HomeMy WebLinkAboutContract 49756 CITY SECRETARY C
CONTRACT N0. l S '
AGREEMENT FOR COMMUNITY BASED PROGRAM
JPS Foundation
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 JPS Foundation, a Texas non-profit
corporation ("Contractor") acting by and through Laura Wheat, Chairperson of the Board of
Directors, 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 Stop
the Cycle of Violence 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 Stop
the Cycle of Violence 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 $78,221.00 to provide to Contractor on a
reimbursable basis for the operation of the Stop the Cycle of Violence in Fort Worth 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
The Agreement documents shall include the following:
1. This Agreement between City and Contractor
2. Exhibit A—Proposal Abstract and Narrative
3. Exhibit B—Budget
4. Exhibit C—Request for Reimbursement '0
5. Exhibit D—Program Activities Report 1 0
6. Exhibit E—Program Effectiveness Measurement Re
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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.
The term"Program participant" shall refer to individuals providing services through the Stop the
Cycle of Violence Fort Worth Program.
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 Abstract and
Narrative. Contractor shall be responsible for day-to-day administration of the Stop the Cycle of
Violence in Fort Worth program ("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 $78,221.00 ("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
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be submitted to City no later than the 15'' day following the end of the month. Submittal of a
monthly RFR and Program Activities Report is required even if services are not provided.
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.
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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."
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 `B," 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 15th 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 CCPD 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.
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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;
(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. Administrative Requirements.
6.1 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.
6.2 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.
6.3 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
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sanction, penalty, or other charge levied against City because of such misuse, misapplication or
misappropriation.
6.4 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 Stop the Cycle of Violence in Fort Worth assets as appropriate, if
deemed required by the City in its sole discretion.
6.5 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 6 shall survive the expiration or termination of this Agreement.
7. Independent Contractor.
7.1 Contractor shall operate hereunder as an independent contractor and not as an officer,
agent, or servant or employee of City. Contractor shall have control of, and the right to control,
the details of the work and services performed hereunder, and all persons performing same, and
shall be 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.
7.2 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.
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8. Liability and Indemnification.
ONLY TO THE EXTENT PERMITTED BY THE CONSTITUTION AND LAWS OF THE
STATE OF TEXAS AND LIMITED BY THE LIMITS OF L1ABILITYAS SET FORTH IN
THE TEXAS TORT CLAIMS ACT (TEXAS CIVIL PRACTICE AND REMEDIES CODE
CHAPTER 101), CONTRACTOR SHALL BE LIABLE AND RESPONSIBLE FOR ANY
AND 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.
ONLY TO THE EXTENT PERMITTED BY THE CONSTITUTION AND LAWS OF THE
STATE OF TEXAS AND LIMITED BY THE LIMITS OF L19BILITY AS SET FORTH IN
THE TEXAS TORT CLAIMS ACT (TEXAS CIVIL PRACTICE AND REMEDIES CODE
CHAPTER 101), CONTRACTOR AGREES TO INDEMNIFY AND HOLD THE CITY, ITS
OFFICERS,AGENTS, SERVANTS,AND EMPLOYEES HARMLESS AGAINST ANY AND
ALL THIRD PARTY 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 MAY RELATE TO,ARISE OUT OF, OR BE OCCASIONED BY ANY NEGLIGENT
ACT OR OMISSION OR INTENTIONAL MISCONDUCT OF CONTRACTOR, ITS
OFFICERS, AGENTS, ASSOCIATES, EMPLOYEES, CONTRACTORS (OTHER THAN
THE CIM, OR SUBCONTRACTORS RELATED TO THE PERFORMANCE OF THIS
AGREEMENT, EXCEPT THAT THE INDEMNITY PROVIDED FOR IN THIS SECTION
SHALL NOT APPLY TO ANY LIABILITY 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, IF ANY, SHALL BE
APPORTIONED COMPARATIVELY IN ACCORDANCE WITH THE LAWS OF THE
STATE OF TEXAS. NOTHING HEREIN SHALL BE CONSTRUED AS A WAIVER OF
THE CITY'S GOVERNMENTAL IMMUNITY OR THE GOVERNMENTAL IMMUNITY
OF THE CONTRACTOR OR THE TARRANT COUNTY HOSPITAL DISTRICT 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.
9. 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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10. Prohibition Against Interest.
10.1 No member, officer, or employee of City, or its designees or agents; no member of the
governing body of the locality in which the Stop the Cycle of Violence in Fort Worth Program is
situated; and no other public official of such locality or localities who exercises any functions or
responsibilities with respect to the 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.
10.2 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, or member. 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.
11. Nondiscrimination.
11.1 In accordance with the federal, state, and local laws and ordinances, Contractor covenants
that neither it nor any of its officers, members, agents, employees, 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.
