HomeMy WebLinkAboutContract 53961 RECEIVED
0 -2 2020 CSC No.53961
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bTATE OF TEXAS §
COUNTY OF TARRANT §
This contract ("Contract") is made and entered into by and between the City of Fort
Worth (hereafter "City') and The Salvation Army, A Georgia Corporation(hereafter "Agency"),
a Texas non-profit corporation. City and Agency may be referred to individually as a"Party"and
jointly as "the Parties".
The Parties state as follows:
WHEREAS, City receives grant monies from the United States Department of Housing
and Urban Development through the Community Development Block Grant ("CDBG")
Program, Program No. B-1 9-MC-48-00 10,Catalog of Federal Domestic Assistance No. 14.218;
WHEREAS, a national objective of the CDBG program is to benefit low and moderate
income citizens in accordance with 24 CFR Part 570,as amended from time to time;
WHEREAS, Agency submitted a proposal to use CDBG funds for a program to serve
individuals and families, of whom 100% must meet the HUD definition of a presumed benefit
population;
WHEREAS, City citizens, the Community Development Council, and the City Council
have determined that CDBG programs are needed by the City's citizens.
NOW,THEREFORE,the Parties understand and agree as follows:
1. INCORPORATION OF RECITALS.
City and Agency hereby agree that the recitals set forth above are true and correct and
form the basis upon which the Parties have entered into this Contract.
2. DEFINITIONS.
In addition to terms defined in the body of this Contract, the terms set forth below shall
have the definitions ascribed to them as follows:
Area Median Income or AMI means the median family income for the Fort Worth-Arlington
metropolitan statistical area as established annually by HUD. The 2019 income limits are
attached hereto as EXHIBIT"A-1"—2019 HUD Income Limits.
Business Diversity Enterprise Ordinance or BDE means the City's Business Diversity
Ordinance, Ordinance No. 20020-12-2011.
CDBG means Community Development Block Grant.
CDBG PRESUMED BENEFIT PSA CONTRACT 2019-2020 OKJCIAL RECORE
The Salvation Army,A Georgia Corporation Rev. May 18,2020 CITY SECRETARY
FT. WORTH. ,
Complete Documentation means the following documentation as applicable:
• Attachments I, II, and III, with supporting documentation including:
o Proof of expense: copies of timesheets, invoices, leases, service contracts
or other documentation showing that payment is due by Agency.
o Proof of payment: cancelled checks, bank statements, or wire transfers
necessary to demonstrate that amounts due by Agency were actually paid
by Agency.
o Proof of client eligibility: Client eligibility for all clients as outlined in
Section 6.
• Complete Documentation shall meet the standards described in the attached
EXHIBIT "F" - Standards for Complete Documentation.
• Any other document or record reasonably necessary to verify costs spent and
client eligibility for the Program.
CDBG Funds means the CDBG grant funds supplied by City to Agency under the terms of this
Contract.
CDBG Regulations means regulations found at 24 CFR Part 570 et seq.
DBE means disadvantaged business enterprise in accordance with 49 CFR Part 26.
Director means the Director of the Neighborhood Services Department.
Effective Date means May 19, 2020.
HUD means the United States Department of Housing and Urban Development.
IDIS means Integrated Disbursement Information System, HUD's project tracking system.
Income Eligible Client means a client whose annual income adjusted for family size does not
exceed 80% of AMI using the most current HUD Income Guidelines and Technical Guidance
for Determining Income and Allowances. The definition of annual income to determine client
income eligibility shall be the definition contained in 24 CFR Part 5.609, as amended from time
to time.
National Objective means an activity that benefits low and moderate income persons. For the
purposes of this Contract, at least 100% of the clients served by the Program fall into a
"presumed benefit" category as defined in 24 CFR Part 570, and therefore are presumed to be
Income Eligible Clients.
Neighborhood Services Department means the City's Neighborhood Services Department.
OMB means the Office of Management and Budget.
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Program means the services described in EXHIBIT "A"—Program Summary.
Reimbursement Request means all reports and other documentation described in Section 9.
Source Documentation means documentation of full household income of any type described
under the definition of annual income in 24 CFR Part 5.609, including but not limited to copies
of paychecks, Social Security and disability verification letters, interest or rental income
statements, retirement income statements, child support and alimony verification, unemployment
benefit letters, and the like.
Unduplicated Clients means a count of all clients served by the Program at least once in the
Contract Term. Clients served by the Program more than once in the Contract Term will only be
counted the first time they are served when determining the total count of Unduplicated Clients.
ZoomGrants—Outline database for Agency to submit monthly reimbursement requests.
3. TERM.
The term of this Contract begins on the Effective Date and terminates on September 30,
2020 unless earlier terminated as provided in this Contract.
4. DUTIES AND RESPONSIBILITIES OF CITY.
4.1 Provide CDBG Funds.
City shall provide up to $18,000.00 of CDBG Funds under the terms and conditions of
this Contract.
4.2 Monitor.
City will monitor the activities and performance of Agency and any of its contractors,
subcontractors or vendors as necessary, but no less than annually. Monitoring by City will
include determining whether Agency is meeting the National Objective during the term of this
Contract.
5. DUTIES AND RESPONSIBILITIES OF AGENCY.
5.1 Required Services.
Agency shall perform the services described in EXHIBIT "A"—Program Summary in
accordance with the terms and conditions of this Contract.
5.2 Use of CDBG Funds.
5.2.1. Compliance with CDBG Regulations and Contract.
Agency shall be reimbursed for eligible Program costs with CDBG Funds only if City
determines in its sole discretion that:
5.2.1.1 Costs are eligible expenditures in accordance with CDBG Regulations.
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5.2.1.2 Costs are in compliance with this Contract and are reasonable and
consistent with industry norms.
5.2.1.3 Complete Documentation, as applicable, is submitted to City by
Agency.
5.2.2 Budget.
5.2.2.1 The CDBG Funds will be paid on a reimbursement basis in accordance
with EXHIBIT "B"-Budget.
5.2.2.2 During the term of this Contract, Agency may submit written requests
to increase or decrease line-item amounts in the Budget, including an
explanation of why such increases or decreases are necessary. All
requests shall be approved by Director or Director's designee in
writing, with such approval being in the City's sole discretion. If the
Agency's proposed Budget amendment is approved (as approved, the
"Amended Budget"), then the Amended Budget shall be
memorialized in a written amendment to this Contract. The Amended
Budget will take effect on the first day of the month following the
month in which the Contract amendment is executed, unless otherwise
specified in the amendment.
5.2.3 Change in Program Budget.
5.2.3.1 Agency will notify City promptly of any additional funds it receives
for operation of the Program, and City reserves the right to amend this
Contract in such instances to ensure compliance with HUD regulations
governing cost allocation.
5.2.3.2 Agency agrees to utilize the CDBG Funds to supplement rather than
supplant funds otherwise available for the Program.
5.2.4 Payment of CDBG Funds to Agency.
CDBG Funds will be disbursed to Agency upon City's approval of Reimbursement
Requests including submission of Complete Documentation to City in compliance with Section
9. If Agency expends all funds budgeted for the Program prior to September 30, 2020. City
may hold back a small amount of the CDBG Funds until the end of the term. During this interim
period, Agency must continue to submit Attachment III — Client Data Report in Exhibit "D" —
Reimbursement Forms monthly. It is expressly agreed by the Parties that any CDBG Funds
not spent or approved for reimbursement to Agency shall remain with City.
5.3 Program Performance Milestones.
5.3.1 Agency represents that the Program will achieve the following milestones in
accordance with EXHIBIT "A"—Program Summary and the table below:
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Unduplicated Clients as
specified in EXHIBIT
"A"—Program
Month Expenditures Summary
3 25% 25%
6 50% 50%
9 75% 75%
12 100% 100%
5.3.2 Failure of Agency to meet these milestones or a material deviation from them as
outlined in this Section 5.3 is a breach of this Contract. For the purpose of this Section,
"material deviation" shall mean more than 10% lower than the specified goal. In the event of
such breach, City reserves the right in its sole option to (i) delay or withhold payment of
Reimbursement Requests, (ii) lower Agency's allocation of CDBG Funds, or (iii) terminate this
Contract.
5.3.3 Failure to meet at least 80% of its performance milestones or serve 75
Unduplicated Clients under this Contract may, in City's sole discretion disqualify Agency for
consideration under the City's Request for Proposals for the 2020-2021 Program Year for federal
grant funds.
5.3.4 Amendments to performance milestones regarding CDBG Funds must be
approved by the Director in writing, with such approval being in the Director's sole discretion.
If Director approves the Agency's proposed amended performance milestones (as approved, the
"Amended Performance Milestones"), then the Amended Performance Milestones shall be
memorialized in a written amendment to this Contract. The Amended Performance Milestones
will take effect on the first day of the month following the month in which the Contract
Amendment is executed unless otherwise specified in the amendment. All requests for
amendments to performance milestones must be submitted by May 31, 2020. Notwithstanding
the above, any amendments to this Contract shall not reduce the number of Unduplicated Clients
stated in Section 5.3.3 and in EXHIBIT "A" -Program Summary.
5.4 Identify Program Expenses Paid with CDBG Funds.
Agency will keep accounts and records in such a manner that City may readily identify
and account for Program expenses reimbursed with CDBG Funds. These records shall be made
available to City for audit purposes and shall be retained as required hereunder.
5.5 Meet National Obiective.
Agency shall ensure that the activities carried out in the Program will meet the National
Objective.
5.6 Program Subcontracts.
Agency shall not enter into a subcontract with another agency, contractor, or vendor to
provide a service to clients for any part of the Program that will be paid with CDBG Funds
without City's written consent.
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6. CLIENT ELIGIBILITY VERIFICATION.
6.1 Client Eligibility.
Agency will document client eligibility as follows:
6.1.1 Agency Clients.
Agency must document that all clients served by the Program fall under a "presumed
benefit" category as defined in 24 CFR Part 570. For purposes of this Contract, the categories of
presumed benefit are: severely disabled adults, homeless persons, abused or neglected children
and youth, or elderly persons. Eligible forms of documentation for each category include:
6.1.1.1 Severely Disabled Adults. Written, signed and dated diagnosis from
a licensed medical professional. As an acceptable alternative, Agency
may use the form attached hereto as Exhibit"H"—Severely Disabled
Certification Form.
6.1.1.2 Homeless Persons. Written, signed and dated certification from an
outreach worker.
6.1.1.3 Abused or Neglected Children and Youth. Written, signed and
dated certification from an outreach worker.
6.1.1.4 Elderly Persons. An elderly person is an individual at least 62 years
of age. Copy of a birth certificate, driver's license, passport,
immigration card, military identification, or any other state, local,
national or international documentation, must be provided showing
current information about the age or birth date of the client. The form
in Exhibit "E" — Form of Income Self Certification, or a similar
document, will also be required in order to collect demographic data.
6.2 Submission of Complete Documentation.
Agency must submit copies of documentation of client eligibility described in Section 6.1
with Attachment III with each month's Reimbursement Request for all Unduplicated Clients.
6.3 Maintain Documentation.
Agency must maintain copies of all documentation required by this Section for 5 years
following the expiration of the Contract term. This Section shall survive the earlier termination
or expiration of this Contract.
7. ADDITIONAL CDBG REQUIREMENTS.
Agency agrees to comply with all requirements of the CDBG Program as stated in the
CDBG Regulations, including but not limited to the following:
7.1 Environmental Review.
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CDBG Funds will not be paid, and costs cannot be incurred until City has conducted an
environmental review and completed an Environmental Review Record as required by 24 CFR
Part 58. The environmental review may result in a decision to proceed with, modify, or cancel
the funding for the Program. Further, Agency will not undertake or commit any funds to
physical or choice limiting actions as described in any applicable federal regulations. Any
violation of this provision will (i) cause this Contract to terminate immediately, and (ii) require
Agency to repay City the CDBG Funds it has already received and forfeit any future payments of
CDBG Funds.
7.2 Contract Not Constituting Commitment of Funds.
Notwithstanding any provision of this Contract, the Parties agree and acknowledge that
this Contract does not constitute a commitment of funds, and that such commitment of funds or
approval may occur only upon (i) satisfactory completion of an environmental review and receipt
by City of an authorization to use grant funds from HUD under 24 CFR Part 58, (ii) approval of
City's 2019-2020 Action Plan, and (iii) receipt by City of a grant agreement from HUD.
7.3 Monitoring.
7.3.1 Agency understands and agrees that it will be subject to monitoring by City for
compliance with terms and provisions of this Contract and the CDBG Regulations for the term of
this Contract. Agency is subject to such monitoring during the term of this Contract and for 5
years after the Contract term ends. Agency will provide reports and access to Program files as
requested by City during this 5 year period. For purposes of this Contract, this 5 year period for
monitoring is deemed to begin on October 1, 2020 and end on September 30, 2025 regardless
of whether or not this Contract is earlier terminated.
7.3.2 Representatives of City, HUD, HUD Office of Inspector General, and the United
States Comptroller General shall have access during regular business hours, upon 48 hours prior
notice, to Agency's offices and records pertaining to the use of the CDBG Funds, and to
Agency's officers, directors, agents, employees, contractors, subcontractors and vendors for the
purpose of such monitoring.
7.3.3 In addition to other provisions of this Contract regarding frequency of monitoring,
City reserves the right to perform desk reviews or on-site monitoring of Agency's compliance
with the terms and conditions of this Contract. City shall provide Agency with a written report
of the monitor's findings after each monitoring visit. If the monitoring report notes deficiencies
in Agency's performance, the report shall include requirements for the timely correction of said
deficiencies by Agency. Failure by Agency to take the action specified in the monitoring report
may be cause for suspension or termination of this Contract as provided herein.
7.3.4 Subsections 7.3.1 through 7.3.3 shall be applicable for the Contract Term and for
5 years thereafter and shall survive the earlier termination or expiration of this Contract.
7.3.5 Agency shall provide City annually the results of any state or federal monitoring.
Such results shall be submitted within 60 days of receipt of such state or federal monitoring
report, or with the January Reimbursement Request, whichever is earlier.
