HomeMy WebLinkAboutContract 51467CITY SECRETARiaa�i_ CONTRACT NO.
AGREEMENT FOR CONINJUNITY BASED PROGIZAM
.IPS Foundation
FISCAL YEAR 2019
In consideration of the mutual covcnants. promises and agrezmcnts contained herein. THIS
AGRLLNIENT ("Agreement") is made and entered into between CITY OF FORT WORTH. a
home rule municipal corporation Of the State of Teras. ('Vity") acting b} anti throu(M�h .twos
Chapa. its dudv authorized Assistant City tilanager. and JPS Foundation. Zi I exas non-protit
corporation ("Contractor") actin b} and throe(Ih Kristen Sullivan. F.yCCuTIve [)hector. its duly
authorized representatty e.
RECITALS
WHEREAS, C itv has determined that Community -Based Programs are necessary to
support crime prevention in Cite during-) Fiscal Year X019 to meet one or more of the Crime
Control and Prevention District ("(_CPD) goals. vv hick are (I) to support eft0rts to reduce
violent crime and gang -related activities through enhanced enforcement actio hies and crime
Prevention programs. (?) to support efforts to increase the safety of residents and to decrease
crime throughout Fort Worth neighEiorhoods, and (3) to support efforts to increase the safet} of
youth and reduce,juvenile crime thrOW111 crime prevention and intery ention pru�aram,: and
WHEREAS. Contractor has agreed to operate a C,)mmunity-Based Program called Stop
the CvCie of ViOlence in Fort "'Orth. v\hich v -gill support the police department's crime
prevention efforts throughout the community: and
WHEREAS, City dcsit'cs to enter into an agreement %%Ith Contractor to operate the Stop
the Cvcic of Violence in bort ll(_,rth Pro"t'am and
WHEREAS, ('It\, as consideration for the performance of Contractor, has appropt'ialed
monies in the CCPD B ldl_et in the amount of $83.007.05 ("Prop rangy Funds) to provide to
Contractor on a reimhursable haslS for the Operation of the 'Stop the ()cle of Violence in Dort
North Program suhject to and in accordance with this agreenttnt_
I cvprc"ed. the
1GREENIENT DOCUtiIFNTS
I -he A,_=recmcnt document, shall include the in
1 . phis .\greenIent bet\\CCII CI tN and Contractor
1 \hihit - Proposal AI)Stract and `arrame
I \hihit 13 13udet
4. L.xhibit C - Request for IZeiIll bursentent
5. F.yhlblt D Pros=ram ACtiv hies Report OFFICIAL RECORD
CITY SECRETARY
�G ti6vy 09 l o munif,. ka,c l . , F?. WORTH, TX
Oun,l,iIi, �n Page l ot'24
O 16�
OGS
K Exhibit E — Pro,,raln Fr1`Cctiv mess IMCaSUrolient Report
7. I:xlllbit I- - Request for I3ud1Iet Modification
FxhlbitS '\ throu�,i1 F- vyhieh are attached hereto and incorporated herein. are made a Part of this
Agmement Or all purposes. In the event or an) 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. agent;. cmpkgccs. and representatives.
The term "Contractor.. shall include Contractor. and its officers. agents. employees.
representatives, servants. contractors, and subcontractors.
rhe term "Party" shall refer to either City or Contractor.
The term "Parties" shall refer to both City and Contractor.
AGREEMENT
1. Responsibilities of Contractor.
Contractor covenants and agrees to fully perform. or cause to be performed, with good
NUM and due diligence, all "ork and services described in Exhihit "A" — Proposal Narrative.
Contractor shall be responsible for day-to-day administration of the Stop the Cycle of Violence
in Dort Worth program. Contractor agrees to expend the Prograni Fruid; in accordance with the
BUdget as described in F,xhibit 13". Program activities shall be reported in accordancc with
Exhibit "D"- Program Activities Report and effectiveness measures shall be reported in
accordance with Exhibit -F! Program Fttectiycness Measures Report.
2. Pro(ram Funds.
_),I Ili no ev�_Iit itis((( the data( l kirlhUtkm fh'lii t Itv IMAC 1W �il.: tU'�di d ll111= tI
erlll
A thl" ("I'rotgr,t;?' 1 ands-).
2.2 PCl\IllCnt of t(1C ProLn-alll Funds troll( C Itl_ to (ont'aCtOr Sala(( he ((lade Oil a Co�,t-
i'einlburselllcllt hash follow Ing receipt hVC itV froln (ollt'aCtol' of a Slgned RCCIUetit [01'
Reimbursement (RFRL an described in Fxhihit "C..- ahmg with copies Wall receipts and other
supporting documentation. Contractor shall deliver to Cite a written detailed Pro_ram Activitis;
Report and Program I:ftectivcness Measures Report as described in Section 4.2 below with each
RFR to support cypenditurc of Program Funds. Such reports shall he signed by the Contractor or
dolv authori/ed oilicer ofthe Contractor. Fhe RFR and month(\ Program oivitics Report shall
be submitted to Cit\ no later than the 15" da\ following the end of the month. Suhnlittal of a
month(\ RFR and :actio ities Report is requked even irsery ices are not prov ided.
F1 201') C wnnnniiiv l'>Alell 1'ru,ruu
.it's 1 oundalion Page 2 024
The mollthl) RVR. wlth an ori�ilnal ti1,1111alUre b\ all authorized representam c. 11111st he sUblllltted
to the Grants and Prl),_rdlll N-Tanagement Section UI the Fort ��ortll l)olice Department.
ATTENTION: Contract Compliance Specialist, Financial Management Division, Bob
Bolen Public Safety Complex, SOS W. Felix St., Fort Worth, Texas, 76115. Re] IllbUrseillents
Neill not be made until atter receipt of an acceptable and approved RFR and a monthly Program
Activities Report from the Contractor. Additionally, a quarterly Pro-ranl Effectiveness
Measurement Report from Contractor is required as described in section 4.2 and must be
approved prior to reimbursements. Reinlbursenlents shall he made within ,0 days receipt of said
documents.
-1. 3 Contractor is authorized to modify up to Five (5) percent of any huducted line -iteral in the
ori"inal approved budIM without prior written permission from City. llov%cver. Contractor
must submit the Request for Budget Modification Form (Exhibit "F") to Cltx. w ith the monthly
RFR. dtu-in11 the month the modification tool: place. The neve modified bud -et cannot exceed the
total amount of Program Funds.
2.4 Any modifications of more than five (5) percent of any bud(,eted line -item in the ori6nal
approved buduct must llavC prior written permission from City before the modifications are
made. The Buduct Modification Form (Exhibit 'I"') must be submitted. and request must he
approved by City. before any mone% is moved to the line -item. Once the Bud -et Modification is
approved. the modified bud1-jet vvilltake effect on the first day of the folluvv ink month. The Ilevy
modified budget shall not exceed the total amount of Program FLII1dS.
2..Arae modifications to zero line -items in the original approved budget must havc prior
written permission frons City hetore the modifications are made. The Budget .Modification Form
(Exhibit -T-) must he completed and approved by City before money is transferred into the new
line -Item. Once the Bridget Ad0dllicatlon Is approved, the modified hlld(-'et 1\ Ill take effect oil the
first da\ of the follo\V Ill,- Illonth. The tie\V modified Midget shall [lot exceed the total all101-111t Of
Program Fund,.
