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COPINIAMT O
AGREEMENT FOR COMMUNITY BASED PROGRAM
GIRLS INCORPORATED OF TARRANT COUNTY
FISCAL YEAR 2016
In consideration of the mutual covenants, promises and agreements contained herein, THIS
AGREEMENT ("Agreement") is made and entered into between CITY OF FORT WORTH, a
home rule municipal corporation of the State of Texas, ("City") acting by and through Valerie R.
Washington, its duly authorized Assistant City Manager, and GIRLS INCORPORATED OF
TARRANT COUNTY, a Texas private non-profit corporation ("Contractor") acting by and
through Jennifer Limas, President and Chief Executive Officer, its duly authorized
representative.
RECITALS
WHEREAS, City has determined that Community Based Programs are necessary to
support crime prevention in City during Fiscal Year 2016 to meet one or more of the Crime
Control and Prevention District ("CCPD") goals, which are (1) to support efforts to reduce
violent crime and gang -related activities through enhanced enforcement activities and crime
prevention programs, (2) to support efforts to increase the safety of residents and to decrease
crime throughout Fort Worth neighborhoods, and (3) to support efforts to increase the safety of
youth and reduce juvenile crime through crime prevention and intervention programs; and
WHEREAS, Contractor has agreed to operate a Community Based Program called Girls
Inc. Mentoring and Leadership Program at Eastern Hills High School, which will support the
police department's crime prevention efforts throughout the community; and
WHEREAS, City desires to enter into an agreement with Contractor to operate the Girls
Inc. Mentoring and Leadership Program; and
WHEREAS, City, as consideration for the performance of Contractor, has appropriated
monies in the CCPD Budget as reimbursed by the CCPD in the amount of $33,336.00 ("Program
Funds") to provide to the Contractor for the operation of the Girls Inc. Mentoring and Leadership
Program;
NOW, THEREFORE, in consideration of the mutual covenants herein expressed, the
parties agree as follows:
AGREEMENT DOCUMENTS
The Agreement documents shall include the following:
1. This Agreement
2. Exhibit A — Proposal Abstract and Narrative
3. Exhibit B — Budget
4. Exhibit C — Request for Reimbursement
FY 2016 Community Based Program
Girls Incorporated of Tarrant County
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Page 1 of 12
5. Exhibit D — Program Activities Report
6. Exhibit E — Program Effectiveness Measurement Report
7. Exhibit F — Request for Budget Modification
Exhibits A through F, which are attached hereto and incorporated herein, are made a part of this
Agreement for all purposes. In the event of any conflict between the terms and conditions of
Exhibits A through F and the terms and conditions set forth m the body of this Agreement, the
terms and conditions of this Agreement control
AGREEMENT
1. Resnonsibilities of Contractor.
Contractor covenants and agrees to fully perform, or cause to be performed, with good
faith and due diligence all work and services described in Exhibit "A" — Proposal Narrative .
Contractor shall be responsible for day-to-day administration of the Girls Inc. Mentoring and
Leadership Progiam. Contractor agrees to expend the Program Funds in accordance with the
Budget as described in Exhibit "B". Program activities shall be reported in accordance with
Exhibit "D" and effectiveness measures shall be reported in accordance with Exhibit "E".
2. Program Funds.
2.1 In no event shall the total distribution from City made to the Contractor during the Term
of this Agreement exceed $33,336.00 ("Program Funds").
2.2 Payment of the Program Funds from City to Contractor shall be made on a cost -
reimbursement basis following receipt by City from Contractor of a signed Request for
Reimbursement (RFR), as described in Exhibit "C" along with supporting documentation.
Contactor shall deliver to City a written detailed Program Activities Report and Program
Effectiveness Measures Report as described in Section 4.2 below with each RFR to support
expenditure of Program Funds. Such reports shall be signed by the Contactor or duly authorized
officer of the Contactor The RFR and monthly Program Activities Report shall be submitted to
City no later than the 15th day following the end of the month. Submittal of a monthly RFR and
Program Activities Report is required even if services are not provided.
The monthly RFR, with an original signature by an authorized representative, must be submitted
to the Research and Planning Section of the Fort Worth Police Department, ATTENTION
Grants Management Unit, Bob Bolen Public Safety Complex, 505 W. Felix St., Fort Worth,
Texas, 76115. Reimbursements will not be made until after receipt of an acceptable and
approved RFR and a monthly Ptogram Activities Report from the Contactor. Reimbursements
shall be made within 30 days receipt of said documents.
2.3 Contractor is authorized to modify up to five (5) percent of any budgeted line -item in the
original approved budget without prior written permission fiom City However, Contractor
must submit the Request for Budget Modification Form (Exhibit "F") to City, with the monthly
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Girls Incorporated of Tarrant County Page 2 of 12
RFR, during the month the modification took place. The new modified budget cannot exceed the
total amount of Program Funds
2.4 Any modifications of more than five (5) percent of any budgeted line -item in the original
approved budget must have prior written permission from City before the modifications are
made. The Budget Modification Form (Exhibit "F") must be submitted, and request must be
approved by City, before any money is moved to the line -item. Once the Budget Modification is
approved, the modified budget will take effect on the first day of the following month. The new
modified budget shall not exceed the total amount of Program Funds.
2.5 Any modifications to zero line -items in the original approved budget must have prior
written permission from City before the modifications ale made The Budget Modification Form
(Exhibit "F") must be completed and approved by City before money is transferred into the new
line -item. Once the Budget Modification is approved the modified budget will take effect on the
first day of the following month. The new modified budget shall not exceed the total amount of
Program Funds.
2.6 Budget modification can only occur within the Direct and Indirect costs. Funds may not
be moved from a Direct line -item into an Indirect line -item, or vise versus. Modification of
Direct and Indirect approved budgets must follow the guidelines outlined in sections 2.3, 2.4. and
2.5.
Budget adjustments shall be submitted to the Grants Management Unit of the Fort Worth
Police Department at Bob Bolen Public Safety Complex at 505 W. Felix St., Fort Worth,
Texas, 76115.
3. Term. This Agreement shall commence upon October 1, 2015 ("Effective Date"), and
shall end on September 30, 2016 ("Term"). All of Contractor s expenditures under this
Agreement must be completed no later than September 30, 2016.
4. Program Performance.
4.1 Contractor agrees to maintain full documentation supporting the performance of the work
set forth in Exhibit "A."
4.2 Contractor agrees to provide a monthly Program Activities Report and quarterly Program
Effectiveness Measurement Report to document the performance of the work described in
Exhibit "D" and Exhibit "E," respectively. The Program Activities and Effectiveness Measures
shall document the program activity names numbers of participants attending, details of the
activities, and a description of the goals achieved in support of the CCPD goals Program
Effectiveness Measures shall be reported on a quarterly basis and included in the January, April,
July, and October RFR and Program Activities Report submittals. Additionally, the Program
Effectiveness Measurement Report must describe include any realized successes. The monthly
Program Activities and quarterly Pi ogram Effectiveness Measurement Reports shall be
submitted to City no later than the 15th day after the end of each month.
