HomeMy WebLinkAboutContract 41932 (2)CITY SECRETARY
CONTRACT NO. J R 3
A'MENT FOR SERVICES
THI5 AGREEMENT ("Agreement") is made and entered into by and between THE
CITY OF FORT WORTH, a home rule municipal corporation of the State of Texas
(hereinafter referred to as "City"), acting by and through Susan Alams, its duly authorized
Assistant City Manager, and SAFEHAVEN, a nonprofit Texas corporation (hereinafter referred
to as "Contractor"), acting by and through Ms. Mary Lee Hafley, its duly authorized
CEO/President.
RECITALS
WHEREAS, Contractor provides child care services; and
WHEREAS, such services serve a public purpose in serving low to moderate income individuals
which benefits the Fort Worth community; and
WHEREAS, City and Contractor desire to enter into a contract to have such services provided
which benefit the Fort Worth community.
NOW, THEREFORE, in consideration of the mutual covenants herein expressed, the parties
agree as follows:
AGREEMENT
1. SCOPE OF SERVICES.
Contractor covenants and agrees to fully perform, or cause to be performed, with
good faith and due gence, all services and objectives described in Exhibitattached and
incorporated herein for all purposes incident to this Agreement ("Services").
2. COMPENSATION.
In consideration of the Services to be performed hereunder by Contractor, City agrees to
reimburse Contractor via monthly installments up to a total amount not to exceed Five Thousand
Five Hundred and No/100 ($5,500.00) ("Funds"). Any funds not requested as provided in
Section 3 shall remain with the City.
AFFICIAL REC®Itli
CITY SECRETA��
3. REPORTING OF EXPENDITURES.
a. Contractor shall deliver to City a monthly statement of the request for reimbursement
("Request for Reimbursement") of Funds detailing how the Funds were expended by
Contractor to accomplish performance of the Services. All expenditures included in the Request
for Reimbursement must be eligible for reimbursement by federal funds as determined by City in
its sole discretion. The monthly statement shall be in the same format as the attached Exhibit
"B" which is incorpoiated herein for all purposes.
b. Each month's Request for Reimbursement is due to City by 5:00 p.m. on the 10h day
of the following month (for example all expenses for June must be submitted to City by July
10th). City will not accept late Requests for Reimbursement. If a timely Request for
Reimbursement is not received for any month, Conti actor will not receive reimbursement for that
month. Notwithstanding the above, the Request for Reimbursement for the month of September
shall be due by September 23, 2011 The failure to make such request by September 23, 2011
shall result in no funds being paid for the month of September.
c. Each Request for Reimbursement must be prepared and signed by an authorized
representative of the Contractor.
d. If the Contractor deviates from the reporting requirements in Sections 3(a), 3(c) or
Section 4, the Contractor will be considered in non-compliance with this Agieement. City will
notify Contractor of such non-compliance, and Contractor will have ten (10) business days to
cure such non compliance (the "Cute Period"). If the noncompliance is not cured by the
expiration of the Cure Period to City's satisfaction, Contractor will be in default of this
Agreement and will not receive reimbursement.
e. Any non-compliance by Contractor under Section 3 of this Agreement may jeopardize
the Contractor's ability to receive future funding from the City.
4. REPORTING OF SERVICES.
A report of services shall accompany each Request for Reimbursement. The report of
services shall be in substantial conformity with the attached Exhibit "C" and Exhibit "C-1'
and Exhibit ` C-2", if applicable. Contractor shall be subject to a review by the City of its
services and activities in performance of this Agreement.
5. TERM AND TERMINATION.
a. This Agreement shall be for a term beginning June 1, 2011 and ending September
30, 2011.
b. Either party may cancel this Agreement upon thirty (30) days notice in writing to
the other party of such intent to terminate.
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c. The City may terminate this Agreement immediately for any violation by
Contractor of Section 3, "Request for Reimbursement" or Section 4, "Reporting of Services,"
above.
d. In the event no funds or insufficient funds are appropriated by the City in any fiscal
period for any payments hereunder City will notify the Contractor of such occurrence and this
Agreement shall terminate on the last day of the fiscal pei iod for which appropriations were
received without penalty or expense to City of any kind whatsoever except as to the portions of
the payments herein agreed upon for which funds shall have been appropriated.
6. RIGHT TO MONITOR SERVICES.
Contractor covenants and agrees to fully cooperate with City in monitoring the
effectiveness of the Services to be performed under this Agreement, and City shall have access at
all reasonable hours to offices and records of Contractor for the purpose of such monitoring
during the term of this agreement.
7. INDEPENDENT CONTRACTOR.
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 Services performed hereunder and all persons performing same,
and shall be solely responsible for the acts and omissions of its officers, agents, servants,
employees subcontractors and program participants. The doctrine of respondeat superior shall
not apply as between the City and Contractor its officers, agents, servants, employees
subcontractors, or program participants, 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, agent, employee, or subcontractor of Contractor is in the paid service of
City.
