HomeMy WebLinkAboutContract 35690 (2) CITY SECRETARY
CONTRACT No
. _k J 2t
STATE OF TEXAS
COUNTY OF TARRANT
THIS contract ("Contract") is made and entered into by and between the City of Fort Worth
("City"), whose address is 1000 Throckmorton St., Fort Worth Texas 76102, acting by and through
Dale A. Fisseler, its duly authorized Assistant City Manager, and Cook Children's Health Care
System ("Contractor"), whose address is 801 Seventh Avenue, Fort Worth, Texas, 76104, acting by
and through Ms. Linda Chappell, its duly authorized Senior Vice President, Quality Management.
(Sometimes City and Contractor are referred to individually as a "Party" and collectively as the
"Parties".)
WHEREAS, City has received grant monies from the United States Department of Housing
and Urban Development ("HUD") under Title 1 of the Housing and Community Development Act
of 1974, as amended, (42 USC 5301 et seq.) for utilization in connection with its Community
Development Block Grant ("CDBG"),Program No. B-07-MC-48-0010, for Year XXXIII;
WHEREAS, one of the national objectives of the CDBG program is to benefit low and
moderate income citizens (the "National Objective");
WHEREAS, the assigned Catalog of Federal Domestic Assistance (CFDA) number is 14.218 for
this Federal program; and
WHEREAS City citizens, the Community Development Council, and the City Council have
determined that CDBG programs are needed by the City's low and moderate-income citizens.
NOW, THEREFORE, THIS AGREEMENT FURTHER WITNESSETH:
THAT, the Parties covenant and agree as follows:
1. Scope of Services
a. Contractor wM` administer youth services to citizens of the City of Fort Worth under the
program narne Save a Smile ("Program"), for the term June 1, 2007 to May 31, 2008.
b. Contractor will be responsible for administering Save a Smile in a manner satisfactory to City
and consistent with any standards required as a condition of providing the CDBG funds (as
hereinafter defined). The Program will include the following CDBG eligible activities:
Contractor will provide the services and activities as set forth in Exhibit A-Program
Summary in accordance with Exhibit B-Program Services Schedule.
c. Contractor agrees to meet the National Objective of activities benefiting low and moderate-
income individuals and to maintain full documentation supporting fulfillment of this
National Objective in its files as defined in 24 CFR 570.208. Contractor certifies that the
activities carried out under this Contract will serve low and moderate-income persons.
Contractor will obtain information on family size and income of Program participants. All
such documentation shall be furnished to City upon request if necessary for City to fulfill its
obligations under its Federal grant. If this documentation is not maintained and furnished
to City on request, City may exercise all remedies available under this Contract,
including the
REVA
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right to withhold payment to Contractor on this Contract or any other contract with
Contractor, or terminate this Contract as described herein.
d. City will monitor and evaluate Contractor's performance using the goals and performance
standards required in this Contract. Substandard performance as determined by City
monitoring will constitute non-compliance with this Contract. If action to correct such
substandard performance is not taken by Contractor within a reasonable period of time after
being notified in writing by City, procedures to suspend or terminate the Contract will be
initiated.
e. If applicable, Contractor shall comply and assist City in complying with the provisions of
any federal requirements regarding displacement,relocation and/or real property acquisition.
f Contractor agrees to take reasonable steps to ensure meaningful access to the Program and
associated activities by limited English proficient persons.
2. Compensation and Method of Payment
a. City will disburse CDBG Year XXXIII funds ("CDBG Funds") in an amount up to twenty
four thousand and three hundred and no/100 dollars, $24,300 to Contractor on a
reimbursement of expenses basis.
b. Payment will be processed by City following receipt from Contractor of the following
monthly financial documents: (1) Attachment I- Request For Funds, (2) Attachment II-
Detail Statement of Costs, and (3) Attachment III-Expenditures Worksheet. Payment by
City to Contractor shall require completion of all City forms and copies of adequate
supporting documentation verifying eligibility of expenses as well as, where applicable,
eligibility of Program participants. Reimbursement for the payment of eligible expenses
shall be made against the budget specified in Exhibit C-Program Operating Budget and in
accordance with performance specified in Exhibit B-Program Services Schedule. City will
not disburse funds for expenditures that occurred prior to the beginning date of the term of
this Contract.
c. Contractor agrees to utilize all disbursed CDBG Funds for the benefit of the Program.
Contractor agrees that all funds will be expended in accordance with Exhibit C-Program
Operating Budget. Contractor may not increase or decrease line-item amounts in the
approved CDBG Funds portion of Exhibit C-Program Operating Budget without City's
prior written approval. Contractor acknowledges and agrees that any CDBG Funds not
used in accordance with the CDBG Regulations and the terms of this Contract will be
repaid to City.
d. It is understood that the total cost for operation of this Program is $326,630 and that
Contractor will obtain from other sources the remaining funds in excess of the CDBG
Funds as detailed in Exhibit C-Program Operating Budget. Contractor will notify City
promptly of any additional funds it receives for operation of the Program, and City reserves
the right to amend Exhibit C-Program Operating Budget in such instances.
e. Contractor agrees to keep all CDBG Funds on hand in interest bearing accounts. All interest
earned shall be reported to City on a monthly basis, at the same time as submission of the
monthly report following the end of the Contract month during which the interest was
earned. Interest in an amount of $25.00 or less per month may be used for authorized
Program expenses. These amounts must be reported on the monthly financial statements
filed pursuant to this Contract. Interest earned in excess of $25.00 per month is subject to
remittance to City as directed by City.
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3. Uniform Administrative Requirements and Program Management Standards
a. Financial Management
1. Accounting Standards
Contractor agrees to comply with OMB Circular A-110, "Uniform Administrative
Requirements for Grants and Agreements with Institutions of Higher Education,
Hospitals and other Non-Profit Organizations", and agrees to adhere to the accounting
principles and procedures required therein, utilize adequate internal controls, and
maintain necessary source documentation for all costs incurred.
ii. Cost Principles
Contractor shall administer the Program in conformance with OMB Circular A-122,
"Cost Principles for Non-Profit Organizations" and attachments and revisions thereto,
regarding principles for determining costs for the Program.
b. Documentation and Record Keeping
i. Requirement
Contractor shall maintain all records pertinent to the activities to be funded under this
Contract required in 24 CFR § 570.506. In addition, Contractor agrees to keep records
to fully document all expenditures charged to the CDBG portion of the Program,
including records documenting the eligibility of Program participants as more
particularly described herein. The documentation must support the amounts charged to
the Program, the eligibility of the Program participants, and demonstrate that the
expenditures were appropriate to the stated goals of the Program and allowable and/or
eligible under applicable Federal, state and City guidelines.
ii. Retention
(1) All records pertaining to Program shall be retained for four (4) years following the
termination of this Contract. Contractor may destroy Program records at the end of
this four (4) year period if no outstanding audit finding exists.
(2) Contractor will retain any Program loan records until four (4) years after the
expiration of any loan.
iii. Real Property Records
Contractor shall maintain real property inventory records that clearly identify properties
purchased, unproved, or sold. Properties retained shall meet eligibility criteria and shall
conform to the requirements of 24 CFR� 570.505.
iv. Closeouts
Contractor's obligation to City shall not end until all closeout requirements are
completed. Activities during this closeout period shall include, but are not limited to:
making final payments, disposing of Program assets (including the return of all unused
materials, equipment, unspent cash advances, Program income balances, and accounts
receivable to City), and determining the custodianship of records.
v. Audits and Inspections
(1) City, HUD, and the United States Comptroller General, or their respective
representatives, shall have access to any books, documents, records and papers
relating to the operations of Contractor under this Contract for the purpose of
audit, examination, exception and transcription at all of Contractor's offices at all
reasonable hours.
