HomeMy WebLinkAboutContract 47276 (2)•
STATE OF TEXAS
COUNTY OF TARRANT
CONTItArT 17
CITY Mit? Li /1,) 762
This contract ("Contract") is made and entered into by and between the City of Fort
Worth (hereafter "City") and Presbyterian Night Shelter (hereafter "Agency"), a Texas non-
profit corporation. City and Agency may be referred to individually as a "Party" and jointly as
"the Parties".
The Parties state as follows:
WHEREAS, City receives grant monies from the United States Department of Housing
and Urban Development through the Community Development Block Grant ("CDBG")
Program, Program No. B-15-MC-48-0010, Catalog of Federal Domestic Assistance No. 14.218;
WHEREAS, a national objective of the CDBG program is to benefit benefit low and
moderate income citizens in accordance with 24 CFR Part 570, as amended from time to time;
WHEREAS, Agency submitted a proposal to use CDBG funds for a program to serve
individuals and families, of whom 100% must meet the HUD definition of a presumed benefit
population;
WHEREAS, City citizens, the Community Development Council, and the City Council
have determined that CDBG programs are needed by the City's citizens.
NOW, THEREFORE, the Parties understand and agree as follows:
1. INCORPORATION OF RECITALS.
City and Agency hereby agree that the recitals set forth above are true and correct and
form the basis upon which the Parties have entered into this Contract.
2. DEFINITIONS.
In addition to terms defined in the body of this Contract, the terms set forth below shall
have the definitions ascribed to them as follows:
Area Median Income or AMI means the median family income for the Fort Worth -Arlington
metropolitan statistical area as established annually by HUD. The 2015 income limits are
attached hereto as EXHIBIT "A-1" — 2015 HUD Income Limits.
Business Diversity Enterprise Ordinance or BDE means the City's Business Diversity
Ordinance, Ordinance No. 20020-12-2011.
CDBG means Community Development Block Grant.
CDBG PRESUMED BENEFIT PSA CONTRACT 2015-2016
Presbyterian Night Shelter
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
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Complete Documentation means the following documentation as applicable:
0
Attachments I, II, and III, with supporting documentation including:
o Proof of expense: copies of timesheets, invoices, leases, service contracts
or other documentation showing that payment is due by Agency.
o Proof of payments cancelled checks, bank statements, or wire transfers
necessary to demonstrate that amounts due by Agency were actually paid
by Agency.
o Proof of client eligibility Client eligibility for all clients as outlined in
Section 6.
• Complete Documentation shall meet the standards described in the attached
EXHIBIT "F" - Standards for Complete Documentation.
• Any other document or record reasonably necessary to verify costs spent and
client eligibility for the Program.
CDBG Funds means the CDBG grant funds supplied by City to Agency under the terms of this
Contract.
CDBG Regulations means regulations found at 24 CFR Part 570 et seq.
DBE means disadvantaged business enterprise in accordance with 49 CFR Part 26.
Director means the Director of the Neighborhood Services Department
Effective Date means October 1, 2015.
HUD means the United States Department of Housing and Urban Development
IDIS means Integrated Disbursement Information System, HUD's project tracking system.
Income Eligible Client means a client whose annual income adjusted for family size does not
exceed 80% of AMI using the most cuiTent HUD Income Guidelines and Technical Guidance
for Determining Income and Allowances. The definition of annual income to deteiniine client
income eligibility shall be the definition contained in 24 CFR Part 5.609, as amended from time
to time.
National Objective means an activity that benefits low and moderate income persons. For the
purposes of this Contract, at least 100% of the clients served by the Program must be Income
Eligible Clients
Neighborhood Services Department means the City's Neighborhood Services Department.
OMB means the Office of Management and Budget.
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Program means the services described in EXHIBIT "A" — Program Summary.
Reimbursement Request means all reports and other documentation described in Section 9
Source Documentation means documentation of full household income of any type described
under the definition of annual income in 24 CFR Part 5.609, including but not limited to copies
of paychecks, Social Security and disability verification letters, interest or rental income
statements, retirement income statements, child support and alimony verification, unemployment
benefit letters, and the like.
Unduplicated Clients means a count of all clients served by the Program at least once in the
Contract Term. Clients served by the Program more than once in the Contract Term will only be
counted the first time they are served when determining the total count of Unduplicated Clients
3. TERM.
The term of this Contract begins on the Effective Date and terminates on September 30,
2016 unless earlier teuninated as provided in this Contract.
4. DUTIES AND RESPONSIBILITIES OF CITY.
4.1 Provide CDBG Funds.
City shall provide up to $75,000.00 of CDBG Funds under the terms and conditions of
this Contract.
4.2 Monitor.
City will monitor the activities and performance of Agency and any of its contractors,
subcontractors or vendors as necessary, but no less than annually. Monitoring by City will
include determining whether Agency is meeting the National Objective durmg the teen of this
Contract.
5. DUTIES AND RESPONSIBILITIES OF AGENCY.
5.1 Reauired Services.
Agency shall perform the services described in EXHIBIT "A" — Program Summary in
accordance with the terms and conditions of this Contract.
5.2 Use of CDBG Funds.
5.2.1. Compliance with CDBG Regulations and Contract.
Agency shall be reimbursed for eligible Program costs with CDBG Funds only if City
determines in its sole discretion that:
5.2.1.1 Costs are eligible expenditures in accordance with CDBG Regulations.
5.2.1.2 Costs are in compliance with this Contract and are reasonable and
consistent with industry norms.
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5.2.1.3 Complete Documentation, as applicable, is submitted to City by
Agency.
5.2.2 Budget.
5.2.2.1 The CDBG Funds will be paid on a reimbursement basis in accordance
with EXHIBIT "B" - Budget
5.2.2.2 During the term of this Conti act, Agency may submit written requests
to increase or decrease line -item amounts in the Budget, including an
explanation of why such increases or decreases are necessary. All
requests shall be approved by Director in writing, with such approval
being in the Director's sole discretion If Director approves the
Agency's proposed Budget amendment (as approved, the "Amended
Budget"), then the Amended Budget will take effect on the first day
of the month following the month in which it was approved by
Director, unless otherwise specified in the amendment All requests
for Budget amendments must be submitted by June 1, 2016.
5.2.3 Change in Proaram Budget.
5.2.3.1 Agency will notify City promptly of any additional funds it receives
for operation of the Program, and City reserves the right to amend this
Contract in such instances to ensure compliance with HUD regulations
governing cost allocation.
5.2.3.2 Agency agrees to utilize the CDBG Funds to supplement rather than
supplant funds otherwise available for the Program
5.2.4 Payment of CDBG Funds to Agency.
CDBG Funds will be disbursed to Agency upon City's approval of Reimbursement
Requests including submission of Complete Documentation to City in compliance with Section
9. If Agency expends all funds budgeted for the Program prior to September 30, 2016, City
may hold back a small amount of the CDBG Funds until the end of the term. During this interim
period Agency must continue to submit Reimbursement Requests with an invoiced amount of
$0. It is expressly agreed by the Parties that any CDBG Funds not spent or approved for
reimbursement to Agency shall remain with City.
5.3 Proaram Performance Milestones.
5.3.1 Agency represents that the Program will achieve the following milestones in
accordance with EXHIBIT "A" - Program Summary and the table below:
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Month
3
6
9
12
Expenditures
25%
50%
75%
100%
Unduplicated Clients as
specified in EXHIBIT
"A" --Program
Summary
25%
50%
75%
100%
5.3.2 Failure of Agency to meet these milestones or a material deviation from them as
outlined in this Section 5.3 is a breach of this Contract. For the purpose of this Section,
"material deviation" shall mean more than 10% lower than the specified goal. In the event of
such breach, City reserves the right in its sole option to (i) delay or withhold payment of
Reimbursement Requests, (ii) lower Agency's allocation of CDBG Funds, or (iii) terminate this
Contract.
5.3.3 Failure to meet at least 80% of its performance milestones or serve 600
Unduplicated Clients will automatically disqualify Agency for consideration under the City's
Request for Proposals for the 2016-2017 Program Year for federal grant funds.
5.3.4 Amendments to performance milestones must be approved by the Director in
writing, with such approval being in the Director's sole discretion If Director approves the
Agency's proposed amended performance milestones (as approved, the ` Amended
Performance Milestones"), then the Amended Performance Milestones will take effect on the
first day of the month following the month in which it was approved by Director, unless
otherwise specified in the amendment All requests for amendments to performance milestones
must be submitted by June 1, 2016. Notwithstanding the above, any amendments to this
Contract shall not reduce the number of Unduplicated Clients stated in Section 5.3.3 and in
EXHIBIT "A" - Program Summary.
5.4 Identifv Program Expenses Paid with CDBG Funds.
Agency will keep accounts and records in such a manner that City may readily identify
and account for Program expenses reimbursed with CDBG Funds These records shall be made
available to City for audit purposes and shall be retained as required hereunder.
5.5 Meet National Objective.
Agency shall ensure that the activities carried out in the Program will meet the National
Objective.
5.6 Program Subcontracts.
Agency shall not enter into a subcontract with another agency, contractor, or vendor to
provide a service to clients for any part of the Program that will be paid with CDBG Funds
without City's written consent
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6. CLIENT ELIGIBILITY VERIFICATION.
6.1 Client Eligibility.
Agency will document client eligibility as follows:
6.1.1 Agency Clients.
Agency must document that all clients served by the Program fall under a "presumed
benefit" category as defined in 24 CFR Part 570. For purposes of this Contiact, the categories of
presumed benefit are: severely disabled adults, homeless persons, abused or neglected children
and youth, or elderly persons. Eligible foitus of documentation for each category include:
6.1.1.1 Severely Disabled Adults. Written, signed and dated diagnosis from
a licensed medical professional. As an acceptable alternative, Agency
may use the form attached hereto as Exhibit "H' - Severely Disabled
Certification Form.
6.1.1.2 Homeless Persons. Written, signed and dated certification from an
outreach worker.
6.1.1.3 Abused or Neglected Children and Youth. Written, signed and
dated certification from an outreach worker.
6.1.1.4 Elderly Persons. An elderly person is an individual at least 62 years
of age. Copy of a birth certificate, driver's license passport,
immigration card, military identification, or any other state local,
national or international documentation, must be provided showing
current information about the age or birth date of the client The form
in Exhibit "E" - Form of Income Self Certification, of a similar
document, will also be required in order to collect demographic data.
6.2 Submission of Complete Documentation.
Agency must submit copies of documentation of client eligibility described in Section 6.1
with Attachment III with each month's Reimbursement Request for all Unduplicated Clients
6.3 Maintain Documentation.
Agency must maintain copies of all documentation required by this Section 6 for 5 years
following the expiration of the Contract term. This Section shall survive the earlier teiniination
or expiration of this Contract.
7. ADDITIONAL CDBG REOUIREMENTS.
Agency agrees to comply with all requirements of the CDBG Program as stated in the
CDBG Regulations, including but not limited to the following:
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7.1 Environmental Review.
CDBG Funds will not be paid, and costs cannot be incurred until City has conducted an
environmental review and completed an Environmental Review Record as required by 24 CFR
Part 58. The environmental review may result in a decision to proceed with, modify, or cancel
the funding for the Program. Further, Agency will not undertake or commit any funds to
physical or choice limiting actions as described in any applicable federal regulations. Any
violation of this provision will (i) cause this Contract to terminate immediately, and (ii) require
Agency to repay City the CDBG Funds it has already received and forfeit any future payments of
CDBG Funds.
7.2 Contract Not Constituting Commitment of Funds.
Notwithstanding any provision of this Contract, the Parties agree and acknowledge that
this Contract does not constitute a commitment of funds, and that such commitment of funds or
approval may occur only upon (i) satisfactory completion of environmental review and receipt
by City of an authorization to use grant funds from HUD under 24 CFR Part 58, (ii) approval of
City's 2015-2016 Action Plan, and (iii) receipt by City of a grant agreement from HUD.
7.3 Monitoring.
7.3.1 Agency understands and agrees that it will be subject to monitoring by City for
compliance with terns and provisions of this Contract and the CDBG Regulations for the teen of
this Contract. Agency is subject to such monitoring during the term of this Contract and for 5
years after the Contract tern ends Agency will provide reports and access to Program files as
requested by City during this 5 year period. For purposes of this Contract, this 5 year period for
monitoring is deemed to begin on October 1, 2016 and end on September 30, 2021 regardless
of whether or not this Contract is earlier terminated.
7.3.2 Representatives of City, HUD, HUD Office of Inspector General, and the United
States Comptroller General shall have access during regular business hours upon 48 hours prior
notice, to Agency's offices and records pertaining to the use of the CDBG Funds, and to
Agency s officers, directors, agents, employees, contractors, subcontractors and vendors for the
purpose of such monitoring.
7.3.3 In addition to other provisions of this Contract regarding frequency of monitoring,
City reserves the right to perform desk reviews or on -site monitoring of Agency's compliance
with the terms and conditions of this Contract. City shall provide Agency with a written report
of the monitor's findings after each monitoring visit. If the monitoring report notes deficiencies
in Agency's performance the report shall include requirements for the timely correction of said
deficiencies by Agency. Failure by Agency to take the action specified in the monitoring report
may be cause for suspension or termination of this Contract as provided herein.
7.3.4 Subsections 7.3.1 through 7.3.3 shall be applicable for the Contract term and for 5
years thereafter and shall survive the earlier termination or expiration of this Contract.
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7.3.5 Agency shall provide City annually the results of any state or federal monitoring.
Such results shall be submitted within 60 days of receipt of such state or federal monitoring
report, or with the January Reimbursement Request, whichever is earlier.
7.4 Agency Procurement Standards.
Agency shall comply with allapplicable federal, state and local laws, regulations, and
ordinances for making procurements under this Contract In adition to the conflict of interest
provisions in Section 14.13.3, Agency shall establish written procurement procedures to ensure
that materials and services are obtained in a cost effective manner and that provides for full and
open competition When procuring materials and services for this Contract, Agency shall
comply at a minimum with the procurement standards in 2 CFR Part 200.317 through Part
200.326.
7.4.1 Contracts in excess of $10,000.00 made by Agency using CDBG Funds must
address termination for cause and convenience including the manner by which such termination
shall be effected and the basis for settlement of the terminated contract, if any, as required by
Appendix II (B), 2 CFR Part 200.
7.4.2 Agency shall not make any contract with parties listed on the governmentwide
System for Award Management, www.sam gov ("SAM"). Agency must confirm by search of
SAM that all contractors paid with CDBG Funds are not listed by SAM as being debarred, both
prior to hiring and prior to submitting a Reimbursement Request which includes invoices from
any such contractor. Failure to submit such proofs of search shall be an event of default.
7.5 Cost Principles/Cost Reasonableness.
Agency shall administer its use of CDBG Funds in compliance with 2 CFR Part 200 as
applicable. The eligibility of costs incurred for performance tendered shall be determined in
accordance 2 CFR Part 200.400 through Part 200.475.
7.6 Financial Management Standards.
Agency agrees to comply with 2 CFR Part 200 as applicable. Agency also agrees to
adhere to the accounting principles and procedures required therein, utilize adequate internal
controls, and maintain necessary supporting and back-up documentation for all costs incurred in
accordance with 2 CFR Part 200.302 and Part 200.303.
7.7 Uniform Administrative Requirements.
Agency will comply with the Uniform Administrative Requirements, Cost Principles, and
Audit Requirements for Federal Awards in 2 CFR Part 200, as applicable, or any reasonably
equivalent procedures and requirements that City may require.
7.8 Terms Applicable to Contractors. Subcontractors and Vendors.
Agency understands and agrees that all terms of this Contract, whether regulatory or
otherwise, shall apply to any and all contractors subcontractors and vendors of Agency which
are in any way paid with CDBG Funds or who perform any work in connection with the
Program. Agency shall cause all applicable provisions of this Contract to be included in and
made a part of any contract or subcontract executed in the performance of its obligations
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hereunder including its obligations regarding the CDBG Regulations. Agency shall monitor the
services and work performed by its contractors, subcontractors and vendors on a regular basis for
compliance with the CDBG Regulations and Contract provisions. Agency must cure all
violations of the CDBG Regulations committed by its contractors, subcontractors or vendors.
City maintains the right to insist on Agency's full compliance with the tetius of this Contract and
the CDBG Regulations and Agency is responsible for such compliance regardless of whether
actions taken to fulfill the requirements of this Contract are taken by Agency or by Agency's
contractors, subcontractors or vendors. Agency acknowledges that the provisions of this Section
shall survive the earlier termination or expiration of this Contract and shall be applicable for 5
years after the Contract -Lena ends
7.9 Copvrieht and Patent Riszhts.
No reports, maps, or other documents produced in whole or in part under this Contract
shall be the subject of an application for copyright by or on behalf of Agency. HUD and City
shall possess all rights to invention or discovery, as well as rights in data, which may arise as a
result of Agency's performance under this Contract.
7.10 Conflict of Interest Disclosure.
In accordance with the requirements of Section 14.13.2 1 and 14.13.4, Agency shall
establish conflict of interest policies for federal awards Agency shall disclose to City in writing
any potential conflict of interest.
7.11 Compliance with FFATA and Whistleblower Protections.
Agency shall comply with the requirements of 2 CFR 300(b), including provisions of the
Federal Funding Accountability and Transparency Act (` FFATA") governing requirements on
executive compensation and provisions governing whistleblower protections contained in 10
U.S.C. 2409, 41 U.S.C. 4712, 10 U.S.C. 2324, 41 U.S.C. 4304 and 41 U.S.C. 4310.
