HomeMy WebLinkAboutContract 46160�! � �i����'�i� ,
������� ��. ,._�_ _ -- - - _.... _�.
STATE OF TEXAS �
§
CUUNTY OF TARItANT §
This contj-act {"Contract") is rnade and entered into by and b�tween the City of Fort
Worth (het•eafter "Ciiy") and The Woinen's Cenier of Tarrant County lnc. (hereafter "Ag�ncy"),
a Texas non-pro�it corporation. City and AgenCy may be refe�•red �o individua�ly as a"Party" and
�{ointly as "the Parties".
The Partiss state as fallaws:
WHEREAS, City recei�es g�•ant i�anies from the United States Departar�ent af Hausing
and Ur6an Dev�lopment through the Community Development Block Grant ("CDBG"}
Pragram, Prograrr� No. B-14-MC-4$-0010, Catalog of Federal Do�nest�c Assistance No. 14.21 S;
WHEREAS, a national objecfiive oi the CDBG program is to benefit benefit [ow and
moderate income citizens in accordance with 24 CFR Part 570.200 (a)(2);
WHEREAS, Agency submitted a pcoposal to use CDBG fiands for an eligible prograim
under tHe CDBG Etegulations vvhereby Agency wilI peovide services to low and moderate
incoi-�e City citizens;
WHEIZEAS, Ciiy citizens, the Community Development Council, and the Cit� Cauncil
have determined that CDBG programs are needed by the City's citizens.
NOW, THEREFORE, the Parties understand and agree as follQws:
1. INCORPORATION OF RECITAL�.
City and Agency hereby agree tha� the recitals set fortlz abave are true and eorrect and
form the hasis upon which the Parties ha�e entered inta #his Contract.
�. D�FINITIONS.
in additioa ta terms defined in the bod.y of this Contract, the terms set forth 6elow sh�.11
have the definitions ascribed to them as follows:
Area Median Income oi• AMI means the median family income for the Fart Worth-Arlington
metropalitan statistical area as estabiished anr�ually by HUD. The 2�14 ineome limits ai•e
attached hereto as Exhibif "A-1" — 2014 HUD Income Limits.
Business Diversity Enterprise Ordinance or BDE means the City's Business Diversity
Oi•dinance, Ordinance No. 20020-12-2011.
CDSG means Community DeveIopment Block Gcant.
CDBG PSA CONTRACT 2p14-201 S
The Wamen's Center of Tarrant Couniy [ne.
� �=���#� R��ti�1.� �
_, i']f � S��o'R`��"'J� �h �,
�'�' ��T'�# `� �
��
�����V�� �iQ� � % ���
Corr�plete Docurnenfation rneans the followiilg documei7tation as applicable:
� At#achrnents I, II, and III, with supporting docuinentatiot� including:
o Proof of expense: copies Qf tii�esheets, invoices, leases, ser�ice coiatracts
or other documentation showing that payinent is due by Agency.
Q Proof of payment: cancelled checks, banIc statemeilts, or wire transfers
necessary to demanst�-ate that azraunts due by Agency were actually paid
by A�ency.
o Proaf o� client eligibility; (i) S�urce Docuinentation su#�icient to show
that clients pai�ticipating in the Prograrr� are CDBG Eligibje Clients; or (ii}
doeu��nentation athe� than Saurce Docurnentation to shnw that clienis
served by the Program are CDBG Eligible Clients.
Complete Doeumen�ation shall meet tha standards described in the attac�ed
Exhibit "F" - Standards for Complete Dacumentation.
flny other dacument or record reasanably necessary� to verify costs spent and
client eligibiIity for the Program.
CDBG Eligible Clienf rneans a client whose annUal income ad�usted for famiIy size daes no�
exceed SO% of AMI u�ing the most cUrrent HUD liicorne Guidelines and Technical Guidance
for Determining Incoine and Allowances �erified by eather Source Dacumentation ar the form in
Exhibit "E" - Form of Ineome �el%Cer�ificxtion. Agencies Serving 100% CIientele .must
follovv the ret�uireinents set forth in Section 6.1.3.
CDSG Funds rneans the CDBG grant funds supplied hy City to Agency under the terms af this
Contract.
CDBG Regu�ations means �•egUlations fat�nd at 24 CFR Part S70 et seq.
DBE means disadvantaged b�siness enterpi•ise in accordance with 49 CFR Part 26.
Director means the Director ofthe City's Housing and Econonnic De�elopment De�aar�ment.
Effec�ive Date means October 1, 2014.
HED Department ineans the City's Housing and Econoinic Development Department.
FIUD means the Unitec� States Departrnent of Housing and Urban Develaptnent.
IDIS tneans HUD's integrated Disbuc•sement InFortnation �ystern.
National Objective means at least 5i% oi the clients served und�r this Contract must ha�e
incomes at or below 80 �/o ofAMI in accordance with 24 CFR 5�0.20$(a)(2).
Program means the services described in Eathibit "A" — Program Summary.
CDBG P�A CONTRACT 201�4-2015
The Women's Center of Tarrant County Inc.
Reimbursement Request means all re�orts and other documentation described in Section 9.
Source Documentatiou means any documentation alIowed under the de�nition of annual
incoine in 24 CF'R Parl 5.609.
Unduplicated Clients ineans a caunt of CDBG Ejigible Clients served once in the Contract
Term. CDBG Eligible C�ients served more than once in the CQntract Term will o�lly be counted
once when deteri�ining the number of Unduplicated Clients.
3. TERM.
The terin of this Cantract i��gins on Oetober 1, 2014 and terminates on September 30,
2015 unless earlier terminated as pravided in this Cantract.
4. DUTIES AND RESPONSIBILITI�S OF CITY.
4.1 Provide CDBG Funds.
City shall provide up to Seventy Fi�e Thousand and 001100 Dallars ($75,000.00} of
CDBG Funds under the terms and conditians herein.
4.2 Manitor.
City will monitor the acti�iiies and �erfocmance of Agenc� and any of its contractorss
subcon�ractors or vendors as necessary, but no l�ss than ann�ally.
5. DUTIES AND RESPONSYBYLITIES OF AGENCY.
5.1 Required �ervices.
Agency shali perforrn the services descrihed in Exhibit "A" — Program Summary in
accoj•dance with the terins and conditions of this Contract.
5.2 Use af CDBG Funds.
5.2.1. Comafiance with CDBG Regulations and Cantract.
Agency shall be rei�nbursed for eligib�e Prograrn costs with CDBG Funds �nly ii Ciiy
determines in its saIe discreiion that:
5.2.1.1 Costs are eligible expenditures in accordance with CDBG Regulations.
S.Z.1.2 Costs are in co�npliance with this Contract and are reasonable and
consistent wiih inc3ustry norms,
5.2.1.3 Complete Documentatioq is submitted to City by Agency.
CDBG PSA CONTRACT 2014-2015 3
The Women's Center of Tarrant County Inc.
5.2.2 Bud�et.
5.2.2.1 Agency agrees that CDSG runds will be paid on a reimbursernent
basis iiz accordance with Exhibit "B" - Budget.
5.2.2.2 During the term of this Contract, Agency may submit written requests
to increase or decrease line-ite��n amaunts in tlie Bndget, including an
explanation of why such increases or dec��eases are necessary. All
such requests must be approved by the Dir�ctor in writing, with such
approval being in the Director's sole discretion. If Director approves
the Ageney's proposed Budget am�ndment (as appraved, the
"Anr�endec� Budget"), ihen the Amended Budget will talce effect on
the first day of the month fol[owing the month in which it was
approved by Director, unless otherwise specified in the amendinent.
All requests for Budget amendments must be subrnitted by June 1,
24l �.
5.2.3 Chan�e in Pro�ram Bud�et.
5.2.3.1 Agency wil! notify City promptly af any additional funds it receives
for operation of the Program, and City reserves the right to arnend this
Contract in such instances to ensure campliance with HUD regulations
governing cost allocation.
5.2.3.2 Agency agre�s to utilize funds a�ailable under this Contract to
supplelrtent rathee than sup}�lant iunds ot��erwise available for use in
the P�'ogram.
5.2.4 Pavment of CDBG Funds fo A�encv.
CDBG Funds will be disbursed ta Agency upon City's approval of Agency's written and
signed Reimbursement Requests including submissian of Complete Documentation ta City in
compliance with Section 9. If Agency expends ai! funds budgeted far the Program prior to
September 20, 2015, City may hold back a small amount of ihe CDBG Funds until the end af the
term. During this interim period, Agency must continue to submit Reimbursement Requesks
with an invoiced amauni of$0. li is expressly agreed by the Parties that any CDBG Funds eit�er
�not spent or nat approved for rei�nburseinent to Agency shall remain with City.
CDBG PSA CONTRACT 20I4-20 L 5
The Women's Center of Tarrant County Inc.
5.3
5.3.j
milesto��es:
Pro�ram Performance Milestones.
Agency warran�s and re�resents that the Progra�n will achieve the %llowing
�Iorth
6
S
�1
i [J�����licated Cli�nts as
J�%4'4 C�IFr{I II3 i?�h�hit �•�„
�7{j:4�i�C�MiI:?'E'S — Y'rtip�r�fn �:l�::nl�!'S�
27.27% 27.27%
54.54% 5�4.54%
72.72% 72.72%
X Q�°�a 1 �Q%
5.3.2 Failure of Agency ta meet these milestones ar a material deviation froin th�m as
outlined in this Section 5.3 is a breach of this Contra�ct. �or the purpose of this Sectian,
"material deviation" shall mean more than 10% lower than tl�e specified goal. In the event of
such breach, City reserves the right in its sole option ta delay or withhoid payment af
l2eimburseinent Reyuests, Co lower Agency's allocation of CDBG Funds, or to terminate this
Contract.
5.3.3 Failure to meet at least 80°/a of its perfarmance milestones or serve 1 SO
Unduplicated Clien�s under this Contrac�t will automatically disqualify Agency for. �onsideration
Linder tl�e City's Request for Praposals fnr the 20�6-2017 Program Year for Fedej•al grant funds.
5.3.4 Amendments to perfarmance milestones �nust be approved by the Direcior in
writing, with such approval being in the Director's sole discretian. If Director approves the
Agency's proposed amended performance milestones {as approved, the "Amended
Perforun�ance Milestones"), then the Arnended Performance Mi[estones will take efFect on the
first day of t�e month following the month in which it was approved by Director, unless
otherwise specified in the amendment. Al� requests for a�nendinents to perFarmance milest�nes
must be submitted by June i, �015. No�withstanding the above, any am�ndments to
performance milestones shall nat reduce the numbers for serving 180 Unduplicated Clients stated
in Section 5.3.3.
5.4 Idenhfy Pro�ram �xpenses Paid with CDSG Funds.
Agency will keep accounts and �•ecoa•ds in such a manner that City may readily identify
and account for Program expenses reimbursed with CDBG Funds. These records shall be xnade
a�ailable to City for au�it purposes and shall be retained as required hereunder.
5.5 Me�t National Obiective.
Agency certifi�� that t�e activities carried aut under the Progracn anci this Contract will
meet the Natianal Objective.
CDBG PSA CONTRAC'1' 2014-2Q15
The Women's Cenier af Tan•ant County Ir�c.
G. CLIENT ELIGIB�LITY V�RIFICATION.
6.1 Client Eligibilitv.
Agency w�il document the eligibility of al] prospectiv� clients. Agency will documeni
client eligibility using the specifc method deseribed below in Seetion 6.1.1 that is applicable
to Agency and its Pragram. Ail other subsectioa�s of this Section 6.1 are not applicable to
Agency.
b.l .l A�encies Scrvin� a Presumed Benefit Clientele.
Agency must document that all clienfs seived fall under a"presumed beneft" catego�y as
de�ned in 24 C�'R Part 57d. Relevant eategot�ies of presuined b�nefit are: severely ciisabled
adults, homeless persons, abused or t�eglected childran asid youth or elderly persons. Elig�ble
forjns of docutnentation include:
6.1.1.1 Severely Disabled Adults. W�•itten, signed and dated diagt�osis from
a licensed medical proFessional. As an acceptable alternative, Agency
inay use the forcn attached hereto as Exhibit "H" — Severely Disabled
Certifca#ion Form.
6.1.1.2
6.1.1.3
6.1.1.4
Hameless Persons. Written, signed and dated certificatian fi�om an
outreach worker.
Abused or Neglected Children and Youth. Wri�ten, signed and
dated certification from an outreach worker.
license, passport,
other state, local,
it contains eurrent
information abaut the age oj• birth of the possessor. The farm in
Exhibit "E" — Form of Income Self Certi�cation also requires that
patential ciients list their age a.nd certify the validity of the information
provided. This may be sufficient but should only be used as a last
resort with an expjanation in the file case notes indicating why the
formal forins of veri�cation were not available. An eld�rly person is
defined as being at least 62 years of age.
Elderly Persons. A birth cer�tificate, driver's
immigration card, military identi�cation, or any
national ar interna�ianal documentation, provided
6.l .2 A�encies Servin� a General Clientele.
Agency must v�rify all new clients' income eligibility with either So�rce Documentation
or fhe form attachecf as Exhfbit "�" — Farm of Income Self Certifiea�ian. Agency must use
the annual income definition in 24 CFR Part 5.609 to establish client incnme eligibility and must
Use the most current HUD Ineome Gui�eiines. All clients° incaine must be documented, but
only �1 % of elients m��st mee# income eligibili#y requirements described in 24 CFR Part 5.609.
CDBG PSA CONTRACT 2014-2flL5
The Women's Center of Tarrant County Inc.
6.13 A�e��cies Servin� 100% Clientele.
Ageney must �ei°ify income eligibility of a�l Llnduplicated Clients wifih Source
Doeumentatian. Source Docu�nentation must be collected and i�ai��tained ir� Agency files even
if Agency reports inco�ne eiigibility using khe fojm attached as Exhibit "E" — Form of Income
Self Certi�cation.
6.2 Submission of Comiplete Documentation.
Agei�cy must submit copies of all eli�iUility verifieation documentation described in
Section 6.l with Attachment III in each month's Reimbursement Request for all Unduplicat�d
Clients served for the first time, and must maintain copies of such docu�r�entation as required
under this C�ntract.
'�. Additional CDSG Requirements.
Ageney agrees to comply with all requireinents of the CDBG Program as stated in ihe
CDB� Regulations, including but not liinited to the following:
7.l Environmental Review.
CDBG Funds will not be paid, and costs cannot be incucred until City has completed ar�
en�iron�nental re�iew as required by 24 CFR Part 58. The environmental review may result in a
d�cision to pj�oceed with, modify, or cancel the funding for the Program. Fur�her, Age�cy �ill
not unde�•take nr eornmit any funds to physical or choice limiting actions as described in any
applicable Federal reg�alations. Any violation of this pro�ision will (i) cause this Contract ta
terrninate immediately, and (ii) require Agency to repay City the CDBG Funds it has already
received and fa•feit any future payments of CDBG Funds.
7.2 Cantract Not Constitutin� Commitm+�nt of Fund�.
Notwithstanding any proviszon of this Contract, the Parties agree and aeknowledge that
this Contraet does not constitute a commitinent of funds, and that such cotnmitment of funds or
appraval may occur anly upan (i} satisfactory completion of environmental review and reeeipt
by City of an authorization to use gran# funds froin HUD u�der 24 CFR Part S$, (ii) a��rovaj of
City's 2014-2015 Action Plan, and (iii) receipt by City of a grant agreement from HUD.
7.3 Monitorin�.
7.3.1 Agency understands and agrees that City will monitnr th� ad�quacy and
timeliness af Agency's pe�•%rmance under the terms of this Contract as well as its compliance
with the CDBG Re�ulations. Agency is subjeet to such monitoring during the ter�n of this
Contraet and for � years after the Contract term ends. Agency will px•avide reporks and aacess to
Progra�n files as requested by City duj-ing this 5 year pe�•iod. �'�r purposes of this Contract, this 5
year period for monitoring is deeined to begin an October 1, 2015 and end on Septetnber 30,
2020 regardfess of whether ai• not this Coi�traci is earlisr terminated.
'13.2 E�epresentati�es of City, HUD, and the United States Coraptroller General shall
have access during regular business l�ours, upon 48 houcs pcior notice, to Agency's offices and
CDBG P5A CONTRACT 2a14-2015
The Wdmen's Center ofTarrant County l��c.
records pei•taining to the use of the CDBG Funds, and to Agency's officers, directors, agei�ts,
eznplayees, contractors, subcontractors and vendors for the �urpose of such mo�itoring.
'7.3.3 ln addition ta other proaisions of.this Contract regarding frequency of monitai{ing,
City reseives the rignt to pei•form desk reviews o�• on-site monitaeing of Agency's compliance
wit1Y the terms and conditians of this Contract. City shall provide Aget3cy with a written report
of tl�e inoraitor's findings after each manitori�tg visiti. If the ��onitoring report notes deficiencies
in Agency's performance, the reporC sha11 include require�nents for the timely correction of said
deficiencies by Agency. Failt�re by Agency to take ihe actian specifi�d in the monitoring repo�-t
may be cause for suspension or termination of this Cor�tract as provided hecein.
7.3.4 This Section 7.3 shall be applicable for the Contract term and for 5 years
thereafter and sh�ll sutvive the earlier termination ar expiration af this Contract:
7.4 A�encv Procurement Standards.
Agency shall compiy with all applicable Federal, state and local laws, regulations, and
ordinances for making praeucernents under this Contract. Agency shall establish procureitlent
procedures to ensure that rnaterials and ser�ices are obtained in a cost eff�etive manner. When
procuring services ta be pravided under this Contract, Agency shall comply at a i�ninimum with
the procurement standards at 24 CFR Fart 84.40 thraugh 24 CFR Part 84.48.
7.5 Cost PrincinleslCost Reasonableness.
Agency shall administer its use of CDBG Funds in compliance with OMB Circular
A-122, "Cost Princip�es fo�• Non-Proft Organizations", as amended frorn time to time. The
elig'rbility of casts incuri•ed for pec-for��nanee j�endered shall be determined in accordance witk�
OMB Gircular A-122 as supplei�nented by the pravisions af �his Contract.
7.6 Accountin� Standards.
Agency agree� to comply vvith DMB Circular A-ll�, "Unifnrm Administrative
Requfrements for Grants and Agreements with Institutions of Higher Educatio�r, Haspitals and
other Non-Profit Organizations", and agrees to adhe�•e to the accounting principles and
procedures reyuired therein, utilize adequate internal controls, and maintain necessary supporting
and back-up documentation far all costs incurred.
7.7 Uniform Admin��trative Reauirements.
Agency will comply wzth the Unifarm Ad�ninistrative Requirements set forth in 24 CFR
Part 5'1.502 or any reasonably equivalent procedures and require�nents that City may require.
7.8 Ter�ns Anr�licable ta Contractors. Subcnntwactors and Vendors.
Agency understands and agrees ihat aIl terms of this Conti•act, whether regulatoiy or
otherwise, shall apply to any and all contractors, subcantractors and vendors of Agency w�ich
are in any way paid witl� CDBG FUnds or who perfarm any work in connection with the
Program. Agency sHall cause a!l applicable provisions of this Contract to be included in and
made a part of any cantract or subcontcact executed in the performaace of its obligations
het•eunder ineluding its obligations regarding the CDBG Regulations. Ageney shall monitor #he
services and work per•formed by its contractors, subcontractors and vendars an a reg��lar basis for
CDBG PSA CONTRACT 2014-2015 — g
The Women's Center of Tat•rant Couniy Inc.
compliance wiCh the CDBG Reg�lations and Cantract provisions. Agency must cure all
violations of the CDBG Regulatians committed by its contractors, subcontractors or vendors.
City inaintains the right to insist on Agency's full ca�npliance with the terms of this Contract and
the C.DBG Regulations and Agency is responsible for such com�aliance regai�dless of whethe�•
actians taken to fulfil� the requirements of this Contract are talcen by Agency or by Agency's
contractors, subcontra.ctors or vendors. Aget�cy acicnowledges that the provisions of this Section
shall sui�vi�e the ea�•lier termination or ez�piratinn of this Contract.
'7.9 Copvri�ht and Patent Ri�hts.
No reports, maps, or other documents produeed in whale or in part under this Contract
shall be the subject of an application far copyright by or on behalf of Agency. HUD an� City
shail possess all cights ta invention or discovery, as vvell as rights in data, which may arise as a
resUlt of Agency's per�orinance under this Contract.
S. RECORD KEEPING; REPORTING AND DOCUMENTATI�N,
REQUIREMENTS; AUDIT.
S,1 Record Keepin�.
Agency shall �naintain a record-keeping system as part of iCs performance of this Conirac�
and shall promptly provide City with copies af any doeument City deems necessary for the
effective fulfillment of City's monitoring and evaluaiion responsibilities. Speci�cally, Agency
w111 keep or cause to be kept an accurate r�cord of all actions �alce�i and all funds spent, wvith
supporting and back-up docuipentatian. Agency will maintain all records and documentation
related to this Contract for S years after the Contract term ends. If any claim, litigation, or aUdit
is initiated before the expiration of the S year periad, the relevant records and doeUmentation
must b� retained until ail such claims, liiigatian or audi#s have been resolved. For purposes of
this Contracfi, this 5 year period for z•ecord retention is deemed to begin an October l, 2015 and
end on Septetnber 30, 2020 regardless of whether or not this Cantract is earlier terminated.
8.2 Access ta Records.
Representatives of City, HUD and any duly authorjzed officials of the Federal
go�ernment will have full access to, and the right to examine, audit, capy, excer�t andlnr
transcribe any of Agency's records per�aining to all matters co�ered by this Contract for 5 years
after the Contract term ends. Such access shall be during r�gular business hours and upon at
least 48 hours prior natice. For purposes of this Contract, this 5 year periacf for access to records
is deemed ta �begin on Octnber 1, 201 S and end on Septembee 30, 2020 z•egardless of wh�ther ar
not this Contract is eaz'lier Ce�•minatad.
8.3 Reports.
Agency will submit to City all reports and documentat�on described in this Contract in
such form as City inay presccibe. Agency may also be required to submit a final performance
and/or fnal fnancial report if requir�d by.City at the termination of this Contract in such forir�
and within such times as City may prescribe. Failure to submit to City any iepoct or
documentation described in this Contract shall be a« event of default of this Cantract and City
may eXercise a11 nf its reinedies for default under this Contract.
CDBG PSA CONTRACT 2014-2015 �
The Women's Center of Tarrant County Inc.
$.3.1 Additi4nalInfor�nation.
Agency shall provide City with additional informatioii as may be required by state or
Federal agencies to subs#antiate Prograin activities and/or expenditure eligibility.
8.A Chan�e in Renortin� Reauirements and Forms.
