HomeMy WebLinkAboutContract 62972 (2)CSC No. 62972
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 Guardianship Services, Inc. (hereafter "Agency"), a Texas non-profit
corporation. City and Agency may be referred to individually as a "Party" and jointly as "the
Parties".
The Parties state as follows:
WHEREAS, City receives grant monies from the United States Department of Housing
and Urban Development through the Community Development Block Grant ("CDBG") Program,
Program No. B-20-MW-48-0010, Catalog of Federal Domestic Assistance No. 14.218;
WHERAS, City has received an additional allocation of CDBG grant monies under the
Coronavirus Aid, Relief, and Economic Security Act (CARES" Act), referenced by HUD as
"CDBG-CV/CV3";
WHERAS, the CDBG regulations and related HUD guidance publications establish all
requirements for the CDBG-CV/CV3 funds except for those specifically described in this Contract
as deriving from the CARES Act;
WHEREAS, a national objective of the CDBG program is to benefit low and moderate
income citizens in accordance with 24 CFR Part 570, as amended from time to time;
WHEREAS, Agency submitted a proposal and was selected to use CDBG-CV3 funds to
provide eligible public services to individuals and families, of whom 100% must meet the HUD
definition of a presumed benefit population;
WHEREAS, City citizens, the Community Development Council, and the City Council
have determined that CDBG-CV/CV3 programs are needed by the City's citizens to respond to
the impact of the Coronavirus Pandemic.
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:
OFFICIAL RECORD
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2025 CITY SECRETARY
GUARDIANSHIP SERVICES, INC. FT. WORTH, Tx
Area Median Income or AMI means the median family income for the Fort Worth -Arlington
metropolitan statistical area as established annually by HUD. The 2024 income limits are
attached hereto as EXHIBIT "A-1" — 2024 HUD Income Limits.
Business Equity Ordinance or BEO means the City's Business Diversity Ordinance, Ordinance
No. 25165-10-2021, as may be amended from time to time.
CDBG means Community Development Block Grant.
Complete Documentation means the following documentation as applicable:
• Attachments I, II, and III within Exhibit "D", with supporting documentation
including:
o Proof of expense: copies of timesheets, invoices, leases, service contracts or
other documentation showing that payment is due by Agency.
o Proof of payment: cancelled checks, bank statements, or wire transfers
necessary to demonstrate that amounts due by Agency were actually paid by
Agency.
o Proof of client eligibility: client eligibility for all clients as outlined in
Section 6.
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-CV3 Funds/CDBG-CV means the grant funds supplied by City to Agency under the
terms of this Contract. Under the terms of this Agreement, they will collectively be referred to as
"CDBG-CV."
CDBG Regulations means regulations found at 24 CFR Part 570 et seq.
Countywide Agencies means agencies with 10% or more of clients that reside outside of the
boundaries of the City. All other agencies are considered Fort Worth agencies.
DBE means disadvantaged business enterprise in accordance with 49 CFR Part 26.
Director means the Director of the Neighborhood Services Department.
Effective Date means January 1, 2025.
HUD means the United States Department of Housing and Urban Development.
IDIS means Integrated Disbursement Information System, HUD's project tracking system.
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Income Eligible Client means a client whose annual income adjusted for family size does not
exceed 80% of AMI using the most current HUD Income Guidelines and Technical Guidance for
Determining Income and Allowances. The definition of annual income to determine client income
eligibility shall be the definition contained in 24 CFR Part 5.609, as amended from time to time.
National Objective means an activity that benefits low- and moderate -income persons. For the
purposes of this Contract, at least 51% of the clients served by the Program must be Income
Eligible Clients.
Neighborhood Services Department means the City's Neighborhood Services Department.
Neighborly Software — Online database for Agency to submit monthly reimbursement requests.
OMB means the Office of Management and Budget.
Program means the services described in EXHIBIT "A" — Program Summary.
Reimbursement Request means all reports and other documentation described in Section 9.
Source Documentation means documentation of full household income of any type described
under the definition of annual income in 24 CFR Part 5.609, including but not limited to copies of
paychecks, Social Security and disability verification letters, interest or rental income statements,
retirement income statements, child support and alimony verification, unemployment benefit
letters, and the like.
Unduplicated Clients means a count of all clients served by the Program at least once in the
Contract Term. Clients served by the Program more than once in the Contract Term will only be
counted the first time they are served when determining the total count of Unduplicated Clients.
3. TERM.
The term of this Contract begins on the Effective Date and terminates on September 30,
2025, unless earlier terminated as provided in this Contract. This Contract may be extended by
mutual agreement of the Parties in writing if such extension is necessary for completion of the
program. Extensions will be memorialized in an amendment to the Agreement so long as the
amendment complies with City policies and all applicable laws and regulations governing the use
of federal grant funds. The Contract term shall include any extension, if exercised, as provided
herein.
4. DUTIES AND RESPONSIBILITIES OF CITY.
4.1 Provide CDBG-CV/CV3 Funds.
City will provide up to $70,000.00 of CDBG-CV/CV3 Funds under the terms and
conditions of this Contract.
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GUARDIANSHIP SERVICES, INC.
4.2 Monitor.
City will monitor the activities and performance of Agency and any of its contractors,
subcontractors or vendors as necessary, but no less than annually. Monitoring by City will include
determining whether Agency is meeting the National Objective during the term of this Contract.
5. DUTIES AND RESPONSIBILITIES OF AGENCY.
5.1 Required Services.
Agency shall perform the services described in EXHIBIT "A" — Program Summary in
accordance with the terms and conditions of this Contract.
5.2 Use of CDBG-CV/CV3 Funds.
5.2.1. Compliance with CDBG Regulations and Contract.
Agency shall be reimbursed for eligible Program costs with CDBG-CV/CV3 Funds only
if City determines in its sole discretion that:
5.2.1.1 Costs are eligible expenditures in accordance with CDBG Regulations.
5.2.1.2 Costs are in compliance with this Contract and are reasonable and
consistent with industry norms.
5.2.1.3 Complete Documentation, as applicable, is submitted to City by
Agency.
5.2.1.4 Costs are in compliance with HUD guidance regarding use of CDBG-
CV/CV3 funds and HUD CPD Notice published at FR 6218-N-01.
5.2.2 Budget.
5.2.2.1 The CDBG-CV/CV3 Funds will be paid on a reimbursement basis in
accordance with EXHIBIT `B" - Budget.
5.2.2.2 During the term of this Contract, Agency may submit written requests
to increase or decrease line item amounts in the Budget, including an
explanation of why such increases or decreases are necessary. All
requests shall be approved by Director or Director's designee in writing,
with such approval being in the City's sole discretion. If the Agency's
proposed Budget amendment is approved (as approved, the "Amended
Budget"), then the Amended Budget shall be memorialized in a
written amendment to this Contract. The Amended Budget will take
effect on the first day of the month following the month in which the
Contract amendment is executed, unless otherwise specified in the
amendment. All requests for Budget amendments must be
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submitted no later than 90 days prior to the date of the end of the
term of this Contract.
5.2.3 Change in Program Budget.
5.2.3.1 Agency will notify City promptly of any additional funds it receives for
operation of the Program, and City reserves the right to amend this
Contract in such instances to ensure compliance with HUD regulations
governing cost allocation.
5.2.3.2 Agency agrees to utilize the CDBG-CV/CV3 Funds to supplement
rather than supplant funds otherwise available for the Program.
5.2.4 Pavment of CDBG-CV/CV3 Funds to A2encv.
CDBG-CV/CV3 Funds disbursement to Agency is applicable upon City's approval of
Reimbursement Requests including submission of Complete Documentation to City in compliance
with Section 9. If Agency expends all funds budgeted for the Program prior to completion pf
90% of performance goals, City may hold back a small amount of the CDBG-CV/CV3 Funds
until the end of the term to ensure completion of all performance goals. During this interim
period, Agency must continue to submit Attachment III — Client Data Report in EXHIBIT "D" —
Reimbursement Forms monthly. It is expressly agreed by the Parties that any CDBG-CV/CV3
Funds not spent or approved for reimbursement to Agency shall remain with City.
5.3 Program Performance Milestones. Review and Corrective Action Plans.
5.3.1 Agency represents that the Program will achieve the following milestones in
accordance with EXHIBIT "A" — Program Summary and the table below:
% of Unduplicated
Clients Served (as
specified in EXHIBIT
"A" — Program
Month
Expenditures
Summary)
3
25%
25%
6
50%
50%
9
75%
75%
12
100%
100%
5.3.2 Failure of Agency to meet these milestones or a material deviation from them is a
breach of this Contract. For the purpose of this Section, "material deviation" shall mean more
than 10% lower than the specified goal. In the event of such breach, City reserves the right in its
sole option to (i) delay or withhold payment of Reimbursement Requests, (ii) institute a Corrective
Action Plan ("CAP") as described below, (iii) lower Agency's allocation of or deobligate all
CDBG-CV/CV3 Funds, (iv) terminate this Contract, or (v) any combination of the above options.
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2025
GUARDIANSHIP SERVICES, INC.
5.3.2.1 Policy.
To ensure the Program meets the client goals provided by Agency and included herein,
City will periodically review Program performance to ensure the expenditure of the funds is
roughly proportional to the number of eligible, unduplicated clients being served, as described
above in 5.3.1. City expects that most programs will expend funds in a proportional amount to
clients served, but City reserves the ability to take into account unique program characteristics that
may impact the ratio between expenditures and clients served.
5.3.2.2 Review.
At the end of each quarter, City will review the information in the required reports provided
to City by Agency. City will review the amount of funds expended compared to the percentage of
eligible, unduplicated clients served. If City believes in its sole discretion that Agency is (i) in
danger of not spending the full amount of the funds allocated, (ii) in danger of expending all funds
prior to serving 100% of the unduplicated client goal (meaning the percentage of funds expended
relative to the overall funding allocated is not within 10% of the percentage of eligible,
unduplicated clients served relative to the overall client goal), or is (iii) in danger of not otherwise
meeting the performance goals within this Contract, City will notify Agency and set up a Program
Review Meeting ("Review Meeting"). Failure by Agency to attend the Review Meeting is
considered a breach of this contract and City may invoke any and all remedies included herein.
During the Review Meeting, City and Agency will review the information provided, the Program,
and discuss any concerns. If the City believes that no additional action is needed to ensure
Agency's performance, no additional requirements will be put in place; however, if the City, in its
sole discretion, believes that additional requirements are needed to ensure Agency's performance,
City may require the Agency to enter into a Corrective Action Plan or may move forward with
deobligating funds from the Contract.
5.3.2.3 Corrective Action Plans. ("CAP")
A CAP will be unique to the Agency and the Program and will be designed to ensure that
the Agency (i) expends the funds allocated to it by the City, and (ii) serves the required number of
unduplicated clients through the Program. A CAP may require additional outreach or marketing,
additional reporting, additional monitoring, or any other mechanism that will reasonably ensure
the Program goals are met and that expenditures are roughly proportional to the number of eligible,
unduplicated clients served.
5.3.2.4 Deobligation of Funds
If after any quarterly review the City determines that a CAP will not be sufficient to ensure
that the Agency (i) expends the funds allocated to it by the City, and (ii) serves the required number
of unduplicated clients through the Program, City shall be able to deobligate a portion of the funds
provided to Agency that is at -risk of not being expended or that is the proportional amount of funds
compared to the number of eligible, unduplicated clients that are anticipated to not be served. Any
deobligation shall be in the form of a contract amendment. By way of example, if an agency was
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allocated $100,000 and was required to serve 100 unduplicated clients, if that agency was expected
to only be able to serve 75% of its client goal, then City would allow agency to keep 75% of the
allocated funding and deobligate 25% of the funds to correspond with the 25% of clients that are
anticipated to not be served.
5.3.3 Failure to comply with the Corrective Action Plan (CAP), meet the Program Goals,
or otherwise comply with serving 139 unduplicated clients may, in City's sole discretion,
disqualify Agency for consideration under the City's Request for Proposals for the succeeding
Program Year for federal grant funds.
5.3.4 Amendments to performance milestones regarding CDBG-CV/CV3 Funds must
have approval by the Director in writing, with such approval being in the Director's sole discretion.
If Director approves the Agency's proposed amended performance milestones (as approved, the
"Amended Performance Milestones"), then the Amended Performance Milestones shall be
memorialized in a written amendment to this Contract. The Amended Performance Milestones
will take effect on the first day of the month following the month in which the Contract
Amendment is executed unless otherwise specified in the amendment. Except in extreme
circumstances, Amendments will not reduce the number of Unduplicated Clients stated in Section
5.3.3 and in EXHIBIT "A" - Program Summary. In the event that an Amendment has an approval
for such purpose, the amendment will also likely result in and include a reduction of CDBG-
CV/CV3 funding for the Program.
5.4 Identifv Program Expenses Paid with CDBG-CV/CV3 Funds.
Agency will keep accounts and records in such a manner that City may readily identify and
account for Program expenses reimbursed with CDBG-CV/CV3 Funds. These records shall be
made available to City for audit purposes and shall be retained as required hereunder.
5.5 Meet National Objective.
Agency shall ensure that the activities carried out in the Program will meet the National
Objective.
5.6 Program Subcontracts.
Agency shall not enter into a subcontract with another agency, contractor, or vendor to
provide a service to clients for any part of the Program that will have payment with CDBG-
CV/CV3 Funds without City's written consent.
6. CLIENT ELIGIBILITY VERIFICATION.
6.1 Client Eligibility.
Agency will document client eligibility as follows:
6.1.1 Agency Clients.
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Agency must verify all new clients' income with either a verifiable self -certification of
income such as the City's Certification of Income Statement attached as EXHIBIT "E" — Self -
Certification of Income Form or a similar form approved by City, or Source Documentation.
Agency must use the annual income definition in 24 CFR Part 5.609 to establish client income and
must use the most current HUD Income Guidelines. The income of all Program clients must have
documentation and at least 51 % of them must be Income Eligible Clients. In addition, Agency
must document client eligibility for CARES Act assistance by maintaining records of client need
directly related to and/or caused by the Coronavirus Pandemic, as well as other eligibility
documentation further described in Exhibit "A"- Program Summary.
6.1.1.1 If Agency serves both Fort Worth and non -Fort Worth clients, the
proportion of Program costs allocated to the CDBG-CV/CV3 funded
portion of the Program Budget must be consistent with the proportion
of Fort Worth clients to all clients.
6.1.1.2 All Program lients in st be reported on EXHIBIT "D" —
Reimbursement Forms, Attachment III. All Program clients whose
income has not been verified will be deemed to not be Income Eligible
Clients and shall not be included in the 51%.
6.1.2 Verification of Program Eligibility.
6.1.2.1 At the end of each quarter during the Contract term, Agency shall verify
CDBG-CV/CV3 Program Eligibility by confirming that at least 51 % of
clients served by the Program to date are Income Eligible Clients as
reported on Attachment III.
6.1.2.2 If Agency fails to meet the requirements of Section 6.1.2.1, Agency will
have thirty (30) calendar days, or until the next monthly invoice, to cure.
