HomeMy WebLinkAboutContract 46158STATE QF TEXAS
COUNTY OF TARRANT
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This cantract ("Cantract") is made and entered into by and between the City of Fori
Worth {hexeafter "City"} and Presbyterian Night �helter (hereafter "Agency"), a Texas ��n-
profit corporation. City and Agency may be refet�red to individually as a"Party" and jointly as
"the Parties".
The Parties state as follows:
WHEREAS, City receives grant monies from the United �tates Department of Housing
and Urban Development through the Community Development Block Grant ("CDBG")
Prograrn, Frogram No. B-14-MC-4$-�010, Catalog of Federal Damestic Assistance No. 14.218;
WHEREAS, a natianal objective of the CDBG program is ta benefit benefit low and
moderate income citizens in accordance witli 24 CFR Part 57Q,200 (a){2};
WHEREAS, Agency submitted a proposal to use CDBG funds for an eligible pxogram
under Y.he CDBG Regulatians whereby Agency will p�ovide services to low and moderate
income City citizens;
WHEREAS, City citizens, the Com�unity D�velopment Council, and the City Council
have determined tiiat CDBG programs are need�d by the City's citizens.
NOW, THEREFORE, the Parties understand and agree as follows:
1. INCORPORATION OF RECITALS.
City and Agency hereby agree that the reeitals s�t forth above are true and correct and
form the basis upon which the Parties have enfered into this Contract.
2. I��`IiYITIONy�
Tn addition to terms defined in the body of this Contract, the terms set forth below shall
have the defi�i�ions ascribed to them as follows:
Area Median Income o� ANII mean� �he median �arnily income for the Fart Worth-Arlington
metrapolitan statistical area as established annua.11y by HiJD. The 2014 income limits are
attached hereto as Exhibit "A�1" — 2014 HIID Income Limits.
Business Diversiiy Enterprise Orclinance ar SDE means the City's Susiness Diversity
Ordinance, Ordinance No. 2Q020-�2-2�11.
CDBG means Community Development B1ock Grant.
CDBG PSA CONTRACT 2014-2015
Presbyterian Night Shelter
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Cornpie�e Documentation means the following documentation as applicable:
o Attachments I, II, and III, with supporting documentatian includ'zng:
o Praof of expense: copies of timesheets, invoices, leases, service contracts
or other documentation showing ihat payment is due by Agency.
o Proof of �ayment: cancelled checks, bank statemenis, or wire transfers
necessary ta demonstrate that arnounts due by Agency were actually paid
by Agency.
o Proof of client eligibility: (i) �ource Documentation sufficient to show
that clients participating in the Program are CDBG Eligihle Clients; ar (ii)
documentation other than Source Documentatian to show that clients
serv�ed. by the Progxam are CDBG E3igible Clients.
a Complete Documentatian shal_l meet �he sta�daxds described zn the attached
Exhibit "F" � Standards for Co�nplete Documentation.
Any other doc�ment ar record reas�nably necessary to verify costs spent and
client eligibility for the Pragram.
CDBG Eligible Client means a client whos� annual income adjusted for family size does nai
exceed �0% of AMT using xhe most current HUD Incozr�e Guidelines and Teahnical Guidance
for Determining Income and A1lowance� �erified by either Source Documentation or the forrn in
Exk�ibit "E" � Form of Income Self-Cert'�f'ication. Agencies Serving 100% ClienteIe must
follow the requirements set forth in Section 6.13.
CDBG Funds means the CDBG grant funds supplied by City �o Agency under the terms of this
Contract.
CDBG Regulations means regulations found at 24 CFR Part 570 et seq.
DBE means disadvantaged business enterprise in accordance with 49 CFR Part 26.
Directo�r means the Director of the City's Housing and Economic Development Department.
Effective Date means October 1, 2014.
HED Department means the City's Housing and Economic De�elopment Department.
HUD means the United States Department of Housing and Urban Development.
IDIS means II[TD's Integrated Disbursement Information System.
National Objective means at least �1% of the clients served under this �antract must have
incomes at or belo�cnr SO % of AMI in accardance with 24 CFR 570.208(a}(2).
Program means the services described in Exhibit `�A" — Program SUmmary.
CDBG PSA CONTRACT 2014-2015 2
Presbyterian Night Shelter
Reimbursement Request means aIi reports and other documentation described in Section 9.
Source Dacumentation rneans any documentation allowed und�r the defuution of annual
incoma in 24 CFR Part 5.609.
Undu�licated Clients means a count of CDBG Eligible Ciients served once in the Cantract
Terrn. CDBG Eligible Clienis served more than once in the Contract Term will only be counted
once when determining tbe number of Unduplicated Clients.
3. TERM.
`The term of this Contract begins on Octob�r 1, 2014 and terminates on Sept�mb�r 30,
2015 unless earlier termi�ated as provided in this Coz�t�act.
4. DUTIES AND RESPONSYBILITIE5 OF CITY.
4.1 Provide CDBG Funda.
City shall p�ovide up to Eighty Two TY�Qusand and 0011 DO Dollars ($82,Q00.00) of
CDBG Funds under the terms and eonditions herein.
4.2 Monitotr.
City will monitor the activities anc� perfor�nance of Agency and any of its contractors,
subcontractors or vendors as necessary, but no less than annually.
5. DUTI�S AND RESPONSISILITIES OF AGENCY.
S.I Repuired Serviees.
Agency sha11 perForm the sezvices descxibed zn Ex�ibi� "A" — Program Snmma� in
accordaz�ce with fihe terms and canditions of this Contract.
5.2 Use of CDBG Funds.
S.2.1.. Comnliance wi�h CDBG Rc�ulations and Contract.
Agency shall be reirnbursed for eligible Program casts with CDBG Funds only if City
determines in its sole discr�tion that:
5.2.1.1 Costs are eligible expenc�itures in accordance with CDBG Regulations.
5.2.1.2 Costs are in compliance with this Contract and are reasanable and
cansistent with indusi�y narms.
5.2.1.3 Complete Documentation is subrnitted to City by Agency.
CDBG PSA CONTRACT 2014-2015 3
Presbyterian Night Shelter
5,2.2 B�rd�et..
5.2.2.1 Agency agrees that CDBG Fund� will be paid on a reimbursernent
basis in aceordance with Earhibxt "B" - Budge#.
5.2.2.2 During the term of this Contract, Agency may submii written requests
to incr�ase or decxease line-item am�unts in the Sudget, including an
explanation of why such inc;reases or decreases are necessary. All
such rec�uest� must be approved by the Director in wri�ing, with such
approval being in the Director's sole discretion. If Director approves
the Agency's praposed Sudget arnendment (as approved, the
"Amez�ded Budget"}, then the Amended Budget will take effect on
the first day of the month following the month in which it was
approved by Director, unless otherwise specified in the amendment.
All requests for Budget am�ndm�nts must be submitt�d by June 1,
�01�.
5.2.3 Chan�e in Pro�ram Budget.
5.23.1 Agency vvill notify City promptly o� any additional �unds it receives
for operation of the Frogram, and City reserves the right to amend this
Contract in such instances to ensure compliance with HUD regulations
governing cost allocation.
5.2.3.2 Agency agrees to utilize funds available under ihis Contract to
supplernent rather than supplant funds otherwise available for use in
the Prflgrarn.
5.2.� Pavment of CDBG Funds ta A�encv.
CDBG Funds will be disbursed to Agency upon City's approval of Agency's wri�ten and
signed Reimbursement Requests including submission af Carnplete Docunnentation to City in
compliance wrth Section 9. If Agency expends aIl funds budgeted for ihe Program priar to
Septernber 20, 2015, City may hold back a small amaunt of the CDBG Funds until the end of the
term. Dur�ng this interim period, Agency must cantinue to submit Reimburseme�t Requests
with an invoiced amaunt af �0. It is expresslq agreed by the Parties that any CDBG Funds either
not spent or no� appraved for reimbursemen� to Agency sha11 remain with City.
CDBG PSA CONTRACT 2014-2Q15 4
Presbyterian Night Shelter
5.3
5.3.1
milestones:
Pro�ram Performance Milestones.
Agency warrants and represents that the Pragram wil� acluev� the following
T.J��d����lit��lec! Glien�� Ek�
��.�e�i�li�ci iii E�;�I�ilrif ``A'`
�DI1�11 L��l$lll�l�Ul'�.`3 — ��`lF�k'illll :`1U111111�11'.�'
� ?7.Z%% � 1.2, %°%o
6 54.54% 54.54%
8 72.72% 72.72%
I1 100% 1�0%
5.3.2 Failur� of Ag�ncy to meet these milestones or a material de�iation from them as
outlined xn this Section S.3 is a b:reach of thzs Contract. For the purpose of this Section,
"material deviation" shall mean more than 10% lower than the specified goal. In the event o�
�uch breach, City resarves tlie right in its sole option to d�lay or withhold payment of
Reimburseme�t Reque�s, to lower Agez�cy's allacation of CDBG Funds, or to teriminate this
Contract.
5.33 FaiIure to meet at least 80% of its performance rnilestones or serve 950
Unduplicated Clients undex this Cantract w�ill autamatically disqualify Agency for consideration
under the City's Request for Proposals for the 2016-2017 Program Year for Federal grat�t funds.
53.4 Amendments ta performance milestones must be approved by the Director in
writing, wit11 such approval being in the Directar's sole discretion. If Directar approves the
Agency's praposed amended pexfarmance milestones {as appraved, the "Amended
Performance Milestones"), then the Amended Performance Miles�ones will take effect on the
first day of the month folIowing the month in which ii was approved by Directar, unless
oth.exw� se specified in the amen.dment. All requests for amendments to per�azmance miles�ones
must be submitted by June 1, 2015. Natwithstanding the above, any amendments ta
p�rformance milestones shall not reduce the numbers for �erving 950 Und�aplicated Ciients stated
in Section 5.3.3.
5.4 Identifv Pro�ram Exnens�s Paid with CDBG Funds.
Agency will keep accounts and records in such a manner that City may readi�y identify
and account �ar Pragram expenses reimbwrsed with CDBG Funds. These records shall be made
available to City for audit purposes a�d shalI be retained as required hexeundex.
5.5 Meet National Obiective.
Agency certifi�s that the activities carried aut under the Prograrn and this Contract will
meet the National �Jbjective.
CDHG PSA CONTRACT 2014-2Q15
Presbyterian Night 5helter
6. CLIENT ELIGIBIL�TY VER�FICATIQN.
6.1 Client Eligibilitv.
Agency will document the eligibility of a11 praspective clients. Agency will docutnent
clicnt eiigibiiity usin� the specific mefhod described below in Section fi.11 that is apPlicable
to Agency and its Pro�ram. All other s�bsections of this Section G.1 are not ap�licable to
A�ency.
6.1.1 Agencies Servin� a Presumed Benefit Clientel�.
Agency must docurnent tha.t all clients served f�ll under a"presumed benefit" categary as
defined in 24 GFR Part 570. Relevant ca#egories of presumed benefit are: severely disabled
adults, homeless persons, abusec� or n�glected children and yauth or �1derly persons. Eligible
forms of docu�nantation include:
6.1.1.1 5everely Disabled Adults. Written, signed and dated diagnosis from
a licensed tnedical professional. As an acceptabl� alternative, Agency
rnay use the fo:rm attached hereto as Exhibit "H" — Severely Disabled
Certification Form.
6.1.1.2 Homeless Persons. Written, signed and dai�d certifcation from an
autreach worker.
6.1.1.3 Abused or Neglected Children and Yonth. �Vritten, signed and
dated certificaiian from an outreach worker.
6.1.1.4 Elderly Persons. A birth certificate, driver'� license, passpart,
imrnigration card, military identification, or any other state, local,
natianal ar international documentat�on, pxovided it contains current
information about the age or birth of the possessor. The form in
Ext�ibit "E" -- Form of Income Self Certi�cation also requires that
potential client� list their age and certify the valiciity of the information
provided. This may be sufficient but should onty be used as a last
r•esort with an explana�ian in the file case nvtes indicating why the
fQrrnal forms of ver�cation were not ava.ilable. An eld�rly person is
defined as b�ing at lcast 6� ycars of age.
6.1.2 A�encies Servin� a Gen�ral Clientele.
Agency must verify all new clients' income eligi�ility with either Source Documenta�ion
or the forrn attached as Exhibit "E" — Form of Income Seif Certificatian. Agency must use
the annual incnme definitio�. i�n 24 CFR Part 5.609 to establish client incame elzgibility a�d must
use the most curren� H[JD Income Guidelines. All clients' income must be documented, but
only �1% of clients must meet income eligibility requirements described in 24 CFR Part 5.609.
CDBG PSA CONTRACT 2014-ZO 15
Presbyterian Night Sl�elter
6.1..3 A�encies Servin� 100% Clientele.
Agency must verify income eligibility of a11 Unduplicated Clients with Source
Documentation. Saurce Documentatian must be collectad and maintained in Agency files even
if Agency repar�s income eligibility usin.g the form attached as Exhibit "E" — For�n of Tncome
Self Certi�cation.
6.2 Submission of Comnlete Documen�ation.
Ageney musi submit capies of all eligibility verification dacumentation described in
Section 6.1 with At�achinent II� in each month's Reimbursement Request for a11 Und�plicated
Clients served for the first time, and must maintain copies of such documentation as required
under this Contract.
'�. Additional CDBG Reauir�ments.
Agency agrees to comply with all requirerrrents of the CDBG Program as stated in the
GDBG Regulations, including but not limited to the �ollowing:
7.1 Environmental Review.
CDBG Funds will not be paid, and costs cannot be incurred until City has completed an
environmental re�iew as required by 24 CFR Part 58. The �nvirflnmental review may result in a
decision to proceed with, madify, ar cancei �he funding for the Progra.m. Furt�er, Agency will
not undertalce or commit any funds ta physical or choice limiting actions as described in any
applicable Federal regulations. Any violation of this provisian will {i) cause ihis Contract to
te�minate imm�diatel�, and (ii) require Agency to repay CityT the CDBG Funds it has al��ady
received and forfeit any fut-�re payments of CDBG Funds.
7.2 Contract Not Constxtnting Commitment af Funds.
Notwithstanding any provision of this Contract, the Pat�ties agree and acknowledge that
Ykus Coniract does �at constitute a commitment of funds, and tha� suc� comrnihnent of fiinds or
approval may occ�r 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 5$, (ii} approval of
City's 2014-2015 Action Plan, and (iii) receipt by City af a grant agreement from HUD.
7.3 Monitarin�.
7.3.1 Agency understands and agrees that City �vill monitoz the adequacy arnd
timeliness af Agency's performance under the terms of this Gontract as well as its compliance
with the CDBG Regulations. Agency is subject to such monitaring during the terrn of this
Contraci and for � years after the Contract term ends. Agency will provide reports and access to
Pxogra.m files as requested by City duriag this � year pexiod. For pw.poses �f th.is Contract, this �
year period for monitoring is deemed to begin on October l, 2015 and end on September 30,
2024 regardless of whether or not thi� Contract is earlier terminated.
7.3.2 Representatives of City, HiJD, and the United States Carnptraller General shall
have access during regular business hours, upan 48 ha�xrs przor z�atice, to Agency's offic�s and
CDBG P�A CONTRACT 2014-20I S 7
Presbyierian Nighi Shelter
recards pertaining to the use o� thc CDBG Funds, and to Agency's afficers, directors, agents,
empIoyees, contractors, subcontraetors and vendors for the purpose of such monitoring.
7.3 .3 Tn addiiion to viher provisio:�s of this Contract regarding frequency o� manitoring,
City reserves the right to perform desk reviews or on-site manitoring of Agency' S COIX1p�l�11C�
with the terms and canditions of tUis Contract. City shall provide Agency with a written repax�k
of the monitor's fndings aftex each monitoring visit. If the monitoring report notes deficiencies
in Agency's performance, the report shall inciud� requirements for the timely eorrection of said
de�ciencies by Agency. Failure by Agency ta take the acfian specified in the monitoring report
may be cause fox suspensian ar terminaiion of this Contract as pxovided herein.
7.3.4 This Section 7.3 shall be applicable for the Coniract term ar�d for � years
thereafter and sha11 survive the earlier termination or expiratian of this Cantract.
7.4 A�eucv Procure�uent �tandards.
Agency shall comply with ali applicable Federal, state and �ocal laws, regulations, and
ordi�ances for making procurements under this Contract. Agency shall establish procurement
proeedures ta ensure that m�.terials and services are obtained in a cost �ffective manner. When
procuring serviees to be provided �tnder this Contract, A�ency shall cornply at a minimum with
the procurement standards at 24 CFR Part 84.40 through 24 CFR Part 84.48.
7.5 Cost Pri�ncit�les/Cost Reasanableness.
Agency shall administer its use af CDBG Funds in compliance with OMB Cireular
A-122, "Cost Principles for Non-Proft Organizations", as amended from time ta time. The
eligibility o� costs incurred for performance rendered shall be deterrnined in accordance witli
OMB Circular A-122 as supplemented by the provisions of this Confract.
7.6 Accountins Standards.
Agency agrees to comply with OMB Circular A-110, "Uniform Administrative
R�quirements for Grants and A�reements with Institutians of Higher Education, Hospitals anri
other Non-Prafit Organizat�nns", and agr�es to adhere to the accounting principles and
procedures required therein, utilize adequate internal con�rols, and maintain necessaiy supporting
and back-up documentation for aIl costs incurred.
7.7 Uniform Administrative Requirements.
Agency wi11 eomply with the Uniform Administrative Requirements set fortlx in 24 CFR
Part 57.SU2 or a�y reasonably equivalent procedures and requirements that City may require.
7.8 Terms Anplieable to Contractors, Subcontractors and Vendars.
Agency understands and agrees that a11 terms of this Contract, whethe-r regulatary or
othetwise, shall apply to any and all contracto�s, subcontractors and vendors of Agency which
are in any way paid with CDBG Funds or who perfozm any work in connection with ihe
Program. Agency shall cause aIl applicable provisions of this Cant�act ta be included in and
made a pari of any contract ar subcontract executed in the performance o� its obligatians
hereunder including its obligations regarding the CDBG Regulatians. Agency shall monitar the
services and wark performed by its contractors, subcont�•actors and vendars on a regular basis for
CDBG PSA CONTRACT 2014-2Q 15 S
Preshyterian Night Shelter
compiiance with the CDBG Regulations and Contract provisions. Agency must cure aIl
violations of the CDBG Regulations committed by its contractors, subcontractars or vendors.
City maintains the z�ght to insist on Agency's fitll campliance with the terrns of this Contraet and
the CDBG Regulations and Agency is responsible for such compliance xegardless a� whether
actions talfan tQ fulfill the requirernents of this Contract are taken by A�ency or by Agency's
contractors, subcantractors or vendors. Agency acknowledges �liat the provisions of this Section
shaIl sutvive the earlier termination or expiration of this Contract.
7.9 Convri�ht and Patent Ri�hts.
No reports, maps, or other dacumenfs produced in wbole ar in part under this Contract
shall l�e the subject of an application for copyright by ar on behalf af Agency. H[.JD and Ci�.y
shall possess all right� to inveniion or discovary, as well as rights in data, whick� may arise as a
result of Agency's perfortnance under this Contract.
�. R.�CORD KEEPING. $E�ORTING AND DOCUMENTATYON
REOUIREMENTS; ALTDI'I.
8.1 Record Keenin�.
Agency shall maintain a record�keeping systern as part of ifs pe:rfonnance af this Contract
and shall promptly �rovide Gity with copies of any document City deems necessary for the
effecti�e fulfillment o� City's monitoring and evaluation responsibilities. Specifically, Agency
will keep or cause to be kept an accurate record af all actions taken and all fiands spent, with
supporting �nd back-up documentation. Agency will maintain al� records and documentation
related to this Contract for � years after the Contract term ends. If any clairn, litigation, ax audit
is initiated before the expiration of the � year period, �he relevant recards and documentation
must be retained until all such claims, litigation or audits have been resolv�d. For pu�poses of
this Cantract, this � year periad for record retention is deemed to begin on October 1, 2015 and
end on September 30, 2020 regardIess a� whet�er ox nai this Contracf is earlier terminated,
8.2 Access to Recoxds.
Representatives of City, HUD and any duly authorized officials of the �'cderal
government will have full access to, and the right to examine, audit, copy, excerpt and/or
transcribe any af Ageney'� records pertaining to all matters covered by this Contract for � years
atter the Cantract tezm ends. Sucb acces,s sha11 be during regular business hours and upon at
least 4� hours prior notice. For purposes of thits Contract, this � qear pexiod for access to records
is deemed to begin on October 1, 2015 and end on September 30, 2020 regaxdless o£' whether ar
not ihis Contraet is earlier terminated.
8.3 Renorts.
Agency wiIl submit to City all reports and dacumentation described in this Cantract in
such form as City may prescribe. Agency may also be required to submit a final pexforrnance
and/or fmal financial report if required by City at the termination of this Contract in such form
and witl�in such times as Ciiy �ay prescribe. Failure to submit ta City any report or
document�tion described in this Contract �hall be an event of default of this Contract and City
may exercise alI of its remedies for default under this Contract.
CDBG PSA CONTRACT 2014-2015
Presbykerian Night Shelter
$.3.1 AdditionalInfarmation.
Ageney shall provide City with additional in�ormation as rnay be renu�red by state ar
Federal agencies io sulastantia�e Program activities and/or expenditUre eligibility.
