HomeMy WebLinkAboutContract 48504 QM1234S
ry �
.. `� CITY SECRETARY
o CONTRACT NO.
r �+
STATED TEXAS §
�9 §
S b E Z - Y OF TARRANT §
This contract("Contract")is made and entered into by and between the City of Fort Worth
(hereafter "City") and Fort Worth Area Habitat for Humanity, dba Trinity Habitat for Humanity
(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 Community Development Block Grant("CDBG")Program,
Program No. B-15-MC-48-0010, Catalog of Federal Domestic Assistance No. 14.218;
WHEREAS, a national objective of the CDBG program is to benefit low and moderate
income citizens in accordance with 24 CFR Part 570, as amended from time to time;
WHEREAS, Agency submitted a proposal to use CDBG funds for a program to serve
individuals and families, 100% of whom must be low and moderate income;
WHEREAS, City citizens, the Community Development Council, and the City Council
have determined that CDBG 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 2016 income limits are
attached hereto as EXHIBIT "A-1"—2016 HUD Income Limits.
Business Diversity Enterprise Ordinance or BDE means the City's Business Diversity
Ordinance, Ordinance No.20020-12-2011.
CDBG means Community Development Block Grant. OFFICIAL RECORD
CITY SECRETARY
Complete Documentation means the following documentation as applicable: IT ySECREORTHl A
• Attachments I,II, and III, with supporting documentation includi g:
TX
o Proof of expense: copies of timesheets, invoices, leases,service
other documentation showing that payment is due by Agency.
CDBG REHABILITATION CONTRACT 2016-2017 Page 1
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
o Proof of payment: cancelled checks, bank, statements, or wire transfers
necessary to demonstrate that amounts due by Agency were actually paid by
Agency.
o Proof of client eligibility: Source Documentation for all clients participating
in the Program.
• 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.
CDBG Funds means the CDBG grant funds supplied by City to Agency under the terms of this
Contract.
CDBG Regulations means regulations found at 24 CFR Part 570 et seq.
DBE means disadvantaged business enterprise in accordance with 49 CFR Part 26.
Director means the Director of the Neighborhood Services Department.
Effective Date means September 12, 2016.
HUD means the United States Department of Housing and Urban Development.
IDIS means Integrated Disbursement Information System, HUD's project tracking system.
Income 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. The definition of annual income to determine client income
eligibility shall be the definition contained in 24 CFR Part 5.609, as amended from time to time.
National Objective means an activity that benefits low and moderate income persons. For the
purposes of this Contract, 100% of the clients served by the Program must be Income Eligible
Clients.
Neighborhood Services Department means the City's Neighborhood Services Department.
OMB means the Office of Management and Budget.
Program means the services described in EXHIBIT "A"—Program Summary.
Reimbursement Request means all reports and other documentation described in Section 9.
Source Documentation means documentation of full household income of any type described
under the definition of annual income in 24 CFR Part 5.609, including but not limited to copies of
paychecks, Social Security and disability verification letters, interest or rental income statements,
CDBG REHABILITATION CONTRACT 2016-2017 Page 2
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
retirement income statements, child support and alimony verification, unemployment benefit
letters, and the like.
Unduplicated Clients means a count of all clients served by the Program at least once in the
Contract Term. Clients served by the Program more than once in the Contract Term will only be
counted the first time they are served when determining the total count of Unduplicated Clients.
3. TERM.
The term of this Contract begins on the Effective Date and terminates on September 30,
2017 unless earlier terminated as provided in this Contract.
4. DUTIES AND RESPONSIBILITIES OF CITY.
4.1 Provide CDBG Funds.
City shall provide up to $250,000.00 of CDBG Funds under the terms and conditions of
this Contract.
4.2 Monitor.
City will monitor the activities and performance of Agency and any of its contractors,
subcontractors or vendors as necessary,but no less than annually. Monitoring by City will include
determining whether Agency is meeting the National Objective during the term of this Contract.
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 CDBG Funds.
5.2.1. Compliance with CDBG Regulations and Contract.
Agency shall be reimbursed for eligible Program costs with CDBG Funds only if City
determines in its sole discretion that:
5.2.1.1 Costs are eligible expenditures in accordance with CDBG Regulations.
5.2.1.2 Costs are in compliance with this Contract and are reasonable and
consistent with industry norms.
5.2.1.3 Complete Documentation, as applicable, is submitted to City by
Agency.
5.2.2 Budget.
5.2.2.1 The CDBG Funds will be paid on a reimbursement basis in accordance
with EXHIBIT `B"-Budget.
CDBG REHABILITATION CONTRACT 2016-2017 Page 3
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
5.2.2.2 During the term of this Contract, Agency may submit written requests
to increase or decrease line-item amounts in the Budget, including an
explanation of why such increases or decreases are necessary. All
requests shall be approved by Director in writing, with such approval
being in the Director's sole discretion. If Director approves the
Agency's proposed Budget amendment (as approved, the "Amended
Budget"),then the Amended Budget will take effect on the first day of
the month following the month in which it was approved by Director,
unless otherwise specified in the amendment. All requests for Budget
amendments must be submitted by June 1,2017.
5.2.3 Chanj4e in Prolzram Budget.
5.2.3.1 Agency will notify City promptly of any additional funds it receives for
operation of the Program, and City reserves the right to amend this
Contract in such instances to ensure compliance with HUD regulations
governing cost allocation.
5.2.3.2 Agency agrees to utilize the CDBG Funds to supplement rather than
supplant funds otherwise available for the Program.
5.2.4 Payment of CDBG Funds to ALYency.
CDBG Funds will be disbursed to Agency upon City's approval of Reimbursement
Requests including submission of Complete Documentation to City in compliance with Section 9.
If Agency expends all funds budgeted for the Program prior to September 30, 2016, City may
hold back a small amount of the CDBG Funds until the end of the term. During this interim period,
Agency must continue to submit Attachment III — Client Data Report in EXHIBIT "D" —
Reimbursement Forms monthly. It is expressly agreed by the Parties that any CDBG Funds not
spent or approved for reimbursement to Agency shall remain with City.
5.3 ProjZram Performance Milestones.
5.3.1 Agency represents that the Program will achieve the following milestones in
accordance with EXHIBIT "A"—Program Summary and the table below:
UnduplicaG
ted lJeAts as
specl�ed ul EXHIBIT
N /
N« ��
AProgram
Month Expenditures'" :: Suiriina
3 25% 25%
6 50% 50%
9 75% 75%
12 100% 100%
5.3.2 Failure of Agency to meet these milestones or a material deviation from them as
outlined in this Section 5.3 is a breach of this Contract. For the purpose of this Section,"material
deviation"shall mean more than 10% lower than the specified goal. In the event of such breach,
CDBG REHABILITATION CONTRACT 2016-2017 Page 4
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
City reserves the right in its sole option to (i) delay or withhold payment of Reimbursement
Requests, (ii) lower Agency's allocation of CDBG Funds, or(iii)terminate this Contract.
5.3.3 Failure to meet at least 80%of its performance milestones or serve 12 Unduplicated
Clients under this contract may, in City's sole discretion, disqualify Agency for consideration
under the City's Request for Proposals for the 2017-2018 Program Year for federal grant funds.
5.3.4 Amendments to performance milestones regarding CDBG funds must be approved
by the Director in writing, with such approval being in the Director's sole discretion. If Director
approves the Agency's proposed amended performance milestones (as approved, the "Amended
Performance Milestones"), then the Amended Performance Milestones will take effect on the
first day of the month following the month in which it was approved by Director, unless otherwise
specified in the amendment. All requests for amendments to performance milestones must be
submitted by June 1, 2017. Notwithstanding the above, any amendments to this Contract shall
not reduce the number of Unduplicated Clients stated in Section 5.3.3 and in EXHIBIT "A" -
Program Summary.
5.4 Identify Program Expenses Paid with CDBG Funds.
Agency will keep accounts and records in such a manner that City may readily identify and
account for Program expenses reimbursed with CDBG Funds. These records shall be made
available to City for audit purposes and shall be retained as required hereunder.
5.5 Meet National Obiective.
Agency shall ensure that the activities carried out in the Program will meet the National
Objective.
5.6 Program Subcontracts.
Agency shall not enter into a subcontract with another agency, contractor, or vendor to
provide a service to clients for any part of the Program that will be paid with CDBG Funds without
City's written consent.
6. CLIENT ELIGIBILITY VERIFICATION.
6.1 Client Eligibility.
Agency will document client eligibility as follows:
6.1.1 Agency Clients.
Agency must verify all new clients' income with Source Documentation. Agency must
use the annual income definition in 24 CFR Part 5.609 to establish client income and must use the
most current HUD Income Guidelines. The income of all Program clients must be documented
and 100% of them must be Income Eligible Clients.
6.1.1.1 All Program clients must be reported on EXHIBIT "D" —
Reimbursement Forms, Attachment III. Any Agency clients for
which the appropriate Source Documentation is not obtained shall be
presumed ineligible.
CDBG REHABILITATION CONTRACT 2016-2017 Page 5
Fort Worth Area Habitat for Humanity, dba Trinity Habitat for Humanity Rev.9.28.2016
6.2 Submission of Complete Documentation.
Agency must submit copies of documentation of client eligibility described in Section 6.1
with Attachment III with each month's Reimbursement Request for all Unduplicated Clients.
6.3 Maintain Documentation.
Agency must maintain copies of all documentation required by this Section 6 for 5 years
following the expiration of the Contract term. This Section shall survive the earlier termination
or expiration of this Contract.
7. ADDITIONAL CDBG REQUIREMENTS.
Agency agrees to comply with all requirements of the CDBG Program as stated in the
CDBG Regulations, including but not limited to the following:
7.1 Environmental Review.
CDBG Funds will not be paid, and costs cannot be incurred until City has conducted an
environmental review and completed an Environmental Review Record as required by 24 CFR
Part 58. The environmental review may result in a decision to proceed with,modify, or cancel the
funding for the Program. Further, Agency will not undertake or commit any funds to physical or
choice limiting actions as described in any applicable federal regulations. Any violation of this
provision will (i) cause this Contract to terminate immediately, and (ii) require Agency to repay
City the CDBG Funds it has already received and forfeit any future payments of CDBG Funds.
7.1.2 Environmental Mitigation.
If applicable, Agency must take the mitigation actions outlined in EXHIBIT "A-2" —
Environmental Mitigation Actions. Failure to complete the required mitigation action is an
event of default under this Contract.
7.2 Contract Not Constituting Commitment of Funds.
Notwithstanding any provision of this Contract, the Parties agree and acknowledge that
this Contract does not constitute a commitment of funds, and that such commitment of funds or
approval may occur only upon (i) satisfactory completion of an environmental review and receipt
by City of an authorization to use grant funds from HUD under 24 CFR Part 58, (ii) approval of
City's 2016-2017 Action Plan, and (iii) receipt by City of a grant agreement from HUD.
7.3 Monitoring.
7.3.1 Agency understands and agrees that it will be subject to monitoring by City for
compliance with terms and provisions of this Contract and the CDBG Regulations for the term of
this Contract. Agency is subject to such monitoring during the term of this Contract and for 5
years after the Contract term ends. Agency will provide reports and access to Program files as
requested by City during this 5 year period. For purposes of this Contract, this 5 year period for
monitoring is deemed to begin on October 1,2017 and end on September 30,2022 regardless of
whether or not this Contract is earlier terminated.
CDBG REHABILITATION CONTRACT 2016-2017 Page 6
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
7.3.2 Representatives of City, HUD, HUD Office of Inspector General, and the United
States Comptroller General shall have access during regular business hours, upon 48 hours prior
notice,to Agency's offices and records pertaining to the use of the CDBG Funds, and to Agency's
officers, directors, agents, employees, contractors, subcontractors and vendors for the purpose of
such monitoring.
7.3.3 In addition to other provisions of this Contract regarding frequency of monitoring,
City reserves the right to perform desk reviews or on-site monitoring of Agency's compliance with
the terms and conditions of this Contract. City shall provide Agency with a written report of the
monitor's findings after each monitoring visit. If the monitoring report notes deficiencies in
Agency's performance, the report shall include requirements for the timely correction of said
deficiencies by Agency. Failure by Agency to take the action specified in the monitoring report
may be cause for suspension or termination of this Contract as provided herein.
