HomeMy WebLinkAboutContract 39242 (2)STATE OF TEXAS �
CONTRACT NO 3
COUNTY OF TARRANT 5
THIS contract ("Contract") is made and entered into by and between the City of Fort Worth
("City"), whose address is 1000 Throckmorton St., Fort Worth Texas 76102, acting by and through
T.M. Higgins, its duly authorized Assistant City Manager, and Mental Health Association of Tarrant
County (" Contractor ), whose address is 3136 West 4''' Street, Fort Worth, Texas, 76107, acting by
and duo °-ark4*4mot, its duly authorized• Executive Director. Sometimes Cityand
Contractor are referre individually as a "Party" and collectively as the "Parties",)
WHEREAS, City has received grant monies from the United States Department of Housing
and Urban Development ("HUD") under Tide 1 of the Housing and Community Development Act
of 1974, as amended, (42 USC 5301 et seq.) for utilization in connection with its Community
Development Block Grant ("CDBG"), Program No. B-09-MC-48-0010, for Year XCYV;
WHEREAS, one of the national objectives of the CDBG program is to benefit low and
moderate income citizens (the "National Objective");
WHEREAS, the assigned Catalog of Federal Domestic Assistance (CFDA) number is 14.218 for
this Federal program; and
WHEREAS City citizens, the Community Development Council, and the City Council have
determined that CDBG programs are needed by the City's low and moderate -income citizens.
NOW, THEREFORE, THIS AGREEMENT FURTHER WITNESSETH:
THAT, the Parties covenant and agree as follows:
1. Scope of Sertrices
a. Contractor will administer Public services to citizens of the City of Fort Worth under the
program name Long Term are Ombudsman ("Program"), for the term June 1, 2009 to May
31, 2010.
b. Contractor will be responsible for administering Long Term Care Ombudsman Program in a
manner satisfactory to City and consistent with any standards required as a condition of
providing the CDBG funds (as hereinafter defined). Contractor will provide the services
and activities as set forth in Exhibit A -Program Summary in accordance with Exhibit B-
Program Services Schedule.
c. Contractor agrees to meet the National Objective of activities benefiting low and moderate -
income individuals and to maintain full documentation supporting fulfillment of this
National Objective in its files as defined in 24 CFR 570.208. Contractor certifies that the
activities carried out under this Contract will serve the required percentage of low and
moderate -income persons as set forth in Exhibit A - Program Summary. Contractor will
obtain information on family size and income of Program participants. All such'
documentation shall be furnished to City upon request if necessary for City to7ffulfill its
If this documentation is not maintained and furnished under its Federal grant.
to City on request, City may exercise all remedies available under this Contract, including the
>CORD
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Menta1 Health Association of Tarrant County Page I
right to withhold payment to Contractor on this Contract or any other contract with
Contractor, or terminate this Contract as described herein.
d. City will monitor and evaluate Contractor's performance using the goals and performance
standards required in this Contract. Substandard performance as determined by City
monitoring, including noncompliance with any applicable regulation of the U.S. Department
of Housing and Urban Development, will constitute non-compliance with this Contract. If
action to correct such substandard performance is not taken by Contractor within a
reasonable period of time after being notified in writing by City, procedures to suspend or
terminate the Contract will be initiated.
e. If applicable, Contractor shall comply and assist City in complying with the provisions of
any federal requirements regarding displacement, relocation and/or real property acquisition;
uniform administrative requirements and cost principles; employment and contracting
opportunities, use of debarred, suspended or ineligible contractors or subrecipients;
eligibility restrictions for certain resident aliens; conflict of interest, and other requirements
of Subpart K of the CDBG Regulations. .
f. Contractor agrees to take reasonable steps to ensure meaningful access to the Program and
associated activities by limited English proficient persons.
2. Compensation and Method of Payment
a. City will disburse CDBG Year YYYV funds ("CDBG Funds") in an amount up to
FIFTEEN THOUSAND SEVEN HUNDRED FIFTY AND NO/100 DOLLARS
($15,750.00) to Contractor on a reimbursement of expenses basis. Contractor is acting as a
Subrecipient for the purposes of this Contract in carrying out the agreed -upon eligible
activities as set forth in Exhibit A — Program Summary.
b. Payment will be processed by City following receipt from Contractor of the following
monthly financial documents: (1) Attachment I- Request For Funds, (2) Attachment II -
Detail Statement of Costs, and (3) Attachment III -Expenditures Worksheet. Payment by
City to Contractor shall require completion of all City forms and copies of adequate
supporting documentation verifying eligibility of expenses as well as, where applicable,
eligibility of Program participants. Reimbursement for the payment of eligible expenses
shall be made against the budget specified in Exhibit C-Program Operating Budget and
in accordance with performance specified in Exhibit B-Program Services Schedule. City
will not disburse funds for expenditures that occurred prior to the beginning date of the
term of this Contract.
c. Contractor agrees to utilize all disbursed CDBG Funds for the benefit of the Program.
Contractor agrees that all funds will be expended in accordance with Exhibit C-Program
Operating Budget. Contractor may not increase or decrease line -item amounts in the
approved CDBG Funds portion of Exhibit C-Program Operating Budget without City's
prior written approval. Contractor acknowledges and agrees that any CDBG Funds not
used in accordance with the CDBG Regulations and the terms of this Contract will be
repaid to City.
d. It is understood that the total cost for operation of this Program is $46,734.94 and that
Contractor will obtain from other sources the remaining funds in excess of the CDBG
Funds as detailed in Exhibit C-Program Operating Budget. Contractor will notify City
promptly of any additional funds it receives for operation of the Program, and City reserves
the right to amend Exhibit C-Program Operating Budget in such instances to ensure
compliance with HUD regulations governing cost allocation.
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e. Contractor agrees to keep all CDBG Funds on hand in interest bearing accounts. All interest
earned shall be reported to City on a monthly basis, at the same time as submission of the
monthly report following the end of the Contract month during which the interest was
earned. Interest in an amount of $25.00 or less per month may be used for authorized
Program expenses. These amounts must be reported on the monthly financial statements
filed pursuant to this Contract. Interest earned in excess of $25.00 per month is subject to
remittance to City as directed by City.
£ Contractor will not commingle CDBG Funds with any other funds in any manner that
would prevent City from readily identifying expenditures for operation of the Program.
3. Uniform Administrative Regazireme�zts and Program Nlazzagea7ezzt Standards
a. Financial Management
i. Accounting Standards
Contractor agrees to comply with OMB Circular A-110, "Uniform Administrative
Requirements for Grants and Agreements with Institutions of Higher Education,
Hospitals and other Non -Profit Organizations", and agrees to adhere to the accounting
principles and procedures required therein, utilize adequate internal controls, and
maintain necessary source documentation for all costs incurred.
ii. Cost Principles
Contractor shall administer the Program in conformance with OMB Circular A-122,
Cost Principles for Non -Profit Organizations" and attachments and revisi
'ons thereto,
regarding principles for determining eligible and allocable costs for the Program.
b. Documentation and Record Keeping
i. Requirement
Contractor shall maintain all records pertinent to the activities to be funded under this
Contract required in 24 CFR § 570.506. In addition, Contractor agrees to keep records
to fully document all expenditures charged to the CDBG portion of the Program,
including records documenting the eligibility of Program participants as more
particularly described herein. The documentation must support the amounts charged to
the Program, the eligibility of the Program participants, and demonstrate that the
expenditures were appropriate to the stated goals of the Program and allowable and/or
eligible under applicable Federal, state and City guidelines.
ii. Records Retention
(1) All records pertaining to Program shall be retained for four (4) years following the
termination of this Contract. Contractor may destroy Program records at the end of
this four (4) year period if no outstanding audit finding exists.
