HomeMy WebLinkAboutContract 39342 (3)STATE OF TEYAS � �����" ��CRETARIf
`�'��r+ �'tiCT NO.
COUNTY OF TARRANT �
THIS contract ("Contract") is made and entered into by and between the City of Fort Worth ("City"),
whose address is 1000 Throckmorton St., Fort Worth Texas 76102, acting by and through T.M. Higgins, its
duly authorized Assistant City Manager, and Tarrant County Samaritan Housing, Inc. ("Contractor"),
whose address is 929 Hemphill Fort Worth, Texas, 76104, acting by and through Steve Dutton its duly
authorized President and Chief Executive Officer. (Sometimes City and Contractor are referred to
individually as a "Party" and collectively as the "Parties".)
WHEREAS, City has received grant monies from the United States Department of Housing and
Urban Development ("HUD") under the AIDS Housing Opportunity Act, as amended, (42 USC 12901 et
�•eq.) for utilization in connection with the Housing Opportunities for Persons with AIDS ("HOPWA")
program, Grant No. TXH-09-F002, for Year 2009-2010;
WHEREAS, the objective of he HOPWA program is to address the needs of eligible persons
associated with the challenge of living with HN/AIDS and their families;
WHEREAS, City has been designated by HUD to service Tarrant, Johnson, Hood and Parker
Counties through HOPWA;
WHEREAS, City citizens, the Community Development Council, and the City Council have
determined that HOPWA programs are needed by the City's low and moderate -income citizens with
documented HIV/AIDS status and their families as defined in 24 CFR 574.3(2).
NOW, THEREFORE, THIS AGREEMENT FURTHER WITNESSETH:
THAT, the Parties covenant and agree as follows:
1. Scope of Seruice.r
a. Contractor will administer HOPWA services to citizens of the City of Fort Worth for the purpose
of preventing homelessness of low-income persons with HN/AIDS and their families under the
program name Supportive Housing ("Program"), for the term June 1, 2009 to l�iay 31, 2010.
Contractor agrees to ensure the confidentiality of the name of any Program participant assisted
under the Program and any other information regarding individuals receiving assistance.
b. Contractor will provide the services and activities as set forth in Exhibit A -Program Summary in
accordance with Exhibit B-Program Services Schedule.
c. Contractor agrees to abide by the HOPWA Regulations, 24 CFR 24 574 et seq.) and will utilize
HOPWA funds to benefit low income individuals with documented HN/AIDS status and their
families. Contractor agrees to conduct an annual assessment of the housing assistance and assure
the adequate provision of the supportive services described in 24 CRR 574.300 (b)(7) to Program
participants assisted with housing under this Contract. No fee except rent shall be charged of any
Program participant for any housing or services provided with funds from this Contract.
Contractor will comply with 24 CFR 574.310(e) regarding any termination of assistance.
Contractor agrees to maintain full documentation supporting fulfillment of these requirements in
its files. All such documentation shall be furnished to City upon request if necessary for City to
fulfill its obligations under its Federal grant. If this documentation is not maintained and furnished
to City on request, City may exercise all remedies available under this Contract, including the right
-to wthbold� payment to Contractor on this Contract or any other contract with Contractor, or
rminat� s ntract as described herein.
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d. City will monitor and evaluate Contractor's performance using the goals and performance standards
required in this Contract. Substandard performance as determined by City monitoring, including
noncompliance with any applicable regulation of the U.S. Department of Housing and Urban
Development, will constitute non-compliance with this Contract. If action to correct such
substandard performance is not taken by Contractor within a reasonable period of time after being
notified in writing by City, procedures to suspend or terminate the Contract will be initiated.
e. If applicable, Contractor shall comply and assist City in complying with the provisions of 24 CFR
574.630 regarding displacement, relocation and real property acquisition; uniform administrative
requirements and cost principles; employment and contracting opportunities; use of debarred,
suspended, or ineligible contractors or subrecipients; eligibility restrictions for certain resident
aliens; conflict of interest, and other requirements
f. Contractor agrees to take reasonable steps to ensure meaningful access to the program and
associated activities by limited English proficient person.
2. Compensation and Method of Payment
a. City will disburse HOPWA Year 2009-2010 funds ("HOPWA Funds") in an amount up to TWO
HUNDRED AND SIXTY NINE THOUSAND THREE HUNDRED AND SEVENTY TWO
AND NO/100 DOLLARS ($269,372.00) to Contractor on a reimbursement of expenses basis.
HOPWA Funds may be used to assist all forms of housing designed to prevent homelessness
I
ncluding emergency housing, shared housing arrangements, apartments, single room (SRO)
occupancy dwellings, community residences, and supportive housing services such as case
management, in accordance with 24 CFR 574.300. Contractor shall not use any HOPWA Funds
for any prohibited activities as set forth in 24 CFR 574. Contractor is acting as a Project Sponsor
for the purposes of dus Contract in carrying out the agreed -upon eligible activities as set forth in
Exhibit A- Program Summary.
b. Payment will be processed by City following receipt from Contractor of the following monthly
financial documents: (1) Attachment I- Request For Funds, (2) Attachment II -Detail Statement of
Costs, and (3) Attachment III -Expenditures Worksheet. Payment by City to Contractor shall
require completion of all City forms and copies of adequate supporting documentation verifying
eligibility of expenses as well as, where applicable, eligibility of Program participants.
Reimbursement for the payment of eligible expenses shall be made against the budget specified in
Exhibit C-Program Operating Budget and in accordance with performance specified in Exhibit
B-Program Services Schedule. City will not disburse funds for expenditures that occurred prior
to the beginning date of the term of this Contract.
c. Contractor agrees to utilize all disbursed HOPWA Funds for the benefit of the Program. Contractor
agrees that all funds will be expended in accordance with Exhibit C-Program Operating Budget.
Contractor may not increase or decrease line -item amounts in the approved HOPWA Funds
portion of Exhibit C-Program Operating Budget without City's prior written approval.
Contractor acknowledges and agrees that any HOPWA Funds not used in accordance with the
HOPWA Regulations and terms of this Contract must be repaid to City.
d. It is understood that the total cost for operation of this Program is $1,748,202.00 and that
Contractor will obtain from other sources the remaining funds in excess of the HOPWA Funds as
detailed in Exhibit C-Program Operating Budget. Contractor will notify City promptly of any
additional funds it receives for operation of the Program, and City reserves the right to amend
Exhibit C-Program Operating Budget in such instances to ensure compliance with HUD
regulations governing cost allocation.
e. Contractor agrees to keep all HOPWA Funds on hand in interest bearing accounts. All interest
earned shall be reported to City on a monthly basis, at the same time as submission of the monthly
report following the end of the Contract month during which the interest was earned. Interest in an
amount of $25.00 or less per month may be used for authorized Program expenses. These amounts
must be reported on the monthly financial statements filed pursuant to this Contract. Interest
earned in excess of $25.00 per month is subject to remittance to City as directed by City.
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£ Contractor will not commingle HOPWA Funds with any other funds in any manner that would
prevent City from readily identifying expenditures for operation of the Program.
3. U11ifo17n Administrative Requirements and Program 1Management Standards
a. Financial Management
i. Accounting Standards
The Contractor agrees to comply with OMB Circular A-110, "Uniform Administrative
Requirements for Grants and Agreements with Institutions of Higher Education, Hospitals and
other Non -Profit Organizations", and agrees to adhere to the accounting principles and
procedures required therein, utilize adequate internal controls, and maintain necessary source
documentation for all costs incurred.
H* Cost Principles
Contractor shall administer the Program in conformance with OMB Circular A-122, "Cost
Principles for Non -Profit Organizations" and attachments and revisions thereto, regarding
principles for determining eligible and allocable costs for the Program.
b. Documentation and Record Keeping
i. Requirement
Contractor shall maintain all records pertinent to the activities to be funded under this Contract
required in 24 CFR § 574.530. In addition, Contractor agrees to keep records to fully document
all expenditures charged to the HOPWA portion of the Program, including records
documenting the eligibility of Program participants as more particularly described herein. The
documentation must support the amounts charged to the Program, the eligibility of the Program
participants, and demonstrate that the expenditures were appropriate to the stated goals of the
Program and allowable and/or eligible under applicable Federal, state and City guidelines.
ii. Record Retention
(1) All records pertaining to Program shall be retained for four (4) years following the
termination of this Contract. Contractor may destroy Program records at the end of this
four (4) year period if no outstanding audit finding exists.