7.11.1 Agency shall provide City with its DUNS number.
7.12 Internal Controls.
In compliance with the requirements of 2 CFR Part 200.303, Agency shall:
7.12.1 Establish and maintain effective internal control over the CDBG Funds that
provides reasonable assurance that Agency is managing the CDBG Funds in compliance with
federal statutes, regulations, and the terms and conditions of this Contract. These internal
controls shall be in compliance with guidance in "Standards for Internal Control in the Federal
Government' issued by the Comptroller General of the United States or the "Internal Control
Integrated Framework" issued by the Committee of Sponsoring Organizations of the Treadway
Commission ("COSO");
7.12.2 Comply with federal statutes, regulations, and the terms and conditions of this
Contract;
7.12.3 Evaluate and monitor Agency's compliance with statutes, regulations and the
terms and conditions of this Contract;
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7.12.4 Take prompt action when instances of noncompliance are identified including
noncompliance identified in audit findings; and
7.12.5 Take reasonable measures to safeguard protected personally identifiable
information and other information that HUD or City designates as sensitive or Agency considers
sensitive consistent with apphcable federal, state, local and tribal laws regarding privacy and
obligations of confidentiality.
8. RECORD KEEPING; REPORTING AND DOCUMENTATION
REOUIREMENTS; AUDIT.
8.1 Record Keepint.
Agency shall maintain a record -keeping system as part of its performance of this Contract
and shall promptly provide City with copies of any document City deems necessary for the
effective fulfillment of City's monitoring and evaluation responsibilities. Specifically, Agency
will keep or cause to be kept an accurate record of all actions taken and all funds spent, with
supporting and back-up documentation. Agency will maintain all records and documentation
related to this Conti act for 5 years after the Contract term ends If any claim, litigation, or audit
is initiated before the expiration of the 5 year period, the relevant records and documentation
must be retained until all such claims, litigation or audits have been resolved. For purposes of
this Contract, this 5 year period for record retention is deemed to begin on October 1, 2016 and
end on September 30, 2021 regardless of whether or not this Contract is earlier terminated.
8.2 Access to Records.
Representatives of City, HUD and any duly authorized officials of the federal
government will have full access to, and the right to examine, audit, copy, excerpt and/or
transcribe any of Agency's records pertaining to all matters covered by this Contract for 5 years
after the Contract term ends Such access shall be during regular business hours and upon at
least 48 hours prior notice. For purposes of this Contract, this 5 year period for access to records
is deemed to begin on October 1, 2016 and end on September 30, 2021 regardless of whether or
not this Contract is earlier terminated.
8.3 Reports.
Agency will submit to City all reports and documentation described in this Contract in
such form as City may prescribe. Agency may also be required to submit a final performance
and/or final financial report if required by City at the termination of this Contract in such form
and within such times as City may prescribe. Failure to submit to City any report or
documentation described in this Contract shall be an event of default of this Contract and City
may exercise all of its remedies for default under this Contract.
8.3.1 Additional Information.
Agency shall provide City with additional information as may be required by state or
federal agencies to substantiate Program activities and/or expenditure eligibility.
8.4 Change in Reporting Requirements and Forms.
City retains the right to change reporting requirements and forms at its discretion. City
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will notify Agency in writing at least 15 days prior to the effective date of such change, and the
Parties shall execute an amendment to the Contract reflecting such change if necessary.
8.5 Audit.
8.5.1 Entities that Expend $750,000 or more in Federal Funds Per Year
All non-federal entities that expend $750,000 or more in federal funds within 1 year,
regardless of the source of the federal award, must submit to City an annual audit prepared in
accordance with specific reference to 2 CFR Part 200.501 through Part 200.521. The audit shall
cover the Agency's fiscal years during which this Contract is in force. The audit must be
prepared by an independent certified public accountant, be completed within 6 months following
the end of the period being audited and be submitted to City within 30 days of its completion.
Agency's audit certification is attached hereto as EXHIBIT "C" - ' Audit Certification Form"
and "Audit Requirements". The Audit Certification Form must be submitted to City prior to
or with the first Reimbursement Request. Entities that expend less than $750,000 a year in
federal funds are exempt from federal audit requirements for that year, but records must be
available for review or audit by appropriate officials of the federal agency, City, and General
Accounting Office.
8.5.2 City Reserves the Right to Audit.
City reserves the right to perfoiru an audit of Agency's Program operations and finances
at any time during the terra of this Contract and for 5 years after the Contract term ends if City
determines that such audit is necessary foi City's compliance with the CDBG Regulations or
other City policies. Agency agrees to allow access to all pertinent materials as described herein
for such audit. For purposes of this Contract, this 5 year period foi City audit is deemed to begin
on October 1, 2016 and end on September 30, 2021 regardless of whether or not this Contract
is earlier terminated. If such audit reveals a questioned practice or expenditure, such questions
must be resolved within 15 business days after notice to Agency of such questioned practice or
expenditure If questions are not resolved within this period, City reserves the right to withhold
further funding under this Contract and/or any other contracts with Agency IF AS A RESULT
OF ANY AUDIT IT IS DETERMINED THAT AGENCY HAS FALSIFIED ANY
DOCUMENTATION OR MISUSED, MISAPPLIED OR MISAPPROPRIATED CDBG
FUNDS OR SPENT CDBG FUNDS ON ANY INELIGIBLE ACTIVITIES, AGENCY
AGREES TO REIMBURSE CITY THE AMOUNT OF SUCH MONIES PLUS THE
AMOUNT OF ANY SANCTIONS, PENALTY OR OTHER CHARGE LEVIED
AGAINST CITY BY HUD BECAUSE OF SUCH ACTIONS.
9. REIMBURSEMENT REOUIREMENTS.
9.1 Deadline for Submitting Reimbursement Requests.
9.1.1 Reimbursement Requests shall be submitted monthly to the City and must be
received by the City on or before the 15th day of the month following the month expenses were
paid by Agency For example, the Reimbursement Request for June expenses must be received
by July 15. In the event the 15t'' falls on a weekend or City holiday, Reimbursement Requests
shall be due the next day that the City is open for business. Failure to submit a Reimbursement
Request in a timely fashion will result in City taking the actions outlined in Section 10.1.
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NOTWITHSTANDING ANYTHING ABOVE, THE REIMBUSEMENT REQUEST FOR
EXPENSES INCURRED FOR SEPTEMBER 2016 MUST BE RECEIVED BY OCTOBER
1, 2016. COMPLETE DOCUMENTATION FOR ALL SEPTEMBER 2016 EXPENSES
MUST BE SUBMITTED BY OCTOBER 15, 2016. FAILURE TO SUBMIT A FINAL
REIMBURSEMENT REQUEST WITH COMPLETE DOCUMENTATION BY
OCTOBER 15, 2016 WILL RESULT IN FORFEITURE OF PAYMENT OF THE
SEPTEMBER REIMBURSEMENT REQUEST.
9.1.2 City will notify Agency by e-mail within 20 calendar days if a Reimbursement
Request is lacking Complete Documentation or corrections are needed. Agency will have 10
business days from the date of the e-mail notice to submit any requested information or missing
documentation Agency will be penalized in the Request for Proposal for the 2016-2017
Program Year for any notifications received under this Section. If Agency fails to submit all the
required information or missing documentation within 30 calendar days from the first e-mail,
Agency shall forfeit any payments otherwise due that month and failure to submit any requested
information will be considered an event of default as outlined in Section 10.1.2.
9.2 Submission of Reimbursement Requests.
Agency shall provide City with Complete Documentation and the following reports as
shown in EXHIBIT ` D" -Reimbursement Forms with each Reimbursement Request:
9.2.1 Attachment I - Invoice.
This report shall contain the amount requested for reimbursement each month, the
cumulative reimbursement requested to date (inclusive of that month's request), and must
be signed by an authorized signatory of Agency. By signing Attachment I Agency is
certifying that the costs are valid eligible, consistent with the terms and conditions of this
Contract, and the data contained in the report is true and correct. This report must be
submitted even if Agency is requesting $0 for a particular month.
9.2.2 Attachment II - Exnenditure Worksheet.
This report shall itemize each expense requested for reimbursement by Agency and shall
include the Account corresponding the expense to a Budget line item. In order for this report to
be complete the following must be submitted:
9.2.2.1 For payroll expenses timesheets signed by employees and approved
by supervisor for all payroll expenses listed. Timesheets must
distinguish between CDBG-funded time and non-CDBG funded time
and reflect actual time spent on CDBG-funded activities. Agency may
not submit payroll expenses dated 60 calendar days prior to the date of
the Reimbursement Request.
9.2.2.2 For non -payroll expenses, invoices for each expense listed with an
explanation as to how the invoiced expense pertains to the Program.
Agency may not submit invoices dated 60 calendar days prior to the
date of the Reimbursement Request.
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9.2.2.3 Proof that each expense was paid by Agency, which proof can be
satisfied by cancelled checks, wire transfer documentation, paid
receipts or other appropriate banking documentation.
9.2.3 Attachment III - Client Data Report.
This report shall list each Unduplicated Client served during the month along with his or
her demographic infoimation. The Client Data Report must maintain a list of all clients served
during the Contract term In order for this report to be complete, the following must be
submitted:
9.2.3.1 Documentation of "presumed benefit" eligibility for each
Unduplicated Client the first time the client is served by the Program,
as defined in Section 6.
9.2.4 Delivery of Reimbursement Request.
Reimbursement Requests can be mailed or delivered in person to Neighborhood
Services Department, 908 Monroe Street, Fort Worth, Texas 76102. In addition, Agency can
submit Reimbursement Requests via email to psa(a,fortworthtexas 2ov, but Agency must
submit a signed original of Attachment I by the deadline in Section 9 1 1
9.3 Withholding Payment.
CITY SHALL HAVE NO OBLIGATION TO PAY ANY REIMBURSEMENT
REQUEST THAT IS NOT RECEIVED BY THE DUE DATE. Failure to timely submit
Reimbursement Requests and Complete Documentation along with any required reports
shall be an event of default.
10. DEFAULT AND TERMINATION.
10.1 Failure to Submit Reimbursement Request or Required Documentation.
10.1.1 If Agency fails to submit a Reimbursement Request in accordance with
Section 9, Agency shall be in default of this Contract. City will notify Agency in writing of such
default and the Agency will have 10 business days from the date of the written notice to submit
such Reimbursement Request to cuie the default. If Agency fails to cure the default within such
time, Agency shall forfeit any payments otherwise due that month.
10.1.2 If Agency fails to submit requested infoimation or missing documentation as
set forth in Section 9 1 2, then Agency shall forfeit payment due that month and the failure to
submit shall be considered an event of default that shall not be cured.
10.1.3 NOTWITHSTANDING THE PROVISIONS OF SECTION 10.1.1 OR
10.1.2, IF AGENCY FAILS TO SUBMIT THE REIMBURSEMENT REQUEST DUE
OCTOBER 15, 2016, OR IF THE SUBMITTED REIMBURSEMENT REQUEST FOR
OCTOBER 15, 2016 IS LATE, INCOMPLETE OR OTHERWISE NOT IN
COMPLIANCE WITH THIS CONTRACT OR THE CDBG REGULATIONS AS
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DETERMINED BY CITY IN ITS SOLE DISCRETION, THERE WILL BE NO CURE
PERIOD AND ANY REIMBURSEMENT WILL BE FORFEITED.
10.1.4 In the event of (i) an uncured default under Section 10.1.1 or an event of
default under 10.1.2 or (ii) more than 2 instances of default, cured or uncured, under these
Sections, City reserves the right at its sole option to terminate this Contract effective
immediately upon written notice of such intent with no penalty or liability to City.
10.1.5 Notwithstanding anything to the contrary herein, City will not be required to
pay any CDBG Funds to Agency during the period that any Reimbursement Request, report or
documentation is past due or is not in compliance with this Contract or the CDBG Regulations,
or during any period during which Agency is in default of this Contract.
10.1.6 In the event of termination under this Section 10.1, all CDBG Funds awarded
but unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency shall
have no further right to such funds.
10.2 Failure to Maintain Records or Submit Renorts and Documentation.
If Agency fails to maintain all records and documentation as required in Section 8, or if
the maintained or submitted report or documentation is not in compliance with this Contract or
the CDBG Regulations as determined by City in its sole discretion, City will notify Agency in
writing and Agency will have 30 calendar days from the date of the written request to obtain or
recreate the missing records and documentation or submit or resubmit any such report or
documentation to City. If Agency fails to maintain the required reports or documentation, or
fails to submit or resubmit any such report or documentation within such time, City shall have
the right to terminate this Contract effective immediately upon written notice of such intent with
no penalty or liability to City.
10.2.1 In the event of termination under this Section 10.2, all CDBG Funds awarded
but unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency shall
have no further right to such funds, and any CDBG Funds paid to Agency must be repaid to City
within 30 days of termination. If such CDBG Funds are not repaid to City within the 30 day
period, City shall exercise all legal remedies available under this Contract.
10.3 In General.
10.3.1 Subject to Section 10.2, and unless specifically provided otherwise in this
Contract, Agency shall be in default under this Contract if Agency breaches any term or
condition of this Contract. In the event that such a breach remains uncured after 30 calendar
days following written notice by City (oi such other notice period as may be specified herein) or,
if Agency has diligently and continuously attempted to cure following i eceipt of such written
notice but reasonably requires more than 30 calendar days to cure, as determined by both Parties
mutually and in good faith, City shall have the right to elect in City s sole discretion to (r) extend
Agency s time to cure, (ii) terminate this Contract effective immediately upon written notice of
such intent to Agency, or (iii) pursue any other legal remedies available to City under this
Contract.
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10.3.2 City's remedies may include:
10.3.2.1 Direct Agency to prepare and follow a schedule of actions for
carrying out the affected activities, consisting of schedules,
timetables and milestones necessary to implement the affected
activities.
10.3.2.2 Direct Agency to establish and follow a management plan that
assigns responsibilities for carrying out the remedial activities.
10.3.2.3 Reprogram CDBG Funds that have not yet been expended from
affected activities to other eligible activities or withhold CDBG
Funds.
10.3.2.4 Any other appropriate action including but not limited to any
remedial action legally available such as declaratory judgment,
specific performance, damages, temporary or permanent
injunctions, termination of this Contract or any other contracts with
Agency, and any other available remedies.
10.3.3 In the event of termination under this Section 10.3, all CDBG Funds awarded
but unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency shall
have no further right to such funds, and any CDBG Funds already paid to Agency must be repaid
to City within 30 days of the termination. Failure to repay such CDBG Funds within the 30 day
period will result in City exercising all legal remedies available under this Contract.
10.4 No Funds Disbursed while in Breach.
Agency understands and agrees that no CDBG Funds will be paid to Agency until all
defaults are cured to City's satisfaction
10.5 No Compensation After Date of Termination.
Agency shall not receive any compensation for work undertaken after the date of the
termination.
10.6 RiEhts of City Not Affected.
Termination shall not affect or terminate any of the existing rights of City against
Agency, or which may thereafter accrue because of Agency s default and this provision shall be
in addition to any and all other rights and remedies available to City under the law. Such
termination does not terminate any provisions of this Contract that have been expressly noted as
surviving the teini or termination of the Contract. No delay or omission by City in exercising
any right or remedy available to it under this Contract shall impair any such right or remedy or
constitute a waiver or acquiescence in any Agency default.
10.7 Waiver of Breach Not Waiver of Subsequent Breach.
The waiver of a default or breach of any term, covenant, or condition of this Contract
shall not operate as a waiver of any subsequent default or breach of the same or any other term,
covenant or condition hereof.
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10.8 Civil, Criminal and Administrative Penalties.
Failure to perform all the Contract terms may result in civil, criminal or administrative
penalties, including, but not limited to those set out in this Contract.
10.9 Termination for Cause.
10.9.1 City may terminate this Contract in the event of Agency's default, inability, or
failure to perform subject to notice, glace and cure periods In the event City terminates this
Contract for cause, all CDBG Funds awarded but unpaid to Agency pursuant to this Contract
shall be immediately rescinded and Agency shall have no further right to such funds and any
CDBG Funds already paid to Agency must be repaid to City within 30 days of termination.
Failuie to repay such CDBG Funds within 30 days will result in City exercising all legal
remedies available to City under this Contract. AGENCY ACKNOWLEDGES AND
AGREES THAT IF CITY TERMINATES THIS CONTRACT FOR CAUSE, AGENCY
OR ANY AFFILIATES OF AGENCY SHALL NOT BE CONSIDERED FOR ANY
OTHER CITY CONTRACT FOR CDBG FUNDS FOR A MINIMUM OF 5 YEARS
FROM THE DATE OF TERMINATION.
10.9.2 Agency may terminate this Contract if City does not provide the CDBG Funds
substantially in accordance with this Contract.
10.10 Termination for Convenience.
In terminating in accordance with 2 CFR Part 200, Appendix II, this Contract may be
terminated in whole or in part only as follows:
10.10.1 By City with the consent of Agency in which case the Parties shall agree upon
the termination conditions, including the effective date and in the case of partial termination, the
portion to be terminated; or
10.10.2 By Agency upon at least 30 days written notification to City, setting forth the
reasons for such termination, the effective date, and in the case of partial termination, the portion
to be terminated. In the case of a partial termination, City may terminate the Contract in its
entirety if City determines in its sole discretion that the remaining portion of the Contract to be
performed or CDBG Funds to be spent will not accomplish the purposes for which the Contract
was made.
10.11 Dissolution of Atencv Terminates Contract.
This Contract shall terminate in the event Agency is dissolved or ceases to exist. In the
event of termination under this Section, all CDBG Funds are subject to repayment and/or City
may exercise all of its remedies under this Contract.
10.12 Reversion of Assets.
In the event this Contract is terminated with or without cause, all assets acquired by
Agency with the CDBG Funds including cash, interest payments from loans or otherwise, all
outstanding notes, mortgages or other security instruments any accounts receivable attributable
to the use of the CDBG Funds, and any real or personal property owned by Agency that was
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improved with the CDBG Funds shall automatically transfer to City or to such assignee as City
may designate.
