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HomeMy WebLinkAboutContract 51470C!Tr.�ECRET,ARY Ct N-1 CT NO. _ O AGREEMENT FOR COMMUNITY BASED PROGRAM OGS �6 CASA of Tarrant County, Inc. c= FISCAL YEAR 2019 In consideration of the mutual covenants, promises and agreements contained herein, THIS AGREEMENT ("Agreement") is made and entered into between CITY OF FORT WORTH, a home rule municipal corporation of the State of Texas, ("City") acting by and through Jesus Chapa, its duly authorized Assistant City Manager, and CASA of Tarrant County, Inc. a Texas private non-profit corporation ("Contractor") acting by and through Don Binnicker, CEO, its duly authorized representative. RECITALS WHEREAS, City has determined that Community -Based Programs are necessary to support crime prevention in City during Fiscal Year 2019 to meet one or more of the Crime Control and Prevention District ("CCPD") goals, which are (1) to support efforts to reduce violent crime and gang -related activities through enhanced enforcement activities and crime prevention programs, (2) to support efforts to increase the safety of residents and to decrease crime throughout Fort Worth neighborhoods, and (3) to support efforts to increase the safety of youth and reduce juvenile crime through crime prevention and intervention programs; and WHEREAS, Contractor has agreed to operate a Community -Based Program called Supporting Foster Youth through Permanency and Collaborative Family Engagement, which will support the police department's crime prevention efforts throughout the community; and WHEREAS, City desires to enter into an agreement with Contractor to operate the Supporting Foster Youth through Permanency and Collaborative Family Engagement Program and WHEREAS, City, as consideration for the performance of Contractor, has appropriated monies in the CCPD Budget in the amount of $51,675.00 ("Program Funds") to provide to Contractor on a reimbursable basis for the operation of the Supporting Foster Youth through Permanency and Collaborative Family Engagement Program subject to and in accordance with this agreement; NOW, THEREFORE, in consideration of the mutual covenants herein expressed, the parties agree as follows: AGREEMENT DOCUMENTS The Agreement documents shall include the following: 1. This Agreement between City and Contractor 2. Exhibit A — Proposal Abstract and Narrative 3. Exhibit B — Budget CITY SECRETARY FY 2019 Community Based Program FT WORTH, TX CASA of Tarrant County, Inc. Page 1 of 25 4. Exhibit C — Request for Reimbursement 5. Exhibit D — Program Activities Report 6. Exhibit E — Program Effectiveness Measurement Report 7. Exhibit F — Request for Budget Modification Exhibits A through F, which are attached hereto and incorporated herein, are made a part of this Agreement for all purposes. In the event of any conflict between the terms and conditions of Exhibits A through F and the terms and conditions set forth in the body of this Agreement, the terms and conditions of this Agreement control. DEFINITIONS The term "City" shall include City, and its officers, agents, employees, and representatives. The term "Contractor" shall include Contractor, and its officers, agents, employees, representatives, servants, contractors, and subcontractors. The term "Party" shall refer to either City or Contractor. The term "Parties" shall refer to both City and Contractor. AGREEMENT 1. Responsibilities of Contractor. Contractor covenants and agrees to fully perform, or cause to be performed, with good faith and due diligence, all work and services described in Exhibit "A" — Proposal Narrative. Contractor shall be responsible for day-to-day administration of the Supporting Foster Youth through Permanency and Collaborative Family Engagement program. Contractor agrees to expend the Program Funds in accordance with the Budget as described in Exhibit "B". Program activities shall be reported in accordance with Exhibit "D"- Program Activities Report and effectiveness measures shall be reported in accordance with Exhibit "E"- Program Effectiveness Measures Report. 2. Program Funds. 2.1 In no event shall the total distribution from City made to the Contractor during the Term of this Agreement exceed $51,675.00 ("Program Funds"). 2.2 Payment of the Program Funds from City to Contractor shall be made on a cost - reimbursement basis following receipt by City from Contractor of a signed Request for Reimbursement (RFR), as described in Exhibit "C" along with copies of all receipts and other supporting documentation. Contractor shall deliver to City a written detailed Program Activities Report and Program Effectiveness Measures Report as described in Section 4.2 below with each RFR to support expenditure of Program Funds. Such reports shall be signed by the Contractor or FY 2019 Community Based Program CASA of Tarrant County, Inc. Page 2 of 25 duly authorized officer of the Contractor. The RFR and monthly Program Activities Report shall be submitted to City no later than the 15th day following the end of the month. Submittal of a monthly RFR and Program Activities Report is required even if services are not provided. The monthly RFR, with an original signature by an authorized representative, must be submitted to the Grants and Program Management Section of the Fort Worth Police Department, ATTENTION: Contract Compliance Specialist, Financial Management Division, Bob Bolen Public Safety Complex, 505 W. Felix St., Fort Worth, Texas, 76115. Reimbursements will not be made until after receipt of an acceptable and approved RFR and a monthly Program Activities Report from the Contractor. Additionally, a quarterly Program Effectiveness Measurement Report from Contractor is required as described in section 4.2 and must be approved prior to reimbursements. Reimbursements shall be made within 30 days receipt of said documents. 2.3 Contractor is authorized to modify up to five (5) percent of any budgeted line -item in the original approved budget without prior written permission from City. However, Contractor must submit the Request for Budget Modification Form (Exhibit "F") to City, with the monthly RFR, during the month the modification took place. The new modified budget cannot exceed the total amount of Program Funds. 2.4 Any modifications of more than five (5) percent of any budgeted line -item in the original approved budget must have prior written permission from City before the modifications are made. The Budget Modification Form (Exhibit "F") must be submitted, and request must be approved by City, before any money is moved to the line -item. Once the Budget Modification is approved, the modified budget will take effect on the first day of the following month. The new modified budget shall not exceed the total amount of Program Funds. 