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HomeMy WebLinkAboutContract 47107 CITY SECMTAW CTRACT N0. �10 AGREEMENT FOR CO1:�MUNITY BASED PROGRAM THE WOMEN'S CENTER OF TARRANT COUNTY FISCAL YEAR 2016 In consideration of the mutual covenants, promises and agreements contained herein, THIS AGREEMENT ("Agreement") is made and entered into between CITY OF FORT WORTH, a home rule municipal corporation of the State of Texas, ("City") acting by and through Valerie R. Washington, its duly authorized Assistant City Manager, and THE WOMEN'S CENTER OF TARRANT COUNTY, a Texas private non-profit corporation ("Contractor") acting by and through Laura Hilgart, President and Chief Executive Officer, its duly authorized representative. RECITALS WHEREAS, City has determined that Community Based Programs are necessary to support crime prevention in City during Fiscal Year 2016 to meet one or more of the Crime Control and Prevention District (`CCPD") goals, which are (1) to support efforts to reduce violent crime and gang-related activities through enhanced enforcement activities and crime prevention programs, (2) to support efforts to increase the safety of residents and to decrease crime throughout Fort Worth neighborhoods, and (3) to support efforts to increase the safety of youth and reduce juvenile crime through crime prevention and intervention programs; and WHEREAS, Contractor has agreed to operate a Community Based Program called Comprehensive Legal Services for Victims of Violence Program, which will support the police department's crime prevention efforts throughout the community; and WHEREAS, City desires to enter into an agreement with Contractor to operate the Comprehensive Legal Services for Victims of Violence Program; and WHEREAS, City, as consideration for the performance of Contractor, has appropriated monies in the CCPD Budget as reimbursed by the CCPD in the amount of$15,281.00 (`Program Funds") to provide to the Contractor for the operation of the Comprehensive Legal Services for Victims of Violence Program; NOW, THEREFORE, in consideration of the mutual covenants herein expressed, the parties agree as follows: AGREEMENT DOCUMENTS The Agreement documents shall include the following: 1. This Agreement OFFICIAL RECORD 2. Exhibit A— Proposal Abstract and Narrative CITY SECRETARY 3. Exhibit B —Budget 4. Exhibit C —Request for Reimbursement FT. WORTH,TX 5. Exhibit D— Program Activities Report FY 2016 Community Based Program The Women's Center of Tarrant County Page 1 of 12 6. Exhibit E—Program Effectiveness Measurement Report 7. Exhibit F— Request for Budget Modification Exhibits A through F, which are attached hereto and incorporated herein, are made a part of this Agreement for all purposes. In the event of any conflict between the terms and conditions of Exhibits A through F and the terms and conditions set forth in the body of this Agreement, the terms and conditions of this Agreement control. AGREEMENT 1. Responsibilities of Contractor. Contractor covenants and agrees to fully perform, or cause to be performed, with good faith and due diligence, all work and services described in Exhibit "A" — Proposal Narrative . Contractor shall be responsible for day-to-day administration of the Comprehensive Legal Services for Victims of Violence Program. Contractor agrees to expend the Program Funds in accordance with the Budget as described in Exhibit 'B". Program activities shall be reported in accordance with Exhibit "D" and effectiveness measures shall be reported in accordance with Exhibit "E". 2. Program Funds. 2.1 In no event shall the total distribution from City made to the Contractor during the Term of this Agreement exceed $15,281.00 ("Program Funds"). 2.2 Payment of the Program Funds from City to Contractor shall be made on a cost- reimbursement basis following receipt by City from Contractor of a signed Request for Reimbursement (RFR), as described in Exhibit "C" along with supporting documentation. Contractor shall deliver to City a written detailed Program Activities Report and Program Effectiveness Measures Report as described in Section 4.2 below with each RFR to support expenditure of Program Funds. Such reports shall be signed by the Contractor or duly authorized officer of the Contractor. The RFR and monthly Program Activities Report shall be submitted to City no later than the 15'h day following the end of the month. Submittal of a monthly RFR and Program Activities Report is required even if services are not provided. The monthly RFR, with an original signature by an authorized representative, must be submitted to the Research and Planning Section of the Fort Worth Police Department, ATTENTION: Grants Management Unit, Bob Bolen Public Safety Complex, 505 W. Felix St., Fort Worth, Texas, 76115. Reimbursements will not be made until after receipt of an acceptable and approved RFR and a monthly Program Activities Report from the Contractor. Reimbursements shall be made within 30 days receipt of said documents. 2.3 Contractor is authorized to modify up to five (5) percent of any budgeted line-item in the original approved budget without prior written permission from City. However, Contractor must submit the Request for Budget Modification Form (Exhibit "F") to City, with the monthly FY 2016 Community Based Program The Women's Center of Tarrant County Page 2 of 12 RFR, during the month the modification took place. The new modified budget cannot exceed the total amount of Program Funds. 2.4 Any modifications of more than five (5) percent of any budgeted line-item in the original approved budget must have prior written permission from City before the modifications are made. The Budget Modification Form (Exhibit "F") must be submitted, and request must be approved by City, before any money is moved to the line-item. Once the Budget Modification is approved, the modified budget will take effect on the first day of the following month. The new modified budget shall not exceed the total amount of Program Funds. 2.5 Any modifications to zero line-items in the original approved budget must have prior written permission from City before the modifications are made. The Budget Modification Form (Exhibit "F") must be completed and approved by City before money is transferred into the new line-item. Once the Budget Modification is approved, the modified budget will take effect on the first day of the following month. The new modified budget shall not exceed the total amount of Program Funds. 2.6 Budget modification can only occur within the Direct and Indirect costs. Funds may not be moved from a Direct line-item into an Indirect line-item, or vise versus. Modification of Direct and Indirect approved budgets must follow the guidelines outlined in sections 2.3, 2.4. and 2.5. Budget adjustments shall be submitted to the Grants Management Unit of the Fort Worth Police Department at Bob Bolen Public Safety Complex at 505 W. Felix St., Fort Worth, Texas, 76115. 3. Term. This Agreement shall commence upon October 1, 2015 ("Effective Date"), and shall end on September 30, 2016 ("Term"). All of Contractor's expenditures under this Agreement must be completed no later than September 30, 2016. 4. Program Performance. 