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Contract 51666
STATE OF TEXAS § COUNTY OF TARRANT § This contract ("Contract") is made and entered into by and between the City of Fort Worth (hereafter "City") and AIDS Outreach Center, Inc. (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 Housing Opportunities for Persons with AIDS Program ("HOPWA") Program, Program No. TX-H-18-F002, Catalog of Federal Domestic Assistance No. 14.241; WHEREAS, the HOPWA program is intended to address the needs of eligible persons associated with the challenge of living with HIV/AIDS and their families; WHEREAS, Agency submitted a proposal to use HOPWA funds for an eligible program under the HOPWA Regulations whereby Agency will provide services to low and moderate income persons; WHEREAS, City citizens,the Community Development Council,and the City Council have determined that HOPWA 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 2018 income limits are attached hereto as EXHIBIT "A-1"—2018 HUD Income Limits. Business Diversity Enterprise Ordinance or BDE means the City's Business Diversity Ordinance, Ordinance No. 20020-12-2011. D� JAOPWA PSA CONTRACT 2018.2019 OFFICI M. ORD C is F0�1\N,AIDS Outreach Center,Inc. 16 TARY FT. WORTHo TX G1�Y S� Complete Documentation means the following documentation as applicable: O Attachments I,II, and HI, with supporting documentation including: o Proof of expense: copies of timesheets, invoices, leases, service contracts or other documentation showing that payment is due by Agency. o Proof of payment: cancelled checks, bank statements, or wire transfers necessary to demonstrate that amounts due by Agency were actually paid by Agency. o Proof of client eligibility: Source Documentation sufficient to show that clients participating in the Program are HOPWA Eligible Clients as described in Section 6. a 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. DBE means disadvantaged business enterprise in accordance with 49 CFR Part 26. Director means the Director of the City's Neighborhood Services Department, Effective Date means October 1, 2018. HOPWA means Housing Opportunities for Persons with AIDS. HOPWA 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 Detennining Income and Allowances verified by Source Documentation. The client must also have a documented diagnosis of HIWAIDS. HOPWA Funds means the HOPWA grant funds supplied by City to Agency under the terms of this Contract. HOPWA Regulations means regulations found at 24 CFR Part 574 et Seq. HUD means the United States Department of Housing and Urban Development. IDIS means Integrated Disbursement Information System, HUD's project tracking system. Neighborhood Services Department means the City's Neighborhood Services Department. OMB means the Office of Management and Budget. Program means the services described in EXHIBIT "A"—Program Summary. Reimbursement Request means all reports and other documentation described in Section 9. HOPWA PSA CONTRACT 2018-2019 Page 2 AIDS Outreach Center,Inc. Rev. 9.12.2018 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 HOPWA Eligible Clients served at least once in the Contract Term. HOPWA Eligible Clients served more than once in the Contract Term will only be counted the first time they are served when determining the total count of Unduplicated Clients. 3. TERM. The term of this Contract begins on the Effective Date and terminates on September 30, 2019 unless earlier terminated as provided in this Contract. 4. DUTIES AND RESPONSIBILITIES OF CITY. 4.1 Provide HOPWA Funds. City shall provide up to $656,000 of HOPWA 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 requirements of the HOPWA Regulations during the term of this Contract. 5. DUTIES AND RESPONSIBILITIES OF AGENCY. 5.1 Required Services. Agency shall perform the services described in EXHIBIT "A" — Program Summary in accordance with the terms and conditions of this Contract. 5.2 Use of HOPWA Funds. 5.2.1. Compliance with HOPWA Regulations and Contract. Agency shall be reimbursed for eligible Program costs with HOPWA Funds only if City determines in its sole discretion that: 5.2.1.1 Costs are eligible expenditures in accordance with HOPWA 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. HOPWA PSA CONTRACT 2018-2019 Page 3 AIDS Outreach Center,Inc. Rev.9.12.2018 5.2.2 Budget 5.2.2.1 The IIOPWA 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 July 31,2019. 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 HOPWA Funds to supplement rather than supplant funds otherwise available for the Program. 5.2.4 Payment of HOPWA Funds-to Agency. HOPWA 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 30,2019, City may hold back a small amount of the HOPWA 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 HOPWA Funds not spent or not approved for reimbursement to Agency shall remain with City. HOPWA PSA CONTRACT 2018-2019 Page 4 AIDS Outreach Center,Inc. Rev.9.12.2018 5.3 Pro rare 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: Unduplicated CLeats.ss specified in E=BrY "A" — Program qbntf7 Kx.ORditums _ Su.— 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 delay or withhold payment of Reimbursement Requests, to lower Agency's allocation of HOPWA Funds, or to terminate this Contract. 5.3.3 failure to meet at least 80%of its performance milestones or serve 110 Unduplicated Clients under this Contract may, in City's sole discretion, disqualify Agency for consideration under the City's Request for Proposals for the 2019-2020 Program Year for federal grant funds. 5.3.4 Amendments to performance milestones regarding HOPWA 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 July 31,2019. Notwithstanding the above, any amendments to this Contract shall not reduce the number of Unduplicated CIients stated in Section 5.3.3 and in EXHIBIT"A"—Program Summary. 5.4 Identify Program Expenses Paid with HOPWA Funds. Agency will keep accounts and records in such a manner that City may readily identify and account for Program expenses reimbursed with HOPWA Funds. These records shall be made available to City for audit purposes and shall be retained as required hereunder. 5.5 Pro ram 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 HOPWA Funds without City's written consent. HOPWA PSA CONTRACT 2018-2019 Page 5 AIDS Outreach Center,Inc. Rev.9.12.2018 6. CLIENT ELIGIBILITY VERIFICATION. 6.1 Client Eligibility. Agency will document the eligibility of all prospective clients. Agency may redact the client's personal information and substitute a client number. Agency will document client eligibility as follows: 6.1.1 Income. Agency must verify all new clients' income eligibility with Source Documentation. Agency must use the annual income definition used by 24 CFR Part 5.609 to establish client income eligibility and must use the most current HUD Income Guidelines. 6.1.2 Diagnosis. Agency must submit a signed, dated statement that the client's file contains documentation of the client's diagnosis of HIV/AIDS. The IIIV/AIDS diagnosis must be made by a licensed health care provider; a client's self-certification of diagnosis is not sufficient. Agency should not submit the actual diagnosis to City. 6.1.3 Emerizency Need. For clients receiving short term rental, mortgage or utility assistance, Agency must also verify and document that the client has an emergency need, such as sudden loss of income,eviction, utility shutoff, or extraordinary and unexpected healthcare costs. Agency must submit its policy regarding documenting emergency need to City by October 1,2018. 6.2 Submission of Complete Documentation. Agency must submit copies of documentation of client eligibility described in Section 6.1 with Attachment III in each month's Reimbursement Request for all Unduplicated Clients. 6.3 Maintain Documentation. Agency must maintain copies of all documentation required by this Section 6 for 5 years following the expiration of the Contract term. This Section shall survive the earlier terminations or expirations of this Contract. 7. ADDITIONAL HOPWA REQUIREMENTS. Agency agrees to comply with all requirements of the HOPWA Program as stated in the HOPWA Regulations, including but not limited to the following: 7.1 Environmental Review. HOPWA 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 HOPWA Funds it has already received and forfeit any future payments of HOPWA Funds. HOPWA PSA CONTRACT 2018-2019 Page 6 AIDS Outreach Center,Inc. Rev. 9.12.2018 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 2018- 2019 Action Plan, and (iii) receipt by City of 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 HOPWA 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, 2019 and end on September 30, 2024 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 HOPWA 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 fanuary Reimbursement Request,whichever is earlier. 7.4 Agency Procurement Standards. Agency shall comply with all applicable federal, state and local laws, regulations, and ordinances for malting procurements under this Contract. In addition to the conflict of interest provision in Section 14.13.3, Agency shall establish written procurement procedures to ensure that materials and services are obtained in a cost effective manner and that provides for full and open competition. When procuring materials and services for this Contract, Agency shall comply at a minimum with the procurement standards in 2 CFR Part 200.317 through 2 CFR Part 200.326. HOPWA PSA CONTRACT 2018-2019 Page 7 AIDS Outreach Center,Inc. Rev.9.12.2018 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 snake any contract with parties listed on the government wide System for Award Management, www.sain.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 HOPWA Funds in compliance with 2 CFR Part 200, as applicable. The eligibility of costs incurred for performance rendered shall be determined in accordance with 2 CFR Part 200.400 through 2 CFR Part 200.475. 7.6 Financial Management Standards. Agency agrees to comply with 2 CFR Part 200, as applicable. Agency also agrees to adhere to the accounting principles and procedures required therein, utilize adequate internal controls, and maintain necessary supporting and back-up documentation for all costs incurred in accordance with 2 CFR Part 200.302 and Part 200.303. 7.7 Uniform Administrative Requirements, Cost Prinei les 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 HOPWA 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 HOPWA Regulations. Agency shall monitor the services and work performed by its contractors, subcontractors and vendors on a regular basis for compliance with the HOPWA Regulations and Contract provisions. Agency must cure all violations of the HOPWA Regulations committed by its contractors, subcontractors or vendors. City maintains the right to insist on Agency's full compliance with the terms of this Contract and the HOPWA 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. HOPWA PSA CONTRACT 2018-2019 Page 8 AIDS Outreach Center,Inc. Rev.9.12.2018 7.9 Copyriaht and Patent Ri hts. 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. IIUD 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, 4J 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 HOPWA Funds that provides reasonable assurance that Agency is managing the HOPWA Funds in compliance with federal statutes, regulations, and the terms and conditions of this Contract. These internal controls shall be in compliance with guidance in"Standards for Internal Control in the Federal Government" issued by the Comptroller General of the United States or the "Internal Control Integrated Framework" issued by the Committee of Sponsoring Organizations of the Treadway Commission ("COSO"); 7.12.2 Comply with federal statutes, regulations, and the terms and conditions of this Contract; 7.12.3 Evaluate and monitor Agency's compliance with statutes, regulations and the terms and conditions of this Contract; 7.12.4 Take prompt action when instances of noncompliance are identified including noncompliance identified in audit findings; and 7.12.5 Take reasonable measures to safeguard protected personally identifiable information and other information that HUD or City designates as sensitive or Agency considers sensitive consistent with applicable federal, state, local and tribal laws regarding privacy and obligations of confidentiality. 7.13 Required Certification of Completion of Training. At least 1 Agency employee must complete the IIUD required "Getting to Work Training Curriculum" by April 15, 2019 and submit the required certifications to City with the April 2019 HOPWA PSA CONTRACT 2018-2019 Page 9 AIDS Outreach Center,Inc. Rev.9.12.2018 Reimbursement Request as more particularly described on EXHIBIT "A-2" — Requirements for Completion of"Getting to Work Training Curriculum". 7.14 Housing Quality Standards. All housing assisted under this Contract must meet housing quality standards and habitability standards as required by 24 CFR Part 574.310(b). City shall have the right to inspect to confirm compliance with these standards. 7.15. Violence Against Women Act Requirements 7.15.1 Agency shall comply with the Violence Against Women Act ("VAWA") and shall ensure that any property owner,manager, or facility assisted by the HOPWA Funds shall,at the time of application for services,provide all clients receiving rental assistance with a Notice of Occupancy Rights under the Violence Against Women Act in substantially the same form as the form attached and incorporated as Exhibit "L"-Notice of Occupancy Rights Under VAWA in compliance with VAWA and 24 CFR Part 574.604(a)(2),where applicable. 7.15.2 Agency agrees that no applicant for HOPWA assistance may be denied admission or assistance under the Program on the basis or as a direct result of the fact that they are or have been a victim of domestic violence, dating violence, sexual assault, or stalking, as long as they would otherwise qualify for the Program. 7.15.3 Agency shall be responsible for reviewing VAWA and 24 CFR Part 574.604 and shall respond to all emergency transfer requests in accordance with the requirements of those provisions. Agency may request that all clients requesting an emergency transfer under VAWA fill out the form attached and incorporated as Exhibit "M" — VAWA Emergency Transfer Request Form. 7.15.4 Agency shall document and report to City any VAWA emergency transfer request and outcome in compliance with 24 CFR Part 91.520 and 24 CFR Part 574 8. RECORD KEEPING; REPORTING AND DOCUMENTATION REQUIRE,MENTS• 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 terra 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. HOPWA PSA CONTRACT 2018-2019 Page 10 AIDS Outreach Center,Inc. Rev.9.12.2018 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, 2019 and end on September 30, 2024 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 Chance in Reportinlz Requirements and Forms City retains the right to change reporting requirements and forms at its discretion. City will notify Agency in writing at least 15 days prior to the effective date of such change, and the Parties shall execute an amendment to the Contract reflecting such change if necessary. 8.5 Audit 8.5.1 Entities that Expend $750,000 or more in Federal Funds Per Year All non-federal entities that expend $750,000 or more in federal funds within 1 year, regardless of the source of the federal award, must submit to City an annual audit prepared in accordance with specific reference to 2 CFR Part 200.501 through Part 200.521. The audit shall cover the Agency's fiscal years during which this Contract is in force. The audit must be prepared by an independent certified public accountant, be completed within G 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 HOPWA Regulations or other HOPWA PSA CONTRACT 2018-2019 Page 1 I AIDS Outreach Center,Inc. Rev.9.12.2018 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, 2019 and end on September 30, 2024 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 HOPWA FUNDS OR SPENT HOPWA 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 RE UIREMENTS 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 I5tl day of the month following the month expenses were paid by Agency. For example, the Reimbursement Request for June expenses must be received by July 15. In the event the 15" fails 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 11.1. NOTWITHSTANDING ANYTHING ABOVE, THE REIMBURSEMENT REQUEST FOR EXPENSES INCURRED FOR SEPTEMBER 2019 MUST BE RECEIVED BY OCTOBER 1, 2019. COMPLETE DOCUMENTATION FOR ALL SEPTEMBER 2017 EXPENSES MUST BE SUBMITTED BY OCTOBER 15, 2019. FAILURE TO SUBMIT A FINAL REIMBURSEMENT REQUEST WITH COMPLETE DOCUMENTATION BY OCTOBER 15, 2019 WILL RESULT IN FORFEITURE OF PAYMENT OF THE SEPTEMBER REIMBURSEMENT REQUEST. 9.1.2 City will notify Agency by e-mail within 14 calendar days if a Reimbursement Request is lacking Complete Documentation or corrections are needed.Agency will have 7 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 2019-2020 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 9.1.2. 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: HOPWA PSA CONTRACT 2018-2019 Page 12 AIDS Outreach Center,Inc. Rev.9.12.2018 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). 9.2.1.1 Agency must submit a separate invoice for each activity type, i.e. Administration, Facility Based Operating Costs, Supportive Services, Short-term Rent, Mortgage and Utility Assistance ("STRMU"), and Tenant Based Rental Assistance ("TBRA"). 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 HOPWA-funded time and non-HOPWA funded time and reflect actual time spent on HOPWA-funded activities. Agency may not submit payroll expenses dated 60 calendar days prior to the date of the Reimbursement Request. 9.2.2.2 For non-payroll expenses, invoices for each expense listed with an explanation as to how the invoiced expense pertains to the Program. Agency may not submit invoices dated 60 calendar days prior to the date of the Reimbursement Request. 9.2.2.3 Proof that each expense was paid by Agency,which proof can be satisfied by canceled checks, wire transfer documentation, paid receipts or other appropriate banking documentation. 9.2.3 Attachment III-- Client Data Report. This report shall list each Unduplicated Client served during the month along with his or her demographic information. The Client Data Report must maintain a list of all clients served during the Contract term. In order for this report to be complete,the following must be submitted: 9.2.3.1 Documentation of income verification for each Unduplicated Client the first time the client is served by the Program, which will be Source Documentation. 9.2.4 Overview Report. Agency shall submit the Overview, Report, attached hereto as EXHIBIT "H" — Overview Report, quarterly with the December, March, June and September Reimbursement Requests. 9.2.5 Deli-very of Reimbursement Request. Reimbursement Requests will be submitted through ZoomGrants on the designated due date. HOPWA PSA CONTRACT 2018-2019 Page 13 AIDS Outreach Center,Inc. Rev. 9.12.2018 9.3 Withholdinj 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 7 calendar days from the date of the written notice to submit such Reimbursement Request to cure the default. If Agency fails to cure the default within such time, Agency shall forfeit any payments otherwise due that month. 10.1.2 If Agency fails to submit requested information or missing documentation as set forth in Section 9.1.2, then Agency shall forfeit payment due that month and the failure to submit shall be considered an event of default that shall not be cured. 10.1.3 NOTWITHSTANDING THE PROVISIONS OF SECTION 10.1.1 OR 10.1.2, IF AGENCY FAILS TO SUBMIT THE REIMBURSEMENT REQUEST DUE OCTOBER 1, 2019, OR IF THE SUBMITTED REIMBURSEMENT REQUEST FOR OOCTOBER 1,2019 IS LATE,INCOMPLETE OR OTHERWISE NOT IN COMPLIANCE WITH THIS CONTRACT OR THE HOPWA REGULATIONS AS DETERMINED BY CITY IN ITS SOLE DISCRETION, THERE WILL BE NO CURE PERIOD AND ANY REIMBURSEMENT WILL BE FORFEITED. 10.1.4 In the event of(i) an uncured default under Section 10.1.1 or an event of default under 10.1.2 (ii) or more than 2 instances of default, cured or uncured, under these Sections, City reserves the right at its sole option to terminate this Contract effective immediately upon written notice of such intent with no penalty or liability to City. 10.1.5 Notwithstanding anything to the contrary herein, City will not be required to pay any HOPWA 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 HOPWA 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 HOPWA 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 HOPWA PSA CONTRACT 2018-2019 Page 14 AIDS Outreach Center,Inc. Rev.9.12.2018 HOPWA 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 HOPWA 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 HOPWA Funds paid to Agency must be repaid to City within 30 days of termination. If such HOPWA funds are not repaid to City within the 30 day period, City shall exercise all legal remedies available under this Contract. 10.3 In General. 10.3.1 Subject to Section 10.2, and unless specifically provided otherwise in this Contract, Agency shall be in default under this Contract if Agency breaches any term or condition of this Contract. In the event that such a breach remains uncured after 30 calendar days following written notice by City (or such other notice period as may be specified herein) or, if Agency has diligently and continuously attempted to cure following receipt of such written notice but reasonably requires more than 30 calendar days to cure, as determined by both Parties mutually and in good faith, City shall have the right to elect in City's sole discretion to (i) extend Agency's time to cure, (ii) terminate this Contract effective immediately upon written notice of such intent to Agency, or (iii)pursue any other legal remedies available to City under this Contract. 10.3.2 City's remedies may include: 10.3.2.1 Direct Agency to prepare and follow a schedule of actions for carrying out the affected activities, consisting of schedules, timetables and milestones necessary to implement the affected activities. 10.3.2.2 Direct Agency to establish and follow a management plan that assigns responsibilities for carrying out the remedial activities. 