HomeMy WebLinkAboutContract 44868 ciTy c L)LU
CONT'RACT NO.
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 Lena Pope Home, Inc. (hereafter "Agency"), a Texas
nonprofit 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-13-MC-48-0010, Catalog of Federal
Domestic Assistance No. 14.218;
WHEREAS, a national objective of the CDBG program is to benefit low and
moderate income citizens in accordance with 24 CFR Part 570.200 (a)(2); ;
WHEREAS, Agency submitted a proposal to use CDBG ftinds for an eligible
program under the CDBG Regulations whereby Agency will provide services to low and
moderate income City citizens;
WHEREAS, City citizens, the Community Development Council, and the City
Council have determined that CDBG programs are needed by the City's citizens;
NOW, THEREFORE, the Parties understand and agree as follows:
1. INCORPORATION OF RECITALS.
City and Agency hereby agree that the 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 2013 income
limits are attached hereto as Exhibit "A-111—2013 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. OFF"ICI
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CDBG PSA CONTRACT 2013-2014-LENA POPE HOME,INC.
Complete Documentation means the following documentation as applicable:
• Attachments 1, 11, and 111, with supporting documentation including:
o Proof of expense: copies of timesheets, invoices, leases, set-vice
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 sufficient to
show that clients participating in the Program are CDBG Eligible
Clients; or (ii) documentation other than Source Documentation to
show that clients served by the Program are CDBG Eligible
Clients.
• 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 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 verified by either Source
Documentation or the form in Exhibit "E" - Form of Income Self-Certification.
Agencies Serving 100% Clientele must follow the requirements set forth in Section 6.1.3.
CDBG Funds means the CDBG 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.
DBE means disadvantaged business enterprise.
Director means the Director of the City's Housing and Economic Development
Department.
Effective Date means October 1, 2013.
HED Department means the City's Housing and Economic Development Department.
HUD means the United States Department of Housing and Urban Development.
CDBG PSA CONTRACT 2013-2014-LENA POPE HOME,INC. 2
IDIS means HUD's Integrated Disbursement Information System.
National Objective means at least 51% of the clients served under this Contract must
have incomes at or below 80 % of AMI in accordance with 24 CFR 570.208(a)(2).
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 any documentation allowed under the definition of annual
income in 24 CFR Part 5.609
Unduplicated Clients means a count of CDBG Eligible Clients served once in the
Contract Term. CDBG Eligible Clients served more than once in the Contract Term will
only be counted once when determining the number of Unduplicated Clients.
3. TERM.
The term of this Contract begins on October 1, 2013 and terminates on September
30, 2014 unless earlier terminated as provided in this Contract.
4. DUTIES AND RESPONSIBILITIES OF CITY.
4.1 Provide CDBG Funds.
City shall provide -up to EIGHTY-TWO THOUSAND THREE HUNDRED
TWENTY-SIX and 00/100 Dollars ($82,326.00) of CDBG Funds on a reimbursement of
expenses basis,under the terrns and conditions herein.
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.
S. 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 Funds.
5.2.1. Compliance with CDBG Regulations and Contract.
Agency shall be reimbursed for eligible Program costs with CDBG Funds only if
City determines in its sole discretion that:
CDBG PSA CONTRACT 2013-2014-LENA POPE HOME,INC. 3
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 is submitted to City by Agency.
5.2.2 Budget.
Agency agrees that CDBG Funds will be paid on a reimbursement basis in
accordance with Exhibit "B" - Budget. 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 such
requests 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 Budget
amendment (as approved, the "Amended Budget"), then the Amended Budget will take
effect on the first day of the month following the month in which it was approved by
Director, unless otherwise specified in the amendment. All requests for Budget
amendments must be submitted by August 15, 2014,
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 funds available under this Contract to
supplement rather than supplant funds, otherwise available for
use in the Program.
5.2.4 Payment of CDBG Funds to Agency.
CDBG Funds will be disbursed to Agency upon City's approval of Agency's
written and signed 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 September 20, 2014, City may hold back a small
amount of the CDBG Funds until the end of the ten-n. During this interim period, Agency
must continue to submit Reimbursement Requests with an invoiced amount of$0. It is
expressly agreed by the Parties that any CDBG Funds either not spent or not approved for
reimbursement to Agency shall remain with City.
CDBG PSA CONTRACT 2013-2014-LENA POPE HOME,INC. 4
5.3 Program Performance Milestones.
Agency warrants that the Program will achieve the following milestones:
i
//ii/iii%/
3 27.27% 27.27%
6 54.54% 54.54%
8 72.72% 72.72%
11 100% 100%
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 at its sole option to delay or withhold
payment of Reimbursement Requests, to lower Agency's allocation of CDBG Funds, or
to terminate this Contract.
5.4 Identify Program Expenses Paid with CDBG Funds.
Agency will keep accounts and records in such a manner that City may readily
identify and account for Program expenses reimbursed with CDBG 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 certifies that the activities carried out under the Program and this Contract
will meet the National Objective.
6. CLIENT ELIGIBILITY VERIFICATION.
6.1 Client Eligibility.
Agency will document the eligibility of all prospective clients. Agency will
document client eligibility using the specific method described below in Section
6.1,2. All other subsections of this Section 6.1 are not applicable to Agency under
this Contract.
6.1.1 Agencies Serving a Presumed Benefit Clientele.
Agency must document that all clients served fall under a "presumed benefit"
category as defined in 24 CFR 570. Relevant categories of presumed benefit are:
severely disabled adults, homeless persons, abused or neglected children and youth or
elderly persons. Eligible forms of documentation include:
6.1.1.1 Severely Disabled Adults, Agency form, approved by the
City, filled out by Agency staff or the CDBG Client indicating
client meets the Census definition of"severely disabled." As
an acceptable alternative, Agency may use the form attached
CDBG PSA CONTRACT 2013-2014-LENA POPE HOME,INC. 5
hereto as Exhibit 111111 — Severely Disabled Certification
Form.
6.1.1.2 Homeless Persons. Written, signed and dated certification
from an outreach worker.
6.1.1.3 Abused or Neglected Children and Youth. Written, signed
and dated certification from an outreach worker.
6.1.1.4 Elderly Persons. A birth certificate, driver's license, passport,
immigration card, n-fflitary identification, or any other state,
local, national or international documentation, provided it
contains current information about the age or birth of the
possessor. The form in Exhibit "E" — Form of Income Self
Certification also requires that potential clients list their age
and certify the validity of the information provided. This may
be sufficient but should only be used as a last resort with an
explanation in the file case notes indicating why the formal
forms of verification were not available. An elderly person is
defined as being at least 62 years of age.
6.1.2 Agencies Serving a General Clientele.
Agency must verify all new clients' income eligibility with either Source
Documentation or the form attached as Exhibit "E" — Form of Income Self
Certification. Agency must use the annual income definition in 24 CFR 5.609 to
establish client income eligibility and must use the most current HUD Income
Guidelines. All clients' income must be documented, but only 51% of clients must meet
income eligibility requirements described in 24 CFR 5.609.
6.1.3 Agencies Serving 100% Clientele.
Agency must verify income eligibility of all Unduplicated Clients with Source
Documentation. Source Documentation must be collected and maintained in Agency
files even if Agency reports income eligibility using the form attached as Exhibit "E" —
Form of Income Self Certification.
6.2 Submission of Complete Documentation.
Agency must submit copies of all eligibility verification documentation described
in Section 6.1 with Attachment III in each month's Reimbursement Request for all
Unduplicated Clients served for the first time, and must maintain copies of such
documentation as required under this Contract.
7. Additional CDBG Requirements.
Agency agrees to comply with all requirements of the CDBG Program as stated in
the CDBG Regulations, including but not limited to the following:
7.1 Environmental Review.
CDBG PSA CONTRACT 2013-2014-LENA POPE HOME,INC. 6
CDBG Funds will not be paid, and costs cannot be incurred until City has
conducted and completed an environmental review 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 (1) cause this Contract to terminate immediately; and
(ii) require Agency to repay to City the CBDG Funds it has already received and forfeit
any future payments of CDBG Funds.
7.1,2 Environmental Mitigation.
If applicable, Agency must take the mitigation actions outlined in Exhibit "A-2"
— Environmental Mitigation Actions. Failure to complete the required mitigation
action is an event of default under this Contract.
7.2 Contract Not Constitutinp,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
environmental review and receipt by City of an authorization to use grant funds from
HUD under 24 CFR Part 58, (11) approval of City's 2013-2014 Action Plan, and (iii)
receipt by City of grant agreement from HUD.
7.3 Monitoring.
7.3.1 Agency understands and agrees that City will monitor the adequacy and
timeliness of Agency's performance under the terms of this Contract as well as its
compliance with the CDBG Regulations. 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 for during this 5 year
period. For purposes of this Contract, this 5 year period for monitoring is deemed to
begin on October 1, 2014 and end on September 30, 2019 regardless of whether or not
this Contract is earlier terminated.
7.3,2 Representatives of City, HUD, 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 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. After each
monitoring visit, City shall provide Agency with a written report of the monitor's
findings. 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.
CDBG PSA CONTRACT 2013-2014-LENA POPE HOME,INC. 7
7.3'4 Agency agrees to likewise monitor the effectiveness uf the services and
work Lobe performed bv its contractors, subcontractors and vendors.
7.3.5 This Section 7.3 obeU Survive the earlier termination or expiration of this
Contract.
7.4 AiZency Procurement Standards.
Agency shall comply with all applicable federal, state and local laws, regulations,
and ordinances for making procurements under this CooLoucL Agency shall establish
procurement procedures to ensure that materials and services are obtained in u cost
effective nuuuoer. When procuring services to be provided under this Contract, Agency
shall comply at a minimum with the procurement standards at 24 CFR Part 8440 through
24CFDL Part Q4.48.
7.5 Cost Principles/Cost Reasonableness.
Agency shall udodoiutcr its use of CZ)8(] Funds in compliance with ()MB
Circular }\-122, "Cost Principles for Non-Profit()rgaoizaLionS", as uozcuded from time to
time. The aliVvvubi|ityof costs incurred for per5oona000rendered shall bo determined io
accordance with ()N4B Circular A-122 as supplemented by the provisions of this
Contract.
7.6 Accountin Standards.
Agency ug,ecu to comply with {)MB Circular A-)lA, "Uniform Adouioiutnsdvn
Ilogoirenuouts for [},uots and }\greoruouLs with Institutions of Higher Education,
I{oupi1o|s and other Non-Profit {)rgooizutionu", and ugrcou to adhere to the accounting
principles and procedures required therein, utilize adequate iu[ecua\ coubn\m' and
maintain necessary supporting and back-tip documentation for all costs incurred.
7.7 Uniform Administrative Requirements-
Agency will comply with the Uniform Ado-Lioiybutivc Requirements act forth in
24CF}tPart 57.502 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, abu\| apply to any and all contractors, subcontractors and vendors of
Agency which are in any way paid with CI)BG 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 u part of any contract or subcontract executed in the
po,{oon&oce of its obligations hereunder including its obligations regarding the CT)BG
Regulations. Agency shall monitor the services and work performed by its 0001zmctnry,
subcontractors and vendors on u regular huuim for compliance with the CI)BG
Regulations and Contract provisions. Agency must cure all violations of the CDBG
Regulations committed by its contractors, subcontractors 0rvendors. City maintains the
right to insist on Agency's full compliance with the terms of this Contract and the CI)8C}
Regulations and Agency is responsible for such compliance regardless of whether actions
CDBOpSA CONTRACT 2Ol3-28l4-LENA POPE HOME,INC. 8
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,
7.9 Copyright 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 flights to invention or discovery, as well as rights in data,
which may arise as a result of Agency's performance under this Contract.
8. RECORD KEEPING, REPORTING AND DOCUMENTATION
REQUIREMENTS; AUDIT.
8.1 Record Keening.
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
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 October 1, 2014
and end on September 30, 2019 regardless of whether or not this Contract is earlier
terminated.
8.2 Access to Records.
City 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 October 1, 2014 and end on September 30, 2019 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.
8.4 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
CDBG PSA CONTRACT 2013-2014-LENA POPE HOME,INC. 9
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 $500,000 or more in Federal Funds Per Year.
All non-federal entities that expend $500,000 or more in Federal funds within one
year, regardless of the source of the Federal award, must submit to City an annual audit
prepared in accordance with specific reference to OMB Circular A-133. 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 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 $500,000 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 City 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 October 1, 2014 and end on September 30,
2019 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 with-hold further funding under
this Contract and/or any future 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.
Each Reimbursement Request shall 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 IS. 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.
CDBG PSA CONTRACT 2013-2014-LENA POPE HOME, INC. 10
NOTWITHSTANDING ANYTHING ABOVE, EXPENSES FOR SEPTEMBER
2014 MUST BE RECEIVED BY SEPTEMBER 20, 2014. FAILURE TO SUBMIT
A FINAL REIMBURSEMENT REQUEST BY SEPTEMBER 20, 2014 WILL
RESULT IN AUTOMATIC FORFEITURE OF PAYMENT OF THE
SEPTEMBER REIMBURSEMENT REQUEST.
9.2 Agency shall provide City with Complete Documentation and the
following reports as shown in Exhibit "D11 —Reimbursement Forms with each
Reimbursement Request:
9.2.1 Attachment I—Invoice.
This report shall contain the amount requested for reimbursement each month, the
cumulative reimbursement requested to date (inclusive of that month's request), and must
be signed by an authorized signatory of Agency. By signing Attachment 1, Agency is
certifying that the costs are valid, eligible, consistent with the terms and conditions of this
Contract, and the data contained in the report is true and correct. This report must be
submitted even if Agency is requesting $0 for a particular month.
9.2.2 Attachment 11—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
Attachment 11. 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-funded time and
non-CDBG funded time and reflect actual time spent on
CDBG-funded activities.
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.
9.2.2.3 Proof that cacti 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 contain a list of all
clients served during the Contract period. 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 he or she is served, which will either be the
Source Documentation described in Section 6.1 or the
completed form attached hereto as Exhibit "E" - Form of
CDBG PSA CONTRACT 2013-2014-LENA POPE HOME,INC. I I
Income Self Certification. AGENCIES SERVING 100%
CLIENTELE MUST FOLLOW THE REQUIREMENTS
SET FORTH IN SECTION 6.1.3.
9.3 Withholding Payment.
CITY HAS NO OBLIGATION TO MAKE PAYMENT ON ANY
REIMBURSEMENT REQUEST THAT IS NOT RECEIVED BY THE DUE DATE.
Failure to timely submit 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 Required Documentation
10.1.1 If Agency fails to submit a Reimbursement Request, or if the
submitted Reimbursement Request is incomplete or otherwise not in compliance with this
Contract or CDBG Regulations as determined by City in its sole discretion, Agency shall
be in default of this Contract. City will notify Agency in Writing of such default and the
Agency will have 10 calendar days from the date of the written notice to submit or
resubmit any such Reimbursement Request to cure the default. If Agency falls to cure
the default within such time, Agency shall forfeit any payments otherwise due that
month.
10.1.2 NOTWITHSTANDING THE PROVISIONS OF SECTION
10.1.1, IF AGENCY FAILS TO SUBMIT THE REIMBURSEMENT REQUEST
DUE SEPTEMBER 20, 2014, OR IF THE SUBMITTED REIMBURSEMENT
REQUEST FOR SEPTEMBER 20, 2014 IS LATE, INCOMPLETE OR
OTHERWISE NOT IN COMPLIANCE WITH THIS CONTRACT OR CDBG
REGULATIONS AS DETERMINED BY CITY IN ITS SOLE DISCRETION,
THERE WILL BE NO CURE PERIOD AND ANY REIMBURSEMENT WILL BE
AUTOMATICALLY FORFEITED.
10.1.3 In the event of(i) an uncured default under Section 10.1.1 or (11) more
than 2 instances of default, cured or uncured, under such Section, 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 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 tcri-nination under this Section 10.1, all CDBG Funds
awarded but unpaid to Agency pursuant to this Contract shall be immediately forfeited
and Agency shall have no further right to such funds.