11. REPAYMENT OF CDBG FUNDS.
All CDBG Funds are subject to repayment in the event the Program does not meet the
requirements of this Contract or in the CDBG Regulations. If Agency takes any action that
results in the City being required to repay all or any portion of the CDBG Funds to HUD,
Agency agrees it will reimburse City for such repayment. If Agency takes any action that
results in City receiving a finding from HUD about the Program, whether or not
repayment of all or any portion of the CDBG Funds is required of City, Agency agrees it
will pay City 10% of the CDBG Funds as liquidated damages. The Parties agree that City's
damages in the event of either repayment to HUD being required or receiving a finding from
HUD are uncertain and would be difficult to ascertain and may include an impact on City's
CDBG grant or other federal grant funds, m addition to the finding by HUD or a required
repayment of funds to HUD by City. Therefoie, the Parties agree that payment under this
Section of 10% of the CDBG Funds by Agency to City is liquidated damages and not a penalty.
12. CHANGE IN NON-PROFIT STATUS.
Agency must provide City with written notification of any changes to its non-profit status
within 15 calendar days of being notified of the change If the non-profit status of Agency
changes after the date of this Contract, City may but is not obligated to, terminate this Contract.
City has 30 calendar days to make such determination after receipt of written notice from
Agency and failure to make such determination will constitute a waiver In the event of
termination under this Section 12, all CDBG Funds awarded but not yet paid to Agency pursuant
to this Contract shall be immediately rescinded and Agency shall have no further right to such
funds Any CDBG Funds aheady paid to Agency must be repaid to City within 30 calendar days
of termination under this Section.
13. SURVIVAL.
Any provision of this Contract that pertains to auditing, monitoring, client income
eligibility, record keeping and reports, City ordinances, or applicable CDBG requirements, and
any default and enforcement provisions necessary to enforce such provisions, shall survive the
termination of this Contract for 5 years after the Contract term ends and shall be enforceable by
City against Agency. For purposes of this Contract, this 5 year period for survival of certain
Contract provisions is deemed to begin on October 1, 2016 and end on September 30, 2021
regardless of whether or not this Contract is earlier terminated.
14. GENERAL PROVISIONS.
14.1 AEencv an Indenendent Contractor.
Agency shall operate hereunder as an independent contractor and not as an officer, agent,
servant or employee of City. Agency shall have exclusive control of, and the exclusive right to
control, the details of the work and services performed hereunder, and all persons performing
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same, and shall be solely responsible for the acts and omissions of its officers, members, agents,
servants, employees, contractors, subcontractors, vendors, clients, licensees or invitees.
14.2 Doctrine of Respondeat Superior.
The doctrine of respondeat superior shall not apply as between City and Agency, or its
officers, members, agents servants, employees, contractors, subcontractors, vendors, clients,
licensees or invitees, and nothing herein shall be construed as creating a partnership or joint
enterprise between City and Agency. City does not have the legal right to control the details of
the tasks performed hereunder by Agency, its officers, members, agents, employees, contractors,
subcontractors, vendors, clients, licensees or invitees.
14.3 Agency Property.
City shall under no circumstances be responsible for any property belonging to Agency,
or its officers, members, agents, employees, contractors, subcontractors, vendors, clients,
licensees or invitees that may be lost, stolen or destroyed or in any way damaged and AGENCY
HEREBY INDEMNIFIES AND HOLDS HARMLESS CITY AND ITS OFFICERS,
AGENTS, AND EMPLOYEES FROM ANY AND ALL CLAIMS OR SUITS
PERTAINING TO OR CONNECTED WITH SUCH PROPERTY.
14.5 Religious Organization.
No portion of the CDBG Funds shall be used in support of any sectarian or religious
activity In addition, there must be no religious or membership criteria for clients of a CDBG-
funded set vice.
14.6 Venue.
Venue shall lie in Tarrant County, Texas for any action, whether real or asserted, at law
or in equity, arising out of the execution, performance, attempted performance or
non-performance of this Contract.
14.7 Governing Law.
This Contract shall be governed by and construed in accordance with the laws of the
State of Texas If any action, whether real or asserted, at law or in equity, arises out of the
execution, performance or non-performance of this Contract or on the basis of any provision
herein, for any issue not governed by federal law, the choice of law shall be the laws of the State
of Texas.
14.8 Severability.
The provisions of this Contract are severable, and if for any reason a clause, sentence,
paragraph or other part of this Contract shall be determined to be invalid by a court or federal or
state agency, board or commission having jurisdiction over the subject matter thereof, such
invalidity shall not affect other provisions which can be given effect without the invalid
provision
14.9 Written Agreement Entire Contract.
This written instrument and the Exhibits, Attachments, and Addendums attached hereto,
which are incorporated by reference and made a part of this Contract for all purposes, constitute
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the entire agreement by the Parties concerning the work and services to be performed under this
Contract. Any prior or contemporaneous oral 01 written agreement which purports to vary the
terms of this Contract shall be void. Any amendments to the terms of this Contract must be in
writing and executed by the Parties.
14.10 Paragraph Headings for Reference Only. No Legal Significance; Number
and Gender.
The paragraph headings contained herein are for convenience in reference to this
Contract and are not intended to define or to limit the scope of any provision of this Contract.
When context requires, singular nouns and pronouns include the plural and the masculine gender
shall be deemed to include the feminine o1 neuter and the neuter gender to include the masculine
and feminine. The words "include" and "including" whenever used herein shall be deemed to be
followed by the words "without limitation".
14.11 Compliance With All Applicable Laws and Regulations.
Agency agrees to comply fully with all applicable laws and regulations that are currently
in effect or that are hereafter amended during the performance of this Contract. Those laws
include, but are not limited to:
➢ CDBG Regulations found in 24 CFR Part 570
➢ Title I of the Housing and Community Development Act of 1974, as amended, (42
USC 5301
➢ Title VI of the Civil Rights Act of 1964 (42 IJ.S.C. Sections 2000d et seq.) including
provisions requiring recipients of federal assistance to ensure meaningful access by
person of limited English proficiency
➢ The Fair Housing Act, Title VIII of the Civil Rights Act of 1968 (42 U.S.C. Sections
3601 et seq.)
➢ Executive Orders 11063, 11246 as amended by 11375 and 12086 and as
supplemented by Department of Labor regulations 41 CFR Part 60
➢ The Age Discrimination in Employment Act of 1967
➢ The Age Discrimination Act of 1975 (42 U.S.C. Sections 6101 et seq.)
➢ The Uniform Relocation Assistance and Real Property Acquisition Policies Act of
1970 (42 U.S.C. Sections 4601 et seq. and 49 CFR Part 24) (` URA")
➢ Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. Sections 794 et seq.) and 24
CFR Part 8 where applicable
➢ National Environmental Policy Act of 1969, as amended, 42 U.S.C. Sections 4321 et
seq. ("NEPA") and the related authorities listed in 24 CFR Part 58.
➢ The Clean Air Act, as amended, (42 U.S.C. Sections 1251 et seq) and the Clean
Water Act of 1977, as amended (33 U.S.C. Sections 1251 et seq.) and the related
Executive Order 11738. In no event shall any amount of the assistance provided
under this Contract be utilized with respect to a facility that has given rise to a
conviction under the Clean Air Act or the Clean Water Act.
➢ Immigration Reform and Control Act of 1986 (8 U.S.C. Sections 1101 et seq.)
specifically including the provisions requiring employer verifications of legal status
of its employees
➢ The Americans with Disabilities Act of 1990 (42 U.S.C. Sections 12101 et seq.), the
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Architectural Barriers Act of 1968 as amended (42 U.S.C. Sections 4151 et seq.) and
the Uniform Federal Accessibility Standards, 24 CFR Part 40, Appendix A
➢ Regulations at 24 CFR Part 87 related to lobbying, including the requirement that
certifications and disclosures be obtained from all covered persons
➢ Drug Free Workplace Act of 1988 (41 U.S.C. Sections 701 et seq.) and 24 CFR Part
23, Subpart F
➢ Executive Order 12549 and 24 CFR Part 5.105(c) pertaining to restrictions on
participation by ineligible, debarred or suspended persons or entities
➢ Section 6002 of the Solid Waste Disposal Act, as amended by the Resource
Conservation and Recovery Act
➢ Guidelines of the knvironmental Protection Agency at 40 CFR Part 247
➢ For contracts and subgrants for construction or repair, Copeland "Anti -Kickback" act
(18 U.S.C. 874) as supplemented in 29 CFR Part 5
➢ For construction contracts awarded by Agency in excess of $2,000, and in excess of
$2,500 for other contracts which involve the employment of mechanics or laborers,
Sections 103 and 107 of the Contract Work Hours and Safety Standards Act (40
U.S.C. 327A 300) as supplemented by 29 CFR Part 5
➢ Lead -Based Paint Poisoning Prevention Act (42 U.S.C. 4801 et seq.), as amended by
the Residential Lead -Based Paint Hazard Reduction Act of 1992 (42 U.S.C. 4851 et
seq.) and implementing regulations at 24 CFR Part 35, subparts A, B, M, and R
➢ Uniform Administrative Requirements, Cost Principles, and Audit Requirements for
Federal Awards, 2 CFR Part 200 et seq.
➢ Federal Funding Accountability and Transparency Act of 2006 ("FFATA") (Pub L
109-282, as amended by Section 6205(a) of Pub L 110-252 and Section 3 of Pub L
113-101)
➢ Federal Whistleblower Regulations as contained in 10 U.S.C. 2409, 41 U.S.C. 4712,
10 U.S.C. 2324, 41 U.S.C. 4304 and 41 U.S.C. 4310.
14.11 HUD -Assisted Proiects and Emnlovment and other Economic Opportunities;
Section 3 Requirements.
14.11.1 Requirement that Law Be Quoted in Covered Contracts. — Certain
Requirements Pertaining. to Section 3 of the Housint and Urban
Develonment Act of 1968 as Amended (12 U.S.C. Sections 1701 et seq.)
and its Related Regulations at 24 CFR Part 135.
If the Program results in the creation of neta employment, training, or contracting
opportunities on a contractor or subcontractor level resulting from the expenditure of the CDBG
Funds, Agency shall comply with the following and will ensure that its contractors also comply.
If the work performed under this Contact is on a project assisted under a program providing
direct federal financial assistance from HUD, Section 3 of 24 CFR Part 135.38 ("Section 3")
requires that the following clause, shown in italics, be inserted in all covered contracts ("Section
3 Clause"):
Section to be quoted in covered contracts begins:
"A. The rework to be performed under this contract is subject to the
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requirements of Section 3 of Housing and Urban Development Act of 1968, as
amended, 12 U.S.C. section 1701u (Section 3). The purpose of Section 3 is to
ensure that employment and other economic opportunities generated by HUD
assisted or HUD -assisted programs 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 it has a collective bargaining agreement or
other understanding, if any, a notice advising the labor organization or workers'
representatives 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 apprentice 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 that it will include this Section 3 clause in every
subcontract to comply with regulation 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 finding that the subcontractor is in violation of the
regulations in 24 CFR Part 135. The contractor will not subcontract with any
subcontractor where it has notice or knowledge that the subcontractor has been
found in violation of regulations in 24 CFR Part 135.
E. The contractor will certifi, that any vacant employment positions,
including training positions that are filed: (1) after the contractor is selected but
before the contract is executed, and (2) with persons other than those to whom the
regulations of 24 CFR Part 135. The contractor will not subcontract with any
subcontractor where it has notice or knowledge that the subcontractor has been
found in violation of regulations in 24 CFR Part 135.
F. Noncompliance with HUD's regulation in 24 CFR Part 135 may result in
sanctions, termination of this contract for default, and debarment or suspension
from fixture 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. Section 450(e) 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
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7(b) agree to comply with Section 3 to the maximum extent feasible, but not in
derogation of compliance with Section 7(b). "
Section to be quoted in covered contracts ends.
14.11.2 Agency Responsibilities for Section 3 Requirements.
City and Agency understand and agree that compliance with the provisions of Section 3,
the regulations set forth in 24 CFR Part 135, and all applicable rules and orders of HUD shall be
a condition of the federal financial assistance provided to the Program binding upon City and
Agency and their respective successors, assigns contractors and subcontractors. Failure to fulfill
these requirements shall subject Agency and its contractors and subcontractors and their
respective successors and assigns to those sanctions specified by the giant agreement through
which federal assistance is provided and to such sanctions as are specified by 24 CFR Part 135.
Agency's responsibilities include:
14.11.2.1 Implementing procedures to notify Section 3 residents and
business concerns about training, employment, and contracting
opportunities generated by Section 3 covered assistance;
14.11.2.2 Notifying potential contractors working on Section 3 covered
projects of their responsibilities;
14.11.2.3 Facilitating the training and employment of Section 3 residents and
the award of contracts to Section 3 business concerns;
14.11.2.4 Assisting and actively cooperating with the HED Department in
making contractors and subcontractors comply;
14.11.2.5 Refraining from entering into contracts with contractors that are in
violation of Section 3 regulations;
14.11.2.6 Documenting actions taken to comply with Section 3; and
14.11.2.7 Submitting Section 3 Annual Summary Reports (Form HUD-
60002) in accordance with 24 CFR Part 135.90.
14.11.3 Section 3 Reporting Requirements.
In order to comply with the Section 3 requirements, Agency must submit the forms
attached hereto as EXHIBIT "G" - Section 3 Reporting Forms
14.11.3.1 Report to the City on a quarterly basis all applicants for
employment, and all applicants foi employment by contractor and
subcontractor. This shall include name, address, zip code, date of
application, and status (hired/not hired) as of the date of the report.
14.11.3.2 Advertise available positions to the public for open competition,
and provide documentation to City with the quarterly report that
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demonstrates such open advertisement in the form of printout of
Texas Workforce Commission posting, copy of newspaper
advertisement, copy of flyers and listing of locations where flyers
were distributed, and the like.
14.11.3.3 Report to the City on a quarterly basis all contracts awarded by
contractor and subcontractor. This shall include name of
contractor and/or subcontractor, address, zip code, and amount of
award as of the date of the report.
14.12 Prohibition Against Discrimination.
14.12.1 General Statement.
Agency shall comply in the execution, performance or attempted perfounance of this
Contract, with all non-discrimination requirements of 24 CFR Part 570.607 and Chapter 17,
Article III, Division 4 — Fair Housing of the City Code. Agency may not discriminate against
any person because of race, color, sex, gender, religion, national origin, familial status, disability
or perceived disability, sexual orientation, gender identity, gender expression, or transgender, nor
will Agency permit its officers, members, agents, employees, or clients to engage in such
discrimination
This Contract is made and entered into with reference specifically to Chapter 17, Article
III, Division 3 - Employment Pi actices of the City Code, and Agency hereby covenants and
agrees that Agency, its officers, members, agents, employees and contractors, have fully
complied with all provisions of same and that no employee, or applicant for employment has
been discriminated against under the terms of such ordinances by either or its officers, members,
agents, employees or contractors.
14.12.2 No Discrimination in Emplovment during the Performance of This
Contract.
During the performance of this Contract Agency agrees to the following provision, and
will require that its contractors and subcontractors also comply with such provision by including
it in all contracts with its contractors:
[Contractor's, Subcontractor's or Vendor's name] will not unlawfully discriminate
against any employee or applicants for employment because of race, color, sex, gender, religion,
national origin familial status, disability or perceived disability, sexual orientation, gender
identity, gender expression or transgender. [Contractor's, Subcontractor's or Vendor's name]
will take affirmative action to ensure that applicants are hired without regard to race, color, sex,
gender religion, national origin, familial status, disability or perceived disability, sexual
orientation, gender identity, gender expression or transgender and that employees are treated
fairly during employment without regard to their race, color, sex, gender religion, national
origin, familial status, disabihty or perceived disability sexual orientation, gender identity,
gender expression or transgender. Such action shall include, but not be limited to, the following:
employment, upgrading, demotion or transfer, recruitment or recruitment advertising, layoff or
termination, rates of pay or other forms of compensation, and selection for training, including
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apprenticeship [Contractor's, Subcontractor's or Vendor's name] agrees to post in conspicuous
places, available to employees and applicants for employment, notices setting forth the
provisions of this nondiscrimination clause.
[Contractor's, Subconti actor's or Vendor's name] will, in all solicitations or
advertisements for employees placed by or on behalf of [Conti actor's, Subcontractor's or
Vendor's name], state that all qualified applicants will receive consideration for employment
without regard to race, color, sex, gender, religion, national origin, familial status, disability or
perceived disability, sexual orientation, gender identity, gender expression or transgender.
[Contractor's, Subcontractor's or Vendor 's name] covenants that neither it nor any of its
officers members, agents, employees, or contractors, while engaged in performing this Contract,
shall, in connection with the employment, advancement or discharge of employees or in
connection with the terms, conditions or privileges of their employment, discriminate against
persons because of their age or because of any disability or perceived disability, except on the
basis of a bona fide occupational qualification, retirement plan or statutory requirement
(Contractor's, Subcontractor's or Vendor's name] further covenants that neither it nor its
officers members, agents, employees, contractors, or persons acting on their behalf, shall
specify in sohcitations or advertisements for employees to work on this Contract, a maximum
age limit for such employment unless the specified maximum age limit is based upon a bona fide
occupational qualification, retirement plan or statutory requirement.
