Date Ac Howl dged:
no
(v
3 Provide the identification number used by the governmental entity or state agency to track or identify the contract,and provide a
description of the services,goods,or other property to be provided under the contract.
FY2018 CCPD SafeKids
Support the FWPD crime prevention and intervention efforts.
Nature of interest
4
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling I Intermediary
5 Check only if there is NO Interested Party.
X
6 AFFIDAVIT I swear,or affirm,under penalty of perjury,that the above disclosure is true and correct.
FAITH E PARCHMAN
=�`•' = Notary Public.State of Texas
My Commission Expires
November 05, 2017
Signature of author' ed agen ontracting usiness entity
AFFIX NOTARY STAMP/SEAL ABOVE
Sworn to and subscribed before me,by the said� is the a��� day of
20 ��1 ,to certify which,witness my hand and seal of office.
Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.3337