CDBG PSA CONTRACT 2013-2014-LENA POPE HOME,INC. 12
|OZ Failure to Maintain Records or Submit Roorts and
If Agency fails to maintain all records and documentation as required in Section
8, or if the maintained orusubmitted report or documentation is not in compliance with
this [bobmot or the CDBG Regulations as determined by City in its uo|c 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 toi|u to ozuiutuiu the
required reports or documentation, or fails to submit or resubmit any such report or
documentation within such time, City shall have the right Co terminate this Contract
effective immediately upon written notice of such ioLoot with no penalty or liability to
City.
10.2.1 In the event of termination under this Section 10.2, all CDBG Funds
awarded but unpaid to Agency pursuant to this Contract mba1| be immediately forfeited
and Agency mhu|| have no further right tm such funds, and any CDB(} Funds paid to
Agency must be repaid to City within 30 days of termination. If such CZ)BQ funds are
not repaid to City vvidbiu the 30 day period, City obai| exercise all legal remedies
available under this Contract.
|O.3 In General.
Subject to Section lO.), and uu|osa ayooiOoa\ly provided otherwise in this
Contract, Agency shall be in default under this Contract if Agency breaches any term or
condition of this ConbuoL In the event that such u breach remains uncured after 30
calendar days following written notice hy City (or such other notice period as may be
specified herein) or, if Agency has diligently and 000iiuuoom|y attempted to uuzu
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\ teooinute
this Contract effective immediately upon written notice of such intent to Agency, or (iii)
pursue any other legal remedies available toCity.
10.3.1 In the event of termination under this Soudnu 10.3, all CZ)BG Funds
awarded but unpaid to Agency pursuant to this Contract sbu|} be immediately forfeited
and Agency shall have uo further right to such funds, and any CDI9(] Funds al-ready paid
io Agency must berepaid to City within 3A days nf the termination. [f such CDB[; funds
are not repaid to City within the 30 day period, City mbu|\ exercise all legal ,onocdirn
available tinder this Cunt,uoL
10.4 No Funds Disbursed while in Breach.
Agency understands and agrees that no CDBG 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.
CDBG9S6 CONTRACT 2Ol3-20l4-L5N/\POPE HOME,INC. 13
10.6 Rights of City 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. Such termination
does not terminate any provisions of this Contract that have been expressly noted as
surviving the term or termination of the Contract.
10.7 Waiver of Breach Not Waiver of Subsequent Breach.
The waiver of a default or breach of any teen, 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 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 Funds already paid to Agency must be repaid
to City within 30 days of termination. Failure to repay such CDBG Funds within 30 days
will result in City exercising all legal remedies available to City under this Conti-act.
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 Funds substantially in accordance with this Contract.
10.10 Termination for Convenience.
In terminating in accordance with 24 C.F.R. 85.44 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 the Agency upon 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 Funds to be spent will not accomplish the
purposes for which the Contract was made.
CDBG PSA CONTRACT 2013-2014-LENA POPE HOME,INC. 14
|O]| Dissolution of A2ency Terminates Contract.
In the event Agency is dissolved orceases to exist, this Contract shall terminate.
In the event of termination under this Section, all CDBG Funds are subject to repayment
and/or City may exercise all Vfits remedies tinder this Contract.
l0.|2 Reversion of Assets.
lo the event this Contract is ionmiuotcd with or without cause, all assets acquired
with the CDBG Funds including ouSb, interest payments from loans or odborwiee, all
outstanding notes, mortgages or other security iuehnuo\cuts` any accounts receivable
attributable 10 the use of the CDBG Funds, and any n:u( or personal property n\moed by
Agency that was acquired or improved with CDBG Funds shall automatically transfer to
City 0rtO such assignee a8 City may designate.
IX' REPAYNtENT OF CDBG FUNDS.
All CI)BG Funds are subject ho repayment inthe event the Program does not meet
the requirements as mot out in 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 CDBGFunds to HUD, Agency agrees it will reimburse City for such repayment.
If Agency takes any action that results im City receiving afinding from HUD about
the Program, whether ornot repayment wf all urany portion uf the CD]0G Funds in
required of City, Agency agrees it will pay City 10% of the CDBG Vrwmdm as
liquidated damages. The Parties agree that Cin/`S dnnzugoS in the event of either
repayment to HOI] being required or receiving u finding from E)UIl are uncertain and
would be difficult to ascertain and may include an impact on City's CZ]1]G grant orother
Federal grant ftiodS, iu addition (onfiudiogby HUD oru repayment of funds tn HUD by
City. Therefore, the Parties agree that payment under this Section of 10% of the C1)I](3
Funds by Agency to City io liquidated damages and not apenalty.
82. CHANGE IN NON-PROFIT STATUS.
lf the non-profit status of Agency changes after the date ofthis Contract, City
may but is not obligated Ln` tenniuute this Contract. Agency must provide City with
v/dtteo uodUoadnu of any changes to its 000'y,ofii status vvbbin 85 cu|eudu, days of
being notified of the change. City has 30 calendar days to make such determination after
receipt of notice from Agency and failure to make such determination will constitute
waiver. lo the event of termination under this Section l2, all [DBG Funds awarded but
unpaid to Agency puzSuou1 t0 this Contract shall be immediately forfeited and A8cmuy
shall have oo further right to such funds. Any[DBG Funds already paid to Agency must
be repaid to City within 30 calendar days 0fteoniuu1iou.
13.
Any provision of this Contract that pertains to auditing, monitoring, client income
eligibility, record keeping and reports, City ordinances, or applicable CDB(}
requirements, and any default and enforcement provisions ucccoaory to enforce such
provisions, shall survive the \ooninnd*u of this Contract for 5 years after the Contract
CDBGP3ACONTDACT2O|}-20)4-LENA POPE HOME,INC. 15
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 October 1, 2014 and end on September 30, 2019 regardless of whether or not this
Contract is earlier terminated.
14. GENERAL PROVISIONS
14.1 Agency 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 Respondeat 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, employees, contractors, subcontractors, vendors, clients, licensees or
invitees.
14.3 Agency Property.
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.
No portion of the CDBG 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-funded service.
14.6 Venue.
Venue 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,
shall lie in Tarrant County, Texas.
CDBG PSA CONTRACT 2013-2014—LENA POPE HOME,INC. 16
)4.7 Governing Law.
This Contract shall bo governed b« and construed in accordance with the laws of
the State 0fTexas. If any action, whether real Orasserted, at }uvv or in equity, oriumz 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
|un/s of the State of Texas.
14.8
The provisions of this Contract are severable, and, if for any reason a clause,
sentence, paragraph or odlmc podL of this Contract abu|l he determined to be invalid by a
court nr Federal oz state agency, board or commission having jurisdiction over the subject
matter thereof, such invalidity yhu|| not affect other provisions vvbiob can he given effect
without the invalid provision.
14.9 Written Apreement Entire Contract.
This written instrument and the Exhibits, Attachments, and Addeodurom attached
hereto, which are incorporated by reference and made n part of this Contract for all
puzpoec9, constitute the entire agreement by the Parties hereto cmoCenuiog the vv0dk and
services to be yerfhnued under this Contract. Any prior or contemporaneous oral or
written agreement, which purports to vary the inmum of this Contract, mbu!l be void. Any
amendments to the i000m of this Contract must be in writing and nnumr be executed by
each Party tn this Contract.
14.10
Number and Gender.
The pu,ug,opb headings contained herein are for 000vouieooc in reference to this
Contract and are not intended to dofiuc or to |icoiL the scope of any provision of this
C0oU[ucL When context requires, singular nouns and pronouns include the plural and the
ruu8uu(ine gender shall be deecutdtoinclude the feminine Oc neuter and the neuter gender
to include the nouscu|iuo and feminine. The vvozdm "include" and "including" v/hooevn,
used herein uhu|\ be deemed to be followed by the words "without limitation".
14.11 Compliance With All Applicable Laws and Regulations.
By signing this Contract, Agency certifies that it complies with all applicable laws
and regulations that are currently in effect or that are hereafter uozcodod during the
performance of this Contract. Those laws include, but are not limited to:
CDB{I Regulations found in24 [Ffl Part 57O.
Title I of the Housing and Community Development Act of 1974, as amended,
/42TJSC5301
> Title \/I of the Civil Rights Act of 1964 (42 U.S.C. Sections 2000d o/ se9.)
including provisions requiring recipients of federal assistance to ensure
meaningful access by person 0f\inuiicd English proficiency
> The Fair Housing Act, Title VIII of the Civil Rights /\ci of 1068 (42 U.S.C.
Sections ]6O| ol seq.)
Executive (}rdcm 11063' 11248 as amended by 11375 and 12086 and as
supplemented by Department oF Labor regulations 41CFPL, Part 60
CI)B(;PS/&CONTRACT 2O|}'ZO]4-LENA POPE HOME,INC. 17
➢ 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 et seq.) and the
Clean Water Act of 1977, as amended (33 U.S.C. Sections 1251 et seq.) 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 Administration Requirements of 24 CFR Part 85
CDBG PSA CONTRACT 2013-2014-LENA POPE HOME,INC. 18
14.11 HUD-Assisted Protects and Employment and other Economic
Opportunities; Section 3 Requirements.
14,11.1 Requirement that Law Be Quoted in Covered Contracts.-Certain
Requirements Pertaining to Section 3 of the Housing and Urban
Development Act of 1968 as Amended (12 U.S.C. Sections 1.701 et
seq.) and its Related Regulations at 24 CFR Part 135.
If the Program results in the creation of new employment, training, or contracting
opportunities on a contractor or subcontractor level resulting from the expenditure of the
CDBG Funds, Agency shall comply with the following and will ensure that its
contractors also comply. If the work performed under this Conti-act is on a project
assisted under a program providing direct Federal financial assistance from HUD, Section
3 of 24 CFR 135.38 ("Section 3") requires that the following clause, shown in italics, be
inserted in all covered contracts ("Section 3 Clause"):
Section to be quoted in covered contracts begins:
"A. The work to be performed under this contract is subject to the
requirements of Section 3 of Housing and Urban Development Act of
1968, as amended, 12 U.S.0 section 1701u (Section 3). The purpose of
Section 3 is to ensure that employment and other economic opportunities
generated by HUD assisted or HUD-assisted programs covered by
Section 3, shall to the greatest extent feasible, be directed to low- and
very-low income persons,particularly persons who are recipients of HUD
assistance far housing.
B. The parties to this contract agree to comply with HUD's
regulations in 24 CFR Part 135, which implement Section 3. As evidenced
by their execution of this contract, the parties to this contract certify that
they are under no contractual or other impediment that would prevent
them from complying with the Part 135 regulations.
C The contractor agrees to send to each labor organization or
representative of workers with which it has a collective bargaining
agreement or other understanding, if any, a notice advising the labor
organization or workers' representatives of the contractor's commitments
under this Section 3 clause and will post copies of the notice in
conspicuous places at the work site where both employees and applicants
.for training and employment positions can see the notice. The notice shall
describe the Section 3 preference, shall set forth minimum number and job
titles subject to hire, availability of apprentice and training positions, the
qualifications.for each; and the name and location of the person(s) taking
applications for each of the positions; and the anticipated date the work
shall begin.
D. The contractor agrees that it will include this Section 3 clause in
every subcontract to comply with regulation in 24 CFR Part 135, and
agrees to take appropriate action, as provided in an applicable provision
of the subcontract or in this Section 3 clause, upon finding that the
subcontractor is in violation of the regulations in 24 CFR Part 135. The
CDBG PSA CONTRACT 2013-2014-LENA POPE HOME,INC. 19
contractor will not subcontract with any subcontractor where it has notice
or knowledge that the subcontractor has been found in violation of
regulations in 24 CFR 135.
E. The contractor will certify that any vacant employment positions,
including training positions that are filed: (1) after the contractor is
selected but before the contract is executed, and (2) with persons other
than those to whom the regulations of 24 CFR Part 135. The contractor
will not subcontract with any subcontractor where it has notice or
knowledge that the subcontractor has been found in violation of
regulations in 24 CFR 135.
F. Noncompliance with HUD's regulation in 24 CFR Part 135 may
result in sanctions, termination of this contract.for default, and debarment
or suspension from future HUD assisted contracts.
G. With respect to work performed in connection with Section 3
covered Indian housing assistance, section 7(h) of the Indian Self-
Determination and Education Assistance Act (25 U.S.C. section 450e) also
applies to the work to be performed under this Contract. Section 7(b)
requires that to the greatest extent feasible (i) preference and
opportunities for training and employment shall be given to Indians, and
(ii)preference in the award of contracts and subcontracts shall be given to
Indian organizations and Indian-owned Economic Enterprises. Parties to
this contract that are subject to the provisions of Section 3 and Section
79b) agree to comply with Section 3 to the maximum extent feasible, but
not in derogation of compliance with Section 7(b).
Section to be quoted in covered contracts ends.
14.11.2 Agency Responsibilities for Section 3 Requirements.
City and Agency understand and agree that compliance with the provisions of
Section 3, the regulations set forth in 24 CFR Part 135, and all applicable rules and orders
of HUD shall be a condition of the Federal financial assistance provided to the Program
binding upon City and Agency, and their respective successors, assigns, contractors and
subcontractors. Failure to fulfill these requirements shall subject Agency and its
contractors and subcontractors and their respective successors and assigns to those
sanctions specified by the grant agreement through which Federal assistance is provided
and to such sanctions as are specified by 24 CFR Part 135. Agency's responsibilities
include:
14,11.2.1 Implementing procedures to notify Section 3 residents and
business concerns about training, employment, and
contracting opportunities generated by Section 3 covered
assistance-,
14.11.2.2 Notifying potential contractors working on Section 3
covered projects of their responsibilities;
14.11.2.3 Facilitating the training and employment of Section 3
residents and the award of contracts to Section 3 business
CDBG PSA CONTRACT 2013-2014-LENA POPE ROME,INC. 20
concerns;
14.11.2.4 Assisting and actively cooperating with the HED
Department in making contractors and subcontractors
comply;
14.11.2.5 Refraining from entering into contracts with contractors
that are in violation of Section 3 regulations;
14.11.2.6 Documenting actions taken to comply with Section 3; and
14,112.7 Submitting Section 3 Annual Summary Reports (form
HUD-60002) in accordance with 24 CFR Part 135.90.
14.11.3 Section 3 Reporting Requirements.
In order to comply with the Section 3 requirements, Agency must submit the
forms attached hereto as Exhibit "G" - Section 3 Reporting Forms.
14.11.3.1 Report to the City on a quarterly basis all applicants for
employment, and all applicants for employment by
contractors and any subcontractors. This shall include
name, address, zip code, date of application, and status
(hired/not-hired) as of the date of the report,
14.11.3.2 Advertise available positions to the public for open
competition, and provide documentation to City with the
quarterly report that demonstrates such open advertisement,
in the form of printout of Texas Workforce Commission
posting, copy of newspaper advertisement, copy of flyers
and listing of locations where flyers were distributed, and
the like.
14.11.3.3 Report to the City on a quarterly basis all contracts awarded
by contractors and any subcontractors. This shall include
name of contractor and/or subcontractor, address, zip code,
and amount of award as of the date of the report.
14.12 Prohibition Against Discrimination.
14.12.1 General Statement.
Agency, in the execution, performance or attempted performance of this Contract,
shall comply with all non-discrimination requirements of 24 CFR 570.607 and the
ordinances codified at Chapter 17, Article 111, 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.
CDBG PSA CONTRACT 2013-2014-LENA POPE HOME,INC. 21
This Contract is made and entered into with reference specifically to the
ordinances codified at Chapter 17, Article 111, 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.
14,12.2 No Discrimination in Employment durinI4 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 or subcontractor'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. Agency 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. Agency agrees to post
in conspicuous places, available to employees and applicants for employment, notices
setting forth the provisions of this nondiscrimination clause.
[Contractor or subcontractor's name] will, in all solicitations or advertisements
for employees placed by or on behalf of Agency, 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 or subcontractor'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 pet-sons 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.