2.5 Any modifications to zero line -items in the original approved budget must have prior written permission from City before the modifications are made. The Budget Modification Form (Exhibit "F") must be completed and approved by City before money is transferred into the new line -item. Once the Budget Modification is approved, the modified budget will take effect on the first day of the following month. The new modified budget shall not exceed the total amount of Program Funds. 2.6 Budget modification can only occur within the Direct and Indirect costs. Funds may not be moved from a Direct line -item into an Indirect line -item, or vise versus. Modification of Direct and Indirect approved budgets must follow the guidelines outlined in sections 2.3, 2.4. and 2.5. Budget adjustments shall be submitted to the Contract Compliance Specialist, Financial Management Division, the Fort Worth Police Department at Bob Bolen Public Safety Complex at 505 W. Felix St., Fort Worth, Texas, 76115. 3. Term. This Agreement shall commence upon October 1, 2018 ("Effective Date"), and shall end on September 30, 2019 ("End Date"). All of Contractor's expenditures under this Agreement must be completed no later than September 30, 2019. FY 2019 Community Based Program CASA of Tarrant County, Inc. Page 3 of 25 4. Program Performance. 4.1 Contractor agrees to maintain full documentation supporting the performance of the work and fulfillment of the objectives set forth in Exhibit "A." 4.2 Contractor agrees to provide a monthly Program Activities Report and quarterly Program Effectiveness Measurement Report to document the performance of the work described in Exhibit "D" and Exhibit "E," respectively. The Program Activities and Effectiveness Measures shall document the program activity names, numbers of participants attending, details of the activities, and a description of the goals achieved in support of the CCPD goals. Program Effectiveness Measures shall be reported on a quarterly basis and included in the January, April, July, and October RFR and Program Activities Report submittals. Additionally, the Program Effectiveness Measurement Report must include descriptions of any realized successes. The monthly Program Activities and quarterly Program Effectiveness Measurement Reports shall be submitted to City no later than the 15th day after the end of each month. 4.3 Contractor agrees that the monthly Request for Reimbursement and Program Activities Report and quarterly Program Effectiveness Measurement Report will be submitted to City no later than the 15th day after the end of each month. Should Contractor not meet these requirements, Contractor will be given an additional 15 days to submit the required reports to City. If, at the end of this 15 -day extension period, Contractor has not submitted the required reports, City will send a non-compliance letter notifying Contractor's duly authorized representative of a possible suspension of program funding. 4.4 A representative of the program shall attend quarterly meetings of the Crime Control and Prevention District Board as requested. 5. Default and Termination. 5.1 This Agreement is wholly conditioned upon the actual receipt by City of Program Funds from the CCPD. All monies distributed to Contractor hereunder shall be exclusively from monies received from the CCPD, and not from any other monies of City. In the event that funds from the CCPD are not received in whole or in part, City may, at its sole discretion, terminate this Agreement and City shall not be liable for payment for any work or services performed by Contractor under or in connection with this Agreement. 5.2 In the event no funds or insufficient funds are appropriated by the City in any fiscal year for any payments due hereunder, City will notify Contractor of such occurrence and this Agreement shall terminate on the last day of the fiscal period for which appropriations were received without penalty or expense to the City of any kind whatsoever, except as to the portions of payments herein agreed upon for which funds have been appropriated. 5.3 The City may terminate this Agreement at any time and for any reason by providing the other party with thirty (30) days' written notice of termination. FY 2019 Community Based Program CASA of Tarrant County, Inc. Page 4 of 25 5.4 Termination will be effected by delivering to Contractor written notice of termination. Upon Contractor's receipt of notice of termination, Contractor shall: (a) Stop work under the Agreement on the date and to the extent specified in the notice of termination; (b) Place no further order or subcontracts, except as may be necessary for completion of the work not terminated; (c) Terminate all orders and contracts to the extent that they relate to the performance of the work terminated by the notice of termination; and (d) Cease expenditures of Program Funds, except as may be necessary for completion of the work not terminated. 5.5 In the event City suspends or terminates this Agreement, Contractor expressly waives any and all rights to monetary damages, including but not limited to actual, consequential, and punitive damages, court costs and attorney's fees. 5.6 Within thirty (30) days following the date of termination of this Agreement, Contractor shall return to City any property provided hereunder. City will have no responsibility or liability for Contractor's expenditures or actions occurring after the effective date of termination of the Agreement. 6. Equipment and Maintenance. All equipment purchased with Program Funds must meet all eligibility requirements of City. Contractor shall maintain all equipment used in the administration and execution of Supporting Foster Youth through Permanency and Collaborative Family Engagement Program. Contractor shall maintain, replace, or repair any item of equipment used in support of the Supporting Foster Youth through Permanency and Collaborative Family Engagement program or for use under the terms of this Agreement that no longer functions or is lost or stolen. The cost for maintenance, replacement or repair of any equipment used in support of Supporting Foster Youth through Permanency and Collaborative Family Engagement program and/or for use under the terms of this Agreement is the sole responsibility of Contractor. Contractor shall not use Program Funds to repair or replace said equipment. Contractor shall use any and all equipment purchased with Program Funds exclusively in support of the Supporting Foster Youth through Permanency and Collaborative Family Engagement program. Within 10 days following the purchase of equipment, Contractor shall submit to City a detailed inventory of all equipment purchased with Program Funds to the Grants and Program Management Section at the address set forth in paragraph 2.2 above. The equipment inventory shall include an itemized description of each piece of equipment, the date each piece of equipment was purchased, the cost of purchase for each piece of equipment, and the location of each piece of equipment. 