City retains the right to change reporting require�nents and forms at its disccetian. City
will notify Agency in writing at least l� days prior to fhe effective date of such cha�ge, and the
Parties shall execute an amendrnei�t to the Contract reflecting such change if necessary.
8.5 Audit.
8.5.1 Entities that Exqend $SOO,DOQ or more in Federal Funds Per Year.
All non-federal entities that expend $500,000 or more in Fec�eral funds within one year,
regardless of the source nf the Federal awaz�d, �nust submit to City an annual audit prepared in
accordance with specific reference to OMB Circular A-133. The audit s1�all cover the Agency's
fiscal years �uring which this Contract is in force. The aU�it must be prepared by an independent
certified public accountant, be completed within 6 months fallowing the end af the period being
aUdited and be submitted to Ciiy within 30 days of its co��pletion. Agency's audit c�rtification
is attached hereto as Exhibit ��C" —"Audit Cert�ficafion Form" and "Audit Requirements".
The Audit Certifieation Fornn must be submitted to City priar to or with the first
Reimbursement Request. Entities that expend less than $500,000 a year in Federal funds are
exe�npt fi•oin Federal audit requirements for that year, but records must be a�aiiable for review or
audit by appropriate officials ofthe Federal agency, City, and General Accounting Office.
8.5.2 Citv Reserves ti�e Ri�ht to Audit.
City reserves the right to p�i°form an audit of Agency's Pragram operations and finances
at any ti�ne during the term of this Contract and for � years after the Contract Term ends if City
deterrnines Lhat such audit is nec�ssary for City's co�npliance with the CDBG Regulatians or
other City policies. Agency agrees to allow access tn all pertinent materials as described herein
for such audit. For purpases oithis Contract, this 5 year periad for City audit is dee�ned to begin
on October I, 2015 and end on Sept�mber 30, 2020 regardless of whether or not this Contract is
earlier terininated. If such audit reveals a questiar�ed practice or expenditure, such questians
must be resoIved within 15 businass days after notice to Agency of such questioned practice o�•
�xpendittire. If questions are not resolved within this perioc3, City reserves the right to withhold
fui�ther funding under this Cont�•act and/or any oiher contracts with Agency. IF AS A RESULT
OF ANY AUDIT IT I� DETERMIN�D THAT AGENCY HAS FALSIF�ED ANY
DOCUMENTATION OR M�SUSED, MISAPPLIED OR MI�APPROPRIATED CDBG
FUNDS OR SPENT CDSG FUNDS ON ANY INELIGISLE ACTIVITIES, AGENCY
AGREES TD REIMBiTRSE CITY THE AMOUNT OF SUCI3 MONL�S PLUS THE
AMOUNT OF ANY SANCTI�NS, PENALTY OR OTHER CHA1tGE LEVIED
AGAINST CITY BY HIID BECAUSE OF SUCFI ACTIONS.
CDBG PSA CONTRAC'T 2Q 14-20 ] S t�
"Che Women's Cent�r ofTarrant County lnc.
9. REIMBURSEMENT REQUIREMENTS.
9.l Deadline for Submittin� Reimbursement Reauests.
9.1.1 Reiinbursement Requests shail be received by the City on ar before the 1St"
day of the rnanth following the month expe�ses were paid by Agency. For exa�nple, the
Reimbursement Renu�st for ]une expenses must be received by July I5. In the event the 15"'
falls on a weelcend or City hoiiday, Reimbursement Requests shall be due �he next day that the
City is open fnr business. Failure to submit a Reimbursement Request in a timely fashion will
resul� in City tal�ing the actians outlined in Section 10.1. NOTWITHSTANDING
ANYTHING ASOV�, EXPENSES FOR SEPTEMBER 2fl1� MUST SE RECEIVED BY
SEPTEMBER 20, ZQ1�, FAILURE TO SUSNIIT A FINAL REIMBURSEMENT
REQUEST BY SEPTEMBER �0, �01� WILL RESULT IN AUTOMATIC FORFE�TURE
OF PAYMENT �F THE SEPTEMBER REIMBURSEMENT REQUEST.
9.1.2 City will notify Agency by e-mail within 20 calendar days if a Reimbursement
Request is ia�cking Complete Documentation or corrections are needed. Agency wi�l have XO
business days irom the date of the e-mail notiee to submit any requested infarmation or missing
documentation. Agency will be penalized in the Request for Praposaj far the 2015-2016
Pragram Year for any notifications received under this Section. If Agency fails to submit all the
re�uired information or missing documentation within 3a calenda�• da�s frain the frst e-mail,
Agency shall forfeit any payinents otherwise due that montl� and failure to submit any j•equested
inforir�ation will be considered an �vent of default as outlined in Section 10.1.2.
9.2 Agency shall prov'rde City with Cvmplete Documentation and the following
repo�-�s as shown in Exhibit "D" —Reimbursement Forms with each L�eimbursement Request:
9.2.1 Attachment I — Invoiee.
This report shall contain the amount reyuested for reimbucsem�nt each month, the
cumulative reimbursetnent requested to date (inclusive of that month's request), and must be
signed by an authorized signatory of Agency. By signing Attac�ement I, Agency is certifying
that the costs are �alid, eligible, consistent with tl�e terms and conditions af this Conti•act, and the
dafa cantained in the repart is true anci car�•ect. This repo�� must be submitted even if Agency is
requesting $0 for a particulat• month.
9.2.2 Attachment II— Expenditure Works�cet.
This report shall iteinize each expense request�d for reimburseinent by Agency and shall
include the Account corr�sponding the expense to a Budget line item. ]n order for this report to
be complete the following must be submitted:
9.2.2.I For payroll �xpenses, timesheets signed by employees ar�d appr�ved
by supex•visor for all pay��oll expenses listed. Ti�nesheets must
distinguish betweetl CDBG-funded time and non-CDBG funded time
and refleet actual titne spent on CDBG-funded activities. Ageney i�nay
not suhmit payroll expenses dated 6Q days prior to the date of the
Reiinbursement Request.
9.2.2.2 For non-payroll expens�s, invoices for each expense listed with an
CDBC PSA CONTRACT 2014-2�015 i 1
'I'he Women's Center of Tarrant County 1�7c.
explanation as to how the invoiced expense pei�tains to the
Program. Age�cy inay not submit invoices dated b0 days prior to
the date ofthe Reimbursement Re�uest.
9.2.2.3 Proof that each expense was paid by Agency, which proof can be
satisfied by cancelled checIcs, wire transfer docu�nentation, paid
receipts or other appropriate ba�iking documentation.
9.2.3 Atiachment III -- Clie�it Data Re�ort.
This repoi•t shall list each Unduplicated Client se�•ved during the month along with his or
her demographic information. The Client Data Report must contain a list of all clients $erved
during the Contract period. In order for this report to be camplete tha foilowing must be
submitted:
9.2.3.1 Documentation of income verification for each Unduplieated Client
th� first tiine ha or she is sei•�ed, which will either be the Souree
Docui�eittation described in Sect'ron 6.1 or the completed form of
Exhibit "E" - Form of Income Self Certifcation. AGENCIES
SERVING 100% CLI�NTEIlE iVIUST FOLL4W THE
REQUIREMENTS SET FORTH IN SECTION 6.1.1.
�.2.� Submission of Reimbursemen� Request.
Reimbur�emenf Reyuests can be mailed or deliver in person to HED Depat�tmeni, 90$
Monroe Street, FQi`� Worth, Texas 76102. In addition, Ageneies can submit Reimbursement
Etequests via einail ta nsa(cr�,fortworthtexas.�ov but in addition Agency must submit a signed
o�•i.ginal of Attachment I and Exhibit "E" — Form of Income Self-Cer#i#�cation to City by the
deadline in Section 9.1.1.
R3 Withholdin� PavYnent.
CITY HAS NQ OBLIGATION TO MAKE PAYMENT ON ANY
R�:IMBURSEMENT REQUEST THAT IS NOT RECErVED BY THE DUE DATE.
Failure t� timely subnnit Reimbursernettt Requests and Complete Documen�ation along
vvith any required reporfs shall be an event of de�ault.
10. DEFAULT AND TERMINATION.
10.1 Fail�ure to Sub�nit Reimbursement Request or Repe�ired Documentation
10.1.1 If Agency fails to submit a Reimbursernent Request in aecordance with
Section 9, Ageiicy shall be in default of this Contract. City will nntify Agency in writing of such
defaUlt and the Agency will ha�e 10 business days fi•om the date of the written notice to submit
such Reimbursement Request to cure the default. �f Agency fails io cure the default within such
tirne, Agency shall forfeit any payments otherwise due that manth.
10. L2 If Agency fails to submit requested inforr�ation or missing documentation as
s�t forth in Section 9.1.2, then Agency shall farfeit pay�nent due that month and the failure to
s�abmit shall be considered an event of ciefault that s�a11 not be cu��ed.
CDBG PSA CONTRACT 2014-2015 12
The Women's Cente�• ofTarrant Coi�nty Inc.
10.I.3 NOTWITHSTANDING THE PROVISIONS OF SECTION 10.1.1 OR
101.2, IF AGENCY FAILS TO SUBMIT THE REIMBURS�MENT REQUEST DIIE
SEPT�MEER 2Q, 2D15, OR IF THE SUBM�TTED REIMBURSEMENT REQUEST FUR
SEPTEMSER �0, 2015 IS LATE, INCOMPLETE OR OTHERW�SE NOT IN
COMPLIANCE VVITH THIS CONTRACT OR THE CDBG RCGULATIONS AS
DETERMINED BY CITY IN ITS SOLE DISCRET�ON, THERE WII,L B� NO CURE
PERIOD AND ANY REIMBURSEMENT WILL B� AUTOMATICALLY �ORFEYTED.
10.1.4 l�i the event af (i) an uncured defauit under Section 1 Q.1.1 or an event of
default under 10.1.2 (ii) more than � instances of default, cured or uncured, under these Sectians,
City reserves the right at its sole option to tecminate this Contract effeetive immediately upon
written notice oi such intent with no penalty or liability to City.
10.1.5 Notwithstanding anytl�ing to the c4ntrary h�rein, City will not be required to
pay any CDBG Funds to Agency during the period that ai�y Reiznburseinent Request, report or
documentatian is past due or is not in campliance with ihis Contract or the CDBG Regulaiinns,
or during any periad during which Agency is ir� default of this Contract.
10.1.b in the ev�nf of termination under this Section 10.1, all CDBG Funds awa.rded
bu� unpai� �o Agency pursuant ta this Cont�•act slzall be immediately farfeited ai�d Agency shalI
have no fur�her right to such funds.
10.2 Failure to Maintain Recards or Submit Reqorts and Documentation.
If Ag�ncy fails to maintain all records anc� docujnentation as required in Section S, or if
the maintained oi• submitted report or documentation is not i� compliance with this Coi�tract or
the CDBG Regulations as determined by City in its sole discreti�n, City will notify Agency in
writing and Agency will have 30 calendar days ii•om the date of the vvritten request to obtain or
recreaie the �nissing records and docuinentation or submit or resUbmit any such report or
doa�amentation to City. If Agency fails ta rnaintain the required reparts ar dacumentation, or
fails io submit or resubmit any such report or documentation within such titne, City shall ha�e
the right to terminate this Contract effective immediate�y upon written nati�e of such intent with
no p�nalty or liability to City.
10.2.1 In th� eve�li of terinination under this Section 10.2, all CDBG Funds awarded
but unpaid to Agency pursuant to this Contract shall be iminediately forfeited and Agency shall
have na further right to such func#s, ar�d any CDBG Funds paid to Agency must be repaid ta City
within 30 ciays of termination. If such CDBG �unds are not repaid t� City within the 30 day
period, Gity shall exercise all legal remedies available under this Cantract.
CDBG PSA CDNTRACT 2014-2015 l3
The Women's Center ofTarrant County Inc.
10.3 In General.
iO3.1 SUb�ect to Sect�on 10.2, ai�d unless specifically pravided otherWise in this
Cailtract, Agency shall be in default under tl�is C.ontract if Agency breaches any term or
conditian of this Contract. in the event that such a breach remains uncured after 3Q eafendar
days following wriiten notice by City {or such other notice period as may be specified herein} or,
if Agency has diligently and confinuousiy attempted to cure following receipt of such written
notice but re�sonably requires more tha�i 30 calei�dar days to cure, as determined by both Parties
mutually and in good faith, Gity shall have the right to elect in City's soie discretion to (i) extend
Agency's Cime to cure, (iz) terminate this Contract effective imir�ediately upon written no�ice of
such int�nt to Agency, or (iii) pursue any other legal re�nedies available to Ciiy under this
Cont�-act.
IQ3.2 City's remedies may iticlude:
1 D.3,2.1 Dii•ect Agency to prepar� and follow
carrying out the affected activities,
timetables and milestones necessary t
activities.
a scheduie of actions far
consisting of schedules,
o implement the affected
10.3.2.2 Direct Agency to establish and follow a znanagement �alan t�at
assigns responsibilities for carrying out the r�medial activities,
10.3.2.3 Rept�ogram CDBG Funds that have not yet been expended from
affected acti�fties to other eligible activities or withho�d CDBG
Funds.
10.3.2.4 Any other appropriate actian incIuding but not limited to any
remedial action legally available sucl� as declaratory judgxnent,
specific �aerformance, damages, tempora�ry oe permanent
injunctions, terin'tiiafion of this Contraet or any other contracts with
Agency, and any other availabl� rernedies.
10.3.3 ln the e�ent of t�rmination under tnis Seciion 10.3, all CDBG F��ds awarded
but unpaid to Ageney pursuant to this Cnntract shall be immediately forfeited and Agency shall
have no fU�•ther right to such �'unds, and any CDBG Funds already paid to Agency must be repaid
to City within 30 days ofthe terr�ination. Failure to re�aay such CDiiG Funds within the 30 day
period will result in City exercising all legal remedies available under this Contract.
I�.4 No Funds Disbnrsed wi�ile in Sreach.
Agency u�derstands and agrees that no CDBG Funds will be paid tti Agency until all
c�efaulis ai•e cured ta City's satisfaction.
CDBG PSA CONTRACT 2014-2015 14
The Women's Center of Tarrant County I�tic.
1 Q.5 No Com�ensation After Date of Termivatiou.
Agency shall not receive any compensation for worlc undertalcen after the daie of the
termination.
l 0.6 Ri�hts of Citv Not Affected.
Termina�ion shall not affect ar term�nate any of the existing rights nf Citiy against
Agency, or whic�a may thereafter acc�•ue because af Agency's defau[t and this pro��sion shall be
in addition to any and all other �•ights ai�d r��nedies a�aila�le to City undet• the iaw. Such
termination does not tertninate any pro�isions of this Contract that ha�e been e�pressly noted as
surviving the term or termination af the Contr�ct. No delay ar omission by City in exercising
any right or remedy available to it unde�• this Contract shall impair any such right or remedy or
constitute a waiver or acquiescen�e in any Agency default.
10.7 Waiver of Breach Not Waiver of SubseQaent Breach.
The waiver of a default or breach of any term, covenant, or condition of this Contract
shall nof operate as a vvaivej• of any subsequent default or breach af the same or any ather tern�,
cov�nant or condition hereof.
10.8 Ci�il. Criminai and Admin�strative Penalties.
Failu�•e to perfortn all the Contract tertns �nay resu�t in civil, cri�ninaI or administratiWe
per�alties, including, but not limiled ta those set out in this Cont�•act.
10.9 T'erminaHon for Cause.
10.9.1 City inay terininate this Contract in the event of Agency's defaUlt, inability, or
failure to perform su��ect to notice, grace and cure periods. ln the event City terminates this
Contract for cause, all CDBG Fuiids awarded b�t unpaid to Agency pursuant to this Contract
shall be imrnediately rescinded and Agency shalI have no further right ta such funds and any
CDBG Funds already paid to Agency in�ast be repaid to City within 30 days of termination.
Failure to repay such CDBG Funds with�n �a aays wi11 result in City exercising all �egal
remedies a�ailable to City under this Contracfi. AGENCY ACKNOWLEDGES AND
AGREES THAT IF CITY T�RMINATES THIS CONTRACT FOR CAUSE, AGENCY
OR ANY AFFILIATES OF AGENCY SHALL NOT BE CONSIDERED FOR ANY
�THER CITY CONTRACT FOA CDBG FUNDS FOR A MINIMUM OF 5 YEARS
FROM THE DATE OF TERMINATION.
1 a.9.2 Agency may tej'minate this C�ntract if City does not pravide the CDBG Funds
substantially in accordance with this Coniract.
10.10 Termination fow Convenience.
In terminating in acoorda�ce with 24 C.F.R. 85.�4 ihis Contract may be terminated in
whole or in pa�� anly as follows:
10.1 D. ] By City with the consent of Agency in which case the Parties shall agree upnn
the terminatinn conditions, including the effective date and i�i the case of partial termination, the
partion to be teri�inated; or
CDBG 1'SA CONTI�P.CTZQ]A�-2015 i5
The Women's Center of Tarrant County Ine.
10.10.2 By Agency upon at least 30 days written notification to City, setting forth the
reasons far auch terminatioal, the effective date, and in the case of pa�•kial termination, the portian
to be terminated. In the case of a partial terininatian, City may teri�inate the Contract in its
entirety if City determines in its sole discretion that the rernaining portion of the Contract to be
perforined or CDBG Funds ta be spent wiIl not accamplish ihe purposes for which the Contract
was made.
i 0.11 DissoIution of A�encv Terminates Contract.
This Contract shall terminate in the event Agency is dissoived or ceases to exist. In Che
event of termination ur�der this Section, all CDBG Funds are subjecf to repay�nent and/or City
may exercise all of its reinedies under this Contract.
10.12 Reve�-sion af Assets.
ln the event this Cantraet is terminafed with or withaut cause, all assets acquired by
Agency with the CDBG Funds including cash, interest payments fr�m loans ar atherw�se, alI
outstanding notes, moi�tgages or other security instruments, any accounts receivable attributable
ta the use of the CDBG Punds, and any real or �ersonal property owned by Agency that was
impro�ed with the CDBG Funds shall autornatically transfei• to City or ta such assignee as City
nlay desi�nate,
11, REPAYMENT O�' GDBG FUNDS.
Al1 CDBG l�unds are subject ta repayment in the event the Program does not meet khe
reguireinents of this Contract or in the CDBG Regulations. If Agency tal{es any action that
results in the City being required ta repay all nr any portion of the CDBG Funds to HUD,
Agency agrees it wYll reinnburse City for such Xepayment. If Agcncy takes any action t�at
results in City receiving a finding from HUD abaut the Program, whether or not
repayment of all or any portian of the CDBG Funds is required of City, Agency agrees it
will pay Ciiy 10% of the C�BG F�nds as liquidated damages. The PaE�ties agree that City's
damages in the ev�nt of either repayment ta HUD being required or ceceiving a finding from
HUD are uncertain ai�� wou�d be diffieult to ascertain and may include an impact on City's
CDBG grant or oiher Federal grant funds, in addition to the fir�ding by HUD ox• a required
repayment of fi�nds to HUD by City. Therefore, the Parties agree that payment under this
Section of 10% of the CDBG Funds by Agenc� to City is liquidated damages and i�ot a �aenalty.
12. CFIANGE IN NOlV-PRUFIT STATUS.
Agency must provide City with w�•itten natification ofany changes ta its non-�rofit status
within 15 caI�ndar days of being notified oF the cha�ge, lf the non-profit status of Agency
changes after the date af this Cantract, City may but is not obligated to, tet•ininat� this Coniract.
City has 30 calendar days ta make such determination after receipt of written notice f`rom
Agency and failure to malce such determinatian will constitute a waiver. In the event af
terminafion under this Seciion 12, all CDBG Funds awarded but not yet paid ta Agency pui�suant
to this Cai�traet shali be immet�iately reseinded and Agency sl�all have no further right ta sueh
fu�ids. Any CDBG Funds aiready paid to Agency rnust be repaid to City within 30 calendar days
of terrnination unde�• this Section.
CDBG PSA CONTRACT 2�1�4-2Q15 16
The Women's Center of Tarrant CounTy Ine.
13. SURVIVAL.
Any provision oi this Confi�act that pertains to auditing, . monitoring, client income
eligibility, record Iceeping and reports, City o�•dinances, flr applicable CDI3G requirements, and
any default and enforcement prov�sians necessary to enforce such provisions, shall survive the
ter�ninatio�i of this Cantract fnr S years after the Contract term ends ai�d shal� be enforceable by
City against Agency. For pur�oses of this Contract, this � year period for surviva� of c�rtain
Contract provisions is deemed to begin on October l, 2015 and end on September 30, 2Q20
regardless of whether or not this Confiract is earlier ter�ninated.
14. GENERAL PROVIS�ONS
14.1 A��ncv an Indeuendent Contractor.
Agency shall operate hereunder as an independent contractot- and �yot as an officer, age�t,
ser�ant or employee of City. Agency shal� have exclusive cantral of, and the exclusive right to
control, the detaifs of the worlc ar�d services performed hereunder, and ali persons per%rming
sa�ne, and shall be solely responsible for the acts and omissions af its offcers, metnbers, agents,
sei°�ants, emplayeas, contractors, subcontractors, �endors, clients, licensees or invitees.
14.2 Daetrine of Resnondeat Sunerior.
The doct�•ine of respondeat superiar shall not apply as between City and Agency, or its
officers, members, agen�s, servants, employees, contractors, subcontractors, vendors, clients,
licensees oi• invitees, and nothing herein shall b� construed as creating a partnership ar joint
enterprise between City and Agency. City does not have the legal right to controi the details of
the taslcs pecformed hereunder by Agency, its offieers, membea•s, agents, em�loyees, contr�etors,
subcor�tractors, �endors, clients, licensees or invitees.
14.3 Agencv Pro�ertv.
City shall under na circumstanc�s be responsil�le for any property belonging to Agency,
or its offcers, members, agents, employees, conCractors, subcant�•actors, vendors, clients,
licensees or invitees that may be lost, stolen or destroy�ed or in any way dainaged and AGENCY
HERESY INDEMNIFIES AND HOLD� HARMLESS CITY AND ITS OFFICERS,
AGENTS, AND EMPLOYEES FROM ANY AND ALL CLA]�MS OR SUITS
PERTAINING TO OR CONNECTED WYTH SUCH PROPERTY.
14.5 Reli�ious Organizati�n.
No portion of the CDSG Funds shall be used in support of any sectarian or religious
activity. [n addition, t1�ej•e must be no religious or membership �riteria for clients of a CDBG-
funded service.
CDSG l'SA CONTRACT 2014-2015 � �
The W omen's Center of Tarrant CounEy Inc.
1 �#.6 Venue.