CDBG PSA CONTRACT 2013-2014-LENA POPE HOME,INC. 22
[Contractor or subcontractor'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.
14.12.3 Agency'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 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 OR CONTRACTORS AGAINST CITY ARISING OUT OF
AGENCY'S AND/OR ITS CONTRACTORS', AGENTS' OR EMPLOYEES'
ALLEGED FAILURE TO COMPLY WITH THE ABOVE-REFERENCED LAWS
CONCERNING DISABILITY DISCRIMINATION IN THE PERFORMANCE OF
THIS CONTRACT.
14.13. Prohibition Against Interest/ Conflict of Interest.
14.13.1 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 conflict of interest or potential conflict of interest described above,
immediately upon discovery of such.
14.13.2 No persons who are employees, agents, consultants, officers or elected
officials or appointed officials of City or of Agency who exercise or have exercised any
ftinctions or responsibilities with respect to activities assisted with CDBG 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 services, may obtain a financial interest
or benefit from a CDBG-assisted activity, or have an interest in any contract, subcontract
or agreement with respect thereto, or the proceeds thereunder, either for themselves or
those with whom they have family or business ties, during their tenure or for I year
thereafter, unless they are accepted in accordance with the procedures set forth at 24 CFR
570.611.
14.13.3 Agency affirms that it will adhere to the provisions of the Texas Penal
Code which prohibits bribery and gifts to public servants.
CDBG PSA CONTRACT 2013-2014-LENA POPE HOME,INC. 23
14]3.4 The conflict O[interest provisions of 24 CF{l Part 85.36 and 24 CFR
Pad 84.42, respectively, mboi| apply in the procurement of property and services by
/\�eoCy. [ouU cases not hv those sections, the provisions of24CFK570.6\ l
o[the CDB(] Regulations shall apply.
14.14 Subcontracting with Small and Minority Firms, Women's
Business Enterprises and Labor Surplus Areas.
14.14.1 For procurement contracts larger than $50,000.00 Agency agrees to
ubk10 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 8on/icea, purchase of equipment and supplies and
provision of other services required by City. Agency agrees to incorporate the City's
BI}E Ordinance, and all aoocodnoeote or successor policies or ordinances thereto, into all
contracts and subcontracts for pn)ouccmoot larger than $50,000.00 and will further
require all persons orentities with which itao contracts to comply with said ordinance.
14.14.7 [tin national policy to award 4 fair share 0fcontracts to disadvantaged
business enterprises (^IlE3Es"), mcno\) business eotcrpdact (^^SOES"), minority business
enterprises ("MBEs"), and vvonnco`s business enterprises (^^WBSlx"). Accordingly,
affirmative steps must be taken to assure that DBEs, SBEs, MI]|Gs" and VV]8]Bm are utilized
when possible as sources of supplies, equipment, construction and services.
)4.}5 Other Laws.
The Coikoo to list any federal, state or City ordinance, (un/ 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
/\geuoy`9 failure to fb!|0vv the }uvv' if applicable.
14.16
Agency shall not assign all or any part of its rights, privileges, or duties under this
Contract without the prior written approval of Director. Any attempted assignment of
same without approval shall be void, and shall constitute a breach of this Contract.
}4.}7. Right to Ins ect Apency Contracts.
Itis agreed that City has the right ioopcc� uod approve in vvddu� uuyproposed
cou�actmbetween /�geooyand any contractor engaged iu any uohvityiuco .unction with
ihiSCZ)B[}-fuuded Program prior t0 any charges being incurred.
|4.l8 Force Maieure
I[Agency becomes unable, either io whole Urpart, to fulfill its obligations under
this Contract due k> acts ofGod, strikes, lockouts, or other industrial disturbances, acts of
public enemies, v/uos, 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 dimbub3000S, or explosions, or some other
reason beyond Agency's control (cn(|cciivc\y, "Force M jcureEvent"), tbcub|igudoomso
affected by such Force M jouroEveot `millhcauspendcdoulydoriug the continuance of
CD8GPS}\CONTRACT 20]3'20l4—LENA POPE HOME,INC. 24
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.
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 KIND 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 KINDS 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 PSA CONTRACT 2013-2014—LENA POPE HOME,INC. 25
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
$82,326.00 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 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 Effective
Date, 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 Effective Date, 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, or require its general contractor to maintain, the following
coverage and limits thereof:
CDBG PSA CONTRACT 2013-2014-LENA POPE HOME,INC. 26
Commercial General Liability (CGL) Insurance
$5AOJ)0A each occurrence
$L,000,0U0 aggregate limit
Non-Profit Organization Liabilitv or Directors &Officers Liabilt
$1,000,000 Each Occurrence
$1,000,000 Annual Aggregate Limit
Business Automobile Liabili!y Insurance
$1,000,000 each accident ouu combined single-limit basis, or
$250])00 Property Damage
$500,0UU Bodily Injury perpersooycroccurrnnoo
$2,000,000 Aggregate
Insurance policy shall be endorsed io cover"Any &otn",defined us 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 lf
or when /o the course of Agency's business uo contracted herein.
Workers' Compensation Insurance
Part A: Statutory Limits
Part B: Employer's Liability
$100,000 each accident
$|0A,0OU disease-each employee
$5UU,0A0 disease-policy limit
Note: Such insurance uhu\| 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, ifapplicable. In the event the respective contractors
do not noaiubiu coverage, Agency nhu|i nouioLaiu the coverage on such contractor, if
applicable, for each applicable contract.
Additional Reguirements
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 Vf such requirements.
Agency will submit tn City documentation that ithas obtained insurance coverage and
has executed bonds us required iu this Contract prior to payment nf any monies provided
hereunder.
Where applicable, insurance policies required herein shall be endorsed to include City uo
an additional insured as its interest may appear. Additional insured parties sbuii include
employees, officers, agents, and volunteers ofCity.
CDBGP8&CONTRACT 2013'2014—LENA POPE HOME,INC. 27
The Workers' Compensation Insurance policy shall be endorsed to include u waiver uf
subrogation, also referred to as a waiver of rights of recovery, in favor of City.
AnvfaUureoupartofCitytocoguoatccdificato(s) ofioouzunccsbm|| nntbu000sbucdue
u waiver ofsuch requirement orumo waiver ofthe insurance requirements themselves.
Insurers of Agency's iusuzu000 policies shall be licensed to do business in the s1uh: of
Texas by the Department of Insurance or be otherwise eligible and authorized to du
business in the state of Texas. Insurers shall be acceptable to City iusofur as their
financial strength and solvency and each such company shall have u current minimum
A.M. Best Key Rating Guide rating of &-: \/Il or other c4uivo|eo1 insurance industry
standard rating otherwise approved byCity.
Deductible limits on insurance policies Shu|| not exceed $5,000 per occurrence uu}euo
otherwise approved by City.
In the event dhccc 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, \|uiim,
and other requirements as those specified herein; and Agency shall require its contractors
to provide Agency with CCctifiouto/a\ of insurance doou000uiiug such coverage. Also,
Agency shall require its contractors to have City and Agency oodnocd no additional
iuouzcdo (ox their interest may appear) oo their respective boao/ouce policies.
Directors and Officers Liability coverage sbu|| be in force and may be provided on a
C\oiou8-cn&do basis. This coverage may also hereferred to uo Management Liability, and
mbu)l protect the insured against n|airoa arising out of alleged ocro,S 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.
10. CERTIF.ICATION REGARDING LOBBYING.
The undersigned representative of Agency hereby certifies, to the bust of his or
her knowledge and belief, that:
No Federal appropriated funds have been paid or will be paid, by or on behalf of
/\gcucy` to any puruuu for influencing or oltnoumdog to influence an officer or
ccnV|oyeu of any agency, u /nonnbcr of Congress, an nDiccr or onup\uyno 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 orcooperative agreement.
CDBG PSA CONTRACT 2013-2014—LENA POPE HOME,INC. 28
-
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
any agency, mernber of Congress in connection with this Federal contract, grant,
loan or cooperative agreement, Agency shalt 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 falls 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 Patty 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
1000 Throckmorton Street
Fort Worth,TX 76102
Telephone: 817-392-7600
Copy to:
Director of Housing and Economic Development
1000 Throcicmorton Street
Fort Worth, TX 76102
Telephone: 817-392-7540
CDBG PSA CONTRACT 2013-2014-LENA POPE HOME,INC. 29
Copy to:
Program Coordinator-Housing and Economic Development
1000 Throckmorton Street
Fort Worth, TX 76102
Telephone: 817-392-6342
Agency:
Lena Pope Home, Inc.
Executive Director
31.31 Sanguinet Street
Fort Worth, TX 76107
817-255-2676
21. AGENCY HAS LEGAII,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.
[SIGNATURES APPEAR ON NEXT PAGE]
CDBG PSA CONTRACT 2013-2014—LENA POPE HOME,INC. 30
'aw WITNESS WHEREOF, the Parties hereto have executed 4 duplicate
ar Ana f this Contract in Fort Worth, Tarrant County, Texas.
s
ST: CITY OF FORT WORTH
"
y.
B
, s
City S cr Var, � Fernando Co sta, Assistant City Manager
M&C: C- 9
Date: August 6, 2013
APP VED AS TO VORM AND LEGALITY:
Assistant City Attorney
LENA POPE HOME,INC.
Name: �
Title: �� "
STATE OF TEXAS
COUNTY OF TARRANT §
This instrument was acknowledged before me on�' � ��" � , 2013 by
Fernando Costa,Assistant City Manager of the City d"�f Dort Worth, on behalf the City of
Fort Worth.
,
�6blic,`State of Texas
"�e,r'„fi;6fYr4Vtl.,,fw.u�f u.�ralYd,'".w'�
ff Ju8y 4.1w 2L 7
u'J Yit4'
STATE OF TEXAS §
COUNTY OF TARR.ANT §
..
metle] of Pope Homy 2013 by
+its in tr ument was acknowl d ed bef re ame , the� e, lnc., a Texas non t corpo ion, on behalf said corporation.
Notary ry Pt ic, State of Texas
;:�;P Aug•., JUDY VALE
NOTARY PUBLIC
State of Texas
Comm.Exp.11-18-20,4 5
OFFICIAL RECORD
CITYSECRETARY
CDBG PSA CONTRACT 2013-2014—LENA POPE HOME,INC. FTC WORTH3,jrX
EXHIBITS:
Exhibit "A"—Program Summary
Exhibit "A-11'—2013 HUD Income Limits
Exhibit "A-211—Environmental Mitigation Action
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
Exhibit "H"—Severely Disabled Certification Form
CDBG PSA CONTRACT 2013-2014-LENA POPE HOME,INC. 32
Lena Pope Home, Inc. EXHIBIT A
Second Opportunity for Success PROGRAM SUMMARY
PROGRAM SUMMARY
Community Development Block Grant
(CDBG)
October 1, 2013 to September 30, 2014 $82,326.00
PERIOD AMOUNT
PROGRAM:
The program will provide youth and family group education classes to Fort Worth residents
for the purpose of reducing juvenile crime and delinquency. Program services include all
initial phase of group life-skill improvement classes for parents and their children. Upon
completion of the group program, the program will monitor client progress and provide
clients with follow-up case management. Youth who successfully complete the program will
not be adjudicated for their crimes.
CDBG funds will be used to pay for salaries, FICA, and fringe benefits for program
employees. CDBG funds will pay for a portion of general commercial liability and program
facility rent.
Program services will be available at 3800 Hulen, Suite 230, Fort Worth, TX 76107;
Monday through Friday during regular business hours. Group classes and intake will be
held Wednesday and/or Thursday, 5:00 to 8:00 pm.
REGULATORY CLASSIFICATION:
IRIS Matrix Code(s)and Service Category: 05 Other Public Services
National Objective Citation: LMC Low/Mod Limited Clientele 24 CFR 570.208(a)(2)
Regulatory Citation(s): 24 CFR 570.201(e)
Based on the nature of the service provided, Agency will maintain documentation that
verifies that 51% of clients served by the Program are income eligible with current
household incomes at or below 80% of Area Median Income (AMI) as established or
defined by the United States Department of Housing and Urban Development(HUD).
PROGRAM GOALS:
Provide program services to approximately 125 Unduplicated Clients
EXHIBIT A-CDBG: LENA POPE HOME, INC.
EXHIBIT 4'A-159
2013 HUD INCOME LIMITS
2013 Median Family Income—Fort Worth/Arlington, TX*
I Person 2 Persons 3 Persons 4 Persons 5 Persons 6 Persons 7 Persons 8 Persons
30%AMI $13,850 $15,800 $17,800 $19,750 $21,350 $22,950 $24,500 $26,100
50%AMI $23,050 $26,350 $29,650 $32,900 $35,550 $38,200 $40,800 $43,450
80% AMI $36,900 $42,150 $47,400 $52,650 $56,900 $61,100 $65,300 $69,500
*Income limits are established and published at least annually by HUD.
EXHIBIT 66A-2"
ENVIRONMENTAL MITIGATION ACTION
NONE REQUIRED
EXHIBIT B-BUDGET
r,
, � i�r,/,,%�%.�l��x�l i l l.�r i//���d i,�,i,/;///" ,/r�o,i,,,��i�r/�,/G,r,r,r,r�r r�,�,�✓��ar r/i ,,,,�r,,,/
Nr„ „
r
r
2M ii
ii...
Salaries 1001
FICA 1002
Life Insurance 1003
Health Insurance 1004
Disability Insurance 1005
Unemployment-State 1006
Accounting 1007
TOTAL ADMINISTRATIVE EXPENSES 20,971 20,971
%Administrative Cost
ovj� r , : r , ///rill/,a
// //ii viii% ,,; U/fir„!, ,crrc
Salaries 2001 57,692 0 57,692
FICA 2002 4,413 0 4,413
Life Insurance 2003 473 0 473
Health Insurance 2004 10,000 3,755 13,755
Unemployment 2005 902 0 902
Worker's Compensation 2006 629 0 629
Retirement 2007 2,885 0 2,885
Office Supplies 3001 0 4,374 4,374
Office Equipment Rental 3002
Postage 3003
Printin 3004
it, �1' /%E �/� / r o. r rr i io ,/ r nr
/
rr/
;
Construction/Building Materials(only REACH) 4001
Contract Labor(City needs copy of contract before
expenses can be reimbursed) 4002
Craft Supplies 4003
Field Trip Admission Expenses 4004
Other Field Trip Expenses(ifpreapproved by City) 4005
Food Supplies 4006
Teaching Aids 4007
Mileage 0 1,375 1,375
Other Employee Benefits 0 2,279 2,279
Other Professional Fees 0 1,729 1,729
/ r ,
177/r/
/ / ✓
// r
/ l .,iii.
i/
goo
Telephone 5001 0 3,755 3,755
Electric 5002 0 2,099 2,099
Gas 5003
Water and Wastewater 5004
Solid Waste Disposal 5005
Rent(City needs copy of lease before expenses can be
reimbursed) 5006 4,178 14,995 19,173
Custodial Services 5007 0 3,051 3,051
Re airs 5008
Cleaning Supplies 5009
n yy /�yy .Y o„ ,„�+ y�5' �///l/ji' �,��Lay5w7 yV T�IV�/.„,,ff#�",N�.//,,,.%////„%///':.✓,//////%/ /,//,//,1,o,,,/,,/,/,/,//,,,//l/�/„,.r /i r////a„ar�r j,,r///ir /rr,,/r/,... r �r// 77,777,� /
r ig
Fidelity Bond or Equivalent 6001
Directors and Officers 6002
General Commercial Liability 6003 1,154 1,154
ontract ccoun m
A t 6005
„r>
a / „v rrr r z
r r or,r r r r / rrrr, i r r
,c,,,r u��/ / / /����ra/
........
Childcare Scholarships 7001 _mmm _.......
Short-term Rent Assistance 7002
Short-term Mortgage Assistance 7003
Short-term Utilities Assistance 7004
Tenant Based Rental Assistance 7005
TOTAL 82,326 58,383 1 1 140,709
FUNDING A:LENA POPE HOME,INC
FUNDING B:
FUNDING C:
EXHIBIT B-CDBG: LENA POPE HOME, INC.
