HomeMy WebLinkAboutContract 48743-A1 R R f
CITY SECRETARY43743 —,41
CONTRACT NO._
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CF) FIRST AMENDMENT TO CITY SECRETARY CONTRACT NO. 48743
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WHEREAS, on February 22, 2017, the City of Fort Worth ("City") and the Presbyterian
�t Night Shelter of Tarrant County, Inc. ("Developer") made and entered into City Secretary
Contract No. 48743 (the "Contract"), as authorized by the City Council in M&C G-18760
adopted on June 14,2016,which provided$300,000.00 of City's Community Development Block
Grant ("CDBG") funds to Developer;
WHEREAS,the funding provided to Developer in the Contract was from a grant received
by the City from the United States Department of Housing and Urban Development ("HUD")
through the CDBG Program, Catalog of Federal Domestic Assistance No. 14.218;
WHEREAS, a national objective of the CDBG Program is to benefit low and moderate
income persons in accordance with the CDBG Regulations at 24 CFR Parts 570.200 and 570.208;
WHEREAS, the purpose of the Contract was to provide the CDBG funds in the form of a
forgivable loan for a portion of the costs of the rehabilitation of the Lowdon-Schutts Building to
create a shelter for homeless single women;
WHEREAS, Developer serves homeless persons, a "presumed benefit" clientele as
defined in 24 CFR Part 570.208 (a) (2) (A) and has proposed to use CDBG funds for eligible
projects under the CDBG Regulations;
WHEREAS, the 85a' Texas Legislature passed House Bill 89, which prohibits
governmental entities from entering into contracts with entities that boycott Israel, and the City
actively supports the Immigration and Nationality Act, which addresses employment eligibility,
employment verification and nondiscrimination;
WHEREAS,Developer additionally desires to replace HVAC systems in its Main Shelter;
WHEREAS, it is the mutual desire of City and Developer to amend the Contract to add an
additional $30,000.00 in CDBG funds for repair and/or replacement of the failing HVAC systems
and other rehabilitation items at the Main Shelter for a total contract amount of$330,000.00 and
extend the term of the Contract for six months to August 21, 2018 to finish the repairs and
rehabilitation of the items in the Main Shelter, and amend other Contract definitions, terms and
provisions for clarity and to reflect current changes in applicable law;
NOW,THEREFORE, City and Developer hereby agree to amend the Contract as
follows:
I.
DEFINITIONS
The following definitions in the Contract are amended to be and read as follows:
OFFICIAL RECORD
FIRST AMENDMENT to CSC NO.48743 CITY SECRETARY Page 1
The Presbyterian Night Shelter of Tarrant County,Inc. FT,WORTH,TX Rev.01.30.2018
"CDBG Requirements means (i) rehabilitating the Lowdon-Schutts Building to provide
a shelter for single homeless women; (ii)rehabilitation items at the Main Shelter, including
repair and/or replacement of HVAC units, to ensure health and safety of the Main Shelter
clients; (iii) during the Performance Period, (a) operating the Lowdon-Schutts Building as
a shelter for single homeless women; (b) operating the Main Shelter as a shelter for single
homeless men; (c) maintaining a cumulative list of all Unduplicated Clients provided
services by Developer in both buildings; (d) certifying that all clients served by Developer
in both buildings are Income Eligible Clients, and (e) complying with all applicable
provisions of the CDBG Regulations.
"Complete Documentation means the following documentation as applicable:
• Attachments I and II, with supporting documentation as follows:
o Proof of expense: copies of timesheets, invoices, leases, service
contracts or other documentation showing the nature of the cost and
that payment is due by Developer.
o Proof of payment: cancelled checks, bank statements, or wire
transfers necessary to demonstrate that amounts due by Developer
were actually paid by Developer.
• Proof of client eligibility:
o Documentation showing that clients served by the Developer in the
Lowdon-Schutts Building and Main Shelter are Income Eligible
Clients.
