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HomeMy WebLinkAboutContract 51085 $'q 5 g eLetanS Co tGpp••�'r+ �� RErEIVEp �'� TVC Award umber: HTX IS 0551 •�GRMrYsj s �• qs�' �' Fiscal Year: 2018— �-� ~ JUN 29 2018 m CITY SECRETARY o �' ,k �o Austin, Texas �c mmmo _ TEXAS VETERANS � 8 r COMMISSION ��� Veterans P . �' Lefcrwns ytn Q� FVA Housing 4 Texas Heroes RECEIVED Notice of Grant Award �s JUN 2 2 2018 t0 MY OF FORT WORTH 0 CITYSECHRARY City of Fort Worth Mailing Address: Physical Address: Grant Title: Housing 4 Texas Heroes—2018 200 Texas Street 908 Monroe Street Date Grant Awarded: Fort Worth,Texas 76102 Fort Worth,Texas 76102 July 1,2018 Amount of Award: Term of Grant: $300,000 July 1,2018 to June 30,2019 Payment Method: Awarding Agency: Reimbursement I Texas Veterans Commission Authority: Government Code Section 434.017 The approved signature below serves as a formal acceptance by the Texas Veterans Commission(TVC)of the Grantee's Application,and addenda(if any)and the approval of this Notice of Grant Award creates a legally binding agreement between the Grantee and TVC.The Program requirements(e.g.,objectives,scope,budget,methodology)as stated in(1) the applicable federal and/or state statute and regulations,(2)the original Request for Applications(RFA)including any addenda issued,(3)the addenda to Grantee's Application(if applicable),and(4)Grantee's Application are incorporated into and made a part of this Notice of Grant Award for all purposes,supersede any prior or contemporaneous understandings between the parties pertaining to the subject matter herein whether oral or written,and collectively constitute the entire agreement between the parties.In the event of a conflict in the language contained in the incorporated documents,conflicts shall be resolved by reference to the language contained in the documents in the order listed above. Any changes to the approved Grant must follow TVC's amendment process. Approving TVC Official: Date Thomas P.Palladino Executive Director OFFICIAL RECORD CITY SECRETARY Authorized Grantee Official: FT.WORTH,TX 73"- ) Date C,/Z Z/t$ Fernando Costa Assistant City Manager y OF FQ APPR VED AS TO FORM AND LEGALITY / Mary J. KaW, , ` T et' ns Co fission; Cr AT ORKY tance •2A-t8* ��SERgNS, APPENDIX I - THE APPLICATION �0 �+Q�4sss Organization Name: City of Fort Worth AMOLMI Reyue,,ted: $300,000 * r * Total Number of Clients to be Served: 25 TEXAS VETERANS COMMISSION �<< 2018-19 Housing 4 Texas Heroes s iii. '5jrc Grant Fnndina Period:July 1. 2018—June 30. 2019 Applicant Information (Complete all lines) • 1 City of Fort Worth 200 Texas Street • Fort Worth,Texas 76102 ' • 908 Monroe Street Fort Worth,Texas 76102 N/A • N/A http://fortworthtexas.gov/ 817-392-7540 75-6000528 1 073170458 • • • •. Diana Carranza Management Analyst II ' 817-392-7369 Diana.Carranza(a,FortW orthTexas.gov *Applicant Contact ••rdinator—Principal Benedict George *Contact Title: Sr Management Analyst Number: 817-392-7339 *E-Mail Address: Benedict.GeorgegFortWorthTexas.gov * Required Information Fund for Veterans' Assistance Page 1 of 22 2018-19 Housing 4 Texas Heroes Application J��ERArys, APPENDIX I - THE APPLICATION ,�Q� 4sss Organization Name: City of Fort Worth 4 � i Amount Requested: $300,000 * 44 * Total Number of Clients to be Served: 25 TEXAS VETERANS � �,COMMISSION �, 2018-19 Housing 4 Texas Heroes Grant Funding Period: July 1, 2018—June 30, 2019 True and Correct Statement: TO THE BEST OF MY KNOWLEDGE AND BELIEF,ALL INFORMATION IN THIS APPLICATION IS TRUE AND CORRECT AND COMPLETED PER THE DIRECTIONS OUTLINED IN THE ACCOMPANYING REQUEST FOR APPLICATIONS. THE APPLICANT ORGANIZATION REPRESENTATIVE HAS READ AND UNDERSTANDS ALL REQUIRE- MENTS AND PROVISIONS NOTED IN THE ACCOMPANYING REQUEST FOR APPLICATIONS, AND WILL COMPLY WITH ALL REQUIREMENTS AND PROVISIONS NOTED IN THE ACCOMPANYING REQUEST FOR APPLICATIONS AND NOTICE OF GRANT AWARD EFFECTIVE UPON SUBMISSION OF THIS APPLICATION AND THROUGHOUT THE LIFETIME OF THE GRANT IF AN AWARD IS MADE. THE SUBMISSION OF THIS DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT. Fernando Costa Assistant City Manager - . 817-392-6122 Fernando.Costagfortworthtexas.gov - 10/31/2017 x Required Information Fund for Veterans' Assistance Page 2 of 22 2018-19 Housing 4 Texas Heroes Application All information must be in sufficient detail to ensure the application can be weighed with other application. Do not leave any item blank.Refer to Section V. Grant Application of the accompanying 2018-19 Housing 4 Texas Heroes(H4TXH) RFA document for further instructions. The grant funding period is based on a 12-month calendar from July 1,2018 to June 30,2019. The required expenditure and program performance benchmarks(below)should be used as guidelines when completing the Application. Date Grant Period Elapsed Amount Expended Performance Met October 1 25% 15% 15% January 1 50% 40% 40% April 1 75% 70% 70% Part I— Proposed Project Information Proposed Project Name 1. Provide a name for the Proposed Project. Healthy Homes for Heroes Program Amount Requested Select one amount being requested. Applicants must refer to RFA Section IV.Program Guidelines,H.Funding Amounts and Financial Documentation to ensure they are able to support request amount with correct financial documentation and other requirements. Select Amount Requested $300,000 Grant Project Service Category Select one category that best describes the nature of the Proposed Project. See Page 13 of the 2018-2019 H4TXH RFA for more information about what may be included in the Service Categories listed below. This Application is not for Veterans Mental Health programs,General Assistance,or Veteran Treatment Courts. Proposed Proiect Service Category Home Modification Assistance programs Is this proposed project a new FVA-funded project,an expansion of current FVA-funded services,or continuation of an existing FVA-funded project? M New ❑ Expansion ❑ Continuation Geographic Service Area(s) The counties that will be served by this grant are called the Geographic Service Area(s). All Texas counties are grouped into one of eight regions. Check all counties,regardless of region,that the Proposed Project will serve. If the Proposed Project provides services to Veterans living in all counties statewide,only check the statewide box. Rural Counties,per the Office of Rural Health Policy, are designated below in bold. Rural counties with an asterisk are designated as being part of a Metropolitan Area but are considered Rural based on their census tracks as deter- mined by the Office of Rural Health Policy. ❑ Statewide Fund for Veterans' Assistance Page 3 of 22 2018-19 Housing 4 Texas Heroes Application Region 1 —Panhandle ❑ Armstrong * ❑ Bailey ❑ Briscoe ❑ Brown ❑ Callahan ❑ Carson * ❑ Castro ❑ Childress ❑ Cochran ❑ Coleman ❑ Collingsworth ❑ Comanche ❑ Crosby ❑ Dallam ❑ Deaf Smith ❑ Dickens ❑ Donley ❑ Eastland ❑ Fisher ❑ Floyd ❑ Garza ❑ Gray ❑ Hale ❑ Hall ❑ Hansford ❑ Hartley ❑ Haskell ❑ Hemphill ❑ Hockley ❑ Hutchinson ❑ Jones ❑ Kent ❑ King ❑ Knox ❑ Lamb ❑ Lipscomb ❑ Lubbock ❑ Lynn ❑ Mitchell ❑ Moore ❑ Motley ❑ Nolan ❑ Ochiltree ❑ Oldham * ❑ Partner ❑ Potter ❑ Randall ❑ Roberts ❑ Runnels ❑ Scurry ❑ Shackelford ❑ Sherman ❑ Stephens ❑ Stonewall ❑ Swisher ❑ Taylor ❑ Terry ❑ Throckmorton ❑ Wheeler ❑ Yoakum Region 2—West Texas ❑ Andrews ❑ Borden ❑ Brewster ❑ Crane ❑ Culberson ❑ Dawson ❑ Ector ❑ El Paso ❑ Gaines ❑ Glasscock ❑ Howard ❑ Hudspeth * ❑ Jeff Davis ❑ Loving ❑ Martin ❑ Midland ❑ Pecos ❑ Presidio ❑ Reeves ❑ Terrell ❑ Upton ❑ Ward ❑ Winkler Region 3 -Alamo ❑ Atascosa ❑ Bandera ❑ Bexar ❑ Coke ❑ Comal ❑ Concho ❑ Crockett ❑ Dimmit ❑ Edwards ❑ Frio ❑ Gillespie ❑ Guadalupe ❑ Gonzales ❑ Irion * ❑ Karnes ❑ Kendall ❑ Kerr ❑ Kimble ❑ Kinney ❑ La Salle ❑ Mason ❑ Maverick ❑ McCulloch ❑ Medina ❑ Menard ❑ Reagan ❑ Real ❑ Schleicher ❑ Sterling ❑ Sutton ❑ Tom Green ❑ Uvalde ❑ Val Verde ❑ Wilson ❑ Zavala Region 4—South Texas ❑ Aransas ❑ Bee ❑ Brooks ❑ Calhoun ❑ Cameron ❑ DeWitt ❑ Duval ❑ Goliad ❑ Hidalgo ❑ Jackson ❑ Jim Hogg ❑ Jim Wells ❑ Kenedy ❑ Kleberg ❑ Lavaca ❑ Live Oak ❑ McMullen ❑ Nueces ❑ Refugio ❑ San Patricio ❑ Starr ❑ Victoria ❑ Webb ❑ Willacy ❑ Zapata Region 5—Gulf Coast ❑ Austin * ❑ Brazoria ❑ Chambers ❑ Colorado ❑ Fort Bend ❑ Galveston ❑ Harris ❑ Liberty ❑ Matagorda ❑ Montgomery ❑ Walker ❑ Waller ❑ Wharton Fund for Veterans' Assistance Page 4 of 22 2018-19 Housing 4 Texas Heroes Application Region 6—Central Texas ❑ Bastrop ❑ Bell ❑ Blanco ❑ Bosque ❑ Brazos ❑ Burleson ❑ Burnet ❑ Caldwell ❑ Coryell ❑ Falls ❑ Fayette ❑ Freestone ❑ Grimes ❑ Hamilton ❑ Hays ❑ Hill ❑ Lampasas ❑ Lee ❑ Leon ❑ Limestone ❑ Llano ❑ Madison ❑ McLennan ❑ Milam ❑ Mills ❑ Robertson ❑ San Saba ❑ Travis ❑ Washington ❑ Williamson Region 7-East Texas ❑ Anderson ❑ Angelina ❑ Bowie ❑ Camp ❑ Cass ❑ Cherokee ❑ Delta ❑ Franklin ❑ Gregg ❑ Hardin ❑ Harrison ❑ Henderson ❑ Hopkins ❑ Houston ❑ Jasper ❑ Jefferson ❑ Lamar ❑ Marion ❑ Morris ❑ Nacogdoches ❑ Newton ❑ Orange ❑ Panola ❑ Polk ❑ Rains ❑ Red River ❑ Rusk ❑ Sabine ❑ San Augustine ❑ San Jacinto ❑ Shelby ❑ Smith ❑ Titus ❑ Trinity ❑ Tyler ❑ Upshur ❑ Van Zandt ❑ Wood Region 8—North Texas ❑ Archer ❑ Baylor ❑ Clay ❑ Collin ❑ Cooke ❑ Cottle ❑ Dallas ❑ Denton ❑ Ellis ❑ Erath ❑ Fannin ❑ Foard ❑ Grayson ❑ Hardeman ❑ Hood ❑ Hunt ❑ Jack ❑ Johnson ❑ Kaufman ❑ Montague ❑ Navarro ❑ Palo Pinto ❑ Parker ❑ Rockwall ❑ Somervell ® Tarrant ❑ Wichita ❑ Wilbarger ❑ Wise ❑ Young Proposed Project Services 1. Briefly describe the Proposed Project. Be specific in your answer and include the Who, What, Where, and When of the Project. Through the Healthy Homes for Heroes Program,the City of Fort Worth will provide home modification assis- tance to low income (80%of AMI)and/or disabled veterans residing in Tarrant County. Home Modifications to ensure healthy homes will include accessibility modifications such as ramps, grab bars, bathroom modifications, door widening, handrails, as well as health and safety items such as heating and air, water and sewer, unstable rotten flooring, electrical system failures and leaky roofs. The Program will be a partnership between different sections of the Neighborhood Services Department of the City of Fort Worth and other community partners such as St6nes, Inc. (known as Six Stones), a local non-profit agency. The Community Action Partners section of the Neighborhood Services department will provide case management and collect eligibility documentation.The Home Improvement and Construction section will perform inspections, prepare scopes of work and oversee reha- bilitation construction contractors to ensure quality work. St6ones and other community partners will provide ex- terior modifications to the home,while the City will provide modifications in the interior of the home. 2. Briefly describe how Beneficiaries will access and/or be provided with Project services by your organiza- tion. Be specific in your answer and include the How of the Project. Program availability and description of services will be posted on the City of Fort Worth's website, listed with United Way's 2-1-1 assistance service and marketed to local social services providers. Program will also be mar- keted to veteran services organizations such as Wounded Warrior Project, Veterans Coalition of Tarrant County, and others. Beneficiaries can access the program by calling CAP'S Customer Care Center at 817-392-5790 24 Fund for Veterans' Assistance Page 5 of 22 2018-19 Housing 4 Texas Heroes Application hours a day, 7 days a week or may access an application at http://fom�,orthtexas.�Zeelcap,/and mail it in to the ad- dress provided. Beneficiaries will be screened for preliminary eligibility and then will be asked to make an ap- pointment. Once beneficiaries make an appointment,they will be assigned to one of the following CAP Centers: Andrew Doc Session Community Center 201 S. Sylvania Ave. Fort Worth, TX 76111 Central CAP Office 4200 S. Freeway, Suite 2200 Fort Worth, TX 76115 Como Community Center 4900 Horne St. Fort Worth, TX 76107 Martin Luther King Jr. Community Center 5565 Truman Dr. Fort Worth, TX 76112 North Tri-Ethnic Community Center 2950 Roosevelt Ave. Fort Worth,TX 76106 Northside Community Center 1100 N.W. 18`h St. Fort Worth, TX 76164 Southside Community Center 959 E. Rosedale St. Fort Worth, TX 76104 Worth Heights Community Center 3551 New York Ave. Fort Worth,TX 76110 Arlington CAP Office 401 W. Sanford., Suite 2700 Arlington, TX 76011 Beneficiaries will meet with a case worker to ensure they meet program eligibility requirements and to assess the beneficiary's needs. Need Identified 1. What is the community need(s)or existing service gap(s)that the Proposed Project will address? Be spe- cific in your answer and sufficiently describe the need that your service area faces to include the Why of the Project. According to Census data, 22,319 of Tarrant County veterans have service connected disabilities. Out of these, 12,915 have a disability rating of 30—70% or above, making it more likely that these veterans are in need of ac- cessibility modifications for their homes. Fund for Veterans' Assistance Page 6 of 22 2018-19 Housing 4 Texas Heroes Application Additionally,41,441 of veterans are senior citizens(65 and older)who frequently need accessibility or health and safety modifications for their homes. A Needs Assessment for Veterans in the Dallas-Fort Worth(DFW)Region states that housing accounts for 33.1% of the average annual household expenditures in the area and the cost of living exceeds the national average by 8.352%.This is a significant burden for persons living in the DFW region, including some of the 114,943 veter- ans living in Tarrant County. Additionally, during 2016,the most common basis for housing discrimination complaints filed with the Fort Worth Human Relations Commission was disability,at 46%.This indicates a great need for accessibility modifi- cations for Fort Worth residents and residents throughout Tarrant County. 2. How did you identify the community need(s) or problem(s)? Be specific in your answer and sufficiently describe any methods used to identify that the need described above in Need Identified#1 is present in your service area. Include references to data that may substantiate and support that this need exists in your ser- vice area. • Census Bureau data was identified by using the American FactFinder data tool on Census' website at https://factfinder.census.pov/faces/nav/jsf/pages/index.xhtml . Source: US.Census Bureau,2011-2015 American Community Survey 5-Year Estimates • The data for living expenses and number of veterans in Tarrant County was obtained from the Needs As- sessment Veterans in the Dallas-Fort Worth Region by Katherine Kidder,Amy Schafer&Phillip Carter from the Center for a New American Security with a published date of March 29,2016. • The data for the disability-based fair housing complaints was obtained from the Fort Worth Human Rela- tions Commission FY 2016 Annual Report. 