The following tables are purely informational and were created solely for purposes of preparing, negotiating, and
determining the reasonableness of the overall line item budget onthe first page mf this EXHIBIT B—BUDGET and
are not to be considered part of the terms and conditions of this Contract. Contractor may make changes to any
oo|umo except the ^Poyidnn" column in the "Salary Domii^ table without the City's consent so long as the total
amounts obmgcd to the grant do not exceed the line items on the first page of the EXHIBIT B — QODGEJ!`
Changes to the column labeled"Position"may only be made with the prior written consent of the City.
SALARY DETAIL
Position Name Rate Annual Hours Percent to Grant Amount to Grant
Supervisor 30.13 2080 13% 7,834
Admin Assistant 16.03 2080 23% 7,667
Family Specialist 18,88 2080 9% 3,643
Family Specialist 19.21 2080 46% 18,533
Family Specialist 20.71 2080 46% 20,015
FB.lNGEDETAlL
Percent of Payroll Amount Percent to Grant Arnount to Grant
FICA 7.65% 4,413 100% 4,413
Life Insurance .82% 473 100% 473
Health Insurance 23.84% 13,755 73% 10,000
Unemployment 7,29% 902 100% 902
Workers Compensation 1.090 629 100% 629
Retirement 5% 2,885 100% 2,885
SUPPLIES AND SERVICES
Total Budget Percent to Grant Amount to Grant
Office Supplies 4,397 0% 0
Office Equipment Rental
Postage
Printing
MISCELLANEOUS
Contract Labor Total Budget Percent to Grant Arnount to Grant
Craft Supplies
Facility Fees
Field Trip Costs
Food Supplies
Teaching Aids
FACILITY AND UTILITIES
Total Budget Percent to Grant Amount to Grant
Telephone 3,755 0%
Electric 2,099 0% 0
Water and Wastewater
Solid Waste Disposal
Rent 19,173 22% 4,177
Custodial Services 3,051 -0% 0
Repairs
Cleaning Supplies
~ EXHIBIT CDBG: LBN&POPE HOME,INC. 2
FINANCIAL AND INSURANCE
Total Budget Percent to Grant Amount to Grant
Fidelity Bond(or Equivalent)
General Commercial Liability 1,154 100% 1,154
Directors and Officers
Contract Accounting
DIRECT ASSISTANCE
Total Budget Percent to Grant Amount to Grant
Childcare Scholarships
Short-Term Rent Assistance
Short Term Mortgage Assistance
Short Term Utilities Assistance
Tenant Based Rental Assistance
EXHIBIT B-CDBG: LENA POPE HOME,INC. 3
EXHIBIT "C"
Audit Certification Form
[See attached]
AUDIT CERTIFICATION FORM AND AUDIT REQUIREMENTS
Agency: ,- -e
Fiscal Year Ending: September 30,2014
During the fiscal year in which funds will be received, we will exceed the federal expenditure
threshold of $500,000. We will have our Single Audit or Program Specific Audit completed and
will submit the A-133 audit report within seven (7) months after the end of the audited fiscal year
or thirty(30) days within its completion,whichever is the earlier date.
❑ During the fiscal year in which funds will be received, we will not exceed the $500,000 federal
expenditure threshold required for a Single Audit or a Program Specific Audit to be performed this
fiscal year. (Fill out schedule below)
,, r / i '/ ,,.. l,,.ii¢,.iii i ,ii ,,. ,i,i,/i.Irl/�� ""'%",i � I//f/r,/i/✓i /...i, ,,,,.,i // 1 / / .
otal Federal Expenditures for this Fiscal Year:
Signatory and'Title Date
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 OMB Circulars A-133 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.
Exhibit "D" - Reimbursement Forms
[See attached]
Attachment I
INVOICE
Agency:
Address:
City, State, Zip:
Program:
Period of Service:
t ;
Agency's Certification: I certity that the costs incurred are valid and
consistent with the terms and conditions of the contract between
City and Agency. By signing this invoice, I certify that to the best
of my knowledge and belief the data included in this report is true
and accurate. It is acknowledged that the provision of false
information could leave the certifying official subject to the
Signature and Date:
Name:
Title:
Atlathmcnt II
City of Fort Worth
I lousing and F,tanandc Deve.lapment Otpartneent
Bi enditur'e Worksheet
Agency Now
Program._ Progtvm Name
Ifighllghfed are tha only reirvant codex for thla,Program.
Pitmedi ,Tara t Ot wccoaot codca
l' r'�� / iii..../i
/R ,r,;r� �/��% rte///„��„ / /'p+✓�v///�f�'aC� .,aowl�r�, ��%!/,iri;��„��/ri,///„/��� �r,�, c //ir,���'.. .�k�+StanM%,
t .. � �CWX3N!„»TEtAT1YH1 FNdPWA"C5n1 „c a:� i..,,n/ oi;,i!„,�.
2 1 Salaries . ..®..... IGOV
J 1 FICA 1002
4 Life Insurance 1007
5 Health Infitlmnc4 1004
6 Disabili Insurance 1005
7 Unem >yment-Stale I(N}6
8 l.:al&Accaumin -1007
9 P1kpG1PffRRCENkCFC« a", ; , /i, r
IO Salviea 204)1
I 1 _FICA 2002
12 W,1-4 2003
13 Hsith In.—, 2004
14 Unem to men 2005
15 Worker's Cm xn.1m 2006
16 Rctimrrtent 2007
17 suppuismosERWaK,LF/ r
18 Of l"Su lime _3001
19 Office F ui mem Rmntal 3(X72
20 _ Postnga 3003
21 Primim 3064
22 mis,c Lk.Atl'8Ck47sari%iii ,7i„�, r, /iii/ivii,, „%/ii
23 Conference ft Seminar 4001
24 Cnnswc m/Buildi,, Mate6ah 4002
25 Contract Ul,.. 4003
26 - Cron Supplies 4904
Ctcda Re. ,u 4005
28 F—Nt y 1'ao; 4006
......._
29 Field fri r Catice 4007
30 food sun liu 4008
31 _ Mika e 4009
i
32 T—I,i.d Aid, 4010
33 ..._ FACi2t.1'C'IIAND'UTItITTE,'3;r>i„,i L”,
34 Tcicpfionc 5001
JS Llauic 5002
36 Ge 5003
J) W accr and lWastewatm 5004
38 Solid R'nste Die al _ 5005
39 Rent 5006
40 Custodial Service 5007
41 Rc^irs 5008
.._..
42 Or Su r lie> 5(X19
43
44 _ Fidcln Brood ar F uivnlcn 6001
45 Dirraors and OfYir, ti002
46 __ General Comma—1 Lhnb w 6(X13
47 LAal 1— 6004
48 Contract Acco,% 6015
50 _.. _.... Child—S.IwAmbip, 7001
51 Cowraclin •Ittdividusl Sessimu 1002
52 Coun�ling-Grou Scssintrs 7tX73
53 Shari-term Rent As&ivantC 7004
54 Short-Item Mortgage An kutu 7005
55 ................... Shoo-term Unhiiee Awsl—_ 7006
56
Tenant&teed Repeat Axxia4iura 70fA7
-- 58 CAF-it=,U`MT,,. ...�....W�,..... -
rel _ 8001
59 ComPuluS 8002
8003
Total S rt and Rccrcallon'ui.mpr 8004
•Payroll taus,identify mnplaycc.Runt mW'1 idcndfy t—,.Other paym-ts should idantify iodividuab
a
�a .
iiiiiiiiiiiiiiiiiiiiilloinlillin Hill III
Exhibit "E"
Form of Income Self-Certification
[See attached]
CERTIFICATION OF INCOME STATEMENT
Applicant Name:
Current Address: Phone#:
Household Members and Income
(Including Ap licant)
Last Name First Name Age Monthly Source/Employer Name
Income
71
"PERSONAL INFORMATION:(Check one in each item. Optional Information for Federal Reporting Purposes)
a. F-1 MALE b.❑ WHITE ❑BLACK/AFRICAN AMERICAN ❑BLACKJAFRf CAN AMERICAN&WHITE
❑FEMALE ❑ AMERICAN INDIAN/ALASKAN NATIVE [:1 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 CLIENT WOMEN HEAD OF HOUSEHOLD
❑HISPANIC ❑YES ❑YES
❑NON-HISPANIC ❑NO ❑NO
TOTAL NUMBER OF HOUSEHOLD (Include Yourself AND everyone who
MEMBERS lives in the house.)
Total Anticipated Annual Household Income:
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.
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.
Signature of Applicant Date
For use by funding agency:
Household Size: Annual Income:
Income Limit: Is Applicant Eligible:
Person Making Determination: Date:
I I
CERTIFICACION DE DECLARACION DE INGRESOS
Nombre del Solicitante:
Domicilio Actual: Mmero de, Tel6fono:
Miembros en el Hogar e Injzresos
(incl ir el/la solicitante)
Apellido Nombre Edad Ingreso Fuente de Ingresos/Nombre de Empleador
Mensual
**fNFORMAa6N PERSONAL:(Seleccione uno en cada categoria. lnformaci6n optional papa prop6sitos de informaci6n Federal)
a. ❑MASCULrNO b.❑CAUCkSICO (-]NEGRO/AFRICANO AMERICANO
❑NEGRO/AFRICANO AMERICANO&CAUCASICO
❑FEMININO ❑ INDIO AMERICANO/NA,riVO DE ALASKA F-1 ASIATICO
❑ INDIO AMERICANO/NATIVO DE ALASKA&CAUCASico MASIATICO&CAUCASIC0
F-1 NATIVO HAWAJANO/OTRO DE LAS ISLAS PACIFICAS [:] l3ALANCF/OTR0
❑INDIO AMERICANO/NATIVO DE ALASKA&NEGRO/AFRICANO AMERICANO
c. ETNICIDAD d.DISCAPACITADO e.DES EL SOLICITANTE UNA M-UJER YCABECERA DEL HOGAR?
❑HISPANO F-1 si ❑S,
❑NO-1-11SPANO ❑NO ❑NO
N-OMERO TOTAL DE MIEMBROS EN EL HOGAR (Incluye a si mismo y a todos los que viven en
la casa)
Ingreso total del hogar anual anticipado:
Certificac16n:
Certifico que la informaci6n que proporciono es verdad y podria ser susceptible a la comprobaci6n a cualquier
tiempo por terceros. Yo tambi6n reconozco que ]a provisl6n de informacl6n falsa me podria dejar sujeto a las
penalidades Federales, Estatales y locales.
ADVERTENCI[A: TiTIULO, 18, SECC16N 1001 DEL C6DIGO DE EE.UU. QUE UNA PERSONA ES
CULPABLE DE UN DELITO POR SABER Y VOLUNTARIAMENTE HACER DECLARACIONES
FALSAS 0 FRAUDULENTAS A CUALQUIER DEPARTAMENTO DEL GOBIERNO
ESTADOUNIDENSE.
Firma del Solicitante Fecha
Para el use de la agencia financiando:
#De Mlembros en el Hogar: Ingreso Anual:
Limite de Ingreso: �Es el solicitante elegible? :
Persona haciendo la determinaci6n: Fecha:
Exhibit "F" - Standards for Complete Documentation
[See attached]
2013-2014 Documentation Standards for
Public Service Contract Expenses
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Salaries X X If an employee works solely with f;cwakvads eligible clients and solely on Contract eligible items,Yhen the employee s enbre salary is eligible for
reimbursement.Twice in each calendar year,the client must submit a written statement verifying that the above conditions are still true.The
statement must also be signed be a person authorized to sign on behalf of the agency.
If an employee works on a variety of programs,or works with a mixture of Contract eligible clients and non-eligible clients,then the City will only
reimburse(or a reasonable portion of the employee's salary.Each reimbursement request must include not only the employee's limesheel,but also
a won<log breaking out the employee's time by project or activity. For employees paid with multiple funding sources,limesheels must reflect all
funding sources, It separate Umesheals are kept for each funding source,all such timesheets must be submitted to City.
If employees are paid by direct deposit rather than check,then the agency must submit(bath 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 If the City pays gross salary,this is already included.If the City pays the employer portion,then the employer must show a calculation and
documentation of how the invoiced amount was calculated,and include documentation showing payment.
Life Insurance If the City pays gross salary,this is already Included.It we pay the employer ponion,then the employer must show a calculation and documentation
of how the involved amount was calculated,must Include an invoice from the insurer,and must induce documentation showing payment.
Health Insurance If the City pays gross salary,this is already included.If we pay the employer portion,then the employer must show a calculation and documentation
of how the invoiced amount was calculated,must include an invoice from the insurer,and must include documentation showing payment.
Disability Insurance If the City pays gross salary,this a already Included.If we pay the employer portion,then the employer must show a calculation and documentation
of how the invoiced amount was calculated,must include an invoice from the insurer,and must include documentation showing payment.
Unemployment If the City pays gross salary,this is already Included.If we pay the employer portion,then the employer must show a calculation and documentation
Insurance of how the invoiced amount was calculated,and must Include documentation showing payment.
Retirement If we pay gross salary,this is already included.If we pay the employer portion,then the employer must show a calculation and documentation of how
the invoiced amount was calculated,must and include documentation showing payment,and prior to the first reimbursement,must include the
he policy re and' retirement benefits,
,. / r- ✓ ✓iii .,., .oioii ,,;iii r ..r ooi ri.,,,,...,, i !i, oai r r, ,..
Pt`d/d�s�l5ft#I-$srvt � rl�//////G///O/�i////�,/%i/aril///,/,/� r iiiii,,/O/////%%%%/%///,
Accounting X X X If an audit is required because frailest funds exceed$500,000,then the cost should be split evenly by all federal funding sources.
Expenses
/.. <. �/ /r%///i/i�a/ rr// r/ ///r% i,i,,,, //// % r %/rr r r!
I41at�kSs, ,� iii tfttidifiil��stodan�S�r 'iissa//�/�////„ ,o�,.,%„ /�i%//iii.„///i/r .// /i,.,.
Office Supplies X X I I Ix '.' •.,......� ,....
Office Equipment X X X
Rental
Postage X X X The agency should maintain Infonhabon regarding mailouls.If the agency has a Pitney Bowes machine or like postage machine,the records of that
machine must be on file.Likewise,if mail is categorized by payment source,then those records must be on file.For large mailouls,the agency
should keep a caPY o_f the letter and a list of all addressees.
Printing X X I Ix
Construction& X X This category Is only available for REACH.
Building Materials
1Sport and X X X
Recreation
Equipment
Oleanirin Supplies X X X
Teaching Aids X X X
Craft Supplies X X X
Food Supplies X X X
T �e /,,,' ,
�I t'aMek„i4d Fisfd",',firi ,///%/!%/'/%///llll�!Dii//,%oil%%/%/%////i/,,,,,/iii! /i !////i' r ii�ir� IL
Field Trip X X In addition w admission expenses,food expenses will also be allowed so long as the agency has a winner pokey stating that food and drinks are
Admission routine purchases on all field trips,not just Contract-funded field trips.
Expenses
Ri3i1f%tJfiifi saiitl' aiHf natr b«Iftho(6116WAO eX ens®sere"PeidfarataciiitytiYatisu edforbtber purposes;besidestheCeflirtract prodomi th4h the biifsmustbe'
[Telephone 1X X
Gas X X
WateoWastewaler X X -
Electric X X _
Solid Waste X x -
Dis sal
_..__
Facility X X X
Maintenance and
Repairs
Custodial Services X X I I If services are.rovid_�r a contract,agency will provide contracl instead of invoices.
Rent X I Ix
//%i%
Contract Labor X x X
Insurance Required X X -
Under the Contract
Childcare City requires that the agency submit its fee schedule,showing a breakout of Income levels,and for each level a breakout of the portion of the
Scholarships expense to be paid by family and the portion to be raimbursed by the City.This fee schedule is required prior to the first payment.We also require
the Income eligiblity of each household so that we can determine If we are being changed in conformance with the fee schedule.If the fee schedule
changes at any time during the contract year,the agency must notify City and provide a new schedule vothin 30 days of the change.
