HomeMy WebLinkAboutContract 49981 34 56,
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A N F TEXAS § CITY SECTTARY
§ CONTRACT NO,
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9.9 TY OF TARRANT §
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This contract("Contract") is made and entered into by and between the City of Fort Worth
(hereafter"City") and Sixty and Better, Inc. dba Senior Citizen Services (hereafter "Agency"), a
Texas non-profit corporation. City and Agency may be referred to individually as a "Party" and
jointly as "the Parties".
The Parties state as follows:
WHEREAS, City receives grant monies from the United States Department of Housing
and Urban Development through the Community Development Block Grant("CDBG")Program,
Program No. B-I 7-MC-48-00 10, Catalog of Federal Domestic Assistance No. 14.218;
WHEREAS, a national objective of the CDBG program is to benefit low and moderate
income citizens in accordance with 24 CFR Part 570,as amended from time to time;
WHEREAS, Agency submitted a proposal to use CDBG funds for a program to serve
individuals and families, of whom 100% must meet the HUD definition of a presumed benefit
population;
WHEREAS, City citizens, the Community Development Council, and the City Council
have determined that CDBG programs are needed by the City's citizens.
NOW, THEREFORE,the Parties understand and agree as follows:
1. INCORPORATION OF RECITALS.
City and Agency hereby agree that the recitals set forth above are true and correct and form
the basis upon which the Parties have entered into this Contract.
2. DEFINITIONS.
In addition to terms defined in the body of this Contract, the terms set forth below shall
have the definitions ascribed to them as follows:
Area Median Income or AMI means the median family income for the Fort Worth-Arlington
metropolitan statistical area as established annually by HUD. The 2017 income limits are
attached hereto as EXHIBIT "A-1"—2017 HUD Income Limits.
Business Diversity Enterprise Ordinance or BDE means the City's Business Diversity
Ordinance, Ordinance No. 20020-12-2011.
CDBG means Community Development Block Grant. '° "
"Y . `_ Y
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Complete Documentation means the following documentation as applicable:
• Attachments I,II,and III,with supporting documentation including:
o Proof of expense:copies of timesheets,invoices,leases,service contracts or
other documentation showing that payment is due by Agency.
c 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: Client eligibility for all clients as outlined 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.
CDBG Funds means the CDBG grant funds supplied by City to Agency under the terms of this
Contract.
CDBG Regulations means regulations found at 24 CFR Part 570 et seq.
DBE means disadvantaged business enterprise in accordance with 49 CFR Part 26.
Director means the Director of the Neighborhood Services Department.
Effective Date means October 1, 2017.
HUD means the United States Department of Housing and Urban Development.
IDIS means Integrated Disbursement Information System,HUD's project tracking system.
Income Eligible Client means a client whose annual income adjusted for family size does not
exceed 80% of AMI using the most current HUD Income Guidelines and Technical Guidance for
Determining Income and Allowances. The definition of annual income to determine client income
eligibility shall be the definition contained in 24 CFR Part 5.609, as amended from time to time.
National Objective means an activity that benefits low and moderate income persons. For the
purposes of this Contract,at least 100%of the clients served by the Program fall into a"presumed
benefit"category as defined in 24 CFR Part 570,and therefore are presumed to be Income Eligible
Clients.
Neighborhood Services Department means the City's Neighborhood Services Department.
OMB means the Office of Management and Budget.
Program means the services described in EXHIBIT "A"—Program Summary.
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Reimbursement Request means all reports and other documentation described in Section 9.
Source Documentation means documentation of full household income of any type described
under the definition of annual income in 24 CFR Part 5.609, including but not limited to copies of
paychecks, Social Security and disability verification letters, interest or rental income statements,
retirement income statements, child support and alimony verification, unemployment benefit
letters, and the like.
Unduplicated Clients means a count of all clients served by the Program at least once in the
Contract Term. Clients served by the Program more than once in the Contract Term will only be
counted the first time they are served when determining the total count of Unduplicated Clients.
3. TERM.
The term of this Contract begins on the Effective Date and terminates on September 30,
2018 unless earlier terminated as provided in this Contract.
4. DUTIES AND RESPONSIBILITIES OF CITY.
4.1 Provide CDBG Funds.
City shall provide up to $101,800 of CDBG Funds under the terms and conditions of this
Contract.
4.2 Monitor.
City will monitor the activities and performance of Agency and any of its contractors,
subcontractors or vendors as necessary,but no less than annually. Monitoring by City will include
determining whether Agency is meeting the National Objective during the term of this Contract.
5. DUTIES AND RESPONSIBILITIES OF AGENCY.
5.1 Required Services.
Agency shall perform the services described in EXHIBIT "A"—Program Summary in
accordance with the terms and conditions of this Contract.
5.2 Use of CDBG Funds.
5.2.1. Compliance with CDBG Regulations and Contract.
Agency shall be reimbursed for eligible Program costs with CDBG Funds only if City
determines in its sole discretion that:
5.2.1.1 Costs are eligible expenditures in accordance with CDBG Regulations.
5.2.1.2 Costs are in compliance with this Contract and are reasonable and
consistent with industry norms.
5.2.1.3 Complete Documentation, as applicable, is submitted to City by
Agency.
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5.2.2 Budget.
5.2.2.1 The CDBG 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 1,2018.
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 CDBG Funds to supplement rather than
supplant funds otherwise available for the Program.
5.2.4 Payment of CDBG Funds to Agency.
CDBG Funds will be disbursed to Agency upon City's approval of Reimbursement
Requests including submission of Complete Documentation to City in compliance with Section 9.
If Agency expends all funds budgeted for the Program prior to September 30, 2018, City may
hold back a small amount of the CDBG Funds until the end of the term. During this interim period,
Agency must continue to submit Attachment III — Client Data Report in Exhibit "D" —
Reimbursement Forms monthly. It is expressly agreed by the Parties that any CDBG Funds not
spent or approved for reimbursement to Agency shall remain with City.
5.3 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:
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Unduplicated Clients as
specified in EXHIBIT
"X'—Program
Month Expenditures Summar
3 25% 25%
6 50% 50%
9 75% 75%
12 100% 100%
5.3.2 Failure of Agency to meet these milestones or a material deviation from them as
outlined in this Section 5.3 is a breach of this Contract. For the purpose of this Section,"material
deviation" shall mean more than 10% lower than the specified goal. In the event of such breach,
City reserves the right in its sole option to (i) delay or withhold payment of Reimbursement
Requests, (ii) lower Agency's allocation of CDBG Funds, or(iii)terminate this Contract.
5.3.3 Failure to meet at least 80% of its performance milestones or serve 240
Unduplicated Clients under this Contract may, in City's sole discretion disqualify Agency for
consideration under the City's Request for Proposals for the 2018-2019 Program Year for federal
grant funds.
5.3.4 Amendments to performance milestones regarding CDBG Funds must be approved
by the Director in writing, with such approval being in the Director's sole discretion. If Director
approves the Agency's proposed amended performance milestones (as approved, the "Amended
Performance Milestones"), then the Amended Performance Milestones will take effect on the
first day of the month following the month in which it was approved by Director,unless otherwise
specified in the amendment. All requests for amendments to performance milestones must be
submitted by June 1, 2018. Notwithstanding the above, any amendments to this Contract shall
not reduce the number of Unduplicated Clients stated in Section 5.3.3 and in EXHIBIT "A" -
Program Summary.
5.4 Identify Program Expenses Paid with CDBG Funds.
Agency will keep accounts and records in such a manner that City may readily identify and
account for Program expenses reimbursed with CDBG Funds. These records shall be made
available to City for audit purposes and shall be retained as required hereunder.
5.5 Meet National Objective.
Agency shall ensure that the activities carried out in the Program will meet the National
Objective.
5.6 Program Subcontracts.
Agency shall not enter into a subcontract with another agency, contractor, or vendor to
provide a service to clients for any part of the Program that will be paid with CDBG Funds without
City's written consent.
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6. CLIENT ELIGIBILITY VERIFICATION.
6.1 Client Eligibility.
Agency will document client eligibility as follows:
6.3.1 Agency Clients.
Agency must document that all clients served by the Program fall under a "presumed
benefit"category as defined in 24 CFR Part 570. For purposes of this Contract,the categories of
presumed benefit are: severely disabled adults, homeless persons, abused or neglected children
and youth, or elderly persons. Eligible forms of documentation for each category include:
6.3.1.1 Severely Disabled Adults. Written, signed and dated diagnosis from a
licensed medical professional. As an acceptable alternative, Agency
may use the form attached hereto as Exhibit"H"—Severely Disabled
Certification Form.
6.3.1.2 Homeless Persons. Written, signed and dated certification from an
outreach worker.
6.3.1.3 Abused or Neglected Children and Youth. Written,signed and dated
certification from an outreach worker.
6.3.1.4 Elderly Persons. An elderly person is an individual at least 62 years of
age. Copy of a birth certificate, driver's license,passport, immigration
card, military identification, or any other state, local, national or
international documentation, must be provided showing current
information about the age or birth date of the client. The form in
Exhibit "E" — Form of Income Self Certification, or a similar
document,will also be required in order to collect demographic data.
6.4 Submission of Complete Documentation.
Agency must submit copies of documentation of client eligibility described in Section 6.1
with Attachment III with each month's Reimbursement Request for all Unduplicated Clients.
6.3 Maintain Documentation.
Agency must maintain copies of all documentation required by this Section for 5 years
following the expiration of the Contract term. This Section shall survive the earlier termination
or expiration of this Contract.
7. ADDITIONAL CDBG REQUIREMENTS.
Agency agrees to comply with all requirements of the CDBG Program as stated in the
CDBG Regulations, including but not limited to the following:
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7.1 Environmental Review.
CDBG Funds will not be paid, and costs cannot be incurred until City has conducted an
environmental review and completed an Environmental Review Record as required by 24 CFR
Part 58. The environmental review may result in a decision to proceed with,modify,or cancel the
funding for the Program. Further, Agency will not undertake or commit any funds to physical or
choice limiting actions as described in any applicable federal regulations. Any violation of this
provision will (i) cause this Contract to terminate immediately, and (ii) require Agency to repay
City the CDBG Funds it has already received and forfeit any future payments of CDBG Funds.
7.2 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 2017-2018 Action Plan,and(iii)receipt by City of a grant agreement from HUD.
7.3 Monitoring.
7.3.1 Agency understands and agrees that it will be subject to monitoring by City for
compliance with terms and provisions of this Contract and the CDBG Regulations for the term of
this Contract. Agency is subject to such monitoring during the term of this Contract and for 5
years after the Contract term ends. Agency will provide reports and access to Program files as
requested by City during this 5 year period. For purposes of this Contract, this 5 year period for
monitoring is deemed to begin on October 1,2018 and end on September 30,2023 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 CDBG Funds, and to Agency's
officers, directors, agents, employees, contractors, subcontractors and vendors for the purpose of
such monitoring.
7.3.3 In addition to other provisions of this Contract regarding frequency of monitoring,
City reserves the right to perform desk reviews or on-site monitoring of Agency's compliance with
the terms and conditions of this Contract. City shall provide Agency with a written report of the
monitor's findings after each monitoring visit. If the monitoring report notes deficiencies in
Agency's performance, the report shall include requirements for the timely correction of said
deficiencies by Agency. Failure by Agency to take the action specified in the monitoring report
may be cause for suspension or termination of this Contract as provided herein.
7.3.4 Subsections 7.3.1 through 7.3.3 shall be applicable for the Contract term and for 5
years thereafter and shall survive the earlier termination or expiration of this Contract.
7.3.5 Agency shall provide City annually the results of any state or federal monitoring.
Such results shall be submitted within 60 days of receipt of such state or federal monitoring report,
or with the January Reimbursement Request,whichever is earlier.
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7.4 ARency Procurement Standards.
Agency shall comply with all applicable federal, state and local laws, regulations, and
ordinances for making procurements under this Contract. In addition to the conflict of interest
provisions in Section 14.13.3, Agency shall establish written procurement procedures to ensure
that materials and services are obtained in a cost effective manner and that provides for full and
open competition. When procuring materials and services for this Contract,Agency shall comply
at a minimum with the procurement standards in 2 CFR Part 200.317 through Part 200.326.
7.4.1 Contracts in excess of $10,000.00 made by Agency using CDBG Funds must
address termination for cause and convenience including the manner by which such termination
shall be effected and the basis for settlement of the terminated contract, if any, as required by
Appendix II(B), 2 CFR Part 200.
7.4.2 Agency shall not make any contract with parties listed on the government wide
System for Award Management, www.sam.gov ("SAM"). Agency must confirm by search of
SAM that all contractors paid with CDBG Funds are not listed by SAM as being debarred, both
prior to hiring and prior to submitting a Reimbursement Request which includes invoices from any
such contractor. Failure to submit such proofs of search shall be an event of default.
7.5 Cost Principles/Cost Reasonableness.
Agency shall administer its use of CDBG Funds in compliance with 2 CFR Part 200, as
applicable. The eligibility of costs incurred for performance rendered shall be determined in
accordance with 2 CFR Part 200.400 through 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 CDBG Funds or who perform any work in connection with the Program.