2.6 Budget modification can oralv Occur vwithin the Direct alld Indirect costs. Funds ma% not
he n1oved irons a Direct line - item into an IndIrect Iine-item. Or vise versus. Modification Of
Direct and Indirect approved budgets must follow the �,uidel Ines Outlined in sections ?. 3. 2.4. and
Budget adju-�tnlents ',hull he ,ubnlitted 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. fills A,-rcenlent shall cilnlnlence upon October I. 2018 (--Effective Date"). and
shall end on September ,O. 2010 ("End Date-). All of Contractor's expenditures under this
A1'recnlent must be completed tlo later than Septenlher 10. 2010.
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IPS I „un4i,ui„n Pa, -)c 3 ul Z4
4. Pro, -ram I'erformanee.
=4.1 Contractor aL"r cs to inaIntaln fit ll do CUIIlen tat iotI SLIP Porti lIg" the perl'ol'll ancc of tIic vvork
and fulfillment ofthe o*cd\es set forth in Exhibit -'A.-
4.2 Contractor agrees to provide a monthly Progratn Activ ities Report and quarterly I'r01,41-3111
Effectiveness Measurement Report to document the performance of the work described in
Exhibit "D" and Exhibit 07 respectively. The Program Activities and EffectiN eness kleasures
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
Eflectiyeness Measures shall he reported on a quarterly basis and included in the January, April.
Jule. and October RFR and Program Activities Report submittals. .'additionally. the Program
Effectiveness Nleasurenlent Report must include descriptions of any realized successes. file
monthly Program Activities and quarterly Program Effectiveness ,Measurement Reports shall be
submitted to City no later than the I I day after the end of each month.
4.3 Contractor agrees that the monthly Request for Reitnbursenlent and Program ActV ides
Report and quarterly Program Etiectiveness Measurement Report "HI he submitted to City no
later than the 150 day after the end of each month. Should Contractor not meet these
requirements. Contractor "ill be given an additional 15 days to submit the required reports to
Citv. If. at the end of this D-day extension period. Contractor has not submitted the required
reports. City vyill send a non-compliance letter notifying Contlactor's duly authorized
representatioe of a possible suspension of program fundings.
4.4 A representative of the prouranl shall attend quarterly mceti igs of the Crime Control and
Prevention District Board as requested.
5. Default and Termination.
5.1 This Agreement is vyholly conditioned upon the actual receipt by City of Prouram Funds
from the CCPD. All monies distributed to Contractor hereunder shall be exclusivcly frons
monies reccived frons the CCPD. and not lions any other mono, of City. In the: event that funds
Froin the CCPD are not received in whole or in part. City may at its sole discretion. terminate
this Agreement and City shall not he Kahle for payment for any vymt or services pakwmed by
C ontractim, un,!, i' or iii :,Hinectitni vAith thi, k areciram. _
5.2 In tilt: e\ :nt Ilk' fulld" of lilsutficient tulld,� are appropriated h\ the ( it\ Ill ally 11,cal \ear
for MlA paA InCnt'� due heret111der. C It\ V\ ill ilotltV C 011tl-aCt01' of sUCh oCCUrrel1CC 111d tllls
Agrewllellt shall terminate oil the last day of the Iltical Period for Mlich appropriations \\cre
received vv ithout penalty or expense to the City of any land vvhatsoevcr. except as to the portions of
pay111eI1tS herein L1�a1-Ced Upon for \V hich fUllds have been approprixed.
5.3 file Citv nlav terminate this Aurecmcnt at any time and Ar an> reason by prov iding the
other party vAl thirty ritten notice oftermination.
I Y 201 `) l'nn1muniI� Ila.r.1. I'„0eram
I I's I oulAttioll 1'.1_r 4 oi'2 4
5.4 Ferinination "ill be Cilected by delivering tr Contractor Nvritten notice of tcrlllinatiull.
Upon Contractors 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 t«r completion of the
work not terminated:
(c) Terminate all orders and contracts to the extent that tiley relate to the perturnlance o'the
vpork terminated by the notice of termination: and
(d) Cease expenditures of Prc umm Funds. except as may be necessary for completion of the
,,pork not terminated.
5.5 In the event City suspends or terminates this .agreement. Contractor expressly \\aives
any and all rights to munetaq damages. including but not limited to actual. consequential. and
punitive damages. court costs and attorney's flees.
5.6 Within thirty (30) days tolloWng 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 ternlination of the
,Agreement.
6. Equipment and Nlaintenance. All equipment purchased with Pro,granl Funds must
meet al( eligibility requirements of City. Contractor shall maintain all equipment used in the
administration and execution of the Stop the U jcle of Violence in Fort AVorth program.
Contractor shall malntahl. replace. of repair any hem of egtllplllcllt Used ill SUppOrt of the Stop
We CA A of k0lence Ill Fort AA Orth progr'alll or for Use under lie terms Of this Agreement that
no lonz�er functions or Is lest Or stolen. The Cost for maintenance. replacement or repair of any
el]UlplllCllt used Ill Support Of Stop the C ck of VIOIe11Ce In Fort Worth prograin and Or for use
under file terms of this Anecment is the sole rwpOnVilityOf Contractor. Contractor shall not
Use Program F nndS to) repair of replace said egUipment. Contractor shall USC ally and all
egLliplllCrlt purchased "it Progr'arn Funds MCIUSIVA) ill SUppOrt Of the Stop the Cycle 01
Violence in Fort Worth progranl. Within It) days follov\ing the purchase of equipment.
C011traCtOr ;hall Submit to City a detailed inventory of all equipment purchased \\ith Program
Funds to the Grants and Program Nlanancnlent Section at the address set forth in paragraph 2.2
abtIve. the Cquipluent IllvCIIG)ry shall in'J lde .ill ilolili4cd e�lcll piece of
C�lUlplllell'... the date C.lch J)": -,2o ''I Cg1,61Vlent tl)e 1:0'4 101' Cach piece
ofcquipnlem. and the Inca 1011 (If each piece of equipment.
7. administrative Requirements.
7.l
Contractor agrees to keep sufficient records to dOCllIllCllt its adherence to applicable local. state. and
federal regulations. along yv ith documentation and records of all receipts and expenditures or
Pro'-'ranl Fund,. All records shall be retained IN three (3) )oars Folk_wwing the termination or
completion of this :Agrcement. City or its representalik es shall hay C the right to investigate.
examine. and audit at an time any and all such records rclatingr to operations OC Contractor under
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JI'S I onwdatiim 14_c 5 AN
this Agreement. Contractor, its officer. nlcnlbers. agents. emplO�CCS. Lind SUbCo�ntractOrs. upon
demand by Cite. shall make such records readily available for inyCS6,1�ation. examination, and audit.
In the event of such audit by Cit%, a We audh of all Com aetur's operations vv ill be undertaken
and may he conducted either by Clty Wan independent auditor of- C Av's choice. C ontractor shall
submit a cope of any audit performed by their independent auditor vv thin 30 days of receipt of the
final audit report.
72 Van, audit reveals a questioned practice or expenditure, Cit; shall notify Contractor as
soon as reasonably practical. Contractor shall have fifteen (1 5) days to provide City vv ith a
vwritten explanation and any supportino documentation regarding the practice or expenditure. If'
Contractor fails to resolve or cure the questioned practice or expenditure. to the City's
satisfaction. vwithin the fifteen (1 5) day period. City reserves the right to vv ithhold further
Program funds under this and,or future a-reement(s) will Contractor.
