HomeMy WebLinkAboutContract 48898 RECEIVEC Q
2 �ht CITYINOWARY
CONTRACT NO,
CIT(0'���� RY
C1T'1 TATE OF TEXAS §
COUNTY OF TARRANT §
This contract("Contract") is made and entered into by and between the City of Fort Worth
(hereafter"City") and Lighthouse for the Homeless, dba True Worth Place (hereafter"Agency"),
a Texas non-profit corporation. City and Agency may be referred to individually as a"Party" and
jointly as "the Parties".
The Parties state as follows:
WHEREAS, City receives grant monies from the United States Department of Housing
and Urban Development ("HUD") through the Emergency Solutions Grant Program ("ESG"),
Program No. S-16-MC-48-0006, Catalog of Federal Domestic Assistance No. 14.231;
WHEREAS, the ESG program is intended to provide homeless persons or persons at risk
of becoming homeless with financial assistance,basic shelter,essential supportive services,and/or
operations, as applicable;
WHEREAS,Agency submitted a proposal to use ESG funds for an eligible program under
the ESG Regulations whereby Agency will provide services to low and moderate income City
citizens;
WHEREAS, City citizens, the Community Development Council, and the City Council
have determined that ESG programs are needed by the City's citizens;
NOW, THEREFORE,the Parties understand and agree as follows:
1. INCORPORATION OF RECITALS.
City and Agency hereby agree that the recitals set forth above are true and correct and form
the basis upon which the Parties have entered into this Contract.
2. DEFINITIONS.
In addition to terms defined in the body of this Contract, the terms set forth below shall
have the definitions ascribed to them as follows:
Area Median Income or AMI means the median family income for the Fort Worth-Arlington
metropolitan statistical area as established annually by HUD. The 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.
Complete Documentation means the following do ,ap. ' le:
OFFICIAL RIE CORD
ESG PSA CONTRACT 2016-2017 ��TY��� PAGE 1
Lighthouse for the Homeless, dba True Worth Place Rev.2.6.2017
I•`�".WORTHO
r-• rr
• Attachments I,II, and III,with supporting documentation including:
o Proof of expense: copies of timesheets, invoices, leases, service contracts
or other documentation showing that payment is due by Agency.
o Proof of payment: cancelled checks, bank statements, or wire transfers
necessary to demonstrate that amounts due by Agency were actually paid
by Agency.
o Proof of client eligibility: Source Documentation sufficient to show that
clients participating in the Program are ESG Eligible Clients as described
in Section 6.
• Complete Documentation shall meet the standards described in the attached
EXHIBIT "F"- Standards for Complete Documentation.
• Any other document or record reasonably necessary to verify costs spent and client
eligibility for the Program.
Continuum of Care means the Tarrant Area Continuum of Care.
DBE means disadvantaged business enterprise in accordance with 49 CFR Part 26.
Director means the Director of the City's Neighborhood Services Department.
Effective Date means March 7, 2017.
ESG means Emergency Solutions Grant.
ESG Eligible Client means an individual or household that meets the definition of"homeless" or
"at risk of homelessness" as defined in the Hearth Act and the ESG Regulations.
ESG Funds means the ESG grant funds supplied by City to Agency under the terms of this
Contract.
ESG Regulations means regulations found at 24 CFR Part 576 et seq.
HEARTH Act means the Homeless Emergency Assistance and Rapid Transition to Housing Act
of 2009, 42 U.S.C. 11302 et seq.
HMIS means Homeless Management Information System required by HUD for client data
collection.
HUD means the United States Department of Housing and Urban Development.
IDIS means Integrated Disbursement Information System, HUD's project tracking system.
Neighborhood Services Department means the City's Neighborhood Services Department.
ESG PSA CONTRACT 2016-2017 PAGE 2
Lighthouse for the Homeless, dba True Worth Place Rev.2.6.2017
OMB means the Office of Management and Budget.
Program means the services described in EXHIBIT "A"—Program Summary.
Reimbursement Request means all reports and other documentation described in Section 9.
Source Documentation means any documentation sufficient to show under ESG Regulations that
an individual or household is an ESG Eligible Client. Income documentation may include, but is
not limited to, copies of paychecks, Social Security and Disability verification letters, interest or
rental income statements, retirement income statements, child support and alimony verification,
unemployment benefit letters,or any similar documentation allowed under the definition of annual
income in 24 CFR Part 5.609.
Unduplicated Clients means a count of ESG Eligible Clients served at least once in the Contract
Term. ESG Eligible Clients served more than once in the Contract Term will only be counted the
first time they are served when determining the total count of Unduplicated Clients.
3. TERM.
The term of this Contract 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 ESG Funds.
City shall provide up to $104,110.19 of ESG Funds under the terms and conditions herein.
4.2 Monitor.
City will monitor the activities and performance of Agency and any of its contractors,
subcontractors or vendors as necessary,but no less than annually. Monitoring by City will include
determining whether Agency is meeting the requirements of the ESG Regulations during the term
of this Contract.
5. DUTIES AND RESPONSIBILITIES OF AGENCY.
5.1 Required Services.
Agency shall perform the services described in EXHIBIT "A"—Program Summary in
accordance with the terms and conditions of this Contract.
5.2 Use of ESG Funds.
5.2.1. Compliance with ESG Regulations and Contract.
Agency shall be reimbursed for eligible Program costs with ESG Funds only if City
determines in its sole discretion that:
5.2.1.1 Costs are eligible expenditures in accordance with ESG Regulations.
ESG PSA CONTRACT 2016-2017 PAGE 3
Lighthouse for the Homeless,dba True Worth Place Rev.2.6.2017
5.2.1.2 Costs are in compliance with this Contract and are reasonable and consistent with
industry norms.
5.2.1.3 Complete Documentation, as applicable, is submitted to City by
Agency.
5.2.2 Budget.
5.2.2.1. The ESG Funds will be paid on a reimbursement basis in accordance
with EXHIBIT `B"-Budget.
5.2.2.2 During the term of this Contract, Agency may submit written requests
to increase or decrease line-item amounts in the Budget, including an
explanation of why such increases or decreases are necessary. All
requests shall be approved by Director in writing, with such approval
being in the Director's sole discretion. If Director approves the
Agency's proposed Budget amendment (as approved, the "Amended
Budget"),then the Amended Budget will take effect on the first day of
the month following the month in which it was approved by Director,
unless otherwise specified in the amendment. All requests for Budget
amendments must be submitted by June 1,2017.
5.2.3 Change in Program Budget.
5.2.3.1 Agency will notify City promptly of any additional funds it receives for
operation of the Program, and City reserves the right to amend this
Contract in such instances to ensure compliance with HUD regulations
governing cost allocation.
5.2.3.2 Agency agrees to utilize the ESG Funds to supplement rather than
supplant funds otherwise available for the Program.
5.2.4 Payment of ESG Funds to Agency.
ESG Funds will be disbursed to Agency upon City's approval of Reimbursement Requests
including submission of Complete Documentation to City in compliance with Section 9. If Agency
expends all funds budgeted for the Program prior to September 30, 2017, City may hold back a
small amount of the ESG Funds until the end of the term. During this interim period,Agency must
continue to submit Attachment III — Client Data Report in EXHIBIT "D" — Reimbursement
Forms monthly. It is expressly agreed by the Parties that any ESG Funds not spent or not approved
for reimbursement to Agency shall remain with City.
5.3 Program Performance Milestones.
5.3.1 Agency represents that the Program will achieve the following milestones in
accordance with EXHIBIT "A"—Program Summary and the table below:
ESG PSA CONTRACT 2016-2017 PAGE 4
Lighthouse for the Homeless,dba True Worth Place Rev.2.6.2017
Unduplicated ClI as
pecrfied: ri EXHIBIT .
.APrograin .,.
Moritl Ex enditures'' Summa
2 25% 25%
4 50% 50%
6 75% 75%
7 100% 100%
5.3.2 Failure of Agency to meet these milestones or a material deviation from them as
outlined in this Section 5.3 is a breach of this Contract. For the purpose of this Section, "material
deviation" shall mean more than 10% lower than the specified goal. In the event of such breach,
City reserves the right in its sole option to delay or withhold payment of Reimbursement Requests,
to lower Agency's allocation of ESG Funds, or to terminate this Contract.
5.3.3 Failure to meet at least 80% of its performance milestones or serve 934
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 ESG Funds must be approved
by the Director in writing, with such approval being in the Director's sole discretion. If Director
approves the Agency's proposed amended performance milestones (as approved, the "Amended
Performance Milestones"), then the Amended Performance Milestones will take effect on the
first day of the month following the month in which it was approved by Director,unless otherwise
specified in the amendment. All requests for amendments to performance milestones must be
submitted by June 1, 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 ESG Funds.
Agency will keep accounts and records in such a manner that City may readily identify and
account for Program expenses reimbursed with ESG Funds. These records shall be made
available to City for audit purposes and shall be retained as required hereunder.
5.5 Match.
Agency must match ESG Funds dollar for dollar with other funding sources. Potential
sources of match include any sources described at 42 U.S.C. 11375(a). Some common sources
include: (i) Agency funding from non-federal sources and eligible federal grants, (ii) volunteer
time,which may be valued at$5/hour of time;and(iii)the value or fair rental value of any donated
materials or space. The monetary values Agency assigns to all sources of match are subject to
review and approval by City.
5.5.1 Prior to April 1, 2017, Agency must submit to City a completed Match Report on
the form attached hereto as EXHIBIT "H"-Match Report detailing anticipated match sources.
ESG PSA CONTRACT 2016-2017 PAGE 5
Lighthouse for the Homeless,dba True Worth Place Rev.2.6.2017
5.5.2 With each Reimbursement Request, Agency must submit a log of funds expended
to date on the form provided in EXHIBIT"H"-Match Report,plus documentation of any match
expenditures first reported in that month's Reimbursement Request.
5.5.3 Records regarding match funds must be kept by Agency in accordance with Section
8.
5.5.4 If the expenditure of match funds and ESG Funds is not happening at approximately
the same pace on a quarterly basis, then the City shall withhold ESG Funds until match
expenditures are substantially the same as ESG Funds reimbursed to date.
5.6 Program Subcontracts.
Agency shall not enter into a subcontract with another agency, contractor, or vendor to
provide a service to clients for any part of the Program that will be paid with ESG Funds without
City's written consent.
6. CLIENT ELIGIBILITY VERIFICATION.
6.1 Client Eligibility.
Agency will document the eligibility of all prospective clients. Agency may redact the
client's personal information and substitute a client number. Agency may use form attached hereto
as EXHIBIT "I"— Staff ESG Certification Form to document the eligibility of all prospective
clients that receive direct financial assistance as more particularly described as follows.
6.1.1 Agencies Receiving ESG Funds.
6.1.1.1 Coordination of Services. Agency must participate in the local
Continuum of Care and enter data in HMIS.
6.1.1.2 Homelessness Status.Agency must verify that all new clients are ESG
Eligible Clients. Acceptable forms of verification include:
i. For emergency shelter (shelter services for homeless including
childcare for homeless clients):
A signed, dated statement from the client stating that the client is
homeless,or that the client is homeless by virtue of fleeing domestic
violence.
ii. For homelessness prevention- financial assistance services:
1. Documentation that the ESG Eligible Client meets the at risk
of homelessness definition consistent with 24 CFR Part
576.2 (1-3),
2. Source Documentation that the ESG Eligible Client has an
annual income at or below 30% of AMI,
ESG PSA CONTRACT 2016-2017 PAGE 6
Lighthouse for the Homeless,dba True Worth Place Rev.2.6.2017
3. Evidence documenting that the ESG Eligible Client does not
have sufficient resources or support networks immediately
available to prevent them from moving to an emergency
shelter or another place defined in Category 1 of the
"homeless" definition under the HEARTH Act,
4. Documentation of eligibility of the housing unit,habitability
inspection, lease, rent reasonableness, rental assistance
agreement between Agency and landlord,
5. Documentation of client's reasonable prospects of resuming
payment of rent or utilities, as applicable, within a
reasonable time,
6. Evidence documenting that the ESG Eligible Client is not
receiving equivalent or same type of assistance from other
homelessness prevention agencies or funding sources, and
7. Documentation supporting the type and amount of assistance
provided, including, but not limited to, invoices, past due
notices, and/or executed leases, as applicable, and proof of
payment by Agency.
iii. For rapid re-housing services- financial assistance:
1. Documentation that the individual or household meets the
homeless definition in the HEARTH Act and that the client
is eligible consistent with the definition of homelessness in
24 CFR Part 576.2,paragraphs 1 and 4,
2. Documentation of eligibility of the housing unit,habitability
inspection, lease, rent reasonableness, rental assistance
agreement between Agency and landlord,
3. Documentation of client's reasonable prospects of resuming
payment of rent and/or utilities, as applicable, within a
reasonable time,
4. Evidence documenting that the ESG Eligible Client is not
receiving equivalent or same type of assistance from other
rapid re-housing agencies or funding sources, and
5. Documentation supporting the type and amount of assistance
provided, including, but not limited to, invoices, past due
notices, and/or executed leases, as applicable, and proof of
payment by the agency.
iv. For housing relocation and stabilization services:
1. Documentation that services are provided for ESG Eligible
Clients as defined in the HEARTH Act, and
2. Documentation that any staff costs and or
relocation/stabilization services directly benefit the ESG
ESG PSA CONTRACT 2016-2017 PAGE 7
Lighthouse for the Homeless,dba True Worth Place Rev.2.6.2017
Eligible Client and are clearly distinguished from the general
administration of the Program.
6.1.2 Performance Standards.
Agency must verify that the Program is tracking ESG activities and outcomes in
accordance with the City's performance standards as described in EXHIBIT "J" - ESG
Performance Standards.
