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AGREEMENT FOR COMMUNITY BASED PROGRAM
CAMP FIRE FIRST TEXAS
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 CAMP FIRE FIRST TEXAS, a
Texas private non-profit corporation ("Contractor") acting by and through Ann Sheets, 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 Step
Up Truancy Prevention and School Completion Program, 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 Step
Up Truancy Prevention and School Completion 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 $24,547.00 ("Program
Funds") to provide to the Contractor for the operation of the Step Up Truancy Prevention and
School Completion 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
5. Exhibit D — Program Activities Report
FY 2016 Community Based Program
Camp Fire First Texas
OFFICIAL RECORD
CITY SECRETARY
F7'. WORTH, TX
Page 1 of 12
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 in the body of this Agreement, the
terms and conditions of this Agreement control
1. Resnonsibilities of Contractor.
AGREEMENT
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 Step Up Truancy Prevention
and School Completion Program. 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 $24,547.00 ("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.
Contractor 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 Contractor or duly authorized
officer of the Contractor. 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 Program Activities Report from the Contractor. 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 from City. However, Contractor
must submit the Request for Budget Modification Form (Exhibit "F") to City, with the monthly
RFR, during the month the modification took place. The new modified budget cannot exceed the
total amount of Program Funds
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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 are 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 Program Effectiveness Measurement Reports shall be
submitted to City no later than the 15`h day after the end of each month.
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
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later than the 15th day after the end of each month. Should Contractor 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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5.6 Within thirty (30) days following the date of termination of this Agreement, Contractor
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. Contractor shall maintain all equipment used in the
administration and execution of the Step Up Truancy Prevention and School Completion
Program. Contractor shall maintain replace or repair any item of equipment used in support of
the Step Up Truancy Prevention and School Completion 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 Step Up Truancy Prevention and
School Completion Program and/or for use under the terms of this Agreement is the sole
responsibility of Contractor. Contractor shall not use Program Funds or City funds to repair or
replace said equipment. Contractor shall use any and all equipment purchased with Program
Funds exclusively in support of the Step Up Truancy Prevention and School Completion
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 Contracts
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/or 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
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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 Step Up Truancy Prevention and School Completion 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 Contractor under this Agreement, and
8. Independent 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 LL4BLE 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
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DAMAGE OR LOSS (INCLUDING ALLEGED DAMAGE OR LOSS TO OWNER'S
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, offices or employee of City or its designees or agents; no member of the
governing body of the locality in which the Step Up Truancy Prevention and School Completion
Program is situated; and no other public official of such locality or localities who exercises any
functions or responsibilities with respect to the Step Up Truancy Prevention and School
Completion 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.
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12. Nondiscrimination.
Contractor, for itself, its personal representatives assigns, subcontractors and successors in
Interest 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, program 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 officers, 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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(a) Commercial General Liability (CGL)• $1,000,000 per occurrence, with a $2,000,000.00
annual aggregate limit in a form that is acceptable to the City's Risk Manager.
(b) Non -Profit Organization Liability or Directors & Officers Liability: $1,000,000 per
occurrence, with a $1,000,000 annual aggregate limit, in a form that is acceptable to the
City's Risk Manager.
(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 currently 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, written 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 for policies of
worker's compensation or accident/medical insurance shall list the City as an additional
insured. City shall have the right to revise insurance coverage requirements under this
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 from
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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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 or 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 or 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:
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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: Ann Sheets President and Chief Executive Officer
CAMP FIRE FIRST TEXAS
2700 Meacham Boulevard
Fort Worth TX 76137
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Camp Fire First Texas Page 11 of 12
IN WITNESS WHEREOF, the parties hereto have executed th.
Fort )Worth, Tarrant County, Texas,
20)) .