7.3 11. as a result of any audit- it is determined that Conn -actor misused. misapplied or
misappropriated all or any part of the Program f=unds, Contractor agrees to reimburse Citv the
amount of such monies so misused, misapplied or misappropriated. plus the amount of any
sanction, penalty, or other change levied against City because of such misuse, lllisapplication 01-
misappropriation.
rmisappropriation.
7.4 Contractor's obligation to Cite shall not end until Of closeout requirements are
Completed. The Closeout requireinents shall Include. but are not limited to: prov idin,-, final
Program Actl\ Ides Report and prl)gmni E tectiveness Measurement Reports. making Hilal
payments, and disposing of Stop the Cycle of Violence in Fort \\orth assets as appropriate- if
deemed required by the City in its sole discretion.
7.5 Contractor covenants and agrees to fully cooperate yyith City in mo-Anito-yrin:� the
effectiyeilcss of the services and vvori; to he performed fir Contractor under this Agreement. and
vyOrk to be performed by ContraCor Under this Agreement and City shall have acecs, at all
reasonable hours to otlices and records of Contractor, its officers. members, agent;- employees.
and Suheontractol-s fur the purpose of such Monitoring.
SCCtir►11 7 shell aury i%e the cctliration or tei-inination of this A!,i-et:mcnt.
ti. Independent i-ontractor.
8.1 Contractor S11a11 Oper[ne hereunder as all Independent Contractor and [lot a, all officer.
agent. lir sen ant or empkl ec of C q . ("mractor shall have exclusive control Cif, and the
exCIUSi\C right to c0litrOL the details of the \\(irk and services performed hereunder. and all
persons perfornlillg Sallie. and Shall he solely responsible for the acts and oinissions of Its
Officers. members. agents. Sec\anw. cnlphIceS. SUhcontractorS. program participant-, licensees.
or ill\ itec,. I he doctrine of resymdcm Superior Shall my apply as ha"cen C lt\ and (onantor.
its Officers. nienlbem agems, Servanty eillpW3cen subcontractors. program participants.
licensees. or inv Aces, and nothing herein shall be construed as creating a partnership or joint
enterprise hetvycen City and ConUactor. No federal. state. or local income tax. rnor any payroll
I v 2019 (01111uunit� ki 111:d Prn,ram
tax of allV kind. shall he V\Ithlleld of paid bV Clt\ on behalf oI Gontractol'. Gmtlactor shall not be
treated as all cmitioAee V\Ith respect to the service-, pel'Iormed pUCSllant to thi, Al-IreelllClIt tol'
lirderal or state tay purpo,es. It i, CXpcessl\ understood and al -11 -red that ofllcers. Illcntbers.
agents. enlplo\ees. Subcontractors. licensees. or invitees of Contractor. and anv program
participants hereunder are not eli(-,ihle tor, and shall not participate in anv employer pension.
health, or other fringe benefit plan provided by Cita. It is CXpressly understood and agreed that
Cite does not have the le"al right to control the details of the tasks performed hereunder h,,
Contractor, its officers, members. agents. employees, subcontractors. program participants.
licensees, or invitees.
8.- (,it} shall in no way nor under any circumstances he responsible for any property
belon,_)im_, to Contractor. its officers. members. agents, emplo%ces. subcontractors. program
Participants. licensees or invitees. which may be lost. stolen. destro}ed, or in any "a% damaged.
9. Liability and Wdemuitiication.
ONL Y TO THE EXTENT PERMITTED BY THE C'ONSTITUTIO,V AND LA 11 S 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 RE'tiIEDIES CODE
CHAPTER 101), CONTRACTOR SHALL BE LI=1 BLE AND RESPONSIBLE FOR ANY
AND ALL PROPERTY LOSS, PROPERTY DAMAGE AND/OR PERSONAL INJURY,
INCL LDLVG DEATH, TO ANY AND ALL PERSONS, OF ANY KIND OR CH4 RACTER,
WHETHER REAL OR ASSERTED, TO THE EXTENT CAL -SED BY THE ;NEGLIGENT
ACT(S) OR OJIISSION(S), Jl-tLFEASANCE OR INTENTIONAIL JHSCO,` DUCT OF
CONTRACTOR, ITS OFFICERS, AGENTS, SERVANTS OR EMPLOYEES.
OA'LY TO THE EXTENT PERMITTED BY THE CONSTITUTION AND LABS OF THE
ST4 TE OF TEXAS AND LIGHTED BY THE LLIIITS OF LIABILITY AS SET FORTH 1V
THE TEXAS TORT CLALVIS ACT (TEI:AS CIVIL PRACTICE AAD REMEDIES CODE
CHAPTER 101), CONTRACTOR AGREES TO DEFEND, LVDEJI.VIFY AND HOLD THE
CITY, ITS OFFICERS, AGENTS, SERIAN"TS, AAD EM1IPLOYEES HARMLESS AGAINST
ANY A:VD ALL CLALVS, LAIISUIT.S, ACTIOAS, COSTS, AND EXPENSES OF ANY
KIND, IVCL[DLVG, BUT NOT LLIHTED TO, THOSE FOR PROPERTY DAMAGE OR
LOSS (LVCLUDING ALLEGED DA IIAGE OR LOSS TO OWNER'S B[ SLVESS AAD A:NY
RF.S[I-TING LOST PROFITS} IIWPOR PERSON.IL 1N.IVR1' tI.V(L[ DING DEATH)
I'llI T IL 1 Y REL, 111" TO, .1R1SE O[ T OF, OR BE OCCASIONED BY (I)
CONTRACTOR'S BREACH OF ANY OF THE TER.IIS OR PRO! ISIOAS OF' THIS
AGREE.1IENT OR (11) ANY NEGLIGENT ACT OR OMISSION OR INTEATIOx4l,
MISCONDUCT OF CONTRACTOR, ITS OFFICERS, AGENTS, .ASSOCIATES,
E.IIPLOYEES, CONTRACTORS (OTHER THAN THE CITE), OR SUBCONTRACTORS
RELATED TO THE PERFORI6IANCE OF THIS AGREEMENT EXCEPT THAT THE
INDEALVITY PROI IDED FOR IN THIS SECTION SHALL .NOT APPLY TO AA'Y
LI-MILITY RESULTING FROM THE .SOLE :NEGLIGENCE OF THE CITY OR ITS
OFFICERS, -AGENTS, EMPLOYEES, OR .SEPARATE CONTRACTORS, AND IN THE
EI ENT OF JOINT A.ND C'O.VC'[ 'RRE:VT ;SEGLIGL,,N'CE OF BOTH COATRACTOR AND
CITY, RESPONSIBILITY, IF ANF, SHALL BE APPORTIONED COMP.4RATI6 ELY LV
t } X111 'IIll Ill unit_v fi;I',: d I'rn_!,I I
ACCORDAVCE HIM THE L,1 {6S OF THE ST4TE OF TEX4.5. A'OTHLVG HERELV
SHALL BE CONSTRUED AS A WAIVER OF THE CITY'S GO ER.AJIL1'TTL
LIDIU ITYAS FURTHER PROVIDED B1" THE LAGiS OF TEXAS.
