HomeMy WebLinkAboutContract 44865 (2)STATE OF TEXAS
COUNTY OF TARRANT
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This contract ("Contract") is made and entered into by and between the City of
Fort Worth (hereafter "City") and Tarrant County Samaritan Housing, Ina (hereafter
"Agency"), a Texas nonprofit corporation. City and Agency may be referred to
individually as a"Party" and jointly as "the Parties".
The Parties state as follows:
WHEREAS, City receives grant monies from the United States Department of
Housing and Urban Development ("HUD") through the Housing Opportunities for
Persons with AIDS Program ("HOPWA") Program, Program No. TX-H-13-F002 Catalog
of Federal Domestic Assistance No. 14.241;
WHEREAS, the HOPWA program is intended to address the needs of eligible
persons associated with the challenge of living with HIV/AIDS and their families;
WHEREAS, Agency submitted a proposal to use HOPWA funds for an eligible
program under the HOPWA Regulations whereby Agency will provide services to low
and moderate income Ciry citizens;
WHEREAS, City citizens, the Community Development Council, and the City
Council have determined that HOPWA programs are needed by the City's citizens;
NOW, THEREFORE, the Parties understand and agree as follows:
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1. INCORPORATION OF RECITALS.
City and Agency hereby agree that the recitals set forth above are true and correct
and form the basis upon which the Parties have entered into this Contract.
2. DEFINITIONS.
In addition to terms defined in the body of this Contract, the terms set forth below
shall have the definitions ascribed to them as follows:
Area I'Vlediau Iucoine or AIVII means the median family incoine for the Fort Worth-
Arlington metropolitan statistical area as established annually by HCTD. The 2013 income
limits are attached hereto as Exhibit "A-1" — 2013 HUD Iucome Limits.
Busiuess Diversity Euterprise Ordinance or BDE means the City's Business Diversity
Ordinance, Ordinance No. 20020-12-2011.
HOPWA PSA CONTRACT 2013-2014 -- TARRANT COUNTY SAMARITAN HOUSING.
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� Y Complete Documeut�tiou means the following documentation as applicable:
• Attachments I, II, and III, with supporting documentation including:
o Proof of expeuse: copies of timesheets, invoices, leases, service
contracts or other documentation showing that payment is due by
Agency.
o Proof of payment: cancelled checks, bank statements, or wire
transfers necessary to demonstrate that amounts due by Agency
were actually paid by Agency.
o Proof of client eligibility: (i) Source Documentation sufficient to
show that clients pat�ticipating in the Program are HOPWA
Eligible Clients; or (ii) documentation other than Source
Documentation to show that clients served by the Program are
HOPWA Eligible Clients.
• Complete Documentatiou shall meet the standards described in the
attached Exhibit "F"- Standards for Complete Documentation.
• Any other document or record reasonably necessary to verify costs spent
and client eligibility for the Program.
DBE means disadvantaged business enterprise.
Director means the Director of the City's Housing and Economic Development
Department.
Effective Date means October 1, 2013.
HED Department means the City's Housing and Economic Development Department.
HOPWA means Housing Opportunities for Persons with AIDS.
HOPWA Eligible Client means a client whose annual income adjusted for family size
does not exceed 80% of AMI using the most current HUD Income Guidelines and
Technical Guidance for Determining Income and Allowances verified by either Source
Documentation or the form in in Exhibit "E" - Form of Iucome Self-Certificatiou.
The client must also have a documented diagnosis of HIV/AIDS.
HOPWA Fuuds means the HOPWA grant funds supplied by City to Agency under the
terms of this Contract.
HOPWA Regulations means regulations found at 24 CFR Part 574 et seq.
HUD means the United States Department of Housing and Urban Development.
HOPWA PSA CONTRACT 2013-2014 -- `TARRANT COUNTY 3AMARITAN HOUSING, INC. 2
` IDIS means HUD's Integrated Disbursement Information System.
Program means the services described in Exhibit "A" — Program Summary.
Reimbursement Request means all reports and other documentation described in
Section 9.
Source Documeutation means any documentation allowed under the definition of annual
income in 24 CFR Part 5.609.
Unduplicated Clients means a count of HOPWA Eligible Clients served once in the
Contract Term. HOPWA Eligible Clients served more than once in the Contract Term
will only be counted once when determining the number of Unduplicated Clients.
3. TERM.
The term of this Contract begins on October 1, 2013 and terminates on September
30, 2014 unless earlier terminated as provided in this Contract.
4. DUTIES AND RESPONSIBILITIES OF CITY.
4.1 Provide HOPWA Funds.
City shall provide up to TWO HUNDRED SIXTY-ONE THOUSAND SIX
HiJNDRED ELEVEN and 35/100 Dollars ($261,611.35) of HOPWA Funds on a
reimbursement of expenses basis, under the terms and conditions herein.
4.2 Monitor.
City will monitor the activities and performance of Agency and any of its
conh•actors, subcontractors or vendors as necessary, but no less than annually.
5. DUTIES AND RESPONSIBILITIES OF AGENCY.
5.1 Required Services.
Agency shall perform the services described in Exhibit "A" — Program
Summary in accordance with the terms and conditions of this Contract.
5.2 Use of HOPWA Funds.
5.2.1. CoYntoliance vviih ��t i�'A Re6uiaiions and Coniraci.
Agency shall be reimbursed for eligible Program costs with HOPWA Funds only
if City determines in its sole discretion that:
HOPWA PSA CONTRACT 2013-2014 -- TARRANT COUNTY SAMARITAN HOUSING, INC. 3
5.2.1.1 Costs are eligible expenditures in accordance with HOPWA
Regulations.
5.2.1.2 Costs are in compliance with this Contract and are reasonable
and consistent with industry narms.
5.2.1.3 Complete Documentation is submitted to City by Agency.
5.2.2 Bud�et•
Agency agrees that HOPWA Funds will be paid on a reimbursement basis in
accordance with Exhibit "S" - Budget. During the term of this Contract, Agency may
submit written requests to increase or decrease line-item amounts in the Budget,
including an explanation of why such increases or decreases are necessary. All such
requests must be approved by the Director in writing, with such approval being in the
Director's sole discretion. If Director approves the Agency's proposed Budget
amendment (as approved, the "Amended Budget"), then the Amended Budget will take
effect on the �rst day of the month following the month in which it was approved by
Directar, unless otherwise specified in the amendment. All requests for Budget
amendments must be submitted by August 15, 2014.
5.2.3 Chan�e in Pro�ram Sud�et.
5.2.3.1 Agency will notify City promptly of any additional funds it
receives for operation of the Program, and City reserves the
right to amend this Contract in such instances to ensure
compliance with HUD regulations govet�ing cost allocation.
5.2.3.2 Agency agrees to utilize funds available under this Contract to
supplement rather than supplant funds otherwise available for
use in the Program.
5.2.4 Payment of HOPWA Funds to A�eucy.
HOPWA Funds will be disbursed to Agency upon City's approval of Agency's
written and signed Reimbursement Requests including submission of Complete
Documentation to City in compliance with Section 9. If Agency expends all funds
budgeted for the Program prior to September 20, 2014, City may hold back a small
amount of the HOPWA Funds until the end of the term. During this interim period,
Agency must continue to submit Reimbursement Requests with an invoiced amount of
$0. It is expressly agreed by the Parties ihat any HOPWA Funds either not speni or noi
approved for reimbursement to Agency shall remain with City.
HOPWA PSA CONTRACT 2013-2014 -- TARRANT COUNTY SAMARITAN HOUSING, irrc. 4
� 53 Pro�ram Performance Milestones.
Agency warrants that the Program will achieve the following milestones:
Failure of Agency to meet these milestones or a material deviation from them as
outlined in this Section 5.3 is a breach of this Contract. For the purpose of this Section,
"material deviation" shall mean more than 10% lower than the specified goal. In the
event of such breach, City reserves the right at its sole option to delay or withhold
payment of Reimbursement Requests, to lower Agency's allocation of HOPWA Funds,
or to terminate this Contract.
5.4 Identify Pro�ram Expenses Paid with HOPWA Funds.
Agency will keep accounts and records in such a manner that City may readily
identify and account for Program expenses reimbursed with HOPWA Funds. These
records shall be made available to City for audit purposes and shall be retained as
required hereunder.
6. CLIENT ELIGIBILITY VERIFICATION.
6.1 Client Eligibility.
Agency will document the eligibility of all prospective clients.
redact the client's personal information and substitute a client number
document client eligibility as follows:
Agency may
Agency will
6. l.l Income.
Agency must verify all new clients' income eligibility with either Source
Documentation or the form attached as Exhibit "E" - Form of Iucome Self
Certi�cation. Agency must use the annual income definition used by 24 CFR 5.609 to
establish client income eligibility and must use the most current HUD Income
Guidelines.
6.1.2 Diagnosis.
Agency must submit a signed, dated statement that the client's file contains
documentation of the client's diagnosis of HIV/AIDS. The HIV/AIDS diagnosis must be
made by a licensed health care provider; a client's self-certification of diagnosis is not
sufiicient. Ageucy should not submit the actual diabnosis to City.
6.1.3 Emergency Need.
For clients receiving short term rental, mortgage or utility assistance, Agency
must also verify and document that the client has an emergency need, such as sudden loss
HOPWA PSA CONTRACT 2013-2014 -- TARRANT COUNTY SAMARITAN HOUSING, INC. 5
t of income, eviction, utility shutoff, or extraordinary and unexpected healthcare costs.
Agency must submit its policy regarding documenting emergency need to City by
October 1, 2013.
6.2 Submissiou of Complete Documeutation.
Agency must submit copies of all eligibility veriiication documentation described
in Section 6.1 with Attachment III in each month's Reimbursement Request for all
Unduplicated Clients served for the first time, and must maintain copies of such
documentation as required under this Contract.
7. ADDITIONAL HOPWA REQUIREMENTS.
Agency agrees to comply with all requirements of the HOPWA Program as stated
in the HOPWA Regulations, including but not limited to the following:
7.1 Environmental Review.
HOPWA Funds will not be paid, and costs cannot be incurred until City has
conducted and completed an environmental review as required by 24 CFR Part 58. The
environmental review may result in a decision to proceed with, modify, or cancel the
funding for the Program. Further, Agency will not undertake or commit any funds to
physical or choice limiting actions as described in any applicable Federal regulations.
Any violation of this provision will (i) cause this Contract to terminate immediately; and
(ii) require Agency to repay to City the HOPWA Funds it has already received and forfeit
any future payments of HOPWA Funds.
7.1.2 Environmeutal Miti�atiou.
If applicable, Agency must take the mitigation actions outlined in Exhibit "A-2"
— Environmental Mitigation Actions. Failure to complete the required mitigation
action is an event of default under this Contract.
7.2 Contract Not Constitutin� Commitment of Funds.
L�� Notwithstanding any provision of this Contract, the Parties agree and
acknowledge that this Contract does not constitute a commitment of funds, and that such
commitment of funds or approval may occur only upon (i) satisfactory completion of
environmental review and receipt by City of an authorization to use grant funds from
HUD under 24 CFR Part 58, (ii) approval of City's 2013-2014 Action Plan, and (iii)
receipt by City of grant agreement from IIUD.
7.3 Ii�onitorin�.
7.3.1 Agency understands and agrees that City will monitor the adequacy and
tiineliness of Agency's performance under the terms of this Contract as well as its
compliance with the HOPWA Regulations. Agency is subject to such monitoring during
the teim of this Contract and for 5 year•s after the Contract term ends. Agency will
provide reports and access to Program files as requested by City for during this 5 year
period. For purposes of this Contract, this 5 year period for monitoring is deemed to
HOPWA PSA CONTRACT 2013-2014 -- TARRANT COUNTY SAMARITAN HOUSING, INC. 6
3 begin on October 1, 2014 and end on September 30, 2019 regardless of whether or not
this Contract is earlier terminated.
7.3.2 Representatives of City, HUD, and the United States Comptroller General
shall have access during regular business hours, upon 48 hours prior notice, to Agency's
ofiices and records pertaining to the use of the HOPWA Funds, and to Agency's officers,
directors, agents, employees, contractors, subcontractors and vendors for the puipose of
such monitoring.
7.3.3 In addition to other provisions of this Contract regarding frequency of
monitoring, City reserves the right to perform desk reviews or on-site monitoring of
Agency's compliance with the terms and conditions of this Contract. After each
monitoring visit, City shall provide Agency with a written report of the monitor's
fmdings. If the monitoring report notes deficiencies in Agency's performance, the report
shall include requirements for the timely correction of said deficiencies by Agency.
Failure by Agency to take the action specified in the monitoring report may be cause for
suspension or termination of this Contract as provided herein.
7.3.4 Agency agrees to likewise monitor the effectiveness of the services and
work to be performed by its contractors, subcontractors and vendors.
7.3.5 This Section 7.3 shall suivive the earlier termination or expiration of this
Contract.
7.4 A�ency Procurement Standards.
Agency shall comply with all applicable federal, state and local laws, regulations,
and ordinances for making procurements under this Contract. Agency shall establish
procurement procedures to ensure that materials and services are obtained in a cost
effective manner. When procuring services to be provided under this Contract, Agency
shall comply at a minimum with the procurement standards at 24 CFR Part 84.40 through
24 CFR Part 84.48.
7.5 Cost Principles/Cost Reasonableness.
Agency shall administer its use of HOPWA Funds in compliance with OMB
Circular A-122, "Cost Principles for Non-Profit Organizations", as amended from time to
time. The allowability of costs incurred for performance rendered shall be determined in
accordance with OMB Circular A-122 as supplemented by the provisions of this
Contract.
7.6 Accowitin� Standards.
Agency agrees to comply with OMB Circular A-110, "Uniform Administrative
Requirements for Grants and Agreements with Institutions of Higher Education,
Hospitals and other Non-Profit Organizations", and agrees to adhere to the accounting
principles and procedures required therein, utilize adequate internal controls, and
maintain necessary supporting and bacic-up documentation for all costs incurred.
HOPWA PSA CONTRACT 2013-2014 -- TARRANT COUNTY SAMARITAN HOUSING, INC. 7
� 7.7 Uniform Administrative Requirements.
Agency will comply with the Uniform Administrative Requirements set forth in
24 CFR Part 57.502 or any reasonably equivalent procedures and requirements that City
may require.
7.8 Terms Applicable to Contractors, Subcontractors and Veudors.
Agency understands and agrees that all terms of this Contract, whether regulatoiy
or otherwise, shall apply to any and all contractors, subcontractors and vendors of
Agency which are in any way paid with HOPWA Funds or who perform any work in
connection with the Program. Agency shall cause all applicable provisions of this
Contract to be included in and made a part of any contract or subcontract executed in the
performance of its obligations hereunder including its obligations regarding the HOPWA
Regulations. Agency shall monitor the services and worlc performed by its contractors,
subcontractors and vendors on a regular basis for compliance with the HOPWA
Regulations and Contract provisions. Agency must cure all violations of the HOPWA
Regulations committed by its contractors, subcontractors or vendors. City maintains the
right to insist on Agency's full compliance with the terms of this Contract and the
HOPWA Regulations and Agency is responsible for such compliance regardless of
whether actions taken to fuliill the requirements of this Contract are talcen by Agency or
by Agency's contractors, subcontractors or vendors. Agency acknowledges that the
provisions of this Section shall survive the earlier termination or expiration of this
Contract.
7.9 Copyri�ht and Patent Ri�hts.
No reports, maps, or other documents produced in whole or in part under this
Contract shall be the subject of an application for copyright by or on behalf of Agency.
HUD and City shall possess all rights to invention or discovery, as well as rights in data,
which may arise as a result of Agency's performance under this Contract.
8. RECORD KEEPING• REPORTING AND DOCUMENTATION
REQUIREMENTS; AUDIT.
8.1 Record Keepin�.
Agency shall maintain a record-keeping system as part of its performance of this
Contract and shall promptly provide City with copies of any document City deems
necessary for the effective fulfillment of City's monitoring and evaluation
responsibilities. Specifically, Agency wili lceep or cause to be kept an accurate record of
all actions taken and all funds spent, with supporting and back-up documentation.
Agency will maintain all records and documentation related to this Contract for 5 years
after the Contract term ends. If any claim, litigation, or audit is initiated before the
expiration of the 5 year period, the relevant records and documentation must be retained
until all such claims, litigation or audits have been resoived. For purposes of this
Contract, this 5 year period for record retention is deemed to begin on October 1, 2014
and end on September 30, 2019 regardless of whether or not this Contract is earlier
terminated.
HOPWA PSA CONTRACT 2013-2014 -- TARRANT COUNTY SAMARITAN HOUSING, INC. 8
8.2 Access to Records.
City and any duly authorized ofiicials of the Federal government will have full
access to, and the right to examine, audit, copy, excerpt and/or transcribe any of
Agency's records pertaining to all matters covered by this Contract for 5 years after the
Contract term ends. Such access shall be during regular business hours and upon at least
48 hours prior notice. For purposes of this Contract, this 5 year period for access to
records is deemed to begin on October 1, 2014 and end on September 30, 2019 regardless
of whether or not this Contract is earlier teiminated.
8.3 Reports.
Agency will submit to City all reports and documentation described in this
Contract in such form as City may prescribe. Agency may also be required to submit a
final performance andlor iinal financial report if required by City at the termination of
this Contract in such form and within such times as City may prescribe. Failure to submit
to City any report or documentation described in this Contract shall be an event of default
of this Contract and City may exercise all of its remedies for default under this Contract.
8.4 Chan�e in Reportin� Requiremeuts aud Forms.
City retains the right to change reporting requirements and forms at its discretion.
City will notify Agency in writing at least 15 days prior to the effective date of such
change, and the Parties shall execute an amendment to the Contract reflecting such
change if necessary.
8.5 Audit.
8.5.1 Entities that Expend $500,000 or more in Federal Funds Per Year.
All non-federal entities that expend $500,000 or more in Federal funds within one
year, regardless of the source of the Federal award, must submit to City an annual audit
prepared in accordance with specific reference to OMB Circular A-133. The audit shall
cover the Agency's fiscal years during which this Contract is in force. The audit must be
prepared by an independent certified public accountant, be completed within 6 months
following the end of the period being audited and be submitted to City within 30 days of
its completion. Agency's audit certification is attached hereto as Exhibit "C" —"Audit
Certification Form" and "Audit Requirements". The Audit Certification Form must
be submitted to City prior to or with the �rst Reimbursement Request. Entities that
expend less than $500,000 a year in Federal funds are exempt from Federal audit
requirements for that year, but records must be available for review or audit by
appropriate officials of the Federal agency, City, and General Accounting Office.
8.5.2 City Reserves the Ri�ht to Audit.
City reserves the right to perform an audit of Agency's Program operations and
finances at any tiine during the term of this Contract and for 5 years after the Contract
Term ends if City determines that such audit is necessary for City's compliance with the
HOPWA Regulations or other City policies. Agency agrees to allow access to all
pertinent materials as described herein for such audit. For purposes of this Conh�act, this
5 year period for City audit is deemed to begin on October 1, 2014 and end on September
30, 2019 regardless of whether or not this Contract is earlier terminated. If such audit
HOPWA PSA CONTRACT 2013-2014 -- TARRANT COUNTY SAMARITAN HOUSING, INC. 9
reveals a questioned practice or expenditure, such questions must be resolved within 15
business days after notice to Agency of such questioned practice or expenditure. If
questions are not resolved within this period, City reserves the right to withhold further
funding under this Contract and/or any future contracts with Agency. IF AS A RESULT
OF ANY AUDIT IT IS DETERMINED THAT AGENCY HAS FALSIFIED ANY
DOCUMENTATION OR MISUSED, MISAPPLIED OR MISAPPROPRIATED
HOPWA FUNDS OR SPENT HOPWA FUNDS ON ANY INELIGIBLE
ACTIVITIES, AGENCY AGREES TO REIMBURSE CITY THE AMOUNT OF
SUCH MONIES PLUS THE AMOUNT OF ANY SANCTIONS, PENALTY OR
OTHER CHARGE LEVIED AGAINST CITY SY HUD BECAUSE OF SUCH
ACTIONS.
9. REIMBURSEMENT REQUIREMENTS.
9.1 Deadline for Submittin� Reimbursement Requests.
Each Reimbursement Request shall be received by the City on or before the 15th
day of the month following the month expenses were paid by Agency. For example, the
Reimbursement Request for June expenses must be received by July 15. In the event the
15th falls on a weekend or City holiday, Reimbursement Requests shall be due the next
day that the City is open for business. Failure to submit a Reimbursement Request in a
timely fashion will result in City talcing the actions outlined in Section 10.1.
NOTWITHSTANDING ANYTHING ABOVE, EXPENSES FOR SEPTEMBER
2014 MUST SE RECEIVED BY SEPTEMSER 20, 2014. FAILURE TO SUSMIT
A FINAL REIMBURSEMENT REQUEST BY SEPTEMBER 20, 2014 WILL
RESULT IN AUTOMATIC FORFEITUItE OF PAYMENT OF THE
SEPTEMBER REIMBURSEMENT REQUEST.
9.2 Agency shall provide City with Complete Documentation and the
following reports as shown in Exhibit "D" — Reimbursemeut Forms with each
Reimbursement Request:
9.2.1 Attachmeut I — Invoice.
This report shall contain the amount requested for reimbursement each month, the
cumulative reimbursement requested to date (inclusive of that month's request), and must
be signed by an authorized signatory of Agency. By signing Attachment I, Agency is
certifying that the costs are valid, eligible, consistent with the terms and conditions of this
Contract, and the data contained in the report is true and correct. This report must be
submitted even if Agency is requesting $0 for a particular month.
9.2.2 Attachment II — Expeuditure Worksheet.
This report shall itemize each expense requested for reimbursement by Agency
and shall include the Account corresponding the expense to a Budget line item in
Attachment IL In order for this report to be complete the following must be submitted:
9.2.2.1 For payroll expenses, timesheets signed by employees and
approved by supervisor for all payroll expenses listed.
Timesheets must distinguish between HOPWA-funded time
HOPWA PSA CONTRACT 2013-2014 -- TARRANT COUNTY SAMARITAN HOUSING, INC. 10
and non-HOPWA funded time and reflect actual time spent on
HOPWA-funded activities.
9.2.2.2 For non-payroll expenses, invoices for each expense listed with
an explanation as to how the invoiced expense pertains to the
Program.
9.2.2.3 Proof that each expense was paid by Agency, which proof can
be satisiied by cancelled checks, wire transfer documentation,
paid receipts or other appropriate banking documentation.
9.2.3 Attachment III — Client Data Renort.
This report shall list each Unduplicated Client served during the month along with
his or her demographic information. The Client Data Report must contain a list of all
clients served during the Contract period. In order for this report to be complete the
following must be submitted:
9.2.3.1 Documentation of income verification for each Unduplicated
Client the first time he or she is served, which will either be the
Source Documentation described in Section 6.1 or the
completed form attached hereto as Exhibit °�E"- Form of
Income Self Certification.
9.2.4 Overview Report.
Agency shall submit the Overview Report attached hereto as Exhibit "G" —
Overview Report with the October, November, and April reimbursement requests. A
paper copy must be submitted with the Reimbursement Request, and an electronic copy
must also be emailed to avis.chaisson@fortworthtexas.gov.