(2) All non-federal entities that expend $500,000 or more in Federal funds within one (1)
year, regardless of the source of the Federal award, must submit to City an annual
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audit prepared in accordance with 24 CFR Sections § 570.502-570.503 generally, with
specific reference to OMB Circulars (with attachments) A-122, "Cost Principles for
Non-Profit Organizations", and A-133, "Audits of States, Local Governments, and
Non-Profit Organizations", as appropriate. The audit may cover either Contractor's
fiscal year during which this Contract is in force or cover the period of this Contract.
The audit must be prepared by an independent certified public accountant, be
completed within nine (9) months following the end of the period being audited and
be submitted to City within thirty (30) days of its completion. Contractor's audit
certification is attached hereto as Exhibit D - Audit Schedule Independent Audit
Requirement. The Audit Schedule Form must be submitted to City within sixty (60)
days of the end of the period being audited (Contractor's fiscal year). Costs of
preparation of this audit may be an allowable expenditure of CDBG Funds in an
amount proportional to that of the CDBG Funds used in Contractor's total agency
operating budget. Non-profit entities that expend less than $500,000 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 ("GAO").
(3) City reserves the right to perform an audit of Contractor's agency operations and
finances at any time during the term of this Contract, if City determines that such
audit is necessary for City's compliance with OMB Circular A-133. Contractor
agrees to allow access to all relevant books, records and materials. If such audit
reveals a questioned practice or expenditure, such questions must be resolved within
fifteen (15) days after notice to Contractor. If questions are not resolved within this
period, City reserves the right to withhold further funding under this Contract
and/or any other contract(s)with Contractor.
(4) If as a result of any audit it is determined that Contractor has misused, misapplied or
misappropriated all or any part of the CDBG Funds, Contractor agrees to reimburse
the City the amount of such monies so misused, misapplied or misappropriated, plus
the amount of any sanction, penalty or other charge levied against City because of
such misuse, misapplication or misappropriation.
4. Deporting Procedures
a. Financial Reports
Contractor will submit to City on a monthly basis: (1) Attachment I-Request for Funds, (2)
Attachment II-Detailed Statement of Costs, (3) Attachment III-Expenditures Worksheet, as
applicable, for expenses incurred for services and activities accomplished by Contractor in
performance of this Contract. Actual cash receipts for claimed expenditures must be
provided at the time the request for funds is presented. The reports must be signed by a
duly authorized agent of the Contractor and submitted by the 15th of the month following
the month being reported. City is under no obligation to disburse funds for expenditures
that occurred prior to the first day of the month for which the report is submitted.
b. Progress Reports
Contractor will submit to City on a monthly basis: (1) Attachment IVa-Program Services
Report, (2) Attachment IVb-Ditect Benefit Data Report, (3) Attachment V-Performance
Report, and (4) Attachment VI-Client Data Report for services and activities undertaken by
Contractor in performance of this Contract. The report will be signed by a duly authorized
agent of Contractor and submitted by the 15th of the month following the month that is
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reported. City is under no obligation to disburse funds for expenditures that occurred prior
to the beginning date of this Contract.
c. Program Income
Contractor agrees that all program income from operation of the Program in proportion to
the amount of CDBG Funds received hereunder will be expended prior to expending
CDBG Funds and that any such program income is subject to the terms of this Contract.
Contractor may expend CDBG Funds only if program income is insufficient to meet all
eligible Program activity expenses. Contractor agrees to return to City at the end of the
Contract any remaining program income earned from operation of the Program in
proportion to the amount of CDBG Funds in Exhibit A-Program Summary and Exhibit B-
Program Operating Budget.
d. Procurement
i. Compliance
Contractor shall comply with City policy concerning the purchase of equipment and
shall maintain inventory records of all non-expendable personal property, as defined by
such policy, procured with funds provided under this Contract.
ii. OMB Standards
Contractor shall procure all materials, property, or services in accordance with the
requirements of 24 CFR Part 84, Procurement Standards and Property Standards, as
modified by 24 CFR Part 570.502(b)(6), covering utilization and disposal of property.
e. Program Participant Records
i. Contractor will keep or cause to be kept an accurate record of all actions taken and all
CDBG Funds expended,with source documents, in performance of this Contract. Such
records shall be kept for the time period mandated by the CDBG Regulations and this
Contract.
ii. Contractor will obtain and keep on file and furnish to City on request the following
information and/or documentation on each Program participant served by the Program
demonstrating such participant's eligibility for services provided:
a. Participant's name, address, annual income level or other basis for determining
income eligibility, and family size of participant's household.
b. Source documentation used for income verification including but not limited to pay
check stubs, food stamp award letters, income tax returns, SSI award letters, letters
awarding unemployment benefits,W2s and the like.
c. City shall have the final determination, in its sole discretion, as to whether source
documentation used for income verification is adequate.
5. Reversion of Assets
a. Contractor agrees to return to City any CDBG Funds remaining on hand at the end of the
Contract.
b. All property purchased with CDBG Funds under this Contract will be used solely for
operation of the Program. Contractor agrees to obtain City approval prior to purchase of
property and Contractor agrees to notify City upon receipt of property so that it may be
properly tagged and inventoried. Title to such property will be vested in City, and
Contractor will deliver all such property to City for disposition at City's sole discretion at the
termination of the Program.
6. Applicable Laws
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a. Federal
Contractor agrees to comply with the following laws and the applicable regulations as they
are currently written or are hereafter amended during performance of this Contract:
• Regulations at 24 CFR Part 570 pertaining to CDBG ("CDBG Regulations")
• Title I of the Housing and Community Development Act of 1974 (42 USC 5301 et
seq.)
• Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970
(42 USC 4601 et seq.) and its related regulations at 49 CFR Part 24
• Title VI of the Civil Rights Act of 1964 (42 USC 2000d et seq.)
• Title VIII of the Civil Rights Act of 1968 (42 USC 3601 et seq.)
• Executive Orders 11063, 11246, as amended by Executive Orders 11375 and 12086 and
as supplemented by 41 CFR Part 60
• The Age Discrimination in Employment Act of 1967 (29 USC 621)
• The Age Discrimination Act of 1975 (42 USC 6101 et seq.)
• Section 504 of the Rehabilitation Act of 1973 (29 USC 794 et seq.) and 24 CFR Part 8
where applicable
• The Americans with Disabilities Act of 1990 (42 USC 12101)
• National Environmental Policy Act of 1969, as amended, 42 USC 4321 et seq. ("NEPA")
and the related authorities listed 24 CFR Part 58
• The Clean Air Act, as amended (42 USC 7401 et seq.), the Clean Water Act of 1977, as
amended (33 USC 1251 et seq.) and the related EPA regulations at 40 CFR Part 15, as
amended from time to time, and Executive Order 11738. In no event shall any amount
of the assistance provided under this Contract be utilized with respect to a facility that
has given rise to a conviction under the Clean Air Act or the Clean Water Act.