4.1 Contractor agrees to maintain full documentation supporting the performance of the work set forth in Exhibit"A." 4.2 Contractor agrees to provide a monthly Program Activities Report and quarterly Program Effectiveness Measurement Report to document the performance of the work described in Exhibit "D" and Exhibit "E," respectively. The Program Activities and Effectiveness Measures shall document the program activity names, numbers of participants attending, details of the activities, and a description of the goals achieved in support of the CCPD goals. Program Effectiveness Measures shall be reported on a quarterly basis and included in the January, April, July, and October RFR and Program Activities Report submittals. Additionally, the Program Effectiveness Measurement Report must describe include any realized successes. The monthly Program Activities and quarterly Program Effectiveness Measurement Reports shall be submitted to City no later than the 15th day after the end of each month. FY 2016 Community Based Program The Women's Center of Tarrant County Page 3 of 12 4.3 Contractor agrees that the monthly Request for Reimbursement and Program Activities Report and quarterly Program Effectiveness Measurement Report will be submitted to City no later than the 15th day after the end of each month. Should Contractor not meet these requirements, Contractor will be given an additional 15 days to submit the required reports to City. If, at the end of this 15-day extension period, Contractor has not submitted the required reports, City will send a non-compliance letter notifying Contractor's duly authorized representative of a possible suspension of program funding. 4.4 A representative of the program shall attend quarterly meetings of the Crime Control and Prevention District Board as requested. 5. Default and Termination. 5.1 This Agreement is wholly conditioned upon the actual receipt by City of Program Funds from the CCPD. All monies distributed to Contractor hereunder shall be exclusively from monies received from the CCPD, and not from any other monies of City. In the event that funds from the CCPD are not timely received, in whole or in part, City may, at its sole discretion, terminate this Agreement and City shall not be liable for payment for any work or services performed by Contractor under or in connection with this Agreement. 5.2 In the event no funds or insufficient funds are appropriated by the City in any fiscal year for any payments due hereunder, City will notify Contractor of such occurrence and this Agreement shall terminate on the last day of the fiscal period for which appropriations were received without penalty or expense to the City of any kind whatsoever, except as to the portions of payments herein agreed upon for which funds have been appropriated. 5.3 The City may terminate this Agreement at any time and for any reason by providing the other party with thirty (30) days' written notice of termination. 5.4 Termination will be effected by delivering to Contractor written notice of termination. Upon Contractor's receipt of notice of termination, Contractor shall: (a) Stop work under the Agreement on the date and to the extent specified in the notice of termination; (b) Place no further order or subcontracts, except as may be necessary for completion of the work not terminated; (c) Terminate all orders and contracts to the extent that they relate to the performance of the work terminated by the notice of termination; and (d) Cease expenditures of Program Funds, except as may be necessary for completion of the work not terminated. 5.5 In the event City suspends or terminates this Agreement for cause, and the cause for such suspension or termination is determined to be invalid, the Contractor's sole remedy shall be reinstatement of this Agreement. Contractor expressly waives any and all rights to monetary damages, including but not limited to actual, consequential, and punitive damages, court costs and attorney's fees. FY 2016 Community Based Program The Women's Center of Tarrant County Page 4 of 12 5.6 Within thirty (30) days following the date of termination of this Agreement, Contractor shall return to City any property provided hereunder. City will have no responsibility or liability for Contractor's expenditures or actions occurring after the effective date of termination of the Agreement. 6. Equipment and Maintenance. All equipment purchased with Program Funds must meet all eligibility requirements of City. Contractor shall maintain all equipment used in the administration and execution of the Comprehensive Legal Services for Victims of Violence Program. Contractor shall maintain, replace or repair any item of equipment used in support of the Comprehensive Legal Services for Victims of Violence Program and/or for use under the terms of this Agreement that no longer functions or is lost or stolen. The cost for maintenance, replacement or repair of any equipment used in support of the Comprehensive Legal Services for Victims of Violence Program and/or for use under the terms of this Agreement is the sole responsibility of Contractor. Contractor shall not use Program Funds or City funds to repair or replace said equipment. Contractor shall use any and all equipment purchased with Program Funds exclusively in support of the Comprehensive Legal Services for Victims of Violence Program. Within 10 days following the purchase of equipment, Contractor shall submit to City a detailed inventory of all equipment purchased with Program Funds to the Grants and Contracts Management Section at the address set forth in paragraph 2.2 above. The equipment inventory shall include an itemized description of each piece of equipment, the date each piece of equipment was purchased, the cost of purchase for each piece of equipment, and the location of each piece of equipment. 7. Administrative Requirements. 7.1 Contractor agrees to keep sufficient records to document its adherence to applicable local, state, and federal regulations, along with documentation and records of all receipts and expenditures of Program Funds. Contractor agrees that the City shall, until the expiration of three (3) years after final payment under this Agreement, have access to and the right to examine any directly pertinent books, documents, papers and records of the Contractor involving transactions relating to this Agreement. Contractor agrees that the City shall have access during normal working hours to all necessary Contractor facilities and shall be provided adequate and appropriate workspace in order to conduct audits in compliance with the provisions of this section. The City shall give Contractor reasonable advance notice of intended audits. 7.2 If any audit reveals a questioned practice or expenditure, City shall notify Contractor as soon as reasonably practical. Contractor shall have fifteen (15) days to provide City with a written explanation and any supporting documentation regarding the practice or expenditure. If Contractor fails to resolve or cure the questioned practice or expenditure, to the City's satisfaction, within the fifteen (15) day period, , City reserves the right to withhold further Program Funds under this and/or future agreement(s) with Contractor. 