6.1.2.3 City will notify Agency by e-mail within fourteen (14) calendar days if
the client eligibility requirements outlined in this Section were not cured
within the timeline outline in 6.1.2.2. Agency will have seven (7)
calendar days from the date of the e-mail notice to meet these
requirements. If Agency fails to meet the requirements, Agency may
forfeit any payments otherwise due that month and failure to meet the
client eligibility requirements will be considered an event of default as
outlined in Section 10.1.
6.1.2.4 In the event the Agency fails to meet the client eligibility requirements,
City reserves the right in its sole option to delay or withhold payment of
Reimbursement Requests, to lower Agency's allocation of CDBG-
CV/CV3 Funds, or to terminate this Contract.
6.2 Submission of Complete Documentation.
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2025
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Agency must submit copies of documentation of client eligibility described in Section 6.1
with Attachment III with each month's Reimbursement Request for all Unduplicated Clients.
6.3 Maintain Documentation.
Agency must maintain copies of all documentation required by this Section 6 for 5 years
following the expiration of the Contract term. This Section shall survive the earlier termination
or expiration of this Contract.
7. ADDITIONAL CDBG REOUIREMENTS.
Agency agrees to comply with all requirements of the CDBG Program as stated in the
CDBG Regulations, as well as any further requirements established by HUD regarding CDBG-
CV/CV3 funds upon receiving notification of such additional requirements from City, including
but not limited to the following:
7.1 Environmental Review.
CDBG-CV/CV3 Funds will not be paid, and costs cannot be incurred until City has
conducted an environmental review and completed an Environmental Review Record as required
by 24 CFR Part 58. The environmental review may result in a decision to proceed with, modify,
or cancel the funding for the Program. Further, Agency will not undertake or commit any funds
to physical or choice limiting actions as described in any applicable federal regulations. Any
violation of this provision will (i) cause this Contract to terminate immediately, and (ii) require
Agency to repay City the CDBG-CV/CV3 Funds it has already received and forfeit any future
payments of CDBG-CV/CV3 Funds.
7.2 Contract Not Constituting Commitment of Funds.
Notwithstanding any provision of this Contract, the Parties agree and acknowledge that
this Contract does not constitute a commitment of funds, and that such commitment of funds or
approval may occur only upon (i) satisfactory completion of an environmental review and receipt
by City of an authorization to use grant funds from HUD under 24 CFR Part 58, (ii) approval of
any applicable Substantial Amendments to the City's 2020-2021 Action Plan regarding CARES
Act grant funds, and (iii) receipt by City of a grant agreement from HUD.
7.3 Monitoring.
7.3.1 Agency understands and agrees that it will be subject to monitoring by City for
compliance with terms and provisions of this Contract, compliance with the CARES Act, and the
CDBG Regulations for the term of this Contract. Agency is subject to such monitoring during
the term of this Contract and for 5 years after the Contract term ends. Agency will provide reports
and access to Program files as requested by City during this 5 year period.
7.3.2 Representatives of City, HUD, HUD Office of Inspector General, and the United
States Comptroller General shall have access during regular business hours, upon 48 hours prior
notice, to Agency's offices and records pertaining to the use of the CDBG-CV/CV3 Funds, and to
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Agency's officers, directors, agents, employees, contractors, subcontractors and vendors for the
purpose of such monitoring.
7.3.3 In addition to other provisions of this Contract regarding frequency of monitoring,
City reserves the right to perform desk reviews or on -site monitoring of Agency's compliance with
the terms and conditions of this Contract. City shall provide Agency with a written report of the
monitor's findings after each monitoring visit. If the monitoring report notes deficiencies in
Agency's performance, the report shall include requirements for the timely correction of said
deficiencies by Agency. Failure by Agency to take the action specified in the monitoring report
may be cause for suspension or termination of this Contract as provided herein.
7.3.4 Subsections 7.3.1 through 7.3.3 shall be applicable for the Contract Term and for 5
years thereafter and shall survive the earlier termination or expiration of this Contract.
7.3.5 Agency shall provide City annually the results of any state or federal monitoring.
Such results shall be submitted within 60 days of receipt of such state or federal monitoring report,
or with the January Reimbursement Request, whichever is earlier.
7.4 Aeencv Procurement Standards.
Agency shall comply with all applicable federal, state and local laws, regulations, and
ordinances for making procurements under this Contract. In addition to the conflict of interest
provisions in Section 14.13.3, Agency shall establish written procurement procedures to ensure
that materials and services are obtained in a cost effective manner and that provides for full and
open competition. When procuring materials and services for this Contract, Agency shall comply
at a minimum with the procurement standards in 2 CFR Part 200.317 through Part 200.326.
7.4.1 Contracts in excess of $10,000.00 made by Agency using CDBG-CV/CV3 Funds
must address termination for cause and convenience including the manner by which such
termination shall be effected and the basis for settlement of the terminated contract, if any, as
required by Appendix II (B), 2 CFR Part 200.
7.4.2 Agency shall not make any contract with parties listed on the government wide
System for Award Management, www.sam.gov ("SAM"). Agency must confirm by search of
SAM that all contractors paid with CDBG-CV/CV3 Funds are not listed by SAM as being
debarred, both prior to hiring and prior to submitting a Reimbursement Request which includes
invoices from any such contractor. Failure to submit such proofs of search shall be an event
of default.
7.5 Cost Principles/Cost Reasonableness.
Agency shall administer its use of CDBG-CV/CV3 Funds in compliance with 2 CFR Part
200, as applicable. The eligibility of costs incurred for performance rendered shall be determined
in accordance with 2 CFR Part 200.400 through 2 CFR Part 200.475.
7.6 Financial Management Standards.
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Agency agrees to comply with 2 CFR Part 200, as applicable. Agency also agrees to adhere
to the accounting principles and procedures required therein, utilize adequate internal controls, and
maintain necessary supporting and back-up documentation for all costs incurred in accordance
with 2 CFR Part 200.302 and Part 200.303.
7.7 Uniform Administrative Requirements, Cost Principles, and Audit
Requirements.
Agency will comply with the Uniform Administrative Requirements, Cost Principles, and
Audit Requirements for Federal Awards in 2 CFR Part 200, as applicable, or any reasonably
equivalent procedures and requirements that City may require.
7.8 Terms Applicable to Contractors, Subcontractors and Vendors.
Agency understands and agrees that all terms of this Contract, whether regulatory or
otherwise, shall apply to any and all contractors, subcontractors and vendors of Agency which are
in any way paid with CDBG-CV/CV3 Funds or who perform any work in connection with the
Program. Agency shall cause all applicable provisions of this Contract to be included in and made
a part of any contract or subcontract executed in the performance of its obligations hereunder
including its obligations regarding the CDBG Regulations. Agency shall monitor the services and
work performed by its contractors, subcontractors and vendors on a regular basis for compliance
with the CDBG Regulations and Contract provisions. Agency must cure all violations of the
CDBG Regulations committed by its contractors, subcontractors or vendors. City maintains the
right to insist on Agency's full compliance with the terms of this Contract and the CDBG
Regulations and Agency is responsible for such compliance regardless of whether actions taken to
fulfill the requirements of this Contract are taken by Agency or by Agency's contractors,
subcontractors or vendors. Agency acknowledges that the provisions of this Section shall survive
the earlier termination or expiration of this Contract and shall be applicable for 5 years after the
Contract term ends.
7.9 Covvright and Patent Rights.
No reports, maps, or other documents produced in whole or in part under this Contract shall
be the subject of an application for copyright by or on behalf of Agency. HUD and City shall
possess all rights to invention or discovery, as well as rights in data, which may arise as a result of
Agency's performance under this Contract.
7.10 Conflict of Interest Disclosure.
In accordance with the requirements of Section 14.13.2.1 and 14.13.4, Agency shall
establish conflict of interest policies for federal awards. Agency shall disclose to City in writing
any potential conflict of interest.
7.11 Compliance with FFATA and Whistleblower Protections.
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Agency shall comply with the requirements of 2 CFR 300(b), including provisions of the
Federal Funding Accountability and Transparency Act ("FFATA") governing requirements on
executive compensation and provisions governing whistleblower protections contained in 10
U.S.C. 2409, 41 U.S.C. 4712, 10 U.S.C. 2324,41 U.S.C. 4304 and 41 U.S.C. 4310.
7.11.1 Agency shall provide City with its DUNS number.
7.12 Internal Controls.
In compliance with the requirements of 2 CFR Part 200.303, Agency shall:
7.12.1 Establish and maintain effective internal control over the CDBG-CV/CV3 Funds
that provides reasonable assurance that Agency is managing the CDBG-CV/CV3 Funds in
compliance with federal statutes, regulations, and the terms and conditions of this Contract. These
internal controls shall be in compliance with guidance in "Standards for Internal Control in the
Federal Government" issued by the Comptroller General of the United States or the "Internal
Control Integrated Framework" issued by the Committee of Sponsoring Organizations of the
Treadway Commission ("COSO");
7.12.2 Comply with federal statutes, regulations, and the terms and conditions of this
Contract;
7.12.3 Evaluate and monitor Agency's compliance with statutes, regulations and the terms
and conditions of this Contract;
7.12.4 Take prompt action when instances of noncompliance are identified including
noncompliance identified in audit findings; and
7.12.5 Take reasonable measures to safeguard protected personally identifiable
information and other information that HUD or City designates as sensitive or Agency considers
sensitive consistent with applicable federal, state, local and tribal laws regarding privacy and
obligations of confidentiality.
8. RECORD KEEPING; REPORTING AND DOCUMENTATION
REOUIREMENTS; AUDIT.
8.1 Record 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, regardless of whether or not this Contract is
earlier terminated. 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
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audits have been resolved.
8.2 Access to Records.
Representatives of City, HUD and any duly authorized officials of the federal government
will have full access to, and the right to examine, audit, copy, excerpt and/or transcribe any of
Agency's records pertaining to all matters covered by this Contract for 5 years after the Contract
term ends, regardless of whether or not this contract is earlier terminated. Such access shall be
during regular business hours and upon at least 48 hours prior notice.
8.3 Reports.
Agency will submit to City all reports and documentation described in this Contract in such
form as City may prescribe. Agency may also be required to submit a final performance and/or
final financial report if required by City at the termination of this Contract in such form and within
such times as City may prescribe. Failure to submit to City any report or documentation described
in this Contract shall be an event of default of this Contract and City may exercise all of its
remedies for default under this Contract.
8.3.1 Additional Information.
Agency shall provide City with additional information as may be required by state or
federal agencies to substantiate Program activities and/or expenditure eligibility.
8.4 Change in Reporting Requirements and Forms.
City retains the right to change reporting requirements and forms at its discretion. City
will notify Agency in writing at least fifteen (15) days prior to the effective date of such change,
and the Parties shall execute an amendment to the Contract reflecting such change if necessary.
8.5 Audit.
8.5.1 Entities that Expend $1,000,000.00 or more in Federal Funds Per Year.
All non-federal entities that expend $1,000,000.00 or more in federal funds within 1 year,
regardless of the source of the federal award, must submit to City an annual audit prepared in
accordance with specific reference to 2 CFR Part 200.501 through Part 200.521. The audit shall
cover the Agency's fiscal years during which this Contract is in force. The audit must be prepared
by an independent certified public accountant, be completed within six 6 months following the end
of the period being audited and be submitted to City within thirty 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 $1,000,000.00 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.
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8.5.2 Citv Reserves the Right to Audit.
City reserves the right to perform an audit of Agency's Program operations and finances at
any time during the term of this Contract and for 5 years after the Contract term ends, regardless
of whether or not this Contract is earlier terminated, 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. If such audit reveals a
questioned practice or expenditure, such questions must be resolved within fifteen (15) business
days after notice to Agency of such questioned practice or expenditure. If questions are not
resolved within this period, City reserves the right to withhold further funding under this Contract
and/or any other contracts with Agency. IF AS A RESULT OF ANY AUDIT IT IS
DETERMINED THAT AGENCY HAS FALSIFIED ANY DOCUMENTATION OR
MISUSED, MISAPPLIED OR MISAPPROPRIATED CDBG FUNDS OR SPENT CDBG
FUNDS ON ANY INELIGIBLE ACTIVITIES, AGENCY AGREES TO REIMBURSE
CITY THE AMOUNT OF SUCH MONIES PLUS THE AMOUNT OF ANY SANCTIONS,
PENALTY OR OTHER CHARGE LEVIED AGAINST CITY BY HUD BECAUSE OF
SUCH ACTIONS.
9. REIMBURSEMENT REQUIREMENTS.
9.1 Deadline for Submitting Reimbursement Requests.
9.1.1 Reimbursement Requests shall be submitted monthly to the City and must be
received by the City on or before the 15t" day of the month following the month expenses were
paid by Agency. For example, the Reimbursement Request for June expenses must be received
by July 15. In the event the 15t' 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.
NOTWITHSTANDING ANYTHING ABOVE, THE REIMBURSEMENT REQUEST FOR
EXPENSES INCURRED FOR SEPTEMBER 2025 MUST BE RECEIVED BY OCTOBER
4, 2025. COMPLETE DOCUMENTATION FOR ALL SEPTEMBER 2025 EXPENSES
MUST BE SUBMITTED BY OCTOBER 15, 2025. FAILURE TO SUBMIT A FINAL
REIMBURSEMENT REQUEST WITH COMPLETE DOCUMENTATION BY
OCTOBER 15, 2025 WILL RESULT IN FORFEITURE OF PAYMENT OF THE
SEPTEMBER REIMBURSEMENT REQUEST.
9.1.2 City will notify Agency by e-mail within fourteen (14) calendar days if a
Reimbursement Request is lacking Complete Documentation or corrections are needed. Agency
will have seven (7) calendar days from the date of the e-mail notice to submit any requested
information or missing documentation. Agency may be penalized, at City's sole discretion, in the
Request for Proposal for the following Program Year for any notifications received under this
Section. If Agency fails to submit all the required information or missing documentation within
seven (7) calendar days from the first e-mail, Agency may forfeit any payments otherwise due that
month and failure to submit any requested information will be considered an event of default as
outlined in Section 10.1.2.
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9.2 Submission of Reimbursement Requests.
Agency shall provide City with Complete Documentation and the following reports
as shown in EXHIBIT "D" —Reimbursement Forms with each Reimbursement Request:
9.2.1 Attachment I — Request Summarv.
This report shall contain the amount requested for reimbursement each month, and the
cumulative reimbursement requested to date (inclusive of that month's request).
9.2.2 Attachment II — Expenditure Worksheet.
This report shall itemize each expense requested for reimbursement by Agency and shall
include the Account corresponding the expense to a Budget line item. In order for this report to
be complete the following must be submitted:
9.2.2.1 For payroll expenses, timesheets signed by employees and approved by
supervisor for all payroll expenses listed. Timesheets must distinguish
between CDBG-CV/CV3 funded time and non-CDBG-CV/CV3 funded
time and reflect actual time spent on CDBG-CV/CV3 funded activities.
Agency may not submit payroll expenses dated sixty (60) calendar days
prior to the date of the Reimbursement Request unless approved in
writing in advance by City as authorized under CARES Act.
