HomeMy WebLinkAboutContract 46162 r ITY SECRETARY/ l
STATE OF TEXAS §
I §
COUNTY OF TARRANT §
This contract ("Contract") is- made and entered into by and between the City of Fort
Worth (hereafter "City") and AIDS Outreach Center, Inc. (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 through the Housing Opportunities for Persons with AIDS Program
("HOPWA") Program, Program No. TX-H-14-F002, Catalog of Federal Domestic Assistance
No:14.241;
WHEREAS, the HOPWA program is intended to address the needs of eligible persons
associated with the challenge of living with HIV/AIDS and their families;
WHEREAS, Agency submitted a proposal to use HOPWA funds for an eligible program
under the HOPWA 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 HOPWA 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 2014 income limits are
attached hereto as Exhibit"A-1"—2014 HUD Income Limits.
Business Diversity Enterprise Ordinance or BDE means the City's Business Diversity
Ordinance,Ordinance No.20020-12-2011.
FOFFICIAL RECORD
r TA,,RY
HOPWA PSA CONTRACT 2014-2015. 1 AIDS Outreach Center,Inc. 1 rill
RECEIVED NOV 17 7014
_ Complete Documentation means the following documentation as applicable:
® Attachments I,II,and HI,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: (i) Source Documentation sufficient to show
that clients participating in the Program are HOPWA Eligible Clients; or
(ii) documentation other than Source Documentation to show that clients
served by the Program are HOPWA Eligible Clients. In the event that
Agency is a facility that provides a public service, this means
documentation that clients served by Agency are HOPWA Eligible
Clients.
• 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.
DBE means disadvantaged business enterprise in accordance with 49 CFR Part 26.
Director means the Director of the City's Housing and Economic Development Department.
Effective Date means October 1, 2014.
HED Department means the City's Housing and Economic Development Department.
HOPWA means Housing Opportunities for Persons with AIDS.
HOPWA Eligible Client means a client whose annual income adjusted for family size does not
exceed 80%of AMI using the most current HUD Income Guidelines and Technical Guidance for -
Determining Income and Allowances verified by either Source Documentation or the form in in
Exhibit "E" - Form of Income Self-Certification. The client must also have a documented
diagnosis of HIV/AIDS.
HOPWA Funds means the HOPWA grant funds supplied by City to Agency under the terms of
this Contract.
HOPWA Regulations means regulations found at 24 CFR Part 574 et seq.
HUD means the United States Department of Housing and Urban Development.
HOPWA PSA CONTRACT 2014-2015 2
AIDS Outreach Center,Inc.
IDIS means HUD's Integrated Disbursement Information System.
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 documentaiton allowed under the definition of annual
income in 24 CFR Part 5.609
Unduplicated Clients means a count of HOPWA Eligible Clients served once in the Contract
Term. HOPWA Eligible Clients served more than once in the Contract Term will only be
counted once when determining the number of Unduplicated Clients.
3. TERM
The term of this Contract begins on October 1, 2014 and terminates on September 30,
2015 unless earlier terminated as provided in this Contract.
4. DUTIES AND RESPONSIBILITIES OF CITY
4.1 Provide HOPWA Funds.
City shall provide up to Five Hundred Fifty Six Thousand Seven Hundred Fifty Seven
and 00/100 Dollars ($556,757.00) of HOPWA 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.
5. DUTIES AND RESPONSIBILITIES OF AGENCY
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 HOPWA Funds
5.2.1. Compliance with HOPWA Regulations and Contract
Agency shall be reimbursed for eligible Program costs with HOPWA Funds only if City
determines in its sole discretion that:
5.2.1.1 Costs are eligible expenditures in accordance with HOPWA
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 is submitted to City by Agency.
HOPWA PSA CONTRACT 2014-2015 3
AIDS Outreach Center,Inc.
5.2.2 Budget
Agency agrees that HOPWA Funds will be paid on a reimbursement basis in accordance
with Exhibit `B" - Budget. 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 such requests 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 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 1,2015.
5.2.3 ChanIze in Program Budj4et
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 funds available under this Contract to
supplement rather than supplant funds otherwise available for use in
the Program.
5.2.4 Payment of HOPWA Funds to Agency
HOPWA Funds will be disbursed to Agency upon City's approval of Agency's written
and signed 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 20, 2015, City may hold back a small amount of the HOPWA Funds until the end of
the term. During this interim period, Agency must continue to submit Reimbursement Requests
with an invoiced amount of$0. It is expressly agreed by the Parties that any HOPWA Funds
either not spent or not approved for reimbursement to Agency shall remain with City.
5.3 Program Performance Milestones
5.3.1 Agency warrants and represents that the Program will achieve the following
milestones:
Unduplicate d Clients as
specified tri Exhibit"A'>
Month E eziditures_ Pro ram Summa
3 27.27% 27.27%
6 54.54% 54.54%
8 72.72% 72.72%
I1 100% 100%
HOPWA PSA CONTRACT 2014-2015 4
AIDS Outreach Center,Inc.
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 HOPWA Funds, or to terminate this
Contract.
5.3.3 Failure to meet at least 80% of its performance milestones or serve 173
Unduplicated Clients under this Contract will automatically disqualify Agency for consideration
under the City's Request for Proposals for the 2016-2017 Program Year for Federal grant funds.
5.3.4 Amendments to performance milestones 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, 2015. Notwithstanding the above, any amendments to
performance milestones shall not reduce the numbers for serving 173 Unduplicated Clients stated
in Section
5.4 Identify Prot4ram Expenses Paid with HOPWA Funds
Agency will keep accounts and records in such a manner that City may readily identify
and account for Program expenses reimbursed with HOPWA Funds. These records shall be
made available to City for audit purposes and shall be retained as required hereunder.
6. CLIENT ELIGIBILITY VERIFICATION
6.1 Client EIigibility
Agency will document the eligibility of all prospective clients. Agency may redact the
client's personal information and substitute a client number. Agency will document client
eligibility as follows:
6.1.1 Income
Agency must verify all new clients' income eligibility with either Source Documentation
or the form attached as Exhibit "E"o Form of Income Self Certification. Agency must use the
annual income definition used by 24 CFR 5.609 to establish client income eligibility and must
use the most current HUD Income Guidelines.
6.1.2 Diagnosis
Agency must submit a signed, dated statement that the client's file contains
documentation of the client's diagnosis of HIV/AIDS. The HIV/AIDS diagnosis must be made
by a licensed health care provider; a client's self-certification of diagnosis is not sufficient.
Agency should not submit the actual diagnosis to City.
HOPWA PSA CONTRACT 2014-2015 5
AIDS Outreach Center,Inc.
6.1.3 Emergency Need
For clients receiving short term rental, mortgage or utility assistance, Agency must also
verify and document that the client has an emergency need, such as sudden loss of income,
eviction, utility shutoff, or extraordinary and unexpected healthcare costs. Agency must submit
its policy regarding documenting emergency need to City by October 1, 2014.
6.1.4 Submission of Complete Documentation
Agency must submit copies of all eligibility verification documentation described in
Section 6.1 with Attachment III in each month's Reimbursement Request for all Unduplicated
Clients served for the first time, and must maintain copies of such documentation as required
under this Contract.
7. ADDITIONAL HOPWA REQUIREMENTS
Agency agrees to comply with all requirements of the HOPWA Program as stated in the
HOPWA Regulations, including but not limited to the following:
7.1 Environmental Review
HOPWA Funds will not be paid, and costs cannot be incurred until City has conducted
and completed an environmental review 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 will (i) cause
this Contract to terminate immediately; and (ii) require Agency to repay to City the HOPWA
Funds it has already received and forfeit any future payments of HOPWA 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 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 2014-2015 Action Plan, and (iii)receipt by City of grant agreement from HUD.
7.3 Monitoring
7.3.1 Agency understands and agrees that City will monitor the adequacy and
timeliness of Agency's performance under the terms of this Contract as well as its compliance
with the HOPWA Regulations. Agency is subject to such monitoring during the term of this
Contract and for 5 years after the Contract term ends. Agency will provide reports and access to
Program files as requested by City for during this 5 year period. For purposes of this Contract,
this 5 year period for monitoring is deemed to begin on October 1, 2015 and end on September
30, 2020 regardless of whether or not this Contract is earlier terminated.
7.3.2 Representatives of City, HUD, and the United States Comptroller General shall
have access during regular business hours, upon 48 hours prior notice, to Agency's offices and
HOPWA PSA CONTRACT 2014-2015 6
AIDS Outreach Center,Inc.
_ records pertaining to the use of the HOPWA 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 7.3.4 This Section 7.3 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 This Section 7.3 shall survive the earlier termination or expiration of this
Contract.
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. Agency shall establish procurement
procedures to ensure that materials and services are obtained in a cost effective manner. When
procuring services to be provided under this Contract, Agency shall comply at a minimum with
the procurement standards at 24 CFR Part 84.40 through 24 CFR Part 84.48.
7.5 Cost Principles/Cost Reasonableness.
Agency shall administer its use of HOPWA Funds in compliance with OMB Circular
A-122, "Cost Principles for Non-Profit Organizations", as amended from time to time. The
eligibility of costs incurred for performance rendered shall be determined in accordance with
OMB Circular A-122 as supplemented by the provisions of this Contract.
7.6 Accounting Standards
Agency agrees to comply with OMB Circular A-110, ."Uniform Administrative
Requirements for Grants and Agreements with Institutions of Higher Education, Hospitals and
other Non-Profit Organizations", and agrees to adhere to the accounting principles and
procedures required therein, utilize adequate internal controls, and maintain necessary supporting
and back-up documentation for all costs incurred.
7.7 Uniform Administrative Requirements
Agency will comply with the Uniform Adm-inistrative Requirements set forth in 24 CFR
Part 57.502 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 HOPWA 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
HOPWA PSA CONTRACT 2014-2015 7
AIDS Outreach Center,Inc.
made a part of any contract or subcontract executed in the performance of its obligations
hereunder including its obligations regarding the HOPWA Regulations. Agency shall monitor
the services and work performed by its contractors, subcontractors and vendors on a regular basis
for compliance with the HOPWA Regulations and Contract provisions. Agency must cure all
violations of the HOPWA 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 HOPWA 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.
7.9 Copyriaht 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.
8. RECORD KEEPING; REPORTING AND DOCUMENTATION
REQUIREMENTS; AUDIT
8.1 Record Keepina
Agency shall maintain a record-keeping system as part of its performance of this Contract
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, this 5 year period for record retention is deemed to begin on October 1, 2015 and
end on September 30, 2020 regardless of whether or not this Contract is earlier terminated.
8.2 Access to Records
City 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, this 5 year period for access to records is deemed to begin on October
1, 2015 and end on September 30, 2020 regardless of whether or not this Contract is earlier
terminated.
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
HOPWA PSA CONTRACT 2014-2015 8
AIDS Outreach Center,Inc.
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$500,000 or more in Federal Funds Per Year
All non-federal entities that expend $500,000 or more in Federal funds within one year,
regardless of the source of the Federal award, must submit to City an annual audit prepared in
accordance with specific reference to OMB Circular A-133. 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 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 $500,000 a year in Federal funds are
exempt from Federal audit requirements for that year, but records must be available for review or
audit by appropriate officials of the Federal agency, City, and General Accounting Office.
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 HOPWA 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,this 5 year period for City audit is deemed to begin
on October 1, 2015 and end on September 30, 2020 regardless of whether or not this Contract is
earlier terminated. 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 HOPWA
FUNDS OR SPENT HOPWA 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.
HOPWA PSA CONTRACT 2014-2015 9
AIDS Outreach Center,Inc.
9. REIMBURSEMENT REQUIREMENTS
9.1.1 Reimbursement Requests shall be received by the City on or before the 15t"
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, EXPENSES FOR SEPTEMBER 2015 MUST BE RECEIVED BY
SEPTEMBER 20, 2015. FAILURE TO SUBMIT A FINAL REIMBURSEMENT
REQUEST BY SEPTEMBER 20, 2015 WILL RESULT IN AUTOMATIC FORFEITURE
OF PAYMENT OF THE SEPTEMBER REIMBURSEMENT REQUEST.
9.1.2 City will notify Agency by e-mail within 20 calendar days if a Reimbursement
Request is lacking Complete Documentation or corrections are needed. Agency will have 10
business days from the date of the e-mail notice to submit any requested information or missing
documentation. Agency will be penalized in the Request for Proposal for the 2015-2016
Program Year for any notifications received under this Section. If Agency fails to submit all the
required information or missing documentation within 30 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 10.1.3.
9.2 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), and must be
signed by an authorized signatory of Agency. By signing Attachment I, Agency is certifying
that the costs are valid, eligible, consistent with the terms and conditions of this Contract, and the
data contained in the report is true and correct.. This report must be submitted even if Agency is
requesting$0 for a particular month.
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 HOPWA-funded time and non-HOPWA funded
time and reflect actual time spent on HOPWA-funded activities.
Agency may not submit payroll expenses dated 60 days prior to the
date of the Reimbursement Request.
HOPWA PSA CONTRACT 2014-2015 10
AIDS Outreach Center,Inc.
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 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 contain a list of all clients
served during the Contract period. If Agency, receives funds from the United States
Department of Justice, 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:
9.2.3.1 Documentation of income verification for each Unduplicated Client
the first time he or she is served, which will either be the Source
Documentation described in Section 6.1 or the completed form
attached hereto as Exhibit "E"- Form of Income Self Certification.
9.2.5 Overview Report
Agency shall submit the Overview Report, attached hereto as Exhibit "H" — Overview
Report, quarterly with the January, April, July and October Reimbursement Requests. A paper
copy must be submitted with the Reimbursement Request, and an electronic copy must also be
emailed to psa @fortworthtexas.gov.
9.2.6 Submission of Reimbursement Request.
Reimbursement Requests can be mailed or deliver in person to HED Department, 908
Monroe Street, Fort Worth, Texas 76102. In addition, Agencies can submit Reimbursement
Requests via email to psa(a,fortworthtexas.ijov but in addition Agency must submit a signed
original of Attachment I and Exhibit "E"—Form of Income Self-Certification to City by the
deadline in Section 9.1.1.
9.3 Withholdinjj Payment
CITY HAS NO OBLIGATION TO MAKE PAYMENT ON ANY
REIMBURSEMENT REQUEST THAT IS NOT RECEIVED BY THE DUE DATE.
Failure to timely submit Reimbursement Requests and Complete Documentation along
with any required reports shall be an event of default.
HOPWA PSA CONTRACT 2014-2015 11
AIDS Outreach Center, Inc.
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 10 business 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
SEPTEMBER 20, 2015, OR IF THE SUBMITTED REIMBURSEMENT REQUEST FOR
SEPTEMBER 20, 2015 IS LATE, INCOMPLETE OR OTHERWISE NOT IN
COMPLIANCE WITH THIS CONTRACT OR THE HOPWA REGULATIONS AS
DETERMINED BY CITY IN ITS SOLE DISCRETION, THERE WILL BE NO CURE
PERIOD AND ANY REIMBURSEMENT WILL BE AUTOMATICALLY 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)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 HOPWA 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 HOPWA 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 HOPWA 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 HOPWA 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.
HOPWA PSA CONTRACT 2014-2015 12
AIDS Outreach Center,Inc.
10.2.1 In the event of termination under this Section 10.2, all HOPWA 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 HOPWA Funds paid to Agency must
be repaid to City within 30 days of termination. If such HOPWA 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 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 HOPWA Funds that have not yet been expended from
affected activities to other eligible activities or withhold HOPWA
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 HOPWA 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 HOPWA Funds already paid to
Agency must be repaid to City within 30 days of the termination. Failure to repay such HOPWA
Funds within the 30 day period will result in City exercising all legal remedies available under
this Contract.
HOPWA PSA CONTRACT 2014-2015 13
AIDS Outreach Center,Inc.
10.4 No Funds Disbursed while in Breach.
Agency understands and agrees that no HOPWA 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.
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 HOPWA 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
HOPWA Funds already paid to Agency must be repaid to City within 30 days of termination.
Failure to repay such HOPWA 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 HOPWA FUNDS FOR A MINIMUM OF 5 YEARS
FROM THE DATE OF TERIVIINATION.
10.9.2 Agency may terminate this Contract if City does not provide the HOPWA
Funds substantially in accordance with this Contract.
10.10 Termination for Convenience.
In terminating in accordance with 24 C.F.R. 85.44 this Contract may be terminated in
whole or in part only as follows:
HOPWA PSA CONTRACT 2014-2015 14
AIDS Outreach Center,Inc.
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 HOPWA Funds to be spent will not accomplish the purposes for which the
Contract was made.
10.11 Dissolution of Aaency 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 HOPWA Funds are subject to repayment acid/or City
may exercise all of its remedies under this Contract.
10.12 Reversion of Assets.
In the event this Contract is terminated with or without cause, all assets acquired by
Agency with the HOPWA 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 HOPWA Funds, and any real or personal property owned by Agency that was
improved with the HOPWA Funds shall automatically transfer to City or to such assignee as City
may designate.
11. REPAYMENT OF HOPWA FUNDS.
All HOPWA Funds are subject to repayment in the event the Program does not meet the
requirements of this Contract or in the HOPWA Regulations. If Agency takes any action that
results in the City being required to repay all or any portion of the HOPWA Funds to
HUD,Agency agrees it will reimburse City for such repayment. 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 HOPWA Funds is required of City,Agency agrees it
will pay City 10% of the HOPWA Funds 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
HOPWA 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 HOPWA 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. If the non-profit status of Agency
changes after the date of this Contract, City may but is not obligated to, terminate this Contract.