8. LIABILITY AND INDEMNIFICATION.
CITY SHALL IN NO WAY OR UNDER ANY CIRCUMSTANCES BE
RESPONSIBLE FOR ANY PROPERTY BELONGING TO CONTRACTOR, ITS
OFFICERS, AGENTS, EMPLOYEES, SUBCONTRACTORS, PROGRAM
PARTICIPANTS, OR RECIPIENTS, WHICH MAY BE LOST, STOLEN, DESTROYED,
OR IN ANY WAY DAMAGED. CONTRACTOR HEREBY AGREES TO INDEMNIFY
AND HOLD HARMLESS THE CITY, ITS OFFICERS, AGENTS, AND EMPLOYEES
FROM AND AGAINST ANY AND ALL CLAIMS OR SUITS CONCERNING SUCH
PROPERTY. 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 AGREEMENT AND/OR THE
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OPERATIONS, ACTIVITIES AND SERVICES 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 AGREEMENT AND/OR THE OPERATIONS, ACTIVITIES
AND SERVICES 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, PROGRAM PARTICIPANTS, OR RECEIPIENTS, WHETHER OR NOT
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 AGREEMENT, EVEN IF THE INJURY, DEATH, DAMAGE OR LOSS IS
CAUSED BY CITY'S SOLE OR CONCURRENT NEGLIGENCE.
Contractor shall require all of its subcontractors and Recipientsto include in their
subcontracts a release and indemnity in favor of City in substantially the same form as
above.
9. MISAPPRORIATION OF FUNDS.
IN THE EVENT IT IS DETERMINED THAT CONTRACTOR HAS MISUSED,
MISAPPLIED OR MISAPPROPRIATED ALL OR ANY PART OF THE FUNDS
PROVIDED HEREUNDER, CONTRACTOR AGREES TO INDEMNIFY, HOLD
HARMLESS AND DEFEND THE CITY OF FORT WORTH, ITS OFFICERS, AGENTS,
SERVANTS, AND EMPLOYEES, FROM AND AGAINST ANY AND ALL CLAIMS OR
SUITS RESULTING FROM SUCH MISUSE, MISAPPLICATION OR
MISAPPROPRIATION.
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10. CHARITABLE IMMUNITY.
If Contractor, as a charitable or nonprofit organization, has or claims an immunity or
exemption (statutory or otherwise) from and against liability for damage or injury, including
death to persons or property, Contractor hereby expressly waives its rights to plead defensively
such immunity or exemption as against the City.
11. ASSIGNMENT AND SUBCONTRACTING.
Contractor shall not assign or subcontract all or any part of its rights, privileges or duties
under this Agreement without the prior written consent of City, and any attempted assignment or
subcontract of same without such prior written approval shall be void and constitute a breach of
this agieement.
12. COMPLIANCE WITH LAWS, ORDINANCES, RULES AND REGULATIONS.
Contractor, its officers, agents, employees and subcontractors, shall abide by and comply
with all laws, federal, state and local, including all ordinances rules and regulations of City. It is
agreed and understood that, if City calls to the attention of Contractor any such violation on the
part of Contractor or any of its officers, agents, employees or subcontractors, then Contractor
shall immediately desist from and correct such violation.
13. NON-DISCRIMATION COVENANT.
Contractor, in the execution, performance or attempted performance of this contract and
Agreement, will not discriminate against any person or persons because of disability, age
familial status, sex, race, religion color, national origin, gender identity, gender expression or
transgender nor will Contractor permit its officers, agents, employees, or subcontractors to
engage in such discrimination. This Agreement is made and entered into with reference
specifically to Chapter 17, Article III, Division 3, of the City Code of the City of Fort Worth
( `Discrimination in Employment Practices"), and Contractor hereby covenants and agrees that
Contractor, its agents, employees and subcontractors have fully complied with all provisions of
same and that no employee or employee -applicant has been discriminated against by either
Contractor, its agents, employees or subcontractors.
14. INSURANCE.
Contractor shall procure and shall maintain during the term of this Agreement the
following insurance coverage:
1. Commercial General Liability (CGL): $1,000,000 per occurrence, with a
$2,000,000.00 annual aggregate limit, in a form that is acceptable to the
City s Risk Manager.
2. Non -Profit Organization Liability or Directors & Officers Liability:
$1,000,000 per occurrence, with a $1,000,000 annual aggregate limit, in a
form that is acceptable to the City's Risk Manager.
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Contractor's insurer(s) must be authorized to do business in the State of Texas for the lines of
insurance coverage provided and be currently rated in terms of financial strength and solvency to
the satisfaction of the City's Risk Manager
Each insurance policy required herein shall be endorsed with a waiver of subrogation in favor of
the City. Each insurance policy required by this Agieement, except for policies of worker's
compensation or accident/medical insurance shall list the City as an additional insured. City
shall have the right to revise insurance coverage requirements under this Agieement.