7.3 If, as a result of any audit, it is determined that Contractor misused, misapplied or misappropriated all or any part of the Program Funds, Contractor agrees to reimburse City the FY 2016 Community Based Program The Women's Center of Tarrant County Page 5 of 12 amount of such monies so misused, misapplied or misappropriated, plus the amount of any sanction, penalty, or other charge levied against City because of such misuse, misapplication or misappropriation. 7.4 Contractor's obligation to City shall not end until all closeout requirements are completed. The closeout requirements shall include, but are not limited to: providing final Program Activities Report and Program Effectiveness Measurement Reports, making final payments, and disposing of Comprehensive Legal Services for Victims of Violence Program assets as appropriate. 7.5 Contractor covenants and agrees to fully cooperate with City in monitoring the effectiveness of the services and work to be performed by Contractor under this Agreement, and 8. Independent Contractor. 8.1 Contractor shall operate hereunder as an independent contractor and not as an officer, agent, or servant or employee of City. Contractor shall have exclusive control of, and the exclusive right to control, the details of the work and services performed hereunder, and all persons performing same, and shall be solely responsible for the acts and omissions of its officers, members, agents, servants, employees, subcontractors, program participants, licensees, or invitees. The doctrine of respondent superior shall not apply as between City and Contractor, its officers, members, agents, servants, employees, subcontractors, program participants, licensees, or invitees, and nothing herein shall be construed as creating a partnership or joint enterprise between City and Contractor. It is expressly understood and agreed that no officer, member, agent, employee, subcontractor, licensee, or invitee of the Contractor, nor any program participant hereunder is in the paid service of City. City does not have the legal right to control the details of the tasks performed hereunder by Contractor, its officers, members, agents, employees, subcontractors, program participants, licensees, or invitees. 8.2 City shall in no way nor under any circumstances be responsible for any property belonging to Contractor, its officers, members, agents, employees, subcontractors, program participants, licensees or invitees, which may be lost, stolen, destroyed, or in any way damaged. 9. Liability and Indemnification. CONTRACTOR SHALL BE LIABLE AND RESPONSIBLE FOR ANY AND ALL PROPERTY LOSS, PROPERTY DAMAGE AND/OR PERSONAL INJURY, INCLUDING DEATH, TO ANY AND ALL PERSONS, OF ANY KIND OR CHARACTER, WHETHER REAL OR ASSERTED, TO THE EXTENT CAUSED BY THE NEGLIGENT ACT(S) OR OMISSION(S), MALFEASANCE OR INTENTIONAL MISCONDUCT OF CONTRACTOR, ITS OFFICERS, AGENTS, SER VA NTS OR EMPLOYEES. CONTRACTOR AGREES TO DEFEND, INDEMNIFY,AND HOLD THE CITY, ITS OFFICERS, AGENTS, SERVANTS, AND EMPLOYEES HARMLESS AGAINST ANY AND ALL CLAIMS, LAWSUITS, ACTIONS, COSTS, AND EXPENSES OF FY 2016 Community Based Program The Women's Center of Tarrant County Page 6 of 12 ANY KIND, INCLUDING, BUT NOT LIMITED TO, THOSE FOR PROPERTY DAMAGE OR LOSS (INCLUDING ALLEGED DAMAGE OR LOSS TO OWNER'S BUSINESS AND ANY RESULTING LOST PROFITS) AND/OR PERSONAL INJURY(INCLUDING DEATH) THAT MAY RELATE TO,ARISE OUT OF, OR BE OCCASIONED BY (I) CONSULTANT'S BREACH OF ANY OF THE TERMS OR PROVISIONS OF THIS AGREEMENT OR (II) ANY NEGLIGENT ACT OR OMISSION OR INTENTIONAL MISCONDUCT OF CONTRACTOR, ITS OFFICERS, AGENTS, ASSOCIATES, EMPLOYEES, CONTRACTORS (OTHER THAN THE CITY), OR SUBCONTRACTORS RELATED TO THE PERFORMANCE OF THIS AGREEMENT, EXCEPT THAT THE INDEMNITY PROVIDED FOR IN THIS SECTION SHALL NOT APPLY TO ANY LIABILITY RESULTING FROM THE SOLE NEGLIGENCE OF THE CITY OR ITS OFFICERS, AGENTS, EMPLOYEES, OR SEPARATE CONTRACTORS, AND IN THE EVENT OF JOINT AND CONCURRENT NEGLIGENCE OF BOTH CONSULTANT AND CITY, RESPONSIBILITY, IF ANY, SHALL BE APPORTIONED COMPARATIVELY IN ACCORDANCE WITH THE LAWS OF THE STATE OF TEXAS. NOTHING HEREIN SHALL BE CONSTRUED AS A WAIVER OF THE CITY'S GOVERNMENTAL IMMUNITY AS FURTHER PROVIDED BY THE LAWS OF TEXAS. Contractor shall require all of its subcontractors to include in their subcontracts a release and indemnity in favor of City in substantially the same form as above. This section shall survive the expiration or termination of this Agreement. 10. Non-Assignment. No assignment or delegation of duties under this Agreement by Contractor shall be effective without City's prior written approval. 11. Prohibition Against Interest. 11.1 No member, officer or employee of City, or its designees or agents; no member of the governing body of the locality in which the Comprehensive Legal Services for Victims of Violence Program is situated; and no other public official of such locality or localities who exercises any functions or responsibilities with respect to the Comprehensive Legal Services for Victims of Violence Program during his tenure or for one year thereafter, shall have any interest, direct or indirect, in any contract or subcontract, or the proceeds thereof, for work to be performed hereunder. Contractor shall incorporate, or cause to be incorporated, like language prohibiting such interest, in all contracts and subcontracts hereunder. 11.2 No officer, employee, member, or program participant of Contractor shall have a financial interest, direct or indirect, in this Agreement or the monies transferred hereunder, or be financially interested, directly or indirectly, in the sale to Contractor of any land, materials, supplies, or services purchased with any funds transferred hereunder, except on behalf of Contractor, as an officer, employee, member, or program participant. Any willful violation of this paragraph with the knowledge, expressed or implied, of Contractor or its subcontractors, shall render this Agreement voidable by City of Fort Worth. FY 2016 Community Based Program The Women's Center of Tarrant County Page 7 of 12 12. Nondiscrimination. Contractor, for itself, its personal representatives, assigns, subcontractors and successors in interest, as part of the consideration herein, agrees that in the performance of Contractor's duties and obligations hereunder, it shall not discriminate in the treatment or employment of any individual or group of individuals on any basis prohibited by law. IF ANY CLAIM ARISES FROM AN ALLEGED VIOLATION OF THIS NON-DISCRIMINATION COVENANT BY CONTRACTOR, ITS PERSONAL REPRESENTATIVES, ASSIGNS, SUBCONTRACTORS OR SUCCESSORS IN INTEREST, CONTRACTOR AGREES TO ASSUME SUCH LIABILITY AND TO INDEMNIFY AND DEFEND THE CITY AND HOLD THE CITY HARMLESS FROM SUCH CLAIM. This section shall survive the expiration or termination of this Agreement. 13. Compliance. 