14.12.3 AEencv s Contractors and the ADA.
In accordance with the provisions of the Americans With Disabilities Act of 1990
("ADA"), Agency warrants that it and any of its contractors will not unlawfully discriminate on
the basis of disability in the provision of services to the general public, nor in the availability,
terms and/or conditions of employment for applicants for employment with, or employees of,
Agency or any of its contractors. AGENCY WARRANTS IT WILL FULLY COMPLY
WITH THE ADA'S PROVISIONS AND ANY OTHER APPLICABLE FEDERAL,
STATE AND LOCAL LAWS CONCERNING DISABILITY AND WILL DEFEND,
INDEMNIFY AND HOLD CITY HARMLESS AGAINST ANY CLAIMS OR
ALLEGATIONS ASSERTED BY THIRD PARTIES, CONTRACTORS
SUBCONTRACTORS, VENDORS OR AGENTS AGAINST CITY ARISING OUT OF
AGENCY'S AND/OR ITS CONTRACTORS', SUBCONTRACTORS', VENDORS' OR
AGENTS' OR THEIR RESPECTIVE EMPLOYEES' ALLEGED FAILURE TO
COMPLY WITH THE ABOVE -REFERENCED LAWS CONCERNING DISABILITY
DISCRIMINATION IN THE PERFORMANCE OF THIS CONTRACT.
14.13. Conflicts of Interest and Violations of Criminal Law.
14.13.1 AEencv Safeguards.
Agency shall establish safeguards to prohibit its employees, board members, advisors and
agents from using positions for a purpose that is or gives the appearance of being motivated by a
desire for private gain for themselves or others, particularly those with whom they have family,
CDBG PRESUMED BENEFIT PSA CONTRACT 2015-2016
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Page 24
Rev. 10.30.2015
business or other ties. Agency shall disclose to City any such conflict of interest or potential
conflict of interest, immediately upon discovery of such.
14.13.2 General Prohibitions Against Conflicts of Interest.
No employees, agents, consultants, officers or elected officials or appointed officials of
City or of Agency who exercise or have exercised any functions or responsibilities with respect
to activities assisted with CDBG funds or who are in a position to participate in a decision -
making process or gain inside information with regard to these activities may utilize CDBG
services, may obtain a financial interest or benefit from a CDBG-assisted activity, or have an
interest in any contract, subcontract or agreement with respect thereto, or the proceeds
thereunder, either foi themselves or those with whom they have family or business ties, during
their tenure or for 1 year thereafter, unless they are accepted in accordance with the procedures
set forth at 24 CFR Part 570.611.
14.13.2.1 Agency shall establish conflict of interest policies for federal
awards including the CDBG Funds and shall disclose in writing
potential conflicts of interest to City as authorized by 2 CFR Part
200.112.
14.13. 3 Conflicts of Interest Involving Procurement
The conflict of interest provisions of 2 CFR Part 200.31 shall apply in the procurement of
property and services by Agency In all cases not governed by this Section, the provisions of 24
CFR Part 570.611 of the CDBG Regulations shall apply.
14.13.3.1 As more particularly described in 2 CFR Part 200.318, Agency
shall maintain and submit to City written standards of conduct
covering conflicts of interest and governing the perfoiniance of its
employees engaged in the selection, award, and administration of
contracts. No employee, officer, or agent may participate in the
selection, award, or administration of a contract supported by a
federal award if he or she has a seal or apparent conflict of interest.
The standards of conduct must provide for disciplinary actions to
be applied for violations of such standards by officers, employees,
or agents of Agency.
14.13.3.2 The officers, employees, and agents of Agency shall neither solicit
nor accept gratuities, favors, or anything of monetary value from
contractors or parties to subcontracts.
14.13.3.3 Notwithstanding the prohibition contained in Section 14.13.3.2,
Agency may set standards of conduct for situations in which the
financial interest is not substantial or the gift is an unsolicited item
of nominal value. Such standards of conduct must provide for
disciplinary actions to be applied for violations of such standards
by Agency's officers, employees or agents.
14.13.3.4 Agency shall maintain written standards of conduct covering
organizational conflicts of interest. Organizational conflicts of
CDBG PRESUMED BENEFIT PSA CONTRACT 2015-2016
Presbyterian Night Shelter
Page 25
Rev. 10.30.2015
interest means that because of relationships with a parent company,
affiliate, or subsidiary organization, Agency is unable or appears to
be unable to be impartial in conducting a procurement action
involving a related organization.
14.13.3.5 Agency must maintain records sufficient to detail the history of
procurement. These records will include, but are not necessarily
limited to the following: rationale for the method of procurement,
selection of contract type, contractor selection or rejection, and the
basis for the contract price.
14.13.4 Disclosure of Conflicts of Interest.
In compliance with 2 CFR Part 200.112, Agency is required to timely disclose to City in
writing any potential conflict of interest.
14.13.5 Disclosure of Texas Penal Code Violations.
Agency affiilus that it will adhere to the provisions of the Texas Penal Code which
prohibit bribery and gifts to public servants.
14.13.6 Disclosure of Federal Criminal Law Violations.
In compliance with 2 CFR Part 200.113, Agency is required to timely disclose to City all
violations of federal criminal law involving fraud, bribery or gratuity violations potentially
affecting the Agency.
14.14 Subcontracting with Small and Minority Firms, Women's Business
Enterprises and Labor Surplus Areas.
14.14.1 For procurement contracts $50,000.00 or larger that are paid for, in part or in
full, with the CDBG Funds, Agency agrees to abide by City's policy to involve Minority
Business Enterprises and Small Business Enterprises and to provide them equal opportunity to
compete for contracts for construction, provision of professional services, purchase of equipment
and supplies and provision of other services required by City. Agency agrees to incorporate the
City's BDE Ordinance, and all amendments or successor policies or ordinances thereto, into all
contracts and subcontracts for procurement larger than $50,000.00 or larger that are paid for in
part or in full, with the CDBG Funds and will further require all persons or entities with which it
so contracts to comply with said ordinance.
14.14.2 It is national policy to award a fair share of contracts to disadvantaged
business enterprises ("DBEs"), small business enterprises ("SBEs"), minority business
enterprises ("MBEs"), and women's business enterprises ("WBEs"). Accordingly, affirmative
steps must be taken to assure that DBEs, SBEs, MBEs, and WBEs are utilized when possible as
sources of supphes, equipment, construction and services.
14.14.2.1 In order to comply with federal reporting requirements as
described in 24 CFR Part 570.506 (g)(6) Agency must submit the
form attached hereto as EXHIBIT "I" — MBE Reporting Form
CDBG PRESUMED BENEFIT PSA CONTRACT 2015-2016
Pi esbytei ian Night Shelter
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Rev. 10.30.2015
for each contract or subcontract with a value of $10,000.00 or
more paid of to be paid with the CDBG Funds. Agency shall
submit this folio by the date specified in EXHIBIT "I" - MBE
Reporting Form
14.15 Other Laws.
The failure to list any federal, state or City ordinance, law or regulation that is applicable
to Agency does not excuse or relieve Agency from the requirements or responsibilities in regard
to following the law, nor from the consequences or penalties for Agency's failure to follow the
law, if applicable.
14.16 Assignment.
Agency shall not assign all or any part of its rights, privileges, or duties under this
Contract without the prior written approval of City. Any attempted assignment of same without
approval shall be void, and shall constitute a breach of this Contract.
14.17. Right to Inspect Agency Contracts.
It is agreed that City has the right to inspect and approve in writing any proposed
contracts between Agency and any contractor or vendor engaged in any activity in conjunction
with this CDBG-funded Program prior to any charges being incurred.
14.18 Force Majeure
If Agency becomes unable, either in whole or part, to fulfill its obligations under this
Contract due to acts of God, strikes, lockouts, of other industrial disturbances, acts of public
enemies, wars, blockades, insurrections, riots, epidemics, earthquakes, fires, floods, restraints or
prohibitions by any court, board, department, commission or agency of the United States or of
any States civil disturbances, or explosions, or some other reason beyond Agency's control
(collectively, "Force Majeure Event"), the obligations so affected by such Force Majeure hvent
will be suspended only during the continuance of such event Agency will give City written
notice of the existence, extent and nature of the Force Majeure Event as soon as reasonably
possible after the occurrence of the event Failure to give notice will result in the continuance of
Agency's obligation regardless of the extent of any existing Force Majeure hvent Agency will
use commeicially reasonable efforts to remedy its inability to perform as soon as possible.
15. INDEMNIFICATION AND RELEASE.
AGENCY COVENANTS AND AGREES TO INDEMNIFY, HOLD HARMLESS
AND DEFEND, AT ITS OWN EXPENSE, CITY AND ITS OFFICERS, AGENTS,
SERVANTS AND EMPLOYEES FROM AND AGAINST ANY AND ALL CLAIMS OR
SUITS FOR PROPERTY LOSS OR DAMAGE AND/OR PERSONAL INJURY,
INCLUDING DEATH, TO ANY AND ALL PERSONS, OF WHATSOEVER 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, ACTIVITIES AND SERVICES OF THE PROGRAM DESCRIBED
HEREIN, WHETHER OR NOT CAUSED IN WHOLE OR IN PART, BY ALLEGED
CDBG PRESUMED BENEFIT PSA CONTRACT 2015-2016
Presbytei ian Night Sheltei
Page 27
Rev. 10 30 2015
NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES,
CONTRACTORS OR SUBCONTRACTORS OF CITY; AND AGENCY HEREBY
ASSUMES ALL LIABILITY AND RESPONSIBILITY OF CITY AND ITS OFFICERS,
AGENTS, SERVANTS, AND EMPLOYEES FOR ANY AND ALL CLAIMS OR SUITS
FOR PROPERTY LOSS OR DAMAGE AND/OR PERSONAL INJURY, INCLUDING
DEATH, TO ANY AND ALL PERSONS, OF WHATSOEVER KINDS OR
CHARACTER, WHETHER REAL OR ASSERTED, ARISING OUT OF OR IN
CONNECTION WITH THE EXECUTION, PERFORMANCE, ATTEMPTED
PERFORMANCE OR NONPERFORMANCE OF THIS CONTRACT AND/OR THE
OPERATIONS, ACTIVITIES AND SERVICES OF THE PROGRAM DESCRIBED
HEREIN, WHETHER OR NOT CAUSED IN WHOLE OR IN PART BY ALLEGED
NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES,
CONTRACTORS OR SUBCONTRACTORS OF CITY. AGENCY LIKEWISE
COVENANTS AND AGREES TO AND DOES HEREBY INDEMNIFY AND HOLD
HARMLESS CITY FROM AND AGAINST ANY AND ALL INJURY, DAMAGE OR
DESTRUCTION OF PROPERTY OF CITY, ARISING OUT OF OR IN CONNECTION
WITH ALL ACTS OR OMISSIONS OF AGENCY, ITS OFFICERS, MEMBERS,
AGENTS, EMPLOYEES, CONTRACTORS, SUBCONTRACTORS, INVITEES,
LICENSEES, OR CLIENTS, OR CAUSED, IN WHOLE OR IN PART, BY ALLEGED
NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES,
CONTRACTORS OR SUBCONTRACTORS OF CITY.
IT IS THE EXPRESS INTENTION OF THE PARTIES, BOTH AGENCY AND
CITY, THAT THE INDEMNITY PROVIDED FOR THIS SECTION INCLUDES
INDEMNITY BY AGENCY TO INDEMNIFY AND PROTECT CITY FROM THE
CONSEQUENCES OF CITY'S OWN NEGLIGENCE, WHETHER THAT
NEGLIGENCE IS ALLEGED TO BE THE SOLE OR CONCURRING CAUSE OF THE
INJURY, DAMAGE OR DEATH.
AGENCY AGREES TO AND SHALL RELEASE CITY, ITS AGENTS,
EMPLOYEES, OFFICERS AND LEGAL REPRESENTATIVES FROM ALL
LIABILITY FOR INJURY, DEATH, DAMAGE OR LOSS TO PERSONS OR
PROPERTY SUSTAINED IN CONNECTION WITH OR INCIDENTAL TO
PERFORMANCE UNDER THIS CONTRACT, EVEN IF THE INJURY, DEATH,
DAMAGE OR LOSS IS CAUSED BY CITY'S SOLE OR CONCURRENT
NEGLIGENCE.
AGENCY SHALL REQUIRE ALL OF ITS CONTRACTORS AND
SUBCONTRACTORS TO INCLUDE IN THEIR CONTRACTS AND SUBCONTRACTS
A RELEASE AND INDEMNITY IN FAVOR OF CITY IN SUBSTANTIALLY THE
SAME FORM AS ABOVE.
16. WAIVER OF IMMUNITY BY AGENCY.
If Agency, as a charitable or nonprofit organization, has or claims an immunity or
exemption (statutory or otherwise) from and against liability for damages or injury including
death to persons or property, Agency hereby expressly waives its rights to plead defensively
CDBG PRESUMED BENEFIT PSA CONTRACT 2015-2016
Presbyterian Night Shelter
Page 28
Rev. 10 30 2015
such immunity or exemption as against City. This Section shall not be construed to affect a
governmental entity's immunities under constitutional, statutory or common law.
17. INSURANCE AND BONDING.
Agency will maintain coverage in the form of insurance or bond in the amount of
$75,000.00 to insure against loss from the fraud, theft or dishonesty of any of Agency's officers,
agents, trustees, directors or employees. The proceeds of such insurance or bond shall be used to
reimburse City for any and all loss of CDBG Funds occasioned by such misconduct. To
effectuate such reimbursement, such fidelity coverage shall include a rider stating that
reimbursement for any loss or losses shall name the City as a Loss Payee.
Agency shall furnish to City in a timely manner, but not later than the Effective Date,
certificates of insurance as proof that it has secured and paid for policies of commercial
insurance as specified herein If City has not received such certificates by the Effective Date,
Agency shall be in default of the Contract and City may, at its option, terminate the Contract.
Such insurance shall cover all insurable risks incident to or in connection with the
execution, perfoumance, attempted performance or nonperformance of this Contract. Agency
shall maintain the following insurance coverage and limits:
Commercial General Liability (CGL) Insurance
$ 500,000 each occurrence
$1,000,000 aggregate limit
Non -Profit Organization Liability or Directors & Officers Liability
$1,000,000 Each Occurrence
$1,000,000 Annual Aggregate Limit
Business Automobile Liability Insurance
$1,000,000 each accident on a combined single -limit basis, or
$ 250,000 Property Damage
$ 500,000 Bodily Injury per person per occurrence
$2,000,000 Aggregate
Insurance policy shall be endorsed to cover "Any Auto", defined as autos owned, hired,
and non -owned. Pending availability of the above coverage and at the discretion of
City, the policy shall be the primary responding insurance policy versus a personal
auto insurance policy if or when in the course of Agency's business as contracted
herein.
Workers' Compensation Insurance
Part A: Statutory Limits
Part B: Employer's Liability
CDBG PRESUMED BENEFIT PSA CONTRACT 2015-2016
Presbyterian Night Shelter
Page 29
Rev. 10.30.2015
$100,000 each accident
$100,000 disease -each employee
$500,000 disease -policy limit
Note: Such insurance shall cover employees performing work on any and all projects
including but not limited to construction, demolition, and rehabilitation. Agency or its
contractors shall maintain coverages, if applicable In the event the respective contractors
do not maintain coverage, Agency shall maintain the coverage on such contractor, if
applicable, for each applicable contract.
Additional Requirements
Such insurance amounts shall be revised upward at City's reasonable option and no more
frequently than once every 12 months, and Agency shall revise such amounts within 30 days
following notice to Contractor of such requirements
Agency will submit to City documentation that it has obtained insurance coverage and has
executed bonds as required in this Contract prior to payment of any monies provided hereunder.
Where applicable, insurance policies required herein shall be endorsed to include City as an
additional insured as its interest may appear. Additional insured parties shall include employees,
officers, agents, and volunteers of City.
Any failure on part of City to request certificate(s) of insurance shall not be construed as a
waiver of such requirement or as a waiver of the insurance requirements themselves.
Insurers of Agency's insurance policies shall be licensed to do business in the state of Texas by
the Department of Insurance or be otherwise eligible and authorized to do business in the state of
Texas. Insureis shall be acceptable to City insofar as their financial strength and solvency and
each such company shall have a current minimum A.M. Best Key Rating Guide rating of A-: VII
or other equivalent insurance industry standard rating otherwise approved by City.
Deductible limits on insurance policies shall not exceed $5,000 per occurrence unless otherwise
approved by City.
In the event there are any local, federal or other regulatory insurance or bonding requirements for
the Program, and such requirements exceed those specified herein, the former shall prevail.
Agency shall require its contractors to maintain applicable insurance coverages, limits, and other
requirements as those specified herein; and Agency shall require its contractors to provide
Agency with certificate(s) of insurance documenting such coverage. Also, Agency shall require
its contractors to have City and Agency endorsed as additional insureds (as their interest may
appear) on their respective insurance policies.
Directors and Officers Liability coverage shall be in force and may be provided on a claims -
made basis This coverage may also be referred to as Management Liability, and shall protect
the insured against claims arising out of alleged errors in judgment, breaches of duty and
CDBG PRESUMED BENEFIT PSA CONTRACT 2015-2016
Piesbyterian Night Shelter
Page 30
Rev. 10.30.2015
wrongful acts arising out of their organizational duties. Coverage shall protect not only the
entity, but all past, present and future directors, officers, trustees, employees, volunteers and
committee members.
Notwithstanding any provision in this Contract to the contrary, when applicable, Agency
shall comply with the requirements of 2 CFR 200.310 and shall, at a minimum, provide the
equivalent insurance coverage for real property and equipment acquired or improved with
CDBG Funds as provided to property owned by Agency.
18. CERTIFICATION REGARDING LOBBYING.
The undersigned representative of Agency hereby certifies, to the best of his or her
knowledge and belief, that:
No federal appropriated funds have been paid or will be paid, by or on behalf of Agency,
to any person for influencing or attempting to influence an officer or employee of any
agency, a member of Congress, an officer or employee of Congress in connection with
the awarding of any federal contract, the making of any federal grant, the making of any
federal loan, the entering into of any cooperative agreement and the extension,
continuation, renewal, amendment, or modification of any federal contract, grant, loan or
cooperative agreement
If any funds other than federally appropriated funds have been paid or will be paid to any
person for influencing or attempting to influence an officer or employee of any agency,
member of Congress in connection with this federal contract, grant, loan or cooperative
agreement, Agency shall complete and submit Standard Form-LLL, "Disclosure Fouu to
Report Lobbying," in accordance with its instructions.