APPROVED AND AGREED FOR
CITY OF FORT WORTH
\lab PL-7*
• v
Valerie R. Washington
Assistant City Manager
Date: Lot511‘
APPROVAL RECOMMENDED
to be effective this
(Moa,s°--
Rhon• a K. Robertson
Chief of Police
Date:
/0--105-45
APPROVED AS TO FORM AND
LEGALITY FOR CITY OF FORT
WORTH
ViNfols40 -0/
Victoria D. Honey
Assistant City Attorney
Date:
piq Sa
FY 2016 Community Based Program
Camp Fire First Texas
agreement i i lti les in
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APPROVED AND AGREED FOR
CAMP FIRE FIRST TEXAS
c__:\/\. V\
Ann Sheets
President and Chief Executive Officer
Date:
2211C
APPROVED AS TO FORM AND
LEGALITY FOR CAMP FIRE
FIRST TEXAS
Camp Fire First Texas Attorney
Date:
City cretary
Date:
M&C No.
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
NO MIS° REQUIRED
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Page 12 of 12
Exhibit A
Proposal Abstract and Narrative
CONTRACTOR:
DIRECTOR:
]PHONE NUMBER: 817 831-2111
PHYSICAL ADDRESS:
CONTACT PERSON: Ludi Navarro
PHONE NUMBER: 817 831-2111
PROGRAM TITLE:
+' Y 2014 CRIME CONTROL AND PREVENTION DISTRICT,
PROPOSAL COVER SHEET
Camp Fire First Texas
Zem Neill
2700 Meacham Blvd. Fort Worth TX 76137
EMAIL ADDRESS: Ludi@CampFireFW.org
FAX NUMLBER:
817 831-5070
Step Up truancy prevention and school completion program
CCPD FUNDS REQUESTED: $ 24,547
CONTRACTOR STATUS:
Private Nonprofit
Public Nonprofit
Mark the goal(s) that your program addresses.
i
ve
Support efforts to reduce violent crime 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:
'TITLE:
SIGNATURE:
Zem Neill
President/CEO
DATE: S r / 3 - iJ !
RFP No.15-0193, FY 2016 Community Based Programs, Page 4
AN Camp Fire
First Texas
PROGRAM ABSTRACT
Step Up is Camp Fire First Texas' truancy prevention and school completion program. Step Up
serves primarily Hispanic, low-income youth who reside in 76164 and 76104 zip codes and are
at risk for truancy. Youth from North Side and Diamond Hill Jarvis High Schools and
Kirkpatrick and J.P. Elder Middle Schools may participate in the program.
The primary goal of Step Up is for participants to increase the grade level performance of at -risk
middle and high school students so that they complete high school. In order to achieve this
goal, the program aligns services with the following performance objectives: (1) increase school
attendance, (2) improve grades, (3) increase parent involvement, (4) increase youth's
engagement in school and community, and (5) decrease delinquent behavior.
The major issues that the Step Up program addresses are truancy, poor school achievement,
unhealthy habits including drug and alcohol abuse, gang activity, physical and sexual abuse,
poor anger management, and violence. The goal of the program is to reduce truancy, drop -out
rates, and unhealthy habits among students attending North Side and Diamond Jarvis High
Schools, Kirkpatrick and J.P. Elder Middle Schools, helping them to stay in school, graduate,
and pursue college or career plans after graduation.
•
5
At/
" Camp Fire
First Texas
PROPOSAL NARRATIVE
Camp Fire First Texas respectfully requests an award of $24,547 from the Fort Worth Crime
Control and Prevention District (CCPD) to support the Step Up School Completion Program
(Step Up). The primary goal of Step Up is for participants to increase their grade level
performance and, ultimately, complete high school. In order to achieve this goal, the program
aligns services with the following performance objectives: (1) increase school attendance, (2)
improve grades, (3) increase parent involvement, (4) increase youth's engagement in school and
community, and (5) decrease delinquent behavior.
1. Describe in detail the problem that your program addresses.
The major issues that the Step Up program addresses are truancy, poor school achievement,
unhealthy habits including: drug and alcohol abuse, gang activity, physical and sexual abuse,
poor anger management, and violence. The goal of the program is to reduce truancy, drop -out
rates, and unhealthy habits among students attending North Side and Diamond Hill Jarvis High
Schools, J.P. Elder and Kirkpatrick Middle Schools, helping them to stay in school, graduate,
and pursue college or career plans after graduation.