Agency shall cause all applicable provisions of this Contract to be included in and made a part of
any contract or subcontract executed in the performance of its obligations hereunder including its
obligations regarding the CDBG Regulations. Agency shall monitor the services and work
performed by its contractors, subcontractors and vendors on a regular basis for compliance with
the CDBG Regulations and Contract provisions. Agency must cure all violations of the CDBG
Regulations committed by its contractors, subcontractors or vendors. City maintains the right to
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insist on Agency's full compliance with the terms of this Contract and the CDBG Regulations and
Agency is responsible for such compliance regardless of whether actions taken to fulfill the
requirements of this Contract are taken by Agency or by Agency's contractors, subcontractors or
vendors. Agency acknowledges that the provisions of this Section shall survive the earlier
termination or expiration of this Contract and shall be applicable for 5 years after the Contract term
ends.
7.9 Copyright and Patent Rights.
No reports,maps,or other documents produced in whole or in part under this Contract shall
be the subject of an application for copyright by or on behalf of Agency. HUD and City shall
possess all rights to invention or discovery,as well as rights in data,which may arise as a result of
Agency's performance under this Contract.
7.10 Conflict of Interest Disclosure.
In accordance with the requirements of Section 14.13.2.1 and 14.13.4, Agency shall
establish conflict of interest policies for federal awards. Agency shall disclose to City in writing
any potential conflict of interest.
7.11 Compliance with FFATA and Whistleblower Protections.
Agency shall comply with the requirements of 2 CFR 300(b), including provisions of the
Federal Funding Accountability and Transparency Act ("FFATA") governing requirements on
executive compensation and provisions governing whistleblower protections contained in 10
U.S.C. 2409,41 U.S.C. 4712, 10 U.S.C. 2324, 41 U.S.C. 4304 and 41 U.S.C. 4310.
7.11.1 Agency shall provide City with its DUNS number.
7.12 Internal Controls.
In compliance with the requirements of 2 CFR Part 200.303,Agency shall:
7.12.1 Establish and maintain effective internal control over the CDBG Funds that
provides reasonable assurance that Agency is managing the CDBG Funds in compliance with
federal statutes,regulations,and the terms and conditions of this Contract. These internal controls
shall be in compliance with guidance in "Standards for Internal Control in the Federal
Government" issued by the Comptroller General of the United States or the "Internal Control
Integrated Framework" issued by the Committee of Sponsoring Organizations of the Treadway
Commission("COSO");
7.12.2 Comply with federal statutes, regulations, and the terms and conditions of this
Contract;
7.12.3 Evaluate and monitor Agency's compliance with statutes,regulations and the terms
and conditions of this Contract;
7.12.4 Take prompt action when instances of noncompliance are identified including
noncompliance identified in audit findings; and
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7.12.5 Take reasonable measures to safeguard protected personally identifiable
information and other information that HUD or City designates as sensitive or Agency considers
sensitive consistent with applicable federal, state, local and tribal laws regarding privacy and
obligations of confidentiality.
8. RECORD KEEPING; REPORTING AND DOCUMENTATION
REOUIREMENTS; AUDIT.
8.1 Record Keeping.
Agency shall maintain a record-keeping system as part of its performance of this Contract
and shall promptly provide City with copies of any document City deems necessary for the
effective fulfillment of City's monitoring and evaluation responsibilities. Specifically, Agency
will keep or cause to be kept an accurate record of all actions taken and all funds spent, with
supporting and back-up documentation. Agency will maintain all records and documentation
related to this Contract for 5 years after the Contract term ends. If any claim, litigation,or audit is
initiated before the expiration of the 5 year period, the relevant records and documentation must
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, 2018 and end
on September 30,2023 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 1,2018 and end on September 30,2023 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.
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8.5 Audit.
8.5.1 Entities that Expend $750,000 or more in Federal Funds Per Year.
All non-federal entities that expend $750,000 or more in federal funds within 1 year,
regardless of the source of the federal award, must submit to City an annual audit prepared in
accordance with specific reference to 2 CFR Part 200.501 through Part 200.521. The audit shall
cover the Agency's fiscal years during which this Contract is in force. The audit must be prepared
by an independent certified public accountant,be completed within 6 months following the end of
the period being audited and be submitted to City within 30 days of its completion. Agency's audit
certification is attached hereto as EXHIBIT "C" — "Audit Certification Form" and "Audit
Requirements". The Audit Certification Form must be submitted to City prior to or with the
first Reimbursement Request. Entities that expend less than $750,000 a year in federal funds are
exempt from federal audit requirements for that year, but records must be available for review or
audit by appropriate officials of the federal agency, City, and General Accounting Office.
8.5.2 City Reserves the Right to Audit.
City reserves the right to perform an audit of Agency's Program operations and finances at
any time during the term of this Contract and for 5 years after the Contract term ends if City
determines that such audit is necessary for City's compliance with the CDBG Regulations or other
City policies. Agency agrees to allow access to all pertinent materials as described herein for such
audit. For purposes of this Contract, this 5 year period for City audit is deemed to begin on
October 1, 2018 and end on September 30, 2023 regardless of whether or not this Contract is
earlier terminated. If such audit reveals a questioned practice or expenditure, such questions must
be resolved within 15 business days after notice to Agency of such questioned practice or
expenditure. If questions are not resolved within this period, City reserves the right to withhold
further funding under this Contract and/or any other contracts with Agency. IF AS A RESULT
OF ANY AUDIT IT IS DETERMINED THAT AGENCY HAS FALSIFIED ANY
DOCUMENTATION OR MISUSED, MISAPPLIED OR MISAPPROPRIATED CDBG
FUNDS OR SPENT CDBG FUNDS ON ANY INELIGIBLE ACTIVITIES, AGENCY
AGREES TO REIMBURSE CITY THE AMOUNT OF SUCH MONIES PLUS THE
AMOUNT OF ANY SANCTIONS,PENALTY OR OTHER CHARGE LEVIED AGAINST
CITY BY HUD BECAUSE OF SUCH ACTIONS.
9. REIMBURSEMENT REQUIREMENTS.
9.1 Deadline for Submitting Reimbursement Requests.
9.1.1 Reimbursement Requests shall be submitted monthly to the City and must be
received by the City on or before the 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 REIMBUSEMENT REQUEST FOR
EXPENSES INCURRED FOR SEPTEMBER 2018 MUST BE RECEIVED BY OCTOBER
1, 2018. COMPLETE DOCUMENTATION FOR ALL SEPTEMBER 2018 EXPENSES
MUST BE SUBMITTED BY OCTOBER 15, 2018. FAILURE TO SUBMIT A FINAL
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REIMBURSEMENT REQUEST WITH COMPLETE DOCUMENTATION BY
OCTOBER 15, 2018 WILL RESULT IN 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 2018-2019 Program Year for any notifications received under this Section. If Agency fails
to submit all the required information or missing documentation within 30 calendar days from the
first e-mail,Agency shall forfeit any payments otherwise due that month and failure to submit any
requested information will be considered an event of default as outlined in Section 10.1.2.
9.2 Submission of Reimbursement Requests.
Agency shall provide City with Complete Documentation and the following reports as
shown in EXHIBIT "D"—Reimbursement Forms with each Reimbursement Request:
9.2.1 Attachment I—Invoice.
This report shall contain the amount requested for reimbursement each month,the
cumulative reimbursement requested to date (inclusive of that month's request).
9.2.2 Attachment II—Expenditure Worksheet.
This report shall itemize each expense requested for reimbursement by Agency and shall
include the Account corresponding the expense to a Budget line item. In order for this report to
be complete the following must be submitted:
9.2.2.1 For payroll expenses,timesheets signed by employees and approved by
supervisor for all payroll expenses listed. Timesheets must distinguish
between CDBG-funded time and non-CDBG funded time and reflect
actual time spent on CDBG-funded activities. Agency may not submit
payroll expenses dated 60 calendar days prior to the date of the
Reimbursement Request.
9.2.2.2 For non-payroll expenses, invoices for each expense listed with an
explanation as to how the invoiced expense pertains to the Program.
Agency may not submit invoices dated 60 calendar days prior to the date
of the Reimbursement Request.
9.2.2.3 Proof that each expense was paid by Agency, which proof can be
satisfied by cancelled checks,wire transfer documentation,paid receipts
or other appropriate banking documentation.
9.2.3 Attachment III—Client Data Report.
This report shall list each Unduplicated Client served during the month along with his or
her demographic information. The Client Data Report must maintain a list of all clients served
during the Contract term. In order for this report to be complete,the following must be submitted:
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9.2.3.1 Documentation of"presumed benefit"eligibility for each Unduplicated
Client the first time the client is served by the Program, as defined in
Section 6.
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.
9.3 Withholding Payment.
CITY SHALL HAVE NO OBLIGATION TO PAY 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.
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 15, 2018, OR IF THE SUBMITTED REIMBURSEMENT REQUEST FOR
OCTOBER 15,2018 IS LATE,INCOMPLETE OR OTHERWISE NOT IN COMPLIANCE
WITH THIS CONTRACT OR THE CDBG REGULATIONS AS DETERMINED BY CITY
IN ITS SOLE DISCRETION, THERE WILL BE NO CURE PERIOD AND ANY
REIMBURSEMENT WILL BE FORFEITED.
10.1.4 In the event of(i)an uncured default under Section 10.1.1 or an event of default
under 10.1.2 or(ii) more than 2 instances of default, cured or uncured,under these Sections, City
reserves the right at its sole option to terminate this Contract effective immediately upon written
notice of such intent with no penalty or liability to City.
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10.1.5 Notwithstanding anything to the contrary herein, City will not be required to
pay any CDBG Funds to Agency during the period that any Reimbursement Request, report or
documentation is past due or is not in compliance with this Contract or the CDBG Regulations,or
during any period during which Agency is in default of this Contract.
10.1.6 In the event of termination under this Section 10.1, all CDBG Funds awarded
but unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency shall
have no further right to such funds.
10.2 Failure to Maintain Records or Submit Reports and Documentation.
If Agency fails to maintain all records and documentation as required in Section 8,or if the
maintained or submitted report or documentation is not in compliance with this Contract or the
CDBG Regulations as determined by City in its sole discretion,City will notify Agency in writing
and Agency will have 30 calendar days from the date of the written request to obtain or recreate
the missing records and documentation or submit or resubmit any such report or documentation to
City. If Agency fails to maintain the required reports or documentation, or fails to submit or
resubmit any such report or documentation within such time,City shall have the right to terminate
this Contract effective immediately upon written notice of such intent with no penalty or liability
to City.
10.2.1 In the event of termination under this Section 10.2, all CDBG Funds awarded
but unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency shall
have no further right to such funds, and any CDBG Funds paid to Agency must be repaid to City
within 30 days of termination. If such CDBG Funds are not repaid to City within the 30 day
period, City shall exercise all legal remedies available under this Contract.
10.3 In General.
10.3.1 Subject to Section 10.2, and unless specifically provided otherwise in this
Contract,Agency shall be in default under this Contract if Agency breaches any term or condition
of this Contract. In the event that such a breach remains uncured after 30 calendar days following
written notice by City (or such other notice period as may be specified herein) or, if Agency has
diligently and continuously attempted to cure following receipt of such written notice but
reasonably requires more than 30 calendar days to cure, as determined by both Parties mutually
and in good faith, City shall have the right to elect in City's sole discretion to (i)extend Agency's
time to cure, (ii)terminate this Contract effective immediately upon written notice of such intent
to Agency, or(iii)pursue any other legal remedies available to City under this Contract.
10.3.2 City's remedies may include:
10.3.2.1 Direct Agency to prepare and follow a schedule of actions for
carrying out the affected activities, consisting of schedules,
timetables and milestones necessary to implement the affected
activities.
10.3.2.2 Direct Agency to establish and follow a management plan that
assigns responsibilities for carrying out the remedial activities.
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10.3.2.3 Reprogram CDBG Funds that have not yet been expended from
affected activities to other eligible activities or withhold CDBG
Funds.
10.3.2.4 Any other appropriate action including but not limited to any
remedial action legally available such as declaratory judgment,
specific performance, damages, temporary or permanent
injunctions,termination of this Contract or any other contracts with
Agency, and any other available remedies.
10.3.3 In the event of termination under this Section 10.3, all CDBG Funds awarded
but unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency shall
have no further right to such funds, and any CDBG Funds already paid to Agency must be repaid
to City within 30 days of the termination. Failure to repay such CDBG Funds within the 30 day
period will result in City exercising all legal remedies available under this Contract.
10.4 No Funds Disbursed while in Breach.
Agency understands and agrees that no CDBG Funds will be paid to Agency until all
defaults are cured to City's satisfaction.
10.5 No Compensation After Date of Termination.
Agency shall not receive any compensation for work undertaken after the date of the
termination.