11.2 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, or subcontractors to engage in such
discrimination.
ONLY TO THE EXTENT PERMITTED BY THE CONSTITUTION AND LAWS OF
THE STATE OF TEXAS AND LIMITED BY THE LIMITS OF LIABILITY AS SET
FORTH IN THE TEXAS TORT CLAIMS ACT (TEXAS CIVIL PRACTICE AND
REMEDIES CODE CHAPTER 101), IF ANY CLAIM ARISES FROM AN ALLEGED
VIOLATION OF THIS NONDISCRIMINATION COVENANT BY CONTRACTOR, ITS
PERSONAL REPRESENTATIVES,ASSIGNS, SUBCONTRACTORS OR SUCCESSORS
IN INTEREST, CONTRACTOR AGREES TO ASSUME SUCH LIABILITY AND TO
INDEMNIFY 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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12. Compliance.
12.1 Contractor, its officers, members, agents, employees, 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, or subcontractors,then Contractor
shall immediately desist from and correct such violation.
12.2 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, or subcontractors, then Contractor shall immediately desist from and correct such
violation.
13. Governmental Powers. It is understood that by execution of this Agreement, the City
does not waive or surrender any of it governmental powers.
14. 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.Notwithstanding the preceding
sentence,this section shall not be construed to affect or waive Contractor's immunities and limits
of liability as set forth in Texas Health and Safety Code Section 281.0565 and in the Texas Tort
Claims Act(Texas Civil Practice and Remedies Code Chapter 101).
15. Insurance Requirement.
15.1 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): Contractor is self-insured in keeping with the
terms of the Texas Tort Claims Act. Contractor will furnish a Certificate of Self-
Insurance in lieu of the required general liability insurance certificate.
(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.
15.2 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
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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.
15.3 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.
15.4 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. Contractor will furnish a Certificate of Self-Insurance in lieu of
the required Worker's Compensation insurance certificate.
15.5 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.
15.6 Any failure on the part of the City to request required insurance documentation shall not
constitute a waiver of the insurance requirement.
15.7 Certificates of Insurance and Certificates of Self-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.
16. Miscellaneous Provisions.
16.1 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.
16.2 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.
16.3 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 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.
16.4 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.
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16.5 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.
16.6 Any amendments to the terms of this Agreement must be in writing and must be signed
by authorized representatives of each Party.
16.7 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.
16.8 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.
16.9 Captions and headings used in this Agreement are for reference purposes only and shall
not be deemed a part of this Agreement.
16.10 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.
16.11 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.
17. 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: Brittany Taylor
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: JPS Foundation
Attn: Alexandra Dunn,
Senior Grants Specialist
1223 S. Main Street
Fort Worth, TX 76104
18. 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 of
Contractor's 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 of Contractor's employees, and upon
request, provide City with copies of all I-9 forms and supporting eligibility documentation for
each of Contractor's employees who perform 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. Only to the extent permitted by the constitution and laws of the State of Texas and
limited by the limits of liability as set forth in the Texas Tort Claims Act (Texas Civil Practice
and Remedies Code Chapter 101), 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 agre ment in multiples in Fort
Worth,Tarrant County, Texas,to be effective this_[L)__day of 0 CAla b(C , 20I.
APPROVED AND AGREED FOR APPROVED AND AGREED FOR JPS
CITY OF FORT WORTH FOUNDATION
14-1 k4A;eZ
Vale R. Washington Laur heat
Assistant City Manager Chairperson of the Board of Directors for
Date:
(l` JPS Foundation
l� h �
Date:
APPROVAL RECOMMENDED
T
Joel F. Fitzgerald /, �:' %
Chief of Police
aiWJ. Kayser
Date: 1'0 / ,,
City Secretary ie
APPROVED AS TO FORM AND ,S
LEGALITY FOR CITY OF FORT
WORTH Date: 16 11Q1
Matthew A. Murray
Assistant City Attorney
M&C No.NOT REQUIRED
Date:
1295 CERTIFICATION: 2017-263472
Contract Compliance Manager:
By signing I acknowledge that I am the person
responsible for the monitoring and
administration of this contract,including
ensuring all performance and reporting
quirements. r
ame
FY 2018 Community Based Program
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CITY CET Wj
FT.4° ,SRT ,TX
Exhibit A
Proposal Abstract and Narrative
Stop the Cycle of Family Violence in Fort Worth
Project Abstract
The proposed program,Stop the Cycle of Family Violence in Fort Worth, addresses two significant safety
issues in Fort Worth: human trafficking and family violence. In the first four months of 2017,Fort Worth
Police identified almost as many human trafficking victims as had been found in all of 2016.Many human
trafficking victims are also victims of domestic violence. Domestic and family violence account for 59%
of violent crime in Tarrant County. Domestic violence is a vicious cycle, where the victims are subject to
repeated acts of violence and abuse,and children raised in these environments are more likely to be victims
or abusers themselves.CCPD can reduce violent crime and increase public safety in Fort Worth by targeting
domestic violence and human trafficking. One of the barriers to stemming family violence and human
trafficking is successfully identifying victims. Hospitals and healthcare providers are in a unique position
to identify victims because domestic violence victims average 17 medical visits per year. Unfortunately,
the DFW Hospital Council has found that none of the local hospitals use a research-tested domestic violence
or human trafficking screening instrument, which results in victims falling through the cracks, and even
one devastating story of a victim who was beaten to death after not being identified by multiple area
hospitals.