9.2.2.2 For non -payroll expenses, invoices for each expense listed with an
explanation as to how the invoiced expense pertains to the Program.
Agency may not submit invoices dated sixty 60 calendar days prior to
the date of the Reimbursement Request.
9.2.2.3 Proof that each expense was paid by Agency. Proof can be satisfied by
cancelled checks, wire transfer documentation, paid receipts or other
appropriate banking documentation.
9.2.3 Attachment III — Client Data Report.
This report shall list each Unduplicated Client served during the month along with his or
her demographic information. The Client Data Report must maintain a list of all clients served
during the Contract term. In order for this report to be complete, the following must be submitted:
9.2.3.1 Documentation of income verification for each Unduplicated Client the first
time the client is served by the Program, which will either be the completed form
of EXHIBIT "E" — Self- Certification of Income Form or similar form approved
by City, and Source Documentation.
9.2.4 Delivery of Reimbursement Request.
Reimbursement Requests must be submitted through Neighborly Software or other
reporting software as approved by the City by the deadline in Section 9.1.
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9.2.5 Countvwide Agencies
Countywide Agencies shall submit EXHIBIT "A-2" — Reporting Requirements for
Countywide Agencies quarterly with the December, March, June and September Reimbursement
Requests. Reports due under this section have the same due date as the Reimbursement Request.
9.3 Withholding Pavment.
CITY SHALL HAVE NO OBLIGATION TO PAY ANY REIMBURSEMENT
REQUEST THAT IS NOT RECEIVED BY THE DUE DATE AS OUTLINED HEREIN.
Failure to timely submit accurate and complete Reimbursement Requests and Complete
Documentation along with any required reports shall be an event of default.
10. DEFAULT AND TERMINATION.
10.1 Failure to Submit Reimbursement Request or Required Documentation.
10.1.1 Failure to submit a Reimbursement Request in accordance with Section 9 and
Exhibits "D" and "F," may be in default of this Contract. If Agency has not provided the requested
information or missing documentation within the seven (7) calendar day notice period as provided
for in Section 9.1.2, City will provide Agency with a written Default Notice. Agency will have
five (5) calendar days from the date of the written Default Notice to submit information and
documentation to cure the default. If Agency fails to cure the default within such time, Agency
shall forfeit any payments otherwise due that month and the failure to submit shall be considered
an event of default that shall not be cured.
10.1.2 NOTWITHSTANDING THE PROVISIONS OF SECTION 10.1.1, IF
AGENCY FAILS TO SUBMIT THE REIMBURSEMENT REQUEST DUE OCTOBER 4,
2025 OR IF THE SUBMITTED REIMBURSEMENT REQUEST DUE OCTOBER 4, 2025
IS LATE, INCOMPLETE OR OTHERWISE NOT IN COMPLIANCE WITH THIS
CONTRACT OR THE CDBG REGULATIONS AS DETERMINED BY CITY IN ITS
SOLE DISCRETION, THERE WILL BE NO CURE PERIOD AND ANY
REIMBURSEMENT WILL BE FORFEITED.
10.1.3 In the event of an uncured default under this 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-CV/CV3 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.
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10.1.5 In the event of termination under this Section 10.1, all CDBG-CV/CV3 Funds
awarded but unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency
shall have no further right to such funds.
10.2 Failure to Maintain Records or Submit Reports and Documentation.
If Agency fails to maintain all records and documentation as required in Section 8, or if the
maintained or submitted report or documentation is not in compliance with this Contract or the
CDBG Regulations as determined by City in its sole discretion, City will notify Agency in writing
and Agency will have thirty (30) calendar days from the date of the written request to obtain or
recreate the missing records and documentation or submit or resubmit any such report or
documentation to City. If Agency fails to maintain the required reports or documentation, or fails
to submit or resubmit any such report or documentation within such time, City shall have the right
to terminate this Contract effective immediately upon written notice of such intent with no penalty
or liability to City.
10.2.1 In the event of termination under Section 10.2, all CDBG-CV/CV3 Funds
awarded but unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency
shall have no further right to such funds.
10.2.2 In the event of termination under Section 10.2, any CDBG-CV/CV3 Funds paid
to Agency must be repaid to City within thirty (30) days of termination. If such CDBG-CV/CV3
Funds are not repaid to City within the thirty (30) day period, City shall exercise all legal remedies
available under this Contract.
10.3 In General.
10.3.1
Subject to Section 10.2, and unless specifically provided otherwise in this Contract,
Agency shall be in default under this Contract if Agency breaches any term or condition of this
Contract. In the event that such a breach remains uncured after thirty (30) calendar days following
written notice by City (or such other notice period as may be specified herein) or, if Agency has
diligently and continuously attempted to cure following receipt of such written notice but
reasonably requires more than thirty (30) calendar days to cure, as determined by both Parties
mutually and in good faith, City shall have the right to elect in City's sole discretion to: (i) extend
Agency's time to cure, (ii) terminate this Contract effective immediately upon written notice of
such intent to Agency, or (iii) pursue any other legal remedies available to City under this Contract.
10.3.2 City's remedies may include:
10.3.2.1 Direct Agency to prepare and follow a schedule of actions for
carrying out the affected activities, consisting of schedules,
timetables and milestones necessary to implement the affected
activities.
10.3.2.2 Direct Agency to establish and follow a management plan that
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assigns responsibilities for carrying out the remedial activities.
10.3.2.3 Reprogram CDBG-CV/CV3 Funds that have not yet been expended
from affected activities to other eligible activities or withhold
CDBG-CV/CV3 Funds.
10.3.2.4 Any other appropriate action including but not limited to any
remedial action legally available such as declaratory judgment,
specific performance, damages, temporary or permanent
injunctions, termination of this Contract or any other contracts with
Agency, and any other available remedies.
10.3.3 In the event of termination under Section 10.3, all CDBG-CV/CV3 Funds
awarded but unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency
shall have no further right to such funds, and any CDBG-CV/CV3 Funds already paid to Agency
must be repaid to City within thirty (30) days of the termination. Failure to repay such CDBG-
CV/CV3 Funds within the thirty (30) day period will result in City exercising all legal remedies
available under this Contract.
10.4 No Funds Disbursed while in Breach.
Agency understands and agrees that no CDBG-CV/CV3 Funds will be paid to Agency until
all defaults are cured to City's satisfaction.
10.5 No Compensation After Date of Termination.
Agency shall not receive any compensation for work undertaken after the date of the
termination.
10.6 Rights of Citv Not Affected.
Termination shall not affect or terminate any of the existing rights of City against Agency,
or which may thereafter accrue because of Agency's default and this provision shall be in addition
to any and all other rights and remedies available to City under the law. Such termination does
not terminate any provisions of this Contract that have been expressly noted as surviving the term
or termination of the Contract. No delay or omission by City in exercising any right or remedy
available to it under this Contract shall impair any such right or remedy or constitute a waiver or
acquiescence in any Agency default.
10.7 Waiver of Breach Not Waiver of Subsequent Breach.
The waiver of a default or breach of any term, covenant, or condition of this Contract shall
not operate as a waiver of any subsequent default or breach of the same or any other term, covenant
or condition hereof.
10.8 Civil, Criminal and Administrative Penalties.
Failure to perform all the Contract terms may result in civil, criminal or administrative
penalties, including, but not limited to those set out in this Contract.
10.9 Termination for Cause.
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10.9.1 City may terminate this Contract in the event of Agency's default, inability, or
failure to perform subject to notice, grace and cure periods. In the event City terminates this
Contract for cause, all CDBG-CV/CV3 Funds awarded but unpaid to Agency pursuant to this
Contract shall be immediately rescinded and Agency shall have no further right to such funds and
any CDBG-CV/CV3 Funds already paid to Agency must be repaid to City within thirty (30) days
of termination. Failure to repay such CDBG-CV/CV3 Funds within thirty (30) days will result in
City exercising all legal remedies available to City under this Contract. AGENCY
ACKNOWLEDGES AND AGREES THAT IF CITY TERMINATES THIS CONTRACT
FOR CAUSE, AGENCY OR ANY AFFILIATES OF AGENCY SHALL NOT BE
CONSIDERED FOR ANY OTHER CITY CONTRACT FOR CDBG FUNDS FOR A
MINIMUM OF 5 YEARS FROM THE DATE OF TERMINATION.
10.9.2 Agency may terminate this Contract if City does not provide the CDBG-
CV/CV3 Funds substantially in accordance with this Contract.
10.10 Termination for Convenience.
In terminating in accordance with 2 CFR Part 200, Appendix II, this Contract may be
terminated in whole or in part only as follows:
10.10.1 By City with the consent of Agency in which the Parties agree upon the
termination conditions, including the effective date and in the case of partial termination, the
portion to be terminated; or
10.10.2 By Agency upon at least thirty (30) days written notification to City, setting
forth the reasons for such termination, the effective date, and in the case of partial termination, the
portion to be terminated. In the case of a partial termination, City may terminate the Contract in
its entirety if City determines in its sole discretion that the remaining portion of the Contract to be
performed or CDBG-CV/CV3 Funds to be spent will not accomplish the purposes for which the
Contract was made.
10.11 Dissolution of A2encv Terminates Contract.
This Contract shall terminate in the event Agency is dissolved or ceases to exist. In the
event of termination under this Section, all CDBG-CV/CV3 Funds are subject to repayment and/or
City may exercise all of its remedies under this Contract.
10.12 Non -appropriation of Funds.
In the event no funds or insufficient funds are appropriated by City in any fiscal period for
any payments due hereunder, City will notify Agency of such occurrence and this Agreement shall
terminate on the last day of the fiscal period for which appropriations were received without
penalty or expense to City of any kind whatsoever, except as to the portions of the payments herein
agreed upon for which funds have been appropriated.
10.13 Reversion of Assets.
In the event this Contract is terminated with or without cause, all assets acquired by Agency
with the CDBG-CV/CV3 Funds including cash, interest payments from loans or otherwise, all
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outstanding notes, mortgages or other security instruments, any accounts receivable attributable to
the use of the CDBG-CV/CV3 Funds, and any real or personal property owned by Agency that
was improved with the CDBG-CV/CV3 Funds shall automatically transfer to City or to such
assignee as City may designate.
11. REPAYMENT OF CDBG-CV/CV3 FUNDS.
All CDBG-CV/CV3 Funds are subject to repayment in the event the Program does not
meet the requirements of this Contract or in the CDBG Regulations. If Agency takes any action
that results in the City being required to repay all or any portion of the CDBG-CV/CV3
Funds to HUD, Agency agrees it will reimburse City within thirty (30) days of notice from
the City for such repayment. Additionally, if Agency takes any action that results in City
receiving a finding from HUD about the Program, whether or not repayment of all or any
portion of the CDBG-CV/CV3 Funds is required of City, Agency agrees City may require
that 10% of the CDBG-CV/CV3 Funds be repaid to City as liquidated damages. The Parties
agree that City's damages in the event of either repayment to HUD being required or receiving a
finding from HUD are uncertain and would be difficult to ascertain and may include an impact on
City's CDBG grant or other federal grant funds, in addition to the finding by HUD or a required
repayment of funds to HUD by City. Therefore, the Parties agree that payment under this Section
of 10% of the CDBG-CV/CV3 Funds by Agency to City is liquidated damages and not a penalty.
12. CHANGE IN NON-PROFIT STATUS.
Agency must provide City with written notification of any changes to its non-profit status
within fifteen (15) calendar days of being notified of the change. Regardless of notice by Agency,
if the non-profit status of Agency changes after the date of this Contract, City may but is not
obligated to, terminate this Contract. In the event of termination under this Section 12, all CDBG-
CV/CV3 Funds awarded but not yet paid to Agency pursuant to this Contract shall be immediately
rescinded and Agency shall have no further right to such funds. City, in its sole discretion, may
require that any CDBG-CV/CV3 Funds already paid to Agency must be repaid to City within thirty
(30) calendar days of termination under this Section.
13. SURVIVAL.
Any provision of this Contract that pertains to auditing, monitoring, indemnity obligations,
client income eligibility, record keeping and reports, City ordinances, or applicable CDBG
requirements, and any default and enforcement provisions necessary to enforce such provisions,
shall survive the termination of this Contract for 5 years after the Contract term ends, regardless
of whether or not this Contract is earlier terminated, and shall be enforceable by City against
Agency.
14. GENERAL PROVISIONS
14.1 Agencv an Independent Contractor.
Agency shall operate hereunder as an independent contractor and not as an officer, agent,
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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.
14.4 Religious Organization.
Agency shall comply with all applicable requirements as more particularly described in 24
CFR Part 5.109. No portion of the CDBG-CV/CV3 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.
14.4.1. Separation of Explicitly Religious Activities.
Agency retains its independence and may continue to carry out its mission, including the
definition, development practice, and expression of its religious beliefs, provided that it does not
use CDBG-CV/CV3 Funds to support or engage in any explicitly religious activities (including
activities that involve overt religious content such as worship, religious instruction, or
proselytization), or in any other manner prohibited by law.
14.4.2 Explicitly Religious Activities.
If Agency engages in explicitly religious activities (including activities that involve overt
religious content such as worship, religious instruction, or proselytization), the explicitly religious
activities must be offered separately, in time or location, from the programs or activities supported
by CDBG-CV/CV3 Funds and participation must be voluntary for clients of a CDBG-CV/CV3-
funded service.
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14.4.3 Reauired Notices.
If Agency constitutes a Faith -based organization under 24 CFR Part 5.109, Agency must
provide all clients of a CDBG-CV/CV3-funded service with the notice attached as EXHIBIT
"I" —Notice of Beneficiary Rights. Such notice shall be provided to the client prior to enrollment
in any CDBG-CV/CV3-funded program or activity. In addition, if a client or prospective client of
a CD13G-CV/CV3-funded service objects to the religious character of Agency, then Agency must
promptly undertake reasonable efforts to identify and refer the client or prospective client to an
alternate provider to which the client or prospective client has no such objection, as more
particularly described in 24 CFR Part 5.109.
14.5 Venue.
Venue shall lie in state courts in Tarrant County, Texas or the United States District
Court for the Northern District of Texas, Fort Worth Division 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.
14.6 Governing Law.
This Contract shall be governed by and construed in accordance with the laws of the State
of Texas. If any action, whether real or asserted, at law or in equity, arises out of the execution,
performance or non-performance of this Contract or on the basis of any provision herein, for any
issue not governed by federal law, the choice of law shall be the laws of the State of Texas.
14.7 Severabilitv.
The provisions of this Contract are severable, and if for any reason a clause, sentence,
paragraph or other part of this Contract shall be determined to be invalid by a court or federal or
state agency, board or commission having jurisdiction over the subject matter thereof, such
invalidity shall not affect other provisions which can be given effect without the invalid provision.
14.8 Written Agreement Entire Contract.
This written instrument and the Exhibits, Attachments, and Addendums attached hereto,
which are incorporated by reference and made a part of this Contract for all purposes, constitute
the entire agreement by the Parties concerning the work and services to be performed under this
Contract. Any prior or contemporaneous oral or written agreement which purports to vary the
terms of this Contract shall be void. Any amendments to the terms of this Contract must be in
writing and executed by the Parties.
