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HomeMy WebLinkAboutContract 56612ESG PSA CONTRACT 2021-2022 Page 1 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 STATE OF TEXAS § § COUNTY OF TARRANT § This contract (“Contract”) is made and entered into by and between the City of Fort Worth (hereafter “City”) and Lighthouse for the Homeless, dba True Worth Place (hereafter “Agency”), a Texas non-profit corporation. City and Agency may be referred to individually as a “Party” and jointly as “the Parties”. The Parties state as follows: WHEREAS, City receives grant monies from the United States Department of Housing and Urban Development (“HUD”) through the Emergency Solutions Grant Program (“ESG”), Program No. E-21-MC-48-0010, Catalog of Federal Domestic Assistance No. 14.231; WHEREAS, the ESG program is intended to provide homeless persons or persons at risk of becoming homeless with financial assistance, basic shelter, essential supportive services, and/or operations, as applicable; WHEREAS, Agency submitted a proposal to use ESG funds for an eligible program under the ESG Regulations whereby Agency will provide services to low and moderate income City citizens; WHEREAS, City citizens, the Community Development Council, and the City Council have determined that ESG programs are needed by the City’s citizens; NOW, THEREFORE, the Parties understand and agree as follows: 1.INCORPORATION OF RECITALS. City and Agency hereby agree that the recitals set forth above are true and correct and form the basis upon which the Parties have entered into this Contract. 2.DEFINITIONS. In addition to terms defined in the body of this Contract, the terms set forth below shall have the definitions ascribed to them as follows: Area Median Income or AMI means the median family income for the Fort Worth-Arlington metropolitan statistical area as established annually by HUD. The 2021 income limits are attached hereto as EXHIBIT “A-1” – 2021 HUD Income Limits. Business Diversity Enterprise Ordinance or BDE means the City’s Business Diversity Ordinance, Ordinance No. 24534-11-2020, as may be amended from time to time. CSC No. 56612 ESG PSA CONTRACT 2021-2022 Page 2 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 Complete Documentation means the following documentation as applicable: •Attachments I, II, and III, with supporting documentation including: o Proof of expense: copies of timesheets, invoices, leases, service contracts or other documentation showing that payment is due by Agency. o Proof of payment: cancelled checks, bank statements, or wire transfers necessary to demonstrate that amounts due by Agency were actually paid by Agency. o Proof of client eligibility: Source Documentation sufficient to show that clients participating in the Program are ESG Eligible Clients as described in Section 6. •Complete Documentation shall meet the standards described in the attached EXHIBIT “F”- Standards for Complete Documentation. •Any other document or record reasonably necessary to verify costs spent and client eligibility for the Program. Continuum of Care means the Tarrant Area Continuum of Care. DBE means disadvantaged business enterprise in accordance with 49 CFR Part 26. Director means the Director of the City’s Neighborhood Services Department. Effective Date means October 1, 2021. ESG means Emergency Solutions Grant. ESG Eligible Client means an individual or household that meets the definition of "homeless" or "at risk of homelessness" as defined in the Hearth Act and the ESG Regulations. ESG Funds means the ESG grant funds supplied by City to Agency under the terms of this Contract. ESG Regulations means regulations found at 24 CFR Part 576 et seq. HEARTH Act means the Homeless Emergency Assistance and Rapid Transition to Housing Act of 2009, 42 U.S.C. 11302 et seq. HMIS means Homeless Management Information System required by HUD for client data collection. HUD means the United States Department of Housing and Urban Development. IDIS means Integrated Disbursement Information System, HUD’s project tracking system. ESG PSA CONTRACT 2021-2022 Page 3 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 Neighborhood Services Department means the City’s Neighborhood Services Department. Neighborly Software – Online database maintained by the City of Fort Worth through which Agency is required to submit monthly reimbursement requests. OMB means the Office of Management and Budget. Program means the services described in EXHIBIT “A” – Program Summary. Reimbursement Request means all reports and other documentation described in Section 9. Source Documentation means any documentation sufficient to show under ESG Regulations that an individual or household is an ESG Eligible Client. Income documentation may include, but is not limited to, copies of paychecks, Social Security and Disability verification letters, interest or rental income statements, retirement income statements, child support and alimony verification, unemployment benefit letters, or any similar documentation allowed under the definition of annual income in 24 CFR Part 5.609. Unduplicated Clients means a count of ESG Eligible Clients served at least once in the Contract Term. ESG Eligible Clients served more than once in the Contract Term will only be counted the first time they are served when determining the total count of Unduplicated Clients. 3.TERM. The term of this Contract (Contract Term) begins on the Effective Date and terminates on September 30, 2022 unless earlier terminated as provided in this Contract. This Contract may be extended, by the written mutual agreement of the parties, if such extension is necessary for completion of the program, or to amend the contracts if necessary to achieve program goals provided any amendment is within the scope of the program and in compliance with City policies and all applicable laws and regulations governing the use of federal grant funds. The Contract Term shall include any extension, if exercised, as provided herein. 4.DUTIES AND RESPONSIBILITIES OF CITY. 4.1 Provide ESG Funds. City shall provide up to $177,000.00 of ESG Funds under the terms and conditions herein. 4.2 Monitor. City will monitor the activities and performance of Agency and any of its contractors, subcontractors or vendors as necessary, but no less than annually. Monitoring by City will include determining whether Agency is meeting the requirements of the ESG Regulations during the term of this Contract. 5.DUTIES AND RESPONSIBILITIES OF AGENCY. ESG PSA CONTRACT 2021-2022 Page 4 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 5.1 Required Services. Agency shall perform the services described in EXHIBIT “A” – Program Summary in accordance with the terms and conditions of this Contract. 5.2 Use of ESG Funds. 5.2.1. Compliance with ESG Regulations and Contract. Agency shall be reimbursed for eligible Program costs with ESG Funds only if City determines in its sole discretion that: 5.2.1.1 Costs are eligible expenditures in accordance with ESG Regulations. 5.2.1.2 Costs are in compliance with this Contract and are reasonable and consistent with industry norms. 5.2.1.3 Complete Documentation, as applicable, is submitted to City by Agency. 5.2.2 Budget. 5.2.2.1. The ESG Funds will be paid on a reimbursement basis in accordance with EXHIBIT “B” - Budget. 5.2.2.2 During the term of this Contract, Agency may submit written requests to increase or decrease line-item amounts in the Budget, including an explanation of why such increases or decreases are necessary. All requests shall be approved by Director in writing, with such approval being in the Director’s sole discretion. If Director approves the Agency’s proposed Budget amendment (as approved, the “Amended Budget”), then the Amended Budget will take effect on the first day of the month following the month in which it was approved by Director, unless otherwise specified in the amendment. All requests for Budget amendments must be submitted by June 1, 2022. 5.2.3 Change in Program Budget. 5.2.3.1 Agency will notify City promptly of any additional funds it receives for operation of the Program, and City reserves the right to amend this Contract in such instances to ensure compliance with HUD regulations governing cost allocation. 5.2.3.2 Agency agrees to utilize the ESG Funds to supplement rather than supplant funds otherwise available for the Program. ESG PSA CONTRACT 2021-2022 Page 5 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 5.2.4 Payment of ESG Funds to Agency. ESG Funds will be disbursed to Agency upon City’s approval of Reimbursement Requests including submission of Complete Documentation to City in compliance with Section 9. If Agency expends all funds budgeted for the Program prior to September 30, 2022, City may hold back a small amount of the ESG Funds until the end of the term. During this interim period, Agency must continue to submit Attachment III – Client Data Report in EXHIBIT “D” – Reimbursement Forms monthly. It is expressly agreed by the Parties that any ESG Funds not spent or not approved for reimbursement to Agency shall remain with City. 5.3 Program Performance Milestones. 5.3.1 Agency represents that the Program will achieve the following milestones in accordance with EXHIBIT “A” – Program Summary and the table below: Month Expenditures Unduplicated Clients as specified in EXHIBIT “A” – Program Summary 3 25% 25% 6 50% 50% 9 75% 75% 12 100% 100% 5.3.2 Failure of Agency to meet these milestones or a material deviation from them as outlined in this Section 5.3 is a breach of this Contract. For the purpose of this Section, “material deviation” shall mean more than 10% lower than the specified goal. In the event of such breach, City reserves the right in its sole option to delay or withhold payment of Reimbursement Requests, to lower Agency’s allocation of ESG Funds, or to terminate this Contract. 5.3.3 Failure to meet at least 80% of its performance milestones or serve 3,136 Unduplicated Clients under this Contract may, in City’s sole discretion, disqualify Agency for consideration under the City’s Request for Proposals for the 2022-2023 Program Year for federal grant funds. 5.3.4 Amendments to performance milestones regarding ESG Funds must be approved by the Director in writing, with such approval being in the Director’s sole discretion. If Director approves the Agency’s proposed amended performance milestones (as approved, the “Amended Performance Milestones”), then the Amended Performance Milestones will take effect on the first day of the month following the month in which it was approved by Director, unless otherwise specified in the amendment. All requests for amendments to performance milestones must be submitted by June 1, 2022. Notwithstanding the above, any amendments to this Contract shall not reduce the number of Unduplicated Clients stated in Section 5.3.3 and in EXHIBIT “A” – Program Summary. 5.4 Identify Program Expenses Paid with ESG Funds. Agency will keep accounts and records in such a manner that City may readily identify and account for Program expenses reimbursed with ESG Funds. These records shall be made available to City for audit purposes and shall be retained as required hereunder. ESG PSA CONTRACT 2021-2022 Page 6 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 5.5 Match. Agency must match ESG Funds dollar for dollar with other funding sources. Potential sources of match include any sources described at 42 U.S.C. 11375(a). Some common sources include: (i) Agency funding from non-federal sources and eligible federal grants, (ii) volunteer time, which may be valued at $5/hour of time; and (iii) the value or fair rental value of any donated materials or space. The monetary values Agency assigns to all sources of match are subject to review and approval by City. 5.5.1 Prior to October 1, 2021, Agency must submit to City a completed Match Report on the form attached hereto as EXHIBIT “H”- Match Report detailing anticipated match sources. 5.5.2 With each Reimbursement Request, Agency must submit a log of funds expended to date on the form provided in EXHIBIT “H” - Match Report, plus documentation of any match expenditures first reported in that month’s Reimbursement Request. 5.5.3 Records regarding match funds must be kept by Agency in accordance with Section 8. 5.5.4 If the expenditure of match funds and ESG Funds is not happening at approximately the same pace on a quarterly basis, then the City shall withhold ESG Funds until match expenditures are substantially the same as ESG Funds reimbursed to date. 5.6 Program Subcontracts. Agency shall not enter into a subcontract with another agency, contractor, or vendor to provide a service to clients for any part of the Program that will be paid with ESG Funds without City’s written consent. 6.CLIENT ELIGIBILITY VERIFICATION. 6.1 Client Eligibility. Agency will document the eligibility of all prospective clients. Agency may redact the client’s personal information and substitute a client number. Agency may use form attached hereto as EXHIBIT “I” – Staff ESG Certification Form to document the eligibility of all prospective clients that receive direct financial assistance as more particularly described as follows. 6.1.1 Agencies Receiving ESG Funds. 6.1.1.1 Coordination of Services. Agency must participate in the local Continuum of Care and enter data in HMIS. 6.1.1.2 Homelessness Status. Agency must verify that all new clients are ESG Eligible Clients. Acceptable forms of verification include: i.For emergency shelter (shelter services for homeless including childcare for homeless clients): ESG PSA CONTRACT 2021-2022 Page 7 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 A signed, dated statement from the client stating that the client is homeless, or that the client is homeless by virtue of fleeing domestic violence. ii.For homelessness prevention- financial assistance services: 1.Documentation that the ESG Eligible Client meets the at risk of homelessness definition consistent with 24 CFR Part 576.2 (1-3), 2.Source Documentation that the ESG Eligible Client has an annual income at or below 30% of AMI, 3.Evidence documenting that the ESG Eligible Client does not have sufficient resources or support networks immediately available to prevent them from moving to an emergency shelter or another place defined in Category 1 of the “homeless” definition under the HEARTH Act, 4.Documentation of eligibility of the housing unit, habitability inspection, lease, rent reasonableness, rental assistance agreement between Agency and landlord, 5.Documentation of client’s reasonable prospects of resuming payment of rent or utilities, as applicable, within a reasonable time, 6.Evidence documenting that the ESG Eligible Client is not receiving equivalent or same type of assistance from other homelessness prevention agencies or funding sources, and 7.Documentation supporting the type and amount of assistance provided, including, but not limited to, invoices, past due notices, and/or executed leases, as applicable, and proof of payment by Agency. iii.For rapid re-housing services- financial assistance: 1.Documentation that the individual or household meets the homeless definition in the HEARTH Act and that the client is eligible consistent with the definition of homelessness in 24 CFR Part 576.2, paragraphs 1 and 4, 2.Documentation of eligibility of the housing unit, habitability inspection, lease, rent reasonableness, rental assistance agreement between Agency and landlord, 3.Documentation of client’s reasonable prospects of resuming payment of rent and/or utilities, as applicable, within a reasonable time, 4.Evidence documenting that the ESG Eligible Client is not receiving equivalent or same type of assistance from other rapid re-housing agencies or funding sources, and ESG PSA CONTRACT 2021-2022 Page 8 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 5.Documentation supporting the type and amount of assistance provided, including, but not limited to, invoices, past due notices, and/or executed leases, as applicable, and proof of payment by the agency. iv. For housing relocation and stabilization services: 1.Documentation that services are provided for ESG Eligible Clients as defined in the HEARTH Act, as may be amended from time to time, and 2.Documentation that any staff costs and or relocation/stabilization services directly benefit the ESG Eligible Client and are clearly distinguished from the general administration of the Program. 6.1.2 Performance Standards. Agency must verify that the Program is tracking ESG activities and outcomes in accordance with the City’s performance standards as described in EXHIBIT “J” - ESG Performance Standards. 6.1.3 Written Standards for ESG Assistance. Agency must verify that the Program is documenting Client Eligibility in accordance with the City’s written standards as described in EXHIBIT “J-1” – Written Standards for ESG Assistance. Agency must maintain all records in accordance with Section 8. 6.2 Submission of Complete Documentation. Agency must submit copies of documentation of client eligibility described in Section 6.1 with Attachment III in each month’s Reimbursement Request for all Unduplicated Clients. 6.3 Maintain Documentation. Agency must maintain copies of all documentation required by this Section for 5 years following the expiration of the Contract term. This Section shall survive the earlier terminations or expirations of this Contract. 7.ADDITIONAL ESG REQUIREMENTS. Agency agrees to comply with all requirements of the ESG Program as stated in the ESG Regulations, including but not limited to the following: 7.1 Environmental Review. ESG Funds will not be paid, and costs cannot be incurred until City has conducted an environmental review and an Environmental Review Record as required by 24 CFR Part 58. The environmental review may result in a decision to proceed with, modify, or cancel the funding for the Program. Further, Agency will not undertake or commit any funds to physical or choice limiting actions as described in any applicable federal regulations. Any violation of this provision ESG PSA CONTRACT 2021-2022 Page 9 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 will (i) cause this Contract to terminate immediately; and (ii) require Agency to repay City the ESG Funds it has already received and forfeit any future payments of ESG Funds. 7.2 Contract Not Constituting Commitment of Funds. Notwithstanding any provision of this Contract, the Parties agree and acknowledge that this Contract does not constitute a commitment of funds, and that such commitment of funds or approval may occur only upon (i) satisfactory completion of an environmental review and receipt by City of an authorization to use grant funds from HUD under 24 CFR Part 58, (ii) approval of City’s 2021 - 2022 Action Plan, and (iii) receipt by City of grant agreement from HUD. 7.3 Monitoring. 7.3.1 Agency understands and agrees that it will be subject to monitoring by City for compliance with terms and provisions of this Contract and the ESG Regulations for the term of this Contract. Agency is subject to such monitoring during the term of this Contract and for 5 years after the Contract term ends. For purposes of this Contract, unless this Contract is earlier terminated, this 5 year period for monitoring is deemed to begin on October 1, 2022, or October 1, 2023 if the Contract is extended, and shall end no later than September 30, 2028 regardless of. 7.3.2 Representatives of City, HUD, HUD Office of Inspector General, and the United States Comptroller General shall have access during regular business hours, upon 48 hours prior notice, to Agency’s offices and records pertaining to the use of the ESG Funds, and to Agency’s officers, directors, agents, employees, contractors, subcontractors and vendors for the purpose of such monitoring. 7.3.3 In addition to other provisions of this Contract regarding frequency of monitoring, City reserves the right to perform desk reviews or on-site monitoring of Agency’s compliance with the terms and conditions of this Contract. City shall provide Agency with a written report of the monitor’s findings after each monitoring visit. If the monitoring report notes deficiencies in Agency’s performance, the report shall include requirements for the timely correction of said deficiencies by Agency. Failure by Agency to take the action specified in the monitoring report may be cause for suspension or termination of this Contract as provided herein. 7.3.4 Subsections 7.3.1 through 7.3.3 shall be applicable for the Contract term and for 5 years thereafter and shall survive the earlier termination or expiration of this Contract. 7.3.5 Agency shall provide City annually the results of any state or federal monitoring. Such results shall be submitted within 60 days of receipt of such state or federal monitoring report, or with the January Reimbursement Request, whichever is earlier. 7.4 Agency Procurement Standards. Agency shall comply with all applicable federal, state and local laws, regulations, and ordinances for making procurements under this Contract. In addition to the conflict of interest provisions in Section 14.13.3, Agency shall establish written procurement procedures to ensure that materials and services are obtained in a cost effective manner and that provides for full and open competition. When procuring materials and services for this Contract, Agency shall comply ESG PSA CONTRACT 2021-2022 Page 10 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 at a minimum with the procurement standards in 2 CFR Part 200.317 through 2 CFR Part 200.326. 7.4.1 Contracts in excess of $10,000.00 made by Agency using ESG Funds must address termination for cause and convenience including the manner by which such termination shall be effected and the basis for settlement of the terminated contract, if any, as required by Appendix II (B), 2 CFR Part 200. 7.4.2 Agency shall not make any contract with parties listed on the government wide System for Award Management, www.sam.gov (“SAM”). Agency must confirm by search of SAM that all contractors paid with ESG Funds are not listed by SAM as being debarred, both prior to hiring and prior to submitting a Reimbursement Request which includes invoices from any such contractor. Failure to submit such proofs of search shall be an event of default. 7.5 Cost Principles/Cost Reasonableness. Agency shall administer its use of ESG Funds in compliance with 2 CFR Part 200, as applicable. The eligibility of costs incurred for performance rendered shall be determined in accordance with 2 CFR Part 200.400 through 2 CFR Part 200.475. 