7. Administrative Requirements. 7.1 Contractor agrees to keep sufficient records to document its adherence to applicable local, state, and federal regulations, along with documentation and records of all receipts and expenditures of Program Funds. All records shall be retained for three (3) years following the termination or FY 2019 Community Based Program CASA of Tarrant County, Inc. Page 5 of 25 completion of this Agreement. City or its representatives shall have the right to investigate, examine, and audit at any time any and all such records relating to operations of Contractor under this Agreement. Contractor, its officers, members, agents, employees, and subcontractors, upon demand by City, shall make such records readily available for investigation, examination, and audit. In the event of such audit by City, a single audit of all Contractor's operations will be undertaken and may be conducted either by City or an independent auditor of City's choice. Contractor shall submit a copy of any audit performed by their independent auditor within 30 days of receipt of the final audit report. 7.2 If any audit reveals a questioned practice or expenditure, City shall notify Contractor as soon as reasonably practical. Contractor shall have fifteen (15) days to provide City with a written explanation and any supporting documentation regarding the practice or expenditure. If Contractor fails to resolve or cure the questioned practice or expenditure, to the City's satisfaction, within the fifteen (15) day period, City reserves the right to withhold further Program Funds under this and/or future agreement(s) with Contractor. 7.3 If, as a result of any audit, it is determined that Contractor misused, misapplied or misappropriated all or any part of the Program Funds, Contractor agrees to reimburse City the amount of such monies so misused, misapplied or misappropriated, plus the amount of any sanction, penalty, or other charge levied against City because of such misuse, misapplication or misappropriation. 7.4 Contractor's obligation to City shall not end until all closeout requirements are completed. The closeout requirements shall include, but are not limited to: providing final Program Activities Report and Program Effectiveness Measurement Reports, making final payments, and disposing of Supporting Foster Youth through Permanency and Collaborative Family Engagement assets as appropriate, if deemed required by the City in its sole discretion. 7.5 Contractor covenants and agrees to fully cooperate with City in monitoring the effectiveness of the services and work to be performed by Contractor under this Agreement, and work to be performed by Contractor under this Agreement and City shall have access at all reasonable hours to offices and records of Contractor, its officers, members, agents, employees, and subcontractors for the purpose of such monitoring. Section 7 shall survive the expiration or termination of this Ap_reement. 8. Independent Contractor. 8.1 Contractor shall operate hereunder as an independent contractor and not as an officer, agent, or servant or employee of City. Contractor shall have exclusive control of, and the exclusive right to control, the details of the work and services performed hereunder, and all persons performing same, and shall be solely responsible for the acts and omissions of its officers, members, agents, servants, employees, subcontractors, program participants, licensees, or invitees. The doctrine of respondent superior shall not apply as between City and Contractor, its officers, members, agents, servants, employees, subcontractors, program participants, licensees, or invitees, and nothing herein shall be construed as creating a partnership or joint FY 2019 Community Based Program CASA of Tarrant County, Inc. Page 6 of 25 enterprise between City and Contractor. No federal, state, or local income tax, nor any payroll tax of any kind, shall be withheld or paid by City on behalf of Contractor. Contractor shall not be treated as an employee with respect to the services performed pursuant to this Agreement for federal or state tax purposes. It is expressly understood and agreed that officers, members, agents, employees, subcontractors, licensees, or invitees of Contractor, and any program participants hereunder are not eligible for, and shall not participate in any employer pension, health, or other fringe benefit plan provided by City. It is expressly understood and agreed that City does not have the legal right to control the details of the tasks performed hereunder by Contractor, its officers, members, agents, employees, subcontractors, program participants, licensees, or invitees. 8.2 City shall in no way nor under any circumstances be responsible for any property belonging to Contractor, its officers, members, agents, employees, subcontractors, program participants, licensees or invitees, which may be lost, stolen, destroyed, or in any way damaged. 9. Liability and Indemnification. CONTRACTOR SHALL BE LIABLE AND RESPONSIBLE FOR ANY AND ALL PROPERTY LOSS, PROPERTY DAMAGE AND/OR PERSONAL INJURY, INCLUDING DEATH, TO ANY AND ALL PERSONS, OF ANY KIND OR CHARACTER, WHETHER REAL OR ASSERTED, TO THE EXTENT CAUSED BY THE NEGLIGENT ACT(S) OR OMISSION(S), MALFEASANCE OR INTENTIONAL MISCONDUCT OF CONTRACTOR, ITS OFFICERS, AGENTS, SERVANTS OR EMPLOYEES. CONTRACTOR AGREES TO DEFEND, INDEMNIFY, AND HOLD THE CITY, ITS OFFICERS, AGENTS, SERVANTS, AND EMPLOYEES HARMLESS AGAINST ANYAND ALL CLAIMS, LAWSUITS, ACTIONS, COSTS, AND EXPENSES OF ANY KIND, INCLUDING, BUT NOT LIMITED TO, THOSE FOR PROPERTY DAMAGE OR LOSS (INCLUDING ALLEGED DAMAGE OR LOSS TO OWNER'S BUSINESS AND ANY RESULTING LOST PROFITS) AND/OR PERSONAL INJURY (INCLUDING DEATH) THAT MAY RELATE TO, ARISE OUT OF, OR BE OCCASIONED BY (I) CONTRACTOR'S BREACH OF ANY OF THE TERMS OR PROVISIONS OF THIS AGREEMENT OR (II) ANY NEGLIGENT ACT OR OMISSION OR INTENTIONAL MISCONDUCT OF CONTRACTOR, ITS OFFICERS, AGENTS, ASSOCIATES, EMPLOYEES, CONTRACTORS (OTHER THAN THE CITY), OR SUBCONTRACTORS RELATED TO THE PERFORMANCE OF THIS AGREEMENT, EXCEPT THAT THE INDEMNITY PROVIDED FOR IN THIS SECTION SHALL NOT APPLY TO ANY LIABILITY RESULTING FROM THE SOLE NEGLIGENCE OF THE CITY OR ITS OFFICERS, AGENTS, EMPLOYEES, OR SEPARATE CONTRACTORS, AND IN THE EVENT OF JOINT AND CONCURRENT NEGLIGENCE OF BOTH CONTRACTOR AND CITY, RESPONSIBILITY, IF ANY, SHALL BE APPORTIONED COMPARATIVELY IN ACCORDANCE WITH THE LAWS OF THE STATE OF TEXAS. NOTHING HEREIN SHALL BE CONSTRUED AS A WAIVER OF THE CITY'S GOVERNMENTAL IMMUNITY AS FURTHER PROVIDED BY THE LAWS OF TEXAS. FY 2019 Community Based Program CASA of Tarrant County, Inc. Page 7 of 25 Contractor shall require all of its subcontractors to include in their subcontracts a release and indemnity in favor of City in substantially the same form as above. This section shall survive the expiration or termination of this Agreement. 