Venue shall lie in Tarrant Caunty, Texas for any action, whether real or asserted, at law
ar in equity, arising aut of the execution, performance, attempted perfor�nance ar
non-perfor�nance af this Contract.
i 4.7 Governin� Law.
This Conti°act shall be governed by and construed in accordance with the laws of the
State af Texas. if any actian, wheiher real or asserted, at law or in equity, arises out of the
execution, performance or non-perforinance of this Co�tract or on the basis af any �rovision
herein, fQr any issue not governed by Federa! law, the choice of law shall be the laws o�the State
of Texas.
14.8 Severability.
The provisions of this Contract are severable, and if %r any reason a clause, sentence,
�aragraph or otlier part of this Contract shall be determined to be invalid by a court or �ederal or
state agency, board or commission having jurisdiction over the subject matter thereaf, such
invalidity shall not affect ather provisions which can be given eifect withaut the invalici
provision.
14.9 Written A�reement Entire Contract.
This written instxumenfi and the Exhibits, Attachments, and Addendums attached hereto,
which are incorparated by reference and made a part af this Contract for �ll purposes, constitute
the entire agreement by the Parties concez•ning the work and services Co be,pe�'formed under this
Contract. Any prior or contetnporaneaus oral or written agreement which purports to vary the
terms af this Contract shall be void. Any a�nendments to the terms of this Contract must be in
writing and executed by the Parties.
14.1 Q Para�raqh Headin�s for Reference Onlv. No Le�al Si�nificance; Number
and Gender.
The paragraph headings cantained herein are for convenience in reference to this
Contract and are not intended ta define or tn limit the scape of any provision of this Contraet.
When context requires, singular nouns and pronouns include the plural and the tx►asculine gender
shall be deemed to include the feminine or neuter ar�d the neuter gender to ineiude t�e �r�asculine
and fe�ninine. The words "include" and "including" whenever used herein sha11 be deemed to be
followed by the words "without limitation".
14.11 Comnliance With All Apulicable La�vs and Re�ulations.
Agency agrees to corriply fully with all applicabl� laws and regulations that are cu�•rently
in effect aa• that are heceafter amen�ed during the performance of this Cai�tract. Those laws
include, but are not limited to:
➢ CDBG Regulakions found in 24 CFR Part 5'10
➢ Title [ of the Housing and Community Development Act of 1974, as atnended, (42
USC 5301
A Title VI af the Civij Rights Act of 1964 {42 U.S.C. Seciions 2000d et seq.) including
provisions requiring recipients �f federal assistance to ensu�e ineaningful access by
CDl3� PSA CONTRACT 2014-2Q I 5 1 g
The Women's Genter ofTarrant County Inc.
perso�� o�limited Engli�h proficiency
A The Fair Housing Act, Title VIIi of the Civil Rights Aci of 1968 (42 U.S.C. 5ectians
3601 et seq.)
A E�ecutive Orders 1I063, 1124G as amendeci by I1375 aiid 120$6 and as
supplemented by Deparhnent of Labor regulations 41 CI�R Part b0
➢ The Age Discriinination in Employment Act of 1967
A The Age Discrirnination Act of 1975 (42 U.S.C. Sectio�ls 6101 et seq.)
➢ The Uniform Relocation Assistance and Real Praperty Acquisition Policies Act of
I97� (�2 U.S.C. Sections 4601 et seq. and 49 CFR Pa�•t 24) {"URA")
➢ Section 504 af the Rehabilitation Act of 1973 {29 U.S.C. S�ctions 79� et seq.) ar�c� 2�
CFiZ Part S wl�ere appiicable
A National En�ironmental Policy Act of 1969, as amended, 42 U.S.C. Sections 432I et
seq. ("ItiiEPA") aild the �•elated aut��orities listed in 24 CFR Part 58.
A The Clean Air Act, as amended, (42 U.S.C. Secti�ns 1251 et seq.j atid the Clean
Water Act vf ] 977, as amended {33 U.S.C. Sections 125 i et seq.) and the related
Executive 4rder 11738. In no event st�a(1 any amount of the assistance provided
under this Contraet be utilized with respect to a facility that has given rise to a
conviction under the Clean Air Act or the Clean Water Act.
➢ Immigration Reform and Cantrol Aet of 1986 (S U.S.C. Sections 1101 et seq.)
specifically including the �arovisions requiring employer verifications of I�ga� status
of its employees
➢ The Americans with Disabilities Act of 1990 (42 U.S.C. Sections ]210] et seq.}, the
Architectura] Barriers Act of 1468 as amended (42 U.S,C. Sections 4151 et seq.) and
the Uniforin Federal Accessibility Standards, 24 CFR Pa� 4d, Appendix A
➢ Regulatians at 24 CFR Part $7 reIated to lobbying, including the j•�quireme�t ihat
certi�cations and disclosur�s be obtainerl froin all co�et•ed persans
➢ Drug Free Warkplace Aet of 1988 (41 U.S.C. Sections 70I et seg.) and 24 CFR Part
23, Subpart F
➢ E�ecutive (�cder 12549 and 24 CFR Part 5.1 �5(c) pertaining to restrictia�►s on
participation by ineligible, debarred or suspended persons or entities
➢ Section 60D2 of the Solid VVaste Disposal Act, as amended by the �esourc�
Conserva�ion and Recovery Act
A Guidelines af the Environmental Protection Agency at �0 CFR Part 247
� For cantracts a.nd subgrailts for construction or repair, Copeland "Anti�Kicltback" act
(18 U.S.C. $74) as supplemented in 24 CFR Part 5
� Fo�- construction contracts awarded by Agency ii1 excess of $2,000, and in excess of
$2,50Q for other cantracts which invo�ve the einployi�er�t of inechanics or Iaborers,
Sections ] 03 and 107 af the Contracf Work Hou�•s and Safety Standards Act (40
U.S.C. 327A 30d) as supplemented by 29 CFR Par� 5
� Lead-Based Paint PQisoning Pre�entian Act (42 U.S.C. �180I et seq.}, as amended by
th� Reside�itial Lead-Based Paint Hazard Reduction Act of 1992 (42 U.S.C. �851 et
seq.) and i�nplementing regulatians at 24 CFR Pa�•k 3S, subparts A, B, M, and R
� Unifarm Admi��ists�tion ReqUirements of 24 CFR Pact 85
CDBG PSA GONTRACT 2014-201 S � g -
The Women's Center of Tarrat�t County Inc.
14.11 HUD-Ass�sfed Pwaiects and Emnlovme�it and o�her Economic,
Onnartunities; �ectian 3 Reauirements.
14.11.I Requirement that Law Be Ouoted in Covered Contrac�s. — Cer�ain
Reauirements Pertainin� tp Sec�ion 3 of the Housin� and Urban
Develor�ment Act of 19C8 as Amended (1� U.S.C. Sections 1y01 et seq.�
and its Related Re�ulatians at �4 CFR Part 135.
If the Program results in the �reation of raew einpinyment, training, ar conta•acting
Qpportunities on a contractar or subcontractor level resulting froin the �xpenditure of t�e CDBG
Funds, Agency shall comply witi� the following and will ensure that its contractors also comply.
If the work perforined under this Contract is on a proyect assisted uncier a pro�ram pro�iding
direct Federal financial assisiance frain HUD, Section 3 of 24 CFR 135.38 ("Saction 3") requires
that the following clause, shown in italics, be insected in all co�ered contracts ("Section 3
Clause"):
Section ta t�e quoted in cavered co�tracts begins:
"A. The work to be perfor�ed under this contract is subject to the
requir�erraents of Sectfon 3 af I�ousing and U�ban Developme�rt Act of I968, a�s
amenc%d, 12 U.S.C. sectio� 1701u (Secxian 3). The purpose of Section 3 is to
ensur� that emplaymeni �and othe� econornic opportuniiaes generated by HUD
rxssisted oN HUD-as�isted p�ograms cove�ed by Sectio� 3, shall ta. the greatest
extent fecrsible, be directed to lvw- and very-low iracome persons, particularly
pe�sans ivha are recipients afHUD assisttrnce for housing.
B. The pariies io this eontract agree to comply with HUD's regulations in 24
CFR Part 135, tivhicl� irr�plement Sectian 3. As evidenced by their execution of
this c�ntract, the parties to this contract ce�-tify that they rzre under� no contractuai
or other i�pedfinent that woul.d preveni them f�-om. corraplying with the Pa�i 135
regulations.
C. The contractor agrees to send to each labo� organization oY
rep�esentative of �vorke�s �vith whacl� it has a collective bargaining ag�-eement o�
otdze� u�aderstartdi�tg, if any, a�aotice advisang the labor orgarrization o� worke�s'
rep�esentatives of the contractor's commiime�ats u�ader this Sectian 3 clause c�ncl
will post copies of ihe notrce in co�aspieuous plaees crt the wark srte where both
empdoyees and applicants for t�-ctrning ar�d employ�rae�rt positions can see the
not,iee. The noiice shall desc�rhe the S�c�ion 3 preference, shall set forth
miraimurn number and jab titles sub,jeci to hi�e, avarlability of apprer�tr.'ce and
train�ng posrtions, the qualificatians fo� each; and the name and location of ihe
person(s) takirrg applicataons for each of the positlons; a�ad the anticipaied date
the vvork shall begin.
D. The contr^actor agrees fhat �t will i�clude thas Section 3 clause i� every
subcont�act to comply wath regulcrtion i�r 2�4 CFR Pcart 135, and agYees to take
appropriate action, as p�ovided i� a�r a�plicable p�ovision of the subcontract or
i�a tlais Section 3 clause, upon frndi�ag thai the subcorri�actor is in violatXon of ihe
regula#ions rn 24 CFR Par�i I35. The conl�acia� will rrot subca�tract with arty
subcontracto� where it has natice o� knowledge t.hat tlae subcorrt�'a�tor has been
CDBG PSA CONTRACT 2014-2015 ��
The Women`s CenteE• of Tarrant County Inc.
found rn viaJatian af regulations in 24 CFR Part 135.
E. The corrlract.or �rill, cert.rfy that any vactr�at erraplaynaeni positior�s,
including tYainr.'ng positions that are frled: (1) afler the contractor is sedected but
be�'ore the corttrcrct is executed, �rnd (Z) with persons ather. thar� those to whona the
r�gulations of 24 CFR Part 135. The contractar will rrot sx�bco�t�aet ��ilh any
subco�rtractor yvhere it has notice or knowl.edge t�aat the subcontractar has been
,found in violatrora of r�egulatiorrs itx 24 CFR I35.
F. Noncartapliance. with HUD's regulatiorr in �4 CFR Parl 135 rtray Nesult in
,sanciions, terrnination of this cantract for default, and debarment or suspensia�a
fYom futacre HUD assisted cont�acts.
G. With �espect ia work perfarrsaed i�a cannection wr.th Section 3 cave�ed
Indian housing assista�rce, sectrorr. 7(b) af the Indiarr Self-L?eter°mi�ation and
Education Assistance Act (25 U.S.C. ,Secttan 450e) also a�a�lie,s to the work lo be
perforrt�ed under this Contract. Section 7(b) require� that ta the g�eatest exte�tf
feasible (i) preference and oppo�tunrties for trai�aing and employrrrent �hall he
given to Irrdians, atad (ii) preferer�ce rn the award of contracts a�d subcont�acts
shall be given io l'ndian o�gctr�i.zations a�ad I�tdian-owt�ed Economic E�rte�^prises.
PaNties to this contract ihat are subject to the �t-ovisions af Section 3 a�rd Sectio�
79bj agree to canzply with Sectro� 3 to th.e maximum ext.ent feasible, but not in
derogation of catnpliance with Sectia�r 7(b). "
Section to be quoted iu covered cor�tracts ends.
14.11.2 Asencv Resuonsibilities for Sectian 3 Rec�virements.,
City and Agency understand and agree that compliance with the pro�isions of Section 3,
the re�ulations set forth in 24 CFR Part 135, and all applicable rules and orde�•s of Hi1D shall be
a conditio� nf the Federal iinancial assistance provided to the Program binding upon City and
Agency and their respective successors, assigns, contractors and suhcontractors. Failure to fulfill
these requirements shall sUbject Agency and its contractors and subcontraciors and their
respective successors and assigns to those sanctians specified by the grant agreeinent thraugh
whic4� F�deral assistance is provided ai�d to sUc� sanctions as are specified by 24 CFR Part 135.
Agency's responsibilities include:
14.11.2.1 Implernenting procedures ia natify Section 3 j•esidents and
business concerns about training, etnployment, and contracting
oppot-tui3ities generated by Section 3 covered assistance;
l�}.l 1.2.2 Naiifying potential contractors working on Sectifln 3 covered
projects of their respansibiliti�s;
14.11.2.3 Facilitating the training and empIoyment of Seciion 3 residents and
the award of contj�acts to Section 3 busii3ess cancerns;
14.11.2.4 Assisting and acti�ely cooperating with the HED Department in
malcing contractors and slibcontracto�•s coinply;
14.11.2.5 Refi•aining from entering into caiitracts with contractors that a�•e in
CC7BG PSA C�NTRACT 2014-20 LS ��
The W omen's Center of Tarrant Ct3unty Inc.
vialatiar� of Section 3 regulatioils;
14.1 l.2.6 Documenting actions taken to eomply wiih �ectian 3; and
14.11.2.7 Submittuig Section 3 Annual Su�nmar� Reports (Form HUD-
60002) in acco�dance with 24 CFR Part 135.90.
14. I I.3 Section 3�tenortin� R�auirements.
ln qrder to comply vvith the �EC�1011 3 requirements, Agency �nust submit the forms
atfached hereto as Exhibit ��G" - Sectian 3 Re�prting Fornas.
14.11.3.! Repart to the City an a quarierly basis all appl�canfs for
emple�yment, anci all applicants fac employment by contractor and
subcantracto�•. This shali inelude nam�, address, zip cod�, date of
applic�tion, and status {hiredlnot hired) as of tlie d�te of the repo�-t.
14.11.3.2 Adr�ertise available positions to the publ�c for open competition,
and �ravide documentation to City with the Quarterly report #hat
demonstrates such cspen advertisement in the fo1•m of printout of
Texas Wnrkforce Cammission posting, copy of newspaper
adve�rtisement, ctipy of flyers and listing of iocations w�ere flyers
we��e distr'ibuted, and the lilce.
14.11.3.3 Report to the City on a yuai�terly basis all co�iracts awarded by
contracto�• and subcontractor. This shall incfu�le name of
contractor andlor subcor�tractor, address, zip code, and amount of
awaj'd as of the date of the report.
14.12 Prohibiiian A�ainst Discrimination.
1�.12.1 General Statement.
Agency shall eomply in the execution, perforir�ance ar attenipted pea•farmance nf tihis
Contract, with all non-discrimination requirements oi 24 CFR 570.6(?7 and Chapter 17, Article
[Ii, Division 4— Fair Housing of the City Code. Agency may not discriminate against any
person because of race, color, sex, gender, religian, national origin, familial status, disability oi•
pereeived disability, sexual orientatian, gender identity, gender expression, or transgender, nor
wi[1 Agency permit its officers, inei�bera, agents, employees, or clienfs to engage in such
discrimination.
This Coniract is made and entered into wifh reference specifically to Chapter 17, Article
lll, Division 3- Employment P�^aciices of the City Code, and Agency hereby covenants and
agr•ees that Agenc}r, its officers, members, agents, employees and contractors, have Fully
complied with al( provisions of saine and that no e�nplayee, or applicant for employment has
been c�isci•iminated against unciej• the terms of such ordin�.nces by either nr its af�ee�•s, mernbers,
agents, employees or contractors.
CDBG P5A CONTRACT 2014-ZO15 22
The Wamen's Center afTar�•ant County Inc.
14.12.2 No Discrimina�ion in Emnlo�ment dari�i� tihe Performance of This,
Contract.
During the perfarmance nf tlzis Contract Agency agrees Lo the follawing pro�ision, and
will require that its contractors and subcontractors also comply with such provision by including
it in all eontracts with its contractnrs:
[Cont�actor's, Subcdn.t.�actor's o�- Yendor's narsae] will not unlawfull� discrijninate
agaii�st any einployee or applicants for employment because of race, color, sex, gender, religion,
natioi3al origin, familial status, disability or perceived disabi�ity, sexual orientation, gender
identiiy, gender expression or tratts�ender. [Cantractor's, Subcoratr^acior's or VendoY's
name]wil! take affirmative action to ensure that applicants are hired without regard to ��ace, color,
sex, gender, religion, national origin, fami�ial sta�us, disability oi• perceived disability, sexual
orientation, gender identity, ger►der expression or transgender and tlzat employees aa•e lreated
fairly during emplayinent without regard to their race, color, sex, gender, religion, national
origin, familial status, disability or pereeive� disability, sexual orientation, gender identity,
gender expression or transgender. 5uch aetion shall include, but not be liinited to, the following:
employment, upgrading, dernotion or transfer, recruitrnent or recruitment ad�er�kising, layoff or
terinination, rates of pay or other fori�ns of coinpensatian, and selection for training, �ncluding
apprenticeship. [Confractor's, SubeontNactor�'s o� T�endor's r�ame] agrees to post in conspicuous
places, available to employees and applicants for einploytnent, notic�s setting forth the
pro�isions af this nondiscrimination ciau�e.
[Contr�aclor's Subcontracto�-'s or Vendor's name] will, in all solicitations or
adver�isements for employees placed by or on behalf of [Can�acto�'s, Subcontractor's or
vendor's name], state that all qualified applicants wilI receive consideratiQn for employment
without regard ta race, color, sex, gender, �•eligion, national arigin, familial status, disability or
perceived disability, sexual orientation, gender identity, gender expressian or �ansgender.
[Cor�tractor's, S�bcontracto�'s o� Vendor's name] covenar�ts th�t r�either it nor any of its
officers, members, agents, employ�es, or eontractors, while engaged in pe�°forming this Contract,
shall, in conneciion witl� the emp�oyment, ad�ancement or discharge of einplayees ar in
cannectian with the teims, conditions or pri�ileges of their employment, discriminate against
persons because of their age ar because of any disability or perceiv�d disability, except on the
basis of a bona fide o�cupational qualification, retirement plan or statutoiry requirement.
[Co�rtractor's, Subcontractar's or I�endor's r�ame] fiarther co�enan�s that neither it nor its
officers, members, agents, e�mploy�es, contractars, or persons acting on their behalf, shail
speci�'y, in salicitations or advertisements for empinyees ta wo�k on this Contract, a�naxirnum
age liinit for such emplayinent unless the specified inaximwn age liinit is based upan a bona fide
occupational gualification, ret�reme�t plan �r statuto�y requirement.
l�.12.3 A�encv's Con#ractors �►nd the ADA.
in accordance with the provisians of the Ameriaans With Disabilities Act of 194Q
{"ADA"), Agency warrants that it and any of its co�ltractors wiI! not unlawfully discriminate on
the basis of disability in �he provision oi services to the gene�•al public, nor in the availability,
terms andlor eonditions oF einployment for applicants fc�r ernployinent with, oc employees of,
CDBG PSA CONTRACT 2014-2415 23
The Women's Center of Tarrarit County Inc.
Agency or• ai�y of its contractors. AGENCY WARRANT� IT WILL FULLY COMPLY
WITI-� THE ADA'S PROVISIONS AND ANY OTHER APPLICABLE FEDERAL,
STATE AND LOCAL LAWS CONCERNING DISABII,ITY AND W�LL DEFEND,
IND�MNIFY AND HOLD CITY HARMLESS AGAINST ANY . CLAIMS OR
ALLEGAT�ONS ASSERT�D BY TH�RD PARTIES, CONTRACT�RS
SUBC4NTRACTORS, VENDORS OR AGENTS AGAINST CITY ARISING OUT OF
AGENCY'S AND/OR ITS CONTRACTORS', SUBCONTRACTORS', VENDORS' OR
AGENTS' OR THEIR R�SPECTIVE EMPLOY�ES' ALLEGED FAILURE TO
COMPLY WYTH TFIE ABOVE-R�FERENCED LAWS CONCERNING DISABILITY
DISCRIMINATION IN THE PERFORMANCE OF TH�S CONTRACT.
14.13. Prohibition A�ainst Interest / Conflict of Interest.,
14.13.1 Agency shall establish safeguards to prohibit its employees, board members,
advisors and agents from using positions far a Wurpose that is or gives the appearance of bein�
motivated by a desire for private gain for theinsel�es or others, particularly those with whom
they have family, business or other ties. Agency si�all disclose �o City any such conflict of
interest or patential conflict of interest, imrnediately upon discovery of sueh.
14.13.2 No etnployees, agents, consultants, officers or elected officials or appointed
officials of City or oi Agency who exercise or ha�e exercised any functions ar responsibilities
with respect to acti�ities assisted with CDBG funds or who are in a positinn to participate in a
decision-making �rocess or gain ir�side information with regard to these activities inay utilize
CDBG services, niay obtain a fnancial interest or bene�t fror� a CDBG-assisted activity, or
have an inte�•est in any contract, subcon#ract nr agree�nent with respect thereto, or the proceeds
thereunder, either far themsel�es ar those with whom they have family or b�asiness ties, during
their ienure or far 1 year thereafter, unless they ate accepted in accordar�ce with the procedures
set forth at 24 CFR 570.611.
14.13.3 Agency ai'firms that it will adhere to the provisions of the Texas Penal Code
whieh prohibits bribery and gifts ta public servants.
14.13.4 The conflict of interest provisions of 24 CFR Part 85.36 and 24 CFR Part
$�.42, respectively, shall appIy in the procurement of propet�ty and ser�ices by Agency. In all
cases not go�eenad by those Seetions, the provisions of 24 CFR 570.611 af the CDBG
lZegulations shall a�ply.
14.1 Q� Subcontractin� with Small and Minoritv Firms, Women's Business
Enternrises and Labor Surulus Areas..
14.14.1 For procurement contracts $50,00�.00 0�• larg�r Agency agrees to abide by
City's policy to in�olue Minority Business Ei�terprises and Small Business E��terprises artd to
provide them equal o�portunity to coinpete far contraets for canstruction, provision af
professiona! secvices, purchase of equipment and supplies and provision of other set•vices
r�quired by City. Agency agrees to incorpot•ate the City's BDE �rdinance, and all ainendmenis
or successo�• policies or ordinances thereto, into al� contracts anci subcontracts for procurement
CDBG P5A CONTRACT 2fl14-2015 �4
The Women's Center of`�'arrant County Inc.
larger than $SO,ODD.00 or larger and will fw-ther i•equire all persons or e�ltities with which it so
eontracts to co�nply with said ordinance.
14.14.2 lt is national poli.cy to award a fair share of cont:racts to ciisativanta�ed
business enter�arises ("DBEs"), sinall business enterprises ("SBEs"), minority busin�ss
enterprises {"MBEs"), and women's business enterpris�s {"WBEs"}. Accnrdingly, affirmativ�
steps rnust be talcen ta assure that DB�s, SBEs, MBEs, and WBEs are uiilized when �ossible as
saurces ofsup�lies, equipment, construction and services.
