HomeMy WebLinkAboutContract 44867 (2)�; 'i
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STATE OF TEXAS §
§
COUNTY OF TARRANT §
This contract ("Contract") is made and entered into by and between the City of
Fort Worth (hereafter "City") and AIDS Outc•each Center, Inc. (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 fi•om the United States Department of
Housing and Urban Development ("HUD") through the Housing Opportunities for
Peisons 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
peisons associated with the challenge of living with HIV/AIDS and their families;
WHEREAS, Agency submitted a proposal to use HOPWA funds for an eligible
program under the HOPWA Regulations whereby Agency will provide services to low
and moderate income City citizens;
WHEREAS, City citizens, the Community Development Council, and the City
Council have determined that HOPWA programs are needed by the City's citizens;
NOW, THEREFORE, the Pat-ties understand and agree as follows:
1. INCORPORATION OF RECITALS.
City and Agency hereby agree that the recitals set forth above are true and conect
and form the basis upon which the Parties have entered into this Contract.
2. DEFINITIONS.
In addition to terms defined in the body of this Contract, the terms set forth below
shall have the definitions ascribed to them as follows:
Area Median Income or A1V1I means the median family income for the Fort Worth-
� Arlington meh�opolitan statistical area as established annually by HIJD. The 2013 income
� limits are attached hereto as Exhibit "A-1" — 2013 HUD Income Limits.
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mBusiness Diversity Enterprise Ordinance or BDE means the City's Business Diversity
c� Ordinance, Ordinance No. 20020-12-20ll.
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HOPWA PSA CONTRACT 2013-2014 -- AIDS OUTREACH CENTER, INC.
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Complete Documentation means the following documentation as applicable:
• Attachments I, II, and III, with supporting documentation including:
o Proof of expense: copies of timesheets, invoices, leases, service
contt•acts 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 participating 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 Documentation shall meet the standards described in the
attached Exhibit "F"- Standards for Complete Documentation.
• Any other document or record reasonably necessary to verify costs spent
and client eligibility for the Program.
DBE means disadvantaged business enterprise.
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 Income Self-Certification.
The client must also have a documented diagnosis of HIV/AIDS.
HOPWA Funds means the HOPWA grant funds supplied by City to Agency under the
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 -- AIDS OUTREACH CENTER, 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 othet� documentation described in
Section 9.
Source Documentation 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.
Citv shall t�rovide up to SIX HUNDRED TWENTY-TWO THOUSAND SIX
�IUNDRED NINETY-FOUR and 00/100 Dollars ($622,694.00) of HOPWA Funds on a
reimbursement of expenses basis, under• the tei�rns and conditions herein.
4.2 Monitor.
City will monitor the activities and performance of Agency and any of its
contractois, 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. Compliance with HOPWA Re�ulations and Contract.
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 -- AIDS OUTREACH CENTER, 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 r•easonable
and consistent with industry norms.
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 "B" - 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 �irst day of the month following the month in which it was approved by
Director, unless otherwise specified in the amendment. All requests for Budget
amendments must be submitted by August 15, 2014.
5.2.3 Chan�e in Pro�ram Bud�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 Contt•act in such instances to ensure
compliance with IILID regulations governing 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 Pavment of HOPWA Funds to A�ency.
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 that any HOPWA Funds either not spent or not
approved for reimbursement to Agency shall remain with City.
HOPWA PSA CONTRACT 2013-2014 -- AIDS OUTREACH CENTER, INC: 4
5.3 Program 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 Identifv 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
6.1.1 Income.
Agency must verify all new clients' income eligibility with either Source
Documentation or the form attached as Exhibit "E" - Form of Income Self
Certification. Agency must use the annual income definition used by 24 CFR 5.609 to
establish client income eligibility and must use the most current HUD Income
Guidelines.
6.1.2 Diagnosis.
Agency must submit a signed, dated statement that the client's file contains
documentation of the client's diagnosis of HIV/AIDS. The HIV/AIDS diagnosis must be
made by a licensed health care provider; a client's self-certification of diagnosis is not
sufficient. Agency should not submit the actual diagnosis to City.
6.1.3 Emergency Need.
For clients receiving shoi-t 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 -- AIDS OUTREACH CENTER, INC: 5
of income, eviction,
Agency must submi
October 1, 2013.
utility shutoff, or extraordinary and unexpected
t its policy regarding documenting emergency
healthcare costs.
need to City by
6.2 Submission of Complete Documentation.
Agency must submit copies of all eligibility verification 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, ot• 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 Environmental Miti�ation.
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.
Notwithstanding any provision of this Contract, the Parties agree and
acicnowledge 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 HUD.
7.3 Monitorin�.
7.3.1 Agency understands and agrees that City will monitor the adequacy and
timeliness 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 term of this Contract and for 5 years 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 per•iod for monitoring is deemed to
HOPWA PSA CONTRACT 2013-2014 -- AIDS OUTREACI� CENT`ER, INC.: 6
begin on October l, 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 pet-taining to the use of the HOPWA Funds, and to Agency's officers,
directors, agents, employees, contractors, subcontractors and vendois for the purpose of
such monitoring.
7.3.3 In addition to other provisions of this Contract r•egarding 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
findings. 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.
73.4 Agency agrees to likewise monitor the effectiveness of the services and
work to be performed by its contractors, subconh•actors and vendors.
73.5 This Section 7.3 shall survive 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 Pai�t 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 incuri•ed for performance rendered shall be determined in
accordance with OMB Circular A-122 as supplemented by the provisions of this
Contract.
7.6 Accountin� Standards.
Agency agrees to comply with OMB Circular A-110, "Unifor•m Administrative
Requit•ements 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 intet•nal controls, and
maintain necessary suppoi�ting and back-up documentation for all costs incurred.
HOPWA PSA CONTRACT 2013-2014 -- AIDS OUTREACH CENTER, 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 Vendors.
Agency understands and agrees that all terms of this Contt�act, whether regulatory
or otherwise, shall apply to any and all contractors, subcontractors and vendors of
Agency which are in any way paid with HOPWA Funds or who perform any worlc in
connection with the Program. Agency shall cause all applicable provisions of this
Contract to be included in and made a part of any contract or subcontract executed in the
performance of its obligations hereunder including its obligations regarding the HOPWA
Regulations. Agency shall monitor the services and work performed by its contractors,
subcontractors and vendors on a regular basis for compliance with the HOPWA
Regulations and Contract provisions. Agency must cure all violations of the HOPWA
Regulations committed by its contractors, subcontractors or vendors. City maintains the
right to insist on Agency's full compliance with the terms of this Contract and the
HOPWA Regulations and Agency is responsible for such compliance regardless of
whether actions talcen to fiilfill the requirements of this Contract are taken by Agency or
by Agency's contractors, subcontractors or vendors. Agency acicnowledges that the
provisions of this Section shall survive the earlier termination or expiration of this
Contract.
7.9 Copvright and Patent Rights.
No reports, maps, or other documents produced in whole or in part under this
Contract shall be the subject of an application for copyright by or on behalf of Agency.
HUD and City shall possess all rights to invention or discovery, as well as rights in data,
which may arise as a result of Agency's performance under this Contract.
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 will keep or cause to be kept an accurate record of
all actions taken and all funds spent, with supporting and back-up documentation.
Agency will maintain all records and documentation related to this Contract for 5 years
after the Contract term ends. If any claim, litigation, or audit is initiated before the
expiration of the 5 year period, the relevant records and documentation must be retained
until all such claims, litigation or audits have been resolved. For purposes of this
Contract, this 5 year period for record retention is deemed to begin on October 1, 2014
and end on September 30, 2019 regardless of whether or not this Contract is eat•lier
terminated.
HOPWA PSA CONTRACT 2013-2014 -- AIDS OUTREAGH CENTER, ING" 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 hout•s 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 terminated.
8.3 Renorts.
Agency will submit to City all reports and documentation described in this
Contract in such form as City may prescribe. Agency may also be required to submit a
final performance and/or final financial report if required by City at the termination of
this Contract in such form and within such times as City may prescribe. Failure to submit
to City any repoi�t 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� Requirements and 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 necessaty.
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 �scal years during which this Contract is in force. The audit must be
prepared by an independent certified public accountant, be completed within 6 months
following the end of the period being audited and be submitted to City within 30 days of
its completion. Agency's audit certification is attached hereto as Exhibit "C" —"Audit
Certification Form" and "Audit Requirements". The Audit Certification Form must
be submitted to City prior to or with the first Reimbursement Request. Entities that
expend less than $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
�nances at any time during the term of this Contract and for 5 years after the Contract
Term ends if City determines that such audit is necessaiy 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 Contract, 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 -- AIDS OUTREACH CENTER, 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 BY HUD BECAUSE OF SUCH
ACTIONS.
9. REIMBURSEMENT REpUIREMENTS.
9.1 Deadline for Submittin� Reimbursement Requests.
Each Reimbursement Request shall be received by the City on or before the 15tn
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
15t1' falis on a weekend or City holiday, Reimbursement Requests shall be due the next
day that the City is open for business. Failure to submit a Reimbursement Request in a
timely fashion will result in City taking the actions outlined in Section 10.1.
NOTWITHSTANDING ANYTHING ABOVE, EXPENSES FOR SEPTEMBER
2014 MUST BE RECEIVED BY SEPTEMBER 20, 2014. FAILURE TO SUBMIT
A FINAL REIMBURSEMENT REQUEST BY SEPTEMBER 20, 2014 WILL
RESULT IN AUTOMATIC FORFEITURE 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" — Reimbursement Forms with each
Reimbursement Request:
9.2.1 Attachment I — Invoice.
This report shall contain the amount requested for reimbursement each month, the
cumulative reimbursement requested to date (inclusive of that month's request), and must
be signed by an authorized signatory of Agency. By signing Attachment I, Agency is
certifying that the costs are valid, eligible, consistent with the terms and conditions of this
Contract, and the data contained in the report is true and correct. This report must be
submitted even if Agency is requesting $0 for a particular month.
9.2.2 Attachment II — Expenditure Worksheet.
This report shall itemize each expense requested for reimbursement by Agency
and shall include the Account corresponding the expense to a Budget line item in
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 -- AIDS OUTREACH CENTER, ING.
10
a
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 satisfied by cancelled checks, wire transfer documentation,
paid receipts or other appropriate banking documentation.
9.2.3 Attachment III — Client Data Report.
This report shall list each Unduplicated Client served during the month along with
his or her demographic information. The Client Data Report must contain a list of all
clients seived 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� Pavment.
CITY HAS NO OBLIGATION TO MAI�E 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 default.
10. DEFAULT AND TERMINATION.
10.1 Failure to Submit Required Documentation
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 -- AIDS OUTREACH CENTER, INC; 11
10.1.2 NOTWITHSTANDING THE PROVISIONS OF SECTION
10.1.1, IF AGENCY FAILS TO SUBMIT THE REIMBURSEMENT REQUEST
DUE SEPTEMBER 20, 2014, OR IF THE SUBMITTED REIMBURSEMENT
REQUEST FOR SEPTEMBER 20, 2014 IS LATE, INCOMPLETE OR
OTHERWISE NOT IN COMPLIANCE WITH THIS CONTRACT OR HOPWA
REGULATIONS AS DETERMINED BY CITY IN ITS SOLE DISCRETION,
THERE WILL BE NO CURE PERIOD AND ANY REIMBURSEMENT WILL BE
AUTOMATICALLY FORFEITED.
10.1.3 In the event of (i) an uncured default under Section 10.1.1 or (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 shali 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 -- AIDS OUTREACH CENTER, INC: 12
Contract, Agency shall be in default under this Contract if Agency breaches any term or
condition of this Contract. In the event that such a breach remains uncured after 30
calendar days following written notice by City (or such other notice period as may be
specified herein) or, if Agency has diligently and continuously attempted to cure
following receipt of such written notice but reasonably requires more than 30 calendar
days to cure, as determined by both Parties mutually and in good faith, City shall have the
right to elect in City's sole discretion to (i) extend Agency's time to cure, (ii) terminate
this Contract effective immediately upon written notice of such intent to Agency, or (iii)
pursue any other legal remedies available to City.
10.3.1 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 Termination.
Agency shall not receive any compensation for work undertalcen after the date of
the termination.
10.6 Rights of Citv 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 term or termination of the Contract.
10.7 Waiver of Breach Not Waiver of Subsequent Breach.
The waiver of a default or breach of any term, covenant, or condition of this
Contract shall not operate as a waiver of any subsequent default or breach of the same or
any other tei�rn, covenant or condition hereof.
10.8 Civil, Criminal and Administrative Penalties.
Failure to perform all the Contract terms may result in civil, criminal or
administrative penalties, including, but not limited to those set out in this Contract.
10.9 Termination for Cause.
10.91 City may terminate this Contract in the event of Agency's default,
inability, or failure to perform subject to notice, grace and cure periods. In the event City
terminates this Contract for cause, all HOPWA Funds awarded but unpaid to Agency
pursuant to this Contract shall be immediately rescinded and Agency shall have no
further right to such funds and any HOPWA Funds already paid to Agency must be
HOPWA PSA CONTRACT 2013-2014 -- AIDS OUTREACH CENTER, INC: 13
repaid to City within 30 days of termination. 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 FOR ANY OTHER
CITY CONTRACT FOR HOPWA FUNDS FOR A MINIMUM OF 5 YEARS
FROM THE DATE OF TERMINATION.
10.9.2 Agency may terminate this Contract if City does not provide the
HOPWA Funds substantially in accordance with this Contract.
10.10 Termination for Convenience.
In terminating in accordance with 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
1010.2 By the Agency upon written notification to City, setting forth the
reasons for such termination, the effective date, and in the case of partial termination, the
portion to be terminated. In the case of a partial termination, City may terminate the
Contract in its entirety if City determines in its sole discretion that the remaining portion
of the Contract to be performed or HOPWA Funds to be spent will not accomplish the
purposes for which the Contract was made.
1011 Dissolution of A�encv Terminates Contract.
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
repayment and/or City may exercise all of its remedies under this Contract.
10.12 Reversion of Assets.
In the event this Contract is terminated with or without cause, all assets acquired
with the HOPWA Funds including cash, interest payments fi•om loans or otherwise, all
outstanding notes, mortgages or other security instruments, any accounts receivable
attributable to the use of the HOPWA Funds, and any real or personal property owned by
Agency that was 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 repayment in the event the Program does not
meet the requirements as set out in this Contract or in the HOPWA Regulations. If
Agency takes any action that results in the City being required to repay all or any
portion of the HOPWA Funds to HUD, Agency agrees it will reimburse City for
such repayment. If Agency takes any action that results in City receiving a finding
from HUD about the Program, whether or not repayment of all or any portion of
HOPWA PSA CONTRACT 2013-2014 -- AIDS OUTREACH CENTER, INC; 14
the HOPWA Funds is required of City, Agency agrees it will pay City 10% of the
HOPWA Funds as liquidated damages. The Parties agree that City's damages in the
event of either repayment to HUD being required or receiving a finding from 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 HUD or a
repayment of funds to HUD by City. Therefore, the Parties agree that payment under this
Section of 10% of the HOPWA Funds by Agency to City is liquidated damages and not a
penalty.
12. CHANGE IN NON-PROFIT STATUS.
If the non-profit status of Agency changes after the date of this Contract, City
may but is not obligated to, terminate this Contract. Agency must provide City with
written notification of any changes to its non-proiit status within 15 calendar days of
being notifed of the change. City has 30 calendar days to malce such determination after
receipt of notice fi•om 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 pursuant to this Contract shall be immediately forfeited and
Agency shall have no further r•ight 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�encv an Independent Contractor.
Agency shall operate hereunder as an independent contractor and not as an
officer, agent, servant or employee of City. Agency shall have exclusive control of, and
the exclusive right to control, the details of the worlc and services performed hereunder,
and all persons performing same, and shall be solely responsible for the acts and
omissions of its officers, members, agents, servants, employees, contractors,
subcontractors, vendors, clients, licensees or invitees.