13.1 Contractor, its officers, members, agents, employees, program participants, and subcontractors, shall abide by and comply with all laws, federal, state and local, including all ordinances, rules and regulations of City. If City calls to the attention of Contractor any such violation on the part of Contractor or any of its officers, members, agents, employees, subcontractors or program participants, then Contractor shall immediately desist from and correct such violation. I3.2 Contractor shall utilize Program Funds strictly for those purposes and goals intended under the terms and conditions of this Agreement. If City calls the attention of Contractor to any such violations on the part of Contractor or any of its officers, members, agents, employees, program participants or subcontractors, then Contractor shall immediately desist from and correct such violation. 14. Governmental Powers. It is understood that by execution of this Agreement, the City does not waive or surrender any of it governmental powers. 15. Waiver of Immunity. If Contractor is a charitable or nonprofit organization and has or claims an immunity or exemption (statutory or otherwise) from and against liability for damages or injury, including death, to persons or property; Contractor hereby expressly waives its rights to plead defensively such immunity or exemption as against City. This section shall not be construed to affect a governmental entity's immunities under constitutional, statutory or common law. 16. Insurance Requirement. FY 2016 Community Based Program The Women's Center of Tarrant County Page 8 of 12 16.1 Coverages and Limits. Contractor shall provide the City with certificate(s) of insurance documenting policies of the following minimum coverage limits that are to be in effect prior to commencement of any work pursuant to this Agreement: (a) Commercial General Liability (CGL): $1,000,000 per occurrence, with a $2,000,000.00 annual aggregate limit, in a form that is acceptable to the City's Risk Manager. (b) Non-Profit Organization Liability or Directors Officers LiabilitY: $1,000,000 per occurrence, with a $1,000,000 annual aggregate limit, in a form that is acceptable to the City's Risk Manager. (c) Automobile Liability: $1,000,000 each accident on a combined single limit basis OR split limits are acceptable if limits are at least $250,000 Bodily Injury per person, $500,000 Bodily Injury per accident and $100,000 Property Damage. 16.2 Contractor's insurer(s) must be authorized to do business in the State of Texas for the lines of insurance coverage provided and be currently rated in terms of financial strength and solvency to the satisfaction of the City's Risk Manager. All insurers must have a minimum rating of A- VII in the current A.M. Best Key Rating Guide, or have reasonably equivalent financial strength and solvency to the satisfaction of Risk Management. If the rating is below that required, written approval of Risk Management is required. Evidence of self-insurance will also be accepted. 16.3 Each insurance policy required herein shall be endorsed with a waiver of subrogation in favor of the City. Each insurance policy required by this Agreement, except for policies of worker's compensation or accident/medical insurance shall list the City as an additional insured. City shall have the right to revise insurance coverage requirements under this Agreement. 16.4 Contractor further agrees that it shall comply with the Worker's Compensation Act of Texas and shall provide sufficient compensation insurance to protect Contractor and City from and against any and all Worker's Compensation claims arising from the work and services provided under this Agreement. 16.5 The commercial general liability policy shall name the City as an additional insured thereon, as its interests may appear. The term City shall include its employees, officers, officials, agents, and volunteers in respect to the contracted services. 16.6 A minimum of Thirty (30) days' notice of cancellation or reduction in limits of coverage shall be provided to the City. Ten (10) days' notice shall be acceptable in the event of non- payment of premium. Notice shall be sent to the Risk Manager, City of Fort Worth, 1000 Throckmorton, Fort Worth, Texas 76102, with copies to the City Attorney at the same address. 16.7 Any failure on the part of the City to request required insurance documentation shall not constitute a waiver of the insurance requirement. 16.8 Certificates of Insurance evidencing that the Consultant has obtained all required insurance shall be delivered to the City prior to Consultant proceeding with any work pursuant to this Agreement. FY 2016 Community Based Program The Women's Center of Tarrant County Page 9 of 12 17. Miscellaneous Provisions. 17.1 If any provision of this Agreement is held to be invalid, illegal or unenforceable, the validity, legality and enforceability of the remaining provisions shall not in any way be affected or impaired. 17.2 City's failure to insist upon the performance of any term or provision of this Agreement or to exercise any right herein conferred shall not be construed as a waiver or relinquishment to any extent of City's right to assert or rely upon any such term or right on any future occasion. 17.3 Should any action, whether real or asserted, at law or in equity, arise out of the execution, performance, attempted performance or non-performance of this Agreement, venue for said action shall lie in state courts located in Tarrant County, Texas or the United States District Court for the Northern District of Texas, Fort Worth Division.. 17.4 Contractor represents that it possesses the legal authority, pursuant to any proper, appropriate and official motion, resolution or action passed or taken, to enter into this Agreement and to perform the responsibilities herein required. 17.5 This written instrument and Exhibits A through F, constitute the entire agreement between the parties concerning the work and services to be performed hereunder, and any prior or contemporaneous, oral or written agreement which purports to vary from the terms hereof shall be void. 17.6 Any amendments to the terms of this Agreement must be in writing and must be signed by authorized representatives of each Party. 17.7 None of the performance rendered under this Agreement shall involve, and no portion of the Program Funds received hereunder shall be used, directly or indirectly, for the construction, operations, maintenance or administration of any sectarian or religious facility or activity, nor shall said performance rendered or funds received be utilized so as to benefit, directly or indirectly, any such sectarian or religious facility or activity. 17.8 Contractor certifies that it has obtained a 501 (c) (3) Certificate from the Internal Revenue Service. Contractor shall notify City in writing of any changes to its 501 (c) (3) tax- exempt status during the term of this Agreement. 17.9 Captions and headings used in this Agreement are for reference purposes only and shall not be deemed a part of this Agreement. 