(2) Contractor will retain any Program loan records until four (4) years after the expiration of
any loan.
in. Real Property Records
Contractor shall maintain real property inventory records that clearly identify properties
purchased, improved, or sold. Properties retained shall meet eligibility criteria and shall conform
to the requirements of 24 CFR 574.630.
iv. Closeouts
Contractor's obligation to City shall not end until all closeout requirements are completed.
Activities during this closeout period shall include, but are not limited to: making final
payments, disposing of Program assets (including the return of all unused materials, equipment,
unspent cash advances, Program income balances, and accounts receivable to City), and
determining the custodianship of records and verification of compliance with record retention
requirements.
V. Audits and Inspections
(1) City, HUD, and the United States Comptroller General, or their respective representatives,
shall have access to any books, documents, records and papers relating to the operations of
Contractor under this Contract for the purpose of audit, examination, exception and
transcription at all of Contractor's offices at all reasonable hours.
(2) All non-federal entities that expend $500,000 or more in Federal funds within one (1) year,
regardless of the source of the Federal award, must submit to City an annual audit
prepared in accordance with 24 CFR Sections § 570.502-570.503 generally, (known as a
Single Audit), with specific reference to OMB Circulars (with attachments) A-122, "Cost
Principles for Non -Profit Organizations", and A-133, "Audits of States, Local
Governments, and Non -Profit Organizations", as appropriate. The audit may cover either
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Contractor's fiscal year during which this Contract is in force or cover the period of this
Contract. The audit must be prepared by an independent certified public accountant, be
completed within nine (9) mondis following tie end of the period being audited and be
submitted to City within thirty (30) days of its completion. Contractor's audit certification
is attached hereto as Exhibit D - Audit Certification Form, The Audit Certification
Form must be submitted to City within sixty (60) days of the end of the period being
audited (Contractor's fiscal year). Costs of preparation of this audit may be an allowable
expenditure of HOPWA Funds in an amount proportional to that of the HOPWA Funds
used in Contractor's total agency operating budget. Non-profit entities that expend less
than $500,000 a year in Federal funds are exempt from Federal audit requirements for that
year, but records must be available for review or audit by appropriate officials of the
Federal agency, City, and General Accounting Office ("GAO").
(3) All non-federal entities acting as a Subrecipient for City grant funds that expend less than
$500,000 in any federal funds within one year shall provide City with a copy of any other
financial audit or audited financial statements prepared during the contract term, if
available.
(4) City reserves the right to perform an audit of Contractor's agency operations and finances
at any time during the term of this Contract, if City determines that such audit is necessary
for City's compliance with OMB Circular A-133. Contractor agrees to allow access to all
relevant books, records and materials. If such audit reveals a questioned practice or
expenditure, such questions must be resolved within thirty (30) days after notice to
Contractor. If questions are not resolved within this period, City reserves the right to
withhold further funding under this Contract and/or any other contract(s) with Contractor.
(5) If as a result of any audit it is determined that Contractor has misused, misapplied or
misappropriated all or any part of the HOPWA Funds, Contractor agrees to reimburse the
City the amount of such monies so misused, misapplied or misappropriated, plus the
amount of any sanction, penalty or other charge levied against City because of such
misuse, misapplication or misappropriation.
4. Reporti�rg Procedures
a. Financial Reports
Contractor will submit to City on a monthly basis: (1) Attachment I -Request for Funds, (2)
Attachment II -Detailed Statement of Costs, (3) Attachment III -Expenditures Worksheet, as
applicable, for expenses incurred for services and activities accomplished by Contractor in
performance of this Contract. Actual cash receipts for claimed expenditures must be provided at
the time the request for funds is presented. The reports must be signed by a duly authorized agent
of the Contractor and submitted by the 15`h of the month following the month being reported.
City is under no obligation to disburse funds for expenditures that occurred prior to the first day
of the month for which the report is submitted.
b. Progress Reports
Contractor will submit to City on a monthly basis as applicable to Program: (1) Attachment IVa-
Program Services Report, (2) Attachment IVb-Tenant Based Rental Assistance -Direct Benefit Data
Report, (3) IVc-Short-Term Rent/Mortgage and Utility Assistance -Direct Benefit Data Report, (4)
Attachment IVd-Living Situation Counts (5) IVe-Supportive Services Report (6) IVf- Supportive
Services- Direct Benefit Data (7) Attachment VI -Client Data Report for services and activities
undertaken by Contractor in performance of this Contract. The report will be signed by a duly
authorized agent of Contractor and submitted by the 15`' of the month following the month that is
reported. City will not disburse funds for expenditures that occurred prior to the beginning date of
the term of this Contract.
c. Procurement
i. Compliance
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Contractor shall comply with City policy concerning the purchase of equipment and shall
maintain inventory records of all non -expendable personal property, as defined by such policy,
procured with funds provided under this Contract.
ii. OMB Standards
Contractor shall procure all materials, property, or services in accordance with the requirements
of 24 CFR Part 84, Procurement Standards and Property Standards
d. Program Participant Records
i. Contractor will keep or cause to be kept an accurate record of all actions taken and all HOPWA
Funds expended, with source documents, in performance of this Contract. Such records shall
be kept for the time period mandated by the HOPWA Regulations and this Contract.
ii. Contractor will obtain and keep on file and furnish to City on request the following information
and/or documentation on each Program participant served by the Program demonstrating such
participant's eligibility for services provided:
a. Participant's name, documented HIV/AIDS status, address, annual income level or other
basis for determining income eligibility, and family size of participant's household.
b. Source documentation used for income verification including but not limited to pay check
stubs, food stamp award letters, income tax returns, SSI award letters, letters awarding
unemployment benefits, W2s and the like.
c. Necessary documentation to support expenditures related to Tenant -Based Rental
Assisantance (TBRA), and/or Short -Term Rent, Mortgage, and Utility Assistance,
including current, applicable Fair Market Rent (FMR), utility allowances, enforceable lease
agreements, housing inspections, and other requirements set forth in 24 CFR 574 related to
specific activities administered.
d. City shall have the final determination, in its sole discretion, as to whether source
documentation used for income verification is adequate.
5. Reversion of Assets
a. Contractor agrees to return to City any HOPWA Funds remaining on hand at the end of the
Contract.
b. All property purchased with HOPWA Funds under this Contract will be used solely for operation
of the Program. Contractor agrees to obtain City approval prior to purchase of property and
Contractor agrees to notify City upon receipt of property so that it may be properly tagged and
inventoried. Title to such property will be vested in City, and Contractor will deliver all such
property to City for disposition at City's sole discretion at the termination of the Program.
6. Applicable Laws
a. Federal
Contractor agrees to comply with the following laws and the applicable regulations as they are
currently written or are hereafter amended during performance of this Contract:
• AIDS Housing Opportunity Act, as amended, (42 USC 12901 et seq.)
• Regulations at 24 CFR Part 574 pertaining to HOPWA ("HOPWA Regulations")
0 Title VI of the Civil Rights Act of 1964 (42 USC 2000d et seq.)
• Title VIII of the Civil Rights Act of 1968 (42 USC 3601 et seq.)
• Executive Orders 11063, 11246, as amended by Executive Orders 11375 and 12086 and as
supplemented by 41 CFR Part 60
• The Age Discrimination in Employment Act of 1967 (29 USC 621)
• The Age Discrimination Act of 1975 (42 USC 6101 et seq.)
• Section 504 of the Rehabilitation Act of 1973 (29 USC 794 et seq.) and 24 CFR Part 8 where
applicable
• The Americans with Disabilities Act of 1990 (42 USC 12101 et seq)
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• National Environmental Policy Act of 1969, as amended, 42 USC 4321 et seq. ("NEPN) and
the related authorities listed 24 CFR Part 58
• The Clean Air Act, as amended (42 USC 7401 et seq.), the Clean Water Act of 1977, as amended
(33 USC 1251 et seq.) and the related EPA regulations at 40 CFR Part 15, as amended from time
to time, and Executive Order 11738. In no event shall any amount of the assistance provided
under this Contract be utilized with respect to a facility that has given rise to a conviction under
the Clean Air Act or the Clean Water Act.
• The Immigration Reform and Control Act of 1986 (8 USC 1101 et seq.), specifically including
the provisions requiring employer verification of the legal status of its employees
• The Americans with Disabilities Act of 1990 (42 USC 12101 et seq.)