10.6 Rights of City Not Affected.
Termination shall not affect or terminate any of the existing rights of City against Agency,
or which may thereafter accrue because of Agency's default and this provision shall be in addition
to any and all other rights and remedies available to City under the law. Such termination does
not terminate any provisions of this Contract that have been expressly noted as surviving the term
or termination of the Contract. No delay or omission by City in exercising any right or remedy
available to it under this Contract shall impair any such right or remedy or constitute a waiver or
acquiescence in any Agency default.
10.7 Waiver of Breach Not Waiver of Subsequent Breach.
The waiver of a default or breach of any term,covenant, or condition of this Contract shall
not operate as a waiver of any subsequent default or breach of the same or any other term,covenant
or condition hereof.
10.8 Civil, Criminal and Administrative Penalties.
Failure to perform all the Contract terms may result in civil, criminal or administrative
penalties, including,but not limited to those set out in this Contract.
10.9 Termination for Cause.
10.9.1 City may terminate this Contract in the event of Agency's default, inability, or
failure to perform subject to notice, grace and cure periods. In the event City terminates this
Contract for cause, all CDBG Funds awarded but unpaid to Agency pursuant to this Contract shall
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be immediately rescinded and Agency shall have no further right to such funds and any CDBG
Funds already paid to Agency must be repaid to City within 30 days of termination. Failure to
repay such CDBG Funds within 30 days will result in City exercising all legal remedies available
to City under this Contract. AGENCY ACKNOWLEDGES AND AGREES THAT IF CITY
TERMINATES THIS CONTRACT FOR CAUSE, AGENCY OR ANY AFFILIATES OF
AGENCY SHALL NOT BE CONSIDERED FOR ANY OTHER CITY CONTRACT FOR
CDBG FUNDS FOR A MINIMUM OF 5 YEARS FROM THE DATE OF TERMINATION.
10.9.2 Agency may terminate this Contract if City does not provide the CDBG Funds
substantially in accordance with this Contract.
10.10 Termination for Convenience.
In terminating in accordance with 2 CFR Part 200, Appendix II, this Contract may be
terminated in whole or in part only as follows:
10.10.1 By City with the consent of Agency in which case the Parties shall agree upon
the termination conditions, including the effective date and in the case of partial termination, the
portion to be terminated; or
10.10.2 By Agency upon at least 30 days written notification to City, setting forth the
reasons for such termination, the effective date, and in the case of partial termination, the portion
to be terminated. In the case of a partial termination,City may terminate the Contract in its entirety
if City determines in its sole discretion that the remaining portion of the Contract to be performed
or CDBG Funds to be spent will not accomplish the purposes for which the Contract was made.
10.11 Dissolution of 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 CDBG Funds are subject to repayment and/or City may
exercise all of its remedies under this Contract.
10.12 Reversion of Assets.
In the event this Contract is terminated with or without cause,all assets acquired by Agency
with the CDBG Funds including cash, interest payments from loans or otherwise, all outstanding
notes, mortgages or other security instruments, any accounts receivable attributable to the use of
the CDBG Funds, and any real or personal property owned by Agency that was improved with the
CDBG Funds shall automatically transfer to City or to such assignee as City may designate.
11. REPAYMENT OF CDBG FUNDS.
All CDBG Funds are subject to repayment in the event the Program does not meet the
requirements of this Contract or in the CDBG Regulations. If Agency takes any action that
results in the City being required to repay all or any portion of the CDBG Funds to HUD,
Agency agrees it will reimburse City for such repayment. If Agency takes any action that
results in City receiving a finding from HUD about the Program,whether or not repayment
of all or any portion of the CDBG Funds is required of City,Agency agrees City may require
that 10% of the CDBG Funds be repaid to City as liquidated damages. The Parties agree that
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City's damages in the event of either repayment to HUD being required or receiving a finding
from HUD are uncertain and would be difficult to ascertain and may include an impact on City's
CDBG grant or other federal grant funds, in addition to the finding by HUD or a required
repayment of funds to HUD by City. Therefore,the Parties agree that payment under this Section
of 10% of the CDBG Funds by Agency to City is liquidated damages and not a penalty.
12. CHANGE IN NON-PROFIT STATUS.
Agency must provide City with written notification of any changes to its non-profit status
within 15 calendar days of being notified of the change. Regardless of notice by Agency, if the
non-profit status of Agency changes after the date of this Contract, City may but is not obligated
to, terminate this Contract. In the event of termination under this Section 12, all CDBG Funds
awarded but not yet paid to Agency pursuant to this Contract shall be immediately rescinded and
Agency shall have no further right to such funds. City in its sole discretion, may require that any
CDBG Funds already paid to Agency must be repaid to City within 30 calendar days of termination
under this Section.
13. SURVIVAL.
Any provision of this Contract that pertains to auditing, monitoring, client income
eligibility, record keeping and reports, City ordinances, or applicable CDBG requirements, and
any default and enforcement provisions necessary to enforce such provisions, shall survive the
termination of this Contract for 5 years after the Contract term ends and shall be enforceable by
City against Agency. For purposes of this Contract, this 5 year period for survival of certain
Contract provisions is deemed to begin on October 1, 2018 and end on September 30, 2023
regardless of whether or not this Contract is earlier terminated.
14. GENERAL PROVISIONS.
14.1 Agency an Independent Contractor.
Agency shall operate hereunder as an independent contractor and not as an officer, agent,
servant or employee of City. Agency shall have exclusive control of, and the exclusive right to
control, the details of the work and services performed hereunder, and all persons performing
same, and shall be solely responsible for the acts and omissions of its officers, members, agents,
servants, employees, contractors, subcontractors,vendors, clients, licensees or invitees.
14.2 Doctrine of Respondeat Superior.
The doctrine of respondeat superior shall not apply as between City and Agency, or its
officers, members, agents, servants, employees, contractors, subcontractors, vendors, clients,
licensees or invitees, and nothing herein shall be construed as creating a partnership or joint
enterprise between City and Agency. City does not have the legal right to control the details of
the tasks performed hereunder by Agency, its officers, members, agents, employees, contractors,
subcontractors,vendors, clients, licensees or invitees.
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14.3 Agency Property.
City shall under no circumstances be responsible for any property belonging to Agency,or
its officers, members, agents, employees, contractors, subcontractors, vendors, clients, licensees
or invitees that may be lost, stolen or destroyed or in any way damaged and AGENCY HEREBY
INDEMNIFIES AND HOLDS HARMLESS CITY AND ITS OFFICERS, AGENTS, AND
EMPLOYEES FROM ANY AND ALL CLAIMS OR SUITS PERTAINING TO OR
CONNECTED WITH SUCH PROPERTY.
14.5 Religious Organization.
Agency shall comply with all applicable requirements as more particularly described in 24
CFR Part 5.109. No portion of the CDBG Funds shall be used in support of any sectarian or
religious activity. In addition,there must be no religious or membership criteria for clients of a
CDBG-funded service.
14.5.1. Separation of Explicitly Religious Activities.
Agency retains its independence and may continue to carry out its mission, including the
definition, development practice, and expression of its religious beliefs,provided that it does not
use CDBG Funds to support or engage in any explicitly religious activities (including activities
that involve overt religious content such as worship, religious instruction, or proselytization), or
in any other manner prohibited by law.
14.5.2 Explicitly Religious Activities.
If Agency engages in explicitly religious activities (including activities that involve overt
religious content such as worship,religious instruction,or proselytization),the explicitly religious
activities must be offered separately,in time or location,from the programs or activities supported
by CDBG Funds and participation must be voluntary for clients of a CDBG-funded service.
14.5.3 Required Notices.
If Agency constitutes a Faith-based organization under 24 CFR Part 5.109, Agency must
provide all clients of a CDBG-funded service with the notice attached as EXHIBIT"K"—Notice
of Beneficiary Rights. Such notice shall be provided to the client prior to enrollment in any
CDBG-funded program or activity. In addition,if a client or prospective client of a CDBG-funded
service objects to the religious character of Agency, then Agency must promptly undertake
reasonable efforts to identify and refer the client or prospective client to an alternate provider to
which the client or prospective client has no such objection, as more particularly described in 24
CFR Part 5.109.
14.6 Venue.
Venue shall lie in Tarrant County, Texas for any action,whether real or asserted, at law
or in equity, arising out of the execution,performance,attempted performance or
non-performance of this Contract.
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14.7 Governing Law.
This Contract shall be governed by and construed in accordance with the laws of the State
of Texas. If any action, whether real or asserted, at law or in equity, arises out of the execution,
performance or non-performance of this Contract or on the basis of any provision herein, for any
issue not governed by federal law,the choice of law shall be the laws of the State of Texas.
14.8 Severability.
The provisions of this Contract are severable, and if for any reason a clause, sentence,
paragraph or other part of this Contract shall be determined to be invalid by a court or federal or
state agency, board or commission having jurisdiction over the subject matter thereof, such
invalidity shall not affect other provisions which can be given effect without the invalid provision.
14.9 Written Agreement Entire Contract.
This written instrument and the Exhibits, Attachments, and Addendums attached hereto,
which are incorporated by reference and made a part of this Contract for all purposes, constitute
the entire agreement by the Parties concerning the work and services to be performed under this
Contract. Any prior or contemporaneous oral or written agreement which purports to vary the
terms of this Contract shall be void. Any amendments to the terms of this Contract must be in
writing and executed by the Parties.
14.10 Paragraph Headings for Reference Only, No Legal Significance; Number
and Gender.
The paragraph headings contained herein are for convenience in reference to this Contract
and are not intended to define or to limit the scope of any provision of this Contract. When context
requires,singular nouns and pronouns include the plural and the masculine gender shall be deemed
to include the feminine or neuter and the neuter gender to include the masculine and feminine.
The words"include"and"including"whenever used herein shall be deemed to be followed by the
words"without limitation".
14.11 Compliance With All Applicable Laws and Regulations.
Agency agrees to comply fully with all applicable laws and regulations that are currently
in effect or that are hereafter amended during the performance of this Contract. Those laws
include,but are not limited to:
➢ CDBG Regulations found in 24 CFR Part 570
➢ Title I of the Housing and Community Development Act of 1974, as amended, (42
USC 5301)
➢ Title VI of the Civil Rights Act of 1964 (42 U.S.C. Sections 2000d et seq.) including
provisions requiring recipients of federal assistance to ensure meaningful access by
persons of limited English proficiency
➢ The Fair Housing Act, Title VIII of the Civil Rights Act of 1968 (42 U.S.C. Sections
3601 et seq.)
➢ Executive Orders 11063, 11246 as amended by 11375 and 12086 and as supplemented
by Department of Labor regulations 41 CFR Part 60
➢ The Age Discrimination in Employment Act of 1967
➢ The Age Discrimination Act of 1975 (42 U.S.C. Sections 6101 et seq.)
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➢ 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.
113-101)
➢ Federal Whistleblower Regulations, as contained in 10 U.S.C. 2409, 41 U.S.C. 4712,
10 U.S.C. 2324, 41 U.S.C. 4304 and 41 U.S.C. 4310.
14.12 HUD Assisted Proieets and Employment and other-Eeonomie Oppertuni
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14.13 Prohibition Against Discrimination.
14.13.1 General Statement.
Agency shall comply in the execution, performance or attempted performance of this
Contract,with all non-discrimination requirements of 24 CFR Part 570.607 and Chapter 17,Article
III,Division 4—Fair Housing of the City Code. Agency may not discriminate against any person
because of race, color,sex,gender,religion,national origin,familial status,disability or perceived
disability, sexual orientation, gender identity, gender expression, or transgender, nor will Agency
permit its officers,members, agents, employees, or clients to engage in such discrimination.
This Contract is made and entered into with reference specifically to Chapter 17, Article
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 l will take affirmative
action to ensure that applicants are hired without regard to race, color, sex, gender, religion,
national origin, familial status, disability or perceived disability, sexual orientation, gender
identity,gender expression or transgender and that employees are treated fairly during employment
without regard to their race, color, sex, gender, religion, national origin,familial status, disability
or perceived disability,sexual orientation,gender identity,gender expression or transgender. Such
action shall include, but not be limited to, the following: employment, upgrading, demotion or
transfer, recruitment or recruitment advertising, layoff or termination, rates of pay or other forms
of compensation, and selection for training, including apprenticeship. [Contractor's,
Subcontractor's or Vendor's name] agrees to post in conspicuous places, available to employees
and applicants for employment, notices setting forth the provisions of this nondiscrimination
clause.
[Contractor's. Subcontractor's or Vendor's name] will, in all solicitations or
advertisements for employees placed by or on behalf of [Contractor's. Subcontractor's or
Vendor's name], state that all qualified applicants will receive consideration for employment
without regard to race, color, sex, gender, religion, national origin, familial status, disability or
perceived disability, sexual orientation, gender identity, gender expression or transgender.
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[Contractor's. Subcontractor's or Vendor'sname] 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 Agency Safeguards.
Agency shall establish safeguards to prohibit its employees,board members, advisors and
agents from using positions for a purpose that is or gives the appearance of being motivated by a
desire for private gain for themselves or others, particularly those with whom they have family,
business or other ties. Agency shall disclose to City any such conflict of interest or potential
conflict of interest, immediately upon discovery of such.