To increase public safety,the John Peter Smith [JPS] Foundation requests CCPD funding to implement a
research-tested domestic violence and human trafficking screening survey designed to identify victims and
prevent repeated violence.The screening survey will be implemented at intake for all patients in three high-
traffic locations: JPS' Emergency Room, Level I Trauma Center—which treats the county's most life-
threatening injuries—and the Stop Six Community Clinic. In Stop the Cycle,JPS will identify a research-
tested screening survey, train clinical staff in the screening, and implement the screening survey for all
patients in these three departments.This screening will be completed as part of every patient's intake and
medical history, identifying victims who would otherwise fall through the cracks. Once victims are
identified, they will be referred to Fort Worth Police and social service providers. Additionally, to break
the cycle of violence,JPS will provide books and connections to literacy resources for victims with children.
Over the grant period, JPS projects screening almost 18,000 patients for domestic violence and human
trafficking. An estimated 2,500 patients will be identified as victims, and JPS will provide books and
literacy resources to 1,500 children of victims. Further, through the DFW Hospital Coalition, JPS will
provide the identified screening survey, training tools, and lessons learned to other Fort Worth hospitals,
catalyzing the implementation of a domestic violence and human trafficking screening survey throughout
hospitals in Fort Worth.Stop the Cycle addresses all three CCPD goals,both priority considerations,and is
able to have a great impact on city-wide safety and reductions in violent crime.
PROPOSAL NARRATIVE:
Provide a 4-5 page description of your program to be funded. In this narrative,please respond
to each of the following questions:
1) In one sentence, describe the purpose of your proposed program.
Stop the Cycle of Family Violence in Fort Worth will reduce violent crime and improve public safety by
increasing identification of domestic violence and human trafficking victims and connecting those victims
to the Fort Worth Police Department.
2) Who will the program benefit? How many people? What age group?
As the county's safety net hospital,JPS is uniquely positioned to identify victims of domestic violence and
human trafficking—who would otherwise not be identified—when they seek treatment for injuries or
illnesses. JPS can then refer victims to Fort Worth Police and social service providers. JPS predicts that
Stop the Cycle will identify 2,500 domestic violence and human trafficking victims in the grant period.
Stop the Cycle will empower victims of domestic violence and sex trafficking and strengthen their families.
JPS will implement a screening survey in three departments which treat patients ages 15 and older.Children
younger than age 15 in homes of identified victims will also benefit through connection to community
resources,removal from a violent home environment through the proper court processes,and through Stop
the Cycle's literacy component.
Finally,Stop the Cycle will be shared with the other hospitals serving Fort Worth to create a more thorough and
robust community-wide screening system.JPS is leading an initiative within the local Hospital Council coalition
to systematically address domestic violence and human trafficking in the North Texas healthcare system.
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.
Initially, Stop the Cycle will serve people throughout Fort Worth, Tarrant County, and the surrounding areas
who come to the JPS Health Network.Although the three proposed implementations sites(i.e.,JPS'Emergency
Room,Level I Trauma Center,and the Stop Six Clinic),are within only two zip codes, 76104 and 76119,the
population served extends far beyond those areas.Last year,JPS'Emergency Room treated 120,000 individuals
from Tarrant County and the Level 1 Trauma Center treated 3,600 traumatic injuries from 19 North Texas
counties.Please refer to the map below to see the areas served by the Level I Trauma Center.
I I ___-1 The overarching goal of the program is to
JPS serves as the Only establish best practices for hospital-based
Level 1 Trauma domestic violence and human trafficking
Center for these 10 screening and intervention that will be shared
counties. with all the hospitals in Fort Worth and Tarrant
County. JPS is leading an initiative within the
JPS selves as the a local Hospital Council coalition to address
Level 1 Trauma °`"""` , domestic violence in the North Texas healthcare
Center for these 9 system.Other members of the Hospital Council
Counties when Dallas' ^U� working with JPS to implement best practices in
domestic violence and trafficking screening
Trauma Centers need ° v.,.� include Texas Health Resources and Baylor,
assistance. Scott,and White.
4) Describe in detail the problem that your program addresses.