17.10 The provisions and conditions of this Agreement are solely for the benefit of City and Contractor and are not intended to create any rights, contractual or otherwise, to any other person or entity. FY 2016 Community Based Program The Women's Center of Tarrant County Page 10 of 12 18. Notice. Notices to be provided hereunder shall be sufficient if forwarded to the other party by hand-delivery or via U.S. Postal Service certified mail, postage prepaid,to the address of the other party shown below: CITY: Valerie R. Washington,Assistant City Manager City Manager's Office City of Fort Worth 1000 Throckmorton Street Fort Worth, TX 76102 Copies To: Tiffany Hayes Grants Management Unit Bob Bolen Public Safety Complex 505 West Felix St. Fort Worth, TX 76115 CONTRACTOR: Laura Hilgart, President and Chief Executive Officer THE WOMEN'S CENTER OF TARRANT COUNTY 1723 Hemphill Street Fort Worth, TX 76110-1516 FY 2016 Community Based Program The Women's Center of Tarrant County Page 11 of 12 IN WITNESS WHEREOF, the parties hereto have executed this agreement in multi les in Fort Worth, Tarrant County, Texas, to be effective this day of , 20)-<. APPROVED AND AGREED FOR APPROVED AND AGREED FOR CITY OF FORT WORTH THE WOMEN'S C NTER OF TARRAN OUN Valerie R. Washington Assistant City Manager Laura 1411gart President and Chief Executive Officer Date: Date: I c 1 I APPROVED AS TO FORM AND APPROVAL RECOMMENDED LEGALITY FOR THE WOMEN'S CENTER OF TARRANT COUNTY Rhonda K. Robertson Chief of Police The Women's Center of Tarrant County Attorney Date: Date: APPROVED AS TO FORM AND LEGALITY FOR CITY OF FORT WORTH ATTEST Victoria D. Honey ' V��Ry` aa Assistant City Attorney Diary J. pp.�►c°° °° ,l City Se tary �.og.l d Date: vC/ 1 o o=� Date: 0 o ,hd 0 M&C No. °°00000° �a SAA�44,�ya LOFFICIAL RECORD CRETARYFY 2016 Community Based Program RTH,TX The Women's Center of Tarrant County Page 12 of 12 Exhibit A Proposal Abstract and Narrative FY 2014 CRIME CONTROL AND PREVENTION DISTRICT PROPOSAL COVER SHEET CONTRACTOR: The Women's Center of Tarrant County, Inc. DIRECTOR: Laura Hilgart PHONE NUMBER: 817-927-4006 PHYSICAL ADDRESS: 1723 Hemphill St., Fort Worth, TX 76110 CONTACT PERSON: Laura Hilgart EMAIL ADDRESS: Ihilgart@womenscentertc.org PHONE NUMBER: 817-927-4006 FAX NUMBER: 817-924-2662 PROGRAM TITLE: Comprehensive Legal Services for Victims of Violence CCPD FUNDS REQUESTED: $ 15,281.80 CONTRACTOR STATUS: ■ Private Nonprofit ❑ Public Nonprofit Mark the goal(s)that your program addresses. ❑ Support efforts to reduce violent crime and gang-related activities through enhanced enforcement activities and crime prevention programs ■ Support efforts to increase the safety of residents and to decrease crime throughout Fort Worth neighborhoods; and ❑ Support efforts to increase the safety of youth and reduce juvenile crime through crime prevention and intervention programs. Additionally,does program address the priority consideration listed below? ■ Program is a prevention or intervention program for youth and/or family violence. CERTIFICATION: 1 certify that the information contained in this proposal fairly represents the above-named Contractor's operating plans and budget for the proposed program. 1 acknowledge that I have read and understand the requirements and provisions of the Request for Proposal and that the above-named Contractor will comply with all applicable rules and regulations relating to the procurement process. I certify that I am authorized to sign this proposal and to enter into and execute a contract with the City of Fort Worth to provide the services authorized. TYPED NAME: Laura Hilgart TITLE: P C SIGNATURE: DATE: RFP No.15-0193, FY 2016 Community Based Programs,Page 3 of 19 The Women's Center of Tarrant County FY 2016 Community Based Programs: Comprehensive Legal Services for Victims of Violence PROGRAM ABSTRACT Provide a short description of your program to be funded.Please summarize the problem and what your program will do to address it.(Roughly 2 paragraphs in length on a separate page) Violent crimes including sexual assault,domestic violence,dating violence and stalking are widespread and have grave consequences for victims,their families and the overall community.Left untreated,the trauma resulting from victimization leads to depression,substance abuse,Post-Traumatic Stress Disorder and even suicide. In addition to the significant emotional trauma victims face,those who are escaping and/or recovering from violence encounter many economic and legal barriers. Moreover,navigating the unfamiliar,complex and intimidating legal system are especially difficult for individuals who have or are currently in an abusive or violent situation. Over the last 35 years,The Women's Center has developed a continuum of care to address the wide range of both short-term and long-term needs of victims.24-hour crisis intervention,forensic rape exam accompaniment,clinical counseling and case management help victims address trauma and begin the healing process.In 2014,the Women's Center added Comprehensive Legal Services to the continuum of care.The latter provides adult and adolescent victims with access to legal information,short-term legal intervention and long-term legal representation so they may stabilize and focus on healing from trauma.Services include responding to subpoenas for records and testimony;facilitating immigration documentation and visa requests;addressing family law issues like child support and divorce;filing emergency and non-emergency protection orders;protecting client safety, privacy,and confidentiality;and providing criminal justice accompaniment. Most importantly,the Legal Services Project offers victims of sexual and relationship violence with critical opportunities for empowerment,justice,and healing. PROGRAM ABSTRACT Provide a short description of your program to be funded. Please summarize the problem and what your program will do to address it.(Roughly 2 paragraphs in length on a separate page) PROPOSAL NARRATIVE: Provide a 4-5 page description of your program to be funded. In this narrative, please respond to each of the following questions: 1) Describe in detail the problem that your program addresses. Sexual,family and intimate partner violence affect thousands of Fort Worth women,men and children each year.The problems resulting from violence are overwhelming in the numbers of people impacted,its effect on the lives of child and adult victims,and in the negative repercussions it has for families and the community at large. Sexual.Family&Intimate Partner Violence: • Nationwide,more than 1 in 3 women have experienced rape,physical violence and/or stalking by an intimate partner in their lifetime. • Closer to home, 12,446 Family Violence Incidents were reported in Tarrant County in 2013(the most recent data available). • Of the 119 Texas women killed by an intimate partner the same year,11 were Tarrant County residents. • In 2013,victims reported 1,436 sexual assaults to Tarrant County law enforcement.While this number is appalling,studies indicate that in Texas,only 18%of victims report their assault to law enforcement. If the 1,436 assaults represent only 18% of the total number of sexual assaults committed in Tarrant County that year,then the"true"number of sexual assaults could be as high as 7,977. • Many victims of family violence also experience sexual violence.Studies indicate that batterers are likely to also victimize family members through sexual violence including incest and intimate partner rape. • Tarrant County Children are also victims of sexual violence and family violence.449 child sexual abuse victims were treated at Cook Children's Medical Center in Fort Worth in 2013.In the same year, 19,564 confirmed allegations of child abuse/neglect were reported