HomeMy WebLinkAboutContract 37832C1 FY SIFORETARY
�oNTRACT NO , .0 a13
STATE OF TEXAS
COUNTY OF TARRANT n
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
Joe Paniagua, Jr., its duly authorized First 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 fiom 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 Giant ("CDBG"), Program No. B-08-MC-48-0010, for Year XXXIV;
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 will administer youth services to citizens of the City of Fort Worth under the
program name Save a Smile ("Program"), for the term June 1, 2008 to May 0
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 an�Ic furnished
to City on request, City may exercise all remedies available under this Contract, including the„ iAD
YF NARY
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CDBG YEAR XXXIV CONTRACT Rev, 06-19 07
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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 titne after
being notified in writing by City; procedures to suspend or terminate thc 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. Co���ela.ratio�z a�ad Method of Pay�neaat
a. City will disburse CDBG Year ��'ZN funds ("CDBG Funds") in an amount up to twenty
one thousand and eight hundred seventy and no/100 dollars, $21,870 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 $340,926 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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f. Contractor will not commingle CDBG Funds with any other funds in any manner that
would prevent City from readily identifying expenditures for operation of the Program.
3. Uniform Administrative Begnirements and Program Management Standard
a. Financial Management
i. 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,
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ncluding 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 Cite guidelines.
He 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.
in. Real Property Records
Contractor shall maintain real property inventory records that clearly identify properties
purchased, improved, 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.
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(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
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 deterinined 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. Repos�ilag Procedarre.r
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 15"' of the month following
the month being reported. City is under no obligation to disburse funds for expenditures
that occurred prior to die 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-Direct Benefit Data Report, (3) Attachment V-Performance
Report, and (4) Attachment VI -Client Data Report for services and activities undertaken by
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Contractor in performance of this Contract. The report will be signed by a duly audhorized
agent of Contractor and submitted by the 15`t' of the month following d1e month that is
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 dus 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 widh funds provided under dhis Contract.
It 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, %vita source documents, in performance of this Contract. Such
records shall be kept for the time period mandated by the CDBG Regulations and this
Contract.
us 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 whedier source
documentation used for income verification is adequate.
5. Aeversioiz 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 wide 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. Tide 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.
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6. Applicable Lazes
a. Federal
Contractor agrees to comply Nvith 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 Nvith respect to a facility that
has given rise to a conviction under the Clean Air Act or the Clean Water Act.
• The Immigration 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 Nvith 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"):
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`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
(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 Nvith 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
contractor's 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 minunuin number and job titles subject to lire, 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
contractor's 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 die 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
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Contractor, and their respective successors, assigns and subcontractors. Failure to fulfill these
requirements shall subject Contractor and its subcontractors, and their respective successors and
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. Non�liscrznai�aation
a. Contractor will not unlawfully discriminate against any person or persons because of sex,
race, religion, age, disability, color, national origin, or familial status, not 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
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n 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 die performance of this
Contract.
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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
Code, and Contractor hereby covenants and agrees that Contractor, its officers, members,
agents, employees and subcontractors, have fully complied with all provisions of same 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.
S. Prohi6itian Against Interest
a. No member, officer or employee of City or its designees of 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 IY/onren Barsiness Enterprise Commitment
If applicable, Contractor agrees to abide by City's policy to involve Mino>ity and Women
Business Entea.-prises ("Iv1WBEs") 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 Contt�ctor 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,
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licensees or invitee. The doctrine of respondeat superior shall not apply as between City and
Contractor, its officers, members, agents, servants, employees, subcontractors, Program
participants, licensees or invitees, and nothing herein shall be construed as creating a
partnership or joint enterprise between City and Contractor. It is expressly understood and
agreed that no officer, member, agent, employee; subcontractor, licensee or invitee of the
Contractor, not 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 Nvay
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. Inde��alaification, In.r�rance a�a�l Bola�ling
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 KTND 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, 'I'O 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 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,
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SUBCONTRACTORS, INVITEES, LICENSEES, OR PROGRAM
PARTICIPANTS, OR CAUSED, IN WHOLE OR IN PART, BY ALLEGED
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 fidelitjT coverage in the form of a bond in the amount of
$21,870, 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.