Contractor further agrees that it shall comply with the Worker's Compensation Act of Texas and
shall provide sufficient compensation insurance to protect Contractor and City from and against
any and all Worker's Compensation claims arising from the work and services provided under
this Agreement.
15. RIGHT TO AUDIT RECORDS.
Contractor agrees that the City shall, until the expiration of three (3) years after final
payment under this Agreement, have access to and the right to examine, whether in hard copy or
electronic format, any directly pertinent books, documents papers and records of the Contractor
involving transactions relating to this Agreement. Contractor agrees that the City shall have
access during normal working hours to all necessary Contractor facilities and shall be provided
adequate and appropi late workspace in order to conduct audits in compliance with the provisions
of this section. The City shall give Contractor reasonable advance notice of intended audits.
Contractor further agrees to include in all of its subcontractor and Recipient agreements
hereunder a provision to the effect that the subcontractor and/or the Recipient agrees that the
City shall, until the expiration of three (3) years after final payment under the subcontract or this
Agreement, have access to and the right to examine, whether in hard copy or electronic format,
any directly pertinent books, documents papers and records of such subcontractor involving
transactions to the subcontract or this Agreement, and further that City shall have access during
normal working hours to all subcontractor or Recipient facilities and shall be provided adequate
and appropriate workspace in order to conduct audits in compliance with the provisions of this
paragraph City shall give subcontractor or Recipient reasonable advance notice of intended
audits. This Section 16 shall survive the expiration of the term of this Agreement
16. GOVERNING LAW AND VENUE.
This Agreement shall be governed by and construed under the laws of the state of Texas.
Should any action, whether real or asserted, at law or in equity at ise out of the execution
performance, attempted performance of this Agreement, venue for said action shall he in Tarrant
County, Texas.
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17. NOTICES.
Notices to be provided hereunder shall be sufficient if forwarded to the other party by
hand -delivery or via U.S. Postal Service certified mail, postage prepaid to the address of the
other party shown below:
Jesus "Jay" Chapa
Director of Economic Development
City of Fort Worth
1000 Throckmorton St.
Fort Worth, Texas 76102
18. NO WAIVER.
Ms. Mary Lee Hafley
CEO/President
Safehaven
6815 Manhattan Blvd., Suite 105
Foit Worth, TX 76120
The failure of City or Contractor to insist upon the performance of any term or provision
of this Agreement or to exercise any right herein conferred shall not be construed as a waiver or
relinquishment to any extent of City's or Contractor's right to assert or rely upon any such term
or right on any future occasion.
19. DISCLOSURE OF CONFLICTS AND CONFIDENTIAL INFORMATION.
Contractor hereby warrants to the City that Contractor has made full disclosure in
writing of any existing or potential conflicts of interest related to Contractor's services under
this Agreement. In the event that any conflicts of interest arise after the Effective Date of this
Agreement, Contractor hereby agrees immediately to make full disclosure to the City in
writing. Contractor, for itself and its officers, agents and employees, further agrees that it shall
treat all information provided to it by the City as confidential and shall not disclose any such
information to a third party without the prior written approval of the City. Contractor shall store
and maintain City Information in a secure manner and shall not allow unauthorized users to
access, modify, delete or otherwise corrupt City Information in any way. Contractor shall notify
the City immediately if the security or integrity of any City information has been compromised
or is believed to have been compromised.
20. SEVERABILITY.
If any provision of this Agreement is held to be invalid, illegal or unenforceable, the
validity legality and enforceability of the remaining provisions shall not in any way be affected
or impaired.
21. FORCE MAJEURE.
The City and Contractor shall exercise their best efforts to meet their respective duties
and obligations as set forth in this Agreement, but shall not be held liable for any delay or
omission in performance due to force majeure or other causes beyond their reasonable control
(force majeure), including but not limited to, compliance with any government law, ordinance
or regulation, acts of God, acts of the public enemy, fires, strikes, lockouts, natural disasters,
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wars, riots, material or labor restrictions by any governmental authority, transportation problems
and/or any other similar causes.
22. HEADINGS NOT CONTROLLING.
Headings and titles used in this Agreement are for reference purposes only and shall not
be deemed a part of this Agreement
23. ENTIRETY OF AGREEMENT.
This written instrument constitutes the entire agreement by the parties hereto 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.
[SIGNATURES APPEAR ON FOLLOWING PAGE.]
8
IN WITNESS WHEREOF, the parties hereto have executed this agreement in multiples in Fort
Worth, Tarrant County, Texas, to be effective June 1, 2011.
rty endrix
ity Secretary
Date: �/. q/1i
APPROVED AS TO
UTHORIZATION: A
Assistant City Attorney
)ate: f
ATTEST
Name:
Title:
CITY OF FORT WORTH
By_
Alanis
ant City Manager
Date: (0I �� I
CONTRACT
M&C: C-24905
Date Approved: OS/17/2011
Safetiaveu:
By:
Name:
Lee Hafley
Title: CEO/President
STATE OF TEXAS §
COUNTY OF TARRANT §
BEFORE ME, the undersigned authority, a Notary Public in and for the State of Texas,
on this day personally appeared Ms. Mary Lee Hafley, known to me to be the person whose
name is subscribed to the foregoing instrument and acknowledged to me that the same was the
act of the Safehaven and that she executed the same as the act of said Safehaven for the purpose
and consideration therein expressed and in the capacity therein stated.