Stop the Cycle addresses two significant safety issues in Fort Worth: domestic violence and human
trafficking. In Texas,one in three women will become a victim of domestic violence. In 2015, 158 women
were killed by their intimate partners in Texas, 108 of whom were mothers (Texas Council on Family
Violence, 2015). As shown in the table below, a staggering 59% of violent crime in Tarrant County is
family violence. Further, family violence has increased steadily in the last four years. In order for Fort
Worth to reduce violent crime,the cycle of family violence must be addressed.
Crime Category 2013 2014 2015 2016
Aggravated Assaults(Non-Family Violence) 895 913 952 1,682
Aggravated Assault(Family Violence) 796 793 761 1,094
Assault Bodily Injury(Non FV) 1,896 1,938 1,841 1,904
Assault Bodily Injury FV 3,440 3,605 3,573 3,443
'ABI with Strangulation (F 423 415 396 504
Assault By Contact(Non FV) 913 745 784 904
Assault By Contact FV 1,180 1,227 1,265 1,354
Human trafficking has become a growing concern for North Texas.Statewide,there are estimated to be 313,000
victims ofhuman trafficking.Fort Worth is especially vulnerable to human trafficking because ofthe three major
highways—Interstates 35,30,and 20—which cross the city.The number of identified human trafficking cases
in Fort Worth has sky-rocketed. While 28 cases were identified in all of 2016, 26 cases had already been
identified in the first four months of 2017—indicating a projected 175%increase for 2017(Fort Worth Business
Press,2017).Often,human trafficking victims are also victims of domestic violence.
Medical professionals are often in contact with domestic violence and human trafficking victims. Domestic
violence victims average 17 medical visits per year,with over 27%of domestic violence victims having more
than 20 medical visits per year(Corporate Alliance to End Partner Violence,2017).Because of this,JPS has
made preventing repeat domestic violence injuries a healthcare priority. As a first step,domestic violence
and human trafficking screening should be done systematically,using well-trained staff,and using a research-
tested tool.Last year,within JPS'Emergency Room and Level I Trauma Center,only 30%of Trauma patients
were screened for domestic violence and none were screened for human trafficking. The domestic violence
screening survey used has not been proven accurate at detecting domestic violence and staff have not been
trained specifically to identify people at-risk of domestic violence. As a result, patients who are domestic
violence or human trafficking victims may fall through the cracks,with devastating consequences.
In July of 2016, the Tarrant County Adult Fatality Review Team reviewed a case for a person who was
brutally murdered in December of 2012 by her partner. She had visited JPS and another Dallas County
Emergency Department three times in the weeks preceding her death without being screened for domestic
violence. The same case was also discussed at Dallas County Adult Fatality Review, as she had also
received care at a Dallas facility.Unfortunately,she hadn't been screened for domestic violence there either.
If she had been screened properly,she could have been connected with victim support services,potentially
saving her life. The Tarrant and Dallas County Adult Fatality Review Teams recognized that a lack of
consistent domestic violence screening was a problem across Fort Worth and the whole Metroplex with
deadly consequences. This prompted the formation of DFW Domestic Violence Coalition to explore
domestic violence screenings of all Emergency Room patients in local hospitals.
5) Describe what your program does to 1) support efforts to reduce violent crime and gang-related
activities through enhanced enforcement activities and crime prevention programs, 2) support efforts
to increase the safety of residents and to decrease crime throughout Fort Worth neighborhoods;and 3)
support efforts to increase the safety of youth and reduce juvenile crime through crime prevention and
intervention programs. 4)address a literacy element as required by the CCPD Board.
Stop the Cycle supports efforts to reduce violent crime through enhanced enforcement activities by:
identifying an effective domestic violence and human trafficking screening survey; implementing standards
within the JPS Health Network to perform domestic violence and human trafficking screening on all patients;
identifying barriers to conducting effective screening;tailoring screening education to eliminate these barriers;
training staff in three targeted departments to properly perform domestic violence and human trafficking
screenings,increasing positive identification of victims;and setting up a referral system that connects victims to
Fort Worth Police and social service providers. An important component of the screening process is to use
techniques that encourage the victim to answer honestly and report the violent acts that injure them. Proper
training and follow-up by healthcare staff is one of the best ways to make successful screening possible and
facilitate victims' connections to Fort Worth Police and victim support programs.This can increase the number
of victims who report these crimes and increase the number of perpetrators who are prosecuted. Since family
violence accounts for over 50%of all violent crime,reducing family violence will both reduce violent crime and
also increase the safety of residents.A person is most likely to experience violent crime from a family member,
so reducing family violence will increase safety for Fort Worth.Further,human trafficking is one of the most
terrifying local problems,and reducing human trafficking will greatly increase the community's safety.
After a victim has been screened and identified,their children can also be removed from a violent situation.
