HomeMy WebLinkAboutContract 46162�� STATE OF TEXA� � §
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• This contract {"Contcact"} is made and entered into by and between the City of For�
Woz�tk� (herea$er "City") and AIDS Outreach Center, Inc. (hereafter "Agency"}, a Texas nai�-
proft corporation. City and Agency may be refcrred to individually as a"Party" and jointly as
"fhe Parties".
The Parties sta�e as folIows:
W�REAS, City receives graz�t monies frozn the United S�fies Departzx�ent of Housing
and Urban Development through the Houszng Oppartunities far Persons wzth AIDS Prograrn
("HOPWA") Program, Program No. TX-H-I4-FQ02, Cataing oi FederaI Doznestic Assistance
No.' I4.241;
WF��tEAS, the HOPWA program is intended to address the needs of eligible parsons
associat�d with the challenge of Iivimg with HIV/AIDS and their fa�ilzes;
WHER�AS, Agency subrnitted a proposal to use HO�VVA func�s for an eIigible progra.m
under the HOPWA Regulatians whereby. Agency wilI provide services io low aud moderate
ir�con:ae Czty citizens; �
. WHEREAS, Ci1y� citizens, the Comrnunity Development Cauncil, and the Ci'ty CounciI
have determined that HOPWA prng�rams are needed by tha City's citizens; �
NOV�, TI�RLFORE, the Pa.rties understand and agree as follows:
].. r1VCORPORATION OF R.ECITALS �
City and Agency hereby agree that tha reeitals set �aifih above are trne ana correct a�nd
form the basis upon which the �'artzes have entered into this Contract. �
2. DEFIIVITIONS
Izi addition to terms defined in the bndy af this Contract, the t�rms set %rth beIow shall
have the definitions ascribed to thern as %Ilows; .
Area Median Incame ar A1VII means the median famiiy incoan� for the Fort Worth-Arling�an
mel.-ropolitan statistical area as established annually by HUD. The 2014 incoz�ae limits are
attaehed hereto as Exhibit "A-1" — 2014 IIUD �ncome Limits.
Business Diversitq Enterprise Ordinance ar BDE rneans the City's Business Dzversity
Ordinance, Ordinanca No. 20020- I2-2fl 11.
HOPWA P5A CONTRACT 261�-20�5.
AIDS Outreach Center, Inc.
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ComQlete Doeu�mentation means the fallowing dacumenfia.tion as applicable:
o Attachments I, II, and III, with supporting documentation including:
o Proof of expense: copies of tiznesheets, invaices, leases, service contracts
or oiher c�ocumentation showing that payment zs due by Agency.
o Proaf of p�.�ment: cancelled checks, bank statements, ar wire transfers
necessary to demonstrate that amounts due by Agency were actually paid
by Agency.
o Proof of client eligibility: (i) Source Docurnentation suff'icient to show
that clients particzpat�g in the Program are HOPWA Eligible Clients; or
(ii) documentaiion ather than Souxce Documentation ia show that clients
s�rved by the PrQgrann are HOPWA Eligible Clients. Tn the event that
Agency is a facility tk�at provides a public service, this means
documentation that cIients served by Agency are H4PWA Elzgible
Clicnts.
Complete Documenta#ion shall meet the standards described in the attached
E�ibit "F"� �tandards inr Camglete Docu�eutation.
Any other docurrxent or recard reasonably necessary to verify cnsts spent and
clieni eligibility for the Program. „
DS� means disadvantag�d business enterprise in accordance witk� 49 CFR �art 26.
Director xneans the Director oit�ie City's Housing and Economic Develop�ent Department.
�ffecfive Date zneans 4ctaber 1, 20I4.
i3ED Departxneut means the City's Haus�ng and Econ�omic Developrnent Department.
HOPWA means �Iousing Opportuni�ies for Persons with AIDS.
HOPWA �ligible Client means a client whose annual inconne adjusted for farn.ily size does nai
e�ceed S�% af AMI using �the most current IIUD Income Guidelines az�d Technical Guidance for
Detennining Income and Allawances verified by either Source Documen#ation or the form in in
Exhibit "E° - Forrn of Income Self C�r�ification. The client rr�ust also ha�ve a dacumented
CI1�T10515 O�H��,l���.
HOPWA Fnnds n�.eans the HOPVi7A grant funds suppli�d by Cit� to Agency under the terms of
this Contract. �
HOPWA Regulations zneaz�s regulatipns found at 24 CFR Part 574 et seq.
H�CJll means the United States Department o�Housin.g an.d Urban Developzxzent.
HOPWA PSA CONTRAGT 20i4-2015 2
1LIDS Outreach Center, Inc.
�DI� means HUD's Integrated Disbursement i.nformation Syster�.
Program means the services described in Exhibit "A" — Program Sumrnary.
Rei�ribursement Request rr�eans all raports an�. other dacumentation c�escribed in Section 4:
Source Documentatian Yneazis any documentaiton allowed under the definifiion of annual
income in 24 CFR Part S.6Q9
Unduplicated Ciients means a count of HOPWA Eligible Clients served ance in the Contract
Term. HOPWA Eligible Clients served more than once in the Contr�et Term will only be
covnted once when determining the number af Unduplicated Clients.
3. TERM
The term of this Cont�act begins on Oetober 1, 2014 and t�rminates on Sepfiember 30,
2015 unless earlier tez-�ninated as provided in this Car�tra.ct.
4. DUTIES AN7] RESPONSI�BILITIE� OF CITY
A.1 Pravide HOPWA Func�s.
Cziy shall provide up to Five Hundred Fifly Six Thousand �5even Hundred Fifty S�ven
and OOIIO� Dollars {$556,757.00) of HOPWA Fur�ds under t1�e terms and ca�ditians herein.
4.2 Moni#�r
City wil� ix�.anitar the activities and performance oi Agenc� and any of its coniractors,
subconiractors or vendars as nec�ssary, but no less than annually.
S. DUTIE� AND RESP�NSIBILITIES OF AG�NCY
5.1 Required Services
Agency shall perforrz� the services �escril�ed in Ex�ibit "�" — Program Summary in
accardance with the terms and canditions of this Co�iract.
5.2 Use af HOPWA Funds
5.2.1. Comalia.�nce wifh FIOPWA Re�l�.fions and Contract
Agency shaIl be reimbursed for eligible Pxograrn cflsts with HOPWA Funds only if City
deiermines in its sole discretion �hat:
5.2.1.1 Casts are �iigible e�enditures in accordance with �I�PWA
Regulations.
5.2.1.2 Costs are in compliance with this Con�ract and are reasanable and
consistent wi�h industry nortns.
5.2.1.3 Comp3eie Dociirr�entation is submitted �o City by Agency.
HOPWA PSA CONTRAGT 2QI4-2015 3
AIDS Outreach Center, Inc.
5.2.2 Buciget
Agency agrees �hat HOPWA Funds will be paid on a reimbursement basis in accordance
�wvith E�hibit "B" - Sudget. During the term of this Contract, Agency �nay submit writtez�
raquesfs to increase Qx decrease line-item amounts in the Budget, including a� expianation of
why such increases or decreases are necessaxy. A11 such requests must be approved by the
Director in writing, with. suck� appraval being in the Director's sole discretion. If Director
appro�ves the Agency's proposed Budget amendrnent (as appro�ved, the "Amended Budget"),
then the Am�nded Budget will talce effect on the first day of the manth foIlor�ving the month in
which it was ap�raved by Director, unless o#herwzse specified in the amendment. All requests
for Budget amendments must he submitted by Jun.e 1, 2015.
Se2.3 Chan�e in Pro�ram Sud�et
5.2.3. J Agency wil! notify City promptly of any additional funds it receives
for operation of th� Program, and City r�serves the right to aznend this
Con�ract i� st�eh instances to ensure compliance with HUD reguIations
governing cost allocation.
5.23.2 Agency agrees to utilize �unds a�vailable under this Con�ract to
supplem�ent rather than supplant funds atherwise availahla �or use in
the Pxogra�.
5.2.4 Pavment of HOPWA Funds to A�encv
HOl'WA Funds �will be disbursed to Agency upon City's appraval of Agency's written
and signed Reimbursemcnt Requests including submission of Co�nplete Documentation to C�ty
in carnpliance with Section 9. �f Agency expends aII funds hudgeted �or the Program prior to
Septennber 20, 2015, City may hold back a small amount of �e HOPWA Funds until the end of
the term. Aur�ng this interim period, Agency must continue to submit Reimbursement Requests
with an i�z�voiced amount af $0. It is e�pressi� agreed by the Parties that any HOPWA Funds
either not spen# or not approved far reimbursement to Agency s�all remain with City.
5.3 Pro�rara Per�ormaa�e Milestones
5.3.1 Ag�ncy warrants and represents that the Program will achieve the fallowing
milestones: '
?vto, it n
Il
HOPWA P5A CONTRACT 2014-2015
AIDS Outreach Centar, Inc.
l!n�11�E�lica�ec� C:li�i�ts �s
�p�cifi�ii ars 1;�I�E1}ii "r�•'
�xpen�irures —Pr���•�m �ximmary
27.27% 27.27%
54.54% 54.54%
72.72% 72.72%
�aa°�a �oo°ia
4
5.3.2 Failure of Agency to meet these milestones or a material deviation irorn them as
outlined � in this Section 5.3 is a breach of this Contract. For the purpose of this Section,
"material d��viatian" shall mean more than 10% lawe�° than the speci�ied goal. In the event of
sl�ch breach, City reserves the right in its sole option to deIay or withhold payment oi
Reiznbuxsement Requests, to lawer Agency's allocatian of HOPWA Funds, or to terminate this
Contract.
5.3.3 Failure to m.eet at least 80% of its perfarmance milestones or serve 173
Unduplicated Clients under this Contract will �utomatically disqualify Agency for consideration
under the City's Requesi for Proposals for the 2016-2017 Progra►n Year for �'ederal grant �'unds.
5.3.4 A.mendments to perform.ar�ce mil��tanes must be approved by the Di�ector in
writing, with such approvaI being in the Direc�or's sole discretion. Tf Director app�aves the
Agency's proposed amended perfoximance milestones (as approved, ihe "Amended
Performance Mii�stone�"), then tha Amended Perfdrmance Milestones wi11 take effeat o� the
first day of the m.onth foilowing the montb in which i� was approved by Director, unless
atherwise speciized in the amendment. AIl requests for �.mendrnents to performance �nilesto�es
must be submitted. by J�une 1, �015. Notwithstanding the above, any amendments to
performance milestones sha11 r�ot reduce the numbers for serving 173 Unduplicat�d Clients stated
in. Sectian
5.4 Identifv Pro�ram Eaznenses PaYd with HOPWA Fands
Agez�cy will keep accounts anc�. records in such a manner ihat City may r�adily identify
and account for P��ogram e�penses reimbursed with HOPWA Funds. These recards shall be
made a�ailable to Ciry for audit purposes and shall be reta�ned as required hereunder.
6. CLIENT EL�GISIL�TY VERIFICA'T�ON
5.1 Cliez�t Eligibility
Agency will document th� eIigibility of all pxospective clients. Agency may redact the
clienfi's personal info�atia� and substii:ut� a clienf number. Agency wi11 document client
eligibiliiy as �alIows:
6.1.1 rncome
Agency mus� verify a.11 new clients' incame eligibility with either Source Docum.entatian
or the form attached as Exhibit "E" - Form of Ineame �elf Certification. Agency must use the
annual incort�e definitinn used by 24 CFR 5.609 to establish client income eligibiliiy and �r�.ust
use f.he most current IICJll Income Guidelines. .
6.1.2 Diagnosis
Agency rnust submit a signed, dated stafement that the client's file contains
documemation of the client's diagnosis of HIV/AIDS. The HiV/AIDS diagnosis must be made
h� a licensed health care provider; a client's self-certification of diagnosis is not s�fficient.
Agency should not s�b�nit the actual diagnosis to City.
HOPWA PSA CONTRACT 201�4-20I5
AIDS Outreac� Center, Inc.
� 6.1.3 Emergency Need _
For clients receiving short term rentaI, rnortgage or utility assisiance, Agency must alsa
verify and dacument that the client has ar� er�.ergency need, such as sudden lass of income,
e�vic�ion, u#iliiy shutoff, or extraordinary anc� unexpected healihcare eosts. Agency must submit
its policy regaxding doc�.unenting eYnergency need to Ciiy by Octaber �, 2014.
6.1.4 Sabmis�ion of Comple�e Documentation
A.gency rnust submit copies of all eligibiliiy verif cation dacum�ntation described in
�ection 6.1 with Attachment III in each month's Reimbursement Request for aIl Unduplicated
Clients served for Che �rst time, and must maintain copies of such docuix�.entation as required
under this Contract.
7, ADDITIONAL HOPWA REOUI]t�MENTS
Ageney agreas to comply with all requirements af �be HOPWA Program as stated in the
HOPWA �egulations, including but not lizx�ited to the f�llovving:
7.1 Environmental Review
HOPWA �'unds will not be paid, and costs cannot be iz�curred unYil City has conducted
and cor�.pleted an environmentaI revievv as required by 24 CFR �'art 58. The environmenfial
revievv naay result in a decision to proceed with, modify, or eancel the funding for the Pragratn.
Further, Agen.cy wiXl not undez�a.ke or commii any funds to physical or choice limiting actions as
described in any applicable Federal regulations. Any violation of tihis pravision will (i) cause
this Contra�t to � terminaie innnaed'zately; �nd (ii) require Agency to repay to City the HOPWA
Funds it has already received a�d forfeit an� future payments af HOPWA Funds.
7.2 Cantrac# Not Co�stitutin� Co�mitrnent of Funds
Notwithstanding any provision of this Contract, xhe Parties agree and acknowledge thai
t$is Contr�c� does not constit�ate a corzzzaaitzxaent of funds, and that such commitment of funds or
approval may accur only upon (i) satisfactoty coznpletion of environrnental review and receipt
by Czty of an autnorization to nse grant funds fiom �-IUD under 2� C�'R 1'art 58, (ii) approval af
Ciiy's 20X4-20I5 �Lction Plan, and {iii) receipt by Gity of grant agreennent fronn X1CJD.
7.3 Monitorin�
7.3.1 Agency understands and agrees that City will moniinr ihe adec�uacy and
iimelin�ss of A�ency's perfoz-ianance under the terms af this Contract as wel� as irs compliance
with the HOPWA Regulations. Agancy is subje�t �o sucb monitoring during the term of this
Conts•act and for 5 yaars after the Cantract ternn ends. Agency will provide reports and aceess to
Program files as requested by City for du�•ing tlxis 5 year periad. For purposes of thzs Cont�act,
�his � yea.r period for monitoring is deezx�ed to begin on 4ctaber 1, 20IS and end an Septezxzbex
30, 2020 rega.rdless af whether or not this Contract is earliex tez�inated.
7:3.2 Representatives of City, I3UD, and the Unzted States Comptroller GeneraI sha11
have access during reg�alar business hours, upon �S hours prior not�ce, to Agency's of�ices and
HOPWA PSA CDNTRAC'T` 2614-2015
AIDS Outreach Center, Tnc.
records pertaining to the use of �e HOPWA Funds, ax�d to Agency's officers, dixectars, agents,
employees, contractars, subcontractors and vendors for ihe pur�aose oi such. monitoring.
7.3.3 In addition to other provisians aithis Contract regarding fr�quency of monitoring,
Ciiy reserves the right to perform desk reviews ar Qn-site monitQring p� Agency's cornpl'zaaace
with �ihe tej�ns and conditions ofthis Contract. City sha11 provide Agency with a written report
of the monitoz•'s �ndings after each m.onztoring visit. If the monitr�ring reporE notes deficiencies
in Agency's perfarmanca, the report sha.lI include requirements fQr the tiznely correction oF said
deficiencies by Agency. Failure l�y Agency to take the action specif ed in the monitoring report
may be cause for suspension or termination of this Contract as pro�ided herein.
7.3.4 7.3.4 This Section 7.3 shall be appiicable for the Contract tarm a.nd for � years
�ereafter and sha11 s�zxviue the earlier �ermination or expir�tion af �his Contract.
7e3.5 This Saction 7e3 shall survive the earlier termi�nation ar expiration ofthis
Contract.
7.4 A�eyecv Procurement Standards.
Agency shall comply with all applicable Federal, 5t1t� �iICI IOC1� �aWS, 2'�gill�$IbIiS, and
ordinanc�s for making procurements under this Contract. Agency shall establish procurement
proceduz�es to ensure that materials and services are obtained in a cost effective zz�anner. �Vhen
procuring services to be provided undex this Conl�act, Agency �ha11 comply at a minizx�um with
the procurement sta�dards at 24 CFR Part 84.40 through 2� CFR Part 84.48.
7.5 Cost PrincinleslCost Reasnnab[eness.
Agency shall administer its use of HOPWA� F�.uzds iza coznpliance wi�h OMB Circular
A-122, "Cost Principles £ar Non-Prafit Organi�ations", as ame�.ded from time ia time. The
eligibility of costs incuz�red for per�ormance rendered shall be determined in accordance with
QMB Circular A-122 as supplemented by the provisioris ofthis Cantract.
7.6 Accountin� Standarr�s
Agency agrees to cozxxply with OMB Circular A-I10, ."Uniform Adzxiin.istrative
Requireznents for Grants and Agreements wit� �nstitu�ions of Higher Educaiion, Hospitals an.d
other Non-Profit Organizations", and agrees to adhere to the accounting principles and
procedures required therein, utiliza adequate internaI contz�ols, and maintain necessary su�porting
and back-up dacumentation for alI costs incurred.
7.7 Uniform Administrative Reauiremeuts
AgEncy will comply with ti�e Uniform Administraiive Requireznen.ts set forth in 2� CFR
Part �7.502 or any reasonably equivalent procedur�s and requirements that City zn.ay require.
'1.8 Terms Annlicable to Coatractors, Subcontracfiors and Ve�dors
Agency understands and agrees that all terms of ihis Contract, vvhether regulatary ar
otherwise, shall apply to any and all contractors, s�rbcon�ractors and vendars af Agency which
are in any way paid vvith HOPWA Fun�.s ar who perform any wark in connection with the
Prograrn. Agency shall cause a11 applicable provisions of this Con�ract to be included in and
HOPWA PSA CONTRACT 20i4-2015 7
AIDS Outreach Center, Inc.
made a part of any contract or subcontract executed in the perforn�ance of its obligations
hereunder including its obligatians regarding tkze HO�'WA Regulaiinns. Agency shaIl rr�onitor
the services and vvork performed by its contractoxs, subcontractors and vendors on a regular baszs
far compliance wit1� tha H�PWA Regulations an.d Contract pravisions. Agency must cure a1X
violations of the HOPWA Regulations comzx�itted by its can�ractors, subcontractars ar vendors.
City znaintains the right to insist on Agency's full campizance with the terms of this Contract and
the HOPWA Regulations and Agency is respansable for such cornpliance regarciless of whether
actions taken to fulfill th� requirements of this Cantract are #aken by Agency or by Agency's
contractors, subcontractors or vandors. Agency acknowledges that the provisions of fihis Section
shall survive tlae earizer termination or expiration of this Contract.
7.9 Convright and Patent Ri6hts
No reports, faaaps, or other documenis praduced in whoie o� in part under tlazs Can�rac�
shall be the subject o£ an applicatian for copyright by or on behalf of Agency. T-IUI� and City
shall possess a11 rights to invention or discove;y, as well as rights in data, which may arise as a
result nf Agency's performance Under tbis Contract.
8. RECORD � KEEPING; REPORTING AND DOCUMENTATION
REOUIItEMENTS; AUDIT
8.1 Record Keeqin�
Agency shaIl maintain a record-keeping system. as part of its performance of this Gontract
and shall prozaaptly pro�ide City with copies of any documerzt City deems necessar� for the
ef�ective fulfillxx�:ent af City's monitori�.g and evaluatian respon.sibilities. Specifically, Agency
will keep ar ca�zse to be kept an accu�.rate reeord of a11 actions taken and ali funds spent, with
supporting and bac�-up docume�tation. Agency will �naintain alI records and documentation
related to this Coz�t7ract for 5 years after the Cantract ierm ends. If any clairn, �itlgs3tlRt1� or audit
is initiated before the e�cpiration o� the 5 year period, the relevazit records azad dacumentation
must b� retained until all such c�airns, litigation or audits have been resolved. Far puzpases of
this Contract, this 5 year period for recard retention is deemed to begin on Ociober 1, 201 S azzd
e�d o� �eptember 30, 2020 regardless af whether or not this Cnntract is earlier terminated.
$.2 Access to Records
City and any duly authorized officials of tl�e Federal goveznrnent wiIl have full access to,
and the rigk�t to examine, audit, copy, excerpt and/or tram.scribe a�ay of Agency's records
pertaining ta all matters covered by this Contract for 5 yeaxs after ihe Contract term ends. Such
access shaIl �e duxi�g regular business hours and upan at least 4S hours prior notice. For
purposes of this Contract, this � year period �or access to records is deemed to begin on 4ctober
1, 2015 and end on September 3fl, 2020 tegardIess of whether or not this Contract zs earlier
terrninated.
S.3 Renarts
Agency will submit to City alI reparts and docurnenta�ion described in this Contract in
such form as City may prescribe. Agency �nay also be required to submit a fnal performance
az�dlor final financial report if required by City at the tei-mination of this Contract in such form
and within such iimes as City may prescribe. Failure to subrnit to City any report flr
HOPWA PSA CONTRACT 2014--2a15
AIDS Dutreach Centex, Inc.
documentation described izx this Con�ract shall be an event of default of this Contract and City
may exercis� all of its remedies for default under this Contract.
8.3.I AdditionalInformataon.
Agency shalI pro�ide City with additional information as may be required by state or
FederaI agencies to substantiate Program activities a.nd/or expenditure eligibility.
8.4 Chan�e in Re�orfin� Reauirenaents aad Forms
City retains the right to change repor�ing requirements and forms at its discretion. City
wi11 notify Agen.cy in writing at least 15 days prior to the effective date of such change, and the
Parties shall execute an amez�dment to the Contract reflecting such change iinecessary.
S.S Andit
8.5.1 Entities t�at Exnend $500,000 or more ir� Federai Fnnds Per Year
AI1 nan-federal entities that expend $500,000 or more in Federal funds wi�hin one yeat,
regardless of the source of the Fedexal award, �us� subrnit to City an annual audit prepared in
accordance with speciFic reference ta OMB Circular A-133. The audit shalI caver ttxe Agency's
�iscal years during which this Contraci is in force. The audit must be prepared by an independenf
certified public accoun�ant, be completed within. G m4n�ths following the end of the period being
audited a�d be submitted to City within 3a days o£ its campletian. Agency's audit certificatian
is attached hereto as Exhibit "C" —"Audit Certification Form" and "Audit Requerements".
TY�e Audit Certi�cation Form must $e suhmitted to City prior to or with the %st
Reimbnrsement Request. Enti�ies that �xpend less than $SOO,OOa a year in Federal fr�nds are
�xempt from Fedexal audzt requirements far that year, but records zx�ust be available for revsew or
audit b� appropriate officials of �he Federa� agency, City, az�d �xeneral Accounting Of�ce.
8.5.2 Ci#v Rese�rves the Ri�ht #o Audit.
City reserves the right to perfarm an audit of Agency's Program operations and finances
at any time during the term of this Contract and %r 5 ycars after the Contract Term ends if City
c}etermines that such audit is necessary £or City's Gompliance with the HOPWA Regulatians or
otlaex City policies. Agency agrees to allow access ta a11 pertinent materials as described herein
for such audit. For purposes of ihis Cantract, thzs S year period for Gity audit is deemed to begin
- on October 1, 20 � 5 and end on September 30, 202Q regaz�dIess af whe�er or not ihis Contraet is
earlier terminated. �If such audit reveals a questioned practice ox expenditure, such questions
must be resolved within i5 business days after natice �o Age�►cy o� such quesiioned practice or
expenditure. If questions are not resolved vvithin this pexiod, City reserves the right to withhold
further firnding under this Cantract and/or any other coniracts with Agency. IF AS A RESULT
OF ANY AUDIT IT I� DETEHMI�NED THAT AGENCY HAS FALS�PIED ANY
DOCUMENTATION OR NIISUSED, �IISAPPLIED OR NIISAPPROPR�ATED HOPWA
FL]:NDS OR SPENT HOPWA FUNDS ON ANY INELIGIBLE ACTIVITIES, AGENCY
AGREES T4 REIMSURSE CITY TLiE AMQYJNT OF SUCH MONIES PLUS THE
AMOUNT OF ANY SANCTIONS, PENALTY OR OTHER CHARGE LEV�D
AGAINST CITY SY HUI3 BECAUSE �F SUCH ACTIONSo
HOPWA PSA CONTRACT 2014-2QI5
AID� Outreach Center, Inc.
9. REIMBURSEMENT REO�CJIl7EMENTS
9.1.1 Rei�mbuxsenn.ent Reques#s shall be received by the City on or before th� 15te
day of the month fallowing �e znonth expenses were paid by Agency. For example, th�
Reimbursement Request for June expenses must be received by 3uly 15. In the event the IS��
�alls on a weekend or City haliday, Reiznbursement Requ�sts shall be due the next day that ir�ie
Ciiy is open for business. �'ailure to submit a Reimburs�m�nt Request in a tiznely £ashion will
resuIt in City taking the actions outlined in Section 10.1. NOTWITHSTANDING
ANYTHING ABOVE, EXPENSES FOR SEPTEMBER 2015 MUST SE RECEIVED BY
SEPTEMBER 20, �015. FAILURE TO SUSNIIT A FTNAL REIlVIBURSEMENT
RCQUEST BY SEPTEMBE�t 2Q, �015 WILL RESULT IN AUTOMATIC FORFEITURE
OF PAYMENT OF THE SEPT�MSER REIMBURSE�ENT REQUEST.
9.1.2 City will nc�tify Agency by e-mail within 20 calendar days if a Reimb�arsement
Requesi is lackin�g Co�nplete Dacumenta�ion or cQrrections are needed. Agency w�lI have 10
business days from the date of the e-mail notice to submit any req�aesied information or �issirig
dacumentation. Agency will be penalized in the Request for Pxoposal for the 2015-2016
Program Year for any notifications received under this Section. Tf Agency fails to submit aIl th�
required information or missing docuxinentation within 30 calendar days from tk�e first e-mail,
Agency shalI forfeit ariy payments otherwise due that month and failure to submit any requested
infar�nation will be considered an event of default as outlined in Seciion 10.1.3.
9.2 Agency shall provide City with Coinplete Documentation and ihe following
re}�arts as shown in Exhibit "D" -- Reimburs�z�ent Forms with each Reimbursemant Request:
9.2.% Attachment I — Iuvoice
Tlais report shall contain the amount requested far reimbarsemen� each manth, the
cumulative reimbursen:kent requested to date (inclusive of that mazxth's request}, and must he
signed by an authorized signatary oiAgency. By sioning Attac�ment �, Agency is certifying
that �he costs are valid, eligihle, consistent with the terms and conditions of tka.is Cdn�,ract, and the
data contained in tlze report is true and carrect.. This report rn�st be submatted even if Ageney is
requesting $0 far a particula�r month.
9.2.2 Attachment II — Exne�diture Workshee#
Th.is xepart sha11 itemize each expense requested for reimbursement by Agency and shall
include the Account corresponding the expense to a Budget line iterr�. In order for tlus report ta
be complete the following musi be submitted:
9.2.2.1 �'or payroll expense�, timesheets signed by employees and approved
by supervisor far a11 payroli expenses l�s#ed. Time,sheets r�ust
disfinguish betw�en HOP�A-funded tirr�e and non-HOPWA funded
time and reilect ach�al tirne spent on H�P�VA-funded activities.
Agency may not snbmit payrolI expenses dated 60 da�+s prior fio t�e
date of the Reimbursement Request.
HOPWA P5A CONTRACT 201�k-2a15 10
AIDS Outreach Center, Inc.
9.2.2.2 �ox nan-payxoIl expenses, znvoices £oz� each expense listed with an
explanation as io how ihe invoiced e�pense pertains to the Program.
Agency may not subrr�it invoices dated 60 days prior to the date of the
R�imhursement Request.
9.2.2.3 Proof that each expense was paid by Agency, which proof can be
satisfied by canceied checks, wire transfer documentation, paid
receipt� or other appropriate banking documentation.
9.2.3 Attachu�ent III — Client Data ReAort.
This report sha11 list each Unduplicated Client served during the monih along with his or
her demographic information. The Client Data Report must contain a list of alI clients
served during the Cantr�.ct periad. If Agency, receives fiands from the United States
Department of Justice, then Agency is prohibi�ed froxz�. submitting t�.e Clien.t Data Repart
to the City. However, Agency must complete all required forms under this Section 9.2.3
and maintain in client files in accardance with Section 8. Iri order for this report to be
complete the following must be submitted:
9.2.3.1 Documentation of income verif cation for each Unduplicated Clie�t
the first time he or she is served, which will either be the Source
Docunnentatioz� descz�i.bed in Section 6.l ox the coxnpleted �orrn
attached hereto as Exhi6it "E"- Form af Income Self Certification.
9.2.5 Overvierna Report
Age�cy shall sub�ait the Ovexview Report, attached hexeto as E�hibit "H" — Ovearvie�
�teporf, quarterly with the January, April, Ju1y and October Reimbursement Requests. A paper
copy must be submitted with the Reimbursement Request, and an electronic copy must aiso be
email�d to psa@fortworthtexas.gov.
9.2.� Submission of Reimbursemen� Reaues#.
Reimbursement Rec�uests can be mailed or delive� in person to �TED Departnzent, 948
Monroe Stre�t, Fort Worth, Texas 76102. In addition, Agencies can submit Reirnbursement
Requests vi�a e�xi.azl to usa�,fortworthtexas.�ov but in additzon Agez�cy rnust subnart a sig�ed
original af Attachment I and Exhibit "E" — Form of Income Seli Certi_fication to City by the
deadline in Section 9.1.1.
9.3 Withholding Pavment
CITY HAS NO OBLIGATION TO MAKE PAYMENT ON ANY
RE�MBURSENIENT R�QUEST THAT IS NOT RECEIVED SY THE DiiE DATE.
Failure to timely subnait Reinnbnxsean:�ent Rec�uests and Co�nnplete Docunxentatian along
with any required reports shall be an event of default.
HOPWA PSA CONTRACT 2014-2015 11
AIDS Outreac$ Center, Inc.
10. DEFAULT AND TERMINATION
I0.1 Failure to Submit Reimbursement Reauest ar Renuireti Docnmaniation,
10.1.1 If Agency fails to subanit a Re�rnbursem.ent Request in accordance with
Section 9, Agency shall be in deiault of this Contract. City wi11 notify Agency in writing of such
de�ault and the Agency �will have 10 business days from the date af the written notice to s�bmit
such Reimbursement Request to cure the defauIt. �f Agency fails to cure the default within such
ti�ne, Agency s�al1 �'orfeit any payments oiherwise due that month.
I O.I.2 Ii Agency fails to submit requested in%rmation ar missing documentation as
set forth i.7n Section 9.1.2, then Agency shall forfeit payment due that m�onth and the faiiure ta
submit shall be considered an even.t of default that shall nat be cured.
101.3 NOTWITHSTANDING THE PROVISIONS OF SECTION 10.1.1 �R
10,1.�, IF AGENCY FA�LS TO SUBNIIT THE REIMBURSEMENT ItEQLTEST DiTE
SEPTEMBER �0, 20�.�, DR IF THE SUSNIITTED REIMBURSEMENT REQUE�T FOR
SEPTEMBER �0, 2U1� IS LATE, INCOMPLETE OR OTHERWISE NOT IN
COMPLYANCE WiTH THIS CONTRACT OR TAE HOPWA REGULATIONS AS
DETE�.2MINED BY CITY IN YTS SOLE DiSCRETION, TI3ERE WILL BE NO C'[JRE
PERIDD AND ANY REIlVIB�EMENT WII�L SE AiTTOMA'TICALLY FORFEITED.
10.1.�4 In the event o£ (i) an uncured deiault under Section 10,1.1 or an event o�
default under 10.1.2 (ii) mare than 2 instances of de�ault, cured or uncured, under these Seetion.s,
City resexves the right at its sole opiion fo #ermiur�ate this Conhaet effective i�rn�diately upon
written notice of such intent with no penaIty or liabilzty to City.
1�.1.5 Notwithstand•ing anything to the cantrary herein, City will not be required to
pay any HOPWA �unds ta Agency during the period that any Reimbursement Requesfi, �eport ar
dc�cumentatian is past due or is not i� campliance vvith t�is Cantract or the H�PWA Regulations,
or during any period during which Agency is in default of ihis Contract.
10.1.6 In the event of ter.rnination under this Section 1 D.1, a1I HOPWA Funds
awarded but unpaid to Agency pursuant ta this Contxact shall b�e immediately forfeited and
Agez�cy shall have no furthex rzght to sueh funds.
10.2 Failure to Mainfai� Records or S�bmit Re�oorfs and Doc�men�ation,
If Agency fails to maintain all recnrds and documentation as required in Section 8, or if
the maintained or submitted report or dacumentation is �ot in cnmpliance wi�h this Contract or
the HO�WA Regu�ations as deternnined by City in its sole dis�retion, City will r�otify Agency in
writing and Agency will have 30 calendar days from the date a�'the written request to nbtain or
xecreate t1�e missing xecords and documentation or sub�it ar resubmit any such report or
documentation to City. If Agency fails to maintain the requ�red reports or dacuz�aentation, or
fails �o suhmit or resubmii an� such report ar documentation within such time, City shall have
the right to terminate this Contract effective imrneciiatiely upan �vritten nntice of such zntent with
no penalty or liability to City.
HOPWA P8A CONTRACT 2014-2015 12
AIDS auireach Center, Iuc. �
I0.2.1 In the eveni of ternaination under this Sec�ion 10.�, all HUPWA Funds
awardad but unpaid to A.gency pursuat�t to this Contract shall be immediately forfeited and
Agenc� shall have na further right to such fu�zds, and any HOPWA Funds paid ia Agency nausi
ba repaid to City witIiin 30 days of tertninatian. If such HO�WA funds are not repaid to City
within the 3Q day period, City shall exercise all legal rer�edies available under this Contract.