Contractor shall require all of its subcontractors to include in their subcontracts a release and
indemnity in favor of Cite in substantially the same form as above.
This section shall sunhv the expiration or termination of this Agreement.
10. Non -Assignment. No assignment or delegation of dirties under this Agreement by
Contractor shall be effective without Cih's prior vwritten approval.
11. Prohibition Against Interest.
11.1 No nlenlber, officer, or enlploy0e of Cite. or its designees or agents_ no to nlher of the
governing body ofthe 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 "ho exercises any functions or
responsibilities with respect to the Stop the Cycle of Violence in Fort Worth program durinzI, his
tenure or for one year thereafter, shall have any interest, direct or indirect. in any contract or
subcontract. or the proceeds thereof, for worn: to he performed hereunder. Contractor shall
incorporate, or cause to be incorporated, like language prohibiting such interest, in all contracts
and subcontracts hereunder.
11.2 No officer. employee. nlcnlber. or program participant of Contractor shall have a
financial interest, direct or indirect. in this Agreement or the monies hansferred hereunder. or be
financially interested. directly or indirectly. in the sale to Contractor of any land. materials.
supplies. or sere ices purchased Wdi an� funds transferred hereunder. except on hellalf of
Contractor. as an officer, enlplo�ec. nlcither. or program participant. Any vv illful y iolation of
this paragraph xvith the kno"Iedge. expressed or implied. of Contractor or its suhcuntractors.
shall render this A-reement voidable by City of Fort Furth.
12. Nondiscrimination.
12.1 In accordance "it the Federal. state. and local lays and ordinances. Contractor
C,)\cllallt�, drat neither it 11ol" alt\ i Il, Mllccr,. Clllplo) ee,, tvol-11'alll
participalllti. ,- !ncc"Iltractorti. AVhi!'- +l,a,cli ;n pNrtOrmnllll�, A��r«Iliellt shall Ill Col"11CCii,Ill
vv ith the employ nlent. adv ancenlent. or of empho cc,. in connection iv hh the terms,
conditions or prix ileacs of their employ nlent. discriminate a.,ah st persons because of their wigc-
excepton the hasis of a bona lido occupational qualification. retirement plan, stauam-r
rellUil-Citent, or StatUtOr\ Or Ordin"Ince C\ccptioll.
12.2 Contractor vyill not unlavvCulk di-scrinlinate against any per50n or persons hecause ol'
aLC. race. color. vCh'.ion. scx. disah0it%, national ori,,in, ur sexual orientation. nor vv ill Contractor
perillit Its officcr�. Illclllher�. elllplO\CCS.`StlhC011traCtt)rti. Or prO,raill partlClpallt�, to
Cn,'agC in Such dlSCrllllinatlon.
FY 201 1) (,unIll uiit� cin>Cd PIt)er:Ill
II'S I OLUILL16011
ONLY TO THE EXTENT PERMITTED BN THE CONSTITUTION AND LANN'S OF
THE STATE OF TEXAS AND LIMITED BY THE LIMITS OF LIABILITY AS SET
FORTH IN THE TEXAS PORT CLAIMS ACT (TEXAS CIVIL PRACTICE AND
RENIEDIES CODE CHAPTER 101), IF ANN' CLAIM ARISES FROfm AN ALLEGED
VIOLATION OF THIS NON-DISCRIMINATION COVENANT BY CONTRACTOR, ITS
PERSONAL REPRESENTATIVES, ASSIGNS, SUBCONTRACTORS OR SUCCESSORS
IN INTEREST, CONTRACTOR AGREES TO ASSUME SUCH LIABILITY AND TO
INDEMNIFY AND DEFEND THE CITY AND HOLD THE CITY HARMLESS FROM
SUCH CLAIM.
This section shall sure iv a the expiration or termination of this Agreement.
13. Compliance.
13.1 Contractor. its officers. members. agents. emplo�ces. program participants. and
subcuntraCtors, shall abide b� and compl% �v ith all IaNNS. fCcieral. state and local. including" all
ordinances. rules and I-egulations of Cite. If CitN calls to the attention of Contractor in vv riling to
am such v-iolation on the part of Contractor or ani of its officers. members. agents. emploNecs.
subcontractors or program participants. then Contractor shall immediately desist G'om and
Cort'CCt such N iolation.
I I.2 Contractor shall utilize Pro,ram Funds strictly for those purposes and goals intended
under the terms and conditions of this Au'recnlent. If Citv calls the attention of Contractor in
Titin(' to allV such viol_itions on the part of ConU'actor or ani or its orticers. members. a-cnts,
empimecs. pro( -Tram participants or subcontractors. then Contractor shall immediate]v desist
from and correct such violation.
14. Gmernmenta) Powers. It is understood that by csecution 01'1111S agreement. the Clty does
not vvaiN C or surrender ani of it (-,overnniental powers.
I,. Waiver of Immunity. ►f Contractor IS a charitable or nonprofit organization and has or
claims an immunity or CXCmptloll (statutory or other -MS) from and JI-Iain;t liability fur damaLles
or injurA. inc(udin'-' death. to persons or property: Contractor herebN e.xpressk vNaiNes its rights to
hl�l�i �lel�n�lVcl\ "li,:Il _Liillmmit\ or 111 Lt" shall Ilot I',,:
w allect :I 110 CntltVLtIlder �ULWol'\ of o'11It1�-I
16. Insurance Requirement.
16.1 C'ol,crages and Limits. Contractor ,hall proN ide the C'ity vv ith ccrtilicate(s) of insurance
d0cumentin(-1 policies of the lt,lluMin<< mini�nunt CoNlimits that are to he in effect prior to
commencement of ani v\ ort pursuant to this V-'rcCmcnt:
onlnlllnll\ II3>L:d Procr;utl
ti's I ouncintion P,J_c 901,34
(a) Commercial General Llahlllt\ (CGA.): C011(1 MM' IS Belt-111SUred ill kceping A\ Ith
the terrlls of the Texas fort Claims Act. Contractor v�ill furnish a Certificate of Seif-
hlsurance in lieu of the re�luired ��eneraf li�thility insurLrncc certificate.
(h) Jon -profit Or;anization Liability or Directors & Of tcers Liahility: $1.(100.000 per
occurrence, vyith a $1.000.000 annual ao_gregme limit, in a form that is acceptable to the
City's Risk Nianaoer.
(C) AUtomohile Liability: $1.000.000 each accident on a conlhined single limit hasis OR
split limits are acceptable if limits are at least $250.000 Bodily InjurA per person.
$500,000 Bodily hljurti per accident and $100.000 Property Dama,,�,e.
(d) Any other insurance the City nlav reasonahly require to protect the interest of, the Citv.
16.2 C'ontractor's insurer(s) must he authorized to do hLISItlCSS in the State of TeSas for the
lines of insurance coverage provided and be currentlV rated in terms of financial strength and
solVenc\ to the satisfaction of the C It) s Risk NJana-er. All IlltiUrerS Illtlst line Ll Illlillllllllll
rating-, of A- VII in the current AAM. Best Key Rating Guide. or have reasonably equivalent
financial strem_th and solvency to the satisfaction of Risk Nilanagenlent. If the ratim-, is helovv
that required. written approval of Risk Management is required.