Primarily, this will increase the safety of these youth by identifying violent homes that otherwise would
not be identified and placing youth in a safe environment according to the judicial system.Further,Stop the
Cycle improves the city's chances of preventing youth violence that results from growing up in an
environment where domestic violence occurs, and potentially create a means of stopping the cycle of
domestic violence.Proper identification of domestic violence victims positively impacts the whole family,
especially youth,and also prevents domestic violence in the next generation.
Another important factor of stopping the cycle of family violence and preventing human trafficking is
improving literacy for children. Low academic achievement and illiteracy are risk factors for future
family violence (CDC, Intimate Partner Violence, 2016) and human trafficking. JPS proposes to support
the literacy and academic achievement of children with a program called Books for Tarrant County
Children. Two primary drivers of illiteracy for vulnerable families are parents that do not read to their
children and a lack of books in the home. To address this, JPS will include one book per child of each
identified domestic violence or human trafficking victim at discharge along with instructions from the
discharge nurse about the importance of reading to their child to provide stability and bonding in their
stressful situation. For children younger than age two,JPS has purchased special bilingual books(English
and Spanish)which feature illustrations of diverse families and are filled with tips for reading and talking
to babies.The back page of each book contains custom information on how new families can connect with
Fort Worth Library services using a uniquely designed special access library card.JPS has been providing
these books to all children born at JPS in 2017. For children older than age two, JPS will provide age-
appropriate books with information about accessing more books and literacy resources at the Fort Worth
Library.Books for Tarrant County Children will help stem the cycle of family violence and prevent human
trafficking by promoting literacy skills, connecting families to community resources at the library, and
increasing bonding and stability for children.
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 ages0-
9?Describe how your program addresses this priority?
The proposed project, Stop the Cycle of Family Violence in Fort Worth, addresses all three of CCPD's
priorities.The purpose of the program is to reduce family violence by increasing identification of domestic
violence and human trafficking victims in JPS' Emergency Room, Level I Trauma Center, and Stop Six
Clinic. After these victims have been identified, they are connected to Fort Worth Police to report these
crimes and to local non-profits to seek safety. By helping victims report domestic violence and human
trafficking, and receive necessary services, the children of these victims will be safer. Providing these
children with an opportunity for safe placement with books to promote literacy will help reduce their risk
of continuing the cycle of violence.
Family Violence Intervention Youth Violence Prevention Literacy For Children
identify family violence victims Allows children to be removed Provide books, referral to Fort
and connect them to Fort Worth from family violence homes Worth library, and instructions on
Police and domestic violence according to judicial system, reading to children in discharge
resources stopping the cycle of violence instructions
Because family violence victims have frequent contacts with hospitals and medical providers,JPS provides
a unique opportunity to identify domestic violence victims that otherwise would not be identified and
intervene to help them protect themselves and their children.Further,JPS will work with the local Hospital
Council to expand domestic violence screenings for all patients in all Fort Worth emergency rooms.
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 to the CCPD Board.
Stop the Cycle will train 300 clinical staff at JPS in a domestic violence and human trafficking
screening survey, screen over 17,000 patients in the grant period for domestic violence and human
trafficking, refer an estimated 2,500 victims to Fort Worth Police, and provide an estimated 1,500
books to children of victims. With a grant from CCPD, JPS will increase the percent of patients who
receive domestic violence and human trafficking screenings by 100% and successfully refer 90% of
identified victims to Fort Worth Police.
JPS will use its electronic health record system to track the number of patients who are screened for
domestic violence and human trafficking, referred to Fort Worth Police, and provided children's
books. Staff training will be tracked by JPS'Injury Prevention Manager.JPS'Research Associate will
analyze the increase in the number of patients who are screened and referred to Fort Worth Police.
Please see the attached Activities and Effectiveness Measures Summaries.
Further,JPS will use the Agency for Healthcare Research and Quality's(AHRQ)Delphi Instrument for
Hospital-Based Domestic Violence Programs to measure the improvement in JPS'compliance with best
practices in screening for and helping domestic violence victims. JPS will complete this assessment
before beginning Stop the Cycle and re-evaluate the assessment six months after implementation to
determine how much JPS' program has improved and identify areas for improvement.
8) What makes this program unique from any other crime prevention program in Fort Worth?
Hospitals are an ideal place to identify domestic violence and human trafficking victims when they seek
treatment for their injuries. The average domestic violence victim sees a healthcare provider 17 times per
year.As a safety net hospital,JPS serves vulnerable,underserved populations,regardless of their ability to
pay for care. As such, JPS has access to the most at-risk persons for domestic violence recidivism and
human trafficking.By improving the procedures,quality,and rates of screening within the hospital,JPS is
uniquely positioned to identify a large number of victims of domestic violence or human trafficking, and
connect victims and their families to Fort Worth Police and appropriate support services.