£ 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
CDBG YEAR XXXIV CONTRACT Rev. 06-19-07
Cools Children's Health Care System Page 11
require its subcontractors to provide Contractor with certificates) of insurance documenting
such coverage. Also, Contractor shall require its subcontractors to have City and Contractor
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. 1TVaiver of Immunity
If Contractor is a charitable or nonprofit organization and has or claims an immunity or
exemption (statutory or otherwise) from and against liability for damages or injury, including
death, to persons or property; Contractor hereby expressly waives its rights to plead defensively
such immunity or exemption as against City. This section shall not be construed to affect a
governmental entity's immunities under constitutional, statutory or common law.
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 seq.) 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
XXXIV 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 Contractor's 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.
£ 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
CDBG YEAR XX}ZIV CONTRACT Rev. 0649-07
Cook Children's Health Care System Page 12
have no responsibility or liability for Contractor's expenditures or actions occurring after the
effective date of Contract termination.
15. Certification KegarcdingLobbying
a. The undersigned tepresentative of Contractor hereby certifies, to the best of lus 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 making of any Federal loan, the
entering into of any cooperative agreement and the extension, continuation, renewal,
amendment, or modification of any Federal contract, grant, loan or cooperative agreement.
Contractor shall requite 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 Nvith this Federal contract, grant, loan or cooperative agreement,
Contractor shall complete and submit Standard Forinn-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 requited 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. 112i.rcellaneozrr 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
CDBG YEAR XXXIV CONTRACT Rev. 06-19-07
Cools Children's Hea1th Care 0ystem Page 13
hereof shall be void. Any amendments to die terms of this Contract must be in writing and
must be approved by each Party.
f. All notices requited 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 (hi) addressed to the other Party at tic 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 tendered under this Contract shall involve, and no portion of tie
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 tendered or funds received be utilized so as to benefit, directly or
inditecdy, 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.
i. 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 ��IV CONTRACT Rev. 06-19-07
Cools Children's Health Care System Page 14
IN WITNESS WHEREOF, the Parties hereto have executed three copies of this Contract in
Fort Worth, Tarrant County, Texas, this 3rd-1 day of ) Cc•dbf •r , 20 02_.
CITY OF FORT WORTH
By:
'jF�h'1" �•Ii0'O,inS
First Assistant City Manager
APPROVED AS TO FORM AND LEGALITY
ATTEST:
CitST Secretary
STATE OF TEXAS �
COUNTY OF TARRANT
Cook Children's Health Care System
Ms. Linda Ch ppell VV
Senior Vice President, Quality Management
C�aa��g
Contract AuthorizaltiONL
L
O
Date
c1 •g TvS instrument was acknowledged before me on 2 Z , 2008 by Joe
Assistant City Manager of the City of Fort Worth, on behalf of the City of
Fort Worth.
MR
>'"Y P"� ROSELLA BARNES
*' MY COMMISSION EXPIRES
= OW March 31, 20D9
�19
„W
Notary Public, State of Texas
STATE OF TEXAS �
COUNTY OF TARRANT �
This instrument was acknowledged before me on .OdU 90o 2, 2008 by Ms.
Linda Chappell, the Senior Vice President, Quality Management of Cook Children's Health Care
System, a Texas non-profit corporation, on behalf of said corporation.
SUSAN D.ROBERTSHAW
MY COMMISSION EXPIRES
April 25, 2012
CDBG YEAR XXXIV CONTRACT
Cook Children's Health Care System
Public, State of Texas _�,
�►�ElGIA�. E�ECC}RQ
CITY SECRETARY
FTI WORTH, TX
- Rev.06-19-07
Page 15
Cook Children's Health Care System
Save a Smile
PROGRAM SUMMARY
June 1, LWO — May 31, 2009
CONTRACT NO. PERIOD
Scone of Services
EXHIBIT A
SCOPE OF SERVICES
$21,870
AMOUNT
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 OBaIECTIVES
Educate 100% of targeted children seen by Save a Smile volunteer dentists in proper oral health via educational
materials, provide 100% of targeted children with a dental hygiene kit and provide referral to a volunteer
provider, Medicaid, CHIP or JPS county dental clinic for children in need of immediate treatment (Class 1's).