10.3.2.3 Reprogram HOPWA Funds that have not yet been expended from affected activities to other eligible activities or withhold HOPWA 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 11.3, all HOPWA Funds awarded but unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency shall have HOPWA PSA CONTRACT 2018-2019 Page 15 AIDS Outreach Center,Inc. Rev. 9.12.2018 no further right to such funds, and any HOPWA Funds already paid to Agency must be repaid to City within 30 days of the termination. Failure to repay such HOPWA 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 HOPWA Funds will be paid to Agency until all defaults are cured to City's satisfaction. 1.0.5 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 HOPWA Funds awarded but unpaid to Agency pursuant to this Contract shall be immediately rescinded and Agency shall have no further right to such funds and any HOPWA Funds already paid to Agency must be repaid to City within 30 days of termination. Failure to repay such HOPWA 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 HOPWA 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 HOPWA Funds substantially in accordance with this Contract. HOPWA PSA CONTRACT 2018-2019 Page 16 AIDS Outreach Center,Inc. Rev.9.12.2018 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 HOPWA 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 HOPWA 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 HOPWA 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 HOPWA Funds, and any real or personal property owned by Agency that was improved with the HOPWA Funds shall automatically transfer to City or to such assignee as City may designate. 11. REPAYMENT OF HOPWA FUNDS. All HOPWA Funds are subject to repayment in the event the Program does not meet the requirements of this Contract or in the HOPWA Regulations. If Agency takes any action that results in the City being required to repay all or any portion of the HOPWA 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 HOPWA Funds is required of City,Agency agrees City may require that 10% of the HOPWA Funds be repaid to City as liquidated damages. The Parties agree that City's damages in the event of either repayment to I-IUD being required or receiving a finding from HUD are uncertain and would be difficult to ascertain and may include an impact on City's HOPWA 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 HOPWA 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 HOPWA Funds HOPWA PSA CONTRACT 2018-2019 Page 17 AIDS Outreach Center,Inc. Rev.9.12.2018 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 HOPWA 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 HOPWA 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, 2019 and end on September 30, 2024 regardless of whether or not this Contract is earlier terminated. 14. GENERAL PROVISIONS. 14.1 Agency an Independent Contractor. Agency shall operate hereunder as an independent contractor and not as an officer, agent, servant or employee of City. Agency shall have exclusive control of, and the exclusive right to control, the details of the work and services performed hereunder, and all persons performing same, and shall be solely responsible for the acts and omissions of its officers, members, agents, servants, employees, contractors, subcontractors, vendors, clients, licensees or invitees. 14.2 Doctrine of Respondeat Superior. The doctrine of respondeat superior shall not apply as between City and Agency, or its officers, members, agents, servants, employees, contractors, subcontractors, vendors, clients, licensees or invitees, and nothing herein shall be construed as creating a partnership or joint enterprise between City and Agency. City does not have the legal right to control the details of the tasks performed hereunder by Agency, its officers, members, agents, employees, contractors, subcontractors, vendors, clients, licensees or invitees. 14.3 Agency Property, City shall under no circumstances be responsible for any properly 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 ReIiLFious Organization. Agency shall comply with all applicable requirements as more particularly described in 24 CFR Part 5.109. No portion of the HOPWA 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 HOPWA-funded service. HOPWA PSA CONTRACT 2018-2019 Page 18 AIDS Outreach Center,Inc. Rev.9.12.2018 14,5.1. Separation of Expficit!j Explicit! 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 I-IOPWA 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 HOPWA Funds and participation must be voluntary for clients of a HOPWA-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 HOPWA-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 HOPWA-funded program or activity. In addition, if a client or prospective client of a HOPWA- funded service objects to the religious character of Agency,then Agency must promptly undertake reasonable efforts to identify and refer the client or prospective client to an alternate provider to which_the client or prospective client has no such objection, as more particularly described in 24 CFR Part 5.109. 14.6 Venue. Venue shall lie in Tarrant County, Texas for any action, whether real or asserted, at law or in equity, arising out of the execution, performance, attempted performance or non-performance of this Contract. 14.7 Governing Law. This Contract shall be governed by and construed in accordance with the laws of the State of Texas. If any action, whether real or asserted, at law or in equity, arises out of the execution, performance or non-performance of this Contract or on the basis of any provision herein, for any issue not governed by federal law,the choice of law shall be the laws of the State of Texas. 14.8 Severability. The provisions of this Contract are severable, and if for any reason a clause, sentence, paragraph or other part of this Contract shall be determined to be invalid by a court or federal or state agency,board or commission having jurisdiction over the subject matterthereof,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 HOPWA PSA CONTRACT 2018-2019 Page 19 AIDS Outreach Center,Sync. Rev.9.12.2018 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: ➢ I-IOPWA Regulations found in 24 CFR Part 574 ➢ AIDS Housing Opportunity Act, as amended (42 USC 12901 et seq.) ➢ 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 Vlll 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 etseq.) ➢ 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 1 I738. 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 CIean 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 HOPWA PSA CONTRACT 2018-2019 Page 20 AIDS Outreach Center,Inc. Rev.9.12.2018 ➢ 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) ofPub.L. 110-252 and Section 3 ofPub.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. X1310. 14.12 urY�'._- Assisted A oieetsztnd Employment and other Eeenontie 14.13 Prohibition A14ainst 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 574.603 and Chapter 17,Article III, Division 4 —Fair Housing of the City Code. Agency may not discriminate against any person because of race, color, sex, gender, religion, national origin, familial status, disability or perceived disability, sexual orientation, gender identity, gender expression, or transgender, nor will Agency permit its officers, members, agents, employees, or clients to engage in such discrimination. This Contract is made and entered into with reference specifically to Chapter 17, Article 111, Division 3 -Employment Practices of the City Code, and Agency hereby covenants and agrees that Agency, its officers, members, agents, employees and contractors, have fully complied with all provisions of same and that no employee, or applicant for employment has been discriminated against under the terms of such ordinances by either or its officers, members, agents, employees or contractors. HOPWA PSA CONTRACT 2018-2019 Page 21 AIDS Outreach Center,Inc. Rev.9.12.2018 1 X1.13.2 No Discrimination in Employment during the Performance of This Contract. During the performance of this Contract Agency agrees to the following provision, and will require that its contractors and subcontractors also comply with such provision by including it in all contracts with its contractors: [Contractor's, Subcontractor's or Vendor's name] will not unlawfully discriminate against any employee or applicants for employment because of race, color, sex, gender, religion, national origin, familial status, disability or perceived disability, sexual orientation, gender identity, gender expression or transgender. [Contractor's, Subcontractor's or Vendor's name]will tape 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 namej, state that all qualified applicants will receive consideration for employment without regard to race, color, sex, gender, religion, national origin, familial status, disability or perceived disability, sexual orientation, gender identity, gender'expression or transgender. [Contractor's, Subcontractor's or Vendor's name] covenants that neither it nor any of its officers, members, agents, employees, or contractors, while engaged.in performing this Contract, shall, in connection with the employment, advancement or discharge of employees or in connection with the terms, conditions or privileges of their employment, discriminate against persons because of their age or because of any disability or perceived disability, except on the basis of a bona fide occupational qualification, retirement plan or statutory requirement. [Contractor's, Subcontractor's or Vendor's name] further covenants that neither it nor its officers, members, agents, employees, contractors, or persons acting on their behalf, shall specify, in solicitations or advertisements for employees to work on this Contract, a maximum age limit for such employment unless the specified maximum age limit is based upon a bona fide occupational qualification, retirement plan or statutory requirement. 14.13.3 Aaeney'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 HOPWA PSA CONTRACT 2018-2019 Mage 22 AIDS Outreach Center,Inc. Rev.9.12.2018 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 A13OVE-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 HOPWA 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 HOPWA services, may obtain a financial interest or benefit from a HOPWA-assisted activity, or have an interest in any contract, subcontract or agreement with respect thereto, or the proceeds thereunder, either for themselves or those with whom they have family or business ties, during their tenure or for 1 year thereafter. 14.14.2.1 Agency shall establish conflict of interest policies for federal awards including the 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 200.318, shall apply in the procurement of property and services by Agency. In all cases not governed by those Sections, the provisions of 24 CFR Part 574.625 of the HOPWA 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. HOPWA PSA CONTRACT 2018-2019 Page 23 AIDS Outreach Center,Inc. Rev. 9.12.2018 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 15.13.3.2, Agency may set standards of conduct for situations in which the financial interest is not substantial or the gift is an unsolicited item of nominal value. Such standards of conduct must provide for disciplinary actions to be applied for violations of such standards by Agency's officers, employees or agents. 14.14.3.4 Agency shall maintain written standards of conduct covering organizational conflicts of interest. Organizational conflicts of interest means that because of relationships with a parent company, affiliate,or subsidiary organization,Agency is unable or appears to be unable to be impartial in conducting a procurement action involving a related organization. 14.14.3.5 Agency must maintain records sufficient to detail the history of procurement. These records will include, but are not necessarily limited to the following: rationale for the method of procurement, selection of contract type, contractor selection or rejection, and the basis for the contract price. 14.14.4 Disclosure of Conflicts of Interest. In compliance with 2 CFR Part 200.112, Agency is required to timely disclose to City in writing any potential conflict of interest. 14.14.5 Disclosure of Texas Penal Code Violations. Agency affirms that it will adhere to the provisions of the Texas Penal Code which prohibit bribery and gifts to public servants. 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 frill, with HOPWA 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 HOPWA PSA CONTRACT 2018-2019 Page 24 AIDS Outreach Center,Inc. Rev.9.12.2018 subcontracts for procurement larger than$50,000.00 or larger that are paid for, in part or in full,with the HOPWA Funds and will further require all persons or entities with which it so contracts to comply with said ordinance. 14.15.2 It is national policy to award a fair share of contracts to disadvantaged business enterprises ("DBEs"), small business enterprises ("SBEs"), minority business enterprises ("MBEs"), and women's business enterprises ("WBEs"). Accordingly, affirmative steps must be taken to assure that DBEs, SBEs, MBEs, and WBEs are utilized when possible as sources of supplies, equipment, construction and services. 14.15.2.1 In order to comply with federal reporting requirements, Agency must submit the form attached hereto as EXHIBIT "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 HOPWA 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 Assi n ent• Agency shall not assign all or any part of its rights,privileges, or duties under this Contract without the prior written approval of City. Any attempted assignment of same without approval shall be void, and shall constitute a breach of this Contract. 14.18. Right to Inspect Agency Contracts. It is agreed that City has the right to inspect and approve in writing any proposed contracts between Agency and any contractor or vendor engaged in any activity in conjunction with this HOPWA-funded Program prior to any charges being incurred. 14.19 Force Male 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. HOPWA PSA CONTRACT 2018-2019 Page 25 AIDS Outreach Center,Inc. Rev.9.12.2018 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 (1-9), 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 HIND OR CHARACTER,WHETHER REAL OR ASSERTED, ARISING OUT OF OR IN CONNECTION WITH THE EXECUTION, PERFORMANCE, ATTEMPTED PERFORMANCE OR NONPERFORMANCE OF THIS CONTRACT AND/OR THE OPERATIONS,ACTIVITIES AND SERVICES OF THE PROGRAM DESCRIBED HEREIN, WHETHER OR NOT CAUSED IN WHOLE OR IN PART, BY ALLEGED NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS OR SUBCONTRACTORS OF CITY; AND AGENCY HEREBY ASSUMES ALL LIABILITY AND RESPONSIBILITY OF CITY AND ITS OFFICERS, AGENTS, SERVANTS, AND EMPLOYEES FOR ANY AND ALL CLAIMS OR SUITS FOR PROPERTY LOSS OR DAMAGE AND/OR PERSONAL INJURY, INCLUDING DEATH, TO ANY AND ALL PERSONS, OF WHATSOEVER KINDS OR CHARACTER, WHETHER REAL OR ASSERTED,ARISING OUT OF OR IN CONNECTION WITH THE EXECUTION, PERFORMANCE, ATTEMPTED PERFORMANCE OR 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. HOPWA PSA CONTRACT 2018-2019 Page 26 AIDS Outreach Center,Inc. Rev. 9.12.2018 IT IS THE EXPRESS INTENTION OF THE PARTIES,BOTH AGENCY AND CITY, THAT THE INDEMNITY PROVIDED FOR THIS SECTION INCLUDES INDEMNITY BY AGENCY TO INDEMNIFY AND PROTECT CITY FROM THE CONSEQUENCES OF CITY'S OWN NEGLIGENCE, WHETHER THAT NEGLIGENCE IS ALLEGED TO BE THE SOLE OR CONCURRING CAUSE OF THE INJURY,DAMAGE OR DEATH. AGENCY AGREES TO AND SHALL RELEASE CITY, ITS AGENTS, EMPLOYEES, OFFICERS AND LEGAL REPRESENTATIVES FROM ALL LIABILITY FOR INJURY,DEATH,DAMAGE OR LOSS TO PERSONS OR PROPERTY SUSTAINED IN CONNECTION WITH OR INCIDENTAL TO PERFORMANCE UNDER THIS CONTRACT, EVEN IF THE INJURY, DEATH, DAMAGE OR LOSS IS CAUSED BY CITY'S SOLE OR CONCURRENT NEGLIGENCE. AGENCY SHALL REQUIRE ALL OF ITS CONTRACTORS AND SUBCONTRACTORS TO INCLUDE IN THEIR CONTRACTS AND SUBCONTRACTS A RELEASE AND INDEMNITY IN FAVOR OF CITY IN SUBSTANTIALLY THE SAME FORM AS ABOVE. 16. WAIVER OF IMMUNITY BY AGENCY. If Agency,as a charitable or nonprofit organization,has or claims an immunity or exemption (statutory or otherwise)from and against liability for damages or injury, including death, to persons or property, Agency hereby expressly waives its rights to plead defensively such immunity or exemption as against City. This Section shall not be construed to affect a governmental entity's immunities under constitutional, statutory or common law. 17. INSURANCE AND BONDING. Agency will maintain coverage in the form of insurance or bond in the amount of$656,000 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 HOPWA 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 HOPWA PSA CONTRACT 2018-2019 Page 27 AIDS Outreach Center,Inc. Rev.9.12.2018 Non-Profit Organization Liabili y 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' Com ensation Insurance Part A: Statutory Limits Part B: Employer's Liability $100,000 each accident $100,000 disease-each employee $500,000 disease-policy limit Note: Such insurance shall cover employees performing work on any and all projects including but not limited to construction, demolition, and rehabilitation. Agency or its contractors shall maintain coverages, if applicable. In the event the respective contractors do not maintain coverage, Agency shall maintain the coverage on such contractor, if applicable, for each applicable contract. Additional Requirements Such insurance amounts shall be revised upward at City's reasonable option and no more frequently than once every 12 months, and Agency shall revise such amounts within 30 days following notice to Contractor of such requirements. Agency will submit to City documentation that it has obtained insurance coverage and has executed bonds as required in this Contract prior to payment of any monies provided hereunder. Where applicable, insurance policies required herein shall be endorsed to include City as an additional insured as its interest may appear. Additional insured parties shall include employees, officers, agents, and volunteers of City. Any failure on part of City to request certificate(s) of insurance shall not be construed as a waiver of such requirement or as a waiver of the insurance requirements themselves. HOPWA PSA CONTRACT 2018-2019 Page 28 AIDS Outreach Center,Inc. Rev. 9.12.2018 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 Ivey Rating Guide rating of A-: VIl 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 Iocal, federal or other regulatory insurance or bonding requirements for the Program, and such requirements exceed those specified herein, the former shall prevail. Agency shall require its contractors to maintain applicable insurance coverages, limits, and other requirements as those specified herein; and Agency shall require its contractors to provide Agency with certificate(s) of insurance documenting such coverage. Also, Agency shall require its contractors to have City and Agency endorsed as additional insureds (as their interest may appear) on their respective insurance policies. Directors and Officers Liability coverage shall be in force and may be provided on a claims-made basis. This coverage may also be referred to as Management Liability, and shall protect the insured against claims arising out of alleged errors in judgment, breaches of duty and wrongful acts arising out of their organizational duties. Coverage shall protect not only the entity,but all past,present and future directors, officers, trustees, employees, volunteers and committee members. Notwithstanding any provision in this Contract to the contrary,when applicable,Agency shall comply with the requirements of 2 CFR 200.310 and shall, at a minimum, provide the equivalent insurance coverage for real property and equipment acquired or improved with CDBG Funds as provided to property owned by Agency. 18. CERTIFICATION REGARDING LOBBYING. The undersigned representative of Agency hereby certifies, to the best of his or her knowledge and belief,that: No federal appropriated funds have been paid or will be paid, by or on behalf of Agency,to any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress in connection with the awarding of any federal contract, the making of any federal grant,the malting of any federal loan, the entering into of any cooperative agreement and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan or cooperative agreement. If any funds other than federally appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, member of Congress in connection with this federal contract, grant, loan or cooperative agreement, Agency shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. HOPWA PSA CONTRACT 2018-2019 Page 29 AIDS Outreach Center,Inc. Rev. 9.12.2018 This certification is a material representation of fact upon which reliance was placed when this Contract was made or entered into. Submission of this certificate is a prerequisite for making or entering into this Contract imposed by 31 U.S.C. Section 1352. Any person who fails to file the required certification shall be subject to a civil penalty of not less than$10,000.00 and not more than$100,000.00 for each such failure. Agency shall require that the language of this certification be included in all subcontracts or agreements involving the expenditure of federal funds. 19. LITIGATION AND CLAIMS. Agency shall give City immediate notice in writing of any action, including any proceeding before an administrative agency, filed against Agency in conjunction with this Contract or the Program. Agency shall furnish immediately to City copies of all pertinent papers received by Agency with respect to such action or claim. Agency shall provide a notice to City within 10 days upon filing under any bankruptcy or financial insolvency provision of law. 20. NOTICE All notices required or permitted by this Contract must be in writing and are deemed delivered on the earlier date of the date actually received or the third day following deposit in a United States Postal Service post office or receptacle; with proper postage, certified mail return receipt requested; and addressed to the other Party at the address set out below or at such other address as the receiving Party designates by proper notice to the sending Party. Citi: City Attorney's Office 200 Texas Street Fort Worth,TX 76102 Telephone: 817-392-7600 Copy to: Neighborhood Services Department 200 Texas Street Fort Worth, TX 76102 Attention: Assistant Director Telephone: 817-392-7510 Copy to: Neighborhood Services Department 200 Texas Street Fort Worth, TX 76102 Attention: Contract Administrator Telephone: 817-392-8550 HOPWA PSA CONTRACT 2018-2019 Page 30 AIDS Outreach Center,Inc. Rev. 9.12.2018 Agency: AIDS Outreach Center, Inc. Shannon Hilgart, Executive Director 400 N. Beach St. Fort Worth, TX 76111 817-335-1994 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] HOPWA PSA CONTRACT 2018-2019 Page 31 l AIDS Outreach Center,Inc. Rev.9.12.2018 WITNESS WHEREOF, the Parties hereto have executed 4 duplicate originals of this oritrt in Fart Worth, Tarrant County, Texas. ' ATT T: CITY OF FORT WORTH .e. .. p '9 ,.