6.1.3 Written Standards for ESG Assistance.
Agency must verify that the Program is documenting Client Eligibility in accordance with
the City's written standards as described in EXHIBIT "J-1" — Written Standards for ESG
Assistance. Agency must maintain all records in accordance with Section 8.
6.2 Submission of Complete Documentation.
Agency must submit copies of documentation of client eligibility described in Section 6.1
with Attachment III in each month's Reimbursement Request for all Unduplicated Clients.
6.3 Maintain Documentation.
Agency must maintain copies of all documentation required by this Section 6 for 5 years
following the expiration of the Contract term. This Section shall survive the earlier terminations
or expirations of this Contract.
7. ADDITIONAL ESG REQUIREMENTS.
Agency agrees to comply with all requirements of the ESG Program as stated in the ESG
Regulations, including but not limited to the following:
7.1 Environmental Review.
ESG Funds will not be paid, and costs cannot be incurred until City has conducted an
environmental review and an Environmental Review Record as required by 24 CFR Part 58. The
environmental review may result in a decision to proceed with, modify, or cancel the funding for
the Program. Further, Agency will not undertake or commit any funds to physical or choice
limiting actions as described in any applicable federal regulations. Any violation of this provision
will (i) cause this Contract to terminate immediately; and (ii) require Agency to repay City the
ESG Funds it has already received and forfeit any future payments of ESG Funds.
7.2 Contract Not Constituting Commitment of Funds.
Notwithstanding any provision of this Contract, the Parties agree and acknowledge that
this Contract does not constitute a commitment of funds, and that such commitment of funds or
approval may occur only upon (i) satisfactory completion of an environmental review and receipt
by City of an authorization to use grant funds from HUD under 24 CFR Part 58, (ii) approval of
City's 2016-2017 Action Plan, and (iii)receipt by City of grant agreement from HUD.
ESG PSA CONTRACT 2016-2017 PAGE 8
Lighthouse for the Homeless,dba True Worth Place Rev.2.6.2017
7.3 Monitoriniz.
7.3.1 Agency understands and agrees that it will be subject to monitoring by City for
compliance with terms and provisions of this Contract and the ESG Regulations for the term of
this Contract. Agency is subject to such monitoring during the term of this Contract and for 5
years after the Contract term ends. 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.
7.3.2 Representatives of City, HUD, HUD Office of Inspector General, and the United
States Comptroller General shall have access during regular business hours, upon 48 hours prior
notice, to Agency's offices and records pertaining to the use of the ESG Funds, and to Agency's
officers, directors, agents, employees, contractors, subcontractors and vendors for the purpose of
such monitoring.
7.3.3 In addition to other provisions of this Contract regarding frequency of monitoring,
City reserves the right to perform desk reviews or on-site monitoring of Agency's compliance with
the terms and conditions of this Contract. City shall provide Agency with a written report of the
monitor's findings after each monitoring visit. If the monitoring report notes deficiencies in
Agency's performance, the report shall include requirements for the timely correction of said
deficiencies by Agency. Failure by Agency to take the action specified in the monitoring report
may be cause for suspension or termination of this Contract as provided herein.
7.3.4 Subsections 7.3.1 through 7.3.3 shall be applicable for the Contract term and for 5
years thereafter and shall survive the earlier termination or expiration of this Contract.
7.3.5 Agency shall provide City annually the results of any state or federal monitoring.
Such results shall be submitted within 60 days of receipt of such state or federal monitoring
report, or with the January Reimbursement Request, whichever is earlier.
7.4 Aizency Procurement Standards.
Agency shall comply with all applicable federal, state and local laws, regulations, and
ordinances for malting 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 2 CFR Part 200.326.
7.4.1 Contracts in excess of$10,000.00 made by Agency using ESG Funds must address
termination for cause and convenience including the manner by which such termination shall be
effected and the basis for settlement of the terminated contract, if any, as required by Appendix II
(B), 2 CFR Part 200.
7.4.2 Agency shall not make any contract with parties listed on the government wide
System for Award Management, www.sam.gov ("SAM"). Agency must confirm by search of
SAM that all contractors paid with ESG Funds are not listed by SAM as being debarred,both prior
ESG PSA CONTRACT 2016-2017 PAGE 9
Lighthouse for the Homeless,dba True Worth Place Rev.2.6.2017
to hiring and prior to submitting a Reimbursement Request which includes invoices from any such
contractor. Failure to submit such proofs of search shall be an event of default.
7.5 Cost Principles/Cost Reasonableness.
Agency shall administer its use of ESG Funds in compliance with 2 CFR Part 200, as
applicable. The eligibility of costs incurred for performance rendered shall be determined in
accordance with 2 CFR Part 200.400 through 2 CFR Part 200.475.
7.6 Financial Management Standards.
Agency agrees to comply with 2 CFR Part 200,as applicable. Agency also agrees to adhere
to the accounting principles and procedures required therein,utilize adequate internal controls,and
maintain necessary supporting and back-up documentation for all costs incurred in accordance
with 2 CFR Part 200.302 and Part 200.303.
7.7 Uniform Administrative Requirements, Cost Principles, and Audit
Requirements.
Agency will comply with the Uniform Administrative Requirements, Cost Principles, and
Audit Requirements for Federal Awards in 2 CFR Part 200, as applicable, or any reasonably
equivalent procedures and requirements that City may require.
7.8 Terms Applicable to Contractors, Subcontractors and Vendors.
Agency understands and agrees that all terms of this Contract, whether regulatory or
otherwise, shall apply to any and all contractors, subcontractors and vendors of Agency which are
in any way paid with ESG Funds or who perform any work in connection with the Program.
Agency shall cause all applicable provisions of this Contract to be included in and made a part of
any contract or subcontract executed in the performance of its obligations hereunder including its
obligations regarding the ESG Regulations. Agency shall monitor the services and work
performed by its contractors, subcontractors and vendors on a regular basis for compliance with
the ESG Regulations and Contract provisions. Agency must cure all violations of the ESG
Regulations committed by its contractors, subcontractors or vendors. City maintains the right to
insist on Agency's full compliance with the terms of this Contract and the ESG Regulations and
Agency is responsible for such compliance regardless of whether actions taken to fulfill the
requirements of this Contract are taken by Agency or by Agency's contractors, subcontractors or
vendors. Agency acknowledges that the provisions of this Section shall survive the earlier
termination or expiration of this Contract and shall be applicable for 5 years after the termination
of the Contract.
7.9 Copyright and Patent Rights.
No reports,maps,or other documents produced in whole or in part under this Contract shall
be the subject of an application for copyright by or on behalf of Agency. HUD and City shall
possess all rights to invention or discovery, as well as rights in data,which may arise as a result of
Agency's performance under this Contract.
ESG PSA CONTRACT 2016-2017 PAGE 10
Lighthouse for the Homeless, dba True Worth Place Rev.2.6.2017
7.10 Conflict of Interest Disclosure.
In accordance with the requirements of Section 14.13.2.1 and 14.13.4, Agency shall
establish conflict of interest policies for federal awards. Agency shall disclose to City in writing
any potential conflict of interest.
7.11 Compliance with FFATA and Whistleblower Protections.
Agency shall comply with the requirements of 2 CFR 300(b), including provisions of the
Federal Funding Accountability and Transparency Act ("FFATA") governing requirements on
executive compensation and provisions governing whistleblower protections contained in 10
U.S.C. 2409, 41 U.S.C. 4712, 10 U.S.C. 2324, 41 U.S.C. 4304 and 41 U.S.C. 4310.
7.11.1 Agency shall provide City with its DUNS number.
7.12 Internal Controls.
In compliance with the requirements of 2 CFR Part 200.303,Agency shall:
7.12.1 Establish and maintain effective internal control over the ESG Funds that provides
reasonable assurance that Agency is managing the ESG Funds in compliance with federal statutes,
regulations, and the terms and conditions of this Contract. These internal controls shall be in
compliance with guidance in "Standards for Internal Control in the Federal Government" issued
by the Comptroller General of the United States or the "Internal Control Integrated Framework"
issued by the Committee of Sponsoring Organizations of the Treadway Commission ("COSO");
7.12.2 Comply with federal statutes, regulations, and the terms and conditions of this
Contract;
7.12.3 Evaluate and monitor Agency's compliance with statutes,regulations and the terms
and conditions of this Contract;
7.12.4 Take prompt action when instances of noncompliance are identified including
noncompliance identified in audit findings; and
7.12.5 Agency must have written procedures to safeguard protected personally identifiable
information and other information that HUD or City designates as sensitive or Agency considers
sensitive consistent with applicable federal, state, local and tribal laws regarding privacy and
obligations of confidentiality. Agency shall ensure that all records of personally identifiable
information are kept secure and confidential as required by the ESG Regulations at 24 CFR Part
576.500.
8. RECORD KEEPING; REPORTING AND DOCUMENTATION
REQUIREMENTS; AUDIT.
8.1 Record Keepinz.
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
ESG PSA CONTRACT 2016-2017 PAGE 11
Lighthouse for the Homeless, dba True Worth Place Rev.2.6.2017
will keep or cause to be kept an accurate record of all actions taken and all funds spent, with
supporting and back-up documentation. Agency will maintain all records and documentation
related to this Contract for 5 years after the Contract term ends. If any claim, litigation, or audit is
initiated before the expiration of the 5 year period, the relevant records and documentation must
be retained until all such claims, litigation or audits have been resolved. For purposes of this
Contract, this 5 year period for record retention is deemed to begin on October 1, 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
ESG PSA CONTRACT 2016-2017 PAGE 12
Lighthouse for the Homeless,dba True Worth Place Rev.2.6.2017
than$750,000 a year in federal funds are exempt from federal audit requirements for that year,
but records must be available for review or audit by appropriate officials of the federal agency,
City, and General Accounting Office.
8.5.2 City Reserves the Riaht to Audit.
City reserves the right to perform an audit of Agency's Program operations and finances at
any time during the term of this Contract and for 5 years after the Contract Term ends if City
determines that such audit is necessary for City's compliance with the ESG Regulations or other
City policies. Agency agrees to allow access to all pertinent materials as described herein for such
audit. For purposes of this Contract, 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 ESG
FUNDS OR SPENT ESG FUNDS ON ANY INELIGIBLE ACTIVITIES, AGENCY
AGREES TO REIMBURSE CITY THE AMOUNT OF SUCH MONIES PLUS THE
AMOUNT OF ANY SANCTIONS,PENALTY OR OTHER CHARGE LEVIED AGAINST
CITY BY HUD BECAUSE OF SUCH ACTIONS.
9. REIMBURSEMENT REQUIREMENTS.
9.1 Deadline for Submitting Reimbursement Requests.
9.1.1 Reimbursement Requests shall be submitted monthly to the City and must be
received by the City on or before the 15th day of the month following the month expenses were
paid by Agency. For example, the Reimbursement Request for June expenses must be received
by July 15. In the event the 15th falls on a weekend or City holiday, Reimbursement Requests
shall be due the next day that the City is open for business. Failure to submit a Reimbursement
Request in a timely fashion will result in City taking the actions outlined in Section 10.1.
NOTWITHSTANDING ANYTHING ABOVE,THE REIMBURSEMENT REQUEST FOR
EXPENSES INCURRED FOR SEPTEMBER 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
ESG PSA CONTRACT 2016-2017 PAGE 13
Lighthouse for the Homeless,dba True Worth Place Rev.2.6.2017
first e-mail,Agency shall forfeit any payments otherwise due that month and failure to submit any
requested information will be considered an event of default as outlined in Section 10.1.2.
9.2 Submission of Reimbursement Requests.
Agency shall provide City with Complete Documentation and the following reports as
shown in EXHIBIT "D"—Reimbursement Forms with each Reimbursement Request:
9.2.1 Attachment I—Invoice.
This report shall contain the amount requested for reimbursement each month, the
cumulative reimbursement requested to date (inclusive of that month's request), and must be
signed by an authorized signatory of Agency. By signing Attachment I,Agency is certifying that
the costs are valid, eligible, consistent with the terms and conditions of this Contract, and the data
contained in the report is true and correct.
9.2.1.1 Agency must submit a separate invoice for each activity type, i.e.
Shelter Operations,Homeless Prevention,Rapid Rehousing,and HMIS.
9.2.2 Attachment II—Expenditure Worksheet.
This report shall itemize each expense requested for reimbursement by Agency and shall
include the Account corresponding the expense to a Budget line item. In order for this report to
be complete the following must be submitted:
9.2.2.1 For payroll expenses,timesheets signed by employees and approved by
supervisor for all payroll expenses listed. Timesheets must distinguish
between ESG-funded time and non-ESG funded time and reflect actual
time spent on ESG-funded activities. Agency may not submit payroll
expenses dated 60 calendar days prior to the date of the Reimbursement
Request.
9.2.2.2 For non-payroll expenses, invoices for each expense listed with an
explanation as to how the invoiced expense pertains to the Program.
Agency may not submit invoices dated 60 calendar days prior to the date
of the Reimbursement Request.
9.2.2.3 Proof that each expense was paid by Agency, which proof can be
satisfied by canceled checks,wire transfer documentation,paid receipts
or other appropriate banking documentation.
9.2.3 Attachment III—Client Data Report.
This report shall list each Unduplicated Client served during the month along with his or
her demographic information. The Client Data Report must maintain a list of all clients
served during the Contract term. If Agency, receives funds from the United States
Department of Justice, then Agency is prohibited from submitting the Client Data Report
to the City. However, Agency must complete all required forms under this Section 9.2.3
and maintain in client files in accordance with Section 8. In order for this report to be
complete the following must be submitted:
ESG PSA CONTRACT 2016-2017 PAGE 14
Lighthouse for the Homeless, dba True Worth Place Rev.2.6.2017
9.2.3.1 Documentation of income verification for each Unduplicated Client the
first time the client is served, which either will be the completed form
attached hereto as EXHIBIT "E"-Form of Income Self Certification
or Source Documentation.