City has 30 calendar days to make such determination after receipt of written notice from
HOPWA PSA CONTRACT 2014-2015 15
AIDS Outreach Center,Inc.
Agency and failure to make such determination will constitute a waiver. In the event of
termination under this Section 12, all HOPWA 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. Any HOPWA 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, client income
eligibility, record keeping and reports, City ordinances, or applicable HOPWA 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 enforceable by
City against Agency. For purposes of this Contract, this 5 year period for survival of certain
Contract provisions is deemed to begin on October 1, 2015 and end on September 30, 2020
regardless of whether or not this Contract is earlier terminated.
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.
No portion of the HOPWA 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 HOPWA-
funded service.
HOPWA PSA CONTRACT 2014-2015 16
AIDS Outreach Center,Inc.
14.6 Venue.
Venue shall lie in Tarrant County, Texas 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 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:
➢ HOPWA Regulations found in 24 CFR Part 574
➢ AIDS Housing Opportunity Act, as amended(42 USC 12901 et seq.)
➢ Title VI of the Civil Rights Act of 1964 (42 U.S.C. Sections 20004 et seq.) including
provisions requiring recipients of federal assistance to ensure meaningful access by
person of limited English proficiency
➢ The Fair Housing Act, Title VIII of the Civil Rights Act of 1968 (42 U.S.C. Sections
HOPWA PSA CONTRACT 2014-2015 17
AIDS Outreach Center,Inc.
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
(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 Administration Requirements of 24 CFR Part 85
14.11 HUD-Assisted Proiects and Employment and other Economic
Opportunities; Section 3 Requirements.
14.11.1 Requirement that Law Be Ouoted in Covered Contracts. — Certain
HOPWA PSA CONTRACT 2014-2015 18
AIDS Outreach Center,Inc.
Requirements Pertaining to Section 3 of the Housing and Urban
Development Act of 1968 as Amended (12 U.S.C. Sections 1701 et seq.)
and its Related Regulations at 24 CFR Part 135.
If the Program results in the creation of new employment, training, or contracting
opportunities on a contractor or subcontractor level resulting from the expenditure of the
HOPWA Funds,Agency shall comply with the following and will ensure that its contractors also
comply. If the work performed under this Contract is on a project assisted under a program
providing direct Federal financial assistance from HUD, Section 3 of 24 CFR 135.38 ("Section
3") requires that the following clause, shown in italics, be inserted in all covered contracts
("Section 3 Clause"):
Section to be quoted in covered contracts begins:
"A. The work to be performed under this .contract is subject to the
requirements of Section 3 of Housing and Urban Development Aet of 1968, as
amended, 12 U.S.C. section 1701 a (Section 3). The purpose of Section 3 is to
ensure that employment and other economic opportunities generated by HUD
assisted or HUD-assisted programs covered by Section 3, shall to the greatest
extent feasible, be directed to low- and very-low income persons, particularly
persons who are recipients of HUD assistance for housing.
B. The parties to this contract agree to comply with HUD's regulations in 24
CFR Part 135, which implement Section 3. As evidenced by their execution of
this contract, the parties to this contract certify that they are tinder no contractual
or other impediment that would prevent them from complying with the Part 135
regulations.
C. The contractor agrees to send to each labor organization or
representative of workers with which it has a collective bargaining agreement or
other understanding, if any, a notice advising the labor organization or workers'
representatives of the contractor's commitments under this Section 3 clause and
will post copies of the notice in conspicuous places at the work site where both
employees and applicants for training and employment positions can see the
notice. The notice shall describe the Section 3 preference, shall set forth
minimum number and job titles subject to hire, availability of apprentice and
training positions, the qualifications for each, and the name and location of the
person(s) taking applications for each of the positions; and the anticipated date
the work shall begin.
D. The contractor agrees that it will include this Section 3 clause in every
subcontract to comply with regulation in 24 CFR Part 135, and agrees to take
appropriate action, as provided in an applicable provision of the subcontract or
in this Section 3 clause, upon finding that the subcontractor is in violation of the
regulations in 24 CFR Part 135. The contractor will not subcontract with any
subcontractor where it has notice or knowledge that the subcontractor has been
found in violation of regulations in 24 CFR Part 135.
E. The contractor will certify that any vacant employment positions,
including training positions that are filed: (1) after the contractor is selected but
before the contract is executed, and(2) with persons other than those to whom the
HOPWA PSA CONTRACT 2014-2015 19
AIDS Outreach Center,Inc.
regulations of,24 CFR Part 135. The contractor will not subcontract with any
subcontractor where it has notice or knowledge that the subcontractor has been
found in violation of regulations in 24 CFR 135.
F. Noncompliance with HUD's regulation in 24 CFR Part 135 may result in
sanctions, termination of this contract for default, and debarment or suspension
from fixture HUD assisted contracts.
G. With respect to work performed in connection with Section 3 covered
Indian housing assistance, section 7(b) of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. Section 450e) also applies to the work to be
performed under this Contract. Section 7(b) requires that to the greatest extent
feasible (i) preference and opportunities for training and employment shall be
given to Indians, and (ii)preference in the award of contracts and subcontracts
shall be given to Indian organizations and Indian-owned Economic Enterprises.
Parties to this contract that are subject to the provisions of Section 3 and Section
79b) agree to comply with Section 3 to the maximum extent feasible, but not in
derogation of compliance with Section 7(b). "
Section to be quoted in covered contracts ends.
14.11.2 A2ency Responsibilities for Section 3 Requirements.
City and Agency understand and agree that compliance with the provisions of Section 3,
the regulations set forth in 24 CFR Part 135, and all applicable rules and orders of BUD shall be
a condition of the Federal financial assistance provided to the Program binding upon City and
Agency and their respective successors, assigns, contractors and subcontractors. Failure to fulfill
these requirements shall subject Agency and its contractors and subcontractors and their
respective successors and assigns to those sanctions specified by the grant agreement through
which Federal assistance is provided and to such sanctions as are specified by 24 CFR Part 135.
Agency's responsibilities include:
14.11.2.1 Implementing procedures to notify Section 3 residents and
business concerns about training, employment, and contracting
opportunities generated by Section 3 covered assistance;
14.11.2.2 Notifying potential contractors working on Section 3 covered
projects of their responsibilities;
14.11.2.3 Facilitating the training and employment of Section 3 residents and
the award of contracts to Section 3 business concerns;
14.11.2.4 Assisting and actively cooperating with the BED Department in
making contractors and subcontractors comply;
14.11.2.5 Refraining from entering into contracts with contractors that are in
violation of Section 3 regulations;
14.11.2.6 Documenting actions taken to comply with Section 3; and
HOPWA PSA CONTRACT 2014-2015 20
AIDS Outreach Center,Inc.
14.11.2.7 Submitting Section 3 Annual Summary Reports (Form HUD-
60002) in accordance with 24 CFR Part 135.90.
14.11.3 Section 3 Reporting Requirements.
In order to comply with the Section 3 requirements, Agency must submit the forms
attached hereto as Exhibit"G"m Section 3 Reporting Forms.
14.11.3.1 Report to the City on a quarterly basis all applicants for
employment, and all applicants for employment by contractor and
subcontractor. This shall include name, address, zip code, date of
application, and status (hired/not hired) as of the date of the report.
14.11.3.2 Advertise available positions to the public for open competition,
and provide documentation to City with the quarterly report that
demonstrates such open advertisement in the form of printout of
Texas Workforce Commission posting, copy of newspaper
advertisement, copy of flyers and listing of locations where flyers
were distributed, and the like.
14.11.3.3 Report to the City on a quarterly basis all contracts awarded by
contractor and subcontractor. This shall include name of
contractor and/or subcontractor, address, zip code, and amount of
award as of the date of the report.
14.12 Prohibition Against Discrimination.
14.12.1 General Statement.
Agency shall comply in the execution, performance or attempted performance of this
Contract, with all non-discrimination requirements of 24 CFR 574.603 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.
14.12.2 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
HOPWA PSA CONTRACT 2014-2015 21
AIDS Outreach Center,Inc.
it in all contracts with its contractors:
[Contractor's, Subcontractor's or Vendor's name] will not unlawfiilly 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, 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 nan7e] 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 nan7e] 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.
14.12.3 Aaency'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
HOPWA PSA CONTRACT 2014-2015 22
AIDS Outreach Center,Inc.
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.
14.13. Prohibition Against Interest/Conflict of Interest.
14.13.1 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.
14.13.2 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 HOPWA 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
HOPWA services, may obtain a financial interest or benefit from a HOPWA-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, unless they are accepted in accordance with the procedures
set forth at 24 CFR 574.625.
14.13.3 Agency affirms that it will adhere to the provisions of the Texas Penal Code
which prohibits bribery and gifts to public servants.
14.13.4 The conflict of interest provisions of 24 CFR Part 85.36 and 24 CFR Part
84.42, respectively, shall apply in the procurement of property and services by Agency. In all
cases not governed by those Sections, the provisions of 24 CFR 574.625 of the HOPWA
Regulations shall apply.
14.14 Subcontracting with Small and Minority Firms, Women's Business
Enterprises and Labor Surplus Areas.
14.14.1 For procurement contracts $50,000.00 or larger 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 and will further require all persons or entities with which it so
contracts to comply with said ordinance.
14.14.2 It is national policy to award a fair share of contracts to disadvantaged
HOPWA PSA CONTRACT 2014-2015 23
AIDS Outreach Center,Inc.
business enterprises ("DBEs"), small business enterprises ("SBEs"), minority business
enterprises ("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 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.
14.16 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.
14.17. 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 HOPWA-funded Program prior to any charges being incurred.
14.18 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, 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.
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
HOPWA PSA CONTRACT 2014-2015 24
AIDS Outreach Center,Inc.
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 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
HOPWA PSA CONTRACT 2014-2015 25
AIDS Outreach Center,Inc.
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
$556,757.00 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 HOPWA 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 coverage and limits thereof:
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
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
HOPWA PSA CONTRACT 2014-2015 26
AIDS Outreach Center,Inc.
$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
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
HOPWA PSA CONTRACT 2014-2015 27
AIDS Outreach Center,Inc.
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.
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 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
HOPWA PSA CONTRACT 2014-2015 28
AIDS Outreach Center,Inc.
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.
Cfiv:
City Attorney's Office
1000 Throckmorton Street
Fort Worth,TX 76102
Telephone: 817-392-7600
Copy to:
Director of Housing and Economic Development
1000 Throckmorton Street
Fort Worth, TX 76102
Telephone: 817-392-7540
Copy to:
Program Coordinator
1000 Throckmorton Street
Fort Worth, TX 76102
Telephone: 817-392-6342
Agency:
AIDS Outreach Center, Inc.
Stephanie Cagle,Director of Case Management
400 N.Beach, Ste. 100
Fort Worth, TX 76111
Telephone: 817-335-1994
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.
[SIGNATURES APPEAR ON NEXT PAGE]
HOPWA PSA CONTRACT 2014-2015 29
AIDS Outreach Center,Inc.
IN WITNESS WHEREOF,the Parties hereto have executed 4 duplicate originals of this
Contract in Fort Worth,Tarrant Cou
c>r .'
ATTEST: ��o , „,`�F FORT WORTH
CAV
City Secre ando Costa,Assistant City Manager
M&C: C-26893 �ic��>t:aoa�a
Date: August 5, 2014
APPR VED AS TO FO AND LEGALITY:
Assistant City Attorney
AIDS OUT A H C ' TER,INC.
By:
Name: Vl
Title: Cpl 1(
STATE OF TEXAS §
COUNTY OF TARRANT §
This instrument was acknowledged before me on 01)y - 2014 by
Fernando Costa, Assistant City Manager of the City of Fort Worth, on behalf the City of Fort
Worth.
"P LINDA M,HIRNLINGEfi _ No ary-Public,State-of _-__Texas
_--__--- - - - -_
MY COMMISSION EXPIRES
Febn:ary2,2018
STATE OF TEXAS §
COUNTY OF TARRANT §
This instrument was acknowledged before?? me n � � 2014 by
the (�,, of AVO 1' a Texas non-profit
corporation, on behalf of said corporation. ,n o Q I ,
Notary Publ c, State of Texas
EM ELLIS ate of Texas n Expires 2018
OFFICIAL RECORD
HOPWA PSA CONTRACT 2014-2015 CITY SECRETARY 30
AIDS Outreach Center,Inc. r71w WORTH,TX
EXHIBITS:
Exhibit"A"—Program Summary
Exhibit"A-1"—2014 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
Exhibit"H"—Overview Report
HOPWA PSA CONTRACT 2014-2015 31
AIDS Outreach Center,Inc.
AIDS OUTREACH CENTER,INC. EXHIBIT "A"
Supportive Services, STRMU, and TBRA PROGRAM SUMMARY
PROGRAM SUMMARY
Housing Opportunities for Persons with AIDS
(HOPWA)
October 1,2014 to September 30,2015 $556,757.00
PERIOD AMOUNT
PROGRAM:
The Program provides each HOPWA Eligible Client with one or more of the following:
1) supportive services
2)tenant based rental assistance("TBRA"); OR,
3) short-term rental,mortgage, or utility assistance("STRMU").
Supportive Services, includes housing counseling and case management.
TBRA,tenant based rental assistance includes long-term monthly rental assistance. Clients must
be income eligible according to HUD guidelines, live in a rental that passes inspections, and
have an identified housing need as determined by the client's AOC case manager.
STRMU, short term rental, mortgage, or utility assistance, includes short term assistance for up
to 21 weeks. STRMU provides assistance with utilities, rent, or mortgage and must not exceed a
client's current monthly budget deficit caused by an unavoidable, unplanned, documented
emergency consistent with_HUD guidelines and as defined by AOC's local-policy Clients -
receiving other government housing assistance are not eligible.
Program services will be accessible at 400 N. Beach Street Suite 100, Fort Worth, TX 76111,
Monday thru Thursday 8:30 am to 5:00 pm and Friday 8:30 am to 4:00 pm.
HOPWA will serve eligible clients in Tarrant, Johnson, Parker, Wise, Hood and Somervell
counties.
HOPWA Funds will pay for direct assistance such as TBRA and STRMU. HOPWA Funds will
also be used to pay costs associated with delivering supportive services to any client receiving
either TBRA or STRMU assistance, including salaries, and fringe benefits, and FICA for
employees, supplies, insurance, and Program facility and utility costs. No more than 7% of the
HOPWA Funds will be used to pay administrative costs, including salaries, insurance,taxes, and
legal and accounting fees associated with the Program.
The Programs will be provided consistent with HUD guidance.
HOPWA PSA CONTRACT 2014-2015—EXHIBIT"A"—PROGRAM SUMMARY 1
AIDS Outreach Center,Inc.
REGULATORY CLASSIFICATION:
IDIS matrix Code(s) and Service Category: 31D HOPWA Project Sponsor Administration 31C
HOPWA Project Sponsor Activity
Regulatory Citation(s): 24 CFR 574.300(b)(10)—Administrative Expenses
24 CFR 574.300(b)(7)—Supportive Services
24 CFR 574.300(b)(6)—STRMU
24 CFR 574.300(b)(6)-TBRA
Based on the nature of the service provided, Agency will maintain documentation that verifies
that 100%of clients served by the Program are eligible under HOPWA Regulations.
PROGRAM GOALS:
• Provide Program services to approximately 173 Unduplicated Clients
• Provide TBRA services to approximately 58 Unduplicated Clients
• Provide STRMU services to approximately 115 Unduplicated Clients
HOPWA PSA CONTRACT 2014-2015—EXHIBIT"A"—PROGRAM SUMMARY 2
AIDS Outreach Center,Inc.
EXHIBIT "A-1"
2014 HUD Income Limits
2014 Median Family Income-Fort Worth/Arlington, TX*
1 Person 2 Persons 3 Persons 4 Persons 5 Persons 6 Persons 7 Persons 8 Persons
30%AMI $13,850 $15,800 $19,790 $23,850 $27,910 $31,970 $36,030 $40,090
50%AMI $23,050 $26,350 $29,650 $32,900 $35,550 $38,200 $40,800 $43,450
80%AMI $36,900 $42,150 $47,400 $52,650 $56,900 $61,1001 $65,300 $69,500
x Income Limits are established and published at least annually by HUD
HOPWA PSA CONTRACT 2014-2015—EXHIBIT"A-1"-2014 HUD INCOME LIMITS 1
AIDS Outreach Center,Inc.