3. How will the Proposed Project address the identified need(s) or problem(s)? Be specific in your answer and sufficiently describe how the components of the Proposed Project as described above in Proposed Pro- ject Services#1 will assist in attempting to resolve the need described above in Need Identified#1. The Healthy Homes for Heroes Program will assist veterans with needed home modifications.According to the Census Bureau, 39.1%of the owner-occupied housing in Tarrant County was built prior to 1979,this is a rela- tively high percentage of older homes,which become in need of repair or replacement of most major systems once the housing is 30 years old or older.The goal of the Healthy Homes for Heroes Program is to provide assis- tance to these homeowners.The Program will assist with filling in some of these gaps by providing the health and safety repairs that beneficiary homes are in desperate need of, in addition to accessibility improvements. 4. How is the Proposed Project unique from other similar services that may be available in your proposed service area? Be specific with details about what sets your Proposed Proiect apart. The program is unique because of the internal and external partnerships. St6nes, Inc. and other community part- ners will provide assistance with repairing exteriors of homes,while the City provides assistance with the interior of the home, creating an opportunity for more comprehensive services while leveraging funds from different fund- ing streams.The Community Action Partners and the Home Improvement and Construction sections of the Neighborhood Services Department provide an array of services, including job training, case management,weath- erization repairs,lead abatement,health and safety related repairs among other benefits. Program beneficiaries will have access to the services provided by both sections of the department if they qualify,giving them a unique opportunity for additional services and leveraging funding to provide more comprehensive services.Additionally, the program will provide services to all veterans regardless of era,branch of service,duty status and specific char- acter of discharge. Fund for Veterans'Assistance Page 7 of 22 2018-19 Housing 4 Texas Heroes Application Beneficiaries 1. For this grant, Veteran and/or family member beneficiaries must meet specific eligibility criteria: • Be considered Low Income (as defined in RFA Section III. Definition of Key Terms) • Be considered Very Low Income(as defined in RFA Section Ill. Definition of Key Terms) • Be a Disabled Veteran(as defined in RFA Section III. Definition of Key Terms), OR • Be a Veteran who is undergoing long-term treatment at a medical facility in Texas Additionally, Grantees will be required to verify that those Veteran and/or family member beneficiaries receiving home modification, home repair, or weatherization assistance are current on any existing mortgage loans or home equity loans prior to providing assistance. Related to the information provided in Need Identified above,Applicants may also elect to restrict Proposed Pro- ject services to particular groups to address needs by narrowing the eligibility of who can receive services through the Proposed Project. Examples include,but are not limited to: • Veterans of a particular era(such as Vietnam or OEF/OIF era Veterans); • Veterans with a specific character of discharge(such as Honorable, other than Dishonorable, etc.); • Veterans' duty status(such as National Guard, Reservist, or Active Duty);or • Particular Veteran dependents(such as dependents of newly separated veterans, or surviving spouses of reservists or Guards Members). Provide a definition below for each applicable category that will be eligible to receive services, listing any appli- cable service restrictions,through the Proposed Project. Be specific. Do not include the number of clients you anticipate serving. Veterans: defined as persons who served in the military, naval, or air service and have been discharged. All vet- erans will be served regardless of era or character of discharge. Active duty,National Guard, and reservist may be eligible for services, however, preference will be given to discharged veterans. Veteran Dependents: Spouse, minor son, or daughter, including stepchild of a Veteran residing with the Veteran or under age 24 if a full-time student. Surviving Spouses: defined as spouses of deceased Veterans who are currently still unmarried. Choose from the list below all discharge statuses that will be accepted by your organization: ® Honorable 0 General Under Honorable Conditions ® Other Than Honorable Conditions 0 Bad Conduct 0 Dishonorable ® Dismissed ® Uncharacterized 2. Describe any other restrictions on eligibility,if applicable(example: beneficiaries living in a specific service area like a county or region or referral from VA or other such organization). • All beneficiaries must have incomes at or below 80%of Area Median Income(AMI), adjusted for house- hold size as issued by the U.S. Department of Housing and Urban Development(HUD). • All beneficiaries must live within Tarrant County limits as demonstrated by the Tarrant Appraisal District (TAD). • All beneficiaries must be homeowners and be current on any existing mortgage loans or home equity loans as required by application guidelines. • All beneficiaries must have a health and safety, accessibility or other significant home repair need. Prior- ity will be given to elderly veterans(60 years and older) and veterans with a service connected disability. Fund for Veterans' Assistance Page 8 of 22 2018-19 Housing 4 Texas Heroes Application Beneficiaries must provide copies of paystubs with the most recent 30 days' worth of income or an equivalent employer verification form to verify income eligibility. Official award letters will also be required such as Social Security,VA Benefits, Social Security Disability, etc. Beneficiaries that claim no income will be required to com- plete a certification of zero income. Additionally, all beneficiaries must provide proof of Veteran status by provid- ing one of the documents listed in the Project Eligibility section of this document.Veterans with"entry level hon- orable discharge"status will be eligible for services under"General Under Honorable Conditions"status. 3. If your organization receives grant funds, it will be responsible for tracking required performance measures. For this grant,regardless of what Service Category is selected, all grantees must track and report on each individual Veteran,their dependents, and survivors that receive grant-funded service(s). The number of unduplicated Veter- ans, dependents and survivors,as well as cumulative totals, will be reported to the FVA quarterly. Additionally,for those Proposed Projects that fall under the Home Modification Assistance Service Category, grantees will be required to track and report on the number of home modifications completed using H4TXH grant funds. The number of completed home modifications,as well as cumulative totals,will be reported to the FVA quarterly. a. Estimated Number of Clients to be Served Enter the estimated number of unduplicated Veterans,Dependents,and Surviving Spouses to be served by the Proposed Project.The information to be entered is a number. Do not enter a percentage and do not enter a range. Performance Measure Estimated Number of Clients to be Served Number of Veterans served. 