10.3 Xu General.
103.1 Subject �o Sectian 10.2, and unless speci�ically pro�ided otherwise in this
Contract, Agency shall be in default under this Contract if Agez�cy br�aches any term or
condition oi this Cantract. In the event that suc� a breach remains uncured after 30 calendar
days follawing writien notice by Ciiy {ar such other notice period as rtaay be speci�ed herein) or,
i� Agency has diIigently and continuously attempted to cure following receipt of suc�: written
notice but reasonably requires mare th.an 30 calendar days to cure, as determin�d by both Parties
mutually and in good fai�b., City shall have the right to elect in City's sole ciiscretion to {i) extend
Agency's tirne to cure, (zi} terminate this Cantract effective immediataly upan writt�n notice of
sueh inteni to Agency, or (iii) pursue any other Iegal remed'zes available to City under this
Contract.
10.3.2 City°s remedies ma� include:
10.3.2.1 Direct Agency to prepare and follow a schedule �f actions for
carrying out the affected activities, consisting o� schedules,
tirnetables and milestanes necessary to implement the affected
activitzes.
10.3.2.2 Direct Agency to establish and follow a management plan tl�at
assigns responsibilities for carrying out the remedial activities.
10.3.2.3 Reprogram HOPWA Furzds that have not ye# been expended from
a�fi'ected activi�ies to other elzgible acti�vities or withhold HOPWA
Funds.
14<3.2.4 Any other appropriate action including but not limited to any
re�nedial action legal�y available such as declaratary judgrnent,
speci�c performance, damages, t�mparary or permanent
znjunctions, termination of this Contract or any nther contracts with
Agency, and any ather available remedies.
1Q.3.3 In the e�ent of tezxninatian undez this Section 1Q.3, all HOPWA Func�s
awarded but unpaid to A.gency pursuant to this Contract shall be immediately forfeited and
Agency shall have no further right ta st�ch fiinds, and any HOPWA Fu�ds aIready pazd fo
Agency must be repaid to City within 3Q days of the termin.ation. Failure #a repay such HOPWA
Fwcads within the 30 day period will res��lt i� City e�ercising al� legal remedies avaiIa6le under
this Cantract.
HOPWA PSA CON"I'12ACT 201�+-2015 Z3
AIDS O�treach Center, Inc,
10.� No Funds Disbursed w�ile x� Breac�.
Agency ua�derstands and agr�es that no HOP�7VA Funds will be pazd to Agen�y until all
defaults are cured to City's satisfacrion.
i O.S No Comnensation After Date of Termination.
Agency shall not receive a.ny compensation for r�work undertaken after the date of the
tertnination.
10.� Ri�hts of Citv Not Af�ected.
Termination s�all not affect or terminate any Qf tlze existing rights of City against
Agency, or which may �ereafter accrue because of Agency's de�ault and this provision sha11 be
in addiiion to any and aII other rights and rennedies available to City under the Iaw. Such
termination dnes not terminate any provisiflns of this Cpnt�ract that have bee� expressly noied as
suzviviaxg the terin or termir�ation of �he Contraet. No delay or oznission �y City in exercising
any right or remedy available to it under this Contract shall im�air any such right or remedy or
constitute a waiver ar acquiesc�nce in any Agency default.
10.7 - Waiver of Sreach Not Waiver of Subsequeut Br�ach
The �aiver of a default ar breach of any term, covenant, ar conditio� of tb.is Contract
sha11 not operate as a waiver af any sul�sequent default or breach of the same ar any other tar�,
covenant or condiiion hexeo�
I0.8 Civil, Cri�minal and Administrative Penalties
FaiIure to perfortn all #he Can�act terms may result in civil, criminaI nr adminis�rative
pena�ties, incIuding, bu� not limited to those set out in this Con�ract.
10.9 Termination for Cause
14.9.1 City may terminate this Confxac� in the event o�Agency's deiaulfi, inabiIi�y, ar
faiIure tQ perfor�n subject to notice, graca and cure periods. In the event City �erminates this
Con�ract for cause, ali HOPWA Funds awarded but uz�paic� to Agency pursuant io this Contract
shall be imnneciiately rescinded and Agency shall have no furt�aer right to such fi�nds and �ny
HOPWA FUnds already paid to Ag�ncy must be repaid to City within 30 days of texz�.inafion.
Faiiure to repay such HOPWA �'unds avithin 3Q days wilI result in City exercisir�g aIl legal
remedies. a�vailable to Ciiy ur�der this Con�ract. AGENCY ACKNO�VLEDG�S A.1VD
AGREES THAT IF CITY TERMiNATES THIS CONTRACT FOR CAU�E, AGENCY
QR ANY AFFII.IATES QF AGENCY SIY�LL NOT BE CONSIDERED FOR ANY
�TXZER C�TY CQNTRACT FOR HOPW.A FUNDS F�R A NIINIMUM OF 5 YEARS
FROM THE DATE OF TERNIINATION.
10.9.2 Agency may terminate this Gon�ract if Cziy daes nat provi�e the HOPWA
Funds substantzally in accordance wvith this Contract.
10.1� Termination for Convenience.
In termin�ating in a.ccordance with 24 C.F.R. 85.44 this Contract may� be terminated in
�whole or in part only as follows:
HOPWA PSA CONTTZAC'I' 2014-2615 14
AIDS Outreach Center, Inc.
10.1 Q.1 By City with the consent a� Agency in which case the Parties shall agree upan
the termination co�ditions, includizag the effective date a�d in the case of partial iermina�on, ihe
portion to be terrninated; or
10.10.2 By Agency upon at least 3D days written notification to City, setting forth ihe
reasons for such term.ination, the efFactive date, and in the case ofpartial termination, the portion
to b� terminated. In the case oi a partial te�7nination, City may terminafe the Contract in its
entirety if City �ieterr�zz�es in its sale discre#ion #hat the remaining portion af the Contract to be
pe�rformed or HOPWA Funds to be spent will not accomplish the purposes �or which �the
Con�r'act was made.
1�J.11 Dissolution of Agencv Ter�inates Contract.
This Contract sha1l terminate in the e�ent Agency is dissolved ar ceas�s to exist. I� the
event of termin.atian under this Section, ali HOP'WA Funds are subject to repayment arid/or City
xnay e�ercise a11 of its remedi�s under this Contract. �
� O.I� Reversion af Assets.
In the event this Contract is terminaied with or without cause, all assets acquired by
Agency rv�ith the HOPWA Funds including cash, interest payments from loans or otherwise, all
outstandiz�g notes, mortgages or other security instruments, any accounts receivable attributable
to the use af the HOPWA Funds, and any real or persor�al pxoperty owned hy Agency tl�at was
improved with the HOPWA Funds shall automatically transfer to City or to such asszgnee as City
may designate.
11. REPAYMI±.NT` OF HOPWA FTJNllS.
All H�PWA Funds are �ubject to repayment in the evez�t t�e Pragram does not meet the
req�irernents af this Cantract or in the HOPWA Regulations. If Ag�ncy takes any action that
re,sults in the City b�ing required to repay all or any portion of the HOPWA Funds to
�1L]D, Agency agrees it wi11 reimburse City fox such repayment. If Agez�cy fakes any action
that results in City receiving a finding fro� TiUD abaut the Program, whether or not
repaymeni of aIl or any portion of #he HOPWA Fn�ds is required of City, Agency agrees if
will pay City �0% of the HOPWA Funds as liqnidated damages. The Parties agree ti�at
City's daz�ages in the event of eather repayment to HUD being required or receiving a f�nding
frorn HUD az�e lzncertain and would be difficult to ascertain and rnay include an impact an Czty's
HOPWA grant or other Federa! giran� funds, in addition to the �nding by H[TD c�r a required
repayment of funds to HiTD by City. Therefare, the Parties agree that payment zander t�is
Section of 10% o£ the HOPWA Funds by Agency to Gity is liquzdated damages and not a
penalty.
1�. CFIANGE IN NON-PROFIT STATUS.
Agency mnst provide City with written z�otifcation a�any changes to its nan�profit status
withiu 1� cal�ndar days of being notifFed of the cha�ge. If the non-profit status of Agency
changes after �e date of this Contract, City may �ut is not obligated to, terminate tkzis Contract.
City has 30, calendar days to naake such de�armination after receipt of written natice £rom
HQPWA PSA CONTRACT 2�14-2015 � S
A.IDS Oufreach Center, Tnc.
Agency and failUre to make such determination rvill constitute a waiver. In the event o�
termitiation under this Secfion 12, all H4PWA Funds awarded but not yet paid to Agency
pursuant to this Contract shall be iz�amediately rescinded and Agency shall have no further right
to such fiznds. Any HOPWA �unds already paid to Agency must be repaid io City within 3D
calendar days of termination un.der this Sectioz�.
13. SURVIVAL.
Any provision of this Contract that pertain.s to auditing, nr�onitoring, client incame
eligihili#�, record keeping and reports, City ordina�ces, or applicable HOPWA requirements, and
az�y default and enforcement provisions necessary to enfarce such provisions, shall survive tl�e
termination of �his Contract far 5 y�ars after th� Contract term ends and shall be ezzfarceable by
City against Agency. �or pur�oses af this Cantract, this 5 year period far survival o� certair�
Contxact provisians is de�med to begin on �ciober 1, 2015 and end an September 30, 2020
regardless of whether ox not this Cantraci is earlier terminated.
14. GENERAL PROV�S�ONS
�. i4.1 A�encv an Indenendent Contractor.
Agency shail oparate heraur�der as an independent cor�tractar and not as an officer, ageni,
servant or employee of City. Agency shall have exclusive control of, and the e�clusiv� right to
contral, the details of the work and services perforn:�ed hereunder, and all persons per��rming
sarne, and shall be s�lely responsible for �he a�ts and omissions of its officers, members, agents,
servants, employees, contractors, subcontractors, vendors, cliants, licensees ar invitees.
14.2 Doctrine of Resnondeat Sunerior.
The docirine oi respondeat superior sha11 not apply as between City and Agencyy Dr It5
O�iCOIS, �S10C11bBT'S, agents, SETV&I1�S, employees, CDI1tCaCt�PS, subcontractors, VO�.fIOxS, C�lellf8,
licensees or invitaes, and. nothing herein shall be construed as creating a partnership ar joint
enterprise between. City and Agency. City daes not have the legal right to control the details of
tha iasks perfornied hereuz�.der by Agency�, its afficers, m�mbers, agents, employees, contrac#ors,
subcontractors, v�ndors, clients, license�s ox invitees,
14.3 A�encv Proqertv.
City shall under no cireumstances be responszble for azry praperty belonging to Agency,
or its officers, rr�embErs, agents, employees, contractors, subcon�ractors, vendors, clients,
licensees or invit�es that may be lost, stolen or destroyed ar in arny way dan��aged and AGENCY
HEREBY INDEMN�FIES AND HOLDS NAI�MT_,ESS CITY AND ITS OFFICER�,
AGENTS, AND EMPLOYEES FROM ANY AND ALL CLA�MS OR SUITS
PERTAIN7NG TO OR CONNECTED WITH SUCFi PROPERTY.
14.5 Reli�iaus Or�anization.
No portion of the HOPWA Funds s�all be used in support of any sectarian or religious
activity. In addiiion, there must be no religious or membership criteria %r clients of a HOFWA-
funded service.
HOPWA PSA �ONTRACT 2014-2015 lb
AIDS Outreach Center, Ine.
l�.b Venne.
Venue shall lie in Tarrant County, Texas for any action, whether real ox asserted, at Iaw
or in eqUiiy, arising out ofthe execution, performance, attempied performaz�ce or
non-perforzz�ance of this Contract. �
14.7 Gavernin� Lavv.
This Contract shall be governed by aa�d eonstrued in accorc�ance with the laws of th�
Stat� nf Texas, If any action, whether real or asserted, at �aw or in equiiy, arises out of the
axecution, performance ar non�performance of tbis Con�tr�,ct or on the basis of any provision
herein, far any issue not go�erned hy Federallaw, the ck�oice of law shall be the la�s of t�e State
of Texas.
14.8 Severabilitv.
The provisions of this Contract are severable, and if for any reason a clause, sentence,
paragraph c�r other part of this Contract shall be determined to be invalid by a cour� or Faderal or
state agency, board or comtnission having jurisdiction over the subject ma�ter thereof, such
invalidity shall not ai'fect other pxovisions which can be given effect without fhe invalid
pravision.
14.9 Written A�reement Entire Contract.
This w�•itten instrument and the Exhibits, Attachments, and Addendunas attached �ereto,
which are incorporated by reference and rn.ade a part of this Contract for aIl purposes, constitute
the entire agreement by the Parties concerning the work and services �a ba performed under fi17is
Con�tract. Any prior or cantemporaneous oral or written agreement which purports to vary the
terms o�'this Contract shaXl be vaid. Any amendments ta the terms of this Cantract �nust be in
writing anci executed by the Parties.
14.10 ParagraAh Headin�s for Re�ereuce ��tiv, No Le�al �i�nifcance: Nuznber
and Gender.
Tl�e, paxa.graph headings contained herein are for eonvenzence in ref�rence to this
Contraci and are not inte�ded to de�ne or to limit the scope of any pravision af this Contract.
When can#ext requires, singular nour�s and pronouns incl�de the plural an.d the masculine gender
shall be deemed to include the feminine or �euter and the neuter gender to include the masculine
and %minine. The words "includa" and "including" whenever used herein shaIl be deemed to be
followed by the words "v�ithout limitation".
14.11 Coanpliaace With Al� An�licable Lawa and Re�ulations.
Agency agrees to comply fiilIy with aIl appIicable laws and regulatinns that are currently
in effect ax that are hereaf�er amended during the performazxce af this Contract. Those laws
include, but are not limited to:
➢ HOPWA Regulatiozas found in 24 CFR Part 5�4
➢ AIDS Housing Opportunity Act, as amended {42 USC 129Q1 et seq.)
➢ TitIe VX of the Ci�+il Rights Act of 1964 (42 U.S.C. Sections 2000d et seq.} including
provisions requiring recipie�ts of federal assistance ta ensure meaningful access by
person of limited E�glish proficiency
➢ The Fair Housing Act, Title VIII flf the Civil Rights Act of 1968 (�2 UoS.G. Sections
HOPWA PSA C�N'T`RACT 20f4-2015 17
AIDS Quireach Center, Tnc.
36Q1 e�tseq.)
� Executive Orders 1T063, 1124G as amended by 11375 and X2486 and as
supplernented by D�pariment of Labor reguIatians 41 CFR Part 5�
9 The Age Discrirriination in Employm.e�xt Act of J 467
➢ The Age Discrimination Act of 1975 (42 U.S.C. Sections b101 et seq.)
➢ The Unifar�x� Relocation Assistance and Real Property Acquisition Policies Act of
1970 (42 U.S.C. Sections 4601 et seq, and 49 CFR Part 24) ("URA")
➢ Section 504 of the Rehabilitation Act of 1973 (29 U.S,C. Sections 794 et seq.) and 24
CFR Part S where applicable
➢ National Environmental Po�icy Act nf 1969, as ann�nded, �2 �[7.S.C. Sections 4321 et
seq. {"NEPA°') and the reIafed autharities listed in 24 CFR Part 58.
� The Clean Air Act, as azn.ended, (42 U.S.C. Sections 1251. et seq.) and the Clean
Water Act of 1977, as amerzded (33 U.S.C. Seetions 125I et seq.} and the related
Executive Order 11738. In na event shall any amount o� the assistance pro�ided
under this Coniract be utilized with respect to a facility that Yzas given rise io a
cozz�iction under the C1ean Air Act ar the Clean Water Act.
9 Immigration Reform and Cantrol Act of 1986 ($ U.�.C. �ections 1I01 e� seq.)
speci�cally including the provisions requiring empio�er verifications a£ legal sta.tus
of its ernplayees �
➢ The Americans with Disabilities Act of 1990 {42 U.S.C. Sections 121�1 et seq.), fhe
Architectural Bazxiers Act of 1968 as amended (�2 U.S.C. Sections 4151 et seg.} and
the Unifornn Fedexa� Accessibility Standards, 24 CFR Par� 44, Append'rx A
➢ Regulations at 24 CFR Part 87 rela�ed to lobbyin�, including the requirement thaf
certifcations and disclosures be obtained from all covered.persons
➢ Drug Free Workplace Act of 1985 (41 U.S.C. Sections 701 et seq.} and 24 CFR Part
23, Subpart F
➢ Execu�ive Order I2549 and 24 CFR Part 5.105(c) pez�taining to restrictions on
participation �y ineligible, debarred or suspended persons or en�ities
➢ Section 6002 nf the Solid Waste Dispos�� Act, as arnended by the Resource
Conservation and Recovery A.ct
➢ GUide�ines of the En�viranmentaI Protection Ageney at 40 CFR Part 247
9 For contxacts and snbgrants far constructian ar repair, Copeland "Anti-Kickback" act
(1 S U.S.C. S7�} as supplemented in 29 CFR Pari S
➢ For construction cantracts awarded by Agency in excess oi $2,400, and in excess of
$2,500 for other contracts which involve the emplayment of m�chanics or laborers,
S�Ct10i15 iO3 and I07 flf the Contract Work Hours and Safeiy Standards Act (4Q
U.S.C. 327A 3Qa} as s�pplemented by 29 CFR Part 5
➢ Lead-Based Paint Poisoning Prevention Act (42 U.S.C. 480� et seq.}, as amended by
tl�.e Residential Lead-Based Paint Hazard Reduction Ac� of 1992 (42 U.S.C. 4851 et
seq.) and imple�nenting regulatians at 24 CFR Part 3S, subparts A, B, M, and R
➢ Uni£orm Administration Requirements of 24 CFR �art 8 S
14.11 17�[JD-Assisted Proiects and Em�iovment and ot�er Ecanamac
On�ortunities; Section 3 Reauire�uents.
14.11.1 Reauiremcnt that Lavv Be Ouated in Covered Confracts. -� Certain,
HD�WA PSA CONTAACT 2014-2015 X$
,AIDS Outreaeh Cenier, Inc.
Reaiairements Pertainin� ta Section 3 of the Housin� and Urbau
Developznent Acf oi I968 as A�ended (12 U.S.G. Sections 1701 et sea�.j
and iis Related Re�u[ations at �4 CFR Part 135.
�f the Program results in the creation oi r�ew employment, training, or eontracting
opportuzxities on a cnntractox or suhcontractor leve] xesulting frorn th� �xpendzture of the
HOPWA Funds, Agency shall caznply with th� followiz�g and wi11 ensure that its contracfioxs also
comply. I� the work perfornned uz�der this Contract is on a project assis�ed u�der a pragrarn
prnviding direct Federal �nancial assistance irom HUD, Section 3 of 24 CFR I35.3$ ("Section
3"} requires that the foljowing ciause, shown in italics, be iz�serted in aIl covered coniracts
("Section 3 Clause"):
Section to be q�oted in cavere+d contracts begins:
"A. The� �vork to be per. formed ur�d�r this . cant�act is subj�ct to the
requi�ements of Section 3 of Housing and Urban Developrrtent Act of 1968, cas
amended, IZ U.SC. section 1701u (�ectran 3). 2'he pu�pose ofSeclion 3 is to
ensuYe that enzployrnent and othe� ecnnomic oppaYtunities gene�ated by HUD
assisted or HUD-assisted pYograrns cove�ed �y Sectaon 3, shall ta the gf^eatest
e�tefzl feasible, Z�e dr�ected to low- and ve�ydaw ancome persorts, pa�ticulardy
persons who a�e r�ecapients of H�TD assistance far housing.
�. The partYes ta t�tis contract agree to comply with HUD's �egulatrons in 24
CFR Pa�t 135, v�hich implerrtent Section 3. As e�rdenced by their execuiion of
this contract, the,�aart�es to tFizs contract cert� that they are under no contr�xctual
ot� othe� impediment thrzt would pYevent thexn,ft�om compdying with ihe Pcr�t 135
regulations.
C. The contracto� c�gYees to send to ertch labo� arg�nizatio�t ar°
represen�ative of workers wit�i which it has a coilective ba�gaining agreement o�
othe� under�stancz'ang, af any, a natiee advising the labor orgarzization or worke�s'
represent�ataves of the contracto�'s cammitments unde� this Sectian 3 clause aru�'
will post copies a,f the notice in conspicuous places at tl�e work s�te where both
empdoyees rxnd applicc�r�t� foY training and empdoymeni positions cc�rt see the
notice. The notice shall describe the Section 3 pr�feYence, shall set forth
minzrrzum numbe� and ,�ob titles subject to hir�e, a�ailal�ilaty of app�entice and
training position,s, the qualzfications foY each; and the nc�rrae and locatian of the
pepson(s) taking c�pplicatians for each of the positfons; and the anticipated date
the work shall ,�egin.
D. The coniiactor agrees that it will include this Saciion 3�lause in every
subcontract ta comply with Negulatzon in 2� CFR Pa�l 135, and agrees to take
appro,�rriate actian, as provided rs� an applicable p�ovisron of the subcontr�ct o�
in this Section 3 clau,se, upon finditag that the subcontracto� is rrt violation of the
regulations in .24 CFR Pa�-t 135, The coniractar �vild nat subcontract with any
subcaniracio� wher�e it has notice o� lcnowledge that ihe suhcontNzzetor' has been
fQund in violation of r�eg�latiar�s in 24 CFR Pa�1135.
E. The cont�c�clor will ceri� 1`hat any vaeant employment po,sztions,
irtcludtng trdining posi�ians thai ars�Ied: (1� afiet� the contracto� is selecled but
be, fo�e the cantract is executed, and (2) wfth pe�sons ather than those to wharaa the
fiOPWA PSA CO1�ITRACT 201�4-2a15 �g
AID3 Outreach Center, Inc.
regulataons af ,Z4 CF� Part 135. The cont�actot- will not subcant�act With any
subcontractor where it has natice or knowledge �hat t�ie subcont�actor has been
for�nd in vaolation of regudatior�s in 24 CFR 1�S.
F. Noncompliance wrth HUD's regulataon in 2� CFR Pcari 135- may resuii in
sanctaons, terrrlrnation of this contrc�ct foY default, and debarrnent or suspension
fram future HUD assisted cantracts.
G. Wrth respect to �voNk performed in connectaon with 5'ection 3 cove�ed
Indian housing assistance, section 7(h) of the Indian Self-Deterrnination and
Eciucation As,sastcance Act (25 U.�S:C. Sectio�a 4�4e) also rxpplies to the tivork to be
pe�fo�med unde� thrs Cont�act Sectron 7(h) requires that to ihe greatest extent
feasible (i) prefet�ence and opportttnities for i�ainang a�zd employment shall be
given ta Indians, and (ii) p�efe�ence in the award a� contr�acts and suhcontracts
sl�all be given to Indicrn organizations and Indict�z-otiv�tec� Econamic E��e�prises.
Pcarties ta this cont�-act that are subject ta the p�avisiorts of Seciion 3 and Seetion
79h) ag�ee to corraply with Section 3 ta the rnaxi�aaurra extent feasible, but noi in
de�agation of campliance �wiih �`ection 7(b). "
Sec#eoz� to be quoted in covered contracfs ends.
14.11.2 A�encv Resoonsibilities far Section 3 Requirements.
City and Agency uns�erstand and agree that compliance with the pro�visions of Section 3,
the regulations set forth in 24 CFR Part 135, �and a11 applicable rules and orders of HUD shall be
a candition of the Fedez•al �na�cial assistance provided to the Program binding upnn City and
Agency and their �espective successars, assigz�s, cantractors and subcontractars. Failur��to fulf 11
ti�es� requirements sha11 subject Agency and i#s contractaxs and suhco�tractors and their
respecti�ve successors and assigns to those saz�ctions specified by the grant agreement thraugh
which Federal assistance is provided and ta such sanctions as aa-e specified by 24 CFR Part 135.
Agency's responsibiIities include:
14.1 �.2.1 Impiem�nting �rocedures to �otify �ection 3 residen#s and
business concerns about training, empIoyment, and contracting
opportunities generated by Section 3 eovered assistance;
14.].1,2e2 Notifying goten�ial con�raciors working on 5�ction 3 covered
projects of �heir respansibilities;
1411.2.3 Facilitating the tra�izxiu�g and emplayment oi Section 3 residenis and
the award of contracts to Section 3 business concems;
14.11.2.4 Assisting and acti�ely cooperating with the HED Department in
making contractors and subcontraciors coznply;
14.11.2.5 Refraining from ent�ring into cantracts with contractors that are in
violation o� Seetion 3 regulations;
14.11.2.G Documen�ing actions takan to compiy with Section 3; and
HOPWA P5A CONTRACT 20f4-2015 20
AIDS Outreach Center,lne.
14.I1.2.7 Subrnitting S�ciion 3 Annual Summary Reports (Farm In.Tll-
60Q02) in accordance with 24 CFR Part 135.9D.
14.11.3 Section 3 Reportin� Renuirements.
Ir� arder to cor�ply with the Section 3 req�iirements, Agency must subm�t the for�ns
attached hereto as Exhibit "G" - Secfion 3 Reporting Forms.
14.11.3.1 Repart to the City on a quarterly basis all applicants for
employrnent, and all applicants for empIoyment by eontractor and
subcontraciQr. This shall incIuda name, address, zip cade, date of
application, and status (hired/not hired) as of the date of the report.
1411.3.2 Advertise available positions to the public for Qpen competition,
and provide docurnentation io City with� the quarter�y report that
�emonstrates such. open ad�vertisement in t��e form of prin.tout of
Texas Work%rce Commission posiing, copy of newspaper
advertis�ment, copy of flyers and listing of locations whexe flyers
were dis�ributed, and the �ike.
14.11.3.3 Report to the City on a quarterly basis a11 contracis awarded by
coniractor and subcantractor. This shall include name of
cantractar aradlar subcontractor, address, zip cad�, and amount of
award as of the date of the report.
14.12 ProhibYtion A�ainst Discrimivation.
14.12.1 General Stafemen�.
Agency shall comply in tihe execution, perf�rmance or attetnpted performance of ihis
Contract, with aIl non-discrimination requirernents of 24 CFR 574.603 and Ch.apter 17, A�r�icle
III, Division 4— Fair Housing oi the City Code. Agency may not discriminate again.st any
person because Qf race, coloar, sex, gender, religion, nationaI origin, familial status, disability or
perceivad disability, se�ual orientation, gender identity, ge�der expression, or transgender, nor
rvill Agency permit its afficers, members, agenfis, empioyees, or clients to engage in s�ch
discrimina�ion.
This Contract is made and entered into with re�erence specificalty to Chapter 17, Artieie
In, Divi�zon 3- Empioyrraent Practices of the City Code, a�ad Agen.cy hereby covenants and
agrees that Agency, its officers, members, agents, employees and contxactors, have fully
eomplied with all pravisions of same and that no employee, ar applicant for ern.ploy�nent has
been discrirnin.ated agaizast under the terms of such ordinances by eifi.her or its o�f'icers, rnenxbers,
agents, employees or eon#ractors.
14.12.Z No Discrimination in �mplovment durin� the PerFormance of This
Contract.
During the performance of this Contract Agency agrees tn the following provision, and
wiIl require that its contrac�ors and subcontrac#ors also comply with such provisian by including
HOPWA P5�1 CONTRACT 201�-2Q15 21
AIDS Ou#reach Center, Inc,
it in all contracfs with its contractors:
[Cont�actor's, Subcontractor's or Yendor's narne] will not unlawfi�Ily discriminate
against any employee ar a.pplicants for errsployment because of race, coIor, sex, gender, religion,
national origin, fazniIial status, disability or pereeived disability, se�ual orientation, gender
identity, gender e�pression or transgender. [Contractar's, SubcontractaN's or Yendor's
namelwiIl tal�e afF'�rmative action to ensure that applicants are hired without regard to race, color,
sex, gender, religion, natianal arigin, familial status, disability or perceived disabilzfy, sexual
orientation, gender identiiy, gender e�pression tir transgender and that employees are treated
fairly during emplayment withou# regard to tl�eir race, color, sex, g�nder, religion, natiaraal -
arigin, familial status, disability ar perceived disability, sexual ori�nta�ion, gender identity,
ge�.der expression or t�ansgender. Such action shall �clude, but not b� ��mited to, ihe follawing:
ernployn�ent, upgrading, demotion or transfex, xecruitment or recruitment adv�rtising, layoff or
fiez�min.ation, rates of pay or other farms of coinpensation, and selection %r iraining, including
apprenticeship. [Contrc�cto�-'s, Subcotatracto�'s o� Yendo�'s name� agrees 1:a past in conspicuous
places, available to employees and applicant5 far employmeant, �o#ices set�ing forth the
provisions of this nondiscriminatian clause. �
[Contr�etar's Subcantpacto�'s or Tjendor's narne] will, in alI solicita#ions or
advertisements for employees placed by or on behalf of [�o�tractor�'s, Subcont�actor's o�
Yendor's name], state tlaaf all qnalified applicants will receive eflnsideratian for ezxzplayment
withaut re�ard to race, color, se�, gender, religian, natianal origin, familial status, disability or
pexceived disability, sexual orientation, gender zdentity; gender ex�ression or transgender.
[ContYactor's, Subcontracta�'s ar Vendor�'s �aame] cc�venan�s �hat neither it nor any of its
offzcers, members, ag�nts, employees, ar contractors, while engaged in per�'Qrming this Contrac�,
shalI, in conneciion with the emp�oynnent, advancement or discharge of �mployees or in
c�z�nection with th� terms, conditions or pxivileges of their empIoymeni, discrirninate against
p�rsans because af their age or because of any disability' or percei�ed disability, except on tha
basis o� a bona fide accupational qualif cation, reti�ement plaa� or statutory requirement.
[Contracfor's, Subcontractor's or Yendor-'s name] fizriher covenat�.ts that neither it nor its
afficers, members, agents, ennpIoyees, contractors, or persons acting on theix behal£, shall
specify, in solicitations or advertisements for employees to work on this Contraet, a maxiznum
age limit for such employment �anless the speeified ma�imum age limit is based upon a bona f de
occupational quali�cation, retirerner�t plaz� or statutory requir�mer�t.
14.12.3 A�encv's Contractors and th� ADA.
In accordance with the prowisions of the Americans With �isabilities Act of 1990
("ADA"), Agency warrants �hat it and any of its contractors will not unlawfuliy discrirninate on
the basis of disabiIity in the provision of serviees to the general public, nor in the availability,
terms and/ar conditions a� emplayment for applicants far employment with, or e�nplayees of,
Agency or any of its contractors. AGENCY WARRANTS IT WILL FULLY CQMPLY
yV1T�I THE ADA'S PR�V�SIONS AND ANY OTFIER APPLICASLE FEDER�L,
STATE AND LOCAL LAWS CONCEItNING DISr�BILITY AND WILL DEFEND,
INDEMNYFY AND HOLD CITY �TARML�SS AGAINST ANY CLAIMS OR
H�PWA PSA CONTRACT 2014-2015 �2
AIDS Outreach Centex, Ine.
ALLEGATIONS ASSERTED BY TH�RD PARTIES, CONZItACTORS
SiTBCONTRACTORS, VENDORS OR AGENTS AGAINST CITY ARISING OUT �F
AGENCY'S ,r�Nll/OR ITS CON'�RACTORS', SUBCONTRACTORS', VENDORS' OR
AGENTS' �R THEIR RESPECTYVE EMPLOY��S' ALLEGED FAILURE TO
COMPLY WITH THE AB�VE-REFERENCED LAWS C�NCERNING DISABILITY
DI�CRI117INATZON YN THE PERFORMANCE OF THIS CONTRACT.
14013. Prohibition A�ainsf Tnteres� / Confliet of In.terest.
14.13.1 Agency shall establish safeguards �o prohibit its ezx�pIoyees, board �nembers,
advisors and �gents frazn using positions for a purpose that is ar gives the a�apearance of being
zx�.otivatec� by a deszre far privata gain for theinselves or ofhers, particularly those with whozn
tk�ey have faxnily, t�Usiness or other ties. Agency shall disclose to City auy suc�i canflict of
interest or potential conflict of int�rest, imraaediately upon discovery of such. .
14, I3.2 Na employee�, agents, con�ulta�ts, officers ar elected officials ar appointed
officials of City or of Agency w�io exercise or ha�e exercised any functions or respansibilities
with respect to activities assisted with HOPi�1A funds or who are in a position to participate in a
decision-maki�g process Qr gain inside in%rmation with regaxd to these activities rxiay utilize
HOPWA sezvices, may obtain a�inancial in�erest or benefit from a HOPWA-assisted activity, or
have an interest in aizy cantract, subcant�act or agreement vaith respect thereto, or the pz'aceeds
thereunder, either for themselves or thase with whom they �:ave family or business ties, during
their tenure or for 1 year thereafter, unless tk�ey are accepted in accordance wi�h the procedLires
set forth at 24 CFR.57�4.625.
I4.13.3 Agency afiurms that ii will adhere to the provisions of the Texas Pena! Code
which prohibits bribeiry and gifts to public servants.
1�.13,9� The con.flict of interest provision.s of 24 CFR Part 85.36 az�d 2� CFR Part
84.42, respectively, shall apply in fihe procuremeni of praperty and services by Agency. In all
cases not gavernec� by those Sectians, the pro�isions af 24 CFR 574.�25 of the HOPWA
Regulations shall apply.
14.14 Subcontractin� w�it� Small and Miaorifv Firms, Wamen's Busiuess,
Enternrises and Laboz- Surnl�s Areas.
14.14.1 For procurement contracts $50,000.40 or largex Agency agrees to abide by
City's policy to invol�e Minority Business Enterprises and Sma11 Business Enterprises and to
provide thern equal opport�nity to compete far contracts for construction, provision of
professiflnal services, purchase of equipment and supplies and provision o� othe�° �ervices
required by Cit�. Agency agrees io incorparate the City's BDE Ordinanee, and all amendments
ar successor policies or ardinances thereto, into all contracts and su�contracts for procurement
Iarger than $50,040.00 or larger and will fiu�f.her require all persons or entities with which zt so
cnntracts to carnply vvith said o�•dinance.