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Girls Incorporated of Tarrant County Page 3 of 12
4.3 Contractor agrees that the monthly Request for Reimbursement and Program Activities
Report and quarterly Program Effectiveness Measurement Report will be submitted to City no
later than the 15ti day after the end of each month. Should Contiactor not meet these
requirements, Contractor will be given an additional 15 days to submit the required reports to
City. If, at the end of this 15-day extension period, Contractor has not submitted the required
reports, City will send a non-compliance letter notifying Contractor's duly authorized
representative of a possible suspension of program funding.
4.4 A representative of the program shall attend quarterly meetings of the Crime Control and
Prevention District Board as requested.
5. Default and Termination.
5.1 This Agreement is wholly conditioned upon the actual receipt by City of Program Funds
from the CCPD. All monies distributed to Contractor hereunder shall be exclusively from
monies received from the CCPD, and not from any other monies of City. In the event that funds
from the CCPD are not timely received in whole or in part, City may, at its sole discretion,
terminate this Agreement and City shall not be liable for payment for any work or services
performed by Contractor under or in connection with this Agreement.
5.2 In the event no funds or insufficient funds are appropriated by the City in any fiscal year
for any payments due hereunder, City will notify Contractor of such occurrence and this
Agreement shall terminate on the last day of the fiscal period for which appropriations were
received without penalty or expense to the City of any kind whatsoever, except as to the portions of
payments herein agreed upon for which funds have been appropriated.
5.3 The City may terminate this Agreement at any time and for any reason by providing the
other party with thirty (30) days' written notice of termination.
5.4 Termination will be effected by delivering to Contractor written notice of termination.
Upon Contractor's receipt of notice of termination, Contractor shall:
(a) Stop work under the Agreement on the date and to the extent specified in the notice of
termination;
(b) Place no further order or subcontracts, except as may be necessary for completion of the
work not terminated;
(c) Terminate all orders and contracts to the extent that they relate to the performance of the
work terminated by the notice of termination; and
(d) Cease expenditures of Program Funds, except as may be necessary for completion of the
work not terminated.
5.5 In the event City suspends or terminates this Agreement for cause, and the cause for such
suspension or termination is determined to be invalid, the Contractor's sole remedy shall be
reinstatement of this Agreement. Contractor expressly waives any and all rights to monetary
damages, including but not limited to actual, consequential, and punitive damages, court costs
and attorney's fees.
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Girls Incorporated of Tarrant County Page 4 of 12
5.6 Within thirty (30) days following the date of termination of this Agreement, Contactor
shall return to City any property provided hereunder. City will have no responsibility or liability
for Contractor's expenditures or actions occurring after the effective date of termination of the
Agreement.
6. Euuinment and Maintenance. All equipment purchased with Program Funds must
meet all eligibility requirements of City. Contactor shall maintain all equipment used in the
administration and execution of the Girls Inc. Mentoring and Leadership Program Contractor
shall maintain, replace or repair any item of equipment used in support of the Girls Inc.
Mentoring and Leadership Program and/or for use under the terms of this Agreement that no
longer functions or is lost or stolen. The cost for maintenance replacement or repair of any
equipment used in support of the Girls Inc. Mentoring and Leadership Program and/or for use
under the terms of this Agreement is the sole responsibility of Contactor. Contractor shall not
use Program Funds or City funds to repair or replace said equipment. Contactor shall use any
and all equipment purchased with Program Funds exclusively in support of the Girls Inc.
Mentoring and Leadership Program. Within 10 days following the purchase of equipment,
Contractor shall submit to City a detailed inventory of all equipment purchased with Program
Funds to the Grants and Contacts Management Section at the address set forth in paragraph 2.2
above. The equipment inventory shall include an itemized description of each piece of
equipment, the date each piece of equipment was purchased, the cost of purchase for each piece
of equipment, and the location of each piece of equipment.
7. Administrative Requirements.
7.1 Contractor agrees to keep sufficient records to document its adherence to applicable local, state, and
federal regulations, along with documentation and records of all receipts and expenditures of Program
Funds Contractor agrees that the City shall, until the expiration of three (3) years after final payment
under this Agreement, have access to and the right to examine any directly pertinent books, documents
papers and records of the Contractor involving transactions relating to this Agreement. Contractor agrees
that the City shall have access during normal working hours to all necessary Contractor facilities and
shall be provided adequate and appropriate workspace in order to conduct audits in compliance with the
provisions of this section. The City shall give Contractor reasonable advance notice of intended audits
7.2 If any audit reveals a questioned practice or expenditure, City shall notify Contractor as
soon as reasonably practical. Contractor shall have fifteen (15) days to provide City with a
written explanation and any supporting documentation regarding the practice or expenditure. If
Contractor fails to resolve or cure the questioned practice or expenditure, to the City's
satisfaction, within the fifteen (15) day period, , City reserves the right to withhold further
Program Funds under this and/oi future agreement(s) with Contractor.
7.3 If as a result of any audit, it is determined that Contractor misused, misapplied or
misappropriated all or any part of the Program Funds, Contractor agrees to reimburse City the
amount of such monies so misused, misapplied or misappropriated, plus the amount of any
FY 2016 Community Based Program
Girls Incorporated of Tarrant County Page 5 of 12
sanction, penalty, or other charge levied against City because of such misuse, misapplication or
misappropriation.
7.4 Contractor's obligation to City shall not end until all closeout requirements are
completed. The closeout requirements shall include, but are not limited to: providing final
Program Activities Report and Program Effectiveness Measurement Reports making final
payments, and disposing of Girls Inc. Mentoring and Leadership Program assets as appropriate.
7.5 Contractor covenants and agrees to fully cooperate with City in monitoring the
effectiveness of the services and work to be performed by Contractoi under this Agreement, and
8. Indenendent Contractor.
8.1 Contractor shall operate hereunder as an independent contractor and not as an officer,
agent, or servant or employee of City Contractor shall have exclusive control of, and the
exclusive right to control the details of the work and services performed hereunder, and all
persons performing same and shall be solely responsible for the acts and omissions of its
officers, members, agents, servants, employees, subcontractors, program participants, licensees,
or invitees. The doctrine of respondent superior shall not apply as between City and Contractor,
its officers, members, agents, servants employees, subcontractors, program participants,
licensees, or invitees, and nothing herein shall be construed as creating a partnership or joint
enterprise between City and Contractor. It is expressly understood and agreed that no officer
member, agent, employee, subcontractor, licensee, or invitee of the Contractor, nor any program
participant hereunder is in the paid service of City. City does not have the legal right to control
the details of the tasks performed hereunder by Contractor, its officers, members, agents
employees, subcontractors program participants, licensees, or invitees.
8.2 City shall in no way nor under any circumstances be responsible for any property
belonging to Contractor, its officers, members, agents, employees, subcontractors program
participants, licensees or invitees, which may be lost, stolen, destroyed, or in any way damaged.