GIVEN UNDER MY HAND AND SEAL OF OFFICE this day of ,
2011.
MARILYN J. MEADOR
Notary Public, State of Texas
My Commission Expires
September 23, 2014
STATE OF TEXAS §
COUNTY OF TARRANT §
Notary Public iin and
of Texas
BEFORE ME, the undersigned authority, a Notary Public in and for the State of Texas,
on this day personally appeared Susan Alanis, known to me to be the person whose name is
subscribed to the foregoing instrument and acknowledged to me that the same was the act of the
City of Fort Worth for the purpose and consideration therein expressed and in the capacity
therein stated.
GIVEN UNDER MY HAND AND SEAL OF OFFICE this aLt� day of 11ry ,
2011.
Notary Public in and for the State of Texas
LINDA M. HI9RLINGER
MY COMMISSION EXPIRES
February 2, 20i4
EXHIBIT A
SERVICES
11
SafeHaven of Tarrant County EXHIBIT A
Supportive Childcare SCOPE OF SERVICES
PROGRAM SUMMARY
EMERGENCY SHELTER GRANT (ESG)
June 1, 2011- September 30, 2011
PERIOD
SCOPE OF SERVICES
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 Emergency Shelter Grant
(ESG) 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 SafeHaven of Tarrant County will provide ESG services to homeless persons or persons at risk of homelessness at
the Fort Worth Shelter location (address is confidential and available upon request). The Supportive Childcare program
will include the following tasks and activities; childcare services to children between the ages of 2 and 5 who are
residents of the emergency shelter. All services will be provided at the Fort Worth Shelter location (address is
confidential and available upon request) from 8:30 a m to 5 p.m.; Monday through Friday and on Saturdays, as needed.
The purpose of the program will be to provide childcare services to children between the ages of 2 and 5 who are
residents of the emergency shelter. 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 June 1, 2011 — September 30,
2011.
The funds will be used to pay for the salary of a Child Advocate Lead which is consistent with Exhibit B - Detailed
Statement of Costs.
REGULATORY CLASSIFICATION:
Regulatory Citation & Activity Allocated Funds °A° of Total Allocation
24 CFR 576.3; 576.21(a)(2) Essential Services
24 CFR 576.3; 576.21(a)(3) Operational Costs
24 CFR 576.3; 576.21(a)(4) Homeless Prevention
Based on the nature of the service provided, Subrecipient, SafeHaven of Tarrant County will maintain documentation
that verifies that 100% clients served are homeless; or for prevention activities, documentation that verifies clients served
by the homeless prevention program are at risk of homelessness through eviction notices or notices of termination of
utility services. Eviction/disconnection notices must be supported by documentation verifying (1) the inability of the
family to make the required payments is due to a sudden reduction in income; (2) the assistance is necessary to avoid the
eviction or termination of services; (3) there is a reasonable prospect that the family will be able to resume payments
within a reasonable period of time; and (4) the assistance will not supplant funding for preexisting homelessness
prevention activities from other sources.
GEOGRAPHICAL LOCATION:
Site Address: The physical address is confidential and is available upon request.
Client Beneficiary Location (Neighborhood, District, Citywide...): City of Fort Worth
PROGRAM GOALS:
SafeHaven s Supportive Childcare program provides childcare to youth between the ages of 2 and 5 who are victims of
domestic violence and abuse In addition, reduce family violence through services that support victims and their families
and prevent abuse through intervention and education.
PROGRAM OBJECTIVES:
Provide childcare services to children between the ages of 2 and 5 who are residents of the emergency shelter.