16.) Each insurance poliC\ required herein shall he endorsed vv ith a \\a]\ Cr of "UhrOglation in
livor of the City. Lash insurance polis} required b\ this Agreement. except for policies of
worker's compensation or accident medical insurance shall list the Cite as an additional
insured. City shall have the ri011t to revise insurance coyera«e requirements under this
Agreement.
16.4 Contractor further a,recs that It shall compl\ \\ Ith the Worker's Compensation Act of
Texas and shall pro\ Ide SLIftICICIlt Comperisati011 111SLll'a11CC to protCCt C 011tractor and C It\ h-olll
and a�_)alnst Gln\ Cind all Workcr s Compensation claims Lirisino from the \\lark and scr\ Ices
prm ldcd under this Agreement. Contractor will furnish a Certificate of Sclf-IIlNLIr IlCC in lieu of
the required Workers ('onlPell sat Ioil insurance certificate.
16.E A minimum of l hi Iv (;0) days' notice of cancellation or rcduction in limit,, of Coverage
Shull he rwidCd to the (Itv, lCll 11th notick �0,di ?)e l(CC,l)tahle In the e\cw of Iloll-
pa\I1ICnt of [)I",21MLIIII. 11i,111 Ike lil2Ilt to [lie RIS1v ItV A I i)rt \\or[h. 200 [eva",
Street. hurt \\ olrth. fc�as 7610x. \\ ith copies to the Cit\ Attonic\ at the sante addre�s.
16.0 Ally 1a11urc on the Part of the LIIv to rcgLICSt rCgLllrCd III',tIra11CC d0CL1111CIltati011 Shall IIOt
COIIJTItL1tC a \A al\ Cr of the I11SrIranCe rCgLlircillent.
16.7 C CrtlflCatCS of II1SLIrLIIICe ev Idencim-,, that the C Ontractor has obtained all rCgtllred
instn_ance shall he delivcreel to the Citv Prior to Contractor proceeding with any wort: pursuanl to
this A1_rccnient.
1V 2019 ( ommullm 11,1 1 1'101-11am
IPS f 11) ui24
17. ,Miscellaneous Provisions.
17.1 The pro%isions of this Agreement arc acv cr�lblc. and. 11' fur ani reason a clause. �CIIICIice.
paragraph, or other part of this Agreement stealI he determined to be invalid by a court of Federal Or
state agencv, board. or commission hav ing jurisdiction over the subject matter thereof. such
invalidit} shall not affect other provisions which can be "iven effect without the imalid prov ision.
17.2 City 's failure to insist upon the performance of any term or provision of this Agreement
or to exercise till\, richt herein conferred shall not be construed as a waiver or relinquishment to
any extent of City's rI,,ht to assert or rely upon any such term or right on an\, future occasion.
17. , Should any action, v\,hether real or asserted. at law or ill equity. arise out of the execution.
performance. attempted pertornlance or non-pertornlance of this Agreement. venue for said
action shall tie ill state courts located in Farrant County. Texas or the United States District
Court for the Northern District of Texas. Fort Worth Dirision.
17.4 Contractor represents that it possesses the legal authority. pursuant to any proper.
appropriate and official motion. resolution or action passed or taken. to enter into this A(_31,eenlent
and to perform the responsibilities herein required.
17.5 This yvritten instrument and Exhibits A through F constitute the entire a�yreenlent between
the parties collcerning, the vwt-L and services to be perf0rn1ed hel-eundel'. and any prior or
contempolalleOLIS, Oral of V\ Pitted agreement \yhlch pUrports to \ ar\ f -om the terms hereof shall
be %old.
17.6 Ali\ amendments to the terms of thlS Agreelllent Il1LISt be In \\rItIng and 1llUst be sl,�ned
by authorized representatives of each Partv.
17.7 None of the pertornlance rendered under this Agreement shall involve. and no portion of
the Program Funds receired IICl'eLII1dCr shall be used. directly or indircctly. for the construction.
operations. ilia i11tenaulce or administration of any sectarian or religious facility or activity, not,
shall said performance rendered or funds received be utilized so as to herncht, directly o('
indirectly. a11y such sectarian or religious flCitity or acti\,ity.
17.8 fhc parlies that each n.lrty a11d it. Counsel hay c I'Cv 1k:\\Cd illi, .Agrec�ucnt
LIM] that the Ill rniai I Ci�Il,�tl'llcttoll to the cfkcCt that ltll\ allliV Llltle', are to be IV'W!� !Li
a,ailist the drafting, part\, ,haul not he in the 111terpretati011 of this .A rccnlcnt Or
e\hihits hereto.
17.9 Captions and headin�,s used in this A,_,1'ccmcnt are For relerence purposes 0111v and shall
not be deemed a part of this Agreement.
17.10 Hie provisions and conditions of' this Aureement are solely For the benefit of CitN and
Contractor and are not 111tended to Create an\ 1'I1 1I.S. CoIltraCtLIJI lir I)tllel'111,,e. to all\ Other pct -,,,)Il
or elltlt\.
F1 ?11I�) C'OnimLIIIM 13a,rLl I'r„eriiu
IPs I uun(1a01 m Paer I I ,1 2-I
17.11 ContractoI- certIFies that it has obtained a 501(c1( ") Certificate from the Internal Revenue
Service. Contractor shall notif} City III %writing of am chanes to its 501(c)(;) tax-exempt status
during the term of this :'agreement.
18. Notice.
Notices to be provided hereunder shall be sufficient if forwarded to the other party by Hand -delivery or
via U.S. Postal Service certified mail. postage prepaid. to the address of the other party shown below:
CITY: Jesus Chapa, Assistant Citti N'lanager
Cite k1ana-'er's Office
City of Fort Worth
200 Texas Street
Fort Worth, TX 7610?
Copies To: Contract Compliance Specialist
Financial Mana�oement Division
Bob Bolen Public Safety Complex
50� West Felix St.
Fort Worth, TX 7611
Cit} Attorneti's Ofitce
Atm: Notice Contracts
'00 Texas Street
Fort Worth, TX 7610?
CONTRACTOR: Connie Winkle
Seuiol- Grants Specialist
122? S. Malll Street
Fort AAorth. TX 76104
19. Immigration Nationality .act.
Colit !..lrt �l' �,h',I vcrity the IJclltity .Iud cInplovmc1)t c[iZ,0-)I itv 4 it> employee; vvho pert,61,111
TI\ Lit IJ,:r Hf'. 1`CCCnlell!, it!C uJiIn7_ �_:nlplCilll` the t.i,!I \1!lent III!`II�ili"\ \:i!it�.:"i.io!1 1"01,111
1-111. t I)k it C,:,ILICSt by C Iiy, l 0IIt( dCtol' ldll f)h1_ idC i- IIx wtll copse, td t1i 1-1) IoCnl, allJ
supporting cli�1ihilitV docunlcntation ti,r each enlplvvLe vvho pertiOrnl; vwrk u( dcr this
A,.11'eeillellt. Contractor Shall adllerC to all Federal and State kms as \\ell as establish appropriate
pl'ocedLIrcS and Control', So that Ito SCI-\ Ices 1\ ll l hC perfoi'llled h\ all% Contractor emplll\ ce \V ho
is not ICI-Idlk eligih[e to perform such sere ices. CONTR-\CI-OR SHALL INDF�IM fFY Cl FY
.AND I IOLD CI FY ITARMLL:l-,S FROM[ \,,,Y PL:N.ALTILS. LIABILITILS. OR LOSSVS Dl_'[.