(2) Contractor will retain any Program loan records until four (4) years after the
expiration of any loan.
iii. Real Property Records
Contractor shall maintain real property inventory records that clearly identify properties
purchased, improved, or sold. Properties retained shall meet eligibility criteria and shall
conform to. the requirements of 24 CFR S 570.505.
iv. Closeouts
Contractor's obligation to City shall not end until all closeout requirements are
completed. Activities during this closeout period shall include, but are not limited to:
making final payments, disposing of Program assets (including the return of all unused
materials, equipment, unspent cash advances, Program income balances, and accounts
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receivable to City), and determining the custodianship of records and verification of
compliance with record retention requirements.
v. Audits and Inspections
(1) City, HUD, and the United States Comptroller General, or their respective
representatives, shall have access to any books, documents, records and papers
relating to the operations of Contractor under this Contract for the purpose of
audit, examination, exception and transcription at all of Contractor's offices at all
reasonable hours.
(2) All non-federal entities that expend $500,000 or more in Federal funds within one (1)
year, regardless of the source of the Federal award, must submit to City an annual
audit prepared in accordance with 24 CFR Sections g 570.502-570.503 generally,
(known as a Single Audit), with specific reference to OMB Circulars (with
attachments) A-122, "Cost Principles for Non -Profit Organizations", and A-133,
"Audits of States, Local Governments, and Non -Profit Organizations", as
appropriate. The audit may cover either Contractor's fiscal year during which this
Contract is in force or cover the period of this Contract. The audit must be prepared
by an independent certified public accountant, be completed within nine (9) months
following the end of the period being audited and be submitted to City within thirty
(30) days of its completion. Contractor's audit certification is attached hereto as
Exhibit D - Audit Certification Form. The Audit Certification Form must be
submitted to City within sixty (60) days of the end of the period being audited
(Contractor's fiscal year). Costs of preparation of this audit may be an allowable
expenditure of CDBG Funds in an amount proportional to that of the CDBG
Funds used in Contractor's total agency operating budget. Non-profit entities that
expend less than $500,000 a year in Federal funds are exempt from Federal audit
requirements for that year, but records must be available for review or audit by
appropriate officials of the Federal agency, City, and General Accounting Office
("GAO").
(3) All non-federal entities acting as a Subrecipient for City grant funds that expend less
than $500,000 in any federal funds within one year shall provide City with a copy of
any other financial audit or audited financial statements prepared during the contract
term, if available.
(4) City reserves the right to perform an audit of Contractor's agency operations and
finances at any time during the term of this Contract, if City determines that such
audit is necessary for City's compliance with OMB Circular A-133. Contractor
agrees to allow access to all relevant books, records and materials. If such audit
reveals a questioned practice or expenditure, such questions must be resolved within
fifteen (15) days after notice to Contractor. If questions are not resolved within this
period, City reserves the right to withhold further funding under this Contract
and/or any other contract(s) with Contractor.
(5) If as a result of any audit it is determined that Contractor has misused, misapplied or
misappropriated all or any part of the CDBG Funds, Contractor agrees to reimburse
the City the amount of such monies so misused, misapplied or misappropriated, plus
the amount of any sanction, penalty or other charge levied against City because of
such misuse, misapplication or misappropriation.
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4. Reporting Procedures
a. FinanciaLKepOrLS
Contractor will submit to City on a monthly basis: (1) Attachment I -Request for Funds, (2)
Attachment II -Detailed Statement of Costs, (3) Attachment III -Expenditures Worksheet, as
applicable, for expenses incurred for services and activities accomplished by Contractor in
performance of this Contract. Actual cash receipts for claimed expenditures must be
provided at the time the request for funds is presented. The reports must be signed by a
duly authorized agent of the Contractor and submitted by the 15`h of the month following
the month being reported. City is under no obligation to disburse funds for expenditures
that occurred prior to the first day of the month for which the report is submitted.
b. Progress Reports
Contractor will submit to City on a monthly basis: (1) Attachment IVa-Program Services
Report, (2) Attachment IVb-Direct Benefit Data Report, (3) Attachment V-Performance
Report, and (4) Attachment VI -Client Data Report for services and activities undertaken by
Contractor in performance of this Contract. The report will be signed by a duly authorized
agent of Contractor and submitted by the 15"' of the month following the month that is
reported. City is under no obligation to disburse finds for expenditures that occurred prior
to the beginning date of this Contract.
c. Program Income
Contractor agrees that all program income from operation of the Program in proportion to
the amount of CDBG Funds received hereunder will be expended prior to expending
CDBG Funds and that any such program income is subject to the terms of this Contract.
Contractor may expend CDBG Funds only if program income is insufficient to meet all
eligible Program activity expenses. Contractor agrees to return to City at the end of the
Contract any remaining program income earned from operation of the Program in
proportion to the amount of CDBG Funds in Exhibit A -Program Summary and Exhibit
B-Program Operating Budget.
d. Procurement
i. Compliance
Contractor shall comply with City policy concerning the purchase of equipment and
shall maintain inventory records of all non -expendable personal property, as defined by
such policy, procured with funds provided under this Contract.
no OMB Standards
Contractor shall procure all materials, property, or services in accordance with the
requirements of 24 CFR Part 84, Procurement Standards and Property Standards, as
modified by 24 CFR Part 570.502(b)(6), covering utilization and disposal of property.
e. Program Participant Records
i. Contractor will keep or cause to be kept an accurate record of all actions taken and all
CDBG Funds expended, with source documents, in performance of this Contract. Such
records shall be kept for the time period mandated by the CDBG Regulations and this
Contract.
no Contractor will obtain and keep on file and furnish to City on request the following
information and/or documentation on each Program participant served by the Program
demonstrating such participant's eligibility for services provided:
a. Participant's name, address, annual income level or other basis for determining
income eligibility, and family size of participant's household.
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b. Source documentation used for income verification including but not limited to pay
check stubs, food stamp award letters, income tax returns, SSI award letters, letters
awarding unemployment benefits, W2s and the like.
c. City shall have the final determination, in its sole discretion, as to whether source
documentation used for income verification is adequate.
5. Reversion of Assets
a. Contractor agrees to return to City any CDBG Funds remaining on hand at the end of the
Contract.
b. All property purchased with CDBG Funds under this Contract will be used solely for
operation of the Program. Contractor agrees to obtain City approval prior to purchase of
property and Contractor agrees to notify City upon receipt of property so that it may be
properly tagged and inventoried. Title to such property will be vested in City, and
Contractor will deliver all such property to City for disposition at City's sole discretion at the
termination of the Program.
6. App/icable I aU11/J'
a. Federal
Contractor agrees to comply with the following laws and the applicable regulations as they
are currently written or are hereafter amended during performance of this Contract:
• Regulations at 24 CFR Part 570 pertaining to CDBG ("CDBG Regulations")
• Title I of the Housing and Community Development Act of 1974 as amended (42
USC 5301 etseq.)
• Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970
(42 USC 4601 et seq.) and its related regulations at 49 CFR Part 24
• Title VI of the Civil Rights Act of 1964 (42 USC 2000d et seq.)
• Title VIII of the Civil Rights Act of 1968 (42 USC 3601 et seq.)
• Executive Orders 11063, 11246, as amended by Executive Orders 11375 and 12086 and
as supplemented by 41 CFR Part 60
• The Age Discrimination in Employment Act of 1967 (29 USC 621)
• The Age Discrimination Act of 1975 (42 USC 6101 et seq.)
• Section 504 of the Rehabilitation Act of 1973 (29 USC 794 et seq.) and 24 CFR Part 8
where applicable
• The Americans with Disabilities Act of 1990 (42 USC 12101)
• National Environmental Policy Act of 1969, as amended, 42 USC 4321 et seq. ("NEPA")
and the related authorities listed 24 CFR Part 58
• The Clean Air Act, as amended (42 USC 7401 et seq.), the Clean Water Act of 1977, as
amended (33 USC 1251 et seq.) and the related EPA regulations at 40 CFR Part 15, as
amended from time to time, and Executive Order 11738. In no event shall any amount
of the assistance provided under this Contract be utilized with respect to a facility that
has given rise to a conviction under the Clean Air Act or the Clean Water Act.