PROGRAM SERVICES and ACTIVITIES
Total Unduplicated Clients Served
90
Level of service should be identified in a quantifiable unit and directly related to specified objectives,
EXHIBIT B
FORM OF REQUEST FOR REIMBURSEMENT
[ATTACHED]
12
CITY OF FORT WORTH
HOUSING AND ECONOMIC DEVELOPMENT DEPARTMENT
COMPLIANCE DIVISION
REQUEST FOR FUNDS
EMI
AGENCY: PROGRAM:
ADDRESS: CONTRACT NUMBER:
CONTRACT AMOUNT:
CONTRACT DATE:
DATE OF REQUEST:
IDIS NUMBER
SECTION 1 (AGENCY) CURRENT MONTH CUMULATIVE
1. Reimbursement Request
A. Expenditures: $ $
B. Reimbursement $ $
2. Requested By:
A. Agency
(Name)
(Signature) (Date)
SECTION II (CITY)
1. BUYSPEED - Purchasing Request
A. BUYSPEED INPUT: Vendor/PO Number/Requisition Number
B. Fund/Account/Center:
C. Total Amount of this Request:
SECTION Ili (CITY)
1. Verification
A. Contract Compliance Specialist
B. Accounting
2. Authorization
A. Grants Manager
B. Sr. Admin. Services Mgr
C. Director
Mark Folden
(Name) (Signature) (Date)
Benedict George
(Name)
Robin Bentley
(Signature) (Date)
(Name) (Signature) (Date)
Socorro Gray
(Name) (Signature) (Date)
Jesus Chapa
(Name)
Note: Any Request for Funds that exceeds $25,000 requires the Director's signature
(Signature) (Date)
CITY OF FORT WORTH
HOUSING AND ECONOMIC DEVELOPMENT DEPARTMENT
DETAIL STATEMENT OF COSTS
AGENCY
PROGRAM
CONTRACT NO,
TO
DATE
REPORT PERIOD
COST CATEGORY
PROGRAM
BUDGET
BALANCE
MONTHLY
CUMULATIVE
TO DATE
EXPENDITURES
ADMINISTRATIVE COSTS
Salaries
FICA
Life Insurance
Health Insurance
Unemployment
Tax
Worker's
Comp
Legal
and Accounting
Office
Supplies
PROGRAMMATIC COSTS
Salaries
5,055.00
FICA
Life Insurance
Health Insurance
Unemployment
— Federal
Unemployment
— State
Workers
Compensation
Medical Supplies
Security
Utilities (Telephone,
Water, Wastewater,
Gas,
Electric,
Waste Disposal)
Rent
Office Equipment
Rental
Printing
Accounting
Postage
Building
Maintenance and Repair
Office Supplies
Food
Other Operating
Supplies
Liability
Insurance
Private Auto Allowance
Childcare Scholarships
Meals
Teaching
Aids
Contractual
Services
Contract Labor
Conferences and Seminars
Short Term Rent, Mortgage
Assistance (STRMU)
and Utility
Tenant Based Rental
(TBRA)
Assistance
TOTAL
$0.00
$0.00
$0.00
$0.00
Contractor's Certification: I certify that the costs incurred are taken from the books of account and that such costs are valid and
consistent with the terms of the agreement.
NAME and TITLE OF AUTHORIZED OFFICER
SIGNATURE and DATE
CITY OF FORT WORTH
HOUSING & ECONOMIC DEVELOPMENT DEPARTMENT
EXPENDITURES WORKSHEET
Agency
Program
Contract Number
Date
To
Reoort Petiod
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
TOTAL
$0.00
TITLE OF AUTHORIZED OFFICER
SIGNATURE AND DATE
EXHIBIT C
FORM OF SERVICES REPORT
16
CITY OF FORT WORTH
HOUSING & ECONOMIC DEVELOPMENT DEPARTMENT
1. Name and Address of Sub -Grantee
2. Program Name
5. Program Services and Activities
Number of New
Households and/or
Persons Served
Current Month
Month & Year
Cumulative
6. Direct Benefit
(Continued)
Current Month
Cumulative
Extremely Low Very Low Income
Income (0<30%) (31-50%)
Low Income
(51-80%)
Above Low Income
(80%>)
Household Size
1
2
3
4
5
6
7
8
0-30%
$13,850
$15,850
$17,800
$19,800
$21,400
$22,950
$24, 550
$26,150
31-50%
$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, 700
Certification: The undersigned, hereby, gives assurance that to the best of my knowledge and belief, the data included in this report is true and accurate. 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
17
CITY OF FORT WORTH
HOUSING & ECONOMIC DEVELOPMENT DEPARTMENT
t. Name and Address of Sub=Grantee 2. Program Name
Month &Year
8. Direct Benefit Data (New Household and /or Persons Served)
Race: Section Must be Completed)
Ethnicity:
Section
Must be
Completed)
Current
Month
Hispanic
Current
Cumulative Month
Non -
Hispanic
Hispanic Current
Cumulative Month
Non -
Hispanic
Cumulative
White
Black/AfricanAmerican
Asian
American indian/Alaskan Native
Native Hawaiian/Other Pacific Islander
Indian/Alaskan Native & White
Asian & White
Black/African American&White
American Indian/Alaskan Native & Black
African American
Other Multi=Racial
TOTAL
0
0 0
0 0
0
Female
Head of
Household
Current Month
Cumulative
Certification: The undersigned, hereby, gives assurance that to the best of my knowledge and belief, the data included in this
report is true and accurate. 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:
Signature Required
1. Name and Address of Sub -Grantee
CITY OF FORT WORTH
HOUSING & ECONOMIC DEVELOPMENT DEPARTMENT
2. Program Name
5. PROGRAM SERVICES AND ACTIVITIES -
Unduplicated Clients
MID
CURRENT
CUMULATIVE
6. SCOPE OF WORK NARRATIVE:
7. PROBLEMS ENCOUNTERED / SOLUTIONS
PROPOSED•
8. ANTICIPATED ACTIVITY DURING THE NEXT
MONTH.