It is well documented that youth who drop out of school are likely to participate in criminal
activity and become a financial burden on the economy of the local community. Drop -out rates
are usually measured by tracking attrition or by calculating the percentage of 9th graders who
are not enrolled in school four years later. According to a recent report, Fort Worth ISD had a
graduation rate of only 50%, ranking it the 12th worst among the country's 50 largest school
districts. Furthermore, in 2010 (latest year available) North Side and Diamond Hill Jarvis High
Schools had higher than average drop -out rate (6% and 3.9% respectively) compared to the state
average of 2.9%. (httv://www. texas tribune. org/vubZic-ed/exvlore/fort-worth-sd/diainond-hilt-iarvts-
high-school/) Step Up serves to reduce this drop -out rate.
The non -completion of high school is an indicator of the increased likelihood for delinquent
behavior, criminal activity, and future incarceration. According to the Alliance for Excellent
Education, for every 40 students who complete high school, over half a million dollars is added
to the Tarrant County economy each year. Furthermore, it is estimated that the 90 graduates
completing the Step Up program in 2014 would contribute over $180 million in the form of
wages, taxes, and purchases over the course of their lifetimes. On the other hand, the
community spends $200,000-$300,000 per student drop out for costs associated with law
enforcement interaction, incarceration, and welfare.
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According to the Bill and Melinda Gates Foundation, the clearest early indicator of future
dropouts is persistent absenteeism. Other indicators include low grades, behavior problems,
lack of school involvement, and grade retention. 68% of students at North Side High school are
considered at -risk for dropping out. To that end, Step Up strives to proactively address these
indicators.
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.
The Step Up program works to reduce violent crime and gang activity in the program service
area by reducing truancy rates and increasing school completion. According to Creating Safe and
Drug Free Schools: An Action Guide, truancy is a gateway to crime. High rates of truancy are
linked to high daytime burglary rates and high vandalism. Truancy is the most powerful
predictor of juvenile delinquent behavior. "I've never seen a gang member who wasn't a truant
first," says California District Attorney Kim Menninger. The Camp Fire Director of Teen
Services and Program Speciahst work with the court and school systems to establish a path for
success for truant youth in the Step Up program. Weekly attendance monitoring and regular
communication with school counselors, teachers, and parents ensure students receive the
support they need to stay in school.
Camp Fire program staff focus on increasing the safety and reducing crime in the affected
neighborhoods through community and parental involvement. Step Up program participants
engage in community service projects, teaching them the importance of volunteerism and
engaging them in their neighborhood. Step Up works with parents to increase their engagement
in the community as well. The characteristics of a student s family may include parent(s) who:
do not value education, did not complete school, were truant themselves, have poor parenting
skills, are of low socio-economic status, have a family history of delinquency, are single parent
families, or have many children in the family Step Up helps identify these issues and will work
with families to identify social service organizations that can help them. This adds to the
stability of the household and supports the learning environment for the student.
The program increases the safety of youth and works to reduce juvenile crime through weekly
group sessions, many with a focus on crane prevention. Step Up utilizes the research -based
Step-It-Up-2-Thrive curriculum, created by Thrive Foundation For Youth. Step-It-Up-2-Thrive is
a theory of change with four stages. The first stage is identification of youths' sparks, followed
by development of a growth mindset. The third stage encourages youth self -reflection about
indicators of thriving and risk factors in the way. The fourth stage builds youths' goal
management skills, or what we term GPS (Goal selection, Pursuit of strategies, and Shifting
gears in the face of challenge). The full Step-It-Up-2-Thrive process motivates youth to achieve
personal development goals.
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They also receive education and information on truancy issues and laws, making each student
aware of the consequences of their behavior.
The Director of Teen Services and Program Specialist focus on creating a supportive group
atmosphere, as well as providing individual life skills training which includes conflict
resolution, communication skill building, and goal setting. Staff then works individually with
students, mentoring them on specific needs.