9. Liability and Indemnification.
CONTRACTOR SHALL BE LIABLE AND RESPONSIBLE FOR ANY AND ALL
PROPERTY LOSS, PROPERTY DAMAGE AND/OR PERSONAL INJURY,
INCLUDING DEATH, TO ANY AND ALL PERSONS, OF ANY KIND OR
CHARACTER, WHETHER REAL OR ASSERTED, TO THE EXTENT CAUSED BY
THE NEGLIGENT ACT(S) OR OMISSION(S), MALFEASANCE OR
INTENTIONAL MISCONDUCT OF CONTRACTOR, ITS OFFICERS, AGENTS,
SERVANTS OR EMPLOYEES.
CONTRACTOR AGREES TO DEFEND, INDEMNIFY, AND HOLD THE CITY, ITS
OFFICERS, AGENTS, SERVANTS, AND EMPLOYEES HARMLESS AGAINST
ANY AND ALL CLAIMS, LAWSUITS, ACTIONS, COSTS, AND EXPENSES OF
ANY KIND, INCLUDING, BUT NOT LIMITED TO, THOSE FOR PROPERTY
DAMAGE OR LOSS (INCLUDING ALLEGED DAMAGE OR LOSS TO OWNER'S
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BUSINESS AND ANY RESULTING LOST PROFITS) AND/OR PERSONAL
INJURY (INCLUDING DEATH) THAT MAY RELATE TO, ARISE OUT OF, OR BE
OCCASIONED BY (I) CONSULTANT'S BREACH OF ANY OF THE TERMS OR
PROVISIONS OF THIS AGREEMENT OR (II) ANY NEGLIGENT ACT OR
OMISSION OR INTENTIONAL MISCONDUCT OF CONTRACTOR, ITS
OFFICERS, AGENTS, ASSOCIATES, EMPLOYEES, CONTRACTORS (OTHER
THAN THE CITY), OR SUBCONTRACTORS RELATED TO THE PERFORMANCE
OF THIS AGREEMENT, EXCEPT THAT THE INDEMNITY PROVIDED FOR IN
THIS SECTION SHALL NOT APPLY TO ANY LIABILITY RESULTING FROM
THE SOLE NEGLIGENCE OF THE CITY OR ITS OFFICERS, AGENTS,
EMPLOYEES, OR SEPARATE CONTRACTORS, AND IN THE EVENT OF JOINT
AND CONCURRENT NEGLIGENCE OF BOTH CONSULTANT AND CITY,
RESPONSIBILITY, IF ANY, SHALL BE APPORTIONED COMPARATIVELY IN
ACCORDANCE WITH THE LAWS OF THE STATE OF TEXAS. NOTHING
HEREIN SHALL BE CONSTRUED AS A WAIVER OF THE CITY'S
GOVERNMENTAL IMMUNITY AS FURTHER PROVIDED BY THE LAWS OF
TEXAS.
Contractor shall require all of its subcontractors to include in their subcontracts a release
and indemnity in favor of City in substantially the same form as above.
This section shall survive the expiration or termination of this Agreement.
10. Non -Assignment. No assignment or delegation of duties under this Agreement by
Contractor shall be effective without City's prior written approval.
11. Prohibition Against Interest.
11.1 No member, officer or employee of City, or its designees or agents; no member of the
governing body of the locality in which the Girls Inc. Mentoring and Leadership Program is
situated; and no other public official of such locality or localities who exercises any functions or
responsibilities with respect to the Girls Inc. Mentoring and Leadership Program during his
tenure or for one year thereafter, shall have any interest, direct or indirect in any contract or
subcontract, or the proceeds thereof, for work to be performed hereunder. Contractor shall
incorporate, or cause to be incorporated, like language prohibiting such interest, in all contracts
and subcontracts hereunder.
11.2 No officer employee, member, or program participant of Contractor shall have a
financial interest, direct or indirect, in this Agreement or the monies transferred hereunder, or be
financially interested, directly or indirectly, in the sale to Contractor of any land, materials,
supplies or services purchased with any funds transferred hereunder, except on behalf of
Contractor, as an officer, employee, member, or program participant. Any willful violation of
this paragraph with the knowledge, expressed or implied, of Contractor or its subcontractors,
shall render this Agreement voidable by City of Fort Worth.
12. Nondiscrimination.
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Girls Incorporated of Tarrant County Page 7 of 12
Contractor, for itself, its personal representatives assigns, subcontractors and successors in
mtetest as part of the consideration herein agrees that in the performance of Contractor's duties
and obligations hereunder, it shall not discriminate in the treatment or employment of any
individual or group of individuals on any basis prohibited by law. IF ANY CLAIM ARISES
FROM AN ALLEGED VIOLATION OF THIS NON-DISCRIMINATION COVENANT
BY CONTRACTOR, ITS PERSONAL REPRESENTATIVES, ASSIGNS,
SUBCONTRACTORS OR SUCCESSORS IN INTEREST, CONTRACTOR AGREES TO
ASSUME SUCH LIABILITY AND TO INDEMNIFY AND DEFEND THE CITY AND
HOLD THE CITY HARMLESS FROM SUCH CLAIM.
This section shall survive the expiration or termination of this Agreement.
13. Compliance.
13.1 Contractor, its officers, members, agents, employees, piogram participants, and
subcontractors, shall abide by and comply with all laws, federal, state and local including all
ordinances rules and regulations of City. If City calls to the attention of Contractor any such
violation on the part of Contractor or any of its officers, members, agents, employees,
subcontractors or program participants, then Contractor shall immediately desist from and
correct such violation.
13.2 Contractor shall utilize Program Funds strictly for those purposes and goals intended
under the terms and conditions of this Agreement. If City calls the attention of Contractor to any
such violations on the part of Contractor or any of its offices s, members, agents, employees,
program participants or subcontractors, then Contractor shall immediately desist from and
correct such violation.
14. Governmental Powers. It is understood that by execution of this Agreement, the City does not waive
or surrender any of it governmental powers.
15. Waiver of Immunity. If Contractor is a charitable or nonprofit organization and has or
claims an immunity or exemption (statutory or otherwise) from and against liability for damages
or injury, including death, to persons or property; Contractor hereby expressly waives its rights to
plead defensively such immunity or exemption as against City This section shall not be
construed to affect a governmental entity's immunities under constitutional, statutory or common
law.
16. Insurance Requirement.
16.1 Coverages and Limits. Contractor shall provide the City with certificate(s) of
insurance documenting policies of the following minimum coverage limits that are to be in
effect prior to commencement of any work pursuant to this Agreement:
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Girls Incorporated of Tarrant County Page 8 of 12
(a) Commercial General Liability (CGL): $1,000,000 pei occurrence, with a $2,000,000.00
annual aggregate limit, in a form that is acceptable to the City's Risk Manager.
(b) Non -Profit Organization Liability or Directois & Officers Liability: $1,000,000 per
occurrence, with a $1,000 000 annual aggregate limit, in a form that is acceptable to the
City's Risk Manager.
(c) Automobile Liability: $1,000,000 each accident on a combined single limit basis OR
split limits are acceptable if limits are at least $250,000 Bodily Injury per person,
$500,000 Bodily Injury per accident and $100 000 Property Damage.
