HomeMy WebLinkAboutContract 60316CSC No. 60316
STATE OF TEXAS §
COUNTY OF TARRANT §
This contract ("Contract") is made and entered into by and between the City of Fort
Worth (hereafter "City") and Tarrant Area Food Bank (hereafter "Agency"), a Texas non-
profit corporation. City and Agency may be referred to individually as a "Party" and jointly
as "the Parties".
The Parties state as follows:
WHEREAS, City receives grant monies from the United States Department of
Housing and Urban Development (HUD) through the Community Development Block
Grant ("CDBG") Program, Program No. B-20-MW-48-0010, Catalog of Federal Domestic
Assistance No. 14.218;
WHEREAS, City has received an additional allocation of CDBG grant monies
under the Coronavirus Aid, Relief, and Economic Security Act ("CARES" Act), referenced
by HUD as "CDBG-CV 3";
WHEREAS, the CDBG regulations and related HUD guidance publications
establish all requirements for the CDBG-CV 3 funds except for those specifically described
in this Contract as deriving from the CARES Act;
WHEREAS, a national objective of the CDBG program is to benefit low and moderate
income citizens in accordance with 24 CFR Part 570, as amended from time to time;
WHEREAS, additional CDBG funding has recently become available through
unprogrammed funding that was previously allocated to organizations with unexpended
balances and reallocated administrative funds totaling $800,000.00 and City Council
recommended that these funds be awarded directly to agencies providing services in three
priority categories: elderly services, employment related services, and food insecurity
(Mayor and Council Communication 23-0594);
WHEREAS, Agency is one of the selected organizations to receive additional
funding and Agency has decided to utilize these funds to run a grocery delivery program
known as the Boost Delivery Program;
WHEREAS, the funding will be utilized to pay for 2 FTE salaries and fringe
benefits to enroll participants into the program which addresses food deserts in the city of
Fort Worth by providing mobile food delivery to low -to -moderate income populations
within the City;
WHEREAS, City citizens, the Community Development Council, and the City
Council have determined that CDBG programs are needed by the City's citizens.
CDBG-CV 3 PSA CONTRACT 22-23 OFFICIAL RECORD Page 1
Tarrant Area Food Bank- Boost Delivery CITY SECRETARY
Rev. 10/ 10/2023
FT. WORTH, TX
NOW, THEREFORE, the Parties understand and agree as follows:
1. INCORPORATION OF RECITALS.
City and Agency hereby agree that the recitals set forth above are true and correct
and form the basis upon which the Parties have entered into this Contract.
2. DEFINITIONS.
In addition to terms defined in the body of this Contract, the terms set forth below
shall have the definitions ascribed to them as follows:
Area Median Income or AMI means the median family income for the Fort Worth -
Arlington metropolitan statistical area as established annually by HUD. The 2023 income
limits are attached hereto as EXHIBIT "A-1" — 2023 HUD Income Limits.
Business Diversity Enterprise Ordinance or BDE means the City's Business Diversity
Ordinance, Ordinance No. 20020-12-2011.
CDBG means Community Development Block Grant.
Complete Documentation means the following documentation as applicable:
• Attachments I, II, and III, with supporting documentation including:
o Proof of expense: copies of timesheets, invoices, leases, service
contracts or other documentation showing that payment is due by
Agency.
o Proof of payment: cancelled checks, bank statements, or wire
transfers necessary to demonstrate that amounts due by Agency were
actually paid by Agency.
o Proof of client eligibility: (i) Source documentation of household
income, or (ii) only if source documentation is not available,
verifiable self -certification of income such as the City's Certification
Income Statement attached as EXHIBIT "E" — Form of Income
Self -Certification or a similar form approved by City, and
documentation of client need directly related to and/or caused by the
Coronavirus Pandemic; and other eligibility documentation further
described in Exhibit "A" — Program Summary.
Complete Documentation shall meet the standards described in the
attached EXHIBIT "F" - Standards for Complete Documentation.
• Any other document or record reasonably necessary to verify costs spent
and client eligibility for the Program.
CDBG-CV 3 PSA CONTRACT 22-23 Page 2
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CDBG-CV 3 Funds means the CDBG-CV 3 grant funds supplied by City to Agency
under the terms of this Contract.
CDBG Regulations means regulations found at 24 CFR Part 570 et seq.
Countywide Agencies means agencies with 10% or more of clients that reside outside of
the boundaries of the City. All other agencies are considered Fort Worth agencies.
DBE means disadvantaged business enterprise in accordance with 49 CFR Part 26.
Director means the Director of the Neighborhood Services Department.
Effective Date means June 27, 2023.
HUD means the United States Department of Housing and Urban Development.
IDIS means Integrated Disbursement Information System, HUD's project tracking
system.
Income Eligible Client means a client whose annual income adjusted for family size does
not exceed 80% of AMI using the most current HUD Income Guidelines and Technical
Guidance for Determining Income and Allowances. The definition of annual income to
determine client income eligibility shall be the definition contained in 24 CFR Part 5.609,
as amended from time to time.
National Objective means an activity that benefits low and moderate income persons. For
the purposes of this Contract, at least 51% of the clients served by the Program must be
Income Eligible Clients.
Neighborhood Services Department means the City's Neighborhood Services
Department.
OMB means the Office of Management and Budget.
Program means the services described in EXHIBIT "A" — Program Summary.
Reimbursement Request means all reports and other documentation described in
Section 9.
Source Documentation means documentation of full household income of any type
described under the definition of annual income in 24 CFR Part 5.609, including but not
limited to copies of paychecks, Social Security and disability verification letters, interest
or rental income statements, retirement income statements, child support and alimony
verification, unemployment benefit letters, and the like.
Unduplicated Clients means a count of all clients served by the Program at least once in
the Contract Term. Clients served by the Program more than once in the Contract Term
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Rev. 10/ 10/2023
will only be counted the first time they are served when determining the total count of
Unduplicated Clients.
3. TERM.
The term of this Contract begins on the Effective Date and terminates eighteen (18)
months following the date of Contract execution December 2024 unless earlier terminated
as provided in this Contract.
4. DUTIES AND RESPONSIBILITIES OF CITY.
4.1 Provide CDBG-CV 3 Funds.
City shall provide up to $60,000.00 of CDBG-CV 3 Funds under the terms and
conditions of this Contract.
4.2 Monitor.
City will monitor the activities and performance of Agency and any of its
contractors, subcontractors or vendors as necessary, but no less than annually. Monitoring
by City will include determining whether Agency is meeting the National Objective
during the term of this Contract.
5. DUTIES AND RESPONSIBILITIES OF AGENCY.
5.1 Required Services.
Agency shall perform the services described in EXHIBIT "A" — Program
Summary in accordance with the terms and conditions of this Contract.
5.2 Use of CDBG-CV 3 Funds.
5.2.1. Compliance with CDBG Regulations and Contract.
Agency shall be reimbursed for eligible Program costs with CDBG-CV 3 Funds
only if City determines in its sole discretion that:
5.2.1.1 Costs are eligible expenditures in accordance with CDBG
Regulations.
5.2.1.2 Costs are in compliance with this Contract and are reasonable
and consistent with industry norms.
5.2.1.3 Complete Documentation, as applicable, is submitted to City by
Agency.
5.2.2 Budget.
5.2.2.1 The CDBG-CV 3 Funds will be paid on a reimbursement basis
in accordance with EXHIBIT `B" - Budget.
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5.2.2.2 During the term of this Contract, Agency may submit written
requests to increase or decrease line -item amounts in the
Budget, including an explanation of why such increases or
decreases are necessary. All requests shall be approved by
Director or Director's designee in writing, with such approval
being in the City's sole discretion. If the Agency's proposed
Budget amendment is approved (as approved, the "Amended
Budget"), then the Amended Budget shall be memorialized in
a written amendment to this Contract. The Amended Budget will
take effect on the first day of the month following the month in
which the Contract amendment is executed, unless otherwise
specified in the amendment. All requests for Budget
amendments must be submitted no later than 90 days prior to the
date of the end of the term of this Contract.
5.2.3 Change in Program Budget.
5.2.3.1 Agency will notify City promptly of any additional funds it
receives for operation of the Program, and City reserves the right
to amend this Contract in such instances to ensure compliance
with HUD regulations governing cost allocation.
5.2.3.2 Agency agrees to utilize the CDBG Funds to supplement rather
than supplant funds otherwise available for the Program.
5.2.4 Pavment of CDBG-CV 3 Funds to Agencv.
CDBG-CV 3 Funds will be disbursed to Agency upon City's approval of
Reimbursement Requests including submission of Complete Documentation to City in
compliance with Section 9. If Agency expends all funds budgeted for the Program prior
to completion of 90% of performance goals, City may hold back a small amount of the
CDBG-CV 3 Funds until the end of the term to ensure completion of all performance goals.
During this interim period, Agency must continue to submit Attachment III — Client Data
Report in EXHIBIT "D" — Reimbursement Forms monthly. It is expressly agreed by
the Parties that any CDBG Funds not spent or approved for reimbursement to Agency shall
remain with City.
5.3 Program Performance Milestones.
5.3.1 Agency represents that the Program will achieve the following milestones
in accordance with EXHIBIT "A" — Program Summary and the table below:
nduplicated Clients as
Up
ecified in EXHIBIT
"A" — Program
onth Ex n itures Sum r
3 16% 16%
CDBG-CV 3 PSA CONTRACT 22-23 Page 5
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6
32%
32%
9
48%
48%
12
64%
64%
15
80%
80%
18
100%
100%
5.3.2 Failure of Agency to meet these milestones or a material deviation from
them as outlined in this Section 5.3 is a breach of this Contract. For the purpose of this
Section, "material deviation" shall mean more than 10% lower than the specified goal.
In the event of such breach, City reserves the right in its sole option to (i) delay or withhold
payment of Reimbursement Requests, (ii) lower Agency's allocation of CDBG-CV 3
Funds, or (iii) terminate this Contract.
5.3.3 Failure to meet at least 80% of its performance milestones or serve 2,160
Unduplicated Clients under this Contract may, in City's sole discretion, disqualify Agency
for consideration under future City Requests for Proposals for federal grant funds.
5.3.4 Amendments to performance milestones regarding CDBG-CV 3 Funds
must be approved by the Director in writing, with such approval being in the Director's
sole discretion. If Director approves the Agency's proposed amended performance
milestones (as approved, the "Amended Performance Milestones"), then the Amended
Performance Milestones shall be memorialized in a written amendment to this Contract.
The Amended Performance Milestones will take effect on the first day of the month
following the month in which the Contract Amendment is executed unless otherwise
specified in the amendment. All requests for amendments to performance milestones must
be submitted by six months prior to the date of the end of the term of this Contract.
Notwithstanding the above, any amendments to this Contract shall not reduce the number
of Unduplicated Clients stated in Section 5.3.3 and in EXHIBIT "A" - Program
Summary.
5.4 Identifv Program Expenses Paid with CDBG-CV 3 Funds.
Agency will keep accounts and records in such a manner that City may readily
identify and account for Program expenses reimbursed with CDBG-CV 3 Funds. These
records shall be made available to City for audit purposes and shall be retained as required
hereunder.
5.5 Meet National Obiective.
Agency shall ensure that the activities carried out in the Program will meet the
National Objective.
5.6 Program Subcontracts.
Agency shall not enter into a subcontract with another agency, contractor, or vendor
to provide a service to clients for any part of the Program that will be paid with CDBG-CV
3 Funds without City's written consent.
CLIENT ELIGIBILITY VERIFICATION.
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6.1 Client Eligibility.
Agency will document client eligibility as follows:
6.1.1 Monthly Revort Form: CDBG Eligibility.
Agency must verify all new clients' income with either a verifiable self -certification
of income such as the City's Certification of Income Statement attached as EXHIBIT "E"
— Form of Income Self -Certification or a similar form approved by City, or Source
Documentation. Agency must use the annual income definition in 24 CFR Part 5.609 to
establish client income and must use the most current HUD Income Guidelines. The
income of all Program clients must be documented and at least 51 % of them must be
Income Eligible Clients.
6.1.1.1 If Agency serves both Fort Worth and non -Fort Worth clients,
the proportion of Program costs allocated to the CDBG-funded
portion of the Program Budget must be consistent with the
proportion of Fort Worth clients to all clients.
6.1.1.2 All Program clients must be reported on EXHIBIT "D" —
Reimbursement Forms, Attachment III. All Program clients
whose income has not been verified will be deemed to not be
Income Eligible Clients and shall not be included in the 51%.
6.1.2 Verification of Program Eligibility.
6.1.2.1 At the end of each quarter during the Contract term, Agency
shall verify CDBG Program Eligibility by confirming that at
least 5 1 % of clients served by the Program to date are Income
Eligible Clients as reported on Attachment III.
6.1.2.2 If Agency fails to verify Program eligibility on a quarterly basis
in compliance with this Section, Agency will have 30 calendar
days or until the next monthly invoice to cure.
6.1.2.3 City will notify Agency by e-mail within 14 calendar days if the
Program performance milestones were not met within the
requirements outlined in this Section 6.1.2.2. Agency will have
an additional 7 calendar days from the date of the e-mail notice
to meet these requirements.
6.1.2.4 In the event the Agency fails to meet the Program performance
milestones, City reserves the right in its sole option to delay or
withhold payment of Reimbursement Requests, to lower
Agency's allocation of CDBG Funds, or to terminate this
Contract.
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6.2 Monthly Performance Goals.
On average agency will provide 120 households per month with food and will also
obtain applications for TANF and similar food programs for 60 households per month.
6.3 Maintain Documentation.
Agency must maintain copies of all documentation required by this Section 6 for 5
years following the expiration of the Contract term. This Section shall survive the earlier
termination or expiration of this Contract.
7. ADDITIONAL CDBG REQUIREMENTS.
Agency agrees to comply with all requirements of the CDBG Program as stated in
the CDBG Regulations, as well as any further requirements established by HUD regarding
CDBG funds upon receiving notification of such additional requirements from City,
including but not limited to the following:
7.1 Environmental Review.
CDBG-CV 3 Funds will not be paid, and costs cannot be incurred until City has
conducted an environmental review and completed an Environmental Review Record as
required by 24 CFR Part 58. The environmental review may result in a decision to proceed
with, modify, or cancel the funding for the Program. Further, Agency will not undertake
or commit any funds to physical or choice limiting actions as described in any applicable
federal regulations. Any violation of this provision will (i) cause this Contract to terminate
immediately, and (ii) require Agency to repay City the CDBG-CV 3 Funds it has already
received and forfeit any future payments of CDBG-CV 3 Funds.
7.2 Contract Not Constituting Commitment of Funds.
Notwithstanding any provision of this Contract, the Parties agree and acknowledge
that this Contract does not constitute a commitment of funds, and that such commitment of
funds or approval may occur only upon (i) satisfactory completion of an environmental
review, (ii) approval of any applicable Substantial Amendments to the 2019-2020 Action
Plan regarding CARES Act grant funds, and (iii) receipt by City of a grant agreement from
HUD.
7.3 Monitoring.
7.3.1 Agency understands and agrees that it will be subject to monitoring by City for
compliance with terms and provisions of this Contract and the CDBG Regulations for the
term of this Contract. Agency is subject to such monitoring during the term of this
Contract and for 5 years after the Contract term ends. Agency will provide reports and
access to Program files as requested by City during this 5-year period. For purposes of
this Contract, this 5-year period for monitoring is deemed to begin on the date after the
final date of the full contract term including any extensions in term, and end on the date
five full years after that date.