9.2.3.2 Agency may use the form attached hereto as EXHIBIT"I"—Staff ESG
Certification Form to verify client eligibility as described in Section
6.1.
9.2.4 Delivery of Reimbursement Request.
Reimbursement Requests 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.
9.2.5 Match Report.
This report shall document actual expenditure of match funds, as further described in
Section 5.5.
9.2.6 ESG Quarterly HMIS Report.
Agency shall submit the ESG Quarterly HMIS Report, attached hereto as EXHIBIT "K"
— Quarterly Report, with the January 15, April 15, July 15 and October 1 Reimbursement
Requests to document Agency's participation in the local Continuum of Care's HMIS. A paper
copy must be submitted with the Reimbursement Request, and an electronic copy must also be
emailed to psa@fortworthtexas.gov or to the Agency's designated City contract administrator.
9.3 Withholding Payment.
CITY SHALL HAVE NO OBLIGATION TO PAY ON ANY REIMBURSEMENT
REQUEST THAT IS NOT RECEIVED BY THE DUE DATE. Failure to timely submit
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.
ESG PSA CONTRACT 2016-2017 PAGE 15
Lighthouse for the Homeless,dba True Worth Place Rev.2.6.2017
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 ESG REGULATIONS AS DETERMINED BY CITY
IN ITS SOLE DISCRETION, THERE WILL BE NO CURE PERIOD AND ANY
REIMBURSEMENT WILL BE FORFEITED.
10.1.4 In the event of(i)an uncured default under Section 10.1.1 or an event of default
under 10.1.2 (ii) or more than 2 instances of default, cured or uncured, under these Sections, City
reserves the right at its sole option to terminate this Contract effective immediately upon written
notice of such intent with no penalty or liability to City.
10.1.5 Notwithstanding anything to the contrary herein, City will not be required to
pay any ESG Funds to Agency during the period that any Reimbursement Request, report or
documentation is past due or is not in compliance with this Contract or the ESG Regulations, or
during any period during which Agency is in default of this Contract.
10.1.6 In the event of termination under this Section 10.1, all ESG Funds awarded but
unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency shall have
no further right to such funds.
10.2 Failure to Maintain Records or Submit Reports and Documentation.
If Agency fails to maintain all records and documentation as required in Section 8, or if the
maintained or submitted report or documentation is not in compliance with this Contract or the
ESG Regulations as determined by City in its sole discretion, City will notify Agency in writing
and Agency will have 30 calendar days from the date of the written request to obtain or recreate
the missing records and documentation or submit or resubmit any such report or documentation to
City. If Agency fails to maintain the required reports or documentation, or fails to submit or
resubmit any such report or documentation within such time, City shall have the right to terminate
this Contract effective immediately upon written notice of such intent with no penalty or liability
to City.
10.2.1 In the event of termination under this Section 10.2, all ESG Funds awarded but
unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency shall have
no further right to such funds, and any ESG Funds paid to Agency must be repaid to City within
30 days of termination. If such ESG funds are not repaid to City within the 30 day period, City
shall exercise all legal remedies available under this Contract.
10.3 In General.
10.3.1 Subject to Section 10.2, and unless specifically provided otherwise in this
Contract,Agency shall be in default under this Contract if Agency breaches any term or condition
of this Contract. In the event that such a breach remains uncured after 30 calendar days following
written notice by City (or such other notice period as may be specified herein) or, if Agency has
diligently and continuously attempted to cure following receipt of such written notice but
ESG PSA CONTRACT 2016-2017 PAGE 16
Lighthouse for the Homeless, dba True Worth Place Rev.2.6.2017
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 ESG Funds that have not yet been expended from
affected activities to other eligible activities or withhold ESG Funds.
10.3.2.4 Any other appropriate action including but not limited to any
remedial action legally available such as declaratory judgment,
specific performance, damages, temporary or permanent
injunctions,termination of this Contract or any other contracts with
Agency, and any other available remedies.
10.3.3 In the event of termination under this Section 10.3, all ESG Funds awarded but
unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency shall have
no further right to such funds, and any ESG Funds already paid to Agency must be repaid to City
within 30 days of the termination. Failure to repay such ESG Funds within the 30 day period will
result in City exercising all legal remedies available under this Contract.
10.4 No Funds Disbursed while in Breach.
Agency understands and agrees that no ESG Funds will be paid to Agency until all defaults
are cured to City's satisfaction.
10.5 No Compensation After Date of Termination.
Agency shall not receive any compensation for work undertaken after the date of the
termination.
10.6 Rights of City Not Affected.
Termination shall not affect or terminate any of the existing rights of City against Agency,
or which may thereafter accrue because of Agency's default and this provision shall be in addition
to any and all other rights and remedies available to City under the law. Such termination does
not terminate any provisions of this Contract that have been expressly noted as surviving the term
or termination of the Contract. No delay or omission by City in exercising any right or remedy
available to it under this Contract shall impair any such right or remedy or constitute a waiver or
acquiescence in any Agency default.
ESG PSA CONTRACT 2016-2017 PAGE 17
Lighthouse for the Homeless,dba True Worth Place Rev.2.6.2017
10.7 Waiver of Breach Not Waiver of Subsequent Breach.
The waiver of a default or breach of any term, covenant, or condition of this Contract shall
not operate as a waiver of any subsequent default or breach of the same or any other term,covenant
or condition hereof.
10.8 Civil Criminal and Administrative Penalties.
Failure to perform all the Contract terms may result in civil, criminal or administrative
penalties, including, but not limited to those set out in this Contract.
10.9 Termination for Cause.
10.9.1 City may terminate this Contract in the event of Agency's default, inability, or
failure to perform subject to notice, grace and cure periods. In the event City terminates this
Contract for cause, all ESG Funds awarded but unpaid to Agency pursuant to this Contract shall
be immediately rescinded and Agency shall have no further right to such funds and any ESG Funds
already paid to Agency must be repaid to City within 30 days of termination. Failure to repay such
ESG Funds within 30 days will result in City exercising all legal remedies available to City under
this Contract. AGENCY ACKNOWLEDGES AND AGREES THAT IF CITY
TERMINATES THIS CONTRACT FOR CAUSE, AGENCY OR ANY AFFILIATES OF
AGENCY SHALL NOT BE CONSIDERED FOR ANY OTHER CITY CONTRACT FOR
ESG FUNDS FOR A MINIMUM OF 5 YEARS FROM THE DATE OF TERMINATION.
10.9.2 Agency may terminate this Contract if City does not provide the ESG Funds
substantially in accordance with this Contract.
10.10 Termination for Convenience.
In terminating in accordance with 2 CFR Part 200, Appendix Il, this Contract may be
terminated in whole or in part only as follows:
10.10.1 By City with the consent of Agency in which case the Parties shall agree upon
the termination conditions, including the effective date and in the case of partial termination, the
portion to be terminated; or
10.10.2 By Agency upon at least 30 days written notification to City, setting forth the
reasons for such termination, the effective date, and in the case of partial termination, the portion
to be terminated. In the case of a partial termination, City may terminate the Contract in its entirety
if City determines in its sole discretion that the remaining portion of the Contract to be performed
or ESG Funds to be spent will not accomplish the purposes for which the Contract was made.
10.11 Dissolution of Agency Terminates Contract.
This Contract shall terminate in the event Agency is dissolved or ceases to exist. In the
event of termination under this Section, all ESG Funds are subject to repayment and/or City may
exercise all of its remedies under this Contract.
10.12 Reversion of Assets.
In the event this Contract is terminated with or without cause,all assets acquired by Agency
ESG PSA CONTRACT 2016-2017 PAGE 18
Lighthouse for the Homeless, dba True Worth Place Rev.2.6.2017
with the ESG Funds including cash, interest payments from loans or otherwise, all outstanding
notes, mortgages or other security instruments, any accounts receivable attributable to the use of
the ESG Funds, and any real or personal property owned by Agency that was improved with the
ESG Funds shall automatically transfer to City or to such assignee as City may designate.
11. REPAYMENT OF ESG FUNDS.
All ESG Funds are subject to repayment in the event the Program does not meet the
requirements of this Contract or in the ESG Regulations. If Agency takes any action that results
in the City being required to repay all or any portion of the ESG Funds to HUD, Agency
agrees it will reimburse City 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 ESG Funds is required of City,Agency agrees City may require that 10%
of the ESG Funds be repaid to City as liquidated damages. The Parties agree that City's
damages in the event of either repayment to HUD being required or receiving a finding from HUD
are uncertain and would be difficult to ascertain and may include an impact on City's ESG grant
or other federal grant funds, in addition to the finding by HUD or a required repayment of funds
to HUD by City. Therefore,the Parties agree that payment under this Section of 10% of the ESG
Funds by Agency to City is liquidated damages and not a penalty.
12. CHANGE IN NON-PROFIT STATUS.
Agency must provide City with written notification of any changes to its non-profit status
within 15 calendar days of being notified of the change. Regardless of notice by Agency, if the
non-profit status of Agency changes after the date of this Contract, City may but is not obligated
to, terminate this Contract. In the event of termination under this Section 12, all ESG Funds
awarded but not yet paid to Agency pursuant to this Contract shall be immediately rescinded and
Agency shall have no further right to such funds. City, in its sole discretion, may require that any
ESG Funds already paid to Agency must be repaid to City within 30 calendar days of termination
under this Section.
13. SURVIVAL.
Any provision of this Contract that pertains to auditing, monitoring, client income
eligibility, record keeping and reports, City ordinances, or applicable ESG requirements, and any
default and enforcement provisions necessary to enforce such provisions, shall survive the
termination of this Contract for 5 years after the Contract term ends and shall be 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
ESG PSA CONTRACT 2016-2017 PAGE 19
Lighthouse for the Homeless,dba True Worth Place Rev.2.6.2017
same, and shall be solely responsible for the acts and omissions of its officers, members, agents,
servants, employees, contractors, subcontractors, vendors, clients, licensees or invitees.
14.2 Doctrine of Respondeat Superior.
The doctrine of respondeat superior shall not apply as between City and Agency, or its
officers, members, agents, servants, employees, contractors, subcontractors, vendors, clients,
licensees or invitees, and nothing herein shall be construed as creating a partnership or joint
enterprise between City and Agency. City does not have the legal right to control the details of
the tasks performed hereunder by Agency, its officers, members, agents, employees, contractors,
subcontractors, vendors, clients, licensees or invitees.
14.3 Agency Property.
City shall under no circumstances be responsible for any property belonging to Agency, or
its officers, members, agents, employees, contractors, subcontractors, vendors, clients, licensees
or invitees that may be lost, stolen or destroyed or in any way damaged and AGENCY HEREBY
INDEMNIFIES AND HOLDS HARMLESS CITY AND ITS OFFICERS, AGENTS, AND
EMPLOYEES FROM ANY AND ALL CLAIMS OR SUITS PERTAINING TO OR
CONNECTED WITH SUCH PROPERTY.
14.5 Religious Organization.
Agency shall comply with all applicable requirements as more particularly described in 24
CFR Part 5.109. No portion of the ESG Funds shall be used in support of any sectarian or religious
activity. In addition,there must be no religious or membership criteria for clients of a ESG-funded
service.
14.5.1. Separation of Explicitly Religious Activities.
Agency retains its independence and may continue to carry out its mission, including the
definition, development practice, and expression of its religious beliefs, provided that it does not
use ESG Funds to support or engage in any explicitly religious activities (including activities that
involve overt religious content such as worship,religious instruction,or proselytization), or in any
other manner prohibited by law.
14.5.2 Explicitly Religious Activities.
If Agency engages in explicitly religious activities (including activities that involve overt
religious content such as worship,religious instruction, or proselytization),the explicitly religious
activities must be offered separately, in time or location, from the programs or activities supported
by ESG Funds and participation must be voluntary for clients of a ESG-funded service.
14.5.3 Required Notices.
If Agency constitutes a Faith-based organization under 24 CFR Part 5.109, Agency must
provide all clients of a ESG-funded service with the notice attached as EXHIBIT "M"—Notice
of Beneficiary Rights. Such notice shall be provided to the client prior to enrollment in any ESG-
funded program or activity. In addition, if a client or prospective client of a ESG-funded service
objects to the religious character of Agency, then Agency must promptly undertake reasonable
efforts to identify and refer the client or prospective client to an alternate provider to which the
ESG PSA CONTRACT 2016-2017 PAGE 20
Lighthouse for the Homeless, dba True Worth Place Rev.2.6.2017
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 Governin14 Law.
This Contract shall be governed by and construed in accordance with the laws of the State
of Texas. If any action, whether real or asserted, at law or in equity, arises out of the execution,
performance or non-performance of this Contract or on the basis of any provision herein, for any
issue not governed by federal law,the choice of law shall be the laws of the State of Texas.
14.8 Severability.
The provisions of this Contract are severable, and if for any reason a clause, sentence,
paragraph or other part of this Contract shall be determined to be invalid by a court or federal or
state agency, board or commission having jurisdiction over the subject matter thereof, such
invalidity shall not affect other provisions which can be given effect without the invalid provision.
14.9 Written Agreement Entire Contract.
This written instrument and the Exhibits, Attachments, and Addendums attached hereto,
which are incorporated by reference and made a part of this Contract for all purposes, constitute
the entire agreement by the Parties concerning the work and services to be performed under this
Contract. Any prior or contemporaneous oral or written agreement which purports to vary the
terms of this Contract shall be void. Any amendments to the terms of this Contract must be in
writing and executed by the Parties.
14.10 Paragraph Headings for Reference Only, No Legal Significance; Number
and Gender.
The paragraph headings contained herein are for convenience in reference to this Contract
and are not intended to define or to limit the scope of any provision of this Contract. When context
requires, singular nouns and pronouns include the plural and the masculine gender shall be deemed
to include the feminine or neuter and the neuter gender to include the masculine and feminine.