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• The Immigration Reform and Control ct of 1986 (8 USC 1101 et seq.), specifically
including the provisions requiring employer verification of the legal status of its
employees
• Drug Free Workplace Act of 1988 (41 USC 701 et seq.) and 24 CFR Part 23, Subpart F
• Regulations as 24 CFR Part 87 related to lobbying, including the requirement that
certifications and disclosures be obtained from all covered persons
• Executive Order 12549 and 24 CFR Part 5.105 (c) pertaining to restrictions on
participation by ineligible, debarred, or suspended persons or entities.
b. Section 3 of the Housing and Urban Development Act of 1968, as amended, (12 USC 1701 u
et seq.) and its related regulations at 24 CFR Part 135
If the work to be performed under this Contract is on a project assisted under a program
providing direct Federal financial assistance from HUD, Section 3 of 24 CFR 135.38
("Section 3") requires that the following clause be inserted in all covered contracts ("Section
3 Clause") Such covered contracts or activities include CDBG-funded construction,
reconstruction, conversion or rehabilitation of housing as set forth at 24 CFR 135.5.
"A. The work to be performed under this contract is subject to the requirements of section
3 of the Housing and Urban Development Act of 1968, as amended, 12 U.S.C. 1701u
(section 3). The purpose of Section 3 is to ensure that employment and other economic
opportunities generated by HUD assistance or HUD -assisted projects covered by
Section 3, shall, to the greatest extent feasible, be directed to low- and very low-income
persons, particularly persons who are recipients of HUD assistance for housing.
B. The Parties to this contract agree to comply with HUD's regulations in 24 CFR Part 135)
which implement Section 3. As evidenced by their execution of this contract, the Parties
to this contract certify that they are under no contractual or other impediment that
would prevent them from complying with the Part 135 regulations.
C. The contractor agrees to send to each labor organization or representative of workers
with which the contractor has a collective bargaining agreement or other understanding,
if any, a notice advising the labor organization or workers' representative of the
contractor's commitments under this section 3 clause, and will post copies of the notice
in conspicuous places at the work site where both employees and applicants for training
and employment positions can see the notice. The notice shall describe the Section 3
preference, shall set forth minimum number and job titles subject to hire, availability of
apprenticeship and training positions, the qualifications for each; and the name and
location of the person(s) taking applications for each of the positions; and the
anticipated date the work shall begin.
D. The contractor agrees to include this section 3 clause in every subcontract subject to
compliance with regulations in 24 CFR Part 135, and agrees to take appropriate action,
as provided in an applicable provision of the subcontract or in this Section 3 clause,
upon a finding that the subcontractor is in violation of the regulations in 24 CFR Part
135. The contractor will not subcontract with any subcontractor where the contractor
has notice or knowledge that the subcontractor has been found in violation of the
regulations in 24 CFR Part 135,
E. The contractor will certify that any vacant employment positions, including training
positions, that are filled (1) after the contractor is selected but before the contract is
executed, and (2) with persons other than those to whom the regulations of 24 CFR Part
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135 require employment opportunities to be directed, were not filled to circumvent the
contractor's obligations under 24 CFR Part 135.
F. Noncompliance with HUD's regulations in 24 CFR Part 135 may result in sanctions,
termination of this contract for default, and debarment or suspension from future HUD
assisted contracts.
G. With respect to work performed in connection with Section 3 covered Indian housing
assistance, section 7(b) of the Indian Self -Determination and Education Assistance Act
(25 U.S.C. 450e) also applies to the work to be performed under this contract. Section
7(b) requires that to the greatest extent feasible (i) preference and opportunities for
training and employment shall be given to Indians, and (ii) preference in the award of
contracts and subcontracts shall be given to Indian organizations and Indian -owned
Economic Enterprises. Parties to this contract that are subject to the provisions of
section 3 and section 7(b) agree to comply with Section 3 to the maximum extent
feasible, but not in derogation of compliance with section 7(b)."
City and Contractor understand and agree that compliance with the provisions of Section 33
the regulations set forth in 24 CFR Part 135, and all applicable rules and orders of HUD shall be
a condition of the Federal financial assistance provided to the Program, binding upon City and
Contractor, and their respective successors, assigns and subcontractors. Failure to fulfill these
requirements shall subject Contractor and its subcontractors, and their respective successors and
assigns, to those sanctions specified by the Grant Agreement through which Federal assistance is
provided and to such sanctions as are specified by 24 CFR Part 135.
c. Other Laws
Contractor covenants and agrees that its officers, members, agents, employees, Program
participants and subcontractors shall abide by and comply with all other laws, Federal, state
and local, relevant to the performance of this Contract, including all applicable City
ordinances, rules and regulations and Title I of the Housing and Community Development
Act of 1974 (42 USC 5301 et seq.), as amended, and the CDBG Regulations, as amended, (24
CFR Part 570 et seq.). Contractor further promises and agrees that it has read, and is familiar
with, the terms and conditions of the Community Development Block Grant under which
CDBG Funds are granted and any applicable provisions of the CDBG Regulations and that
it will fully comply with them. It is agreed and understood that, if City notifies Contractor
of any such violation on the part of Contractor or any of its officers, members, agents,
employees, Program participants or subcontractors, then Contractor shall immediately desist
from and correct such violation.
7. Nondi.rcjzmination
a. Contractor will not unlawfully discriminate against any person or persons because of sex,
race, religion, age, disability, color, national origin, or familial status, nor will Contractor
permit its officers, members, agents, employees, subcontractors or Program participants to
engage in such discrimination.
b. Contractor covenants that neither it nor any of its officers, members, agents, employees,
Program participants or subcontractors, while engaged in performing this Contract, shall, in
connection with the employment, advancement or discharge of employees or in connection
with the terms, conditions or privileges of their employment, discriminate against persons
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because of their age except on the basis of bona fide occupational qualification, retirement
plan or statutory requirement.
c. Contractor further covenants that neither it nor its officers, members, agents, employees,
subcontractors, Program participants, or persons acting on their behalf, shall specify, in
solicitations or advertisements for employees to work on this contract, a maximum age limit
for such employment unless the specified maximum age limit is based upon a bona fide
occupational qualification, retirement plan or statutory requirement.
d. In accordance with the provisions of the Americans With Disabilities Act of 1990 ("ADA"),
Contractor warrants that it and any and all of its subcontractors will not unlawfully
discriminate on the basis of disability in the provision of services to the general public, nor
in the availability, terms and/or conditions of employment for applicants for employment
with Contractor, or employees of Contractor or any of its subcontractors. Contractor
warrants it will fully comply with ADA's provisions and any other applicable Federal, state
and local laws concerning disability and will defend, indemnify and hold City harmless
against any claims or allegations asserted by third parties or subcontractors against City
arising out of Contractor's and/or its subcontractors' alleged failure to comply with the
above -referenced laws concerning disability discrimination in the performance of this
Contract.
e. This Contract is made and entered into with reference specifically to the ordinances codified
at Chapter 17, Article III, Division 3 "Discrimination in Employment Practices", of the City
Code, and Contractor hereby covenants and agrees that Contractor, its officers, members,
agents, employees and subcontractors, have fully complied with all provisions of same and
that no employee, employee -applicant or Program participant has been discriminated against
by the terms of such ordinances by either the Contractor or its officers, members, agents,
employees or subcontractors.
8. Prohibition Against Lrterest
a. No member, officer or employee of City or its designees or agents; no member of the
governing body of the locality in which the Program is situated; and no other public official
of such locality or localities, who exercises any functions or responsibilities with respect to
the Program funded hereunder during his or her tenure or for one year thereafter, shall have
any interest, direct or indirect, in any contract or subcontract, or the proceeds thereof, for
work to be performed hereunder. Contractor shall incorporate, or cause to be incorporated,
like language prohibiting such interest in all contracts and subcontracts entered into in
connection with the Program.
b. No member, officer, employee, or Program participant of Contractor or its subcontractors
shall have a financial interest, direct or indirect, in this Contract or the CDBG Funds
transferred hereunder or be financially interested, directly or indirectly, in the sale to
Contractor of any land, materials, supplies or services purchased with any CDBG Funds
transferred hereunder, except on behalf of Contractor, as an officer, employee, member or
Program participant. Any willful violation of this paragraph with the expressed or implied
knowledge of Contractor or its subcontractors shall render this Contract voidable by City.