��..�. By: City Secr t Fernando Costa, Assistant City Manager M&C: G-193 8 1295 Certification No. 2018 -362865 Date: August 7, 2018 APPROVED AS TO FORM AND LEGALITY: Assistant City Attorney 'je /)6n 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 r Barbara Asbury Compliance and Planning Manager AIDS OUTREACH CENT R, INC. By: Shannon Hil rt, Executive Director HOPWA PSA CONTRACT 2018-2019 OFFICIAL F%(e)hD AIDS Outreach Center, Inc. CITYS . y FT. WORTH,'TX EXHIBITS: EXHIBIT "A"—Program Summary EXHIBIT "A-1" —2018 HUD Income Limits EXHIBIT "A-2" -Requirements for Completion of"Getting to Work Training Curriculum" 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"—Overview Report EXHIBIT "I"—MSE Reporting Form EXHIBIT "X'—Duties of the Parties for Use of NSD Community Centers EXHIBIT "K"—Notice of Beneficiary Rights EXHIBIT "L"—Notice of Occupancy Rights Under VAWA EXHIBIT "M"—Emergency Transfer Request Form HOPWA PSA CONTRACT 201.8-2019 Page 33 AIDS Outreach Center,Inc. Rev.9.12.2018 AIDS OUTREACH CENTER,INC. EXHIBIT "A" Supportive Services, STRMU, and TBRA PROGRAM SUMMARY PROGRAM SUMMARY (HOPWA) October 1, 2018 to September 30, 2019 $656,000.00 PERIOD AMOUNT Capitalized terms not defined herein shall have meanings assigned them in the Contract. PROGRAM: The Program provides HOPWA Eligible Clients with one or more of the following: 1) supportive services; 2)tenant based rental assistance ("TBRA"); and/or, 3) short-term rental, mortgage, or utility assistance ("STRMU"). Supportive Services include housing counseling and case management,including the development of housing plans. TBRA includes long-term monthly rental assistance. Clients must be Income Eligible according to HUD guidelines, live in a rental unit that passes habitability inspections, and have an identified housing need as determined by the client's AOC case manager. STRMU includes short term assistance for up to 21 weeks. STRMU provides assistance with utilities, rent, or mortgage payments and must not exceed a client's current monthly budget deficit caused by an unavoidable, unplanned, documented emergency consistent with HUD guidelines and AOC's local policy. Clients receiving other government housing assistance are not eligible. Agency's office and Program services will be available at 400 N. Beach Street, Suite 100, Fort Worth, TX 76111, Mondays and Thursdays 8:30 a.m. to 5:00 p.m., Tuesdays and Wednesdays 8:30 a.m. to 6:00 p.m. and Friday, 8:30 a.m. to 4:00 p.m. The Program will serve HOPWA Eligible Clients in Tarrant, Johnson, Parker, Wise, Hood and Somervell counties. HOPWA Funds will pay for direct assistance such as TBRA and STRMU. HOPWA Funds will also be used to pay costs associated with delivering supportive services to any client receiving either TBRA or STRMU assistance, including salaries,FICA for employees, and Program facility rent. No more than 7% of the HOPWA Funds will be used to pay administrative costs, including salaries, FICA and contracted accounting services associated with the Program. REGULATORY CLASSIFICATION: HOPWA PSA CONTRACT 2018-2019—EMILBIT"A"--PROGRAM SUMMARY Page 1 AIDS Outreach Center,Inc. IDIS matrix Code(s) and Service Category: 31D HOPWA Project Sponsor Administration 31C HOPWA Project Sponsor Activity Regulatory Citation(s): 24 CFR 574.3 00(b)(I 0)--Administrative Expenses 24 CFR 574.300(b)(7)—Supportive ,Services 24 CFR 574.300(b)(6)—STRMU 24 CFR 574.300(b)(6)--TBRA Agency will maintain documentation which verifies that 100% of clients served by the Program are eligible under HOPWA Regulations. PROGRAM GOALS: Minimum Contract Performance Outcome: The Program must provide services to a minimum of 137 Unduplicated Clients. The Program must provide TBRA services to a minimum of 63 Unduplicated Clients and must provide STRMU services to a minimum of 74 Unduplicated Clients, Unduplicated Clients must be residents of Tarrant, Johnson, Parker, Wise, Hood or Somervell counties as shown by the monthly reports on Attachment 111. HOPWA PSA CONTRACT 2015-2019—EXHIBIT"A"—PROGRAM SUMMARY Page 2 AIDS Outreach Center,Inc. EXHIBIT "A-1" 2018 HUD INCOME LIMITS 2018 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 $15,800 $18,050 $20,780 $25,100 $29,420 $33,740 $38,060 $42,380 50%AMI $26,350 $30,100 $33,850 $37,600 $40,650 $43,650 $46,650 $49,650 80%AMT $42,150 $48,150 $54,150 $60,150 $65,000 1 $69,800 $74,600 $79,400 YIneome limits are published at least annually by HUD. HOPWA PSA CONTRACT 2018-2019--EXIIIBIT"A-1"—2018 IND INCOME LIMITS Page 1 AIDS Outreach Center,Inc. EXHIBIT "A-2" REQUIREMENTS FOR COMPLETION OF"GETTING TO WORK TRAINING CURRICULUM" HOPWA PSA CONTRACT 2018-2019 Page I EXHIBIT"A-2"REQL7IREM-NTS FOR COMPLETION OF"GETTING TO WORK TRAINING CURRICULUM" AIDS Outreach Center,Inc. Getting to Work: A Training Curriculum for HIV/AIDS Service Providers and Housing Providers At least 1 Agency employee must complete this required training curriculum by the deadline of April 15,2019. Proof of completion must be submitted with the April reimbursement request. The Getting to Work Training Curriculum is divided into 3 online modules: Module 1: Understanding the Value of Work Module 2: Adopting an Employment and Training Mindset—Organizationally and Individually Module 3: Incorporating Employment into the HIV/AIDS Service Menu To view the modules: 1. Click the module title. 2. You will be prompted to either create or log into your HUD Exchange Learn account. 3. Follow this guidance when creating a HUD Exchange account: Step 1 of 2 screen: Fill out the required Personal Information, and Login Information sections. For the Organization Information, if you are not affiliated with a HUD program, choose None of the Above and I am an Individual. Step 2 of 2 screen: All HUD Program Experience fields on the Learner Profile page are optional. Click Update to complete the account creation process. 4. After creating an account or logging in, you will enter the HUD Exchange Learn system. 5. Click the Enroll button on the HUD Exchange Learn course description to access the course. 6. The module name will appear under Activities. Click the Module Name to access the course. 7. The module will launch in a new window, so please make sure your pop-up blockers are turned off. To receive credit for completing each module: 1. Take the completion quiz under Activities on the IIUD Exchange Learn course description. Each module has a quiz. 2. Score 80% or better on the quiz. You may take the quiz multiple times. 3. After you pass the quiz, you will be able to print a completion certificate on the HUD Excbange Learn course description. You can access information about the modules by visiting the HUD Exchange website at www.hudexchange.com or by using the following link: https://www.hudexchange.info/training= events/dol-hud-getting-to-work-curriculum-for-hiv-aids-providers. You may also contact your assigned contract administrator to get additional information. HOPWA PSA CONTRACT 2018-2019 Page 1 EXHIBIT"A-2"REQUIR'MENTS FOR COMPLETION OF"GETTING TO WORK TRAINING CURRICULUM" AIDS Outreach Center,Inc. EXHIBIT"B"-BUDGET AVk!mint [.rant Bud gel :i B C Tirt:Lr - - A.15NMIS'I'Ile MTC I Salaries 1001 $ 4,800.00 $ 5,938.50 $ 10,738.50 FICA 1002 $ 367.00 $ 454.00 $ 821.00 Life/Disability Insurance 1003 $ 890.00 Health/DentalInsurance 1004 $ 7,040.00 $ 7,040.00 Unemployment-State 1005 $Worker's Compensation 1006 $ - Contract Labor-Accounting 1007 $ 5,833.00 $ 2,040.00 $ 7,873.00 Mileage 1008 _ Insurance-Commercial Umbrella Liability 1009 $ 899.00 $ 899.00 Insurance-Directors and Officers 1010 Insurance-Fidelity Bond or Equivalent 1011 TOTAL ADMINISTRATIVE EXPENSES $ 11,000.00 $ 17,261.50 $ - $ 27,371.50 %Administrative Cost 2% - SUPYOkVIVE SERVICES MOGRiLM VER501�'I�ML. Salaries 2001 $ 55,551.50 $ 55,551.50 FICA 2002 $ 4,249.69 $ 4,249.69 Life/Disability Insurance 2003 Health/DentalInsurance 2004 $ - Unemployment-State 2005 $ - Worker's Compensation 2006 STJPPI [T-9 ,1-ND 8LRVrCE -- - Office/MedicalSupplies 3001 $ 2,011.00 $ -2,0I1.00 Office Equipment Rental 3002 $ 271.00 $ 271.00 Postage 3003 $ 599.00 $ 599.00 Printing 3004 $ I19.00 $ 119.00 iVIISC'�1 .'•�:�l�fT Contract Labor-Nutritionist 4001 Food Supplies 4002 1zelC=r�.l l 1'AItiLI UT.11rITCS Telephone 5001 $ 509.00 $ 509.00 Electric 5002 $ 1,373.00 $ 1,373.00 Gas 5003 Water and Wastewater 5004 Solid Waste Disposal 5005 Rent(City needs copy of lease before expenses can be reimbursed) 5006 $ 5,198.81 $ 1,058.19 $ 6,257.00 Custodial Services 5007 $ - Maintenance/Repairs 5008 $ 917.00 $ 917.00 Building Security 5009 1 $ 71.00 $ 71.00 HOPWA PSA CONTRACT 2018-2019-EXHIBIT"B"-BUDGET AIDS Outreach Center,Inc. Page I LEGAL, FINANCIAL AND 1M1S11RANC2 Professional LiabilitylBusiness Auto 6001 TOTAL SUPPORTIVE SERVICE EXPENSES $ 65,000.00 1 $ 6,928.19 $ - $ 71,928.19 D=CT ASSISTANCE-STRNTU Short-term hent Assistance 7001 $ 90,000.00 $ 90,000.00 Short-term Mortgage Assistance 7002 $ 15,000.00 $ 15,000.00 Short-term Utilities Assistance 7003 $ 15,000.00 $ '15,000.00 Total Direct Assistance-STRMU $ 120,000.00 $ 120,000.00 DIiRFCT A-SkSTAIr i'F-TR R,S Tenant Based Rental Assistance (TBRA) 8001 $ 460,000.00 $ 460,000.00 Total Direct Assistance-TBRA $ 460,000.00 $ 460,000.00 FAMIAT'Y BA$JED OPEk—k 1 l0n4S rL12i"Ifle/Disability aries 9001 CA 9002 Insurance 9003 Health/Dentallnsurance 9004 Unemployment-State 9005 Worker's Compensation 9006 Insurance-Commercial Property and Professional Liability 9007 TOTAL FACILITY BASED OPERATION EXPENSES BUDGET TOTAL $ 656,000.00 $ 24,189.69 $ - $ 680,189.69 FUNDING A: RYAN WHITE FUNDING 13: PRIVATE DONATIONS HOPWA PSA CONTRACT 2018-2019-EXHIBIT"B"-BUDGET AIDS Outreach Center,Inc. Page 2 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 July 31, 2019. SALARY DETAIL- ADMINISTRATIVE Est. Percent to Amount to Position Title Annual Salary Grant Grant Staff Accountant $ 28,080.00 17.1% $ 4,800.00 TOTAL $ 28,080.00 17.1% $ 4,800.00 FRINGE DETAIL-ADMINISTRATIVE Percent of Est. Percent to Amount to Payroll Amount Grant Grant FICA 7.65% $ 2,148.12 17.1% $ 367.00 Life/Disability Insurance Health/Dentallnsurance $ 4,260.00 Unemployment-State $ 674.00 Worker's Compensation $ - TOTAL $ 7,082.12 5.2% $ 367.00 MISCELLANEOUS -ADMINISTRATIVE Est. Percent to Amount to Total Budget Grant Grant Contract Labor-Accounting $ 5,833.00 100.0% $ 5,833.00 Mileage Insurance-Commercial Umbrella Liability $ 899.00 Insurance-Directors and Officers Insurance-Fidelity Bond or Equivalent TOTAL $ 6,732.00 86.6% $ 5,833.00 11 SALARY DETAIL - SUPPORTIVE SERVICES Est. Percent to Amount to Position Title Annual Salary Grant Grant Director of Case Management $ 63,000.00 7.0% $ 4,41.0.00 Housing Coordinator $ 44,000.00 92.0% $ 40,480.00 Associate Executive Director $ 82,500.00 3.0% $ 2,475.00 Case Manager $ 45,000.00 7.0% $ 3,150.00 Case Manager $ 38,950.00 7.0% $ 2,726.50 Case Manager $ 33,000.00 5.0%1 $ 2,310.00 TOTAL $ 306,450.00 18.1%1 55,551.50 HOPWA PSA CONTRACT 2018-2019-EXHIBJT"B -BUDGET AIDS Outreach Center,Inc. Page 3 FRINGE DETAIL- SUPPORTIVE SERVICES Percent of Est. Percent to Amount to Payroll Amount Grant Grant FICA 7.65% $ 23,443.43 18.1% $ 4,249.69 Life/Disability Insurance Health/Dentallnsurance $ 21,676.00 Unemployment-State $ 2,328.00 Worker's Compensation TOTAL $ 47,447.43 9.0% $ 4,249.69 SUPPLIES AND SERVICES - SUPPORTIVE SERVICES Est. Percent to Amount to Total Budget Grant Grant Office/Medical Supplies $ 2,011.00 Office Equipment Rental $ 271.00 Postage $ 599.00 Printing $ 119,001 i TOTAL is 3,000.00 MISCELLANEOUS - SUPPORTIVE SERVICES Est. Percent to Amount to Total Budget Grant Grant Contract Labor-Nutritionist Food Supplies TOTAL FACILITY AND UTILITIES - SUPPORTIVE SERVICES Est. Percent to Amount to Total Budget Grant Grant Telephone $ 509.00 Electric $ 1,373.00 Gas Water and Wastewater Solid Waste Disposal Rent (City needs copy of lease before expenses can be reimbursed) $ 5,198.81 100.0% $ 5,198.81 Custodial Services $ 917.00 Maintenance/Repairs $ 62.00 Building Security $ 71.00 TOTAL $ 8,130.81 63.9% $ 5,198.81 HOPWA PSA CONTRACT 2018-2019-EXHIBIT"B"-BUDGET AIDS Outreach Center,Inc. Page 4 LEGAL, FINANCIAL AND INSURANCE- SUPPORTIVE SERVICES Est. Percent to Amount to Total Budget Grant Grant Professional Liability/Business Auto TOTAL DIRECT ASSISTANCE - STRMU Est. Percent to Amount to Total Budget Grant Grant Short-Term Rent Assistance $ 90,000.00 100.0% $ 90,000.00 Short Term Mortgage Assistance $ 15,000.00 100.0% $ 15,000.00 Short Term Utilities Assistance $ 15,000.00 100.0% $ 15,000.00 TOTAL $ 120,000.00 100.0% $ 120,000.00 DIRECT ASSISTANCE-TBRA Est. Percent to Amount to Total Budget Grant Grant Tenant Based Rental Assistance $ 460,000.00 100.0% $ 460,000.00 TOTAL $ 460,000.00 100.0% $ 460,000.00 SALARY DETAIL-FACILITY BASED OPERATIONS Est. Percent to Amount to Position Title Annual Salary Grant Grant Property Manager Property Support-Admin Assistant Driver/Maintenance Manager Driver/Maintenance Technician TOTAL FRINGE DETAIL-FACILITY BASED OPERATIONS Percent of Est. Percent to Amount to Payroll Amount Grant Grant FICA Life/Disability Insurance Health/Dental Insurance Unemployment-State Worker's Compensation Retirement TOTAL HOPWA PSA CONTRACT 20I 8-2019-EXHIBIT"B" -BUDGET AIDS Outreach Center,Inc. Page 5 MISCELLANEOUS - FACILITY BASED OPERATIONS Est. Percent to Amount to Total Budget Grant Grant Insurance-Commercial Property and Professional Liability TOTAL HOPWA PSA CONTRACT 2018-2019-EXHIBIT"B"-BUDGET AIDS Outreach Center,Inc. Page 6 AUDIT CERTIFICATIQN FORM AND AUDIT REQUIREMENTS Agency: AIDS Outreach Center l+isc I Year Ending; Se tember 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 and of the audited fiscal year or 30 days within its completion,whichever is the earlier date, [1 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) Vii. f :. :I.jkti :111 " , .i ;Eti NOT r%�,i dirc..'�,;_ _ _ Ld 1 � t'1C:�r] {"ff::i 1�5?i •�'„—.a .. xY..-.. . .�..`G1i r.I;Ya; i EIE I Total Federal Expenditures es for this Fiscal Year: Ve lo/ W ignatory and Title Efate. Failure to submit this or a similar statement or failure to submit a completed single audit package as described in the federally required audit requirements described in 2 CFR Part 200, as applicable,by the required due date may result in suspension of funding and may affect eligibility for future funding. Notwithstanding the above, this certification acknowledges the agency's commitment to greet all other financial reporting, financial statements, and other audit requirements as may be set forth in the Contract. i I I 5 i t 1 S s HOPWA PSA CONTRACT 2017-2018–EXHIBIT"C"—AUDIT CERTIFICATION FORM 2 AIDS Outreach Center I c i i EXHIBIT "D" REPORTING FORMS I-IOPWA PSA CONTRACT 2015-2019—EXHIBIT"D"—REPORTING FORMS Page 1 AIDS Outreach Center ATTACHMENT I Invoice INVOICIE Agency:. Address: City, State, Zip: Program: Period of Service:- Tax IIS No- P.O. No. FID No. Arvqmuit Program Ills Invoice Cumulative to Date, HOPWA PSA CONTRACT 2018-2019—EXHIBIT"D"—REPORTING FORMS Page 2 AIDS Outreach Center ATTACHMENT II Expenditure Worksheet City ofI'olt Worth Neighborhood Services Department_ __- Expenditnm Worlcslteet Agency:: - - - -- - - -- Program _ Onlyhighlightedeodes can be reimbursed _ Please OUP like accomrt codes. A coouul X12 Gidn{:SG Y>i�ii Lina llrT Lao C1td-k SS, Oor- -I';rr Lne'-livnflh�Tw- 1Cc4.lu EL ht Anuunl. Aeaurrt 1 _ AFIM ISIR{71YF _ 2 Salaries 1001 _ _ FICA 1002 _ 4 _ UfeUsabilitr insurance 1003 HeahlVDentaUnsurance lug 6 Unen ]o meat-S€ale ]005 _ 7 _ Woder's Con ensalion 1006 41€9 _ Contract Labor tA07 - 9 Olhcr tons _ 10 Insurance-Cormmmial Uab. 1009 711� _ Insurance-Directors&Offiieers IOto 12 _ Insurance-Fidelity band or 1011 ' 13 __& S.UPPl51t`AIVE,S•fV1G'�F5 14 _PROGRAMPFRSONNIL 15 _ Salaries 2001 16 _ FICA 2002 l7 _ Ln/Disabiky Insumncc 203 18 _ HcaltlUDenlal Insurance 2W4 19 _ Unnu lovment-Stale 2005 _ 20 Wodsr's Cot ensalion 3006 _ 2l _SUPPL.LF.S AND SERVICES 22 _ Office/Medical Supplies 300I Office ni memt Rental3002 _ 24 _ Posta a 3003 - 25 _ Pirqing #1 3004 26 _hiiS09.IANCD115 -, 27 Contract Libor 4001 22 _ Food Supplies 4002 29 _FACLLITYAND i ILITI6 _ 30 Telephone 501 _ 31 _ Electric 5002 32 as 5003 3' Waterand Wast—ter 50(9 74 Sand Waste Dis osal 5005 Rent 5006 _ 36 Custodial Services 5007 37 Maimmance/Re aim Sods 34 _ Building-security 1 5009 - 39 LCGA4 FINANCIAL:AND WSIRANCF _ 40 _ Professional Liab./Buss.Auto 6001 _ 4€ Plfiltt'7'jL5eETN'4rm9,fi4&Rl _ 42 _ SitorW m:RcnLAssistance 7001 43 _ Short-term Mort n eAssistance 7002 _ Short-term Uttlitics Assistance 70P 46 Tenant Based Rental Assistance 6001 _ 47ir�7-i1UCIL1TY2BifSID;()P,P.RrP�I)t� ::' 48 Salaries 901 49 _ FICA w .. 50 Life/Disability Insuran 9003 51 _ Health/Dental Insurance 9ON 52 Uncn lovtrent-Stale 9005 _ 53 Worker's Co ensalion 9006 54 Ins:Comm Pro .and Pm f,Liab. 9007 57 - - - ---- - - --- 59 60 Tota] 90.00 -Forsafades,state cogrloyee's title under Descriptinn/lob Title.Rent must identify tenant HOPWA PSA CONTRACT 2018-2019—EXHIBIT"D"—REPORTING FORMS Mage 3 ,AIDS Outreach Center ATTACHMENT III Client Data Report-Supportive Services and Operations }Itai ' "�4 xllvLrF av�4.. fnY n>c>; - we al LK —777 HOPWA PSA CONTRACT 2018-2019 -EXHIBIT"D"REPORTING FORMS AIDS Outreach Center ATTACHMENT III Client Data Report-TBRA .u�u'bvr`(yrr LI.ILT RiSARz>bkt FmPnci Sawnt n=wtl Naor�l,t.u�nn�a(nllkkl .. rnlirx��L4�Lf�:t."t S�l��aYYNlw hl�-wj..z r.iy�..�j��+.,..i F.ni.�nnnn .L.1�L¢:.,..a.K "..,i w� rarx _ s+nlai4zw r<�,.sir.�..der.i.ni,ai..+iinniortr�-w..�.C%r#F�LF��...r r � •ra(wIw W++.......��a�.r a.,rru�.�..+�r�r.�li.ia W a5. MI+Y VI �osu� I „z1.a wva. w I•i�f HOPWA BSA CONTRACT 2018-2019 -EXHIBIT"D"REPORTING FORMS AIDS Outreach Center ATTACHMENT III Client Data Report-STRMU gym. �•H '+�� �.. i Nr gams�r IW =1 ma EWE HOPWA PSA CONTRACT 2018-2019 -EXHIBIT"D" REPORTING FORMS AIDS Outreach Center EXHIBIT "E" INCOME CERTIFICATION FORMS HOPWA PSA CONTRACT 2019-2019--EXHIBIT"E"--INCOME CERTIFICATION FORM AIDS Outreach Center Page I City of Fort Worth CERTIFICATIONS OF INCOME STATEMENT Applicant Name: Current Address: Phone #: City and Zip: Household Members and Income (including app licant) Last Name First Name Age Monthly Source of Income Income $$ TOTAL NUMBER OF FAMILY MEMBERS (Include Yourself,Spouse,Children,etc.) Total Gross Annual Household Income: PERSONAL INFORMATION:(Check one in each item. This Information is Required for Federal Reporting Purposes) a. ❑MALE b. ❑WHITE ❑BLACK/AFRICAN AMERICAN ❑BLACK/AFRICAN AMERICAN&WHITE ❑FEMALE ❑AMERICAN INDIAN/ALASKAN NATIVE ❑ASIAN ❑AMERICAN INDIAN/ALASKAN NA'T'IVE&WHITE ❑ASIAN&WIIITE ❑NATIVE HAWAIIANIOTHER PACIFIC ISLANDER ❑BALANCE/OTI-TER ❑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 hy Agency staff only---- ---_- Household Size: Gross Annual Income: Applicable Income Limit: Is Applicant Eligible? Check if Applicant refused to provide demographic information: O Staff Assessment of Demographics: Person Making Determination: Date: NOTE: Address, income amounts and sources for ALL household members are required. Ciudad de Fort Worth HOPWA PSA CONTRACT 2018-2019--EXHIBIT"E"--INCOME CERTIFICATION FORM AIDS Outreach Center Page 2 CERTIFICACION DE DECLARACION DE INGRESOS Nombre del Solicitante: Direction de Actualidad: Telefono: Ciudad y Codigo Postal: Miembros Del Ho agar e In rg esos (Incluyendo el/la Solicitante) Apellido Nombre Edad Ingreso Origen de Ingresos Mensual *TOTAL N['JMERO DE MIEMBROS DEL HOGAR (Incluyase Usted.) Total Anual de Ingresos del hogar: **INFORMACION PERSONAL:(Seleccione uno en each artfeulo. Esta uiformacion es requerida por el Gobierno federal.) a. ❑MASCULINO b.