The words "include" and"including"whenever used herein shall be deemed to be followed by the
words"without limitation".
14.11 Compliance With All Applicable Laws and Regulations.
Agency agrees to comply fully with all applicable laws and regulations that are currently
in effect or that are hereafter amended during the performance of this Contract. Those laws
include, but are not limited to:
➢ ESG Regulations found in 24 CFR Part 576
➢ SubtitleB of Title IV of the McKinney-Vento Homeless Assistance Act, as amended,
(42 USC 11371)
➢ Title VI of the Civil Rights Act of 1964 (42 U.S.C. Sections 2000d et seq.) including
provisions requiring recipients of federal assistance to ensure meaningful access by
ESG PSA CONTRACT 2016-2017 PAGE 21
Lighthouse for the Homeless, dba True Worth Place Rev.2.6.2017
persons of limited English proficiency
➢ The Fair Housing Act, Title VIII of the Civil Rights Act of 1968 (42 U.S.C. Sections
3601 etseq.)
➢ Executive Orders 11063, 11246 as amended by 11375 and 12086 and as supplemented
by Department of Labor regulations 41 CFR Part 60
➢ The Age Discrimination in Employment Act of 1967
➢ The Age Discrimination Act of 1975 (42 U.S.C. Sections 6101 et seq.)
➢ The Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970
(42 U.S.C. Sections 4601 et seq. and 49 CFR Part 24) ("URA")
➢ Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. Sections 794 et seq.) and 24
CFR Part 8 where applicable
➢ National Environmental Policy Act of 1969, as amended, 42 U.S.C. Sections 4321 et
seq. ("NEPA") and the related authorities listed in 24 CFR Part 58.
➢ The Clean Air Act, as amended, (42 U.S.C. Sections 1251 et seq.) and the Clean Water
Act of 1977, as amended (33 U.S.C. Sections 1251 et seq.) and the related Executive
Order 11738. In no event shall any amount of the assistance provided under this
Contract be utilized with respect to a facility that has given rise to a conviction under
the Clean Air Act or the Clean Water Act.
➢ Immigration Reform and Control Act of 1986 (8 U.S.C. Sections 1101 et seq.)
specifically including the provisions requiring employer verifications of legal status of
its employees
➢ The Americans with Disabilities Act of 1990 (42 U.S.C. Sections 12101 et seq.), the
Architectural Barriers Act of 1968 as amended (42 U.S.C. Sections 4151 et seq.) and
the Uniform Federal Accessibility Standards, 24 CFR Part 40,Appendix A
➢ Regulations at 24 CFR Part 87 related to lobbying, including the requirement that
certifications and disclosures be obtained from all covered persons
➢ Drug Free Workplace Act of 1988 (41 U.S.C. Sections 701 et seq.) and 24 CFR Part
23, Subpart F
➢ Executive Order 12549 and 24 CFR Part 5.105(c) pertaining to restrictions on
participation by ineligible, debarred or suspended persons or entities
➢ Section 6002 of the Solid Waste Disposal Act, as amended by the Resource
Conservation and Recovery Act
➢ Guidelines of the Environmental Protection Agency at 40 CFR Part 247
➢ For contracts and subgrants for construction or repair, Copeland "Anti-Kickback" act
(18 U.S.C. 874) as supplemented in 29 CFR Part 5
➢ For construction contracts awarded by Agency in excess of$2,000, and in excess of
$2,500 for other contracts which involve the employment of mechanics or laborers,
Sections 103 and 107 of the Contract Work Hours and Safety Standards Act(40 U.S.C.
327A 300) as supplemented by 29 CFR Part 5
➢ Lead-Based Paint Poisoning Prevention Act (42 U.S.C. 4801 et seq.), as amended by
the Residential Lead-Based Paint Hazard Reduction Act of 1992 (42 U.S.C. 4851 et
seq.) and implementing regulations at 24 CFR Part 35, subparts A, B, M, and R
➢ Uniform Administrative Requirements, Cost Principles, and Audit Requirements for
Federal Awards, 2 CFR Part 200 et seq.
➢ Federal Funding Accountability and Transparency Act of 2006 ("FFATA") (Pub.L.
109-282, as amended by Section 6205(a) of Pub.L. 110-252 and Section 3 of Pub.L.
ESG PSA CONTRACT 2016-2017 PAGE 22
Lighthouse for the Homeless,dba True Worth Place Rev.2.6.2017
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.
Assisted d Employmentnd othe. Economic
14.12HUDrese� P�ry�Tccc+��—aPi�
n + •t c +• z Requirements.
14.13 Prohibition ALainst Discrimination.
14.13.1 General Statement.
Agency shall comply in the execution, performance or attempted performance of this
Contract, with all non-discrimination requirements of 24 CFR Part 5 as modified by 24 CFR Part
576.57(a) and Chapter 17, Article III, Division 4 —Fair Housing of the City Code. Agency may
not discriminate against any person because of race, color, sex, gender, religion, national origin,
familial status, disability or perceived disability, sexual orientation, gender identity, gender
expression, or transgender, nor will Agency permit its officers, members, agents, employees, or
clients to engage in such discrimination.
This Contract is made and entered into with reference specifically to Chapter 17, Article
III,Division 3 -Employment Practices of the City Code,and Agency hereby covenants and agrees
that Agency, its officers, members, agents, employees and contractors, have fully complied with
all provisions of same and that no employee, or applicant for employment has been discriminated
against under the terms of such ordinances by either or its officers, members, agents, employees
or contractors.
14.13.2 No Discrimination in Employment during the Performance of This
Contract.
During the performance of this Contract Agency agrees to the following provision, and
will require that its contractors and subcontractors also comply with such provision by including
it in all contracts with its contractors:
[Contractor's Subcontractor's or Vendor's name]will not unlawfully discriminate against
any employee or applicants for employment because of race, color, sex, gender,religion, national
origin,familial status,disability or perceived disability, sexual orientation,gender identity, gender
expression or transgender. [Contractor's Subcontractor's or Vendor's name]will take affirmative
action to ensure that applicants are hired without regard to race, color, sex, gender, religion,
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
ESG PSA CONTRACT 2016-2017 PAGE 23
Lighthouse for the Homeless, dba True Worth Place Rev.2.6.2017
Vendor's name], state that all qualified applicants will receive consideration for employment
without regard to race, color, sex, gender, religion, national origin, familial status, disability or
perceived disability, sexual orientation, gender identity, gender expression or transgender.
[Contractor's, Subcontractor's or Vendor's name] covenants that neither it nor any of its
officers, members, agents, employees, or contractors, while engaged in performing this Contract,
shall, in connection with the employment, advancement or discharge of employees or in
connection with the terms, conditions or privileges of their employment, discriminate against
persons because of their age or because of any disability or perceived disability, except on the
basis of a bona fide occupational qualification, retirement plan or statutory requirement.
(Contractor's Subcontractor's or Vendor's name] further covenants that neither it nor its
officers,members, agents, employees, contractors, or persons acting on their behalf, shall specify,
in solicitations or advertisements for employees to work on this Contract, a maximum age limit
for such employment unless the specified maximum age limit is based upon a bona fide
occupational qualification, retirement plan or statutory requirement.
14.13.3 Agency's Contractors and the ADA.
In accordance with the provisions of the Americans With Disabilities Act of 1990
("ADA"), Agency warrants that it and any of its contractors will not unlawfully discriminate on
the basis of disability in the provision of services to the general public,nor in the availability,terms
and/or conditions of employment for applicants for employment with,or employees of,Agency or
any of its contractors. AGENCY WARRANTS IT WILL FULLY COMPLY WITH THE
ADA'S PROVISIONS AND ANY OTHER APPLICABLE FEDERAL, STATE AND
LOCAL LAWS CONCERNING DISABILITY AND WILL DEFEND, INDEMNIFY AND
HOLD CITY HARMLESS AGAINST ANY CLAIMS OR ALLEGATIONS ASSERTED BY
THIRD PARTIES, CONTRACTORS SUBCONTRACTORS, VENDORS OR AGENTS
AGAINST CITY ARISING OUT OF AGENCY'S AND/OR ITS CONTRACTORS',
SUBCONTRACTORS', VENDORS' OR AGENTS' OR THEIR RESPECTIVE
EMPLOYEES'ALLEGED FAILURE TO COMPLY WITH THE ABOVE-REFERENCED
LAWS CONCERNING DISABILITY DISCRIMINATION IN THE PERFORMANCE OF
THIS CONTRACT.
14.14. Conflicts of Interest and Violations of Criminal Law.
14.14.1 ALTency Safeguards,
Agency shall establish safeguards to prohibit its employees, board members, advisors and
agents from using positions for a purpose that is or gives the appearance of being motivated by a
desire for private gain for themselves or others, particularly those with whom they have family,
business or other ties. Agency shall disclose to City any such conflict of interest or potential
conflict of interest, immediately upon discovery of such.
14.14.2 General Prohibition Against Conflicts of Interest.
No employees, agents, consultants, officers or elected officials or appointed officials of
City or of Agency who exercise or have exercised any functions or responsibilities with respect to
activities assisted with ESG funds or who are in a position to participate in a decision-making
process or gain inside information with regard to these activities may utilize ESG services, may
ESG PSA CONTRACT 2016-2017 PAGE 24
Lighthouse for the Homeless, dba True Worth Place Rev.2.6.2017
obtain a financial interest or benefit from a ESG-assisted activity, or have an interest in any
contract, subcontract or agreement with respect thereto, or the proceeds thereunder, either for
themselves or those with whom they have family or business ties, during their tenure or for 1 year
thereafter..
14.14.2.1 Agency shall establish conflict of interest policies for federal awards
including the ESG Funds and shall disclose in writing potential
conflicts of interest to City as authorized by 2 CFR Part 200.112.
14.14.2.2 Agency shall comply with HUD requirements regarding
organizational conflicts of interest in provision of shelter, housing,
prevention and related services as more particularly described in 24
CFR Part 576.404.
14.14.3 Conflicts of Interest Involving Procurement.
The conflict of interest provisions of 2 CFR Part 200.318 , shall apply in the procurement
of property and services by Agency. In all cases not governed by those Sections, the provisions
of 24 CFR Part 576.57(d) of the ESG Regulations shall apply.
14.14.3.1 As more particularly described in 2 CFR Part 200.318,Agency shall
maintain and submit to City written standards of conduct covering
conflicts of interest and governing the performance of its employees
engaged in the selection, award, and administration of contracts. No
employee, officer, or agent may participate in the selection, award,
or administration of a contract supported by a federal award if he or
she has a real or apparent conflict of interest. The standards of
conduct must provide for disciplinary actions to be applied for
violations of such standards by officers, employees, or agents of
Agency.
14.14.3.2 The officers, employees, and agents of Agency shall neither solicit
nor accept gratuities, favors, or anything of monetary value from
contractors or parties to subcontracts.
14.14.3.3 Notwithstanding the prohibition contained in Section 14.13.3.2,
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.
ESG PSA CONTRACT 2016-2017 PAGE 25
Lighthouse for the Homeless,dba True Worth Place Rev.2.6.2017
14.14.3.5 Agency must maintain records sufficient to detail the history of
procurement. These records will include, but are not necessarily
limited to the following: rationale for the method of procurement,
selection of contract type, contractor selection or rejection, and the
basis for the contract price.
14.14.4 Disclosure of Conflicts of Interest.
In compliance with 2 CFR Part 200.112, Agency is required to timely disclose to City in
writing any potential conflict of interest.
14.14.5 Disclosure of Texas Penal Code Violations.
Agency affirms that it will adhere to the provisions of the Texas Penal Code which prohibit
bribery and gifts to public servants.
14.14.6 Disclosure of Federal Criminal Law Violations.
In compliance with 2 CFR Part 200.113, Agency is required to timely disclose to City all
violations of federal criminal law involving fraud, bribery or gratuity violations potentially
affecting the Agency.
14.15 Subcontracting with Small and Minority Firms, Women's Business
Enterprises and Labor Surplus Areas.
14.15.1 For procurement contracts $50,000.00 or larger that are paid for, in part or in
full, with ESG Funds, Agency agrees to abide by City's policy to involve Minority Business
Enterprises and Small Business Enterprises and to provide them equal opportunity to compete for
contracts for construction,provision of professional services,purchase of equipment and supplies
and provision of other services required by City. Agency agrees to incorporate the City's BDE
Ordinance, and all amendments or successor policies or ordinances thereto, into all contracts and
subcontracts for procurement larger than $50,000.00 or larger that are paid for, in part or in full,
with the ESG Funds and will further require all persons or entities with which it so contracts to
comply with said ordinance.
14.15.2 It is national policy to award a fair share of contracts to disadvantaged business
enterprises ("DBEs"), small business enterprises ("SBEs"), minority business enterprises
("MBEs"), and women's business enterprises ("WBEs"). Accordingly, affirmative steps must be
taken to assure that DBEs, SBEs, MBEs, and WBEs are utilized when possible as sources of
supplies, equipment, construction and services.
14.15.2.1 In order to comply with federal reporting requirements, Agency
must submit the form attached hereto as EXHIBIT "L" — MBE
Reporting Form for each contract or subcontract with a value of
$10,000.00 or more paid or to be paid with the ESG Funds. Agency
shall submit this form by the date specified in EXHIBIT "L" —
MBE Reporting Form.
14.16 Other Laws.
The failure to list any federal, state or City ordinance, law or regulation that is applicable
to Agency does not excuse or relieve Agency from the requirements or responsibilities in regard
ESG PSA CONTRACT 2016-2017 PAGE 26
Lighthouse for the Homeless, dba True Worth Place Rev.2.6.2017
to following the law, nor from the consequences or penalties for Agency's failure to follow the
law, if applicable.