7.3.4 Subsections 7.3.1 through 7.3.3 shall be applicable for the Contract term and for 5
years thereafter and shall survive the earlier termination or expiration of this Contract.
7.3.5 Agency shall provide City annually the results of any state or federal monitoring.
Such results shall be submitted within 60 days of receipt of such state or federal monitoring
report, or with the January Reimbursement Request, whichever is earlier.
7.4 Aizency Procurement Standards.
Agency shall comply with all applicable federal, state and local laws, regulations, and
ordinances for making procurements under this Contract. In addition to the conflict of interest
provisions in Section 14.13.3, Agency shall establish written procurement procedures to ensure
that materials and services are obtained in a cost effective manner and that provides for full and
open competition. When procuring materials and services for this Contract, Agency shall comply
at a minimum with the procurement standards in 2 CFR Part 200.317 through Part 200.326.
7.4.1 Contracts in excess of $10,000.00 made by Agency using CDBG Funds must
address termination for cause and convenience including the manner by which such termination
shall be effected and the basis for settlement of the terminated contract, if any, as required by
Appendix II (B), 2 CFR Part 200.
7.4.2 Agency shall not make any contract with parties listed on the government wide
System for Award Management, www.sam.gov ("SAM"). Agency must confirm by search of
SAM that all contractors paid with CDBG Funds are not listed by SAM as being debarred, both
prior to hiring and prior to submitting a Reimbursement Request which includes invoices from any
such contractor. Failure to submit such proofs of search shall be an event of default.
7.5 Cost Principles/Cost Reasonableness.
Agency shall administer its use of CDBG Funds in compliance with 2 CFR Part 200, as
applicable. The eligibility of costs incurred for performance rendered shall be determined in
accordance with 2 CFR Part 200.400 through 2 CFR Part 200.475.
CDBG REHABILITATION CONTRACT 2016-2017 Page 7
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
7.6 Financial Management Standards.
Agency agrees to comply with 2 CFR Part 200,as applicable. Agency also agrees to adhere
to the accounting principles and procedures required therein,utilize adequate internal controls,and
maintain necessary supporting and back-up documentation for all costs incurred in accordance
with 2 CFR Part 200.302 and Part 200.303.
7.7 Uniform Administrative Requirements, Cost Principles, and Audit
Requirements.
Agency will comply with the Uniform Administrative Requirements, Cost Principles, and
Audit Requirements for Federal Awards in 2 CFR Part 200, as applicable, or any reasonably
equivalent procedures and requirements that City may require.
7.8 Terms Applicable to Contractors, Subcontractors and Vendors.
Agency understands and agrees that all terms of this Contract, whether regulatory or
otherwise, shall apply to any and all contractors, subcontractors and vendors of Agency which are
in any way paid with CDBG Funds or who perform any work in connection with the Program.
Agency shall cause all applicable provisions of this Contract to be included in and made a part of
any contract or subcontract executed in the performance of its obligations hereunder including its
obligations regarding the CDBG Regulations. Agency shall monitor the services and work-
performed
orkperformed by its contractors, subcontractors and vendors on a regular basis for compliance with
the CDBG Regulations and Contract provisions. Agency must cure all violations of the CDBG
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 CDBG Regulations and
Agency is responsible for such compliance regardless of whether actions taken to fulfill the
requirements of this Contract are taken by Agency or by Agency's contractors, subcontractors or
vendors. Agency acknowledges that the provisions of this Section shall survive the earlier
termination or expiration of this Contract and shall be applicable for 5 years after the Contract term
ends.
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.
7.10 Conflict of Interest Disclosure.
In accordance with the requirements of Section 14.13.2.1 and 14.13.4, Agency shall
establish conflict of interest policies for federal awards. Agency shall disclose to City in writing
any potential conflict of interest.
7.11 Compliance with FFATA and Whistleblower Protections.
Agency shall comply with the requirements of 2 CFR 300(b), including provisions of the
Federal Funding Accountability and Transparency Act ("FFATA") governing requirements on
executive compensation and provisions governing whistleblower protections contained in 10
U.S.C. 2409, 41 U.S.C. 4712, 10 U.S.C. 2324, 41 U.S.C. 4304 and 41 U.S.C. 4310.
CDBG REHABILITATION CONTRACT 2016-2017 Page 8
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
7.11.1 Agency shall provide City with its DUNS number.
7.12 Internal Controls.
In compliance with the requirements of 2 CFR Part 200.303, Agency shall:
7.12.1 Establish and maintain effective internal control over the CDBG Funds that
provides reasonable assurance that Agency is managing the CDBG Funds in compliance with
federal statutes,regulations, and the terms and conditions of this Contract. These internal controls
shall be in compliance with guidance in "Standards for Internal Control in the Federal
Government" issued by the Comptroller General of the United States or the "Internal Control
Integrated Framework" issued by the Committee of Sponsoring Organizations of the Treadway
Commission("COSO");
7.12.2 Comply with federal statutes, regulations, and the terms and conditions of this
Contract;
7.12.3 Evaluate and monitor Agency's compliance with statutes,regulations and the terms
and conditions of this Contract;
7.12.4 Take prompt action when instances of noncompliance are identified including
noncompliance identified in audit findings; and
7.12.5 Take reasonable measures to safeguard protected personally identifiable
information and other information that HUD or City designates as sensitive or Agency considers
sensitive consistent with applicable federal, state, local and tribal laws regarding privacy and
obligations of confidentiality.
7.13 Lead Safe Housing Rule.
Agency will ensure compliance with the Lead Safe Housing Rule at 24 CFR Part 35, as
applicable. This includes but is not limited to Provision of Lead Hazard Information pamphlet,
use of Lead Certified contractors,use of Lead-Safe work practices, and clearance of the work site,
as applicable to the age of the housing unit and the extent of rehabilitation. Agency shall certify
that work affects only "de minimus" areas as appropriate to specific sites. Agency shall submit
EXHIBIT "J"—Lead Safe Hazard Certification to City when appropriate.
8. RECORD KEEPING; REPORTING AND DOCUMENTATION
REQUIREMENTS; AUDIT.
8.1 Record Keeping.
Agency shall maintain a record-keeping system as part of its performance of this Contract
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
CDBG REHABILITATION CONTRACT 2016-2017 Page 9
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
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, 2017 and end
on September 30,2022 regardless of whether or not this Contract is earlier terminated.
8.2 Access to Records.
Representatives of City, HUD and any duly authorized officials of the federal government
will have full access to, and the right to examine, audit, copy, excerpt and/or transcribe any of
Agency's records pertaining to all matters covered by this Contract for 5 years after the Contract
term ends. Such access shall be during regular business hours and upon at least 48 hours prior
notice. For purposes of this Contract, this 5 year period for access to records is deemed to begin
on October 1,2017 and end on September 30,2022 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 documentation described
in this Contract shall be an event of default of this Contract and City may exercise all of its
remedies for default under this Contract.
8.3.1 Additional Information.
Agency shall provide City with additional information as may be required by state or
federal agencies to substantiate Program activities and/or expenditure eligibility.
8.4 Change in Reporting Requirements and Forms.
City retains the right to change reporting requirements and forms at its discretion. City
will notify Agency in writing at least 15 days prior to the effective date of such change, and the
Parties shall execute an amendment to the Contract reflecting such change if necessary.
8.5 Audit.
8.5.1 Entities that Expend $750,000 or more in Federal Funds Per Year.
All non-federal entities that expend $750,000 or more in federal funds within 1 year,
regardless of the source of the federal award, must submit to City an annual audit prepared in
accordance with specific reference to 2 CFR Part 200.501 through Part 200.521. The audit shall
cover the Agency's fiscal years during which this Contract is in force. The audit must be prepared
by an independent certified public accountant,be completed within 6 months following the end of
the period being audited and be submitted to City within 30 days of its completion. Agency's audit
certification is attached hereto as EXHIBIT "C" — "Audit Certification Form" and "Audit
Requirements". The Audit Certification Form must be submitted to City prior to or with the
first Reimbursement Request. Entities that expend less than $750,000 a year in federal funds are
exempt from federal audit requirements for that year, but records must be available for review or
audit by appropriate officials of the federal agency, City, and General Accounting Office.
CDBG REHABILITATION CONTRACT 2016-2017 Page 10
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
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 CDBG 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, 2017 and end on September 30, 2022 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 CDBG
FUNDS OR SPENT CDBG FUNDS ON ANY INELIGIBLE ACTIVITIES, AGENCY
AGREES TO REIMBURSE CITY THE AMOUNT OF SUCH MONIES PLUS THE
AMOUNT OF ANY SANCTIONS,PENALTY OR OTHER CHARGE LEVIED AGAINST
CITY BY HUD BECAUSE OF SUCH ACTIONS.
9. REIMBURSEMENT REQUIREMENTS.
9.1 Deadline for Submitting Reimbursement Requests.
9.1.1 Reimbursement Requests shall be submitted monthly to the City and must be
received by the City on or before the 15" 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 15" falls on a weekend or City holiday, Reimbursement Requests
shall be due the next day that the City is open for business. Failure to submit a Reimbursement
Request in a timely fashion will result in City taking the actions outlined in Section 10.1.
NOTWITHSTANDING ANYTHING ABOVE,THE REIMBURSEMENT REQUEST FOR
EXPENSES INCURRED FOR SEPTEMBER 2017 MUST BE RECEIVED BY OCTOBER
1, 2017. COMPLETE DOCUMENTATION FOR ALL SEPTEMBER 2017 EXPENSES
MUST BE SUBMITTED BY OCTOBER 15, 2017. FAILURE TO SUBMIT A FINAL
REIMBURSEMENT REQUEST WITH COMPLETE DOCUMENTATION BY
OCTOBER 15,2017 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 may be penalized, at City's sole discretion, in the Request for Proposal
for the 2017-2018 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 10.1.2.
9.2 Submission of Reimbursement Requests.
Agency shall provide City with Complete Documentation and the following reports
CDBG REHABILITATION CONTRACT 2016-2017 Page 11
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
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 1,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.
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 CDBG-funded time and non-CDBG funded time and reflect
actual time spent on CDBG-funded activities. Agency may not submit
payroll expenses dated 60 calendar days prior to the date of the
Reimbursement Request.
9.2.2.2 For non-payroll expenses, invoices for each expense listed with an
explanation as to how the invoiced expense pertains to the Program.
Agency may not submit invoices dated 60 calendar days prior to the date
of the Reimbursement Request.
9.2.2.3 Proof that each expense was paid by Agency, which proof can be
satisfied by cancelled checks,wire transfer documentation,paid receipts
or other appropriate banking documentation.
9.2.3 Attachment III—Client Data Report.
This report shall list each Unduplicated Client served during the month along with his or
her demographic information. The Client Data Report must maintain a list of all clients served
during the Contract term. In order for this report to be complete,the following must be submitted:
9.2.3.1 Source Documentation of income verification for each Unduplicated
Client the first time the client is served by the Program
9.2.4 Delivery of Reimbursement Request.
Reimbursement Requests can be mailed or delivered in person to Neighborhood Services
Department, 908 Monroe Street, Fort Worth, Texas 76102. In addition, Agency can submit
Reimbursement Requests via email to psa@fortworthtexas.gov or to the Agency's designated City
contract administrator,but Agency must submit a signed original of Attachment I by the deadline
in Section 9.1.1.
9.3 Withholding Payment.
CITY SHALL HAVE NO OBLIGATION TO PAY ANY REIMBURSEMENT
CDBG REHABILITATION CONTRACT 2016-2017 Page 12
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
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.
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
OCTOBER 1, 2017, OR IF THE SUBMITTED REIMBURSEMENT REQUEST FOR
OCTOBER 1,2017 IS LATE,INCOMPLETE OR OTHERWISE NOT IN COMPLIANCE
WITH THIS CONTRACT OR THE CDBG REGULATIONS AS DETERMINED BY CITY
IN ITS SOLE DISCRETION, THERE WILL BE NO CURE PERIOD AND ANY
REIMBURSEMENT WILL BE FORFEITED.
10.1.4 In the event of(i)an uncured default under Section 10.1.1 or an event of default
under 10.1.2 or (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 CDBG 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 CDBG 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 CDBG 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
CDBG 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
CDBG REHABILITATION CONTRACT 2016-2017 Page 13
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
City. If Agency fails to maintain the required reports or documentation, or fails to submit or
resubmit any such report or documentation within such time, City shall have the right to terminate
this Contract effective immediately upon written notice of such intent with no penalty or liability
to City.