'Proof of payment effective October 1,2013: Payments or Expenses must be documented In the following manner.
A)Image of the check AND bank statement showing the check Geared the bank;OR,
B)Image of the cancelled check(ex.At end of bank statement);OR,
C)Payroll'Advace'or Statement AND Bank Statement indicating payroll,OR,
D)For wire or ii-transfers:Reciept or statement from payee/vendor OR bank statement.
EXHIBIT "G"
SECTION 3 REPORTING FORMS
cit
EXHIBIT li J
Section 3 Summary Report U.S.Department of Housing OMB Approval No: 2529-0043
Economic Opportunities for and Urban Development (exp. 11/30/2010)
Low—and Very Low-Income Persons Office of Fair Housing
And Equal Opportunity HUD Field Office:
Section back of page for Public Reporting Burden statement
1.Recipient Name&Address: (street,city,at 2,Federal Identification: (grant no.) 3. Total Amount of Award:
4.Contact Person 5 Phone: (include area code)
6.Length of Grant: 7.Reporting Period:
8.Date Report Submitted: 9.Program Code: (Use separate sheet 10. Program Name:
for each program code)
I L_
Part 1: Employment and Training Columns B,C and F are manda o fields. Include New Hires in E&F)
A B C D E F
Number of Number of New %of Aggregate Number %of Total Staff Hours Number of Section 3
Job Category New Hires Hires that are of Staff Hours of New Hires for Section 3 Employees Trainees
Sec.3 Residents that are Sec.3 Residents and Trainees
Professionals
Technicians
Office/Clerical
Construction by Trade(List)
Trade
Trade
Trade
Trade
Trade
Other(List)
Total
Program Codes 3=Public/Indian Housing 4=Homeless Assistance 8=CDBG State Administered
I=Flexible Subsidy A=Development, 5=HOME 9=Other CD Programs
2=Section 202/811 B=Operation 6=HOME State Administered 10=Other Housing Programs
C=Modernization 7=CDBG Entitlement
Page 1 of 2 form HUD 60002(6/2001)
Ref 24 CFR 135
Part II: Contracts Awarded
1. Construction Contracts:
A. Total dollar amount of all contracts awarded on the project $
B. Total dollar amount of contracts awarded to Section 3 businesses $
C. Percentage of the total dollar amount that was awarded to Section 3 businesses %
D. Total number of Section 3 businesses receiving contracts
2. Non-Construction Contracts:
A. Total dollar amount all non-construction contracts awarded on the project/activity $
B. Total dollar amount of non-construction contracts awarded to Section 3 businesses $
C. Percentage of the total dollar amount that was awarded to Section 3 businesses %
D. Total number of Section 3 businesses receiving non-construction contracts
Part III: Summary
Indicate the efforts made to direct the employment and other economic opportunities generated by HUD financial assistance for housing
and community development programs,to the greatest extent feasible,toward low-and very low-income persons,particularly those who
are recipients of government assistance for housing, (Check all that apply.)
Attempted to recruit low-income residents through: local advertising media,signs prominently displayed at the project site,
contracts with the community organizations and public or private agencies operating within the metropolitan area(or
nonmetropolitan county)in which the Section 3 covered program or project is located,or similar methods.
Participated in a HUD program or other program which promotes the training or employment of Section 3 residents.
Participated in a HUD program or other program which promotes the award of contracts to business concerns which meet the
definition of Section 3 business concerns.
Coordinated with Youthbuild Programs administered in the metropolitan area in which the Section 3 covered project is located.
Other;describe below.
Public reporting for this collection of information is estimated to average 2 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.
This agency may not collect this information,and you are not required to complete this form,unless it displays a currently valid OMB
number.
Section 3 of the Housing and Urban Development Act of 1968,as amended,12 U.S.C, 1701u,mandates that the Department ensures that
employment and other economic opportunities generated by its housing and community development assistance programs are directed
toward low-and very-low income persons,particularly those who are recipients of government assistance housing. The regulations are
found at 24 CFR Part 135. The information will be used by the Department to monitor program recipients'compliance with Section 3,to
assess the results of the Department's efforts to meet the statutory objectives of Section 3,to prepare reports to Congress,and by
recipients as self-monitoring tool. The data is entered into a database and will be analyzed and distributed. The collection of information
involves recipients receiving Federal financial assistance for housing and community development programs covered by Section 3. The
information will be collected annually to assist HUD in meeting its reporting requirements under Section 808(e)(6)of the Fair Housing Act
and Section 916 of the HCDA of 1992. An assurance of confidentiality is not applicable to this form. The Privacy Act of 1974 and OMB
Circular A-108 are not applicable. The reporting requirements do not contain sensitive questions. Data is cumulative;personal identifying
information is not included.
Page 2 of 2 form HUD 60002(11/2010)
Ref 24 CFR 135
Form HUD-60002,Section 3 Summary Report,Economic Opportunities for Low"and Very Low-Income Persons.
Instructions: This form is to be used to report annual 8. Program Code: Enter the appropriate program code as listed at
accomplishments regarding employment and other economic the bottom of the page.
opportunities provided to low-and very low-income persons under 9. Program Name: Enter the name of HUD Program corresponding
Section 3 of the Housing and Urban Development Act of 1968. The with the"Program Code"in number 8.
Section 3 regulations apply to any public and Indian housing
programs that receive: (1)development assistance pursuant to Part I: Employment and Training Opportunities
Section 5 of the U.S.Housing Act of 1937;(2)operating assistance Column A: Contains various job categories. Professionals are
pursuant to Section 9 of the U.S.Housing Act of 1937;or(3) defined as people who have special knowledge of an occupation(i.e.
modernization grants pursuant to Section 14 of the U.S.Housing Act supervisors,architects,surveyors,planners,and computer
of 1937 and to recipients of housing and community development programmers). For construction positions,list each trade and provide
assistance In excess of$200,000 expended for: (1)housing data in columns B through F for each trade where persons were
rehabilitation(including reduction and abatement of lead-based paint employed. The category of"Other"includes occupations such as
hazards);(2)housing construction;or(3)other public construction service workers,
projects;and to contracts and subcontracts In excess of$100,000 Column B: (Mandatory Field) Enter the number of new hires for
awarded in connection with the Section-3-covered activity, each category of workers identified in Column A in connection with
Form HUD-60002 has three parts,which are to be completed for this award. New hire refers to a person who is not on the contractor's
all programs covered by Section 3. Part I relates to employment or recipient's payroll for employment at the time of selection for the
and training.The recipient has the option to determine numerical Section 3 covered award or at the time of receipt of Section 3 covered
employment/training goals either on the basis of the number of hours assistance.
worked by new hires(columns B,D,E and F). Part II of the form Column C: (Mandatory Field) Enter the number of Section 3 new
relates to contracting,and Part III summarizes recipients'efforts to hires for each category of workers identified in Column A in
comply with Section 3. connection with this award. Section 3 new hire refers to a Section 3
Recipients or contractors subject to Section 3 requirements must resident who Is not on the contractor's or recipient's payroll for
maintain appropriate documentation to establish that HUD financial employment at the time of selection for the Section 3 covered award or
assistance for housing and community development programs were at the time of receipt of Section 3 covered assistance.
directed toward low-and very low-income persons.` A recipient of Column D: Enter the percentage of all the staff hours of new hires
Section 3 covered assistance shall submit one copy of this report to (Section 3 residents)in connection with this award.
HUD Headquarters,Office of Fair Housing and Equal Opportunity. Column E: Enter the percentage of the total staff hours worked for
Where the program providing assistance requires an annual Section 3 employees and trainees(including new hires)connected
performance report,this Section 3 report is to be submitted at the with this award. Include staff hours for part-time and full-time
same time the program performance report is submitted. Where an positions.
annual performance report is not required,this Section 3 report is to be Column F: (Mandatory Field) Enter the number of Section 3
submitted by January 10 and,if the project ends before December 31, residents that were trained in connection with this award.
within 10 days of project completion. Only Prime Recipients are Part II: Contract Opportunities
required to report to HUD. The report must include Block 1: Construction Contracts
accomplishments of all recipients and their Section 3 covered Item A: Enter the total dollar amount of all contracts awarded on the
contractors and subcontractors. project/program.
HUD Field Office: Enter the Field Office name. Item B: Enter the total dollar amount of contracts connected with this
1. Recipient: Enter the name and address of the recipient projectprogram that were awarded to Section 3 businesses.
submitting this report. Item C: Enter the percentage of the total dollar amount of contracts
2. Federal Identification: Enter the number that appears on the connected with this project/program awarded to Section 3 businesses.
award form(with dashes). The award may be a grant, Item D: Enter the number of Section 3 businesses receiving awards.
cooperative agreement or contract. Block 2: Non-Construction Contracts
3, Dollar Amount of Award: Enter the dollar amount,rounded to the Item A: Enter the total dollar amount of all contracts awarded on the
nearest dollar,received by the recipient. project/program.
4&5. Contact Person/Phone: Enter the name and telephone number Item B: Enter the total dollar amount of contracts connected with this
of the person with knowledge of the award and the recipient's project awarded to Section 3 businesses.
implementation of Section 3. Item C: Enter the percentage of the total dollar amount of contracts
6, Reporting Period: Indicate the time period(months and year) connected with this projecUprogram awarded to Section 3 businesses.
this report covers. Item D: Enter the number of Section 3 businesses receiving awards.
7. Date Report Submitted: Enter the appropriate date. Part III: Summary of Efforts—Self-explanatory
Submit one(1)copy of this report to the HUD Headquarters Office of
Fair Housing and Equal Opportunity,at the same time the The Secretary may establish income ceilings higher or lower than 80 percent
performance report is submitted to the program office. The Section 3 of the median for the area on the basis of the Secretary's findings such that
report is submitted by January 10. Include only contracts executed variations are necessary because of prevailing levels of construction costs
during the period specified in item 8. PHAs/IHAs are to report all or unusually high-or low-income families. Very low-income persons mean
contracts/subcontracts. low-income families(including single persons)whose incomes do not
exceed 50 percent of the median family income area,as determined by the
The terms"low-income persons"and very low-income persons"have Secretary with adjustments or smaller and larger families,except that the
the same meanings given the terms in section 3(b)(2)of the United Secretary may establish Income ceilings higher or lower than 50 percent of
States Housing Act of 1937. Low-income persons mean families the median for the area on the basis of the Secretary's findings that such
(including single persons)whose incomes do not exceed 80 percent of variations are necessary because of unusually high or low family incomes.
the median income for the area,as determined by the Secretary,with
adjustments for smaller and larger families,except that
Page i form HUD 60002(11/2010)
Ref 24 CFR 135
EXHIBIT "H" — Severely Disabled Certification Form
[See attached
[AGENCY]
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.
F-1 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: Date:
Signature/Title:
CFW HED: Revised as of August 30,2013
|
�
������ �
'=� �� Request for Taxpayer
pev.^=u°,`"'" Identification Number and Certification requester.Do not
=of the Treasury send to the IRS.
anus Service
Name(as ahovvn on your Income tax return)
LENA POPE HOME,INC
Business name/disregarded entity name,if different from above
Check appmphate box for federal tax
classification(required): El Individual/sole proprietor R1 C Corporation El S Corporation El Partnership El TrusVestate
*�,'t EJ Limited liability company,Enter the tax classification(C=C corporation,S=S corporation,P=partnership)10-
EJ other(see Instructions)),
!E Address(number,street,and apt.or suite no.) Requester's name and address(optional)
4a) 3131 SANGUINET ST
City,state,and ZIP code
U) FORT WORTH,TEXAS 76107
List account numbeds)here(optional)
KMII Taxpayer identification Number(TIN)
Enter your TIN In the appropriate box,The TIN provided must match the name given on the"Name"line Social security number
to avoid backup withholding.For Individuals,this Is your social security number(SSN).However,for a
resident alien,sole proprietor,or disregarded entity,see the Part I Instructions on page 3.For other
entitles,It Is your employer Identillcation number(EIN).If you do not have a number,see How to get a
TIN on page 3.
Note.If the account Is In more than one name,see the chart on page 4 for guidelines on whose Employer Identification number
number to enter. T5 —� 6 � 0 � 0 � 3 � 5T8fl3
EM Certification
_
undo »enultieemperjvm|oertify that:
1. The number shown un this form Is my correct taxpayer Identification number(or|am waiting for o number muo Issued mme).and
u. /am not subject to backup withholding uu from backup withholding, |have not been mw by the Internal Revenue
Service(IRS)that I am subject to backup withholding as a result of a failure to report all Interest or dividends,or(c)the IRS has notified me that I am
no longer subject m backup withholding,and
1 |"muu.a.citizen or other U.o.person(defined bolow,
Certification Instructions,You must cross out Item 2 above If you have been notified by the IRS that you are currently subject to backup withholding
be=uvou you have failed/ n all Interest and dividends tax return.For real estate transactions,Item 2 does not apply.For n
Interest pald,acquisition or abandonment of secured property,cancellation of debt,contributions to an Individual retirement arrangement(IRA),and
generally,payments other tharLInterest and dividends,you are not required to sign the certification,but you must ovide your correct TIN,See the
Sign signature of
Here U.S.person 10 Date 0-
General Instructions Note.If a requester gives you a form other than Form W-9 to request
your TIN,you must use the requester's form If It Is substantially similar
Section references are to the Internal Revenue Code unless otherwise to this Form W-9.
noted. Definition of a U.S.person.For federal tax purposes,you are
Purpose of Form considered a U.S.person If you are:
»person who Is required t file on Information return with the IRS must °»n Individual who Isuu.o.citizen n,u.a.resident alien,
uwm your correct taxpayer Identification number(TIN)m report,for °A partnership,corporation,cnmpuny.n,association created m
oxumv/o,munmv paid to you,real estate tranoanoono,mortgage mmmat owun/zou In the unnvo atutoo or under the|avo of the United omtna,
you vaio,acquisition or abandonment of secured vmpvny.cancellation °An estate(other than u/o«uon votate),or
o/debt,o,contributions you made manIRA.
~A domestic trust(as defined mnvnv|unonoo°vnonoo1.77o1-7)
uuvrunnw-von�hyuvo�uU.S.pomon(mcmumopnmmont �
unen).m provide your correct TIN m the person requesting x(the Special rules for partnerships.Partnerships that conduct u trade n,
requester)and,when applicable,to: business m the United States are generally required t pay ^withholding
tax vn any foreign partners'share or Income from such uuom°ou
1.cam�matme TIN you amnwno|ovv,�m�,you am*miunofor o pu�ho,.mco�om cases where a Form w'o has not been moo/ve
� u
numummua|oouem). pa�nommp|umqumuwpmoumomutupu�nv,|ouwm|unno,v�n.
u.c°n|fy that you are not subject m backup withholding,or and pay the withholding tax.Therefore,If you are au.a.person that Is
o.Claim exemption from backup withholding x you are au.a.exempt partner mu partnership conducting^trade o,business m the United
payee.If applicable,you are also certifying that as a U,S,person,your States,provide Form w'om the partnership to establish your U.a.
allocable share n/any partnership Income from uu.m.trade v,business status and avoid withholding on your share v(partnership Income.
|o not subject m the withholding tax on foreign partners'share o,
effectively connected Income,
AC"R" DATE(MM
CERTIFICATE OF LIABILITY INSURANCE 1/29/2011DDfYYYY)
3
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND-CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
.'BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER,
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsoment(s).
PRODUCER C W
0 1
Higginbotham Insurance Agency, Inc. NAMPO ecky_EuneL_ACSR_NW
PHONE
500 W. 13th Street La4Z-aOl MAIL Fort Worth TX 76102 ADDRES !bes,9ner0hjgglnb fhaM,nef
INSURERS AFFORDING COVERAGE NAIC#
INSURERA:Philad
INSURED INSURER 13:Texa
22945
Lena Pope Home, Inc.