8.4 Cha�a�e iva� Repar '� Rec�uirements and Forms.
City retains the right to change reporting requirernents and forms at iis discretian. City
will notify Agency in writing at least 1� days prior to the effeciive date of such change, and the
Parties shall execute an amendment to the Cantra.ct reflecting such change if necessary.
S.5 Audit.
8.5.1 Entities that Exnend $�00.000 or more in Federal Funds Per I'ear.
All non-federal entifies that expend $5D0,000 or more in Federal funds within one year,
regardiess of the source of the Federal aw�rd, must subrnit to City an ann�al audit prepared in
accordance with specific reference to OMB Circular A-133. The a�dit shall cover the Agency's
fiscal years during whioh this Coniract is in force. The audit mus� be prepared by an independent
certified public accountant, be completed within 6 manths following �he end of Y1�e period being
audited and be submittec� to City within 3U days af its completion. Agency's audit certi�'ication
is attached hereto as Exhibit "C" —"Audit Certification Form" and "Andit Requirements".
The Audit Certification Form must be submitted to City prior to or with the first
Reimbursemen�t Request. Entities that expend less t1�an $500,0�0 a year in Federal fuuds ar�
exempt from Federal audit requiremenis for that year, bu# records musi be available for review or
audit by appropriate offcials of the Federal agency, City, and General Accounting Office.
$.5.2 Citv Reserves the Ri�h� ta Audit.
City reserves the rigY�t to perform �n audi� af Agency's Program operations a�d fin.ances
at �ny time during the terrn of this Cont�act and for 5 years after the Cant�act Term ends if City
determines that such audit is necessary %r City's compliance vvith the CDBG Regulations ar
ofiher City policies. Agency agrees to allow access to all pertinent materials as described herein
for such audit. Far purposes of this Contract, this � year pexiod for City audit is deemed ta begin
on Oetober 1, 2015 and end on September 30, 2020 regal•dless of whether or not this Contract is
earlier terminated. If such audit reveals a questioned practice or expenditure, such c�uestions
mu�t be resolved within. 15 business days after notice to Agency of such quesYianed practice or
expenditure. If questions are not resolved within this periad, City reserves the right to wz�hhold
furth�r funding under this Contract andlor any other contracts with Agency. IF AS A RESiTLT
OF ANY AUDIT IT IS DETER1VlINED THAT AGENCY HAS FALSIFIED ANY
DOCi1MENTAT�ON OR MISUSED, MISAPPLIED OR MISAPPROPRIATED CDBG
FUNDS OR SPENT CDBG FUNDS ON ANY INELIGIBLE ACTIVITIES, AG�NC�
AGR�ES TO REIMBURSE CITY TH� AMOUNT OF SUCH MONIES PLUS TIiE
AMOUNT OF ANY SANCTIOl�I�, PEPTALTY OR OTHER CHARGE LEVI�D
AGAINST CITY BY HUD BECAUSE OF SUCH ACT�ONS.
GDBG PSA CONTRACT 2014-2015 10
Presbyterian Night Shelter
9. REIMSURSEMENT REOUIREMEl�TS.
9.1 Der�dline for Submiftins Reimbursement Requests.
9.1.1 Reimbursement Requests shall be received by the City on or before the l a�"
day of t�e month follow�ing the month expenses wer� paid by Agency. For examp�e, the
Reimbursement Request for June expenses must be received by July 1S. In the event the 1§rh
falls on a weekend ar 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 actians outli�ed in Secfion la.l. NOTWITHSTANDING
ANYTHING ABOVE, EXPENSES FOR SEPTEMBER 2015 MUST BE RECE�VED BY
SEPTEMBER �0, �01�. FAILi1RE TO SUBMIT A FINAL REIMBURSEMENT
REQUEST BY SEPTEMBER 20, 2ai� WILL RESIILT IN AUTOMATIC FORFEITURE
OF PAYMENT OF THE SEPTEMBER REIMBIIRSEMENT R�QU�ST.
9.1.2 City will notify Agency by e-mail within 20 calendar days if a Reimbursement
Request is l�cking Complete Documentation or carrections are needed. Agency will have 10
business �.ays fraxn the date oFthe e-z�ail notice to subrnit any requested informaiian ar missing
documentation. Agency will be penalized in t�.e Request for Propasal for th� 2015-2016
Program Year for any notifcations received under this Section. If Agency fails ta submit all the
required information or missing docuxnentation within 30 calendar days from the first e-mail,
Agency shall �arfeit any payments otherwise due that month and failure to submit any requested
information will be considered an event of default as outlined in Section 10.1.2.
9.2 Agency shall provide City with Co�npleie Documentatian and the following
reports as shown in Exhibit "D" Reimburseme�t Forms with each Reimbursement Request:
9.2.1 Attachmeni I — Invoice.
This repart sha1l contain fi�xe atnount requested for reirr�bursement each month, the
cumulative reimbursement requested to date (inclusive of that montl�'s xequest), and must be
signed by an autk�orized signatory of Agency. By signing Attachment I, Agency is certifying
that the casts are valid, aligible, consistent with tha terms and conditions of this Contz�act, and ihe
data contained in the report is trtte and co��r�ct. This report must be submitted even if Agency is
requesting $0 for a particular month.
9.2.2 Attachment II— Exr�enditure Worksheet.
This report shall itemize each expense requested for reimbursernent by Agency and sha11
include the Account carresponding �he expense to a Budget Xi�e item. In order for this report to
be complete ihe following must be submitted:
9.2.2.1 Fox payroll expenses, timesh�ets signed by employees and approved
by superviso:r fox all payrall expenses Iisted. Timesheets must
distinguish between CDBG-fii.nded time and non-CDBG funded time
and reflect actual time spent on CDBG-fi.inded activities. Agency may
noi submit payroll expenses dated 60 days prior to the daYe af the
Reimbursement Request.
9.2.2.2 For non-payroll expenses, invaices for each expense listed with an
CDBG PSA CONTRACT 2014-2015 11
�resbyterian Night Shelter
explanation as to how the invoiced expense pertains to the
Program. Agenc� may not submit invoices dated 6Q days prior to
the date of the Reimbursement Request.
9.2.2.3 Proof that eack� expense was paid by Agency, which proof ean be
satisfied by cancelled checks, wire transfex dacumentation, paid
receipts ar other appropriate banking documentation.
9.2.3 Attachment II� — Clien� Data Renart.
This report shall list each LFnduplicated Client seiv�d during the month along with his or
her dcmographic information. The Client Data Report must eontain a list of all clients served
during the Cc�ntract perzod. In arder for �is repart to be camplete the following must be
submitted:
9.23.1 Documentation of income verification for each Unduplicated Client
the first time he ar she is served, whicb will eith�r be the Source
Documentation described in Section 6.1 ar �he cornp�eted form of
Exhibit "E" - Form of Income Self Certification. AGENCIES
SERVING 100% CLIENTELE MUST FOLLOW THE
R,�QiT[RCMENTS SET FORTH IN S�CTION 6.L1.
9.2.4 Submission of Reiu�bursement Reauesi.
Reimbursement Request� can be mailed or deliver in person to HED Department, 908
Monroe Street, Fart Wortl�, Texas 76102. In addi�zon, Agencies can submit Reimbursement
Requests via email to �► '�riwortht�xaR.�n� but in addition Agency must submit a signed
original of Attachment I and Exhibi� "E" — Form of Income Self-Certi�cation to City by the
deadline in Sectian 9.1.1.
9.3 Withholdin� Pavmcnt.
CTTY HAS NO OBLIGATYON TO MAKE PAYMENT ON ANY
REIMBURSEMENT REQUEST THAT IS NDT RECEIVED BY THE DUE DATE.
Failure to timely submit Reimbursement Requests and Complete Documentation alang
with any reqnired reports shall be an e�ent of default.
10. DEFAULT AND TERNIINATION.
1D.1 Failure to Submit Reimbursemen� Reauest or R�auired Documentation
10.1.1 If Ag�ncy fails to submit a R�imbursement Requcst in accordance with
Section 9, Agency shall be in default o�this Cantract. City will notiFy Agency in writing of such
defauIt and the Agency wiIl have l.0 business days from the date of the written notice ta subnut
such Reimbursement Request �o cure the default. If Agency fa.ils to cure �he default within 5uch
time, Agency shall forfeit any payments otherwise due that monih.
10.1.2 If Agency fails to submit requested information or missing documentation as
set fort� in Section 9.1.2, t�en Agency shall �ozfeit paymez�t due that moz�th and t�e �ailure to
submit sha�l be considered an event of default that shall no� be cured.
CDBG PSA CONTRACT 2014-2015 12
Presbyterian Nighi Shelter
10.1.3 NOTWITHSTANDING THE PROVISIONS OF SECTION 10.I.1 OR
10.1.�, IF AGENCY FAILS TO SUBM�T THC REIMBURS�MENT R�QUEST DUE
SEPTEMBER 20, 2015, OR IF THE SUBMITTED REIMBURSEMENT REQUEST FOR
SEPT�MBER �0, �Ol� IS LATE, INCOMPLETE OR OTHERWISE NOT IN
COMPLIANCE WITH THIS CONTRACT QR THE CDBG REGULATIOl�TS AS
DETERMINED BY CITY IN ITS SOLE DISCRETION, THERE WILL BE NO CURE
PERIOD AND ANY REIMBURSEMENT WILL BE AUTOMATICALLY FORFEITED.
14.1.4 In the event of (i) an uncur�d d�fault under S�ction 10,1.1 or an event of
deiault under 10.1.2 (ii) rnore than 2 instances o� de�ault, cured or uncured, undex these Sections,
City reserves the right at its sole aption to terminate this Contract effective irnmediately upon
written notice of such intent with no penalty or liability to City.
10.1.5 Notwithstanding anything to the contrary herein, City will not be rcquired to
pay any CDBG Funds to Agency during the period that any Reimbursement Request, report ar
documentation is past due or is not in compliance with this Contract or tlie CDBG Regulatians,
or during any period during which Agency is in default of this Contract.
10.1.6 In the event of �ermi_uation under this Seetion 10.1, all CDBG Funds awarded
but unpaid �o Agency pursuant to this Contract shall be immediately farfeited anc� A�eney shall
have na further right to such funds.
10.2 Failure to Maintain Records or Submii Reports and Documentation.
If Agency fails to maintain all records and �iocumentation as required in Section $, or if
the maintained or submitted repart or documentation xs not zn compliance with this Con�act or
the �DBG Regulations as determined bq City in its sole discretion, City will notify Agency in
writing and Agency will have 30 calendar days from the daxe of the written request to obtazn or
recreate the missing records and documentation or submit or resubmit any such report or
docurnentation to City. If Ag�ncy fails to maintain the required reporis or documentation, or
farls �o s�xbmit or resubmit any such xeport or documentation within such time, City shall have
the right to �erminaie this Goniract effective immediately upon written notiee of such intent with
no penalty or liability to City.
I0.2.1 In the event of tezrninatian under this Section 10.2, all CDBG Funds awarded
but unpaid io Agency pursuant to this Contract shall be immediately forfeited and. Agency shall
have no furth�r right to such funds, and any CDBG Funds paid to Agency must be repaid to City
within 34 days af termina�ion. If such CDBG fi�ds are not repaid to City within the 30 day
period, City sha11 exercise alI legal rez�edies ava�ilable undex this Con�ract.
CDBG P�A CONTRACT 2014-2015 13
Pre�byte�-ian Night Shelter
1 U.3 In General.
10.3.I Subject to Section 10,2, a.ud unless specifically provided otherwise in this
Contract, Agenc� shall be in deiault under this Cantrac� if Agency breaches any �erm or
condition of this Contract. In the event that such a breach remains uncured aft�r 30 calendar
days following wriiten notice by City (or such other notice perxod as rnay be specified herein} or,
if Agency has diligently and cantiztuously attempted to cure following receipt af sueh written
notice but reasonabIy requires more than 30 calendar days to cure, as determined by both Parties
muivally azld in good faith, City sha11 ha�e the �ight io eleet in City'S sole discretion to (i} extend
Agency's time to cure, (ii) terminate this Contract effeciive im�nediately upan written notice of
such intent to Agency, or (iii} pursue any tither legal rennedies available tfl City under this
Contract.
10.3.2 City's remedias may include:
10.3.2.1 Dixect Agency to prepare and follow a sehedule of actions for
carrying out the affected activities, consisting of schedules,
timetables and milestnnes necessary to irnpleme�t tl�e affected
activities.
1Q.3.2.2 Direct Agency to es#abiish and follow a management plan that
assigns responsibilities for car�ying out the re�.aedial activzties.
10.3.2.3 Repragram CDBG Funds that have not yet been expended frorn
affected activities to other eligible activities or withhald CDBG
Funds.
10.3.2.4 Any other appropriate action includir�g hut not limited to any
rer�edial action legaIly available such as declaraiory judgment,
specific performance, damages, temporaty or pernlanent
injunctians, termination of this Contract or any oiher conhacts with
Agency, and any o�er available rem�die�.
10.3.3 Tn t�a� ev�nt af termination urider #his �ectio� 10.3, aIl CDBG Funds awaxded
but unpaid ta Agency pursuant to this Contract shall be immediately forfeited and Agency sha.�l
have no further righ� #o such funds, and any CDBG F�ands already paid to Agency must be repaid
to City within 30 days of the termination. Failure to repa� such CDBG Funds within the 30 day
period will result in City ez�ercising all legal reinedies available under this Contract.
10.4 No Funds Disbursed while in Breach.
Agency understands and agrees that no CDBG Funds will be paid to Agency untiX ali
defauIts are cured to City°s satisfaction.
CDBG PSA CONTRACT 2014-2415 14
Presbyterian Night Shelter
10.5 No Comnensation Aiter Date of Termination.
Agency shall not receive a�ty compe�sation for work undertaken af�er the date of the
terrnination.
10.6 Righ�s af Citv Not Affected.
Termination shall nat affect ar termir�ate any of the existing right� of City against
Agency, or which may thereafter accrue beeause af Agency�'s default and this provision shall be
in additian to any and all other rights and remed�es avaiiable to City under the Iaw. Such
terminatian does nat terminate any pravisions of this Cantract that have been expressly noted as
surviving the term or terminatian of the Cont7ract. No delay or omissian by City in exercising
any righ� or remedy available to i� u�der this Conir�ct shall impai� any such right or remedy or
can.stitufie a waiver or acquiescence in any Agency defauli.
10.7 Waiver of �reach Not Waiver of 5ubseauent Breach.
The waiver of a default or breach of any term, eovenant, or condition of this Contract
shall not operate as a waiver of any subsequent default or breach o� the same ar any other term,
covenant or condition hereaf.
10.8 Civil, Criminal and Administr�tive Penalties.
Failure �o perform aIl the Con�ract terms may result in civil, criminal or administrative
penalties, including, but not lirnit�d to those set out in this Contrac�,
10.9 Termination for Cause.
10.9.1 City may term.inate this Cantract in the eve�t of Agency',s default, inability, or
fazlure to perfoxm subject to notice, graee and cure periods. In the event Gity terminates this
Contract for cause, aIl CDBG Funds awarded bu� unpaid io Agency pursuant to this Contract
shall be immediately rescinded and Ag�ncy shall have no further right to such funds and any
CDBG Funds al�eady paid ta Agency must be repaid to City within 3a days of fie�rnination.
Failure to repay such CDBG Funds witYrin 30 days wi11 result in City exercising a11 legal
reinedies available to City under this Contract. AGENCY ACKNOWL�DGES AND
AGREES THAT IF CITY TERMINATES THIS CONTRACT FOR CAUSE, AGENCY
OR ANY AFFILIATES OF AGENCY SFIALL NOT B� CONSIDERED FOR ANY
OTHER CITY CONTRACT FOR CDBG FUNDS FOR A NIINIMUM OF � YEARS
N_�I �ZIA/ �I 11:191 i7_1111 �[1�,���7�,T��;� ��1�
109.2 Agency may ternlinate �s Cant�aci i� City does not provide the CDBG Funds
substannally in accordance with this Contract.
10.10 Termination for Canvenience.
In terminating in accordance with 24 C.F.R. $5.44 this Contract may be terminated in.
whole ar in part only as follows:
10.10.1 By City with the consent of Agency in which case the Parties shall agree upan
�e terminatian candi�ions, xncluding the e�'fective date and in ihe case oipartial termination, the
portion to be terminated; or
CDBG PSA CONTRACT 2,014-2015 15
Pr�sbyterian Night Shelfier
I0.10.2 By Agency upon at least 30 days writt�n notification to City, setting �arkh the
reasons for such termination, the effective date, and 'm ihe case ofpartial termin�tion, the portion
io be terminated. In the case of a partial termination, City may termina�e the Contract in its
entirety if City detet�nines in its sole discretion that the remaining po�rtion. of the Cantrac# to be
performed or CDBG Funds to be spent will �ot accomplish the purpases far which the Coni�•act
was made.
10.11 Dissolution of A�encv Terminates Contract.
This Contract shall terrninate in the event Agency is dissolved or ceases to exist. In the
event of ternunatian wnde:r this Section, all CDBG Funds are subject to repayment andlor City
may exercise all o� rts remedies under this Contract.
10.12 Reversion of Assets.
In the event this Con�ract is terminated with or without cause, aIl asseis acquirad by
Agency with the CDBG Funds ineluding cash, interest payments from loa.ns or ot�erwise, all
autstanding notes, mortgages ox other security instruments, any account� receivable athibutable
to the use of the CDBG Funds, and any real or personal properEy owned by Agency that was
irnproved with the CDBG Funds shall autamatically iransfer to City or to such assign�e as City
rr�ay designate.
11. REPAYMENT OF CDBG FUNDS.
A11 CDBG Funds are subject to repayrnent in the event xhe Program does not meet tk�e
raquirements af this Contract or in the CDBG Regulatiox�s. If Agency takes any actio� that
results in the City being �reyuired to repay all or any nortion of the CDBG Funds to HUD,
Agency agrces it will reimbur�e City far such repayment. If Agency takes any action that
results in City receivin� a�nding from HUD about the Program, whether or not
repayment of all or any porhon of the CDBG Funds is reqUired of City, A�ency agrees� it
will pay City 14% of the CDBG Funds as liquida�ed damages. The Parties a�ee that Ciiy's
damages in the event of either repayment to HL7D being requued ar receiving a fnding from
HUD are uncertain and �ovould be difficul� to ascertain and may include an impact on City's
CDBG grant or other Federal granfi funds, in addition to the finding by H[JD or a ret�uired
repayment of funds to IIUD by City. Therefore, the Parties agree that payment tander this
Section of 10% of the CDBG Funds by Agency to City is liquidated damages and not a penalty.
1�. CHANGE IN N�N�PROFTT STATUS.
Agency �ust provide City with written notification of any cha,nges to its non-profit status
within 15 calendar days of beir�g notifi�d of the change. If the nan-profit statu� of Agency
changes aft�r ihe da�e of this Cantract, Czty may bui is not obligatad to, terminate this Contraet.
City has 30 calendar days to make such determination after receipt of written no�ice fram
Agency and failure to make such deter�nination will constitute a waive�•, In the ev�nt of
termination under this Section 12, all CDBG Funds awarded but not yet paid to Agency pursuant
to this Cantract sha11 be immed�ately re�cinded and Agency sha11 ha�e no further righi to such
£unds. Any CDBG Funds already paid to Agency must be repaid to City within 30 calendar days
of termination under this Section.
cDaG PsA corrr�cT zo i4-Za z s � 6
Presbyterian Nght Shelter
13. SURVIVAL.
Any provision oi this Contract that pertains to auditing, rnonitoring, client income
eligibil'zty, record keeping and reports, City ordinances, or applicable CDBG tequirernents, and
any default and er�farcement provisions nec�ssar� ta en�oxce such pravisions, sha11 survive the
terminati�n of this Con�ract for � years after the Contract term ends and shall be enfarceable by
City against Agency. Far purpases of this Contra.ct, this 5 year period for survival of certain
Contract pravisions is deemed to begin on October 1, 2015 and end on September 30, 2020
regardless of whether or not this Con�ract is earlier termi�ated.
14. GENERAL PROVISIONS
14.1 Agencv an Ind�nendent Contractor.
Agency shall aperate �ereunder as an independent contractor and no� as an officer, agent,
servant ar employee of City. Agency shall have exclusive con#rol of, and the exclusi�ve right to
contral, the details of the work and services perforrned hereunder, and a11 persons performing
same, and sha11 be solely responsible for the acts and ornissions of its officers, members, agents,
servants, empIoyees, contractnxs, subcontractors, vendors, clients, licensees ar inviteas.
14.2 Doctrine of Resnondeat Sunerior.
The doctrine of respondeat superior sha.11 nat apply a� between City and Agency, or its
officers, members, agBI1�S� servants, employees, COritraCtOTS, subcontractars, vendors, C11�T1t5,
licensees or invrtees, and nothing herein shall be construed as creating a parkuership ar joint
enterprise between City and Agency. City daes not have il�e �egal right to control the details of
the tasks performed h�reunder by Agency, xts of�cers, members, agents, employees, contractors,
subcontractors, vendors, clients, licensees ar invitees.