L4.1S OtherLaws.
The failure to list any �'ederal, state or Gity ordinance, law or regulation ihat is applicable
to Agency does not excuse or relieve Agency fi�n�n the reguirements or ��esponsibilities in regard
to following the Iaw; nor irom the consequences or penalties far Agency's failure to failaw the
Iaw, if applieable.
14.16 Assi�nment.
Agency shall not assign all or any �aart nf its rights, privileges, or duties under this
Contract wi#hout the prior wi•itten appraval of City. Any attempted as�ignment of same without
approval s�all be �oid, and shall con�titute a breach of this Contract.
] 4.17. Ri�ht to Inspect A�encv Contracts.
It is agreed that City has the right to inspe�t a�ld approve in writing ariy proposed
contracts between Agency and any contractor or vendar engaged in any activity in canjtanction
with this CDBG-funded Progz•am prior to any charges being incurred.
14.18 Fnrce Maieure
If Agency becomes unable, either in whole or part, to ful�ii its obligatipns under this
Contract due to acts of God, strilces, locicouts, or other industrial distw�bances, aets of public
enenlies, wars, b�ackades, insurrections, rints, epidemies, eart�qualces, fi�•es, floods, restraints or
prahibitions by any court, board, depa�-tinent, commission or agency of the United States or of
any States, civil disturbances, ar explosions, oc same other reason beyond Agency's contral
(callectively, "Force Majeur� Event"}, the obligations so affected by such Force Majeure E�ent
will be suspended only during the continuanee of such event. Agency will give City written
na��ce nf' the existence, extent and natuj•e o�' the Force Majeure Event as soon as reasonably
possible ai�er the occur�•ence of the e�went. Failure to give notice will result in the continuanee a�
Agency's obligation regardless ofthe extent of any existing Po�-ce Majeure Even#. Agency wifi
use co�nmercial�y reasonable effor�s to remedy its inability to pei°forin as soon as possible.
15. IIV�D�MNIFICATION AND RELEASE.
AG�NCX COVENAI�TTS A�TD AGREES T� INDEMNIFY, HOLD HARNfLESS
AI�D DEFEND, AT I'I'S OWN EXPENSE, CIT'Y AND ITS O�'FICERS, AGENTS,
SERVANTS AND EMPLOYE�S FROM AND AGAINST ANY AND ALL CLAIMS OR
SUITS FOR PROPERTY LOSS OR DAMAGE AND/�R PERSONAL INJURY,
INCLUDING D�ATH, TO ANY AND ALL PERSONS, OF WHATSOEVER KIND QR
C�IARACTER, WHETHER REAL OR ASSERTED, ARISING OUT �F OR IN
CDI3G PSA CONTRACT 20] 4-201 S �g
The Women's Center of Tarrant Coun#y Inc.
CQNNECTION WITH THE EXECUTION, PERFORMANCE, ATTEMPTED
PERFORMANCE 0Y2 NONP�RFORMANCE OF THTS CONTRACT AND/OR THE
�PERA,TIONS, AC'�IVITIES AND SERVICES OF THE PROGRAM DE,SCRIBED
HEREIN, WHETHER OR NOT CAUSED IN WHO�E OR IN PART, BY ALLEG�D
NEGLIGENCE OF OFFIC�RS, AGENTS, SERVANTS, �MPLOYEES,
CONTRACTORS OR SUBCONTRACTClRS OF CITY; AND AGENCY HEREBY
ASSUMES ALL LIABILITY AND It�ESPONSIBILITY OF CITY AND ITS OFFICERS,
_ AGENTS, SERVANTS, AND EMPLOYEES �OR ANY AND ALL CLAIMS OR SUITS
FOR PROPERTY LOSS OR DAMAGE ANDIOR PERSONAL IN3URY, INCLi7DING
DEATH, T� ANY AND ALL PERS4N5, OF WHATSOEVER KINDS OR
CHARACTER, WHETHER REAL OR ASSERTED, ARIS7NG OUT OF OR IN
CQNNECTION WiTH THE EXECLTTION, PERFQRMANCE, ATTE�VIPTED
PERFORMANCE OR NONPERFORMANCE OF THIS CONTRACT AND/OR THE
OPERATIONS, ACTIVYTIES AND SERVICE� OF THE PROGRAM DE�CRIB�D
HEREIl�T, WT��TA�R OR NOT CAU�ED IN WHOLE OR IN PART I3Y ALLEGED
NEGLIGENCE 4F OFFICERS, AGENTS, SERVANTS, �MPL�YEES,
CONTRACTORS OR SUBCONTRACTORS OF CITY. AGENCY LII�EWISE
COVE�IT�INTS AND AGREES TO ANb DOES HEREBY INDEMNIFY AND AOLD
HARMLESS CITY FROM AND AGAINST ANY AND AL�. �NJ�URY, DAMAGE OR
DESTRUCTI�N OF PROPERTY OF CITY, ARISING OUT OF OR IN C4NNECTION
W�TH ALL ACTS QR ONTIS,�IONS DF AGENCY, ITS OFFICERS, MEMBERS,
AGENTS, EMPLOYEES, CONTRA,CTORS, �UBCONTRACT�RS, INVITEES,
LTCENSE�S, OR CLIENTS, OR CAiISED, IN WHOL� �R.iN PART, BY ALL�G�D
NEGLIGENCE OF OFFICERS, AGENT�, SERVANTS, EMPLOYE��,
CQNTRACTORS OR SU�CONTRACTOR� OF CITY.
IT I� TH.E EXPRESS INTENTION aF THE PARTIES, BOTH AGE1�iCY AND
CITX, THAT TIiE INDEMNITY PROVIDED FOR TH�S SECTION INCLUDES
YNDEMNITY BY AGENCY T4 INDEMNIFY AND pROTECT CITY FROM THE
CUNSEQUENCES OF CITY'S OWN NEGLIGENCE, WHETAER THAT
NEGLIG�NCE TS ALLEGEA TO BE THE SOLE OR CONCURRING CAUSE 4F THE
INJURY, DAMAGE �R DEATH.
AG�NCY AGIt�EES TO AND SHALL RELEASE CITY, ITS AGENTS,
EMPLOYEES, OFFICERS AND LEGAL REPRESENTATIVE5 FR�M ALL
LIAI3�LITY FOR IN�URY, DEATH, DAMAGE OR LOSS TO P�RSONS OR
PR�PERTY �iTSTAINED I1V CONNECTION WITH OR YNCIDENTAL TO
PER�'ORMANCE UNDER TI��S CONTRACT, EVEN IF' TFIE INJ[JRY, DEATH,
DAMAGE OR L�SS IS CAUSED BY CITY'S SOLE OR C`ONCURRENT
i�1EGLIGENCE.
A.GENCY SHA.LL REQUIRE ALL OF ITS CQNTRACTORS A1VD
SUBCONTRACT4RS TO INCLUDE TN THEIR CONTRACTS AND SUBCQNTRACTS
A RELEASL AND INDEMNITY IN FAVOR OF CITY IN �UB�TANTIALLY TH�
�AME FORM AS AB�VE.
CDgG PSA CONTRACT 2�14-2015 2�
The Wame�i's Center of'I'arrant County Inc.
1G. WAIVER OF IMMUN7TY BY AGENCY.
[f Agency, as a charitable or nonprofit organization, has or claims an immunity or
exemption (statutory o�• otherwise} from ana against liability for damag�s or injury, including
death, to persons or property, Agency hereby .expressIy wai�es its rights to plead defensively
such immunity or exemption as against City�. This Section shall r�ot be coi�strued to affect a
governmental entity's immunities under constitutional, statt�to�y or comtnon law.
17. INSURANCE AND B4NDIN�.
Ag�ncy will maintain coverage in the foj•m of insurance or bond in the a�nount of
75,�D0.00 ta insure against loss from tl�e fraud, iheft o�• dishonesty of any of Agency's of�cers,
aget�ts, trustees, directars or einployees. TI�e proceeds of such insurance or bond shall be used to
reiir�burse City for any and all ioss of CDBG Funds aecasioned by such tnisconduct. To
ef%ctuate such reimbursemet�t, such fidelity eoverag� shall include a rider stating that
reimbu�•semei�f for any loss or losses shalI name the City as a Loss Payee.
Agency shall furnish to City in a time�y inanner, but not jater than the Effective Date,
certifieates of insurance as proof that it has secured and paid far policies of commercial
insurance as speci�ed herein. If City has not receiued such certi�cates by the Effective Date,
Agency sha]! be in default of the Contract and City may, at its aption,. terminate the Contract.
Such insurance shall cover alj insurable ris�Cs incident to ar in cannection with the
executian, performance, .attempted performance or nonperfarmance of this Contraet. Agency.
shall maintain, the following ca�erage and limits thereaf:
Commercial General Liabilitv (CGL) Insurance
$500,000 each occurrence
$3,OOQ,000 aggregate limit
Non-Prafit Or�anization I.iabilitv or Directors & Officers Liabilitv
$l,aao,OQQ Each 4ccurrence
$1,000,000 Annual Aggregate Lir�it
Business Autotnabile Liabilitv Insurance
$I,000,000 each accident on a combined single-limit basis, or
$ 250,000 Property Damage �
$ 500,OOa Bodily Injury per person pei• aceurrence
$2,000,0�0 Aggregate
[nsui-ance policy shall be endorsed ta cover "Any Auto", de�ned as autns owned, hired,
and non-awned. Pending availabilit�y oi the above coverage and at �he diseretio� oi
City, the �aolicy shall be the primary responding insurance policy �versus a persanal
auto insurance �oiicy if or when in the course of Agency's business as contracted
herein.
C�BG F'SA CONTRACT 20142015 Z�
The Women's Gent��• of Tarrant County Inc.
Worlcers' Co�npensation Insurance
Part A: Statutory Li�nits
Part B: Employer's Liability
$100,004 each accident
$1D0,000 disease�each employee
$500,000 disease-palicy lin�it
Note: S�ich insurance shal! cover emplayees performing work on any and alj projects
including �ut not limited to consfiruction, demolition, and rehabilitation. Agency or its
contractors shall maintain coverages, if applicable. In the event the �•espective contractors
do not maintain eoverage, Agency shail maintain the caverag� on such contractor, i�
applicable, fax• each applicabje contract.
Additional Reauirements
Such insurance amou�ts sha�l be revised upvward at City's �•easonable option and no more
frequently than once every 1� moi�ths, and Agency shaIl re�ise such a�nounts within 3Q days
following notice to Contractor of such requirements.
Agency vvill submit to City documentation that it has abtained insurance caverage and has
executed bonds as required in this Contraet priar to payment of any monies provided hereunder.
Where applicabje, insurar�ce policies required herein shall be endorsed to include City as an
additional insl�red as its inter�st may appear. Additional insured parties shall include employees,
officers, agents, and volunteers of City.
Any failure o❑ parf of City ta request certi�cate{s) oi insurance shall not be construed as a
waiver of such reyuirement or as a waiver af the insurance requirements thernselves.
Insurers of Agency's insura�ce policies shall be licensed to do business in the siate of Texas by
the Department of [nsurance or be otherwise eligible and authorized to da business in the state of
Texas. Insurers shalf be acceptable to City insofar as their finaneial strength and solvency and
each such company shall ha�e a current minimum A.M. Best Key Rating Guide rating of A-: VII
o�• other enuivalent insurance indUstry standard rating otherwise approved by City.
Deductible Iimits on insurance palicies shall not exceed $5,000 per oceurrence unless atl�erwise
appro�ed by City.
In the event there are any local, federal or other regulatory insurance or bonding requiremants for'
the Progra�tt, and sueh requirements e�ceed those specifiied hei•ein, the former shall prevail.
Agency shall require its contractors to maiiltain applicable insurartee coverages, limits, and other
reQuirements as those specified herein; and l�gency shall require its conh•actors to �aro�id�
Agency with cei�tificate{s) oF insurance documenting such coverage. Also, Agency shall require
its contractors to have City and Agency endorsed as additianal insureds {as their interest may
appear) on tl�eir respective insura�ce policies.
CDBG PSA CONTRAC'I' 2Q14-20i5 28
The Women's Center of Ta��rant County Inc.
Directors aCid Ofiicers Liability cov�rage sl�all be in %rce and may be provided on a claims�
made basis. This coverage may also be referred to as Managein�nt Liab�kity, and sha!] protec#
the insured against claijns arising out of alleged ert�ors in jucigment, breaches of duty and
w�rongful acts arising out of their organizational du#ies, Coverage shall protect not onfy the
entity, but alf past, pcesent and future di��ectors, afficers, trustees, employees, volui�teers and
committee meinbers.
18. CERTIFICA'I'ION REGARDING LOBBYING..
The undersigned represenfiative of Agency here�y cecti�es, to the best of his or her
lcnawledge and belief, that:
No Federal appropriated funds ha�e been paid or will be paid, by or oi� behalf of Agency,
ta any person f�or influencing or attempting t� inf�uence an officee or employee of any
agency, a me�i�ber of Congress, an af�cer or employee of Congress in connection with
the awarding of any Federal contract, the making of any Federa� grant, the making of any
Federal loan, the entering into af any cooperative agreement- and the e�t�nsion,
eontinuation, renewal, ainendment, or modifcation of any Fedara� contract, grant, loan or
cooperative agreetnent.
ii any funds other than federally appropriated fnnds have be�n paid nr wi11 be paid to any
person for influencing or attempting tn influence an oificer or employee of any ageney,
member of Congress in connection with this Federal con#ract, grant, loan or caoperativ�
agreament, Agency shall complete and subcnit Standard Form-LLL, "Disclosure Form to
Report Labbying," in a.ccordance with its ins�ructions.
This c�rtification is a rnaierial rep�•ese�tation of fact upon v�+hich reliance was placed
when this CQntract was made or entered into. Submission oi this certificate is a
prerequisite for making or entering inta this Contract: imposed by 31 U.S.C. Seciion
1352. Any person wha fails to fije the reyuired certifcation shall be subject to a civil
penalty of not less than $1fl,00fl.00 and not more than $IOQ,aao.00 for each such failure.
Agency shall reguire that the language of this certification be included in alj subconta-acts
or agreements involving the expenditure ofFederal fi.�nd�.
19. LITIGATION AND CLAIMS.
Agency shall give City im�nediate notic� in writing of any action, incEuding any
Qrnceeding before an administrative a�ency, filed against Agency ii� conjunction with this
Contract or tt�e Pragram. Agency shall furnis� immediately to City copies af ail pertinent pape�•s
received by Agency with respect to such action br ciaim. Agency shall pro�ide a notice �o City
within 10 days upan filing under a�y bankruptcy or financial insolvency provision of law.
CDBG PSA CON'FRACT20i4-2�L5 29
The Wamen's Center of Tarrant Couniy lnn.
20. NOTICE.
All notices required or permitted by this Contract must be in writing and are cieeined
delivered on th.e earlier date of th� date actually recei�ved or the third day fnllowing deposit in a
United �tates Posta! Ser�ice post offtce or receptacle; with proper postage, certified maii return
receipt requested; and addr�ssed to the ather Par�y at the address set out below or at such other
address as the receiving Party designates by prope�• notice to the sending Party.
Citv:
City Attot•ney's Office
1 Q00 Throck�llorton Street
Fort Wot-�h, TX '�6102
Telephone: $17-392-7600
Copy to:
Hausing and Economic lle�elop�nent Department
1400 T�rockmortan Stre�t
Fort Worth, TX 76i02
Attention: Assistant Director
Te lephane: 817-3 42-75 40
Capy to:
Housing and Economic De�elopment Department
1000 Throckmorto� Street
Fort Worth, TX 76102
Attention: Prograin Caarciinator
Telephone; SI7-392-b342
A�e�acv:
The Women's Cen�er of Tarrant County Inc.
Laura Hilgar�
1723 Hemphill Street
Fort Wortl�, TX 76] 10
Telephone: 817-332-5410
21. AGENCY FIA� LEGAL AUTHORITY TO ENTER INTO CONTRACT.,
Agency represents that it possesses the legal authority, pursuant to any proper,
appropriate and afiicial motion, resolution Qr action passed or iaken, to enter into this Contract
and ta per%rm the responsibilities herein required.
22. COUNT�:RPARTS.
This Contract rnay be exeouted in multiple caunte�•pa�•ts, eaeh of which shall he
considered an ociginal, but all of w4�ich shall constitute one instru��ent which rnay be sufficiently
evideneed by one counterpa�-t.
CDBG PSA CONTRACT 2014-201 S ��
T11e Women's Center of Tarrant County Inc.
[SIGNATUIt�S APPEAR ON N�XT PAGE]
CbBG P5A CONTRACT 2014-201 S 3�
The Womer�`s Center of Tarrant Caunty l�ic.
IN WITN�SS WHEREOF, the Parties hereto have executed 4 dupl icate o�-iginals of this
Cantract in Fort Worth, Tar��ant Coui�ty, Texas.
AT��T: �� �
, ; _ � �'�
0
' b .��J P
it Secr i � _ � $
M&C: GZb 93 ��b$
Date: August 5, 2014 �no�
�
OF FORT WORTH
-- - � -- �
,_�-��� -
ando Costa, Assistant City Managei•
APPROVED A� TO FURM
' � �_ 1�
��
Assistant City Attorney
THE WOME+17d'.� C 1�'.R OF TARR.t�NT
COUNTY T�T.C'. .� ,
B�' - - � � � � —,
- ,
Name: _� .rt, _ � — �� _r. . -�_
Title: " � 4� _ _�
. C _.. -
STATE DF TEXAS §
COUNTY OF T,�ItRANT § � r
T�is instrument was acknawledged before rne an � �, �V - f� , 2014 by
Fernando Costa, Assistant City Manager of the City of Fort �orth, on behalf the City of Fart
Worth. -ti% Y -'
��,. � . �0.. r� 1 i ii��-�l, �t
�'�'�i �l1�4AI;11,FIiRRLINCER . -
�� "��_�.� MkaSiQN EXPlFl�S = No u�lic, State of Texas �
� 1AY CCJ�i
�! -�, .. �:�f ���r�i�t `�, �di8
Y 3 �ii�+' �'�a.+�� . � ,
t�� .� ,,.�
STATE OF TEXAS �
COUNTY OF TARRANT § �
This instrument was ac[cnowledged before me on �J , 2014 by
�, , the of � , a Texas non-profit
corporation, on behalf of said c�•po1•ation. �+�n� C��s.+fr�, �'.��.
.���.,..�. ,,F, ;,
d '�"" MELiSSA A. MA�TiN
�o`�4Y Sye�
•' ��'+�'' '•� Notary Public, 5tate of Yexas
� �vly Commisslon Expires
! ��o;s�g� June i5, 2015 �,
remnN ,
e�,�. ,�. �.�_ .. .. � �
CDBG PSA CONTRACT 2014-2015
The Women's Center of Tarrant County Inc.
/ . � �:�J
Notary ubiic, State of Texa
��i�'�F9�i ����if a "
��� �������',�
�i■ ������ Y�
32
�xx�B�Ts:
Exhibit "A" --Prograrn Summary
Exhibit "A-1" — 201�4 FIUD Income Limits
Exhibit "B" — Budget
Exhibif "C" — Audit Certification Fo�rm
Exhibit "D" — Reimburse�nent Forms
E�hibit G6E" — Form of I�xcame Self-Certi�ication
�xhibit "F" — Stanc�ards for Com�lete Docunaentation
�xhibi� "G" — Secteon 3 Re�aarting Forms
Exhibit "H" — Severely Disabled Certification Fvrm
CDI3G P5A CONTRACT 2Q 14-201 S 3�
The Women's Center ofTarrant County Inc.
THE WOMEN'S CENTER OF TAItItANT COUNTY
Counseling Services for Senior Citizens
PROGRAM SUI�MARY
C�mmunity De�elopinent Block Grant
(CDBGj
�ctober 1, 2014 to Septeinber 30, 20i 5
PERIOD
PROGRAM:
��s,oao.00
AMQUNT
Program wi{I pravide Fort WQrth Senior Citizens {aged 62 and over) with ClinicaI Counselors,
case management, information and referrels, education, and support groups.
CDBG funds will be used to pay for salaries azid fi•inge ben�fits for ernployees whose worlc is
necessary to carry out the dai�y operatians of the Pragram.
The Woznens Center of Tarrant County is located at 1723 Hemphill Stceet, Fort Worth, TX
76110. Services are available Monday thru Friday, 630 am to 8:0� pm.
REGULATORY CLASSIF�CATTON:
1DIS Matrix Cade(s) and Service Categary: OSA Senior Ser�ices
Nationaj Dbjective Citation: LMC Low/Mod Limited Clientele 2� CPR 57D.208{a){2)
Regulatory Citation(s): 24 CFR 57�.201(e)
Based on the nature of the service provided, Agency r�vill mai�tain docuinentation that vei•ifies
that 100% of clients served by the Progi•am are Elc�erly Persons per the Presumed Benefit CDBG
clientele categories and therefore are at SO% of Ai•ea Median Income (AMI) as established oc
defined by the United States Departmen� of Housing and Urban DeveIopment {HUD).
PROGRA.M GOALS:
Pro��de Prog�•am services to approxirnately i80 Unduplicated Clients.
EXHIBIT "A"
PRDGRAM SUMMARY
CDBG PSA CON'TRACT 2�14-2015 — EXHIBIT "A" -- PROGRAM SUMMARY
The V�Jomen's Center Of Tarrant County.
I 30% AM�
I 50% AM1
I 80°/a AMI
EXHIBIT "A-1"
2014 HUD Income Lirnits
2014 Median Fa�niiy.Income - Fort Worth/Arlington, TX*
1 Person 2 Persons 3 Persons 4 Pers�ons 5 Persons 6 Persons
$13,850 $15,800 $19,790 $23,850 $27,91 � $31,970
$23,050 $26,35D $29,b5a $32,900 $35,55a $38,200
$36,�aa $42,150 $47,40� $52,650 $56,900 $61,j001
� Income Li�nits are estabiished and published at least annuafly by HUD
CpBG PSA CONTRACT 2014-2015 —EXHISii' "A-1"-2014 I�UD INCOME L1M1TS
The Women's Ce�tei• of Tarrant County Inc.