CDBG-CV 3 PSA CONTRACT 22-23 Page 8
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7.3.2 Representatives of City, HUD, HUD Office of Inspector General,
and the United States Comptroller General shall have access during regular business hours,
upon 48 hours prior notice, to Agency's offices and records pertaining to the use of the
CDBG-CV 3 Funds, and to Agency's officers, directors, agents, employees, contractors,
subcontractors and vendors for the purpose of such monitoring.
7.3.3 In addition to other provisions of this Contract regarding frequency of
monitoring, City reserves the right to perform desk reviews or on -site monitoring of
Agency's compliance with the terms and conditions of this Contract. City shall provide
Agency with a written report of the monitor's findings after each monitoring visit. If the
monitoring report notes deficiencies in Agency's performance, the report shall include
requirements for the timely correction of said deficiencies by Agency. Failure by Agency
to take the action specified in the monitoring report may be cause for suspension or
termination of this Contract as provided herein.
7.3.4 Subsections 7.3.1 through 7.3.3 shall be applicable for the Contract Term
and for 5 years thereafter and shall survive the earlier termination or expiration of this
Contract.
7.3.5 Agency shall provide City annually the results of any state or federal
monitoring. Such results shall be submitted within 60 days of receipt of such state or
federal monitoring report during the term of this Contract.
7.4 ALencv Procurement Standards.
Agency shall comply with all applicable federal, state and local laws, regulations,
and ordinances for making procurements under this Contract. In addition to the conflict of
interest provisions in Section 14.13.3, Agency shall establish written procurement
procedures to ensure that materials and services are obtained in a cost effective manner and
that provides for full and open competition. When procuring materials and services for
this Contract, Agency shall comply at a minimum with the procurement standards in 2 CFR
Part 200.317 through Part 200.326.
7.4.1 Contracts in excess of $10,000.00 made by Agency using CDBG-CV 3
Funds must address termination for cause and convenience including the manner by which
such termination shall be affected and the basis for settlement of the terminated contract,
if any, as required by Appendix II (B), 2 CFR Part 200.
7.4.2 Agency shall not make any contract with parties listed on the government
wide System for Award Management, www.sam.gov ("SAM"). Agency must confirm
by search of SAM that all contractors paid with CDBG-CV 3 Funds are not listed by SAM
as being debarred, both prior to hiring and prior to submitting a Reimbursement Request
which includes invoices from any such contractor. Failure to submit such proofs of
search shall be an event of default.
7.5 Cost Principles/Cost Reasonableness.
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Agency shall administer its use of CDBG-CV 3 Funds in compliance with 2 CFR
Part 200, as applicable. The eligibility of costs incurred for performance rendered shall be
determined in accordance with 2 CFR Part 200.400 through 2 CFR Part 200.475.
7.6 Financial Management Standards.
Agency agrees to comply with 2 CFR Part 200, as applicable. Agency also
agrees to adhere to the accounting principles and procedures required therein, utilize
adequate internal controls, and maintain necessary supporting and back-up documentation
for all costs incurred in accordance with 2 CFR Part 200.302 and Part 200.303.
7.6.1 Prohibition of Duplication of Benefits
Agency agrees to comply with Section 312 of the Stafford Disaster Relief
and Emergency Assistance Act which prohibits the duplication of benefits or financial
assistance to people or entities affected by a Federally declared emergency. Agency agrees
to establish and maintain adequate procedures to prevent any duplications of benefits with
CDBG-CV 3 funds.
7.7 Uniform Administrative Requirements, Cost Principles, and Audit
Requirements.
Agency will comply with the Uniform Administrative Requirements, Cost
Principles, and Audit Requirements for Federal Awards in 2 CFR Part 200, as applicable,
or any reasonably equivalent procedures and requirements that City may require.
7.8 Terms Applicable to Contractors, Subcontractors and Vendors.
Agency understands and agrees that all terms of this Contract, whether regulatory
or otherwise, shall apply to any and all contractors, subcontractors and vendors of Agency
which are in any way paid with CDBG-CV 3 Funds or who perform any work in connection
with the Program. Agency shall cause all applicable provisions of this Contract to be
included in and made a part of any contract or subcontract executed in the performance of
its obligations hereunder including its obligations regarding the CDBG Regulations.
Agency shall monitor the services and work performed by its contractors, subcontractors
and vendors on a regular basis for compliance with the CDBG Regulations and Contract
provisions. Agency must cure all violations of the CDBG Regulations committed by its
contractors, subcontractors or vendors. City maintains the right to insist on Agency's full
compliance with the terms of this Contract and the CDBG Regulations and Agency is
responsible for such compliance regardless of whether actions taken to fulfill the
requirements of this Contract are taken by Agency or by Agency's contractors,
subcontractors or vendors. Agency acknowledges that the provisions of this Section shall
survive the earlier termination or expiration of this Contract and shall be applicable for 5
years after the Contract term ends.
7.9 Covvright and Patent Rights.
No reports, maps, or other documents produced in whole or in part under this
Contract shall be the subject of an application for copyright by or on behalf of Agency.
HUD and City shall possess all rights to invention or discovery, as well as rights in data,
which may arise as a result of Agency's performance under this Contract.
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7.10 Conflict of Interest Disclosure.
In accordance with the requirements of Section 14.14.2.1 and 14.14.4, Agency shall
establish conflict of interest policies for federal awards. Agency shall disclose to City in
writing any potential conflict of interest.
7.11 Compliance with FFATA and Whistleblower Protections.
Agency shall comply with the requirements of 2 CFR 300(b), including provisions
of the Federal Funding Accountability and Transparency Act ("FFATA") governing
requirements on executive compensation and provisions governing whistleblower
protections contained in 10 U.S.C. 2409,41 U.S.C. 4712, 10 U.S.C. 2324,41 U.S.C. 4304
and 41 U.S.C. 4310.
7.11.1 Agency shall provide City with its DUNS number.
7.12 Internal Controls.
In compliance with the requirements of 2 CFR Part 200.303, Agency shall:
7.12.1 Establish and maintain effective internal control over the CDBG-CV 3
Funds that provides reasonable assurance that Agency is managing the CDBG-CV 3 Funds
in compliance with federal statutes, regulations, and the terms and conditions of this
Contract. These internal controls shall be in compliance with guidance in "Standards for
Internal Control in the Federal Government" issued by the Comptroller General of the
United States or the "Internal Control Integrated Framework" issued by the Committee of
Sponsoring Organizations of the Treadway Commission ("COSO");
7.12.2 Comply with federal statutes, regulations, and the terms and conditions of
this Contract;
7.12.3 Evaluate and monitor Agency's compliance with statutes, regulations and
the terms and conditions of this Contract;
7.12.4 Take prompt action when instances of noncompliance are identified
including noncompliance identified in audit findings; and
7.12.5 Take reasonable measures to safeguard protected personally identifiable
information and other information that HUD or City designates as sensitive or Agency
considers sensitive consistent with applicable federal, state, local and tribal laws regarding
privacy and obligations of confidentiality.
8. RECORD KEEPING, REPORTING AND DOCUMENTATION
REOUIREMENTS. AUDIT.
8.1 Record Keeping.
Agency shall maintain a record -keeping system as part of its performance of this
Contract and shall promptly provide City with copies of any document City deems
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necessary for the effective fulfillment of City's monitoring and evaluation responsibilities.
Specifically, Agency will keep or cause to be kept an accurate record of all actions taken
and all funds spent, with supporting and back-up documentation. Agency will maintain all
records and documentation related to this Contract for 5 years after the Contract term ends.
If any claim, litigation, or audit is initiated before the expiration of the 5-year period, the
relevant records and documentation must be retained until all such claims, litigation or
audits have been resolved. For purposes of this Contract, this 5-year period for record
retention is deemed to begin on the date after the final date of the full contract term and
end on the date five full years after that date regardless of whether or not this Contract is
earlier terminated.
8.2 Access to Records.
Representatives of City, HUD and any duly authorized officials of the federal
government will have full access to, and the right to examine, audit, copy, excerpt and/or
transcribe any of Agency's records pertaining to all matters covered by this Contract for 5
years after the Contract term ends. Such access shall be during regular business hours and
upon at least 48 hours prior notice. For purposes of this Contract, this 5 year period for
access to records is deemed to begin on the date after the final date of the full contract term
and end on the date five full years after that date regardless of whether or not this Contract
is earlier terminated.
8.3 Reports.
Agency will submit to City all reports and documentation described in this Contract
in such form as City may prescribe. Agency may also be required to submit a final
performance and/or final financial report if required by City at the termination of this
Contract in such form and within such times as City may prescribe. Failure to submit to
City any report or documentation described in this Contract shall be an event of default of
this Contract and City may exercise all of its remedies for default under this Contract.
8.3.1 Additional Information.
Agency shall provide City with additional information as may be required by state
or federal agencies to substantiate Program activities and/or expenditure eligibility.
8.4 Change in Reporting Requirements and Forms.
City retains the right to change reporting requirements and forms at its discretion.
City will notify Agency in writing at least 15 days prior to the effective date of such change,
and the Parties shall execute an amendment to the Contract reflecting such change if
necessary.
8.5 Audit.
8.5.1 Entities that Expend $750,000 or more in Federal Funds Per Year.
All non-federal entities that expend $750,000 or more in federal funds within 1 year,
regardless of the source of the federal award, must submit to City an annual audit prepared
in accordance with specific reference to 2 CFR Part 200.501 through Part 200.521. The
audit shall cover the Agency's fiscal years during which this Contract is in force. The audit
must be prepared by an independent certified public accountant, be completed within 6
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months following the end of the period being audited and be submitted to City within 30
days of its completion. Agency's audit certification is attached hereto as EXHIBIT "C"
— "Audit Certification Form" and "Audit Requirements". The Audit Certification
Form must be submitted to City prior to or with the first Reimbursement Request. Entities
that expend less than $750,000 a year in federal funds are exempt from federal audit
requirements for that year, but records must be available for review or audit by appropriate
officials of the federal agency, City, and General Accounting Office.
8.5.2 Citv Reserves the Right to Audit.
City reserves the right to perform an audit of Agency's Program operations and
finances at any time during the term of this Contract and for 5 years after the Contract term
ends if City determines that such audit is necessary for City's compliance with the CDBG
Regulations or other City policies. Agency agrees to allow access to all pertinent materials
as described herein for such audit. For purposes of this Contract, this 5-year period for
City audit is deemed to begin on the date after the final date of the full contract term and
end on the date five full years after that date regardless of whether or not this Contract is
earlier terminated. If such audit reveals a questioned practice or expenditure, such
questions must be resolved within 15 business days after notice to Agency of such
questioned practice or expenditure. If questions are not resolved within this period, City
reserves the right to withhold further funding under this Contract and/or any other contracts
with Agency. IF AS A RESULT OF ANY AUDIT IT IS DETERMINED THAT
AGENCY HAS FALSIFIED ANY DOCUMENTATION OR MISUSED,
MISAPPLIED OR MISAPPROPRIATED CDBG FUNDS OR SPENT CDBG
FUNDS ON ANY INELIGIBLE ACTIVITIES, AGENCY AGREES TO
REIMBURSE CITY THE AMOUNT OF SUCH MONIES PLUS THE AMOUNT OF
ANY SANCTIONS, PENALTY OR OTHER CHARGE LEVIED AGAINST CITY
BY HUD BECAUSE OF SUCH ACTIONS.
9. REIMBURSEMENT REQUIREMENTS.
9.1 Deadline for Submitting Reimbursement Requests.
9.1.1 Reimbursement Requests shall be submitted monthly to the City and
must be received by the City on or before the 15" day of the month following the month
expenses were paid by Agency. For example, the Reimbursement Request for June
expenses must be received by July 15. In the event the 15" falls on a weekend or City
holiday, Reimbursement Requests shall be due the next day that the City is open for
business. Failure to submit a Reimbursement Request in a timely fashion will result in
City taking the actions outlined in Section 10.1.
9.1.2 City will notify Agency by e-mail within 14 calendar days if a
Reimbursement Request is lacking Complete Documentation or corrections are needed.
Agency will have 7 calendar days from the date of the e-mail notice to submit any requested
information or missing documentation. If Agency fails to submit all the required
information or missing documentation within 7 calendar days from the first e-mail, Agency
may, at the City's sole discretion, forfeit any payments otherwise due that month and
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failure to submit any requested information may, at the City's sole discretion, be considered
an event of default as outlined in Section 10.1.2.
9.2 Submission of Reimbursement Requests.
Agency shall provide City with Complete Documentation and the following
reports as shown in EXHIBIT "D" —Reimbursement Forms with each Reimbursement
Request:
9.2.1 Attachment I — Invoice.
This report shall contain the amount requested for reimbursement each month or
partial month, the cumulative reimbursement requested to date (inclusive of that month's
or partial month's request).
9.2.2 Attachment II — Expenditure Worksheet.
This report shall itemize each expense requested for reimbursement by Agency and
shall include the Account corresponding the expense to a Budget line item. In order for
this report to be complete the following must be submitted:
9.2.2.1 For payroll expenses, timesheets signed by employees and
approved by supervisor for all payroll expenses listed.
Timesheets must distinguish between CDBG-CV 3-funded time
and non-CDBG-CV 3 funded time and reflect actual time spent
on CDBG-CV 3-funded activities. Agency may not submit
payroll expenses dated 60 calendar days prior to the date of the
Reimbursement Request unless approved in writing in advance
by City as authorized under the CARES Act.
9.2.2.2 For non -payroll expenses, invoices for each expense listed with
an explanation as to how the invoiced expense pertains to the
Program. Agency may not submit invoices dated 60 calendar
days prior to the date of the Reimbursement Request.
9.2.2.3 Proof that each expense was paid by Agency, which proof can
be satisfied by cancelled checks, wire transfer documentation,
paid receipts or other appropriate banking documentation.
9.2.3 Attachment III — Client Data Report.
This report shall list each Unduplicated Client served during the month along with
his or her demographic information. The Client Data Report must maintain a list of all
clients served during the Contract term. In order for this report to be complete, the
following must be submitted:
9.2.3.1 Documentation of income verification for each Unduplicated Client
the first time the client is served by the Program, which will either be the
completed form of EXHIBIT "E" - Form of Income Self Certification or
similar form approved by City, or Source Documentation.
9.2.4 Delivery of Reimbursement Request.
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Reimbursement Requests must be submitted through required software
system approved by City or in other manner required by City by the deadline(s) in
Section 9.1.1.
9.3 Withholding Pavment.
Failure to timely submit accurate and complete Reimbursement Requests and
Complete Documentation along with any required reports shall be an event of default.
10. DEFAULT AND TERMINATION.
10.1 Failure to Submit Reimbursement Request or Required
Documentation.
10.1.1 If Agency fails to submit a Reimbursement Request in accordance with
Section 9, Agency shall be in default of this Contract. City will notify Agency in writing
of such default and the Agency will have 5 calendar days from the date of the written notice
to submit such Reimbursement Request to cure the default. If Agency fails to cure the
default within such time, Agency may, at the City's sole discretion, forfeit any payments
otherwise due that month.
10.1.2 If Agency fails to submit requested information or missing
documentation as set forth in Section 9.1.2, then Agency shall forfeit payment due that
month and the failure to submit shall be considered an event of default that shall not be
cured.