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
Follow up Phone calls 100
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CITY OF FORT WORTH
CDBG BUDGET 2008-2009
CONTRACT PERIOD From: 6/1/2008 To: 5/31/2009
Name of Sub Grantee
Name of Program
I:cl10JE>i.A
Page 1 of 3
Cook's Children Healthcare System
Save a Smile
Program
CDBG
Cost Category
Budget
Funds
[a] [b] [c] [d]
PERSONAL
SERVICES
Salaries
104,910000
104,910000
FICA
71344,00
7,344.00
Life & Disability Insurance
420.00
420.00
Health & Dental Insurance
10,911400
10,911000
Other
3,043.00
31043000
Unemployment- State
105.00
105.00
Employment Tax - Federal
Worker's Comp
839.00
839.00
Retirement
31252600
3,252.00
SUPPLIES
Office Supplies
Postage
11150,00
11000,00
1,150.00
11000,00
Teaching Aids
Food Supplies
40000000
41000000
Other (Dental Hygiene Kits)
21,000,00
21,000,00
CONTRACTUAL SERVICES
Contract Labor (temp)
31000,00
3,000,00
Consulting (staff)
152,000000
21,870,00
152,000400
Contracted Services
(courier)
250.00
250.00
Water/Waste Disposal
Rent [Building]
1,872.00
11872,00
Custodial Services
Travel/Parking
31000400
31000000
Marketing -Printing
12,450,00
121450,00
Repairs
Fidelity Bond
Liability Insurance
Legal & Accounting
Private Auto Allowance -
Advertising
3,300.00
31300,00
Marketing -Spec Events
6,100.00
61100000
Inter Department
250.00
250.00
Awards & Recognition
30.00
30.00
Education
500.00
500.00
CAPITAL OUTLAY
Office Furniture
Office Equipment (minor)
200.00
200.00
Other: [Described]
TOTAL 340,926.00 21,870.00 340,926.00
MATCHING FUND SOURCES
a) Other Grants/Gifts
CCHCS-In Kind Contribution
over $25,000 in support
BUDGET DETAIL
PERSONAL SERVICES
Page 2 of 3
Hourly Annual % of
Position / Title Rate Hours Time Amount
Licensed Master's Social
Worker 19.23 2,080.00 9% 31645,00
Case Aide 1 FTE 11.50 21080,00 15% 31645,00
Case Aide 3 FTEs @ $11
each 11.00 21080000 19% 10,935,00
Case Aide 1 FTE 10.25 21080,00 20% 3,645.00
TOTAL STAFF SALARIES 21,870.00
Category
FICA
H
Life Insurance
ealth Insurance
Employment Tax -State
Employment Tax- Federal
Worker's Comp
Retirement
TOTAL FRINGE BENEFITS
TOTAL PERSONAL
SERVICES
CATEGORY
Telephone
Electric
Gas
Waste/Water Disposal
FRINGE BENEFITS
f %Paid %Paid
o
Payroll Amount by Agency by CDBG Amount
BUDGET DETAIL ON SELECTED MONTHLY EXPENSES Page 3 of 3
UTILITIES
AVERAGE COST PER NUMBER OF MONTHS
MONTH
►I W 17i•lr �
Other
Total Utilities
Space uses
TOTAL BUILDING LEASE
CATEGORY
Fidelity Bond
Liability Insurance
Legal & Accounting
(Other) Contractual Services
(alarm)
(Other) Contractual Services
(mowing)
TOTAL OTHER EXPENSES
TOTAL CONFERENCES
AND SEMINARS
ITEM
Office furniture &equipment
Maintenance
TOTAL OFFICE
EQUIPMENT RENTAL
BUILDING LEASE
BUILDING COST PER SQUARE
LOCATION NO. SQUARE FOOT FOOT AMOUNT
OTHER EXPENSES
TOTAL CHARGE %CHARGED TO CDBG
CONFERENCES AND SEMINARS
IMEWTAMMIN
TOTAL CHARGE %CHARGED TO CDBG
OFFICE EQUIPMENT RENTAL
TOTAL CHARGE %CHARGED TO CDBG
AMOUNT
RTW�P►I I
AMOUNT
i
SmileWave a
All Applicants
The standards in OMB Circular A.I 10, 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 k��ME A��li:canta �>alV
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 CD13&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:
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 S s� tam
(Name of Organization)
X 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 ofsubcontractor)
(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
LJ
Signature of
Linda S. Chappell, Senior Vice President, Quality Management
Typed Name and Titte
APPENDIX A — CONSTITUTIONAL PROVISION