14.2 Doctrine of Respondeat Superior.
The doctrine of respondeat superior shall not apply as between City and Agency,
or its offcers, members, agents, servants, employees, contractors, subcontractors,
vendors, clients, licensees or invitees, and nothing herein shall be construed as creating a
partnership or joint enterprise between City and Agency. City does not have the legal
HOPWA PSA CONTRACT 2013-2014 -- AIDS OUTREACH CENTER, 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 Agencv Propertv.
City shall under no circumstances be responsible for any property belonging to
Agency, or its officers, members, agents, employees, contractors, subcontractors,
vendors, clients, licensees or invitees that may be lost, stolen or destroyed or in any way
damaged and AGENCY HEREBY INDEMNIFIES AND HOLDS HARMLESS
CITY AND ITS OFFICERS, AGENTS, AND EMPLOYEES FROM ANY AND
ALL CLAIMS OR SUITS PERTAINING TO OR CONNECTED WITH SUCH
PROPERTY.
14.5 Reli�ious Organization.
No portion of the HOPWA Funds shall be used in support of any sectarian or
religious activity. In addition, there must be no religious or membership criteria for
clients of a HOPWA-funded service.
14.6 Venue.
Venue for any action, whether real or asserted, at law or in equity, ar•ising 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 Feder•al law, the choice of law shall be the
laws of the State of Texas.
14.8 Severabilitv.
The provisions of this Contract are severable, and, if for any reason a clause,
sentence, paragraph or other part of this Contract shall be determined to be invalid by a
court or Federal or state agency, board or commission having jurisdiction over the subject
matter thereof, such invalidity shall not affect other provisions which can be given effect
without the invalid provision.
14.9 Written A�reement Entire Contract.
This written instrument and the Exhibits, Attachments, and Addendums attached
hereto, which are incorporated by reference and made a part of this Contract for all
purposes, constitute the entire agreement by the Parties hereto concerning the work and
seivices to be performed under this Contract. Any prior or contemporaneous oral or
written agreement, which purports to vary the terms of this Contract, shall be void. Any
amendments to the terms of this Contract must be in writing and must be executed by
each Party to this Contract.
HOPWA PSA CONTRACT 2013-2014 -- AIDS OUTREACH CENTER, INC. 16
14.10 Para�raph Headin�s for Reference Only, No Le�al Si�nificance;
Number and Gender.
The pat•agraph headings contained herein are for convenience in reference to this
Contract and are not intended to define or to limit the scope of any provision of this
Contract. When context requires, singular nouns and pronouns include the plural and the
masculine gender shall be deemed to include the feminine or neuter and the neuter gender
to include the masculine and feminine. The words "include" and "including" whenever
used herein shall be deemed to be followed by the words "without limitation".
1411 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:
➢ 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
meaningfiil access by person of limited English proficiency
➢ The Fair Housing Act, Title VIII of the Civil Rights Act of 1968 (42 U.S.C.
Sections 3601 et seq.)
➢ Executive Orders 11063, 11246 as amended by 11375 and 12086 and as
supplemented by Department of Labor regulations 41 CFR, Part 60
➢ The Age Discrimination in Employment Act of 1967
➢ The Age Discrimination Act of 1975 (42 U.S.C. Sections 6101 et seq.)
➢ The Uniform Relocation Assistance and Real Property Acquisition Policies
Act of 1970 (42 U.S.C. Sections 4601 et seq. and 49 CFR Part 24) ("URA")
➢ Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. Sections 794 et seq.)
and 24 CFR Part 8 where applicable
➢ National Environmental Policy Act of 1969, as amended, 42 U.S.C. sections
4321 et seq. ("NEPA") and the related authorities listed in 24 CFR Pai�t 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 veri�cations 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 Wor•lcplace Act of 1988 (41 U.S.C. Sections 701 et sec�.) and 24
HOPWA PSA CONTRACT 2013-2014 -- AIDS OUTREAGH CENTER, INC. 17
CFR Part 23, Subpart F
➢ Executive Order 12549 and 24 CFR Part 5.105(c) pei�taining to restrictions on
participation by ineligible, debarred or suspended persons or entities
➢ Section 6002 of the Solid Waste Disposal Act, as amended by the Resource
Conservation and Recovery Act
➢ Guidelines of the Environmental Protection Agency at 40 CFR Part 247
➢ For contracts and subgrants for construction or repair, Copeland "Anti-
Kicicback" 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 Emulovment and other Economic
Opportunities; Section 3 Requirements.
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. Sections 1701 et
seq.) and its Related Re�ulations 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 worlc performed under this Contract is on a project
assisted under a program providing direct Federal financial assistance from IIL7D, 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 pe�formed under this conh�act is s2�bject to the
��equirements of Section 3 of Housing and Urbarr Developn7ent Act of
1968, as amended, 12 U. S. C. section 1701 u(Section 3). The pzrrpose of
Section 3 is to ens2rre thai en�ployment and other economic oppoNtunrties
generated by HUD assisted oi• HUD-assisted programs covef�ed by
Section 3, shall to the greatest extent feasible, be directed to lou�- arrd
very-low income per•sons, particularly persons who af�e recipients of HUD
asszstance fo� hortsing.
B. The parties to this contr�act agree to comply with HUD's
regzclations in 24 CFR PaT^t 135, which implement Sectio�r 3. As evidenced
by their execution of this contr�act, the parties to this contNact cert� that
HOPWA PSA CONTRACT 2013-2014 -- AIDS OUTREACH CENTER, INC.: 18
they aT^e under no contf�actual or other impediment that would prevent
them from complying ��ith the Part 135 regz{lations.
C. The cont��actor agr�ees to send to each labor organization of�
��epresentative of workers with which it has a collective bargaining
agreement ot� other uhde��standi�g, if any, a notice advising the labo��
organizatiorr of� workers' f�ep�^esentatives of the contracto��'s commit��ents
undef� this Section 3 clause and will post copies of the notice in
conspicuous places at the work site where both employees and applicants
fo�• t�^aining and employment positions can see the notice. The notice shall
describe the Section 3 prefe�°ence, shall set forth n�inimzrm nzrmber� and job
titles sa{bject to hi�^e, availability of apprentice and training positions, the
qualiftcations for each; a�d the name and location of the person(s) taking
applications fo�� each of the positions; and the anticipated date the wof•k
shall begin.
D. The conti^acto� agr�ees that it will irrclude this Section 3 clause in
every szrbcontract to comply with ��egarlation in 24 CFR Pa��t 135, and
agrees to take app�opriate action, as pf�ovided in an applicable p�"OV7SIOY1
of the szrbcontract or in this Section 3 clause, upon finding that the
subcontf�actor is in violation of the regulations in 24 CFR Part 135. The
corrh�actor will not subcontract with any subcontracto�� where it has notice
o�� knowledge that the subcontractor has been found in violation of
�egulaiions in 24 CFR 135.
E. The contr•actor r�ill cef�t� that any vacant employment positions,
including tr�aining positions that are frled.� (1) after the contractor is
selected but before the conh•act is executed, and (2) with persons other
than those to whom the regulations of 24 CFR Part 135. The conti�actor
will not szrbcontract with any s2rbcontractor where it has notice or
knowledge that the subcontractor has been found in violaiion of
regulations in 24 CFR 135.
F. Noncomplrance with HUD's regulation in 24 CFR Part 135 may
reszrlt in sanctions, te��n�ination of this contract for defazrlt, and debaf°ment
or szrspension from firture HUD assisted contracts.
G. With ��espect to work pef fo��mecl in connection with Section 3
covered Indran hoarsing assistance, section 7(b) of the Indian Self-
Detern�ination and Education Assistance Act (25 U.S.C. section 450e) also
applies to the ��ork to be pe�fo�•med undef� this Contt•act. Section 7(b)
reqz�ires that to the g��eatest extent feasible (i) preference and
opportzrnities fof- t��airring and employment shall be given to Indiarrs, and
(ii) preference in the award of coniracts and sarbcontracts shall be given to
Indian organizations and Indian-owned Economic Enterprises. Parties to
this cont�^act that are sarbject to the proviszons of Section 3 and Section
79b) ag��ee to comply with Section 3 to the maximzrm extent feasible, but
not in de�°ogation of compliance with Section 7(b). "
Section to be quoted in covered contracts ends.
HOPWA PSA CONTRACT 2013-2014 -- AIDS OUTREACH CENTER, ING
�
14.11.2 Agency Responsibilities for Section 3 Requirements.
City and Agency understand and agree that compliance with the provisions of
Section 3, the regulations set forth in 24 CFR Part 135, and all applicable rules and orders
of HUD shall be a condition of the Federal financial assistance provided to the Program
binding upon City and Agency, and their respective successors, assigns, contractors and
subcontractors. Failure to fulfill these requirements shall subject Agency and its
contractors and subcontractors and their respective successors and assigns to those
sanctions specified by the 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 working on Section 3
covered projects of their responsibilities;
14.11.2.3 Facilitating the training and employment of Section 3
residents and the award of contracts to Section 3 business
concerns;
14.11.2.4 Assisting and actively cooperating with the HED
Department in making contractors and subcontractors
comply;
14.11.2.5 Refraining from entering into conh�acts 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� Requirements.
In order to comply with the Section 3 requirements, Agency must 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 -- AIDS OUTREAGH CENTER, INC. 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 include
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 Discrimination.
14.12.1 General 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 codified 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 speciiically to the
ordinances codiiied 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
terms of such ordinances by either or its officers, members, agents, employees or
contractors.
14.12.2 No Discrimination in Emplovment durin� the Performance of
This Contract.
During the performance of this Contract Agency agrees to the following
provision, and will require that its contractors and subcontractors also comply with such
provision by including it in all contracts with its contractors:
[Co�rt�^acto�^ or subcont�^actor's nan�e] will not unlawfully discriminate against
any employee or applicants for employment because of race, color, sex, gender, religion,
national origin, familiai status, disability or perceived disability, sexual orientation,
gender identity, gender expression or transgender. Agency will take affirmative action to
ensure that applicants are hired without regard to race, color, sex, gender, religion,
national origin, familial status, disability or perceived disability, sexual orientation,
gender identity, gender expression or transgender and that employees are treated fairly
during employment without regard to their race, color, sex, gender, religion, national
origin, familial status, disability or perceived disability, sexual orientation, gender
identity, gender expression or transgender. Such action shall include, but not be limited
to, the following: employment, upgrading, demotion or transfer, recruitment or
HOPWA PSA CONTRACT 2013-2014 -- AIDS OUTREACH CENTER, 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.
[Contractof° or subconh•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.
[Conh�actor or• sa[bconii�actor's name] covenants that neither it nor any of its
officeis, members, agents, employees, or contractors, while engaged in performing this
Contract, shall, in connection with the employment, advancement or discharge of
employees or in connection with the terms, conditions or privileges of their employment,
discriminate against persons because of their age or because of any disability or
perceived disability, except on the basis of a bona fide occupational qualification,
retirement plan or statutory requirement.
[Contf•actoi° o�� subcontractor's name] further covenants that neither it nor its
officers, members, agents, employees, contractors, or persons acting on their behalf, shall
specify, in solicitations or advertisements for employees to work on this Contract, a
maximum age limit for such employment unless the specified maximum age limit is
based upon a bona fide occupational qualification, retirement plan or statutory
requirement.
1412.3 Agencv's Contractors and the ADA.
In accordance with the provisions of the Americans With Disabilities Act of 1990
("ADA"), Agency warrants that it and any of its contractors will not unlawfully
discriminate on the basis of disability in the provision of services to the general public,
nor in the availability, terms and/or conditions of employment for applicants for
employment with, or employees of Agency or any of its contractors. AGENCY
WARRANTS IT WILL FULLY COMPLY WITH ADA'S PROVISIONS AND
ANY OTHER APPLICABLE FEDERAL, STATE AND LOCAL LAWS
CONCERNING DISABILITY AND WILL DEFEND, INDEMNIFY AND HOLD
CITY HARIVILESS 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'
ALLEGED FAILURE TO COMPLY 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 -- AIDS OUTREACH CENTER, 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 persons who are employees, agents, consultants, officers or elected
officials or appointed officials of City or• of Agency who exercise or have exercised any
functions or responsibilities with respect to activities assisted with HOPWA funds or who
are in a position to participate in a decision-making process or gain inside information
with regard to these activities may utilize HOPWA services, may obtain a financial
interest or benefit from a HOPWA-assisted activity, or have an interest in any contract,
subcontract or agreement with respect thereto, or the proceeds thereunder, either for
themselves or those with whom they have family or business ties, during their tenure or
for• 1 year thereafter, unless they are accepted in accordance with the procedures set forth
at 24 CFR 574.625.
14.13.3 Agency affirms 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 Minoritv Firms, Women's
Business Enterprises and Labor Surplus Areas.
14.141 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 seivices, purchase of equipment and supplies and
provision of other services required by City. Agency agrees to incorporate the City's
BDE Ordinance, and all amendments or successor policies or ordinances thereto, into all
contracts and subcontracts for procurement larger than $50,000.00 and will further
require all persons or entities with which it so contracts to comply with said ordinance.
14.14.2 It is national policy to award a fair share of contracts to disadvantaged
business enterprises (DBEs), small business enterprises (SBEs), minority business
enterprises (MBEs), and women's business enterprises (WBEs). Accordingly,
affirmative steps must be taken to assure that DBEs, SBEs, MBEs, and WBEs are utilized
when possible as sources of supplies, equipment, construction 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 -- AIDS OUTREACH CENTER, ING 23
14.16 Assi�nment.
Agency shall 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. Right to Inspect Agencv Contracts.
It is agreed that City has the right to inspect and approve in writing any proposed
conh�acts 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 Maieure
If Agency becomes unable, either in whole or part, to fulfill its obligations under
this Contract due to acts of God, strikes, lockouts, or other industrial disturbances, acts of
public enemies, wars, blockades, insurrections, riots, epidemics, eat-thqualces, fires,
floods, 1•estraints or prohibitions by any court, board, department, commission or agency
of the United States or of any States, civil disturbances, or explosions, or some other
reason beyond Agency's control (collectively, "Force Majeure Event"), the obligations so
affected by such Force Majeure Event will be suspended only during the continuance of
such event. Agency will give City written notice of the existence, extent and nature of
the Force Majeure Event as soon as reasonably possible after the occurrence of the event.
Failure to give notice will result in the continuance of Agency's obligation regardless of
the extent of any existing Force Majeure 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 FOR PROPERTY LOSS OR DAMAGE
AND/OR PERSONAL INJURY, INCLUDING DEATH, TO ANY AND ALL
PERSONS, OF WHATSOEVER KIND OR CHARACTER, WHETHER REAL OR
ASSERTED, ARISING OUT OF OR IN CONNECTION WITH THE
EXECUTION, PERFORMANCE, ATTEMPTED PERFORMANCE OR
NONPERFORMANCE OF THIS CONTRACT AND/OR THE OPERATIONS,
ACTIVITIES AND SERVICES OF THE PROGRAM DESCRIBED HEREIN,
WHETHER OR NOT CAUSED IN WI�OLE OR IN PART, BY ALLEGED
NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES,
CONTRACTORS OR SUSCONTRACTORS OF CITY; AND AGENCY HEREBY
ASSUMES ALL LIABILITY AND RESPONSIBILITY OF CITY AND ITS
OFFICERS, AGENTS, SERVANTS, AND EMPLOYEES FOR ANY AND ALL
CLAIMS OR SUITS FOR PROPERTY LOSS OR DAMAGE AND/OR
PERSONAL INJURY, INCLUDING DEATH, TO ANY AND ALL PERSONS, OF
WHATSOEVER KINDS OR CHARACTER, WHET�IER REAL OR ASSERTED,
ARISING OUT OF OR IN CONNECTION WITH THE EXECUTION,
PERFORMANCE, ATTEMPTED PERFORMANCE OR NONPERFORMANCE
OF THIS CONTRACT AND/OR THE OPERATIONS, ACTIVITIES AND
HOPWA PSA CONTRACT 2013-2014 -- AIDS OUTREACH CENTER, INC. 24
SERVICES OF THE PROGRAM DESCRIBED HEREIN, WHETHER OR NOT
CAUSED IN WHOLE OR IN PART BY ALLEGED NEGLIGENCE OF
OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS OR
SUBCONTRACTORS OF CITY. AGENCY LIKEWISE COVENANTS AND
AGREES TO AND DOES HEREBY INDEMNIFY AND HOLD HARMLESS
CITY FROM AND AGAINST ANY AND ALL INJURY, DAMAGE OR
DESTRUCTION OF PROPERTY OF CITY, ARISING OUT OF OR IN
CONNECTION WITH ALL ACTS OR OMISSIONS OF AGENCY, ITS
OFFICERS, MEMSERS, 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 TffiS SECTION
INCLUDES INDEMNITY BY AGENCY TO INDEMNIFY AND PROTECT CITY
FROM THE CONSEQUENCES OF CITY'S OWN NEGLIGENCE, WHETHER
THAT NEGLIGENCE IS ALLEGED TO BE THE SOLE OR CONCURRING
CAUSE OF THE INJURY, DAMAGE OR DEATH.