• Drug Free Workplace Act of 1988 (41 USC 701 et seq.) and 24 CFR Part 23, Subpart F
• Regulations as 24 CFR Part 87 related to lobbying, including the requirement that certifications
and disclosures be obtained from all covered persons
• Executive Order 12549 and 24 CFR Part 5.105 (c) pertaining to restrictions on participation by
ineligible, debarred, or suspended persons or entities.
b. Section 3 of the Housing and Urban Development Act of 1968, as amended, (12 USC 1701u et seq.)
and its related regulations at 24 CFR Part 135
If the work to be performed under this Contract is on a project assisted under a program
providing direct Federal financial assistance from HUD, Section 3 of 24 CFR 135.38 ("Section 3")
requires that the following clause be inserted in all covered contracts ("Section 3 Clause"). Such
covered contracts or activities include CDBG-funded construction, reconstruction, conversion or
rehabilitation of housing as set forth in 24 CFR 135.5.
'A. The work to be performed under this contract is subject to the requirements of section 3 of
the Housing and Urban Development Act of 1968, as amended, 12 U.S.C. 1701u (section 3).
The purpose of Section 3 is to ensure that employment and other economic opportunities
generated by HUD assistance or HUD -assisted projects covered by Section 3, shall, to the
greatest extent feasible, be directed to low- and very low-income persons, particularly persons
who are recipients of HUD assistance for housing.
B. The Parties to this contract agree to comply with HUD's regulations in 24 CFR Part 135,
which implement Section 3. As evidenced by their execution of this contract, the Parties to
this contract certify that they are under no contractual or other impediment that would prevent
them from complying with the Part 135 regulations.
C. The contractor agrees to send to each labor organization or representative of workers with
which the contractor has a collective bargaining agreement or other understanding, if any, a
notice advising the labor organization or workers' representative of the contractor's
commitments under this section 3 clause, and will post copies of the notice in conspicuous
places at the work site where both employees and applicants for training and employment
positions can see the notice. The notice shall describe the Section 3 preference, shall set forth
minimum number and job titles subject to lure, availability of apprenticeship and training
positions, the qualifications for each; and the name and location of the person(s) taking
applications for each of the positions; and the anticipated date the work shall begin.
D. The contractor agrees to include this section 3 clause in every subcontract subject to
compliance with regulations in 24 CFR Part 135, and agrees to take appropriate action, as
provided in an applicable provision of the subcontract or in this Section 3 clause, upon a
finding that the subcontractor is in violation of the regulations in 24 CFR Part 135. The
contractor will not subcontract with any subcontractor where the contractor has notice or
knowledge that the subcontractor has been found in violation of the regulations in 24 CFR
Part 135.
E. The contractor will certify that any vacant employment positions, including training positions,
that are filled (1) after the contractor is selected but before the contract is executed, and (2)
with persons other than those to whom the regulations of 24 CFR Part 135 require
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employment opportunities to be directed, were not filled to circumvent die contractor's
obligations under 24 CFR Part 135.
E Noncompliance with HUD's regulations in 24 CFR Part 135 may result in sanctions,
termination of this contract for default, and debarment or suspension from future HUD
assisted contracts.
G. With respect to work performed in connection with Section 3 covered Indian housing
assistance, section 7(b) of the Indian Self -Determination and Education Assistance Act (25
U.S.C. 450e) also applies to the work to be performed under this contract. Section 7(b) requires
that to the greatest extent feasible (i) preference and opportunities for training and
employment shall be given to Indians, and (ii) preference in the award of contracts and
subcontracts shall be given to Indian organizations and Indian -owned Economic Enterprises.
Parties to this contract that are subject to the provisions of section 3 and section 7(b) agree to
comply with Section 3 to the maximum extent feasible, but not in derogation of compliance
with section 7(b)."
City and Contractor understand and agree that compliance with the provisions of Section 3, the
regulations set forth in 24 CFR Part 135, and all applicable rules and orders of HUD shall be a
condition of the Federal financial assistance provided to the Program, binding upon City and
Contractor, and their respective successors, assigns and subcontractors. Failure to fulfill these
requirements shall subject Contractor and its subcontractors, and their respective successors and
assigns, to those sanctions specified by the Grant Agreement through which Federal assistance is
provided and to such sanctions as are specified by 24 CFR Part 135.
c. Other Laws
Contractor covenants and agrees that its officers, members, agents, employees, Program
participants and subcontractors shall abide by and comply with all other laws, Federal, state and
local, relevant to the performance of this Contract, including all applicable City ordinances, rules
and regulations and the AIDS Housing Opportunity Act, as amended, (42 USC 12901 et seq.) and
the HOPWA Regulations, as amended, (24 CFR Part 574 et seq.). Contractor further promises and
agrees that it has read, and is familiar with, the terms and conditions of the Housing Opportunities
for Persons with Aids program, and the HOPWA Regulations, under which HOPWA Funds are
granted and that it will fully comply with them. It is agreed and understood that, if City notifies
Contractor of any such violation on the part of Contractor or any of its officers, members, agents,
employees, Program participants or subcontractors, then Contractor shall immediately desist from
and correct such violation.
7. Nondiscrimination
a. Contractor will not unlawfully discriminate against any person or persons because of sex, race,
religion, age, disaty, color, national origin, or familial status, nor will Contractor permit its
officers, members, agents, employees, subcontractors or Program participants to engage in such
discrimination.
b. Contractor covenants that neither it not any of its officers, members, agents, employees, Program
participants or subcontractors, while engaged in performing this Contract, shall, in connection with
the employment, advancement or discharge of employees or in connection with the terms,
conditions or privileges of their employment, discriminate against persons because of their age
except on the basis of bona fide occupational qualification, retirement plan or statutory
requirement.
c. Contractor further covenants that neither it nor its officers, members, agents, employees,
subcontractors, Program participants, or persons acting on their behalf, shall specify, in solicitations
or advertisements for employees to work on this contract, a maximum age limit for such
employment unless the specified maximum age limit is based upon a bona fide occupational
qualification, retirement plan or statutory requirement.
d. In accordance with the provisions of the Americans With Disabilities Act of 1990 ("ADA"),
Contractor warrants that it and any and all of its subcontractors will not unlawfully discriminate on
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the basis of disability in the provision of services to the general public, not in the availability, terms
and/or conditions of employment for applicants for employment with Contractor, or employees of
Contractor or any of its subcontractors. Contractor warrants it will fully comply with RDA's
provisions and any other applicable Federal, state and local laws concerning disability and will
defend, indemnify and hold City harmless against any claims or allegations asserted by third parties
or subcontractors against City arising out of Contractor's and/or its subcontractors' alleged failure
to comply with the above -referenced laws concerning disability discrimination in the performance
of this Contract.
e. This Contract is made and entered into with reference specifically to the ordinances codified at
Chapter 17, Article III, Division 3 "Discrimination in Employment Practices", of the City Code,
and Contractor hereby covenants and agrees that Contractor, its officers, members, agents,
employees and subcontractors, have fully complied with all provisions of same and that no
employee, employee -applicant or Program participant has been discriminated against by the terms
of such ordinances by either the Contractor or its officers, members, agents, employees or
subcontractors.
8. Prohibition Against Interest
a. No member, officer or employee of City or its designees or agents; no member of the governing
body of the locality in which the Program is situated; and no other public official of such locality or
localities, who exercises any functions or responsibilities with respect to the Program funded
hereunder during his or her tenure or for one year thereafter, shall have any interest, direct or
indirect, in any contract or subcontract, or the proceeds thereof, for work to be performed
hereunder. Contractor shallincorporate, or cause to be incorporated, like language prohibiting such
interest in all contracts and subcontracts entered into in connection with the Program.
b. No member, officer, employee, or Program participant of Contractor or its subcontractors shall
have a financial interest, direct or indirect, in this Contract or the HOPWA Funds transferred
hereunder or be ' financially interested, directly or indirectly, in the sale to Contractor of any land,
materials, supplies or services purchased with any HOPWA Funds transferred hereunder, except on
behalf of Contractor, as an officer, employee, member or Program participant. Any willful
violation of this paragraph with the expressed or implied knowledge of Contractor or its
subcontractors shall render this Contract voidable by City.
9. Minority and IY/omen Business Enterp�zse Commitment
Contractor agrees to abide by City's policy to involve Minority and Women Business Enterprises
("NfWBEs") in all phases of its procurement practices and to provide them an equal opportunity to
compete for contracts for construction, provision of professional services, purchase of equipment and
supplies and provision of other services required by City. Contractor agrees to incorporate City
Ordinance No. 15530, and all amendments or successor policies thereto, into all contracts and will
further require all persons or entities with whom it contracts to comply with said 1bfWBEs policy.