EXHIBIT`B"-BUDGET
Grant A B C TOTAL
Account
Budget'
ADMINISTRATIVE (HOPIVA ONLY) 29,893
Salaries 1001 5,736 500 23,657
FICA 1002 438 38 1,811 2,287
Life Insurance 1003 10 10
Health Insurance 1004 121 42 2,854 3,017
Disability Insurance 1005 5 5
Unemployment-State 1006 14 5 244 263
Accounting
1007 2,675 6,151 22,670 31,496 TOTAL ADMINISTRATIVE EXPENSES 8,999 6,736 51,236 66,971
PROGRAM PERSONNEL 217,267
Salaries 2001 50,537 112,186 54,544
FICA 2002 3,866 8,582 4,173 16,621
Life Insurance 2003 10 10
Health Insurance 2004 3,126 17,624 256 21,006
Unemployment 2005 649 949 678 2,276
Worker's Compensation 2006 200 200
Retirement 2007
SUPPLIES AND SERVICES
Office Supplies 3001 571 400 4,852 5,823
Office Equipment Rental 3002 312 625 764 1,701
Postage 3003 146 155 1,147 1,448
Printing 3004 50 150 299 499
MISCELLANEOUS
Construction/Building Materials(only REACHL 4001
Contract Labor(City needs copy of contract
before expenses can be reimbursed) 4002
Craft Supplies 4003
Field Trip Admission Expenses 4004
Other Field Trip Expenses(if preapproved by
city) 4005
Food Supplies 4006
Teaching Aids-- _ - - -- 4007 -
FACILITY AND UTILITIES 3,492
Telephone 5001 577 625 2,290
Electric 5002 991 750 4,065 5,806
Gas 5003 400 400
Water and Wastewater 5004 400 400
Solid Waste Disposal 5005
Rent(City needs copy of lease before expenses
can be reimbursed) 5006 3,567 4,687 12,846 21,100
Custodial Services 5007 697 625 9,213 10,535
Repairs 5008 29 275 12 316
Cleaning Supplies 5009
Building Security 5010 50 85 219 354
LEGAL,FINANCIAL,AND INSURANCE
Fideli Bond or Equivalent 6001
Directors and Officers 6002
General Commercial Liability 6003 258 1,341 3,399 4,998
Contract Accounting 6005
DIRECT ASSISTANCE
Childcare Scholarships 7001
Short-term Rent Assistance 7002 28,123 28,123
Short-term Mortgage Assistance 7003 6,021 6,021
Short-term Utilities Assistance 7004 26,687 26,687
Tenant Based Rental Assistance 7005 420,491 407,491
TOTAL 556,757 155,795 149,993 1 849,545
FUNDING A: Tarrant County
FUNDING B: Private Funding
FUNDING C:
HOPWA PSA CONTRACT 2014-2015-EXHIBIT`B"-BUDGET 1
AIDS Outreach Center,Inc.
The following tables are purely informational and were created solely for purposes of preparing,
negotiating, and determining the reasonableness of the overall line item budget on the first page
of this EXHIBIT `B"—BUDGET and are not to be considered part of the terms and conditions
of this Contract. Contractor may make changes to any column except the "Position" column in
the "Salary Detail" table without the City's consent so long as the total amounts charged to the
grant do not exceed the line items on the first page of the EXHIBIT `B"—BUDGET. Changes
to the column labeled"Position"may only be made with the prior written consent of the City.
SALARY DETAIL
Position Name Rate Annual Hours Percent to Grant Amount to Grant
DIR CASE MGMT 23.47 2080 5% 2,441
CASE MGR 19.47 2080 98.77% 40,000
AED 29.57 2080 5.4% 3,321
CASE MGR 15.86 2080 5% 1,650
CASE MGR 14.90 2080 5% 1,550
CASE MGR 15.14 2080 5% 1,575
RECEPTIONIST 12.74 2080 5% 1,325
ACCOUNTANT 17.18 2080 5% 1,787
DIR.ADMIN SVCS 25.23 2080 5% 2,624
TOTAL 1 56,273
FRINGE DETAIL
Percent of Amount Percent to Grant Amount to Grant
Payroll
FICA 7.65% 18,908 22.76% 4,304
Life Insurance 20 100% 20
Health Insurance 24,023 13.52% 3,247
Unemployment 2,539 26.11% 663
Disability Insurance 5 100% 5
Workers Compensation 200 100%
Retirement
TOTAL 8,439
SUPPLIES AND SERVICES
Total Budget Percent to Grant Amount to Grant
Office Supplies 5,823 9.81% 571
Office Equipment Rental 1,701 18.34% 312
Postage 1,448 10.08% 146
Printing 499 10% 50
TOTAL 1,079
MISCELLANEOUS
Total Budget Percent to Grant Amount to Grant
Contract Labor 2,675 100% 2,675
Craft Supplies
Facility Fees
Field Trip Costs
Food Supplies
Teaching Aids
TOTAL 2,675
HOPWA PSA CONTRACT 2014-2015 —EXHIBIT"B"—BUDGET 2
AIDS Outreach Center,Inc.
FACILITY AND UTILITIES
Total Budget Percent to Grant Amount to Grant
Telephone 3,492 16.52% 577
Electric 5,806 17.07% 991
400 100% 400
Gas
Water and Wastewater 400 100% 400
Solid Waste Disposal
Rent 21,100 16.91% 3,567
Custodial Services 10,535 6.62% 697
Repairs 316 9.18% 29
Building Security 354 14.12% 50
6
TOTAL ,711
LEGAL,FINANCIAL AND INSURANCE
Total Budget Percent to Grant Amount to Grant
Fidelity Bond(or Equivalent) 258
General Commercial Liability 4,998 5.16%
Directors and Officers
Contract Accounting 258
TOTAL
DIRECT ASSISTANCE
Total Budget Percent to Grant Amount to Grant
Childcare Scholarships 28,123
Short-Term Rent Assistance 28,123 100%
Short Term Mortga e Assistance 6,021 100% 6,021
Short Term Utilities Assistance 26,687 100% 26,687
Tenant Based Rental Assistance 420,491 100% 420,491
TOTAL 481,322
HOPWA PSA CONTRACT 2014-2015—EXHIBIT`B"—BUDGET 3
AIDS Outreach Center,Inc.
EXHIBIT"C"—Audit Certification Form
[See attached]
HOPWA PSA CONTRACT 2014-2015—EX MIT"C"—AUDIT CERTIFICATION FORM 1
AIDS Outreach Center,Inc.
AUDIT CERTIFICATION FORM AND AUDIT REQUIREMENTS
Agency: AIDS Outreach Center,Inc.
Fiscal Year Ending: September 30,2015
During the fiscal year in which funds will be received, we will exceed the federal
expenditure threshold of $500,000. We will have our Single Audit or Program Specific
Audit completed and will submit the A-133 audit report within seven (7) months after the
end of the audited fiscal year or thirty (30) days within its completion, whichever is the
earlier date.
❑ During the fiscal year in which funds will be received, we will not exceed the $500,000
federal expenditure threshold required for a Single Audit or a Program Specific Audit to be
performed this fiscal year. (Fill out schedule below)
Federal Expenditure Disclosure
MUST be filled out if Sin le Audit or Pro ram Audit is NOT`re wired.
Pass Through Program Name&' Contract Expenditures
Federal Grantor Grantor CFDA Number Number
Total Federal Expenditures for this Fiscal Year:
q.
Signatory and Title Date
Failure to submit this or a similar statement or failure to submit a completed single audit package
as described in the federally required audit requirements described in OMB Circulars A-133 by
the required due date may result in suspension of erti�icat on acknowledges the for
genucy's
funding. Notwithstanding the above, this c
commitment to meet all other financial reporting, financial statements, and other audit
requirements as may be set forth in the Contract.
>,— 2
HOPWA PSA CONTRACT 2014-2015—EXHIBIT C AUDIT CERTIFICATION FORM
AIDS Outreach Center,Inc.
Exhibit "D" --Reporting Forms
[See attached]
HOPWA PSA CONTRACT 2014-2015 Exhibit"D"--REIMBURSEMENT FORMS 1
AIDS Outreach Center,Inc.
Attachment I
INVOICE
Agency: AIDS Outreach Center, Inc.
Address: 400 N. Beach, Ste. 100
City, State,Zip: Fort Worth, TX 76111
Program: Supportive Services, STRMU and TBRA
Period of Service:
Amount
Program This Invoice Cumulative to Date
Agency's Certification: I certify that the costs incurred are valid and
consistent with the terms and conditions of the contract between City and
Agency. By signing this invoice,I-certify that to the best of my knowledge
and belief the data included in this report is true and accurate. It is
acknowledged that the provision of false information could leave the
certifying official subject to the penalties of federal, state, and local law.
Signature and Date:
Name:
Title:
HOPWA PSA CONTRACT 2014-2015 Exhibit"D"--REIMBURSEMENT FORMS
2
AIDS Outreach Center,Inc.
Attachment II
City of Fort Worth
Housing and Economic Development Department
Expenditure Worksheet
Agency: AIDS Outreach Center Inc.
Program: Supportive Services,STRMU and TBRA
Highlighted are the only relevant codes for this Program.
Please group like account codes.
AccounLCode;' Expense Lino,Item
Lme No.' CheckNo,---. pa yes - .Descri tion See Ke to Ri tit Amount' " .AaeounC
1 ADMINISTRATIVE'HOPWA Only),
2 Salaries 1001
3 FICA 1002
4 Life Insurance 1003
5 Health Insurance 1004
6 Disability Insurance 1005
7 Unemployment-State 1006
8 Legal&Accounting 1007
9 PROGRAM PERSONNEL
10 Salaries 2001
11 FICA 2002
12 Life Insurance 2003
13 Health Insurance 2004
14 Unemployment 2005
15 Workers Compensation 2006
16 Retirement 2007
17 SUPPLIES AND SERVICES
18 Office Supplies 3001
19 Office E ui ment Rental 3002
20 Postage 3003
21 Printing 3004
22 MISCELLANEOUS
23 Conference&Seminars 4001
24 Construction]Buildin Materials 4002
25 Contract Labor 4003
26 Craft Supplies 4004
27 Credit Reports 4005
28 Facility Fees 4006
29 Field Trip Costs 4007
30 Food Supplies 4008
31 Mileage 4009
32 Teaching Aids 4010
33 FACILITYAND U71LMES
34 Telephone 5001
35 Electric 5002
36 Gas 5003
37 Water and Wastewater 5004
38 Solid Waste Disposal 5005
39 Rent 5006
40 Custodial Services 5007
41 Repairs 5008
42 Cleaning Supplies 5009
43 LEGAL:FINANCIAL,AND INSURANCE
44 Fidelity Bond or Equivalent 6001
45 Directors and Officers 6002
46 General Commercial Liability 6003
47 Le al Fees 6004
48 Contract Accounting 6005
49 DIRECT ASSISTANCE
50 Childcare Scholarships 7001
51 Counseling-Individual Sessions 7002
52 Counseling-Group Sessions 7003
53 Short-term Rent Assistance 7004
54 Short-term Mortgage Assistance 7005
55 Short-term Utilities Assistance 7006
56 Tenant Based Rental Assistance 7007
57 CAPITAL OUTLAY'
58 Furniture,Fixtures 8001
59 Computers 8002
60 Office Equipment 8003
Total Sort and Recreation E ui ment 8004
'Payroll must identify employee. Rent must identify tenant. Other payments should identify individuals,if applicable.
z
HOP WA PSA CONTRACT 2014-2015 Exhibit'D"--REIMBURSEMENT FORMS
AIDS Outreach Center,Inc.
'o z
LL�
a d 0 0
_ c o 0 0 0
Ep mQ <��Mnmm
U p S p a
3T = N v
$ $ MQ yiv v
Vs N Y rm
t.2
t�,« NmYbmrm
m E d
� N
b d =
T S
Y d
Z
et L N
L« p•_
d
3 e $
d
Ec3z�¢E
o
in Q— do¢
§H d¢aa
a
'o
� 1.2
3�
$ o` d 3
a a
� w4
U
=z E > Z a
w — O
O w m
rw-
Q M�
U p
J N m Q E
Q
o —
O
E E
d o
6
d d
N w
«d
'n
E m
i QZ
N� Q
C —
d
o ZS
Op eS U«
�p d t3
o N m d
$. O E
ti
x o
N
p "t
= d
G Q
O T x
N L
6 O d
b Y
'C
�co7
dgL x
Ioa p
Eax y
o nr�
N«6
E
E s
a` N
C
O
V E
� z
N
C
HOPWA PSA CONTRACT 2014-2015 --EXHIBIT"E"--INCOME CERTIFICATION FORMS 4
AIDS Outreach Center,Inc.
Exhibit"E"—Income Certification Forms
[See attached]
HOPWA PSA CONTRACT 2014-2015 --EXHIBIT"E"--INCOME CERTIFICATION FORMS 1
AIDS Outreach Center,Inc.
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 Source of Income
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 onl -----------------
Household Size: Gross Annual Income:
Applicable Income Limit: Is Applicant Eligible?
Check if Applicant refused to provide demographic information: ❑
Staff Assessment of Demographics:
Person Making Determination: Date:
NOTE. Address, income amounts and sources for ALL household members are required.
HOPWA PSA CONTRACT 2014-2015 --EXHIBIT`B"--INCOME CERTIFICATION FORMS 2
AIDS Outreach Center,Inc.
Ciudad de Fort Worth
CERTIFICACION DE DECLARACION DE INGRESOS
Nombre del Solicitante:
Direccion de Actualidad: Telefono:
Ciudad y Codigo Postal:
Miembros Del flogar e Ingresos
(Incluyendo el/la Solicitante)
Apellido Nombre Edad Ingreso Origen de Ingresos
Mensual
*TOTAL NUMERO DE MIEMBROS DEL HOGAR (Incluyase Usted.)
Total Anual de Ingresos del hogar:
**INFORMACION PERSONAL:(Seleccione uno en cada articulo. Esta informacion es requeridapor 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. DES LA CABEZA DEL HOGAR MUJER?
❑HISPANO ❑ SI ❑SI
❑NO-HISPANO ❑NO ❑NO
Certificacion: Yo certifico que la informacion que yo estoy proporcionando es verdadera y puedo ser sujeto a
verificacion a cualquiera hora por tercera parte. Yo tambien reconozco que la provision de informacion falsa
puede dejarme sujeto a penalidades Federales, Estatales, y a ley local.
Firma del Solicitante Fecha
ADVERTENCIA: TITULO 18,SECCION 1001 DEL CODIGO 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 em leados de la a encia-----------------
#De Miembros de Familia: Ingreso Anual:
Limite de Ingreso: �Es solicitante elegible?
Compruebe si el solicitante se nego a dar su informacion personal: ❑
Evaluacion del empleado sobre informacion personal:
Persona haciendo la determinacion: Fecha:
Note: La direccion de la casa y los ingresos (y sits origenes) para todos miembros del hogar son requeridos.
HOPWA PSA CONTRACT 2014-2015--EXHIBIT"E"--INCOME CERTIFICATION FORMS 3
AIDS Outreach Center,Inc.
i
Exhibit "F" - Standards for Complete Documentation
[See attached]
HOPWA PSA CONTRACT 2014-2015 Exhibit"F" -- STANDARDS FOR COMPLETE DOCUMENTATION
AIDS Outreach Center,Inc. 1
2014-2015 Documentation Standards for
Public Service Contract Expenses
mA
` aoutn
-
m'o
E
E, a m 'X w`$2 ..fitotestONtet
Bu` etriri¢ifams
E
MUM
nt loyee Salaries,and aenefits -
Salaries X X. If an employee works solely with Contract eligible clients and solely on Contract eligible items,then the employee's entire salary is eligible for
reimbursement.Twice in each calendar year,the client must submit a written statement verifying that the above conditions are still true.The
statement must also be signed be a person authorized to sign on behalf of the agency.
If an employee works on a variety of programs,or works with a mixture of Contract eligible clients and non-eligible clients,then the City will only
reimburse for a reasonable portion of the employee's salary.Each reimbursement request must include not only the employee's timesheet,but
also a work log breaking out the employee's time by project or activity. For employees 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.
'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 If the City pays gross salary,this is already included.If the City pays the employer portion,then the employer must show a calculation and
documentation of how the invoiced amount was calculated and include documentation showing payment.
Life Insurance if the City pays gross salary,this is already included.If we pay the employer portion,then the employer must show a calculation and
documentation of how the invoiced amount was calculated,must include an invoice from the insurer,and must include documentation showing
a ment.
Health Insurance if the City pays gross salary,this is already included.If we pay the employer portion,then the employer must show a calculation and
documentation of how the invoiced amount was calculated,must include an invoice from the insurer,and must include documentation showing
a ment.
Disability If the City pays gross salary,this is already included.If we pay the employer portion,then the employer must show a calculation and
Insurance documentation of how the invoiced amount was calculated,must include an invoice from the insurer,and must include documentation showing
payment.
Unemployment if the City pays gross salary,this is already included.If we pay the employer portion,then the employer must show a calculation and
Insurance documentation of how the invoiced amount was calculated and must include documentation showing payment.
Retirement If we pay gross salary,this is already included.If we pay the employer portion,then the employer must show a calculation and documentation of
how the invoiced amount was calculated,must and include documentation showing payment,and prior to the first reimbursement,must include the
personnel policy regarding retirement benefits.
Professional Services
Accounting X X I I X If an audit is required because federal funds exceed$500,000,then the cost should be split evenly by all federal funding sources.
Ex enses
Materials Equipment Goods and Supplies
Office Supplies 2L X X -
Office Equipment X X X -
Rental
Postage X X X The agency should maintain information regarding mailouts.If the agency has a Pitney Bowes machine or like postage machine,the records of
that machine must be on file.Likewise,if mail is categorized by payment source,then those records must be on file.For large mailouts,the agency
should keep a copy of the letter and a list of all addressees.
Printing X X X
Construction R X X This category is only available for REACH.