14.14.2 Tt is national policy to a�vard a fair share of contracts to disadvantaged
HOPWA P5A C�N'I'RACT ZOI4-2015 � 2�
AID5 Outreach Canter, Inc,
busin�ss entexprises ("DBEs"}, small business entexpxises {"SBEs"), rz�inority busin�ss
enterprises ("MBEs"), and women's business enierprises {"WBEs"}. Accardingly, affirmative
steps must be taken to assur� that DBEs, SBEs, MBEs, and WBEs are utilized when passible as
soUrces of supplies, equipment, eonstructia�n and services.
14.15 Ot�►er Laws.
The iailure io list any Federal, state or City ordinance, 1aw or regulation that is applicable
ta Agency does not ex�use or relieve Agency frou3. the requirements oz• responsibilities in regard
to follow�ing the lar�v, nQr fram the consequences or penalties for Agency's �aiIur� to follow the
law, if applicable.
14.16 Assi�nmen�f.
Agen.cy shall not assign all or any part of its xights, privileges, or duties Under �ihis
Contract withaut the prior written approval of City. Any attemp�ed assignment of sam� wiihout
approval shall be void, and sha11 eonstitute a breach of this Cantract.
14.17. Ri�ht to Insnect A�encv Contracts.
It is agreed that City has the rxght fa inspect �and approve in writing aaxy proposed
contz�acts between Agency arid any contractor or vendar engaged in any activiiy in conjunction
with this HO�WA-funded Prograrn prior ta aany charges being incunred.
J.�}.18 Force Ma�eure
If Agency hecornes unable, either in wl�ale or par�, �o fuIfiil its obligatior�s under this
Contract due ta acts of God, sirikes, lockouts, or other industrial disturbances, acts of public
enemies, wars, blocicades, insurrectionsa riots, epidezx�ics, earthquakes, %res, floods, restraints or
prohibitians by any eourt, l�aaxd, department, con�u�aission or agency of the United Statas or of
any States, civil disturbances, or explosions, ar som.e other reason beyond Agency's control
(colIectively, "�'arce Majetare Event"}, the abligaiions so affeoted by such Farce Majeure Event
wi11 be suspended only during the con�inuance of such event. Agenc� will give City written
nofice of the existence, extent and nature of ih� Force Ma�eure Event as soan as reasonably
possible after the occurrence of the event. Failur� to give notice wiil result in the eon�inuance of
Agency's obligation regardless of the e�tent oi any existing Force Majeure E�vent. Agency will
use commercially reasonable efforts to remedy its inability to perforzn as saon as possible.
15. INDEMNIFICATION .AND RELEASE.
AGENCY CUVENANTS ANll AGREES TO IlYDENTNII+`Y, HOLD NARMT.E��
AND DEFEND, AT ITS OWN EXPENSE, CITY ANll YTS OFFICERS, AGENTS,
SERVANTS AND EMPLOYEES FROM AND AGAIN�T .�N Y AND ALL CLATM� OR
SU�T� FOR PR�PERTY LOSS OR DAMAGE ANDIOR P�RSONAL TNJURY,
INCLUDING DEATH, TO ANY EiND ALL PER�ON�, OF WHATSOEVER KIND OR
CHAi�ACTER, WHETHER REAL OR ASSERTED, AR�SING OUT OF DR IN
CONNECTZON W�TH THE EXECUTYON, PERFORMANCE, ATTEMPTED
PERFO].tMANCE OR NONPERFORMANCE OF TFIIS CONTRACT ANDIOR THE
OPERA.TYON�, ACTZVIT�ES AND SERVICES OF THE PR4GRAM DESCRIBED
Fi�REIlv, V4'�THER OR NOT CAUSED IN WHOLE OR IN PART, BY ALLEGED
HOPWA PSt1 CONTRACT 20�4-2015 �4
AIDS Outreach Center, inc.
NEGLIG�NCE �F OFFICERS, AGENTS, SERVANTS, EMPLOYEES,
CONTRACTORS OR SUBCONTRACTORS OF CITY; ANn AGENCY HEREBY
ASSUMES ALL LIABILITY AN�D RESPONSIB�LYTY OF CITY AND YTS OFFICERS,
AGENTS, SERVANTS, AND EMPLOYEES FOR ANY AND ALL CL�YMS OR SLT.[TS
FOR PR�PERTY LOSS OR DAMAG� ANDIOR PERSONAL INJURY, INCLiJDING
DEATFi, TO ANY AND ALL PERSONS, OF WHATSOEVER K�CNDS UR
CHARACTER, WH�'I��R REAL OR ASS�RTED, ARISING OUT OF OR IN
CONNECTION WITH THE EXECUTION, PERFORMANCE, ATTEMPTED
PERFORMANCE OR NONPERFaItMANCE OF THIS CONTRACT ANI)/OR TI3E
OPERATIONS, ACTTVIT'IE5 A.ND SERVICES OF THE PROGRAM DESCRISED
HEREIN, WHET��ER OR NOT CAUSED IN WHOL� OR Y1V PART BY AIILEGED
NEGLIGENCE �F �FFICERS, AGENTS, SERVANT�, EMPLOYEES,
CQNTRACTORS OR SUBCONTRA.CTORS OF GITY. AGENCY LIKEE'W�SE
COVENANTS AND AGItEES TO ANJl DOES FIEREBY �NDEMNIFY AND HOLD
HARMI.ESS CITY FR�M AND AGAINST �NY AND ALL INJURY, DAMAGE UR
DESTRUCTY�N OF PROPERTY OF CITY, ARISING OUT OF �R IN CONNECTi�N
WITH ALL ACTS OR OMIS�IONS OF AGENCY, ITS OFF�CERS, MEIWIBER�,
AGENTS, EMPLOYEES, CONTRACTORS, SY]BCONTRACTORS, INVITEES,
LICENSEES, OR CLIENTS, OR CAUSED, IN WHOLE OR IN PART, BY ALLEGED
NEGLIGENCE OF OFF�CER�, AGENTS, SERVANI'S, EMYLOYEES,
CONTRACT�RS OR SUBCONTRACTORS OF CITY.
IT IS THE EXPRESS INTENTIOIV �F THE PART7ES, BOTH AGENCY AND
C�TY, THAT THE Il�TDEMNITY PROVIDED FOR THIS SECTION INCL�UDES
INDEMNITY BY AGENCY TO INDEMNiFY AND PROTECT GITY FR�M THE
CONSEQTTENC�S OF CITY'S OWN NEGLIGENCE, WHETHER THAT
NEGLIGENCE IS ALLEGED TO BE TI�E �OLE OR CQNCURI2ING CAUSE OF THE
INNRY, DAMAGE OR DEATH.
AGENCY AGR�E� TO AND SI:[.ALL RELEASE C1TY, IT� AGENTS,
EMPLDYEES, OFFICERS AND LEGAL REPRESENTATIVE� FROM ALL
T,TABILITY FOR INJURY, DEATH, DAMAGE OR LOSS TO PERSUNS OR
PROPERTY SUSTAINED lN CONNECTION WITH OR INiCIDENTAL TO
PERFORMANCE UNDER THI,S CONTRACT, EVEN g' THE INJURY, DEATH,
D.AMAGE OR LOS� IS CAUSED SY CITY'S SOL� OR CONCURREIVT
NEGLIGENCE. �
AGENCY SHALL REQLJIRE ALL OF ITS CQNTRACTORS ANll
SUBCONTR�iCTORS TO INCLUDE IN TTIEIR CONTRACT� AND SiTECQNTRACTS
A RELEASE AND INDEMNITY IN FAVOR OF CITY IN SUBSTANTIALLY THE
SAIV� FORM AS ABOVE.
16. WAIV�R OF IMMUN:iTY BY AGENCY.,
if Agency, as a charitable or nonprofit organizatinn, has or clainns an immunity or
exemptian (statutory or otherwise) from and against liability iar damages or iz�jury, including
HOPWA P5A CONTRACT 2014-2015 ZS
AIDS Out�•each Center, Inc.
death, to persons or property, Agency hereby exprassly w�aives its rights to plead defensively
such iz�nunity or exemption as against City. This Section shaIl not be constru�d to affect a
govern�x►ental entity's immunities uz�der canstztufiional, statutory or common law.
17. IN�UR.ANCE AND BONDING.
Agency will maintain coverage in the farm of insurance ar bond in the amaunt of
$556,757.Q0 to insure against Ioss from the firaud, theft or dishonesty of any af Agency's
afFcers, agents, t�u�tees, directors or ernployees. The proceeds af such insurance or hond shall
be used to reimburse City �or ar�y and all Ioss ofHOPWA Funds accasinned by such misconduct.
To effectuate such reirnbursemen�, such fic�eli�.y covexage sha11 incIude a rider siating �at
reimburs�mant for any loss or losses sha11 name ihe City as a Loss Payee. �
Agency shall furnzs� to City in a timely manner, but not 3ater than the Effective Date,
certi�ieates ai insurance as praof that it L�as secured and paid for policies Qi commarcial
insuxaz�ce as specifed herein. I£ City has no� re�eived such certificates by the Effecti�re Date,
Agency shall be in default of the Con.tract and City may, at i�s optzon, te�inate tlie Contract.
Sueh insurance sY�all co�er all in.surable risks incident to OT Iil COXI.��C�lQll Wli�l tI7B
execution, performance, attempted perforxx�a�r�ce or nonper%rmance of this Contract. Agency
shaIl maintain., the following co�verage and lzzx�its t�ereo%
Commercial General �.iabili#v (GGL� Insurance
$500,000 each occurrence
$1,000,000 aggregate limit
No�-Profit Or�anization Liabilitv or Directors & Qfficers Liabilitv
_ $1,000,000 Each Occurrenee
$1,OOO,Q40 Annual Aggregate Lirr�it
Business Au�omobile Liabilitv Insurance
$I,OQ0,000 each accident on a co�binad single-limit basis, or
$ 250,Oa01'roperty Damage
$ 500,000 Bodily Injury per person per occurrence
$2,000,000 Aggregate
3r�surance policy shall be endarsed to cover "Any Auto", definad as autas owned, hired,
and non-owned. Pending availability of �he above coverage and at the discr�iio�u of
City, the policy sb�all be the primary respanding insur�nce policy versns a persana!
anto insnrance policy ii or when in fhe eourse of Agency's business as contracted
herein.
Warkers' Comnensationt Insurance
Par� A: Siatutory Lin�its
Part B: Employer's Liabzlity
HOPWA PSA CQNT�ACT 2Q14-2015 2�
AIDS Outreach Center, Inc.
$100,000 each acczdent
$100,000 disease-eaeh employee
$5�4,OQ0 disease-policy limit
Note: S�ch insurance shall caver empIoyees perfoxming work on any and alI projects
includin.g but not limited to canstructian, demolitioz�, ar�d rehabilitation. Agency or its
cantractors shall maintain coverages, if applicable. In the event the respeetive contractors
do not rnaintain caverage, A.gency shall maintain the coveraga on such contractor, if
applicable, for each applicable contract.
Additianal Reauirements
Such insurance amouz�ts shall be revised upward at City's reasonable option and no more
freqnently than once evezy ]Z months, and Agency shall revise sUch amounts �ithin 3U days
following notic� to Contractor of such requiremen.ts.
Agency will subrnit io City documentation tt�at it has obtained insuraxice co�erage and has
executed bonds as required in this Cantraet prior to }�ayznent Qf any monies pxovided hereunder.
Where applicable, insurance policies xequired �i�rein sha�l he endorsed to includa Gity as an
additional insured as its interest may a}�pear. Additional insu.red partaes s1�a11 include employees,
o££'icers, agents, az�d volun�eers of City.
�1ny failure on part of City to request certi�cate(s) of insurance shall nat be eonstrued as a
waiver of such requirement ar as a�vaiver of the igsurance requireme�ts themselves.
Insurers of Agency's ins�.irance policies shall be Licensed to do business in the s�ate of Texas by
ihe Departmeni af Insurance or be otherwise eligible and authorized to do busiuess in the state o�
Texas. Insurets shall be acceptable to City insofax as their f nancial strengfh and solvency anc�
each suck corz�pany shall have a current minimum A.M. Best Key Rating Guide rating �f A-: VII
or other egui�alent insurance industry sfiandard rating otherwise approved by City.
Deductible lunits on insuranca policies shall not exceed $5,04Q per occurrence unless othere�vise
approved by City.
In the event there are an.y lacal, federal or other regulatory insurance or bonding require7nents for
the Pro�ram, and such requzrements exceed those specified herein, the foxmer shall prevail.
Agency shall require iis contr�.ctars to maintain applicab�e insurance coverages, lzmits, and other
requir�ments as thase speci�ied herein; and Agency shail require its contractors ta provide
Agency with Gertificate(s) of insurance documenting such coverage. Also, Agency shall require
its eontractors to have Ciiy and Agency endorsed as additional insureds {as their in�erest may
appear) on their respective insurance policies,
Directars and Of�'icers Liability co�erage shall be in force and �nay be prQvided on. a clazms-
rnade basis. This co�erage rnay also be referred to as Manage�nent Liability, and shall pxotect
t�e insured against claims arising out of alleged errors in judgznent, breaches of duty and
HOPWA 1'SA CQNTRACT 2614-2015 2�
AIDS Ouireacl� Center, Inc.
wrongful acts arising out o� �eir organizational d�ities. Coverage sha11 protect not aniy the
entity, but all pasr, present and f�.iture di�ectors, of�'icers, frustees, employees, volunieers and
committee members.
18. CERTZFICATION REGARDING L4BBYING.
The underszgned representati�e of Agency hereby certifies, to the best of his or her
knowledge and belief, that:
No Federal appropria#ed funds ha�v� been paid or will be paid, by or on behalf of Agency,
t� any person for in#Iuencing or attempting to influence an officer or ernplayee of any
agency, a rnember of Congress, an officer or ennployee o� Congress in ca�aection with
the awarding of az�y k'ederal contraet, the maki�.g o� any Federal grant, the rnaking of any
Federal loan, the entering mto of any coapexative agr��ment and the extension,
continuation, renewal, amendraent, or mndifieation of any �'ederal contract, grant, Ioan or
cooperative agreement. �
If any funds other �han federally appropriated fiinds have been paid or will be paid to ar�y
person foz influencing or attempting to influenc� an officer or e�nn.playee of any agency,
member of Congress in connection witk� this rederal contract, grant, loan or cooperative
agreement, Agency sl�all �complete and submit Standard Form-LLL, "Disclosure Forrn to
Report Lobbyiwg," in accordance with its instructions.
This certification is a material representation af fact upon rvhich reliance was plac�d
wl�en this Con.tract was rr�ade or entered znta. Subm'rssion of this certi£'icate is a
prerequisite far ma�ing or entering into fi.his Contract imposed by 31 U.S.C. Section
1352. Any person w�a fails to file the required certification shall be subject io a civil
penalty of not less than $I0,000.00 and not rriore than $100,000.00 for each such £aiIure.
Agency shall require that the lang�age of this cer�ification be included in all subcontracts
or agreements inval�ing the expendit�are af �ederal funds.
19. LITiGATION ANll CLA�MS.
Agency shall give City immediate notice �n writing of any aciion, in.cluding any
proceeding beiQr� an admin.istrative agency, filed aga.inst Agency in eonjunction with this
Coniract or the Program. Agency shall firrnish �rnmediately ta City copies of all pertinent papers
received by Agency with respect to such action oF claim. Agency shall providE a notice to City
within 10 days upon �'iling under any bankruptcy or financial insolvency provisinn of law.
26. NOTICE
Al! notices requ�red or permitted by this Contract must be in writing and ate deemed
deli�ered on the earlier date of the date actually xeceived or the third day follawing deposit in a
Ux�ited States Postal Sez•vice �aost office or receptacle; with proper postage, certified mail returri
H�PWA PSA CONTRACT 2014-2015 ��
AIDS Outreach Center, Inc.
��ecei�t requested; and addressed to the other Party at the address set out belaw or at s�ch other
address as the receiving Party designates by proper notice to tha sending Party.
Citv:
City Attaz7t�ey's OFfice
1000 Throckmorton Street
Fort Worth, TX 76102
Telephone: 817-392-'1600
Copy to:
Director nf Hausing az�.d Econoinic Dev�lopment
1000 Thronkmorton Street
Fort Worth, T� 76102
Tele��ane: $17-392-7540
cQ�y fa�
Prograzn Coordinator
IDOQ Throekrnorton Street
Fort Worth, TX 76142
TeIephane : 817-3 92-6342
A�en�v:
AIDS Outreach Center, Tnc. .
Stephanie Cagle, Direetor of Case Management
400 N. Seach, Ste. 100
Fort Worth, TX 76111
Telephone: 817-33 5 -1994
�1. AGENCY HAS LEGAL AUTHORITY TO ENTER INTO CONTRAC'T.,
Agency represents that it possesses the Iegal autharit}r, pursuani to any proper,
ap}�ropriate and afficial motion, rasolutian or actian passed or taken, ta enter into tl�is Contract
ar�d tQ perfarm the responsibiIities herein required.
��. C4UNTERPARTS.
This Cantraet rnay be executed in multiple counterparts, each of which shall be
considered az� ariginal, but all of which shall constitute ane i�strurnent rvhich may be suf�'iciently
e�ridenced by one co�nterpart.
[�IGNATUR.ES APPEAR ON NEXT PAGE�
H�PWA P5A CDNTRACT 20I4-2015 29
AIDS Outreach Center, Inc.
Il�T WITNESS dVI�ERE�F, the Paz�ties hereto have executed 4 duplicate ariginals of this
Contract in �'oi� Wai�h, Taxrant Ca k a b��- r�
! � �°�°°e°o�,
ATTEST: ' J ��°
�� � , �
, � GG
� �s
. �City Secre �r,
M&C: C-2G893 -. �-�������,o��
Date: August 5, 2014 '���
FORT WORTH
„v. ya3
=A� � _�_�:. �� � _ �
�°��anda Costa, Assistant City Manager
APPR VED A� TO FO AND LEGALIT�:
� �� �
Assistant Cily Attarney
AIDS OUTI�A�H CE�TER, INC.
By: _ � �-� � ��. . .
Narne�_ - - - ! - - - - '
Title: 'f
STATE OF TEXAS §
COUNTY OF TARRANT § - �� �� 2014 by
This instx�ument was aekn,awledged before me an � i`�, �
Fernando Gosta, Assistant City Manager of the City o� Fort Worth, on behal� the City of Fort
Worth. - - - � � � , l a
....,.,,. . _. . ,.. . ,� ,.�; � ..�... ; e' ' ti k-�L'�LT`'j
_,,. ���„,�
- — _;�`� �y!�;: - I.INtiA M� HIRF�LINQ�R - L - - --- - NQ -P-ublics �tate af Texas--- - - ='- ----
���< �v caM��s�ion� �x��r��s a
-:;� �,�;�' ��br�aary2,?.,I�14 _
� -� -
STATE OF TEXAS §
COUNTY OF TARRANT §
Thi; • instrument was acknnvvledged before me �n
the ' p� -
corporat%n, on behalf af` said corporation. �
,
,,;��,����, • • �
+ ��p'� pU/� ..LARRY D. ELl.IS
;`$��:�= Notary Public, Siate oi 7exas
:; ,,,,.�P,: My Commissian Expires
'!'i�°ii,���``� June i 9, 2� � 8
HOPWA PSA CONTRACT 2014-20]5
AIDS Outreach Center, Tnc.
� • --
_ '�'�1 �.�.
. _ ��� (� � +
, 2a1� by
, a Te�as non-�rofit
Notairy Pub�c, �tate of Texas
i;���I.�'+I� e%G�I�.'
�I�'Y' ��G�"CA�t'ti
�'�• ��ii"�'�i� `I'�'L �
3a
E�HIBITS:
Exhibifi "A" — Program Summary
Exhibit "�-l." — �014 ��iJD Iucome �.imits
Exhibit `B" — Budget
E�zhibit "C" — Audit Certification Form
Exhibit "D" — Reirnburrse�nent Farms
E�chibit "E" — Farm o£ Income Sel£ Certi�cation
Exhibit "F" — Standards for Complete Documentatzon
Exhibit "G" — Section 3 Reporting Forms
Exhi�it "H�" — aver�iew Report
HOPWA P5A CONTR ACT 201Q-2015
AIDS Outreach Canter, Inc,
31
AIDS OUTREACH CENTER, INC.
Suppvr�.ive Sa�vices, STRMi7, and TBRA
EXH�I'I` "A"
PROGRA�VI SUMMEIRY
PROGI2AM SIIMMARY
Housing Opportunities for Persaz�s wiih AIDS
(HOPWA)
Octab�r l, 2014 to September 30, 20].5
PERTi]D
P�OGRAM:
$55G,i5�'.OU
AMOUNT
The Program provides each HOPWA Eligible Client with one or znar� of the follawing:
1) supportive services
2) tenant based rental assistance {"TBRA."); OR,
3) short-ierm rental, znortgage, or utility assistance ("STRMIJ"}.
Supportive Services, includes housi�g counseling azad case manage�ent.
T$RA, tenant based ren�al assistance includes long-terrn manthly rental assisfance. Clients must
be income eligible according to HLTD guidelines, live in a rental that passes inspectians, and
haue an iden�if ed housing need as determined by the clie�t's AOC case manag�r.
STRMU, s�c�i� terrn. �•ental, mortgage, or utilit�y assistance, includes shQrt term assistance for up
to 2i weeks. ST�2MU provides assistance with utiliiies, rent, or mortgage and must not exceed a
clien�'s c�rrent monthly budg�t def cit caused by an unavvida�le, �rzplaiuled, documented
emergency consistent wifili--HU� guiclelines ��1- as defined-by—AOC's local-poliey.- C-lier�ts- ------ -
receiving ather gave�-nrnent housing assistance are not e�igihle.
Program sezvices wi�l be accessible at 4DD N. Beach Street Suite lOQ, Fort Worth, TX 76111,
Monc�ay thru Thursday 8:30 arn to 5:00 pm and Friday 8:30 azx� ta 4:0� pm.
HOPWA will serve eligible clients iui Tai7ant, Johnsan, Parker, �Iise, I�ood and Sornervall
CQuri'C1BS.
�OPWA Funds wi1l pay for direct assistance such a� TBRA and STRMU. HOPWA �unds will
also be used to pay costs associated with delivering supportive services to any c�ient recezving
either TBRA o�r STRMiJ assistanee, including sala�ries, and fringe hene�ts, and FiCA for
ennp�oyees, supplies, insurance, an.d Program facility and utility cos�s. Na more than 7% of'the
HOPWA Fun.ds will be used ta pay administrative costs, incZuding salaries�, insurance, iaxes, and
legal and accounting fees associated vvit� the Progratn.
The Progtains will be p�ovided cansistent with. HCTD guidanee.
HOPWA �'SA CONTAACT 20I4-2015 —�XI�BTT "A" — PROGRAM SLTMIVIARY
AIDS OU1�each Centar, Iac.
REGULATORY CLASSIFICATION:
lDZS mat�ix Code{sj and Service Categor�: 31D HOPWA Project Spnnsor Adminisicatior� 31C
HOP�VA Project Span.sor Activiiy
Regulatory Citation(s): 24 C�R 574.300{b){IO) — Administrative Expe�ses
24 CFR 574.300(b)(7) -- Su�portive �ervices
24 CFR 57430Q(b)(6) — STRM[J
24 C�R 574.300(b)(6} - TBRA
Based on the natu�e of ihe service provided, Agency will tnaintain docuinen#ation that verifies
t1�at 1�0% of clients served by tbe Program are eligible under HOPt�VA Regulations.
PROG�AM GOALS:
� Provid� Progratn services to appxaximately 173 Undup�icated Clients
• Provide'�BR.A services to appra�imately� 58 �Tnciuplicated Clients
• Provide STRMi.T services to appxoxintately 115 Unduplicated Clients
HOPWA PSA CONTRACT 2014-2015 — EXTIIBIT "A" — PIZOGRAM Si.TMMARY 2
AIDS Outreach Center, Inc.
30°/a A�.VII
SO% AMi
SQ% AMI
EXIi[BIT "A-i"
�4Y4 H[TD Income Limitis
2014 Median Family Income - Fort Worth/Arlir�gton, TX'�
1 Persan 2 Persons 3 Persoz�s 4 Persons 5 Persons 6 Persons
$13,850 $15,8�0 $19,790 $23,SS0 $27,910 $31,970
$23,054 $26,350 $29,650 $32,900 $35,550 $38,20�
$36,900 $42,15� $�7,400 $52,554 $56,900 $61,100
� Incoma Limi�s are established and puhlished at least annually by HUD
HOPWA PSA CONTRACT 2014-2015 —� BXHIBIT "A-1"-201� HUD INCOTVIELIlVIITS
AIDS Outreach Center, Inc.
7 Persons
$36,030
$40, S00
$65,300
8 Persans
$40,090
$43,450
$69,504
1
EXIiiBIT "B" - BUDGET
- � r��t���,.��
�,►r���rrvi���E�,��[��v�, c����^►v_�or�i.v�
� 5alaries 1U01
�FICA lOD2
LifeInsuranae i0Q3
� Health Insurance 1004
� Disabilitylnsurance ��a5
llnemployment-State �fla6
Aecounting 1007
TOTAL Afl1�IINISTRA`�'IV� �?CPENSES
� - . _ ..
�'�PROG�tAlYT"�?ERS�iV1Y�L . . ,
� Salar�es 2001
FICA zaaz
� Lifc Insusanca 2003
� Hea[th Tnsurance 20U4
� Uncinployment 2065
� Worker's Compensation zQ�6
Itetirement 2007
I ,SiJP��lE5ANYl SF:kVjC�4
� ai6Ce 5upplies 3001
� Of�ceEpuipment�iental 3D02
�Posta$e 3003
Printin 3D04
� 1VIISC�ti�hi4R[�115
� Construction/Buildin,� Materia�s (only REACT-n 4Q0 i
Contract I.a6or (City r�eeds copy of conEract
� befare exuenses can 6e raim6ursed) 40Q2
Crsft Swnlies 4flD3
� Fie1d Trin Admission Lxne�vses 4D04
IOther Field Trip Expenses (if preapproved 6y
C��, 4005
Foo� SuppIies 4006
Teschin�Aids _ 4007
Frt<=iL1'I'S' Al�u lfFii�3T#�'�
� Telephone SDUI
� Electric 5002
��� 5003
VUater and Wastawater 5044
� 5olidVJasieDisposaf 5005
I Re�rt (Ciry needs copy aflesse Uefore expenses
can be reimUnrsed) 5D06
�Gustodiel Servi�es 50Q7
Repairs 50p8
� Cleaning Sunplies 50Q9
� Buildin� 5aourity 5010
�.;;LEGAT�,'F'�N�i\'CIAL;'AIr'D:xNS[1�2;�NC� ";� .
Fidelity Bond ar Equivalent b001
� Directors and qfficers 60U2
General Commercia! LiaUility 64U3
� Contract Account�'ny� 6005
�:-pIR�C'I';AStSIS'I`AI�GE�`- - - -
� Childcare Sel�olarshi�s 7DO l
� Sltort-term Itent Assistance 7p02
5hort-term IVlort��ge Assistance ���3
� 5�ort-term Utilities Assistanoe 7004
� Tenant Based Rental Assistance 7005
� TOTAL
FiINBING A: TarrAnt Conntp
FLiNDINGB: Yrivatek�ndiog
FIIN DINCr C:
c��,����
I�t��r�a��
5,736
A38
10
I21
5
lA
2,675
8,999
50,537
3,86f
1D
3,126
649
aoo
571
3j2
146
50
�
SOa
38
42
5
b,151
6,735
112,186
8,582
17,629�
949
4D0
$25
155
isa
�+
23,657
1,811
2,854
2�44
22,670
51,236
5d,:i44
�},173
256
678
4,852
7G4
I,147
244
�
�-�� .k i.
x9,893 {
2.287 I
10 �
3,017
5
263 f
31,496 I
6G,971 �
_j
� �
zi7,267 J
1G,521 �
10 �
21,Ofl6 �
2,276
I 200 �
i
5,�23 ;
i,701 �
I 1,448 �
499 �
_ �
577 625 2,290
99f 750 4 065
400
400 I
3,567 4,687 12,846
697 62S 4,213
29 275 12
50 85 I , 219
258 1,34i
28,123
6,02!
26,G87
h20,49j
556,757 155,795
HOPWA PSA GONTRAC`� 2014-2015 -�XHIBIT `B" -- BUDGET
AII]�S Outr�ach Center, Inc.
3; 492 -
5,806
40�
400
I �
21,100
10,535
316
354 J
�
3,399 4,9R8
28,123
6,021
26,687
447,491 !
149,993 � I 849,545 J
1
Tbe following tat�les are pur�ly infor��aational and were created sa�ely for purposes of prepaxing,
negotiat�ng, and determining iha reasanabieness of the overall line zte�n budget on ihe �rst page
oithis EXHIBIT °`B" , BUDGET aa�d are not to be conszdered part of the terms and conditions
af this Cantract. Cantractor r�ay mal�e changes to any co�umr� except the "Position" column in
tha "Salaxy Detail" tabXe wiihaut t11e City's consent so loiig as the iotal amounts charged �o the
grant do not exceed the line items on t.�e first page �f tihe EXHIBIT "B" — BUDGET. Char�ges
to the ca�umn labeled "Position" may only be madE with the prioz written consent of the Ci�ty.
! Pnsition NaYne
� DIR CASE MGMT
� CASE MGR
� AED
�CASE MGR
CASB MGR
� CAS� MGR
� RECEPTIOIVIST
�ACCDUNTANT
�DIlt ADMIN SVCS
TOTAL
FIGA
Li% Tnsurance
� Health Tnsurance
� Unemployment
� Dasability Insurance
Workers Compensa#ion
Retixement
TOTAL
DfFice 5upplies
Office Ec�uipment Re�tal
� 1'ostage
Printin�
TOTAL
� Contract Labor
� Craft Supplies
� Facility Fees
� Field Trip Casts
� Food Supplies
Teaching Aids
TOTAL
Rate
23.47
19.47
29.57
l 5.86
14.90
15.14
12.74
17.18
25.23
SALARY DETAIL
� Ann�aal Hours �'ercent fo Grant ,
2d80 5% �
2080 98.77% �
2484 5.4% I
2fl$0 S%
2080 � S% �
j 2084 � 5% �
2080 � 5%
208Q S% ,
� 2U80 � 5°10 `
� � I
FRINGE DETAIL
�'ercenfi of Am�ount � �'exce�t La Grant
PayroIl
7.65% 18,90$ � 22.76%
�
-- --- I-
�
E
Amount to Graot
2,441
40,000
3,321
1,GS0
1,550
1,575
1,325
1,787
2,624
56,273
Amount to Grant
20 � 100%
24,023 � 13.52°10
2,539 Z6.11%
5 100% �
260 - - �--- — I�0l3%0 -
� �
9�,3Q4 �
20 �
3,247 �
663
5
- -2U4 - - -
8,439 �
SUPPLIE� AND SERVICES
� Total �udget Percent to Grant Amo�nk to Grant �
1 5,823 9.81% 571
1,741 18.34°/Q 3 I2
I 1,448 10.08% I 146
` 499 ] 0°10 � 5U j
� ],079 �
MISCELLANEOUS
Total Sud�et Percent Eo Grant Amaunt to �rant
2,675 100°/u I 2,675
�
� 2,675
HOl'WA PSA CON7RACT 2014-2015 — EXIIIBIT "B" — BZ]DG�T
AIDS Outreach Center, Ina.
2
0
0
�
�Telephone
Electric
� Gas
Water and Wastewater
Solid Waste Disposal
� Itent
� Custodial Services
� Repairs
� Building Securiry
� TOTAL
� Fide3ity Bond (or F�uivalent)
� General Commarcial Liability
�Directors and Officexs
Confiraci Accounti�g
I TOTAL
FACILTTY t1ND UTILITIES
Tota! Bud�at Percent to Grant
3,492 Id.52°l0
5,806 17.07%
4d0 1Q0%
400 1d0%
2I,104 16.91%
10,535 6.62%
316 $.18%
35Q� 1/1�.12%
Amount to Grant
577
991
AOR
400
3,567
697
29
SU
5,'il l
LEGAL, FIN.ANCIAL .AND TNSURI�NCE
I Total Bud�et Percent to Grant Arnount to Grant
4,998 S.l 6°/a 258
25$
�
Childcare Schnlarships
5hart-Term Rent Assistance
Short Term 11�Inrt�age Assistance
Short Term Ut�Iities Assistance
Tenant Based Rental Assistaiica
I TOTAL
DTRECT ASSISTANCE
Total Bud�et Percent to Grant
28,123 1Q0%
� 6,a21 1UD%
26,687 100°/a
� �420,491 100%
;
HOPWA PSA CON'TRACT 2{�i 4-2015 -- EXHIBIT "B" -- BUDG�T
AIDS Outreach Genter, Inc.
Amonnt to Grant �
28,123
6,021
26,687 _
420,491
481,322 �
3
E�HIBIT "C" -- Andit Certification Form
[See attached]
xoPwA PSA CON�zAcT 20 �4-zo 15 — ExH�rr °°C°° — AUD�T c�R�iCATION FORM i
AIDS Oatreach Center, Inc.
AUDIT CERTIFICATION F�1�M AND AUDIT 12EQUIREMEIoiTS
A�ency:
Fiscal Year Ending:
AIDS �utreacl� Center, Inc. .
Septembew 30�_ �Ola
�During the fiscal year in which funds will be receivec�, we will exceed the federal
expenciiture threshold of $SOO,Q00. We will have our Singl� Audit ar Program Specific
Audit eon:�pleted and will submit the A-133 audit repori r'vithin se�en {7) months after the
end of the audited fiscal year or thirty (30) days witf�in its completion, whichever is the
earlier date,
❑ During ihe iiscal year in which funds vvill be received, r�ve will not exceed the $500,UOQ
federal expenditure threshold required far a Sing�e Audit or a 1'rogram Specifzc Audit to be
perFormed ti�is fiscal year. (Fi11 out schedude below)
— - - �e�ier�f ���Ser�sist�:c �li�:cl+��i.��`�
�1r�El�;'�' l�e fiilled c�u�. �I" Stt�� �ur�it or �'ro _�r�� �utEit �� lV[1"E'�t+i�•� .