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7.4 Agency Procurement Standards.
Agency shall comply with all applicable federal, state and local laws, regulations, and
ordinances for making procurements under this Contract. In addition to the conflict of interest
provisions in Section 14.13.3, Agency shall establish written procurement procedures to ensure
that materials and services are obtained in a cost effective manner and that provides for full and
open competition. When procuring materials and services for this Contract, Agency shall
comply at a minimum with the procurement standards in 2 CFR Part 200.317 through Part
200.326.
7.4.1 Contracts in excess of $10,000.00 made by Agency using CDBG Funds must
address termination for cause and convenience including the manner by which such termination
shall be effected and the basis for settlement of the terminated contract, if any, as required by
Appendix II (B), 2 CFR Part 200.
7.4.2 Agency shall not make any contract with parties listed on the government wide
System for Award Management, www.sam.gov ("SAM"). Agency must confirm by search of
SAM that all contractors paid with CDBG Funds are not listed by SAM as being debarred, both
prior to hiring and prior to submitting a Reimbursement Request which includes invoices from
any such contractor. Failure to submit such proofs of search shall be an event of default.
7.5 Cost Principles/Cost Reasonableness.
Agency shall administer its use of CDBG Funds in compliance with 2 CFR Part 200, as
applicable. The eligibility of costs incurred for performance rendered shall be determined in
accordance with 2 CFR Part 200.400 through Part 200.475.
7.6 Financial Management Standards.
Agency agrees to comply with 2 CFR Part 200, as applicable. Agency also agrees to
adhere to the accounting principles and procedures required therein, utilize adequate internal
controls, and maintain necessary supporting and back-up documentation for all costs incurred in
accordance with 2 CFR Part 200.302 and Part 200.303.
7.7 Uniform Administrative Requirements, Cost Principles, and Audit
Requirements.
Agency will comply with the Uniform Administrative Requirements, Cost Principles, and
Audit Requirements for Federal Awards in 2 CFR Part 200, as applicable, or any reasonably
equivalent procedures and requirements that City may require.
7.8 Terms Applicable to Contractors, Subcontractors and Vendors.
Agency understands and agrees that all terms of this Contract, whether regulatory or
otherwise, shall apply to any and all contractors, subcontractors and vendors of Agency which
are in any way paid with CDBG Funds or who perform any work in connection with the
Program. Agency shall cause all applicable provisions of this Contract to be included in and
made a part of any contract or subcontract executed in the performance of its obligations
hereunder including its obligations regarding the CDBG Regulations. Agency shall monitor the
services and work performed by its contractors, subcontractors and vendors on a regular basis for
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compliance with the CDBG Regulations and Contract provisions. Agency must cure all
violations of the CDBG Regulations committed by its contractors, subcontractors or vendors.
City maintains the right to insist on Agency's full compliance with the terms of this Contract and
the CDBG Regulations and Agency is responsible for such compliance regardless of whether
actions taken to fulfill the requirements of this Contract are taken by Agency or by Agency's
contractors, subcontractors or vendors. Agency acknowledges that the provisions of this Section
shall survive the earlier termination or expiration of this Contract and shall be applicable for 5
years after the Contract term ends.
7.9 Copyright and Patent Rights.
No reports, maps, or other documents produced in whole or in part under this Contract
shall be the subject of an application for copyright by or on behalf of Agency. HUD and City
shall possess all rights to invention or discovery, as well as rights in data, which may arise as a
result of Agency's performance under this Contract.
7.10 Conflict of Interest Disclosure.
In accordance with the requirements of Section 14.13.2.1 and 14.13.4, Agency shall
establish conflict of interest policies for federal awards. Agency shall disclose to City in writing
any potential conflict of interest.
7.11 Compliance with FFATA and Whistleblower Protections.
Agency shall comply with the requirements of 2 CFR 300(b), including provisions of the
Federal Funding Accountability and Transparency Act ("FFATA") governing requirements on
executive compensation and provisions governing whistleblower protections contained in 10
U.S.C. 2409,41 U.S.C. 4712, 10 U.S.C. 2324, 41 U.S.C. 4304 and 41 U.S.C. 4310.
7.11.1 Agency shall provide City with its DUNS number.
7.12 Internal Controls.
In compliance with the requirements of 2 CFR Part 200.303, Agency shall:
7.12.1 Establish and maintain effective internal control over the CDBG Funds that
provides reasonable assurance that Agency is managing the CDBG Funds in compliance with
federal statutes, regulations, and the terms and conditions of this Contract. These internal
controls shall be in compliance with guidance in "Standards for Internal Control in the Federal
Government" issued by the Comptroller General of the United States or the "Internal Control
Integrated Framework" issued by the Committee of Sponsoring Organizations of the Treadway
Commission("COSO");
7.12.2 Comply with federal statutes, regulations, and the terms and conditions of this
Contract;
7.12.3 Evaluate and monitor Agency's compliance with statutes, regulations and the
terms and conditions of this Contract;
7.12.4 Take prompt action when instances of noncompliance are identified including
noncompliance identified in audit findings; and
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7.12.5 Take reasonable measures to safeguard protected personally identifiable
information and other information that HUD or City designates as sensitive or Agency considers
sensitive consistent with applicable federal, state, local and tribal laws regarding privacy and
obligations of confidentiality.
8. RECORD KEEPING; REPORTING AND DOCUMENTATION
REQUIREMENTS; AUDIT.
8.1 Record Keeping.
Agency shall maintain a record-keeping system as part of its performance of this Contract
and shall promptly provide City with copies of any document City deems necessary for the
effective fulfillment of City's monitoring and evaluation responsibilities. Specifically, Agency
will keep or cause to be kept an accurate record of all actions taken and all funds spent, with
supporting and back-up documentation. Agency will maintain all records and documentation
related to this Contract for 5 years after the Contract term ends. If any claim, litigation, or audit
is initiated before the expiration of the 5 year period, the relevant records and documentation
must be retained until all such claims, litigation or audits have been resolved. For purposes of
this Contract, this 5 year period for record retention is deemed to begin on October 1, 2020 and
end on September 30, 2025 regardless of whether or not this Contract is earlier terminated.
8.2 Access to Records.
Representatives of City, HUD and any duly authorized officials of the federal
government will have full access to, and the right to examine, audit, copy, excerpt and/or
transcribe any of Agency's records pertaining to all matters covered by this Contract for 5 years
after the Contract term ends. Such access shall be during regular business hours and upon at
least 48 hours prior notice. For purposes of this Contract, this 5 year period for access to records
is deemed to begin on October 1, 2020 and end on September 30, 2025 regardless of whether or
not this Contract is earlier terminated.
8.3 Reports.
Agency will submit to City all reports and documentation described in this Contract in
such form as City may prescribe. Agency may also be required to submit a final performance
and/or final financial report if required by City at the termination of this Contract in such form
and within such times as City may prescribe. Failure to submit to City any report or
documentation described in this Contract shall be an event of default of this Contract and City
may exercise all of its remedies for default under this Contract.
8.3.1 Additional Information.
Agency shall provide City with additional information as may be required by state or
federal agencies to substantiate Program activities and/or expenditure eligibility.
8.4 Change in Reporting Requirements and Forms.
City retains the right to change reporting requirements and forms at its discretion. City
will notify Agency in writing at least 15 days prior to the effective date of such change, and the
Parties shall execute an amendment to the Contract reflecting such change if necessary.
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8.5 Audit.
8.5.1 Entities that Expend $750,000 or more in Federal Funds Per Year.
All non-federal entities that expend $750,000 or more in federal funds within 1 year,
regardless of the source of the federal award, must submit to City an annual audit prepared in
accordance with specific reference to 2 CFR Part 200.501 through Part 200.521. The audit shall
cover the Agency's fiscal years during which this Contract is in force. The audit must be
prepared by an independent certified public accountant, be completed within 6 months following
the end of the period being audited and be submitted to City within 30 days of its completion.
Agency's audit certification is attached hereto as EXHIBIT "C"—"Audit Certification Form"
and "Audit Requirements". The Audit Certification Form must be submitted to City prior to
or with the first Reimbursement Request. Entities that expend less than $750,000 a year in
federal funds are exempt from federal audit requirements for that year, but records must be
available for review or audit by appropriate officials of the federal agency, City, and General
Accounting Office.
8.5.2 City Reserves the Right to Audit.
City reserves the right to perform an audit of Agency's Program operations and finances
at any time during the term of this Contract and for 5 years after the Contract term ends if City
determines that such audit is necessary for City's compliance with the CDBG Regulations or
other City policies. Agency agrees to allow access to all pertinent materials as described herein
for such audit. For purposes of this Contract, this 5 year period for City audit is deemed to begin
on October 1, 2020 and end on September 30, 2025 regardless of whether or not this Contract
is earlier terminated. If such audit reveals a questioned practice or expenditure, such questions
must be resolved within 15 business days after notice to Agency of such questioned practice or
expenditure. If questions are not resolved within this period, City reserves the right to withhold
further funding under this Contract and/or any other contracts with Agency. IF AS A RESULT
OF ANY AUDIT IT IS DETERMINED THAT AGENCY HAS FALSIFIED ANY
DOCUMENTATION OR MISUSED, MISAPPLIED OR MISAPPROPRIATED CDBG
FUNDS OR SPENT CDBG FUNDS ON ANY INELIGIBLE ACTIVITIES, AGENCY
AGREES TO REIMBURSE CITY THE AMOUNT OF SUCH MONIES PLUS THE
AMOUNT OF ANY SANCTIONS, PENALTY OR OTHER CHARGE LEVIED
AGAINST CITY BY HUD BECAUSE OF SUCH ACTIONS.
9. REIMBURSEMENT REQUIREMENTS.
9.1 Deadline for Submitting Reimbursement Requests.
Reimbursement Requests shall be submitted monthly to the City and must be received by
the City on or before the 15`h day of the month following the month expenses were paid by
Agency. For example, the Reimbursement Request for June expenses must be received by July
15. In the event the 151h falls on a weekend or City holiday, Reimbursement Requests shall be
due the next day that the City is open for business. Failure to submit a Reimbursement Request
in a timely fashion will result in City taking the actions outlined in Section 10.1.
NOTWITHSTANDING ANYTHING ABOVE, THE REIMBURSEMENT REQUEST
FOR EXPENSES INCURRED FOR SEPTEMBER MUST BE RECEIVED BY
OCTOBER 1 OF THAT SAME YEAR. COMPLETE DOCUMENTATION FOR ALL
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SEPTEMBER EXPENSES MUST BE SUBMITTED BY OCTOBER 15TH OF THAT
SAME YEAR. FAILURE TO SUBMIT A FINAL REIMBURSEMENT REQUEST WITH
COMPLETE DOCUMENTATION BY OCTOBER 15TH OF THAT SAME YEAR WILL
RESULT IN FORFEITURE OF PAYMENT OF THE SEPTEMBER REIMBURSEMENT
REQUEST.
9.1.2 City will notify Agency by e-mail within 14 calendar days if a Reimbursement
Request is lacking Complete Documentation or corrections are needed. Agency will have 7
calendar days from the date of the e-mail notice to submit any requested information or missing
documentation. Agency may be penalized, at City's sole discretion, in the Request for Proposal
for the 2020-2021 Program Year for any notifications received under this Section. If Agency
fails to submit all the required information or missing documentation within 7 calendar days
from the first e-mail, Agency shall forfeit any payments otherwise due that month and failure to
submit any requested information will be considered an event of default as outlined in Section
10.1.2.
9.2 Submission of Reimbursement Requests.
Agency shall provide City with Complete Documentation and the following reports as
shown in EXHIBIT "D"—Reimbursement Forms with each Reimbursement Request:
9.2.1 Attachment I—Invoice.
This report shall contain the amount requested for reimbursement each month, the
cumulative reimbursement requested to date (inclusive of that month's request).
9.2.2 Attachment II—Expenditure Worksheet.
This report shall itemize each expense requested for reimbursement by Agency and shall
include the Account corresponding the expense to a Budget line item. In order for this report to
be complete the following must be submitted:
9.2.2.1 For payroll expenses, timesheets signed by employees and approved
by supervisor for all payroll expenses listed. Timesheets must
distinguish between CDBG-funded time and non-CDBG funded time
and reflect actual time spent on CDBG-funded activities.
9.2.2.2 For non-payroll expenses, invoices for each expense listed with an
explanation as to how the invoiced expense pertains to the Program.
9.2.2.3 Proof that each expense was paid by Agency, which proof can be
satisfied by cancelled checks, wire transfer documentation, paid
receipts or other appropriate banking documentation.
9.2.3 Attachment III—Client Data Report.
This report shall list each Unduplicated Client served during the month along with his or
her demographic information. The Client Data Report must maintain a list of all clients served
during the Contract term. In order for this report to be complete, the following must be
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submitted:
9.2.3.1 Documentation of "presumed benefit" eligibility for each
Unduplicated Client the first time the client is served by the Program,
as defined in Section 6.
9.2.4 Delivery of Reimbursement Request.
Reimbursement Requests must be submitted through ZoomGrants by the deadline
in Section 9.1.1.
9.2.5 Countywide Agencies.
Countywide Agencies shall submit EXHIBIT "A-2" — Reporting Requirements for
Countywide Agencies quarterly with the December, March, June and September
Reimbursement Requests. Reports due under this section have the same due date as the
Reimbursement Request.
9.3 Withholding Payment.
CITY SHALL HAVE NO OBLIGATION TO PAY ANY REIMBURSEMENT
REQUEST THAT IS NOT RECEIVED BY THE DUE DATE. Failure to timely submit
accurate and complete Reimbursement Requests and along with any required reports shall
be an event of default.
10. DEFAULT AND TERMINATION.
10.1 Failure to Submit Reimbursement Request or Required Documentation.
10.1.1 If Agency fails to submit a Reimbursement Request in accordance with
Section 9, Agency shall be in default of this Contract. City will notify Agency in writing of such
default and the Agency will have 5 calendar days from the date of the written notice to submit
such Reimbursement Request to cure the default. If Agency fails to cure the default within such
time, Agency shall forfeit any payments otherwise due that month.