14.3 A�encv Pronertv.
City shall under no circumstances be responsible far any property belonging to Agency,
or its officers, members, agents, employees, contractors, subconiractors, vendors, clients,
licensees or invitees that may be lost, stolen or desiroyed or in any way damaged a.nd AGENCY
HEREBY INDEMNIFIES AND HOLDS HARMLE5S CITY AND ITS �FFICERS,
AGENTS, AND EMPLQYEES FROM ANY AND ALL CLAiMS OR SUITS
PERTA.II�TING TU OR CONNECTED WITH SUCH PROPERTY.
14.5 Religious Or�ani�ation.
No portian af the CDBG Funds shall be used in support of any sectarian or religious
activzty. ��. additian, there must be no religious or membership criteria'for cli�nts of a CDBG-
funded service.
CDBG PSA CONTRACT 2014-2015 17
Presbyterian Night Shelter
14.6 Venue.
Venue shall lie in Tarrant County, Texas for any action, whether real or asserted, at law
or in equity, arising o�.rt of the execution, performance, attempted perfarmance ar
nan-perfoxmance o� this Contract.
14.7 Governin� Law.
This Contract sha11 be go�erned by and construed in accordance with the laws of tlie
S#ate of Texas. If any actian, whe�er real or asserted, at lavv or in equity, arises out of the
execution, perforrnance or nan-perfor�ance of this Co�tract or on the basis of any pravision
herein, for ar�y issue not governed by Federal law, the choice of law shall be the laws of the State
af Texas.
14.8 Severabilitv.
Th� provisions of this Contract ar� severab�e, and if for any reason a clause, sentence,
paragraph ar ather part of this Contract shall b� detertnitL�d to b� invalid by a court or Federal or
state agency, board or cornmission having jurisdictivn aver ihe subject matter thereof, such
invalidity shall not affect o�her provisions which can be given e�%ct without fhe in�alid
provision.
14.9 Written Agreement E�ii�e Contract.
This written instrument and the Exhibits, Attachmenis, and Addendums attached hereto,
which are incorporated by reference and made a par�t of this Contract for all purposes, constitute
the entire agreement by �he Parties concerning the work and servic�s to be performed under this
Contract. Any prior or contemporaneou� oral or written agreemen.t which purports to vaty the
terms of this Contract shall be void. Any arnendments to the terms af this Contract must be in
writzng and e�ecuied by the Parties.
14.10 Para�ranh Headiu�s �nr Re�erence Onl�r, Na Le�al Si�nificance; Nnmber
and Gender. � - � ---�-------- -- -- ---
The paragraph headings contained herein are for convenience in reference to this
Contract and axe not infended to define or to limit th� scope of any pro�ision of this Contract.
When contexi requires, singular nouns and pronouns include tk�e plural and the masculine gandar
sk�all be deeme� 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
fallo�ved by the words "wi�hout limitation".
] 4.1 ] Cumpliance With All Applicable Laws and Re�ulations.
Agency agrees to comply fuily with a.11 applicable laws and regulations that are currently
in effect ar that are herea,fter amended during the pe�ozmazxce of this Contract. Those Iaws
include, bui are not limited to:
➢ CDBG Regulations found in 24 CFR Part 570
➢ Tit1e I of the Hausing and Community Developrnent Act of I974, as amended, {42
USC 5301
➢ Title VI of the Civil Ri�hts Act af I964 (42 U.S.C. Sections 2000d et seq.} including
pro�isions requiring recipients of fed�ral assistance to ensure meaningful access by
CDBG P5A CONTRACT 2014-20I 5 18
Presbyterian Night Sheltez
8
➢
➢
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9
➢
➢
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➢
➢
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person of limited English proficiency
The Fair Housing Act, Title VIII af the Ci�i1 Rig�ts Act o� 196$ (42 U.S.C. Seciions
3601 ei seq.}
ExecuYive Ordexs 11063, 11246 as amended by 11375 and 12�86 and as
supplemented by Department oi Labor regulations 41 CFR Part b0
The Age Discrimination in �mploymeni Aet of 1967
The Age Discrir�ination Act of 1975 {42 U.S.C. Sections b101 et seq.}
The Uruforrn Relocation Assistance and Real Praperty Acquisition Policies Act of
i970 (42 U.S.C. Sections 4601 et seq. and 49 CFR Part 24) {"URA")
Sectiion 504 of the Rehabilitation Act af 1973 (29 U.S.C. Sections 794 e� seq.) and 24
CFR Part 8 where applicable
Nationai Enviranmental Policy Act of 1969, as arnended, 42 U.S.C. Sections 4321 et
seq. ("NEPA") and the related authorities listed in 24 CFR Part 58.
The Clean Air Act, as amended, (42 U.S.C. Sections 1251 et seq.) and the CIean
Water Act af 1977, as amended (33 U.�.C. Sections 1251 et seq.) and the rel�ted
Executive Orcier 11738. In na event shall any amount of the assistance provided
under this Contraci be utili�ed with respect to a faciliiy that has given rise to a
�onviction under the Clean Air Act or the Clean Water Act.
Immigration Refoxm and Cantrol Act of 1486 (8 U.S.C. Sections 1101 et seq.)
specifically including the provisions requixing emplayer verifications of legal status
o� its emplayees
The Americans with Disabilities Act of 1990 (42 U.S.C. Sections 12101 et seq.}, the
Archiiectural Ba�rriers Act of 1968 as amended (42 U.S.C. Sections 4151 et seq.) and
the Uniform Federal Accessibiliiy Sta�daxds, 24 CFR Part 40, Appendix A
Regulations at 24 CFR Part 87 ralated to lobbying, in.cluding the requiremeni that
certificatio�s and disclosures be obtained from a11 co�ered persons
Drug Free Wox�place Acf o� 1988 (41 U.S.C. Sections 701 et seq,} and 24 CFR Part
23, Subpart F
Executive Order 12549 and �4 CFR Pa�rt 5.105(c} pertaining to resirictions on
participation by ineligible, debarred or suspended persons or ez�tities
Section 6002 of the Solid Waste Disposal Act, as amended by the Resaurce
Conservation and Reco�ery Act
➢ Guidelines of the Environrriental Protection A�ency at 40 CFR Part 247
➢ For contracts and subgrants for eonstruction or repair, Copeland "Anti-Kickback" ac�
(18 U.S.C. 874} a� supplemenfed in 29 CFR Part 5
➢ For construction contrac�s awarc�ed by Agency in excess of $2,000, and in excess of
$2,500 for other contracts which invo�ve the employz�►�.ent of inechanics or Iabarers,
Sections 103 and 107 of the Contract Work Hours and Safety Standards Act (40
U.S.C. 327A 300} as supplemented by 29 CFR Part 5
A Lead-Based Paint Poi�oning P;reve�tion Act (42 U.S.C. 4841 et seq.}, as arnended by
the Residential Lead-Based Paint Hazard Reductio�t Act of 1992 (42 U.S.C. 4851 et
seq.) and implerrienting regulations at 24 CFR Part 35, subpaxts A, B, M, �nd R
➢ Uniform Administz�afiian Requirernents of 24 C�'R Part SS
CDBG PSA CONTRACT 2D14-2015 19
Presbyterian Night Shelter
14.11 HUD-Assisted Proiects and Emnlovment and other Economic
�nnortunities; Section 3 Reauirements.
14.11.1 Reauirement that Law Be �uoted in Cavered Co�i �racts. -- Certain
Reauirem�ents Pertai��n� to Section 3 of fhe Housing and Urban
DeveIonment Act of 1968 as Amended (12 U.S.C. Sectians �701 et seQ.)
and its Related Re�ulations a� �4 CFR Part 13�.
If the Prograrn results in the creation af new emplayment, training, or contracting
oppartunities an a contaractor or subcontractor level resulting from the expenc�iture of the CDBG
Funds, Agency shall comply with the following and will ensure that its contractors also carnply.
If the work performed under this Coniract is on a projact assisted under a program providing
direct I��deral fnancial assistance fra�n HLJD, Section 3 af 24 CFR 135.38 ("Section 3"} requires
that the folkowi�g clause, s�iown in italics, be inserted in a11 covered cantracts ("Sectian 3
Clause"):
Section to be c�Uoted in covered contracts begins:
"A. The work to be performed under this coniract is subject to the
requi�ements of Section 3 of Housing and U�ban Deuelopment Act of 196&, a.r
amended, 12 U. S. C. sectio� I701 u(5ection 3}. The pa�rpose of Section 3 is to
ensure ihat employrraent a�ad other econornac oppo�-tuniiies gener�aied by HUD
assisted or hrUD-assisted pr�grcams covet�ed by Seciian 3, shall to the g�-eatest
extent feasihle, be df�ected to low- and very�-low income persons, particularly
persans wha a�e recipients afHUD assistance for housing.
B. The parties to this conl�aci ag�ee to comply with HUD's regulc�tians rn 24
CFR Part 135, which implement Section 3. As evidenced by their execution of
this cont�act, the pa�ties to this contract ce�tify that they a�e urtder no contr�actual
or oiher impedi�raent that would prevent them fi°om conzplying with the Pa�t I35
regtclations.
C. T�ae contractor ag�ees to send to each labo� organizataon or
r�epresentative of wor�e�s with which it has a calleciive bc�gainirxg agreement o�
other unde�sianding, if any, a notice advising the labo� organization o� worker.�'
rep�-esentatives of the contractor's commitments under this Section 3 clause arad
will post copies of the notice in conspicuous places at the wo�k sate whe�e both
employees and applicants for trainirag and employment pasztions can see th�
notice. The notice shall describe the Section 3 pYefe�ence, .shall set , farth
�ninimum nurr�ber� �xnd job ttlle�s sul�ject to hire, availability of app�entice and
training po�itions, the q�alifications fot� each; and the name and locatian of the
pe�son(s) taking applicatia�as for each of the �ositaons; and the ar�ticipcated date
the work shall begin.
D. 7�'he eantractor agrees that it �vill include this 5ectian 3 clause in every
subcontr�act to comply with regulatfon in 2� CFR Part I35, and ag�ees to take
ap�ro�riate actian, as pravided ira an appZicable pr^ovisian af the subcontract or�
in this Section 3 clause, upon finding that the subcontractor is in viodation af the
regulations in 24 CFR Part 135. The contt�actor will not subcontract with any
subcontractor where it has notice o� knowledge th�rt th� subcontractoY has been
CDBG PSA CONTRACT 2014-2015 20
Presbyterian Night Shelter
found in vaolation of �egula�ions in 24 CFR Pa�t 135.
E. T'he contractor will ceYtify that any vacant employme�t positions,
including training positiotas that are filed: (1) afier the cont�actor as selected but.
l�efore the cont�act is execu%d, and (2} with persons other than those to whom the
regulations of 24 CFR Pat-t I35. The cant�acto� �rill not subcont�^act with c�y
subcant�actor where it has natice o� k�aowledge that the subcont�acta� has heen
faund in violation of regulatians in 24 CFR 135.
F. Noncomplianee with HUD's r�egulcrtian in �4 CFR Part 135 snay result in
sanctions, ter�mination af this cont�act far default, and deba�ment or� suspenszon
f�om future HUD assisted contracts.
G. With r�espect to wa�k pe�fo�^rrted in connection with Section 3 cove�ed
Indaan housi�ag assistance, .�ecifon 7(b} of the Inclian Self-Determinaiion and
Education A�sistance Act (25 U.S.C. S�ctinn 450e) also applies ta the wo�-k to be
perfarmed under this Cont�act. 5ection 7(�i� r�equi�es that ta the greatest extent
feasible (i) prefer�ence and apportunities for tt-aanang and employ�nent shall be
given to Indians, and (ii) prefer�ence an the awa�d of cont�acts and subcontract,�
shall be given to Iradian oYganizatzons and Indian-awned Econo�nic Enterpri.ses.
Parties to this contract that a�e subject to the p�-ovasions of Section 3 and Sectian
79b) ag��ee ta comply wath Sectzon 3 to the maximum extent feasible, but nat in
der�ogation of compliance waih Sectian 7(b). "
Section to be quoted in co�ered contracts ends.
14.11.2 At�encv Responsibi�ities for Section 3 Requirements.
City and Agency understand a�d agree �at compliance vv�th the provisions o� Sectian 3,
the regulations set forth in 24 CFR Part 13 5, and a�l applicable rules and orders of IIUD sha11 be
a condxfion of ihe Federal financial assistance provided to �he Program binding upon City and
Agency and fiheir respective succ�ssors, assigns, contractors and subcontractors. Failure to fulfill
these requirements shall subject Agency and its contractors and suhcontractors and their
respective successors and assigns to ihose sanctians specified by the grant agreement tlu•ough
which Federal assistance is provided and to such sanctions as are specified by 24 CF'R Part 135.
Agency's responsibilities include:
14.11.2.1 Implementing procedu�res ta notify S�ction 3 residents and
bu�iness concerns aboui training, employment, and contracting
opportunities generated hy Section 3 covered assistance;
14.11.2.2 Notifying potential contractors working an Section 3 cavered
projects of iheir responsibilities;
14.11.2.3 Facilitat�ng �.e tra.ining and amployment of Section 3 reside�ts and
the award of �ontracts to Section 3 busin�ss concerns;
1�.11.2.4 Assisting and actively coopera�ing with fihe HED Department in
makir�g contractors and subcontractors comply;
14.11.2.5 Refraining from enterin.g iz�to eantracts with contractors that are in
CDBG P8A C�NTRACT 2014-2015 21
Pj•esbyterian Night Shelter
viaiatinn af Section 3 regulations;
14.11.2.6 Dacumenting actians taken to comply with Section 3; and
14.11.2.7 Submitting Section 3 Annual Sumrnary Reports (For�z�. HUD-
60002) in accordance wi�tl� 24 CFR Part 135,90.
1�.11.3 Sec�ion 3 Renorting Reguirements.,
In order to cQmply with the Section 3 requirements, Agency nzust submit the forms
attached hereto as Exhibit "G" � Section 3 Reporfing Forms. �
14.11.3.1 Report ta the City on a quarteriy basis all applicants for
emplo�rnent, and a11 applicants for employment by contractor and
subcontractor. This shall include name, address, zip code, date of
- applicatiQn, and status (hired/not hired) �.s of the date of the report.
14.11.3.2 Advertise available positions ta the public for open competition,
and provide documentation to City with the quarterly re�ort that
demonstrates such open advertisement in t�.e form af printout of
Texas Workforce Comrnis�ion post�ng, copy of taewspaper
advertisement, capy af flyers and li�ting of locations where flyers
were distribuied, and the 1ike.
1�.11.3.3 Repart ta the City on a quarterly basis all contracts awarded by
con�ractor and subcos�tractor. Tbis shall include name of
contractor and/or subcontractor, address, zip code, and amount of
award as of the date of the report.
14.12 Prohibitian A�ainst Di�criminatznn.
14.12.1 Generai Statement.
Agency shall comply in the executian, performance or attempted performance of this
Contract, with all non-discriminatian requiaremenfs af 24 CFR 570.&07 a.nd Chapter 17, Article
III, Division 4— Fai� Housing of the City Code. Agency may not discriminate ag�inst any
person becaus� of race, colar, sex, gender, religion, national origin, f�.milial status, disability or
pexcezved disability, sexual arientation, gender identity, gend�r expression, ar transgender, nor
will Agency permit its officers, members, agents, employees, ar c�ients ta engage in such
discrimination.
Thrs Contract is made and entered inta with reference speciiically to Chapter 17, Article
III, Division 3- Employrs�ent Praciices of fihe City Code, and Agency hereby cavenants and
agrees thai Agency, its officers, member�, agents, employees and contractars, have fiiIly
complied with all provisions of same and that no employee, ar �pplicant for employmen� has
been discrinainated against under the terms of such ordinances by �ither or its off cers, members,
agents, em�loyees or contracfors.
CDBG PSA CONTItACT 2014-2015 22
4'resbyterian Night Shelter
I4.12.2 Na Discrim�nation in Emnlovment durin� the Per�oxmance of This
Contract.
During the performance of this Contract Agency agrees ta tlie following provision, and
will require that its contractors and subcontractors also comply with such provisian by including
it in all cantracts witb its contractors:
[Contractor's, Subcont�acior's a� Vendor's name] will not unlawfully discrimi�ate
against any employee or applicants for employme�t because of race, eolor, sex, gender, religion,
national arigin, famiiial status, disability or perceived disabilit�, se�ual orientation, gender
identity, gender expression or transgender. [Cani�acto�'s, Subcontr^actor�'s or Vendar's
nrxrrae]will ta�e affii�native action to ensure that applicants are hired without regard to race, calor,
sex, gender, religion, national origin, familial status, disability or perceived disability, sexual
orientation, gender identity, gender expression ar transgender and that employees are treat�d
�aarly duz�in.g employmer�t without regard to their race, color, sex, gender, religion, national
origin, familial sta.ius, disability or pexceived disability, sexual orientation, gender identity,
gender expression or transgender. Such action shall include, but not be limited to, th� foIlowing:
employment, upgrading, derr�otion ar transfer, recruitment or recruitment advertising, layoff or
termination, rates of pay or other forms of compensation, and selection for training, including
appreniiceship. [Cont�acto�'s, Subcontractor's a� Yendo�'s name� agrees �a post in conspicuous
places, available to employees and applicants for employment, notices setting forth the
provisions of this nondiscrimination clause.
[Contracto�'.� Sz��ieont�actor'� or TjendoY's name] will, in aIl solicitations or
advertisements for �mploye�s placed by or on behalf of [Contractor's, Subcontr�acta�'s o�
Vendor's nqme], state that all qualified applicants wi11 receive consideration for ennployment
w�ithout regard to race, colar, sex, gender, relxgzon, national origin, familial status, disability or
perceived disability, sexual orientation, gender identity, gender expression ar �ransgender.
[ContYactor's, S2�bcantracto�'s a� Yendo�'s name] covenants that neither it nar any of its
officers, members, agents, employees, or contractors, whil� engaged in performing this Contract,
shall, in connection wi�h the employment, advancement ar discharge of employees or in
connection with the terms, eonditions or privileges of their employYnent, discrirninate against
persons because of their age or because of any disability or perceived disability, excepfi on the
basis of a bona fide occupational qualzfication, retirement plan or sta.tuto�y requirement.
[Cant�actar's, Subconiracto�'s or� Vendo�'s name] further covenants that neither it nor its
afficers, members, ageats, emplayees, contractors, or persons aciing on their behalf, shall
specify, in solicitations or advertisements %r employees to �vork on this Contract, a maximjam
age Iimit for such employment unless the specif ed rziaximum age limit is based upon a bona fide
occupational qualification, retirement plan or statutory requirernent.
14.12.3 A�ez�cv's Cot►tractors and the ADA.
In accordance with the provisions of �kie Americans With Disabili�ies Act of 1990
("ADA"), Agency warra�ts that it and any of its contracta:rs will not unlawfully discriminate on
the basis of disability in ihe provision of services to the general public, nor in the availabiliiy,
terms and/or condxtaons af employment far applican�s for employment wit�, or employees of,
CDBG PSA CONTRACT 2D14-2015 23
Presbyterian Night S�elter
Agency or any of its contractors. AGEI�TCY WARRANTS IT WILL FULLY COMPLY
WITH 'T�� ADA'S PROVIS�ONS AND ANY OTHER APPLICABLE FED�,RAL,
STATE AND LOCAL LAWS C�NCERIVING D�SABILITY AND W`ILL DEFEND,
INDEMNIFY AND HOLD CITY IIARMLES� AGAINST A1�iY CL�MS OR
ALLEGATIONS ASSERTED BY TH1RD PARTIES, COlvTRACT�RS
Si1BCONTRACTORS, VENDURS OR AGENTS AGAINST CITY ARISING OUT OF
AGENCY'S ANDIOR ITS CONTRACTORS', SUBCONTRA.CTORS', VEll�DORS' OR
AGENTS' OR THEIR RESPECTTVE EMPL4YEES' ALLEGED FAILURE TO
COMPLY WITH THE ABOVE-REFERENC�D LAWS CONCERNING DISABILITY
DISCRIMINATION IN THE PERFORMANC� OF THIS CONTRACT.
14.13. Prohibition A�ainst Interest / Conflict of Interest.
1�.13.1 Agency shall establish safeguards to prohibit its ernployees, boa�rd me�nbers,
advisors and agents from using positians for a purpose that is or gives the appearance of being
rnotivated by a desire for privaie gain for thernseives or others, particularly those with whom
they have fam�ily, business or other ties. Agency shall disclose to City atay such confiict of
in�erest or potential conflict o� intexest, immediately upon discovexy of sueh.
14.13.2 No employees, agents, consultants, off cers or e�ected afficials or appointed
officials o� City or af Agency who exercise or have exercised any functions or respansibilities
with respect to activYties assisted with CDBG �unds or who are in a position to participate in a
dccisio�-making process or gain inside information with regard io fhese activities may utilize
CDBG services, may obtain a financial interest or benefit from a CDBG-assisted activity, or
have an interest in any contract, subcontract or agreement with respect thereto, or the praceeds
thereunder, either for themselves ar thase with whom they have family or business ties, during
their tenure ar for 1 year thereaftex, unless they are accepted in accordanee wi�h the procedures
sei forth at 24 CFR 570.611.
14.13.3 Agency affirms tliat it vvill a�ere to the pravisions of the Texas Penal Code
which prohibits bribery and gifts to public servants.
