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STATE OF TEXAS
COUNTY OF TARRANT
This contract ("Contract") is made and entered into by and between the City of Fort Worth
(hereafter "City") and AIDS Outreach Center, Inc. (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 Housing Opportunities for Persons with AIDS Program
("HOPWA") Program, Program No. TX-H-15-F002, Catalog of Federal Domestic Assistance No.
14.241;
WHEREAS, the HOPWA program is intended to address the needs of eligible persons
associated with the challenge of living with HIV/AIDS and their families;
WHEREAS, Agency submitted a proposal to use HOPWA funds for an eligible program
under the HOPWA Regulations whereby Agency will provide services to low and moderate
income City citizens;
WHEREAS, City citizens, the Community Development Council, and the City Council
have determined that HOPWA 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. 01 t 12 Ai
Complete Documentation means the following documentation as applicable:
HOPWA PSA CONTRACT 2015-2016
AIDS Outreach Center, Inc.
OFFICIAL RECORD'
CITY SECRETARY I
FT. WORTH, TX
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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: Source Documentation sufficient to show that
clients participating in the Program are HOPWA Eligible Clients as
described 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.
DBE means disadvantaged business enterprise in accordance with 49 CFR Part 26.
Director means the Director of the City's Neighborhood Services Department
Effective Date means October 1, 2015.
HOPWA means Housing Opportunities for Persons with AIDS
HOPWA Ehgible Client means a client whose annual income adjusted for family size does not
exceed 80% of AMI using the most current HUD Income Guidelines and Technical Guidance for
Deteiuninmg Income and Allowances verified by either Source Documentation or the form in in
EXHIBIT "E ' - Form of Income Self -Certification The client must also have a documented
diagnosis of HIV/AIDS
HOPWA Funds means the HOPWA grant funds supplied by City to Agency under the teilus of
this Contract.
HOPWA Regulations means regulations found at 24 CFR Part 574 et seq.
HUD means the United States Department of Housing and Urban Development
IDIS means Integrated Disbursement Information System, HUD's project tracking system
Neighborhood Services Department means the City's Neighborhood Services Department.
OMB means the Office of Management and Budget.
Program means the services described in EXHIBIT "A" - Program Summary.
Reimbursement Request means all reports and other documentation described in Section 9.
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AIDS Outreach Center, Inc Rev. 10 02 2015
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 HOPWA Eligible Clients served at least once in the
Contract Term. HOPWA Eligible Clients served 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 October 1, 2015 and terminates on September 30,
2016 unless earlier terminated as provided in this Contract.
4. DUTIES AND RESPONSIBILITIES OF CITY.
4.1 Provide HOPWA Funds.
City shall provide up to $552,027.00 of HOPWA Funds under the tettns 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 requirements of the HOPWA Regulations
during the teini of this Contract.
5. DUTIES AND RESPONSIBILITIES OF AGENCY.
5.1 Required Services.
Agency shall perform the services described in EXHIBIT "A" — Program Summary in
accordance with the terms and conditions of this Contract.
5.2 Use of HOPWA Funds.
5.2.1. Compliance with HOPWA Regulations and Contract.
Agency shall be reimbursed for eligible Program costs with HOPWA Funds only if City
determines in its sole discretion that:
5.2.1.1 Costs are eligible expenditures in accordance with HOPWA
Regulations.
5.2.1.2 Costs are in compliance with this Contract and are reasonable and consistent
with industry norms.
5.2.1.3 Complete Documentation, as applicable, is submitted to City by Agency.
5.2.2 Budget
5.2.2.1 The HOPWA Funds will be paid on a reimbursement basis in
accordance with EXHIBIT "B" - Budget.
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5.2.2.2 During the team of this Contract, Agency may submit written requests to
increase or decrease line -item amounts in the Budget, including an
explanation of why such increases or decreases are necessary. All such
requests 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 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 Program Budget.
5.2.3.1 Agency will notify City promptly of any additional funds it receives for
operation of the Program, and City reserves the right to amend this
Contract in such instances to ensure compliance with HUD regulations
governing cost allocation.
5.2.3.2 Agency agrees to utilize the HOPWA Funds to supplement rather than
supplant funds otherwise available for the Program.
5.2.4 Payment of HOPWA Funds to Agency.
HOPWA 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 HOPWA 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 HOPWA Funds not spent or not approved for
reimbursement to Agency shall remain with City.
5.3 Program Performance Milestones.
5.3.1 Agency represents that the Program will achieve the following
accordance with EXHIBIT "A" — Program Summary and the table below:
Month
3
6
8
12
Expenditures
25%
50%
75%
100%
Unduplicated Clients as
specified in EXHIBIT
"A" — Program
Summary
25%
50%
75%
100%
milestones in
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
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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 delay or withhold payment of Reimbursement Requests,
to lower Agency's allocation of HOPWA Funds, or to terminate this Contract.
5.3.3 Failure to meet at least 80% of its performance milestones or serve 91
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 Identify Program Expenses Paid with HOPWA Funds.
Agency will keep accounts and records in such a manner that City may readily identify and
account for Program expenses reimbursed with HOPWA Funds. These records shall be made
available to City for audit purposes and shall be retained as required hereunder.
5.5 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 HOPWA Funds
without City's written consent.
6. CLIENT ELIGIBILITY VERIFICATION.
6.1 Client Eligibility.
Agency will document the eligibility of all prospective clients. Agency may redact the
client's personal information and substitute a client number. Agency will document client
eligibility as follows:
6.1.1 Income.
Agency must verify all new clients' income eligibility with either Source Documentation or
the form attached as EXHIBIT "E ' - Form of Income Self Certification. Agency must use the
annual income definition used by 24 CFR Part 5.609 to establish client income eligibility and must
use the most current HUD Income Guidelines
6.1.2 Diagnosis.
Agency must submit a signed, dated statement that the client's file contains documentation
of the client's diagnosis of HIV/AIDS The HIV/AIDS diagnosis must be made by a licensed
health care provider; a client s self -certification of diagnosis is not sufficient. Agency should not
submit the actual diagnosis to City.
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6.1.3 Emergency Need.
For clients receiving short term rental, mortgage or utility assistance, Agency must also
verify and document that the client has an emergency need, such as sudden loss of income,
eviction, utility shutoff, or extraordinary and unexpected healthcare costs. Agency must submit its
policy regarding documenting emergency need to City by October 1, 2015.
6.2 Submission of Complete Documentation.
Agency must submit copies of documentation of client eligibility described in Section 6.1
with Attachment III in 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 terminations or
expirations of this Contract.
7. ADDITIONAL HOPWA REOUIREMENTS.
Agency agrees to comply with all requirements of the HOPWA Program as stated in the
HOPWA Regulations, including but not limited to the following:
7.1 Environmental Review.
HOPWA 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 HOPWA Funds it has already received and forfeit any future payments of HOPWA
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 (iir) receipt by City of grant agreement from HUD.
7.3 Monitoring.
7.3.1 Agency understands and agrees that it will be subject to monitoring by City for
compliance with terms and provisions of this Contract and the HOPWA Regulations for the term
of this Contract. Agency is subject to such monitoring during the term of this Contract and for 5
years after the Contract terra 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.
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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 HOPWA 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 perfoiiu 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 tei mnation or expiration of this Contract.
7.3.5 Agency shall provide City annually the results of any state or federal monitoring.
Such results shall be submitted within 60 days of receipt of such state or federal monitoring report,
or with the January Reimbursement Request, whichever is earlier
7.4 Aeencv Procurement Standards.
Agency shall comply with all applicable federal, state and local laws, regulations, and
ordinances for making procurements under this Contract In addition to the conflict of interest
provision 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 2 CFR 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 confiiiu 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 HOPWA Funds in compliance with 2 CFR Part 200 as
applicable. The eligibility of costs incurred for performance rendered shall be determined in
accordance 2 CFR Part 200.400 through 2 CFR Part 200.475.
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7.6 Accounting Standards.
Agency agrees to comply with 2 CFR Part 200 as applicable. Agency also agrees to
adhere to the accounting principles and procedures required therein, utilize adequate internal
controls, and maintain necessary supporting and back-up documentation for all costs incurred in
accordance with 2 CFR Part 200.302 and Part 200.303.
7.7 Uniform Administrative Requirements. Cost Principles, and Audit
Rea uirements.
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 teiins 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 HOPWA Funds or who perform any work in connection with the Program.
Agency shall cause all applicable provisions of this Contract to be included in and made a part of
any contract or subcontract executed in the performance of its obligations hereunder including its
obligations regarding the HOPWA Regulations Agency shall monitor the services and work
performed by its contractors, subcontractors and vendors on a regular basis for compliance with
the HOPWA Regulations and Contract provisions. Agency must cure all violations of the
HOPWA Regulations committed by its contractors, subcontractors or vendors. City maintains the
right to insist on Agency's full compliance with the terns of this Contract and the HOPWA
Regulations and Agency is responsible for such compliance regardless of whether actions taken to
fulfill the requirements of this Contract are taken by Agency or by Agency's contractors,
subcontractors or vendors. Agency acknowledges that the provisions of this Section shall survive
the earlier termination or expiration of this Contract and shall be applicable for 5 years after the
Contract Term ends
7.9 Convriaht and Patent Rights
No reports, maps, or other documents produced in whole or in part under this Contract shall
be the subject of an application for copyright by or on behalf of Agency. HUD and City shall
possess all rights to invention or discovery, as well as rights in data, which may arise as a result of
Agency's performance under this Contract.
7.10 Conflict of Interest Disclosure.
In accordance with the requirements of Section 14.13.2 1 and 14.13.4, Agency shall
establish conflict of interest policies for federal awards. Agency shall disclose to City in writing
any potential conflict of interest.
7.11 Compliance with FFATA and Whistleblower Protections.
Agency shall comply with the requirements of 2 CFR 300(b), including provisions of the
Federal Funding Accountability and Transparency Act ("FFATA ') governing requirements on
executive compensation and provisions governing whistleblower protections contained in 10
U.S.C. 2409, 41 U.S.C. 4712, 10 U.S.C. 2324, 41 U.S.C. 4304 and 41 U.S.C. 4310.
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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 HOPWA Funds that
provides reasonable assurance that Agency is managing the HOPWA Funds in compliance with
federal statutes, regulations, and the terms and conditions of this Contract. These internal controls
shall be in compliance with guidance in "Standards for Internal Control in the Federal
Government" issued by the Comptroller General of the United States or the "Internal Control
Integrated Framework" issued by the Committee of Sponsoring Organizations of the Treadway
Commission ("COSO");
7.12.2 Comply with federal statutes, regulations, and the terms and conditions of this
Contract;
7.12.3 Evaluate and monitor Agency's compliance with statutes, regulations and the terms
and conditions of this Contract;
7.12.4 Take prompt action when instances of noncompliance are identified including
noncompliance identified in audit findings; and
7.12.5 Take reasonable measures to safeguard protected personally identifiable
information and other information that HUD or City designates as sensitive or Agency considers
sensitive consistent with applicable federal, state, local and tribal laws regarding privacy and
obligations of confidentiality
7.13 Reauired Certification of Completion of Training.
At least 1 Agency employee must complete the HI ID required "Getting to Work Training
Curriculum" by April 15, 2016 and submit the required certifications to City with the April 2016
Reimbursement Request as more particularly described on EXHIBIT "A-2" - Requirements for
Completion of ` Getting to Work Training Curriculum".
8. RECORD KEEPING: REPORTING AND DOCUMENTATION REOUIREMENTS:
AUDIT.
8.1 Record Keeping.
Agency shall maintain a record -keeping system as part of its performance of this Contract
and shall promptly provide City with copies of any document City deems necessary for the
effective fulfillment of City's monitoring and evaluation responsibilities. Specifically, Agency
will keep or cause to be kept an accurate record of all actions taken and all funds spent, with
supporting and back-up documentation. Agency will maintain all records and documentation
related to this Contract for 5 years after the Contract term ends If any claim, litigation, or audit is
initiated before the expiration of the 5 year period, the relevant records and documentation must be
retained until all such claims, litigation or audits have been resolved. For purposes of this
Contract, this 5 year period for record retention is deemed to begin on October 1, 2016 and end on
September 30, 2021 regardless of whether or not this Contract is earlier terminated.
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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 foi 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 perfoiuuance 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 Chanfle in Reportint Requirements and Forms
City retains the right to change reporting requirements and foi is at its discretion City will
notify Agency in writing at least 15 days prior to the effective date of such change, and the Parties
shall execute an amendment to the Contract reflecting such change if necessary.
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 foi review or
audit by appropriate officials of the federal agency, City, and General Accounting Office
8.5.2 City Reserves the Right to Audit.
City reserves the right to perform an audit of Agency's Program operations and finances at
any time during the term of this Contract and for 5 years after the Contract Term ends if City
deteunines that such audit is necessary for City's compliance with the HOPWA Regulations or
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other City policies. Agency agrees to allow access to all pertinent materials as described herein for
such audit. For purposes of this Contract, this 5 year period for City audit is deemed to begin on
October 1, 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 HOPWA
FUNDS OR SPENT HOPWA 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 15th falls on a weekend or City holiday, Reimbursement Requests shall
be due the next day that the City is open for business. Failure to submit a Reimbursement Request
in a timely fashion will result in City taking the actions outlined in Section 10.1.
NOTWITHSTANDING ANYTHING ABOVE, THE REIMBURSEMENT REQUEST FOR
EXPENSES INCURRED FOR SEPTEMBER 2016 MUST BE RECEIVED BY OCTOBER
1, 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 infouuation 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
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signed by an authorized signatory of Agency. By signing Attachment I, Agency is certifying that
the costs are vand, 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.
9.2.1.1 Agency must submit a separate invoice for each activity type, i.e.
Administration, Facility Based Operating Costs, Supportive Seivices,
Short-term Rent, Mortgage and Utility Assistance (`STRMU"), and
Tenant Based Rental Assistance ("TBRA").
9.2.2 Attachment II - Expenditure Worksheet
This report shall itemize each expense requested for reimbursement by Agency and shall
include the Account corresponding the expense to a Budget line item. In order for this report to be
complete the following must be submitted:
9.2.2.1 For payroll expenses, timesheets signed by employees and approved by
supervisor for all payroll expenses listed. Timesheets must distinguish
between HOPWA-funded time and non-HOPWA funded time and
reflect actual time spent on HOPWA-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.
9.2.2.3 Proof that each expense was paid by Agency, which proof can be
satisfied by canceled checks, wire transfer documentation, paid receipts
or other appropriate banking documentation
9.2.3 Attachment III - Client Data Report.
This report shall list each Unduplicated Client served during the month along with his or
her demographic information. The Client Data Report must maintain a list of all clients served
during the Contract term. In order for this report to be complete, the following must be submitted:
9.2.3.1 Documentation of income verification for each Unduplicated Client the
first time the client is served by the Program, which will either be the
completed foal of EXHIBIT `E"- Form of Income Self Certification
or Source Documentation.
9.2.4 Overview Report.
Agency shall submit the Overview Report, attached hereto as EXHIBIT "H" - Overview
Report, quarterly 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 nsa(aifortworthtexas.gov.
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9.2.5 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, Agencies can submit
Reimbursement Requests via email to psa(a,fortworthtexas.wov 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 cure the default. If Agency fails to cure the default within such time,
Agency shall forfeit any payments otherwise due that month.
10.1.2 If Agency fails to submit requested information or missing documentation as set
forth in Section 9 1 2, then Agency shall forfeit payment due that month and the failure to submit
shall be considered an event of default that shall not be cured.
10.1.3 NOTWITHSTANDING THE PROVISIONS OF SECTION 10.1.1 OR
10.1.2, IF AGENCY FAILS TO SUBMIT THE REIMBURSEMENT REQUEST DUE
OCTOBER 1, 2016, OR IF THE SUBMITTED REIMBURSEMENT REQUEST FOR
OOCTOBER 1, 2016 IS LATE, INCOMPLETE OR OTHERWISE NOT IN COMPLIANCE
WITH THIS CONTRACT OR THE HOPWA REGULATIONS AS 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 (ii) or 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 HOPWA 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 IIOPWA Regulations,
or during any period during which Agency is in default of this Contract.
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10.1.6 In the event of termination under this Section 10.1, all HOPWA Funds awarded
but unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency shall
have no further right to such funds.
10.2 Failure to Maintain Records or Submit Reports and Documentation.
If Agency fails to maintain all records and documentation as required in Section 8, or if the
maintained or submitted report or documentation is not in compliance with this Contract or the
HOPWA 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 teiniinate 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 HOPWA 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 HOPWA Funds paid to Agency must be repaid to City
within 30 days of termination If such HOPWA 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 tens or condition
of this Contract In the event that such a breach remains uncured after 30 calendar days following
written notice by City (or such other notice period as may be specified herein) or, if Agency has
diligently and continuously attempted to cure following receipt of such written notice but
reasonably requires more than 30 calendar days to cure, as determined by both Parties mutually
and in good faith, City shall have the right to elect in City's sole discretion to (i) extend Agency's
time to cure, (ii) terminate this Contract effective immediately upon written notice of such intent to
Agency, or (iii) pursue any other legal remedies available to City under this Contract.
10.3.2 City's remedies may include:
10.3.2.1 Direct Agency to prepare and follow a schedule of actions for
carrying out the affected activities, consisting of schedules,
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 HOPWA Funds that have not yet been expended from
affected activities to other eligible activities or withhold HOPWA
Funds.
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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 HOPWA 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 HOPWA Funds already paid to Agency must be
repaid to City within 30 days of the termination. Failure to repay such HOPWA 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 HOPWA Funds will be paid to Agency until all
defaults are cured to City's satisfaction.
10.5 No Comnensation After Date of Termination.
Agency shall not receive any compensation for work undertaken after the date of the
termination.
10.6 Rights of City Not Affected.
Termination shall not affect or terminate any of the existing rights of City against Agency,
or which may thereafter accrue because of Agency's default and this provision shall be in addition
to any and all other rights and remedies available to City under the law. Such termination does not
teinuinate any provisions of this Contract that have been expressly noted as surviving the term or
teiniination of the Contract. No delay or omission by City in exercising any right or remedy
available to it under this Contract shall impair any such right or remedy or constitute a waiver or
acquiescence in any Agency default.
10.7 Waiver of Breach Not Waiver of Subsequent Breach
The waiver of a default or breach of any term, covenant, or condition of this Contract shall
not operate as a waiver of any subsequent default or breach of the same or any other term,
covenant or condition hereof.
10.8 Civil, Criminal and Administrative Penalties
Failure to perform all the Contract terms may result in civil, criminal or administrative
penalties, including, but not limited to those set out in this Contract.
10.9 Termination for Cause
10.9.1 City may terminate this Contract in the event of Agency's default, inability, or
failure to perform subject to notice, grace and cure periods In the event City terminates this
Contract for cause, all HOPWA 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
HOPWA Funds already paid to Agency must be repaid to City within 30 days of teiniination.
Failure to repay such HOPWA Funds within 30 days will result in City exercising all legal
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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 HOPWA 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 HOPWA
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 HOPWA Funds to be spent will not accomplish the purposes for which the Contract
was made.
10.11 Dissolution of Aaencv 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 HOPWA 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 HOPWA Funds including cash, interest payments from loans o1 otherwise, all
outstanding notes, mortgages or other security instruments any accounts receivable attributable to
the use of the HOPWA Funds, and any real or personal property owned by Agency that was
improved with the HOPWA Funds shall automatically transfer to City or to such assignee as City
may designate.