14.14.2 General Prohibitions Against Conflicts of Interest.
No employees, agents, consultants, officers or elected officials or appointed officials of
City or of Agency who exercise or have exercised any functions or responsibilities with respect to
activities assisted with CDBG funds or who are in a position to participate in a decision-making
process or gain inside information with regard to these activities may utilize CDBG services,may
obtain a financial interest or benefit from a CDBG-assisted activity, or have an interest in any
contract, subcontract or agreement with respect thereto, or the proceeds thereunder, either for
themselves or those with whom they have family or business ties,during their tenure or for 1 year
thereafter.
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14.14.2.1 Agency shall establish conflict of interest policies for federal awards
including the CDBG Funds and shall disclose in writing potential
conflicts of interest to City as authorized by 2 CFR Part 200.112.
14.14. 3 Conflicts of Interest Involving Procurement.
The conflict of interest provisions of 2 CFR Part 200.31 shall apply in the procurement of
property and services by Agency. In all cases not governed by this Section, the provisions of 24
CFR Part 570.611 of the CDBG Regulations shall apply.
14.14.3.1 As more particularly described in 2 CFR Part 200.318,Agency shall
maintain and submit to City written standards of conduct covering
conflicts of interest and governing the performance of its employees
engaged in the selection,award,and administration of contracts. No
employee, officer, or agent may participate in the selection, award,
or administration of a contract supported by a federal award if he or
she has a real or apparent conflict of interest. The standards of
conduct must provide for disciplinary actions to be applied for
violations of such standards by officers, employees, or agents of
Agency.
14.14.3.2 The officers, employees, and agents of Agency shall neither solicit
nor accept gratuities, favors, or anything of monetary value from
contractors or parties to subcontracts.
14.14.3.3 Notwithstanding the prohibition contained in Section 14.13.3.2,
Agency may set standards of conduct for situations in which the
financial interest is not substantial or the gift is an unsolicited item
of nominal value. Such standards of conduct must provide for
disciplinary actions to be applied for violations of such standards by
Agency's officers,employees or agents.
14.14.3.4 Agency shall maintain written standards of conduct covering
organizational conflicts of interest. Organizational conflicts of
interest means that because of relationships with a parent company,
affiliate, or subsidiary organization,Agency is unable or appears to
be unable to be impartial in conducting a procurement action
involving a related organization.
14.14.3.5 Agency must maintain records sufficient to detail the history of
procurement. These records will include, but are not necessarily
limited to the following: rationale for the method of procurement,
selection of contract type, contractor selection or rejection, and the
basis for the contract price.
14.14.4 Disclosure of Conflicts of Interest.
In compliance with 2 CFR Part 200.112,Agency is required to timely disclose to City in
writing any potential conflict of interest.
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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 the CDBG Funds,Agency agrees to abide by City's policy to involve Minority Business
Enterprises and Small Business Enterprises and to provide them equal opportunity to compete for
contracts for construction,provision of professional services,purchase of equipment and supplies
and provision of other services required by City. Agency agrees to incorporate the City's BDE
Ordinance, and all amendments or successor policies or ordinances thereto, into all contracts and
subcontracts for procurement larger than $50,000.00 or larger that are paid for, in part or in full,
with the CDBG Funds and will further require all persons or entities with which it so contracts to
comply with said ordinance.
14.15.2 It is national policy to award a fair share of contracts to disadvantaged business
enterprises ("DBEs"), small business enterprises ("SBEs"), minority business enterprises
("MBEs"), and women's business enterprises ("WBEs"). Accordingly,affirmative steps must be
taken to assure that DBEs, SBEs, MBEs, and WBEs are utilized when possible as sources of
supplies, equipment, construction and services.
14.15.2.1 In order to comply with federal reporting requirements in 24 CFR
Part 570.506 (g)(6), Agency must submit the form attached hereto
as EXHIBIT "I" — MBE Reporting Form for each contract or
subcontract with a value of$10,000.00 or more paid or to be paid
with the CDBG Funds. Agency shall submit this form by the date
specified in EXHIBIT"I"—MBE Reporting Form.
14.16 Other Laws.
The failure to list any federal, state or City ordinance, law or regulation that is applicable
to Agency does not excuse or relieve Agency from the requirements or responsibilities in regard
to following the law, nor from the consequences or penalties for Agency's failure to follow the
law, if applicable.
14.17 Assignment.
Agency shall not assign all or any part of its rights,privileges,or duties under this Contract
without the prior written approval of City. Any attempted assignment of same without approval
shall be void, and shall constitute a breach of this Contract.
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018 Page 24
Sixty and Better,Inc.dba Senior Citizen Services Rev.9.25.2017
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
CDBG-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.
14.20 IMMIGRATION NATIONALITY ACT.
City actively supports the Immigration&Nationality Act(INA)which includes provisions
addressing employment eligibility,employment verification,and nondiscrimination.Agency shall
verify the identity and employment eligibility of all employees who perform work under this
Agreement. Agency shall complete the Employment Eligibility Verification Form (I-9), maintain
photocopies of all supporting employment eligibility and identity documentation for all
employees, and upon request,provide City with copies of all I-9 forms and supporting eligibility
documentation for each employee who performs work under this Agreement. Agency shall
establish appropriate procedures and controls so that no services will be performed by any
employee who is not legally eligible to perform such services. Agency shall provide City with a
certification letter that it has complied with the verification requirements required by this
Agreement. Agency shall indemnify City from any penalties or liabilities due to violations of this
provision. City shall have the right to immediately terminate this Agreement for violations of this
provision by Agency.
15. INDEMNIFICATION AND RELEASE.
AGENCY COVENANTS AND AGREES TO INDEMNIFY, HOLD HARMLESS
AND DEFEND, AT ITS OWN EXPENSE, CITY AND ITS OFFICERS, AGENTS,
SERVANTS AND EMPLOYEES FROM AND AGAINST ANY AND ALL CLAIMS OR
SUITS FOR PROPERTY LOSS OR DAMAGE AND/OR PERSONAL INJURY,
INCLUDING DEATH, TO ANY AND ALL PERSONS, OF WHATSOEVER KIND OR
CHARACTER, WHETHER REAL OR ASSERTED, ARISING OUT OF OR IN
CONNECTION WITH THE EXECUTION, PERFORMANCE, ATTEMPTED
PERFORMANCE OR NONPERFORMANCE OF THIS CONTRACT AND/OR THE
OPERATIONS, ACTIVITIES AND SERVICES OF THE PROGRAM DESCRIBED
HEREIN, WHETHER OR NOT CAUSED IN WHOLE OR IN PART, BY ALLEGED
NEGLIGENCE OF OFFICERS,AGENTS,SERVANTS,EMPLOYEES,CONTRACTORS
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018 Page 25
Sixty and Better,Inc.dba Senior Citizen Services Rev.9.25.2017
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 HINDS OR CHARACTER,
WHETHER REAL OR ASSERTED, ARISING OUT OF OR IN CONNECTION WITH
THE EXECUTION, PERFORMANCE, ATTEMPTED PERFORMANCE OR
NONPERFORMANCE OF THIS CONTRACT AND/OR THE OPERATIONS,
ACTIVITIES AND SERVICES OF THE PROGRAM DESCRIBED HEREIN,WHETHER
OR NOT CAUSED IN WHOLE OR IN PART BY ALLEGED NEGLIGENCE OF
OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS OR
SUBCONTRACTORS OF CITY. AGENCY LIKEWISE COVENANTS AND AGREES TO
AND DOES HEREBY INDEMNIFY AND HOLD HARMLESS CITY FROM AND
AGAINST ANY AND ALL INJURY,DAMAGE OR DESTRUCTION OF PROPERTY OF
CITY,ARISING OUT OF OR IN CONNECTION WITH ALL ACTS OR OMISSIONS OF
AGENCY, ITS OFFICERS, MEMBERS, AGENTS, EMPLOYEES, CONTRACTORS,
SUBCONTRACTORS, INVITEES, LICENSEES, OR CLIENTS, OR CAUSED, IN
WHOLE OR IN PART, BY ALLEGED NEGLIGENCE OF OFFICERS, AGENTS,
SERVANTS,EMPLOYEES, CONTRACTORS OR SUBCONTRACTORS OF CITY.
IT IS THE EXPRESS INTENTION OF THE PARTIES, BOTH AGENCY AND
CITY, THAT THE INDEMNITY PROVIDED FOR THIS SECTION INCLUDES
INDEMNITY BY AGENCY TO INDEMNIFY AND PROTECT CITY FROM THE
CONSEQUENCES OF CITY'S OWN NEGLIGENCE,WHETHER THAT NEGLIGENCE
IS ALLEGED TO BE THE SOLE OR CONCURRING CAUSE OF THE INJURY,
DAMAGE OR DEATH.
AGENCY AGREES TO AND SHALL RELEASE CITY, ITS AGENTS,
EMPLOYEES,OFFICERS AND LEGAL REPRESENTATIVES FROM ALL LIABILITY
FOR INJURY, DEATH, DAMAGE OR LOSS TO PERSONS OR PROPERTY
SUSTAINED IN CONNECTION WITH OR INCIDENTAL TO PERFORMANCE UNDER
THIS CONTRACT, EVEN IF THE INJURY, DEATH, DAMAGE OR LOSS IS CAUSED
BY CITY'S SOLE OR CONCURRENT NEGLIGENCE.
AGENCY SHALL REQUIRE ALL OF ITS CONTRACTORS AND
SUBCONTRACTORS TO INCLUDE IN THEIR CONTRACTS AND SUBCONTRACTS
A RELEASE AND INDEMNITY IN FAVOR OF CITY IN SUBSTANTIALLY THE SAME
FORM AS ABOVE.
16. WAIVER OF IMMUNITY BY AGENCY.
If Agency, as a charitable or nonprofit organization, has or claims an immunity or
exemption (statutory or otherwise) from and against liability for damages or injury, including
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.
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018 Page 26
Sixty and Better,Inc.dba Senior Citizen Services Rev.9.25.2017
17. INSURANCE AND BONDING.
Agency will maintain coverage in the form of insurance or bond in the amount of$101,800
to insure against loss from the fraud, theft or dishonesty of any of Agency's officers, agents,
trustees, directors or employees. The proceeds of such insurance or bond shall be used to
reimburse City for any and all loss of CDBG Funds occasioned by such misconduct. To effectuate
such reimbursement, such fidelity coverage shall include a rider stating that reimbursement for
any loss or losses shall name the City as a Loss Payee.
Agency shall furnish to City in a timely manner, but not later than the Effective Date,
certificates of insurance as proof that it has secured and paid for policies of commercial insurance
as specified herein. If City has not received such certificates by the Effective Date, Agency shall
be in default of the Contract and City may, at its option,terminate the Contract.
Such insurance shall cover all insurable risks incident to or in connection with the
execution,performance,attempted performance or nonperformance of this Contract. Agency shall
maintain the following insurance coverage and limits:
Commercial General Liability(CGL) Insurance
$ 500,000 each occurrence
$1,000,000 aggregate limit
Non-Profit Orizanization 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
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018 Page 27
Sixty and Better,Inc.dba Senior Citizen Services Rev.9.25.2017
Note: Such insurance shall cover employees performing work on any and all projects
including but not limited to construction, demolition, and rehabilitation. Agency or its
contractors shall maintain coverages, if applicable. In the event the respective contractors
do not maintain coverage, Agency shall maintain the coverage on such contractor, if
applicable, for each applicable contract.
Additional Requirements
Such insurance amounts shall be revised upward at City's reasonable option and no more
frequently than once every 12 months, and Agency shall revise such amounts within 30 days
following notice to Contractor of such requirements.
Agency will submit to City documentation that it has obtained insurance coverage and has
executed bonds as required in this Contract prior to payment of any monies provided hereunder.
Where applicable, insurance policies required herein shall be endorsed to include City as an
additional insured as its interest may appear. Additional insured parties shall include employees,
officers,agents, and volunteers of City.
Any failure on part of City to request certificate(s)of insurance shall not be construed as a waiver
of such requirement or as a waiver of the insurance requirements themselves.
Insurers of Agency's insurance policies shall be licensed to do business in the state of Texas by
the Department of Insurance or be otherwise eligible and authorized to do business in the state of
Texas. Insurers shall be acceptable to City insofar as their financial strength and solvency and
each such company shall have a current minimum A.M. Best Key Rating Guide rating of A-: VII
or other equivalent insurance industry standard rating otherwise approved by City.
Deductible limits on insurance policies shall not exceed $5,000 per occurrence unless otherwise
approved by City.
In the event there are any local, federal or other regulatory insurance or bonding requirements for
the Program, and such requirements exceed those specified herein,the former shall prevail.
Agency shall require its contractors to maintain applicable insurance coverages, limits, and other
requirements as those specified herein;and Agency shall require its contractors to provide Agency
with certificate(s) of insurance documenting such coverage. Also, Agency shall require its
contractors to have City and Agency endorsed as additional insureds(as their interest may appear)
on their respective insurance policies.