Certification: The undersigned, hereby, gives assurance that to the best of my knowledge and belief, the data included in this report is true and
accurate. 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
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CITY OF FORT WORTH
HOUSING & ECONOMIC DEVELOPMENT DEPARTMENT
CLIENT DATA REPORT
1. Name and Address of Sub -Grantee 2. Program Name
Month & Year
Name Age Sex Ethnicity Race Disabled # Fam Income FHOH Street Address
Certification: The undersigned, hereby, gives assurance that to the best of my knowledge and belief, the data included in this report is true and accurate. 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
Number:
EXHIBIT C-1
ADDITIONAL FORM OF SERVICES REPORT - ESG AGENCIES
1. Name and Address of Sub -Grantee
CITY OF FORT WORTH
HOUSING & ECONOMIC DEVELOPMENT DEPARTMENT
2. Program Name
3. Contract Number
4. Date of Request
Date and Year
Beneficiary by Housing Tvae: EMERGENCY OR TRANSITIONAL SHELTERS
Current Month
Cumulative
Chronically Homeless
(Emergency Shelter only)
Severely Mentally III
Chronic Substance Abuse
Other Disability
Veterans
Persons with HIV/AIDS
Victims of Domestic Violence
Elderly
TOTAL
0
0
Beneficiary by Housing Type: Number served in Emergency or Transitional Shelters
SHELTER TYPE
Current Month
Cumulative
Barracks
Group/Large
House
Scattered Site Apartment
Single
Family Detached
House
Single
Room Occupancy
Mobile Home/Trailer
Hotel/Motel
Other
TOTAL
0
0
ESG Funding
Sources :
Funding
Amount
Current Month
Cumulative Total
ESG
Other Federal
Local Government
Private
Fees
Other
Total
Certification: The undersigned, hereby, gives assurance that to the best of my knowledge and belief, the data included in this report is true and accurate. It is
also acknowledged that the provision of false information could leave the certifying offici
Date:
Submitted by: Phone No.
Si • nature Re . uired
1. Name and Address of Sub -Grantee
CITY OF FORT WORTH
HOUSING & ECONOMIC DEVELOPMENT DEPARTMENT
2. Program Name
3. Contract Number
4. Date of Request
Date and Year
EMERGENCY OR TRANSITIONAL SHELTERS
N UMBER OF INDIVIDUAL HIOUSEHOLDS (SINGLES): Current Month Cumulative
Unaccompanied 18 and over ( Male
Unaccompanied under 18 Male
Female
Female
N UMBER OF FAMILY HOUSEHOLDS WITH CHILDREN HEADED BY: Current Month Cumulative
Single 18 and over
Single under 18
Male I Female
Male Female
N UMBER OF FAMILY HOUSEHOLDS WITH NO CHILDREN:
TOTAL I
Certification: The undersigned, hereby, gives assurance that to the best of my knowledge and belief, the data included in this report is true
and accurate. It is also acknowledged that the provision of false information could leave the certifying offici
Date:
Submitted by: Phone No,
Signature Required
EXHIBIT C-2
ADDITIONAL FORM OF SERVICES REPORT - HOPWA AGENCIES
24
1. Name and Address of Sub -Grantee
CITY OF FORT WORTH
HOUSING & ECONOMIC DEVELOPMENT DEPARTMENT
2. Program Name
3. Contract Number
4. Date of Request
Date and Year
5. Program Services and Activities (Report Clients, Not Payments
HOPWA
CURRENT
MONTH
ONLY
Cumulative
# Assisted
With Other
Funds
Amount of
Other
Funds
a.# of Tenant -Based Rental Assistance
(TBRA)
b.# of Short -Term Rental, Mortgage
and Utility Assistance
(STRMU)
c.# of STRMU clients that have
moved
to TBRA
d.Total # of Unduplicated
Clients
(a+b)-c
Number of Households
HOPWA
CURRENT
MONTH
ONLY
CUMULATIVE
AMOUNT OF
HOPWA FUNDS
#
ASSISTED
W/ OTHER
FUNDS
AMOUNT
OF OTHER
FUNDS
6. Supportive
Services
7. Resource
Identification/Technical Assistance
8. Housing
Information Services
9. Permanent
Housing
Placement Services
10. Monthly Income Groups of Households for all Unduplicated
Clients
$0-250
$251-
500
$501-1000
$1001-1500
$1501-2000
Over $2000
TOTAL
Current
Month
0
Cumulative
0
Short;
<tJYihty.Asst'(STRMU)
Term, Rent,Mortgage
$0-250
$251-��
500
$501-1000
$1001-1500
$1501-2000
Over $2000
TOTAL
Current
Month
0
Cumulative
0
$0-250
$251-
500
$501-1000
$1001-1500
$1501-2000
Over $2000
TOTAL
Current
Month
0
Cumulative
0
Certification: The undersigned, hereby, gives assurance that to the best of my knowledge and belief, the data included in this report is true and
accurate. 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:
Signature Required
Phone Number:
25
1. Name and Address of Sub -Grantee
CITY OF FORT WORTH
HOUSING & ECONOMIC DEVELOPMENT DEPARTMENT
2. Program Name