• Other documentation: (i) final lien releases signed by Developer's general
contractor or subcontractors, if applicable; (ii)copies of all City permits and
City-issued "pass" inspections for such work; (iii) documentation showing
compliance with BDE or DBE bidding process for procurement or Contract
activities, if applicable; (iv) proof of contractor, vendor or subcontractor
eligibility as described in Section 6.6;and(v)any other documents or records
reasonably necessary to verify costs spent and regulatory compliance for the
project.
• Complete Documentation shall meet the standards described in the
attached Exhibit "J" - Standards for Complete Documentation.
"Completion means the substantial completion of all rehabilitation items at the Lowdon-
Schutts Building and the Main Shelter as evidenced by a Neighborhood Services
Department Minimal Acceptable Standard Inspection Report, a HUD Compliance
Inspection Report, all applicable City final inspection approvals, receipt of a final
Certificate of Occupancy, if applicable, and verification that the National Objective has
been met.
"Completion Deadline means August 21, 2018.
"Income Eligible Client means a client who meets the definition of a"presumed benefit"
client under CDBG Regulations. All clients served in the buildings are homeless persons,
a category of "presumed benefit" clients in 24 CFR Part 570.208 (a) (2) (A) and are
FIRST AMENDMENT to CSC NO.48743 Page 2
The Presbyterian Night Shelter of Tarrant County,Inc. Rev.01.30.2018
deemed to be Income Eligible Clients. The definition of an annual income to determine
client income eligibility shall be the definition contained in 24 CFR Part 5.609,as amended
from time to time.
Program means the services provided by Developer in the Lowdon-Schutts Building and
in the Main Shelter,more particularly described in Exhibit"A"—Project Summary and
Scope of Work and Exhibit"K" Services Performed.
Required Improvements or the project means all the improvements to the Lowdon-
Schutts Building and the Main Shelter together with all fixtures, tenant improvements, if
any, and appurtenances now or later to be located on the Property and/or in such
improvements(the Lowdon-Schutts Building and the Main Shelter are sometimes together
referred to as the"buildings"). A list of the construction requirements for the rehabilitation
items to be performed in the buildings is shown in the attached Exhibit "A" — Project
Summary and Scope of Work. The Lowdon-Schutts Building is located at 2401 Cypress
Street,Fort Worth,TX 76102,and the Main Shelter is located at 2400 Cypress Street,Fort
Worth,TX 76102.
"Unduplicated Client means a client served by Developer with the Program at the
Lowdon-Schutts Building and the Main Shelter at least once during each year of the
Performance Period beginning October 1 of each calendar year. Clients served more than
once during each year of the Performance Period shall only be counted the first time they
are served when determining the total count of Unduplicated Clients."
II.
Section 3.2 Term of Contract is amended to be and read as follows:
"Section 3.2 Term of Contract.
The term of this Contract is for 18 months beginning on the Effective Date unless
earlier terminated as provided in the Contract."
Section 4.1 Provide CDBG Funds is amended to be and read as follows:
"Section 4.1 Provide CDBG Funds
City shall provide$330,000.00 of CDBG Funds in the form of the Loan for eligible
expenses under the terms and conditions of this Contract and the Loan Documents."
Section 5.2.3.2 is amended to be and read as follows:
"5.2.3.2 Developer agrees to utilize the CDBG Funds to supplement rather
than supplant funds otherwise available for the project. City
acknowledges that Developer has received grants of $600,000.00
for the remainder of the costs of rehabilitation of the Lowdon-
Schutts Building."
FIRST AMENDMENT to CSC NO.48743 Page 3
The Presbyterian Night Shelter of Tarrant County,Inc. Rev.01.30.2018
Section 5.6.1.8 is amended to insert the words"and/or the Main Shelter"after the words
"the Lowden-Schutts Building" in(i) in the second sentence.