This certification is a material representation of fact upon which reliance was placed
when this Contract was made or entered into. Submission of this certificate is a
prerequisite for making or entering into this Contract imposed by 31 U.S.C. Section
1352. Any person who fails to file the required certification shall be subject to a civil
penalty of not less than $10,000.00 and not more than $100,000.00 for each such failure.
Agency shall require that the language of this certification be included in all subcontracts
or agreements involving the expenditure of federal funds.
19. LITIGATION AND CLAIMS.
Agency shall give City immediate notice in writing of any action, including any
proceeding before an administrative agency, filed against Agency in conjunction with this
Contract or the Program. Agency shall furnish immediately to City copies of all pertinent papers
received by Agency with respect to such action or claim. Agency shall provide a notice to City
within 10 days upon filing under any bankruptcy or financial insolvency provision of law.
CDBG PRESUMED BENEFIT PSA CONTRACT 2015-2016
Presbyterian Night Shelter
Page 30-1
Rev. 10 30 2015
20. NOTICE.
All notices required or permitted by this Contract must be in writing and are deemed
delivered on the earlier date of the date actually received or the third day following deposit in a
United States Postal Service post office or receptacle; with proper postage, certified mail return
receipt requested; and addressed to the other Party at the address set out below or at such other
address as the receiving Party designates by proper notice to the sending Party.
City:
City Attorney's Office
1000 Throckmorton Street
Fort Worth, TX 76102
Telephone: 817-392-7600
Copy to:
Neighborhood Services Department
1000 Throckmorton Street
Fort Worth, TX 76102
Attention• Assistant Director
Telephone: 817-392-7540
Copy to:
Neighborhood Services Department
1000 Throckmorton Street
Fort Worth, TX 76102
Attention Program Cooidinator
Telephone* 817-392-6342
A2encv:
Presbyterian Night Shelter
Debra Rabalais
2400 Cypress Street
Fort Worth, TX 76102
Telephone' 817-632-7402
21. AGENCY HAS LEGAL AUTHORITY TO ENTER INTO CONTRACT.
Agency represents that it possesses the legal authority, pursuant to any proper
appropriate and official motion, resolution or action passed or taken, to enter into this Contract
and to perform the responsibilities herein required.
22. COUNTERPARTS.
This Contract may be executed in multiple counterparts, each of which shall be
considered an original, but all of which shall constitute one instrument which may be sufficiently
evidenced by one counterpart.
[SIGNATURES APPEAR ON NEXT PAGE]
CDBG PRESUMED BENEFIT PSA CONTRACT 2015-2016
Piesbyterian Night Shelter
Page 30-2
Rev. 10.30.2015
IN WITNESS WHEREOF, the Parties hereto have executed 4 duplicate originals of this
Contract in Fort Worth, Tarrant County, Texas.
ATTEST: CITY OF FORT WORTH
By:
City Secretary
M&C: G-18521
Date: August 4, 2015
APPROVED AS TO FORM AND LEGALITY:
Assistant City Attorney
Fernando Costa, Assistant City Manager
PRESBYTERIAIGHT SHELTER
By:
Name:
Title:
CDBG PRESUMED BENEFIT PSA CONTRACT 2015-2016
Presbyterian Night Shelter
C
--r
t—verv1000,66,-.
s-
oFFrCIAL RECORD
CITY SECRETARY
fit WORrH, TX
Page 31
Rev. 09.01.2015
IN WITNESS WHEREOF, the Parties hereto have executed 4 duplicate originals of this
Contract in Fort Worth, Tar.as0- 2_ Texas.
CITY OF FORT WORTH
By:
ity Seas
M&C: G- 1 85f21
Date: August 4, 2015
APPROVED AS TO FORM AND LEGALITY:
Assistant City Attorney
Fernando Costa, Assistant City Manager
PRESBYTERIAN NIGHT SHELTER
By:
Name: Toby Owen
Title: CEO
OFFICIAL )/.1m,
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CDBG PRESUMED BENEFIT PSA CONTRACT 2015-2016
Presbyterian Night Shelter
Page 31
Rev. 10.30.2015
EXHIBITS:
EXHIBIT
EXHIBIT
EXHIBIT
EXHIBIT
EXHIBIT
EXHIBIT
EXHIBIT
EXHIBIT
EXHIBIT
EXHIBIT
EXHIBIT
"A" —Program Summary
"A-1" — 2015 HUD Income Limits
"A-2" — Reporting Requirements for Countywide Agencies
"B" — Budget
"C" — Audit Certification Form
"D" — Reimbursement Forms
"E" — Form of Income Self -Certification
"F" — Standards for Complete Documentation
"G" — Section 3 Reporting Forms
"H" — Severely Disabled Certification Form
"I" — MBE Reporting Form
CDBG PRESUMED BENEFIT PSA CONTRACT 2015-2016
Pi esbyterian Night Shelter
Page 32
Rev. 10.30.2015
PRESBYTERIAN NIGHT SHELTER EXHIBIT "A"
Moving Home Program PROGRAM SUMMARY
PROGRAM SUMMARY
(CDBG)
October 1, 2015 to September 30, 2016
PERIOD
$75 000.00
AMOUNT
Capitalized terms not defined herein shall have meanings assigned them in the Contract.
PROGRAM:
The Program will provide single men and women with case management services while in the
shelter and in housing Clients who have incomes at or less than $300 per month, will be
assigned to the Vocational Program where they will work 16 hours per week in janitorial,
kitchen, and grounds keeping duties at the shelter.
CDBG Funds will be used to pay for salaries and fringe benefits for Program employees. CDBG
Funds will pay for a percentage of the shelter's utilities for clients participating in the Moving
Home Program.
Agency Program services will be available at 2400 Cypress Street, Fort Worth, TX 76102.
Agency's shelter provides services 24 hours a day, 365 days a year. Case management services
will be provided Monday through Friday, 9:00 a m to 9:00 p.m., and Saturdays, 9:00 a.m. to
9:00 p.m.
REGULATORY CLASSIFICATION:
IDIS Matrix Code(s) and Service Category: 05 Other Public Services
National Objective Citation' LMC Low/Mod Limited Clientele 24 CFR 570.208(a)(2)
Regulatory Citation(s): 24 CFR 570.201(e)
Agency will maintain documentation which verifies that 100% of clients served by the Progiam
are Homeless Persons per the Presumed Benefit CDBG clientele category and therefore are at or
below 80% of AMI
PROGRAM GOALS:
Minimum Number of Fort Worth Clients to be Served: The Program must serve a minimum
of 750 Unduplicated Clients from Fort Worth as shown by the monthly reports on Attachment
III.
CDBG PRESUMED BENEFIT PSA CONTRACT 2015-2016 — EXHIBIT "A" — PROGRAM SUMMARY Page 1
Presbytei ian Night Shelter
30% AMI
50% AMI
80% AMI
1 Person
$14,650
$24,400
$39,050
EXHIBIT "A-1"
2015 HUD INCOME LIMITS
2015 Median Family Income - Fort Worth/Arlington, TX*
2 Persons
$16,750
$27,900
3 Persons
$20,090
$31,400
$44,600 $50,200
4 Persons
$24,250
$34,850
$55,750
5 Persons 6 Persons 7 Persons
$28,410 $32,570 $36,730
$37,650 $40,450 $43,250
$60,250 $64,700 $69,150
*Income limits are published at least annually by HUD.
8 Persons
$40,890
$46,050
$73,600
CDBG PRESUMED BENEFIT PSA CONTRACT 2015-2016 -- EXHIBIT "A-1" — 2015 HUD INCOME LIMITSPage 1
Presbyterian Night Shelter
EXHIBIT "A-2"
REPORTING REQUIREMENTS FOR COUNTYWIDE AGENCIES
CDBG PRESUMED BENEFIT CONTRACT 2015-2016 -- EXHIBIT "A-2"
REPORTING REQUIREMENTS FOR COUNTYWIDE AGENCIES
Piesbyterian Night Shelter
Page 1
Presbyterian Night Shelter
REPORTING REQUIREMENTS FOR COUNTYWIDE AGENCIES
Quarterly Report
The purpose of the Quarterly Report is for the Countywide Agencies to report the number of non -Fort Worth
clients who participate in the Program. The Quarterly Report must be submitted with the January, April, July
and October Reimbursement Requests. A paper copy must be submitted with the Reimbursement Request,
and an electronic copy must also be emailed to Dsa a,fortworthtexas. gov. The information provided in the
Quarterly Report will be reviewed and monitored by the Neighborhood Services Department Compliance
Division.
DUE DATE
A
January 15, 2016
April 15, 2016
July 15, 2016
September 20, 2016
# OF FORT
REPORTING RANGE WORTH
CLIENTS
B
EXAMPLE:
October 1, 2015 —
December 31, 2015
January 1 2016 —
March 30 2016
April 1, 2016 —
June 30, 2016
July 1, 2016 —
September 20, 2016
TOTAL
C
250
TOTAL # OF % OF
# OF NON -FORT CLIENTS FORT WORTH
WORTH CLIENTS SERVED BY THE CLIENTS
PROGRAM
(C+D) (C=E)
D E
200
450
F
250+450=55%
I, Agency representative, certify that I verified the information I reported this quarter and it is correct to the
best of my knowledge.
Certified by:
Signature/Title:
Date:
CDBG PRESUMED BENEFIT CONTRACT 2015-2016 -- EXHIBIT "A-2"
REPORTING REQUIREMENTS FOR COUNTYWIDE AGENCIES
Presbyterian Night Shelter
Page 2
ADMINISTRATIVE (HOPWA ONLY)
Salaries
FICA
Life Insurance
Health Insurance
Disability Insurance
Unemployment -State
Accounting
TOTAL ADMINISTRATIVE EXPENSES
% Administrative Cost
PROGRAM PERSONNEL
Salaries
FICA
Life Insurance
Health Insurance
Unemployment
Worker's Compensation
Retirement
SUPPLIES AND SERVICES
Office Supplies
Office Equipment Rental
Postage
Printing
MISCELLANEOUS
Construction/Building Materials (only REACH)
Contract Labor (City needs copy of contract
before expenses can be reimbursed)
Craft Supplies
Field Trip Admission Expenses
Other Field Trip Expenses (if preapproved by
City)
Food Supplies
Teaching Aids
FACILITY AND UTILITIES
Telephone
Electric
Gas
Water and Wastewater
Solid Waste Disposal
Rent (City needs copy of lease before expenses
can be reimbursed)
Custodial Services
Repairs
Cleaning Supplies
LFGAL, FINANCIAL, AND INSURANCE
Fidelity Bond or Equivalent
Directors and Officers
General Commercial Liability
Contract Accounting
DIRECT ASSISTANCE
Childcare Scholarships
Short-term Rent Assistance
Short-term Mortgage Assistance
Short-term Utilities Assistance
OTHER EXPENSES
TOTAL
FUNDING A: ESG (CITY, STATE, COUNTY)
FUNDING B: CFW DIRECTIONS HOME
FUNDING C: PRIVATE
EXHIBIT "B" - BUDGET
Account
1001
1002
1003
1004
1005
1006
1007
2001
2002
2003
2004
2005
2006
2007
3001
3002
3003
3004
4001
4002
4003
4004
4005
4006
4007
5001
5002
5003
5004
5005
5006
5007
5008
5009
6001
6002
6003
6005
7001
7002
7003
7004
Grant Budget A
67,980
7,020
75,000
102,104
7,811
11,120
B
77,542
5,932
8,864
529
202
4,304
c
315,283
29,319
46,340
5,630
6,493
1,976
166,858
TOTAL
562,909
43,062
58,346
6,159
6,695
1,976
4,304
166,858
25,000
5,000
2,774
13,224
48,219
16,359
231,611
4,044
1,880
10,703
114,00
12,201
9,590
4,478
29,373
7,070
33,035
25,969
1,969
30,856
726,440
12,201
34,590
9,478
39,167
7,070
33,035
30,013
17,073
48,219
64,786
1,147,051
CDBG PSA CONTRACT 2015-2016
Pt esbyterian Night Shelter
EXHIBIT "B" - BUDGET
Page 1
The following tables were created for the purpose of preparing, negotiating, and determining the
cost reasonableness and cost allocation method used by the Agency for the line item budget
represented on the first page of this EXHIBIT "B" — Budget. The information reflected in the
tables is to be considered part of the terms and conditions of the Contract. Agency must have
prior written approval by the City to make changes to any line item in the Budget as outlined in
Section 5 2 2 in the Contract. The deadline to make changes to EXHIBIT `B' — Budget is June
1, 2016.
SALARY DETAIL
Position Name Rate Annual Hours Percent to Grant
Case Manager 33,990 2,080 100%
Case Manager 33,990 2,080 100%
TOTAL
FICA
Life Insurance
Health Insurance
Unemployment
Workers Compensation
Retirement
TOTAL
Office Supplies
Office Equipment Rental
Postage
Printing
TOTAL
Contract Labor
Craft Supplies
Facility Fees
Field Trip Costs
Food Supplies
Teaching Aids
TOTAL
Amount to Grant
33,990
33,990
67,980
FRINGE DETAIL
Percent of Payroll Amount Percent to Grant Amount to Grant
1
1
1
SUPPLIES AND SERVICES
Total Budget Percent to Grant
MISCELLANEOUS
Total Budget
Percent to Grant
Amount to Grant
Amount to Grant
CDBG PSA CONTRACT 2015-2016 — EXHIBIT "B" — BUDGET Page 2
Presbyterian Night Shelter
FACILITY AND UTILITIES
Total Budget Percent to Grant
Telephone 12,201
Electric 34,590
Gas 9,478
Water and Wastewater 39,167 17.9%
Solid Waste Disposal
Rent
Custodial Services
Repairs
Cleaning Supplies
TOTAL 95,436 7.4%
Fidelity Bond (or Equivalent)
General Commercial Liability
Directors and Officers
Contract Accounting
TOTAL
Childcare Scholarships
Short -Tenn Rent Assistance
Short Term Mortgage Assistance
Short Term Utilities Assistance
Tenant Based Rental Assistance
TOTAL
FINANCIAL AND INSURANCE
Total Budget Percent to Grant
DIRECT ASSISTANCE
Total Budget Percent to Grant
1
1
1
1
1
Amount to Grant
7,020
7,020
Amount to Grant
Amount to Grant
i
CDBG PSA CONTRACT 2015-2016 — EXHIBIT "B" — BUDGET Page 3
Presbyterian Night Shelter
EXHIBIT "C"
AUDIT CERTIFICATION FORM
CDBG PRESUMED BENEFIT PSA CONTRACT 2015-2016 — EXHIBIT "C" — AUDIT CERTIFICATION
FORM Page 1
Presbyterian Night Shelter
AUDIT CERTIFICATION FORM AND AUDIT REQUIREMENTS
Agency: Presbyterian Night Shelter
Fiscal Year Ending: September 30, 2016
During the fiscal year in which funds will be received, we will exceed the federal
expenditure threshold of $750,000. We will have our Single Audit or Program Specific
Audit completed and will submit the audit report described in 2 CFR Part 200 within 7
months after the end of the audited fiscal year or 30 days within its completion, whichever
is the earlier date.
During the fiscal year in which funds will be received, we will not exceed the $750,000
federal expenditure threshold required for a Single Audit or a Program Specific Audit to be
performed this fiscal year. (Fill out schedule below)
; 1US.Tbefilf:e :6100'
Fe_deral.Expen:diture:Dis�o�ure.
. • f
:Pass ThroughPxogram;Nane;=& Contract` :;.
� ii 0. .:Expenditures
Gr for 1 J ®A Turriber zN:um
.-J�.
Jt+•1. l.it. �l ..._ .. •3 ..if _ .. ..a t__ .._ - i .w.�'. ... ..... ..
Total Federal Expenditures for this Fiscal Year:
6ilz
Signatory and Title
23- IS
Date
Failure to submit this or a similar statement or failure to submit a completed single audit package
as described in the federally required audit requirements described in 2 CFR Part 200, as
applicable, by the required due date may result in suspension of funding and may affect
eligibility for future funding. Notwithstanding the above, this certification acknowledges the
agency's commitment to meet all other financial reporting, financial statements, and other
audit requirements as may be set forth in the Contract.
CDBG PRESUMED BENEFIT PSA CONTRACT 2015-2016 — EXHIBIT "C" AUDIT CERTIFICATION
FORM Page 2
Presbyterian Night Shelter
EXHIBIT "D"
REPORTING FORMS
CDBG PRESUMED BENEFIT PSA CONTRACT 2015-2016 — EXHIBIT "D" — REPORTING FORMS Page 1
Piesbyteiian Night Shelter
Agency:
Address:
City, State Zip
Program.
Period of Service:
Tax ID No.
Program
ATTACHMENT I
Invoice
Amount
This Invoice Cumulative to Date
By signing this report, I certify to the best of my knowledge and
belief that the report is true, complete, and accurate and the
expenditures, disbursements and cash receipts are for the purposes
and objectives set forth in the terms and conditions of the Federal
award. I am aware that any false, fictitious or fraudulent information,
o r the omission of any material fact, may subject me to criminal, civil,
o r administrative penalties for fraud, false statements, false claims,
o r otherwise. U.S. Code Title 18, Sec. 1001 and Title 31, Sec. 3729-
3730 and 3801-3812.