14.9 Paragraph Headings for Reference Only, No Legal Significance; Number
and Gender.
The paragraph headings contained herein are for convenience in reference to this Contract
and are not intended to define or to limit the scope of any provision of this Contract. When context
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requires, singular nouns and pronouns include the plural and the masculine gender shall be deemed
to include the feminine or neuter and the neuter gender to include the masculine and feminine.
The words "include" and "including" whenever used herein shall be deemed to be followed by the
words "without limitation".
14.10 Compliance with All Applicable Laws and Regulations.
Agency agrees to comply fully with all applicable laws and regulations that are currently
in effect or that are hereafter amended during the performance of this Contract. Those laws
include, but are not limited to:
➢ CDBG Regulations found in 24 CFR Part 570
➢ Coronavirus Aid, Relief, and Eonomic Security Act of 2020
➢ Title I of the Housing and Community Development Act of 1974, as amended, (42
USC 5301)
➢ Title VI of the Civil Rights Act of 1964 (42 U.S.C. Sections 2000d et seq.) including
provisions requiring recipients of federal assistance to ensure meaningful access by
persons of limited English proficiency
➢ The Fair Housing Act, Title VIII of the Civil Rights Act of 1968 (42 U.S.C. Sections
3601 et seq.)
➢ Executive Orders 11063, 11246 as amended by 11375 and 12086 and as supplemented
by Department of Labor regulations 41 CFR Part 60
➢ The Age Discrimination in Employment Act of 1967
➢ The Age Discrimination Act of 1975 (42 U.S.C. Sections 6101 et seq.)
➢ The Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970
(42 U.S.C. Sections 4601 et seq. and 49 CFR Part 24) ("URA")
➢ Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. Sections 794 et seq.) and 24
CFR Part 8 where applicable
➢ National Environmental Policy Act of 1969, as amended, 42 U.S.C. Sections 4321 et
seq. ("NEPA") and the related authorities listed in 24 CFR Part 58.
➢ The Clean Air Act, as amended, (42 U.S.C. Sections 1251 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
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participation by ineligible, debarred or suspended persons or entities
➢ Section 6002 of the Solid Waste Disposal Act, as amended by the Resource
Conservation and Recovery Act
➢ Guidelines of the Environmental Protection Agency at 40 CFR Part 247
➢ For contracts and subgrants for construction or repair, Copeland "Anti -Kickback" act
(18 U.S.C. 874) as supplemented in 29 CFR Part 5
➢ For construction contracts awarded by Agency in excess of $2,000, and in excess of
$2,500 for other contracts which involve the employment of mechanics or laborers,
Sections 103 and 107 of the Contract Work Hours and Safety Standards Act (40 U.S.C.
327A 300) as supplemented by 29 CFR Part 5
➢ Lead -Based Paint Poisoning Prevention Act (42 U.S.C. 4801 et seq.), as amended by
the Residential Lead -Based Paint Hazard Reduction Act of 1992 (42 U.S.C. 4851 et
seq.) and implementing regulations at 24 CFR Part 35, subparts A, B, M, and R
➢ Uniform Administrative Requirements, Cost Principles, and Audit Requirements for
Federal Awards, 2 CFR Part 200 et seq.
➢ Federal Funding Accountability and Transparency Act of 2006 ("FFATA") (Pub.L.
109-282, as amended by Section 6205(a) of Pub.L. 110-252 and Section 3 of Pub.L.
113-101)
➢ Federal Whistleblower Regulations, as contained in 10 U.S.C. 2409, 41 U.S.C. 4712,
10 U.S.C. 2324, 41 U.S.C. 4304 and 41 U.S.C. 4310.
➢ The Build America, Buy America Act (BABA) enacted under Division G, Title IX of
the Infrastructure Investment and Jobs Act (IIJA, Pub. L. No. 117-58) signed into law
on November 15, 2021.
14.12 Prohibition Against Discrimination.
14.12.1 General Statement.
Agency shall comply in the execution, performance or attempted performance of this
Contract, with all non-discrimination requirements of 24 CFR Part 570.607 and Chapter 17, Article
III, Division 4 — Fair Housing of the City Code. Agency may not discriminate against any person
because of race, color, sex, gender, religion, national origin, familial status, disability or perceived
disability, sexual orientation, gender identity, gender expression, or transgender, nor will Agency
permit its officers, members, agents, employees, or clients to engage in such discrimination.
This Contract is made and entered into with reference specifically to Chapter 17, Article
III, Division 3 - Employment Practices of the City Code, and Agency hereby covenants and agrees
that Agency, its officers, members, agents, employees and contractors, have fully complied with
all provisions of same and that no employee, or applicant for employment has been discriminated
against under the terms of such ordinances by either or its officers, members, agents, employees
or contractors.
14.12.2 No Discrimination in Emplovment during the Performance of This
Contract.
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During the performance of this Contract Agency agrees to the following provision, and
will require that its contractors and subcontractors also comply with such provision by including
it in all contracts with its contractors:
[Contractor's, Subcontractor's or Vendor's name] will not unlawfully discriminate against
any employee or applicants for employment because of race, color, sex, gender, religion, national
origin, familial status, disability or perceived disability, sexual orientation, gender identity, gender
expression or transgender. [Contractor's, Subcontractor's or Vendor's name] will take affirmative
action to ensure that applicants are hired without regard to race, color, sex, gender, religion,
national origin, familial status, disability or perceived disability, sexual orientation, gender
identity, gender expression or transgender and that employees are treated fairly during employment
without regard to their race, color, sex, gender, religion, national origin, familial status, disability
or perceived disability, sexual orientation, gender identity, gender expression or transgender. Such
action shall include, but not be limited to, the following: employment, upgrading, demotion or
transfer, recruitment or recruitment advertising, layoff or termination, rates of pay or other forms
of compensation, and selection for training, including apprenticeship. [Contractor's,
Subcontractor's or Vendor's name] agrees to post in conspicuous places, available to employees
and applicants for employment, notices setting forth the provisions of this nondiscrimination
clause.
[Contractor's, Subcontractor's or Vendor's name] will, in all solicitations or
advertisements for employees placed by or on behalf of [Contractor's, Subcontractor's or
Vendor's name], state that all qualified applicants will receive consideration for employment
without regard to race, color, sex, gender, religion, national origin, familial status, disability or
perceived disability, sexual orientation, gender identity, gender expression or transgender.
[Contractor's, Subcontractor's or Vendor's name] covenants that neither it nor any of its
officers, members, agents, employees, or contractors, while engaged in performing this Contract,
shall, in connection with the employment, advancement or discharge of employees or in
connection with the terms, conditions or privileges of their employment, discriminate against
persons because of their age or because of any disability or perceived disability, except on the
basis of a bona fide occupational qualification, retirement plan or statutory requirement.
[Contractor's, Subcontractor's or Vendor's name] further covenants that neither it nor its
officers, members, agents, employees, contractors, or persons acting on their behalf, shall specify,
in solicitations or advertisements for employees to work on this Contract, a maximum age limit
for such employment unless the specified maximum age limit is based upon a bona fide
occupational qualification, retirement plan or statutory requirement.
14.12.3 Mencv's Contractors and the ADA.
In accordance with the provisions of the Americans With Disabilities Act of 1990
("ADA"), Agency warrants that it and any of its contractors will not unlawfully discriminate on
the basis of disability in the provision of services to the general public, nor in the availability, terms
and/or conditions of employment for applicants for employment with, or employees of, Agency or
any of its contractors. AGENCY WARRANTS IT WILL FULLY COMPLY WITH THE
ADA'S PROVISIONS AND ANY OTHER APPLICABLE FEDERAL, STATE AND
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LOCAL LAWS CONCERNING DISABILITY AND WILL DEFEND, INDEMNIFY AND
HOLD CITY HARMLESS AGAINST ANY CLAIMS OR ALLEGATIONS ASSERTED BY
THIRD PARTIES, CONTRACTORS SUBCONTRACTORS, VENDORS OR AGENTS
AGAINST CITY ARISING OUT OF AGENCY'S AND/OR ITS CONTRACTORS',
SUBCONTRACTORS', VENDORS' OR AGENTS' OR THEIR RESPECTIVE
EMPLOYEES' ALLEGED FAILURE TO COMPLY WITH THE ABOVE -REFERENCED
LAWS CONCERNING DISABILITY DISCRIMINATION IN THE PERFORMANCE OF
THIS CONTRACT.
14.13 Conflicts of Interest and Violations of Criminal Law.
14.13.1 Agency Safeguards.
Agency shall establish safeguards to prohibit its employees, board members, advisors and
agents from using positions for a purpose that is or gives the appearance of being motivated by a
desire for private gain for themselves or others, particularly those with whom they have family,
business or other ties. Agency shall disclose to City any such conflict of interest or potential
conflict of interest, immediately upon discovery of such.
14.13.2 General Prohibitions Against Conflicts of Interest.
No employees, agents, consultants, officers or elected officials or appointed officials of
City or of Agency who exercise or have exercised any functions or responsibilities with respect to
activities assisted with CDBG-CV/CV3 funds or who are in a position to participate in a decision -
making process or gain inside information with regard to these activities may utilize CDBG-
CV/CV3 services, may obtain a financial interest or benefit from a CDBG-CV/CV3-assisted
activity, or have an interest in any contract, subcontract or agreement with respect thereto, or the
proceeds thereunder, either for themselves or those with whom they have family or business ties,
during their tenure or for 1 year thereafter.
14.13.2.1 Agency shall establish conflict of interest policies for federal awards
including the CDBG-CV/CV3 Funds and shall disclose in writing
potential conflicts of interest to City as authorized by 2 CFR Part
200.112.
14.13.3 Conflicts of Interest Involving Procurement.
The conflict of interest provisions of 2 CFR Part 200.318 shall apply in the procurement
of property and services by Agency. In all cases not governed by this Section, the provisions of
24 CFR Part 570.611 of the CDBG Regulations shall apply.
14.13.3.1 As more particularly described in 2 CFR Part 200.318, Agency shall
maintain and submit to City written standards of conduct covering
conflicts of interest and governing the performance of its employees
engaged in the selection, award, and administration of contracts. No
employee, officer, or agent may participate in the selection, award,
or administration of a contract supported by a federal award if he or
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she has a real or apparent conflict of interest. The standards of
conduct must provide for disciplinary actions to be applied for
violations of such standards by officers, employees, or agents of
Agency.
14.13.3.2 The officers, employees, and agents of Agency shall neither solicit
nor accept gratuities, favors, or anything of monetary value from
contractors or parties to subcontracts.
14.13.3.3 Notwithstanding the prohibition contained in Section 14.13.3.2,
Agency may set standards of conduct for situations in which the
financial interest is not substantial or the gift is an unsolicited item
of nominal value. Such standards of conduct must provide for
disciplinary actions to be applied for violations of such standards by
Agency's officers, employees or agents.
14.13.3.4 Agency shall maintain written standards of conduct covering
organizational conflicts of interest. Organizational conflicts of
interest means that because of relationships with a parent company,
affiliate, or subsidiary organization, Agency is unable or appears to
be unable to be impartial in conducting a procurement action
involving a related organization.
14.13.3.5 Agency must maintain records sufficient to detail the history of
procurement. These records will include, but are not necessarily
limited to the following: rationale for the method of procurement,
selection of contract type, contractor selection or rejection, and the
basis for the contract price.
14.13.4 Disclosure of Conflicts of Interest.
In compliance with 2 CFR Part 200.112, Agency is required to timely disclose to City in
writing any potential conflict of interest.
14.13.5 Disclosure of Conflicts of Interest for A2encv Clients.
Agency understands that its clients will be receiving assistance partially or fully funded
utilizing Housing and Urban Development (HUD) funds received by City. Agency will assist City
in determining whether eligible clients have a potential relationship to the City that constitutes a
conflict of interest by having clients fill out the Conflict of Interest Disclosure Form, attached
hereto as Exhibit "J". In the event a conflict of interest exists, this may affect the client's eligibility
to receive services. As a result, if a potential client provides information on the form that a conflict
may exist, Agency must notify City for a determination prior to providing services.
14.13.6 Disclosure of Texas Penal Code Violations.
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Agency affirms that it will adhere to the provisions of the Texas Penal Code which prohibit
bribery and gifts to public servants. Agency will timely disclose to City all violations.
14.13.7 Disclosure of Federal Criminal Law Violations.
In compliance with 2 CFR Part 200.113, Agency is required to timely disclose to City all
violations of federal criminal law involving fraud, bribery or gratuity violations potentially
affecting the Agency.
14.14 Subcontracting with Small and Minoritv Firms, Women's Business
Enterprises and Labor Surplus Areas.
14.14.1 For procurement contracts $100,000.00 or larger that are paid for, in part or in
full, with the CDBG-CV/CV3 Funds, Agency agrees to abide by City's policy to involve Minority
Business Enterprises and Small Business Enterprises and to provide them equal opportunity to
compete for contracts for construction, provision of professional services, purchase of equipment
and supplies and provision of other services required by City. Agency agrees to incorporate the
City's BDE Ordinance, and all amendments or successor policies or ordinances thereto, into all
contracts and subcontracts for procurement larger than $100,000.00 or larger that are paid for, in
part or in full, with the CDBG-CV/CV3 Funds and will further require all persons or entities with
which it so contracts to comply with said ordinance.
14.14.2 It is national policy to award a fair share of contracts to disadvantaged business
enterprises ("DBEs"), small business enterprises ("SBEs"), minority business enterprises
("MBEs"), and women's business enterprises ("WBEs"). Accordingly, affirmative steps must be
taken to assure that DBEs, SBEs, MBEs, and WBEs are utilized when possible as sources of
supplies, equipment, construction and services.
14.14.2.1 In order to comply with federal reporting requirements 24 CFR Part
570.506 (g)(6), Agency must submit the form attached hereto as
EXHIBIT "H" — MBE Reporting Form for each contract or
subcontract with a value of $25,000.00 or more paid or to be paid
with the CDBG-CV/CV3 Funds. Agency shall submit this form by
the date specified in EXHIBIT "H" — MBE Reporting Form.
14.15 Other Laws.
The failure to list any federal, state or City ordinance, law or regulation that is applicable
to Agency does not excuse or relieve Agency from the requirements or responsibilities in regard
to following the law, nor from the consequences or penalties for Agency's failure to follow the
law, if applicable.
14.16 Assignment.
Agency shall not assign all or any part of its rights, privileges, or duties under this Contract
without the prior written approval of City. Any attempted assignment of same without approval
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shall be void, and shall constitute a breach of this Contract.
14.17 Right to Inspect Agencv Contracts.
It is agreed that City has the right to inspect and approve in writing any proposed contracts
between Agency and any contractor or vendor engaged in any activity in conjunction with this
CDBG-CV/CV3-funded Program prior to any charges being incurred.