_ ' F'��ss'1`h�ou�k� � Prc��,ram 1*laa7�c .S� Cai�tr��ct � �:.;?Cj}CEl4�h�lll`�5
�'CL{41'il��']k'a1�7E�}i [21'37f�;}i' ��'�)}��[It�'1�1Cf �Llfl"I�]4l
fTotal Fedaral Ex�endi�ures for this Fiscal Year:
` q. ���I�
�� �. x���,�,v� ��`u��c�
�Signato�ry and Title Da#e
Failure to submit this or a similar statement or failure to submit a compieted single audit package
as described in the federally required audit requirements described in 4MB Circulars A-133 by
the required due date rnay result in suspension af funding and may affect eligibility for future
funding. Notwithstanding; the above, this certi�ca�ion acknowledges the agency's
commitment to meet all other financial reporting, financial statements, and ot�er a�dit
requirements as may be set forth in the Cantracf.
HOPWA PSA CONTRACT 2D 14-2015 — EXHIBTT "C" — AUDIT CERT�ICATION FORM
2
AIDS Outreach Center, Inc.
Exhibit "D" -- Repartin� Forms
[See attached�
HOPWA�SA CON'IRAC'F 2Q14-2fl15 Exhi6it "D" -- REIMBURSEMENT �'ORMS
ATDS Outreach Center, inc.
Attachment I
nvvoxc�
Agency: AIDS �utreach Center, Inc.
Address: 400 N. Beach, Ste. 100
City, State, Zip: For� Worth, TX 76'1 i 1 ,
Program: Supportive ServEces, STRMU and TBRA ,
Period �f 5enrice: ,
'� - �rrw;:,�n+; . �
ProgM'w� T�;� �nvoEc+� C+�m�Eativ+� to Q�ie !
_ d
Agency's Certification: I certify that the costs incurred are valid and
consistent with the tarms and conditions of the contracf befween City and
Agency. By signing this irt�oice; I certi�y tf�at-to the f�est of my kl�ovsi e ge
--- ---- -
and belief the data included in this repori is true and accurate. It is
acknowledged tha# the pro��sian of false information could leave the
certifying official su6jeet to ihe penalties of federal, state, and local faw.
Signature and Date:
Name:
Title:
HOPWA PSA CONTRACT 2014-2015 E�chibit "D" -- REIlWIBi1RSEMEN'F' FORMS
.AIDS Outi°each Csnter, Inc.
2
Attachment II
City of Fort Warth
Hausing and Ernnamic Oevelapment Department
Expenditure Worksheet
Agancy:
Progrem:
` �,ir�#,k � GheCk Wo-
I 1
I 2
� 3
� 4
I 5
I 6
I 7
I 8
I 9
� 10
I 11
I 12
� '13
f 14
� 15
I 16
17
iB
19
20
21
�
23
24
25
26
I P7
1 2s
� 29
I 34
I 31
� 32
I as
� 34
I 35
I 36
� 37
I 38
I s9
I 40
I 41
� 42
I 93
I 44
I 4s
I 4B
� 47
I 48
I a9
_ 50
51
52
53
54
55
56
� 57
� 58
i 59
I so
I Total
r�4�a
AI�S Ouheach CenterI Inc.
SupPoetjYe $ervlc@s, STRMU end TBRA
please arouo Ilke eccaun� codas.
sn;r.riahon`
i}�G4WIh CM4 I
I5u� IS�`y iO i2:ArAS AM1�e�ll51
I
1
1
I
�
'Payrall must identiiy employee. Rent must identify lenant. Othar paymants should ideniify individuals, if applisahle.
Fti191 il� ghlcd arc Ihtl {;qfy rUlnr-91is cotle5 �of 11115 PIvS�Firn
{� XPun�c �Ynu Itani
EAo�r�r�sTah nvE ariahwA� o�5irf
alarles
I FICA
I �.ife Insurartce
I Health [nsurancs
I �isabill�1' Insurance
I Une�laymant-Siaie
I L (& Accountin�
k pE#'wi� ;irci
I �ares
I FICA
I Ufa Insurance
I Neelthlnsurance .
I Vnemalo�ment
� Warker's ompeneatlan
I Retirement
�iwG 9ERVBG�
ice oqPJies
4(fice Enuipment Rental
Post�a
Prinliq
ll9T��`�MEOU6
onference & Seminers
ConstncclioNBufldina Malerials
Conttact Lahor
Graft Sy�ulies
� Credit f2eparta
I Fecili�y Fees
I Fleld Trlp Casls
I Foad Suoolles
� hrlile�p�
Teachi� Afds
��rr�++u ur�n�a
elephane
I Elaclric
I Gas
I Water and Wasteweier
� Solid Waste I]is�osal
I Rent
I Custodlal5ervices
I Raczairs
C10ani%� S�yr !I�ie�s
�., �10-1,4M1{��A�, AND INS[]WU�CE
enty Bond or Equ�valent
I Dirmctvrs and Qfficers
I General Commerciai Liability
� Lepal Fees
Contract Awouniln
�I �yA5511S7.4����
�hildcsre Seholarshios
Counselina - Individual Sessions
Counselin4� Group SesSions
ShoA-term R�nt Assislance
ShoA-term Morj as�e Assistanse
BhoA-term Util ties Assislance
Tenani Sased Aentsl Assistance
ICA�1��4417UTa.A1'
Pumicure. Fbdures
I Compulers
I OKice �aW'yfnent
I Sqnri and FEecreation Equipment
� Ac[ounl
' _ 1�01_
�ooa
io�3
�004
1005
�oos
1007
2ooi
2002
20�3
2004
2p05
2605
2Q07
340�1
3002
3003
300A
aoa�
4062
4Q�3
400A
4005
40(i6
aao7
90Q8
90�9
A010
5001
5002
60a3
5004
5005
5006
5007
5008
5009
60q1
6002
6003_ _ _
6004
6005
70�7
7002
7003
7004
7Q05
70�6
7007
I 8401
aaas
8003
8004
HOPWA P3A C0131RAGT �4I42015 Hxhi6it "D" -- REIM6iJR5EMENT F�RMS
AII]S Outreach Ce�ter, Ina
A7T FII
uNn1l2LCATEn cuENT ppTA REpoR7
qgerny.
Pragram:
Ma�Nh:
ThI� +cpan i. �nranr � tst all µ�.p�icmn �Ilaa sarv�c 8u�iiG � nomr�F 4np �51w.e ��=:;i w �hPVS.Iblf 7P� ;01 LI� C4F+m�mL1� hl�ou .iJ .iiY ���'w. Pnt�n+nl}� �i��aRnhrr Gimnc Y�u xill xl=e �:ii e14=•�14'tiaF�-.�rt I��m wr orh r�. �I�.aM.y-Nevi�im57upitcated?
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45
HOPWA PSA CONTRACT 2Q14-2015 -- EXHIBIT "E" -- INCOME CERTIFICATION FORMS
AIDS Outreach Center, Inc.
Ezhibit "E" — Income Certification Forms
�See attach�d]
HOPWA PSA CONTRACT 2014-2015 -- EXHIBIT "E" -- TNCOME CERTIFICATION �`ORMS
AIDS Outreach CenYer, Tnc.
City of Fort Worth
C�I�T'I�l��►il�R� O� 1NG0�� �'irAi���Al�'
Applicant Name:
Current Adc�ess:
City and Zip:
Last Name
Phone #:
H�usehold Mer�bers and Income
(iacluding applicant}
First Name Age M�nthly Source of Incorne
Income $$
TOTAL NUMBER OF FAMII.Y MEMBERS
Toial Gross Annual Hausehold Income:
(Include Xourself, Spouse, Children, etc.)
PERSDNAL INFORMATION: {Check one in each item. This Information is lZequired for Federal �iepariing Purpnses)
a. ❑ MALE b. � WHITE ❑ BLACK/AFRICAN AMERICAN ❑ BLACKIAFRiCAN AMERiCAN & WIIITE
❑ FEMALE ❑ t�MER3CAN IND7A1VJqI,ASKAN NATiVE ❑ ASIAN
❑ AM�RICAN INDIAN/ALASKAN NATN� & WHiTE ❑ ASIAN & WETITE
❑ NAi'NE HAWAILANIOTHER Pl�CIFIC ISLANDER ❑ BALANCE/OTHER
❑ ANIEIiICAN INDIANIALASKAN NATI1rE & BLACK/AI'RICAN AML'RICAN
c. ETHMCITS' d. DISABLED e. IS HEAD �F HOUSEHOLD F�MALE7
❑ HI5PANIC ❑ YES ❑ 1'�S
❑ NON-HISPAMC ❑ NO ❑ NO
Certifcation: I certify that the in�armation I�.m providing xs true and could be subject ta verificatiQn at any
time by a third party. Z also acknawledge that the provision af �alse information could leave m� subj ect to the
penalties of Federal, State and locallaw.
Signature o#' Applicant
Dat�
W.ARNING: T�TL� 18, SECTION lOO� OF THE U.S. CODE STATES THAT A PERS4N 1S GUILTY OF A FELONY
FOR KNOWINGLY AND WILLINGL,Y MAKING FAI,SE OR FRAUDULENT STATEMENTS TO ANY DEPARTME�I�T OF
xHE UHIT�D STATES GOVERNNi�NT.
6------�-----�--�For use by Agency str�J'f o�aly---.�.��_oo_..a_
I Household Size:
ApplXcable Income Limi�:
Gross Annual Income:
Is Applicant Eligible?
Check if Applicant refused to provide demographic information: ❑
Sta�f Assessment of Demographics:
Person Making Determination:
Date:
�VOT`E: Address, incorrte amaunts nncl sot�rces for ALL household mem6ers are requir�erl.
I�OPWA PSA CONTRACT 2014-2015 -- EXI3IBIT "E" -- INCOM� CERTIFICATION FORMS 2
AIDS Outreach Centar, Ine.
Cxudad de Fort Worth
C���1�ICi4Cl��! D� ��C��R�CION �E 1�4GFi��O�
Nombre del Solicitante:
Direccion de Actualidad:
Ciudad y Codiga Postal:
Apellido
Telet'ona:
Miembros Del Ho�ar e In�resos
(Incluy�ndo ellla Solicitante)
Nornbre Edad Tngreso Origen de Ingresos
Mensual
� TOTAL N[]MERO DE MIEMBROS DEL HpGAR
(Incluyase ilsted.}
Tat�l Anual de Ingr�sos del hogar:
**INFORMACIDN PERSONAL: (5eieccinne uno en cada articulo. Esta informacion es requerida por el Gobierno federal.)
a. ❑ MASCULINO b. 0 B�.ANCO ❑ NEGRO/AFRICANO AMERICANO ❑ NEGRa/AFRICANQ AMERICANO & BLANCO
❑ FEMININ� ❑ INDIO AMERICANQ/NAT'IVO DE ALASKA ❑ ASIATICO
❑ INDIO .AMERICANO/NATIVO DE ALASKA & BLANCfl ❑ ASIATICQ & BLANCO
❑ NAT1V0 HAWAIANO/OTILO DE LA5 ISLAS PACIFICAS ❑ BALANCE/OTRO
❑ INDIO AMERICANO 1 NATIVO DE ALASI�A & NECiRO/AFRICANO ANIERICANO
c. ETHN3CIDAD d. INCAPACITADO e. �,ES LA CABE�A DEL HOGAR IvI[J3ER?
❑ HISPANO ❑ SI ❑ 5I
❑ NO-HISPANO ❑ NO ❑ NO
Certifieaeion: Yo certifico que la infarmaci6n que yo estoy proporcionando es verdadera y puedo ser sujeto a
verificacion a eua.iquiera h�ra par tercera parte. Yo tatnbien reconozco que la provision de informacion falsa
puede dejarme sujeto a penalidades F�derales, Estatales, y a ley Local.
Firma del Solicitante
Fecha
A.DVERTENCIA: TITULO 18� SECCIDN lOOl DEI. CODIGO DE LOS ESTADOS UNIDOS INDICA QUE UNA
PERSONA ES CULPABLE DE IIN DELITO PUR SABER Y VOLUNTARIAMENTE HACER DECLARACYOIV�S FALSOS O
FRAUDULENTAS A CUALQUIER DEPARTAM�N�'O DE GOSIERI�O DE LOS ES'1'ADOS UNIDOS.
�---d�-w--�----�--Pr�ra use de em,�Zec�dos de in r�gencir�-�---�---�-
�# De Miembras de Familia:
Limite de Ingreso:
Ingxeso Anua1:
�Es solicitante elegible? :
Compruebe si el solicitante se negb a dar su informacian personai: ❑
E�aluaci6n d�1 empleado sobre infarmaci6n personal:
Persona haciendo la determinacion: Fecha:
Note: La direccion de la casa y los ingresos (y sus arigenes) para todos miertabros del hogar son requer�dos.
HOPWA PSA CON'FRACT 2D14-2015 -- EXIIIBIT "E" -- INCOME CERTIFICATION FORMS 3
AIDS Outreach Center, Inc.
Exhxb�t "F" � Standards for Complete Documentation
�5ee attached]
HOPWA PSA CONTRACT 2014-2Q15 E�ibit "F" -- STANDARDS FOR COMPLETE DOCUMENTATION
AIDS Outreach Center, Inc.
�3�tlge1 k,lpa I�ms
f��h�14y4* SPIILfirtx
Salanes
FICAlMedicara
LiTe Insurance
�
€
R
`v
i�
g�
x
20�94�24�a �oc�menta4ion S�andards gor
�ubl"rc Se�vice Cor�t�aci �a�penses
��z
� 4 �
� E � �
�
� �.f a
g
`a a � �
� � � =
: y � �
� n ,�
b � � �
� n .. � aYSiusJdlhn�
If an employee works solely wllh Cantract e3igia[e cllents and so;a[y on Cantract ell8iole rzems, khen the emptoyee's eniire selary ia elipinle [or
reim6ursement Twlce Iq each taSendar year, li7e client must aubmH a written siaEement vedTying Iha! the above condldana are stil! Irue. The
staiement must also 6e sipnad be a persan authorized to sign an 6ehal! oithe agency.
Heaith Insurence
Rlsability
Insurance
I lJnemployment
Insurartce
Refirement
��j-atl�6�rApal5�rvlca� —
IAccpunUng I Ix �� I IX
Expenses I
��Ie�jala,�9ulPm�n�+#vnde end Suppklee
OFfICB SUOpIIBS )C �C K
Office Equipmen! X X X
Rentel
Postage X X X
Prinfina X
Constrcution & X
Huildlna Matedals
Spart antl X
Recreatlon
Ep�ioment
1 C[eanina Su�Jplies X
I Teachinp Alds X
I Crafl Supplies X
Faod Supplfes X
;rav+� ��Q Fl+ld 7rXpg
�FieldTnp �iC
Admisaion
Exoenses
b�, �CTn�, �UiUilfr.a an� [
I elephane
i �� x
I WaterMlaateweter x
I Elec[ric X
I Solid Wasle X
f]isoosal
Facility X
Maintenance antl
Reoairs
I Custodial Senrices X
I ReM
Iy�/y-Ieeella n�ow
I Conlract La6or
I Insurance X
Req�lred Lfnder
1he Cuntrac!
IChlldcare
Scholarships
X I
If an employee wadcs on a variety af progrema, ar warka wilh a miMure of ConVscl eligihle clienls and nan-ellgihle clfents, fhen 1he Ciry wlll anly
reim6�rse for a reasonatle portion oF the employee's safary. Each reimbursement requeat must include not anry Ihe amployee's limesheel, put
also a wark 3og 6reaking out the employee's flme by projealor acGvity. �'or emplayees paiq with mul�ple (unding sources, timesheets mus! reilect
alf furtdiqg saurces. If separate fimesheets are kept Far each fanding saurce, all euch fimesheets musi tre suhmilted ta City.
'If employeaa arg paid by direct deposlt rather fhan check, then the sgency must su6mh boih We dired depasit paymenl campanys report {such
as an ADT repaAj and a bank slaWment ar check showing payment ta tha direet deposil cvmpeny.
If tBe Cily pays gross salary, this Is already included. If Ehe Ciry pays the emAloye� portlon, ihen Ehe emplaye� must show a calcWatiort and I
documentatlan of how iha Invoiced amouniwas calculated. and include documentatiun sl�p7�na� vment.
If the Ciry paye grass selary, this Is already included. If we pay the emplayer portian, Nen the employer must show a caleula&on and
documenlatlon af hawihe Invaiced amount was calculatad, muat indude art invoice fram 1he Insurar, and must include documenlatlon showing
navment.
If the City pays grass salsry, thie is already included. If we pay 1he employer poNan, then Fhe employer mustshow a cslculation sn@
documenlation of haw Ihe involced amouni was calwlated, musl indude an Invalce tram the Insurer, and must Include dacumeniation showing
pavment_
If the Cify pays groas salary, this Is alreatly included. IF we pay the empluyer portian, lhen the emplayer must shaw a calculatian and
documantntion af how the involcad amount was calrailated, musl incWde an Invaice trom tha Insurar, and mc�ei Inclutla documsnlaflan showing
�pvment.
If dta Cify pays grnss salary, this �s already Included. If we pay the employer portlan, then the employer must show a talcsilaiion and I
�rcumenlation af how the Invalce@ amount wfls calculaYed. end musi inclade documentation shawina pa�menl
wg pay g�nss salary, thia ls already Included. If we pay the ernployer portlnn,lhen the employer mus! show a calculallon and dacumentalion o!
how the Invoiced amounl was calculaEed, must and inclutle dacumeMation showing payment, anq prio� to the fl�st �eimbursement, musl incNde the
pereannel poticv �estaMlnq retiremenk herteilts,
If an autllt is requlren trecause federal mrnis exceed .�500,d00, �hen the wst shouia oe apin evemy by ali reaeral funuing sources.
The agency should malnlain Informatian regarding mailouts. If 1�e agency �es e pilney Bpwes machine ar Ifke poslage nschine, the resards of
that ma�lne must 6e on flle. Likawlse, if mail i5 cetegoozed by peyment sou[ce, then ittose recards musl6e an Ifle. Fa� large msilauW, liie agency
shoultl keep a cpp4 of the letter and a list of all addresaees.
Thls categary is only available For REACH.
�In addifion ta atlmission expenses, faad expenses wlll alsa 6e allowed sv lonp as the agency has a wrttten poilcy statlng lhat Eaod and drfnics are
rnuline purchases on all fleld trips, notjust Contractdunded fleld tr3ps.
tiasldas tihe_l:nfllratt ��ograrn, ihen iho bilk muFl
�
{
c
H
�rLu
X"
b
�
r
'i{�
-1! U74 in11UwU'I� #MO#11l�#d u� Rb14 i+s�8 �uC�l{y Ihal j6
x,
x x
if services are provided per a contract, agancv will provEde contracl instead of imaces.
Clty requlres thal the agency su4mit fls fee echedula, aho�vlrtg a 6reakaut of Ncome levels, a�d far each level a bfeakout oF the poA€on oF IFte
expense Eo be peid 6y famiiy and !he po�ion to be relmbursed by the City. This Fee schedule is reqWred prior la tha fiBf payment, We also reqvire
the incame eligiblity of eacii hflueehold sa that we ran delermine iF we are 6eing ciianged in conformance with the fee schedule, I� Uie fee
scheduEe changes at arry tlme during the tonlratt year, the agency rnust notify Ciry antl provide a new schedule wHhin 34 days af tha change.
•ProoT oi payment eftectlne Octo6ar 1, 2U14: Paymeats or Facpenses must 6e dacumented in the fallawing manner;
Ay lmege of 1he check AND hank slatement showing the check cleared the bank; OR,
B} Image o€the cance4led check (az At end of bank s[afement}; OR.
Cj Payroll "Advace" ar Stsiement ANO 6enk Siatemenl indlcatlr�g payroll; OR,
D) For wire or e•transfers: Reciapt or statament !mm payealvendor pR 6ank slaMmenl.
HOPWA PSA CONTRACT 2Dk4-2015 Exhibit "F" -- STANPARDS F'ORCaMPLETE DpCIIMENTATION
AIDS Outreach Canter, Inc.
EXHIBIT "G"
SECTXON 31t�P�RTIrIG FORM�
[See attached]
HOPWA PSA CONTRACT 2014-2Q15 -- EXHIBiT "G" -- SECTION 3 REPDRTING� FORMS
AIDS Outreach Center, Tnc.
EXHIBIT „G"
��C�1��1 ��lC11'Ifl'l�� ���D� U.S. Deparkrnent af Hausing • OMS Appraval No: 2529-pQ43
Econom9c apportunities for and urban qevelopment (exp. 11I30I2d1Q)
Low — and Very Low-Income Persons office of �air Housing
And �quaV OpporkunCty � HIJp FieSd Otfice: I
Secqon baak oi paga far Pu61ic RepQ�ting Burden staiement
1. Reciplenl Nams & Address: {slreel, city, skaie, zip) 2. Federal l8entificaiion: (g�ani no.) S. 7otel Amount af Awerd: I
4. Contact Person 5. Pitone: (Include area code)
6. Length af Grant: 7. Repa�ing Period:
I 8. oate fteport Submiited: 9. I'rogram Code: (Use separete sheet 16. Prog[am Name: �
Ifor each program code}
I!'art I: Employment and Trainlnq (*'" Co[umns 6, C and F are manda;ary fieEds. lndude New H(�es in �&F)
A i B C D � F
Number ot Nu�nBerof New %of Aggregaie �lum6er 46 of Toial Staff Nours Num6eroi5ectian 3
.lob Gstegory New Hlres Hlres t[tal are of 51aff Ha�us of New Hires for Sectlan 3 Employess 7ralnees
Sec, 3 Res'sdenls Ihat era Sec. 3 Rssidenis and Trainees
1 Nfo�B551oL7813 -
Technicians I
G'�J::elClerlcal
Constructian by Trade (List) I
Trade
; r
'i'Kade ' �
ITrade I
j Tr�� � f
ITrade � 1
fC_?ther (tist)
I
I Tatal
• Program Codeg
7 = Flexlbla 6ubsidy
2 = Saclion 2�218i1
3= Pu6feJln�2f1 Housing 4= Home[ess Asslstanse
A =17eye[opme�t, 5 = HOME
B= Operation 6= h10ME Stata Administered
C» Modsmizaiion 7= C�eG Enlitlemeni
i
8 = Gk3BG State Adminlstered
�= OtherCo Pragrams
10 = Other Mousing Plograrns
Page 1 012 fo[m hUn 60002 (612001)
Ref 24 CFR 135
Part 11: Coniracts Awarded
1. Co�strucifon Contracls;
A. Total dallar amount af all contracts awarded on the projed
g. Tnial dollar amount of confrscts awarded to Seclion 3 businesses
C. Perck.ntage of the total dollar amount that wsa awrarded to Section 3 businessea
D. Total numbef of Seciion 3 Guslnesses receiving oontracls
2. Non-Construction ConUants:
A. Total dollar amount al] non-construction conEracts awarded on the plojectfadiviiy
8. Tota1 dolfar arrEount of non-construction wntracis awarded fo Secaon 3 businessas
C. Percentage of lhe talal dolfar amount thatwas awarded ta 5eclion 3 businasses
D. Tota1 number of Sect[on 3 busfnesses receivfng non-cvnstrucifan cantrects
l�arf Ili: Summary
Indicate the efforis made to direct the smployment and oth�r econam[c opporfunit�es generated by HU[7 financial assistance for housfng
and communliy deveEo�ment programs, fo ths greafest extent feasib�e, loward low and very low-Income persons, particularly lhose who
are recipfents of go�ernment assistance far hausing. (Check all lhat apply.)
Aftempted ta recruit low-income residents throug�: local adverfising media, aigns pramfnent�y dispEayed at the proJect siie,
contracts witf� the communiiy organizations and puhlic or private agencies operalfng within the metropolitan area (or
nonmetrapolitan countyj in which the Section 3 covered program or project is locaied, or similar methods.
Participated in a HU� pragram or uther program whiah promotes ihe training or ernployment of 5ection 3 residents.
Partic�pated in a HU[7 program or flthar program which promotes the award of contracts lo business concems which meet fhe
definifion of 5ection 3 husiness concerns.
Coordinated with Yauthbuiid I'rograms adrrrfnistered in the metropolitan area in which lhe Section 3 cavered project is lncated.
Other; desaribe below.
Publia report�ng fnr this collecUon of information is eslimated to average 2 hours per r�spanse, including the iime for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and revlewing the wllec#ion of informalian.
Th�s agency rnay not coflecf ihis iniarinatian, and you are nat required ta compEete this form, un[ess it d(splays a currently valid OfORB
number.
SectEan 3 of the Housing and Urban Development Aci of 1958, as amended, 12 L1,S.C. 1709 u, mandates that the bepartment ensures �hat
employment and oiher economic opporluniUes generated by tts housing and community development assislance �rograms are dfrected
toward low- and very-low fncome persons, particular�y those who are recipients of governmenE assistan�e housfng. The regufatfons are
found at 24 CFR Part 135, The information wi11 be used by the Department fo monitor program reclpien[s' compllance with Seciion 3, to
assess the results of the Deparlmeni's efforts to meet the sfafutory obJecfives of Section 3, to prepare reparts fo Gnngress, and by
recipients as self-man{taring tool. The data Is entered info a database and will �e anafyzed and d�stributed. The collection af informativn
invoives reciplents receiv[ng Federal financial assistance for housing and community development programs covered by Section 3. Tha
informalian will be collected annually to assist HUD in rrseeking ils reporting requirements under Secffan 808(e)(6) of the Falr Housing Act
and Seatlan 9i6 of ihe HCDA of 9992. An assurance of confidentfahiy is not applicable fo this form. The I'ri�acy Act of i974 ar�d ON9B
Circular A-108 are not appi[cabls. The reporting requirements do not contain sensitfve questions. �ata is c�roulaiive; personal id�ntiying
information Es not included.
Ps9B �� 2 form HUD 60002 {1 tt2010)
Ref 2b CFR 'f 35
FBrm HU�-60002, Section 3 Summary Repblt, Economic Opportunifles for Low- and Very l.ow-Incame Persons.
Instructlons: This (orm is to be used ta repod annual
aocomplishments regartling employmeqt and other economic
apportunities provided ko Eaw- and uery tow-Incnme persnns under
Saction 3 oT Yhe Housing and Urqan 1?evelopment Act of 1968. The
SectEon 3 regutations app{y to any publlc artd fndian housTng
programs that receive: (1) de�elopment essistancm pursuant ta
Ssciion 5 of tila U.S. Hnusing Aci of 1937; (2} aperating assisience
pursuant io Section 9 of the U,S. Nousing Aot of 1s37; or {3}
modernizatian grants pursuant to Section 74 of the U.S. Housing Acl
of 1939 and to recipienis af housing and cammunify developmeot
assistance 1n excess of $200,04d expended fvr: (i) housing
rehabilitafion (Induding reducUon andabatement of lead-based paint
hazards); (2j haus[ng constr�ctron; ar (3) other pu6lic construction
projects; and to confraets andsu[rcaniracis in excEtiss of$4f1Q000
awarded in connecNan wiih the Secifon-3-covared aetivity,
Farm HU�-80002 has three parts, Which are to be cvmpleted for
all programs covered by Secllon 3, Part 1 relates to emplvyment
and fraJning. The recipient has the option tn determine numerical
emplaymanUlraining goals either on the basis of the number of hours
worked by new hires (columns B, Q, E and F). Part 11 oP the form
relates to contrectlnq, and Part 1[I summarizes reciplents' effarts lo
camply with Section 3.
Recipienfs or contracfars subjecE to Seclion 3 requirements must
malhlaln epproprlate documentation to esEahlish thaE HUD flnanetal
assistance far housing and communiiy development pragrams were
directed toward low- and very low-incame persons,' A re�iplent of
Section 3 cavared assisiance shall submit one copy of lhIs repad ta
HUD Headqusrters, Offlce of �air Housing and �qual Opportunity.
Where the progrem proWding assistance requlres an annual
perFarmance report, this Section 3 report la to he submilted at the
same Hme the p�ogram performance report is su6mitted. Where an
annual performanca report is not reguired, thls SeeNon 3 report ls to he
submilted hy Januery 10 and, if the �roject ends defore �ecember 31,
wilhin 10 days of project compfetion, On1yPr'fine Reclplenfs are
reqirired to report to NGD. 7he reAnrt mr�st lnclude
aaeomp!lshments of af! reciple�ts and fhelrSection 3 aavered
eontracfors ana�subconh�actars.
HUD Ffeld 4ffica: Enfer the Fteld Office name .
1. Recipient: Enter the name and address of tfie recipfenf
submitting ihis report.
2. Federalldentiilcation: �nterthenumberthalappearsoniha
award Porm (wEth dasAes). The award may be a grant,
cooperative agraement w canEract
3. Qollar Amount of Award: �nEer the doliar amount, munded fo the
nearest dollar, received by the r�ciplent.
4& 5. ConEact PersnnFPhane: Enter the oame and felephane number
af the parson with knowledge of �he award and the resipienYs
implementa�ian of Section 3.
6. Reporting Peridd; lndieate the tirne period {months and yearj
fhis reporl cavers.
7. Qate RepaR Submitted: Enter the appropriate date.
8. Progrem Cade: Enter the appropriaie program code as listed at
the boriam of ihe page.
9. Program Name: Eoier the name of HL1D Program corresponding
with the "Proglam Gode" in number B.
Part l: Empioymant attd Train[ng DpparFunities
Cotumn A: Contalns variaus job cafegaries. Profass�onals are
defined as people who hx�e special knawledge af an occupation (i.e.
supervisors, architects, surueyors, ptanners, and computer
programmers). Far constructlon posiiions, list each trada and provide
data In columos B through F{or each Vade where persnns were
employsd. 'fhe category af "Other' inGudes accupatinns such as
serviee wwkere.
Column Bc (Mandatory Field) Entar the number of new hires for
each category o� workere iclentified in Cofumn A In conneclion with
ihis award. New hire refers to a person wha is not on the coniracfor's
or recipienYs payroll for empinyment at the tima of selectian fur tha
Section 3 covered award ar aE the t[me af receipt of Sectian 3 covered
assisEance.
Column C: (Mandatary Field} Enterthe n�m6arof Seet[on 3 new
hires for each caiegory of+niorkers identified In Column A[n
cvnnectitm with th�s award, Seetion 3 new hire refers to a Section 9
resident who is not on the contractor's or rec3pfenYs payroN tor
employmeM at the time af select[on for the 3ecilon 3 coVered award or
at tf�e fima of racefpE of Sectian 3 covered assistance.
Co[umn �: Enter the percentage of all the staff hours of new hires
(Sec6on 3 residents) fn connection with this award.
C41umn E Enter the percentage af the tatal staff haura worked for
Section 3 employeas and trainees (ir�cluding new hires) connected
with thls award. Include staff hours fcsr part-time and full-time
positians.
Column F: (Mandatory Fletd) Enier the numder of Section 3
residents tfiat were trained in cannecHon with ihis award.
?art kl: Confract Oppartunities
Block 1: Canstruction Cahhacts
Item A: Enber the total dollar amount o( all oantracts awarded on the
projectlprogram.
Item B: Ertter the total dollar amount of cvrMtracts connected with this
projacUpragram that tvere awarded to Section 3 businesses.
Item C: �nter the percentaga af the total dollar amovnt a} contracta
connected wifh this projecE/program awarded lo Section 3 bus[nesaes.
Item R; Enter the number of Section 3 businesses recslving awards.
Block 2: Non-Construction Cantracts
ltem A: Enter tha total do8ar amount of all contracts awarded on the
pro}ecE/pragram.
Ifeat B: Enfer the toEal do1lar amount of contracts conneeted with this
proJeat awarded ta SecHon 3 businesses.
item C: Enteriha percentage of Ihe total doilaramount of cantracts
cannected with this projectlprogram awarde�i to Sectivn 3 businesses.
item 6: �nter the num6er oF Section 3 businesses receiving awartis,
Pah {ll: Summary of Efforts — Self -exptanatory
Submit one (1j copy of this report to the HUD Headquarfers Office of
Fair Hvusing and Equal Oppartunity, at the same time the
peiformance repaR is submiried to the prograrn afftce. The Sectinn 3
repvrt 9s suhmitted hy ,Fanuary i0. Include oniy cantracfs execcated
during the periad specifted in item 8. P}iAsiIF1As are to repart all
co ntraclslsu bcontracfs.
' The terms "low tncome persons" aad very low incame persnns" have
the same meanings giVen the tarrrls in section 3(b) {2} of tha Uoiled
5tates Housing Act of 1937. iow•incnme pa�sons mean familles
(includir�g singla persans) whose incomes dn not axceed SO percent of
the medtan incame far the area, as detesmined by the 5ecretary, with
adJusGnents for smallar and largerfamilies, except that
Pagai
The Secietary rr3ay esteblish Income Ceilings hlgher or lower than 80 percent
of the median for the area on �he basis of the 5ecrefary's findings sucf� that
variations are necessary pecause of prevailing levels of construction cosLs
or unusually high- or low-incs�rne families. Verylotv�income parsons mean
low-incama Pamilies (includtng singls persnns) whnse incomes do not
exceed 50 �ercent of the median family in�ome area, as de#ermined by the
Secretary wffh adjusfinents or smaller and farger familtes, except tEsat the
Secretary nsay establish income Ceilinga higher or [ower than 50 percent of
the median for tfie area on the basis tiF the Sacretary's ffndings that such
variations are necessary 6ecause of unusually hi0h or low family incomes.
form HUR 650a02 (1 V3.Oi4}
Ref �{ CFR 135
EXI�IBIT '"H"
OVER'VIEW REP4RT
[See attached]
HOPWA P�t1� CONTR�CT` 2D 14-201 S-- EXHIBIT "I�' — OVERVIEW 1�EPORT
AIDS Outreach Center, Inc.