TO VIOLAIJONS OF TIAs PAR AGRAP[I BY CU'IN TR.AC"FOR. C0NTRAC"FUR'S
L;NIPLOI'Lt:S. St 113CON-FR\( k)RS.:AGEN I"S. UR LI(TNSFL:S. Clty, upon vvrittcn notice to
Contractor, shall ha\C the rl,_,ht to Imillediatel_\ terminate this /A'lreelllent for \ Iolatlons of thls
provision by Contactor.
I l -,lil') C uniIll unit_- tI't„_eraIII
IN WITNESS WHEREOF, the parties hereto have executed this a e ent in multiples in Fort
Worth, Tarrant County, Texas, to be effective this �ay of , 20 .
APPROVED AND AGREED FOR
CITY OF FORT WORTH
Jesus J. Chapa
Assistant City Manager
Date:
APPROVAL RECOM ED
j ::�71
Joel F. Fitzgerald
Chief of Police
Date: / 017, Zib 6S
APPROVED AS TO FORM AND
LEGALITY FOR CITY OF FORT
WORTH
Thomas R. Hansen
Assistant City Attorney
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
C-,,rep+r J r ui epts.
Namely 9W'(n I pA+&
Title: (tiktc Ovv�Ylivivye S?PM*II5�
FY 2019 Community Based Program
JPS Foundation
APPROVED AND AGREED FOR
JPS FOUNDATION
Kristen Sulliv
Executive Director
Date:
APPROVED AS TO FORM AND
LEGALITY FO JPS OUNDATION
&,r� 4IXJ' a4"CX-
Neal W. Adams
ADAMS, LYNCH & LOFTIN, P.C.
Tarrant County Hospital District General
Counsel, On Behalf of the JPS Foundation
Date: /-:> - l5- ~ 2-0 /:?
* CITY
ATTEST
r 70
MaryJAEV& Y
City Secretary N) -
Date: 1D131I N
M&C No. NOT REQUIRED
1295 CERTIFICATION: „20 fig' lite 6%
OFFICIAL RECURC Page 13 of 24
CITY SECRETARY
FT. WORTH, TX
t__t. i
PROGRAM ABSTRACT
Provide a short description of your program to be funded. Please summarize the problem and what
your program will do to address it. (Roughly 2 paragraphs in length on a separate page)
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. Domestic and family violence account for
50'/o 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. However,
as of last year, the DFW Hospital Council 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. That trend changed with the help of CCPD funding in 1017-18 for JPS' Stop
the Cycle of FamMy Violence in Fort Worth project. JPS has identified and implemented a research -tested
domestic violence and human trafficking screening survey designed to identify victims and prevent repeated
violence. The project trained clinical staff in the screening and conducted a ten -week trial pilot in the
Emergency Room, where screenings went from 30% (using an old survey) to 6wo using the new screening
tool. JPS will be fully implementing the screening survey for all patients at three high -traffic locations: JPS'
Emergency Room, Level I Trauma Center, and the Polytechnic Community Clinic, as of June 4, 2018.
To continue to increase public safety, the JPS Foundation requests CCPD funding to expand
implementation of this domestic violence and human trafficking screening survey in other areas of the JPS
Health Network, including the Main JPS Health Center for Women, OB Triage, and JPS Urgent Care. The
first two are high-volume areas where JPS health services are focused on women. Urgent Care is a high -
traffic area where men, women, and children with violence -related injuries can be identified. The 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 are referred to Fort Worth Police and
social service providers. Additionally, to increase literacy skills to help break the cycle of violence, JPS
will provide books for patients with children with instructions on how to spend time reading together. Over
the grant period, JPS projects screening 39,550 patients for domestic violence and human trafficking.
An estimated 400 or more patients will be identified as victims; and JPS will provide books and
literacy resources to 1,500 children of patients. In addition, through the DFW Hospital Coalition, JPS is
providing 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
ableto have a great impact on city-wide safety and reductions in violent crime.
FY 2019 Community Based Program
JPS Fclndation — Exhibit - P Page 14 of 24
Exhibit B- I3j dget Nartaij.t
2018-2019
BUDGET SUMMARY
Amount
Reauested
A. Direct Personnel
59,061.50
B. Direct Fringe Benefits
0
C. Direct Travel
8 400.00
D. Direct Equipment
E. Direct Supplies,
_0
5,000.00
F. Direct Contracts/Consultants
3,000.
G. Indirect Cost up to 10%
7,546.15
TOTAL
93 007.6
BUDGET DETAIL
A. Direct -Personnel
Name Position Rate of Pay x # of Hours Cost
Mary Ann Contreras, Injury Prevention Manager, $118,123 x 0.50 FTE (1,0401us) $59,061.50
TOTAL Personnel
$59,06150
B. Direct - Fringe Benefits
Name Position Description of Benefits Cost
Provided In-kind by JPS Health Network Please see leverage of favids.
TOTAL Fringe Benefits SO
FY 2019 i ... uumry Based Program
JPS F. ani - Exhibit B Page 15 of 24
C. Direct - Travel
Purpose of Travel Location Item Cost
Anti -violence Conferences — Registration, travel, hotel at $2,100 x 4 staff $8,400.00
(such as Stop Violence -Emerging Trends, Crimes Against Women, and/or Strangulation)
TOTAL Travel $8,400.00
D. Direct - Equipment
f
Item Cost per Item Quantity Cost
TOTAL Equipment $0
E. Direct - Supplies
Item Cost per Item Quantity Cost
Books $5.00 1,000 $5,000.00
TOTAL
F. Direct - Contracts/Consultants
Description of the Service Cost
Training for staff on domestic violence and human trafficking issues $3,000.00
from national expert
TOTAL Contracts/Consultants
FY 2019 t .onwniq Based Progran,
JPS F -i w Exhibit B Page 16 of 24
G. Indirect - Personnel
Name Position Rate of Pay x # of Hours Cost
TOTAL Personnel $e
R. Indirect — Fringe Benefits
Name Position
TOTAL Fringe Benefits
Description of Benefits
I. Indirect - Other Costs
Item Cost per Item Quantity
JPS Foundation has a 10% administrative cost rate.
$74,061.50 in direct costs x 10% admin rate
TOTAL Other Cost
FY 2019 Community Based Program
JPS Foundation — Exhibit B
Cost
$0
Cost
$7,546.15
$7,546.15
Page 17 of 24
A. Direct—Personnel
INJURY PREVENTION MANAGER is responsible for training staff on domestic violence screening
instrument, implementing the domestic violence screening instrument expansion in three departments,
training staff to connect victims to FWPD and to provide literacy materials. Injury Prevention Manager will
also ensure the program meets grant outcomes and shares information with other Fort Worth Hospitals.
• Annual salaryis $l 18,123 x0.50 FTE = $59,061.50.
B. Direct —Fringe
Fringe benefits are provided as leveraged funds by JPS Health Network. Fringe benefits are 29% of salary
costs, and include FICA, unemployment taxes, insurance premiums, and retirement plans.