10.1.3 In the event of (i) an uncured default under Section 10.1.1 or an event
of default under 10.1.2 or (ii) more than 2 instances of default, cured or uncured, under
these Sections, City reserves the right at its sole option to terminate this Contract effective
immediately upon written notice of such intent with no penalty or liability to City.
10.1.4 Notwithstanding anything to the contrary herein, City will not be
required to pay any CDBG-CV 3 Funds to Agency during the period that any
Reimbursement Request, report or documentation is past due or is not in compliance with
this Contract or the CDBG Regulations, or during any period during which Agency is in
default of this Contract.
10.1.5 In the event of termination under this Section 10.1, all CDBG-CV 3
Funds awarded but unpaid to Agency pursuant to this Contract shall be immediately
forfeited and Agency shall have no further right to such funds.
10.2 Failure to Maintain Records or Submit Reports and
Documentation.
If Agency fails to maintain all records and documentation as required in Section 8,
or if the records maintained or reports submitted or documentation is not in compliance
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with this Contract or the CDBG Regulations as determined by City in its sole discretion,
City will notify Agency in writing and Agency will have 30 calendar days from the date of
the written request to obtain or recreate the missing records and documentation or submit
or resubmit any such report or documentation to City. If Agency fails to maintain the
required reports or documentation, or fails to submit or resubmit any such report or
documentation within such time, City shall have the right to terminate this Contract
effective immediately upon written notice of such intent with no penalty or liability to City.
10.2.1 In the event of termination under this Section 10.2, all CDBG-CV 3
Funds awarded but unpaid to Agency pursuant to this Contract shall be immediately
forfeited and Agency shall have no further right to such funds, and any CDBG-CV 3 Funds
paid to Agency must be repaid to City within 30 days of termination. If such CDBG-CV
3 Funds are not repaid to City within the 30 day period, City shall exercise all legal
remedies available under this Contract.
10.3 In General.
10.3.1 Subject to Section 10.2, and unless specifically provided otherwise in
this Contract, Agency shall be in default under this Contract if Agency breaches any term
or condition of this Contract. In the event that such a breach remains uncured after 30
calendar days following written notice by City (or such other notice period as may be
specified herein) or, if Agency has diligently and continuously attempted to cure following
receipt of such written notice but reasonably requires more than 30 calendar days to cure,
as determined by both Parties mutually and in good faith, City shall have the right to elect
in City's sole discretion to (i) extend Agency's time to cure, (ii) terminate this Contract
effective immediately upon written notice of such intent to Agency, or (iii) pursue any
other legal remedies available to City under this Contract.
10.3.2 City's remedies may include:
10.3.2.1 Direct Agency to prepare and follow a schedule of actions
for carrying out the affected activities, consisting of
schedules, timetables and milestones necessary to
implement the affected activities.
10.3.2.2 Direct Agency to establish and follow a management plan
that assigns responsibilities for carrying out the remedial
activities.
10.3.2.3 Reprogram CDBG-CV 3 Funds that have not yet been
expended from affected activities to other eligible activities
or withhold CDBG-CV 3 Funds.
10.3.2.4 Any other appropriate action including but not limited to any
remedial action legally available such as declaratory
judgment, specific performance, damages, temporary or
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permanent injunctions, termination of this Contract or any
other contracts with Agency, and any other available
remedies.
10.3.3 In the event of termination under this Section 10.3, all CDBG-CV 3
Funds awarded but unpaid to Agency pursuant to this Contract shall be immediately
forfeited and Agency shall have no further right to such funds, and any CDBG-CV 3 Funds
already paid to Agency must be repaid to City within 30 days of the termination. Failure
to repay such CDBG-CV 3 Funds within the 30 day period will result in City exercising
all legal remedies available under this Contract.
10.4 No Funds Disbursed while in Breach.
Agency understands and agrees that no CDBG-CV 3 Funds will be paid to Agency
until all defaults are cured to City's satisfaction.
10.5 No Compensation After Date of Termination.
Agency shall not receive any compensation for work undertaken after the date of
the termination.
10.6 Rights of Citv Not Affected.
Termination shall not affect or terminate any of the existing rights of City against
Agency, or which may thereafter accrue because of Agency's default and this provision
shall be in addition to any and all other rights and remedies available to City under the law.
Such termination does not terminate any provisions of this Contract that have been
expressly noted as surviving the term or termination of the Contract. No delay or omission
by City in exercising any right or remedy available to it under this Contract shall impair
any such right or remedy or constitute a waiver or acquiescence in any Agency default.
10.7 Waiver of Breach Not Waiver of Subsequent Breach.
The waiver of a default or breach of any term, covenant, or condition of this
Contract shall not operate as a waiver of any subsequent default or breach of the same or
any other term, covenant or condition hereof.
10.8 Civil, Criminal and Administrative Penalties.
Failure to perform all the Contract terms may result in civil, criminal or
administrative penalties, including, but not limited to those set out in this Contract.
10.9 Termination for Cause.
10.9.1 City may terminate this Contract in the event of Agency's default,
inability, or failure to perform subject to notice, grace and cure periods. In the event City
terminates this Contract for cause, all CDBG-CV 3 Funds awarded but unpaid to Agency
pursuant to this Contract shall be immediately rescinded and Agency shall have no further
right to such funds and any CDBG-CV 3 Funds already paid to Agency must be repaid to
City within 30 days of termination. Failure to repay such CDBG-CV 3 Funds within 30
days will result in City exercising all legal remedies available to City under this Contract.
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AGENCY ACKNOWLEDGES AND AGREES THAT IF CITY TERMINATES
THIS CONTRACT FOR CAUSE, AGENCY OR ANY AFFILIATES OF AGENCY
SHALL NOT BE CONSIDERED FOR ANY OTHER CITY CONTRACT FOR
CDBG FUNDS FOR A MINIMUM OF 5 YEARS FROM THE DATE OF
TERMINATION.
10.9.2 Agency may terminate this Contract if City does not provide the CDBG-
CV 3 Funds substantially in accordance with this Contract.
10.10 Termination for Convenience.
In terminating in accordance with 2 CFR Part 200, Appendix II, this Contract may
be terminated in whole or in part only as follows:
10.10.1 By City with the consent of Agency in which case the Parties shall agree
upon the termination conditions, including the effective date and in the case of partial
termination, the portion to be terminated; or
10.10.2 By Agency upon at least 30 days written notification to City, setting
forth the reasons for such termination, the effective date, and in the case of partial
termination, the portion to be terminated. In the case of a partial termination, City may
terminate the Contract in its entirety if City determines in its sole discretion that the
remaining portion of the Contract to be performed or CDBG-CV 3 Funds to be spent will
not accomplish the purposes for which the Contract was made.
10.11 Dissolution of ALencv Terminates Contract.
This Contract shall terminate in the event Agency is dissolved or ceases to exist.
In the event of termination under this Section, all CDBG-CV 3 Funds are subject to
repayment and/or City may exercise all of its remedies under this Contract.
10.12 Reversion of Assets.
In the event this Contract is terminated with or without cause, all assets acquired
by Agency with the CDBG-CV 3 Funds including cash, interest payments from loans or
otherwise, all outstanding notes, mortgages or other security instruments, any accounts
receivable attributable to the use of the CDBG-CV 3 Funds, and any real or personal
property owned by Agency that was improved with the CDBG-CV 3 Funds shall
automatically transfer to City or to such assignee as City may designate.
11. REPAYMENT OF CDBG-CV 3 FUNDS.
All CDBG-CV 3 Funds are subject to repayment in the event the Program does not
meet the requirements of this Contract or in the CDBG Regulations. If Agency takes any
action that results in the City being required to repay all or any portion of the CDBG-
CV 3 Funds to HUD, Agency agrees it will reimburse City for such repayment. If
Agency takes any action that results in City receiving a finding from HUD about the
Program, whether or not repayment of all or any portion of the CDBG-CV 3 Funds
is required of City, Agency agrees City may require that 10% of the CDBG-CV 3
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Funds be repaid to City as liquidated damages. The Parties agree that City's damages
in the event of either repayment to HUD being required or receiving a finding from HUD
are uncertain and would be difficult to ascertain and may include an impact on City's
CDBG grant or other federal grant funds, in addition to the finding by HUD or a required
repayment of funds to HUD by City. Therefore, the Parties agree that payment under this
Section of 10% of the CDBG-CV 3 Funds by Agency to City is liquidated damages and
not a penalty.
12. CHANGE IN NON-PROFIT STATUS.
Agency must provide City with written notification of any changes to its non-profit
status within 15 calendar days of being notified of the change. Regardless of notice by
Agency, if the non-profit status of Agency changes after the date of this Contract, City may
but is not obligated to, terminate this Contract. In the event of termination under this
Section 12, all CDBG-CV 3 Funds awarded but not yet paid to Agency pursuant to this
Contract shall be immediately rescinded and Agency shall have no further right to such
funds. City, in its sole discretion, may require that any CDBG-CV 3 Funds already paid to
Agency must be repaid to City within 30 calendar days of termination under this Section.
13. SURVIVAL.
Any provision of this Contract that pertains to auditing, monitoring, client income
eligibility, record keeping and reports, City ordinances, or applicable CDBG requirements,
and any default and enforcement provisions necessary to enforce such provisions, shall
survive the termination of this Contract for 5 years after the Contract term ends and shall
be enforceable by City against Agency. For purposes of this Contract, this 5 year period
for survival of certain Contract provisions is deemed to begin on the date after the final
date of the full eighteen month contract term and end on the date five full years after that
date regardless of whether or not this Contract is earlier terminated.
14. GENERAL PROVISIONS
14.1 Aeencv an Independent Contractor.
Agency shall operate hereunder as an independent contractor and not as an officer,
agent, servant or employee of City. Agency shall have exclusive control of, and the
exclusive right to control, the details of the work and services performed hereunder, and
all persons performing same, and shall be solely responsible for the acts and omissions of
its officers, members, agents, servants, employees, contractors, subcontractors, vendors,
clients, licensees or invitees.
14.2 Doctrine of Resvondeat Superior.
The doctrine of respondeat superior shall not apply as between City and Agency,
or its officers, members, agents, servants, employees, contractors, subcontractors, vendors,
clients, licensees or invitees, and nothing herein shall be construed as creating a partnership
or joint enterprise between City and Agency. City does not have the legal right to control
the details of the tasks performed hereunder by Agency, its officers, members, agents,
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employees, contractors, subcontractors, vendors, clients, licensees or invitees.
14.3 Mencv Proverty.
City shall under no circumstances be responsible for any property belonging to
Agency, or its officers, members, agents, employees, contractors, subcontractors, vendors,
clients, licensees or invitees that may be lost, stolen or destroyed or in any way damaged
and AGENCY HEREBY INDEMNIFIES AND HOLDS HARMLESS CITY AND
ITS OFFICERS, AGENTS, AND EMPLOYEES FROM ANY AND ALL CLAIMS
OR SUITS PERTAINING TO OR CONNECTED WITH SUCH PROPERTY.
14.5 Religious Organization.
Agency shall comply with all applicable requirements as more particularly
described in 24 CFR Part 5.109. No portion of the CDBG-CV 3 Funds shall be used in
support of any sectarian or religious activity. In addition, there must be no religious or
membership criteria for clients of a CDBG-CV 3-funded service.
14.5.1. Separation of Explicitly Religious Activities.
Agency retains its independence and may continue to carry out its mission,
including the definition, development practice, and expression of its religious beliefs,
provided that it does not use CDBG-CV 3 Funds to support or engage in any explicitly
religious activities (including activities that involve overt religious content such as
worship, religious instruction, or proselytization), or in any other manner prohibited by
law.
14.5.2 Explicitly Religious Activities.
If Agency engages in explicitly religious activities (including activities that involve
overt religious content such as worship, religious instruction, or proselytization), the
explicitly religious activities must be offered separately, in time or location, from the
programs or activities supported by CDBG-CV 3 Funds and participation must be
voluntary for clients of a CDBG-CV 3-funded service.
14.5.3 Reauired Notices.
If Agency constitutes a Faith -based organization under 24 CFR Part 5.109, Agency
must provide all clients of a CDBG-CV 3-funded service with the notice attached as
EXHIBIT "K"—Notice of Beneficiary Rights. Such notice shall be provided to the client
prior to enrollment in any CDBG-CV 3-funded program or activity. In addition, if a client
or prospective client of a CDBG-CV 3-funded service objects to the religious character of
Agency, then Agency must promptly undertake reasonable efforts to identify and refer the
client or prospective client to an alternate provider to which the client or prospective client
has no such objection, as more particularly described in 24 CFR Part 5.109.
14.6 Venue.
Venue shall lie in Tarrant County, Texas for any action, whether real or asserted,
at law or in equity, arising out of the execution, performance, attempted performance or
non-performance of this Contract.
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14.7 Governing Law.
This Contract shall be governed by and construed in accordance with the laws of
the State of Texas. If any action, whether real or asserted, at law or in equity, arises out of
the execution, performance or non-performance of this Contract or on the basis of any
provision herein, for any issue not governed by federal law, the choice of law shall be the
laws of the State of Texas.
14.8 Severabilitv.
The provisions of this Contract are severable, and if for any reason a clause,
sentence, paragraph or other part of this Contract shall be determined to be invalid by a
court or federal or state agency, board or commission having jurisdiction over the subject
matter thereof, such invalidity shall not affect other provisions which can be given effect
without the invalid provision.
14.9 Written Agreement Entire Contract.
This written instrument and the Exhibits, Attachments, and Addendums attached
hereto, which are incorporated by reference and made a part of this Contract for all
purposes, constitute the entire agreement by the Parties concerning the work and services
to be performed under this Contract. Any prior or contemporaneous oral or written
agreement which purports to vary the terms of this Contract shall be void. Any
amendments to the terms of this Contract must be in writing and executed by the Parties.
14.10 Paragraph Headings for Reference Onlv, No Legal Significance;
Number and Gender.
The paragraph headings contained herein are for convenience in reference to this
Contract and are not intended to define or to limit the scope of any provision of this
Contract. When context requires, singular nouns and pronouns include the plural and the
masculine gender shall be deemed to include the feminine or neuter and the neuter gender
to include the masculine and feminine. The words "include" and "including" whenever
used herein shall be deemed to be followed by the words "without limitation".
14.11 Compliance With All Applicable Laws and Regulations.
Agency agrees to comply fully with all applicable laws and regulations that are
currently in effect or that are hereafter amended during the performance of this Contract.
Those laws include, but are not limited to:
➢ CDBG Regulations found in 24 CFR Part 570
➢ Coronavirus Aid, Relief, and Economic Security Act of 2020
➢ Title I of the Housing and Community Development Act of 1974, as amended,
(42 USC 5301)
➢ Title VI of the Civil Rights Act of 1964 (42 U.S.C. Sections 2000d et seq.)
including provisions requiring recipients of federal assistance to ensure
meaningful access by persons of limited English proficiency
➢ The Fair Housing Act, Title VIII of the Civil Rights Act of 1968 (42 U.S.C.
Sections 3601 et seq.)
➢ Executive Orders 11063, 11246 as amended by 11375 and 12086 and as
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supplemented by Department of Labor regulations 41 CFR Part 60
➢ The Age Discrimination in Employment Act of 1967
➢ The Age Discrimination Act of 1975 (42 U.S.C. Sections 6101 et seq.)