11. REPAYMENT OF HOPWA FUNDS.
All HOPWA Funds are subject to repayment in the event the Program does not meet the
requirements of this Contract or in the HOPWA Regulations If Agency takes any action that
results in the City being required to repay all or any portion of the HOPWA 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 HOPWA Funds is required of City, Agency agrees it will pay City
10% of the HOPWA 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 IIUD are
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uncertain and would be difficult to ascertain and may include an impact on City's HOPWA grant
or other federal grant funds, in addition to the finding by HUD or a required repayment of funds to
HUD by City. Therefore, the Parties agree that payment under this Section of 10% of the
HOPWA 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 HOPWA 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 HOPWA
Funds already paid to Agency must be repaid to City within 30 calendar days of teinuination 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 HOPWA 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 teuu 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 Agency an Independent Contractor.
Agency shall operate hereunder as an independent contractor and not as an officer, agent,
servant or employee of City. Agency shall have exclusive control of, and the exclusive right to
control, the details of the work and services performed hereunder, and all persons performing
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
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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 HOPWA 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 HOPWA-
funded service.
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, perfouiiance, attempted performance or non-performance of
this Contract.
14.7 Governing Law.
This Contract shall be governed by and construed in accordance with the laws of the State
of Texas If any action, whether real or asserted, at law or in equity, arises out of the execution,
performance or non-performance of this Contract or on the basis of any provision herein, for any
issue not governed by federal law, the choice of law shall be the laws of the State of Texas
14.8 Severability.
The provisions of this Contract are severable, and if for any reason a clause, sentence,
paragraph or other part of this Contract shall be determined to be invalid by a court or federal or
state agency, board or commission having jurisdiction over the subject matter thereof, such
invalidity shall not affect other provisions which can be given effect without the invalid provision
14.9 Written Agreement Entire Contract.
This written instrument and the Exhibits, Attachments, and Addendums attached hereto,
which are incorporated by reference and made a part of this Contract for all purposes, constitute
the entire agreement by the Parties concerning the work and services to be performed under this
Contract. Any prior or contemporaneous oral or written agreement which purports to vary the
tetnis 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 Onlv, No Legal Significance: Number
and Gender.
The paragraph headings contained herein are for convenience in reference to this Contract
and are not intended to define or to limit the scope of any provision of this Contract. When
context requires, singular nouns and pronouns include the plural and the masculine gender shall be
deemed to include the feminine or neuter and the neuter gender to include the masculine and
feminine. The words "include ' and "including' whenever used herein shall be deemed to be
followed by the words "without limitation"
14.11 Compliance With All Applicable Laws and Regulations.,
Agency agrees to comply fully with all applicable laws and regulations that are currently in
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effect or that are hereafter amended during the performance of this Contract. Those laws include,
but are not limited to:
➢ HOPWA Regulations found in 24 CFR Part 574
➢ AIDS Housing Opportunity Act, as amended (42 USC 12901 et seq.)
➢ Title VI of the Civil Rights Act of 1964 (42 U.S.C. Sections 2000d et seq) including
provisions requiring recipients of federal assistance to ensure meaningful access by
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 Disciimination 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.0 Sections 12101 et seq.), the
Architectural Barriers Act of 1968 as amended (42 U.S.0 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 Sohd Waste Disposal Act, as amended by the Resource
Conservation and Recovery Act
➢ Guidelines of the Environmental Protection Agency at 40 CFR Part 247
➢ For contracts and subgrants for construction or repair, Copeland "Anti -Kickback" act
(18 U.S.C. 874) as supplemented in 29 CFR Part 5
➢ For construction contracts awarded by Agency in excess of $2,000, and in excess of
$2,500 for other contracts which involve the employment of mechanics or laborers,
Sections 103 and 107 of the Contract Work Hours and Safety Standards Act (40 U.S.C.
327A 300) as supplemented by 29 CFR Part 5
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➢ 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 Requiiements 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 Employment and other Economic
Opportunities: Section 3 Requirements.
14.11.1 Requirement that Law Be Ouoted in Covered Contracts. — Certain,
Requirements Pertaining to Section 3 of the Housing and Urban
Development 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 new employment, training, or contracting
opportunities on a contractor or subcontractor level resulting fiom the expenditure of the HOPWA
Funds, Agency shall comply with the following and will ensure that its contractors also comply If
the work performed under this Contract 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 work to be performed under this contract is subject to the 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 cent( that they are under no contractual or
o ther 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
e mployees and applicants for training and employment positions can see the notice.
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The notice shall describe the Section 3 preference, shall set forth minimurn 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 cert5 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 future HUD assisted contracts.
G. With respect to work performed in connection with Section 3 covered Indian
housing assistance, section 7(b) of the Indian Self -Determination and Education
Assistance Act (25 U.S.C. 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 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 Auencv 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 apphcable 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 grant 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;
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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 (Foini 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 for 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
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 performance of this
Contract with all non-discrimination requirements of 24 CFR Part 574.603 and Chapter 17,
Article III, Division 4 — Farr 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
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perceived disability, sexual orientation, gender identity, gender expression, or transgender, nor will
Agency permit its officers, members, agents, employees, or clients to engage in such
discrimination.
This Contract is made and entered into with reference specifically to Chapter 17, Article
III, Division 3 - Employment Practices of the City Code, and Agency hereby covenants and agrees
that Agency, its officers, members, agents, employees and contractors, have fully complied with
all provisions of same and that no employee, or applicant for employment has been discriminated
against under the teiius of such ordinances by either or its officers, members, agents, employees or
contractors.
14.12.2 No Discrimination in Employment during the Performance of This
Contract.
During the perfoiniance of this Contract Agency agrees to the following provision, and will
require that its contractors and subcontractors also comply with such provision by including it in
all contracts with its contractors:
[Contractor's, Subcontractor's or Vendor's name] will not unlawfully discriminate against
any employee or applicants for employment because of race, color, sex, gender, religion, national
origin, familial status, disability or perceived disability, sexual orientation, gender identity, gender
expression or transgender. [Contractor's. Subcontractor's or Vendor's name.]will take affirmative
action to ensure that applicants are hired without regard to race, color, sex, gender, religion,
national origin, familial status, disability or perceived disability, sexual orientation, gender
identity, gender expression or transgender and that employees are treated fairly during employment
without regard to their race, color, sex, gender, religion, national origin, familial status, disability
or perceived disability, sexual orientation, gender identity, gender expression or transgender. Such
action shall include, but not be limited to, the following: employment, upgrading, demotion or
transfer, recruitment or recruitment advertising, layoff or termination, rates of pay or other forms
of compensation, and selection for training, including apprenticeship [Contractor's,
Subconti actor's or Vendor's name] agrees to post in conspicuous places, available to employees
and applicants for employment, notices setting forth the provisions of this nondiscrimination
clause.
[Contractor's Subcontractor's or Vendor's name] will, in all solicitations or advertisements
for employees placed by or on behalf of [Contractor's, Subcontractor's or Vendor's name], state
that all qualified applicants will receive consideration foi employment without regard to race,
color sex, gender, religion, national origin, familial status, disability or perceived disability, sexual
orientation, gender identity, gender expression of 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.
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[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 solicitations or advertisements for employees to work on this Contract, a maximum age limit for
such employment unless the specified maximum age limit is based upon a bona fide occupational
qualification, retirement plan or statutory requirement.
14.12.3 Agencv'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 At encv 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,
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 HOPWA funds or who are in a position to participate in a decision -making
process or gain inside infoirnation with regard to these activities may utilize HOPWA services,
may obtain a financial interest or benefit from a HOPWA-assisted activity, or have an interest in
any contract, subcontract or agreement with respect thereto, or the proceeds thereunder, either for
themselves or those with whom they have family or business ties, during their tenure or foi 1 year
thereafter, unless they are accepted in accordance with the procedures set forth at 24 CFR Part
574.625.
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.
HOPWA PSA CONTRACT 2015-2016
AIDS Outreach Center, Inc
Page 24
Rev. 10.02.2015
14.13.3 Conflicts of Interest Involving Procurement.
The conflict of interest provisions of 24 CFR Part 85.36 and 24 CFR Part 84.42,
respectively, shall apply in the procurement of property and services by Agency In all cases not
governed by those Sections, the provisions of 24 CFR Part 574.625 of the HOPWA 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 performance of its employees
engaged in the selection, award, and administration of contracts. No
employee, officer, or agent may participate in the selection, award,
or administration of a contract supported by a federal award if he or
she has a real or apparent conflict of interest. The standards of
conduct must provide for disciplinary actions to be applied for
violations of such standards by officers, employees, or agents of
Agency.
14.13.3.2 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 of 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
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 affirms that it will adhere to the provisions of the Texas Penal Code which prohibit
bribery and gifts to public servants.
HOPWA PSA CONTRACT 2015-2016
AIDS Outreach Center, Inc
Page 25
Rev. 10.02.2015
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 HOPWA 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 HOPWA 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, affainative steps must be
taken to assure that DBEs, SBEs, MBEs, and WBEs are utilized when possible as sources of
supplies, equipment, construction and services.
14.14.2.1 In order to comply with federal reporting requirements, Agency must
submit the form attached hereto as EXHIBIT "I" — MBE
Reporting Form for each contract or subcontract with a value of
$10,000.00 or more paid or to be paid with the HOPWA Funds
Agency shall submit this form 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
HOPWA-funded Program prior to any charges being incurred.
HOPWA PSA CONTRACT 2015-2016 Page 26
AIDS Outreach Center, Inc Rev. 10.02.2015
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, or other industrial disturbances, acts of public
enemies, wars, blockades, insurrections, riots, epidemics, earthquakes, fires, floods, restraints or
prohibitions by any court, board, department, commission or agency of the United States or of any
States, civil disturbances, or explosions, or some other reason beyond Agency's control
(collectively, "Force Majeure Event"), the obligations so affected by such Force Majeure Event
will be suspended only during the continuance of such event Agency will give City written notice
of the existence, extent and nature of the Force Majeure Event as soon as reasonably possible after
the occurrence of the event Failure to give notice will result in the continuance of Agency's
obligation regardless of the extent of any existing Force Majeure h,vent Agency will use
commercially 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
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.
HOPWA PSA CONTRACT 2015-2016 Page 27
AIDS Outreach Center, Inc Rev. 10 02 2015
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 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 foini of insurance or bond in the amount of
$552,027.00 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 HOPWA Funds occasioned by such misconduct. To
effectuate such reimbursement, such fidelity coverage shall include a rider stating that
reimbursement for any loss or losses shall name the City as a Loss Payee.
Agency shall furnish to City in a timely manner, but not later than the Effective Date,
certificates of insurance as proof that it has secured and paid for policies of commercial insurance
as specified herein If City has not received such certificates by the Effective Date, Agency shall
be in default of the Contract and City may, at its option, terminate the Contract.
Such insurance shall cover all insurable risks incident to or in connection with the
execution, performance, attempted performance or nonperformance of this Contract. Agency shall
maintain the following insurance coverage and limits:
Commercial General Liability (CGL) Insurance
$ 500,000 each occuiience
$1,000,000 aggregate limit
HOPWA PSA CONTRACT 2015-2016 Page 28
AIDS Outreach Center, Inc Rev. 10.02.2015
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
$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.
HOPWA PSA CONTRACT 2015-2016 Page 29
AIDS Outreach Center, Inc. Rev. 10 02 2015
Insurers of Agency's insurance policies shall be licensed to do business in the state of Texas by the
Department of Insurance or be otherwise eligible and authorized to do business in the state of
Texas Insurers shall be acceptable to City insofar as their financial strength and solvency and
each such company shall have a current minimum A.M. Best Key Rating Guide rating of A-: VII
or other equivalent insurance industry standard rating otherwise approved by City.
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 pievail.
Agency shall require its contractors to maintain applicable insurance coverages, limits, and other
requirements as those specified herein; and Agency shall require its contractors to provide Agency
with certificate(s) of insurance documenting such coverage. Also, Agency shall require its
contractors to have City and Agency endorsed as additional insureds (as their interest may appear)
on their respective insurance policies.
Directors and Officers Liability coverage shall be in force and may be provided on a claims -made
basis. This coverage may also be referred to as Management Liability, and shall protect the
insured against claims arising out of alleged errors in judgment, breaches of duty and wrongful
acts arising out of their organizational duties. Coverage shall protect not only the entity, but all
past, present and future directors, officers, trustees, employees, volunteers and committee
members.
Notwithstanding any provision in this Contract to the contrary, when applicable, Agency
shall comply with the requirements of 2 CFR 200 310 and shall, at a minimum, provide the
equivalent insurance coverage for real property and equipment acquired or improved with
CDBG Funds as provided to property owned by Agency.
18. CERTIFICATION REGARDING LOBBYING.
The undersigned representative of Agency hereby certifies, to the best of his or her
knowledge and belief, that
No federal appropriated funds have been paid or will be paid, by or on behalf of Agency, to
any person for influencing or attempting to influence an officer or employee of any agency,
a member of Congress an officer or employee of Congress in connection with the
awarding of any federal contract, the making of any federal grant, the making of any
federal loan, the entering into of any cooperative agreement and the extension,
continuation, renewal, amendment, or modification of any federal contract, grant, loan or
cooperative agreement.
If any funds other than federally appropriated funds have been paid or will be paid to any
person for influencing or attempting to influence an officer or employee of any agency,
member of Congress in connection with this federal contract, grant, loan or cooperative
HOPWA PSA CONTRACT 2015-2016 Page 30
AIDS Outreach Center, Inc Rev. 10.02.2015
agreement, Agency shall complete and submit Standard Form-LLL, "Disclosure Form to
Report Lobbying," in accordance with its instructions.
This certification is a material representation of fact upon which reliance was placed when
this Contract was made or entered into. Submission of this certificate is a prerequisite for
making or entering into this Contract imposed by 31 U.S.C. Section 1352. Any person who
fails to file the required certification shall be subject to a civil penalty of not less than
$10,000.00 and not more than $100,000.00 for each such failure.
Agency shall require that the language of this certification be included in all subcontracts or
agreements involving the expenditure of federal funds.
19. LITIGATION AND CLAIMS.
Agency shall give City immediate notice in writing of any action, including any proceeding
before an administrative agency, filed against Agency in conjunction with this Contract or the
Program Agency shall furnish immediately to City copies of all pertinent papers received by
Agency with respect to such action or claim. Agency shall provide a notice to City within 10 days
upon filing under any bankruptcy or financial insolvency provision of law.
20. NOTICE
All notices required or permitted by this Contract must be in writing and are deemed
delivered on the earlier date of the date actually received or the third day following deposit in a
United States Postal Service post office or receptacle; with proper postage, certified mail return
receipt requested; and addressed to the other Party at the address set out below or at such other
address as the receiving Party designates by proper notice to the sending Party.
City:
City Attorney's Office
1000 Throckmorton Street
Fort Worth, TX 76102
Telephone: 817-392-7600
Copy to:
Diiector of Neighborhood Services Department
1000 Throckmorton Street
Fort Worth, TX 76102
Attention* Assistant Director
Telephone: 817-392-7540
Copy to:
Diiector of Neighborhood Services Department
1000 Throckmorton Street
Fort Worth, TX 76102
Attention* Program Coordinator
Telephone: 817-3 92-63 42
HOPWA PSA CONTRACT 2015-2016
AIDS Outreach Center, Inc
Page 31
Rev. 10 02 2015
Azencv:
AIDS Outreach Center, Inc
Stephanie Cagle, Director of Case Management
400 N. Beach Street, Ste. 100
Fort Worth, TX 76111
Telephone• 817-335-1994
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 perfoini 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]
HOPWA PSA CONTRACT 2015-2016
AIDS Outreach Center, Inc
Page 31-1
Rev. 10.02.2015
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
HOPWA PSA CONTRACT 2015-2016
AIDS Outreach Center, Inc.
Fernando Costa, Assistant City Manager
AIDS OUTREACH CENTER , INC.
By: \ AS'S
Name: Y!CLVJAIDVV 1tffiicvt
Title: E'*!w1htt VXVUitii
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Page 32
Rev. 09.01.2015
IN WITNESS WHEREOF r� ._r� o have executed 4 duplicate originals of this Contract
in Fort Worth, Tarrant Co
di'ty Secre4i
M&C: Gli8521
Date: August 4, 2015
APPROVED AS TO FORM A
Assistant City Attorney
HOPWA PSA CONTRACT 2015-2016
AIDS Outreach Center, Inc.
TY OF FORT WORTH
Fernando Costa, Assistant City Manager
AIDS OUTREACH CENTER, INC.
By:
Name: Shannon Hilgart
Title: Executive Director
OFFICIAL RECORD
CITY SECRETARY
'31MORTH, a J+
Page 32
Rev. 10.02.2015
EXHIBITS:
EXHIBIT
EXHIBIT
EXHIBIT
EXHIBIT
EXHIBIT
EXHIBIT
EXHIBIT
EXHIBIT
EXHIBIT
EXHIBIT
EXHIBIT
"A" — Program Summary
"A-1" — 2015 HUD Income Limits
"A-2" - Requirements for Completion of "Getting to Work Training Curriculum"
"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" — Overview Report
"I" — MBE Reporting Form
HOPWA PSA CONTRACT 2015-2016
AIDS Outreach Center, Inc
Page 33
Rev. 10.02.2015
AIDS OUTREACH CENTER, INC. EXHIBIT "A"
Supportive Services, STRMU, and TBRA PROGRAM SUMMARY
PROGRAM SUMMARY
(HOPWA)
October 1, 2015 to September 30, 2016
PERIOD
$552,027 00
AMOUNT
Capitalized terms not defined herein shall have meanings assigned them in the Contract.
PROGRAM:
The Program provides HOPWA Eligible Clients with one or more of the following:
1) supportive services;
2) tenant based rental assistance ("TBRA");and/or,
3) short-term rental, mortgage, or utility assistance ("STRMU").
Supportive Services includes housing counseling and case management, including the
development of housing plans.
TBRA includes long-term monthly rental assistance. Clients must be income eligible according
to HUD guidelines, live in a rental unit that passes habitability inspections, and have an
identified housing need as determined by the client's AOC case manager.
STRMU includes short term assistance for up to 21 weeks. STRMU provides assistance with
utilities, rent, or mortgage payments and must not exceed a client's current monthly budget
deficit caused by an unavoidable, unplanned, documented emergency consistent with HUD
guidelines and AOC's local policy. Clients receiving other government housing assistance are
not eligible.
Agency's office and Program services will be available at 400 N. Beach Street, Suite 100, Fort
Worth, TX 76111, Monday through Thursday 8:30 a m. to 5 00 p.rn. and Friday, 8:30 a.m. to
4:00 p.m.
The Program will serve HOPWA Fi 1igible Clients in Tarrant, Johnson, Parker, Wise, Hood and
Somervell counties.
HOPWA Funds will pay for direct assistance such as TBRA and STRMU. HOPWA Funds will
also be used to pay costs associated with delivering supportive services to any client receiving
either TBRA or STRMU assistance, including salaries, fringe benefits, and FICA for employees,
supplies, insurance, and Piogram facility rent and utility costs. HOPWA Funds will also pay for
contracted labor services that include accounting and security services. No more than 7% of the
HOPWA Funds will be used to pay administrative costs, including salaries, insurance, taxes, and
legal and accounting fees associated with the Program.