7.6 Financial Management Standards. Agency agrees to comply with 2 CFR Part 200, as applicable. Agency also agrees to adhere to the accounting principles and procedures required therein, utilize adequate internal controls, and maintain necessary supporting and back-up documentation for all costs incurred in accordance with 2 CFR Part 200.302 and Part 200.303. 7.7 Uniform Administrative Requirements, Cost Principles, and Audit Requirements. Agency will comply with the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards in 2 CFR Part 200, as applicable, or any reasonably equivalent procedures and requirements that City may require. 7.8 Terms Applicable to Contractors, Subcontractors and Vendors. Agency understands and agrees that all terms of this Contract, whether regulatory or otherwise, shall apply to any and all contractors, subcontractors and vendors of Agency which are in any way paid with ESG Funds or who perform any work in connection with the Program. Agency shall cause all applicable provisions of this Contract to be included in and made a part of any contract or subcontract executed in the performance of its obligations hereunder including its obligations regarding the ESG Regulations. Agency shall monitor the services and work performed by its contractors, subcontractors and vendors on a regular basis for compliance with the ESG Regulations and Contract provisions. Agency must cure all violations of the ESG Regulations committed by its contractors, subcontractors or vendors. City maintains the right to insist on Agency’s full compliance with the terms of this Contract and the ESG Regulations and Agency is responsible for such compliance regardless of whether actions taken to fulfill the requirements of this Contract are taken by Agency or by Agency’s contractors, subcontractors or vendors. Agency acknowledges that the provisions of this Section shall survive the earlier termination or expiration of this Contract and shall be applicable for 5 years after the termination of the Contract. ESG PSA CONTRACT 2021-2022 Page 11 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 7.9 Copyright and Patent Rights. No reports, maps, or other documents produced in whole or in part under this Contract shall be the subject of an application for copyright by or on behalf of Agency. HUD and City shall possess all rights to invention or discovery, as well as rights in data, which may arise as a result of Agency’s performance under this Contract. 7.10 Conflict of Interest Disclosure. In accordance with the requirements of Section 14.13.2.1 and 14.13.4, Agency shall establish conflict of interest policies for federal awards. Agency shall disclose to City in writing any potential conflict of interest. 7.11 Compliance with FFATA and Whistleblower Protections. Agency shall comply with the requirements of 2 CFR 300(b), including provisions of the Federal Funding Accountability and Transparency Act (“FFATA”) governing requirements on executive compensation and provisions governing whistleblower protections contained in 10 U.S.C. 2409, 41 U.S.C. 4712, 10 U.S.C. 2324, 41 U.S.C. 4304 and 41 U.S.C. 4310. 7.11.1 Agency shall provide City with its DUNS number. 7.12 Internal Controls. In compliance with the requirements of 2 CFR Part 200.303, Agency shall: 7.12.1 Establish and maintain effective internal control over the ESG Funds that provides reasonable assurance that Agency is managing the ESG Funds in compliance with federal statutes, regulations, and the terms and conditions of this Contract. These internal controls shall be in compliance with guidance in “Standards for Internal Control in the Federal Government” issued by the Comptroller General of the United States or the “Internal Control Integrated Framework” issued by the Committee of Sponsoring Organizations of the Treadway Commission (“COSO”); 7.12.2 Comply with federal statutes, regulations, and the terms and conditions of this Contract; 7.12.3 Evaluate and monitor Agency’s compliance with statutes, regulations and the terms and conditions of this Contract; 7.12.4 Take prompt action when instances of noncompliance are identified including noncompliance identified in audit findings; and 7.12.5 Agency must have written procedures to safeguard protected personally identifiable information and other information that HUD or City designates as sensitive or Agency considers sensitive consistent with applicable federal, state, local and tribal laws regarding privacy and obligations of confidentiality. 7.13 Confidentiality of Client Information ESG PSA CONTRACT 2021-2022 Page 12 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 Consistent with the requirements of 24 CFR Part 576.500, Agency shall comply with the City’s written standards as described in EXHIBIT “N” – Written Standards for Maintenance of Personally Identifying Information. Furthermore, in compliance with this section, Agency shall develop and implement written procedures to ensure the following: 7.13.1 Personally Identifying Information All records containing personally identifying information (as defined in HUD’s standards for participation, data collection, and reporting in a local HMIS) of any individual or family who applies for and/or receives ESG assistance will be kept secure and confidential. 7.13.2 Victim Information The address or location of any domestic violence, dating violence, sexual assault, or stalking shelter project assisted by ESG funds will not be made public, except with written authorization of the person responsible for the operation of the shelter. 7.13.3 Program Participant Information The address or location of any housing of a client must not be made public, except as provided under a preexisting policy of either City or Agency and consistent with state and local laws regarding privacy and obligations of confidentiality. 7.14 Violence Against Women Act Requirements 7.14.1 Agency shall comply with the Violence Against Women Act (“VAWA”) and shall ensure that any property owner, manager, or facility assisted by the ESG Funds shall, at the time of application for services, provide all clients receiving rental assistance with a Notice of Occupancy Rights under the Violence Against Women Act in substantially the same form as the form attached and incorporated as Exhibit “O”-Notice of Occupancy Rights Under VAWA in compliance with VAWA and 24 CFR Part 574.604(a)(2), where applicable. 7.14.2 Agency agrees that no applicant for ESG assistance may be denied admission or assistance under the Program on the basis or as a direct result of the fact that they are or have been a victim of domestic violence, dating violence, sexual assault, or stalking, as long as they would otherwise qualify for the Program. 7.14.3 Agency shall be responsible for reviewing VAWA and 24 CFR Part 574.604 and shall respond to all emergency transfer requests in accordance with the requirements of those provisions. Agency may request that all clients requesting an emergency transfer under VAWA fill out the form attached and incorporated as Exhibit “P” – VAWA Emergency Transfer Request Form. 8.RECORD KEEPING; REPORTING AND DOCUMENTATION REQUIREMENTS; AUDIT. 8.1 Record Keeping. Agency shall maintain a record-keeping system as part of its performance of this Contract ESG PSA CONTRACT 2021-2022 Page 13 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 and shall promptly provide City with copies of any document City deems necessary for the effective fulfillment of City’s monitoring and evaluation responsibilities. Specifically, Agency will keep or cause to be kept an accurate record of all actions taken and all funds spent, with supporting and back-up documentation. Agency will maintain all records and documentation related to this Contract for 5 years after the Contract term ends. If any claim, litigation, or audit is initiated before the expiration of the 5 year period, the relevant records and documentation must be retained until all such claims, litigation or audits have been resolved. For purposes of this Contract, unless this Contract is earlier terminated, this 5 year period for record retention is deemed to begin on October 1, 2021, or October 1, 2022 if the Contract is extended, and shall end no later than September 30, 2027. 8.2 Access to Records. Representatives of City, HUD and any duly authorized officials of the federal government will have full access to, and the right to examine, audit, copy, excerpt and/or transcribe any of Agency’s records pertaining to all matters covered by this Contract for 5 years after the Contract term ends. Such access shall be during regular business hours and upon at least 48 hours prior notice. For purposes of this Contract, unless this Contract is earlier terminated, this 5 year period for access to records is deemed to begin on October 1, 2021, or October 1, 2022 if the Contract is extended, and shall end no later than September 30, 2027. 8.3 Reports. Agency will submit to City all reports and documentation described in this Contract in such form as City may prescribe. Agency may also be required to submit a final performance and/or final financial report if required by City at the termination of this Contract in such form and within such times as City may prescribe. Failure to submit to City any report or documentation described in this Contract shall be an event of default of this Contract and City may exercise all of its remedies for default under this Contract. 8.3.1 Additional Information. Agency shall provide City with additional information as may be required by state or federal agencies to substantiate Program activities and/or expenditure eligibility. 8.4 Change in Reporting Requirements and Forms. City retains the right to change reporting requirements and forms at its discretion. City will notify Agency in writing at least 15 days prior to the effective date of such change, and the Parties shall execute an amendment to the Contract reflecting such change if necessary. 8.5 Audit. 8.5.1 Entities that Expend $750,000 or more in Federal Funds Per Year. All non-federal entities that expend $750,000 or more in federal funds within 1 year, regardless of the source of the federal award, must submit to City an annual audit prepared in accordance with specific reference to 2 CFR Part 200.501 through Part 200.521. The audit shall cover the Agency’s fiscal years during which this Contract is in force. The audit must be prepared by an independent certified public accountant, be completed within 6 months following the end of the period being audited and be submitted to City within 30 days of its ESG PSA CONTRACT 2021-2022 Page 14 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 completion. Agency’s audit certification is attached hereto as EXHIBIT “C” – “Audit Certification Form” and “Audit Requirements”. The Audit Certification Form must be submitted to City prior to or with the first Reimbursement Request. Entities that expend less than $750,000 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. 8.5.2 City Reserves the Right to Audit. City reserves the right to perform an audit of Agency’s Program operations and finances at any time during the term of this Contract and for 5 years after the Contract Term ends if City determines that such audit is necessary for City’s compliance with the ESG Regulations or other City policies. Agency agrees to allow access to all pertinent materials as described herein for such audit. For purposes of this Contract, unless this Contract is earlier terminated, this 5 year period for City audit is deemed to begin on October 1, 2022, or October 1, 2023 if the Contract is extended, and shall end no later than September 30, 2028. If such audit reveals a questioned practice or expenditure, such questions must be resolved within 15 business days after notice to Agency of such questioned practice or expenditure. If questions are not resolved within this period, City reserves the right to withhold further funding under this Contract and/or any other contracts with Agency. IF AS A RESULT OF ANY AUDIT IT IS DETERMINED THAT AGENCY HAS FALSIFIED ANY DOCUMENTATION OR MISUSED, MISAPPLIED OR MISAPPROPRIATED ESG FUNDS OR SPENT ESG FUNDS ON ANY INELIGIBLE ACTIVITIES, AGENCY AGREES TO REIMBURSE CITY THE AMOUNT OF SUCH MONIES PLUS THE AMOUNT OF ANY SANCTIONS, PENALTY OR OTHER CHARGE LEVIED AGAINST CITY BY HUD BECAUSE OF SUCH ACTIONS. 9.REIMBURSEMENT REQUIREMENTS. 9.1 Deadline for Submitting Reimbursement Requests. 9.1.1 Reimbursement Requests shall be submitted monthly to the City and must be received by the City on or before the 15th day of the month following the month expenses were paid by Agency. For example, the Reimbursement Request for June expenses must be received by July 15. In the event the 15th falls on a weekend or City holiday, Reimbursement Requests shall be due the next day that the City is open for business. Failure to submit a Reimbursement Request in a timely fashion will result in City taking the actions outlined in Section 10.1. NOTWITHSTANDING ANYTHING ABOVE, THE REIMBURSEMENT REQUEST FOR EXPENSES INCURRED FOR SEPTEMBER 2022 MUST BE RECEIVED BY OCTOBER 1, 2022. COMPLETE DOCUMENTATION FOR ALL SEPTEMBER 2022 EXPENSES MUST BE SUBMITTED BY OCTOBER 15, 2022. FAILURE TO SUBMIT A FINAL REIMBURSEMENT REQUEST WITH COMPLETE DOCUMENTATION BY OCTOBER 15, 2022 WILL RESULT IN AUTOMATIC FORFEITURE OF PAYMENT OF THE SEPTEMBER REIMBURSEMENT REQUEST. 9.1.2 City will notify Agency by e-mail within 14 calendar days if a Reimbursement Request is lacking Complete Documentation or corrections are needed. Agency will have 7 calendar days from the date of the e-mail notice to submit any requested information or missing ESG PSA CONTRACT 2021-2022 Page 15 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 documentation. Agency may be penalized, at City’s sole discretion, in the Request for Proposal for the 2022-2023 Program Year for any notifications received under this Section. If Agency fails to submit all the required information or missing documentation within 7 calendar days from the first e-mail, Agency shall forfeit any payments otherwise due that month and failure to submit any requested information will be considered an event of default as outlined in Section 10.1.2. 9.2 Submission of Reimbursement Requests. Agency shall provide City with Complete Documentation and the following reports as shown in EXHIBIT “D” – Reimbursement Forms with each Reimbursement Request: 9.2.1 Attachment I – Invoice. This report shall contain the amount requested for reimbursement each month, the cumulative reimbursement requested to date (inclusive of that month’s request). 9.2.1.1 Agency must submit a separate invoice for each activity type, i.e. Shelter Operations, Homeless Prevention, Rapid Rehousing, and HMIS. 9.2.2 Attachment II – Expenditure Worksheet. This report shall itemize each expense requested for reimbursement by Agency and shall include the Account corresponding the expense to a Budget line item. In order for this report to be complete the following must be submitted: 9.2.2.1 For payroll expenses, timesheets signed by employees and approved by supervisor for all payroll expenses listed. Timesheets must distinguish between ESG-funded time and non-ESG funded time and reflect actual time spent on ESG-funded activities. Agency may not submit payroll expenses dated 60 calendar days prior to the date of the Reimbursement Request. 9.2.2.2 For non-payroll expenses, invoices for each expense listed with an explanation as to how the invoiced expense pertains to the Program. Agency may not submit invoices dated 60 calendar days prior to the date of the Reimbursement Request. 9.2.2.3 Proof that each expense was paid by Agency, which proof can be satisfied by canceled checks, wire transfer documentation, paid receipts or other appropriate banking documentation. 9.2.3 Attachment III – Client Data Report. This report shall list each Unduplicated Client served during the month along with his or her demographic information. The Client Data Report must maintain a list of all clients served during the Contract term. If Agency, receives funds from the United States Department of Justice or the Victims of Crime Act, then Agency is prohibited from submitting the Client Data Report to the City. However, Agency must complete all required forms under this Section 9.2.3 and maintain in client files in accordance with Section 8. In order for this report to be complete the following must be submitted: ESG PSA CONTRACT 2021-2022 Page 16 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 9.2.3.1 Documentation of income verification for each Unduplicated Client the first time the client is served, which either will be the completed form attached hereto as EXHIBIT “E”- Form of Income Self Certification or Source Documentation. 9.2.3.2 Agency may use the form attached hereto as EXHIBIT “I” – Staff ESG Certification Form to verify client eligibility as described in Section 6.1. 9.2.4 Delivery of Reimbursement Request. Reimbursement Requests must be submitted through Neighborly Software by the deadline in Section 9.1.1. 9.2.5 Match Report. This report shall document actual expenditure of match funds, as further described in Section 5.5. 9.2.6 ESG Quarterly HMIS Report. Agency shall submit the ESG Quarterly HMIS Report, attached hereto as EXHIBIT “K” –Quarterly Report, with the December, March, June and September Reimbursement Requests to document Agency’s participation in the local Continuum of Care’s HMIS. 9.3 Withholding Payment. CITY SHALL HAVE NO OBLIGATION TO PAY ON ANY REIMBURSEMENT REQUEST THAT IS NOT RECEIVED BY THE DUE DATE. Failure to timely submit accurate and complete Reimbursement Requests and Documentation along with any required reports shall be an event of default. 10.DEFAULT AND TERMINATION. 10.1 Failure to Submit Reimbursement Request or Required Documentation. 10.1.1 If Agency fails to submit a Reimbursement Request in accordance with Section 9, Agency shall be in default of this Contract. City will notify Agency in writing of such default and the Agency will have 5 calendar days from the date of the written notice to submit such Reimbursement Request to cure the default. If Agency fails to cure the default within such time, Agency shall forfeit any payments otherwise due that month. 10.1.2 If Agency fails to submit requested information or missing documentation as set forth in Section 9.1.2, then Agency shall forfeit payment due that month and the failure to submit shall be considered an event of default that shall not be cured. 10.1.3 NOTWITHSTANDING THE PROVISIONS OF SECTION 10.1.1 OR 10.1.2, IF AGENCY FAILS TO SUBMIT THE REIMBURSEMENT REQUEST DUE OCTOBER 1, 2022, OR IF THE SUBMITTED REIMBURSEMENT REQUEST FOR ESG PSA CONTRACT 2021-2022 Page 17 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 OCTOBER 1, 2022 IS LATE, INCOMPLETE OR OTHERWISE NOT IN COMPLIANCE WITH THIS CONTRACT OR THE ESG REGULATIONS AS DETERMINED BY CITY IN ITS SOLE DISCRETION, THERE WILL BE NO CURE PERIOD AND ANY REIMBURSEMENT WILL BE FORFEITED. 10.1.4 In the event of (i) an uncured default under Section 10.1.1 or an event of default under 10.1.2 (ii) or more than 2 instances of default, cured or uncured, under these Sections, City reserves the right at its sole option to terminate this Contract effective immediately upon written notice of such intent with no penalty or liability to City. 10.1.5 Notwithstanding anything to the contrary herein, City will not be required to pay any ESG Funds to Agency during the period that any Reimbursement Request, report or documentation is past due or is not in compliance with this Contract or the ESG Regulations, or during any period during which Agency is in default of this Contract. 10.1.6 In the event of termination under this Section 10.1, all ESG Funds awarded but unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency shall have no further right to such funds. 10.2 Failure to Maintain Records or Submit Reports and Documentation. If Agency fails to maintain all records and documentation as required in Section 8, or if the maintained or submitted report or documentation is not in compliance with this Contract or the ESG Regulations as determined by City in its sole discretion, City will notify Agency in writing and Agency will have 30 calendar days from the date of the written request to obtain or recreate the missing records and documentation or submit or resubmit any such report or documentation to City. If Agency fails to maintain the required reports or documentation, or fails to submit or resubmit any such report or documentation within such time, City shall have the right to terminate this Contract effective immediately upon written notice of such intent with no penalty or liability to City. 10.2.1 In the event of termination under this Section 10.2, all ESG Funds awarded but unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency shall have no further right to such funds, and any ESG Funds paid to Agency must be repaid to City within 30 days of termination. If such ESG funds are not repaid to City within the 30 day period, City shall exercise all legal remedies available under this Contract. 10.3 In General. 10.3.1 Subject to Section 10.2, and unless specifically provided otherwise in this Contract, Agency shall be in default under this Contract if Agency breaches any term or condition of this Contract. In the event that such a breach remains uncured after 30 calendar days following written notice by City (or such other notice period as may be specified herein) or, if Agency has diligently and continuously attempted to cure following receipt of such written notice but reasonably requires more than 30 calendar days to cure, as determined by both Parties mutually ESG PSA CONTRACT 2021-2022 Page 18 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 and in good faith, City shall have the right to elect in City’s sole discretion to (i) extend Agency’s time to cure, (ii) terminate this Contract effective immediately upon written notice of such intent to Agency, or (iii) pursue any other legal remedies available to City under this Contract. 10.3.2 City’s remedies may include: 10.3.2.1 Direct Agency to prepare and follow a schedule of actions for carrying out the affected activities, consisting of schedules, timetables and milestones necessary to implement the affected activities. 10.3.2.2 Direct Agency to establish and follow a management plan that assigns responsibilities for carrying out the remedial activities. 10.3.2.3 Reprogram ESG Funds that have not yet been expended from affected activities to other eligible activities or withhold ESG Funds. 10.3.2.4 Any other appropriate action including but not limited to any remedial action legally available such as declaratory judgment, specific performance, damages, temporary or permanent injunctions, termination of this Contract or any other contracts with Agency, and any other available remedies. 