• The Iminigration Reform and Control Act of 1986 (8 USC 1101 et seq.), specifically
including the provisions requiring employer verification of the legal status of its
employees
• The Housing and Community Development Act of 1987 (42 USC 5301 et seq.)
• The Americans with Disabilities Act of 1990 (42 USC 12101 et seq.)
• Drug Free Workplace Act of 1988 (41 USC 701 et seq.) and 24 CFR Part 23, Subpart F
• Regulations as 24 CFR Part 87 related to lobbying, including the requirement that
certifications and disclosures be obtained from all covered persons
• Executive Order 12549 and 24 CFR Part 5.105 (c) pertaining to restrictions on
participation by ineligible, debarred, or suspended persons or entities.
b. Section 3 of the Housing and Urban Development Act of 1968, as amended, (12 USC 1701u
et seq.) and its related regulations at 24 CFR Part 135
As the work to be performed under this Contract is on a project assisted under a program
providing direct Federal financial assistance from HUD, Section 3 of 24 CFR 135.38
("Section 3") requires that the following clause be inserted in all covered contracts ("Section
3 Clause"):
"A. The work to be performed under this contract is subject to the requirements of section
3 of the Housing and Urban Development Act of 1968, as amended, 12 U.S.C. 1701u
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(section 3). The purpose of Section 3 is to ensure that employment and other economic
opportunities generated by HUD assistance or HUD-assisted projects covered by
Section 3, shall, to the greatest extent feasible, be directed to low- and very low-income
persons, particularly persons who are recipients of HUD assistance for housing.
B. The Parties to this contract agree to comply with HUD's regulations in 24 CFR Part 135,
which implement Section 3. As evidenced by their execution of this contract, the Parties
to this contract certify that they are under no contractual or other impediment that
would prevent them from complying with the Part 135 regulations.
C. The contractor agrees to send to each labor organization or representative of workers
with which the contractor has a collective bargaining agreement or other understanding,
if any, a notice advising the labor organization or workers' representative of the
contractors commitments under this section 3 clause, and will post copies of the notice
in conspicuous places at the work site where both employees and applicants for training
and employment positions can see the notice. The notice shall describe the Section 3
preference, shall set forth minimum number and job titles subject to hire, availability of
apprenticeship and training positions, the qualifications for each; and the name and
location of the person(s) taking applications for each of the positions; and the
anticipated date the work shall begin.
D. The contractor agrees to include this section 3 clause in every subcontract subject to
compliance with regulations in 24 CFR Part 135, and agrees to take appropriate action,
as provided in an applicable provision of the subcontract or in this Section 3 clause,
upon a finding that the subcontractor is in violation of the regulations in 24 CFR Part
135. The contractor will not subcontract with any subcontractor where the contractor
has notice or knowledge that the subcontractor has been found in violation of the
regulations in 24 CFR Part 135.
E. The contractor will certify that any vacant employment positions, including training
positions, that are filled (1) after the contractor is selected but before the contract is
executed, and (2) with persons other than those to whom the regulations of 24 CFR Part
135 require employment opportunities to be directed, were not filled to circumvent the
contractors obligations under 24 CFR Part 135.
F. Noncompliance with HUD's regulations in 24 CFR Part 135 may result in sanctions,
termination of this contract for default, and debarment or suspension from future HUD
assisted contracts.
G. With respect to work performed in connection with Section 3 covered Indian housing
assistance, section 7(b) of the Indian Self-Determination and Education Assistance Act
(25 U.S.C. 450e) also applies to the work to be performed under this contract. Section
7(b) requires that to the greatest extent feasible (i) preference and opportunities for
training and employment shall be given to Indians, and (ii) preference in the award of
contracts and subcontracts shall be given to Indian organizations and Indian-owned
Economic Enterprises. Parties to this contract that are subject to the provisions of
section 3 and section 7(b) agree to comply with Section 3 to the maximum extent
feasible, but not in derogation of compliance with section 7(b)."
City and Contractor understand and agree that compliance with the provisions of Section 3,
the regulations set forth in 24 CFR Part 135, and all applicable rules and orders of HUD shall be
a condition of the Federal financial assistance provided to the Program, binding upon City and
Contractor, and their respective successors, assigns and subcontractors. Failure to fulfill these
requirements shall subject Contractor and its subcontractors, and their respective successors and
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assigns, to those sanctions specified by the Grant Agreement through which Federal assistance is
provided and to such sanctions as are specified by 24 CFR Part 135.
c. Other Laws
Contractor covenants and agrees that its officers, members, agents, employees, Program
participants and subcontractors shall abide by and comply with all other laws, Federal, state
and local, relevant to the performance of this Contract, including all applicable City
ordinances, rules and regulations and Title I of the Housing and Community Development
Act of 1974 (42 USC 5301 et seq.), as amended, and the CDBG Regulations, as amended, (24
CFR Part 570 et seq.). Contractor further promises and agrees that it has read, and is familiar
with, the terms and conditions of the Community Development Block Grant under which
CDBG Funds are granted and any applicable provisions of the CDBG Regulations and that
it will fully comply with them. It is agreed and understood that, if City notifies Contractor
of any such violation on the part of Contractor or any of its officers, members, agents,
employees, Program participants or subcontractors, then Contractor shall immediately desist
from and correct such violation.
7. Nondi.mmination
a. Contractor will not unlawfully discriminate against any person or persons because of sex,
race, religion, age, disability, color, national origin, or familial status, nor will Contractor
permit its officers, members, agents, employees, subcontractors or Program participants to
engage in such discrimination.
b. Contractor covenants that neither it nor any of its officers, members, agents, employees,
Program participants or subcontractors, 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 except on the basis of bona fide occupational qualification, retirement
plan or statutory requirement.
c. Contractor further covenants that neither it nor its officers, members, agents, employees,
subcontractors, Program participants, 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.
d. In accordance with the provisions of the Americans With Disabilities Act of 1990 ("ADA"),
Contractor warrants that it and any and all of its subcontractors 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 Contractor, or employees of Contractor or any of its subcontractors. Contractor
warrants it will fully comply with ADA's provisions and any other applicable Federal, state
and local laws concerning disability and will defend, indemnify and hold City harmless
against any claims or allegations asserted by third parties or subcontractors against City
arising out of Contractor's and/or its subcontractors' alleged failure to comply with the
above-referenced laws concerning disability discrimination in the performance of this
Contract.
e. This Contract is made and entered into with reference specifically to the ordinances codified
at Chapter 17, Article III, Division 3 "Discrimination in Employment Practices", of the City
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Code, and Contractor hereby covenants and agrees that Contractor, its officers, members,
agents, employees and subcontractors, have fully complied with all provisions of salve and
that no employee, employee-applicant or Program participant has been discriminated against
by the terms of such ordinances by either the Contractor or its officers, members, agents,
employees or subcontractors.