1�.13.� The conflict af interest pro�isions of 24 CFR Part 85.3b and 2� CFR Part
84.42, respectively, shall apply in the procurement of proparty and services by Agency. In all
cases not governed by those Sections, the provisions of 24 CFR 570.611 of the CDBG
Regulatians shall applp.
14.14 Subcont�-acting witl� Small and Minoritv Firms, Women's Business
Enterprises and Labor Surnlus Areas.
14.14.1 For procurernent cor�tracts $50,000.00 or larger Agency agrees to abide by
City's policy to invalve Mi�ority Business Ent�rprises and Srnall Business Enterprises and ta
provide therri equal opportunity to compete for contracts far canstt�uctian, provision of
professional seivices, purchase of equipment and supplies and pxovision a� other services
required by City. Agency agrees to incorporate the City's BDE Ord�nance, and alI amendments
or successor policies ar ordinances thereto, into all contracts and subconhacts for procurement
CDBG PSA CONi'RACT 2014-2015 24
Presbyterian Night Shelter
larger than $SO,OOQ.�Q or larger and will further require aIl persons or enti�ies wi�h which it so
can�racts to comply with said o:rdinance.
14.14.2 It is national palicy to awaxd a fair share of eantracts to disadvantaged
business enterprises ("DBEs"), small business enterprises ("SBEs"), minority business
enterprises {"MBEs"}, and women's business entezprises ("WBEs"}. Accordingly, affirrnative
s�eps must be taken to assure that DBEs, SBEs, MBEs, and WBEs are utiiized when possihle as
sources of supplies, �quipment, construction and services.
14.1 S Othcr Laws.
The failure to Iist any Federal, state ar Czty ordinazice, Iaw or regula�ian that is applicable
ta Agency does not excuse or relieve Agency from the requirements or responsibilities in rega.rd
to following the law, nor from the consequences or penalties for Agency's failure to follow the
law, i� applicable.
14.16 Assignment.
Agency shall not assign all or any part af its rights, privileges, or duties under this
Contract witho�t the prior wrztten approval of City. Any a�tempted assignment of same wiihout
approval shall be void, and shall constitute a breach of this Contract,
14.17. Ri«ht to Ins�ect Agencv Contracts.
It is agxeed that City �as the right to inspect and approve in writing any proposed
contracts between Agency and any contractor or vendor engaged i.zz any activity in eonjunc�ion
with tl�is CDBG-funded Prograrn prior to any charges being incurred.
14.18 Foarce Maicu�rc
If Agency becomes us�able, either in whole nr part, ta ful�ll its obligations under this
Contract due to acis of God, strikes, Iockouts, or other industrial disturbarzces, acts af public
enemies, wars, blockades, insurrections, riots, epidernics, earthquakes, fires, floods, restraints or
prohibitions by any court, boaxd, depa�nent, commission or agency of t�e United States or of
any States, civil disturbances, or explosions, or some other reason beyond Agencq's controi
(col�ectively, "Farce Majeure Event"}, the obligations so affected by such Force Majeure Event
will be suspended only during the cantinuance of such event. Agency will give City written
notice of the existence, e�ten� and nature o� the Farce Majeure Event as soon as reasona�aly
possible after the oecurrence �f �he event. Failure to give notice wi11 xesult in the continuanee of
Agency's obligati�n regardless of the extent of any existing Force Majeure Event. Agency will
use commercially reasonab�e effoxts to reinedy its inability to perforrn as soon as possible.
1�. INDEMNIFICATION AND R�LEASE.
AGENCY C�V�NANTS AND AGREES TO INDENiNIFY, HOLD HARNIL�SS
AND D�F�ND, AT ITS OWN EXPENSE, CITY AND ITS OFFICER�, AGENTS,
SERVANTS AND EMPLOI'�ES FROM AND AGAINST ANY AND ALL CLA1M5 OR
SU�TS F�R PROPERTY LOSS OR DAMAGE ANDIOR PERSONAL INJURY,
YNCLiIDING DEATH, TO ANY AND ALL PERSOl�TS, OF WHATSOEVER KIND OR
CHARACTER, WHETHER REAL OR AS�ERTED, ARISiNG OUT OF OR IN
CDBG PSA CONTRACT 2014-2Q15 25
Presbyterian Night Shelter
CONNECTION WITH THE EXECUTION, PERFORMANCE, ATTEMPTED
PERFORMANCE OR NONPERFORMANCE �F THIS CONTRACT AND/OR THE
OPERATIONS, ACTTVITYES AND SERVICES OF THE PR�GRAM DESCRIBED
HEItEIN, WHETHER OR NOT CAUSED TN WHOLE OR IN PART, BY ALLEGED
N�GLIGENC� OF OFFICERS, AGENTS, SERVANTS, EMPL�YEES,
CONTRACTORS OR SUBCONTRACT�RS �F C�TY; AND AGENCY HEREBY
ASSUMES ALL LIABILITY AND RESPONSIBILITY OF CITY AND ITS OFFICERS,
AGENTS, SERVANT5, AND EMPLOY�ES FOR ANY AND ALL CLAINIS OR SUIT�
FQR PROPERTY LOSS OR DAMAGE AND/OR PERSONAL INJURY, INCLUDII�G
DEATH, TO ANY AND ALL PER�ONS, OF WHATSOEVER KINI)S OR
CHARACTER, WHETAER REAL �R ASSERTED, ARISING OUT OF OR IN
CONNECTION WITH THE EXECUTION, PERFORMANCE, ATTEMPTED
PERFORMANCE �R NONPERFORMANCE OF THIS CONTRACT ANDIOR THE
OPERATIONS, ACTIVITIES AND SERVICES OF THE PROGRAM DESCRIBED
HEREIN, WHETHER OR NOT CAUSED IN WHOLE �R IN PART BY ALLEGED
NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES,
CONTRACTORS OR SUBCONTRACTORS OF CITY. AGENCY LIKEWISE
COVENANTS AND AGREES TO AND DOES HEREBY INDEMNYFY AND HOLD
FIARMLESS C�TY FROM AND AGAINST ANY AND ALL INJURY, DAMAGE OR
DESTRUCTION OF PROPERTY OF CIT'�, ARIS�NG OUT OF OR IN CONNECTION
WITH ALL ACT� OR OMIS�IONS OF AGENCY, ITS OFFICERS, M�MBERS,
AGENTS, EMPLOY�ES, CONTRACTORS, SUBCONTRACTORS, IN VITEES,
LICENSEES, OR CLIENTS, OR CAUSED, IN WHOLE OR IN PART, BY ALLEGED
NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES,
CQNTRACTORS OR SI7BCOl�TTRACTORS OF C�TY.
IT IS TI� EXPRESS INTENTI�N OF THE PARTIE�, BOTH AGENCY AND
CITY, THAT TI� IND�MNITY PROVIDED FOR THIS SECTION INCLUDES
INDEMNITY BY AGENGY TO INDEMNIFY AND PROTECT CITY FROM THE
CONSEQUENCES OF CiTY'S OVVN NEGLIGENCE, WHETHER THAT
NEGLIGENC� IS ALLEGED TO BE THE SOL� OR CONCURRING CAUSE OF TAE
�N.TURY, DAMAGE OR DEATH.
AGENCY AGREES TO AND SHALL RELEAS� CITY, ITS AGENTS,
EMPLOYE�S, OFFICERS AND LEGAL R�PRESENTATIVES FROM ALL
L�ABILITY FOR INJURY, DEATH, DAMAGE OR L�SS TO PERSONS OR
PROPERTY SUSTAINED IN CONNECTION WITH OR INCIDENTAL TO
PERFORMANCE UNDER THIS C�NTRACT, EVEN IF THE TNJURY, DEATH,
DAMAGE OR LOSS IS CAUSED BY CITY'S SOLE OR CONCURRENT
NEGLIGENC�.
AGENCY SHALL REQUIRE ALL OF ITS CONTRACTORS AND
SUBCONTRACTORS TO INCLUDE IN THEIR CONTRACTS AND SUBCONTRACTS
A RELEA�E �ND INDEMNIT� IN FAVOR OF C�TY IN SUBSTANTIALLY THE
SAME FORM AS ABOVE.
CDBG P5A CONTRACT 2014-2Q 15 26
P`resbyterian Night Shelter
16. WAIVER OF IMMUNITY BY AGEli�CY.
I� Agency, as a charita.ble or nonprof t organization, has or claims an immunity or
exemption (statutory or athez�wise} from ar�d agai�st liabi�ity far damages or injury, including
death, to persons or property, Agency hereby expressly waives its rzghts ta plead defensively
such immunity or exemption as against City. This Section shall not be construed ta affect a
gavernmental entity's immunities under constitutional, siatutory or common law.
17. INSURANCE AND BONDING.
Agency will ma.intain coverage in the form of insurance or bond in the amount a�
$2,000.00 to insure against loss frorn �he fraud, thef� ar dishonesty of any of Agency's off cers,
agents, trustees, directors ar employees. The proceeds of such insurance or bond shall be used to
reimburse City for any and all loss of CDBG Funds occasioned by such miscanduct. To
ef�ectuate sucl� reimbuxse�nent, such fidelity coverage shall include a rider stating that
reimbursement for any lo�s or losses shall z�ame the City as a Loss Payee.
Agency sha11 furnish to City in a timeiy manner, but not later thar� the EfFective Date,
certif cat�s af in�uranc� as proof that it has secured and paid for policies of coznmercial
insurance as specified herein. If City has not received such certificates by the Effective Date,
Agency shall be in defauIt oi�he Con.tz�act and Cxty may, at its option, terminate tha Con�t•act.
�uch insuranee sha1l cover a11 insurable risks incident to or in connection with the
execution, per�or�ma.nce, attempted performance or nonperformance of this Gontract. Agency
shall maintain, the following coverage and Iimits thexeaf.
Commercial General Liabilitv �CGL� Insurance
$500,�00 each accurrence
$I,OOO,OOQ aggregate li�it
Non-Profit Or�anization Liabilitv or Directors & Officers Liabilitv
$1,00O,OOQ Each Occurrence
$1,OOQ,OOQ Annual Aggregate Limi.t
Business Automabile Liability Tnsurance
$1,400,Ofl0 each accident on a comhined single-iirnit basis, or
$ 250,Q00 Property Da�age
$ 500,400 Bodily Injury per person per occi.u�rence
$2,000,000 Aggregate
Insurance policy shall be endarsed to cover "Any Auto", defined as autos owned, hired,
and nan-awned. Pending avaiiabiliiy oithe above covera�e and at the discretion of
City, the policy shall be the prinnary respondir�g in�urance palicp versus a Personal
auto insurance policy if or when in the course of Agency's business as contracted
herein.
CDBG PSA CDNTRACT 2014-2015 27
Pres6yterian Nigh4 Sl�elter
Work�rs' Com�ensation Insurance
Part A: Statutory Limits
Part B: Employer's Liability
$100,000 each accid�nt
$100,000 disease-each employee
$SQO,D00 disease-policy Iimit
Note: Such insurance shall cover employees pearforming work on any and all projects
including but not Iimited to construction, demolition, and rehabilitatian. Agency or it�
contractors shall maintain coverages, if applicable. In the e�ent the respective contractars
do nat rnaintain coverage, Agency shal! ma.intain the coverage on such CO�l.fi'�C�QT, if
appiicabie, for each applicable contract.
Additional Requirements
Such insurance amaunts shall b� revised upward at City'� reasonable option and no more
frequently ihan once every l.2 months, anc� Agency shall revise such amounts within 30 days
following notice to Contractor of such requirements.
Agez�cy will submit ta City documentation that it has obtained insurance cQverage and has
executed bonds as required in this ContraCt prior ta payment of a.ny monies pro�ided hereunder.
Where applicable, insurance policies required herein shall be endor�ed ta inelude City as an
additional insured as its znterest may app�ar. Additional insured parties shall include employees,
officers, agents, and volunteers o� City.
Any failure an pari of City ta req�est certificate(s) of insurance shall not be construed as a
waiver of such requixement ar as a waiver of the insurance requirements themselves.
Insurers of Agency's insurance palicies shall be licensed to do business in the state of Texas by
the Department of Insurance or be otherwise eligii�le and authorized ta da business in the state of
Texas. Insurers shall be acceptabie to City insofar as their financial sirength and solvency and
each such company shall have a cuxz•ent minim�m A.M. Best Key Rating Guide rating of A-: VII
or oth�r equivalent insurance industry standard rating othezw:'tse appro�ved by City.
Deductible lina.its �n insurance policies shall noi exceed $5,000 per occurrence unless otherwise
approved by Ciiy.
In tl�e e�ent #here are a.ny local, federal or other regulatory insurance or banding requirements for
the Program, a�d such requirements exceed those specified herein, the forrnex shall prevail.
Agency shaIl require its contractoxs to maantain applicable insurance covera�es, limits, and othex
xeq�irements as ihose specified her�in; and Agency shall require it� contractars to provide
Agency with certificate(�) of insurance documentin� such coverage. Alsa, Agency shall require
its contractors to have City and Agency �ndorsed as additional insureds �as their interest may
appear) on their respective insurance policies.
CDBG PSA CONTRACT 20 ] 4-2015 28
Presbyterian Night Shelter
Directars and Ofiicers Liability coverage shall be in force and may be provided on a claims-
rnade basis. Tiiis coverage may also be r�f�rred to as Mana�ement Liability, and shall protect
the insured against claims arising out af alleged errors in judgment, lareaches of duty and
wrongful acts arising out of their organizationai duties. Coverage sha.11 protect not only the
entity, but all pasi, pxesent and future directors, officers, trustees, employees, volunteers and
commiitee members.
18. CERTIFICATION REGARD�NG LOBBYING.
The undersigned xepresentative of Agency hereby certifies, to ihe best o� his or her
knowledge and belief, that:
No Federal apprapriated funds have been paid or will be paid, by or on behalf of Agency,
to any pe:rson far influencing or attEmpting to influence an officer or emp�oyee of any
agency, a member of Congress, an o�f cer or employee of Congress in connection with
the awarding of any Federal contract, the rnaking of any Federal grant, the rnaking of any
Federal loan, �e entering into of arry cooperaiive agreernent and tl�e Extens'ron,
continuation, renewal, arnendment, or mtidification of any Federal cantract, grant, loan or
cooperativa agreement.
If any fi�ds other than fedez�ally appropriated fiands ha�e been paid or will be paid to any
person for influencing or attempting ta influence an officer or emploqee af any ag�ncy,
member of Congress in connection with this Federal coniract, grant, loan or coopexative
agreement, Agency shall complete and submit Standard Form-LLL, "Disclosure Fornn to
Report Lobbying," in accordance with its instructions.
This eertification is a rnatexzal representatio� of fact upon which reliance was placed
when this Contract was made ar entered into. Submission of this certificate is a
prerequisite for rnaking or entering in�o this Con�ract imposed by 31 U.S.C. Section
13�2. Any person w�o �ails to file the required certiftcation shall be subject ta a civil
penalty of not less than $10,000.00 and nat more than $100,000.04 for each such fa�iluxe.
Agency s�a.11 require that the language of this certifieation be ineluded fn all subcontracts
ar agreements involving the expenditure of Federal funds.
19. LITIGATION AND CLAIMS.
Agency shall give City irnmediate noiice in vv�iting of any action, inciuding any
proceeding before an adrninistrative agency, filed against Agency in conj�ctaon with this
Contract or the Program. Agency shall furnish immediately to City copies of a11 pertinent papers
received by Agency with respect to such action or clairn. Agency shall provide a notice �o City
within 10 days upon filing under any bankruptcy or financial insolvency provisxan of 1aw.
CDBG PSA C(3NTRACT 2014-2015 24
Presbyterian Night Sheiter
�o. NoTzc�.
All natices required or �ermitted by �his Coniract must be in writing and are deemed
delivexed on the earlier date of the dafe actually received or the thi�d day following deposit in a
United Sfiates Postal Service post ofFice or receptacle; with proper posiage, certified mail return
receipt requested; and addressed to the other Party at the address set out belaw or at such other
address as the receiving Party designates by proper notice to the sending Party.
Ci :
City Attorney's Office
1000 Throckmorton Street
�'ort Worth, TX 76102
Tel�phone: 817-392-760fl
Copy to:
Housing and Economic Dev�lopment Departm�nt
1Q00 Thrackmortan Street
Fort Worth, TX 76102
Attention: Assistant Director
Telephone : 8 I 7- 3 92-75 40
Copy to:
Housing and Ecanomic Development Depat�trnent
1000 Thr�ckmorton Street
Fort Worth, TX 7G102
Aitenti�n: Program Coordinaior
Telephone: 817-3 92-b� 42
A�encv:
Presbyterian Night Shelter
Toby Owen
2400 Cypress S�'eet
Fort Woxfh, TX 76113
Telephone: 817-53 2-7405
21. AGENCY HAS LEGAL AU 1'HORZTY TO ENTER INTO CONTRACT.
Agency ��epresents that it possesses the legal au�hority, pursuarzt io a�y proper,
apprapriate and o�'icial motion, resoluiion ar action passed or taken, to enter into ihis Contract
and to perform the responsibilities herein r�quired.
�2. COUNTERPARTS.
This Contract may be executed in muitiple counterparts, each of which sha1l be
considered an original, but aIl of which shall constitute one instrument which may be sufficiently
evidenced hy o�e counterpart.
CDBG PSA CONTRACT 20 i4-2015 30
Presbyterian Night Shelter
[SIGNATURES APP�AR ON NEXT PAGE]
CDBG PSA CONTRACT 2014-2015 31
Preshyterian Night Shelter
IN WYTNESS WHEREOF, the Parties hexeto have execu#ed 4 duplicate originals af this
Contract in Fort Workh, T
ATTEST: —
�i� ' +� '��� /
,, �
i
i Secret
M&G: C-26893
Date: August S, 2014
APPR VED AS TO FORM ND LEGALITY:
. , � , ����--
Assistant City A�torney
OF F�RT WORTH
9 ��,� nrbsl+'�"' �-)
emando Costa, Assisfiant City Manager
PRESBYTER��N 1�TIGHT SHELTER
By: ,�i �c�-�
Name: `�a�a y b t,�i � �
�
Title: �/� �
STATE OF TEXAS §
CDUNTY OF TARRANT � �fy
This instrument was acknowledged b�fore me on �V�l� �, `1'j , 2014 by
Fernando Costa, Assistant City Manager of the City of Fort Worth, on be�ialf the City of Fart
Waz�h.
..�-I11,fI11i. � � i� �� � �� i i i .�
: �`� ��,.; LINDA M, HIRF�L{N��A
'"� �"= MY COMMI�SIC}�! EXPIRES -
"'�,.v;,+„�*' F66tuary �, 2010 `
=���-•,�+����.;:a;.�-.. _ _ - a
,- ' ��n�� � � � `� �i,llJ�fi. -f�
Notary Pubhc, State of Texas
STATE OF TEXAS §
COi]NTY OF TARRA�IT §
This inst�ument was aclazawledged before me on C�C"�a3c�-- :�' , 2014 by
� a��' the .�'� of ��arg�P-����.�, a Te�as non-profit
corpo ation, on behalf of said corporation. ���
/ Y��X r 1
���'� �
Notary P�tblic, State o� Texas
t�F'�'I�f� ���M���
�i�'�' ��4�����.'
� ����� ��
CDBG PSA CONTRACT 2014-2015
Fresbyterian Night Shelter
P �
MARTNA J HILL
My Commissfon Expires
� August 31, 2015
� �A1�pF�E'� ,
32
EXHIBITS:
Exhibit "A" —Pro�ram Summary
Exhibit "A-1" — �014 HiJD Yncame Limits
Exhibit "B" — Budget
Exhibit "C" — Audit Certification Form
Exhibit "D" — Reimbursement Forms
Exhibit "E" — Form of Income 5elf-Certification
Exhibit "F" — Standards for Complete Dacuimentation
Exhibit "G" — Section 3 Reporting Forms
Exhibit "H" -- Severely Disabled Certification Form
CDBG PSA CONTRACT 2014-20I 5 33
Presbyterian Night Shelter
PRESBYTERIAN NIGHT SHELTER
Shelter Based Case Management and 5ervices
PROGRA,M SUMMARY
Community Development Block Grant
(CDBC'i)
October 1, 2q14 to September 30, 2015
PERiOD
PROGRAM:
$82,000.00
AMOUNT
The Prograrn will expand case management services for homeless persons in the emergency
shelter, to help them find housing, employrnent, and support services to inerease seif-sufficiency.
GDBG funds wilI be used to pay fox s�Iaries a.nd fringe benefits for two additional case
managexs.
Program services will be a�ailable at 2400 Cypress Street, Fort Worth, TX 761 p2. The shelter
provides services 24 hours a day, 7 day� a wee�, and 365 days a year.
REGULATORY CLASSIFICATIQN:
IDIS Ma�rix Code(s) and Service Category: 05 Other Public Services
National Objective Citation: LNIC Low/Mod Limited Clientele 24 CFR 570.208(a){2}
Regulafory Citation(s}: 24 CFR 570.201(e)
Based on the nature o� the ser�ice provided, Agency w:ill maintain documentation that verif es
1�0% of clients served by the Progiram are Homeless Persons per the Presumed Benefit CDBG
c�ientele category and therefa�re are at or below $0% of Area Median Income {AMI) as
established or defined by the United States Departrnent af Housing and Urban Development
(HUD}.
PROGRAM GOALS:
Provida Prograin ser`vices ta approximately 950 Unduplicated Clients.