3131 Sanguinet
Fort Worth TX 76107 INSURERD:
INSURER E:
INSURERF:
COVERAGES CERTIFICATE NUMBER:1113763583 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
iNISk L I C�E F�FP MO ILDI POLICY IFEP
LTR TYPE OF INSURANCE IN SR WVD POLICYNUMBER (MMIDDfYYYYI IMMIDDIYYYY) LIMITS
C GENERAL LIABILITY NCPKG0254500 2/1/2013 2/1/2014 EACH OCCURRENCE $1,000,000
COMMERCIAL GENERAL LIABILITY DAMKG970_RMFD
_PREMISE�ilEe occurrence _$100 0N.—
X CLAIMS-MADE
OCCUR EXP,An one person) $io�000
PERSONAL&ADV INJURY $1,000,000
-GENERAL AGGREGATE $3,000,000
GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $3,000.000
POLICY PE'& F LOC Employee Dishonesty $500,000
AUTOMOBILE LIABILITY NCAUT0254500 2/1/2013 211/2014 =MBTNEE
(Ea accident _$1,000.000
ANY AUTO BODILY INJURY(Per person) S
ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS I I AUTOS
NON-OWNED PROPERTY DAMAGE
$
HIRED AUTOS AUTOS (Paraccident)
P – $
C UMBRELLA LIAR OCCUR NCFXS0254500 2/1/2013 1/2014 EACH OCCURRENCE $10,000,000
X EXCESS LIAB X CLAIMS-MADE AGGREGATE $10,000,000
DED RETENTIONS "See Sub-limit $
B WORKERS COMPENSATION TSF11 1174020130201 2/1/2013 1/2014 X WC_STATU- I JOTH-
AND EMPLOYERS'LIABILITY YIN I ER
ANY PROPRIETOR/PARTNER/EXECUTIVE[E El,EACH ACCIDENT $1,000,000
OFFICERIMEMBER EXCLUDED? Y❑ NIA
(Mandatory In NH) E.L.DISEASE E�,EA EMPLOYE $1.000,000
If rs
S,describe under
RIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1.000,000
A Directors/Officers&EPL PHS0800154 2/1/2013 2/1/2014 D&0 1 Emp Prat $5,000,000
C Professional-C I alms Made NCPKG0254600 /112013 2/1/2014 $1,000.000 $3,000,000
AbuseiMoiestation-Claims Made $1,000,000 $3,000,000
_L L -A L
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required)
***Excess includes Sexual Abuse and Professional at a$5,000,000 Sublimit
Policy#NCPKG0254500 includes:
Professional Liability coverage part is"Claims Made"with a Retro Date of 2-1-2004
Sexual Abuse&Sexual Molestation coverage part is"Claims Made"with a Retro Date of 2-1-2004
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Lena Pope Home, Inc. ACCORDANCE WITH THE POLICY PROVISIONS.
3131 Sanguinet
Fort Worth TX 76107
AUTHORIZED REPRESENTATIVE
@ 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD
EXHIBITS:
Exhibit "All—Program Summary
Exhibit"A-1"—2013 HUD Income Limits
Exhibit"A-2"—Environmental Mitigation Action
Exhibit"B" —Budget
Exhibit"C"—Audit Certification Form
Exhibit I'D"—Reimbursement Forms
Exhibit"E"—Form of Income Self-Certification
Exhibit'IF"—Standards for Complete Documentation
Exhibit"G"—Section 3 Reporting Forms
Exhibit"H"—Severely Disabled Certification Form
CDBG PSA CONTRACT 2013-2014-LENA POPE HOME,INC. 32
Lena Pope Home, Inc. EXHIBIT A
Second Opportunity for Success PROGRAM SUMMARY
PROGRAM SUMMARY
Community Development Block Grant
(CDBG)
October 1, 2013 to September 30, 2014 $82,326.00
PERIOD AMOUNT
PROGRAM:
The program will provide youth and family group education classes to Fort Worth residents
for the purpose of reducing juvenile crime and delinquency. Program services include an
initial phase of group life-skill improvement classes for parents and their children. Upon
completion of the group program, the program will monitor client progress and provide
clients with follow-up case management. Youth who successfully complete the program will
not be adjudicated for their crimes.
CDBG funds will be used to pay for salaries, FICA, and fringe benefits for program
employees. CDBG funds will pay for a portion of general commercial liability and program
facility rent.
Program services will be available at 3800 Hulen, Suite 230, Fort Worth, TX 76107;
Monday through Friday during regular business hours. Group classes and intake will be
held Wednesday and/or Thursday,5:00 to 8:00 pm.
REGULATORY CLASSIFICATION:
IDIS Matrix Code(s) and Service Category: 05 Other Public Services
National Objective Citation: LMC Low/Mod Limited Clientele 24 CFR 570.208(a)(2)
Regulatory Citation(s): 24 CFR 570.201(e)
Based on the nature of the service provided, Agency will maintain documentation that
verifies that 51% of clients served by the Program are income eligible with current
household incomes at or below 80% of Area Median Income (AM[) as established or
defined by the United States Department of Housing and Urban Development(HUD).
PROGRAM GOALS:
Provide program services to approximately 125 Unduplicated Clients
EX141BIT A-CDBG: LENA POPE HOME, INC.
EXHIBIT 66A-1"
2013 HUD INCOME LIMITS
2013 Median Family Income— Fort Worth/Arlington, TX*
1 Person 2 Persons 3 Persons 4 Persons 5 Persons 6 Persons 7 Persons 8 Persons
30% AMI $13,850 $15,800 $17,800 $19,750 $21,350 $22,950 $24,500 $26,100
50% AMI $23,050 $26,350 $29,650 $32,900 $35,550 $38,200 $40,800 $43,450
80% AMI $36,900 $42,150 $47,400 $52,650 $56,900 $61,1.00 $65,300 $69,500
*Income limits are established and published at least annually by HUD.
EXHIBIT 66A-21"
ENVIRONMENTAL MITIGATION ACTION
NONE REQUIRED
EXHIBIT B-BUDGET
Accauttt- Grant Bud et A & G T TAL
ADMI TRATIe
Salaries 1001
FICA 1002
Life Insurance 1003
Health Insurance 1004
Disability Insurance 1005
Unemployment-State 1006
Accounting 1007
TOTAL ADMINISTRATIVE EXPENSES 20,971 20,971
%Administrative Cost
PROGRAM,PBRSONNX
Salaries 2001 57,692 0 57,692
FICA 2002 4,413 0 4,413
Life Insurance 2003 473 0 473
Health Insurance 2004 10,000 3,755 13 755
Unemployment 2005 902 0 902
Worker's Compensation 2006 629 0 629
Retirement 2007 —2,885 0 2,885
WrFP °AND SRRWC i$
Office Supplies 3001 0 4,374 4,374
Office Equipment Rental 3002
Postage 3003
Printin 3004
MISCMI I TWOU
ConstructionTuildi�Materi,als onl REAL 4001
Contract Labor(City needs copy of contract before
expenses can be reimbursed) 4002
Craft Supplies 4003
Field Trip Admission Expenses 4004
Other Field Trip Expenses(ifpreapproved by Ci 4005
Food Supplies 4006
Teaching Aids 4007
Mileage 0 g75 1,375
Other Employee Benefits 0 2,279 2,279
Other Professional Fees 0 1,729 1,729
FACII,L ZN-5UTILMES
Telephone 5,001 0 1,755 3,755
Electric 5002 0 2,099 2,099
Gas 5003
Water and Wastewater 5004
Solid Waste Disposal 5005
Rent(City needs copy of lease before expenses can be
reimbursed) 5006 4,178 14,995 19,173
Custodial Services 5007 0 3,051 3,051
Repairs 5008
Cleaning Su lies 5009
LRGA>La , x%1"1 '
AN -INS IJBi4�NG r:""
Fidelity Bond or Equivalent 6001
Directors and Officers 6002
General Commercial Liability 6003 1,154 1,154
Contract Accounting 6005
DIU AMI' 141'[ CIF-
Childcare Scholarships 7001
Short-term Rent Assistance 7082
Short-term Mortgage Assistance 7003 _
Short-term Utilities Assistance 7004
Tenant Based Rental Assistance 7005
TOTAL 1 8.2,326 58 383 140,709
FUNDING A:LENA POPE HOME,INC
FUNDING B:
FUNDING C:
EXHIBIT B-CDBG: LENA POPE HOME,INC.
The following tables are purely informational and were created solely for purposes of preparing, negotiating, and
determining the reasonableness of the overall line item budget on the first page of this EXHIBIT B-- BUDGET and
are not to be considered part of the terms and conditions of this Contract. Contractor may make changes to any
column except the "Position" column in the "Salary Detail" table without the City's consent so long as the total
amounts charged to the grant do not exceed the line items on the first page of the EXHIBIT B — BUDGET."
Changes to the column labeled"Position"may only be made with the prior written consent of the City.
SALARY DETAIL
Position Name Rate Annual Hours Percent to Grant Amount to Grant
Supervisor 30.13 2090 13% 7,834
Admin Assistant 16.03 2080 23% 7,667
Family Specialist 18.88 2080 9% 3,643
Family Specialist 19,21 2080 46% 18,533
Family Specialist 20.71 2080 46% 20,015
FRINGE DETAIL
Percent of Payroll Amount Percent to Grant Amount to Grant
FICA 7,65% 4,413 100% 4,413
Life Insurance .82% 473 100% 473
Health Insurance 23.84% 13,755 73% 10,000
Unemployment 7.29% 902 100% 902
Workers Compensation 1.09% 629 l00% 629
Retirement 5% 2,885 100% 2,885
SUPPLIES AND SERVICES
Total Budget Percent to Grant Amount to Grant
Office Supplies 4,397 0% 0
Office Equipment Rental
Postage
Printing
MISCELLANEOUS
Total Budget Percent to Grant Amount to Grant
Contract Labor
Craft Supplies
Facility Fees
�Field Tri Costs
Food Sup lies
Teaching Aids
FACILITY AND UTILITIES
Total Budget Percent to Grant Amount to Grant
Telephone 3,755 0% 0
Electric 2,099 0% 0
Gas
Water and Wastewater
Solid Waste Disposal
Rent 19,173 22% 4,177
Custodial Services 3,051 0% 0
Repairs
Cleaning Supplies
EXHIBIT B -CDBG: LENA POPE HOME, INC. 2
FINANCIAL AND INSURANCE
Total Budget Percent to Grant Amount to Grant
Fidelity Bond or Equivalent)
General Commercial Liability 1,154 100% 1,154
Directors and Officers
Contract Accounting
DIRECT ASSISTANCE
Total Budget Percent to Grant Amount to Grant
Childcare Scholarships
Short-Term Rent Assistance
Short Term Mortgage Assistance
Short Tenn Utilities Assistance
Tenant Based Rental Assistance
EXHIBIT B-CDBG: LENA POPE HOME,INC. 3
EXHIBIT 66C91
Audit Certification Form
[See attached]
AUDIT CERTIFICATION FORM AND AUDIT REQUIREMENTS
Agency:
Fiscal Year Ending: September 30,2014
F-1 During the fiscal year in which funds will be received, we will exceed the federal expenditure
threshold of $500,000. We will have our Single Audit or Program Specific Audit completed and
will submit the A-133 audit report within seven (7) months after the end of the audited fiscal year
or thirty (30) days within its completion, whichever is the earlier date.
❑ During the fiscal year in which funds will be received, we will not exceed the $500,000 federal
expenditure threshold required for a Single Audit or a Program Specific Audit to be performed this
fiscal year. (Fill out schedule below)
or Pro Audit is 0T`fequire4,o,-,,,,
MU ,be,filled out,If Slinggle,Audit
Pasft"Through Program Name Contract"
Fedeialaw
,"Gr
C x1im1bev",
Grantor,
Total Federal Expenditures for this Fiscal Year:
Signatory and Title Date
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 OMB Circulars A-133 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.
Exhibit "D" - Reimbursement Forms
[See attached]
Attachment I
INVOICE
Agency:
Address:
City, State, Zip:
Program:
Period of Service:
0 am
ii.`,.,
This Ia"Vol CumuIatly tr�,,,I ate
Agency's Certitication: 1 certify that the costs incurred are valid and
consistent with the terms and conditions of the contract between
City and Agency. By signing this invoice, I certify that to the best
of my knowledge and belief the data included in this report is true
and accurate. It is acknowledged that the provision of false
information could leave the certifying official subject to the
Signature and Date:
Name:
Title:
Altatdmtnl l3
Ctty of Fort Worth
Housing and Evonomlt D—lopmtot Orpsrtmtnt
Erptnditure Worksheet
ABBY Namr
Pm911— Program Namr
Highlighted an the only refrvant coda for this Fropam
Please --a hke actouat coder.
11, j�qi///j/Oi riv i i �r ✓
balm
I AD ,
2 ncs 100)
3 FICA 1002
4 Life Insurance 1003
5 _ 11-10 I-ursna 1001
6
Disability Insurance 1005
7 Unem it ment-Stau 1006
a Leg]&A—unims 1007
10 Salaries 2001
tl FICA 2002
12 Life Insuranct 2tN)3
13 Heald Insurance 2D04
14 Unem la corn, 2005
15 Worker's Com ensauon 2006
16 Retlsemem ,7tMTT
17
18 Office,Supplies 3001
19 Omce E ui ment Rental 3002
20 poster 3003
21 Printin 3004
22 7,
i ,
,�c ,„
23 Conference&Stminan 4001
24 C—trort—B.,ldiog Materiah 4002
25 Contra.Labor 4003
26 Coll Sop lip 4004
27 Credit Rep" 4003
28
F—hry Fee, 41M76
29 Field Trip Cosu =4007
Food Supplum 4008
31 Miles c 3009
t2 Teachin Aids 4010
1d 3 N ✓„
34 Tel one StMDI
35 - Elccmc 5002
36 Goa 5003
37 Water and Wasewate, 5004
38 Solid Waste Disposal 5003
39 Rem 5006
40 Custodial Services 5007
41 Rep— 5008
42 Clemin Su lies 5009
43 L& ' i/�„
44 Fidehl Bond or E wx.len 6001
45 Dirxtora and Officer, 6002
46 Gonerai Commcreiai L.iabilin 6003
47 Lc IFe. 6004
98 Contract Accounun 6005
49 fJ L
40 Chiidcarc Seh.1—him 7001
51 1 Couaae4u�g.:lndwidual Session:.
52 Counueling-Group Sermon 7003
Si Shon-term Rem Assistance—y 7004
54 Short-term Mon a e Assimanet 7003
N16 Short-term s stanct 71MM Tcnam Based Rental Amisism 1pori iture Fut cocas 8002 ce E ui mens 8003
and Reeraaum Ee ui men 8004
Payroll must identify employet. Reet mum identify tenant.Other paymrnu shmtd idmufy indt,vdwit
` .
M-T---- ---------
ayjlr
r ji/i uy
11TI I I
' ' Hill 11 111111111
r
1
Exhibit "E"
Form of Income Self-Certification
[See attached]
CERTIFICATION OF INCOME STATEMENT
Applicant Name:
Current Address: Phone #:
Household Members and Income
(Including Applicant)
Last Name First Name Age Monthly Source/Employer Name
Income
"PERSONAL INFORMATION:(Check one in each item. Optional Information for Federal Reporting Purposes)
a. 1:1 MALE b.❑ WHITE ❑BLACK/AFRICAN AMERICAN ❑BLACK/AFRICAN AMERICAN&WHITE
❑FEMALE ❑ AMERICAN INDIAN/ALASKAN NATIVE El ASIAN
❑ AMERICAN INDIAN/ALASKAN NATIVE&WHITE ❑ASIAN&WHITE
❑NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER [_1 BALANCE/OTHER
❑ AMERICAN INDIAN/ALASKAN NATIVE&BLACK/AFRICAN AMERICAN
c. ETHNICITY d. DISABLED c. IS CLIENT WOMEN HEAD OF HOUSEHOLD
❑HISPANIC ❑ YES ❑YES
❑NON-HISPANIC ❑NO ❑NO
TOTAL NUMBER OF HOUSEHOLD (Include Yourself AND everyone who
MEMBERS lives in the house.)