8. Prohibition Against Interest
a. No member, officer or employee of City or its designees or agents; no member of the
governing body of the locality in which the Program is situated; and no other public official
of such locality or localities, who exercises any functions or responsibilities with respect to
the Program funded hereunder during his or her tenure or for one year thereafter, shall have
any interest, direct or indirect, in any contract or subcontract, or the proceeds thereof, for
work to be performed hereunder. Contractor shall incorporate, or cause to be incorporated,
like language prohibiting such interest in all contracts and subcontracts entered into in
connection with the Program.
b. No member, officer, employee, or Program participant of Contractor or its subcontractors
shall have a financial interest, direct or indirect, in this Contract or the CDBG Funds
transferred hereunder or be financially interested, directly or indirectly, in the sale to
Contractor of any land, materials, supplies or services purchased with any CDBG Funds
transferred hereunder, except on behalf of Contractor, as an officer, employee, member or
Program participant. Any willful violation of this paragraph with the expressed or implied
knowledge of Contractor or its subcontractors shall render this Contract voidable by City.
9. Minority and IYlomen Business Entepnse Commitment
Contractor agrees to abide by City's policy to involve Minority and Women Business Enterprises
("MWBEs") in all phases of its procurement practices and to provide them an 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. Contractor agrees to
incorporate City Ordinance No. 15530, and all amendments or successor policies thereto,into all
contracts and will further require all persons or entities with whom it contracts to comply with
said MWBEs policy.
10. Non Assignment
No assignment or delegation of duties under this Contract by Contractor shall be effective
without City's prior written approval.
11. Independent Contractor
a. Contractor shall operate hereunder as an independent contractor and not as an officer,
agent, servant or employee of City. Contractor shall have exclusive control of, and the
exclusive right to control, the details of the work and services performed hereunder, and all
persons performing same, and shall be solely responsible for the acts and omissions of its
officers, members, agents, servants, employees, subcontractors, Program participants,
licensees or invitee. The doctrine of respondeat superior shall not apply as between City and
Contractor, its officers, members, agents, servants, employees, subcontractors, Program
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participants, licensees or invitees, and nothing herein shall be construed as creating a
partnership or joint enterprise between City and Contractor. It is expressly understood and
agreed that no officer, member, agent, employee, subcontractor, licensee or invitee of the
Contractor, nor any Program participant hereunder, is in the paid service of City and that
City does not have the legal right to control the details of the tasks performed hereunder by
Contractor, its officers, members, agents, employees, subcontractors, Program participants,
licensees or invitees.
b. City shall in no way nor under any circumstances be responsible for any property belonging
to Contractor, its officers, members, agents, employees, subcontractors, Program
participants, licensees or invitees, which may be lost, stolen, destroyed or in any way
damaged; and Contractor hereby indemnifies and holds harmless City and its officers,
agents, and employees from and against any and all claims or suits.
12. Indemnification, Insurance and Bonding
a. CONTRACTOR 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 CONTRACTOR
HEREBY ASSUMES ALL LIABILITY AND RESPONSIBILITY OF CITY AND
ITS OFFICERS,AGENTS, SERVANTS,AND EMPLOYEES FOR ANY AND ALL
CLAIMS OR SUITS FOR PROPERTY LOSS OR DAMAGE AND/OR
PERSONAL INJURY, INCLUDING DEATH, TO ANY AND ALL PERSONS, OF
WHATSOEVER HINDS OR CHARACTER, WHETHER REAL OR ASSERTED,
ARISING OUT OF OR IN CONNECTION WITH THE EXECUTION,
PERFORMANCE, ATTEMPTED PERFORMANCE OR NON-PERFORMANCE
OF THIS CONTRACT AND AGREEMENT AND/OR THE OPERATIONS,
ACTIVITIES AND SERVICES OF THE PROGRAMS DESCRIBED HEREIN,
WHETHER OR NOT CAUSED IN WHOLE OR IN PART, BY ALLEGED
NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES,
CONTRACTORS OR SUBCONTRACTORS OF CITY. CONTRACTOR
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 CONTRACTOR, ITS OFFICERS, MEMBERS, AGENTS, EMPLOYEES,
SUBCONTRACTORS, INVITEES, LICENSEES, ORI N�oJ�
PARTICIPANTS, OR CAUSED, IN WHOLE OR IN PART, B ' rl , C-1Q ,�-
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Y Rev. ' � b1
System
NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES,
CONTRACTORS OR SUBCONTRACTORS OF CITY.
CONTRACTOR 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 THE CITY'S SOLE OR
CONCURRENT NEGLIGENCE.
CONTRACTOR SHALL REQUIRE ALL OF ITS SUBCONTRACTORS TO
INCLUDE IN THEIR SUBCONTRACTS A RELEASE AND INDEMNITY IN
FAVOR OF THE CITY IN SUBSTANTIALLY THE SAME FORM AS ABOVE.
b. Contractor will maintain blanket fidelity coverage in the form of a bond in the amount of
$24,300, to insure against loss from the fraud, theft or dishonesty of any of Contractor's
officers, agents, trustees, directors or employees. The proceeds of such bond shall be used
to reimburse City for any and all loss of CDBG Funds occasioned by such misconduct. To
effectuate such reimbursement, such bond shall include a rider stating that reimbursement
for any loss or losses thereunder shall be made directly to City for the uses and benefit of
Contractor.
c. Contractor shall furnish certificates of insurance as proof that it has secured and paid for
policies of workers' compensation, public liability and automobile liability insurance covering
all risks incident to or in connection with the execution, performance, attempted
performance or nonperformance of this Contract. The amounts of such insurance shall not
be less than the maximum liability that can be imposed on City under the laws of the State
of Texas. Contractor understands and agrees that such insurance amounts may be revised
upward at City's option and that Contractor shall revise such amounts within thirty (30) days
following notice to Contractor of such requirements.
d. Contractor will submit documentation to City that it has obtained insurance coverage and
has executed bonds as required in this contract within thirty (30) days of the execution of
this Contract and prior to payment of any monies hereunder.
e. Any failure on part of the City to request certificate(s) of insurance shall not be construed as
a waiver of such requirement or as a waiver of the insurance requirements themselves.
Insurers of Contractor 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 business in
the state of Texas. Insurers shall be acceptable to City insofar as their financial strength and
solvency and each such company shall have a current minimum A.M. Best Key Rating Guide
rating of A: VII or other equivalent insurance industry standard rating unless otherwise
approved by City. Deductible limits on insurance policies shall not exceed $5,000 per
occurrence unless otherwise approved by City.
f. Any local, federal or other regulatory insurance or bonding requirements for the Program
that exceed those specified herein shall prevail.
g. Contractor shall agree to require its subcontractors to maintain applicable insurance
coverages, limits, and other requirements as those specified herein; and, Contractor shall
require its subcontractors to provide Contractor with certificate(s) of insurance documenting
such coverage. Also, Contractor shall require its subcontractors to have City and Contractor
CDBG YEAR XXXIII CONTRACT Rev.06-19-07
Cook Children's Health Care System Page 11
endorsed as additional insured (as their interests may appear) on their respective insurance
policies. Contractor shall require its subcontractors to maintain builders risk insurance at the
limit of applicable project(s) costs when the value of materials involved exceeds $10,000 or
at a different limit value limit as specified by City.
13. Waiver of Immunity
If Contractor is a charitable or nonprofit organization and has or claims an immunity or
exemption (statutory or otherwise) from and against liability for damages or injury, including
death, to persons or property; Contractor hereby expressly waives its rights to plead defensively
such immunity or exemption as against City. This section shall not be construed to affect a
governmental entity's immunities under constitutional, statutory or con-Anon law.