The program also extends into the summer so that students remain connected to their families,
schools, and communities. During this time, participants help plan for and coordinate service -
learning projects, often alongside community volunteers. Through these projects and
educational field trips, Step Up participants not only contribute to their local community, but
also further develop personal skills and learn about career preparation.
In 2014, actively engaged participants significantly increased academic performance as
compared to their non -engaged peers. Students who attended all sessions increased their GPA
by 22% as opposed to those who did not participate regularly and had a 4% drop in GPA. The
one-on-one mentorship offered through Step Up helps to achieve a 100% graduation rate each
year since 2010, as well as more than 90% next grade level achievement in participating youth.
This resulted in positive behavior and reduction in risk factors including: decreased drug and
alcohol abuse, decreased gang activity, decreased interaction with law enforcement, and
increased involvement in community and service -learning activities.
3. Does your program address the CCPD priority/special emphasis of the prevention or
intervention of youth violence and/or family violence? Describe how your program
addresses this priority.
Step Up addresses family violence, abuse awareness and recognition prevention efforts, and
protocol for safely escaping from an abusive situation. This is done through home visits, phone
calls, PTA meetings, and presentations at community centers. In addition, several group
sessions throughout the year focus on abuse and violence prevention and reporting, by bringing
in outside experts such as: law enforcement, counseling, and abuse prevention experts. This
program focus has led to successful interventions for a number of program participants.
The Director of Teen Services and Program Specialist also work closely with community
partners that address abuse and provide safe housing and tools for individuals from abusive
situations.
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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.
Step Up program success is measured by assessing a variety of participant performance
indicators including: school attendance (monitored weekly) progress and grade reports
(monitored in 3-week intervals), attitude, juvenile delinquent incidents, and participation in
program activities. The Director of Teen Services and Program Specialist regularly meet with
teachers, counselors, the Stay -in -School coordinators, principal, and other relevant school staff to
discuss student progress and school collaborations. The evaluation will be conducted utilizing
the following multi -model tools:
a. Pre -Post retrospective survey. With the retrospective pretest, participants are asked
to share the knowledge or attitude they had toward a particular subject before they
participate in the Step Up program, and after. When participants are asked to respond
to a question about how much they know about a particular subject after they have
some basic knowledge of the subject itself, they are more able to accurately reflect on
the degree of change in knowledge or attitude (Rockwell (St Kohn, 1989).
b. Observation reports from the Program Specialist
c. Academic reports provided by school (with parental consent) — attendance reports,
progress reports, report cards, and other academic records
d. Notes from school faculty and parent(s)/guardian(s)
e. Referral tracking from community providers
5. Who does the program benefit? How many people? What age group? What geographic
area will it serve? Please include geographic boundaries.
Step Up focuses on serving primarily low-income youth ages 11-18, who reside in the 76164 and
76104 zip code areas, attend North Side or Diamond Hill Jarvis High Schools, Kirkpatrick or J.P.
Elder Middle Schools, and who have been identified as truant. The program is operated at the
schools during the school year, and at neighborhood community centers during the summer.
Camp Fire First Texas anticipates that it will serve a total of 90 students in the 2015 — 2016
program year.
The definition of truant behavior used for the purpose of the program ranges from moderate
truancy levels that affect the student's grades to excessive truancy where students face truancy
court and a possible mandated exit from school. The target population is primarily Hispanic
students In addition, participants often are identified with additional risk factors associated
with juvenile delinquency including, but not limited to: poor expressive language, lack of self-
control, impulsiveness, aggressive temperament, poor social skills, friends who engage in
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problem behaviors low school attendance, parents with low academic attainment, parents who
were teen parents, high parental conflict, a family history of problem behaviors, low grade point
average, and a history of mistreatment.
6. What makes the program unique from any other crime prevention program in Fort
Worth?
The Step Up program is unique in both its high success rate as well as the scope of activities and
educational opportunities offered. Over the past 4 years the program has had a 100% success
rate of participating seniors graduating and continuing on to college or vocational school.