Building Materials
Sport and X X X -
Recreation
Equipment
'..
Cleaning Supplies X X X
Teaching Aids X X X '..
Craft Supplies X Ix I I Ix '..
Food Supplies X X X
Travel and Field
Trips,''.
lField Trip Ix Ix In addition to admission expenses,food expenses will also be allowed so long as the agency has a written policy stating that food and drinks are
Admission routine purchases on all field trips,not just Contract-funded field trips.
Expenses
Rent,'Utillties and Maintenance-If the follawm I expenses are alcTfora facility that'ls usedfor other"purposes besides the Contract program,then the bills must
Telephone X X -
Gas X X
Water/Wastewater X X
Electric X X
Solid Waste X X
Disposal
Facility X X X -
Maintenance and
Re airs
Custodial Services X X If services are provided per a contract agency will provide contract instead of invoices.
Rent X X
Miscellaneous
Contract Labor X X. X .. . . K
Insurance X X -
Required Under
the Contract
Childcare City requires that the agency submit its fee schedule,showing a breakout of income levels,and for each level a breakout of the portion of the
Scholarships expense to be paid by family and the portion to be reimbursed by the City.This fee schedule is required prior to the first payment.We also require -
the income efigibfity of each household so that we can determine if we are being changed in conformance with the fee schedule.If the fee -
schedule changes at any time during the contract year,the agency must notify City and provide a new schedule within 30 days of the change.
'Proof of payment effective October 1,2014: 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"Advace"or Statement AND Bank Statement indicating payroll;OR,
D)For wire or e-transfers:Reciept or statement from payee/vendor OR bank statement.
HOPWA PSA CONTRACT 2014-2015 Exhibit"F"--STANDARDS FOR COQ-fPLETE DOCUMENTATION
AIDS Outreach Center,Inc.
2
EXHIBIT "G"
SECTION 3 REPORTING FORMS
[See attached]
HOPWA PSA CONTRACT 2014-2015--EXHIBIT"G"—SECTION 3 REPORTING FORMS 1
AIDS Outreach Center,Inc.
EXHIBIT "Gil
Section 3 Summary ep® U.S.Department of Housing OMB Approval No: 2529-0043
Economic Opportunities for and Urban Development (exp.11/3012010)
Low—and Very Low-Income Persons Office of Fair Housing HUD Field Office:
And Equal Opportunity
Section back of page for Public Reporting Burden statement
1.Recipient Name&Address: (street,city,state,zip) 2.Federal Identification: (grant no.) 3. Total Amount of Award:
4.Contact Person 5.Phone: (Include area code)
6.Length of Grant: 7.Reporting Period:
8.Date Report Submitted: 9.Program Code: use separate sheet 10. Program Name:
for each program code)
Part I: Employment and Training Columns B,C and F are mandatory fields. Include New Hires in E&E F
A B C D
Number of Number of New %of Aggregate Number %of Total Staff Hours Number of Section 3
Job Category New Hires Hires that are of Staff Hours of New Hires for Section 3 Employees Trainees
Sec.3 Residents that are Sec.3 Residents and Trainees
Professionals
Technicians
Office/Clerical
Construction by Trade(List)
Trade
Trade
Trade
Trade
Trade
Other List
Total
'Pro ram Codes 3=Public/Indian Housing 4=Homeless Assistance 88=CODBG St to Administered
g A=Development,
2=Section 202/811 B=Operati on 5=HOME
1=Flexible Subsidy 6=HOME State Administered 10=Other Housing Programs
C=Modernization 7=CDBG Entitlement
Page 1 of 2 form HUD 60002(6/2001)
Ref 24 CFR 135
Part II: Contracts Awarded
1. Construction Contracts:
A. Total dollar amount of all contracts awarded on the project $
B. Total dollar amount of contracts awarded to Section 3 businesses $
C. Percentage of the total dollar amount that was awarded to Section 3 businesses
D. Total number of Section 3 businesses receiving contracts
2. Non-Construction Contracts:
A. Total dollar amount all non-construction contracts awarded on the project/activity $
B. Total dollar amount of non-construction contracts awarded to Section 3 businesses $
C. Percentage of the total dollar amount that was awarded to Section 3 businesses
D. Total number of Section 3 businesses receiving non-construction contracts
Part III: Summary
Indicate the efforts made to direct the employment and other economic opportunities generated by HUD financial assistance for housing
and community development programs,to the greatest extent feasible,toward low-and very low-income persons,particularly those who
are recipients of government assistance for housing. (Check all that apply.)
Attempted to recruit low-income residents through: local advertising media,signs prominently displayed at the project site,
contracts with the community organizations and public or private agencies operating within the metropolitan area(or
nonmetropolitan county)in which the Section 3 covered program or project is located,or similar methods.
Participated in a HUD program or other program which promotes the training or employment of Section 3 residents.
Participated in a HUD program or other program which promotes the award of contracts to business concerns which meet the
definition of Section 3 business concerns.
Coordinated with Youthbuild Programs administered in the metropolitan area in which the Section 3 covered project is located.
Other;describe below.
Public reporting for this collection of information is estimated to average 2 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.
This agency may not collect this information,and you are not required to complete this form,unless it displays a currently valid OMB
number.
Section 3 of the Housing and Urban Development Act of 1968,as amended,12 U.S.C.1701 u,mandates that the Department ensures that
employment and other economic opportunities generated by its housing and community development assistance programs are directed
toward low-and very-low income persons,particularly those who are recipients of government assistance housing. The regulations are
found at 24 CFR Part 135. The information will be used by the Department to monitor program recipients'compliance with Section 3,to
assess the results of the Department's efforts to meet the statutory objectives of Section 3,to prepare reports to Congress,and by
recipients as self-monitoring tool. The data is entered into a database and will be analyzed and distributed. The collection of information
involves recipients receiving Federal financial assistance for housing and community development programs covered by Section 3. The
information will be collected annually to assist HUD in meeting its reporting requirements under Section 808(e)(6)of the Fair Housing Act
and Section 916 of the HCDA of 1992. An assurance of confidentiality is not applicable to this form. The Privacy Act of 1974 and OMB
Circular A-108 are not applicable. The reporting requirements do not contain sensitive questions. Data is cumulative;personal identifying
information is not included.
Page 2 of 2 form HUD 60002(1112010)
Ref 24 CFR 135
1
Form HUD-60002,Section 3 Summary Report,Economic Opportunities for Low-and Very Low-income Persons.
Instructions: This form is to be used to report annual 8. Program Code: Enter the appropriate program code as listed at
accomplishments regarding employment and other economic the bottom of the page.
opportunities provided to low-and very low-income persons under 9. Program Name: Enter the name of HUD Program corresponding
Section 3 of the Housing and Urban Development Act of 1968. The
with the"Program Code"in number 8.
Section 3 regulations apply to any public and Indian housing part I: Employment and Training Opportunities
programs that receive: (1)development assistance pursuant a Column A: Contins various job categories. Professionals are
Section 5 of the U.S.Housing Act of 1937;(2)operating assistance
pursuant to Section 9 of the U.S.Housing Act of 1937;or(3) defined as people who have special knowledge of an occupation(i.e.
modernization grants pursuant to Section 14 of the U.S.Housing Act supervisors,architects,surveyors,planners,and computer
programmers). For construction positions,list each trade and provide
of 1937 and to recipients of housing and community development
assistance in excess of$200,000 expended for: (1)housing data in columns B through F for each trade where persons were
rehabilitation(including reduction and abatement of lead-based paint employed. The category of"Other"includes occupations such as
service workers.
hazards);(2)housing construction;or(3)other public construction
projects;and to contracts and subcontracts in excess of$100,000 c Column B: (Mandatory Field) Enter the number new hires for
awarded in connection with the Section-3-covered activity. each category of workers identified in Column A in connection with
this award. New hire refers to a person who is not on the contractor's
Form HUD-60002 has three parts,which are to be completed for
all programs covered by Section 3. Part I relates to employment or recipient's payroll for employment the time of selection for the
and training.The recipient has the option to determine numerical Section 3 covered award or at the time a of receipt of Section 3 covered
employment/training goals either on the basis of the number of hours assistance.
worked by new hires(columns B,D,E and F). Part II of the form Column C: (Mandatory Field) Enter the number of Section 3 new
relates to contracting,and Part III summarizes recipients'efforts to hires for each category of workers identified in Column A in
connection with this award. Section 3 new hire refers to a Section 3
comply with Section 3. resident who is not on the contractor's or recipient's payroll for
Recipients or contractors subject to Section 3 requirements must
maintain appropriate documentation to establish that HUD financial employment at the time of selection for the Section 3 covered award or
assistance for housing and community development programs were at the time of receipt of Section 3 covered assistance.
Column D: Enter the percentage of all the staff hours of new hires
directed toward low-and very low-income persons.* f recipient of
Section 3 covered assistance shall submit one copy l this report. Section 3 residents)in connection with this award.Column E: Enter the percentage of the total staff hours worked for
HUD Headquarters,Office of Fair Housing and Equal Opportunity.
Where the program providing assistance requires an annual Section 3 employees and trainees(including new hires)connected
with this award. Include staff hours for part-time and full-time
performance report,this Section 3 report is to be submitted at the wositions.
same time the program performance report is submitted. Where an Column F: (Mandatory Field Enter the number of Section 3
annual performance report is not required,this Section 3 report is to be residents that were trained elconnection ter th with this award.
submitted by January 10 and,if the project ends before December 31, part II: Contract Opportunities
within 10 days of project completion. Only Prime Recipients are Block 1: Construction Contracts
required to report to HUD. The report must include Item A: Enter the total dollar amount of all contracts awarded on the
accomplishments of all recipients and their Section 3 covered
contractors and subcontractors. project/program.
Item B: Enter the total dollar amount of contracts connected with this
HUD Field Office: Enter the Field Office name.
1. Recipient: Enter the name and address of the recipient project/program that were awarded to Section 3 businesses.
submitting this report. Item C: Enter the percentage of the total dollar amount of contracts
appears on the connected with this project/program awarded to Section 3 businesses.
2. Federal Identification: Enter the number that
award form(with dashes). The award may t a grant, Item D: Enter the number of Section 3 businesses receiving awards.
Block 2: Non-Construction Contracts
cooperative agreement or contract.
Dollar of Award: Enter the dollar amount,rounded to the
Item A: Enter the total dollar amount of all contracts awarded on the
3. project/program.
nearest dollar,received by the recipient. Item B: Enter the total dollar amount of contracts connected with this
e
4&5. Contact Person/Phone: Enterthe name and telephone number a ect awarded to Section 3 businesses.
of the person with knowledge of the award and the recipient's hero C: Enter the percentage of the total dollar amount of contracts
implementation of Section 3.
6. Reporting Period:indicate the time period(months and year) connected with this project/program awarded to Section 3 businesses.
Item D: Enter the number of Section 3 businesses receiving awards.
this report covers.
7. Date Report Submitted: Enter the appropriate date.
Part III: Summary of Efforts—Self-explanatory
Submit one(1)copy of this report to the HUD Headquarters Office of The Secretary may establish income ceilings higher or lower than 80 percent
Fair Housing and Equal Opportunity,at the same time the of the median for the area on the basis of the Secretary's findings such that
performance report is submitted to the program office. The Section 3 variations are necessary because of prevailing levels of construction costs
report is submitted by January 10. Include only contracts executed or unusually high-or low-income families. Very low-income persons mean
during the period specified in item 8. PHAs/IHAs are to report all low-income families(including single persons)whose incomes do not
contracts/subcontracts. exceed 50 percent of the median family income area,as determined by the
* The terms"low-income persons"and very low-income persons"have Secretary with adjustments or smaller and larger families,except that the
the same meanings given the terms in section 3(b)(2)of the United Secretary may establish income ceilings higher or lower than 50 percent of
States Housing Act of 1937. Low-income persons mean families the median for the area on the basis of the Secretary's findings that such
(including single persons)whose incomes do not exceed 80 percent of variations are necessary because of unusually high or low family incomes.
the median income for the area,as determined by the Secretary,with
adjustments for smaller and larger families,except that
form HUD 60002(11/2010)
Page i Ref 24 CFR 135
EXHIBIT "H"
OVERVIEW REPORT
[See attached]
HOPWA PSA CONTRACT 2014-2015--EXHIBIT"H'—OVERVIEW REPORT 1
AIDS Outreach Center,Inc.
�Q��eEUrp,�y
1
voG9 11�1��1 oQ u�
T
eqN DEVB'
Housing Opportunities for Persons With AIDS
(HOPWA) Program
Consolidated Annual Performance and
Evaluation Report (CAPER)
Measuring Performance Outcomes
Final Released 1/12/12
OMB Number 2506-0133(Expiration Date: 1013112014)
The CAPER report for HOPWA formula grantees provides annual information on program accomplishments
that supports program evaluation and the ability to measure program beneficiary outcomes as related to:
maintain housing stability;prevent homelessness;and improve access to care and support. This information is
also covered under the Consolidated Plan Management Process(CPMP)report and includes Narrative
Responses and Performance Charts required under the Consolidated Planning regulations. The public reporting
burden for the collection of information is estimated to average 42 hours per manual response,or less if an
automated data collection and retrieval system is in use,along with 60 hours for record keeping,including the
time for reviewing instructions,searching existing data sources,gathering and maintaining the data needed,and
completing and reviewing the collection of information.Grantees are required to report on the activities
undertaken only,thus there may be components of these reporting requirements that may not be applicable. This
agency may not conduct or sponsor,and a person is not required to respond to a collection of information unless
that collection displays a valid OMB control number.
Previous editions are obsolete form HUD-401 10-D(Expiration Date:10/31/2014)
Overview. The Consolidated Annual Performance and Evaluation Report Assistance,Housing Relocation&Stabilization Services,Employment,
(CAPER)provides annual performance reporting on client outputs and Education,General Health Status,,Pregnancy Status,Reasons for Leaving,
outcomes that enables an assessment of grantee performance in achieving the Veteran's Information,and Children's Education. Other HOPWA projects
housing stability outcome measure. The CAPER,in conjunction with the sponsors may also benefit from collecting these data elements.
- Integrated Disbursement Information System(IDIS),fulfills statutory and
regulatory program reporting requirements and provides the grantee and Final Assembly of Report. After the entire report is assembled,please
HUD with the necessary information to assess the overall program number each page sequentially.
performance and accomplishments against planned goals and objectives.
HOPWA formula grantees are required to submit a CAPER,and complete Filing Requirements. Within 90 days of the completion of each program
annual performance information for all activities undertaken during each year,grantees must submit their completed CAPER to the CPD Director in
program year in the IDIS,demonstrating coordination with other the grantee's State or Local HUD Field Office,and to the HOPWA Program
Consolidated Plan resources. HUD uses the CAPER and IDIS data to obtain Office:at HOPWA@Iiud.gov. Electronic submission to HOPWA Program
essential information on grant activities,project sponsors,Subrecipient office is preferred;however,if electronic submission is not possible,hard
copies can be mailed to:Office of HIV/AIDS Housing,Room 72
organizations,housing sites,units and households,and beneficiaries(which U.S.
includes racial and ethnic data on program participants). The Consolidated Department of Housing and Urban Development,451 Seventh Street,SW,
Plan Management Process tool(CPMP)provides an optional tool to integrate Washington,D.C.
the reporting of HOPWA specific activities with other planning and reporting
on Consolidated Plan activities. Record Keeping. Names and other individual information must be kept
confidential,as required by 24 CFR 574.440.However,HUD reserves the
Table of Contents right to review the information used to complete this report for grants
management oversight purposes,except for recording any names and other
PART 1:Grantee Executive Summary identifying information. In the case that HUD must review client level
1.Grantee Information data,no client names or identifying information will be retained or
2.Project Sponsor Information recorded. Information is reported in aggregate to HUD without
3.Administrative Subrecipient Information personal identification.Do not submit client or personal information in
4.Program Subrecipient Information data systems to HUD.
5.Grantee Narrative and Performance Assessment
a.Grantee and Community Overview
b.Annual Performance under the Action Plan Definitions
c.Barriers or Trends Overview Adjustment for Duplication: Enables the calculation of unduplicated
d.Assessment re Unmet Housing Needs output totals by accounting for the total number of households or units that
PART 2 Assessment
of Leveraging and Program Income received more than one type of HOPWA assistance in a given service
1. Sources of Leveraging category such as HOPWA Subsidy Assistance or Supportive Services.For
example,if a client household received both TBRA and STRMU during the
2.Program Income and Resident Rent Payments
PART 3•Accomplishment Data:Planned Goals and Actual Outputs operating year,report that household in the category of HOPWA Housing
PART 4•Summary of Performance Outcomes Subsidy Assistance in Part 3,Chart 1,Column[lb]in the following manner:
1.Housing Stability: Permanent Housing and Related Facilities
2.Prevention of Homelessness: Short-Term Housing Payments [1] Outputs'
3.Access to Care and Support: Housing Subsidy Assistance with HOPWA Housing Subsidy Number of
Supportive Services Assistance
PART 5•Worksheet-Determining Housing Stability Outcomes Households
PART 6•Annual Certification of Continued Use for HOPWA Facility- 1. Tenant-Based Rental Assistance
Based Stewardship Units(Only) 1
PART 7:Summary Overview of Grant Activities Permanent Housing Facilities:
A.Information on Individuals,Beneficiaries and Households Receiving 2a. Received Operating
HOPWA Housing Subsidy Assistance(TBRA,STRMU,PHP,Facility Subsidies/Leased units
Based Units,Master Leased Units ONLY) Transitional/Short-term Facilities:
B.Facility-Based Housing Assistance 2b. Received Operating Subsidies
Continued Use Periods. Grantees that received HOPWA funding for new Permanent Housing Facilities:
construction,acquisition,or substantial rehabilitations are required to operate Capital Development Projects placed
their facilities for HOPWA-eligible beneficiaries for a ten(10)years period. 3a. in service during the operating year
If no further HOPWA funds are used to support the facility,in place of
completing Section 7B of the CAPER,the grantee must submit an Annual
Certification of Continued Project Operation throughout the required use
periods. This certification is included in Part 6 in CAPER.The required use Transitional/Short-term Facilities:
period is three(3)years if the rehabilitation is non-substantial. 36 Capital Development Projects placed
in service during the operating year
In connection with the development of the Department's standards for
Homeless Management Information Systems(HMIS),universal data Short-term Rent,Mortgage,and
elements are being collected for clients of HOPWA-funded homeless 4.