AGENCY AGREES TO AND SHALL RELEASE CITY, ITS AGENTS,
EMPLOYEES, OFFICERS AND LEGAL REPRESENTATIVES FROM ALL
LIABILITY FOR INJURY, DEATH, DAMAGE OR LOSS TO PERSONS OR
PROPERTY SUSTAINED IN CONNECTION WITH OR INCIDENTAL TO
PERFORMANCE UNDER THIS CONTRACT, EVEN IF THE INJURY, DEATH,
DAMAGE OR LOSS IS CAUSED BY CITY'S SOLE OR CONCURRENT
NEGLIGENCE.
AGENCY SHALL REQUIRE ALL OF ITS CONTRACTORS AND
SUBCONTRACTORS TO INCLUDE IN THEIR CONTRACTS AND
SUBCONTRACTS A RELEASE AND INDEMNITY IN FAVOR OF CITY IN
SUBSTANTIALLY THE SAME FORM AS ABOVE.
16. WAIVER OF IMMUNITY BY AGENCY.
If Agency, as a charitable or nonprofit organization, has or claims an immunity or
exemption (statutoiy or othei�vise) from and against liability for damages or injury,
including death, to persons or property, Agency hereby expressly waives its rights to
plead defensively such immunity or exemption as against City. This section shall not be
construed to affect a governmental entity's immunities under constitutional, statutory or
common law.
17. INSURANCE AND BONDING.
Agency will inaintain coverage in the form of insurance or bond in the ainount of
$622,694.00 to insure against loss from the fraud, theft or dishonesty of any of Agency's
HOPWA PSA CONTRACT 2013-2014 -- AIDS OUTREACH CENTER, INC: 25
officers, agents, trustees, directors or employees. The proceeds of such insurance or bond
shall be used to reimbur•se City for any and all loss of HOPWA Funds occasioned by such
misconduct. To effectuate such reimbursement, such fidelity coverage shall include a
rider stating that reimbursement for any loss or losses shall name the City as a Loss
Payee.
Agency shall furnish to City in a timely manner, but not later than the Effective
Date, certificates of insurance as proof that it has secured and paid for policies of
commercial insurance as specified herein. If City has not received such certificates by
the Effective Date, Agency shall be in default of the Contract and City may, at its option,
terminate the Contract.
Such insurance shall cover all insurable 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 thereo£
Commercial General Liability (CGL) Insurance
$500,000 each occurrence
$1,000,000 aggregate limit
Non-Profit Or�anization Liabilitv or Directors & Officers Liabilitv
$1,000,000 Each Occurrence
$1,000,000 Annual Aggregate Limit
Business Automobile Liabilitv Insurance
$1,000,000 each accident on a combined single-limit basis, or
$250,000 Proper-ty Damage
$500,000 Bodily Injury per person per occurrence
$2,000,000 Aggregate
Insurance policy shall be endorsed to cover "Any Auto", defined as autos owned, hired, and non-
owned. Pending availability of the above coverage and at the discretion of City, the policy
shall be the primary responding insurance policy versus a personal auto insurance policy if
or when in the course of Agency's business as contracted herein.
Workers' Compensation Insurance
Part A: Statutory Limits
Part B: Employer's Liability
$100,000 each accident
$100,000 disease-each employee
$500,000 disease-policy limit
Note: Such insurance shall cover employees performing work on any and all projects
including but not limited to construction, demolition, and rehabilitation. Agency or its
contractors shall maintain coverages, if applicable. In the event the respective contractors
HOPWA PSA CONTRACT 2013-2014 -- AIDS OUTREAGH CENTER, 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
fi�equently than once every 12 months, and Agency shall revise such amounts within 30
days following notice to Contractor of such requirements.
Agency will submit to City documentation that it has obtained insurance coverage and
has executed bonds as required in this Contract prior to payment of any monies provided
hereunder.
Where applicable, insurance policies required herein shall be endorsed to include City as
an additional insured as its interest may appear. Additional insured parties shall include
employees, offcers, agents, and volunteers of City.
The Worlceis' 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 certificate(s) of insurance shall not be construed as
a waiver of such requirement or as a waiver of the insurance requirements themselves.
Insurers of Agency's insurance policies shall be licensed to do business in the state of
Texas by the Department of Insurance or be otherwise eligible and authorized to do
business in the state of Texas. Insurers shall be acceptable to City insofar as their
financial strength and solvency and each such company shall have a current minimum
A.M. Best Key Rating Guide rating of A-: VII or other equivalent insurance industry
standard rating otherwise approved by City.
Deductible limits on insurance policies shall not exceed $5,000 per occurrence unless
otherwise approved by City.
In the event there are any local, federal or other regulatory insurance or bonding
requirements for the Program, and such requirements exceed those specified herein, the
former shall prevail.
Agency shall require its contractors to maintain applicable insurance coverages, limits,
and other requirements as those specified herein; and Agency shall require its contractors
to provide Agency with certificate(s) of insurance documenting such coverage. Also,
Agency shall require its contractors to have City and Agency endorsed as additional
insureds (as their interest may appear) on their respective insurance policies.
Directors and Officers Liability coverage shall be in force and may be provided on a
claims-made basis. This coverage may also be referred to as Management Liability, and
shall protect the insured against claims arising out of alleged errors in judgment, breaches
of duty and wrongful acts arising out of their organizational duties. Coverage shali
HOPWA PSA CONTRACT 2013-2014 -- AIDS OUTREACH CENTER, INC: 27
protect not only the entity, but all past, present and future directors, officers, trustees,
employees, volunteers and committee members.
18. CERTIFICATION REGARDING LOBBYING.
The undersigned representative of Agency hereby cei�tifies, to the best of his or
her knowledge and belief, that:
No Federal appropriated funds have been paid or will be paid, by or on behalf of
Agency, to any person for influencing or attempting to influence an ofiicer or
employee of any agency, a member of Congress, an officer or employee of
Congress in connection with the awarding of any Federal contract, the making of
any Federal grant, the malcing of any Federal loan, the entering into of any
cooperative agreement and the extension, continuation, renewal, amendment, or
modi�ication 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
certificate is a prerequisite for making or entering into this Contract imposed by
31 U.S.C. Section 1352. Any person who fails to file the required certification
shall be subject to a civil penalty of not less than $10,000.00 and not more than
$100,000.00 for each such failure.
Agency shall require that the language of this certification be included in all
subcontracts or agreements involving the expenditure of Federal funds.
19. LITIGATION AND CLAIMS.
Agency shall give City immediate notice in writing of any action, including any
proceeding before an administrative agency, filed against Agency in conjunction with this
Contract or the Program. Agency shall furnish immediately to City copies of all pertinent
papers received by Agency with respect to such action or claim. Agency shall provide a
notice to City within 10 days upon filing under any bankruptcy or financial insolvency
provision of law.
20. NOTICE.
All notices required or permitted by this Contract must be in writing and are
deemed delivered on the earlier date of the date actually received or the third day
following deposit in a United States Postal Service post office or receptacle; with proper
HOPWA PSA CONTRACT 2013-2014 -- AIDS OUTREACH CENTER, INC: 28
postage, certified mail return receipt requested; and addressed to the other Party at the
address set out below or at such other address as the receiving Party designates by proper
notice to the sending Party.
Citv:
City Attorney's Ofiice
1000 Throckmorton Street
Fort Worth, TX 76102
Telephone: 817-392-7600
Copy to:
Director of Housing and Economic Development
1000 Throckmorton Street
Fort Worth, TX 76102
Telephone: 817-392-7540
Copy to:
Development Project Coordinator — Housing and Economic Development
1000 Throckmorton Street
Fort Worth, TX 76102
Telephone: 817-392-6342
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 talcen, to enter into this
Contract and to perform the responsibilities herein required.
22. COUNTERPARTS.
This Contract may be executed in multiple counterpai�ts, 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 -- AIDS OUTREACH CENTER, INC.: 29
�VITNESS WHEREOF, the Parties hereto have executed 4 duplicate
this Contract in Fort Worth, Tarrant County, Texas.
CITY OF FORT WORTH
M&C: C=263�9
Date: August 6, 2013
:
�VED AS TO FO
� _ T �1
t City Attorney
:
►I
T
AND LEGALITY:
STATE OF TEXAS §
COUNTY OF TARRANT §
This instrument was acknowledged before me on oZ , 2013 by
Feinando Costa, Assistant City Manager of the �ity of Fort Worth, on behalf the City of
Fort Worth.
. This instiument as acknowledged before me on `� x' ���,'ti'���� � 1� , 2013 by
�= �( l'�'�,�,,���� ��1 �`�'��e �� j% of AIDS OutreachP Center, Inc., a Texas non-profit
corporation, o� behalf of said corporation. ��, j,_ ,
,
`����P�,�...- _�� � C'YIJ�iYe/=1 LH�aV���C_J ,
:_ �� `�= Notary Public, State of Texa: ,
;�s:��.��; My Commission Expires
`,'�E,,���+.-' July 10, 2017
Public, State
STATE OF TEXAS §
COUNTY OF TARRANT § � � _,
LARRY D. ELLIS
Notary Pubtic, State of Texas
My Commission Expires
June 19, 2014
i / ;J a�j"
f �
Notary �ubli
�{�k�'/,
��/��r � .���--'l�"��
of Texas
� ' P f�'_ _" �', 1
'.
,a
,�i i
HOPWA PSA CONTRACT 2013-2014 -- AIDS OUTREACH CENTER, INC.
30
AIDS OUTREACH CENTER, INC.
Fernando Costa, Assistant City Manager
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 -- AIDS OUTREAGH CENTER, INC.
31
AIDS Outreach Center, Inc.
EXHIBIT A
PROGRAM SUMMARY
PROGRAM SUMMARY
Housing Opportunities for Persons with AIDS
(HOPWA)
October 1, 2013 to September 30, 2014
PERIOD
$ 622,694.00
AMOUNT
PROGRAM:
The program provides each HOPWA—eligible client with one or more of the following: 1)
supportive services including housing counseling and case management; 2) tenant based
rental assistance ("TBRA"); OR, 3) short term rental, mortgage, or utility assistance
("STRMU").
Program services �vill be accessible at 400 North Beach Street, Fort Worth, Texas 76111
from 8:30 am to 5:00 pm, Monday through Friday.
HOPWA Funds will pay for direct assistance such as TBRA and STRMU. HOPWA funds
will also be used to pay costs associated with delivering supportive services to any client
receiving either TBRA or STRMU assistance, including salaries and fringe bene�ts, and
FICA for employees; supplies; insurance; and, program facility and utility costs. No more
than 7% of the HOPWA Funds will be used to pay administrative costs, including salaries,
insurance, taxes, and legal and accounting fees associated with the Program.
REGULATORY CLASSIFICATION:
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)(10)—Administrative Expenses
24 CFR 574.300(b)(7)—Supportive Services
24 CFR 574.300(b)(6)—STRMU
24 CFR 574.300(b)(6�TBRA
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 supportive services to approximately 237 Unduplicated Clients
• Provide TBRA services to approximately 70 Unduplicated Clients
• Provide STRMU services to approximately 167 Unduplicated Clients
EXHIBIT A- HOPWA: AIDS OUTREACH CENTER, INC.
EXHIBIT "A-1"
2013 HUD INCOME LIMITS
2013 Median Family Income — Fort Worth/Arliugton, TX*
1 Pet•son 2 Peisons 3 Persons 4 Peisons 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:
FUNDING C:
EXHIBIT B- HOPWA: AIDS OUTREACH CENTER, 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.
SAT,ARY DETAIL
Position Name Rate Annual Hours Percent to Grant Amotmt to Grant
AED 30.21 2080 5.4% 3,393.19
Staff Accountant 23.27 2080 5.4% 2,613.69
Dir Admin Svcs 25.74 2080 5.4% 2,891.12
Dir Case Mgmt 23.18 2080 5.4% 2,410.72
Case Manager 19.23 2080 100% 39,998.40
Receptionist 12.87 2080 5% 1,338.31
Case Manager 15.85 2080 5% 1,643.99
Case Manager 15.30 2080 10% 3,126.78
FRiNGE DETAIL
Percent of Payroll Amount Percent to Grant Amotimt to Grant
FICA 7.65% 26358.23 17% 4,392.34
Life Insurance
Health Insurance 8% 27225.00 24% 6,559.00
Unemployment .5% 1847.00 27% 500.00
Workers Compensation
Retirement
STTPPT.TF.R AT�TT) SF,RVT('.F,S
Total Budget Percent to Grant Amount to Grant
Office Supplies 5228.00 11% 570.83
Office Equipment Rental 2282.00 14% 312.50
Postage 810.00 18% 146.69
Printing 574.00 9% 50.00
MTSCELLANEOUS
Total Budget Percent to Grant Amount to Grant
Contract Labor
Craft Supplies
Facility Fees
Field Trip Costs
Food Supplies
Teaching Aids
EXHIBIT B— HOPWA: AIDS OUTREACH CENTER, INC. 2
FAC'TT,TTY AND i7TiLITiES
Total Budget Percent to Grant Amount to Grant
Telephone 2943.00 20% 577.08
Electric 5099.44 20% 1,000.00
Gas 1274.86 20% 250.00
Water and Wastewater 2763.70 20% 541.67
Solid Waste Disposal
Rent 36550.00 16% 5,690.67
Custodial Services 5020.00 14% 696.88
Repairs 213.00 14% 29.17
Cleaning Supplies
AL, FINANCIAL AND INSURANCE
Total Bud�et Percent to Grant
Fidelity Bond (or Equivalet
General Commercial Liabil
Directors and Officers
5078.00
9%
Contract
21303.00
I�TRF,CT ASSTSTANCF
15%
Amount to Grant
458.32
3093.75
Total Budget Pei•cent to Grant Amount to Grant
Childcare Scholarships
Short-Term Rent Assistance 72245.38 100% 72,245.38
Shoi�t Teim Mortgage Assistance 12040.88 100% 12,040.88
Short Term Utilities Assistance 36122.65 100% 36,122.65
Tenant Based Rental Assistance 420000.00 100% 420,000.00
EXHIBIT B— HOPWA: AIDS OUTREACH CENTER, INC. 3
EXHIBIT "C"
Audit Certification Form
[See attached]
AUDIT CERTIFICATION FORM AND AUDIT REQUIREMENTS
Agency: Name of A�encv
Fiscal Year Ending: September 30, 2014
❑ During the fiscal year in which funds will be received, we will exceed the federal eapenditure
threshold of $500,000. We will have our Single Audit or Program Specific Audit completed and
will subinit 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 ear•lier date.