14.17 Assignment.
Agency shall not assign all or any part of its rights,privileges,or duties under this Contract
without the prior written approval of City. Any attempted assignment of same without approval
shall be void, and shall constitute a breach of this Contract.
14.18. Right to Inspect Agency Contracts.
It is agreed that City has the right to inspect and approve in writing any proposed contracts
between Agency and any contractor or vendor engaged in any activity in conjunction with this
ESG-funded Program prior to any charges being incurred.
14.19 Force 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 HIND OR
CHARACTER, WHETHER REAL OR ASSERTED, ARISING OUT OF OR IN
CONNECTION WITH THE EXECUTION, PERFORMANCE, ATTEMPTED
PERFORMANCE OR NONPERFORMANCE OF THIS CONTRACT AND/OR THE
OPERATIONS, ACTIVITIES AND SERVICES OF THE PROGRAM DESCRIBED
HEREIN, WHETHER OR NOT CAUSED IN WHOLE OR IN PART, BY ALLEGED
NEGLIGENCE OF OFFICERS,AGENTS,SERVANTS,EMPLOYEES, CONTRACTORS
OR SUBCONTRACTORS OF CITY; AND 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
ESG PSA CONTRACT 2016-2017 PAGE 27
Lighthouse for the Homeless,dba True Worth Place Rev.2.6.2017
NONPERFORMANCE OF THIS CONTRACT AND/OR THE OPERATIONS,
ACTIVITIES AND SERVICES OF THE PROGRAM DESCRIBED HEREIN,WHETHER
OR NOT CAUSED IN WHOLE OR IN PART BY ALLEGED NEGLIGENCE OF
OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS OR
SUBCONTRACTORS OF CITY. AGENCY LIKEWISE COVENANTS AND AGREES TO
AND DOES HEREBY INDEMNIFY AND HOLD HARMLESS CITY FROM AND
AGAINST ANY AND ALL INJURY,DAMAGE OR DESTRUCTION OF PROPERTY OF
CITY,ARISING OUT OF OR IN CONNECTION WITH ALL ACTS OR OMISSIONS OF
AGENCY, ITS OFFICERS, MEMBERS, AGENTS, EMPLOYEES, CONTRACTORS,
SUBCONTRACTORS, INVITEES, LICENSEES, OR CLIENTS, OR CAUSED, IN
WHOLE OR IN PART, BY ALLEGED NEGLIGENCE OF OFFICERS, AGENTS,
SERVANTS,EMPLOYEES, CONTRACTORS OR SUBCONTRACTORS OF CITY.
IT IS THE EXPRESS INTENTION OF THE PARTIES, BOTH AGENCY AND
CITY, THAT THE INDEMNITY PROVIDED FOR THIS SECTION INCLUDES
INDEMNITY BY AGENCY TO INDEMNIFY AND PROTECT CITY FROM THE
CONSEQUENCES OF CITY'S OWN NEGLIGENCE,WHETHER THAT NEGLIGENCE
IS ALLEGED TO BE THE SOLE OR CONCURRING CAUSE OF THE INJURY,
DAMAGE OR DEATH.
AGENCY AGREES TO AND SHALL RELEASE CITY, ITS AGENTS,
EMPLOYEES, OFFICERS AND LEGAL REPRESENTATIVES FROM ALL LIABILITY
FOR INJURY, DEATH, DAMAGE OR LOSS TO PERSONS OR PROPERTY
SUSTAINED IN CONNECTION WITH OR INCIDENTAL TO PERFORMANCE UNDER
THIS CONTRACT, EVEN IF THE INJURY, DEATH, DAMAGE OR LOSS IS CAUSED
BY CITY'S SOLE OR CONCURRENT NEGLIGENCE.
AGENCY SHALL REQUIRE ALL OF ITS CONTRACTORS AND
SUBCONTRACTORS TO INCLUDE IN THEIR CONTRACTS AND SUBCONTRACTS
A RELEASE AND INDEMNITY IN FAVOR OF CITY IN SUBSTANTIALLY THE SAME
FORM AS ABOVE.
16. WAIVER OF IMMUNITY BY AGENCY.
If Agency, as a charitable or nonprofit organization, has or claims an immunity or
exemption (statutory or otherwise) from and against liability for damages or injury, including
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
$104,110.19 to insure against loss from the fraud, theft or dishonesty of any of Agency's officers,
agents, trustees, directors or employees. The proceeds of such insurance or bond shall be used to
reimburse City for any and all loss of ESG Funds occasioned by such misconduct. To effectuate
such reimbursement, such fidelity coverage shall include a rider stating that reimbursement for
ESG PSA CONTRACT 2016-2017 PAGE 28
Lighthouse for the Homeless, dba True Worth Place Rev.2.6.2017
any loss or losses shall name the City as a Loss Payee.
Agency shall furnish to City in a timely manner, but not later than the Effective Date,
certificates of insurance as proof that it has secured and paid for policies of commercial insurance
as specified herein. If City has not received such certificates by the Effective Date, Agency shall
be in default of the Contract and City may, at its option,terminate the Contract.
Such insurance shall cover all insurable risks incident to or in connection with the
execution,performance,attempted performance or nonperformance of this Contract. Agency shall
maintain the following insurance coverage and limits:
Commercial General Liability(CGL) Insurance
$ 500,000 each occurrence
$1,000,000 aggregate limit
Non-Profit Organization Liability or Directors & Officers Liability
$1,000,000 Each Occurrence
$1,000,000 Annual Aggregate Limit
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.
ESG PSA CONTRACT 2016-2017 PAGE 29
Lighthouse for the Homeless, dba True Worth Place Rev.2.6.2017
Additional Requirements
Such insurance amounts shall be revised upward at City's reasonable option and no more
frequently than once every 12 months, and Agency shall revise such amounts within 30 days
following notice to Contractor of such requirements.
Agency will submit to City documentation that it has obtained insurance coverage and has
executed bonds as required in this Contract prior to payment of any monies provided hereunder.
Where applicable, insurance policies required herein shall be endorsed to include City as an
additional insured as its interest may appear. Additional insured parties shall include employees,
officers, agents, and volunteers of City.
Any failure on part of City to request certificate(s) of insurance shall not be construed as a waiver
of such requirement or as a waiver of the insurance requirements themselves.
Insurers of Agency's insurance policies shall be licensed to do business in the state of Texas by
the Department of Insurance or be otherwise eligible and authorized to do business in the state of
Texas. Insurers shall be acceptable to City insofar as their financial strength and solvency and
each such company shall have a current minimum A.M. Best Key Rating Guide rating of A-: VII
or other equivalent insurance industry standard rating otherwise approved by City.
Deductible limits on insurance policies shall not exceed $5,000 per occurrence unless otherwise
approved by City.
In the event there are any local, federal or other regulatory insurance or bonding requirements for
the Program, and such requirements exceed those specified herein, the former shall prevail.
Agency shall require its contractors to maintain applicable insurance coverages, limits, and other
requirements as those specified herein; and Agency shall require its contractors to provide Agency
with certificate(s) of insurance documenting such coverage. Also, Agency shall require its
contractors to have City and Agency endorsed as additional insureds (as their interest may appear)
on their respective insurance policies.
Directors and Officers Liability coverage shall be in force and may be provided on a claims-made
basis. This coverage may also be referred to as Management Liability,and shall protect the insured
against claims arising out of alleged errors in judgment,breaches of duty and wrongful acts arising
out of their organizational duties. Coverage shall protect not only the entity, but all past, present
and future directors, officers,trustees, employees, volunteers and committee members.
Notwithstanding any provision in this Contract to the contrary, when applicable, Agency
shall comply with the requirements of 2 CFR 200.310 and shall, at a minimum, provide the
equivalent insurance coverage for real property and equipment acquired or improved with
ESG Funds as provided to property owned by Agency.
ESG PSA CONTRACT 2016-2017 PAGE 30
Lighthouse for the Homeless,dba True Worth Place Rev.2.6.2017
18. CERTIFICATION REGARDING LOBBYING.
The undersigned representative of Agency hereby certifies, to the best of his or her
knowledge and belief,that:
No federal appropriated funds have been paid or will be paid, by or on behalf of Agency,
to any person for influencing or attempting to influence an officer or employee of any
agency, a member of Congress, an officer or employee of Congress in connection with the
awarding of any federal contract,the making of any federal grant,the malting of any federal
loan, the entering into of any cooperative agreement and the extension, continuation,
renewal, amendment, or modification of any federal contract, grant, loan or cooperative
agreement.
If any funds other than federally appropriated funds have been paid or will be paid to any
person for influencing or attempting to influence an officer or employee of any agency,
member of Congress in connection with this federal contract, grant, loan or cooperative
agreement, Agency shall complete and submit Standard Form-LLL, "Disclosure Form to
Report Lobbying," in accordance with its instructions.
This certification is a material representation of fact upon which reliance was placed when
this Contract was made or entered into. Submission of this certificate is a prerequisite for
making or entering into this Contract imposed by 31 U.S.C. Section 1352. Any person
who fails to file the required certification shall be subject to a civil penalty of not less than
$10,000.00 and not more than$100,000.00 for each such failure.
Agency shall require that the language of this certification be included in all subcontracts or
agreements involving the expenditure of federal funds.
19. LITIGATION AND CLAIMS.
Agency shall give City immediate notice in writing of any action,including any proceeding
before an administrative agency, filed against Agency in conjunction with this Contract or the
Program. Agency shall furnish immediately to City copies of all pertinent papers received by
Agency with respect to such action or claim. Agency shall provide a notice to City within 10 days
upon filing under any bankruptcy or financial insolvency provision of law.
20. NOTICE.
All notices required or permitted by this Contract must be in writing and are deemed
delivered on the earlier date of the date actually received or the third day following deposit in a
United States Postal Service post office or receptacle; with proper postage, certified mail return
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.
ESG PSA CONTRACT 2016-2017 PAGE 31
Lighthouse for the Homeless, dba True Worth Place Rev.2.6.2017
City:
City Attorney's Office
200 Texas Street
Fort Worth, TX 76102
Telephone: 817-392-7600
Copy to:
Neighborhood Services Department
200 Texas Street
Fort Worth, TX 76102
Attention: Assistant Director
Telephone: 817-392-7540
Copy to:
Neighborhood Services Department
200 Texas Street
Fort Worth, TX 76102
Attention: Management Analyst II
Telephone: 817-392-7369
A enc :
Lighthouse for the Homeless, dba True Worth Place
Toby Owen, Executive Director
1513 E. Presidio St.
Fort Worth, TX 76102
Telephone: 817-632-7440
ESG PSA CONTRACT 2016-2017 PAGE 32
Lighthouse for the Homeless, dba True Worth Place Rev.2.6.2017
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]
ESG PSA CONTRACT 2016-2017 PAGE 33
Lighthouse for the Homeless,dba True Worth Place Rev.2.6.2017
IN WITNESS WHERE e Parties hereto have executed 4 duplicate originals of this
Contract in Fort Worth, Ta as.
ZTST: O ITY OF FORT WORTH
(7
{fSCAty Secretary Fernando Costa,Assistant City Manager
M&C: C-28066
1295 Certification No. 201
Date: January 24, 2017
IZVED AS TO FORM AND LEGALITY:
Paige Mebane,Assistant City Attorney
Contract Compliance Manager:
By signing, I acknowledge that I am the person responsible
for the monitoring and administration of this contract, including
ensuring all performance and reporting requirements
&"4 6euk
Barbara Asbury
Compliance and Planning Manag
LIGHTHOUSE FOR THE HOMELESS,
DBA TRUE WORTH PLACE
By:
To y Owen, Executive Director
OFFICIAL RECORD
CITY SECRETARY
I.WVORTM,TX
ESG PSA CONTRACT 2016-2017 PAGE 34
Lighthouse for the Homeless,dba True Worth Place Rev.2.6.2017
EXHIBITS:
EXHIBIT "A"—Program Summary
EXHIBIT "A-1"—2016 HUD Income Limits
EXHIBIT "B"—Budget
EXHIBIT "C"—Audit Certification Form
EXHIBIT "D"—Reimbursement Forms
EXHIBIT "E"—Form of Income Self-Certification
EXHIBIT "F"—Standards for Complete Documentation
EXHIBIT "G"—Section 3 Reporting Forms (NOT APPLICABLE)
EXHIBIT "H"—Match Report
EXHIBIT "I"—ESG Staff Certification Form
EXHIBIT "J" -ESG Performance Standards
EXHIBIT "J-1" —Written Standards for ESG Assistance
EXHIBIT "K"—ESG Quarterly HMIS Report
EXHIBIT "L"—MBE Reporting Form
EXHIBIT "M"—Notice of Beneficiary Rights
ESG PSA CONTRACT 2016-2017 PAGE 35
Lighthouse for the Homeless,dba True Worth Place Rev.2.6.2017
LIGHTHOUSE FOR THE HOMELESS EXHIBIT "A"
DBA TRUE WORTH PLACE
True Worth Place PROGRAM SUMMARY
PROGRAM SUMMARY
(ESG)
March 7, 2017 to September 30, 2017 $104,110.19
PERIOD AMOUNT
Capitalized terms not defined herein shall have meanings assigned them in the Contract.
PROGRAM:
The Program provides homeless persons access to daytime emergency shelter services, including
basic personal facilities such as showers and laundry. Navigation services are also provided
including linking clients to critical services and resources such as public benefits, housing,
employment services, health and mental health care and substance abuse.
ESG Funds will be used to pay for the salaries and FICA of Program employees involved with
daily operations of the facility. ESG Funds will also pay for a portion of the shelter utility
expenses.
Agency office and Program services will be provided at 1513 E. Presidio St, Fort Worth, TX
76102, Monday through Sunday, 7:00 a.m. to 3:00.
REGULATORY CLASSIFICATION:
Service Category (if more than one category, specify amount for each): ESG Emergency Shelter
Component
Regulatory Citation(s): 24 CFR 576.102
Agency will maintain documentation which verifies that 100% of the clients served are
homeless based on current FIUD definitions.