16.2 Contractor's insurer(s) must be authorized to do business in the State of Texas for the
lines of insurance coverage provided and be cuiiently rated in terms of financial strength and
solvency to the satisfaction of the City's Risk Manager. All insurers must have a minimum
rating of A- VII in the current A.M. Best Key Rating Guide, or have reasonably equivalent
financial strength and solvency to the satisfaction of Risk Management. If the rating is below
that required, wiitten approval of Risk Management is required. Evidence of self-insurance will
also be accepted.
16.3 Each insurance policy required herein shall be endorsed with a waiver of subrogation in
favor of the City Each insurance policy required by this Agreement, except foi policies of
worker's compensation or accident/medical insurance shall list the City as an additional
insured. City shall have the right to revise insurance coverage requirements under this
Agreement.
16.4 Contractor further agrees that it shall comply with the Worker's Compensation Act of
Texas and shall provide sufficient compensation insurance to protect Contractor and City fiom
and against any and all Worker's Compensation claims arising from the work and services
provided under this Agreement.
16.5 The commercial general liability policy shall name the City as an additional insured
thereon, as its interests may appear The term City shall include its employees, officers, officials
agents, and volunteers in respect to the contracted services.
16.6 A minimum of Thirty (30) days' notice of cancellation or reduction in limits of coverage
shall be provided to the City. Ten (10) days' notice shall be acceptable in the event of non-
payment of premium Notice shall be sent to the Risk Manager, City of Fort Worth, 1000
Throckmorton, Fort Worth, Texas 76102, with copies to the City Attorney at the same address.
16.7 Any failure on the part of the City to request required insurance documentation shall not
constitute a waiver of the insurance requirement.
16.8 Certificates of Insurance evidencing that the Consultant has obtained all required insurance
shall be delivered to the City prior to Consultant proceeding with any work pursuant to this
Agreement.
17. Miscellaneous Provisions.
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Girls Incorporated of Tarrant County Page 9 of 12
17.1 if any provision of this Agreement is held to be invalid, illegal or unenforceable, the validity,
legality and enforceability of the remaining provisions shall not in any way be affected or impaired.
17.2 City's failure to insist upon the performance of any term or provision of this Agreement
or to exercise any right herein conferred shall not be construed as a waiver or relinquishment to
any extent of City's right to assert or rely upon any such term o1 right on any future occasion.
17.3 Should any action, whether real or asserted, at law or in equity, arise out of the execution,
performance attempted performance or non-performance of this Agreement, venue for said
action shall lie in state courts located in Tarrant County, Texas or the United States District
Court for the Northern District of Texas, Fort Worth Division..
17.4 Contractor represents that it possesses the legal authority, pursuant to any proper,
appropriate and official motion resolution or action passed or taken, to enter into this Agreement
and to perform the responsibilities herein required.
17.5 This written instrument and Exhibits A through F, constitute the entire agreement between
the parties concerning the work and services to be performed hereunder, and any prior or
contemporaneous, oral or written agreement which purports to vary from the terms hereof shall
be void
17.6 Any amendments to the terms of this Agreement must be in writing and must be signed by
authorized representatives of each Party.
17.7 None of the performance rendered under this Agreement shall involve, and no portion of
the Program Funds received hereunder shall be used, directly or indirectly for the construction,
operations, maintenance or administration of any sectarian or religious facility o1 activity, nor
shall said performance rendered or funds received be utilized so as to benefit, directly or
indirectly any such sectarian or religious facility or activity.
17.8 Contractor certifies that it has obtained a 501 (c) (3) Certificate from the Internal
Revenue Service. Contractor shall notify City in writing of any changes to its 501 (c) (3) tax-
exempt status during the term of this Agreement.
17.9 Captions and headings used in this Agreement are for reference purposes only and shall
not be deemed a part of this Agreement.
17.10 The provisions and conditions of this Agreement are solely for the benefit of City and
Contractor and are not intended to create any rights, contractual or otherwise, to any other person
or entity.
18. Notice.
Notices to be provided hereunder shall be sufficient if forwarded to the other party by hand -delivery or
via U.S. Postal Service certified mail, postage prepaid, to the address of the other party shown below:
FY 2016 Community Based Program
Girls Incorporated of Tarrant County Page 10 of 12
CITY:
Copies To:
Valerie R. Washington, Assistant City Manager
City Manager's Office
City of Fort Worth
1000 Throckmorton Street
Fort Worth, TX 76102
Tiffany Hayes
Grants Management Unit
Bob Bolen Public Safety Complex
505 West Felix St.
Fort Worth, TX 76115
CONTRACTOR: Jennifer Limas, President and Chief Executive Officer
GIRLS INCORPORATED OF TARRANT COUNTY
2820 Matlock Road
Fort Worth, TX 76015
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Girls Incorporated of Tarrant County Page 11 of 12
IN WITNESS WHEREOF, the parties hereto have execute ' this agreement .in m lti les in
Fort Woith, Tarrant County, Texas, to be effective this �,�;f dayof
20 /
y
APPROVED AND AGREED FOR
CITY OF FORT WORTH
Valerie R. .0(shington
Assistant City Manager
Date:►AsI (5
APPROVAL RECOMMENDED
crwAikt-
Rhonda K. Robertson
Chief of Police
Date: /6 - DS - /5"
APPROVED AS TO FORM AND
LEGALITY FOR CITY OF FORT
WORTH
I /1f0/1, O'CtQa
Victoria D. Honey
Assistant City Attorney
Date:
FY 2016 Community Based Program
Girls Incorporated of Tarrant County
APPROVED AND AGREED FOR
GIRLS INCORPORATED OF
TARRANT COUNTY
Jerifiifer Lianas
President and Chief Executive Officer
Date:
ATTEST
Aet- re-
-•,-9 atC
Mary J. K. :eye
City Secretary
Date:
M&C No.
INO AMC IREQUIR
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Page 12 of 12
Exhibit A
Proposal Abstract and Narrative
FY 2016 CRIME CONTROL AND PREVENTION DISTRICT
PROPOSAL COVER SHEET
CONTRACTOR: Girls Incorporated of Tarrant County
DIRECTOR: Jennifer Limas
PHONE NUMBER: 817-468-0306
PHYSICAL ADDRESS: 2820 Matlock Rd., Arlington, TX 76015
CONTACT PERSON: Jennifer Limas EMAIL ADDRESS: jlimas a>girlsinctarrant.org
PHONE NUMBER: 817-259-1050 FAX NUMBER: 817-259-1049
PROGRAM TITLE: Girls Inc Mentoring and Leadership Program at Eastern Hills High School
CCPD FUNDS REQUESTED: $33,336
CONTRACTOR STATUS:
■
x
Private Nonprofit
Public Nonprofit
Mark the goal(s) that your program addresses.