❑BLANCO ❑NEGRO/AFRICANO AMERICANO ❑NEGRO/AFRICANO AMERICANO&BLANCO ❑FEMININO ❑INDIO AMERICANOINATIVO 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? ❑msmNO ❑SI ❑SI ❑NO-HISPANO ❑NO ❑NO Certification: Yo certifico que la information que yo estoy proporcionando es verdadera y puedo ser sujeto a verificacion a cualquiera bora por tercera parte. Yo tambien reconozco que la provision de informacion 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 a eneia----------------- # De Miembros de Familia: Ingreso Anual: Limite de Ingreso: ZEs solicitante elegible? Compruebe si el solicitante se nego a dar su informacion personal: Evaluation del empleado sobre informacion personal: Persona haciendo la determinacion: Fecha: Note: La direction de la casa y los ingresos (y sus origenes) para todos los miembros del hogar, es requerida. HOPWA PSA CONTRACT 2018-2019--EXHIBIT"E"--INCOME CERTIFICATION FORM AIDS Outreach Center Page 3 EXHIBIT "F" STANDARDS OF DOCUMENTATION HOPWA PSA CONTRACT 2018-2019--EXHWIT"P"--STANDARDS OF DOCUNMNTATION Page I AIDS Outreach Center 2018-2019 Documentation Standards for HOPWA Public Service Contract Expenses Emlitoyud,Salarias and baneflts-�'rty will only mimbursR a pnri;entago of any enlptgt'P4'¢'6aLZr�'jZntl Igeucflla whn work direc.tly with the HOPYdA�ursrl3tt'Progrilrrt, PWaentagae wifl be ccst uFiceated and datarminngl priaf 1b the ezer-ution rif[114 KUPINA CnmIva rt. AgencISS Tagiiestln3 tim reinihi.trSeniont u1 100°,(ofany-Agency employee V 10 regi3ir4y,Tlnf C I1V approval. Aqu"r1ris esus t sliow rake i.1101m,nu bow Lkte HOPWA port-son rxf rimptoyee'yatarles and benefits were f alculpted w.th IN!110PWA Contract . If an employee works on both a HOPWA eligible and non-HOPWA eligible program(s),the City will only reimburse for a reasonable portion of the employee's salary. Prior to the execution of the HOPWA 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 HOPWA-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 HOPWA-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 HOPWA 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,alf 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 catculated and invoiced to Cfly. *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. FICNMedicare X X X Life insurance X X X Health X X X 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 employee is enrolled in the benefit plan,must show a calculation and documentation of how the invoiced amount was calculated,and Cisability X X X 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 XXX employee is enrolled in the benefit plan,must show a calculation and documentation of how the invoiced amount was calculated,and must provide documentation showing payment.Invoice and proof of payment are only required with the first reimbursement request and at any time there are changes to amounts,enrollments,disenrollments,etc. IV1aturi1Ld;,rQurpment.Gofi is And Suppltas-Gtty Wil l f my relmbursa for 11111 cc--5r-11113catetl peri er er limounl spe ni Irl!juppwl of tkte HOPWA-funded Program. Agencie* req,eesting mimbumument tof these itHrun will require prior Clty clpproval, Aganclas must thaw ral_uWloft on how ttse HOPWA-poitfon Dfthasrp oxp*ne¢s were eaicWated conn--sRtorttly with the HOPWA Contract, Office Supplies X X X Office Equipment X X X X X Rental Posta e 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 Supplies Teaching Aids X X X Craft Su lies X X X Food Supplies X X X This category is only available to the Program provided by Meals on Wheels. Rent, tltliiip.p illrlfa Maintenance•Glfy willionly pay for 1 poftlogs of these exp43n16- Thit pcoloi!i7f thu5e ef9penses wltl bD dotermin*d by th le Squ-Am rpafage atirEbutahlE To the 1-14P'NA•furided Propri'm Mild sisatl be cosi•;j{I4cOtt d 01 atcoedanra W;lh It,r,w7liALnt dFspace used fir the 1-1913WA,,fiuided Program, triose Fxpen9ee may only ha in sr ppur;of the'H0041'A-funded Pr134ram. -krn iterns listed belov4 rtlq"lfe pr,af City approval and}hu Agnrtcy Is required to identify any fundirg-soarne lhol payx fol'fhc p Dftion of Mo.axp�rra ea that isnot pnlrl with HOPWA trindn, Agencies muck s h Tw carnrr{,rtlon nn have the H<7P1"fA portion ref disusi ex Lenses wrrc celruietsd corsssstentty with Ilio ftlDPWA Controoi. _ - Tela hone X X Gas X X WatedWastew X X ater Electric X X Solid Waste X X HOPWA PSA CONTRACT 2019-2019 E)�ANil"F-STANDARDS FOR COMPLETE DOCUMENTATION i Facility This item requires approval by the City prior to the execution of the HOPWA Contract. Repairs maybe categorized as major/minor Maintenanceix X X rehabilitation projects and must be approved through the full HUD Environmetal Review. and Repairs Rent 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 HOPWA- funded program. Miscellanedpi This item requires prior approval by the City. Prior to the execution of the HOPWA 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 Contract Labor X X X X X procurement of such 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 HOPWA-funded program. City requires that the agency submit its fee schedule or formula on how the Agency calculates the childcare scholarship amount. The fee scheduletformula should demonstrate a breakout of income levels,and for each income level the schedule should demonstrate Childcare X X which portion of the expense is to be paid by the family and which portion of the expense is to be reimbursed by the City. A fee Scholarships schedulelformula 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. "s0"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 16,living in the housohold,submit a$0 Income Certification. If an audit is required because federal funds exceed$750,000,then the cost should be split evenly by all grant funding sources. Agency must show calculation on how the HOPWA portion of the accounting services were calculated. For example,if the HOPWA grant is Audit Services X X X X 10%of your Agency's budget,then invoice shall not exceed 10%of the overall cost. Agency must show a calculation and documentation of how the invoiced amount was calculated,and must provide documentation showing payment. 'Proof of payment effective October 1,2013: payments or Expenses must be documented in the following manner: A)Image of the check AND bank statement showing the check cleared the bank;OR, B)Image of the cancelled check(ex.At end of bank statement);OR, C)Payroll Check Stub,"Advice",or Statement AND Bank Statement indicating payroll;OR, D)For wire or e-transfers:Reciept or statement from payeelvendor OR bank statement. Final .109119120 18 SF HOPWAPSA CONTRACT 2098-2019 Exhibit"P—sTANOARDS FOR COMPLETE DOCUMENTATION 5 EXHIBIT "G" SECTION 3 REPORTING FORMS NOT APPLICABLE HOPWA PSA CONTRACT 2018-2019--EXHIBIT"G"--SECTION 3 REPORTING FORMS Page 1 AIDS Outreach Center EXHIBIT "H" OVERVIEW REPORT HOPWA PSA CONTRACT 2018-2019--EXHIBIT"IF'—OVERVIEW REPORT Page I AIDS Outreach Center• �SiE[E�i5t3TpF 4 41 Housing Opportunities for Persons With AffDS (HOPWA) Program Consolidated Annual Performance and Evaluation Report (CAPER) Measuring Performance Outcomes OMB Number 2506-0133(Expiration Date: 0113112021) The CAPER report for HOPWA formula grantees provides annual information on program accomplishments that supports program evaluation and the ability to measure program beneficiary outcomes as related to: maintain housing stability;prevent homelessness;and improve access to care and support. This information is also covered under the Consolidated Plan Management Process(CPMP)report and includes Narrative Responses and Performance Charts required under the Consolidated Planning regulations. Reporting is required for all HOPWA formula grantees. The public reporting burden for the collection of information is estimated to average 41 hours per manual response,or less if an automated data collection and retrieval system is in use, along with 60 hours for record keeping,including the time for reviewing instructions,searching existing data sources,gathering and maintaining the data needed,and completing and reviewing the collection of information. Grantees are required to report on the activities undertaken only,thus there may be components of these reporting requirements that may not be applicable. This agency may not conduct or sponsor,and a person is not required to respond to a collection of information unless that collection displays a valid OMB control number. Previous editions are obsolete formHUD-40110-D(Expiration Date:0113112021) Overview. The Consolidated Annual Performance and Evaluation Report Identification Number. These arc intended to match the elements under (CAPER)provides annual performance reporting on client outputs and HMIS.The HOPWA program-level data elements include:Income and outcomes that enables an assessment of grantee performance in achieving Sources,Non-Cash Benefits,HIVIAIDS Status,Services Provided, the housing stability outcome measure. The CAPER fulfills statutory and Housing Status or Destination at the end ofthe operating year,Physical regulatory program reporting requirements and provides the grantee and Disability,Developmental Disability,Chronic Health Condition,Mental HUD with the necessary information to assess the overall program Health,Substance Abuse,Domestic Violence,Medical Assistance,and T performance and accomplishments against planned goals and objectives. eel]Count. Other HOPWA projects sponsors may also benefit from collecting these data elements. HMIS local data systems must maintain client confidentiality by using a closed system in which medical HOPWA formula grantees are required to submit a GAPER demonstrating information and H1V status are only shared with providers that have a coordination with other Consolidated Plan resources. HUD uses the direct involvement in the client's case management,treatment and care,in CAPER data to obtain essential information on grant activities,project line with the signed release of information from the client. sponsors„housing sites,units and households,and beneficiaries(which includes racial and ethnic data on program participants). The Consolidated Plan Management Process tool(CPMP)provides an optional tool to Operating Year. HOPWA formula grants are annually awarded for a integrate the reporting of HOPWA specific activities with other planning three-year period of performance with three operating years.The and reporting on Consolidated Plan activities. information contained in this CAPER must represent a one-year period of HOPWA program operation that coincides with the grantee's program year,this is the operating year. More than one HOPWA formula grant Table of Contents awarded to the same grantee may be used during an operating year and the PARI'I:Grantee Executive Summar CAPER must capture all formula grant funding used during the operating 1.Grantee Information year. Project sponsor accomplishment information must also coincide_ 2.Project Sponsor Information with the operating year this CAPER covers. Any change to the period of 5.Grantee Narrative and Performance Assessment perfoortance requires the approval of HUD by amendment,such as an a.Grantee and Community Overview extension for an additional operating year. b.Annual Performance under the Action Plan c.Barriers or Trends Overview Final Assembly of Report. After the entire report is assembled,number PART 2:Sources of Leveraging and Program Income 1each page sequentially. . Sources of Leveraging 2. Program Income and Resident Rent Payments PART 3:Accomplishment Data:Planned Goals and Actual Outputs Filing Requirements, Within 90 days of the completion of each program PART 4:Summary of Performance Outcomes year,grantees must submit their completed CAPER to the CPD Director in 1.Housing Stability: Permanent Housing and Related Facilities the grantee's State or Local IIUD Field Office,and to the HOPWA 2.Prevention of Homelessness: Short-Term Housing Payments Program Office:at HOPWA@hud.aov. Electronic submission to HOPWA 3.Access to Care and Support: Housing Subsidy Assistance with Program office is preferred;however,if electronic submission is not Supportive Services possible,hard copies can be mailed to:Office of HIV/AIDS Housing, PART 5:Worksheet-Determining Housing Stability Outcomes Room 7248,U.S.Department of Housing and Urban Development,451 PART 6.Annual Report of Continued Use for HOPWA Facility-Based Seventh Street,SW,Washington,D.C.,20410. Stewardship Units(Only) PART 7:summary Overview of Grant Activities A.Information on Individuals,Beneficiaries and Households Receiving Definitions HOPWA Housing Subsidy Assistance(TBRA,STRMU,PHP,Facility Adjustment for Duplication: Enables the calculation of unduplicated Based Units,Master Leased Units ONLY) output totals by accounting for the total number of households or units that B.Facility-Based Housing Assistance received more than one type of HOPWA assistance in a given service category such as HOPWA Subsidy Assistance or Supportive Services.For example,if a client household received both TBRA and STRMU during Continued Use Periods. Grantees that used IIOPWA funding for new the operating year,report that household in the category of HOPWA construction,acquisition,or substantial rehabilitation of a building or Housing Subsidy Assistance in Part 3,Chart 1,Column[lb]in the structure are required to operate the building or structure for HOPWA- following manner: eligible beneficiaries for a ten(10)years period.If no further HOPWA fonds are used to support the facility,in place of completing Section 713 of the CAPER,the grantee must submit an Annual Report of Continued HOPWA Housing Subsidy Outputs: Project Operation throughout the required use periods. This report is Number of included in Part 6 in CAPER.The required use period is three(3)years if Assistance Householdsthe rehabilitation is non-substantial. 1. Tenant-Based Rental Assistance I Record Keeping. Names and other individual information must be kept Permanent Housing Facilities: confidential,as required by 24 CFR 574.440.However,HUD reserves the 2a. Received Operating Subsidies/Leased right to review the information used to complete this report for grants units management oversight purposes,except for recording any names and other Tmusitional/Short-term Facilities: identifying information. In the ease that I-IUD must review client-level 2b. Received Operating Subsidies data,no client names or identifying information will be retained or recorded. Information is reported in aggregate to HUD without Permanent Housing facilities:Capital personal identification.Do not submit client or personal information 3a. Development Projects placed in service in data systems to HUD. during the operating ear Trausitional/Short-term Facilities: In connection with the development of the Department's standards for 3b. Capital Development Projects placed in Homeless Management Information Systems(HMIS),universal data service during the o eratin year elements are beingcollected for clients of HOPWA-funded homeless 4. Short-term Rent,Mortgage,and assistance projects. These project sponsor records would include:Name, Utility Assistance I Social Security Number,Date of Birth,Ethnicity and Race,Gender, S. Adjustment for duplication(subtract) I Veteran Status,Disabling Conditions,Residence Prior to Program Entry, 6 TOTAL Housing Subsidy Assistance Zip Code of Last Permanent Address,housing Status,Program Entry Sum of Rows 1-4 minus Row 5 1 Date,Program Exit Date,Personal Identification Number,and Household Previous editions arc obsolete Page ii form HUD-40110-1)(Expiration Date:0 113 112 0 2 1) Administrative Costs: Costs for general management,oversight, Housing Placement services and Master Leasing)and/or residing in units coordination,evaluation,and reporting. By statute,grantee administrative of facilities dedicated to persons living with HIV/AIDS and their families costs are limited to 3%of total grant award,to be expended over the life of and supported with HOPWA funds during the operating year. the grant. Project sponsor administrative costs are limited to 7%o£the portion of the grant amount they receive. Household: A single individual or a family composed of two or more persons for which household incomes are used to determine eligibility and Beneficiary(ies):All members of a household who received HOPWA for calculation of the resident rent payment. The tern is used for assistance during the operating year including the one individual who collecting data on changes in income,changes in access to services,receipt qualified the household for HOPWA assistance as well as any other of housing information services,and outcomes on achieving housing members of the household(with or without HIV)who benefitted from the stability.Live-In Aides(see definition for Live-In Aide)and non- assistance. beneficiaries(e.g.a shared housing arrangement with a roommate)who resided in the unit are not reported on in the CAPER. Chronically Homeless Person:An individual or family who:(i)is homeless and lives or resides individual or family who:(i)Is homeless and Housing Stability: The degree to which the HOPWA project assisted lives or resides in a place not meant for human habitation,a safe haven,or beneficiaries to remain in stable housing during the operating year. See in an emergency shelter;(ii)has been homeless and living or residing in a Part S:Determining Housing Stability Outcomes for definitions of stable place not meant for human habitation,a safe haven,or in an emergency and unstable housing situations. shelter continuously for at least 1 year or on at least 4 separate occasions in the,last 3 years;and(iii)has an adult head of household(or a minor head of household if no adult is present in the household)with a diagnosable bovine-ldnd Leveraged Resources: These are additional types er support substance use disorder,serious mental illness,developmental disability(as provided to assist HOPWA beneficiaries such as volunteer services, defined in section 102 of the Developmental Disabilities Assistance and materials,use of equipment and building space. The actual value of the support can be to the contribution ze professional services,based on Bill of Rights Act of 2000(42 U.S.C. 15002)),post traumatic stress customary rates for this specialized support,or actual costs contributed disorder,cognitive impairments resulting from a brain injury,or chronic from other leveraged resources. In determining a rate for the contribution physical illness or disability,including the co-occurrence of 2 or more of those conditions.Additionally,the statutory definition includes as The value o time and services,use the criteria described in 2 CPR 200. chronically homeless a person who currently lives or resides in an The value of any donated material,equipment,building,e lease should be institutional care facility,including a jail,substance abuse or mental health based on the fair market value at time ti donation. Related documentation treatment facility,hospital or other similar facility,and has resided there can be from recent bills of sales,advertised prices,appraisals,or other for fewer than 90 days if such person met the other criteria for homeless information for comparable property similarly situated. prior to entering that facility.(Sce 42 U,S.C.11360(2))This does not include doubled-up or overcrowding situations. Leveraged Funds: The amount of finds expended during the operating year from non-HOPWA federal,state,local,and private sources by Disabling Condition: Evidencing a diagnosable substance use disorder, grantees or sponsors in dedicating assistance to this client population. serious mental illness,developmental disability,chronic physical illness, Leveraged fiends or other assistance are used directly in or in support of or disability,including the co-occurrence of two or more of these HOPWA program delivery. conditions. In addition,a disabling condition may limit an individual's ability to work or perform one or more activities of daily living.An Live-In Aide: A person who resides with the HOPWA Eligible Individual HIV/AIDS diagnosis is considered a disabling condition. and who meets the following criteria:(1)is essential to the care and well- Facility-Based Ifousing Assistance: All eligible HOPWA Housing being of the person;(2)is not obligated for the support of the person;and expenditures for or associated with supporting facilities including (3)would not be living in the unit except to provide the necessary community residences,SRO dwellings,short-term facilities,project-based supportive services. See t24 CFR 5.403 and the HOPWA Grantee rental units,master leased units,and other housing facilities approved by Oversight Resource Guide for additional reference. HUD. Master Leasing:Applies to a nonprofit or public agency that leases units Faith-Based Organization: Religious organizations of three types:(1) of housing(scattere(i-sites or entire buildings)from a landlord,and congregations;(2)national networks,which include national subleases the units to homeless or low-income tenants.By assuming the' denominations,their social service arms(for example,Catholic Charities, tenancy burden,the agency facilitates housing of clients who may not be Lutheran Social Services),and networks of related organizations(such as able to maintain a lease on their own due to poor credit,evictions,or lack YMCA and YWCA);and(3)freestanding religious organizations,which of sufficient income. are incorporated separately from congregations and national networks. Operating Costs: Applies to facility-based housing only,for facilities Grassroots Organization: An organization headquartered in the local that are currently open. Operating costs can include day-to-day housing community where it provides services;has a social services budget of function and operation costs like utilities,maintenance,equipment, $300,000 or less annually,and six or fewer full-time equivalent insurance,security,furnishings,supplies and salary for staff costs directly employees. Local affiliates of national organizations are not considered related to the housing project but not staff costs for delivering services. "grassroots." Outcome: The degree to which the HOPWA assisted household has been HOPWA Eligible Individual: The one(1)low-income person with enabled to establish or maintain a stable living environment in housing that HPV/MDS who qualifies a household for HOPWA assistance.This person is safe,decent,and sanitary,(per the regulations at 24 CFR 574.3I0(b)) may be considered"Head of Household."When the CAPER asks for and to reduce the risks of homelessness,and improve access to HIV information on eligible individuals,report on this individual person only. treatment and other health care and support. Where there is more than one person with HIV/AIDS in the household,the additional PWWA(s),would be considered a beneficiary(s). Output: The number of units of housing or households that receive HOPWA assistance during the operating year. HOPWA Housing Information Services: Services dedicated to helping persons living with HIV/AIDS and their families to identify,locate,and Permanent Housing Placement: A supportive housing service that helps acquire housing.This may also include fair housing counseling for eligible establish the household in the housing unit,including but not limited to persons who may encounter discrimination based on race,color,religion, reasonable costs for security deposits not to exceed two months of rent sex,age,national origin,familial status,or handicap/disability. costs. HOPWA Housing Subsidy Assistance Total: The unduplicated number Program Income: Gross income directly generated from the use of of households receiving housing subsidies(TBRA,STRMU,Permanent HOPWA funds,including repayments. See grant administration Previous editions are obsolete Page iii form IIUD-40110-D(Expiration Date:0113112021) requirements on program income at 2 CFR 200.307. Stewardship Units: Units developed with HOPWA,where HOPWA Project-Based Rental Assistance(PBRA): A rental subsidy program funds were used fpr acquisition,new construction and rehabilitation that that is tied to specific facilities or units owned or controlled by a project no longer receive operating subsidies from HOPWA. Report information sponsor. Assistance is tied directly to the properties and is not portable or for the units is subject to the three-year use agreement if rehabilitation is transferable. non-substantial and to the ten-year use agreement if rehabilitation is substantial. Project Sponsor Organizations: Per HOPWA regulations at 24 CRR 574,3,any nonprofit organization or governmental housing agency that Tenant-Based Rental Assistance(TBRA): TB1ZA is a rental subsidy receives funds under a contract with the grantee to provide eligible housing