EXAIS�T ��A"
PROGRAM SUMMARY
CDBG PSA CONTRACT 2014-201 S—�XHIBIT "A" -- FROGRAM SllMMARY
Presbyterian Night Shelter
30% ANLI
SD% AMI
I 80% AMI
EXI�IBIT "A-1"
�414 HUD Income Limits
2014 Median Family Income - Fort VL�orthlArling�on, TX*
1 Person 2 P�rsons 3 Persons 4 Persons 5 Persans 6 Persons
$13,850 $15,800 $19,79� $23,850 $27,914 $31,970
$23,050 $26,35Q $29,650 $32,900 $35,550 $38,200
$36,900 $42,150 $47,400 $52,650 $56,9�0 $61,100
* Income Limits are estal�lished and published at Ieast annually b� HiJD
CDBG PSA CONTRA.CT 2014-2015 —EXIIIBIT "A-1"-2014 HUD INCOME LIMITS
Presbyterian Night Shelter
7 Persons
$36,03Q
$�0,$00
$65,300
8 Persons �
$40,09D
$43,450
$69,500
0
N�;� � �� t fl�iia: : ILIIl�y
�.— �
� .►I)MIN�R7T�.t'I'IVC ll101`1Y,1 ONL3'j
� 5altuics
� FiCA
� Life Insurance
� Health Insurance
Disabilify Ins«rance
Unemployment-StaEe
Accounting
TQTAL ADMIl�iIST'RATIV� EXPEI�'S�+$
% Administrative Cost
rixoci�n�i ��:rxsan'�lEL
� Salaries
� FICA
E Life Insurance
Health Insurance
UnemploymenY
� Wor3cer's Compensatian
� Itetirement
{ Rj1Pi`�.IEFi �t��l1} SERNC'i�:S. —
Office Sup�lies
O�ce Eqwpment RenYal
Pasta�e
Prinring
hil4C f �, I.�Al� �:{]�2i
� Construction/Building Matennls (onEy 12EACH)
Contract Labor {City needs eopy of contract
before expenses can be reimbursed}
� Craft Supplies
� Field Trip Admissian Expenses
�Other Fieid Trip �xpenses (if preapproved by
City)
� Food Suppiies
� Teaching Aids
I+A(.'ILI�i Y ,�,Y[F LITL�.fr1FS
Telepnone
Electric
Gas
Water and Wastawater
5oiid Waste Disposal
Rent (City needs eopy oi lease before expenses I
can 6e reim6ursed}
� Custodial5ervices
� Repairs
Cleaning Supplies
� �.lilir5l . IrIY��lI'I,�1y R�l} ff��I.I��C;I;
� Pidehty I3ond pr Equivalent
� Directors and Offieers
General Conunercial Liahility
Contract Accountm�
i1ir��{. r �,�si�J'���riii�.[.
Childcare 5cholarships
Short-term Rent Assistance
SEtiort-tcrm Mart�a�e Assistance
5hort-term Utilities Assistance
I OT1I�R �XPENSES
� TOTAL
FUNDING A: bIR�CTIONS HOME
FUNbING $: �THER C,OVERNMEi�T
FIJNDING C: PRIVAT� GONTItIBUT�qN5
+� 4� i�9119{
1001
i aoz
1Q03
lOQ4
IDOS
lOUG
1007
20U1
2D02
2003
20D4
zaos
2006
2007
3001
3p02
3003
3004
4001
4UO2
4Q03
4004
4D05
4006
4Q07
wOpl
5002
50�3
5004
5405
5006
5�07
5008
5009
6Du1
G002
6003
6005
7001
7002
7UO3
7004
�:1'uliC �lu���'C I Ik
�
G6,990
S,124
5,786
4,100
77,��2
5,932
9,342
915
i,Q24
� l
G5,9$h `sOD,5G0
2,057 25,983
9,022 35,003
5,116
5,722
��•�ni. I
511,07$
39,096
59,I 13
b,031 �
b,746 �
�
I
1
�
�
13,000 16,3Q5 33,4D5
82,000 94,715 90,465 388,689 655,469 _
CDBG PSA CONSRACT 20I4-2015 — EXHIBIT "B" — BLTDGET 1
Presbyterian Night Shelter
The following tables are purely informational ar�d r�rere created solely for purposes of pxeparing,
negotiating, and determining the reasonabieness af the overall �ine item budget on the first page
of this EXHIBIT "B" — BUDGET a�d are not to be considered part of the terms and conditians
of this Contract. Contractor may make changes to any calumn except the "Position" colun�.t� in
the "Salary Dataii" table without the City's consent so long as the tatal amounts charged io the
grant da nat exce�d the line items on the first page of the EXHIBIT "B" — BUDGET. Changes
to the column Iabeled "Pasiiian" may only be made witi� the prior writ�en consent of the City.
� Position Name
� Case Manager
� Case Mana�er
SALARY DETAIL
Rate - Annual Hours
33,495 2,08Q
33,4�5 2,080
P�rcent to Grant
100%
1�J�%
Amount to Grant
33,495
33,495
1
1
I
1
TOTAL
�
� FICA
Life Insurance
Health insurance
Unemployment
� Workers Compensation
� Retirement
� TOTAL
Off'ice Supplies
Office Equiprnent Rental
Postage
Printin�
TOTAL
Contract Labor
Craft Suppiies
� Facility Fees
� Field Trip Costs
�Food �uppiies
Teaching Aids
I TOTAL
FRINGE DETATL
Percent of Payroll Amount
7.65% 39,�96
Percent fa Grant
13.11%
11.57'% 59, I 13 9.79%
1.1 ff°/a 6,031 0
132°1a 6{746 0
SUPPLIE� AND SERVICES
Total Budget Percent to Grant
1,875 0
MISCELLANEOUS
Total Budget
15,0$Q
164,812
Percent to Grant
0
0
66,990
Amount to Grant
5,124
5,7$6
0
0
10,910
Amount ta Grant �
0
1
1
0
Amount to Grant I
0 1
0
0
CDBG PSA CONTRACT 2014-2015 — BXHI�IT `B" —� BUDG�T z
Presbyterian Night S1�elter
I Telepnone
� EIectric
Gas
Water and Wastewater
Solid Was�e Disposal
Rent
� Custodial Services
Repairs
Cleanirig Supplies
I TOTAL
� �'idelity Bond (or Equivalent)
� General Commercial I,iab�lity
� Directors and Ofiicers
Con4ract Accounting
TOTAL
� Childcare Scholarships
� Shart-'�e�rm Rent Assistance
� Short Ter�n Mort�a�e Assistanca
�Short'I'erm Utilities Assistance
Tenant Based Rental Assistance
� TOTAL
FACILITY AND UTILITIES
Total Budget Percent to Grant Amoun� to Grant �
s,sis o a
37,8QQ Q �
9,12q Q 0
33,�05 12.27% 4,100 �
7,056 Q 0 �
32,'183
39,523
0
0
�
a I
Q �4,lOQ
FINANCIAL AND IN�iJRANCE
Total Bud�et Percent to Grant Amount to Grant �
1
16,733 0 0 j
0
DTRECT ASSI�TANCE
Total Budget Percent ta Grant Amount to Gn•ant �
1
1
0
CDBG PSA CONTRACT 2Q 1�-2015 — EXHIBIT "B" — BUDGET 3
Presbyterian Night Shelfer
EXHIBIT "C" — Audit Gerti�cation Fo�m
[See attached]
CDBG PSA CONTRACT 2Q14-2015 — EXIIIBIT "C" — AUDIT CERTIFICATIQN FORM
Presbyferian Night ShelYer
AUDIT CERTIFICATION FORM AND AUD�T R�QUIRCM�NTS
Agency:
Fiscal Year Ending:
Presbyterian Night Shelter
Sentember 30, 2015
❑ D�uing the fiscal year in which funds will be received, we will excced the federal
exp�nditure threshold of $500,OQ0. We will have our Single Audit or Program Specific
Audit completed and will submit the A-133 audit repart witkin seven (7) months after the
end oi the audited. f scal year or thirty (30) days within its completio�, whichever is the
earlier date.
❑ During �the fiscal year in which fiinds will be received, we wili not exceed the $500,000
fedexaI expendituxe threshold requa�ed for a Single Audit ar a Program Specific Audit to be
performed this fiscal year. (Fill out schedule helow)
� I+�+Jc:•�rl Cx��ent�'stu�-r l}i��E���ui�e
Nj�*��'T b� i�l�e� c�ui if ��t��,lc �u�liE o�� i'�����.r�i7t �i�4lri i� l�[�'1' ��qti�r���,
i'��� '1'�u•uu�E� 1'robE•��E13 �:�12i� c�'. I C:on�ract
���Ej�i-.9� �J�'Ij1111?3' �.}1'#i111�1f [_'���L?�1 �Iuir�L��r �lur��ber Fx}������lit����.�
Total Federal Expenditures for this Fiscal Year:
Signatory and Title
Date
Failure to submit tl�is flr a similar statement or failure to submit a completed single audit package
as described in the federal�y requi�ed audit requirements described in OMB Circulars A-133 by
ihe required due date may resuli �n suspension af funding and may afFect eligibility for fizture
funding. Notwithstanding fhe abave, this certificahon acknowled�es the agency's
cammitment to meet all other financial �eportin�, financial statements, and other audit
requirements as may be set foxth 7i�n the Contract.
CDBG PSA CONTRA.CT 20I4-2015 — EXHIBIT "C" -- AUDIT CERTIFICATION FORM
Presbyte�•ian Night Shelter
Exhibit'"D" �- Reporting Forn�s
[See attached]
CDBG PSA COI�ITRACT 2014-2015 Exhibit "D" -- IiEE1MBURS�MEN1" FORMS
Peesbyterian Night Shelter
Attachment I
Agency:
Address:
City, State, Zip;
Prag�-am:
Period of Service:
INVOICE
Presbyterian Ni�ht Sheiter - CQBG
2400 Cypress Street
Fort Worth, TX 76113
Main Shelter Based Case Manaqement
Prbgrarn
Arr�c�t�ni
�13is Inuaice C�in�laiiv� tn Eiat�
Agency's Certification: I certify that the costs incurred are valid and
consistent with the terms and canditions of the contract between City and
Agency. By signir�g this invoice, I cer#ify that to the best of my knowledge
and beli�f the data included in this report is true and aceurate. It is
acknowledged that the pravision of false informatian could leave khe
cer�ifying official subject to the penalties of federal, state, and local law.
Signature and Date:
Name:
Title:
CDBG PSA CONTRACT 2014-2015 �xhibit "D" -- REIMBURSEM�;NT FORIWIB
Preshyterian Night Shelter
Aitachment 11
City of FoR Warth
Hausing and Economic nevelopment Oapartment
Expenditure Worksheet
Agency:
Program:
ilr�a ka �nec� F�o
1
za
46
47
48
49
50
59
52
53
54
55
66
b7
58
59
60
Total
f'�vo4
Presllv�rlan NI�tShelte�-C68G
Main She�ter Base Case Mana4ement
Please Slroup Ilke account codss.
f�rcc��il �:uJn I
baasnouun' i5+vo Ka� In Rlor,�} qmn�Ns
'Payroll mus! identify employes. Reni must identify tanenl. OC�er paymerns should idernify individuals, IP appllcable.
}Ng.iYi^yh[aJ �rn 1�5� op�y� �olry�i�l codd}ar Ihks �rog!om
k++� un+w �,Ina rinn�
Ik4+dEN45TRA714 E tM4PV4�4 4n141
�alaries
FICA
Life Insuranee
Healkh Insurance
�isehiliW Insurance
Une� yJoymeni-Slate
Le�af & Accountir�y
AC#Clwnnrq PEiifi[SFINEL
Salaries
FICA
Life Insurance
Healkh Insurance
Unemplov(�ent
Worker's Compensstion
Retlrement
�ff' F�ANG 6�RwlC€�3
ice u�pIles
Office Eq�eipment Rental
Postaqe
PYintinp
�CELLr+N U�i
CoMerence & Sertnne��a
ConslraclioNBuildirrq Materials
CortVacf Labor
Cralt �upplies
Credit Reports
FacililY Fees
Feld 7rip Cdsis
Faod Supplies
MlleaDa
Tear}�in Aids
k�+L71.ITY �!} UiIL�TaE'�
Telep}lons
Eleclric
Gas
Watar and Wastewater
Solid Waste Disvosal
Renl
Custpdial Sarvlces
fiepa1rs
Cleaning SuppEies
1.�G���1�1�4NCIFt;+4H6_ IHairyiA}!C�
i Fi tnv Bond or ��uivalent
I Direc#ars and ORieess
1 General Commercial Lia6ility
I Le,qel Fees
IConiraci Aecountinp
UIp +:JAgg�fANC:E
� �h��acare $cholarshj�s
I Counsellnn-Individual5essions
I Caunselln, - Group Sessians
I Shori-term�entAssistance
I Short-term Mo� a_qe Assislance
I Sitat-ta�m Utilifies Assistance
Tenant Hesed Rental Assistanae
GAr TAi QUT�AY
I �umilure. Flxtures
I Camputers
I O�ca Ea�/nent
I Sport and ecreation Equipmern
Aoc�unr
1a41
t0U2
1003
1004
1�45
1�46
1007
20D1
20D2
2043
2044
2005
zaas
2097
3001
3002
3043
3�04
400'I V
40fl2 �
A003
400q
40D5
Atl46
4007
4QQ8
A009 I
4010 I
I
5001 �
5oaz I
5003 I
5004 I
50U5 I
5006 I
5q07 I
5�48 I
soo9 I
r
6001 i
6002 I
BOU3 I
6004 I
6005 I
�
7oot 1
7002 I
7a03 I
7004 I
70D5 �
7008 I
7007 I
800�
8002 I
8403 I
8004 �
C�BG PSA CONTRACT 2014-2015 F, xinihit "D" -- REIM8l1R5EMENT FORMS
Presbyterlan Night Shelter
arrm
UNUUPI-ICqTEU CLlEN7 DATA REA�Ri
P,gen�y.
Program:
Momh:
�ns tr�eUani.
I I�i. ��Cen la mr�n� � L,L �il wri�.l�imJ Jlrr� �ai+�tl tl�i�n9 Te e�iNr � 1Mx i�i�odr-'� �a �� oo- ir.Rm�nhr �0� :9'xl. �� mnnw� Nl.ur. s�d ii4 IirN� I�H.VVLI'1 lilil{�i1� _'.a1hL' Vvt W II flLi{ ]m{h EIli�l,yy dOPN�M�Firi�� 1� 4iGh vr GIInC *rw.. �n�lu��l rWi��
LIr�iL� shr�v�U ht ���wd hebw �a+'u��ali �4R4AlR TSF. T� �I Iliir �hwM rlll a�l �r a rsii r.� Lillk. rlu� � �f�14 li�[ vli�iiL1 Lnf U�lif_ Jul L*; �{ �.!"i Ifi4�1:1 YVS .^.�[% R'.F�14 Hm{a.!��� Ir �.�nn _r �uo� a�.pw� i�rxis �c niiilllP�� mim_41, Ilicj 8�114' 1'a� h Gi ilClklf tlli��.
i.n�s. '.ea� �'-k�uvJ.`RR^�P'IR�bLK �[y9NInGthSClle�rtF f a_rH�nlui'_r�-a e�r
[es L'Fr��iry
�In7��ir �nr: Ilnxicno �,.:
Rac. I�rn• C•el
-OhaLled ��}� Fs�rm �HOM
�kdsi� ral �4-IV J�Ova4 5 �f ��� 1{ ul �-']� II.. 7f! �T�� 4I��,
+S,�.t �� "i"S". .i""r . _. . �'a� ,
�, t.i
' ' r�t <3a=.}� .� 'i
ra.--. _n.er,+mrc3 ape A�nwim"i rIH:�- _ =9-' --_-- -;�;`-��r
'�r.T Nem�lr I l-tl��n� r. w ' '.��7_�:r'_'._�= ''� tu
N��.r ���ii�;ci Anuo �4h�i —_-_�-1 _ -�=._�<c;.-=
,�on�or HrM+i.0 :��I.u�i 31�te[r Ilvo= I G7.F{71e ',i 4ry.'y.'_-' __---,u�.��._i_
�ii���n 7lfr c iii.`ilr� �+4+.bn a,i.r�ii u�d.91.�1 Rya =�a=J�r.c:��i:1��' .��r,i �a�i:.:r�
Il�i hn[Lii: +�M1L�n ?�:i[ I•��� A�rn..r, emxim�� UiAiS�a�ii[��xtiyY -.`-ti�G ����_'�_'E=r4r�'tS�=?..
_� _ Kahs�r- r-aa�:r. •�.�w zt1Li 6mn�i.ai� �cavle 'hlne e�tlY.hlra..YJN� _a,d.44�[k.hm�a'� �m' ' -'•=d-3+�5� __' NS??'
2 � i - � _ - - - - — --
3 _
4 -
�
B
7
8
9
iC( _ -.
S1
tS �_ -
Fg
S�
SS
t� _
il
,� -
Efl —
2h � -
21 - - - -
� ' - -
2� _ - _ -
� - —
7� —
2� -- I -
P7 I
2E � - . —
2� � -
3�
a� _
�p` —
� - _ — � —
37
3�
3� - - --
4 - - _
4 ' - —
�'.
4� �
44
45
� _ —
47 —
� -
Eachibit "E" — Income Certiiication Farms
[�ee attached]
GDBG PSA CONTRACT 20I4-2015 -- EXHIBIT "E" -- INCOME CERTIFICATION FORMS
Presbyterian Night 5helter
Presbyterian Night SheIter
CERTIFICATIQN OF INCOME STATEMENT
AppIicant Narne:
Current Address:
Phone #:
Household Members and Inc�me
'Including Applicant)
Last Name First Name Age Manthly ,�ourCelEmployer Nazne
Income
�`#PERSONAL INFORMATION: (Check one in each item. Optional Infarmation for Federal Repar#ing Purposes)
a. ❑ MALE b. [] WHITE ❑ BLACK/AFRICAN AMERICAN ❑ SLACK/AFRICAN AMERICAN & WHITE
❑ FEMAI.E ❑ AM�RICAN IN�IANIALASKAN NATTVE ❑ ASIAN
❑ AMERICAN INDIANIAI.ASKAN NATIV� & WHiTE ❑ ASiAN & WHITE
❑ NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER ❑ BALANCE/O I'HER
❑ AMERICAN INDIANIALASKAN NATIVE & BT.ACKIAF�tICAN AMERiCAN
c. ETHN[CITY d. DISABLET] e. TS CLI�NT WOMEN HEAB OF HOUSEHOLD
❑ HISPAMC ❑ I'ES ❑ YES
❑ NON-HISPANIC ❑ NO ❑ NO
'� TOTAL NUMBER �F HOUSEHOLD MEMBERS (Include Yourself AND everyone who lives in the house.)
Total Anticipated Annual Household Incom�:
Certification:
I certify that the infonnatxon I am pxavidi�,g is t.rue and cauld be subject to verification at any time by a third
party. I alsa aeknowledge that the provision of false information could leave me subjeci to #he penalties of
Fedaral, State and local la�.
WARNING: TITLE 1�� SECTION 1001 OF THE U.S. CODE STATES THAT A PER$ON IS Gi3ILTY O�' A F'�X,ONY
�"OR KNOWINGLY AND WILLINGLY MAKING FALSE OR FRAUDUL�NT STATEMiNT5 TO ANY DEPARTMENT OF
THE UNTT�D STATES GOVERNMENT.
Signature oiApplacant Dat�
---�--�-9--��-�- For use by A�ency staff only-----�-_..�.�....�_
Household Size: Grass Annual Income:
Applical�le Incorne Limit: Is �pplicant Eligible?
Check if Applicant refizsed to provide dernographic information: ❑
Staf�Ass�ssm�nt of Demographics:
Person Making Determination:
Date:
N4TE: A�lclress, in�a�ne amotrnts and sources farAL� householrl rrteytahers are requiretl.
CDBG PSA CONTRACT 2014-2015 -- BXHIBIT "E" -- INCOME CERTIFICATION FORMS 2
Presbyterian Night Shelter
Presbyterian Night Shelter
CERTIFICACION DE DECLARAC�ON DE INGRESOS
Nombre del Solicitan�e:
Dornicilia Actual:
Nurnero d� Telefono:
Miernbros en el Ha�ar e Tn�resos
(Incluir ellla solicitante)
Apellic�a
Nombre Edad Ingreso Fuente de Tngresos/Nombre de Empleador
Mensual
**INFOIiMAC16N PER50NAI,: (Seleccione uno en cada categori�. Infomnacibn opcional para prapositos de informacibn k'ederal)
a. ❑ MASCULINO b. � CAUCASTCO ❑ NEGRO/AFRICANO AMERIC.ANO
❑ NEGROlAFRIC�NO AMERICANO & CAUCASICO
❑ PEMININQ ❑ INDiO AMERICANO/NATIVO DE ALASKA ❑ ASIA'I'ICO
❑ IND[O AMERICANOfNAT1V0 D� ALASKA & CAUCA5IC0 ❑ ASIATICO & CAUCASICO
❑ NA'I'IVO HAWAIAN�/QTRO DE LAS ISLAS PACIFICAS ❑ BALAlYCE/OTRO
❑ INDIO A1VI�12ICAN0 / NATNQ DE ALASKA & NEGROIAFRICANO AMERiCANO
c. ETTTICIDAD d. DISCAPACI"I`ADO e. �E5 EL SOLTCT'I'ANTE UNA MUdER Y CABECERA DEI. HOGAR7
❑ HISPANO ❑ 5I ❑ sZ
❑ NO-HISPANO ❑ NO ❑ NO
� NUMERO TOTAL DE MIEMBRQS EN EL HOGAR
Ingreso total del hogar anual anticipado:
(Incluye a si mismo y a todos los que viven en la casa)
Certificacion:
Certifco que Ia inFormacion que proporciono es verdad y podria ser susceptible a Ia com.probacion a cualquier
tiempo por terceros. Yo tarnbien reconozco que la provision de informacion falsa me podria dejar sujeto a las
penalidades Federales, Estatal�s y 1c�cales.