10.3.3 In the event of termination under this Section 10.3, all ESG Funds awarded but unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency shall have no further right to such funds, and any ESG Funds already paid to Agency must be repaid to City within 30 days of the termination. Failure to repay such ESG Funds within the 30 day period will result in City exercising all legal remedies available under this Contract. 10.4 No Funds Disbursed while in Breach. Agency understands and agrees that no ESG Funds will be paid to Agency until all defaults are cured to City’s satisfaction. 10.5 No Compensation After Date of Termination. Agency shall not receive any compensation for work undertaken after the date of the termination. 10.6 Rights of City Not Affected. Termination shall not affect or terminate any of the existing rights of City against Agency, or which may thereafter accrue because of Agency’s default and this provision shall be in addition to any and all other rights and remedies available to City under the law. Such termination does not terminate any provisions of this Contract that have been expressly noted as surviving the term or termination of the Contract. No delay or omission by City in exercising any right or remedy available to it under this Contract shall impair any such right or remedy or constitute a waiver or acquiescence in any Agency default. ESG PSA CONTRACT 2021-2022 Page 19 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 10.7 Waiver of Breach Not Waiver of Subsequent Breach. The waiver of a default or breach of any term, covenant, or condition of this Contract shall not operate as a waiver of any subsequent default or breach of the same or any other term, covenant or condition hereof. 10.8 Civil, Criminal and Administrative Penalties. Failure to perform all the Contract terms may result in civil, criminal or administrative penalties, including, but not limited to those set out in this Contract. 10.9 Termination for Cause. 10.9.1 City may terminate this Contract in the event of Agency’s default, inability, or failure to perform subject to notice, grace and cure periods. In the event City terminates this Contract for cause, all ESG Funds awarded but unpaid to Agency pursuant to this Contract shall be immediately rescinded and Agency shall have no further right to such funds and any ESG Funds already paid to Agency must be repaid to City within 30 days of termination. Failure to repay such ESG Funds within 30 days will result in City exercising all legal remedies available to City under this Contract. AGENCY ACKNOWLEDGES AND AGREES THAT IF CITY TERMINATES THIS CONTRACT FOR CAUSE, AGENCY OR ANY AFFILIATES OF AGENCY SHALL NOT BE CONSIDERED FOR ANY OTHER CITY CONTRACT FOR ESG FUNDS FOR A MINIMUM OF 5 YEARS FROM THE DATE OF TERMINATION. 10.9.2 Agency may terminate this Contract if City does not provide the ESG Funds substantially in accordance with this Contract. 10.10 Termination for Convenience. In terminating in accordance with 2 CFR Part 200, Appendix II, this Contract may be terminated in whole or in part only as follows: 10.10.1 By City with the consent of Agency in which case the Parties shall agree upon the termination conditions, including the effective date and in the case of partial termination, the portion to be terminated; or 10.10.2 By Agency upon at least 30 days written notification to City, setting forth the reasons for such termination, the effective date, and in the case of partial termination, the portion to be terminated. In the case of a partial termination, City may terminate the Contract in its entirety if City determines in its sole discretion that the remaining portion of the Contract to be performed or ESG Funds to be spent will not accomplish the purposes for which the Contract was made. 10.11 Dissolution of Agency Terminates Contract. This Contract shall terminate in the event Agency is dissolved or ceases to exist. In the event of termination under this Section, all ESG Funds are subject to repayment and/or City may exercise all of its remedies under this Contract. 10.12 Non-appropriation of Funds. ESG PSA CONTRACT 2021-2022 Page 20 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 In the event no funds or insufficient funds are appropriated by City in any fiscal period for any payments due hereunder, City will notify Agency of such occurrence and this Agreement shall terminate on the last day of the fiscal period for which appropriations were received without penalty or expense to City of any kind whatsoever, except as to the portions of the payments herein agreed upon for which funds have been appropriated. 10.13 Reversion of Assets. In the event this Contract is terminated with or without cause, all assets acquired by Agency with the ESG Funds including cash, interest payments from loans or otherwise, all outstanding notes, mortgages or other security instruments, any accounts receivable attributable to the use of the ESG Funds, and any real or personal property owned by Agency that was improved with the ESG Funds shall automatically transfer to City or to such assignee as City may designate. 11.REPAYMENT OF ESG FUNDS. All ESG Funds are subject to repayment in the event the Program does not meet the requirements of this Contract or in the ESG Regulations. If Agency takes any action that results in the City being required to repay all or any portion of the ESG Funds to HUD, Agency agrees it will reimburse City within thirty days of notice from the City for such repayment. Additionally, if Agency takes any action that results in City receiving a finding from HUD about the Program, whether or not repayment of all or any portion of the ESG Funds is required of City, Agency agrees City may require that 10% of the ESG Funds be repaid to City as liquidated damages. The Parties agree that City’s damages in the event of either repayment to HUD being required or receiving a finding from HUD are uncertain and would be difficult to ascertain and may include an impact on City’s ESG grant or other federal grant funds, in addition to the finding by HUD or a required repayment of funds to HUD by City. Therefore, the Parties agree that payment under this Section of 10% of the ESG Funds by Agency to City is liquidated damages and not a penalty. 12.CHANGE IN NON-PROFIT STATUS. Agency must provide City with written notification of any changes to its non-profit status within 15 calendar days of being notified of the change. Regardless of notice by Agency, if the non-profit status of Agency changes after the date of this Contract, City may but is not obligated to, terminate this Contract. In the event of termination under this Section 12, all ESG Funds awarded but not yet paid to Agency pursuant to this Contract shall be immediately rescinded and Agency shall have no further right to such funds. City, in its sole discretion, may require that any ESG Funds already paid to Agency must be repaid to City within 30 calendar days of termination under this Section. 13.SURVIVAL. Any provision of this Contract that pertains to auditing, monitoring, indemnity obligations, client income eligibility, record keeping and reports, City ordinances, or applicable ESG requirements, and any default and enforcement provisions necessary to enforce such provisions, shall survive the termination of this Contract for 5 years after the Contract term ends and shall be ESG PSA CONTRACT 2021-2022 Page 21 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 enforceable by City against Agency. For purposes of this Contract, unless this Contract is earlier terminated, this 5 year period for City audit is deemed to begin on October 1, 2022, or October 1, 2023 if the Contract is extended, and shall end no later than September 30, 2028. 14.GENERAL PROVISIONS 14.1 Agency an Independent Contractor. Agency shall operate hereunder as an independent contractor and not as an officer, agent, servant or employee of City. Agency 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, contractors, subcontractors, vendors, clients, licensees or invitees. 14.2 Doctrine of Respondeat Superior. The doctrine of respondeat superior shall not apply as between City and Agency, or its officers, members, agents, servants, employees, contractors, subcontractors, vendors, clients, licensees or invitees, and nothing herein shall be construed as creating a partnership or joint enterprise between City and Agency. City does not have the legal right to control the details of the tasks performed hereunder by Agency, its officers, members, agents, employees, contractors, subcontractors, vendors, clients, licensees or invitees. 14.3 Agency Property. City shall under no circumstances be responsible for any property belonging to Agency, or its officers, members, agents, employees, contractors, subcontractors, vendors, clients, licensees or invitees that may be lost, stolen or destroyed or in any way damaged and AGENCY HEREBY INDEMNIFIES AND HOLDS HARMLESS CITY AND ITS OFFICERS, AGENTS, AND EMPLOYEES FROM ANY AND ALL CLAIMS OR SUITS PERTAINING TO OR CONNECTED WITH SUCH PROPERTY. 14.5 Religious Organization. Agency shall comply with all applicable requirements as more particularly described in 24 CFR Part 5.109. No portion of the ESG Funds shall be used in support of any sectarian or religious activity. In addition, there must be no religious or membership criteria for clients of a ESG-funded service. 14.5.1. Separation of Explicitly Religious Activities. Agency retains its independence and may continue to carry out its mission, including the definition, development practice, and expression of its religious beliefs, provided that it does not use ESG Funds to support or engage in any explicitly religious activities (including activities that involve overt religious content such as worship, religious instruction, or proselytization), or in any other manner prohibited by law. 14.5.2 Explicitly Religious Activities. If Agency engages in explicitly religious activities (including activities that involve overt religious content such as worship, religious instruction, or proselytization), the explicitly religious ESG PSA CONTRACT 2021-2022 Page 22 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 activities must be offered separately, in time or location, from the programs or activities supported by ESG Funds and participation must be voluntary for clients of a ESG-funded service. 14.5.3 Required Notices. If Agency constitutes a Faith-based organization under 24 CFR Part 5.109, Agency must provide all clients of a ESG-funded service with the notice attached as EXHIBIT “M”—Notice of Beneficiary Rights. Such notice shall be provided to the client prior to enrollment in any ESG- funded program or activity. In addition, if a client or prospective client of a ESG-funded service objects to the religious character of Agency, then Agency must promptly undertake reasonable efforts to identify and refer the client or prospective client to an alternate provider to which the client or prospective client has no such objection, as more particularly described in 24 CFR Part 5.109. 14.6 Venue. Venue shall lie in state courts located in Tarrant County, Texas or the United States District Court for the Northern District of Texas, Fort Worth Division for any action, whether real or asserted, at law or in equity, arising out of the execution, performance, attempted performance or non-performance of this Contract. 14.7 Governing Law. This Contract shall be governed by and construed in accordance with the laws of the State of Texas. If any action, whether real or asserted, at law or in equity, arises out of the execution, performance or non-performance of this Contract or on the basis of any provision herein, for any issue not governed by federal law, the choice of law shall be the laws of the State of Texas. 14.8 Severability. 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. 14.9 Written Agreement Entire Contract. This written instrument and the Exhibits, Attachments, and Addendums attached hereto, which are incorporated by reference and made a part of this Contract for all purposes, constitute the entire agreement by the Parties concerning the work and services to be performed under this Contract. Any prior or contemporaneous oral or written agreement which purports to vary the terms of this Contract shall be void. Any amendments to the terms of this Contract must be in writing and executed by the Parties. 14.10 Paragraph Headings for Reference Only, No Legal Significance; Number and Gender. The paragraph headings contained herein are for convenience in reference to this Contract and are not intended to define or to limit the scope of any provision of this Contract. When context requires, singular nouns and pronouns include the plural and the masculine gender shall be deemed to include the feminine or neuter and the neuter gender to include the masculine and feminine. The words “include” and “including” whenever used herein shall be deemed to be followed by the ESG PSA CONTRACT 2021-2022 Page 23 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 words “without limitation”. 14.11 Compliance With All Applicable Laws and Regulations. Agency agrees to comply fully with all applicable laws and regulations that are currently in effect or that are hereafter amended during the performance of this Contract. Those laws include, but are not limited to: ESG Regulations found in 24 CFR Part 576 SubtitleB of Title IV of the McKinney-Vento Homeless Assistance Act, as amended, (42 USC 11371) Title VI of the Civil Rights Act of 1964 (42 U.S.C. Sections 2000d et seq.) including provisions requiring recipients of federal assistance to ensure meaningful access by persons of limited English proficiency The Fair Housing Act, Title VIII of the Civil Rights Act of 1968 (42 U.S.C. Sections 3601 et seq.) Executive Orders 11063, 11246 as amended by 11375 and 12086 and as supplemented by Department of Labor regulations 41 CFR Part 60 The Age Discrimination in Employment Act of 1967 The Age Discrimination Act of 1975 (42 U.S.C. Sections 6101 et seq.) The Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (42 U.S.C. Sections 4601 et seq. and 49 CFR Part 24) (“URA”) Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. Sections 794 et seq.) and 24 CFR Part 8 where applicable National Environmental Policy Act of 1969, as amended, 42 U.S.C. Sections 4321 et seq. (“NEPA”) and the related authorities listed in 24 CFR Part 58. The Clean Air Act, as amended, (42 U.S.C. Sections 1251 et seq.) and the Clean Water Act of 1977, as amended (33 U.S.C. Sections 1251 et seq.) and the related 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. Immigration Reform and Control Act of 1986 (8 U.S.C. Sections 1101 et seq.) specifically including the provisions requiring employer verifications of legal status of its employees The Americans with Disabilities Act of 1990 (42 U.S.C. Sections 12101 et seq.), the Architectural Barriers Act of 1968 as amended (42 U.S.C. Sections 4151 et seq.) and the Uniform Federal Accessibility Standards, 24 CFR Part 40, Appendix A Regulations at 24 CFR Part 87 related to lobbying, including the requirement that certifications and disclosures be obtained from all covered persons Drug Free Workplace Act of 1988 (41 U.S.C. Sections 701 et seq.) and 24 CFR Part 23, Subpart F Executive Order 12549 and 24 CFR Part 5.105(c) pertaining to restrictions on participation by ineligible, debarred or suspended persons or entities Section 6002 of the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act Guidelines of the Environmental Protection Agency at 40 CFR Part 247 For contracts and subgrants for construction or repair, Copeland “Anti-Kickback” act ESG PSA CONTRACT 2021-2022 Page 24 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 (18 U.S.C. 874) as supplemented in 29 CFR Part 5 For construction contracts awarded by Agency in excess of $2,000, and in excess of $2,500 for other contracts which involve the employment of mechanics or laborers, Sections 103 and 107 of the Contract Work Hours and Safety Standards Act (40 U.S.C. 327A 300) as supplemented by 29 CFR Part 5 Lead-Based Paint Poisoning Prevention Act (42 U.S.C. 4801 et seq.), as amended by the Residential Lead-Based Paint Hazard Reduction Act of 1992 (42 U.S.C. 4851 et seq.) and implementing regulations at 24 CFR Part 35, subparts A, B, M, and R Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, 2 CFR Part 200 et seq. Federal Funding Accountability and Transparency Act of 2006 (“FFATA”) (Pub.L. 109-282, as amended by Section 6205(a) of Pub.L. 110-252 and Section 3 of Pub.L. 113-101) Federal Whistleblower Regulations, as contained in 10 U.S.C. 2409, 41 U.S.C. 4712, 10 U.S.C. 2324, 41 U.S.C. 4304 and 41 U.S.C. 4310. 14.12 HUD-Assisted Projects and Employment and other Economic Opportunities; Section 3 Requirements. 14.13 Prohibition Against Discrimination. 14.13.1 General Statement. Agency shall comply in the execution, performance or attempted performance of this Contract, with all non-discrimination requirements of 24 CFR Part 5 as modified by 24 CFR Part 576.57(a) and Chapter 17, Article III, Division 4 – Fair Housing of the City Code. Agency may not discriminate against any person because of race, color, sex, gender, religion, national origin, familial status, disability or perceived disability, sexual orientation, gender identity, gender expression, or transgender, nor will Agency permit its officers, members, agents, employees, or clients to engage in such discrimination. This Contract is made and entered into with reference specifically to Chapter 17, Article III, Division 3 - Employment Practices of the City Code, and Agency hereby covenants and agrees that Agency, its officers, members, agents, employees and contractors, have fully complied with all provisions of same and that no employee, or applicant for employment has been discriminated against under the terms of such ordinances by either or its officers, members, agents, employees or contractors. 14.13.2 No Discrimination in Employment during the Performance of This Contract. During the performance of this Contract Agency agrees to the following provision, and will require that its contractors and subcontractors also comply with such provision by including it in all contracts with its contractors: [Contractor’s, Subcontractor’s or Vendor’s name] will not unlawfully discriminate against any employee or applicants for employment because of race, color, sex, gender, religion, national origin, familial status, disability or perceived disability, sexual orientation, gender identity, gender expression or transgender. [Contractor’s, Subcontractor’s or Vendor’s name] will take affirmative action to ensure that applicants are hired without regard to race, color, sex, gender, religion, ESG PSA CONTRACT 2021-2022 Page 25 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 national origin, familial status, disability or perceived disability, sexual orientation, gender identity, gender expression or transgender and that employees are treated fairly during employment without regard to their race, color, sex, gender, religion, national origin, familial status, disability or perceived disability, sexual orientation, gender identity, gender expression or transgender. Such action shall include, but not be limited to, the following: employment, upgrading, demotion or transfer, recruitment or recruitment advertising, layoff or termination, rates of pay or other forms of compensation, and selection for training, including apprenticeship. [Contractor’s, Subcontractor’s or Vendor’s name] agrees to post in conspicuous places, available to employees and applicants for employment, notices setting forth the provisions of this nondiscrimination clause. [Contractor’s Subcontractor’s or Vendor’s name] will, in all solicitations or advertisements for employees placed by or on behalf of [Contractor’s, Subcontractor’s or Vendor’s name], state that all qualified applicants will receive consideration for employment without regard to race, color, sex, gender, religion, national origin, familial status, disability or perceived disability, sexual orientation, gender identity, gender expression or transgender. [Contractor’s, Subcontractor’s or Vendor’s name] covenants that neither it nor any of its officers, members, agents, employees, or contractors, 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 or because of any disability or perceived disability, except on the basis of a bona fide occupational qualification, retirement plan or statutory requirement. [Contractor’s, Subcontractor’s or Vendor’s name] further covenants that neither it nor its officers, members, agents, employees, contractors, 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. 14.13.3 Agency’s Contractors and the ADA. In accordance with the provisions of the Americans With Disabilities Act of 1990 (“ADA”), Agency warrants that it and any of its contractors will not unlawfully discriminate on the basis of disability in the provision of services to the general public, nor in the availability, terms and/or conditions of employment for applicants for employment with, or employees of, Agency or any of its contractors. AGENCY WARRANTS IT WILL FULLY COMPLY WITH THE ADA’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, CONTRACTORS SUBCONTRACTORS, VENDORS OR AGENTS AGAINST CITY ARISING OUT OF AGENCY’S AND/OR ITS CONTRACTORS’, SUBCONTRACTORS’, VENDORS’ OR AGENTS’ OR THEIR RESPECTIVE EMPLOYEES’ ALLEGED FAILURE TO COMPLY WITH THE ABOVE-REFERENCED LAWS CONCERNING DISABILITY DISCRIMINATION IN THE PERFORMANCE OF THIS CONTRACT. 14.14. Conflicts of Interest and Violations of Criminal Law. ESG PSA CONTRACT 2021-2022 Page 26 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 14.14.1 Agency Safeguards. Agency shall establish safeguards to prohibit its employees, board members, advisors and agents from using positions for a purpose that is or gives the appearance of being motivated by a desire for private gain for themselves or others, particularly those with whom they have family, business or other ties. Agency shall disclose to City any such conflict of interest or potential conflict of interest, immediately upon discovery of such. 14.14.2 General Prohibition Against Conflicts of Interest. No employees, agents, consultants, officers or elected officials or appointed officials of City or of Agency who exercise or have exercised any functions or responsibilities with respect to activities assisted with ESG funds or who are in a position to participate in a decision-making process or gain inside information with regard to these activities may utilize ESG services, may obtain a financial interest or benefit from a ESG-assisted activity, or have an interest in any contract, subcontract or agreement with respect thereto, or the proceeds thereunder, either for themselves or those with whom they have family or business ties, during their tenure or for 1 year thereafter.. 