14.18 Force Maieure.
If Agency becomes unable, either in whole or part, to fulfill its obligations under this
Contract due to acts of God, strikes, lockouts, or other industrial disturbances, acts of public
enemies, wars, blockades, insurrections, riots, epidemics, pandemics, earthquakes, fires, floods,
restraints or prohibitions by any court, board, department, commission or agency of the United
States or of any States, civil disturbances, or explosions, or some other reason beyond Agency's
control (collectively, "Force Majeure Event"), the obligations so affected by such Force Majeure
Event will be suspended only during the continuance of such event. Agency will give City written
notice of the existence, extent and nature of the Force Majeure Event as soon as reasonably
possible after the occurrence of the event. Failure to give notice will result in the continuance of
Agency's obligation regardless of the extent of any existing Force Majeure Event. Agency will
use commercially reasonable efforts to remedy its inability to perform as soon as possible.
14.19 IMMIGRATION NATIONALITY ACT.
Agency shall verify the identity and employment eligibility of its employees who perform
work under this Contract, including completing the Employment Eligibility Verification Form (I-
9). Upon request by City, Agency shall provide City with copies of all I-9 forms and supporting
eligibility documentation for each employee who performs work under this Contract. Agency
shall adhere to all Federal and State laws as well as establish appropriate procedures and controls
so that no services will be performed by any Agency employee who is not legally eligible to
perform such services. AGENCY SHALL INDEMNIFY CITY AND HOLD CITY
HARMLESS FROM ANY PENALTIES, LIABILITIES, OR LOSSES DUE TO
VIOLATIONS OF THIS PARAGRAPH BY AGENCY, AGENCY'S EMPLOYEES,
SUBCONTRACTORS, AGENTS, OR LICENSEES. City, upon written notice to Agency, shall
have the right to immediately terminate this Contract for violations of this provision by Agency.
15. INDEMNIFICATION AND RELEASE.
AGENCY COVENANTS AND AGREES TO INDEMNIFY, HOLD HARMLESS
AND DEFEND, AT ITS OWN EXPENSE, CITY AND ITS OFFICERS, AGENTS,
SERVANTS AND EMPLOYEES FROM AND AGAINST ANY AND ALL CLAIMS OR
SUITS FOR PROPERTY LOSS OR DAMAGE AND/OR PERSONAL INJURY,
INCLUDING DEATH, TO ANY AND ALL PERSONS, OF WHATSOEVER HIND OR
CHARACTER, WHETHER REAL OR ASSERTED, ARISING OUT OF OR IN
CONNECTION WITH THE EXECUTION, PERFORMANCE, ATTEMPTED
PERFORMANCE OR NONPERFORMANCE OF THIS CONTRACT AND/OR THE
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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 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
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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
$70,000.00_ 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-CV/CV3 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 the following insurance coverage and limits:
Commercial General Liability (CGL) Insurance
$ 500,000 each occurrence
$1,000,000 aggregate limit
Non -Profit Organization Liability or Directors & Officers Liability
$1,000,000 Each Occurrence
$1,000,000 Annual Aggregate Limit
Business Automobile Liability Insurance
$1,000,000 each accident on a combined single -limit basis, or
$ 250,000 Property Damage
$ 500,000 Bodily Injury per person per occurrence
$2,000,000 Aggregate
Insurance policy shall be endorsed to cover "Any Auto", defined as autos owned, hired,
and non -owned. Pending availability of the above coverage and at the discretion of
City, the policy shall be the primary responding insurance policy versus a personal
auto insurance policy if or when in the course of Agency's business as contracted
herein.
Workers' Compensation Insurance
Part A: Statutory Limits
Part B: Employer's Liability
$100,000 each accident
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$100,000 disease -each employee
$500,000 disease -policy limit
Note: Such insurance shall cover employees performing work on any and all projects
including but not limited to construction, demolition, and rehabilitation. Agency or its
contractors shall maintain coverages, if applicable. In the event the respective contractors
do not maintain coverage, Agency shall maintain the coverage on such contractor, if
applicable, for each applicable contract.
Additional Requirements
Such insurance amounts shall be revised upward at City's reasonable option and no more
frequently than once every 12 months, and Agency shall revise such amounts within thirty (30)
days following notice to Contractor of such requirements.
Agency will submit to City documentation that it has obtained insurance coverage and has
executed bonds as required in this Contract prior to payment of any monies provided hereunder.
Where applicable, insurance policies required herein shall be endorsed to include City as an
additional insured as its interest may appear. Additional insured parties shall include employees,
officers, agents, and volunteers of City.
Any failure on part of City to request certificate(s) of insurance shall not be construed as a waiver
of such requirement or as a waiver of the insurance requirements themselves.
Insurers of Agency's insurance policies shall be licensed to do business in the state of Texas by
the Department of Insurance or be otherwise eligible and authorized to do business in the state of
Texas. Insurers shall be acceptable to City insofar as their financial strength and solvency and
each such company shall have a current minimum A.M. Best Key Rating Guide rating of A-: VII
or other equivalent insurance industry standard rating otherwise approved by City.
Deductible limits on insurance policies shall not exceed $5,000 per occurrence unless otherwise
approved by City.
In the event there are any local, federal or other regulatory insurance or bonding requirements for
the Program, and such requirements exceed those specified herein, the former shall prevail.
Agency shall require its contractors to maintain applicable insurance coverages, limits, and other
requirements as those specified herein; and Agency shall require its contractors to provide Agency
with certificate(s) of insurance documenting such coverage. Also, Agency shall require its
contractors to have City and Agency endorsed as additional insureds (as their interest may appear)
on their respective insurance policies.
Directors and Officers Liability coverage shall be in force and may be provided on a claims -made
basis. This coverage may also be referred to as Management Liability, and shall protect the insured
against claims arising out of alleged errors in judgment, breaches of duty and wrongful acts arising
out of their organizational duties. Coverage shall protect not only the entity, but all past, present
and future directors, officers, trustees, employees, volunteers and committee members.
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Notwithstanding any provision in this Contract to the contrary, when applicable, Agency
shall comply with the requirements of 2 CFR 200.310 and shall, at a minimum, provide the
equivalent insurance coverage for real property and equipment acquired or improved with
CDBG Funds as provided to property owned by Agency.
18. CERTIFICATION REGARDING LOBBYING.
The undersigned representative of Agency hereby certifies, to the best of his or her
knowledge and belief, that:
No federal appropriated funds have been paid or will be paid, by or on behalf of Agency,
to any person for influencing or attempting to influence an officer or employee of any
agency, a member of Congress, an officer or employee of Congress in connection with the
awarding of any federal contract, the making of any federal grant, the making of any federal
loan, the entering into of any cooperative agreement and the extension, continuation,
renewal, amendment, or modification of any federal contract, grant, loan or cooperative
agreement.
If any funds other than federally appropriated funds have been paid or will be paid to any
person for influencing or attempting to influence an officer or employee of any agency,
member of Congress in connection with this federal contract, grant, loan or cooperative
agreement, Agency shall complete and submit Standard Form-LLL, "Disclosure Form to
Report Lobbying," in accordance with its instructions.
This certification is a material representation of fact upon which reliance was placed when
this Contract was made or entered into. Submission of this certificate is a prerequisite for
making or entering into this Contract imposed by 31 U.S.C. Section 1352. Any person
who fails to file the required certification shall be subject to a civil penalty of not less than
$10,000.00 and not more than $100,000.00 for each such failure.
Agency shall require that the language of this certification be included in all subcontracts
or agreements involving the expenditure of federal funds.
19. LITIGATION AND CLAIMS.
Agency shall give City immediate notice in writing of any action, including any proceeding
before an administrative agency, filed against Agency in conjunction with this Contract or the
Program. Agency shall furnish immediately to City copies of all pertinent papers received by
Agency with respect to such action or claim. Agency shall provide a notice to City within 10 days
upon filing under any bankruptcy or financial insolvency provision of law.
20. NOTICE.
All notices required or permitted by this Contract must be in writing and are deemed
delivered on the earlier date of the date actually received or the third day following deposit in a
United States Postal Service post office or receptacle; with proper postage, certified mail return
receipt requested; and addressed to the other Party at the address set out below or at such other
address as the receiving Party designates by proper notice to the sending Party.
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City:
City Attorney's Office
100 Fort Worth Trail
Fort Worth, TX 76102
Telephone: 817-3 92-7600
COUV to:
Neighborhood Services Department
100 Fort Worth Trail
Fort Worth, TX 76102
Attention: Kacey Bess
Telephone: 817-3 92-7540
CoVV to:
Neighborhood Services Department
100 Fort Worth Trail
Fort Worth, TX 76102
Attention: Jeanette Greenwood
Telephone: 817-3 92-2715
Agency:
Guardianshiop Services, Inc.
Lyn Scott, TxCG
1125 College Ave., Fort Worth, TX 76104
Fort Worth, TX 76104
Telephone: 817-921-0499
21. AGENCY HAS LEGAL AUTHORITY TO ENTER INTO CONTRACT.
Agency represents that it possesses the legal authority, pursuant to any proper, appropriate
and official motion, resolution or action passed or taken, to enter into this Contract and to perform
the responsibilities herein required.
22. COUNTERPARTS.
This Contract may be executed in multiple counterparts, each of which shall be considered
an original, but all of which shall constitute one instrument which may be sufficiently evidenced
by one counterpart.
23. PROGRAM INCOME
Parties agree that no program income as defined by HUD shall be earned as a result of this
contract.
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24. PROHIBITION ON CONTRACTING WITH CO ANIES THAT BOYCOTT
ISRAEL
If Agency has less than ten employees, this contract is for less than $100,000, or Agency
does not meet the definition of a "company" under the applicable section of the Texas Government
Code, this provision shall not apply. Agency acknowledges that in accordance with Chapter 2270
of the Texas Government Code, the City is prohibited from entering into a contract with a company
for goods or services unless the contract contains a written verification from the company that it:
(1) does not boycott Israel; and (2) will not boycott Israel during the term of the contract. The
terms "boycott Israel" and "company" shall have the meanings ascribed to those terms in Section
808.001 of the Texas Government Code. By signing this contract, Agency certifies that Agency's
signature provides written verification to the City that Agency: (1) does not boycott Israel; and (2)
will not boycott Israel during the term of the contract.
25. PROHIBITION ON BOYCOTTING ENERGY CO ANIES
Agency acknowledges that in accordance with Chapter 2276 of the Texas Government
Code, the City is prohibited from entering into a contract for goods or services that has a value of
$100,000 or more that is to be paid wholly or partly from public funds of the City with a company
with 10 or more full-time employees unless the contract contains a written verification from the
company that it: (1) does not boycott energy companies; and (2) will not boycott energy companies
during the term of the contract. To the extent that Chapter 2276 of the Government Code is
applicable to this Agreement, by signing this Agreement, Agency certifies that Agency's signature
provides written verification to the City that Agency: (1) does not boycott energy companies; and
(2) will not boycott energy companies during the term of this Agreement.
26. PROHIBITION ON DISCRIMINATION AGAINST FIREARM AND
AMMUNITION INDUSTRIES
Agency acknowledges that except as otherwise provided by Chapter 2274 of the Texas
Government Code, the City is prohibited from entering into a contract for goods or services that
has a value of $100,000 or more that is to be paid wholly or partly from public funds of the City
with a company with 10 or more full-time employees unless the contract contains a written
verification from the company that it: (1) does not have a practice, policy, guidance, or directive
that discriminates against a firearm entity or firearm trade association; and (2) will not discriminate
during the term of the contract against a firearm entity or firearm trade association. To the extent
that Chapter 2274 of the Government Code is applicable to this Agreement, by signing this
Agreement, Agency certifies that Agency's signature provides written verification to the City that
Agency: (1) does not have a practice, policy, guidance, or directive that discriminates against a
firearm entity or firearm trade association; and (2) will not discriminate against a firearm entity or
firearm trade association during the term of this Agreement.
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27. ELECTRONIC SIGNATURES.
This Contract may be executed by electronic signature, which will be considered as an
original signature for all purposes and have the same force and effect as an original signature. For
these purposes, "electronic signature" means electronically scanned and transmitted versions (e.g.
via pdf file or facsimile transmission) of an original signature, or signatures electronically inserted
via software such as Adobe Sign.
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[SIGNATURES APPEAR ON NEXT PAGE]
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IN WITNESS WHEREOF, the Parties hereto have executed this Contract in Fort Worth,
Tarrant County, Texas.
9 �naL
� o� fORT"add
ATTEST:
�o
Pvo �=d
QdQ4 nEopSObp
Jannette Goodall
City Secretary
M&C: 24-0079
Date: January 28, 2025
1295 Certification No. 2024-1219767
RECOMMENDED BY:
Kacey Bess
Neighborhood Services Director
APPROVED AS TO FORM AND LEGALITY:
9.;' a),, �.�
Jessika Williams
Assistant City Attorney
CITY OF FORT WORTH:
bva E91-a kAr 03/14/2025
Dana Burghdoff (MarY6, 2025 11:42 CDT)
Dana Burghdoff
Assistant City Manager
CONTRACT COMPLIANCE ADMINISTRATOR:
By signing, I acknowledge that I am the person responsible
for the monitoring and administration of this contract, including
Suring pof
nce and reporting requirements
Jeanette Greenwood, Contract Administrator
GUARDIANSHIP SERVICES, INC.
1�1- 5cett
Lyn Scott, TxCG, CEO
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2025
GUARDIANSHIP SERVICES, INC.
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
38
EXHIBITS:
EXHIBIT "A" —Program Summary
EXHIBIT "A-1" — 2024 HUD Income Limits
EXHIBIT "A-2" — Reporting Requirements for Countywide Agencies
EXHIBIT `B" — Budget
EXHIBIT "C" — Audit Certification Form
EXHIBIT "D" — Reimbursement Forms
EXHIBIT "E" — Self -Certification of Income Form
EXHIBIT "F" — Standards for Complete Documentation
EXHIBIT "G" — Severely Disabled Certification Form (only applicable to Presumed
Benefit contracts)
EXHIBIT "H" — MBE Reporting Form
EXHIBIT "I" — Notice of Beneficiary Rights
EXHIBIT "J" — Conflict of Interest Disclosure Form
39
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2025
GUARDIANSHIP SERVICES, INC.
Agency Name: Guardianship Services, Inc. (GSI) EXHIBIT "A"
Program Name: Money Smart+ Elder Financial Fraud PROGRAM SUMMARY
Prevention Workshops for Older Adults
PROGRAM SUMMARY
(CDBG-CV)
October 1, 2024 to September 30, 2025 $70,000
PERIOD AMOUNT
Capitalized terms not defined herein shall have meanings assigned them in the Contract.
PROGRAM:
To reduce rising rates of elder fraud and financial exploitation, rates that exploded during and
after the COVID-19 pandemic, Guardianship Services, Inc. (GSI) offers Money Smart+ fraud
awareness and financial literacy workshops. These two-hour workshops are based on Money
Smart for Older Adults, a curriculum created by the Consumer Financial Protection Bureau and
the Federal Deposit Insurance Corporation. Workshops reinforce financial management skills,
raise awareness of the warning signs of fraud and financial exploitation, and help participants
prevent losses from these crimes. Workshops also include a briefing on GSI's benefits eligibility
services, which help eligible seniors access Medicare Savings Programs, the Extra Help
prescription drug program, and Supplemental Nutrition Assistance Program (SNAP) benefits.