'1 Persons
$36,43Q
$�4,800
$65,300
8 Persans
$4Q,090
$43,450
$b9,5�0
�
EXHIBIT "B" - BUDGET
� Accauul �ruui Iludg4l �
,�1}:�11h'�,tiG'1{A'171'l[ 1#101'1Y.11}vL.k'y _
Sa�aries� i 001
� FICA 1002
� LifaInsurance I 1003
� Hea1th Insurance 1004
�Disabifity Insurance 1D05
Unemployment-Statc i ODG
� Accounting 1007
� TOTAI. ADMII�'LSTRATIVE �XPEIVS�S
% Adminisirakive Cost
l Pli��5��t171�R[�S��Pi�CEL --
a ar�es �001 53,462
�F[CA 2402 4,855
LifeInsurance 2003 320
� �lealth Insurance 2004 I S,b59
� Unemployment � 2005 1$9
� Worker's Compensation 2D06 125
�Retirement 2007 390
� u����' s ,�I��'�} s� �vrc�,s r
�r"�ice SupPjies 30D1
� Office Equ�pment Rental 3tl02 I
I iosta�e I 3a03
Printmg 3004
I411�CF;LJ 01 �R �
Constru�c�t�i�u �ding Mate�ials {only i2EACE3) 40Q1
Contracf Labor (City needs copy of contract hePore
expenses can be reimhursed) I 4002 �
� Craft Snpplies 4003
� Field Tnp Admission 6xpenses 4004
I Other Field Tri Expenses (if preanpmved by City) �4005
Faod Suppiies�City needs copy of cantract before
� expenses can be reimbursed) 40D6
'Teaahing Aids , 4fl07
�A�:Ti,TTti' Ah'C! U'1'�I.ITTC'3 - - �
Telepltona 5�01
� Electric 5002
� Gas SQa�
� Water and Wastewater SOU4
5olid Wssfe Disposal 5005 I
Rent (City needs copy of ]ease befare expenses can ha
reimbursed� 5006
� Custodial ervices SOD7
� ltepaits 5008
� Cleaning 5up�lies 50U9
I.IC�Af ELT!�r�?YC[�L�Jk�3��LIV"�UiZAE��L�.. �
Fideiily 9onci or �.uu�va�ent bt�01
� DirecFors and Officers 6002
� Genera! Commercial LiabiGty 6D43
�Contract Accounting 6005
�}�f�ltC'T,{l5Sll�l-,1`�(`Ir . _ I
�Childcare Scho�arshlps 7001
Shnrt-term RenT Assiskance 7002
j Short-term Mort�age Assistance 7003
� Short-term Utilities Assistance 7D04
OTFTER (Progra�n Supplies, Recruitme��i, Mileage,
Training, Membership pues, Client Assistance, Mbsa.,
Database, Suppart Proration)
� 'I'QTAL 75,Ofl0
FUNDI1tiIG A: Contributions, Speeial Evenis, and the United yVay oFTerrant County
FUNDING S: Prograin Fees and Unassociated Organizations
FUI�[DING C: Lease lte�enue ar�d lnteeest [ncame
,� � � c;
.. �.��
1
i
1
1
I �
223,412 �2,d90 58,��2 35�,j26
295 23,897 fl 29,D47 �
45� I 640 397 1,811 �
16,468 4,959 7,542 34,628 �
1,364 0 0 1,553 _
740 122 I 0 987
2�,493 b,560 0 9,443
?.581 j � 2,�&1 !
5,815 5 815 1
125 �25 1
700 I .. _ 700 II
5,535
4,469
2{T6
sto
840
9,424
2;477
6,049
2,553
10�
b50
3,053
2,269
35,479
328,261
17,732
76,000
.
3,899
'a,oao
5,535
4,469
206
sto i
800
9,424
2,477
G,049
2,553 1
; �JO �
6sa �
3,053 �
2,2{}9
�_�
{
s�,��o 1
549,261
CDBG PSA CONTRACT 2014-2015 -- EXHiBIT "B" - BUDGET �
The Women's Center of Tara'ant County Inc.
The following tables are purely informational and were created solely far purposes of praparing, negotiating, and
detennining the reasanableness of the o�erall line item budget an the first page of this EXHIBIT "S" - BUDGET
and are not to be considereci part of the terms and conditions oi this Contract, Contractar may make changes to any
column except the "Position" column in the "Salary Detail" table withaut kt�e City's cansent so lang as the fiotai
amounts charged to the grant do not exceed the line items on the first page of the EXHIBIT "B" - BUDGET."
Ck�anges to the column lab�led "Position" may only be maci� with ihe prior written consent of the Gity.
� Position Name
�Clinical Therapist
Case Manager
I Director of Genera!
� Counseling
� TOTAL
` FICA
� I,ife Insurance
� Hea�th Insurance
Unemployment
Workers Compensation
� R�tirement
� TO'TAL
� Office Supplies
� Office Bquiprt�ent Rental
j Postage
� Printing
� TOTAL
SAI�ARY DETAiL
lZate Annual Haurs
19.23 2,48Q
17.79 2,080
30.05 2,080
FKINGE DETAIL**
Parcent af Payro1l Amaunt
7.65% 29,4�F7
1% l,$11
9% 34,628
0% 1,553
0% 987
1 % 9,443
77,469
Percent to Grant
100%
� 50%
i.94°/a
Percent to Grant
17%
18°/a
Ib%
12%
13%
4°10
SUPI'LIES AND SERVICES
Tqtal Bud�et
2,581
5,815
125
700
9,221
.
MISCELLANBOUS
� Tatal Budget
Contract Labor D
Craft Supplies 0
Facility Fees 0
�Field Trip Costs 4
Food Supplies 0
� Teaching Aids 0
OTHER (1'rogram Supplies, R�cruitment, 57,i i0
Mileage, Training, Members�ip Dues, Client
Assistance, M'tsc., Database, Support Proration)
� TOTAL
57,110
Percent to Grant
0
a
0
0
Percent to Grant
fl
Q
0
D
0
4
Amount ta Grant
- 40,QOd
18,500
4,962
63,4b2
Amount to Grant
4,855
320
5,659
189
I2S
39Q
11,538
Amount to Grant
0
0
0
0
a
Amount to Grani
0
0
0
0
0
0
4
fl
CDBG PSA CONTltACT 2014-2015 -- EXHIBIT "B" - BUDGET 2
The Woman's Genter of Tarrant County Inc.
� Tale�hone
�Electric
Gas
� Water and Was�ewater
�Sofid V�aste Disposal
Rent
� Custodia� Services
� Repairs
j Cleaning 5uppiies
I TOTAL
�
� Fidelity Bond (or Equivalent)
� General Commercial Liability
j Direciors and Officers
� Contract Accounting
� TOTAL
�
Cbiidcare Scholarsh�ps
Short-Term Rent Assistance
� Short Term Mortga�e Assistance
� Short Tercn Utilities Assistance
� Tenant Based Rental Assistance
� TO'T'AL
FACT .ITY AND UT[LITiES
Total Sud�et Percent to Grant
5,535 0
4,469 0
206 0
$10 0
800 4
9,424 0
2,477 D
6,049 0
2,553 0
32,323 - — -
FINANCIAL AND 3NSURANCE
Total Budget Percent to Grant
lOD 0
3,053 0
650 0
2,209 0
6,012
DIR�CT ASSISTANCE
Total �udget
0
0
D
a-
0
Qercent to Grant
0
0
- o -
0
** Piease note that "Fringe Details" calculations include rounding errors.
�mouut ta Grant
0
0 I
0 �
D �
� �
0 � 0
0 �
0 �
Amount to Grant �
0 I
0 �
� l
0 � 0
Amount to Grant �
0 �
0
p I
o —
0
0 �
CDBG PSA CONTRACT 2Q14-2015 -- EXHIBIT "B" — BUDGET 3
The Women's Center of Tarrant Cnunty Ina
EXHIB�T ��C" — Aadit Cerfification Form
[See attached�
CClBG P5A CONTRACT 2014-2015 — EXHIB[T "C" -- AUDCi' CERTI�ICATION PORM
The Wa�nen's Center of Tarrant County Inc.
AUDIT CERTII+'ICATION F�RM AND AUDIT REQi7YRE11+IENTS
Agency:
Fiscal Year �nding:
The Women's Center of Tarrant County Inc.
Sentember 30. 2015
[� During the fiscal year in which funds will be received, we wifr exceed the federal
expenditure threshold of $500,0�0. We will have our Single Audit or Program Specific
Audit cornpleted and will submit the A-l33 audit r�port within �even (7� months after the
end of the audited fiscal year o�• thirty (30) days within its coinpletion, whichever is the
ear�ier date.
❑ During the fiscal year in which funds will be r�ceived, we wiIl not exceed the $500,000
federal expenciiture threshold required far a Single Audit or a Program Specific Audit to be
performed this fiscal year. (Fi11 out schedt�le below)
F��lei•��i T',Z�1L`11[.Iiftit"L` E)iael�r�ur�
��'1E15'�' Fre fillcd ���t if �3r��lc llx�ilil c��' i'rn���t�� fl�t�fi� i� I���'I' reqtiircci,
P��s�'f-ltrnu�l� Pru�ral�� �Jsit�e8c �.c�Mry�roct Er:�c�tdilk��'�s
��e�er�t� (:Rr��nt�r �:;�ni��` ['I�{C3A Nu�titikr�:r l�lu�nb�.r � -- - -
Total Federal Expenditures for this Fiscal Year: ,
� � ' � �� �r�
Y Signd�.� a it[e
,
r � � r ��
Date
Failure to submit this or a similar statement or fail�re to sub�-nit a completed single audit pacicage
as described in �he federally required audit requit•ements described in OMB Circulars A-133 by
the requii•ed due date inay result in suspension af funding and may affect eligibility for future
funding. Notwithstanding the abave, this eertification acknowledge� the agency's
camrnitnner�t to rr�eet all other �nancial reporting, famancia[ sta�ements, and otl�er �udit
requirements as may be set fort� in the Contract.
CDBG PSA CONTRACT 2014-2015 — EXHIHIT "C" — AUDIT CERTIFICATION FORM 2
The Wo�nen's Center ofTarrant County Inc.
Exhibit "D" -- Repart'rng �'orms
[See attached]
CDBG P5A CDNTRACT 2Q14-2015 Bxhibit "D" -- REIMBURSEMENT FORMS
The Wnmen's Center of Tarrant County lnc.
Attachment I
Agency:
Address:
City, 5tate, Zip:
Program:
Period of Service:
INVOICE
The Women's Cent�r of Tarra�t County Inc.
'f723 Hemphill Street
ForE Worth, TX 7611 D
Counseling Ser�ices fior Senior Citizens
Pr��rz;:�
Afri^:�n# �
This Inv���e Cu� ^a:tWtive t� l�at� ;
Agency's Certification: I certify tnak the costs incurred are valid and
consistent with the terms and conditions of the contrac# between City and
Agency. By signing this invoice, I certify that to the best of my knowledge
and belief the daia included in this report is true and accurate. It is
acknawledged that the pravision ofi false information could leave the
ce�tifying official subject to the penalties of federal, state, and local law.
Signature and Date:
Name:
7itle:
CDBG PSA CONTRACT 2014-2015 Exhibit "D° -- REIMBURSEMENT FORMS
The Women's Center of Tarrant County Inc. 2
Attachmentll
City of FaR WoRh
Housfng and Eeonamic �evelopment �epartment
Expenditure Worksheet
Agency:
Program;
�Ni�+`�� jII+��'v� ih�e �i �ky lef8u��! tBtFes IsS� 1'7Es Ph7�le111
The Wamen's Cenker of Tarrant Countv Inc.
Counsellrt57 Services for Senior Cltlzens
please group llke aeeaUnt eodes.
��f�R �V 4.M4Gk �4
i
2
3
4
5
6
� r
8
9
I 10
� 'l i
I 12
i 13
� 14
I 15
I 16
I 17
I 1S
� 19
I 20
I 21
I 22
I 23
I 2a
� 25
I zs
� 27
I za
I 29
� 30
I 31
I 32
� 33
I 34
I 35
I 3s
I 37
I 3s
� 38
I 40
I a1
I 42
I 43
� 44
I 45
� 46
I 47
I 46
I �4
I 50
I 51
I 52
I 53
I sa
I �
I 55
57
5B
59
60
Tatal
FaPwi
�yccau��r GOdo I
13ea !S� ia k19R{1 M�oMi �l
�
�
�
b�uW��.
'Payrall must idsntify emp�oyee. Rent must identiiy tenant. Ofher payments should identify indiuiduels, i( applicable.
ExPPrs� �ina ryam
n6�NI�tRATLUE � Hi1R4�R Unl4 E
eia���s
I FICA
I Llfe Insuranne
I FEealth Insurance
I Disa6illtv Insurance
I Unemqloyment-Siate
I � yc-al R Accountin.�
�RflLsFiAIA P�FC6�SNHEL
I 5alari�s
I FICA
I Life Insursnce
I Haalth Insurance
�llnemn[oYmen!
Warker's Compensailon
Relireinent
15llN�u�6 Atlo RE�S+IL�s
pffce Suq Jies
q�flce Eau�pment Rental
post�e
Printinq
%�4L°iLAi�P_4k�6
Cortference & 5aminars
Canslructionl9uildinp Materials
Cnntract Labor
I CraR Suppl�es
� creait Reports
1 Faclllty Fees
I Field Tria Casts
I Food Suoolies
I Milea�e
I Teachin(�. Aids
I�l�IC.ITY �k14 UiILITJlS� - --
I �relephone
I Electric
I Gas
� Water and Wastewater
I Solid Waste �fsposal
I Rent
Custodial Servlces
Rey airs
Cfeaning Supplies
��GA FIN,4�l�F.�L, ANa �NSUAANCE
F�deutv Bontl or�quivalertt
I Direetora and Officsfs
I General Comme[cial Llabilitv
I Les�al Fees
� Contract ACeounl�9
� i care Schola s�y s
I Gounselin4 - Individual 5essians
I Counselina - Group 5essions
I Short-lerm Reni Assistance
I 5hoR-lerm hhortaage Assisiance
I Short-tarm Ulilities Rsslstance
�Tenanl Based ReMaf Assistance
C,yPiTA�.174TI.kY
Fumiture, Fixtures
Compulers
Difica EQuI ment
SpOT� 811d �BCfaB11oR EqS1lpRle(1l
A�couail �
�
100i
�aoz
i6�3
i004
3005
�oos
1007
2001
2002
2Q03
20D4
2006
2�06
20Q7
:iaD1
3002
3463
�naa
4UU1
4002
4408
4004
4005
40Q5
nan�
40Q8
4009
AOtO
5a41
5002
5RQ3
5�4
5005
5006
5007
5008
5009
6001
6002
6003
8004
6005
�oo�
7002
70a3
700a
7005
7�R6
7407
SQ01
$002
8403
80Q4
C�BG PSA C6NTRACT 2014-2015 Exhi6iF "�" — REIMBIIRSEMEN7 FORNFS
Ths Women's Center of Tarrant Caunly, Inc.
ATT III
11NOl1PLICAT@0 CLI�dT DATA REPORT
p.gencY: _
Progrem:
Month:
�Is rtpwt+n m� m Ine all u�W�p.tumt iho�a srr+.d tl��rr � ra caiU.� C{ar 14clndcr � 3ai� 77�n�i.in6ni '0� :7,i1. C�rn ironM� F�caoo veu ry n.w. prv�lo-�i��y �mn.�yv� �lon� Y_M.Sr! �ix= am[h el�glhirrf Ccc��m.ry�i� iur u'�h new �%im�l� rrw r�'h'�ioa2d'
11�3[FIIGt�44=5' -16nr.d�cd�tllurJn�ln+�pmr4-i�ly,.nork�a�aaYw�Oksx2er.�ll�=�r�ILQay.U�l.�lmua�r'rllc=u.-r..�i�m�.�i�4y�.r�`sin�entlilhaliheim-.:rn.�Yr.a.�r`r.i���:anLcaRanxxL �n,.�.on�o�r�r,J�Plcrc•x+Cs_Ihn!'w�Y••"Iw4oitw2lrre:
v+r rirtr-'ii'i�i9d�4Prrr.i.ria=o�ra�lnra^G�'rc�omo..s��ni�kYrict�tic
�rx nlhni�. ' _� a�� i�i�aley¢ One� qk�6i.d � Hi.InW+� r"3k �,
�Indwale 4na� {8���y rha7�a I[{ Yx t��umnr� nnJl�w O��ni �
;5,n�om. C�w� �7ntllr.d[ Onn� _ _ _
.. __— — . . ;saTrS� S�.BC?4
- c�+,j;ui ;rn klh -3GFnJihi
raara � S;mM,Stldrnx hGs �x�i� MiSu.t'.1��1 y �) 3G} _ �i'1�'= �AE.i�".
�1J7�?+�� �*// ti.�e..'_'
1.1l�• fnri4 ' PIrC= Ya N4 "+�+� I� }j:1�'Y2��:.��a. i�+���i, i_`L' 'fn� hii
Flm.e �1T�=u ' r,aalr CCN� iG�Y Ta����t9Od S#S�hY ll(��� ��
1 � �i�r-,�n �i.wali� ��annr 8�d�vi i FIn1�r Ih�fyr c��i5�.�+i�zii] 565o'J'l.l'�5�9/�
I ���duiR �14d�,r ���Ci�n� na�.�r hV.�.�i 'r?d9avc �Ra=a �-}�,;G�7J� ip1 F.+Si11U� �*5'S�1Y�
N`.iF ,4ia�Yan AFz�� P 5= *ha+�e kf�no�pme�ldnlork�ii�n'Ger.ai�e� �'d=t�•nn �G�q 1y� hS95��'t59�3[G
__ . _ rt�ae�z Ni.rmr. �Llx. ,+alni J�nim� . h'�r 'r.��i�r rtlY.TIG_ Sy.M�__ •��r!•�k��,cm.ii��r.� fn�' . .. IcE7fi�'{4�drt1?_{[ 'p�i��i8i �SBp�tr= _"
t � !
2 �
3
4
5
5 �
i _
l
. _ _ _ I
Exl►ibit "E" — Income Certificatian Forms
[See attached]
CDBG PSA CONTRACT 2014-2015 -- �XHIBIT "E" -- INCOME CERTI�'ICATION FORMS
The Wornen's Center of Tarrant County Inc.
The Women`s Center of Tarrant County Inc.
CERTIFICATION UF INC�ME STATEMENT
Applicanfi Name:
Current Address:
Phone #:
Household Members and Inco_me
�7ncluding At�plicant)
Last Name First Name Age Monthly Source/Employer Name
Incame
*�PERSOI�IAL INFORMATIUN: (Checl� one in each item. f3ptiona! Information for Federal Reporcing Purposes)
�. ❑ M�,� b. p w�r� ❑ BL�crcia�Rrc�v �iucarr ❑ BLAc��iucArr .v��ucarr & �TTE
❑ FEMALE ❑ AMERICAN IND7ANIALASKAN NATIVE ❑ ASIAN
❑ AMERICAN INDIAN/ALASKAN NATIVE & WHITS ❑ ASIAN & WI�ITE
❑ NATIV� HAWAlIAN10'I'H�IL PACIFIC ISLANDER ❑ BAI.ANCEfQTi�R
❑ �1MERICAN INDIAN/ALASKAN NATIVE & BLACK/AFRICAN AMERiCAN
c. ETHNICITY d. DISASLED e. IS CLIENT WOMEN HEAD OF HOU5EHOLD
❑ HISPANIC ❑ YES ❑ YE5
❑ NpN-HISPANIC ❑ NO ❑ Nq
* TOTr1L NUMBER OF HOUSEHOLD MEMBERS (Include Yourself AND everyone who livas in the house.)
Total Anticipated Annual Household Incame:
Certif cation:
I certify that the information T am providing is true and cauld be subject ta verif cation at any time by a third
party. I also acknawledge that the provision of false inforrnation could leave rne subj�ct to the penalties of
Federal, State and lacal law.
WARNING: TITLE 1S� SECTION �.DO� OF THE U.S. CODE STATE5 THAT A PERSUN I� GUILTY OF A FELONY
FOR KNOWINGLY ANIi WILLINGLY MAKING FALSE OR FRAUDULENT STATEMENTS TO ANY DEPARTMENT O�
THE UNITED STATES GOVERNMENT.
Signature of Applicant Date
�-��---�----�-For use hy A,�eney staff only-
Ho�.sehold �ize: Gross Anntsal Iz�cazne:
Applicable Incame Limit: Is Applicant Eligible?
Check if Applicant refused to prav�ide demographic information: ❑
Staff Assessment of Demographics:
Person Ma�cing Determination: Date:
NOTE: Address, income amounts r�nd sources for ALL household members a�e required.
CDBG PSA CONTRACT 2014-2015 -- EXHIBIT "E" -- INCOME CERTIFICATIQN FOAMS 2
The Women's Center of Tarrant Caunty Inc.
The Women's Center of Tarrant County Tnc.
CERTIFICAC�ON DE DECLARACION DE INGRES�S
Nombre del5olicitante:
DamiciIio Actual:
Nurnero de Telefono:
Miembros e� el Ho�ar e In�resos
(Iucluir eilla solicitante)
Apellido
Nombre Edad Zn�'�so Fuente de Ir�g�'esQslNombre de Empleac�or
Mensual
*'�INFORMACI(SN �ER50NAL: (Seleccione uno en cada categaria. lnformaciGn opcional para propbsitos de informaci8n Federal)
a. ❑ NTASCULINO b. � CAUCr�SICO ❑ NEGRO/AFRICANO AMERICANO
❑ NEGRO/AFRICANO AN[ERiCANO & CAUCASICO
❑ FEMININO ❑ IND10 AMEAICANOIIVATIVO DE ALA3KA ❑ ASTA'I'ICO
❑ INDIO AMERICANO/NATIVO DE ALASKA & CAUCASICO ❑ ASIATICO & CAUCASICO
❑ NATNO HAWAIANO/OTRO DE LAS TSLAS PACIFICAS ❑ BALANCE/�TRO
❑ INDIO AIvIERICAN0/ NATNO DE ALASKA & NEGRO/A�'RiCANO AIvI�RICANO
c. BTNICIDAD d. DISCAPACITADO e. �ES �L SOLICITANTE UNA MUJER Y CABECERA DEL HOGAR7
❑ HISPANO ❑ SI ❑ SI
❑ NO-HISPANO ❑ NO ❑ NO
° NLJMERQ 7'OTAL DE MIEMBROS EN EL HOGAR
Ingreso tatal del hogar anual anticipado:
{Incluye a si misma y a todas los que viven en la c�.sa)
Certificacibn:
Certifico que Ia informacion que proporciano es verdad y podria ser susceptibl� a la comprobaci6n a cualquier
tiempo por terceros. Yo tambien reconozco que 1�. provisi6n de informaci6n falsa me podria dejar sujeto a las
penalidades Federales, Estatales y locales.