9. IVlinorzty and IY/onren Business Enterprise Commitment
Contractor agrees to abide by Cit<�'s policy to involve Minority and Women Business Enterprises
("i�I�y/BEs") in all phases of its procurement practices and to provide them an equal opportunity
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Mental Health Association of Tarrant County Page 9
to compete for contracts for construction, provision of professional services, purchase of
equipment and supplies and provision of other services required by City. Contractor agrees to
incorporate City Ordinance No. 15530, and all amendments or successor policies thereto, into all
contracts and will further require all persons or entities with whom it contracts to comply with
said NIWBEs policy.
10. Non Assignment
No assignment or delegation of duties under this Contract by Contractor shall be effective
without City's prior written approval. If such assignment occurs, Contractor shall ensure that all
requirements of this Contract are enforced and maintained by any such Subcontractor or
Assignee by means of a currently executed written agreement covering the Contract term, a copy
of which shall be made available to City
11. I�rdependent Contractor•
a. Contractor shall operate hereunder as an independent contractor and not as an officer,
agent, servant or employee of City. Contractor shall have exclusive control of, and the
exclusive right to control, the details of the work and services performed hereunder, and all
persons performing same, and shall be solely responsible for the acts and omissions of its
officers, members, agents, servants, employees, subcontractors, Program participants,
licensees or invitee. The doctrine of respondeat superior shall not apply as between City and
Contractor, its officers, members, agents, servants, employees, subcontractors, Program
participants, licensees or invitees, and nothing herein shall be construed as creating a
partnership or joint enterprise between City and Contractor. It is expressly understood and
agreed that no officer, member, agent, employee, subcontractor, licensee or invitee of the
Contractor, nor any Program participant hereunder, is in the paid service of City and that
City does not have the legal right to control the details of the tasks performed hereunder by
Contractor, its officers, members, agents, employees, subcontractors, Program participants,
licensees or invitees.
b. City shall in no way nor under any circumstances be.responsible for any property belonging
to Contractor, its officers, members, agents, employees, subcontractors, Program
participants, licensees or invitees, which may be lost, stolen, destroyed or in any way
damaged; and Contractor hereby indemnifies and holds harmless City and its officers,
agents, and employees from and against any and all claims or suits.
12. Indemnification, Insurance and Bonding
a. CONTRACTOR COVENANTS AND AGREES TO INDEMNIFY, HOLD
HARMLESS AND DEFEND, AT ITS OWN EXPENSE, CITY AND ITS
OFFICERS, AGENTS, SERVANTS AND EMPLOYEES FROM AND AGAINST
ANY AND ALL CLAIMS OR SUITS FOR PROPERTY LOSS OR DAMAGE
AND/OR PERSONAL INJURY, INCLUDING DEATH, TO ANY AND ALL
PERSONS, OF WHATSOEVER KIND 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,
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ACTIVITIES AND SERVICES OF THE PROGRAM DESCRIBED HEREIN,
WHETHER OR NOT CAUSED, IN WHOLE OR IN PART, BY ALLEGED
NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES,
CONTRACTORS OR SUBCONTRACTORS OF CITY; AND CONTRACTOR
HEREBY ASSUMES ALL LIABILITY AND RESPONSIBILITY OF CITY AND
ITS OFFICERS, AGENTS, SERVANTS, AND EMPLOYEES FOR ANY AND ALL
CLAIMS OR SUITS FOR PROPERTY LOSS OR DAMAGE AND/OR
PERSONAL INJURY, INCLUDING DEATH, TO ANY AND ALL PERSONS, OF
WHATSOEVER KINDS OR CHARACTER, WHETHER REAL OR ASSERTED,
ARISING OUT OF OR IN CONNECTION WITH THE EXECUTION,
PERFORMANCE, ATTEMPTED PERFORMANCE OR NON-PERFORMANCE
OF THIS CONTRACT AND AGREEMENT AND/OR THE OPERATIONS,
ACTIVITIES AND SERVICES OF THE PROGRAMS DESCRIBED HEREIN,
WHETHER OR NOT CAUSED IN WHOLE OR IN PART, BY ALLEGED
NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES,
CONTRACTORS OR SUBCONTRACTORS OF CITY. CONTRACTOR
LIKEWISE COVENANTS AND AGREES TO AND DOES HEREBY
INDEMNIFY AND HOLD HARMLESS CITY FROM AND AGAINST ANY AND
ALL INJURY, DAMAGE OR DESTRUCTION OF PROPERTY OF CITY,
ARISING OUT OF OR IN CONNECTION WITH ALL ACTS OR OMISSIONS
OF CONTRACTOR, ITS OFFICERS, MEMBERS, AGENTS, EMPLOYEES,
SUBCONTRACTORS, INVITEES, LICENSEES, OR PROGRAM
PARTICIPANTS, OR CAUSED, IN WHOLE OR IN PART, BY ALLEGED
NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES,
CONTRACTORS OR SUBCONTRACTORS OF CITY.
CONTRACTOR AGREES TO AND SHALL RELEASE CITY, ITS AGENTS,
EMPLOYEES, OFFICERS AND LEGAL REPRESENTATIVES FROM ALL
LIABILITY FOR INJURY, DEATH, DAMAGE OR LOSS TO PERSONS OR
PROPERTY SUSTAINED IN CONNECTION WITH OR INCIDENTAL TO
PERFORMANCE UNDER THIS CONTRACT, EVEN IF THE INJURY,
DEATH, DAMAGE OR LOSS IS CAUSED BY THE CITY'S SOLE OR
CONCURRENT NEGLIGENCE.
CONTRACTOR SHALL REQUIRE ALL OF ITS SUBCONTRACTORS TO
INCLUDE IN THEIR SUBCONTRACTS A RELEASE AND INDEMNITY IN
FAVOR OF THE CITY IN SUBSTANTIALLY THE SAME FORM AS ABOVE.
b. Contractor will maintain blanket fidelity coverage in the form of a bond in the amount of
(15,750.00), to insure against loss from the fraud, theft or dishonesty of any of
Contractor's officers, agents, trustees, directors or employees. The proceeds of such bond
shall be used to reimburse City for any and all loss of CDBG Funds occasioned by such
misconduct. To effectuate such reimbursement, such bond shall include a rider stating that
reimbursement for any loss or losses thereunder shall be made directly to City for the uses
and benefit of Contractor.
c. Contractor shall furnish certificates of insurance as proof that it has secured and paid for
policies of workers' compensation, public liability and automobile liability insurance covering
all risks incident to or in connection with the execution, performance, attempted
CDBG YEAR XXXV SUBRECIPIENT CONTRACT Rev. 08-24-09
Mental Health Association of Tarrant County Page 11
performance or nonperformance of this Contract. The amounts of such insurance shall not
be less than the maximum liability that can be imposed on City under the laws of the State
of Texas. Contractor understands and agrees that such insurance amounts may be revised
upward at City's option and that Contractor shall revise such amounts within thirty (30) days
following notice to Contractor of such requirements.
d. Contractor will submit documentation to City that it has obtained insurance coverage and
has executed bonds as required in this contract within thirty (30) days of the execution of
this Contract and prior to payment of any monies hereunder.
e. Any failure on part of the City to request certificate(s) of insurance shall not be construed as
a waiver of such requirement or as a waiver of the insurance requirements themselves.
Insurers of Contractor insurance policies shall be licensed to do business in the State of
Texas by the Department of Insurance or be otherwise eligible and authorized to business in
the state of Texas. Insurers shall be acceptable to City insofar as their financial strength and
solvency and each such company shall have a current minimum A.M. Best Key Rating Guide
rating of A: VII or other equivalent insurance industry standard rating unless otherwise
approved by City. Deductible limits on insurance policies shall not exceed $5,000 per
occurrence unless otherwise approved by City.
f. Any local, federal or other regulatory insurance or bonding requirements for the Program
that exceed those specified herein shall prevail.
g. Contractor shall agree to require its subcontractors to maintain applicable insurance
coverages, limits, and other requirements as those specified herein; and, Contractor shall
require its subcontractors to provide Contractor with certificate(s) of insurance documenting
such coverage. Also, Contractor shall require its subcontractors to have City and Contractor
endorsed as additional insured (as their interests may appear) on their respective insurance
policies. Contractor shall require its subcontractors to maintain builders risk insurance at the
limit of applicable project(s) costs when the value of materials involved exceeds $10,000 or
at a different limit value limit as specified by City.