9.3 Withholdin� PaYment.
CITY HAS NO OBLIGATION TO MAKE PAYMENT ON ANY
REIMBURSEMENT REQUEST THAT IS NOT RECEIVED BY THE DUE DATE.
Failure to timely submit Reimbursement Requests and Complete Documentation
along with any required reports shall be an event of def�ult.
10. DEFAULT AND TERMINATION.
10.1 Failure to Submit Required Docnmentatiou
10.1.1 If Agency fails to submit a Reimbursement Request, or if the
submitted Reimbursement Request is incomplete or otherwise not in compliance with this
Contract or HOPWA Regulations as determined by City in its sole discretion, Agency
shall be in default of this Contract. City will notify Agency in writing of such default and
the Agency will have 10 calendar days from the date of the written notice to submit or
resubmit any such Reimbursement Request to cure the default. If Agency fails to cure
the default within such time, Agency shall forfeit any payments otherwise due that
month.
HOPWA PSA CONTRACT 2013-2014 -- TARRANT COUNTY SAMARITAN FIOUSING, INC. 11
10.1.2 NOTWITHSTANDING THE PROVISIONS OF SECTION
10.1.1, IF AGENCY FAILS TO SUBMIT THE REIMBURSEMENT REQUEST
DUE SEPTEMSER 20, 2014, OR IF THE SUSMITTED REIMBURSEMENT
REQUEST FOR SEPTEMBER 20, 2014 IS LATE, INCOMPLETE OR
OTHERWISE NOT IN COMPLIANCE WITH THIS CONTRACT OR HOPWA
REGULATIONS AS DETERMINED SY CITY IN ITS SOLE DISCRETION,
THERE WILL BE NO CURE PERIOD AND ANY REIMSURSEMENT WILL BE
AUTOMATICALLY FORFEITED.
10.1.3 In the event of (i) an uncured default under Section 10.l.lor (ii) more
than 2 instances of default, cured or uncured, under such Section, City reserves the right
at its sole option to terminate this Contract effective immediately upon written notice of
such intent with no penalty or liability to City.
10.1.4 Notwithstanding anything to the contrary herein, City will not be
required to pay any HOPWA Funds to Agency during the period that any Reimbursement
Request, report or documentation is past due or is not in compliance with this Contract or
the HOPWA Regulations, or during any period during which Agency is in default of this
Contract.
10.1.5 In the event of termination under this Section 10.1, all HOPWA Funds
awarded but unpaid to Agency pursuant to this Contract shall be immediately forfeited
and Agency shall have no further right to such funds.
10.2 Failure to Maintain Records or Submit Reports and
Documentation.
If Agency fails to maintain all records and documentation as required in Section
8, or if the maintained or a submitted report or documentation is not in compliance with
this Contract or the HOPWA Regulations as determined by City in its sole discretion,
City will notify Agency in writing and Agency will have 30 calendar days from the date
of the written request to obtain or recreate the missing records and documentation or
submit or resubmit any such report or documentation to City. If Agency fails to maintain
the required reports or documentation, or fails to submit or resubmit any such report or
documentation within such time, City shall have the right to terminate this Contract
effective immediately upon written notice of such intent with no penalty or liability to
City.
10.2.1 In the event of termination under this Section 10.2, all HOPWA Funds
awarded but unpaid to Agency pursuant to this Contract shall be immediately forfeited
and Agency shall have no further right to such funds, and any HOPWA Funds paid to
Agency must be repaid to City within 30 days of termination. If such HOPWA funds are
not repaid to City within the 30 day period, City shall exercise all legal remedies
available under this Contract.
10.3 In General.
Subject to Section 10.1, and unless specifically provided otherwise in this
HOPWA PSA CONTRACT 2013-2014 -- TARRANT COUNTY SAMARITAN HOUSING, INC. 12
Conh-act, Agency shall be in default under this Contract if Agency breaches any term or
condition of this Contract. In the event that such a breach remains uncured after 30
calendar days following written notice by City (or such other notice period as may be
speci�ed herein) or, if Agency has diligently and continuously attempted to cure
following receipt of such written notice but reasonably requires more than 30 calendar
days to cure, as determined by both Parties mutually and in good faith, City shall have the
right to elect in City's sole discretion to (i) extend Agency's time to cure, (ii) terminate
this Contract effective immediately upon written notice of such intent to Agency, ar(iii)
pursue any other legal remedies available to City.
103.1 In the event of termination under this Section 10.3, all HOPWA Funds
awarded but unpaid to Agency pursuant to this Contract shall be immediately forfeited
and Agency shall have no further right to such funds, and any HOPWA Funds already
paid to Agency must be repaid to City within 30 days of the termination. If such
HOPWA funds are not repaid to City within the 30 day period, City shall exercise all
legal remedies available under this Contract.
10.4 No Funds Disbursed while in Breach.
Agency understands and agrees that no HOPWA Funds will be paid to Agency
until all defaults are cured to City's satisfaction.
10.5 No Compensation After Date of Termivatiou.
Agency shall not receive any compensation for work undertaken after the date of
the termination.
10.6 Ri�hts of City Not Affected.
Termination shall not affect or terminate any of the existing rights of City against
Agency, or which may thereafter accrue because of Agency's default. Such termination
does not terminate any provisions of this Contract that have been expressly noted as
suiviving the tei�n or termination of the Contract.
10.7 Waiver of Breach Not Waiver of Subsequent Sreach.
The waiver of a default or breach of any term, covenant, or condition of this
Contract shall not operate as a waiver of any subsequent default or breach of the same or
any other term, covenant or condition hereof.
10.8 Civil Criminal and Administrative Peualties.
Failure to perform all the Contract terms may result in civil, criminal or
administrative penalties, including, but not limited to those set out in this Contract.
10.9 Termination for Cause.
10.9.1 City may terminate this Contract in the event of Agency's default,
inability, or failure to perform subject to notice, grace and cure periods. In the event City
terminates this Contract for cause, all HOPWA Funds awarded but unpaid to Agency
pursuant to this Contract shall be immediately rescinded and Agency shali have no
further right to such funds and any HOPWA Funds already paid to Agency must be
HOPWA PSA CONTRACT 2013-2014 -- TARRANT COUNTY SAMARITAN HOUSING, INC. 13
repaid to City within 30 days of teimination. Failure to repay such HOPWA Funds
within 30 days will result in City exercising all legal remedies available to City under this
Contract. AGENCY ACKNOWLEDGES AND AGREES THAT IF CITY
TERMINATES THIS CONTRACT FOR CAUSE, AGENCY OR ANY
AFFILIATES OF AGENCY SHALL NOT BE CONSIDERED F012 ANY OTHER
CITY CONTRACT FOR HOPWA FUNDS FOR A MINIMUM OF 5 YEARS
FROM THE DATE OF TERMINATION.
10.9.2 Agency may terminate this Contract if City does not provide the
HOPWA Funds substantially in accordance with this Contract.
10.10 Terminatiou for Convenience.
In terminating in accordance with 24 C.F.R. 85.44 this Contract may be
terminated in whole or in part only as follows:
10.10.1 By City with the consent of Agency in which case the Parties shall
agree upon the termination conditions, including the effective date and in the case of
partial termination, the portion to be terminated; or
10.10.2 By the Agency upon written notiiication to City, setting forth the
reasons for such termination, the effective date, and in the case of partial termination, the
portion to be terminated. In the case of a partial termination, City may terminate the
Contraet in its entirety if City determines in its sole discretion that the remaining portion
of the Contract to be performed or HOPWA Funds to be spent will not accomplish the
purposes for which the Contract was made.
10.11 Dissolution of A�ency Terminates Coutract.
In the event Agency is dissolved or ceases to exist, this Contract shall terminate.
In the event of termination under this Section, all HOPWA Funds are subject to
repayinent andlor City may exercise all of its remedies under this Contract.
10.12 Reversion of Assets.
In the event this Contract is terminated with or without cause, all assets acquired
with the HOPWA Funds including cash, interest payments from loans or otherwise, all
outstanding notes, mortgages or other security instiuments, any accounts receivable
attributable to the use of the HOPWA Funds, and any real or personal property owned by
Agency that was acquired or improved with HOPWA Funds shall automatically transfer
to City or to such assignee as City may designate.
11. REPAYMENT OF HOPWA FUNDS.
All HOPWA Funds are subject to repayinent in the event the Program does not
meet the requirements as set out in this Contract or in the HOPWA Regulations. If
Agency tal�es any action that results in the City beiug required to repay all or auy
portion of the HOPWA Funds to HUD, Agency agrees it will reimburse City for
such repayment. If Agency talces �ny action that results in City receiving a findiug
from HUD about the Program, whether or not repayment of all or any portion of
HOPWA PSA CONTRACT 2013-2014 -- TARRANT COUNTY SAMARITAN HOUSING, INC. 14
the HOPWA Fuuds is required of City, Agency agrees it will pay City 10% of the
HOPWA Funds as liquidated dam�ges. The Parties agree that City's damages in the
event of either repayment to HtJD being required or receiving a finding from HUD are
uncertain and would be difficult to ascertain and may include an impact on City's
HOPWA grant or other Federal grant funds, in addition to a finding by IILID or a
repayment of funds to H[ID by City. Therefore, the Parties agree that payment under this
Section of 10% of the HOPWA Funds by Agency to City is liquidated damages and not a
penalty.
12. CHANGE IN NON-PROFIT STATUS
If the non-profit status of Agency changes after the date of this Contract, City
may but is not obligated to, teiminate this Contract. Agency must provide City with
written notification of any changes to its non-proiit status within 15 calendar days of
being notiiied of the change. City has 30 calendar days to malce such determination after
receipt of notice from Agency and failure to malce such determination will constitute a
waiver. In the event of termination under this Section 12, all HOPWA Funds awarded
but unpaid to Agency pm•suant to this Contract shall be immediately forfeited and
Agency shall have no further right to such funds. Any HOPWA Funds already paid to
Agency must be repaid to City within 30 calendar days of termination.
13. SURVIVAL.
Any provision of this Contract that pertains to auditing, monitoring, client income
eligibility, record keeping and reports, City ordinances, or applicable HOPWA
requirements, and any default and enforcement provisions necessary to enforce such
provisions, shall survive the termination of this Contract for 5 years after the Contract
term ends and shall be enforceable by City against Agency. For purposes of this
Contract, this 5 year period for survival of certain Contract provisions is deemed to begin
on October 1, 2014 and end on September 30, 2019 regardless of whether or not this
Contract is earlier terminated.
14. GENERAL PROVISIONS
14.1 A�ency an Independeut Contractor.
Agency shall operate hereunder as an independent contractor and not as an
officer, agent, servant or employee of City. Agency shall have exclusive control of, and
the exclusive right to control, the details of the worlc and seivices performed hereunder,
and all persons performing same, and shall be solely responsible for the acts and
omissions of its officers, members, agents, servants, employees, contractors,
subcontractors, vendors, clients, licensees or invitees.
14.2 Doctrine of Respoudeat Superior.
The doctrine of respondeat superior shall not apply as between City and Agency,
or its officers, members, agents, seivants, employees, conh-actors, subcontractors,
vendors, clients, licensees or invitees, and nothing herein shall be conshued as creating a
partnership or joint enterprise between Ciry and Agency. City does not have the legal
HOPWA PSA CONTRACT 2013-2014 -- TARRANT COUNTY SAMARITAN HOUSING, INC. 15
right to control the details of the taslcs performed hereunder by Agency, its officers,
members, agents, employees, contractors, subcontractors, vendors, clients, licensees or
invitees.
14.3 A�ency Property.
City shall under no circumstances be responsible for any property belonging to
Agency, or its officers, members, agents, employees, contractors, subcontractors,
vendois, clients, licensees or invitees that may be lost, stolen or destroyed or in any way
damaged and AGENCY HEIZEBY INDEMNIFIES AND HOLDS HARMLESS
CITY AND ITS OFFICERS, AGENTS, AND EMPLOYEES FROM ANY AND
ALL CLAIMS OR SUITS PERTAINING TO OR CONNECTED WITH SUCH
PROPERTY.
14.5 Reli�ious Or�anization.
No portion of the HOPWA Funds shall be used in support of any sectarian or
religious activity. In addition, there must be no religious or membership criteria for
clients of a HOPWA-funded service.
14.6 Venue.
Venue for any action, whether real or asserted, at law or in equity, arising out of
the execution, performance, attempted performance or non-performance of this Contract,
shall lie in Tarrant County, Texas.
14.7 Governin� Law.
This Contract shall be governed by and construed in accordance with the laws of
the State of Texas. If any action, whether real or asserted, at law or in equity, arises out
of the execution, performance or non-performance of this Contract or on the basis of any
provision herein, for any issue not governed by Federal law, the choice of law shall be the
laws of the State of Texas.
14.8 Severability.
The provisions of this Contract are severable, and, if for any reason a clause,
sentence, paragraph or other part of this Conh•act shall be determined to be invalid by a
court or Federal or state agency, board or commission having jurisdiction over the subject
matter thereof, such invalidity shall not affect other provisions which can be given effect
without the invalid provision.
14.9 Written A�reement Entire Contract.
This written insh-ument and the Exhibits, Attachments, and Addendums attached
hereto, which are incorporated by reference and made a part of this Contract for all
purposes, constitute the entire agreement by the Parties hereto conceming the worlc and
services to be performed under this Conh•act. Any prior or contemporaneous oral or
written agreernent, which purports to vary the terms of this Contract, shall be void. Any
amendments to the terms of this Contract must be in writing and must be executed by
each Party to this Contract.
HOPWA PSA CONTRACT 2013-2014 -- TARRANT COUNTY SAMARITAN HOUSING, INC. 16
14.10 P�►ra�raph He�diuQs for Reference Only, No Le�al Si�nificance;
Number and Gender.
The paragraph headings contained herein are for convenience in reference to this
Contract and are not intended to define or to limit the scope of any provision of this
Contract. When context requires, singular nouns and pronouns include the plural and the
masculine gender shall be deeined to include the feminine or neuter and the neuter gender
to include the masculine and feminine. The words "include" and "including" whenever
used herein shall be deemed to be followed by the words "without limitation".
14.11 Compliance With All Applicable Laws and Re�ulations.
By signing this Contract, Agency certifies that it complies with all applicable laws
and regulations that are currently in effect or that are hereafter amended during the
performance of this Contract. Those laws include, but are not limited to:
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HOPWA Regulations found in 24 CFR Part 574.
AIDS Housing Opportunity Act, as amended (42 USC 12901 et seq.)
Title VI of the Civil Rights Act of 1964 (42 U.S.C. Sections 2000d et seq.)
including provisions requiring recipients of federal assistance to ensure
meaningful access by person of limited English proiiciency
The Fair Housing Act, Title VIII of the Civil Rights Act of 1968 (42 U.S.C.
Sections 3601 et seq.)
Executive Orders 11063, 11246 as amended by 11375 and 12086 and as
supplemented by Department of Labor regulations 41 CFR, Part 60
The Age Discrimination in Employment Act of 1967
The Age Discrimination Act of 1975 (42 U.S.C. Sections 6101 et seq.)
The Uniform Relocation Assistance and Real Property Acquisition Policies
Act of 1970 (42 U.S.C. Sections 4601 et seq. and 49 CFR Part 24) ("URA")
Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. Sections 794 et seq.)
and 24 CFR Part 8 where applicable
National Environmental Policy Act of 1969, as amended, 42 U.S.C. sections
4321 et seq. ("NEPA") and the related authorities listed in 24 CFR Part 58.
The Clean Air Act, as amended, (42 U.S.C. Sections 1251 et seq.) and the
Clean Water Act of 1977, as amended (33 U.S.C. Sections 1251 et seq.) and
the related Executive Order 11738. In no event shall any amount of the
assistance provided under this Contract be utilized with respect to a facility
that has given rise to a conviction under the Clean Air Act or the Clean Water
Act.
Immigration Reform and Control Act of 1986 (8 U.S.C. Sections 1101 et seq.)
specifically including the provisions requiring employer verifications of legal
status of its employees
The Americans with Disabilities Act of 1990 (42 U.S.C. Sections 12101 et
seq.), the Architectural Barriers Act of 1968 as amended (42 U.S.C. sections
4151 et seq.) and the Uniform Federal Accessibility Standards, 24 CFR Part
40, Appendix A
Regulations at 24 CFR Part 87 related to lobbying, including the requirement
that certifications and disclosures be obtained from all covered persons
Drug Free Worlcplace Act of 1988 (41 U.S.C. Sections 701 et seq.) and 24
HOPWA PSA CONTRACT 2013-2014 -- TARRANT COUNTY SAMARITAN HOUSING, INC. 17
CFR Part 23, Subpart F
➢ Executive Order 12549 and 24 CFR Part 5.105(c) pertaining to restrictions on
participation by ineligilile, debarred or suspended persons or entities
➢ Section 6002 of the Solid Waste Disposal Act, as amended by the Resource
Conseivation and Recovery Act
➢ Guidelines of the Environmental Protection Agency at 40 CFR Part 247
➢ For contracts and subgrants for construction or repair, Copeland "Anti-
Kickbacic" act (18 U.S.C. 874) as supplemented in 29 CFR Part 5
➢ For construction contracts awarded by Agency in excess of $2,000, and in
excess of $2,500 for other contracts which involve the employment of
mechanics or laborers, Sections 103 and 107 of the Contract Worlc Hours and
Safety Standards Act (40 U.S.C. 327A 300) as supplemented by 29 CFR Part
5
➢ Lead-Based Paint Poisoning Prevention Act (42 U.S.C. 4801 et seq.), as
amended by the Residential Lead-Based Paint Hazard Reduction Act of 1992
(42 U.S.C. 4851 et seq.) and implementing regulations at 24 CFR Part 35,
subparts A, B, M, and R
➢ Uniform Administration Requirements of 24 CFR Part 85
14.11 HUD-Assisted Projects and Employmeut and other Economic
OpUortunities; Sectiou 3 Requiremeuts.
14.11.1 Requirement that Law Be Quoted in Covered Contracts. — Certain
Requirements Pertainin� to Section 3 of the Housin� and Urban
Development Act of 1968 as Amended (12 U.S.C. Sectious 1701 et
seq.) and its Related Re�ulatious at 24 CFR Part 135.
If the Program results in the creation of new employment, training, or contracting
opportunities on a contractor or subcontractor level resulting from the expenditure of the
HOPWA Funds, Agency shall comply with the following and will ensure that its
contractors also comply. If the work performed under this Contract is on a project
assisted under a program providing direct Federal financial assistance from HIID, Section
3 of 24 CFR 135.38 ("Section 3") requires that the following clause, shown in italics, be
inserted in all covered contracts ("Section 3 Clause"):
Section to be quoted in covered contracts begins:
"A. The work to be performed ttncler this contrc�ct is subject to the
requirements of Section 3 of Housing and Urbccn Development Act of
1968, as amended, 12 U.S. C. seclion 1701 u(Section 3). The pu�pose of
Section 3 is to ensure thczt employment and other economic opportunities
gener�zted by HUD czssisted or HUD-czssisted programs covered by
Sectiolz 3, shall to the greatest extent feasible, be tlirected to low- and
very-low income persons, particularly persons who czre recipie�Zts of HUD
assistance for housing.
B. The parties to this contract czgree to comply with HUD's
regailations in 24 CFR Ptcrt 135, which impleme��t Section 3. As eviclenced
by their execution of this contrc�ct, the parties to this contract certify that
HOPWA PSA CONTRACT 2013-2014 -- TARRANT COUNTY SAMARITAN HOUSING, INC. 18
they ccre under no contractzral or other impediment that would prevent
them from complying with the Part 135 regulcztions.
C, The contractor agrees to seizd to each lc�bor organizcztion or
YepYesentative of workers with which it has a collective ba�gaining
czgreement or other understcz�zc�ing, if any, a notice advising the lc�bor
organization or workers' representatives of the contractor's commitments
under this Section 3 clause and will post copies of the notice in
conspicuous places at the worlc site where both employees and applicants
for training �znd employment positions can see the notice. The notice shall
descNibe the Section 3 preference, shall set forth minimum nasmber and job
titles subject to laire, availability of apprentice and training positions, the
qaialifications for each; and the nczme and location of the person(s) taking
applications for eczch of the positions; c�nd the c�nticipatecl dcrte the worlc
shall begin.
D. The contractor agrees that it will inclucle this Section 3 cic�arse in
every subcontract to comply with regulation in 24 CFR Part 135, and
agrees to take c�ppropriate action, as provided in an applicable provision
of the subcontract or in this Section 3 clause, upon finding that the
subcontractor is in violation of the regulations in 24 CFR Pc�rt 135. The
contractor will not subcontract with any subcontractor where it has notice
or knowledge that the satbcontracton c�zs been found in violation of
regulations in 24 CFR 135.
E. The co�atractor will certify that ccny vaccznt employment positions,
including tYaiizing positions that are fzled: (1) after the contractor is
selected bzct before the contract is exectcted, and (2) with persons other
than those to whom the regulations of 24 CFR Part 135. The contractor
will not subcontract with any subcontractor where it has notice or
knowleclge that the subcontracton c�cs been found in violation of
regulations in 24 CFR 135.
F. Noncompliance with HUD's regulcztion in 24 CFR Part 135 nzay
result in sccnctions, termincztion of this contract for default, and debarment
or suspension from futacre HUD assisted contracts.
G. With respect to worlc performed in connection with Section 3
covered Indiczn housing assistance, section 7(b) of the Inclian SeZf-
Determinc�tion c�nd Edascation Assistcrnce Act (25 U.S. C. section 450e) also
czpplies to the worlc to be performed under this Contract. Sectzon 7(b)
requires that to the grecztest extent feasible (i) preference cznd
opporttcnities for training and en2ploy�nent shall be given to Indiczns, ar�d
(ii) preference in the c�ward of contracts and subco�ztracts shczll be given to
InclicciZ organizcztions crnd Indiczn-owned Economic Enterprises. Parties to
this contract that czre sttbject to the provisions of Section 3 and Section
79b) agYee to comply with Section 3 to the maxifnuin extent feasible, but
not ilz clerogation of complic�nce with Section 7(b). "
Sectioii to be quoted iu covered contracts ends.
HOPWA PSA CONTRACT 2013-2014 -- TARRANT COUNTY SAMARITAN HOUSING, INC. 19
14.11.2 A�eucy Responsibilities for Sectiou 3 Requirements.
City and Agency understand and agree that compliance with the provisions of
Section 3, the regulations set forth in 24 CFR Part 135, and all applicable rules and orders
of HUD shall be a condition of the Federal fnancial assistance provided to the Program
binding upon City and Agency, and their respective successors, assigns, contractors and
subcontractors. Failure to fulfill these requirements shall subject Agency and its
contractors and subcontractors and their respective successors and assigns to those
sanctions specified by the grant agreement through which Federal assistance is provided
and to such sanctions as are specified by 24 CFR Part 135. Agency's responsibilities
include:
14.11.2.1 Implementing procedures to notify Section 3 residents and
business concerns about training, employment, and
contracting opportunities generated by Section 3 covered
assistance;
14.11.2.2 Notifying potential contractors worlcing on Section 3
covered projects of their responsibilities;
14.11.2.3 Facilitating the training and employment of Section 3
residents and the award of contracts to Section 3 business
concerns;
14.11.2.4 Assisting and actively
Department in making
comply;
cooperating with the HED
contractors and subcontractors
14.11.2.5 Refraining from entering into contracts with contractors
that are in violation of Section 3 regulations;
14.11.2.6 Documenting actions taken to comply with Section 3; and
14.11.2.7 Submitting Section 3 Annual Summary Reports (form
HUD-60002) in accordance with 24 CFR Part 135.90.