Support efforts to reduce violent cnme and gang -related activities through enhanced
enforcement activities and crime prevention programs
Support efforts to increase the safety of residents and to decrease crime throughout Fort
Worth neighborhoods; and
Support efforts to increase the safety of youth and reduce juvenile crime through crime
prevention and intervention programs.
Additionally, does program address the priority consideration listed below?
Program is a prevention or intervention program for youth and/or family violence.
CERTIFICATION:
I certify that the information contained in this proposal fairly represents the above -named
Contractor s operating plans and budget for the proposed program I acknowledge that I have read
and understand the requirements and provisions of the Request for Proposal and that the above -
named Contractor will comply with all applicable rules and regulations relating to the procurement
process. I certify that I am authorized to sign this proposal and to enter into and execute a contract
with the City of Fort Worth to provide the services authorized.
TYPED NAME: Jennifer Limas
TITLE: President & CEO
SIGNATURE:'` n , terrIficell DATE& o
i' t
RFP No. 14-0106, FY 2015 Community Based Programs, Page 3
PROGRAM ABSTRACT
Provide a short description of your program to be funded. Please summarize the problem and what
your program will do to address it. (Roughly 2 paragraphs in length on a separate page)
The Girls Inc. Mentoring and Leadership Program at Eastern Hills High School program addresses the
problems of youth violence, substance abuse, violence against girls and women, and other crime by
delivering programs that increase protective factors and decrease risk factors for girls.
Focusing on the East Fort Worth area (Zip code 76112) which has neighborhoods with high rates of
truancy, high school dropout, crime and substance abuse. Girls Inc. provides researched -based programs
during and after school in a safe, supportive and mentoring environment on the campus of Eastern Hills
High School One hundred 9th —12th grade girls will be served with CCPD funds.
Girls Inc. curricula include programming to educate and empower girls to:
• Build skills to positively navigate social situations and overcome relational aggression that can
escalate into violent behavior
• Raise awareness about violence in girls' lives and assess, respond to, and avoid potentially violent
situations.
• Build skills to resist pressure to use/abuse alcohol, drugs and other harmful substances.
• Learn basic financial concepts including money management and skills for self-sufficiency.
• Gain an understanding of various aspects of the media and its influence in girls lives.
• Participate in other activities including Academic Advisement and Mentoring field trips, and
community service projects.
RFP No. 14-0106, FY 2015 Community Based Programs, Page 4
PROPOSAL NARRATIVE•
1) Describe in detail the problem that your program addresses.
Girls Inc Mentoring and Leadership Program at Eastern Hills High School (EHHS) program addresses
the problems of youth violence, substance abuse, and other crime by increasing protective factors through
delivery of nationally research -based programming for girls in a supportive, mentoring environment.
EHHS is located in a low-income neighborhood, where 45% of families headed by women with children
in Zip code 76112 live below poverty level (U.S. Census, American Factfinder 2012) and 64% of
students are on free or reduced lunch (Fort Worth ISD, 2014). EHHS is one of the lowest performing
schools in Fort Worth ISD and has a history of poor student attendance and academic performance.
Twenty percent (20%) of girls in the EIIHS Class of 2013 dropped out — over three times the State
dropout rate of 6.6% for all students (based on four-year longitudinal rate, Texas Education Agency)
Contributing to the problems faced by EHHS girls is that teen pregnancy is a critical problem in Tarrant
County, where the teen birth rate is 60 births per 1,000 girls aged 15-19 — more than twice the U.S. teen
birth rate of 29 births per 1 000 girls (www.countyhealthrankings org 2012). Poverty and teen pregnancy
contribute to absenteeism, poor academic performance and school drop -out. Research shows that young
people who do not complete high school are more likely to become unemployed, homeless,
pregnant, and/or become involved with the juvenile justice or criminal justice system.
Substance use and abuse among Fort Worth teens is also prevalent. According to the Texas School
Survey of Alcohol and Drug Use (2012), results indicated that of Fort Worth ISD students:
• 62.7% of 9th graders had used alcohol before; 24.6% had used it in the past month.
• 74.2% of high school seniors had used alcohol before; 41.2 had used it in the past month. 22.1%
reported using alcohol several times per month
• 33.2% of 9t) graders had used marijuana before —10 2% within the past month.
• 44.7% of high school seniors had used marijuana before — 20.6% within the past month. 9.5%
reported using marijuana several times per month.
In addition, 497 Fort Worth youth under age 17 were arrested for alcohol -related incidents and 903 youth
arrests were made for drug possession in 2012.
The Girls Inc. Mentoring and Leadership Program addresses barriers contributing to absenteeism,
educational failure, school drop -out, and involvement in the juvenile justice system including:
• Basic needs not met at home (food, clothing, sleep)
• Low self-esteem and lack of self-confidence
• Lack of positive, trusted adult role models
• Attitude of hopelessness toward school
• BulIying or being bullied
• Substance abuse
• Early sexual involvement and teen pregnancy/parenting
• Lack of life skills such as good decision -making anger management, money management,
leadership, and other skills that help girls develop into independent, productive adults.
Eastern Hills High School is one of the most challenging schools to deliver programming, due to the
problems faced by the girls who live in the surrounding community. Many EHHS girls live in poverty,
lack family support, have low self-esteem, have witnessed drug and alcohol abuse in their homes and
neighborhoods, and/or have witnessed or experienced family violence or violence/gang violence and
crime in their neighborhood. The population of girls that we serve at EHHS are girls with the most
difficult problems and life experiences.
RFP No. 14-0106, FY 2015 Community Based Programs, Page 5
Girls Inc. responds to the needs of EHHS girls by providing one-to-one mentoring, working with the girls
to identify what their barriers to school and personal success are, and helping them make a plan to
overcome the challenges they face. Girls Inc. provides a support system of caring adult mentors and
positive peers to help girls to overcome negative attitudes and behaviors and work toward academic and
personal improvement, achievement, and success.
2) Describe what your program does to 1) support efforts to reduce violent crime and gang -related
activities through enhanced enforcement activities and crime prevention programs, 2) support
efforts to increase the safety of residents and to decrease crime throughout Fort Worth
neighborhoods; and 3) support efforts to increase the safety of youth and reduce juvenile crime
through crime prevention and intervention programs.
Girls Inc. of Tarrant County partners with Eastern Hills High School (EHHS) and the Fort Worth
Independent School District to provide the Girls Inc Mentoring and Leadership program on the EHHS
campus. Girls Inc. delivers research -based curricula, mentoring, and leadership programs to 9th —12th
grade girls at nsk of or currently failing school classes. Curricula focuses on building protective factors
that help girls improve their school attendance and academic performance in order to stay in school,
succeed academically, and graduate. Girls Inc. programs build girls' self-esteem and self-confidence,
teach girls skills to resist participation in harmful behaviors, and create a support system of positive
mentors and peers.
The program is a unique partnership between Girls Inc. of Tarrant County and Eastern Hills High School.