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(�[��P�VA) P�°o��°�m�
�o�s���ate� ���w�l ]P�rfo��na�nce ���i
Eva��at�on I2.ep��°� {CA.]P]El�)
1���.su����n� �Per�a����ce O��c�m�es
Final Released 1/12/1�
OMB Number 2506-0133 (�xpiration date: 70I3912U14)
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Tha CAPER report for HOPWA formula grantees pro�ides annual information on program accomplishments
that supports progi'am evalnation and the abiiity to measure program beneSciary outcomes as related to:
maintain housing stability; prevent homelessness; and i�nprove accsss ta care and supporti. This information is
also w�vered under the Consolidated Ptan Management Process {CPMP) repoi�t and includes Narrative
Respanses and Perfo�xnance Charts required under ihe Consolidated Plazaning regulations. The public reporting
burden for tha collection of i�nfoimatron is estimated to average 42 hours per ma►�ual response, ax less ii an
automated data collectian and retrieval system is in use, along with 60 hours for record i�ecping, incIuding the
time for reviewing inst�•uctions, searching exrsting data sources, gathering and rnaintaining the data needed, and
completing and reviewing the collection of infonnation. Grantees are rec�uired to repo� on the ac#ivities
undertaken only, thus there may be components of ttiese reporting requfrements that may not be applicable. This
agency may not conduet or sponsor, and a person is not required tn respond to a collection a� infonnation unless
that collection displays a�ralid OMB control number.
Previons editions Are obsoletc form HCID-4d11U-D (�xgiration Datc: 1 013 112 0 1 4)
Ove��view. The Consolidated Annual Perfannance and Evaluation Report
(�APLR) provides anntEa) perfonnance regnrting on cliet�t outputs and
outcomes that enables a�i assessment oigrantee perfarmance in achieving Ehe
housing stabflify outcome measure. Tl�e CAPBR, in conjunetion witlt the
Integrated Disbursement Informatinn System (IDIS), ful�Ils stahrtory and
regulatory program reporting requlrements and prnvides tl�e granlee and
IIi1D with the necessary inFormation to assess the overall program
performance and accomplishments againstplanned goafs and objecfives.
HOPWA formula grantees are required Yo submit a CAP�R, and co�nplete
annual perFormance infoemadon for alt acti�ities undertaken during each
program year in the iDIS, demonstrating caordination with atlier
Consolidated Pla�a resources. IND uses the CAPE'R attd IDIS data to obtain
esseut3al iezformation on grant activities, project sponsors, Subrecipi�nt
arganizations, housing; sites, units and households, and beneficiarfes (which
includes racial and etluiic daEa on progra�n partieipants}. 'I73e Consolidated
Plan Management Process too] (CPMP) provides an aptional too! to integrate
tt�e reporting of HOPWA specific activities witia vther planning and reporting
on Consalidated Ylan activi#ies.
Table o�Contents
C'ART i: Granfee Execntive Summary
1. Grantee Informataon
2. Project Spoasor Information
3. Adminislrative 5ubrecipie�tInfonnafion
4. Program Subrecipient Tn%rmation
5. Grantes Narrative And Performance Assessment
a. Grentee and Conumuiity Overview
b. Ana3ual Performance under the Action PIan
a. Sazciers or Trends Qverview
d. Assessment vf Unmet Honsing AIeeds
YART Z: Sources ofLFverseine and Proeram Income
1. 5ources ofLeveragmg
2. Progam Tncome and Resident Itent Payments
PA12T'3: Accomulishmentbata: Planned Gaals and Actual OaMul�
PA12T4:5ummA�v ofPerfortnance0utcames
l. Housing Stability: Pennanent Housing and Related Facilities
2. Prevention af Homelessness: 5hort-Term I%using Payments
3. Access to Care and Suppnrt; I3ousing 5ubsidy Assistance with
Supportive Serviees
PART 5: Worksbeef - Defermirtine Housias Sfabiliiv OutComes
PART 6: Annual Certi�ration of Cortinued Use for HbPWA FaciliSv-,
Sasetl Stetivardshio T1niSs fOnlv)
PA�tT' 7: Summary Overview of GrantAstivities
A. Tnfori�aatiori on Individuals, Benefioearies and Househalds Receiving
�IOPWA Housing 3uhsidy Assistauce ('TBRA, STTtM[.T, YTiP,Facility
Based Units, Master Leased Units ONL�
B. �'acility Based EIousing Assistance
Coatinued T3ae Periads. Grautees thai received HOPWA iunding for new
construction, acquisition, or snhstantial rellabilitaCions are required ta nperate
their facilities far HOPWA-eligible heneficia�ies for a ten (10) years period.
I£na ftirther HOPWA funds are used to support tUe facility, in place o£
coiup[ating Section 7B of the CAP�It, the grantee must su6mit an Annual
Certification of Co3atinued Project Operation throughout the required use
periods, '1'his certi&cation is included in Part 6 in CAPER. The required use
period is three (3) years if the rehabilitation is non substantial,
7n conneetion with the developme�3t of the DepartmenYs sYandards for
Ho�neless Management Information Systems (fIMIS), uaiveisal data
elements are being callected for clients ofHOPWA funded homeless
assisEance nroiaatg. These project sponsarlsubrecipienE recards wquld
incl�de: Name, 5ocial Security Number, Date of Birth, Efhnicity and Race,
Gender, Veteran Sfatus, Disabling Conditions, Residence Yrior ta Program
Eutry, Zip Cade of LasE Permanent Address, Housing 5tatus, Program Entry
Date, Prngram Txit Date, Personal IdentificationNumher, and Household
Identi�caEianNumber, These are intended to tnatch the elemenfs tmdcr
HNllB. The I�OPWA program-level data ela��►ents include; Tnaome and
Saurces, Non-Gash Bencfi�s, HNIAIDS Status, 5eraices Provided, and
FTousing Status or Aestinatio�i at the and of tite uperatu�g year. Otl�er
seEggested but optioual elements are: P13ysical Disabil�ty, TJevelopmental
Disability, Chronic Health Ca��dition,lvlental fIealth, 5u6stance Abuse,
TJnmestie Violenoe, Bate of Ca�tacC, Dats ufEngagement, Financial
Assistan�e, Housing Relocatiun & StabilizaYion Services, Employment,
Education, General IieaEth StahEs, , Pregnancy 5tatus, Reasons fvr Leaving,
Veteran's Information, and Gl�ildren's Education. Other I�QPWA projects
sponsors may also benefit from collecting titese data clements.
Tinal Assembfy ofReporF, After the entire report 9s assemUled, please
namber each page sequentially.
Tiiing RequiremeuEs. Within 90 days afthe completion ofeach ptogtam
year, grantees must suhmit their completed CAP�R to Ehe CPD Direetar in
the grantee's State or Local HiJD Field Office, and to tha HOPWA Progratn
Qffice: at Hf}PG�A r�it hud.�ay. ElecErouic sttbmission to I-IOPWA Program
officc is prefeaed; however, if electronic submission is nnt possible, l�ard
cvpies can be mailed to: Offica of HIVIAIT3S Housing, Room 7212, U.S.
Depart��rentofkIausingand Urhan ]aevelupment, 451 5aventh Street, 5W,
Washington, D.C.
Itecord Keeping. Names an8 other individual iafonnation muet be kepf
confideatiel, as required by 2A �FR 574,440. However, IIiJD reserves the
riglit to review the infoemation used to eomplete this report for grants
management eversight purposes, except for recordiag any nanies and u6�er
identifying informaiion, In tha case th�t HUD must revicrY clie�uk level
daht, no client uxmes or idenfif�+ing information will be retxined or
a•ecorded. Infarmatian is reparfed in aggregate 10 FIiTD witho�t
personal identification. Do nof submit clicnf oa• personal inFarmation in
data systems to HiJD.
lleflnitians
Adjustment for Auplicatfan: Enables t�e calculation ofunduplicated
output totals by accounting for the ttrtal nuiuber of households or units that
received more than one type of FIOPWA assistancc w a giyen service
category suah as HOPWA Subsidy Assiatance or Suppotti�e 5ervices. For
a�caenple, if a aL'eent household received hotb TBRA and S1RMU during the
operafing year, report ttiat househnld in the category vfHOPWA Housing
Subsidy Assistance in Part 3, Chart I, Colmnn [lb] in the following mamler.
HOPWA Housin� Subsidy �1] Outputs:
A.ssistance Number of
Househalds
1. Te��ant Based Rea�tal Assis[ance
Permanent Hoesing FaciliFies:
2a, -Received QperaHqg
SuhsidieslLeascd imits
TSransitionallShvrf-fcrm Faeilitiea:
2b. Received Operating Subsidies
PermanenY ftousing I'xcilifies:
�a Capital Developmen# Projects placed
in service duringthe operatingyear
Transition�USlaort-kerm F�ci�itles:
3� Capital Devalopment Projeets placad
in service during the pperating year
4. �Short ferm Rent, Mortgage, and I —
Utility Assisiance I
$ Adjustmeat for duplication
(SuUtracY) I 1
x'OTAL kIousing Subsidy
6. Assistauce (Sum oi'Ita4�s 1-4 minus I �
Row �
Previous editions are obsoiete Page i form IiIJI)-40110-ll (�xpu�tiou ➢xte: 1Q/31/2014)
Adrainistrative Costs; Costs for geneeal managemenY, oversighE,
coordination, evaluetion, and reparting. By stahrte, grantee adminis#rsiive
costs are limited to 3% of tota! grazzt award, to 6e expendad Qver the li% of
tl�e grant. Projeet sponsor adminisfrative wsts are limited to 7%aFthe
portian of the grant amount they reeeive.
BenefiiciAry{ies): All members of a househald who received HOpWA
assistance during the operating year including the one individual tiwho
qual�ed the household for HbPWA assis#ance as wal) as any od�er
mefi�bers oF the hausehold (wikh or without HIV) who banefiited fran fhe
assistauce.
Central Caatraetor Aegishafion (CCA}: T[ie primary registrant
database for khe U.S. Federal Govemment. CCIZ co[lecfs, �alidaYes, stares,
and disserainates data in support of agency acquisition missions, i�cl�ding
Federal agency contract and assistancs awards. Bot6 current and potenfiial
federaf govemmea�t regstrants {granfces) are required ta register in CCR
in arder to be awarded contracts Uy the federal govemment. Registrants
must update or renew t�eir registration at ]eest once per year to maintain
an aetive status. Although recipienis of direct federal contracts and grant
awards have been required Yo be registered with CCR since 20D3, t]�is
requirement is now %eing extendc�ci ta indirect recipients of federal funds
rvith the passage nf ARRA (A�nerican Recovery and Reinvestment Act).
Per ARRA and FFA'T'A (Federal Funding Accountability and
Transpareney Act) federal reguiat9ons, all grantces and sub-grantees or
suLcantrsckors receiving federal grant awards or coniracts must I�ave a
DL1N5 {Data Universal Numbering Systemj Num6ar.
Chranxcally Homeiess Person: An individL�al or fami{y who :(i) is
homeless and Iives or resides individuat or famiiy wha: (i} Ts home[ess and
lives or resides in a plaee uot meaot for human hahitation, a sa% 33avan, or
in an emergency shelter, (ii) has becn horneless and living or residing in a
place not meant for hwnan habifation, a safe haven, or in an emergency
shelter cont'ruuously fo� at least 1 year ar on at least 4 separate occasions in
tlie 3ast 3 yeazs; and (iii) has an adult head of household (or a minor head
af househol8 ifnn adnit is presei�t in the hvusehold) wiUi a diagnosable
suUstance use disorder, serious inental illness, developmental disaUility (as
defined in section 102 of tho Developmental Disabilities Assistance and
]3i11 of Ttights Act of 2000 (42 LJ.5.C. ! SDfl2)�, pnsi traumatic stress
disorder, cognitive unpairments resulting from a brain injury, or chro►uc
physical iflness nr disabiGty, includi[tg fhe co-occurrence of 2 ar more of
those condikions. Additionally, #he statutory definition inoludes as
cluaaicalty homeles5 a person who cunently lives or resides in an
i�istifutional care facilily, including x jail, substance abuse or mental healkh
4reaLnent fAoility, hospital or othar similar facility, and has resided there
for few+er than 90 days if sucltperson met the other eriteria £or hnmelesa
prior to eniering that iacility. (5ee 42 U.S.C. 113b0(2)jThis dves not
incl�de doubled-up or overcrowding situations.
Disabling Condifiau: Bvidencing a diagnvsabls substattce use disorder,
serious mex�fal illness, developmezrtal disa6iliry, ehronec physical illuess,
or disability, including the co-occur�ence af trvo or uiara o£these
conditions. in addition, a disaUfiag conditinn may limit an individuai's
abiliry to work Qr periarm one or more activities of daily living. An
IiIV1ATD5 diagnusis is consicEered a disa6ling �ondition,
�'aciiity-Rased Hausing Assisi�nce: All eligibla HDPVi�A Hvusing
expenditures for or associaied with supporting facilities inciudvag
community residances, SRO dwellings, sliort-term facilities, praject based
rental units, master leased un{ts, and ofl�er housing faciiities approved l�y
HC7�.
Raid�-Based OrgAn9zation: Religiousvrganizatiops ofthree types: (1}
congregataons; (2) national networks, which iuelude national
denotnittations, their social service arms (fQr example, Catholic Charities,
Lutheran Social Seivices), and networks of releted orgaoizstions (such as
YMCA and YWCA); and (3) freestanding rcligious organizations, wlaich
are incorporated separately from congregations and national networks.
GrassrooYs Organization: An organizatian headquarte[ed in the lacal
cammunity whare it pmvides services; has a social serviccs budget of
$3UO,Q06 ar less armually, and six or fewer Full�tune equivalent
employees. Local affiliates afnational organizetions are notconsidered
"grassrwts."
HOl'WA �iigibTe Individual: The ane (1) low-inoome person with
H1VlAIDS who qualifies a hausehold for HOPWA assistance. T'his persott
msy be considerad "Head nf Iiousehald." Wheu the CAPER asks for
u�formation ou eligible individuals, report nn t[tis individual person only.
Where there is more #I�an ane persan uaith HIV/A]DS in the ltousehold, the
addidonal PWHIA(s), would be considered a beneficiary.(s).
FIOPWA, Hnusing Information 5ervites: Services dedicated to helping
perso��s living wifh HN/AIDS and their families to identify, locate, and
acquire hoi�sing, This may also include fair housing cotmseling for aligible
persons w13o may encounter discri�nination based on race, co]or, religion,
sex, age, national origirt, fa�nilial stah�s, vr handicap/disabiGty. .
HOPWA Iiousfng Subsidy Assistance Tota1: The unduplieated numUer
of hotueholds receiving housing subsidies (TBRA, STItMtJ, Permanent
Housing Placemenfi services and Master Lensii�g} and/or residing in Luvfs
offaciliiies dedicated to perso�sliving with HNIAIDS and their families
and supported with HOPWA funds duri�3g the operating year.
Househald: A single individual or a�'amily eompased of two or more
persvns %r which hausehold incomes are used to detenniiie eiigbility and
for eaiculatiun offha resident rent paymerct. The term is used for
co{lecting daEa on changes in income, changes in access to services, eeceipt
of l�ousing infotmafion serviaes, and outcomes on achieving housin$
shability. Live-IrE Aides (s� defiaution for Live-In Aide) and non�
henefieiaries (e.g. ashared hausing arrange�nent with a roommate) who
resided in tUe unit are not rcported nn in the CAPER.
gvusing Stabiiity: The degree to whiclti the HOPWA project assisted
beite�iciazies to remain ui stable Iiousing during the apera#ing yoat See
Pard 5: DeterminingHnusingStabiliry Outcomes for definitions ofsiable
and unstaUle hpusing sihiations.
tn-kind T,everagecl [tesaurces: Thase involve additional rypes af sttpport
pravided Yo assist T3QPWA bene�ciaries such as �volunteer services,
materials, use af eguip►rienk and huilding space, The actual value ofthe
support can be the contribation of professinna{ services, hased on
customary rates for this specialized support, or achial costs contributed
from ather leveraged resources. In detennining a rate for the contrihu6on
ofvalunteer time and services, use the ra#e sstablished in HUD notices,
such as the ra#e of ten dollars per hour. The value o£any donated material,
equipment,_building, or leesa should be based on the fair market value at
tiine of danatinn. Related documen�ation can be from recent 6ills of sales,
advertised prices, appraisals, or other infonnation for comparab[e property
similarly sihiated.
Leveraged F4�nds: The x�nount of fimds expended diuing the operaiing
year from qon-HOFWA federal, state, local, and private sources Uy
grantees ox sponsors in dedicating assistanCe to fhis olient populatio��.
Leveraged funds or ather assisiance are used directly in or in support o£
IiOPWA prograuz deiivery.
Livc-in A.fde: A person wl�o resides with fhe HQPWA Eligible Tndividual
and who oteets fl�e follawing criteria: (i) is essential tn the care attd well-
being of tl�e person; {2) is nof obligated for the support of the person; a�id
(3) would not he living ict the unit except #o provade the necessary
sapportive services, See tl�e Code ofFederal Regarlatloras Title 24, Peerl
SA03 ar�d the HDP�� Granlee Ove�sight Resource Gcride for' additional
t efere�ce,
1!^Iaster Leasing: Agplies to a nonprofit or public agency that leases units
oihousing (scattered-sites or entire buildings) fmm a landlord, and
subleases the w�its to hameless or [aw-incrome tenants. By assuming tl�e
tenancy burden, tfie agency fecil irafes housing af ctie�zts who may nat be
ahIe to maintain a lease mt their awn due to poar credit, evictiot�s, or iack
ofsufficient income,
Operating Costs: Applies fa facility-based housing only, far facilities
that are currently ope��. Operating costs can iztclude day-to-day housing
Previous editions are o4solete Page ii form H[3D-40110-D {Expirafinn DAte: 1U13112014)
iunction and opetation costs lilce utiliUes, mainYenance, equipmaAit,
insurance, security, ilunishings, sapplies snd salary £or staif costs directly
re(ated to tl�e hausing pro}ect beit nmt sfaff costs for deli�ering services.
OuEcame: T'he degr6e to which tlie HOPWA assisted hausehold has been
ena62ed to establish or maintain a stable iiving envirn�unan{ in housing tUat
is safe, deceiit, and sanitary, (per the rsgulations af 24 CFR 574.310(b))
and #o reduce the rislcs of liQmelessness, and improve access ta HIV
treatment snd ather health eare and support.
Output: Tl�e»umberoiunitso£housingorhousehaldsthatraceive
IIOPWA assiskance during the operating year.
Permanent Honsing Placement: A siippottive housing se�+ice thai helps
estabiish the hoi�sel�oid in the huusing unit, inckiding but not limited to
reasona6le costs fnr securtty depnsits not to exceed hva months of rent
costs. '
Program Incnme: Gross incnme directly generated from the usa af
HQPWA funds, including repayments, See granY administration
re�uirements on prog�am ineome for state and locaf gaverrnnents et 24
GPR $5.25, or for non-profits at 24 C�R 84.24.
Project-13ased Bani�i Assistance (I'BAF#); A renfal subsidy program
U�at is tied ta specif'ia iacilities or imits owned or camrolled 6y a project
sponsor or 5uhrecipient, Assistance is tied directly to the properkies and is
not portable or#ransferable.
Project Sponsor Organiznti4us: t?,ny nnnpro$t organization or
gavemmental housing agency that receives funds uuder a contsact with tl�e
grantee to pro�ide eligible hnusing aud otlier support services or
adininistia#ive services as defitted in 2�} CFR 574.3Up. Project 5ponsor
organizations are required ta provide performance data nn households
served and funds expended, Funding flows to d project spansar as
faAows;
HIIb Funding �� Grantae --� Project Sponsor
Short-Term Rent, Martgage, and Utilify (STX�'I[7) Assistance: A
tim�limiteci, housing sulasidy assistance designed to prevent homelessness
and increase housing stahility, Grantees may pro�icEe essistance fur up Yo
21 weeks in sny 52 week period. The amvunt of assistance varie5 par
client depending on funds availa6le, tenant need and program guidelines,
Stetiv�rdshipTlaits: UnitsdevelopedwithHOF'WA,whereHOPWA
funds were used for acquisitisan, new canstruction and rehabilitation that
no ]onger receive operating suhsidies frnm HOPWA. Repnrt infazmation
for the units is sub,{ectto tlie three-yeat use agreemeni if rehabilitatinn is
non-substanftal and to the ten-year use ageement if rehahi[ifation is
suUstantial.
5nbreeipient Organiz�hou: Any organization that receives funds from a
project sponsor to pravide eligi6le l�ausing and other support services
and/or administrative services as de�ned in 24 CFR 57430Q. If a
suUrecipient organizatinn provides liousi�g a�idlor other supportiva
services dircctly to clients, the subrecipient organizatioai must �rovide
pec£ormanee data ari househald served and fiinds expended. Funding
flows to subrecipients as follows:
HI3D Funding --- j Grantee � Projeat Sponsur --�SuUrecipient
Tenant-I3ased Rentai t�ssistance (TBAA): TSRA is a rental suhsidy
prqgram siinilar to t13e Housing Choice Vnuchee prograut that grantees can
prpvide Eo help low-i�come Mousekolds ac¢ess affordable housing. Tha
TBTtA voucher is not tied to a speci�c unit, sa teciants roay move to a
differant unit witlio[d lasing their assistance, su6tect to individual program
rules. The subsidy emount is determined in part bt�sed on hausehofd
i�ome and reutal casts associeted rvitlt tha tenanYs leas�.
'�'ransgender; 'T'ransgender is defined as a gerson whv ident�es with, or
presents as, a gender Yhat is different from hislher gendcr at birth.
Veteran: A veteran is sumew�e wMo has served on active duty in li�e
Armed Forces of fhe United States. This does ttot include inactive military
reserves or the l�iational Gr�ard unless the parsan was called up to acfive
dury.
Previaus editions sre abaolete Psge iii fnrm HT711-4�1I4-A {�xpiration Aatc: 1013112U14)
Housin� ��pc�rtunities fa�• �P�-crir� ��tF� ��InS �1�'�'�+�JPWA)
�onscr9idated r�!-!!�►��� P�rf�►rmax�c-e �::t? ��vaR�l�tiori ��pr�ri (�'A�'FR�
�Vlea�n�rin� �'�rtvrmar��� �D��t�u�s and f�i,±e��r,�,��
DiUIB fUumber 25D6-0'E33 (Explration Date: 1013112014)
�Part �: �rante� ��:�,+rivP S�ir�nmsry —
As applicable, complete the cha�ts below to pro�ide more detailed information aboui the agencies and organization.s respansi6le
for the administration and implementation Qfthe kIOPWA progcam. Chart 1 requests ger�eral Grantee Infarmation and Chart 2 is
to be completed for each arganization selected ar designated as a project spansor, as defined by CFR 574.3. In Cf►art 3, indicate
each subrecipient organizatiora with a centrac�lagreeme��t of $25,000 ar�reatet that assists grantees or �roject sponsors carrying
out their administrative or evaluation aciivities. In. Chart 4, indicate each subrecipient organizaiion with a contract/agreement to
provide HOPWA-fuudeti setvices to client housellolds. These elements address requirements in the Federa� Funding a�xd
Accountabilzty anci �'ransparency Act of 2�06 (Public Law 109-282}.
Note: Pler�se see the defarrition sectio�t for disti�tctions betiveen project sponsor cr�d s�tbrecfpient.
Note: If arry informatiorr do�s not a�a�dy to your arganizqtion, piease enter N/�!. Do rrot leave a�y seetian blt�nk,
1. Graniee Infor�naEion
T�CJD Grant 1Vum6er
Operafing YeAr far fhis re�rorfi
Finf:: (nu►✓rlrU�g'1 ra (n�rrt/drU17'J
Granfec Namc
Business Address
� City, County, Staie, Zip
�mploytr Tdentifieafi4n Number (EQ� ar
1'air Tdentitication Number (TIN)
AUIY +Yc Br�dsh•eet Number (Dill\'s}:
�Congressional bistrict of Grxntee's Eusiness
Address
*Congressiona! Distr3ct ofPrlmary Service
Area(s)
�City(ics} n�d County{iesj of PrImarg Scrvicc Citie9:
Area(s)
�rgaaization's Website Address
Central Gontractor Registratrou (CCR):
Is the granfee's CCR status currently active?
❑ Yes ❑ i�Fo
Ifyes, provide CCR Number;
� CounHes:
Is tkcre u tiv�iting lisi(s) for IiOPWA liousin� Snbsidy Assistaace
5erviees in the Granfce service Area? ❑ Yes ❑ No
Ifycs, explAin in the aarrative section what services maintaip a waiting
Iist and hory this list is administercd.
* Service delivary area information an�y n�eeded for program activfties befng directTy carried out 6y tlae grat�tee.
Previaus edition� are absnletc �'age 1 iorm HUq-4011U-A (�xpiration Date:1QI31/2014)
0
2. Pra,�eci S,ponsar In%rmation
PIease complete Chart 2%r each organizat�or� designaied or selecteci #o serve as a prnject spansnr, as defined by CFR 574.3.
Use this section to repo�t on organizations in�+alved in the direct delivery of services for client househoids. These alem�nts
address require�►ents in the Federa! Financial Accoun#ability and Transparency Act of 2006 (Public Law I09-282).
�ote: .Please see� the deftnitiorts foY disti�ctians between p��oject sponsor arrd subrecipiet�t,
Note: If arty informaiian does noi a��ly to yaur orgartizatiota, �lease enter N/.4.
Pro,ject 3pousor Agency Name
�Name and Title of ContsetatProjeet
Sptlnsar Agency
I�mailAdcU•ess
IBusiness Address
� Ciky, CounYy, 5txie, �ip�
Pl�one Aiumbcr (witTr rrrarr code)
EmpIoyer ldenH£ication Num6er {�Il� or
Tax Iden 'hi"ieA[ian ]�'umber (TINj
AiIN & Bradstreet Aumber (DUNs}:
Parent Co�npany Name, if rr,�,pltcm�ile
I � I
l Fax 1�Iwnber (with area cnde)
I
CongtressionnlDistrlct aiProjectSponsor's
Business t#ddress
Congrcssional Aistrict(s) of Primary Service
Area(s)
City(ies)antlCounly(ies}ofPrlmaryServiee �ties:
Area(s) I
Totai HOPWA cantraet amauat far tLis
Organization far thc opera4in� year
Organizatiau's Wehsite Addreas
Counties:
Ts the sponsor q nanprofit atganization? ❑ Yes ❑ No
Please chech if yes artd Q f�rfih-bused a�gartizatian. ❑
Ylease check rfyes and a grassroots a�gctni�a�iox, ❑
Does yaur organization maiutain a waiting lisf7 ❑ Yes ❑ Na
Ifyes, explxin in the narrative sectian hotiv fhis list is s�dminisiered.
Previous editions are o6solete P�ge 2 %rm HUD-40i10-ll {Expiration pate; 10131/i014J
3. Adnninistrative Subrecipient �nfornzation
Use Cl�art 3 ta provide the follnwing inforination for each su6recipient with a cnniractJagteement of $25,OOD or greater that
assists project sponsors to carry out theiu• adminish•ati�e services but na servic�s ditectiy to alient households. Agreements
inalude: granfis, subgrants, Ioans, awards, cooperativa agreements, and other forms of �nancial assistance; anci cont�a�ts,
su4�contracts, purchase order�, task orders, and delivery orders. {Organizations Iisted rnay ha�ve conti�acts with project sponsors}
These elements address requirements in the Federal �'undir�g and Accountability and Transparency Act of 20�6 (Publio Law 109-
282).
11�o�e; PTease see the definilzons for disiinetions between project sponsor atrd subrecipisnt.
Nate: I, f any irtfa�matiorr does not apply to yozrr orga�rizatian, please enter N/A.
Subrecipient Name
INeme snd xitle of Contatct at Subrecipient
Emsil Address
Busiuess Address I
I Cily, 5tate, Zip, County
Phone lt'umher (tivith area code)
�mployer ldentifcation Numl�er (EIN) or
Tax TdentiScation �Yumber fTiN�
IDTJN & Sradsfreet l�Iumber (�UNs):
North American Indnshy Classification
System (NAICS) Code
1 Congressiana►I D9strict of Snbrecipicnt's
I Bnsiness Address
Congressinn�l District ofPrimary Service
Area
City (ics) and County (iea) af Primary Service
Area(s)
�TotaII�OPWAS�hcontractAmountofthis
Organization Fnr the operaiine year
CitieS:
�'arent Company Name, lf rrpplicable
I
rax NumBer (iucInde area code}
ICoundies:
Previous editions �re obsolete �'age 3 form TiYJD-4U170-D {�xpiration nafc: 1U/3112014)
4. Pragram Subx•ecipient Information
Complete the %jlowing infornaation for each subrecipient organization providing HOPWA-funded setvices �o client households.
'These nrg�nizations would hvld � canh^ac#f�greament with a project sponsar(s) to provide these seitiices. For example, a
snhrecipi�nt arganizstion may receive �unds From a project sponsor ta provide nutritional services for clienfs residing within a
HOPWA facility�based housing program. Please note that subrecipients who work directly with client households mast provid�e
perforrnance data fnr the grantee to include in Paris 2-7 of the CAPER.
lYate: 1'Iease see the defirrition of a sarbrecipient foY more ir�formation.
Nate: Types af coradracts/agreements rnay f�eiude: gra�rts, sub gxunts, loarrs, awczrds, caoper�ative agreemer�ts, arid other forms
of f na�a�iad assastance; rxnd cantracts, saabco�ttracds, palrchuse orders, iask or�ders, and delivery arders.
Note: If ar�y ir�farnraiion ts rrof ap�lacahfe to ihe organizafian, please repor�t N/�1 fn the a�propriate hox, Do not leave boxes
blanl�
Su6-recipient lYame
Name and Title of Cnntact at Contractarl
5uh-cuntracior Agency
T�maII A�ddress
Husiness Address
ICily, County, �tatc, �ip
, 1'hone Number (included �rea code)
Earployer [dentification Pfumhcr (EllV) or
'I'ax Identificafion PTumber (TINj
IllUN & Brndstreet Number {DUNs)
�North American Industry Clasaffcation
System {NAIC5) Code
Congressional District of the Sub-recipient's
Business Address
Congressianttl Aestriet(s) af Primary Service
Area
City{ies) and County(ies) ofPrimary3ervice
Area
CiHra:
Yarent Company l�ame, if applicrt6le
Ir'sx Number {include arca code)
1 CounNes:
Tofal PIOi'WA SnbcontrAct Amount of this
drganizaiion tor the operattng year
Previous edifions are obsolete PAge 4 form HUD-401I4-Tl (Expirafian Date:10131I201a)
5. Grantee Na�rrative and �erfarmance Assessment
a. Grantee and Communitv Overview
Provide a one ta three page natra�ive summarizing majar achievements and highlights tha� were praposed and completed diu•ing
the progra�n year. Ir�ciude a brief description of the grant organization, area of service, the name(s} o�the program contact(s),
and an ove�view of the xange/type of housing activit�es provided. This overview may 6e used for puhlic informatian, inciuding
�osting on I1CFD's website. Nate: Text fiel'ds are expandabde.
�. .Annual Performance under the Actian Plan
Provide a narrative addressing each of the following four iterns:
1. Outputs Rcpa�•ied. Describe significant accomplishments or challenges in achieving the number af housing uruts suppoi�ted
and the numUer honseholds assisted with HOFWA funds during this operating year compared to plans fQr ihss assistance, as
approved in the Consolidated PLanlAction Plan. Describe how HOPWA funds were distsibuted during your program year a�nong
diffe�°ent categories ai hoUsing and geographic areas to address needs throughout the grant seivice area, consist�ni �rith appro�ed
plans.
2. Outcomes Assessed, Assess your program's success in enabling HO�WA beneficiaries to establish and/ar better maintain a
stabla living environment in housing that is sa%, decent, and sanitary, and improve access to care. Compare current year results
to baseline resuIts for clients. Deserib� how program activiki�slproj ects contributed to meeting stated goals. Lf program did not
achieve expected targets, please desoribe �ow your program plans to address ci►allenges in progxa.� implementation and the steps
currentiy being taken to achieve goais in next ap�rdting year. If your program� axceeded program targets, please describe
strategies the prograrn utilized and how those contri6uted io }arograrn successes.
3. Coordination. R�port on program coordination vvith of�er mainstream housing ar�d supportiva services resources, including
the use of committed Ieveraging from other public and private sources tha# �elpeci to address needs for eligible persans identi�ed
in the Consolidated PlanlStrategic Plan.
�. Tecl�nical Assisfance. Describe an}� pro�•am technical assistance needs and hovr they would benefit prograzn 6ene�iciaries.
c. Barriers and'I'rends Ove��view
Provide a narrative addressing items 1 througl� 3. Explain how barriers and trands affected yaur program's �bility to achzeve the
abjectives and outeomes discussed in t�e previous section.
1. Describe any barriers (including regulatoiy and non-regulatory) eneountered in the administration ar im.plementation of
the HOPWA program, how they affected yoUr program's abiliLy to achie�ve the objeetives and outcomes discussed, and,
actions fiaken in response to baa�riers, and recom�nendaiions for program, improvement. Provide an explanation far each
harrier seleated.
❑ HOPWAIHUD RegulaGans
❑ Aiscrimie�ation/Confidentiality
❑ 5upportive Servi�es
[j Housing Affordability
❑ Plauning
[� Multiple Diagnoses
❑ CreditIlistory
❑ Geograpl�ylRural Aaeess ❑ Other, please explain further
❑ IIousing Availabilify
❑ Btigibility
❑ Rental History
❑ I2ent Dstenninafion and Fair Market
Rents
❑ Technical Assistance or Training
❑ Criminal Justice History
�'revioas edilions are o6soletc Page 5 form HiJ�-44114-D (�xpirstion Date: 10/31/2014}
2. Describe any trends in khe community tl�at may affect ihe way in which the needs of persans living with HIV/AIDS
are being addressed, and provide any other information impartant to the future pravision o� ser�ices to this population.
3. Identify any evaluations, studies, or other assessn�ents of the HOPWA pragram that are auailable to the puhlie.
d. Unmet Honsin� Needs: An Assessment of Tlnm�ef Housing Needs
Tn Chart 1, provide an assessment of the number of �TOPWA-eligible hauselzolds thaE rec�uire HOPWA housing subsifly
assistance but ar�; not currently served by any HOPWA-�itnded housing subsidy assistance in this service area.
In Row 1, �eport the total unmet peed of the geagraphical sarvice area, as reported in UnmetNeeds for Persorrs wiih Hl�/.4I1)S,
Chart 1B of the Consolidated or Annual Plan(s), or as reported under HOPWA warksbee# in the Needs Workboak oithe
Consolidated Planning Management I'rocess (CPMP) tool.