ADVERTENCIA: TiTULo 1$, SEccioN 1001 DE�. ConiGo D� EE.UU. QUE UNA PERSONA E5 CULPAB�� DE
UN DELITO POR SABER Y VOLUNTARIAMENTE HACER DECLAAACIONES FALSAS O FRAUDULENTAS A
CUALQIJIER DEPARTAMENTO DEL GOSIERNO ESTADOUi�fIDENSE.
Firma del Sr�licitante
Fecha
�a__o�__.o__o_ papa use de emple�tdos �le la agencia-�-----�---��---
# De Miernbros de Familia: In.greso Anual:
Limite de Ingreso: GEs salicitante elegible? :
Compruebe si el solicitante se nego a dar su infarmacion personal: ❑
Evaluacion deJ empieado sobre informacion personal:
Persona haciendo la deYerminacion: Fecha:
� Note: La direccion de la casa y das ingresos (y sus �rigenes) para todos miemb�os ded hog�rr son requeridos.
CDBG PSA CONTRACT 2014-2015 -- EXHIBTT "E" -- TNCOME CERTIFICATiON FORMS
Presbyterian Night Shelier
Exhibit "F" � Standards for Complete IDocumentation
[See attached]
CDBG PSA CONTIZAC'I' 2014-2015 ��ihit "�"' -- STANDARDS FOR COMPLETE DOCUMENTATION
Presbyterian Night Shelter
� ����
4� 9 4
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a S G � � e �,
� s ��n ¢�' F4
IFICAIMedicare
ILife knsurance I
� Heallh Insurence
j Disabilily Insursnce
IIIUnemployment
Insurance
Retirement
Profcs�fan�! Se�ulc.ei
Accouptlng X
Ec enses
Nlaletla?5. F�ulPsnar,l
'H`� �R��a9 �
I ica quipment
Rental
� Poslage X
Printi�n X X
Conslnscllon & X X
Bl1��f11FlA f4EBIBfiB�S
Spod and X X
Reoreauon
Fqyigknen!
Cleaning Syp ies X X
Teachins� Af� X X
Crat{ 6vr�pjies X iX
Food Suppjies J( lii
20�4-�Q'�5 Documenfafion Sfandawds for
Pu�blic Se�rice �onfracg Expens�s
X• I ' ' ' If an i. ,. �� :,.,:.� eiy unih Conlract augibla cllents and �olety on Contrecl eugib[e nems, then the empioyee's ann�s salary �s eligipte Tar �
refmhursement. T+rAce in each calemfar year, lhe ellent musl su6mN a wrflfen statement ver3fying that lhe a6ave condltions are still true. 7he
statement mus! also 6e signed be a person authorized to algrt on hehelf oElhe agency.
If an employee warks on a vadety o1 programs, or war3cs with a mixlure oT ConVact aflglLle cl�en[s and non-e]iglble Giants, Ihen Ihe City will only
reimhurse for a reasonahle padlon ollha employee's salery. �Cach reM6ursemeM requesl mus! Inclutle nat only Ihe employee's limashee[, bu[ alsa
a vro[k log dreaking out Fhe employaa's fime hy praject or activity. For emptoyaes paid wilh mulllple funding sourcas, tlmasheels must repecl all
funding snuroes. If separate tfinesfieets are kept for each funding source, ell such limeshaels must be suhmittad lo Ciry.
'If employees are paid by dlrect deposit ralher than theck, ihen 1he ageney musl submit holh Ihe dlrec[ tl¢posil paymanl comAeny's repo[t (such es
an AOT repoM1) and a hank stetemeni af�ack ahawing payment fo 1he d'vect depasll mmpeny.
If the Gily pays gross salary, this is already included. IF the Ciry pays the emQloyer poNan, then ihe empleye� musl show a calculetlon and
dosumentxtlon of howthe invpiced emounl aas ca3evlated, and inrJuq� documaptetip�+ s oxnnu pavmeni. ,
It Ihe Cily pays gross saEary, Ihis fs already included. If we pay the employer poriion, lhen e empfoyer must showe ealculalion and tlacumentaiion
oT how the Invaiced emouniwas calculated, must inefude an Imoice imm the Insurer, and m�st include documeMation shovvi�9 paymenl.
If ihe Ciry pays grass salary, this is already Inclutled. If we pay �he emptoyer podion, then tlie employer must show a caltulstion and documentatlon 1
at how the inaoiced amount was calculaled, muat I�lutle an €nvoice fram the insurer, and masl incluke documerttatfon showing payment. I
If the Ciry peys gross selery, ihis Is al[eady included, livre pay tha employer podlon,lhen the employar musl chow a calculauun �nd documentaGon
of how the invo3ced amounl was ealcuEaled, must Inciu6e an invofce fram khe insuret, and must include documenfeAan showing payment
I(fiie Cily pays grass salary, this is e�ready included. If we pay the employerQnnian, Ihen 1he employer mual shewa calculaUon snd documentaUon
oihaw 1he invafced emouM was calculalea a d Tusl includa documenlaIIon showir� oavment.
I If we pay gmss salery, this Is already Indude�f we pay the emp�oyer partlon, fhen khe employer inust show a calculation and �xomentatlon of how �
1he Involced amountwas calculated, musi and indude documenlation stiowing payment, and pdor lo the Tirst raimhursement, musl include fhe
en audrt is requireef beaause teaeral Ivnns exceed 500,8f30, tMen Iha coat snoutd oe spl3t avenry ny all lederel t�ntling sourees.
X
X
x
X
X
X
Waie�lUVeotewater X X �
ElecMc X X
Solid Waste � X
�sq�sa�
Fauliry X X I X
MaMlenance and
Regpi�s
Cuslodlal Sarvices x x
Rent X A _ X _
k��l�nraud
�pnlrac�� L��pr �x r X %
fnsuronce RequlrctLX yt
lJnder Ihe Contract
Chfldcare
5cholarships
The agency should mainialn inTortnauon regarding mailouts. If Ihe agency has a Pilney 6owes mschine or like posiage machine, khe records of lhet
macpine musl be on file. Like�n3se, If mail Is categorized by peymenl source, then lhoae records musl6e on 41e. Far targa malauts, the agency
s�ould kaep a conv uF the 1eHer and a Ilsl of all addressees.
`i'his ca€egory is only avaitame for R�A,CN.
�R�
+■
�`
�
�,. . r� an expenses, food expenses un11 also tie aRowetl so long as �he egency has a
purchases on al1 fiald triP� not Just ConVact-fundetl fleltl tdps.
M1ify ert nklA inr a daoilll4 LhCll 19 tidCd �O� W�f�F G91h76�at �aa�do3 rh� �
lf serv�ces �g prov�ded per a conlrect, 8cepry will pfov�de conErBtt 1�31Cfld of iqvoices.
1
{
driqks are
hllla m�FFk bo�
i
Oiry rar{ui�as that the agency submit Ils Fea schedule, showlrtg a breakaut of incoma levefs, and for each ievef a breakaut of the portion of the I
mxpense io 4e paid by famfly end the portion to ba reimbursed by 1he City. This fea srfiedule Is required priar to ihe Frsl paymant. We alao require
Ihe lncome eliglblfy of each househald so Ihatwe esn delermine if we are baing changed in conTormance with the fee schedule. If lhe Tea schedule
changes at any time Buring ths conlrec[ year, tha agency must noGty cify and provide a new schedule wi�hin ao days of Ihe change.
1
*Proof oi payment effective OctoBar 1, 2Q14' Payments or Expsnaes mvst De documanted in Ine Following [nanne�
A) Image oTthe check AND pank statement showing Ihe check claared the hank; OR,
B) Image of ttse csnce3led check (eY. At ertd of bank afelemenq; OR,
C) Pay�oll "Advacs" ar Siatement AND Bartk Stalemenl indieating payroll; OR,
�y Forwire ot e�lransfera: Reciept arslaiement Tram payee7vendor OR hank slalamant.
CDBG PSA CbNTRACT 20142a15 E�hibil "F"' — STANOARDS FOA COMPLETe DOCUMENTAIION
Pres6ylerian Nighi Shcl[cr
EXIIIBIT "G"
�ECTION 3 REPORTING FORMS
[See attached]
CDBG PSA CONTRACT 2014-2015 -- EXHIBIT "G" — SECTIDN 3 R�PORTING FORM5
P�•esbyterian Night Shelter
EXHIBIT "G"
�lC��Ofy �$uf��l�� ����� U.S. Department of Housing OMB Approval No: 2529-0043
Eronomic O�partunities for and Urban Developmeni (exp. 11l3012010}
Low -- and Very Low-lncame Persons Office of Fair Housing �
And Equal Oppoftunily � HIJp Field Otflce:
Section Gack of page for Pubhc Reporting Burden statement
1. Recipient Name & Address: (slreel, ci1y, state, zip) 2 Federal Identlfication: {grant no.) 3. Total Amount of Award: 1
�
4. Cnntact Person 5, Phone: (Include area code) 1
I
6. Length of Grant 7. Repnrting Period:
i
B. Uate Repart SubmiHed: 9. Program Code: (Use separaFe sheet 1a. Prvgrsm Name:
tor each program code}
� Part I: �mploymenr and Training (*` Cafumns B, C and F are manda� ory fields. Include IVew Hires in E&F] 1
A s c o e F
Numt�er of Numkzer ot New % of Aggregate Number % of Total 51aff Hours FJumber of Section 3
.Eob Categnry New FEires Hires thet are of Siaff Nours of Naw Hires {or Seciion 3 Empioyees Trainees
Sec. 3 Residents ihai are Sec. 3 Residenla and Trainees
�f�E9SSt0173:3 -� - — - II �
ITechnlclans _
Ol:r�e�Cleeic�l i - - -
Consfruction by Trade (List)
Trade
I�ra�e �
Trade - _ — �
T�sde I I _
ITrade _ _ _ - - I
Other (Listi � _ - -- - - _ �_
!
I _ -
I �
� � I — �
- -I ' � I
_ _ _ i I
I , -- ' — — �
I —_ — — �
__ i _ _ � —
— —— 1 '— �
'r��a�
s
' Program Godes 3= Publlc�lndlan Housing 4= Homeless Assistance e= C�BG State Administared
1= FlexiBle Subsidy A= t]evelopment, 5= HaME 9= Other GP Programs
2= Seclian 202l813 S� Operetion 6= HOME Siate Adminislered 10 = Olher FEousing Programs
C= Moderniiailon 7= CDBG Eniiilement
Page i of 2 farm Hlld 60002 (612001)
Rsf 2A CFR i35
Part II: Contracts Awarded
1. ConstrucEion Coniracts:
A. Tota1 dol]ar amount of aH confracts awarded on the project
B. Total dollar s�nount of contracts awarded to 5ection 3 buslnesses
C. Percentage of lhe total doAar amount that was awarded ta 5ection 3 6usinesses
D. Total number of Sectian 3 businesses recelving, conlracts
2. Non-Conslruction Gantracts:
A. Total dollar amount a11 non-construction contracts awarded on Ehe projecUactivlEy
B. Total dollar amount of non-conslruotion cantracts awarded to 5ection 3 husinesses
G. Percentage of the total dollar amount that was awarded to Seclion 3 businesses
�. Total number of Secllon 3 husinesses rec�iving nornconstrucfion contracls
Part III: Summary
%
Indicate khe efforts made to direct the emp]oyment and other ewnomic opportunitiss generated by HUfl financial assistance for housing
and community development programs, to the greatest extent feasible, toward 1ow-and very low-income persans, particularly those who
are reciplents af government assistance for housing. (Check all that apply.)
Attempted to recruft law-incame rasidents through: locai advertising media, signs prominently displayed at the project site,
contracts with the community organizations and public or pri�ate agencies operating within lhe metropolitan area (or
nonmetropolitan caunty) in which the Section 3 covered program or project is located, or similar methods.
Participated in a HUD program or other program which pramotes the training or employment of Section 3 r�sidents,
Participated in a HUD program or other pragram which promofes the award of contracts to business concerns which meet the
definition of 5�ction 3 business concerns.
Coordinated with Youthbuild Programs administered in the rr�etrapalitan area in which the Section 3 co�ered project is located.
Other; describe below.
Public reporting for this collection of information is esfimated to average 2 hours per response, including the tirne for reviewing instructians,
searching existing data sources, gathering and maintaining the data needed, and completing and re�iewing the collectian of information.
This agency may not collect this information, and you are not required to complete fhis form, unless it displays a currently valid OMB
number.
Section 3 aF the Mousing and Urban Development Act of 196$, as amended, 12 U.S.C. 'i701 u, mandaias that the Department ensures tha#
ernploymant and other economic opportunitfes generated by its housing and community developmenl assistance programs are directed
taward low- and very-low income persons, particularly those who are recipients af government assistance housing. The regulations are
found at 24 CFR Part 135. The information will be used by the Depaftment io monitor pragram recipients' comp�iance with Section 3, to
assess the resuits oF the Department's efforts to rneet the statutory ohjectives of Section 3, to prepare reports to Congress, and by
recipients as self-monitoring tool. The data is entered into a database and will be analyzed and distributed. She collection of information
in�olves recipients receiving Federal financial assistance Far housing and communify develapment programs covered by 5ection 3. The
infarmatian wifl be wllectad annually to assist HUD in meetir�g its reporting requirements under 5ectian �08{e)(6) of the Fair Housing Act
and Section 916 of tite HCpA af 1992. An assurance of confidentiality is not applicable to tf�is form. The Privacy Act of 4974 and Oh1lB
Circular A-'f OS are not applicahle. The reporttng requirements do not contain sensitive questions. I]ata is cumuEative; personal identifying
information is nat included.
Page 2 of 2 fnfm HU� 60002 {1112010]
Ref 24 CFR 135
Form HU�-60002, 5ection 3 5ummary Report, Ecanomic Opportunities for Low- and Very Low-Incorrse Persons.
Instructions: This €orm is to be used to repoR annual
accomplishmenls regarding empEoyment arid olher economic
oppartunities provicfed to low- and very low-income persons under
Seciion 3 of the Housing and Urban Qe�elopmenf Act of 1868. The
Section 3 regulations apply to any pudlic and lndlan housing
programs that receive: (1) development ass{stance pursuant to
Section 5 of lhe U.S. Housing Act of 1837; (2) operating assistance
pursuant to Section 9 of the U.S. Housing Act of 1937; ar {3)
modemization grants pursuant to 5edlon 14 of tha U.S. Housing Aat
of 1937 and to reciplents oF housing and community development
assisiance in excess of �240,000 expended for: {i) housing
rehabiliiaUon (including reduction and abatemant of lead-based paint
hazards); {2) housing construction; or (3) other public constr�ction
projects; and to confracts ar+d snirnonfracfs �n excess of S70U,OD0
awarded in connection with the Section-3-cavered activity.
Form HU�-60002 has three parls, which are to 6e completed for
all programs covered 6y Section 3. Part I relates to employmenf
and tralnFng. The recipieni has the npfion to determine numerical
employmentltraining goals either on tMe basis of the number of hours
warked by new hires (columns B, D, E and Fj. Part II of tne form
refates to contracting, and Parl III summarizes recipients' eifarts to
comply with 5ectian 3.
Rec9pients or contractors subjeet to Section 3 requireme�ts must
mainiain appropriate documentation to estaGlish that HUD financial
assistance for housing and community developmant pragrams were
directed toward low- and very low-income persons" A recipient of
Section 3 covered assistance shall submit one copy of lhis report to
HUD Headquarters, Df(ice of Fair Housing and EqualOpportunity.
Where the program providing assistance requfres an annual
performance report, lhis S�ction 3 report is to ke submittad at the
same tlme the program performance report is suhmifted. 1Nhere an
annual pertormance repoR is not required, this 5ection 3 report is fo be
submitked by .lanuary 10 and, if the project ends hefore December 31,
wilhin 1 o days of projecl camplstlon. Onfy Prlme Recipients are
reqolred fo repert !a HUD. The repart must fnclude
accampllshments of aA reclAlents and their 5ectlon 3 cove�ed
contractors and sohconfractors.
HU� Field Q{fice: Enter the Field affice name .
1. Recipient: Enter the name and address of the recipient
su6mitting this report.
2. Federal IdentificaFlon: �nter the number that eppears on the
award form (with dashes). The award may be a grant,
cooperative agreement or contract.
3, Dollar Amount of Award: Enter the dollar amouni, rounded lo the
nearest dollar, receiv�d by the recipient.
4& 5. Contact PersaNPhone: Enter the name and iefephane number
of the person with knowEedge of the award and the recipienYs
implementation of 5ection 3,
B. Reporting Period: Indicate the t�me period (months and year)
th9s reporl covers.
7. Qate Report 5ubmitled: Enter the approprfaie date.
Program Code: EnYer the appropriate program cade as lisfed at
the boitam of the page.
Program Name: Enter the name of HUD Program corresponding
with the "Program Code' in number 8.
PaR f: E.mpioyment and Training Opportunities
Column A: Contains varinus jnb categories. Professionals are
defined as people who hawe special knowledge of an occupation (i.e.
supervisors, archiiects, sunreyors, planners, and computar
programmers). For construction positians, list each trade and provide
dala in columns 8 through F for eac� trade where persons were
emplayed. The category of "Ofher° includes occupations such as
service wnrkers.
Column B: (Mandatory Fie1d) Enter the numher of new hires for
each category of workers identified In Column A In connectian with
this award. New hire refers lo a person who is nof on the cantractnr's
or reciplenfs payroll for empfoyment at the time of selection for the
Sedlon 3 covered award or at the time of receipt qf Section 3 covered
assistance.
Column C: (Mandatory Field) Enter the number of Section 3 new
hires for eacfi category of workers ldentifed In Column A in
canneclion with this award. 5ection 3 new hire refers to a 3ection 3
resident who is not an the contracto�s or recipient's payroll for
employm�nt at the time of selec6on for the Section 3 covered award or
at the time of recaipt of SectEon 3 covered assistance.
Column a: Enter the percentage of all the staff hours of new hires
(Sect€on 3 residents) in connection with this award,
Column E: Enter the percentage of the total staff hours worked for
Section 3 employees and trainees (including new hires) connectad
with this award. Include slaff hours for paR-time and fuli-time
positions.
Column F: (Mandatary Fieldj Enter the numfoer of Section 3
residents that were trained in cannection with this award.
Part II: Cantract Opportunities
elock 1: Construction Contracls
ltem A: Enter the lotal dollar arrEount of all contracls awarded on the
proJecVprogram.
Item B: Enler tne total doAar amount of contracts connected with this
prajecUpragram that were awarded to Section 3 businesses.
Item C: Enter the perc;entage of the tolal dnikar amount of contracts
connected with thls projectlprogram awarded to Section 3 businesses.
ltem D: Enter the number of Section 3 businesses receiving awards.
Block 2: Non-Constructfon Coniracts
Itsm A: Enfer the total doAar amount of all contracts awarded on the
projecUprogram.
Item B: Enler the total doAar amount of contracis connecled with thls
proyect awarded Ea Section 3 husinesses.
Item C: Enter the percentage of the intal dallar amount of contracls
connected with this projec!lprogram awarded to Section 3 businesses.
Item D: �nter the number af Section 3 businesses receiving awards.
Part III: Summary of Efforts — Self -explanatory
Submit ane (1} copy ofi thls report ta the HUD Headquarters Offlce of
Fair Housing and Equal Oppartunity, al 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 perlod specified in item 8. PHAspHAs ara to repart al1
contractslsubcontracts.
` The terms "low-income persons" and very low-income persvnsH havE
the same meanings given the terms in section 3(6) (2) of lhe United
States Hausing Rct of 1937. Lou�incame persans mean families
(including single persons} whose incomes do not exceed 84 percent of
the medlan income for the area, as determined 6y the SecreEary, with
adjustments far smaller and larger famllies, excepl that
The Secreiary �ay establish income oeilings higher or lower than 8o percent
oF the median fvr the area on the 6as{s of the Secretary's �ndings such ihat
var€aiions are necessary beca�[se of prevailing levels of constructlon costs
or unusualiy high- or lowv-income families. Verylevwlncome persons mean
low-income familfes (including single persons) whose incomes do not
exceed 50 percent of the median famlly incame area, as determined by the
5ecretary with adjustments ar smaller and larger families, �xcept thal the
Secretary may establish incoma ceilings higher or iower than 50 percent of
the median for the area on the basis of the Secretary's findings that such
variations are necessary because of unusuaAy h9gh or 1aw family incomes,
Page i form HUI? 600�2 {9112010j
Ref 24 CFR i35
EXHIBIT "H" — Severely Disabied Certif cation �+'arm
[See attachedJ
CDBG PSA CONTRACT 2014-2015 —EXIIIBIT "H" -- SEVEAELY DISABLED CERTIFICATION FORM I
Presbyterian Night ShaIter
Presbyterian Ni�ht Shelter
CERTIFICATION FORM
DOCUMENTING CLTENT STATU� AS "SEVERELY DISABLED ADULT"
Client Na�ne:
Address:
City, State, Zip
Client Ide�,tificatian No.