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?
JPS is currently providing some screening for domestic violence in the Emergency Room,Level I Trauma
Center, and some clinics. JPS is not currently conducting any human trafficking screenings. JPS is
dedicating personnel from numerous divisions to participate in coalitions to discuss fatality cases and ways
of improving domestic violence screening practices in hospital settings.However,the best practices of Stop
the Cycle have not yet been implemented, such as using a research-tested screening survey, consistently
screening all patients, and using trained providers to conduct screenings. Financial support is needed to
accelerate JPS' efforts to streamline and enhance victim identification, including a researched screening
survey, training for providers specifically for domestic violence and human trafficking screening, and
education materials for service providers and victims.
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.
Stop the Cycle is a new program.JPS has not yet applied for other funding. To implement Stop the Cycle,
the following steps will be taken: identify a research-tested domestic violence and human trafficking
screening survey; train JPS clinical staff at the Emergency Room, Level I Trauma Center, and Stop Six
Clinic in screening for domestic violence and human trafficking; implement the screening survey in those
three departments; begin screening patients for domestic violence and human trafficking; refer identified
victims to Fort Worth Police; provide reading materials and books to children of victims; and collect data
on victims who screen positive and any future injuries.Please see attached timeline.
11) Briefly describe the specific expenditures planned for CCPD funding.You MUST fully complete
attached budget forms.
JPS is requesting funding for: .50 FTE Injury Prevention Manager,.15 FTE Research Associate,books for
children of victims,and 10%for indirect costs.JPS is also providing over$21,000 as leveraged funds.
12) If funds are awarded, will this program continue beyond the CCPD funding period?
Once the screening instrument is in place,Stop the Cycle can be sustained without additional funding.JPS
will work with Human Resources and clinical education requirements to ensure that all new staff receive
training in domestic violence and human trafficking screening.Further,the data collected during the grant
period will justify additional training costs at JPS and in other Fort Worth hospitals to increase domestic
violence and human trafficking screenings and interventions.
13) Has your agency obtained funding through the Crime Control and Prevention District previously? ❑
Yes ®No If so,please fill out the form on page 17.
References
Centers for Disease Control (2016). Intimate Partner Violence: Risk and Protective Factors=
https://www.cdc.gov/violeiicepreveiition/intimatepartnerviolence/riskprotec; efactors.html.
Corporate Alliance to End Partner Violence(2016).Medical Consequences.
http://www.caepv.or /g etinfo/facts stats.php?factsec=6.
Automated Reporting System(2016).Tarrant County Violent Crime Statistics.
Fort Worth Business Press(2017).Police Report on Area Human Trafficking Problem.
s http://www.fortworthbusiness.coin/news/police-report-on-area-human-trafficking
problem/article 7f63afea-3c l c-l 1 e7-8aee-cQc057eea36.html
u
u
Exhibit B
Budget Narrative and Summary
BUDGET SUMMARY
Amount
Requested
A. Direct Personnel $66,110
B. Direct Fringe Benefits $0
C. Direct Travel $0
D. Direct Equipment $0
E. Direct Supplies $5,000
F. Direct Contracts/Consultants $0
G. Indirect Cost up to 10% $7,111
TOTAL $78,221
BUDGET DETAIL
A. Direct-Personnel
Name Position Rate of Pay z#of Hours Cost
Mary Ann Contreras Injury Prevention Manager Salary$110,240 x.5 FTE $55,120
Mackenzie Campbell- Research Associate Salary$73,278 x.15 FTE $10,990
Furtick
TOTAL Personnel S 66,110
B. Direct-Fringe Benefits
Name Position Description of Benefits Cost
Provided In-Kind by JPS Health Network.Please see Leverage of Funds.
TOTAL Fringe Benefits $ 0
RFP No.17-0237,FY2018 Community Based Programs
Page 22 of 28
C. Direct-Travel
Purpose of Travel Location Item Cost
N/A
TOTAL Travel $0
D. Direct-Equipment
Item Cost per Item Quantity Cost
N/A
TOTAL Equipment $0
E. Direct-Supplies
Item Cost per Item Quantity Cost
Books for children of $5.00 1,000 $5,000
domestic violence and
sex trafficking victims
500 additional books provided
in-kind.Please see Leverage
of Funds.