14.11.3 Section 3 Reportin� Reqiiirements.
In order to comply with the Section 3 requirements, Agency inust submit the
forms attached hereto as Exhibit "H" - Section 3 Reporting Forms.
14.11.3.1 Report to the City on a quarterly basis all applicants for
employment, and all applicants for employment by
contractors and any subcontractors. This shall include
name, address, zip code, date of application, and status
(hired/not-hired) as of the date of the report.
14.11.3.2 Advertise available positions to the public for open
competition, and provide documentation to City with the
HOPWA PSA CONTRACT 2013-2014 -- TARRANT COUNTY SAMARITAN HOUSING, WC. 20
quarterly report that demonstrates such open advertisement,
in the form of printout of Texas Workforce Commission
posting, copy of newspaper advertisement, copy of flyers
and listing of locations where flyers were distributed, and
the like.
14.11.3.3 Report to the City on a quarterly basis all contracts awarded
by contractors and any subcontractors. This shall inchide
name of contractor and/or subcontractor, address, zip code,
and amount of award as of the date of the report.
14.12 Prohibition A�ainst Discriminatiou.
14.12.1 Gener�l Statement.
Agency, in the execution, performance or attempted performance of this Contract,
shall comply with all non-discrimination requirements of 24 CFR 574.603 and the
ordinances codiiied at Chapter 17, Article III, Division 4— Fair Housing of the City
Code. Agency may not discriminate against any person because of race, color, sex,
gender, religion, national origin, familial status, disability or perceived disability, sexual
orientation, gender identity, gender expression, or transgender, nor will Agency permit its
officers, members, agents, employees, or clients to engage in such discrimination.
This Contract is made and entered into with reference speci�cally to the
ordinances codified at Chapter 17, Article III, Division 3- Employment Practices of the
City Code, and Agency hereby covenants and agrees that Agency, its officers, members,
agents, employees and contractors, have fully complied with all provisions of same and
that no employee, or applicant for employment has been discriminated against under the
terins of such ordinances by either or its officers, members, agents, employees or
contractors.
14.12.2 No Discrimination in Emplovmeut durin� the Performauce of
This Contract.
During the performance of this Contract Agency agrees to the following
provision, and will require that its contractors and subcontractors also comply with such
provision by including it in all contracts with its contractors:
[Cont�actor or subcontrczctor's name] will not unlawfully discriminate against
any employee or applicants for employment because of race, color, sex, gender, religion,
national origin, familial status, disability or perceived disability, sexual orientation,
gender identity, gender expression or transgender. Agency will take afiirmative action to
ensure that applicants are hired without regard to race, color, sex, gender, religion,
national origin, familial status, disability ar perceived disability, sexual orientation,
gender identity, gender expression or transgender and that employees are treated fairly
during employment without regard to their race, color, sex, gender, religion, national
origin, familial status, disability or perceived disability, sexual orientation, gender
identity, gender expression or transgender. Such action shall include, but not be limited
to, the following: employment, upgrading, demotion or transfer, recruitment or
HOPWA PSA CONTRACT 2013-2014 -- TARIZANT COUNTY SAMARITAN HOUSING, INC. 21
recruitment advertising, layoff or termination, rates of pay or other forms of
compensation, and selection for training, including apprenticeship. Agency agrees to post
in conspicuous places, available to employees and applicants for employment, notices
setting forth the provisions of this nondiscrimination clause.
[Contractor or sLcbcont�actor's name] will, in all solicitations or advertisements
for employees placed by or on behalf of Agency, state that all qualified applicants will
receive consideration for employment without regard to race, color, sex, gender, religion,
national origin, familial status, disability or perceived disability, sexual orientation,
gender identity, gender expression or transgender.
[Contrc�ctor or st�bcoiztractor's nc�me] covenants that neither it nor any of its
officers, members, agents, employees, or contractors, while engaged in performing this
Contract, shall, in connection with the employment, advancement or discharge of
employees or in connection with the ternis, conditions or privileges of their employment,
discriminate against persons because of their age or because of any disability or
perceived disability, except on the basis of a bona fide occupational qualification,
retirement plan or statutory requirement.
[Contractor or subcontractor's nanae] further covenants that neither it nor its
officers, members, agents, employees, contractors, or persons acting on their behalf, shall
specify, in solicitations or advertisements for employees to worlc on this Contract, a
maximum age limit for such employment unless the specified maximum age limit is
based upon a bona fide occupational quali�cation, retirement plan or statutory
requirement.
14.12.3 A�ency's Contractors and the ADA.
In accordance with the provisions of the Americans With Disabilities Act of 1990
("ADA"), Agency warrants that it and any of its contractars will not unlawfully
discriminate on the basis of disability in the provision of services to the general public,
nor in the availability, terms andlor conditions of employment for applicants for
employment with, or employees of Agency or any of its contractors. AGENCY
WARRANTS IT WILL FULLY COMPLY WITH ADA'S PROVISIONS AND
ANY OTHER APPLICABLE FEDERAL, STATE AND LOCAL LAWS
CONCERNING DISABILITY AND WILL DEFEND, INDEMNIFY AND HOLD
CITY HARMLESS AGAINST ANY CLAIMS OR ALLEGATIONS ASSERTED
BY THIRD PARTIES OR CONTRACTORS AGAINST CITY ARISING OUT OF
AGENCY'S AND/OR ITS CONTRACTORS', AGENTS' OR EMPLOYEES'
AI,LEGED �AILURE TO COIV�PLY WITH THE ABOVE-REFERENCED LAWS
CONCERNING DISABILITY DISCRIMINATION IN THE PERFORMANCE OF
THIS CONTRACT.
14.13. Prohibition A�ainst Interest / Conflict of Interest.
14.13.1 Agency shall establish safeguards to prohibit its employees, board
members, advisors and agents from using positions for a purpose that is or gives the
appearance of being motivated by a desire for private gain for themselves or others,
HOPWA PSA CONTRACT 2013-2014 -- TARRANT COUNTY SAMARITAN HOUSING, INC. 22
particularly those with whom they have family, business or other ties. Agency shall
disclose to City any conflict of interest or potential conflict of interest described above,
immediately upon discovery of such.
14.13.2 No peisons who are employees, agents, consultants, officers or elected
of�cials or appointed officials of City or of Agency who exercise or have exercised any
functions or responsibilities with respect to activities assisted with HOPWA funds or who
are in a position to participate in a decision-malcing process or gain inside information
with regard to these activities may utilize HOPWA services, may obtain a imancial
interest or beneiit froin a HOPWA-assisted activity, or have an interest in any contract,
subcontract or agreement with respect thereto, or the proceeds thereunder, either for
themselves or those with whom they have family or business ties, during their tenure or
for 1 year thereafter, unless they are accepted in accordance with the procedures set forth
at 24 CFR 574.625.
14.13.3 Agency af�rms that it will adhere to the provisions of the Texas Penal
Code which prohibits bribery and gifts to public servants.
14.13.4 The conflict of interest provisions of 24 CFR Part 85.36 and 24 CFR
Part 84.42, respectively, shall apply in the procurement of property and services by
Agency. In all cases not governed by those sections, the provisions of 24 CFR 574.625
of the HOPWA Regulations shall apply.
14.14 Subcontractin� with Small and Minority Firms, Women's
Business Enterprises and Labor Surplus Areas.
14.14.1 For procurement contracts larger than $50,000.00 Agency agrees to
abide by City's policy to involve Minority Business Enterprises and Small Business
Enterprises and to provide them equal opportunity to compete for contracts for
construction, provision of professional services, purchase of equipment and supplies and
provision of other seivices required by City. Agency agrees to incorporate the City's
BDE Ordinance, and all amendments or successor policies or ordinances thereto, into all
contracts and subcontracts for procurement larger than $50,000.00 and will further
require all persons or entities with which it so contracts to comply with said ordinance.
14.14.2 It is national policy to award a fair share of contracts to disadvantaged
business enterprises (DBEs), small business enterprises (SBEs), minority business
enterprises (MBEs), and women's business enterprises (WBEs). Accordingly,
affirmative steps must be taken to assure that DBEs, SBEs,1VIBEs, and WBEs are utilized
when possible as sources of supplies, equipment, constiuction and services.
14.15 Other Laws.
The failure to list any federal, state or City ordinance, law or regulation that is
applicable to Agency does not excuse or relieve Agency from the requirements or
responsibilities in regard to following the law, nor from the consequences or penalties for
Agency's failure to follow the law, if applicable.
HOPWA PSA CONTRACT 2013-2014 -- TARRANT COUNTY SAMARITAN HOUSING, INC. 23
14.16 Assi�ument.
Agency shail not assign all or any part of its rights, privileges, or duties under this
Contract without the prior written approval of Director. Any attempted assignment of
same without approval shall be void, and shall constitute a breach of this Contract.
14.17. Ri�ht to Inspect A�ency Contracts.
It is agreed that City has the right to inspect and approve in writing any proposed
contracts between Agency and any contractor engaged in any activity in conjunction with
this HOPWA-funded Program prior to any charges being incurred.
14.18 Force Majeure
If Agency becomes unable, either in whole or part, to ful�ll its obligations under
this Contract due to acts of God, strilces, locicouts, or other industrial disturbances, acts of
public enemies, wars, blocicades, insurrections, riots, epidemics, earthquakes, fires,
floods, restraints or prohibitions by any court, board, department, commission or agency
of the United States or of any States, civil disturbances, or explosions, or some other
reason beyond Agency's cont�ol (collectively, "Force Majeure Event"), the obligations so
affected by such Force Majeure Event will be suspended only during the continuance of
such event. Agency will give City written notice of the existence, extent and nature of
the Force Majeure Event as soon as reasonably possible after the occurrence of the event.
Failure to give notice will result in the continuance of Agency's obligation regardless of
the extent of any existing Force Majeure Event. Agency will use commercially
reasonable efforts to remedy its inability to perform as soon as possible.
15. INDEMNIFICATION AND RELEASE.
AGENCY COVENANTS AND AGREES TO INDEMNIFY, HOLD
HARMLESS AND DEFEND, AT ITS OWN EXPENSE, CITY AND ITS
OFFICERS, AGENTS, SERVANTS AND EMPLOYEES FROM AND AGAINST
ANY AND ALL CLAIMS OR SUITS FO'� PROPERTY LOSS 012 DAMAGE
AND/OR PERSONAL INJURY, INCLUDING DEATH, TO ANY AND ALL
PERSONS, OF WHATSOEVER I�IND OR CHARACTER, WHETHER REAL OR
ASSERTED, ARISING OUT OF OR IN CONNECTION WITH T�IE
EYECUTION, PERFORMANCE, ATTEMPTED PERFORMANCE OR
NONPERFORMANCE OF THIS CONTRACT AND/OR THE OPERATIONS,
ACTIVITIES AND SERVICES OF THE PROGRAM DESCRIEED HEREIN,
WHETHER OR NOT CAUSED IN WHOLE OR IN PART, BY ALLEGED
NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES,
CONTRACTORS OR SUBCONTRACTORS OF CITY; AND AGENCY HEREBY
ASSUMES ALL LIABILITY AND RESPONSIBILITY OF CITY AND ITS
OFFICERS, AGENTS, SERVANTS, AND EMPLOYEES FOR ANY AND ALL
CLAIMS OR SUITS FOR PROPERTY LOSS OR DAMAGE AND/OR
PERSONAL INJURY, INCLUDING DEATH, TO ANY AND ALL PERSONS, OF
WHATSOEVER I�INDS OR CHARACTER, WHETHER REAL OR ASSERTED,
ARISING OUT OF OR IN CONN�CTION WITH THE EXECUTION,
PERFORMANCE, ATTEMPTED PERFOa2MANCE OR NONPEI2F'ORMANCE
OF THIS CONTRACT AND/OR THE OPERATIONS, ACTIVITIES AND
HOPWA PSA CONTRACT 2013-2014 -- TARRANT COUNTY SAMARITAN HOUSING, INC. 24
SERVICES OF THE PROGRAM DESCRISED HEREIN, WHETHER OR NOT
CAUSED IN WHOLE OR IN PART BY ALLEGED NEGLIGENCE OF
OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS OR
SUBCONTRACTORS OF CITY. AGENCY LII�EWISE COVENANTS AND
AGREES TO AND DOES HEREBY INDEMNIFY AND HOLD HARMLESS
CITY FROM AND AGAINST ANY AND ALL INJURY, DAMAGE OR
DESTRUCTION OF PROPERTY OF CITY, ARISING OUT OF OR IN
CONNECTION WITH ALL ACTS OR OMISSIONS OF AGENCY, ITS
OFFICERS, MEMBERS, AGENTS, EMPLOYEES, CONTRACTORS,
SUBCONTRACTORS, INVITEES, LICENSEES, OR CLIENTS, OR CAUSED, IN
WHOLE OR IN PART, BY ALLEGED NEGLIGENCE OF OFFICERS, AGENTS,
SERVANTS, EMPLOYEES, CONTRACTORS OR SUBCONTRACTORS OF
CITY.
IT IS THE EXPRESS INTENTION OF THE PARTIES, BOTH AGENCY
AND CITY, THAT THE INDEMNITY PROVIDED FOR THIS SECTION
INCLUDES INDEMNITY BY AGENCY TO INDEMNIFY AND PROTECT CITY
FROM THE CONSEQUENCES OF CITY'S OWN NEGLIGENCE, WHETHER
THAT NEGLIGENCE IS ALLEGED TO BE THE SOLE OR CONCUIZItING
CAUSE OF THE INJiJItY, DAMAGE OR DEATH.
AGENCY AGREES TO AND SHALL RELEASE CITY, ITS AGENTS,
EMPLOYEES, OFFICERS AND LEGAL REPRESENTATIVES FROM ALL
LIABILITY FOR INJURY, DEATH, DAMAGE OR LOSS TO PERSONS OR
PROPERTY SUSTAINED IN CONNECTION WITH OR INCIDENTAL TO
PERFORMANCE UNDER THIS CONTRACT, EVEN IF T�IE INJURY, DEATH,
DAMAGE OR LOSS IS CAUSED BY CITY'S SOLE OR CONCURR�NT
NEGLIG�NCE.
AGENCY SHALL REQUIRE ALL OF ITS CONTRACTORS AND
SUSCONTRACTORS TO INCLUDE IN THEIR CONTI2ACTS AND
SUBCONTRACTS A RELEASE AND INDEMNITY IN FAVOR OF CITY IN
SUBSTANTIALLY THE SAME FORM AS ASOVE.
16. WAIVER OF IMMUNITY BY AGENCY.
If Agency, as a charitable or nonprofit organization, has or claims an immunity or
exemption (statutory or otherwise) from and against liability for damages or injury,
including death, to persons or property, Agency hereby expressly waives its rights to
plead defensively such immmiity or exemption as against City. This section shall not be
construed to affect a governmental entity's immunities under constitutional, statutory or
common law.
17. INSURANCE AND SONDING.
Agency will maintain coverage in the form of insurance or bond in the amount of
$261,611.35 to insure against loss fi•om the fraud, theft or dishonesry of any of Agency's
HOPWA PSA CONTRACT 2013-2014 -- TARRANT COUNTY SAMARITAN HOUSING, INC. 25
officers, agents, hustees, directors or employees. The proceeds of such insurance or bond
shall be used to reimburse City for any and all loss of HOPWA Funds occasioned by such
misconduct. To effectuate such reimbursement, such iidelity coverage shall include a
rider stating that reimbursement for any loss or losses shall name the City as a Loss
Payee.
Agency shall furnish to City in a timely manner, but not later than the Effective
Date, certificates of insurance as proof that it has secured and paid for policies of
commercial insurance as specified herein. If City has not received such certiiicates by
the Effective Date, Agency shall be in default of the Contract and City may, at its option,
terminate the Contract.
Such insurance shall cover all insurable rislcs incident to or in connection with the
execution, performance, attempted performance or nonperformance of this Contract.
Agency shall maintain, or require its general contractor to maintain, the following
coverage and limits thereof:
Commercial General Liability�CGL) Insurance
$500,000 each occurrence
$1,000,000 aggregate limit
Non-Proiit Organization Liability or Directors & Officers Liability
$1,000,000 Each Occurrence
$1,000,000 Annual Aggregate Limit
Business Automobile Liabilitv Insurance
$1,000,000 each accident on a combined single-lilnit basis, or
$250,000 Property Damage
$500,000 Bodily Injury per person per occurrence
$2,000,000 Aggregate
Insurance policy shall be endorsed to cover "Any Auto", defined as autos owned, hired, and non-
owned. Pending availability of tiie above coverage and at the discretion of City, the policy
shall be the primary responding insurance policy versus a personal anto insurance policy if
or when in the course of Agency's business as contracted herein.
Worlcers' Compensation Insurance
Part A: Statutory Limits
Part B: Employer's Liability
$100,000 each accident
$100,000 disease-each employee
$500,000 disease-policy limit
Note: Such insurance shall cover employees performing worlc on any and all projects
including but not limited to construction, demolition, and rehabilitation. Agency or its
contractors shall maintain coverages, if applicable. In the event the respective contractors
HOPWA PSA CONTRACT 2013-2014 -- TARRANT COUNTY SAMARITAN HOUSING, INC. 26
do not maintain coverage, Agency shall maintain the coverage on such contractor, if
applicable, for each applicable contract.
Additional Requirements
Such insurance amounts shall be revised upward at City's reasonable option and no more
frequently than once every 12 months, and Agency shall revise such amounts within 30
days following notice to Contractor of such requirernents.
Agency will submit to City documentation that it has obtained insurance coverage and
has executed bonds as required in this Contract prior to payment of any monies provided
hereunder.
Where applicable, insurance policies required herein shall be endorsed to include City as
an additional insured as its interest may appear. Additional insured parties shall include
employees, ofiicers, agents, and volunteers of City.
The Worlcers' Compensation Insurance policy shall be endorsed to include a waiver of
subrogation, also referred to as a waiver of rights of recovery, in favor of City.
Any failure on part of City to request certiiicate(s) of insurance shall not be constiued as
a waiver of such requirement or as a waiver of the insurance requirements themselves.
Insurers of Agency's insurance policies shall be licensed to do business in the state of
Texas by the Department of Insurance or be otherwise eligible and authorized to do
business in the state of Texas: Insurers shall be acceptable to City insofar as their
financial strength and solvency and each such company shall have a current minimum
A.M. Best Key Rating Guide rating of A-: VII or other equivalent insurance industry
standard rating othettivise approved by City.
Deductible limits on insurance policies shall not exceed $5,000 per occurrence unless
otherwise approved by City.
In the event there are any local, federal or other regulatory insurance or bonding
requirements for the Program, and such requirements exceed those specified herein, the
former shall prevail.
Agency shall require its contractors to maintain applicable insurance coverages, limits,
and other requirements as those speciiied herein; and Agency shall require its contractors
to provide Agency with certificate(s) of insurance documenting such coverage. Also,
Agency shall require its contractors to have City and Agency endorsed as additional
insureds (as their interest may appear) on their respective insui•ance policies.
Directors and Ofiicers LiaUility coverage shall be in force and may be provided on a
claims-made basis. This coverage may also be referred to as Management Liability, and
shall protect the insured against claims arising out of alleged errors in judgment, breaches
of duty and wrongful acts arising out of their organizational duties. Coverage shall
HOPWA PSA CONTRACT 2013-2014 -- TARRANT COUNTY SAMARITAN HOUSING, INC. 27
� protect not only the entity, but all past, present and future directors, officeis, trustees,
employees, volunteers and committee membeis.
18. C�RTIFICATION RIEGARDING LOBBYING.
The undersigned representative of Agency hereby certifies, to the best of his or
her knowledge and belief, that:
No Federal appropriated funds have been paid or will be paid, by or on behalf of
Agency, io any person for influencing or attempting to influence an officer or
employee of any agency, a member of Congress, an officer or employee of
Congress in connection with the awarding of any Federal contract, the malcing of
any Federal grant, the malcing of any Federal loan, the entering into of any
cooperative agreement and the extension, continuation, renewal, amendment, or
modification of any Federal contract, grant, loan or cooperative agreement.
If any funds other than federally appropriated funds have been paid or will be paid
to any person for influencing or attempting to influence an officer or employee of
any agency, member of Congress in connection with this Federal contract, grant,
loan or cooperative agreement, Agency shall complete and submit Standard
Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its
instructions.
This certification is a material representation of fact upon which reliance was
placed when this Contract was made or entered into. Submission of this
certi�cate is a prerequisite for malcing or entering into this Contract imposed by
31 U.S.C. Section 1352. Any person who fails to iile the required certification
shall be subject to a civil penalty of not less than $10,000.00 and not more than
$100,000.00 for each such failure.
Agency shall require that the language of this certiiication be included in all
subcontracts or agreements involving the expenditure of Federal funds.
19. LITIGATION AND CLAIMS.
Agency shall give City immediate notice in writing of any action, including any
proceeding before an administrative agency, filed against Agency in conjunction with this
Contract or the Program. Agency shall furnish immediately to City copies of all pertinent
papers received by Agency witl� respect to such action or claim. Agency shall provide a
notice to City within 10 days upon fling under any banlcruptcy or iinancial insolvency
provision of law.
20. NOTICE.
All notices required or permitted by this Contract must be in writing and are
deemed delivered on the earlier date of the date actually received or the third day
following deposit in a United States Postal Service post office or receptacle; with proper
HOPWA PSA CONTRACT 2013-2014 -- TARRANT COUNTY SAMARITAN HOUSING,INC. 28
� postage, certified inail rehirn receipt requested; and addressed to the other Party at the
address set out below or at such other address as the receiving Party designates by proper
notice to the sending Party.
City
City Attorney's Office
1000 Throckmorton Sh•eet
Fort Worth, TX 76102
Telephone: 817-3 92-7600
Copy to:
Director of Housing and Economic Development
1000 Throcicmorton Street
Fort Worth, TX 76102
Telephone: 817-3 92-7540
Copy to:
Development Project Coordinator — Housing and Economic Development
1000 Throcicmorton Street
Fort Worth, TX 76102
Telephone: 817-3 92-63 42
A�ency:
Tarrant County Samaritan Housing, Inc.
President and CEO
929 Hemphill
Fort Worth, TX 76104
817-332-6410
21: AGENCY HAS LEGAL AUTHORITY TO ENTER INTO CONTRACT.
Agency represents that it possesses the legal authority, pursuant to any proper,
appropriate and official motion, resolution or action passed or taken, to enter into this
Contract and to perform the responsibilities herein required.
22. COUNTERPARTS.
This Contract may be executed in multiple counterparts, each of which shall be
considered an original, but all of which shall constitute one instrument which may be
sufficiently evidenced by one counterpart.