to the Texas Department of Family and Protective Services for our area. 1,558(8 percent)of these cases were sexual abuse. • While reliable local data on stalking and Dating Violence are not available,a 2007 telephone random survey of Texas reported that 18%of those polled had been stalked during their life time. • Numerous studies acknowledge the significant incidence of dating violence among teenagers and young adults.For example,a 2010-2011 survey conducted by the Centers for Disease Control and Prevention found that"9.4%of students nationwide had been hit,slapped,or physically hurt on purpose by their boyfriend or girlfriend"("Youth Risk Behavior Surveillance—United States,2011"). Left untreated,the trauma resulting from victimization has long-term and grave consequences for individuals,families and the community at large.Victims of family,sexual and intimate partner violence are significantly more likely to suffer from depression, post-traumatic stress disorder,abuse drugs and alcohol and even commit suicide.Likewise,victims who are recovering from and escaping violence face many economic and legal barriers that prevent them from addressing trauma,finding"safety"and participating in the criminal justice system to convict perpetrators.According to the National Network to end Domestic violence, concerns over economic security for themselves and their children are a significant reason that victims may stay in or return to an abusive relationship. Moreover, navigating unfamiliar,complex and often intimidating legal systems is especially difficult for individuals who have or are currently in an abusive or violent situation. Over the last 35 years,The Women's Center has developed a continuum of care to address the wide range of both short-term and long-term needs of victims. 24-hour crisis intervention,forensic rape exam accompaniment,clinical counseling and case management helping victims address trauma and begin the heal process.In 2014,the Women's Center added a Comprehensive Legal Services Program to provide low-and moderate-income adult and adolescent female victims of sexual assault,domestic violence,dating violence,and stalking with comprehensive and compassionate legal assistance related to their victimizations. Provided by an On-Site Full Time Attorney and Paralegal,services include responding to subpoenas for both records and testimony; facilitating immigration documentation and visa requests;addressing family law issues like child support and divorce;filing emergency and non-emergency protection orders;protecting client safety,privacy,and confidentiality;and providing criminal RFP No.15-0193, FY 2016 Community Based Programs,Page 4 of 19 justice accompaniment. Most importantly,the Legal Services Project offers victims of sexual and relationship violence with critical opportunities for empowerment,justice,and healing. In addition to direct legal assistance for victims,the attorney and paralegal will also host quarterly information sessions about the Legal Services Project to introduce Center partner agencies and other community organizations to this new service in Fort Worth. The proposed Legal Services Project will also establish a local victim services legal network,launched and coordinated by the attorney and paralegal.This network will serve as a model to other communities that,like Fort Worth,have limited legal resources for victim services,especially for low-and moderate-income populations,and are looking to strengthen,enhance,and expand these services in their respective communities. 2) Describe what your program does to 1) support efforts to reduce violent crime and gang-related activities through enhanced enforcement activities and crime prevention programs, 2) support efforts to increase the safety of residents and to decrease crime throughout Fort Worth neighborhoods;and 3)support efforts to increase the safety of youth and reduce juvenile crime through crime prevention and intervention programs. The Comprehensive Legal Services program provides victims of sexual assault,domestic violence,dating violence and stalking with legal information,legal intervention and longer term legal services so that victims and families may stabilize their lives after victimization.The program increases the safety of residents and decreases crime throughout Fort Worth neighborhoods in the following ways: • Informing victims of their rights,available community resources and empowering them to recognize that abuse is not their fault; • Helping victims to develop safety plans to avoid and prevent future violence; • Petitioning for protective orders on behalf of victims; • Utilizing legal remedies to assist victims in removing barriers to basic needs such as housing,employment,victims compensation etc.; • Negotiating child custody/visitation to prevent abusive parents from unsupervised visitations with children,etc; • Providing victims with the confidence and support needed to report crime and participate in the prosecution of perpetrators. 3) Does your program address the CCPD priority/special emphasis of the prevention or intervention of youth violence and/or family violence? Yes,the Comprehensive Legal Services program addresses the CCPD priority of prevention and intervention of youth and/or family violence. Describe how your program addresses this priority? Victims of family violence are a specific priority group for this project.The Comprehensive Legal Services program enables victims to access legal remedies to the many issues that result from family violence such as protective order assistance,divorce,child support, child custody/visitation issues,immigration status and coordination with prosecutors to convict abusers. 4) How will you measure the effectiveness of the program? You must include specific performance measures within the Activities and Outcomes Summary and describe evaluation tools and the method of data collection that you will use. If awarded funding,these performance measures will be included as an exhibit in the contract,and you will be required to report progress towards these measures, which will be reported to the CCPD Board. The goal of the Comprehensive Legal Services program is to provide legal information and legal remedies for violent crimes victims so they can achieve stability,focus on healing and regain a sense of empowerment and control.Likewise,the program promotes the prosecution of perpetrators,therefore,preventing future violence.Clients accessing legal services have greatly varying needs depending on the unique circumstances and issues resulting from their particular victimization.As such,the specific legal needs for clients cannot be predicted,but the Center does expect to provide victims with three types of service levels.An explanation of each service level is provided below including the estimated length of service and examples of the legal needs addressed within that timeframe. RFP No.15-0193,FY 2016 Community Based Programs,Page 5 of 19 Service Level/Service Length/Examples of Legal Need: 1) Legal Information and Referral/2 hours to 2 weeks/Educating victims on general legal rights and responsibilities,explaining criminal justice process, creating a safety plan, advocacy on behalf of a client to another agency or attorney, providing referrals to community resources best matching the victim's current needs. 