Although these benefits can save seniors thousands annually by lowering out-of-pocket
healthcare costs and making limited food budgets go further, less than 40% of eligible Tarrant
County seniors are currently enrolled, according to the National Council on Aging Benefits
Participation Map. Participants are briefed on benefit program criteria and referred to GSI staff
for help navigating the application process.
CDBG funds will be used to pay for a percentage of salaries for program employees.
Workshops will be provided at or marketed to residents aged 62 and older who frequent or live
near the following locations. Program activities typically are scheduled on weekdays between 9
a.m. and 5 p.m. through September 30, 2025. Benefits eligibility services can be offered in
person at GSI offices at 1125 College Avenue in Fort Worth or by telephone as needed.
Andrew Doc Session Center, 201 S Sylvania Ave., Fort Worth, TX 76111
Atatiana Carr -Jefferson Center, 1201 E Maddox Ave., Fort Worth, TX 76104
Casa de Esperanza Apartments, 3804 Tanacross Dr., Fort Worth, TX 76137
Catherine Booth Friendship House Residence, 1901 E Seminary Dr., Fort Worth, TX 76119
Evangeline Booth Friendship House, 1909 E Seminary Dr., Fort Worth, TX 76119
Chisholm Trail Community Center, 4936 McPherson Blvd., Fort Worth, TX 76123
Cobblestone Manor Senior Apartments, 8201 Sartain Dr., Fort Worth, TX 76120
Como Community Center, 4660 Horne St., Fort Worth, TX 76107
Cornerstone Assistance Network, 3500 Noble Ave., Fort Worth, TX 76111
CDBG-CV 2024-25 — EXHIBIT "A" — PROGRAM SUMMARY- Guardianship Services, Inc. (GSI)
Page 1
Diamond Hill Community Center, 1701 NE 36th St., Fort Worth, TX 76106
Eugene McCray Senior Center, 4932 Wilbarger St., Fort Worth, TX 76119
Fairview Retirement Community, 7832 Chapin Rd., Fort Worth, TX 76116
Greenbriar Community Center, 5200 Hemphill St., Fort Worth, TX 76115
Handley Meadowbrook Community Center, 6201 Beaty St., Fort Worth, TX 76112
Highland Hills Community Center, 1600 Glasgow Rd., Fort Worth, TX 76134
Jewish Family Services, 4900 Briarhaven Rd., Fort Worth, TX 76109
MLK Community Center, 5565 Truman Dr., Fort Worth, TX 76112
North Tri-Ethnic Community Center, 2950 Roosevelt Ave., Fort Worth, TX 76106
Northside Community Center, 1100 NW 18th St., Fort Worth, TX 76164
Silverstone Retirement Community, 2800 Broadmoor Dr., Fort Worth, TX 76116
Southside Community Center, 959 E Rosedale St., Fort Worth, TX 76104
Southwest Community Center, 6300 Welch Ave., Fort Worth, TX 76133
Thomas Place Community Center, 4237 LaFayette Ave., Fort Worth, TX 76107
Victory Forest Community Center, 3427 Hemphill St., Fort Worth, TX 76110
Worth Heights Community Center, 3551 New York Ave., Fort Worth, TX 76110
Hanratty Place, 800 S. Jennings Ave., Fort Worth, TX 76104
Home Town at Matador Ranch, 8500 Crowley Rd., Fort Worth, TX 76134
Linwood Square Apartment, 3201 Sondra Dr., Fort Worth, TX 76107
Salvation Army Mabee Center, 1855 E Lancaster Ave., Fort Worth, TX 76103
True Worth Place, 1513 E Presidio St., Fort Worth, TX 76102
Community Connections North Texas, Genesis United Methodist Church, 7635 S Hulen St., Fort
Worth, TX 76133
Friendship Group, Resource Connection, 1100 Circle Dr., Fort Worth, Texas 76119
REGULATORY CLASSIFICATION:
IDIS Matrix Code(s) and Service Category: 05A Senior Services
National Objective Citation: LMC Low/Mod Limited Clientele 24 CFR 570.208(a) (2)
Regulatory Citation(s): 24 CFR 570.201(e)
Agency will maintain documentation which verifies that 100% of clients served by the Program
are Elderly in accordance with the CDBG Presumed Benefit clientele definition.
CDBG-CV 2024-25 — EXHIBIT "A" — PROGRAM SUMMARY- Guardianship Services, Inc. (GSI)
Page 2
PROGRAM GOALS:
Minimum Number of Fort Worth Clients to be Served: The Program must serve a minimum
of 139 Unduplicated Clients from Fort Worth as shown by the monthly reports on Attachment
III.
The outcomes or success of the program will be evaluated by the number of seniors participating
in Money Smart+ workshops: Attendance at workshops will be logged, along with interest in
benefits eligibility support generated by the workshops.
GSI also measures participants' progress in Money Smart+ education through pre-tests and post-
tests administered to each participant. The performance standard is for 80% of participants to
demonstrate improved confidence in their ability to recognize warning signs of fraud or financial
exploitation and use the resources available to them.
Findings and feedback are used to adapt and adjust presentations to best serve participants and are
reviewed quarterly.
CDBG-CV 2024-25 — EXHIBIT "A" — PROGRAM SUMMARY- Guardianship Services, Inc. (GSI)
Page 3
EXHIBIT "A-1"
2024 HUD INCOME LIMITS
AMI 1 person
2 people
3 people
4 people
5 people
6 people
7 people
8 people
30% $21,400
$24,450
$27,500
$30,550
$33,000
$35,450
$37,900
$40,350
50% $35,700
$40,800
$45,900
$50,950
$55,050
$59,150
$63,200
$67,300
80% $57,050
$65,200
$73,350
$81,500
$88,050
$94,550
$101,100
$107,600
*Income limits are published at least annually by HUD.
Effective 510112024
EXHIBIT "A-2"
REPORTING REQUIREMENTS FOR COUNTYWIDE AGENCIES
(ONLY APPLICABLE TO COUNTYWIDE AGENCIES)
CDBG PSA CONTRACT-- EXHIBIT "A-2"
REPORTING REQUIREMENTS FOR COUNTYWIDE AGENCIES
REPORTING REQUIREMENTS FOR COUNTYWIDE AGENCIES
Quarterly Report
The purpose of the Quarterly Report is for the Countywide Agencies to report the number of non -Fort
Worth clients who participate in the Program. The Quarterly Report must be submitted with the
December, March, June and September Reimbursement Requests. The submission of the Quarterly
Report is through Neighborly Software. The information provided in the Quarterly Report will be
reviewed and monitored by the Neighborhood Services Department Compliance Division.
A B C D E F
EXAMPLE: 250 200 450 250=450=55%
January 15, 2025 October 1, 2024 —
December 31, 2024
April 15, 2025 January 1, 2025—
March 30, 2025
July 15, 2025 April 1, 2025 —
June 30, 2025
October 1, 2025 July 1, 2025 —
September 30, 2025
TOTAL
I, Agency representative, certify that I verified the information I reported this quarter and it is correct
to the best of my knowledge.
Certified by:
Signature/Title:
CDBG PSA CONTRACT-- EXHIBIT "A-2"
REPORTING REQUIREMENTS FOR COUNTYWIDE AGENCIES
Date:
GUARDIANSHIP SERVICES, INC.
EXHIBIT "B" - BUDGET
(Salaries
1001
$ 67,478.30 $
31,845.00
$ 120,556.00
$
74,526.00
$
259,834.00
$
554,239.30
IFICA
1002
$ 2,521.70 $
2,450.00
$ 9,276.00
$
5,734.00
$
19,992.00
$
39,973.70
ILife/DisabilityInsurance
1003
$
291.00
$ 1,101.00
$
680.00
$
2,372.00
$
4,444.00
IHealth/DentalInsurance
1004
$
5,599.00
$ 21,198.00
$
13,104.00
$
45,688.00
$
85,589.00
(Unemployment -State
1005
$
497.00
$ 1,883.00
$
1,164.00
$
4,058.00
$
7,602.00
Worker's Compensation
1006
$
59.00
$ 222.00
$
138.00
$
479.00
$
898.00
Retirement
1007
Staff Training
1008
SUPPLIES AND SERVICES
Office/Program Supplies
2001
$
708.00
$ 2,681.00
$
1,657.00
$
5,777.00
$
10,823.00
(Postage
2002
$
115.00
$ 435.00
$
269.00
$
936.00
$
1,755.00
(Printing
2003
$
38.00
$ 145.00
$
90.00
$
312.00
$
585.00
Adv/Media, Dues/Pub, Printing,
Bank Fees
$
-
other (tech supplies)
2004
$
1,178.00
$ 4,461.00
$
2,758.00
$
9,615.00
$
18,012.00
MISCELLANEOUS
Contract Labor Poo
Supplies/Meals (City needs copy
of contract before expenses can be
reimbursed)
3001
$
147.00
$ 557.00
$
344.00
$
1,201.00
$
2,249.00
(Food Supplies
3002
$
-
I Teaching Aids
3003
$
-
I Craft Supplies
3004
$
-
IField Trip Expenses
3005
$
-
Mileage
3006
$
643.00
$ 2,433.00
$
1,504.00
$
5,244.00
$
9,824.00
FACILITY AND UTILITIES
Telephone
4001
$
481.00
$ 1,820.00
$
1,125.00
$
3,923.00
$
7,349.00
(Electric
4002
$
421.00
$ 1,593.00
$
985.00
$
3,434.00
$
6,433.00
(Gas
4003
$
-
Water and Wastewater
4004
$
-
Solid Waste Disposal
4005
$
-
Rent (City needs copy of lease
before expenses can be
reimbursed)
4006
$
3,040.00
$ 11,507.00
$
7,113.00
$
24,801.00
$
46,461.00
Cleaning Supplies
4007
$
-
IRepairs
4008
$
666.00
$ 2,520.00
$
1,558.00
$
5,432.00
$
10,176.00
Custodial Services
4009
Utilities, Transportation, PP &E
4010
LEGAL, FINANCIAL AND
INSURANCE
Fidelity Bond or Equivalent
5001
IDirectors and Officers
5002
IGeneral Commercial Liability
5003
$
501.00
$ 1,897.00
$
1,173.00
$
4,089.00
$
7,660.00
(Bank fees
I volunteer
Ivolunteer
Prof Fees
5004
jjnCT ASSISTANCE jS
Audit/IT/Legal Volunteer
Recruitment, Misc.
6001
$
3,821.00
$ 14,466.010
$
8,942.00
$
31,178.00
$
58,407.00
(BUDGET TOTAL
$ 70,000.00 $
52,500.00
$ 198,751.00
$
122,864.00
$
428,365.00 $
- $
872,480.00
FUNDING A: Tarrant County HOME ARP
FUNDING B: Area Agency on Aging
FUNDING C: Elder Justice Coalition
FUNDING C: Other
Page 1
The following tables were created for the purpose of preparing, negotiating, and determining the cost
reasonableness and cost allocation method used by the Agency for the line item budget represented on
the first page of this EXHIBIT `B" — Budget. The information reflected in the tables is to be
considered part of the terms and conditions of the Contract. Agency must have prior written approval
by the City to make changes to any line item in the Budget as outlined in Section 5.2.2 in the
Contract. The deadline to make changes to EXHIBIT "B" — Budget is April 15, 2025.
SALARY DETAIL -PROGRAM PERSONNEL
Position Title
Community Outreach and Engagement Manager
Money Management Program Administrator
Money Management Acct Manager (.8 FTE)
Director of Accounting & Administration
CEO
TOTAL
FICA
Life/Disability Insurance
Health/Dental Insurance
Unemployment -State
Worker's Compensation
Retirement
Staff Training
TOTAL
Annual Salary
40,475.14
48,204.00
38,563.50
68,848.29
110,444.33
$ 306,535.26
Est. Percent to
Grant
25.00%
62.50%
12.50%
12.50%
12.50%
$
FRINGE DETAIL -PROGRAM PERSONNEL
Est. Percent to
Percent of Payroll Amount Grant
7.65000% $ 23,449.95 10.8% $
$ 23,449.95
SUPPLIES AND SERVICES
Total Budget
Est. Percent to
Grant
E1
Amount to
Grant
10,118.79
30,127.50
4,820.44
8,606.04
13,805.54
67,478.30
Amount to
Grant
2,521.70
2,521.70
Amount to
Grant
CDBG PSA CONTRACT 2024-25 - EXHIBIT "B" - BUDGET Page 2
Office/Program Supplies
Postage
Printing
Adv/Media, Dues/Pub, Printing, Bank Fees
TOTAL $
Contract Labor
Food Supplies
Teaching Aids
Craft Supplies
Field Trip Expenses
Mileage
TOTAL
MISCELLANEOUS
Total Budget
Est. Percent to
Grant
#DIV/0!
$ - #DIV/0! $
FACILITY AND UTILITIES
Est. Percent to
Total Budget Grant
Telephone
Electric
Gas
Water and Wastewater
Solid Waste Disposal
Rent
Cleaning Supplies
Repairs
Custodial Services
Utilities, Transportation, PP & E
TOTAL $ -
LEGAL, FINANCIAL AND INSURANCE
Est. Percent to
Total Budget Grant
Fidelity Bond or Equivalent
Directors and Officers
General Commercial Liability
Prof Fees
TOTAL $ -
DIRECT ASSISTANCE
Est. Percent to
Total Budget Grant
Amount to
Grant
Amount to
Grant
Amount to
Grant
Amount to
Grant
CDBG PSA CONTRACT 2024-25 - EXHIBIT "B" - BUDGET Page 3
Audit/IT/Legal Volunteer Recruitment, Misc.
TOTAL
CDBG PSA CONTRACT 2024-25 - EXHIBIT "B" - BUDGET Page 4
EXHIBIT "C"
AUDIT CERTIFICATION FORM
PSA CONTRACT - EXHIBIT "C" - AUDIT
CERTIFICATION FORM --
AUDIT CERTIFICATION FORM AND AUDIT REQUIREMENTS
Agency:
Fiscal Year Ending: September 30, 2025
During the fiscal year in which funds will be received, we will exceed the federal expenditure
threshold of $1,000,000.00. We will have our Single Audit or Program Specific Audit
completed and will submit the audit report described in 2 CFR Part 200 within 7 months
after the end of the audited fiscal year or 30 days within its completion, whichever is the
✓❑ earlier date.
