HomeMy WebLinkAboutContract 58023 CSC No. 58023
LOW INCOME HOUSEHOLD WATER ASSISTANCE PROGRAM
WATER PROVIDER AGREEMENT
PURPOSE.The purpose of the Low Income Household Water Assistance Program ("LIHWAP")Water Provider Agreement
("Vendor Agreement") is to provide a grant for emergency assistance to low-income households, particularly those with
the lowest incomes that pay a high proportion of household income for water, storm water, drinking water,
wastewater/sewer,and groundwater services,said services herein collectively referred to as"Water Services".
The Water Services Provider identified below, agrees to the terms of the LIHWAP grant and to accept payment from
LIHWAP agencies only for eligible LIHWAP clients to whom Vendor continues to provide Water Services. The Water
Assistance Provider identified below, agrees to make payments only for eligible LIHWAP clients.
PARTIES.This Vendor Agreement Is by and between:
Water Assistannc(e� Provider("Agency")
Water Services Provider("Vendor")
The Agency and Vendor are each a party to this Vendor Agreement and herein each referred to as"Party"or collectively
referred to as"Parties".
SEREVICE AREA.Vendor and Agency agree to assist eligible LIHWAP clients In the following Texas counties:
:TCLE
WATER SERVICES. Water Services provided and billed by Vendor:
C9 Water Fees
ID Stormwater Fees
Wastewater
Sewer Fees
❑ Groundwater Fees
❑ Other:_(:kaCbp9
TERM.This Vendor Agreement shall be effective from_J u 20 and shall terminate on the
earlier date of jor September 30, 2023. Either of the Parties may terminate this Vendor Agreement by
written notice.Such written notice of termination shall not affect any obligation by either of the Parties incurred prior to
the receipt of such notice.
NOTICE. Notice shall be sent via certified mail to the addresses below with return receipt requested.
Vendor Lusk c- �PS'o iLs- Pr
(Vendor Name)
n pfl l� (YY�.�1 �� t`C,ttc1, - �a.C e
(Vendor Mailing Address)
O
(Vendor Certificate of Convenience and Necessity# ("CCN"))
OFFICIAL RECORD
CITY SECRETARY
1 June FT.WORTH, TX
Aaency' C 1 A:�j c-4 �4, `)e r V I I -P t
(Agency Name) n bZ 5+ t \-� -1 t -1 G 16a
(Agency Mailing Address) l
AGENCY REPRESENTATIONS.The Agency represents and warrants to Vendor that it is an entity under contract with the
Texas Department of Housing and Community Affairs,a public and official agency of the State of Texas("TDHCA")and as
such is authorized and has received funding from the TDHCA to provide bill payment assistance service for eligible LIHWAP
clients. In addition,the Agency further represents and warrants to Vendor that it has determined eligible LIHWAP clients
to be eligible under the LIHWAP guidelines. The funds will be used to cover and/or reduce arrearages, rates and fees
associated with reconnection, or prevention of disconnection of service, and to pay either partially or in full an eligible
LIHWAP client's current due water bill, known as"Eligible Costs" related to Water Services.
VENDOR'S REPRESENTATIONS.The Vendor represents and warrants that it will apply any payments received from Agency
to the eligible LIHWAP client's account related to Eligible Costs.
AGENCY AND VENDOR ACKNOWLEDGEMENT. Both Parties acknowledge that this Vendor Agreement and the services
provided by the Vendor are governed by and subject to the federal and state laws and regulations in accordance with the
LIHWAP.
Both Parties acknowledge that TDHCA may select other entities to serve LIHWAP clients in the identified Texas Counties,
and that Vendor shall not refuse to enter into other Agreements with these entities because of the existence of this Vendor
Agreement.
AMENDMENTS.Any and all amendments to this Vendor Agreement shall be in writing, approved by TDHCA,and agreed
upon by both Parties.
VENDOR'S RESPONSIBLITIES.Vendor will,with reference to an eligible LIHWAP client:
• Provide the Agency with at least one designated contact person who shall be available to respond by telephone
and email to all reasonable inquiries regarding eligible LIHWAP clients and client accounts including but not
limited to bills, payments,and services.
• Provide water services to each eligible and approved household for which payment is provided under LIHWAP.
• Extend the potential LIHWAP application for water services for up to ten calendar days while the Agency
determines whether the potential LIHWAP applicant Is eligible pursuant to the LIHWAP.