Moreover, 90% of participating youth moved on to the next grade level with improved grades,
attendance, and attitude.
Also unique to Step Up are the opportunities that students receive through outreach events,
family services, school services, field trips, guest speakers, and outdoor education. Students
attend outdoor programs at Camp Fire Camp El Tesoro in Granbury, Texas and go on field trips
to museums, local universities, and community colleges. They participate in educational
projects led by local experts. Moreover, Camp Fire works with community partners like
Northside Inter -Community Agency, Fort Worth Museum of Science and History, Cornerstone
Assistance Network, Beautiful Feet, and Communities in Schools to provide service projects for
participants. These opportunities, along with crime prevention education and the academic
success rate of the program, make it unlike any other school -based crime prevention program in
the community.
7. Is the program already in operation? If so, how long have you operated the program?
What resources are currently used to operate the program? Why are CCPD funds
necessary at this time?
This is the fifth year the Camp Fire has operated the Step Up program. The one-on-one
mentorship offered through Step Up helps to achieve a 100% graduation rate each year since
2010, as well as more than 90% next grade level achievement in participating youth. This
resulted in positive behavior and reduction in risk factors including: decreased drug and
alcohol abuse, decreased gang activity, decreased interaction with law enforcement, and
increased involvement in community and service -learning activities In 2014, actively engaged
participants significantly increased academic performance as compared to their non -engaged
peers. Students who attended all sessions of Step Up increased their GPA by 22% as opposed to
those who did not participate regularly and had a 4% drop in GPA.
Resources currently used to operate the program include grants from foundations, CBDG and
CCPD program funds. the program is implemented through a team of staff including the
Director of Teen Services, a Program Specialist, Vice President of Group Services, Director of
Program Quality, and Administrative Assistant for Group Services, who ensure its ongoing
success. We have submitted a proposal for CDBG funds for the 2015 — 2016 program year, and
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continue to solicit foundations for support of the program. CCPD funds are necessary to fully
and successfully maintain the program during the 2015 - 2016 program year.
8. Is this a new program? If so, what other funds have you applied for? Also, please
describe the sequence of steps needed to implement your program and the tisneframer in
which this will occur.
N/A. This is not a new program; it is in its 5th year of operation.
9. Briefly describe the specific expenditures planned for CCPD funding. You MUST fully
complete attached budget forms.
The requested funds will be utilized as follows:
Description
Salaries: Vice President, Group Services, 5%
Salaries: Administrative Assistant, Group Services 23%
Health Insurance
Retirement (3%)
FICA/workers comp/unemployment (9.25%)
Travel: Mileage for Director of Teen Services, 4,573 miles @ $.045
Travel: Mileage for FT Program Specialist, 2,256 miles @ $.045
Travel: Field trips for Step Up program participants @ $100 each
Supplies: Notebooks, pens, snacks & new curriculum
Supplies: Printing
Supplies: Postage
Supplies• Dues & subscriptions
Supplies• Insurance
Supplies: Miscellaneous
Supplies: Telephone
Contracts: Program enhancement leadership
Contracts: Training for staff on new curriculum
TOTAL REQUEST i
Amount
$3,500
$5,750
$1,675
$278
$856
$2,057
$1,016
$997
$5,088
$333
$71
$78
$234
$553
$319
$742
$1,000
$24,547
10. If funds are awarded, will this program continue beyond the CCPD funding period?
Please explain your plan to sustain this program.
Camp Fire intends to continue to operate the successful Step Up program for years to come.
Camp Fire has an annual strategic plan to raise the funds necessary to provide critical programs
and services to the community. Fundraising methods include a variety of strategies such as
individual solicitations, direct response appeals, special events, third party promotions and
events, funding proposals, corporate sponsorships and collaborations, and planned giving
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(bequests, annuities, etc.) An assortment of communications and marketing strategies support
and enhance fundraising efforts.