13. lYlaiver of Immunity
If Contractor is a charitable or nonprofit organization and has or claims an immunity or
exemption (statutory or otherwise) from and against liability for damages or injury, including
death, to persons or property; Contractor hereby expressly waives its rights to plead defensively
such immunity or exemption as against City. This section shall not be construed to affect a
governmental entity's immunities under constitutional, statutory or common law.
14. Rernedie.r for Breach of Contract
Upon identification of possible breaches of this Contract, and prior to exercising its Termination
Rights under this Contract, City may elect to exercise any of the following Remedies: a) issuance
of a warning letter indicating that further failure to comply with applicable requirements will
result in serious sanction and giving the Contractor a limited time to correct the deficiency; b)
placing conditions upon award of future grants; c) directing the Contractor to stop incurring
costs until the deficiency is corrected and the correction is verified; d) requiring repayment of
CDBG Funds previously disbursed to the Contractor; and/or e) reducing the amount of future
grant awards or disallowing of future awards to the Contractor.
CDBG YEAR XXXV SUBRECIPIENT CONTRACT Rev. 08-24-09
Mental Health Association of Tarrant County Page 12
15. Termination
a. In addition to, and not in substitution for, other provisions of this Contract regarding the
provision of public services with CDBG Funds, pursuant to Title I of the Housing and
Community Development Act of 1974, as amended, (42 USC 5301 et seq.) and the CDBG
Regulations, it is expressly understood and agreed by and between the Parties that this
Contract is wholly conditioned upon the actual receipt by City of Federal CDBG Year
X= funds; that all monies distributed to Contractor hereunder shall be exclusively from
Federal monies received under said grant and not from any other monies of City; and that if
such funds under City's grant are not timely forthcoming, in whole or in part, City may, at
its sole discretion, terminate this Contract and City shall not be liable for payment for any
work or services performed by Contractor under or in connection with this Contract.
b. City may terminate this Contract whenever such termination is determined to be in City's
best interest, in event of Contractor's default, inability or failure to perform or to comply
with any of the terms herein, or, for other good cause.
c. The Parties acknowledge that CDBG Funds paid hereunder are intended to provide only
partial funding for Contractor's agency operations. City may terminate this Contract if non-
CDBG funds included in the Operating Budget are not forthcoming to Contractor during
the Contract term.
d. CDBG Funds provided hereunder may not be used as collateral for loans to Contractor to
defray agency operation expenses, and any attempted use of CDBG Funds for this purpose
will result in termination of this Contract by City.
e. Termination will be effected by written notice to Contractor, specifying the portions of the
Contract affected and the effective date of termination. Upon Contractor's receipt of such
termination notice, Contractor will:
• Stop work under the Contract on the date and to the extent specified by City;
• Cease expenditures of CDBG Funds, except as necessary for completion of the
portions of the Contract not terminated; and
• Terminate all orders and contracts to the extent that they relate to portions of the
Contract being terminated.
f. Contractor will return to City any unused CDBG Funds previously advanced by City under
this Contract within thirty (30) days of the effective date of Contract termination. City will
have no responsibility or liability for Contractor's expenditures or actions occurring after the
effective date of Contract termination.
16. Certification Regarding Lobbying
a. The undersigned representative of Contractor hereby certifies, to the best of his or her
knowledge and belief, that: No federal appropriated funds have been paid or will be paid, by
or on behalf of Contractor, to any person for influencing or attempting to influence an
officer or employee of any agency, a member of Congress, an officer or employee of
Congress or an employee of a member of Congress in connection with the awarding of any
Federal contract, the making of any Federal grant, the making of any Federal loan, the
entering into of any cooperative agreement and the extension, continuation, renewal,
amendment, or modification of any Federal contract, grant, loan or cooperative agreement.
Contractor shall require that the language of this certification be included in all subcontracts
or agreements involving the expenditure of Federal funds.
CDBG YEAR XXXV SUBRECIPIENT CONTRACT Rev. 08-24-09
Mental Health Association of Tarrant County Page 13
b. If any funds other than Federal appropriated funds have been paid or will be paid to any
person for influencing or attempting to influence an officer or employee of any agency, a
member of Congress, an officer or employee of Congress, or an employee of a member of
Congress in connection with this Federal contract, grant, loan or cooperative agreement,
Contractor shall complete and submit Standard Form-LLL, "Disclosure Form to Report
Lobbying," in accordance with its instructions.
c. This certification is a material representation of fact upon which reliance was placed when
this Contract was made or entered into. Submission of this certificate is a prerequisite for
making or entering into this Contract imposed by 31 USC Section 1352. Any person who
fails to file the required certification shall be subject to a civil penalty of not less than
$10,000.00 and not more than $100,000.00 for each such failure.
17. Miecellaneosr.r Provi�ions
a. All terms of this Contract shall apply to any and all subcontractors of Contractor who are in
any way paid with CDBG Funds or who perform any work in connection with Contractor's
Program.
b. The provisions of this Contract are severable, and, if for any reason a clause, sentence,
paragraph or other part of this Contract shall be determined to be invalid by a court or
Federal or state agency, board or commission having jurisdiction over the subject matter
thereof, such invalidity shall not affect other provisions which can be given effect without
the invalid provision.
c. City's failure to insist upon the performance of any term or provision of this Contract or to
exercise any right herein conferred shall not be construed as a waiver or relinquishment to
any extent of City's right to assert or rely upon any such term or right on any future
occasion.
d. Should any action, whether real or asserted, at law or in equity, arise out of the execution,
performance, attempted performance or nonperformance of this Contract, venue for action
shall lie in Tarrant County, Texas.
e. This written instrument and the exhibits attached hereto, which are incorporated by
reference and made a part of this Contract for all purposes, constitute the entire agreement
between the Parties concerning the work and services to be performed hereunder, and any
prior or contemporaneous, oral or written agreement which purports to vary from the terms
hereof shall be void. Any amendments to the terms of this Contract must be in writing and
must be approved by each Party.
£ All notices required or permitted by this Contract must be in writing and are deemed
delivered on the earlier of the date actually received or the third day following (i) deposit in
a United States Postal Service post office or receptacle; (ii) with proper postage (certified
mail, return receipt requested); and (iii) addressed to the other Party at the address set out in
the preamble of this Contract or at such other address as the receiving Party designates by
proper notice to the sending Party.
g. None of the performance rendered under this Contract shall involve, and no portion of the
CDBG Funds received hereunder shall be used, directly or indirectly, for the construction,
operations, maintenance or administration of any sectarian or religious facility or activity, nor
shall said performance rendered or funds received be utilized so as to benefit, directly or
I
ndirectly, any such sectarian or religious facility or activity.
CDBG YEAR X�D�V SUBRECIPIENT CONTRACT Rev. OS-2409
Mental Health Association of Tarrant County Page 14
h. Contractor represents that it possesses the legal authority, pursuant to any proper,
appropriate and official motion, resolution or action passed or taken, to enter into this
Contract and to perform the responsibilities herein required.
i. Contractor certifies that it has obtained a 501 (c) (3) Certificate from the Internal Revenue
Service. Contractor shall notify City in writing of any changes to its 501 (c) (3) tax-exempt
status during the term of this Contract.
[SIGNATURES APPEAR ON FOLLOWING PAGE]
CDBG YEAR 7CXXV SUIIRECIPIENT CONTRACT Rev. 08-24-09
Mental Health Association of Tarrant County Page 15
r
�uthorize the Execution• •11 and Interdepartmental Letters of Agreement •. Social and Housing
ervices for •a. 119010 Funded with Grant Fundsfrom ! States Departmentof
rant. Emergenciv Shelter Grant
md Housing Opportunities for Persons with AIDS Program
It is recommended that the City Council:
l . Authorize the City Manager, or his designee, to execute contracts for
federal grant funds for Program Year 2009-2010 for Community
Development Block Grant, Emergency Shelter Grant and Housing
Opportunities for Persons with AIDS grant funds, contingent upon receipt
of adequate funding from the United States Department of Housing and
Urban Development;
2. Authorize the City Manager, or his designee, to extend or renew the
contracts for up to one year if an agency requests an extension and such
extension is necessary for completion of the program; and
3. Authorize the City Manager, or his designee, to amend the contracts, if
necessary, to achieve program goats, provided any amendment is within
the scope of the program and in compliance with all applicable laws and
regulations governing the use of federal grant funds.