14. Termination
a. In addition to, and not in substitution for, other provisions of this Contract regarding the
provision of public services with CDBG Funds, pursuant to Title I of the Housing and
Community Development Act of 1974, as amended, (42 USC 5301 et feg.) and the CDBG
Regulations, it is expressly understood and agreed by and between the Parties that this
Contract is wholly conditioned upon the actual receipt by City of Federal CDBG Year
funds; that all monies distributed to Contractor hereunder shall be exclusively from Federal
monies received under said grant and not from any other monies of City; and that if such
funds under City's grant are not timely forthcoming, in whole or in part, City may, at its sole
discretion, terminate this Contract and City shall not be liable for payment for any work or
services performed by Contractor under or in connection with this Contract.
b. City may terminate this Contract whenever such termination is determined to be in City's
best interest, in event of Contractor's default, inability or failure to perform or to comply
with any of the terms herein, or, for other good cause.
c. The Parties acknowledge that CDBG Funds paid hereunder are intended to provide only
partial funding for Contractor's program operations. City may terminate this Contract if
non-CDBG funds included in the Operating Budget are not forthcoming to Contractor
during the Contract term.
d. CDBG Funds provided hereunder may not be used as collateral for loans to Contractor to
defray program operation expenses, and any attempted use of CDBG Funds for this
purpose will result in termination of this Contract by City.
e. Termination will be effected by written notice to Contractor, specifying the portions of the
Contract affected and the effective date of termination. Upon Contractors receipt of such
termination notice, Contractor will:
• Stop work under the Contract on the date and to the extent specified by City;
• Cease expenditures of CDBG Funds, except as necessary for completion of the
portions of the Contract not terminated; and
• Terminate all orders and contracts to the extent that they relate to portions of the
Contract being terminated.
f. Contractor will return to City any unused CDBG Funds previously advanced by City under
this Contract within thirty (30) days of the effective date of Contract termination. City will
have no responsibility or liability for Contractor's expenditures or actions occurring after the
effective date of Contract termination.
CDBG YEAR XXXIII CONTRACT Rev.06-19-07
Cook Children's Health Care System Page 12
15. Certification Regarding Lobbying
a. The undersigned representative of Contractor 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 Contractor, 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 or an employee of a member of Congress in connection with the awarding of any
Federal contract, the making of any Federal grant, the leaking 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.
Contractor shall require that the language of this certification be included in all subcontracts
or agreements involving the expenditure of Federal funds.
b. If any funds other than Federal 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, a
member of Congress, an officer or employee of Congress, or an employee of a member of
Congress in connection with this Federal contract, grant, loan or cooperative agreement,
Contractor shall complete and submit Standard Form-LLL, "Disclosure Form to Report
Lobbying," in accordance with its instructions.
c. 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 unposed by 31 USC 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.
16. Miscellaneous Provisions
a. All terms of this Contract shall apply to any and all subcontractors of Contractor who are in
any way paid with CDBG Funds or who perform any work in connection with Contractor's
Program.
b. The provisions of this Contract are severable, and, if for any reason a clause, sentence,
paragraph or other part of this Contract shall be determined to be invalid by a court or
Federal or state agency, board or commission having jurisdiction over the subject matter
thereof, such invalidity shall not affect other provisions which can be given effect without
the invalid provision.
c. City's failure to insist upon the performance of any term or provision of this Contract or to
exercise any right herein conferred shall not be construed as a waiver or relinquishment to
any extent of City's right to assert or rely upon any such term or right on any future
occasion.
d. Should any action, whether real or asserted, at law or in equity, arise out of the execution,
performance, attempted performance or nonperformance of this Contract, venue for action
shall lie in Tarrant County,Texas.
e. This written instrument and the exhibits attached hereto, which are incorporated by
reference and made a part of this Contract for all purposes, constitute the entire agreement
between the Parties concerning the work and services to be performed hereunder, and any
prior or contemporaneous, oral or written agreement which purports to vary from the terms
hereof shall be void. Any amendments to the terms of this Contract must be in writing and
must be approved by each Party.
CDBG YEAR XXXIII CONTRACT Rev.06-19-07
Cook Children's Health Care System Page 13
f. All notices required or permitted by this Contract must be in writing and are deemed
delivered on the earlier of the date actually received or the third day following (i) deposit in
a United States Postal Service post office or receptacle; (ii) with proper postage (certified
mail, return receipt requested); and (iii) addressed to the other Party at the address set out in
the preamble of this Contract or at such other address as the receiving Party designates by
proper notice to the sending Party.
g. None of the performance rendered under this Contract shall involve, and no portion of the
CDBG Funds received hereunder shall be used, directly or indirectly, for the construction,
operations, maintenance or administration of any sectarian or religious facility or activity, nor
shall said performance rendered or funds received be utilized so as to benefit, directly or
indirectly, any such sectarian or religious facility or activity.
h. Contractor represents that it possesses the legal authority, pursuant to any proper,
appropriate and official motion, resolution or action passed or taken, to enter into this
Contract and to perform the responsibilities herein required.
1. Contractor certifies that it has obtained a 501 (c) (3) Certificate from the Internal Revenue
Service. Contractor shall notify City in writing of any changes to its 501 (c) (3) tax-exempt
status during the term of this Contract.
[SIGNATURES APPEAR ON FOLLOWING PAGE]
CDBG YEAR XXXIII CONTRACT Rev.06-19-07
Cook Children's Health Care System Page 14
IN WITNESS WHEREOF, the Parties hereto have execu d three copies of this Contract in
Fort Worth, Tarrant County,Texas, this L3/ day of , 20 Q:;Z .
CITY OF FORT WORTH Cook Chil_drren's Health Care Systena
By: 2 By: _ f
Dale Fissele Ms. Linda a Pell
Assistant City Manager Senior Vice Pr sident, Qua U Management
APPROVED AS TO FORM AND LEGALITY;
5�City Attorney
AST: co—ntr�act Aut rizatioa
A _L
44L7_
Gate -^.� r.
City Secretary
STATE OF TEXAS
COUNTY OF TAR_RANT
This instrument was acknowledged before me on O� , 2007 by Dale
Fisseler, the Assistant City Manager of the City of Fort Wortgo behalf of the ty of Fort Worth.
MEN3NO of texas Notary Public, State of Texas
xpires011
STATE OF TEXAS
COUNTY OF TARRANT
This instrument was acknowledged before me on� _ 2�� , 2007 by Ms.
Linda Chappell, the Senior Vice President, Quality Manag ent of Cook Children's Health Care
System, a Texas non-profit corporation, on behalf of said corporation.
YYYf YYYIY
SUSAN D.ROBERTSHAW
' NOTARY PUBLIC STATE OF TEXAS
Notary Public, State of Texas
COMMISSION EXPIRES:
APRIL 25, 2008
fYYdYYY
f J I ENDO
CDBG YEAR X=II CONTRACT �� �'V�� 07 6
Cook Children's Health Care System I age 15
Cook Children's Health Care System EXHIBIT A
Save a Smile SCOPE OF SERVICES
PROGRAM SUMMARY
June 1, 2007 — May 31, 2008 $24,300
CONTRACT NO. PERIOD AMOUNT
Scope of Services
This Scope of Services is based on the proposal prepared and submitted by the Subrecipient through the City of Fort
Worth and the Housing Department Contract Management Division's annual Request for Proposal(RFP) process.