10. Non assignment
No assignment or delegation of duties under this Contract by Contractor shall be effective without
City's prior written approval. If such assignment occurs, Contractor shall ensure that all requirements
of this Contract are enforced and maintained by any such Subcontractor or Assignee by means of a
currently executed written agreement covering the Contract Terms, a copy of which shall be made
available to City.
11. Independent Contractor
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a. Contractor shall operate hereunder as an independent contractor and not as an officer, agent,
servant or employee of City. Contractor shall have exclusive control of, and the exclusive right to
control, the details of the work and services performed hereunder, and all persons performing
same, and shall be solely responsible for the acts and omissions of its officers, members, agents,
servants, employees, subcontractors, Program participants, licensees or invitee. The doctrine of
respondeat superior shall not apply as between City and Contractor, its officers, members, agents,
servants, employees, subcontractors, Program participants, licensees or invitees, and nothing herein
shall be construed as creating a partnership or joint enterprise between City and Contractor. It is
expressly understood and agreed that no officer, member, agent, employee, subcontractor, licensee
or invitee of the Contractor, nor any Program participant hereunder, is in the paid service of City
and that City does not have the legal right to control the details of the tasks performed hereunder
by Contractor, its officers, members, agents, employees, subcontractors, Program participants,
licensees or invitees.
b. City shall in no -way nor under any circumstances be responsible for any property belonging to
Contractor, its officers, members, agents, employees, subcontractors, Program participants,
licensees or invitees, which may be lost, stolen, destroyed or in any way damaged; and Contractor
hereby indemnifies and holds harmless City and its officers, agents, and employees from and against
any and all claims or suits.
12. Indemnification, Insurance and Bonding
a. CONTRACTOR COVENANTS AND AGREES TO INDEMNIFY, HOLD HARMLESS
AND DEFEND, AT ITS OWN EXPENSE, CITY AND ITS OFFICERS, AGENTS,
SERVANTS AND EMPLOYEES FROM AND AGAINST ANY AND ALL CLAIMS OR
SUITS FOR PROPERTY LOSS OR DAMAGE AND/OR PERSONAL INJURY,
INCLUDING DEATH, TO ANY AND ALL PERSONS, OF WHATSOEVER HIND OR
CHARACTER, WHETHER REAL OR ASSERTED, ARISING OUT OF OR IN
CONNECTION WITH THE EXECUTION, PERFORMANCE, ATTEMPTED
PERFORMANCE OR NONPERFORMANCE OF THIS CONTRACT AND/OR THE
OPERATIONS, ACTIVITIES AND SERVICES OF THE PROGRAM DESCRIBED
HEREIN, WHETHER OR NOT CAUSED, IN WHOLE OR IN PART, BY ALLEGED
NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES,
CONTRACTORS OR SUBCONTRACTORS OF CITY; AND CONTRACTOR HEREBY
ASSUMES ALL LIABILITY AND RESPONSIBILITY OF CITY AND ITS OFFICERS,
AGENTS, SERVANTS, AND EMPLOYEES FOR ANY AND ALL CLAIMS OR SUITS
FOR PROPERTY LOSS OR DAMAGE AND/OR PERSONAL INJURY, INCLUDING
DEATH, TO ANY AND ALL PERSONS, OF WHATSOEVER KINDS OR
CHARACTER, WHETHER REAL OR ASSERTED, ARISING OUT OF OR IN
CONNECTION WITH THE EXECUTION, PERFORMANCE, ATTEMPTED
PERFORMANCE OR NON-PERFORMANCE OF THIS CONTRACT AND
AGREEMENT AND/OR THE OPERATIONS, ACTIVITIES AND SERVICES OF
THE PROGRAMS DESCRIBED HEREIN, WHETHER OR NOT CAUSED IN
WHOLE OR IN PART, BY ALLEGED NEGLIGENCE OF OFFICERS, AGENTS,
SERVANTS, EMPLOYEES, CONTRACTORS OR SUBCONTRACTORS OF CITY.
CONTRACTOR LIKEWISE COVENANTS AND AGREES TO AND DOES HEREBY
INDEMNIFY AND HOLD HARMLESS CITY FROM AND AGAINST ANY AND ALL
INJURY, DAMAGE OR DESTRUCTION OF PROPERTY OF CITY, ARISING OUT OF
OR IN CONNECTION WITH ALL ACTS OR OMISSIONS OF CONTRACTOR, ITS
OFFICERS, MEMBERS, AGENTS, EMPLOYEES, SUBCONTRACTORS, INVITEES,
LICENSEES, OR PROGRAM PARTICIPANTS, OR CAUSED, IN WHOLE OR IN
PART, BY ALLEGED NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS,
EMPLOYEES, CONTRACTORS OR SUBCONTRACTORS OF CITY.
HOPWA YEAR 2009-2010 CONTRACT Rev. 08-25-09
Tarrant County Samaritan Housing Inc. Page 9
CONTRACTOR AGREES TO AND SHALL RELEASE CITY, ITS AGENTS,
EMPLOYEES, OFFICERS AND LEGAL REPRESENTATIVES FROM ALL LIABILITY
FOR INJURY, DEATH, DAMAGE OR LOSS TO PERSONS OR PROPERTY
SUSTAINED IN CONNECTION WITH OR INCIDENTAL TO PERFORMANCE
UNDER THIS CONTRACT, EVEN IF THE INJURY, DEATH, DAMAGE OR LOSS IS
CAUSED BY THE CITY'S SOLE OR CONCURRENT NEGLIGENCE.
CONTRACTOR SHALL REQUIRE ALL OF ITS SUBCONTRACTORS TO INCLUDE
IN THEIR SUBCONTRACTS A RELEASE AND INDEMNITY IN FAVOR OF THE
CITY IN SUBSTANTIALLY THE SAME FORM AS ABOVE.
b. Contractor will maintain blanket fidelity coverage in the form of a bond in the amount of
$269,372.003 to insure against loss from the fraud, theft or dishonesty of any of Contractor's
officers, agents, trustees, directors or employees. The proceeds of such bond shall be used to
reimburse City for any and all loss of HOPWA Funds occasioned by such misconduct. To
effectuate such reimbursement, such bond shall include a rider stating that reimbursement for any
loss or losses thereunder shall be made directly to City for the uses and benefit of Contractor.
c. Contractor shall furnish certificates of insurance as proof that it has secured and paid for policies of
workers' compensation, public liability and automobile liability insurance covering all risks incident
to or in connection with the execution, performance, attempted performance or nonperformance
of this Contract. The amounts of such insurance shall not be less than the maximum liability that
can be imposed on City under the laws of the State of Texas. Contractor understands and agrees
that such insurance amounts may be revised upward at City's option and that Contractor shall revise
such amounts within thirty (30) days following notice to Contractor of such requirements.
d. Contractor will submit documentation to City that it has obtained insurance coverage and has
executed bonds as required in this contract Within thirty (30) days of the execution of this Contract
and prior to payment of any monies hereunder.
e. Any failure on part of the City to request certificate(s) of insurance shall not be construed as a waiver
of such requirement or as a waiver of the insurance requirements themselves. Insurers of
Contractor insurance policies shall be licensed to do business in the State of Texas by the
Department of Insurance or be otherwise eligible and authorized to business in the state of Texas.
Insurers shall be acceptable to City insofar as their financial strength and solvency and each such
company shall have a current minimum A.M. Best Key Rating Guide rating of A: VII or other
equivalent insurance industry standard rating unless otherwise approved by City. Deductible limits
on insurance policies shall not exceed $5,000 per occurrence unless otherwise approved by City.
f. Any local, federal or other regulatory insurance or bonding requirements for the Program that
exceed those specified herein shall prevail.
g. Contractor shall agree to require its subcontractors to maintain applicable insurance coverages, limits,
and other requirements as those specified herein; and, Contractor shall require its subcontractors to
provide Contractor with certificate(s) of insurance documenting such coverage. Also, Contractor
shall require its subcontractors to have City and Contractor endorsed as additional insured (as their
interests may appear) on their respective insurance policies. Contractor shall require its
subcontractors to maintain builders risk insurance at the limit of applicable project(s) costs when
the value of materials involved exceeds $10,000 or at a different limit value limit as specified by
City.