PROGRAM GOALS:
Minimum Number of Fort Worth Clients to be Served: The Program must serve a minimum
of 1,167 Unduplicated Clients from Fort Worth as shown by the monthly reports on Attachment
III.
ESG PSA CONTRACT 2016-2017—EXHIBIT"A"—PROGRAM SUMMARY Page 1
Lighthouse for the Homeless dba True Worth Place
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
30%AMI $14,600 $16,650 $18,750 $20,800 $22,500 $24,150 $25,800 $27,500
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.
ESG PSA CONTRACT 2016-2017--EXHIBIT"A-1"—2016 HUD INCOME LIMITS Page 1
Lighthouse for the Homeless, dba True Worth Place
EXHIBIT"B"-BUDGET
Accommt .GrantBudget A.' B C. Total
EMERGENCYSHELTER.
ESSENTIAL SERVICES
Salaries 1001 $ 80,080.00 $ 695,160.00 $ 57,000.00 $ 832,240.00
FICA 1002 $ 4,030.19 $ 59,635.81 $ 63,666.00
Life/Disability Insurance 1003 $
Health/Dental Insurance 1004 $ 66,579.00 $ 66,579.00
Unemployment-State 1005 $ 19,558.00 $ 19,558.00
Workers Compensation 1006 $ 8,322.00 $ 8,322.00
Office Supplies 1007 $ 35,000.00 $ 35,000.00
Food Supplies 1008 $ -
Insurance 1009 $ -
Accounting 1010 $ 9,000.00 $ 9,000.00
Contract Labor Legal and Professional Fees(City
needs copy of contract before expenses can be
reimbursed) 1011 $ 89,610.00 $ 89,610.00
Other(Trainings,Printing,Events&Direct Client
Expenses) 1012 $ 75,750.00 $ 75,750.00
SHELTER OPERATIONS
Maintenance 2001 $ 36,500.00 $ 36,500.00
Security 2002 $ -
Insurance 2003 $ 40,000.00 $ 40,000.00
Utilities 2004 $ 20,000.00 $ 156,773.00 $ 176,773.00
Supplies 2005 $ -
Repairs 2006 $ -
Other(Accounting,Janitorial Services,Tranings,
Printing,Evens) 2007 $ 95,250.00 $ 95,250.00
SUBTOTAL EMERGENCY SHELTER $ 104,110.19 1 S 1,387,137.81 S 57,000.00 $ 1,548,248.00
HOUSIlgGI2ELOCATIQ&AND STABILIZATION'"': `
PREVENTION
Salaries 3001
FICA 3002
Life/Disability Insurance 3003
Health/Dental Insurance 3004
Unemployment-State 3005
Worker's Compensation 3006
Other() 3007
REHOUSING
Salaries 4001
FICA 4002
Life/Disability Insurance 4003
Health/Dental Insurance 4004
Unemployment-State 4005
Worker's Compensation 4006
Other() 4007
SUBTOTAL HR&S
IPTANCIALASSISTANCE
PREVENTION
Rental Assistance 5001
Utility Payments 5002
REHOUSING
Rental Assistance 6001
Security Deposits 6002
Utility Deposits 6003
Utility Payments 6004
Moving Costs 6005
Motel/Hotel Vouchers 6006
SUBTOTAL FINANCIAL ASSISTANCE
$OMEI ESS MANAGEMENT INFORMATIONSYSTEIYI(HrlHS)
HMIS Software Costs* 7001
SUBTOTAL HMIS
BUDGET TOTAL $ 104,110.19 $ 1,387,137.81 $ 57,000.00 S 1,548,248.00
*HMIS Software costs are eligible for reimbursement beginning January 20,2017
FUNDING A:Fort Worth Foundation
FUNDING B:MHMR
ESG PSA CONTRACT 2016-2017-EXHIBIT"B"-BUDGET
Lighthouse for the Homeless dba True Worth Place 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
Est. Percent to Amount to
Position Title Annual Salary Grant Grant
Lead Client Service Specialist $ 27,040.00 100.0% $ 27,040.00
Client Service Specialist $ 27,040.00 100.0% $ 27,040.00
Client Service Specialist $ 26,000.00 100.0%1 $ 26,000.00
TOTAL 1 $ 80,080.00 100.0%1 $ 80,080.00
FRINGE DETAIL
Percent of Est. Percent to Amount to
Payroll Amount Grant Grant
FICA 7.65% $ 63,666.00 6.3% $ 4,030.19
Life/Disability Insurance
Health/DentalInsurance 8.00% $ 66,579.00
Unemployment-State 2.35% $ 19,558.00
Worker's Compensation 1.00% $ 8,322.00
Other()
TOTAL $ 158,125.00 2.5%1 $ 4,030.19
SUPPLIES AND SERVICES
Est. Percent to Amount to
Total Budget Grant Grant
Office Supplies $ 35,000.00
Food Supplies
TOTAL $ 35,000.00
MISCELLANEOUS
Est. Percent to Amount to
Total Budget Grant Grant
Insurance
Accounting $ 9,000.00
Contract Labor(Legal and Professional Fees) $ 89,610.00
Other(Trainings, Printing, Events &Direct
Client Expenses) $ 75,750.00
TOTAL $ 174,360.00
ESG PSA CONTRACT 2016-2017-EXHIBIT"B"-BUDGET
Lighthouse for the Homeless dba True Worth Place Page 2
SHELTER OPERATIONS
Est. Percent to Amount to
Total Budget Grant Grant
Maintenance $ 36,500.00
Security
Insurance $ 40,000.00
Utilities $ 176,773.00 11.3% $ 20,000.00
Supplies
Repairs
Other(Accouting, Janitorial Services, $ 92,250.00
TOTAL $ 345,523.00 5.8% $ 20,000.00
FINANCIAL ASSISTANCE
Est. Percent to Amount to
Total Budget Grant Grant
Rental Assistance
Security Deposits
Utility Payments
Utility Deposits
Moving Costs
Motel/Hotel Vouchers
TOTAL
HMIS
Est. Percent to Amount to
Total Budget Grant Grant
HMIS Software Costs*
TOTAL
*HMIS Software costs are eligible for reimbursement beginning January 20,2017
ESG PSA CONTRACT 2016-2017-EXHIBIT"B"-BUDGET
Lighthouse for the Homeless dba True Worth Place Page 3
EXHIBIT "C"
AUDIT CERTIFICATION FORM
ESG PSA CONTRACT 2016-2017—EXHIBIT"C"—AUDIT CERTIFICATION FORM Page 1
Lighthouse for the Homeless,dba True Worth Place
AUDIT CERTIFICATION FORM AND AUDIT REQUIREMENTS
Agency: Lighthouse for the Homeless, dba True Worth Place
Fiscal Year Ending: September 30,2017
Qj 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 yea or 30 ays within its compl tion whichever is the arlie date.
L4>LA( toe P,Gam" wM��=
tJ,- &W �lc alaa
❑ During the fiscal year in which funds will exce d the$750,000 federal
expenditure threshold required for a Single Audit or a Program Specific Audit to be performed
this fiscal year. (Fill out schedule below)
federal ExpenditureDisclosure
MTTST be�fiiled outlf Single Audit or Program"Audit"is,NOT re aired.,
x Pass ThroughPragram Name 8c Contract
Federal Grantor = - - :r Expenditures
Total Federal Expenditures for this Fiscal Year:
Signatory and Title Date
day dwe>1
Failure to submit this or a similar statement or failure to submit a completed single audit package
as described in the federally required audit requirements described in 2 CFR Part 200, as
applicable,by the required due date may result in suspension of funding and may affect eligibility
for future funding. Notwithstanding the above, this certification acknowledges the agency's
commitment to meet all other financial reporting, financial statements, and other audit
requirements as may be set forth in the Contract.
ESG PSA CONTRACT 2016-2017—EXHIBIT"C"—AUDIT CERTIFICATION FORM Page 2
Lighthouse for the Homeless,dba True Worth Place
EXHIBIT "D"
REPORTING FORMS
ESG PSA CONTRACT 2016-2017—EXHIBIT"D"—REPORTING FORMS Page 1
Lighthouse for the Homeless,dba True Worth Place
ATTACHMENT I
Invoice
Agency:
Address:
City, State, Zip:
Program:
Period of Service:
Tax ID No.
P.O. No.
FID No.
Program
: ti Amount s:
This nuoice Gumula#iue, 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:
ESG PSA CONTRACT 2016-2017—EXHIBIT"D"—REPORTING FORMS Page 2
Lighthouse for the Homeless, dba True Worth Place
ATTACHMENT 11
Expenditure Worksheet
City of Worth
Neighborhood Services Department
Expenditure Worksheet
Age.ey:
program:
Only highlighted codes can be reimbursed
Please g oup like account codes.
Iiue
n
Date ,,,,,Wscnpho To 2""sZ
14c. ok �",-Xrnaurrt, 4, recount
I EKWGlVCYSHELTHC,,
2 ESS SERVICES
3 Salaries 1001
4 FICA 1002
5 Life/Disability Insurance 1003
6 Health/Dental Insurance 1004
7 Unernploymcm-State 1005
8 Worker's Compensation 1006
9 Office Supplies 1007
10 Food Supplies 1008
11 insurance 1009
12 Accounting 1010
13 Contract Labor 1011
14 Othero 1012 1
15 SBIELTEROPERATIONS
16 Maintenance 2001
17 Security 2002
18 Insurance 2003
19 Utilities 2004
20 Supp ties 2005
21 Re airs 2006
22 Moro 2007
23 HOLNIKGRMOCATION AND STABnJT"ON
24 PREV=ON
25 Salaries 3001 1
26 FICA 3002
27 Life/Disabitity Insurance 3003
28 Health/Dental Insurance 3004
29 Uneroploymant-State 3005
30 Compensation 3006
31 1 Othero 3007
32 REHOISING
33 Salaries 4001
34 FtCA 4002 1
35 Life/Disability Insurance 4003
36 Health(D-tallasurance 4004
37 Unernplovonent-State 4005
38 Workers Compensation 4006
39 OtherO 4007
40 IRNANCLkL ASSISTANCE
41 PREVENTION
42 Rental Assistance 5001
43 Utili y Pavinents 5002
44 REHOUSING
45 Rental Assistance 6001
46 Security Deposits 6002
47 Lhifitv Deposits 6003
48 Utility Payments 6004
49 Moving Costs 6005
50 MotelfflotelVouchers 6006
51
52 1 wAlssoftme Costs- 7001
53 -MILS Softiinrc cots are eligible for
54 reimbursement beginning October 18,2016
55
56
57
J59
0tal
*For Salaries,state employee's title under Description/Job Title.Rent most identify tenant
ESG PSA CONTRACT 2016-2017—EXHIBIT"U' REPORTING FORMS Page 3
Lighthouse for the Homeless,dba True Worth Place
ATTACHMENT III
Client Data Report
_..
(MINT DATA Rn<af.. _....
;. '"" . '� lb wl urmm +audmeu m:+a�aoir.'w.t41o1 msg�:lR�epi'r�s,ti�.r.r?sd.luamd:aar. wprimmhi.�t��,.><rrsvrmmw.sd��r.o+s�a:�xmr"o�.xs .�c�®*dsmeaiagr�wae�c�auma�a�h gel
' Instra 9ontr..;;. a.,a..m�unwlai.i.x!mr:�ia�-fl�eary�iman eo<a�aa.�t.=smxuiMaa,.�,ler cawmc.;mg,..mm��a..,y�rQ�e4k�ah:wwa�med��ee.mai.vst<mti}�.r.e�am<.a..rng.n,alg�a..m w..;a :aom.�ss a.mi
,';4N4CWftCfRtMT1[O.1TR 'Fleae6�51ltyklen.Enx tv d.mA
'..L'i$fli4lTlA'E dCRe� _
1 23 lA 3 A
..,. �'1 ;cam), mxrlormA�) 1
..r v
EIDiC' tAftSilh+q X11@. �r { .t''\Ea�;,� / 3YFRf Y tOi .m4.Mk 33i W ,
,..
;., �u4 Lua V 1L.4ia.%+Tta Tao ,, SIib1
IYPI- !l.ASGa; Ylsd F AASr .11ff6rW W N10. -T 301 hiH 1-HfA3a„hY31® .,
.Al£ LAll! SOLVE ffifP.UY!@P.11;G 1U c'ams ]NiNikamE dl®nv ..SS hU SIZE NY9 W 3RlaS ffi tA.
B
M
q3
:1
9
Jel
S
ESG PSA CONTRACT 2016-2017—EXHIBIT"D"—REPORTING FORMS Page 4
Lighthouse for the Homeless,dba True Worth Place
EXHIBIT "E"
INCOME CERTIFICATION FORMS
ESG PSA CONTRACT 2016-2017--EXHIBIT`B"--INCOME CERTIFICATION FORMS Page 1
Lighthouse for the Homeless,dba True Worth Place
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 Making Determination: Date:
NOTE: Address, income amounts and sources for ALL household members are required.
ESG PSA CONTRACT 2016-2017--EXHIBIT`B"--INCOME CERTIFICATION FORMS Page 2
Lighthouse for the Homeless, dba True Worth Place
Ciudad de Fort Worth
CERTIFICACION DE DECLARAC16N DE INGRESOS
Nombre del Solicitante:
Direcci6n de Actualidad: Telefono:
Ciudad y C6digo Postal:
Miembros Del Hogar e Ingresos
(Incluyendo el/la Solicitante)
Apellido Nombre Had Ingreso Origen de Ingresos
Mensual
*TOTAL NOMERO DE MIEMBROS DEL HOGAR (Incluyase 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. 6ES LA CABEZA DEL HOGAR MUJER?
❑MSPANO ❑ SI ❑SI
❑NO-MSPANO ❑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.