1 !s
On April 15, 2009, the City's Action Plan for use of federal grant fiends
under the Community Development Block Grant Program (CDBG),
HOME Investment Partnerships Program (HOME), Emergency Shelter
Grant (ESG), and Housing Opportunities for Persons With AIDS Program
(HOPWA) (M&C G-16513) was submitted to the United States
Department of Housing and Urban Development (HUD). On May 1,
2009, HUD requested a revised Action Plan that provided more detail on
the programs to be undertaken. The City's revised Action Plan (M&C
G-16600) was submitted to HUD on June 23, 2009, and approved on June
27, 2009.
The revised Action Plan allocated $1,043,688.00 in CDBG funds to public
services activities including child care, youth and senior services and
other housing related services that benefit primarily Iow and moderate
income or disabled and disadvantaged populations. It also allocated
$865,754.00 in HOPWA funds to non—profit organizations providing
housing and supportive services to persons with AIDS and awarded
$27%757.00 in ESG funds to homeless services providers and local
emergency shelters. The City's Community Development Council
reviewed grant fund proposals and heard presentations in public meetings
and recommended grant awards as part of the Action Plan development
process. Contracts will be executed with the agencies listed below and in
accordance with HUD recommendation, interdepartmental letters of
agreement executed by the respective department heads will be used to
govern all grant funded activities implemented by City departments. All
contracts and interdepartmental letters of agreement will authorize
reimbursement of eligible costs as of their initial dates.
In order to approve the revised Action Plan, HUD required that the eight
programs listed below have a contract term of 11 months from July 1,
2009, to May 31, 2010, for their full grant award. Each agency or
department was notified of the shortened contract period and agreed with
the adjustment.
Or�ani7.atiora
Senior Citizen Services —Como Senior Citizens
Senior Citizen Services —Diamond Hill Senior Center
Senior Citizen Services —Doc Session Senior Citizens
YWCA Fort Worth and Tarrant County —Child Development Program
The Salvation Army—S.T.A.R.T.
CFW—PACSD—Northside Community Action Partners (CAP) Rehabilitation
CFW—PACSD—Northside Community Action Partners (CAP) Utility Payments
CFW—PACSD—Como I(ids
CFW—PACSD—Woodhaven After School Enrichment
The agencies implementing the programs and activities Listed below will
be awarded contracts for a full 12 month term.
Gr�anization
AB Christian Learning Center —Stop Six Community Go Center
Boys and Girls Club of Greater Fort Worth—Estrellas
Cenikor Foundation —Substance Abuse Sevcs/Homeless
Child Care Associates —Child Care
CJ's Studio of Performing Arts —Dance Studio
Clayton YES —Greenbrier Preschool
Clayton YES —School Aged Child Care
Cook Children's Health Care System —Save a Smile
Cornerstone Assistance —New Life Center
Cultural Center of Americas—GED/Adult Literacy in Spanish
Day Resource Center for the Homeless
EFW Montessori School, Inc. —Montessori Child Care
Fort Worth Housing Authority—Amaka Child Care Center
Girls, Inc., of Tarrant County —Girl Power
CFW—HED Housing Counseling and Foreclosure Prevention
JMAC Youth Center of Tarrant County
The Ladder Alliance —Employment Training
Latin Arts Association, d/b/a Artes de la Rasa— After School Drama Program
Meals on Wheels, Inc., of Tarrant County -Home Delivered Meals
Mental Health Association of Tarrant County. Ombudsman Program
Mental Health Association of Tarrant County -Mental Health Advocate
Northside InterChurch Agency -Good Works/Buenas Obras
REACH, Inc. -Project Ramp
Tarrant Area Food Bank -Community Kitchen
United Community Centers -Crisis Intervention Program
UNT Health Science Center -Community Go Center
YWCA �My Own Place
TOTAL
ttni7,ation
Presbyterian Night Shelter —Emergency Shelter
SafeHaven of Tarrant County —Shelter Operations
SafeHaven of Tarrant County —Supportive Childcare
YWCA Fort Worth and Tarrant County —Supportive Living
City of Fort Worth PACSD—SHIPP
TOTAL LSG
Housine Opt�ortunities For Persons With AIDS (HOPWAI•
r�n7,ntion
AIDS Outreach Center-HOPWA
AIDS Resources of Rural Texas-HOPWA
Catholic Charities -Lady Hogan Project
Tarrant County Samaritan Housing, Inc.�Supportive Services
TOTAL HOPWA
Fhi'AL INFO ATIQN:
The Financial Management Services Director certifies that upon approval
of the above recommendations funds will be available in the current
operating budget, as appropriated, of the Grants Fund, contingent upon
approval and receipt of adequate funding from HUD for the term
beginning June 1, 2009, and ending May 31, 2010.
III * , •. i1.
it i� i ? i� ii :. •. "
•* a
IN WITNESS WHEREOF, the Parties hereto have executed three copies of this Contract in
Fort Worth, Tarrant County, Texas, this tom day of Q0Ci�19� , 20 ()9_.
CITY OF FORT WORTH
i. lvi. i11��RIls
Assistant City Manager
APPROVED AS TO FORM AND LEGALITY:
City Attorney
ATTEST:
STATE OF TEXAS �
COUNTY OF TARRANT
Mental Health Association of Tarrant County
terim Executive Director
ntract Authorization
i
•
This instrument was acknowledged before me on , 20by T.M.
Higgins, the Assistant City Manager of the City of Fort Worth, on behalf of the City of Fort
Worth.99
MARIA S. SANCHEZ
NOTARY PUBLIC
STATE OF TEXAS
My Comm. Exp.
STATE OF TEXAS �
COUNTY OF TARRANT �
No ary Public, State of Texas
This instrument was acknowledged
Exrlel Vvgzl, the h Executive Director of Mental H ssociation of Tarrant County, a
-e%Texas non-profit corporation, on behalf of said corporation.
aO.�rpYPUg�,O LINDA FULMER
. � ,, NOTARY PUBLIC
�oF� STATE OF TEXAS
MY COMM. EXP. 1-8-11
Notary Public, State of Texas
®FFICIAL RECOR[�
CITY SECRETAR�d
WORTH,
CDBG YEAR XXXV SUBRECIPIENT CONTRACT
Mental Health Aesociation of Tarrant County
Rev. 08-24-09
FT. rrORTH' TX Page 16
�''
Long Term Care Ombudsman SCOPE OF SERVICES
PROGRAM SUMMARY
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)
CONTRACT NO.
June 1, 2007 -May 31, 2010
PERIOD
$15, riv
AMOUNT
This Scope of Services is based on the proposal prepared and submitted by the Subrecipient through the City of Fort
Worth's annual Request for Proposal (RFP) process. The Subrecipient agrees to operate this Community Development
Block Grant (CDBG) program in a manner consistent with the program delivery stated in the approved proposal.
However, in the event of any conflict between the proposal and any provision contained, herein, this Agreement shall
control.
The Mental Health Association of Tarrant County will provide long term care ombudsman services to seven or more inner
city nursing homes located within the City of Fort Worth. The Long Term Care Ombudsman Program will include the
following tasks and activities; 7 weekly monitoring visits to nursing facilities, conduct resident interviews, investigate and
resolve complaints, and provide in-service educational programs for nursing home staff. All services will be provided at
the identified nursing homes primarily during business hours Monday through Friday. From time to time, services may be
provided on the weekends or in the evenings, as needed by the facilities and their residents.
The purpose of the program will be to prevent abuse and neglect of residents of inner city nursing homes. The specific
objectives, goals and level of services to be provided are listed below along with the geographical location of clients served.
All services will be provided from 1 June 2009 to 31 May 2010 (dates).