program similar to the Housing Choice Voucher program that grantees can and other support services or administrative services as defined in 24 CFR provide to help low-income households access affordable housing. The 574.300. Project Sponsor organizations are required to provide TBRA voucher is not tied to a specific unit,so tenants may move to a performance data on households served and funds expended. different unit without losing their assistance,subject to individual program rules. The subsidy amount is determined in part based on household SAM:All organizations applying for a Federal award must have a valid income and rental costs associated with the tenant's lease. registration active at sam,gov.SAM(System for Award Management) registration includes maintaining current information and providing a valid Transgender: Transgender is defined as a person who identifies with,or DUNS number. presents as,a gender that is different from his/her gender at birth. Short-Term Rent,Mortgage,and Utility(STRMU)Assistance: A 'Veteran: A veteran is someone who has served on active duty in the time-limited,housing subsidy assistance designed to prevent homelessness Armed Forces of the United States. This does not include inactive military and increase housing stability. Grantees may provide assistance for up to reserves or the National Guard unless the person was called up to active 21 weeks in any 52-week period. The amount of assistance varies per duty. client depending on fiords available,tenant need and program guidelines. Previous editions are obsolete Page iv form HUD-40110-D(Expiration Date:01/3112021) Mousing Opportunities for Person With AIDS (HOPWA) Consolidated Annual Performance and Evaluation Report (CAPER) Measuring Performance Outputs and Outcomes OMB Number 2506-0133(Expiration Date: 0113112021) Part 1: Grantee Executive Summary As applicable, complete the charts below to provide more detailed information about the agencies and organizations responsible for the administration and implementation of the HOPWA program.Chart 1 requests general Grantee Information and Chart 2 is to be completed for each organization selected or designated as a project sponsor,as defined by 24 CFR 574.3. Note:If any information does not apply to your organization,please enter NIA. Do not leave any section blank _ 1.Grantee Information HUD Grant Number Operating Year for this report From(rnm/dd/yy) To(mm/dd/yy) Grantee Name Business Address City,County,State,Zip Employer Identification Number(EIN)or Tax Identification Number TIN DUN&Bradstreet Number(DUNs): System for Award Management(SAM.):: Is the grantee's SAM status currently active?. D Yes ❑No If yes,provide SAM Number: Congressional District of Grantee's Business Address *Congressional District of Primary Service Area(s) *City(ies)and County(ies)of Primary Service Cities: Counties: Arca s Organization's Website Address Is there a waiting list(s)for HOPWA Housing Subsidy Assistance Sex-vices in the Grantee Service Area? ❑Yes ❑No If yes,explain in the narrative section what services maintain awaiting list and how this list is administered. F Service delivery area information only needed for program activities being directly carried out by the grantee. Previous editions are obsolete Page 1 form IIUD-40110-D(Expiration Date:01/3112021) 2.Project Sponsor Information Please complete Chart 2 for each organization designated or selected to serve as a project sponsor,as defined by 24 CFR 574.3. Use this section to report on organizations involved in the direct delivery of services for client households. Nate:If any information does not apply to your organization,please enter N/A. Project Sponsor Agency Name Parent Company Name,if applicable Name and Title of Contact at Project Sponsor A enc Email Address Business Address City,County,State,Zip, Phone Number(with area code) Employer Identification Number(EIN)or Fax Number(with area code) Tax Identification Number(TIN) DUN&Bradstreet Number(DUNs): Congressional District of Project Sponsor's Business Address Congressional Distriet(s)of Primary Service Area(s) City(ies)and County(ics)of Primary Service Cities: Counties: Area(s) Total HOPWA contract amount for this Organization for the operating ear Organization's Website Address Is the sponsor a nonprofit organization? D Yes ❑No Does your organization maintain a waiting list? ❑Yes El No Please check ifyes and a faith-based organization. ❑ If yes,explain in the narrative section how this list is administered. Please check of yes and a grassroots organization. ❑ Previous editions are obsolete Page 2 form HUD-401 10-D(Expiration Date:0413112021) S.Grantee Narrative and Performance Assessment a.Grantee and CommunitOverview Provide a one to three page narrative summarizing major achievements and highlights that were proposed and completed during the program year. Include a brief description of the grant organization,area of service,the name(s)of the program contact(s), and an overview of the range/type of housing activities provided. This overview may be used for public information, including posting on HUD's website. Note: Textfields are expandable. b.Annual Performance under the Action Plan Provide a narrative addressing each of the following four items: 1. Outputs Reported. Describe significant accomplishments or challenges in achieving the number of housing units supported and the number households assisted with HOPWA funds during this operating year compared to plans for this assistance,as approved in the Consolidated Plan/Action.Plan. Describe how HOPWA funds were distributed during your operating year among different categories of housing and geographic areas to address needs throughout the grant service area,consistent with approved plans. 2. Outcomes Assessed. Assess your program's success in enabling HOPWA beneficiaries to establish and/or better maintain a stable living environment in housing that is safe,decent, and sanitary,and improve access to care. Compare current year results to baseline results for clients. Describe how program activities/projects contributed to meeting stated goals. If program did not achieve expected targets,please describe how your program plans to address challenges in program implementation and the steps currently being taken to achieve goals in next operating year. If your program exceeded program targets,please describe strategies the program utilized and how those contributed to program successes. 3.Coordination. Report on program coordination with other mainstream housing and supportive services resources,including the use of committed leveraging from other public and private sources that helped to address needs for eligible persons identified in the Consolidated Plan/Strategic Plan. 4.Technical Assistance. Describe any program technical assistance needs and how they would benefit program beneficiaries. c.Barriers and Trends Overview Provide a narrative addressing items 1 through 3.Explain how barriers and trends affected your program's ability to achieve the objectives and outcomes discussed in the previous section. I.Describe any barriers(including regulatory and non-regulatory)encountered in the administration or implementation of the HOPWA program,how they affected your program's ability to achieve the objectives and outcomes discussed,and, actions taken in response to barriers,and recommendations for program improvement.Provide an explanation for each barrier selected. ❑ HOPWA/HUD Regulations ❑ Planning ❑Housing Availability ❑Rent Determination and Fair Market Rents ❑ Discrimination/Confidentia]ity ❑ Multiple Diagnoses ❑ Eligibility ❑ Technical Assistance or Training ❑ Supportive Services ❑ Credit History Il Rental History ❑Criminal Justice History ❑ Housing Affordability ❑ Geography/Rural Access ❑ Other,please explain further Previous editions are obsolete Page 3 form IIUD-40110-D(Expiration Date:0113112029) 2.Describe any trends in the community that may affect the way in which the needs of persons living with HIV/AIDS are being addressed,and provide any other information important to the future provision of services to this population. 3.identify any evaluations,studies,or other assessments of the HOPWA program that are available to the public. End of PART 1 Previous editions are obsolete Page 4 form IIUD-40110-D(Expiration Date:01/3112021) PART 2: Sources of Leveraging and Program Income 1. Sources of Leveraging Report the source(s)of cash or in-kind leveraged federal,state,local or private resources identified in the Consolidated or Annual PIan and used in the delivery of the HOPWA program and the amount of leveraged dollars. In Column[1],identify the type of leveraging. Some common sources of leveraged funds have been provided as a reference point. You may add Rows as necessary to report all sources of leveraged funds. Include Resident Rent payments paid by clients directly to private landlords. Do NOT include rents paid directly to a HOPWA program as this will be reported in the next section.In Column[2] report the amount of leveraged funds expended during the operating year. Use Column[3]to provide some detail about the type of leveraged contribution(e.g.,case management services or clothing donations). In Column[4],check the appropriate box to indicate whether the leveraged contribution was a housing subsidy assistance or another form of support. Note: Be sure to report on the number of households supported with these leveraged funds in Part 3, Chart 1, Column d A. Source of Leveraging Curt [2]Amount of [4] Housing,Subsidy Leveraged [3]Type of Assistance or Other [I]Source of Leveraging Funds Contribution Support Public Funding ❑Housing Subsidy Assistance Ryan White-Housing Assistance ❑Other Support ❑Housing Subsidy Assistance Ryan White-Other ❑ Other Support ❑Housing Subsidy Assistance Housing Choice Voucher Program ❑ Other Support ❑Housing Subsidy Assistance Low Income Housing Tax Credit ❑ Other Support ❑Housing Subsidy Assistance HOME ❑ Other Support ❑Housing Subsidy Assistance Continuum of Care ❑ Other S1 apport tJ Housing Subsidy Assistance Emergency Solutions Grant ❑ Other Support ❑Housing Subsidy Assistance Other Public: ❑ Other Support ❑Housing Subsidy Assistance Other Public: 0 Other Support 0 Housing Subsidy Assistance Other Public: ❑ Other Support ❑Housing Subsidy Assistance Other Public: ❑ Other Support ❑Housing Subsidy Assistance Other Public: ❑ Other Support Private Funding ❑Housing Subsidy Assistance Grants ❑ Other Support ❑Housing Subsidy Assistance In-kind Resources ❑Other Support 0 Housing Subsidy Assistance Other Private: ❑ Other Support ❑Housing Subsidy Assistance Other Private: ❑ Other Support Other Funding ❑Housing Subsidy Assistance Grantee/Project Sponsor(Agency)Cash 0 Other Support Resident Rent Payments by Client to Private Landlord TOTAL Sum of all Rows Previous editions are obsolete Page 5 form HUD-40110-D(Expiration Date:0113112021) 2. Program Income and Resident Rent Payments In Section 2, Chart A,report the total amount of program income and resident rent payments directly generated from the use of HOPWA funds,including repayments.Include resident rent payments collected or paid directly to the HOPWA program. Do NOT include payments made directly from a client household.to a private landlord. !Vote:Please see report directions section for definition of (Additional information on program income is available in the IIOPWA Grantee Oversight Resource Guide). A. Total Amount Program Income and Resident Rent Payment Collected During the Operating Year Total Amount of Program Program Income and Resident Rent Payments Collected Income (for this operating year) 1. Program income(e.g.repayments) 2. Resident Rent Payments made directly to HOPWA Program 3. dotal Program Income and Resident Rent Payments(Sum of Rows I and 2) B. Program Income and Resident Rent Payments Expended To Assist HOPWA Households In Chart B,report on the total program income and resident rent payments(as reported above in Chart A)expended during the operating year. Use Row I to report Program Income and Resident Rent Payments expended on Housing Subsidy Assistance Programs(i.e.,TBRA,STRIVIU,PHP,Master Leased Units, and Facility-Based Housing). Use Row 2 to report on the Program Income and Resident Rent Payment expended on Supportive Services and other non-direct Housing Costs. Total Amount of Program Program Income and Resident Rent Payment Expended on Income Expended HOPWA programs (for this operating year) I, Program Income and Resident Rent Payment Expended on Housing Subsidy Assistance costs 2. Program Income and Resident Rent Payment Expended on Supportive Services and other non- direct housing costs 3. Total Program Income Expended(Sum of Rows 1 and 2) End of PART 2 Previous editions are obsolete Page 6 form HUD-40110-D(Expiration Date:01131/2021) PART 3: Accomplishment Data Planned Goal and Actual Outputs In Chart 1, enter performance information(goals and actual outputs)for all activities undertaken during the operating year supported with HOPWA funds. Performance is measured by the number of households and units of housing that were supported with HOPWA or other federal,state,local,or private funds for the purposes of providing housing assistance and support to persons living with HIV/AIDS and their families. 1. HOPWA Performance Planned Goal and Actual Outputs JIl Outpu#: fiultscbtild i21 Ou#put.F.npt3iug HOJ'35'h LcverogeJ HOPWA Performance tlassflance 12o�iseholds 13Ls]}4wi�A Funds Planned Goal b, d. f and Actual a a� a ¢ c ¢ xPn W¢ I-IOPWrt Hslising Suboldy iNsslstaukt _ _ 1 Ou ntl-Ffa ed olf1p 121 Qu at=Fundle 1. Tenant-Based Rental Assistance a. Permanent Housing Facilities: Received Operating Subsidies/Leased units Households Served) b. Transitional/Short-term Facilities: Received Operating Subsidies/Leased units(Households Served) (Households Served) a. Permanent Housing Facilities: Capital Development Projects placed in service during the operating year I3ouseholds Served) 3b. Transitional/Short-term Facilities: Capital Development Projects placed in service during the operating year Households Served) hort-Term Rent,Mortgage and Utility Assistance Permanent Housing Placement Services S. Adjustments for duplication(subtract) 7. Total HOPWA Housing Subsidy Assistance (Columns a—d equal the sum of Mows 1-5 minus Row 6;Columns a and f equal the sum of Rows 1-5) .re using.toevrleprmeot(Oorkstrnrben and SfeM'60014 t,V l'flcilii hp.rd hnusing) — [ )"tPad: llnumiu itniFx J21 011ipur_f+anffla Facility-based units; Capital Development Projects not yet opened(Housing Units) 9. Stewardship Units subject to 3-or 10-year use agreements 10, Total Housing Developed Sum of Rows 8&9 i�PPm tine Sc�3'Iccs r F}a mr;Ilouuk4ldiF {)ui—ut;FmndinR _ 1 la. Supportive Services provided by project sponsors that also delivered IIOPWA housing subsidy assistance I lb. Supportive Services provided by project sponsors that only provided supportive ervices. 12. Adjustment for duplication(subtract) 13. Total Supportive Services (Columns a—d equals the sum of Rows 11 a&b minus Row 12;Columns a and f equal the sum of Rows 11a&11b) OuBiLg IpfnrmaHnn'.4rrvJees I11{}Ytinlr.Ffn4FF'IH11414 I�I.O1�rCs1I;'Nunrling 14. Housing Information Services 15. Total Housing Information Services Previous editions are obsolete Page 7 Form HUD-40110-D(Expiration Date:0113 112 0 2 1) f,rnui.LdmintsTl't�flluo azul tlthei`ActivWee [F1 Unlpu� Flawel�oid� 12[fi�ttl+ut;Riar�ltnn 16, r esource Identification to establish,coordinate and develop housing assistance resources 17. Technical Assistance if approved in grant agreeanent) _ 18. Grantee Administration maximum 3%of total HOPWA grant) 19. Project Sponsor Administration maximum 7%ofportion of HOPWA grant awarded) 0. otal Grant Administration and Other Activities Sum of Rows 16-14) 17J klutpuki HUPSV.kl?+ di f'nlalTtxprodetl .¢x erded _ 9ad rt hctv�l 1. Total Expenditures for operating year(Sum of Rows 7,10,13,15,and 20) 2.Listing of Supportive Services Report on the households served and use of HOPWA funds for all supportive services. Do NOT report on supportive services leveraged with non-HOPWA funds. Data check:Total unduplicated households and expenditures reported in Row 17 equal totals reported in Part 3, Chart 1,Row 13. Supportive Services [1]Output:Number of Households [2]Output:Amount of HOPWA Funds Expended 1. Adult day care and personal assistance 2. Alcohol and drug abuse services 3, Case management 4. Child care and other child services 5. Education 6. Employment assistance and training Health/medical/intensive care services,if approved 7. Now Client records most conform with 24 CFR§514.310 8. Legal services 9. Life skills management outside of case management) W. Meals/nutritional serviecs 11. Mental health services 12. Outreach 13. Transportation Other Activity(if approved in grant agreement). 14. Specify: Sub-Total Households receiving Supportive Services 15. Sum of Rows 1-14 I6. Adjustment for Duplication subtract — TOTAL Unduplicated Households receiving Supportive Services(Column(11 equals Row 15 17. minus Row 16,Column 21 equals sum of Rows 1-14) Previous editions are obsolete Page 8 form HUD-40110-D(Expiration Date:0113112021) 3.Short-Term Rent,Mortgage and Utility Assistance(STRMU) Summary In Row a,enter the total number of households served and the amount of HOPWA funds expended on Short-Term Rent, Mortgage and Utility(STRMU)Assistance. In Row b,enter the total number of STRMU-assisted households that received assistance with mortgage costs only(no utility costs)and the amount expended assisting these households. In Row c,enter the total number of STRMU-assisted households that received assistance with both mortgage and utility costs and the amount expended assisting these households. In Row d,enter the total number of STRMU-assisted households that received assistance with rental costs only(no utility costs)and the amount expended assisting these households. In Row e,enter the total number of STRMU-assisted households that received assistance with both rental and utility costs and the amount expended assisting these households. In Row f,enter the total number of STRMU-assisted households that received assistance with utility costs only(not including rent or mortgage costs)and the amount expended assisting these Households. In row g,report the amount of STRMLJ funds expended to support direct program costs such as program operation staff. Data Check:The total households reported as served with STRMU in Row a, column(I]and the total amount of HOPWA funds reported as expended in Row a,column C21 equals the household and expenditure total reported for STRMU in Part 3, Chart 1, Row 4, Columns b and f, respectively. Data Cheek The total number of households reported in Column(11,Rows b,c,d,e, and f equal the total number of STRMU households reported in Column[1],Row a. The total amount reported as expended in Column[2],Rows b,c,d, e,f,and g. equal the total amount of STRMU expenditures reported in Column[2],Row a. [1] Output: Number of [2) Output:Total Housing Subsidy Assistance Categories(STRMU) Households Served HOPWA Funds Expended on STRMU during Operating Year Total Short-term mortgage,rens anfiliw utilFiy 15TRMIli ! a- assistance Of the total STRMU reported on Row_a,total who received h- assistance with mortgage costs ONLY. Of the total STRMU reported on Row a total who received C. assistance with mortgage and utility costs. Of the total STRMU reported on Row a total who received d. assistance with rental costs ONLY. Of the total STRMU reported on_---,__,-_,__._,Row a total who received e• assistance with rental and utility costs. Of the total STRMU reported on Row_a__total who received f assistance with utility costs ONLY. Direct program delivery costs(e.g.,program operations staff time) 9- End of PART 3 Previous editions are obsolete Page 9 form HUD-40110-D(Expiration Date:0913112021) Part 4: Summary of Performance Outcomes In Column [1],report the total number of eligible households that received HOPWA housing subsidy assistance,by type. In Column[2],enter the number of households that continued to access each type of housing subsidy assistance into next operating year_ In Column[3],report the housing status of all households that exited the program. Data Check: The suin of Columns[2](Number of Households Continuing)and(3](Exited Households)equals the total reported in Column fl]. Note: Refer to the housing stability codes that appear in Part 5: Worksheet-Determining Housing Stability Outcomes. Section 1.Housing Stability:Assessment of Client Outcomes on Maintaining Housing Stability(Permanent Housing and Related Facilities) A.Permanent Housin Subsidy Assistance [11 Output:Total [2]Assessment:Number of [31 Assessment:Number of Number of Households that Continued Households that exited this [4]HOPWA Client Households Receiving HOPWA Housing HOPWA Program; their Housing Outcomes Served Subsidy Assistance into the Next Status after Exiting Operating Year I Emergency Shelter/Streets Unstable Arrangements 2 Temporary Housing Temporarily Stable,with Reduced Risk of Homelessness 3 Private Housing Tenant-Based 4 Other HOPWA Rental StablelPermanent Housing(PH) Assistance 5 Other Subsidy 6 Institution 7 Jail/Prison Unstable Arrangements 8 Disconnected/Unknowu 9 Death Life Event 1 Emergency Shelter/Streets Unstable Arrangements 2 Temporary Housing Temporarily Stable,with Reduced Risk of Homelessness 3 Private Housing Permanent Supportive 4 Other HOPWA Stable/Permanent Housing(PH) Housing 5 Other Subsidy Facilities/Units G Institution 7 Jail/Prison 8 Disconnected/Unknown Unstable Arrangements 9 Death Life Event B.Transitional Housing Assistance [11 Output: Total [2]Assessment:Number of [3]Assessment:Number of Number of Households that Continued Households that exited this Households Receiving HOPWA Housing HOPWA Program; their [41 HOPWA Client Outcomes Served Subsidy Assistance into the Next Housing Status after Exiting Operating Year I Emergency Shelter/Streets Unstable Arrangements 2 Temporary Housing Temporarily Stable with Reduced Risk of Homelessness Transitional/ 3 Private Housing Short-Term Housing 4 Other HOPWA Facilities/Units S Other Subsidy StablelPermanent Housing(PH) 6 Institution 7 Jail/Prison Unstable Arrangements 8 Discomaectedhmknown 9 Death Life Event Previous editions are obsolete Page 10 form I-RJD-40110-D(Expiration Date:0913112021) B 1:Total number of households receiving transitional/short-term housing assistance whose tenure exceeded 24 months Section 