[SIGNATURES APPEAR ON NEXT PAGE]
HOPWA PSA CONTRACT 2013-2014 -- TARRANT COUNTY SAMARITAN HOUSING, INC. 29
WHEREOF, the Parties hereto have executed 4 duplicate
Contract in Fort Worth, Tarrant County, Texas.
CITY OF F0�2T WORTH
By: /� �.� ��,
Fernando Costa, Assistant City Manager
M&C: C-
APPR ED AS TO FO AND LEGALITY:
v �� �.
Assistaut City Attoruey
�
By: `!r
Natne:
Title:
SAMARITAN HOUSING, INC.
STATE OF TEXAS §
COUNTY OF TAI2IZANT §
This instiument was acicnowledged before me on %% � , 2013 by
Fernando Costa, Assistant City Manager of the City o Fort Worth, on behalf the City of
Fort Worth.
VONIA DANIELS
��,��N�rary Public, Siote of Texas
�= My Commission Expires
�'_ � _ '' 17 t
otary Public, State of Texas
STATE OF TEXAS §
COUNTY OF TAI2I2ANT §
Thi instium nt was acicnowledged before me on ������ , 2013 by
�� t� , the (� of Tai•1•ant County Samaritan Housing, Inc., a Texas
non-profit corporation, on behalf of said corparation. „ � C� �
TED A LOVATO
Notary Public
State of Texas
My Comm. Exp. 01-i6-2018
Notary �ublic, State of Texas
r��-�� ��;1� r�T;���
e- � =
,; � �
HOPWA PSA CONTRACT 2013-2014 -- TARRANT COUNTY SAMARITAN HOUSING, INC. 30
Date: August 6, 2013
EXHIBITS:
Exhibit "A" — Program Summary
Exhibit "A-1" — 2013 HUD Income Limits
Exhibit "A-2" — Environmental Mitigation Action
Exhibit "B" — Budget
Exhibit "C" — Audit Certification Form
Exhibit "D" — Reimbursement Forms
Exhibit "E" — Form of Income Self-Certification
Exhibit "F" — Standards for Complete Documentation
Exhibit "G" — Overview Report
Exhibit "H" — Section 3 Reporting Forms
HOPWA PSA CONTRACT 2013-2014 -- TARRANT COUNTY SAMARITAN HOUSING, INC. 31
Tarrant County Samaritan Housing, Inc. EXHIBIT A
Samaritan House Suppartive Services PROGRAM SIJMMARY
PROGRAM SUMMARY
Housing Opportunities for Persons with AIDS
(HOPWA)
October 1, 2013 to September 30, 2014
PERIOD
$ 261,611.35
AMOUNT
PROGRAM:
The program will provide each HOPWA-eligible client with supportive services including
case management and housing counseling. Program services may also include social work
case management; congregate meals; medical case management; substance abuse
counseling; medical transportation; recreation and social programs; education programs;
and, life and job skills programs.
HOPWA funds will be used to provide each HOPWA-eligible client with supportive services
including case management and housing counseling.
No more than 7% of the HOPWA funds will be used to pay for administrative costs,
including salaries, insurance, taxes, and legal and accounting fees associated with the
program.
Program services will be available at 929 Hemphill Street, Fort Worth, Texas 76104 from
9:00 a.m. to 5:00 p.m., Monday through Friday.
REGULATORY CLAS5IFICATION:
IDIS Matrix Code(s) and Service Category: 31D HOPWA Project Sponsor Administration
31C HOPWA Project Sponsor Activity
National Objective Citation: not applicable
Regulatory Citation(s): 24 CFR 574.300(b)(lO�Administrative Expenses
24 CFR 574.300(b)('7)--Supportive Services
Based on the
verifies that
Regulations.
nature of the service provided, Agency will maintain documentation that
100% of clients served by the Program are eligible under HOPWA
PROGRAM GOALS:
Provide services to approximately 87 Unduplicated Clients
EXHIBIT A- HOPWA: TARRANT COUNTY SAMARITAN HOUSE, iNC.
EXHIBIT "A-1"
2013 HUD INCOME LIMITS
2013 Median Family Income — Fort Worth/Arlington, TX*
1 Person 2 Persons 3 Persons 4 Persons 5 Persons 6 Persons 7 Persons 8 Persons
30%AMI $13,850 $15,800 $17,800 $19,750 $21,350 $22,950 $24,500 $26,100
50% AMI $23,050 $26,350 $29,650 $32,900 $35,550 $38,200 $40,800 $43,450
80%AMI $36,900 $42,150 $47,400 $52,650 $56,900 $61,100 $65,300 $69,500
*Income limits are established and published at least annually by HUD.
EXHIBIT "A-2"
ENVIRONMENTAL MITIGATION ACTION
NONE REQUIRED
EXHIBIT B - BUDGET
FUNDING B: HOPWA SPNS COMPETTI'IVE TCCD
F[JNDING C: SUPPORTIVE HOUSING PROGRAM - SHP/TCAC/CONTINUUM OF CARE/GRACE VILLAGE
FiINDING D: FUNDRAISING, FOUNDATIONS, PRIVATE CONTRIBUTIONS
*FUNDING A- TOTAL ALSO INCLUDES MILEAGE AND CLIENT TRANSPORTATION -$12,399
**FiJNDING B- TOTAL ALSO INCLUDES MILEAGE -$517
***FUNDING C- TOTAL ALSO INCLUDES MILEAGE -$2,750
****PUNDING D- TOTAL ALSO INCLUDES MILEAGE -$3,847
EXHIBIT B- HOPWA: TARRANT COUNTY SAMARITAN HOUSE,INC.
The following tables are purely informational and were created solely for purposes of preparing, negotiating, and
determining the reasonableness of the overall line item budget on the first page of this EXHIBIT B- BUDGET and
are not to be considered part of the terms and conditions of this Contract. Contractor may make changes to any
column except the "Position" column in the "Salary Detail" table without the City's consent so long as the total
amounts charged to the grant do not exceed the line items on the first page of the EXHIBIT B- BUDGET."
Changes to the column labeled "Position" may only be made with the prior written consent of the City.
C.Yfll:� �•ZJ� •�L
Position Name Rate Annual Hours Percent to Grant Amount to Grant
CEO 40.87 2,080 5 4,250
COO 32.89 2,080 17.5 12,000
CFO 3 8.32 2,080 8.9 7,173
Admin Asst Accountin 17.25 1,300 10 2,000
Food Service Manager 18.74 2,080 27 10,626
Cook 13.13 2,080 31 8,500
Cook 2 12.75 2,080 33 8,750
Cook 3 9.00 1,333 50 6,000
Medical Case Manager 27.88 2,080 14 8,000
Social Work Case Mgr 18.27 2,080 77 29,260
RCA Lead 12.02 2,080 50 12,500
RCA 11.00 2,080 56 11,650
RCA 2 11.00 2,080 50 5,720
RCA 3 11.00 1,040 50 4,680
RCA 4 9.00 1,040 50 3,120
RCA 5 11.00 520 26 1,352
RCA 6 11.00 520 26 1,352
Driver�Ivlaintenance 1734 2,080 40 14,477
Famil Health�Ed Coord 15.29 2,080 18 5,724
Pro e Mana er 21.29 2,080 20 8,857
Pro eriy Su ort AA 9.00 2,080 30 5,707
LCDC 17.31 2,080 25 9,000
Su ort Services M r 17.31 2,080 65 23,400
FRiN(iE DETAIL
Percent of Payroll Amount Percent to Grant Amount to Grant
FICA 7.65 94,445 16.53 15,614
Life Insurance 1.12 13,908 14.67 2,041
Healtt�/DentalInsurance 12.25 151,348 16.18 24,491
Unemployment 2.99 37,035 16.53 6,123
Workers Com ensation 1.90 23,574 11.66 2,750
Retirement
�.Y�»����►.yv��j.y�:a�icy�t.�
Total Budget Percent to Grant Amount to Grant
Office Su lies 9,674 0 0
Office E ui ment Rental 5,111 0 0
Postage 1,392 0 0
Printing 9,317 0 0
MISCELLANEOUS
Total Budget Percent to Grant Amount to Grant
Contract Labor 31,257 0 0
Craft Su lies 0 0 0
Facility Fees 0 0 0
Field Trip Costs 0 0 0
Food Supplies 56,845 0 0
Teaching Aids 0 0 0
EXHIBIT B- HOPWA: TARRANT COUNTY SAMARITAN HOUSE, INC. 2
FACILITY AND UTILITIES
Total Budget Percent to Grant Amount to Grant
Telephone 11,000 0 0
Electric 30,271 0 0
Gas 2,970 0 0
Water and Wastewater 5,000 0 0
Solid Waste Dis osal 0 0
Rent/Pro erty Tax 7,000 0 0
C�stodial Services 11,300 0 0
Re airs 13,795 0 0
Cleaning/Medical Supplies 5,5'77 0 0
Fidelity Bond (or Equ
General Commercial I
Directors and Officers
Contract Accounting
LEGAL, FINANCIAL AND INSURANCE
Total Budget Percent to Grant
629.44 60.28
35,004 12.56
1,273 0
0 0
DIRECT ASSISTANCE
Amount to Grant
37935
0
0
Total Bud et Percent to Grant Amount to Grant
Childcare Scholarships 0 0 0
Short-Term Rent Assistance 0 0 0
Short Term Mortga e Assistance 0 0 0
Short Term Utilities Assistance 0 0 0
Tenant Based Rental Assistance 219,922 0 0
EXHIBIT B- HOPWA: TARRANT COUNTY SAMARITAN HOUSE, INC. 3
EXHIBIT "C"
Audit Certification Form
[See attached]
AUDIT CERTIFICATION FORM AND AUDIT REQUIREMENTS
Agency: Name of Asencv
Fiscal Year Ending: Seutember 30, 2014
❑ During the fiscal year in which funds will be received, we will exceed the federal expenditure
threshold of $500,000. We will have our Single Audit or Program Speciiic Audit completed and
will submit the A-133 audit report within seven (7) months after the end of the audited fiscal year
or thirty (30) days within its completion, whichever is the earlier date.
❑ During the fiscal year in which funds will be received, we will not exceed the $500,000 federal
expenditure threshold required for a Single Audit or a Program Specific Audit to be performed this
fiscal year. (Fill out schedule below)
Signatory and Title Date
Failure to submit this or a similar statement or failure to submit a completed single audit package as
described in the federally required audit requirements described in OMB Circulars A-133 by the
required due date may result in suspension of funding and may affect eligibility for future funding.
Notwithstanding the above, this certification acknowledges the agency's commitment to meet all
other financial reporNng, financial statements, and other audit requirements as may be set forth
in the Contract.
Exhibit "D" - Reimbursement Forms
[See attached]
Attachment I
INVOICE
Agency:
Address:
City, State, Zip:
Program:
Period of Service:
Agency's C;ertitication: 1 certity that the costs incurred are valid and
consistent with the terms and conditions of the contract between
City and Agency. By signing this invoice, I certify that to the best
of my knowledge and belief the data included in this report is true
and accurate. It is acknowledged that the provision of false
information could leave the certifying official subj ect to the
Signature and Date:
Name:
Title:
A[fachmcnt II
City of Forf \Varth
Hausing and Economic Derelopmenf Deparfmcnt
Eipenditurc�Vorksheet
Agc�cy: Name
Pmgram: Program Name
Piease r u like accoun[ wdes.
Accounl Cod
(See Key lo
Line No. Check No. Dale Pa �ee Drscri tion• Ri t Amounl
2
3
a
s
6
7
S
9
10
1
12
13
14
IS
16
I7
18
19
20
21
22
23
24
25
26
27
28
29
30
3t
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Total
•Payroll must identify employee. Rent muri identiCy tenanL Other payments should identiCy individual:
Hlghlighted are Ihe only relevant codee for this Program.
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Exhibit "E"
Form of Income Self-Certification
[See attached]
CERTIFICATION OF INCOME STATEMENT
Applicant Name:
Current Address:
Phone #:
**PERSONAL INFORMATION: (Check one in each item. Optional Information for Federal Reporting Purposes)
a. ❑ MALE b. ❑ WHITE ❑ BLACK/AFRICAN AMERICAN ❑ BLACK/AFRICAN AMERICAN & WHITE
❑ FEMALE ❑ AMERICAN INDIAN/ALASKAN NATIVE ❑ ASIAN
❑ AMERICAN INDIAN/ALASKAN NATIVE & WHITE ❑ ASIAN & WHITE
❑ NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER ❑ BALANCE/OTHER
❑ AMERICAN INDIAN/ALASKAN NATIVE & BLACK/AFRICAN AMERICAN
c. ETHNICITY d. DISABLED e. IS CLIENT WOMEN HEAD OF HOUSEHOLD
❑ HISPANIC ❑ YES ❑ YES
❑ NON-HISPANIC ❑ NO ❑ NO
* TOTAL NiJMBER OF HOUSEHOLD (Include Yourself AND everyone who
MEMBERS lives in the house.)
Total Anticipated Annual Household Income:
Certification:
I certify that the infortnation I am providing is true and could be subject to verification at any time by a third
party. I also acknowledge that the provision of false information could leave me subject to the penalties of
Federal, State and local law.
WARNING: TITLE IH� SECTION 1001 OF THE U.S. CODE STATES THAT A PERSON IS GUILTY OF A FELONY
FOR KNOWINGLY AND WILLINGLY MAHING FALSE OR FRAUDITLENT STATEMENTS TO ANY DEPARTMENT OF
THE UNITED STATES GOVERNMENT.
Signature of Applicant
Date
For use by funding agency:
Household Size:
Income Limit:
Person Making Determination:
Annual Income:
Is Applicant Eligible:
Date:
Household Members and Income
CERTIFICACION DE DECLARACION DE INGRESOS
Nombre d�l Solicitante:
Domicilio Actual:
Numero de Telefono:
**INFORMACION PERSONAL: (Seleccione uno en cada categoria. Informacion opcional para propositos de informacion Federal)
a. ❑ MASCULINO b. Q CAUCASICO ❑ NEGRO/AFRICANO AMERICANO
❑ NEGRO/AFRICANO AMERICANO & CAUCASICO
❑ FEMININO ❑ INDIO AMERICANO/NATNO DE ALASKA ❑ ASIATICO
❑ INDIO AMERICANO/NATIVO DE ALASKA & CAUCASICO ❑ ASIATICO & CAUCASICO
❑ NATIVO HAWAIANO/O'1'RO DE LAS ISLAS PACIFICAS ❑ BALANCE/OTRO
❑ INDIO t1IvIERICANO / NATIVO DE ALASKA & NEGRO/AFRICANO AMERICANO
c. ET'NICIDAD d. DISCAPACITADO e. �ES EL SOLICITANTE iJNA MUJER Y CABECERA DEL HOGAR?
❑ HISPANO ❑ SI ❑ SI
❑ NO-HISPANO ❑ NO ❑ NO
* NUMERO TOTAL DE MIEMBROS EN EL HOGAR
Ingreso total del hogar anual anticipado:
(Incluye a si mismo y a todos los que viven en
la casa)
Certificacion:
Certifico que la informacibn que proporciono es verdad y podria ser susceptible a la comprobacion a cualquier
tiempo por terceros. Yo tambien reconozco que la provision de informacion falsa me podria dejar sujeto a las
penalidades Federales, Estatales y locales.
ADVERTENCIA: TITULO 18, SECCION 1001 DEL CODIGO DE EE.UU. QUE UNA PERSONA ES
CULPABLE DE UN DELITO POR SABER Y VOLUNTARIAMENTE HACER DECLARACIONES
FALSAS O FRAUDULENTAS A CUALQUIER DEPARTAMENTO DEL GOBIERNO
ESTADOUNIDENSE.
Firma del Solicitante
Fecha
Para el uso de la agencia financiando:
# De Miembros en el Hogar:
Limite de Ingreso:
Persona haciendo la determinacion: Fecha:
Ingreso Anual:
�Es el solicitante elegible? :
Miembros en el Hogar e In�resos
Exhibit "F" - Standards for Complete Documentation
[See attached]
2013-2014 Documentation Standards for
Public Service Contract Expenses
�a
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°°� r m a � E'
Budget Llne Items c a` E v � w�= � NoleslOther
Em loyee Salaries and Benefits
Salanes X X` If an employee worics solely wAh Conlracl eligible Gients and solely on Contract eligible ilems, lhen the employee's enlire salary is eligible for
reimbursemenL Twice in each calendar year, lhe client must submd a written slalement veriTying thal lhe a6ove conditions are still Uue. The
slatement must also be signed be a person aulhorized lo sign on behalf of the agency.
If an employee works on a vanety of programs, or works vnth a mocture of Conlracl eligible clients and non-eligible clienls, then lhe City will only
reimburse for a reasonable portion of lhe employee's salary. Each reim6ursement request must indude nol only lhe employee's timesheet, but also
a work log breaking out the employee's lime hy pmjed or aclivity. For employees paid wilh multiple funding sources, timesheets must refiect all
funding sources. If separale timesheets are kept tor each (unding source, all such limesheets musl be submifled to City.
'If employees are paid by direct deposit ralher lhan check, lhen lhe agency mus[ submit both the dired deposit payment companys report (such as
an ADT report) and a bank statement or check showing payment to lhe direct deposil company.
FICNMedicare It lhe City pays gross salary, lhis is already included. If lhe City pays lhe empbyer portion, lhen lhe employer must show a calculalion and
documentalion of how lhe invoiced amountwas calculated, and inGude documenlation showin a ment.
Lite Insurance If lhe City pays gross salary, lhis is already included. IFwe pay lhe employer portion, lhen the employer must show a calculation and documentation
of how lhe invoiced amount was calculaled, must include an invoice fmm lhe insurer, and must include documenlation showing payment.
Health Insurance If lhe City pays gross salary, this is already included. If we pay the employer podion, then lhe employer must show a calculation and documenlation
of how lhe invoiced amount was calculaled, must include an imoice from the insurer, and must include documenlalion showing paymenl.
Disability Insurance If lhe City pays gross salary, lhis is already included. B we pay the employer poAioq lhen lhe employer must show a calculalion and documenlalion
oi how lhe invoiced amount was calculated, must include an invoice from the insurer, and must include documentation showing paymenl.
Unemploymenl It lhe City pays gross salary, lhis is already included. If we pay Ihe employer portion, then the employer must show a calculation and documentalion
Insurance ot how lhe invoiced amounl was calculaled, and must include documentalion showin a ment.
Reliremenl IFwe pay gross salary, lhis is already included. If we pay the employer poAion, then lhe employer musl show a calculation and documentation oi how
the invoiced amounl was calculated, must and include documentalion showing payment, and prior to lhe firsl reimbursemenl, musl include lhe
ersonnel olic re ardin re[irement benefils.
Professfonal Services
Accounting X X X If an audil is required because federal funds exceed $500,000, Ihen the cost should be splil evenly by all federal funding sources.
Ex enses
Materials, E ul ment Goods and Su lies
OKce Su lies X X X
OKce Equipment X X X -
Rental
Poslage X X X The agency should main�ain information regarding mailouts. If lhe agency has a Pilney Bowes machine or like poslage machine, ihe records of lhal
machine musl be on file. Likewise,'rf mail is categorized by payment source, lhen those records must be on fle. For large mailouls, lhe agency
should kee a co of the leller and a list of all addressees.
Prinlin X X X
Construclion & X X This category is only available for REACH.
Buildin Materials
Sport and X X X -
Recrealion
E ui ment
Cleanin Su lies X X X
Teachin Aids X X X
CraR Su lies X X X
Food Su lies X X X
Travel and Fleld Tri s
Field Trip X X In addition lo admission expenses, food expenses will also be allowed so long as lhe agency has a written policy stating lhat Tood and drinks are
Admission rouline purchases on all field Mps, noljusl Conlract-funded field Mps.
Ex enses
Rent, Utilitles and Maintenance - If the foilowin ex enses are ald for a faclli that Is used for other ur oses besfdes the Contract ro ram, then the bills muat be
Tele hone X X
Gas X X
WatedWaslewaler X X
ElecMc X X
Solid Waste X X -
Dis osal
Facility X X X -
Mainlenance and
Re airs
Cuslodial Services X X R services are rovided er a conlracl, a en will rovide conlracl instead of invoices.
Renl X X
Miscellaneous
Contred Labor X X X
Insurance Required X X -
Under the Conlracl
Childcare City requires lhat lhe agency submit ils fee schedule, showing a breakoul oi income levels, and for each level a breakout of lhe poAion of the
Scholarships expense to be paid by tamily and the poAion lo be reimbursed by lhe City. This fee schedule is required pnor lo lhe first payment. We also require
the income eligiblity of each household so lhat we ran delermine if we are being changed in conformance �vilh lhe fee schedule. If lhe fee schedule
changes at any lime during lhe conUact year, the agency musl notiiy City and provide a new schedule within 30 days oi lhe change.
*Proof of payment effeCtive October 1, 2013: Paymenls or Expenses must be documented in lhe following manner:
A) Image oi the check AND bank slalemenl showing the check deared the bank; OR,
B) Image of lhe cancelled check (ex. Al end of bank stalement); OR,
C) Payroll'Advace' or Slatemenl AND Bank Slatement indicating payroll; OR,
D) For �vire or e-lrensiers: Reciept or slalement from payeeNendor OR bank stalement.
EXHIBIT "G"
HOPWA OVERVIEW REPORT
Exhibit "G"
Pt�.1i NT pF
y��* I I * G�
,ZO I � � �2
G I III Q�
9e'V'� DEVF��
Housing Opportunities for Persons with AIDS
(HOPWA) Program
Consolidated Annual Performance and
Evaluation Report (CAPER)
Measuring Performance Outcomes
Final Released 1/12/12
OMB Number 2506-0133 (Expiration Date: 10/31/201
The CAPER report for HOPWA formula grantees provides annual information on program accomplishments
that supports program evaluation and the ability to measure program beneficiary outcomes as related to:
maintain housing stability; prevent homelessness; and improve access to care and support. This information is
also covered under the Consolidated Plan Management Process (CPMP) report and includes Narrative
Responses and Performance Charts required under the Consolidated Planning regulations. The public reporting
burden for the collection of information is estimated to average 42 hours per manual response, or less if an
automated data collection and retrieval system is in use, along with 60 hours for record keeping, including the
tiine for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. Grantees are required to report on the activities
undertaken only, thus there may be components of these reporting requirements that may not be applicable. This
agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless
that collection displays a valid OMB control number.
Previous editions are obsolete form HUD-40110-D (ExpiraHon Date: 10/31/2014)
Overview. The Consolidated Annual Performance and Evaluation Report
(CAPER) provides annual perfo�mance reporting on client outputs and
outcomss that enables an assessment of grantee performance in achieving the
housing stabiliry outcome measure. The CAPER, in conjunction with the
lntegrated Disbursement Information System (IDIS), fulfills statutory and
regulatory program reporting requirements and provides the grantee and
HUD with the necessary information to assess the overall progam
performance and accomplishments against planned goals and objectives.