Signature and Date:
Name:
Title:
CDBG PRESUMED BENEFIT PSA CONTRACT 2015-2016 — EXHIBIT "D" — REPORTING FORMS Page 2
Piesbytei ian Night Shelter
Line No.
2
4
3
6
7
8
9
10
11
12
13
14
15
16
17
I8
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Total
Agency,
Program
CbeckNo.
ATTACHMENT II
Expenditure Worksheet
Ci y of Fort Worth
N ighborh od Services Department
Expenditure Worksheet
Presb terian Night Shelter
Please group like account codes.
Account Code (See
Paste TAscrintion* Kev to Right) Amount
'Payroll most identify employee. Rent oust identify tenant. Other payments should identify individuals, ifapplicable.
H'ighlightcd are the only relesant codes for this Program
Expense line Item
ADMINJSTRAIIVE(HOPWA Only)
Salaries
FICA
Life Insurance
Health Insurance
Disability Insurance
Uneunbvment-State
Legal d Accounting
PROGRAMrFRsONNIZ
Salaries
FICA
Life Insurance
Health Insurance
Unermkvnent
Worker's Compensation
Retirement
SIPPLIES AND SERVICES
Office Supplies
Office Eouipuent Rental
Postage
Printing
IMISCFI.LANEOIS
Conference & Seminars
Constniction7Buddina Materials
Contract Labor
Craft Supplies
Credit Reports
Facility Fees
Field Trip Costs
Food Supplies
Mileage
Teaching Aids
FACILITY AND UIILITIES --
Telephone
Electric
Cps
Water and Wastewater
Solid Waste Disposal
Rent
Custodial Senires
Remus
Cleaning Supplies
LEGAL.FINANCW, AND INSIRANCE
Fidelity Bond or Equivalent
Directors and Officers
General Commercial Liability
Legal Fees
Contract Accounting
DIRECFASSISTANCE
C1Adcare Scholarships
Counseling - Individual Session
counseling - Group Sessions
Short-temnRent Assistance
Short -tens Mortgage Assistance
Short-teunUtihtics Assistance
Tenant Based Rental Assistance
CAPITAL OUTLAY
Furniture. Figures
Commuters
Office Equipment
Sport and Recreation Equim ent
Account
IWI
1002
1003
1004
1005
1006
1007
2W1
2W2
2W3
2004
2005
2006
2007
31001
3002
3003
3004
4W1
4002
4003
4004
4005
4006
4W7
4W8
4009
4010
5001
5002
5003
5004
5005
5006
5007
5W8
5009
6001
6W2
6003
6004
6005
7001
7W2
7003
7004
7005
7006
7007
SWI
8W2
8603
8004
CDBG PRESUMED BENEFIT PSA CONTRACT 2015-2016 — EXHIBIT "D" — REPORTING FORMS Page 3
Presbyter Ian Night Shelter
ATTACHMENT III
Client Data Report
Agency:
Program:
Month:
Instructions:
This report is meant to list ail unduplicated clients screed daring the Contract terra (October 1.201StoSeptembsr30,2016). Fichesoath. please report the Intornailono(clients tot predotslrreported. You are required to attacheligibilityverification doyenne otaticnFar each cum client New unduplicated clients
ebouldbelisted below any presioflyreported ones sathat this sheet will act as aroiling tally. Please oviy list clients one tine dcricg the Drat month that they retell e serstce. Clients thatcontinue to receive Progran services formultiple months only teed to be listed one tine- Put an *X'itteach appropriate bos
regarding the client's sex. ethnicity, rare, etc. Please note that re imlurume rd for salaries w (11 ngzlre tint the neacy apart to the CItynll the clients that were served by that particular staff person In that program. Information Far each client listed below nut have the deeaograpllc lnlare+ation of ecttd In columns 1
three 12.
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
156/1
t
17
18
19
20
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
43
49
50
2
FORT
WORTH
REstriarn
YES OR NO
2A
S R%1_s: LC AT1ON
(IF API LICAE Et
1
1
i
1
1
1
i
1
1
1
1
1
1
3
NAME
1
Cits for CURRENT MONTH
1TI3'EUndalnted Clients
•Proposed Client Goat Per Contract
%ofMilestone Met
• Please highlight new clients for the month.
•Do rut re; he ibe erece goal tnless the eerarad Is ended act amire y.
4
STREETADDRESS
t Chita Address)
1
1
1
1
1
1
1
1
5
AGE
6
(Inn cec Cte )
MALE
7
EIIF`at1TY
Ilas•t,,, One)
MULE Ind
NON-
h1.sfA`.TC_
ttaJ_4N
LSTt1AN
OR.
ALA!XAN
NATIVE
A4_1N
B LUtM
OR
AFPJCAN
AteticAN
1
1
1
1
I
NATIVE
HAWAHA
N ci_
OTHER
£ACI R"
SANDER
8
RAO
(l:.h tnt)oe)
N"FIiIE
MIR/Ca:I
ECDLL•t
OR
ALA —WAN
NATIVE
AND
A}{IFE
A3A`1
AND
pil1TE
ELAM
OR
AFF1t_+L.•1
a CAN
AND
MINE
.Lvp.I:.AN
WOW:
OR
AI_k9
NATIVE
AND
OR
AFRfCAN
At njflL_j A4
OTHER
V471T1F31:
RACE
CC'MBNA
TENS*
9 i 10
DISABLED
n)
Orel
YES
1
1
1
1
1
:;O
1
1
11
11H e;COME
(Qdy ch+xe I of the 5 cotarn
31
% T. AVE
I'QMf- 3.`1-73,aCO
UNKNOWN
LFrsnd
Ova' FJ'i
AM
YES 1:O
CDBG PRESUMED BENEFIT PSA CONTRACT 2015-2016
Presbyterian Night Shelter
EXHIBIT "D"
REPORTING FORMS Page 4
EXHIBIT "E"
INCOME CERTIFICATION FORMS
CDBG PRESUMED BENEFIT PSA CONTRACT 2015-2016 -- EXHIBIT `E" -- INCOME CERTIFICATION FORMS
Piesbyterian Night Shelter Page 1
Presbyterian Night Shelter
CERTIFICATION OF INCOME STATEMENT
Applicant Name:
Current Address: Phone :
Household Members and Income
(Including Applicant)
Last Name First Name Age Monthly Source/Employer Name
Income
**PERSONAL INFORMATION: (Check one in each item. Optional Information for Federal Reporting Purposes)
a. (1 MALE b. ■ WHITE ❑ BLACK/AFRICAN AMERICAN ❑ BLACK/AFRICAN AMERICAN & WHITE
❑ FEMALE n AMERICAN INDIAN/ALASKAN NATIVE ❑ ASIAN
❑ AMERICAN INDIAN/ALASKAN NATIVE & WHITE ❑ ASIAN & WHITE
❑ NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER (1 BALANCE/OTHER
AMERICAN INDIAN/ALASKAN NATIVE & BLACK/AFRICAN AMERICAN
■
c. ETHNICITY d. DISABLED e. IS CLIENT WOMEN HEAD OF HOUSEHOLD
■
HISPANIC ❑ YES ❑ YES
NON -HISPANIC E NO ❑ NO
* TOTAL NUMBER OF HOUSEHOLD MEMB hRS
Total Anticipated Annual Household Income:
(Include Yourself AND everyone who lives in the house.)
Certification*
I certify that the infoimation I am providing is true and could be subject to verification at any time by a third
party. I also acknowledge that the provision of false information could leave me subject to the penalties of
Federal, State and local law.
WARNING: TITLE 18, SECTION 1001 OF THE U.S. CODE STATES THAT A PERSON IS GUILTY OF A FELONY
FOR KNOWINGLY AND WILLINGLY MAKING FALSE OR FRAUDULENT STATEMENTS TO ANY DEPARTMENT OF
THE UNITED STATES GOVERNMENT.
Signature of Applicant Date
For use by Agency staff only
Household Size: Gross Annual Income•
Applicable Income Limit: Is Applicant Eligible?
Check if Applicant refused to provide demographic information: ❑
Staff Assessment of
Demographics:
Person Making Determination: Date:
NOTE: Address, income amounts and sources for ALL household members ate required.
CDBG PRESUMED BENEFIT PSA CONTRACT 2015-2016 -- EXHIBIT "E" -- INCOME CERTIFICATION FORMS
Presbyterian Night Shelter Page 2
Presbyterian Night Shelter
CERTIFICACION DE DECLARACION DE INGRESOS
Nombre del Solicitante:
Domicilio Actual: Numero de Telefono:
Apellido Nombre
Miembros en el Hogar e Ingresos
(Incluir el/la solicitante)
Edad Ingreso
Mensual
Fuente de Ingresos/Nombre de Empleador
**INFORMACION PERSONAL (Seleccione uno en cada categoria. Informacion opcional para propositos de informacion Federal)
a. ❑ MASCULINO b. ■ CAUCASICO P1 NEGRO/AFRICANO AMERICANO
❑ NEGRO/AFRICANO AMERICANO & CAUCASICO
FEMININO ❑ INDIO AMERICANO/NATIVO DE ALASKA ❑ ASIATICO
❑ INDIO AMERICANO/NATIVO DE ALASKA & CAUCASICO ■ ASIATICO & CAUCASICO
❑ NATIVO HAWAIANO/OTRO DE LAS ISLAS PACIFICAS ❑ BALANCE/OTRO
❑ INDIO AMERICANO /NATIVO DE ALASKA & NFGRO/AFRICANO AMERICANO
c. ETNICIDAD d. DISCAPACITADO e. DES EL SOLICITANI E UNA MUJER Y CABECERA DEL HOGAR?
HISPANO ■ SI ❑ SI
NO-HISPANO ■ NO ❑ NO
■
■
■
* NUMERO TOTAL DE MIEMBROS EN EL HOGAR
Ingreso total del hogar anual anticipado:
(Incluye a si mismo y a todos los que viven en la casa)
Certificacion:
Certifico que la informacion que proporciono es verdad y podria ser susceptible a la comprobacion a
cualquier tiempo por terceros. Yo tambien reconozco que la provision de informacion falsa me podria dejar
sujeto a las penalidades Federales, Estatales y locales.
ADVERTENCIA: TITULO 18, SECCION 1001 DEL CODIGO DE EE.UU. QUE UNA PERSONA Es CULPABLE DE
UN DELITO POR SABER Y VOLUNTARIAMENTE HACER DECLARACIONES FALSAS 0 FRAUDULENTAS A
CUALQUIER DEPARTAMENTO DEL GOBIERNO ESTADOUNIDENSE.
Firma del Solicitante Fecha
Para use de entpleados de la agencia
# De Miembros de Familia: Ingreso Anual:
Limite de Ingreso: LEs solicitante elegible? :
Compruebe si el solicitante se nego a dar su informacion personal
hvaluacion del empleado sobre informacion personal:
Persona haciendo la determinacion• Fecha•
Note: La direccion de la casa y los ingresos (y sus origenes) para todos miembros del hogar son requeridos.
CDBG PRESUMED BENEFIT PSA CONTRACT 2015-2016 -- EXHIBIT "E" -- INCOME CERTIFICATION FORMS
Pi esbyterian Night Shelter Page 3
EXHIBIT "F"
STANDARDS OF DOCUMENTATION
CDBG PRESUMED BENEFIT PSA CONTRACT 2015-2016 -- EXHIBIT "F" -- STANDARDS OF
DOCUMENTATION
Presbyterian Night Shelter
Page 1
(
2015-2016 Documentation Standards for
CDBG Public Service Contract Expenses
Employee Salaries and Benefits - City will only reimburse a percentage of any employee's salary and benefits who work directly with the CDBG-funded Program.
Percentages will be cost allocated and determined prior to the execution of the CDBG Contract. Agencies requesting the reimbursement of 100% of any Agency employee
will require prior City approval. Agencies must show calculation on how the CDBG portion of employee salaries and benefits were calculated consistently with the CDBG
Contract. - - - -
Salaries
FICA/Medicare
Life Insurance
Health
Insurance
Disability
Insurance
U nemployment
Insurance
X XI
X X
X X
X X
X X
If an employee works on both a CDBG eligible and non-CDBG eligible program(s), the City will only reimburse for a reasonable portion
of the employee's salary. Prior to the execution of the CDBG Contract, the Agency will priovide the City with a written statement on how
each employee's time will be allocated. If an employee works 100% of their time directly with the CDBG-funded Program, then 100% of
the employee's salary may be eligible for reimbursement. Agency must submit a written statement that 100% of the employee's time is
spent working directly with the CDBG-funded Program. Statements must be signed by a person authorized to sign on behalf of the
Agency and will be submitted with the October invoice.
Reimbursement requests must include a timesheet and work log that reflects the hours worked by the employee(s) working directly on
the CDBG-funded Program. For employees who are paid with multiple funding sources, timesheets must reflect all funding sources. If
separate timesheets are kept for each funding source, all such timesheets must be submitted to City. Timesheets must be signed by
employee and supervisor. Agency must show a calculation and documentation of how the employee's salary was calculated and
invoiced to City.
*If employees are paid by direct deposit rather than check, then the agency must submit both the direct deposit payment company's
report (such as an ADT report) and a bank statement or check showing payment to the direct deposit company.
If the City pays gross salary, this is already included. If the City pays the employer portion, the Agency must provide proof that the
employee is enrolled in the benefit plan, must show a calculation and documentation of how the invoiced amount was calculated, and
must provide documentation showing payment.
If the City pays gross salary, this is already included. If the City pays the employer portion, the Agency must provide proof that the
Retirement X X employee is enrolled in the benefit plan, must show a calculation and documentation of how the invoiced amount was calculated, and
must provide documentation showing payment.
Materials, Equipment, Goods and Supplies - City will only reimburse for the cost allocated percent or amount spent in support of the CDBG-funded Program. Agencies
requesting reimbursement for these items will require prior City approval. Agencies must show calculation on how the CDBG portion of these expenses were calculated
consistently with the CDBG Contract.
Office Supplies
Office
Equipment
Rental
Postage
P rinting
Construction &
Building
Materials
S port and
Recreation
Eauioment
Cleaning
S uoolies
Teaching Aids
I Craft Supplies
Food Supplies
X X
X X X
X X
X X
X X
X
X
X
X
X
X X
X
X
X
X
X X
This category is only available for the REACH Program.
X X X
XIX X
X X X This category is only available to the Program provided by Meals on Wheels.
Rent, Utilities and Maintenance - City will only pay for a portion of these expenses. The portion of these expenses will be determined by the square footage attributable to
the CDBG-funded Program and sha I be cost -allocated in accordance with the amount of space used for the CDBG-funded Program. These expenses may only be in support
of the CDBG-funded Program. The 'tams listed below require prior City approval and the Agency is required to identify any funding source that pays for the portion of the
expenses that is not paid with CDBG funds. Agencies must show calculation on how the CDBG portion of these expenses were calculated consistently with the CDBG
Contract.
Telephone
Gas
Water/Wastew
ater
Electric
Solid Waste
Facility
Maintenance
and Repairs
Rent
X X
X X
X X
X X
X X
X
X
X
X
X
X
X
This item requires approval by the City prior to the execution of the CDBG Contract. Repairs may be categorized as major/minor
rehabilitation projects and must be approved through the full HUD Environmetal Review.
City will pay for a portion of the rent for the Program facility so long as its in proportion to the square footage attributable to the CDBG-
funded program.
CDBG PRESUMED BENEFIT PSA CONTRACT 2015-2016 Eibf "F
STANDARDS FOR COMPLETE DOCUMENTATION
1
Miscellaneous
This item requires prior approval by the City. Prior to the execution of the CDBG Contract, the Agency must submit a written statement
that lists the contract labor services to be used during the Contract term. Agency will submit a memo related to the procurement of such
Contract Labor X X X X X services and will forward any information pertaining to the procurement process to City. This requirement applies to, but is not limited to,
services retained for security services, legal, accounting, transportation providers, educational facilitators, custodial services, etc.
Agencies may not use the contract services of any City of Fort Worth Department.
City -required City will only pay for a percentage of the City -required insurance so long as it's in proportion to the square footage attributable to the
Insurance CDBG-funded program.
City requires that the agency submit its fee schedule or formula on how the Agency calculates the childcare scholarship amount. The
fee schedule/formula should demonstrate a breakout of income levels, and for each income level the schedule should demonstrate
Childcare X X which portion of the expense is to be paid by the family and which portion of the expense is to be reimbursed by the City. A fee
Scholarships schedule/formula must be submitted to the City prior to the first payment. Agency must submit documentation supporting that the client
is income eligible and that the household is being charged in conformance with the fee schedule. If the fee schedule/formula changes at
any time during the contract term, the Agency must immediately notify City on the date the new fee schedule/formula takes into effect.
X X
10" Income
Certifications
Audit Services X X X X
Agecies that are required to verify and provide proof of household income to determine eligibility, must require that anyone who is over
the age of 18, living in the housohold, submit a $0 Income Certification.
If an audit is required because federal funds exceed $750,000, then the cost should be split evenly by all grant funding sources. Agency
must show calculation on how the CDBG portion of the accounting services were calculated. For example, if the CDBG grant is 10% of
your Agency's budget, then invoice shall not exceed 10% of the overall cost. Agency must show a calculation and documentation of
how the invoiced amount was calculated, and must provide documentation showing payment.
*Proof of payment effective October 1, 2013: Payments or Expenses must be documented in the following manner:
A) Image of the check AND bank statement showing the check cleared the bank; OR,
B) Image of the cancelled check (ex. At end of bank statement); OR,
C) Payroll Check Stub, "Advice", or Statement AND Bank Statement indicating payroll; OR,
D) For wire or e transfers: Reciept or statement from payee/vendor OR bank statement.