The CDBG funds will be used to pay for salary of the ombudsman staff (describe costs) which is consistent with Exhibit
C- Detailed Budget.
REGULATORY CLASSIFICATION:
National Objective Citation: 24 CFR 570.208(a)(2){a} Limited Clientele
Regulatory Citation: 24 CFR 570.201(e) Public Service
Based on the nature of the service provided, Subrecipient Mental Health Association of Tarrant County will maintain
documentation that verifies that 51 % (at least 51 % or 100% depending on nature of service) of clients served by the Long
Term Care Ombudsman program are income eligible with current household incomes under 80% of Area Median Income
(AMI) as established by the Department of Housing and Urban Development (HUD).
Site Address: 7 or more inner city nursing homes located within Fort Worth city limits.
Client Beneficiary Location (Neighborhood, District, Citywide...): Citywide
PROGRAM GOALS:
(Goals should be broad and describe the general intention of the program.)
Prevent abuse and neglect of residents in long-term care facilities.
(Objectives should be specific processes or methods the agency will use to fulfill the listed goals. Descriptions should be precise
and concrete.)
12esolve 95% of substantiated complaints
PROGRAM SERVICES and ACTIVITIES Totat Units of Services for Year
Level of service should be identified in a quantifiable unit and directly related to specified objectives. These
activities should be consistent with activities listed on Exhibit B- Program Schedule. Activities should also be
consistent with those required by IDIS.
Number of unduplicated clients 850
Conduct weekly monitoring visits to 7 nursing homes 350
Conduct resident interviews 12,000
Investigate/resolve complaints 125
Provide in-service educational programs for facility staff 7
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CITY OF FORT WORTH EXHIBIT C
CDBG YEAR XXXV
Page 1 of 3
CONTRACT PERIOD From: 6/1/2009 To: 5/31/2010
Name of Sub Grantee Mental Health Association of Tarrant County Name of Program: Long Term Care Omb.
Program
Cost Category Budget Funds a b c d
PERSONNEL SERVICES
Salaries $32,635.00 $ 15,750400 $ 16,885.00
FICA $ 11204.88 $ - $ 11204.88
Life Insurance $ 191.00 $ - $ 191.00
Health Insurance $ 5,515.06 $ - $ 51515006
Employment Tax - State $ 246.00 $ - $ 246.00
Employment Tax - Federal $ - $ - $ -
Worker's Comp $ 150.00 $ - $ 150.00
Retirement $ 11110.00 $ 1,110.00
SUPPLIES
Office Supplies $ 332.00 $ - $ 332.00
Postage $ 198.00 $ - $ 198.00
Teaching Aids $ - $ - $ -
Food Supplies $ - $ - $ -
Other Operating Expenses $ - $ - $ -
CONTRACTUAL SERVICES
Telephone $ 392.00 - $ 392.00
Electric $ 749.00 $ - $ 749.00
Gas $ - $ - $ -
Water/Waste Disposal $ - $ - $ -
Rent [Building] $ - $ - $ -
Custodial Services $ 242.00 $ - $ 242.00
Office Equipment Rental $ 942.00 $ - $ 942.00
Printing $ 268.00 $ - $ 268.00
Repairs $ 294.00 $ - $ 294.00
Fidelity Bond $ 7.00 $ - $ 7.00
Liability Insurance $ 361.00 $ - $ 361.00
Legal & Accounting $ 698.00 $ - $ 698.00
Private Auto Allowance - Local $ 1,200.00 $ - $ 1/200000
Advertising $ - $ - $ -
Conference & Seminars $ - $ - $ -
Contractual Services $ -
Miscellaneous $ -
CAPITAL OUTLAY $ -
Ice urns ure $ - -
Computer Equipment $ - $ -
Other: Described $ - $ -
$0.00 $0.00
TOTAL $46,734.94 $15,750.00 $30,984.94 $0.00 $0.00 $0.00
MATCHING
FUND SOURCES
[ajUnited Way of Tarrant County
[b]
[cJ
[dj
1
2
3
4
5
6
7
TOTAL STAFF SALARIES
CATEGORY
FICA
Life Insurance
Health Insurance
Employment Tax
Worker's Comp
Retirement
TOTAL FRINGE BENEFITS
r
Hourly Annual °lo of
Position / Title Rate Hours Time
Staff Ombudsman 15.89 2080 48°�
TOTAL PERSONNEL SERVICES
of
Payroll
FRINGE BENEFITS
Amount
15,750
15,750
Paid %Paid
Amount by Agency by CDBG Amount
CATEGORY
Telephone
Electric
Gas
Waste/Water Disposal
Other
Total Utilities
1
2
3
TOTAL BUILDING LEASE
CATEGORY
Fidelity Bond
Liability Insurance
Legal & Accounting
Office Supplies
Postage
Printing
Mileage
Advertising
TOTAL OTHER EXPENSES
EVENT
a
UTILITIES
AVERAGE COST PER
MONTH
ILDING
NUMBER OF MONTHS
Page 3 of 3
AMOUNT
0
0
0
0
0
BUILDING COST PER SQUARE
LOCATION NO. SQUARE FOOT FOOT AMOUNT
OTHER EXPENSES
TOTAL CHARGE
CHARGED TO CDBG
CONFERENCES AND SEMINARS
TOTAL CHARGE
1
2
3
TOTAL CONFERENCES AND SEMINARS
ITEM
N/A
N/A
N/A
N/A
AMOUNT
CHARGED TO CDBG AMOUNT
OFFICE EQUIPMENT RENTAL
TOTAL CHARGE
%CHARGED TO CDBG
1 Copier Lease 0 070
2
70TAL OFFICE EQUIPMENT RENTAL
EXHIBIT D
CITY OF FORT WORTH IIOIJSING & ECONOMIC DEVELOPMENT
Audit Certification Form
0 c%
Subrecipient: d� -ti I- / �s% c Fiscal Year Ending:/ +� / t�
Mo Day Yr
❑ During the fiscal year in which funds will be received, we will exceed the federal
expenditure threshold of $500,000. We will have our Single Audit or Program Specific Audit
completed and will submit the X133 audit report within nine (9) months after the end of the
audited fiscal year or thirty (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
$500,000 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 Single Audit or Program Audit is not required.
Federal Grantor
Pass Through
Grantor
Program Name &
CFDA Number
Contract
Number
Expenditures
Total Federal Expenditures for this Fiscal Year
Authorized Signature (Must be CFO, CEO or equivalent)
Title (Must be CFO, CEO
Phone Number
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 OMB
Circulars X133 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.
Mental Health Associationof Tarrant County
Long Term Care Ombudsman
CONFLICT OF INTEREST
All Applicants
The standards in OMB Circular A -I 10, Subpart C, provide that no employee, officer, or agent shall participate in the
selection, award, or administration of a contract supported by Federal funds if real or apparent conflict of interest would be
involved. Such a conflict would arise when an employee, officer, or agent, any member of his or her immediate family, his
or her partner, or an organization which employs or is about to employ any of the parties indicated herein, has a financial
or other interest in the firm selection for an award.
CDBG and HOME Applicants Only
The CDBG regulations at 24 CFR 570 570.611 and HOME regulations at 24 CFR 92,356 provide that no person who is
an employee, agent , consultant, officer, or elected official or appointed official of the recipient or Subrecipient that are
receiving CDBG or HOME funds and (1) who exercises or has exercised any functions or responsibilities with respect to
activities assisted with CDBG funds; or (2) who is in a position to participate in a decision -making process or gain inside
information with regard to these activities, may obtain a financial interest from a CDBG-assisted or HOM&assisted
activity, or have any interest in any contract, subcontract, or agreement with respect thereto, or the proceeds, thereunder,
either for themselves or those with who they have family or business ties, during their tenure or for one (1) year thereafter.