10.2.1 In the event of termination under this Section 10.2, all CDBG 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 CDBG Funds paid to Agency must be repaid to City
within 30 days of termination. If such CDBG 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 CDBG Funds that have not yet been expended from
affected activities to other eligible activities or withhold CDBG
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 CDBG 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 CDBG Funds already paid to Agency must be repaid
to City within 30 days of the termination. Failure to repay such CDBG Funds within the 30 day
period will result in City exercising all legal remedies available under this Contract.
CDBG REHABILITATION CONTRACT 2016-2017 Page 14
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
10.4 No Funds Disbursed while in Breach.
Agency understands and agrees that no CDBG 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 Rij4hts 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 CDBG 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 CDBG
Funds already paid to Agency must be repaid to City within 30 days of termination. Failure to
repay such CDBG 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
CDBG FUNDS FOR A MINIMUM OF 5 YEARS FROM THE DATE OF TERMINATION.
10.9.2 Agency may terminate this Contract if City does not provide the CDBG Funds
substantially in accordance with this Contract.
10.10 Termination for Convenience.
In terminating in accordance with 2 CFR Part 200, Appendix II, this Contract may be
terminated in whole or in part only as follows:
CDBG REHABILITATION CONTRACT 2016-2017 Page 15
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
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 CDBG Funds to be spent will not accomplish the purposes for which the Contract was made.
10.11 Dissolution of Allency 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 CDBG Funds are subject to repayment and/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 CDBG 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 CDBG Funds, and any real or personal property owned by Agency that was improved with the
CDBG Funds shall automatically transfer to City or to such assignee as City may designate.
11. REPAYMENT OF CDBG FUNDS.
All CDBG Funds are subject to repayment in the event the Program does not meet the
requirements of this Contract or in the CDBG Regulations. If Agency takes any action that
results in the City being required to repay all or any portion of the CDBG 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 CDBG Funds is required of City,Agency agrees City may require
that 10% of the CDBG Funds be repaid to City as liquidated damages. The Parties agree that
City's damages in the event of either repayment to HUD being required or receiving a finding
from HUD are uncertain and would be difficult to ascertain and may include an impact on City's
CDBG 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 CDBG Funds by Agency to City is liquidated damages and not a penalty.
12. CHANGE IN NON-PROFIT STATUS.
Agency must provide City with written notification of any changes to its non-profit status
within 15 calendar days of being notified of the change. Regardless of notice by Agency, if the
non-profit status of Agency changes after the date of this Contract, City may but is not obligated
to, terminate this Contract. In the event of termination under this Section 12, all CDBG Funds
awarded but not yet paid to Agency pursuant to this Contract shall be immediately rescinded and
Agency shall have no further right to such funds. City, in its sole discretion, may require that any
CDBG Funds already paid to Agency must be repaid to City within 30 calendar days of termination
under this Section.
CDBG REHABILITATION CONTRACT 2016-2017 Page 16
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
13. SURVIVAL.
Any provision of this Contract that pertains to auditing, monitoring, client income
eligibility, record keeping and reports, City ordinances, or applicable CDBG 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, 2017 and end on September 30, 2022
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.
Agency shall comply with all applicable requirements as more particularly described in 24
CFR Part 5.109. No portion of the CDBG 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
CDBG-funded service.
14.5.1. Separation of Explicitly Religious Activities.
Agency retains its independence and may continue to carry out its mission, including the
definition, development practice, and expression of its religious beliefs, provided that it does not
use CDBG Funds to support or engage in any explicitly religious activities (including activities
that involve overt religious content such as worship, religious instruction, or proselytization), or
in any other manner prohibited by law.
CDBG REHABILITATION CONTRACT 2016-2017 Page 17
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
14.5.2 Explicitly Religious Activities.
If Agency engages in explicitly religious activities (including activities that involve overt
religious content such as worship,religious instruction, or proselytization),the explicitly religious
activities must be offered separately,in time or location, from the programs or activities supported
by CDBG Funds and participation must be voluntary for clients of a CDBG-funded service.
14.5.3 Required Notices.
If Agency.constitutes a Faith-based organization under 24 CFR Part 5.109, Agency must
provide all clients of a CDBG-funded service with the notice attached as EXHIBIT "K"—Notice
of Beneficiary Rights. Such notice shall be provided to the client prior to enrollment in any
CDBG-funded program or activity. In addition, if a client or prospective client of a CDBG-funded
service objects to the religious character of Agency, then Agency must promptly undertake
reasonable efforts to identify and refer the client or prospective client to an alternate provider to
which the client or prospective client has no such objection, as more particularly described in 24
CFR Part 5.109.
14.6 Venue.
Venue shall lie in 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.
CDBG REHABILITATION CONTRACT 2016-2017 Page 18
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
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 Relzulations.
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:
➢ CDBG Regulations found in 24 CFR Part 570
➢ Title I of the Housing and Community Development Act of 1974, as amended, (42
USC 5301)
➢ Title VI of the Civil Rights Act of 1964 (42 U.S.C. Sections 2000d et seq.) including
provisions requiring recipients of federal assistance to ensure meaningful access by
persons of limited English proficiency
➢ The Fair Housing Act, Title VIII of the Civil Rights Act of 1968 (42 U.S.C. Sections
3601 et seq.)
➢ Executive Orders 11063, 11246 as amended by 11375 and 12086 and as supplemented
by Department of Labor regulations 41 CFR Part 60
➢ The Age Discrimination in Employment Act of 1967
➢ The Age Discrimination Act of 1975 (42 U.S.C. Sections 6101 et seq.)
➢ The Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970
(42 U.S.C. Sections 4601 et seq. and 49 CFR Part 24) ("URA")
➢ Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. Sections 794 et seq.) and 24
CFR Part 8 where applicable
➢ National Environmental Policy Act of 1969, as amended, 42 U.S.C. Sections 4321 et
seq. ("NEPA") and the related authorities listed in 24 CFR Part 58.
➢ The Clean Air Act, as amended, (42 U.S.C. Sections 1251 et seq.)and the Clean Water
Act of 1977, as amended (33 U.S.C. Sections 1251 et seq.) and the related Executive
Order 11738. In no event shall any amount of the assistance provided under this
Contract be utilized with respect to a facility that has given rise to a conviction under
the Clean Air Act or the Clean Water Act.
➢ Immigration Reform and Control Act of 1986 (8 U.S.C. Sections 1101 et seq.)
specifically including the provisions requiring employer verifications of legal status of
its employees
➢ The Americans with Disabilities Act of 1990 (42 U.S.C. Sections 12101 et seq.), the
Architectural Barriers Act of 1968 as amended (42 U.S.C. Sections 4151 et seq.) and
the Uniform Federal Accessibility Standards, 24 CFR Part 40,Appendix A
➢ Regulations at 24 CFR Part 87 related to lobbying, including the requirement that
certifications and disclosures be obtained from all covered persons
➢ Drug Free Workplace Act of 1988 (41 U.S.C. Sections 701 et seq.) and 24 CFR Part
23, Subpart F
➢ Executive Order 12549 and 24 CFR Part 5.105(c) pertaining to restrictions on
participation by ineligible, debarred or suspended persons or entities
➢ Section 6002 of the Solid Waste Disposal Act, as amended by the Resource
Conservation and Recovery Act
➢ Guidelines of the Environmental Protection Agency at 40 CFR Part 247
CDBG REHABILITATION CONTRACT 2016-2017 Page 19
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
➢ 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
➢ 2 CFR Part 200 et seq.
➢ Federal Funding Accountability and Transparency Act of 2006 ("FFATA") (Pub.L.
109-282, as amended by Section 6205(a) of Pub.L. 110-252 and Section 3 of Pub.L.
113-101)
➢ Federal Whistleblower Regulations, as contained in 10 U.S.C. 2409, 41 U.S.C. 4712,
10 U.S.C. 2324, 41 U.S.C. 4304 and 41 U.S.C. 4310.
14.12 HUD-Assisted Projects and Employment and other Economic Opportunities;
Section 3 Requirements.
14.12.1 Requirement that Law Be Quoted in Covered Contracts. — Certain
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 CDBG
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 Part 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 Act of 1968, as amended, 12
U.S.C. section 1701u (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 under no contractual or
other impediment that would prevent them from complying with the Part 135
regulations.
C. The contractor agrees to send to each labor organization or representative
of workers with which it has a collective bargaining agreement or other
CDBG REHABILITATION CONTRACT 2016-2017 Page 20
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
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 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 Part 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 future HUD assisted contracts.
G. With respect to workperformed 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 450(e) also applies to the work to be performed
under this Contract. Section 7(b) requires that to the greatest extent feasible (i)
preference and opportunities for training and employment shall be given to Indians,
and (ii)preference in the award of contracts and subcontracts shall be given to
Indian organizations and Indian-owned Economic Enterprises. Parties to this
contract that are subject to the provisions of Section 3 and Section 7(b) agree to
comply with Section 3 to the maximum extent feasible, but not in derogation of
compliance with Section 7(b). "
Section to be quoted in covered contracts ends.
14.12.2 Aizency 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 HUD 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:
CDBG REHABILITATION CONTRACT 2016-2017 Page 21
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
14.12.2.1 Implementing procedures to notify Section 3 residents and business
concerns about training, employment, and contracting opportunities
generated by Section 3 covered assistance;
14.12.2.2 Notifying potential contractors working on Section 3 covered
projects of their responsibilities;
14.12.2.3 Facilitating the training and employment of Section 3 residents and
the award of contracts to Section 3 business concerns;
14.12.2.4 Assisting and actively cooperating with the HED Department in
making contractors and subcontractors comply;
14.12.2.5 Refraining from entering into contracts with contractors that are in
violation of Section 3 regulations;
14.12.2.6 Documenting actions taken to comply with Section 3; and
14.12.2.7 Submitting Section 3 Annual Summary Reports (Form HUD-
60002) in accordance with 24 CFR Part 135.90.
14.12.3 Section 3 Reporting Requirements.
In order to comply with the Section 3 requirements,Agency must submit the forms attached
hereto as EXHIBIT "G" - Section 3 Reporting Forms.
14.12.3.1 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.
14.12.3.2 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.
14.12.3.3 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.
14.13 Prohibition ALlainst Discrimination.
14.13.1 General Statement.
Agency shall comply in the execution, performance or attempted performance of this
CDBG REHABILITATION CONTRACT 2016-2017 Page 22
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
Contract,with all non-discrimination requirements of 24 CFR Part 570.607 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
111,Division 3 -Employment Practices of the City Code, and Agency hereby covenants and agrees
that Agency, its officers, members, agents, employees and contractors, have fully complied with
all provisions of same and that no employee, or applicant for employment has been discriminated
against under the terms of such ordinances by either or its officers, members, agents, employees
or contractors.
14.13.2 No Discrimination in Employment during the Performance of This
Contract.
During the performance of this Contract Agency agrees to the following provision, and
will require that its contractors and subcontractors also comply with such provision by including
it in all contracts with its contractors:
[Contractor's, Subcontractor's or Vendor's name]will not unlawfully discriminate against
any employee or applicants for employment because of race, color, sex, gender, religion, national
origin,familial status, disability or perceived disability,sexual orientation, gender identity, gender
expression or transgender. [Contractor's, Subcontractor's or Vendor's name]will take affirmative
action to ensure that applicants are hired without regard to race, color, sex, gender, religion,
national origin, familial status, disability or perceived disability, sexual orientation, gender
identity,gender expression or transgender and that employees are treated fairly during employment
without regard to their race, color, sex, gender, religion, national origin, familial status, disability
or perceived disability, sexual orientation,gender identity,gender expression or transgender. Such
action shall include, but not be limited to, the following: employment, upgrading, demotion or
transfer, recruitment or recruitment advertising, layoff or termination, rates of pay or other forms
of compensation, and selection for training, including apprenticeship. [Contractor's,
Subcontractor's or Vendor's name] agrees to post in conspicuous places, available to employees
and applicants for employment, notices setting forth the provisions of this nondiscrimination
clause.