• $59,061.50 in total salaries X'28% = $16,537.22 leveraged fimds
C. Direct— Travel
Registration, travel, and hotel for Anti -Violence Conferences (such as Stop Flolence-Emerging Trends,
Crimes Against Women, and/or Strangulation) for Injury Prevention Manager and one staff from each of the
areas of Health Center for Women -Main, OB Triage, and Urgent Care. Representatives from each area will
be responsible for sharing knowledge learned to their department.
• $2,100 x4 staff =$8,400
D. Direct—Equipment N/A
E. Direct—Supplies
Children of patients will each receive a book at patient's discharge, along with encouragement to read to their
children to promote bonding, stability, and literacy.
• 1,000 books x $5.00 per book = $5,000 grant request.
• JPS Health Network will also provide 500 books. 500 x $5.00 per book — $2,500 in leveraged funds.
F. Direct - Contracts/Consultauts
Training for staff on domestic violence and human trafficking issues from national experts.
• 1 x $3,000 = $3,000
G. IndirectCost—Personnel N/A
H. Indirect Cost—Fringe Benefits N/A
I. Indirect Cost— Other Costs
JPS Foundation has a 10% administrative cost rate.
• $75,461.50 in direct costs x 109/6 admin rate $7,546.15
FY 2019 r-�mrnunity Based Program
Page 18 of 24
Exhibit B
Budget Summary
Fiscal Year 2019
DIRECT PROGRAM COSTS (90% Minimum) Total $75,461.50
A. PERSONNEL
Salaries
$59,061.50
PERSONNEL TOTAL:
$59,061.50
B. FRINGE BENEFITS
Benefits 28%
$0
FRINGE BENEFITS TOTAL
$0
C. TRAVEL AND TRAINING
Conference
$8,400.00
TRAVEL AND TRAINING TOTAL $8,400.00
D. EQUIPMENT
EQUIPMENT TOTAL $0.00
E. SUPPLIES
Books
$5,000.00
SUPPLIES TOTAL
$5,000.00
F. CONTRACTS/CONSULTANTS
Training
$3,000.00
CONTRACTS/CONSULTANTS TOTAL
$3,000.00
G. OTHER APPROVED
OTHER APPROVED TOTAL
$0.00
INDIRECT PROGRAM COSTS (10% Maximum) Total $7,546.15
A. PERSONNEL
Salaries
PERSONNEL TOTAL:
B. FRINGE BENEFITS
FICA
Disability Insurance
Unemployment -State
FRINGE BENEFITS TOTAL
FY 2019 Community Based Program
JPS Foundation — Exhibit B Page 19 of 24
C. TRAVEL AND TRAINING
None
TRAVEL AND TRAINING TOTAL
D. EQUIPMENT
None
EQUIPMENT TOTAL $0.00 .
E. SUPPLIES
None
SUPPLIES TOTAL
$0.00
F. CONTRACTS/CONSULTANTS
None
CONTRACTS/CONSULTANTS TOTAL
$0.00
G. OTHER APPROVED
None
OTHER APPROVED TOTAL $0.00
GRAND TOTAL $83,007.65
FY 2019 Community Based Program
JPS Foundation — Exhibit B Page 20 of 24
FORT WORTH.
V
CRIME CONTROL.
AND PREVENTION DISTRICT
Submit To:
Bob Bolen Public Safety Complex
Attn: Grant Managment Unit
Financial Management Division
505 West Felix St.
Fort Worth, TX 76115
Exhibit C
Request for Reimbursement (RFR)
FY 2019
Submitting Agency:
JPS Foundation
Contact Name:
Connie Winkle
Phone Number:
817-702-7379
Email:
cwinkle010-iosheaRh.ory
Remit Address:
1223 S. Main Street, Fort Worth TX 76104
Invoice Number:
'total of PreviousB+C)
This Month's
Reimbursements Total Requested
Requested Request
To -Date
Month of Request:
A
Supporting documents required with monthly requests.
This includes, timesheets depictng CCPD funded activities, copy
of paychecks, novices and receipts detailing all CCPD funded
expenditures.
Summary:
'Total Budget: S 83,007.65
Previous Requests: S -
Ttus Request: S
Total Requested To -Nate S
Remaining Funds S 83,007.65
I have reviewed this request and certify that these listed expenses and support documentation are accurate.
Authorised Signatory Signatory Title Date
Fists al Agent Use Only
Purchase Order # Fund Dept. ID Acnasrd
RFR Approved Fw Plarmeef
Grant Staff'Signatutre Date
Finance Received Stamp Placed Below
FY 2019 Community Based Program
JPS Foundation — Exhibit C Page 21 of 24
INDIRECT COSTS (10% Maxi mum)
A B C D
A
DIRECT COSTS (90% Minimum)
B C D
Budget Category
E
(A -D)
Remaining Balance
Availabk
Bud etCate o ry
Personnel
Budget Amount
'total of PreviousB+C)
This Month's
Reimbursements Total Requested
Requested Request
To -Date
A -D)
Remaining Balance
Availabk
A
Personnel
$
59,06150
S -
$
59,06150
B
Fringe Benefits-
S
S
S
S
S
C
ITravel & Training
$
8,400.00
$
$
8,400.00
D
Equipment
$
-
S
S
-
E
Supplies
S
5,000.00
S
5,000.00
F
Contracts Consultants
$
3,000.00
S
3,000,00
G
Other Approved
S
S
Total Direct Costs
Is
75,461.50 s
S $
$
75,46150
Supporting documents required with monthly requests.
This includes, timesheets depictng CCPD funded activities, copy
of paychecks, novices and receipts detailing all CCPD funded
expenditures.
Summary:
'Total Budget: S 83,007.65
Previous Requests: S -
Ttus Request: S
Total Requested To -Nate S
Remaining Funds S 83,007.65
I have reviewed this request and certify that these listed expenses and support documentation are accurate.
Authorised Signatory Signatory Title Date
Fists al Agent Use Only
Purchase Order # Fund Dept. ID Acnasrd
RFR Approved Fw Plarmeef
Grant Staff'Signatutre Date
Finance Received Stamp Placed Below
FY 2019 Community Based Program
JPS Foundation — Exhibit C Page 21 of 24
INDIRECT COSTS (10% Maxi mum)
A B C D
E
Budget Category
Total of Previous (B+C)
Bridget Amount Reimbursements This Month's Total Requested
Requested Request To -Date
(A -D)
Remaining Balance
Availabk
A
Personnel
S
s
B
Fringe Benefits
C
E awl & Tranrnig
D
Equipment
S
S
E
Supplies
S
s
F
Contracts Consultants
S
S -
G
Other Approved
$ 7,546.15 S
$ 7,546.15
Total loth rev t Costs
Is 7,546.15 S $ S
$ 7 .15
Supporting documents required with monthly requests.
This includes, timesheets depictng CCPD funded activities, copy
of paychecks, novices and receipts detailing all CCPD funded
expenditures.
Summary:
'Total Budget: S 83,007.65
Previous Requests: S -
Ttus Request: S
Total Requested To -Nate S
Remaining Funds S 83,007.65
I have reviewed this request and certify that these listed expenses and support documentation are accurate.