Contractor represents that it is, or may be deemed to be, a religious or denominational institution or an organization
operated for religious purposes which is supervised or controlled by or in connection with a religious or
denominational institutional or organization. Pursuant to Title 24 CFR CH. V § 570,2000). Contractor agrees that in
connection with this contract:
a. It will not discriminate against any person applying for such public services on the basis of religion
and will not limit such services or give preference to persons on the basis of religion, and;
b. It will not discriminate against any person applying for such public services on the basis of religion
and will not limit such services or give preference to persons on the basis of religion, and;
c. It will provide no religious instruction or counseling, conduct no religious worship or services, engage
in no religious proselytizing, and exert no other religious influence in the provision of such public
services, and;
d. Where public services provided under paragraph 0)(3) of section 24 CFR 570. 200 are carried out on
property owned by the primarily religious entity, CDBG funds may also be used for minor repairs to
such property which are directly related to carrying out the public services where the cost constitutes in
dollar terms only an incidental portion of the CDBG expenditure for the public services.
CITY OF FORT WORTH
HOUSING DEPARTMENT
CONTRACT MANAGEMENT DIVISION
REQUEST FOR FUNDS
AGENCY: Cook Children's Healthcare System
ADDRESS: 801 Seventh AVenUe
Fort Worth, Texas 76104
SECTION I (AGENCY)
I. Reimbursement Request
1. Expenditures:
2. Income
A. Program Income
B. City of Fort Worth
C. Interest Earned CDBG Funds
3. 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:
C. Total Amount of this Request:
SECTION I11
I. Verification
A. Contract Compliance Specialist
B. BYSPEED -Purchasing
C. Accounting
II. Authorization
A. Agency
B. Sr. Contract Compliance
C. Housing Director
Charletra Hurt
(Name)
(Name)
(Name)
Linda Chappell
(Name)
Marilyn Jackson
(Name)
(Name)
CONTRACT NUMBER:
CONTRACT AMOUNT:
CONTRACT DATE
DATE OF REQUEST:
CURRENT MONTH
0
G R76/529120/005206270320
(Signature)
(Signature)
(Signature)
(Signature)
(Signature)
(Signature)
Distribution:
1 Copy -Accounting
1 Copy -Con. Mgmt
Note: Any Request for Funds that exceed $8500 require the signature of both Marilyn Jackson and Jerome Walker
Attachment I
Save a Smile
$211870
6/1 /2008
CUMULATIVE
(Date)
(Date)
(Date)
(Date)
(Date)
(Date)
CITY OF FORT WORTH
HOUSING DEPARTMENT
CONTRACT MANAGEMENT DIVISION
DETAIL STATEMENT OF COSTS
Cook Children's Healthcare System
AGENCY
Save a Smile
PROGRAM
CONTRACT NO.
REPORT PERIOD
TO
ATTACHMENT II
DATE
6/1 /2008
COST CATEGORY
ACCOUNT
PROGRAM
BUDGET
MONTHLY
EXPENDITURES
CUMULATIVE
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 [Building]
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
21,870,00
CAPITAL OUTLAY
Furniture, Fixtures
541 330
Office Equipment, Computers
541 370
Other Equipment
541 320
TOTAL
21,870,00
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
NAME and TITLE OF AUTHORIZED OFFICER
PREPARE ONE FORM FOR EACH SOURCE OF FUNDS
DISTRIBUTION:
1 Copy -Accounting
I Copy -CM
I Copy - Agency
2
SIGNATURE and DATE
IABGM FORM Apri12002
ATTACHMENT III
CITY OF FORT WORTH
HOUSING DEPARTMENT
CONTRACT MANAGEMENT DIVISION
EXPENDITURES WORKSHEET
Cook Children's Healthcare System
Agency
Save a Smile
Program
Contract Number
To
Report Period
6/1/2008
Date
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
TITLE OF AUTHORIZED OFFICER
Distribution:
1 copy -Accounting
1 copy-IAGM
1 copy -Agency
SIGNATURE AND DATE
City of Fort Worth
Contract Management Division
CDBG Year XXXIV
Public Service
Attachment IVa
1. Name and Address of Sub -Grantee
2. Project Name Save a Smile
Cook Children's Healthcare System
801 Seventh Avenue 3. Contract No.
Fort Worth, Texa 76104 4. Date of Request
Month & Year
6, Program Services and Activities
Current Month Cumulative
Number of New
Households and/or
Persons Served
6. Direct Benefit
(Continued)
Extremely Low Low Income Moderate Income Above Moderate Income
Income (0<30%) (31-60%) (61-80%) (80%>)
Current Month
Cumulative
Household Size 1 2 3 4 5 6 7 8
0-30% $13,600 $15,500 $17,450 $19,400 $20,950 $22,500 $24,050 $25,600
31=50% $22,600 $25,850 $29,050 $32,300 $34,900 $37,450 $40,050 $42,650
51.80% $36,200 $41,350 $46,550 $51,700 $55,850 $59,950 $64,100 $68,250
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.
Name and Address of Sub -Grantee
Cook Children's Healthcare
01 Seventh Avenue
Fort Worth, Texas 76104
I8. Direct Benefit Data
CITY OF FORT WORTH
CONTRACT MANAGEMENT DIVISION
CDBG YEAR XXXIV
PUBLIC SERVICE
Household and /or Persons
2. Project Name
3. Contract No.
4. Date of Request
Month &Year
Save a Smile
Completed) Hispanic Non -Hispanic
Month
ive
American
>_ction Must be Black Indian/Alaskan
ed) White African/American Asian Native
urrent Month
(Cumulative
Asian and Black/African
White American&White
Month
Female Head of Household
Month
umulative
American
Indian/Alaskan Native
& Black African
American Other Multi -Racial
Attachment IVb
Native Hawaiian/Other American Indian/Alaskan)
Pacific Islander Native and White
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-
profitagency,
has
been approved by the governing body of the
organization prior to submission.
Date: Submitted by:
IWiL.7iLa01ia
nature Required
Step 1: Ethnicity- Report whether client identifies themselves as Hispanic orNon-Hispanic
Step 2: Race -Identify the category chosen by the clientt
Agency/Address
CITY OF FORT WORTH
HOUSING DEPARTMENT
PUBLIC SERVICE
2. Project Name
Cook Children's Healthcare System 3. Contract No:
801 Seventh Avenue
Fort Worth, Texas 76104 4. Date of Request:
Month &Year
Save a Smile
ATTACHMENT V
Contract Date: June 1, 2008
ContractAmount:_ 21,870
5. PROGRAM SERVICES AND ACTIVITIES : CURRENT CUMULATIVE
6. SCOPE OF WORK NARRATIVE.
7. PROBLEMS ENCOUNTERED / SOLUTIONS PROPOSED
8. ANTICIPATED ACTIVITY DURING THE NEXT MONTH
9. Certification:
The undersigned
hereby gives assurance
that to the best
of my
knowledge
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Page 1 of 3
City of Fort Worth, Texas
.: • • • .• •
DATE: Tuesday, August 19, 2008
LOG NAME: 050809GRANTACT
REFERENCE NO.: C-22978
SUBJECT:
Authorize Execution of Contracts for Community Development Block Grant Year XXXIV, Emergency
Shelter Grant Year 2008-2009 and Housing Opportunities .for Persons with AIDS 2008-2009
Contracts
RECOMMENDATION:
It is recommended that the City Council authorize the City Manager to:
1. Execute contracts for Community Development Block Grant Year XXXIV, Emergency Shelter Grant
Year 2008-2009 and Housing Opportunities for Persons with AIDS Year 2008-2009 with the listed
organizations to administer their respective programs, contingent upon approval and receipt of adequate
funding from the United States Department of Housing and Urban Development, for a term beginning June
1, 2008, and ending May 31, 2009;
2. 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. 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.