Final as of 08 28 2015 Ihr
CDBG PRESUMED BENEFIT PSA CONTRACT 2015-2016 Exhibit "F" -- STANDARDS FOR COMPLETE DOCUMENTATION
EXHIBIT "G"
SECTION 3 REPORTING FORMS
CDBG PRESUMED BENEFIT PSA CONTRACT 2015-2016 -- EXHIBIT "G" -- SECTION 3 REPORTING
FORMS Page 1
Presbyterian Night Shelter
EXHIBIT "G"
Section 3 SummaryReport
Economic Opportunities for
Low — and Very Low -Income Persons
Section back of page for Public Reporting Burden statement
U.S. Department of Housing
and Urban Development
Office of Fair Housing
And Equal Opportunity
1. Recipient Name & Address: (street, city, state, zip) 2. Federal Identification: (grant no.)
4. Contact Person
6. Length of Grant:
8. Date Report Submitted: 9. Program Code: (Use separate sheet
for each program code)
Part I. Employment and Training (** Columns B, C and F are mandatory fields. Include New
A B
Number of
Job Category New Hires
Professionals
Technicians
Office/Clerical
Construction by Trade (List)
Trade
Trade
Trade
Trade
Trade
Other (List)
Total
* Program Codes
1 = Flexible Subsidy
2 = Section 202/811
C
Number of New
Hires that are
Sec. 3 Residents
3 = Public/Indian Housing
A = Development,
B = Operation
C = Modernization
D
of Aggregate Number
of Staff Hours of New Hires
that are Sec. 3 Residents
OMB Approval No: 2529-0043
(exp. 11/30/2010)
HUD Field Office:
3. Total Amount of Award:
5. Phone: (Include area code)
7. Reporting Period:
10. Program Name:
Hires in E &F1
E
of Total Staff Hours
for Section 3 Employees
and Trainees
4 = Homeless Assistance
5 = HOME
6 = HOME State Administered
7 = CDBG Entitlement
F
Number of Section 3
Trainees
8 = CDBG State Administered
9 = Other CD Programs
10 = Other Housing Programs
Page 1 of 2
form HUD 60002 (6/2001)
Ref 24 CFR 135
Part II: Contracts Awarded
1. Construction Contracts:
A. Total dollar amount of all contracts awarded on the project
B. Total dollar amount of contracts awarded to Section 3 businesses
C. Percentage of the total dollar amount that was awarded to Section 3 businesses
D. Total number of Section 3 businesses receiving contracts
2. Non -Construction Contracts.
A. Total dollar amount all non -construction contracts awarded on the project/activity $
B. Total dollar amount of non -construction contracts awarded to Section 3 businesses $
C. Percentage of the total dollar amount that was awarded to Section 3 businesses
D. Total number of Section 3 businesses receiving non -construction contracts
Part III: Summary
Indicate the efforts made to direct the employment and other economic opportunities generated by HUD financial assistance for housing
and community development programs, to the greatest extent feasible, toward low -and very low-income persons particularly those who
are recipients of government assistance for housing. (Check all that apply.)
Attempted to recruit low -Income residents through: local advertising media, signs prominently displayed at the project site,
contracts with the community organizations and public or private agencies operating within the metropolitan area (or
nonmetropolitan county) in which the Section 3 covered program or project is located, or similar methods.
Participated in a HUD program or other program which promotes the training or employment of Section 3 residents
Participated in a HUD program or other program which promotes the award of contracts to business concerns which meet the
definition of Section 3 business concerns.
Coordinated with Youthbuild Programs administered in the metropolitan area in which the Section 3 covered project is located.
Other describe below.
Public reporting for this collection of information is estimated to average 2 hours per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
This agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB
number.
Section 3 of the Housing and Urban Development Act of 1968, as amended, 12 U.S.C. 1701 u, mandates that the Department ensures that
employment and other economic opportunities generated by its housing and community development assistance programs are directed
toward low- and very -low income persons, particularly those who are recipients of government assistance housing. The regulations are
found at 24 CFR Part 135. The information will be used by the Department to monitor program recipients' compliance with Section 3, to
assess the results of the Department's efforts to meet the statutory objectives of Section 3, to prepare reports to Congress, and by
recipients as self -monitoring tool. The data is entered into a database and will be analyzed and distributed. The collection of information
involves recipients receiving Federal financial assistance for housing and community development programs covered by Section 3. The
information will be collected annually to assist HUD in meeting its reporting requirements under Section 808(e)(6) of the Fair Housing Act
and Section 916 of the HCDA of 1992. An assurance of confidentiality is not applicable to this form. The Privacy Act of 1974 and OMB
Circular A-108 are not applicable. The reporting requirements do not contain sensitive questions. Data is cumulative; personal identifying
information is not included
Page 2 of 2 form HUD 60002 (11/2010)
Ref 24 CFR 135
Form HUD-60002, Section 3 Summary Report, Economic Opportunities for Low- and Very Low -Income Persons.
Instructions: This form is to be used to report annual
accomplishments regarding employment and other economic
opportunities provided to low- and very low-income persons under
Section 3 of the Housing and Urban Development Act of 1968. The
Section 3 regulations apply to any public and Indian housing
programs that receive: (1) development assistance pursuant to
Section 5 of the U.S. Housing Act of 1937; (2) operating assistance
pursuant to Section 9 of the U.S. Housing Act of 1937; or (3)
modernization grants pursuant to Section 14 of the U.S. Housing Act
of 1937 and to recipients of housing and community development
assistance in excess of $200,000 expended for: (1) housing
rehabilitation (including reduction and abatement of lead -based paint
hazards); (2) housing construction; or (3) other public construction
projects; and to contracts and subcontracts in excess of $100,000
awarded in connection with the Section-3-covered activity.
Form HUD-60002 has three parts, which are to be completed for
all programs covered by Section 3. Part I relates to employment
and training. The recipient has the option to determine numerical
employment/training goals either on the basis of the number of hours
worked by new hires (columns B, D, E and F). Part II of the form
relates to contracting, and Part III summarizes recipients' efforts to
comply with Section 3.
Recipients or contractors subject to Section 3 requirements must
maintain appropriate documentation to establish that HUD financial
assistance for housing and community development programs were
directed toward low- and very low-income persons.* A recipient of
Section 3 covered assistance shall submit one copy of this report to
HUD Headquarters, Office of Fair Housing and Equal Opportunity.
Where the program providing assistance requires an annual
performance report, this Section 3 report is to be submitted at the
same time the program performance report is submitted. Where an
annual performance report is not required, this Section 3 report is to be
submitted by January 10 and, if the project ends before December 31,
within 10 days of project completion. Only Prime Recipients are
required to report to HUD. The report must include
accomplishments of all recipients and their Section 3 covered
contractors and subcontractors.
HUD Field Office: Enter the Field Office name .
1. Recipient: Enter the name and address of the recipient
submitting this report.
2. Federal Identification: Enter the number that appears on the
award form (with dashes). The award may be a grant,
cooperative agreement or contract.
3. Dollar Amount of Award: Enter the dollar amount, rounded to the
nearest dollar, received by the recipient.
4 & 5. Contact Person/Phone: Enter the name and telephone number
of the person with knowledge of the award and the recipient's
implementation of Section 3.
6. Reporting Period: Indicate the time period (months and year)
this report covers.
7. Date Report Submitted: Enter the appropriate date.
Submit one (1) copy of this report to the HUD Headquarters Office of
Fair Housing and Equal Opportunity, at the same time the
performance report is submitted to the program office. The Section 3
report is submitted by January 10. Include only contracts executed
during the period specified in item 8. PHAs/IHAs are to report all
contracts/subcontracts.
The terms "low-income persons" and very low-income persons" have
the same meanings given the terms in section 3 (b) (2) of the United
States Housing Act of 1937. Low-income persons mean families
(including single persons) whose incomes do not exceed 80 percent of
the median income for the area, as determined by the Secretary, with
adjustments for smaller and larger families, except that
8. Program Code: Enter the appropriate program code as listed at
the bottom of the page.
9. Program Name: Enter the name of HUD Program corresponding
with the "Program Code" in number 8.
Part I: Employment and Training Opportunities
Column A: Contains various job categories. Professionals are
defined as people who have special knowledge of an occupation (i.e.
supervisors, architects, surveyors, planners, and computer
programmers). For construction positions, list each trade and provide
data in columns B through F for each trade where persons were
employed. The category of "Other" includes occupations such as
service workers.
Column B: (Mandatory Field) Enter the number of new hires for
each category of workers identified in Column A in connection with
this award. New hire refers to a person who is not on the contractor's
or recipient's payroll for employment at the time of selection for the
Section 3 covered award or at the time of receipt of Section 3 covered
assistance.
Column C: (Mandatory Field) Enter the number of Section 3 new
hires for each category of workers identified in Column A in
connection with this award. Section 3 new hire refers to a Section 3
resident who is not on the contractor's or recipient's payroll for
employment at the time of selection for the Section 3 covered award or
at the time of receipt of Section 3 covered assistance.
Column D: Enter the percentage of all the staff hours of new hires
(Section 3 residents) in connection with this award.
Column E• Enter the percentage of the total staff hours worked for
Section 3 employees and trainees (including new hires) connected
with this award. Include staff hours for part-time and full-time
positions.
Column F: (Mandatory Field) Enter the number of Section 3
residents that were trained in connection with this award.
Part II: Contract Opportunities
Block 1: Construction Contracts
Item A: Enter the total dollar amount of all contracts awarded on the
project/program.
Item B: Enter the total dollar amount of contracts connected with this
project/program that were awarded to Section 3 businesses.
Item C: Enter the percentage of the total dollar amount of contracts
connected with this project/program awarded to Section 3 businesses.
Item D: Enter the number of Section 3 businesses receiving awards.
Block 2: Non -Construction Contracts
Item A: Enter the total dollar amount of all contracts awarded on the
project/program.
Item B: Enter the total dollar amount of contracts connected with this
project awarded to Section 3 businesses.
Item C: Enter the percentage of the total dollar amount of contracts
connected with this project/program awarded to Section 3 businesses.
Item D: Enter the number of Section 3 businesses receiving awards.
Part III: Summary of Efforts — Self -explanatory
The Secretary may establish income ceilings higher or lower than 80 percent
of the median for the area on the basis of the Secretary's findings such that
variations are necessary because of prevailing levels of construction costs
or unusually high- or low-income families. Very low-income persons mean
low-income families (including single persons) whose incomes do not
exceed 50 percent of the median family income area, as determined by the
Secretary with adjustments or smaller and larger families, except that the
Secretary may establish income ceilings higher or lower than 50 percent of
the median for the area on the basis of the Secretary's findings that such
variations are necessary because of unusually high or low family incomes.
Page i
form HUD 60002 (11/2010)
Ref 24 CFR 135
EXHIBIT "H"
SEVERELY DISABLED CERTIFICATION FORM
CDBG PRESUMED BENEFIT PSA CONTRACT 2015-2016 — EXHIBIT "H" — SEVERELY DISABLED
CERTIFICATION FORM Page 1
Pi esbyterian Night Shelter
Presbyterian Night Shelter
CI-RTIFICATION FORM
DOCUMFiNTING CLIENT STATUS AS "SEVERELY DISABLED ADULT"
Client Name:
Address:
City, State, Zip
Client Identification No.
CHECK ALL THAT APPLY
Has used a wheelchair, a walker, cane , crutches or other special aid for six
months or longer
Has been diagnosed with one of the following conditions: Alzheimer's
disease, mental retardation or other developmental disability, senility or
dementia, cerebral palsy, or autism; or has another mental or emotional
condition that seriously interferes with everyday tasks.
Is unable to perform one or more of the following "Functional Activities":
seeing, hearing, speaking and having one's speech understood, lifting or
carrying, using stairs, grasping small objects, or walking.
Is unable to perform or needs assistance to perform one or more of the
following Activities of Daily Living (ADL)• getting around inside the home,
getting in or out of bed or a chair, bathing, dressing, eating, and toiletmg.
Is unable to perfolin or needs assistance to perfoiin one or more of the
following Instrumental Activities of Daily Living (IADL)• going outside the
home, keeping track of money and bills, preparing meals, doing light
housework, taking prescription medications in the light amount and at the right
time, and using the telephone
Has a condition that prevents them from working at a job or doing housework.
The undersigned Agency representative conducted a visual assessment of the client identified on
this form and certifies that the client meets at least one of the conditions indicated above, which
determines that he/ she meets the definition of "severely disabled' according to the U.S. Census
Bureau.
Certified by: Date:
Signature/Title:
CFW Neighborhood Services Dept.: Revised 08.30.2013
CDBG PRESUMED BENEFIT PSA CONTRACT 2015-2016 — EXHIBIT "H" — SEVERELY DISABLED
CERTIFICATION FORM Page 2
Piesbyterian Night Shelter
EXHIBIT "I"
MBE REPORTING FORM
CDBG PRESUMED BENEFIT PSA CONTRACT 2015-2016 -- EXHIBIT "I" -- MBE REPORTING FORM Page 1
Presbyter ian Night Shelter
Contract and Subcontract Activity
U.S. Department of Housing and Urban Development
OMB Approval No.: 2577-0088 OMB
Approval No • 2502-0355
Public reporting burden for this collection of information is estimated to average .5 hours per response, including the time for rcvic s ng instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The Information is voluntary. HUD may not
collect this information, and you arc not required to complete this form. unless it displays a currently valid OMB Control Number.
Executive Orders dated July 14, 1983, directs the Minority Business Development Plans shall be developed by each Federal Agency and the these annual plans shall establish minority business development objectives. The information is used by HUD to monitor and evaluate MBE activities against the total program activity and
the designated minority business enterprise (MBE) goals. The Department requires the information to provide guidance and oversight for programs for the development of minority business enterprise concerning Minority Business Development. If the information is not collected HUD would not be able to establish meaningful
MBE goals nor evaluate MBE performance against these goals.
Privacy Act Notice = The United States Department of Housing and Urban Development, Federal Housing Administration, is authorized to solicit the Information requested in this form by virtue of Title 12, United States Code, Section 1701 ct seq., and regulation. It will not be disclosed or rclescd outside the United States
Department of Housing and Urban Development without your consetn, except as required or permitted by Law.
1 Grantee/Project Owner/Developer/Sponsor/Builder/Agency
City of Fort Worth
3a. Name of Contact Person 3b. Phone Number (Including Arca Code)
Sarah Burkett 817-392-7538
Contractor or
Subcontractor
Type of Trade Business
Amount of Contract Code Racianthnic
or Subcaauct (See below) (See below)
76, 7c. 7d.
Gr nUProjcct Number or HUD
Case Number or other
identification of property.
subdivision. dwelling unit, etc.
7a.
CPD:
1 = New Construction
2 - Rducation/fraining
3 - Other
Previous editions are obsolete.
Woman Owned Business
(Yes or No) Sec. 3 Business
le. (Yes or No)
7c: The of Trade Codes:
Housing/Public [lousing:
1 = New Comtmction 6 - Professional
2 = Substantial Rehab.
3 - Repair
4 - Sorvicc
5 - Proicct Mama.
Prune Contractor Identification (ID)
Number
7f.
7 - Tenant Services
8 - Education/Training
9 = Arch./Engrg. Appraisal
n = Other
4. Reporting Period
Lx Oct. 1 - Sept. 30 (Annual ^Y)
Sec. 3
7g.
(
Subcontractor
Identification (ID)
Number
7h
7d: RacialfEthnic Codes:
I - White Americans
2 -Black Americans
3 - Native Americans
4 - Hispanic Americans
5 - Asiaol'acilic Americans
6 = Hasidic Jews
Scc. 3
7i.
Check if:
PH
IH
CPD
!Housing
5. Program Code (Nat applicable for CPD Programs.)
See explanation of Codes at bottom of Page Use a
separate sheet for each program code.
Contractor/Subcontractor Name and Address
Name
2. Location (City. State Zip Code)
1000 Throckmorton, Fort Worth. TX 76102
6. Duns Submitted to Field Office
Street City
5: Program Codes (Complete for Housing and Public and Indian Housing programs only):
1 - All Insured, including Section8
2-- Flexible Subsidy
3 = Section 8 Noninsured. Non-IIFDA
4 - Insured (Management)
5 = Section 202
6 = HUD -I (cld (Management)
7 - Public/India Housing
8 - Section 811
form HUD-2516 (8/98)
State
7j.
Zit)
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#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
HDTV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/01
#DIV/01
#DIV/01
#DIV/0!
#DIV/01
#DIV/0!
#D V/0!
'.'DIV/OI.I
#DIV/0! I
#DIV/0! I
#DIV/0! j
This report is to be completed by grantees, developers, sponsors, builders, agencies, and/or
project owners for reporting contract and subcontract activities of $10,000 or more under the
following programs: Community Development Block Grants (entitlement and small cities);
Urban Development Action Grants; Housing Development Grants; Multifamily Insured and
Noninsured; Public and Indian Housing Authorities; and contracts entered into by recipients of
CDBG rehabilitation assistance.
Contracts/subcontracts of less than $10,000 need be reported only if such contracts represent a
significant portion of your total contracting activity. Include only contracts executed during this
reporting period.
This form has been modified to capture Section 3 contract data in columns 7g and 7i. Section 3
requires that the employment and other economic opportunities generated by HUD financial
assistance for housing and community development programs shall, to the greatest extent
feasible, be directed toward low- and very low-income persons, particularly those who are
recipients of government assistance for housing. Recipients using this form to report Section 3
contract data must also use Part I of form HUD-60002 to report employment and training
opportunities data. Form HUD-2516 is to be
Community Development Programs
1. Grantee: Enter the name of the unit of government submitting this report.
3. Contact Person: Enter name and phone of person responsible for maintaining and submitting
contract/subcontract data.
7a. Grant Number: Enter the HUD Community Development Block Grant Identification
Number (with dashes). For example: B-32-MC-25-0034. For Entitlement Programs and Small
City multi -year comprehensive programs, enter the latest approved grant number.