[Contractor's, Subcontractor's or Vendor's name] will, in all solicitations or
advertisements for employees placed by or on behalf of [Contractor's Subcontractor's or
Vendor's name], state that all qualified applicants will receive consideration for employment
without regard to race, color, sex, gender, religion, national origin, familial status, disability or
perceived disability, sexual orientation, gender identity, gender expression or transgender.
[Contractor's Subcontractor's or Vendor's name] covenants that neither it nor any of its
officers, members, agents, employees, or contractors, while engaged in performing this Contract,
shall, in connection with the employment, advancement or discharge of employees or in
connection with the terms, conditions or privileges of their employment, discriminate against
persons because of their age or because of any disability or perceived disability, except on the
basis of a bona fide occupational qualification, retirement plan or statutory requirement.
CDBG REHABILITATION CONTRACT 2016-2017 Page 23
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
[Contractor's Subcontractor's or Vendor's name] further covenants that neither it nor its
officers, members, agents,employees, contractors, or persons acting on their behalf, shall specify,
in solicitations or advertisements for employees to work on this Contract, a maximum age limit
for such employment unless the specified maximum age limit is based upon a bona fide
occupational qualification, retirement plan or statutory requirement.
14.13.3 Agency's Contractors and the ADA.
In accordance with the provisions of the Americans With Disabilities Act of 1990
("ADA"), Agency warrants that it and any of its contractors will not unlawfully discriminate on
the basis of disability in the provision of services to the general public,nor in the availability,terms
and/or conditions of employment for applicants for employment with, or employees of,Agency or
any of its contractors. AGENCY WARRANTS IT WILL FULLY COMPLY WITH THE
ADA'S PROVISIONS AND ANY OTHER APPLICABLE FEDERAL, STATE AND
LOCAL LAWS CONCERNING DISABILITY AND WILL DEFEND, INDEMNIFY AND
HOLD CITY HARMLESS AGAINST ANY CLAIMS OR ALLEGATIONS ASSERTED BY
THIRD PARTIES, CONTRACTORS SUBCONTRACTORS, VENDORS OR AGENTS
AGAINST CITY ARISING OUT OF AGENCY'S AND/OR ITS CONTRACTORS',
SUBCONTRACTORS', VENDORS' OR AGENTS' OR THEIR RESPECTIVE
EMPLOYEES'ALLEGED FAILURE TO COMPLY WITH THE ABOVE-REFERENCED
LAWS CONCERNING DISABILITY DISCRIMINATION IN THE PERFORMANCE OF
THIS CONTRACT.
14.14. Conflicts of Interest and Violations of Criminal Law.
14.14.1 Agency Safeguards.
Agency shall establish safeguards to prohibit its employees, board members, advisors and
agents from using positions for a purpose that is or gives the appearance of being motivated by a
desire for private gain for themselves or others, particularly those with whom they have family,
business or other ties. Agency shall disclose to City any such conflict of interest or potential
conflict of interest, immediately upon discovery of such.
14.14.2 General Prohibitions Against Conflicts of Interest.
No employees, agents, consultants, officers or elected officials or appointed officials of
City or of Agency who exercise or have exercised any functions or responsibilities with respect to
activities assisted with CDBG 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 CDBG services,may
obtain a financial interest or benefit from a CDBG-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 I year
thereafter.
14.14.2.1 Agency shall establish conflict of interest policies for
federal awards including the CDBG Funds and shall disclose in
writing potential conflicts of interest to City as authorized by 2 CFR
Part 200.112.
CDBG REHABILITATION CONTRACT 2016-2017 Page 24
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
14.14.3 Conflicts of Interest Involving Procurement.
The conflict of interest provisions of 2 CFR Part 200.3 1, shall apply in the procurement of
property and services by Agency. In all cases not governed by this Section, the provisions of 24
CFR Part 570.611 of the CDBG Regulations shall apply.
14.14.3.1 As more particularly described in 2 CFR Part 200.318,Agency shall
maintain and submit to City written standards of conduct covering
conflicts of interest and governing the performance of its employees
engaged in the selection, award, and administration of contracts. No
employee, officer, or agent may participate in the selection, award,
or administration of a contract supported by a federal award if he or
she has a real or apparent conflict of interest. The standards of
conduct must provide for disciplinary actions to be applied for
violations of such standards by officers, employees, or agents of
Agency.
14.14.3.2 The officers, employees, and agents of Agency shall neither solicit
nor accept gratuities, favors, or anything of monetary value from
contractors or parties to subcontracts.
14.14.3.3 Notwithstanding the prohibition contained in Section 14.13.3.2,
Agency may set standards of conduct for situations in which the
financial interest is not substantial or the gift is an unsolicited item
of nominal value. Such standards of conduct must provide for
disciplinary actions to be applied for violations of such standards by
Agency's officers, employees or agents.
14.14.3.4 Agency shall maintain written standards of conduct covering
organizational conflicts of interest. Organizational conflicts of
interest means that because of relationships with a parent company,
affiliate, or subsidiary organization,Agency is unable or appears to
be unable to be impartial in conducting a procurement action
involving a related organization.
14.14.3.5 Agency must maintain records sufficient to detail the history of
procurement. These records will include, but are not necessarily
limited to the following: rationale for the method of procurement,
selection of contract type, contractor selection or rejection, and the
basis for the contract price.
14.14.4 Disclosure of Conflicts of Interest.
In compliance with 2 CFR Part 200.112, Agency is required to timely disclose to City in
writing any potential conflict of interest.
14.14.5 Disclosure of Texas Penal Code Violations.
Agency affirms that it will adhere to the provisions of the Texas Penal Code which prohibit
bribery and gifts to public servants.
CDBG REHABILITATION CONTRACT 2016-2017 Page 25
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
14.14.6 Disclosure of Federal Criminal Law Violations.
In compliance with 2 CFR Part 200.113, Agency is required to timely disclose to City all
violations of federal criminal law involving fraud, bribery or gratuity violations potentially
affecting the Agency.
14.15 Subcontracting with Small and Minority Firms, Women's Business
Enterprises and Labor Surplus Areas.
14.15.1 For procurement contracts $50,000.00 or larger that are paid for, in part or in
full,with the CDBG Funds,Agency agrees to abide by City's policy to involve Minority Business
Enterprises and Small Business Enterprises and to provide them equal opportunity to compete for
contracts for construction,provision of professional services,purchase of equipment and supplies
and provision of other services required by City. Agency agrees to incorporate the City's BDE
Ordinance, and all amendments or successor policies or ordinances thereto, into all contracts and
subcontracts for procurement larger than $50,000.00 or larger that are paid for, in part or in full,
with the CDBG Funds and will further require all persons or entities with which it so contracts to
comply with said ordinance.
14.15.2 It is national policy to award a fair share of contracts to disadvantaged business
enterprises ("DBEs"), small business enterprises ("SBEs"), minority business enterprises
("MBEs"), and women's business enterprises ("WBEs"). Accordingly, affirmative steps must be
taken to assure that DBEs, SBEs, MBEs, and WBEs are utilized when possible as sources of
supplies, equipment, construction and services.
14.15.2.1 In order to comply with federal reporting requirements as described
in 24 CFR Part 570.506 (g)(6), Agency must submit the form
attached hereto as EXHIBIT"I"—MBE Reporting Form for each
contract or subcontract with a value of$10,000.00 or more paid or
to be paid with the CDBG Funds. Agency shall submit this form by
the date specified in EXHIBIT "I"—MBE Reporting Form.
14.16 Other Laws.
The failure to list any federal, state or City ordinance, law or regulation that is applicable
to Agency does not excuse or relieve Agency from the requirements or responsibilities in regard
to following the law, nor from the consequences or penalties for Agency's failure to follow the
law, if applicable.
14.17 Assignment.
Agency shall not assign all or any part of its rights,privileges,or duties under this Contract
without the prior written approval of City. Any attempted assignment of same without approval
shall be void, and shall constitute a breach of this Contract.
14.18. Right to Inspect A2ency 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
CDBG-funded Program prior to any charges being incurred.
CDBG REHABILITATION CONTRACT 2016-2017 Page 26
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
14.19 Force Maieure
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
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.
CDBG REHABILITATION CONTRACT 2016-2017 Page 27
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
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
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
$250,000.00 to insure against loss from the fraud,theft or dishonesty of any of Agency's officers,
agents, trustees, directors or employees. The proceeds of such insurance or bond shall be used to
reimburse City for any and all loss of CDBG Funds occasioned by such misconduct. To effectuate
such reimbursement, such fidelity coverage shall include a rider stating that reimbursement for
any loss or losses shall name the City as a Loss Payee.
Agency shall furnish to City in a timely manner, but not later than the Effective Date,
certificates of insurance as proof that it has secured and paid for policies of commercial insurance
as specified herein. If City has not received such certificates by the Effective Date, Agency shall
be in default of the Contract and City may, at its option,terminate the Contract.
Such insurance shall cover all insurable risks incident to or in connection with the
execution,performance,attempted performance or nonperformance of this Contract. Agency shall
maintain the following insurance coverage and limits:
Commercial General Liability(CGL) Insurance
$ 500,000 each occurrence
$1,000,000 aggregate limit
CDBG REHABILITATION CONTRACT 2016-2017 Page 28
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
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
$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 certificates) of insurance shall not be construed as a waiver
of such requirement or as a waiver of the insurance requirements themselves.
CDBG REHABILITATION CONTRACT 2016-2017 Page 29
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
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 wrongful acts arising
out of their organizational duties. Coverage shall protect not only the entity, but all past, present
and future directors, officers, trustees, employees, volunteers and committee members.
Notwithstanding any provision in this Contract to the contrary, when applicable, Agency
shall comply with the requirements of 2 CFR 200.310 and shall, at a minimum, provide the
equivalent insurance coverage for real property and equipment acquired or improved with
CDBG Funds as provided to property owned by Agency.
18. CERTIFICATION REGARDING LOBBYING.
The undersigned representative of Agency hereby certifies, to the best of his or her
knowledge and belief,that:
No federal appropriated funds have been paid or will be paid, by or on behalf of Agency,
to any person for influencing or attempting to influence an officer or employee of any
agency, a member of Congress, an officer or employee of Congress in connection with the
awarding of any federal contract,the malting 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
CDBG REHABILITATION CONTRACT 2016-2017 Page 30
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
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.
CDBG REHABILITATION CONTRACT 2016-2017 Page 31
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
20. NOTICE.
All notices required or permitted by this Contract must be in writing and are deemed
delivered on the earlier date of the date actually received or the third day following deposit in a
United States Postal Service post office or receptacle; with proper postage, certified mail return
receipt requested; and addressed to the other Party at the address set out below or at such other
address as the receiving Party designates by proper notice to the sending Party.
City:
City Attorney's Office
1000 Throckmorton Street
Fort Worth, TX 76102
Telephone: 817-392-7600
Copy to:
Neighborhood Services Department
1000 Throckmorton Street
Fort Worth, TX 76102
Attention: Assistant Director
Telephone: 817-392-7540
Copy to:
Neighborhood Services Department
1000 Throckmorton Street
Fort Worth, TX 76102
Attention: Management Analyst II
Telephone: 817-392-7369
Amency:
Fort Worth Area Habitat for Humanity, dba Trinity Habitat for Humanity
Gage Yager,Executive Director
9333 N.Normandale St.
Fort Worth, TX 76116
Telephone: 817-926-9219
CDBG REHABILITATION CONTRACT 2016-2017 Page 32
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
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]
CDBG REHABILITATION CONTRACT 2016-2017 Page 33
Fort Worth Area Habitat for Humanity, dba Trinity Habitat for Humanity Rev.9.28.2016
IN WITNESS WHEREOF, the Parties hereto have executed 4 duplicate originals of this
Contract in Fort Worth, Tarrant County, Texas.