❑ During the fiscal year in which funds will be received, we will not exceed the $500,000 federal
expenditure threshold reqt�ired for a Single Audit or a Pr•ogram Specific Audit to be perforined this
fiscal year. (Fill out schedule belotiv)
Signatory and Title Date
Failure to submit this or a sunilar stateinent or faihire to submit a completed single audit package as
described in the federally required audit requirements described in OMB Circular•s A-133 by the
r•equired due date may result in suspension of funding and rnay affect eligibility for fiiture funding.
Notwithstanding the above, this certification acknowledges the agency's commitment to meet all
other financial reporting, financial statements, and other audit requirements as may be set forth
in the Contract.
Exhibit "D" - Reimbursement Foi•ms
[See attached]
Attachment I
INVOICE
Agency:
Address:
City, State, Zip:
Program:
Period of Service:
Agency's C;ertitication: 1 certify 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:
Alfachment II
Ci�c of For[ Wor�h
F(ousing and Ecmiomic Decelopment Deparfinent
Ezpenditure Wurl:shee�
Agcncy: Name
Progmm: ProKrnm Namc
'Pa}'roll must identifp employm. Renl must idcNit}' tennnf. Other payments should identif}' indiridimt:
Hig6lighfed arcYhe only relerant coJes for ihis Progmm �_ -
F
C
�FO
Z�
�JO
<F
7
<�
U
Exhibit "E"
Form of Income Self-Certification
[See attached]
CERTIFICATION OF INCOME STATEMENT
' Applicant Name:
Current Address:
Phone #:
*'�`PERSONAL INFORMATION: (Check one in each itein. Optional InfoiYnation for Federal Reporting Purposes)
a. ❑ MALE b. � WHITE ❑ BLACK/AFRICAN AMERICAN ❑ BLACIUAFRICAN AMERICAN & WHITE
❑ FEMALE ❑ AMERICAN INDIAN/ALASI�AN NA"ITVE ❑ ASIAN
❑ AMERICAN INDIAN/ALASKAN NATIVE & WHITE ❑ ASIAN & WHITE
❑ NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER ❑ BALANCE/OTHER
❑ AMERICAN INDIAN/ALASKAN NATIV� & BLACK/AFRICAN AMERICAN
c. ETHNICITY d. DISABLED
❑ HISPAr1IC ❑ YES
❑ NON-HISPANIC ❑ NO
* TOTAL NUMBER OF HOUSEHOLD
MEMBERS
Total Anticipated Annual Household Income:
(Include Yourself AND everyone who
lives in the house.)
Certification:
I certify that the information I am providing is true and could be subject to verification at any tiine by a third
party. I also acicnowledge that the provision of false information could leave ine subject to the penalties of
Federal, State and local law.
WARNING: TITLE 18, SECTION 1001 OF THE U.S. CODE STATES THAT A PERSON IS GUILTY OF A FELONY
FOR ICNOWINGLY AND WILLINGLY MAHING FALSE OR FRAUDULENT STATEMENTS TO ANY DEPARTMENT OF
THE UNITED STATES GOVERNMENT.
Signature of Applicant
Date
For use by funding agency:
Household Size:
Income Limit:
Person Malcing Determination: Date:
e. IS CLIENT WOMEN HEAD OF HOUSEHOLD
❑ YES
❑ NO
Annual Income:
Is Applicant Eligible:
Household Members and Income
CERTIFICACION DE DECLARACION DE INGRESOS
Nombre del Solicitante:
Domicilio Actual:
''�`�`INFORMACION PERSONAL: (Seleccione uno en cada categoria. Informacion opcional para propositos de informacion Federal)
a. ❑ MASCULINO b. � CAUCASICO ❑ NEGRO/AFRICANO AMERICANO
❑ NEGRO/AF'RICANO AMERICANO & CAUCASICO
❑ FEMININO ❑ INDIO AMERICANO/NATIVO DE ALASICA ❑ ASIATICO
❑ INDIO AMERICANO/NATNO DE ALASKA & CAUCASICO ❑ ASIATICO & CAUCASICO
❑ NATIVO HAWAIANO/OTRO DE LAS ISLAS PACIFICAS ❑ BALANCE/OTRO
❑ INDIO AMERICANO / NATIVO DE ALASKA & NEGRO/AFRICANO AMERICANO
c. ETNICIDAD d. DISCAPACITADO e. �ES EL SOLICITANTE UNA MUJER Y CABECERA DEL HOGAR?
❑ HISPANO ❑ SI ❑ SI
❑ NO-HISPANO ❑ NO ❑ NO
x NTJMERO TOTAL DE MIEMBROS EN EL HOGAR
Ingreso total del hogar anual anticipado:
Fit•ma del Solicitante
Certificacion:
Certifico que la informacion que proporciono es verdad y podria ser susceptible a la coinprobacion 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 GOSIERNO
ESTADOUNIDENSE.
Numero de Telefono:
(Incluye a si mismo y a todos los que viven en
la casa)
Fecha
Para el uso de la agencia financiando:
# De Miembros en el Hogar:
Limite de Ingreso:
Persona haciendo la determinacion:
Ingreso Anual:
�Es el solicitante elegible? :
Fecha:
Miembros en el Ho a�e In rg esos
Exhibit "F" - Standards for Complete Documentation
[See attached]
2013-2014 Documentation Standards for
Public Service Contract Expenses
an employee works sofely with Contract eli9ible clients and solely on Contract eligibie items, ihen the employee's entire salary is e�lglule m
imbursemenL Twice in each calendar year, the client must submii a written statement verifying fiat the above condAions are still true. The
atement must also be signed be a person authorized to sign on behalf of the agency.
an employee works on a variety of programs, or works wdh a miMure of Contract eligible clients aod non-eligible clients, ihen the City will onty
�imburse (or a reasonable portion of ihe empioyee's sa�ary. Each reimbursemenl request must include not only ihe employee's timesheet, but also
work Iog breaking out ihe employee's time by project or activity. For employees paid with multiple funding sources, timesheets must reFlect all
intling sources. If separate timesheets are kept for each funding source, all such timesheets must be submilletl to CAy.
f employees are paitl by direct deposit rather than check, then the agency must submit both Ihe direct deposfl payment companys report (such as
i ADT repod) and a bank statement or check showing payment io the tlirect deposit company.
pays gross
Insurance
cumentalion of how the invoiced amount was calculatetl antl Incwae aocumentaaon snowmq paymenc.
he City pays gross salary, this is already inGudetl. If we pay ihe employer portion, ihen ihe employer must show a calculation and docc
how ihe invoiced amount was calcu�ated, must indude an invoice from lhe insurer, and must include documentation showing payment.
If the City pays gross salary, ihis is alreatly included. If we pay �he emp�oyer poAion, ihen ihe empioyer musi show a calculation and tloc�
of how ihe invoiced amount was caiculatetl, must inciude an invoice from the insurer, antl must inclutle documentation showing payment.
he Cfty pays gross saiary, tms
how Ihe invoiced amount was
pays gross saiary, tms
: invoiced amount was
Recreation
and
musl show a
we pay gross salary, ihis is already included. If we pay the employer portion, ihen tne empwyer mus[ snow a camwa�wn ano oocumema�wn
e invoiced amount was calculated, must and include documentation showing payment, and prior to the first reimbursement, must include the
an audfl is required
sources.
agency shou�d maintain information regarding mailouts. If the agency has a Nnney eowes macmne or nKe pos�age macnine, me recu�us u�
hine must be on fife. Likewise, if mail is categorized by payment source, ihen ihose records must be on fiie. Por large mailouts, the agency
In addition lo admission e�enses, footl expefises w111 also De allowea so
routine purchases on all field trips, not just CONract-Ponded field trips.
services
as the agency
k7l-=
Under ihe Contract
Chi�ticare City requires that ihe agency submit its fee scheduie, showi�g a breakout of income leveis, antl for each level a breakout of the portion of the
Scholarships expense to be paid by famity and ihe poAion lo be reimbursed by �he Cily. This fee schedule is requiretl prior to the first payment. We a�so require
ihe income eligiblity oi each household so that we can determine if vre are being changed in conformance with lhe fee schedWe. If ihe fee schedule
chan9es at any time during ihe contract year, the a9ency must notify City and provide a new schedule wilhin 30 days of the change.
�cluded. If we pay ihe employer portrton, men tne empioyer musc snow a caicmauon ana aocc
must include an invoice from ihe insurer, and must include documentation showing paymeni.
'Proof of payment effectiVe Octobe� 1, 2013• Payments or Expenses must be documented in ihe following manner:
A) Image of the check AND bank statement showing Ihe check cleared ihe bank; OR,
B) Image of ihe cancelled check (ex. Ai end of bank statement); OR,
C) Payroll "Advace" or Statement AND Bank Statement indicaling payroll; OR,
D) For wire or e-transters: Reciept or statement from payeeNendor OR bank statement.
EXHIBIT "G"
HOPWA OVERVIEW REPORT
Exhibit "G"
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Housing Opportunities for Persons with AIDS
(HOPWA) Program
Consolidated Annual Performance and
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OMB Number 2506-0133 (Expiration Date: 10/31/2014)
The CAPER report for HOPWA formula grantees provides annual information on progt•am accomplishments
tllat supports prog►•am evaluation and the ability to measure program beneficiary outcomes as related to:
maintain housing stability; prevent homelessness; and improve access to care and support. This information is
also covered under the Consolidated Plan Management Process (CPMP) report and includes Narrative
Responses and Performance Charts required under the Consolidated Planning regulations. The public reporting
burden for the collection of information is estimated to average 42 hours per manual response, or less if an
automated data collection and retrieval system is in use, along with 60 hours for record keeping, including the
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. Grantees are rec�uired to report on the activities
undertaken only, thus there may be coinponents of these reporting requirements that may not be applicable. This
agency inay not conduct or sponsor, and a person is not required to respond to a collection of information unless
that collection displays a valid OMB control number.
Previous editions are obsolete form HUD-40110-D (Expiration Date: 10/31/2014)
Overview. The Consolidated Annual Perforniance and Evaluation Report
(CAPER) provides annual perfonnance reporting on client outputs and
outcomes that enables an assessment of grantee performance in achieving the
housing stability outcome measure. The CAPER, in conjLmction with tl�e
Integrated Disbursement Infonnation Systein (IDIS), fulfills statutory and
regulatory program reporting requirements and provides the grantee and
HUD �vith the necessary infonnation to assess the overall program
perfonnance and accomplishments against planned goals and objectives.
HOPWA formida grantees are required to submit a CAPER, and complete
annual perfonnance information for all activities u��dertaken during each
program year in the IDIS, demonstrating coordination �vith other
Consolidated Plan resources. HIJD uses the CAPER and IDIS data to obtain
essential infonnation on grant activities, project sponsors, Subrecipient
organizations, housing sites, units and households, and beneficiaries (which
includes racial and ethnic data on program participants). The Consolidated
Plan Management Process tool (CPMP) provides an optional tool to integrate
the reporting of HOPWA specific activities with otl�er planning and reporting
on Consolidated Plan activities.
Table of Contents
PART 1: Grantee �xecutive Summary
1. Grantee Infonnation
2. Project Sponsor Information
3. Administrative Subrecipient Liformation
4. Program Subrecipient Information
5. Grantee Narrative and Perfonnance Assessment
a. Grantee and Commimity Overview
b. Annual Performance under tl�e Action Plan
c. Barriers or Trends Overvie�v
d. Assessment of Unmet Housing Needs
PART 2: Sources of LeveraEine and Proeram Income
1. Sources of Leveraging
2. Program Income and Resident Rent Payments
PART 3: Accomnlishment Data: Planned Goals and Actual Outnuts
PART 4: Summary of Performance Outcomes
1. Aousing 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: �Vorlcsheet - Determinine Housine Stabilitv Outcomes
PART 6• Annual Certification of Continued Use for HOP�VA Facilih�-
Based Ste�i�ardsliia Units (Onlvl
PART 7: Summary Overview of Grant Activities
A. Infonnation on Individuals, Beneficiaries and Households Receiving
HOPWA Housing Subsidy Assistance (TBRA, ST'RMU, PHP,Facility
Based Units, Master Leased Units ONLY)
B. Facility-Based Housing Assistance
Continued Use Periods. Grantees that received HOPWA fimding for ne�v
construction, acquisition, or substantial rehabilitations are required to operate
their facilities for HOPWA-eligible beneficiaries for a ten (10) years period.
If no further HOPWA fimds are used to support the facility, in place of
completing Section 7B of the CAPER, the grantee must submit an Annual
Certification of Contiuued Project Operation throughout the required use
periods. This certification is inciuded in Part 6 in CAPER. The required use
period is three (3) years if the rehabilitation is non-substantial.
Li connection �vith the development of the DepartmenYs standards for
Homeless Management Infonnation Systems (HMIS), universal data
elements are being collected for clients of HOPWA-fimded homeless
assistance pro'iects. These project sponsodsubrecipient records wou(d
inchide: Name, Social Security Number, Date ofBirth, Etluiicity and Race,
Gender, Veteran Stahis, Disabling Conditions, Residence Prior to Program
Entry, Zip Code of Last Pennanent Address, Housing Status, Program Entry
Date, Program Exit Date, Personal Identification Number, and Household
Ideutification Number. These are intended to match the elements under
HMIS. The HOPWA program-level data elements include: Income and
Sources, Non-Cash Benefits, HN/AIDS Stahis, Services Provided, and
Housing Status or Destination at the end of the operating yeac Other
suggested but optional elements are: Physical Disability, Developmental
Disability, Chronic Health Condition, Mental Health, Substance Abuse,
Domestic Violence, Date of Contact, Date of Engagement, Financial
Assistance, Housing Relocation & Stabilization Services, Employment,
Education, General Health Status, , Pregnancy Status, Reasons for Leaving,
Veteran's Infonnation, 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.
P'iling Requirements. Within 90 days of the completion of each program
year, grantees must submit their completed CAPER to the CPD Director in
the grantee's State or Local HIJD Field Office, and to the HOPWA Program
Office: at HOPWA(n�hud.sov. Electronic submission to HOPWA Prograin
office is preferred; however, if electronic submission is not possible, hard
copies can be mailed to: O�ce of HIV/AIDS Housing, Room 7212, U.S.
Department of Housing and Urban Development, 451 Seventh Street, SW,
Washington, D.C.
Record ICeeping. Names and other individual information must be kept
confidential, as required by 24 CFR 574.440. Ho�vever, HUD reserves the
right to review the infonnation used to complete this report for grants
management oversight purposes, except for recording any names and other
identifying information. In the case that HUD must review client level
data, no client names or identifying information �vill be retained or
recorded. Information is reported in aggregate to HUD �vithout
personal identificatioa Do not submit client m• personal information in
data systems to HUD.
DefiniHons
Adjustment for Dnplication: Enables the calculation ofunduplicated
output totals by accouuting for the total number of households or units that
received more than one type of HOPWA assistance in a given service
category such as HOPWA Subsidy Assistance or Supportive Services. For
example, if a client household received both TBIZA and STRMU during the
operating year, report that household in the category of HOPWA Housing
Subsidy Assistance in Pad 3, Chart 1, Column []b] in the follo�ving ma�mer:
HOPWA Housing Subsidy [1] Outputs:
- Assistance Number of
Households
1. Tenant-Based Rental Assistance 1
Permanent Housing Facilities:
2a. Received Operating
Subsidies/Leased units
TransitionaUShort-term Facilities:
2b. Received Operating Subsidies
Permanent Housing Tacilities:
3a. Capital Development Projects placed
in service during the operating year
TransitionaUShort-term Facilities:
3b. Capital Development Projects placed
in service during the operating year
4 Short-tenn Rent, Mortgage, and
Utility Assistance I
5 Adjustment for duplication
subh•act 1
TOTAL Housing Subsidy
6. Assistance (Sum of Ro�vs 1-4 minus I
Row 5)
Previous editions are obsolete Page i form HUD-40110-D (�xpiration Date: 10/31/2014)
Administrative Costs: Costs for general management, oversight,
coordination, evaluatiou, and reporting. By stahrte, grantee administrative
costs are limited to 3% of total grant award, to be expended over the life of
the grant. Project sponsor administrative costs are limited to 7% of tlte
portion of the grant amount they receive.