10.1.2 If Agency fails to submit requested information or missing documentation as
set forth in Section 9.1.2, then Agency shall forfeit payment due that month and the failure to
submit shall be considered an event of default that shall not be cured.
10.1.3
NOTWITHSTANDING THE PROVISIONS OF SECTION 10.1.1 OR 10.1.2, IF
AGENCY FAILS TO SUBMIT THE REIMBURSEMENT REQUEST DUE OCTOBER 1
OR IF THE SUBMITTED REIMBURSEMENT REQUEST DUE OCTOBER 1 IS LATE,
INCOMPLETE OR OTHERWISE NOT IN COMPLIANCE WITH THIS CONTRACT
OR THE CDBG REGULATIONS AS DETERMINED BY CITY IN ITS SOLE
DISCRETION, THERE WILL BE NO CURE PERIOD AND ANY REIMBURSEMENT
WILL BE FORFEITED.
i
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10.1.4 In the event of (i) an uncured default under Section 10.1.1 or an event of
default under 10.1.2 or (ii) more than 2 instances of default, cured or uncured, under these
Sections, City reserves the right at its sole option to terminate this Contract effective
immediately upon written notice of such intent with no penalty or liability to City.
10.1.5 Notwithstanding anything to the contrary herein, City will not be required to
pay any CDBG Funds to Agency during the period that any Reimbursement Request, report or
documentation is past due or is not in compliance with this Contract or the CDBG Regulations,
or during any period during which Agency is in default of this Contract.
10.1.6 In the event of termination under this Section 10.1, all CDBG Funds awarded
but unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency shall
have no further right to such funds.
10.2 Failure to Maintain Records or Submit Reports and Documentation.
If Agency fails to maintain all records and documentation as required in Section 8, or if
the maintained or submitted report or documentation is not in compliance with this Contract or
the CDBG Regulations as determined by City in its sole discretion, City will notify Agency in
writing and Agency will have 30 calendar days from the date of the written request to obtain or
recreate the missing records and documentation or submit or resubmit any such report or
documentation to City. If Agency fails to maintain the required reports or documentation, or
fails to submit or resubmit any such report or documentation within such time, City shall have
the right to terminate this Contract effective immediately upon written notice of such intent with
no penalty or liability to City.
10.2.1 In the event of termination under this Section 10.2, all CDBG Funds awarded
but unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency shall
have no further right to such funds, and any CDBG Funds paid to Agency must be repaid to City
within 30 days of termination. If such CDBG Funds are not repaid to City within the 30 day
period, City shall exercise all legal remedies available under this Contract.
10.3 In General.
10.3.1 Subject to Section 10.2, and unless specifically provided otherwise in this
Contract, Agency shall be in default under this Contract if Agency breaches any term or
condition of this Contract. In the event that such a breach remains uncured after 30 calendar
days following written notice by City(or such other notice period as may be specified herein) or,
if Agency has diligently and continuously attempted to cure following receipt of such written
notice but reasonably requires more than 30 calendar days to cure, as determined by both Parties
mutually and in good faith, City shall have the right to elect in City's sole discretion to (i) extend
Agency's time to cure, (ii) terminate this Contract effective immediately upon written notice of
such intent to Agency, or (iii) pursue any other legal remedies available to City under this
Contract.
10.3.2 City's remedies may include:
10.3.2.1 Direct Agency to prepare and follow a schedule of actions for
carrying out the affected activities, consisting of schedules,
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timetables and milestones necessary to implement the affected
activities.
10.3.2.2 Direct Agency to establish and follow a management plan that
assigns responsibilities for carrying out the remedial activities.
10.3.2.3 Reprogram CDBG Funds that have not yet been expended from
affected activities to other eligible activities or withhold CDBG
Funds.
10.3.2.4 Any other appropriate action including but not limited to any
remedial action legally available such as declaratory judgment,
specific performance, damages, temporary or permanent
injunctions, termination of this Contract or any other contracts with
Agency, and any other available remedies.
10.3.3 In the event of termination under this Section 10.3, all CDBG Funds awarded
but unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency shall
have no further right to such funds, and any CDBG Funds already paid to Agency must be repaid
to City within 30 days of the termination. Failure to repay such CDBG Funds within the 30 day
period will result in City exercising all legal remedies available under this Contract.
10.4 No Funds Disbursed while in Breach.
Agency understands and agrees that no CDBG Funds will be paid to Agency until all
defaults are cured to City's satisfaction.
10.5 No Compensation After Date of Termination.
Agency shall not receive any compensation for work undertaken after the date of the
termination.
10.6 Rights of City Not Affected.
Termination shall not affect or terminate any of the existing rights of City against
Agency, or which may thereafter accrue because of Agency's default and this provision shall be
in addition to any and all other rights and remedies available to City under the law. Such
termination does not terminate any provisions of this Contract that have been expressly noted as
surviving the term or termination of the Contract. No delay or omission by City in exercising
any right or remedy available to it under this Contract shall impair any such right or remedy or
constitute a waiver or acquiescence in any Agency default.
10.7 Waiver of Breach Not Waiver of Subsequent Breach.
The waiver of a default or breach of any term, covenant, or condition of this Contract
shall not operate as a waiver of any subsequent default or breach of the same or any other term,
covenant or condition hereof.
10.8 Civil, Criminal and Administrative Penalties.
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Failure to perform all the Contract terms may result in civil, criminal or administrative
penalties, including, but not limited to those set out in this Contract.
10.9 Termination for Cause.
10.9.1 City may terminate this Contract in the event of Agency's default, inability, or
failure to perform subject to notice, grace and cure periods. In the event City terminates this
Contract for cause, all CDBG Funds awarded but unpaid to Agency pursuant to this Contract
shall be immediately rescinded and Agency shall have no further right to such funds and any
CDBG Funds already paid to Agency must be repaid to City within 30 days of termination.
Failure to repay such CDBG Funds within 30 days will result in City exercising all legal
remedies available to City under this Contract. AGENCY ACKNOWLEDGES AND
AGREES THAT IF CITY TERMINATES THIS CONTRACT FOR CAUSE, AGENCY
OR ANY AFFILIATES OF AGENCY SHALL NOT BE CONSIDERED FOR ANY
OTHER CITY CONTRACT FOR CDBG FUNDS FOR A MINIMUM OF 5 YEARS
FROM THE DATE OF TERMINATION.
10.9.2 Agency may terminate this Contract if City does not provide the CDBG Funds
substantially in accordance with this Contract.
10.10 Termination for Convenience.
In terminating in accordance with 2 CFR Part 200, Appendix Il, this Contract may be
terminated in whole or in part only as follows:
10.10.1 By City with the consent of Agency in which case the Parties shall agree upon
the termination conditions, including the effective date and in the case of partial termination, the
portion to be terminated; or
10.10.2 By Agency upon at least 30 days written notification to City, setting forth the
reasons for such termination, the effective date, and in the case of partial termination, the portion
to be terminated. In the case of a partial termination, City may terminate the Contract in its
entirety if City determines in its sole discretion that the remaining portion of the Contract to be
performed or CDBG Funds to be spent will not accomplish the purposes for which the Contract
was made.
10.11 Dissolution of Agency Terminates Contract.
This Contract shall terminate in the event Agency is dissolved or ceases to exist. In the
event of termination under this Section, all CDBG Funds are subject to repayment and/or City
may exercise all of its remedies under this Contract.
10.12 Reversion of Assets.
In the event this Contract is terminated with or without cause, all assets acquired by
Agency with the CDBG Funds including cash, interest payments from loans or otherwise, all
outstanding notes, mortgages or other security instruments, any accounts receivable attributable
to the use of the CDBG Funds, and any real or personal property owned by Agency that was
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improved with the CDBG Funds shall automatically transfer to City or to such assignee as City
may designate.
11. REPAYMENT OF CDBG FUNDS.
All CDBG Funds are subject to repayment in the event the Program does not meet the
requirements of this Contract or in the CDBG Regulations. If Agency takes any action that
results in the City being required to repay all or any portion of the CDBG Funds to HUD,
Agency agrees it will reimburse City for such repayment. If Agency takes any action that
results in City receiving a finding from HUD about the Program, whether or not
repayment of all or any portion of the CDBG Funds is required of City, Agency agrees City
may require that 10% of the CDBG Funds be repaid to City as liquidated damages. The
Parties agree that City's damages in the event of either repayment to HUD being required or
receiving a finding from HUD are uncertain and would be difficult to ascertain and may include
an impact on City's CDBG grant or other federal grant funds, in addition to the finding by HUD
or a required repayment of funds to HUD by City. Therefore, the Parties agree that payment
under this Section of 10% of the CDBG Funds by Agency to City is liquidated damages and not
a penalty.
12. CHANGE IN NON-PROFIT STATUS.
Agency must provide City with written notification of any changes to its non-profit status
within 15 calendar days of being notified of the change. Regardless of notice by Agency, if the
non-profit status of Agency changes after the date of this Contract, City may but is not obligated
to, terminate this Contract. In the event of termination under this Section 12, all CDBG Funds
awarded but not yet paid to Agency pursuant to this Contract shall be immediately rescinded and
Agency shall have no further right to such funds. City in its sole discretion, may require that any
CDBG Funds already paid to Agency must be repaid to City within 30 calendar days of
termination under this Section.
13. SURVIVAL.
Any provision of this Contract that pertains to auditing, monitoring, client income
eligibility, record keeping and reports, City ordinances, or applicable CDBG requirements, and
any default and enforcement provisions necessary to enforce such provisions, shall survive the
termination of this Contract for 5 years after the Contract term ends and shall be enforceable by
City against Agency. For purposes of this Contract, this 5 year period for survival of certain
Contract provisions is deemed to begin on October 1, 2020 and end on September 30, 2025
regardless of whether or not this Contract is earlier terminated.
14. GENERAL PROVISIONS.
14.1 Agency an Independent Contractor.
Agency shall operate hereunder as an independent contractor and not as an officer, agent,
servant or employee of City. Agency shall have exclusive control of, and the exclusive right to
control, the details of the work and services performed hereunder, and all persons performing
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same, and shall be solely responsible for the acts and omissions of its officers, members, agents,
servants, employees, contractors, subcontractors, vendors, clients, licensees or invitees.
14.2 Doctrine of Respondeat Superior.
The doctrine of respondeat superior shall not apply as between City and Agency, or its
officers, members, agents, servants, employees, contractors, subcontractors, vendors, clients,
licensees or invitees, and nothing herein shall be construed as creating a partnership or joint
enterprise between City and Agency. City does not have the legal right to control the details of
the tasks performed hereunder by Agency, its officers, members, agents, employees, contractors,
subcontractors, vendors, clients, licensees or invitees.
14.3 Agency Property.
City shall under no circumstances be responsible for any property belonging to Agency,
or its officers, members, agents, employees, contractors, subcontractors, vendors, clients,
licensees or invitees that may be lost, stolen or destroyed or in any way damaged and AGENCY
HEREBY INDEMNIFIES AND HOLDS HARMLESS CITY AND ITS OFFICERS,
AGENTS, AND EMPLOYEES FROM ANY AND ALL CLAIMS OR SUITS
PERTAINING TO OR CONNECTED WITH SUCH PROPERTY.
14.5 Religious Organization.
Agency shall comply with all applicable requirements as more particularly described in
24 CFR Part 5.109. No portion of the CDBG Funds shall be used in support of any sectarian or
religious activity. In addition, there must be no religious or membership criteria for clients of a
CDBG-funded service.
14.5.1. Separation of Explicitly Religious Activities.
Agency retains its independence and may continue to carry out its mission, including the
definition, development practice, and expression of its religious beliefs, provided that it does not
use CDBG Funds to support or engage in any explicitly religious activities (including activities
that involve overt religious content such as worship, religious instruction, or proselytization), or
in any other manner prohibited by law.
14.5.2 Explicitly Religious Activities.
If Agency engages in explicitly religious activities (including activities that involve overt
religious content such as worship, religious instruction, or proselytization), the explicitly
religious activities must be offered separately, in time or location, from the programs or activities
supported by CDBG Funds and participation must be voluntary for clients of a CDBG-funded
service.
14.5.3 Required Notices.
If Agency constitutes a Faith-based organization under 24 CFR Part 5.109, Agency must
provide all clients of a CDBG-funded service with the notice attached as EXHIBIT "K"—
Notice of Beneficiary Rights. Such notice shall be provided to the client prior to enrollment in
any CDBG-funded program or activity. In addition, if a client or prospective client of a CDBG-
funded service objects to the religious character of Agency, then Agency must promptly
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undertake reasonable efforts to identify and refer the client or prospective client to an alternate
provider to which the client or prospective client has no such objection, as more particularly
described in 24 CFR Part 5.109.
14.6 Venue.
Venue shall lie in Tarrant County, Texas for any action, whether real or asserted, at law
or in equity, arising out of the execution, performance, attempted performance or
non-performance of this Contract.
14.7 Governing Law.
This Contract shall be governed by and construed in accordance with the laws of the
State of Texas. If any action, whether real or asserted, at law or in equity, arises out of the
execution, performance or non-performance of this Contract or on the basis of any provision
herein, for any issue not governed by federal law, the choice of law shall be the laws of the State
of Texas.
14.8 Severability.
The provisions of this Contract are severable, and if for any reason a clause, sentence,
paragraph or other part of this Contract shall be determined to be invalid by a court or federal or
state agency, board or commission having jurisdiction over the subject matter thereof, such
invalidity shall not affect other provisions which can be given effect without the invalid
provision.
14.9 Written Agreement Entire Contract.
This written instrument and the Exhibits, Attachments, and Addendums attached hereto,
which are incorporated by reference and made a part of this Contract for all purposes, constitute
the entire agreement by the Parties concerning the work and services to be performed under this
Contract. Any prior or contemporaneous oral or written agreement which purports to vary the
terms of this Contract shall be void. Any amendments to the terms of this Contract must be in
writing and executed by the Parties.
14.10 Paragraph Headings for Reference Only, No Legal Significance; Number
and Gender.