2.Prevention of Homelessness: Assessment of Client Outcomes on Reduced Risks of homelessness (Short-Term Housing Subsidy Assistance) Report the total number of households that received STRMU assistance in Column[I]. In Column[2],identify the outcomes of the households reported in Column[I] either at the time that they were known to have left the STRMU program or through the project sponsor's best assessment for stability at the end of the operating year. Information in Column[3]provides a description of housing outcomes;therefore,data is not required. At the bottom of the chart: • In Row la,report those households that received STRMU assistance during the operating year of this report,and the prior operating year. • In Row Ih,report those households that received STRMU assistance during the operating year of this report,and the two prior operating years. Data Check: The total households reported as served with STRMU in Column X11 equals the total reported in Part 3, Chart I, Row 4, Column R Data Check: The sum of Column[2]should equal the number of households reported in Column[1]. Assessment of Households that Received STRMU Assistance [I] Output: Total [2] Assessment of Housing Status [3] HOPWA Client Outcomes number of households Maintain Private Housing without subsidy (e.g.Assistance provided/completed and client is stable,not likeLy to seek additional support) Other Private Housing without subsidy (e.g.client switched housing units and is now stable,not likely to seek additional support) SlablelPermanent Housing(PH) Other HOPWA housing Subsidy Assistance Other Housing Subsidy(PH) Institution (e.g.residential and long-term care) Likely that additional STRMU is needed to maintain current housing arrangements Transitional Facilities/Short-term Temporarily Stable, with (e.g.temporary or transitional arrangement) Reduced Risk of Homelessness Temporary/Non-Permanent Housing arrangement (e.g.gave up lease,and moved in with family orfriends but expects to live there less than 90 days) Emergency Shelter/street Jail/Prison Unstable Arrangements Disconnected Death Life Event la.Total number of those households that received STRMU Assistance in the operating year of this report that also received STRMU assistance in the prior operating year(e.g.households that received STRMU assistance in two consecutive operating years). lb.Total number of those households that received STRMU Assistance in the operating year of this report that also received STRMU assistance in the two prior operating years(e.g.households that received STRMU assistance in three consecutive operating years). Previous editions are obsolete Page 11 form IIUD-40110-D(Expiration Date.0113112029) Section 3. HOPWA Outcomes on Access to Care and Support 1a. Total Number of Households Line[I]:For project sponsors that provided HOPWA housing subsidy assistance during the operating year identify in the appropriate row the number of households that received HOPWA housing subsidy assistance(TBRA, STRMU,Facility- Based,PHP and Master Leasing)and HOPWA funded case management services. Use Row c to adjust for duplication among the service categories and Row d to provide an unduplicated household total. Line[2]:For project sponsors that did NOT provide HOPWA housing subsidy assistance identify in the appropriate row the number of households that received HOPWA funded case management services. .!Vote: These numbers will help you to determine which clients to report Access to Care and Support Outcomes for and will he used by HUD as a basis for analyzing the percentage of households who demonstrated or maintained connections to care and support as identified in Chart 1h below. Total Number of Households 1. For Project Sponsors that provided PIOPWA Housing Subsidy Assistance: Identify the total number of households that received the following HOPWA funded services: a. Housing Subsidy Assistance(duplicated)-'!'BRA,STRMU,PHP,Facility-Based Housing,and Master Leasing b. Case Management C. Adjustment for duplication(subtraction) d. Total Households Served by Project Sponsors with Housing Subsidy Assistance(Sum of Rows a and b minus Row c) 2. For Project Sponsors did NOT provide HOPWA Housing Subsidy Assistance: Identify the total number of households that received the following HOPWA-funded service: a. HOPWA Case Management b. Total Households Served by Project Sponsors without Housing Subsidy Assistance 1b. Status of Households Accessing Care and Support Column[1]: Of the households identified as receiving services from project sponsors that provided HOPWA housing subsidy assistance as identified in Chart 1 a,Row 1 d above,report the number of households that demonstrated access or maintained connections to care and support within the operating year. Column[2]:Of the households identified as receiving services from project sponsors that did NOT provide HOPWA housing subsidy assistance as reported in Chart la,Row 2b,report the number of households that demonstrated improved access or maintained connections to care and support within the operating year. Note.For in ormation on tykes and sources of income and medical insurance assistance, refer to Charts below. [11 For project sponsors that [2]For project sponsors that provided Hdid NOT provide HOPWAOPWA housing subsidy Outcome Categories of Services Accessed assistance,identify the households housing subsidy assistance, Indicator who demonstrated the following: identify the households who demonstrated the following: 1.Has a housing plan for maintaining or establishing stable on- Support for going housing Stable Housing 2.Had contact with case manager/benefits counselor consistent with the schedule specified in client's individual service plan Access to (may include leveraged services such as Ryan White Medical Support Case Management) 3.Had contact with a primary health care provider consistent recess to with the schedule specified in client's individual service plan Health Care 4.Accessed and maintained medical insurance/assistance Access to Health Care 5.Successfully accessed or maintained qualification for sources Sources of of income Income Chart 1b,Line d: Sources of Medical Insurance and Assistance include, but are not limited to the following (Reference oil • MEDICAID Health Insurance Program,or • Veterans Affairs Medical Services use local program • AIDS Drug Assistance Program(ADAP) Ryan White-funded Medical or Dental name • State Children's Health Insurance Program Assistance • MEDICAPM.Ilealth Insurance Program,or (SCHIP),or use local program name use local program name Previous editions are obsolete Page 12 form HUD-40110-D(Expiration Date:0913112021) Chart Ib,Row S: Sources of Income include, but are not limited to the following Reference only) • Earned Income • Child Support • General Assistance(GA),or use local • Veteran's Pension • Social Security Disability Income(SSDI) program name • Unemployment Insurance • Alimony or other Spousal Support • Private Disability Insurance • Pension from Former Job Veteran's Disability Payment • Temporary Assistance for Needy • Supplemental Security Income(SSI) • Retirement Income from Social Security Families(TANF) • Worker's Compensation • Other Income Sources Ie. Households that Obtained Employment Column[1]:Of the households identified as receiving services from project sponsors that provided HOPWA housing subsidy assistance as identified in Chart la,Row id above,report on the number of households that include persons who obtained an income-producing job during the operating year that resulted from HOPWA-funded Job training,employment assistance,education or related case managetnent/counseling services. Column[2]: Of the households identified as receiving services from project sponsors that did NOT provide HOPWA housing subsidy assistance as reported in Chart la,Row 2b,report on the number of households that include persons who obtained an incoaue-producing job during the operating year that resulted from HOPWA-funded Job training,employment assistance, education or case management/counseling services. Note: This includes jobs created by this project sponsor or obtained outside this agency. Note: Do not include Jobs that resulted from leveraged job training, employment assistance, education or case management/counseling services. [I For project sponsors that provided [21 For project sponsors that did NOT provide Categories of Services Accessed HOPWA housing subsidy assistance,identify HOPWA housing subsidy assistance,identify the the households who demonstrated the households who demonstrated the following: following: Total number of households that obtained an incomc-pmducing job End of PART 4 Previous editions are obsolete Page 13 form HUD-40110-D(Expiration Date:0 1 13112 0 2 1) PART S: Worksheet-Determining Housing Stability Outcomes(optional) 1.This chart is designed to assess program results based on the information reported in Part 4 and to help Grantees determine overall program performance. Completion of this worksheet is o tp ional. Permanent Stable Housing Temporary Housing Unstable Life Event Housing Subsidy (#of households (2) Arrangements (9) Assistance remaining in program (1+7+8) plus 3+4+5+6) Tenant-Based Rental Assistance TSRA) Permanent Facility- based Housing Assistance/Units Transitionat/Short- Term Facility-based Housing Assistance/Units Total Permanent HOPWA Housing Subsidy Assistance Reduced Risk of StabWPermanent Temporarily Stable,with Reduced Risk of Unstable Life Events Homelessness: Housing Homelessness Arraugements Short-Term Assistance Short-'Perm Rent, Mortgage,and Utility Assistance (STRMU) 'total HOPWA Housing Subsidy Assistance Background on HOPWA Housing Stability Codes Stable Permanent Housing/Ongoing Participation 3=Private Housing in the private rental or home ownership market(without known subsidy, including permanent placement with families or other self-sufficient arrangements)with reasonable expectation that additional support is not needed. 4=Other HOPWA-funded housing subsidy assistance(not STRMU),e.g.TBRA or Facility-Based Assistance. 5—Other subsidized house or apartment(non-HOPWA sources,e.g.,Section 8,HOME,public housing). 6=Institutional setting with greater support and continued residence expected(e.g.,residential or long-term care facility). Temporary Housing 2=Temporary housing-moved in with family/fl•iends or other short-term arrangement,such as Ryan White subsidy,transitional housing for homeless,or temporary placement in institution(e.g.,hospital,psychiatric hospital or other psychiatric facility, substance abuse treatment facility or detox center). Unstable Arrangements 1 =Emergency shelter or no housing destination such as places not meant for habitation(e.g.,a vehicle,an abandoned building, bus/train/subway station,or anywhere outside). 7=Jail/prison. 8=Disconnected or disappeared from project support,unknown destination or no assessments of housing needs were undertaken. Life Event 9=Death,i.e.,remained in housing until death.This characteristic is not factored into the housing stability equation. Tenant-based Rental Assistance: Stable Housing is the sum of the number of households that(i)remain in the housing and(ii) those that left the assistance as reported under: 3,4,5,and 6.Temporary Housing is the number of households that accessed assistance,and left their current housing for a non-permanent housing arrangement,as reported under item:2.Unstable Situations is the sum of numbers reported under items: 1,7,and 8. Previous editions are obsolete Page 14 form HUD-40110-D(Expiration Date:0113412029) Permanent Facility-Based Housing Assistance: Stable Housing is the sum of the number of households that(i)remain in the housing and(ii)those that left the assistance as shown as items:3,4,5,and 6.Temporary Housing is the number of households that accessed assistance,and left their current housing for a non-permanent housing arrangement, as reported under item 2. Unstable Situations is the sum of numbers reported under items: 1,7,and 8. Transitional/Short-Term Facility-Based Housing Assistance: Stable Housing is the sum of the number of households that(i) continue in the residences(ii)those that left the assistance as shown as items:3,4,5,and 6.Other Temporary Housing is the number of households that accessed assistance,and left their current housing for a non-permanent housing arrangement,as reported under item 2. Unstable,Situations is the sum of numbers reported under items: 1,7,and 8. Tenure Assessment. A baseline of households in transitional/short-term facilities for assessment purposes,indicate the number of households whose tenure exceeded 24 months. STRMU Assistance: Stable Housing is the sum of the number of households that accessed assistance for some portion of the permitted 21-week period and there is reasonable expectation that additional support is not needed in order to maintain permanent housing living situation (as this is a time-limited form of housing support)as reported under housing status:Maintain Private Housing with subsidy; Other Private with Subsidy; Other HOPWA support; Other Housing Subsidy;and Institution. Temporarily Stable,with Reduced Risk of Homelessness is the sum of the number of households that accessed assistance for some portion of the permitted 21-week period or left their current housing arrangement for a transitional facility or other temporary/non-permanent housing arrangement and there is reasonable expectation additional support will be needed to maintain housing arrangements in the next year, as reported under housing status:Likely to maintain current housing arrangements,with additional STRMU assistance; Transitional Facilities/Short-term;and Temporary/Non-Permanent Housing arrangements Unstable Situation is the sum of number of households reported under housing status:Emergency Shelter;Jail/Prison;and Disconnected. End of PART 5 Previous editions are obsolete Page I5 form HUD-01 10-D(Expiration Date:0113112029) PART 6: Annual Report of Continued Usage for HOPWA Facility-Based Stewardship Units(ONLY) The Annual Report of Continued Usage for HOPWA Facility-Based Stewardship Units is to be used in place of Part 7B of the CAPER if the facility was originally acquired,rehabilitated or constructed/developed in part with HOPWA funds but no HOPWA funds were expended during the operating year. Scattered site units may be grouped together on one page. Grantees that used HOPWA funding for new construction, acquisition,or substantial rehabilitation are required to operate their facilities for HOPWA eligible individuals for at least ten(10)years. If non-substantial rehabilitation funds were used,they are required to operate for at least three(3)years. Stewardship begins once the facility is put into operation. Note:See definition of Stewardship Units. J.General information Operating Year for this report HUD Grant Number(s) From(ntmlddlyy)To(tnuilddlyy) ❑Final Yr ❑ Yr 1; ❑Yr 2; ❑Yr 3; ❑Yr 4; ❑Yr 5; ❑Yr 6; ❑Yr 7; ❑Yr&; ❑Yr 9; ❑Yr 10 Grantee Name Date Facility Began Operations(mmlddlyy) 2. Number of Units and Non-HOPWA Ex enditures Facility Name: Number of Stefvardship Units Amount of Non-HOPWA Funds Expended in Support of the Developed with HOPWA Stewardship Units during the Operating Year funds Total Stewardship Units (subjeetto 3-or 10-year useperiods) 3.Details of Project Site Project Sites:Name ofHOPWA-funded project Site Information:Project Zip Code(s) Site Information:Congressional District(s) Is the address of the project site confidential? ❑ I es,protect information;do not fist ❑ Not confidential,-information can be made available to the public If the site is not confidential: Please provide the contact information,phone, email address/location,if business address is different from facility address End of PART 6 Previous editions are obsolete Page 16 form HUD-40110-D(Expiration Date:0113112021) Part 7: Summary Overview of Grant Activities A. Information on Individuals,Beneficiaries, and Households Receiving HOPWA Housing Subsidy Assistance (TBRA,STRMU,Facility-Based Units,Permanent Housing Placement and Master Leased Units ONLY) Note:Reporting for this section should include ONLY those individuals, beneficiaries, or households that received and/or resided in a household that received HOPWA Housing Subsidy Assistance as reported in Part 3, Chart 1,Row 7, Column b. (e.g:, do not include households that received HOPWA supportive services ONLY). Section 1. HOPWA-Eligible Individuals Who Received HOPWA Housing Subsidy Assistance a. Total HOPWA Eligible Individuals Living with HIV/AIDS In Chart a.,provide the total number of eligible(and unduplicated)low-income individuals living with HIV/AIDS who qualified their household to receive HOPWA housing subsidy assistance during the operating year, This total should include only the individual who qualified the household for HOPWA assistance,NOT all HIV positive individuals in the household. Individuals Served with Housing Subsidy Assistance Total Number of individuals with HN/AIDS who qualified their household to receive HOPWA housing subsidy assistance. Chart b.Prior Living Situation In Chart b,report the prior living situations for all Eligible Individuals reported in Chart a. In Row 1,report the total number of individuals who continued to receive HOPWA housing subsidy assistance from the prior operating year into this operating year. In Rows 2 through 17,indicate the prior living arrangements for all new HOPWA housing subsidy assistance recipients during the operating year. Data Check: The total number of eligible individuals served in Row 18 equals the total number of individuals served through housing subsidy assistance re orted in Chart a above. Total HOPWA Category Eligible Individuals Receiving Housing Subsidy Assistance 1. 1 Continniniz to receive HOPWA support from the prior operating year New Individuals who received HOPWA HousingSubsidy Assistance support during Operating Year 2 Place not meant for human habitation such as a vehicle,abandoned building,bus/train/subway station/airport,or outside) 3. Emergency shelter(including hotel,motel,or campground paid for with emergency shelter voucher) 4. Transitional housing:For homeless persons 5. Total number of new Eligible Individuals who received HOPWA Housing Subsidy Assistance with a Prior Living Situation that meets HUD definition of homelessness Sum of Rows 2—4 6 Permanent housing for formerly homeless persons(such as Shelter Plus Care,SHP,or SRO Mod Rehab) 7. Psychiatric hospital or other psychiatric facility 8. Substance abuse treatment facility or detox center 9. Hospital(non-psychiatric facility) 10. Foster care home or foster care group home 11. Jail,prison or juvenile detention facility 12. Rented room,apartment,or house 13. House you own 14. Staying or living in someone else's(family and friends)room,apartment,or house I5. Hotel or motel paid for without emergency shelter voucher 16. Other 17. Don't Know or Refused 18. 'TOTAL Number of HOPWA Eligible Individuals(sum of Rows 1 and 5-17) Previous editions are obsolete Page 17 form HUD-401 10-D(Expiration Date:0113112021) c. Homeless Individual Summary In Chart c,indicate the number of eligible individuals reported in Chart b,Row 5 as homeless who also are homeless Veterans and/or meet the definition for Cbronically Homeless(See Definition section of CAPER). The totals in Chart c do not need to equal the total in Cbart b,Row 5. Number of Number of Chronically Category Homeless Homeless Veteran(s) HOPWA eligible individuals served with HOPWA Housing Subsidy Assistance Section 2. Beneficiaries In Chart a,report the total number of HOPWA eligible individuals living with IIIV/AIDS who received HOPWA housing subsidy assistance(as reported in Part 7A, Section 1, Chart a),and all associated members of their household who benefitted from receiving HOPWA housing subsidy assistance(resided with HOPWA eligible individuals). Note:See definition of HOP W,4 Eligible Individual Note:See definition of Transgender. Note: See definition of Bene iciaries. Data Cheek: The sum of each of the Charts b &c on the following two pages equals the total number of beneficiaries served with HOP W,4 housing subsidy assistance as determined in Chart a,Row 4 below. a.Total Number of Beneficiaries Served with HOPWA Housing Subsidy Assistance Individuals and Families Served with HOPWA Housing Subsidy Assistance Total Number 1. Number of individuals with MWAIDS who qualified the household to receive HOPWA housing subsidy assistance(equals the munber of HOPWA Eligible Individuals reported in Part 7A,Section 1,Chart a) 2. Number of ALL other persons diagnosed as FIIV positive who reside with the HOPWA eligible individuals identified in Row I and who benefitted from the HOPWA housing subsidy assistance 3. Number of ALL other persons NOT diagnosed as HIV positive who reside with the HOPWA eligible individual identified in Row 1 and who benefited from the HOPWA housing subsidy 4. TOTAL number of ALL beneficiaries served with Housing,Subsidy Assistance(Sum of Rows 1,2,&3) Previous editions arc obsolete Page 18 form HUD-40110-D()expiration Date;01!3112029) b.Age and Gender In Chart b,indicate the Age and Gender of all beneficiaries as reported in Chart a directly above. Report the Age and Gender of all HOPWA Eligible Individuals(those reported in Chart a,Row 1)using Rows 1-5 below and the Age and Gender of all other beneficiaries(those reported in Chart a,Rows 2 and 3)using Rows 6-10 below. The number of individuals reported in Row 11, Column E. equals the total number of beneficiaries reported in Part 7,Section 2,Chart a,Row 4. HOPWA Eli ible Individuals Chart a,Row 1) A. B. C. D. E. TOTAL(Sum of Male Female Trans eioder M to F Tr us ender F to M Columns A-D) I. Under 18 2. 18 to 30 years 3. 31 to 50 years 51 years and 4. Older Subtotal(Sum 5. of Rows 1-4 All Other Beneficiaries Chant a,Rows 2 and 3 A. B. C. D. F. TOTAL(Sum of Male Female Traus ender M to F Trans ender F to M Columns A-D 6. 1 Under 18 7. 18 to 30 years 8. 