The first sentence of Section 7.1.1 Income Eligibility is amended to be and read as follows:
"Developer must document that all clients served in the Lowdon-Schutts Building
and the Main Shelter fall under a "presumed benefit" category as defined in 24 CFR
Part 570."
Section 7.1.3 Client Demographic Data/Household Characteristics is amended to insert
"and the Main Shelter"after"the Lowden-Schutts Building" in the entire section.
Section 7.2 Services Provided in the Building is amended to be and read as follows:
667.2 Services Provided in the Buildings.
Grant funds from the CDBG Program were used to pay for a portion of the
rehabilitation of the Lowdon-Schutts Building and for eligible rehabilitation items at the
Main Shelter, including needed repair/replacement of HVAC units at that building;
therefore, City and Developer agree that the Program must meet the National Objective."
The last sentence of Section 7.3 Property Standards During Performance Period is
amended to be and read as follows:
"Developer will allow City to make on-site inspections of the Lowdon-Schutts
Building and the Main Shelter to verify maintenance of the buildings and the Required
Improvements if City requests such an inspection; provided however, City has no
obligation to inspect the premises."
Section 7.4 Program Income is amended to be and read as follows:
"Section 7.4 Program Income.
Income from the use of the buildings, if any, is hereby assigned to Developer. A
summary report of income earned must be provided semi-annually to City during the
Performance Period using Exhibit"M"—Report of Program Income. City has the right
to monitor activities on the Property that generate program income, as well as activities on
which program income is spent, to ensure that such activities aid in maintaining the
buildings and other improvements to the Property in order for Developer to deliver services
at the Lowdon-Schutts Building and the Main Shelter that meet the National Objective.
Section 9.4.1 Entities that Expend$750,000 or more in Federal Funds Per Year
is amended to be and read as follows:
"9.4.1 Entities that Expend $750,000 or more in Federal Funds Per
Year.
Intentionally Deleted."
FIRST AMENDMENT to CSC NO.48743 Page 4
The Presbyterian Night Shelter of Tarrant County,Inc. Rev.01.30.2018
Section 13.2 is deleted in its entirety.
III.
The following provision will be added as Section 23 to the Contract
6623. Immigration Nationality Act.
City actively supports the Immigration and Nationality Act ("INA") which
includes provisions addressing employment eligibility, employment verification,
and nondiscrimination. Vendor shall verify the identity and employment eligibility
of all employees who perform work under this Agreement. Vendor shall complete
the Employment Eligibility Verification Form (1-9), maintain photocopies of all
supporting employment eligibility and identity documentation for all employees,
and upon request, provide City with copies of all 1-9 forms and supporting
eligibility documentation for each employee who performs work under this
Agreement. Vendor 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. Vendor shall provide City with a certification letter that it has
complied with the verification requirements required by this Agreement. Vendor
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 Vendor."
The following provision will be added as Section 24 to the Contract:
"24. Boycotting Israel Prohibited.
Developer acknowledges that in accordance with Chapter 2270 of the Texas
Government Code, the City is prohibited from entering into a contract with a
company for goods or services unless the contract contains a written verification
from the company that it: (1)does not boycott Israel; and(2)will not boycott Israel
during the term of the contract. The terms"boycott Israel" and "company" shall
have the meanings ascribed to those terms in Section 808.001 of the Texas
Government Code. By signing this Contract, Developer certifies that
Developer's signature provides written verification to the City that Developer:
(1) does not boycott Israel; and (2) will not boycott Israel during the term of
this Contract.
FIRST AMENDMENT to CSC NO.48743 Page 5
The Presbyterian Night Shelter of Tarrant County,Inc. Rev.01.30.2018
IV.
Exhibit"A" Project Summary and Scope of Work is hereby deleted and replaced with
the attached Exhibit"A" Project Summary and Scope of Work Revised 1/2018.
Exhibit"A-2" Environmental Mitigation Action is hereby deleted and replaced with
Exhibit"A-2" Environmental Mitigation Action Revised 1/2018.