Community Development Block Grant (CDBG)
Organization
CJ's Studio of Performing Arts -Performing Arts
CFW-PACSD-Como Kids
Cooks Childrens Hospital -Save a Smile
All Church Home for Children -Buffalo Soldiers
CFW-PACSD-Woodhaven After School Enrichment
Boys and Girls Club-ESTRELLAS
Southside Youth Association-U.N.I.T.Y
YWCA -Child Delopment Program
Child Care Associates
FWHA-AMAKA Child Care Center
Clayton YES -School Aged Child Care
JMAC Youth Center of Tarrant County
Clayton YES-Greenbriar Preshool
Senior Citizen Services -Como Senior Citizens
Amount�Not to Exceed)
$10,886.00
$25,000.00
$21, 870.00
$14, 580.00
$16,200.00
$14,400.00
$9,000.00
$135,000.00
$117,000.00
$27, 000.00
$54,000.00
$25,000.00
$18,000.00
$17,597.00
http : //app s. cfwnet. org/council�acket/Reports/mc�rint. asp
10/23/2008
Page 2 of 3
Meals on Wheels
Senior Citizen Services -Riverside Senior Citizens
CFW-PACSD-Community Action Partners (CAP)
Mental Health Assoc.- Mental Health Advocate
Mental Health Assoc. -Long Term Ombudsman
United Community Centers -Crisis Intervention Program
CFW-PACSD-SHIPP
CFW-PACSD-Utility Assistance Program
Centro Cultural De Las Americas-GED Classes
Northside InterChurch Agency -Good Works
Tarrant Area Food Bank -Community Kitchen
MASS, Inc. -Serving Poor and Incarcerated
Housing Counseling
A -Prep Center of Tarrant County
Reach Inc, -Project Ramp
TOTAL CDBG:
Emergency Shelter Grant (ESG)
Organization
YWCA -Supportive Living
Cornerstone Assistance -New Life Center
Presbyterian Night Shelter- Homeless Shelter
SafeHaven of Tarrant County
YWCA -My Own Place
Presbyterian Night Shelter- Elderly and Infirmary
CFW-PACSD-SHIPP
SafeHaven of Tarrant County -Supportive Child Care
Cenikor Foundation -Emergency Shelter
Parents and Children Together, Inc.
TOTAL ESG:
Housing_Opportunities for Persons with HIV/AIDS (HOPWA)
Organization
AIDS Outreach Center
Tarrant County Samaritan Housing, Inc.
AIDS Resources of Rural Texas
TOTAL HOPWA:
DISCUSSION:
$33,696.00
$15,271.00
$25, 724.00
$22,275.00
$15,750.00
$16,200.00
$37,800.00
$66,759.00
$18,070.00
$21,092.00
$18,000.00
$27,000.00
$50,000.00
$60,477.00
$21,500.00
$955,147.00
Amount (Not to Exceed)
$13,039.00
$15,297.00
$138,474.00
$20,000.00
$17,628.00
$14,161.00
$15,500.00
$14,997.00
$12,978.00
$16,521.00
$278,595.00
Amount (Not to Exceed)
$460,701.00
$262,211.00
$114,198.00
$837,110.00
On April 8, 2008, the City Council adopted the budgets and the appropriation ordinance increasing
estimated receipts and appropriations for the Year XXXIV (June 1, 2008, to May 31, 2009) Community
Development Block Grant (CDBG) funds, 2008-2009 Emergency Shelter Grant (ESG) funds and 2008-2009
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.
http : //app s. cfwnet. org/council�acket/Reports/mc�rint. asp
10/23/2008
Page 3 of 3
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 City-wide.
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 United States
Department of Housing and Urban Development (HUD) for the term beginning June 1, 2008, and ending
May 31, 2009.
TO Fund/AccountlCenters
Submitted for City Manager's Office b�
Originating Department Head:
Additional Information Contact:
FROM Fund/Account/Centers
GR76 539120 005206274XXX $837,110.00
GR76 539120 005206273XXX
$278, 595.00
GR76 539120 005206270XXX $955,147.00
Joe Paniagua (6140)
Jerome Walker (7537)
Sherry Johnson (7333)
http://apps.cfwnet.org/council�acket/Reports/mc�rint.asp 10/23/2008