3. Contract Number
4. Date of Request
Date and Year
Tenant Based Rental Assistance-(TBRA)
Race: Section Must be Completed)
Current Month Cumulative
White
Black/African American
Asian
American Indian/Alaskan Native
Native Hawaiian/Other Pacific
Islander
Indian/Alaskan Native & White
Asian & White
Black/African American&White
American Indian/Alaskan Native &
Black African American
Other Multi -Racial
TOTAL
0
0
0
Unduplicated Beneficiary Data
Total
Number of persons
Children with HIV/AIDS
received Housing
Assistance
(Adults and
who
Number of Other Persons in Family
unit who received Housing
Assistance
Households Previously Homeless
Of Previously Homeless
Households, number of those who
were Chronically Homeless
This data relates to participants
Current Month
Cumulative
Female Head
of Household
Current
Month
Unduplicated
A
Female TBRA
Participants
Male TBRA
Participants
17 and
Under
18 to 30
Years
31 to 50
Years
51 Years
and Older
Total
Certification: The undersigned, hereby, gives assurance that to the best of my knowledge and belief, the data included in this report is true and accurate. 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
26
1. Name and Address of Sub -Grantee
CITY OF FORT WORTH
HOUSING & ECONOMIC DEVELOPMENT DEPARTMENT
2. Program Name
3. Contract Number
4. Date of Request
Date and Year
Short Term Rent, Mortgage, and Utility Assistance (STRMU)
Race: Section Must be Completed)
Current Month Cumulative
White
Black/African American
Asian
American Indian/Alaskan Native
Native Hawaiian/Other Pacific
Islander
Indian/Alaskan Native & White
Asian & White
Black/African American&White
American Indian/Alaskan Native &
Black African American
Other Multi -Racial
TOTAL
0
nicety:''
ectt
0
0
0
Unduplicated Beneficiary Data
Total
Number of persons
Children with HIV/AIDS
received Housing
Assistance
(Adults and
who
Number of Other Persons
unit who received Housing
Assistance
in Family
Households Previously Homeless
Of Previously Homeless
Households, number of those who
were Chronically Homeless
This data relates to participants
Current Month
Cumulative
Female Head
of Household
Current
Month
Unduplicated
Ane
Female TBRA
Participants
Male TBRA
Participants
17 and
Under
18 to 30
Years
31 to 50
Years
51 Years
and Older
Total
Certification: The undersigned, hereby, gives assurance that to the best of my knowledge and belief, the data included in this report is true and accurate. 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
27
1. Name and Address of Sub -Grantee
CITY OF FORT WORTH
HOUSING & ECONOMIC DEVELOPMENT DEPARTMENT
2. Program Name
3. Contract Number
4. Date of Request
Date and Year
Supportive Services
Race: Section Must be Completed}
White
Black/African American
Asian
American Indian/Alaskan Native
Native Hawaiian/Other Pacific
Islander
Indian/Alaskan Native & White
Asian & White
Black/African American&White
American Indian/Alaskan Native &
Black African American
Other Multi -Racial
TOTAL
Current Month Cumulative
0
Unduplicated Beneficiary Data
Total
Number of persons
Children with HIV/AIDS
received Housing
Assistance
(Adults and
who
Number of Other
unit who received
Assistance
Persons in Family
Housing
Households Previously Homeless
Of Previously Homeless
Households, number of those who
were Chronically Homeless
This data relates to participants
Current Month
Cumulative
Female Head
of Household
Current
Month
Unduplicated
Aae
Female TBRA
Participants
Male TBRA
Participants
17 and
Under
18 to 30
Years
31 to 50
Years
51 Years
and Older
Total
Certification: The undersigned, hereby, gives assurance that to the best of my knowledge and belief, the data included in this report is true and accurate. 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
28
1. Name and Address of Sub -Grantee
CITY OF FORT WORTH
HOUSING & ECONOMIC DEVELOPMENT DEPARTMENT
2. Program Name
3. Contract Number
4. Date of Request
Date and Year
**All data reported should be unduplicated for the current month
a. Outreach
b. Case Management
c. Life Management
d. Nutritional Services/Meals
e . Adult Day Care and Personal Assistance
f. Child Care and other Children% Services
g. Education
h Employment Assistance
i. Alcohol and Drug Abuse Services
j. Mental Health Services
k. Health/Medical/Intensive Care Services
I. Transportation
m. Other (specify)
n . Other (specify)
o . Number of Jobs that resulted from g. and h.