Exhibit"B" -Budget is hereby deleted and replaced with Exhibit"B" Budget Revised
1/2018.
Exhibit"C" Construction and Reimbursement Schedule is hereby deleted and
replaced with Exhibit"C" Construction and Reimbursement Scheduled Revised 1/2018.
Exhibit"D"—Audit Requirements is deleted in its entirety:
Exhibit"F" -Reimbursement Forms is hereby deleted and replaced with Exhibit"F"
Reimbursement Forms Revised 1/2018.
Exhibit"G" -Documentation of CDBG Requirements is hereby deleted and replaced
with Exhibit"G"-Documentation of CDBG Requirements Revised 1/2018.
Exhibit"K" - Services Performed is hereby deleted and replaced with the attached
Exhibit"K" - Services Performed Revised 1/2018.
Exhibit"L" -MBE Reporting Form (HUD 2516) is hereby deleted and replaced with
the attached Exhibit"L" -MBE Reporting Form (HUD 2516)Revised 1/2018.
Exhibit"M" Report of Program Income is hereby deleted and replaced with the
attached Exhibit"M" Report of Program Income Revised 1/2018.
V.
This amendment is effective as of the Effective Date of the Contract.
VI.
All other terms and conditions of the Contract not amended herein remain unaffected and
in full force and effect, are binding upon the parties, and are hereby ratified by the parties.
Capitalized terms not defined herein shall have the meanings assigned to them in the Contract.
[SIGNATURES APPEAR ON NEXT PAGE.]
FIRST AMENDMENT to CSC NO.48743 Page 6
The Presbyterian Night Shelter of Tarrant County,Inc. Rev.01.30.2018
ACCEPTED AND AGREED:
THE PRESBYTERIAN NIGHT SHELTER OF TARRANT COUNTY, INC.
By: -,-
Toby Owen
Chief Executive Officer
Date: oZ-^��"�g
CITY kRORTH
By: e(
ernand
Assistant City Manager
Date:
ATTEST: APPROVED AS TO FORM AND
LEGALITY:
By: _ z By:
ary J. Ka t edret ;D Vicki S. Ganske, Sr. Asst. City Attorney
M&C: C-28 3 y
Date: November 14,
1295 Cert. No.2017-2
w Y
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.
Name: Z�� -Z�
Chad LaRoque
Acting
pHousi�n7g Development and Grants Manager
Date: ,9 t - /O
OFFICIAL RECORD
FIRST AMENDMENT to CSC NO.48743 CITY SECRETARY Page 7
The Presbyterian Night Shelter of Tarrant County,Inc. FT.WORTH,TX Rev.01.30.2018
EXHIBIT "A"
PROJECT SUMMARY AND SCOPE OF WORK REVISED 1/2018
THE PRESBYTERIAN NIGHT SHELTER OF TARRANT COUNTY,INC.
Capitalized terms not defined herein shall have meanings assigned to them in the Contract.
DESCRIPTION:
Developer will use CDBG funds for a portion of the costs of the rehabilitation of the Lowdon-
Schutts Building,including both interior and exterior work.Additionally,Developer will use some
of the CDBG funds for eligible rehabilitation items at its Main Shelter, including
repair/replacement of old and poorly functioning HVAC units. The National Objective of this
project is to serve individuals and families of whom 100% must meet the HUD definition of a
presumed benefit population, of which definition includes the homeless. The operational capacity
of the Lowdon-Schutts Building is expected to be 160 homeless single women. The operational
capacity of the Main Shelter will be 330 homeless single men once the single women are moved
from the Main Shelter to the Lowdon-Schutts Building.
Developer shall notify City if it substantially changes or modifies Program services at either of the
buildings to enable City to determine if such changes affect the National Objective, the CDBG
Requirements, ,or other requirements of the CDBG Regulations.Developer
further agrees that it will notify City of any other services that it offers on a regular basis to clients
using the buildings in order to determine if such services are eligible for presumed benefit clients
using those additional services and to determine if the additional services can be counted towards
the National Objective, the CDBG Requirements, or other applicable
requirements of the CDBG Regulations.