13. lYlaiver of hnrrrarrrity
If Contractor is a charitable or nonprofit organization and has or claims an immunity or exemption
(statutory or otherwise) from and against liability for damages or injury, including death, to persons or
property; Contractor hereby expressly waives its rights to plead defensively such immunity or
exemption as against City. This section shall not be construed to affect a governmental entity's
immunities under constitutional, statutory or common law
HOPWA YEAR 2009-2010 CONTRACT Rev. 0S-25-09
Tarrant County Samaritan Housing Inc. Page 10
14. Remedies for Breach of Contract
Upon identification of possible breaches of contract, and prior to exercising its Termination
Rights under this Contract, City may elect to exercise any of the following Remedies: a) issuance of
a warning letter indicating that further failure to comply with applicable requirements will result in
serious sanction and giving the Subrecipient a limited time to correct the deficiency; b) placing
conditions upon award of future grants; c) directing the Subrecipient to stop incurring costs until
the deficiency is corrected and the correction is verified; d) requiring repayment of previously
reimbursed grant funds; or e) reducing in the amount of future grant awards or disallowing of
future awards to the Contractor.
15. Termination
a. In addition to, and not in substitution for, other provisions of this Contract regarding the provision
of public services with HOPWA Funds, pursuant to the AIDS Housing Opportunity Act, as
amended, (42 USC 12901 et seq.) the HOPWA Regulations, it is expressly understood and agreed by
and between the Parties that this Contract is wholly conditioned upon the actual receipt by City of
Federal HOPWA Year 2009-2010 funds; that all monies distributed to Contractor hereunder shall
be exclusively from Federal monies received under said grant and not from any other monies of
City; and that if such funds under City's grant are not timely forthcoming, in whole or in part, City
may, at its sole discretion, terminate this Contract and City shall not be liable for payment for any
work or services performed by Contractor under or in connection with this Contract.
b. City may terminate this Contract whenever such termination is determined to be in City's best
interest, in event of Contractor's default, inability or failure to perform or to comply with any of
the terms herein, or, for other good cause.
c. The Parties acknowledge that HOPWA Funds paid hereunder are intended to provide only partial
funding for Contractor's agency operations. City may terminate this Contract if non-HOPWA
funds included in the Operating Budget are not forthcoming to Contractor during the Contract
term.
d. HOPWA Funds provided hereunder may not be used as collateral for loans to Contractor to defray
agency operation expenses, and any attempted use of HOPWA Funds for this purpose will result in
termination of this Contract by City.
e. Termination will be effected by written notice to Contractor, specifying the portions of the Contract
affected and the effective date of termination. Upon Contractor's receipt of such termination
notice, Contractor will: '
• Stop work under the Contract on the date and to the extent specified by City;
• Cease expenditures of HOPWA Funds, except as necessary for completion of the portions of
the Contract not terminated; and
• Terminate all orders and contracts to the extent that they relate to portions of the Contract
being terminated.
f. Contractor will return to City any unused HOPWA Funds previously advanced by City under this
Contract within thirty (30) days of the effective date of Contract termination. City will have no
responsibility or liability for Contractor's expenditures or actions occurring after the effective date
of Contract termination.
16. Certification Regarding LoGGyin,g
a. The undersigned representative of Contractor hereby certifies, to tie best of his or her knowledge
and belief, that: No federal appropriated funds have been paid or will be paid, by or on behalf of
Contractor, to any person for influencing or attempting to influence an officer or employee of any
agency, a member of Congress, an officer or employee of Congress or an employee of a member
HOPWA YEAR 2009-2010 CONTRACT Rev. 08-25-09
Tarrant County Samaritan Housing Inc. Page 11
of Congress in connection with the awarding of any Federal contract, the making of any Federal
grant, the making of any Federal loan, the entering into of any cooperative agreement and the
extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan
or cooperative agreement. Contractor shall require that the language of this certification be
I
ncluded in all subcontracts or agreements involving the expenditure of Federal funds.
b. If any funds other than Federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency, a member of
Congress, an officer or employee of Congress, or an employee of a member of Congress in
connection with this Federal contract, grant, loan or cooperative agreement, Contractor shall
complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance
with its instructions.
c. This certification is a material representation of fact upon which reliance was placed when this
Contract was made or entered into. Submission of this certificate is a prerequisite for making or
entering into this Contract imposed by 31 USC Section 1352. Any person who fails to file the
required certification shall be subject to a civil penalty of not less than $10,000.00 and not more
than $100,000.00 for each such failure.
17. Mi.rcellaneozrr Provisions
a. All terms of this Contract shall apply to any and all subcontractors of Contractor Vvho are in any
way paid with HOPWA Funds or who perform any work in connection with Contractor's program.
b. The provisions of this Contract are severable, and, if for any reason a clause, sentence, paragraph or
other part of this Contract shall be determined to be invalid by a court or Federal or state agency,
board or commission having jurisdiction over the subject matter thereof, such invalidity shall not
affect other provisions which can be given effect without the invalid provision.
c. City's failure to insist upon the performance of any term or provision of this Contract or to exercise
any right herein conferred shall not be construed as a waiver or relinquishment to any extent of
City's right to assert or rely upon any such term or right on any future occasion.
d. Should any action, whether real or asserted, at law or in equity, arise out of the execution,
performance, attempted performance or nonperformance of this Contract, venue for action shall
he in Tarrant County, Texas.
e. This written instrument and the exhibits attached hereto, which are incorporated by reference and
made a part of this Contract for all purposes, constitute the entire agreement between the Parties
concerning the work and services to be performed hereunder, and any prior or contemporaneous,
oral or written agreement which purports to vary from the terms hereof shall be void. Any
amendments to the terms of this Contract must be in writing and must be approved by each Party.
f. All notices required or permitted by this Contract must be in writing and are deemed delivered on
the earlier of the date actually received or the third day following (i) deposit in a United States
Postal Service post office or receptacle; (ii) with proper postage (certified mail, return receipt
requested); and (iii) addressed to the other Party at the address set out in the preamble of this
Contract or at such other address as the receiving Party designates by proper notice to the sending
Party.
g. In accordance with the requirements of 24 CFR Part 574.300, none of the performance rendered
under this Contract shall involve, and no portion of the HOPWA Funds received hereunder shall
be used, directly or indirectly, for the construction, operations, maintenance or administration of
any sectarian or religious facility or activity, nor shall said performance rendered or funds received
be utilized so as to benefit, directly or indirectly, any such sectarian or religious facility or activity.
h. 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 Contract and to perform the
responsibilities herein required.
i. Contractor certifies that it has obtained a 501 (c) (3) Certificate from the Internal Revenue Service.
Contractor shall notify City in writing of any changes to its 501 (c) (3) tax-exempt status during the
term of this Contract.
HOPWA YEAR 2009-2010 CONTRACT Rev. 08-25-09
Tarrant County Samaritan Housing Inc. Page 19
[SIGNATURES APPEAR ON FOLLOWING PAGE]
HOPWA YEAR 2009-2010 CONTRACT
Tarrant County Samaritan Housing Inc. Rev. OS-25-09
Page 13
IN WITNESS WHEREOF, the Parties hereto have executed three duplicate originals of this Contract
in Fort Worth, Tarrant County, Texas, this Q Qt� day of , 200n.8
CITY OF FORT WORTH
By:
T.M. Higgins
Assistant City Manager
AS TO FORM
s
INS931
City Attorney
ATTEST:
City Secretary
STATE OF TEXAS �
COUNTY OF TARRANT §
LEGALITY:
Tarrant County Samaritan Housing, Inc.
sy:
President and Chief Executive Officer
Connr L AutlIhorizatiox
I�lO
bate
This instrument was acknowled ed bef r �I
T.11i
g o e me on 200� by
Higgins, the Assistant City Manager of the City of Fort Worth, on behalf of the City of�Fort Worth.
STATE OF TEXAS �
COUNTY OF TARRANT S
This instrument was acknowledged befi
Dutton, the President and Chief Executive
non-profit corporation, on behalf of said cc
0 �
re me on , 200 9 by Steve
Officer of Tarrant County Samaritan Housing, Inc., a Texas
poration.
�i�" �;. KATHERINE DAVI3
*:' :`= MY COMMI9610N EXPIRES
Novertiber 6, 2011
i�lotary Public, State of Texas
OFFICIAL RECORD
CITY SECRET�`��
FT. WORTH, T)(
HOPWA YEAR 2009-2010 CONTRACT
Tarrant County Samaritan Housing Inc.