TOTAL Supplies $ 5,000
F. Direct-Contracts/Consultants
Description of the Service Cost
N/A
TOTAL Contracts/Consultants $ 0
RFP No.17-0237,FY2018 Community Based Programs
Page 23 of 28
* 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
Name Position Rate of Pay x#of Hours Cost
N/A
TOTAL Personnel $ 0
H.Indirect—Fringe Benefits
Name Position Description of Benefits Cost
N/A
TOTAL Fringe Benefits $ 0
I. Indirect-Other Costs
Item Cost per Item Quantity Cost
JPS Foundation 10%Direct Expenses $71,110 Direct Expenses $7,111
Administrative Rate
TOTAL Other Cost $ 7,111
RFP No.17-0237,FY2018 Community Based Programs
Page 24 of 28
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 Injury Prevention Manager is responsible for training staff on domestic violence screening instrument,
implementing the domestic violence screening instrument in 3 departments,and training 300 staff to conned victims to FWPD and to provide
literacy materials.Injury Prevention Manager will also ensure the program meets grant outcomes and share information with other
Fort Worth hospitals.Estimated to take 20 hours per week.Salary is$110,240 x.50 FTE=$55,120.
Research Associate will provide research and data to identify an appropriate screening instrument,and collect evaluation data.
B. Direct-Fringe Salary is$73,278 x.15 FTE=$10,991.
Fringe benefits are provided as leveraged funds by JPS Health Network.Fringe benefits are 28%of salary costs,and include FICA,
unemployment taxes,insurance premiums,and retirement plans.
.28 x$66,111 in total salaries=$18,511 provided as leveraged funds
C. Direct-Travel
N/A
D. Direct-Equipment
N/A
E. Direct-Supplies
Each domestic violence victim with a child will receive a book for all of their children at discharge,along with encouragement to read to
their children to promote bonding,stability,and literacy.$5.00 per book x 1,000 books=$5,000 grant request
JPS Health Network will also provide 500 books to this project.$5.00 per boox x 500 books=$2,500 provided as leveraged funds
F. Direct-Contracts/Consultants
N/A
G.Indirect Cost up to 10%
JPS Foundation has a 10%administrative cost rate.$71,111 in direct costs x 10%administrative rate=$7,111
H. Indirect Cost—Personnel
N/A
L Indirect Cost—Fringe Benefits
N/A
J. Indirect Cost—Other Costs
JPS Foundation has a 10%administrative cost rate.Please see letter"G"above.
RFP No. 17-0237,FY2018 Community Based Programs
Page 25 of 28
Exhibit C
Request for Reimbursement
FORT WORTH Exhibit C
Request for Reimbursement(RFR)
FY 2018
CRIME CONTROL
AND PREVENTION DISTRICT
Submit To: Submitting Agency: JPS Foundation
Bob Bolen Public Safety Complex Contact Name: Alexandra Dunn
Attn:Brittany Taylor Phone Number: 817-702-226
Financial Management Division Email: adunn04Oipshealth.orci
505 West Felix St.
Fort Worth,TX 76115 Remit Address: 1223 S.Main Street,Fort Worth,TX 76104
Invoice Number:
Month of Request:
DIRECT COSTS(90%Minimum)
A B C D E
Total of PreviousB+C A-D
This Month's
Budget Category Budget Amount Reimbursements Request Total Requested Remaining Baiaea
Requested q To-Date Available
A Personnel $ 66,110.00 $ - S 66,110.00
B Fringe Benefits $ - S - $ -
C Travel&Training S - S - $ -
D Equipment $ - S - S -
E Supplies S 5,000.00 $ 51000.00
F Contracts/Consultants S - $ -
G Other Approved $ S
Total Direct Costs $ 71,110.00 $ $ S S 71,110.00
INDIRECT COSTS(10%Maximum)
A B C D E
Total of PreviousB+C A-D
Thu Month's
Budget Category Budget Amount Reimbursements Request Total Requested Remaining Balsam
Requested q To-Date Available
A Personnel S - S -
B Fringe Benefits S - S -
C Travel&Training $ - $ -
D Equipment S S
E Supplies $ - S -
F Contracts/Consultants S - S -
G Other Approved $ 7,111.00 $ S 7,111.00
Total InDirect Costs $ 7111.00 S $ $ $ 7,111.00
supporting documents required with monady requests. Summary:
This includes,t®esheeb depicting CCPD tanded activities, Total Budget: S 78,221.00
copy of paycbal&,invoices and receipts detailing all CCPD Previous Requests: S
tanded expenditures. This Request: S
Total Requested To-Date S
Remaining Funds S 78,221.00
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 to Account
RFR Approved For Payment
Grant Staff Signature Date
Finance Received Stamp Placed Below
118 Interlocal Agreement After School Program
-f Fort Worth Crowley Independent School District
Exhibit D
Activity Report
FORT WORTH
CRIME CONTROL
&PREVFYTION DISTRICT
Exhibit D
Fiscal Year 2018
Monthly Program Activities Report
Current Reporting Month
Submitting Agency JPS Foundation
Contact Name Alexandra Dunn
Phone Number and Email adunn04 @jpshealth.org
Remit Address 1223 S. Main Street, Fort Worth, TX 76104
Activity Current To Date Year
Month Total End
Total Goal
1 Identify and select screening instruments for human trafficking and 2
domestic violence to be used in JPS Emergency Department, Trauma, and
1 Clinic
2 Train clinical Staff in Emergency Department, Trauma, and 1 Clinic on 300
screening instrument
3 Number of patients that will be screened using screening instrument 17,925
4 Number of domestic violence and sex trafficking victims referred to FWPD 2,500
Victim Assistance and Family Justice Center(One Safe Place)
5 Number of reading materials and books proved to children of domestic 1,500
violence and sex trafficking
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&JPS Foundation
Exhibit E
Quarterly Program
Effectiveness Measurement
Report
FORT WORTH
CRAZE CON-rROL
&PREVr!MON Dwmic..T
Exhibit E
Fiscal Year 2018
Quarterly Program Effectiveness Measurement Report
Current Reporting Quarter
Submitting Agency JPS Foundation
Contact Name Alexandra Dunn
Phone Number and Email adunn04@jpshealth.org
Remit Address 1223 S. Main Street, Fort Worth, TX 76104
Please include outcome narrative that describes how measure was accomplished for each quarter.