14.14.2.1 Agency shall establish conflict of interest policies for federal awards including the ESG Funds and shall disclose in writing potential conflicts of interest to City as authorized by 2 CFR Part 200.112. 14.14.2.2 Agency shall comply with HUD requirements regarding organizational conflicts of interest in provision of shelter, housing, prevention and related services as more particularly described in 24 CFR Part 576.404. 14.14.3 Conflicts of Interest Involving Procurement. The conflict of interest provisions of 2 CFR Part 200.318 , shall apply in the procurement of property and services by Agency. In all cases not governed by those Sections, the provisions of 24 CFR Part 576.57(d) of the ESG Regulations shall apply. 14.14.3.1 As more particularly described in 2 CFR Part 200.318, Agency shall maintain and submit to City written standards of conduct covering conflicts of interest and governing the performance of its employees engaged in the selection, award, and administration of contracts. No employee, officer, or agent may participate in the selection, award, or administration of a contract supported by a federal award if he or she has a real or apparent conflict of interest. The standards of conduct must provide for disciplinary actions to be applied for violations of such standards by officers, employees, or agents of Agency. 14.14.3.2 The officers, employees, and agents of Agency shall neither solicit nor accept gratuities, favors, or anything of monetary value from contractors or parties to subcontracts. 14.14.3.3 Notwithstanding the prohibition contained in Section 14.14.3.2, ESG PSA CONTRACT 2021-2022 Page 27 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 Agency may set standards of conduct for situations in which the financial interest is not substantial or the gift is an unsolicited item of nominal value. Such standards of conduct must provide for disciplinary actions to be applied for violations of such standards by Agency’s officers, employees or agents. 14.14.3.4 Agency shall maintain written standards of conduct covering organizational conflicts of interest. Organizational conflicts of interest means that because of relationships with a parent company, affiliate, or subsidiary organization, Agency is unable or appears to be unable to be impartial in conducting a procurement action involving a related organization. 14.14.3.5 Agency must maintain records sufficient to detail the history of procurement. These records will include, but are not necessarily limited to the following: rationale for the method of procurement, selection of contract type, contractor selection or rejection, and the basis for the contract price. 14.14.4 Disclosure of Conflicts of Interest. In compliance with 2 CFR Part 200.112, Agency is required to timely disclose to City in writing any potential conflict of interest. 14.14.5 Disclosure of Texas Penal Code Violations. Agency affirms that it will adhere to the provisions of the Texas Penal Code which prohibit bribery and gifts to public servants. 14.14.6 Disclosure of Federal Criminal Law Violations. In compliance with 2 CFR Part 200.113, Agency is required to timely disclose to City all violations of federal criminal law involving fraud, bribery or gratuity violations potentially affecting the Agency. 14.15 Subcontracting with Small and Minority Firms, Women’s Business Enterprises and Labor Surplus Areas. 14.15.1 For procurement contracts $50,000.00 or larger that are paid for, in part or in full, with ESG Funds, Agency agrees to abide by City’s policy to involve Minority Business Enterprises and Small Business Enterprises and to provide them 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. Agency agrees to incorporate the City’s BDE Ordinance, and all amendments or successor policies or ordinances thereto, into all contracts and subcontracts for procurement larger than $50,000.00 or larger that are paid for, in part or in full, with the ESG Funds and will further require all persons or entities with which it so contracts to comply with said ordinance. 14.15.2 It is national policy to award a fair share of contracts to disadvantaged business enterprises (“DBEs”), small business enterprises (“SBEs”), minority business enterprises ESG PSA CONTRACT 2021-2022 Page 28 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 (“MBEs”), and women’s business enterprises (“WBEs”). Accordingly, affirmative steps must be taken to assure that DBEs, SBEs, MBEs, and WBEs are utilized when possible as sources of supplies, equipment, construction and services. 14.15.2.1 In order to comply with federal reporting requirements, Agency must submit the form attached hereto as EXHIBIT “L” – MBE Reporting Form for each contract or subcontract with a value of $10,000.00 or more paid or to be paid with the ESG Funds. Agency shall submit this form by the date specified in EXHIBIT “L” – MBE Reporting Form. 14.16 Other Laws. The failure to list any federal, state or City ordinance, law or regulation that is applicable to Agency does not excuse or relieve Agency from the requirements or responsibilities in regard to following the law, nor from the consequences or penalties for Agency’s failure to follow the law, if applicable. 14.17 Assignment. Agency shall not assign all or any part of its rights, privileges, or duties under this Contract without the prior written approval of City. Any attempted assignment of same without approval shall be void, and shall constitute a breach of this Contract. 14.18. Right to Inspect Agency Contracts. It is agreed that City has the right to inspect and approve in writing any proposed contracts between Agency and any contractor or vendor engaged in any activity in conjunction with this ESG-funded Program prior to any charges being incurred. 14.19 Force Majeure If Agency becomes unable, either in whole or part, to fulfill its obligations under this Contract due to acts of God, strikes, lockouts, or other industrial disturbances, acts of public enemies, wars, blockades, insurrections, riots, epidemics, pandemics, earthquakes, fires, floods, restraints or prohibitions by any court, board, department, commission or agency of the United States or of any States, civil disturbances, or explosions, or some other reason beyond Agency’s control (collectively, “Force Majeure Event”), the obligations so affected by such Force Majeure Event will be suspended only during the continuance of such event. Agency will give City written notice of the existence, extent and nature of the Force Majeure Event as soon as reasonably possible after the occurrence of the event. Failure to give notice will result in the continuance of Agency’s obligation regardless of the extent of any existing Force Majeure Event. Agency will use commercially reasonable efforts to remedy its inability to perform as soon as possible. 14.20 IMMIGRATION NATIONALITY ACT. Agency shall verify the identity and employment eligibility of its employees who perform work under this Contract, including completing the Employment Eligibility Verification Form (I- 9). Upon request by City, Agency shall provide City with copies of all I-9 forms and supporting ESG PSA CONTRACT 2021-2022 Page 29 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 eligibility documentation for each employee who performs work under this Contract. Agency shall adhere to all Federal and State laws as well as establish appropriate procedures and controls so that no services will be performed by any Agency employee who is not legally eligible to perform such services. AGENCY SHALL INDEMNIFY CITY AND HOLD CITY HARMLESS FROM ANY PENALTIES, LIABILITIES, OR LOSSES DUE TO VIOLATIONS OF THIS PARAGRAPH BY AGENCY, AGENCY’S EMPLOYEES, SUBCONTRACTORS, AGENTS, OR LICENSEES. City, upon written notice to Agency, shall have the right to immediately terminate this Contract for violations of this provision by Agency. 15.INDEMNIFICATION AND RELEASE. AGENCY 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 KIND 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 AGENCY 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 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. AGENCY 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 AGENCY, ITS OFFICERS, MEMBERS, AGENTS, EMPLOYEES, CONTRACTORS, SUBCONTRACTORS, INVITEES, LICENSEES, OR CLIENTS, OR CAUSED, IN WHOLE OR IN PART, BY ALLEGED NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS OR SUBCONTRACTORS OF CITY. IT IS THE EXPRESS INTENTION OF THE PARTIES, BOTH AGENCY AND CITY, THAT THE INDEMNITY PROVIDED FOR THIS SECTION INCLUDES INDEMNITY BY AGENCY TO INDEMNIFY AND PROTECT CITY FROM THE CONSEQUENCES OF CITY’S OWN NEGLIGENCE, WHETHER THAT NEGLIGENCE ESG PSA CONTRACT 2021-2022 Page 30 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 IS ALLEGED TO BE THE SOLE OR CONCURRING CAUSE OF THE INJURY, DAMAGE OR DEATH. AGENCY 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 CITY’S SOLE OR CONCURRENT NEGLIGENCE. AGENCY SHALL REQUIRE ALL OF ITS CONTRACTORS AND SUBCONTRACTORS TO INCLUDE IN THEIR CONTRACTS AND SUBCONTRACTS A RELEASE AND INDEMNITY IN FAVOR OF CITY IN SUBSTANTIALLY THE SAME FORM AS ABOVE. 16.WAIVER OF IMMUNITY BY AGENCY. If Agency, as a charitable or nonprofit organization, has or claims an immunity or exemption (statutory or otherwise) from and against liability for damages or injury, including death, to persons or property, Agency 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. 17.INSURANCE AND BONDING. Agency will maintain coverage in the form of insurance or bond in the amount of $177,000.00 to insure against loss from the fraud, theft or dishonesty of any of Agency’s officers, agents, trustees, directors or employees. The proceeds of such insurance or bond shall be used to reimburse City for any and all loss of ESG Funds occasioned by such misconduct. To effectuate such reimbursement, such fidelity coverage shall include a rider stating that reimbursement for any loss or losses shall name the City as a Loss Payee. Agency shall furnish to City in a timely manner, but not later than the Effective Date, certificates of insurance as proof that it has secured and paid for policies of commercial insurance as specified herein. If City has not received such certificates by the Effective Date, Agency shall be in default of the Contract and City may, at its option, terminate the Contract. Such insurance shall cover all insurable risks incident to or in connection with the execution, performance, attempted performance or nonperformance of this Contract. Agency shall maintain the following insurance coverage and limits: Commercial General Liability (CGL) Insurance $ 500,000 each occurrence $1,000,000 aggregate limit Non-Profit Organization Liability or Directors & Officers Liability $1,000,000 Each Occurrence $1,000,000 Annual Aggregate Limit ESG PSA CONTRACT 2021-2022 Page 31 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 Business Automobile Liability Insurance $1,000,000 each accident on a combined single-limit basis, or $ 250,000 Property Damage $ 500,000 Bodily Injury per person per occurrence $2,000,000 Aggregate Insurance policy shall be endorsed to cover “Any Auto”, defined as autos owned, hired, and non-owned. Pending availability of the above coverage and at the discretion of City, the policy shall be the primary responding insurance policy versus a personal auto insurance policy if or when in the course of Agency’s business as contracted herein. Workers’ Compensation Insurance Part A: Statutory Limits Part B: Employer’s Liability $100,000 each accident $100,000 disease-each employee $500,000 disease-policy limit Note: Such insurance shall cover employees performing work on any and all projects including but not limited to construction, demolition, and rehabilitation. Agency or its contractors shall maintain coverages, if applicable. In the event the respective contractors do not maintain coverage, Agency shall maintain the coverage on such contractor, if applicable, for each applicable contract. Additional Requirements Such insurance amounts shall be revised upward at City’s reasonable option and no more frequently than once every 12 months, and Agency shall revise such amounts within 30 days following notice to Contractor of such requirements. Agency will submit to City documentation that it has obtained insurance coverage and has executed bonds as required in this Contract prior to payment of any monies provided hereunder. Where applicable, insurance policies required herein shall be endorsed to include City as an additional insured as its interest may appear. Additional insured parties shall include employees, officers, agents, and volunteers of City. Any failure on part of 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 Agency’s 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 do business in the state of Texas. Insurers shall be acceptable to City insofar as their financial strength and solvency and ESG PSA CONTRACT 2021-2022 Page 32 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 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 otherwise approved by City. Deductible limits on insurance policies shall not exceed $5,000 per occurrence unless otherwise approved by City. In the event there are any local, federal or other regulatory insurance or bonding requirements for the Program, and such requirements exceed those specified herein, the former shall prevail. Agency shall require its contractors to maintain applicable insurance coverages, limits, and other requirements as those specified herein; and Agency shall require its contractors to provide Agency with certificate(s) of insurance documenting such coverage. Also, Agency shall require its contractors to have City and Agency endorsed as additional insureds (as their interest may appear) on their respective insurance policies. Directors and Officers Liability coverage shall be in force and may be provided on a claims-made basis. This coverage may also be referred to as Management Liability, and shall protect the insured against claims arising out of alleged errors in judgment, breaches of duty and wrongful acts arising out of their organizational duties. Coverage shall protect not only the entity, but all past, present and future directors, officers, trustees, employees, volunteers and committee members. Notwithstanding any provision in this Contract to the contrary, when applicable, Agency shall comply with the requirements of 2 CFR 200.310 and shall, at a minimum, provide the equivalent insurance coverage for real property and equipment acquired or improved with ESG Funds as provided to property owned by Agency. 18.CERTIFICATION REGARDING LOBBYING. The undersigned representative of Agency hereby certifies, to the 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 Agency, 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 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. If any funds other than federally 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, member of Congress in connection with this federal contract, grant, loan or cooperative agreement, Agency shall complete and submit Standard Form-LLL, “Disclosure Form to Report Lobbying,” in accordance with its instructions. 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 ESG PSA CONTRACT 2021-2022 Page 33 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 making or entering into this Contract imposed by 31 U.S.C. 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. Agency shall require that the language of this certification be included in all subcontracts or agreements involving the expenditure of federal funds. 19.LITIGATION AND CLAIMS. Agency shall give City immediate notice in writing of any action, including any proceeding before an administrative agency, filed against Agency in conjunction with this Contract or the Program. Agency shall furnish immediately to City copies of all pertinent papers received by Agency with respect to such action or claim. Agency shall provide a notice to City within 10 days upon filing under any bankruptcy or financial insolvency provision of law. 20.NOTICE. All notices required or permitted by this Contract must be in writing and are deemed delivered on the earlier date of the date actually received or the third day following deposit in a United States Postal Service post office or receptacle; with proper postage, certified mail return receipt requested; and addressed to the other Party at the address set out below or at such other address as the receiving Party designates by proper notice to the sending Party. City: City Attorney’s Office 200 Texas Street Fort Worth, TX 76102 Telephone: 817-392-7600 Copy to: Neighborhood Services Department 200 Texas Street Fort Worth, TX 76102 Attention: Director Telephone: 817-392-7540 Copy to: Neighborhood Services Department 200 Texas Street Fort Worth, TX 76102 Attention: Contract Administrator Telephone: 817-392-8550 Agency: Toby Owen Lighthouse for the Homeless, dba True Worth Place ESG PSA CONTRACT 2021-2022 Page 34 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 2400 Cypress Fort Worth, Texas 76102 Telephone: 817-632-7402 21.AGENCY HAS LEGAL AUTHORITY TO ENTER INTO CONTRACT. Agency 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. 22.COUNTERPARTS. This Contract may be executed in multiple counterparts, each of which shall be considered an original, but all of which shall constitute one instrument which may be sufficiently evidenced by one counterpart. 23.PROGRAM INCOME Parties agree that no program income as defined by HUD shall be earned as a result of this contract. 24.PROHIBITION ON CONTRACTING WITH COMPANIES THAT BOYCOTT ISRAEL If Agency has less than ten employees, this contract is for less than $100,000, or Agency does not meet the definition of a “company” under the applicable section of the Texas Government Code, this provision shall not apply. Agency acknowledges that in accordance with Chapter 2270 of the Texas Government Code, the City is prohibited from entering into a contract with a company for goods or services unless the contract contains a written verification from the company that it: (1) does not boycott Israel; and (2) will not boycott Israel during the term of the contract. The terms “boycott Israel” and “company” shall have the meanings ascribed to those terms in Section 808.001 of the Texas Government Code. By signing this contract, Agency certifies that Agency’s signature provides written verification to the City that Agency: (1) does not boycott Israel; and (2) will not boycott Israel during the term of the contract. 25.PROHIBITION ON BOYCOTTING ENERGY COMPANIES Agency acknowledges that in accordance with Chapter 2274 of the Texas Government Code, as added by Acts 2021, 87th Leg., R.S., S.B. 13, § 2, the City is prohibited from entering into a contract for goods or services that has a value of $100,000 or more that is to be paid wholly or partly from public funds of the City with a company with 10 or more full-time employees unless the contract contains a written verification from the company that it: (1) does not boycott energy companies; and (2) will not boycott energy companies during the term of the contract. The terms “boycott energy company” and “company” have the meaning ascribed to those terms by Chapter 2274 of the Texas Government Code, as added by Acts 2021, 87th Leg., R.S., S.B. 13, § 2. To the extent that Chapter 2274 of the Government Code is applicable to this Agreement, by signing this ESG PSA CONTRACT 2021-2022 Page 35 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 Agreement, Agency certifies that Agency’s signature provides written verification to the City that Agency: (1) does not boycott energy companies; and (2) will not boycott energy companies during the term of this Agreement. 