IF NO CONFLICTS EXIST, COMPLETE THE FOLLOWING:
I certify that no conflict of interest exists between The City of Fort Worth and
(Name of Organization)
u I certify that no conflict of interest exists between the subcontractors of and
(Name of Organization)
IF THERE IS A CONFLICT, COMPLETE THE FOLLOWING:
I certify that a conflict of interest does exist between The City of Fort Worth and
(Name of Organization)
0 I certify that a conflict of interest does exist between
and
(Name of subcontractor)
(Name of Organization)
Describe the nature of the conflict of interest below: (Please identify the individual, employment, and the conflict or potential conflict [their affiliation with your
Attachment I
CITY OF FORT WORTH
HOUSING AND ECONOMIC DEVELOPMENT DEPARTMENT
COMPLIANCE DIVISION
REQUEST FOR FUNDS
AGENCY: Mental Health Association of Tarrant County PROGRAM: Long Term Care Ombudsman
ADDRESS: 3136 West 4th Street CONTRACT NUMBER:
Fort Worth, TX 76107 CONTRACT AMOUNT: $150750
SECTION I (AGENCY)
1. Reimbursement Request
A Expenditures:
B. Reimbursement
2. Requested By:
A Agency
(Name)
SECTION li (CITY)
1. BUYSPEED -Purchasing Request
CONTRACT DATE:
DATE OF REQUEST:
IDIS NUMBER:
CURRENT MONTH
A BUYSPEED INPUT; Vendor/PO Number/Requisition Number.
B. Fund/AccounUCenter.
C. Total Amount of this Request $
SECTION ill (CITY)
1. Verification
A Contract Compliance Specialist
(Name)
B. Accounting
(Name)
2. Authorization
A Grants Manager Barbara Asbury
(Name)
B. Director Jesus "Jay" Chapa
(Name)
(Signature)
(Signature)
(Signature)
(Signature)
(Signature)
Distribution:
1 Copy -Accounting
1 Copy -Compliance
Note: Any Request for Funds that exceed $8500 require the signature of both Grants Manager/Designee and Director
CUMULATIVE
(Date)
(Date)
(Data)
(Date)
(Date)
Attachment II
AGENCY
CITY OF FORT WORTH
HOUSING & ECONOMIC DEVELOPMENT DEPARTMENT
COMPLIANCE DIVISION
DETAIL STATEMENT OF COSTS
of Tarrant
MHA Lona Term Care Ombudsman
CONTRACT N0.
TO
REPORT PERIOD
COST CATEGORY
ACCOUNT
PROGRAM
BUDGET
MONTHLY
EXPENDITURES
CUMULATNE
TO DATE
BALANCE
PERSONAL SERVICES
Salaries
516 010
15 570.00
FICA
518 010
Life Insurance
518 050
Health Insurance
518 060
Unemployment Tax- State
518 090
Worker's Comp
518 040
Retirement
518 070
SUPPLIES
Office Supplies
521 010
Postage
521 020
Teaching Aids (Equipment)
522 030
Food Supplies
522 030
Other Operating
Supplies
523 300
CONTRACTUAL SERVICES
Telephone
535 040
Electric
535 020
Gas[Utility]
535 010
Water/Waste Disposal
535 030
Rent[Building]
537 010
Custodial Services
539 220
Office E ui ment Rental
537 030
Printing
533 030
Repairs
536 010
Fidelity Bond
538 210
Liability Insurance
534 020
Legal & Accounting
538 050
Private Auto Allowance- Local
532 130
Advertising
533 010
Conferences & Seminars
531 180
Contractual Services
539 120
CAPITAL OUTLAY
Furniture Fixtures
541 330
Office Equipment Computers
541 370
Other E ui went 1
541 320
TOTAL
$15 570.00
$0.00
$0.00
Contractor's Certification: 1 certify that the costs incurred are taken from the books of account and that such costs are valid
and consistent with the terms of the agreement.
NAME and TITLE OF AUTHORIZED OFFICER SIGNATURE and DATE
PREPARE ONE FORM FOR EACH SOURCE OF FUNDS
DISTRIBUTION:
1 Copy-Aocoanting
1 Copy -Compliance
I Copy - Agency
Attachment III
CITY OP FORT WORTH
HOUSING & ECONOMIC DEVELOPMENT DEPARTMENT
COMPLIANCE DIVISION
EXPENDITURES WORKSHEET
Mental Health Association of Tarrant County
Agency
MHA Long Term Care Ombudsman
Program
0
NO
DATE
CHECK NO
PAYEE
DESCRIPTION
ACCOUNT NO.
AMOUNT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
TOTAL
$0.00
TITLE OP AUTHORIZED OFFICER 31GNATURE AND DATE
CITY OF FORT WORTH Attachment IVa
HOUSING AND ECONOMIC DEVELOPMENT DEPARTMENT
COMPLIANCE DIVISION
CDBG YEAR XXXV
1. Name and Address of Sub=Grantee
2. Project Name Long Term Care Ombudsman
Mental Health Association of Tarratn Count
3136 West 4th Street 3. Contract No.
Fort Worth, TX 76107 4. Date of Request
Month & Year
S. Program Services and Activities
Current Month Cumulative
Number of New
Households and/or
Persons Served
6 Direct Benefit
Continued
Extremely Low Very Low Income Low Income
Income (0<30%) (31-60%) (61-80%) Above Low Income (80%>)
Current Month
Cumulative
Household Size 1 2 3 4 5 6 7 8
NO% $13,850 $15,850 $17,800 $19,800 $21,400 $22,950 $24,550 $26,150
31050% $23,100 $26,400 $29,700 $33,000 $35,650 $38,300 $40,900 $43,550
51=80% $36,950 $42,250 $47,500 $52,800 $57,000 $61,250 $65,450 $69,7 00
Certification: The undersigned, hereby, gives assurance that to the beat of my knowledge and belief, the data included in this report is true and accurate. It is also
acknowledged that the provision of false information could leave the certifying official subject to the penalties of federal, state, and local law.
Date: Submitted by: Phone No.
Signature Required
CITY OF FORT WORTH
HOUSING AND ECONOMIC DEVELOPMENT DEPARTMENT
COMPLIANCE DIVISION
CDBG YEAR XXXV
Name and Address of SubwGrantse
2. Project Name Long Term Care Ombudsman
Mental Health Association of Tarram
136 West 4th Street 3, contract No,
Worth, TX 76107 $. Date of Request
Month 8 Year
Direct Benefit Data
meNcan
elan
merican
dIan/Alaskan Native
®tive Hawalianlpthei
�cific Islander
dIan/Alaskan Native
White
clan &White
dian/Alaskan Native
Black African
IM uiti-Reclel
I�1
Household and /or Persona
Current Month Cumulative
Female Head of Household
idonth
ive
Attachment IVb
The undersigned, hereby, gives assurance that to the best of my knowledge and belief, the data included in this report is true and accurate. It is also
1 that the provision of false information could leave the certfrying official subject to the penakiea of federal, state, and local law.
Date: Submitted by:
Phone No.
wired
Ethnicity- Report whether client ident�es themselves as Hispanic or Non -Hispanic
Race- Identify the category chosen by the client
CITY OF FORT WORTH Attachment V
HOUSING AND ECONOMIC DEVELOPMENT DEPARTMENT
COMPLIANCE DIVISION
CDBG YEAR XXXV
Agency/Address 2. Program Name: MHA Long Term Care Ombudsman
Mental Helath Associaton of Tarrant County 3. Contract No: Contract Date:
3136 West 4th Street Contract Amount: 15 750
mob
Fort Worth, TX 76107 4. Date of Request:
Month & Year
5. PROGRAM SERVICES AND ACTIVITIES: CURRENT CUMULATIVE
"Goals listed on Contract Exhibits A&B should be listed here.
Number of unduplicated clients
Conduct weekly monitoring visits to 7 nursing homes
Conduct resident interviews
Investigate/resolve complaints
Provide in-service educational programs for facility staff
6. SCOPE OF WORK NARRATIVE:
7. PROBLEMS ENCOUNTERED / SOLUTIONS PROPOSED:
Mow
8. ANTICIPATED ACTIVITY DURING THE NEXT MONTH:
Certification: The undersigned, hereby, gives assurance that tc the best of my knowledge and belief, the data included in this report is true and accurate. tt is
also acknowledged that the provision of false information could leave the certifying official subject to the penalties of federal, state, and local law.
Date: Phone No.
Signature Required
3
0
w 00wh
3
09
m