Effectiveness Measures and Quarterly Outcomes
Measure 1 Increase by 15%the number of domestic violence and human trafficking victims who are identified
as victims at JPS Polytechnic Clinic.
Outcome
Measure 2 Increase by 15%the number of domestic violence and human trafficking victims who are identified
as victims at JPS Emergency Department.
Outcome
Measure 3 Increase by 15%the number of domestic violence and human trafficking victims who are identified
as victims at JPS Level I Trauma admission floors.
Outcome
Measure 4 Increase by 15%the number of domestic violence and human trafficking victims from JPS
Polytechnic Clinic who are referred to law enforcement and the local Family Justice Center for
services.
Outcome
Measure 5 Increase by 15%the number of domestic violence and human trafficking victims from JPS
Emergency Department who are referred to law enforcement and the local Family Justice Center
for services.
Outcome
Measure 6 Increase by 15%the number of domestic violence and human trafficking victims from JPS Level I
Trauma Center admission floors who are referred to law enforcement and the local Family Justice
Center for services.
Outcome
Report due each quarter: 1St Quarter(Oct-Dec)due January 15 2nd Quarter(Jan-Mar)due April 15
3`d Quarter(Apr-June)due July 15 4th Quarter(Jul-Sep)due October 15
FY 2018 Interlocal Agreement After School Program
City of Fort Worth&JPS Foundation
FORT WORTH
CRIME COKTROL
&PR£vETmON Y�y18TRICT
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: V Quarter(Oct-Dec)due January 15 2"d Quarter(Jan-Mar)due April 15
3rd Quarter(Apr-June)due July 15 4"'Quarter(Jul-Sep)due October 15
FY 2018 Interlocal Agreement After School Program
City of Fort Worth&JPS Foundation
Exhibit F
Request for Budget
Modification
FORT
CRIME CONTROL
&PRraemom DISTRICT
• 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 JPS Foundation
Contact Name Alexandra Dunn
Phone Number and Email adunn04@jpshealth.org
Remit Address 1223 S. Main Street,Fort Worth,TX 76104
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 STAFF USE ONLY
C7 Modification Approved C3 Modification NOT Approved
CERTIFICATE OF INTERESTED PARTIES
FORM 3.295
lofl
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 parties. 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. 2017-263472
JPS Foundation
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 09/20/2017
being filed.
City of Fort Worth Police Department Date Acknowledged:
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.
FY18 CCPD Program
domestic violence screening
4
Nature of interest
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling Intermediary
Whitley,Glenn Fort Worth,TX United States X
Starling,Gloria Fort Worth,TX United States X
Hill,James Fort Worth,TX United States X
Herchert, Bob Fort Worth,TX United States X
Anfin, Larry Fort Worth,TX United States X
Jackson,James"Jack' Fort Worth,TX United States X
Truitt,Todd Fort Worth,TX United States X
Murphey,John Fort Worth,TX United States X
Wheat,Larua Fort Worth,TX United States X
5 Check only if there is NO Interested Party. ❑
6 AFFIDAVIT I swear,or affirm,under penalty of perjury,that the above disclosure is true and correct.
jj�vp''/. TAJANEE WHITE
yz; :Notary Public,State of Texas # J
y� 4? Comm.Expires 12-16-2020 /
Notary ID 130935149 i
Si at re of authorized agent A6ntracting business entity
AFFIX NOTARY STAMP/SEAL ABOVE
Sworn to and subscribed before me,by the said / i/ (�!(([ � � this the day of
20 to to certify which,witness my hand and seal of office.
/, —e rcu b lit, a-Ho
i lure o fficer administering oath Printed name of fficer administering oath Title of officer administer' oath
For s{� ed by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.3337