HOPWA formula grantees are required to submit a CAPER, and complete
annual performance information for all activities undertaken during each
program year in the IDIS, demonstrating coordination with other
Consolidated Plan resources. HiJD uses the CAPER and IDIS data to obtain
essential information on grant activities, project sponsors, Subrecipient
organizations, l�ousing sites, units and households, and beneficiaries (wl�ich
includes racial and ethnic data on program participants). The Consolidated
Plan Management Process tool (CPMP) provides an optional tool to integrate
the reporting of HOPWA specific activities with other planning and reporting
on Consolidated Plan activities.
Table of Contents
PART 1: Grantee Executive Summary
1. Grantee Information
2. Project Spo�sor Information
3. Administrative Subrecipient Infonnation
4. Program Subrecipient Information
5. Grantee Narrative and Performance Assessment
a. Grantee and Community Overview
b. Annual Performance under the Action Plan
c. Barriers or Trends Overvie�v
d. Assessment of Unmet Housing Needs
PART 2: Sources oi' Leveraeine and Proeram Income
1. Sources of I,everaging
2. Program Income and Resident Rent Payments
PART 3: Accomplishment Data: Planned Goals and Actual Outauts
PART 4: Summary of Performance Outcomes
1. Housing Stability: Permanent Housing and Related Facilities
2. Prevention of Homelessness: Short-Term Housing Payments
3. Access to Care and Support: Housing Subsidy Assistance with
Supportive Services
PART 5: Worksheet - Determinine Housin2 Stabilitv Outcomes
PART 6: Annual CerH�carion of ConHnued Use for HOPWA Facilitv-
Based Stewardshiu Units (Onlvl
PART 7: Summary Overview oi' Grant Activifies
A. Information on Individuals, Beneficiaries and Households Receiving
HOPWA Housing Subsidy Assistance (TBRA, STRMiJ, PHP,Facility
Based Units, Master Leased Units ONLI�
B. Facility-Based Housing Assistance
Continued Use Periods. Grantees that received HOPWA funding for ne�v
construction, acquisitiov, or substantial rehabilitations are required to operate
their facilities for HOPWA-eligible beneficiaries for a ten (10) years period.
If no further HOPWA funds are used to support the facility, in place of
completing Section 7B of the CAPER, the grantee must submit an Annual
Certification of Continued Project Operation throughout the required use
periods. This certification is included in Part 6 in CAPER. The required use
period is three (3) years if the rehabilitation is non-substantial.
In connection with the development of the Department's standards for
Homeless Management Information Systems (HMIS), universal data
elements are being collected for clients of HOPWA-funded homeless
assistance projects. These project sponsor/subrecipient records would
include: Name, Social Security Number, Date of Birth, Ethnicity and Race,
Gender, Veteran Status, Disabling Conditions, Residence Prior to Program
Entry, Zip Code of L,ast Pernianent Address, Housing Status, Program Enhy
Date, Program Exit Date, Personal Identification Number, and Household
Identification Number. These are intended to match the elements under
HMIS. The HOPWA program-level data elements include: Income and
Sources, Non-Cash Benefits, HIV/AIDS Status, Services Provided, and
Housing Status or Destination at the end of the operating year. Other
suggested but optional elements are: Physical Disability, Developmental
Disability, Chronic Health Condition, Mental Health, Substance Abuse,
Domestic Violence, Date of Contact, Date of Engagement, Financial
Assistance, Housing Reiocation & Stabilization Services, Employment,
Education, General Healdi Status, , Pregnancy Status, Reasons for Leaving,
Veteran's Information, and Children's Education. Other HOPWA projects
sponsors may also benefit from collecting these data elements.
Final Assembly of Report. After the entire report is assembled, please
number each page sequentially.
Filing Requirements. Within 90 days of the completion of each program
year, grantees must sub�nit their completed CAPER to the CPD Director in
the grantee's State or Local IIIID Field Office, and to the HOPWA Program
Office: at HOPWA(a-hud.gov. Electr�onic submission to HOPWA Program
office is preferred; ho�vever, if electronic submission is not possible, hard
copies can be mailed to: Office of HIV/AIDS Housing, Room 7212, U.S.
Department ofHousing and Urban Development, 451 Seventh Street, SW,
Washington, D.C.
Record Keeping. Names and other individual information must be kept
confidential, as required by 24 CFR 574.440. However, IlUD reserves the
right to review the inforniation used to complete this report for grants
management oversight purposes, except for recording any names and other
identifying information. In the case that Hi7D must review client level
data, no client names or identifying informaHon will be retained or
recorded. Information is reported in aggregate to HUD without
personal identification. Do not submit client or personal information in
data systems to HUD.
Definitions
Adjustment for Duplication: Enables the calculation of unduplicated
output totals by accounting far the total number of households or units that
received more than one type of HOPWA assistance in a given service
category such as HOPWA Subsidy Assistance or Supportive Services. For
example, if a client household received both TBRA and STRMU during the
operating year, report that household in the category of HOPWA Housing
Subsidy Assistance in Part 3, Chart 1, Column [lb] in the following manner:
HOPWA Housing Subsidy [1] Outputs:
Assistance Number of
Households
1. Tenant-Based Rental Assistance 1
Permanent Housing FaciliHes:
2a. Received Operating
Subsidies/Leased units
TransitionaUShort-term Facilities:
2b. Received Operating Subsidies
Permanent Housing FaciliHes:
Capital Development Projects placed
3a. �n service during the operating year
TransitionallShort-term FaciliHes:
3b. Capital Development Projects placed
in service during the operating year
4 Short-term Rent, Mortgage, and
Utility Assistance 1
5 Adjustment for duplication
subtract 1
TOTAL Housing Subsidy
6. Assistance (Sum of Rows 1-4 minus 1
Row �
Previous ediHons are obsolete Page i form HUD-40110-D (Expiration Date: 10/31/2014)
Administrative Costs: Costs for general management, oversight,
coordination, evatuation, and reporting. By statute, grantee administrative
costs are limited to 3% of total grant a�vard, to be expended over the life of
the grant. Project sponsor administrative costs are limited to 7% of the
portion of the grant amount they receive.
Beneficiary(ies): All members of a household who received HOPWA
assistance during the operating year including the one individual who
qualified the household for HOPWA assistance as well as any other
members of the household (with or without HI� who benefitted from the
assistance.
Central Contractor Registration (CCR): The primaiy registrant
database for the U.S. Federal Government. CCR collects, validates, stores,
and disseminates data in support of agency acquisition missions, including
Federal agency contract and assistance awards. Both current and potential
federal government registrants (grantees) are required to register in CCR
in order to be awarded contracts by the federal govemment. Registrants
must update or renew their registration at least once per year to maintain
an active scatus. Although recipients of direct federal contracts and grant
awards have been required to be registered with CCR since 2003, this
requirement is now being extended to indirect recipients of federal funds
�vith the passage of ARRA (American Recovery and Reinvestment Act).
Per ARRA and FFATA (Federal Funding Accountability and
Transparency Act) federal regulations, all grantees and sub-grantees or
subcontractors receiving federal grant awards or contracts must have a
DiJNS (Data Universal Numbering Sysfem) Number.
Chronically Homeless Person: An individual or family who :(i) is
homeless and lives or resides individual or family �vho: (i) Is homeless and
lives or resides in a place not meant for human habitation, a safe haven, or
in an emergency shelter; (ii) has been homeless and living or residing in a
place not meant for human habitation, a safe haven, or in an emergency
shelter continuously for at least 1 year or on at least 4 separate occasions in
the last 3 years; and (iii) has an adult head of household (or a minor head
of household if no adult is present in the household) �vith a diagnosable
substance use disorder, serious mental illness, developmental disability (as
defined in section 102 of the Developmental Disabilities Assistance and
Bill of Rights Act of 2000 (42 U.S.C. 15002)), post traumatic stress
disorder, cognitive impairments resulting from a brain injury, or chronic
physical illness or disabiliry, including the co-occurrence of 2 or more of
those conditions. Additionally, the staturory definition includes as
chronically homeless a person who currently lives or resides in an
institutional care facility, including a jail, substance abuse or mental health
treatment facility, hospital or other similar facility, and has resided there
for fewer than 90 days if such person met the other criteria for homeless
prior to entering that facility. (See 42 U.S.C. 11360(2))This does not
include doubled-up or overcrowding situations.
Disabling Condition: Evidencing a diagnosable substance use disorder,
serious mental illness, developmental disability, chronic physical illness,
or disability, including the co-occurrence of rivo or more of these
conditions. In addition, a disabling condition may limit an individual's
abiliry to work or perform one or more activities of daily living. An
HN/AIDS diagnosis is considered a disabling condition.
Facility-Based Housing Assistance: All eligible HOPWA Housing
expenditures for or associated with supporting facilities including
community residences, SRO dwellings, short-term facilities, project-based
rental units, master leased units, and other housing facilities approved by
HUD.
Faith-Based Organization: Religious organizations ofthree types: (1)
congregations; (2) national netwarks, which include national
denominations, their social service arms (for example, Catholic Charities,
Lutheran Social Services), and nehvorks of related organizations (such as
YMCA and YWCA); and (3) freestanding religious organizations, which
are incorporated separately from congregations and national nehvorks.
Grassroots Organization: An organization headquartered in the local
community where it provides services; has a social services budget of
$300,000 or less annually, and six or fewer full-time equivalent
employees. Local affiliates of national organizations are not considered
"grassroots."
HOPWA Eligible Individual: The one (1) low-income person with
HN/AIDS who qualifies a household far HOPWA assistance. This person
may be considered "Head of Household." When the CAPER asks for
informaHon on eligible individuals, report on this individual person only.
Where there is more than one person with HIV/AIDS in the household, the
additional PWH/A(s), would be considered a beneficiary(s).
HOPWA Housing InformaHon Services: Services dedicated to heiping
persons living with HN/AIDS and their families to identify, locate, and
acquire housing. This may also include fair housing counseling far eligible
persons who may encounter discrimination based on race, color, religion,
sex, age, national origin, familial status, or handicap/disability. .
HOPWA Housing Subsidy Assistance Total: The unduplicated number
of households receiving housing subsidies (TBRA, STRMiJ, Permanent
Housing Placement services and Master L.easing) and/or residing in units
of facilities dedicated to persons living with HIV/AIDS and their families
and supported with HOPWA funds during the operating year.
Household: A single individual or a family composed of hvo or more
persons for which household incomes are used to determine eligibility and
for calculation of the resident rent payment. The term is used for
collecting data on changes in income, changes in access to services, receipt
of housing information services, and outcomes on achieving housing
stability. Live-In Aides (see definition for Live-In Aide) and non-
beneficiaries (e.g. a shared housing arrangement with a roommate) who
resided in the unit are not reported on in the CAPER.
Housing Stability: The degree to which the HOPWA project assisted
beneficiaries to remain in stable housing during the operating year. See
Part S: Deternri��ing Housing Sfability Otdcomes for definitions of stable
and unstable housing situations.
In-ldnd Leveraged Resources: These involve additional types of support
provided to assist HOPWA beneficiaries such as volunteer services,
materials, use of equipment and building space. The actual value of the
support can be the contribution of professional services, based on
customary rates for this specialized support, or actual costs contributed
from other leveraged resources. In determining a rate for the contribution
of volunteer time and services, use the rate established in HUD notices,
such as the rate of ten dollars per hour. The value of any donated material,
equipment, building, or lease should be based on the fair market value at
time of donation. Related documentation can be from recent bills of sales,
advertised prices, appraisals, or other information for comparable property
similarly situated.
Leveraged Funds: The amount of funds expended during the operating
year from non-HOPWA federal, state, local, and private sources by
grantees or sponsors in dedicating assistance to this client population.
Leveraged funds or other assistance are used directly in or in support of
HOPWA program delivery.
Live-In Aide: A person �vho resides with the HOPWA Eligible Individual
and who meets the following criteria: (1) is essential to the care and well-
being of the person; (2) is not obligated for the support of the person; and
(3) would not be living in the unit except to provide the necessary
supportive services. See the Code of Federal Regulaliorts Title 24, Part
5.903 and t17e HOPWA Grantee Oversight Resaurce Gttide for additrorra!
refererrce.
Master Leasing: Applies to a nonprofit or public agency that leases units
of housing (scattered-sites or entire buildings) from a landlord, and
subleases the units to homeless or low-income tenants. By assuming the
tenancy burden, the agency facilitates housing of clients who may not be
able to maintain a lease on their own due to poor credit, evictions, or lack
of sufficient income.
Operating Costs: Applies to facility-based housing only, for facilities
that are currently open. Operating costs can include day-to-day housing
Previous editions are obsolete Page ii form HUD-40110-D (Expiration Date: 10/31/2014)
function and operation costs like utilities, maintenance, equipment,
insurance, security, fumishings, supplies and salary for staff costs directly
related to the housing project but not staff costs for delivering services.
Outcome: The degree to which the HOPWA assisted household has been
enabled to establish or maintain a stable living environment in housing that
is safe, decent, and sanitary, (per the regulations at 24 CFR 574310(b))
and to reduce the risks of homelessness, and improve access to HN
treatment and other health care and support.
Output: The number of units of housing or households that receive
HOPWA assistance during the operating year.
Permanent Housing Placement: A supportive housing service that helps
establish the household in the housing unit, including but not limited to
reasonable costs for security deposits not to exceed nvo months of rent
costs.
Program Income: Gross income directly generated from the use of
HOPWA funds, including repayments. See grant administration
requirements on program income for state and local governments at 24
CFR 85.25, or for non-profits at 24 CFR 84.24.
Project-Based Rental Assistance (PBRA): A rental subsidy program
that is tied to specific facilities or units owned or conh•olled by a project
sponsor or Subrecipient. Assistance is tied directly to the properties and is
not portable or transferable.
Project Sponsor OrganizaHons: Any nonprofit organization or
governmental housing agency that receives funds under a contract �vith the
grantee to provide eligible housing and other support services or
administrative services as defined in 24 CFR 574.300. Project Sponsor
organizations are required to provide performance data on households
served and funds expended. Funding flows to a project sponsor as
follo�vs:
fIL1D Funding � Grantee � Project Sponsor
Short-Term Rent, Mortgage, and UHlity (STRMU) Assistance: A
time-limited, housing subsidy assistance designed to prevent homelessness
and increase housing stability. Grantees may provide assistance for up to
21 weeks in any 52 week period. The amount of assistance varies per
client depending on funds available, tenant need and program guidelines.
Stewardship Units: Units developed with HOPWA, where HOPWA
funds were used for acquisition, new construction and rehabilitation that
no longer receive operating subsidies from HOPWA. Report information
for the units is subject to the three-year use agreement if rehabilitation is
non-substantial and to the ten-year use agreement if rehabilitation is
substantial.
Subrecipient OrganizaHon: Any organization that receives funds fi•om a
project sponsor to provide eligible housing and other support services
and/or administrative services as defined in 24 CFR 574.300. If a
subrecipient organization provides housing and/or other supportive
services directly to clients, the subrecipient organization must provide
performance data on household served and funds expended. Funding
flows to subrecipients as follows:
HiID Funding � Grantee � Project Sponsor �Subrecipient
Tenant-Based Rental Assistance ('I'BRA): TBRA is a rental subsidy
program similar to the Housing Choice Voucher program that grantees can
provide to help low-income households access affordable housing. 'I'he
TBRA voucher is not tied to a specific unit, so tenants may move to a
different unit �vithout losing their assistance, subject to individual program
ivles. The subsidy amount is deteimined in part based on household
income and rental costs associated with the tenant's lease.
Transgender: Transgender is defined as a person who identiFies with, or
presents as, a gender that is different from his/her gender at birth.
Veteran: A veteran is someone who has served on active duty in the
Armed Forces of the United States. This does not include inactive military
reserves or the National Guard unless the person was called up to active
duty.
Previous ediHons are obsolete Page ui form HUD-40110-D (Expiration Date: 10/3l/2014)
As applicable, complete the charts below to provide more detailed information about the agencies and organizations responsible
for the administration and implementation of the HOPWA program. Chart 1 requests general Grantee Information and Chart 2 is
to be completed for each organization selected or designated as a project sponsor, as defined by CFR 574.3. In Chart 3, indicate
each subrecipient organization with a contract/agreement of $25,000 or greater that assists grantees or project sponsors carrying
out their administrative or evaluation activities. In Chart 4, indicate each subrecipient organization with a contracbagreement to
provide HOPWA-funded services to client households. These elements address requirements in the Federal Funding and
Accountability and Transparency Act of 2006 (Public Law 109-282).
Note: Please see the definition section for distinctions between project sponsor and subrecipient.
Note: If any infonnation does not apply to your organization, please enter N/A. Do not leave any section blank.
1. Grantee Information
HUD Grant Number Operating Year for this report
Froin (nrni/dd/yy) To (m��r/dd/yy)
Grantee Name
Business Address
City, County, State, Zip
Employer ldentification Number (EIl� or
Tax IdentiTication Number I
DUN & Bradstreet Number (DUNs): Central Contractor RegistraHon (CCR):
Is the grantee's CCR status currently active?
❑ Yes ❑ No
If yes, provide CCR Number:
*Congressional District of Grantee's Business
Address
*Congressional District of Primary Service
Area s
*City(ies) and County(ies) of Primary Service CiHes: Counties:
Area s
Organization's Website Address Is there a waiting list(s) for HOPWA Housing Subsidy Assistance
Services in the Grantee service Area? ❑ Yes ❑ No
If yes, explain in the narrative secHon what services maintain a waiHng
list and how this list is administered.
* Service delivery area information only needed for program activities being directly carried out by the grantee.
Previous ediHons are obsolete Page 1 form HUD-40110-D (ExpiraHon Date: 10/31/2014)
OMB Number 2506-0133 (Expiration Date: 10/31/2014)
2. Project Sponsor Information
Please complete Chart 2 for each organization designated or selected to serve as a project sponsor, as defined by CFR 574.3.
Use this section to report on organizations involved in the direct delivery of services for client households. These elements
address requirements in the Federal Financial Accountability and Transparency Act of 2006 (Public Law 109-282).
Note: Please see the definrtions for distinctions between project sponsor and subr�ecipient.
Note: If any i»formation does not apply to your• organization, please enter N/A.
Project Sponsor Agency Name Parent Company Name, if app/icable
Name and Title oS Contact at Project
S onsor A enc
Email Address
Business Address
City, County, State, Zip,
Phone Number (�vith area code)
Employer ldentificaHon Number (EIl� or Fax Number (with area code)
Tax Identification Number (TIl�
DUN & Bradstreet Number (DUNs):
Congressional District of Project Sponsor's
Business Address
Congressional District(s) of Primary Service
Area s
City(ies) and County(ies) of Primary Service Cities: Counties:
Area(s)
Total HOPWA contract amount for this
Or anization for the o eratin ear
Organizafion's Website Address
Is the sponsor a nonprofit organization? ❑ Yes ❑ No Does your organizaHon maintain a waiting list? ❑ Yes ❑ No
Please check if yes and a failh-based organizatiort ❑ If yes, explain in the narraNve section how this list is administered.
Please check if yes and a grassroots organization. ❑
Previous ediHons are obsolete Page 2 form HUD-40110-D (Expiration Date: 10/31/2014)
3. Administrative Subrecipient Information
Use Chart 3 to provide the following information for each subrecipient with a contracbagreement of $25,000 or greater that
assists project sponsors to carry out their administrative services but no services directly to client households. Agreements
include: grants, subgrants, loans, awards, cooperative agreements, and other forms of financial assistance; and contracts,
subcontracts, purchase orders, task orders, and delivery orders. (Organizations listed may have contracts with project sponsors)
These elements address requirements in the Federal Funding and Accountability and Transparency Act of 2006 (Public Law 109-
282).
Note: Please see the defrnitions for� distinctions between project sponsor and subr•ecipient.
Note: If any inforrnation does not apply to your organization, please enter N/A.
Subrecipient Name Parent Company Name, if applicable
Name and Title ot' Contact at Subrecipient
Email Address
Business Address
City, State, Zip, County
Phone Number (with area code) Fax Number (inciude area code)
Employer ldenHfication Number (EIi� or
Tax Identification Number I
DUN & Bradstreet Number (DUNs):
North American Industry Classificarion
S stem AICS Code
Congressional District of Subrecipient's
Business Address
Congressional District of Primary Service
Area
City (ies) and County (ies) of Primary Service Cities: Counties:
Area s
Total HOPWA Subcontract Amount of this
Or anizaHon for the o eratin ear
Previous editions are obsolete Page 3 form HUD-40110-D (Expiration Date: 10/31/2014)
4. Program Subrecipient Information
Complete the following information for each subrecipient organization providing HOPWA-funded services to client households.
These organizations would hold a contracdagreement with a project sponsor(s) to provide these services. For example, a
subrecipient organization may receive funds from a project sponsor to provide nutritional services for clients residing within a
HOPWA facility-based housing program. Please note that subrecipients who work directly with client households must provide
performance data for the grantee to include in Parts 2-7 of the CAPER.
Note: Please see the defrnition of a subrecipient for more inforrnation.
Note: Types
of frnancial
Note: If any
blank.
of contracts/agreements may include: grants, sub-grants, loans, awards, cooperative agreements, and other forms
assistance; and contracts, subcontracts, purchase orders, task orders, and delivery or�ders.
infonnation is not applicable to the organization, please r�eport N/A in the appropr•iate box. Do not leave boxes
Sub-recipient Name Parent Company Name, ifapplicable
Name and TiBe of Contact at Contractor/
Sub-contractor Agency
Email Address
Business Address
City, County, State, Zip
Fax Number (include area code)
Phone Number (included area code)
Employer ldentiscation Number (EII� or
Tax IdentificaHon Number (T'Il�
DUN & Bradstreet Number (DUNs)
North American Industry ClassiScation
System (NAICS) Code
Congressional District oS the Sub-recipienNs
Business Address
Congressional District(s) of Primary Service
Area
City(ies) and County(ies) of Primary Service Ciries: Counties:
Area
Total HOPWA Subcontract Amount of this
Organization for the operating year
Previous editions are obsolete Page 4 farm HUD-40110-D (ExpiraHon Date: 10/31/2014)
5. Grantee Narrative and Performance Assessment
a. Grantee and Communitv Overview
Provide a one to three page narrative summarizing major achievements and highlights that were proposed and completed during
the program year. Include a brief description of the grant organization, area of service, the name(s) of the program contact(s),
and an overview of the range/type of housing activities provided. This overview may be used for public information, including
posting on HUD's website. Note: Text ftelds are expandable.
b. Annual Performance under the Action Plan
Provide a narrative addressing each of the following four items:
1. Outputs Reported. Describe significant accomplishments or challenges in achieving the number of housing units supported
and the number households assisted with HOPWA funds during this operating year compared to plans for this assistance, as
approved in the Consolidated Plan/Action Plan. Describe how HOPWA funds were distributed during your program year among
different categories of housing and geographic areas to address needs throughout the grant service area, consistent with approved
plans.
2. Outcomes Assessed. Assess your program's success in enabling HOPWA beneficiaries to establish and/or better maintain a
stable living environment in housing that is safe, decent, and sanitary, and improve access to care. Compare current year results
to baseline results for clients. Describe how program activities/projects contributed to meeting stated goals. If program did not
achieve expected targets, please describe how your program plans to address challenges in program implementation and the steps
currently being taken to achieve goals in next operating year. If your program exceeded program targets, please describe
strategies the program utilized and how those contributed to program successes.