Rev. 08-25-09
Page 14
Tarrant County Samaritan Dousing, Inc. EXHIBIT A
Supportive Housing SCOPE OF SERVICES
PROGRAM SUMMARY
HOUSING OPPORTUNITIES FOR PERSONS WITH AIDS (HOPWA)
June 1, 2009 - May 31, 2010 $2699372
CONTRACT NO, PERIOD AMOUNT
SCOPE OF SERVICES
This Scope of Services is based on the proposal prepared and submitted by the Subrecipient through the City of Fort
Worth's annual Request for Proposal (RFP) process. The Subrecipient agrees to operate this Housing Opportunities for
Persons With AIDS (HOPWA) program in a manner consistent with the program delivery stated in the approved proposal.
However, in the event of any conflict between the proposal and any provision contained, herein, this Agreement shall
control.
Tarrant County Samaritan Housing, Inc., (Samaritan House) will provide Supportive Housing Services to homeless and
low-income persons living with HIV/AIDS at 929 Hemphill Street, Fort Worth Texas. The Supportive Housing program
will include the following tasks and activities 24-hour on -site home health assistance, medical case management, and
nutritional services including three hot meals daily. All services will be provided at 929 Hemphill Street 24 hours per day 7
days per week.
The purpose of the program will be to serve homeless and low-income persons by providing safe affordable housing, 24-
hour on -site assistance, medical case management, three hot meals daily, nutritional services, transportation, counseling,
and social case management, among others. The specific objectives, goals and level of services to be provided are listed
below along with the geographical location of clients served. All services will be provided from June 1, 2009 to may 31,
2010.
The HOPWA funds will be used to pay for supportive and administrative services including payroll, benefits, insurance,
supplies, etc., which is consistent with Exhibit C- Detailed Budget.
REGULATORY CLASSIFICATION•
If any of the activities listed below are not applicable, put "N/A ".
Reeulatory Citation &Activity
24 CFR 574.300(b)(5) TBRA
24 CFR 574.300(b)(6) STRMU
24 CFR 574.300(b)(7) Supportive Services
24 CFR 574.300(b)(10) Admin
Allocated Funds
N/A
N/A
$251,018
$18,354
of Total Allocation
N/A
N/A
20%
6%
Based on the nature of the service provided, Subrecipient Tarrant County Samaritan Housing, Inc. will maintain
documentation that verifies that 100% of clients served by the Supportive Housing program are diagnosed with HIV/AIDS
and are income eligible with current household incomes at or below 80% of Area Median Income (AMI) as established by
the Department of Housing and Urban Development (HUD). Agency should also document the number of clients placed
on jobs as a result of HOPWA supportive services provided.
GEOGRAPHICAL LOCATION:
Site Address: 929 Hemphill, Fort Worth Texas 76104
Client Beneficiary Location (Neighborhood, District, Citywide...): Citywide
PROGRAM GOALS:
Samaritan House's program goals are focused on fostering independence and developing skills that enable clients to
become vital, contributing members of society; individuals who succeed in this process can eventually move away from
permanent dependence on governmental and other support services. In addition, recent studies have demonstrated that
affordable housing models such as Samaritan House are important factors in reducing new HIV infections, further limiting
the number of people the City must support and saving individuals in Fort Worth from contracting this devastating disease.
PROGRAM OBJECTIVES:
Samaritan House will provide 106 unduplicated persons with supportive housing services. We also will provide 106
unduplicated persons with 6,336 units of Case Management and 9,504 units of Home Health / Attended Care. 106
unduplicated persons will receive Chemical Dependency Counseling, and 106 will benefit from 2,534 units of Nutritional
Services.
Level of service should be iderrtified in a quarrtifiable unit and directly related to specified objectives. These
activities should be consistent with activities listed on Exhibit X Program Schedule. Activities should also he
consistent with those required by IDIS.
Housin er month &number of undu licated clients served
106
Case Management- units of service
6 336
Home Health / Attended Care
Nutritional Services
99504
2 534
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ITC
Organization: Tarrant County Samaritan Housing
Program Title: Supportive Housing
Expense Category
Total
Budget
A
Grant
Budget
B
RWA,
RWB, SS
C
HOPWA
SPNS
D
SHP &
TBLA
E
All
Other
F
ADMINISTRATIVE SERVICES
Salaries
2717907
13,000
12,895
16,000
61500
223,512
FICA
20,800
994
986
1,224
497
17,099
Life Insurance
19685
105
225
325
122
908
Health Insurance
209818
29935
1,619
1,396
1,420
13,448
Disability Insurance
2,000
220
200
250
135
11195
Unemployment -State
1,280
600
170
235
98
177
Legal & Accounting
0
Office Supplies
31500
500
500
2,500
Postage
1,000
11000
Telephone
3,000
3,000
TOTAL AOMIN EXPENSES
325,990
18;354.
,. 16.595'
- 19430
8,772
262,839;
°/a Administrative Cost .. .: ,%
18:6%
, .:/" f.8%`a
4.5%
,` .; ' , $.5°I°
:. = :.- ,. 3,0%
50.9°la
SUPPORTIVE SERVICES
Salaries
864,270
198,161
2182305
108,252
1839443
156,109
FICA
63,222
14,612
16,700
8,281
14,033
9,596
Life Insurance
71915
896
21069
1,250
11275
2,425
Health Insurance
95,182
13,170
22,985
10,525
1%135
29,367
Disability Insurance
11,500
1,800
2,543
39335
21485
11337
Unem to ment-State
139720
21400
21460
985
11625
6,250
Medical Supplies
4,500
41500
Other fees
9,000
6,000
1,184
11816
Food/ Nutrition Supplies
80,000
71,878
71017
19105
Electric
24,000
15,000
90000
Office
Equipment Rental*
91350
4,250
T385
11065
1,650
Printing
129500
31000
39070
61430
Repairs
0
Postage
2,400
21400
Building Maintenance
11,021
39139
49500
3,382
Office Supplies
9,000
11300
1,000
61700
Telephone
12,000
41000
3,000
51000
Fidelity Bond***
725
725
Corporate Insurance****
21,000
45229
71449
61000
11109
2,213
Private Auto Allowance
12,000
11200
1,599
1,818
3,200
41183
Conference & Seminars
69000
11696
41304
TOTAL SUPPORTIVE-
SERVICES,.-,, ;°
112691305,
51,018
3152,184
161,057
-..:"'; 251,054
253*9923
SHORT TERM RENT; MORTGAGE, ; UTI%ITYASSISTANM.
' ' 0
TENAN f-BASED RENTAL'ASSISTANCE,
152;907
11.6;522
.' 361385
TOTAL,02
1,748,2;
269,372
= 368,779
297;009
` : 296,211
516,831
Note: Column A should be the total of Columns B through F
"Specify on Budget Detail (following pages)
'*Use One column for each non -grant funding source; note below which column equates to each source (from Leverage of Funds):
(C) RWA< RWB, State Services (E) SHP and TBLA15
(D) HOPWA SPNS (F) All Other Agency
*'* Fidelity bond and liability insurance are required of all subcontractors and may be paid from grant funds or other funds.
Organization: Tarrant County Samaritan Housing
GRANT BUDGET DETAIL
GRANT FUNDED ITEMS ONLY
Program Title: Supportive Housing
EXHIBIT C
Position/Title
TOTAL
VA)
Salary
Hourly Rate
cB)**
Annual
Hours X
(C)
% of Time
=
(D)
Total
Amount
Executive Director
35.45
21080
6.78%
51000
Director of Finance
24.95
21080
7.70%
49000
Administrative Assistant
20.00
21080
9.62%
41000
Medical Case Manager
24.55
21080
5.87%
31000
Associate Exec Director
24.95
2,080
26.98%
14,000
Housing Coordinator
22.10
2,080
17.40%
8,000
Resident Care Attendant
14.50
21080
59.68%
18,000
Resident Care Attendant
10.00
29080
48.08%
10,000
Resident Care Attendant
10.00
21080
48.08%
10,000
Resident Care Attendant
10.00
21080
48.08%
10,000
Resident Care Attendant
10.00
21080
48.08%
10,000
Resident Care Attendant
10.00
2,080
48.08%
10,000
Resident Care Attendant
10.00
21080
34.42%
7,161
Kitchen Manager/Cook
17.30
21080
27.79%
10,000
Weekend Cook
12.05
2,080
27.93%
71000
Prep Cook-1
12.05
2,080
27.93%
71000
Prep Cook-2
12.05
29080
11.97%
31000
Caretaker
16.35
21080
52.93%
18,000
Follow Up Coordinator
15.35
21080
40.72%
13,000
Social Work Case Mgr
18.25
21080
57.96%
22,000
Social Work Case Mgr
16.10
21080
17.92%
61000
Social Work Case Mgr
16.10
21080
6,000
Famil Health Coordinator
14.45
2,080t17s92%
19.960%/o
6,000
STAFF SALARIES $ 211 161
*'` Note: 2,080 hours annually comprise afull-time position
FRINGE BENEFITS -ADMINISTRATIVE SERVICES
Category
of
Payroll
Amount
%Paid by
Employer
%Paid by
Grant
Total
Amount
FICA
7.395%
$
84,022
81.43%
18.57%
$
15,606
Life Insurance
0.845%
$
91600
89.57%
10.43%
$
1,001
Health Insurance
100210%
$
116,000
86.12%
13.88%
$
169105
Disability Insurance
1.188%
$
13,500
85.04%
14.96%
$
2,020
Unemployment Insurance
1.320%
$
15,000
80.00%
20.00%
$
3,000
TOTAL FRINGE BENEFITS
$
37,732
TOTAL PERSONAL SERVICES Total Staff Salaries +Total Fringe Benefits
ITC
Organization: Tarrant County Samaritan Housing
Program Title: Supportive Housing
GRANT BUDGET DETAIL
(GRANT FUNDED ITEMS ONLY)
(CONTINUED)
UTILITIES
Average Cost Number of Total
Category Per Month Months Amount
Other KSpecif
TOTAL
UTILITIES
$0
BUILDING RENTAL
Number of Cost Per Number of Total
Building Location Square Feet Square Foot Months Amount
1.