31 to 50 years 51 years and 9. Older Subtotal(Sam 10. of Rows 6-9 Total Beneficiaries Chart a,Row 4 TOTAL(Sum 11. of Rows 5&10) Previous editions are obsolete Page 19 form HUD-40110-D(Expiration Date:0 9 13 9120 2 4) c.Race and Ethnicity` Tn Chart c,indicate the Race and Ethnicity of all beneficiaries receiving HOPWA Housing Subsidy Assistance as reported in Section 2,Chart a,Row 4. Report the race of all HOPWA eligible individuals in Column[A]. Report the ethnici of all HOPWA eligible individuals in column[B]. Report the race of all other individuals who benefitted froth the HOPWA housing subsidy assistance in column[C]. Report the ettmici of all other individuals who benefitted from the HOPWA housing subsidy assistance in column[D]. The summed total of columns [A] and [C]equals the total number of beneficiaries reported above in Section 2,Chart a,Row 4. HOPWA Eligible Individuals All Other Beneficiaries [A] Mace [Cl Race Category [all individuals [B]Ethnicity [total of [D]Ethnicity reported in [Also identified as individuals [Also identified as rep Sectionrep r Chart a, Hispanic or reported in Hispanic or Row 1] Latino] Section 2,Chart a, Latino] Rows 2&31 1. American Indian/Alaskan Native 2. Asian 3, Black/African American 4. Native Hawaiian/Other Pacific Islander 5. White 6, American Indian/Alaskan Native&White 7. Asian&White & Black/African American&White 9 American Indian/Alaskan Native& Black/Afirican American 10. Other Multi-Racial 11. Column Totals(Sum of Rows 1-10) Data Check.Sum of Row Il Colman A and Row I I Column C equals the total number HOPW l Beneficiaries reported in Part 3.4,Section 2, Chart a,Romp 4. *Reference(data requested consistent with Form HUD-27061 Race and Ethnic Data Reporting Form) Section 3. Households Household Area Median Income Report the income(s)for all households served with HOPWA housing subsidy assistance. Data Check: The total number of households served with HOPWA housing subsidy assistance should equal Part 3C, Row 7, Column b and Part 7A,Section 1, Chart a. (Total HOPWA Eligible Individuals Served with HOPWA Housing Subsidy Assistance). Note: Refer to hgps://www.huduser.gov/portal/datasets/il.html for information on area median income in your C mmunity. Percentage of Area Median Income households Served with HOPWA Housing Subsidy Assistance 1. 0-30%of area median income(extremely low) 2. 31-50%of area median income(very low) 3, 51-80%of area median income(low) 4. Total(Sum of Rows 1-3) Previous editions are obsolete Page 20 form HUD-40110-D(Expiration Date:0113112021) Part 7: Summary Overview of Grant Activities B. Facility-Based Housing Assistance Complete one Part 7B for each facility developed or supported through HOPWA funds. Do not complete this Section for programs originally developed with HOPWA funds but no longer supported with HOPWA funds. If a facility was developed with HOPWA funds(subject to ten years of operation for acquisition,new construction and substantial rehabilitation costs of stewardship units,or three years for non-substantial rehabilitation costs),but HOPWA funds are no longer used to support the facility,the project sponsor should complete Part 6:Continued Usage for HOPWA Facility-Based Stewardship Units(ONLY). Complete Charts 2a,Project Site Information,and 2b,Type of HOPWA Capital Development Project Units,for all Development Projects,including facilities that were past development projects,but continued to receive HOPWA operating dollars this reporting year. 1. Pro'ect S onsor Agency Name(Required) 2. Capital Development 2a.Project Site Information for HOPWA Capital Development of Projects (Por Current or Past Capital Development Projects that receive HOPWA Operating Costs this reporting year) Note:If units are scattered-sites, report on them as.a gray and under Type of Facili write "Scattered Sites." HOPWA Name of Facility: Type of Funds Non-HOPWA funds Development Expended Expended this operating this operating t applicable) year year (f pp ) (i a licable) ❑New construction $ $ Type of Facility [Check only one box.] ❑Rehabilitation $ $ ❑ Permanent housing ❑ Short-term Shelter or Transitional housing ❑Acquisition $ S ❑ Supportive services only facility ❑Operating S $ a. Purchase/lease of property: Date(mm/dd/yy): b. Rehabilitation/Construction Dates: Date started: Date Completed: C. Operation dates: Date residents began to occupy: ❑ Not yet occupied d. Date supportive services began: Date started: ❑ Not yet providing services e. Number of units in the facility: HOPWA-funded units— Total Units ❑Yes ❑No f. Is a waiting fist maintained for the facility? Yyes,number of participants on the list at the end of operating year g. What is the address of the facility(if different from business address)? h. Is the address of the project site confidential? ❑ Yes,protect information;do not publish list ❑ No,can be made available to the public Previous editions are obsolete Page 2I form HUD-40110-D(Expiration Date:0113112021) 2b. Number and Type of HOPWA Capital Development Project Units(For Current or Past Capital Development Projects that receive HOPWA Operating Costs this Reporting Year) For units entered above in 2a, please list the number of HOPWA units that fulfill the following criteria: Number Designated Number for the Chronically Designated to Number Energy- Number 504 Accessible IIomeIess Assist the Star Compliant Homeless Rental units constructed (new)and/or acquired with or without rehab Rental units rehabbed Homeownership units constructed(if approved) 3. Units Assisted in Types of Housing Facility/Units Leased by Project Sponsor Charts 3a 3b and 4 are required for each facility. In Charts 3a and 3b,indicate the type and number of housing units in the facility,including master leased units,project-based or other scattered site units leased by the organization,categorized by the number of bedrooms per unit. Note: The number units may not equal the total number of households served. Please complete separate charts for each housing facility assisted. Scattered site units may be grouped together. 3a. Check one only ❑ Permanent Supportive Housing Facility/Units ❑ Short-term Shelter or Transitional Supportive Housing Facility/Units 3b. Type of Facility Complete the following Chart for all facilities leased,master leased,project-based,or operated with HOPWA funds during the reporting year. Name of Project Sponsor/Agency Operating the Facility/Leased Units: Total Number of Units in use during the Operating Year Type of housing facility operated by the Cate orized by the Number of Bedrooms per Units project sponsor SRO/Studio/0 1 bdrm 2 bdrm 3 bdrm 4 bdrm 5+bdrm bdrm a. Single room occupancy dwelling " T b. Community residence c. Project-based rental assistance units or leased units Other housing facility d S mi 4.Households and Housing Expenditures Enter the total number of households served and the amount of HOPWA funds expended by the project sponsor on subsidies for housing involving the use of facilities,master leased units,project based or other scattered site units leased by the organization. Housing Assistance Category:Facility Based Housing Output:Number of Output:Total HOPWA Funds Expended during Households Operating Year by Project Sponsor a Leasing Costs b Operating Costs c Project-Based Rental Assistance(PBRA)or other leased units d Other Activity(if approved in grant agreement)Specify: e Adjustmcut to eliminate duplication(subtract) TOTAL Facility-Based Housing Assistance t Sum Rows a through d minus Row c) Previous editions are obsolete Page 22 form HUD-40110-D(Expiration Date:01131/2021) EXHIBIT "I" MBE REPORTING FORM NOT APPLICABLE HOPWA PSA CONTRACT 2018-2019--EXtUBIT"I"--MBE REPORTING FORM Page 1 AIDS Outreach Center m O O _ m � O Cc N n m � N R m m =.m n E S Lm m E w w o ImH R � Z OR 16 N�� ¢ a Q m m �" b U❑.O m m � m❑ a ID oai °'v a m m v rp x�- y � m m o Q IML m Z W a rn mE 'mm m m m a cy�m Jo m 2 o O N N a Q tL(n.... -t OL �j N ]I II 11 II N 6 N"mO 12sL-C G m N m 3 >o E m o o d mT mEsa'a ao. ami me O1ocmi mo C y E m O.Q N E �a row Eu; z } p m U Eo cL .p C NO C U} m M r ti C E 137 u}im N❑m E .��amr ~o� (] �ccmE m O wr+❑ ._. m U V � 14 m ti m LL w� m o c a ti L m m E¢ Eo cLi� cm .c i� UQ — ¢� ._Z � QQQ�Qo m m y m m fn d W N Y m i6 G N U }Q m- o w C ole m G 'C7 ti - �rOZ2 Q2 a m w m ni m a m b" ❑ c m e c o o ¢ r.o� _ m o 0 mi ti a> G m mn rtsm - Ec m N'mC y o m n c N LLo` a' m d �rom H 0 o m o i o ov E m m z o E w mz t Sc' o r a.�❑:o o y o O m" m dmto pn p omm.c o rn� m y ❑ rn U mo `ani amimmrn n_ wmU m'� uta 0o cw . �-I Uyma N C L � a•_- O m C� ti m m+•oS o� .mtoW £ E 'N N 42 C C cc a N o to N m mD. 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C n m � Q o aa� ��a Em- m m c cE mE a a � [t" � � w � 0.0mo t °— Qac m c fi m y cq o� � 3 on a E w E a.c ° �'0 3-� ° oU °- m o v0, o m c m o y ° m o 0 o O m o m cu E [S U y fS Z Q F- 0 3 0 U m c `m U m E (q f!1 m (!f p o �?� mGma Y � aoi moS.c'E co E b Goa m .°oam2 m cc Em mac Ui F- NG E Ela N U �' w co nim V ,; C-i m ti p0. m •r° c l� in v c�iin arm �� cpi ti Mn`.� ti ti`0.?C] i, i�� EXHIBIT "J" DUTIES OF THE PARTIES USE OF NEIGHBORHOOD SERVICES DEPARTMENT COMMUNITY CENTERS HOPWA PRESUMED BENEFIT PSA CONTRACT 2018-2019--EXHIBIT",I" DU7FJE-S OF THE PARTIES USE OF NEIGHBORI-IOOD SERVICES DEPARTMENT COMMUNITY CENTERS Page 1 AIDS Outreach Center AIDS Outreach Center 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: PIOPWA PRESUMED BENEFIT PSA CONTRACT 2018-2019--EXMBIT"J"--DUTIES OF THE PARTIES— USE OF NEIGHBORHOOD SERVICES DEPARTMENT COMMUNITY CENTERS Page 1 AIDS Outreach Center 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 Ist) 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 fail 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. HOPWA PRESUMED BENEFIT PSA CONTRACT 20.18-2019 EXHIBIT"J"----DUTIES OF THE PARTIES— USE OF NEIGMORHOOD SERVICES DEPARTMENT COMMUNITY CENTERS Page 2 AIDS Outreach Center EXHIBIT "K" NOTICE OF BENEFICIARY RIGHTS HOPWA FSA CONTRACT 2015-2019--EXHIBIT"K"---NO'T'ICE OF BENEFICIARY RIGHTS Page 1 AIDS Outreach Center Notice of Beneficiary Rights Nance of Agency: AIDS Outreach Center,Inc. Name of Program: Supportive Services, STRMU, and TBRA 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. HOPWA PSA CONTRACT 2015-2019--EXHIBIT"K"—NOTICE OF BENEFICIARY RIGH'T'S Page 2 AIDS Outreach Center EXHIBIT "L" NOTICE OF OCCUPANCY RIGHTS UNDER VAWA HOPWA PSA CONTRACT 2018-2019--EXHIBIT"L"—NOTICE OF OCCUPANCY RIGIITS UNDER VAWA AIDS Outrcach Center NO'T'ICE 01 OCCUPANCY RIGHTS UNDER U.S.Department of Housing and Urban Development THE VIOLENCE AGAINST WOMEN ACT OMB Approval No.2577-0286 Expires 06/30/2017 EXHIBIT "L"—Notice of Occupancy Rights Under VAWA [Insert Name of Housing_Providers] Notice of Occupancy Rights under the Violence Against Women Acte To all Tenants and Applicants The Violence Against Women Act (VAWA)provides protections for victims of domestic violence, dating violence, sexual assault, or stalking. VAWA protections are not only available to women, but are available equally to all individuals regardless of sex, gender identity, or sexual orientation.3 The U.S. Department of Housing and Urban Development(HUD) is the Federal agency that oversees that [insert name of program or rental assistance] is in compliance with VAWA. This notice explains your rights under VAWA. A HUD-approved certification form is attached to this notice. You can fill out this form to show that you are or have been a victim of domestic violence, dating violence, sexual assault, or stalking, and that you wish to use your rights under VAWA." Protections for Applicants If you otherwise qualify for assistance under [insert name of program or rental assistance], you. cannot be denied admission or denied assistance because you are or have been a victim of domestic violence, dating violence, sexual assault, or stalking. 1 The notice uses HP for housing provider but the housing provider should insert its name where HP is used. HUD's program-specific regulations identify the individual or entity responsible for providing the notice of occupancy rights. 2 Despite the name of this law,VAWA protection is available regardless of sex,gender identity,or sexual orientation. 3 Housing providers cannot discriminate on the basis of any protected characteristic,including race, color,national origin,religion,sex,familial status,disability,or age. HUD-assisted and HUD-insured housing must be made available to all otherwise eligible individuals regardless of actual or perceived sexual orientation,gender identity,or marital status. Form HUD-5380 (12/2016) 2 Protections for Tenants If you are receiving assistance under [insert name of program or rental assistance], you may not be denied assistance, terminated from participation, or be evicted from your rental housing because you are or have been a victim of domestic violence, dating violence, sexual assault, or stalking. Also, if you or an affiliated individual of yours is or has been the victim of domestic violence, dating violence, sexual assault, or stalking by a member of your household or any guest, you may not be denied rental assistance or occupancy rights under [insert name of program or rental assistance) solely on the basis of criminal activity directly relating to that domestic violence, dating violence, sexual assault, or stalking. Affiliated individual means your spouse,parent, brother, sister, or child, or a person to whom you stand in the place of a parent or guardian (for example, the affiliated individual is in your care, custody, or control); or any individual, tenant, or lawful occupant living in your household. Removing the Abuser or Perpetrator from the Household HP may divide (bifurcate) your lease in order to evict the individual or terminate the assistance of the individual who has engaged in criminal activity(the abuser or perpetrator) directly relating to domestic violence, dating violence, sexual assault, or stalking. If HP chooses to remove the abuser or perpetrator, HP may not take away the rights of eligible tenants to the unit or otherwise punish the remaining tenants. If the evicted abuser or perpetrator was the sole tenant to have established eligibility for assistance under the program, HP must allow the tenant who is or has been a victim and other household members to remain in the unit for a period of time, in order to establish eligibility under the program or under another HUD housing program covered by VAWA, or, find alternative housing. Forin HUD-5380 (1212016) 3 In removing the abuser or perpetrator from the household, HP must follow Federal, State, and local eviction procedures. In order to divide a lease, HP may, but is not required to, ask you for documentation or certification of the incidences of domestic violence, dating violence, sexual assault, or stalking. Moving to Another Unit Upon your request, HP may permit you to move to another unit, subject to the availability of other units, and still keep your assistance. In order to approve a request, HP may ask you to provide documentation that you are requesting to move because of an incidence of domestic violence, dating violence, sexual assault, or stalking. If the request is a request for emergency transfer,the housing provider may ask you to submit a written request or fill out a form where you certify that you meet the criteria for an emergency transfer under VAWA. The criteria are: (1) You are a victim of domestic violence, dating violence, sexual assault, or stalking. If your housing provider does not already have documentation that you are a victim of domestic violence, dating violence, sexual assault, or stalking, your housing provider may ask you for such documentation, as described in the documentation section below. (2) You expressly request the emergency transfer. Your housing provider may choose to require that you submit a form, or may accept another written or oral request. (3) You reasonably believe you are threatened with imminent harm from further violence if you remain in your current unit. This means you have a reason to fear that if you do not receive a transfer you would suffer violence in the very near future. Foran HUD-53 S 0 (12/2016) 4 OR You are a victim of sexual assault and the assault occurred on the premises during the 90-calendar-day period before you request a transfer. If you are a victim of sexual assault, then in addition to qualifying for an emergency transfer because you reasonably believe you are threatened with imminent harm from further violence if you remain in your unit, you may qualify for an emergency transfer if the sexual assault occurred on the premises of the property from which you are seeking your transfer,and that assault happened within the 90-calendar-day period before you expressly request the transfer. HP will keep confidential requests for emergency transfers by victims of domestic violence, dating violence, sexual assault, or stalking, and the location of any move by such victims and their families. HP's emergency transfer plan provides further information on emergency transfers, and HP must make a copy of its emergency transfer plan available to you if you ask to see it. Documenting You Are or Have Been a Victim of Domestic Violence, Dating Violence, Sexual Assault or Stalking HP can, but is not required to, ask you to provide documentation to"certify" that you are or have been a victim of domestic violence, dating violence, sexual assault, or stalking. Such request from HP must be in writing, and HP must give you at least 14 business days (Saturdays, Sundays, and Federal holidays do not count) from the day you receive the request to provide the documentation. HP may, but does not have to, extend the deadline for the submission of documentation upon your request. Form HUD-53 80 (12/2016) S You can provide one of the following to HP as documentation. It is your choice which of the following to submit if HP asks you to provide documentation that you are or have been a victim of domestic violence, dating violence, sexual assault, or stalking. • A complete FUJD-approved certification form given to you by YIP with this notice, that documents an incident of domestic violence, dating violence, sexual assault, or stalking. The form will ask for your name,the date,time, and location of the incident of domestic violence, dating violence, sexual assault, or stalking, and a description of the incident. The certification form provides for including the name of the abuser or perpetrator if the name of the abuser or perpetrator is known and is safe to provide. • A record of a Federal, State, tribal,territorial, or local Iaw enforcement agency, court, or administrative agency that documents the incident of domestic violence, dating violence, sexual assault, or stalking. Examples of such records include police reports,protective orders, and restraining orders, among others. • A statement,which you must sign, along with the signature of an employee, agent, or volunteer of a victim service provider, an attorney, a medical professional or a mental health professional (collectively, "professional") from whom you sought assistance in addressing domestic violence, dating violence, sexual assault, or stalking, or the effects of abuse, and with the professional selected by you attesting under penalty of perjury that he or she believes that the incident or incidents of domestic violence, dating violence, sexual assault, or stalking are grounds for protection. • Any other statement or evidence that HP has agreed to accept. If you fail or refuse to provide one of these documents within the 14 business days, HP does not have to provide you with the protections contained in this notice. Porm HUD-5380 (12/2016) 6 If HP receives conflicting evidence that an incident of domestic violence, dating violence, sexual assault, or stalking has been committed (such as certification forms from two or more members of a household each claiming to be a victim and naming one or more of the other petitioning household members as the abuser or perpetrator), HP has the right to request that you provide third-party documentation within thirty 30 calendar days in order to resolve the conflict. If you fail or refuse to provide third-party documentation where there is conflicting evidence, HP does not have to provide you with the protections contained in this notice. Confidentiality HP must keep confidential any information you provide related to the exercise of your rights under VAWA, including the fact that you are exercising your rights under VAWA. HP must not allow any individual administering assistance or other services on behalf of HP (for example, employees and contractors) to have access to confidential information unless for reasons that specifically call for these individuals to have access to this inforrnation under applicable Federal, State, or local law. HP must not enter your information into any shared database or disclose your information to any other entity or individual. HP, however, may disclose the information provided if: + You give written permission to HP to release the information on a time limited basis. • HP needs to use the information in an eviction or termination proceeding, such as to evict your abuser or perpetrator or terminate your abuser or perpetrator from assistance tinder this program. • A law requires HP or your landlord to release the information. Form HTTP-5380 (12/2016) 7 VAWA does not limit HP's duty to honor court orders about access to or control of the property. This includes orders issued to protect a victim and orders dividing property among household members in cases where a family breaks up. Reasons a Tenant Eligible for Occupancy Rights under VAWA May Be Evicted or Assistance May Be Terminated You can be evicted and your assistance can be terminated for serious or repeated lease violations that are not related to domestic violence, dating violence, sexual assault, or stalking committed against you. However, HP cannot hold tenants who have been victims of domestic violence, dating violence, sexual assault, or stalking to a more demanding set of rules than it applies to tenants who have not been victims of domestic violence, dating violence, sexual assault, or stalking. The protections described in this notice might not apply, and you could be evicted and your assistance terminated, if HP can demonstrate that not evicting you or terminating your assistance would present a real physical danger that: 1) Would occur within an immediate time frame, and 2} Could result in death or serious bodily harm to other tenants or those who work on the property. If HP can demonstrate the above, HP should only terminate your assistance or evict you if there are no other actions that could be taken to reduce or eliminate the threat. Other Laws VAWA does not replace any Federal, State, or local law that provides greater protection for victims of domestic violence, dating violence, sexual assault, or stalking. You may be entitled to Form HUD-5390 (12/2016) 8 