HOPWA PSA CONTRACT 2015-2016 — EXHIBIT "A"
AIDS Outreach Center, Inc
PROGRAM SUMMARY Page 1
REGULATORY CLASSIFICATION:
1DIS matrix Code(s) and Service Category: 31D HOPWA Project Sponsor Administration 31C
HOPWA Project Sponsor Activity
Regulatory Citation(s): 24 CFR 574.300(b)(10) — Administrative Expenses
24 CFR 574.300(b)(7) — Supportive Services
24 CFR 574.300(b)(6) — STRMU
24 CFR 574.300(b)(6) - TBRA
Agency will maintain documentation which verifies that 100% of clients served by the Program
are eligible under HOPWA Regulations
PROGRAM GOALS:
Minimum Contract Performance Outcome. The Program must provide services to a
minimum of 113 Unduplicated Clients. The Program must provide TBRA services to a
minimum of 57 Unduplicated Clients and must provide STRMU services to a minimum of 56
Unduplicated Clients. Unduplicated Clients must be residents of Tarrant, Johnson, Parker, Wise,
Hood or Somervell counties as shown by the monthly reports on Attachment III
HOPWA PSA CONTRACT 2015-2016 — EXHIBIT "A" — PROGRAM SUMMARY Page 2
AIDS Outreach Center, Inc
30%AMI
50% AMI
80% AMI
EXHIBIT "A-1"
2015 HUD INCOME LIMITS
2015 Median Family Income - Fort Worth/Arlington, TX*
1 Person 2 Persons
$14,650 $16,750
$24,400 $27,900
$39,050 $44,600
3 Persons 1 4 Persons
$20,090
$31,400
$50,200
$24,250
$34,850
$55,750
5 Persons
$28,410
$37,650
$60,250
6 Persons 7 Persons
$32,570 $36,730
$40,450 $43,250
$64,700 $69,150
*Income limits are published at least annually by HUD.
HOPWA PSA CONTRACT 2015-2016 -- EXHIBIT "A-1" —2015 HUD INCOME LIMITS
AIDS Outreach Center, Inc
8 Persons
$40,890
$46,050
$73,600
Page 1
EXHIBIT "A-2"
REQUIREMENTS FOR COMPLETION OF "GETTING TO WORK TRAINING
CURRICULUM"
HOPWA PSA CONTRACT 2015-2016 Page l
EXHIBIT "A-2" REQUIREMENTS FOR COMPLETION OF "GE I ING TO WORK TRAINING CURRICULUM"
AIDS Outreach Center, Inc.
Getting to Work:
A Training Curriculum for HIV/AIDS Service Providers and Housing Providers
At least 1 Agency employee must complete this required training curriculum by the deadline of April 15,
2016. Proof of completion must be submitted with the April reimbursement request.
The Getting to Work Training Curriculum is divided into 3 online modules:
Module 1: Understanding the Value of Work
Module 2: Adopting an Employment and Training Mindset — Organizationally and Individually
Module 3: Incorporating Employment into the HIV/AIDS Service Menu
To view the modules:
1. Click the module title.
2. You will be prompted to either create or log into your HUD Exchange Learn account.
3. Follow this guidance when creating a HUD Exchange account:
Step 1 of 2 screen: Fill out the required Personal Information, and Login Information sections. For the
Organization Information if you are not affiliated with a HUD program, choose None of the Above
and I am an Individual.
Step 2 of 2 screen: All HUD Program Experience fields on the Learner Profile page are optional.
Click Update to complete the account creation process
4. After creating an account or logging in, you will enter the HUD Exchange Learn system.
5. Click the Enroll button on the HUD Exchange Learn course description to access the course.
6. The module name will appear under Activities. Click the Module Name to access the course.
7. The module will launch in a new window, so please make sure your pop-up blockers are turned off.
To receive credit for completing each module:,
1. Take the completion quiz under Activities on the HUD Exchange Learn course description. F ach
module has a quiz.
2. Score 80% or better on the quiz. You may take the quiz multiple times.
3. After you pass the quiz, you will be able to print a completion certificate on the HUD Exchange
Learn course description.
You can access information about the modules by visiting the HUD Exchange website at
www hudexchange.com or by using the following hnk: https://www.hudexchange.info/training-events/dol-
hud-getting-to-work-curriculum-for-hiv-aids-providers. You may also contact your assigned contract
administrator to get additional information.
HOPWA PSA CONTRACT 2015-2016 Page 2
EXHIBIT "A-2" REQUIREMENTS FOR COMPLETION OF "GE1 1ING TO WORK TRAINING CURRICULUM"
AIDS Outreach Center, Inc.
1
1
1
1
1
Salaries
FICA
Life Insurance
Health Insurance
Disability Insurance
Unemployment -State
Contract Labor — Accounting
TOTAL ADMINISTRATIVE EXPENSES
EXHIBIT "B" - BUDGET
Account I Grant I A
Budget
ADMINISTRATIVE (HOPWA ONLY)
1001 5735 2200
1002 439 167
1003
1004 367 190
1005
1006 89 12
1007
6,630 2,569
SUPPORTIVE SERVICE
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 — Accounting
(City needs copy of contract before expenses
can be reimbursed)
Contract Labor — IT
(City needs copy of contract before expenses
can be reimbursed)
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
Building Security
LEGAL, FINANCIAL, AND INSURANCE
Fidelity Bond or Equivalent
Directors and Officers
General Commercial Liability
Contract Accounting — Audit Requirements
TOTAL SUPPORTIVE SERVICE EXPENSES
DIRECT ASSISTANCE
Childcare Scholarships
DIRECT ASSISTANCE - STRMU
Short-term Rent Assistance
Short-term Mortgage Assistance
I
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
5010
6001
6002
6003
6005
7001
7002
7003
50407
3856
3000
724
925
400
50
50
2500
2,500
625
800
200
200
4200
650
0
100
71,187
20000
3210
123378
9438
18676
1604
1
1
510
925
330
325
3135
3000
250
700
125
250
3142
450
575
800
167,613
i
1
106768
1448
1760
137
110,113
75358
1652
17065
6675
620
625
44,365
5,405
11625
14500
3675
3550
76658
11900
0
1100
274,773
1
1
114703
2054
2,317
238
119,312
249143
14946
21676
2328
18500
8000
1000
1000
50,000
10,905
12500
16000
4000
4000
84000
13000
575
2000
513,573
20000
3210
,
I
HOPWA PSA CONTRACT 2015-2016
AIDS Outreach Center, Inc.
EXHIBIT "B" BUDGET
Page 1
Short-term Utilities Assistance
TOTAL STRMU EXPENSES
DIRECT ASSISTANCE — TBRA
Tenant Based Rental Assistance
TOTAL TBRA EXPENSES
BUDGET TOTAL
FUNDING A: Tarrant County Pass Through
FUNDING B: Other Funding
FUNDING C:
7004
7005
7000
30,210
444,000
444,000
552,027 170,182 384,886
7000
30,210
444,000
444,000
1,107,095
HOPWA PSA CONTRACT 2015-2016 — EXHIBIT "B"
AIDS Outreach Center, Inc
BUDGET
Page 2
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.
Position Name
Receptionist
Director of Administrative
Services
Accountant
TOTAL
FICA
Life Insurance
Health Insurance
Disability Insurance
Unemployment
Retirement
TOTAL
Contract Labor Accounting
TOTAL
Position Name
DIRECTOR CASE MGMT
CASE MANAGER
ASSOC EXEC DIRECTOR
CASE MANAGER
CASE MANAGER
CASE MANAGER
TOTAL
SALARY DETAIL — ADMINISTRATIVE
Est. Percent to
Grant
Rate
25,480
52,984
36,239
114,703
Annual Hours
2080
2080
2080
5%
5%
5%
Amount to Grant
1,274
2,649
1,812
5% 1 5,735
FRINGE DI -,TAIL — ADMINISTRATIVE
Percent of
Payroll
7.65%
6.40%
1.55%
Amount
2,054
Est. Percent to
Grant
21%
2,317 16%
238 37%
4,609 1 19%
MISCELLANEOUS — ADMINISTRATIVE
Est. Percent to
Grant
Total Budget
SALARY DETAIL — SUPPORTIVE SERVICES
Est. Percent to
Grant
56,143 2080 5%
41,000 2080 98%
61,000 2080 5%
30,000 2080 I 5%
31,000 2080 1 5%
30,000 2080 1 5%
249,143 20%
Rate
Annual Hours
Amount to Grant
439
367
89
895
Amount to Grant
0
0
Amount to Grant
2,807
40,000
3 050
1 500
1 550
1 500
50,407
HOPWA PSA CONTRACT 2015-2016 — EXHIBIT "B" — BUDGET
AIDS Outreach Center, Inc
Page 3
Telephone
Electric
Gas
Water and Wastewater
Solid Waste Disposal
Rent
Custodial Services
Repairs
Building Security
TOTAL
FICA
Life Insurance
Health Insurance
Unemployment
Disability Insurance
Workers Compensation
Retirement
TOTAL
FRINGE DETAIL - SUPPORTIVE SERVICES
Percent of
Payroll
7.65%
5.94%
1.44%
Amount
14,946
21,676
2,328
38,950
SUPPLIES AND SERVICES
Office Supplies
Office Equipment Rental
Postage
Printing
TOTAL
Contract Labor — IT
Contract Labor — Accounting
Craft Supplies
Facility Fees
Field Trip Costs
Food Supplies
Teaching Aids
TOTAL
Total Budget
18,500
8,000
1,000
1,000
28,500
Est. Percent to
Grant
26%
14%
31%
19%
SUPPORTIVE SERVICES
Est. Percent to
Grant
5%
5%
5%
5%
5%
MISCELLANEOUS - SUPPORTIVE SERVICES
Est. Percent to
Grant
23%
5%
Total Budget
10,905
50,000
60,905 8%
Amount to Grant
3,856
3,000
724
7,580
Amount to Grant
925
400
50
50
1,425
Amount to Grant
FACILITY AND UTILITIES - SUPPORTIVE SERVICES
Est. Percent to
Grant
5%
5%
5%
5%
Total Budget
12,500
16,000
4,000
4,000
84,000
13,000
575
134,075
5%
5%
5%
2,500
2,500
5,000
Amount to Grant
625
800
200
200
4,200
650
0
6,675
HOPWA PSA CONTRACT 2015-2016
AIDS Outreach Center, Inc.
EXHIBIT "B" BUDGET
Page 4
LEGAL, FINANCIAL AND INSURANCE
Est. Percent to
Grant
Fidelity Bond (or Equivalent)
General Commercial Liability
Directors and Officers
Contract Accounting — Audit Requirements i
TOTAL
Short -Term Rent Assistance
Short Term Mortgage Assistance
Short Term Utilities Assistance
TOTAL
Tenant Based Rental Assistance
TOTAL
Total Budget
2,000
2,000
5%
50/0
DIRECT ASSISTANCE - STRMU
Total Budget Est. Percent to
Grant
20,000 100%
3 210 100%
7 000 100%
30,210 I 100%
DIRECT ASSISTANCE - TBRA
Est. Percent to
Grant
100%
100%
Total Budget
444,000
444,000
Amount to Grant
100
100
Amount to Grant
20,000
3 210
7 000
30,210
Amount to Grant
444,000
444,000
HOPWA PSA CONTRACT 2015-2016 — EXHIBIT "B" — BUDGET
AIDS Outreach Center, Inc
Page 5
EXHIBIT "C"
AUDIT CERTIFICATION FORM
HOPWA PSA CONTRACT 2015-2016 — EXHIBIT "C"
AIDS Outreach Center, Inc
AUDIT CERTIFICATION FORM Page 1
AUDIT CERTIFICATION FORM AND AUDIT REQUIREMENTS
Agency: AIDS Outreach Center, Inc.
Fiscal/Year Ending: September 30, 2016
tct/
During the fiscal year in which funds will be received, we will exceed the federal
expenditure threshold of $750,000. We will have our Single Audit or Program Specific
Audit completed and will submit the audit report described in 2 CFR Part 200 within 7
months after the end of the audited fiscal year or 30 days within its completion, whichever
is the earlier date.
During the fiscal year in which funds will be received, we will not exceed the $750,000
federal expenditure threshold required for a Single Audit or a Program Specific Audit to be
performed this fiscal year. (Fill out schedule below)
Federal Expenditure Disclosure
MUST be filled out if Single Audit or Program Audit is NOT required.
Federal Grantor
Pass Through
Grantor
Program Name & Contract
CFDA Number Number
Total Federal Expenditures for this Fiscal Year:
Expenditures
/r9 Li/ire)
Signat ry aiid Title
Date
Failure to submit this or a similar statement or failure to submit a completed single audit package
as described in the federally required audit requirements described in 2 CFR Part 200, as
applicable, by the required due date may result in suspension of funding and may affect
eligibility for future funding. Notwithstanding the above, this certification acknowledges the
agency's commitment to meet all other financial reporting, financial statements, and other
audit requirements as may be set forth in the Contract.
HOPWA PSA CONTRACT 2015-2016 — EXHIBIT "C" — AUDIT CERTIFICATION FORM Page 2
AIDS Outreach Center, Inc.
EXHIBIT "D"
REPORTING FORMS
HOPWA PSA CONTRACT 2015-2016 — EXHIBIT "D" — REPORTING FORMS Page 1
AIDS Outreach Center, Inc
ATTACHMENT
Invoice - Administrative
r
INVOICE
HOPWA Administrative
Agency:
Address:
City, State Zip*
Program*
Period of Service:
Program
Administrative
Expenses
AIDS Outreach Center, Inc.
Supportive Services, STRMU, and TBRA
Amount
This Invoice Cumulative to Date
Agency's Certification: 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, or the
omission of any material fact, may subject me to criminal, civil, or
administrative penalties for fraud, false statements, false claims, or
otherwise. U.S. Code Title 18, Sec. 1001 and Title 31 Sec. 3729-3730
and 3801-3812.
Signature and Date:
Name.
Title:
HOPWA PSA CONTRACT 2015-2016 — EXHIBIT "D" — REPORTING FORMS Page 2
AIDS Outreach Center, Inc
ATTACHMENT I
Invoice — Supportive Services
INVOICE
HOPWA Supportive Services
Agency:
Address:
City, State ZJp:
Program:
Period of Service:
Program
Supportive Services
AIDS Outreach Center, Inc.
Supportive Services, STRMU, and TBRA
Amount
This Invoice Cumulative to Date
Agency's Certification: 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, or the
omission of any material fact, may subject me to criminal, civil, or
administrative penalties for fraud, false statements, false claims, or
otherwise. U.S. Code Title 18, Sec. 1001 and Title 31, Sec. 3729-3730
and 3801-3812.
Signature and Date:
Name:
Title:
HOPWA PSA CONTRACT 2015-2016 — EXHIBIT "D" — REPORTING FORMS Page 3
AIDS Outreach Center, Inc
City,
Period
Agency:
Address:
State Z1pa
Program
of Service:
Program
STRMU
ATTACHMFNT I
Invoice — STRMU
INVOICE
HOPWA STRNIU
AIDS Outreach Center, Inc.
Supportive Services, STRMU, and TBRA
Amount
This Invoice Cumulative to Date
Agency s Certification: 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, or the
omission of any material fact, may subject me to cnminal civil, or
administrative penalties for fraud, false statements, false claims, or
otherwise. U.S. Code Title 18, Sec. 1001 and Title 31 Sec. 3729-3730
and 3801-3812.
Signature and Date:
Name:
Title:
HOPWA PSA CONTRACT 2015-2016 — EXHIBIT "D" — REPORTING FORMS
AIDS Outreach Center, Inc
Page 4
A 1"1 ACHMENT I
Invoice -TBRA
INVOICE
HOPWA TBRA
Agency: AIDS Outreach Center, Inc.
Address:
City, State Zipm
Program: Supportive Services, STRMU, and TBRA
Period of Service:
Program
TBRA
Amount
This Invoice Cumulative to Date
Agency's Certification: 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, or the
omission of any material fact, may subject me to criminal, civil, or
administrative penalties for fraud, false statements, false claims, or
otherwise. U.S. Code Title 18, Sec. 1001 and Title 31 Sec. 3729-3730
and 3801-3812
Signature and Date:
Name:
Title:
i
HOPWA PSA CONTRACT 2015-2016 — EXHIBIT "D" — REPORTING FORMS Page 5
AIDS Outreach Center, Inc
Agency
Program
CheekNo.
2
3
4
5
6
7
8
9
10
I
12
13
14
I5
16
17
18
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
ATTACHMENT II
Expenditure Worksheet — Administration
HOPWA Administration
City of Fort Worth
Rousing and Economic Development Department
Expenditure Worksheet
AIDS outreach Center, Inc.
Supportive Senices, STRAW, and TBRA
Pleas group like account codes.
Account Code (See
Payee Description* Rev to Rik) Amount
`Payroll must identify employee. Rent must identify tenant. Other payments should identify indnidmis, if applicable
HOPWA PSA CONTRACT 2015-2016 — EXHIBIT "D"
AIDS Outreach Center, Inc
Expense Line Item
ADMINISTRATIVE (I?OP WA Onlv)
Salaries
FIC
Life Insurance
Health Insurance
Disability Insurance
Unemployment -State
Contract Labor - Accoumtinu
PROGRAM PERSONNEL
Salaries
FICA
Life Insurance
Health Insurance
Unemployment
Worker's Comrensation
Retirement
SUPPLIES AND SERVICES
Office Supplies
OIDce Ewioment Rental
Postage
Printirn
MISCELLANEOUS
Construction/Building Materials
Contract Labor - Accounting/ IT
Craft Suwlies
Field Trio Admission Expanses
Food Studies
Teaching Aids
FACJLI1YAND UTILU1ES
Telephone
Electric
Gas
Water and Wastewater
Solid Waste Disposal
Rent
Custodial Senices
Repairs
Cleaning Sureties
Building Security
I LEGAL, FINANCIAL. AND INSURANCE
Fidelity Bond or Equivalent
Directors and Officers
General Commercial Liability
Contract Accounting.
I DIRECT ASSLSTANCE
Childare Scholarships
DIRECT ASSISTANCE - STRMU
Short -temp Rent Assistance
Short -tern Mortpge Assistance
Short-term Utilities Assistance
IDIRECIASSISTANCE - SMART
Tenant Based Rental Assistance
Highlighted are the only relevant codes for this Program.
Account
1001
1002
1003
1004
1005
1006
1007
2001
2002
2003
2004
2005
2006
2007
3001
3002
3003
3004
4002
4003
4004
4005
4006
4007
5001
5002
5003
5004
5005
5006
5007
5008
5009
5010
6001
6002
6003
6004
7001
7002
7003
7004
7005
REPORTING FORMS Page 6
LineNo.
2
3
5
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Total
Agency:
Program
CleckNo.
A 1'1 ACHMENT II
Expenditure Worksheet — Supportive Services
HOPWA Supportive Services
City of Fort Worth
Housing and Economic Development Department
Expenditure Worksheet
AIDS Outreach Center. Inc.
Su Imo rti se Services. STRAW, and TBRA
Please group like account codes.
Account Code (See
Payee Descrintion' Key to Right) Amotmt
'Payroll must identify employee. Rent must identify tenant Other payments should identify individuals, if applicable.
Highlighted are the only relevant codes for this Program.
Expense Line Item
ADMINISHIATRE (HOPWA Onh)
Salaries
FICA
Life hssuance
Health Insuran:e
Disability Insurance
Unemployment -State
Leah& Accounting
PROGRAMPERSONNEL
Salaries
FICA
Life Insurance
Health haimance
Unemployment
Worker's Compensation
Retirement
SUPPLIES AND SERVICES
Office Staplies
Office Eouivment Rental
Postage
Printing
MISCELLANEOUS
Construction/Building Materials
Conine( Labor- Accotntine/H
Croft supplies
Field Trip Admission Expenses
Suwlies
Teaching Aids
FACILUYAND tTUL1TiES
TelephonFood
Electric
Gas
Water and Wastewater
Solid Waste Disposal
Rent
Custodial Senices
Repairs
Cleaning Supplies
Building Security
LEGAL. FINANCIAL, AND INSURANCE
Fidelity Bond or Equivalent
Directors and Officers
General Commercial Lialility
Contract Accoumtirt.