2.
3,
TOTAL BUILDING RENT $0
OTHER EXPENSES (See Note Below)
Total %Charged Total
Category Charge to Grant Amount
Legal & Accounting
Supplies
Postage
Copying & Printing
Building Maintenance
Corporate Insurance
Office Equipment Rental
Other - Building Security Guard & Monitoring
Repairs
Other
$0
TOTAL OTHER EXPENSESSmall
CONFERENCES &SEMINARS
Total % Charged Total
Event Charge to Grant Amount
1.
2,
3.
TOTAL CONFERENCES & SEMINARS $0
OFFICE EQUIPMENT RENTAL
Note: %charge to CDBG cannot exceed 20% of CDBG budget allocation or 7% of HOPWA budget allocation
EXHIBIT C
Organization: Tarrant County Samaritan Housing Program Title: Supportive Housing
LEVERAGE OF FUNDS
The City of Fort Worth, through its CDBG, ESG and HOPWA funds, does not provide 100% of the funding for programs, Please
indicate below the funding source and amount of funds that will be used to leverage the requested CDBG,ESG and HOPWA
funds for the entire period of the program, Letters of commitment should be attached in support of all leveraged funds,
ANTICIPATED DATE
FUNDING SOURCE OF R1=r1=l0T A11AA1 Wor
EXHHiIT D
CITY OF FORT WORTH HOUSING &ECONOMIC DEVELOPMENT
Audit Certification Form
/�
Subrecipi/nIn isca nding: 9 00
Mo Day Yr
During the fiscal year in which funds will be received, we will exceed the federal
expenditure threshold of $500,000. We will have our Single Audit or Program Specific Audit
completed and will submit the A-133 audit report within nine (9) months after the end of the
audited fiscal year or thirty (30) days within its completion, whichever is the earlier date.
❑ During the fiscal year in which funds will be received, we will not exceed the
$500,000 federal expenditure threshold required for a Single Audit or a Program Specific Audit
to be performed this fiscal year. (Fill out schedule below)
Federal Expenditure Disclosure
Federal Funds
Must
be tilled out if Single Audit or Program Audit is not required:
Federal Grantor
Pass Through
Grantor
Program Name &
CFDA Number
Contract
Number
Expenditures
Total Federal Expenditures for this Fiscal Year
tle (Must be CFO, CEO or equivalent)
Phone Number Date
Failure to submit this or a similar statement or failure to submit a completed single
audit package as described in the federally required audit requirements described in OMB
Circulars A-133 by the required due date may result in suspension of funding and may
eligibility for future funding. Notwithstanding the above, this certification acknowledges
the agency's commitment to meet all other financial reporting, financial statements,
and other audit requirements as may be set forth in the contract.
Tarrant County Samaritan Housing Inc.
Supportive Housing
EXHIBIT E
CONFLICT OF INTEREST
All Applicants
The standards in OMB Circular A-110, Subpart C, provide that no employee, officer, or agent shall participate in the
selection, award, or administration of a contract supported by Federal funds if real or apparent conflict of interest would
be involved. Such a conflict would arise when an employee, officer, or agent, any member of his or her immediate
family, his or her partner, or an organization which employs or is about to employ any of the parties indicated herein, has
a financial or other interest in the firm selection for an award.
CDBG and HOME Applicants Only
The CDBG regulations at 24 CFR 570 570.611 and HOME regulations at 24 CFR 92.356 provide that no person who is
an employee, agent, consultant, officer, or elected official or appointed official of the recipient or Subrecipient that are
receiving CDBG or HOME funds and (1) who exercises or has exercised any functions or responsibilities with respect to
activities assisted with CDBG funds; or (2) who is in a position to participate in a decision -making process or gain inside
information with regard to these activities, may obtain a financial interest from a CDBG-assisted or HOME -assisted
activity, or have any interest in any contract, subcontract, or agreement with respect thereto, or the proceeds, thereunder,
either for themselves or those with who they have family or business ties, during their tenure or for one (1) year
thereafter.
IF NO CONFLICTS EXIST, COMPLETE THE FOLLOWING:
I certify that no conflict of interest exists between Tl_ie City of Fort Worth and
I certify that no conflict of interest exists between the subcontractors of and
(Name of Organization)
IF THERE IS A CONFLICT, COMPLETE THE FOLLOWING:
I certify that a conflict of interest does exist between The City of Fort Worth and
(Name of Organization)
I certify that a conflict of interest does exist between
(Name of subcontractor)
(Name of Organization)
Describe the nature
and
below: (Please identify the individual, employment, and the conflict or potential conflict [their atiiliation with your
Authorized Ageficy Official Name, PositioYlTitle
Typed Name and Title
Attachment I
CITY OF FORT WORTH
HOUSING AND ECONOMIC DEVELOPMENT DEPARTMENT
COMPLIANCE DIVISION
REQUEST FOR FUNDS
HOPWA 20094010
AGENCY: Tarrant Cry Samaritan Housing, Inc.
ADDRESS: 929 Hemphill
Fort Worth, TX 76104
SECTION I (AGENCY)
1. Reimbursement Request
A. Administrative Expenditures:
B. Supportive Service Expenditures:
C. STRMU Expenditures:
D. TBRA Expenditures:
E. Total Reimbursement:
2. Requested By:
A. Agency
James Askey
(Name)
SECTION II (CITY)
1. 13UYSPEED -Purchasing Request
A. BUYSPEED INPUT: Vendor/PO Number/Requisition Number.
B. Fund/Account/Center:
Administration
Supportive Services
STRMU
TBRA
C. Totai Amount of this Request:
SECTION III (CITY)
1. Verification
A. Contract Compliance Specialist
B. Accounting
2. Authorization
8. Director
Sherry Johnson
(Name)
(Name)
Asbury
Barbara
(Nerve}
Jesus Jay° Chapa
(Name)
PROGRAM:
CONTRACT NUMBER:
CONTRACT AMOUNT:
CONTRACT DATE:
DATE OF REQUEST:
IDIS NUMBER:
CURRENT MONTH
(Signature)
Supportive Housing
$269,372
6/1/2009
CUMULATIVE
(Date)
G R 76/516010/017206364050
$0.00
(Signature) (Date)
(Signature) (Date)
(Signature) (Date)
(Signature) (Date)
Distribution:
t Copy -Accounting
1 Copy -Compliance
Note: Any Request for Funds that exceed $6600 require the signature of both Grants ManagedDesignee and Director
CITY OF FORT WORTH
HOUSING AND ECONOMIC DEVELOPMENT DEPARTMENT
COMPLIANCE DIVISION
DETAILED STATEMENT OF COSTS
Tarrant County Samaritan Housing, Inc.