➢ The Uniform Relocation Assistance and Real Property Acquisition Policies Act
of 1970 (42 U.S.C. Sections 4601 et seq. and 49 CFR Part 24) ("URA")
➢ Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. Sections 794 et seq.)
and 24 CFR Part 8 where applicable
➢ National Environmental Policy Act of 1969, as amended, 42 U.S.C. Sections
4321 et seq. ("NEPA") and the related authorities listed in 24 CFR Part 58.
➢ The Clean Air Act, as amended, (42 U.S.C. Sections 1251 etseq.) and the Clean
Water Act of 1977, as amended (33 U.S.C. Sections 1251 etseq.) and the related
Executive Order 11738. In no event shall any amount of the assistance provided
under this Contract be utilized with respect to a facility that has given rise to a
conviction under the Clean Air Act or the Clean Water Act.
➢ Immigration Reform and Control Act of 1986 (8 U.S.C. Sections 1101 et seq.)
specifically including the provisions requiring employer verifications of legal
status of its employees
➢ The Americans with Disabilities Act of 1990 (42 U.S.C. Sections 12101 et
seq.), the Architectural Barriers Act of 1968 as amended (42 U.S.C. Sections
4151 et seq.) and the Uniform Federal Accessibility Standards, 24 CFR Part 40,
Appendix A
➢ Regulations at 24 CFR Part 87 related to lobbying, including the requirement
that certifications and disclosures be obtained from all covered persons
➢ Drug Free Workplace Act of 1988 (41 U.S.C. Sections 701 et seq.) and 24 CFR
Part 23, Subpart F
➢ Executive Order 12549 and 24 CFR Part 5.105(c) pertaining to restrictions on
participation by ineligible, debarred or suspended persons or entities
➢ Section 6002 of the Solid Waste Disposal Act, as amended by the Resource
Conservation and Recovery Act
➢ Guidelines of the Environmental Protection Agency at 40 CFR Part 247
➢ For contracts and subgrants for construction or repair, Copeland "Anti -
Kickback" act (18 U.S.C. 874) as supplemented in 29 CFR Part 5
➢ For construction contracts awarded by Agency in excess of $2,000, and in
excess of $2,500 for other contracts which involve the employment of
mechanics or laborers, Sections 103 and 107 of the Contract Work Hours and
Safety Standards Act (40 U.S.C. 327A 300) as supplemented by 29 CFR Part 5
➢ Lead -Based Paint Poisoning Prevention Act (42 U.S.C. 4801 et seq.), as
amended by the Residential Lead -Based Paint Hazard Reduction Act of 1992
(42 U.S.C. 4851 et seq.) and implementing regulations at 24 CFR Part 35,
subparts A, B, M, and R
➢ Uniform Administrative Requirements, Cost Principles, and Audit
Requirements for Federal Awards, 2 CFR Part 200 et seq.
➢ Federal Funding Accountability and Transparency Act of 2006 ("FFATA")
(Pub.L. 109-282, as amended by Section 6205(a) of Pub.L. 110-252 and Section
3 of Pub.L. 113-101)
➢ Federal Whistleblower Regulations, as contained in 10 U.S.C. 2409, 41 U.S.C.
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4712, 10 U.S.C. 2324, 41 U.S.C. 4304 and 41 U.S.C. 4310.
14.13 Prohibition Against Discrimination.
14.13.1 General Statement.
Agency shall comply in the execution, performance or attempted performance of
this Contract, with all non-discrimination requirements of 24 CFR Part 570.607 and
Chapter 17, Article III, Division 4 — Fair Housing of the City Code. Agency may not
discriminate against any person because of race, color, sex, gender, religion, national
origin, familial status, disability or perceived disability, sexual orientation, gender identity,
gender expression, or transgender, nor will Agency permit its officers, members, agents,
employees, or clients to engage in such discrimination.
This Contract is made and entered into with reference specifically to Chapter 17,
Article III, Division 3 - Employment Practices of the City Code, and Agency hereby
covenants and agrees that Agency, its officers, members, agents, employees and
contractors, have fully complied with all provisions of same and that no employee, or
applicant for employment has been discriminated against under the terms of such
ordinances by either or its officers, members, agents, employees or contractors.
14.13.2 No Discrimination in Employment during the Performance of This
Contract.
During the performance of this Contract Agency agrees to the following provision,
and will require that its contractors and subcontractors also comply with such provision by
including it in all contracts with its contractors:
[Contractor's, Subcontractor's or Vendor's name] will not unlawfully discriminate
against any employee or applicants for employment because of race, color, sex, gender,
religion, national origin, familial status, disability or perceived disability, sexual
orientation, gender identity, gender expression or transgender. [Contractor's,
Subcontractor's or Vendor's name] will take affirmative action to ensure that applicants
are hired without regard to race, color, sex, gender, religion, national origin, familial status,
disability or perceived disability, sexual orientation, gender identity, gender expression or
transgender and that employees are treated fairly during employment without regard to
their race, color, sex, gender, religion, national origin, familial status, disability or
perceived disability, sexual orientation, gender identity, gender expression or transgender.
Such action shall include, but not be limited to, the following: employment, upgrading,
demotion or transfer, recruitment or recruitment advertising, layoff or termination, rates of
pay or other forms of compensation, and selection for training, including apprenticeship.
[Contractor's, Subcontractor's or Vendor's name] agrees to post in conspicuous places,
available to employees and applicants for employment, notices setting forth the provisions
of this nondiscrimination clause.
[Contractor's, Subcontractor's or Vendor's name] will, in all solicitations or
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advertisements for employees placed by or on behalf of [Contractor's, Subcontractor's or
Vendor's name], state that all qualified applicants will receive consideration for
employment without regard to race, color, sex, gender, religion, national origin, familial
status, disability or perceived disability, sexual orientation, gender identity, gender
expression or transgender.
[Contractor's, Subcontractor's or Vendor's name] covenants that neither it nor any
of its officers, members, agents, employees, or contractors, while engaged in performing
this Contract, shall, in connection with the employment, advancement or discharge of
employees or in connection with the terms, conditions or privileges of their employment,
discriminate against persons because of their age or because of any disability or perceived
disability, except on the basis of a bona fide occupational qualification, retirement plan or
statutory requirement.
[Contractor's. Subcontractor's or Vendor's name] further covenants that neither it
nor its officers, members, agents, employees, contractors, or persons acting on their behalf,
shall specify, in solicitations or advertisements for employees to work on this Contract, a
maximum age limit for such employment unless the specified maximum age limit is based
upon a bona fide occupational qualification, retirement plan or statutory requirement.
14.13.3 Agencv'S Contractors and the ADA.
In accordance with the provisions of the Americans With Disabilities Act of 1990
("ADA"), Agency warrants that it and any of its contractors will not unlawfully
discriminate on the basis of disability in the provision of services to the general public, nor
in the availability, terms and/or conditions of employment for applicants for employment
with, or employees of, Agency or any of its contractors. AGENCY WARRANTS IT
WILL FULLY COMPLY WITH THE ADA'S PROVISIONS AND ANY OTHER
APPLICABLE FEDERAL, STATE AND LOCAL LAWS CONCERNING
DISABILITY AND WILL DEFEND, INDEMNIFY AND HOLD CITY HARMLESS
AGAINST ANY CLAIMS OR ALLEGATIONS ASSERTED BY THIRD PARTIES,
CONTRACTORS SUBCONTRACTORS, VENDORS OR AGENTS AGAINST
CITY ARISING OUT OF AGENCY'S AND/OR ITS CONTRACTORS',
SUBCONTRACTORS', VENDORS' OR AGENTS' OR THEIR RESPECTIVE
EMPLOYEES' ALLEGED FAILURE TO COMPLY WITH THE ABOVE -
REFERENCED LAWS CONCERNING DISABILITY DISCRIMINATION IN THE
PERFORMANCE OF THIS CONTRACT.
14.14. Conflicts of Interest and Violations of Criminal Law.
14.14.1 Auencv Safeguards.
Agency shall establish safeguards to prohibit its employees, board members,
advisors and agents from using positions for a purpose that is or gives the appearance of
being motivated by a desire for private gain for themselves or others, particularly those
with whom they have family, business or other ties. Agency shall disclose to City any such
conflict of interest or potential conflict of interest, immediately upon discovery of such.
14.14.2 General Prohibitions Against Conflicts of Interest.
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No employees, agents, consultants, officers or elected officials or appointed
officials of City or of Agency who exercise or have exercised any functions or
responsibilities with respect to activities assisted with CDBG-CV 3 funds or who are in a
position to participate in a decision -making process or gain inside information with regard
to these activities may utilize CDBG-CV 3-funded services, may obtain a financial interest
or benefit from a CDBG-CV 3-assisted activity, or have an interest in any contract,
subcontract or agreement with respect thereto, or the proceeds thereunder, either for
themselves or those with whom they have family or business ties, during their tenure or for
1 year thereafter.
14.14.2.1 Agency shall establish conflict of interest policies for federal
awards including the CDBG-CV 3 Funds and shall disclose
in writing potential conflicts of interest to City as authorized
by 2 CFR Part 200.112.
14.14.3 Conflicts of Interest Involving Procurement.
The conflict of interest provisions of 2 CFR Part 200.318 shall apply in the
procurement of property and services by Agency. In all cases not governed by this Section,
the provisions of 24 CFR Part 570.611 of the CDBG Regulations shall apply.
14.14.3.1 As more particularly described in 2 CFR Part 200.318,
Agency shall maintain and submit to City written standards
of conduct covering conflicts of interest and governing the
performance of its employees engaged in the selection,
award, and administration of contracts. No employee,
officer, or agent may participate in the selection, award, or
administration of a contract supported by a federal award if
he or she has a real or apparent conflict of interest. The
standards of conduct must provide for disciplinary actions to
be applied for violations of such standards by officers,
employees, or agents of Agency.
14.14.3.2 The officers, employees, and agents of Agency shall neither
solicit nor accept gratuities, favors, or anything of monetary
value from contractors or parties to subcontracts.
14.14.3.3 Notwithstanding the prohibition contained in Section
14.14.3.2, Agency may set standards of conduct for
situations in which the financial interest is not substantial or
the gift is an unsolicited item of nominal value. Such
standards of conduct must provide for disciplinary actions to
be applied for violations of such standards by Agency's
officers, employees or agents.
14.14.3.4 Agency shall maintain written standards of conduct covering
organizational conflicts of interest. Organizational conflicts
of interest means that because of relationships with a parent
CDBG-CV 3 PSA CONTRACT 22-23 Page 25
Tarrant Area Food Bank- Boost Delivery
Rev. 10/ 10/2023
company, affiliate, or subsidiary organization, Agency is
unable or appears to be unable to be impartial in conducting
a procurement action involving a related organization.
14.14.3.5 Agency must maintain records sufficient to detail the history
of procurement. These records will include, but are not
necessarily limited to the following: rationale for the method
of procurement, selection of contract type, contractor
selection or rejection, and the basis for the contract price.
14.14.4 Disclosure of Conflicts of Interest.
In compliance with 2 CFR Part 200.112, Agency is required to timely disclose to
City in writing any potential conflict of interest.
14.14.5 Disclosure of Texas Penal Code Violations.
Agency affirms that it will adhere to the provisions of the Texas Penal Code which
prohibit bribery and gifts to public servants.
14.14.6 Disclosure of Federal Criminal Law Violations.
In compliance with 2 CFR Part 200.113, Agency is required to timely disclose to
City all violations of federal criminal law involving fraud, bribery or gratuity violations
potentially affecting the Agency.
14.15 Subcontracting with Small and Minority Firms, Women's Business
Enterprises and Labor Surplus Areas.
14.15.1 For procurement contracts $50,000.00 or larger that are paid for, in part
or in full, with the CDBG-CV 3 Funds, Agency agrees to abide by City's policy to involve
Minority Business Enterprises and Small Business Enterprises and to provide them equal
opportunity to compete for contracts for construction, provision of professional services,
purchase of equipment and supplies and provision of other services required by City.
Agency agrees to incorporate the City's BDE Ordinance, and all amendments or successor
policies or ordinances thereto, into all contracts and subcontracts for procurement larger
than $50,000.00 or larger that are paid for, in part or in full, with the CDBG-CV 3 Funds
and will further require all persons or entities with which it so contracts to comply with
said ordinance.
14.15.2 It is national policy to award a fair share of contracts to disadvantaged
business enterprises ("DBEs"), small business enterprises ("SBEs"), minority business
enterprises ("MBEs"), and women's business enterprises ("WBEs"). Accordingly,
affirmative steps must be taken to assure that DBEs, SBEs, MBEs, and WBEs are utilized
when possible as sources of supplies, equipment, construction and services.
14.15.2.1 In order to comply with federal reporting requirements 24
CFR Part 570.506 (g)(6), Agency must submit the form
attached hereto as EXHIBIT "I" — MBE Reporting Form
for each contract or subcontract with a value of $10,000.00
CDBG-CV 3 PSA CONTRACT 22-23 Page 26
Tarrant Area Food Bank- Boost Delivery
Rev. 10/ 10/2023
or more paid or to be paid with the CDBG Funds. Agency
shall submit this form by the date specified in EXHIBIT "I"
— MBE Reporting Form.
14.16 Other Laws.
The failure to list any federal, state or City ordinance, law or regulation that is
applicable to Agency does not excuse or relieve Agency from the requirements or
responsibilities in regard to following the law, nor from the consequences or penalties for
Agency's failure to follow the law, if applicable.
14.17 Assignment.
Agency shall not assign all or any part of its rights, privileges, or duties under this
Contract without the prior written approval of City. Any attempted assignment of same
without approval shall be void, and shall constitute a breach of this Contract.
14.18. Right to Inspect Agency Contracts.
It is agreed that City has the right to inspect and approve in writing any proposed
contracts between Agency and any contractor or vendor engaged in any activity in
conjunction with this CDBG-funded Program prior to any charges being incurred.
14.19 Force Maieure
If Agency becomes unable, either in whole or part, to fulfill its obligations under
this Contract due to acts of God, strikes, lockouts, or other industrial disturbances, acts of
public enemies, wars, blockades, insurrections, riots, epidemics, earthquakes, fires, floods,
restraints or prohibitions by any court, board, department, commission or agency of the
United States or of any States, civil disturbances, or explosions, or some other reason
beyond Agency's control (collectively, "Force Maj eure Event"), the obligations so affected
by such Force Majeure Event will be suspended only during the continuance of such event.
Agency will give City written notice of the existence, extent and nature of the Force
Majeure Event as soon as reasonably possible after the occurrence of the event. Failure to
give notice will result in the continuance of Agency's obligation regardless of the extent of
any existing Force Majeure Event. Agency will use commercially reasonable efforts to
remedy its inability to perform as soon as possible.
14.20 IMMIGRATION NATIONALITY ACT.
City actively supports the Immigration & Nationality Act (INA) which includes
provisions addressing employment eligibility, employment verification, and
nondiscrimination. Agency shall verify the identity and employment eligibility of all
employees who perform work under this Agreement. Agency shall complete the
Employment Eligibility Verification Form (I-9), maintain photocopies of all supporting
employment eligibility and identity documentation for all employees, and upon request,
provide City with copies of all I-9 forms and supporting eligibility documentation for each
employee who performs work under this Agreement. Agency shall establish appropriate
procedures and controls so that no services will be performed by any employee who is not
legally eligible to perform such services. Agency shall provide City with a certification
letter that it has complied with the verification requirements required by this Agreement.
CDBG-CV 3 PSA CONTRACT 22-23 Page 27
Tarrant Area Food Bank- Boost Delivery
Rev. 10/ 10/2023
Agency shall indemnify City from any penalties or liabilities due to violations of this
provision. City shall have the right to immediately terminate this Agreement for violations
of this provision by Agency.