Beneficia�y(ies): All members of a household who received HOPWA
assistance during the operating year including the one individuai who
qualifed the household for HOPWA assistance as weil as any other
members of the household (with or without HN) who benefitted from tUe
assistance.
Central Contractor Registration (CCR): The primary 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 cunent 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 status. Although recipients of direct federal contracts and grant
awards have been required to be registered �vith CCR since 2003, this
requirement is no�v being eatended to indirect recipients of federal fimds
with tl�e 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 a�vards or contracts must have a
DITNS (Data Universal Numbering System) 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 contimiously 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 tlie 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 disability, including the co-occurrence of 2 or more of
those conditions. Additionally, the statutory definition includes as
chronically homeless a person who currently lives or resides in an
instihitional care facility, including a jail, substance abuse or mental health
treatment facility, hospital or other similaz facility, and has resided there
for fe�ver 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 sihiations.
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
ability to �vork or perfonn one or more activities of daily living. An
HN/AIDS diagnosis is considered a disabling condition.
Facility-Based Housing Assistance: All eligible HOPWA Housing
expendih�res for or associated �vith supporting facilities including
coinmunity residences, SRO d�vellings, short-term facilities, project-based
rental units, master leased units, and other housing faci(ities approved by
HUD.
Faith-Based Organization: Religious organizations oftl�ree types: (1)
covgregations; (2) vational networks, whicl� include national
denominations, their social service arms (for example, Catholic Charities,
Lutheran Social Services), and networks of related organizations (such as
YMCA and YWCA); and (3) freestanding religious organizations, �vhich
are incorporated separately from congregations and national nehvorks.
Grassroots Organization: An organization headquartered in the local
comuumity �vhere it provides services; has a social services budget of
$300,000 or less annually, and sia or fewer fiill-time equivalent
employees. Local affiliates of national organizations are not considered
"grassroots."
HOPWA �ligible Individual: The one (I) low-income person with
HIV/AIDS who qualifies a household for HOPWA assistance. This person
may be considered "Head of Household." When the CAPER asks for
information on eligible individuals, report on this individual person only.
Where there is more than one person �vith HIV/AIDS in the household, the
additional PWH/A(s), �vould be considered a beneficiary(s).
HOP�VA Housing Information Services: Services dedicated to helping
persons living with HIV/AIDS and their families to identify, locate, and
acquire housing. This may also include fair housing counseling for eligible
persons who may encounter discrimination based on race, color, religion,
sea, age, national origin, familial stahis, or handicap/disability. .
HOP�VA Housing Subsid,y Assistance Total: The unduplicated number
of households receiving housing subsidies (TBRA, ST'RMU, Pennanent
Housing Placement sen�ices and Master Leasing) and/or residing in units
of facilities dedicated to persons living �vith HIV/AIDS and their families
and supported with HOPWA fimds during the operating year.
Household: A single individual or a family composed oftwo or more
persons for �vhich l�ousehoid incoines are used to determine eligibility and
for calculation of the resident rent payment. The tenn is used for
collecting data on cl�anges 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 �vith a roommate) who
resided in the iuiit are not reported on in the CAPER.
Housing Stability: The degree to �vhich the HOPWA project assisted
beneficiaries to remain in stable housing during the operating yeac See
Pnrt 5: Determining Housing Stabilit}> Oulcarres for definitions of stable
and unstable housing situations.
In-lcind Leveraged Resources: These involve additional types of support
provided to assist HOPWA beneficiaries sucli 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 HIJD notices,
such as the rate of ten dollars per hour. The value of any donated material,
equipment, building, or (ease 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 sihiated.
Leveraged Tunds: The amount of fimds expended during the operating
year from non-HOPWA federal, state, local, aod private sources by
grantees or sponsors in dedicating assistance to this client poptdation.
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 tl�e followi��g criteria: (1) is essential to the care aud �vell-
being of the person; (2) is not obligated for the support of the person; and
(3) �voidd not be living in the unit except to provide the necessary
supportive services. See the Code ofFecleral Reg:�lations Title 24, Par•t
5.403 nnd Ilre HOPIVA Granfee Oreisight Resour•ce G:dde fa• additional
refererrce.
Master Leasing: Applies to a nonprofit or public agency that leases units
of housing (scattered-sites or entire buildings) from a landiord, and
subleases the iuiits 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 o��ni 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 (�spiration Date: 10/31/2014)
fimction and operation costs like utilities, maintenance, equipment,
insurance, security, fiimisliings, supplies and salary for staff costs directly
related to the housing project but not staft costs for delivering services.
Outcome: The degree to �vhich the HOPWA assisted household has been
enabled to establish or maintain a stable living environment in 1lousing that
is safe, decent, and sanitary, (per Uie regulations at 24 CFR 574310(b))
and to reduce the risks of homelessness, and improve access to H1V
treatment and otller health care and support.
Outpuh The number of units of housing or households that receive
HOPWA assistance during the operating year.
Permanent Housing Placement: A supportive housing service tliat helps
establisl� the household in the housing tmit, including but not litnited to
reasonable costs for security deposits not to exceed hvo months of rent
costs.
Program Income: Gross income directly generated from the use of
HOPWA fimds, including repayments. See grant administration
requirements on program income for state and local govemments at 24
CFR 85.25, or for non-profits at 24 CFR 84.24.
Project-Based Rental Assistance (PBRA): A rental subsidy program
that is tied to specific facilities or units owned or controlled by a project
sponsor or Subrecipient. Assistance is tied directly to the properties and is
not portable or transferable.
Project Sponsor Oiganizations: Any nonprofit organization or
governmental housing agency that receives fimds u��der a contract with the
grantee to provide eligible housing and other support sen�ices or
administrative services as defined in 24 CFR 574300. Project Sponsor
organizations are required to provide performance data on households
served and fimds eapended. Funding flo�vs to a project sponsor as
follo�vs:
HiJD FLmding 3 Grantee —� Project Sponsor
Sl�ort-Term Rent, Nlortgage, and Utility (STRMU) Assistance: A
time-limited, housing subsidy assistance designed to prevent homelessness
and inerease housing stability. Grantees may provide assistance for up to
21 weeks in any 52 week period. The amoimt of assistance varies per
client depending on fimds available, tenant need and program guidelines.
Stewardship Units: Units developed �vith HOPWA, where HOPWA
fimds were used for acquisition, new constn�ction 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 tlte ten-year use agreemei�t if rehabilitation is
substantial.
Previous editim�s are obsolete Page iii
Subrecipient Organizatimt: Any organization that receives fimds from a
project sponsor to provide eligible housing and other support services
and/or administrative services as defined in 24 CFR 574.300. If a
subrecipient organization provides liousing and/or other supportive
services directly to clients, the subrecipient orgauization must provide
performance data on household served and fimds eapended. Fimding
flo�vs to subrecipients as follows:
HUD Funding � Grantee � Project Sponsor �Subrecipient
Tenant-Based Rental Assistance (TBRA): TBRA is a rental subsidy
program similaz to the Housing Choice Voucher program that grantees can
provide to help low-income households access affordable housing. The
TBRA voucher is not tied to a specific unit, so tenants may move to a
different unit without losing their assistance, subject to individual program
rules. The subsidy amount is detennined in part based on household
income and rentai 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
Anned Porces of the United States. This does not include inactive military
reserves or the National Guard unless Uie person was called up to active
duty.
form HUD-40ll0-D (�spiration Date: 10/3U2014)
7•
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 cont►•act/agreement to
provide HOPWA-funded services to client households. These elements address requirements in the Federal Funding and
Accountability and Transparency Act of 2006 (Public Law 109-282).
Note: Please see the defrnitiof� section for distii�ctions behveen project spot�so�• rn�d strbrecipient.
Note: If any if fo�mation does not apply to yozrr o��ganization, p7ease ef7ter N/A. Do ��ot lecn�e any sectioJ� blaf�lc.
� r...,,,�..,, r„f,,,.,,,..+:.,,,
HUD Grant Number' � Operating Year for this report
F/'OI/t �l)1i1�(ffl�)� To (f�mr/drUJ7i
Grantee Name
Business Address
Cit}�, Countj�, State, Zip
Emptoyer ldentification Number (�IN) or
Tax Identification Number (TIN)
DUN & Bradstreet Number (DUNs)• Central Contractor Registration (CCR):
Is tlie grantee's CCR status currentl,y active?
❑ Yes ❑ No
If yes, provide CCR Number:
"Congressional District of Grantee's Business
Address
"Congressional District of Primary Service
Area s)
YCity(ies) and Cow�ty(ies) of Primary Service Ci6es: Counties:
Area(s)
Organization's �Yebsite Address Is there a waiting list(s) for HOP�VA Housing Snbsid}� Assistance
Services in the Grantee se�vice Area? ❑ Yes ❑ No
If yes, esplain in the narrative section �;�hat services maintain a waifing
list and how this list is administered.
''� Service deliveiy area inf"ormation only neenea tor program activicies oe�ng uirec�,y cn� �.eu vu� uy �.,c �� n..«�.
Previous editions are obsolete Page 1 form HUD-40110-D (�xpiration 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 seive as a project sponsor, as defined by CFR 574.3.
Use this section to report on organizations involved in the direct deliveiy 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 defr»itions for distif�ctiot�s beh��een pr•oject sponsor and st�brecipie»t.
Note: If any if�formation does not apply to yotn• organization, please enter N/A.
Project Sponsor Agenc}� Name Parent Company Name, if npplicnble
Name and Title of Contact at Project
S onsor Agency
�mail Address
Business Address
City, County, State, Zip,
Phone Number (rvitJe nren code)
Employer ldentification Number (EIN) or Fa�c Number (with area code)
Tax Identification Number (TIN)
DUN & Bradstreet Number (DUNs):
Congressional District of Project Sponsor's
Business Address
Congressional District(s) of Primary Service
Area(s)
City(ies) and County(ies) of Primary Service Cities: Counties:
Area(s)
Total HOP�VA contract amount for this
Or anization for the o eratin year
Organization's �Yebsite Address
Does your organization maintain a�i�aiting list? ❑ Yes ❑ No
Is the sponsm• a nonprofit organization? ❑ Yes ❑ No
Please check if��es and a faid7-bnse�l organi=ntion. ❑ If yes, explain in the narrative sectimi lio�v this list is administered.
Plense check if��es and a grnssroots orgnnization. ❑
Previous editions are obsolete Page 2 form HUD-40110-D (Expiration Date: 10/31/2014)
3. Administrative Subrecipient Information
Use Chart 3 to provide the following information for each subrecipient with a contract/agreement of $25,000 or greater that
assists project sponsors to cariy out their administ►•ative 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 definitions for cfistinctions behveen project sponsor and subreci�iet�t.
Note: If any i»forrnatio�� does not ap�ly to yozn� o�gaf�ization, please ef�ter N/�I.
Subrecipient Name Parent Company Name, ifnpplicnLle
Name and Title of Contact at Subrecipient
�mail Address
Rusiness Address
Ciry, State, Zip, County
Phone Number (witli area code) Tas Number (inclu�e area code)
�mplo`�er ldentification Number (�IN) or
Taz Identiffcation Number TIN)
DUN & Bradstreet Number (DUNs):
North American Industry Classification
S stem (NAICS) Code
Congressional District of Subrecipient's
Business Address
Congressional District of Prima�y Service
Area
City (ies) and County (ies) of Primary Service Ci6es: Counfies:
Area(s)
Total HOPWA Subcontract Amomtt of this
Or anization for ttie o eratin year
Previous editions are obsolete Page 3 form AUD-40110-D (�x�iration llate: 10/31/2014)
4. Program Subrecipient Information
Compiete the following information for each subrecipient organization providing HOPWA-fimded services to client households.
These oiganizations would hold a contract/agreement with a project sponsor(s) to provide these services. For example, a
subrecipient organization may receive funds fi•om a project sponsor to provide mrtritional seivices for clients residing within a
HOPWA facility-based housing prog►•am. 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: Plense see the defit�ition of a subrecipieni for mo�•e information.
Note: Types of contracts/agreements may inclarde: grants, st�b-gr•anis, loans, cnvrn�ds, cooperative agr•eements, and other forn�s
offinancial assistai�ce; af�d contracts, subcoi�tracts, pen•chase o�•ders, taslc orders, ai�d deline�y order•s.
Note: If �my i� forrnatiof� is not applicable to the o�gaj�ization, �lease report N/A ir� the ap�ropriate boa; Do ��ot lea>>e boxes
blaJ�Ic.
Sub-recipient Name Parent Company Name, if npplicrrble
Name and Title of Contact at Contractor/
Sub-contractor Agenc,y
�mail Address
Business Address
City, Coiu�ty, State, Zip
Fas Nnmber (include area code)
Pl�one Number (included area code)
�mployer ldentification Number (�IN) or
Tas Identifcation Number (TIN)
DUN & Bradstreet Number (DUNs)
North American Industry Classification
System (NAICS) Code
Congressional District of tl�e Sub-recipienYs
Business Address
Congressional District(s) of Primary Service
Area
City(ies) and County(ies) of Primary Service Cities: Counties:
Area
Total HOPWA Subcontract Amount of t6is
Organization for the operating }�ear
Previous editions are obsolete Page 4 form HIJD-40110-D (Expiration 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 arganization, area of seivice, the uame(s) of the program contact(s),
and an overview of the range/type of housing activities provided. This overview may be used for public infonnation, incliidiug
posting on HLJD's website. Note: Te1:t fields are ea�andable.
b. Annual Perfoj•mance 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 househoids assisted with HOPWA funds during this operating year compared to plans for this assistance, as
appi•oved in the Consolidated Plan/Action Plan. Describe how HOPWA fiinds 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. Compai•e 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 identifed
in the Consolidated Plan/Strategic Plan.
4. Technical Assistance. Describe any program technical assistance needs and how they would benefit program beneficiaries.
c. Barriej•s and T�•ends Overview
Provide a narrative addressing items 1 through 3. E�plain how barriers and trends affected your program's ability to achieve the
objectives and outcomes discussed in the previous section.
1. Describe any ban•iers (including regulatory and non-regulatoiy) 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 talcen in response to barriers, and recommendations for program improvement. Provide an explanation for each
barrier selected.
A/HUD Regulations
❑ Discrimination/Confidentiality
❑ Supportive Services
❑ Muitiple Diagnoses
❑ Credit History
Housing
❑ Eligibility
❑ Rental History
Determination and Fair
Rents
❑ Technical Assistance or Training
❑ Housing Affordability
❑ Geogaphy/Rural Access
❑ Other, please explain further
❑ Criminal Justice History
Previous editions are obsolete Page 5 form HUD-40110-D (�xpiration 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 Housin� Needs
In Chart 1, provide an assessment of the number of HOPWA-eligible households that rec�uire HOPWA housing subsidy
assistance but are not currently seived by any HOPWA-funded housing subsidy assistance in this service area.
In Row 1, report the total unmet need of the geographical service area, as reported in Unnaet Needs for• Perso�s ivith HI i�/AIDS,
Chart 1B of the Consolidated or Annual Plan(s), or as reported under HOPWA worksheet in the Needs Workbook of the
Consolidated Planning Management Process (CPMP) tool.
Note: Report most czrrrent data available, tlaroz�gh Consolidated or Af���aial Plan(s), and accoamt for local hotrsing issues, or
cl�anges i� HIi�/AIDS cases, by aisii�g conabination of one or naore of the sotrr•ces if� 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 approxiinate 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 ciients who are
already receiving HOPWA-funded housing subsidy assistance.