AGENCY
Supportive Housing
PROGRAM
ATTACHMENT II
CONTRACT NO. DATE
TO
REPORT PERIOD
COST CATEGORY
ACCOUNT
PROGRAM
BUDGET
MONTHLY
EXPENDITURES
CUMULATIVE
TO DATE
BALANCE
ADMINISTRATIVE EXPENSES
Salaries
516 010
$13,000.00
FICA
518 010
$994,00
Life Insurance
518 050
$105,00
Health Insurance
518 060
$2,935400
Disability Insurance
518040
Unemployment
518090
$600600
Legal and Accounting
538050
Office Supplies
521010
$500,00
Posta a
521020
Worker's Compensation
535010
$220.00
ADMINISTRATIVE -EXPENSES
S1J8=TOTAL,
SUPPORT SERVICES
Salaries
516010
$198,161,00
FICA
518 010
$14,612.00
Life Insurance
518 050
$896400
Health Insurance
518 060
$13,170,00
Disability Insurance
508070
Unemployment - State
535 020
$2,400000
Worker's Compensation
535 010
$1,800,00
Other (Specify)
535 030
Electric/ Gas Meter / Utilities
537 010
Rent(Building)
539 220
Office Equipment Rental
537 030
$4,250.00
Printing
533 030
$3,000.00
Audit
536 010
$6,000.00
Postage
538 210
Building Maintenance
534 020
Office Supplies
538 050
$1,300.00
Telephone
532130
Liability Insurance
534130
$4,229,00
Private Auto Allowance
532130
$1,200,00
Conference & Seminars
539120
TOTA SUFPOR"SERVICES
-..
>�. = $261;018000
:'"_
r o7777-7777
�,
.
_,
SNOh TERMEN
MORTGAOEri lI iL lTY
ASSI8TANC
` i1
;%%"5
.
RENTAi
TENANT4ASE#i
w
ASS18Tl`ANCS
53912I
Total Rental Services
TOTAL
$269,372.00
Contractors Certification: I certify that the costs incurred are taken from the books of account and that such costs are valid and consistent with the terms of
the agreement.
NAME and TITLE OF AUTHORIZED OFFICER SIGNATURE and DATE
Attachment In
CITY OF FORT WORTH
HOUSING &ECONOMIC DEVELOPMENT DEPARTMENT
COMPLIANCE DIVISION
EXPENDITURES WORKSHEET
Tarrant County Samaritan Housing, Inc.
Agency Date
Supportive Housing
Program
To
Report Period
NO DATE CHECK NO PAYEE
DESCRIPTION
ACCOUNT NO.
AMOUNT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
TOTAL
Woo
TITLE OF AUTHORIZED OFFICER SIGNATURE AND DATE
Attachment IVa
CITY OF FORT WORTH
HOUSING AND ECONOMIC DEVELOPMENT DEPARTMENT
COMPLIANCE DIVISION
HOPWA 2009-2010
1. Name and Address of Subgrantee: 2. Project Name:
Supportive Housing
Tarrant County Samaritan Housing, Inc.
3. Contract Number:
929 Hemphill
4. Contract Date:
June 1 2009- May 31, 2010
Fort Worth, TX 76104
Month &Year
HOPWA
CURRENT
MONTH ONLY
Cumulative
# Assisted
With Other
Funds
Amount of
Other Funds
a.# of Tenant -Based Rental Assistance (TBRA)
b.# of Short -Term Rental, Mortgage and Utility Assistance (STRMU)
c.# of STRMU clients that have moved to TBRA
d.Total # of Unduplicated Clients (a+b)-c
HOPWA
CURRENT
I#
ASSISTED
AMOUNT OF
MONTH
AMOUNT OF
WI OTHER
OTHER
ONLY
CUMULATIVE
HOPWA FUNDS
FUNDS
FUNDS
6. Supportive Services
7. Resource Identification/Technical Assistance
i. Housing Information Services
9. Permanent Housing Placement Services
10.
Monthly Income Groups of Households
for all
Unduplicated Client
$0-250
$251400
$501-100 $1001-1500
$1501-2000
Over $2000
TOTAL
Current Month
Cumulative
0
�... w'k'��i � _ram":'Y iratiia:..x»sa;,fCTOt1i11\�
$0-250
$251-500 $501-100 $1001-1500
$1501-2000
Over $2000
TOTAL
Current on
Cumulative
$0-250
$251-500
$501-100 $1001-1500
$1501-2000
Over $2000
TOTAL
Current Month
Cumulative
Certification: The undersigned, hereby, gives assurance that to the best of my knowledge and belief, the data included in this report is true and
accurate. it is also acknowledged that the provision of false information could leave the certifying official subject to the penalties of federal, state,
and local law.
DATE:
Submitted by: Phone Number_
Signature Required
City of Fort Worth
Housing and Economic Development
Compliance Division
HOPWA 2009-2010
1. Name and Address of Sub -Grantee
2. Project Name
Supportive Housing
Tarrant County Samaritan Housing, Inc.
929 Hemphill
3. Contract No.
Fort Worth, TX 76104
Month & Year
**All data reported should be unduplicated for the current month
-��7umbec�of
.Number of
_
iNourh :
households with
Amoant of Other
ouseltold4
Girrrent
'Expenditures
Otherfunds
- funds �whethe� �
with, :
_
dit ofHOPWA
.(Whether
from Grautee
from Grantee'urr'
iiOPV1'
ount
or
}' r fso uxcesj
Su ortive Sernees ;`
funds
funfie
otilier. sources
othe
, ,,
„
a. Outreach
b. Case Management
c. Life Management
d. Nutritional Services/Meals
e. Adult Day Care and Personal Assistance
f. Child Care and other Children's Services
Education
g.
It. Employment Assistance
i. Alcohol and Drug Abuse Services
'. Mental Health Services
k. Health/Medical/Intensive Care Services
1. Transportation
in. Other(specify)
n. Other (specify)
o. Number of Jobs that resulted from g. and It.
TOTAL
(current month HOPWA expenditure column
should equal total in supportive service section
on Attachment lL
Receiving
Supportive
Services w/
Receiving
Housing
Supportive Services
Current Month Undu licated Only
Assistance
Only
Persons with HIV/AIDS
Other Persons in Family Unit
Certification: The undersigned, hereby, gives assurance that to the best of my knowledge and belief,
the data included in this report is true and
It is also acknowledged that the provision of
false information
could leave the certifying
official subject to the penalties of federal, state, and
accurate.
local law.
Submitted by:
Phone No.
Date:
Signature Required
Attachment IVb
E
City of Fort Worth
Housing and Economic Development
Compliance Division
HOPWA 2009-2010
2. Project Name Supportive Housing
Hemphill 3. Contract No.
TX 76104
Month &Year
rove Services (Unduplicated data only,• clients reported on Attachment /Vb & /Vc should not be
/African American
can Indian/Alaskan Native
Hawaiian/Other Pacific Islander
JAlaskan Native & White
& White
African AmericanBWhite
can Indian/Alaskan Native $ Black
n American
Multi -Racial
Cunent Month Cumulattve
IUnduoiicated Beneficiary Data Total
Number of persons (Adults and
Children with HIV/AIDS who
received Housing Assistance
Number of Other Persons in Family
unit who received Housing
Assistance
Households Previously Homeless
Of Previously Homeless
Households, number of those who
were Chronically Homeless
Female Head of
This data relates to participants Household
Current Month II
Cumulative
Current Month Female TBRA Male TBRA
Undualicated Aoe Participants Participants
17 and Under
18 to 30 Years
31 to 50 Years
51 Years and Older
Total
Attachment IVc
ication: The undersigned, hereby, gives assurance
that to
the best of my knowledge
and
belief, the
data included in this report is true and accurate.
It is also acknowledged that the provision of
information could leave the certifying official subject
to the
penalties of federal, state,
and
local law.
Date: Submitted by: Phone No.
City of Fort Worth
Housing and Economic Development
Compliance Division
HOPWA 2009-2010
Attachment V
Agency/Address 2. Program Name: Supportive Housing
Tarrant County Samaritan Housing, Inc. 3. Contract No: Contract Date: June 1, 2009
929 Hemphill Contract Amount: $269,372
Fort Worth, TX 76104 4. Date of Request:
Month &Year
5. PROGRAM SERVICES AND ACTIVITIES: CURRENT CUMULATIVE
**Goals listed on Contract Exhibits A&B should be listed here.
6. SCOPE OF WORK NARRATIVE:
7. PROBLEMS ENCOUNTERED / SOLUTIONS PROPOSED:
8. ANTICIPATED ACTIVITY DURING THE NEXT MONTH:
Certification: The undersigned, hereby, gives assurance that to the best of my knowledge and belief, the data included in this report is true and
accurate. It is also acknowledged that the provision of false information could leave the certifying official subject to the penalties of federal,
state, and local law.
Date: Submitted By: Phone No.
ature Required
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