The paragraph headings contained herein are for convenience in reference to this
Contract and are not intended to define or to limit the scope of any provision of this Contract.
When context requires, singular nouns and pronouns include the plural and the masculine gender
shall be deemed to include the feminine or neuter and the neuter gender to include the masculine
and feminine. The words "include" and"including"whenever used herein shall be deemed to be
followed by the words "without limitation".
14.11 Compliance With All Applicable Laws and Regulations.
Agency agrees to comply fully with all applicable laws and regulations that are currently
in effect or that are hereafter amended during the performance of this Contract. Those laws
include, but are not limited to:
➢ CDBG Regulations found in 24 CFR Part 570
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➢ Title I of the Housing and Community Development Act of 1974, as amended, (42
USC 5301)
➢ Title VI of the Civil Rights Act of 1964 (42 U.S.C. Sections 2000d et seq.) including
provisions requiring recipients of federal assistance to ensure meaningful access by
persons of limited English proficiency
➢ The Fair Housing Act, Title VIII of the Civil Rights Act of 1968 (42 U.S.C. Sections
3601 et seq.)
➢ Executive Orders 11063, 11246 as amended by 11375 and 12086 and as
supplemented by Department of Labor regulations 41 CFR Part 60
➢ The Age Discrimination in Employment Act of 1967
➢ The Age Discrimination Act of 1975 (42 U.S.C. Sections 6101 et seq.)
➢ The Uniform Relocation Assistance and Real Property Acquisition Policies Act of
1970 (42 U.S.C. Sections 4601 et seq. and 49 CFR Part 24) ("URA")
➢ Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. Sections 794 et seq.) and 24
CFR Part 8 where applicable
➢ National Environmental Policy Act of 1969, as amended, 42 U.S.C. Sections 4321 et
seq. ("NEPA") and the related authorities listed in 24 CFR Part 58.
➢ The Clean Air Act, as amended, (42 U.S.C. Sections 1251 et seq.) and the Clean
Water Act of 1977, as amended (33 U.S.C. Sections 1251 et seq.) and the related
Executive Order 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.
➢ Immigration Reform and Control Act of 1986 (8 U.S.C. Sections I101 et seq.)
specifically including the provisions requiring employer verifications of legal status
of its employees
➢ The Americans with Disabilities Act of 1990 (42 U.S.C. Sections 12101 et seq.), the
Architectural Barriers Act of 1968 as amended (42 U.S.C. Sections 4151 et seq.) and
the Uniform Federal Accessibility Standards, 24 CFR Part 40, Appendix A
➢ Regulations at 24 CFR Part 87 related to lobbying, including the requirement that
certifications and disclosures be obtained from all covered persons
➢ Drug Free Workplace Act of 1988 (41 U.S.C. Sections 701 et seq.) and 24 CFR Part
23, Subpart F
➢ Executive Order 12549 and 24 CFR Part 5.105(c) pertaining to restrictions on
participation by ineligible, debarred or suspended persons or entities
➢ Section 6002 of the Solid Waste Disposal Act, as amended by the Resource
Conservation and Recovery Act
➢ Guidelines of the Environmental Protection Agency at 40 CFR Part 247
➢ For contracts and subgrants for construction or repair, Copeland "Anti-Kickback" act
(18 U.S.C. 874) as supplemented in 29 CFR Part 5
➢ For construction contracts awarded by Agency in excess of$2,000, and in excess of
$2,500 for other contracts which involve the employment of mechanics or laborers,
Sections 103 and 107 of the Contract Work Hours and Safety Standards Act (40
U.S.C. 327A 300) as supplemented by 29 CFR Part 5
➢ Lead-Based Paint Poisoning Prevention Act (42 U.S.C. 4801 et seq.), as amended by
the Residential Lead-Based Paint Hazard Reduction Act of 1992 (42 U.S.C. 4851 et
seq.) and implementing regulations at 24 CFR Part 35, subparts A, B, M, and R
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➢ Uniform Administrative Requirements, Cost Principles, and Audit Requirements for
Federal Awards, 2 CFR Part 200 et seq.
➢ Federal Funding Accountability and Transparency Act of 2006 ("FFATA") (Pub.L.
109-282, as amended by Section 6205(a) of Pub.L. 110-252 and Section 3 of Pub.L.
113-101)
➢ Federal Whistleblower Regulations, as contained in 10 U.S.C. 2409, 41 U.S.C. 4712,
10 U.S.C. 2324,41 U.S.C. 4304 and 41 U.S.C. 4310.
Seetion
14.13 Prohibition Against Discrimination.
14.13.1 General Statement.
Agency shall comply in the execution, performance or attempted performance of this
Contract, with all non-discrimination requirements of 24 CFR Part 570.607 and Chapter 17,
Article III, Division 4 — Fair Housing of the City Code. Agency may not discriminate against
any person because of race, color, sex, gender, religion, national origin, familial status, disability
or perceived disability, sexual orientation, gender identity, gender expression, or transgender, nor
will Agency permit its officers, members, agents, employees, or clients to engage in such
discrimination.
This Contract is made and entered into with reference specifically to Chapter 17, Article
III, Division 3 - Employment Practices of the City Code, and Agency hereby covenants and
agrees that Agency, its officers, members, agents, employees and contractors, have fully
complied with all provisions of same and that no employee, or applicant for employment has
been discriminated against under the terms of such ordinances by either or its officers, members,
agents, employees or contractors.
14.13.2 No Discrimination in Employment during the Performance of This
Contract.
During the performance of this Contract Agency agrees to the following provision, and
will require that its contractors and subcontractors also comply with such provision by including
it in all contracts with its contractors:
[Contractor's, Subcontractor's or Vendor's name] will not unlawfully discriminate
against any employee or applicants for employment because of race, color, sex, gender, religion,
national origin, familial status, disability or perceived disability, sexual orientation, gender
identity, gender expression or transgender. [Contractor's, Subcontractor's or Vendor's name]
will take affirmative action to ensure that applicants are hired without regard to race, color, sex,
gender, religion, national origin, familial status, disability or perceived disability, sexual
orientation, gender identity, gender expression or transgender and that employees are treated
fairly during employment without regard to their race, color, sex, gender, religion, national
origin, familial status, disability or perceived disability, sexual orientation, gender identity,
gender expression or transgender. Such action shall include, but not be limited to, the following:
employment, upgrading, demotion or transfer, recruitment or recruitment advertising, layoff or
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termination, rates of pay or other forms of compensation, and selection for training, including
apprenticeship. [Contractor's, Subcontractor's or Vendor's name] agrees to post in conspicuous
places, available to employees and applicants for employment, notices setting forth the
provisions of this nondiscrimination clause.
[Contractor's, Subcontractor's or Vendor's name] will, in all solicitations or
advertisements for employees placed by or on behalf of [Contractor's, Subcontractor's or
Vendor's name], state that all qualified applicants will receive consideration for employment
without regard to race, color, sex, gender, religion, national origin, familial status, disability or
perceived disability, sexual orientation, gender identity, gender expression or transgender.
[Contractor's, Subcontractor's or Vendor's name l covenants that neither it nor any of its
officers, members, agents, employees, or contractors, while engaged in performing this Contract,
shall, in connection with the employment, advancement or discharge of employees or in
connection with the terms, conditions or privileges of their employment, discriminate against
persons because of their age or because of any disability or perceived disability, except on the
basis of a bona fide occupational qualification, retirement plan or statutory requirement.
[Contractor's, Subcontractor's or Vendor's name l further covenants that neither it nor its
officers, members, agents, employees, contractors, or persons acting on their behalf, shall
specify, in solicitations or advertisements for employees to work on this Contract, a maximum
age limit for such employment unless the specified maximum age limit is based upon a bona fide
occupational qualification, retirement plan or statutory requirement.
14.13.3 Agency's Contractors and the ADA.
In accordance with the provisions of the Americans With Disabilities Act of 1990
("ADA"), Agency warrants that it and any of its contractors will not unlawfully discriminate on
the basis of disability in the provision of services to the general public, nor in the availability,
terms and/or conditions of employment for applicants for employment with, or employees of,
Agency or any of its contractors. AGENCY WARRANTS IT WILL FULLY COMPLY
WITH THE ADA'S PROVISIONS AND ANY OTHER APPLICABLE FEDERAL,
STATE AND LOCAL LAWS CONCERNING DISABILITY AND WILL DEFEND,
INDEMNIFY AND HOLD CITY HARMLESS AGAINST ANY CLAIMS OR
ALLEGATIONS ASSERTED BY THIRD PARTIES, CONTRACTORS
SUBCONTRACTORS, VENDORS OR AGENTS AGAINST CITY ARISING OUT OF
AGENCY'S AND/OR ITS CONTRACTORS', SUBCONTRACTORS', VENDORS' OR
AGENTS' OR THEIR RESPECTIVE EMPLOYEES' ALLEGED FAILURE TO
COMPLY WITH THE ABOVE-REFERENCED LAWS CONCERNING DISABILITY
DISCRIMINATION IN THE PERFORMANCE OF THIS CONTRACT.
14.14. Conflicts of Interest and Violations of Criminal Law.
14.14.1 Agency Safeguards.
Agency shall establish safeguards to prohibit its employees, board members, advisors and
agents from using positions for a purpose that is or gives the appearance of being motivated by a
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desire for private gain for themselves or others, particularly those with whom they have family,
business or other ties. Agency shall disclose to City any such conflict of interest or potential
conflict of interest, immediately upon discovery of such.
14.14.2 General Prohibitions Against Conflicts of Interest.
No employees, agents, consultants, officers or elected officials or appointed officials of
City or of Agency who exercise or have exercised any functions or responsibilities with respect
to activities assisted with CDBG funds or who are in a position to participate in a decision-
making process or gain inside information with regard to these activities may utilize CDBG
services, may obtain a financial interest or benefit from a CDBG-assisted activity, or have an
interest in any contract, subcontract or agreement with respect thereto, or the proceeds
thereunder, either for themselves or those with whom they have family or business ties, during
their tenure or for 1 year thereafter.
14.14.2.1 Agency shall establish conflict of interest policies for federal
awards including the CDBG Funds and shall disclose in writing
potential conflicts of interest to City as authorized by 2 CFR Part
200.112.
14.14. 3 Conflicts of Interest Involving Procurement.
The conflict of interest provisions of 2 CFR Part 200.31 shall apply in the procurement of
property and services by Agency. In all cases not governed by this Section, the provisions of 24
CFR Part 570.611 of the CDBG Regulations shall apply.
14.14.3.1 As more particularly described in 2 CFR Part 200.318, Agency
shall maintain and submit to City written standards of conduct
covering conflicts of interest and governing the performance of its
employees engaged in the selection, award, and administration of
contracts. No employee, officer, or agent may participate in the
selection, award, or administration of a contract supported by a
federal award if he or she has a real or apparent conflict of interest.
The standards of conduct must provide for disciplinary actions to
be applied for violations of such standards by officers, employees,
or agents of Agency.
14.14.3.2 The officers, employees, and agents of Agency shall neither solicit
nor accept gratuities, favors, or anything of monetary value from
contractors or parties to subcontracts.
14.14.3.3 Notwithstanding the prohibition contained in Section 14.13.3.2,
Agency may set standards of conduct for situations in which the
financial interest is not substantial or the gift is an unsolicited item
of nominal value. Such standards of conduct must provide for
disciplinary actions to be applied for violations of such standards
by Agency's officers, employees or agents.
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14.14.3.4 Agency shall maintain written standards of conduct covering
organizational conflicts of interest. Organizational conflicts of
interest means that because of relationships with a parent company,
affiliate, or subsidiary organization, Agency is unable or appears to
be unable to be impartial in conducting a procurement action
involving a related organization.
14.14.3.5 Agency must maintain records sufficient to detail the history of
procurement. These records will include, but are not necessarily
limited to the following: rationale for the method of procurement,
selection of contract type, contractor selection or rejection, and the
basis for the contract price.
14.14.4 Disclosure of Conflicts of Interest.
In compliance with 2 CFR Part 200.112, Agency is required to timely disclose to City in
writing any potential conflict of interest.
14.14.5 Disclosure of Texas Penal Code Violations.
Agency affirms that it will adhere to the provisions of the Texas Penal Code which
prohibit bribery and gifts to public servants.
14.14.6 Disclosure of Federal Criminal Law Violations.
In compliance with 2 CFR Part 200.113, Agency is required to timely disclose to City all
violations of federal criminal law involving fraud, bribery or gratuity violations potentially
affecting the Agency.
14.15 Subcontracting with Small and Minority Firms, Women's Business
Enterprises and Labor Surplus Areas.
14.15.1 For procurement contracts $50,000.00 or larger that are paid for, in part or in
full, with the CDBG Funds, Agency agrees to abide by City's policy to involve Minority
Business Enterprises and Small Business Enterprises and to provide them equal opportunity to
compete for contracts for construction, provision of professional services, purchase of equipment
and supplies and provision of other services required by City. Agency agrees to incorporate the
City's BDE Ordinance, and all amendments or successor policies or ordinances thereto, into all
contracts and subcontracts for procurement larger than $50,000.00 or larger that are paid for, in
part or in full, with the CDBG Funds and will further require all persons or entities with which it
so contracts to comply with said ordinance.
14.15.2 It is national policy to award a fair share of contracts to disadvantaged
business enterprises ("DBEs"), small business enterprises ("SBEs"), minority business
enterprises ("MBEs"), and women's business enterprises ("WBEs"). Accordingly, affirmative
steps must be taken to assure that DBEs, SBEs, MBEs, and WBEs are utilized when possible as
sources of supplies, equipment, construction and services.
14.15.2.1 In order to comply with federal reporting requirements in 24 CFR
CDBG PRESUMED BENEFIT PSA CONTRACT 2019-2020 Page 24
The Salvation Army,A Georgia Corporation Rev. May 18,2020
Part 570.506 (g)(6), Agency must submit the form attached hereto
as EXHIBIT "I" — MBE Reporting Form for each contract or
subcontract with a value of$10,000.00 or more paid or to be paid
with the CDBG Funds. Agency shall submit this form by the date
specified in EXHIBIT "I"—MBE Reporting Form.