The Lowdon-Schutts Building is located at 2401 Cypress Street, Fort Worth, TX 76102, and the
Main Shelter is located at 2400 Cypress Street, Fort Worth, TX 76102. Developer owns and
operates other buildings adjacent to the Property in which it offers shelter and services to the
homeless. The adjacent buildings to the Property and the Lowdon-Schutts Building and the Main
Shelter are commonly known as the Presbyterian Night Shelter. None of the CDBG Funds
provided under this Contract shall be used for any purpose in any other building owned and
operated by Developer as part of the Presbyterian Night Shelter other than the Lowdon-Shutts
Building and the Main Shelter as more specifically described in this Contract and the Exhibits.
Developer will be entitled to make Reimbursement Requests until 30 days after the Completion
Deadline.
PROJECT OBJECTIVES:
Developer will rehabilitate the Lowdon-Schutts Building to create an emergency shelter for
homeless single women who are currently housed with men in the Main Shelter. The Lowdon-
Schutts Building will provide a safer and more secure environment for homeless single women
who often feel unsafe sharing shelter space with men. Additionally, Developer will perform
eligible rehabilitation items at its Main Shelter, including needed repair/replacement of HVAC
units in order to create a safe and healthy environment for the clients of the Main Shelter.
First Amendment to CSC No.48743-EXHIBITS Page 1
The Presbyterian Night Shelter of Tarrant County,Inc. Rev. 1.30.18
SPECIFIC PURPOSE:
The purpose of the project is to rehabilitate the Lowdon-Schutts Building to provide an emergency
shelter for homeless single women and to perform rehabilitation items at the Main Shelter,
including needed repair/replacement of poorly working HVAC units in that building. The project
will meet the National Objective of serving low to moderate income persons, specifically the
homeless, who are a presumed benefit population.
First Amendment to CSC No.48743 -EXHIBITS Page 2
The Presbyterian Night Shelter of Tarrant County,Inc. Rev. 1.30.18
EXHIBIT "A-2"
ENVIRONMENTAL MITIGATION ACTION REVISED 1/2018
THE PRESBYTERIAN NIGHT SHELTER OF TARRANT COUNTY, INC.
No mitigations are required.
This categorically excluded activity/project converts to EXEMPT per Section 58.34(a)(12),
because it does not require any mitigation for compliance with any listed statutes or authorities,
nor requires any formal permit or license. Funds may be committed and drawn down after
certification of this part for this (now) EXEMPT project.
First Amendment to CSC No.48743 -EXHIBITS Page 3
The Presbyterian Night Shelter of Tarrant County,Inc. Rev. 1.30.18
EXHIBIT "B"
BUDGET REVISED 1/2018
THE PRESBYTERIAN NIGHT SHELTER OF TARRANT COUNTY, INC.
SOURCES AND USES
Proiect: Rehabilitation of Lowdon-Schutts Building and Rehabilitation Items at Main
Shelter, including Needed Repair/Replacement of HVAC Units at Main Shelter
Source No. Funding Priority of Rehab Loan Grant Financing
Description Lien Stage Amounts Participants
Amount
1 CDBG Loan 1st $330,000.00 City of Fort
Worth
2 Bank Loan 2nd $500,000.00 Federal
Home Loan
Bank of
Dallas
3 Other NA $100,000.00 The Fort
Grants and Worth
Donations Foundation
TOTAL $330,000.00 $600,000.00 TOTAL
SOURCES SOURCES:
OF FUNDS $930,000.00
TOTAL $930,000.00
USES OF
FUNDS
CDBG FUNDS BUDGET
Constructions Costs for Rehabilitation of $330,000.00
Lowdon-Schutts Building and Rehabilitation
Items at Main Shelter, including Needed
Repair/Replacement of HVAC Units at Main
Shelter
TOTAL $330,000.00
First Amendment to CSC No.48743 -EXHIBITS Page 4
The Presbyterian Night Shelter of Tarrant County,Inc. Rev. 1.30.18
EXHIBIT "C"
CONSTRUCTION AND REIMBURSEMENT SCHEDULE REVISED 1/2018
THE PRESBYTERIAN NIGHT SHELTER OF TARRANT COUNTY, INC.