QT ST: CITY OF FORT WORTH
F0RB
k.�dity Secretary ando Costa,Assistant City Manager
M&C: G-18793
Date: August 9, 2016 _
APPROVED AS TO FORM AN
Paige Meba e, Assistant City Attorney
FORT WORTH AREA HABITAT FOR
HUMANITY, DBA TRINITY HABITAT FOR
HUMANITY
By: .�—
Gagea r, Ex utive Director
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH,TX
CDBG REHABILITATION CONTRACT 2016-2017 Page 34
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
EXHIBITS:
EXHIBIT "A"—Program Summary
EXHIBIT "A-1"—2016 HUD Income Limits
EXHIBIT "A-2"—Lead-Safe and Preserve a Home Programs Partnership
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"—Severely Disabled Certification Form
EXHIBIT "I"—MBE Reporting Form
EXHIBIT "J"—Lead Safe Hazard Certification
EXHIBIT "K"—Notice of Beneficiary Rights
CDBG REHABILITATION CONTRACT 2016-2017 Page 35
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Rev.9.28.2016
Fort Worth Area Habitat for Humanity, dba EXHIBIT "A"
Trinity Habitat for Humanity
Preserve a Home Program PROGRAM SUMMARY
PROGRAM SUMMARY
(CDBG)
September 12, 2016 to September 30, 2017 $250,000.00
PERIOD AMOUNT
Capitalized terms not defined herein shall have meanings assigned them in the Contract.
PROGRAM:
The Program provides home repairs to low income persons living in the Como neighborhood of
Fort Worth. Eligible homeowners must be Income Eligible Clients, occupy the home as their
principal residence and must not have the financial means or physical ability to renovate their
homes.
Only exterior work will be completed, including replacing/repairing siding, roof
replacement/repair, replacing/reglazing windows or doors,replacing trim and painting.
Agency or homeowner is responsible for submitting any applications for City permits or
approvals. These approvals may include but are not limited to Historic & Cultural Landmarks
Commission, Board of Adjustment, Zoning approvals, and building inspections. Cost for
permits or approvals are reimbursable under this Contract.
Agency must coordinate with City to ensure compliance with the Lead Safe Housing Rule.
CDBG Funds will be used to pay for materials, building permits, contractor labor for the home
repairs and project delivery costs in the form of salaries and mileage for staff directly dealing
with clients.
Agency is located at 9333 N. Normandale St, Fort Worth, TX 76116, with operating hours of
8:30 a.m. to 5:30 p.m., Monday through Thursday and 8:30 a.m. to 4:00 p.m. on Fridays.
Agency Program services will be delivered in the Como neighborhood of Fort Worth at the
homeowners' residences during the hours of 7:00 a.m. to 6:00 p.m.,Monday through Saturday.
REGULATORY CLASSIFICATION:
IDIS Matrix Code(s) and Service Category: 14A Rehab: Single-Unit Residential
National Objective Citation: LMH Low/Mod Housing Benefit 24 CFR 570.208(a)(3)
Regulatory Citation(s): 24 CFR 570.202(b)(I1)
CDBG REHABILITATION PSA CONTRACT 2016-2017—EXHIBIT"A"—PROGRAM SUMMARY Pagel
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity
Agency will maintain documentation that verifies that 100% of clients served by the Program are
Income Eligible Clients.
PROGRAM GOALS:
Minimum Number of Clients to be Served: The Program must serve a minimum of 15
Unduplicated Clients from the Como neighborhood of Fort Worth as shown by the monthly
reports on Attachment III.
CDBG REHABILITATION PSA CONTRACT 2016-2017—EXHIBIT"A"—PROGRAM SUMMARY Pagel
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity
EXHIBIT "A-1"
2016 HUD INCOME LIMITS
2016 Median Family Income -Fort Worth/Arlington, TX*
1 Person 2 Persons 3 Persons 4 Persons 5 Persons 6 Persons 7 Persons 8 Persons
Extremely $14,600 $16,650 $20,160 $24,300 $28,440 $32,580 $36,730 $40,890
Low
Income
50%AMI $24,300 $27,800 $31,250 $34,700 $37,500 $40,300 $43,050 $45,850
80%AMI $38,850 $44,400 $49,950 $55,500 $59,950 $64,400 $68,850 $73,300
*Income limits are published at least annually by HUD.
CDBG REHABILITATION PSA CONTRACT 2016-2017--EXHIBIT"A-1"—2016 HUD INCOME LIMITS
Page 1
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity
EXHIBIT "A-2"
LEAD-SAFE AND PRESERVE A HOME PROGRAMS PARTNERSHIP
The following identifies what each partner will be responsible for:
Items to be performed by Agency:
• Intake and application process
• Client qualification, including obtaining all required documentation:
o Client is an Income Eligible client as defined by contract
o Client is a Fort Worth resident
o Client owns property or has permission from owner(s)to perform work
o Client is up to date on all property taxes
o Client signs authorization for work to be performed
• Referral to Lead-Safe Program
o Once Agency determines that client is eligible as described above, Agency will
refer the client to the Lead-Safe Program (LSP) staff by sending a written
notification to the City contract administrator
• Contractor/inspector assessment/work write-up (after Lead Risk-Assessment has been
performed)
o Determine what work needs to be completed to the outside of property (including
any applicable items found on the risk-assessment)
o Take photos of areas/items where work is needed as well as the following:
■ front of the property
■ left and right side view of property
■ house to the left and right
■ house across the street
■ left street view of homes
■ right street view of homes
o Coordinate with client to obtain agreement on all work to be performed on
exterior. Client signs approval of scope of work including acknowledgement and
completeness of exterior scope to be performed by Agency
o Prepare a work-write up that includes all work proposed for the exterior and cost
estimate
• Submit client qualification documentation, work write-up and pictures to City contract
administrator for review
• Preparation of initial ER request form and attachments
o Full description of work to be performed
o Pictures as described above,provided to City contract administrator in electronic
form
CDBG REHABILITATION PSA CONTRACT 2016-2017—EXHIBIT"A-2"—LEAD-SAFE AND
PRESERVE A HOME PROGRAMS PARTNERSHIP Page 1
Fort Worth Area Habitat for Humanity, dba Trinity Habitat for Humanity
• Submit client qualification documentation, work write-up and ER request form with
attachments to City contract administrator for review
• After Environmental request is approved and release received from City contract
administrator, Agency issues a Notice to Proceed to contractor for Agency portion of full
scope of work
• Contractor performs work as described in the environmental request
• Agency requests reimbursement
CDBG REHABILITATION PSA CONTRACT 2016-2017—EXHIBIT"A-2"—LEAD-SAFE AND
PRESERVE A HOME PROGRAMS PARTNERSHIP Page 1
Fort Worth Area Habitat for Humanity, dba Trinity Habitat for Humanity
Items to be performed by City:
Lead-Safe Program Referral
NOTE: If any of the reviewers in the process described below have questions or need additional
information, City contract administrator will contact Agency to request the additional
information.
• Contract administrator receives referral
o Lead-Safe Program staff determines whether client is eligible for services
o Lead-Safe program staff orders Lead Risk-Assessment
• Risk assessment
o Lead-Safe Program staff will evaluate risk assessment and will determine what
works needs to be done
o LSP staff will inform Agency of lead hazards on the outside and prepare a work
write-up for the inside of the house and for any exterior lead hazard reduction
activities not included in Agency's initial submission
• City contract administrator prepares Environmental request(including work to be done
by agency) and sends to environmental coordinator
• Environmental coordinator reviews request and attachments
• Environmental coordinator sends request to Historic Preservation Officer
• Historic Preservation Officer reviews and prepares letter to the Texas Historic
Commission
• Texas Historic Commission has 30 days to review and conquer with City's determination
of no impact, remediation steps or provide additional guidance
• Historic Commission will notify Historic Preservation Officer of results
• Historic Preservation Officer will provide results to Senior Planner who will prepare
Environmental forms and put together all attachments
• If no environmental impact is anticipated, Senior Planner will sign and send
environmental review to Planning Manager for signature
• Planning Manager will sign and inform City contract administrator when environmental
review is ready
• While ER process is underway, City contract administrator will coordinate with agency
to determine which work items will be performed by City Lead-Safe Program, and which
work items will be performed by Agency
o Final list for each partner will be confirmed in writing prior to issuance of Notice
to Proceed
• Contract administrator will send Agency a Notice to Proceed and will include the
environmental review and all attachments
• LSP staff will order work to be performed by LSP contractor
CDBG REHABILITATION PSA CONTRACT 2016-2017—EXHIBIT"A-2"—LEAD-SAFE AND
PRESERVE A HOME PROGRAMS PARTNERSHIP Page 1
Fort Worth Area Habitat for Humanity, dba Trinity Habitat for Humanity
• Once all work is done, City inspects work to verify work is consistent with environmental
request description and will perform tests to ensure interim controls were performed
properly
• City reimburses once inspection is complete
CDBG REHABILITATION PSA CONTRACT 2016-2017—EXHIBIT"A-2"—LEAD-SAFE AND
PRESERVE A HOME PROGRAMS PARTNERSHIP Page I
Fort Worth Area Habitat for Humanity, dba Trinity Habitat for Humanity
EXHIBIT"B"-BUDGET
" Accoun# Gran'YBudget AB."�:.':; C Total
PROGRANTPERSONNEL ' ' ; _
Salaries 1001 $ 27,868.09 $ 27,868.09
FICA 1002 $ 2,131.91 $ 2,131.91
Life/Disability Insurance 1003 $ -
Health/Dental Insurance 1004 $ -
Unemployment-State 1005 $ -
Worker's Compensation 1006 $ -
Retirement 1007 $ -
SUPP,LTES
Office/Program Supplies 2001 $ -
Postage 2002 $ -
Printing 2003 $ -
Other() 2004 $ -
IIIISCELLAN> OUSZV
Construction/Building Materials 3001 $ 109,375.00 $ 109,375.00
Contract La or Permitting(City
needs copy of contract before
expenses can be reimbursed) 3002 $ 109,375.00 $ 109,375.00
Food Supplies 3003 $ -
Teaching Aids 3004 $ -
Craft Supplies 3005 $ -
Field Trip Expenses 3006 $ -
Mileage 3007 $ 1,250.00 $ 1,250.00
Other() 3008
Other() 3009
Telephone 4001 $ -
Electric 4002 $ -
Gas 4003 $ -
Water and Wastewater 4004 $ -
Solid Waste Disposal 4005 $ -
Rent(City needs copy of lease
before expenses can be
reimbursed) 4006 $ -
Cleaning Supplies 4007 $ -
Other Q 4008 $ -
LEGAL IINANCIAL;AND
Fidelity Bond or Equivalent 5001 $ -
Directors and Officers 5002 $ -
General Commercial Liability 5003 $ -
Other() 5004
DIRECT A SSI,STANCE =;
Othero 6001
BUDGET TOTAL 1 $ 250,000.00 $ - $ - $ 250,000.00
CDBG REHABILITATION PSA CONTRACT 2016-2017-EXHIBIT"B"-BUDGET
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Page 1
The following tables were created for the purpose of preparing, negotiating, and determining the cost
reasonableness and cost allocation method used by the Agency for the line item budget represented on
the first page of this EXHIBIT "B"—Budget. The information reflected in the tables is to be
considered part of the terms and conditions of the Contract. Agency must have prior written approval
by the City to make changes to any line item in the Budget as outlined in Section 5.2.2 in the
Contract. The deadline to make changes to EXHIBIT "B"—Budget is June 1, 2017.