To ensure the ongoing availability of services, Camp Fire First Texas has established a
comprehensive development plan that enables the organization to identify and secure financial
support of programs. The organization's development management system is utilized to
identify potential donors, track contributions, and monitor the continuing reporting
requirements necessary to fulfill our obligations to funders. Additionally, on -going
communication between the development staff, executive leadership, and the Board of
Directors provides a continuous cycle of donor development to ensure the review of all
identified funding opportunities and determination of feasible options to coordinate the
preparation and submission of funding requests.
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PROGRAM ACTIVITIES & SCHEDULE
Organization: Program Title:
Please indicate month(s) when each program activity will occur by placing an "X" in the month column.
ACTIVITY OCT NOV DEC JAN FEB MAR APR MAY JUN JULY AUG SEPT
A Small group
sessions at x x x x x x x x x
school
B Summer
program x x x
sessions
C Supportive
educational x x x x x x x x x x x x
activities
D
E
F
G
RFP No.15-0193, FY 2016 Community Based Programs, Page 13
Exhibit B
Budget
FORT WORTH
CRIME CONTROL
& PREVENTION DISTRICT
Budget Summary
Total Award: $24,547.00
DIRECT PROGRAM COSTS (90% Minimum)
A. PERSONNEL
Director of Teen Services (624 hrs.)
PERSONNEL TOTAL:
B. FRINGE BENEFITS
None
FRINGE BENEFITS TOTAL
C. TRAVEL AND TRAINING
Mileage for Director of Teen Services and Program
Specialist (6,829 @ $.45 miles)
Field trips for participants _
TRAVEL AND TRAINING TOTAL
D. EQUIPMENT
None
EQUIPMENT TOTAL 1 $0.00
Total
$12,059.00
$12,059.00
$0.00
$0.00
$3,073.00
$997.00
$4,070.00 I
$0.00 �
E. SUPPLIES
Notebooks, pens, snacks, curriculum $5,088.00
Printing 1 $333.00
Postage 1 $71.00
Dues 1 $40.00
Subscriptions 1 $38.00
Insurance 1 $234.00
Telephone (Cell phone for Director of Teen Services and $319.00
Program Specialist)
Miscellaneous (Background checks, office supplies, $553.00
recognition awards, and membership/registration fees for
student activities )
SUPPLIES TOTAL
F. CONTRACTS/CONSULTANTS
Program enrichment leadership
Staff training
CONTRACTS/CONSULTANTS TOTAL
INDIRECT PROGRAM COSTS (10% Maximum) Total: $0.00
A. PERSONNEL
None
PERSONNEL TOTAL:
B. FRINGE BENEFITS
None
FRINGE BENEFITS TOTAL
G. OTHER APPROVED
i
$6,676.00
$742.00
$1,000.00
$1,742.00
$0.00 �
$o.00
$0.00 j
$o.00
FORT WORTH
CRIME CONTROL
& PREVENTION DISTRICT
I None
OTHER APPROVED TOTAL
iI
$o.00
$0.00 j
1
Exhibit C
Request for Reimbursement
FORT WORTH --ear°
CRIME CONTROL
AND PRI VE,V'I IoN VLStMC
Submit To:
Bob Bolan Public Safety Complex
Attn: Tiffany Hayes
Program Support Division
505 West Felix St.
Fort Worth, TX 76115
A
B
Ic
ID
IE
IF
A
Budget Category Budget Amount
Personnel
Fringe Benefits
Travel & Training
Equipment
Supplies
Contracts/Consultants
Total Direct Costs
Request for Reimbursement (RFR)
FY 2016
S
A
Budget Category Budget Amount
A Personnel
B Fringe Benefits
C 'Travel & Training
D 'Equipment
E 'Supplies
F I Contracts/Consultants
(Total InDirect Costs
s
Supporting documents required with monthly requests.
This includes, timesheets depicting CCPD funded activities,
copy of paychecks, invoices and receipts detailing all CCPD
funded expenditures.