Activity CDBG Funds
PHASE I and II Costs for Rehabilitation of Lowdon-Schutts
ACTIVITIES Building
PHASE I Contractor/subcontractor/vendor searches under $290,000.00
COMPLETED by: the Federal System for Award Management
August 15,2017 (31ww.sam.2ov) must be submitted prior to any
reimbursement under the Phase.
• Inspections by Neighborhood Services
Department Inspectors
PHASE II Final Reimbursement for Costs for Rehabilitation $10,000.00
COMPLETED by: of Lowdon-Schutts Building
March 1,2018 • Contractor/subcontractor/vendor searches
under the Federal System for Award
Management(www.sam.gov) must be
submitted prior to any reimbursement
under this Phase
• Punch List/Final Inspections by
Neighborhood Services Department
Inspectors, if applicable
• Rehabilitation Completed
PHASE III Rehabilitation Items at Main Shelter, including
ACTIVITIES Needed Repair/Replacement of HVAC Units at
Main Shelter
PHASE III • Contractor/subcontractor/vendor searches $25,000.00
COMPLETED by: under the Federal System for Award
May 1,2018 Management(www.sam.2ov) must be
submitted prior to any reimbursement
under this Phase
• Inspections by Neighborhood Services
Department Inspectors, if applicable
FINAL PAYMENT Final Reimbursement for Rehabilitation Items at $5,000.00
PHASE COMPLETED Main Shelter, including Needed Repair/
by: August 21,2018 Replacement of HVAC Units at Main Shelter
• Punch List/Final Inspections by
Neighborhood Services Department
Inspectors, if applicable
• Rehabilitation Completed
TOTAL CDBG FUNDS $330,000.00
First Amendment to CSC No.48743-EXHIBITS Page 5
The Presbyterian Night Shelter of Tarrant County,Inc. Rev. 1.30.18
EXHIBIT "D"
AUDIT REQUIREMENTS
THE PRESBYTERIAN NIGHT SHELTER OF TARRANT COUNTY, INC.
Intentionally Deleted
First Amendment to CSC No.48743-EXHIBITS Page 6
The Presbyterian Night Shelter of Tarrant County,Inc. Rev. 1.30.18
EXHIBIT "F"
REIMBURSEMENT FORMS REVISED 1/2018
THE PRESBYTERIAN NIGHT SHELTER OF TARRANT COUNTY, INC.
First Amendment to CSC No.48743 -EXHIBITS Page 7
The Presbyterian Night Shelter of Tarrant County,Inc. Rev. 1.30.18
INVOICE
Developer: The Presbyterian Night Shelter of Tarrant County,Inc.
Address: P.O.Box 2645
City,State,Zip: Fort Worth,TX 76113
Project: Rehabilitation of Lowdon-Schutts Building and Main Shelter Building
Tax ID NO.:
Amount
Developer's Certification: I certify that the costs incurred are valid and consistent with the terms and conditions
of the Contract between City and Developer. By signing this invoice,I certify that to the best of my knowledge
and belief the data included in this report is true and accurate. It is acknowledged that the provision of false
information could leave the certifying official subject to the penalties of federal,state,and local law.
Signature and Date:
Name:
Title:
First Amendment to CSC No.48743-EXHIBITS Page 8
The Presbyterian Night Shelter of Tarrant County,Inc. Rev. 1.30.18
Attachment II
City of Fort Worth
Neighborhood Services Department
Expenditure Worksheet
Agency:The Presbyterian Night Shelter of
Tarrant County,Inc.