10. Non -Assignment. No assignment or delegation of duties under this Agreement by Contractor shall be effective without City's prior written approval. 11. Prohibition Against Interest. 11.1 No member, officer, or employee of City, or its designees or agents; no member of the governing body of the locality in which the Supporting Foster Youth through Permanency and Collaborative Family Engagement program is situated; and no other public official of such locality or localities who exercises any functions or responsibilities with respect to Supporting Foster Youth through Permanency and Collaborative Family Engagement program during his tenure or for one year thereafter, shall have any interest, direct or indirect, in any contract or subcontract, or the proceeds thereof, for work to be performed hereunder. Contractor shall incorporate, or cause to be incorporated, like language prohibiting such interest, in all contracts and subcontracts hereunder. 11.2 No officer, employee, member, or program participant of Contractor shall have a financial interest, direct or indirect, in this Agreement or the monies transferred hereunder, or be financially interested, directly or indirectly, in the sale to Contractor of any land, materials, supplies, or services purchased with any funds transferred hereunder, except on behalf of Contractor, as an officer, employee, member, or program participant. Any willful violation of this paragraph with the knowledge, expressed or implied, of Contractor or its subcontractors, shall render this Agreement voidable by City of Fort Worth. 12. Nondiscrimination. 12.1 In accordance with the federal, state, and local laws and ordinances, Contractor covenants that neither it nor any of its officers, members, agents, employees, program participants, or subcontractors, while engaged in performing this Agreement shall in connection with the employment, advancement, or discharge of employees, in connection with the terms, conditions or privileges of their employment, discriminate against persons because of their age, except on the basis of a bona fide occupational qualification, retirement plan, statutory requirement, or statutory or ordinance exception. 12.2 Contractor will not unlawfully discriminate against any person or persons because of age, race, color, religion, sex, disability, national origin, or sexual orientation, nor will Contractor permit its officers, members, agents, employees, subcontractors, or program participants to engage in such discrimination. IF ANY CLAIM ARISES FROM AN ALLEGED VIOLATION OF THIS NON- DISCRIMINATION COVENANT BY CONTRACTOR, ITS PERSONAL REPRESENTATIVES, ASSIGNS, SUBCONTRACTORS OR SUCCESSORS IN FY 2019 Community Based Program CASA of Tarrant County, Inc. Page 8 of 25 INTEREST, CONTRACTOR AGREES TO ASSUME SUCH LIABILITY AND TO INDEMNIFY AND DEFEND THE CITY AND HOLD THE CITY HARMLESS FROM SUCH CLAIM. This section shall survive the expiration or termination of this Agreement. 13. Compliance. 13.1 Contractor, its officers, members, agents, employees, program participants, and subcontractors, shall abide by and comply with all laws, federal, state and local, including all ordinances, rules and regulations of City. If City calls to the attention of Contractor in writing to any such violation on the part of Contractor or any of its officers, members, agents, employees, subcontractors or program participants, then Contractor shall immediately desist from and correct such violation. 13.2 Contractor shall utilize Program Funds strictly for those purposes and goals intended under the terms and conditions of this Agreement. If City calls the attention of Contractor in writing to any such violations on the part of Contractor or any of its officers, members, agents, employees, program participants or subcontractors, then Contractor shall immediately desist from and correct such violation. 14. Governmental Powers. It is understood that by execution of this Agreement, the City does not waive or surrender any of it governmental powers. 15. Waiver of Immunity. If Contractor is a charitable or nonprofit organization and has or claims an immunity or exemption (statutory or otherwise) from and against liability for damages or injury, including death, to persons or property; Contractor hereby expressly waives its rights to plead defensively such immunity or exemption as against City. This section shall not be construed to affect a governmental entity's immunities under constitutional, statutory or common law. 16. Insurance Requirement. 16.1 Coverages and Limits. Contractor shall provide the City with certificate(s) of insurance documenting policies of the following minimum coverage limits that are to be in effect prior to commencement of any work pursuant to this Agreement: (a) Commercial General Liability (CGL): $1,000,000 per occurrence, with a $2,000,000.00 annual aggregate limit, in a form that is acceptable to the City's Risk Manager. (b) Non -Profit Organization Liability or Directors & Officers Liability: $1,000,000 per occurrence, with a $1,000,000 annual aggregate limit, in a form that is acceptable to the City's Risk Manager. (c) Automobile Liability: $1,000,000 each accident on a combined single limit basis OR split limits are acceptable if limits are at least $250,000 Bodily Injury per person, $500,000 Bodily Injury per accident and $100,000 Property Damage. (d) Any other insurance the City may reasonably require to protect the interest of the City. FY 2019 Community Based Program CASA of Tarrant County, Inc. Page 9 of 25 16.2 Contractor's insurer(s) must be authorized to do business in the State of Texas for the lines of insurance coverage provided and be currently rated in terms of financial strength and solvency to the satisfaction of the City's Risk Manager. All insurers must have a minimum rating of A- VII in the current A.M. Best Key Rating Guide, or have reasonably equivalent financial strength and solvency to the satisfaction of Risk Management. If the rating is below that required, written approval of Risk Management is required. 16.3 Each insurance policy required herein shall be endorsed with a waiver of subrogation in favor of the City. Each insurance policy required by this Agreement, except for policies of worker's compensation or accident/medical insurance shall list the City as an additional insured. City shall have the right to revise insurance coverage requirements under this Agreement. 16.4 Contractor further agrees that it shall comply with the Worker's Compensation Act of Texas and shall provide sufficient compensation insurance to protect Contractor and City from and against any and all Worker's Compensation claims arising from the work and services provided under this Agreement. 16.5 The commercial general liability policy shall name the City as an additional insured thereon, as its interests may appear. 