23 Veterans (Required performance measure for all applicants.) Number of Dependents served. 0 Dependents (Required performance measure if served.) Number of Veterans' Surviving Spouses served. 2 Surviving Spouses (Required performance measure if served.) Total Estimated Number of Clients to be Served 25 Total Unduplicated Beneficiaries b. Estimated Number of Home Modifications to be Completed If applicable to your Proposed Project, enter the estimated number of unduplicated Veterans,Dependents, and Surviving Spouses to be served by the Proposed Project. The information to be entered is a number. Do not enter a percentage and do not enter a range. Performance Measure Estimated Number of Home Modifications to be Completed Number of Home Modifications to be completed. (Required performance measure for all Home Modi- 25 Home Modifications fication Service Category ro'ects. Total Estimated Number of Clients to be Served 25 Total Home Modifications c. Additional Performance Measures and Estimated Volume of Services Provided to Clients First enter additional performance measures that align with and are related to the Proposed Project in the Per- formance Measure column. For example,if the Proposed Project is to provide homelessness prevention ser- vices through rental assistance, an additional performance measure may be"number of rental assistance pay- ments to be made." Another example, if the Proposed Project is to provide home modification assistance,an additional performance measure may be"number of ramps installed"or"number of bathroom modifications completed." Then provide the estimated volume for the additional performance measure listed. For example, "60 rental assistance payments"or"20 bathroom modifications." Fund for Veterans'Assistance Page 9 of 22 2018-19 Housing 4 Texas Heroes Application Additional lines may be added. Performance Measure Estimated Volume of Services Provided to Clients Examples: Examples: Number of rental assistant payments to be made. 60 rental assistance payments Number of bathroom modifications completed 20 bathroom modifications Number of referrals to other services Beneficiaries will receive at least 1 referral for other ser- vices Number of veteran households receiving additional home repair services from leveraged funding sources 5 (Community Development Block Grant,Lead Haz- ard Reduction Grant, Weatherization programs, etc. d. Goals and Anticipated Outcomes 1. First enter goals that align with and are related to the Proposed Project in the Goals column. For example, if the Proposed Project is to provide homelessness prevention services through rental assistance, a goal may be"clients provided with rental assistance were able to avoid eviction and homelessness,and main- tain housing stability." If the Proposed Project is to provide home modification assistance, a goal may be "clients provided with home modification assistance were able to remain in their house,increasing their safety, independence,and overall well-being." Then provide the anticipated outcome for the goal listed in the"Anticipated Outcomes"column. For ex- ample,"90%of clients were able to avoid eviction"or"90%of clients were able to remain safely in their homes"or"95%of clients experienced increased safety,independence,and overall well-being." Additional lines may be added. Goals Anticipated Outcomes Examples: Clients provided with rental assistance were able to Examples: avoid eviction and homelessness, and maintain hous- 90%of clients were able to avoid eviction and homeless- ing stability. ness. Clients provided with home modification assistance 90%of clients were able to remain safely in their homes. were able to remain in their house, increasing their safety, independence, and overall well-being. Clients provided with home modification assistance were able to remain in their house,increasing their 90%of clients were able to remain safely in their homes safety,independence,and overall well-being. 2. Next,describe how you will determine if anticipated outcomes are met. Examples may include us- ing a client satisfaction survey,following up with clients 30-90 days after receiving services to deter- mine status,tracking pertinent client data. A client satisfaction survey will be done at the conclusion of services as well as an on-site construction inspection to ensure quality work within 60 days of completing construction. Project Eligibility 1. Eligibility to receive services must be verified and documented. The RFA includes a list of specific forms your organization staff may use to verify eligibility of clients who can receive services and ensure that it is applicable to beneficiary definitions above in Beneficiaries#1 (Veteran,dependent,surviving spouse related)and#2(any other applicable eligibility requirements). Select the forms your agency will use to verify eligibility. Fund for Veterans'Assistance Page 10 of 22 2018-19 Housing 4 Texas Heroes Application ® DD Form 214, Certificate of Release or Discharge from Active Duty ® NGB-22,National Guard Report of Separation and Record of Service ® NA Form 13038,Certification of Military Service ® Department of Veterans Affairs(VA)official letter or disability letter with character of service listed ® E-Benefits summary letter with character of service listed ® Honorable discharge certificate ® Uniform Services Identification Card ® State of Texas Issued Driver License with Veteran designation If dependents and surviving spouses are listed as eligible beneficiaries,include how their eligibility will be veri- fied. Select the forms your agency will use to verify eligibility Dependents: ® Uniform Services Identification Card ® Marriage Certificate ® Birth Certificate ® Adoption Certificate Surviving Spouse: ® Uniform Services Identification Card N Marriage Certificate ® Death Certificate or one of the forms listed above for Veterans eligibility 2. Describe how the eligibility verification documents will be retained(example: as listed in your or- ganization's retention policy) and maintained(example: in locked filing cabinet or electronically on your organization's server). Note: Retention period must meet minimum requirements as defined in 2 CFR 200.333 of the Uniform Administrative Requirements,Cost Principles,and Audit Requirements for Federal Awards. Eligibility verification documentation will be kept at each site in locked filing cabinets for a minimum of 3 years after the end of the grant period as required by 2 CFR 200.333 unless exceptions noted on 2 CFR 200.333 require a longer retention period. Project Principal Participants List the principal participants in the organization. Indicate which principal(s),if any, are Veterans. As defined in the RFA Section III. Definitions of Key Terms Principal Participants