Refer to Chart 2, and chec]< all sources consulted to calculate unmet need. Reference any data fi•om neighboring states' or
municipalities' Consolidated Plan or other planning effoi�ts that informed the assessment of Unmet Need in your seivice area.
Note: In or�der to eJ�szrre that the z�nmet need assessmerrt foi• the region is comprehef�sive, HOPWA for��r�trla grantees shotild
inchide those Za�nlet rreeds assessed by HOPNtA competitive gr•antees oper•ating ii�ithit� the service area.
1. Total number of households that have unmet
housin� 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
(STRM CJ)
• Assistance with rental costs
• Assistance with mortgage payments
• Assistance with utility costs.
c. Housing Facilities, such as community residences,
SRO dwellings, other hoiising facilities
Previous ediHons are obsolete Page 6 form HUD-40110-D (�xpiration Date: 10/31/2014)
2. Recommended Data Sources for Assessin� Unmet Need (checic all sources
R =Data as reported in the area Consolidated Plan, e.g. Table IB, CPNIP charts, and related narratives
= Data established by area HIV/AIDS l�ousing planning and coordination efforts, e.g. Continuum of Care
=Data from client infonnation provided in Homeless Management Information Systems (HMIS)
= Data from project sponsors or housing providers, including waiting lists for assistance or other assessments on need including those
completed by HOPWA competitive grantees operating in the region.
= Data from prisons or jails on persons being discharged with HIV/AIDS, if mandatory testing is conducted
= Data from local Ryan White Planning Councils or reported in CARE Act Data Reports, e.g. number of clients �vith permanent
= Data collected for HN/AIDS surveillance reporting or other health assessments, e.g. local health department or CDC surveillance data
End of PART 1
Previous editions are obsolete Page 7 form HUD-40ll0-D (Espiration Date: l0/31/2014)
PART 2: Sources of Lev
1. Sources of Leveraging
Report the source(s) of cash or in-kind leveraged federal, state, local or private resources identified in the Consolidated or
Annual Plan and used in the delivery of the HOPWA program and the amount of leveraged dollars. In Column [1], identify the
type of leveraging. Some common sources of leveraged funds have been provided as a reference point. You may add Rows as
necessary to report all 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 nea�t 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 forin of support.
Note.� Be san•e to report on the ��zirnber• of hozrseholds szrppw7ed ivith these leveraged firr�ds in Part 3, Chart 1, Colz�mf� 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 Funding `
❑Housing Subsidy Assistance
Ryan White-Housing Assistance ❑Other Support
❑Housing Subsidy Assistance
Ryan White-Other ❑Other Support
❑Housing Subsidy Assistance
Housing Choice Voucher Program ❑Other Support
❑Housing Subsidy Assistance
Low Income Housing Tax Credit ❑Other Support
❑Housing Subsidy Assistance
HOME ❑Other Support
❑Housing Subsidy Assistance
Shelter Plus Care ❑Other Support
❑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 Suppoi�t
❑Housing Subsidy Assistance
Other Public: ❑Other Support
❑Housing Subsidy Assistance
Other Public: ❑Other Suppoi�t
Private Funding '
❑Housing Subsidy Assistance
Grants ❑Other Support
❑Housing Subsidy Assistance
In-kind Resources ❑Other Support
❑Housing Subsidy Assistance
Other Private: ❑Other Support
❑Housing Subsidy Assistance
Other Private: ❑Other Support
Other Funding `
❑Housing Subsidy Assistance
Grantee/Project Sponsor/Subrecipient (Agency) Cash ❑Other Support
Resident Rent Payments by Client to Private Landlord
TOTAL Sum of all Ro«�s)
Previous editions are obsolete Page 8 form HUD-40110-D (�xpiration Date: 10/31/2014)
2. Program Income and Resident Rent Payments
In Section 2, Chart A., report the total amount of program income and resident rent payments directly generated from the use of
HOPWA fimds, 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 r•eport cli��ections sectio�� for defrnition ofpro�am income. (Additional information on progrm�a income is
available in the HOPlYA Grantee One�sight Resozo�ce 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 Resideat Rent Pa,yments (Sum of Ro�;-s 1 and 2)
S. 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 bicome and Resident Rent Payment E�pended on Housing St�bsidy Assistance costs
2. Program Hicome and Resident Rent Payment Eapended on Supportive Services and other non-
direct housing costs
3. Total Program Income �xpended (Sum of Rows 1 and 2)
End of PART 2
Previous editions are obsolete Page 9 form HUD-40110-D (Expiration Date: 10/31/2014)
PART 3: Accomplishment Data Planned Goal and Actual 0utputs
In Chart 1, enter perfoimance information (goals and actual outputs) for all activities undertaken during the operating year
supported with HOPWA fimds. 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 HIV/AIDS and their families.
Note: The total hozrsehoJds assisted inith HOP N'A firf�ds arrd i�eported if� PART 3 of the CAPER shozdd be the same as r•epor�ted
in the an�tral year�-end IDIS data, and goaJs reported shozdd be consistent ivitl� the Annzial Plan i»for•naation. �lny disc��epancies
w• deviations shozrld be explaii�ed in the nar•rative section of PART 1.
1. HOPWA Performance Planned Goal and Actual Outputs
HOPWA Performance
Planned Goal
and Actual
Housing Facilities:
Operating Subsidies/Leased units (Households Served)
naUSliort-term Pacili6es:
Operating Subsidies/Leased units (Households Served)
�ent Housing Facilities:
Development Projects placed in service during the operating year
ionaUShort-term Facilities:
Development Projects placed in service during the operating year
Temi Rent, Mortgage and Utility Assistance
ment Housing Placement Services
ication (subtract)
�I'otal HOP�i'A Housing Subsidy Assistance
I(Columns a. — d. equal the sum of Rows 1-5 minus Rotiv 6; Columns e. :
�� thn cmm �f Rnwc 1_Sl
I la. Supporti�
delivered
116 Supporti�
stt orti�
12. Adjustm�
13. otal Su
(Column
e ��al thi
FIousing:
l4. Housing
(5. TotalHa
-based units;
Development Projects not yet opened (Housing Units)
Iship Units subject to 3 or ]0 year use agreements
[ousing Developed
f Rorti�s 78 & 9)
qual '
a. � b. � c. ( d. � e. � f.
¢ ¢
� � � � a� a�
C7 ¢ C7 ¢ xw xa
Services provided by project sponsors/subrecipient that also
[OPWA housing subsidy assistance
Services provided by projectsponsors/subrecipientthatonly provided
services.
t for duplication (subtract)
vs 1
Services
n of Rows ll a. & b. minus Row 12; C
llbJ
�rvices
olumns e. and 7
Previons editions are obsolete Page 10
-■
'� a�'��'�a t4a�s'
�o-t��.��t�t+a
.�
e���t�4a��'�s
� a �t. o.t � $-+ k t:�
fbrm HUD-40110-D (�xpiration 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 repoi�t on suppot-tive seivices
leveraged with non-HOPWA fimds.
Dtrta cJreclr: Total ur�darplicnted Izouseholds arrd eapenditzrres reported in Ro�t� ]7 ec�ual totals ��eportecl in Pm•t 3, Chart 1, Roiv 13.
Supportive Services [1] Outpnt: Number of Households [2] Output: Amount of HOPWA Funds
�spended
1. Adult day care and personal assistance
2. Alcohol and dnig abuse services
3. Case mana ement
4. Child care and other child services
5. Education
6. Employment assistance and training
Health/medical/intensive care services, if approved
7. Note: Client records must confonn with 24 CFR §574310
8. Legalservices
9. Life skills management (oirtside of case mana ement)
10. Meals/nutritional services
11. Mental health services
12. Outreach
]3. Transportation
Other Activity (if approved in grant agreement).
14. Specify:
� '
Sub-Total Households receiving Supportive Services � � �"
15. (Sum of Rows 1-14) �'�Y'�'�'��������' "�� � � �
16. Ad'ustment for Du lication (subtract
TOTAL Unduplicated Households receiving
Supportive Services (Column [I] equals Row 15
17. minus Row 16; Column [2� e uals sum of Rows 1-14)
Previous editions are obsolete Page 11 form HUD-40110-D (�xpiration Date: 10/31/2014)
3. Short-Term Rent, Mortgage and Utility Assistance (STRMU) Summary
In Row a., enter the total number of households seived and the amo�mt of HOPWA funds expended on Short-Term Rent,
Mortgage and Utility (STRMU) Assistance. In Row b., enter the total number of STRMCJ-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 STRM[J-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 STRMLJ-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
STRMII-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 STRMiJ-assisted households that received assistance with utility costs only (not
including rent or inortgage costs) and the amount expended assisting these households. In row g., report the amount of STRM[J
funds expended to support direct program costs such as program operation staff.
Data Checlr: The total households reported as served u�ith STR�i1U in Ro�v a., cohrmn [I J and tbe total nmotmt of HOPiT'A firnds re�orted as
expended in Ro1v n., cohrntn [2J eqzrals the hozrsehold and eaper�ditin�e total reyo�7ed fo�� STR�1�fU in Part 3, Cl�ar•! I, Row 4, Cohrmrzs b. n�rd f.,
�•es�ectively.
Dtrta Clrec/r: Tl�e lotal n:nrrber of Iaotrsel�olds �•eporied in Cohman [1], Rou�s b., c., d., e., nnd f. ec�zrnl the total latnnber of STR�ITCT Iloirseholds
repo�7ed ira Colznnn [I], Roiv n. Tl�e total amount reported as e�pe�tded in Coharna �2�, Roivs b., c., d., e., f., and g. equal ilae total nmozmt of
STR1l�tU e�penditcn�es reported in Col:rmn [2J, Ro1v a.
[1] Output: Number [2] Output: Total
Housing Subsidy Assistance Categories (STRMU) of Households Served HOPWA Funds Expended
on STRMU during
O erating Year
Total Short-term mortgage, rent and/or utility (STRMiJ)
a assistauce
Of the total STTZMU re�orted on Row a, total who received
b� assistance with mortgage costs ONLY.
Of the total STRMiJ reported on Row a, total �vho received
�• assistance with mortgage and utility costs.
Of the total STRMIJ reported on Row a, total who received
d� assistance �vith rental costs ONLY.
Of the total STRMU reported on Row a, total �vho received
e� assistance with rental and utility costs.
Of Uie total STRMU reported on Ro�v a, total �vho received
f assistance with utility costs ONLY.
Direct program delivery costs (e.g., program operations staff �.
time)
,�
g � �,.
End of PART 3
Previous editions are obsolete Page 12 form HUD-40110-D (�xpiration Date: 10/31/2014)
�
)utcomes -
In Column [1], report the total number of eligible households that received HOPWA housing subsidy assistance, by type.
In Column [2], enter the number of households that continued to access each type of housing subsidy assistance into next
operating year. In Column [3], report the housing status of all households that exited the program.
Data Checlr: The sum of Cohanr�s [2J (Nznnber of Hotrseholds Contin:ting) and [3J (Exited Households) eqteals tlte total reported in Cohnrnt�IJ.
Note: Refer to 1he ho:�sing stabilit�� codes that appenr i1� Part S: JYor•ks7�eet - Deler�nir�ing Hozrsir�g Stabrlifj� Oi�tcomes.
Section 1. Housing Stability: Assessment of Client Outcomes on Maintaining Housing Stability (Permauent Housing and
Related Facilities)
A. Pe►•manent Housin Subsid}� Assistance
[1] Output: Total [2] Assessment: Number of [3] Assessment: Number of
Number of Households that Continued Households that exited this �4] HOP�VA Client
Households Receiving HOPWA Housing HOP�VA Program; their Housing Outcomes
Served Subsidy Assistance into the Next Status after Exiting
Operating I'ear
1 Emergency Shelter/Streets Unstable tlri'angenleflts
2 Temporary Housi��g Tempornril�� Stable, irith Reduced
Risk of Homeless:ress
3 Private Housing
Te�ant-Based 4 Od�er HOP�VA
Rental Stable/Per��ranertt Hotrsing (PH)
Assistance 5 Other Subsidy
6 Itustitution
7 7aiVPrison
Urtstable Arrangements
8 Disconnected/Unknowu
9 Deatli Life Et�ertl
1 Emergency Sl�elter/Streets Unstable An•attgements
2 Temporary Housing Tempornrily Stable, iridt Reduced
Risk of Ha�reless�ress
3 Pmate Housing
Permanent
Su ortive 4 Od�er HOPtiVA
PP Stable/Perntnrtent Hotrsing (PH)
Housing 5 Other Subsidy
Facilities/ Units
6 Institutioi�
7 JaiUPrison
8 Disconvected/Onkuown Urrstable An•angemerrts
9 Death Life Erent
B. Transitional Housin Assistance
[1] Output: Total [2] Assessment: Number of [3] Assessment: Number of
Number of Households that Continued Housel�olds that exited this
Households Receiving HOP�VA Aousing HOP�VA Program; their [4] HOP�VA Client Outcomes
Se�ved Subsidy Assistance into the Next Housing Status after �siting
O eratin Year
i Emergency Sheiter/Streets Unstable Ari angemen�s
2 Temporary Housing Temporari(y S�able irith Red:rced
Risk of Homelessrress
TYenSitionaU 3 Private Housing
Sl�ort-Term
Housing 4 Other HOPNA
Facilities/ Units Slable/Pernra�rent Hotrsi�tg (PH)
5 OtherSubsidy
6 H�s[itution
7 IaillPrisoi�
Unstable Arrartgemerrts
8 Disconnected/unkuown
9 Death Life Erent
Previous editions are obsolete Page 13 form HUD-40110-D (Espiration Date: 10/31/2014)
B 1:Total number of households receiving transitional/short-tenn 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 STRMCJ 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 STRMIJ program or through the project sponsor or subrecipient's 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 rec�uired.
At the bottom of the chart:
o In Row la., report those households that received STRMLJ assistance during the operating year of this report, and the
prior operating year.
• In Row lb., report those households that received STRMLJ assistance during the operating year of this report, and the
two prior operating years.
Data Clreclr: The total households repol•ted as served with STIZA�IU in Colzrmf� [IJ eq�ials the total reported if� Part 3, Chart 1,
Roiv 4, Cohrmn b.
Data Clteck; The sun� of Colannn [2J sl�ould eqaral the tnrmber of hozrseholds repor7ed in Cohrmn [IJ.
�� »+ �fA�, �oh�lrl� th�t Rn�PivPri CTRMTT Accictanre
[1] Output: Total [2] Assessment of Aousing Status [3] HOPWA Client Outcomes
number of
households
D4aintain Privatc Housing without subsid,y
(e.g. Assistance proricfed/completed and client is stnble, no�
likely to seek additional s:ippoi•t)
Other Private Housing without subsidy
(e.g. client switched housing units and is no�v stable, not likely
to seek additional support)
Stable/Permanent Hotising (PH)
Other HOPWA Housing Subsidy Assistance
Other Housing Subsidy (PH)
Institution
(e.g. residential and long-ternr care)
Likely that additional STRMU is needed to maintain current
housing arrangements
Transitional Facilities/Short-term T2mpoYC7t'7%y StQble, 1VIth
(e.g. temporm�� or lrar�sitional ar•r•m�ge»tent) Redt�Ced R7SIC of Hon7elessYless
Temporar��/Non-Permanent Housing arrangement
(e.g. gare trp lease, and nrored in irilh fm�ri7�� or fi•iends b:rt
e�pects to lire tlrere 7ess tha�t 90 days)
Emergency Shelter/street
7ai1/Prison Urrstable Arrangemer�ts
Disconnected
Death Life Eve��t
la. Total number of those households that received S'IRMU Assistance in the operating year of this report that also received
STRMU assistance in the prior operating year (e.g. households that received STRMU assistance in two consecutive operating
years).
1 b. Total number of those households that received STRMU Assistance in the operating year of this report that also received
STRMU assistance in the hvo prior operating years (e.g. households that received STRMU assistance in three consecutive
operating years).