Note: Rapori mast c�rrerat dafa avcrilable, through Consolidatad ar,4n�tual Plarr(s}, a�ad accotr.rrtfo� local housing issues, ar
cha�tges in I�IY/.41`DS eases, by ustng corrrbinatiorr af one or moYe nf the sources in Char12.
Tf' data is collected an t1►e type of housing that is needed in Rows a. through c., enter the number of HOPWA-eligible �ious�holds
6y type of hausing svbsidy assistance needed. �or an appraximate hreakdown of overal3 unmet need by type of housing subsidy
assistanc� refer to the Consolidated ar Azuival Plar� (s), CPMP toal or local distribution of fi�nds. Do nat inelude clients who are
already receiving HOPR+A-funded housing subsidy assistance.
Refer to Chart 2, and check a31 sources eonsult�d to calcu(ate unmet need. Aeference a��y data fram n�ighboring states' ar
municipalities' Consolidated Pla�s or ofher planning efforts that informed the assessment of ITnmet Need in your serviee area.
Note: Irr order to ensure that the zrrrmet �aeed assessmerrt for the region is comprehensive, �1OPWA formula gra�rtees should
zr►clua'e those urrmei needs assessed by HOl'W.� competztive grat�tees operatirrg within ihe service area.
L Plann'sn� Estimate of Area's Uamet Needs for HOPWA-Eli�ible Househo�ds
1, Total number of households that have unmat ^
housin� subsidy assistance need.
2, From the total repotted in Row 1, identify the
num6er of households with un.�net housing needs
by type of housing suhsidy assistance:
a. Tenaat-Based Rental Assistance (TS�.)
h. Shart Term Rent, Mortgage and Utility paymants
(STRMU}
e Assistance with rental cvsts
• Assistance with mortgage payments
� Assjstance with utility costs,
c. Housing Facilities, such as community residences,
SRO dwellings, other houszng facilities
Previous editions arc obsoleic Page 6 form IiUD-4D110-I] (Expirafion Aate; 1013112014)
2. Recommended Dafa Sar�rces far Assessin� Unmet Need {checic all sources used)
= DatA as rcporfed in ti�e s�rea Consoiidated Plan, c.g. Tabie 1B, CPMd' charts, and related narratives
= Tlata established by area HIV/AIDS hnusing planning and coordinafion efforts, e.g. Cott€inuum of Care
= llata from olient u�Yormation provided in Homeless Mana$ement Tnformation 5ystems (%1MIS}
= Data from groject sponsors ar housing providers, including waiting lists for assistance or ocher assessments on need includin� tllose
completed by TiOPWA competitive grantees aperatin$ in the tegion.
= Da#a from prisons or,{ails ou persons 6eing discharged with HIVIAIDS, i£mandatory testing is eonducted
= T]ata from local Ryan Wlute Planning Couiacils or reported in CAILE Act Daia Reports, e.g. number ofclienfs with permaneni
�iDllSll1�4;
= Data colleeted for HTVIAIDS surveillanee reporfing oi other Ucalth essessments, e.g. local hcalth depattment or CDG sun+eillance date
�+ nd of PART 1
Previoas e�itions arc absolete �'age'1 form �IiJD-40174-D (Expirafion 11atc;10/31/2014)
IPART 2: Sources of Leveragin� and Program Xncome
1. Sources oiLeverAging
Report the saurce[s) of casn or in-kind le�+eraged federal, state, Iocal or private resources identi�ied in the Consolidated or
Annual Plan and used in. the delivery ofthe HOPWA program and the a�naunt of leveraged dnllars. In Column []], identify the
type of Ieveragi�tg. Some common sources oileveraged funds have been provided as a reference �oint. Yau may add Rows as
necessary to report all saurces af leveraged funds, Include Resident Rent paymen�s paid by ciients directSy to p�ivate landlords.
Do NOT inciude :rents paid direetly to a HOPWA program as this will be ceported in the next sec�ion In Golumn [2] raport the
amount af leveraged fUnds expended during the operating year. Use CalurAw [3] io provide same detail about the type of
leveraged contribution (e.g., case management serviees or �Iothing donations). In Column [4], check the appropriate box to
indicate whetl�er the Ieveraged contribution was a housing subsidy assistance or another fonn of suppait.
Nale: Be s�ere to report on ihe number af hoxrseholds strpported with these leveraged furtds in Part 3, Chart 1, Colacmn d.
A. �onrce of Leveraging Chart
� fX1 �o�rce ofLeveragin�
, Public Funding
Ryan White-Hausing �Lssistance
i Ryan White-Other
IHousing Choiee Voucher Program
� Low Income Housing Tax CrediY
HOME
Shelter Plus Care
�mergency 5alutions Grant
Other Public:
IOther Public:
IOther Publie:
� Other Poblic:
Other Public:
f��sva � �'::n�;„a
Grar�.ts
In-kind Resources
Other Private:
Qther Private:
�tEl9: �un�y'Iin�r
GranfeelProjeet Sponsorl5ubrecipient (Agency) Cash
IZesident Rent Payments by Client to 1'rzvafe LandLord
TOTAL (Sum o#'�ll Rows)
[2] Amonnt
of T�everagecl
Funcis
[3] Type of [4] Hovsing Subsidy
Contrihu�ion Assistance or Other 5upport
❑Housing Subsidy Assistance
❑Other Support
❑Housiag Subsidy Assistar►ae
❑Odiex 5appart
❑Housing Subsidy Assisfance
❑Other Support
[]Housing Subsidy Assistance
❑OtherSupport
❑Housing Subsidy Assistance
DOther Supj�ori
�Housing Subsidy AssisYance
�Other Support
❑Housi3ig Subsidy Assistanoe
❑Other Su port
❑I�ousing �ubsidy Assistanee
❑Other Support
OHousing Subsidy Assistance
QOther �pport
[]Finusing Subsi�y Assistauce
❑Dthex 5upport
OHousizag Subsidy Assistance
❑OfherSupport
❑Housing Subsidy Assistance
❑Qther Support
❑Housing Subsidy Assistance
❑Other Support
❑Housing Subsidy Assistance
�Dther S�pport
t]Hausing Subsidy Assistance
❑OtherSupport
�Housing Subsidy Assistance
❑Other Suppart
�
i ❑Haus��g Subsidy Assistanca
❑Other Su ort
1'revious editians are obsolete Pa$e S form HiTD-40110-A (�xpiraHon Date: 1013]120ib)
2. P�•ogram Tncome and Resident Rent Payments
In Section 2, Cha�•t A., report the total arnount of progra�n sncome and resideni re�t payments directly generated froir► the use of
HOPWA fiu�ds, including repayments. Tnclude resident rent payments coll�ated or paxd directly io the HOPWA program. Do
NOT include payments made directly from a elient household to a private landlord.
Nate: PTecrse see repart directions section for deftnition of pt•o�rarn incame. (Additiorral i�afornrcrtion on pragram income fs
avczilable in ihe HOPW�1 Gr�antee Oversight Resource Gxride).
A. Total Amount Program Income $nd Resident Rent T'Ay�nent Collected During the Operating Year
program Income and Resident Rent Payrnents Cajlected
1.
2.
3.
Program income tc.g, repayments}
Itesident TtentP�yments made directly to IiOP'�4+A Pm�am
Total Program Tncome and Resident ltent P�yments (Sum of Iiows 1 and 2}
Total Amount of
Program Income
(far this operating
year}
I
_ I
1
B. Progr�m Income and Resident Rent Yayments Expeaded To Assist HOPWA Households
In Chart B, ��eport on the tatal pragram income and resident rent payments (as reported aboae in Chart A) @�ended during �he
o�eratiag year. Use R�w 1 ta report Program Incorne and Resident Asnt Payments expended on Housing S�bsidy Assistance
Pragrams (i.e., TBRA, STRM[J, PHP, MasterLeased Units, and Facility-Based Housing). Use Row 2 to report on #he Prograx►x
Income and Rasident Rent Payment expended on Supportive Servioes and other non-direct Ho�sing Costs.
Program Incame and Resident Rent Paymenf Expended an
HOPR'A progranas
2.
3.
Pragtam Income and I2esident Rent Payment Expended ou Housing Subsidy Assistance cosEs
Program Income and i2esiden# Rent Payment Expended on SuppnrYive Servicea a�x3 othcr non- I
d�rect hausing casts
Tatal Program Incomc Expended (Sum oi'Iio�vs 1 antl 2} I
End of PART 2
Total Amount of Pragram
Incorne E�peuded
{for this operatiag year}
Pi°ewioas edi6ons are obaolete Psgc 9 farm Hi11]-4U110-A (Exp9ration Aate:14f3if1014)
IPART 3: Aceom�lishment Data Planned Goal and Actuai Outputs
In Chart 1, enter perFormance informatian {goais and actual outputs) for all acti�+ities undei�taicen during the opea�ating year
supported with HOPWA funds. 1'erforrnance is measured by the number oi households and units of housi�ig that wera supported
with HOPWA or other fedexal, state, laeal, or private fiz�ds far tiae purposes of providing housing assistance and support to
persons living witly HlVlAIDS and their £amilies,
Note: The to#al hoarseholds assisted �vith HOPWA fir.nds and reported in PART 3 of the CAPER should be the same as reporded
in the annuad year-end IDIS data, arrd goals reported shax�ld be carasistent �vith the .�nnual Plarr informatior�. �iny discreparrcies
or r�eviatior�s shoudd be explain�d ira the narrative secttarz ofP�lRT 1.
1. 30PWA �erformance Planned Goal aud Actual Ou�puts
' [Ij,i7utPuf:._Housr.5old's' (2J.Outputi:Rundfng.
I3�PWA Performance
Planned Goal
and Actual
�• :'i{}�'�ti'ik ���ik71a;; �IliiYiliy ri45�w�I�JM� —
Il. Tenant Based Rental Assistance
2a. PermanentHousingT'acilitiss:
Received OneraGng Subsidies.�l.eased units (Househnlds Served)
2b, i`ransitionallShort-term �'neilitics:
Iteceived aperating SuhsidieslLeased unifs (Fiauseholds Served)
(Households Served)
�a. PermanentI�uusingFacil[kies;
ICapital Development Projeets placed in sErvice during the operating year
(Households Served)
3h. TrstnsiiinnaUShort-term Facilities:
Capital Development Projects placed in service duri�g the operating year
(Hoaseholds 5ervedi
4. IShort-Term Rent, Mortgage and Utility Assistance
I5. Permanent Hvusing Ylacement Services
�. '�ldjustments for duplication (su6tr�ct)
7. Tvt�1.HOYWA Housin� 5u6s1dy Assistance
(Culumns R.— d. � nuaY thc �um +,f �?o�va ?-; m;n,�c Raw 6: Columris e. and f. eqt�al
tfhe sum of Ro►vs 1-5) / 1 L
I�OCiirib nPVP�f1rlf[IPflt'II�CiiK�i'i i7CIiR/I 'JTIiI �iiYflil{i'JJii�l lif f,er�}ftY�hR4ed Nou�in�1
8, Facility-k�ased tuuts,
Capital Development Projects not ye# opened (hlousing Unitsj
4. �Stewardship Units subject fo 3 ot 10 year use agreemenSs '
I10. TotalFlausingAevelaped —
(3�m of ltosys 7$ & 9)
tiiq:pt:l' eivc '�c rvic}�s
I�4PWl� I.ewcra9:cd
Assistance' Rlir:�+rfia„•+s
�, b, c. d,
� � �
� � �
�I� [SuIPul=f�n5� ebN��i
I I I �s�ti%r,l� 1lu�s��� Ljpir�
��
. _
I la, �5upportive Services pravided hy p�oject sponsors/subtccipient that also delivered :
Ii�P�A housing subsidy assistance
I lb Suppnrtiva 8ervices provided by Qroject sponsorslsubrecipient that anly provided ,
su pPortive services,
12_ Ad�us�nent far duplicatian (sublract} •
13. Tots�1 Suppartive Services
(Col�mns a.-- d. cqna� tl�e sum ofRows I1 a. & b. minus Itory 12; Columns e. and f.
e�ual the sum ofRows i1a. & 11b.1 — — — I
�W �S.C� :^.0��^4'4i���n Car:i�r`p9-+ .
I14. �Iousing In%nnation Services
�i5. Tota1 HqusiagXnformRtion Services
I
I
IiO#`1VrL Fu::i#
e. £•
d 6
� x� �a�
{Zj 1]� {SFi`kc �� uodinV.
y
- I �
a �. .�rat-f� +{'a`
_ `
�—
�I�Qv!Eri�_Il�i�rS:U��:i!, �
i - — —
_ — _ �
�
��-=
j�SO,r'� �ik����Wi�,�,i...._._.
-��J _—^�c.
�'�'-ti.- -�_�-_� -=-'�
����
�2� Ob7p5�ii I�urs�kH�E
1 —
jzSl]UrP�•�� I�uad�iF�._
���i}ar��nrt. Vund'.o{;
Previous editions arc o6solete Page 10 tarm IND-40I1p-D (�xpirafian Aate: 1613112014)
'Griin# �rlmErii:4�ratinn a±itt (lthar Activitic�' -- �
�16. Resource Identification to establEsh, coordinate and develop Itiousing assistance resourccs ;-���--
� � �'u::::
117. Techuica! Assistance ;- ; __
(ifapproved in �rant a�reement)
18. Gruntee AdmimsUatioa � ��
(maximum 3°/a af total HOPI�VA grant) ,-�
i9. Project Sponsor Administratinn - - �
(ma�eimum 7% of pvrtion of I-T�PWA grant awarded) _�_
20. Tat�l Grant Administration and Oiher Activities l
(5um af liotivs 16 -19) I
� I � Cln�n� r ffo�,�:!:'^'+!:
+�---,.. �f_�.�y �.�.f�-_ _" .�
-�ry -'��.-� " - -+�
_4 _ __ �, _^'I',�_i :
- �� F JI_�'~��_- R: -
�-I�� �. L�� - -, - — _.�
i ` - - •-'I
--j2€ OaaT,��� Fucukiir�
E It���r��a���.�,� ��ul�x5',kE�s�u�
1C*;il'lfi;:�;� anr,IvcN _ C��irorlail
�-�'-' ' —� '' �� EluJr�+ l �k�ru�L
s�'_ I':— � I
�21. Tota! Ex�entl€itures f'or prngram pexr (3trm of Rows 7,10,13,15, aud 20) ��' �� y
� �`•,� �.` i _. _..��
2. Listing of Supportive �e�vices
Report on the households served and use afHOPWA funds far all supporii�e ser�iees. Da NOT report on supportive services
leveraged with non H(�PWA f�nds.
Dnt�r check: Total urrduplicatea" househo]ds and expenditures reparted in Row 17 equad totals reparted ir� Part 3, Chm•t I, Row 13.
Supportive Services
� Adalt day care and personal ass�stance
� 2. Alcohol and dn�g abuse services
� 3.
I 4•
I 5.
6_
7.
I 8•
`9.
� 10.
I 1 L,
I 12•
I i3,
Case management
Ci�ild care and other chiEd services
Educafion
Employment assisEance and fraining
Healthlmedicaliintevsi�e caze services, ifapproved
Note: Clicnt records miust confonn with 24 Ci7t �574.318
Legal services
Life slrills tnanagement {outside of case matta�ement)
Meals/ntitritianal serviees
Mental healYh sarvices
qutreach
Transpor[ation
pther Aetiviry (if approved in grant agreemeni).
14. Spe�if.y:
Sub-Tatal Houselio2ds rcceiving 5upportive 5ervices
I5. (Sum of I�ows 1-14)
I16, Ad.iustment for Duplication Isubtrxct)
TOTAL Unduplicated Iiouseholds receiving
Support'rva Servicea (Column [1] eqaals Rory 15
17. minus Row IG; Cviumn fZl epu�ls sum nf Rowa 1-14) �
[l� Uutput: Numher of Hauseholds
(2] Oa#puf: Amount u£HOPWA T'unds
Expended
�._:_'*.,` - _. - - = --'-��� �-I
___ __rl'�r�y '.C'_' �'
;n. �-r l � _ -_ _ _ _ -- --_�._-_-
, - � - . - - - _` =9
Previous edi[ians are obsulete Page il form IiUI}-4011Q-D (ExpiratianDate: IU/3]/2Q14}
3. Shoa•t-Term Rent,lVYoj•t�age �nd Utility Assisi�nce (S'�RMU) Sumanary
In Row a., enter the total number of households seived and the aznount ofHO�WA fands expended on Short-`�enn Rent,
Mortgage and UtiIity (STRMU) Assistance. In Row b., enter the total number of STItMU-assisted hausehalds ihat received
assisfance with mortgage costs anIy (no utility costs} and the ainount expended assisting thes�e households. In Row c., enter CIta
total nvmber of STRMLJ-assisted households that received assistance with both martgage and uti�iiy casts and the amount
expend�d assisting these households. In Row d., enter the total numbex of STRMiJ-assisted households that received assis#ance
with rental costs olily {no utility costs) and the amount expended assisting these l�ouseholds. In Row e., enter the total number oi
STRMU-assisted households that received assistance with both �•ental and utility casts and the amount expended assisting thesa
households, In Raw £, ent�r the toial number of STI�MU-assisted househalds that reoeived assistance with utility costs only (not
including rent or martgage costs) and ihe amount expended assisiing th�se households. In raw g., re�ort the amQunt of STRMU
funds expended to support direct program oosts such as prograrn operation staff
Data Cl�eek: The totnl househadds reported as setved with STRMU rn Row a., calumn (I] aMd !he datal nn�ount ofHOPWi� furrds reportecl crs
expenc%d in Row a., column (2J ec�:ruls the hausehold ancl expenditure totnl repartecl for STRMU in Par•t 3, Char�t l, Itow 4, CoTiurrns b, and f.,
respectiwely.
Data Cherk: The total nun�ber of households reparded ih Colun:n (I], Rows b., c., d., e., and f. ec�ual the fofal nurn8er ofSTRh.lUhoarseholds
�eported in Column (1], Raw a. 7'he total amount �eparteel crs expendect in G`alaznzn E2], Rows b., c., d., e., f., and g, ee�ual the fatal crmount af
STRN1Uexperrfiitures re�arted in Column (2j, Row a.
Housing Subsidy Assista�ce CaEegaries (STRM[J}
Total Shnrt tenn morkgage, ret�t and/or utilify (STRMU}
a- assistance
Of the total S1"RIvIY3 ranorted on Row a, total who received
b• 8ssistance witl� mortgage costs ONi.Y.
Ofthe total 5'ITtML7 reoorted anRow a, tofal wh� received
�- assisfance with martgage and utility costs.
Ofthe tatal STILMiJ renorted on Rovv a, total who received
�• assistance with rental cosb ONLY.
t7f fhe totaf 5"I'RMU renorted vn Aow a, t[rtal wha received
e� assista�e with rental and utiGty costs.
IOf khe toYa15'I'RM[I reaorted on Row a_ total wliq rcceived
� assisfence with utilityr casts ONLY.
birect program delivery cosks (e.g, program operations staff
time)
g•
[1] Ouiput: Number nf
Hos�sehulds �erved
End of PAAT 3
[2] Output: Tofa]
HOl'WA Funds Expended
on STRMU during
Operatin� Year
Prevaous editions are a6solete Pagc 12 form IIUD-401I0-A (�xpiration Date: 1U13112D14}
�Part �: ��mmary oiPerformance Ou�comes �
In Column. [1], report the tafal number of eligible Iaouseholds that received HOPWA housing subsidy assistance, by type.
In Column [2], enter the number of househalds that continued ta access each type of housing subsidy assistance into ne�ct
operating yea�•. In Column [3], report the housing status of a�l househoIds that exited the prngram.
Drrtn Clleck; �'he surn of Codumns C2] (Num6er of Households Conti��in�j arrd (3] (,�xited Hoarsehol'dsJ ec�uals 1he total repo�•te�l in Colunarr(7].
1Vote: Refer ta the hausing stability codes that appea�� in Pard 5: YY'orksheei - DeiernzinfngHoasing Sta6flity Outcomes.
Seeiran l, Honsing Stab�lity: Assesstt�ent of Claent Outcomes on Maintaining Honsin� �tability {�'ermanent Housing and
Re[ated �'acilities)
A. �'ermanent 3ousin� Subsid.y As4istance
[1] Out�rut: �'otal [2] Assessment: Number of [3] Assessment: Nurober o£
Number of Honseholds that Continued Hauschplds fhat exiteci this �4] HOPW�i Client
Househalds Receiving HUFWA Hausing HOPWA Pragram; thei�• Housing p�fcomes
Served Subsidy Assistance into tl�e Next Status after Exiting
Operating Year i
Teuant-Bascd
Renial
Assistance
Perm�nent
Suppnrtive
Hoasing
FaciGties( Units
B.'rransitiona HousingAssistance
' [1] Output: Tatai
Number of
Honseholds
Served
TrausitiunaV
, Shart Term
Housing
raciltHes! IIuifa
Pre�ious edihons are ohsolete
[2J Assessment: Number of
House�olcis thst Cantinued
Receiving HOPWA Housing
Subsidy Assisfs+ttce inio the Next
Ope�rating Ycar
Pagc 13
] Emergency Sl�elterlStrceta
2 Temporary Housing
I3 Privata Housing
la a��rxnrwa
f S Ol�et Sa6sidy
�
� 5 Inststution
I7 JaillPrisou
S Disconnected/[lnlrnown
9 Deatli
II �mcrgency Shelter/Strceta
`2 Temporary}Ioasing
I
� 3 Private I-Tausing
I 4 Othcr fFOPWA
�5 OthcrSu6sidy
G Instihrtion
I7 IaiVPrison
� 8 �iseonnected/[Inknown
9I�eath
U�stvUd� .4rrangements
Temporarrly SlaGle, fvrtJ� Reducsd
Risk ofHonrelessness
Stable/Pemrane�rt Housing {PH)
Unstable �rrxrngenrenls
ILife Everri
� Urtslable.41•rangenfents
� T"emporaa�ily Stabfe, ivrth Reduced
12isk ofHomelessness
I
SictUle/Pernranent Haysing (PHJ
U�s[abfe .4rra�agente�ls
Life Event
[3] Assessmenf: Number oF
Householc�s that exited this
HOPWA Program; their
Housing Status after �xiting
l Emergency ShelterlStreets
2 "1'emporary Housing
, 3 Private Housing
I 4 Other FfOPWA
5 Ot�er SnUsidy
Ib Tnstitulioa I
T JaillPRson I
I$ DiscDnnacfediunftnown i
I9 Death I
[4] HOPWA Client Outcomes
Ui�sta8le .�n•rrtr�gentents
Tetw�orarily,Stahle tivith Redtrced
Rrsk of Hontelessness
�
� S'tuble/Perrtramerrt Haarsing (Pf�J
U"nstable �trrangeneents
Iiife Everrt
form HUD-40110-D (�xpiraflon Aate: 10131I20i4)
B1:Tota1 number afhauseholds receiving transitiarcalfshort-term housirgl
assistance whose tanure exaeeded 24 months �
5ection �, Prevenfiion of Iion�elessness; Assessment of C[ient Outcames an Reduced Risks o£ Horr�eNessaess
(Short-Term Housing Subsidy Assisfanee)
Aeport the totai �.umher of households that receivad ST].2MLT asszstance in Colutnn [1].
In Coluinz� [Z], identify the autcomes of the househaids repa��ed in Calumn [1] either at the �ime that they were known to ha�e
left the STRMU pragram or tl�rough the project sponsor or subracipient's best assassynent for stabi�ity at tha end of the operating
}+ear.
Information in Column [3] provides a descriptian of housang outcomes; therefore, data is not required.
At the bottona of the chart:
o In Row la., report those households tk�at received STItMi7 assistance during the operating yea�- af this i•eport, and the
prior operating year.
� In Row lb., report those households that ceceived STl�1VICJ assistance during tha operating year of this repart, and the
two prior aperating y�a�s.
Data Check: The total hoaaseholds reported as served �vith �`TItMCJ in Colurrrn f1� equals the tatal repoYted irt Part 3, Chart 1,
Row 4, Column b.
D�tfa Check: The sum of Calt�mn �2� shauld equaT the �ttrmber afhousehoJds r•eported in Calxrriz� �I].
A�sessmeni of Households thAt Rcceived �`TRMU AssisEance
[1] Ouipat: '�atal [2] Assessment of Housing Status
number of
households
ll�fa'rnfain Privste Hausing witlmnf subsidy
(e.g. Assistanca provided/con�pl�ted and clfer�( is staBls, not
Tlkely tu seek addrlinna! szrpport)
Other Private Housing withont subsidy
(e.g, client swiiahed housing units and is naw stable, not likely
to seek additional support)
Othu Hf3PWA Housirag 5ubsidy Assistance
Other Housing Subsidy (PH}
Institufion
(a.g, residen#al and Iang-terin care)
Lil�ely thaC �dditionalSTRM[] is nee�led fo maintain cuaent
housing anrangements
TrAnsikional Facilitiea/Sltnrt-term
{e.g. te+nparary of• transrliorrai m•rar�genrer+t)
TempararylNnn-Permanenf F[oosing arrnngement
(e,g. gcrve u� lease, and nroved 9n ivrth family nr frierrris but
expects �o Trve �here �ess [han 9D days)
Emergency Shelterlstreet
Jail/Prison
Disconnected
Ueath
[3] HOPWA Client Dufcames
Stable/Pepmarrent Hoa�,sing (,PH)
7'emporurily Stcrble, �vith
Redt�ced Risk of Homelessness
�� � � i�
Unstr.�ble Arrangernents
� � �
Life Evenf
la. Tntai number of those households that received STRIVICT Assistance in the operating year of this report that also received
S'CRM[1 assistance in the prior aperating year (e.g. households t[�at received 3TRM[J assistauce in two consecutive operating
yeaes).
1b. Total mimber af those households thaY reeeived STI2M[7 Assistance in the aperaYingyear of this repart that alsa received i f
STRMU assistance in tlie two priar operating years (e.g. households Yhat received STItMii assistance lia three cansecuUve � I
operating yeats). �
Previous editiobs are oUso�ete Page ]A farm I�[TD-401I0-A (�xpiratiun Dafe: 1QI3112a14)
Seetian 3. HOPWA Ou#comes on Access to Care and Support
�.a. Totar Nu�mber of Households
Line [] ]: For project sponsorslsubi�ecipients that provided I�QPWA housing subsidy assistance during the op�raYing year
identify in tb8 appropriate row ihe nunnber of households that i°ecaived HOPWA hnusing subsic�y assistance (T'BRA,
STRMU, Pacility-Based, PHI' and Master Leasing) and HOPWA iunded case management services. Use Row c. to adjust
far dapiication among the service ca#egories and Raw d, to provide an unduplicated househald total.
Line [2}: For project sponsorslsubrecipients that did NOT pmvide Z�OPWA housing subsidy assistanoe zdenfiify in the
appropriate inw the number af households that recei�red H�PWA funded case management services.
Note: 3'hese nxtmbers tiwill heTp yau to detertrzine which clients to repoi•d ticcess to Car�e artd ,�ispport Outcarvaes for artd will be
used by HUD rxs a basis for cr�alyzing the percentage af househoT�ls �vho derraor�stratad or n�airrtained conraections to care arrd
support as iderttified in Chari 1 b. &elaw.
Total Number oi House[�olds �
I. Y?�r•D.wjeeiSnonsorsl$uhcecipienis fhAt nrovided N41'WA NnLsn�r Subsidy Assts�AnCP- Jde��tify th; rntal ni�mhernFhousel2nleis Ntat �
rr:�t�vpd t�t fu:':c ^� �EiGPWk-f.uiidec! se :�;ce.a E
a. Hvusiug Subsidy Assistance (duplicated)-TSRA, S'TRM[7, PHP, Facility-]3ased Housing, and Master Leasing I
b. Case A+Ianagement j
c. Adjustma�t for duplication (subtractionj
I d. Total Households Served by Projact Sponsarsl5ubrecipienSs with Housing 5nbsidy Assistance {Sum of Raws a.b, I
miuus Itow c.y �
{ ! � ry F: nject Spansors/Suhrecipients did NC3'i grnyerlP i1fSpWA f(01157l3g' S1�E181(Ij� AS915iRnce: ��� ;!;�+ th; tnral n�nrhrr nf�touseholds th&Y
` ��ceived :1�c. tn3!aiving 1iQPtiVA-tunded aerv�cc:
� a. HOPWA Case Management I
� h. Tutal Housel�olds Served by Project 5ponsors/Subrecipients without Housing Subsidy Assistance
lb. Status of HonseuoZds Accessing Care and Support
Coiumn [I]: Of ihe househoids identi�ed as recei�ing services irom project sponsorslsubr�cipients that p�•ovided HOPWA
housing subsidy assistance as identifed in Chart Ia., Row ld. aho�+e, regort the number of househnlds that demonstr•ated
access or maintained connections to care and suppait within th� prograrn year.
Calumn [2]: Of tha k�ouseholds identiiied as receiving services from praject sponsors/subrecipiants that did NOT provide
HQPWA housir►g subsidy assistance as reported in Chart la., Row 2b., report the number of households that damonstrated
impraved access ar maintained con�ectians to care and support within the program year.
Note: Far in�'ormation on types ancl sourees o�`income arad medicQ! lnsura�ace/assastar�ce, refer ta Charis below.
[1] I+or pr�ject [2] Fax• project
sponsnrsJsubrc�ipients that sponsorslsubrecipients that I
Cate ories af Services Accessed ravided HOPWA ho�rsin subsid did NOT provide HUPWA Dutcame
g � g y'housing subsidy assistance, Indicatar
assistance, identify the households identify the houseUoids �vho
whp �lemanstrs�ted the following: �emonstrated the followiug: ,
1. Tias a hotising plan for maintaining or esf�b[ishing siable on-
going housing
2. Had can#act wit11 case ananager/bene�its counselor consistent
ith the schadu[e speeified in clienf's uidividual service plan
(may inofude lever�ged services such as Ryan White Medical
Case ivIanagement}
I3, Had contact with a prirnary health care provider consistent
with the schedule specifiad in clienYs individual servica Plan
�4. Accessed a�d mainfained mediaalinsvTance/assistance
�5. Successfully accessed or mainiained quaGfication for soiarces
of inoomc
Su��ort for
Siable
Houstng
Access to
Suppor•!
ticcess to
Health Care
�ccess to
Health Care
Sources af
Irream�
Previous editions are ohsolete Page 15 form IIi7D-4UIltl-D (Expirntion n�tc: 1OP31/2014)
Chart lb., Line 4: �urces of MedicaN Insuranc� and Ass�stance include, bu� are not Iimited fo the fallowing
SReference nnly}
� MIEDTCAID Health �nsurance Program, or
use Incal program
name
o Veterans Affairs Medical5ervices
• AIDS Drug Assistance Program (AD[3.P}
• State Ghifdren's EZealdi Insurauce Program
{SCH]P), oe use local program name
n Ryxn Whice-fianded Medical or Dental
Assistance
• MEDICAIZE Tiealth fnsurance Program, or
use local program name
C�art lb., Row 5: Sources o� Inco�e include, but are not limited to tl�e followin� (Reference anly)
� Eamed Incame � Child 5upport • General Asslstance (GA), or use loca!
• Veteran's Pension e Socisl5ec[�rity 17i5abillfy Tncome (SSDI} program nanie
• Unemployment Insurance • Alimony or oilier SpDusal Support a �rivate Disability Insurance
e Pension from �'ormer To6 • Veteran's Disabllily Payment e Temporary Assist�nce far ATeedy
• Supple�nanta! Security Incoine (SST} e Retirement Income from 5acial Security Families (TANF)
• Worker's Compensation • Other Income Sources
1e. Households that Obtained EmployrrAent
Coluinn [1]: Of the hauseholds identified as receiving ser�ices fro�n projeoi sponsors/subreeipiants that pravided �TOPWA
housing subsidy assistance as identiiiad in Char� Ia., Row 1d. above, repart on the numher of households that inalude
persons who obtained an iucome-producing job during the operating year that resulted from HOPWA-funded Job training,
a�nployment assistance, educ�tion or related case naanagement/aaunseling sei�vices,
Column [2]: Oithe households identi�ed as receiving services from project sponsors/subrecipients that did NOT provide
HOPWA housing subsidy assistanc� as reported in Chart 1a., RoW 2b., report an the nUmUer of households that inciude
persons who obtained an income-producing job during the operating year that resulted from HO�WA-funded �ob training,
employmant assistance, edueakion ar case managemen�/caunseling se�rvices.
Note: This i�tcludes jobs created by fhfs projeci sporrsor/su$r�ecipierrts op abtatned a�tsid� thts agsncy.
Nate; Do rroi include jabs that resultedfrom leve�'aged�ob tt'aini�rg, employment assistance, education or case
managemen�caaenseling services.
[1 For prpject sponsors/subrecipients fhat [2] For projcct sponsorslsubreeipients thut did
Categories of Services Aceessed Provided HOPWA housing su6sidy N�T provicle HOPWA hausing subsic�y assistance,
assisfunce, identify the hopse�ol�]s wlio identify the households w�o �emonstrAted the
demonsirated the following: followin�:
Tata! num6er of househalds that
obtained an income-produoing �ob
End af PART �4
Previnus editions are obsolete Pagc 16 form HUD-40110-D {Expiration Date: I0131/2014)
�PART �: Works�eet - Deter�x►ining Housing S�abiiity ()utcomes (aptionar)
1. This chart is designed to assess program results hased on the infonnation repoi�ted in Part � and to help Grantees defermine
o��rall program pe �Fonnance. Completion of this worksheef is o#ianal.
Permanent 3table Housing Temporary Housing
Housing Subsidy {# of households (2}
AssistA nce
Tenant-Based
Aentai Assistance
(TBR�i.?
Permanent Faciliry-
based Housing
Aesistancel[Jnits
Transitivnak/Short
Term Facility-based
Housing
Assisfancel{Jnits
7'otal Yermanent
HOl'WA Haasiug
$11b8td,y !�9 S1 SE A n C C
Rcduced Risk of
Homelessness:
Shprt-'I'erm
Assistancc
Short-Term Rent,
Mortgage, and
Utility Assistance
(S'CRMU)
Total HOF�'A
�uusiug Su6sldy
Assistance
remaining in program
p]uy 3+4+5}6)
� __ fM__ _i'.