Total Anticipated Annual Household Income:
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.
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.
Signature of Applicant Date
For use by funding agency:
Household Size: Annual Income:
Income Limit: Is Applicant Eligible:
Person Making Determination: Date:
CERTIFICACI6N DE DECLARACI6N DE INGRESOS
Nombre del Solicitante:
Domicilio Actual: Mmero de Tel6fono:
Miembros en el Ho air e Ingresos
incluir eUla solicitante
Apellido Nombre Had Ingreso Fuente de Ingresos/Nombre de Empleador
Mensual
**INFORMACION PERSONAL:(Seleccione uno en cada categoria. Inforcnaci6n optional para prop6sitos de informaci6n Federal)
a. []MASCULINO b.❑CAUCASICO ❑NEGRO/AFRICANO AMERICANO
❑NEGRO/AFRICANO AMERICANO&CAUCASICO
❑FEMININO ❑ INDIO AMERICANO/NATIVO DE ALASKA ❑ASIATICO
❑INDIO AMERICANO/NATIVO DE ALASKA&CAUCASICO ❑ASIATICO&CAUCASICO
❑NATIVO HAWAIANO/OTRO DE LAS ISLAS PACIFICAS ❑BALANCE/OTRO
❑ INDIO AMERICANO/NATIVO DE ALASKA.&NEGRO/AFRICANO AMERICANO
c. ETNICIDAD d. DISCAPACITADO e.DES EL SOLICITANTE UNA MUJER Y CABECERA DEL HOGAR?
❑HISPANO ❑SI ❑Si
❑NO-HISPANO ❑NO ❑NO
*N)mERO'rOTAL DE MIEMBROS EN EL HOGAR (Incluye a si mismo y a todos los que viven en
la casa)
Ingreso total del hogar anual anticipado:
Certificaci6n:
Certilico que la informaci6n que proporciono es verdad y podria ser susceptible a la comprobaci6n a cualquier
tiempo por terceros. Yo tambi6n reconozco que la provisi6n de informaci6n falsa me podria dejar sujeto a las
penalidades Federales, Estatales y locales.
ADVERTENCIA: TITULO 18, SECCION 1001 DEL CUDIGO DE EE.UU. QUE UNA PERSONA ES
CULPABLE DE UN DELITO POR SABER Y VOLUNTAR:IAMEN'TE HACER DECLARACIONES
FALSAS O FRAUDULENTAS A CUALQUIER DEPARTAMENTO DEL GOBIERNO
ESTADOUNIDENSE.
Firma del Solicitante Fecha
Para el use de la agencia financlando:
# De Miembros en el Hogar: Ingreso Acual:
Limite de Ingreso: GEs el solicitante elegible?
Persona haciendo la determinaci6n: Fecha:
Exhibit "F" - Standards for Complete Documentation
[See attached]
2013-2014 Documentation Standards for
Public Service Contract Expenses
I,
EYYt I
Saharfas X X' If an employee works soWty with Contract eliglbie clfill and solely on Contract eligible items,then The employees entire salary Is eligible for
reimbursement.Twice in each calendar year,the client must submit a written statement verifying that the above conditions are still true.The
statement must also be signed be a person authorized to sign on behalf of the agency.
If an employee works on a variety of programs,or works with a mixture of Contract eligible clients and non-elgible clients,then the City will only
reimburse for a reasonable portion of the employees salary.Each reimbursement request must include not ony the employee's bmesheet,but also
a work log breaking out the employee's time by project or activity. For employees paid with multiple funding sources,bmesheets must reflect all
funding sources. If separate timesheets are kept for each turning source,all such bmesheets must be submitted 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 stowing payment to the direct deposit company.
FICA/Medicare If the City pays gross salary,this is already included.If the City pays the employer portion,then the employer must show a calculation and
documentation of how the Invoiced amount was calculated and include documentation showing payment.
Life Insurance d the City pays gross salary,this is already included.five pay the employer portion,then the employer must show a calculation and documentation
of how the invoiced amount was calculated,must include an invoice horn the insurer,and must include documentation showing payment.
Health Insurance If the City pays gross salary,this is already included.If we pay the employer portion,then the employer must show a calculation and documentation
of how tare invoiced amount.was calculated,must include an invoice from the insurer,and must include documentation showing payment.
Disability Insurance It the City pays gross salary,this is already included.If we p cu
ay the employer portion,then the employer must show a calculation and documentation
of how the invoiced amount was calculated,must inckde an invoice from the insurer,and must include documentation showing payment.
Unemployment If the City pays gross salary,this is already included,if we pay the employer portion,then the employer must show a calculation and documentation
Insurance at how the Invoiced amount was calculated and must include documentation showing payment.
Retirement If we pay gross salary,this is already Included.If we pay the employer portion,than the employer must show a calculation and documentation of how
the invoiced amount was calculated,must and include documentation showing payment,and prior to the first reimbursement,must include the
ersonnel r�/; artli rekiremem benefits.
ltiml �„
-%„,9� i�„e,fi ,ll,✓,�%,,,, , ��, a%x IG,.y ,,,, r,,,,+,,, �„ .,,/;,i„„,,,�,� ��i,,,,l„r, ,��l,l,�/ err,//i„/,
Accounting X X 'X If an audit is required because federal funds exceed 5500,000.then The Gust should be split event'by all federal funding sources.
Ex sues
77,77,17=777 7777
Ma
Office Su ries X X I I ix
Office Equipment X X X
Rental
Postage X X X The agency should maintain information regarding mallotuts.11 the agency has a Pitney Bowes machine or like postage machine,the records of that
machine must be on file.likewise,it mail is categorized by payment source,then those records must be on file.For large meltable,the agency
should keep a copyciftho letter and a list of all addressees.
Printing X X I IX
Construction 6 X X This calegory is ony available for REACH.
Building Materials
Sport and X X X
Rreation
Equipment
Clearing Supplies IX X IX
Tea,chial Aids X X X
Craft Su lies X X X
Food Supplies X X Ix
+r,,, 77
Field Trip X X In addition to admission expenses,food expenses MI also be allowed so king as the agency has a written policy stating that food and Minks ale
Admission routine purchases on all fold trips,not just Contract-funded field trips,
Expenses
Rr!
I. r
Tefe a X X
Gas X X
Waler/Waslawaeer X X
Electric X X
Solid Waste X X
Disposal
Facility X X X -
Maintenance and
Repairs
Custodial Services X X It services are provided per a contract agency will provide contract instead of invoices.
Rent X X
IYFI'li ..<v i l „ � , c,te , i ,�, �,ce „
Contract labor X I ix I Ix
Insurance Required X X
Under the Contract
Childcare City requires that the agency submit its fee schedule,showing a breakout of income levels,and for each level a breakout of the portion of the
Scholarships expense to be paid by!army,and the portion to be reimbursed by the City.This fee schedule is required prior to the first payment.We also require
the income aigil lity o1 each household so that we can determine d we are being charged in conformance with the fee schedule.If the fee schedule
changes at any time during the contract year,the agency most notify City and provide a new schedule within 30 days of the change.
'Proof of payment effective October 1,2013: Payments or Expenses must be documented in the following manner.
A)Image of the check AND bank statement showing the check deared the bank:OR,
B)Image of the cancelled check(ex.At end of bank statement);OR,
C)Payros'Advace'or Statement AND Bank Statement indicating payroll;OR,
D)For wire or a-transfers:Redept or statement from payes/vendor OR bank statement
EXHIBIT "G"
SECTION 3 REPORTING FORMS
EXHIBIT "G"
Section 3 Summary Report U.S.Department of Housing OMB Approval No: 2529-0043
Economic Opportunities for and Urban Development (exp. 1 1/30120 1 0)
Low—and Very Low-Income Persons Office of Fair Housing
And Equal Opportunity FH—UD
Section back of page for Public Reporting Burden statement
I,Recipient Name&Address: (street,city,state,—zip) 2.Federal ldenfficati�n. (grant no.) 3. Total Amount of Award:
4.Contact Person 5,Phone: (include area code)
6 Length of Grant: —7 Reporting—Pedod: —
8.Date�Report Submitted: Program Code:........__(Use—separate sheet - 10. Program—Name:
for each program code)
_Part 1-* Employment and T Columns B,C and F are fields. Include New Hires in E&F)
A — 1 0 E F
Number� of"a- %of Aggregate umber %of Total Staff Hours Number of Section 3
as
Job Category FZK�4' H, he of Staff Hours Now Hires for Section 3 Employees Trainees
Sec Residents urs
aid.,,. that are Sec.3 Residents and Trainees
Professionals
Technicians
OfficelCterical
Construction by Trade(List)
Trade
Trade
Trade:
Trade
Trade
Other(List)
Total
.Program Codes 3=PublicAndian Housing 4=Homeless Assistance 8=CDBG State Administered
I=Flexible Subsidy A=Development, 5zHOME 9 z Other CD Programs
2=Section 2021811 8=Operation 6=HOME State Administered 10=Other Housing Programs
C=Modernization 7=CDBG Entitlement
Page I of 2 form HUD 60002(612001)
Ref 24 CFR 135
Part II: Contracts Awarded
1. Construction Contracts:
A. Total dollar amount of all contracts awarded on the project $
B. Total dollar amount of contracts awarded to Section 3 businesses $
C. Percentage of the total dollar amount that was awarded to Section 3 businesses %
D. Total number of Section 3 businesses receiving contracts
2. Non-Construction Contracts:
A. Total dollar amount ail non-construction contracts awarded on the projecuactivity $
B. Total dollar amount of non-construction contracts awarded to Section 3 businesses $
C. Percentage of the total dollar amount that was awarded to Section 3 businesses I
D. Total number of Section 3 businesses receiving non-construction contracts
Part III: Summary
Indicate the efforts made to direct the employment and other economic opportunities generated by HUD financial assistance for housing
and community development programs,to the greatest extent feasible,toward low-and very low-income persons,particularly those who
are recipients of government assistance for housing. (Check all that apply.)
Attempted to recruit low-income residents through: local advertising media,signs prominently displayed at the project site,
contracts with the community organizations and public or private agencies operating within the metropolitan area(or
nonmetropolitan county)in which the Section 3 covered program or project is located,or similar methods.
Participated in a HUD program or other program which promotes the training or employment of Section 3 residents.
Participated in a HUD program or other program which promotes the award of contracts to business concerns which meet the
definition of Section 3 business concems.
Coordinated with Youthbuild Programs administered in the metropolitan area in which the Section 3 covered project is located.
Other;describe below.
Public reporting for this collection of information is estimated to average 2 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.
This agency may not collect this information,and you are not required to complete this form,unless it displays a currently valid OMB
number.
Section 3 of the Housing and Urban Development Act of 1968,as amended,12 U.S.C. 1701u,mandates that the Department ensures that
employment and other economic opportunities generated by its housing and community development assistance programs are directed
toward low-and very-low income persons,particularly those who are recipients of government assistance housing. The regulations are
found at 24 CFR Part 135. The information will be used by the Department to monitor program recipients'compliance with Section 3,to
assess the results of the Department's efforts to meet the statutory objectives of Section 3,to prepare reports to Congress,and by
recipients as self-monitoring tool. The data is entered into a database and will be analyzed and distributed. The collection of informaflon
involves recipients receiving Federal financial assistance for housing and community development programs covered by Section 3. The
information will be collected annually to assist HUD in meeting its reporting requirements under Section 808(e)(6)of the Fair Housing Act
and Section 916 of the HCDA of 1992. An assurance of confidentiality is not applicable to this form. The Privacy Act of 1974 and OMB
Circular A-108 are not applicable. The reporting requirements do not contain sensitive questions. Data is cumulative;personal identifying
information is not included.
Page 2 of 2 form HUD 60002(11=10)
Ref 24 CFR 135
Form HUD-60002,Section 3 Summary Report, Economic Opportunities for Low-and Very Low-Income Persons,
Instructions: This form is to be used to report annual 8. Program Code: Enter the appropriate program code as listed at
accomplishments regarding employment and other economic the bottom of the page.
opportunities provided to low-and very low-income persons under 9. Program Name: Enter the name of HUD Program corresponding
Section 3 of the Housing and Urban Development Act of 1968. The with the"Program Code"in number 8.
Section 3 regulations apply to any public and Indian housing
programs that receive: (1)development assistance pursuant to Part I: Employment and Training Opportunities
Section 5 of the U.S.Housing Act of 1937;(2)operating assistance Column A: Contains various job categories. Professionals are
pursuant to Section 9 of the U.S.Housing Act of 1937;or(3) defined as people who have special knowledge of an occupation(i.e.
modernization grants pursuant to Section 14 of the U.S.Housing Act supervisors,architects,surveyors,planners,and computer
of 1937 and to recipients of housing and community development programmers), For construction positions,list each trade and provide
assistance in excess of$200,000 expended for. (1)housing data in columns B through F for each trade where persons were
rehabilitation(including reduction and abatement of lead-based paint employed. The category of"Other"includes occupations such as
hazards);(2)housing construction;or(3)other public construction service workers.
projects;and to contracts and subcontracts in excess of$100,000 Column B: (Mandatory Field) Enter the number of new hires for
awarded in connection with the Section-3-covered activity. each category of workers identified in Column A in connection with
Form HUD-60002 has three parts,which are to be completed for this award. New hire refers to a person who is not on the contractor's
all programs covered by Section 3. Part I relates to employment or recipient's payroll for employment at the time of selection for the
and training.The recipient has the option to determine numerical Section 3 covered award or at the time of receipt of Section 3 covered
employmentitraining goals either on the basis of the number of hours assistance.
worked by new hires(columns B,D,E and F). Part II of the form Column C: (Mandatory Field) Enter the number of Section 3 new
relates to contracting,and Part III summarizes recipients'efforts to hires for each category of workers identified in Column A in
comply with Section 3. connection with this award. Section 3 new hire refers to a Section 3
Recipients or contractors subject to Section 3 requirements must resident who is not on the contractors or recipient's payroll for
maintain appropriate documentation to establish that HUD financial employment at the time of selection for the Section 3 covered award or
assistance for housing and community development programs were at the time of receipt of Section 3 covered assistance.
directed toward low-and very low-income persons.' A recipient of Column D: Enter the percentage of all the staff hours of new hires
Section 3 covered assistance shall submit one copy of this report to (Section 3 residents)in connection with this award.
HUD Headquarters,Office of Fair Housing and Equal Opportunity. Column E: Enter the percentage of the total staff hours worked for
Where the program providing assistance requires an annual Section 3 employees and trainees(including new hires)connected
performance report,this Section 3 report is to be submitted at the with this award. Include staff hours for part-time and full-time
same time the program performance report is submitted. Where an positions.
annual performance report is not required,this Section 3 report is to be Column F: (Mandatory Field) Enter the number of Section 3
submitted by January 10 and,it the project ends before December 31, residents that were trained in connection with this award.
within 10 days of project completion. Only Prime Recipients are Part It: Contract Opportunities
required to report to HUD. The report must include Block 1: Construction Contracts
accomplishments of all recipients and their Section 3 covered Item A: Enter the total dollar amount of all contracts awarded on the
contractors and subcontractors. project/program.
HUD Field Office: Enter the Field Office name. Item B: Enter the total dollar amount of contracts connected with this
1. Recipient: Enter the name and address of the recipient project/program that were awarded to Section 3 businesses.
submitting this report. Item C: Enter the percentage of the total dollar amount of contracts
2. Federal Identification: Enter the number that appears on the connected with this projectiprogram awarded to Section 3 businesses.
award form(with dashes). The award may be a grant, Item D: Enter the number of Section 3 businesses receiving awards.
cooperative agreement or contract. Block 2: Non-Construction Contracts
1 Dollar Amount of Award: Enter the dollar amount,rounded to the Item A: Enter the total dollar amount of all contracts awarded on the
nearest dollar,received by the recipient. projectiprogram.