can include: Project Coordinator,Financial Coordinator,Executive Director or any other key stakeholders in the Proposed Project.Rdsumds are to be included for each Principal Participant and should describe applicable experience by position Name of Veteran #of years of Resum4 Principal Participant Title (I,/N) experience in Attached position—--_ _- -- 1. Sonia Singleton Assistant Director N 8 Y 2. John Cain Neighborhood N 2 Y Development Manager 3. Benedict George Senior Management N 12 Y Analyst 4. Eric Vodicka Management Analyst I Y 1 Y 5. Fernando Cosi-a—f Assistant Ci Manager Y 10 Y Fund for Veterans'Assistance Page 11 of 22 2018-19 Housing 4 Texas Heroes Application 6. Marie Francis Human Services Man- N Y ager 1. What are the roles,responsibilities, and qualification of the Principal Participants listed in the table above as re- lated to the Proposed Project? For example, if a CFO is listed as a principal participant,the description should reference his/her role,responsibilities, and qualifications as it relates to the Proposed Project. Principal Participant#1: Sonia Singleton will provide overall supervision for the Community Resources Divi- sion which the Community Action Partners Program falls under. Ms. Singleton will also provide guidance and support as requested by Principal Participants and the Case Workers in charge of providing services. Sonia has been the Assistant Director for the Community Resources Division since 2009. Principal Participant#2:John Cain will provide direct supervision of all home modification and construction activities, along with support and training to the project Principal Participants and technicians under the Home Improvement and Construction section of the department.Mr. Cain has supervised this section since January 2016. Principal Participant#3:Benedict George will provide financial support by reconciling and tracking cost and revenue data and will assist in the completion of financial reports required by the grant. Mr. George currently performs these tasks and is responsible for the financial and accounting reporting for about 12 million dollars of grant funds that the City of Fort Worth receives;he has performed these duties since 2005. Principal Participant#4:Eric Vodicka will coordinate all aspects of record-keeping and reporting requirements for the grant. Mr.Vodicka currently assists with grant reporting for grants from the U.S..Department of Housing and Urban Development(HUD),and has performed these duties since January 2017. Principal Participant#5: Fernando Costa serves as the Assistant City Manager for the City of Fort Worth.He provides overall leadership and oversight for the Neighborhood Services Department and has the authority to en- ter into contracts on behalf of the City. Principal Participant#6: Marie Francis,Human Services Manager will ensure case workers are trained to conduct intakes,understand the eligibility criteria for program,reviews any client denials and ensures that guidelines are provided to each staff person responsible for working with the program. Likewise Ms.Fran- cis is available to provide technical assistance to case workers,provide guidance on program implementa- tion and responsible for networking with other local agencies for referrals. Partnerships List agencies and/or organizations that your organization partners with to assist in serving Beneficiaries as part of the Proposed Project. Use additional page(s)if needed.Note:Partnerships may be subject to verification. Name of Address Telephone Website Partner Organization St6nes, Inc. 209 N.Industrial Blvd, Suite 214 817-868-7400 http://www.6stones.org/ Housing Channel 4200 S.Freeway 817-924-5091 http://www.housingehan- nel.or Trinity Habitat for Humanity 9333 N.Normandale St 817-926-9219 https://trinityhabitat.org/ Tarrant County 100 E. Weatherford St 817-884-1111 http://www.tar- rantcounty.com/en.html City of Arlington 101 W.Abram St 817-459-6777 http://www.arlington-tx.gov/ 1. Describe the role and how each partner listed in the table above is necessary to accomplish the Proposed Project. Will partner with St6ones,Trinity Habitat for Humanity and other community partners for repairs to the exterior of homes. Will partner with Housing Channel,Tarrant County and the City of Arlington to make and take refer- rals as applicable. Marketing and Outreach Fund for Veterans'Assistance Page 12 of 22 2018-19 Housing 4 Texas Heroes Application I. Does your organization have an outreach and/or marketing plan to ensure your organization is able to reach and provide services to the Estimated Number of Clients to be Served as listed in the table for Beneficiaries#3? ® Yes ❑ No 2. If yes, describe the outreach and/or marketing plan and how it will ensure that your organization is able to reach and provide services to the Estimated Number of Clients to be Served as listed in the table for Benefi- ciaries#3. Outreach is performed by Public Education Specialists throughout the county at Health Fair events, Community events and Job Fairs.Clients are also recruited through direct advertising(flyers)sent to churches,apartment complexes and other venues or through partner agencies such as United Way 211. Social media will also be used, i.e.Facebook,twitter,etc.Additionally, Principal Participant Eric Vodicka will contact veteran services organiza- tions directly to market the program, make presentations, and generate referrals as applicable. Information and of flyers will also be provided at 21 local community centers. Sustainability after the Grant 1. If your organization were to receive a one-year FVA grant,will the Proposed Project continue after the one-year grant period if you did not receive additional FVA funding? ® Yes ❑ No 2. If yes,please describe how the Proposed Project will continue. Be specific. Include in your answer what other funding will be available to your organization and what other organizations with whom you may be partnering or working to carry on the work of the Proposed Project after June 30,2019: The Program would still be viable,however, it would not have the same impact and reach the same number of clients.The City has a HUD-funded home repair program that makes health and safety repairs(Priority Repair Program),however,the cost limit is $5,000 and the income limits are 60%instead of 80%.The City also funds a non-profit agency(REACH)that provides accessibility modifications,however,they do not widen doors. Addi- tionally,both of these programs are open to the general public and not specific to veterans and their households. 