SALARY DETAIL-PROGRAM PERSONNEL
Est. Percent to Amount to
Position Title Annual Salary Grant Grant
Construction Administrator $ 30,306.00 29.92% $ 9,068.09
Construction Manager $ 40,000.00 47.0% $ 18,800.00
TOTAL 1 $ 70,306.00 39.64%1 $ 27,868.09
FRINGE DETAIL-PROGRAM PERSONNEL
Percent of Est. Percent to Amount to
Payroll Amount Grant Grant
FICA 7.65% $ 5,378.41 39.64% $ 2,131.91
Life/Disability Insurance
Health/Dental Insurance
Unemployment-State
Worker's Compensation
Retirement
TOTAL 1 1 $ 5,378.411 39.6%1 $ 2,131.91
SUPPLIES AND SERVICES
Est. Percent to Amount to
Total Budget Grant Grant
Office/Program Supplies
Postage
Printing
Other()
TOTAL
CDBG REHABILITATION PSA CONTRACT 2016-2017-EXHIBIT"B"-BUDGET
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Page 2
MISCELLANEOUS
Est. Percent to Amount to
Total Budget Grant Grant
Construction/Building Materials $ 109,375.00 100.0% $ 109,375.00
Contract Labor $ 109,375.00 100.0% $ 109,375.00
Food Supplies
Teaching Aids
Craft Supplies
Field Trip Expenses
Mileage $ 1,250.00 100.0% $ 1,250.00
Other()
OtherO
TOTAL $ 220,000.00 100.0% $ 220,000.00
FACILITY AND UTILITIES
Est. Percent to Amount to
Total Budget Grant Grant
Telephone
Electric
Gas
Water and Wastewater
Solid Waste Disposal
Rent
Cleaning Supplies
Other()
TOTAL
LEGAL, FINANCIAL AND INSURANCE
Est. Percent to Amount to
Total Budget Grant Grant
Fidelity Bond or Equivalent
Directors and Officers
General Commercial Liability
Other O
TOTAL
DIRECT ASSISTANCE
Est. Percent to Amount to
Total Budget Grant Grant
OtherO
TOTAL
CDBG REHABILITATION PSA CONTRACT 2016-2017-EXHIBIT"B"-BUDGET
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity Page 3
EXHIBIT "C"
AUDIT CERTIFICATION FORM
CDBG REHABILITATION PSA CONTRACT 2016-2017—EXHIBIT"C"—AUDIT CERTIFICATION FORM Page I
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity
I
AUDIT CERTIFICATION FORM AND AUDIT REQUIREMENTS
Agency: Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity
Fiscal Year Ending: September 30,2017
1
❑ During the fiscal year in which funds will be received, we will exceed the federal
expenditure threshold of$750,000. We will have our Single Audit or Program Specific
Audit completed and will submit the audit report described in 2 CFR Part 200 within 7
months after the end of the audited fiscal year or 30 days within its completion, whichever
is the earlier date.
During the fiscal year in which funds will be received, we will not exceed the $750,000 fr
federal expenditure threshold required for a Single Audit or a Program Specific Audit to be
performed this fiscal year. (Fill out schedule below)
1H'eeiiEgpend�tureIllrsclose s j
Pass Throu�lt i'rog�ratn Naiz3�8c C•o�l#r������ �� sndt res ;
F�delai Ctanto� _ -� ,
HUD City of Fort Worth HAPCFDA 14.239 HAP D-P Asst.Prog. $172,995 G
HUD HFHI SHOP 2014 CFDA 14.257 SH14-001 $125,000
HUD City of Fort Worth CDBG CFDA 14.218 CDBG 2017 $250,000
HUD HFHI Capacity Building Grant CB2013 $5,654
e
t
Total Federal Expenditures for this Fiscal Year: $553,649
S Y-'b�hchV� q l a 1 I
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 2 CFR Part 200, as
applicable, by the required due date may result in suspension of funding and may affect a
eligibility for future funding. Notwithstanding the above, this certification acknowledges the
agency's commitment to meet all other financial reporting, financial statements, and other
audit requirements as may be set forth in the Contract. g
i
s
• i
:
CDBG REHABILITATION PSA CONTRACT 2016-2017—EXHIBIT"C"—AUDIT CERTIFICATION FORM Page 2
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity
t
r
EXHIBIT "D"
REPORTING FORMS
CDBG REHABILITATION PSA CONTRACT 2016-2017—EXHIBIT"D"—REPORTING FORMS Page 1
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity
ATTACHMENT I
Invoice
Agency:
Address:
City, State, Zip:
Program:
Period of Service: '
Tax ID No.
P.O. No.
FID No.
Program Amount
;This lnuoice ;Curnut iii `to`Date
!'Agency's Certification: By signing this report, I certify to the best of my
knowledge and belief that the report is true, complete, and accurate,
and the expenditures, disbursements and cash receipts are for the
purposes and objectives set forth in the terms and conditions of the
"Federal award. I am aware that any false, fictitious or fraudulent
information, or the omission of any material fact, may subject me to
criminal, civil, or administrative penalties for fraud, false statements,
false claims, or otherwise. U.S. Code Title 18, Sec. 1001 and Title 31,
Sec. 3729-3730 and 3801-3812.
Signature and Date:
Name:
Title:
CDBG REHABILITATION PSA CONTRACT 2016-2017—EXHIBIT"D"—REPORTING FORMS Page 2
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity
ATTACHMENT 11
Expenditure Worksheet
Neighborhood Services Department
Expenditure Worksheet..
Agency: Rehabilitation,Education and Advocaay for Persons iiith f1srulicaps,dba REACH,Inc.
Frog—
Project R..p
Only highlighted codas can be reimbursed
Please g oup like account codes.
pause Unt
1510�
Pavcc Des dInvorilJo go cN,to g- cc
eltem
ile ChcckN6'�', Date c bT, -,itj Amount, Account
I PROGRAMI'MONNEL
2 Salaries 1001
3 FICA 1002
4 Life/ sabilitv Insurance 1003
Flealth/DarnalInsurance 1004
6 Uncuployment-State— 1005
7 Workcr's Cornpensation 1006
8 Ratirement 1007
9 SUPPIM"AND SERVICES"
10 office/Pro gnansuppties 2001
11 Posta
-,a 2002
12 Not
rag 2003
13 Otharo 2004
14
15 Construction/Building Materials 3001
16 Contract Labor/Permitting 3002
17 Food Supplies 3003
18 Tcaching Aids 3004
19 Cmil Supplies 3005
20 Trip EVenses 3006
21 Mileage 3007
22 Otharo 3008
2001
2
23 Other() 3009,
24 FAcu=ANDurffxim
25 Telephone
4001
26 Bectric 4002
27 Gas 4003
28 Water and Wastewater 4004
29 Solid Waste Disposal 4005
30 Rent 4006
31 cleaning Supplies 4007
32 Otharo 4008
33 LEGAL FINANCIAL,AND INSURANCE
34 Fidelity Bond or Equivalent 5001
35 Directors and Offkers 5002
36 General Commercial Liabilitv 5003
37 Othero 5004
38
39 1 Othero 600I
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Total $0.00
*For Salaries,state craployees title under Description/Job Title.Rent most identity tenant
CDBG REHABILITATION PSA CONTRACT 2016-2017 EXHIBIT"D"—REPORTING FORMS Page 3
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity
ATTACHMENT III
Client Data Report
Pmganc
L��� , :",:� .', nnr.�cu.mm�wl.n�r am n.wigao.rqn.nn.mtl!rtt<ry�oi6osspw�.a4ie1A aa�Apn...pl� 'am,spuh®hnienal .�.au'®,a!s�.'€a.viz,�sa<.rym:.5r�.iwnnaex.o-,mie�e�masro.�r.++R;1s+!R�+lsm
! hukuc69m: 'cwaraka,man.rdfvsmy,A�ds�imae.erg'mtr���l:Baa:i�jr.�,ele.t�.:c�.moammrv'n..r rt�mid�n�=a€p.�m�yraukrw�'met:Frs.a:�+.�naadad..ti�r.rcn,*•sm�w..d�ua:e�n�wr ni�aanra�naa.�
rgmn8e6gdaea@usi+tQre.rtia4aatn6!Y�Iortrenah0apiga Mxm�tzt�dmlF naeawnoltu0etrab+�;WtL€amanrmpea6ct�renli `; .,
.,'Pedp(:Ib buCUIIRFi1Tb[O,Y('0 i•lHn.lk�t.�:alau rsa.^,m�... .
';;,G'lbllFfl114Elld riGdf�e6
i(Mt)utav Met bON.01
: •lame.9.demexlf.+le,.u6a�a�.on.Yty.sd.�
. ��, •,. .' .,,,, '• ,'ffi� ':E3ffi3�TI5 �:65rS � `. CSiHID 181aamR
., .,.; rc ,�.:. � �'�„� ,...;:, .,,�',': ..t':'&ateox)'- (H.r-�dsoul tbF foal: � p�Oz) itr]PshrasSafhi•3w�iJ #i]rcj�..
x'WE,
>'
,fflErt;QB1�1I1> llYCi2YkillF' 1:WE�, a7jfkTtTl1�5 .,, u 4 .M ,, �,, '..; ".,=. .3uveu H1tcv 13µ&i^ # UN]S9e'
.^ .14E 3CUE fF11MG i{I�C3?16FlMS Y\Iiti '.itvn( 3v4xe'Av.tit4ffi �tDID"miE •H1Et)3LahiI6!+>Qu'+a( .£bs�� Y41 2A�13Wtli 0�f31tAV' ' � lS Ml
1
3
6
8
9
19
I
I'
21 1
11
11
16
I1
19
13
1i
ffi
)3
}1
11
11
ll
N
L
u
n
x
a
CDBG REHABILITATION PSA CONTRACT 2016-2017—EXHIBIT"D"—REPORTING FORMS Page 4
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity
EXHIBIT "E"
INCOME CERTIFICATION FORMS
CDBG REHABILITATION PSA CONTRACT 2016-2017--EXHIBIT`B"--INCOME CERTIFICATION FORMS
Page 1
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity
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 only-----------------
Household Size: Gross Annual Income:
Applicable Income Limit: Is Applicant Eligible?
Check if Applicant refused to provide demographic information: O
Staff Assessment of Demographics:
Person Malting Determination: Date:
NOTE: Address, income amounts and sources for ALL household members are required.
CDBG REHABILITATION PSA CONTRACT 2016-2017--EXHIBIT`B"--INCOME CERTIFICATION FORMS Page 2
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity
Ciudad de Fort Worth
CERTIFICACION DE DECLARAC16N DE INGRESOS
Nombre del Solicitante:
Direcci6n de Actualidad: Telefono:
Ciudad y C6digo Postal:
Miembros Del Ho ag r e Ingresos
(Incluyendo el/la Solicitante)
Apellido Nombre Edad Ingreso Origen de Ingresos
Mensual
*TOTAL N( MERO DE MIEMBROS DEL HOGAR (Incl6yase Usted.)
Total Anual de Ingresos del hogar:
**INFORMACION PERSONAL:(Seleccione uno en cada articulo. Esta informaci6n es requerida por el Gobierno federal.)
a. ❑MASCULINO b.❑BLANCO ❑NEGRO/AFRICANO AMERICANO ❑NEGRO/AFRICANO AMERICANO&BLANCO
❑FEMININO ❑INDIO AMERICANO/NATIVO DE ALASKA ❑ASIATICO
❑INDIO AMERICANO/NATIVO DE ALASKA&BLANCO ❑ASIATICO&BLANCO
❑NATIVO HAWAIANO/OTRO DE LAS ISLAS PACIFICAS ❑BALANCE/OTRO
❑INDIO AMERICANO/NATIVO DE ALASKA&NEGRO/AFRICANO AMERICANO
c. ETHNICIDAD d. INCAPACITADO e. SES LA CABEZA DEL HOGAR MUJER?
❑HISPANO ❑ SI ❑SI
❑NO-HISPANO ❑NO ❑NO
Certificaci6n: Yo certifico que la informaci6n que yo estoy proporcionando es verdadera y puedo ser sujeto a
verificaci6n a cualquiera hora por tercera parte. Yo tambien reconozco que la provisi6n de informaci6n falsa
puede dejarme sujeto a penalidades Federales, Estatales, y a ley local.
Firma del Solicitante Fecha
ADVERTENCIA:TITULO 18,SECCI6N 1001 DEL CODIGO DE LOS ESTADOS UNIDOS INDICA QUE UNA
PERSONA ES CULPABLE DE UN DELITO POR SABER Y VOLUNTARIAMENTE RACER 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: SEs solicitante elegible?
Compruebe si el solicitante se neg6 a dar su informaci6n personal: O
Evaluaci6n del empleado sobre informaci6n personal:
Persona haciendo la determinaci6n: Fecha:
Note: La direction de la casa y los ingresos (y sus origenes) para todos miembros del hogar son requeridos.