14.16 Other Laws.
The failure to list any federal, state or City ordinance, law or regulation that is applicable
to Agency does not excuse or relieve Agency from the requirements or responsibilities in regard
to following the law, nor from the consequences or penalties for Agency's failure to follow the
law, if applicable.
14.17 Assignment.
Agency shall not assign all or any part of its rights, privileges, or duties under this
Contract without the prior written approval of City. Any attempted assignment of same without
approval shall be void, and shall constitute a breach of this Contract.
14.18. Right to Inspect Agency Contracts.
It is agreed that City has the right to inspect and approve in writing any proposed
contracts between Agency and any contractor or vendor engaged in any activity in conjunction
with this CDBG-funded Program prior to any charges being incurred.
14.19 Force Majeure
If Agency becomes unable, either in whole or part, to fulfill its obligations under this
Contract due to acts of God, strikes, lockouts, or other industrial disturbances, acts of public
enemies, wars, blockades, insurrections, riots, epidemics, earthquakes, fires, floods, restraints or
prohibitions by any court, board, department, commission or agency of the United States or of
any States, civil disturbances, or explosions, or some other reason beyond Agency's control
(collectively, "Force Majeure Event"), the obligations so affected by such Force Majeure Event
will be suspended only during the continuance of such event. Agency will give City written
notice of the existence, extent and nature of the Force Majeure Event as soon as reasonably
possible after the occurrence of the event. Failure to give notice will result in the continuance of
Agency's obligation regardless of the extent of any existing Force Majeure Event. Agency will
use commercially reasonable efforts to remedy its inability to perform as soon as possible.
14.20 IMMIGRATION NATIONALITY ACT.
City actively supports the Immigration & Nationality Act (INA) which includes
provisions addressing employment eligibility, employment verification, and nondiscrimination.
Agency shall verify the identity and employment eligibility of all employees who perform work
under this Agreement. Agency shall complete the Employment Eligibility Verification Form (I-
9), maintain photocopies of all supporting employment eligibility and identity documentation for
all employees, and upon request, provide City with copies of all 1-9 forms and supporting
eligibility documentation for each employee who performs work under this Agreement. Agency
shall establish appropriate procedures and controls so that no services will be performed by any
employee who is not legally eligible to perform such services. Agency shall provide City with a
certification letter that it has complied with the verification requirements required by this
CDBG PRESUMED BENEFIT PSA CONTRACT 2019-2020 Page 25
The Salvation Army,A Georgia Corporation Rev. May 18,2020
Agreement. Agency shall indemnify City from any penalties or liabilities due to violations of this
provision. City shall have the right to immediately terminate this Agreement for violations of this
provision by Agency.
15. INDEMNIFICATION AND RELEASE.
AGENCY COVENANTS AND AGREES TO INDEMNIFY, HOLD HARMLESS
AND DEFEND, AT ITS OWN EXPENSE, CITY AND ITS OFFICERS, AGENTS,
SERVANTS AND EMPLOYEES FROM AND AGAINST ANY AND ALL CLAIMS OR
SUITS FOR PROPERTY LOSS OR DAMAGE AND/OR PERSONAL INJURY,
INCLUDING DEATH, TO ANY AND ALL PERSONS, OF WHATSOEVER HIND OR
CHARACTER, WHETHER REAL OR ASSERTED, ARISING OUT OF OR IN
CONNECTION WITH THE EXECUTION, PERFORMANCE, ATTEMPTED
PERFORMANCE OR NONPERFORMANCE OF THIS CONTRACT AND/OR THE
OPERATIONS, ACTIVITIES AND SERVICES OF THE PROGRAM DESCRIBED
HEREIN, WHETHER OR NOT CAUSED IN WHOLE OR IN PART, BY ALLEGED
NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES,
CONTRACTORS OR SUBCONTRACTORS OF CITY; AND AGENCY HEREBY
ASSUMES ALL LIABILITY AND RESPONSIBILITY OF CITY AND ITS OFFICERS,
AGENTS, SERVANTS, AND EMPLOYEES FOR ANY AND ALL CLAIMS OR SUITS
FOR PROPERTY LOSS OR DAMAGE AND/OR PERSONAL INJURY, INCLUDING
DEATH, TO ANY AND ALL PERSONS, OF WHATSOEVER KINDS OR
CHARACTER, WHETHER REAL OR ASSERTED, ARISING OUT OF OR IN
CONNECTION WITH THE EXECUTION, PERFORMANCE, ATTEMPTED
PERFORMANCE OR NONPERFORMANCE OF THIS CONTRACT AND/OR THE
OPERATIONS, ACTIVITIES AND SERVICES OF THE PROGRAM DESCRIBED
HEREIN, WHETHER OR NOT CAUSED IN WHOLE OR IN PART BY ALLEGED
NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES,
CONTRACTORS OR SUBCONTRACTORS OF CITY. AGENCY LIKEWISE
COVENANTS AND AGREES TO AND DOES HEREBY INDEMNIFY AND HOLD
HARMLESS CITY FROM AND AGAINST ANY AND ALL INJURY, DAMAGE OR
DESTRUCTION OF PROPERTY OF CITY, ARISING OUT OF OR IN CONNECTION
WITH ALL ACTS OR OMISSIONS OF AGENCY, ITS OFFICERS, MEMBERS,
AGENTS, EMPLOYEES, CONTRACTORS, SUBCONTRACTORS, INVITEES,
LICENSEES, OR CLIENTS, OR CAUSED, IN WHOLE OR IN PART, BY ALLEGED
NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES,
CONTRACTORS OR SUBCONTRACTORS OF CITY.
IT IS THE EXPRESS INTENTION OF THE PARTIES, BOTH AGENCY AND
CITY, THAT THE INDEMNITY PROVIDED FOR THIS SECTION INCLUDES
INDEMNITY BY AGENCY TO INDEMNIFY AND PROTECT CITY FROM THE
CONSEQUENCES OF CITY'S OWN NEGLIGENCE, WHETHER THAT
NEGLIGENCE IS ALLEGED TO BE THE SOLE OR CONCURRING CAUSE OF THE
INJURY, DAMAGE OR DEATH.
AGENCY AGREES TO AND SHALL RELEASE CITY, ITS AGENTS,
CDBG PRESUMED BENEFIT PSA CONTRACT 2019-2020 Page 26
The Salvation Army,A Georgia Corporation Rev. May 18,2020
EMPLOYEES, OFFICERS AND LEGAL REPRESENTATIVES FROM ALL
LIABILITY FOR INJURY, DEATH, DAMAGE OR LOSS TO PERSONS OR
PROPERTY SUSTAINED IN CONNECTION WITH OR INCIDENTAL TO
PERFORMANCE UNDER THIS CONTRACT, EVEN IF THE INJURY, DEATH,
DAMAGE OR LOSS IS CAUSED BY CITY'S SOLE OR CONCURRENT
NEGLIGENCE.
AGENCY SHALL REQUIRE ALL OF ITS CONTRACTORS AND
SUBCONTRACTORS TO INCLUDE IN THEIR CONTRACTS AND SUBCONTRACTS
A RELEASE AND INDEMNITY IN FAVOR OF CITY IN SUBSTANTIALLY THE
SAME FORM AS ABOVE.
16. WAIVER OF IMMUNITY BY AGENCY.
If Agency, as a charitable or nonprofit organization, has or claims an immunity or
exemption (statutory or otherwise) from and against liability for damages or injury, including
death, to persons or property, Agency hereby expressly waives its rights to plead defensively
such immunity or exemption as against City. This Section shall not be construed to affect a
governmental entity's immunities under constitutional, statutory or common law.
17. INSURANCE AND BONDING.
Agency will maintain coverage in the form of insurance or bond in the amount of
$18,000.00 to insure against loss from the fraud, theft or dishonesty of any of Agency's officers,
agents, trustees, directors or employees. The proceeds of such insurance or bond shall be used to
reimburse City for any and all loss of CDBG Funds occasioned by such misconduct. To
effectuate such reimbursement, such fidelity coverage shall include a rider stating that
reimbursement for any loss or losses shall name the City as a Loss Payee.
Agency shall furnish to City in a timely manner, but not later than the Effective Date,
certificates of insurance as proof that it has secured and paid for policies of commercial
insurance as specified herein. If City has not received such certificates by the Effective Date,
Agency shall be in default of the Contract and City may, at its option, terminate the Contract.
Such insurance shall cover all insurable risks incident to or in connection with the
execution, performance, attempted performance or nonperformance of this Contract. Agency
shall maintain the following insurance coverage and limits:
Commercial General Liability(tom) Insurance
$ 500,000 each occurrence
$1,000,000 aggregate limit
Non-Profit Organization Liability or Directors & Officers Liability
$1,000,000 Each Occurrence
$1,000,000 Annual Aggregate Limit
Business Automobile Liability Insurance
$1,000,000 each accident on a combined single-limit basis, or
CDBG PRESUMED BENEFIT PSA CONTRACT 2019-2020 Page 27
The Salvation Army,A Georgia Corporation Rev. May 18,2020
$ 250,000 Property Damage
$ 500,000 Bodily Injury per person per occurrence
$2,000,000 Aggregate
Insurance policy shall be endorsed to cover"Any Auto", defined as autos owned,hired,
and non-owned. Pending availability of the above coverage and at the discretion of
City, the policy shall be the primary responding insurance policy versus a personal
auto insurance policy if or when in the course of Agency's business as contracted
herein.
Workers' Compensation Insurance
Part A: Statutory Limits
Part B: Employer's Liability
$100,000 each accident
$100,000 disease-each employee
$500,000 disease-policy limit
Note: Such insurance shall cover employees performing work on any and all projects
including but not limited to construction, demolition, and rehabilitation. Agency or its
contractors shall maintain coverages, if applicable. In the event the respective contractors
do not maintain coverage, Agency shall maintain the coverage on such contractor, if
applicable, for each applicable contract.
Additional Requirements
Such insurance amounts shall be revised upward at City's reasonable option and no more
frequently than once every 12 months, and Agency shall revise such amounts within 30 days
following notice to Contractor of such requirements.
Agency will submit to City documentation that it has obtained insurance coverage and has
executed bonds as required in this Contract prior to payment of any monies provided hereunder.
Where applicable, insurance policies required herein shall be endorsed to include City as an
additional insured as its interest may appear. Additional insured parties shall include employees,
officers, agents, and volunteers of City.
Any failure on part of City to request certificate(s) of insurance shall not be construed as a
waiver of such requirement or as a waiver of the insurance requirements themselves.
Insurers of Agency's insurance policies shall be licensed to do business in the state of Texas by
the Department of Insurance or be otherwise eligible and authorized to do business in the state of
Texas. Insurers shall be acceptable to City insofar as their financial strength and solvency and
each such company shall have a current minimum A.M. Best Key Rating Guide rating of A-: VII
or other equivalent insurance industry standard rating otherwise approved by City.
CDBG PRESUMED BENEFIT PSA CONTRACT 2019-2020 Page 28
The Salvation Army,A Georgia Corporation Rev. May 18,2020
Deductible limits on insurance policies shall not exceed $5,000 per occurrence unless otherwise
approved by City.
In the event there are any local, federal or other regulatory insurance or bonding requirements for
the Program, and such requirements exceed those specified herein, the former shall prevail.
Agency shall require its contractors to maintain applicable insurance coverages, limits, and other
requirements as those specified herein; and Agency shall require its contractors to provide
Agency with certificate(s) of insurance documenting such coverage. Also, Agency shall require
its contractors to have City and Agency endorsed as additional insureds (as their interest may
appear) on their respective insurance policies.
Directors and Officers Liability coverage shall be in force and may be provided on a claims-
made basis. This coverage may also be referred to as Management Liability, and shall protect
the insured against claims arising out of alleged errors in judgment, breaches of duty and
wrongful acts arising out of their organizational duties. Coverage shall protect not only the
entity, but all past, present and future directors, officers, trustees, employees, volunteers and
committee members.
Notwithstanding any provision in this Contract to the contrary, when applicable, Agency
shall comply with the requirements of 2 CFR 200.310 and shall, at a minimum, provide the
equivalent insurance coverage for real property and equipment acquired or improved with
CDBG Funds as provided to property owned by Agency.
18. CERTIFICATION REGARDING LOBBYING.
The undersigned representative of Agency hereby certifies, to the best of his or her
knowledge and belief, that:
No federal appropriated funds have been paid or will be paid, by or on behalf of Agency,
to any person for influencing or attempting to influence an officer or employee of any
agency, a member of Congress, an officer or employee of Congress in connection with
the awarding of any federal contract, the making of any federal grant, the 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.
If any funds other than federally appropriated funds have been paid or will be paid to any
person for influencing or attempting to influence an officer or employee of any agency,
member of Congress in connection with this federal contract, grant, loan or cooperative
agreement, Agency shall complete and submit Standard Form-LLL, "Disclosure Form to
Report Lobbying," in accordance with its instructions.
This certification is a material representation of fact upon which reliance was placed
when this Contract was made or entered into. Submission of this certificate is a
prerequisite for making or entering into this Contract imposed by 31 U.S.C. Section
CDBG PRESUMED BENEFIT PSA CONTRACT 2019-2020 Page 29
The Salvation Army,A Georgia Corporation Rev. May 18,2020
1352. Any person who fails to file the required certification shall be subject to a civil
penalty of not less than $10,000.00 and not more than $100,000.00 for each such failure.
Agency shall require that the language of this certification be included in all subcontracts
or agreements involving the expenditure of federal funds.
19. LITIGATION AND CLAIMS.
Agency shall give City immediate notice in writing of any action, including any
proceeding before an administrative agency, filed against Agency in conjunction with this
Contract or the Program. Agency shall furnish immediately to City copies of all pertinent papers
received by Agency with respect to such action or claim. Agency shall provide a notice to City
within 10 days upon filing under any bankruptcy or financial insolvency provision of law.