----------------- ara 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 direccion de la casa y los ingresos (y sus origenes) para todos miembros del bogar son requeridos
ESG PSA CONTRACT 2016-2017--EXHIBIT`B"--INCOME CERTIFICATION FORMS Page 3
Lighthouse for the Homeless, dba True Worth Place
EXHIBIT "F"
STANDARDS OF DOCUMENTATION
ESG PSA CONTRACT 2016-2017--EXHIBIT"F"--STANDARDS OF DOCUMENTATION Page 1
Lighthouse for the Homeless,dba True Worth Place
2016-2017 Documentation Standards for
ESG Public Service Contract Expenses
41
Items ca
Employee Salaries and Benefits City wdl only Xermburse a percentage of any employee s salary and benefits who work directly witf['the ESG funded program Peccentaggs,'
will be cost allocated and determined poor to the executwor!of theESG Contract Agencies requesting the reimbursement of 100°/of anyggency employee writ 7equrre prior'
City approval Agencres must show calculation on how:the ESG portion of employee salaries and benefits were calculatetl consistenfly with the ESG Contract
If an employee works on both a ESG eligible and non-ESG eligible program(s),the City will only reimburse for a reasonable portion of
the employee's salary. Prior to the execution of the ESG Contract,the Agency will priovide the City with a written statement on how
each employee's time will be allocated. If an employee works 100%of their time directly with the ESG-funded Program,then 100%of
the employee's salary may be eligible for reimbursement. Agency must submit a written statement that 100%of the employee's time is
spent working directly with the ESG-funded Program. Statements must be signed by a person authorized to sign on behalf of the
Agency and will be submitted with the October invoice.
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 ESG-funded Program. For employees who are paid with multiple funding sources,timesheets must reflect all funding sources. If
separate timesheets are kept for each funding source,all such timesheets must be submitted to City. Timesheets must be signed by
employee and supervisor. Agency must show a calculation and documentation of how the employee's salary was calculated and
invoiced to City.
'If employees are paid by direct deposit rather than check,then the agency must submit both the direct deposit payment company's
report(such as an ADT report)and a bank statement or check showing payment to the direct deposit company.
FICA/Medicare X X
Life Insurance X X
Health X If the City pays gross salary,this is already included.If the City pays the employer portion,the Agency mustprovide proof that the
Insurance
employee is enrolled in the benefit plan,must show a calculation and documentation of how the invoiced amount was calculated,and
Disability XX 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,Goods and Supplies=Citywiil only reimburse forthe costallocated percent or amount spent to support ofthe ESG funtled Program Agencies."'
k,,, ,...
requesting reimbursement fortfiese'items will require prior city approvaC.:Ageiicies iiiusfshow calculation on how the ESG"portion ofthese expenses were calculated
consistentiy"ivitlrthe ESG'Contract
Office Supplies X X X
Office
Equipment X X X X X
Rental
Postage X X X
Printing X X X
Construction&
Building X X X X This category is only available for the REACH Program.
Materials
Sport and
Recreation X X X
E ui ment
Cleaning X X X
Supplies
Teaching Aids X X X
Craft Supplies X X1 I I X
Food Supplies X X X This category is only available to the Program provided by Meals on Wheels.
Rent, Utilities and Maintenance City will only pay for a portion of these expenses The podion of these expenses wilt be determined by the square footage attnbatable to
the ESG fundec3,Program and shall be cost allocated m,accordance with the amount.of space;used forthe ESG fiinded Program `These expenses may only be m support ofc
the ESG funtled Program The dems listed below require poor Crtj/approval'and the Agency�s required to identify arty funding source�that pays for the portion oft1%e
expenses that is tYot paid with ESG fugds Agencies must show;catculation on how the;ES portion of these expenses were calculated consi`stentiy with the ESG Contract
u,. ,... .,�.... " ..
Telephone X X
Gas X X
Water/Wastew X X
ater
Electric X X
Solid Waste X X
ESG PSA CONTRACT 2016-2017 E#iibH"F'--STANDARDS FOR COMPLETE DOCUMENTATION 1
Facility This item requires approval by the City prior to the execution of the ESG 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 ESG-
funded program.
This item requires prior approval by the City. Prior to the execution of the ESG Contract,the Agency must submit a written statement
that lists the contract labor services to be used during the Contract term. Agency will submit a memo related to the procurement of such
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-required XX
City will only pay for a percentage of the City-required insurance so long as its in proportion to the square footage attributable to the
Insurance ESG-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 household,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
must show calculation on how the ESG portion of the accounting services were calculated. For example,if the ESG grant is 10%of
Audit Services X X X X 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 of 09/16/2016 do
ESG PSA CONTRACT 2016-2017 Exhibtt"F--STANDARDS FOR COMPLETE DOCUMENTATION 1
EXHIBIT "G"
SECTION 3 REPORTING FORMS
NOT APPLICABLE
ESG PSA CONTRACT 2016-2017--EXHIBIT"G"--SECTION 3 REPORTING FORMS Page 1
Lighthouse for the Homeless,dba True Worth Place
EXHIBIT "H"
MATCH REPORT
ESG PSA CONTRACT 2014-2015--EXHIBIT"IT'—MATCH REPORT 1
Lighthouse for the Homeless, dba Tice Worth Place
CITY OF FORT WORTH
NEIGHBORHOOD SEVICES DEPARTMENT
EMERGENCY SOLUTIONS GRANT
This attachment is designed to document proposed sources and to assess compliance with the
required Emergency Shelter Grant(ESG)match portion at 24 CFR 576.51.ESG funds are matched
dollar-for-dollar for each program year allocation.
City of Fort Worth ESG Funds $ Agency ESG Match $
1. SOURCES OF LOCAL MATCH:
Other Federal (including pass-through funds, e.g., City CDBG, County FEMA, etc.)
MATCH SOURCE MATCH AMOUNT
TOTAL MATCH $
2. STATE/LOCAL GOVERNMENT FUNDING: (e.g., State Housing Trust Funds,Local
Assessment, etc.)
MATCH SOURCE MATCH AMOUNT
$
TOTAL MATCH $
3. PRIVATE (including recipient)FUNDING:
MATCH SOURCE MATCH$ AMOUNT
Fund Raising/Cash $
Loans $
Building Value or Lease $
Donated Goods $
ESG PSA CONTRACT 2014-2015--EXHIBIT"H"—MATCH REPORT 2
Lighthouse for the Homeless, dba True Worth Place
Donated Computers $
New Staff Salaries $
Volunteers($5/hr) $
Volunteer Medical/Legal $
TOTAL MATCH $
Comments:
CERTIFICATION: The undersigned, hereby, gives assurance that to the best of my knowledge and belief, the data
included in this report is true and accurate,and if submitted by a non-profit agency,has been approved by the governing
body of the organization prior to submission.The match funds identified in this report are not included as contribution for
any other federally assisted project or program as required by 24 CFR 84.23(a)(2)
Date: Submitted by: Phone Number:
ESG PSA CONTRACT 2014-2015--EXHIBIT"H"—MATCH REPORT 3
Lighthouse for the Homeless,dba True Worth Place
EXHIBIT "I"
ESG STAFF CERTIFICATION FORM
ESG PSA CONTRACT 2016-2017—EXHIBIT"I"—ESG STAFF CERTIFICATION FORM Page 1
Lighthouse for the Homeless,dba True Worth Place
City of Fort Worth
STAFF CERTIFICATION OF ELIGIBILITY FOR ESG FINANCIAL ASSISTANCE
Instructions:In order for City to approve reimbursement for any client,agency must submit: (1)client documentation of income(source documentation or self-
certification);(2)documentation of homelessness;(3)copy of lease;and(4)this completed form.(1)-(4)must be submitted upon initial reimbursement request for
assistance for each client.
HOMELESS PREVENTION ONLY:(1)-(4)upon agency request for reimbursement for the 4`h month of rent for a client(excluding arrears).
1. General Information
Head of Household Name: Age:
Names of Other Household Members: Age:
Age:
Age:
Age:
Age:
Household Income is less than 30%AMI? Yes❑ No❑ NIA(Rapid Rehousing Initial Evaluations Only)❑
Client Lacks Resources/Support Networks? Yes❑ No❑
Type(s)of ESG Financial Assistance: Rent❑ Rent Arrears❑ Utility❑ Deposit(s)❑
Unit Address(must be in City of Fort Worth):
2. Other ESG Requirements
Lease in agency file? Yes❑ No❑
Client receives NO other rental subsidy(ie.Housing Choice Voucher)? Yes❑ No❑
Rental Assistance Agreement between landlord and agency in agency file? Yes❑ No❑
Unit Number of Bedrooms:
Fair Market Rent(FMR)&Rent Reasonableness: Area FMR Limit(as published by HUD):
Unit Rent per lease:
Unit meets Habitability Standards? Yes❑ No❑ Date of Inspection:
3. Lead-Safe Housing:
Applicable when(1)providing ESG rental assistance for more than 3 months excluding arrears,(2)pre-1978 housing unit,AND(3)child under 6 in household.
Not Applicable ❑
Number of Months Rental Assistance Provided(excluding arrears):
Year Housing Unit Built: Visual Inspection Indicates Unit and Property Free of Deteriorated Paint?
Yes❑ No❑
Name of Visual Assessor*:
*For named,agency must have on file a certificate of completion of HUD's Visual Assessment Course(hftp:/hvww.hud gQWoffrces/lead/training/visualassessment/h00100.cfin)
Required certifications:Each person signing below certifies to the following:(1)To the best of my knowledge,the program participant named above meets all requirements
to receive assistance under the Emergency Solutions Grant(ESG). (2)To the best of my knowledge and ability, all of the information used in making this eligibility
determination is true and complete.(3)I am not related to the program participant through family,business or other personal ties.(4)To the best of my knowledge,neither I
nor anyone related to me has received or will receive any financial benefit for this eligibility determination.(5)I understand that fraud is investigated by the Department of
Housing and Urban Development,Office of Inspector General,and may be punished under Federal laws to include,but not limited to,18 U.S.C. 1001 and 18 U.S.C.641(6)
I understand that if any of these certifications is found to be false,I will be subject to criminal,civil and administrative penalties and sanctions.
ESG Staff Signature: Date:
ESG Supervisor Signature: Date:
ESG PSA CONTRACT 2016-2017—EXHIBIT"I"—ESG STAFF CERTIFICATION FORM Page 1
Lighthouse for the Homeless, dba True Worth Place
EXHIBIT "J"
ESG PERFORMANCE STANDARDS
Emer enc Solutions Grant Performance Standards
Street Outreach Number of persons:
- Placed in shelter or safe havens
- With more non-cash benefits at program exit
- Receiving case management
Emergency Shelter Number of persons:
- Exiting to temporary/transitional housing destinations
- Exiting to permanent housing destinations
- Receiving case management
Homelessness Number of persons:
Prevention - Who maintained their permanent housing for 3
months
- Exiting to permanent housing destinations
- With higher income at program exit
- With more non-cash benefits at program exit
- Receiving case management
Rapid Re-Housing Number of persons:
- Who maintained their permanent housing for 3
months
- Exiting to permanent housing destinations
- With higher income at program exit
- With more non-cash benefits at program exit
- Receiving case management
In order to successfully record performance outcomes, the CoC system requires that once
a household is enrolled in an ESG program,non-domestic violence agencies must complete
an initial HUD Intake Assessment within the HMIS system(ETO),the HUD Mid-Program
Assessment, and the HUD Exit Assessment upon program. Performance outcomes will be
reported to the City using the HMIS generated ESG reports.
Domestic Violence Organizations will provide the same data utilizing their similar data
systems.
Reassessments are required for program participants receiving homelessness prevention
assistance and rapid re-housing assistance. Participants receiving homeless prevention
must be reassessed monthly; rapid re-housing participants must be reassessed at least
quarterly. All participants must receive an exit assessment and enter it into HMIS or a
comparable-level database.
ESG PSA CONTRACT 2014-2015--EXMBIT"G"—ESG PERFORMANCE STANDARDS 1
Lighthouse for the Homeless, dba True Worth Place
EXHIBIT 64J-1"
Written Standards for ESG Assistance
Individuals and families eligibility. Households receiving either emergency shelter or rapid re-housing
assistance must meet HUD's revised definition of homelessness. Households receiving homelessness
prevention assistance must meet the definition of"at risk of homelessness",have incomes at or below 30%
AMI, and lack sufficient resources and support networks to retain housing. Eligible ESG-assisted
individuals and households must reside in the City of Fort Worth. Individuals receiving rapid re-housing
assistance must be housed to a unit located in the City of Fort Worth. Agencies will conduct initial
evaluation of clients to determine program eligibility, and kind of assistance needed. Agencies will re-
evaluate quarterly the assistance provided to homelessness prevention recipients, and yearly, to rapid re-
housing clients. Re-evaluation will ascertain that: i) annual incomes do not exceed 30% AMI; ii) clients
lack resources and support networks to retain housing without ESG assistance. Annual incomes are
established per 24 CFR 5.609. All clients must receive an exit assessment that will then be entered into
HMIS or comparable database.
Coordination among emergency shelter,homelessness prevention,rapid re-housing,and other homeless
assistance and housing providers. To receive ESG funds, an agency has to be an active member of the
Continuum of Care (CoC). The CoC leads the coordination among agencies to assist the homeless and
prevent homelessness. It also engages and coordinates resources to improve current programs and funding
strategies.
Determining andprioritizing homelessnessprevention and rapid re-housing assistance. Rapid re-housing
and homelessness prevention providers will determine prioritization among eligible clients. This should be
based on a risk assessment. Prioritization should take into account: 1) families with children, and elderly
and disabled persons who do not require permanent supportive housing;and 2)the share of rent and utilities
costs that each client must pay, if any, while receiving homelessness prevention or rapid re-housing
assistance. The City recommends that clients share in rent and utility costs, unless there are reasons for
receiving 100%ESG-assistance.