CHECK ALL THAT APPLY
� Has used a wheelchair, a walker, cane , crutches or other special aid for six
months ox lon.ger
Has been diagnosed with ane o� the following canditians: Alzheimer's
� disease, mental retardation or other developmental disability, senil�ty or
dementia, cerebral palsy, or autism; or has another mental or e�notional
candition that seriously interferes with everyday tasks.
Is unable to p�rform on� or mar� of the following "Functional Activities":
❑ seeing, hearing, speaking and having ane's speech understoad, lifting or
carrying, using stairs, grasping small objects, or walking.
Is unable to perform or needs assistance to perform one or more o� the
❑ following Activities of Dai1y Living {ADL}: getting around inside the honr�e,
gettiz�g in or out of hed ar a chair, bathing, dressing, eating, and toileting.
Is unable to perfarm or n�eds assistance to perform one or more of the
following Instrumental Activities of Daily Living (IADL): going outside the
❑ hame, keeping track of money and bills, preparing rneals, doing ligh�
hausewark, taking prescription medications in the righ� amount and at the xight
time, and using the telephane.
❑ Has a condition� that prevents tl�em from working at a job or doing hausework.
The under�igned agency representative conducted a visua� asses�ment of th�e client identified on
th�is form and ceriifies that the client meets at least one o� the conditions indicated abo�e, which
determines that h.el she rneets th� definition of "severely disabled" accarding to the LT.S. Census
Bureau.
Certified by:
Signatuxe/Title:
Date:
CFW HED: Revised as ofAugnsf 30, 2D13
CDSG PSA CONTRACT 2014-2015 --EXHiBTT "H" — SEVERELY DISABLED CERTIFICATION FORM 2
Presbyterian Night Shelter
91I1812014 .
�a�v ����c�� 1�����s
M&C Review
official site af the City af Fort Worth, Texas
�OR.T�O�TI�1
'��
COLINCIL ACYIOM: Approved on 8151�014 � Ordinance No. 21363=�8a�01�i
COWT[WlJE� FROIV� A F'R�VIOUS lN��K
DAiE: 712212014REF�REMCE C-26893 �,p(� �q��; 17HUDACTIONPLANPY2014�
�{p,; 2015
CO�E: C TYP�: NON- PU�LIC YES
CONSENT HEARiNG:
SUBJ�CT: Conduct Two Public Hearings and Appro�e the City's Actian F'lan for the Use of Fed�ral
Grant Funds in the Amount of $9,827,252.00 from the United States Department of
Hausing and Urban Devekopment for Program Year 2014-2Q15 from the Community
Development Blocic Grant, HOME lnvestmant Partnerships Program, �mergency Solutions
Grant and Housing Opportunities for Persons with AIDS Grant Pragrams, Authorize
Collection and lJse of Program Income, Authorize Waiver af Appiication of [n�irect Cost
Rates, Authorize Execution of Related Contracts and Interde{�artmental Letters of
Agreement and Adopt Ap�ropriation Ordinance (ALL COUNCIL DISTRICTS)
RECOIVfIU��NDATION.
It is recdmmended that th� City Council:
1�. Gonduct two public hearings to a11ow citizen input and cansideration of the City's 2014-2D15 Acfion
Pfan for use nfi federa{ grant funds from the Unitet� S�ates ❑epartment of Hausing anc[ Urban
Development in the amount of $9,827,252.00 for Program Year 2014-20'{5 from the Community
De��lopment Block Grant, HOME In�estment Partnerships Program, �mergency Solutions Grant a�d
Housing Opportunities far Persons with AIDS grant programs and for the use ofi pragram income from
acti�ities using prior years' federal grant funds;
2. Apprave fhe City's 2014-20'i5 Ac#ion Plan for submission to the United Sfates Department of
Hausing and Urban De�elopment including allacafians af grant funds to particular programs and
activities as t�etailed belaw;
3. Authorize the collection and use of an estimated amount of $50,0OO.OD of pragram income resul#ing
fram activities using priar years` Community Develapment Blocis Grant funds fior the programs and
acti�ities detail�d belo�nr;
4. Authorize the collection and use of an esfiimated amount of $100,a00_00 ofi pr�yram income resulting
fram ac#ivities using �rior ysars' HOME Investment Partnerships Pragram funds for the Ciiy's
Homebuyer Ass�stance Program;
5. Auihorize the City Manager ar his designee to execute contracts and [nterdepartmental Letters af
Agreement for a one year term wit� the agencies listed below in Talales 1, 2 and 3 for Program Year
2014-20'{5 far Community Development Biock Grant, Em�rgency Solutions Grant and F�ousing
Qpporkunities for Persans with AI�S grant fur►ds, contingent upon receipt af fiunding;
6. Autharize the City Manager or his designee ta extend the contracts and Interdepartmental Letters of
Agreement for up t� ane year if an agency or depar�ment requests an extansion and such extension is
necessary for complefion of the program, or to amend the contracis and Interdeparkmental Latters of
Agre�ment if necessary to achie�e program gaals pravided any amendment is within the scope of the
program and in compliance with City policies and all applieable laws and reg�alations gaverning the use
of f�deral grant funds;
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8. Authorize a waiver of indirect cast rates as applicable for the Grants Fund, in accordance with the
City's Administrative Regulations; and
9. Adopt the attached appropr�ation ordinance �ncreasing the estimated receipts and apprapriations to
the Grants Fund in the taial arnount of $9,$27,252.04 consisting of $6,193,950.00 in Communify
Developmeni Block Grant funds, $2,143,383.00 in HOME In�estment Partnerships Pragram funds,
$493,90�.40 in Emergency Solutions Grant funds and $996,018.OQ ir� Housing Opporkunities for
Persons with AIDS grant funds, �ius any program income, all subject to receipt of s�ch funds.
DISCUSSiON:
The City`s Anr�ual Action Plan summarizes the major housing and community d��elopment activif�es
and propos�d expendi�ures far use of fed�ral grant funds tataling $9,827,252.00 frarn the United States
Departrrtent of Housing and Urban Development (HUD) for Comrriunity Development Block Granf
(CDBG}, HOME Investment Partner'ships Program (HOME)� Emergency Sol�tions Grant (ESG) and
Hausing Opportunities for People with AIDS (HOPWA) grant progr�ms for the program year b�ginning
October 1, 2014 anc� �nding Sepfember 3Q, 2015. This year's Actior� Plan also summarizes the use of
program incom� resulting fram activities using prior y�ears' CDBG and HOME funds. TE�e purpose of
these grant funds is ta primarify benefit low and moderate incom� City residents, with E5G funds
primarily benefiting homeless persons and HOP1111A funds primar3ly benefiting persons with HIVlAIDS.
Staff de�eloped recommendations for the allocation af ihe estimat�c! funding from HUD and pr�s�nted
them fo the Cammunity Developme�t Council (CDC) on May 21, 2014 and to the City Council at the
Pre-Council meeting on June 1Q, 2Q14. Notice of a 3Qrday public comment period from July 2, 2014 to
Ju{y 31, 2014 was puk�lished in the Fort Worth Star-Teleqram on June 28, 2014. Any comments
received will be maintained by fF�e Housing and Economic Development Department, in accordance
with federal regulations. The City will hold two public hear[ngs as par� of the HUD-required citizen
participation process, the f�rst an July 22, 2094 and the second on August 5, 2014 at which time the City
Courtcil is scheduled to a�prove the Action Plan. In additiort, public hearir�gs were held an .�une 24,
2p14 at 10:00 a.m. and 6:Q0 p.m. for citizens to provide comment on the praposed list af n�ighborhood
streets eligible for reconstruction using CDBG funds.
A summary of the CDC's funding recommendations is provided below in Tables 1, 2 and 3 and a
spreadshee# of all specific funding recommendations is aitached. The Action Pfan must be submifted to
HUD by August 15, 2014,
For Program Year 2014-201�, it is recamm�nded that fhe amounf af $fi,193,950.00 in CDBG funds
and the estimated amaunt of $50,000.00 af C�BG proc�ram income be allacated as follaws:
�ub�ic Ser�ices y �929,092.50
This item includes social �er�ices for low to moderate income, rlEsabled and disadvantage popuiations,
Housing Programs and Services - $2,'15D,600.00
This [tem includes funding for the City's Priority Repair Program, Cowtawn Brusfi�-LJp, hom�buyer and
housing services and accessibElity modi�ca#ions to the homes of senior andlor disabled individuals and
related project delivery costs for these programs.
CD�G Match Funds a $�OD,�OO.aU
This item includes mat�h funds for th� Lead Grant pragram.
lnfrastructure S�rvices - $638,1�6.�0
This item indudes funding for recanstruc#ian of neighborhoad streets.
CD�G Econom�c Der�efapment � $737,340.70
Th�s item is t�e City`s annual payment on its Section 108 loan from HUD.
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GDBC Estimated Program Income � $50,Od0.Q0
The CDC recommended allocating any CDBG pragram income for the reconstr�tction of neighbarhood
streefs.
CD�G General Administratian � $1,�3�,�'90.00
This ite�'r includes costs for administering the CDBG grant inc[uding allacations far Financial
Manag�ment Services, Internal Audit and Trarrsportatiot� ancf Public Works Depariments.
For Prog�am Year 2a14-2015, it is recammEnded that the amo�nf of $2,143,383.00 in HOME funds
and the estimated amount af $100,0OO.OQ of HOME pragram incom� be allacated as foliows:
Homebuyer Assis#ance Program - $'1,097,�05.70
This items includes funding for down payment andlor closing cost assisfance to faw and moderat�
incame homebuyers.
Cammunity Develapment Housing �rganixations �CbDO) Set kAside a$3�'C,�Ol.40
HUD requires khat a r�inimum af 15 percent of HOME funcls be allacated to CHDOs for affordabfe
housing projects and GHDO administrati�e operatin� costs. These funds will be usec� to complete #he
Hillside Marningside Neighborhood Single Family Infill Development which wil[ resulfi in the construction
of up to 17 single family F�ouses bythe Tarrant County Hausing Partnership CHDO.
Multifamily pevelopment � $570,131.60
Funding will be useci for the Columbia at Renaissance Square, an ap�roximately 140-unit mixed
incame development, with 28 mark�t rate units. The rest af the units will provide quality affordable
f�ousing ta For� INorth farnilies wit� incomes at or below 80 percent of Area Median Income. The
de�elopmen# wi{I be located ai 3801 W.G. Daniels Drive in Council District 8.
HOME Cenera! Administration - $�14,338.3Q
This item includes costs for administering the HOME grant.
HDIIflE Estimated Pragrarr� Income - $100,004.00
The pragram income will be used in the City`s Homebuyer Assistanc� Program.
For Program Year 2014-2015, it is recommended that the amount of $996,(?18.00 in HOPWA funds be
allocated as foffows:
hlon-Prafi# S�rvice Praviders - $9�6,137.46
HO�WA Pragram Adminis#ra�ron - $�9,880.54
For Program Year 2014-2Q� 5, it is recammended that the amount af $493,9Q1,00 in ESG funds be
allocated as follows:
Nan=Profit Service Providers � $4�6,8�8.42
ESG Pragram Adminis#ration � $37,04�.�8
The CDC and Staff recommend that contracts be executed with the agencies Eisted belaw in the
amounfs s�town in the followir�g tables:
Commtanitv Develonment Blocic Granf:
� �
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Table 1 � C�B� Agencies
- rgani�ation
�Women's Center of Tarrant County
Senior Citizens af Greater Tarrant
County
YMCA of Metropolitan Fort Worth
YWCA of Fort Worth and Tarrant
County
Ch�ldcare Associates
�Giris Inc. af Tarrant Counfy
�Camp Fire
�Lena Pope Home
�L.adder Alliance
�Tarrant County Housing Partners�ip
IPresbyterian Night 5helter
��program
�Senior Services
��5enior Ser�ices
�,Child Care Services
1 Child Develapment
�IChild Care Services
��Youth Services
I(Youth Services
jjYau�h Services
� Empla�men�IJob Training
1 Housing Counseling &
Educaiion
Case Mana�ementlMain
Shelter
Meals on Wheels of Tarrant County Home-del�vered Meals
Pragram
CD�C� �ublic Service Sub�o4al �
*REACH Resource Center on 1INe�d-Prajeci Ramps
Independent Living �
�Tofia1 ���C �on#rac�s ��
*REACH will be funded fram fhe CDBG Housing Pragrams budget.
program
Housina Onqortunit��s For Persons Wifh AIDS:
7able � - Fi�P1aVA Ag�ncies
Organization j
i
Tarrant
County
Samaritan
Housing, Inc.
AIDS
Oufireach
Center, Inc.
TOTAL
H OPllVA
Contracts
I
��Amount j
� $ 75,000.00 �
$ 93,092.50
50,000.00 �
�o,aoo.oa
50,000.00�
75,000.00�
75,000.00 �
75,OQ0.00�
75,OOQAO�
$ 124,00�.00
$ 82,ona.00
� � o�,oao.00
��$ 929,092.50�
Il� 7�,o�a.���
�$1,004,09�.�Q �
II Amount �
Adrninisiratian {seven percent) and Suppar�ive Services $409,384.46
Adrninistration (se�en percent), Supportive Services,
Tenant Based Rerttal Assistance (TBRA), and 5hort
Term R�nt Mortgage and Utility Assistance (STRMU)
Emeraencv Salutions Grant:
Tabfe 3 - ESG Agencies
�5��,���.oa
$986,137,4f
e
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.
i •
�'� Organization
ISafeHaven of Tarrant County
Presbyterian Night Shelter
Day Resaurc� Center for the
Homeless
The Sai�ation Army, a Georgia
Carporation
Cathalic Charities of Fort Worth
YOTAL E5� Contracts
M&C Revie�u
Progra�n
Sh�lter Services
7
Amount
$ 85,Q65.04 �
Shelter Services $ 95,544A0 I
�
Shelter Services $� 15,732.00
Homeless�ess Prevenfiar�IRapid Re- � 43,13C.Oq
Housing
HomefessnessPreventionlRapidRe- ���7,381.�42
Hausjng
$4a6,8�8.�6� �
Th�s� pragrams are availab[e in ALL COUNCIL DISTRICTS.
F15CAL INFORi�iAY[ONICERTIF'ICA7IAAl:
The Financial Ma�a�ement Services Direetor cer�ifies that uport approval af the a�o�e
recommendatiorts, adoption of the attached appropriatian ordinance and receipi of grant funds, funds
will be available in the current operating budget, as appropriated, of the Grants Fund.
�0 �undlAccountlCenters
GR76 451i27 0172Q6720XXX $6.'193.9�0.00
GR76 5XXXXX 017206720XXX $6.193.950.00
GR76 451727 017206721 XXX $2.143.383.00
GR76 SXXXXX
017208721 XXX
GR76 451727 0�7206723XXX
GR76 5XXXXX 0'[7206723XXX
GR76 451727 01i20fi724XXX
GR76 SXXXXX D17206724XXX
GR76 476099 017206T20XXX
�R�s sx�ocxx a� 72as7aaxxx
GR76 476675 0'17206721XXX
GR76 5XXXXX 0'f7206721XXX
$2.143.383.Q0
$493.901.Q0
$493.901 AO
�996, D'18.00
9i996.01$.OQ
$50.000.00
$�a.000.ao
$1D0,000_OD
$100.00OAO
Submitted for Citv IV�anaaer's Office bv:
Oriainatina Deoarfinent Head:
Additional lnformatian Contact:
FRO{411 F�undlAccauntlGer�ters
Fernando Costa (6122)
Jay Chapa (58d4)
Cynthia Garcia (8187)
Leiicia Radriguez (7319}
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ATTACHIIIIEIViS
17HU[]ACTIONPLANPY2014-2015 AO 2014.docx
Action Plan 14 -15.ndf
PROPOSED 2D14 CDBG Streets Attachrnent.pdf
AA&C Review
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����,��°�' ��:�G���'�'����'
L�J`��L+I Y�Qr��1�9 �lau �__�rr�_—..�`�—...��,. '
�� �� �� �� � �rJ
November 5, 20I5
Presbyterian Night Sheltei•
Attn: Toby Owen, Cksief Executive �fficer
2400 Cypress Street
Fort Worth, Texas 76102
RE: Final Budget Revision of City Secretary Conteact Na. 46158 and 46158 A-1 between t�e City of
Fort Worth ("City"} and Presbyterian Night Shelter ("Agency"} fflr CDBG Funds ("Contract")
Dear Mr. O�ven,
This letter is to advise you that the Budget line items in the Contract witla your Agency will
require a iinal re�ision. As ouilined in Section 5.2.2.2 of ihe Contract, Agency rnay increase ar decrease
lin� item ainourits in the Budget, subject to wriiten approval by the Director ofthe N�ighborhood Sezvices
Department. In order for Agency to expend a�l CDBG Funds, City will waive the June 1, 2415 deadline
for Agency requests far Budget amendments.
The Budget shown on EXHIBTT "B" — BUDGET Revised 071�015 of the Cantract is hereby
replaced by EXHIB�T "S" — BUDGET Revised 1dIZ01� atfached to this letter, and deemea effective as
of October 1, 2014.
To indicate your agreement with the revised Budget and its Effective Date, please sign where
indicated below and return four copies of the original executeci documants to the following address at
yaur earliest convenience:
Neighborhood Serviees Depattment
Attn: Leticia Rodriguez, Neighborhood Developmant Coordinator
City of Fort WQrth
1000 Throclanorton 5treet
Fort Warth, Texas 7b102
Sincerely,
ACCEPTED AND AGR.EED:
Presbyterian NigfShelter
By: ,l � _ _ — � �
Toby O t�f Executive �fficer
_ _� - ,
Allison Gray, Actin� Dye�yi�r
Neighborhood Services llepaiRment
Approved as to F r and Legality:
h
I
Assistant City Attorney �, �
�
Attest� ' � �
�
City Secre� � ��S
M&C C-26893' Date: 0
��
1 ``� ����� ' _ . -� � _ , _- ,,.��
�� � � �'' S��R�'�16R�" �
�?�� Y �`� r - � � •
EXHIBIT `iB" — BUDGET Revised 1U1�015
— — � (e�.�i�t lii�a�.l ` Iutetues' I7CCIi41i�' I�4'S'lr�'1!
r�L{'filllll { i�l'�h,h� Eloidi rl
:klttil�l�'I'�t�k'f�1Vk: �NUi"14'.S t��t.l' - --- ...��—
5alanes 14Ui ^ �
� FICA � 1002 -- — I
� Lifelnsurance � 1003 I I
I Health Insurance I 1044 - - �
�Disability [nsurance � IQOS � � -
Unemployment 3cate � 100b � { �
Accoun�in� 1 D�7 I
I TOTAL A.�MINISTRATIVE EXPENSES i i -I I
� % Administrative Cost 1 I I I
�� ' ' -
alaries ,�.041 64,990 11,589.83 55,400.17
I'ICA 2002 5,124 I 1,007.94 4,116,06
Life Tnsurnnce � 2003 I ` I
� i3ealttt Insurance 2004 � 5,785 + I 224.90 5,556.1.0—,
� Unempfoy}nent 2pfl5 � � �
� Warker's Compensation � 2pp6 �
� Rati�ment � 2007 I I I I
� Office �uip►�ent Rental I
M Yosta�e �
� Printtng
I Cantraet Labar {Ciry needs eopy afeontract I
�efpre expenses can be reimbursed)
I rai� suppttes �
� Field Tnp Admission �xpenses
IOther Field Trip Expenses (if preappro�ed by I
City}
� Fooc� SuPplies �
Teachin Aids
Telephnne
Electric
I Gas
I Water arnl Wastewater �
� Solid Wasfe Disposal �
I Rent (Gity needs copy oflease before expenses I
can be reimbursedj
I Custodia! 5ervices �
� Repairs — - - - �
Cleaning Supplies
E
�ideliry Sond ar EquivaEent
I Directars And O�cers �
� General Cammercial Liabi�ity �
� Contract Aacounting �
��
Childcare Scholarships
Sl�ort-term Rent Assistance
Shart-ferm Mort�a�e Assistance �
� Short-term iJtihties Assistanca �
I OTIICIt EXPENSES �
� TOTAL �
3002 �
3�03 _ `
30Ud �
40D2 I
4003 I
40Q4 �
4005
4066 I
aao� �
I _
�
I
5002 � I
5003
5004 � 2A,50� 12,&27.67
5005 1 —
50f)G I
50D7 I I
SD08 � � `
5009 I I I
6Q02
6003
b005
7002 I -
7003
7044 � -
] 02,40U
� �
I I
1 37,327.67 �
I
� -
� � �
- i - I — I
12,827.67 12,827.67 I 102,40D �
f
The following tables are purely informational and were creai�d solely for purposes of preparing,
negotiating, and detertnining the reasonableness of the overall line item budget on the f rst page
of this EXHIBIT ��B" — Bi�DGET and are no� to be considered part of the terms and eonditions
of this Contract. Contractor may enake changes to any column except the "Position" eolumn in
the "Sa�ary Detail" table without the City's consent sa long as the total amounts ck�arged to the
grant do not exceed the line iiems an the first page of the EXHIBIT "B" — BUDGET. Changes
to the column labeled "Pasition" may only be made with the prior written consent af the City.