Stable/PermAneni Temporarily 5tahle, �vitH Reduced Ttisk of
IIousimg Hamelessness
Unstxble I Life Event
Arrangemenls (9}
(1+7+8)
* _�
Unstable T,ife Events
Arrsngements
Bactigraund on HOPWA Hausing Stability Cades
Stable Permanent Housingl0ngoing Participation
3= Private Housing in th� private xental or I�ome ownership market {without known suhsidy, in.oluding permanent placement
witl� fami�ies or other self-suf�cient arrangements) with reasonable expectatiQn that additional suppart is not needed.
4= Other HOPWA-funded housing subsidy assistance (nnt STRMU}, e.g. TBRA or �aciliiy-Based Assistance.
5= Other subsidized house ox apartrnent (non-HOPWA sources, a.g., Section 8, HOME, public housing).
6= Insii#utianal setting with greater support and continued residence exp�cted (e.g., residential or long-term care facility).
Tempor�xry Hou�ing
2= Temporarq housing - moved in. with familylirie�ds or oiher short-term arrange�nent, such as Ayan White subsidy, transitional
housing far horneless, or tennparary placement in iastitution (e.g,, hospital, psychiatric haspital or other psychiafric faciGty,
subsfanee a6use h•eafnnent facility or detox ccnter).
IInstable Arrsngen�aents
l= Emergency shelter ar no housing desiination such as places noi meant for habitation (e.g., a v�hicle, an abandoned building,
bus/train/subway s#ation, or anywhere autside).
7 = Jail Iprison.
8= Disconnected or disappeared from proj ect support, unknown destinatian or no assessments of honsing needs rvere
undertalcen.
Life E�ent
9= Death, i.e., remafned in housing until death. This charactaristic is not factored into the hQusing srability ec�uation.
Ten�nt-based Rental Assistance: 5tabla Housine ss the sum af the numbar of housel�olds that {i) remain in the housing and (ii)
those that lef� ihe assistance as repoi�ted under: 3, 4, 5, and G. Temoorary Housin� is the number of hanseholds tha� accessed
assistance, aad left their current hoasing :for a non-permanent housing arrangement, as reparted under item: 2. Clnstai�le
Situations is the sum of aumbers re}�i�ted under iterns: 1, 7, and 8.
Previons cditians are o6solctc Yagc 17 ferm HUA-4�110-D (�cpirAtion Axfe: 1Ql31/2fl14)
PermAnenE �'acility-Based Housiung Assistance: Stable Housin� is the suin of the number of households t�at (i) rerx�ain in the
liousing and (ii} those ihat left the assistance as showtt as items: 3, 4, S, and 5. 'I'etnporary Housin is the numbet of households
that accessed assistanc�, and fe�t their current housing for a non-permanent housing an�angernent, as reparted under it�m 2.
Unstable Situations is t�e snm of nu�nbers r�pQrted under items: 1, 7, and 8.
Tran.sition�llShort-Term It'acility-BAsed Housing Assistiance: Stable Housin� is the sum of ik�e number af househalds that (i)
continue in the r�sidences (ii) those that left the assistance as shown as items: 3, 4, 5, and 6. Other Temoorary �iousine is the
nuinber oi households that accessed assistance, and Iei� their current housing for a non-permanent housing arrangaznent, as
repos-�ed under item 2. Unsta6le 5ituations is the sum af numbers r�pot�ied unrler items: 1, 7, and 8.
Tenure Assessment. A baseline of households in transitionailshort-term facili�ies fpr assessment purpases, indicate the number
of househoIds whase tenure exceeded 24 months.
STRMU Assistance: Stab�e Housin� is the su�n ofthe numher aihouselialds tliat accessed assistance �or some portion of tk►e
permitted 21-�veek period and there is reasonable expectation tlaat additioa�al support is not needed in order to maintain
permanent hausing living situa�ion (as this is a time-limited forrn o�housing support) as reported und�r housing status: Maintain
Private Housing with subsidy; Oiher Private with Subsidy; Oth�r HOPWA support; Other Hausing Subsidy; and Institu�ion.
Ternnorariiv 5tahle. �vith ReduGed Risk o£HoineIessness is the sum of the number of households that acoessed assistance for
some portion of the permitted 21-weak period or left flieir curi�ent housing arrangement for a transitional facility or other
ternporxryfnon-permanent housing arrangement and there is xeasonable expeotation additional suppari will be needed io maintain
housing arrangements in the next year, as reporteci under hausing status: L,ikely to maintain eurrent fiousing arrangements, with
additional STRMiJ essistance; Transitional Facilifies/Short-term; and'�'emporaryfNon-PermaaentHousing arrangements
Unstable Situation is tha sum of number o� hQusenolds reported under housing status: Emergency �helter; 7ai11Prison; and
Disconnected.
End of PART 5
Prerious editions are obsoIete Page 18 iarm Ii11A-4611U-D (C�rpiratiou Date: 14F3Il2014)
IPART 6: Annt�al Certificatian o� Conlaaaued Usage f�r N!���� i��c4)i .ty-l3ased �te�uvardsbi� Units {[➢NL�
1'i�e Annual Certification o£Usage for HOPWA Facility-Based Stev�ardship Units is to be used in place of Part 7B ofthe
CAPBR if the faciiity was originally acquired, rehabiliiated or constructedldeveloped in part with HOPWA funds but nn
HOPWA funds w�ere expended during the operating year. Scattered site units may $e grouped fagefher on nne page.
Grantees that us�d HOPWA funding for aew construction, acqt�isikiors, or substantial rehabilitation are required io
operate iheir faci�sties for HOP�A eligible individUals fnr at least ten (10} years. If non-substantial rehabilitation funds
were Us�d they are rec�usred ta operate for at least three {3) years. Stewardship begins once the facility is put into
operation.
iVofe: See def�nifion ofStewardshi.n Untts.
1. Geaiera! informs�tion
IIiID Grant Number(s)
Grantee Name
Operatin� Xear fvr this report
Fi•w+a (Hrm/dd/yyJ Ta (»�aa/dd�YY) ❑ Final Yr
❑'Yr 1; ❑'Yr 2; ❑ Yr 3; ❑ Yr 4; ❑ Yr 5; ❑ Yr d;
❑ Yr 7l ❑ Yr S; ❑ Xr 9: ❑ Xr 1�0r�
AaCe �'acility Began Operalions (nafrr/dd/yyJ
2. Number of IInits ancl Nan-HOPWA �xpenditures
Facility 1Vame:
Namber of Ste�rardship Unifs
Dcvcloped wiih HUl'WA
funds
Amaunt of Nun-IiOP�YA Funds Expended in �nppor� ofthe
5tewardship Uuits during khe �perating Year
Total Stewardship Units
{subject to 3- or 1Q- year use periods}
3. Details af Praject Site
Yroject 5ites: Name oFHOPVI�'A-funded project
Site Infozmation: Project Zip Cade{s)
Site Infonnation: Con�essional DistrieY(s)
Is tl�e address of the project sila confidential7
If the site is uat confidential;
Please p[nvide the cpnt�ct infonnation, plione,
email addresslloeaYion, if business address is
diTf'erent from facility address
❑ Yes, pmtecl info�•i�zatio�; da not list
❑ Not co�dentfal; ii�forma�ion ccrPr be made averrlable to rhe nublic
I certify that the facility that received assistance for acquisition, rehabili#afiion, or new eonskruciian fmm the Hbusing Qppartunities
for Persons with AIDS Progxam has operated as a faaility to assist HOl'WA-eligible persons from the date shown above. I also
certify tlaa€t the gtant is stiil serving tha planned uumber of HOPWA-efigible households ak this facility through Ieveraged resotuces
and all other requirements of the grant agreemenf are being satis�ied.
� I her•eby cert fy ahat a!! the rr�''ornrerdian stated herein, as 3ve7I as any inforrmrdian Drovided in the ucconap�nin�enl hereivil�s, ts lrare and accemate,
Nxme & Tlfle ofAuthorized Offtciai ui'the organizaiion that cantinnes 3igpxture & Aatc (mmlddlyy)
to nperate the facility:
1�Inme & Title af Contacf at Gr�tntee Agency Contact Phane (with Area codej
(persot� ivho can artsiver qa�estiarrs about the repor•t atad program)
End of PART 6
Previnus editians arc obsalete Page 19 form H[]D�40110-D (�xpu�ntion Aate: IDl3112014)
Parf 7: Summary Overwiew of Gran� Actir+i�ies
A. Infvrmation an lndividuals, SeneYiciaries, and Househoids �.�.eceiv�ng �OPWA Housing �u��ic�y !+�Q��tance
(TBRA, STRMU, Facilify-Based �.r*�±±e, l'errr►aueut Haus'tng P�Rceroenf and Master Leased Units QNL�
1t�ote: Repor^ti�rg}�or this sectian s�Zoirld incl�rde ONL�'those irzdividxrals, �ieneficiaries, or hausehalds tha# received a�rcUor
residecd rrr a household that receivecl HOPyYA Housi�rg,SEcbsicly Assistarrce e�s reported in Part 3, Churt 1, Row 7, Column b.
(e,g., do rtot rrrcZude ho�rsehalds that received HOPW.4 su,pportive servic�s ONL�'),
Section� 1. HOPWA.-Eli�ible I�diwiduals wl�o Receiv�ed HOPWA Housing Subsidy As�istance
a. Total HQPWA Eligibla Individuals Livin� with HIVIA�I}S
Ira Chart a., provide the tota3 number of eligible {and unduplicated) Iow�income sndividuals livin� with HIVIAIDS who c�ualified
their household to rec�ive HQPWA housing subsidy assistance during the operatizig year. This total should includs only the
individual who qualif ed the household for HQPWA AssisYance, NOT al! �V posiiive ittciividuals in the household.
Indi�iduals Se�-ved with Housin� �ubsidy AssistRnce ; Total
Number Qf individuals rvith HIVIAIDS who qualiiied their �ousehold to receiva HQi' WA housing subsidy assistance.
Chart b. Prior Living Situation
In Chart b., report t1�e prior living situaiions %r alI Eli�ible Individuals reported in Chart a. Tn Row 1, r��ori the total number of
individuals who con�inued to receive HOPWA housing subsidy assistance from the priar operating year into this operating year.
rn Rows 2 through 17, indicate the prior living arrangem�nts %r ail new HOPWA �ousing subsidy assistance recipien�s during
the opera�ing year.
Dartr� Check: The tatal number of edigible i�tdivida�als served in Roty 18 equals tFre fatal ttumber of indaviduals served th�ough
housing subsic�y assistarrce reported in Chari a. above.
Category
I1. ' Continuin� to receive HOPWA support from fhe prior operating yeax'
New Tndividvals ivho receivecl HD�WA Houainv, Subsidy Assistance suppart dur'rng Operating Ye�r
� 2 P12ce ttot meant for hurnan habitation
(sueh as a vehicle, abandoned buiiding, 6usltrainlsubway statio3alairport, or outside}
�3. Emergency sheltar (inclutiing hoiel, motel, or campgrpund paid for with emerg,ency shelter vauoher)
4. Trensitional housing for homeless persons
g, �r�rfli n���»her nf new Eii�ibtc Cndividuels who re.���?�1 i[pPWA Hnusin� Suhsidy egs�tan�e with t! Prior
�.eve:+�'�;:;:�:e�r :l�Rl meets F1Ul3 de�nition of homcicsane�a (Sum uiRovr3 2- 3}
6 Perri►anent housuig for formerly homeless psrsons (such as She3ter Plus Care, SHP, ar SRO Mod
Rehah)
� 7. Psyohiatric hospital or other psychiatric facili4y
I8, Substance abuse treatment facillYy or detox eenter
9. Haspital (non-psyohiatric facility)
10. Foster care home ar faster care group home
11. Jail, prison or juvenile detentian :f$cility
12. Rented rQom, aparfinent, or hause
l3. House you orvn
� 14. Staying or living in sameone else's {fami1y and friends) room, apartment, or house
'rotal HOPWA
Eligihlc Tnd[vidusls
Receiving Housing
Subsidp A�ssistance
I15. Hotel or motel gaid for withaut einergency shelter voncher �
� 16. Other �
I17. Don't Know ar 12efused
f 18. TO'I'AL Number of H�PWA �ligible Indir�idaals (sum of Rows 1 and 5-17j ,
Previvus editious are obsolete �'age 20 form HTJi)-4011Q-D (�xpiratian Datc:16131/2014)
c. Honrxeless Individual �uxnmary
In Chart c., indicate tha nusnber oi eligible indi�iduals reported in Chait b., Row 5 as homeless wlio alsa are homeless Veterans
andlor meet the deiu�►ition for Chronicaily Hameless {See Definition section of CAPER}. The totals in Chart c. do not need to
ec�ual the totaS in Chart b,, Raw 5.
Num6er of Number of Ch�ronicaiCy
Category Homeless gomeless
Veteran(s)
HOPWA eligible andividuals served with
I�OPWA Housing Subsidy Assistanc�
SQction 2. Bene�ciaries
In Chart a., report the to#al number ofHQ�WA eiigihle individuals li�ing with HIV/AIDS who received HOPWA l�ousing
subszdy assistance (as re�orFed in Pqrt TA, Section I, Chart a.), and aIl associated membets of their household who benef tted
from receiving HOPWA bousing subsidy assistance (resided with HOPWA eligib�e individuals).
Note: See defr�itio�t afHOPW<4 Eli�ible lnclividuc�l
Note: See definitaon vfTranseender.
Note: See �'efarrition of Berrefrciaries.
Data Cf�eck: The s�rm of each nf the Charts b. & c. orr the folloiving two pages equals the total rrzrmber nf berre�ciaries served
wiih HOPWA housirag st�bsiciy assistarrce as determaned in Chart a., 12aw 4 below.
a. Total Number of Senefici�ries Served wyth HOPWA Housin� Subsid� Assistance
I Indi�iduals and k'amilies Served �►�vith HOPWA Hovsing Suhsidy Assistance Total Number
1. Number of individuals with HIV/AIDS who c�ualitied the household to receive HQ�PWA housing st�bsidy
assistanee (equals fhe number ofHOPWA Eligible Indivicluals reparted in Part 7A., Section I, Chart a.)
2. Number of ALL nther persans diagnosed as HIV posiiive wha reside with tha HOl'WA. eligible individuals
identified in Row 1 and who bene�itted from t�e HQPWA housing subsidy assistance
3. Numher of ALL other persans 1�iOT diagnoseti as HTV posiYive who �reside with fhe HOPWA eligible
individual identified in Raw 1 a�id who henefited from the HOPWA hausing subsidy
f4. 7'UTAT. num6er of ALI, bene�ciaries served wiYh T�ousing Subsidy Assistancc {Sum of Rows 1,2, & 3)
PrevEous edifions are ahsnlete Page 21 form HUD-401I0-D (�xpiration Date: 1Qf311Z014)
b. Age and Gender
In Chart b., indicate the Age and Gender of all beneiiciaries as reported in Char� a. di�ectly above. Report the Age and Gender oi
al� HOPWA �ligible Individuais (those reported in Ghart a., Rflvi+ 1} using Rows 1-5 below anc� the Age and Gender of al1 other
beneficiaries (those raported in Chart a., Rows 2 and 3) ►�sing Rows 6-10 helow. �'he nutn ber of individuais j�eporied in Row 11,
Column E, ec�ua�s the iafial number of hene�ciaries reparted in Part'1, Section 2, Chart a, Row 4.
1, Under 18
2. 16 ta 3o years
3. 31 to SD yerjrs
51 years and
4. Older
5ubtotal (5um
5. nSltnwsl-4) i
I
� 6. ' i7nder 1$
I7. 1 B to 30 yeaes
� S. 31 to 54 years
51 yeats and
9. Older
$ubtotul [Sum
lU. of Rofvs 6-9)
�
TOTAL (Sum
11. of Rows 5& 10)
Previous edi#ians are obsoletc
N�3p�4'A Et�t�iblr l��divi�iu�ls f,Chart i+, lRc:a' 1�
A. B. C. D. E.
'1'OiAL (Sum of
iWlale T'emale Transgender 1VF to T TransQander F to M CoSumns A,-D)
A,'1 +G�L�:L:' �ienefiCiaries (Chart a, Y;^:us � :::�I 3}
A. B. c, n.
Male reroale Trans�ender 1VI to T Transgender � to M
'1'�tAI �?a^aiP��i�ri�c �Ch�rt fl. RL':�' i4�
Page 22
i. �
'�'UTAL (Sum of j
Calumns A-A) �
form IIUD-40110-D (�xpirntion Date: 101311241.4)
c. Race and Ethnicity*
In Chart e., indicate ttie Race and Ethnicity of all beneficiaries receiving HOI'WA Housi�g Subsidy Assistance as Xeported in
Sec#ion 2, Chart a., Row 4. Report W� zace of all H�PWA eligible indi�iduais in Column [A]. Repo�� �e ethnici of al!
HOPWA eligible individuals in colu�nn [B]. Repor� ihe race of all other indi�iduals who bene�itted from the I�OPWA housing
subsidy assistance in cvlurnn [C]. Aeport the ethnici af all other individuals who benefited fro3n the HO�'WA housuig subsidy
assistance in eoiumn [D]. The summed total af columns [A] and [C] equals the total number o� bene�iciaries reported above in
5ection 2, Chart a., Row 4.
�
�r�: ^ge:�}
1. Aiuerican Indiw�/�1laskan Mative
2. Asian
3. D12c1r/Afr�can American
4, Nativa Hawaiia3yOther Paeific Islander
5_ White
G. American IndianlAlaskan Native & White
:;:lYWA Fligiblc :nifi�edaAEs ,;:: nt!.e: $cnefit`��r[es
�A] Race [C] Rxce
jall iudividuals �1 Ethnicity [fotai of [Dj �thnicity
reporfed in IAIso identiSed as individuals [Alsa identified as I
Section 2, Chart X��spAnic or rcported in Hispanic ar
A.� �OW lj �AfEI10� SCCilOII Z� CLATf Lxt'r�a3
fly �D�Y5 Z �c ��
7. Asian & White
8, B1aak/African American & White
I 4 Americaa IndianlAlaskan Native &
BlacklAfrican A�ncrican
` 1Q. OtherMulti-Racial
jI1. CalumnTotals (Sum ofRows i-lU) I
�Dtrtrt Ckeck: �errat ofRatv 11 Co]'urnn �I atrd Roiv 11 Coharrn C equc�ls the totaC munber Hf)YYYABenef iciaries reporled in Pari 3A, Seetion 2,
Char! a.. Rnw 9.
*Reference (dada �•eguested eonsrstent ivith Forn� HUD-,270b1 Race a�rd &thezr�c Dara ReportrngFornaJ
Sectian 3. House�olds
Ho+�sehald Area Median Income
Report the area median inco�ne{s) for alI households served with I�OPWA housing subsidy assistance.
Data Clseck: The �otal rrurn6er of hoa�sehoids s�rved with H�PY�A housing su6sidy assistance sho:rdd equal Parf 3G; Rory 7,
Caluin�r b ar�d Part 7A, Section l, Chart a. (`I'atal HDPWA Eligible I�dividuals Served �viih HOPWA Hotrsi�rg Subsidy
�lssistanee).
Note: Refer ta httr�://wvv►v.huduser.or�/vo�•ial/datasets/il/i12010/select Geo�rar�hv rraf.odn for� irrformation orr area median
irrcorne in yoarr commurrity.
Percentage oSArea Medis�n Incame
, 1. Q-3D% of area median income (e�ctremely low)
I2. 31-50% of area median income (very low}
3. 51-84°10 of area median income (low}
4.
'Total (3wn ofRo�vs J.-3)
Houschoids Se�rved tivith HOPW�A Housing Snbsidy
Assistance
Previous editions are odsalete Ppge 23 form HL7D-4011ff-D (Expi�•aflon Dxte: 10131/2014)
�Part 7: Snmmary Overview af Grant Activities
B. Facility-Based Hausing ��sist�nce
Cornp�ete one Pa�t 7B for each facility deve[opad or supparted tnraugh HOPWA funds.
Do not comnlete titis Section for nt•a�r�t�s ori�inally deWeloped with HOPWA func3s but no lonu..er sunaorted with
HOPWA funds. If a faaility was develdped with HOPWA funds {subject to ten years of operation far acquisition, new
construction and substantia! rehabilitation costs of stewardship units, or three years far nnn-substantial rehabilitation costs), but
HOPWA funds are no longer �sed to support the facil�ty, the p�ojact sponsor or subrecipient should eompleta Pari 6: Annual
Certification of Continued Usage for HOPW� �acility-Based Stewardship Units (ONLY).
Cornple�e Charts 2a., Project Site Tnformation, and 2b., Type of HOPWA Capiial Devela�ment Px�oject Unxts, %r a11
Deveiopment Prajects, including facilities that were past development projects, but ccmtu�ued ta receiv� HOPWA operating
dallars this x•eporting year.
].. Project Sponsorl�ubrecip'rent A�enc,y Name (Required)
2. Capita� Develop�n�nt
2a. ProjecE Site Infarmat�on for �OPWA Capifal Developmeat of Pro�ecfs (For Current or Past Capr`tal
De�elopment Projects tl�at recei�e FIOPWA Operatin� Costs this repartin� year}
Not�: If urrits are sCa 'tered-sites, report o,� therra as a�raup arrd under type of FaeiiiZy �rite "Scaktered Si1es. "
HppWA � Name of Facility:
Type af
Development
this operati�g
yeax
❑ New construction
❑ Rehahilitatian
❑ Acquisitiou
❑ Oparating
Funds
E�pe�nded
�his aperating
year
(�f applicablej
$
$
a. Purohase/iease of prqperry:
b. ReIiabilitationlConstructionDates:
a. Operativn dates:
d. Date supportive services hegan:
e. Number ofunits in #he facility:
f. Ts a waiiing list maintsioed for the faciliry7
g. Whatistheaddressoffhefanility(ifdifferei�Yfrombusinessaddress)7
li• Is the address of the project site eon6den#taf?
Non-FIOPWA iunds
Expended
(if applicuhle)
� Type a� Faciliiy [Chec� onlv one l�ox.]
� ❑ Permanent 6ousing
❑ Shart-Yerm Shelter nr Transitiorial housing
� I❑ Supportive services anly faciEity
Date (mmldd/yy):
bate slarted:
I]ate Cnmpleted:
IDate residents began ta occupy:
❑ Nat yct occupied
�Dafe sfarted:
❑ 1+Int yet providin� services
1 I�OPWA-fitnded iurits = Tota] (lnits =
❑ Yes ❑ No
If yes, rzern�ber ofpardlcipar+ts orr the lrst at the end of aperading yem•
❑ Yes, protect rnforutntion; do notparbNsh 7ist
❑ NP, can be rnude avarlable ta rhe puhlic
Previous cd9tlans are obsnlete Page 24 form IIUA-40110-A (Expiration Date:10/3112014)
2b. Number and Type ofHOPWA Capital Develapment Project Uni�s {For Curreat or Past �apital
Development Projeets that receide I�OPWA Operatin� �osts this Reportin� Year)
For units entered above in 2a. please list tha number of HOPWA units that fulfill the follor�vin� criteria:
Num6er Designated
for the Chranically
Homeless
Rental �its consfructed
(�ew) and/or acquired
with or without rehab
Rental units rehabbed
Honleuwnershig unifs
construcfied (if approved)
Number
Designatcd ta Number Energy-
Assist the Skar Compl�ant
�omeless
Num6er 5U4 Accessi6le
3. Units Assisted in Types of $onsin� F�acKlityliJni�s Leased by Project Sponsor or SnbrecipXent
Charts 3a,. 3b. and � are reauu�d Far each facilitv. Tn Cha�ts 3a, and 36., indicate the type and numher of housing ue�its in the
facility, including m�ster leased units, project-based nr other scattered sr`te units leased by tl�e organization, categorized by the
number of bedrooins per unit.
Note: 2"he number arrrits may noi equal the toiczd nzcmb�r af hatrsehodds senaed.
P�ease complete separate c�arts for each housing facility assisted. Scattered site anits rn�ay be gi•ouped together.
3a. Cbeck one only
❑ Permanent Supportive Housing FacilitylCTnits
❑�hort-term Shelter or Transitional Supportive Housing FacilitylUnits
3b. T�pe of Facifity
Gomplete the following Chart for all facilities leased, master leased, projeet-based, or operated with HOPWA funds during the
reparting year.
Na�e o�Pro,ject Spoasor/A�enc,y Operatiq� the Facilily/Leased Units:
Tot�l Nuraber of Units in use during tlse Operating Year
Type of housing iacility operated by t�e Cate�vr�ized b,y the Number of Bedroom�s per Units
project sponsorJsubrecipieat S�tOlStudio/0 � 1 bdrm 2 bdrm 3 bdrm � bdrm ! 5�-bdrm
bdrEn �
e. 3ingle room occupaney dweliing — _ —
b. Cotttmuniry residence
c. Project-based re�tal assistance units or leased units � �
d Other housing facility I � I I
S ecif • � i
4. Households and Hausing E�enditures
Enter the total �urnb�r o�households served and the amount ofHOPWA funds expended by the project sponsor/subrecipient on
subsidies for housing invalving the usa af facilities, master leased units, project based or other scat�ered siie units ]eased by the
organization.
Iiousing A�ssistance Category: FaciIity Bxsed Housing Output: Numher af
Housel►alds
g Leasing Costs
b. pAeraiing Costs
� Praject-Based Rental Assistance (PBRA,) nr other leased units I
d OUter Aetivity (if approved iit grant agrcement� S ecit' : I
0, Adj�stmcnt to climinafe duplitTfion (subfracfj
�'QTAT, Tt`acility-Based Housing Assists�nce
f (Sum Rvws a. throu�h d. minus Ro�v c.)
QuEput: Total H�PWA Funds Ex�enriet� c3uring �
OperafRn� Year by Pro.ject Sponsor/subreciuicnf
!
I
I I
� -- — _ --� _ - - �
I' -_- - -
Previous cdifinns are obso[ete Page 25 forsn HiJD-4�110-D (Expiratiun Datc: 10l31/2414)-
� 11115120'14
���r°�r ���n��a�, A��n���
DATE;
OFFicial site of t#�e Gty of Fart Wbrth, Te�:as
�O�i7 ���Tl�
�
COUNCIL ACilO�l: Approv�d on 8151��14 � Ordinance Na �13fi3�08o�014
CONTINUED I�ROM A PR�VI4US WEEF�
7�22�2014R�FEREPlC� C-26893 �.�(� �q��,; 17HUDACTIONPLANPY2014-
Wf O.: 20 � 5
CO��: C '�yp�; NON- PUBLIC YES
CONSENT H�A�ING:
SU�J�C�': Conduct Two Public Hearings and Appro�e the Cify's Actian Plan for the Use of Federa�
Grant Funds in the Amaunt af $9,827,252.00 fram the United States Department af
Housing and Urbar� Development for Program Year 2Q14-2Q� 5 from the Community
De�elopment Block Grant, HOME Invesfinent Par�nerships Program, Emergency So1u#ions
Grant and Housing Opportunities for Persons with AIDS Grant Pragrams, A�t�orize
Collection and Use of Program incame, Authorize Waiver af Application of Indirect Cost
Rates, Authorize Execution of Related Contracts and Interdepartmental I�etters of
Agr�em�nt and Adop# Appropriation Ordinance {ALL COUNCIL DISTRICTS)
RECOIViIIflE�IDAiIOIV:
lt is recommended that the City Council:
1. Conduct two public hearings to allow citizen input and consideration of the City's 20142016 Action
Plan for use of federal grant funds from the Unit�d States Department of Housing and Urban
Development in the amount of $9,827,252.OD for Program Year 2014-2015 from the Community
De�elopment Block Grant, HOME ln�estment Partnerships Program, Emergency Solutions Grant and
Housing Opportunities for Persons with A1�5 grant programs and for the use of program income from
activities using prior years' federal grant funds;
2. A�pro�e the Ciiy's 2014-2015 Action Plan for su�mission to the United Sfates Department of
Housing and Urban Development including allacations af grant funds ta parficular programs and
activities as detail�d be[ow;
3. Autharize the collectian and use of an estimated amo�ant of $50,000.00 of program income resulting
from activities using prior years' Community �evelopment Block Grant funds for the programs and
activities deta�led below;
4. At�thorize th� cflllection and use of an es#imated amount of $100,OOO.pO of program incoma resulting
from acti��ties using prior years' HOME In�estment Partnerships Program funds for the City`s
Home�uyer Assistance Program;
5. Aufhorize the City Manager or his designee to execute contracts and Interdepartmental Letters of
Agre�;m�nt for a on� y�ar term with th� ag�:nci�s list�d be[ow in Tables 1, 2 and 3 for Program Year
2014-20�5 for Community Deve�opment Block Grant, Emergency SolUtions Grant and Housing
Opportunities for Persons with AIDS grant iunds, contingent upon receipt af funding;
6. Authorize the City Man�ger or his designee to extend the contracts and Interdepartmental Le�fers of
Agre�:m�:nt for up ta ane year if an agency or d�partment r�quests an e�ct�nsion and such �xtension is
necessary for compleiion of the program, ar to amend the contracts an� Interdepartrnental Letters of
Agreement if necessary to achieve program goals prauided any amendment is within the scape of the
program and in compliance with City policies and all applicable laws and regulations governing the use
af federal gra�t funds;
M&C Raview
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iN&C Review
8. Authorize a waiver of indirect cost rates as applicable for the Grants Fund, in accordance wif� the
City's Administrati�e Regulations; and
9. Adopt ihe aftached apprapriation ord�nance �ncreasing the estimated recei�fs and appropriations ta
the Grants Fund in the tafa[ amount af $9,827,252.00 consis#ing of $6,193,95p.OD in Community
De�elopment Bfock Grant funds, $2,143,383.00 in HOME Investment Partnerships Program funds,
$493,901.00 in �mergency Solutions Grant funds and $996,01$.00 in Housing Opportunit�es for
P�rsons vvith AI�S grant funds, plus any program incom�, all subject to rec�ipt of such funds.
DISC�JSSION:
The City's Annual Action Plan summariz�s the major housing and community clevelo�ment aetivities
anci proposed expenditures far use af federal grant funds totaling $9,827,252.00 from the United Staies
Department of Housing and Ur�an Devefopment (HUD) for Community Development Block Grant
(CDBGj, HOME Investm�nt Partnerships Pragram (HOME}, Emergency Solutions G�ant {ESG) and
Housing Opportunities for Peopfe with AIDS {HOPWA) gra�t programs far the program year beginning
Octaber 1, 2014 and ending September 30, 2Q15. This year's Action P[an also summariz�s the us� af
program income resulting fram activities using priflr years' CDBG and HOME funds. The purpose of
tf�ese grant funds is fo primarily benefit low and moderate �ncame City residenis, with �SG funds
primarily benefiting homeless persons and HOPVIIA funds primarily benefiting persons with HIVIAIDS.
Siaff de�e[oped recommendations for tF�e allocation of the estimated furtd`[rtg fram HUD and presented
them to the Community De�elopment Cauncil (CDC) on May 21, 2Q�4 and to t�� City Couneil at th�
Pre-Council meeting on June 10, 2014. Notice o�' a 30-day public comment periad from July 2, 2014 to
July 31, 20'[4 was published in the Fort Worth Star-Telearam an June 28, 2014. Any comments
r�ce�ved will b� maintained by the Housing and Ecanomic Development Department, in accordance
with federal regulatior�s. The City will hold two public hearings as part of the HUD-rec�uired citizen
participation process, the first on July 22, 2014 and the second an August �, 2014 at which time the City
Council is scheduled to appro�e the Actian Plan. In addition, public hearings were held on June 24,
2014 af � 0:00 a.m. ar�d 6:00 p.m, for citizens fa provide comment ar� the proposed lisY of neighborhQod
streets eligible for reconstructian using CDBG funds.
A summary of the CDC's funding recammendafions is pravided below in Tables '[, 2 and 3 and a
spr�adsheef of a[[ specific funding recommendatians is attached. The Acfiion Plan must be s�bmitted �o
HUD �y A�gust 'i5, 201�4.
F'or Pragram Year 2014-2d�5, it is recomm�nded t�at the �mount of $6,193,950.00 in CDBG funds
and the estimated arriount of $50,000.00 af CDBG prograrri income be allacated as follows:
Puh{�c Ser�ices � $929,092.50
This item includes social services for low to moderate incQme, disabled and disad�antage popufations.
bausing Programs a�d Services - $2,150,600.00
This item includes funding for the City's Priarity Repair Program, Cowtown Brush�Up, homebuyer and
housing services and accessibility modifications to the hames ofi senior andlar disabied individuals and
re[ated project defivery costs for these �rograms.
CDBG Match Funds � $50a,004.00
This item includes match funds for the Lead Grant program.
lnfrastrucfiure Services - $638,'126.80
This item includes funding for reconstructian of neigh6orhaod streets.
C��G �conomic De�elaprr�ent o $737,3�40,70
This iiem is the City's annual p�ymant on its Section 108 loan from HUD_
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CDBG Estiimated Program Incame o$�0,000.04
The CDC recammended allocating any CDBG program income for the r�construciion of n�igh�orhaod
streefs.
CD�G Genera[ Administration � $'[,238,790,00
This item includes costs for administering the CD�G gran# incfudmg allocations for Financial
Management Services, �niernal Audit and Transportation and Public Works Departments.
For Program Year 2014�2015, it is recommended fihat the amount of $2,143,383.00 in HOME funds
and the estimated amount of $104,OOQ.00 of HOME program income be allocat�d as follows:
Homebuyer �ssistance Program p $1,Q97,4U5,70
This items includes funding for down paym�nt andlor closing cost assistance to low and moderate
income hame�uyers.
Community O�velopment Housing Organizations (CHDO) 5et Aside �$321,507.40
HUD requires that a minimum of 15 percent of H�ME funds be allocated to CHDOs for affordable
housing projects and CHDO adrninistrati�� operating casis. T�ese funds wiI1 be used to com�[ete the
Hiliside Morningside NeigF�borhood Single Family [nfill DeveCopment which wilf result in the construction
of up to 97 single family houses by the Tarrant County Housing Partnership CHDO.