16.6 A minimum of Thirty (30) days' notice of cancellation or reduction in limits of coverage shall be provided to the City. Ten (10) days' notice shall be acceptable in the event of non- payment of premium. Notice shall be sent to the Risk Manager, City of Fort Worth, 200 Texas Street, Fort Worth, Texas 76102, with copies to the City Attorney at the same address. 16.7 Any failure on the part of the City to request required insurance documentation shall not constitute a waiver of the insurance requirement. 16.8 Certificates of Insurance evidencing that the Contractor has obtained all required insurance shall be delivered to the City prior to Contractor proceeding with any work pursuant to this Agreement. 17. Miscellaneous Provisions. 17.1 The provisions of this Agreement are severable, and, if for any reason a clause, sentence, paragraph, or other part of this Agreement 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. 17.2 City's failure to insist upon the performance of any term or provision of this Agreement or to exercise any right herein conferred shall not be construed as a waiver or relinquishment to any extent of City's right to assert or rely upon any such term or right on any future occasion. 17.3 Should any action, whether real or asserted, at law or in equity, arise out of the execution, performance, attempted performance or non-performance of this Agreement, venue for said FY 2019 Community Based Program CASA of Tarrant County, Inc. Page 10 of 25 action shall lie in state courts located in Tarrant County, Texas or the United States District Court for the Northern District of Texas, Fort Worth Division. 17.4 Contractor represents that it possesses the legal authority, pursuant to any proper, appropriate and official motion, resolution or action passed or taken, to enter into this Agreement and to perform the responsibilities herein required. 17.5 This written instrument and Exhibits A through F constitute the entire agreement between the parties concerning the work and services to be performed hereunder, and any prior or contemporaneous, oral or written agreement which purports to vary from the terms hereof shall be void. 17.6 Any amendments to the terms of this Agreement must be in writing and must be signed by authorized representatives of each Party. 17.7 None of the performance rendered under this Agreement shall involve, and no portion of the Program Funds received hereunder shall be used, directly or indirectly, for the construction, operations, maintenance or administration of any sectarian or religious facility or activity, nor shall said performance rendered or funds received be utilized so as to benefit, directly or indirectly, any such sectarian or religious facility or activity. 17.8 The parties acknowledge that each party and its counsel have reviewed this Agreement and that the normal rules of construction to the effect that any ambiguities are to be resolved against the drafting party shall not be employed in the interpretation of this Agreement or exhibits hereto. 17.9 Captions and headings used in this Agreement are for reference purposes only and shall not be deemed a part of this Agreement. 17.10 The provisions and conditions of this Agreement are solely for the benefit of City and Contractor and are not intended to create any rights, contractual or otherwise, to any other person or entity. 17.11 Contractor certifies that it has obtained a 501(c)(3) Certificate from the Internal Revenue Service. Contractor shall notify City in writing of any changes to its 501(c)(3) tax-exempt status during the term of this Agreement. 18. Notice. Notices to be provided hereunder shall be sufficient if forwarded to the other party by hand -delivery or via U.S. Postal Service certified mail, postage prepaid, to the address of the other party shown below: CITY: Jesus Chapa, Assistant City Manager City Manager's Office City of Fort Worth 200 Texas Street Fort Worth, TX 76102 FY 2019 Community Based Program CASA of Tarrant County, Inc. Page 11 of 25 Copies To: Financial Management Division Bob Bolen Public Safety Complex 505 West Felix St. Fort Worth, TX 76115 City Attorney's Office Attn: Police Contracts 200 Texas Street Fort Worth, TX 76102 CONTRACTOR: Catelyn Devlin Grants Manager 101 Summit Ave., Suite 505 Fort Worth, TX 76102 19. Immigration Nationality Act. Contractor shall verify the identity and employment eligibility of its employees who perform work under this Agreement, including completing the Employment Eligibility Verification Form (I-9). Upon request by City, Contractor shall provide City with copies of all I- 9 forms and supporting eligibility documentation for each employee who performs work under this Agreement. Contractor shall adhere to all Federal and State laws as well as establish appropriate procedures and controls so that no services will be performed by any Contractor employee who is not legally eligible to perform such services. CONTRACTOR SHALL INDEMNIFY CITY AND HOLD CITY HARMLESS FROM ANY PENALTIES, LIABILITIES, OR LOSSES DUE TO VIOLATIONS OF THIS PARAGRAPH BY CONTRACTOR, CONTRACTOR'S EMPLOYEES, SUBCONTRACTORS, AGENTS, OR LICENSEES. City, upon written notice to Contractor, shall have the right to immediately terminate this Agreement for violations of this provision by Contractor. 20. Background Screening For Persons Working With Children. Contractors are required to conduct criminal background screenings for all volunteers or employees who will be working with children under the proposed program. All criminal background checks shall be in compliance with Texas Department of Family and Protective Services standards, the Texas Administrative Code and all other applicable law. Contractors will be responsible for conducting criminal background screening and for maintaining appropriate records, which will be subject to review by the City. CONTRACTOR SHALL INDEMNIFY CITY AND HOLD CITY HARMLESS FROM ANY PENALTIES, LIABILITIES, OR LOSSES DUE TO VIOLATIONS OF THIS PARAGRAPH BY CONTRACTOR, CONTRACTOR'S EMPLOYEES, SUBCONTRACTORS, AGENTS, OR LICENSEES. FY 2019 Community Based Program CASA of Tarrant County, Inc. Page 12 of 25 IN WITNESS WHEREOF, the parties hereto have executedthis agree -ent in multiple in Fort Worth, Tarrant County, Texas, to be effective this 3s day of , 20 APPROVED AND AGREED FOR CITY OF FORT WORTH Jesus Chapa Assistant City Manager Date: APPROVAL RECOMMENDED Ij 41 --- Joel F. Fitzgerald Chief of Police Date:Dhqlz& APPROVED AS TO FORM AND LEGALITY FOR CITY OF FORT WORTH Thomas R. Hansen 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 re rti equments. Nam : �c(wvti ba yvtti Title: c.