3. If your organization has received FVA funding in the past for the Proposed Project,describe why you are applying for a grant again. The City received a General Assistance Grant for the 2017-2018 grant period.The grant provides financial assis- tance to Tarrant County veterans and it has been crucial in ensuring that veterans served are able to remain housed and that they do not become homeless. Our goal is to receive the Housing for Texas Heroes grant as well to pro- vide urgently needed home modifications and repairs for Tarrant County's low-income/disabled veteran home- owners. Fund for Veterans'Assistance Page 13 of 22 2018-19 Housing 4 Texas Heroes Application Part II — Organization Background Organization Overview 1. What is the purpose or mission of your organization? The City of Fort Worth's mission is"Working together to build a strong community" 2. What year was your organization established? The City of Fort Worth was established in the spring of 1849. The Neighborhood Services Department was formed in 2015. The Department was re-organized through a combination of the Community Resources Division, from Parks and Recreation Department and the Housing Division from the Housing and Economic Development Department. The Department was formed in order to consolidate administration of the City's major grant sources for serving low to moderate income residents,which include all of the following: the Community Services Block Grant(CSBG),the Community Development Block Grant(CDBG),the HOME Investment Partnerships Program (HOME)the Emergency Solutions Grant(ESG),the Housing Opportunities for Persons With AIDS grant (HOPWA),the Low Income Heating and Energy Assistance Program(LIHEAP),the Comprehensive Energy As- sistance Program (CEAP),the Weatherization Assistance Program (WAP), and the Lead Hazard Reduction Demonstration Grant(LHRD). The Neighborhood Services Department is therefore able to provide comprehen- sive and integrated social services and affordable housing programs. 3. What types of programs/services does your organization as a whole currently provide? Provide examples and briefly describe program components. • The City of Fort Worth provides essential services to its citizens, such as safety and sanitation, recrea- tional services, creation of affordable housing, home repairs, assistance for MWBE and SBE businesses and many others as required by Fort Worth citizens. • Community Action Partners (CAP)provides an array of social and community services for low income residents and neighborhoods, such as emergency rent assistance, utility assistance(gas, water, electric and propane), case management to transition families out of poverty, Christmas toy program, youth out of school time programs, social, educational and recreational activities for older adults at Neighborhood Centers. CAP also provides income tax filling assistance through Volunteer Income Tax Assistance (VITA) and other programs. Additionally, CAP received an FVA General Assistance Grant for the 2017- 2018 grant period and is currently offering services to veterans and their families in Tarrant County. The programs administered by Community Action Partners are based on need and income,and are essential for maintain both the City's and CAP's mission. • The Home Improvement and Construction section administers four programs: o Cowtown Brush Up provides minor repairs of rotten trim/siding and painting exterior of the house, coordinating this effort through Trinity Habitat for Humanity which recruits volunteers to paint the houses after City contractors have performed all necessary prep work. o Weatherization provides HVAC repairs and services to improve the energy efficiency of homes. o Priority Repair provides emergency or mechanical system repairs(up to$5,000 in repair work) to address health and safety needs. o Lead-Safe provides home repairs in the form of lead based paint hazard reduction and healthy home repairs for families with children(under age six). 4. Are veterans currently being served and what services is your organization providing to the veterans? • The City of Fort Worth serves all residents including veterans • CAP is currently providing exclusive services to veterans through a General Assistance grant awarded by FVA for the 2017-2018 grant period Fund for Veterans' Assistance Page 14 of 22 2018-19 Housing 4 Texas Heroes Application • The Home Improvement and Construction Division served a minimum of 21 low-income veteran house- holds with the Priority Repair Program in the past 18 months. These veterans were served without spe- cific marketing to them and with lower income limits than the Healthy Homes for Heroes Program. With this program we will be able to reach a higher number of veterans. Organizational Structure 1. What type of organization is applying? ® City/Municipal government ❑ County government ❑ Nonprofit organization ❑ Other,please describe: 2. What type of governing body does your organization have? ® City Council/Mayor/City Manager ❑ County Commissioners' Court/County Judge ❑ Board of Directors/Board Officers/Executive Director ❑ Other,please describe: Previous FVA Grant Awards List any previous grants your organization was awarded from the FVA. Was previous funding for the Amount Final Final same Proposed Awarded Grant/Contract# Begin Date End Date Exp % Perf% j Pro ect under this applica- tion? Y $300,000 FVA 17 0409 7/01/2017 6/30/2018 14%* 21%* Y $300,000 Total FVA Grant Awards *as of 10/19/2017 Other Grants and TVC Contracts List all grants and TVC contracts your organization received within the last two(2)years.Do not include FVA grants listed above. Do not list in-kind donations.Use additional pages if needed. Audit Amount Grantor Grant/Contract# Begin End Date Performed Awarded Date es or No) N/A $0 Total Other Grants/Contracts Awards 1. Provide a brief narrative for each TVC (non-FVA)contract that is listed in the above table. Fund for Veterans'Assistance Page 15 of 22 2018-19 Housing 4 Texas Heroes Application N/A Fiscal Management Answer each question below and do not leave any item unanswered. 1. What software does your organization use to record accounting transactions? PeopleSoft 2. Does your organization have written accounting policies and procedures for the following?Please be aware that you may be asked to provide copies of the below policies and procedures to FVA staff should you be awarded a grant.Do not list N/A. YES NO A. Procurement ® ❑ B. Vendor Payments ® ❑ C. Payroll ® ❑ D. Grants Administration ® ❑ E. Cash Management ® ❑ F. Travel ® ❑ G. Capitalization and Equipment ® ❑ 3. Indicate if each statement is true or false for your organization. Do not list N/A. TRUE FALSE A. There has been no staff turnover or reorganization in the past 6 months. M ❑ B. The organization uses a Chart of Accounts. M ❑ C. Time sheets are approved and signed by supervisory personnel. M ❑ D. An A-133 Single Audit has been performed in the past 2 years. M ❑ E. Travel receipts are submitted for travel reimbursement requests. M ❑ F. At what amount does your organization capitalize equipment? $5,000 Performance Reporting 1. What type(s)of data collection tools will your organization use to document Beneficiaries receiving ser- vices,the number of home modifications completed,and any other additional performance measures in Beneficiaries#3 a.,b.,and c.? CAP currently uses Shah Software,New Gen component,which is a client tracking system for data collection and performance measure.The Home Improvement and Construction Section will use Happy Software for client tracking,work write-up and construction management. 