26.PROHIBITION ON DISCRIMINATION AGAINST FIREARM AND AMMUNITION INDUSTRIES Agency acknowledges that except as otherwise provided by Chapter 2274 of the Texas Government Code, as added by Acts 2021, 87th Leg., R.S., S.B. 19, § 1, the City is prohibited from entering into a contract for goods or services that has a value of $100,000 or more that is to be paid wholly or partly from public funds of the City with a company with 10 or more full-time employees unless the contract contains a written verification from the company that it: (1) does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association; and (2) will not discriminate during the term of the contract against a firearm entity or firearm trade association. The terms “discriminate,” “firearm entity” and “firearm trade association” have the meaning ascribed to those terms by Chapter 2274 of the Texas Government Code, as added by Acts 2021, 87th Leg., R.S., S.B. 19, § 1. To the extent that Chapter 2274 of the Government Code is applicable to this Agreement, by signing this Agreement, Agency certifies that Agency’s signature provides written verification to the City that Agency: (1) does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association; and (2) will not discriminate against a firearm entity or firearm trade association during the term of this Agreement. [SIGNATURES APPEAR ON NEXT PAGE] ESG PSA CONTRACT 2021-2022 Page 36 Lighthouse for the Homeless, dba True Worth Place REV. 8/30/2021 IN WITNESS WHEREOF, the Parties hereto have executed 1 original of this Contract in Fort Worth, Tarrant County, Texas. ATTEST: CITY OF FORT WORTH _________________________________ By: _____________________________________ Acting City Secretary Fernando Costa, Assistant City Manager M&C: 21-0522 1295 Certification No. 2021-724908 Date: 8/3/2021 RECOMMENDED BY: _____________________________ Victor Turner, Neighborhood Services Director APPROVED AS TO FORM AND LEGALITY: _________________________________ Taylor Paris, 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 reporting requirements _________________________________________ Barbara Asbury Compliance and Planning Manager LIGHTHOUSE FOR THE HOMELESS, DBA TRUE WORTH PLACE By: _____________________________ Toby Owen, Chief Executive Officer Toby Owen (Nov 1, 2021 14:28 CDT) Toby Owen Barbara Asbury (Nov 2, 2021 12:08 CDT) Barbara Asbury Fernando Costa (Nov 2, 2021 17:06 CDT) ESG PSA CONTRACT 2021-2022 Lighthouse for the Homeless, dba True Worth Place Page 37 REV. 8/30/2021 EXHIBITS: EXHIBIT “A” – Program Summary EXHIBIT “A-1” – 2021 HUD Income Limits EXHIBIT “B” – Budget EXHIBIT “C” – Audit Certification Form EXHIBIT “D” – Reimbursement Forms EXHIBIT “E” – Form of Income Self-Certification EXHIBIT “F” – Standards for Complete Documentation EXHIBIT “G” – Section 3 Reporting Forms (NOT APPLICABLE) EXHIBIT “H” – Match Report EXHIBIT “I” – ESG Staff Certification Form EXHIBIT “J” - ESG Performance Standards EXHIBIT “J-1” – Written Standards for ESG Assistance EXHIBIT “K” – ESG Quarterly HMIS Report EXHIBIT “L” – MBE Reporting Form EXHIBIT “M” – Notice of Beneficiary Rights EXHIBIT “N” – Written Standards for Maintenance of Personally Identifying Information EXHIBIT “O” – Notice of Occupancy Rights Under VAWA EXHIBIT “P” – VAWA Emergency Transfer Request Form ESG PSA CONTRACT 2021-2022 ― EXHIBIT “A” ― PROGRAM SUMMARY Page 1 Lighthouse for the Homeless dba True Worth Place LIGHTHOUSE FOR THE HOMELESS DBA TRUE WORTH PLACE EXHIBIT “A” True Worth Place PROGRAM SUMMARY PROGRAM SUMMARY (ESG) October 1, 2021 to September 30, 2022 $177,000.00 PERIOD AMOUNT Capitalized terms not defined herein shall have meanings assigned them in the Contract. PROGRAM: The Program provides homeless persons access to daytime emergency shelter services, including basic personal facilities such as showers and laundry. Navigation services are also provided including linking clients to critical services and resources such as public benefits, housing, employment services, health and mental health care and substance abuse. ESG Funds will be used to pay for the salaries, FICA and Health Insurance of Program employees involved with daily operations of the facility. Agency office and Program services will be provided at 1513 E. Presidio St, Fort Worth, TX 76102, Monday through Sunday, 7:00 a.m. to 3:00 p.m.. REGULATORY CLASSIFICATION: Service Category (if more than one category, specify amount for each): ESG Emergency Shelter Component Regulatory Citation(s): 24 CFR 576.102 Agency will maintain documentation which verifies that 100% of the clients served are homeless based on current HUD definitions. PROGRAM GOALS: Minimum Number of Fort Worth Clients to be Served: The Program must serve a minimum of 4900 Unduplicated Clients from Fort Worth as shown by the monthly CAPER reports. EXHIBIT "A-1” 2021 HUD INCOME LIMITS AMI 1 person 2 persons 3 persons 4 persons 5 persons 6 persons 7 persons 8 persons 30% $17,000 $19,400 $21,850 $24,250 $26,200 $28,150 $30,100 $32,050 50% $28,300 $32,350 $36,400 $40,400 $43,650 $46,900 $50,100 $53,350 60% $33960 $38820 $43680 $48480 $52380 $56280 $60120 $64020 80% $45,300 $51,750 $58,200 $64,650 $69,850 $75,000 $80,200 $85,350 *Income limits are published at least annually by HUD. Effective 6/1/2021 Page 1 Account Grant Budget A B C Total ESSENTIAL SERVICES Salaries 1001 148,351.00$ 276,018.00$ 358,893.00$ 783,262.00$ FICA 1002 11,349.00$ 26,136.00$ 22,212.00$ 59,697.00$ Life/Disability Insurance 1003 -$ Health/Dental Insurance 1004 17,300.00$ 35,737.00$ 53,037.00$ Unemployment-State 1005 2,129.00$ 2,129.00$ Worker's Compensation 1006 16,590.00$ 16,590.00$ Office Supplies 1007 11,000.00$ 11,000.00$ Food Supplies 1008 -$ Insurance 1009 -$ Accounting 1010 3,000.00$ 3,000.00$ Contract Labor Security (City needs copy of contract before expenses can be reimbursed)1011 -$ Other()1012 4,400.00$ 4,400.00$ SHELTER OPERATIONS Maintenance 2001 40,000.00$ 40,000.00$ Security 2002 5,000.00$ 5,000.00$ Insurance 2003 52,470.00$ 52,470.00$ Utilities 2004 72,679.00$ 12,000.00$ 41,921.00$ 126,600.00$ Supplies 2005 55,000.00$ 55,000.00$ Repairs 2006 -$ Other(meals)2007 21,500.00$ 21,500.00$ SUBTOTAL EMERGENCY SHELTER 177,000.00$ 374,833.00$ 12,000.00$ 669,852.00$ 1,233,685.00$ PREVENTION Salaries 3001 -$ FICA 3002 -$ Life/Disability Insurance 3003 -$ Health/Dental Insurance 3004 -$ Unemployment-State 3005 -$ Worker's Compensation 3006 -$ Other()3007 -$ REHOUSING Salaries 4001 FICA 4002 Life/Disability Insurance 4003 Health/Dental Insurance 4004 Unemployment-State 4005 Worker's Compensation 4006 HRA 4007 Retirement 4008 Parking 4009 Mileage 4010 Rental Asistance/Security Deposits Utility Deposits/Payments Other: (Program supplies and admin): Food; postage; telephone/network/internet; occupancy; mileage; training and professional development; other direct client and supportive services; equipment rental/non-cap; indirect Other (Fringe Benefits): Employee prescreening 4011 SUBTOTAL HR&S -$ PREVENTION Rental Assistance 5001 Utility Payments 5002 REHOUSING Rental Assistance 6001 .40,000.00$ 40,000.00$ Security Deposits 6002 Utility Deposits 6003 Utility Payments 6004 Moving Costs 6005 26,000.00$ 26,000.00$ Motel/Hotel Vouchers 6006 SUBTOTAL FINANCIAL ASSISTANCE -$ 66,000.00$ -$ 66,000.00$ HMIS Software Costs 7001 SUBTOTAL HMIS BUDGET TOTAL 177,000.00$ 374,833.00$ 78,000.00$ 669,852.00$ 1,299,685.00$ FUNDING A:CARES FUNDING B:Tarrant ESG, TCHC FUNDING C:Donations HOMELESS MANAGEMENT INFORMATION SYSTEM (HMIS) FINANCIAL ASSISTANCE EXHIBIT "B" - BUDGET EMERGENCY SHELTER HOUSING RELOCATION AND STABILIZATION ESG PSA CONTRACT 2021-2022 - EXHIBIT "B" - BUDGET Lighthouse for the Homeless, dba TWP Page 2 Annual Salary Est. Percent to Grant Amount to Grant $ 111,749.82 50% $ 55,875.00 $ 42,436.00 50% $ 21,218.00 $ 35,360.00 83% $ 29,190.00 $ 21,840.00 83% $ 18,029.00 $ 29,120.00 83% $ 24,039.00 $- 240,505.82$ 62%148,351.00$ Percent of Payroll Amount Est. Percent to Grant Amount to Grant FICA 7.65%18,398.70$ 62%11,349.00$ Health/Dental Insurance 17,300.00$ 100%17,300.00$ TOTAL 35,698.70$ 80.3%28,649.00$ Total Budget Est. Percent to Grant Amount to Grant Total Budget Est. Percent to Grant Amount to Grant TOTAL MISCELLANEOUS Insurance Accounting Contract Labor (Security) Other() TOTAL SHELTER OPERATIONS The following tables were created for the purpose of preparing,negotiating,and determining the cost reasonableness and cost allocation method used by the Agency for the line item budget represented on the first page of this EXHIBIT “B” –Budget. The information reflected in the tables is to be considered part of the terms and conditions of the Contract. Agency must have prior written approval by the City to make changes to any line item in the Budget as outlined in Section 5.2.2 in the Contract. The deadline to make changes to EXHIBIT “B” – Budget is June, 1, 2022. SALARY DETAIL Position Title TOTAL FRINGE DETAIL SUPPLIES AND SERVICES VP of Operations Facilities Care Specialist Donation Warehouse Manager Facilities Caretaker Facilities Care Specialist ESG PSA CONTRACT 2021-2022 - EXHIBIT "B" - BUDGET Lighthouse for the Homeless, dba True Worth Place Page 3 Total Budget Est. Percent to Grant Amount to Grant #DIV/0! -$ #DIV/0!-$ Total Budget Est. Percent to Grant Amount to Grant -$ Total Budget Est. Percent to Grant Amount to Grant TOTAL Moving Costs Motel/Hotel Vouchers TOTAL HMIS HMIS Software Costs Utility Deposits Insurance Utilities Supplies Repairs Other(Meals) TOTAL FINANCIAL ASSISTANCE Rental Assistance Security Deposits Utility Payments Security Maintenance 1 ESG PSA CONTRACT – EXHIBIT “C” ― AUDIT CERTIFICATION FORM -- Lighthouse for the Homeless, dba TWP EXHIBIT “C” AUDIT CERTIFICATION FORM AUDIT CERTIFICATION FORM AND AUDIT REQUIREMENTS Agency: LIGHTHOUSE FOR THE HOMELESS, DBA TRUE WORTH PLACE Fiscal Year Ending: September 30, 2022 ✓During the fiscal year in which funds will be received, we will exceed the federal expenditure threshold of $750,000. We will have our Single Audit or Program Specific Audit completed and will submit the audit report described in 2 CFR Part 200 within 7 months after the end of the audited fiscal year or 30 days within its completion, whichever is the earlier date. D During the fiscal year in which funds will be received, we will not exceed the $750,000 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 MUST be filled out if Single Audit or Program Audit is NOT required. Fe,deral Gran tor •, Pass Through Program Name & Contract Expenditures Grantor CFDA Number Number Total Federal Expenditures for this Fiscal Year: 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 2 CFR Part 200, as applicable, by the required due date may result in suspension of funding and may affect eligibility for future funding. Notwithstanding the above, this certification acknowledges the age ncy's commitment to meet all other financial reporting, financial statements, and other audit requirements as may be set forth in the Contract. ESG PSA CONTRACT 2021-2022- EXHIBIT "C" -AUDIT CERTIFICATION - LIGHTHOUSE FOR THE HOMELESS, DBA TWP 2 ESG PSA CONTRACT ― EXHIBIT “D” ― REPORTING FORMS Page 1 EXHIBIT “D” REPORTING FORMS ESG PSA CONTRACT ― EXHIBIT “D” ― REPORTING FORMS Page 2 ATTACHMENT I Invoice Agency: Address: City, State, Zip: Program: Period of Service: Tax ID No. P.O. No. FID No. This Invoice Cumulative to Date Attachment I INVOICE AmountProgram ESG PSA CONTRACT ― EXHIBIT “D” ― REPORTING FORMS Page 3 ATTACHMENT II Expenditure Worksheet Agency: Program: Only highlighted codes can be reimbursed Please group like account codes. Line No.Check No.Date Payee Description/Job Title* Account Code (See Key to Right)Amount Expense Line Item Account 1 2 Salaries 1001 3 FICA 1002 4 Life/Disability Insurance 1003 5 Health/Dental Insurance 1004 6 Unemployment-State 1005 7 Worker’s Compensation 1006 8 Retirement 1007 9 10 Office/Program Supplies 2001 11 Postage 2002 12 Printing 2003 13 Other()2004 14 15 Contract Labor 3001 16 Food Supplies 3002 17 Teaching Aids 3003 18 Craft Supplies 3004 19 Field Trip Expenses 3005 20 Mileage 3006 21 Other()3007 22 Other()3008 23 24 Telephone 4001 25 Electric 4002 26 Gas 4003 27 Water and Wastewater 4004 28 Solid Waste Disposal 4005 29 Rent 4006 30 Cleaning Supplies 4007 31 Other()4008 32 33 Fidelity Bond or Equivalent 5001 34 Directors and Officers 5002 35 General Commercial Liability 5003 36 Other()5004 37 38 Other()6001 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Total $0.00 Expenditure Worksheet ATTACHMENT II City of Fort Worth Neighborhood Services Department *For Salaries, state employee's title under Description/Job Title. Rent must identify tenant FACILITY AND UTILITIES MISCELLANEOUS LEGAL, FINANCIAL, AND INSURANCE DIRECT ASSISTANCE PROGRAM PERSONNEL SUPPLIES AND SERVICES ESG PSA CONTRACT ― EXHIBIT “D” ― REPORTING FORMS Page 4 ATTACHMENT III Client Data Report Agency: Program: Month: 4900 0.00% *Do not revise the client goal unless the contract is amended, accordingly. 2 2A 3 4 5 10 <30%AMI 30%-50% AMI 51-80% AMI >80% AMI 1<$17,000 1<$28,300 1<$45,300 1>$45,300 2<$19,400 2<$32,350 2<$51,750 2>$51,750 3<$21,850 3<$36,400 3<$58,200 3>$58,200 4<$24,250 4<$40,400 4<$64,650 4>$64,650 5<$26,200 5<$43,650 5<$69,850 5>$69,850 6<$28,150 6<$46,900 6<$75,000 6>$75,000 7<$30,100 7<$50,100 7<$80,200 7>$80,200 8<$32,050 8<$53,350 8<$85,350 8>$85,350 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 ATTACHMENT III CLIENT DATA REPORT Lighthouse for the Homeless, dba True Worth Place True Worth Place Undup Clts for CURRENT MONTH * Please highlight new clients for the month. CUMULATIVE Unduplicated Clients *Proposed Client Goal Per Contract % of Milestone Met Instructions:This report is meant to list all unduplicated clients served during the Contract term (October 1, 2021 to September 30, 2022). Each month, please report the information of clients not previously reported. You are required to attach eligibility verification documentation for each new client. New unduplicated clients should be listed below any previously reported clients so that this sheet will act as a rolling tally. Please only list clients one time during the first month that they receive service. Clients that continue to receive Program services for multiple months only need to be listed one time. Put an "X" in each appropriate box regarding the client's sex, ethnicity, race, etc. Please note that reimbursement for salaries will require that the agency report to the City all the clients that were served by that particular staff person in that program. Information for each client listed below must have the demographic information reflected in columns 1 thru 12. 1 6 7 8 9 11 12 DATE CLIENT RECEIVED SERVICE FORT WORTH RESIDENT? YES OR NO SERVICE LOCATION (IF APPLICABLE) NAME STREET ADDRESS (Client Address) AGE GENDER (Indicate One) ETHNICITY (Indicate One) HH INCOME (Only choose 1 of the 4 columns) ASIAN BLACK OR AFRICAN AMERICAN NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER WHITE AMERICAN INDIAN OR ALASKAN NATIVE AND WHITE FHOH (Indicate One) MALE FEMALE HISPANIC NON- HISPANIC AMERICAN INDIAN OR ALASKAN NATIVE ASIAN AND WHITE RACE (Indicate One) DISABLED (Indicate One) HH SIZE YES NO BLACK OR AFRICAN AMERICAN AND WHITE AMERICAN INDIAN OR ALASKA NATIVE AND BLACK OR AFRICAN AMERICAN OTHER MULTIPLE RACE COMBINAT- IONS*YES NO 2 Agency: Address: City, State, Zip: Program: Period of Service: Tax ID No. This Invoice Cumulative to Date ESG-Match Program Amount MATCH Lighthouse for the Homeless dba True Worth Place PO Box 2645 Fort Worth, TX 76113 True Worth Place Agency: Program: Line No.Check No.Date Payee Description Funding Source 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 40 41 42 43 44 45 46 47 48 49 50 51 52 Total $0.00 Neighborhood Services Department MATCH Expenditure Worksheet Lighthouse for the Homeless, dba True Worth Place True Worth Place *Payroll must identify employee. Rent must identify tenant. Other payments should identify individuals, if applicable. ESG PSA CONTRACT -- EXHIBIT “E” -- INCOME CERTIFICATION FORM Page 1 EXHIBIT “E” INCOME CERTIFICATION FORMS ESG PSA CONTRACT -- EXHIBIT “E” -- INCOME CERTIFICATION FORM Page 2 City of Fort Worth CERTIFICATION OF INCOME STATEMENT Applicant Name: ____________________________________ Current Address: ____________ Phone #: City and Zip: _____________ Household Members and Income (including applicant) Last Name First Name Age Monthly Income $$ Source of Income TOTAL NUMBER OF FAMILY MEMBERS (Include Yourself, Spouse, Children, etc.) Total Gross Annual Household Income: ________ PERSONAL INFORMATION: (Check one in each item. This Information is Required for Federal Reporting Purposes) a. MALE b. WHITE BLACK/AFRICAN AMERICAN BLACK/AFRICAN AMERICAN & WHITE FEMALE AMERICAN INDIAN/ALASKAN NATIVE ASIAN AMERICAN INDIAN/ALASKAN NATIVE & WHITE ASIAN & WHITE NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER BALANCE/OTHER AMERICAN INDIAN/ALASKAN NATIVE & BLACK/AFRICAN AMERICAN c.ETHNICITY d.DISABLED e.IS HEAD OF HOUSEHOLD FEMALE? HISPANIC YES YES NON-HISPANIC NO NO Certification: I certify that the information I am providing is true and could be subject to verification at any time by a third party. I also acknowledge that the provision of false information could leave me subject to the penalties of Federal, State and local law. __________________ _____________ Signature of Applicant Date WARNING: TITLE 18, SECTION 1001 OF THE U.S. CODE STATES THAT A PERSON IS GUILTY OF A FELONY FOR KNOWINGLY AND WILLINGLY MAKING FALSE OR FRAUDULENT STATEMENTS TO ANY DEPARTMENT OF THE UNITED STATES GOVERNMENT. -----------------For use by Agency staff only----------------- Household Size: Gross Annual Income: Applicable Income Limit: Is Applicant Eligible? Check if Applicant refused to provide demographic information: Õ Staff Assessment of Demographics:____________________________________________________________ Person Making Determination: Date: NOTE: Address, income amounts and sources for ALL household members are required. Ciudad de Fort Worth ESG PSA CONTRACT -- EXHIBIT “E” -- INCOME CERTIFICATION FORM Page 3 CERTIFICACIÓN DE DECLARACIÓN DE INGRESOS Nombre del Solicitante: Dirección de Actualidad: Teléfono: Ciudad y Código Postal: ______ Miembros Del Hogar e Ingresos (Incluyendo el/la Solicitante) Apellido Nombre Edad Ingreso Mensual Origen de Ingresos *TOTAL NÚMERO DE MIEMBROS DEL HOGAR (Inclúyase Usted.) Total Anual de Ingresos del hogar: **INFORMACIÓN PERSONAL: (Seleccione uno en cada artículo. Esta información es requerida por el Gobierno federal.) a. MASCULINO b. BLANCO NEGRO/AFRICANO AMERICANO NEGRO/AFRICANO AMERICANO & BLANCO FEMININO INDIO AMERICANO/NATIVO DE ALASKA ASIATICO INDIO AMERICANO/NATIVO DE ALASKA & BLANCO ASIATICO & BLANCO NATIVO HAWAIANO/OTRO DE LAS ISLAS PACIFICAS BALANCE/OTRO INDIO AMERICANO / NATIVO DE ALASKA & NEGRO/AFRICANO AMERICANO c.ETHNICIDAD d.INCAPACITADO e. ¿ES LA CABEZA DEL HOGAR MUJER? HISPANO SI SI NO-HISPANO NO NO Certificación: Yo certifico que la información que yo estoy proporcionando es verdadera y puedo ser sujeto a verificación a cualquiera hora por tercera parte. Yo también reconozco que la provisión de información falsa puede dejarme sujeto a penalidades Federales, Estatales, y a ley local. Firma del Solicitante Fecha ADVERTENCIA: TITULO 18, SECCIÓN 1001 DEL CÓDIGO DE LOS ESTADOS UNIDOS INDICA QUE UNA PERSONA ES CULPABLE DE UN DELITO POR SABER Y VOLUNTARIAMENTE HACER DECLARACIONES FALSOS O FRAUDULENTAS A CUALQUIER DEPARTAMENTO DE GOBIERNO DE LOS ESTADOS UNIDOS. -----------------Para use de empleados de la agencia----------------- # De Miembros de Familia: Ingreso Anual: Límite de Ingreso: ¿Es solicitante elegible? : Compruebe si el solicitante se negó a dar su información personal: Õ Evaluación del empleado sobre información personal:____________________________________________ Persona haciendo la determinación: Fecha: Note: La dirección de la casa y los ingresos (y sus orígenes) para todos miembros del hogar son requeridos ESG PSA CONTRACT -- EXHIBIT “F” -- STANDARDS OF DOCUMENTATION Page 1 EXHIBIT “F” STANDARDS OF DOCUMENTATION InvoiceProof of Payment*TimesheetContract/AgreementSAM.gov SearchLeaseExplanation of how expense is related to ProgramNotes/Other Salaries X X * If an employee works on both a ESG eligible and non-ESG eligible program(s), the City will only reimburse for a reasonable portion of the employee's salary. Prior to the execution of the ESG Contract, the Agency will priovide the City with a written statement on how each employee's time will be allocated. If an employee works 100% of their time directly with the ESG-funded Program, then 100% of the employee's salary may be eligible for reimbursement. Agency must submit a written statement that 100% of the employee's time is spent working directly with the ESG-funded Program. Statements must be signed by a person authorized to sign on behalf of the Agency and will be submitted with the October invoice. Reimbursement requests must include a timesheet and work log that reflects the hours worked by the employee(s) working directly on the ESG-funded Program. For employees who are paid with multiple funding sources, timesheets must reflect all funding sources. If separate timesheets are kept for each funding source, all such timesheets must be submitted to City. Timesheets must be signed by employee and supervisor. Agency must show a calculation and documentation of how the employee's salary was calculated and invoiced to City. *If employees are paid by direct deposit rather than check, then the agency must submit both the direct deposit payment company's report (such as an ADT report) and a bank statement or check showing payment to the direct deposit company. FICA/Medicare X X X Life Insurance X X X Health Insurance X X X Disability Insurance X X X Unemployment Insurance X X X Retirement X X X If the City pays gross salary, this is already included. If the City pays the employer portion, the Agency must provide proof that the employee is enrolled in the benefit plan, must show a calculation and documentation of how the invoiced amount was calculated, and must provide documentation showing payment. Invoice and proof of payment are only required with the first reimbursement request and at any time there are changes to amounts, enrollments, disenrollments, etc. Office Supplies X X X Office Equipment Rental X X X X X Postage X X X Printing X X X Construction & Building Materials X X X X This category is only available for the REACH Program and Habitat for Humanity. Sport and Recreation Equipment X X X Cleaning Supplies X X X Teaching Aids X X X Craft Supplies X X X Food Supplies X X X This category is only available to the Program provided by Meals on Wheels. Telephone X X Gas X X Water/Wastew ater X X Electric X X Solid Waste X X 2021-22 Documentation Standards for ESG Public Service Contract Expenses Budget Line Items Employee Salaries and Benefits - City will only reimburse a percentage of any employee's salary and benefits who work directly with the ESG-funded Program. Percentages will be cost allocated and determined prior to the execution of the ESG Contract. Agencies requesting the reimbursement of 100% of any Agency employee will require prior City approval. Agencies must show calculation on how the ESG portion of employee salaries and benefits were calculated consistently with the ESG Contract. If the City pays gross salary, this is already included. If the City pays the employer portion, the Agency must provide proof that the employee is enrolled in the benefit plan, must show a calculation and documentation of how the invoiced amount was calculated, and must provide documentation showing payment. Invoice and proof of payment are only required with the first reimbursement request and at any time there are changes to amounts, enrollments, disenrollments, etc. Materials, Equipment, Goods and Supplies - City will only reimburse for the cost allocated percent or amount spent in support of the ESG-funded Program. Agencies requesting reimbursement for these items will require prior City approval. Agencies must show calculation on how the ESG portion of these expenses were calculated consistently with the ESG Contract. Rent, Utilities and Maintenance - City will only pay for a portion of these expenses. The portion of these expenses will be determined by the square footage attributable to the ESG-funded Program and shall be cost-allocated in accordance with the amount of space used for the ESG-funded Program. These expenses may only be in support of the ESG-funded Program. The items listed below require prior City approval and the Agency is required to identify any funding source that pays for the portion of the expenses that is not paid with ESG funds. Agencies must show calculation on how the ESG portion of these expenses were calculated consistently with the ESG Contract. ESG PSA CONTRACT 2021-22 Exhibit "F" -- STANDARDS FOR COMPLETE DOCUMENTATION 1 Facility Maintenance and Repairs X X X X This item requires approval by the City prior to the execution of the ESG Contract. Repairs may be categorized as major/minor rehabilitation projects and must be approved through the full HUD Environmetal Review. Rent X X X City will pay for a portion of the rent for the Program facility so long as its in proportion to the square footage attributable to the ESG- funded program. Contract