During the fiscal year in which funds will be received, we will not exceed the
$1,000,000.00 federal expenditure threshold required for a Single Audit or a Program
Specific Audit to be performed this fiscal year. (Fill out schedule below)
U.S. Dept of Health & Human Services Area Agency on Aging of Tarrant County 93.044 265,000
U.S. Dept of Housing & Urban Development
The Health & Human Services commission
The American Rescue Plan Act
Total Federal Expenditures for this Fiscal Year:
47
46auc
4igA%atory and Title
City of Fort Worth 14.218 70,000
93.667 HHS001313900004 112,200
Tarrant County 21.027 M21-DP480200 70,000
517,200
12
Vt Flo?- 61--
' Dfite
Failure to submit this or a similar statement or failure to submit a completed single audit package
as described in the federally required audit requirements described in 2 CFR Part 200, as
applicable, by the required due date may result in suspension of funding and may affect eligibility
for future funding. Notwithstanding the above, this certification acknowledges the agency's
commitment to meet all other financial reporting, financial statements, and other audit
requirements as may be set forth in the Contract.
PSA CONTRACT — EXHIBIT "C" — AUDIT CERTIFICATION FORM
Exhibit D
Attachment I- Request Summary
Agency:
Address:
City, State, Zip:
Program:
Month of Service:
Tax ID Number:
Contract Number:
Case ID:
P.O. Number:
FID Number:
IDIS Number:
Program Account Amount
Original Amount This Invoice Cumulative to Date I Remaining Balance
(Program Name) Case ID
Salaries
1001
$
$
$
FICA
1002
$
$
$
$
Life/Disability Insurance
1003
$
$
$
$
Health/DentalInsurance
1004
$
$
$
$
Unemployment -State
1005
$
$
$
$
Worker's Compensation
1006
$
- $
- $
- $ -
Office Supplies
1007
$
$
$
Food Supplies
1008
$
$
$
$
Insurance
1009
$
$
$
$
Accounting
1010
$
- $
- $
- $ -
Contract Labor
1011
$
$
$
$
TOTAL
$
$
$
$
Request Summary
Budget
Expenditure
Percentage Spent
Table Total
$
$
#DIV/0!
$
Oct-24
Nov-24
Dec-24
Jan-25
Feb-25
Mar-25
Apr-25 May-25
Jun-25 Jul-25 Aug-25
Sep-25
$ - $ -
$ - $ - $ -
$ -
Client Goals
Goal Amount
Cumulative Total
Goal Met %
Table Total
0
#DIV/0!
0
Oct-24
Nov-24
Dec-24
Jan-25
Feb-25
Mar-25
0
0
0
0
0
0
Apr-25
May-25
Jun-25
Jul-25
Aug-25
Sep-25
0
0
0
0
0
0
ATTACHMENT II
City of Fort Worth
Neighborhood Services Department
Expenditure Worksheet
Agency:
Program:
Please group like account codes.
Account Code
Line (See Key to
No. Check No. Date Payee .—In.... Title* Right) Amount
13
14
15
16
17
18
19
I 10
I 11
I 12
I 13
I 14
I 15
I 16
I 17
I 18
I 19
I 20
I 21
I 22
I 23
I 24
I 25
I 26
I 27
I 28
I 29
I 30
I 31
I 32
I 33
I 34
I 35
I 36
I 37
I 38
I 39
I 40
I 41
I 42
I 43
I 44
I 45
I 46
I 47
I 48
I 49
I
Total
*For Salaries, state employee's title> der Description/Job Title. Rent must identytenant
Only highlighted codes can be reimbursed
Expense Line Item
Account
PROGRAM PERSONNEL
Salaries I OOl
I FICA002
1003
Life/Disabil�unce
IIII
wnHeath/Da 104
State
0Uno1005
Ws.sation 1006
er'�ompe
Retirement I007
SUPPLIES AND SERVICES
Off ce/Program Supplies
2001
Postage
2002
I Printigff
2003
Other(CaseWorthy, Phones, Computers)
2004
MISCELLANEOUS
Contract Labor 3001
I Food Supplies 3002
I Teaching Aids 3003
I Craft SZ lies 3004
I Field Tnp Expenses 3005
I Mileage 3006
Other(Client Em lo7. ent Incentives) 3007
Other(Client CreSenhaling Fund) 3008
FACILITY AND UTILITIES
Telephone 4001
I Electric 4002
I Gas 4003
I Water and Wastewater 4004
I Solid Waste Disposal 4005
I Rent 4006
I Cleaning Suppplies 4007
Other(Custodial Services, Repairs, Use 4008
LEGAL, FINANCIAL, AND INSURANCE
Fidelity Bond or Equivalent
7
I Directors and Officers
5002
I General Commercial Liability
5003
Other(IDC, Interpretation)
5004
DIRECT ASSISTANCE
Other(Training, Transportation) 6001
I
3
EXHIBIT "E"
SELF -CERTIFICATION OF INCOME FORM
PSA Contract 2024-2025 Page 1
City of Fort Worth
SELF -CERTIFICATION OF INCOME STATEMENT
Applicant Name:
Current Address:
City and Zip:
Last Name
First Name
Phone #:
Household Members and Income
(including applicant)
TOTAL NUMBER OF FAMILY MEMBERS
Total Gross Annual Household Income:
Age Monthly Source of Income
Income $$
(Include Yourself, Spouse, Children, etc.)
PERSONAL INFORMATION: (Check one in each item. This Information is Required for Federal Reporting Purposes)
a. ❑ MALE b. ❑ WHITE ❑ BLACK/AFRICAN AMERICAN ❑ BLACK/AFRICAN AMERICAN & WHITE
❑ FEMALE ❑ AMERICAN INDIAN/ALASKAN NATIVE ❑ ASIAN
❑ AMERICAN INDIAN/ALASKAN NATIVE & WHITE ❑ ASIAN & WHITE
❑ NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER ❑ BALANCE/OTHER
❑ AMERICAN INDIAN/ALASKAN NATIVE & BLACK/AFRICAN AMERICAN
c. ETHNICITY d. DISABLED e. IS HEAD OF HOUSEHOLD FEMALE?
❑ HISPANIC ❑ YES ❑ YES
❑ NON -HISPANIC ❑ NO ❑ NO
Certification: I certify that the information I am providing is true and could be subject to verification at any
time by a third party. I also acknowledge that the provision of false information could leave me subject to the
penalties of Federal, State and local law.
Signature of Applicant Date
WARNING: TITLE 18, SECTION 1001 OF THE U.S. CODE STATES THAT A PERSON IS GUILTY OF A FELONY
FOR KNOWINGLY AND WILLINGLY MAKING FALSE OR FRAUDULENT STATEMENTS TO ANY DEPARTMENT OF
THE UNITED STATES GOVERNMENT.
Household Size:
Applicable Income Limit:
-----------------For use by Agency staff only ------------
Gross Annual Income:
Is Applicant Eligible?
Check if Applicant refused to provide demographic information: 0
Staff Assessment of Demographics:
Person Making Determination: Date:
NOTE: Address, income amounts and sources for ALL household members are required.
PSA Contract 2024-2025 Page 2
Ciudad de Fort Worth
AUTOCERTIFICACION DE DECLARACION DE INGRESOS
Nombre del Solicitante:
Direccion de Actualidad:
Ciudad y Codigo Postal:
Apellido Nombre
Telefono:
Miembros Del Ho2ar e Ingresos
"Incluyendo el/la Solicitante)
Had Ingreso Origen de Ingresos
Mensual
* TOTAL NUMERO DE MIEMBROS DEL HOGAR
(Incluyase Usted.)
Total Anual de Ingresos del hogar:
**INFORMACION PERSONAL: (Seleccione uno en cada articulo. Esta informacion es requerida por el Gobierno federal.)
a. ❑ MASCULINO b. ❑ BLANCO ❑ NEGRO/AFRICANO AMERICANO ❑ NEGRO/AFRICANO AMERICANO & BLANCO
❑ FEMININO ❑ INDIO AMERICANO/NATIVO DE ALASKA ❑ ASIATICO
❑ INDIO AMERICANO/NATIVO DE ALASKA & BLANCO ❑ ASIATICO & BLANCO
❑ NATIVO HAWAIANO/OTRO DE LAS ISLAS PACIFICAS ❑ BALANCE/OTRO
❑ INDIO AMERICANO / NATIVO DE ALASKA & NEGRO/AFRICANO AMERICANO
c. ETHNICIDAD d. INCAPACITADO e. DES LA CABEZA DEL HOGAR MUJER?
❑ HISPANO ❑ SI ❑ SI
❑ NO-HISPANO ❑ NO ❑ NO
Certificacion: Yo certifico que la informacion que yo estoy proporcionando es verdadera y puedo ser sujeto a
verificacion a cualquiera hora por tercera parte. Yo tambien reconozco que la provision de informacion falsa
puede dejarme sujeto a penalidades Federales, Estatales, y a ley local.
Firma del Solicitante
Fecha
ADVERTENCIA: TITULO 18, SECCION 1001 DEL CODIGO DE LOS ESTADOS UNIDOS INDICA QUE UNA
PERSONA ES CULPABLE DE UN DELITO FOR SABER Y VOLUNTARIAMENTE HACER DECLARACIONES FALSOS O
FRAUDULENTAS A CUALQUIER DEPARTAMENTO DE GOBIERNO DE LOS ESTADOS UNIDOS.
---- Para use de empleados de la agencia -----------
# De Miembros de Familia: Ingreso Anual:
Limite de Ingreso: �Es solicitante elegible? :
Compruebe si el solicitante se nego a dar su informacion personal:
Evaluacion del empleado sobre informacion personal:
Persona haciendo la determinacion: Fecha:
Note: La direction de la casa y los ingresos (y sus origenes) para todos los miembros del hogar, es requerida.
PSA Contract 2024-2025 Page 3
EXHIBIT "F"
STANDARDS OF DOCUMENTATION
CDBG-CV PRESUMED BENEFIT - PSA CONTRACT -- EXHIBIT "F" -- STANDARDS OF DOCUMENTATION
2024-25 Documentation Standards for
CDBG Public Service Contract Expenses
Employee Salaries and Benefits - City will only reimburse a percentage of any employee's salary and benefits who work directly with the CDBG-funded Program.
Percentages will be cost allocated and determined prior to the execution of the CDBG Contract. Agencies requesting the reimbursement of 100% of any Agency employee
will require prior City approval. Agencies must show calculation on how the CDBG portion of employee salaries and benefits were calculated consistently with the CDBG
Contract.
If an employee works on both a CDBG eligible and non-CDBG eligible program(s), the City will only reimburse for a reasonable portion
of the employee's salary. Prior to the execution of the CDBG Contract, the Agency will priovide the City with a written statement on how
each employee's time will be allocated. If an employee works 100% of their time directly with the CDBG-funded Program, then 100% of
the employee's salary may be eligible for reimbursement. Agency must submit a written statement that 100% of the employee's time is
spent working directly with the CDBG-funded Program. Statements must be signed by a person authorized to sign on behalf of the
Agency and will be submitted with the October invoice.
Salaries X X Reimbursement requests must include a timesheet and work log that reflects the hours worked by the employee(s) working directly on
the CDBG-funded Program. For employees who are paid with multiple funding sources, timesheets must reflect all funding sources. If
separate timesheets are kept for each funding source, all such timesheets must be submitted to City. Timesheets must be signed by
employee and supervisor. Agency must show a calculation and documentation of how the employee's salary was calculated and
invoiced to City.
'If employees are paid by direct deposit rather than check, then the agency must submit both the direct deposit payment company's
report (such as an ADT report) and a bank statement or check showing payment to the direct deposit company.
FICA/Medicare )� X X
Life Insurance x x x
Health x x x
If the City pays gross salary, this is already included. If the City pays the employer portion, the Agency must provide proof that the
Insurance
employee is enrolled in the benefit plan, must show a calculation and documentation of how the invoiced amount was calculated, and
Disability
must provide documentation showing payment. Invoice and proof of payment are only required with the first reimbursement request and
x x x
Insurance
at any time there are changes to amounts, enrollments, disenrollments, etc.
Unemployment
x x x
Insurance
If the City pays gross salary, this is already included. If the City pays the employer portion, the Agency must provide proof that the
Retirement x x x
employee is enrolled in the benefit plan, must show a calculation and documentation of how the invoiced amount was calculated, and
must provide documentation showing payment. Invoice and proof of payment are only required with the first reimbursement request and
at any time there are changes to amounts, enrollments, disenrollments, etc.
Materials, Equipment, Goods and Supplies - City will only reimburse for the cost allocated percent or amount spent in support of the CDBG-funded Program. Agencies
requesting reimbursement for these items will require prior City approval. Agencies must show calculation on how the CDBG portion of these expenses were calculated
consistently with the CDBG Contract.
Office Supplies X X X
Office
Equipment
X X X X
X
Rental
Postage
X
X
Printing
X
X
Construction &
Building
X X X
X This category is only available for the REACH Program and Habitat for Humanity.
Materials
Sport and
Recreation
X X
X
Equipment
Cleaning
X X
X
Supplies
Teaching Aids X X X
Craft Supplies )� X X
Food Supplies X X X This category is only available to the Program provided by Meals on Wheels.
Rent, Utilities and Maintenance - City will only pay for a portion of these expenses. The portion of these expenses will be determined by the square footage attributable to
the CDBG-funded Program and shall be cost -allocated in accordance with the amount of space used for the CDBG-funded Program. These expenses may only be in support
of the CDBG-funded Program. The items listed below require prior City approval and the Agency is required to identify any funding source that pays for the portion of the
expenses that is not paid with CDBG funds. Agencies must show calculation on how the CDBG portion of these expenses were calculated consistently with the CDBG
Contract.
Telephone XJ XJ
Gas )( )(
Water/Wastew X X
ater
Electric
Solid Waste X
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2024-2025 Exhibit "F" — STANDARDS FOR COMPLETE DOCUMENTATION
Facility
Maintenance X X X
This item requires approval by the City prior to the execution of the CDBG Contract. Repairs may be categorized as major/minor
X
and Repairs
rehabilitation projects and must be approved through the full HUD Environmetal Review.
Rent X X X
City will pay for a portion of the rent for the Program facility so long as its in proportion to the square footage attributable to the CDBG-
funded program.
This item requires prior approval by the City. Prior to the execution of the CDBG Contract, the Agency must submit a written statement
that lists the contract labor services to be used during the Contract term. Agency will submit a memo related to the procurement of such
Contract Labor X X X X
X services and will forward any information pertaining to the procurement process to City. This requirement applies to, but is not limited to,
services retained for security services, legal, accounting, transportation providers, educational facilitators, custodial services, etc.
Agencies may not use the contract services of any City of Fort Worth Department.
City -required X X
City will only pay for a percentage of the City -required insurance so long as it's in proportion to the square footage attributable to the
Insurance
CDBG-funded program.
City requires that the agency submit its fee schedule or formula on how the Agency calculates the childcare scholarship amount. The
fee schedule/formula should demonstrate a breakout of income levels, and for each income level the schedule should demonstrate
Childcare X X
which portion of the expense is to be paid by the family and which portion of the expense is to be reimbursed by the City. A fee
Scholarships
schedule/formula must be submitted to the City prior to the first payment. Agency must submit documentation supporting that the client
is income eligible and that the household is being charged in conformance with the fee schedule. If the fee schedule/formula changes at
any time during the contract term, the Agency must immediately notify City on the date the new fee schedule/formula takes into effect.