Previous editions are obsolete Page 14 form HUD-40110-D (�xpiration 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,
STRMLJ, 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: Tl�ese nz�mber•s lnill help yoar to deter�»�ine �vhieh clie»ts to re�ort Access to Care af�d Szrpport Otrtcomes fof• and ivi11 be
zised by HUD as a basis foi• ana7yzing the percentage of I�otrsel�olds ivho demonstrated or rnaintained connections to car•e a��d
support as identified in Chart 1 b. beloiv.
lb. Status of Households Accessing Care and Support
Column [1): Of the households identified as receiving seivices fi•om project sponsors/subrecipients that provided HOPWA
housing subsidy assistance as identified in Chart la., Row ld. above, report the number of households that demonstrated
access or maintained connections to care and support within the program year.
Column [2]: Ofthe households identified as receiving services fi•om project sponsors/subrecipients that did NOT provide
HOPWA housing subsidy assistance as repoi�ted 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 info�-mation on types arrd sources of incorne and rnedical irrstn-ance/assistance, refer to Cl�arts belotiv.
[1] For project (ZI For project
sponsors/subrecipients that sponsors/subrecipients that
Categories of Services Accessed provicled HOP�VA housing subsidy ��� NOT provide HOP�VA Outcome
assistance, identify the households housing subsidy assistance, Indicator
who demonstrated the followin ��lentify the households who
g' demonstrated the followin :
Szr�port for
1. Has a I�ousing plan for maintaining or establishing stable on- Stable
going housing
HOZlSTi1g'
2. Had contact with case manager/benefits counselor consistent
�vith the schedule specified in clienYs individual service plan Access to
(may include leveraged services such as Ryan White Medical Sttppm•i
Case Management)
3. Had contact with a primary health care provider consistent Access to
witl� the schedule specified in client's individual service plan Henith Care
4. Accessed and maintained medical insurance/assistance Access lo
HeaJtla Care
5. Successfidly accessed or maintained qualification for sources Sotn�ces of
of income Incorne
Previous editions are obsolete Page 15 form HUD-40ll0-D (�xpiration Date: 10/31/2014)
Chart lb., Line 4: Sources of Medical Insurance and Assistance include, but are not limited to the following
• MEDICAID Heaith Insurauce Program, or
use local program
name
• MEDICARE Health Lisurance Program, or
use local nroeram name
• Veterans Affairs Medical Services
• AIDS Drug Assistance Program (ADAP)
• State Children's Health Insurance Program
(SCHIP), or use local program name
Chart lb., Row 5: Sources of Income
• Earned Income
' • Veteran's Pension
• Unempioyment Insurance
• Pension from Former Job
• Suppleinental Security Income (SSI)
.
.
but are not limited to the
Child Support
Social Security Disability Income (SSDI)
Alimony or other Spousal Support
Veteran's Disability Payment
Retirement Income from Social Security
Worker's Compensation
• Ryan White-funded Medical or Dental
Assistance
• General Assistance (GA}, or use local
program name
• Private Disability Insurance
• Temporary Assistance for Needy
Families (TANF)
• Oflier Ltcome 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 1 a., Row 1 d. above, repoi�t on the number of households that include
persons who obtained an income-producing job during the operating year that resulted fi•om HOPWA-funded Job training,
employment assistance, education or related case management/counseling seivices.
Coiumn [2]: Of the households identified as receiving services fi•om project sponsors/subrecipients that did NOT provide
HOPWA housing subsidy assistance as reported in Chart la., Row 2b., report on the number of households that include
persons who obtained an income-producing job during the operating year that resulted from HOPWA-funded Job training,
employment assistance, education or case management/counseling seivices.
Note: This irrchides jobs created by this yroject sponso�/subrecipients o�• obtained outside this agency.
Note: Do not inchrde jobs that restdted fi•on� leve�•aged job b•aini»g, enaployn�ent assista��ce, education or case
maJ�agement/cozn�seling services.
[1 For project sponsors/subrecipients that [2] For project sponsorslsubrecipients that clid
Categories of Se►vices Accessed P�'°�'ided HOP�VA housing subsidy NOT provide HOP�VA housing subsidS� assistance,
assistance, identify the households �vho identify the households who demonstrated the
demonstrated the followin : followin :
Total number ofhouseholds that
obtained an income- roducing job
�;na ot raxi 4
Previous editions are obsolete Page 16 form HUD-40110-D (�xpiration Date: 10/31l2014)
PART 5• Worlcsheet - Determining Housing Stability Outcomes (optional)
1. This chart is designed to assess program results based on the information reported in Part 4 and to help Grantees determine
overall program performance. Completion of this worksheet is o t� ional.
Perma�ent Stable I3ousing Temporary Housing Unstable Life Event
Housing Subsidy (# of households (2) Arrangements (9)
Assistance remaining in program (1+7+8)
plus 3+4+5+6)
Tenant-Based
Rental Assistance
(TBRA)
Pennanent Facility-
based Housing
Assistance/Units
TransitionaUShort-
Term Pacility-based
Housing
Assistance/Units
Total Permanent
HOP�VA Housing
Subsidy Assistance
Reduced Ristc of Stable/Permanent Temporarily Stable, �i�ith Reduced Risk of Unstable Life �vents
Hamelessness: Hoasing Homelessness Arrangements
Short-Term
Assistance
Short-Tenn Rent,
Mortgage, and
Utility Assistance
(STRMU)
Total HOP�VA
Housing Subsidy
Assistance
Bacicground on HOPWA Housing Stability Codes
Stable Permanent Housing/Ongoing Pai•ticipation
3= Private Housing in the private rental or home ownership market (without known subsidy, including permanent placement
with families or other self-sufficient an�angements) with reasonable expectation that additional support is not needed.
4= Other HOPWA-funded housing subsidy assistance (not STRMLJ), 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 suppoi�t and continLied residence expected (e.g., residential or long-term care facility).
Temporary Housing
2= Temporaiy housing - moved in with family/fi•iends or other short-term arrangement, such as Ryan White subsidy, transitional
housing for homeless, or temporaiy placement in institution (e.g., hospital, psychiatric hospital or other psychiatric facility,
substance abuse treatment facility or deto�: 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
undertalcen.
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 Housin� is the sum of the mimber of households that (i) remain in the housing and (ii)
those that left the assistance as reported under: 3, 4, 5, and 6. Temporaty 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 (Expiration Date: 10/31/2014)
Permanent Facility-Based Housing Assistance: Stable Housing is the sum of the number of households that (i) remain in the
housing and (ii) those that left the assistance as shown as items: 3, 4, 5, and 6. Temporary Housing is the number of households
that accessed assistance, and left their current housing for a non-permanent housing arrangement, as reported under item
2. Unstable Situations is the sum of numbers reported under items: 1, 7, and 8.
Transitional/Short-Term Facility-Based Housing Assistance: Stable Housin� is the sum of the number of households that (i)
continue in the residences (ii) those that left the assistance as shown as items: 3, 4, 5, and 6. Other Temporary Housin� is the
number of households that accessed assistance, and left their current housing for a non-permanent housing arrangement, as
reported under item 2. Unstable Situations is the sum of numbers reported under items: 1, 7, and 8.
Tenure Assessment. A baseline of households in transitional/short-term facilities for assessment purposes, indicate the number
of households whose tenure exceeded 24 months.
STRMU Assistance: Stable Housin� is the sum of the number of households that accessed assistance for some portion of the
permitted 21-week period and there is reasonable expectation that additional support is not needed in 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 suppoi�t; Other Housing Subsidy; and
Institution. Temporarilv 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 temporaiy/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 STRMCJ 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 editions are obsolete Page 18 form HUD-40ll0-D (�xpiration Date: 10/31/2014)
ts (ONLY)
The Annual Certification of Usage for HOPWA Facility-Based Stewardship Units is to be used in place of Part 7B of the
CAPER if the facility was originally acquired, rehabilitated or constructed/developed in part with HOPWA funds but no
HOPWA funds were expended during the operating year. Scattered site units may be grouped together on one page.
Grantees that used HOPWA funding for new construction, acquisition, or substantial rehabilitation are required to
operate their facilities for HOPWA eligible individuals for at least ten (10) years. If non-substantial rehabilitation fiinds
were used they are required to operate for at least three (3) years. Stewardship begins once the facility is put into
operation.
Note: See defrnitiorr of Steina��dship U�its.
� ro„o,.�� :.,f r.,,�r;.,.,
�. .�.,...,_ ... ....... ...•---�--
Operating Year for this report
HUD Grant Number(s) Frrnn (van/dcf/}�) To (nrnr/dd/j�) ❑ Final Yr
❑ Yr 1; ❑ Yr 2; ❑ Yr 3; ❑ Yr 4; ❑ Yr 5; ❑ Yr 6;
❑ Yr 7; ❑ Yr 8; ❑ Yr 9; ❑ Yr 10;
Grantee Name Date Facility Began Operations (nrm/c3d/y�)
3. Details of ]
Project Sites: Na�
Site Information:
Site Information:
Site
of HOPWA-fimded
Is the address of the project site confidential?
❑ Yes, protect iJ forvration; do not list
Not
If tl�e site is not confidential:
Please provide the contact information, phone,
email address/location, ifbusiness address is
different from facility address
carr be made ararlable to �lre
I certify that the facility that received assistance for acquisition, rehabilitation, or new consh•uction fi•om the Housing Opportunities
for Persons with AIDS Program has operated as a facility to assist HOP WA-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 requireinents of the grant agreement are being satisfied.
I hereb7� certify lhat all
Name & Title of Auth
to operate the facility:
statec! Irerei�a, as irell as
Official of the organization that continues
Name & Title of Contact at Grantee Agency
(pe�so�r ivho can a�r.nver q:�es�ions about tlre r•eport and progi•an:)
i proricfed in 1he accompnnimen�
Sig�ature & Date(mm/dd/yy)
ContactPhone (with area code)
End of PART 6
is trt�e anc/ ncctrrate.
Previous editions are obsolete Page 19 fm•m HUD-40110-D (Expiration Date: 10/31/2014)
2. Number of Units and Non-ROPWA Expenditures
!�ssistance
fLY)
Note: Reporting for this section shotdd inchrde ONLY those individuals, beneficiaries, or households that received and/or
resided in a household that receil�ed HOPiT'A Hotrsif�g Szibsidy Assistarrce as re�orted in Pa�7 3, Chart 1, Row 7, Cohrmn b.
(e.g., do ��ot inclzide hozrseholds that received HOPiVA sarppor•tive se�vices ONL1).
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 undliplicated) low-income individuals livin� 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 c�ualified the household for HOPWA assistance, NOT all HIV positive individuals in the household.
Individuals Served with Housing Subsidy Assistance
Number of individuals �vith HIV/AIDS �vlio qualified their household to receive HOPWA housing subsidy assistance.
Total
Chart b. Prior Living Situation
In Chart b., report the prior living situations for all Eligible Individuals reported in Chart a. In Row l, report the total number of
individuals who continued to receive HOPWA housing subsidy assistance fi•om the prior operating year into this operating year.
In Rows 2 through 17, indicate the prior living arrangements for all new HOPWA housing subsidy assistance recipients during
the operating year.
Data Clteck: Tl�e total f�an�aber of eligible individuals served in Ro1>> 18 equals the total mrmber of individuals served through
housin� subsidv assistance ret�orted in Chart a. aboi�e. _
Category
l. � Continuin� to receive HOPWA support from the prior operating year
New Individuais ���ho received HOP�VA Housin Subsid Assistance su ort durin O eratin Year
2 Place not meant for human habitation
(such as a vehicle, abandoned building, bus/h•ain/subway station/airport, or outside)
3. Emergency shelter (including hotel, motel, or campground paid for �vith emergency shelter voucher)
4.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
1 S.
Transitional housing for homeless persons
Permanent housing for formerly hoineless persons (such as Shelter Plus Care, SHP, or SRO Mod
Psychiatric hospital or other psychiatric facility
Substance abuse treatment facility or deto� center
Hospital (non-psychiatric facility)
Foster care home or foster care group home
Jail, prison or juvenile detention facility
Rented room, apartment, or house
House you o�vn
Staying or living in someone else's (family and friends) room, apartment, or house
Hotel or motel paid for �vithout emergency shelter voucher
Other
Don't ICnow or Refused
TOTAL Number of HOP�'VA Eligible Individuals (sum of Rows 1 and 5-17)
Total HOP�VA
Eligible Inciividuals
Receiving Housing
Subsidv Assistance
Previous editions are obsolete Page 20 form HUD-40110-D (Expiration Date: 10/31/2014)
c. Homeless Individual Summary
In Chart c., indicate the number of eligible individuals reported in Chart b., Row 5 as homeless who also are homeless Veterans
and/or meet the definition for Chronically Homeless (See Definition section of CAPER). The totals in Chart c. do not need to
eq�ial the total in Chart b., Row 5.
Section 2. Beneficiaries
In Chart a., report the total number of HOPWA eligible individuals living with HIV/AIDS who received HOPWA housing
subsidy assistance (as reported in Part 7A, Section 1, Chart a.), and all associated members of their household who benefitted
fi•om receiving HOPWA housing subsidy assistance (resided with HOPWA eligible individuals).
Note: See definition ofHOPiT'A EliQible Individaral
Nofe: See defi»ition of Ti�af�sgender.
Note: See definition ofBeneficiai•ies.
Data Checlr: The siim of each of the Chcrrts b. & c. on tl�e follolning hi�o pages egtrals tl�e total mrmber of beneficiaries served
ii�ith HOPTVA hoa�sing szrbsidy assistar7ce as deter•mined in Char•t a., Ro1n 4 belo�v.
a. Total Number of Beneficiaries Served with HOPWA Housing Subsidy Assistance
Individuals'and Families Served with HOPWA Housing Subsicly Assistance '
1. Number of individuals with HIV/ATDS �vho qualified the household to receive HOPWA housing subsidy
assistance (equals the number of HOPWA Eligible Individuals reported in Pu�t 7A, Section 1, Chart a.)
2. Number of ALL other persons diagnosed as HIV positive who reside �vith the HOPWA eligible individuals
identified in Ro�v 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 Ro�v 1 and who benefited fi•om the HOP WA housing subsidy
4. TOTAL number of ALL
served with Hous
Subsidy Assistance (Sum of Rows 1,2, &
1
Previous editions are obsolete Page 21 fm•m HUD-40ll0-D (�xpiration 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. ec�uals the total number of beneficiaries reported in Part 7, Section 2, Chart a., Row 4.
HOPWA Eli ible Individuals (Chart a, Row 1)
A. B. C. D. �.
TOTAL (Sum of
Male Female Trans ender M to T 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 Rotii�s 1-4)
All Other Bene�ciaries Chart a, Rows 2 and 3)
A. B. C. D. �.
TOTAL (Sum of
Male Female Trans ender NI to F Trans ender r to M Columns A-D
6. Under 18
7. 18 to 30 ears
8. 31 to 50 years
51 years and
9. Older
Subtotal (Sum
10. of Rows 6-9
Total Beneficiaries Chart a, Row 4
TOTAL (Sum
11. of Ro�vs 5& 10)
Previous editions are obsolete Page 22 form HUD-40ll0-D (�xpiration Date: 10/31/2014)
c. Race and Ethnicity*
In Chart c., indicate the Race and Ethnicity of all beneficiaries receiving HOPWA Housing Subsidy Assistance as reported in
Section 2, Chart a., Row 4. Report the race of all HOPWA eligible individuals in Column [A]. Report the ethnicitv of all
HOPWA eligible individuals in column [B]. Repoi�t the race of all other individuals who benefitted from the HOPWA housing
subsidy assistance in column [C]. Report the ethnicitv 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.