Utility Assistance 1
assistance projects. These project sponsor/subrecipient records would Adjustment for duplication
include:Name,Social Security Number,Date of Birth,Ethnicity and Race, 5. subtract 1
Gender,Veteran Status,Disabling Conditions,Residence Prior to Program TOTAL Housing Subsidy
Entry,Zip Code of Last Permanent Address,Housing Status,Program Entry 6. Assistance(Sum of Rows 1-4 minus 1
Date,Program Exit Date,Personal Identification Number,and Household Row 5)
Identification Number. These are intended to match the elements under
HMIS.The HOPWA program-level data elements include:Income and
Sources,Non-Cash Benefits,HIV/AIDS Status,Services Provided,and
Housing Status or Destination at the end of the operating year. Other
suggested but optional elements are:Physical Disability,Developmental
Disability,Chronic Health Condition,Mental Health,Substance Abuse,
Domestic Violence,Date of Contact,Date of Engagement,Financial
Previous editions are obsolete Page i form HUD-40110-D(Expiration Date:10/31/2014)
Administrative Costs: Costs for general management,oversight, "grassroots."
coordination,evaluation,and reporting. By statute,grantee administrative
costs are limited to 3%of total grant award,to be expended over the life of HOPWA Eligible Individual: The one(1)low-income person with
the grant. Project sponsor administrative costs are limited to 7%of the HIV/AIDS who qualifies a household for HOPWA assistance.This person
portion of the grant amount they receive. may be considered"Head of Household"When the CAPER asks for
information on eligible individuals,report on this individual person only.
Beneficiary(ies):All members of a household who received HOPWA Where there is more than one person with HIV/AIDS in the household,the
assistance during the operating year including the one individual who additional PWH/A(s),would be considered a benefciary(s).
qualified the household for HOPWA assistance as well as any other
members of the household(with or without HIV)who benefitted from the HOPWA Housing Information Services: Services dedicated to helping
assistance. persons living with HIV/AIDS and their families to identify,locate,and
acquire housing.This may also include fair housing counseling for eligible
Central Contractor Registration(CCR): The primary registrant persons who may encounter discrimination based on race,color,religion,
database for the U.S.Federal Government.CCR collects,validates,stores, sex,age,national origin,familial status,or handicap/disability.
and disseminates data in support of agency acquisition missions,including
Federal agency contract and assistance awards.Both current and potential HOPWA Housing Subsidy Assistance Total: The unduplicated number
federal government registrants(grantees)are required to register in CCR of households receiving housing subsidies(TBRA,STRMU,Permanent
in order to be awarded contracts by the federal government.Registrants Housing Placement services and Master Leasing)and/or residing in units
must update or renew their registration at least once per year to maintain of facilities dedicated to persons living with HIV/AIDS and their families
an active status.Although recipients of direct federal contracts and grant and supported with HOPWA hinds during the operating year.
awards have been required to be registered with CCR since 2003,this
requirement is now being extended to indirect recipients of federal funds Household: A single individual or a family composed of two or more
with the passage of ARRA(American Recovery and Reinvestment Act). persons for which household incomes are used to determine eligibility and
Per ARRA and FFATA(Federal Funding Accountability and for calculation of the resident rent payment. The term is used for
Transparency Act)federal regulations,all grantees and sub-grantees or collecting data on changes in income,changes in access to services,receipt
subcontractors receiving federal grant awards or contracts must have a of housing information services,and outcomes on achieving housing
DUNS(Data Universal Numbering System)Number. stability.Live-In Aides(see definition for Live-In Aide)and non-
beneficiaries(e.g.a shared housing arrangement with a roommate)who
Chronically Homeless Person:An individual or family who:(i)is resided in the unit are not reported on in the CAPER.
homeless and lives or resides individual or family who:(i)Is homeless and
lives or resides in a place not meant for human habitation,a safe haven,or Housing Stability: The degree to which the HOPWA project assisted
in an emergency shelter;(ii)has been homeless and living or residing in a beneficiaries to remain in stable housing during the operating year. See
place not meant for human habitation,a safe haven,or in an emergency Part 5:Determining Housing Stability Outcomes for definitions of stable
shelter continuously for at least 1 year or on at least 4 separate occasions in and unstable housing situations.
the last 3 years;and(iii)has an adult head of household(or a minor head
of household if no adult is present in the household)with a diagnosable In-ldnd Leveraged Resources: These involve additional types of support
substance use disorder,serious mental illness,developmental disability(as provided to assist HOPWA beneficiaries such as volunteer services,
defined in section 102 of the Developmental Disabilities Assistance and materials,use of equipment and building space. The actual value of the
Bill of Rights Act of 2000(42 U.S.C.15002)),post traumatic stress support can be the contribution of professional services,based on
disorder,cognitive impairments resulting from a brain injury,or chronic customary rates for this specialized support,or actual costs contributed
physical illness or disability,including the co-occurrence of 2 or more of from other leveraged resources. In determining a rate for the contribution
those conditions.Additionally,the statutory definition includes as of volunteer time and services,use the rate established in HUD notices,
chronically homeless a person who currently lives or resides in an such as the rate of ten dollars per hour. The value of any donated material,
institutional care facility,including a jail,substance abuse or mental health equipment,building,or lease should be based on the fair market value at
treatment facility,hospital or other similar facility,and has resided there time of donation. Related documentation can be from recent bills of sales,
for fewer than 90 days if such person met the other criteria for homeless advertised prices,appraisals,or other information for comparable property
prior to entering that facility.(See 42 U.S.C.11360(2))This does not similarly situated.
include doubled-up or overcrowding situations.
Disabling Condition: Evidencing a diagnosable substance use disorder, Leveraged Funds: The amount of funds expended during the operating
serious mental illness,developmental disability,chronic physical illness, year from non-HOPWA federal,state,local,and private sources by
or disability,including the co-occurrence of two or more of these grantees or sponsors in dedicating assistance to this client population.
conditions. In addition,a disabling condition may limit an individual's Leveraged funds or other assistance are used directly in or in support of
ability to work or perform one or more activities of daily living.An HOPWA program delivery.
HIV/AIDS diagnosis is considered a disabling condition.
Live-In Aide: th person who resides with the HOPWA Eligible Individual
Facility-Based Housing Assistance: All eligible HOPWA Housing
expenditures for or associated with supporting facilities including and who meets the following criteria: (1)is essential to the care and
being of the person;(2)is not obligated for the support of the person;and and
community residences,SRO dwellings,short-term facilities,project-based (3)would not be living in the unit except to provide the necessary
rental units,master leased units,and other housing facilities approved by supportive services. See the Code of Federal Regulations Title 24,Part
HUD. 5.403 and the HOPWA Grantee Oversight Resource Guide for additional
Faith-Based Organization: Religious organizations of three types:(1)
reference.
congregations;(2)national networks,which include national
denominations,their social service arms(for example,Catholic Charities, Master Leasing:Applies to a nonprofit or public agency that leases units
Lutheran Social Services),and networks of related organizations(such as of housing(scattered-sites or entire buildings)from a landlord,and
YMCA and YWCA);and(3)freestanding religious organizations,which subleases the units to homeless or low-income tenants.By assuming the
are incorporated separately from congregations and national networks. tenancy burden,the agency facilitates housing of clients who may not be
able to maintain a lease on their own due to poor credit,evictions,or lack
Grassroots Organization: An organization headquartered in the local of sufficient income.
community where it provides services;has a social services budget of
$300,000 or less annually,and six or fewer full-time equivalent Operating Costs: Applies to facility-based housing only,for facilities
employees. Local affiliates of national organizations are not considered that are currently open. Operating costs can include day-to-day housing
Previous editions are obsolete Page ii form HUD-40110-D(Expiration Date:10/31/2014)
function and operation costs like utilities,maintenance,equipment, Subrecipient Organization: Any organization that receives funds from a
insurance,security,furnishings,supplies and salary for staff costs directly project sponsor to provide eligible housing and other support services
related to the housing project but not staff costs for delivering services. and/or administrative services as defined in 24 CFR 574.300. If a
Subrecipient organization provides housing and/or other supportive
Outcome: The degree to which the HOPWA assisted household has been services directly to clients,the subrecipient organization must provide
enabled to establish or maintain a stable living environment in housing that performance data on household served and funds expended. Funding
is safe,decent,and sanitary,(per the regulations at 24 CFR 574.310(b)) flows to subrecipients as follows:
and to reduce the risks of homelessness,and improve access to HIV
treatment and other health care and support. HUD Funding --->Grantee Project Sponsor— Subrecipient
Output: The number of units of housing or households that receive Tenant-Based Rental Assistance(TBRA): TBRA is a rental subsidy
HOPWA assistance during the operating year. program similar to the Housing Choice Voucher program that grantees can
provide to help low-income households access affordable housing. The
Permanent Housing Placement: A supportive housing service that helps TBRA voucher is not tied to a specific unit,so tenants may move to a
establish the household in the housing unit,including but not limited to different unit without losing their assistance,subject to individual program
reasonable costs for security deposits not to exceed two months of rent rules. The subsidy amount is determined in part based on household
costs. income and rental costs associated with the tenant's lease.
Program Income: Gross income directly generated from the use of Transgender: Transgender is defined as a person who identifies with,or
HOPWA funds,including repayments. See grant administration presents as,a gender that is different from his/her gender at birth.
requirements on program income for state and local governments at 24
Veteran: A veteran is someone who has served on active duty in the
CFR 85.25,or for non-profits at 24 CFR 84.24.
Armed Forces of the United States. This does not include inactive military
Project-Based Rental Assistance(PBRA): A rental subsidy program reserves or the National Guard unless the person was called up to active
that is tied to specific facilities or units owned or controlled by a project duty.
sponsor or Subrecipient. Assistance is tied directly to the properties and is
not portable or transferable.
Project Sponsor Organizations: Any nonprofit organization or
governmental housing agency that receives funds under a contract with the
grantee to provide eligible housing and other support services or
administrative services as defined in 24 CFR 574.300. Project Sponsor
organizations are required to provide performance data on households
served and funds expended. Funding flows to a project sponsor as
follows:
HUD Funding ----> Grantee-->Project Sponsor
Short-Term Rent,Mortgage,and Utility(STRMU)Assistance: A
time-limited,housing subsidy assistance designed to prevent homelessness
and increase housing stability. Grantees may provide assistance for tip to
21 weeks in any 52 week period. The amount of assistance varies per
client depending on funds available,tenant need and program guidelines.
Stewardship Units: Units developed with HOPWA,where HOPWA
funds were used for acquisition,new constriction and rehabilitation that
no longer receive operating subsidies from HOPWA. Report information
for the units is subject to the three-year use agreement if rehabilitation is
non-substantial and to the ten-year use agreement if rehabilitation is
substantial.
Previous editions are obsolete Page iii form HUD-40110-D(Expiration Date:10/31/2014)
Housing Opportunities for Person with AIDS (HOPWA)
Consolidated Annual Performance and Evaluation Report (CAPER)
Measuring Performance Outputs and Outcomes
OMB Number 2506-0133(Expiration Date: 10/3112014)
Part 1: Grantee Executive Summary
As applicable,complete the charts below to provide more detailed information about the agencies and organizations responsible
for the administration and implementation of the HOPWA program.Chart 1 requests general Grantee Information and Chart 2 is
to be completed for each organization selected or designated as a project sponsor,as defined by CFR 574.3. In Chart 3,indicate
each subrecipient organization with a contract/agreement of$25,000 or greater that assists grantees or project sponsors carrying
out their administrative or evaluation activities. In Chart 4,indicate each subrecipient organization with a contract/agreement to
provide HOPWA-funded services to client households. These elements address requirements in the Federal Funding and
Accountability and Transparency Act of 2006(Public Law 109-282).
Note:Please see the definition section for distinctions between project sponsor and subrecipient.
Note:If any information does not apply to your organization,please enter N/A. Do not leave any section blank.
1.Grantee Information
HUD Grant Number Operating Year for this report
From(MmIddlyy) To(mnn/ddUyy)
Grantee Name
Business Address
City,County,State,Zip
Employer Identification Number(EIN)or
Tax Identification Number TIN
DUN&Bradstreet Number(DUNs): Central Contractor Registration(CCR
Is the grantee's CCR status currently active?
❑Yes ❑No
If yes,provide CCR Number:
*Congressional District of Grantee's Business
Address
*Congressional District of Primary Service
Area(s)
*City(ies)and County(ies)of Primary Service Cities: Counties:
Area(s)
Organization's Website Address Is there a waiting lists)for HOPWA Housing Subsidy Assistance
Services in the Grantee service Area? ❑Yes ❑No
If yes,explain in the narrative section what services maintain a waiting
list and how this list is administered.
Service delivery area information only needed for program activities being directly carried out by the grantee.
Previous editions are obsolete Page 1 form HUD-40110-D(Expiration Date:10/31/2014)
2.Project Sponsor Information
Please complete Chart 2 for each organization designated or selected to serve as a project sponsor,as defined by CFR 574.3.
Use this section to report on organizations involved in the direct delivery of services for client households. These elements
address requirements in the Federal Financial Accountability and Transparency Act of 2006(Public Law 109-282).
Note:Please see the definitions for distinctions behteen project sponsor and subrecipient.
Note:If any information does not apply to your organization,please enter N/A.
Project Sponsor Agency Name Parent Company Name,if applicable
Name and Title of Contact at Project
Sponsor Agency
Email Address
Business Address
City,County,State,Zip,
Phone Number(with area torte)
Employer Identification Number(EIN)or Fax Number(with area code)
Tax Identification Number(TIN)
DUN&Bradstreet Number(DUNs):
Congressional District of Project Sponsor's
Business Address
Congressional District(s)of Primary Service
Area(s)
City(ies)and County(ies)of Primary Service Cities: Counties:
Areas)
Total HOPWA contract amount for this
Organization for the operating ear
Organization's Website Address
=Does zation maintain a waiting list? ❑Yes ❑No
Is the sponsor a nonprofit organization? ❑Yes Please check ifyes and a faith-based organization. ❑ he narrative section how this list is administered.
Please check if yes and a grassroots organization. ❑
Previous editions are obsolete Page 2 form HUD-40110-D(Expiration Date:10/3112014)
3.Administrative Subrecipient Information
Use Chart 3 to provide the following information for each subrecipient with a contract/agreement of$25,000 or greater that
assists project sponsors to carry out their administrative services but no services directly to client households. Agreements
include:grants,subgrants,loans,awards,cooperative agreements,and other forms of financial assistance;and contracts,
subcontracts,purchase orders,task orders,and delivery orders. (Organizations listed may have contracts with project sponsors)
These elements address requirements in the Federal Funding and Accountability and Transparency Act of 2006(Public Law 109-
282).
Note:Please see the definitions for distinctions between project sponsor and subrecipient.
Note:If any information does not apply to your organization,please enter N/A.
Subrecipient Name Parent Company Name,if applicable
Name and Title of Contact at Subrecipient
Email Address
Business Address
City,State,Zip,County
Phone Number(with area code) Fax Number(include area code)
Employer Identification Number(EIN)or
Tax Identification Number TIN
DUN&Bradstreet Number(DUNs):
North American Industry Classification
System AICS Code
Congressional District of Subrecipient's
Business Address
Congressional District of Primary Service
Area
City(ies)and County(ies)of Primary Service Cities: Counties:
rTotal rea s
HOPWA Subcontract Amount of this
r anization for the o eratin ear
Previous editions are obsolete Page 3 form HUD-40110-D(Expiration Date:1013112014)
4.Program Subrecipient Information
Complete the following information for each subrecipient organization providing HOPWA-funded services to client households.
These organizations would hold a contract/agreement with a project sponsor(s)to provide these services. For example,a
subrecipient organization may receive funds from a project sponsor to provide nutritional services for clients residing within a
HOPWA facility-based housing program.Please note that subrecipients who work directly with client households must provide
performance data for the grantee to include in Parts 2-7 of the CAPER.
Note:Please see the definition of a subrecipient for more information.
Note:Types of contracts/agreements may include:grants,sub-grants, loans, awards, cooperative agreements, and other forms
of financial assistance;and contracts,subcontracts,purchase orders, task orders, and delivery orders.