Submitting Agency:
Contact Name:
Phone Number:
Email:
Remit Address:
Invoice Number:
Month of Request:
DIRECT COSTS (90% Minimum)
B
Total of Previous
Reimbursements
Requested
$
C
This Month's
Request
MD
1
1
I$
D
(B+C)
Total Requested
To -Date
INDIRECT COSTS (10% Maximum)
B
$
Total of Previous
Reimbursements
Requested
C
This Month's
Request
D
(B+C)
Total Requested
To -Date
$
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
I have reviewed this request and certify that these listed expenses and support documentation are accurate.
Authorized Signatory
Purchase Order #
RFR Approved For Payment
Grant Staff Signature
1
Date
Finance Received Stamp Placed Below
Signatory Title
Fiscal Agent Use Only
Fund Dept ID
•
Date
Account
I
Oa
Exhibit D
Program Activities Report
FORT WORTH
CRIME CONTROL
& PREVENTION DisrRlcr
Current Reporting Month
Submitting Agency
Contact Name
Phone Number and Email
Remit Address
1
2
3
4
Fiscal Year 2016
Monthly Program Activities Report
Camp Fire First
Activity
Small group sessions at schools includes goal setting, recognizing barriers
to success, problem solving, Step-It-Up-2-Thrive curriculum
Number of unduplicated participants attending the small group sessions
during school year
Summer program sessions include service learning, conflict resolution,
socially -appropriate behaviors, and citizenship.
Number of unduplicated participants attending the summer program
sessions
5 Supportive educational activities include visits to colleges/universities,
panels on interviewing skills, job shadowing, confidence and competence
building activities.
6 Number of participants attending supportive educational activities through
summer and small groups sessions during the year
7
8
Current
Month
Total
To Date
Total
I have reviewed this report and certi that the measures provided are accurate and appropriately reflect the
CCPD goals set forth in the contract.
Authorized Signatory
Signatory Title Date
Year
End
Goal
100
65
12
25
8
65
Exhibit E
Program Effectiveness
Measurement Report
FORT WORTH
CRIME CormtoL
& PREVENTION IItsrRtcr
Current Reporting Quarter
Submitting Agency
Contact Name
Phone Number and Email
Remit Address
Fiscal Year 2016
Quarterly Program Effectiveness Measurement Report
Camp Fire First Texas
Please include outcome narrative that describes how measure was accomplished for each quarter.
Effectiveness Measures and Quarterly Outcomes
50% of participants will Increase school attendance (by 25%)
Measure 1
Outcome
Measure 2 50% or participants will Improve academic performance (by 20%)
Outcome
Measure 3 70% of participants will Increase youth engagement in school and the community by participating
in a supportive educational activity
Outcome
Measure 4
Outcome
Measure 5
Outcome
75% of participants will report a positive difference from pre -post change in at least 4 out of the 6
outcome areas (Confidence, Caring, Character, Competency, Connection, Contribution) thus
Decrease delinquent behavior
I have reviewed this report and certifi) 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) clue January 15
3rd Quarter (Apr -June) due July 15 4th Quarter (Jul -Sep) due October 15
2nd Quarter (Jan -Mar) due April 15
Exhibit F
Request for Budget Modification
FORT WORTH
CRIME CONTROL
& PREVENTION DISTRICT
• 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
Fringe Benefits
Travel & Training
Equipment
Supplies
Contracts/Consultants
Total Direct Costs
Budget Category
Personnel
Fringe Benefits
Travel & Training
Equipment
Supplies
Contracts/Consultants
Total Indirect Costs
Request for Budget Modification
Fiscal Year 2016
DIRECT COSTS (90% minimum)
Approved Budget Change Requested
INDIRECT COSTS (10% maximum)
Approved Budget 1 Change Requested
1
1
Revised Budget
Revised Budget
Modification Narrative (describe in detail what change is for)
I have reviewed this request and cert that the listed modifications are correct.
Authorized Signatory
0 Modification Approved
FWPD Staff Signature
Signatory Title
FWPD STAFF USE ONLY
Date
DModification NOT Approved
Date