• Upon accepting payment from Agency for the eligible LIHWAP client,continue or restore water services to eligible
LIHWAP with no increases in charges,service charges,or other charges or fees affecting the total cost of the bill,
except for Increases approved by the Water Provider's governing body applicable to all Water Provider's
customers.
• In the event the Agency requires the eligible LIHWAP client to pay a portion of the bill prior to having a pledge
made on their account on or before the disconnect date,nothing in this agreement requires the Vendor to delay
a disconnect if the eligible LIHWAP client has not paid their required portion.
• Invoice the eligible LIHWAP client in accordance with Vendor's normal billing practices.
2 June 2022
• Upon verbal or written request from Agency,provide at no cost to the Agency the eligible LIHWAP client's billing
and usage history for previous twelve(12)months,or available history plus monthly estimates If less than twelve
(12) months of billing history and usage is available. Vendor will transmit such billing history via electronic mail
or facsimile as soon as possible, but no later than forty-eight hours following the request.
• Work with Agency and eligible LIHWAP client to explore the feasibility of offering flexible payment arrangements
that may include, without limitation, waiving security deposits, reconnect fees, application fees, and all other
fees whenever possible.
• Not discriminate against eligible LIHWAP client in price or services,including the availability of deferred payment
plans, level or average payment plans,discount, budget,advance payment or other credit plans.
• Not refuse to provide water service or otherwise discriminate in the marketing and provision of water service to
any eligible LIHWAP client because of race,creed,color, national origin, ancestry,sex, marital status,age, lawful
source of income, level of Income, disability, financial status, location of client in an economically distressed
geographic area, or qualification for low-income or water-efficiency services.
• Allow Agency thirty(30)days from the date of pledge for assistance payment to forward payment to the Vendor.
Vendor agrees not to consider the portion of the eligible LIHWAP client's account to be paid by the Agency
delinquent If said payment is received within the above mentioned thirty(30)day period,and Vendor Is provided
with a verbal or signed pledge from the Agency within thirty(30) days of identifying an eligible LIHWAP client.
• Not interrupt service if eligible LIHWAP client is eligible under other state agency regulations(as applicable),and
enters into an agreement with the Vendor concerning how the eligible LIHWAP client will pay the balance owed
Vendor and the eligible LIHWAP client is meeting the obligation under such agreement.
• If the Agency has paid for an initial deposit or similar refundable instrument, upon the termination of service to
the eligible LIHWAP client,the Vendorshall return funds Including interest(after any balance owed)to the Agency
in accordance with 10 Texas Administrative Code§6.312(f)(as applicable).
• Not apply LIHWAP payments to account balances that have previously been written off or paid with other funds.
• Not apply LIHWAP payments to commercial accounts. LIHWAP payments must only be applied to residential
accounts.
• Clearly enter, on LIHWAP household bills, the amount of LIHWAP payment(s) received in a manner which
Identifies the payment as received from LIHWAP or at least the amount paid by LIHWAP shown as credited.
• Continually maintain accurate records of LIHWAP credit balances and annually reconcile accounts.After one year,
credit balances must be refunded to the Agency, in compliance with LIHWAP Vendor Refund Policies.
• Not exchange the household's credit authorization for cash or give any cash equivalent for excess credit.
• Cooperate with any Federal, State, or local Investigation, audit, or program review. Understand that failure to
cooperate with any Federal, State, or local Investigation, audit, or program review may result in the immediate
disqualification from participation In the LIHWAP.
3 June 2022
• Vendor's application materlals should Include language that authorizes the Vendor to release the applicant's
Information as described below to the Agency,Texas Department of Housing and Community Affairs,Texas State
Auditor's Office,Office of the Attorney General of Texas,U.S. Department of Health and Human Services,the U.S.
Department of Health and Human Services Internal Auditor, or the designee of any of these governmental
agencies.
• Data related to a eligible LIHWAP client's Water Services and payments must be provided within a timeframe
specified by the Agency at no cost and must be provided in the format requested by the Agency.The data must
be provided to the Agency for the purposes of verification, research, evaluation, analysis, and reporting. The
eligible LIHWAP client's signed LIHWAP application will authorize the Vendor to release this information to the
Agency.
AGENCY RESPONSIBLITIES.The Agency will:
• 'Accept written referrals for LIHWAP benefits by the Vendor, and evaluate whether the referral is eligible as an
eligible LIHWAP client.