2. How will your organization consolidate the collected data to ensure that beneficiaries that are reported to the FVA are unduplicated? New Gen system is capable of generating reports to ensure the numbers are unduplicated.A separate component can be added to the system for the Healthy Homes for Heroes Program. The Happy software can also generate reports on clients and repairs performed. Fund for Veterans'Assistance Page 16 of 22 2018-19 Housing 4 Texas Heroes Application Part III — Bud2et Tables and Budget Narratives The budget is broken up into Direct and Indirect Costs. Within Direct Costs there are six allowable sections. Indirect Costs has one section. Each section represents a Budget Category that will make up your Total Grant Amount Request. The total grant amount request must equal the Amount Requested checked in Part I—Proposed Project. Complete each Table as applicable to your Proposed Project. Costs must be broken out in Tables to a degree that is suffi- cient to determine if costs are reasonable,allowable, and necessary for the successful performance of the grant project. Costs will be reviewed for compliance with UGMS and federal grant guidance found in 2 CFR Part 200, Uniform Admin- istrative Requirements, Cost Principles, and Audit Requirements for Federal Awards. Following each table, a narrative description supporting and discussing each budget item must be entered, as well as a calculation demonstrating how the cost was arrived at. For example, if there is travel in the budget,the narrative must discuss travel and the appropriateness of travel to the project,and the narrative must include calculations to support how the cost was determined. Costs claimed as direct costs that appear indirect in nature or budgets claiming no indirect costs will be scrutinized for accuracy. Any such costs claimed as direct need to be fully explained, supported, be reasonable and treated in a consistent manner across your organization. The FVA may ask the applicant to re-classify costs as indirect if the support provided does not meet the above criterion. All tables should be rounded to the nearest whole dollar. Do not leave a table blank. Place an "N/A" in the first line and a "0" in Total for the table if you are not budgeting those cost in this application. DIRECT COSTS A. Salaries and Wages 1. Enter each employee that will be directly associated with the Proposed Project.Enter their position title, employee name,percent of time to be allotted to the Project, and employee's annual salary rate. Table A % of Time Position Title Employee Name Annual Salary Allocated to the Total Cost Grant Sr. Human Vacant $54,265 50% $27,132 Services Specialist Rehabilitation Carlos Salguero $50,960 25% $12,740 Technician 11 $ % $ Total Table A $39,872 2. Describe the roles, responsibilities, and qualifications including any required license or certification of each of the positions listed under Salaries and Wages and how each of those roles are necessary to accomplishing the Proposed Project. Positions allocated 10% or less must be justified as directly working on the grant. Narrative must also include a calculation to demonstrate how the cost was determined. Fund for Veterans' Assistance Page 17 of 22 2018-19 Housing 4 Texas Heroes Application The Sr. Human Services Specialist will be a new position dedicated solely to FVA funds. The City is also apply- ing for a General Assistance fund,and if awarded,the cost of this position would be shared. The incumbent would be responsible for overseeing both veteran programs and for promotion and outreach. This would be a licensed professional who would provide assistance to CAP case workers when needed. Carlos Salguero is a Rehabilitation Technician II for the Home Improvement and Construction section. He will perform inspections,prepare scopes of work and oversee rehabilitation construction contractor to ensure quality work for the Healthy Homes for Heroes Program. B. Fringe Benefits 1. For each Position listed in Table A, include the annual fringe benefits for that position. Table B Annual Fringe % of Time Position Title Employee Name Benefits Allocated to the Total Cost Grant Rehabilitation Carlos Salguero $15,288 25% $3,822 Technician II Total Table B $3,822 2. Describe the benefits—including health insurance, annual leave,social security and any other applicable fringe benefits—for each position listed in Table B and how each of those benefits are necessary to accom- plishing the Proposed Project. Narrative must also include a calculation to demonstrate how the cost was determined. Benefits include health insurance, retirement contributions, life insurance,worker's compensation,unemploy- ment. Benefits are calculated at 30%of salaries. 1.45%for Medicare, Retirement is 8.25%and the rest of the benefits are 20.3%of salaries. These benefits are offered to all employees and are necessary to accomplish the proposed project because they are part of the total cost for each employee. These benefits would likely not be eligible under another grant. C. Travel 1. Enter employee travel in the table below. This can include travel to and from conferences,training, outreach, and travel to provide services to Beneficiaries. As noted in the RFA Section XI. Grantee Training, funds do not need to be budgeted for travel to Austin,TX for grantee training. This training will be done remotely via webinar or conference call, or in some instances, FVA staff may conduct onsite training visits at the Awarded Applicant's facility. Table C Travel Expense Reason for Travel No. of No. of Total Cost Staff Days N/A $ $ $ Total Table C $0 Fund for Veterans' Assistance Page 18 of 22 2018-19 Housing 4 Texas Heroes Application 2. Provide a description for each travel item included in the Table above. The description should include, but is not limited to, what the travel is for, who is traveling, costs to be used for mileage rates, meal rates per day, confer- ence registration fees,and why the travel is necessary to accomplishing the Proposed Project. Narrative must also include a calculation to demonstrate how the cost was determined. N/A D. Capital Equipment This line is not applicable to this FVA grant application and should be left blank. E. Supplies 1. Enter a description, unit cost and quantity for each item of supplies to be purchased for the Proposed Project. This category includes normally consumable and general use items that do not reach the threshold for capital equipment. This can include, but is not limited to, general office supplies, furniture, laptops, printers, and toner. N/A Table E Description of Supplies Unit Cost Quantity Total Cost N/A $ $ Total Table E $0 2. Provide a description for each item of supply listed in the Table above and explain why each supply item is nec- essary to accomplish the Proposed Project. Narrative must also include a calculation to demonstrate how the cost was determined. N/A 3. if this is a continuation request and your organization was previously awarded funding for the Proposed Project, note each item of supply listed in the Table above that was also requested as part of a previously funded applica- tion and explain why it is being requested again. Examples of such items of supply may include laptops, projec- tors, printers, and phones. N/A F. Client Services 1. List each client service and the cost of each service. Client Services may include, but is not limited to, participant support costs such as rental assistance,transportation assistance for Veterans in shelters, household set-ups for Veterans provided with housing, mileage for staff to transport a client, and any contract personnel