7b. Amount of Contract/Subcontract: Enter the dollar amount rounded to the nearest dollar. If
subcontractor ID number is provided in 7f, the dollar figure would be for the subcontract only
and not for the prime contract.
7c. Type of Trade: Enter the numeric codes which best indicates the
contractor's/subcontractor's service. If subcontractor ID number is provided in 7f., the type of
trade code would be for the subcontractor only and not for the prime contractor.
The "other" category includes supply, professional services and all other activities except
construction and education/training activities.
7d. Business Racial/Ethnic/Gender Code: Enter the numeric code which indicates the
racial/ethnic/gender character of the owner(s) and controller(s) of 51% of the business.
When 51% or more is not owned and controlled by any single racial/ethnic/gender category,
enter the code which seems most appropriate. If the subcontractor ID number is provided, the
code would apply to the subcontractor and not to the prime contractor.
7e. Woman Owned Business: Enter Yes or No.
7f. Contractor Identification (ID) Number: Enter the Employer (IRS) Number of the Prime
Contractor as the unique identifier for prime recipient of HUD funds. Note that the Employer
(IRS) Number must be provided for each contract/subcontract awarded.
7g. Section 3 Contractor: Enter Yes or No.
7h. Subcontractor Identification (ID) Number: Enter the Employer (IRS) Number of the
subcontractor as the unique identifier for each subcontract awarded from HUD funds. When the
subcontractor ID Number is provided, the respective Prime Contractor ID Number must also be
provided.
7i. Section 3 Contractor: Enter Yes or No.
7j. Contractor/Subcontractor Name and Address: Enter this information for each firm
receiving contract/subcontract activity only one time on each report for each firm.
completed for public and Indian housing and most community development programs. Form HUD-
60002 is to be completed by all other HUD programs including State administered community
development programs covered under Section3. A Section 3 Contractor/subcontractor is a
business concern that provides economic opportunities to low and very Low-income residents of
the metropolitan area (or nonmetropoiitan county), including a business concern that is 51 person
or more owned by low-income residents;
or provides subcontracting or business development opportunities to businesses owned by low or
low-income residents. Low and very low-income residents; include participants in Youthbuild
programs established under Subtitle D of Title IV of the Cranston -Gonzalez National Affordable
Housing Act,
The terms "low-income persons" and "very low-income persons" have the same meanings given
the terms in section3(b)(2) of the United States Housing Act of 1937. Low-income persons mean
families (including single persons) whose incomes do not exceed 80 per centum of the median
income for the area, as determined by the Secretary, with adjustments for smaller an larger families,
except that the Secretary may establish income ceilings higher or lower than 80 per centum of the
median for the area on the basis of the Secretary's findings that such variations are necessary
because of prevailing levels of construction
Multifamily Housing Programs
1. Grantee/Project Owner: Enter the name of the unit of government, agency or mortgagor entity
submitting this report.
3. Contact Person: Same as item 3 under CPD Programs.
4. Reporting Period: Check only one period.
5. Program Code: Enter the appropriate program code.
7a. Grant/Project Number: Enter the HUD Project Number or Housing Development Grant or
number assigned.
7b. Amount of Contract/Subcontract: Same as item 7b. under CPD Programs.
7c. Type of Trade: Same as item 7c. under CPD Programs.
7d. Business Racial/Ethnic/Gender Code: Same as item 7d. under CPD Programs.
7e. Woman Owned Business: Enter Yes or No.
7f. Contractor Identification (ID) Number: Same as item 7f under CPD Programs.
7g. Section 3 Contractor: Enter Yes or No.
7h. Subcontractor Identification (ID) Number: Same as item 7h. under CPD Programs.
7i. Section 3 Contractor: Enter Yes or No.
7j. Contractor/Subcontractor Name and Address: Same as item 7j. under CPD Programs.
costs or unusually high or low-income families. Very low-income families (including single
persons) whose incomes do not exceed 50 per centum of the median family income for the area, as
determined by the Secretary with adjustments for smaller and larger families, except that the
secretary may establish income ceilings higher or lower than 50 per centum of the median for the
area on the basis of the Secretary's findings that such variations are necessary because of unusually
high or low family incomes.
Submit two (2) copies of this report to your local HUD Office within ten (10) days after the end of
the reporting period you checked in item 4 on the front. Complete item 7h. Only once for each
contractor/subcontractor on each semi-annual report.
Enter the prime contractor's ID in item 71 for all contracts and subcontracts. Include only
contracts expected during this reporting period. PHAs/IHAs are to report all
contracts/subcontracts.
Public Housing and Indian Housing Programs
PHAs/IHAs are to report all contracts/subcontracts. Include only contracts executed during this
reporting period.
1. Project Owner: Enter the name of the unit of government, agency or mortgagor entity
submitting this report. Check box as appropriate.
3. Contact Person: Same as item 3 under CPD Programs.
4. Reporting Period: Check only one period.
5. Program Code: Enter the appropriate program code.
7a. Grant/Project Number: Enter the HUD Project Number or Housing Development Grant or
number assigned.
7b. Amount of Contract/Subcontract: Same as item 7b. under CPD Programs.
7c. Type of Trade: Same as item 7c. under CPD Programs.
7d. Business Racial/Ethnic/Gender Code: Same as item 7d. under CPD Programs.
7e. Woman Owned Business: Enter Yes or No.
7f. Contractor Identification (ID) Number: Same as item 71 under CPD Programs.
7g. Section 3 Contractor: Enter Yes or No.
7h. Subcontractor Identification (ID) Number: Same as item 7h. under CPD Programs.
7i. Section 3 Contractor: Enter Yes or No.
7j. Contractor/Subcontractor Name and Address: Same as item 7j. under CPD Programs.
M&C Review
CITY COUNCIL AGENDA
DATE• 7/28/2015
NO.:
FORT WORTH
CONTINUED FROM A PREVIOUS WEEK
REFERENCE 17NS
CODE G TYPE*
G-18521 LOG NAME: HUDACTIONPLANPY2015-
2016
NON- PUBLIC
CONSENT HEARING:
YES
SUBJECT: Conduct Two Public Hearings and Approve the City's 2015-2016 Action Plan for the
Use of Federal Grant Funds in the Amount of $9,820,979.00 from the United States
Department of Housing and Urban Development from the Community Development
Block Grant, HOME investment Partnerships Program, Emergency Solutions Grant
and Housing Opportunities for Persons with AiDS Grant Programs, Authorize
Collection and Use of Program Income, Authorize Waiver of Application of indirect
Cost Rates, Authorize Execution of Related Contracts and Adopt Appropriation
Ordinance (ALL COUNCIL DISTRICTS)
RECOMMENDATION:
It is recommended that the City Council:
1. Conduct two public hearings to allow citizen input and consideration of the City's 2015-2016
Action Plan for use of federal grant funds from the United States Department of Housing and
Urban Development in the amount of $9,820,979.00 from the Community Development Block
Grant, HOME Investment Partnerships Program, Emergency Solutions Grant and Housing
Opportunities for Persons with AIDS grant programs and for the use of program income from
activities using prior years' federal grant funds;
2. Approve the City's 2015-2016 Action Plan for submission to the United States Department of
Housing and Urban Development including allocations of grant funds to particular programs and
activities as detailed below;
3. Authorize the collection and use of an estimated $50,000.00 of program income, which resulted
from activities using prior years' Community Development Block Grant fund, for the reconstruction
of City streets;
4. Authorize the collection and use of an estimated $200,000.00 of program income, which
resulted from activities using prior years' HOME Investment Partnerships Program funds, for the
City's Homebuyer Assistance Program;
5. Authorize the City Manager or his designee to execute contracts for a one-year term with the
agencies listed in Tables 1, 2 and 3 below for Program Year 2015-2016 for Community
Development Block Grant, Emergency Solutions Grant and Housing Opportunities for Persons
with AiDS grant funds, contingent upon receipt of funding;
6. Authorize the City Manager or his designee to extend the contracts for up to one year if an
agency or department requests an extension and such extension is necessary for completion of
the program or to amend the contracts if necessary to achieve program goals provided any
amendment is within the scope of the program and in compliance with City policies and all
applicable laws and regulations governing the use of federal grant funds;
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M&C Review
7. Authorize a waiver of indirect cost rates as applicable for the Grants Fund in accordance with
the City's Administrative Regulations; and
8. Adopt the attached appropriation ordinance increasing the estimated receipts and
appropriations to the Grants Fund in the total amount of $9,820,979.00 consisting of
$6,332,270.00 in Community Development Block Grant funds, $1,934,447.00 in HOME Investment
Partnerships Program funds, $552,108.00 in Emergency Solutions Grant funds and $1,002,154.00
in Housing Opportunities for Persons with AIDS grant funds, plus any program income, all subject
to receipt of such funds.
DISCUSSION:
The City's 2015-2016 Action Plan summarizes the major housing and community development
activities and proposed expenditures for the program year beginning October 1, 2015 and ending
September 30, 2016 for use of federal grant funds totaling $9,820,979.00 from the United States
Department of Housing and Urban Development (HUD) for Community Development Block Grant
(CDBG), HOME Investment Partnerships Program (HOME), Emergency Solutions Grant (ESG)
and Housing Opportunities for People with AIDS (HOPWA) grant programs. It also summarizes
the use of program income resulting from activities using prior years' CDBG and HOME
funds. The purpose of these grant funds is to primarily benefit low and moderate income City
residents with ESG funds primarily benefiting homeless persons and HOPWA funds primarily
benefiting persons with HIV/AIDS.
Staff developed recommendations for the allocation of the estimated funding from HUD and
presented them to the Community Development Council (CDC) on May 20, 2015 and to the City
Council at its Pre -Council meeting on June 16, 2015. Notice of a 30-day public comment period
from July 1, 2015 to July 31, 2015 was published in the Fort Worth Star -Telegram on June 28
2015. Any comments received will be maintained by the Neighborhood Services Department in
accordance with federal regulations. The City will hold two public hearings as part of the HUD -
required citizen participation process, the first on July 28, 2015 and the second on August 4, 2015
at which time the City Council is scheduled to approve the Action Plan. In addition public
hearings were held on June 18, 2015 at 11:30 a m. and 6:00 p.m. for citizens to provide comment
on the proposed list of neighborhood streets eligible for reconstruction using CDBG funds.
A summary of the CDC's funding recommendations is provided below in Tables 1 2 and 3 and a
spreadsheet of all specific funding recommendations is attached The 2015-2016 Action Plan
must be submitted to HUD by August 14, 2015.
CDBG
For Program Year 2015-2016, it is recommended that the amount of $6,332,270.00 in CDBG
funds and the estimated amount of $50,000.00 of CDBG program income be allocated as follows:
Public Services - $949,840.00
This item includes social services for low to moderate income, disabled and disadvantaged
populations.
Housing Programs and Services - $2,175,600.00
This item includes funding for the City's Priority Repair Program, Cowtown Brush -Up homebuyer
and housing services, accessibility modifications to the homes of senior and/or disabled
individuals and related project delivery costs for these programs.
Infrastructure Services - $1,201,521.53
This item includes funding for the reconstruction of neighborhood streets.
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M&C Review
CDBG Economic Development - $738,854.47
This item is the City's annual payment on its Section 108 loan from HUD.
CDBG Estimated Program Income - $50,000.00
This Item includes funding for the reconstruction of City streets in addition to the funds listed
above under Infrastructure Services. CDBG program income that is received which is over the
estimated amount but not used for reconstruction of City streets will be allocated to priority
activities in the City's Consolidated Plan subject to Council approval.
CDBG General Administration - $1,266,454.00
This item includes costs for administering the CDBG grant including allocations for Financial
Management Services, Internal Audit and Transportation and Public Works Departments.
HOME
For Program Year 2015-2016, it is recommended that the amount of $1,934,447.00 in HOME
funds and the estimated amount of $200,000.00 of HOME program income be allocated as
follows:
Homebuyer Assistance Program (HAP) - $1,097,400.00
This item includes funding for down payment and/or closing cost assistance to low and moderate
income homebuyers.
Community Development Housing Organizations (CHDO) Set Aside - $290,168.00
HUD requires that a minimum of 15 percent of HOME funds be allocated to CHDOs for affordable
housing projects and CHDO administrative operating costs. These funds will be used by Tarrant
County Housing Partnership, Inc. (TCHP), a CHDO, to construct additional single family houses
for the 21 lot Hardy Street Single Family Infill Development in the Diamond Hill -Jarvis
neighborhood (Council District 2). The houses will be sold to homebuyers making at or below 80
percent of area median income set by HUD.
Single -Family Development - $353,435 00
This item includes funding for construction by TCHP of additional single family houses for the
Hardy Street Single Family Infill Development
HOME General Administration - $193,444.00
This item includes costs for administering the HOME grant.
HOME Estimated Program Income - $200,000.00
This item includes funding for the City's HAP for closing cost and/or down payment assistance in
addition to the funds listed above. HOME program income that is received which is over the
estimated amount but not used for HAP will be allocated to priority activities in the City's
Consolidated Plan subject to Council approval HUD allows the City to take 10 percent of any
HOME program income to be used for the costs for administering the HOME grant.
HOPWA
For Program Year 2015-2016, it is recommended that the amount of $1,002,154.00 in HOPWA
funds be allocated as follows:
Non -Profit Service Providers - $972,090.00
HOPWA Program Administration - $30,064.00
ESG
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(Organization
Cenikor Foundation
For Program Year 2015-2016, it is recommended that the amount of $552,108.00 in ESG funds be
allocated as follows:
Non -Profit Service Providers - $510,700.00
ESG Program Administration - $41,408.00
CONTRACT RECOMMENDATIONS
The CDC and Staff recommend that contracts be executed with the listed agencies for the
amounts shown in the following tables:
Community Development Block Grant Contracts:
Table 1 - CDBG Agencies
(Program
Substance Abuse
Senior Citizen Services of Greater Tarrant
County Inc.
YMCA of Metropolitan Fort Worth
YWCA of Fort Worth and Tarrant County
Clayton Child Care Inc. d/b/a Clayton YES!
Girls Inc. of Tarrant County
Camp Fire First Texas
Lena Pope Home, Inc.
The Ladder Alliance
Tarrant County Housing Partnership, Inc.
Presbyterian Night Shelter
The Salvation Army, a Georgia Corporation
Meals on Wheels, Inc. of Tarrant County
CDBG Public Service Subtotal
Rehabilitation Education and Advocacy for
Persons with Handicaps, dba REACH, Inc.**
Total CDBG Contracts
Senior Services
Child Care Services
Child Care Services
Child Care Services
Youth Services
Youth Services
Youth Services
Employment/Job
Training
Housing Counseling
and Education
Case
Management/Main
Shelter
(Amount
$ 75,000.00
$ 75,000.00
$ 75,000.00
$ 49,840.00
$ 75,000.00
$ 75,000.00
$ 75, 000.00
$ 75,000.00
$ 75,000.00
$ 75,000.00
75, 000.00
$ 75,000.00
$ 75,000.00
$ 949,840.00
$ 100,000.00
$1,049,840.00
**REACH will be funded from the CDBG Housing Programs and Services budget.
IHomeless Services
Home delivered
Meals Program
Project Ramp
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Housing Opportunities For Persons With AIDS Contracts:
Table 2 - HOPWA Agencies
Organization Program Amount
Tarrant
County Administration (seven percent) Supportive Services, $420,063.00
Samaritan and Facility Based Housing Subsidy Assistance
Housing, Inc.
AIDS
Outreach
Center, Inc.
TOTAL
HOPWA
Contracts
Administration (seven percent), Supportive Services,
Tenant Based Rental Assistance (TBRA), and Short $552,027.00
Term Rent Mortgage and Utility Assistance (STRMU)
Organization
S afeHaven of Tarrant County
P resbyterian Night Shelter
Day Resource Center for the Homeless
Emergency Solutions Grant Contracts:
Table 3 - ESG Agencies
Program
S helter Services
S helter Services
S helter Services
The Salvation Army, a Georgia
Corporation
YWCA Fort Worth and Tarrant County
TOTAL ESG Contracts
These programs are available in ALL COUNCIL DISTRICTS.
Homelessness
Prevention
Rapid Re -Housing
$972,090.00
Amount
$104,265.00
$ 85, 908.00
$141,092.00
$100,000.00
$ 79,435.00
$510,700.00
FISCAL INFORMATION/CERTIFICATION:
The Financial Management Services Director certifies that upon approval of the above
recommendations, adoption of the attached appropriation ordinance and receipt of grant funds,
funds will be available in the current operating budget, as appropriated, of the Grants Fund.
TO Fund/Account/Centers FROM Fund/Account/Centers
111 4310013 019CDBG $6.332.270,00.
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91001
21001
2.1001
21001
21001
21001
21001
21001
21001
21001
21001
5XXXXXX 019CDBG
4310013 019HOME,
5XXXXXX 019HOME
4310013 019ESG
5XXXXXX 019ESG
4921001 019CDBG
5XXXXXX 019CDBG,
4310013 019HOPWA
5XXXXXX 019HOPWA
4921001 019HOME
5XXXXXX 019HOME
$6.332.270.00
$1.934.447.00
$1.934.447.00
$552.108.00
$552.108.00
$50.000.00
$50.000.00
$1.002.154.00
$1.002.154.00
$200.000.00
$200.000.00
Submitted for City Manaaer's Office by:
Qriainatina Denartment Head:
Additional Information Contact:
Fernando Costa (6122)
Allison Gray (8030)
Avis Chaisson (6342)
Leticia Rodriguez (7319)
ATTACHMENTS
17NS HUDACTIONPLANPY2015-2016 GR76 AO FY2015.docx,
Action Plan 15 16 FINAL MandC Slides LHR.ndf
Proposed 2015 CDBG Infrastructure Proiect MandC.odf
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