• Obtain written permission for Agency to request and have access to eligible LIHWAP client information, including
confidential or personal account information, credit and payment history, from eligible LIHWAP client's seeking
Agency assistance. Social Security numbers are not required for the LIHWAP program and may not be disclosed
to Agency.
• Provide to Vendor,at Vendor's request,eligible LIHWAP client's written permission for Agency's access to eligible
LIHWAP client's Information as stated above.
• Review invoice(s) submitted by the Vendor. The Agency may request additional documentation and/or
clarification of charges as needed. No payment will be made without all required documentation/clarification of
charges.
• Not provide payments on behalf of an eligible LIHWAP client to Vendor without having adequate funds to pay
such payments.
• Provide payment to the Vendor after receipt of proper invoices, and any additional required documentation or
clarification,for services rendered pursuant to this Vendor Agreement, upon full compliance by the Vendor with
the terms herein within thirty(30)days.
• Determine if a client is LIHWAP eligible within ten calendar days of contacting Vendor.
• Provide Vendor a list of names, telephone numbers and e-mail addresses of Agency staff designated to make
payments on behalf of the Agency and eligible LIHWAP clients,If requested from Vendor.
• Comply with all relevant state and federal laws and regulations In its implementation of the LIHWAP. Follow all
supplemental terms and conditions as set forth by the U.S.Department of Health and Human Services.The Agency
shall provide notice of any changes or amendments to policies or guidelines for the LIHWAP.
ASSIGNMENT. Agency's obligations under this Vendor Agreement are contingent upon the receipt and availability of
funding by TDHCA under a contract for Water Services by and between Agency and TDHCA. If funding for Water Services
under said contract is not available to make payments to Vendor under this Vendor Agreement, Agency or TDHCA will
notify Vendor in writing within a reasonable time after such fact is determined.Agency shall then assign its responsibilities
under this Vendor Agreement to TDHCA by executing an assignment on a form approved by TDHCA. If an assignment
under this provision is required, the Parties hereby agree to execute any and all Instruments in order to facilitate the
assignment of the Agency's responsibilities to TDHCA under this Vendor Agreement.
4 June 2022
CONFIDENTIALITY. The terms of any confidential transaction under this Vendor Agreement or any other information
exchanged by the Agency and Vendor relating to any transaction shall not be disclosed to any person not employed or
retained by the Agency or Vendor, their affiliates, or brokers, except to the extent disclosure is 1) required by law; 2)
necessary to disclose to the other Party in connection with a dispute between the Parties; 3) otherwise permitted by
written consent of the other Party;4) required by guarantors to be disclosed; 5) information which must be disclosed to
a third party to transmit water; 6) to meet reliability council, regulatory, administrative, Judicial, governmental, or
regulated commodity exchange requirements where necessary;or 7) information which was or is hereafter in the public
domain(except by breach of this Vendor Agreement.
June 2022
5
Executed to be effective on pro to Form
City Attor ey's Office
VENDOR: Grand Prairie,Texas
8/19/2022
Authorized Vendor Signature Date
William A Hills Deputy City Manager
Typed Name of Authorized Signature Title
{ 7
972-237-8016
Vendor Telephone Number
Vendor Email Address
AGENCY:
Aug 19, 2022
Authorized Agency Signature Date
Victor Turner Director
Typed Name of Authorized Signature Title
{ i
Agency Telephone Number
Victor.Tu rner@fortworthtexas.gov
Agency Email Address
OFFICIAL RECORD
CITY SECRETARY
6 June FT.WORTH, TX
CITY OF FORT WORTH,TEXAS:
*Victor Turner has been delegated the
proper authority to execute this
document on behalf of the City pursuant
to an Interoffice Memorandum from the
City Manager dated July 20, 2021.
RECOMMENDED:
By: A -9
Sonia Singleton
Assistant Neighborhood Services Director
APPROVED AS TO FORM AND LEGALITY:
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By:
Jessika Williams
Assistant City Attorney I
On
Tann ette S. Gaa 11 Pr�1 f p °°°*° ray
ATTEST: o °O°o°y�
°o oBy: JannetteS.Goodall(Aug24,202216: 0 O
Jannette Goodall °0 °°°° =d
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V T�
City Secretary ��� °°°°°°°° a
�EXASaa
Contract Authorization:
M&C: N/A
Date Approved: N/A No M&C required. Ordinance No. 24161-04-2020
CONTRACT COMPLIANCE MANAGER:
By signing below, I acknowledge that I am the person responsible for the monitoring and administration of
this contract, including ensuring all performance and reporting requirements.