3. Coordination. Report on program coordination with other mainstream housing and supportive services resources, including
the use of committed leveraging from other public and private sources that helped to address needs for eligible persons identified
in the Consolidated Plan/Strategic Plan.
4. Technical Assistance. Describe any program technical assistance needs and how they would benefit program beneficiaries.
c. Barriers and Trends Overvie�v
Provide a narrative addressing items 1 through 3. Explain how barriers and trends affected your program's ability to achieve the
objectives and outcomes discussed in the previous section.
1. Describe any barriers (including regulatory and non-regulatory) encountered in the administration or implementation of
the HOPWA program, how they affected your program's ability to achieve the objectives and outcomes discussed, and,
actions taken in response to barriers, and recommendations for program improvement. Provide an explanation for each
barrier selected.
HOPW.
❑ Discrimination/Confidentiality
❑ Supportive Services
❑ Multiple Diagnoses
❑ Credit History
Housing Availability
❑ Eligibility
❑ Rental History
�
Rents
❑ Technical Assistance or Training
❑ Housing Affordability
❑ Geography/Rural Access
❑ Other, please explain further
❑ Criminal Justice History
Previous ediHons are obsolete Page 5 form HUD-40ll0-D (Expiration Date: 10/31/2014)
2. Describe any trends in the community that may affect the way in which the needs of persons living with HIV/AIDS
are being addressed, and provide any other information important to the future provision of services to this population.
3. Identify any evaluations, studies, or other assessments of the HOPWA program that are available to the public.
d. Unmet Housin� Needs: An Assessment of Unmet HousinE Needs
In Chart 1, provide an assessment of the number of HOPWA-eligible households that require HOPWA housing subsidy
assistance but are not currently served by any HOPWA-funded housing subsidy assistance in this service area.
In Row l, report the total unmet need of the geographical service area, as reported in Unmet Needs for Persons with HIY/AIDS,
Chart 1 B of the Consolidated or Annual Pian(s), or as reported under HOPWA worksheet in the Needs Workbook of the
Consolidated Planning Management Process (CPMP) tool.
Note: Report most current data available, thr•ough Consolidated or Annual Plan(s), and account for local housing issues, or
changes in HIY/AIDS cases, by using cornbination of one or more of the sources in Chart 2.
If data is collected on the type of housing that is needed in Rows a. through c., enter the number of HOPWA-eligible households
by type of housing subsidy assistance needed. For an approximate breakdown of overall unmet need by type of housing subsidy
assistance refer to the Consolidated or Annual Plan (s), CPMP tool or local distribution of funds. Do not include clients who are
already receiving HOPWA-funded housing subsidy assistance.
Refer to Chart 2, and check all sources consulted to calculate unmet need. Reference any data from neighboring states' or
municipalities' Consolidated Plan or other planning efforts that informed the assessment of Unmet Need in your service area.
Note: In order to ensure that the unmet need assessment for the region is comprehensive, HOPWA formula grantees should
include those unmet needs assessed by HOPWA competitive grantees operating within the service area.
1. Total number of households that have unmet
iousine subsidv assistance need.
2. From the total reported in Row 1, identify the
number of households with unmet housing needs
by type of housing subsidy assistance:
a. Tenant-Based Rental Assistance (TBRA)
b. Short-Term Rent, Mortgage and Utility payments
(STRMU)
Assistance with rental costs
Assistance with mortgage payments
Assistance with utility costs.
c. Housing Facilities, such as community residences,
SRO dwellings, other housing facilities
Previous editions are obsolete Page 6 form HiJD-40ll0-D (Expiration Date: 10/31/2014)
2. Recommended Data Sources for Assessin� Unmet Need (check all sources
X = Data as reported in the area Consolidated Plan, e.g. Table 1B, CPMP charts, and related narratives
= Data established by area HIV/AIDS housing planning and coordination efforts, e.g. Continuum of Care
= Data from client information provided in Homeless Management Information Systems (HMIS)
= Data from project sponsars or housing providers, including waiting lists for assistance or other assessments on need including those
completed by HOPWA competitive grantees operating in the region.
= Data from prisons or jails on persons being discharged with HN/AIDS, if mandatory testing is conducted
= Data from local Ryan White Planning Councils or reported in CARE Act Data Reports, e.g. number of clients �vith permanent
= Data collected for HIV/AIDS surveillance reporting or other health assessments, e.g. local health department or CDC surveillance data
End of PART 1
Previous ediHons are obsolete Page 7 form HUD-40110-D (ExpiraHon Date: 10/31/2014)
1. Sources of Leveraging
Report the source(s) of cash or in-kind leveraged federal, state,
Annual Plan and used in the delivery of the HOPWA program
local or private resources identified in the Consolidated or
and the amount of leveraged dollars. In Column [1], identify the
type of leveraging. Some common sources of leveraged funds have been provided as a reference point. You may add Rows as
necessary to report all sources of leveraged funds. Include Resident Rent payments paid by clients directly to private landlords.
Do NOT include rents paid directly to a HOPWA program as this will be reported in the next section. In Column [2] report the
amount of leveraged funds expended during the operating year. Use Column [3] to provide some detail about the type of
leveraged contribution (e.g., case management services or clothing donations). In Column [4], check the appropriate box to
indicate whether the leveraged contribution was a housing subsidy assistance or another form of support.
Note: Be sure to report on the number of households supported with these leveraged funds in Par�t 3, Chart 1, Colurnn d.
A. Source of Leveraging Chart
[2] Amount
of Leveraged [3] Type of [4] Housing Subsidy
[1] Source of Levera in Funds Contribution Assistance or Other Su ort
Public Fundin
OHousing Subsidy Assistance
Ryan White-Housing Assistance ❑Other Sup ort
❑Housing Subsidy Assistance
R an White-Other ❑Other Su ort
�Housing Subsidy Assistance
Housin Choice Voucher Pro ram ❑Other Su ort
❑Housing Subsidy Assistance
Low Income Housin Tax Credit ❑Other Su ort
❑Housing Subsidy Assistance
HOME ❑Other Su ort
�I�Iousing Subsidy Assistance
Shelter Plus Care ❑Other Su ort
�Housing Subsidy Assistance
Emergency Solutions Grant ❑Other Support
�Housing Subsidy Assistance
Other Public: ❑Other Su ort
❑Housing Subsidy Assistance
Other Public: ❑Other Su ort
�Housing Subsidy Assistance
Other Public: ❑Other Support
❑Housing Subsidy Assistance
Other Public: ❑Other Su ort
�Housing Subsidy Assistance
Other Public: ❑Other Support
Private Fundin
OHousing Subsidy Assistance
Grants ❑Other Support
�Housing Subsidy Assistance
In-kind Resources ❑Other Su ort
❑Housing Subsidy Assistance
Other Private: ❑Other Su ort
❑Housing Subsidy Assistance
Other Private: ❑Other Support
Other Fundin '
�Housing Subsidy Assistance
Grantee/Pro'ect S onsor/Subreci ient A enc Cash ❑Other Su ort
Resident Rent Pa ents b Client to Private Landlord
TOTAL Sum of all Rows
Previous editions are obsolete Page 8 form HUD-40110-D (Expirarion Date: 10/31/2014)
2. Program Income and Resident Rent Payments
e In Section 2, Chart A., report the total amount of program income and resident rent payments directly generated from the use of
HOPWA funds, including repayments. Include resident rent payments collected or paid directly to the HOPWA program. Do
NOT include payments made directly from a client household to a private landlord.
Note: Please see report directzons section for definition of progrmn income. (Additional inforrnation on program incorne is
available in the HOPWA Gr�antee Oversight Resource Guide).
A. Total Amount Program Income and Resident Rent Payment Collected During the Operating Year
Total Amount of
Program Income
Program Income and Resident Rent Payments Collected (for this operating
year)
1. Program income (e.g. repayments)
2. Resident Rent Payments made directly to HOPWA Program
3. Total Program Income and Resident Rent Payments (Sum of Rows i and 2)
B. Program Income and Resident Rent Payments Expended To Assist HOPWA Households
In Chart B, report on the total program income and resident rent payments (as reported above in Chart A) expended during the
operating year. Use Row 1 to report Program Income and Resident Rent Payments expended on Housing Subsidy Assistance
Programs (i.e., TBRA, STRMIJ, PHP, Master Leased Units, and Facility-Based Housing). Use Row 2 to report on the Program
Income and Resident Rent Payment expended on Supportive Services and other non-direct Housing Costs.
Total Amount of Program
Income Expended
Program Income and Resident Rent Payment Expended on (for this operating year)
HOPWA programs
1. Program Income and Resident Rent Payment Expended on Aousing Subsidy Assistance costs
2. Program Income and Resident Rent Payment Expended on Supportive Services and other non-
direct housing costs
3. Total Program Income Expended (Sum of Rows 1 and 2)
End of PART 2
Previous editions are obsolete Page 9 form HIJD-40ll0-D (Expirafion Date: 10/3U2014)
PART 3: Accomplishment Data Planned Goal and Actual
In Chart 1, enter performance information (goals and actual outputs) for all activities undertaken during the operating year
supported with HOPWA funds. Performance is measured by the number of households and units of housing that were supported
with HOPWA or other federal, state, local, or private funds for the purposes of providing housing assistance and support to
persons living with HN/AIDS and their families.
Note: The total households assisted with HOPWA funds and reported in PART 3 of the CAPER should be the same as reported
in the annual year�-efrd IDIS data, and goals reported should be consistent with the Annual Plan information. Any discrepancies
or• deviations sl�oarld be explaif�ed in the narrative sectio» of PART 1.
1. HOPWA Performance Planned Goal and Actual Out uts
[1] Output: Households [2] Output: Funding
HOPWA Leveraged
HOPWA Performance �sistance Households AOPWA Funds
Planned Goal a. b. c. d. e. f.
and Actual � � � � a � 3 -
a. .n a �
C7 Q C� Q xw' x¢
OPWA Housin Subsid Assistance 1 Out ut: Households 2 Ou ut: Fundfn
1. enant-Based Rental Assistance
a. Permanent Housing Facilities:
eceived O erating Subsidies/I.eased units (Households Served)
b, ransitionaUShort-term Facilities:
eceived Operating Subsidies/I.eased units (Households Served)
(Households Served
a. ermanent Housing Facilities:
apital Development Projects placed in service during the operating year
Househoids Served
b. ransitionaUShort-term Facilities:
Capital Development Projects placed in service duiing the operating year
(Hauseholds Served
Short-Term Rent, Mortgage and Utiliry Assistance
5. ermanent Housing Placement Services
djustments for duplication (subhact)
otal HOPWA Housing Subsidy Assistance
(Columns a. — d. equal the sum of Rows 1-5 minus Row 6; Columns e. and f. equal
the sum of Rows 1-5
ousing Development (ConstrucHon and Stewardship of facility based housiog)
1 Out ut: Housin Units 2 Ou ut: Fundin
8. acility-based units;
Capital Development Projects not yet opened (Housing Units)
. Stewardship Units subject to 3 or 10 year use agreements
10. otal Housing Developed
(Sum of Ro�vs 78 & 9
upportive Services
1 Ou utHouseholds 2 Ou ut: Fundin
lla. Supportive Se�vices provided by project sponsors/subrecipient that also
elivered HOPWA housing subsidy assistance
l lb Supportive Services provided by project sponsors/subrecipient that only provided
u ortive services.
12. djustment for duplication (subtract)
13, otal SupporHve Services
(Columns a. — d. equal the sum of Rows 11 a. & b. minus Row 12; Columns e. and f.
e ual the sum of Rows lla. & llb.
ousing Information Services (1] Output Households [2] Output: Fuud;ng
14. ousing Inforniation Services
15. otal Housing InfbrmaHon Services
Previous editions are obsolete Page 10 form HUD-40110-D (Expiration Date: 10/31/2014)
2. Listing of Supportive Services
Report on the households served and use of HOPWA funds for all supportive seivices. Do NOT report on supportive services
leveraged with non-HOPWA funds.
Dnta clreck: Total unduplicated hot�seholds and expe�rdittmes reported in Row 17 eq:ral totals repof7ed in Pa�•t 3, Chart 1, Rotiv 13.
SupporHve Services [1] Output: Number of Households [2] Output: Amount of HOPWA Funds
Expended
1. Adult day care and ersonal assistance
2. Alcohol and dru abuse services
3. Case mana ement
4. Child care and other child services
5. Education
6. Em loyment assistance and training
Health/medicaUintensive care services, if approved
7. Note: Client records must confwm with 24 CFR §574310
8. Le al services
9. Life skills mana ement outside of case mana ement)
10. Meals/nutritional services
11. Mental health services
12. Outreach
13. Trans ortation
Other Activity (if approved in grant agreement).
14. Specify:
Sub-Total Households receiving Supportive Services
15. (Sum of Rows 1-14
16. Ad'ustment for Du licaHon subtract
TOTAL Unduplicated Households receiving
Supportive Services (Column [1] equals Row 15
17. minus Row 16; Column �2] e uals sum of Rows 1-14)
Previous ediHons are obsolete Page 11 form HUD-40ll0-D (Expiration Date: 10/31/2014)
3. Short-Term Rent, Mortgage and Utility Assistance (STRMin Summary
In Row a., enter the total number of households served and the amount of HOPWA funds expended on Short-Term Rent,
Mortgage and Utility (STRMU) Assistance. In Row b., enter the total number of STRMU-assisted households that received
assistance with mortgage costs only (no utility costs) and the amount expended assisting these households. In Row c., enter the
total number of STRMU-assisted households that received assistance with both mortgage and utility costs and the amount
expended assisting these households. In Row d., enter the total number of STRMIJ-assisted households that received assistance
with rental costs only (no utility costs) and the amount expended assisting these households. In Row e., enter the total number of
STRMU-assisted households that received assistance with both rental and utility costs and the amount expended assisting these
households. In Row f., enter the total number of STRMU-assisted households that received assistance with utility costs only (not
including rent or mortgage costs) and the amount expended assisting these households. In row g., report the amount of STRMU
funds expended to support direct program costs such as program operation staff.
Data Clieck: The total households reported as served with STRMU in Row a., colirmn [IJ and fhe total arno:mt of HOPWA fi�nds reported as
expended in Row a., column �2J equals 1he household and expenditure total repor7ed for STRMU in Part 3, Chart 1, Row 4, Columns b. and f.,
r•espectively.
Data Check: The total number of households reported in Cok�mn [IJ, Rows b., c., d., e., and f. equal the total n¢nnber of STRMU households
t•eported in Colunan [1J, Ro�v a. The total amotmt reported as e,rpended in Coltnrin [2J, Ro�vs b., c., d., e., f., and g. equal the total amount of
STRMU expenditures reported in Column [2J, Row a.
� � �� � i �I
� � � t� •� �' i i• �•i
� � � •�t '
- - � ' � II
� � , -
� � � • ��
�• - �. ' • ,•��;��•'� •. � - -�
� -
� • - � . ' ' . -. � -; • • � •. � . � - - �
� • - � . - ; � -, � ' � � . � - - �
� • - • . : r; -� � '/• � . � - -�
� • . �. ' -;• -;� '� �. � - - •�
• � •� �- � � ��. •�- •
End of PART 3
Previous editions are obsolete Page 12 form HUD-40110-D (Expiration Date: 10/31/2014)
In Co�umn [1], report the total number of eligible households that received HOPWA housing subsidy assistance, by type.
In Column [2], enter the number of households that continued to access each type of housing subsidy assistance into next
operating year. In Column [3], report the housing status of all households that exited the program.
Data Check.• The sunr of Colunans [2J (Nuntber• ofHouseholds Continzrin� and [3J (Exited Households) equals the total reported in Column[I].
Note: Refer to the hoeising stability codes that appear in Part S: Worksheet - Determining Housing Stability Oertcomes.
Section 1. Housing Stability: Assessment of Client Outcomes on Maintaining Housing Stability (Permanent Housing and
Related Facilities)
A. Permanent Housin Subsid Assistance
[1] Output: Total (2] Assessment: Number of [3) Assessment: Number of
Number of Households that Continued Households that exited this [4] HOPWA Client
Households Receiving HOPWA Housing HOPWA Program; their Aousing putcomes
Served Subsidy Assistance into the Next Status after Exiting
Operating Year
1 Emergency Shelter/Streets Unstable Arr•angemenJs
2 Temporary Housing Temporarily Stable, lvith Red:�ced
Risk of Homelessness
3 Private Housing
Tenant-Based 4 Other HOP�VA
Rental StablelPermanentHousn�g (PFn
Assistance 5 Other Subsidy
6 Institution
7 JaiUPrison
Urtslable Arrangements
8 DisconneetecWnknown
9 Death L1fe Event
1 Emergency Shelter/Streets Urtstable Arrangenrerrts
2 Temporary Housing Temporarily Stable, with Reduced
Risk of Homelessness
3 Private Housing
Permanent 4 Other HOPWA
SupporHve Stable/Permanent Housing (PH)
Housing 5 Other Subsidy
Facilities/ Units
6 Institution
7 JaiVPrison
8 Disconnected(Unknown Unstable Arrangements
9 Death Life Eve�tt
B. Transitional Housin Assistance
[1] Output: Total [2] Assessment: Number of [3] Assessment: Number of
Number of Households that Continued Households that exited this
Households Receiving HOPWA Housing HOPWA Program; their [4] HOPWA Client Outcomes
Served Subsidy Assistance into the Next Housing Status after Exiting
O eratin Year
1 Emergency Shelter/Streets Unstable Arra��gemenfs
2 Temporary Housing Tentporarily S/able with Reduced
Risk ofHomeless�tess
TransitionaU 3 Private Housing
Short-Term
Housing 4 Other HOPWA
FaciliHes/ Units Stable/Permanent Housing (PF�
5 Other Subsidy
6 Institution
7 JaillPrison
Unstable Arrangemerzts
8 Disconnected/unknown
9 Death Life Event
Previous ediHons are obsolete Page 13 form HUD-40110-D (Expiration Date: 10/31/2014)
B I:Total number of households receiving transitionaUshort-terrn housing
assistance whose tenure exceeded 24 months
Section 2. Prevention of Homelessness: Assessment of Client Outcomes on Reduced Risks of Homelessness
(Short-Term Housing Subsidy Assistance)
Report the total number of households that received STRMU assistance in Column [1].
In Column [2], identify the outcomes of the households reported in Column [1] either at the time that they were known to have
left the STRMU program or through the project sponsor or subrecipienYs best assessment for stability at the end of the operating
year.
Information in Column [3] provides a description of housing outcomes; therefore, data is not required.
At the bottom of the chart:
In Row 1 a., report those households that received STRMU assistance during the operating year of this report, and the
prior operating year.
In Row lb., report those households that received STRMU assistance during the operating year of this report, and the
two prior operating years.
Data Check: The total households repor•ted as served with STRMU in Column [IJ equals the total reported in Part 3, Chart 1,
Row 4, Colurnn b.
Data C{:eck: The sum of Column [2J should equal the nu�nber of households reported in Column [IJ.
Assessment of Households that Received STRMU Assistance
(1] Output: Total [2] Assessment of Housing Status [3] HOPWA Client Outcomes
number of
households
Maintain Private Housing without subsidy
(e.g. AssistmJce provided/completed and client is s�able, not
likel ro seek additional s:i ort
Other Private Aousing without subsidy
(e.g. client switched housing units and is now stable, not likely
to seek additional support)
Stable/Perrnanent Housing (PH)
Other HOPWA Housing Subsidy Assistance
Other Housing Subsidy (PI�
InstituHon
(e.g. residential and long-term care)
Likely that additional STRMU is needed to maintain current
housing arrangements
Transitional FacilitieslShort-term TempoYpY[/y S�tab/e, wlth
(e.g. tempora�y or tra�rsitional arrangement) Reduced Risk of Homelessness
Temporary/Non-Permanent Housing arrangement
(e.g. gave up lease, a�rd moved in with fanrily or frierrds but
expects to live there less fhan 90 days)
Emergency Shelter/street
7ai1/Prison Unstable Arrangements
Disconnected
Death Ltfe Event
1 a. Total number of those households that received STRMU Assistance in the operating year of this report that also received
STRMII assistance in the prior operating year (e.g. households that received S'I'RMU assistance in two consecutive operating
years).
I b. Total number of those households that received STRMU Assistance in the operating year of this report that also received
STRMLJ assistance in the two prior operating years (e.g, households that received STRMIJ assistance in three consecutive
operating years).
Previous editions are obsolete Page 14 Sorm HUD-40110-D (Expirallon Date: 10/31/2014)
Section 3. HOPWA Outcomes on Access to Care and Support
la. Total Number of Households
Line [1]: For project sponsors/subrecipients that provided HOPWA housing subsidy assistance during the operating year
identify in the appropriate row the number of households that received HOPWA housing subsidy assistance (TBRA,
STRMU, Facility-Based, PHP and Master Leasing) and HOPWA funded case management services. Use Row c. to adjust
for duplication among the service categories and Row d. to provide an unduplicated household total.
Line [2]: For project sponsors/subrecipients that did NOT provide HOPWA housing subsidy assistance identify in the
appropriate row the number of households that received HOPWA funded case management services.
Note: These rrarmbers will help you to determine which clients to report Access to Care and Support Outcornes for and will be
used by HUD as a basis for analyzing the percentage of households who dernonstrated or maintained connections to care and
support as identified in Chart 1 b. below.
lb. Status of Households Accessing Care and Support
Column [I ]: Of the households identified as receiving services from project sponsors/subrecipients that provided HOPWA
housing subsidy assistance as identified in Chart 1 a., Row 1 d. above, report the number of households that demonstrated
access or maintained connections to care and support within the program year.
Column [2]: Of the households identified as receiving services from project sponsors/subrecipients that did NOT provide
HOPWA housing subsidy assistance as reported in Chart la., Row 2b., report the number of households that demonstrated
improved access or maintained connections to care and support within the program year.
Note: For information on types and sources of incorne and medical insurance/assistance, refer to Charts below.
[1] For project [2] For project
sponsors/subrecipients that sponsors/subrecipients that
Cate ories of Services Accessed provided HOPWA housing subsidy did NOT provide HOPWA Outcome
g housing subsidy assistance, Indicator
assistance, identify the households identify the households who
who demonstrated the following: demonstrated the followin :
1. Has a housing plan for maintaining or establishing stable on- Support for
going housing Stable
Housin
2. Had contact with case manager/benefits counselor consistent
with the schedule specified in client's individual service plan Access !o
(may include leveraged services such as Ryan White Medical Support
Case Management
3. Had contact with a primary health care provider consistent Access to
ith the schedule specified in clienYs individual service plan Heallh Care
4. Accessed and maintained medical insurance/assistance Access to
Health Care
5. Successfully accessed or maintained qualification for sources Sources of
of income Income
Previous ediHons are obsolete Page 15 form HUD-40110-D (Expiration Date: 10/31/2014)
Chart lb., Line 4: Sources of Medical Insurance and Assistance include, but are not limited to the following
• MEDICAID Health Insurance Program, or • Veterans Affairs Medical Services
use local program • AIDS Drug Assistance Program (ADAP)
name • State Children's Health Insurance Program
• MEDICARE Health Insurance Program, or (SCHIP), or use local program name
use local rogram name
Chart lb., Row 5: Sources of Income include, but are not limited to the
• Earned Income
• Child Support
Ryan White-funded Medical or Dental
Assistance
• General Assistance (GA), or use local
• Veteran's Pension • Social Security Disability Income (SSD� program name
• Unemployment Insurance • Alimony or other Spousal Support • Private Disability Insurance
• Pension from Former Job • Veteran's Disability Payment • Temporary Assistance for Needy
'• Supplemental Security Income (SSn • Retirement Income from Social Security Families (TANF)
• Worker's Compensation • Other Income Sources
lc. Households that Obtained Employment
Column [1 ]: Of the households identified as receiving services from project sponsors/subrecipients that provided HOPWA
housing subsidy assistance as identified in Chart la., Row ld. above, report on the number of households that include
persons who obtained an income-producing job during the operating year that resulted from HOPWA-funded Job training,
employment assistance, education or related case management/counseling services.