DIRECT ASSISTANCE
Childcare Scholarships
DIRECTASSISTANCE -STRAW
Short-term Rent Assistance
Short -tens Mortgage Assistance
Short -tens Utilities Assistance
DIRECFASSISTANCE- SIRiSIU
Tenant Based Rental Assistance
Account
1001
1002
1003
1004
1005
1006
1007
2001
2002
2003
2004
2005
2006
2007
3001
3002
3003
3004
4002
4003
4004
4005
4006
4007
5001
5002
5003
5004
5005
5006
5007
5008
5009
5010
6001
6002
6003
6004
7001
7002
7003
7004
7005
HOPWA PSA CONTRACT 2015-2016 — EXHIBIT "D" — REPORTING FORMS Page 7
AIDS Outreach Center, Inc
Line No.
1
3
4
5
6
7
8
9
I0
11
12
13
/4
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Total
Agency.
Program.
CheckNo.
A IU ACHMENT II
Expenditure Worksheet — STRMU
HOPWA - STRMU
City of Fort Worth
Housing and Economic Development Department
Expenditure \Vorksheet
AIDS Outreach Center. Inc.
Suoportis a Services, STRMU, and 1BRA
Please:roup like account codes.
Account Code (See
Payee Descriptions' Key to Riebtl Amount
'Payroll must identify employee. Rent must identify tenant Other pa}mtents should idenify iduals, ifapplicable.
HOPWA PSA CONTRACT 2015-2016 — EXHIBIT "D"
AIDS Outreach Center, Inc
Highlighted are the only relevant codes for this Program.
Expense Line Item
ADMINISTRATIVE (HOPWA Onto%
Salaries
FICA
Life Insurance
Health I surarge
Disability Insurance
Unemnlovmtent-State
Legnl & Accounting
PROGRAMPERSONNEL
Salaries
FICA
Life Insurance
Health Insurance
Unemployment
Worker's Compensation
Retirement
SUPPLIES AND SERVICES
Office supplies
Office Equipment Renal
Postage
Printing
bIISCELLANEOUS
Construction/Building Materials
Contract Labor - Accounting/ IT
Craft Supplies
Field Trip Admission Expenses
Food Supplies
Teaching Aids
FACILFIVAND UJILITFES
Telephone
Electric
Gas
Water and Wastegater
Solid Waste Disposal
Rent
Custodial Senices
Remits
Cleaning Supplies
Building Security
LEGAL, FINANCIAL. AND INSURANCE
Fidelity Bond or Ewlsalent
Directors and Officers
General Commercial Liability
Contract Mcouadirm
DIRECEASSDSPANCE
Childcare Scholarships
DIRECFASSISFANCE-STRAH7
ShorItetm Rent Assistance
Short-term Mortpage Assistance
Short-term Utilities Assistance
n_ IR]F.CTASSISTANCE-STRMU
Tenant Based Renal Assistance
1
Account
1001
1002
1003
1004
1005
1006
1007
2001
2002
2003
2004
2005
2006
2007
3001
3002
3003
3004
4002
4003
4004
4005
4006
4007
5001
5002
5003
5004
5005
5006
5007
5008
5009
5010
6001
6002
6003
6004
7001
7002
7003
7004
7005
REPORTING FORMS Page 8
Line No-
1
2
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Total
Agency:
Program
ckNo.
Payee
A I ACHMENT II
Expenditure Worksheet — TBRA
HOPWA- TBRA
City of Fort Worth
Housing and Economic Development Department
Expenditure Worksheet
AIDS Outreach Center, Inc.
Supportis a Semites, STRMU. and TERA
Description
Please group like account codes.
Aecoum Code (See
Rev to Multi Amount
*Payroll must identify employee Rent must identify tenant Other payments should identify indisidua s, of applicable.
Highlighted are the only relevant codes for this Program.
Expense Line Item
ADMINISTRATIVE (HOPWA On1v1
Salaries
FICA
Life Insurance
Health Insurance
Disability insurance
Unemployment -State
Legal & Accotmting
PROGRAMPERSONNEL
Salaries
FICA
Life Insurance
Health Insurance
Unemployment
Worker's Compensation
Retirement
SUPPLIES AND SERVICES
Office Supplies
Office Equipment Rental
Postnv
Printing
MISCELLANEOUS
Construction/Building Materials
Contract Labor - Accounting/ ID
Craft Supplies
Field Trio Admission Expenses
Food Supplies
Teaching Aids
FACILITY AND UTILITIES
Telephone
Electric
Gas
Water and Wastesuater
Solid Waste Disposal
Rent
Custodial Senices
Repairs
Cleaning Supplies
Building Security
LEGAL, FINANCIAL. AND INSURANCE
Fidelity Bond or Eoui alent
Directors and Officers
General Commercial Liability
Contract Accounting
DIRECFASSISTANCE
Childcare Scholarships
DIRECPASSISDANCE-SIRM U
Short-term Rent Assistance
Short-term Mortgage Assistance
Short-term Utilities Assistance
DIRECEASSISTANCE- SIRMU
Tenant BasedReNnl Assistance
Accormt
1001
1002
1003
1004
1005
1006
1007
2001
2002
2003
2004
2005
2006
2007
3001
3002
3003
3004
4002
4003
4004
4005
4006
4007
5001
5002
5003
5004
5005
5006
5007
5008
5009
5010
6001
6002
6003
6004
7001
7002
7003
7004
7005
HOPWA PSA CONTRACT 2015-2016 — EXHIBIT "D" — REPORTING FORMS Page 9
AIDS Outreach Center, Inc
Iutrvrtbu:
A I ACHMENT III
Client Data Report — Supportive Services
Sory tHIS OutreachCenter. Inc.
Progant
Sueeatlhe Services. STRAITLY. and TRII.I
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HOPWA PSA CONTRACT 2015-2016 — EXHIBIT "D" — REPORTING FORMS Page 12
AIDS Outreach Center, Inc
EXHIBIT "E"
INCOME CERTIFICATION FORMS
HOPWA CONTRACT 2015-2016 -- EXHIBIT "E" -- INCOME CERTIFICATION FORMS Page 1
AIDS Outreach Center, Inc.
AIDS Outreach Center, Inc.
CERTIFICATION OF INCOME STATEMENT
Applicant Name:
Current Address: Phone :
Last Name
First Name
Household Members and Income
(Including Applicant)
Age Monthly Source/Employer Name
Income
**PERSONAL INFORMATION: (Check one in each item. Optional Information for Federal Reporting Purposes)
a. ❑ MALE b. ❑ WHILE. ■ BLACK/AFRICAN AMERICAN 0 BLACK/AFRICAN AMERICAN & WHITE
❑ FEMALE f AMERICAN INDIAN/ALASKAN NATIVE ■ ASIAN
❑ AMERICAN INDIAN/ALASKAN NATIVE & WHITE ❑ ASIAN & WHITE
NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER ❑ BALANCE/OTHER
❑ AMERICAN INDIAN/ALASKAN NATIVE & BLACK/AFRICAN AMERICAN
c. ETHNICITY d. DISABLED e. IS CLIENT WOMEN HEAD OF HOUSEHOLD
❑ HISPANIC 0 YES 0 YES
❑ NON -HISPANIC ❑ NO ■ NO
* TOTAL NUMBER OF HOUSEHOLD MEMBERS
Total Anticipated Annual Household Income.
(Include Yourself AND everyone who lives in the house.)
Certification:
I certify that the information I am providing is true and could be subject to verification at any time by a third
party. I also acknowledge that the provision of false information could leave me subject to the penalties of
Federal, State and local law.
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 are required.
HOPWA CONTRACT 2015-2016 -- EXHIBIT "E" -- INCOME CERTIFICATION FORMS Page 2
AIDS Outreach Center, Inc.
AIDS Outreach Center, Inc.
CERTIFICACION DE DECLARACION DE INGRESOS
Nombre del Solicitante:
Domicilio Actual: Numero de Telefono:
Apellido
Nombre
Miembros en el Hogar e Inaresos
(Incluir el/la solicitante)
Edad Ingreso Fuente de Ingresos/Nombre de Empleador
Mensual
**INFORMACION PERSONAL: (Seleccione uno en cada categoria. Informacion opcionai para propositos de informacion Federal)
a. ❑ MASCULINO b. ■ CAUCASICO ❑ 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 & NEGRO/AFRICANO AMERICANO
■
■
c. ETNICIDAD d. DISCAPACITADO e. tES EL SOLICITANTE UNA MUJER Y CABECERA DEL HOGAR?
HISPANO El si ❑ si
❑ NO-HISPANO ❑ NO ❑ NO
* NUMERO TOTAL DE MIEMBROS EN EL HOGAR (Incluye a si mismo y a todos los que viven en la casa)
Ingreso total del hogar anual anticipado:
Certificacion:
Certifico que la informacion que proporciono es verdad y podria ser susceptible a la comprobacion a cualquier
tiempo por terceros. Yo tambien ieconozco 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
Para use de ernpleados de la agenda
# De Miembros de Familia: Ingreso Anual:
Limite de Ingreso: LEs solicitante elegible? :
Compruebe si el solicitante se nego a dar su informacion personal:
Evaluacion del empleado sobre informacion personal:
Persona haciendo la determinacion: Fecha:
Note: La direccion de la casa y los ingresos (y sus origenes) pat a todos miembros del hogar son requeridos.
HOPWA CONTRACT 2015-2016 -- EXHIBIT "E" -- INCOME CERTIFICATION FORMS Page 3
AIDS Outreach Center, Inc.
Fecha
EXHIBIT "F"
STANDARDS OF DOCUMENTATION
HOPWA PSA CONTRACT 2015-2016 -- EXHIBIT "F" -- STANDARDS OF DOCUMENTATION Page 1
AIDS Outreach Center, Inc
2015-2016 Documentation Standards for
HOPWA Public Service Contract Expenses
Budget Line
Items
Employee Salaries and Benefits - City will reimburse the salary and benefits of any employee(s) who work directly with the HOPWA Program. Amounts will be determined
prior to the execution of the HOPWA Contract. Agencies must show calculation on how the HOPWA portion of employee salaries and benefits were calculated consistently
with the HOPWA Contract. The calculation(s) will apply to the HOPWA Administration line item, Supportive Services, and Facility Based Operations.
r cIIIIUUI Jell lel It Ie4IUC Lb IIIUM IIIUUUC a UI Ilea!IOet CH IU vvuln July ulat Icucuw ulc I wino wulncU uy ulc culpIuycc\a/ WLJINII9 uu many up uIc
HOPWA-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. 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. The duties for administrative personnel defined by the job
descriptions must reflect eligible administrative costs. Agencies will be required to identify hours worked on a specific activity, i.e.
Administrative, Supportive, or Operations.
Administrative Services: Employees who work hours for the general management, oversight, coordination, evaluation, and reporting of
HOPWA-eligible activities will be required to supply documentation reflecting hours worked on the HOPWA-funded Program. The duties
Salaries X for administrative personnel defined by the job descriptions must reflect eligible administrative costs.
Supportive Services: Employees who work hours for direct client support, which includes but is not limited to housing case managment to
clients, assessing and monitor the client's needs and personal support systems, assisting clients with housing assesments, housing plans,
filling out intake forms, coordinating payment with hotels/motels, and provides referrals to other housing sources, etc. will be required to
supply documentation reflecting hours worked directly with clients.
Facility Based Operations: Employees who work hours for the daily and ongoing operation of a facility or facilities will be required to supply
documentation reflecting hours worked on the operation of a facility or facilities.
`If employees are paid by direct deposit rather than check, then the agency must submit both the direct deposit payment company's report
FICA/
Medicare
Life Insurance
Health
Insurance
Disability
Insurance
Unemployment
Insurance
Retirement
X X
X X
X X
X X
X X
X X
Ma erials, Equipment, Goods and Supplies
reimbursement for these items will require
with the HOPWA Contract. Costs must be
Office Supplies X X
Office
Equipment X X X X
Rental
Postage X X
Printing/Copies X X X 1
Medical X X X
Supplies
Rent, Utilities and M_intenance - City will only pay for a prorated portion of these expenses. The portion will be determined by the square footage attributable to the HOPWA-
funded Program and shall be cost -allocated in accordance with the amount of space used for the HOPWA-funded Program. These expenses may only be in support of the
HOPWA-funded Program. The items listed below require prior City approval and the Agency is required to identify any funding source that pays for the portion of the
expenses that is not paid with City HOPWA funds. Agencies must show calculation on how the HOPWA portion of these expenses were calculated consistently with the
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
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.
City will only reimburse for the amount spent on the direct support of the HOPWA-funded Program. Agencies requesting
prior City approval. Agencies must show calculation on how the HOPWA portion of these expenses were calculated consistently
reasonable and documented expenses.
HOPWA Contract.
Telephone X
Gas X
Water/
Wastewater
Electric
Solid Waste
Disposal
Facility
Maintenance X X X X
and Repairs
These costs can be associated with the delivery of a HOPWA activity provided by the Agency. Agencies will be required to identify which
expenses will be allocated to specific activities, i.e. Administrative, Supportive, or Operations.
X
Rent
X
X
X
X
X
X
X
X
This item requires approval by the City prior to the execution of the HOPWA Contract. Repairs may be categorized as major/minor
rehabilitation projects and must be approved through the full HUD Environmetai 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 HOPWA-
funded program.
HOPWA PSA CONTRACT 2015-2016 Exhibit
F" -- STANDARDS FOR COMPLETE DOCUMENTATION
Supportive Services, STRMU/TBRA Client Eligibility Documentation
Demograhic
Information
Medical
Documentation
STRMU Client X X
TBRA Client X X
Miscellaneous
City -required
Insurance
Other
Insurance
X X
X X
Procurement - X X X X
Contract Labor
Audit Services X X X
HOPWA
CAPER
Quarterly
Report
X
X
X
Client documentation provided must reflect demographic & household/family composition.
Agency will submit information in the form of a letter that certifies that the Agency has medical documentation confirming the clients'
HIV/AIDS status.
Agency will submit documentation that demonstrate compliance with the assistance time limits, 21 weeks in any 52 week period, complete
lease, utility bill(s), proof of emergency situation, and income source documentation to show clients is at or below 80% AMI.
Agency will submit documentation that demonstrates the client was certified on an annual basis through an annual income certification or
recertification, submit a complete lease, utility bill(s), Habitability Inspection or Housing Quality Standard (HQS) Inspection, Rent
Reasonableness, and income source documentation to show client is at or below 80% AMI.
City will only pay for a percentage of the City -required insurance solong as it is in proportion to the square footage attributable to the
HOPWA-funded program.
City will only pay fora percentage of other required insurance. Insurance such as, but not limited to, Commercial Property and Liability,
Professional Liability, Crime and Fidelity, Business Auto, and Commercial Umbrella Liability, solong as it is in proportion to Agencies total
budget. Agencies will be required to identify which expenses will be allocated to specific activities, i.e. Administrative, Supportive, or
Operations. Agency must show a calculation and documentation of how the invoiced amount was calculated, and must provide
documentation showing payment.
This item requires prior approval by the City. Prior to the execution of the ESG 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
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, nutritionist, hazmat services,
custodial services, etc. Agencies may not use the contract services of any City of Fort Worth Department.
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.
Agency must submit a HOPWA CAPER quarterly report.
*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 20151hr
HOPWA PSA CONTRACT 2015-2016 Exhibit F - STANDARDS FOR COMPLETE DOCUMENTATION
1
EXHIBIT "G"
SECTION 3 REPORTING FORMS
HOPWA PSA CONTRACT 2015-2016 -- EXHIBIT "G" -- SECTION 3 REPORTING FORMS Page 1
AIDS Outreach Center, Inc
Section 3 Summary Report
Economic Opportunities for
Low — and Very Low -Income Persons
Section back of page for Public Reporting Burden statement
1. Recipient Name & Address: (street, city, state, zip)
8. Date Report Submitted:
Part l: Employment and Training
A
Job Category
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
(** Columns B, C and F are
B
Number of
New Hires
U.S. Department of Housing
and Urban Development
Office of Fair Housing
And Equal Opportunity
2. Federal Identification: (grant no.)
4. Contact Person
6. Length of Grant:
9. Program Code: (Use separate sheet
for each program code)
mandatory fields. Include New
C
Number of New
Hires that are
Sec. 3 Residents
3 = Public/Indian Housing
A = Development,
B = Operation
C = Modernization
Page 1 of 2
D
of Aggregate Number
of Staff Hours of New Hires
that are Sec. 3 Residents
EXHIBIT "G"
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 &F)
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
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
Page i
Program Code: Enter the appropriate program code as listed at
the bottom of the page.
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 (Le.
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.
form HUD 60002 (11/2010)
Ref 24 CFR 135
EXHIBIT "H"
OVERVIEW REPORT
HOPWA PSA CONTRACT 2015-2016 EXHIBIT "H"—OVERVIEW REPORT Page 1
AIDS Outreach Center, Inc
Housing Opportunities for Persons with AIDS
(HOPWA) Program
Consolidated Annual Performance and
Evaluation Report (CAPER)
Measuring Performance Outcomes
Final Released 1/12/12
OMB Number 2506-0133 (Expiration Date: 10/31/2014)
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The CAPER report for HOPWA formula grantees provides annual information on program accomplishments
that supports piogram evaluation and the ability to measure program beneficiary outcomes as related to:
maintain housing stability prevent homelessness; and improve access to care and support. This information is
also covered under the Consolidated Plan Management Process (CPMP) report and includes Narrative
Responses and Performance Charts required under the Consolidated Planning regulations. The public reporting
burden for the collection of information is estimated to average 42 hours per manual response, or less if an
automated data collection and retrieval system is in use, along with 60 hours for record keeping, including the
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. Grantees are required to report on the activities
undertaken only, thus there may be components of these reporting requirements that may not be applicable. This
agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless
that collection displays a valid OMB control number.
Previous editions are obsolete form HUD-40110-D (Expiration Date: 10/31/2014)
Overview. The Consolidated Annual Performance and Evaluation Report
(CAPER) provides annual performance reporting on client outputs and
outcomes that enables an assessment of grantee performance in achieving the
housing stability outcome measure. The CAPER, in conjunction with the
Integrated Disbursement Information System (IDIS), fulfills statutory and
regulatory program reporting requirements and provides the grantee and
HUD with the necessary information to assess the overall program
performance and accomplishments against planned goals and objectives.
HOPWA formula grantees are required to submit a CAPER, and complete
annual performance information for all activities undertaken during each
program year in the IDIS, demonstrating coordination with other
Consolidated Plan resources. HUD uses the CAPER and IDIS data to obtain
essential information on grant activities, project sponsors, Subrecipient
organizations, housing sites, units and households, and beneficiaries (which
includes racial and ethnic data on program participants). The Consolidated
Plan Management Process tool (CPMP) provides an optional tool to integrate
the reporting of HOPWA specific activities with other planning and reporting
on Consolidated Plan activities.
Table of Contents
PART 1: Grantee Executive Summary
1. Grantee Information
2. Project Sponsor Information
3. Administrative Subrecipient Information
4. Program Subrecipient Information
5. Grantee Narrative and Performance Assessment
a. Grantee and Community Overview
b. Annual Performance under the Action Plan
c. Barriers or Trends Overview
d. Assessment of Unmet Housing Needs
PART 2: Sources of Leveraging and Program Income
1. Sources of Leveraging
2. Program Income and Resident Rent Payments
PART 3: Accomplishment Data: Planned Goals and Actual Outputs,
PART 4: Summary of Performance Outcomes
1. housing Stability: Permanent Housing and Related Facilities
2. Prevention of Homelessness: Short -Term Housing Payments
3. Access to Care and Support: Housing Subsidy Assistance with
Supportive Services
PART 5: Worksheet - Determining Housing Stability Outcomes
PART 6: Annual Certification of Continued Use for HOPWA Facility-
Based Stewardship Units (Only).