However, in the event of any conflict between the proposal and any provision contained herein,this Agreement shall
control. In addition to the activities listed below,the Subrecipient agrees to operate this Community Development Block
Grant program consistent with the program delivery stated in the approved proposal.
CDBG funds will assist with the salaries of case aides and their supervising licensed Master's level social
workers, who facilitate the provision of free dental care, translation services and transportation services to
targeted low-income children, pre--kindergarten through third grade, who would otherwise lack access to
dental care.
COUNCIL DISTRICT (S)—2,4, 8, 9
PROGRAM OBJECTIVES
Educate 100% of targeted children in proper oral health, provide 100% of targeted children with a dental
hygiene kit and provide referral to a volunteer provider or Medicaid for children in need of treatment.
PROGRAM GOALS
To improve the dental health and awareness of proper dental care of children in targeted schools.
PROGRAM SERVICES and ACTIVITIES Total Units of Services for Year
Dental Screenings 4,600
Initial Dental Appointments 320
Follow-Ups 455
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CITY OF FORT WORTH
CDBG YEAR XXXIII
CONTRACT PERIOD I From: 6/i/2007 To: 5/31/2008
Cook Children's Health Care System
Save a Smile
Expense Category Total Grant Other Sources **
Budget Budget [C] [D] [E] [F]
[Al [Bl
PERSONNEL SERVICES
Salaries $93,936 $93,936
FICA $6,576 $6,576
Life Insurance $188 $188
Health Insurance $9,863 $9,863
Unemployment- State $188 $188
Worker's Compensation $845 $845
Retirement $3,100 $3,100
Other $2,442 $2,442
SUPPLIES
Office Supplies $2,600 $2,600
Postage $1,850 $1,850
Food $4,000 $4,000
Other(Dental Hygiene Kits)* $18,900 $18,900
CONTRACTUAL SERVICES
Telephone $840 $840
Contract Labor(Temp) $2,400 $2,400
Consulting(Staff) $146,696 $24,300 $122,396
Contracted Services(Courier) $250 $250
Rent[Building] $1,728 $1,728
Advertising&Art $3,300 $3,300
Marketing-Printing $12,200 $12,200
Marketing-Collateral $250 $250
Marketing-Spec Events $6,100 $6,100
Fidelity Bond***
Liability Insurance***
Inter Department $500 $500
Awards and Recognition 1 $22 $22
Travel/Parking $5,160 $5,160
Education $500 $500
CAPITAL OUTLAY
Office Equipment(Minor) $2,196 $2,196
TOTALS $326,630 $24,300 $302,330
Note:Column A should be the total of Columns B through F.
* Specify on Budget Detail(following pages)
Use one column for each non-grant funding source; note below which column equates to each source(from L ewer gi�Fo
***Fidelity bond and liability insurance are required of all subcontractors and may be paid from grant funds or atl�i�PS 1 V'/d I
[C] Other Grants/Gifts1 �t�cu�
CCHCS-In-Kind Contribution over$25,000 in support services
Rv:
GRANT BUDGET DETAIL
(GRANT FUNDED ITEMS ONLY)
CONTRACT STAFF SALARIES
Position/Title [A] [B]** [C] [D]
Salary Annual % of Time Total
Hourly Rate Hours X = Amount
1. Licensed Master's Social Worker $18.26 $37,980.80 11% $4,050.00
2. Case Aide I FTE $11.25 $19,890.00 20% $4,050.00
3. Case Aide 3 FTEs @$10.75 each $10.75 $57,018.00 21% $12,150.00
4. Case Aide I FTE $10.00 $17,680.00 23% $4,050.00
5.
6.
7.
8.
9.
10
11
12
13
14
15
16
17
18
19
20
21
22
23
TOTAL STAFF SALARIES $24,300.00
**Note:2,080 hours annually comprise a full-time position.
Category % of Amount %Paid by % Paid by Total
Payroll Employer Grant Amount
FICA
Life Insurance
Health Insurance
Unemployment Insurance
Worker's Compensation
Retirement
TOTAL FRINGE BENEFITS $ .00
TOTAL PERSONNEL SERVICES (Total Staff Salaries+Total Fringe Benefits) $24,300.00
GRANT BUDGET DETAIL
(GRANT FUNDED ITEMS ONLY)
UTILITIES
Category Average Cost Number of Total
Per Month Months Amovint
Telephone
Electric
Gas
Water/Waste Disposal
Other(Specify)
TOTAL UTILITIES
No.of Cost Per Number of Total
Building Location Square Feet Square Foot Months Amount
1.
2.
3.
TOTAL BUILDING RENT
OTHER EXPENSES See Note Below
Category Total Charge %Charged Total
to Grant Amount
Fidelity Bond
Liability Insurance
Legal&Accounting
Other(Specify)
TOTAL OTHER EXPENSES
CONFERENCES & SEMINARS
Event Total Charge % Charged Total
to Grant Amount
1.
2.
3.
TOTAL CONFERENCES& SEMINARS
OFFICE EQUIPMENT RENTAL
Item Total Charge % Charged Total
to Grant Amount
1.
2.
TOTAL OFFICE EQUIPMENT RENTAL
Note: % charged to CDBG cannot exceed 20% of CDBG budget allocation, 7% of HOPWA budget
allocation, or 10% of ES budget allocation.
EXHIBIT "D"
AUDIT SCHEDULE
INDEPENDENT AUDIT REQUIREMENT
BUSINESS/AGENCY NAME: Cook Children's Health Care System
PROGRAM: Save a Smile Program
CDBG YEAR: XXXIII
AMOUNT FUNDED: $24,300
Name of Independent Auditor who will perform agency audit:
Independent Auditor to be contracted during CDBG contract period.
Date audit is to be performed:
Within 60 days of completion of CDBG funded project.
The following language is a condition of your contract with the City:
(1) For all contracts in which Contractor is cumulatively receiving federal
monies in the amount of$500,000 or more, Contractor must submit to City an
annual audit prepared in accordance with 24 CFR Sections § 570.502-570.503
generally, with specific reference to OMB Circulars (with attachments) A-122
and A-133 as appropriate. The audit may cover either Contractor's fiscal year
during which this contract is in force or cover the period of this contract. The
audit must be prepared by an independent certified public accountant, be
completed within nine (9)months following the end of the period being audited
and be submitted to City within thirty (30) days of its completion. Contractor's
audit schedule is attached hereto as Exhibit D - Audit Schedule. Costs of
preparation of this audit may be an allowable expenditure of CDBG funds in an
amount proportional to that of the CDBG funds used in contractor's total agency
operating budget.
This form is to be completed and submitted to the Housing Department Contract Management
Division at the beginning of each contract year.
Linda S. happelll
Senior Vice President, ality Management
Cook Children's Health Care System EXHIBIT E
Save a Smile CONFLICT OF INTEREST
All Applicants
The standards in OMB Circular A-110, Subpart C,provide that no employee,officer, or agent shall participate in the
selection,award,or administration of a contract supported by Federal funds if real or apparent conflict of interest would
be involved. Such a conflict would arise when an employee, officer, or agent, any member of his or her immediate
family,his or her partner, or an organization which employs or is about to employ any of the parties indicated herein,has
a financial or other interest in the firm selection for an award.