Directors and Officers Liability coverage shall be in force and may be provided on a claims-made
basis. This coverage may also be referred to as Management Liability,and shall protect the insured
against claims arising out of alleged errors in judgment,breaches of duty and 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.
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018 Page 28
Sixty and Better,Inc.dba Senior Citizen Services Rev.9.25.2017
Notwithstanding any provision in this Contract to the contrary, when applicable, Agency
shall comply with the requirements of 2 CFR 200.310 and shall, at a minimum, provide the
equivalent insurance coverage for real property and equipment acquired or improved with
CDBG Funds as provided to property owned by Agency.
18. CERTIFICATION REGARDING LOBBYING.
The undersigned representative of Agency hereby certifies, to the best of his or her
knowledge and belief,that:
No federal appropriated funds have been paid or will be paid, by or on behalf of Agency,
to any person for influencing or attempting to influence an officer or employee of any
agency,a member of Congress, an officer or employee of Congress in connection with the
awarding of any federal contract,the making of any federal grant,the making of any federal
loan, the entering into of any cooperative agreement and the extension, continuation,
renewal, amendment, or modification of any federal contract, grant, loan or cooperative
agreement.
If any funds other than federally appropriated funds have been paid or will be paid to any
person for influencing or attempting to influence an officer or employee of any agency,
member of Congress in connection with this federal contract, grant, loan or cooperative
agreement, Agency shall complete and submit Standard Form-LLL, "Disclosure Form to
Report Lobbying," in accordance with its instructions.
This certification is a material representation of fact upon which reliance was placed when
this Contract was made or entered into. Submission of this certificate is a prerequisite for
making or entering into this Contract imposed by 31 U.S.C. Section 1352. Any person
who fails to file the required certification shall be subject to a civil penalty of not less than
$10,000.00 and not more than$100,000.00 for each such failure.
Agency shall require that the language of this certification be included in all subcontracts or
agreements involving the expenditure of federal funds.
19. LITIGATION AND CLAIMS.
Agency shall give City immediate notice in writing of any action,including any proceeding
before an administrative agency, filed against Agency in conjunction with this Contract or the
Program. Agency shall furnish immediately to City copies of all pertinent papers received by
Agency with respect to such action or claim. Agency shall provide a notice to City within 10 days
upon filing under any bankruptcy or financial insolvency provision of law.
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018 Page 29
Sixty and Better,Inc.dba Senior Citizen Services Rev.9.25.2017
20. NOTICE.
All notices required or permitted by this Contract must be in writing and are deemed
delivered on the earlier date of the date actually received or the third day following deposit in a
United States Postal Service post office or receptacle; with proper postage, certified mail return
receipt requested; and addressed to the other Party at the address set out below or at such other
address as the receiving Party designates by proper notice to the sending Party.
City:
City Attorney's Office
100 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
Agency:
Sixty and Better,Inc. dba Senior Citizen Services
Attention: Jerome H.Mosman, Chief Executive Officer
1400 Circle Drive#300
Fort Worth, Texas 76119
Telephone: 817-413-4949
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018 Page 30
Sixty and Better,Inc.dba Senior Citizen Services Rev.9.25.2017
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.
23. PROGRAM INCOME
Parties agree that no program income as defined by HUD shall be earned as a result of this
contract.
[SIGNATURES APPEAR ON NEXT PAGE]
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018 Page 31
Sixty and Better,Inc.dba Senior Citizen Services Rev.9.25.2017
IN WITNESS WHEREOF,the Parties hereto have executed 4 duplicate originals of this
Contract in Fort Worth,T ant County, Texas.
AT T: FUR F FORT WORTH
ity Secre&4 ' Fe do Costa, Assistant City Manager
M&C: G-1 9V6 U
1295 Certification No. 2017-235 'k
Date: August 1, 2017xja,
APPROVED AS TO FORM AND LEGALITY:
Paige Meba e,Assistant City Attorney
CONTRACT COMPLIANCE MANAGER:
By signing, I acknowledge that I am the person responsible
for the monitoring and administration of this contract, including
ensuring all
performance and reporting requirements
Barbara Asbury
Compliance and Planning Manager
SIXTY AND BETTER,INC.DBA SENIOR CITIZEN SERVICES
By:
9 ----
Jerome H. Mosman, Chief Executive Officer
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018 Page 32
Sixty and Better,Inc.dba Senior Citizen Services Rev.9.25.2017
EXHIBITS:
EXHIBIT "A"—Program Summary
EXHIBIT "A-1"—2017 HUD Income Limits
EXHIBIT "A-2"—Reporting Requirements for Countywide Agencies
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"—Severely Disabled Certification Form
EXHIBIT "I"—MBE Reporting Form
EXHIBIT "J"—Duties of the Parties for Use of NSD Community Centers
EXHIBIT "K"—Notice of Beneficiary Rights
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018 Page 33
Sixty and Better,Inc.dba Senior Citizen Services Rev.9.25.2017
SIXTY AND BETTER, INC. DBA SENIOR EXHIBIT "A"
CITIZEN SERVICES
Connecting Seniors to Community PROGRAM SUMMARY
PROGRAM SUMMARY
(CDBG)
October 1,2017 to September 30, 2018 $101,800.00
PERIOD AMOUNT
Capitalized terms not defined herein shall have meanings assigned them in the Contract.
PROGRAM:
The Program will provide transportation services to Fort Worth seniors age 62 and over to and
from their homes to activity centers and for shopping or field trips.
CDBG Funds will be used to pay for a percentage of salaries for Program employees supervising
the Program and administering the transportation contracts. CDBG Funds will also be used to
pay for rides for clients on a per unit basis. Cost for rides shall be the same as the rate charged to
the Agency by the vendor or subcontractor providing the rides.
Agency's office is located at 1400 Circle Dr. #300, Fort Worth, TX 76119,with operating hours
of 8:00 a.m.to 5:00 p.m.,Monday through Friday.
Program services will be available to and from client homes to the following locations:
City of Fort Worth Neighborhood Centers
Como Neighborhood Center-4900 Horne Street, Fort Worth,TX 76107
Northside Neighborhood Center- 1100 NW 18th, Fort Worth, TX 76164
Worth Heights Neighborhood Center- 3551 New York, Fort Worth,TX 76110
North Tri-Ethnic Community Center-2950 Roosevelt, Fort Worth,TX 76106
Fellowship Corner- 1601 New York, Fort Worth, TX 76104
Additional Locations
Barnabas House, Christ Lutheran-4409 Sycamore School Road,Fort Worth, TX 76133
CASA- 3201 Sandra, Fort Worth,TX 76107
Diamond Hill Community Center- 1701 NE 36th,Fort Worth, TX 76106
Eugene McCray Community Center-4932 Wilbarger, Fort Worth,TX 76119
Handley-Meadowbrook Community Center- 6201 Beaty, Fort Worth,TX 76112
Hometown at Matador Ranch—8500 Crowley Road,Fort Worth, TX 76134
Jewish Family Services-4900 Briarhaven, Fort Worth,TX 76109
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018—EXHIBIT"A"—PROGRAM SUMMARY
Sixty and Better,Inc.dba Senior Citizen Services Page I
Agency shall not change any locations without prior City approval. Costs incurred at any
locations that have not been approved by City will not be reimbursed.
REGULATORY CLASSIFICATION:
IDIS Matrix Code(s)and Service Category: 05A Senior Services
National Objective Citation: LMC Low/Mod Limited Clientele 24 CFR 570.208(a)(2)
Regulatory Citation(s): 24 CFR 570.201(e)
Agency will maintain documentation which verifies that 100% of clients served by the Program
are Elderly in accordance with the CDBG Presumed Benefit clientele definition.
PROGRAM GOALS:
Minimum Number of Fort Worth Clients to be Served: The Program must serve a minimum
of 300 Unduplicated Clients from Fort Worth as shown by the monthly reports on Attachment
III.
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018—EXHIBIT"A"—PROGRAM SUMMARY
Sixty and Better,Inc.dba Senior Citizen Services Page 2
EXHIBIT "A-1"
2017 HUD INCOME LIMITS
2017 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 $15,000 $17,150 $19,300 $21,400 $23,150 $24,850 $26,550 $28,250
50%AMI $25,000 $28,600 $32,150 $35,700 $38,600 $41,450 $44,300 $47,150
80%AMI $40,000 $45,700 $51,400 $57,100 $61,700 $66,250 $70,850 $75,400
*Income limits are published at least annually by HUD.
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018--EXHIBIT"A-1"—2017 HUD INCOME LIMITS
Sixty and Better,Inc.dba Senior Citizen Services Page 1
EXHIBIT "A-2"
REPORTING REQUIREMENTS FOR COUNTYWIDE AGENCIES
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018--EXHIBIT"A-2"
REPORTING REQUIREMENTS FOR COUNTYWIDE AGENCIES Page I
Sixty and Better,Inc.dba Senior Citizen Services
Sixty and Better,Inc. dba Senior Citizen Services
REPORTING REQUIREMENTS FOR COUNTYWIDE AGENCIES
Quarterly Report
The purpose of the Quarterly Report is for the Countywide Agencies to report the number of non-Fort
Worth clients who participate in the Program. The Quarterly Report must be submitted with the
December, March, June and September Reimbursement Requests. A paper copy must be submitted
with the Reimbursement Request, and an electronic copy must also be emailed to
psa@fortworthtexas.gov or to Agency's designated City Contract administrator. The information
provided in the Quarterly Report will be reviewed and monitored by the Neighborhood Services
Department Compliance Division.
TOTAL#OF
#OF FORT #OF NON-FORT CLIENTS FORT WORTH
DUE DATE REPORTING RANGE WORTH WORTH SERVED BY CLIENTS
CLIENTS CLIENTS THEPROGRAM
r
A B C D E F
EXAMPLE: 250 200- 450 250_450=55%
January 15,2018 October 1,2017-
December 31,2017
April 15,2018 January 1,2018-
March 30,2018
July 15,2018 April 1,2018-
_June 30,2018
October 1,2018 July1T 2018-
September 30,2018
TOTAL
I,Agency representative, certify that I verified the information I reported this quarter and it is correct
to the best of my knowledge.
Certified by: Date:
Signature/Title:
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018--EXHIBIT"A-2"
REPORTING REQUIREMENTS FOR COUNTYWIDE AGENCIES Page 1
Sixty and Better,Inc.dba Senior Citizen Services
EXHIBIT"B" BUDGET
Account Grant Budget A B C D E Total
PROGRAM PERSONNEL
Salaries 1001 $ 15,270.00 $ 15,000.00 $ 6,150.00 $ 300.00 $ 36,720.00
FICA 1002
Life/Disability Insurance 1003
Health/DentalInsurance 1004
Unemployment-State 1005
Worker's Compensation 1006
Retirement 1007
Staff Training ---
SUPPLIES AND SERVICES
Office/Program Supplies 2001
Postage
Printing
C)(herO
11 lISCClp.LLA+IE1J[y
Contract Labor City needs copy cit
contract before expenses can be
reimbursed) 3001 $ 86,530.00 $ 85,000 ! S 31.5 :i,tili I. 1 S _',,o ,W.00
Food Supplies 3002
Teaching Aids 3003
Craft Supplies 3004
Field Trip Expenses 3005
Mileage 3006
FACILITY AND UTILITIES
Telephone 4001
Electric 4002
Gas 4003
Water and Wastewater 4004
Solid Waste Disposal 4005
Rent(City needs copy of lease
before expenses can be reimbursed) 4006
Cleaning Supplies 4007
Repairs 4008
Custodial Services 4009
Other O 4010
1.1U:A1.,I.INANCIA1.AN1) 7
INS11RANC'.E At
12dclm 1iqw%;11011 500(
1)ir ttt�rs
('rnrial L ahait;
DIREC"I'ASSISI ANC E
131 W.ETTOTAL $ 101,800.00 S 100,000.011 S 41,1100.011 $ 2,000.00 $ 244,8011.00
FUNDING A.Area Agency on Aging
FUNDING B:Tarrant County
FUNDING C:Participant Contributions
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018-EXHIBIT"B"-BUDGET
Sixty and Better,Inc.dba Senior Citizen Services 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 1,2018.
SALARY DETAIL-PROGRAM PERSONNEL
Est. Percent to Amount to
Position Title Annual Salan- Grant Grant
Director of Operations 5 i.20 1.00 29.8% $ 15,270.00
TOTAL $ 51,201.00 29.8% $ 15,270.00
FRINGE DETAIL-PROGRAM PERSONNEL
Percent of Est.Percent to Amount to
Payroll Amount Grant Grant
FICA
I.ife/Disabilit} Insurance
Health/De wal Insurance
Unemployment-State
Worker's Compensation
Retirement
Staff Training
TOTAL
SUPPLIES AND SERVICES
Est. Percent to Amount to
Total Budget Grant Grant
OfficeJli-oi-,ram Supplies
PostaL�c
Printing.