2) Brief Legal Services/2 weeks to 2 months/ protective orders, eviction and other housing issues, subpoena requests & U- Visas. 3) Long-Term Legal Services resulting in a Administrative or Court Decision/2 months to 6 months/Court Case Representation and/or Accompaniment, Divorce,Child Custody and Visitation. To measure the effectiveness of the program at each of these service levels, The Women's Center has established a series of performance measures. 1) Legal Information and Referral 80% of clients who receive information & referral services and make contact with the referral agency feel more informed about their rights and responsibilities. 2) Brief Legal Services 80%of clients who received brief legal services achieve the desired aim of service within 2 months. 3) Long-Term Legal Services 80%of clients who received long-term legal services achieve a positive administrative or court decision within 6 months. For specific information on how the Center will track and document these performance measures,please see the attached PROGRAM EFFECTIVENESS MEASURE SUMMARY. 5) Who will the program benefit? Low-and moderate-income female victims of sexual assault,domestic violence,dating violence,and stalking. How many people? so What age group? Female victims aged 11 and over What geographic area will it serve? Please include geographic boundaries. The entire project serves Tarrant and surrounding counties, but funds from this grant will serve specifically the City of Fort Worth. 6) What makes this program unique from any other crime prevention program in Fort Worth? Specialized expertise and training in victimization issues is crucial to providing victims with compassionate and effective legal services.The Women's Center's Comprehensive Legal Services program is currently the only affordable legal services targeted to serve sexual assault,dating violence,and stalking victims in Fort Worth.Likewise,only limited affordable legal services are available for domestic violence victims through the City's main domestic violence shelter.This domestic violence-focused legal program,centered on family and immigration law,cannot meet the total demand for services in Fort Worth.And the City's main nonprofit legal services organization,while free,has an extensive waitlist and qualification process and only offers assistance with general civil intake like wills and estates,landlord/tenant cases,public benefits,federal tax,and real property matters.Of course, private legal representation is available to victims in Fort Worth;however,this assistance is expensive and does not guarantee the victim that her attorney will have special expertise in victimization-related issues. RFP No.15-0193, FY 2016 Community Based Programs,Page 6 of 19 7) Is the program already in operation? Yes. If so,how long have you operated the program? Since October of 2014. What resources are currently used to operate the program? Resources currently used to operate the program include: • Staff. Rape Crisis&Victim Services Attorney and Paralegal, Director of Rape Crisis&Victim Services, Director of Reporting&Quality Assurance • Building/Office Space: Fort Worth Women's Center Offices • Other: Insurance including Legal Malpractice insurance;communications—phone,fax,Internet;postage; equipment maintenance—computers/network,copiers,and Efforts To Outcomes database software for program performance management/evaluation. Why are CCPD funds necessary at this time? A grant from the Office on Violence Against Women is the primary funding source for The Women's Center's Comprehensive Legal Assistance Program.The grant allowed the Center to develop the program and includes funding to sponsor the costs of the program staff(Attorney,Paralegal,Director of Rape Crisis&Victim Services and administrative staff time on the project).Funding is also provided for Mileage,Staff Computers,and Grant required training activities etc. However,the cost to operate the program is higher than the resources available through this funding source.Specifically,additional resources are needed to cover cost of Court Filing Fees,State of Texas Legal Reference Books,Tarrant County District Court"e-filing" fees and Legal Software,which are essential to delivering the program in an effective way for low to moderate income victims. 8) Is this a new program? If so, what other funds have you applied for? Also, please describe the sequence of steps needed to implement your program and the timeframe in which this will occur. No,it is an ongoing program. 9) Briefly describe the specific expenditures planned for CCPD funding. You MUST fully complete attached budget forms. Funding from CCPD would allow The Women's Center to provide victims with thorough, accurate and timely legal services. Specifically,funding would cover the cost of: • Court Filing Fees, which depending on the nature of the specific legal case range from $150 to $1000 per client with an average estimated cost of$500.All clients who receive brief legal services and long-term services will require legal fees. • Legal software to help program staff manage and track case milestones, outcomes and required legal documentation.The cost of software subscription is"'$250 per month. • Tarrant County District Clerk Online Filing Account required to "e-file" family law and other civil cases, which are all electronic.The monthly cost of this service is—$35. • Current State of Texas Legal Reference Books on issues related to victimization including, but not limited to Texas Family Law Manual & Form Book, Texas Family Code, Criminal Laws of Texas and Rules of Civil Procedures. Texas Law Books are updated with each legislative session and cost approximately$150 each. • Program Overhead & Indirect will cover a portion of the cost for legal program's equipment maintenance (IT support, security and maintenance)and telephones(office phones and messaging systems). 10) If funds are awarded,will this program continue beyond the CCPD funding period? Please explain your plan to sustain this program. Yes,the primary funding for the program is through a 3-year Office on Violence Against Women(OVW)grant.Funding from CCPD will allow The Women's Center to cover start up and ongoing costs that are not included in OVW funding.The Women's Center will raise additional funds to support the program after the three-year term from individuals,civic and community organizations,private and corporate foundations,and through events like our annual Monster Mash gala.Recently The Women's Center has expanded our fundraising efforts by growing our special events and launching major gift and planned giving initiatives.These new fundraising strategies have helped The Women's Center diversify and strengthen our funding streams. RFP No.15-0193, FY 2016 Community Based Programs,Page 7 of 19 a rWn X X X a o aX X X w � o a ►0-, X X X v z X X X %1 0 a ON P 4. •p O 00 _ Ix X X X W a a a A a WV ^a w X X X V as z O cd � F, � ►�-� X X X v W i p W CA H c •a A X X X �. Q z X X X O C c O X X N ew C1: U 4. � a> � ab 14 op ri p a to O v W v ° y k u i0 a v p a\ O �. y . QS .b U 03 a� .