PART 7: Summary Overview of Grant Activities
A. Information on Individuals, Beneficiaries and Households Receiving
HOPWA Housing Subsidy Assistance (TBRA, STRMU, PHP,Facility
Based Units, Master Leased Units ONLY)
B. Facility -Based Housing Assistance
Continued Use Periods. Grantees that received HOPWA funding for new
construction, acquisition, or substantial rehabilitations are required to operate
their facilities for HOPWA-eligible beneficiaries for a ten (10) years period.
If no further HOPWA funds are used to support the facility, in place of
completing Section 7B of the CAPER, the grantee must submit an Annual
Certification of Continued Project Operation throughout the required use
periods. This certification is included in Part 6 in CAPER. The required use
period is three (3) years if the rehabilitation is non -substantial.
In connection with the development of the Department's standards for
Homeless Management Information Systems (HMIS), universal data
elements are being collected for clients of HOPWA-funded homeless
assistance Droiects. These project sponsor/subrecipient records would
include: Name, Social Security Number, Date of Birth, Ethnicity and Race,
Gender, Veteran Status, Disabling Conditions, Residence Prior to Program
Entry, Zip Code of Last Permanent Address, Housing Status, Program Entry
Date, Program Exit Date, Personal Identification Number, and Household
Identification Number. These are intended to match the elements under
HMIS. The HOPWA program -level data elements include: Income and
Sources, Non -Cash Benefits, HIV/AIDS Status, Services Provided, and
Housing Status or Destination at the end of the operating year. Other
suggested but optional elements are: Physical Disability, Developmental
Disability, Chronic Health Condition, Mental Health, Substance Abuse,
Domestic Violence, Date of Contact, Date of Engagement, Financial
Assistance, Housing Relocation & Stabilization Services, Employment,
Education, General Health Status, , Pregnancy Status, Reasons for Leaving,
Veteran's Information, and Children's Education. Other HOPWA projects
sponsors may also benefit from collecting these data elements.
Final Assembly of Report. After the entire report is assembled, please
number each page sequentially.
Filing Requirements. Within 90 days of the completion of each program
year, grantees must submit their completed CAPER to the CPD Director in
the grantee's State or Local HUD Field Office, and to the HOPWA Program
Office: at HOPWAahud.eov. Electronic submission to HOPWA Program
office is preferred; however, if electronic submission is not possible, hard
copies can be mailed to: Office of HIV/AIDS Housing, Room 7212, U.S.
Department of Housing and Urban Development, 451 Seventh Street, SW,
Washington, D.C.
Record Keeping. Names and other individual information must be kept
confidential, as required by 24 CFR 574.440. However, HUD reserves the
right to review the information used to complete this report for grants
management oversight purposes, except for recording any names and other
identifying information In the case that HUD must review client level
data, no client names or identifying information will be retained or
recorded. Information is reported in aggregate to HUD without
personal identification. Do not submit client or personal information in
data systems to HUD.
Definitions
Adjustment for Duplication: Enables the calculation of unduplicated
output totals by accounting for the total number of households or units that
received more than one type of HOPWA assistance in a given service
category such as HOPWA Subsidy Assistance or Supportive Services. For
example, if a client household received both TBRA and STRMU during the
operating year, report that household in the category of HOPWA Housing
Subsidy Assistance in Part 3, Chart 1, Column [lb] in the following manner:
HOPWA Housing Subsidy
Assistance
l . Tenant -Based Rental Assistance
Permanent Housing Facilities:
2a. Received Operating
Subsidies/Leased units
Transitional/Short-term Facilities:
2b. Received Operating Subsidies
3a.
3b.
4
Permanent Housing Facilities:
Capital Development Projects placed
in service during the operating year
Transitional/Short-term Facilities:
Capital Development Projects placed
in service during the operating year
Short-term Rent, Mortgage, and
Utility Assistance
Adjustment for duplication
(subtract)
TOTAL Housing Subsidy
6. Assistance (Sum of Rows 1-4 minus
Row 5)
[1] Outputs:
Number of
Households
1
Previous editions are obsolete Page i
form HUD-40110-D (Expiration Date: 10/31/2014)
Administrative Costs: Costs for general management, oversight,
coordination, evaluation, and reporting. By statute, grantee administrative
costs are limited to 3% of total grant award, to be expended over the life of
the grant. Project sponsor administrative costs are limited to 7% of the
portion of the grant amount they receive.
Beneficiary(ies): All members ofa household who received HOPWA
assistance during the operating year including the one individual who
qualified the household for HOPWA assistance as well as any other
members of the household (with or without HIV) who benefitted from the
assistance.
Central Contractor Registration (CCR): The primary registrant
database for the U.S. Federal Govemment. CCR collects, validates, stores,
and disseminates data in support of agency acquisition missions, including
Federal agency contract and assistance awards. Both current and potential
federal government registrants (grantees) are required to register in CCR
in order to be awarded contracts by the federal government. Registrants
must update or renew their registration at least once per year to maintain
an active status. Although recipients of direct federal contracts and grant
awards have been required to be registered with CCR since 2003, this
requirement is now being extended to indirect recipients of federal funds
with the passage of ARRA (American Recovery and Reinvestment Act),
Per ARRA and FFATA (Federal Funding Accountability and
Transparency Act) federal regulations, all grantees and sub -grantees or
subcontractors receiving federal grant awards or contracts must have a
DUNS (Data Universal Numbering System) Number.
Chronically Homeless Person: An individual or family who : (i) is
homeless and lives or resides individual or family who: (i) Is homeless and
lives or resides in a place not meant for human habitation, a safe haven, or
in an emergency shelter; (ii) has been homeless and living or residing in a
place not meant for human habitation, a safe haven, or in an emergency
shelter continuously for at least 1 year or on at least 4 separate occasions in
the last 3 years; and (iii) has an adult head of household (or a minor head
of household if no adult is present in the household) with a diagnosable
substance use disorder, serious mental illness, developmental disability (as
defined in section 102 of the Developmental Disabilities Assistance and
Bill of Rights Act of 2000 (42 U.S.C. 15002)), post traumatic stress
disorder, cognitive impairments resulting from a brain injury, or chronic
physical illness or disability, including the co -occurrence oft or more of
those conditions. Additionally, the statutory definition includes as
chronically homeless a person who currently lives or resides in an
institutional care facility, including a jail, substance abuse or mental health
treatment facility, hospital or other similar facility, and has resided there
for fewer than 90 days if such person met the other criteria for homeless
prior to entering that facility. (See 42 U.S.C. 11360(2))This does not
include doubled -up or overcrowding situations.
Disabling Condition: Evidencing a diagnosable substance use disorder,
serious mental illness, developmental disability, chronic physical illness,
or disability, including the co -occurrence of two or more of these
conditions. In addition, a disabling condition may limit an individual's
ability to work or perform one or more activities of daily living. An
HIV/AIDS diagnosis is considered a disabling condition.
Facility -Based Housing Assistance: All eligible HOPWA Housing
expenditures for or associated with supporting facilities including
community residences, SRO dwellings, short -tern facilities, project -based
rental units, master leased units, and other housing facilities approved by
HUD.
Faith -Based Organization: Religious organizations of three types: (1)
congregations; (2) national networks, which include national
denominations, their social service arms (for example, Catholic Charities,
Lutheran Social Services), and networks of related organizations (such as
YMCA and YWCA); and (3) freestanding religious organizations, which
are incorporated separately from congregations and national networks.
Grassroots Organization: An organization headquartered in the local
community where it provides services; has a social services budget of
$300,000 or less annually, and six or fewer full-time equivalent
Previous editions are obsolete Page ii
employees. Local affiliates of national organizations are not considered
"grassroots"
HOPWA Eligible Individual: The one (1) low-income person with
HIV/AIDS who qualifies a household for HOPWA assistance. This person
may be considered "Head of Household." When the CAPER asks for
information on eligible individuals, report on this individual person only.
Where there is more than one person with HIV/AIDS in the household, the
additional PWH/A(s), would be considered a beneficiary(s).
HOPWA Housing Information Services: Services dedicated to helping
persons living with HIV/AIDS and their families to identify, locate, and
acquire housing. This may also include fair housing counseling for eligible
persons who may encounter discrimination based on race, color, religion,
sex, age, national origin, familial status, or handicap/disability. .
HOPWA Housing Subsidy Assistance Total: The unduplicated number
of households receiving housing subsidies (TBRA, STRMU, Permanent
Housing Placement services and Master Leasing) and/or residing in units
of facilities dedicated to persons living with H1V/AIDS and their families
and supported with HOPWA funds during the operating year.
Household: A single individual or a family composed of two or more
persons for which household incomes are used to determine eligibility and
for calculation of the resident rent payment. The term is used for
collecting data on changes in income, changes in access to services, receipt
of housing information services, and outcomes on achieving housing
stability. Live -In Aides (see definition for Live -In Aide) and non -
beneficiaries (e.g. a shared housing arrangement with a roommate) who
resided in the unit are not reported on in the CAPER.
Housing Stability: The degree to which the HOPWA project assisted
beneficiaries to remain in stable housing during the operating year. See
Part 5: Determining Housing Stability Outcomes for definitions of stable
and unstable housing situations.
In -kind Leveraged Resources: These involve additional types of support
provided to assist HOPWA beneficiaries such as volunteer services,
materials, use of equipment and building space. The actual value of the
support can be the contribution of professional services, based on
customary rates for this specialized support, or actual costs contributed
from other leveraged resources. In determining a rate for the contribution
of volunteer time and services, use the rate established in HUD notices,
such as the rate of ten dollars per hour. The value of any donated material,
equipment, building, or lease should be based on the fair market value at
time of donation. Related documentation can be from recent bills of sales,
advertised prices, appraisals, or other information for comparable property
similarly situated.
Leveraged Funds: The amount of funds expended during the operating
year from non-HOPWA federal, state, local, and private sources by
grantees or sponsors in dedicating assistance to this client population.
Leveraged funds or other assistance are used directly in or in support of
HOPWA program delivery.
Live -In Aide: A person who resides with the HOPWA Eligible Individual
and who meets the following criteria: (1) is essential to the care and well-
being of the person; (2) is not obligated for the support of the person; and
(3) would not be living in the unit except to provide the necessary
supportive services. See the Code of Federal Regulations Title 24, Part
5.403 and the HOPWA Grantee Oversight Resource Guide for additional
reference.
Master Leasing: Applies to a nonprofit or public agency that leases units
of housing (scattered -sites or entire buildings) from a landlord, and
subleases the units to homeless or low-income tenants. By assuming the
tenancy burden, the agency facilitates housing of clients who may not be
able to maintain a lease on their own due to poor credit, evictions, or lack
of sufficient income.
form HUD-40110-D (Expiration Date: 10/31/2014)
Operating Costs: Applies to facility -based housing only, for facilities
that are currently open. Operating costs can include day-to-day housing
function and operation costs like utilities, maintenance, equipment,
insurance, security, furnishings, supplies and salary for staff costs directly
related to the housing project but not staff costs for delivering services.
Outcome: The degree to which the HOPWA assisted household has been
enabled to establish or maintain a stable living environment in housing that
is safe, decent, and sanitary, (per the regulations at 24 CFR 574.310(b))
and to reduce the risks of homelessness, and improve access to HIV
treatment and other health care and support.
Output: The number of units of housing or households that receive
HOPWA assistance during the operating year.
Permanent Housing Placement: A supportive housing service that helps
establish the household in the housing unit, including but not limited to
reasonable costs for security deposits not to exceed two months of rent
costs.
Program Income: Gross income directly generated from the use of
HOPWA funds, including repayments. See grant administration
requirements on program income for state and local governments at 24
CFR 85.25, or for non -profits at 24 CFR 84.24.
Project -Based Rental Assistance (PBRA): A rental subsidy program
that is tied to specific facilities or units owned or controlled by a project
sponsor or Subrecipient. Assistance is tied directly to the properties and is
not portable or transferable.
Project Sponsor Organizations: Any nonprofit organization or
governmental housing agency that receives funds under a contract with the
grantee to provide eligible housing and other support services or
administrative services as defined in 24 CFR 574.300. Project Sponsor
organizations are required to provide performance data on households
served and funds expended. Funding flows to a project sponsor as
follows:
HUD Funding > Grantee > Project Sponsor
Short -Term Rent, Mortgage, and Utility (STRAW) Assistance: A
time -limited, housing subsidy assistance designed to prevent homelessness
and increase housing stability. Grantees may provide assistance for up to
21 weeks in any 52 week period. The amount of assistance varies per
client depending on funds available, tenant need and program guidelines.
Stewardship Units: Units developed with HOPWA, where HOPWA
funds were used for acquisition, new construction and rehabilitation that
no longer receive operating subsidies from HOPWA. Report information
for the units is subject to the three-year use agreement if rehabilitation is
non -substantial and to the ten-year use agreement if rehabilitation is
substantial.
Previous editions are obsolete Page iii
Subrecipient Organization: Any organization that receives funds from a
project sponsor to provide eligible housing and other support services
and/or administrative services as defined in 24 CFR 574.300. If a
subrecipient organization provides housing and/or other supportive
services directly to clients, the subrecipient organization must provide
performance data on household served and finds expended. Funding
flows to subrecipients as follows:
HUD Funding > Grantee > Project Sponsor ]Subrecipient
Tenant -Based Rental Assistance (TBRA): TBRA is a rental subsidy
program similar to the Housing Choice Voucher program that grantees can
provide to help low-income households access affordable housing. The
TBRA voucher is not tied to a specific unit, so tenants may move to a
different unit without losing their assistance, subject to individual program
rules. The subsidy amount is determined in part based on household
income and rental costs associated with the tenant's lease.
Transgender: Transgender is defined as a person who identifies with, or
presents as, a gender that is different from his/her gender at birth.
Veteran: A veteran is someone who has served on active duty in the
Armed Forces of the United States. This does not include inactive military
reserves or the National Guard unless the person was called up to active
duty.
form HUD-40110-D (Expiration Date: 10/31/2014)
Housing Opportunities for Person with AIDS (HOPWA)
Consolidated Annual Performance and Evaluation Report (CAPER)
Measuring Performance Outputs and Outcomes
OMB Number 2506-0133 (Expiration Date: 10/31/2014)
Part 1: Grantee Executive Summary
As applicable, complete the charts below to provide more detailed information about the agencies and organizations responsible
for the administration and implementation of the HOPWA program. Chart 1 requests general Grantee Information and Chart 2 is
to be completed for each organization selected or designated as a project sponsor, as defined by CFR 574.3. In Chart 3, indicate
each subrecipient organization with a contract/agreement of $25,000 or greater that assists grantees or project sponsors carrying
out their administrative or evaluation activities. In Chart 4, indicate each subrecipient organization with a conti act/agreement to
provide HOPWA-funded services to client households. These elements address requirements in the Federal Funding and
Accountability and Transparency Act of 2006 (Public Law 109-282).
Note: Please see the definition section for distinctions between project sponsor and subrecipient.
Note: If any information does not apply to your organization, please enter N/A. Do not leave any section blank.
1. Grantee Information
HUD Grant Number
Grantee Name
Business Address
City, County, State, Zip
Employer Identification Number (EIN) or
Tax Identification Number (TIN)
DUN & Bradstreet Number (DUNs):
*Congressional District of Grantee's Business
Address
*Congressional District of Primary Service
Area(s)
*City(ies) and County(ies) of Primary Service
Area(s)
Organization s Website Address
Cities:
Operating Year for this report
From (min/dd5') To (mm/d y)
Central Contractor Registration (CCR):
Is the grantee's CCR status currently active?
❑ Yes ❑ No
If yes, provide CCR Number:
Counties:
Is there a waiting list(s) for HOPWA Housing Subs'dy Assistance
Services in the Grantee service Area9 El Yes ■ No
If yes, explain in the narrative section what services maintain a waiting
list and how this list is administered.
* Service delivery area information only needed for program activities being directly carried out by the grantee.
Previous editions are obsolete
Page 1
form HUD-40110-D (Expiration Date: 10/31/2014)
2. Project Sponsor Information
Please complete Chart 2 for each organization designated or selected to serve as a project sponsor, as defined by CFR 574.3.
Use this section to report on organizations involved in the direct delivery of services for client households These elements
address requirements in the Federal Financial Accountability and Transparency Act of 2006 (Public Law 109-282).
Note: Please see the definitions foi distinctions between project sponsor and subrecipient.
Note: If any information does not apply to your organization, please enter N/A.
Project Sponsor Agency Name
Name and Title of Contact at Project
Sponsor Agency
Email Address
Business Address
City, County, State, Zip,
Phone Number (with area code)
Employer Identification Number (EIN) or
Tax Identification Number (TIN)
DUN & Bradstreet Number (DUNS):
Congressional District of Project Sponsor's
Business Address
Congressional District(s) of Primary Service
Area(s)
City(ies) and County(ies) of Primary Service Cities:
Area(s)
Total HOPWA contract amount for this
Organization for the operating year
Organization's Website Address
Is the sponsor a nonprofit organization? ❑ Yes ■ No
Please check ifyes and a faith -based organization.
Please check ifyes and a grassroots organization.
■
Parent Company Name, if applicable
Fax Number (with area code)
Counties:
Does your organization maintain a waiting list? ■ Yes LJ No
If yes, explain in the narrative section how this list is administered.
1
Previous editions are obsolete Page 2 form HUD-40110-D (Expiration Date: 10/31/2014)
3. Administrative Subrecipient Information
Use Chart 3 to provide the following information for each subrecipient with a contract/agreement of $25,000 or greater that
assists project sponsors to carry out their administrative services but no services directly to client households Agreements
include: grants, subgrants, loans, awards, cooperative agreements, and other forms of financial assistance; and contracts,
subcontracts, purchase orders, task orders, and delivery orders. (Organizations listed may have contracts with project sponsors)
These elements address requirements in the Fedeial Funding and Accountability and Transparency Act of 2006 (Public Law 109-
282).
Note: Please see the definitions for distinctions between project sponsor and subrecipient.
Note: If any information does not apply to your organization, please enter N/A.
Subrecipient Name
Name and Title of Contact at Subrecipient
Email Address
Business Address
City, State, Zip, County
Phone Number (with area code)
Employer Identification Number (EIN) or
Tax Identification Number (TIN)
DUN & Bradstreet Number (DUNs):
North American Industry Classification
System (NA1CS) Code
Congressional District of Subrecipient's
Business Address
Congressional District of Primary Service
Area
City (ies) and County (ies) of Primary Service
Area(s)
Total HOPWA Subcontract Amount of this
Organization for the operating year
Parent Company Name, if applicable
Fax Number (include area code)
Cities: I Counties:
Previous editions are obsolete Page 3 form HUD-40110-D (Expiration Date: 10/31/2014)
4. Program Subrecipient Information
Complete the following information for each subrecipient organization providing HOPWA-funded services to client households.
These organizations would hold a contract/agreement with a project sponsor(s) to provide these services. For example, a
subrecipient organization may receive funds from a project sponsor to provide nutritional services for clients residing within a
HOPWA facility -based housing program. Please note that subrecipients who work directly with client households must provide
performance data for the grantee to include in Parts 2-7 of the CAPER.
Note: Please see the definition of a subrecipient for more information.