4&5. Contact Person/Phone: Enter the name and telephone number Item B: Enter the total dollar amount of contracts connected with this
of the person with knowledge of the award and the recipient's project awarded to Section 3 businesses.
implementation of Section 3. Item C: Enter the percentage of the total dollar amount of contracts
6. Reporting Period: Indicate the time period(months and year) connected with this project/program awarded to Section 3 businesses.
this report covers. Item D: Enter the number of Section 3 businesses receiving awards.
7. Date Report Submitted: Enter the appropriate date. Part ill: Summary of Efforts—Self-explanatory
Submit one(1)copy of this report to the HUD Headquarters Office of
Fair Housing and Equal Opportunity,at the same time the The Secretary may establish income ceilings higher or lower than 80 percent
performance report is submitted to the program office. The Section 3 of the median for the area on the basis of the Secretary's findings such that
report is submitted by January 10. Include only contracts executed variations are necessary because of prevailing levels of construction costs
during the period specified in item 8. PHAs/IHAs are to report all or unusually high-or tow-income families. Very low-income persons mean
contractsisubcontracts. low-income families(including single persons)whose incomes do not
exceed 50 percent of the median family income area,as determined by the
The terms"low-income persons"and very low-income persons"have Secretary with adjustments or smaller and larger families,except that the
the same meanings given the terms in section 3(b)(2)of the United Secretary may establish income ceilings higher or lower than 50 percent of
States Housing Act of 1937. Low-Income persons mean families the median for the area on the basis of the Secretary's findings that such
(including single persons)whose incomes do not exceed 80 percent of variations are necessary because of unusually high or low family incomes.
the median income for the area,as determined by the Secretary,with
adjustments for smaller and larger families,except that
Page i form HUD 60002(11/2010)
Her 24 CFR 135
EXHIBIT "H" —Severely Disabled Certification Form
[See attached)
M&CRcviovv Puom / *f6
Official site of the City of Fort Worth,Texas
FoRTWoRTH
CITY � �
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COUNCIL ACTION: Approved on8/8/2O13 'Ordinance No. 2D854-U8-2013
CONTINUED FROM APREVIOUS WEEK
F��F�P�EN��
DATE: 7Y�3/2O13 C-26369 LKJ<� N^�K8E' 17HUOACTPLANPY13-14
. N��.: .
NOW ��8U��
CODE: C TYPE' YES
' CONSENT HEARING.
SUBJECT: Conduct Public Hearings and Approve the City's 2013-2018 Consolidated Plan and 2013-
2O14 Action Plan for the Use of Federal Grant Funds in the Amount of$8.413.14100
from the United States Department of Housing and Urban Development for Program Year
2U13-2U14 from the Community Development Block Grant, HOME Investment
Partnerships Program, Emergency Solutions Grant and Housing Opportunities for
Persons with AIDS Grant Progrems, Authorize Collection and Use of Program Income,
Authorize Waiver of Application of Indirect Cost Rates, Authorize Execution ofRelated
Contracts and Interdepartmental Letters of Agreement and Adopt Appropriation
Ordinance (ALL COUNCIL DISTRICTS)
RECOMMENDATION:
|tim recommended that the City Council:
1. Conduct u public hearing to allow citizen input and consideration ofthe City's 2O13-201OConsolidated
Plan;
2. Approve the City's 2013-2018 Consolidated Plan for submission to the United States Department of
Housing and Urban Development;
3. Conduct a public hearing to allow citizen input and consideration of the City's 2013-2014 Action Plan for
use of federal grant funds from the United Gtotoa Department nfHousing and Urban Development in the
amount of$9.413.143.0O for Program Year 2013-2014 from the Community Development Block Grant,
HOME Investment Partnerships Program, Emergency Solutions Grant and Housing Opportunities for
Persons with AIDS grant programs and for the use of program income from activities using prior years'
federal grant funds;
4. Approve the City's 2013-2014 Action Plan for submission to the United States Department of Housing
and Urban Development including allocations of grant funds to particular programs and activities as
detailed below;
5. Authorize the collection and use of an estimated amount of$50,000.00 of program income resulting
from activities using prior years' Community Development Block Grant funds for the programs and activities
detailed below;
8. Authorize the collection and use of an estimated amount of$250,000.00 of program income resulting
from activities using prior years' HOME Investment Partnerships Program funds for the City's Homebuyer
Assistance Program;
7. Authorize the City Manager or his designee to execute contracts and Interdepartmental Letters of
Agreement for a one year term with the agencies listed below in Tables 1, 2 and 3 for Program Year 2013-
2014 for Community Development Block Grant, Emergency Solutions Grant and Housing Opportunities for
Persons with AIDS grant funds, contingent upon receipt uffunding;
8. Authorize the City Manager or his designee to extend the contracts and Interdepartmental Letters of
Agreement for up to one year if an agency or department requests an extension and such extension is
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necessary for completion of the program;
8. Authorize the City Manager or his designee to amend the contracts and Interdepartmental Letters of
Agreement if necessary to achieve program goals, provided any amendment is within the scope of the
program and in compliance with City policies and all applicable laws and regulations governing the use of
federal grant funds;
10. Authorize a waiver for indirect cost rates as applicable for the Grants Fund, in accordance with the
City's Administrative F7aQu|uUonw; and
11. Adopt the attached appropriation ordinance increasing the estimated receipts and appropriations to the
Grants Fund in the total amount of$Q.413.143.00 (the amount mf$0.O7Q.822DO in Community
Development Block Grant funds, the amount of$1,996,541.00 in HOME Investment Partnerships Program
funds, the amount cf$425`325.00in Emergency Solutions Grant funds and the amount cf$911,655.00 in
Housing Opportunities for Persons with AIDS Grant funds) plus any program income, all subject to receipt
of such funds.
DISCUSSION:
The City receives an annual allocation of federal grant funds from the United States Department of
Housing and Urban Development (HUD)for the Community Development Block Grant(CDBG). HOME
Investment Partnerships Program (HOME), Emergency Solutions Grant(ESG) and Housing Opportunities
for People with AIDS (HOPVVA)grant programs. |n order to continue to receive these funds, the City must
submit a Consolidated Plan (ConPlan)every three to five years and an Annual Action Plan. The 2013-
2018
ConPlan summarizes housing and community development needs, particularly those of low-income
persons or households and provides the goals, objectives and strategies to address HUD's goals for
decent housing, suitable living environment and expanded economic opportunities. The ConP|an will cover
the period from October 1. 2013to September 3O. 2O18.
The ConP\mn consists of two parts: (i)the five year Strategic Plan (October 1, 2O13to September 3O.
2018)and (ii)the Annual Action Plan, which includes housing and community development activities and
proposed expenditures for the upcoming Program Year. The plan for the first year nf the CnnP\animlisted
below.
The City's Annual Action Plan is a comprehensive summary of the major housing and community
development activities, programs and proposed expenditures for the use of$9,413,143.00 of federal grant
funds from HUD from CDBG, HOME, ESG and HOPWA grant programs for the Program Year beginning
October 1. 2O13 and ending September 3O. 2O14. This year's Action Plan also summarizes the use of
program income resulting from activities using prior years CDBG and HOME funds. The purpose pfthese
grant funds is to primarily benefit low and moderate income City residents, with ESG funds primarily
benefiting homeless persons and HOPWA funds primarily benefiting persons with HIV/AIDS.
A notice was published inthe on June 21. 2O13 regarding the 3O'dmypublic
comment period for the City's proposed ConP\an and Annual Action Plan. The public comment period was
held from June 23. 2O13to July 23. 2O13. Any comments will bo maintained by the Housing and Economic
Development Department, in accordance with federal regulations, These public hearings on the City's
ConPlan and Action Plan will be the first public hearings for the HUD-required citizen participation
process. The second public hearings will be held August G. 2O13at which time the City Council is
scheduled to approve the ConP|an and the Action Plan. The CnnP\en and Action Plan must besubmitted
tn HUD by August 1S. 2U13.
In addition, public hearings were held on June 20, 2013 at 10:00 a.m. and 6:00 p.m. for citizens to provide
comment on the proposed list of neighborhood streets eligible for reconstruction using CDBG funds. The
Transportation and Public Works Department prepared a list of priority streets in CDBG-eligible areas. The
streets selected for reconstruction were based on the comments provided at the public hearings. A list of
the streets im attached and will be included in the Action Plan.
Staff developed recommendations for the allocation of the estimated funding from HUD and presented
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them to the Community Development Council (CDC)on May 22, 2013 and to the Housing and Economic
Development Committee on June 4. 2013. A summary cf the COC'o funding recommendations isprovided
below in Tables 1, 2 and 3 and a spreadsheet of all specific funding recommendations is attached.
For Program Year 2013-2014. itim recommended that the amount of$G.O70.G22.00 |nC[}BG funds and the
estimated amount of$50,000.00 of CDBG program income be allocated as follows:
Public Services -$811'943.0@
This item includes social services for low to moderate income, disabled and disadvantaged
populations.
Housing Programs and Services -$2'149'1S3.50
This item includes funding for the City's Priority Repair Program, Cowtown Brush-Up, homebuyer
and housing services and accessibility modifications to the homes of senior and/or disabled
individuals and related project delivery costs for these programs.
Demolition and Infrastructure Services -$1.0WG.211.30
This item includes funding for neighborhood streets reconstruction and demolition of residential
structures toeliminate slum and blight in City neighborhoods.
C0BG Economic Development -$736'349.8¢
This item io the City's annual payment on its Section 108 loan from HUD.
CDBG Estimated Program Income ~$5O.000.OU
The CDC recommended allocating any CDBG program income for the demolition of residential
structures tneliminate slum and blight in City neighborhoods.
CDBG General Administration -$1,215,$24.4Q
This item includes costs for administering the CD8G grant including a|>uoaUona for Financial
Management Services, Internal Audit and Planning and Development Departments.
For Program Year 2013-2014. itia recommended that the amount o[$1.Q08.541.00in HOME funds and
the estimated amount of$250,000.00 of HOME program income to be allocated as fn||nvvs:
Hommwbuyer Assistance Program -$1,O97,405.75
This item includes funding to provide down payment and/or closing cost assistance to low and
moderate income homebuyana.
Community Development Housing Organivationa (CHDO) Set Aside -$299.481'15
HUD requires that a minimum of 15 percent of HOME funds be allocated to CHDOs for affordable
housing projects and CHDO administrative operating costs. These funds will be used for the
Hillside K4orningsideSing|e Family |nfiU Project by the Tarrant County Housing PadnprnhipCHDO.
Multi-family Development ~$4O0.000'D0
Funding will be used for the Angle Apartments Development (Development). The Development will
result in approximately 3O8 units and 68Oon-site parking spaces. This Development will address a
need for quality affordable housing by providing 100 percent income restricted units to Fort Worth
families ator below 80 percent of Area Median Income. The approximate address will be3Q0OAngle
Avenue, Fort Worth, Texas 761OG. Council District 2.
HOME General Administration -$1SM'654j0
This item includes costs for administering the HOME grant.
Staff anticipates the receipt of program income in the 2013-2014 Program Year from activities using HOME
funds. Any future program income will be used for the City's Homebuyer Assistance Program (HAP) after
the 10 percent allocation, excluding recapture, for HOME General Administration.
For Program Y*mr2013-2014. itimrmcommendedthottheannountof$Q11.G55.O0inHOPVVA[unduba
allocated amfollows:
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Non-Profit Service Providers -$884,305.35
HOPWA Program Administration -$27,349.65
For Program Year 2013-2014, it is recommended that the amount of$425,325.00 in ESG funds be
allocated as follows:
Non-Profit Service Providers -$393,425.62
ESG Program Administration -$31,899.38
The CDC and Staff recommend that contracts be executed with the agencies listed below in the amounts
shown in the following tables:
Co.mmunity-9-eyelopme—nt Block—Grant:
Table I -CDBG Agencies
Organization Program Amount
Cenikor Foundation Substance Abuse
Treatment $ 82,075.00
Childcare Associates Childcare Associates $ 35,335.00
Clayton Child Care. Inc. d/b/a Clayton Out of School Time
YES! $ 82,326.00
Counseling/Shelter
Day Resource Center for the Homeless Based Case
Management $ 43,908.00
Girls Inc. of Tarrant County Girls Inc. Northside Fort
Worth $ 82,075.00
Lena Pope Home, Inc. Second Opportunity for
Success $ 82,326.00
Meals on Wheels, Inc. of Tarrant County Home-Delivered Meals
$ 82,326.00
Senior Citizens of Greater Tarrant Connecting Seniors to
County Community $ 81,824.00
Tarrant County Housing Partnership Housing Counseling and
Education $ 124,935.00
The Ladder Alliance Computer Skills Training $ 100,235.00
The Salvation Army, a Georgia S.T.A.R.T
Corporation $ 43,908.00
YMCA of Metropolitan of Fort Worth Early Childhood
Education $ 35,335.00
YWCA Fort Worth &Tarrant County Child Development
Program $ a5_a35.Q0
CDBG Public Service Subtotal $911,943.00
*REACH Resource Center on Project Ramp
Independent Living $_75_000.00
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1 TOTAL CDBG Contracts I $986,943.00
*REACH will be funded from the CDBG Housing Programs budget.
Housirtg0p,portunitL
es For Persons With AIDS:
Table 2 -HOPWA Agencies
Organization Program Amount
Tarrant County Samaritan Housing, Inc. Administration (three percent)and
Supportive Services
$ 261,611.35
AIDS Outreach Center, Inc. Administration (three percent),
Supportive Services, Tenant Based
Rental Assistance (TBRA), and Short
Term Rent Mortgage and Utility
Assistance (STRMU)
694.00
TOTAL HOPWA Contracts $ 884,305.35
Emergency Solutions Grant:
Table 3 -ESG Agencies
Organization Program Amount
SafeHaven of Tarrant County Shelter Services $ 85,065.00
Presbyterian Night Shelter Shelter Services $ 85,065.00
Day Resource Center for the Shelter Services
Homeless $ 85,065.00
The Salvation Army, a Georgia
Corporation Homelessness Prevention/Rapid Re-Housing $43,136.00
CFW Parks and Community
Services
Homelessness Prevention/Rapid Re-Housing $ 63,015.62 1
Catholic Charities of Fort Worth Homelessness Prevention/Rapid Re-Housing $ 32,079.00
TOTAL ESG Contracts 1 $393,425.62
These programs are available in ALL COUNCIL DISTRICTS.
FISCAL INFORMATION/CERTIFICATION:
The Financial Management Services Director certifies that upon approval of the above recommendations,
adoption of the attached appropriation ordinance and receipt of grant funds, funds will be available in the
current operating budget, as appropriated, of the Grants Fund.
TO Fund/Account/Centers FROM Fund/Account/Centers
GR76 451727 01720665OXXX $5,079,622.00
GR76 5XXXXX T9 2Z.00
-QL7 2Q6 55QXM $0—O 6-- — —
GR76 451727 017206653XXX $425,325.00
GR76 5XXXXX 0172066 3XXX $425,325.00
GR76 451727 017206654- $91
-_16550Q
GR76 5XXXXX .017206654XXX $911,655.00
GR76 451685 017 06650XXX
$5-0-OQ9-00
GR716-5XXXXX 017206650XXX $5-0-OaQ MOO
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GR76 451.6$5_01.72060 „51XM $250.000.00
OR76.5XXXXX 017206651XXX $250,000.0.0
GR76 451727 017206651XXX $1-9196 541.00
GR76 5XXXXX x,996,541.00
017206651 XXX
Submitted for_City Manager's Office bye Fernando Costa (6122)
OrW nating_DepartmentHead Cynthia Garcia (8187)
Addtional.lnformation Contact: Robert Sturns (8003)
Leticia Rodriguez(7319)
ATTACHMENTS
17H UDACTPLANPY1 -1 013 ( ).do0
201 - + ConPl n temp—HEI .13CG.p f
ActionPlan 2013-14 funding r Ornrn rud�ltl0ns.pdf
List of Selected Street for Action Dian 2013.pdf
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