� O p p O y y rn y 0 bD p y t, M 4. t, w 3 > � o .� � > c E �° o > O0 = o > o p h C G E y 'D �, p 0 y C o i'C•, H O E cai > y •v y U C Lz• q C cd '> 't• bD O bD F, &- U > eb � U O >' �Y C y y 'O V y bD->_U •� >>•C 4• d vi 4 $> N C 2CA cc$ � w 6i bD'cd U cH .� v •O O N C2- .� N O a 0 > •v o y > > PG U 3 p b ycd cc ed Qf > c y U u Cd C N d + d O a •G y Q C > '00 a' 4. C 0 -0 SSO U O F O yO E y G y N a V O 00 � y N r .O •p > 'O D O N y O >� O O v u m �! �? WU C y^ •O O, d C C O v1 f�'i1 G .y bD y O C0. O o O bD > c � 03 O fL d y y 0. p V 0. � u Q a AO V A W f=, G9 Exhibit B Budget FOR_, O�R,TH C"a cmmm m do Pnvrm m Dwoca Budget Summary Total Project: $15,281.00 DIRECT PROGRAM COSTS 90%Minimum Total:$14,020.00 A.PERSONNEL None $0.00 PERSONNEL TOTAL: $0.00 B.FRINGE BENEFITS None $0.00 FRINGE BENEFITS TOTAL $0.00 C.TRAVEL AND TRAINING None $0.00 TRAVEL AND TRAINING TOTAL $0.00 D.EQUIPMENT None $0.00 EQUIPMENT TOTAL $0.00 E.SUPPLIES Court filing fees(Estimated$500 per client x 20 clients) $10,000.00 State of Texas legal reference books(4 books a$150each) $600.00 SUPPLIES TOTAL $10,600.00 F.CONTRACTS/CONSULTANTS Legal Software($250 month x 12 months) $3,000.00 Tarrant County District Clerk filing account($35month x 12 $420.00 months) CONTRACTS/CONSULTANTS TOTAL $3,420.00 INDIRECT PROGRAM COSTS 10%Maximum Total: $1,261.80 A.PERSONNEL None $0.00 PERSONNEL TOTAL: $0.00 B.FRINGE BENEFITS None $0.00 FRINGE BENEFITS TOTAL $0.00 G. OTHER APPROVED Equipment maintenance(IT security$61.95 per month x 12 $743.48 months) Telephone costs $517.52 OTHER APPROVED TOTAL $1,261.00 Exhibit C Request for Reimbursement URT IVU T Request for Reimbursement(RFR) FY 2016 CxM C09TRO.. AlmrVXvZ n MDMKlct Submit To: Submitting Agency: Bob Bolan Public Safety Complex Contact Name: Attn:Tiffany Hayes Phone Number: Program Support Division Email: 505 West Felix St. Remit Address: Fort Worth,TX 76115 Invoice Number. Month of Request: DIRECT COSTS(90%Minimum) A B C D E Total of Previous (B+Q A-D This Mosth's Budget Category Budget Amount Reimbursemeeb Total Requested Remaining Balance Requested �0� To-Date Available A Personnel $ $ B Fringe Benefits $ $ - C Travel&Training D Equipment $ S E Supplies F Contracts/Consultams Total Direct Costs S S $ S S INDIRECT COSTS(10%Maximum) A B C D E Total of Previous (B+Q A-D Budget Category This Month's BudgetAmoust Reimbursements Total Requested Remaining Balance Requested Request To-Dste Available A Personnel $ $ B Fringe Benefits $ S C Travel&Training $ $ D Equipment is E Supplies $ $ F Contracts/Consultants S $ Total InDirect Costs $ $ $ $ $ Supporting documcnb required with mouldy requests. Summary This includes,timesheets depicting CCPD forded activities, Total Budget: $ copy of parchccks,invoices and receipts detailing all CCPD Previous Requests: S hmded expenditures. This Request: $ Total Requested To-Date $ Remaining Funds $ /have reviewed this request and certify that these listed expenses and support documentation are accurate. Authorised Signatory Signatory Title Date Fiscal Agent Use Only Purchase Order# £rod Dept!D Account R£RApproved£or Payment Grant Staff Signature Date Finance Received Stamp Placed Below Exhibit D Program Activities Report FORT1 cRUIE COKMOL k PREYemm Dismcr Fiscal Year 2016 Monthly Program Activities Report Current Reporting Month Submitting Agency Women's Center of Tarrant County Contact Name Phone Number and Email Remit Address Activity Current To Date Year Month Total End Total Goal 1 Number of clients provided legal information and legal referrals for victims of sexual assault,domestic violence, dating violence and/or stalking. Examples include: educating victims on general legal rights and 30 responsibilities,explaining criminal justice process, creating a safety plan, advocacy on behalf of a client to another agency or attorney and referring individuals to community resources that best match their current needs. 2 Number of hours spent providing clients with legal information and legal referrals. 60 3 Number of clients provided brief/short term legal services for victims of sexual assault, domestic violence, dating violence and/or stalking. 12 Examples include:protective orders, eviction&other housing issues, subpoena requests and U-Visas. 4 Number of hours spent providing clients with brief/short term legal services 96 5 Number of clients provided long-term legal services for victims of sexual assault,domestic violence,dating violence and/or stalking,resulting in a positive Administrative and/or Court Decision.Examples include: Court 8 Case Representation and/or Accompaniment,Divorce, Child Custody and Visitation. 6 Number of hours spent providing clients with long-term legal services 240 I have reviewed this report and certify that the measures provided are accurate and appropriately reflect the CCPD goals set forth in the contract. Authorized Signatory Signatory Title Date Exhibit E Program Effectiveness Measurement Report Fo` R—TW° Fiscal Year 2016 Quarterly Program Effectiveness Measurement Report Current Reporting Quarter Submitting Agency Women's Center of Tarrant County Contact Name Phone Number and Email Remit Address Please include outcome narrative that describes how measure was accomplished for each quarter. Effectiveness Measures and Quarterly Outcomes Measure 1 80%of clients who receive information&referral services and make contact with the referral agency feel more informed about their rights and responsibilities. Outcome Measure 2 80%of clients who received brief legal services achieve the desired goal of service within 2 months. Outcome Measure 3 80%of clients who received long-term legal services achieve a positive administrative or court decision within 6 months. Outcome Measure 4 Outcome Measure 5 Outcome I have reviewed this report and certify that the measures provided are accurate and appropriately reflect the CCPD goals set forth in the contract. Authorized Signatory Signatory Title Date Report due each quarter: 15'Quarter(Oct-Dec)due January 15 2nd Quarter(Jan-Mar)due April 15 3rd Quarter(Apr-June)due July 15 4th Quarter(Jul-Sep)due October 15 Exhibit F Request for Budget Modification Fob Cma comwx &Paan "Dammer • Up to 5%of any budgeted line-item does not need prior approval but form must be sent to City with monthly RFR • More than 5%of any budgeted line-item must have prior City approval • An increase in a zero line-item must have prior City approval • Modifications cannot be made between Direct and Indirect costs Request for Budget Modification Fiscal Year 2016 Date Submitting Agency Contact Name Phone Number and Email Remit Address DIRECT COSTS 90% minimum Budget Category Approved Budget Change Requested Revised Budget Personnel Fringe Benefits Travel&Training Equipment Supplies Contracts/Consultants Total Direct Costs INDIRECT COSTS 10% maximum Budget Category Approved Budget Change Requested Revised Budget Personnel Fringe Benefits Travel&Training Equipment Supplies Contracts/Consultants Total Indirect Costs Modification Narrative describe in detail what chane is for 1 have reviewed this request and certify that the listed modifications are correct. Authorized Signatory Signatory Title Date FWPD STAFF USE ONLY [3 Modification Approved [14odification NOT Approved FWPD Staff Signature Date