additional housing protections for victims of domestic violence, dating violence, sexual assault, or stalking under other Federal Iaws, as well as under State and local laws. Non-Compliance with The Requirements of This Notice You may report a covered housing provider's violations of these rights and seek additional assistance, if needed, by contacting or filing a complaint with [insert contact information for any intermediary, if applicablel or [insert HUD field officel. For Additional Information You may view a copy of HUD's final VAWA rule at [insert Federal Register link]. Additionally,HP must make a copy of HUD's VAWA regulations available to you if you ask to see them. For questions regarding VAWA,please contact [insert name of prolzram or rental assistance contact information able to answer questions on VAWA]. For help regarding an abusive relationship, you may call the National Domestic Violence Hotline at 1-800-799-7233 or, for persons with hearing impairments, 1-800-787-3224 (TTY). You may also contact [Insert contact information for relevant local organizations]. For tenants who are or have been victims of stalking seeking help may visit the National Center for Victims of Crime's Stalking Resource Center at https://www.victimsoferime.org/our- programs/stalking-resource-center. For help regarding sexual assault, you may contact [Insert contact information for relevant organizations] Victims of stalking seeking help may contact [Insert contact information for relevant organizations]. Attachment: Certification form.HUD-5382 [form approved for this program to be included] Form HUD-5380 (12/2016) EXHIBIT "M" EMERGENCY TRANSFER REQUEST FORM-VAWA HOPWA PSA CONTRACT 2018-2019--EXHIBIT"M"—EMERGENCY TRANSFER REQUEST FORM- VAWA AIDS Outreach Center EXHIBIT "M" -- Emergency Transfer Request Form CERTIFICATION OF U.S. Department of Housing OMB Approval No.2577-0286 DOMESTIC VIOLENCE, and Urban Development Exp.06/30/2017 DATING VIOLENCE, SEXUAL ASSAULT, OR STALKING, AND ALTERNATE DOCUMENTATION Purpose of Form: The Violence Against Women Act("VAWA") protects applicants,tenants, and program participants in certain HUD programs from being evicted, denied housing assistance, or terminated from housing assistance based on acts of domestic violence, dating violence,sexual assault, or stalking against them. Despite the name of this law,VAWA protection is available to victims of domestic violence, dating violence, sexual assault, and stalking, regardless of sex, gender identity, or sexual orientation. Use of This Optional Form: If you are seeking VAWA protections from your housing provider,your housing provider may give you a written request that asks you to submit documentation about the incident or incidents of domestic violence, dating violence, sexual assault,or stalking. In response to this request,you or someone on your behalf may complete this optional form and submit it to your housing provider, or you may submit one of the following types of third-party documentation: (1)A document signed by you and an employee, agent, or volunteer of a victim service provider, an attorney, or medical professional, or a mental health professional(collectively, "professional")from whom you have sought assistance relating to domestic violence, dating violence,sexual assault, or stalking, or the effects of abuse. The document must specify,under penalty of perjury,that the professional believes the incident or incidents of domestic violence,dating violence, sexual assault,or stalking occurred and meet the definition of"domestic violence,""dating violence,""sexual assault,"or "stalking"in HUD's regulations at 24 CFR 5.2003. (2)A record of a Federal, State, tribal,territorial or local law enforcement agency,court, or administrative agency; or (3)At the discretion of the housing provider, a statement or other evidence provided by the applicant or tenant. Submission of Documentation: The time period to submit documentation is 14 business days from the date that you receive a written request froze your housing provider asking that you provide documentation of the occurrence of domestic violence, dating violence, sexual assault, or stalking. Your housing provider may,but is not required to, extend the time period to submit the documentation, if you request an extension of the time period. If the requested information is not received within 14 business days of when you received the request for the documentation, or any extension of the date provided by your housing provider,your housing provider does not need to grant you any of the VAWA protections. Distribution or issuance of this form does not serve as a written request for certification. Confidentiality: All information provided to your housing provider concerning the incident(s)of domestic violence,dating violence,sexual assault, or stalking shall be kept confidential and such details shall not be entered into any shared database. Employees of your housing provider are not to have access to these details unless to grant or deny VAWA protections to you, and such employees may not disclose this information to any other entity or individual,except to the extent that disclosure is: (i) consented to Form HUD-5382 (0612017) 2 by you in writing in a time-limited release; (ii)required for use in an eviction proceeding or hearing regarding termination of assistance; or(iii) otherwise required by applicable law. TO BE COMPLETED BY OR ON BEHALF OF THE VICTIM OF DOMESTIC VIOLENCE DATING VIOLENCE, SEXUAL ASSAULT, OR STALKING 1. Date the written request is received by victim: 2. Name of victim: 3. Your name(if different from victim's): 4. Name(s) of other family member(s)listed on the lease: S. Residence of victim: b. Name of the accused perpetrator(if known and can be safety disclosed): 7. Relationship of the accused perpetrator to the victim: S. Datc(s) and times(s) of incident(s)(if known): 10. Location of incident(s): In your own words,briefly describe the incident(s): This is to certify that the information provided on this form is true and correct to the best of my knowledge and recollection,and that the individual named above in Item 2 is or has been a victim of domestic violence, dating violence, sexual assault, or stalking. I acknowledge that submission of false information could jeopardize program eligibility and could be the basis for denial of admission,tennination of assistance, or eviction. Signature Signed on(Date) Public Reporting Burden: The public reporting burden for this collection of information is estimated to average 1 hour per response. This includes the time for collecting,reviewing,and reporting the data. The information provided is to be used by the housing provider to request certification that the applicant or tenant is a victim of domestic violence,dating violence,sexual assault,or stalking. The information is subject to the confidentiality requirements of VAWA.This agency may not coIIect this information,and you are not required to complete this form,unless it displays a currently valid Office of Management and Budget control number. Form HUD-5382 (0612017) M&C Review Page 1 of 7 Official site of the City of Fort Worth,Texas Ef Wt1 my ("CO, U PqCALGEN, DA COUNCIL ACTION: Approved on 8/7/2018 - Ordinance No. 23310-08-2018 REFERENCE G-19328 19NS HUD CONPLAN DATE: 8/712018 NO.: (Revised) LOG NAME: 2018-22 ACTIONPLAN 2018-19 CODE: G TYPE: NOW PUBLIC CONSENT HEARING: YES SUBJECT: Conduct Public Hearing and Approve the City's 2018-2022 Consolidated Plan Priorities and Goals and 2018-2019 Action Plan for the Use of Federal Grant Funds in the Amount of$12,044,676.00 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 2018-2022 Consolidated Plan Priorities and Goals and 2018-2019 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 $12,044,676.00 from the Community Development Block Grant, HOME Investment Partnerships Program, Emergency Solutions Grant, and Housing Opportunities for Persons with AIDS grant programs, and for the use of program income from activities using prior years' federal grant funds; 2. Approve the City's 2018-2022 Consolidated Plan and 2018-2019 Action Plan for submission, including allocations of grant funds to particular programs and activities as detailed below; 3. Authorize the collection and use of an estimated $2,200,000.00 of program income which is expected to result from activities using prior years' Community Development Block Grant funds for the projects and programs detailed below, and authorize the collection and use of amounts over the $2,200,000.00 of program income, estimated to be $150,000.00, for City's Priority Repair Program; 4. Authorize the collection and use of an estimated $150,000.00 of program income which resulted from activities using prior years' HOME Investment Partnerships Program funds for the City's Homebuyer Assistance Program, and authorize the use of 10 percent of the program income for administrative costs; 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 2018-2019 for Community Development Block Grant, Emergency Solutions Grant, and Housing Opportunities for Persons with AIDS grant funds, contingent upon receipt of funding, 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 M&C Review Page 2 of 7 governing the use of federal grant funds; 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$12,044,676.00 consisting of$7,262,818.00 in Community Development Block Grant funds, $2,861,535.00 in HOME Investment Partnerships Program grant funds, $587,565.00 in Emergency Solutions Grant funds, and $1,332,758.00 in Housing Opportunities for Persons with AIDS grant funds, plus any program income, all subject to receipt of such funds. DISCUSSION: The City's 2018-2022 Consolidated Plan assesses community and affordable housing needs and sets strategic priorities and goals for use of federal.grant funds from the United States Department of Housing and Urban Development (HUD) for a five-year period. These priorities and goals are to be addressed with Annual Action Plans that summarize the major housing and community development activities and proposed expenditures for each of the five years. Recommendations for proposed priorities and goals for the Consolidated Plan were adopted by the City's Community Development Council on May 16, 2018. These priorities and goals were developed to be consistent with strategies and initiatives previously adopted by the City Council, as well as through an assessment of community needs which included the Assessment of Fair Housing planning process conducted in 2017. The recommended Consolidated Plan priorities and goals for use of HUD grant funds over the next five years are summarized below. • Affordable Housing: Promote homeownership, affordable housing, and Fair Housing for both renters and owners Preservation and rehabilitation of existing housing stock Targeted neighborhood improvement and revitalization Poverty reduction, including programs that support self-sufficiency and household stability, such as employment training, adult basic education, and related programs Educational and support programs for children, youth and their families, to prepare them for success through literacy, training, mentorship and related programs e Programming to support aging in place Accessibility improvements in public facilities and housing Services and housing for the homeless, including homelessness prevention and services that help homeless persons achieve the goal of permanent housing The 2018-2019 Action Plan summarizes proposed HUD grant funded activities and expenditures that are consistent with the above priorities and goals for the program year beginning October 1, 2018 and ending September 30, 2019. The federal grant funds covered by this 2018-19 Action Plan represent a total of$12,044,676.00 from 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. The Action Pian 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 residents. ESG funds primarily benefit homeless persons, and HOPWA funds primarily benefit low and moderate income persons with HIV/AIDS. A Notice of Funding Availability (NOFA) for affordable housing developers and other entities seeking funding for major community development projects was published on February 9, 2018. A Request for Proposals from social service agencies seeking grant funding was published on February 16, 2018. All proposals were received on March 16, 2018. Staff reviewed all proposals and developed recommendations for the allocation of the estimated funding from HUD based on the capacity of applicant organizations, consistency with overall City priorities, and compliance with applicable federal regulations. Public hearings were held on April 11, 2018 and April 18, 2018 to provide citizens M&C Review Page 3 of 7 and stakeholders the opportunity to participate in the development of the Consolidated Plan and Action Plan. Recommendations for award amounts were considered and adopted by the Community Development Council (CDC) on May 16, 2018. These recommendations were presented to the Housing and Neighborhood Services Committee on June 5, 2018 and to the City Council on June 12, 2018. Notice of a 30-day public comment period from July 2, 2018 to July 31, 2018 was published in the Fort Worth Star-Telegram on June 10, 2018, in La Estrella on June 16, 2018, and in La Vida News: The Black Voice on June 21, 2018. 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 before City Council on June 26, 2018 prior to the commencement of the 30-day public comment period, and the second public hearing is scheduled for the August 7, 2018 City Council meeting where the Consolidated Plan and Action Plan will be considered for approval by the Council. A summary of the CDC funding recommendations is provided below and in Tables 1, 2 and 3. Additionally, a spreadsheet of all specific funding recommendations is attached. The 2018-2022 Consolidated Pian and 2018-2019 Annual Action Plan must be submitted to HUD by August 15, 2018. A waiver of indirect costs is being requested to maximize program benefits. The CDBG program provides for 43 partially-funded 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 requested to be waived are estimated to be $371,566.00. Community Develo meat Block Grant CDBG For Program Year 2018-2019, it is recommended that the amount of$7,262,818.00 in CDBG funds, and an estimated amount of$2,350,000.00 in CDBG program income totaling $9,612,818 be allocated as follows: Public Services -$1,089,422.00 This item includes social services for low to moderate income, disabled and disadvantaged populations. Housing Program Services -$2,553,000.00 This item includes funding for the City's Priority Repair Program, Cowtown Brush-Up, homebuyer and housing services, accessibility modifications to homes of senior and/or disabled individuals to support Aging In Place and Fair Housing compliance, and related project delivery costs for these programs. (ALL COUNCIL DISTRICTS) Infrastructure Projects & Public Facilities - $1,426,856.00 This item includes funding for Street and Sidewalk Improvements and Open Space Recreational Improvements in the Ash Crescent Neighborhood Improvement Target Area and related Public Facilities, and for Bunche Park improvements in the Stop Six neighborhood. (COUNCIL DISTRICTS 8 and 5) CDBG Economic Development -$740,977.00 This 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 their annual entitlement grant. CDBG Estimated Program Income - $2,350,000.00 This item includes funding for Accessibility Improvements at City Community Centers and other public facilities, water/sewer improvements to support infill housing development on Sheraton Drive, a community facility for early childhood education, and for a multifamily rehabilitation program. This item also includes up to $150,000.00 in 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 M&C Review Page 4 of 7 Program will be allocated to priority activities in the Consolidated Plan subject to City Council approval. CDBG General Administration -$1,452,563.00 (Limited to 20%) This item includes costs for administering the CDBG grant including allocations for the Financial Management Services, Neighborhood Services and Planning and Development Departments. HOME Investment Partnershi s Pro ram HOME For Program Year 2018-2019, it is recommended that the amount of$2,861,535.00 in HOME funds, and an estimated amount of$150,000.00 in HOME program income, totaling $3,011,535.00 be allocated as follows: Homebuyers Assistance Program (HAP) - $1,000,000.00 This item includes funding for down payment and/or closing cost assistance to low and moderate income homebuyers. (ALL COUNCIL DISTRICTS) Community Development Housing Organizations (CHDO) -$519,382.00 HUD requires that a minimum of 15 percent of HOME funds be allocated to CHDOs for affordable housing projects. These funds will be used by Housing Channel, a CHDO, for the Single Family Infill Development at Stafcup and Berry (COUNCIL DISTRICT 5). The City is also authorized to fund CHDO administrative operating costs to support community based affordable housing development, and this funding will be used by Housing Channel to support completion of the Hardy and Riverside Single Family lnfill projects which were funded in previous years (COUNCIL DISTRICTS 2 and 8). All houses constructed with these funds will be sold to homebuyers with incomes at or below 80 percent of the area median income set by HUD. Rental Housing Rehabilitation -- $1,056,151.00 This item represents gap financing for a portion of the costs of rehabilitating affordable multifamily housing for Atlantic Housing Foundation at Manitoba Apartments, and for Tarrant County Samaritan Housing, Inc. for a project to develop permanent supportive housing for the homeless. (COUNCIL DISTRICTS 3 and 9). HOME General Administration --$286,153.00 (Limited to 10%) This item includes costs for administering the HOME grant. HOME Estimated Program Income -$150,000.00 This item includes funding for the Homebuyer Assistance Program and for HOME grant administrative costs. HUD allows the City to take 10 percent of any HOME program income to be used for the costs for administering the HOME grant. HOME program income that is received which is over the estimated amount but not used for the Homebuyer Assistance Program will be allocated to priority activities in the Consolidated Plan subject to City Council approval. _Housing Opportunities for Persons With AIDS Program (HOPWA) For Program Year 2018-2019, it is recommended that the amount of$1,332,758.00 in HOPVVA funds be allocated as follows: Public Services -$1,292,776.00 HOPWA Program Administration --$39,982.00 (Limited to 3%) Emergency Solutions Grant(ESG? For Program Year 2018-2019, it is recommended that the amount of$587,565.00 in ESG funds be allocated as follows: Public Services - $543,498.00 ESG Program: Administration --$44,067.00 (Limited to 7.6%) PUBLIC SERVICES CONTRACT RECOMMENDATIONS M&C Review Page 5 of 7 The CDC adopted recommendations on the award of public services contracts on May 16, 2018. Upon further evaluation and discussion with impacted parties, Staff revised the proposed recommendations for ESG Agencies to provide funding for Safe Haven of Tarrant County. Based on this input and evaluation; staff recommends that contracts be executed with the listed agencies for the amounts shown in the following tables: Community Development Block Grant Contracts: Table 1 -- CDBG A ender Organization Program Amount AB Christian Learning Center Child Care Services $ 80,000.00 Girls inc. of Tarrant Count Youth Services $ 75,000.00 Goodwill Industries of Fort Worth, Employment/Job Training $100,000.00 Inc. Guardianship Services Prevention of Financial $ 75,000.00 Exploitation of Elderly _ Housing Channel Housing Counseling $118,088.00 Services The Ladder Alliance Em io menfilJob Training $ 80,000.00 MCDonaid YMCA Youth Wellness Services $ 75,000.00 Meals on Wheels, Inc. of Greater Home-delivered meals for $ 76,350.00 Tarrant County elder! (disabled Presbyterian Night Shelter of Case Management for $144,987.00 Tarrant County Homeless The Salvation Army Employment Trainin2 $ 75,000.00 Sixty and Better, Inc. Transportation for Elderly $111,800.00 United Community Centers Educational Enrichment for $ 78,197.00 Children CDBG Public Service Subtotal $ 1,089,422.00 Rehabilitation, Education and Accessibility Improvements $100,000.00 Advocacy for Persons with for Low Income Residents Handicaps, dba REACH, Inc.** Trinity Habitat for Humanity Cowtown Brushup Paint $455,000.00 Program Total CDBG Contracts $1,644,422.00 **REACH and Trinity Habitat 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, Supportive Services, $636,776.00 Inc. Facility Based Housing Subsidy Assistance, Tenant Based Rental Assistance, _ and Administration AIDS Outreach Center, Inc. Supportive Services, $656,000.00 Tenant Based Rental Assistance (TBRA), Short Term Rent Mortgage and Utility Assistance (STRMU) and Administration Total HOPWA C©ntracts $1,292,776.00 Emergency Solutions Grant Contracts: M&C Review Page 6 of 7 A waiver of the goal for MBE/SBE subcontracting requirements was requested by the Neighborhood Services Department and approved by the MA/VBE Office, in accordance with the M/WBE or BIDE Ordinance, because the opportunities for subcontracting or suppliers through purchase of goods or services are negligible. All figures have been rounded to the nearest dollar for presentation purposes. Table 3 — BSO Agencies Or anization Program Amount Presbyterian Night Shelter $126,625.00 Shelter of Tarrant Operations/Services Count Lighthouse for the Shelter $ 68,498.00 Homeless dba True OperationslServices Worth Place Safe Haven of Tarrant Safe Solutions for Fort $ 75,000.00 Count Worth The Salvation Army, a Homeless Prevention, $183,375.00 Georgia Corporation Rapid Rehousing, and _ Emergency Shelter Center for Transforming Rapid Rehousing $ 90,000.00 Lives Total ESG Contracts $ 543,498.00 FISCAL INFO RMATIONICE RTI FICATION: 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. These are reimbursement grants. 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 Reference# Amaunt ID ID Year Chartfield 2 FROM Fund I Department Account I Project Program Activity Budget I 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) Eric Vodicka (7583) ATTAGHMFNTS M&C Review Page 7 of 7 19NS HUD CONPLAN 2018-22 ACTiONPLAN 2018-19 AOI 8 docx Form 1295 -.All A encies - Including Safe Haver. df HUD 2018-19 AP Selected Slides REVISED 6-19-2018. df