Labor X X X X X This item requires prior approval by the City. Prior to the execution of the ESG Contract, the Agency must submit a written statement that lists the contract labor services to be used during the Contract term. Agency will submit a memo related to the procurement of such services and will forward any information pertaining to the procurement process to City. This requirement applies to, but is not limited to, services retained for security services, legal, accounting, transportation providers, educational facilitators, custodial services, etc. Agencies may not use the contract services of any City of Fort Worth Department. City-required Insurance X X City will only pay for a percentage of the City-required insurance so long as it's in proportion to the square footage attributable to the ESG-funded program. Childcare Scholarships X X City requires that the agency submit its fee schedule or formula on how the Agency calculates the childcare scholarship amount. The fee schedule/formula should demonstrate a breakout of income levels, and for each income level the schedule should demonstrate which portion of the expense is to be paid by the family and which portion of the expense is to be reimbursed by the City. A fee schedule/formula must be submitted to the City prior to the first payment. Agency must submit documentation supporting that the client is income eligible and that the household is being charged in conformance with the fee schedule. If the fee schedule/formula changes at any time during the contract term, the Agency must immediately notify City on the date the new fee schedule/formula takes into effect. "$0" Income Certifications Agecies that are required to verify and provide proof of household income to determine eligibility, must require that anyone who is over the age of 18, living in the housohold, submit a $0 Income Certification. Audit Services X X X X If an audit is required because federal funds exceed $750,000, then the cost should be split evenly by all grant funding sources. Agency must show calculation on how the ESG portion of the accounting services were calculated. For example, if the ESG grant is 10% of your Agency's budget, then invoice shall not exceed 10% of the overall cost. Agency must show a calculation and documentation of how the invoiced amount was calculated, and must provide documentation showing payment. Final as of 09/26/2017 DC Miscellaneous *Proof of payment effective October 1, 2013:Payments or Expenses must be documented in the following manner: A) Image of the check AND bank statement showing the check cleared the bank; OR, B) Image of the cancelled check (ex. At end of bank statement); OR, C) Payroll Check Stub, "Advice", or Statement AND Bank Statement indicating payroll; OR, D) For wire or e-transfers: Reciept or statement from payee/vendor OR bank statement. ESG PSA CONTRACT 2021-22 Exhibit "F" -- STANDARDS FOR COMPLETE DOCUMENTATION 1 ESG PSA CONTRACT 2021-22 -- EXHIBIT “G” -- SECTION 3 REPORTING FORMS Page 1 EXHIBIT “G” SECTION 3 REPORTING FORMS NOT APPLICABLE ESG PSA CONTRACT 2021-22 -- EXHIBIT “H” – MATCH REPORT 1 EXHIBIT "H" MATCH REPORT ESG PSA CONTRACT 2021-2022 -- EXHIBIT “H” – MATCH REPORT 2 CITY OF FORT WORTH NEIGHBORHOOD SERVICES DEPARTMENT EMERGENCY SOLUTIONS GRANT This attachment is designed to document proposed sources and to assess compliance with the required Emergency Shelter Grant (ESG) match portion at 24 CFR 576.51. ESG funds are matched dollar-for-dollar for each program year allocation. City of Fort Worth ESG Funds $ __________ Agency ESG Match $_________________ 1.SOURCES OF LOCAL MATCH: Other Federal (including pass-through funds, e.g., City CDBG, County FEMA, etc.) MATCH SOURCE MATCH AMOUNT $ $ TOTAL MATCH $ 2. STATE/LOCAL GOVERNMENT FUNDING: (e.g., State Housing Trust Funds, Local Assessment, etc.) MATCH SOURCE MATCH AMOUNT $ $ TOTAL MATCH $ 3. PRIVATE (including recipient) FUNDING: MATCH SOURCE MATCH $ AMOUNT Fund Raising/Cash $ Loans $ Building Value or Lease $ Donated Goods $ ESG PSA CONTRACT 2021-22 -- EXHIBIT “H” – MATCH REPORT 3 Donated Computers $ New Staff Salaries $ Volunteers ($5/hr) $ Volunteer Medical/Legal $ TOTAL MATCH $ Comments: 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, and if submitted by a non-profit agency, has been approved by the governing body of the organization prior to submission. The match funds identified in this report are not included as contribution for any other federally assisted project or program as required by 24 CFR 84.23 (a) (2) Date: __________ Submitted by: _______________________ Phone Number: ________ ESG PSA CONTRACT 2021-22 ― EXHIBIT “I” ― ESG STAFF CERTIFICATION FORM Page 1 EXHIBIT “I” ESG STAFF CERTIFICATION FORM ESG PSA CONTRACT 2021-22 ― EXHIBIT “I” ― ESG STAFF CERTIFICATION FORM Page 2 City of Fort Worth STAFF CERTIFICATION OF ELIGIBILITY FOR ESG FINANCIAL ASSISTANCE Instructions: In order for City to approve reimbursement for any client, agency must submit: (1) client documentation of income (source documentation or self- certification); (2) documentation of homelessness; (3) copy of lease; and (4) this completed form. (1) - (4) must be submitted upon initial reimbursement request for assistance for each client. HOMELESS PREVENTION ONLY: (1)-(4) upon agency request for reimbursement for the 4th month of rent for a client (excluding arrears). 1. General Information Head of Household Name: Age: Names of Other Household Members: Age: Age: Age: Age: Age: Household Income is less than 30% AMI? Yes No N/A (Rapid Rehousing Initial Evaluation Only) Client Lacks Resources/Support Networks? Yes No Type(s) of ESG Financial Assistance: Rent Rent Arrears Utility Deposit(s) Unit Address (must be in City of Fort Worth): 2. Other ESG Requirements Lease in agency file? Yes No Client receives NO other rental subsidy (ie. Housing Choice Voucher)? Yes No Rental Assistance Agreement between landlord and agency in agency file? Yes No Fair Market Rent (FMR) & Rent Reasonableness: Unit Number of Bedrooms: Area FMR Limit (as published by HUD): Unit Rent per lease: Unit meets Habitability Standards? Yes No Date of Inspection: 3. Lead-Safe Housing: Applicable when (1) providing ESG rental assistance for more than 3 months excluding arrears, (2) pre-1978 housing unit, AND (3) child under 6 in household. Not Applicable Number of Months Rental Assistance Provided (excluding arrears): Year Housing Unit Built: Visual Inspection Indicates Unit and Property Free of Deteriorated Paint? Yes No Name of Visual Assessor*: *For named, agency must have on file a certificate of completion of HUD’s Visual Assessment Course (http://www.hud.gov/offices/lead/training/visualassessment/h00100.cfm) Required certifications: Each person signing below certifies to the following: (1) To the best of my knowledge, the program participant named above meets all requirements to receive assistance under the Emergency Solutions Grant (ESG). (2) To the best of my knowledge and ability, all of the information used in making this eligibility determination is true and complete. (3) I am not related to the program participant through family, business or other personal ties. (4) To the best of my knowledge, neither I nor anyone related to me has received or will receive any financial benefit for this eligibility determination. (5) I understand that fraud is investigated by the Department of Housing and Urban Development, Office of Inspector General, and may be punished under Federal laws to include, but not limited to, 18 U.S.C. 1001 and 18 U.S.C. 641 (6) I understand that if any of these certifications is found to be false, I will be subject to criminal, civil and administrative penalties and sanctions. ESG Staff Signature:_________________________________ Date:______________________ ESG Supervisor Signature:____________________________ Date:______________________ 1 ESG PSA CONTRACT -- EXHIBIT “J” – ESG PERFORMANCE STANDARDS EXHIBIT “J” ESG PERFORMANCE STANDARDS Emergency Solutions Grant Performance Standards Activity Output/Outcome Measures Street Outreach Number of Persons: A.Total Unduplicated Served B.Total Unduplicated Engaged Of those receiving Case Management, Number of Persons: A.Those placed in temporary/transitional housing B.Those placed in permanent housing Emergency Shelter Operations Include: CDBG (Moving Home) Number of Persons: A.Total Unduplicated Served Of those receiving Case Management, Number of Persons: A.Those exiting Emergency Shelter to temporary or permanent housing destinations B.Those who have more non-cash benefits at exit C.Number of persons in shelter less than 60 days D.Number of persons in shelter greater than 60+ days E.Unduplicated number of adults with increase in Income Agency determines number _______ and % _____ in PY21-22 Homeless Prevention Number of Persons: A.Total Unduplicated Served Of those served, Number of Persons: A.Those able to maintain housing at exit B.Those who have more non-cash benefits at exit Agency determines number _______ and % _____ in PY21-22 Rapid Re- Housing Number of persons: A.Total Unduplicated Served Of those receiving, Number of Persons: A.Those who exited to permanent housing at exit B.Those who have more non-cash benefits at exit C.Those who have more case income at exit D.Number of persons served less than 60 days between project entry and move-in E.Number of persons served that spent greater than 60+ days between project entry and move-in Agency determines number _______ and % _____ in PY21-22 Coordinated Entry System A.100% of Rapid Re-Housing enrollments come from Coordinated Entry System B.90% of Coordinated Entry System referrals must be accepted by housing providers C.The average length of time between referral to lease up is less than 60 days Pulled From: Coordinated Entry System Reporting Metrics under development A.HMIS Report B.HMIS Report C.CAPER Q22c 2 ESG PSA CONTRACT-- EXHIBIT “J” – ESG PERFORMANCE STANDARDS In order to successfully record performance outcomes, the CoC system requires that once a household is enrolled in an ESG program, non-domestic violence agencies must complete an initial HUD Intake Assessment within the HMIS system (ETO), the HUD Mid-Program Assessment, and the HUD Exit Assessment upon program exit. Performance outcomes will be reported to the City using the HMIS generated ESG reports. Domestic Violence Organizations will provide the same data utilizing their similar data systems. Reassessments are required for program participants receiving homelessness prevention assistance and rapid re-housing assistance. Participants receiving homeless prevention must be reassessed quarterly; rapid re-housing participants must be reassessed at least yearly. All participants must receive an exit assessment and enter it into HMIS or a comparable-level database. ESG PSA CONTRACT EXHIBIT “J-1” ― Written Standards for ESG Assistance 1 EXHIBIT “J-1” Written Standards for ESG Assistance Individuals and families eligibility. Households receiving either emergency shelter or rapid re-housing assistance must meet HUD’s revised definition of homelessness. Households receiving homelessness prevention assistance must meet the definition of “at risk of homelessness”, have incomes at or below 30% AMI, and lack sufficient resources and support networks to retain housing. Eligible ESG-assisted individuals and households must reside in the City of Fort Worth. Individuals receiving rapid re-housing assistance must be housed to a unit located in the City of Fort Worth. Agencies will conduct initial evaluation of clients to determine program eligibility, and kind of assistance needed. Agencies will re- evaluate quarterly the assistance provided to homelessness prevention recipients, and yearly, to rapid re- housing clients. Re-evaluation will ascertain that: i) annual incomes do not exceed 30% AMI; ii) clients lack resources and support networks to retain housing without ESG assistance. Annual incomes are established per 24 CFR 5.609. All clients must receive an exit assessment that will then be entered into HMIS or comparable database. Coordination among emergency shelter, homelessness prevention, rapid re-housing, and other homeless assistance and housing providers. To receive ESG funds, an agency has to be an active member of the Continuum of Care (CoC). The CoC leads the coordination among agencies to assist the homeless and prevent homelessness. It also engages and coordinates resources to improve current programs and funding strategies. Determining and prioritizing homelessness prevention and rapid re-housing assistance. Rapid re-housing and homelessness prevention providers will determine prioritization among eligible clients. This should be based on a risk assessment. Prioritization should take into account: 1) families with children, and elderly and disabled persons who do not require permanent supportive housing; and 2) the share of rent and utilities costs that each client must pay, if any, while receiving homelessness prevention or rapid re-housing assistance. The City recommends that clients share in rent and utility costs, unless there are reasons for receiving 100% ESG-assistance. Duration of rental assistance. Per §576.103 and §576.104, agencies shall provide clients for no more than 24 months, during any 3-year period with short-term rental assistance, medium-term rental assistance, payment of rental arrears, or any combination thereof. Short-term rental assistance is limited to 3 months. Medium-term rental assistance extends over 3 months but not more than 24 months. Payment of rental arrears consists of a one-time payment for up to 6 months of rent in arrears, including any late fees on those arrears. Type, amount, and duration of housing stabilization and/or relocation assistance. Agencies will establish standards for the type, amount, and duration of housing stabilization and/or relocation services provided, acknowledging that services may not extend for more than 24 months within a 3-year period. Housing relocation and stabilization services include financial assistance (moving costs, rental application fees, security deposits, last month’s rent, utility deposits and utility payments), and services (housing search and placement, housing stability and case management, mediation, legal services, and credit repair.) The amount and type of assistance provided shall aim at clients becoming self-sufficient. The City shall have access to documentation that supports the amount and type of assistance provided. ESG PSA CONTRACT - EXHIBIT “K” – ESG QUARTERLY HMIS REPORT Page 1 EXHIBIT "K" ESG QUARTERLY HMIS REPORT City of Fort Worth Emergency Solutions Grant (ESG) Quarterly HMIS Report Prepared by: D.C. and C.A. Updated: 2/11/2015 Page 1 of 2 Homelessness Prevention Rapid Re- Housing Emergency Shelters Veterans Victims of Domestic Violence Elderly HIV/AIDS Chronically Homeless Severely Mentally Ill Chronic Substance Abuse (Drug, Alcohol)Other Disabilities (Physical, Developmental) Total Adults Children Don't Know/Refused/Other Missing Information Total Male Female Transgender Don't Know/Refused/Other Missing Information Total Persons Served Total Persons Served (Cumulative) Persons with Disabilities Total Persons Served This Quarter Special Populations Served-All Activities Reporting Period: From ___________________ To ___________________ This report is meant to collect data that is required for the HUD Consolidated Annual Performance and Evaluation Report (CAPER).This report is due each quarter, on January 15,April 15,July 15 and September 30 of each Contract year. Please fill out the report according to your Agency's accomplishments.If a particular activity does not apply to your Agency (for example,a shelter does not perform homeless prevention) please fill in all zeros for that particular column. This information should be collected from HMIS and the total number of persons should match comparable figures on the City's Attachment III Report.If this report does not match the City's Attachment III Report,the Agency may be required to resubmit the report and provide an explanation for the discrepancy. Number of Persons in Household Gender-All Activities Agency Name: ____________________________________ Contact Person: ____________________________________ Prepared by: D.C. and C.A. Updated: 8/31/2015 Page 2 of 2 Homelessness Prevention Rapid Re- Housing Emergency Shelters Total Persons Served Total Persons Served (Cumulative) Total Persons Served This Quarter Total Under 18 18-24 25 and over Don't Know/Refused/Other Missing Information Total Number of New Units - Rehabilitation Number of New Units - Conversion Total Number of Bed-Nights Available* Total Number of Bed-Nights Provided** Received Case Management Exited to transitional or permanent housing With higher cash income at exit With non-cash benefits at exit Exited to or maintained permanent housing at exit Did not enter CoC Shelter or Transitional Housing during remainder of ESG year ** The number of beds that were filled each night. Count all emergency shelter beds, whether or not they are ESG-funded. *The total number of beds that are available in a year. For example,if they are all year-round beds,it would be 365 multiplied by the number of emergency shelter beds;if some are seasonal as well (e.g., only winter) then add in the number of nights each bed is available. Count all emergency shelter beds, whether or not they are ESG-funded. Performance Standards Age-All Activities Shelter Utilization ESG PSA CONTRACT -- EXHIBIT “L” -- MBE REPORTING FORM Page 1 EXHIBIT “L” MBE REPORTING FORM PH IH CPD Housing Grant/Project Number or HUD Case Number or other identification of property, subdivision, dwelling unit, etc. 7a. Amount of Contract or Subcontact 7b. Type of Trade Code (See below) 7c. Contractor or Subcontractor Business Racial/Ethnic (See below) 7d. Woman Owned Business (Yes or No) 7e. Prime Contractor Identification (ID) Number 7f. Sec. 3 7g. Subcontractor Identification (ID) Number 7h Sec. 3 7i. State Zip CPD: 1 = New Construction 6 = Professional 2 = Education/Training 7 = Tenant Services 3 = Other 8 = Education/Training 0 = Other 7d: Racial/Ethnic Codes: 1 = White Americans 3 = Native Americans 4 = Hispanic Americans 5: Program Codes (Complete for Housing and Public and Indian Housing programs only): 2= Flexible Subsidy 1 = All Insured, including Section8 5 = Section 202 6 = HUD-Held (Management) Housing/Public Housing: 7c: Type of Trade Codes: 2 = Black Americans1 = New Construction 9 = Arch./Engrg. Appraisal 5 = Asian/Pacific Americans 8 = Section 8114 = Insured (Management) 3 = Section 8 Noninsured, Non-HFDA 7 = Public/India Housing OMB Approval No.: 2577-0088 OMB Approval No.: 2502-0355 Executive Orders dated July 14, 1983, directs the Minority Business Development Plans shall be developed by each Federal Agency and the these annual plans shall establish minority business development objectives. The information is used by HUD to monitor and evaluate MBE activities against the total program activity and the designated minority business enterprise (MBE) goals. The Department requires the information to provide guidance and oversight for programs for the development of minority business enterprise concerning Minority Business Development. If the information is not collected HUD would not be able to establish meaningful MBE goals nor evaluate MBE performance against these goals. Public reporting burden for this collection of information is estimated to average .5 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The Information is voluntary. HUD may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB Control Number. Oct. 1 - Sept. 30 (Annual -FY) Check if: Contract and Subcontract Activity Contractor/Subcontractor Name and Address 7j. Name Street City U.S. Department of Housing and Urban Development Privacy Act Notice = The United States Department of Housing and Urban Development, Federal Housing Administration, is authorized to solicit the Information requested in this form by virtue of Title 12, United States Code, Section 1701 et seq., and regulation. It will not be disclosed or relesed outside the United States Department of Housing and Urban Development without your consetn, except as required or permitted by Law. Previous editions are obsolete.form HUD-2516 (8/98) 2 = Substantial Rehab. 3 = Repair 5 = Project Mangt. 4 = Service 6 = Hasidic Jews 1. Grantee/Project Owner/Developer/Sponsor/Builder/Agency 3a. Name of Contact Person 3b. Phone Number (Including Area Code)4. Reporting Period 5. Program Code (Not applicable for CPD programs.) See explanation of Codes at bottom of Page Use a separate sheet for each program code. 6. Date Submitted to Field Office 2. Location (City, State Zip Code) This report is to be completed by grantees, developers, sponsors, builders, agencies, and/or project owners for reporting contract and subcontract activities of $10,000 or more under the following programs: Community Development Block Grants (entitlement and small cities); Urban Development Action Grants; Housing Development Grants; Multifamily Insured and Noninsured; Public and Indian Housing Authorities; and contracts entered into by recipients of CDBG rehabilitation assistance. completed for public and Indian housing and most community development programs. Form HUD- 60002 is to be completed by all other HUD programs including State administered community development programs covered under Section3. A Section 3 Contractor/subcontractor is a business concern that provides economic opportunities to low and very Low-income residents of the metropolitan area (or nonmetropolitan county), including a business concern that is 51 person or more owned by low-income residents; costs or unusually high or low-income families. Very low-income families (including single persons) whose incomes do not exceed 50 per centum of the median family income for the area, as determined by the Secretary with adjustments for smaller and larger families, except that the secretary may establish income ceilings higher or lower than 50 per centum of the median for the area on the basis of the Secretary's findings that such variations are necessary because of unusually high or low family incomes. Contracts/subcontracts of less than $10,000 need be reported only if such contracts represent a significant portion of your total contracting activity. Include only contracts executed during this reporting period. or provides subcontracting or business development opportunities to businesses owned by low or low-income residents. Low and very low-income residents; include participants in Youthbuild programs established under Subtitle D of Title IV of the Cranston-Gonzalez National Affordable Housing Act. Submit two (2) copies of this report to your local HUD Office within ten (10) days after the end of the reporting period you checked in item 4 on the front. Complete item 7h. Only once for each contractor/subcontractor on each semi-annual report. This form has been modified to capture Section 3 contract data in columns 7g and 7i. Section 3 requires that the employment and other economic opportunities generated by HUD financial assistance for housing and community development programs shall, to the greatest extent feasible, be directed toward low- and very low-income persons, particularly those who are recipients of government assistance for housing. Recipients using this form to report Section 3 contract data must also use Part I of form HUD-60002 to report employment and training opportunities data. Form HUD-2516 is to be The terms “low-income persons” and “very low-income persons” have the same meanings given the terms in section3(b)(2) of the United States Housing Act of 1937. Low-income persons mean families (including single persons) whose incomes do not exceed 80 per centum of the median income for the area, as determined by the Secretary, with adjustments for smaller an larger families, except that the Secretary may establish income ceilings higher or lower than 80 per centum of the median for the area on the basis of the Secretary's findings that such variations are necessary because of prevailing levels of construction Enter the prime contractor's ID in item 7f. for all contracts and subcontracts. Include only contracts expected during this reporting period. PHAs/IHAs are to report all contracts/subcontracts. Community Development Programs Multifamily Housing Programs Public Housing and Indian Housing Programs 1. Grantee: Enter the name of the unit of government submitting this report.1. Grantee/Project Owner: Enter the name of the unit of government, agency or mortgagor entity submitting this report. PHAs/IHAs are to report all contracts/subcontracts. Include only contracts executed during this reporting period. 