Authorised Signatory Signatory Title Date
Fists al Agent Use Only
Purchase Order # Fund Dept. ID Acnasrd
RFR Approved Fw Plarmeef
Grant Staff'Signatutre Date
Finance Received Stamp Placed Below
FY 2019 Community Based Program
JPS Foundation — Exhibit C Page 21 of 24
&Dwmcr
Exhibit D
Fiscal Year 2019
Monthly Program Activities Report
Current Reporting Month
Activity
Submitting Agency
JPS Foundation
Contact Name
Alexandra Dunn
Phone Number and Email
817-702-7379
Remit Address
1223 S. Main St. Fort Worth TX 76104
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 2019 Community Based Program
JPS Foundation — Exhibit D Page 22 of 24
Activity
Current
To Date
Year
Month
Total
End
Total
Goal
I
Train clinical staff in each of the three new areas in which survey will be
90
expanded on the correct use and best practices of utilizing survey
instrument.
2
Implement survey at three new areas of JPS Health Network: JPS Health
39,550
Center for Women — Main, JPS OB Triage, and JPS Urgent Care
3
The number of patients that will be screened using screening instrument
39,550
4
The number of domestic violence and sex trafficking victims referred to the
200
FWPD Victim Assistance and Family Justice Center (One Safe Place)
5
The number of reading materials and books provided to children of patients
1,500
6
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 2019 Community Based Program
JPS Foundation — Exhibit D Page 22 of 24
FoRTWORTH
Cma COMWL
� eRave�mon n�rwcr
Exhibit E
Fiscal Year 2019
Quarterly Program Effectiveness Measurement Report
Current Reporting Quarter
Effectiveness Measures and Quarterly Outcomes
Submitting Agency
JPS Foundation
Contact Name
Alexandra Dunn
Phone Number and Email
817-702-7379/ ADunn04gJPSHEALTH.ORG
Remit Address
1223 S. Main St. Fort Worth TX 76104
Please include outcome narrative that describes how measure was accomplished for each quarter.
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
Report due each quarter: I" Quarter (Oct -Dec) due January 15
3'd Quarter (Apr -June) due July 15
FY 2019 Community Based Program
JPS Foundation — Exhibit E
Signatory Title Date
2nd Quarter (Jan -Mar) due April 15
4`h Quarter (Jul -Sep) due October 15
Page 23 of 24
Effectiveness Measures and Quarterly Outcomes
Measure 1
Increase by 15% the number of domestic violence and/or human trafficking victims who are
identified as victims and referred to law enforcement and the local Family Justice Center for
services at JPS Health Center for Women -Main
Outcome
Measure 2
Increase by 15% the number of domestic violence and/or human trafficking victims who are
identified as victims and referred to law enforcement and the local Family Justice Center for
services at JPS OB Triage.
Outcome
Measure 3
Increase by 15% the number of domestic violence and/or human trafficking victims who are
identified as victims and referred to law enforcement and the local Family Justice Center for
services at JPS Urgent Care Clinic.
Outcome
I have reviewed this report and certify that the measures provided are accurate and appropriately reflect the
CCPD goals set, forth in the contract.
Authorized Signatory
Report due each quarter: I" Quarter (Oct -Dec) due January 15
3'd Quarter (Apr -June) due July 15
FY 2019 Community Based Program
JPS Foundation — Exhibit E
Signatory Title Date
2nd Quarter (Jan -Mar) due April 15
4`h Quarter (Jul -Sep) due October 15
Page 23 of 24
FORT WORTH
c� comma
& PE Dwmcr
• 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 2019
Date
DIRECT COSTS 90% minimum
Submitting Agency
JPS Foundation
Contact Name
Alexandra Dunn
Phone Number and Email
ADunn04 c j shealth.or
Remit Address
1223 S. Main Street, Fort Worth, TX 76104
Modification Narrative (describe in detail what change is for)
I have reviewed this request and certify that the listed modifications are correct.
Authorized Signatory
Modification Approved
FWPD Staff Signature
FY 2019 Community Based Program
JPS Foundation — Exhibit F
Signatory Title Date
FWPD STAFF USE ONLY
Modification NOT Approved
Date
Page 24 of 24
DIRECT COSTS 90% minimum
Budget Category
Approved Budget Change Requested Revised Budget
Personnel
$59,061.50
Fringe Benefits
$0
Travel and Training
$8,400.00
Equipment
$0
Supplies
$5,000.00
Contracts/Consultants
$3,000.00
Other Approved
$0
Total Direct Costs
$75,461.50
Modification Narrative (describe in detail what change is for)
I have reviewed this request and certify that the listed modifications are correct.
Authorized Signatory
Modification Approved
FWPD Staff Signature
FY 2019 Community Based Program
JPS Foundation — Exhibit F
Signatory Title Date
FWPD STAFF USE ONLY
Modification NOT Approved
Date
Page 24 of 24
INDIRECT COSTS 10% maximum
Budget Category
Approved Budget Change Requested Revised Budget
Personnel
Fringe Benefits
Travel and Training
Equipment
Supplies
Contracts/Consultants
Other Approved
$7,546.15
Total Indirect Costs
$7.546.15
Modification Narrative (describe in detail what change is for)
I have reviewed this request and certify that the listed modifications are correct.
Authorized Signatory
Modification Approved
FWPD Staff Signature
FY 2019 Community Based Program
JPS Foundation — Exhibit F
Signatory Title Date
FWPD STAFF USE ONLY
Modification NOT Approved
Date
Page 24 of 24
CERTIFICATE OF INTERESTED PARTIES FORM 1295
1 of 2
Complete Nos.1- 4 and 6 if there are interested parties.
Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties.
OFFICE USE ONLY
CERTIFICATION OF FILING
Certificate Number:
2018-411666
Date Filed:
10/05/2018
Date Acknowledged:
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
JPS Foundation
Fort Worth, TX United States
2 Name of governmental entity or state agency that is a party to the contract for which the form is
being filed.
JPS Foundation
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.
FY2019 CCPD JPS
human trafficking and domestic violence screening and referral, literacy
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
Intermediary
Nguyen, D.T.
Fort Worth, TX United States
X
Earley, Robert
Fort Worth, TX United States
X
Whitley, Glen
Fort Worth, TX United States
X
Starling, Gloria
Fort Worth, TX United States
X
Herchert, Bob
Fort Worth, TX United States
X
Anfin, Larry
Fort Worth, TX United States
X
Jackson, James
Fort Worth, TX United States
X
Truitt, Todd
Fort Worth, TX United States
X
Murphey, John
Fort Worth, TX United States
X
Wheat, Laura
Fort Worth, TX United States
X
Sullivan, Kristin
Fort Worth, TX United States
X
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.6711
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
2of2
Complete Nos, 1- 4 and 6 if there are interested parties.
Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties.
OFFICE USE ONLY
CERTIFICATION OF FILING
Certificate Number:
2018-411666
Date Filed:
10/05/2018
Date Ackno 'edge
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
JPS Foundation
Fort Worth, TX United States
2 Name of governmental entity or state agency that is a party to the contract for which the form is
being filed.
JPS Foundation
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.
FY2019 CCPD JPS
human trafficking and domestic violence screening and referral, literacy
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
I Intermediary
5 Check only if there is NO Interested Party. ❑
6 UNSWORN DECLARATION (
My name is Kk 54i g. / A 1 V -,( ru - L/ /yyA and my date of birth is
My address is 223 g 'V' _U
estate (zip code
I declare under penalty of perjury that the foregoing is true and correct.
Executed in County, State of
Signature of authorized agent of contracting business entity
(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.6711