Note: Types of contracts/agreements may include: grants, sub -grants, loans, awards, cooperative agreements, and other forms
offinancial assistance; and contracts, subcontracts, purchase orders, task orders, and delivery orders.
Note: If any information is not applicable to the organization, please report N/A in the appropriate box. Do not leave boxes
blank.
Sub -recipient Name
Name and Title of Contact at Contractor/
Sub -contractor Agency
Email Address
Business Address
City, County, State, Zip
Phone Number (included area code)
Employer Identification Number (EIN) or
Tax Identification Number (TIN)
DUN & Bradstreet Number (DUNs)
North American Industry Classification
System (NAICS) Code
Congressional District of the Sub -recipient's
Business Address
Congressional District(s) of Primary Service
Area
City(ies) and County(ies) of Primary Service
Area
Total HOPWA Subcontract Amount of this
Organization for the operating year
Cities:
Parent Company Name, ifapplicable
Fax Number (include area code)
Counties:
Previous editions are obsolete Page 4 form HUD-40110-D (Expiration Date: 10/31/2014)
5. Grantee Narrative and Performance Assessment
a. Grantee and Community Overview
Provide a one to three page narrative summarizing major achievements and highlights that were proposed and completed during
the program year. Include a brief description of the grant oiganization, area of service, the name(s) of the program contact(s),
and an overview of the range/type of housing activities provided. This overview may be used for public information, including
posting on HUD's website. Note: Text fields are expandable.
b. Annual Performance under the Action Plan
Provide a narrative addressing each of the following four items.
1. Outputs Reported. Describe significant accomplishments or challenges in achieving the number of housing units supported
and the number households assisted with HOPWA funds during this operating year compared to plans for this assistance, as
approved in the Consolidated Plan/Action Plan. Describe how HOPWA funds were distributed during your program year among
different categories of housing and geographic areas to address needs throughout the grant service area, consistent with approved
plans.
2. Outcomes Assessed. Assess your program's success in enabling HOPWA beneficiaries to establish and/or better maintain a
stable living environment in housing that is safe, decent, and sanitary and improve access to care. Compare current year results
to baseline results for clients. Describe how program activities/projects contributed to meeting stated goals. If program did not
achieve expected targets, please describe how your program plans to address challenges in program implementation and the steps
currently being taken to achieve goals in next operating year If your program exceeded program targets, please describe
strategies the program utilized and how those contributed to pi ogram successes.
3. Coordination. Report on pi ogram coordination with other mainstream housing and supportive services resources, including
the use of committed leveraging from other public and private sources that helped to address needs for eligible persons identified
in the Consolidated Plan/Strategic Plan.
4. Technical Assistance. Describe any program technical assistance needs and how they would benefit program beneficiaries.
c. Barriers and Trends Overview
Provide a narrative addressing items 1 through 3. Explain how barriers and trends affected your program's ability to achieve the
objectives and outcomes discussed in the previous section
1. Describe any barriers (including regulatory and non -regulatory) encountered in the administration or implementation of
the HOPWA program, how they affected your program's ability to achieve the objectives and outcomes discussed, and,
actions taken in response to barriers, and recommendations for program improvement. Provide an explanation for each
L7 HOPWA/HUD Regulations ❑ Planning
❑ Discrimination/Confidentiality ❑ Multiple Diagnoses
barrier selected.
Previous editions are obsolete
❑ Housing Availability
Eligibility
❑ Rent Determination and Fair Market
Rents
Technical Assistance or Training
■
Page 5 form HUD-40110-D (Expiration Date: 10/31/2014)
■
Supportive Services
❑ Housing Affordability
❑ Credit History ■ Rental History
■
Geography/Rural Access 0 Other, please explain further
D Criminal Justice History
2. Describe any trends in the community that may affect the way in which the needs of persons living with HIV/AIDS
are being addressed, and provide any other information important to the future provision of services to this population.
3. Identify any evaluations, studies, or other assessments of the HOPWA program that are available to the public.
d. Unmet Housin:? Needs: An Assessment of Unmet Housing Needs
In Chart 1, provide an assessment of the number of HOPWA-eligible households that require HOPWA housing subsidy
assistance but are not currently served by any HOPWA-funded housing subsidy assistance in this service area.
In Row 1, report the total unmet need of the geographical service area, as reported in Unmet Needs for Persons with HIV/AIDS,
Chart 1B of the Consolidated or Annual Plan(s) 01 as reported under HOPWA woiksheet in the Needs Workbook of the
Consolidated Planning Management Process (CPMP) tool.
Note: Report most current data available, through Consolidated or Annual Plan(s), and account for Local housing issues, or
changes in HIV/AIDS cases, by using combination of one or more of the sources in Chart 2.
If data is collected on the type of housing that is needed in Rows a. through c., enter the number of HOPWA-eligible households
by type of housing subsidy assistance needed For an approximate breakdown of overall unmet need by type of housing subsidy
assistance refer to the Consolidated or Annual Plan (s), CPMP tool or local distribution of funds. Do not include clients who are
already receiving HOPWA-funded housing subsidy assistance.
Refer to Chart 2, and check all sources consulted to calculate unmet need. Reference any data from neighboring states' or
municipalities' Consolidated Plan or other planning efforts that informed the assessment of Unmet Need in your service area.
Note: In order to ensure that the unmet need assessment for the region is comprehensive, HOPWA formula grantees should
include those unmet needs assessed by HOP WA competitive grantees operating within the service area.
1. Planning Estimate of At ea's Unmet Needs for HOPWA-Eligible Households
1. Total number of households that have unmet
housing subsidy assistance need.
Previous editions are obsolete Page 6 form HUD-40110-D (Expiration Date: 10/31/2014)
2. From the total reported in Row 1, identify the
number of households with unmet housing needs
by type of housing subsidy assistance:
a. Tenant -Based Rental Assistance (TBRA)
b. Short -Term Rent, Mortgage and Utility payments
(STRMU)
• Assistance with rental costs
• Assistance with mortgage payments
• Assistance with utility costs.
c. Housing Facilities such as community residences,
SRO dwellings, other housing facilities
Previous editions are obsolete Page 7 form HUD-40110-D (Expiration Date: 10/31/2014)
2. Recommended Data Sources for Assessing Unmet Need (check all sources used)
= Data as reported in the area Consolidated Plan, e.g Table 1B, CPMP charts, and related narratives
= Data established by area HIV/AIDS housing planning and coordination efforts, e.g. Continuum of Care
= Data from client information provided in Homeless Management Information Systems (HMIS)
= Data from project sponsors or housing providers, including waiting lists for assistance or other assessments on need including those
completed by HOPWA competitive grantees operating in the region.
= Data from prisons or jails on persons being discharged with HIV/AIDS, if mandatory testing is conducted
= Data from local Ryan White Planning Councils or reported in CARE Act Data Reports, e.g. number of clients with permanent
housing
= Data collected for HIV/AIDS surveillance reporting or other health assessments, e.g. local health depaiturent or CDC surveillance data
End of PART 1
Previous editions are obsolete Page 8 form HUD-40110-D (Expiration Date: 10/31/2014)
PART 2: Sources of Leveraging and Program Income
1. Sources of Leveraging
Report the source(s) of cash or in -kind leveraged federal, state, local or private resources identified in the Consolidated or
Annual Plan and used in the delivery of the HOPWA program and the amount of leveraged dollars. In Column [1], identify the
type of leveraging. Some common sources of leveraged funds have been provided as a reference point. You may add Rows as
necessary to report all soui ces of leveraged funds. Include Resident Rent payments paid by clients directly to private landlords.
Do NOT include rents paid directly to a HOPWA program as this will be reported in the next section. In Column [2] report the
amount of leveraged funds expended duiing the operating year Use Column [3] to piovide some detail about the type of
leveraged contribution (e g., case management services or clothing donations) In Column [4], check the appropriate box to
indicate whether the leveraged contribution was a housing subsidy assistance or another form of support.
Note: Be sure to report on the number of households supported with these leveraged funds in Part 3, Chart 1, Column d.
A. Source of Leveraging Chart
[1] Source of Leveraging
Public Funding
Ryan White -Housing Assistance
Ryan White -Other
Housing Choice Voucher Program
Low Income Housing Tax Credit
HOME
Shelter Plus Care
Emergency Solutions Grant
Other Public:
Other Public:
Other Public:
Other Public:
Other Public:
Private Funding
Grants
In -kind Resources
Other Private:
Other Private:
Other Funding
Grantee/Project Sponsor/Subrecipient (Agency) Cash
Resident Rent Payments by Client to Private Landlord
TOTAL (Sum of all Rows)
[2] Amount
of Leveraged
Funds
[3] Type of
Contribution
[4] Housing Subsidy
Assistance or Other Support
❑Housing Subsidy Assistance
['Other Support
❑Housing Subsidy Assistance
Other Support
❑Housing Subsidy Assistance
❑Other Support
Housing Subsidy Assistance
❑Other Support
Housing Subsidy Assistance
❑Other Support
Housing Subsidy Assistance
Other Support
Housing Subsidy Assistance
(—]Other Support
['Housing Subsidy Assistance
['Other Support
❑Housing Subsidy Assistance
['Other Support
Housing Subsidy Assistance
❑ Other Support
❑Housing Subsidy Assistance
Other Support
Housing Subsidy Assistance
❑ Other Support
■
■
■
■
■
■
■
❑Housing Subsidy Assistance
❑ Other Support
['Housing Subsidy Assistance
❑Other Support
❑Housing Subsidy Assistance
❑Other Support
❑Housing Subsidy Assistance
❑Other Support
■
Housing Subsidy Assistance
❑Other Su, sort
Previous editions are obsolete Page 9 form HUD-40110-D (Expiration Date: 10/31/2014)
2. Program Income and Resident Rent Payments
In Section 2, Chart A., report the total amount of program income and resident rent payments directly generated from the use of
HOPWA funds, including repayments. Include resident rent payments collected or paid directly to the HOPWA program. Do
NOT include payments made directly from a client household to a private landlord.
Note: Please see report directions section for definition of program income. (Additional information on program income is
available in the HOPIVA Grantee Oversight Resource Guide).
A. Total Amount Program Income and Resident Rent Payment Collected During the Operating Year
Program Income and Resident Rent Payments Collected
1. Program income (e.g. repayments)
2. Resident Rent Payments made directly to HOPWA Program
3. Total Program Income and Resident Rent Payments (Sum of Rows 1 and 2)
Total Amount of
Program Income
(for this operating
year)
B. Program Income and Resident Rent Payments Expended To Assist HOPWA Households
In Chart B, report on the total program income and resident rent payments (as reported above in Chart A) expended during the
operating yeas . Use Row 1 to report Program Income and Resident Rent Payments expended on Housing Subsidy Assistance
Programs (i.e., TBRA STRMU, PHP Master Leased Units and Facility -Based Housing). Use Row 2 to report on the Program
Income and Resident Rent Payment expended on Supportive Services and other non -direct Housing Costs.
Program Income and Resident Rent Payment Expended on
HOPWA programs
I . Program Income and Resident Rent Payment Expended on Housing Subsidy Assistance costs
2. Program Income and Resident Rent Payment Expended on Supportive Services and other non -
direct housing costs
3. Total Program Income Expended (Sum of Rows 1 and 2)
End of PART 2
Total Amount of Program
Income Expended
(for this operating year)
Previous editions are obsolete Page 10 form HUD-40110-D (Expiration Date: 10/31/2014)
(PART 3: Accomplishment Data Planned Goal and Actual Outputs
In Chart 1, enter performance information (goals and actual outputs) for all activities undertaken during the operating year
supported with HOPWA funds. Peiformance is measured by the number of households and units of housing that were supported
with HOPWA or other federal, state local, or private funds for the purposes of providing housing assistance and support to
persons living with HIV/AIDS and their families.
Note: The total households assisted with HOPWA funds and reported in PART 3 of the CAPER should be the same as reported
in the annual year-end IDIS data, and goals reported should be consistent with the Annual Plan information. Any discrepancies
or deviations should be explained in the narrative section of PART 1.
1. 3OPWA Performance Planned Goal and Actual Outputs
HOPWA Performance
Planned Goal
and Actual
HOPWA Housing Subsidy Assistance I
I. Tenant -Based Rental Assistance
2a. Permanent Housing Facilities:
Received Operating Subsidies/Leased units (Households Served)
2b. ransitional/Short-term Facilities:
eceived Operating Subsidies/Leased units (Households Served)
Households Served)
a. }Permanent Housing Facilities:
apital Development Projects placed in service during the operating year
Households Served)
TransitionaUShort-term Facilities:
Capital Development Projects placed in service during the operating year
(Households Served)
Short -Term Rent, Mortgage and Utility Assistance
Permanent Housing Placement Services
Adjustments for duplication (subtract)
Total HOPWA Housing Subsidy Assistance
(Columns a. — d. equal the sum of Rows 1-5 minus Row 6; Columns e. and f. equal
the sum of Rows 1-5)
Housing Development (Construction and Stewardship of facility based housing)
8. Facility -based units;
Capital Development Projects not yet opened (Housing Units)
19. Stewardship Units subject to 3 or 10 year use agreements
10. Total Housing Developed
(Sum of Rows 78 & 9)
fupportive Services
l la Supportive Services provided by project sponsors/subrecipient
HOPWA housing subsidy assistance
1 lb Supportive Services provided by project sponsors/subrecipient
supportive services.
12. Adjustment for duplication (subtract)
13. rTotal Supportive Services
Columns a. — d. equal the sum of Rows 11 a. & b. minus Row 12; Columns e. and f.
qual the sum of Rows lia. & 11b.)
Housing Information Services
14. Housing Information Services
15. Total Housing Information Services
Previous editions are obsolete
that also delivered
that only provided
Page 11
[1] Output: Households
HOPWA I Leveraged
Assistance Households
0
b. c. d.
0
0
[2] Output: Funding
HOPWA Funds
f.
11 Output: Households 121 Output: Funding
Ill Output: Housing Units
111 Output Households J21 Output: Funding
11] Output Households 12] Output: Funding
form HUD-40110-D (Expiration Date: 10/31/2014)
Grant Administration and Other Activities
16. Resource Identification to establish, coordinate and develop housing assistance resources
17. Technical Assistance
(if approved in grant agreement)
18. Grantee Administration
(maximum 3% of total HOPWA grant)
19. Project Sponsor Administration
(maximum 7% of portion of HOPWA grant awarded)
[20. Total Grant Administration and Other Activities
(Sum of Rows 16— 19)
Total Expended
121. Total Expenditures for program year (Sum of Rows 7, 10, 13, 15, and 20)
2. Listing of Supportive Services
Report on the households served and use of HOPWA
leveraged with non-HOPWA funds.
Data check: Total unduplicated households and expenditw
Supportive Services
1. Adult day care and personal assistance
2. Alcohol and drug abuse services
3. Case management
Child care and other child services
Education
Employment assistance and training
Health/medical/intensive care services, if approved
Note: Client records must conform with 24 CFR §574.310
Legal services
9. Life skills management (outside of case management)
10. Meals/nutritional services
11. Mental health services
12. Outreach
13. Transportation
11] Output Households
12] Output: Funding
[2] Outputs: HOPWA Funds
Expended
Budget Actual
funds for all supportive services. Do NOT report on supportive services
vs reported in Row 17 equal totals reported in Part 3, Chart 1, Row 13.
[1] Output: Number of Households
Other Activity (if approved in grant agreement).
14. Specify:
Sub -Total Households receiving Supportive Services
15. (Sum of Rows 1-14)
16. Adjustment for Duplication (subtract)
TOTAL Unduplicated Households receiving
Supportive Services (Column [1] equals Row 15
17. minus Row 16; Column [2] equals sum of Rows 1-14)
Previous editions are obsolete
Page 12
[2] Output: Amount of HOPWA Funds
Expended
form HUD-40110-D (Expiration Date: 10/31/2014)
3. Short -Term Rent, Mortgage and Utihty Assistance (STRMU) Summary
In Row a., enter the total number of households served and the amount of HOPWA funds expended on Short -Term Rent,
Mortgage and Utility (STRMU) Assistance. In Row b., enter the total number of STRMU-assisted households that received
assistance with mortgage costs only (no utility costs) and the amount expended assisting these households. In Row c., enter the
total number of STRMU-assisted households that received assistance with both mortgage and utility costs and the amount
expended assisting these households. In Row d., enter the total number of STRMU-assisted households that received assistance
with rental costs only (no utility costs) and the amount expended assisting these households In Row e , enter the total number of
STRMU-assisted households that received assistance with both rental and utility costs and the amount expended assisting these
households. In Row f., enter the total number of STRMU-assisted households that received assistance with utility costs only (not
including rent or mortgage costs) and the amount expended assisting these households. In i ow g., report the amount of STRMU
funds expended to support direct program costs such as program operation staff.
Data Check: The total households reported as served with STRAW in Row a., column DJ and the total amount of HOPWA fends reported as
expended in Row a., column [2] equals the household and expenditure total reported for STRA'IU in Part 3, Chart 1, Row 4, Colunms b. and f.,
respectively.
Data Check: The total number of households reported in Cohwm [If Rows b., c., d., e., and f. equal the total number of STRAW households
reported in Column [I 1, Row a. The total amount reported as expended in Column [2J, Rows b., c., d., e., f, and g. equal the total amount of
STRAW expenditures reported in Cohunn [2], Row a.
Housing Subsidy Assistance Categories (STRMU)
Total Short-term mortgage, rent and/or utility (STRMU)
assistance
Of the total STRMU reported on Row a total who received
b• assistance with mortgage costs ONLY.
c
e
f
g
Of the total STRMU reported on Row a-. total who received
assistance with mortgage and utility costs.
Of the total STRMU reported on Row a. total who received
assistance with rental costs ONLY.
Of the total STRMU reported on Row a, total who received
assistance with rental and utility costs.
Of the total STRMU reported on Row a total who received
assistance with utility costs ONLY.
Direct program delivery costs (e.g., program operations staff
time)
[1] Output: Number of
Households Served
End of PART 3
Previous editions are obsolete Page 13
[2] Output Total
HOPWA Funds Expended
on STRMU during
Operating Year
form HUD-40110-D (Expiration Date: 10/31/2014)
Part 4: Summary of Performance Outcomes
In Column [1], report the total number of eligible households that received HOPWA housing subsidy assistance, by type.
In Column [2], enter the number of households that continued to access each type of housing subsidy assistance into next
operating yea . In Column [3], report the housing status of all households that exited the program.
Data Check: The sum of Columns [2] (Number of Households Continuing) and [3] (Exited Households) equals the total reported in Cohunn[I].
Note: Refer to the housing stability codes that appear in Part 5 • Worksheet - Determining Housing Stability Outcomes.