3. Contact Person: Enter name and phone of person responsible for maintaining and submitting contract/subcontract data.3. Contact Person: Same as item 3 under CPD Programs.1. Project Owner: Enter the name of the unit of government, agency or mortgagor entity submitting this report. Check box as appropriate. 7a. Grant Number: Enter the HUD Community Development Block Grant Identification Number (with dashes). For example: B-32-MC-25-0034. For Entitlement Programs and Small City multi-year comprehensive programs, enter the latest approved grant number. 4. Reporting Period: Check only one period.3. Contact Person: Same as item 3 under CPD Programs. 7b. Amount of Contract/Subcontract: Enter the dollar amount rounded to the nearest dollar. If subcontractor ID number is provided in 7f, the dollar figure would be for the subcontract only and not for the prime contract. 5. Program Code: Enter the appropriate program code.4. Reporting Period: Check only one period. 7c. Type of Trade: Enter the numeric codes which best indicates the contractor's/subcontractor's service. If subcontractor ID number is provided in 7f., the type of trade code would be for the subcontractor only and not for the prime contractor. 7a. Grant/Project Number: Enter the HUD Project Number or Housing Development Grant or number assigned.5. Program Code: Enter the appropriate program code. The "other" category includes supply, professional services and all other activities except construction and education/training activities.7b. Amount of Contract/Subcontract: Same as item 7b. under CPD Programs.7a. Grant/Project Number: Enter the HUD Project Number or Housing Development Grant or number assigned. 7d. Business Racial/Ethnic/Gender Code: Enter the numeric code which indicates the racial/ethnic/gender character of the owner(s) and controller(s) of 51% of the business. 7c. Type of Trade: Same as item 7c. under CPD Programs.7b. Amount of Contract/Subcontract: Same as item 7b. under CPD Programs. When 51% or more is not owned and controlled by any single racial/ethnic/gender category, enter the code which seems most appropriate. If the subcontractor ID number is provided, the code would apply to the subcontractor and not to the prime contractor.7d. Business Racial/Ethnic/Gender Code: Same as item 7d. under CPD Programs.7c. Type of Trade: Same as item 7c. under CPD Programs. 7e. Woman Owned Business: Enter Yes or No.7e. Woman Owned Business: Enter Yes or No.7d. Business Racial/Ethnic/Gender Code: Same as item 7d. under CPD Programs. 7f. Contractor Identification (ID) Number: Enter the Employer (IRS) Number of the Prime Contractor as the unique identifier for prime recipient of HUD funds. Note that the Employer (IRS) Number must be provided for each contract/subcontract awarded. 7f. Contractor Identification (ID) Number: Same as item 7f. under CPD Programs.7e. Woman Owned Business: Enter Yes or No. 7g. Section 3 Contractor: Enter Yes or No.7g. Section 3 Contractor: Enter Yes or No.7f. Contractor Identification (ID) Number: Same as item 7f. under CPD Programs. 7h. Subcontractor Identification (ID) Number: Enter the Employer (IRS) Number of the subcontractor as the unique identifier for each subcontract awarded from HUD funds. When the subcontractor ID Number is provided, the respective Prime Contractor ID Number must also be provided. 7h. Subcontractor Identification (ID) Number: Same as item 7h. under CPD Programs.7g. Section 3 Contractor: Enter Yes or No. 7i. Section 3 Contractor: Enter Yes or No.7i. Section 3 Contractor: Enter Yes or No.7h. Subcontractor Identification (ID) Number: Same as item 7h. under CPD Programs. 7j. Contractor/Subcontractor Name and Address: Enter this information for each firm receiving contract/subcontract activity only one time on each report for each firm.7j. Contractor/Subcontractor Name and Address: Same as item 7j. under CPD Programs.7i. Section 3 Contractor: Enter Yes or No. 7j. Contractor/Subcontractor Name and Address: Same as item 7j. under CPD Programs. ESG PSA CONTRACT -- EXHIBIT “M” – NOTICE OF BENEFICIARY RIGHTS Page 1 EXHIBIT “M” NOTICE OF BENEFICIARY RIGHTS ESG PSA CONTRACT -- EXHIBIT “M” – NOTICE OF BENEFICIARY RIGHTS Page 2 Notice of Beneficiary Rights Name of Agency: Name of Program: Contact information for Program Staff (name, phone number, and e-mail address, if appropriate): Because this program is supported in whole or in part by direct Federal financial assistance from the Federal Government, we are required to let you know that: • We may not discriminate against you on the basis of religion, religious belief, a refusal to hold a religious belief, or a refusal to attend or participate in a religious practice; • We may not require you to attend or participate in any explicitly religious activities that are offered by us and any participation by you in these activities must be purely voluntary; • We must separate, in time or location, any privately funded explicitly religious activities from activities supported by direct Federal financial assistance; •If you object to the religious character of our organization, we must make reasonable efforts to identify and refer you to an alternative provider to which you have no such objection; and • You may report an organization's violations of these protections, including any denial of services or benefits, by contacting or filing a written complaint to HUD [or the intermediary, if applicable]. We must give you this written notice before you enroll in our program or activity, as required by 24 CFR 5.109. ESG PSA CONTRACT -- EXHIBIT “N” – NOTICE OF BENEFICIARY RIGHTS Page 1 EXHIBIT “N” WRITTEN STANDARDS FOR MAINTENANCE OF PERSONALLY IDENTIFYING INFORMATION ESG PSA CONTRACT -- EXHIBIT “N” – NOTICE OF BENEFICIARY RIGHTS Page 2 Written Standards for Maintenance of Client Confidentiality Personally identifying information. Households receiving assistance under ESG must have reasonable assurance of confidentiality. All client records, including name, household members, date of birth, Social Security number, Driver’s License Number, and any other identifying information of any individual or family who applies for and/or receives ESG assistance will be kept secure and confidential. This includes maintaining client records in a safe, locked file cabinet, filing area, or office that is not accessible to the general public and with access that is limited to staff persons providing direct services to the client(s). Domestic Violence Shelter Locations. The address or location of any domestic violence, dating violence, sexual assault, or stalking shelter with ESG funds will not published, disclosed or made public, except with written authorization of the person responsible for the operation of the shelter. Domestic Violence Shelter Participants. The address or location of any housing of a program participant will not be published, disclosed or made public to any individual not providing direct services to the participant, except as provided under a preexisting privacy policy of the agency and consistent with state and local laws regarding privacy and obligations of confidentiality. Federal/Local Government Rights. City, HUD, the HUD Office of Inspector General, and the Comptroller General of the United States, or any of their authorized representatives, must have the right of access to all books, documents, papers, or other records of the agency that are pertinent to the ESG grant, in order to make audits, examinations, excerpts, and transcripts. These rights of access are not limited to the required retention period but last as long as the records are retained. Public Rights. Citizens, public agencies, and other interested parties must have reasonable access (consistent with state and local laws regarding privacy and obligations of confidentiality and the confidentiality requirements in this part) to records regarding any uses of ESG funds the agency received during the preceding 5 years. Reports. The agency must collect and report data on its use of ESG funds in the Homeless Management Information System (HMIS) Compliance. Agency must incorporate into its policies and procedures a process that will ensure the confidentiality of program participants’ identifying information; records pertaining to any individual or family provided family violence prevention; and treatment services offered under any project assisted with ESG funds. Agency Notification. Agency is provided the requirements for maintaining client confidentiality via (a) annual Technical Assistance Training provided by City of Fort Worth Neighborhood Services Department staff, (b) Individual Agency Technical Assistance visits (as scheduled), and (c) annual monitoring visit conducted by City of Fort Worth Neighborhood Services Compliance & Planning Division staff. ESG PSA CONTRACT -- EXHIBIT “N” – NOTICE OF BENEFICIARY RIGHTS Page 3 Open Records Request. City staff required to comply with open records requests will receive the requirements for maintaining client confidentiality and comply in accordance with HUD regulations. NOTICE OF OCCUPANCY RIGHTS UNDER THE VIOLENCE AGAINST WOMEN ACT U.S. Department of Housing and Urban Development OMB Approval No. 2577-0286 Expires 06/30/2017 Form HUD-5380 (12/2016) EXHIBIT “O” – Notice of Occupancy Rights Under VAWA [Insert Name of Housing Provider 1] Notice of Occupancy Rights under the Violence Against Women Act 2 To all Tenants and Applicants The Violence Against Women Act (VAWA) provides protections for victims of domestic violence, dating violence, sexual assault, or stalking. VAWA protections are not only available to women, but are available equally to all individuals regardless of sex, gender identity, or sexual orientation.3 The U.S. Department of Housing and Urban Development (HUD) is the Federal agency that oversees that [insert name of program or rental assistance] is in compliance with VAWA. This notice explains your rights under VAWA. A HUD-approved certification form is attached to this notice. You can fill out this form to show that you are or have been a victim of domestic violence, dating violence, sexual assault, or stalking, and that you wish to use your rights under VAWA.” Protections for Applicants If you otherwise qualify for assistance under [insert name of program or rental assistance], you cannot be denied admission or denied assistance because you are or have been a victim of domestic violence, dating violence, sexual assault, or stalking. Protections for Tenants 1 The notice uses HP for housing provider but the housing provider should insert its name where HP is used. HUD’s program-specific regulations identify the individual or entity responsible for providing the notice of occupancy rights. 2 Despite the name of this law, VAWA protection is available regardless of sex, gender identity, or sexual orientation. 3 Housing providers cannot discriminate on the basis of any protected characteristic, including race, color, national origin, religion, sex, familial status, disability, or age. HUD-assisted and HUD-insured housing must be made available to all otherwise eligible individuals regardless of actual or perceived sexual orientation, gender identity, or marital status. 2 Form HUD-5380 (12/2016) If you are receiving assistance under [insert name of program or rental assistance], you may not be denied assistance, terminated from participation, or be evicted from your rental housing because you are or have been a victim of domestic violence, dating violence, sexual assault, or stalking. Also, if you or an affiliated individual of yours is or has been the victim of domestic violence, dating violence, sexual assault, or stalking by a member of your household or any guest, you may not be denied rental assistance or occupancy rights under [insert name of program or rental assistance] solely on the basis of criminal activity directly relating to that domestic violence, dating violence, sexual assault, or stalking. Affiliated individual means your spouse, parent, brother, sister, or child, or a person to whom you stand in the place of a parent or guardian (for example, the affiliated individual is in your care, custody, or control); or any individual, tenant, or lawful occupant living in your household. Removing the Abuser or Perpetrator from the Household HP may divide (bifurcate) your lease in order to evict the individual or terminate the assistance of the individual who has engaged in criminal activity (the abuser or perpetrator) directly relating to domestic violence, dating violence, sexual assault, or stalking. If HP chooses to remove the abuser or perpetrator, HP may not take away the rights of eligible tenants to the unit or otherwise punish the remaining tenants. If the evicted abuser or perpetrator was the sole tenant to have established eligibility for assistance under the program, HP must allow the tenant who is or has been a victim and other household members to remain in the unit for a period of time, in order to establish eligibility under the program or under another HUD housing program covered by VAWA, or, find alternative housing. 3 Form HUD-5380 (12/2016) In removing the abuser or perpetrator from the household, HP must follow Federal, State, and local eviction procedures. In order to divide a lease, HP may, but is not required to, ask you for documentation or certification of the incidences of domestic violence, dating violence, sexual assault, or stalking. Moving to Another Unit Upon your request, HP may permit you to move to another unit, subject to the availability of other units, and still keep your assistance. In order to approve a request, HP may ask you to provide documentation that you are requesting to move because of an incidence of domestic violence, dating violence, sexual assault, or stalking. If the request is a request for emergency transfer, the housing provider may ask you to submit a written request or fill out a form where you certify that you meet the criteria for an emergency transfer under VAWA. The criteria are: (1)You are a victim of domestic violence, dating violence, sexual assault, or stalking. If your housing provider does not already have documentation that you are a victim of domestic violence, dating violence, sexual assault, or stalking, your housing provider may ask you for such documentation, as described in the documentation section below. (2)You expressly request the emergency transfer. Your housing provider may choose to require that you submit a form, or may accept another written or oral request. (3)You reasonably believe you are threatened with imminent harm from further violence if you remain in your current unit. This means you have a reason to fear that if you do not receive a transfer you would suffer violence in the very near future. 4 Form HUD-5380 (12/2016) OR You are a victim of sexual assault and the assault occurred on the premises during the 90-calendar-day period before you request a transfer. If you are a victim of sexual assault, then in addition to qualifying for an emergency transfer because you reasonably believe you are threatened with imminent harm from further violence if you remain in your unit, you may qualify for an emergency transfer if the sexual assault occurred on the premises of the property from which you are seeking your transfer, and that assault happened within the 90-calendar-day period before you expressly request the transfer. HP will keep confidential requests for emergency transfers by victims of domestic violence, dating violence, sexual assault, or stalking, and the location of any move by such victims and their families. HP’s emergency transfer plan provides further information on emergency transfers, and HP must make a copy of its emergency transfer plan available to you if you ask to see it. Documenting You Are or Have Been a Victim of Domestic Violence, Dating Violence, Sexual Assault or Stalking HP can, but is not required to, ask you to provide documentation to “certify” that you are or have been a victim of domestic violence, dating violence, sexual assault, or stalking. Such request from HP must be in writing, and HP must give you at least 14 business days (Saturdays, Sundays, and Federal holidays do not count) from the day you receive the request to provide the documentation. HP may, but does not have to, extend the deadline for the submission of documentation upon your request. 5 Form HUD-5380 (12/2016) You can provide one of the following to HP as documentation. It is your choice which of the following to submit if HP asks you to provide documentation that you are or have been a victim of domestic violence, dating violence, sexual assault, or stalking. • A complete HUD-approved certification form given to you by HP with this notice, that documents an incident of domestic violence, dating violence, sexual assault, or stalking. The form will ask for your name, the date, time, and location of the incident of domestic violence, dating violence, sexual assault, or stalking, and a description of the incident. The certification form provides for including the name of the abuser or perpetrator if the name of the abuser or perpetrator is known and is safe to provide. • A record of a Federal, State, tribal, territorial, or local law enforcement agency, court, or administrative agency that documents the incident of domestic violence, dating violence, sexual assault, or stalking. Examples of such records include police reports, protective orders, and restraining orders, among others. • A statement, which you must sign, along with the signature of an employee, agent, or volunteer of a victim service provider, an attorney, a medical professional or a mental health professional (collectively, “professional”) from whom you sought assistance in addressing domestic violence, dating violence, sexual assault, or stalking, or the effects of abuse, and with the professional selected by you attesting under penalty of perjury that he or she believes that the incident or incidents of domestic violence, dating violence, sexual assault, or stalking are grounds for protection. • Any other statement or evidence that HP has agreed to accept. If you fail or refuse to provide one of these documents within the 14 business days, HP does not have to provide you with the protections contained in this notice. 6 Form HUD-5380 (12/2016) If HP receives conflicting evidence that an incident of domestic violence, dating violence, sexual assault, or stalking has been committed (such as certification forms from two or more members of a household each claiming to be a victim and naming one or more of the other petitioning household members as the abuser or perpetrator), HP has the right to request that you provide third-party documentation within thirty 30 calendar days in order to resolve the conflict. If you fail or refuse to provide third-party documentation where there is conflicting evidence, HP does not have to provide you with the protections contained in this notice. Confidentiality HP must keep confidential any information you provide related to the exercise of your rights under VAWA, including the fact that you are exercising your rights under VAWA. HP must not allow any individual administering assistance or other services on behalf of HP (for example, employees and contractors) to have access to confidential information unless for reasons that specifically call for these individuals to have access to this information under applicable Federal, State, or local law. HP must not enter your information into any shared database or disclose your information to any other entity or individual. HP, however, may disclose the information provided if: •You give written permission to HP to release the information on a time limited basis. •HP needs to use the information in an eviction or termination proceeding, such as to evict your abuser or perpetrator or terminate your abuser or perpetrator from assistance under this program. •A law requires HP or your landlord to release the information. 