SALARY DETAIL
Position Name Rate Annual Hours Percent to Grant �lmount to Grant
� Case Manager 33,495 2,080 100% 33,495
� Case Manager 33,495 2,OSQ 65.40% 21,905.17
�
�
TOTA�.
�
� FICA
� Life Insurance
�Health Insurance
Unemployment
� Workers Compensation
� Retirement
� TO'TAI.
� Offtce Supplies
� pffice Equipment Rent�1
� Postage
Printing
TOTAL
Contract Labor
Craft Supplies
� I'acility ]Cees
� Field Trip Costs
� Faod Supplies
� Teaching Aids
� TOTt�L
66,990
FRINGE DETAIL
Pcrcent of Payroll Amount
7.65% 39,096
11.57% 59,113
l.l 8% 6,031
1.32% 6,74fi
110,986
5�.�% 55,400.17
Percent to Grant Amount to Grant �
10.53°/u 4,116.06
9,40%
0
0
5,55b.1fl
0
�
8.71 %
9,672.1G
SUPPLIES AND SERVICES
Total Budget Percent to Grant Amount to Grant 1
1,875 0 0
1,875 0 p �
MISCELLANE�LTS
Total Budget 1'ercent to Grant Amount to Grant
15,flSfl fl a
�6a,atz o
1i9,892
a
0
�
� Telephone
� Electric
Gas
Watar and Wastewater
Solid WasteDisposal
� Rent
� CustadiaJ Services
� Repairs
� Cfeaning Supplies
� TDTAL
� Fide�ity Bond (or Equivalent)
� General Commercial Liabi[ity
�Directors and �f�icers
Contract Accounting
� TOTAL
�
Childcare 5chalarships
Shart-Term Rent Assisfiance
Shori Term Martgaga Assistance
� Shart Term UtiIities Assistance
� Tenanf Based Rentai Assistance
� TOTAL
FACILITY AND UTILITIES
Total Budget Percent ta Gtant
8,815 0
37,800 0
9,120 0
53,805 69.38%
7,056 D
32,783 0
39,523 0
1 S8,9D2 19.7U %
FINANCIAL AND INSURANCE
Total Budget Percent to Grani
16,733
0
16,933
0
DIRECT ASSISTANCE
Total Budget Perc�nt to Grant
Art�ount to Grant
0
0
a
37,327.67
0
0
0
37,3tiy.6i
Am ount tn Grant
0 �
1
0 ,
Amount to Girant
1
1
0
���r' ���+'��9 , ,
��r��� ��. � ���� I��
�,. . � .
�
i
,�, � ;! I' , i ,, .
NUW, THEREFOR�, City and Agency hereby agree to am�nd the Contract as follaws:
I.
�-
� . , i: , ; �; �, �
FIRST AMENDMENT TO CITY S�CRETARY �ONTRACT NO. 461�8
WHEREAS the City of Fort Vi�orth ("City") and Presbyterian Ni�ht Shelter ("Agency")
inade and entered inio City Secretacy Contract No. 4615$ ("Contract");
WHEREAS, the Contract provides Funding to Agency pursuant to a grant received by
City from the United Sfiates Department o� Housing and Urhan Development {"HUD") �hrough
the Community Development Hlock Grant Program {"CDBG"};
V�I�REAS, Agency pravi�es s�rvices io a presumed beneiii population pf which 100%
must be low and nnaderate income as de£'ined in 24 CFR Part 570;
WHEREAS, Agency has been operating without closin:g since October 201Q� and has
requested additional CDBG Funds ta hefp it pay the addi�ional utility bills it has incurred;
WHEREAS, it is the mutual desire of City and Agency to amend the Contract to add an
additional $�U,40�A0 oi CDBG Funds fox• a tatal Contract a.mount o� $10�,400,00 and reduce
the number of Unduplicated CIients ser�ed by the Prog�•am iroin 9�0 to 80a because the level of
service to the clients was inereased due ta tk�e 2�-hour operation af the facility;
WHERAS, it is necessary to elarify Agency's reporting requirements regarding the
clients it serves in the Program �ar which city is furnishing CDBG Funds in accordance with the
Cantract, arid
VVHEREAS, it is the mutual desire of City and Agency to amend the Cantract to
complate the Pragram and meet Contract objectives.
Section 2. DEFIN�TIONS is ame�ded by subst�tuting the fallowing far the current
definztions in the Contract:
"Direcior means the Director of the Neighbarhood Services Departmeni."
.•�
��a��� ..
�. ;
��
�
�
�"'rl
�
"Income El'rgible Clie�t meas�s a client whose annual income adjusted for family
size does not exceed SO°/4 of AMI using the most current �IUD Cnco�r�e
Guidelines and Technical Guidance for Deterinining Incorr�e and Allowances.
The de�nition of annual income to determine client incame eligibility shall be the
definition cantained in 24 CFR Part 5.609, as amended froin time ta time. "
"National Objective means an activity that benefiis low and moderate income
persons. For the �urposes of this Contract, 100% of t�e clients served by the
Progratn must be Incaine Eligible Clients."
Amendment No. 1 to CSC No. 4G 158
Presbyterian Night Shelter (CDBG)
�
���t�i�e� ����r���
�fi'll 5��1��`��R�
I�"�, jl�n��`� �'Sr,
Page I
Re�. 07/2Q 15
"Neighborhood Services Department means the City's Neighborhood Services
Department."
"Source Documentation means documentation as described in Section b."
"Unduplieated Clients means a count af al1 clients 5�rved by the Program at least
once in the Cantract tertn. Client� served by tlle Program more than once in the
Cantract term will oniy be counted the first time they are served �wlaen
determining the �otal count of Unduplicated Clients."
Section 2. DEFZNITIONS is amended by deleting the following definitians in tHe
Contract:
"CDBG Eligible Client means a client whose annual income adjusted for family
size does not exceed SU% of AMI using the rnost current H[JD Income
Guidelines and Technical Guidance for Determining Income and A1lawanees
veri�e�i by either Sourca Documentation or the for�n in Exhibit "E" — Form of
Income Self-Certifcatiou. Agencies serving 100% Clientele must follow the
requiremer�ts set forth in Section 6.1.3."
"HED Department rneans the City's Housing and Econornic Development
Department."
z�.
SECt1Di1 4.I Provide CllBG Funds is deleted in its entirety and replaced by the
follawing:
"4.l Provide CDBG Funds.
City shall provrcie up to $102,400.00 of CDBG Funds under the ierms and
conditions herein."
Sections 53.3 and 5.3.4 ace deleted and replaced by the following:
"5.3.3 Failure to rr�eet at least 80% of its performar�ce milestones oj• ser�e 800
UndupSica#ed Clients und�r this Contract will autoinatically disquafify Agency for
consideration under the City's Request for Proposals �or the 2016-2017 Program Year for
Federal grant funcis."
"5.3.4 Amendments to performance milestones must be approvEd by the Director
in writing, with sueh appro�aj being in the Direcfior's soSe discretioj�. If Director
approves the Agency's proposed amended performance milestones (as appraved, the
"Amended Perfornr�ance Milestones"), then the Amended Performance Milestones
will take ef�ect on the first day af the month follawing the month in which it was
approved by Director, unless otherwise speoified in the amend�r�ent. A11 reyuests for
amendments to performance milestones must be sub�nitted by June 1,
Amandment No. 1 to CSC No. 46158 page 2
Presbyterian Night Shelte�• (CDBG) ReW. 07/2015
201�. Notwithstanding the above, ar�y amendments to perforxna.rice milestones shalj not
reduce ti�e numbers for serving S00 Unduplicated Clients stated in Section 5.3.3."
Section 6. CLIENT ELIGIBILITY VERIFICATI4N is deleted in its entirety and
replaced by the following:
"6.1 Client Eli�ibilitv.
Agency nnust dacument that alI clients served fall under a"prasumed benefit"
category as de�inad in 24 CFR Part 570. ltelevant categories of presumed benefit are:
s�verejy disabled adults, homeless persons, abused or neglected childr�n and youth ar
elderly persons. Agency will docurnent client eligibi�ity as follows:
6.1.1 Severelv Disabled Adults.
Written, signed and dated diagnosis from a licensed medical professional. As an
acceptable alternative, Agency may use the farm attached hereta as Exhibit "H" —
Severely Disabled Certification Form.
6.1.2 Homeless Persons.
Written, s�gned and dated certification from an outreach worker.
6.13 Abused or Neglected Children and Youth.
Written, signed and dated cet�ification from an out�each worker.
b.1.4 Elcierlv Persons.
An elderly person is defned as being at least 6� years of age. A birth certificate,
driv�r's Iicense, passport, irnmigration card, military identif cation, or any other state,
local, natianal or international documentation, pro�ided it contains current infarmation
about the age ar birth of the possessor. The farm in Exhibit "E" — Fawm of Incorne Self
Certification also requir�s tliat potential clients list their age and ce�rtify the validity of
the iniarmation provided. This should only be used as a last resort with an explanation in
tile iile case nates indicating why ti�e formal forms of verification were not availa6le."
G.� Sub�g�ssian af Comnlete Docam��tation.
Agency must submit copies of all �I�gibility verificati�n documentation described
in Seetion 6.l with Attachment III in each month's Reirnbursement Request for all
Unduplicated Clients served far the first time, and must maintain copies of such
docuinentation as requireci under this Contract.
6.3 This Section b shall be applicable for the Contract term and for 5 years
thereafter and shall surviv� the earlier terminatian or expiration afthis Confcact."
IIT.
Section 9.2.2.1 and Section 9.2.2.2 are deleted and replaced by the following:
"9.2.2.1 For payroll expenses, timesheets signed by employees and app��oved
Amandment No. 1 to CSC No, 4G158 Page 3
Presbyterian Night Shelter (CDBG) Rev. 07/2015
by supervisor for aI� payroll expenses listed. Tiinesheets inust
dis�inguish between CDBG-funded time and non-CDBG fundeci time
and reflect actual time spent on CDBG-funded activities. A�ency may
not submit payroll expenses dated more than 1�0 days befare the date
af tile Reimbursement Request.
9.2.2,2 For non-payroll expenses, invoices far each expense listed with an
explanation as to how the invaiced expense pei�tains to the Program.
Agency may not submit invoices dated more than 1�0 days before the
date of the Reimburse��aent Request."
The first santence in Section 1'� ZNSURANCE AND BONDING is deleted ar�d replaced
by the following:
"Agency will maintain coverage in the form of insurance or bond in the amount of
$102,40D.dD to insure against loss from the fraud, theft or dishonesty of any of Agency's
officers, agents, truste�s, dzrectors ar employees."
IV.
Section 9.2.3 Attachment III — Client Data Reuort is deleted and replaced by the
following:
"9.2.3 Attachrnent III -- Ciient Data Report
This report shall list each Unc�uplicated Client served during the rnonth along with
his ar her demographic information. The Client Data Report must maintain a list of all
clients served during the Contract term, ineluding non-Fort Wor�h clients. In arder foz•
this report to be camplete, the following must �e submitted:
9.2.3.1 Documentation of income verificatinn far each Unduplicatec�
Client, including non-Fort Worth clients, the first tim� he or
she is served by the Program, which will either be Saurce
Documen�ation ar the completed forrn of E�hibit "E" - Form
of Income Self Certi�cation."
V.
Exhibit "A" — Program Summary, Exhibit `B" — Bndget, and
attached ta the Contract are hereby replace� vvith the attached Exhibit
�umimary Revised 071201�, ExhiUit "B" — Sudget Revised Di/201�,
Attachment III Revised 051�015.
Amendment No. l to CSC No. 46158
P�•esbyterian Night Shelter (CDBG)
Attachmenf III
"A" -- Prograrr�
and tl�e attached
Page 4
Rev. 07/2015
VI.
This amendment is effective as of the Effecti�e Date of the Contract except for the
arnendments to Attachment TII Revised 05/241.5 which shall be ef%cti�e May 1, 2a15.
VII.
All terms and conditions of the Contract not amended herein remain unaft'ec�ed and in
full foree and effect, are binding on the Parties and are hereby rati�ed by the Parties. Capitalized
terms nat defined herein shall have th� ineanings assigned to them in the Cont�act.
[SIGNATURE� APPEAR ON FOLL4WING PAGE]
Amendment No. 1 to CSC Nn. hb158 Page S
Presbytarian Night Shelter (CDBG) Rev. 07/2015
ACCEPTED AND AGREED:
PRESBYTERIAN NIGHT SHELTER
�—'
,.—
By. �--� �
O en, CEO
ATTEST:
�
��
C�ity 5�
M&C:
�
1
��
CTTY OF FORT WORTH
By.+ _ � � % —�
��_�
�'ernando Casta, Assistant City Manager
APPROVED A.� TO FORM AND
� LEGA�rIT�
�- i' %/ -� y � ��L��e�c.�
� „ �"�""`"
Assist�nt City Attorney
��F��IA� �E���
��7°Y' S�C�L��'���'
I �. �I�`��, °�'i�
Ainend�nent No. 1 to CSC No. 46158
Presbyterian Night Shelter (CD$G)
Page G
Rev. 07l2015
PRESBYT�RIAN NTGHT SHELTER
Shelter Based Case Management and Services
PROGRAM SUMMARY
(�CDBGj
October 1, 2Q14 ta September 30, 2015
PERIOD
EXHIBIT "A"
PROGRAM 5UIVIMARY
Re�ised a712015
$102,400.OU
AMOUNT
Capitalized �erms not defined herein shall have meanings assigned them in the Contract.
PROGItAM:
The Program will expand case Rnanagement seivices for horneless persons in Agency's
emergency sheIter to help clients �'ind housing, employment, and support services to increase
self sufficiency.
CDBG F�rnds will be used ta pay for salaries and fringe benefits far � case managers and a
porkion of the utilities for Agenc�'s einergency shalter.
Program services wil� be available at 2400 Cypress Street, Fort Worth, TX 76IO2. Agency's
shelter provid�s ser�ices 24 hours a day, 365 days a year.
REGULATORY CLASSIFICATION:
[DIS Matrix Cade{s) and Service Catagory: OS Other Public Services
National Objecti�e Citation: LMC Low/Mod Limited Clientele 24 CFR 570.208(a){2)
Regulatary Citatian(s): 24 CFR 570.201(e}
Agency will maintain doeum.entation that verifies lOQ% of clients served by the Program are
Homeless Persons per the Fresumed Benefit CDBG clientele category and th�refare are at or
below 80% of AMI.
PROGRAM GO.ALS:
Minimum Contract Performance Outcome: The Program must serve a rr�inimuin af $00
Undu�licated Clients as shown by the monthly reports on Attachment III.
Ame�dment No. ] to CSC No. 4615 S Page 7
I'resbyterian Night 5helter (CDBG} Eiev. D712D 15
EXFiIBIT `B" — BUDGET Revised a7/2415
A cnru n f
uuut
i ooa
i oa�
10U4
I005
i006
IQ07
2001
2002
2003
2004
2005
2406
20D7
Offioc 5upv[ies 3Q01
� O�ee EquipmentRental 3002
� Pasta�e 3003
� Printing 3004
�St'r�1.�4�U�Oi;s
� Construction/Building Materials (only REACH) 4p01
Contract Lahor {City needs copy af cantract
before expqnses can 6ereimbursed} 4002
� Craii Supplics 4003
� Fieid Tnp Admissian �xpenses 4004
Other Field Trip Expenses (if preapproved by
City) 4005
� I�aod Supplies 40fl6
� Teachin Aids 9007
I AL1h�IL�ti]��FkA���i�'L+ tllllPlS'A O*�LY.1
I Salaries
I rica,
I Life [nsurance
I Healfh Insurance
I Disabilily lnsurance
I Unemployment-5tate
Accounting
� TOTALADMINISTRATIVE i:XPL�NS�5
� % Administrative Cost
� PitOCF{L1i41 PE���CINNRL
� Salaries
� FICA
� Life Insu�ance
Health Insura�ee
Unempioyment
Worker's Compensation
Retirement
I �i�P�l,�r� n��i �1FI�Y1C'�5 _. .— - --
� - — —
FACIT.I�'1� ei�'l.r �'I'IE.17'iP:�;
Teleplione
Electric
Gas
� Waterand Wastervater
� Solid Waste Uisposal
Rent {City needs copy af lease before expenses
can be flrimbur�ed)
� Custadial Services
� Repairs
� Cleaning Supplies
� I.Rfir►I., �'IN�1N{'Ir�S,. A�1D fIYSL1�R�►l+iCG
� FidelityBondprEquivaient
� Direntors and Officars
� General Commercial i.iabiiity
� Contract AccounCing
� DCRECT,i��3�TAIVCE
� Chifdcare Scholarships
� Shorf-term l�e�t Assistance
� 5hoh-tenn Mort�a�e Assistance
� 5hort-term Utilities Assistance
� bTFIER �7CP�iYSC�
� TpTAL
T'UNDING A: Dll2EC'fLONS HOME
FIINDING $: 43TH�R GOV�I2NMENT
FUNPING G: PRIVATE CQNTR[SU'E'IONS
Amendment No. l to CSC No. 46158
Presbyterian Night 5helter (CDBG)
5001
5002
soa�
5D04
5pQ5
50D6
5Do7
5008
SQQ9
nD01
6D02
G003
6005
7001
7002
7003
�aaa
S:rnni ilnd�ri :1 IS j C f[}'iAl- �
�
�
I
�
�
�
�
66,99U � 77,542 65,986 300,560 S11,078 �
S,I24 5,932 2,OS7 25,983 39,U95 �
5,78G 9,302 9,022 35,003 59,113 I
915 5, l 16 6,03 I �
I,U24 5,722 6,746
24,5�0 13,0�0 16,305 53,8D5 �
�
]02,4a� I 94,715 40,065 3$8,689 b55,4b9
Page 8
Re�. 07/2015
The falIowing tables are pUrely informational and were created solely for purposes of preparing,
negatiating, and determining the reasonableness of the overajl line item budget an the first page
of tltis EXHIBIT "B" — BUDGET and are nat to be considered part of the ternis and canditions
of Yhis Contract. Contractor may make changes to any column except the "Position" coiurnn in
the "Salary Detail" table without the City's consent so long a� the total amounts charged to Che
grant do not exceed the line iterr�s on the first page of the EXHIBIT "B" — Bi1DGET. Changes
to the column labeled "Positian" may only be macie vvith the prior written cqnsent of the City.
Posiiion Name
Case Manager
Case Managar
TOTAL
�
FICA
Life Insurance
Health Insurance
Unemployment
� Workers Coznpensation
� Retirement
I TOTAL
I
� Office 5uppli�s
� Office �quipment Rental
� Postage
� Printing
� TOTAL
I
� Contract Labor
� Craft Suppiies
� Facility Fees
� Field Trip Costs
� Food 5upplies
� Teaching Aids
I TOTAL
SALARY DETAIL
Rate Annual Hours
33,495 2,080
33,495 2,080
Percent to Grant
i00%
i aa�ia
�RINGE DETAIL
Fercent of Payroll Amount Percent to Grant
7.GS°10 39,09b 1311 %
I l .57% 59,113 9_79%
1.1$°10 6,031 0
1.32% 6,746 0
SUPPLIES AND SERVICES
Total Budget Percent to Grant
lyfilS O
MISCELLANEOUS
Total Budget
15,080
1G4,812
Percent to Grant
a
0
Amaunt to Grant �
33,495 �
33,495 �
�
�
�
6G,990
Amount to Grant �
5,124 �
�
5,786 �
0 I
0 �
10,910
Amaunt ta Grant
�
0
Amountto Grant
0
0
a
Amendment No. 1 to CSC No. 4615$ Page 9
Presbyterian Night 5helter (CDBG) Rev. 071201 S
Telaphone
El ectric
Gas
W ater and W astewater
Solid Waste Disposal
Rent
Custodial Services
ILepairs
Cleanin� Supplias
TOTAL
I
� Fidelity Bond (or Equivalent)
� General Cormnercial Liability
� Directors and Ofiicers
� Contract Aceounting
� TOTAL
Childcara Scholarships
Short-Term Rent Assistance
Short Term Martgage Assistance
Shork Term Uti[ities Assistance
Tena�rt Based Renta[ Assistance
TDTAL
Amendm�nt No. 1 to CSC No. 4615$
Presksyterian Night Shelter (CDBG)
FACILITY AND UTILITIE�
Tokal Bud�et Aercent to Grant
8,815 �
37,800 0
9,12U 0
53,805 45.5%
7,OSb 0
3�,783 0
39,523 0
FINANCIAL AND 1NS�.TRANCE
Tatal Budget Percent to Grant
I G,733 0
DIItECT ASSISTANCE
Tota] B�zdget Percent to Grant
Amoue�# to Grant
0
0
0
24,5a0
0
0
0
aa,�oa
Amount to Grant J
1
a �
1
�
a �
Amount to Grant
0
Page 14
Rev. 07/2015
ATTACHNIENT III
CLIENT DATA REPORT
Revised D5/2015
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Amendment No. 1 to CSC No. 4G158 Page ll
Presbyterian Night Shelter (CDBG) Rev. 07/2p 15