HOP�VA �ligible Individuals All Other Beneficiaries
(A] Race [C] Race
Category [all indrviduals �B� �thnicity �total of [D] Ethnicity
reported in (Also identified as individuals [Also identif7ed as
Section 2, Chart Hispanic or reported in Hispanic or
a., Row 1] Latino] Section 2, Chart Latino]
a., Rows 2 & 3]
I. American India��/Alaskan Native
2. Asian
3. BlacklAfrican America❑
4. Native Ha�vaiiai�/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 Midti-Racial
ll. Column Totals (Sum ofRo�vs 1-10)
Dnta Clreck: Sum of Ro3r 1 L Colwrrn A artd Roro 11 Colunor C eqtrals tlze lotnl �ttnnber HOPTi�A Beneficfaries repor•ted in Part 3A, Seclion 2,
Chart a., Row 4.
*Kefet'ence (data 7'egtrestecf cor7ststenl tl'rtit hon» dUU-t/vot tCace anlJ cr�rruc [�ara nepoi'nng rurn�/
Section 3. Households
Household Area Median Income
Report the area median income(s) for all households served with HOPWA housing subsidy assistance.
Data Cltecic: 77�e total mimbef� of hoarsel�olds served ivith HOPiVA hotrsit�g saibsidy assistance shozrld eqaral Pm•t 3C, Roii� 7,
Colzman b and Part 7A, Section 1, Cl�art a. (Total HOPI�'A Eligible Individzrals Served inith HOPTT�A Hozrsing Sarbsidy
Assistance).
Note: Refer• to http•/%i�it�u� 1�zrdarser• or�/portaJ/datnsets/il/i12010/select Geo�a�Tn� mfr.odn for ii�fornaation oi� ar•ea mediaf�
incorrle i» vour commtmiry. _
Percentage of Area Median Income
0-
area median income (extremely lo�v)
2. I 31-50% of area
3. I 51-80% of area median
4.
(very lo�v)
Total (Sum of Rows 1-3)
Households Served witl� HOP�VA Housing Subsidy
Assistance
Previous editions are obsolete Page 23 form HUD-40110-D (�xpiration Date: 10/31/2014)
Part 7: Summary Overview of Grant Activities
B. Facility=Based Housing Assistance =
Complete one Part 7B for each facility developed or supported through HOPWA funds.
Do not complete this Section foi• pro�rams ori�inallv developed �vith HOPWA funds but no lon�er suppoi•ted with
HOPWA funds. If a facility was developed with HOPWA funds (subject to ten yeais of operation for acquisition, new
construction and substantial rehabilitation costs of stewardship tmits, or three years for non-substantial rehabilitation costs), but
HOPWA funds are no longer used to support the facility, the project sponsor oi• 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, for all
Development Projects, including facilities that were past development projects, but continued to receive HOPWA operating
dollars this reporting year.
l. Pro
2. Capital Development
Name
2a. Project Site Information for HOPWA Capital Development of Projects (For Current or Past Capital
Development Proiects that receive HOPWA Operating Costs this reporting year)
Note: If ainits are scatte��ed-sites, report on t1�em as a group and under type of Facility ivrite "Seattered Sites. "
HOPWA Name of Facility:
Type of Funds Non-HOPWA funds
Development Expended Expended
this operating this operating �if applic�rble)
year year
(i f a licable)
❑ rre��oonsta��tion $ � Type of Facility [Check onlv one box.]
❑ Permanent housing
❑ Rehabilitation $ $ ❑ Short-term Shelter or Transitional housing
❑ Supportive services only facility
❑ Acquisition $ $
❑ Operating $ $
a. Purchase/lease of property: Date (mm/dd/yy):
b. Rehabilitatioi�/Construction Dates: Date started: Date Completed:
c. Operation dates: Date residents began to occupy:
❑ Not et occu ied
d. Date supportive services began: Date started:
❑ Not yet providing services
e. Number of units in the facility: HOPWA-fiinded units = Total Units =
❑ Yes ❑ No
f. Is a waiting list mai��tained for the facility? Ifyes, number ofpar•ticipands on t17e Izst at tTre end ofoperatirrg��ear
g. What is the address of the facility (if different from business address)?
Il. Is the address of the project site confidential? ❑ 3 es, pro�ecl irfornm�ion; CIO ]70l jJlIbI1SI7 I7Sl
❑ No, cmr be nrade arai(ab7e to the pablic
Previous editions are obsolete Page 24 form HUD-40110-D (��piration Date: 10/31/2014)
2b. Number and Type of HOPWA Capital Development Project Units (For Current or Past Capital
Development Projects that receive HOPWA Operating Costs this Reporting Year)
For units entered above in 2a. please list the number of HOPWA units that fulfill the following criteria:
Number Designated Number
for the Chronicaily Designated to Number Energy- Number 504 Accessible
Homeless Assist the Star Complia��t
Rental units constructed
(new) and/or
acquired �vith or svithout
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 oiganization, categorized by the
number of bedrooms per unit.
Note: The nz�mbei• an7its nacry not eqiral tl�e total f�znnber of I�otrseholds se�ved.
Please complete separate charts for each housing facility assisted. Scattej•ed site units may be grouped together.
3a. Checic one only
❑ Permanent Supportive Housing Facility/Units
❑ Short-teim 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.
Hotising Assistance Category: Facility Based Housing ( Output: Number of
a.
b.
c.
d.
e.
f.
Leasing Costs
Operating Costs
Project-Based Rental Assistance (PBRA) or other leased units
Other Activity (if approved in grant agreement) Snecifv:
Adjustment to eliminate dnplication (subtract)
TOTAL Facility-Based Housing Assistance
(Sum Rows a. throu�h d. minus Roti� eJ
Output: Total HOP�VA Funds �xpended during
OneratinE Year bv Project Sponsor/subrecipient
Previous editions are obsolete Page 25 form HUD-40ll0-D (�xpiration 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
Economic Opportunities for
Low — and Very Low-Income Persons
U.S. Department of Housing
and Urban Development
Office of Fair Housing
And Equal Opportunity
OMB Approval No: 2529-0043
(exp. 11 /30l2010)
HUD Fieid O�ce:
Section back of page for Public Reporting Burden statement
1. Recipient Name R Address: (street, city, state, zip) 2. Federal identification: (grant no.) 3. Tota� Amount of Award:
4. Contact Person 5. Phone: (Include area code)
6. Length of Grant: 7. Reporting Period:
8. Date RepoR Submilted: 9. Program Code: (Use separate sheet 10. Program Name:
for each program code)
Part 1: Em lo 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 New Hires Hires fhat 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/Clericai
Construction by Trade (List)
Trade
Trade
Trade
Trade
Trade
' Other List
Total
' Program Codes 3= PubliGindian Housing 4= Homeless Assistance
1= Flexible Subsidy A= Development, 5= HOME
2= Section 202/811 B= Operation 6= HOME State Administered
C= Modernization 7= CDBG Entitlement
Page 1 of 2
8 = CDBG State Administered
9 = Other CD Programs
10 = Oiher Housing Programs
form HUD 60002 (6/2001)
Ref 24 CFR 135
Part II: Contracts Awarded
Construction Contracts:
A. Total dollar amount of ail contracts awarded on the project
B. Total dollar amount of contracts awarded to Section 3 businesses
C. Percentage of the total dollar amount that was awarded to Section 3 businesses
D. Total number of Section 3 businesses receiving contracts
2. Non-Construction Contracts:
A. Total dollar amount all non-construction contracts awarded on the project/activity
B. Total dollar amount of non-construction contracts awarded to Section 3 businesses
0
%
C. Percentage of the totai dollar amount that was awarded to Section 3 businesses � °�a
D. Total number of Section 3 businesses receiving non-construction contracts
Part III: Summary
Indicate the efforts made to direct the employment and other economic opportunities generated by HUD financial assistance for housing
and community development programs, to the greatest extent feasible, toward low-and very low-income persons, particularly those who
are recipients of government assistance for housing. (Check all that apply.)
Attempted to recruit low-income residents through: local advertising media, signs prominently displayed at the project site,
contracts with the community organizations and public or private agencies operating within the metropolitan area (or
nonmetropolitan county) in which the Section 3 covered program or project is located, or similar methods.
Participated in a HUD program or other program which promotes the training or employment of Section 3 residents.
Participated in a HUD program or other program which promotes the award of contracts to business concerns which meet the
definition of Section 3 business concerns.
Coordinated with Youthbuild Programs administered in the metropolitan area in which the Section 3 covered project is located.
Other: describe below.
Public reporting for this collection of information is estimated to average 2 hours per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
This agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB
number.
Section 3 of the Housing and Urban Development Act of 1968, as amended, 12 U.S.C. 1701 u, mandates that the Department ensures that
employment and other economic opportunities generated by its housing and community development assistance programs are directed
toward low- and very-low income persons, particularly those who are recipients of government assistance housing. The regulations are
found at 24 CFR Part 135. The information wili 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 seif-monitoring tool. The data is entered into a database and will be analyzed and distributed. The collection of information
involves recipients receiving Federal financial assistance for housing and community development programs covered by Section 3. The
information will be collected annually to assist HUD in meeting its reporting requirements under Section 808(e)(6) of the Fair Housing Act
and Section 916 of the HCDA of 1992. An assurance of confidentiality is not applicable to this form. The Privacy Act of 1974 and OMB
Circular A-108 are not applicable. The reporting requirements do not contain sensitive questions. Data is cumulative; personal identifying
information is not included.
Page 2 of 2 form NUD 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 lndian housing
programs that receive: (1) development assistance pursuant to
Section 5 of the U.S. Housing Act of 1937; (2) operating assistance
pursuant to Section 9 of the U.S. Housing Act of 1937; or (3)
modernization grants pursuant to Section 14 of the U.S. Housing Act
of 1937 and to recipients of housing and community development
assistance in excess of $200,000 expended for: (1) housing
rehabilitation (including reduction and abatement of lead-based paint
hazards); (2) housing construction; or (3) other public construction
projects; and to contracts and subcontracts in excess of $100,000
awarded in connection with the Section-3-covered activity.
Form HUD-60002 has three parts, which are to be completed for
all programs covered by Section 3. Part I relates to employment
and training. The recipient has the option to determine numerical
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 contracfing, 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 financiai
assistance for housing and community development programs were
directed toward low- and very low-income persons.* A recipient of
Section 3 covered assistance shall submit one copy of this report to
HUD Headquarters, Office of Fair Housing and Equal Opportu�ity.
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 Recipienfs are
required to report to HUD. The report must include
accomplishments of all recipients and iheir Section 3 covered
contractors and subcontractors.
HUD Field Office: Enter the Field Office name .
1. Recipient: Enter the name and address of the recipient
submitting this report.
2. Federal Identification: Enter the number that appears on the
award form (with dashes). The award may be a grant,
cooperative agreement or contract.
3. Dollar Amount of Award: Enter the doilar 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 recipienPs
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: Employment and Training Opportunities
Column A: Contains various job categories. Professionals are
defined as people who have special knowledge of an occupation (i.e.
supervisors, architects, surveyors, planners, and computer
programmers). For construction positions, list each trade and provide
data in columns B through F for each trade where persons were
empioyed. The category of "Other' includes occupations such as
service workers.
Column B: (Mandatory Field) Enter the number of new hires for
each category of workers identified in Column A in connection with
this award. New hire refers to a person who is not on the contractor's
or recipienYs payroll for employment at the time of selection for the
Section 3 covered award or at the time of receipt of Section 3 covered
assistance.
Column C: (Mandatory Field) Enter the number of Section 3 new
hires for each category of workers identified in Column A in
connection with this award. Section 3 new hire refers to a Section 3
resident who is not on the contractor's or recipienYs payroll for
employment at the time of selection for the Section 3 covered award or
at the time of receipt of Section 3 covered assistance.
Column D: Enter the percentage of all the staff hours of new hires
(Section 3 residents) in connection with this award.
Column E: Enter the percentage of the totai staff hours worked for
Section 3 employees and trainees (including new hires) connected
with this award. inciude staff hours for part-time and full-time
positions.
Column F: (Mandatory Field) Enter the number of Section 3
residents that were trained in connection with this award.
Part II: Contract Opportunities
Block 1: Construction Contracts
Item A: Enter the total dollar amount of all contracts awarded on the
projecUprogram.
Item B: Enter the total dollar amount of contracts connected with this
project/program that were awarded to Section 3 businesses.
Item C: Enter the percentage of the total dollar amount of contracts
connected with this project/program awarded to Section 3 businesses.
Item D: Enter the number of Section 3 businesses receiving awards.
elock 2: Non-Construction Contracts
item A: Enter the totai dollar amount of all contracts awarded on the
projecVprogram.
Item B: Enter the total dollar amount of contracts connected with this
project awarded to Section 3 businesses.
Item C: Enter the percentage of the total dollar amount of contracts
connected with this 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 Office of
Fair Housing and Equal Opportunity, at the same time the
performance report is submitted to the program office. The Section 3
report is submitted by January 10. Include only contracts executed
during the period specified in item 8. PHAs/IHAs are to report all
co n tracts/s ubcontracts.
' The terms "low-income persons" and very low-income persons" have
the same meanings given the terms in section 3(b) (2) of the United
States Housing Act of 1937. Low-income persons mean families
(including single persons) whose incomes do not exceed 80 percent of
the median income for the area, as determined by the Secretary, with
adjustments for smailer and larger families, except ihat
�
The Secretary may establish income ceilings higher or lower than 80 percent
of the median for the area on the basis of the Secretary's findings such that
variations are necessary because of prevailing levels of construction costs
or unusually high- or low-income families. Very low-income persons mean
low-income families (including singie persons) whose incomes do not
exceed 50 percent of the median famiiy income area, as determined by the
Secretary with adjustments or smailer and larger families, except that the
Secretary may establish income ceilings higher or lower than 50 percent of
the median for the area on the basis of the Secretary's findings that such
variations are necessary because of unusuaily 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
Official site of the City of Fort Worth, Texas
FoR� F�
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 Development Block Grant, HOME Investment
Partnerships Program, Emergency Solutions Grant and Housing Opportunities for
Persons with AIDS Grant Programs, Authorize Collection and Use of Program Income,
Authorize Waiver of Application of Indirect Cost Rates, Authorize Execution of Related
Contracts and 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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necessary 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
Transpo�tation 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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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 aTfordable 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
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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:
Community 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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r-
� TOTAL CDBG Contracts �
*REACH will be funded from the CDBG Housing Programs budget.
Housinq O�portunities 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
TOTAL 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
These programs are available in ALL COUNCIL DISTRICTS.
FISCAL INFORMATION/CERTIFICATION:
The Financial Management Services Director certifies that upon approval of the above recommendations,
adoption of the attached appropriation ordinance and receipt of grant funds, funds will be available in the
current operating budget, as appropriated, of the Grants Fund.
TO Fund/Account/Centers
GR76 451727 017206650XXX
�6,079.622.00
GR76 5XXX)CX 017206650XXX $6,079.622.00
GR76 451727 017206653XXX $425.325.00
GR76 5XXXXX 017206653XXX
GR76 451727 017206654XXX
GR76 5XXX)CX 017206654XXX
GR76 451685 017206650XXX
GR76 5XXX)CX 017206650XXX
$425.325.00
$911,655.00
$911,655.00
$50,000.00
$50.000.00
FROM Fund/Account/Centers
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�
GR76 451685 0172060651XXX
G R76 5XXX)(X 017206651 XXX
GR76 451727 017206651XXX
GR76_ 5XXXXX
017206651XXX
$250,000.00
$250.000.00
$1 996,541.00
$1,996,541.00
Submitted for City Manager's Office bv:
Originating Department Head:
Additional Information Contact:
Fernando Costa (6122)
Cynthia Garcia (8187)
Robert Sturns (8003)
Leticia Rodriguez (7319)
ATTACHMENTS
17HUDACTPLANPY13-14 A013 _V_G_(1).doc
2013-18ConPlanMemo HED6.4.13CG.pdf
ActionPlan 2013-14 funding recommendations.pdf
List of Selected Street for Action Plan 2013.pdf
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8/21/2013