Section 1. Housing Stability: Assessment of Client Outcomes on Maintaining Housing Stability (Permanent Housing and
Related Facilities)
A. Permanent 'lousing Subsidy Assistance
Tenant -Based
Rental
Assistance
Permanent
Supportive
Housing
Facilities/ Units
B. Transitiona
Transitional/
Short -Term
Housing
Facilities/ Units
[1] Output: Total
Number of
Households
Served
Housing Assistance
[1] Output: Total
Number of
Households
Served
Previous editions are obsolete
[2] Assessment: Number of
Households that Continued
Receiving HOPWA Housing
Subsidy Assistance into the Next
Operating Year
[2] Assessment: Number of
Households that Continued
Receiving HOPWA Housing
Subsidy Assistance into the Next
Operating Year
Page 14
[3] Assessment: Number of
Households that exited this
HOPWA Program; their Housing
Status after Exiting
1 Emergency Shelter/Streets
2 Temporary Housing
3 Private Housing
4 Other HOPWA
5 Other Subsidy
6 Institution
7 Jail/Prison
8 Disconnected/Unknown
9 Death
1 Emergency Shelter/Streets
2 Temporary Housing
3 Private Housing
4 Other HOPWA
5 Other Subsidy
6 Institution
7 Jail/Prison
8 Discomiected/Unknown
9 Death
[3] Assessment: Number of
Households that exited this
HOPWA Program; their
Housing Status after Exiting
1 Emergency Shelter/Streets
2 Temporary Housing
3 Private Housing
4 Other HOPWA
5 Other Subsidy
6 Institution
7 Jail/Prison
8 Disconnected/unknown
9 Death
[4] HOPWA Client
Outcomes
Unstable Arrangements
angements
Temporarily Stable, with Reduced
Risk of Homelessness
Stable/Permanent Housing (PH)
Unstable Arrangements
Life Event
Unstable Arrangements
Temporarily Stable, with Reduced
Risk of Homelessness
Stable/Permanent Housing (PH)
Unstable Arrangements
Life Event
[4] HOPWA Client Outcomes
Unstable Arrangements
Temporarily Stable with Reduced
Risk of Homelessness
Stable/Permanent Housing (PH)
Unstable Arrangements
Life Event
form HUD-40110-D (Expiration Date: 10/31/2014)
B 1 :Total number of households receiving transitional/short-term housing
assistance whose tenure exceeded 24 months
Section 2. Prevention of Homelessness: Assessment of Client Outcomes on Reduced Risks of Homelessness
(Short -Term Housing Subsidy Assistance)
Report the total number of households that received STRMU assistance in Column [1].
In Column [2], identify the outcomes of the households reported in Column [1] either at the time that they were known to have
left the STRMU program or through the project sponsor or subrecipient's best assessment fot stability at the end of the operating
year.
Information in Column [3] provides a description of housing outcomes; therefore, data is not required.
At the bottom of the chart:
• In Row la., report those households that received STRMU assistance during the operating year of this report, and the
prior operating year.
• In Row lb. report those households that received STRMU assistance during the operating year of this report, and the
two prior operating years.
Data Check: The total households reported as served with STRMU in Column [1] equals the total reported in Part 3, Chart 1,
Row 4, Coltnnn b.
Data Check: The sum of Column [2] should equal the number of households reported in Coltnnn [I].
Assessment of Households that Received STRMU Assistance
[1] Output: Total
number of
households
[2] Assessment of Housing Status [3] HOPWA Client Outcomes
Maintain Private Housing without subsidy
(e.g. Assistance provided/completed and client is stable, not
likely to seek additional support)
Other Private Housing without subsidy
(e.g. client switched housing units and is now stable, not likely
to seek additional support)
Other HOPWA Housing Subsidy Assistance
Other Housing Subsidy (PH)
Institution
(e.g. residential and long-term care)
Likely that additional STRMU is needed to maintain current
housing arrangements
Transitional Facilities/Short-term
(e.g. temporary or transitional arrangement)
Temporary/Non-Permanent Housing arrangement
(e.g. gave up lease, and moved in with family or friends but
expects to live there less than 90 days)
Emergency Shelter/street
Jail/Prison
Disconnected
Death
Stable/Permanent Housing (PH)
Temporarily Stable, with
Reduced Risk of Homelessness
Unstable Arrangements
l a. Total number of those households that received STRMIJ Assistance in the operating year of this report that also received
STRMU assistance in the prior operating year (e.g. households that received STRMU assistance in two consecutive operating
years).
1 b. Total number of those households that received STRMU Assistance in the operating year of this report that also received
STRMU assistance in the two prior operating years (e.g. households that received STRMU assistance in three consecutive
operating years).
Previous editions are obsolete
Life Event
Page 15 form HUD-40110-D (Expiration Date: 10/31/2014)
Section 3. HOPWA Outcomes on Access to Care and Support
la. Total Number of Households
Line [1]: For project sponsors/subrecipients that provided HOPWA housing subsidy assistance during the operating year
idenffy in the appropriate row the number of households that received HOPWA housing subsidy assistance (TBRA,
STRMU, Facility -Based, PHP and Master Leasing) and HOPWA funded case management services. Use Row c. to adjust
for duplication among the service categories and Row d. to provide an unduplicated household total.
Line [2]: For project sponsors/subrecipients that did NOT provide HOPWA housing subsidy assistance identify in the
appropi iate row the number of households that received HOPWA funded case management services.
Note: These numbers will help you to determine which clients to report Access to Care and Support Outcomes for and will be
used by HUD as a basis for analyzing the per tentage of households who demonstrated or maintained connections to care and
support as identified in Chart lb. below.
Total Number of Households
1. For Project Sponsors/Subrecipients that provided HOPWA Housing Subsidy Assistance: Identify the total number of households that
received the following HOPWA-funded services:
a. Housing Subsidy Assistance (duplicated)-TBRA, STRMU, PHP, Facility -Based Housing, and Master Leasing
b. Case Management
c. Adjustment for duplication (subtraction)
d. Total Households Served by Project Sponsors/Subrecipients with Housing Subsidy Assistance (Sum of Rows a.b.
minus Row c.)
2. For Project Sponsors/Subrecipients did NOT provide HOPWA Housing Subsidy Assistance: Identify the total number of households that
received the following HOPWA-funded service:
a. HOPWA Case Management
b. Total Households Served by Project Sponsors/Subrecipients without Housing Subsidy Assistance
lb. Status of Households Accessing Care and Support
Column [1]: Of the households identified as receiving services from project sponsors/subrecipients that provided HOPWA
housing subsidy assistance as identified in Chart 1 a., Row ld. above, report the number of households that demonstrated
access or maintained connections to care and support within the program year.
Column [2]: Of the households identified as receiving services from project sponsors/subrecipients that did NOT provide
HOPWA housing subsidy assistance as reported in Chart 1 a., Row 2b., report the number of households that demonstrated
improved access or maintained connections to care and support within the program year.
Note: For information on types and sources of income and medical insurance/assistance, refer to Charts below.
[2] For project
sponsors/subrecipients that
did NOT provide HOPWA Outcome
housing subsidy assistance, Indicator
identify the households who
demonstrated the following:
Categories of Services Accessed
1. Has a housing plan for maintaining or establishing stable on-
going housing
2. Had contact with case manager/benefits counselor consistent
with the schedule specified in client's individual service plan
(may include leveraged services such as Ryan White Medical
Case Management)
3. Had contact with a primary health care provider consistent
with the schedule specified in client's individual service plan
4. Accessed and maintained medical insurance/assistance
5. Successfully accessed or maintained qualification for sources
of income
Previous editions are obsolete
[1] For project
sponsors/subrecipients that
provided HOPWA housing subsidy
assistance, identify the households
who demonstrated the following:
Page 16
Support for
Stable
Housing
Access to
Support
Access to
Health Care
Access to
Health Care
Sources of
Income
form HUD-40110-D (Expiration Date: 10/31/2014)
Chart lb., Line 4: Sources of Medical Insurance and Assistance include, but are not limited to the following
Reference only)
• MEDICAID Health Insurance Program, or
use local program
name
• MEDICARE Health Insurance Program, or
use local program name
Chart lb., Row 5: Sources of
• Eamed Income
• Veteran's Pension
• Unemployment Insurance
• Pension from Former Job
• Supplemental Security Income (SSI)
• Veterans Affairs Medical Services
• AIDS Drug Assistance Program (ADAP)
• State Children's Health Insurance Program
(SCRIP), or use local program name
Income include, but are not limited to the
• Child Support
• Social Security Disability Income (SSDI)
• Alimony or other Spousal Support
• Veteran's Disability Payment
• Retirement Income from Social Security
• Worker's Compensation
• Ryan White -funded Medical or Dental
Assistance
following (Reference only)
• General Assistance (GA), or Ise local
program name
• Private Disability Insurance
• Temporary Assistance for Needy
Families (TANF)
• Other Income Sources
le. Households that Obtained Employment
Column [1]: Of the households identified as receiving services from project sponsors/subrecipients that provided HOPWA
housing subsidy assistance as identified in Chart 1 a., Row Id. above, repot t on the number of households that include
persons who obtained an income -producing job during the operating year that resulted from HOPWA-funded Job training,
employment assistance, education or related case management/counseling services
Column [2]: Of the households identified as receiving services from project sponsors/subrecipients that did NOT provide
HOPWA housing subsidy assistance as reported in Chart l a., Row 2b., report on the number of households that include
persons who obtained an income -producing job during the operating year that resulted from HOPWA-funded Job training,
employment assistance, education or case management/counseling services.
Note: Thu includes jobs created by this project sponsor/subrecipients or obtained outside this agency.
Note: Do not include jobs that resulted from leveraged job training, employment assistance, education or case
management/counseling services.
Categories of Services Accessed
Total number of households that
obtained an income -producing lob
Previous editions are obsolete
[1 For project sponsors/subrecipients that
provided HOPWA housing subsidy
assistance, identify the households who
demonstrated the following:
End of PART 4
Page 17
[2] For project sponsors/subrecipients that did
NOT provide HOPWA housing subsidy assistance,
identify the households who demonstrated the
following:
form HUD-40110-D (Expiration Date: 10/31/2014)
PART 5: Worksheet - Determining Housing Stability Outcomes (optional)
1. This chart is designed to assess program
overall program pe•formance. Completion
Permanent Stable Housing
Housing Subsidy (# of households
Assistance remaining in program
plus 3+4+5+6)
Tenant -Based
Rental Assistance
(TBRA)
Permanent Facility -
based Housing
Assistance/Units
Transitional/Short-
Term Facility -based
Housing
Assistance/Units
Total Permanent
HOPWA Housing
Subsidy Assistance
Reduced Risk of Stable/Permanent
Homelessness: Housing
Short -Term
Assistance
Short -Term Rent,
Mortgage, and
Utility Assistance
(STRMU)
Total HOPWA
Housing Subsidy
Assistance
results based on the information reported in Part 4 and to help Grantees determine
of this worksheet is optional.
Temporary Housing Unstable Life Event
(2) Arrangements (9)
(1+7+8)
rat Temporarily Stable, with Reduced Risk of
Homelessness
Unstable Life Events
Arrangements
Background on HOPWA Housing Stability Codes
Stable Permanent Housing/Ongoing Participation
3 = Private Housing in the private rental or home ownership market (without known subsidy, including permanent placement
with families or other self-sufficient arrangements) with seasonable expectation that additional support is not needed.
4 = Other HOPWA-funded housing subsidy assistance (not STRMU), e.g. TBRA or Facility -Based Assistance.
5 = Other subsidized house or apartment (non-HOPWA sources, e.g., Section 8, HOME, public housing).
6 = Institutional setting with greater support and continued residence expected (e.g., residential or long-term care facility).
Temporary Housing
2 = Temporary housing - moved in with family/friends or other short-term arrangement, such as Ryan White subsidy, ti ansitional
housing for homeless, or temporary placement in institution (e.g. hospital, psychiatric hospital or other psychiatric facility,
substance abuse treatment facility or detox center).
Unstable Arrangements
1 = Emergency shelter or no housing destination such as places not meant for habitation (e.g., a vehicle, an abandoned building,
bus/train/subway station, or anywhere outside).
7 = Jail /prison.
8 = Disconnected or disappeared from project support, unknown destination or no assessments of housing needs were
undertaken.
Life Event
9 = Death, i.e., remained in housing until death. This characteristic is not factored into the housing stability equation.
Tenant -based Rental Assistance: Stable Housing is the sum of the number of households that (i) remain in the housing and (ii)
those that left the assistance as reported under: 3, 4, 5, and 6. Temnorary Housing is the number of households that accessed
assistance, and left their current housing for a non -permanent housing arrangement, as reported under item: 2. Unstable
Situations is the sum of numbers reported under items: 1, 7, and 8.
Previous editions are obsolete
Page 18 form HUD-40110-D (Expiration Date: 10/31/2014)
Permanent Facility -Based Housing Assistance: Stable Housing is the sum of the number of households that (i) remain in the
housing and (ii) those that left the assistance as shown as items 3, 4, 5, and 6. Temporary Housing is the number of households
that accessed assistance, and left their current housing for a non -permanent housing arrangement, as reported under item 2
Unstable Situations is the sum of numbers reported under items: 1, 7, and 8.
Transitional/Short-Term Facility -Based Housing Assistance: Stable Housing is the sum of the number of households that (r)
continue in the residences (ii) those that left the assistance as shown as items: 3, 4, 5, and 6. Other Temporary Housing is the
number of households that accessed assistance, and left their current housing for a non -permanent housing arrangement, as
reported under item 2. Unstable Situations is the sum of numbers reported under items: 1, 7, and 8.
Tenure Assessment. A baseline of households in transitional/short-term facilities for assessment purposes, indicate the number
of households whose tenure exceeded 24 months.
STRMU Assistance: Stable Housing is the sum of the number of households that accessed assistance for some portion of the
permitted 21-week period and there is reasonable expectation that additional support is not needed in or der to maintain
permanent housing living situation (as this is a time -limited form of housing support) as reported under housing status: Maintain
Private Housing with subsidy; Other Private with Subsidy; Other HOPWA support; Other Housing Subsidy; and Institution.
Temporarily Stable. with Reduced Risk of Homelessness is the sum of the number of households that accessed assistance for
some portion of the permitted 21-week period or left their current housing arrangement for a ttansittonal facility or other
temporary/non-permanent housing arrangement and there is reasonable expectation additional support will be needed to maintain
housing arrangements in the next year, as reported under housing status: Likely to maintain current housing arrangements, with
additional STRMU assistance; Transitional Facilities/Short-term; and Temporary/Non-Permanent Housing arrangements
Unstable Situation is the sum of number of households reported under housing status: Emergency Shelter; Jail/Prison; and
Disconnected.
Previous editions are obsolete
End of PART 5
Page 19 form HTJD-40110-D (Expiration Date: 10/31/2014)
(PART 6: Annual Certification of Continued Usage for HOPWA Facility -Based Stewardship Units (ONLY)
The Annual Certification of Usage for HOPWA Facility -Based Stewardship Units is to be used in place of Part 7B of the
CAPER if the facility was originally acquired, rehabilitated or constructed/developed in part with HOPWA funds but no
HOPWA funds were expended during the operating year. Scattered site units may be grouped together on one page.
Grantees that used HOPWA funding for new construction, acquisition, or substantial rehabilitation are required to
operate their facilities for HOPWA eligible individuals for at least ten (10) years. If non -substantial rehabilitation funds
were used they ale required to operate fot at least three (3) years. Stewardship begins once the facility is put into
operation
Note: See definition of Stewardshin Units.
1. General information
HUD Grant Number(s)
Grantee Name
2. Number of Units and Non-HOPWA Expenditures
Facility Name:
Total Stewardship Units
(subject to 3- or 10- year use periods)
3. Details of Project Site
Project Sites: Name of HOPWA-funded project
Site Information. Project Zip Code(s)
Site Information: Congressional District(s)
Is the address of the project site confidential?
If the site is not confidential:
Please provide the contact information, phone,
email address/location, if business address is
different from facility address
Number of Stewardship Units
Developed with HOPWA
funds
Operating Year for this report
From (nun/dd/J9) To (nmr/dciyi) ■ Final Yr
■
■
Yr 1; ■ Yr 2 ❑ Yr 3; ❑ Yr 4; ❑ Yr 5; ❑ Yr 6;
Yr 7 ❑ Yr 8; ❑ Yr 9; ❑ Yr 10;
Date Facility Began Operations (0 mr/dd/jry)
Amount of Non-HOPWA Funds Expended in Support of the
Stewardship Units during the Operating Year
❑ Yes, protect information; do not list
❑ Not confidential; information can be made available to the public
I certify that the facility that received assistance for acquisition, rehabihtation, or new construction from the Housing Opportunities
for Persons with AIDS Program has operated as a facility to assist HOPWA-eligible persons from the date shown above. I also
certify that the grant is still serving the planned number of HOPWA-eligible households at this facility through leveraged resources
and all other requirements of the grant agreement are being satisfied.
I hereby certify that all the information stated herein, as well as any info, »ration provided in the accompaniment herewith, is true and accurate.
Name & Title of Authorized Official of the organization that continues Signature & Date (mm/dd/yy)
to operate the facility:
Name & Title of Contact at Grantee Agency Contact Phone (with area code)
(person who can answer questions about the report and program)
End of PART 6
Previous editions are obsolete Page 20 form HUD-40110-D (Expiration Date: 10/31/2014)
1
Part 7: Summary Overview of Grant Activities
A. Information on Individuals Beneficiaries and Households Receiving HOPWA Housing Subsidy Assistance
(TBRA, STRIMIU, Facility -Based Units, Permanent Housing Placement and Master Leased Units ONLY)
Note: Reporting for this section should include ONLY those individuals, beneficiaries, of households that received and/or
resided in a household that received HOP WA Housing Subsidy Assistance as reported in Part 3, Chart 1, Row 7, Column b.
(e.g., do not include households that received HOPJVA supportive services ONLY).
Section 1. HOPWA-Eligible Individuals who Received HOPWA Housing Subsidy Assistance
a. Total HOPWA Eligible Individuals Living with HIV/AIDS
In Chart a., provide the total number of eligible (and unduplicated) low-income individuals living with HIV/AIDS who qualified
their household to receive HOPWA housing subsidy assistance during the operating year. This total should include only the
individual who qualified the household for HOPWA assistance, NOT all HIV positive individuals in the household.
Individuals Served with Housing Subsidy Assistance
Number of individuals with HIV/AIDS who qualified their household to receive HOPWA housing subsidy assistance.
Total
Chart b. Prior Living Situation
In Chart b., report the prior living situations for all Eligible Individuals reported in Chart a. In Row 1, report the total number of
individuals who continued to receive HOPWA housing subsidy assistance from the prior opeiating year into this operating year.
In Rows 2 through 17, indicate the prior living arrangements for all new HOPWA housing subsidy assistance recipients during
the operating year.
Data Check: The total number of eligible individuals served in Row 18 equals the total number of individuals served through
housing subsidy assistance reported in Chart a. above.
Category
1. Continuing to receive HOPWA support from the prior operating year
New Individuals who received HOPWA Housing Subsidy Assistance support during Operating Year
2 Place not meant for human habitation
(such as a vehicle, abandoned building, bus/train/subway station/airport, or outside)
3. Emergency shelter (including hotel, motel, or campground paid for with emergency shelter voucher)
4. Transitional housing for homeless persons
5.
6.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
Total number of new Eligible Individuals who received HOPWA Housing Subsidy Assistance with a Prior
Living Situation that meets HUD definition of homelessness (Sum of Rows 2 — 4)
Permanent housing for formerly homeless persons (such as Shelter Plus Care, SHP, or SRO Mod
Rehab)
Psychiatric hospital or other psychiatric facility
Substance abuse treatment facility or detox center
Hospital (non -psychiatric facility)
Foster care home or foster care group home
Jail, prison or juvenile detention facility
Rented room, apattiuent, or house
House you own
Staying or living in someone else's (family and friends) room, apartment, or house
Hotel or motel paid for without emergency shelter voucher
Other
Don't Know or Refused
TOTAL Number of HOPWA Eligible Individuals (sum of Rows 1 and 5-17)
Total HOPWA
Eligible Individuals
Receiving Housing
Subsidy Assistance
Previous editions are obsolete Page 21 form HUD-40110-D (Expiration Date: 10/31/2014)
c. Homeless Individual Summary
In Chart c., indicate the number of eligible individuals reported in Chart b., Row 5 as homeless who also are homeless Veterans
and/or meet the definition for Chronically Homeless (See Definition section of CAPER). The totals in Chart c. do not need to
equal the total in Chart b., Row 5.