Note:If any information is not applicable to the organization,please report N/A in the appropriate box.Do not leave boxes
blank.
Sub-recipient Name Parent Company Name,if applicable
Name and Title of Contact at Contractor/
Sub-contractor Agency
Email Address
Business Address
City,County,State,Zip
Fax Number(include area code)
Phone Number(included area code)
Employer Identification Number(EIN)or
Tax Identification Number(TIN)
DUN&Bradstreet Number(DUNs)
North American Industry Classification
System(NAICS)Code
Congressional District of the Sub-recipient's
Business Address
Congressional District(s)of Primary Service
Area
City(ies)and County(ies)of Primary Service Cities: Counties:
Area
Total HOPWA Subcontract Amount of this
Organization for the operating year
Previous editions are obsolete Page 4 form HUD-40110-D(Expiration Date:10/31/2014)
5 Grantee Narrative and Performance Assessment
a Grantee and Community Overview
Provide a one to three page narrative summarizing major achievements and highlights that were proposed and completed during
the program year. Include a brief description of the grant organization,area of service,the name(s)of the program contact(s),
and an overview of the range/type of housing activities provided. This overview may be used for public information,including
posting on HUD's website. Note: Text fields are expandable.
F__
b.Annual Performance under the Action Plan
Provide a narrative addressing each of the following four items:
1. Outputs Reported. Describe significant accomplishments or challenges in achieving the number of housing units supported
and the number households assisted with HOPWA funds during this operating year compared to plans for this assistance,as
approved in the Consolidated Plan/Action Plan. Describe how HOPWA funds were distributed during your program year among
different categories of housing and geographic areas to address needs throughout the grant service area,consistent with approved
plans.
2. Outcomes Assessed. Assess your program's success in enabling HOPWA beneficiaries to establish and/or better maintain a
stable living environment in housing that is safe,decent,and sanitary,and improve access to care. Compare current year results
to baseline results for clients. Describe how program activities/projects contributed to meeting stated goals. If program did not
achieve expected targets,please describe how your program plans to address challenges in program implementation and the steps
currently being taken to achieve goals in next operating year. If your program exceeded program targets,please describe
strategies the program utilized and how those contributed to program successes.
3.Coordination. Report on program coordination with other mainstream housing and supportive services resources,including
the use of committed leveraging from other public and private sources that helped to address needs for eligible persons identified
in the Consolidated Plan/Strategic Plan.
4.Technical Assistance. Describe any program technical assistance needs and how they would benefit program beneficiaries.
c.Barriers and Trends Overview
Provide a narrative addressing items 1 through 3.Explain how barriers and trends affected your program's ability to achieve the
objectives and outcomes discussed in the previous section.
1.Describe any barriers(including regulatory and non-regulatory)encountered in the administration or implementation of
the HOPWA program,how they affected your program's ability to achieve the objectives and outcomes discussed,and,
actions taken in response to barriers,and recommendations for program improvement.Provide an explanation for each
barrier selected.
❑HOPWA/HUD Regulations ❑Planning ❑Housing Availability ❑Rent Determination and Fair Market
Rents
❑Discrimination/Confidentiality ❑Multiple Diagnoses ❑Eligibility ❑Technical Assistance or Training
❑Supportive Services ❑Credit History ❑Rental History ❑Criminal Justice History
❑Housing Affordability ❑Geography/Rural Access ❑Other,please explain further
Previous editions are obsolete Page 5 form HUD-40110-D(Expiration Date:10/31/2014)
2.Describe any trends in the community that may affect the way in which the needs of persons living with HIV/AIDS
are being addressed,and provide any other information important to the future provision of services to this population.
3.Identify any evaluations,studies,or other assessments of the HOPWA program that are available to the public.
d Unmet Housing Needs:An Assessment of Unmet Housing Needs
In Chart 1,provide an assessment of the number of HOPWA-eligible households that require HOPWA housing subsidy
assistance but are not currently served by any HOPWA-funded housing subsidy assistance in this service area.
In Row 1,report the total unmet need of the geographical service area,as reported in Unmet Needs for Persons with Hilt/AIDS,
Chart 1B of the Consolidated or Annual Plan(s),or as reported under HOPWA worksheet in the Needs Workbook of the
Consolidated Planning Management Process(CPMP)tool.
Note:Report most current data available, through Consolidated or Annual Plan(s), and accountfor local housing issues, or
changes in HIV/AIDS cases, by using combination of one or more of the sources in Chart 2.
If data is collected on the type of housing that is needed in Rows a.through c.,enter the number of HOPWA-eligible households
by type of housing subsidy assistance needed. For an approximate breakdown of overall unmet need by type of housing subsidy
assistance refer to the Consolidated or Annual Plan(s),CPMP tool or local distribution of funds.Do not include clients who are
already receiving HOPWA-funded housing subsidy assistance.
Refer to Chart 2,and check all sources consulted to calculate unmet need. Reference any data from neighboring states'or
municipalities' Consolidated Plan or other planning efforts that informed the assessment of Unmet Need in your service area.
Note: In order to ensure that the unmet creed assessment for the region is comprehensive,HOPWA formula grantees should
include those unmet needs assessed by HOPWA competitive grantees operating within the service area
1. Plannine Estimate of Area's Unmet Needs for HOPWA-Eli ible Households
1. Total number of households that have unmet
housing subsidy assistance need.
2. From the total reported in Row 1,identify the
number of households with unmet housing needs
by type of housing subsidy assistance:
a.Tenant-Based Rental Assistance(TBRA)
b.Short-Term Rent,Mortgage and Utility payments
(STRMU)
• Assistance with rental costs
• Assistance with mortgage payments
• Assistance with utility costs.
c.Housing Facilities,such as community residences,
SRO dwellings,other housing facilities
Previous editions are obsolete Page 6 form HUD-40110-D(Expiration Date:10/31/2014)
2.Recommended Data Sources for Assessing Unmet Need check all sources used
=Data as reported in the area Consolidated Plan,e.g.Table 1B,CPMP charts,and related narratives
=Data established by area HIV/AIDS housing planning and coordination efforts,e.g.Continuum of Care
=Data from client information provided in Homeless Management Information Systems(HMIS)
=Data from project sponsors or housing providers,including waiting lists for assistance or other assessments on need including those
completed by HOPWA competitive grantees operating in the region.
=Data from prisons or jails on persons being discharged with HIV/AIDS,if mandatory testing is conducted
=Data from local Ryan White Planning Councils or reported in CARE Act Data Reports,e.g.number of clients with permanent
housing
=Data collected for HIV/AIDS surveillance reporting or other health assessments,e.g.local health department or CDC surveillance data
End of PART 1
Previous editions are obsolete Page 7 form HUD-40110-D(Expiration Date:10/31/2014)
PART 2: Sources of Leveraging and Program Income
1. Sources of Leveraging
Report the source(s)of cash or in-kind leveraged federal,state,local or private resources identified in the Consolidated or
Annual Plan and used in the delivery of the HOPWA program and the amount of leveraged dollars. In Column[1],identify the
type of leveraging. Some common sources of leveraged funds have been provided as a reference point. You may add Rows as
necessary to report all sources of leveraged funds. Include Resident Rent payments paid by clients directly to private landlords.
Do NOT include rents paid directly to a HOPWA program as this will be reported in the next section.In Column[2]report the
amount of leveraged funds expended during the operating year. Use Column[3]to provide some detail about the type of
leveraged contribution(e.g.,case management services or clothing donations). In Column[4],check the appropriate box to
indicate whether the leveraged contribution was a housing subsidy assistance or another form of support.
Note: Be sure to report on the number of households supported with these leveraged funds in Part 3, Chart 1, Cohrrnn d.
A. Source of Leveraging Chart
[2]Amount
of Leveraged [3]Type of [4]Housing Subsidy
1 Source of Leveraging Funds Contribution Assistance or Other Support
Public Funding ❑Housing Subsidy Assistance
El
Other Su ort
Ryan White-Housing Assistance ❑Housing Subsidy Assistance
Ryan White-Other El Other Support
❑Housing Subsidy Assistance
Housing Choice Voucher Program ❑Other Support
❑Housing Subsidy Assistance
Low Income Housing Tax Credit ❑Other Support
❑Housing Subsidy Assistance
❑Other Support
HOME ❑Housing Subsidy Assistance
Shelter Plus Care ❑Other Support
❑Housing Subsidy Assistance
❑Other Support
Emergency Solutions Grant OHousing Subsidy Assistance
Other Public: ❑Other Support
❑Housing Subsidy Assistance
Other Public: ❑Other Support
❑Housing Subsidy Assistance
❑Other Support
Other Public: ❑Housing Subsidy Assistance
Other Public: ❑Other Support
❑Housing Subsidy Assistance
❑Other Support
Other Public:
Private Funding ❑Housing Subsidy Assistance
❑Other Support
Grants OHousing Subsidy Assistance
❑
In-kind Resources Other Support
❑Housing Subsidy Assistance
Other Private: ❑Other Support
❑Housing Subsidy Assistance
❑Other Support
Other Private:
Other Funding ❑Housing Subsidy Assistance
Grantee/Project Sponsor/Subrecipient(Agency)Cash
❑Other Support
Resident Rent Payments by Client to Private Landlord
TOTAL(Sum of all Rows)
Pa e 8 form HUD-401 10-D(Expiration Date:10/31/2014)
Previous editions are obsolete g
2. Program Income and Resident Rent Payments
In Section 2,Chart A.,report the total amount of program income and resident rent payments directly generated from the use of
HOPWA funds,including repayments.Include resident rent payments collected or paid directly to the HOPWA program. Do
NOT include payments made directly from a client household to a private landlord.
Note:Please see report directions section for definition of program income. (Additional information on program income is
available in the HOPWA Grantee Oversight Resource Guide).
A. Total Amount Program Income and Resident Rent Payment Collected During the Operating Year
Total Amount of
Program Income
Program Income and Resident Rent Payments Collected (for this operating
year)
1. Program income(e.g.repayments)
2. Resident Rent Payments made directly to HOPWA Program
3. Total Program Income and Resident Rent Payments(Sum of Rows 1 and 2)
B. Program Income and Resident Rent Payments Expended To Assist HOPWA Households
In Chart B,report on the total program income and resident rent payments(as reported above in Chart A)expended during the
operating year. Use Row 1 to report Program Income and Resident Rent Payments expended on Housing Subsidy Assistance
Programs(i.e.,TBRA,STRMU,PEP,Master Leased Units,and Facility-Based Housing). Use Row 2 to report on the Program
Income and Resident Rent Payment expended on Supportive Services and other non-direct Housing Costs.
Total Amount of Program
Income Expended
Program Income and Resident Rent Payment Expended on (for this operating year)
HOPWA programs
1. Program Income and Resident Rent Payment Expended on Housing Subsidy Assistance costs
2. Program Income and Resident Rent Payment Expended on Supportive Services and other non-
direct housing costs
3. Total Program Income Expended(Sum of Rows 1 and 2)
End of PART 2
Previous editions are obsolete Page 9 form HUD-40110-1)(Expiration Date:10/31/2014)
PART 3: Accomplishment Data Planned Goal and Actual Outputs
In Chart 1,enter performance information(goals and actual outputs)for all activities undertaken during the operating year
supported with HOPWA funds. Performance is measured by the number of households and units of housing that were supported
with HOPWA or other federal,state,local,or private funds for the purposes of providing housing assistance and support to
persons living with HIV/AIDS and their families.
Note: The total households assisted with HOPWA fiends and reported in PART 3 of the CAPER should be the same as reported
in the annual year-end IDIS data, and goals reported should be consistent~Pith the Annual Plan information. Any discrepancies
or deviations should be explained in the narrative section of PART 1.
1. HOPWA Performance Planned Goal and Actual Outputs
[11 Output: Households 121 Output:Funding
HOPWA Leveraged
HOPWA Performance Assistance Households HOPWA Funds,
Planned Goal a. b. c. d, e. f.
and Actual 3
0
' t:Ho 2'Ou mr.Fundin
HOPWA Housing Subsidy Assistance I Ouuu
L enant-Based Rental Assistance
Fa. Permanent Housing Facilities:
Received Op erating Subsidies/Leased units(Households Served)
b. Transitional/Short-term Facilities:
Received Operating Subsidies/Leased units(Households Served)
(Households Served)
3a. Permanent Housing Facilities:
Capital Development Projects placed in service during the operating year
(Households Served)
3b. Transitional/Short-term Facilities:
Capital Development Projects placed in service during the operating year
(Households Served)
4. Short-Term Rent,Mortgage and Utility Assistance
5. ermanent Housing Placement Services
6. djustments for duplication(subtract)
7. OEM—
Total HOPWA Housing Subsidy Assistance
(Columns a.—d. equal the sum of Rows 1-5 minus Row 6; Columns e.and f.equal
the sum of Rows 1-5)
Housing Development(Construction and Stewardship of facility based housing)
110 u ut:Hous;n' Units 2 Ou ut:Funding
8. Facility-based units;
Capital Development Projects not yet opened(Housing Units)
9. Stewardship Units subject to 3 or 10 year use agreements
10. Total Housing Developed
(Sum of Rows 78&9)
Supportive Services ! 1 Out'ur Households 2 On ut:Funding
l la.Supportive Services provided by project sponsors/subrecipient that also delivered
HOPWA housing subsidy assistance
11—b Supportive Services provided by project sponsors/subrecipient that only provided
Supportive services.
12. Adjustment for duplication(subtract)
13. Total Supportive Services
(Columns a.—d.equal the sum of Rows 11 a.&b.minus Row 12;Columns e.and f
equal the sum of Rows Ila.&11 b. 2 Fundin
Housing Information'Services [1]OutputHo'useliolds`:` l I output:1 B
14. Housing Information Services
I5. otal Housing Information Services
Previous editions are obsolete Page 10 form HUD-40110-D(Expiration Date:10/31/2014)
Grant Administration and Other Activities [11 Output Households [21 Output:Funding
16. Resource Identification to establish,coordinate and develop housing assistance resources -
17. Technical Assistance _
(if approved in grant agreement)
18. Grantee Administration
(maximum 3%of total HOPWA grant)
19. Project Sponsor Administration
(maximum 7%of portion of HOPWA grant awarded)
0. ITotal Grant Administration and Other Activities
(Sum of Rows 16-19)
121 Outputs: HOPWA Funds P
total Expended Ex ended
Budget Actual
1. Total Expenditures for program year(Sum of Rows 7,10,13,15,and 20)
2.Listing of Supportive Services
Report on the households served and use of HOPWA funds for all supportive services. Do NOT report on supportive services
leveraged with non-HOPWA funds.
Data check:Total unduplicated households and expenditures reported in Roly 17 equal totals reported in Part 3,Chart 1,Row 13.
Supportive Services [11 Output:Number of Households [2]Output:Amount of HOPWA Funds
Expended
1. Adult day care and personal assistance
2. Alcohol and drug abuse services
3. Case management
4. Child care and other child services
5. Education
6. Employment assistance and training
Health/medical/intensive care services,if approved
7. Note: Client records inust confonn with 24 CFR§574.310
8. Legal services
9. Life skills management(outside of case management)
10. Meals/nutritional services
11. Mental health services
12. Outreach
13. Trans ort ation
Other Activity(if approved in grant agreement).
14. Specify:
-- --- - - -- - ---
Sub-Total Households receiving Supportive Services
15. Sum of Rows 1-14)
Ad'ustment for Duplication(subtract)
TOTAL Unduplicated Households receiving
Supportive Services(Column[1]equals Row 15
17. minus Row 16;Column 2]equals sum of Rows 1-14
Previous editions are obsolete Page 11 form HUD-40110-D(Expiration Date:10/31/2014)
3.Short-Term Rent,Mortgage and Utility Assistance(STRMU)Summary
In Row a.,enter the total number of households served and the amount of HOPWA funds expended on Short-Term Rent,
Mortgage and Utility(STRMU)Assistance. In Row b.,enter the total number of STRMU-assisted households that received
assistance with mortgage costs only(no utility costs)and the amount expended assisting these households. In Row c.,enter the
total number of STRMU-assisted households that received assistance with both mortgage and utility costs and the amount
expended assisting these households. In Row d.,enter the total number of STRMU-assisted households that received assistance
with rental costs only(no utility costs)and the amount expended assisting these households. In Row e.,enter the total number of
STRMU-assisted households that received assistance with both rental and utility costs and the amount expended assisting these
households. In Row f.,enter the total number of STRMU-assisted households that received assistance with utility costs only(not
including rent or mortgage costs)and the amount expended assisting these households. In row g.,report the amount of STRMU
funds expended to support direct program costs such as program operation staff.
Data Check:The total households reported as served ivith STRDIU in Row a.,cohmrn[11 and the total amount ofHOPWA funds reported as
expended in Row a.,column[21 equals the household and expenditure total reported for STRMU in Part 3, Chart 1,Row 4, Colmmns b.and f.,
respectively.
Data Check:The total number of households reported in Column[1],Rows b.,c.,d,e.,and f.equal the total number of STRMUhouseholds
reported in Column[1],Row a. The total amount reported as expended in Cohmnn[21,Rows b.,c.,d,e.,f.,and g.equal the total amount of
STRMU expenditures reported in Column[2],Row a.