that will be providing services to Beneficiaries. An itemized break-out of each client service is required, and extra lines may be inserted into this table. For Home Modification assistance projects,typical Client Services costs include contract labor and supplies. Please note that the maximum amount H4TXH funding for home modification assistance per Veteran household is $15,000. Grantees may utilize other revenue streams in addition to H4TXH funding to fund additional projects on a home modification. Fund for Veterans'Assistance Page 19 of 22 2018-19 Housing 4 Texas Heroes Application Table F Client Service Maximum Cost No. of Clients to Total Cost per Client be Served Contract labor and supplies $9,000 1 25 1 $225,000 Architect fees $1,071 25 $26,766 Total Table F $251,766 2. Provide a description for each Client Service listed in the Table above and explain why each cost is neces- sary to accomplish the Proposed Project. Include,if applicable,the maximum amount of assistance to be provided to clients. Narrative must also include a calculation to demonstrate how the cost was determined. For Home Modification Projects,narrative calculation must include estimated contract labor and supplies costs used to determine the average home modification cost per Veteran household. • Contract labor and supplies include the costs of hiring a contractor to perform the modifications for the inside of the home. Materials would include grab bars, lumber, HVAC components, etc. • Architect fees include the cost of hiring an architect for modifications that require detailed plans such as door widening, ramps, etc. Cost of architect is estimated at$1,071 per home for a total of$26,766*. *Number was rounded to remove cents. Home modifications funded by the FVA grant will not exceed $15,000. G. Construction The FVA grant does not cover the cost of construction. This line is blank. H. Other Direct Costs 1. List any direct costs not included in the above tables. Direct costs that appear indirect in nature need to be fully explained, supported, be reasonable and treated in a consistent manner across your organization. The FVA may ask the applicant to re-classify costs as indirect if the support provided does not meet the above criterion. Table H Other Direct Costs Annual Cost Allocation % Total Cost (if applicable) Marketing/Education $3,540 $3,540 Materials(flyers) Marketing/Advertising ° (ads on newspapers) $1,000 /o $1,000 Total Table H $4,540 2. Provide a description for each item of other direct costs listed in the Table above and explain why each cost is necessary to accomplish the Proposed Project. If costs are allocated an approximate percentage to be Fund for Veterans' Assistance Page 20 of 22 2018-19 Housing 4 Texas Heroes Application charged to this grant is to be included. Narrative must also include a calculation to demonstrate how the cost was determined. Flyers are calculated as follows: I flyer is estimated to cost$0.59, at total of 6,000 flyers will be purchased and distributed throughout the City for a total of$3,540 Newspapers are calculated as follows: 1 newspaper ad is estimated to cost$250 per ad, a total of 4 ads will be published so that beneficiaries will be aware of services being provided. I. Total Direct Charges All Personnel, Fringe Benefits,Travel, Supplies, Client Services and Other Direct Charges should sum to Total Direct Charges on Line I of Table K below. INDIRECT COSTS J. Indirect Costs Allowable Indirect Cost Recovery for FVA grants is limited to 10% of total direct costs for all applicants. Indi- rect charges are those items that are often considered"overhead,"and can be classified as those costs associated with accounting, human resources, and other administrative and facility-related costs. Typical examples of indirect cost for many nonprofit organizations may include depreciation on buildings and equip- ment,the costs of operating and maintaining facilities,and general administration, such as the salaries and expenses of executive officers, personnel administration,and accounting. Please keep in mind that direct and indirect costs must be treated in a similar manner as they are across your organiza- tion and may be reviewed for accuracy during compliance visits. Costs claimed as direct costs that appear indirect in nature or budgets claiming no indirect costs will be scrutinized for accuracy. Any such costs claimed as direct need to be fully explained, supported,be reasonable and treated in a con- sistent manner across your organization. The FVA may ask the applicant to re-classify costs as indirect if the support provided does not meet the above criterion. For more information regarding direct and indirect costs, please see 2 CFR§200.412-414. 1. Enter the total Direct Costs in Table J. to calculate the total allowable Indirect Recovery. Then enter the total In- direct Recover to be charged to the grant—this amount may not be more than the total allowable Indirect Recov- ery. Table J Total Direct Maximum Indirect Total Indirect Costs(Total of Costs Total Allowable Recovery to Table A through (as percentage of Indirect Recovery Table H Direct Costs) Charged to Grant $300,000 10% $30,000.00 $0 Total Table J $0 2. Provide a basic line item description for each indirect cost(ex. Executive Director, IT, Facilities). No further ex- planation is required. Again, direct and indirect costs are to be treated consistently and similarly either as a direct or an indirect cost in order to avoid double-charging the grant. N/A K. Budget Table Enter all the Total lines from Tables A-H and J on the corresponding line below. The total of Table K must match the grant amount being requested in Part I: Proposed Project Information Amount Requested. Fund for Veterans' Assistance Page 21 of 22 2018-19 Housing 4 Texas Heroes Application Table K Table Budget Category Total Cost DIRECT COSTS A Salaries and Wages $39,872 B Fringe Benefits $3,822 C Travel $0 D Capital Equipment E Supplies $0 F Client Services $251,766 G Construction H Other Direct Costs $4,540 I 1 Total Direct Costs $300,000 INDIRECT COSTS J Indirect Costs $0 Total Indirect Costs $0 Total Grant Amount Requested $300,000 L. Matching Funds Describe what other funding sources and/or matching funds your organization will be using to support and accomplish the goals of the Proposed Project. This information helps to provide a complete picture of what resources will be used to accomplish the Proposed Project. Be specific in your answer by including,for exam- ple, any other grants that may fund portions of the Proposed Project,in-kind donations,or volunteer time that assists in the delivery of Proposed Project services. Time spent by CAP case workers will not be charged to the grant and will be used as match, CAP case workers are paid with a combination of CSBG and CEAP funds. Additionally,the fringe benefits of the Sr. Human Service Spe- cialist position requested will not be charged to the grant,these fringe benefits will be paid out of General Funds. Fund for Veterans' Assistance Page 22 of 22 2018-19 Housing 4 Texas Heroes Application 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 requirements. Name of Employee Title ❑ This form is N/A as No City Funds are associated with this Contract Printed Name Signature