Other()
TOTAL
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018-EXHIBIT'B"-BUDGET
Sixty and Better,Inc.dba Senior Citizen Services Page 2
MISCELLANEOUS
Est. Percent to Amount to
Total Budget Grant Grant
Contract Labor $ 208,080.00 41.6% $ 86,530.00
Food SLIpplies
Teaching Aids
Craft Supplies
Field Trip Expenses
Mileage
TOTAL 1 $ 208,080.00 1 41.6%1 $ 86,530.00
FACILITY AND UTILITIES
Est. Percent to Amount to
Total Budget Grant Grant
Telephone
Electric
Gas
Water and Wastewater
Solid Waste Disposal
Rent
Cleaning Supplies
Repairs
Custodial Services
Other()
TOTAL
LEGAL,FINANCIAL AND INSURANCE
Est. Percent to Amount to
Total Budget Grant Grant
Fidelity Bond or Equivalent
Directors and Officers
General Commercial Liability
TOTAL
DIRECT ASSISTANCE
Est. Percent to Amount to
Total Budget Grant Grant
Other()
TOTAL
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018-EXHIBIT'B"-BUDGET
Sixty and Better,Inc.dba Senior Citizen Services Page
EXHIBIT "C"
AUDIT CERTIFICATION FORM
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018–EXHIBIT"C"—AUDIT CERTIFICATION
FORM 1
Sixty and Better,Inc.dba Senior Citizen Services
AUDIT CERTIFICATION FORM AND AUDIT REQUIREMENTS
Agency: Sixty and Better,Inc.dba Senior Citizen Services
Fiscal Year Ending: September 30,2018
During the fiscal year in which funds will be received,we will exceed the federal expenditure
threshold of$750,000. We will have our Single Audit or Program Specific Audit completed
and will submit the audit report described in 2 CFR Part 200 within 7 months after the end
of the audited fiscal year or 30 days within its completion, whichever is the earlier date.
❑ During the fiscal year in which funds will be received,we will not exceed the$750,000 federal
expenditure threshold required for a Single Audit or a Program Specific Audit to be performed
this fiscal year.(Fill out schedule below)
Federal Expenditure Disclosure —
MUST be f ll.ed out if Sing] Audit or Program Audit is NOT re uired.
Pass Through Program.Name& Contract
Federal Grantor Grantor CF'DA.Number Number Expenditures
Total Federal Expenditures for this Fiscal Year:
Signatory an -id Date
Failure to submit this or a similar statement or failure to submit a completed single audit package
as describgd 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.
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018—EXHIBIT"C"—AUDIT CERTIFICATION
FORM 2
Sixty and Better,Inc.dba Senior Citizen Services
EXHIBIT "D"
REPORTING FORMS
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018—EXHIBIT"D'—REPORTING FORMS Page 1
Sixty and Better,Inc.dba Senior Citizen Services
ATTACHMENT I
Invoice
Attachment I
INVOICE
Agency:
Address:
s City, State, Zip:
Program:
Period of Service:
Tax ID No.
P.O. No.
FID No.
Pro ram Amount
g This Invoice Cumulative to Date
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018—EXHIBIT"D"—REPORTING FORMS Page 2
Sixty and Better,Inc.dba Senior Citizen Services
ATTACHMENT II
Expenditure Worksheet
ATTACHMENT II
Neighborhood Services Department
Expenditure Worksheet
Only highlighted coder can be reimbu—d
Please g oup like:recount codes.
Account
line Code(See Expense line Item
No. Chk No, Date Pavee Descri lioWlob Title• KeytoRmhOl A=unt I Account.
I PROGRAM PERSONNEL l?ti:irr:
2 Snlanes loot
3 FICA 1002
4 life/Disabdity Insurance 1003
5 Health;Dental Insurance 1004
6 Un—.l—nrent5tate Ioo5
7 WrrrL,:r 4:'.r!;:_n,,:•.i.i 1006
8 R.ew:ins,', 1007
9 S1 PP:IJIS AND SFRVIC.."S n4„�wPr a5,`>}.a,"l'r
10 Vltr,::P:, Sin-b,•s 2001
II Posta:, 2002
12 Prinlrn: 21MCi
13 2(m It
14 hILS CLU-Aldl t.t5
15 Contractl a! ✓_ 3as1
16 FoodSu .It.•,. 3002
17 Teaching A.:,�—.T_...._ 3003
18 Craft Su yhr, 3001
19 Field Tri L1•enses 3005
20 Mileage 3006
21 Othe 1 3(X)7
22 otbero 3ao8
23 VA_C LM'AND I!TILME5 rx >� "
24 1:I"—,.._,._._. 4(X)1 .
25 flecu. 4002
26 Cas 4003
27 Water and Wastewater 4004
28 Solid WesteDisposal 4005
29 Rent 4(X)(,
30 Clewing Supplies 4007
31 Other() dryrx
32 LE7(:AL FINANC CAL,AND EN S I TRANCE:
33 I:.I i.: Rind or 'usahml
34 tr;n!.>•i and Officers
35 r.n.r. t�rmreraial Liability 51rr;
36 4rciri 5001
37 ))JRkX I'AS515'I ANCE T17 ^+ .�'—.„..
38 Oth"i i fi(1Rl
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Total 50,00
'For Salaries,state erMloyee's title under Description/Job Title.Rent nest identify tenant
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018—EXHIBIT"D"—REPORTING FORMS Page 3
Sixty and Better,Inc,dba Senior Citizen Services
ATTACHMENT III exercise
Client Data Report
ATTAC mlu
MWTU.ITA¢ITO¢T
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Lk
ImQ¢Clfam. neM rr.rr-w.uw....mw.�•�..)�r rw.e.rrr�...��.rx... �.w.,".w.m......r
Y^ n n..�a.".....Inwxrrr.d.�./n�•arra��r.r.r�..n�.uwur�wrw"r.Wy.e,..—..Inufi.w...iw.ri. w•µr4Mwrr
LN.I'Li'iISE I'N 1 �
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¢.�.+.dd MidroJ M�d.W lo$dr.11Mfa.r)
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CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018—EXHIBIT"D"—REPORTING FORMS Page 4
Sixty and Better,Inc.dba Senior Citizen Services
EXHIBIT "E"
INCOME CERTIFICATION FORMS
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018--EXHIBIT`B"--INCOME CERTIFICATION FORM
Sixty and Better,Inc.dba Senior Citizen Services Page 1
City of Fort Worth
CERTIFICATION OF INCOME STATEMENT
Applicant Name:
Current Address: Phone
City and Zip:
Household "'fern: er, id Tnoome
Last Name First Name Age Monthi Source of Income
Income $$
TOTAL NUMBER OF FAMILY MEMBERS (Include Yourself,Spouse,Children,etc.)
Total Gross Annual Household Income:
PFRSONAl.INFORMATION:(Check one in each item. This Information is Required for Federal Reporting Purposes)
a. Q, , o.❑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: ❑
Staff Assessment of Demographics:
Person Making Determination: Date:__
NOTE. Address, income amounts and sources for ALL household members are required.
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018--EXHIBIT"E"--INCOME CERTIFICATION FORM
Sixty and Better,Inc.dba Senior Citizen Services Page 2
Ciudad de Fort Worth
CERTIFICACION DE DECLARAC16N DE INGRESOS
Nombre del Solicitante:
Direcci6n de Actualidad: Teldfono:
Ciudad y C6digo Postal:
Miembros Del Ho ag r�Ingresos
(Incluyendo el/la Solicitante)
Apellido Nombre Had Ingreso Origen de Ingresos
Mensual
*TOTAL NUMERO DE MIEMBROS DEL HOGAR (Inchiyase Usted.)
Total Anual de Ingresos del hogar:
**INFORMACi6N PERSONAL:(Selection uno en cada articulo. Esta infonnacion 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. LES LA CABEZA DEL HOGAR MUJER?
❑HISPANO ❑SI ❑SI
❑NO-HISPANO ❑NO ❑NO
Certificaci6n: Yo certifico que la informaci6n que yo estoy proporcionando es verdadera y puedo ser sujeto a
verificaci6n a cualquiera hora por tercera parte. Yo tambidn reconozco que la provision de informaci6n falsa
puede dejarme sujeto a penalidades Federales,Estatales, y a ley local.
Firma del Solicitante Fecha
ADVERTENCIA:TITULO 18,SECCION 1001 DEL CODIGO DE LOS ESTADOS UNIDOS INDICA QUE UNA
PERSONA ES CULPABLE DE UN DELITO POR SABER Y VOLUNTARIAMENTE RACER DECLARACIONES FALSOS O
FRAUDULENTAS A CUALQUIER DEPARTAMENTO DE GOBIERNO DE LOS ESTADOS UNIDOS.
----,---Para use de em leados de la age n-hi-----------------
#De Miembros de Familia: Ingreso Anual:_ _
Limite de Ingreso: ZEs solicitante elegible?
Compruebe si el solicitante se neg6 a dar su informaci6n personal: ❑
Evaluaci6n del empleado sobre informaci6n personal:
Persona haciendo la determinaci6n: Fecha:_
Note: La direction de la casa y los ingresos (y sus origenes) para todos miembros deo ho,�Lir on reguerido
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018--EXHIBIT"E"--INCOME CERTIFICATION FORM
Sixty and Better,Inc.dba Senior Citizen Services Page 3
EXHIBIT "F"
STANDARDS OF DOCUMENTATION
CDBG PRESUMED BENEFIT PSA CONTRACT 2018-2018--EXHIBIT"F"--STANDARDS OF
DOCUMENTATION
Sixty and Better,Inc.dba Senior Citizen Services Page 1
2017-2018 Documentation Standards for
CDBG Public Service Contract Expenses
Employee Salaries and Benefits City will only reimburse a percentage of any employee's salary and benefits who work directly with the CDBG-funded Program.
Percentages will be cost allocated and determined prior to the execution of the CDBG Contract Agencies requesting the reimbursement of 100%of any Agency employee
will require prior City approval. Agencies must show calculation on how the CDBG portion of employee salaries and benefits were calculated consistently with the CDBG
Contract.
If an employee works on both a CDBG eligible and non-CDBG eligible program(s),the City will only reimburse for a reasonau:portion
of the employee's salary. Prior to the execution of the CDBG Contract,the Agency will priovide the City with a written statement on how
each employee's time will be allocated. If an employee works 100%of their time directly with the CDBG-funded Program,then 100%of
the employee's salary may be eligible for reimbursement. Agency must submit a written statement that 100%of the employee's time is
spent working directly with the CDBG-funded Program. Statements must be signed by a person authorized to sign on behalf of the
Agency and will be submitted with the October invoice.
Salaries X x• Reimbursement requests must include a timesheet and work log that reflects the hours worked by the employee(s)working directly on
the CDBG-funded Program. For employees who are paid with multiple funding sources,timesheets must reflect all funding sources. If
separate timesheets are kept for each funding source,all such timesheets must be submitted to City. Timesheets must be signed by
employee and supervisor. Agency must show a calculation and documentation of how the employee's salary was calculated and
invoiced to City.
'If employees are paid by direct deposit rather than check,then the agency must submit both the direct deposit payment company's
report(such as an ADT report)and a bank statement or check showing payment to the direct deposit company.
FICA/Medicare X X X
Lite Insurance x x x
Health If the City pays gross salary,this is already included.If the City pays the employer portion,the Agency must provide proof that the
Insurance X x x employee is enrolled in the benefit plan,must show a calculation and documentation of how the invoiced amount was calculated,and
Disability x xx must provide documentation showing payment.Invoice and proof of payment are only required with the first reimbursement request and
Insurance at any time there are changes to amounts,enrollments,disenrollments,etc.
Unemployment X 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 x employee is enrolled in the benefit plan,must show a calculation and documentation of how the invoiced amount was calculated,and
must provide docun n showing paymei i proof of payment are only required with the first reimbursement request and
la'any time there are changes to amounts enrol me,Is,disenrollments,etc.
Materials,Equipment,Goods and Supplies-City will only reimburse for the cost allocated percent or amount spent in support of the CDBG-funded Program. Agencies
requesting reimbursement for these items will require prior City approval. Agencies must show calculation on how the CDBG portion of these expenses were calculated
consistently with the CDBG 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 and Habitat for Humanity.
Materials
Sport and
Recreation X x X
Equipment
Cleaning X X X
Su lies
Teaching Aids X X X
Craft Su lies X X1 I X
Food Supplies X X X This ry is only available to the Program provided by Meals on Wheels.
cost-allocated v
Rent, Utilities and Maintenance,,Cl wil o ty pay for a portion of these expenses. The portion of these expenses will be determined by the square footage attributable to
the CDBG-funded Program and shall be allocated
g in accordance with the amount of space used for the CDBG-funded Program. These expenses may only be in support
of the CDBG-funded Program. The items listed below require prior City approval and the Agency is required to identify any funding source that pays for the portion of the
expenses that is not paid with CDBG funds. Agencies must show calculation on how the CDBG portion of these expenses were calculated consistently with the CDBG
Contract.
�le... lep
hone X X
7.4
.Gas X X
aate,IWastew X X
er
Electric X X
._..... . _.