ADVERTENCIA: TiTvi,o 18, SEccio�t l.Q�l D�L Conico D� EE.UU. QUE UNA PERSONA ES CULPABLE DE
UN DELITO POR SABER Y VOLQNTARIAM�N'�'E HACER DECLARACTON�S FALSAS O FRAUDULENTAS A
CUALQUIER DEPARTAM�NTO DEL GOB�ERNO ESTADOUNIDENSE.
Firma dei Salicitante
��--o-_-�----�--Parr� use de em�rler�dos de la rtge�aeia-�-
# De Miembros de Familia: Ingreso Anual:
Limite de Ingreso: �Es solicitante elegible? :
Compruebe si el solicitante se nego a dar su informacion personal: ❑
Evaluacion del empleado sobre info�nacian personal:
Fecha
�
Persona haciendo Ia detern�inacion: Feeha: _
Note: La direccion de la ccrsa y los ingresos (y sus arigenes) para iodos miembras deI hogar son reqxreridos.
CDBG PSA GONTRACT 2014-2015 -- EXHIBT'F "E" -- INCOM� CERTIFICATION FORMS
The Women's Center of Tarrant County Inc.
Exhibit "F" - Sfandards for Complete Documentation
LSee attached]
CDBG PSA CONTRACT 2014-2015 Exhibit "F" -- STANDARDS FOR COIVIPLCTE DOCUMENTATION
The Women's Cente�� of Tarrant Cnuiity 1�1c.
�014�2015 Dacume�tation Standards for
Public Serviee Cantiracf Ex�enses
� I I
: .¢ ' � n
tl+�Hq•I I+�F IlwmF 4 �`' - u' `�
Em�loyae Salarias =n[ �B�e �ts
Salarle5 �X X'�
FICP.lMedicpre
LiFe Insurance
HeaElh Insurance
�ise611ify Insurance
,i �
� r�
on
� E �
S
� 2 � °e
��9E
�y �
— o
4 f � �
,11uMidO�ei
��11 an BmplUyeu ++ofks salely wHh ConlrarA alsgihle mienls and solely 4n Cnnlracl elrgiule Items, ll�en 1he employee's entlfe Saibsy is eligible for
reimhuFsemenl, Twice In each calentlar year, [he al#enl musl suA�fl a wr0.len stalemenl verlfyinp lhat Ihe ahoVe condillons are sIIN frue. The
slalement must eiso he signed 6e a pecsan auth4fized to slgn on 6ehalf oi lhe aA¢ncy.
Ifan employee warks nn a YBiiely oF pfugr8ms, prworks whh a mixlure of Cantracl eligi�fe clients and non�aligible clienfs, ihan Iha Cl1y will only
fe�mburse TPf a reasoqable portion of the emplayee'sselary. Each feimbursamenl feque5! musf include na1 anly Ihe employe9's HmnsheeE, �ul also
a work Ing tifBaking oul lhe employee's liirte by projaCl oI eclivlly. Fo� smplayees peid with mullipFe f�ntling source5, tlmeshBats �nust rellec� aU
funding saurces_ Ifseparets tlmesheets a�e kepl fa� eaeh funding source, sll such limesheats musl6e sudmitked In Cily.
'If employeei are pefd by tlifect ticpnsi� eal�er than check, then the e8ency musL submit 4oth lha direcl deposd paymenl company's repart (svch as
an A�T repart) and a bank slalement or check showing peyqlenifo Ihs direcl deposit eompany, _
f[ lhe City peys gross salery, ihis Is already I�cluded. If ihe C71y pays I�e employer padion, then the empfoyer must show a calculeGan and
documanletlan of how 1ha �nva�ced amount was calcu�efetl, and ineWde tlucumerttalion shyy'�Ing upvrqent.
tl lhe CRy peysgmss salary, this is already InClutlatl. Ifwe pay Ihe employer portlan, Ihen Ihe Bmployer musi si�ow a calculalion end tlocumenlalloa
aTBaw Ihe involced amoun[ was aalcula!¢d, musl Include an Invoice from the tnsurer, and m�sl Inclutle tlocum¢ntadon showing paymenl.
I(Ihe Ciry paqs grass salary, lhis is already includad. IF we pay lhe employat poAlon, Ihen Ihe empluyer musl show a celoulalian end tlnqumenlallan
af how Ihe Invoiced emounl was calcu�eted, must inclutle sn Invoice irom lhe inwrer, artd must Include documenlalion shawfAg payment.
Iffhe Cily pays gross salary, [his is already included- Ilwe pey the emplayer poRian, lhen Ihe eniployef musi shaw s calculeliart and dowmentatlan
of haw ihe Involced amaunl was Calculaled, musl include an involee from Ihe insureP, and must IneSude�documenlelfon showing payfneM.
I Unamployment If the Ci1y pays gross salary,ln3s is elreetly included. lf we pay lhe employer poHion, then the employer musl shusv a calculalfon and dne�menlal3on
Ipsurance nf hew lhe Invpiced amauntwes cafcuFelad, and h1u51 �OClutle tlocumBnE8lion e awlqp pay�qnl.
Retirement IF we pay gross salary,lhls Is already �nclutled. If we pay Ihe employer portimn, �en ihe employer musl shnw a ralCulatlan end documenlalion aTi�aw
the invaieetl amaunl was calcUfeted, m�s1 antl include daeumentation shawing paymen[, and pr3orla Ih¢ first reimbursement, muel Indutle Ihe
pers6nnel poliCy YegaMing rellrement 6ene€tls. _
�Prafesslooal Services k
I Accounflng IX IX I I �ri I1f en aUdil IS req�ved hecause IeJ��� hmas exceed 550Q,Q06, tnen tlte cosi s6vuld 6e spkd evenly by alllederel Funqifrg sources �
E�penses
IMa enals EQuipme it, Goods an S i pEies ,__ .
I amoe �uqp�es X X � - '
I Offca EqulpmeM 1( X X -
Rental
Pv9laga IX X X 7he agBM1cy should meirtain inTnrmellan re8ertling mallouls. If Ih0 agnncy pas a PNney Bowes machirte or tlke Roslage machine, Ihe �ecordg oilhal
meChine musl Ge pn file. Likewise, 3f mall is categqriz0tl hy payment source, lhen lhase recards musl Ce an file. Fof lefge ma;louis, !he egeney
shnuld keep a copv of lhe 1e11er a� a Gsi of all atltlfBssees.
1
�PrinEing X X X -
IConsE�uCtlnn & X X This cal¢gory Is oniy evs
Buildfnp Ma[edals
Spuh and X X % -
Recf9el7an
E�9Jlipment
� CleenfnA S�,plles X X % -
� Teaching A s %% x -
I CreflSwolles % X X -
I Food Suuplles X X % __
�Travel and Fleld T�1 y
FieM Trip X In atltlXlan ta admissi4n
Atlmfission rautlne purchaxes en al1
E�penses
�Rei�, {j�iliiias � �W : v^.. .�. ;Ca - li'iiw i.�ii�mii �� cH P�nsoY are pb:0
I telephone X uX{y -
I Gas X X -
WaFerMJaslewaler X % -
EFaclric X X -
so�id vvasce x x -
�I� �psal
Fadillly X X X -
Maint�nar+ca and
Rg )rs
leble !or REACH. 1
1
1
1
1
— - -- �
ocpanseg, lood expenses wiA afso he allrnvetl so long as the agency has a wri[[en palioy s[aUng Ihat fobd 8nd ddnks are I
leld Irips, notjusl Cantracl-[unded fleld Idps.
fn� i fieF111Y Ib1i11 aF us.ed Ip� u�ler pvfpale3 t�esitl:6 IFiV �'a ;,Fa�q R�68f@ni, U,eh 1nff hils rnust Ue�
_ _� . '
1
i
� Cu5ladial5ervices X X 11servlcesarepravltledReraconifacl,agBncYWillprovFdeconiraciinsleatlofinw€ces.
� Rent X X -
�Nk3scellaneaus
� ConlraM La6or
I fnsurence Requlre(� X
UntleHhe Canlracl
I GllFklcare
Scholarships
CNy requfres lhat the agency suGmlt IEs fee schedule, showing a breekuul of incoma lavels, and Tar each leval a 6reakoul aTlhe portlao af Ihe
expBnse fo be paM Dy lamily and lhe podinn to 6e relmbursed by the Cdy. This Tee schedule is requifnd pderlo Ifie 13rs1 paymeni. We alsn require
Ihe income a0g161$y af eeoh householtl so lhal we can de[ertn�na iF we a1e 6eing changad in caniarmance wi[h the lee schetlula. If Ihe [ee schedule
changes al any time d�dng 1he eonlraG year, lhe aganey musl qopfy CNy and pfovitlg e new schedule wilhin 30 days af Ihe change.
'PfD4f of p9yRleqt Bf(BCflV6 Ocfabe� 1, 2414' Peymenls or Expenses musl be dacumented in lhe Tollawing manner:
� Ay Image af Ihe chesk ANO pank sletemenl s�awing [he check cleared lha bxnk; OR,
Bp Image a! 1he cancelled eheck (eu. A1 end aT 6enk 9latemenq; OR,
G) Paywll "AdVaee' of SEafement ANO Bank SWtemenl Indlcating pay�ol4; OR,
O) Por wlre or e-irensfers: Reciept ar sEatemenl tmm payaelvendof O[2 henk slalemenl.
Cbg�G PSA CONTItACT 21I1J-2Uli Exhi6i[ "F" --STAN�ARRS FOR COI4iPLL'fB �OCUMETd7ATIfiN
The lVonicn`sCc��lc� ofT7mml Couuly hrc.
EXHIBIT "G"
SECTION 3 REPORTING FORMS
[Se�e attached]
CDBC PSA CONTRACT 2014-2015 -- EXHIBIT "G" — SECTION 3 f�EPORTING FORMS
The Women's Center o�'Tarrant County Inc.
. �ec�ion � ��ern�a� R�por�
Economic Opportunities for
Low — and Very Low-Income Persons
U.S, Dapartment of Housing
and Urba� Deveiopment
qffice nf Fair Housing
And Equal Opportunity
Exxls�T �����
OMB Approrral No: 2529-QQ43
_ (exp.1113012D10)
Huo Fieia orrce: I
SecUon �ack of page for PublicRepor7ing Burden stalarnaM
i. Reclpient Name & Adtlress: (street, cily, state, zip} 2. Federal Idantiircalion: S9��nl no.} 3. Total Amounl o! Award:
A. Conlact Persan 5. Phone: pncNtla area coda]
6. Length af Grant: 7. Raporting Period:
8. 6aie Repor! Suhmified: 9. P�ogram Code: (Use saparaie sheet 10. Program Name:
!or each program wdej
Part I: Employment and Treininq {" Columns B, C and F are manda ory felds. Include New Nires in E S�FI
A B C D E
Numi�er oi Numher of New %of Aggregale Number °h of 7ofel Stalf Hou�s
Jo6 Category New Hires Hires that are of Sta[t Haurs of New Hlres for Saction 3�mployees
Sec. 3 Residents ihat are Sec, 3 Residanls and Trainees
IProfessionals
Technlcians
OfficelClerical
Construction by Trade (List)
Trade
Trade
Trade
Trade
Trade
Other {Li&t)
Tota I
` Program Codes
1 = FIe�Jble 5u48idy
2 = Seclian 2021811
3 = Public!lndian Flausing
A = qevelopment,
H = �peration
C = MotleYniz8tlon
Paga 1 of 2
4 = Homeless Assistance
5 = HOM�
6 = HOME Stale Administerad
7 = COBG Entitlemeni
F
Num6erof Sectian 9
Trainees
1
1
— ---�
I
1
8 = CI7gG State Atlminislered
J = OLMarCf] Programs
7 0= 01her Housing Programs
form HLO 60002 (61209t)
Ref24 CFR 135
Part H: Contracis Awarded
1. Construction Eontfaats:
A. Tota1 dollar amount of al! confra�ts awarded on the proJect
B. Total dollar amount of caniracts awa�ded to Section 3 businesses
C. Percenlage o{ the tutal dollar amount tfifat was awarded to Section 3 businesses
D. 7otal number of Seclion 3 businesses receiving contracts
2. Nan-Construclion Contracts:
A. Toial dolfar amaunt a11 non-canstruciion �ontracts awarded on the projectlactivity
6, Total dollar amount of nan-cons#rucllon contrads 2awarded to Section 3 businesses
C. Percenlage of tha total dollar amount that was awarded to Section 3 businesses
6. Total number of Secllon 3 businesses receiving nan-conslruction contracts
Part IIL• 5ummary
Indicale lhe efforts made to direct the employment and olher economic opportunities generated hy HUD tinancial assistance fior housing
and communiiy development programs, to the greatest extent feasible, taward low-and very law-income persons, particularly thase who
are recipients of government assistance for housing. (Check aA that apply.)
Attempted ta recruit low-income residents through: local adve�iising media, signs prominently displayed al lhe praject site,
conVacfs with the community organizations and publlc or private agencies operaling within the melropolitan area (or
nanmetropolifan county) in which lhe Section 3 covered program or project is localed, or similar methods.
Participated in a HUD program or olher program which promates the training or employment of 5ection 3 residents.
Participated In a HUD progrem ar olh�r program which promntes the award of conlracts to business cpncems which meet the
definitian of 5ection 3 husiness cancems.
Coordinated with Youthbuild Programs administered in the melrapolitan area In which the Section 3 co�e�ed project is lacated.
�ther; describe below.
Puhlic reparling for lhis collealion of infarmation is estimated to average 2 hours per response, including the lime for reviewing instructions,
searching exisling data sources, gathering and maintaining the dala needed, and completing and reviewing the cotleclion of information.
This agency may not collect thls Informatian, and you are nat required to complete this form, unlsss il displays a currently valid OMB
n�mber.
5ection 3 of the Housing and Urban Development Act of 1968, as amended, 12 U.S.C, 1701u, mandates that lhe Department ensures that
employment and other economic opporlunities generated by its hausing and community development assistance programs are directed
faward low- and very-low income persdns, particularly thase who are recipients af govarnment assistance housiRg. The regulations are
found at 24 CFR Part 135. The informatian wil{ he used by the Departmenl to monitor program reclpients' compliance with Section 3, to
assess the results of the DeparlmenYs efforts to meet the statutory objectives of Section 3, la prepare repoRs to Congress, and by
recipients as self-moNloring tool. The data is entered inio a database and will be analyzed and distributed. The collection o( information
invalves recipients recei�ing Federal financial assistance for housing and community development programs cn�ered 6y 5ection 3. The
informakion will be collected annually to assist HUD in meeting its reporting requfrements uncier 5ection 808(e}(6} of the Fair Flausing Aet
and Secfion 916 of the HGDA of 1992. An assurance of confidenlialiry is not applicable to fhis farm. The Privacy Act of 1974 and OMB
Cireular A-108 are not applicable. The reporting requiremenls do nol contain sensitive questions. [lata is cumulaYive; persona! identifying
Information is not included.
Page 2 of 2 farm HlJO 60D02 (1112010)
Ref 2-0 CFR 935
Form HU�-60d42, Section 3 5ummary Report, Economic Opportunities for Low- and Very Law-incame Persons.
Instructions: This form is to be used tv report annual
accnmplishmenls regarding employmenl and other ecanamic
opportunifies provided to 1ow- and very low-income persans under
Sectian 3 af the Hausing and Urban Development Act af 1966. The
Secpon 3 regulations apply to any public and Indlan housing
programs tha! recei�e: (1) developmenl asaistance pursuant to
5ection 5 0! the U.S. Housing Aci of 1937; (2) operaling �ssistance
pursuant to Section 9 oF the U.S. FEousing Ac� of 1 s37; or (3j
modernizafion grants pursuant to Seclion 94 of !he U.S. Housing Act
of 1937 and to recipients of housing and community development
assiskance in excess of $200,OU0 expended for. (1) housing
rehabilitation (including reduction and abalement of lead-based paint
hazards); (2) housing construction; or (3) other public construction
projecls; and lo confracts and subcontracts !n excess nf $?OO,D00
awarded'+n connection with the Sadion-3-covered aotivity.
Form HU�-6U002 has three parts, which are ta be complated faf
all programs covered by Secfion 3. Part I relates to emplayment
and training. The recipient has t�e option to determine numerioal
employment�training goaEs either on ihe basis of the numher of hours
worked 6y new hires (columns B, D, E and F). Part II af the form
relates to contracfing, and Part IIl summarizes recipients' elTorts ta
oornpEy with Section 3.
RecipiaMs or coMractors subject to Section 3 requi�ements must
maintain appropriate documentation ta establish that HUD financaal
assistance for housing and community development programs wera
difected toward low- and �ery low-income persons.• A recipient of
Section 3 covered assistance shall submit one copy of lhls repo�f to
HU� Headquarlers, dffice of Fair Housing and �qual Opportunity.
Where the program providing asslstance requires an annual
performance reporl, this Section 3 report Is lo be suhmiited at the
same time fhe program performance report is submsited. Where an
annual perFormance repo�l is noi requ€red, this 5ection 3 report is to tre
submilted by January 10 and, i( ihe projed ends before �ecember 31,
within 10 days of project comple�ion. Qnly Prlme Recipients are
required to report to NUD, The report mustlnclutia
accamplishmenfs af a!1 reclpienis and their Sectiop 3 covered
cantractors and subconfrastovs.
HU� Field Office: Enter the Field Office name .
1. Recipiant Enterthe name and address of the recipient
submitting this feport.
2. Federal Iderttificafion: Er�ier the number that appears or� the
award (orm (with dashes). The award may be a grant,
cooperative agreement or contrad.
3. Dollar Amount of Award: Enter the dollar amount, rounded to the
nearest doller, re�elved by the �ecipient.
4& 5. Conlact PersonlPhone: Enter the name and telephone numher
af the person with knowledge of the award and the recipienYs
implementalion ot Section 3.
6, Repoding Pedod: Indicate ihe tirrEe period (mnnths and yesr)
this repart oo�ers.
7. Date Repnrt SubmitiecE: �nter the appropriate date.
Program Cade: Enier khe appropriate program code as listed at
the bottom of the pege.
Program Name: En1er ihe name of HU� Program corresponding
wifh the "Program Code in number 8.
Partl: EmploymentandTrainingOpportunitEes
Column A: Contains various joh categories. Professianals are
defined as peopie who have special knawfedge of an occupalion {i.e.
supervlsors, archiiects, surveyors, pl�nners, and computer
programmersj. Forcnnsiruction positlons, list each frade and provide
daia in tolumns B Ihrough F for eaah krade where persons were
employed. 7he categary of "Othe�' includes occupatfons such as
service warkers.
Column B: �Mandatoty Field� Enter the number of new hires for
each category o( workers identlfied in Column A in conneclion with
this award. New hire rafers to a person who is not on the contractor's
or recipieni's peyro�l for employmeni at the �ime of selectian for the
Section 3 covered award or at the lime af receipt of Section 3 covered
assistance.
Coiumn C: (Mlandatory Field} Enisr ihe number of Section 3 new
hires for each caiegary of workets idenlified in Calumn A in
oonneclion vuith this award. 5ect[on 3 new hire reiers lo a Section 3
resident who (s nut on the coniractor's or recipienYs peyroll for
employment a� ihe time of selection fot the SeCtion 3 co�ered award or
at the time of receipt o( Seclion 3 covered assistance.
Golumn D: Enter the percenEage p( all the staff hours o[ naw hires
(Section 3 residenis} in connection with this award.
Calumn E; �nter the percentage of the toSal staff hours worked for
5ection 3 employees and trainees {including new hiresj connected
urith this award. Include staff hours for pa�i-time and full-time
positions.
Column F: (Mandatory pield} Entar the number of Seetion 3
resldents that were tralned in connection with this award.
Part II: Contract dpportunities
Block 1: Construclion Gontracts
Item A: Enter the total dollar amount af all coniracEs awarded on the
prajectlprogram.
Item B: Enter the total dollar arriowit af contfacts connected wifh ihis
projactlprograrrl that were awarded ta Section 3 businesses.
Item C: Enter the percentage of the iotal dolla� amou�i of conlracts
connected with this projecVprograln aw�rded tn Section 3 husinesses.
Item De Entar the num6er of Secilon 3 businesses recelving awards.
6fock 2: Non-Construclion Contracts
Item A: Enier the total doilar amount of all cnntracts awarded on the
prajecUprogram.
Item B: Enier the total doNar amaunt of contracts connecfed with this
project awerHed to Section 3 husinesses.
ttem C: Enter the percenlage of the total dallar amount of contracts
eonnected wtfh th[s prn}ect�program awarded to Seclion 3 husinesses,
Item �: �nter the num6er of Section 3 businesses receiving awards.
Part III: Summary of EffoAs — SeIF •explanatory
Submit one (1) copy of fhis reporl to the HU� Headquarters Office of
�air Housing and Equal Oppartunily, at the same time Ihe
performance repori is submitted to the program nffice. The Sectlan 3
report is submltted by January 10. Inelude only cont�aats execuled
during the period speci�ed in it�m 8. PHAslIHAs are to report all
contractslsubconlracks. �
' The terms "low-incame persons" and very low-income persons� ha�e
Ehe same meanings given the terms in settion 3(b} {2) of tha Uniied
Stales Hausing Act of 1937. Zow-income persons mean famllies
{including singls p�rsvns) whose incames do not exce�d 84 paTcent of
the med3an income for the area, as determined by fhe Secretary, with
adjustments For smaller and larger (amilies, except thal
The Saorefary may �stahllsh income ceilings higher or lower than 84 percent
of the median (or the area on the basis ot the Secretary's findings suah �hat
variations are necessary because of prevailing levels of const�ucllon eosts
ar unus�ally high- or low-income families. Verylow-income persons meart
low-income (amilies (Inaluding single persons} whose incomes do nat �
excead 50 percent oF the median family incorne area, as deietmined by Ihe
Secralary with adjustments or smaller and larger iamilies, except that the
Secretary may estabfish Income ceilings higher or lower than 50 percerd of
the media� for the area on the basis af �he Secretary's findings thaf such
varialions �re neoessary because af unusu�lly high or low family incomes,
Pagei form HU�60002f�1fZa�0}
f2eF 24 CFR 135
EXHIBIT "H" — Severely Disabled Certification For�n
[See attached]
CDBG PSA CDNTRACT 2D14-2p15 —EXHIBIT "H"—SEVERELY DISABLEb CERTIFICATION FORM 1
The Women's Centet of Tarrant County Inc.
�
/
f
The Women's Center of Tarrant Caunty �nc.
CERTIFICATION FORM
DOCUMENTING CLIENT STATiJS AS °`��VER�LY DISABLED ADULT"
Client Name:
Address:
City, State, Zip
Client IdentifcationNo.
CHECK ALL THATAPPLY
� Has u�e� a wheelchair, a walker, cane , crutches or ather special aid far six
i�anths or ionger
Has l�een diagnosed with ane of the %llowing canditions: Alzheimer's
� disease, mental r�tardatian ar other develop�r�ental disability, senility or
dementia, cereb�•al palsy, ar autism; or has another mental or emotional
condition that seriously interferes with e�eryday tasks.