�Ilultifamily �levelapment a $�1D,'131.60
Funding wifl be used fior the Calumbia at Renaissance Square, an approximately 140-unit mixed
income develapment, with 28 rnarket rate �nits, Th� r�st of th� units will pra�id� quality afFordable
housing to �'ort Worth �amilies wi�h incflmes at or below 80 percent of Area Median [ncame. The
dev�lopment will �e locaied at 380'[ W.G. Daniels Drive in Council Dis�rict 8.
H(3ME General Administration o $2'14,338.30
This it�m includ�s costs for administering the HOME grant.
HOME Estimated Program Income � $10A,OOO.UO
The prograrn incame wil! be used in the Ciiy`s Homeb�yer Assistance Program.
For Program Year 2(}14-2Q15, it is recommended that the amaunt of $996,01$.QO in HOPWA funds f�e
allocated as follaws:
A6on-Profit 5er�ice Pra�►iders p $966,137.46
WDPWA Program Administratian - $29,88U.a4
For Program Year 20'f4-20�5, i# is recommended fhat the amaunt of $493,901.00 in ESG funds be
alloca�ed as follows:
RlonaProfit Service Providers d $4�6,$�8,�4�
ESG Program Administration a $37,042.58
The CDC and StafF recommend that contracts �e executed with the agencies listed below in the
amounts shown in the follawing tables:
Cornmunitv Devalonment Block Grant:
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Table 4 � CD�G Agencies
f G� �a� �iGdi�on
�Women's Center of Tarrant County
Senior Citizens o� Greater Tarrant
County
YMCA af Metrapafitan Far� Wor�h
YWCA of Far� Wo�th and Tarrant
Cou nty
�Childcare Associates
�Girls Inc. of Tarrant County
�Camp Fire
�Lena Pope Home
L,adder Alliance
ITarrant County Housing Partnership
��r�rogram
�Senior Services
`�Senior Services
�
Ghild Care Services
Child D�velopment
j�Child Care Ser�vices
��Youth Services
�Youth Servic�s
�YoutY� Services
� Em�loymentlJob Training
IHousing Counseling &
Education
�Presbyterian Night 5helter Case ManagementlMain
Shelter
�Meals on Wheels of Tarrant County {�Home-deli�ered Meals
�Program
�CD�C �ublic Senrice Sub�otal ��
�*REACH Resourc� Center on Ne�d-Projecf Ramps
Independent Li�ing
�Yofial C��G Confiracfis ��
*REACH wi�l be funded from the CDBG Housing Programs bud�et.
Program
Housina Onnvrtuniti�s For Persans VIlith AI�S:
Yable 2 e HOI�WA �►gencies
�rganization I
�
Tarrant
Caunty
Samaritan
Housing, Inc.
AfDS
Outreach
Center, Inc.
T07AL
HOPWA
Contracts
���►mounY �
��$ 75,000,00 �
II$ 93, 092.50 �
�
��$ 50,000.00�
� $ S�,OOa.�� �
II� �o,00a.oa�
II� 7�rooa.00�
� $ 75,Op0.Od �
� $ 75,004.00 �
$ 75,QOQ.00�
I�$ 124,oao.oa
�
�I� s�,aoa.00
I�$ 105,000.00`
! �
� $ 9�9,09�.50 �
II$ 75,00(}A(}I
��$'I ,004�,092.�U �
Amount
Administration (seven percent} and Suppartive Services $�4Q9,380.4fi
Adminis#ration {seven percent), Suppartive Services,
Tenant Bas�d Rental Assistanc� (TBRA), and Short
Term Rent Mortgage and Utility Assistance (STRMU)
Emeraenc� Solutions Grant:
Table 3 o ESG Agencies
$556, 757.00
$966,137.46
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� 11'f 8f2014
I
Organization
Saf�Ha�en af Tarrant County
Presbyterian Night 5helter
�ay Resource C�nter for th�
Homeless
The SalWation Army, a Georgia
Corporation
Cathafic Charities of Fort Worth
i�1&C Revlew
Rrogram
Shelter 5ervices
Shelter Services
S�elt�r Se�vices
Amount
$ 55,065.Q0 �
$ 95,544.nn
$19 5,732.00
Homelessness PreventianlRapid Re- `I � 43,136.00
Housing I
Fiamelessness PreventionlRapid Re- �� 17,381.42
Housing
I �'OTAL ESG Contracts 1 $456,858.4�
These prograrns are a�ai[able in ALL COUNCIL �[STRICTS.
FISC�� IN�ORI�ATIONICERYlF1CA�'lON:
The Financial Management Services Director certifies that upon approvaf of the above
recommendations, adoption of the attached appropriation ordinance and receipt of grar�i funds, funds
will be a�ailabfe in the current operating budget, as a�propriated, of the Grants Fund.
TO F�undlAccountlCenters
GR76 45'[72T 017206720XXX
GR76 SXXXXX 017206720XXX
GR76 451727 01720672'fXXX
GR76 SXXXXX
fl172D6721 XXX
GR76 451727 017206723XXX
GR76 SXXXXX 01720fi723XXX
GR7� 4�1727 017206724XXX
GR7'6 5X)OCXX 0�7206724XXX
GR76 476091 017206720XXX
GR76 �XXXXX 017206720XXX
GR76 476076 017206721XXX
GR76 SXXXXX 017206721XXX
$6.193.950.00
$6.193.950.00
$2. � 43.383.00
:�2,143, 383.00
$493.901.00
$493.90'{ .00
$996, 0� 8.00
$996.018.00
$50.004.00
��o. aao.00
��oo,aoo.00
$10D.000.00
Submitted for Citv Nianaaer`s Office bv:
Oriainafiinq Department Head:
Additronal Information Cantact:
FR�IVI �undlAccountlCenters
Fernando Cosfa {6122)
,lay Chapa (58D�)
Cynthia Garcia (8187)
Leticia Rodriguez (7319)
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91118I2014
AiT�AC H 141i Eid iS
17HLiDACTfONPLANPY2014-2015 AO 2014.docx
Action P�an 14 -15.r�df
Pf20POSEQ 2014 CbBG Streets Attachment.odf
M8C Review
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��� �������
����� ��a � j
FII2ST AMENDMENT TO CITY SEGR�TARY CONTRACT NO. 461.62
WHEREAS the City of �'ort Worth {"City") and Aids O�treach �enter, Ina ("Agency"}
made and,entered into Czty Sec�etary Contraci No. �6162 ("Contract");
WHER�AS, the Contxact pxavides funding to Agency pursuant to a grant received by
City from ihe United 5tates Depart.�ent of Housing and Urban Development ("HLJD") through
the Housing Opportunities for Persons with A�DS Program ("HOPWA");
WHEREAS, the Agency provides supportive services including case rnanagement and
housing assistance ta H!OPWA Eligible Clients and has r�quested additianal HOPWA Funds ;
and
WHEREAS, it is the mutual desire of City and Agency ta az�aend th� Contract to add an
additional $75,000.0� of H�PWA Funds far a total Contract amount af $G31.,737.04 of HOPWA
Funds in order to connplete the Program and meet Cantxact objectives.
NOW, TH�REFORE, City and Agency hereby agree to amend the Contract as follows:
I.
Section 4.1 Pravide HOPWA Fnnds is amended to read as follows:
"City shall provide up to �631,7�7.D0 of HOPWA Funds under the texms �nd
conditions herein."
II.
Section 17 INSURANCE AND BONDYNG is ar�aended ta read as follows:
"Agency will maintain couexage in the form of insurance or bond i� the amount of
$631,757.00 to insure against loss from the fraud, th�ft or dishonesty of az�y nf Agency's
officers, agents, trustees, dir�ctars or amployees."
Izz.
�
�
�
m
�
m
c�
�
�
�
��
�
�
�
EXHISTT "A" - PROGRAM SUMMARY and EXHISIT "B" — BUDGET attached to
the Cantract are hereby replaced with the attached EXHIBIT "A" PROGRAM SUNIlI�IA.RY
Revised 04/2U15 and EXHTBIT "S" — BUDGET Revised C141�015.
N.
This amendrnent is effective as of the Effective Date of tl�e Confiract.
Amendrr�ent Na. 1 tn CSC No. �16162
Aids �uixeaeh Center, Inc. (�TOPWA)
� _— - — -
�.��FI�t��. ���t�
! �i'T'�' ��C��i°���'
� �: ��i�`�F'�� '��;
Page 1
1Zev. �/201 S
V>
A11 te�x�as anc�. conditions of the C�nlxact r�ofi am.ended herein remain unaffected and in
fu11 force and effect, are binding on the Parties and are hereby rati�ed by the Parties. Capitalized
terrns not defined herein shall have the meanings assigned tn them in tha Contract.
[SIGNATURES APPEAR DN FOLLOWTNG PAGE�
Amendrnent No. 1 to CSC No. 46162 Page 2
.P.ids Outreach Center, Inc. (HOPWA} , Rev. 4/20I5
AGCEPTED ANI} AGREE�3e
Aids Ou�reacl� Center, Inc.
B�'� — --, _ - �,�,o,
Shannon HiIgart
Title: Executive �irector
ATTEST:
r
�
iI /•
I �
City Se y ;
M&C: C�26893
M&C: C-272�8
�
,
CiTY OF FORT WORTH
B�: �,!� (.�/�
Fernando Costa, Assistant City Manage�
APPROVED AS TO FORM AND
LEGALITY: a
,
� � � �C.�.
� � � �� . _ � �
Assistant City Attorney
�- � - -- -----�..�_
� O��I�IA� ������i
�,�T]P S�CR�`����'
f� �'�TFf, T�'
L�
AmendmentNa. 1 to CSGNo.46162
Aids Outreach Center, Inc. (HOPWA)
Page 3
Itev. 4I2D 15
AIDS �UTREACH CENTER, INCo
Suppartive S�z�vices, STRIVIU, and TBRA
PROGRAM 5UMIVIARY
Housing Oppartunifies for Persons with AIDS
(HOPWA)
October l.9 2014 to Sept�mber 30, 2015
PERIOD
E�H1D1'I' 6GA99
REVZSED 0412015
�631,73'�.OQ
AMOUNT
Re�vised �4/2015
Capitalized ierms nat deiined herein shall �ave meanings assigned to the�rn in the Contracto
PR�GR.A�.M:
The Pxogra.m provides each HOPWA Eligible Client vv�th one ox more af �ze fo��owing:
1} supportive sezvzces
2) tenant based rental assistance ("TBRA"); OR,
3) shoi�t-term rental, martgage, or utility assistance {"�"I'R1VIC1"),
Supportive Services includes housing counseling and case management,
TSRA zncludes Iong-t�rrn rnonthly rental assistar�ce. Clie�.ts must be income elxgible according
to IIUD guidelines9 live in a z'ental unit tha� passes inspecrions9 and have an identified housing
need as determined by the client's Agency case mazxager.
STRMU includes short ierm assisiance fo� up to �1 weeks. STR1ViU pro�ides assistance vvith
u�Iifzes, rent, or �n�rfgage payments and must �ot exceed a client's cuarrent manthly bud�et
deficit caused by �an unavoidable, unplanned, docu�me�.ted emergency consistent with HUD
guidelines and as defined by Agency's local policy. Clients receiving ather gov�rnment�fiiza,ded
housing assistance a�e not eligible.
Program services will be accessible at �00 N. Beach Street Suite IOd, Fort Warth, TX 76111,
Monday thru Thu�rs�.ay 8:30 a.m. to 5:00 p.m. and F`riday 830 a.m. �0 4:40 p.m..
A.gency ma.y u.se HOPWA Funds to ser�r� eligible clients zn Tanrant, �ohnson, Parker, Wise,
Hood and Somervell counties.
HOPWA Fv�ds will pay for TBRA and STRMLJ, HOPWA Funds will also be used ta pay co�ts
associated with deliv�ring supportive services to any client zeceiving ei�ier TBRA or STRMU
assistance9 incIuding salaries, frir�ge b�nefts, and FICA �or employees, supplies, insu�°anc�, and
Program facility and utility casts. No rnore ihan 7% of the HOPWA Funds wil� b� used �o pay
a.dministra�ive costs, including salaries, insuranca, taxes, and legal and accounting fees
associated wrtk� the Pxogram.
Arnenc�nent No. I to CSC No. 46I62 Page 4
Aids Outreach Center, Inc. (HOPWA) Rev. 4l201S
The Program will be provided consisfent wiih HUD guidance �or use o�HOPWA Funds.
REGULA'TORY CLASSIFIC�TION:
IDIS ma�riY Code(s) and Service Cat�gory: 31D HOPWA P�'o�ect Sponsor Aclministz'ation 31C
HOPWA Project Spansor �ctivity
Regulat�ry Citation(s): 24 CFR 574.3D0(b){10} — Admuustrative Expenses
24 CFR 574.3D0(b){7) — Supportive Services
24 CFR 574.300(b){6) -- STRMT_T
24 CFR 574.300(b){S) 4 TBRA
Based on ihe nature of the service provided, Agency will mainiain documentatian that verifies
�at � DO% of cli��ts s�rved by ih� Prvgram are eligibl� under HOPWA Regu.Iations.
I�:Z�Tl�7�1 [l�i7l�.�
Provide Program serviees to approximately I�S Und.uplicated Clients
Provide TBRA sezvices to approximately 7l. Uz�duplicated Clien�s
Prov�ide �TRMCJ services to approximately 14'% Unduplicated Cli�ents
Am�ndmentNo. I to CSC No. 461b2 Pa�e 5
Aids Out�each Center, Inc. (HOPWr�) Rev. 4/2015
EXHIEIT "B" -- BUDGET REVTSED 04/�Q1S
c �c��������r F;I)
,LC�{�(1ti�'I
�i��wG�����r���n�rtva� �a�;���rrrv��.�..
Salaries (Accountant and Dir Admin 5vcs Qnlq)* � 1001
Senefits (FICA, Life Tnsura�ice, Health Insurance, De�ta!
Insur$ace, Visian Insurance, ]]isabil'eiy Inswanee,
Unemployment-5tate, Retirement)* lOD2
{ 'COTAL ADMINiSTRATIVE EXPENS�ES
IPROCHAhI F'ERSf1�l�N�
Salaries (Du Case Mgmt., Case Mgr, AEU, Cas�: \�gr,
Case Mgr, Case Mgr, Receptionist Only)* 20Q1
Benefits (FICA, Life Tnsurance, Heaith Insnrance, Dental
Insurance, Vision Insurance, Disability Insur�nce,
Unemploymant-State, Retirement)* 20D2
i4TI5Cl�1.L•1N C��1 ll4
['ragam Uffica Supp]ies anG Services (Oftice Supplies, �
Dffice Equipment Rental, Postaga, Printing)* 3001
� ConstructionBuiidin� Materials {only REACH} 4U01
Coniract Services anH La6or {Accaunting, Custodial
Services, Security)* (City needs copy of conttact hefnre
expenses can be reimbnrsed) 4002
UtiliGes (Telephanc, Eleefric, Gas, Water and Sewer,
Solid Waste Dispasal)'� SOQI
Program Qecupancy/Facility (Rent (City needs copy of
lease before e.�panses can he reunbursed), Rcpairs,
Mainienance)* snaz
Insurance (, �eneral Commercial Liah'r1iYy, Worker's
Compensation)* 6001
DI�i�:C'T r������T 2�1!( P�
Childcare 5cholarships � � 7001
� ShorE-tenm Rent Assistance 7002
j 5hort-term Mortgage Assistance 7003
� 5hort-term Utilities Assistance 7004
'renant Based Rental Assistance 7p05
�OTAL -- --- •
r�rr��tt����;n
[:��,�� i
Lkl l}€;L7' IN{:621�:,ktiF:
5,736
588
6,324
50,537
7,651
1,U79
Q
3,372
2,368
3,6�6
458
0
28,123
6,021
2b,6$7
�}20,491
i51G.757
Hlsb"ISI�:lM {:��t�IT
n�-:K'r��,��;r, nr�n�r,�r
- -- - 5;736 �
588
6,324
50,537
7.851
I,079
D
3,372
2,3b8
0 p
56,877
8,972
ID,849
20,OOD
.95LHu4 _ R�Mr7i�49
3,6a6
458
_" p__
85,U00
14,993�
15,838
44E1.491
G�1.�57
� '�These �i.n.e items nr�ay have othex eligible expenses of the sa.me iype in each category nat
specifically listed and the Agency may add like expenses ar lilce positions o�fhe same �ype to
these line items only after receiving written authorizatior� to do so fram City.
Aliocation of HOPWA. F�.ds fo�° filae expenses listed above must be appropriately co�t allocated
and charged. The eost allocation made by Agency for each �xp�nse mus� be shown in the
documentatzon supplied to Ci�y with each Reimbursemenf Request.
Amendment Na. 1 to CSC No. 46162 Page b
Aids Oufreach CBnter, Inc_ (HOPWA) Ray. 4/2QI5
Gl�y/ Of �Orf' in/�if°�1� ����S
Illi�y�r ���1 �oa��c�M C��������tdor�
COUNCTL ACTION: Approved on 8/512Q14 - Ordinance No. �1363-08-�014
CONTTNUED FROM A PR�VI�US WEEI�
DATE: Tuesday, July 22, 2014 REFERENCE NO.: C--26893
LOG NAME: I7HiJDACTIONPLANPY2014-2015
SUS IECT:
Conduct Two Public Hearings and Approve the City's Aciion Plan for the Use of Federal Grant Funds in the
Amaunk of $9,827,252.00 from ihe United StaCes Department of Housing and Urban Developa�ent far
Pragrarn Year 2014-2015 from the Community Development Block Grant, HOME Invesiment Partnerships
Frogram, Emergency Solutions Grant and Housing Opportunities for Persons with AIDS Grank Programs,
Authorize Collection �nd Use of Program Income, Authoriza Waiver of Applicatioz� of Indirect Cost Rates,
Authorize Ex�cution of Related Contracts and Interdepartmental Letters of Agreement and Adopt
Appropriation Ordinance (ALL COUNCIL DTSTRICTS)
RECOMMENDATION:
Tt is recammended ti�at the City Council:
1. Conduct two public hearings to allow ciiizen input and conside�•ation of the City's 2014-2015 Aciion Pla�n
for use of federa3 grant funds From the United States Department af Housing and Urban De�elopinent in the
amaunt of $9,827,252.00 for Program Year 2pI4-2015 from the Community Developrr�ent Block Grant,
HOME Investment Partnerships Program, Emergency Solutions Grant and Housing O��artunities for
Per�ons with AIDS grant programs and far the use of program income from activities using prior years'
f�deral grant funds;
2. Approve the City's 2fl14-2015 Action Plan f�z' submission to the United States Departrr�ent af Housing
and i7rban Development including allocations of grant funds to particular pragr�ms and activities as detailed
be�ow;
3. Authoriza the callection and use of an estimated amount Qf $50,OOO.DO of program income resulting fram
activities using prior years' Community DevelopmenC Block Grant funds for the programs and activities
detailed beiow;
4. Autharize the collection and Use of an estimated amount of $].QO,�OO.QQ of program income resulting from
activities using prior years' HOME Ynvestment �'ar�nerships Program funds for the City's Ho�nebuyer
Assistance Program;
S. Authorize Che City Manager or his designee to execute contracts and Interdepartmental Letters of
Agreemeqt for a one year term with the agencies listed below in Tables 1, 2 and 3 for Program Year
2014-2015 for Community De�elopment Block Grant, Emergeney 5olutions Grant and Housing
Opportunities far Persans with AIDS grant funds, eontingent upon receipt af funding;
b. Authorize the City Manager or hzs designee to extend the contracts and Interdep�rtmental Letters of
Agrer�ment for up to ane year if an agency or department requests an extension and such extension is
necessary for completzan of the program, or �o amend the can.tracts and Interdepartmental Letters of
Agreement if necessary to achieve program goals pxavided any amendment is within the scope of the
program and in compiiance with City policies and all applicable Iaws and regulations govez'ning the use of
federai grant funds;
$, Authorize a waiver of indirect cost rates as applicable for ihe Grants Fund, in accordance with the City's
Administrative Regulations; and
9. Adopt the attached appropriation ordinance increasing the estimated receipks and appropriations to the
Grants Fund in the total amount of $9,827,252.00 consisting af $6,193,9SO.Q0 in Community Developmeni
Block Grant funds, $2,143,3$3.00 in HOME Ineest�nent Partnerships Program funds, $493,9Q1.Ofl in
Einergency Solutions Grant funds and $99b,018.00 in Housing �pportunities for Persons with AIDS grant
funds, plus any program income, all subjec[ to receipt of such funds.
I I
The City's AnnuaI Action Pian su�marizes the major housing and comYnunity deveIopment acti�iti�s and
proposed expenditures for use of f�deral gratzt funds totaling $9,827,252.00 from the United States
Department of Housing and Urban Developiaaent (HUD) for Community Development Block Grattt (CDBG),
HOME Investment Partnerships Program (HOME), Ernergency Solutions Grant {ESG) and Housing
Oppartuniti�;s far People with AIDS (HOPWA) grant programs for the progxam year beginning October 1,
2Q14 and ending September 30, 2015. This year's Actian Plan also surnmarizes the use of program income
resulting from activities using prior years' CDBG and HOME £unds. The purpose of these grant funds is to
primarily benefit low and moderate incarne City residents, with ESG funds primarily benefiting homeless
persons and HOPWA funds primaz'ily benefiting p�rsons with HIVIAIDS.
Staff developed recommendations far the alIocation of the es�imated funding from HUD and presented them
to the Cammunity Dev�lopment Counczl {CDC) an May 21, 20I4 and ta the City Council at the �'re—Council
meeting on June 10, 20I4. Natice of a 3Q—day public comment period fro�n ]uly 2, 2014 ta Jt�ly 31, 2014 was
published in tb� Fort Worth Star—Teleg,ram on June 28, 2014. Any comments received will be maintained by
the Housing and Economic Develapment Departmenk, in accordance with federal regulations. The Ciiy wi13
hold two publie hearings as part o� the HUD—required citizen par�icipation pracess, the iirst on July 22, 2014
and the second on August 5, 2014 at wl�ich time the City Council is scheduled to approve ihe Ac�ian Plan, In
addition, public heazings wez'e heId an dune 24, 2fl 14 at 10:00 a.m. and 6:OQ p.m. far citizens to provide
comment on the praposed list of neighborhood streets eligible for reconstructian using CDBG funds,
A summary' af the �DC's funding recommendations is provided below in Tables 1, 2 and 3 and a spseadsheet
of all specific funding recammendations is attached, The Action Plan rnust be submitted to HUD by August
15, 201�1.
For Program Year 2014-2Q15, it is recammencied that the arr�ount Qi $6,193,950.00 in CDBG funds and the
estimated amaunt af $SO,OOOAO of CDBG pragram income be allacated as fpllows;
Public Services — $929,092,50
This item includes sacial services far low to moderate income, disabled and disadvantage populations.
Housirtg Programs and ,Services — $2,150,600.00
This item includes funding for the City's Priority Repair Program, Cowtown Brush—U�, hamebuyer and
housing services and accessibility madificatians to the homes of senior andlo�' disabled individuals and
related project delivery cpsts for these programs.
CDBG Match Funds —$500, aoo. ao
This ikem includes match funds for the Lead Grant progra�n.
Infraslructure Services -- $638,126.80
This item includ�s funding for reconstruction of neighborhaod streets.
CDBG Econornic Developrnent — $737',340.70
This iteFn is the City's annuai payment on its Seetion 108 laan fram HUD.
CDBG Estimated P�og�am Ineome — $50,000.00
The CDC recommended aklocating any CDBG program income for the reeonstruction of nei�hborhQod
skreets.
CDBG GeneraiAdministration — $1,23�,79Q.00
This item includes costs for administering the CDBG grant including allocations far Financial Management
Services, Internal Audit and Transportation and Public Works Departments.
For Prngrann. Year 2014-2015, it is recazmmended that rhe amaunt of $2,143,38�.0� in HOME funds and the
estimated amount of $ip0,000.00 af HOME program incame be allocated as follows:
HomebuyerAssistance Prvgram -- $1,097,4115.70
This items includes funding for down payment and/or closing cost assistance to Iow and mnderate incame
homel�uyers.
Cnmmunity Development Housing Organizations (CHDO) Set Aside —$32I,507.40
Hi1D requires that a minimum af 15 percent of HOME funds be alIocated to CHDOs for affordable housing
projects and CHDO administrative operating costs. These funds wiil be used to cornplete the Hillside
Morningside Neighborhood Single Family Infill Devel�pment whieh will result in tha canstruction of up to
17 single family houses by the Tarrant Caunty Housing Partnership CHDO.
Multifamily Devedopment — .$SIO,131.60
Funding wilI he used for the Columhia at Renaissanc� Square, an approximately 140—unit zir►ixed incame
development, with 28 znarket rate units. The �'est of the units v+�ilI pravide quality affordahle housing to Fort
Worth families with incomes at ar be�ow 80 perc�;nt af Area Median Income, The deaelppment will be
lacated at 3801 W.G. Danieis Drive in Conncil Disti7ci 8.
HOME Generc�l Admittislration — $2I4,33$.30
This item includes costs far administ�ring the HOM� grant.
HOME Estimated Pragram Income — $100,000.00
The program income will be used in the City's Home�uyer Assistance Prograrn.
For Pi°ogram Year 201A-2015, it is recommended that the amount of $996,OI8,OQ in HOPWA fands be
allocated as fallows:
Non—Pro,fit Service Provrders — $966,I37 46
HOPWA Program Adminisiratiora — $29,880.54
For Prngram Year 2p14-2015, it is recommended thak the arrionnt of $493,901.OQ in ESG funds be allacated
as follows;
Nan—Profit Service Praviders — $456,858,42
ESG Program Adyninistration — $37,042.58
The CDC and Staff recommend thak contracts be executed with the agencies listed balow in the amounts
shown in the following tables:
Communitv Develo�ment Blnck Grani:
� Tab1e I— CDBG Ageracies
Organization Progrum Amount
IWomen's Center flf Tarrant County Senior Services $ 75,fl00.00
ISenior Citizens of Greater Tarrant County Senior Ser�iees $ 93,092.50
IYMCA of Met�opolitan Fart Wortb Child Care Services $ 50,000,00
YWCA of �art Worth and Tarrant County Child Davelopment $ 50,000.00
ChiIdcare Associates Child Care Seivices $ 50,040.00
Girls Inc. af Tarrant County Youth Services $ 75,OOQ.QO
�Camp Fire Youth Services � � $ 75,000.00
Pape Home
�r Alliance
Youth Services
Program
Housing Counseling &
County Housing T'artnership Education $ 124,OOO.DO
IPresbyteri�n Night 5helter Case Managemen#IMain Shelter $ 82,OOOAO
Meals on Wheels of Tarrant Caunty Home—delivered Meals $ 1d5,000.00
Program
CDBG Puhlic Service �Subtatai
*REACH Resource Center on Independent
Living Need--Fraject Ramps
I To�al CDBG Contracts
�REACH will be funcled fram the CDBG Hpusing Programs budget,
Housirag Onnortunities For Persons With AIDS:
Table 2 — HOPWA Ager�cies
Orgaraization
Tarrant County
Samaritan Housing,
Inc.
$ 75,OOO.pO
$ 75,000.00
$ 929,092.50
$ 75,000.00
$1,004,09Z,50
Amaunt
Admznistratzan (seven percent) and Supportive Services $409,380.46
AID5 OuCreach Administratian (se�en percent), Support:tve Services,
Center, Ipc. Tenant Based Rental Assistance {TBRA}, and Short Term $556,757.00
Rent Mortgage and Utility Assistance (STRMU)
TOTAL HOPWA
Contracts
Emer�encv Salutions_Grant:_
$966,I37.46
Tal�le 3 — ESG Agencies
� Organi�ation
ISafeHaven af Tarrant County
j Preshyterian Night Shelter �
� Day Resource Center for the Homeless
I The Salvation Army, a Georgia
Corporatian
Catholic Charities of Fort Wort4�
Prograr�a
_ Shelter Services
Shelter Services
Shelter Services
Homeleasness Preventioz�/Rapid
Re—Housing
Homelessness Preven�ionlRapid
R�e—Housing
TOTAL ESG Cont�acts
These pro�rams are available in ALL C4iJNCIL DISTRICTS.
Amount
T � ss,a6s.aa
T $ 95,544.Ofl
$115,732.OQ
$ �3, I36.00
$117,381.42
$456,SSS.42
F��„ S�Ai. INFORMATION:
The Finaneial Management Services Director certifies ti�at upon approval of the above reeammenda�ions,
adoptian of the attached appropriation ardinance and receipt of grant funds, funds will be available in the
current operating budget, as appropriated, of the Grants Fund.
FYTND CENTERS:
TO Fund/AccountlCenters
GR76 451727 0172a6720XXX
GR7C� SXXXXX (}172�6720XXX
C�R76 451727 017206721 XX�
GR76 SX��X 0172fl6721XXX
GR7b 451727 f117206723XX�
GR76 SXX�XX 017206723X�
GR76 451727 Q17206724XXX
GR76 SXXXXX 0172�h724XXX
GR76 47604I 0172b6720XXX
GR76 SXXXXX Q17206720XXX
GR76 476076 0172(1�i72,1 XXX,
��� s�� o�7�,n�7zixxx
�6.193.950.00
$6.193.950.d0
�2143.383.Ofl
$2.143383.00
�4939Q1.00
$4R3_9d1.OQ
�996.018.00
$996.Q18.00,
$50.0{10.00
$50.000.00
�l 00.00Q.Q,Q
�iao.00a.00
FROM Fund/Ac oun Centers
CERTTFICATIONS:
�ubmitted for Citv Mana�er's Office b�v: Fernando Costa (b122)
Ori�jnatin� Denartment H�ead:, Jay Chapa (5804)
Additional InformaEion Contacti Cynthia Garcia ($187}
Leticia Radriguez {7319)
ATTACHMENT�,
I . ,�1'� ]'DACTIONPLANPY2014-201 S AO ?..(11 �. d�
2, Action Plan 14 —1S.ndf
3. �ROPOSFD 2f71q CDBC� Streets Attachment.ndf
�1�'�/ �f �Oi�° ��1�t�1� ��'X��
�l�yor ��d Coun�dd ������nc�����
COUNCIL ACTION: Approved on 4lil�al�
DATE; Tuesday, Apri107, 2Q15 R�FERENC� NO.: **C-27248
LOG NAME: I7NS AID5 OUTREACH CENTER ADDTTIONAL �LINDING
�LTB lECT;
Authorize Change in Use and Expenditure of Additional Housing Opportunities for Persons with AIDS Grant
Funds in the Amounk of $75,000.00 to ATDS Outreach Center, Inc., for a Total Contract Amount of
$631,757.00 and Authorize Execution of a Contract Amendment to City Secretary Coqtract No. 46162 (ALL
COUNCIL DISTRICTS)
RECOMMENDATInN:
It is recommended that the City Council:
1. Authorize a change in use and expenditure of additional unprogrammed Housing Oppartunities for Persons
with AIDS grant funds in the arnount of $7S,O�O.DO to ATDS Outreach Center, Inc.; and
2. Autk�orize the City Manager or hzs designee tn execute a contract amendment to City Secretary Contract
Na, 45162 witla AIDS Outreach Center, Inc„ to increase the contract amount by $75,000.00 for a total
contract amount of $631,757.00.
DISCUSSION:
On August S, 2014, the City Council approved tne City's 2014-2015 Actian Plan, including the exeeution of
a contract wiCh AIDS Outreach Center, Tnc. (AOC}, for Housing Opportunides for Persons with AIDS
(HOPWA) grant funds fxotn the Un'rted States Department of Housing and LTrban Development (HUD} in the
amount of $SSb,757.OQ {M&C C-26893, City Secretary Cantract No, 46I62). AOC utilizes the HOPWA
funds for Tenant—Based Rental Assistance (TBRA) and Short Term RenC, Mortgage and UizIity Assistance
{STRMU) to HOl'WA—elig�ble clients.
AOC has requested additional HOPWA funds in arder tti ensure continued levels oi service to eligibl� clients
and to assist the City in meeting its Consolidated Plan goals. Tbe Action Plan included the authari#y tQ
amend the various contz'acts, if necessary to achieve program gaals provided any amendment is witnin the
scope af the pragram and in compIiancc with City policies and aII applicable regulations regarding the wse of
�'ederal grant funds, Staff recommends an amendment to City Secretary Contract No. 46162, the current
HOPWA contract with AOC, to increase the contract amaunt by $75,OOfl.04 in unprogrammed HOPWA
funds for a total contact arnount of $631,757.00. The $75,000.00 of additional funding may be divided
between TBRA and STRMU services as determined by the needs of the agency in consultation with Staff.
Staff recanvmends the change in use and expenditure of $7S,D00.00 of additional unprogrammed HOPWA
funds to AOC. Actian Plan funding years may �ary and be substituted based on ihe Principle of First In, First
Out in arder to expend olciest grant €unds first. �'edez-al regulations do nat require a public comment period
for this chan�e in use of HOPWA funds.
Ser�ices by AOC are available in ALL COUNCIL DTSTRICTS.
FISCAL YNFORMATI(�N:
The Fiscal Year 2015 bUdget included appropr'rations in the amount pf $7S,Q0(?.00 in the Grants Fund for
Housing Oppartunities for Persons with AIDS programs. As of March 9, 2015, the appropriations have not
heen expended. Upon approval af these recommenda�ions, the Financial Management 5eroices Director
cer�ifies that funds are available within the existing appropriations and can be reallocated to City Secz'etary
Contract No. 4b162 with AIDS Outreach Center, Inc,
Fi1ND CENTER�:
TO Fund/AccountlCenters FROM Fus�cVAccount/Ce�te� �
1&21 C'�R76 �3912� 017200724D30 �SO.QOO.Od 11 GR76 539120 OI72�6'i2499Q �75.00O.QO
1&2) GR76 534120 01720572405D $25.000.00
CERTIFICATIONS:
Submi�ted for Citv Mana�er's Office by: Fernando Costa (6122)
Ori�inating Denartment Head: Cynthia Garcia (8187)
Additional Information Contact: Alice Cruz (7322}
� V�' _i_-�
1, available funds.PDF