CDBG REHABILITATION PSA CONTRACT 2016-2017--EXHIBIT"E"--INCOME CERTIFICATION FORMS Page 3
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity
EXHIBIT "F"
STANDARDS OF DOCUMENTATION
CDBG REHABILITATION PSA CONTRACT 2016-2017--EXHIBIT"F"--STANDARDS OF
DOCUMENTATION Page 1
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity
2016-2017 Documentation Standards for
CDBG Public Service Contract Expenses
41
CL
Employee Salarres and Benefits,„Crty wr1l only rerrriburse a percentage of any employee s salary and benefits who work tlirectty with`the CDB,G,funded Program
Percentages will be costaltocated;and determined prior to the execution of the CDBG Contract Agencies requesting the,reimburseinent of 100°1 of any Agency employee"-
l
Will require prior Crty approval Ap"ejtcres must show calculation on how the CDBG porton of employee salaries antl benefits were calculated consrstentty with the CDBG ?,
If an employee works on both a CDBG eligible and non-CDBG eligible program(s),the City will only reimburse for a reasonable portion
of the employee's salary. Prior to the execution of the CDBG Contract,the Agency will priovide the City with a written statement on how
each employee's time will be allocated. If an employee works 100%of their time directly with the CDBG-funded Program,then 100%of
the employee's salary may be eligible for reimbursement. Agency must submit a written statement that 100%of the employee's time is
spent working directly with the CDBG-funded Program. Statements must be signed by a person authorized to sign on behalf of the
Agency and will be submitted with the October invoice.
Salaries X x• Reimbursement requests must include a timesheet and work log that reflects the hours worked by the employee(s)working directly on
the CDBG-funded Program. For employees who are paid with multiple funding sources,timesheets must reflect all funding sources. If
separate timesheets are kept for each funding source,all such timesheets must be submitted to City. Timesheets must be signed by
employee and supervisor. Agency must show a calculation and documentation of how the employee's salary was calculated and
invoiced to City.
'If employees are paid by direct deposit rather than check,then the agency must submit both the direct deposit payment company's
report(such as an ADT report)and a bank statement or check showing payment to the direct deposit company.
FICA/Medicare X X
Life Insurance X X
Health X X If the Cit pays gross salary,this is alreadyIncluded.If the Cit pays the employer portion,the Agency must provide roof that the
Insurance City g ry' y p y p g y p
Disability employee is enrolled in the benefit plan,must show a calculation and documentation of how the invoiced amount was calculated,and
X X must provide documentation showing payment.
Insurance
Unemployment X X
Insurance
If the City pays gross salary,this is already included.If the City pays the employer portion,the Agency must provide proof that the
Retirement X X employee is enrolled in the benefit plan,must show a calculation and documentation of how the invoiced amount was calculated,and
must provide documentation showing payment.
Materials,Equipment Goo,ds and Supplies „City wdl only reimburse for the;cost allocated percent or amount spent in support of the:CDBG-funded Program Agencres
requesting reim d emeiit for, ese,items wilC'"require prior City approval Agencres must show calculation on howthe CDBG portion°of thes`e;expenses were calcylateil'
. r: ti-.,
consistentlywith'ttie CDBG Contract;
Office Supplies XX X
Office
Equipment X X X X X
Rental
Postage X X I X
Printing X X I X
Construction&
Building X X X X This category is only available for the REACH and Trinity Habitat for Humanity Program.
Materials
Sport and
Recreation X X X
Equipment
Cleaning XX X
Supplies
Teaching Aids X X X
Craft Supplies IXIX X
Food Supplies X X X I This category is only available to the Program provided by Meals on Wheels.
Ren, UtrlI es antl Maintenance:<Cify will only payfor,;a portron`ofthese expenses The portion of these expense's`will be.determined`byhhesquare footage attributable to
the CDBG funded Program;and shall hecost=altocatetl in accordance with"the amount of space rised for the CDBG fundetlP,rogram';;,These expenses may only be m support
ofthe CABG fundetl Program ?he items listed belowrequire,prior Crty approval antl the Agercy rs required to identify any funding s"ource that pays for the portion,of the
expenses that is not paril.wrth CDBG funds ncres;;mustshow calculahgn on how the CDBG portron'of#
Agehese expenseswere calculated consrstentlywith the CDBG
Tele hone IX X
Gas X X
Water/Wastew X X
ater
Electric X X
Solid Waste X X
CDBG REHABILITATION PSA CONTRACT 2016-2017 E#iibl"F'-'STANDARDS FOR COMPLETE DOCUMENTATION 1
Facility This item requires approval by the City prior to the execution of the CDBG Contract. Repairs may be categorized as major/minor
Maintenance X X X X rehabilitation projects and must be approved through the full HUD Environmetal Review.
and Repairs
Rent X X X City will pay for a portion of the rent for the Program facility so long as its in proportion to the square footage attributable to the CDBG-
funded program.
Miscellaneous
This item requires prior approval by the City. Prior to the execution of the CDBG Contract,the Agency must submit a written statement
that lists the contract labor services to be used during the Contract term. Agency will submit a memo related to the procurement of such
Contract Labor X X X X X services and will forward any information pertaining to the procurement process to City. This requirement applies to,but is not limited to,
services retained for security services,legal,accounting,transportation providers,educational facilitators,custodial services,etc.
Agencies may not use the contract services of any City of Fort Worth Department.
City-requiredX X City will only pay for a percentage of the City-required insurance so long as it's in proportion to the square footage attributable to the
Insurance CDBG-funded program.
City requires that the agency submit its fee schedule or formula on how the Agency calculates the childcare scholarship amount. The
fee schedule/formula should demonstrate a breakout of income levels,and for each income level the schedule should demonstrate
ChildcareX X which portion of the expense is to be paid by the family and which portion of the expense is to be reimbursed by the City. A fee
Scholarships schedule/formula must be submitted to the City prior to the first payment. Agency must submit documentation supporting that the client
is income eligible and that the household is being charged in conformance with the fee schedule. If the fee schedule/formula changes at
any time during the contract term,the Agency must immediately notify City on the date the new fee schedule/formula takes into effect.
"$0"Income Agecies that are required to verify and provide proof of household income to determine eligibility,must require that anyone who is over
Certifications the age of 18,living in the housohold,submit a$0 Income Certification.
If an audit is required because federal funds exceed$750,000,then the cost should be split evenly by all grant funding sources. Agency
Audit Services X X X X must show calculation on how the CDBG portion of the accounting services were calculated. For example,if the CDBG grant is 10%of
your Agency's budget,then invoice shall not exceed 10%of the overall cost. Agency must show a calculation and documentation of
how the invoiced amount was calculated,and must provide documentation showing payment.
*Proof of payment effective October 1,2013: Payments or Expenses must be documented in the following manner:
A)Image of the check AND bank statement showing the check cleared the bank;OR,
B)Image of the cancelled check(ex.At end of bank statement);OR,
C)Payroll Check Stub,"Advice",or Statement AND Bank Statement indicating payroll;OR,
D)For wire or e-transfers:Reciept or statement from payee/vendor OR bank statement.
Final as or 09/16/2016 do
CDBG REHABILITATION PSA CONTRACT 2016-2017 Exhibd"F'--STANDARDS FOR COMPLETE DOCUMENTATION 1
EXHIBIT "G"
SECTION 3 REPORTING FORMS
CDBG REHABILITATION PSA CONTRACT 2016-2017--EXHIBIT"G"—SECTION 3 REPORTING FORMS Pagel
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity
EXHIBIT "G"
Section 3 Summary Report U.S.Department of Housing OMB Approval No: 2529-0043
Economic Opportunities for and Urban Development (exp. 11/30/2010)
Low—and Very Low-Income Persons Office of Fair Housing
And Equal Opportunity HUD Field Offce:
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 1: Employment and Training **Columns B,C and F are manda ory fields. Include New Hires in E&F
A B C D E F
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
Program Codes 3=Public/Indian Housing 4=Homeless Assistance 8=CDBG State Administered
1=Flepble Subsidy A=Development, 5=HOME 9=Other CD Programs
2=Section 202/811 B=Operation 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 If: 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 projectlactivity $
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(11/2010)
Ref 24 CFR 135
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
programs that receive: (1)development assistance pursuant to Part 1: Employment and Training Opportunities
Section 5 of the U.S.Housing Act of 1937;(2)operating assistance Column A: Contains various job categories. Professionals are
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
of 1937 and to recipients of housing and community development programmers). For construction positions,list each trade and provide
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
hazards);(2)housing construction;or(3)other public construction service workers.
projects;and to contracts and subcontracts in excess of$100,000 Column B: (Mandatory Field) Enter the number of new hires for
awarded in connection with the Section-3-covered activity. each category of workers identified in Column A in connection with
Form HUD-60002 has three parts,which are to be completed for this award. New hire refers to a person who is not on the contractors
all programs covered by Section 3. Part I relates to employment or recipient's payroll for employment at the time of selection for the
and training.The recipient has the option to determine numerical Section 3 covered award or at the time 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
comply with Section 3. connection with this award. Section 3 new hire refers to a Section 3
Recipients or contractors subject to Section 3 requirements must resident who is not on the contractor's or recipient's payroll for
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.
directed toward low-and very low-income persons.* A recipient of Column D: Enter the percentage of all the staff hours of new hires
Section 3 covered assistance shall submit one copy of this report to (Section 3 residents)in connection with this award.
HUD Headquarters,Office of Fair Housing and Equal Opportunity. Column E: Enter the percentage of the total staff hours worked for
Where the program providing assistance requires an annual Section 3 employees and trainees(including new hires)connected
performance report,this Section 3 report is to be submitted at the with this award. Include staff hours for part-time and full-time
same time the program performance report is submitted. Where an positions.
annual performance report is not required,this Section 3 report is to be Column F: (Mandatory Field) Enter the number of Section 3
submitted by January 10 and,if the project ends before December 31, residents that were trained in connection with this award.
within 10 days of project completion. Only Prime Recipients are Part Il: Contract Opportunities
required to report to HUD. The report must include Block 1: Construction Contracts
accomplishments of all recipients and their Section 3 covered Item A: Enter the total dollar amount of all contracts awarded on the
contractors and subcontractors. project/program.
HUD Field Office: Enter the Field Office name. Item B: Enter the total dollar amount of contracts connected with this
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
2. Federal Identification: Enter the number that appears on the connected with this project/program awarded to Section 3 businesses.
award form(with dashes). The award may be a grant, Item D: Enter the number of Section 3 businesses receiving awards.
cooperative agreement or contract. Block 2: Non-Construction Contracts
3. Dollar Amount of Award: Enter the dollar amount,rounded to the Item A: Enter the total dollar amount of all contracts awarded on the
nearest dollar,received by the recipient. project/program.
4&5. Contact Person/Phone: Enter the name and telephone number Item B: Enter the total dollar amount of contracts connected with this
of the person with knowledge of the award and the recipient's project awarded to Section 3 businesses.
implementation of Section 3. Item C: Enter the percentage of the total dollar amount of contracts
6. Reporting Period: Indicate the time period(months and year) connected with this project/program awarded to Section 3 businesses.
this report covers. Item D: Enter the number of Section 3 businesses receiving awards.
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
Fair Housing and Equal Opportunity,at the same time the The Secretary may establish income ceilings higher or lower than 80 percent
performance report is submitted to the program office. The Section 3 of the median for the area on the basis of the Secretary's findings such that
report is submitted by January 10. Include only contracts executed variations are necessary because of prevailing levels of construction costs
during the period specified in item 8. PHAs/IHAs are to report all or unusually high-or low-income families. Very low-income persons mean
contracts/subcontracts. low-income families(including single persons)whose incomes do not
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
Page i form HUD 60002(11/2010)
Ref 24 CFR 135
EXHIBIT "H"
SEVERELY DISABLED CERTIFICATION FORM
CDBG REHABILITATION PSA CONTRACT 2016-2017—EXHIBIT"H"—SEVERELY DISABLED
CERTIFICATION FORM Page 1
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity
Fort Worth Area Habitat for Humanity, dba Trinity Habitat for Humanity
CERTIFICATION FORM
DOCUMENTING CLIENT STATUS AS "SEVERELY DISABLED ADULT"
Client Name:
Address:
City, State, Zip
Client Identification No.
CHECK ALL THAT APPLY
❑ Has used a wheelchair, a walker, cane , crutches or other special aid for six
months or longer
Has been diagnosed with one of the following conditions: Alzheimer's disease,
El mental retardation or other developmental disability, senility or dementia,
cerebral palsy, or autism; or has another mental or emotional condition that
seriously interferes with everyday tasks.
Is unable to perform one or more of the following "Functional Activities":
❑ seeing, hearing, speaking and having one's speech understood, lifting or
carrying, using stairs, grasping small objects, or walking.
Is unable to perform or needs assistance to perform one or more of the following
❑ Activities of Daily Living(ADL): getting around inside the home, getting in or
out of bed or a chair, bathing, dressing, eating, and toileting.