[1] Output: Number of [2]Output:Total
Househ Served HOP
Housing Subsidy Assistance Categories(STRMU) olds on n S Funds Expended
STRMU during
Operating Year
Total Short-term mortgage,rent and/or utility(STRMU)
a. assistance
Of the total STRMU reported on Row a,total who received
b. assistance with mortgage costs ONLY.
Of the total STRMU reported on Row a.total who received
c• assistance with mortgage and utility costs.
Of the total STRMU reported on Row a,total who received
d. assistance with rental costs ONLY.
Of the total STRMU reported on Row a,total who received
e. assistance with rental and utility costs.
Of the total STRMU reported on Row a,total who received
f. assistance with utility costs ONLY.
Direct program delivery costs(e.g.,program operations staff
time)
g•
End of PART 3
Previous editions are obsolete Page 12 form HUD-40110-D(Expiration Date:10/31/2014)
Part 4: Summary of Performance Outcomes
In Column[1],report the total number of eligible households that received HOPWA housing subsidy assistance,by type.
In Column[2],enter the number of households that continued to access each type of housing subsidy assistance into next
operating year. In Column[3],report the housing status of all households that exited the program.
Data Check:The suns of Columns[2](Number of Households Continuing)and[3](Exited Households)equals the total reported in Colunin[I].
Note:Refer to the housing stability codes that appear in Part 5: Worksheet-Determining Housing Stability Outcomes.
Section 1.Housing Stability:Assessment of Client Outcomes on Maintaining Housing Stability(Permanent Housing and
Related Facilities)
A.Permanent ousing Subsidy Assistance
[1]Output:Total [2]Assessment:Number of [31 Assessment:Number of
Number of Households that Continued Households that exited this [4]HOPWA Client
Households Receiving HOPWA Housing HOPWA Program;their Housing Outcomes
Served Subsidy Assistance into the Next Status after Exiting
Operating Year
1 Emergency Shelter/Streets Unstable Arrangentents
2 Temporary Housing Temporarily Stable,with Reduced
Risk of Homelessness
3 Private Housing
Tenant-Based 4 Other HOPWA
Rental Stable/Permanent Housing(PH)
Assistance 5 Other Subsidy
6 Institution
7 Jail/Prison
Unstable Arrangements
8 Disconnected/Unknown
9 Death Life Event
1 Emergency Shelter/Streets Unstable Arrangements
2 Temporary Housing Temporarily Stable,with Reduced
Risk of Homelessness
3 Private Housing
Permanent 4 Other HOPNVA
Supportive Stable/Per•tnanent Housing(PH)
Housing 5 Other Subsidy
Facilities/Units 6 Institution
7 Jail/Prison
8 Disconnected/Unknown Unstable Arrangements
9 Death Life Event
B.Transitional Housing Assistance
[1]Output: Total [2]Assessment:Number of [3]Assessment:Number of
Number of Households that Continued Households that exited this
Households Receiving HOPWA Housing HOPWA Program;their [4]HOPWA Client Outcomes
Served Subsidy Assistance into the Next Housing Status after Exiting
Operating Year
1 Emergency Shelter/Streets Unstable Arrangements
2 Temporary Housing Temporarily Stable with Reduced
Risk of Homelessness
Transitional/ 3 Private Housing
Short-Term 4 Other HOPWA
Housing Stable/Permanent Housing(PH)
Facilities/Units 5 Other Subsidy
6 Institution
7 Jail/Prison
Unstable Arrangements
8 Disconnected/unknown
9 Death Life Event
form HUD-40110-D(Expiration Date:10/31/2014)
Previous editions are obsolete Page 13
B 1:Total number of households receiving transitional/short-term housing
assistance whose tenure exceeded 24 months
Section 2.Prevention of Homelessness: Assessment of Client Outcomes on Reduced Risks of Homelessness
(Short-Term Housing Subsidy Assistance)
Report the total number of households that received STRMU assistance in Column[1].
In Column[2],identify the outcomes of the households reported in Column[1]either at the time that they were known to have
left the STRMU program or through the project sponsor or subrecipient's best assessment for stability at the end of the operating
year.
Information in Column[3]provides a description of housing outcomes;therefore,data is not required.
At the bottom of the chart:
® assistance during the operating year of this report,and the
In Row la.,report those households that received STRMU
prior operating year.
at received STRMU assistance during the operating year of this report,and the
In Row lb.,report those households th
two prior operating years.
Data Check: The total households reported as served with STRMU in Column[1]equals the total reported in Part 3, Chart 1,
Row 4, Column b.
Data Check: The sum of Coh[mn[2]should equal the number of households reported in Column[1].
Assessment of Households that Received STRMU Assistance
[11 Output:Total [21 Assessment of Housing Status [3]HOPWA Client Outcomes
number of
households
Maintain Private Housing without subsidy
(e.g.Assistance provided/completed and client is stable,not
likely to seek additional support
Other Private Housing without subsidy
(e.g.client switched housing units and is now stable,not likely
to seek additional support) Stable/Permanent Housing(PH)
Other HOPWA Housing Subsidy Assistance
Other Housing Subsidy(PH)
Institution
(e.g.residential and long-term care)
Likely that additional STRMU is needed to maintain current
housing arrangements
Transitional Facilities/Short-term Temporarily Stable,with
(e.g.temporary or transitional arrangement) Reduced Risk of Homelessness
Temporary/Non-Permanent Housing arrangement
(e.g.gave up lease,and moved in with family or friends but
expects to live there less than 90 days)
Emergency Shelter/street
Jail/Prison Unstable Arrangements
Disconnected
Death Life Event
Ia.Total number of those households that received STRMU Assistance in the operating year of this report that also received
STRMU assistance in the prior operating year(e.g.households that received STRMU assistance in two consecutive operating
years).
1b.Total member of those households that received STRMU Assistance in the operating year of this report that also received
STRMIJ assistance in the two prior operating years(e.g.households that received STRMU assistance in three consecutive
operating years).
Previous editions are obsolete Page 14 form HUD-40110-D(Expiration Date:10/31/2014)
Section 3.HOPWA Outcomes on Access to Care and Support
Ia. Total Number of Households
Line[1]:For project sponsors/subrecipients that provided HOPWA housing subsidy assistance during the operating year
identify in the appropriate row the number of households that received HOPWA housing subsidy assistance(TBRA,
STRMU,Facility-Based,PHP and Master Leasing)and HOPWA funded case management services. Use Row c.to adjust
for duplication among the service categories and Row d.to provide an unduplicated household total.
Line[2]:For project sponsors/subrecipients that did NOT provide HOPWA housing subsidy assistance identify in the
appropriate row the number of households that received HOPWA funded case management services.
Note: These numbers will help you to determine which clients to report Access to Care and Support Outcomes for and will be
used by HUD as a basis for analyzing the percentage of households who demonstrated or maintained connections to care and
support as identified in Chart 1b. below.
Total Number of Households
1. For Project Sponsors/Subrecipients that provided HOPWA Housing Subsidy Assistance: Identify the total number of households that
received the following HOPWA-ftuided services:
a. Housing Subsidy Assistance(duplicated)-TBRA,STRMU,PHP,Facility-Based Housing,and Master Leasing
b. Case Management
C. Adjustment for duplication(subtraction)
d. Total Households Served by Project Sponsors/Subrecipients with Housing Subsidy Assistance(Sum of Rows a.b.
minus Row c.)
2. For Project Sponsors/Subrecipients did NOT provide HOPNA Housing Subsidy Assistance: Identify the total number of households that
received the following HOPWA-funded service:
a. HOPWA Case Management
b. Total Households Served by Project Sponsors/Subrecipients without Housing Subsidy Assistance
lb. Status of Households Accessing Care and Support
Column[1]:Of the households identified as receiving services from project sponsors/subrecipients that provided HOPWA
housing subsidy assistance as identified in Chart 1 a.,Row 1 d.above,report the number of households that demonstrated
access or maintained connections to care and support within the program year.
Column[2]:Of the households identified as receiving services from project sponsors/subrecipients that did NOT provide
HOPWA housing subsidy assistance as reported in Chart Ia.,Row 2b.,report the number of households that demonstrated
improved access or maintained connections to care and support within the program year.
Note:For information on es and sources of income and medical insurance/assistance, refer to Charts below.
[1]For project 121 For project
sponsors/subrecipients that
sponsors/subrecipients that did NOT provide HOPWA Outcome
Categories of Services Accessed provided HOPWA housing subsidy housing subsidy assistance, Indicator
assistance,identify the households identify the households who
who demonstrated the following: demonstrated the following:
Support for
1.Has a housing plan for maintaining or establishing stable on- Stable
going housing Housing
2.Had contact with case manager/benefits counselor consistent Access to
with the schedule specified in client's individual service plan
(may include leveraged services such as Ryan White Medical Support
Case Management)
3.Had contact with a primary health care provider consistent Access to
with the schedule specified in client's individual service plan Health Care
Access to
4.Accessed and maintained medical insurance/assistance Health Care
5.Successfully accessed or maintained qualification for sources Sources of
Income
of income
Previous editions are obsolete Page 15 form HUD-40110-D(Expiration Date:10/31/2014)
Chart 1b.,Line 4: Sources of Medical Insurance and Assistance include,but are not limited to the following
(Reference only)
• MEDICAID Health Insurance Program,or • Veterans Affairs Medical Services • Ryan White-funded Medical or Dental
use local program • AIDS Drug Assistance Program(ADAP)
name • State Children's Health Insurance Program Assistance
• MEDICARE Health Insurance Program,or (SCHIP),or use local program name
use local program name
Chart lb.,Row 5: Sources of Income include,but are not limited to the following Reference only)
• Earned Income • Child Support • General Assistance(GA),or use local
• Veteran's Pension • Social Security Disability Income(SSDI) program name
• Unemployment Insurance • Alimony or other Spousal Support • Private Disability Insurance
• Pension from Former Job • Veteran's Disability Payment • Temporary Assistance for Needy
• Supplemental Security Income(SSI) • Retirement Income from Social Security Families(TANF)
a Worker's Compensation • Other Income Sources
lc.Households that Obtained Employment
Column[1]:Of the households identified as receiving services from project sponsors/subrecipients that provided HOPWA
housing subsidy assistance as identified in Chart la.,Row ld.above,report on the number of households that include
persons who obtained an income-producing job during the operating year that resulted from HOPWA-funded Job training,
employment assistance,education or related case management/counseling services.
Column[2]:Of the households identified as receiving services from project sponsors/subrecipients that did NOT provide
HOPWA housing subsidy assistance as reported in Chart la.,Row 2b.,report on the number of households that include
persons who obtained an income-producing job during the operating year that resulted from HOPWA-funded Job training,
employment assistance,education or case management/counseling services.
Note: This includes jobs created by this project sponsor/subrecipients or obtained outside this agency.
Note: Do not include jobs that resulted from leveraged job training, employment assistance, education or case
management/counseling services.
[1 For project sponsors/subrecipients that 121 For project sponsors/subrecipients that did
provided HOPWA housing subsidy NOT provide HOPWA housing subsidy assistance,
Categories of Services Accessed assistance,identify the households who identify the households who demonstrated the
demonstrated the following: followin :
Total number of households that
obtained an income-producing job
End of PART 4
Previous editions are obsolete Page 16 form HUD-40110-D(Expiration Date:10/31/2014)
PART 5: Worksheet-Determining Housing Stability Outcomes(optional)
1.This chart is designed to assess program results based on the information reported in Part 4 and to help Grantees determine
overall program erformance. Com le on of this worksheet is o tional.
Permanent Stable Housing Temporary Housing Unstable Life Event
Housing Subsidy (#of households (2) Arrangements (9)
Assistance remaining in program (1+7+8)
plus 3+4+5+6)
Tenant-Based
Rental Assistance
(TBRA
Permanent Facility-
based Housing
Assistance/Units
Transitional/Short-
Term Facility-based
Housing
Assistance/Units
Total Permanent
HOPWA Housing
Subsidy Assistance
Reduced Risk of Stable/Permanent Temporarily Stable,with Reduced Risk of Unstable Life Events
Homelessness: Housing Homelessness Arrangements
Short-Term
Assistance
Short-Tenn Rent,
Mortgage,and
Utility Assistance
(STRMU
Total HOPWA
Housing Subsidy
Assistance
Background on HOPWA Housing Stability Codes
Stable Permanent Housing/Ongoing Participation
3=Private Housing in the private rental or home ownership market(without known subsidy,including permanent placement
with families or other self-sufficient arrangements)with reasonable expectation that additional support is not needed.
4=Other HOPWA-funded housing subsidy assistance(not STRMU),e.g.TBRA or Facility-Based Assistance.
5=Other subsidized house or apartment(non-HOPWA sources,e.g.,Section 8,HOME,public housing).
6=Institutional setting with greater support and continued residence expected(e.g.,residential or long-term care facility).
Temporary Housing
2=Temporary housing-moved in with family/friends or other short-term arrangement,such as Ryan White subsidy,transitional
housing for homeless,or temporary placement in institution(e.g.,hospital,psychiatric hospital or other psychiatric facility,
substance abuse treatment facility or detox center).
Unstable Arrangements
I=Emergency shelter or no housing destination such as places not meant for habitation(e.g.,a vehicle,an abandoned building,
bus/train/subway station,or anywhere outside).
7=Jail/prison.
8=Disconnected or disappeared from project support,unknown destination or no assessments of housing needs were
undertaken.
Life Event
9=Death,i.e.,remained in housing until death.This characteristic is not factored into the housing stability equation.
Tenant-based Rental Assistance: Stable Housing is the sum of the number of households that(i)remain in the housing and(ii)
those that left the assistance as reported under:3,4,5,and 6.Temporaa Housing is the number of households that accessed
assistance,and left their current housing for a non-permanent housing arrangement,as report ed under item:2.Unstable
Situations is the sum of numbers reported under items: 1,7,and 8.
Previous editions are obsolete Page 17 form HUD-40110-D(Expiration Date:10/31/2014)
Permanent Facility-Based Housing Assistance: Stable Housing is the sum of the number of households that(i)remain in the
housing and(ii)those that left the assistance as shown as items:3,4,5,and 6.Temporary Housing is the number of households
that accessed assistance,and left their current housing for a non-permanent housing arrangement,as reported under item 2.
Unstable Situations is the sum of numbers reported under items: 1,7,and 8.
Transitional/Short-Term Facility-Based Housing Assistance: Stable Housing is the sum of the number of households that(i)
continue in the residences(ii)those that left the assistance as shown as items:3,4,5,and 6.Other Temporary Housing is the
number of households that accessed assistance,and left their current housing for a non-permanent housing arrangement,as
reported under item 2. Unstable Situations is the sum of numbers reported under items: 1,7,and 8.
Tenure Assessment. A baseline of households in transitional/short-term facilities for assessment purposes,indicate the number
of households whose tenure exceeded 24 months.
STRMU Assistance: Stable Housing is the sum of the number of households that accessed assistance for some portion of the
permitted 21-week period and there is reasonable expectation that additional support is not needed in order to maintain
permanent housing living situation(as this is a time-limited form of housing support)as reported under housing status:Maintain
Private Housing with subsidy;Other Private with Subsidy;Other HOPWA support;Other Housing Subsidy;and Institution.
Temporarily Stable with Reduced Risk of Homelessness is the sum of the number of households that accessed assistance for
some portion of the permitted 21-week period or left their current housing arrangement for a transitional facility or other
temporary/non-permanent housing arrangement and there is reasonable expectation additional support will be needed to maintain
housing arrangements in the next year,as reported under housing status:Likely to maintain current housing arrangements,with
additional STRMU assistance;Transitional Facilities/Short-term;and Temporary/Non-Permanent Housing arrangements
Unstable Situation is the sum of number of households reported under housing status:Emergency Shelter;Jail/Prison;and
Disconnected.
End of PART 5
Previous editions are obsolete Page 18 form HUD-40110-D(Expiration Date:10/31/2014)
PART 6: Annual Certification of Continued Usage for HOPWA Facility-Based Stewardship Units(ONLY)
The Annual Certification of Usage for HOPWA Facility-Based Stewardship Units is to be used in place of Part 7B of the
CAPER if the facility was originally acquired,rehabilitated or constructed/developed in part with HOPWA funds but no
HOPWA funds were expended during the operating year. Scattered site units may be grouped together on one page.
Grantees that used HOPWA funding for new construction,acquisition,or substantial rehabilitation are required to
operate their facilities for HOPWA eligible individuals for at least ten(10)years. If non-substantial rehabilitation funds
were used they are required to operate for at least three(3)years. Stewardship begins once the facility is put into
operation.
Note:See definition of Stewardship Units.
1.General information
Operating Year for this report
Front(innr/dd/)9)To(mm/dd/yy) ❑Final Yr
HUD Grant Number(s)
❑Yr 1; ❑Yr 2; ❑Yr 3; ❑Yr 4; ❑Yr 5; ❑Yr 6;
❑Yr 7; ❑Yr 8; ❑Yr 9; ❑Yr 10;
Grantee Name Date Facility Began Operations(nnn/dd/yy)
2.Number of Units and Non-HOPWA Expenditures
Facility Name: Number of Stewardship Units Amount of Non-HOPWA Funds Expended in Support of the
Developed with HOPWA Stewardship Units during the Operating Year
funds
Total Stewardship Units
(subject to 3-or 10-year use periods)
3.Details of Project Site
Project Sites:Name of HOPWA-funded project
Site Information:Project Zip Code(s)
Site Information:Congressional District(s)
Is the address of the project site confidential? ❑ Yes,protect information;do not list
❑ Not con rdential;information can be made available to the public
If the site is not confidential:
Please provide the contact information,phone,
email address/location,if business address is
different from facility address
I certify that the facility that received assistance for acquisition,rehabilitation,or new construction from the Housing Opportunities
for Persons with AIDS Program has operated as a facility to assist HOPWA-eligible persons from the date shown above. I also
certify that the grant is still serving the planned number of HOPWA-eligible households at this facility through leveraged resources
and all other requirements of the grant agreement are being satisfied.