Is unable to perforin ane ar more of the following "Functianal Acti�ities":
❑ seeing, hearing, speaking anci having one's speach understood,� lifting or
carrying, using stairs, grasping small objects, or walking.
Is unable to perfor�n ar neec�s assistance to perform one ar more of the
❑ following Activities of Daily Living (ADL}: g�tting around inside the hoine,
getking in or out of b�d or a chair, bathing, dressing, eating, and toileting.
is unable to perfoMr nr needs assistance to perform one ar i�aaa•e of the
following [nstruinental Activities of Daily Li�ing (IADL): going outsid� the
❑ hame, lceeping t�•ack of money and bills, preparing meals, doing light
housework, talcing prescription medications in the right amount and at the right
tin�e, and using the tela}�hona.
❑ Has a canditian thafi prevents them frQm working at a job or doing ho�sework.
The un�e��signed agency representative conducted a visual assessment of the client identified on
this farm and ce��tifies that the cli�nt ineets at least one of the conditions indicated above, which
determines that hel s1�e meets the defiizition af "severely disabletl" according to the U.S. Census
Bureau.
Certified by;
Signature/Title:
Date:
CFW HED: Itevised as ofAugusl 30, 2D13
CDBG PSA CONTRACT 2014-2015 —EXHIBIT "H"—SEVERELY DfSABLED CEl2TIFICAT�ON FORM 2
The Women's Center of Tarrant County Inc.
�111i812014 •
���1( �OU��I� �C��I���
DA�'�
iV1&C Review
qfficial site of the C�Ly nf Fort 1NnrCh, Tc>as
�� ��
COUf�C1L AC f IOP]: Approved on 8151�D14 o Ordinance Na. 21363-0��2014
COM�'INUL�D FROAII A E'R�VIOUS W��14
7�22�20'I4REF�RENCE C_2�$�� ��� ����F 17HUDACTIONPLANPY2014-
�p.: 2015
COD�: C TY��: NON- PUBLIC Y��
CONSENT HEP►RIWG.
SUBJ�CT: Conduct Two Pub[ic Hearings and Approve the City's Action Plan for the Use of Federal
Grant Fund� in ti�e Amount of $9,827,252.00 from fihe United States �epartment ofi
Hausing and Urban De�elopment far Program Year 2014-20'[5 from the Community
De�elopment Black Grant, HOME In�estment Partnershi�s Program, Emer�ency Solutions
Grant and Housing Opportunifies far Persons with AIDS Grant Programs, Authorize
Callection and lJse of Program Incom�, Authorize Waiver of App[ication o�F Indirect Cost
Rates, Aufhorize Execution of Re[ated Contracts and Interdepartmental Letters of
Agreement and Adopt Apprapriafion 4rdinance (ALL COUNCIL D15TRICTS)
RECOlVi1UiEP! �AiION;
It is recommended that the City CounciL-
1. Conduct two public heari�gs to allow c3tizen input and consideration af the CEty's 2014-20'�5 Aetion
Plan for use af federal grant funds from the United 5tates Departmenf of Housing and lJrban
�e�eiapment in fhe amount of $9,827,252.00 for Program Year 2Q14-2015 from the Commt�nity
Development Block Grant, HOME In�esfrnent Partnerships Program, Emergency Snlutior�s Grant and
Housing Oppartunities for Perso�s wifh AIDS grant programs and for the use af program incorr�e from
activities �sing prior years' federal grant funds;
2, Approve the City's 2014-2015 Ac�ifln Plan for submission tn the United States Department of
Hausing and Urban Developmsnt including allocations of grant funds to particular programs and
activities as detailed befow;
3. Authorize the collection and use of an est�mated amount of $50,000.00 of program irtcome resulting
fram activities using prior years' Communifiy Develapment Bfock Grant funds for the prograrrts and
activities detailed f�elow;
4. Authorize the call�ction and use of an estimated amount of $100,0OO.OD of program income resulting
irom acti�iti�s using prior years' HOME Investment Partrterships Program funds for the City's
Homebuyer Assistance Pragram;
�, Authorize the City Manager or his designee to execute contracts an� Interde�artmental Letters of
Agreement for a nne year term witE� the agencies listed below in Tables "f, 2 and 3 for Program Year
2094-2015 for Community Development Block Grant, Emergency Solutior�s Grant and Housing
Oppartunities far Persons with AIDS grant funds, conti�gent upon receipt of fundi�g;
6. Aufihorize the City Manager or his designee io extend the contracts and Interdepartmental L.etters of
Agreement for up �o on� year if an agency ar department requests ar� extensian and s�ch extensior� is
necessary for completion of the pragram, or to amend the contracts and lnterdepartmental Letters af
Agr��ment if necessary to achie�e program goals pra�ided any amendment is within the scape af the
program and in campliance with City poiici�s and all applicable laws and regu[ations governing the use
of federal grant funds;
htt�a:llapps.cfWnet.orglcauncil�acket�mc review.asp?ID=20027&councildate=81512014 "��6
17118d2�74 �
M&C Re�iaw
8. Authorjze a waiver af indirect cost rates as applicable far the Grants Fund, in accordance w�th the
City's Administrative Regulatians; and
9. Adopt the attached appropriation ordinance increasing the estEmated receipts and appropriatians ta
the Gran�s Fund in the fotal arnount of $9,827,252.00 consisting of $6,193,950.Q0 in Cammunjty
Develaprnent Block Grant funds, $2,143,383A0 in HOME [nvestment Partrrerships Pragram funds,
$493,9D1.00 in Emergency So{utions Grant funds and $996,O�S.QO in Hous�ng Opporiuni#ies for
Persans with AfDS grant funds, plus any �ragram income, all subject to receipt ofi such funds.
DESCUSSiaN:
The Ciry`s Annual Action Plan summarizes the major housing and eommunity devefopment activities
and proposed expenditures far use af #ed�ral grant funds tot�ling $9,827,252.00 from the United States
Department of Housing and Urban De�elopment (HUD) #or Community De�elopment glock Grant
(CDBG}, HOME In�estment Par�nerships Program {HOME}, Emergency Solutions Grant (ESG) and
Housing Opportunities for Peopfe with AIDS (HOPWA) grant programs for the program year beginning
October 1, 2094 and ending September 30, 2015. This year's Actian Plan a[so summarizes the use of
program income resulting from acti�ities using prior years' CDBG and H�ME funds. The purpose of
these grartt funds is fio primar�ly benefit law and moderate income Gity residents, with �SG funds
primarily f�enefiting homeiess persons anc! HOPWA f�tnds primarily benefiting persons with HIVIAIDS.
Staff developed recommendations for the allocat�on af the est[mated fut�ding from HL1D and presented
them to fh� Cammunity De�elopment Council (CDC} on May 21, 2014 and ta the City Coune�l at the
Pre-Caunci{ meet[ng on June 10, 2014. Notice af a 30-day public comm�nt period from July 2, 2094 ta
July 31, 2014 was published in t�e Fort Warth Star-Te{e�ram on June 28, 2014. Any comm�nts
received will be mai�tained by the Housing and Economic Development Departm�nt, in accordance
with federal regulations, The City wil[ hold iwo public hearings as par� of the HUD-requEred citizen
participatian process, the first o� Ju�y 22, 2014 and the second on August 5, 2014 at which time the City
Gouncil is scheduled to a�prove the Action Plan. In additian, pubiic hearings were held on June 24,
2014 at 10:00 a.m. and 6:OQ p.m. far cifizens to provide comment on the proposed list of neighborhood
streets eiigible for reconstruction using CDBG fiunds.
A summary of the CDCs fu�ding recommendatians is provid�d helow in Ta}�les 1, 2 and 3 and a
spreadshe�t of all specific funding recammendations is aftached. The Action Plan must be submitted to
HUD by August 15, 2014.
For Program Year 24�4-2015, it is recommended that �he amoun� of $6,193,950.Op in CDBG funds
and the estimated amaunt of $50,OD0.4� of CDBG program incomc b� allocated as follows:
Public Servic�s � $929,092.50
Tfi�is item includes sacial services for low to moderate incame, disabled and disad�antage populations.
Hausing Programs and Services - $2,150,600.00
This item inc(udes funding far tFte City's Priarity Repair Pro�ram, Cawtown Brush-Up, homebuyer and
housing services and accessik�ility modifications ta the homes of senjar andlor disabled individuals and
related project delivery costs far these programs.
CD�G Nfa4ch Funds n $�OO,OOO.pq
This item includes match funds for the Lead Grant �rogram.
Infrastructure Services o $638,126.80
This item includes funding for reconstruction of neighborhaod streefs.
CDBG Economic Deuelapmen# � $737,3�0.70
This item is th� City's ann�al payment an its Section '{08 [oan from HUD.
hitp:llapps.ciwnet.arglcouncil�acketlmc review.asp?1D=20027&counciEdate=8l5l2014 y�
1i11812�14
M&G Revieur
GUBC Estimated Program Income n$�Q,UOO.QO
The CDC recommended allacating any CDBG program income for the recanstruction of neighborhaod
streets.
CD�G General Administra#ion - $9,�38,i90.a0
This item includes costs far administering the CDBG grant including allocations far Financial
Management Services, lnternal Audit and Transpartafion and Public Vllorks Departmer�ts.
Far Program Year 2014-2015, it is recommended that th� amoUnt of $2,1�43,383.00 in HOME funds
�nd the estimated amount of $1Q0,000.00 of HOME program incame be allacated as follows:
Homebuyer Assis4ance �rogram � $1,097,405.70
Th�s items includes funding for down payment andlor closin� cast assistance to fow and moderate
ir�come homebuy�rs.
Community Devela�ment k�ou�ing Organizations {GHDA� Set Aside -$321,507,40
HUD requ�r�s that a minim�m of 15 percent of HOME funds be allocated to CHD�s for afFordable
housing projects and CHDO adrnin�strative operating costs. These funds wilf be used to camplete the
HilCside Marningside Neighborhoad Single Family Infill Devel4pmen# which Uvill res�lt in the constru�ctian
of up to 17 single family ho�ses by the Tarrant County Housing Partnership GHDO.
flllultifamily bevelapment a $510,731,60
Funding will be used for the Columbia at Rer�aissance Square, an approximately 140-unit mixed
income development, with 28 market rate unifs. The rest of the urtits will provid� quality affordable
hausing to Fart Worth families with incomes at ar be[ow 80 percent of Area Median Income. The
d�:velopment will be located at 3841 W.G. Daniels Drive in Gouncil District 8.
HOIVpE General Administratian = $�1�4,3�8.3�
This item includes cosfs for administering the HOME grant.
HOIUIE Estimated Prograrri lncome o$'IpQ,aao.QO
The program income wil! be used in the City's Hamebuyer Assistance Program,
For Program Year 2014-20'{5, it is recommended that the amount of $996,0'I8.00 in HOPWA funds be
allocated as follows:
iVan-Profif Servic� Pro�iders = $9G6,'f 37.46
HOi�WA F'ragram Administrat�on � $�9,�80.�4
For Program Year 2a14-2Q15, it is recommended that the amaunt af $493,90'[ AO in ESG funcls be
aflocated �s fof[ows:
NonnProf�E Service Providers � $456,858.4�
E5G Program Administratian - $37,042.5�
The CDC and Staff recommend that contrac#s be executed with fhe agencies listed belaw in the
amounts shown in the fnllowing tables:
Cammunitv �evelonment �IocEt Grant:
� �
hi�p:llapps.ciwnetorglcouneil�acketlmc_re���uv.asp71�=200278counclldate=8J51Z0i4 �fi
i111 8120 1 4
M&C Review
Table 7 � CaBG Agencies
fc��y�����a�;on
Women`s Center af Tarrant County
Senior Citizens of Greater Tarrant
Co�nty
�YMCA of Mefropolitan Fa�k Wor�h
IYVIICA of Fork Vllarth and Tarrani
County
�C�ildcare Associates
�'�'rogram
�s�n�a� s�����s
�ISenior Services
�Child Gare Serv�ces
Child De�elopmenf
Child Care Services
�Girls Inc, of Tarrant County ��Youth Seruices
C�mp Fire �Youfh Services
Lena Pope Home ��Youth 5eE-vices
Ladder Allianca I�EmploymentlJob Training
Tarrant County Housing Partnership Housing Caunse[ing &
I Education
IPresbyterian Night Sh�lter Case Manag�m�ntlMain
�Shelter
Meals an Wheels ofi Tarrant County IlHome-deli�ered Meals
�Program
C��C �ub{ic .�'aervice �ub�o�Yal �
*REACH Resource Center on IlNeed-Project Ramps
Independent Li�ing
�To�al GDE3G �ontra�fis ��
*REACH wil! be funded from the CDBG Housing Programs 6udget.
Program
Fiousina Oaoortunities For I'ersons With AIQS:
Tabl� � o HOPWA Agertcies
Organization �
Tarrant
County
5amaritan
Housing, Inc.
AI�S
Outreach
Center, Inc.
TQTr4L
HOPL�VA
Contrac�s
Emeraencv Solutions Grant:
I Tahle 3� ESG Agencies
http,llapps.cfwnet.orglcnunci I,_packetlm c_reviaw.asp?l p =2EH127&councildat�815120i4
Administratian (seven percent) and 5uppartive Services
�Amouni
II� 7�,00a.aa
I$ 93,0�2.50
j� �a,aao.00
� 5o,aoa.00�
$ 50,OOOAO�
��$ 75,a0aA0�
�$ 75,OO�.QO�
��$ 75,Op0.OQ �
� $ 75,000.00 �
$ '124,aao.00l
$ 82,OOOA�
$ '105,000.00
�I$ J29,09�.50 �
I$ 75,OOO.QpI
��$'f ,OD4,D92.�0 �
�
� Amount 1
$409,38�,46
Administration (se�en percenfi), Supporti�e Ser�ices,
Tertant Based Rental Assistance (TBRA), and Short $�56,757,00
Term Rent Mortgage and U#ility Assistance (STRMU)
$966,137.46
416
111�8I2014
� ��
�} � � Organization
� SafeHaven of Tarrant County
1 Presbyterian Night Sheiter
Day Resource Center for the
Homeless
The Salvatian Army, a Georgia
Carporation
Cafholic Charities of �ort Warth
� TOiAL ESG Contracts
M&C Review
Pwogram II Amount
Shelter Services I$ 85,065.00 j
�
Shelter Servicss � $ 95,544.00 I
�
Shelter Services $115,732.Q0
Homefessness PreventionlRapid Re- � 43,936,00
Haus�ng
Homelessness Pre�entionlRapid Re- �� 17,381.42
Housing
� $4a6,��8.421
�
These programs are a�ailabl�; in ALL COUNCiL DISTRICTS.
�ISCAI� IN��R�NATIONIC�RTI�ICATI�N:
The F'inancial Managerrtent Services Directflr certifies that upan approval of the abo�e
recomm�ndations, adoption af the attached appropriation ardinance and reeeipt af grant funds, funds
wil[ be a�aila�le in the curr�:nt operating budget, as appropriafe�f, af the Grants Fund.
TO FundlAccauntlCenters
GR76 451727 017206720XXX
GR76 SXXXXX �17246720XXX
GR76 45�727 017206721XXX
GR76 SXXXXX
0'i 7206721 XXX
GR76 451727 017206723XXX
GR76 SXXXXX 0'f7206723XXX
GR76 451727 0'I7206724XXX
GR76 SXXXXX 017�06724XXX
GR76 A76091 01720672QXXX
GR76 SXXXXX 017206720XXX
GR76 �76076 �172Q6721XXX
GR7B SXXXXX 01 i206721 XXX
$6.193.950.00
$6,193.950.00
$2.143.383.00
$2.143, 383.00
$493.901 AO
$493.901.D0
$996.018.00
$99fi.018.00
$50, 000. 00
$50, 000.00
$10Q.000.00
$10Q.004.00
Su�mi#ted far Cit� Manaaer's Office br�:
Oriqrnatinq Department Head:
Add'rtional Information Contact:
FROM FundlAccountlCenters
Fernando Costa (6122}
Jay Chapa (5804)
Cynih�a Garcia (818i)
L�eticia Rodriguez (7399)
http:llapps.cTwnet.arg/council�ackefilm c_review.asp71D=200278�co�ncilrEate=81512014 ��6
91/1 Bl20i4
AY7ACHtiA�NTS
17HU�ACTIONPLANPY2014-2095 AO 2014.dacx
Action �lan 14 -15.odf
PROI'OSED 2014 CDBG Streets Aftachment.�adf
M&G Review
http:/lapps.cfwnet.orgleouncil�ackeUmc_review.asp?f��2Q�27&couneildate=H1512014 6!6
���rfi������ ���C.,�ri1.,
,,
FIItST AMENDMENT TO CITY S�CRETARY CONTRACT NO. 4616U
�HEREAS the City of Fo�t Worth ("City") and The Women.'s Center af Tarrant Couzity,
Inc. {"Agency") made and entered inta City Secxetary Contract No. 46160 ("Cantract");
WHEREAS, the Coniract pxavides fi�nding to Agency pursuant to a grant recei�red by
City from the LJnited Staies Departmen.t of Housing and Urba.n Development ("HUD"} through
the Cornmuni�y Development Block Grant Program ("CDBG");
WHEREAS, the CDBG xegulations require that docum.enta�ion must be submitted to �ity
which verifzes that �1% of the clienis sezved by the Agency's Prograzn are income eligible wi�th
curxent household zncames at or belaw SO% of AMI;
WHEREAS, it is neces�ary �o clarify Agency's repo�g requirements regarding the
clients ii sezves in thc Program for which City is furnishing CDBG Fuzads in accordance wiih the
Contract;
WHEI�EAS, at the City's requ�st, Agency will use the CDBG Funds to pay for a
percentage of three additional employees ta make s�re tiiat cost allocation principles a�re
consistent with #he percentage af Fort Worth Clients participatin� in tne Progxam; and
WHEREAS, it I5 t.�ie znutual desira of City and Agency tn amend the Contract to
complete the Pragram and meet Contract objeciives.
NOW, THEREFORE, City and Agency hereby agree to arnend the Contxact as follows:
I.
Seetion 2. DEFINITIONS is amended by substituting the following �ar xhe current
definitio�s in the Cont�act:
"Co�np�ete Documentation xneans the fallowing documentation as applicable:
o Attaeh�ents I, II, and IIY, with supporting documentation includ'zng:
,,�� ' .
A'�
�
;�
0
.
n
Proof of e�pense: copies of timesheeis, invoices, leases,
service contracts or other documentation showiaag tl�at payment
is due by Agency.
Proo� of payment: cancelled checks, banlc statemen�s, or wire
transfers necessary to demonstrate t�.at amounts due by Agency
were acivally paxd by Agency.
Proof of client eligibil�ty: 5ource Docurnent�tinn for all
clients participating in the Program, including non-Fort Worth
clients."
"Directar means the Director of t�he Nei�hborlaood Ser� ices Depai�tment."
. �Y . , , ._ . . � ��� .
�#�' ���r�i�'�f�l�'�
Amendment No. 1 to C�C No. 4b 150 �.� ��•��� �� i Page 1
The Wamen's Cent�r oiTa�•rant County, Inc. (CDBG) Rev, 07/201 S
"Inco�nne E�ig�ble Client means a client whase annual income adjus�ed fnr fam'rly
size does not exce�d 80% of AMI usin.g the most curreni IIiTD Incoxne
Guidalines and Technzcal Guidance for Determinirag �noome and Allowances.
The d�f nitxon of annual income to det�rmine client incorrae eligibility sha�l be the
defimztiaz� cantained in 24 CFR Part 5.6Q9, as am�nded from time to nme. "
"National �bjective means an activity that benefits low and mod�rate income
persons. For the purposes of this Contract, ai least SI% of the cli�nts served by
the Program must be Tncome Eligible Clients,"
"Neighborhood Services Department means the City's Neighborhood Services
Department."
"Sourcc Documentation means either (i) a verif able certification fl� fi�ll
household income such as the City's Certification I�.com� Statement attached as
E�hrbit "E" — Form of Income SeIf-Certiiication; or {ii) documentation of full
household incom� of any type described under the definition af az�n.ual income in
24 CFR Part 5.609, including �ut not Iimited t� copies of paychecks, Social
Security and disabiIity verification Ietters, interest or renfal income sia�ements,
re�irem�nt inco�ne statements, child support and alimany verificaiion,
unenrxployment benefit let�ers, and the like."
"UndupIicat�d Clients means a count of all clients served by the Program at ieast
once in #he Contract terzx�. Clients served by the Progrann mare than once in the
Contract term will only be cauz�ted the first time they axe served when
deiermining fibe t�tal count of Unduplicated Clients."
Section 2. DEFINITIONS is am.ended by deleting the following defnitions in the
Contract:
"CDBG EIigible Client means a client tivhose anzival incd�ne adjusted for family
size does not exceed 80% of AMI using the most current Hi_JD Income
GuideIines and Techr�ical Guidaz�.ce for Det�rrnining Tr�come axid Alldwances
verified by eztk�er Source Documentation or the fornl in Exhibit "E" — Form of
Incorne Self-Certification. Age�ncies serving 100% Clien�ele must follow the
requi�ements set forth in Section 6.1.3."
"HED Degartmen� means ihe City's Hausing and Economic Development
Departmer�t."
II.
Section b. CLIENT ELIGIBILITY VERIFICATION is deleted in its entirety and
replaced by fhe �ollowing:
Amendmeni No. I ta CSC NQ. 4b 160 �'age 2
The Women's Centes' af Tarrant County, Inc. {CDBG) Rev. 0712415
"6.1 Client Eli�ibilitv.
Agency will docum�nt client eligibility as fallows:
6.1.1. A�encv Clients Se�-ved bv� �he Pro�ram.
Agency must verify aIl cli�nts' incomes with Source Documentatian.. Age�cy
must u,se the annual income definition in 24 CFR part 5.609 to establish client in.come
and mu�t use the z�r�Qst current HUD Incame GuFdelanes. The inconne af a1I clients served
by iY�e Program must be documented, but at least �l % af them must be I�come Eligible
Clients.
6.1.1.1. Tf Agency �e�tves both Fort Worth and nan-Fort Worth
clients, the proportion nf Program costs allacated to �he
CDBG�fi.�ded portion of the Program Budget must be
consistent with the prop�oriior� af Fort Worth to non-Fort
Worth clients.
61.1.2. AIl elients, whether Fort Worth clients or not, must b�
reported on Exhibit "D" — Reimhursemeni For�ns,
A�tachmenk II�. AIl Program ciients for vvhich Source
Dacumentation is not at�tained will be deezned tn ba not
I�came Eligible Clients az�d shall not be included in the
51 %.