Column [2]: Of the households identified as receiving services from project sponsors/subrecipients that did NOT provide
HOPWA housing subsidy assistance as reported in Chart 1 a., Row 2b., report on the number of households that include
persons who obtained an income-producing job during the operating year that resulted from HOPWA-funded Job training,
employment assistance, education or case managemendcounseling services.
Note: This includes jobs created by this project sponsor/subrecipients or obtained outside this agency.
Note: Do not include jobs that resulted from leveraged job training, employment assistance, education or case
management/counseling services.
[1 For project sponsors/subrecipients that [2] For project sponsors/subrecipients that did
Categories of Services Accessed Provided HOPWA housing subsidy NOT provide HOPWA housing subsidy assistance,
assistance, identify the households who identify the households who demonstrated the
demonstrated the followin : followin :
otal number of households that
obtained an income- roducin 'ob
�:na oi raici 4
Previous ediHons are obsolete Page 16 form HUD-40110-D (ExpiraHon Date: 10/31/2014)
l. This chart is designed to assess program results based on the information reported in Part 4 and to help Grantees determine
overall program erformance. Completion of this worksheet is o tp ional.
Permanent Stable Housing Temporary Housing Unstable Life Event
Housing Subsidy (# of households (2) Arrangements (9)
Assistance remaining in program (1+7+8)
lus 3+4+5+6
Tenant-Based
Rental Assistance
TBRA
Permanent Facility-
based Housing
Assistance/CTnits
TransitionaUShort-
Term Facility-based
Housing
Assistance/CTnits
Total Permanent
HOPWA Housing
Subsid Assistance
Reduced Risk of 5table/Permanent Temporarily Stable, with Reduced Risk of Unstable Lite Events
Homelessness: Housing Homelessness Arrangements
Short-Term
Assistance
Short-Term Rent,
Mortgage, and
Utiliry Assistance
STR
Total HOPWA
Housing Subsidy
Assistance
Background on HOPWA Housing Stability Codes
Stable Permanent Housing/Ongoing Participation
3= Private Housing in the private rental or home ownership market (without known subsidy, including permanent placement
with families or other self-sufficient anangements) with reasonable expectation that additional support is not needed.
4= Other HOPWA-funded housing subsidy assistance (not STRMU), e.g. TBRA or Facility-Based Assistance.
5= Other subsidized house or apartment (non-HOPWA sources, e.g., Section 8, HOME, public housing).
6= Institutional setting with greater support and continued residence expected (e.g., residential or long-term care facility).
Temporary Housing
2= Temporary housing - moved in with family/friends or other short-term arrangement, such as Ryan White subsidy, transitional
housing for homeless, or temporary placement in institution (e.g., hospital, psychiatric hospital or other psychiatric facility,
substance abuse treatment facility or detox center).
Unstable Arrangements
1= Emergency shelter or no housing destination such as places not meant for habitation (e.g., a vehicle, an abandoned building,
bus/train/subway station, or anywhere outside).
7 = Jail /prison.
8= Disconnected or disappeared from project support, unknown destination or no assessments of housing needs were
undertaken.
Life Event
9= Death, i.e., remained in housing until death. This characteristic is not factored into the housing stability equation.
Tenant-based Rental Assistance: Stable Housing is the sum of the number of households that (i) remain in the housing and (ii)
those that left the assistance as reported under: 3, 4, 5, and 6. Temporary Housing is the number of households that accessed
assistance, and left their current housing for a non-permanent housing arrangement, as reported under item: 2. Unstable
Situations is the sum of numbers reported under items: 1, 7, and 8.
Previous editions are obsolete Page 17 form HUD-40110-D (ExpiraHon Date: 10/31/2014)
Permanent Facility-Based Housing Assistance: Stable Housing is the sum of the number of households that (i) remain in the
housing and (ii) those that left the assistance as shown as items: 3, 4, 5, and 6. Temporary Housin� is the number of households
that accessed assistance, and left their current housing far a non-permanent housing arrangement, as reported under item
2. Unstable Situations is the sum of numbers reported under items: 1, 7, and 8.
TransitionaUShort-Term Facility-Based Housing Assistance: Stable Housing is the sum of the number of households that (i)
continue in the residences (ii) those that le8 the assistance as shown as items: 3, 4, 5, and 6. Other Temporary Housing is the
number of households that accessed assistance, and left their current housing for a non-permanent housing arrangement, as
reported under item 2. Unstable Situations is the sum of numbers reported under items: 1, 7, and 8.
Tenure Assessment. A baseline of households in transitionaUshort-term facilities for assessment purposes, indicate the number
of households whose tenure exceeded 24 months.
STRMU Assistance: Stable Housing is the sum of the number of households that accessed assistance for some portion of the
pernutted 21-week period and there is reasonable expectation that additional support is not needed in order to maintain
permanent housing living situation (as this is a time-limited form of housing support) as reported under housing status: Maintain
Private Housing with subsidy; Other Private with Subsidy; Other HOPWA support; Other Housing Subsidy; and
Institution. Temporarily Stable, with Reduced Risk of Homelessness is the sum of the number of households that accessed
assistance for some portion of the permitted 21-week period or left their current housing arrangement for a transitional facility or
other temporary/non-permanent housing arrangement and there is reasonable expectation additional support will be needed to
maintain housing arrangements in the next year, as reported under housing status: Likely to maintain current housing
arrangements, with additional STRMU assistance; Transitional Facilities/Short-term; and Temporary/Non-Permanent Housing
arrangements Unstable Situation is the sum of number of households reported under housing status: Emergency Shelter;
Jail/Prison; and Disconnected.
End of PART 5
Previous ediNons are obsolete Page 18 form HUD-40ll0-D (Expiration Date: 10/37/2014)
The Annual Certification of Usage for HOPWA Facility-Based Stewardship Units is to be used in place of Part 7B of the
CAPER if the facility was originally acquired, rehabilitated or constructed/developed in part with HOPWA funds but no
HOPWA funds were expended during the operating year. Scattered site units may be grouped together on one page.
Grantees that used HOPWA funding for new construction, acquisition, or substantial rehabilitation are required to
operate their facilities for AOPWA eligible individuals for at least ten (10) years. If non-substantial rehabilitation funds
were used they are required to operate for at least three (3) years. Stewardship begins once the facility is put into
operation.
Note: See definition of Stewardship Units.
1. C;eneral i»formatinn
Operating Year for this report
IILID Grant Number(s) From (mrn/dd/yy) To (nrnt/dd/yy) ❑ Final Yr
❑ Yr 1; ❑ Yr 2; ❑ Yr 3; ❑ Yr 4; ❑ Yr 5; ❑ Yr 6;
❑ Yr 7; ❑ Yr 8; ❑ Yr 9; ❑ Yr ] 0;
Grantee Name Date Facility Began Operations (�nm/dd/yy)
2. Number of Units and Non-HOPWA
Facility Name:
Total Stewardship Units
(subiect to 3- or 10- vear use
3. Details of
Sites:
Site Information:
Site Information:
:I6i�Tf��1
Is the address of the project site confidential?
Number of Stewardship Units
Developed with HOPWA
funds
Amount of Non-HOPWA Funds Expended in Support of the
Stewardship Units during the Operating Year
❑ Yes, protect ir formation; do not list
Not
If the site is not confidenHal:
Please provide the contact information, phone,
email address/location, ifbusiness address is
different from facilitv address
can be made available to the
I certify that the facility that received assistance for acquisition, rehabilitation, or new construction from the Housing Opporiunities
for Persons with AIDS Program has operated as a facility to assist HOPWA-eligible persons from the date shown above. I also
certify that the grant is still serving the planned number of HOPWA-eligible households at this facility through leveraged resources
and all other reyuirements of the grant agreement are being satisfied.
I hereby certify tlrat all the ir:formation stalea
Name & Title of Authorized Official of the
to operate the facility:
as wel[ as
Name & Title of Contact at Grantee Agency
(person wlto can answer guestio�ts about 1he report and progr•ant)
r provided in the accompanfinen
Signature & Date (mm/dd/yy)
Contact Phone (with area
End of PART 6
Site
is b7te at�d accurate.
Previous ediHons are obsolete Page 19 form HUD-40110-D (ExpiraHon Date: 10/31/2014)
Section 1. HOPWA-Eligible Individuals who Received HOPWA Housing Subsidy Assistance
a. Total HOPWA Eligible Individuals Living with HIV/AIDS
In Chart a., provide the total number of eligible (and unduplicated) low-income individuals living with HIV/AIDS who qualified
their household to receive HOPWA housing subsidy assistance during the operating year. This total should include only the
individual who qualified the household for HOPWA assistance, NOT all HIV positive individuals in the household.
Individuals Served �vith Housing Subsidy Assistance
Number of individuals with HIV/AIDS who qualified their household to receive HOPWA housing subsidy assistance.
Total
Chart b. Prior Living Situation
In Chart b., report the prior living situations for all Eligible Individuais reported in Chart a. In Row 1, report the total number of
individuals who continued to receive HOPWA housing subsidy assistance from the prior operating year into this operating year.
In Rows 2 tt�rough 17, indicate the prior living arrangements for all new HOPWA housing subsidy assistance recipients during
the operating year.
Data Cf:eck: The total number of eligible individuals served in Row 18 equals the total nurnber of individuals served thr•ough
housing subsidy assistance reported in Chart a. above.
Total HOPWA
Category Eligible Individuals
Receiving Housing
Subsid Assistance
1. ContinuinQ to receive HOPWA support from the prior operating year
New Individuals who received HOPWA Housin Subsid Assistance su ort durin O eratin Year
2 Place not meant for human habitation
such as a vehicle, abandoned buildin , busltrain/subwa station/ai ort, or outside
3. Emergency shelter (including hotel, motel, or campground paid for with emergency shelter voucher)
4. Transitional housing for homeless persons
$, Total number of'new Eligible Individuals who received HOPWA Housing Subsidy Assistance with a;Prior
Livin Situation that meets HUD deSniHon of homelessness Sum of Rows 2— 4
6 Permanent housing for formerly homeless persons (such as Shelter Plus Care, SHP, or SRO Mod
Rehab
7. Psychiatric hospital or other psychiatric facility
8. Substance abuse treatment facility or detox center
9. Hospital (non-psychiatric facility)
10. Foster care home or foster care group home
11. Jail, prison or juvenile detention facility
12. Rented room, apartment, or house
13. House you own
14. Staying or living in someone else's (family and friends) room, apartment, or house
15. Hotel or motel paid for without emergency shelter voucher
16. Other
17. Don't Know or Refused
18. TOTAL Number of HOPWA Eligible Individuals (sum of Rows 1 and 5-17)
Previous ediHons are obsolete Page 20 f'orm HUD-40110-D (Expiration Date: 10/31l2014)
Note: Reporting for this section should include ONLY those individuals, benefrciaries, or households that received and/or
resided in a household that received HOPWA Housing Subsidy Assistance as repor•ted in Part 3, Chart 1, Row � Colurnn b.
(e.g., do not include households that received HOPWA supportive services ONLY).
c. Homeless Individual5ummary
In Chart c., indicate the number of eligible individuals reported in Chart b., Row 5 as homeless who also are homeless Veterans
u andJor meet the definition for Chronically Homeless (See Definition section of CAPER). The totals in Chart c. do not need to
equal the total in Chart b., Row 5.
Number of Number of Chronically
Category Homeless I-Iomeless
Veteran s
HOPWA eligible individuals served with
HOPWA Housing Subsidy Assistance
5ection 2. Benefciaries
In Chart a., report the total number of HOPWA eligible individuals living with HIV/AIDS who received HOPWA housing
subsidy assistance (as reported in Part 7A, Section 1, Chart a. ), and all associated members of their household who benefitted
from receiving HOPWA housing subsidy assistance (resided with HOPWA eligible individuals).
Note: See defrnition of HOPWA Eli�ible Individual
Note: See definition of Trans e�.
Note: See definition ofBene�ciaries.
Data Check: The sum of each of the Char•ts b. & c. on the following two pages equals the total number of beneficiaries served
with HOPWA housing subsidy assistance as determined in Chart a., Row 4 below.
a. Total Number of Beneficiaries Served with HOPWA H
� Individuals and Families Served with HOPWA Housing
1. Number of individuals with HIV/AIDS who qualified the h�
assistance (eauals the number of HOPWA Eligible Individuals
Assistance
Assistance
to receive HOPWA housing si
in Part 7A, Section 1, Chart a.
2. Number of ALL other persons diagnosed as HIV positive who reside with the HOPWA eligible individuals
identified in Row 1 and who benefitted from the HOPWA housing subsidy assistance
3. Number of ALL other persons NOT diagnosed as HIV positive who reside with the HOPWA eligible
individual identified in Row 1 and who benefited from the HOPWA housing subsidy
4. TOTAL number of ALL
served with
Subsidy Assistance (Sum of Rows 1,2, &
Total Number
Previous editions are obsolete Page 21 form AUD-40110-D (Expiration Date: 10/31/2014)
b. Age and Gender
In Chart b., indicate the Age and Gender of all beneficiaries as reported in Chart a. directly above. Report the Age and Gender of
all HOPWA Eligible Individuals (those reported in Chart a., Row 1) using Rows 1-5 below and the Age and Gender of all other
beneficiaries (those reported in Chart a., Rows 2 and 3) using Rows 6-10 below. The number of individuals reported in Row 11,
Column E. equals the total number of benefciaries reported in Part 7, Section 2, Chart a., Row 4.
HOPWA Eli` ible Individuals Chart a, Row 1
A. B. C. D. E.
TOTAL (Sum of
Male Female Trans ender M to F Trans ender F to M Columns A-D)
1. Under 18
2. 18 to 30 ears
3. 31 to 50 years
51 years and
4. Older
Subtotal (Sum
5. of Rows 1-4
All Other Beneficiaries Chart a, Rows 2 and 3
A. B. C. D. E.
TOTAL (Sum of
Male Female Trans ender M to F Trans ender F to M Columns A-D
6. Under 18
7. 18 to 30 ears
8. 31 to 50 ears
51 years and
9. Older
5ubtotal (Sum
10. of Rows 6-9
Total Bene�iciaries Chart a, Row 4
TOTAL (Sum
11. of Rows 5& 10)
Previous ediHons are obsolete Page 22 form HUD-40110-D (Expiration Date: 10/31/2014)
c. Race and Ethnicity*
In Chart c., indicate the Race and Ethnicity of all beneficiaries receiving HOPWA Housing Subsidy Assistance as reported in
Section 2, Chart a., Row 4. Report the race of all HOPWA eligible individuals in Coluinn [A]. Report the ethnicitv of all
HOPWA eligible individuals in column [B]. Report the race of all other individuals who benefitted from the HOPWA housing
subsidy assistance in column [C]. Report the ethnici of all other individuals who benefitted from the HOPWA housing subsidy
assistance in column [D]. The summed total of columns [A] and [C] equals the total number of beneficiaries reported above in
Section 2, Chart a., Row 4.
HOPNA Eligible Individuals All Other Beneficiaries
[A] Race [C] Race
Category [all individuals �B] Ethnicity [total of [D] Ethnicity
reported in ��so identified as individuals [Also identi�ed as
Section 2, Chart Hispanic or reported in Hispanic or
a., Row 1] LaHno] Section 2, Chart Latino]
a., Rows 2 & 3]
1. American Indian/Alaskan Native
2. Asian
3. Black/African American
4. Native Hawaiian/Other Pacific Islander
5. White
6. American Indian/Alaskan Native & White
7. Asian & White
8. Black/African American & White
9 American Indian/Alaskan Native &
Black/African American
10. Other Multi-Racial
1]. Column Totals (Sum of Rows 1-10)
Data Check: S:n�r of Rotiv ]/ Col:o�i» A and Row II Colimrrr C equals tlre �otal rri�mber HOPWA Beneftcia�•ies reporled irt Pa��13A, Section 2,
Chart a., Rotiv 4.
*Refere�rce (data reaa�ested consiste��t ivith For�m HUD-27061 Race ar�d Elhrric Data Reporti�i,g Form)
Section 3. Households
Household Area Median Income
Report the area median income(s) for all households served with HOPWA housing subsidy assistance.
Data Check: The total ncnnber of hoarseholds served with HOPWA housing subsidy assistance should eqi�aJ Part 3C, Row 7,
Co/annn b and Par�t 7A, Section 1, Char•t a. (Total HOP WA Eligible Individttals Served with HOP WA Housing Subsidy
Assistance).
Note: Refer to httU�/h+nvw.hi�duser.orQ/Uo�7a!/datusels/iI/i12010/select Geo�phv mli.odn for infor�nation on area median
Previous ediHons are obsolete Page 23 form HUD-40110-D (Expiration Date: 10/31/2014)
Complete one Part 7B for each facility developed or supported through HOPWA funds.
Do not comnlete this Section for programs orieinallv develoned with HOPWA funds but no longer sunnorted with
HOPWA funds. If a facility was developed with HOPWA fiznds (subject to ten years of operation for acquisition, new
construction and substantial rehabilitation costs of stewardship units, or three years for non-substantial rehabilitation costs), but
HOPWA funds are no longer used to support the facility, the project sponsor or subrecipient should complete Part 6: Annual
Certification of Continued Usage for HOPWA Facility-Based Stewardship Units (ONLY).
Complete Charts 2a., Project Site Information, and 2b., Type of HOPWA Capital Development Project Units, far all
Development Projects, including facilities that were past development projects, but continued to receive HOPWA operating
dollars this reporting year.
1.
2. Capital Development
��
2a. Project Site Information for HOPWA Capital Development of Projects (For Current or Past Capital
Development Pro.jects that receive HOPWA Operating Costs this reporting year)
Note: If units are scattered-sites, report on thern as a group and aender type of Facility write "Scattered Sites. "
HOPWA Name of Facility:
Type of Funds Non-HOPWA funds
Development Expended Expended
this operating this operating t a lrcable
year year �f pp �
(i a licable)
❑ New construction $ $ Type of Facility [Check onlv one box.]
❑ Rehabilitation $ $ ❑ Permanent housing
❑ Short-term Shelter or Transitional housing
❑ Acquisition $ $ ❑ Supportive services only facility
❑ Operating $ $
a. Purchase/lease of properry: Date (mm/dd/yy):
b. Rehabilitation/Conshuction Dates: Date started: Date Completed:
c. Operation dates: Date residents began to occupy:
❑ Not et accu ied
d. Date supportive services began: Date started:
❑ Not et roviding services
e. Number of units in the facility: HOPWA-funded units = Total Units =
❑ Yes ❑ No
f. Is a waiting list maintained for the facilit}i? If yes, ntm:ber• of participants on tlre list at the end of operatirtg year
g. What is the address of the facility (if different from business address)?
h• Is the address of the project site confidential? ❑ Yes, profect i� forntation; do rrotpublisla list
❑ No, car: be ntade available to the t�b/ic
Previous editions are obsolete Page 24 form HUD-40110-D (Expiration Date: 10/31/2014)
2b. Number and Type of HOPWA Capital Development Project Units (For Current or Past Capital
Development Projects that receive HOPWA Operating Costs this Reporting Year)
For units entered above in 2a. lease list the number of HOPWA units that fulfill the followin criteria:
Number Designated Number
for the Chronically Designated to Number Energy- Number 504 Accessible
Homeless Assist the Star Compliant
Homeless
Rental units constructed
(new) and/or
acquired with or without
rehab
Rental units rehabbed
Homeownership units
constructed (if approved)
3. Units Assisted in Types of Housing Facility/Units Leased by Project Sponsor or Subrecipient
Charts 3a. 3b. and 4 are required for each facilitv. In Charts 3a. and 3b., indicate the type and number of housing units in the
facility, including master leased units, project-based or other scattered site units leased by the organization, categorized by the
number of bedrooms per unit.
Note: The number units �nay not equal the total number of households served.
Please complete separate charts for each housing facility assisted. Scattered site units may be grouped together.
3a. Check one only
❑ Permanent Supportive Housing Facility/Units
❑ Short-term Shelter or Transitional Supportive Housing Facility/Units
3b. Type of Facility
Complete the following Chart for all facilities leased, master leased, project-based, or operated with HOPWA funds during the
reporting year.
Housing Assistance Category: Facility Based Housing
I.easing Costs
b.
c.
d.
e.
Operating Costs
Project-Based Rental Assistance (PBRA) or other leased units
Other Activity (if approved in grant agreement) Snecifv:
Adjustment to eliminate duplication (subtract)
TOTAL Facility-Based Housing Assistance
S• (Sum Rows a. throueh d. minus Row e.)
Output: Number of
Households
Output: Total HOPWA Funds Expended during
Oneratin� Year bv Proiect Snonsor/subrecipient
Previous editions are obsolete Page 25 form HUD-40110-D (Expiration Date: 10/31/2014)
4. Households and Housing Expenditures
Enter the total number of households served and the amount of HOPWA funds expended by the project sponsor/subrecipient on
subsidies for housing involving the use of facilities, master leased units, project based or other scattered site units leased by the
EXHIBIT "H"
SECTION 3 REPORTING FORMS
EXHIBIT "H"
Section 3 Summary Report
Economir Opportunities for
�Low — and Very Low-Income Persons
U.S. Department of Housing
and Urban Development
O�ce of Fair Housing
And Equal Opportunity
OMB Approval No: 2529-0043
(exp. 11/30/2010)
HUD Fieid O�ce:
Section back of page for Public Reporting Burden slatement
1. Recipient Name & Address: (street, city, state, zip) 2. Federal Identification: (grant no.) 3. Total Amount of Award:
4. Contact Person 5. Phone: (Indude area code)
6. Length of Granl: 7. Reporting Period:
8. Date Report Submilted: 9. Program Code: (Use separata sheet 10. Program Name:
for each program code)
Part I: Em Io ment and Trainin "� Columns B, C and F are mandato fields. Include New Hires in E&F
A B C D E F
Number of Number of New % of Aggregate Number % of Total Staff Hours Number of Section 3
Job Category Naw Hires Hires that are of Staff Hours of New Hires for Section 3 Employees Trainees
Sec. 3 Residents that are Sec. 3 Residents and Trainees
Professionals
Technicians
Office/Glerical
Construction by Trade (List)
Trade
Trade
Trade
Trade '
Trade
Other List
Total
` Program Codes 3= Publidindian Housing 4= Homeless Assistance
1= Flexible Subsidy A= Development, 5= HOME
2= Section 202/811 B= Operation 6= HOME Slate Administered
C= Modemization 7= CDBG Entitlement
Page 1 of 2
8 = CDBG State Adminislered
9 = Other CD Programs
10 = Olher Housing Programs
form HUD 60002 (6/2007)
Re/24 CFR 135
Part II: Contracts Awarded
Construction Contracts:
A. Total dollar amount of all contracts awarded on the project
B. Total dollar amount of contracts awarded to Section 3 businesses
C. Percentage of the total doilar amount that was awarded to Section 3 businesses
D. Total number of Section 3 businesses receiving contracts
2. Non-Construction Contracts:
A. Total dollar amount all non-construction contracts awarded on the projecUactivity
B. Total doilar amount of non-construction contracts awarded to Section 3 businesses
�
%
C. Percentage of the total dollar amount that was awarded to Section 3 businesses � %
D. Total number of Section 3 businesses receiving non-construction contracts
Part III: Summary
Indicate the efforts made to direct the employment and other economic opportunities generated by HUD financial assistance for housing
and community development programs, to the greatest extent feasibie, toward low-and very low-income persons, particularly those who
are recipients of government assistance for housing. (Check all that apply.)