I hereby certify that all the information stated herein,as well as an in ormation proWded in the accompaniment herewith,is true and accurate.
Name&Title of Authorized Official of the organization that continues Signature&Date(mm/dd/yy)
to operate the facility:
Name&Title of Contact at Grantee Agency Contact Phone with area code)
(person who can answer questions about the report and program)
End of PART 6
Page 19 form HUD-40110-D(Expiration Date:10/31/2014)
Previous editions are obsolete g
Part 7: Summary Overview of Grant Activities
A.Information on Individuals,Beneficiaries,and Households Receiving HOPWA Housing Subsidy Assistance
(TBRA,STRMU,Facility-Based Units,Permanent Housing'Placement and Master Leased Units ONLY)
Note:Reporting for this section should include ONLY those individuals, beneficiaries, or households that received and/or
resided in a household that received HOPWA Housing Subsidy Assistance as reported in Part 3, Chart 1,Row 7, Column b.
(e.g., do not include households that received HOPWA supportive services ONLY).
Section 1. HOPWA-Eligible Individuals who Received HOPWA Housing Subsidy Assistance
a.Total HOPWA Eligible Individuals Living with HN/AH)S
In Chart a.,provide the total number of eligible(and unduplicated)low-income individuals living with HIV/AIDS who qualified
their household to receive HOPWA housing subsidy assistance during the operating year. This total should include only the
individual who qualified the household for HOPWA assistance,NOT all HIV positive individuals in the household.
Individuals Served with Housing Subsidy Assistance Total
Number of individuals with HIV/AIDS who qualified their household to receive HOPWA housing subsidy assistance.
Chart b.Prior Living Situation
In Chart b.,report the prior living situations for all Eligible Individuals reported in Chart a. In Row 1,report the total number of
individuals who continued to receive HOPWA housing subsidy assistance from the prior operating year into this operating year.
In Rows 2 through 17,indicate the prior living arrangements for all new HOPWA housing subsidy assistance recipients during
the operating year.
Data Check: The total number of eligible individuals served in Row 18 equals the total number of individuals sewed through
housing substd assistance re ported in Chart a. above. Total HOPWA
Eligible Individuals
Category Receiving Housing
Subsidy Assistance
i. Continuing to receive HOPWA support from the prior operating year
New Individuals who received HOPWA Housing Subsidy Assistance sup ort during Opera in Year
2 Place not meant for human habitation
(such as a vehicle,abandoned building,bus/train/subway station/airport,or outside)
3. Emergency shelter(including hotel,motel,or campground paid for with emergency shelter voucher)
4. Transitional housing for homeless persons
$, Total number of new Eligible Individuals who received HOPWA Housing Subsidy Assistance with a Prior
Livine Situation that meets HUD definition of homelessness(Sum of Rows 2—4
Permanent housing for formerly homeless persons(such as Shelter Plus Care,SHP,or SRO Mod
6.
Rehab
7. Psychiatric hospital or other psychiatric facility
8. Substance abuse treatment facility or detox center
9. Hospital(non-psychiatric facility)
10. Foster care home or foster care group home
11. Jail,prison or juvenile detention facility
12. Rented room,apartment,or house
13. House you own
14. Staying or living in someone else's(family and friends)room,apartment,or house
15. Hotel or motel paid for without emergency shelter voucher
16. Other
17. Don't Know or Refused
18. TOTAL Number of HOPWA Eligible Individuals(sum of Rows 1 and 5-17)
Page 20 form HUD-40110-D(Expiration Date:10/31/2014)
Previous editions are obsolete g
c. Homeless Individual Summary
In Chart c.,indicate the number of eligible individuals reported in Chart b.,Row 5 as homeless who also are homeless Veterans
and/or meet the definition for Chronically Homeless(See Definition section of CAPER). The totals in Chart c.do not need to
equal the total in Chart b.,Row 5.
Number of Number of Chronically
Category Homeless Homeless
Veteran(s)
HOPWA eligible individuals served with
HOPWA Housing Subsidy Assistance
Section 2. Beneficiaries
In Chart a.,report the total number of HOPWA eligible individuals living with HIV/AIDS who received HOPWA housing
subsidy assistance(as reported in Part 7A,Section 1, Chart a.),and all associated members of their household who benefitted
from receiving HOPWA housing subsidy assistance(resided with HOPWA eligible individuals).
Note:See definition of HOPWA Eligible(Individual
Note:See definition of Transgender.
Note: See definition of Beneficiaries.
Data Check:The surn of each of the Charts b. &c, on the folloiving ttivo pages equals the total number of beneficiaries served
tivith HOPWA housing subsidy assistance as determined in Chart a.,Rory 4 below.
a.Total Number of Beneficiaries Served with HOPWA Housing Subsidy Assistance
Individuals and Families Served with HOPWA Housing Subsidy Assistance Total Number
1. Number of individuals with HIV/AIDS who qualified the household to receive HOPWA housing subsidy
assistance(e uals the number of HOPWA Eligible Individuals reported in Part 7A,Section 1,Chart a.)
2. Number of ALL other persons diagnosed as HIV positive who reside with the HOPWA eligible individuals
identified in Row 1 and who benefitted from the HOPWA housing subsidy assistance
3. Number of ALL other persons NOT diagnosed as HIV positive who reside with the HOPWA eligible
individual identified in Row 1 and who benefited from the HOPWA housing subsidy
4. TOTAL number of ALL beneficiaries served with Housing Subsidy Assistance(Sum of Rows 1,2,&3)
Previous editions are obsolete Page 21 form HUD-40110-D(Expiration Date:10/31/2014)
b.Age and Gender
In Chart b.,indicate the Age and Gender of all beneficiaries as reported in Chart a.directly above. Report the Age and Gender of
all HOPWA Eligible Individuals(those reported in Chart a.,Row 1)using Rows 1-5 below and the Age and Gender of all other
beneficiaries(those reported in Chart a.,Rows 2 and 3)using Rows 6-10 below. The number of individuals reported in Row 11,
Column E.equals the total number of beneficiaries reported in Part 7,Section 2,Chart a.,Row 4.
HOPWA Eligible_Individuals Chart a,Row 1
A. B. C. D. E.
TOTAL(Sum of
Male Female Trans ender M to F Trans ender F to M Columns A-D
1. Under 18
2. 18 to 30 years
3. 31 to 50 years
51 years and
4. Older
Subtotal(Sum
5. of Rows 1-4
All Other Beneficiaries Chart a,Rows 2 and 3
A B C D. E.
TOTAL(Sum of
Male Female Trans ender M to F Trans ender F to M Columns A-D
6. Under 18
7. 18 to 30 years
8. 31 to 50 years
51 years and
9. Older
Subtotal(Sum
10. of Rows 6-9)
Total Beneficiaries Chart a,Row 4
TOTAL(Sum
11. of Rows 5&10)
Previous editions are obsolete Page 22 form HUD-40110-D(Expiration Date:10/31/2014)
c.Race and EthnicityY
In Chart c.,indicate the Race and Ethnicity of all beneficiaries receiving HOPWA Housing Subsidy Assistance as reported in
Section 2,Chart a.,Row 4. Report the race of all HOPWA eligible individuals in Column[A]. Report the ethnicijy of all
HOPWA eligible individuals in column[B]. Report the race of all other individuals who benefitted from the HOPWA housing
subsidy assistance in column[C]. Report the ethnici of all other individuals who benefitted from the HOPWA housing subsidy
assistance in column[D]. The summed total of columns[A]and[C]equals the total number of beneficiaries reported above in
Section 2,Chart a.,Row 4.
HOPWA Eligible Individuals All Other Beneficiaries
[Cl Race
[A] Race [B]Ethnicity [total of [D]Ethnicity
Category [all individuals [Also identified as individuals [Also identified as
reported in Hispanic or reported in Hispanic or
Section 2,Chart Latino] Section 2,Chart Latino]
a.,Row 11 a.,Rows 2&31
F 2.
American Indian/Alaskan Native
Asian
Black/African American
Native Hawaiian/Other Pacific Islander
5. White
6. American Indian/Alaskan Native&White
7. Asian&White
8. Black/African American&White
9 American Indian/Alaskan Native&
Black/African American
10. Other Multi-Racial
11. Column Totals(Sum of Rows 1-10)
Data Check.Sum of Row 11 Column A and Row 11 Col unn C equals the total number HOPWA Beneficiaries reported in Part 3A,Section 2,
Chart a.,Row 4.
*Reference(data requested consistent with Form HUD-27061 Race and Ethnic Data Reporting Form)
Section 3. Households
Household Area Median Income
Report the area median income(s)for all households served with HOPWA housing subsidy assistance.
Data Cheek The total number of households served with HOPWA housing subsidy assistance should equal Part 3C,Row 7,
Column b and Part 7,4,Section 1, Chart a. (Total HOPWA Eligible Individuals Served tivith HOPWA Housing Subsidy
Assistance).
Note: Refer to htW Iliviviv htiduser oiylportal/datasets/il/i12010/select GeogiWhy rmfr.odn for information on area median
income in your community.
Households Served with HOPWA Housing Subsidy
Percentage of Area Median Income Assistance
1. 0-30%of area median income(extremely low)
2. 31-50%of area median income(very low)
3. 51-80%of area median income(low)
4 Total(Sum of Rows 1-3)
Previous editions are obsolete Page 23 form HUD-40110-D(Expiration Date:10/31/2014)
Part 7: Summary Overview of Grant Activities
B. Facility-Based Housing Assistance
Complete one Part 7B for each facility developed or supported through HOPWA funds.
Do not complete this Section for programs originally developed with HOPWA funds but no longer supported with
HOPWA funds. If a facility was developed with HOPWA funds(subject to ten years of operation for acquisition,new
construction and substantial rehabilitation costs of stewardship units,or three years for non-substantial rehabilitation costs),but
HOPWA funds are no longer used to support the facility,the project sponsor or subrecipient should complete Part 6: Annual
Certification of Continued Usage for HOPWA Facility-Based Stewardship Units(ONLY).
Complete Charts 2a.,Project Site Information,and 2b.,Type of HOPWA Capital Development Project Units,for all
Development Projects,including facilities that were past development projects,but continued to receive HOPWA operating
dollars this reporting year.
1.Project S onsor/Subreci Tent Agency Name(Required)
2. Capital Development
2a.Project Site Information for HOPWA Capital Development of Projects(For Current or Past Capital
Development Projects that receive HOPWA Operating Costs this reporting year)
Note:If units are scattered-sites, report on them as a group and under ty e of Facili write "Scattered Sites."
HOPWA Name of Facility:
Type of Funds Non-HOPWA funds
Development Expended Expended
this operating this operating (if applicable)
year year
(if applicable)
❑New construction $ $ Type of Facility[Check only one box.]
❑ Permanent housing
❑Rehabilitation $ $ ❑ Short-term Shelter or Transitional housing
❑ Supportive services only facility
❑Acquisition $ $
❑Operating $ $
a. Purchase/lease of property: Date(mm/ddlyy):
b. Rehabilitation/Construction Dates: Date started: Date Completed:
C. Operation dates: Date residents began to occupy:
❑ Not yet occu ied
d. Date supportive services began: Date started:
❑ Not yet providing services
e. Number of units in the facility: HOPWA-funded units= Total Units=
❑Yes ❑No
£ Is a waiting list maintained for the facility? If yes,number ofparticipants on the list at the end of operating year
g. What is the address of the facility(if different from business address)?
[I h Is the address of the project site confidential? Yes,protect information;do not publish list
❑ No,can be made available to the public
Previous editions are obsolete Page 24 form HUD-40110-D(Expiration Date:10/31/2014)
e
2b. Number and Type of HOPWA Capital Development Project Units(For Current or Past Capital
Development Projects that receive HOPWA Operating Costs this Reporting Year)
For units entered above in 2a.please list the number of HOPWA units that fulfill the following criteria:
Number Designated Number
for the Chronically Designated to Number Energy- Number 504 Accessible
Homeless Assist the Star Compliant
Homeless
Rental units constructed
(new)and/or acquired
with or without rehab
Rental units rehabbed
Homeownership units
constructed(if approved)
3.Units Assisted in Types of Housing Facility/Units Leased by Project Sponsor or Subrecipient
Charts 3a 3b and 4 are required for each facility. In Charts 3a.and 3b.,indicate the type and number of housing units in the
facility,including master leased units,project-based or other scattered site units leased by the organization,categorized by the
number of bedrooms per unit.
Note:The number units may not equal the total number of households served.
Please complete separate charts for each housing facility assisted. Scattered site units may be grouped together.
3a. Check one only
❑ Permanent Supportive Housing Facility/Units
❑ Short-term Shelter or Transitional Supportive Housing Facility/Units
3b.Type of Facility
Complete the following Chart for all facilities leased,master leased,project-based,or operated with HOPWA funds during the
reporting year.
Name of Project Sponsor/Agency O eratin g the Facility/Leased Units:
Total Number of Units in use during the Operating Year
Type of housing facility operated by the Cate orized by the Number of Bedrooms er Units
project sponsor/subrecipient SRO/Studio/0 1 bdrm 2 bdrm 3 bdrm 4 bdrm 5+bdrm
bdrm
a. Single room occupancy dwelling
b. Community residence
C. Project-based rental assistance units or leased units
Other housing facility
d' Saeeifv.
4.Households and Housing Expenditures
Enter the total number of households served and the amount of HOPWA funds expended by the project sponsor/subrecipient on
subsidies for housing involving the use of facilities,master leased units,project based or other scattered site units leased by the
organization.
Housing Assistance Category: Facility Based Housing Output: Number of Output: Total HOPWA Funds Expended during
Households Operating Year by Project S onsor/subreci lent
a Leasing Costs
b Operating Costs
C. Project-Based Rental Assistance(PBRA)or other leased units
d Other Activity(if approved in grant agreement)Specify:
e Adjustment to eliminate duplication(subtract)
TOTAL Facility-Based Housing Assistance
E (Sum Rows a.through d.minus Row e.)
Previous editions are obsolete Page 25 form HUD-40110-D(Expiration Date:10/31/2014)
11/18/2014 M&C Review
Official site of the City of Fort Worth,Texas
CITY COUNCILAGENDA FORTWORTI-I
COUNCIL ACTION: Approved on 8/5/2014 -Ordinance No. 21363-08-2014
CONTINUED FROM A PREVIOUS WEEK
DATE: 7/22/2014 REFERENCE C-26893 LOG NAME: 17HUDACTION PLAN PY2014-
NO.: 2015
CODE: C TYPE: NON- PUBLIC YES
CONSENT HEARING.
SUBJECT: Conduct Two Public Hearings and Approve the City's Action Plan for the Use of Federal
Grant Funds in the Amount of$9,827,252.00 from the United States Department of
Housing and Urban Development for Program Year 2014-2015 from the Community
Development Block Grant, HOME Investment Partnerships Program, Emergency Solutions
Grant and Housing Opportunities for Persons with AIDS Grant Programs, Authorize
Collection and Use of Program Income, Authorize Waiver of Application of Indirect Cost
Rates, Authorize Execution of Related Contracts and Interdepartmental Letters of
Agreement and Adopt Appropriation Ordinance (ALL COUNCIL DISTRICTS)
RECOMMENDATION:
It is recommended that the City Council:
1. Conduct two public hearings to allow citizen input and consideration of the City's 2014-2015 Action
Plan for use of federal grant funds from the United States Department of Housing and Urban
Development in the amount of $9,827,252.00 for Program Year 2014-2015 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 2014-2015 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 amount of$50,000.00 of program income resulting
from activities using prior years' Community Development Block Grant funds for the programs and
activities detailed below;
4. Authorize the collection and use of an estimated amount of$100,000.00 of program income resulting
from activities using prior years' HOME Investment Partnerships Program funds for the City's
Homebuyer Assistance Program;
5. Authorize the City Manager or his designee to execute contracts and Interdepartmental Letters of
Agreement for a one year term with the agencies listed below in Tables 1, 2 and 3 for Program Year
2014-2015 for Community Development Block Grant, Emergency Solutions Grant and Housing
Opportunities for Persons with AIDS grant funds, contingent upon receipt of funding;
6. Authorize the City Manager or his designee to extend the contracts and Interdepartmental Letters of
Agreement 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 and Interdepartmental Letters of ke
Agreement 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;
http://apps.cfwnet.org/council_packet/mc_review.asp?ID=20027&councildate=8/5/2014 1/6
11118/2014 M&C Review
ATTACHMENTS
17HUDACTIONPLANPY2014-2015 AO 2014.docx
Action Plan 14-15.pdf
PROPOSED 2014 CDBG Streets Attachment.pdf
http://apps.cfwnet.org/council_packet/mc_review.asp?ID=20027&councildate=8/5/2014 6/6