Program:Rehabilitation of Lowdon-Schutts
Building and Main Shelter Building
Ck=k
:Elite No. ' No. Date l dv Account Code Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
TOTAL
First Amendment to CSC No.48743-EXHIBITS Page 9
The Presbyterian Night Shelter of Tarrant County,Inc. Rev. 1.30.18
EXHIBIT "G"
DOCUMENTATION OF CDBG REQUIREMENTS REVISED 1/2018
THE PRESBYTERIAN NIGHT SHELTER OF TARRANT COUNTY, INC.
Capitalized terms not defined in this Exhibit shall have meanings assigned to them in the Contract.
NATIONAL OBJECTIVE:
All clients receiving services in the Lowdon-Schutts Building and/or the Main Shelter must qualify
as homeless and therefore be presumed benefit clients.
In order to meet the National Objective, Developer will list all clients who receive services at the
Lowdon-Schutts Building and the Main Shelter on the attached Unduplicated Client Data Report
—Attachment III for each building. Clients will be listed the first time each client is served each
year of the Performance Period. A separate Report must be submitted for each building.
CDBG REQUIREMENTS:
During Term of Contract:
Developer will use the CDBG Funds to rehabilitate the Lowdon-Schutts Building located at 2401
Cypress Street,Fort Worth, TX 76102 in order to create an emergency shelter for homeless single
women. Developer will spend CDBG funds on eligible costs of the rehabilitation of the Lowdon-
Schutts Building.Developer will also use$30,000.00 of the CDBG funds for eligible rehabilitation
items in the Main Shelter,including repair/replacement of old and poorly functioning HVAC units
in that building.
During Term of Performance Period:
In consideration of the CDBG Funds provided through this Contract,Developer agrees to provide
the following information and meet the following requirements for clients served in the Lowdon-
Schutts Building and the Main Shelter.
• Once every quarter submit the attached Unduplicated Client Data Report—Attachment
III listing all clients served in each building. The Unduplicated Client Data Report —
Attachment III summarizes information regarding the household income, size, race,
ethnicity, gender of head of household, disability status, and income for all clients served
by Developer in the Lowdon-Schutts Building and the Main Shelter the first time during
each quarter.Clients served once during each year of the Performance Period shall only be
counted the first time they are served when determining the total count of Unduplicated
Clients.
• Each quarterly report will be due as follows during the Performance Period:
0 1St quarter(October-December)report due January 15
0 2nd quarter(January-March)report due April 15
0 3rd quarter(April-June) report due July 15
0 4th quarter(July-September)report due September 30
First Amendment to CSC No.48743 -EXHIBITS Page 10
The Presbyterian Night Shelter of Tarrant County,Inc. Rev. 1.30.18
• Each report should contain a list of Unduplicated Clients served for the quarter for each
building and should be emailed to the Compliance Division of the Neighborhood Services
Department. Each report will be a cumulative report, meaning the 2°d quarter report will
contain the clients served on the 1St quarter;the 3rd quarter report will include clients served
in quarters 1 and 2 and so on. A new report will be started October 1 of every year.
• Once every quarter, submit an activity performance report for each building in a format
chosen by Developer. The activity report must include information relevant to the
execution of services/activities taken place at the Lowdon-Schutts Building and the Main
Shelter, such as number and nature of services/activities,number of clients served by each
service/activity, and any other relevant information.
• Meet the CDBG Requirements and National Objective as outlined in the Exhibit"G"
o Each Unduplicated Client served will be listed on the Unduplicated Client Data
Report — Attachment III for each building. The form will be verified by
Developer's staff.
o Developer's staff must ensure that all Unduplicated Clients are listed on the reports.
• In order to ensure compliance with the CDBG Requirements, Developer's staff must be
provided with a copy of this Contract and a relevant CDBG training manual.