20. NOTICE.
All notices required or permitted by this Contract must be in writing and are deemed
delivered on the earlier date of the date actually received or the third day following deposit in a
United States Postal Service post office or receptacle; with proper postage, certified mail return
receipt requested; and addressed to the other Party at the address set out below or at such other
address as the receiving Party designates by proper notice to the sending Party.
City:
City Attorney's Office
200 Texas Street
Fort Worth, TX 76102
Telephone: 817-3 92-7600
Copy to:
Neighborhood Services Department
200 Texas Street
Fort Worth, TX 76102
Attention: Compliance and Planning Mgr,
Telephone: 817-392-7331
Copy to:
Neighborhood Services Department
200 Texas Street
Fort Worth, TX 76102
Attention: Contract Compliance Specialist
Telephone: 817-392-8550
Agency:
The Salvation Army, A Georgia Corporation
Ronnie Raymer
1855 East Lancaster
CDBG PRESUMED BENEFIT PSA CONTRACT 2019-2020 Page 30
The Salvation Army,A Georgia Corporation Rev. May 18,2020
Fort Worth, TX 76103
Telephone: 817-344-1831
21. AGENCY HAS LEGAL AUTHORITY TO ENTER INTO CONTRACT.
Agency represents that it possesses the legal authority, pursuant to any proper,
appropriate and official motion, resolution or action passed or taken, to enter into this Contract
and to perform the responsibilities herein required.
22. COUNTERPARTS.
This Contract may be executed in multiple counterparts, each of which shall be
considered an original, but all of which shall constitute one instrument which may be sufficiently
evidenced by one counterpart.
23. PROGRAM INCOME
Parties agree that no program income as defined by HUD shall be earned as a result of
this contract.
[SIGNATURES APPEAR ON NEXT PAGE]
CDBG PRESUMED BENEFIT PSA CONTRACT 2019-2020 Page 31
The Salvation Army,A Georgia Corporation Rev. May 18,2020
Or j}...
..........
•.�
IN WITNESS WHEREOF, the Parties hereto have executed 1 original of this Contract
rt Worth,Tan-ant County,Texas.
U`
`. EST: CITY OF FORT WORTH
�Nlr1�
By:Fernando Costa(Jun 2,202009:12CDT)
City Secretary Fernando Costa, Assistant City Manager
M&C: -20-0328
1295 Certification No. 2020-591214
Date: May 19,2020
APPROVED AS TO FORM AND LEGALITY:
� 2
Tay aris(Jun 2,2020 09:05 CDT)
Taylor C.Paris,Assistant City Attorney
Ordinance No. 24161-04-2020
CONTRACT COMPLIANCE MANAGER:
By signing, I acknowledge that I am the person responsible
for the monitoring and administration of this contract, including
ensuring all performance and reporting requirements
BarbaraBarbara&s 2=
Barbara Asbury(Jun 1,2020 16:45 CDT)
Barbara Asbury,Compliance and Planning Manager
THE SALVATION ARMY, A GEORGIA CORPORATION
By:
Ronnie Raymer, etas Divisional Commander
CDBG PRESUMED BENEFIT PSA CONTRACT 2019-2020 �.-_--
The Salvation Army,A Georgia Corporation Rev. May 18,2020 OFFICIAL RECORD
CITY SECRETARY
FT. WORTH,TX
EXHIBITS:
EXHIBIT "A"—Program Summary
EXHIBIT "A-1"—2019 HUD Income Limits
EXHIBIT "A-2"—Reporting Requirements for Countywide Agencies
EXHIBIT "B"—Budget
EXHIBIT "C"—Audit Certification For
EXHIBIT "D"—Reimbursement Forms
EXHIBIT "E"—Form of Income Self-Certification
EXHIBIT "F"—Standards for Complete Documentation
EXHIBIT "G"—Section 3 Reporting Forms (NOT APPLICABLE)
EXHIBIT "H"—Severely Disabled Certification Form
EXHIBIT "I"—MBE Reporting Form
EXHIBIT "J"—Duties of the Parties for Use of NSD Community Centers
EXHIBIT "K"—Notice of Beneficiary Rights
CDBG PRESUMED BENEFIT PSA CONTRACT 2019-2020 Page 33
The Salvation Army,A Georgia Corporation Rev. May 18,2020
THE SALVATION ARMY, A GEORGIA EXHIBIT "A"
CORPORATION
Fort Worth Mabee Center—Emergency Shelter PROGRAM SUMMARY
Case Manager Position Only
PROGRAM SUMMARY
(ESG)
May 19, 2020 to September 30, 2020 $18,000.00
PERIOD AMOUNT
Capitalized terms not defined herein shall have meanings assigned them in the Contract.
PROGRAM:
The Program provides an Emergency Shelter component:
CDBG Funds will be used to pay for the salary and FICA of a Case Manager position in the
Program, to provide case management and referrals.
Agency's office is located at 1855 E. Lancaster, Fort Worth, TX 76103. Case Management
services will be provided Monday through Friday, 9:00 a.m. to 5:00 p.m., with evening or
weekend appointments scheduled as needed to accommodate client's schedule. Life skills and
financial education classes times vary and are held Monday through Friday.
REGULATORY CLASSIFICATION:
Service Category (if more than one category, specify amount for each):
• Emergency Shelter Component:
Regulatory Citation Emergency Shelter: 24 CFR 576.103
PROGRAM GOALS (Not Applicable):
Emergency Shelter Minimum Number of Fort Worth Clients to be Served: The Program
must serve a minimum of 75 Unduplicated Clients from Fort Worth as shown by the monthly
reports on Attachment III.
CDBG PSA CONTRACT 2019-2020—EXHIBIT"A"—PROGRAM SUMMARY Page I
The Salvation Army,a Georgia Corporation
EXHIBIT 91A-1"
2019 HUD INCOME LIMITS
2019 Median Family Income - Fort Worth/Arlington, TX*
1 Person 2 Persons 3 Persons 4 Persons 5 Persons 6 Persons 7 Persons 8 Persons
30%AMI $16,000 $18,250 $20,550 $22,800 $24,650 $26,450 $28,300 $30,100
50% AMI $26,600 $30,400 $34,200 $38,000 $41,050 $44,100 $47,150 $50,200
60% AMI $31920 $36480 $41040 $45600 $49260 $52920 $56580 $60240
80% AMI $42,600 $48,650 $54,750 $60,800 $65,700 $70,550 $75,400 $80,300
*Income limits are published at least annually by HUD.
CDBG PSA CONTRACT 2019-2020—2019 HUD INCOME LIMITS Page 1
The Salvation Army,A Georgia Corporation
EXHIBIT 46A-2"
REPORTING REQUIREMENTS FOR COUNTYWIDE AGENCIES
CDBG PB PSA CONTRACT 2019-2020
REPORTING REQUIREMENTS FOR COUNTYWIDE AGENCIES Page 1
The Salvation Army, A Georgia Corporation
THE SALVATION ARMY, A GEORGIA CORPORATION
REPORTING REQUIREMENTS FOR COUNTYWIDE AGENCIES
Quarterly Report
The purpose of the Quarterly Report is for the Countywide Agencies to report the number of non-Fort
Worth clients who participate in the Program. The Quarterly Report must be submitted with the
December, March, June and September Reimbursement Requests. The submission of the Quarterly
Report is through ZoomGrants. The information provided in the Quarterly Report will be reviewed
and monitored by the Neighborhood Services Department Compliance Division.
TOTALOF •
#OF FORT #OF NON-FORT CLIENTS FORT WORTH
DUE DATE REPORTING RANGE WORTH WORTH SERVED BY CLIENTS
CLIENTS CLIENTS THEPROGRAM
A B C D E F
EXAMPLE: 250 200 450 250=450=55%
January 15,2020 October 1, 2019—
December 31,2019
April 15, 2020 January 1,2020—
March 30,2020
July 15, 2020 April 1,2020—
June 30,2020
October 1,2020 July 1,2020—
Se tember 30, 2020
TOTAL
I, Agency representative, certify that I verified the information I reported this quarter and it is correct
to the best of my knowledge.
Certified by: Date:
Signature/Title:
CDBG PSA CONTRACT 2019-2020
REPORTING REQUIREMENTS FOR COUNTYWIDE AGENCIES Page 1
The Salvation Army, A Georgia Corporation
EXHIBIT"B"-BUDGET
Account I Grant Budget Total
EMERGENCY SHELTER
ESSENTIAL SERVICES
Salaries 1001 $ 17,000.00 $ 17,000.00
FICA 1002 $ 1,000.00 $ 1,000.00
Life/Disability Insurance 1003 $ -
Health/Dental Insurance 1004 $
Unemployment-State 1005
Worker's Compensation 1006 $
Office/Printing Supplies 1007 $
Food Supplies 1008
Insurance 1009 $
Accounting 1010 $
Contract Labor Security(City needs copy of
contract before expenses can be reimbursed) 1011 $
Retirement 1012 $
SHELTER OPERATIONS
Maintenance 2001 $
Security 2002 $
Insurance 2003 $
Utilities 2004 $
Supplies 2005 $ -
Repairs 2006
Other() 2007
SUBTOTAL EMERGENCY SHELTER $ 18,000.00 $ 18,000.00
HOUSING RELOCATION AND STABILIZATION
PREVENTION
Salaries 3001 $ -
FICA 3002 $
Life/Disability Insurance 3003 $
Health/Dental Insurance 3004 $
Unemployment-State 3005
Worker's Compensation 3006
Other() 3007
REHOUSING
Salaries 4001 $
FICA 4002
Life/Disability Insurance 4003
Health/Dental Insurance 4004 $
Unemployment-State 4005
Worker's Compensation 4006
Other Q 4007
SUBTOTAL HR&S $ - $
FINANCIAL ASSISTANCE
PREVENTION
Rental Assistance 5001 $
Utility Payments 5002
REHOUSING
Rental Assistance 6001 $
Security Deposits 6002 $
Utility Deposits 6003
Utility Payments 6004
Moving Costs 6005
Motel/Hotel Vouchers 6006
SUBTOTAL FINANCIAL ASSISTANCE I $ -
HOMELESS MANAGEMENT INFORMATION SYSTEM(HM1S)
HMIS Software Costs 7001
SUBTOTAL HMIS
BUDGET TOTAL $ 18,000.00 $ 18,000.00
CDBG PSA CONTRACT 2019-2020-EXHIBIT"B"-BUDGET
The Salvation Army,a Georgia Corporation Page 1
The following tables were created for the purpose of preparing, negotiating, and determining the cost
reasonableness and cost allocation method used by the Agency for the line item budget represented on
the first page of this EXHIBIT "B"—Budget. The information reflected in the tables is to be
considered part of the terms and conditions of the Contract. Agency must have prior written approval
by the City to make changes to any line item in the Budget as outlined in Section 5.2.2 in the
Contract. The deadline to make changes to EXHIBIT "B"—Budget is May 31, 2020.
SALARY DETAIL
Est. Percent to Amount to
Position Title Annual Salary Grant Grant
Emergency Shelter Case Worker $ 17,000.00 100.0% $ 17,000.00
TOTAL 1 $ 17,000.00 1 100.0% $ 17,000.00
FRINGE DETAIL
Percent of Est. Percent to Amount to
Payroll Amount Grant Grant
FICA $ 17,000.00 5.9% $ 1,000.00
Life/Disability Insurance $ -
Health/Dental Insurance
Unemployment-State
Worker's Compensation $ -
Retirement $ -
TOTAL $ 17,000.00 5.9% $ 1,000.00
SUPPLIES AND SERVICES
Est. Percent to Amount to
Total Budget Grant Grant
Office Supplies $ -
Food Supplies
TOTAL $ -
MISCELLANEOUS
Est. Percent to Amount to
Total Budget Grant Grant
Insurance $ -
Accounting $ -
Contract Labor (Security) $ -
OtherQ
TOTAL
CDBG PSA CONTRACT 2019-2020- EXHIBIT"B" - BUDGET
The Salvation Army,a Georgia Corporation Page 2
SHELTER OPERATIONS
Est. Percent to Amount to
Total Budget Grant Grant
Maintenance $ -
Security $ -
Insurance $ -
Utilities $ -
Supplies $ -
Repairs
Other()
TOTAL $ -
FINANCIAL ASSISTANCE
Est. Percent to Amount to
Total Budget Grant Grant
Rental Assistance
Security Deposits $ - $ -
Utility Payments
Utility Deposits
Moving Costs
Motel/Hotel Vouchers
TOTAL I $ I $ -
HMIS
Est. Percent to Amount to
Total Budget Grant Grant
HMIS Software Costs
TOTAL
CDBG PSA CONTRACT 2019-2020- EXHIBIT"B" - BUDGET
The Salvation Army, a Georgia Corporation Page 3
EXHIBIT "C"
AUDIT CERTIFICATION FORM
CDBG PSA CONTRACT 2019-2020—EXHIBIT"C"—AUDIT CERTIFICATION FORM l
The Salvation Army, A Georgia Corporation
AUDIT CERTIFICATION FORM AND AUDIT REQUIREMENTS
Agency: The Salvation Army,A Georgia Corporation
Fiscal Year Ending: September 30,2020
❑ During the fiscal year in which funds will be received, we will exceed the federal
expenditure threshold of $750,000. We will have our Single Audit or Program Specific
Audit completed and will submit the audit report described in 2 CFR Part 200 within 7
months after the end of the audited fiscal year or 30 days within its completion, whichever
is the earlier date.
❑ During the fiscal year in which funds will be received, we will not exceed the $750,000
federal expenditure threshold required for a Single Audit or a Program Specific Audit to be
performed this fiscal year. (Fill out schedule below)
Federal Expenditure Disclosure
MUST be filled out if Sin le Audit or Program Audit is NOT re uired.
Pass Through Program Name& Contract
Federal Grantor Grantor CFDA Number Number Expenditures
Total Federal Expenditures for this Fiscal Year:
Signatory and Title Date
Failure to submit this or a similar statement or failure to submit a completed single audit package
as described in the federally required audit requirements described in 2 CFR Part 200, as
applicable, by the required due date may result in suspension of funding and may affect
eligibility for future funding. Notwithstanding the above, this certification acknowledges the
agency's commitment to meet all other financial reporting, financial statements, and other
audit requirements as may be set forth in the Contract.