CDBG and HOME Applicants Only
The CDBG regulations at 24 CFR 570 570.611 and HOME regulations at 24 CFR 92.356 provide that no person who is
an employee, agent, consultant, officer,or elected official or appointed official of the recipient or Subrecipient that are
receiving CDBG or HOME funds and(1)who exercises or has exercised any functions or responsibilities with respect to
activities assisted with CDBG funds; or(2)who is in a position to participate in a decision-making process or gain inside
information with regard to these activities,may obtain a financial interest from a CDBG-assisted or HOME-assisted
activity,or have any interest in any contract, subcontract,or agreement with respect thereto, or the proceeds thereunder,
either for themselves or those with who they have family or business ties, during their tenure or for one(1)year
thereafter.
IF NO CONFLICTS EXIST, COMPLETE THE FOLLOWING:
t I certify that to the best of my knowledge, no conflict of interest exists between The City of Fort Worth and
Cook Children's Health Care System
(Name of Organization)
I certify that to the best of my knowledge,no conflict of interest exists between the subcontractors of and
Cook Children's Health Care System
(Name of Organization)
IF THERE IS A CONFLICT,COMPLETE THE FOLLOWING:
I certify that a conflict of interest does exist between The City of Fort Worth and
(Name of Organization)
I certify that a conflict of interest does exist between
and
(Name of subcontractor)
(Name of Organization)
Describe the nature of the conflict of interest below: (Please identify the individual,employment,and the conflict or potential conflict[their affiliation with your
organization])
D
Signature of Author d NcuFP6fTj'ciaY V VVI lhatel
Linda S.Chappell,Senior Vice President,Quali agement
Typed Name and Title
CITY OF FORT WORTH Attachment I
HOUSING DEPARTMENT
CONTRACT MANAGEMENT DIVISION
REQUEST FOR FUNDS
AGENCY: Cook Children's Health Care System PROGRAM: Save a Smile Program
ADDRESS: 801 Seventh Ave. CONTRACT NUMBER:
Ft. Worth, TX 76104 CONTRACT AMOUNT: $24,300
CONTRACT DATE: 1-Jun-07
DATE OF REQUEST:
SECTION I (AGENCY) CURRENT MONTH CUMULATIVE
I. Reimbursement Request
1. Expenditures: $ $
2. Income
A. Program Income $ $
B. City of Fort Worth $ $
C. Interest Earned CDBG Funds $ $
1 Reimbursement(1 minus 2) $ $
II.Advance Pay Requests/Repayment $ $
III. Reporting Interest
1. Interest over$25 per quarter returned to City of Fort Worth $ $
SECTION II (CITY)
I. BYSPEED -Purchasing Request
A. BYSPEED INPUT:Vendor/PO Number/Requisition Number:
B. Fund/Account/Center: GR76/539120/005206180320
C.Total Amount of this Request: $
SECTION III
I. Verification
A. Contract Manager Aya Ealy
(Name) (Signature) (Date)
B. BYSPEED-Purchasing
(Name) (Signature) (Date)
C. Accounting
(Name) (Signature) (Date)
II.Authorization
A. Agency Linda S. Chappell
(Name) (Signature) (Date)
B. Asst. Director D.Emerson
(Name) (Signature) (Date)
C. Housing Director J. Walker
(Name) (Signature) (Date)
Distribution:
1 Copy-Accounting
1 Copy-Con. Mgmt.
CITY OF FORT WORTH ATTACHMENT II CDBG
HOUSING DEPARTMENT
CONTRACT MANAGEMENT DIVISION
DETAIL STATEMENT OF COSTS
Cook Children's Health Care System
AGENCY CONTRACT NO. DATE
Save A Smile Program TO
PROGRAM REPORT PERIOD
PROGRAM MONTHLY CUMULATIVE
COST CATEGORY ACCOUNT BUDGET EXPENDITURES TO DATE BALANCE
PERSONAL SERVICES
Salaries 516 010
FICA 518 010
Life Insurance 518 050
Health Insurance 518 060
Unemployment Tax-State 518 090
Worker's Comp 518 040
Retirement 518 070
SUPPLIES
Office Supplies 521 010
Postage 521 020
Teaching Aids(Equipment) 522 030
Food Supplies 522 030
Other Operating Supplies 523 300
CONTRACTUAL SERVICES
Telephone 535 040
Electric 535 020
Gas [Utility] 535 010
Water/Waste Disposal 535 030
Rent[Buildin ] 537 010
Custodial Services 539 220
Office Equipment Rental 537 030
Printing 533 030
Repairs 536 010
Fidelity Bond 538 210
Liability Insurance 534 020
Legal&Accounting 538 050
Private Auto Allowance-Local 532 130
Advertising 533 010
Conferences&Seminars 531 180
Contractual Services 539 120
CAPITAL OUTLAY
Furniture, Fixtures 541 330
Office Equipment, Computers 541 370
Other Equipment 541 320
TOTAL
Contractors Certification: I certify that the costs incurred are taken from the books of account and that such costs are valid and consistent with the terms of
Ms.Nancy Cychol,President
NAME and TITLE OF AUTHORIZED OFFICER SIGNATURE and DATE
PREPARE ONE FORM FOR EACH SOURCE OF FUNDS
DISTRIBUTION:
l Copy-Accounting
I Copy-Con.Mgmt,
2 IA&GM FORM May 2003
ATTACHMENT III
CITY OF FORT WORTH
HOUSING DEPARTMENT
CONTRACT MANAGEMENT DIVISION
EXPENDITURES WORKSHEET
Cook Children's Health Care System
Agency Contract Number Date
To
Program Report Period
NO DATE CHECK NO PAYEE DESCRIPTION ACCOUNT NO. AMOUNT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
TOTAL
Ms. Nancy Cychol, President
TITLE OF AUTHORIZED OFFICER SIGNATURE AND DATE
Distribution:
1 copy-Accounting
1 copy-IAGM
1 copy-Agency
City of Fort Worth Revised Attachment IVa
Contract Management Division
CDBG Year XXXIII
1. Name and Address of Sub-Grantee
Cook Children Medical System 2. Project Name Save a Smile
801 Seventh Ave.
Fort Worth, TX 76104 3. Contract No.:
4. Date of Request:
Month&Year
5. Program Services and Activities
Month Cumulative
Number of New
Households and/or
Persons Served
6.Direct Benefit
(Continued)
Extremely Low
Income(0 to Low Income Moderate Above Moderate
30%) (31-60%) Income(51-80%) Income>_80% Total
Current Month
Cumulative
1 2 3 4 5 6 7 8
<30% $13,300 $15,200 $17,100 $19,000 $20,500 $22,050 $23,550 $25,100
<50% $22,200 $25,350 $28,550 $31,700 $34,250 $36,750 $39,300 $41,850
<80% $35,500 $40,550 $45,650 $50,700 $54,750 $58,800 $62,850 $66,900
Certification: The undersigned hereby gives assurance that to the best of my knowledge and belief,the data included in this report is true and accurate,
and if a non-profit agency,has been approved by the governing body of the organization prior to submission.
Date: Submitted by: Phone No.