Services are delivered during the school day, Monday through Friday 8 am — 3:35 pm and after school in
a Girls Inc. —dedicated annex building on the school campus EHHS students may take Girls Inc. as an
elective during the school day. Girls are referred to the Girls Inc. program by counselors or teachers or
they enroll independently. Most girls begin the experience by attending the Girls Inc. elective class;
however, girls may participate in Academic Counseling and Mentoring and Leadership and Community
Action whether or not they are enrolled in the class.
The Girls Inc. Mentoring and Leadership Program at EHHS supports efforts to increase the safety of
youth and reduce juvenile crime by increasing protective factors through our research -based prevention
programming for girls. Girls Inc. curriculum addresses the gender -specific risk factors that make girls
vulnerable to:
• bullying and participating in violent behavior,
• abusing illegal substances,
• becoming involved with gangs and other criminal activity,
• truancy, academic failure, and dropping out of school, and
• engaging in early and risky sexual behavior.
Girls Inc. supports crime prevention by delivering life -changing programs and experiences in a safe,
supportive all -girl environment. Trained mentoring Girls Inc staff deliver Girls Inc. curricula include
violence and substance abuse prevention education as well as development of skills to manage peer
pressure and negative media influences, manage money, and make responsible decisions. Girls Inc. also
increases girls' awareness of the many ways that girls and women experience violence, and builds their
slcilis in assessing, responding to, and avoiding potentially violent situations. Educational support to
complete high school and prepare for and enroll in post -secondary education and family involvement are
also important components of our program. Girls receive academic support services through the Girls
Inc Academic Advisement & Mentoring Program, which includes tutoring college preparation, and
scholarship assistance.
RFP No. 14-0106, FY 2015 Community Based Programs, Page 6
Recognizing that girls face different issues as they progress to and from developmental stages, Girls Inc.
ensures that all materials are specific to the needs of the girls, age -appropriate, and sensitive to cultural
and economic issues. Curricula includes the following:
k Girls Beyond Bullying empowers girls how to create positive bonds among peers and work together
to create positive solutions to potentially violent situations, helping girls build skills to positively
navigate social situations and overcome relational aggression that can escalate into violent behavior.
The program incr eases girls' awareness of the many ways that girls and women experience violence,
and builds their skills in assessing, responding to, and avoiding potentially violent situations.
i' Friendly PEERsuasion® builds girls' skills for resisting pressure to use harmful substances such as
alcohol, tobacco, household chemicals, and other drugs which can lead to participation in other
criminal activity. The two-part substance abuse prevention program teaches girls healthy ways to
manage stress and confront peer, media and other pressures as well as to understand the dangerous
consequences of drugs and alcohol use. The girls then assume roles as PEERsuaders for younger
girls. Girls participate together in program activities that build their leadership skills.
Economic Literacy® introduces girls to basic financial concepts, including money management and
investment. The program explores how money affects us locally and globally as it fosters
development of the skills needed to be financially self-sufficient.
Media Literacy® introduces girls to various aspects of the media, while making girls aware of the
large influence that media plays in the lives of girls. Media Literacy uses a hands-on approach to
making the media a positive outlet in a girl's life.
Girls also participate in Safe In My World: Girls Speak Out on Violence, a Girls Inc. advocacy
initiative to address violence against girls. The program raises awareness about violence in girls' lives,
from the community level to federal policy makers, and inspires dialogue and action to improve safety for
girls. Safe in My World begins with a needs assessment to determine what violence girls are
experiencing and what they would like to see change in the community. These findings are discussed
along with ways to create a safer world for girls.
Girls benefit from the Girls Inc. Mentoring and Leadership program by improving their academic
performance, staying in school, graduating, and planning for post -secondary education. As part of Girls
Inc., they benefit by learning and putting into practice important life skills including how to resist
involvement in substance abuse, early sexual behavior, and/or violence' how to manage money; goal
setting and achieving, how to determine their educational path, complete college and scholarship
applications; as well as time management and leadership skills. Girls also learn the importance as well as
the personal reward of giving back to the community through volunteering.
The program also benefits girls through increased family engagement. An open house at the beginning of
each semester allows parents/guardians to learn about programs and services offered by Girls Inc. and
other resources at EHHS "Talking About Tough Stuff' is a workshop for EHHS parents to learn
communication skills to enhance their relationship with their daughter Parents also receive ti aining to
communicate about topics that can be difficult to discuss such as early and/or risky sexual behavior and
substance abuse. Students can attend with a mentor if a parent/guardian is not available. A Family
Reception is hosted at the end of the year to recognize the accomplishments of each Girls Inc participant.
Attending college and starting a career can enable young women from low-income families to become
successfully employed and become financially independent. However, for many low-income girls, college
seems out of reach At Girls Inc , girls learn how to finance their education through scholarships and
financial aid. and for our seniors who are graduating high school and pursuing post -secondary education,
the agency gives them an annual "College Shower" where they receive gifts of school supplies, backpacks,
RFP No. 14-0106, FY 2015 Community Based Programs, Page 7
laptops, printers, and linens and dorm room items that help level the college playing field for girls from
low-income families.
3) Does your program address the CCPD priority/special emphasis of the prevention or
intervention of youth violence and/or famil3 violence? Describe how your program addresses this
priority?
Our Girls Beyond Bullying program addresses the problem of youth violence by teaching girls how to
work together to create positive solutions to potentially violent situations and helping them to overcome
relational aggression. It addresses family violence and dating violence by increasing girls' awareness of
the many AN ays that girls and women experience violence and builds their skills in assessing, responding
to, and avoiding potentially violent situations. Safe In My World Girls Speak Out on Violence
provides girls the opportunity to have a voice in raising awareness about violence in girls' lives and
prevention of violence, from the community level to federal policy makers.
4) How will you measure the effectiveness of the program? You must include specific performance
measures within the Activities and Outcomes Summary and describe evaluation tools and the
method of data collection that you will use. If awarded funding, these performance measures
will be included as an exhibit in the contract, and you will be required to report progress
towards these measures, which will be reported to the CCPD Board.
Effectiveness of the program will be measured by pre- and post -testing girls participating in Girls Beyond
Bullying, Friendly PEERsuasion"' Economic Liteiacy° , and Media LiteracyO''. The performance standard
is that girls will score 80% or higher on their post-test or raise their score by at least 20%. (See
performance measures in the Activities and Outcomes Summary.)
An additional program measure is that senior girls who participate in the Girls Inc. Mentoring and
Leadership Program will graduate. Last year (2014) 97% of senior girls participating in Girls Inc.
programs graduated and 97% were planning to attend college.
5) Who will the program benefit? How many people? What age group? What geographic area
will it serve? Please include geographic boundaries.
Girls Inc. at Eastern Hills High School will benefit girls and their families residing in the 76112 Zip code
area in East Fort Worth. 100 girls ages 14-18 will be served annually by the programs listed in this
proposal Over 300 girls are served in total annually with support from other sources.
6) What makes this program unique from any other crime prevention program in Fort Worth?
The Girls Inc. Mentoring and Leadership Program at EHHS is particularly unique because it gives girls an
opportunity to take Girls Inc. as an elective course that provides them with skills to help their academic
and personal success.