CDBG PSA CONTRACT 2019-2020—EXHIBIT"C"—AUDIT CERTIFICATION FORM 2
The Salvation Army, A Georgia Corporation
Exhibit "D" -- Reporting Forms
[See attached]
1
Attachment I
INVOICE
Agency: The Salvation Army, A Georgia Corporation
Address: 1855 East Lancaster
City, State, Zip: Fort Worth, TX 76103
Program: Family Shelter/Case Manager
Period of Service:
Tax ID No.
P.O. No.
FID No.
Program Amount
This Invoice Cumulative to Date
CDBG
2
ATTACHMENT II
City of Fort Worth
Neighborhood Services Department
Expenditure Worksheet
Agency. The Salvation Army,A Georgia Corporation
Program: Family Shelter-Case Manager
Only highlighted codes can be reimbursed
Please g oup like account codes.
Account
Line Code(See Expense Line Item
No. Check No. Date Payee Description/Job Title' Key to Right) Amount I Account
I PROGRAM PERSONNEL
2 Salaries 1001
3 FICA 1002
4 Life/Disability Insurance 1003
5 Health/DentalInsurance 1004
6 Unem to ent-State 1005
7 Worker's Compensation 1006
8 Retirement 1007
9 SUPPLIES AND SERVICES
10 Office/Program Supplies 2001
11 Postage 2002
12 Printing 2003
13 Other Com uters 2004
14 Other Books 2005
15 MISCELLANEOUS
16 Contract Labor 3001
17 Food Supplies 3002
18 Teaching Aids 3003
19 Craft Su Iles 3004
20 Field Trip Expenses 3005
21 Mileage 3006
22 Othero 3007
23 Othero 3008
24 FACILITY AND UTILITIES
25 Telephone 4001
26 Electric 4002
27 Gas 4003
28 Water and Wastewater 4004
29 Solid Waste Disposal 4005
30 Rent 4006
31 Cleaning Supplies 4007
32 Othero 4008
33 LEGAL FINANCIAL AND INSURANCE
34 Fidelity Bond or Equivalent 5001
35 Directors and Officers 5002
36 General Commercial Liability 5003
37 Othero 5004
38 DIRECT ASSISTANCE
39 Other(Mem.fees to MLK) 6001
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Total $0.00
'For Salaries,state employee's title under Description/Job Title. Rent must identify tenant
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EXHIBIT "E"
INCOME CERTIFICATION FORMS
CDBG PSA CONTRACT 2019-2020--EXHIBIT"E"--INCOME CERTIFICATION FORM
The Salvation Army,A Georgia Corporation
City of Fort Worth
CERTIFICATION OF INCOME STATEMENT
Applicant Name:
Current Address: Phone #:
City and Zip:
Household Members and Income
i cluding applicant
Last Name First Name Age Monthly Source of Income
Income $$
TOTAL NUMBER OF FAMILY MEMBERS (Include Yourself, Spouse,Children,etc.)
Total Gross Annual Household Income:
PERSONAL INFORMATION:(Check one in each item. This Information is Required for Federal Reporting Purposes)
a. ❑ MALE b. ❑ WHITE ❑ BLACK/AFRICAN AMERICAN ❑ BLACK/AFRICAN AMERICAN&WHITE
❑ FEMALE ❑AMERICAN INDIAN/ALASKAN NATIVE ❑ASIAN
❑ AMERICAN INDIAN/ALASKAN NATIVE&WHITE ❑ASIAN&WHITE
❑NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER ❑BALANCE/OTHER
❑AMERICAN INDIAN/ALASKAN NATIVE&BLACK/AFRICAN AMERICAN
c. ETHNICITY d. DISABLED e. IS HEAD OF HOUSEHOLD FEMALE?
❑ HISPANIC ❑YES ❑ YES
❑NON-HISPANIC ❑NO ❑NO
Certification: I certify that the information I am providing is true and could be subject to verification at any
time by a third party. I also acknowledge that the provision of false information could leave me subject to the
penalties of Federal, State and local law.
Signature of Applicant Date
WARNING: TITLE 18,SECTION 1001 OF THE U.S.CODE STATES THAT A PERSON IS GUILTY OF A FELONY
FOR KNOWINGLY AND WILLINGLY MAKING FALSE OR FRAUDULENT STATEMENTS TO ANY DEPARTMENT OF
THE UNITED STATES GOVERNMENT.
----------------For use by Agency staff onl -------_-_--
Household Size: Gross Annual Income:
Applicable Income Limit: Is Applicant Eligible?
Check if Applicant refused to provide demographic information: O
Staff Assessment of Demographics:
Person Making Determination: Date:
NOTE. Address, income amounts and sources for ALL household members are required.
CDBG PSA CONTRACT 2019-2020--EXHIBIT"E"--INCOME CERTIFICATION FORM
The Salvation Army,A Georgia Corporation
Ciudad de Fort Worth
CERTIFICACION DE DECLARACION DE INGRESOS
Nombre del Solicitante:
Direccion de Actualidad: Telefono:
Ciudad y Codigo Postal:
Miembros Del Hogar e Ingresos
Inclu endo el/la Solicitante
Apellido Nombre Had Ingreso Origen de Ingresos
Mensual
* TOTAL MJMERO DE MIEMBROS DEL HOGAR (Incluyase Usted.)
Total Anual de Ingresos del hogar:
**fNFORMACION PERSONAL:(Seleccione uno en cada articulo. Esta informacion es requerida por el Gobiemo federal.)
a. ❑ MASCULINO b. ❑ BLANCO ❑NEGRO/AFRICANO AMERICANO ❑NEGRO/AFRICANO AMERICANO&BLANCO
❑ FEMININO ❑ INDIO AMERICANO/NATIVO DE ALASKA ❑ASIATICO
❑ INDIO AMERICANO/NATIVO DE ALASKA&BLANCO ❑ASIATICO&BLANCO
❑NATIVO HAWAIANO/OTRO DE LAS ISLAS PACIFICAS ❑ BALANCE/OTRO
❑ INDIO AMERICANO/NATIVO DE ALASKA&NEGRO/AFRICANO AMERICANO
c. ETHNICIDAD d. INCAPACITADO e. DES LA CABEZA DEL HOGAR MUJER?
❑ HISPANO ❑ SI ❑ SI
❑NO-HISPANO ❑NO ❑NO
Certificacion: Yo certifico que la informacion que yo estoy proporcionando es verdadera y puedo ser sujeto a
verificacion a cualquiera hora por tercera parte. Yo tambien reconozco que la provision de informacion falsa
puede dejarme sujeto a penalidades Federales, Estatales, y a ley local.
Firma del Solicitante Fecha
ADVERTENCIA: TITULO 18,SECCION 1001 DEL CODIGO DE LOS ESTADOS UNIDOS INDICA QUE UNA
PERSONA ES CULPABLE DE UN DELITO POR SABER V VOLUNTARIAMENTE HACER DECLARACIONES FALSOS O
FRAUDULENTAS A CUALQUIER DEPARTAMENTO DE GOBIERNO DE LOS ESTADOS UNIDOS.
-----------------Para use de em leados de la a encia---------------
# De Miembros de Familia: Ingreso Anual:
Limite de Ingreso: ZEs solicitante elegible?
Compruebe si el solicitante se nego a dar su informacion personal: O
Evaluacion del empleado sobre informacion personal:
Persona haciendo la determinacion: Fecha:
Note: La direccion de la casa y los ingresos (y sus origenes) para todos miembros del hogar son requeridos.
CDBG PSA CONTRACT 2019-2020--EXHIBIT"E"--INCOME CERTIFICATION FORM
The Salvation Army,A Georgia Corporation
EXHIBIT "F"
STANDARDS FOR COMPLETE DOCUMENTATION
CDBG PSA CONTRACT 20I9-2020- EXHIBIT"F"—STANDARDS FOR COMPLETE DOCUMENTATION
The Salvation Army, A Georgia Corporation
2019-2020 Documentation Standards for
CDBG Public Service Contract Expenses
Budget Line ;.1 Notes/Other
Items 0
.10
Employee Salaries and Benefits-City will only reimburse a percentage of any employee's salary and benefits who work directly with the CDBG-funded Program.
Percentages will be cost allocated and determined prior to the execution of the CDBG Contract. Agencies requesting the reimbursement of 100%of any Agency employee
will require prior City approval. Agencies must show calculation on how the CDBG portion of employee salaries and benefits were calculated consistently with the CDBG
Contract.
If an employee works on both a CDBG eligible and non-CDBG eligible program(s),the City will only reimburse for a reasonable portion
of the employee's salary. Prior to the execution of the CDBG Contract,the Agency will priovide the City with a written statement on how
each employee's time will be allocated. If an employee works 100%of their time directly with the CDBG-funded Program,then 100%of
the employee's salary may be eligible for reimbursement. Agency must submit a written statement that 100%of the employee's time is
spent working directly with the CDBG-funded Program. Statements must be signed by a person authorized to sign on behalf of the
Agency and will be submitted with the October invoice.
Salaries X x• Reimbursement requests must include a timesheet and work log that reflects the hours worked by the employee(s)working directly on
the CDBG-funded Program. For employees who are paid with multiple funding sources,timesheets must reflect all funding sources. If
separate timesheets are kept for each funding source,all such timesheets must be submitted to City. Timesheets must be signed by
employee and supervisor. Agency must show a calculation and documentation of how the employee's salary was calculated and
invoiced to City.
'If employees are paid by direct deposit rather than check,then the agency must submit both the direct deposit payment company's
report(such as an ADT report)and a bank statement or check showing payment to the direct deposit company.
FICAIMedicare X X X
Life Insurance x x x
Health x x x If the City pays gross salary,this is already included.If the City pays the employer portion,the Agency must provide proof that the
Insurance employee is enrolled in the benefit plan,must show a calculation and documentation of how the invoiced amount was calculated,and
Disability x x x must provide documentation showing payment.Invoice and proof of payment are only required with the first reimbursement request and
Insurance at anytime there are changes to amounts,enrollments,disenrollments,etc.
Unemployment x x x
Insurance
If the City pays gross salary,this is already included.If the City pays the employer portion,the Agency must provide proof that the
Retirement x x x employee is enrolled in the benefit plan,must show a calculation and documentation of how the invoiced amount was calculated,and
must provide documentation showing payment.Invoice and proof of payment are only required with the first reimbursement request and
at anytime there are changes to amounts,enrollments,disenrollments,etc.
Materials,Equipment,Goods and Supplies-City will only reimburse for the cost allocated percent or amount spent in support of the CDBG-funded Program. Agencies
requesting reimbursement for these items will require prior City approval. Agencies must show calculation on how the CDBG portion of these expenses were calculated
consistently with the CDBG Contract.
Office Supplies X X X
Office
Equipment X X X X X
Rental
Postage X X X
Printing X X X
Construction&
Building X X X X This category is only available for the REACH Program and Habitat for Humanity.
Materials
Sport and
Recreation X X X
Equipment
Cleaning X X X
Su lies
Teaching Aids X X X
Craft Supplies X X X
Food Supplies X X X This category is only available to the Program provided by Meals on Wheels.
Rent, Utilities and Maintenance-City will only pay for a portion of these expenses. The portion of these expenses will be determined by the square footage attributable to
the CDBG-funded Program and shall be cost-allocated in accordance with the amount of space used for the CDBG-funded Program. These expenses may only be in support
of the CDBG-funded Program. The items listed below require prior City approval and the Agency is required to identify any funding source that pays for the portion of the
expenses that is not paid with CDBG funds. Agencies must show calculation on how the CDBG portion of these expenses were calculated consistently with the CDBG
Contract.
Telephone X X
Gas X X
Water/Wastew X X
ater
Electric X X
Solid Waste X X
CDBG 51%PSA CONTRACT 2019-2020 Exhibit"F"--STANDARDS FOR COMPLETE DOCUMENTATION 1
Facility This item requires approval by the City prior to the execution of the CDBG Contract. Repairs may be categorized as major/minor
Maintenance X X X X rehabilitation projects and must be approved through the full HUD Environmetal Review.
and Repairs
Rent X X X City will pay for a portion of the rent for the Program facility so long as its in proportion to the square footage attributable to the CDBG-
funded program.
Miscellaneous
This item requires prior approval by the City. Prior to the execution of the CDBG Contract,the Agency must submit a written statement
that lists the contract labor services to be used during the Contract term. Agency will submit a memo related to the procurement of such
Contract Labor X X X X X services and will forward any information pertaining to the procurement process to City. This requirement applies to,but is not limited to,
services retained for security services,legal,accounting,transportation providers,educational facilitators,custodial services,etc.
Agencies may not use the contract services of any City of Fort Worth Department.
City-required X X City will only pay for a percentage of the City-required insurance so long as it's in proportion to the square footage attributable to the
Insurance CDBG-funded program.
City requires that the agency submit its fee schedule or formula on how the Agency calculates the childcare scholarship amount. The
fee schedule/formula should demonstrate a breakout of income levels,and for each income level the schedule should demonstrate
Childcare X X which portion of the expense is to be paid by the family and which portion of the expense is to be reimbursed by the City. A fee
Scholarships schedule/formula must be submitted to the City prior to the first payment. Agency must submit documentation supporting that the client
is income eligible and that the household is being charged in conformance with the fee schedule. If the fee schedule/formula changes at
any time during the contract term,the Agency must immediately notify City on the date the new fee schedule/formula takes into effect.
"$0"Income Agecies that are required to verify and provide proof of household income to determine eligibility,must require that anyone who is over
Certifications the age of 18,living in the housohold,submit a$0 Income Certification.
If an audit is required because federal funds exceed$750,000,then the cost should be split evenly by all grant funding sources. Agency
Audit Services X X X X must show calculation on how the CDBG portion of the accounting services were calculated. For example,if the CDBG grant is 10%of
your Agency's budget,then invoice shall not exceed 10%of the overall cost. Agency must show a calculation and documentation of
how the invoiced amount was calculated,and must provide documentation showing payment.