City of Fort Worth Attachment IV(B)
Contract Management Division
CDBG Year XXXIII
Public Service
1. Name and Address of Sub-Grantee
2. Project Name Save a Smile Program
Cook Children's Health Care System
801 Seventh Ave. 3. contract No.
Ft.Worth, TX 76104 4. Date of Request
Month&Year
8. Direct Benefit Data(New Household and/or Persons Served)
Ethnicity:(Section
Must be Completed) Hispanic Non-Hispanic
Current Month
Cumulative
American American
Race:Section Must Black Indian/Alaskan Native Hawaiian/Other Indian/Alaskan Native
be Completed) White African/American Asian Native Pacific Islander and White
Current Month
Cumulative
American
Indian/Alaskan Native
Asian and Black/African &Black African Black/African American
White American&White American Other Multi-Racial &White
Current Month
Cumulative
Female Head of Household
Current Month
Cumulative
Certification: The undersigned hereby gives assurance that to the best of my knowledge and belief,the data included in this report is true and accurate,and if a
non-profit agency,has been approved by the governing body of the organization prior to submission.
Date: Submitted by: Phone No.
11,E�,t���?J
M
ATTACHMENT V
CITY OF FORT WORTH
CONTRACT MANAGEMENT DIVISON
1. Cook Children's Healthcare System 2.Project Name: Save a Smile Program
901 Seventh Ave. 3.Contract No: Contract Date: June 1,2007
Fort Worth,TX 76104 Contract Amount: $24,300
4.Date of Request:
MONTH&YEAR
1. PROGRAM SERVICES AND ACTIVITIES: CURRENT CUMULATIVE
2. SCOPE OF WORK NARRATIVE:
3. PROBLEMS ENCOUNTERED/SOLUTIONS PROPOSED:
4. ANTICIPATED ACTIVITY DURING THE NEXT MONTH:
CERTIFICATION: The undersigned hereby gives assurance that to the best of my knowledge and belief,the data included in this report
is true and accurate,and if a non-profit agency,has been approved by the governing body of the organization prior to submission.
Date: Submitted by: Phone Num:
CM/May 2004
City of Fort Worth, Texas
Mayor and Council Communication
COUNCIL ACTION: Approved on 6/19/2007
DATE: Tuesday, June 19, 2007
LOG NAME: 05060507ACTIVIT REFERENCE NO.: C-22201
SUBJECT:
Authorize Execution of Community Development Block Grant Year XXXIII, Emergency Shelter Grant
Year 2007-2008 and Housing Opportunities for Persons with AIDS 2007-2008 Contracts
RECOMMENDATION:
It is recommended that the City Council:
1. Authorize the City Manager to execute Community Development Block Grant (CDBG) Year XXXIII,
Emergency Shelter Grant (ESG) Year 2007-2008 and Housing Opportunities for Persons with AIDS
(HOWPA) Year 2007-2008, contracts with the listed organizations to administer their respective programs,
contingent upon approval and receipt of adequate funding from the U.S. Department of Housing and Urban
Development (HUD), for a term beginning June 1, 2007, and ending May 31, 2008;
2. Authorize the City Manager to extend or renew the contracts for up to one year if an organization
requests an extension and such extension is necessary for completion of the project; and
3. Authorize the City Manager or his designee to amend the contract, if necessary, to achieve program
goals, provided the amendment is within the scope of the project and in compliance with all applicable laws
and regulations governing the use of federal grant funds.
I. Community Development Block Grant(CDB91
Organization Amount(Not to Exceed)
Centro Cultural de las Americas $20,077.00
Southside Youth Association $10,000.00
Summerbridge-Summerbridge Program $22,500.00
Cooks Children's-Save A Smile $24,300.00
ESTRELLAS-Boys and Girls Clubs $16,000.00
All Church Home (Bridge)-Buffalo Soldiers $16,200.00
JMAC Youth Center $25,000.00
Latin Arts Association-Theater Skills Program $12,600.00
Clayton Child Care-Greenbriar $18,000.00
CJ's Studio of Performing Arts $12,096.00
Near Northside Partners Council $16,639.00
Women's Center-Play It Safe $19,683.00
YWCA-Child Development $135,000.00
Child Care Associates-Pre-School Child Care $117,000.00
FWHA AMAKA Child Care Center $27,000.00
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Clayton Child Care-School Age Child Care $54,000.00
Tarrant Area Food Bank-Community Kitchen $20,000.00
Bottle Bounty Deposit $20,000.00
Senior Citizens Services of Tarrant County-COMO $17,597.00
Senior Citizens Services of Tarrant County-RIVERSIDE $15,271.00
Meals on Wheels $33,696.00
Mental Health Associaton of Tarrant County-OMBUDSMAN $17,500.00
Mental Health Associaton of Tarrant County-Mental Health Advocate $24,750.00
United Community Centers-Crisis Intervention $18,000.00
Northside Interchurch Agency $23,436.00
Day Resource Center Security $21,870.00
NSEAM $17,000.00
MASS, Inc. $30,000.00
REACH, Inc.-Project Ramp $15,000.00
YWCA-Ben &Jerry's Job Trainng/Job Placement $14,748.00
Fort Worth SER-Northside Resource Center $46,800.00
A-Prep Center of Tarrant County $67,197.00
TOTAL CDBG: $948,960.00
II. Emergency Shelter Grant(ESG)
Organization Amount(Not to Exceed)
YWCA-Supportive Living $10,742.00
Cornerstone Assistance $13,000.00
Presbyterian Night Shelter $136,177.00
Cenikor Foundation $10,681.00
Safehaven of Tarrant County $17,700.00
Presbyterian Night Shelter $11,864.00
Mental Health Mental Retardation of Tarrant County $12,650.00
YWCA-My Own Place $15,331.00
Parents And Chldren Together, Inc. $16,521.00
Safehaven of Tarrant County-Childcare $12,700.00
TOTAL ESG: $257,366.00
III. Housing Opportunities for Persons with HIV/AIDS (HOPWA)
Organization Amount(Not to Exceed)
f AIDS Outreach $436,242.00
Tarrant county Samaritan Housing $248,170.00
AIDS Outreach Rural Texas $114,198.00
TOTAL HOPWA: $798,610.00
DISCUSSION:
On April 10, 2007, the City Council adopted the budgets and the appropriation ordinance increasing
estimated receipts and appropriations for the Year XXXIII (June 1, 2007 to May 31, 2008) Community
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Development Block Grant (CDBG) grant funds, (2007-2008) Emergency Shelter Grant (ESG) grant funds
and (2007-2008) Housing Opportunities for Persons with AIDS (HOPWA) grant funds as part of the City's
Consolidated Plan and Consolidated Action Plan. The Consolidated Plan, as adopted by the City Council,
included program descriptions on each program listed above.
The above programs are consistent with the City's approved funding policies and priorities. Each program
meets the requirements of the Department of Housing and Urban Development (HUD) regulations defining
"eligible activity." These programs provide services citywide.
FISCAL INFORMATION/CERTIFICATION:
The Finance Director certifies that funds will be available in the current operating budget as appropriated, in
the Grants Fund contingent upon approval and receipt of adequate funding from the U.S. Department of
Housing and Urban Development (HUD) for the term beginning June 1, 2007, and ending May 31, 2008.
TO Fund/Account/Centers FROM Fund/Account/Centers
GR76 539120 005206184XXX $798,610.00
GR76 539120 005206183XXX $257,366.00
GR76 539120 00520618OXXX $948,960.00
Submitted for City Manager's Office by: Dale Fisseler(6266)
Originating Department Head: Jerome Walker(7537)
Additional Information Contact: Deidra Emerson (7563)
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