Girls Inc. of Tarrant County is also unique in that our programming is based on nationallv-researched
curriculum that addresses the gender -specific risk factors that make girls vulnerable to participating in
violent behavior, abusing illegal substances, bullying and other problems including truancy, academic
failure, high school dropout and engaging in early/risky sexual behavior. Girls Inc 's national
organization includes a National Resource Center (NRC) in Indianapolis which serves as the research,
information services, and training site on gender -specific issues. Research and evaluation conducted by
the NRC provide the foundation for Girls Inc. programs.
7) Is the program already in operation? If so, how long have you operated the program? What
resources are used to operate the program? Why are CCPD funds necessary at this time?
RFP No. 14-0106, FY 2015 Community Based Programs, Page 8
The program, which began in 2012, is in operation. Resources used to operate the program include:
• Donated space (annex building) by Fort Worth ISD and Eastern Hills High School
• Rented office space for staff (2100 N. Main, Fort Worth, 76164) computers, copiers,
telephone/Internet service, office supplies
• Project supplies utilized in program deliver (curricula, handouts, art supplies, videos, paper, pens,
markers, construction paper, magazines, printer, projector, and more)
• Girls Inc. laptop computers and tablets are utilized by participating girls to research and explore
college and career options, apply for scholarships and FAFSA, and complete college applications.
• In -kind donations of project and office supplies, tickets to events and activities
• Girls Inc van to transport girls to/from offsite activities
• Funding from foundation grants, individual contributions, United Way, and special events
• Staff, Interns and volunteers
Why are CCPD funds necessary at this time?
The Girls Inc at Eastern Hills High School program was originally partially funded with a Title I
Education grant which is no longer available and Girls Inc. has been working to establish additional
funding streams to sustain the program. The program is based on community need — creating a safe and
empowering space for girls in a community that has high rates of poverty, crime, drug and alcohol abuse,
and other urban problems so that the girls can build the skills they need to resist involvement in
delinquent and detrimental behavior, and work toward positive change in their lives as well as their
community. Girls Inc. increases the likelihood that girls will graduate — at a high school where 20% of
girls drop -out — 97% of Girls Inc. seniors graduated and 97% were planning to attend college.
8) Is this a new program? No
If so, what other funds have you applied for? n/a
Also, please describe the sequence of steps needed to implement your program and the
timeframe in which this will occur. n/a
9) Briefly describe the specific expenditures planned for CCPD funding. You MUST fully complete
attached budget forms.
Program expenditures include a portion of salaries and benefits of the program director and facilitator,
stipends for interns transportation costs to transport girls to/from offsite program activities,
program/office supplies and field trip expenses.
10) If funds are awarded, will this program continue beyond the CCPD funding period?
Please explain your plan to sustain this program.
The agency's financial stability is built on a foundation of state and federal grants, United Way funding,
and support from foundations and corporations, individual donations and special events. Girls Inc. of
Tarrant County also reinvests the income earned through our child care programs into the programs and
services that fulfill our mission. The Board, President/CEO, and management team are working to
strengthen the agency's fundraising capacity on all levels — individual and corporate contributions, special
events, online giving, mail appeals, auctions, and government grants as well as foundations — and are
committed to expanding and diversifying funding resources for the agency Our commitment to growing
and sustaining the number of girls we serve and continuing to expand programs, activities and
opportunities for our girls translates into a strong commitment to continuing to develop the financial
resources to meet those goals.
And this is not just about a "number" but about the realization that each "number' is an individual girl
whose life that we have the opportunity to touch and to help her reach positive outcomes — to avoid
participating in bullying violence, or other delinquent activity and instead to develop positive life skills,
to succeed academically, to graduate high school and plan for post -secondary education.
RFP No. 14-0106, FY 2015 Community Based Programs, Page 9
A
PROGRAM ACTIVITIES & SCHEDULE
Organization: Girls Incorporated of Tarrant County Program Title: Girls Inc. Mentoring and Leadership Program at EHHS
Please indicate month(s) when each program activity will occur by placing an "X" in the month column.
ACTIVITY
Girls Beyond Bullying curriculum
(note: There are seven class periods and two semesters, so activities may
occur concurrently or at different times of the school year depending on
how it is scheduled by the Program Director)
B Friendly PEERsuasion° substance abuse prevention curriculum
(note: There are seven class periods and two semesters, so activities may
occur concurrently or at different times of the school year depending on
how it is scheduled by the Program Director)
C Economic Literacy®
(note: There are seven class periods and two semesters, so activities may
occur concurrently or at different times of the school year depending on
how it is scheduled by the Program Director)
OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEPT
x x x x x x x x x
x x x x x x x x x
x x x x x x x x x
D Media Literacy° x x x x x x x x x
(note: There are seven class periods and two semesters, so activities may
occur concurrently or at different times of the school year depending on
Jzow it is scheduled by the Program Director)
E Additional activities include: Academic Advisement and x x x x x x x x x
F
G
Mentoring, Safe in My World, community service projects
through Girls Inc. Leadership and Community Action
curriculum, College and Career Readiness, and field trips
RFP No. 14-0106, FY 2015 Community Based Programs, Page 10
Exhibit B
Budget
FORT WORTH
CRIME CONTROL
& PREVENTION DISTRICT
Budget Summary
Total Budget: $33,366.00
I DIRECT PROGRAM COSTS (90% Minmum) _
A. PERSONNEL
Myra Payen- Program Director ($17.12hr x 1,040 hrs)
Zaida Jasso - Program facilitator ($10.00hr x 700 hrs)
PERSONNEL TOTAL:
Total: $33,366.00
$17,805.00
$7,000.00
$24,805.00
B. FRINGE BENEFITS
Myra Payen - Program Director $4,033.00
• 10% health insurance, 7.65% FICA, and 5% short
term disability (22.65% of $17,805.00)
Zaida Jasso - Program facilitator $535.00
• 7.65% FICA total of $7,000.00 _�
FRINGE BENEFITS TOTAL $4,568.00
C. TRAVEL AND TRAINING _
Van transportation- fuel costs for clients' transportation $250.00
to/from field trips & community projects (500 miles @ .50
per mile)
Staff mileage to/from community meetings (600 miles/yr x $300.00
.50)
TRAVEL AND TRAINING TOTAL $550.00
D. EQUIPMENT
Laptop computers for program director & facilitator (2)
EQUIPMENT TOTAL
E. SUPPLIES
Supplies and field trips - paper, pens, pencils, paperclips,
markers, highlighters, thumbtacks, binder clips, glue, stapler,
staples, notepads, correction tape, business cards, postage,
sticky notes, self -stick wall easel pads, notebooks/binders,
files, folders, ink/toner, spiral notebooks, Journals,
incentives, snacks, scissors, construction paper, poster board,
magazines (for Media Literacy), educational dvds,
educational posters art supplies, field trip admissions,
envelopes, flash drives, tape, duct tape, card stock, craft
paint, beads batteries, rubber bands, crayons color pencils,
stickers, paper plates, cups, plastic ware, trash bags, storage
bags, and other supplies needed for program preparation,
marketing, and delivery. Averages $305 per month for 9
months.