15. INDEMNIFICATION AND RELEASE.
AGENCY COVENANTS AND AGREES TO INDEMNIFY, HOLD
HARMLESS AND DEFEND, AT ITS OWN EXPENSE, CITY AND ITS OFFICERS,
AGENTS, SERVANTS AND EMPLOYEES FROM AND AGAINST ANY AND ALL
CLAIMS OR SUITS FOR PROPERTY LOSS OR DAMAGE AND/OR PERSONAL
INJURY, INCLUDING DEATH, TO ANY AND ALL PERSONS, OF
WHATSOEVER HIND OR CHARACTER, WHETHER REAL OR ASSERTED,
ARISING OUT OF OR IN CONNECTION WITH THE EXECUTION,
PERFORMANCE, ATTEMPTED PERFORMANCE OR NONPERFORMANCE
OF THIS CONTRACT AND/OR THE OPERATIONS, ACTIVITIES AND
SERVICES OF THE PROGRAM DESCRIBED HEREIN, WHETHER OR NOT
CAUSED IN WHOLE OR IN PART, BY ALLEGED NEGLIGENCE OF
OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS OR
SUBCONTRACTORS OF CITY; AND AGENCY HEREBY ASSUMES ALL
LIABILITY AND RESPONSIBILITY OF CITY AND ITS OFFICERS, AGENTS,
SERVANTS, AND EMPLOYEES FOR ANY AND ALL CLAIMS OR SUITS FOR
PROPERTY LOSS OR DAMAGE AND/OR PERSONAL INJURY, INCLUDING
DEATH, TO ANY AND ALL PERSONS, OF WHATSOEVER HINDS OR
CHARACTER, WHETHER REAL OR ASSERTED, ARISING OUT OF OR IN
CONNECTION WITH THE EXECUTION, PERFORMANCE, ATTEMPTED
PERFORMANCE OR NONPERFORMANCE OF THIS CONTRACT AND/OR
THE OPERATIONS, ACTIVITIES AND SERVICES OF THE PROGRAM
DESCRIBED HEREIN, WHETHER OR NOT CAUSED IN WHOLE OR IN PART
BY ALLEGED NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS,
EMPLOYEES, CONTRACTORS OR SUBCONTRACTORS OF CITY. AGENCY
LIKEWISE COVENANTS AND AGREES TO AND DOES HEREBY INDEMNIFY
AND HOLD HARMLESS CITY FROM AND AGAINST ANY AND ALL INJURY,
DAMAGE OR DESTRUCTION OF PROPERTY OF CITY, ARISING OUT OF OR
IN CONNECTION WITH ALL ACTS OR OMISSIONS OF AGENCY, ITS
OFFICERS, MEMBERS, AGENTS, EMPLOYEES, CONTRACTORS,
SUBCONTRACTORS, INVITEES, LICENSEES, OR CLIENTS, OR CAUSED, IN
WHOLE OR IN PART, BY ALLEGED NEGLIGENCE OF OFFICERS, AGENTS,
SERVANTS, EMPLOYEES, CONTRACTORS OR SUBCONTRACTORS OF
CITY.
IT IS THE EXPRESS INTENTION OF THE PARTIES, BOTH AGENCY
AND CITY, THAT THE INDEMNITY PROVIDED FOR THIS SECTION
INCLUDES INDEMNITY BY AGENCY TO INDEMNIFY AND PROTECT CITY
FROM THE CONSEQUENCES OF CITY'S OWN NEGLIGENCE, WHETHER
CDBG-CV 3 PSA CONTRACT 22-23 Page 28
Tarrant Area Food Bank- Boost Delivery
Rev. 10/ 10/2023
THAT NEGLIGENCE IS ALLEGED TO BE THE SOLE OR CONCURRING
CAUSE OF THE INJURY, DAMAGE OR DEATH.
AGENCY AGREES TO AND SHALL RELEASE CITY, ITS AGENTS,
EMPLOYEES, OFFICERS AND LEGAL REPRESENTATIVES FROM ALL
LIABILITY FOR INJURY, DEATH, DAMAGE OR LOSS TO PERSONS OR
PROPERTY SUSTAINED IN CONNECTION WITH OR INCIDENTAL TO
PERFORMANCE UNDER THIS CONTRACT, EVEN IF THE INJURY, DEATH,
DAMAGE OR LOSS IS CAUSED BY CITY'S SOLE OR CONCURRENT
NEGLIGENCE.
AGENCY SHALL REQUIRE ALL OF ITS CONTRACTORS AND
SUBCONTRACTORS TO INCLUDE IN THEIR CONTRACTS AND
SUBCONTRACTS A RELEASE AND INDEMNITY IN FAVOR OF CITY IN
SUBSTANTIALLY THE SAME FORM AS ABOVE.
16. WAIVER OF IMMUNITY BY AGENCY.
If Agency, as a charitable or nonprofit organization, has or claims an immunity or
exemption (statutory or otherwise) from and against liability for damages or injury,
including death, to persons or property, Agency hereby expressly waives its rights to plead
defensively such immunity or exemption as against City. This Section shall not be
construed to affect a governmental entity's immunities under constitutional, statutory or
common law.
17. INSURANCE AND BONDING.
Agency will maintain coverage in the form of insurance or bond in the amount of
$60,000 to insure against loss from the fraud, theft or dishonesty of any of Agency's
officers, agents, trustees, directors or employees. The proceeds of such insurance or bond
shall be used to reimburse City for any and all loss of CDBG-CV 3 Funds occasioned by
such misconduct. To effectuate such reimbursement, such fidelity coverage shall include
a rider stating that reimbursement for any loss or losses shall name the City as a Loss Payee.
Agency shall furnish to City in a timely manner, but not later than the Date of
Execution of the Contract, certificates of insurance as proof that it has secured and paid for
policies of commercial insurance as specified herein. If City has not received such
certificates by the Date of Execution of the Contract, Agency shall be in default of the
Contract and City may, at its option, terminate the Contract.
Such insurance shall cover all insurable risks incident to or in connection with the
execution, performance, attempted performance or nonperformance of this Contract.
Agency shall maintain the following insurance coverage and limits:
Commercial General Liability (CGL) Insurance
$ 500,000 each occurrence
$1,000,000 aggregate limit
CDBG-CV 3 PSA CONTRACT 22-23 Page 29
Tarrant Area Food Bank- Boost Delivery
Rev. 10/ 10/2023
Non -Profit Organization Liabilitv or Directors & Officers Liabilitv
$1,000,000 Each Occurrence
$1,000,000 Annual Aggregate Limit
Business Automobile Liabilitv Insurance
$1,000,000 each accident on a combined single -limit basis, or
$ 250,000 Property Damage
$ 500,000 Bodily Injury per person per occurrence
$2,000,000 Aggregate
Insurance policy shall be endorsed to cover "Any Auto", defined as autos owned,
hired, and non -owned. Pending availability of the above coverage and at the
discretion of City, the policy shall be the primary responding insurance policy
versus a personal auto insurance policy if or when in the course of Agency's
business as contracted herein.
Workers' Compensation Insurance
Part A: Statutory Limits
Part B: Employer's Liability
$100,000 each accident
$100,000 disease -each employee
$500,000 disease -policy limit
Note: Such insurance shall cover employees performing work on any and all
projects including but not limited to construction, demolition, and rehabilitation.
Agency or its contractors shall maintain coverages, if applicable. In the event the
respective contractors do not maintain coverage, Agency shall maintain the
coverage on such contractor, if applicable, for each applicable contract.
Additional Requirements
Such insurance amounts shall be revised upward at City's reasonable option and no more
frequently than once every 12 months, and Agency shall revise such amounts within 30
days following notice to Contractor of such requirements.
Agency will submit to City documentation that it has obtained insurance coverage and has
executed bonds as required in this Contract prior to payment of any monies provided
hereunder.
Where applicable, insurance policies required herein shall be endorsed to include City as
an additional insured as its interest may appear. Additional insured parties shall include
employees, officers, agents, and volunteers of City.
Any failure on part of City to request certificate(s) of insurance shall not be construed as a
waiver of such requirement or as a waiver of the insurance requirements themselves.
CDBG-CV 3 PSA CONTRACT 22-23 Page 30
Tarrant Area Food Bank- Boost Delivery
Rev. 10/ 10/2023
Insurers of Agency's insurance policies shall be licensed to do business in the state of Texas
by the Department of Insurance or be otherwise eligible and authorized to do business in
the state of Texas. Insurers shall be acceptable to City insofar as their financial strength
and solvency and each such company shall have a current minimum A.M. Best Key Rating
Guide rating of A-: VII or other equivalent insurance industry standard rating otherwise
approved by City.
Deductible limits on insurance policies shall not exceed $5,000 per occurrence unless
otherwise approved by City.
In the event there are any local, federal or other regulatory insurance or bonding
requirements for the Program, and such requirements exceed those specified herein, the
former shall prevail.
Agency shall require its contractors to maintain applicable insurance coverages, limits, and
other requirements as those specified herein; and Agency shall require its contractors to
provide Agency with certificate(s) of insurance documenting such coverage. Also, Agency
shall require its contractors to have City and Agency endorsed as additional insureds (as
their interest may appear) on their respective insurance policies.
Directors and Officers Liability coverage shall be in force and may be provided on a
claims -made basis. This coverage may also be referred to as Management Liability, and
shall protect the insured against claims arising out of alleged errors in judgment, breaches
of duty and wrongful acts arising out of their organizational duties. Coverage shall protect
not only the entity, but all past, present and future directors, officers, trustees, employees,
volunteers and committee members.
Notwithstanding any provision in this Contract to the contrary, when applicable,
Agency shall comply with the requirements of 2 CFR 200.310 and shall, at a
minimum, provide the equivalent insurance coverage for real property and
equipment acquired or improved with CDBG Funds as provided to property owned
by Agency.
18. CERTIFICATION REGARDING LOBBYING.
The undersigned representative of Agency hereby certifies, to the best of his or her
knowledge and belief, that:
No federal appropriated funds have been paid or will be paid, by or on behalf of
Agency, to any person for influencing or attempting to influence an officer or
employee of any agency, a member of Congress, an officer or employee of
Congress in connection with the awarding of any federal contract, the making of
any federal grant, the making of any federal loan, the entering into of any
cooperative agreement and the extension, continuation, renewal, amendment, or
modification of any federal contract, grant, loan or cooperative agreement.
If any funds other than federally appropriated funds have been paid or will be paid
to any person for influencing or attempting to influence an officer or employee of
CDBG-CV 3 PSA CONTRACT 22-23 Page 31
Tarrant Area Food Bank- Boost Delivery
Rev. 10/ 10/2023
any agency, member of Congress in connection with this federal contract, grant,
loan or cooperative agreement, Agency shall complete and submit Standard Form-
LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
This certification is a material representation of fact upon which reliance was
placed when this Contract was made or entered into. Submission of this certificate
is a prerequisite for making or entering into this Contract imposed by 31 U.S.C.
Section 1352. Any person who fails to file the required certification shall be subject
to a civil penalty of not less than $10,000.00 and not more than $100,000.00 for
each such failure.
Agency shall require that the language of this certification be included in all
subcontracts or agreements involving the expenditure of federal funds.
19. LITIGATION AND CLAIMS.
Agency shall give City immediate notice in writing of any action, including any
proceeding before an administrative agency, filed against Agency in conjunction with this
Contract or the Program. Agency shall furnish immediately to City copies of all pertinent
papers received by Agency with respect to such action or claim. Agency shall provide a
notice to City within 10 days upon filing under any bankruptcy or financial insolvency
provision of law.
20. NOTICE.
All notices required or permitted by this Contract must be in writing and are deemed
delivered on the earlier date of the date actually received or the third day following deposit
in a United States Postal Service post office or receptacle; with proper postage, certified
mail return receipt requested; and addressed to the other Party at the address set out below
or at such other address as the receiving Party designates by proper notice to the sending
Party.
City:
City Attorney's Office
Attention: Jessika Williams
200 Texas Street
Fort Worth, TX 76102
Telephone: 817-3 92-7600
Copy to:
Neighborhood Services Department
200 Texas Street
Fort Worth, TX 76102
Attention: Victor Turner
Telephone: 817-3 92-7540
Copy to:
Neighborhood Services Department
CDBG-CV 3 PSA CONTRACT 22-23 Page 32
Tarrant Area Food Bank- Boost Delivery
Rev. 10/ 10/2023
200 Texas Street
Fort Worth, TX 76102
Attention: Tamara Jones
Telephone: 817-392-595 8
Agency:
Tarrant Area Food Bank
Julie Butner
2600 Cullen St.
Fort Worth, TX 76107
Telephone: 817-857-7120
21. AGENCY HAS LEGAL AUTHORITY TO ENTER INTO CONTRACT.
Agency represents that it possesses the legal authority, pursuant to any proper,
appropriate and official motion, resolution or action passed or taken, to enter into this
Contract and to perform the responsibilities herein required.
22. COUNTERPARTS.
This Contract may be executed in multiple counterparts, each of which shall be
considered an original, but all of which shall constitute one instrument which may be
sufficiently evidenced by one counterpart.
23. PROGRAM INCOME
Parties agree that no program income as defined by HUD shall be earned as a result
of this contract.
[SIGNATURES APPEAR ON NEXT PAGE]
CDBG-CV 3 PSA CONTRACT 22-23 Page 33
Tarrant Area Food Bank- Boost Delivery
Rev. 10/ 10/2023
IN WITNESS WHEREOF, the Parties hereto have executed 1 original of this
Contract in Fort Worth, Tarrant County, Texas.
4 �4404nn
of F�RT�°ad
p�>g �9dd
ATTEST:
o
;des oo :
o
pa4p nEo o54p
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City Secretary, Jannette Goodall
M&C: 23-0594
1295 Certification No. 2023-1029690
Date: June 27, 2023
CITY OF FORT WORTH
APPROVED AS TO FORM AND LEGALITY:
Jessika Williams, Assistant City Attorney
APPROVED BY:
Victor Turner
Director, Neighborhood Services Department
Fernando Costa, Assistant City
Manager
CONTRACT COMPLIANCE MANAGER:
By signing, I acknowledge that I am the person responsible
for the monitoring and administration of this contract, including
ensuring all performance and reporting requirements
Tamar ,16, 202316:45 CDT)
Tamara Jones, Neighborhood Program Coordinator
TARRANT AREA FOOD BANK
By: � gaert" OFFICIAL RECORD
Julie Butner, President and CEO CITY SECRETARY
FT. WORTH, TX
CDBG-CV 3 PSA CONTRACT 22-23 Page 34
Tarrant Area Food Bank- Boost Delivery
Rev. 10/ 10/2023
EXHIBITS:
EXHIBIT "A" —Program Summary
EXHIBIT "A-1" — 2023 HUD Income Limits
EXHIBIT "A-2" — Reporting Requirements for Countywide Agencies
EXHIBIT `B" — Budget
EXHIBIT "C" — Audit Certification Form
EXHIBIT
"D"
— Reimbursement Forms
EXHIBIT
"E"
— Form of Income Self -Certification
EXHIBIT
"F"
— Standards for Complete Documentation
EXHIBIT
"G"
— Section 3 Reporting Forms (NOT APPLICABLE)
EXHIBIT
"H"
— Severely Disabled Certification Form
EXHIBIT
"I" —
MBE Reporting Form
EXHIBIT
"J" —
Duties of the Parties for Use of NSD Community Centers
EXHIBIT
"K"
— Notice of Beneficiary Rights
CDBG-CV 3 PSA CONTRACT 22-23 Page 35
Tarrant Area Food Bank- Boost Delivery
Rev. 10/ 10/2023
EXHIBIT A
PROGRAM SUMMARY
TARRANT AREA FOOD BANK- RESOURCE AND EDUCATION DELIVERED
June 27, 2023 to December $60,000
31, 2024 AMOUNT
PERIOD
Capitalized terms not defined herein shall have meanings assigned them in the contract.