6.1.1.3. At least �1°/a of �ort Worth clients must be Income
Elxgible Clients.
b.2 Submission of Complete Documentation.
Agency must subznit copies of all eligibility vexi�'ication documen.tatzon described
in Section 6.1 vvith Attachment III in each month's Reimbur�ement Request �ar all
Unduplicated Clients served for the �'irst time, and must nnaintain copies of such
documentation as required under �his Coniract.
&.3 T�is Seciion G shall be applicable for �he Contract term and fox � years
thereafter and shall survive the earlier tezrnination or expiration of thi� Contract."
ITT.
Section 9.2.2.1 and Sec�ion 9.2.2.2 a�re deieted and replaeed by the fallowing:
"9.2.2.1 For payrall expenses, timesheets signed by employees a�d approved
by s�pe�visor �'ar all payroll expenses listed. Timesheets must
disiinguish befiween CDBG-funded ti�xj.e and non-CDBG funded time
and reflect actual time spent on CDBG�funded activities. Agency m�ay
not submit payroll expenses dated more than 150 days be�ore the date
af the Reimbursemant Request.
Amendrnent No. 1 ta CSC No. 46160 �ag� �
The Women's Center ofTarrant County, Inc. (GDBG) Rev. �7/2pi5
9.2.2.2 Far non-payroll expenses, z�voices for each expen.se listed with an
e�plana.tion as to how the invoiced expense pertains to the Pragram.
Agency znay nat submii invaices da�ed znore fhan 1�0 days before the
daie of the Reizr�bursement Request."
IV.
Sect-ion 9.�.3 Attachmenf III — Client Data Repart is deleted and xeplaced by the
following:
"9.2.3 Attachmen� III — Client Data Rep�r�
This report shall Ii�t each Unduplicated Client �ez�ved during the month
along with his o:r her demogxaphic infarmaiian. The Clienf Data Report must
maintain a list of a1I clients served durir�g the Contract term, includix�.g non-Fort
Woi�th clients. In order far this repo� to be conaplete, the following m.ust be
submitted:
9,2.3.1 Documentation of income verification for each
Unduplicated Client, ineludang non�Fort Worth clienfis,
the fi�st time he or she is served by the Program, which
will either be Source Documentation ox the completed
form of Exhibit "E" - Form of Income Self
Certifcation."
V.
Eghibft "A" — Program Sum�mary, Exhibit "B" — Budget, and Attachment IIl
attached to the Contract are hereby replaced with the attached Exhibit "A" — Program
Summary Revised 04/201�, Exhibif `iB" — Budget Revised 04120I5, and the attached
Attachnaent III Revised OSI2015.
VI.
This amendment is effective as of the Effective Date af the Coniract except far �ie
amendzxaents to Exhibit "A" — Program Su�mrnary Revised 04/�Ol S and Exhibit "S" — Budget
Revised 04/201.� which shall be effective April 1, 2015, and Section 9.2.3, and Attachme�t III
Revised O�/�U15 which shall be effective May 1, 2015.
VII.
All �erms and conditions of the Contract not amended herein remain unaffeeted and in
full force and e£fect, are binding on th:e Pa��ties and are hereby ratified by the Parties. Capitalized
terms not defined herein shall have the rneanin.gs assign�d to them ir� the Contxact.
�SIGNATURES APPEAR ON FOLLOWTNG PAGE]
Ainendinent No. 1 to CSC No. 46I 60 Page 4
The Women's Center of Tarrant County, Inc. (CDBG) Rev. 07/2015
ACCEPTED AND AGREED:
TH� W4MEN'S CENTER OF TARRANT
COUNTY
. �.
�1 � 1 �
By: - ; - _
Lau�r�JiVIl�itg ,�esident/CE0
ATT
ity
M&(
CITY OF FORT WORTH
�- �RBy. - �
Fernando Costa, Assistant City Manager
APPROVED A� TO FORM AND
LEGAI��Y:
' � ' ' � -
,L � ,} ,� ` 1
� ,
Assistant City Attorney
��'�����X�� R���R�
�:�#`f'Y !��RE�`��i�i�'
�. Mi�TF�, `�
Amendment No. 1 ta CSC No. �4616� Page 5
The Women's Center afTarrant County (CDBG} Re�. �7/2015
THE WOMEN'S CENTER OF TARRAN'T' COUNTY,
INC.
Cour�seling Services for Senior Citizens
PROGRAM SUMMARY
{CDBC'r)
October 1, 2014 to September 30, 2015
PERTOD
EXAIBIT "A"
PR�GR�M SUMMARY
Revised 04/2015
$7S,Q40.00
AMOUNT
Capitalized terms not defined herein shall have meanings assigned them in tk�e Cantract.
PROGR.AM:
The Program will provide clinical counseling, case management, information and refe�xals,
educatian, and support groups to income eligible ciients.
The Program may provide services to Fort Worth and nan-Fort Wortii clients. Agency �will
submit documentation which verifies that �1% of alI clienis served by the Program are Income
Eligible Clients wiih current household incomes at ar below SO% af AMI. In addition, Agency
will provide documentation that verifies that 51% of Fort Vi�'orth clients are Income Eligible
Cliants wit�i current household incomes at or below SO% af I�MI.
CDBG Funds will be used to pay a percentage af salarie,s and fringe benefits fox Pragram
employees. The percentage of any 1'ragram enr�playee's salary and fringa benefts will not
exceed �he percentage of Fort Worth Cliet�ts participating in the Program.
A�en.cy's aff"ice is located at 1723 Hemphill Str��t, Fort Worth, TX 75110, Program services axe
available Mon.da� through Friday, 6:3Q a.m. to 8:�0 p.m.
REGULATORY CLASSIFTCATION:
IDIS Matrix Code(s) and Service Cat�gory: 05�1 Seniox Sexvices
National Objective Citation: LMC Low/Mod Limited Clientele 24 CFR 570.208(a){2}
Regt,ilatory Citation(�): 24 CFR 570.20 I(e)
PROGRAM GOALS;
Minimum Fort Worth Performance �utconae: At least �1% af Fort Worlh clie�ts ser�v�d by
the Pragram must be Income Eligible Clients. For example, if SQO clier�ts out of 1,OU0 clier�ts
served by th� Program a1•e froin �art Worth, 4i1$ of those Fort Warth clients must also be Income
Amendinent No. 1 to CSC No, �46160 Page 6
The Women's C�nter of Ta�-�•ant Cou�ty, Ina (CDBG) Rev. 0712�15
Eligible CIients. In this exampie, Agency would be required io fuz�ish City 1,400 Gertification
of Income Statements that prove at least 4U8 0� the Fort Worth clients ser�+ed by ihe Program are
Income Eligible Clients.
Minim.um N�mber of Forf Worth Clients to be Served: The Program musi serve a minimunn
af 1�0 Unduplicated Clients from Fort Worth as shown by the monthly reports on Attachment
III.
When detern�.ining the number o�' clients which constitutes 51%, HUD regu�atians require that
partial nuznl�exs must be rounded up.
Amendinent No. l to CSC No. 46160 Page 7
The Women's Center of Ta�ra�lt County, Inc. (CDBG) Rev. 07/2Q15
EX�IBIT "B" — BUDGET Re�vised Q412015
I riD}II�J�ti'�'I�A I'YVI: {flf]i'kk'A f7.\1�1�]
r Salaries
� F1CA
� Life lnsuraz�ce
� Health Insurance
� Disahility Insurance
� Unemployment-3tate
� Accounting
� TOTAL ADMINISTRATIVE EXPEN$�B
� % Administrative Cost
���`���r�,�ll�'P.�,� RSC� .f� I.
3alaries
� FICA
� Life Insurance
� Health Insurance
� Unempinyr+�ent
� Worker's Campensation
� Retiremenf
� _ti['1PP��S�1•�I3'�B7i�;�"fC;E�. ,
� Office SuppGes
� O�ce Equipmer�t Rental
� Pastage
� Printin
��.1VIT�CYE�I��TE�Z'•�$t=;�= :�:..
� Construction/Buddin� Mater�aEs (only REACf-1)
I Cantract Labor (City needs copy of epntract be%re
expenses can Ue reimbursed)
� Craft Supplies -
� Field Trip Admission Expenses
I Other Field Trip Expenses {if preapproved by City)
Food 3upplies(City needs copy of contract before
expenses can be reimhursed)
� Teachm Aids � _
I �Achii� A�D ��rrit�i�sd - —
� TeEephane
� Elcctric
� Gas
� Water snd Wastewater
� Solid W�ste Disposal
Rent (City needs cupy of iease before expenses can be
reimhursad)
� Custpdial Services
j Repairs
� Cleat�m Su hes
�i __ p
I �����, Fm[' tv�r�,,����i�:��`� —
� �idelity Bnnd or Equivalent
� Directors a»d Dfficers
� Gee�eral Gommer�ial Liability
� Contracl Accountin�
. _. ,
;`13A21�:[�'I" �155151'_th�'['.
Chi[dcare Saholarships
� Shorl-temi IZent Assistance
� 5horl-ten» Mortga�e Assistancc
� Short-term Utiiities Assistance
OT1I�R �YPENSES
TOTA I..
Amend�nent No. 1 to CSC No. 46160
`I`f�e Women's Centez� af Tarrant County, Inc. (CDBC)
Rcciiuu!
�oai
iaoz
L003
1004
1005
100b
1007
�.I'71141
iSu[ikP.[ ���'I'[q5e I}[CI'fqSC
2401 63,462 2,891
20fl2 4,855 778
2p{�3 320 164
2004 5,659 2,1$5
2005 189 43
2006 125 22
2007 39D 257
3001
3002
30D3
300h
4441
40D2
�003
4004
4005
4UQb
4007 _
soo t
5002
5043
5004
50�5
50Rb
5007
500$
50Q9
riQdl
600�.
6p03
6005
7001
�aaz
�oa�
7004
7�,DOD 3,17D 3,I70
��CS"�SCti
j'��o�;i�a lii
I{�o+i�e�
1
�
�
66,353
4,077
156
3,474
146
147
647
1
1
1
4
.I
I
1
1
1
1
1
�
_�
1
1
1
�
1
1
1
�
75,000 �
Page 8
Re�. a7/2D 15
The follawing tables are purely inforznationaI and were created solely for purpases of preparing,
�egatiati�g, and determining the reasonableness of the overail line item budget on the first page
of this EXHIBIT "B" — BUDGET and are not to be considered part of the terms and conditions
of this Contract. Contractor may make changes to a.ny column except the "Position" coXunnn in
the "Salary Detail" table without the City's co�sent so long as the totaI amounts ch�rged io the
graz�t da not e�ceed the Iine items on the first page of ihe EXHIB�T "B" -- BUDGET." Changes
ta the coluznn labeled "Pnsifion" may only be made with �he prior written cansent o�the City.
� Positian Name
� Clinical Therapist
� Case Managet•
� Director of General Counse[ing
� President & CEO
� Vic� Fresident & C�O
� Grant Coordinator
TOTAL
FICA
Life Insw•arice
Health Insuranca
Unemplayme�t
Warkers Compensation
Retirement
TOTAL
�
� Dffice Supplies
� Office Equipmen# Rental
� 1'ostage
� Printing
I TOTAL
�
� Contract Labor
� Craft S�pplies
l Facility Fees
� Field Trip Costs
� �'ooci Supplies
� Teaching Aids
I TOTAL
Perceni ko Grant Amount to Grant
92.5% 37,031
46.6% I7,250
9.8% 6,146
2% 2,479
2% 1,668
3°10 1,779
66,353
Percent to Grant Ainount to Grant
SALARY DETAIL
Annual Rate Annual Hours
4D,000 2,08�
37,000 2,0$0
63,000 2,0$0
ii�,oaa Z,oso
80,000 2,�80
53,OQQ 2,p80
FRINGE DETAIL�`*
1'ercent af Amaunt
Payroll
6.14% 4,077
Q.24% 15b
5.24°10 3,�7'�F
0.22% 146
Q.22°/n 147
0.98°/a 647
100%
100%
i00%
l OQ°/a
100%
100°la
SUPPL�ES AND SERVICES
T'otal Budget Percent to Grant
MI�CELLANEOUS
Total Budget Parcant to Grant
4,077
156
3,474
146
147
647
8,647
Ainnunt to Grant �
�
�
Amount io Grant �
�
�
�
Amendment No. 1 to CSC No. 461G0 Page 9
The Women's Center of Tar�•ant County, Inc. (CDBG} Rev. �7I2fl 15
�
` Teiephone
� �lectric
� Gas
� Water and Wastewater
� Solid Waste Disposal
� Rent
� Custodtal Services
� Repairs
� Cleaning SuppIies
j TOTAL
� Fid�lity Bond (or Equivalent)
� General Commercial I�iability
� Directars and Officers
� Contract Accdunting
� 'TOTAL
FACILITY AND UTILITTES
Tatal Budget Percent to Grant
FINANCIAL AND iNSURANCE
Total Budget Percent to Grant
Amoutit to Grant
Amount to Gtant
DIRECT ASSISTANCE
Total Budget Percent to Grant Amount to Grant
Childcare Scholarships
Short-Term Rent Assistance
� Short T�rm Mortgage Assistance
� Short Term Utilities Assistance
� Tenant Based Rental Assistance
� TOTAL
** PIease note that "Fringe Details" calculatians include rounding errors.
Amendment No. 1 to CSC No. 46I.60 Page 10
The Women's Centea• af Tari-�nt County, Inc. {CDBG) Rev. �7I20 i S
ATTACHMENT III
CLIENT DATA REPORT
Revised 05/2015
,_.... . . ... . ... - -
� �
� : � � #�
}� `'I ��i� I
�� : � �{C'E��ci 1 �
t� � i ���E. �
� � �, i + �i�� �
�� , , I .�I� ``�� '
�� . � II a;F�i E F
jA `I� f2�2���1�' --
#� x a�'�
�i� .��� � .�
�
h��� - .������— ._
��� ����;���..�
�i �k� �
?s� �9��
�j�. Qil ������ �
i �
��i � ��
�R�� � �ai �
��� :�� -
��� i �
��� � ����� �
'�` � � ���
� ��; � �� _ _
�i� � � �
�,� !_ � a� _ �,I
��� �t� � �
� i
��� ���€ -� '
##� � '��j� � ,
� F j � �
1�� y�� � ��
�f� �+1 i
�f i
�,��� sx# i '
�T�
�ii �
�
�i
� �x
�■
r� �a �
� b
M '-�'�� I
�- — . osr.'a=s�l�s,_eelp_nnrnqv;��nr_,_uaaasu
Amendment No. 1 to CSC No. 4616a Page 11
The Women's Center of Tan�ant Cou�tty, Inc. (CDBG) Re�. 07/2QI5
���°�' �����iA��
�aE�����1� G 11`d'k9. � �
���"��������
October 6, 2015
The Women's Center af Tarrant County
I'723 Hemphill S#reet
Fort Worth, Texas 76110
�.ttn; Laura M. Hilgart, PresidendCEO
RE: Final Budget Revision of CDBG Contract ("Contract") between the City af Fart Worth ("City")
at�d The Wamen's Center of Tarrant County ("Age�cy") to City Secretary Contcact Na. 46164,
46160-A1
D�ar Mrs. HilgarC,
This latter is to advise you that the Budget line items fnr your Agency will require a final revision
so that there will be no negative balances in any ac�ount. As outlined in Section 5.2.2 of the Contract,
Agancy may increase or decrease line item amoUnts in the Budget, subject to written approval by the
Director of the Neighborhood Services Department.
The Budget shown on EXHiBIT °B°' — BUDGET Revised 0412U15 of the Contract is hereby
replaced by EXHIBIT "B" — BIIDGET Revised 091�015 attachad to kisis letter, and deemed effective as
of October 1, 201�F.
To indicate your agreement with the ravised BUdge# and its Effective Date, please sign where
indicated below and retutn four copies of the original executad documents to the following addt'ess at
yaur earliest convenience:
���I��A�6 �Ee�l�� ;
+:i�'Y S��F��i�►�
��: illf�iR�°e�, `��
Attn: Leticia Rodriguez
Neighbarhood S�rvices Department
Ciiy of Port Warth
1000 Throckmorton Street
Fork Workh, Texas 76102
� . �� �r����
Sincerely,
., , .
A1lison Gray, A¢ti�r�r
Neighborho4d 5ervices Department
City of Fort Worth
ACCEPTED AND AGREED: �{�pROV AS TO I
The�ome�i� Cen}�r of'�arrant County
---f , , ' , �
By. _ j ,,_ C! Ai'i'A[�N�Y �'
Laura l�I.lHi�a�, President/CE� � � �
� � �
��- -�.�.�.._....�. � . {- � ' „ %` .._. ., .,_ ._
�� ��� ���u��� ^ ,t. m•
� � �. � �, �i� S��
� � � �r�
EXHIBIT "S" — BUDGET Revised 0912a15
A C L7�ILU I
I AI}411N1:{l`ItA']'l�fL �ISUI"�i'�X UNi_i'j I
� 5alanes ]001
� P'ICA 1002
� Lifelnsurance 1003
� HealYh Insurance lOQ4
� Disability Insurance 1905
� iT�employment-State 1 pQ6
� Accounting 1007
� TOTAL ADIUIINISTRATIV� CXPENSES
% Administrative Cast
rxocr��►� r.rr�sar�rvi;�, �
Salaries I 20G I
� FICA 2002
I Life Insurance 2003
� Health Insurance 2004
� Unemployment 2005
� Worker's Compensation 20U6
� Retirement 20D7
��I1#'I'C_IU�,1,Y11 `.�"i�;f{�1C�:$ I
� Office SupQlies 3(}Ol
� Office Equipment Rental 30D2
� Posta�e � 3D03
Printmg 3004
�i�w[.'�:�. I�#i4 k� lilti
Construction/f3uiltimg Matenals (only ltEAC".H) I ��G�1
Contract Labor (City needs copy of contract before 4602
expensas can be reimbursed)
� Craft Supplies 4003
� Field Trip Admission Expenses 4flD4
I Other Pield Trip E�cpenses (if preapproved by City) 4005
Foad Supplies(City needs copy of contract befare 40Qb
expenses can be reimbursed)
� Teaehing Aids 4007
� FAC[L�I'1�nr��rUr�i.rrr�s �
� Telephone 5001
�Electric 50p2
Gas 5(JU3
� Water and Wasteruater 5004
� 5olid Waste Disposal 50p5
Rent (City needs copy of lease before expenses can bc 50D6
reimbursed)
� Custvdial Services 5007
� Repairs 50Q8
� Cieaning 5upp[ies 5009
I �.rcr:ai_r i���r��c_iki.� �rvU st�s�.�x,a.�c�
� Fidel�ty Bond or Equivalent 6001
� Directors and Officcrs b002
General Commarcial I,iahiliry 6003
Cantract Acopunting 6005
i}fRf? [� A5S45'I'A NC'!c
Childcare Schala�shiPs 7U01
� Short-tcrm Reni Ass�stance 7002
� Short-term Martga�c Assistance 7003
� 5hort kenn Utilities Assistance 7QD4
� OTIjEIt EXP�IYSES
� TOTAL
{. F n ri 1 ��i�i'M4C+�
iiu��e[ Incari�5c betrtast� �FL14f;�9i7E
jl wl��!
I 66,353.00 I
4,077.OD 5.51
15b.OD 3.40
3,474.00 22.90
146.00
147.00
647.00
� �
�
75,04U.00 31.81
I n.36 I bfi,34ti.64
4,082.51
159.40
3,496.90
O.ol 145.99
5,31 I4L69
20.13 626.87
I I- --
�
31.81 75,UOD.UU
The following tables are purely informational and were created solely for purpases af preparing,
negotiating, and determining the reasonableness of the overall line i#em budget on the first page of this
1;Xt11�i1'1' "B" — BT.TDGET and aire not to be considered part af the terms and canditlons of this
Contract. Contractor may make changes to any column except the "Position" column in the "5alary
Deiail" table witho�t the City's consent so long as the tatal amounts charged to the grant do not exceed
the line items on the first page af the EXHIBIT "S" — Bi7DGET." Changes to the column laheled
"Positian" may only be made with the priar written consent of the City�.
Salary Detail
� Position Name
Clinical Therapist
Case Managar
Director of
Caunseling
President & CEO
� Vice President & CF
� Grant Caordinatar
�
I TOTAL
FRINGE DETAIL, * *
Annual Rate
40,000.0�
37,p00.00
General ���OOQ.00
1 i3,000.00
O 80,Q00.00
53,000.00
� FICA
� Life Insurance
� HeaIth Insurance
Unemployment
Workars Comp�nsation
Retireman#
TOTAL
Y�J�;�J.I�y:��l:����l���/[��y
� Office 3upplies
� Of�ce Equipm�nt Rental
� Postage
� Printing
� TOTAL
MISCELLANEOUS
Contract Labor
Craft Supplies
Facility Fees
� ����a Tr�p costs
� Food Suppiies
� Teaching Aids
I TOTAL
�s�,aoo.00
Perc�nf
Payroll
6.1�4%
0.24%
5.24°/a
0.22%
0.22%
0.9$%
Annuai
Hours
2,080
2,080
2,0$0
a,ogo
2,080
2,080
of Amaunt
4,082.51
159.40
3,4�b.9Q
146.99
147.59
C47.87
8,653.36
Fercent to Grant Amount to Grant
92.5%
46.6°fo
9.8%
Z%
2��6
3%
37,024.64
17,2SO.Oa
6,14fi.00
2,4�9.oa
i,�ss.00
1,779.00
1'�.1 %
66,34G.64
PerGent tn Grant Amount �o Grant
l00%
100%
1p0%
100°/n
100%
140%
1Q0%
4,fl82.51
159.40
3,496.9U
145.99
141.69
626.87
8,653.36
Total Budget Percent to Grant Amount to Grant
Total Budget Percent to Grant Amount to Grant
FACILITY AND UTILIT[ES
Total Budget Perc�nt to Grant Amount to Grant
TeIephone
Electric
Gas
Water and Wastevvater
Solid Waste Disposal
Rent
Custodial Services
Repairs
Cleaning Supplies
TOTAL
FINANCIAL AND II�ISURANCE
Fidelity Bond (or Equivalent)
General Commercial Liability
Directors and Officers
Contract Accaunting
TOTAL
DIRE�T ASSISTANCE
�
� Childcare Scholarships
� 5hort-Term Rent Assistance
� Short Term Mortgage Assistance
� 5hort Term Utilities Assistance
Tenant Based Rental Assistance
TOTAL
Tatal Budget Percent to Grant Amount to Grant
TpYal $udget Percentto Grant Amount to Grant
** Please no#e that "Fringe Details" calculatians include rounding errars.