*Proof of payment effective October 1,2019: Payments or Expenses must be documented in the following manner:
A)Image of the check AND bank statement showing the check cleared the bank;OR,
B)Image of the cancelled check(ex.At end of bank statement);OR,
C)Payroll Check Stub,"Advice",or Statement AND Bank Statement indicating payroll;OR,
D)For wire or e-transfers:Reciept or statement from payee/vendor OR bank statement.
Final as of 08/30/2019 SK
CDBG 51%PSA CONTRACT 2019-2020 Ediibd"F"--STANDARDS FOR COMPLETE DOCUMENTATION 1
EXHIBIT "G"
SECTION 3 REPORTING FORMS
NOT APPLICABLE
CDBG PSA CONTRACT 2019-2020-- EXHIBIT"G"-- SECTION 3 REPORTING FORMS
The Salvation Army,A Georgia Corporation
EXHIBIT "H"
SEVERELY DISABLED CERTIFICATION FORM
CDBG PSA CONTRACT 2019-2020—EXHIBIT"H"—SEVERELY DISABLED CERTIFICATION FORM Page l
The Salvation Army, A Georgia Corporation
The Salvation Army, A Georgia Corporation
CERTIFICATION FORM
DOCUMENTING CLIENT STATUS AS "SEVERELY DISABLED ADULT"
Client Name:
Address:
City, State, Zip
Client Identification No.
CHECK ALL THAT APPLY
❑ Has used a wheelchair, a walker, cane , crutches or other special aid for six
months or longer
Has been diagnosed with one of the following conditions: Alzheimer's
❑ disease, mental retardation or other developmental disability, senility or
dementia, cerebral palsy, or autism; or has another mental or emotional
condition that seriously interferes with everyday tasks.
Is unable to perform one or more of the following "Functional Activities":
❑ seeing, hearing, speaking and having one's speech understood, lifting or
carrying, using stairs, grasping small objects, or walking.
Is unable to perform or needs assistance to perform one or more of the
❑ following Activities of Daily Living (ADL): getting around inside the home,
getting in or out of bed or a chair, bathing, dressing, eating, and toiletin .
Is unable to perform or needs assistance to perform one or more of the
following Instrumental Activities of Daily Living (IADL): going outside the
❑ home, keeping track of money and bills, preparing meals, doing light
housework, taking prescription medications in the right amount and at the right
time, and using the telephone.
❑ Has a condition that prevents them from working at a job or doing housework.
The undersigned Agency representative conducted a visual assessment of the client identified on
this form and certifies that the client meets at least one of the conditions indicated above, which
determines that he/ she meets the definition of"severely disabled" according to the U.S. Census
Bureau.
Certified by: Date:
Signature/Title:
CDBG PSA CONTRACT 2019-2020—EXHIBIT"H"—SEVERELY DISABLED CERTIFICATION FORM Page 2
The Salvation Army, A Georgia Corporation
CFW Neighborhood Services Dept.: Revised 08/29/2019
CDBG PSA CONTRACT 2019-2020—EXHIBIT"H"—SEVERELY DISABLED CERTIFICATION FORM Page 3
The Salvation Army,A Georgia Corporation
EXHIBIT "I"
MBE REPORTING FORM
CDBG CONTRACT 2019-2020--EXHIBIT"I"-- MBE REPORTING FORM Page l
The Salvation Army,A Georgia Corporation
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EXHIBIT "J"
DUTIES OF THE PARTIES
USE OF NEIGHBORHOOD SERVICES DEPARTMENT
COMMUNITY CENTERS
CDBG CONTRACT 2019-2020-- EXHIBIT"J"—DUTIES OF THE PARTIES—USE OF NEIGHBORHOOD
SERVICES DEPARTMENT COMMUNITY CENTERS Page l
The Salvation Army,A Georgia Corporation
The Salvation Army, A Georgia Corporation
DUTIES OF THE PARTIES
USE OF NEIGHBORHOOD SERVICES DEPARTMENT
COMMUNITY CENTERS
Agency's Responsibilities:
Agency will perform the following in relation with the use of Community Center:
• Agency will furnish the Center Coordinator with a schedule of Program activities at least
four weeks prior to their occurrence.
• Agency will, at its sole expense, furnish materials, supplies, copies and conduct a
structured Program.
• Agency will ensure that the designated Community Center space is maintained in a neat
and orderly fashion.
• Agency will ensure that the City's standards are maintained regarding security;
cleanliness and communication between and among programs housed at the Community
Center and will ensure cooperation with other Community Center staff and
agencies/programs.
• Agency will report to the Center Coordinator or designee for problems immediately
if/when problems occur.
• Agency will work with the Center Coordinator or designee to schedule any use of the
Community Center for related activities outside of agencies designated meeting time
and/or the Community Center's regular days and hours.
• Agency will maintain sole responsibility and liability for its employees, volunteers and
separate contractors for their actions.
• Agency shall ensure that each of its employees, volunteers and participants desiring to
participate in Community Center-sponsored programs/activities are aware of the
requirement to have a current community center membership card to participate.
• Agency agrees to perform background screenings and checks on staff and volunteers,
with such screenings and checks meeting or exceeding the requirements that the City
imposes for checks and screenings on staff, volunteers and participants in the City's own
programs.
• Agency will provide the Center Coordinator with designated staff contact information for
the purposes of emergencies (center closing, schedule changes or scheduled maintenance)
CDBG PSA CONTRACT 2019-2020-- EXHIBIT"T'—DUTIES OF THE PARTIES—USE OF
NEIGHBORHOOD SERVICES DEPARTMENT COMMUNITY CENTERS Page 1
The Salvation Army, A Georgia Corporation
City's Responsibilities:
City will perform the following in relation with Agency's use of a Community Center:
• City will provide space for conducting the Program, including basic utilities and will also
supply the Agency with appropriate facility access. For purposes of this Contract, basic
utilities shall not include telephone or computer service, which shall remain the sole
responsibility of the Agency.
• City will ensure that the reserved space is set up with appropriate tables and chairs to
accommodate program and/or services.
• City will not be responsible for any additional security other than what is currently
available at the Community Center.
• City assumes no liability or responsibility for the loss of any personal property or office
contents of the Agency, its agents, employees, volunteers, participants or licensees while
at the Community Center.
• City will allow the Agency to conduct properly scheduled classes and other Program
related activities during the days and hours specified in Exhibit "A" PROGRAM
SUMMARY*. In addition, City may, but is not required, through the Center
Coordinator, allow Agency to schedule other classes and Program related activities
outside of the days and hours specified in Exhibit"A" PROGRAM SUMMARY.
• City will maintain sole responsibility and liability for its employees, volunteers and
separate contractors for their actions.
• City will have the discretion to put the Agency in any available room. If placed in a
different location, it is to be only one room.
*The City is closed in observance of the following holidays:
New Year's Day (January 1st)
M.L.K. Jr. Day (Third Monday of January)
Memorial Day (Last Monday in May)
Independence Day (July 41h)
Labor Day (First Monday in September)
Thanksgiving Day (Fourth Thursday of November)
Day after Thanksgiving (Fourth Friday in November)
Christmas Day (December 25th)
**City of Fort Worth observes the above holidays on Friday if they fall on Saturday and on a Monday if they
fall on Sunday.
CDBG PSA CONTRACT 2019-2020-- EXHIBIT"J"—DUTIES OF THE PARTIES—USE OF
NEIGHBORHOOD SERVICES DEPARTMENT COMMUNITY CENTERS Page 2
The Salvation Army, A Georgia Corporation
Additionally, the Community Centers are utilized as shelters during an emergency. If the
Community Center will be closed due to an emergency, Center Coordinator or designee will
inform Agency of the closure.
CDBG PSA CONTRACT 2019-2020-- EXHIBIT"J"—DUTIES OF THE PARTIES—USE OF
NEIGHBORHOOD SERVICES DEPARTMENT COMMUNITY CENTERS Page 3
The Salvation Army,A Georgia Corporation
EXHIBIT "K"
NOTICE OF BENEFICIARY RIGHTS
CDBG PSA CONTRACT 2019-2020-- EXHIBIT"K"—NOTICE OF BENEFICIARY RIGHTS Page I
The Salvation Army, A Georgia Corporation
Notice of Beneficiary Riahts
Name of Agency: The Salvation Army, A Georgia Corporation
Name of Program: Emergency Shelter for Families - CDBG
Contact information for Program Staff(name, phone number, and e-mail address, if appropriate):
Because this program is supported in whole or in part by direct Federal financial assistance from
the Federal Government, we are required to let you know that:
• We may not discriminate against you on the basis of religion, religious belief, a refusal
to hold a religious belief, or a refusal to attend or participate in a religious practice;
• We may not require you to attend or participate in any explicitly religious activities that
are offered by us and any participation by you in these activities must be purely
voluntary;
• We must separate, in time or location, any privately funded explicitly religious activities
from activities supported by direct Federal financial assistance;
• If you object to the religious character of our organization, we must make reasonable
efforts to identify and refer you to an alternative provider to which you have no such
objection; and
• You may report an organization's violations of these protections, including any denial of
services or benefits, by contacting or filing a written complaint to HUD [or the
intermediary, if applicable].
We must give you this written notice before you enroll in our program or activity, as required by
24 CFR 5.109.
CDBG PSA CONTRACT 2019-2020-- EXHIBIT"K"—NOTICE OF BENEFICIARY RIGHTS Page 2
The Salvation Army, A Georgia Corporation
6/4/2020 M&C Review
Official site of the City of Fort Worth,Texas
CITY COUNCIL AGENDA FORTTII
DATE: 5/19/2020 REFERENCE **M&C 20- LOG NAME: 19CDBG15PCTREPROGRAM$58K
NO.: 0328
CODE: G TYPE: CONSENT PUBLIC NO
HEARING:
SUBJECT. Approve Allocation of$58,000.00 of Unprogrammed Community Development Block Grant
Funds for the Ash Crescent Neighborhood Summer Day Camp for Educational Enrichment
Activities for Children by the United Community Centers, Inc., Emergency Shelter Services
for Homeless Families at The Salvation Army, a Georgia Corporation, and for Social
Services by the EnVision Center Program at the Martin Luther King Jr. Community Center,
Authorize Substantial Amendment to the City's 2019-2020 Action Plan, Authorize the
Substitution of Funding Years, and Authorize Execution of a Contract(s) and/or
Amendments(s) (COUNCIL DISTRICTS 5 and 8)
RECOMMENDATION:
It is recommended that the City Council:
1. Authorize a change in use and expenditure of$23,000.00 of Community Development Block Grant
(CDBG) unprogrammed funds and execution of a contract amendment with the United Community
Centers, Inc. for the Ash Crescent Neighborhood Summer Day Camp Program;
2. Authorize a change in use and expenditure of $18,000.00 of CDBG unprogrammed funds and
execution of a contract with The Salvation Army, a Georgia Corporation for a family shelter program
case manager for approval by the City Manager; and
3. Authorize a change in use and expenditure of $17,000.00 of CDBG unprogrammed funds for
direct client assistance for the EnVision Center Program at Martin Luther King Community Center.
DISCUSSION:
On August 6, 2019, City Council approved the City's 2019-2020 Action Plan for submission to
Housing and Urban Development (HUD) (M&C 19-0016). The Action Plan included funding for
$7,270,678.00 in Community Development Block Grant (CDBG)funded activities.
CDBG program income funds come from the repayment of loans and the sale of CDBG-assisted
properties. HUD regulations authorize the City to use up to 15\% of the amount of the prior years'
program income for public service activities during the next program year. Since $394,706.19 was
received in CDBG program income in 2018-2019, $58,000.00 in additional public service funding may
be expended in the 2019-2020 program year.
The opportunity to increase PSA funded services by $58,000.00 was presented to the Community
Development Council (CDC) on December 18, 2019. CDC recommended that these funds be
dedicated to the following high priority activities:
United Community Centers, Inc.: $23,000.00 for the Ash Crescent Neighborhood Summer Day
Camp held at The Greater United Missionary Baptist Church, located at 1624 E. Jessamine.
The Salvation Army, a Georgia Corporation at 1855 E. Lancaster Ave.: $18,000.00 for a
homeless case manager position at the Family Shelter.
Martin Luther King EnVision Center at 5525 Truman Dr.: $17,000.00 for direct client assistance
to increase employability and self-sufficiency, through its existing Community Action Partners
(CAP) Works Program.
A public comment period on this proposed substantial amendment to the 2019-20 Action Plan was
held from January 12, 2020 to February 11, 2020. All comments received are maintained by the
Neighborhood Services Department. To expend oldest grant funds first, the "first in, first out" principle
may be used to determine the Action Plan funding years used for expenditures.
The United Community Centers, Inc./Ash Crescent Neighborhood and The Salvation Army are
located in COUNCIL DISTRICTS 5 and 8.
apps.cfwnet.org/council_packet/mc_review.asp?ID=27897&councildate=5/19/2020 1/2
6/4/2020 M&C Review
The EnVision Center is located in COUNCIL DISTRICT 5
FISCAL INFORMATION/CERTIFICATION:
The Director of Finance certifies that upon approval of the above recommendation, funds are
available in the current operating budget, as appropriated, in the Grants Operating Federal Fund.
Neighborhood Services will be responsible for the collection and deposit of funds due to the City.
Prior to expenditure being incurred, Neighborhood Services has the responsibility to validate the
availability of funds. This is a reimbursement grant.
TO
Fund Department Account Project Program Activity Budget Reference#
I ID ID I I Year Amount
Chartfield 2)
FROM
Fund Department Account Project Program Activity Budget Reference# Amount
ID I I ID Year Chartfield 2
Submitted for City Manager's Office by_ Fernando Costa (6122)
Originating Department Head: Victor Turner(8187)
Additional Information Contact: Barbara Asbury (7331)
Charletta Moaning (7333)
ATTACHMENTS
15%Available Funds from 991999.pdf
apps.cfwnet.org/council_packet/mc_review.asp?ID=27897&councildate=5/19/2020 2/2