Duration of rental assistance. Per§576.103 and§576.104,agencies shall provide clients for no more than
24 months, during any 3-year period with short-term rental assistance, medium-term rental assistance,
payment of rental arrears, or any combination thereof. Short-term rental assistance is limited to 3 months.
Medium-term rental assistance extends over 3 months but not more than 24 months. Payment of rental
arrears consists of a one-time payment for up to 6 months of rent in arrears,including any late fees on those
arrears.
Type,amount,and duration ofhousing stabilization and/or relocation assistance. Agencies will establish
standards for the type, amount, and duration of housing stabilization and/or relocation services provided,
acknowledging that services may not extend for more than 24 months within a 3-year period. Housing
relocation and stabilization services include financial assistance (moving costs, rental application fees,
security deposits,last month's rent,utility deposits and utility payments),and services(housing search and
placement, housing stability and case management, mediation, legal services, and credit repair.) The
amount and type of assistance provided shall aim at clients becoming self-sufficient. The City shall have
access to documentation that supports the amount and type of assistance provided
ESG PSA CONTRACT 2016-2017—EXHIBIT"J-1"—Written Standards for ESG Assistance 1
Lighthouse for the Homeless,dba True Worth Place
EXHIBIT "K"
ESG QUARTERLY HMIS REPORT
ESG PSA CONTRACT 2016-2017--EXHIBIT"K"—ESG QUARTERLY HNIIS REPORT Page 1
Lighthouse for the Homeless,dba True Worth Place
City of Fort Worth
Emergency Solutions Grant(ESG)
Quarterly HMIS Report
Agency Name: Reporting Period: From
Contact Person: To
This report is meant to collect data that is required for the HUD Consolidated Annual Performance and Evaluation Report
(CAPER). This report is due each quarter, on January 15,April 15, July 15 and September 30 of each Contract year. Please
fill out the report according to your Agency's accomplishments. If a particular activity does not apply to your Agency (for
example, a shelter does not perform homeless prevention) please fill in all zeros for that particular column. This information
should be collected from HMIS and the total number of persons should match comparable figures on the City's Attachment III
Report. If this report does not match the City's Attachment III Report, the Agency may be required to resubmit the report and
provide an explanation for the discrepancy.
Total Persons Served Total Persons Total Persons'
Homelessness Rapid Re-([ Emergency Served This Served
Prevention Housing Shelters Quarter (Cumulative)
Special Populations Served-All Activities
Veterans
Victims of Domestic Violence
Elder)
HIV/AIDS
Chronically Homeless
Persons with Disabilities
Severely Mentally III
Chronic Substance Abuse(Drug,
Alcohol
Other Disabilities (Physical,
Developmental)
Tota I
Number of Persons in Household
Adults
Children
Don't Know/Refused/Other
Missing Information
Total
Gender-All Activities
Male
Female
Trans ender
Don't Know/Refused/Other
Missing Information
Prepared by: D.C.and C.A.
Updated:2/11/2015 Page 1 of 2
Total Persons Served Total Persons Total Persons
Homelessness Rapid Re- Emergency Served This Served
Prevention Housing Shelters Quarter (Cumulative)
Total
Age-All Activities
Under 18
18-24
25 and over
Don't Know/Refused/Other
Missing Information
Total
Shelter Utilization
Number of New Units-
Rehabilitation
Number of New Units-Conversion
Total Number of Bed-Nights
Available*
Total Number of Bed-Nights
Provided**
Performance Standards
Received Case Management
Exited to transitional or permanent
housing
With higher cash income at exit
With non-cash benefits at exit
Exited to or maintained permanent
housing at exit
Did not enter CoC Shelter or
Transitional Housing during
remainder of ESG year
*The total number of beds that are available in a year. For example, if they are all year-round beds, it would be 365 multiplied by the
number of emergency shelter beds; if some are seasonal as well(e.g.,only winter)then add in the number of nights each bed is available.
Count all emergency shelter beds,whether or not they are ESG-funded.
**The number of beds that were filled each night. Count all emergency shelter beds,whether or not they are ESG-funded.
Prepared by: D.C. and C.A.
Updated: 8/31/2015 Page 2 of 2
EXHIBIT "L"
MBE REPORTING FORM
ESG PSA CONTRACT 2016-2017--EXHIBIT"L"--MBE REPORTING FORM Page 1
Lighthouse for the Homeless, dba True Worth Place
i2 3 . El'n E E E j� �. n
)
§
\\ ci
` _ #
Ei
\
4)| --
} }f }k
V5 Q
ni
( ! ){ )
>\ \
-
§
/ ( \{$
J \}: .
) - -
}
'a T
v 015 th
tb
c o o q U
.. E t o �•� o o q a` O U
N v ? d C o0 A p, `•
iz
m E
wEp
N y
u
'' E:e o 'c e a z z
�� o v � uo a. s °• � = o c � L �• � h Ga o a
o
o'S O a °�'x m q y .T, � c s •.. o `�' W a � U c .. a c
R
o v. .. G N G o � `O o � •~ � «`°.V F V `m ` c r '� � `o •p y t
o °
m
O R
«
a
�• � ora � � � �o
@"s 9a
w .o•'_ a �8 C0 c7
�H � a tivv r o
E -
o
m
°Ov. ❑4a " �. '� r�- ,oj � ara `. � c O q q � c
C M G .- •O O N �+ O d � r
s_ w =y S o `
ON d
G
of o 0 0 o o 3 v
o z z e
g x mo o c A 's"
=b� N -o F
' ti i [d =
`o � Q o u e .. � is ❑ � w rw
U o so u.c c o G`f gti
tjm e y a U vv c t4 O U L U N
00Qa u E v a w R e H m 3 v c
C
y r E Q'y ti v o N C y yG Yom` d Y h 72
v� M
q]5 O ca
v rte`—,�w
.. y2 oa Z a
_. $ o $ •' 'a_ a E o m <° o sa` o.E ° �, a o h o el ,e
l _'fl, IS o,
o ti
o si
V v c o
m `
om u Co o.n u T D Ea W r
v Oo
15 7 £ w oo
c o
q s o '� ` w a _
u Uq.o n v E o.>
O o o W n o a o ° �_ p O a cd p,s o z
•�- W "E 'mow' 2" zw
A55 ° U i o a o O m o c E u o K .o
o o f c Ga`•c`oY e L b ', E >
� � �O � � y o �?._w q P, ° � v = s �• � v� C7 .. � E u y c � c a;a o. c o 4
c ��� °
o v.U Q y '� .� >, b o a aci o c c a �o H w.n u W ,o c n
�d ❑ �o E E.a w _ � W�
�C a o
_ O'Q .� O W W a V O O O L `\ C m u
0 4 '� 6 N _ •�+' d V z .: C ti O 0 y C a u a G p 0 4 C
K A 7 co 'a % r a a '^ ° E o
o E a UEc arc Fu o2 ro'a y 3 U' o m nuao i` Uv
n ° u °' U ., Hi u r z U y �d n u .� F u n E m u I U I
EXHIBIT "M"
NOTICE OF BENEFICIARY RIGHTS
ESG PSA CONTRACT 2016-2017--EXHIBIT"M"—NOTICE OF BENEFICIARY RIGHTS Page 1
Lighthouse for the Homeless,dba True Worth Place
Notice of Beneficiary Rights
Name of Agency: Lighthouse for the Homeless, dba True Worth Place
Name of Program: True Worth Place
Contact information for Program Staff(name,phone number, and e-mail address, if appropriate):
Because this program is supported in whole or in part by direct Federal financial assistance from
the Federal Government, we are required to let you know that:
• We may not discriminate against you on the basis of religion, religious belief, a refusal
to hold a religious belief, or a refusal to attend or participate in a religious practice;
• We may not require you to attend or participate in any explicitly religious activities that
are offered by us and any participation by you in these activities must be purely
voluntary;
• We must separate, in time or location, any privately funded explicitly religious activities
from activities supported by direct Federal financial assistance;
• If you object to the religious character of our organization, we must make reasonable
efforts to identify and refer you to an alternative provider to which you have no such
objection; and
• You may report an organization's violations of these protections, including any denial of
services or benefits, by contacting or filing a written complaint to HUD [or the
intermediary, if applicable].
We must give you this written notice before you enroll in our program or activity, as required by
24 CFR 5.109.
ESG PSA CONTRACT 2016-2017--EXHIBIT"M"—NOTICE OF BENEFICIARY RIGHTS Page 2
Lighthouse for the Homeless, dba True Worth Place
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
1 of 1
Complete Nos.1-4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos.1,2,3,5,and 6 if there are no interested parties. CERTIFICATION OF FILING
1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business. 2016-149445
Lighthouse for the Homeless
Fort Worth,TX United States Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 12/30/2016
being filed.
True Worth Place Date Acknowledged:
3 Provide the identification number used by the governmental entity or state agency to track or identify the contract,and provide a
description of the services,goods,or other property to be provided under the contract.
TWPESG2016
day shelter services
Nature of interest
4
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling I Intermediary
5 Check only if there is NO Interested Party.
X
6 AFFIDAVIT I swear,or affirm,under penalty of perjury,that the above disclosure is true and correct.
0Z0Z'9JegtuanoNsaJldx3
�(re o b
8t'9E60E#al i N W -• . -
a3A0710 lanr •=k :Asp ''
Signature of authon d econtracting business entity
AFFIX NOTARY STAMP/SEAL ABOVE 0-op
��,, /r
Sworn to and subscribed before me,by the said l..o p to, c r3>^�� !�Qar�'' this the _day -
20to certify which,witness my hand and seal of office.
3, � ) `� Q r m
Signature of officer administering oath Printed name of officer administering oath Title of o cer administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.277
M&C Review Page 1 of 2
Official site of the City of Fort Worth,Texas
ITY COUNCILAGENDA
ORTIVOR
TH
COUNCIL ACTION: Approved on 1/24/2017
REFERENCE * LOG 19NS 2016-
DATE: 1/24/2017 NO.: C-28066 NAME: 17TRUEWORTHPLACEESGCONTRACT
CODE: C TYPE: CONSENT PUBLIC NO
HEARING:
SUBJECT: Authorize a Change in Use and Expenditure of Emergency Solutions Grant Funds from the
U.S. Department of Housing and Urban Development in the Amount of$115,000.00 to
Lighthouse for the Homeless d/b/a True Worth Place, Authorize Execution of a Contract
and a Substantial Amendment to the City's 2016- 2017 Action Plan (ALL COUNCIL
DISTRICTS)
RECOMMENDATION:
It is recommended that the City Council:
1. Authorize a Substantial Amendment to the City's 2016 - 2017 Action Plan;
2. Authorize a change in use and expenditure in the amount of$115,000.00 in Emergency Solutions
Grant funds to Lighthouse for the Homeless d/b/a True Worth Place for day shelter services for the
homeless.
3. Authorize the City Manager or his designee to execute a contract and any related documents with
Lighthouse for the Homeless d/b/a True Worth Place for a one-year term beginning on the date of
contract execution;
4. Authorize the City Manager or his designee to extend the contract term for an additional one-year
term if Lighthouse for the Homeless d/b/a True Worth Place requests an extension and such
extension is necessary for completion of the project; and
5. Authorize the City Manager or his designee to amend the contract, if necessary, to achieve project
goals provided that the amendment is within the scope of the project and in compliance with City
policies and applicable laws and regulations governing the use of federal grant funds.
DISCUSSION:
On August 9, 2016, the City Council approved the City's 2016 - 2017 Annual Action Plan, including
the execution of a contract with Day Resource Center for the Homeless (DRC) for Emergency
Solutions Grant (ESG) funds from the U.S. Department of Housing and Urban Development (HUD) in
the amount of$141,092.00 (M&C G-18793, City Secretary Contract (CSC) No. 48417). DRC had
operated a day shelter for the homeless since 1999 but closed in December 2016. As a result of the
closure, CSC No. 48417 with DRC has been terminated.
True Worth Place opened on December 15, 2016 and has replaced DRC as the area's primary
provider of day shelter services to the homeless and has requested funds for essential staff who will
be operating the facility. In order to ensure continuity of homeless services and the timely
expenditure of ESG funds, Staff recommends awarding the remaining ESG funds from the DRC
contract to True Worth Place.
A Public Notice for this change in use of funds was published on December 14, 2016 in the Fort
Worth Star-Telegram. The 30-day public comment period took place between December 15, 2016
http://apps.cfWnet.org/council_packet/mc_review.asp?ID=24257&councildate=1/24/2017 3/20/2017
M&C Review Page 2 of 2
and January 13, 2017. Any comments are maintained by the Neighborhood Services Department in
accordance with federal regulations. This change in use of funds was communicated to the
Community Development Council during its meeting on January 11, 2017.
True Worth Place is located at 1513 East Presidio St, Fort Worth, Texas 76102 in Council District 8
and the services provided by them are available to Fort Worth residents of ALL COUNCIL
DISTRICTS.
FISCAL INFORMATION/CERTIFICATION:
The Director of Finance certifies that funds are available in the current budget, as appropriated, of the
Federal Grants Capital Fund. This is a reimbursement grant.
TO
Fund Department Account Project Program Activity Budget Reference# Amount
ID ID Year (Chartfield 2)
FROM
Fund Department Account Project Program Activity Budget Reference# Amount
ID I I ID I Year (Chartfield 2)
Submitted for City Manager's Office by: Fernando Costa (6122)
Originating Department Head: Aubrey Thagard (8187)
Additional Information Contact: Sonia Singleton (5774)
Diana Carranza (7369)
ATTACHMENTS
True Worth Place Form 1295.pdf
True Worth Place Public Notice.pdf
http://apps.cfwnet.org/council_packet/mc_review.asp?ID=24257&councildate=1/24/2017 3/20/2017