PROGRAM:
The Program will provide mobile food delivery to low -to- moderate income individuals and families within
target low- and moderate -income neighborhoods in Fort Worth (see Exhibit A -I target area map). The goal
of the program is to reduce the negative impact of food deserts by increasing access to fresh produce and basic
food items not readily available in target communities in Fort Worth. The Program responds to the COVID-
19 Pandemic by reducing the need of vulnerable populations to go to grocery stores or other public places
where COVJD-19 spread is common. Locations in the target area have demonstrated high incidence of
obesity and similar risk factors for COVID-19. This service will provide households to get food delivered at
residency while reducing contact with others to reduce the risk of COVID exposure.
CDBG funds will be used to pay for 2 FTE salaries and fringe benefits to enroll participants into the Boost
delivery program through Kroger.
Agency shall not change target service areas for the program without prior City approval and contract
amendment (which may require revisions to reporting requirements). Costs incurred at any locations that
have not been approved by City shall not be reimbursed.
REGULATORY CLASSIFICATION:
IDIS Matrix Code(s) and Service Category: 5 Public Services
National Objective Citation: 24 CFR 570.208(a)(1)
Regulatory Citation(s): 24 CFR 570.201(e)
PROGRAM GOALS:
Minimum Number of Fort Worth Clients to be Served: The Program will enroll a minimum of
2,160 Unduplicated Clients for the eighteenth -month term from Fort Worth as shown by the
Monthly Performance Report.
CDBG CV 3- Grocery Delivery
Tarrant Area Food Bank
Percent of Low to Moderate Income by Census Block Group
Percent of Low & Moderate Income Individuals
High ( 51 %- 70%)
CDBG CV 3- Grocery Delivery
Tarrant Area Food Bank
U.S. Census
RiiraaU_2pl.ri-
2019 American
Community
Survey (ACS) 5-
Year Estimates
Low and
Moderate
Very High ( More than 70 %
CDBG CV 3- Grocery Delivery
Tarrant Area Food Bank
Incomes
IQ RT WOILT.H
5 0 2 4 8 12 C, Copyright 20170tyof fort Worth Unauthorize<I reproduction is a violation of applicablell;I—This product is for
Info,mational purposes and may noihavebeenprepared for or suitable for legal.engmeenng. or surveying purposes.
It dossnol represent an on-0he-ground survey and repre$ents only approximate relc; hive location of property boundaries.
Miles The Cityof Fort Worth assumes no responsibilily for the accuracy of salddala.
Percent of Low to Moderate Income by Census Block Group
76073
76023
76262
76052
76177
76082
_" 7fi2Q4
y 75248
76}79
h
76020
76088
76086 J
E
76022 75028 50fi 7"07
/ 75019
75006
76092 j
76051 J
75234
75063
- 752zs
76131 78034 ! 75039
76182 75261
75036 75220
75748 _ '�
76085 76137 76039
760 76021 75062
-,i 76180
75}35 r
` 1 _r •, 76022 75061 - - ff
r_ 78040 !
7670 .., 75 d7
76053
No,
MIT 76155 75060
76118
Tfi?fi4�'`
76108 76114 7s11' 7sz1a
f76DD6 75050
76087 76127 - :�• 7
76102 - - - - -
V 76612 76011
76087
76008
7fi 126
T6035 78 9 444 'fiO4.41
Percent of Low & Moderate Income Individuals
Very Low ( Less than 16%) Zip Codes
Low ( 17% - 32% )
Average ( 33% - 50% 1
High (51 % - 70% )
Very High ( More than 70 % }
�— 76107 - 75211
-. 76104 75051
j 76105 76013 76010
76715 76
I `
r �f �`'ir•2 7—
76109 6770
76119 !! 76015 75015 76014
75236
•7fi�1,22
76115
78i32 ' 7S0S2
" 7601T 76018 75116
76133 _.
75134 76060
76249
75137
76591
76123 76140 78002 �_
75054 75 -15
75104
79039 76063 _
L.S. Census Bureau. 2015-2019American Community Survey (ACS) 5-Year Estimates Low and Moderate Incomes
r1 . t 4.
FOR` T� H,:
0 2 4 8 12 ® COpyryhl 2017 CYty of Fod W❑M. unawhWi-4 repr❑d❑ct— 5 a vi❑19ti❑n ❑f applicable f—S.mis prod-t is fo*
iM—tionaf purposes and may nol have been prepared for or suitable for tegal, engm-Ting, or surveying purposes.
11 d— nal represent an an-Iho-g—d —u Y s 4 represents anfy eppmxi mete'0.1 .e 1❑gati❑n of p� perly Oftroan"-
Miles The City of Fad Worth assumes- responsibility far the accuracy .(-id dal.-
EXHIBIT "A-1"
2023 HUD INCOME LIMITS
AMI 1 person
2 people
3 people
4 people
5 people
6 people
7 people
8 people
30% $20,100
$23,000
$25,850
$28,700
$31,000
$33,300
$35,600
$37,900
50% $33,500
$38,300
$43,100
$47,850
$51,700
$55,550
$59,350
$63,200
80% $53,600
$61,250
$68,900
$76,550
$82,700
$88,800
$94,950
$101,050
*Income limits are published at least annually by HUD.
Effective 611512023
EXHIBIT "A-2"
REPORTING REQUIREMENTS FOR COUNTYWIDE AGENCIES
CDBG 5 1 % PSA CONTRACT-- EXHIBIT "A-2"
REPORTING REQUIREMENTS FOR COUNTYWIDE AGENCIES
REPORTING REQUIREMENTS FOR COUNTYWIDE AGENCIES
Quarterly Report
The purpose of the Quarterly Report is for the Countywide Agencies to report the number of non -Fort
Worth clients who participate in the Program. The Quarterly Report must be submitted with the
December, March, June and September Reimbursement Requests. The submission of the Quarterly
Report is through ZoomGrants. The information provided in the Quarterly Report will be reviewed
and monitored by the Neighborhood Services Department Compliance Division.
A B C D E F
EXAMPLE: 250 200 450 250=450=55%
January 17, 2023 October 1, 2022 —
December 31, 2022
April 15, 2023 January 1, 2023—
March 30, 2023
July 15, 2023 April 1, 2023 —
June 30, 2023
October 3, 2023 July 1, 2023 —
September 30, 2023
TOTAL
I, Agency representative, certify that I verified the information I reported this quarter and it is correct
to the best of my knowledge.
Certified by:
Signature/Title:
CDBG 5 1 % PSA CONTRACT-- EXHIBIT "A-2"
REPORTING REQUIREMENTS FOR COUNTYWIDE AGENCIES
Date:
EXHIBIT "B" - BUDGET
Account I Grant Budget I Balance I Increase I Decrease I Total
PROGRAM PERSONNEL I
I A
I
Salaries
1001
$ 48,000.00
FICA
1002
$ 3,900.00
Life/Disability Insurance
1003
$ 600.00
Health/DentalInsurance
1004
$ 7,000.00
Unemployment -State
1005
$ 350.00
Worker's Compensation
1006
$ 150.00
Retirement
1007
Staff Training
1008
SUPPLIES AND SERVICES
Office/Program Supplies
2001
Postage
2002
Printing
2003
Adv/Media, Dues/Pub, Printing,
Bank Fees
other
2004
MISCELLANEOUS
Contract Labor Food
Supplies/Meals (City needs copy
of contract before expenses can be
reimbursed)
3001
Food Supplies
3002
Teaching Aids
3003
Craft Supplies
3004
Field Trip Expenses
3005
Mileage
3006
FACILITY AND UTILITIES 1-1
Telephone
4001
Electric
4002
Gas
4003
Water and Wastewater
4004
Solid Waste Disposal
4005
Rent (City needs copy of lease
before expenses can be
reimbursed)
4006
Cleaning Supplies
4007
Repairs
4008
Custodial Services
4009
Utilities, Transportation, PP &E
4010
INSURANCE
Fidelity Bond or Equivalent 5001
Directors and Officers 5002
General Commercial Liability 5003
Page 1
Bank fees
volunteer
volunteer
Prof Fees 5004
DIRECT ASSISTANCE
Audit/IT/Legal Volunteer
Recruitment, Misc. 6001
BUDGET TOTAL $ 60,000.00 $ - $ - $ - $ 60,000.00
FUNDING A:
FUNDING B:
FUNDING C:
Page 2
The following tables were created for the purpose of preparing, negotiating, and determining the cost
reasonableness and cost allocation method used by the Agency for the line item budget represented on
the first page of this EXHIBIT "B" — Budget. The information reflected in the tables is to be
considered part of the terms and conditions of the Contract. Agency must have prior written approval
by the City to make changes to any line item in the Budget as outlined in Section 5.2.2 in the
Contract. The deadline to make changes to EXHIBIT "B" — Budget is.
SALARY DETAIL -PROGRAM PERSONNEL
Est. Percent to Amount to
Position Title Annual Salary Grant Grant
Community Resource Specialist $ 96,000.00 50.0% $48,000.00
TOTAL $ 96,000.00 $ 48,000.00
FICA
Life/Disability Insurance
Health/Dental Insurance
Unemployment -State
Worker's Compensation
Retirement
Staff Training
TOTAL
Office/Program Supplies
Postage
Printing
FRINGE DETAIL -PROGRAM PERSONNEL
Percent of
Est. Percent to
Amount to
Payroll
Amount
Grant
Grant
$
7,800.00
50.0%
$
3,900.00
$
1,200.00
50.0%
$
600.00
$
14,000.00
50.0%
$
7,000.00
$
700.00
50.0%
$
350.00
$
300.00
50.0%
$
150.00
$
-
50.0%
$
-
$
-
50.0%
$
-
$
24,000.00
$
12,000.00
SUPPLIES AND SERVICES
Est. Percent to Amount to
Total Budget Grant Grant
Adv/Media, Dues/Pub, Printing, Bank Fees
TOTAL $ -
MISCELLANEOUS
Est. Percent to
Amount to
Total Budget
Grant
Grant
Contract Labor
#DIV/0!
Food Supplies
Teaching Aids
Craft Supplies
Field Trip Expenses
Mileage
TOTAL
$ -
#DIV/0!
$ -
FACILITY AND UTILITIES
Est. Percent to
Amount to
Total Budget
Grant
Grant
Telephone
Electric
Gas
Water and Wastewater
Solid Waste Disposal
Rent
Cleaning Supplies
Repairs
Custodial Services
Utilities, Transportation, PP & E
TOTAL $ -
LEGAL, FINANCIAL AND INSURANCE
Est. Percent to Amount to
Total Budget Grant Grant
Fidelity Bond or Equivalent
Directors and Officers
General Commercial Liability
Prof Fees
TOTAL $ -
DIRECT ASSISTANCE
Est. Percent to Amount to
Total Budget Grant Grant
Audit/IT/Legal Volunteer Recruitment, Misc.
TOTAL $ -
EXHIBIT "C"
AUDIT CERTIFICATION FORM
CDBG PSA CONTRAC'r - EXHIBIT "C" -
AUD1T CERTIFICATION FORM --
AUDIT CERTIFICATION F*RM AND AUDIT REQUIREMENTS
Agency: Tarrant Area Food Bank
Fiscal Year Ending: September 30, 2025
During the fiscal year in which fonds will be received, we will exceed the federal expenditure
threshold of$750,000. We will have our Single Audit or Program Specific Audit completed
and will submit the audit report described in 2 CFR Part 200 within 7 months after the end
of the audited fiscal year or 30 days within its completion, whichever is the earlier date.
LlDuring the fiscal year in which fiinds will be received, we will not exceed the $750,000
federal expenditure threshold required for a Single Audit or a Program Specific Audit to be
performed this fiscal year. (Fill out schedule below)
Total Federal Expenditures for this Fiscal Year:
Signatory and Title bate
Failure to submit this or a similar statement or failure to submit a completed single audit package
as described in the federally required audit requirements described in 2 CFR Part 200, as
applicable, by the required due date may result in suspension of funding and may affect eligibility
for future funding. Notwithstanding the above, this certification acknowledges the agency's
commitment to meet all other financial reporting, financial statements, and other audit
requirements as may be set forth in the Contract.
CDBG PSA CONTRACT - EXHIBIT "C" -- AUDIT CERTIFICATION FORM
Exhibit D
Attachment I- Request Summary
Agency:
Address:
City, State, Zip:
Program:
Month of Service:
Tax ID Number:
Contract Number:
Case ID:
P.O. Number:
FID Number:
IDIS Number:
Amount
Program
Account
Original Amount
This Invoice
Cumulative to Date
Remaining Balance
(Program Name) Case ID
Salaries
1001
$
$
FICA
1002
$
$
$
$
Life/Disability Insurance
1003
$
$
$
$
Health/DentalInsmance
1004
$
$
$
$
Unemployment -State
1005
$
$
$
$
Worker's Compensation
1006
$
$
$
$
Office Supplies
1007
$
$
$
$
Food Supplies
1008
$
$
$
$ -
Insurance
1009
$
$
$
$
Accounting
1010
$
$
$
$
Contract Labor
1011
$
$
$
$
TOTAL
$
$
$
$
Request Summary
Budg
Expenditure
Percentage Spent
Table Total
$
$
#DIV/0!
$
22-Oct
22-Nov
22-Dec
23Jan
23-Feb
23-Mar
23-Apr
23-May
23Jun
23-Jul
23-Aug
23-Sep
$ -
Is -
Is
Is
Is
Is -
Client Goals
Goal Amount
Cumulative Total
Goal Met %
Table Total
0
0
#DIV/0!
0
22-Oct
22-Nov
22-Dec
23Jan
23-Feb
23-Mar
1
0
0
0
0
0
23-Apr
23-May
23Jun
23-Jul
23-Aug
23Sep
0
0
0
0
0
0
Agency:
Program:
ATTACHMENT II
City of Fort Worth
Neighborhood Services Depart
Expenditure Worksheet
Please gr
Line
71
No.
Check No.
Date
Payee
Description/Job Title*
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
Total
*For Salaries, state employee's title under Description/Job Title. Rent must identify tenant
;ment
•oup like account codes.