First Amendment to CSC No.48743 -EXHIBITS Page 11
The Presbyterian Night Shelter of Tarrant County,Inc. Rev. 1.30.18
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First Amendment to CSC No.48743-EXHIBITS Page 12
The Presbyterian Night Shelter of Tarrant County,Inc. Rev. 1.30.18
EXHIBIT "K"
SERVICES PERFORMED REVISED 1/2018
THE PRESBYTERIAN NIGHT SHELTER OF TARRANT COUNTY, INC.
SERVICES TO BE PROVIDED BY DEVELOPER AT THE LOWDON-SCHUTTS
BUILDING AND THE MAIN SHELTER:
Developer will provide the following services during the Performance Period: emergency shelter
services to homeless single women and homeless single men.
Developer shall notify City if it substantially changes or modifies its Program services at the
Lowdon-Schutts Building and/or the Main Shelter to enable City to determine if such changes
affect the National Objective, the CDBG Requirements or other requirements of the CDBG
Regulations. Developer further agrees that it will notify City of any other services that it offers
on a regular basis to clients at the Lowdon-Schutts Building and/or the Main Shelter in order to
determine if such services are eligible for presumed benefit clients using those additional
services and to determine if the additional services can be counted towards the National
Objective,the CDBG Requirements, or other applicable requirements of
the CDBG Regulations.
Developer agrees to provide to City on request any reports, audits or similar documents that it has
received during the Performance Period from any state or federal agency having regulatory
authority over the Program or any other services offered by Developer in the Lowdon-Schutts
Building and/or the Main Shelter.
First Amendment to CSC No.48743 -EXHIBITS Page 13
The Presbyterian Night Shelter of Tarrant County,Inc. Rev. 1.30.18
EXHIBIT "L"
MBE REPORTING FORM(HUD2516)REVISED 1/2018
THE PRESBYTERIAN NIGHT SHELTER OF TARRANT COUNTY, INC.
Excel Spreadsheet to be provided.
This report is due to the City of Fort Worth by October 5, 2018.
First Amendment to CSC No.48743 -EXHIBITS Page 14
The Presbyterian Night Shelter of Tarrant County,Inc. Rev. 1.30.18
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First Amendment to CSC No.48743 -EXHIBITS Page 15
The Presbyterian Night Shelter of Tarrant County,Inc. Rev. 1.30.18
EXHIBIT "M"
REPORT OF PROGRAM INCOME REVISED 1/2018
THE PRESBYTERIAN NIGHT SHELTER OF TARRANT COUNTY, INC
(Separate forms should be used for the Lowdon-Schutts Building and the Main Shelter)
Report of Program Income
Program Income- Income generated from the use of the building must be reported yearly to the City of Fort Worth.
Please indicate the date the income was received,the source of the income(i.e.-rental fee for outside organization event,sales from
vending machines,cost for services provided in the building,etc..)
Date Source of Income Amount
First Amendment to CSC No.48743-EXHIBITS Page 16
The Presbyterian Night Shelter of Tarrant County,Inc. Rev. 1.30.18
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CERTIFICATE OF INTERESTED PARTIES
FORM 1295
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Complete Nos.I-4 and 6 it 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.
a 2017-272767
Presbyterian Night Shelter
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 10/16/2017
being filed.
City of Fort Worth,Neighborhood Services Department Date Acknowledged:®
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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
Main Shelter HVAC
HVAC repalcement
4 Nature of interest
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling intermediary
5 Check only If there is NO Interested Party.
6 AFFIDAVIT 1 swear,or affirm,under penalty of perjury,that the above d-tsclosure is true and correct.
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• I.ty CammJsaba Fxptres
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o+: Signator authorized agent of Convecting business entity
AFFIX NOTARY STAMP I SEAL ABOVE f
Swom to and subscribed before me.by the said Ike ''T 1,C V1 this the JV�— day of
20 l 1'" .to certify which,witness my hand and seal of office.
SlorAlwof ofilm adinlrilstetg oath Printed tame of officer administering oath TIAs of otAt ar adminia ty oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.3337
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