Attempted to recruit low-income residents through: Iocai advertising media, signs prominently displayed at the project site,
contracts with the community organizations and public or private agencies operating within the metropolitan area (or
nonmetropoiitan county) in which the Section 3 covered program or project is iocated, or similar methods.
Participated in a HUD program or other program which promotes the training or employment of Section 3 residents.
Participated in a HUD program or other program which promotes the award of contracts to business concerns which meet the
definition of Section 3 business concerns.
Coordinated with Youthbuild Programs administered in the metropolitan area in which the Section 3 covered project is located.
Other; describe below.
Public reporting for this collection of information is estimated to average 2 hours per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
This agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB
number.
Section 3 of the Housing and Urban Development Act of 1968, as amended, 12 U.S.C. 1701 u, mandates that the Department ensures that
employment and other economic opportunities generated by its housing and community development assistance programs are directed
toward low- and very-low income persons, particularly those who are recipients of government assistance housing. The regulations are
found at 24 CFR Part 135. The information will be used by the Department to monitor program recipients' compliance with Section 3, to
assess the results of the DepartmenYs efforts to meet the statutory objectives of Section 3, to prepare reports to Congress, and by
recipients as self-monitoring tool. The data is entered into a database and will be analyzed and distributed. The coltection of information
involves recipients receiving Federal financial assistance for housing and community development programs covered by Section 3. The
information will be collected annually to assist HUD in meeting its reporting requirements under Section 808(e)(6) of the Fair Housing Act
and Section 916 of the HCDA of 1992. An assurance of confidentiality is not appiicable to this form. The Privacy Act of 1974 and OMB
Circular A-108 are not applicable. The reporting requirements do not contain sensitive questions. Data is cumulative; personai identifying
information is not included.
Page 2 of 2 fortn HUD 60002 (11/2010)
Ref 24 CFR 135
Form HUD-60002, Section 3 Summary Report, Economic Opportunities for Low- and Very Low-Income Persons.
Instructions: This form is to be used to report annual
accomplishments regarding employment and other economic
opportunities provided to low- and very low-income persons under
Section 3 of the Housing and Urban Development Act of 1968. The
Section 3 regulations apply to any public and Indian housing
programs that receive: (1) development assistance pursuant to
Section 5 of the U.S. Housing Act of 1937; (2) operating assistance
pursuant to Section 9 of the U.S. Housing Act of 1937; or (3)
modernization grants pursuant to Section 14 of the U.S. Housing Act
of 1937 and to recipients of housing a�d community development
assistance in excess of 5200,000 expended for: (1) housing
rehabilitation (including reduction and abatement of Iead-based paint
hazards); (2) housing construction; or (3) other public construction
projects; and to contracts and subcontracts in excess of $100,000
awarded in connection with the Section-3-covered activity.
Form HUD-60002 has three parts, which are to be completed for
ail programs covered by Section 3. Part I relates to employment
and training. The recipient has ihe option to determine numerical
employmenUtraining goals either on the basis of the number of hours
worked by new hires (columns B, D, E and F). Part II of the form
relates to contracting, and Part III summarizes recipients' efforts to
comply with Section 3.
Recipients or contractors subject to Section 3 requirements must
maintain appropriate documentation to establish that HUD financial
assistance for housing and community development programs were
directed toward low- and very low-income persons.* A recipient of
Section 3 covered assistance shail submit one copy of this report to
HUD Headquarters, O�ce of Fair Housing and Equal Opportunity.
Where the program providing assistance requires an annual
performance report, this Section 3 report is to be submitted at the
same time the program performance report is submitted. Where an
annual performance report is not required, this Section 3 report is to be
submitted by January 10 and, if the project ends before December 31,
within 10 days of project completion. Only Prime Recipients are
required to report to HUD. The report must include
accomplishments of all recipienfs and fheir Section 3 covered
confractors and subconfractors.
HUD Field Office: Enter the Field O�ce name .
1. Recipient: Enter the name and address of the recipient
submitting this report.
2. Federal Identification: Enter the number that appears on the
award form (with dashes). The award may be a grant,
cooperative agreement or contract.
3. Dollar Amount of Award: Enter ihe dollar amount, rounded to the
nearest dollar, received by the recipient.
4& 5. Contact Person/Phone: Enter the name and telephone number
of the person with knowledge of the award and the recipienYs
implementation of Section 3.
6. Reporting Period: Indicate the time period (months and year)
this report covers.
7. Date Report Submitted: Enter the appropriate date.
8. Program Code: Enter the appropriate program code as listed at
the bottom of the page.
9. Program Name: Enter the name of HUD Program corresponding
with the "Program Code" in number 8.
Part I: Empioyment and Training Opportunities
Column A: Contains various job categories. Professionais are
defined as peopie who have special knowledge of an occupation (i.e.
supervisors, architects, surveyors, planners, and computer
programmers). For construction positions, list each irade and provide
data in columns B through F for each trade where persons were
employed. The category of "Other" inciudes occupations such as
service workers.
Column B: (Mandatory Field) Enter the number of new hires for
each category of workers identified in Column A in connection with
this award. New hire refers to a person who is not on the contractor's
or recipienPs payroli for employment at the time of selection for the
Section 3 covered award or at the time of receipt of Section 3 covered
assistance.
Column C: (Mandatory Field) Enter the number of Section 3 new
hires for each category of workers identified in Column A in
connection with this award. Section 3 new hire refers to a Section 3
resident who is not on the contractor's or recipient's payroll for
employment at the time of selection for the Section 3 covered award or
at the time of receipt of Section 3 covered assistance.
Column D: Enter ihe percentage of all the staff hours of new hires
(Section 3 residents) in connection with this award.
Column E: Enter the percentage of the total staff hours worked for
Section 3 employees and trainees (including new hires) connected
with this award. Include staff hours for part-time and fuil-time
positions.
Column F: (Mandatory Field) Enter the number of Section 3
residents that were trained in connection with this award.
Part II: Contract Opportunities
Block 1: Construction Contracts
Item A: Enter the total dollar amount of all contracts awarded on the
projecUprogram.
Item B: Enter the total doilar amount of contracts connected wiih this
projectlprogram that were awarded to Section 3 businesses.
Item C: Enter the percentage of the total dollar amount of contracts
connected with this projecUprogram awarded to Section 3 businesses.
Item D: Enter the number of Section 3 businesses receiving awards.
Block 2: Non-Construction Contracts
item A: Enter the total dollar amount of aIl contracts awarded on the
projecUprogram.
Item B: Enter the total doilar amount of contracts connected with this
project awarded to Section 3 businesses.
Item C: Enter ihe percentage of ihe total dollar amount of contracts
connected with this projecUprogram awarded to Section 3 businesses.
item D: Enter the number of Section 3 businesses receiving awards.
Part III: Summary of Efforts — Self -explanatory
Submit one (1) copy of this report to the HUD Headquarters O�ce of
Fair Housing and Equal Opportunity, at the same time the
performance report is submitted to the program o�ce. The Section 3
report is submitted by January 10. Include oniy contracts executed
during the period specified in item 8. PHAs/IHAs are to report all
contracts/subcontracts.
' The terms "low-income persons" a�d very low-income persons" have
the same meanings given the terms in section 3(b) (2) of the United
States Housing Act of 1937. Low-lncome persons mean families
(including singie persons) whose incomes do not exceed 80 percent of
the median income for the area, as determined by the Secretary, with
adjustments for smaller and larger families, except ihat
Pagei
The Secretary may establish income ceilings higher or lower than 80 percent
of the median for the area on the basis of the Secretarys findings such that
variations are necessary because of prevailing levels of construction costs
or unusualiy high- or low-income families. Very low-income persons mean
low-income families (inciuding single persons) whose incomes do not
exceed 50 percent of the median family income area, as determined by the
Secretary with adjustments or smaller and larger families, except that the
Secretary may establish income ceilings higher or lower than 50 percent of
the median for the area on the basis of the Secretar�s findings that such
variations are necessary because of unusually high or low family incomes.
form HUD 60002 (11/2010)
Ref 24 CFR 135
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CITY COUNCIL AGENDA
Page 1 of 6
O�cial site of the City of Fort Worth, Texas
FORT�WORT�H
�
COUNCIL ACTION: Approved on 8/6/2013 - Ordinance No. 20854-08-2013
CONTINUED FROM A PREVIOUS WEEK
DATE: 7/23/2013 REFERENCE C-26369 LOG NAME: 17HUDACTPLANPY13-14
NO..
CODE: C TYPE:
NON- PUBLIC YES
CONSENT HEARING:
SUBJECT: Conduct Public Hearings and Approve the City's 2013-2018 Consolidated Plan and 2013-
2014 Action Plan for the Use of Federal Grant Funds in the Amount of $9,413,143.00
from the United States Department of Housing and Urban Development for Program Year
2013-2014 from the Community Deve�opment Block Grant, HOME Investment
Partnerships Program, Emergency Solutions Grant and Housing Opportunities for
Persons with AIDS Grant Programs, Authorize Collection and Use of Program Income,
Authorize Waiver of Application of Indirect Cost Rates, Authorize Execution of Related
Contracts and Interdepartmental Letters of Agreement and Adopt Appropriation
Ordinance (ALL COUNCIL DISTRICTS)
RECOMMENDATION:
It is recommended that the City Council:
1. Conduct a public hearing to allow citizen input and consideration of the City's 2013-2018 Consolidated
Plan;
2. Approve the City's 2013-2018 Consolidated Plan for submission to the United States Department of
Housing and Urban Development;
3. Conduct a public hearing to allow citizen input and consideration of the City's 2013-2014 Action Plan for
use of federal grant funds from the United States Department of Housing and Urban Development in the
amount of $9,413,143.00 for Program Year 2013-2014 from the Community Development Block Grant,
HOME Investment Partnerships Program, Emergency Solutions Grant and Housing Opportunities for
Persons with AIDS grant programs and for the use of program income from activities using prior years'
federal grant funds;
4. Approve the City's 2013-2014 Action Plan for submission to the United States Department of Housing
and Urban Development including allocations of grant funds to particular programs and activities as
detailed below;
5. Authorize the collection and use of an estimated amount of $50,000.00 of program income resulting
from activities using prior years' Community Development Block Grant funds for the programs and activities
detailed below;
6. Authorize the collection and use of an estimated amount of $250,000.00 of program income resulting
from activities using prior years' HOME Investment Partnerships Program funds for the City's Homebuyer
Assistance Program;
7. Authorize the City Manager or his designee to execute contracts and Interdepartmental Letters of
Agreement for a one year term with the agencies listed below in Tables 1, 2 and 3 for Program Year 2013-
2014 for Community Development Block Grant, Emergency Solutions Grant and Housing Opportunities for
Persons with AIDS grant funds, contingent upon receipt of funding;
8. Authorize the City Manager or his designee to extend the contracts and Interdepartmental Letters of
Agreement for up to one year if an agency or department requests an extension and such extension is
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p nece�sary for completion of the program;
Page 2 of 6
9. Authorize the City Manager or his designee to amend the contracts and Interdepartmental Letters of
Agreement if necessary to achieve program goals, provided any amendment is within the scope of the
program and in compliance with City policies and all applicable laws and regulations governing the use of
federal grant funds;
10. Authorize a waiver for indirect cost rates as applicable for the Grants Fund, in accordance with the
City's Administrative Regulations; and
11. Adopt the attached appropriation ordinance increasing the estimated receipts and appropriations to the
Grants Fund in the total amount of $9,413,143.00 (the amount of $6,079,622.00 in Community
Development Block Grant funds, the amount of $1,996,541.00 in HOME Investment Partnerships Program
funds, the amount of $425,325.00 in Emergency Solutions Grant funds and the amount of $911,655.00 in
Housing Opportunities for Persons with AIDS Grant funds) plus any program income, all subject to receipt
of such funds.
DISCUSSION:
The City receives an annual allocation of federal grant funds from the United States Department of
Housing and Urban Development (HUD) for the Community Development Block Grant (CDBG), HOME
Investment Partnerships Program (HOME), Emergency Solutions Grant (ESG) and Housing Opportunities
for People with AIDS (HOPWA) grant programs. In order to continue to receive these funds, the City must
submit a Consolidated Plan (ConPlan) every three to five years and an Annual Action Plan. The 2013-
2018
ConPlan summarizes housing and community development needs, particularly those of low-income
persons or households and provides the goals, objectives and strategies to address HUD's goals for
decent housing, suitable living environment and expanded economic opportunities. The ConPlan will cover
the period from October 1, 2013 to September 30, 2018.
The ConPlan consists of two parts: (i) the five year Strategic Plan (October 1, 2013 to September 30,
2018) and (ii) the Annual Action Plan, which includes housing and community development activities and
proposed expenditures for the upcoming Program Year. The plan for the first year of the ConPlan is listed
below.
The City's Annual Action Plan is a comprehensive summary of the major housing and community
development activities, programs and proposed expenditures for the use of $9,413,143.00 of federal grant
funds from HUD from CDBG, HOME, ESG and HOPWA grant programs for the Program Year beginning
October 1, 2013 and ending September 30, 2014. This year's Action Plan also summarizes the use of
program income resulting from activities using prior years CDBG and HOME funds. The purpose of these
grant funds is to primarily benefit low and moderate income City residents, with ESG funds primarily
benefiting homeless persons and HOPWA funds primarily benefiting persons with HIV/AIDS.
A notice was published in the Fort Worth Star-Telegram on June 21, 2013 regarding the 30-day public
comment period for the City's proposed ConPlan and Annual Action Plan. The public comment period was
held from June 23, 2013 to July 23, 2013. Any comments will be maintained by the Housing and Economic
Development Department, in accordance with federal regulations. These public hearings on the City's
ConPlan and Action Plan will be the first public hearings for the HUD-required citizen participation
process. The second public hearings will be held August 6, 2013 at which time the City Council is
scheduled to approve the ConPlan and the Action Plan. The ConPlan and Action Plan must be submitted
to HUD by August 16, 2013.
In addition, public hearings were held on June 20, 2013 at 10:00 a.m. and 6:00 p.m. for citizens to provide
comment on the proposed list of neighborhood streets eligible for reconstruction using CDBG funds. The
Transportation and Public Works Department prepared a list of priority streets in CDBG-eligible areas. The
streets selected for reconstruction were based on the comments provided at the public hearings. A list of
the streets is attached and will be included in the Action Plan.
Staff developed recommendations for the allocation of the estimated funding from HUD and presented
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Page 3 of 6
them to the Community Development Council (CDC) on May 22, 2013 and to the Housing and Economic
Development Committee on June 4, 2013. A summary of the CDC's funding recommendations is provided
below in Tables 1, 2 and 3 and a spreadsheet of all specific funding recommendations is attached.
For Program Year 2013-2014, it is recommended that the amount of $6,079,622.00 in CDBG funds and the
estimated amount of $50,000.00 of CDBG program income be allocated as follows:
Public Services - $911,943.00
This item includes social services for low to moderate income, disabled and disadvantaged
populations.
Housing Programs and Services - $2,149,193.50
This item includes funding for the City's Priority Repair Program, Cowtown Brush-Up, homebuyer
and housing services and accessibility modifications to the homes of senior and/or disabled
individuals and related project delivery costs for these programs.
Demolition and Infrastructure Services - $1,066,211.30
This item includes funding for neighborhood streets reconstruction and demolition of residential
structures to eliminate slum and blight in City neighborhoods.
CDBG Economic Development - $736,349.80
This item is the City's annual payment on its Section 108 loan from HUD.
CDBG Estimated Program Income - $50,000.00
The CDC recommended allocating any CDBG program income for the demolition of residential
structures to eliminate slum and blight in City neighborhoods.
CDBG General Administration - $1,215,924.40
This item includes costs for administering the CDBG grant including allocations for Financial
Management Services, Internal Audit and Planning and Development Departments.
For Program Year 2013-2014, it is recommended that the amount of $1,996,541.00 in HOME funds and
the estimated amount of $250,000.00 of HOME program income to be allocated as follows:
Homebuyer Assistance Program - $1,097,405.75
This item includes funding to provide down payment and/or closing cost assistance to low and
moderate income homebuyers.
Community Development Housing Organizations (CHDO) Set Aside -$299,481.15
HUD requires that a minimum of 15 percent of HOME funds be allocated to CHDOs for affordable
housing projects and CHDO administrative operating costs. These funds will be used for the
Hillside Morningside Single Family Infill Project by the Tarrant County Housing Partnership CHDO.
Multi-family Development - $400,000.00
Funding will be used for the Angle Apartments Development (Development). The Development will
result in approximately 306 units and 680 on-site parking spaces. This Development will address a
need for quality affordable housing by providing 100 percent income restricted units to Fort Worth
families at or below 80 percent of Area Median Income. The approximate address will be 3900 Angle
Avenue, Fort Worth, Texas 76106, Council District 2.
HOME General Administration - $199,654.10
This item includes costs for administering the HOME grant.
Staff anticipates the receipt of program income in the 2013-2014 Program Year from activities using HOME
funds. Any future program income will be used for the City's Homebuyer Assistance Program (HAP) after
the 10 percent allocation, excluding recapture, for HOME General Administration.
For Program Year 2013-2014, it is recommended that the amount of $911,655.00 in HOPWA funds be
allocated as follows:
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Non-Profit Service Providers - $884,305.35
HOPWA Program Administration - $27,349.65
'._- � • :
For Program Year 2013-2014, it is recommended that the amount of $425,325.00 in ESG funds be
allocated as follows:
Non-Profit Service Providers - $393,425.62
ESG Program Administration - $31,899.38
The CDC and Staff recommend that contracts be executed with the agencies listed below in the amounts
shown in the following tables: �
Communiiy Development Block Grant:
Table 1- CDBG A encies
Or anization Pro ram Amount
Cenikor Foundation Substance Abuse
Treatment $ 82,075.00
Childcare Associates Childcare Associates $ 35,335.00
Clayton Child Care. Inc. d/b/a Clayton Out of School Time
YES! $ 82,326.00
Counseling/Shelter
Day Resource Center for the Homeless Based Case
Mana ement $ 43,908.00
Girls Inc. of Tarrant County Girls Inc. Northside Fort
Worth $ 82,075.00
Lena Pope Home, Inc. Second Opportunity for
Success $ 82,326.00
Meals on Wheels, Inc. of Tarrant County
Home-Delivered Meals
$ 82,326.00
Senior Citizens of Greater Tarrant Connecting Seniors to
Count Communit $ 81,824.00
Tarrant County Housing Partnership Housing Counseling and
Education $ 124,935.00
The Ladder Alliance Com uter Skills Trainin $ 100,235.00
he Salvation Army, a Georgia S.T.A.R.T
Cor oration $ 43,908.00
YMCA of Metropolitan of Fort Worth Early Childhood
Education $ 35,335.00
YWCA Fort Worth & Tarrant County Child Development
Pro ram $ 35,335.00
CDBG Public Service Subtotal $911,943.00
*REACH Resource Center on Project Ramp
Inde endent Livin 75 000.00
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�� TOTAL CDBG Contracts �
*REACH will be funded from the CDBG Housing Programs budget.
Housing Opportunities For Persons With AIDS:
Page 5 of 6
� $ 986,943.00 �
Table 2- HOPWA A encies
Or anization Pro ram Amount
Tarrant County Samaritan Housing, Inc. Administration (three percent) and
Supportive Services
$ 261,611.35
AIDS Outreach Center, Inc. Administration (three percent),
Supportive Services, Tenant Based
Rental Assistance (TBRA), and Short
Term Rent Mortgage and Utility
Assistance (STRMU)
$ 622,694.00
TOTA� HOPWA Contracts $ 884,305.35
Emergency Solutions Grant:
Table 3- ESG A encies
Or anization Pro ram Amount
SafeHaven of Tarrant Count Shelter Services $ 85,065.00
Presb terian Ni ht Shelter Shelter Services $ 85,065.00
Day Resource Center for the Shelter Services
Homeless $ 85,065.00
The Salvation Army, a Georgia
Cor oration Homelessness Prevention/Ra id Re-Housin $ 43,136.00
CFW Parks and Community
Services
Homelessness Prevention/Ra id Re-Housin $ 63,015.62
Catholic Charities of Fort Worth
Homelessness Prevention/Ra id Re-Housin $ 32,079.00
TOTAL ESG Contracts $ 393,425.62
���CSC Nivyiani5 arC avauau�e m H�� �,�uiv�.i� uia i rci�. i J.
FISCAL INFORMATION/CERTIFICATION:
The Financial Management Services Director certifies that upon approval of the above recommendations,
adoption of the attached appropriation ordinance and receipt of grant funds, funds will be available in the
current operating budget, as appropriated, of the Grants Fund.
TO FundlAccounUCenters
GR76 451727 017206650XXX
6 079.622.00
GR76 5X�CXX 017206650XXX $6,079,622.00
GR76 451727 017206653XXX
GR76 5XXXXX 017206653XXX
GR76 451727 017206654XXX
GR76 5X�CXX 017206654XXX
GR76 451685 017206650XXX
GR76 5XXXXX 017206650XXX
$425.325.00
$425.325.00
$911.655.00
$911.655.00
$50,000.00
$50.000.00
FROM Fund/Account/Centers
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, M&C Review
) GR76 451685 0172060651XXX
G R76 5XXX)CX 017206651 XXX
G R76 451727 017206651 XXX
GR76 5XXXXX
017206651 XXX
$250,000.00
250,000.00
1 996 541.00
$1,996,541.00
Submitted for City Manager's Office bv: Fernando Costa (6122)
Originating Department Head:
Cynthia Garcia (8187)
Additional Information Contact:
Robert Sturns (8003)
Leticia Rodriguez (7319)
ATTACHMENTS
17HUDACTPLANPY13-14 A013 VG(1 .�c
2013-18ConPlanMemo HED6.4.13CG.pdf
ActionPlan 2013-14 funding recommendations�df
List of Selected Street for Action_ Plan 2013.�df
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8/21/2013