Is unable to perform or needs assistance to perform one or more of the following
Instrumental Activities of Daily Living (IADL): going outside the home,
❑ keeping track of money and bills, preparing meals, doing light housework,
taking prescription medications in the right amount and at the right time, and
using the telephone.
❑ Has a condition that prevents them from working at a job or doing housework.
The undersigned Agency representative conducted a visual assessment of the client identified on
this form and certifies that the client meets at least one of the conditions indicated above, which
determines that he/ she meets the definition of"severely disabled" according to the U.S. Census
Bureau.
Certified by: Date:
Signature/Title:
CFW Neighborhood Services Dept.: Revised 08.30.2013
CDBG REHABILITATION PSA CONTRACT 2016-2017—EXHIBIT"H"—SEVERELY DISABLED
CERTIFICATION FORM Page 2
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity
EXHIBIT "I"
MBE REPORTING FORM
CDBG REHABILITATION PSA CONTRACT 2016-2017--EXHIBIT"I"--MBE REPORTING FORM Page 1
Fort Worth Area Habitat for Humanity,dba Trinity Habitat for Humanity
Contract and Subcontract Activity U.S.Department of Housing and Urban Development OMB Approval No.:2577-0088 OMB
Approval No.:2502-0355
Public reporting burden for this collection of information is estimated to av—gc.5 hours per response,including the time for reviewing instructions,scorching existing data sources,gathering and maintaining the dam needed,and completing and reviewing the collection of information.The Information is voluntary.HUD may not
collect this information,and you are not required to complete this form,unless it displays a currently valid OMB Control Number.
E—tive Orders dated July 14,1983.directs the Minority Business Development Plans shall be developed by each Federal Agency and the these annual plans shall establish minority business development objectives.The mimmation is used by 1-IUD to monitor and evaluate MBE activities against the total program activity and
the desigrmted minority business enterprise(MISE)goals.The Department requires the information to provide guidance and oversight for programs for the development ofmimwity business enterprise consuming Minority Business Development.H'thc information is not collected HUD would not be able to establish meaningful
MBE goals nor evaluate MBE performance against these goals,
Pricncy Act Notice=The United States Department of Housing and Urban Development,Federal Housing Administration,is eulhmiaed to solicit the Information requested in this form by virtue of Title 12,United States Code,Section 1701 et seq„and regulation.It will not be disclosed orrelesed outside the United States
Department of I-Sousing and Urban Development without}'our consem,except as required or permitted by Law,
1.Grmtce/Pr jeetOwner/Developer/Sponsor/Builder/Agency Chuck if. 2.Location(City,State Zip Code)
City of For Worth PFI 1000 Throcl:morton,Fort Worth.TX 76102
H
CPD
Housin
3a.NameaI'Cant,ct Pcnon 3b.Phone Number(Including Neo Code) 4,Reporting Period S.Proprnlm Cede(Not appticnble far CPD pro,.—m ❑ 6.Date Sabmined to Field Otliee
Sce nPlannlion oI`C.d,c at bottom of Pope Usea
Sarah Burkett 817-392-7538 Oct.1-Sept.30 Annual-FY) 'p—t theca for each program code.
Canrcnctor or
G—VPmjcct Number or HUD Subeono-netor
Case Numbcrorodrer T)W fTmde Furnas Subcont— Contractor/Subcontonsor Name and Address
identiGcndonofpmperly, Amount of Cammct Codc RndnVEthde Wamnn Ownedlheircn Pnme Canaacmr ldemiloaion(ID) IdcmiGention(ID) 7j. Nmv
cnbdivision dwelling alts em. or Subconmct (Sees blow) (See belon) (Yecor No) Sec.3 Busirces Nmnb<r Six.3 Number Sec.3 Phew }lircs me >o Sce.3
70. 7b. 7c, 7J. 7c. (Yea ar No) 7f. 7n 7h 7i. Hires Sec.3Rcs. N<sv Hires
u Name Street City State Zi
#DIV/01
#DIV/D!
#DIV/01
#DIV/01
#DIV/01
#DIV/01
#DIV/0!
#DIV/0!
#DIV/01
#DIV101
#DIV/01
#DIV/01
#DIV/01
#DIV/D!
#DIV/D!
#DIV/0!
#DIV/01
#DIV101
#DIV/01
#DIV/0!
7c:Type of Trade Codes: 7d:Raclal/Ethnic Codes: 5:Program Codes(Complete for Housing and Public and Indian Housing programs only):
CPD: IlouvineTabliehoming: I=Whine Aa'riH n 1=All Inured,heluding Section6 5=Secdon 202
1=New Co—wa 1-New Conlmctim 6=Pmf—ioeal 2=Bluk Americans 2-Flexible Subsidy 6=HUD.HeId(Mamgemenp
2=EdacmioNTmiainµ 2=Sub—aa Rehab, 7-Tens Service, 3=Nati,,American 3=Se.ion 8 Nodnured,N-11FDA 7-Publidlydio honing
3-Other 3=Repair 8-Education'Tmat a; 4=Hupadc Amencare 4=leuned(Mamgement) B-Secdon 911
4-S<rvice 9=Arch./Engrg.APpmisd 5=AsiaNPadfic American
S=Pnrect Mongt. 0-Other 6=Hasidic)eco
I'mious cdnie—,otxsd<tc' form HUD-2516(8/98)
This report is to be completed by grantees,developers,sponsors,builders,agencies,and/or completed for public and Indian housing and most community development programs.Form HUD- costs or unusually high or low-income families.Very low-income families(including single
project owners for reporting contract and subcontract activities of$10,000 or more under the 60002 is to be completed by all other HUD programs including State administered community persons)whose incomes do not exceed 50 per centum ofthe median family income for the area,as
following programs:Community Development Block Grants(entitlement and small cities): development programs covered under Section3.A Section 3 Contractor/subcontractor is a determined by the Secretary with adjustments for smaller and larger families,except that the
Urban Development Action Grants;Housing Development Grants:Multifamily Insured and business concern that provides economic opportunities to low and very Low-income residents of secretary may establish income ceilings higher or lower dim 50 per centum of the median for the
Noninsured:Public and Indian Housing Authorities:and contracts entered into by recipients of the metropolitan area(or nonmetropolitan county),including a business concern that is 51 person area on the basis ofthe Secretary's findings that such variations are necessary because of unusually
CDBG rehabilitation assistance, or more owned by low-income residents; high or low family incomes.
Contracts/subcontracts ofless than$10,000 need be reported only ifsuch contracts represent a or provides subcontracting or business development opportunities to businesses owned by low or Submit two(2)copies ofthis report to your local HUD Office within ten(10)days after the end of
significant portion ofyour total contracting activity.Include only contracts executed during this low-income residents. Low and very low-income residents;include participants in Youthbuild the reporting period you checked in item 4 on the front.Complete item 7h.Only once for each
reporting period. programs established under Subtitle D of Title IV of the Cranston-Gonzalez National Affordable contractor/subcontractor on each semi-annual report.
Housing Act.
This form has been modified to capture Section 3 contract data in columns 7g and 7i. Section 3 The terms`low-income persons"and"very low-income persons'have the same meanings given Enter the prime contractor's ID in item 7£for all contracts and subcontracts.Include only
requires that the employment and other economic opportunities generated by HUD financial the terms in seclion3(b)(2)of the United States Housing Act of 1937.Low-income persons mean contracts expected during this reporting period.PHAs/IHAs are to report all
assistance for housing and community development programs shall,to the greatest extent families(including single persons)whose incomes do not exceed 80 per centum ofthe median contracts/subcontracts.
feasible,be directed toward low-and very low-income persons,particularly those who are income for the area,as determined by the Secretary,with adjustments for smaller an larger families,
recipients of government assistance for housing.Recipients using this form to report Section 3 except that the Secretary may establish income ceilings higher or lower than 80 per centum ofthe
contract data must also use Part I of form HUD-60002 to report emplovment and training median for the area on the basis ofthe Secretary's findings that such variations are necessary
opportunities data Form HUD-2516 is to be because of prevailing levels of construction
Community Development Programs Multifamily Housing Programs Public Housing and Indian Housing Programs
1.Grantee:Enter the name ofthe unit of government submitting this report. 1.Grantee/Project Owner:Enter the name ofthe unit of govemmenL agency or mortgagor entity PHAs/lHAs are to report all contracts/subcontracts.Include only contracts executed during this
submitting this report. reporting period.
3.Contact Person:Enter name and phone of person responsible for maintaining and submitting 3.Contact Person:Satre as item 3 under CPD Programs. 1.Project Owner:Enter the name ofthe unit of govemment,agency or mortgagor entity
contract/subcontract data. submitting this report.Check box as appropriate.
7a.Grant Number:Enter the HUD Community Development Block Grant Identification
Number(with dashes).For example:B-32-MC-25-0034.For Entitlement Programs and Small 4.Reporting Period:Check only one period. 3.Contact Person:Same as item 3 under CPD Programs.
City multi-year comprehensive programs,enter the latest approved grant number.
7b.Amount of Contract/Subcontract:Enter the dollar amount rounded to the nearest dollar.I£
subcontractor ID number is provided in 71;the dollar figure would be for the subcontract only 5.Program Code:Enter the appropriate program code. 4.Reporting Period:Check only one period,
and not for the prime contract.
7e.Type of Trade:Enter the numeric codes which best indicates the
contractor's/subcontractor's service.If subcontractor ID number ispyP rovided in 7f.,the type of 7a.Grant/Project Number:Enter the HUD Project Number or Housing Development Grant or trade code would be for the subcontractor only and not for the prime contractor. number assigned. S.Program Code:Enter the appropriate program code.
The"other"category includes supply,professional services and all other activities except 7a.Grant/Project Number:Enter the HUD Project Number or Housing Development Grant or
construction and education/training activities. 7b.Amount of Contraet/Subeontract:Same as item 7b.under CPD Programs. number assigned.
7d.Business Raciaender character
Code:Enter the numeric code which indicates the 7c.Type of Trade:Same as item 7c.under CPD Programs. 7b.Amount of Contract/Subcontract:Same as item 7b.under CPD Programs.
racial/ethnic/gender character of the owner(s)and controller(s)of 51%ofthe business.
When 51%or more is not owned and controlled by any single racial/ethnic/gender category,
enter the code which seems most appropriate.If the subcontractor ID number is provided,the 7d.Business Racial/Ethnic/Gender Code:Same as item 7d.under CPD Programs. 7c.Type of Trade:Same as item 7e.under CPD Programs.
code would apply to the subcontractor and not to the prime contractor.
7e.Woman Owned Business:Enter Yes or No. 7e.Woman Owned Business:Enter Yes or No. 7d.Business Racial/Ethnic/Gender Code:Same as item 7d.under CPD Programs.
7f.Contractor Identification(ID)Number:Enter the Employer(IRS)Number ofthe Prime
Contractor as the unique identifier for prime recipient of HUD funds.Note that the Employer 7f.Contractor Identification(ID)Number:Same as item 7f.under CPD Programs. 7e.Woman Owned Business:Enter Yes or No.
(IRS)Number must be provided for each contract/subcontract awarded.
7g.Section 3 Contractor:Enter Yes or No. 7g.Section 3 Contractor:Enter Yes or No. 7C Contractor Identification(ID)Number:Same as item 7f.under CPD Programs,
7h.Subcontractor Identification(ID)Number:Enter the Employer(IRS)Number ofthe
subcontractor as the unique identifier for each subcontract awarded from HUD funds.When the
subcontractor ID Number is provided,the respective Prime Contractor ID Number must also be 7h.Subcontractor Identification(ID)Number:Same as item 7h,under CPD Programs, 7g.Section 3 Contractor:Enter Yes or No.
provided.
7i.Section 3 Contractor:Enter Yes or No. 7i.Section 3 Contractor:Enter Yes or No. 7h.Subcontractor Identification(ID)Number:Same as item 7h,under CPD Programs.
rewingContcctodSnbcontractorNarae and Address:Enter this information for each firm 7j.Contractor/Subcontractor Name and Address:Same as item 7j.under CPD Programs. 7i.Section 3 Contractor:Enter Yes or No.
receiving contracVsubcontract activity-only one time on each report for each firm.
7j.Contracto•/Subcontractor Name and Address:Same as item 7j,under CPD Programs.