TOTAL
(current month HOPWA expenditure column
should equal total in supportive service section on
Attachment 11)
Current Month Unduplicated Only
Receiving
Supportive
Services w/
Housing
Assistance
Receiving
Supportive Services
Only
Persons with HIV/AIDS
Other Persons in Family Unit
Certification: The undersigned, hereby, gives assurance that to the best of my knowledge and belief, the data included in this report is true and
accurate. 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
M&C Review
Page 1 of 3
official site of the City of Fort Worth, Texas
FORT WORTH
COUNCIL ACTION: Approved on 5/17/2011
DATE: 5/17/2011 REFERENCE NO.: **C-24905 LOG NAME: 17PSAGAP
CODE: C TYPE: CONSENT PUBLIC HEARING: NO
SUBJECT: Authorize Execution of Contracts and Interdepartmental Letters of Agreement to Extend
Public Service Programs Funded by Community Development Block Grant, Emergency
Shelter Grant and Housing Opportunities for Persons with AIDS Grant Funds from June
through September of 2011 (ALL COUNCIL DISTRICTS)
RECOMMENDATION:
It is recommended that the City Council:
1. Authorize the City Manager or his designee to execute contracts or interdepartmental letters of
agreement to extend public service programs funded with Community Development Block Grant,
Emergency Shelter Grant and Housing Opportunities for Persons with AIDS grant funds for the period
from June to September 2011; and
2. Authorize the City Manager or his designee, to amend the contracts or letter agreements, if
necessary, to achieve program goals, 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.
DISCUSSION:
On August 17, 2010, the City Council approved contracts with agencies to deliver public services
using federal grant funds from the United States Department of Housing and Urban Development
(HUD) under the Community Development Block Grant (CDBG) HOME Investment Partnerships
Program (HOME), Emergency Shelter Grant (ESG) and Housing Opportunities for Persons With
AIDS Program (HOPWA) (M&C C-24401). The City has traditionally used a June to May Program
Year, but is changing the Program Year to October to September to correspond with the City's Fiscal
Year.
In September, 2010, the City Council requested a change in the City's Program Year for Federal
Funding from a June to May year to an October to September year. When the City made this change
to the Program Year, it caused a funding gap for the public service agencies. In order to ensure
continuity of services, the City Council allocated General Funds to extend services until the beginning
of the new grant year. The City Council's authorization allows for the funding of the public service
agencies from June 1, 2010 to September 30, 2011. In March of 2011, Staff asked agencies with
current contracts to submit budget requests for the four month period Upon review of the requests,
Staff recommends entering into contracts with the following agencies for the following amounts:
Community Development Block Grant
(CDBG)
Boys & Girls Club
FWHA
Meals on Wheels
Cultural Center of the Americas
United Community Centers
YMCA
Childcare Associates
YWCA - Child Care
4,800.00
9,500.00
11,232.00
6,592.00
5,400.00
15, 000.00
39, 000.00
45,000.00
http://apps.cfwnet.org/council_packet/mc review.asp?ID=15257&councildate=5/17/2011
6/1/2011
M&C Review Page 2 of 3
YWCA - My Own Place
Ladder Alliance
Day Resource Center
AB Christian Learning Center
Clayton YES! - Greenbriar
Clayton YES! - After School
S enior Citizens - Como
S enior Citizens - Doc Sessions
Senior Citizens - Diamond Hill
Cornerstone
PACS - Como
PACS - Northside CAP
PACS - Woodhaven
Northside Inter -Church Agency
Mental Health Association - Ombudsman
Mental Health Association - Advocate
Girls Inc
CDBG Total
Emergency Shelter Grant (ESG)
YWCA - Supportive Living
PACS - SHIPP
S afeHaven - Supportive Childcare
S afeHaven - Shelter Operations
S resbyterian Night Shelter
ESG Total
5,876.00
6,640.00
16,667.00
5,000.00
8,300.00
19,000.00
6,000.00
5,333.33
6,000.00
5,099.00
2,083.00
8,748.00
$ 2,116.00
$ 7,341.00
$ 5,233.00
$ 7,425.00
$ 4,200.00
$ 257,585.33
4,346.00
16,600.00
5,500.00
6,700.00
55,411.00
88,557.00
Housing Opportunities for Persons with AIDS (HOPWA)
S amaritan House $ 98,975.00
ARRT $ 35,331.00
AIDS Outreach Center $ 152,947.00
HOPWA Total $ 287,253.00
GRAND TOTAL $ 633,395.33
These programs are available in ALL COUNCIL DISTRICTS.
FISCAL INFORMATION/CERTIFICATION:
The Financial Management Services Director certifies that funds are available in the current operating
budget, as appropriated, of the General Fund.
TO Fund/Account/Centers
FROM Fund/Account/Centers
GG01 539180 0171000 $6331395.33
Submitted for City Manager's Office by:
Originating Department Head:
Additional Information Contact:
Susan Alanis (8180)
Jay Chapa (5804)
Mark Folden (8634)
Robin Bentley (7315)
http://apps.cfwnet.org/council_packet/mc review.asp?ID=15257&councildate=5/17/2011 6/1/2011
M&C Review Page 3 of 3
ATTACHMENTS
http://apps.cfwnet.org/council packet/mc review.asp?ID=15257&councildate=5/17/2011 6/1/2011