Account Code
(See Key to
Right) Amount
Only highlighted codes can be reimbursed
Expense Line Item
Account
EMERGENCY SHELTER
ESSENTIAL SERVICES
Salaries
1001
FICA
1002
Life/Disability Insurance
1003
Health/Dental Insurance
1004
Unemployment -State
1005
Worker's Compensation
1006
Office Supplies
1007
Food Supplies
1008
Insurance
1009
Accounting
1010
Contract Labor
1011
Other()
1012
SHELTER OPERATIONS
Maintenance
2001
Security
2002
Insurance
2003
Utilities
2004
Supplies
2005
Repairs
2006
OtherO
2007
HOUSING RELOCATION AND STABILIZATION
PREVENTION
Salaries
3001
FICA
3002
Life/Disability Insurance
3003
Health/Dental Insurance
3004
Unemployment -State
3005
Worker's Compensation
3006
Other()
3007
REHOUSING
Salaries
4001
FICA
4002
Life/Disability Insurance
4003
Health/Dental Insurance
4004
Unemployment -State
4005
Worker's Compensation
4006
OtherO 4007
FINANCIAL ASSISTANCE
PREVENTION
Rental Assistance 1 5001
Utility Payments
5002
REHOUSING
Rental Assistance
6001
Security Deposits
6002
Utility Deposits
6003
Utility Payments
6004
Moving Costs
6005
Motel/Hotel Vouchers 6006
HMIS
HMIS Software Costs 7001
Agency:
Program:
Month:
This report is meant to list all undup
Instructions: tally. Please only list clients one time
staff person in that program. Inforn
1
2
2A
3
FORT
DATE
WORTH
SERVICE
CLIENT
RESIDENT?
LOCATION (IF
NAME
RECEIVED
APPLICABLE)
SERVICE
YES OR NO
2
4
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
licated clients served during the Contract term (October 1, 2022 to September 30, 2023). Each month, please report th
during the first month that they receive service. Clients that continue to receive Program services for multiple months
cation for each client listed below must have the demographic information reflected in columns 1 thru 12.
Undup Clts for CURRENT MONTH
CUMULATIVE Unduplicated Clients
*Proposed Client Goal Per Contract
% of Milestone Met I #DIV/O!
*Do not revise the client goal unless the contract is amended, accordingly.
* Please highlight new cli
4
5
6
11
GENDER
ETHN
(Indicate One)
(Indicai
STREET ADDRESS
(Client Address)
AGE
MALE
FEMALE
HISPANIC
ATTACHMENT III
CLIENT DATA REPORT
e information of clients not previously reported. You are required to attach eligibility verification documental
only need to be listed one time. Put an "X" in each appropriate box regarding the client's sex, ethnicity, race,
Tents for the month.
7
8
ICITY
RACE
to One)
(Indicate One)
NATIVE
AMERICAN
AMERICAN
HAWAIIAN OR
INDIAN OR
INDIAN OR
BLACK OR
OTHER
ALASKAN
NON-
ALASKAN
AFRICAN
PACIFIC
NATIVE AND
ASIAN AND
HISPANIC
NATIVE
ASIAN
AMERICAN
ISLANDER
WHITE
WHITE
WHITE
Lion for each new client. New unduplicated clients should be listed below any previously reported clients so that this shl
etc. Please note that reimbursement for salaries will require that the agency report to the City all the clients that were
9 10 11
DISABLED HH INCOME
(Indicate One) (Only choose 1 of the 5 columns)
<30%AMI 30%-50%AMI 51 %-80%AMI >80% AMI
11 <$20,100
1 <$33,500
1 <$53,600
12<$61,250
1>$ 53,600
2<$23,000
2<$38,300
12>$61,250
BLACK OR
AFRICAN
AMERICAN
AND WHITE
AMERICAN
INDIAN OR
ALASKA
NATIVE AND
BLACK OR
AFRICAN
AMERICAN
OTHER
MULTIPLE
RACE
COMBINAT-
IONS*
YES
NO
HH
SIZE
3<$25,850
3<$43,100
3<$68,900
3>$68,900
4<$28,700
4<$47,850
4<$76,550
4>$76,550
5<$31,000
5<$51,700
5<$82,700
5>$82,700
6<$33,300
6<$55,550
6<$88,880
6>$88,880
7<$35,600
7<$59,350
7<$94,950
7>$94,950
8<$37,900
8<$63,200
8<$101,050
8>$101,050
eet will act as a rolling
served by that particular
EXHIBIT "E"
INCOME CERTIFICATION FORMS
CDBG 51 % PSA CONTRACT -- EXHIBIT "E" -- INCOME CERTIFICATION FORMS Page 1
City of Fort Worth
Applicant Name:
Current Address:
City and Zip:
Last Name
CERTIFICATION OF INCOME STATEMENT
First Name
Phone #:
Household Members and Income
(including applicant)
TOTAL NUMBER OF FAMILY MEMBERS
Total Gross Annual Household Income:
Age Monthly Source of Income
Income $$
(Include Yourself, Spouse, Children, etc.)
PERSONAL INFORMATION: (Check one in each item. This Information is Required for Federal Reporting Purposes)
a. ❑ MALE b. ❑ WHITE ❑ BLACK/AFRICAN AMERICAN ❑ BLACK/AFRICAN AMERICAN & WHITE
❑ FEMALE ❑ AMERICAN INDIAN/ALASKAN NATIVE ❑ ASIAN
❑ AMERICAN INDIAN/ALASKAN NATIVE & WHITE ❑ ASIAN & WHITE
❑ NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER ❑ BALANCE/OTHER
❑ AMERICAN INDIAN/ALASKAN NATIVE & BLACK/AFRICAN AMERICAN
c. ETHNICITY d. DISABLED e. IS HEAD OF HOUSEHOLD FEMALE?
❑ HISPANIC ❑ YES ❑ YES
❑ NON -HISPANIC ❑ NO ❑ NO
Certification: I certify that the information I am providing is true and could be subject to verification at any
time by a third party. I also acknowledge that the provision of false information could leave me subject to the
penalties of Federal, State and local law.
Signature of Applicant Date
WARNING: TITLE 18, SECTION 1001 OF THE U.S. CODE STATES THAT A PERSON IS GUILTY OF A FELONY
FOR KNOWINGLY AND WILLINGLY MAKING FALSE OR FRAUDULENT STATEMENTS TO ANY DEPARTMENT OF
THE UNITED STATES GOVERNMENT.
Household Size:
Applicable Income Limit:
-----------------For use by Agency staff only ------------
Gross Annual Income:
Is Applicant Eligible?
Check if Applicant refused to provide demographic information: O
Staff Assessment of Demographics:
Person Making Determination: Date:
NOTE: Address, income amounts and sources for ALL household members are required.
CDBG 51 % PSA CONTRACT -- EXHIBIT "E" -- INCOME CERTIFICATION FORMS Page 2
Ciudad de Fort Worth
CERTIFICACION DE DECLARACION DE INGRESOS
Nombre del Solicitante:
Direcci6n de Actualidad:
Ciudad y C6digo Postal:
Apellido
Telefono:
Miembros Del Ho2ar e Ingresos
'Incluyendo el/la Solicitante)
Nombre Edad Ingreso Origen de Ingresos
Mensual
* TOTAL NUMERO DE MIEMBROS DEL HOGAR
(Inclfiyase Usted.)
Total, Anual de Ingresos del hogar:
**INFORMACIbN PERSONAL: (Seleccione uno en cada articulo. Esta informaci6n es requerida por el Gobiemo federal.)
a. ❑ MASCULINO b. ❑ BLANCO ❑ NEGRO/AFRICANO AMERICANO ❑ NEGRO/AFRICANO AMERICANO & BLANCO
❑ FEMININO ❑ INDIO AMERICANO/NATIVO DE ALASKA ❑ ASIATICO
❑ INDIO AMERICANO/NATIVO DE ALASKA & BLANCO ❑ ASIATICO & BLANCO
❑ NATIVO HAWAIANO/OTRO DE LAS ISLAS PACIFICAS ❑ BALANCE/OTRO
❑ INDIO AMERICANO / NATIVO DE ALASKA & NEGRO/AFRICANO AMERICANO
c. ETHNICIDAD d. INCAPACITADO e. DES LA CABEZA DEL HOGAR MUJER?
❑ HISPANO ❑ SI ❑ SI
❑ NO-HISPANO ❑ NO ❑ NO
Certificacion: Yo certifico que la informaci6n que yo estoy proporcionando es verdadera y puedo ser sujeto a
verificaci6n a cualquiera hora por tercera parte. Yo tambien reconozco que la provision de informaci6n falsa
puede dejarme sujeto a penalidades Federales, Estatales, y a ley local.
Firma del Solicitante
Fecha
ADVERTENCIA: TITULO 18, SECCION 1001 DEL CODIGO DE LOS ESTADOS UNIDOS INDICA QUE UNA
PERSONA ES CULPABLE DE UN DELITO FOR SABER Y VOLUNTARIAMENTE HACER DECLARACIONES FALSOS O
FRAUDULENTAS A CUALQUIER DEPARTAMENTO DE GOBIERNO DE LOS ESTADOS UNIDOS.
-----------------Para use de empleados de la agencia -----------
# De Miembros de Familia:
Limite de Ingreso:
Ingreso Anual:
�Es solicitante elegible?:
Compruebe si el solicitante se neg6 a dar su informaci6n personal: O
Evaluaci6n del empleado sobre informaci6n personal:
Persona haciendo la determinaci6n: Fecha:
Note: La direccion de la casa y los ingresos (y sus origenes) para todos miembros del hogar son requerido
CDBG 51 % PSA CONTRACT -- EXHIBIT "E" -- INCOME CERTIFICATION FORMS Page 3
EXHIBIT "F"
STANDARDS OF DOCUMENTATION
CDBG 5 1 % PSA CONTRACT -- EXHIBIT "F" -- STANDARDS OF DOCUMENTATION
2022-23 Documentation Standards for
CDBG Public Service Contract Expenses
Employee Salaries and Benefits - City will only reimburse a percentage of any employee's salary and benefits who work directly with the CDBG-funded Program.
Percentages will be cost allocated and determined prior to the execution of the CDBG Contract. Agencies requesting the reimbursement of 100% of any Agency employee
will require prior City approval. Agencies must show calculation on how the CDBG portion of employee salaries and benefits were calculated consistently with the CDBG
Contract.
If an employee works on both a CDBG eligible and non-CDBG eligible program(s), the City will only reimburse for a reasonable portion
of the employee's salary. Prior to the execution of the CDBG Contract, the Agency will priovide the City with a written statement on how
each employee's time will be allocated. If an employee works 100% of their time directly with the CDBG-funded Program, then 100% of
the employee's salary maybe eligible for reimbursement. Agency must submit a written statement that 100% of the employee's time is
spent working directly with the CDBG-funded Program. Statements must be signed by a person authorized to sign on behalf of the
Agency and will be submitted with the October invoice.
Salaries X X
Reimbursement requests must include a timesheet and work log that reflects the hours worked by the employee(s) working directly on
the CDBG-funded Program. For employees who are paid with multiple funding sources, timesheets must reflect all funding sources. If
separate timesheets are kept for each funding source, all such timesheets must be submitted to City. Timesheets must be signed by
employee and supervisor. Agency must show a calculation and documentation of how the employee's salary was calculated and
invoiced to City.
*If employees are paid by direct deposit rather than check, then the agency must submit both the direct deposit payment company's
report (such as an ADT report) and a bank statement or check showing payment to the direct deposit company.
FICA/Medicare X X X
Life Insurance x x x
Health x x x
If the City pays gross salary, this is already included. If the City pays the employer portion, the Agency must provide proof that the
Insurance
employee is enrolled in the benefit plan, must show a calculation and documentation of how the invoiced amount was calculated, and
Disability
must provide documentation showing payment. Invoice and proof of payment are only required with the first reimbursement request and
x x x
Insurance
at any time there are changes to amounts, enrollments, disenrollments, etc.
Unemployment x x x
Insurance
If the City pays gross salary, this is already included. If the City pays the employer portion, the Agency must provide proof that the
Retirement x x x
employee is enrolled in the benefit plan, must show a calculation and documentation of how the invoiced amount was calculated, and
must provide documentation showing payment. Invoice and proof of payment are only required with the first reimbursement request and
at any time there are changes to amounts, enrollments, disenrollments, etc.
_
Materials, Equipment, Goods and Supplies - City will only reimburse for the cost allocated percent or amount spent in support of the CDBG-funded Program. Agencies
requesting reimbursement for these items
will require prior City approval. Agencies must show calculation on how the CDBG portion of these expenses were calculated
consistently with the CDBG Contract.
Office Supplies X X
X
Office
Equipment X X X X
X
Rental
Postage X X
X
Printing X X
X
Construction &
Building X X X
X This category is only available for the REACH Program and Habitat for Humanity.
Materials
Sport and
Recreation X X
X
Equipment
Cleaning X X
X
Supplies
Teaching Aids X X X
Craft Supplies X X X
Food Supplies X X X This category is only available to the Program provided by Meals on Wheels. I
Rent, Utilities and Maintenance - City will only pay for a portion of these expenses. The portion of these expenses will be determined by the square footage attributable to
the CDBG-funded Program and shall be cost -allocated in accordance with the amount of space used for the CDBG-funded Program. These expenses may only be in support
of the CDBG-funded Program. The items listed below require prior City approval and the Agency is required to identify any funding source that pays for the portion of the
expenses that is not paid with CDBG funds. Agencies must show calculation on how the CDBG portion of these expenses were calculated consistently with the CDBG
Contract.
Telephone X X
Gas X X
Water/Wastew X X
ater
Electric X X
Solid Waste )( )( I
CDBG 51 % PSA CONTRACT 2022-2023 Exhibit"F' -- STANDARDS FOR COMPLETE DOCUMENTATION
Facility This item requires approval by the City prior to the execution of the CDBG Contract. Repairs may be categorized as major/minor
Maintenance X X X X rehabilitation projects and must be approved through the full HUD Environmetal Review.
and Repairs
Rent X X X City will pay for a portion of the rent for the Program facility so long as its in proportion to the square footage attributable to the CDBG-
funded program.
Miscellaneous
This item requires prior approval by the City. Prior to the execution of the CDBG Contract, the Agency must submit a written statement
that lists the contract labor services to be used during the Contract term. Agency will submit a memo related to the procurement of such
Contract Labor X X X X X services and will forward any information pertaining to the procurement process to City. This requirement applies to, but is not limited to,
services retained for security services, legal, accounting, transportation providers, educational facilitators, custodial services, etc.
Agencies may not use the contract services of any City of Fort Worth Department.
City -required X X City will only pay for a percentage of the City -required insurance so long as it's in proportion to the square footage attributable to the
Insurance CDBG-funded program.
City requires that the agency submit its fee schedule or formula on how the Agency calculates the childcare scholarship amount. The
fee schedule/formula should demonstrate a breakout of income levels, and for each income level the schedule should demonstrate
Childcare X X
which portion of the expense is to be paid by the family and which portion of the expense is to be reimbursed by the City. A fee
Scholarships
schedule/formula must be submitted to the City prior to the first payment. Agency must submit documentation supporting that the client
is income eligible and that the household is being charged in conformance with the fee schedule. If the fee schedule/formula changes at
any time during the contract term, the Agency must immediately notify City on the date the new fee schedule/formula takes into effect.
"$0" Income
Agecies that are required to verify and provide proof of household income to determine eligibility, must require that anyone who is over
Certifications
the age of 18, living in the housohold, submit a $0 Income Certification.
If an audit is required because federal funds exceed $750,000, then the cost should be split evenly by all grant funding sources. Agency
Audit Services X X X X
must show calculation on how the CDBG portion of the accounting services were calculated. For example, if the CDBG grant is 10% of
your Agency's budget, then invoice shall not exceed 10% of the overall cost. Agency must show a calculation and documentation of
how the invoiced amount was calculated, and must provide documentation showing payment.