{ (;OVVIiwe Epeuktil+ FY 2019 Community Based Program CASA of Tarrant County, Inc. APPROVED AND AGREED FOR CASA of�Tarrant County c. Do Binnicker Chief Executive Officer Date: ZA APPROVED AS TO FORM AND LEGALITY FOR CASA of Tarrant County, Inc. C S of Tarran County, Inc. Date: ( 0 ( u -/(v '� '* IT ...... ATT ST r . Mary J. Kay r 7 � City Secretary O� Date: M&C No. NOT REQUIRED 1295 CERTIFICATION: ;019 -if 13360 OFFICIAL RECO CITY SECRETARY FT. ®R a" Pagq 13'ao f 25 EXHIBIT A SCOPE OF WORK PROGRAM ABSTRACT CASA of Tarrant County is a volunteer -based program advocating for the safety, permanency, and healing of abused and neglected children. CASA recruits, trains, and supervises community members to become volunteer advocates for children during their time in foster care. By forming a relationship with the child and the supportive adults in the child's life, the CASA volunteer learns about the child's unique needs and strengths. They help the child obtain therapeutic services the child needs to heal from their abuse while engaging and empowering the child's social support system to surround the child with social support. Over the course of a twelve-month court case, the CASA volunteer assesses if it would be in the child's best interest to return home, be placed with a relative, or be adopted. The CASA then provides the judge with a recommendation regarding what kind of permanent home would be in the child's best interests. They are one of the most consistent sources of support and stability for the child during their difficult and uncertain time in care, and they advocate that all decisions are made to meet the needs of the whole child. North Texas had the highest number of children aging out of foster care in 2016 and 2017, meaning these children leave foster care when they become adults without a permanent family. Youth who age -out of foster care are incredibly at -risk for future criminal activity: in fact, 50% of youth who age out of foster care are incarcerated by age 23 and are more at -risk to commit violent crimes 18.20• To combat this, in 2017 CASA started using Collaborative Family Engagement (CFE), a research -based program designed to increase and strengthen a child's social capital, creating a large network of lifelong support for the child while maintaining existing family relationships and community connections. CFE's goal is to improve permanency outcomes for children in foster care and reduce the number of children aging out of foster care which in tum helps prevent their involvement in the criminal justice system. After only one year, CASA is seeing a difference in permanency outcomes for children: in 2017, 95% of CASA's cases ended in permanency (i.e. the child was returned home, placed with relatives, or adopted) compared to 85% in 2016, a 10% increase in one year. Despite a growing population and migration to cities, Tarrant County was .the only urban area in Texas that experienced a decrease in the number of children who aged out of foster care from 2016 to 2017 (83 children in 2016; 79 children in 2017)5. CASA's use of CFE has an immediate effect: in 2017, Tarrant County children with CASAs were in foster care on average 19 months compared to the county wide average of 21 months, saving taxpayers over $1,000,000 in foster care payments5. Children directly served by 2017 CCPD funding are living, breathing examples of these larger impacts. Our goal this year was to serve 45 children, and since 10/01/2017, 40 children have received CFE services. These children have had increases in the number of committed adults in their lives, and those adults have been FY 2019 Community Based Program CASA of Tarrant County, Inc. — Exhibit A Page 14 of 25 maintained for ongoing support. Of the four children whose cases closed, 100% found permanency and three of them were in care only 18 months, three fewer months than the average stay. Several children were three reading levels behind and after a few months of literacy and educational advocacy have improved by two -grade levels. All FYI 8 CCPD goals are on track to being met or surpassed by 9/30/18. Our community's children need interventions that work, and with support from CCPD, CASA of Tarrant County can create real change in the lives of Fort Worth foster children. Due to the success of CASA of Tarrant County and the CFE intervention, CASA of Tarrant County has been asked by Texas CASA and UT Austin to serve 270% more children with the CFE intervention in 2018. This program is proven and effective at finding permanency for foster children which is directly correlated with reducing future criminal activity. CASA of Tarrant County respectfully requests a grant of $51,675 to cover the Child Advocacy Specialist position who will supervise and manage a team of volunteers to serve 45 children in fiscal year 2018. Because of Collaborative Family Engagement, Tarrant County children who were destined to age out of foster care are now leaving foster care, living with engaged and committed family, and are surrounded by a larger and empowered support system. By ensuring the child finds permanency as efficiently as possible through Collaborative Family Engagement, CASA changes the child's entire life trajectory, helping them avoid being both the victim and later perpetrator of future pain and instability. With help from the City of Fort Worth, CASA can find family for Fort Worth foster children and in tum, prevent future criminality associated with childhood isolation and aging -out of foster care. FY 2019 Community Based Program CASA of Tarrant County, Inc. — Exhibit A Page 15 of 25 FORT CRIME CONTROL & PREvwnm DlsrRlcr Exhibit B — Budget Narrative 2018-2019 BUDGET SUMMARY Amount Requested A. Direct Personnel $41,340 B. Direct Fringe Benefits $10,335 C. Direct Travel $0 D. Direct Equipment $0 E. Direct Supplies $0 F. Direct Contracts/Consultants $0 G. Indirect Cost up to 10% Iso TOTAL 1$51,675 A. Direct - Personnel Name Position Rate of Pay x # of Hours Naomi Sawyer Child Advocacy Specialist $19.88 x 40 hours (x 52 weeks) TOTAL Personnel Cost $41,340 $41,340 B. Direct - Fringe Benefits Name Position Description of Benefits Cost Naomi Sawyer Child Advocacy Specialist Health insurance, taxes $10,335.00 TOTAL Fringe Benefits $10,335 C. Direct -Travel Purpose of Travel Location Item Cost TOTAL Travel $0 FY 2019 Community Based Program CASA of Tarrant County, Inc. — Exhibit B Page 16 of 25 FORT WORTH CRIAfl. C(Jt.IRU4 Y YREVENTION LISTRICT D. Direct - Equipment Item Cost per Item Quantity Cost TOTAL Equipment $0 E. Direct - Supplies Item Cost per Item Quantity Cost TOTAL Supplies $0 F. Direct - Contracts/Consultants Description of the Service Cost TOTAL Contracts/Consultants $0 * The program budget may use up to 10 percent of the funds requested towards indirect/non- program related expenses. Indirect costs include but are not limited to administrative staff salary, rent or lease payments for administrative offices, utility costs for administrative offices, audit costs and insurance premiums. G. Indirect - Personnel Name Position Rate of Pay x # of Hours Cost TOTAL Personnel $0 H. Indirect —Fringe Benefits Name Position Description of Benefits Cost TOTAL