Solid Waste X X
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018 E#libit"P'-STANDARDS FOR COMPLETE DOCUMENTATION 1
Facility This item requires approval by the City prior to the execution of the CDBG Contract. Repairs may be categorized as major/minor
MaintenanceX X X X rehabilitation projects and must be approved through the full HUD Environmetal Review.
and Repairs
RentX X X City will pay for a portion of the rent for the Program facility so long as its in proportion to the square footage attributable to the CDBG-
funded program.
This item requires prior approval by the City. Prior to the execution of the CDBG Contract,the Agency must submit a written statement
that lists the contract labor services to be used during the Contract term. Agency will submit a memo related to the procurement of such
Contract Labor X X X X X services and will forward any information pertaining to the procurement process to City. This requirement applies to,but is not limited to,
services retained for security services,legal,accounting,transportation providers,educational facilitators,custodial services,etc.
Agencies may not use the contract services of any City of Fort Worth Department.
City-required X X City will only pay for a percentage of the City-required insurance so long as it's in proportion to the square footage attributable to the
Insurance CDBG-funded program.
City requires that the agency submit its fee schedule or formula on how the Agency calculates the childcare scholarship amount. The
fee schedule/formula should demonstrate a breakout of income levels,and for each income level the schedule should demonstrate
Childcare 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 X X scheduletformula 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.
IV Income Agecies that are required to verify and provide proof of household income to determine eligibility,must require that anyone who is over
Certifications the age of 18,living in the housohold,submit a$0 Income Certcation.
If an audit is required because federal funds exceed$750,000,then the cost should be split evenly by all grant funding sources. Agency
Audit Services X X X X must show calculation on how the CDBG portion of the accounting services were calculated. For example,if the CDBG grant is 10%of
your Agencys 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 092N1017 DC
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018 EXAIb#"P'—STANDARDS FOR COMPLETE DOCUMENTATION 1
EXHIBIT "G"
SECTION 3 REPORTING FORMS
NOT APPLICABLE
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018--EXHIBIT"G"--SECTION 3 REPORTING
FORMS
Sixty and Better,Inc.dba Senior Citizen Services Page I
EXHIBIT"H"
SEVERELY DISABLED CERTIFICATION FORM
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018—EXHIBIT"If'—SEVERELY DISABLED
CERTIFICATION FORM Page 1
Sixty and Better,Inc.dba Senior Citizen Services
Sixty and Better,Inc. dba Senior Citizen Services
CERTIFICATION FORM
DOCUMENTING CLIENT STATUS AS "SEVERELY DISABLED ADULT"
Client Name:
Address:
City, State,Zip
Client Identification No.
CHECK ALL THAT APPLY
❑ Has used a wheelchair, a walker, cane , crutches or other special aid for six
months or longer
Has been diagnosed with one of the following conditions: Alzheimer's disease,
❑ mental retardation or other developmental disability, senility or dementia,
cerebral palsy, or autism; or has another mental or emotional condition that
seriously interferes with everyday tasks.
Is unable to perform one or more of the following "Functional Activities":
❑ seeing, hearing, speaking and having one's speech understood, lifting or
carrying, using stairs, grasping small objects, or walking.
Is unable to perform or needs assistance to perform one or more of the following
❑ Activities of Daily Living(ADL): getting around inside the home, getting in or
out of bed or a chair, bathing, dressing, eating, and toileting.
Is unable to perform or needs assistance to perform one or more of the following
Instrumental Activities of Daily Living (IADL): going outside the home,
❑ keeping track of money and bills, preparing meals, doing light housework,
taking prescription medications in the right amount and at the right time, and
using the telephone.
❑ Has a condition that prevents them from working at a job or doing housework.
The undersigned Agency representative conducted a visual assessment of the client identified on
this form and certifies that the client meets at least one of the conditions indicated above, which
determines that he/ she meets the definition of"severely disabled" according to the U.S. Census
Bureau.
Certified by: Date:
Signature/Title:
CFW Neighborhood Services Dept.: Revised 08.30.2013
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018—EXHIBIT"If'—SEVERELY DISABLED
CERTIFICATION FORM Page 2
Sixty and Better,Inc.dba Senior Citizen Services
EXHIBIT "I"
MBE REPORTING FORM
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018--EXHIBIT"P'--MBE REPORTING FORM
Sixty and Better,Inc.dba Senior Citizen Services Page 1
Contract and Subcontract Activity US.Department of Hoofing end Urban Dmiepmeat OMB Approval No.:1577-0098 OMB
Approval No.:2502-0355
Public reporting burden for this collection of infommtion is estimated to average.5 hours per response,including the time fm reviewing instructions,searching existing dem sources,gathering and maintaining the date needed,and completing and reviewing the collection of information.The
Infiumation is voluntary.HUD may not collect this information,andyw ensues required to complete this form,unless it displays acmrently valid OMB Control Number.
13—tive Orders dated July 14,1983,directs the Ninunly Business Development Plans shall be developed by each Federal Agency and the these annual plans shall establish minority business development objectives.The information is used by HUD to monitor sod evaluate MBE activities against
the tots)program activity and the designated minority business amerpnse(MBE)goals.The Department require the information to provide guidance and oversight for programs for the development of maturity business enterprise concerning Minority Business Development,If the information is
not collected HUD would not be able to establish meaningful MBE goals nm e4sts MBE performance against these goals.
Privacy Act Notice-The United States Department of Housing and Urban Development,Federal Hooting Administration,is authorized to solicit the Inforntion requested in this form by vimse of Title 12,United States Code,Section 1701 at sea.,and regulation it will not be disclosed or
relseed outside the United States Department of Housing and Urban Development without your ransom,except as required or permitted by dew.
Gmtm(Projec[0—fTieveloper/Sposm/Boader'Ag- 2.Location Ci
Chink if (City,State Zip Code)
PH
LH
CPD
Hc.smg
3s.Nus orCamst Pcsoa 3b.PW=Number Oncludin Ara Code) 4.Reporting Period 5.Program Code(Not applicable for CPD praamma) ❑ 6.Date SaWnioed to PicW M.
Sye ezphwion nrCdes m hoaom of£eye Us e
Oct.I- t.30 Annual- s]>sne e6eet fm rmh Pro8'am code.
Cows
LbaeVHojen,Nu o TIUD Subcwtrxtar
Care Number or other Amoantof T,,eofTrade Basi— Sb.-- Contractodss
5ubcontraetor Name and Addre
idenifiratmn of-,m,, Contractor Code 9 i.a dodc Women Owned Biiunces Prime CooamtorldentSca.11.) IdeutiFutioo(in)
wbdimirion.dwelling umi.ec. SO— (See W—) (S.below) (Yes or No) Number Sec,3 Number See.3 7j
7a, fi. lc. 7d. 7e. X 7 7a 7,.
Name Street Cit State Zi
7e:Type of Trade Codes: 7d:Recial/Edmi,Codes: 5:Program Codex(Complete for Hoaxing and Poblie and Indian Housing programs only):
CPD: 11—ft/Poblic Houdng: t-Whip Americom I-All lnxwcd.inchtding Sections 5-Seca.202
1-New Construction 1-N—Cwaracdan 6-Profeasimul 2=Black A-- 2-Flexibly Subsidy 6-HUD-Hyld(Mcuyamera)
2-FdanalioNTmieieg 2-Sob-61 Rehab. I-Team,Service, 3-Natin Americans 3-Section a Neal—L Non-HFDA 7-PubIkAldia Hissing
3-peer 3-Repan L-F.d—OWT—ft a-Hifpwic Americros 4-loomed(Maugmeml a-Section all
4-Serviac 9.Asch/Engrg Appnwl 5-Asim.dk Amvirans
5-Proiect Mrxt. a-phc 6-Hasidic kc,
Prevbm eauwxm obnipe. form BUD-2516(8/96)
EXHIBIT "J"
DUTIES OF THE PARTIES
USE OF NEIGHBORHOOD SERVICES DEPARTMENT
COMMUNITY CENTERS
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018--EXHIBIT"J"–DUTIES OF THE PARTIES—
USE OF NEIGHBORHOOD SERVICES DEPARTMENT COMMUNITY CENTERS Page 1
Sixty and Better,Inc.dba Senior Citizen Services
Sixty and Better,Inc. dba Senior Citizen Services
DUTIES OF THE PARTIES
USE OF NEIGHBORHOOD SERVICES DEPARTMENT
COMMUNITY CENTERS
Agency's Responsibilities:
Agency will perform the following in relation with the use of Community Center:
• Agency will furnish the Center Coordinator with a schedule of Program activities at least
four weeks prior to their occurrence.
• Agency will,at its sole expense,furnish materials,supplies,copies and conduct a structured
Program.
• Agency will ensure that the designated Community Center space is maintained in a neat
and orderly fashion.
• Agency will ensure that the City's standards are maintained regarding security;cleanliness
and communication between and among programs housed at the Community Center and
will ensure cooperation with other Community Center staff and agencies/programs.
• Agency will report to the Center Coordinator or designee for problems immediately
if/when problems occur.
• Agency will work with the Center Coordinator or designee to schedule any use of the
Community Center for related activities outside of agencies designated meeting time and/or
the Community Center's regular days and hours.
• Agency will maintain sole responsibility and liability for its employees, volunteers and
separate contractors for their actions.
• Agency shall ensure that each of its employees, volunteers and participants desiring to
participate in Community Center-sponsored programs/activities are aware of the
requirement to have a current community center membership card to participate.
• Agency agrees to perform background screenings and checks on staff and volunteers,with
such screenings and checks meeting or exceeding the requirements that the City imposes
for checks and screenings on staff,volunteers and participants in the City's own programs.
• Agency will provide the Center Coordinator with designated staff contact information for
the purposes of emergencies (center closing, schedule changes or scheduled maintenance)
City's Responsibilities:
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018--EXHIBIT"T'–DUTIES OF THE PARTIES—
USE OF NEIGHBORHOOD SERVICES DEPARTMENT COMMUNITY CENTERS Page 1
Sixty and Better,Inc.dba Senior Citizen Services
City will perform the following in relation with Agency's use of a Community Center:
• City will provide space for conducting the Program, including basic utilities and will also
supply the Agency with appropriate facility access. For purposes of this Contract, basic
utilities shall not include telephone or computer service, which shall remain the sole
responsibility of the Agency.
• City will ensure that the reserved space is set up with appropriate tables and chairs to
accommodate program and/or services.
• City will not be responsible for any additional security other than what is currently
available at the Community Center.
• City assumes no liability or responsibility for the loss of any personal property or office
contents of the Agency, its agents, employees, volunteers, participants or licensees while
at the Community Center.
• City will allow the Agency to conduct properly scheduled classes and other Program
related activities during the days and hours specified in Exhibit "A" PROGRAM
SUMMARY*. In addition,City may,but is not required,through the Center Coordinator,
allow Agency to schedule other classes and Program related activities outside of the days
and hours specified in Exhibit"A" PROGRAM SUMMARY.
• City will maintain sole responsibility and liability for its employees, volunteers and
separate contractors for their actions.
• City will have the discretion to put the Agency in any available room. If placed in a
different location, it is to be only one room.
*The City is closed in observance of the following holidays:
New Year's Day(January 1)
M.L.K. Jr. Day(Third Monday of January)
Memorial Day(Last Monday in May)
Independence Day(July 4th)
Labor Day(First Monday in September)
Thanksgiving Day(Fourth Thursday of November)
Day after Thanksgiving(Fourth Friday in November)
Christmas Day(December 25th)
"City of Fort Worth observes the above holidays on Friday if they fall on Saturday and on a Monday if they
fall on Sunday.
Additionally,the Community Centers are utilized as shelters during an emergency. If the
Community Center will be closed due to an emergency, Center Coordinator or designee will
inform Agency of the closure.
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018--EXHIBIT"J"--DUTIES OF THE PARTIES—
USE OF NEIGHBORHOOD SERVICES DEPARTMENT COMMUNITY CENTERS Page 2
Sixty and Better,Inc.dba Senior Citizen Services
EXHIBIT "K"
NOTICE OF BENEFICIARY RIGHTS
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018--EXHIBIT'W'—NOTICE OF BENEFICIARY
RIGHTS Page 1
Sixty and Better,Inc.dba Senior Citizen Services
Notice of Beneficiary Rights
Name of Agency: Sixty and Better, Inc. dba Senior Citizen Services
Name of Program: Connecting Seniors to Community
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.