7 Form HUD-5380 (12/2016) VAWA does not limit HP’s duty to honor court orders about access to or control of the property. This includes orders issued to protect a victim and orders dividing property among household members in cases where a family breaks up. Reasons a Tenant Eligible for Occupancy Rights under VAWA May Be Evicted or Assistance May Be Terminated You can be evicted and your assistance can be terminated for serious or repeated lease violations that are not related to domestic violence, dating violence, sexual assault, or stalking committed against you. However, HP cannot hold tenants who have been victims of domestic violence, dating violence, sexual assault, or stalking to a more demanding set of rules than it applies to tenants who have not been victims of domestic violence, dating violence, sexual assault, or stalking. The protections described in this notice might not apply, and you could be evicted and your assistance terminated, if HP can demonstrate that not evicting you or terminating your assistance would present a real physical danger that: 1) Would occur within an immediate time frame, and 2) Could result in death or serious bodily harm to other tenants or those who work on the property. If HP can demonstrate the above, HP should only terminate your assistance or evict you if there are no other actions that could be taken to reduce or eliminate the threat. Other Laws VAWA does not replace any Federal, State, or local law that provides greater protection for victims of domestic violence, dating violence, sexual assault, or stalking. You may be entitled to 8 Form HUD-5380 (12/2016) additional housing protections for victims of domestic violence, dating violence, sexual assault, or stalking under other Federal laws, as well as under State and local laws. Non-Compliance with The Requirements of This Notice You may report a covered housing provider’s violations of these rights and seek additional assistance, if needed, by contacting or filing a complaint with [insert contact information for any intermediary, if applicable] or [insert HUD field office]. For Additional Information You may view a copy of HUD’s final VAWA rule at [insert Federal Register link]. Additionally, HP must make a copy of HUD’s VAWA regulations available to you if you ask to see them. For questions regarding VAWA, please contact [insert name of program or rental assistance contact information able to answer questions on VAWA]. For help regarding an abusive relationship, you may call the National Domestic Violence Hotline at 1-800-799-7233 or, for persons with hearing impairments, 1-800-787-3224 (TTY). You may also contact [Insert contact information for relevant local organizations]. For tenants who are or have been victims of stalking seeking help may visit the National Center for Victims of Crime’s Stalking Resource Center at https://www.victimsofcrime.org/our- programs/stalking-resource-center. For help regarding sexual assault, you may contact [Insert contact information for relevant organizations] Victims of stalking seeking help may contact [Insert contact information for relevant organizations]. Attachment: Certification form HUD-5382 [form approved for this program to be included] Form HUD-5382 (06/2017) EXHIBIT “P” – Emergency Transfer Request Form CERTIFICATION OF U.S. Department of Housing OMB Approval No. 2577-0286 DOMESTIC VIOLENCE, and Urban Development Exp. 06/30/2017 DATING VIOLENCE, SEXUAL ASSAULT, OR STALKING, AND ALTERNATE DOCUMENTATION Purpose of Form: The Violence Against Women Act (“VAWA”) protects applicants, tenants, and program participants in certain HUD programs from being evicted, denied housing assistance, or terminated from housing assistance based on acts of domestic violence, dating violence, sexual assault, or stalking against them. Despite the name of this law, VAWA protection is available to victims of domestic violence, dating violence, sexual assault, and stalking, regardless of sex, gender identity, or sexual orientation. Use of This Optional Form: If you are seeking VAWA protections from your housing provider, your housing provider may give you a written request that asks you to submit documentation about the incident or incidents of domestic violence, dating violence, sexual assault, or stalking. In response to this request, you or someone on your behalf may complete this optional form and submit it to your housing provider, or you may submit one of the following types of third-party documentation: (1)A document signed by you and an employee, agent, or volunteer of a victim service provider, an attorney, or medical professional, or a mental health professional (collectively, “professional”) from whom you have sought assistance relating to domestic violence, dating violence, sexual assault, or stalking, or the effects of abuse. The document must specify, under penalty of perjury, that the professional believes the incident or incidents of domestic violence, dating violence, sexual assault, or stalking occurred and meet the definition of “domestic violence,” “dating violence,” “sexual assault,” or “stalking” in HUD’s regulations at 24 CFR 5.2003. (2)A record of a Federal, State, tribal, territorial or local law enforcement agency, court, or administrative agency; or (3)At the discretion of the housing provider, a statement or other evidence provided by the applicant or tenant. Submission of Documentation: The time period to submit documentation is 14 business days from the date that you receive a written request from your housing provider asking that you provide documentation of the occurrence of domestic violence, dating violence, sexual assault, or stalking. Your housing provider may, but is not required to, extend the time period to submit the documentation, if you request an extension of the time period. If the requested information is not received within 14 business days of when you received the request for the documentation, or any extension of the date provided by your housing provider, your housing provider does not need to grant you any of the VAWA protections. Distribution or issuance of this form does not serve as a written request for certification. Confidentiality: All information provided to your housing provider concerning the incident(s) of domestic violence, dating violence, sexual assault, or stalking shall be kept confidential and such details shall not be entered into any shared database. Employees of your housing provider are not to have access to these details unless to grant or deny VAWA protections to you, and such employees may not disclose this information to any other entity or individual, except to the extent that disclosure is: (i) consented to 2 Form HUD-5382 (06/2017) by you in writing in a time-limited release; (ii) required for use in an eviction proceeding or hearing regarding termination of assistance; or (iii) otherwise required by applicable law. TO BE COMPLETED BY OR ON BEHALF OF THE VICTIM OF DOMESTIC VIOLENCE, DATING VIOLENCE, SEXUAL ASSAULT, OR STALKING 1.Date the written request is received by victim: _________________________________________ 2. Name of victim: ___________________________________________________________________ 3.Your name (if different from victim’s):________________________________________________ 4. Name(s) of other family member(s) listed on the lease:___________________________________ ___________________________________________________________________________________ 5. Residence of victim: ________________________________________________________________ 6. Name of the accused perpetrator (if known and can be safely disclosed):____________________ __________________________________________________________________________________ 7. Relationship of the accused perpetrator to the victim:___________________________________ 8. Date(s) and times(s) of incident(s) (if known):___________________________________________ _________________________________________________________________ 10. Location of incident(s):_____________________________________________________________ This is to certify that the information provided on this form is true and correct to the best of my knowledge and recollection, and that the individual named above in Item 2 is or has been a victim of domestic violence, dating violence, sexual assault, or stalking. I acknowledge that submission of false information could jeopardize program eligibility and could be the basis for denial of admission, termination of assistance, or eviction. Signature __________________________________Signed on (Date) ___________________________ Public Reporting Burden: The public reporting burden for this collection of information is estimated to average 1 hour per response. This includes the time for collecting, reviewing, and reporting the data. The information provided is to be used by the housing provider to request certification that the applicant or tenant is a victim of domestic violence, dating violence, sexual assault, or stalking. The information is subject to the confidentiality requirements of VAWA. This agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid Office of Management and Budget control number. In your own words, briefly describe the incident(s): ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ City of Fort Worth, Texas Mayor and Council Communication DATE: 08/03/21 M&C FILE NUMBER: M&C 21-0522 LOG NAME: 19NS 2021-2022 ACTION PLAN SUBJECT (ALL) Conduct Public Hearing and Approve the City's 2021-2022 Annual Action Plan for the Use of Federal Grant Funds in the Amount of $13,070,952.00 to be Awarded by the United States Department of Housing and Urban Development from the Community Development Block Grant, HOME Investment Partnerships Program, Emergency Solutions Grant, and Housing Opportunities for Persons with AIDS Programs, Authorize Collection and Use of Program Income, Authorize Execution of Related Contracts, Authorize the Use of Fee Waivers as HOME Match, Adopt Attached Appropriation Ordinance, and Authorize Waiver of Indirect Costs (PUBLIC HEARING - a. Report of City Staff: Sharon Burkley; b. Public Presentations; c. Council Action: Close Public Hearing and Act on the M&C) RECOMMENDATION: It is recommended that City Council: 1. Conduct a public hearing to allow citizen input and consideration of the City's 2021-2022 Annual Action Plan for use of federal grant funds to be awarded by the United States Department of Housing and Urban Development in the amount of $13,070,952.00 from the Community Development Block Grant, HOME Investment Partnerships Program, Emergency Solutions Grant, and Housing Opportunities for Persons with AIDS grant programs, and for the use of program income from activities using prior years' federal grant funds; 2. Approve the City's 2021-2022 Annual Action Plan for submission to the United States Department of Housing and Urban Development, including allocations of grant funds to particular programs and activities as detailed below; 3. Authorize the collection and use of an estimated $75,000.00 of program income which is expected to result from activities using prior years' Community Development Block Grant funds for the City's Priority Repair Program; 4. Authorize the collection and use of an estimated $75,000.00 of program income which is expected to result from activities using prior years' HOME Investment Partnerships Program grant funds for the City's Homebuyer Assistance Program, and authorize the use of 10 percent of the program income for administrative costs; 5. Authorize the City Manager or his designee to execute contracts for one year terms with the agencies listed in Tables 1, 2, and 3 below for Program Year 2021-2022 for Community Development Block Grant, Emergency Solutions Grant, and Housing Opportunities for Persons with AIDS grant funds, contingent upon receipt of funding, and satisfactory completion of all federal regulatory requirements; 6. Authorize the City Manager or his designee to extend the contracts for up to one year if an agency or department requests an extension and such extension is necessary for completion of the program, or to amend the contracts if necessary to achieve program goals provided any amendment is within the scope of the program and in compliance with City policies and all applicable laws and regulations governing the use of federal grant funds; 7. Adopt the attached Appropriation Ordinance increasing the estimated receipts and appropriations to the Grants Operating Federal Fund in the total amount of $13,070,952.00 consisting of $7,477,274.00 in Community Development Block Grant funds, $2,907,320.00 in HOME Investment Partnerships Program grant funds, $632,124.00 in Emergency Solutions Grant funds, and $1,904,234.00 in Housing Opportunities for Persons with AIDS grant funds, plus estimated program income in the amount of $150,000.00, all subject to receipt of such funds; and 8. Authorize a waiver of the Neighborhood Services Department indirect cost rate of 18.73%, estimated total of $303,276.16. DISCUSSION: The City's 2021-2022 Annual Action Plan summarizes the major housing and community development activities and proposed expenditures for the program year beginning October 1, 2021 and ending September 30, 2022 for use of federal grant funds totaling $13,070,952.00 from the United States Department of Housing and Urban Development (HUD) from the Community Development Block Grant (CDBG), HOME Investment Partnerships Program (HOME), Emergency Solutions Grant (ESG), and Housing Opportunities for Persons with AIDS (HOPWA) grant programs. It also summarizes the use of program income resulting from activities using prior years' CDBG and HOME funds, the primary purpose of which is to benefit low-and moderate-income persons in Fort Worth. ESG funds primarily benefit homeless persons, and HOPWA funds primarily benefit low- and moderate-income persons with HIV/AIDS. Staff developed initial recommendations for the allocation of the estimated funding from HUD based on prior years' funding levels. Two public hearings were held on April 14, 2021 and May 12, 2021 to provide citizens the opportunity to participate in the development of the Annual Action Plan. Recommendations for award amounts were considered and adopted by the Community Development Council on May 12, 2021. These funding recommendations were presented in City Council Work Session on June 22, 2021. A 30-day public comment period was held from July 1, 2021 to July 30, 2021. Notice of this public comment period was published in the Wise County Messenger and Glen Rose Reporter on June 25, 2021; in the Cleburne Times-Review, Hood County News, and Weatherford Democrat on June 26, 2021; in the Fort Worth Star-Telegram on June 27, 2021; and in La Vida News on July 1, 2021. TABLE 1: CDBG AGENCIES Any comments received are maintained by the Neighborhood Services Department in accordance with federal regulations. The City held two public hearings as part of the HUD required citizen participation process. The first public hearing was held by staff on July 14, 2021, and the second public hearing is scheduled for the City Council meeting on August 3, 2021. A summary of staff's final funding recommendations is provided below and in Tables 1, 2, and 3. A spreadsheet of funding recommendations is also attached. The 2021-2022 Annual Action Plan will be submitted to HUD by August 15, 2021. Indirect costs totaling approximately $354,132.42 could be charged to these grants, as the Neighborhood Services Department indirect cost rate is 18.73% in the City's most recent Cost Allocation Plan. A waiver of these costs is requested to allow allocation of these funds to further support the programs and services to assist low-to-moderate income citizens. COMMUNITY DEVELOPMENT BLOCK GRANT For Program Year 2021-2022, it is recommended that the amount of $7,477,274.00 in CDBG funds and an estimated amount of $75,000.00 in CDBG program income totaling $7,522,274.00 be allocated as follows: Public Services - $1,121,591.00: Includes social services for low- and moderate-income persons, persons with disabilities, and disadvantaged persons Housing Programs - $2,848,219.00: Includes funding for the City's Priority Repair Program, Cowtown Brush-Up, homebuyer and housing services, accessibility modifications for seniors and persons with disabilities, and related project delivery costs for these programs Major Projects - $2,012,009.00: Includes funding for Southside Community Center improvements, Bunche Park improvements, and Street/Sidewalk improvements Administration - $1,495,455.00: Includes costs for administering the CDBG grant, including allocations for the Financial Management Services and Development Services Departments Estimated Program Income - $75,000.00: Includes up to $75,000.00 in funding for the City's Priority Repair Program. Any CDBG program income over the estimated amount not used for the Priority Repair Program will be allocated to priority activities in the City's Consolidated Plan, subject to City Council approval. HOME INVESTMENT PARTNERSHIPS PROGRAM For Program Year 2021-2022, it is recommended that the amount of $2,907,320.00 in HOME funds and an estimated amount of $75,000.00 in HOME program income totaling $2,982,320.00 be allocated as follows: Homebuyer Assistance Program - $500,000.00: Includes funding for down payment and closing cost assistance for low- and moderate- income homebuyer Community Housing Development Organizations - $1,116,588.00: HUD requires that a minimum of 15 percent of HOME funds be allocated to Community Housing Development Organizations (CHDOs) for affordable housing projects. These funds will be used by Housing Channel for a multifamily rental demolition/reconstruction project in the Polytechnic neighborhood. The City is also authorized by HUD to fund CHDO operating costs to support community-based affordable housing development. These funds for operating costs will be used by Housing Channel to support completion of the multifamily rental demolition/reconstruction project. All housing developed with these funds will be sold to homebuyers making at or below 80 percent of area median income (AMI), set by HUD. Major Projects - $1,000,000.00: Includes funds allocated to the multifamily project to be developed by Fort Worth Housing Solutions (FWHS) as a part of its Choice Neighborhood Initiative (CNI) grant. Administration - $290,732.00: Includes costs for administering the HOME grant Estimated Program Income - $75,000.00: Includes funding for the Homebuyer Assistance Program and HOME grant administrative costs. HUD allows the City to use 10 percent of any HOME program income towards the cost of administering the HOME grant. HOME program income over the estimated amount not used for the Homebuyer Assistance Program will be allocated to priority activities in the City's Consolidated Plan, subject to City Council approval. HOUSING OPPORTUNITIES FOR PERSONS WITH AIDS For Program Year 2021-2022, it is recommended that the amount of $1,904,234.00 in HOPWA funds be allocated as follows: Public Service Agencies - $1,148,627.00 Neighborhood Services Department/Community Action Partners - $698,480.00 Administration - $57,127.00 EMERGENCY SOLUTIONS GRANT For Program Year 2021-2022, it is recommended that the amount of $632,124.00 in ESG funds be allocated as follows: Public Service Agencies - $584,715.00 Administration - $47,409.00 CONTRACT RECOMMENDATIONS The Community Development Council and Neighborhood Services Department staff recommend that contracts be executed with the listed agencies for the amounts shown in the following tables. Community Development Block Grant Contracts AGENCY PROGRAM AMOUNT AB Christian Learning Center After School Tutoring $85,000.00 AB Christian Learning Center Summer Reading Program $65,303.00 Artes de la Rosa Artes Academy $60,000.00 Big Brothers Big Sisters Lone Star Mentor 2.0 @ Young Men's Leadership Academy $50,000.00 Big Brothers Big Sisters Lone Star Mentor 2.0 @ Young Women's Leadership Academy $50,000.00 Boys & Girls Clubs of Greater Tarrant County, Inc.After School Program $60,000.00 United Community Centers, Inc.Educational Enrichment $100,000.00 Family Pathfinders of Tarrant County Financial Capability Program $50,000.00 The Ladder Alliance Computer Skills Training $70,000.00 Housing Channel Homebuyer Education and Housing Counseling Services $125,000.00 Meals-On-Wheels, Inc. of Tarrant County Home-Delivered Meals $116,288.00 Guardianship Services, Inc.Financial Exploitation Prevention Center $70,000.00 The Presbyterian Night Shelter of Tarrant County, Inc.Case Management for Homeless $145,000.00 The Salvation Army Red Shield Emergency Shelter $75,000.00 CDBG Public Service Agencies Total $1,121,591.00 Rehabilitation, Education and Advocacy for Citizens with Handicaps DBA REACH, Inc. Accessibility Improvements for Low Income Residents $115,000.00 Fort Worth Area Habitat for Humanity, Inc. DBA Trinity Habitat for Humanity Cowtown Brush Up Paint Program $455,000.00 Fort Worth Area Habitat for Humanity, Inc. DBA Trinity Habitat for Humanity Preserve-A-Home Program (Como Neighborhood Improvement Strategy)$400,000.00 CDBG Subrecipient Agencies Total $970,000.00 TOTAL CDBG CONTRACTS $2,091,591.00 TABLE 2: HOPWA AGENCIES AGENCY PROGRAM AMOUNT Tarrant County Samaritan Housing, Inc. Supportive Services; Facility-Based Housing Operations; Tenant- Based Rental Assistance; Administration $845,765.00 AIDS Outreach Center, Inc.* Short-Term Rent, Mortgage, and Utility Assistance; Supportive Services; Administration $302,862.00 TOTAL HOPWA CONTRACTS $1,148,627.00 Housing Opportunities for Persons With AIDS Contracts *The City has identified a potential conflict of interest under the HOPWA Regulations related to this award and is in the process of seeking a waiver of the conflict of interest from HUD. A contract will not be executed with AIDS Outreach Center, Inc. unless and until the City receives approval from HUD. In the event the City does not receive approval, an amended Action Plan will be submitted, as necessary, to address the reallocation of the funds. Emergency Solutions Grant Contracts TABLE 3: ESG AGENCIES AGENCY PROGRAM AMOUNT The Presbyterian Night Shelter of Tarrant County, Inc.Shelter Operations/Services $130,315.00 Lighthouse for the Homeless DBA True Worth Place Shelter Operations/Services $177,000.00 The Salvation Army Homelessness Prevention $106,440.00 Center for Transforming Lives Rapid Re-Housing $100,000.00 SafeHaven of Tarrant County Shelter Operations/Services $70,960.00 TOTAL ESG CONTRACTS $584,715.00 All figures have been rounded to the nearest dollar for presentation purposes. These programs are available in ALL COUNCIL DISTRICTS. FISCAL INFORMATION / CERTIFICATION: The Director of Finance certifies that upon approval of the above recommendations and adoption of the attached appropriation ordinance, funds will be available in the current operating budget, as appropriated, in the Grants Operating Federal Fund. The Neighborhood Services Department (and Financial Management Services) will be responsible for the collection and deposit of funds due to the City. Prior to an expenditure being incurred, the Neighborhood Services Department has the responsibility to validate the availability of funds. This is a reimbursement grant. Submitted for City Manager's Office by: Fernando Costa 6122 Originating Business Unit Head:Victor Turner 8187 Additional Information Contact:Sharon Burkley 5785 Sean Stanton 5811