Fringe Benefits $0 I. Indirect - Other Item Cost per Item Quantity Cost TOTAL Other Cost $ 0 FY 2019 Community Based Program CASA of Tarrant County, Inc. — Exhibit B Page 17 of 25 FORT WORTEi CRIME CONTROL & PREvumoN DIaTRIcr i jp K,:ram Please attach a detailed budget narrative that explains the need for all proposed expenditures by individual item. The budget narrative should clearly explain how funds will be used and why expenditures are necessary for successful implementation of your program. Please explain how costs are calculated. A. Direct —Personnel Funding from CCPD in $41,340 would cover the direct personnel salary of the Child Advocacy Specialist (formerly called Casework Supervisor), the most crucial staffing piece of the Collaborative Family Engagement intervention. Each Child Advocacy Specialist maintains a caseload of approximately 25 volunteers at a time. Those volunteers each serve 1 (i.e. a child abuse court case; siblings are considered one case) in a 12 -month period, and with 25 volunteers, Child Advocacy Specialists typically serve at least 25 cases during a 12 -month period. Each case averages 1.75 children per case. 25 cases multiplied by 1.75 children totals to approximately 45 children served by Child Advocacy Specialists. The starting salary for a Child Advocacy Specialist is $41,340. Fort Worth CCPD will cover salary and fringe for a Child Advocacy Specialist only and will not go towards any overhead costs. 100% of funding will go towards program services, specifically the implementation of CFE and advocacy services. Child Advocacy Specialists provide mentoring, coaching, and supervision of volunteers advocating for Fort Worth children. This position ensures volunteer compliance with the agency's minimum standards of expectation, including two visits with the child per month, as well as contact with the child's attorney, observed CPS visits, and contact with teachers, school counselors, therapists and/or daycare as needed. Child Advocacy Specialists are trained in CFE and will be guiding volunteers as they implement the CFE program on their cases. Child Advocacy Specialists work very closely with volunteers, reviewing all CFE tools and attending meetings when a volunteer is unavailable. Volunteers are a cost-efficient way for CASA to implement the CFE intervention, and Child Advocacy Specialists are the critical piece ensuring service delivery. Naomi Sawyer was the Child Advocacy Specialist on the 201712018 CCPD grant to CASA, and she is well versed in reporting requirements. She will serve on the 201812019 CCPD grant if awarded. B. Direct — Fringe: $10,335 will go towards health insurance, retirement, and taxes for Child Advocacy Specialist Naomi Sawyer. C. Direct - Travel: NIA FY 2019 Community Based Program CASA of Tarrant County, Inc. — Exhibit B Page 18 of 25 u-RT ru'*" WO�RTN CRIME CONTROL & PREMMON Dwmicr D. Direct —Equipment: N/A E. Direct —Supplies: N/A F. Direct - Contracts/Consultants: N/A G. Indirect — Cost up to 10%: N/A H. Indirect Cost — Personnel: N/A I. Indirect Cost — Fringe Benefits: N/A Indirect Cost — Other Costs: N/A J. Direct — Fringe K. Direct — Travel L. Direct — Equipment M. Direct — Supplies N. Direct — Contracts/Consultants O. Indirect Cost up to 10% P. Indirect Cost — Personnel Q. Indirect Cost — Fringe Benefits R. Indirect Cost —Other Costs FY 2019 Community Based Program CASA of Tarrant County, Inc. — Exhibit B Page 19 of 25 FORT�RTH CRIME CONTROL & PREYFM70N DISTRICT" Exhibit B Budget Summary Fiscal Year 2019 DIRECT PROGRAM COSTS (90% Minimum) Total $51,675.00 A. PERSONNEL Child Advocacy Specialist — Naomi Sawyer $41,340.00 PERSONNEL TOTAL: $41,340.00 B. FRINGE BENEFITS Naomi Sawyer- health ins, taxes, retirement $10,335.00 FRINGE BENEFITS TOTAL $10,335.00 C. TRAVEL AND TRAINING $0.00 TRAVEL AND TRAINING TOTAL $0.00 D. EQUIPMENT EQUIPMENT TOTAL $0.00 E. SUPPLIES $0.00 SUPPLIES TOTAL $0.00 F. CONTRACTS/CONSULTANTS $0.00 CONTRACTS/CONSULTANTS TOTAL $0.00 G. OTHER APPROVED OTHER APPROVED TOTAL $0.00 INDIRECT PROGRAM COSTS (10% Maximum) Total $0.00 A. PERSONNEL PERSONNEL TOTAL: B. FRINGE BENEFITS FY 2019 Community Based Program CASA of Tarrant County, Inc. — Exhibit B Page 20 of 25 FORT �WORT E� CRIME COOL & PREVF.MiON DISTRICT FRINGE BENEFITS TOTAL C. TRAVEL AND TRAINING TRAVEL AND TRAINING TOTAL D. EQUIPMENT EQUIPMENT TOTAL $0.00 E. SUPPLIES None SUPPLIES TOTAL $0.00 F. CONTRACTS/CONSULTANTS None CONTRACTS/CONSULTANTS TOTAL $0.00 G. OTHER APPROVED None OTHER APPROVED TOTAL $0.00 G RAND TOTAL $51,675.00 FY 2019 Community Based Program CASA of Tarrant County, Inc. — Exhibit B Page 21 of 25 FORT W�oR,T, H CRIME CONTROL & PREVENTION DISTRICT FORT WORTH. ""11� CRIME. CONTROL AND PREVF?fYION DISTRICT Submit To: Bob Bolen Public Safety Complex Atte: Contract Compliance Specialist Financial Management Division 505 West Felix St. Fort Worth, TX 76115 Exhibit C Request for Reimbursement (RFR) FY 2019 Submitting Agency: CASA of Tarrant County Contact Name: Catelyn Devlin Phone Number: 479.871.3416 Email: cateNn.deVin(Mcasatc.org Remit Address: 101 Sumlmit Ave, Suite 505, Fort Worth, TX 76102 Invoice Numlber: Budget Amount Month of Request: (B+C) Total Requested To -Date Supporting documents required with monthly requests. The includes, timesheets depicting CCPD fuaded aetivmes, copy of paychecks, invoices and reeequ detailing all CCPD funded expenditures. Summary Total Budget: $ 51,675.00 Previous Requests: $ This Request: $ Total Requested To -Date S Remaining Funds $ 51,675.00 I have reviewed this request and terrify that these listed expenses and support documentation are accurate. Authorized signatory signatory Title Date Focal Agent Use Only 11ure/wse Order # Fund Dept ID Account RFR Approved Fw Payment Stdr sigrmtme ( Finance Received Stamp Placed Below FY 2019 Community Based Program CASA of Tarrant County, Inc. — Exhibit C Page 22 of 25 A INDIRECT COSTS (10% Maximum) B C D A DIRECTCOSTS (90% Minimum) B C D Told of PreviousB+C Reimbursement& This Month's ToRe RequesTotalque'ted Requested To -Date E A Budget Category $ Budget Amount ToW of Previous Reimbursements This Month's Requested Request (B+C) Total Requested To -Date (A -D Remaining Bance Available A Personnel $ 41,340.00 $ $ $ 41,340.00 B Fringe Benefits $ 10,335.00 S $ $ 10,335.00 C Travel & Training S $ $ S S $ $ $ D Equipment $ $ $ E Supplies $ $ F Contracts/Consultants $ $ G Other Approved $ $ Total Direct Costs 1 $ 51 75.00 1 S S S $ 51 75.00 Supporting documents required with monthly requests. The includes, timesheets depicting CCPD fuaded aetivmes, copy of paychecks, invoices and reeequ detailing all CCPD funded expenditures. Summary Total Budget: $ 51,675.00 Previous Requests: $ This Request: $ Total Requested To -Date S Remaining Funds $ 51,675.00 I have reviewed this request and terrify that these listed expenses and support documentation are accurate. Authorized signatory signatory Title