Category
HOPWA eligible individuals served with
HOPWA Housing Subsidy Assistance
Number of
Homeless
Veteran(s)
Number of Chronically
Homeless
Section 2. Beneficiaries
In Chart a., report the total number of HOPWA eligible individuals living with HIV/AIDS who received HOPWA housing
subsidy assistance (as reported in Part 7A, Section 1, Chat t a.), and all associated members of their household who benefitted
from receiving HOPWA housing subsidy assistance (resided with HOPWA eligible individuals).
Note: See definition of HOPWA Eligible Individual
Note: See definition of Transgender.
Note: See definition of Beneficiaries.
Data Check: The sum of each of the Charts b. & c. on the following two pages equals the total number of beneficiaries served
with HOP EVA housing subsidy assistance as determined in Chart a., Row 4 below.
a. Total Number of Beneficiaries Served with HOPWA Housing Subsidy Assistance
Individuals and Families Served with HOPWA Housing Subsidy Assistance
1. Number of individuals with HIV/AIDS who qualified the household to receive HOPWA housing subsidy
assistance (equals the number of HOPWA Eligible Individuals reported in Part 7A, Section 1 Chart a.)
2. Number of ALL other persons diagnosed as HIV positive who reside with the HOPWA eligible individuals
identified in Row 1 and who benefitted from the HOPWA housing subsidy assistance
3 Number of ALL other persons NOT diagnosed as HIV positive who reside with the HOPWA eligible
individual identified in Row 1 and who benefited from the HOPWA housing subsidy
4. TOTAL number of ALL beneficiaries served with Housing Subsidy Assistance (Sum of Rows 1,2, & 3)
Total Number
Previous editions are obsolete Page 22 form HUD-40110-D (Expiration Date: 10/31/2014)
b. Age and Gender
In Chart b. indicate the Age and Gender of all beneficiaries as reported in Chart
all HOPWA Eligible Individuals (those reported in Chart a., Row 1) using Rows
beneficiaries (those reported in Chart a., Rows 2 and 3) using Rows 6-10 below.
Column E. equals the total number of beneficiaries reported in Part 7, Section 2,
Under 18
18 to 30 years
31 to 50 years
51 years and
Older
Subtotal (Sum
5. of Rows 1-4)
6. Under 18
7. 18 to 30 years
8. 31 to 50 years
51 years and
9. Older
Subtotal (Sum
10. of Rows 6-9)
11.
TOTAL (Sum
of Rows 5 & 10)
Previous editions are obsolete
A.
a. directly above. Report the Age and Gender of
1-5 below and the Age and Gender of all other
The number of individuals reported in Row 11,
Chart a., Row 4.
HOPWA Eligible Individuals (Chart a, Row 1)
B. C.
Male Female
A.
Transgender NI to F
D.
Transgender F to M
All Other Beneficiaries (Chart a, Rows 2 and 3)
B.
Male Female
C.
Transgender M to F
Total Beneficiaries (Chart a, Row 4)
Page 23
E.
TOTAL (Sum of
Columns A-D)
D. E.
TOTAL (Sum of
Transgender F to M Columns A-D)
form HUD-40110-D (Expiration Date: 10/31/2014)
c. Race and Ethnicity*
In Chart c., indicate the Race and Ethnicity of all beneficiaries receiving HOPWA Housing Subsidy Assistance as reported in
Section 2, Chart a., Row 4. Report the race of all HOPWA eligible individuals in Column [A] Report the ethnicity of all
HOPWA eligible individuals in column [B]. Report the race of all other individuals who benefitted from the HOPWA housing
subsidy assistance in column [C]. Repo -t the ethnicity of all other individuals who benefitted from the HOPWA housing subsidy
assistance in column [D]. The summed total of columns [A] and [C] equals the total number of beneficiaries reported above in
Section 2, Chart a., Row 4.
Category
1. American Indian/Alaskan Native
2. Asian
3. Black/African American
4. Native Hawaiian/Other Pacific Islander
5. White
10.
American Indian/Alaskan Native & White
Asian & White
Black/African American & White
American Indian/Alaskan Native &
Black/African American
Other Multi -Racial
HOPWA Eligible Individuals
[A] Race
[all individuals
reported in
Section 2, Chart
a., Row 1]
[B] Ethnicity
[Also identified as
Hispanic or
Latino]
All Other Beneficiaries
[C] Race
[total of
individuals
reported in
Section 2, Chart
a., Rows 2 & 3]
[D] Ethnicity
[Also identified as
Hispanic or
Latino]
11. Column Totals (Sum of Rows 1-10)
Data Check: Sinn of Row 11 Column A and Row 11 Column C equals the total number HOP WA Beneficiaries reported in Pat t 3A, Section 2,
Chart a., Row 4.
*Reference (data requested consistent with Form HUD-27061 Race and Ethnic Data Reporting Form)
Section 3. Households
Household Area Median Income
Report the area median income(s) for all households served with HOPWA housing subsidy assistance.
Data Check: The total number of households served with HOPWA housing subsidy assistance should equal Part 3C, Row 7,
Column b and Part 7A, Section I, Chart a. (Total HOPWA Eligible Individuals Served with HOPWA Housing Subsidy
Assistance).
Note: Refer to http://ivww.huduser.org/aortal/datasets/il/i12010/select Geog raohv_ntf.odn for information on area median
income in your community.
Percentage of Area Median Income
I. 0-30% of area median income (extremely low)
2. 31-S0% of area median income (very low)
3. 51-80% of area median income (low)
4.
Total (Sum of Rows 1-3)
Previous editions are obsolete Page 24
Households Served with HOPWA Housing Subsidy
Assistance
form HUD-40110-D (Expiration Date: 10/31/2014)
e.
f.
g
Part 7: Summary Overview of Grant Activities
B. Facility -Based Housing Assistance
Complete one Part 7B for each facility developed or supported through HOPWA funds.
Do not complete this Section for Programs orieinally developed with HOPWA funds but no lone er sunnorted with
HOPWA funds. If a facility was developed with HOPWA funds (subject to ten years of operation for acquisition, new
construction and substantial rehabilitation costs of stewardship units, or three years for non -substantial rehabilitation costs), but
HOPWA funds are no longer used to support the facility, the project sponsor or subiecipient should complete Part 6: Annual
Certification of Continued Usage for HOPWA Facility -Based Stewardship Units (ONLY).
Complete Charts 2a., Project Site Information, and 2b., Type of HOPWA Capital Development Project Units, for all
Development Projects, including facilities that were past development projects, but continued to receive HOPWA operating
dollars this reporting year.
1. Project Sponsor/Subrecipient Agency Name (Required)
2. Capital Development
2a. Project Site Information for HOPWA Capital Development of Projects (For Current or Past Capital
Development Projects that receive HOPWA Operating Costs this reporting year)
Note: If units are scattered -sites, report on them as a group and under type of Facility rvr ire "Scattered Sites."
HOPWA Name of Facility:
Funds
Expended
this operating
year
(if applicable)
$
Type of
Development
this operating
year
❑ New construction
❑ Rehabilitation
Acquisition
Operating
■
a. Purchase/lease of property.
Rehabilitation/Construction Dates:
c. Operation dates:
Date supportive services began:
Number of units in the facility:
Is a waiting List maintained for the facility?
What is the address of the facility (if different from business address)?
Is the address of the project site confidential?
Non-HOPWA funds
Expended
(if applicable)
$
s
Previous editions are obsolete
Page 25
Type of Facility [Check only one box.]
❑ Permanent housing
❑ Short-term Shelter or Transitional housing
❑ Supportive services only facility
Date (mm/ddlyy):
Date started: Date Completed:
Date residents began to occupy:
❑ Not yet occupied
Date started:
❑ Not yet providing services
HOPWA-funded units = Total Units
❑ Yes ❑ No
Ifyes, numbe • ofparticipants on the list at the end of operating year
■
Yes, protect information; do not publish list
No, can be made available to the public
form HUD-40110-D (Expiration Date: 10/31/2014)
2b. Number and Type of HOPWA Capital Development Project Units (For Current or Past Capital
Development Projects that receive HOPWA Operating Costs this Reporting Year)
For units entered above in 2a. please list the number of HOPWA units that fulfill the following criteria:
Number Designated Number
for the Chronically Designated to Number Energy- Number 504 Accessible
Homeless Assist the Star Compliant
Homeless
Rental units constructed
(new) and/or acquired
with or without rehab
Rental units rehabbed
Homeownership units
constructed (if approved)
3. Units Assisted in Types of Housing Facility/Units Leased by Project Sponsor or Subrecipient
Charts 3a.. 3b. and 4 are reouired for each facility. In Charts 3a. and 3b., indicate the type and number of housing units in the
facility, including master leased units, project -based or other scattered site units leased by the organization, categorized by the
number of bedrooms per unit.
Note: The number units may not equal the total number of households served.
Please complete separate charts for each housing facility assisted. Scattered site units may be grouped together
3a. Check one only
❑ Permanent Supportive Housing Facility/Units
n Short-term Shelter or Transitional Supportive Housing Facility/Units
3b. Type of Facility
Complete the following Chart for all facilities leased, master leased, project -based, or operated with HOPWA funds during the
reporting year
Name of Project Sponsor/Agency Operating the Facility/Leased Units:
Type of housing facility operated by the
project sponsor/subrecipient
a. Single room occupancy dwelling
b. Community residence
c. Project -based rental assistance units or leased units
d.
Other housing facility
Specify:
Total Number of Units in use during the Operating Year
Categorized by the Number of Bedrooms per Units
SRO/Studio/0 1 bdrm 2 bdrm 3 bdrm 4 bdrm 5+bdrm
bdrm
4. Households and Housing Expenditures
Enter the total number of households served and the amount of HOPWA funds expended by the project sponsor/subrecipient on
subsidies for housing involving the use of facilities, master leased units, project based or other scattered site units leased by the
organization.
Housing Assistance Category: Facihty Based Housing
a.
b.
d.
e.
f.
Leasing Costs
Operating Costs
Project -Based Rental Assistance (PBRA) or other leased units
Other Activity (if approved in grant agreement) Specify:
Adjustment to eliminate duplication (subtract)
TOTAL Facility -Based Housing Assistance
(Sum Rows a. through d. minus Row e.)
Previous editions are obsolete
Output: Number of Output: Total HOPWA Funds Expended during
Households Operating Year by Project Sponsor/subrecipient
Page 26 form HUD-40110-D (Expiration Date: 10/31/2014)
EXHIBIT "I"
MBE REPORTING FORM
HOPWA PSA CONTRACT 2015-2016 -- EXHIBIT "I" -- MBE REPORTING FORM Page 1
AIDS Outreach Center, Inc
Contract and Subcontract Actisity US. Otpartmcrd ofHosubg and Urban anclap®ant
Publempc g basins fa' this cotlalnm ofh* tien13 atimatd to average .5 hours pa -response. including the time for minting mstlicau, sevdting misting data surc.Olt ems and maintaiwag the data ntcd and completing and resi-.sins
Ilad this inkrmation, and you ate not required to amylete this foam, mk s it displays a amendyt'alid OMB Control Nwnba
Emanative Orlondatol July Id, 1933, dirais the Atincit) Busnus Development Plans shill be dnelopo1 by cad' Fdaal A_ y' and the thine annual plant shall atabhah minntybminas d e'upmaa objcdists. Thc mf om k and by FILM to monitor an3 nabate MBE aetnnics against the hal progatn aaiaity and
the designated mirevity bmmc s enterprise (MBE) goals She Depadmad r sink the information to prmidt guidane and oversight for pmganu fur the dn'ebp=A ofmiineiitybtmnas enterprise eccaning hf vity Dwtrems Development If the in( ti - n4 11 -td HID uld net Fe able to abblrh mawegful
?CBE goals nor a aluate\®E paformanx against these gusts.
Priaaey Act Nation =The Usual Stets Depamnan of Housing and UrbanDndomaq Federal llcusingAdministration u authorized to solnat the Informati2n rcqucstd inthis form by virtue of Title 12. United Stria Code, Salon 1701 et rah and regulation_ It will not be disclosed orrdad nutrlde the United Stales
Department of Hewing and Urban Dnclopim it withcut yourmnsdn crsyt as requimt or permitted by Law.
L CaaeichOiat Owns,IkacLper.SPmnr9MIevAgmny
Cats of FM Worth
Sarah➢taidt
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8t7-392-753S
Sttreararszr
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(Set taaw)
CPO
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Z Location (Cur)'. State Zip Code)
L000 D-uocSawrtotc Fort [Worth TX 76102
Stet
5. Prcram Cedes (Complete fur I9uiing and Public and Indianllous
:1I: t+HeD1
Ctty
formIIUD-251612,981
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This report is to be completed by grantees, developers. sponsors builders, agencies, and'or
project owners for reporting contract and subcontract activities n(510,000 or more under the
following programs Community Development Block Grants (entitlement and small cities)
Urban Des elopment Action Grants: housing Des elopment 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 SI0,000 need be reported only ifsuch contracts represent a
significant portion of your total contracting activity. Include only contracts executed dunng this
reporting period
This form has been modified to capture Section 3 contract data in columns 7g and 71. Section 3
requires that the employment and other economic opportunities genemted by HUD financial
assistance for ha'using and community development programs shall, to the greatest extent
feasible, be directed toward lops- and r cry low-income persons particularly those rs ho are
recipients of government assistance for housing. Recipients using this form to report Section 3
contract data must also use Part 1 of Wars HUD-60002 to report employment and training
opportunities data Form HUD-2516 is to be
Community Der elopment 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
la. Grant Number: Enter the HUD Community Der elopment Block Grant Identification
Number (with dashes). For example: B-32-MC-25-0034. For Entitlement Pmgmms 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 presided in 7( the dollar figure would be for the subcontract only
and not for the prime contract.
7e Type of Trade: Enter the numeric codes which best indicates the
ractofs/subcontmetot's sonice. 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, professorial sen ices and all other activities except
construction and education/tmining activities
7d. Business RacialfEthnic/Gender Code: Enter the numeric code which indicates the
racial/ethnic/gender character of the owner(s) and contmller(s) of513: of the business.
When 51": or more is not owned and controlled by any single mcial/eihnic/gender category,
enter the code which seems most appropriate. If the subcontractor ID number is presided, the
code would apply to the subcontractor and not to the prime contractor.
7e. Woman Owned Business: Enter Yes or No
71. 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) Nuns her: Enter the Employer (1RS)Number of the
subcontractor as the unique identifier for eat. h subsontrac t awarded from HUD funds When the
subcontractor 1D 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
recet ing contraet/subcontract activity only one time on each report for each fine.
completed for public and Indian housing and most community des elopment programs. Form HUD-
60002 is to be completed by all other HUD programs including State administered community
des elopment programs cosered under Section3. A Section 3 Contractor/subcontractor is a
business concept that parr ides economic opportunities to low and very Low-income residents of
the metropolitan area (or nonmetropolitan county), including a business concern that is 51 person
or more owned by low-income resident;
or presides 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 ADordable
Housing Act
The tents -low-income persons" and `very low-income persons" have the same meanings ghee
the terms in section3(bX2) 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 ler els of construction
Multifamily Housing Programs
1. Grantee/Project Owner: Enter the name of the unit of gas eminent, 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 appmpriate program code.
7a. Grant/Project Number: Enter the HUD Project Number or Housing Development Grant or
number assigned.
7b. Amount of Contract/Subcontract: Sante as item lb. under CPD Programs.
7e. Type of Trade: Sam< 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.
711 Contractor Identification (ID) Number: Same as item if under CPD Programs
7g. Section 3 Contractor: Enter Yes or No
71; Subcontractor Identification (ID) Number: Sante as Item 7h under CPD Pmgrnrn;
71. Section 3 Contractor: Enter Yes or No.
7j. Contractor/Subcontractor Name and Address: Same as item 7j, under CPD Pmgmnss
costs or unusually high or low-income amities Very low-income families (including single
persons) whose incomes do not exceed 50 per centum of the median (emit)/ 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
Deco on the basis of the Secretary's findings that such variations art necesnry because of unusually
high or low family incomes
Submit two (2) copies of this report to your local HUD Office within ten (10) days offer the end of
the reporting period you checked in item 4 on the f nt. Complete item 76. Only once far each
contiactodsubcontracmr on each semi-annual report.
Enter the prime contmctots ID in item 7E for all contracts and subcontracts_ Include only
contracts expected during this reporting period PHM'lIIAs are to report all
contracts/subcontracts
Public Housing and Indian Housing Pmgnms
MIAs/IRAs are to report all contmcts'subcontmct; Include only contracts executed during this
reporting period.
I. Project Owner. Enter the name of the unit of gin emment, 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 Pmject Number or Housing Development Grant or
number assigned_
7b. Amount ofContract/Subcontract: Same as item lb. under CPD Programs
7c. Type of Trade: Same as item 7c. under CPD Program;
7d. Business RacialfEtindc/Gender Code: Same as item 7d. under CPD Programs.
7e. Woman Owned Business: Enter Yes or Na.
7f. Contractor Identification (ID) Number: Same as item 711 under CPD Programs
7g. Section 3 Contactor: Enter Yes or No.
7h Subcontractor Identification (ID) Number: Same as item 7h. under CPD Programs.
7i. Section 3 Contractor: Enter Yes or Na.
7j. Contractor/Subcontractor Name and Address: Same as item 7j. under CPD Programs.
M&C Review
e ice ;site o t e ity of. Fort Worth Texas'
CITY COUNCIL AGENDA
CONTINUED FROM A PREVIOUS WEEK
REFERENCE 17NS
DATE 7/28/2015 NO : G-18521 LOG NAME HUDACTIONPLANPY2015-
2016
CODE G TYPE
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;
FORT WORTH
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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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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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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
amounts shown in the following tables:
Community Development Block Grant Contracts:
Table 1 - CDBG Agencies
Organization
Cenikor Foundation
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
Program
S ubstance Abuse
S enior Services
Child Care Services
Child Care Services
Child Care Services
Youth Services
Youth Services
Youth Services
Employment/Job
Training
Housing Counseling
and Education
the
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
Case
Management/Main $ 75,000.00
S helter
Homeless Services
Home -delivered
Meals Program
P roject Ramp
$ 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 budgets
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Housina 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 Administration (seven percent), Supportive Services,
Outreach Tenant Based Rental Assistance (TBRA), and Short $552,027.00
Center, Inc. Term Rent Mortgage and Utility Assistance (STRMU)
TOTAL
HOPWA
Contracts
Organization
S afeHaven of Tarrant County
P resbyterian Night Shelter
Day Resource Center for the Homeless
The Salvation Army, a Georgia
Corporation
YWCA Fort Worth and Tarrant County
TOTAL ESG Contracts
Emeraencv Solutions Grant Contracts:
Tbble 3 - ESG Agencies
Proaram
S helter Services
S helter Services
S helter Services
Homelessness
P revention
Rapid Re -Housing
These programs are available in ALL COUNCIL DISTRICTS.
$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
21001 4310013 019CDBG $6.332.270.00
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21001
21001
21001
21001
21001
21001
21001
2_1001
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:
Or►ginatina Department Head:
Additional Information Contact
Fernando Costa (6122)
Allison Gray (8030)
Avis Chaisson (6342)
Leticia Rodriguez (7319)
ATTACHMENTS
17NS HUDACTIONPLANPY2015-2016 GR75AO FY2015.docx,
Action Plan 15 16 FINAL MandC Slides LHR.odf
Pronosed 2015 CDBG Infrastructure Proiect MandC.odf
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