*Proof of payment effective October 1, 2023:
Payments or Expenses must be documented in the following manner:
A) Image of the check AND bank statement showing the check cleared the bank; OR,
B) Image of the cancelled check (ex. At end of bank statement); OR,
C) Payroll Check Stub, "Advice", or Statement AND Bank Statement indicating payroll; OR,
D) For wire or e-transfers: Reciept or statement from payee/vendor OR bank statement.
Revised as of 09-14-2020 SK
CDBG 51 % PSA CONTRACT 2022-2023 Exhibit"F" -- STANDARDS FOR COMPLETE DOCUMENTATION
EXHIBIT "G"
SECTION 3 REPORTING FORMS
NOT APPLICABLE
CDBG 51 % PSA CONTRACT -- EXHIBIT "G" -- SECTION 3 REPORTING FORMS Page 1
EXHIBIT "H"
SEVERELY DISABLED CERTIFICATION FORM
CDBG 51 % PSA CONTRACT - EXHIBIT "H" - SEVERELY DISABLED CERTIFICATION FORM
CERTIFICATION FORM
DOCUMENTING CLIENT STATUS AS "SEVERELY DISABLED ADULT"
Client Name:
Address:
City, State, Zip
Client Identification No.
CHECK ALL THAT APPLY
❑ Has used a wheelchair, a walker, cane , crutches or other special aid for six
months or longer
Has been diagnosed with one of the following conditions: Alzheimer's disease,
❑ mental retardation or other developmental disability, senility or dementia,
cerebral palsy, or autism; or has another mental or emotional condition that
seriously interferes with everyday tasks.
Is unable to perform one or more of the following "Functional Activities":
❑ seeing, hearing, speaking and having one's speech understood, lifting or
carrying, using stairs, grasping small objects, or walking.
Is unable to perform or needs assistance to perform one or more of the following
❑ Activities of Daily Living (ADL): getting around inside the home, getting in or
out of bed or a chair, bathing, dressing, eating, and toileting.
Is unable to perform or needs assistance to perform one or more of the following
Instrumental Activities of Daily Living (IADL): going outside the home,
❑ keeping track of money and bills, preparing meals, doing light housework,
taking prescription medications in the right amount and at the right time, and
using the telephone.
❑ Has a condition that prevents them from working at a job or doing housework.
The undersigned Agency representative conducted a visual assessment of the client identified on this
form and certifies that the client meets at least one of the conditions indicated above, which
determines that he/ she meets the definition of "severely disabled" according to the U.S. Census
Bureau.
Certified by:
Signature/Title:
Date:
CFW Neighborhood Services Dept.: Revised 08/29/2019
CDBG 51 % PSA CONTRACT - EXHIBIT "H" - SEVERELY DISABLED CERTIFICATION FORM
EXHIBIT "I"
MBE REPORTING FORM
CDBG 5 1 % PSA CONTRACT -- EXHIBIT "I" -- MBE REPORTING FORM Page 1
Contract and Subcontract Activity U.S. Department of Housing and Urban Development OMB Approval No.: 2577-0088 OMB
Approval No.: 2502-0355
Public reporting burden for this collection of information is estimated to average .5 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The
Information is voluntary. HUD may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB Control Number.
Executive Orders dated July 14, 1983, directs the Minority Business Development Plans shall be developed by each Federal Agency and the these annual plans shall establish minority business development objectives. The information is used by HUD to monitor and evaluate MBE activities against
the total program activity and the designated minority business enterprise (MBE) goals. The Department requires the information to provide guidance and oversight for programs for the development of minority business enterprise concerning Minority Business Development. If the information is
not collected HUD would not be able to establish meaningful MBE goals nor evaluate MBE performance against these goals.
Privacy Act Notice = The United States Department of Housing and Urban Development, Federal Housing Administration, is authorized to solicit the Information requested in this form by virtue of Title 12, United States Code, Section 1701 et seq., and regulation. It will not be disclosed or
relesed outside the United States Department of Housing and Urban Development without your consent, except as required or permitted by Law.
1. Grantee/Project Owner/Developer/Spomor/Builder/Agency
Check if 2. Location (City, State Zip Code)
PH
IH
CPD
Housing
3a. Name of Contact Person
3b. Phone Number (Including Area Code)
4. Reporting
Period
5. Program Code (Not applicable for CPD programs.)
6. Date Submitted to Field Office
See explanation of Codes at bottom of Page Use a
❑
❑
Oct. 1 - Sept. 30 (Annual -FY)
separate sheet for each program code.
Contractor or
Grant/Project Number or HUD
Subcontractor
Case Number or other
Amount of Type of Trade
Business
Subcontractor
Contractor/Subcontractor Name and Address
identification of property,
Contract or Code
Racial/Ethnic
Woman Owned Business Prime Contractor Identification (ID)
Identification (ID)
7j.
subdivision, dwelling unit, etc.
Subcontact (See below)
(See below)
(Yes or No) Number
See. 3
Number See. 3
7a.
7b. 7c.
7d.
7e. 7f.
7g.
7h 7i.
Name Street City State Zip
CPD:
I = New Construction
2 = Education/Traming
3 = Other
7c: Type of Trade Codes:
Housing/Public Housing:
1 —New Construction 6 = Professional
2 — Substantial Rehab. 7 = Tenant Services
3 — Repair 8 = Education/Traming
4 = Service 9 = Arch./Engrg. Appraisal
5 — Project Mangt. 0 = Other
7d: Racial/Ethnic Codes: 5: Program Codes (Complete for Housing and Public and Indian Housing programs only):
1 = White Americans
1 = All Insured, including Sections
5 = Section 202
2 = Black Americans
2= Flexible Subsidy
6 = ITUD-Held (Management)
3 = Native Americans
3 = Section 8 Noninsured, Non-HFDA
7 — Public/India Housing
4 = Hispanic Americans
4 = Insured (Management)
8 — Section 811
5=Asian/Pacific Americans
6 = Hasidic Jews
Previous editions are obsolete. form HUD-2516 (8/98)
EXHIBIT "J"
DUTIES OF THE PARTIES
USE OF NEIGH ORHOOD SERVICES DEPARTMENT
COMMUNITY CENTERS
CDBG 5 1 % PSA CONTRACT - EXHIBIT "J" - DUTIES OF THE PARTIES - USE OF NEIGHBORHOOD SERVICES
DEPARTMENT COMMUNITY CENTERS
DUTIES OF THE PARTIES
USE OF NEIGHBORHOOD SERVICES DEPARTMENT
COMMUNITY CENTERS
Mencv's Responsibilities:
Agency will perform the following in relation with the use of Community Center:
• Agency will furnish the Center Coordinator with a schedule of Program activities at least four weeks
prior to their occurrence.
• Agency will, at its sole expense, furnish materials, supplies, copies and conduct a structured Program.
• Agency will ensure that the designated Community Center space is maintained in a neat and orderly
fashion.
• Agency will ensure that the City's standards are maintained regarding security; cleanliness and
communication between and among programs housed at the Community Center and will ensure
cooperation with other Community Center staff and agencies/programs.
• Agency will report to the Center Coordinator or designee for problems immediately if/when problems
occur.
• Agency will work with the Center Coordinator or designee to schedule any use of the Community
Center for related activities outside of agencies designated meeting time and/or the Community
Center's regular days and hours.
• Agency will maintain sole responsibility and liability for its employees, volunteers and separate
contractors for their actions.
• Agency shall ensure that each of its employees, volunteers and participants desiring to participate in
Community Center -sponsored programs/activities are aware of the requirement to have a current
community center membership card to participate.
• Agency agrees to perform background screenings and checks on staff and volunteers, with such
screenings and checks meeting or exceeding the requirements that the City imposes for checks and
screenings on staff, volunteers and participants in the City's own programs.
• Agency will provide the Center Coordinator with designated staff contact information for the
purposes of emergencies (center closing, schedule changes or scheduled maintenance)
CDBG 5 1 % PSA CONTRACT - EXHIBIT "J" - DUTIES OF THE PARTIES - USE OF NEIGHBORHOOD SERVICES
DEPARTMENT COMMUNITY CENTERS
Citv's Resuonsibilities:
City will perform the following in relation with Agency's use of a Community Center:
• City will provide space for conducting the Program, including basic utilities and will also supply the
Agency with appropriate facility access. For purposes of this Contract, basic utilities shall not include
telephone or computer service, which shall remain the sole responsibility of the Agency.
• City will ensure that the reserved space is set up with appropriate tables and chairs to accommodate
program and/or services.
• City will not be responsible for any additional security other than what is currently available at the
Community Center.
• City assumes no liability or responsibility for the loss of any personal property or office contents of
the Agency, its agents, employees, volunteers, participants or licensees while at the Community
Center.
• City will allow the Agency to conduct properly scheduled classes and other Program related activities
during the days and hours specified in Exhibit "A" PROGRAM SUMMARY*. In addition, City
may, but is not required, through the Center Coordinator, allow Agency to schedule other classes and
Program related activities outside of the days and hours specified in Exhibit "A" PROGRAM
SUMMARY.
• City will maintain sole responsibility and liability for its employees, volunteers and separate
contractors for their actions.
• City will have the discretion to put the Agency in any available room. If placed in a different location,
it is to be only one room.
*The City is closed in observance of the following holidays:
New Year's Day (January I")
M.L.K. Jr. Day (Third Monday of January)
Memorial Day (Last Monday in May)
Juneteenth (June 19ffi)
Independence Day (July 41n)
Labor Day (First Monday in September)
Thanksgiving Day (Fourth Thursday of November)
Day after Thanksgiving (Fourth Friday in November)
Christmas Day (December 251n)
"City of Fort Worth observes the above holidays on Friday if they fall on Saturday and on a Monday if they fall on
Sunday.
Additionally, the Community Centers are utilized as shelters during an emergency. If the Community
Center will be closed due to an emergency, Center Coordinator or designee will inform Agency of the
closure.
CDBG 5 1 % PSA CONTRACT - EXHIBIT "J" - DUTIES OF THE PARTIES - USE OF NEIGHBORHOOD SERVICES
DEPARTMENT COMMUNITY CENTERS
EXHIBIT "K"
NOTICE OF BENEFICIARY RIGHTS
CDBG 51 % PSA CONTRACT- EXHIBIT "K" - NOTICE OF BENEFICIARY RIGHTS
Notice of Beneficiary Riehts
Name of Agency:
Name of Program:
Contact information for Program Staff (name, phone number, and e-mail address, if appropriate):
Because this program is supported in whole or in part by direct Federal financial assistance from
the Federal Government, we are required to let you know that:
• We may not discriminate against you on the basis of religion, religious belief, a refusal
to hold a religious belief, or a refusal to attend or participate in a religious practice;
• We may not require you to attend or participate in any explicitly religious activities that
are offered by us and any participation by you in these activities must be purely
voluntary;
• We must separate, in time or location, any privately funded explicitly religious activities
from activities supported by direct Federal financial assistance;
• If you object to the religious character of our organization, we must make reasonable
efforts to identify and refer you to an alternative provider to which you have no such
objection; and
• You may report an organization's violations of these protections, including any denial of
services or benefits, by contacting or filing a written complaint to HUD [or the
intermediary, if applicable].
We must give you this written notice before you enroll in our program or activity, as required by
24 CFR 5.109.
CDBG 51 % PSA CONTRACT- EXHIBIT "K" - NOTICE OF BENEFICIARY RIGHTS
City of Fort Worth, Texas
Mayor and Council Communication
DATE: 06/27/23 M&C FILE NUMBER: M&C 23-0594
LOG NAME: 19NS CARES ACT HUD FUNDS REALLOCATION
SUBJECT
(ALL) Authorize a Change in Use and Adjust Existing Appropriations in the CARES Act Community Development Block Grant Funds in the
Amount of $800,000.00 to Fund Particular Programs and Activities; Approve a Substantial Amendment to the City of Fort Worth's 2019-2020
Annual Action Plan for the Use of Federal Grant Funds in the Amount of $800,000.00 from the Coronavirus Aid, Relief, and Economic Security Act
Community Development Block Grant Program; and Authorize Execution of Related Contracts
RECOMMENDATION:
It is recommended that City Council:
1. Authorize a change in use and adjust existing appropriations in the CARES Act Community Development Block Grant Funds in the amount
of $800,000.00 to fund particular programs and activities;
2. Approve a Substantial Amendment to the City of Fort Worth's 2019-2020 Annual Action Plan for submission to the U.S. Department of
Housing and Urban Development for the use of federal grant funds in the amount of $800,000.00 to be awarded through the CARES Act
Community Development Block Grant program, including allocations of grant funds to particular programs and activities as detailed below;
3. Authorize the City Manager or his designee to execute contracts for eighteen -month terms with the nonprofit agencies listed in Table 1 below
for CARES Act Community Development Block Grant funds, contingent upon receipt of funding and satisfactory completion of all regulatory
requirements; and
4. Authorize the City Manager or his designee to extend contracts for up to one year if an agency or department requests an extension and
such extension is necessary for completion of the program, or to amend contracts if necessary to achieve program goals, provided any
amendment is within the scope of the program and complies with City policies and all applicable laws and regulations governing the use of
federal grant funds.
DISCUSSION:
In June 2020, the City of Fort Worth was awarded $4,360,291.00 in CARES Act CDBG-CV funds and in September 2020 was awarded
$5,468,206.00 in CARES Act CDBG-CV3 funds to provide services to low and moderate -income residents to prevent, prepare, and respond to
the impact of the Coronavirus Pandemic. The Fort Worth City Council subsequently awarded these funds to local nonprofit organizations
providing a variety of urgently needed COVID-19-related services to eligible populations.
Additional funding has been made available through unprogrammed funding previously allocated to organizations with unexpended balances and
reallocated administrative funds totaling $800,000.00. It is recommended that these funds be awarded directly to agencies for the activities listed
in Table 1 below addressing the following three priority activities:
• Elderly Services/Aging in Place
• Employment Related Services
• Food Insecurity
On May 19,2020, City Council approved a Substantial Amendment to the City's 2019-20 Action Plan for U.S. Department of Housing and Urban
Development (HUD) grant funds stating how CARES Act grant funds were to be used, and amended the Citizen Participation Plan to reduce
public comment period for CARES Act funds from thirty days to five days as authorized by the CARES Act (M&C 20-0330). This 5-day public
comment period was held from June 6, 2023 to June 13, 2023. Notice of this public comment period was published in the Fort Worth Star -
Telegram, posted on the City's website and other ongoing communications activities of the Communications and Public Engagement Office. Any
comments received are maintained by the Neighborhood Services Department in accordance with federal regulations.
TABLE 1: CDBG-CV AGENCIES
Center for Transforming
Lives
Tarrant Area Food Bank
Meals -On -Wheels, Inc. of
Tarrant County
The Presbyterian Night
Shelter of Tarrant County, Inc.
PROGRAM
Economic Mobility
Program (Microenterprise)
Grocery Delivery (SNAP
Participants)
Transportation Program
Journey Home Guides
FUNDING AMOUNT
SOURCE
CDBG-CV $100,000.00
CDBG-CV3 $60,000.00
CDBG-CV3 $350,000.00
CDBG-CV3 $290,000.00
ITOTAL CDBG-CV CONTRACTS $800,000.00
These programs are available in ALL COUNCIL DISTRICTS.
FISCAL INFORMATION / CERTIFICATION:
The Director of Finance certifies that approval of these recommendations will have no material effect on City funds.
Submitted for Citv Manaaer's Office by
Oriainatina Business Unit Head
Additional Information Contact:
Expedited
Fernando Costa
6122
Victor Turner
8187
Sharon Burkley
5785
Terrance Jones
7563