Date Focal Agent Use Only 11ure/wse Order # Fund Dept ID Account RFR Approved Fw Payment Stdr sigrmtme ( Finance Received Stamp Placed Below FY 2019 Community Based Program CASA of Tarrant County, Inc. — Exhibit C Page 22 of 25 A INDIRECT COSTS (10% Maximum) B C D E Budget Category Budget Amount � R ry � Told of PreviousB+C Reimbursement& This Month's ToRe RequesTotalque'ted Requested To -Date A -D Remaining Balance Available A Personnel $ $ B Fringe Benefits $ $ C Travel & Training $ $ D JEquipment $ S E Supplies $ S F Contracts/Consultants $ $ G Other Approved s $ $ Total InDirect Costs $ $ $ $ $ Supporting documents required with monthly requests. The includes, timesheets depicting CCPD fuaded aetivmes, copy of paychecks, invoices and reeequ detailing all CCPD funded expenditures. Summary Total Budget: $ 51,675.00 Previous Requests: $ This Request: $ Total Requested To -Date S Remaining Funds $ 51,675.00 I have reviewed this request and terrify that these listed expenses and support documentation are accurate. Authorized signatory signatory Title Date Focal Agent Use Only 11ure/wse Order # Fund Dept ID Account RFR Approved Fw Payment Stdr sigrmtme ( Finance Received Stamp Placed Below FY 2019 Community Based Program CASA of Tarrant County, Inc. — Exhibit C Page 22 of 25 F� WORTH CRIME CON71O1 & PREYErfnoN DISTRICT Exhibit D Fiscal Year 2019 Monthly Program Activities Report Current Reporting Month Activity Submitting Agency CASA of Tarrant County Contact Name Catelyn Devlin Phone Number and Email 817-877-5891,/ Cate lyn.devIinna,casatc.org Remit Address 101 Summit Ave, Suite 505, Fort Worth, TX 76102 I have reviewed this report and certify that the measures provided are accurate and appropriately reflect the CCPD goals set forth in the contract. Authorized Signatory Signatory Title Date FY 2019 Community Based Program CASA of Tarrant County, Inc. — Exhibit D Page 23 of 25 Activity Current Month Total To Date Total Year End Goal 1 Number of supervised volunteers receiving Collaborative Family Engagement training. 25 2 Number of children receiving Collaborative Family Engagement Intervention. 45 3 Number of children receiving literacy services in Collaborative Family Engagement and/or educational advocacy. 45 4 Number of child contacts made by volunteers each month. 950 5 6 7 8 I have reviewed this report and certify that the measures provided are accurate and appropriately reflect the CCPD goals set forth in the contract. Authorized Signatory Signatory Title Date FY 2019 Community Based Program CASA of Tarrant County, Inc. — Exhibit D Page 23 of 25 FORT WORTH CRIME CONTROL & PREVENMoN DISTRICT Exhibit E Fiscal Year 2019 Quarterly Program Effectiveness Measurement Report Current Reporting Quarter Effectiveness Measures and Quarterly Outcomes Submitting Agency CASA of Tarrant County Contact Name Catelyn Devlin Phone Number and Email 817-877-5891/Catelyn.devlin@casatc.org Remit Address 101 Summit Ave, Suite 505, Fort Worth, TX 76102 Please include outcome narrative that describes how measure was accomplished for each quarter. I have reviewed this report and certify that the measures provided are accurate and appropriately reflect the CCPD goals set forth in the contract. Authorized Signatory Signatory Title Date FY 2019 Community Based Program CASA of Tarrant County, Inc. — Exhibit E Page 24 of 25 Effectiveness Measures and Quarterly Outcomes Measure 1 100% Post -training rate for volunteers' knowledge about Collaborative Family Engagement (CFE). Outcome Measure 2 95% of children will have an increase and/or maintained level of family engagement. Outcome Measure 3 95% of Fort Worth children with closed cases will obtain permanency. Outcome Measure 4 Outcome Measure 5 Outcome I have reviewed this report and certify that the measures provided are accurate and appropriately reflect the CCPD goals set forth in the contract. Authorized Signatory Signatory Title Date FY 2019 Community Based Program CASA of Tarrant County, Inc. — Exhibit E Page 24 of 25 FORTWORTH CRIME CONTROL & PREVENTION DISTRICT • Up to 5% of any budgeted line -item does not need prior approval but form must be sent to City with monthly RFR • More than 5% of any budgeted line -item must have prior City approval • An increase in a zero line -item must have prior City approval • Modifications cannot be made between Direct and Indirect costs Exhibit F Request for Budget Modification Fiscal Year 2019 Date DIRECT COSTS 90% minimum Submitting Agency CASA of Tarrant Count Contact Name Catelyn Devlin Phone Number and Email 817-877-589I/Catelyn.devlin@casatc.org Remit Address 101 Summit Ave, Suite 505, Fort Worth, TX 76102 INDIRECT COSTS 10% maximum Budget Category Approved Budget Change Requested Revised Budget Personnel Fringe Benefits Travel and Training Equipment Supplies Contracts/Consultants Other Approved Total Indirect Costs Modification Narrative (describe in detail what change is for) I have reviewed this request and certify that the listed modifications are correct. Authorized Signatory Signatory Title Date FWPD STAFF USE OnY Modification Approved C3 Modification NOT Approved FWPD Staff Signature Date FY 2019 Community Based Program CASA of Tarrant County, Inc. — Exhibit E Page 25 of 25 DIRECT COSTS 90% minimum Budget Category Approved Budget Change Requested Revised Budget Personnel $41,340.00 Fringe Benefits $10,335.00 Travel and Training Equipment Supplies Contracts/Consultants Other Approved Total Direct Costs $51,675.00 INDIRECT COSTS 10% maximum Budget Category Approved Budget Change Requested Revised Budget Personnel Fringe Benefits Travel and Training Equipment Supplies Contracts/Consultants Other Approved Total Indirect Costs Modification Narrative (describe in detail what change is for) I have reviewed this request and certify that the listed modifications are correct. Authorized Signatory Signatory Title Date FWPD STAFF USE OnY Modification Approved C3 Modification NOT Approved FWPD Staff Signature Date FY 2019 Community Based Program CASA of Tarrant County, Inc. — Exhibit E Page 25 of 25 CERTIFICATE OF INTERESTED PARTIES FORM 3.295 1 of 1 Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2018-413350 CASA of Tarrant County Fort Worth, TX United States Date Filed: 10/10/2018 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. City of Fort Worth Date Ackno ledged: l� 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. FY19 CCPD Contract One Casework Supervisor (staff) to provide advocacy services to improve permanency outcomes for Fort Worth foster children 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. ❑ X 6 UNSWORN DECLARATION My name is and my date of birth is My address is (street) (city) (slate) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in County, State of �Z,�i41-1 on the/�d y of L' , 20,zl month) (year) Signatur4 of authorized agent of contracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.6711