CDBG PRESUMED BENEFIT PSA CONTRACT 2017-2018--EXHIBIT"K"—NOTICE OF BENEFICIARY
RIGHTS Page 2
Sixty and Better,Inc.dba Senior Citizen Services
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Official site of the City of Fort Worth,Texas
CITY COUNCIL AGENDA Foy
Min
COUNCIL ACTION: Approved on 8/1/2017 -Ordinance No. 22814-08-2017
DATE: 8/1/2017 REFERENCE G-19056 LOG NAME: 19NS HUDACTIONPLANPY2017-
NO.: 2018
CODE: G TYPE: NON- PUBLIC YES
CONSENT HEARING:
SUBJECT: Conduct Public Hearing and Approve the City's 2017-2018 Action Plan for the Use of
Federal Grant Funds in the Amount of$10,778,461.00 to be Awarded by the United States
Department of Housing and Urban Development from the Community Development Block
Grant, HOME Investment Partnerships Program, Emergency Solutions Grant and Housing
Opportunities for Persons with AIDS Grant Programs, Authorize Collection and Use of
Program Income, Authorize Waiver of Application of Indirect Cost Rates, Authorize
Execution of Related Contracts and Adopt Appropriation Ordinance (ALL COUNCIL
DISTRICTS)
RECOMMENDATION:
It is recommended that the City Council:
1. Conduct a public hearing to allow citizen input and consideration of the City's 2017-2018 Action
Plan for use of federal grant funds to be awarded by the United States Department of Housing and
Urban Development in the amount of$10,778,461.00 from the Community Development Block Grant,
HOME Investment Partnerships Program, Emergency Solutions Grant, and Housing Opportunities for
Person with AIDS grant programs, and for the use of program income from activities using prior
years'federal grant funds;
2. Approve the City's 2017-2018 Action Plan for submission to HUD, including allocations of grant
funds to particular programs and activities as detailed below;
3. Authorize the collection and use of an estimated $150,000.00 of program income which resulted
from activities using prior years' Community Development Block Grant funds, for the City's Priority
Repair Program;
4. Authorize the collection and use of an estimated $300,000.00 of program income which resulted
from activities using prior years' HOME Investment Partnerships Program funds, for the completion of
the Hardy Street and HFC Terrell Single Family Infill housing development projects and 10 percent
for administrative costs as detailed below;
5. Authorize the City Manager or his designee to execute contracts for one year terms with the
agencies listed in Tables 1, 2 and 3 below, for Program Year 2017-2018 for Community Development
Block Grant, Emergency Solutions Grant, and Housing Opportunities for Person with AIDS grant
funds, contingent upon receipt of funding and satisfactory completion of an Environmental Review
and all regulatory requirements;
6. Authorize the City Manager or his designee to extend the contracts for up to one year if an agency
or department requests an extension and such extension is necessary for completion of the program
or to amend the contracts if necessary to achieve program goals provided any amendment is within
the scope of the program and in compliance with City policies and all applicable laws and regulations
governing the use of federal grant funds;
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7. Authorize a waiver of indirect cost rates as applicable for the Grants Fund in accordance with the
City's Administrative Regulations; and
8. Adopt the attached appropriation ordinance increasing the estimated receipts and appropriations
to the Grants Fund in the total amount of$10,778,461.00 consisting of$6,526,863.00 in Community
Development Block Grant funds, $2,047,626.00 in HOME Investment Partnerships Program funds,
$577,437.00 in Emergency Solutions Grant funds, and $1,176,535.00 in Housing Opportunities for
Person with AIDS grant funds, plus any program income, all subject to receipt of such funds.
DISCUSSION:
The City's 2017-2018 Action Plan summarizes the major housing and community development
activities and proposed expenditures for the program year beginning October 1, 2017 and ending
September 30, 2018 for use of federal grant funds totaling $10,778,461.00 from the United States
Department of Housing and Urban Development(HUD)for Community Development Block Grant
(CDBG), HOME Investment Partnerships Program (HOME), Emergency Solutions Grant(ESG) and
Housing Opportunities for Persons with AIDS (HOPWA) grant programs. It also summarizes the use
of program income resulting from activities using prior years' CDBG and HOME funds, the primary
purpose of which is to benefit low and moderate income City of Fort Worth residents. ESG funds
primarily benefit homeless persons, and HOPWA funds primarily benefit low and moderate income
persons with HIV/AIDS.
Staff developed initial recommendations for the allocation of the estimated funding from HUD based
on prior years' funding levels. A public hearing was held on April 19, 2017 to provide citizens the
opportunity to participate in the development of the Action Plan. The Staff recommendations for
award amounts were presented to the Housing and Neighborhood Services Committee on May 6,
2017 and were adopted by the Community Development Council (CDC) on May 10, 2017. Following
the publication of final funding amounts for FY2017-18 from HUD on June 14, 2017, Staff
recommendations were updated to reflect the actual grant amounts and these revised
recommendations were forwarded to the CDC and presented to the City Council through an Informal
Report at the City Council Work Session on June 20, 2017.
Notice of a 30 day public comment period from June 30, 2017 to July 31, 2017 was published in the
Fort Worth Star-Telegram on June 25, 2017, in La Estrella on June 27, 2017, and in La Vida News:
The Black Voice on June 29, 2017. Any comments received are maintained by the Neighborhood
Services Department in accordance with federal regulations. The City must hold two public hearings
as part of the HUD-required citizen participation process. The first public hearing is scheduled to be
held by City Staff on July 19, 2017, and the second public hearing is scheduled for August 1, 2017 at
the City Council meeting.
A summary of Staffs final funding recommendations is provided below and in Tables 1, 2 and
3. Additionally, a spreadsheet of all specific funding recommendations is attached. The 2017-2018
Annual Action Plan must be submitted to HUD by August 15, 2017.
A waiver of indirect costs is being requested to maximize program benefits. The CDBG program
provides for 23 full-time positions with estimated salaries of$1.3 million. Addition of indirect costs
would result in reduction in Staff and services. The indirect costs that are being asked to be waived
are estimated to be $215,386.00.
CDBG
For Program Year 2017-2018, it is recommended that the amount of$6,526,863.00 in CDBG funds,
and an estimated amount of$150,000.00 in CDBG program income totaling $6,676,863.00 be
allocated as follows:
Public Services -$979,029.00
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This item includes social services for low to moderate income, disabled and disadvantaged
populations.
Housing Program Services -$2,922,228.00
This item includes funding for the City's Priority Repair Program, Cowtown Brush-Up, homebuyer and
housing services, accessibility modifications to the homes of senior and/or disabled individuals, the
Lead Hazard Reduction Demonstration Grant Match, and related project delivery costs for these
programs.
Infrastructure Projects & Public Facilities -$579,255.00
This item includes funding for the Worth Heights Community Center Americans with Disability Act
Improvements.
CDBG Economic Development-$740,979.00
This item is the City's annual payment of its Section 108 loan from HUD. The Section 108 Program is
a loan guarantee program which enables CDBG grantees to borrow up to five times the annual
entitlement grant.
CDBG Estimated Program Income -$150,000.00
This item includes funding for the City's Priority Repair Program. CDBG program income that is
received which is over the estimated amount but not used for the City's Priority Repair Program will
be allocated to priority activities in the City's Consolidated Plan subject to City Council approval.
CDBG General Administration -$1,305,372.00
This item includes costs for administering the CDBG grant including allocations for Financial
Management Services and Planning and Development Departments.
HOME
For Program Year 2017-2018, it is recommended that the amount of$2,047,626.00 in HOME funds,
and an estimated amount of$300,000.00 in HOME program income totaling $2,347,626.00 be
allocated as follows:
Homebuyers Assistance Program (HAP) -$700,000.00
This item includes funding for down payment and/or closing cost assistance to low and moderate
income homebuyers.
Community Development Housing Organizations (CHDO) Set Aside -$307,144.00
HUD requires that a minimum of 15 percent of HOME funds be allocated to CHDOs for affordable
housing projects and CHDO administrative operating costs. These funds will be used by Housing
Channel (formerly Tarrant County Housing Partnership), a CHDO, for the Riverside Single Family
Infill Development(COUNCIL DISTRICT 8). The houses will be sold to homebuyers making at or
below 80 percent of the area median income as set by HUD.
Rental Housing Development—$835,720.00
This item represents gap financing for a portion of the costs of developing Columbia Renaissance
Square, Phase II, an affordable multifamily senior development(COUNCIL DISTRICT 8).
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HOME General Administration—$204,762.00
This item includes costs for administering the HOME grant.
HOME Estimated Program Income -$300,000.00
This item represents gap financing for the Columbia Renaissance Square, Phase II multifamily senior
development. HOME program income that is received which is over the estimated amount but not
used for the Columbia Renaissance Square, Phase II project will be allocated to the Riverside Single
Family Infill development, or to priority activities in the City's Consolidated Plan subject to Council
approval. HUD allows the City to take 10 percent of any HOME program income to be used for the
costs for administering the HOME grant.
HOPWA
For Program Year 2017-2018, it is recommended that the amount of$1,176,535.00 in HOPWA funds
be allocated as follows:
Non-Profit Service Providers -$1,141,239.00
HOPWA Program Administration—$35,296.00
ESG
For Program Year 2017-2018, it is recommended that the amount of$577,437.00 in ESG funds be
allocated as follows:
Non-Profit Service Providers -$534,130.00
ESG Program Administration —$43,307.00
CONTRACT RECOMMENDATIONS
The CDC and Staff recommend that contracts be executed with the listed agencies for the amounts
shown in the following tables:
Community Development Block Grant Contracts:
Table 1 — CDBG Agencies
Organization Program Amount
AB Christian Learning Center Child Care Services $ 76,350.00
Catholic Charities Diocese of Fort EmploymenUJob Training $ 101,800.00
Worth, Inc.
Girls Inc. of Tarrant County Youth Services $ 111,080.00
Goodwill Industries of Fort Worth, Employment/Job Training $ 76,350.00
Inc.
Housing Channel Housing Counseling $ 118,088.00
Services
The Ladder Alliance Employment/Job Training $ 94,974.00
Meals on Wheels, Inc. of Greater General & Special Needs $ 76,350.00
arrant Count
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Presbyterian Night Shelter of Public Service Special $ 144,987.00
Tarrant County Needs
Sixty and Better, Inc. Public Services: Elderly $ 101,800.00
United Community Centers Child Care Services $ 76,350.00
CDBG Public Service Subtotal $ 979,029.00
Rehabilitation, Education and Accessibility $ 102,000.00
Advocacy for Persons with
Handicaps, dba REACH, Inc.**
Total CDBG Contracts $1,081,029.00
**REACH will be funded from the CDBG Housing Programs and Services budget
Housing Opportunities For Persons With AIDS Contracts:
Table 2— HOPWA Agencies
Organization Program Amount
Tarrant County Samaritan Housing, Administration (seven $ 510,204.00
Inc. percent), Supportive
Services and Facility Based
housing Subsidy
Assistance
AIDS Outreach Center. Inc. Supportive Services, $ 631,035.00
Tenant Based Rental
Assistance (TBRA), and
Short Term Rent Mortgage
and Utility Assistance
(STRMU)
Total HOPWA Contracts $1,141,239.00
Emergency Solutions Grant Contracts:
Table 3—ESG Agencies
Organization Program Amount
Presbyterian Night Shelter of Shelter $ 126,625.00
Tarrant County Operations/Services
SafeHaven of Tarrant County Shelter $ 75,975.00
Operations/Services
Lighthouse for the Homeless dba Shelter $ 95,343.00
True Worth Place Operations/Services
The Salvation Army a Georgia Homeless Prevention $ 126,625.00
Corporation
Center for Transforming Lives Rapid Rehousing $ 109,562.00
Total ESG Contracts $ 534,130.00
A waiver of the goal for MBE/SBE subcontracting requirements was requested by the Neighborhood
Services Department and approved by the M/WBE Office, in accordance with the M/WBE or BIDE
Ordinance, because the purchase of goods or services from source(s)where subcontracting or
supplier opportunities are negligible.
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All figures have been rounded to the nearest dollar for presentation purposes.
These programs are available in ALL COUNCIL DISTRICTS.
FISCAL INFORMATION/CERTIFICATION:
The Director of Finance certifies that upon approval of the above recommendations, adoption of the
attached appropriation ordinance and receipt of grant funds, funds will be available in the current
operating budget, as appropriated, of the Grants Operating Federal Fund. This is a reimbursement
grant. The Neighborhood Services Department has the responsibility to validate the availability of
funds prior to an expenditure being made.
TO
Fund Department Account Project Program Activity Budget l Reference# Amount
ID ID Year I (Cha field 2
FROM
Fund Department Account Project Program Activity Budget Reference# Amount
ID ID Year (Chartfield 2
Submitted for City Manager's Office by: Fernando Costa (6122)
Originating Department Head: Aubrey Thagard (8187)
Additional Information Contact: Barbara Asbury (7331)
David Reitz (7563)
ATTACHMENTS
19NS HUDACTIONPLAN PY2017-2018 019 AO 17.docx
Form 1295-All Agencies.pdf
HUD 2017-18 AP Selected Slides.pdf
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CERTIFICATE OF INTERESTED PARTIES FORM 1295
1 C, _I.
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. 2017-235962
Sixty and Better, Inc.
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 0711212017
being filed.
City of Fort Worth 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.
SECDBG2017
Providing programming for seniors that includes meals and socialization,educational and health presentations and workshops.
Nature of interest
4
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling intermediary
S 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.
/- LEGA A.:RUIZNotary Pubifc,Staof Texas
.y Notary ID 590720-9 Signature of authorized agent of contracting business entity
M Nyr CotntrtiiSow Exp.12-1s-2Q
AF
Sworn to and subscribed before me,by the said ,this the / day of
20 ,to certify which,witness my hand and of office.
Al�
ignature of officer administering o Printed name of officer administering oath Title of o er administering o
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1,0.883