$700.00
$700.00
$2,743.00
SUPPLIES TOTAL $2,743.00
F. CONTRACTS/CONSULTANTS
None _ $0.00
CONTRACTS/CONSULTANTS TOTAL 1 $0.00
INDIRECT PROGRAM COSTS (10% Maximum) Total: $0.00 _
FORT WORTH
CRIME CONTROL
& PREVENTION DI37RILr
A. PERSONNEL
None
B. FRINGE BENEFITS
None
FRINGE BENEFITS TOTAL
PERSONNEL TOTAL: 1
G. OTHER APPROVED
None
OTHER APPROVED TOTAL
MEIER IN
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Exhibit C
Request for Reimbursement
ORT WORTH
CRIME C %tRO4
AND PREVENTION ULSTRICI
Submit To:
Bob Bolan Public Safety Complex
Attn: Tiffany Hayes
Program Support Division
505 West Felix St.
Fort Worth, TX 76115
A
B
C
D
E
F
A
B
C
D
E
F
i
Request for Reimbursement (RFR)
FY 2016
A
Budget Category Budget Amount
Personnel
Fringe Benefits
Travel K Training
Equipment
Supplies
Contracts/Consultants
Total Direct Costs
A
Budget Category Budget Amount
Personnel
Fringe Benefits
Travel R Training
Equipment
Supplies
Contracts/Consultants
Total InDirect Costs
s
Supporting documents required with monthly requests.
This includes. timesheets depicting CCPD funded activities.
copy of pawhecks. invoices and receipts detailing all CCPD
funded expenditures.
B
Total of Previous
Reimbursements
Requested
Submitting Agency:
Contact Name:
Phone Number:
Email:
Remit Address:
Invoice Number:
Month of Request:
DIRECT COSTS (90 % Minimum)
B
Total of Previous
Reimbursements
Requested
This Month's
Request
$ - Is
$
s
D
(B+C)
Total Requested
To -Date
INDIRECT COSTS (10 % Maximum)
C D
$
This Month's
Request
$
(B+C)
Total Requested
To -Date
Alp
s
$
S
s
Summary:
Total Budget: $
Previous Requests: $
This Request: $
Total Requested To -Date $
Remaining Funds $
E
(A-D)
Remaining Balance
Available
E
(A-D)
Remaining Balance
Available
t have reviewed this request and certify that these listed expenses and support documentation are accurate.
Authorized Signatory
Pnrclase Order #
RFR Approved For Purulent
Grant Staff Signature
Dale
Finance Received Stamp Placed Below
Signatory Title
Fiscal Agent Use Only
Fund
Dept. 7D
Date
Account
IMP
Alm
•
Exhibit D
Program Activities Report
FORT WORTH
CRIME CONTROL
& PREVENTION DISTRICT
Fiscal Year 2016
Monthly Program Activities Report
Current Reporting Month
Submitting Agency Girls Inc. of Tarrant County
Contact Name Becky Balarin
Phone Number and Email 817-259-1050
Remit Address 2820 Matlock Rd., Arlington, TX 76015
Activity
1 Girls Beyond Bullying Curriculum Delivery class unduplicated attendees
2 Girls Beyond Bullying Curriculum Delivery class number of hours
3 Friendly PEERsuasion Curriculum Delivery class unduplicated attendees
4 Friendly PEERsuasion Curriculum Delivery class number of hours
5 Economic Literacy Curriculum Delivery class unduplicated attendees
6 Economic Literacy Curriculum Delivery class number of hours
7 Media Literacy Curriculum Delivery class unduplicated attendees
8 Media Literacy Curriculum Delivery class number of hours
9 Academic Advisement and Mentoring unduplicated attendees
10 Safe in My World unduplicated attendees
11 Community service projects unduplicated attendees
12 College and Career Readiness unduplicated attendees
Current 1 To Date Year
Month Total End
Total Goal
100
1,275
100
1,445
100
1,275
100
1,020
18
50
100
100
FORT WORTH
CRIME CONTROL
& PREVENTION DISTRICT
13 Number of field trips
I have reviewed this report and certifr that the measures provided are accurate and appropriately reflect the
CCPD goals set forth in the contract.
Authorized Signatory
Signatory Title Date
Exhibit E
Program Effectiveness
Measurement Report
FORT WORTH
CRIME CONTROL
& PREVENTION DISTRICT
Current Reporting Quarter
Submitting Agency
Contact Name
Phone Number and Email
Remit Address
Fiscal Year 2016
Quarterly Program Effectiveness Measurement Report
Girls Inc.
Please include outcome narrative that describes how measure was accomplished for each quarter.
Effectiveness Measures and Quarterly Outcomes
Measure 1 80% of girls participating in the Girls Beyond Bullying program will score 80% or better on their
post-test, or will increase their score by 20% or more.
Outcome
Measure 2 80% of girls participating in the Friendly PEERsuasion R program will score 80% or better on their
post-test, or will increase their score by 20% or more.
Outcome
Measure 3 80% of girls participating in the Economic Literacy R program will score 80% or better on their
post-test, or will increase their score by 20% or more.
Outcome
Measure 4 80% of girls participating in the Media Literacy R program will score 80% or better on their post-
test, or will increase their score by 20% of more
Outcome
Measure 5 90% or more of EHHS seniors participating in Girls Inc. will graduate high school and have a plan
for college.
Outcome
I have reviewed this report and certln) that the measures provided are accurate and appropriately reflect the
CCPD goals set forth in the contract.
Authorized Signatory
Signatory Title Date
Report due each quarter: 1st Quarter (Oct -Dec) due January 15 2"d Quarter (Jan -Mar) due April 15
3rd Quarter (Apr -June) due July 15 4th Quarter (Jul -Sep) due October 15
Exhibit F
Request for Budget Modification
•
•
•
FORT WORTH
CRIME CONTROL
& PREVErmon Dzsnucr
Up to 5% of any budgeted line -item does not need prior approval but form must be sent to City with monthly RFR
More than 5% of any budgeted line -item must have prior City approval
An increase in a zero line -item must have prior City approval
Modifications cannot be made between Direct and Indirect costs
Date
Submitting Agency
Contact Name
Phone Number and Email
Remit Address
Budget Category
Personnel
Supplies & Equipment
Program Services
Travel and Training
Other Approved
Total Direct Costs
Exhibit F
Request for Budget Modification
Fiscal Year 2016
DIRECT COSTS (90% minimum)
Approved Budget Change Requested
INDIRECT COSTS (10% maximum)
Budget Category Approved Budget Change Requested
Personnel
Supplies & Equipment
Operational Services
Travel and Training
Facilities & Utilities
Other Approved
Total Indirect Costs 1
Revised Budget
Revised Budget
Modification Narrative (describe in detail what change is for)
I have reviewed this request and certf, that the listed modifications are correct.
Authorized Signatory
CI Modification Approved
FWPD Staff Signature
Signatory Title
FWPD STAFF USE ONLY
Date
Modification NOT Approved
Date