A
Sonia Singleton
Assistant Neighborhood Services Director
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
7 Revised July 2022
Form Request for Taxpayer Give Form to the
(Rev.October2018) Identification Number and Certification requester. Do not
Department of the Treasury send to the IRS.
Internal Revenue Service ►Go to www.irs.gov/FormW9 for Instructions and the latest Information.
1 Name(as shown on your Income tax relum).Name Is required on this line;do not leave this line blank.
City of Grand Prairie
2 Business name/disregarded entity name,if different from above
y 3 Check appropriate box for federal tax classification of the person whose name Is entered on line 1.Check only one of the 4 Exemptions(codes apply only to
cr following seven boxes. certain entities,not Individuals;see
co
a instructions on page 3):
o [:1Indlvldual/sole proprietor or El Corporation El Corporation El Partnership ElTrust/estate
ai a single-member LLC Exempt payee code(if any) 3
+ ❑ Limited liability company,Enter the tax classification(C=C corporation,S=S corporation,P=Partnership)►
o Note:Check the appropriate box In the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting
rn LLC If the LLC Is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC Is C
'C another LLC that Is not disregarded from the owner for U.S.federal tax purposes.Otherwise,a single-member LLC that code(II any)
a u Is disregarded from the owner should check the appropriate box for the tax classification of Its owner.
?E
y ❑✓ Other(see Instructions)► Municipality (wpuestoaccamram,ml3modomsidetneus.)
to 5 Address(number,street,and apt,or suite no.)See instructions. Requester's name and address(optional)
300 West Main Street
6 City,state,and ZIP code
Grand Prairie TX 75050
7 List account numbers)here(optional)
Taxpayer Identification Number(TIN)
Enter your TIN In the appropriate box.The TIN provided must match the name given on line 1 to avoid Social security number
backup withholding.For Individuals,r this this is generally your social security number(SSNr.However,for a —m _
resident alien,sole proprietor,or disregarded entity,see the instructions for Part I,later.For other
entitles,it is your employer Identification number(EIN).If you do not have a number,see Now to get a
TIN,later. or
Note:If the account is in more than one name,see the instructions for line 1.Also see What Name and I Employer Identification number
Number To Give the Requester for guidelines on whose number to enter.
M75 — 6 0 0 0 5 M43
-
Certification
Under penalties of perjury,I certify that:
1.The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be Issued to me);and
2.1 am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Intemal Revenue
Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am
no longer subject to backup withholding;and
3.1 am a U.S.citizen or other U.S.person(defined below);and
4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting Is correct.
Certification instructions.You must cross out item 2 above If you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all Interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage interest paid,
acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments
other than Interest and dividends,you are not required to sign the certification,but you must provide your correct TIN.See the instructions for Part 11,later.
Sign U.S.person // � �� - Date► 01/21/2022
Here U.S.person► .L---L� g ��
General Instructions •Form 1099-DIV(dividends,Including those from stocks or mutual
funds)
Section references are to the Internal Revenue Code unless otherwise .Form 1099-MISC(various types of income,prizes,awards,or gross
noted, proceeds)
Future developments.For the latest Information about developments .Form 1099-B(stock or mutual fund sales and certain other
related to Form W-9 and its Instructions,such as legislation enacted transactions by brokers)
after they were published,go to www.irs.gov/FormW9.
•Form 1099-S(proceeds from real estate transactions)
Purpose of Form •Form 1099-K(merchant card and third party network transactions)
An Individual or entity(Form W-9 requester)who Is required to file an •Form 1098(home mortgage Interest),1098-E(student loan Interest),
Information return with the IRS must obtain your correct taxpayer 1098-T(tuition)
identification number(TIN)which may be your social security number .Form 1099-C(canceled debt)
(SSN),individual taxpayer identification number([TIN),adoption .Form 1099-A(acquisition or abandonment of secured property)
taxpayer Identification number(ATIN),or employer identification number
(EIN),to report on an information return the amount paid to you,or other Use Form W-9 only If you are a U.S.person(including a resident
amount reportable on an Information return.Examples of information alien),to provide your correct TIN.
returns Include,but are not limited to,the following. If you do not return Form W-9 to the requester with a TIN,you might
•Form 1099-INT(interest earned or paid) be subject to backup wlthholding.See What is backup withholding,
later.
Cat.No.10231X Form W-9(Rev.10-2018)