"$0" Income
Agecies that are required to verify and provide proof of household income to determine eligibility, must require that anyone who is over
Certifications
the age of 18, living in the housohold, submit a $0 Income Certification.
If an audit is required because federal funds exceed $1,000,000.00, then the cost should be split evenly by all grant funding sources.
Audit Services X X X
X Agency must show calculation on how the CDBG portion of the accounting services were calculated. For example, if the CDBG grant is
10% of your Agency's budget, then invoice shall not exceed 10% of the overall cost. Agency must show a calculation and
documentation of how the invoiced amount was calculated, and must provide documentation showing payment.
*Proof of payment effective October 1, 2024: payments or Expenses must be documented in the following manner:
A) Image of the check AND bank statement showing the check cleared the bank; OR,
B) Image of the cancelled check (ex. At end of bank statement); OR,
C) Payroll Check Stub, "Advice", or Statement AND Bank Statement indicating payroll; OR,
D) For wire or e-transfers: Reciept or statement from payee/vendor OR bank statement.
Revised as of 08/07/2024 TJ
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2024-2025 Exhibit "F" — STANDARDS FOR COMPLETE DOCUMENTATION
EXHIBIT "G"
SEVERELY DISABLED CERTIFICATION FORM
CDBG 51% PSA CONTRACT - EXHIBIT "G" - SEVERELY DISABLED CERTIFICATION FORM
CERTIFICATION FORM
DOCUMENTING CLIENT STATUS AS "SEVERELY DISABLED ADULT"
Client Name:
Address:
City, State, Zip
Client Identification No.
CHECK ALL THAT APPLY
❑ Has used a wheelchair, a walker, cane , crutches or other special aid for six
months or longer
Has been diagnosed with one of the following conditions: Alzheimer's disease,
❑ mental retardation or other developmental disability, senility or dementia,
cerebral palsy, or autism; or has another mental or emotional condition that
seriously interferes with everyday tasks.
Is unable to perform one or more of the following "Functional Activities":
❑ seeing, hearing, speaking and having one's speech understood, lifting or
carrying, using stairs, grasping small objects, or walking.
Is unable to perform or needs assistance to perform one or more of the following
❑ Activities of Daily Living (ADL): getting around inside the home, getting in or
out of bed or a chair, bathing, dressing, eating, and toileting.
Is unable to perform or needs assistance to perform one or more of the following
Instrumental Activities of Daily Living (IADL): going outside the home,
❑ keeping track of money and bills, preparing meals, doing light housework,
taking prescription medications in the right amount and at the right time, and
using the telephone.
❑ Has a condition that prevents them from working at a job or doing housework.
The undersigned Agency representative conducted a visual assessment of the client identified on this
form and certifies that the client meets at least one of the conditions indicated above, which
determines that he/ she meets the definition of "severely disabled" according to the U.S. Census
Bureau.
Certified by:
Signature/Title:
Date:
CFW Neighborhood Services Dept.: Revised 08/29/2019
CDBG 51% PSA CONTRACT - EXHIBIT "G" - SEVERELY DISABLED CERTIFICATION FORM
EXHIBIT "H"
MBE REPORTING FORM
CDBG 51 % PSA CONTRACT -- EXHIBIT "H" -- MBE REPORTING FORM Page 1
Contract and Subcontract Activity U.S. Department of Housing and Urban Development OMB Approval No.: 2577-0088 OMB
Approval No.: 2502-0355
Public reporting burden for this collection of information is estimated to average .5 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The
Information is voluntary. HUD may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB Control Number.
Executive Orders dated July 14, 1983, directs the Minority Business Development Plans shall be developed by each Federal Agency and the these annual plans shall establish minority business development objectives. The information is used by HUD to monitor and evaluate MBE activities against
the total program activity and the designated minority business enterprise (MBE) goals. The Department requires the information to provide guidance and oversight for programs for the development of minority business enterprise concerning Minority Business Development. If the information is
not collected HUD would not be able to establish meaningful MBE goals nor evaluate MBE performance against these goals.
Privacy Act Notice = The United States Department of Housing and Urban Development, Federal Housing Administration, is authorized to solicit the Information requested in this form by virtue of Title 12, United States Code, Section 1701 et seq., and regulation. It will not be disclosed or
relesed outside the United States Department of Housing and Urban Development without your consetn, except as required or permitted by Law.
1. Grantee/Project Owner/Developer/Spomor/Builder/Agency
Check if: 2. Location (City, State Zip Code)
PH
IH
CPD
Housing
3a. Name of Contact Person
3b. Phone Number (Including Area Code)
4. Reporting
Period
5. Program Code (Not applicable for CPD programs.)
6. Date Submitted to Field Office
See explanation of Codes at bottom of Page Use a
❑
❑
Oct. 1 - Sept. 30 (Annual -FY)
separate sheet for each program code.
Contractor or
Grant/Project Number or HUD
Subcontractor
Case Number or other
Amount of Type of Trade
Business
Subcontractor
Contractor/Subcontractor Name and Address
identification of property,
Contract or Code
Racial/Edmic
Woman Owned Business Prime Contractor Identification (ID)
Identification (ID)
7j.
subdivision, dwelling unit, etc.
Subcontact (See below)
(See below)
(Yes or No) Number
Sec. 3
Number Sec. 3
7a.
7b. 7c.
7d.
7e. 7f.
7g.
7h 7i.
Name Street City State Zip
CPD:
L = New Construction
2 = Education/Training
3 = Other
7c: Type of Trade Codes:
Housing/Public Housing:
1 —New Construction 6 = Professional
2 — Substantial Rehab. 7 = Tenant Services
3 — Repair 8 = Education/Tminmg
4 = Service 9 = Arch./Engrg. Appraisal
5 — Project Mangt. 0 = Other
7d: Racial/Ethnic Codes: 5: Program Codes (Complete for Housing and Public and Indian Housing programs only):
1 = White Americans
1 = All Insured, including Sections
5 = Section 202
2 = Black Americans
2= Flexible Subsidy
6 = HLJD-Held (Management)
3 = Native Americans
3 = Section 8 Noninsured, Non-HFDA
7 — Public/India Housing
4 = Hispanic Americans
4 = Insured (Management)
8 — Section 811
5=Asian/Pacific Americans
6 = Hasidic Jews
Previous editions are obsolete. form HUD-2516 (8/98)
EXHIBIT "I"
NOTICE OF BENEFICIARY RIGHTS
CDBG PSA CONTRACT- EXHIBIT "I" - NOTICE OF BENEFICIARY RIGHTS
Notice of Beneficiary Riehts
Name of Agency:
Name of Program:
Contact information for Program Staff (name, phone number, and e-mail address, if appropriate):
Because this program is supported in whole or in part by direct Federal financial assistance from
the Federal Government, we are required to let you know that:
• We may not discriminate against you on the basis of religion, religious belief, a refusal
to hold a religious belief, or a refusal to attend or participate in a religious practice;
• We may not require you to attend or participate in any explicitly religious activities that
are offered by us and any participation by you in these activities must be purely
voluntary;
• We must separate, in time or location, any privately funded explicitly religious activities
from activities supported by direct Federal financial assistance;
• If you object to the religious character of our organization, we must make reasonable
efforts to identify and refer you to an alternative provider to which you have no such
objection; and
• You may report an organization's violations of these protections, including any denial of
services or benefits, by contacting or filing a written complaint to HUD [or the
intermediary, if applicable].
We must give you this written notice before you enroll in our program or activity, as required by
24 CFR 5.109.
CDBG PSA CONTRACT- EXHIBIT "I" - NOTICE OF BENEFICIARY RIGHTS
EXHIBIT "J"
CONFLICT OF INTEREST DISCLOSURE:
FOR CITY OF FORT WORTH PROGRAMS ONLY
CDBG 51 % PSA CONTRACT -- EXHIBIT "J" -- CONFLICT OF INTEREST DISCLOSURE
FORT _ T WORT
CONFLICT OF INTEREST DISCLOSURE:
FOR CITY OF FORT WORTH PROGRAMS ONLY
The assistance you are applying for is funded using Housing and Urban Development (HUD) funds and because
of this our office is requesting the following information in order to comply with the funding requirements. Please
complete this form to the best of your ability, sign it, and return it to this Agency at your earliest convenience.
Ili ►TJM
TELEPHONE:
ADDRESS:
E-MAIL ADDRESS (if applicable)
1. Are you employed by the City of Fort Worth? ❑ YES I ❑ NO
1 a. If yes, by which Department and Division:
2. Were you employed by the City of Fort Worth within the most recent 12-month period? ❑ YES I ❑ NO
2a. If yes, by which Department and Division:
3. Are any members of your immediate family currently employed by the City of Fort Worth?
("Immediate Family" includes (whether by blood or adoption): the spouse, parent (including a stepparent), ❑ YES ❑ NO
child (including a stepchild), brother, sister (including a stepbrother or stepsister), grandparent, grandchild,
and in-laws.)
3a. If yes, please provide relative's name(s), Department(s), and Division(s):
4. If No, were any members of your immediate family employed by the City of Fort Worth YES NO
within the most recent 12-month period? El El4a. If yes, please provide relative's name(s), previous Department(s), and Division(s):
5. Are you an elected or appointed official, or agent or consultant, of the City of Fort Worth? YES NO
5a. If yes, by which Department and Division: ❑ ❑
6. Are any immediate family members an elected or appointed official, or agent or consultant YES NO
of the City of Fort Worth? El El6a. If yes, please provide relative's name(s), Department(s), and Division(s):
Certification: I understand and agree that the City may/will contact the City of Fort Worth department including all supervisors in
order to determine whether any of these persons' employment or official functions are or were related to the City's use of federal
grant funds and whether federal funds can be provided. 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.
Applicant/Prospective Applicant Signature
Date
Fpr_City_5taff Only: Once this form is completed and if "Yes" is marked on any of the above questions, please return it
to your Compliance Specialist as soon as possible for processing. If you have any questions, please contact Leticia
Rodriguez, Compliance Administrator, Compliance Division, at 817-392-7319, or Charletta Moaning, Sr. Contract
Compliance Specialist, at 817-392-7333 or at charletta,moaning@a fortworthtexas.gpy.
Neighborhood Services Department -Conflict Disclosure Form, Dated September 23, 2024-City Only
CSC No. 55416
Funding Approval/Agreement
Title I of the Housing and Community
Development Act (Public Law 930383)
HI-00515R of 20515R
1. Name of Grantee (as shown in item 5 of Standard Form 424)
Fort Worth
2. Grantee's Complete Address (as shown in item 5 of Standard Form 424)
1000 Throckmorton
Fort Worth, TX 76102-0000
U.S. Department of Housing and Urban Development
Office of Community Planning and Development
Community Development Block Grant Program OMB Approval No. 2506-0193
exp 5/31/2018
3a. Grantee's 9-digit Tax ID Number
756000528
4. Date use of funds may begin
10/01/2020
5a. Project/Grant No. 1
B-20-M W-48-0010
5b. Project/Grant No. 2
3b. Grantee's 9-digit DUNS Number
073170458
6a. Amount Approved
$9,828,497
6b. Amount Approved
Grant Agreement: This Grant Agreement between the Department of Housing and Urban Development (HUD) and the above named Grantee is made pursuant to the
authority of Title I of the Housing and Community Development Act of 1974, as amended, (42 USC 5301 et seq.). The Grantee's submissions for Title I assistance, the
HUD regulations at 24 CFR Part 570 (as now in effect and as may be amended from time to time), and this Funding Approval, including any special conditions, constitute
part of the Agreement. Subject to the provisions of this Grant Agreement, HUD will make the funding assistance specified here available to the Grantee upon execution
of the Agreement by the parties. The funding assistance specified in the Funding Approval may be used to pay costs incurred after the date specified in item 4 above
provided the activities to which such costs are related are carried out in compliance with all applicable requirements. Pre -agreement costs may not be paid with funding
assistance specified here unless they are authorized in HUD regulations or approved by waiver and listed in the special conditions to the Funding Approval. The Grantee
agrees to assume all of the responsibilities for environmental review, decision making, and actions, as specified and required in regulations issued by the Secretary
pursuant to Section 104(g) of Title I and published in 24 CFR Part 58. The Grantee further acknowledges its responsibility for adherence to the Agreement by sub -
recipient entities to which it makes funding assistance hereunder available.
U.S. Department of Housing and Urban Development (By Name) Grantee Name (Contractual Organization)
Shirley Henley Fort Worth (City Of Fort Worth)
Title
Title
CPD Director
Assistant City Manager
Signature
Date (mmlddlyyyy)
Signature
Date (mm/ddlyyyy)
Xj C/Jy/
' / [�" �j�/
l/ --
01 /21 /2021
� -
XFernando Costa (Mar 16, 202112:21 CDT)
7. Category of Title I Assistance for this Funding Action:
8. Special Conditions
9a, Date HUD Received Submission
10. check one
(check one)
01/19/2021
❑ a. Orig. Funding
Entitlement, Sec 106(b)
❑ None
9b. Date Grantee Notified
Approval
® Attached
01/21/2021
® b. Amendment
9c. Date of Start of Program Year
Amendment Number
(I OtO1/2020)
11. Amount of Community Development
Block Grant
FY (2020)
a. Funds Reserved for
this Grantee $9,828,497
b. Funds now being Approved
c. Reservation to be Cancelled
(1 la minus 11b)
12a. Amount of Loan Guarantee Commitment now being Approvec 12b. Name and complete Adress of Public Agency
N/A City Of Fort Worth
Loan Guarantee Acceptance Provisions for Designated Agencies: 1000 Throckmorton
The public agency hereby accepts the Grant Agreement executed by the Fort Worth, TX 76102-0000
Department of Housing and Urban Development on the above date with 112c. Name of Authorized Official for Designated Public Agency
respect to the above grant number(s) as Grantee designated to receive loan
guarantee assistance, and agrees to comply with the terms and conditions
of the Agreement, applicable regulations, and other requirements of HUD Title
now or hereafter in effect, pertaining to the assistance provided it.
Signature
X
HUD Accounting use Only
Batch TAC Program Y A Reg Area Document No. Project Number Category Amount
FM 153 11 FMnnnFT] FFnFFITI-1FTMI
0
YY Project Number Amount
Y Proiect Number Amount
LLLI-LI�pF Fon). �aa
o°°° °°°tyo�d
Date Entered PAS (mm/ddlyyyy) Date Entered LOCCS (mmlddlyyyy) I Batch Number Transa� �o ° ° 09� p Entered By
OVo a=0
Approved as to form and legality: Attest °°
—fRl!� jl0 QQ� rEXAsaa
Mary J. Kayser,
R 570 City Secretary �naaaa
Effective Date
(mm/dd/yyyy)
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
form HUD-7082 (5115)
Additional CDBG-CV Requirements
In addition to the terms and conditions in the Funding Approval/Agreement, the following
requirements apply to Grantees receiving CDBG-CV funds in accordance with the Coronavirus
Aid, Relief and Economic Security Act (CARES Act) (Pub. L. 116-136).
1) The Grantee agrees to comply with the requirements in the CARES Act that apply to
CDBG-CV grants and must use the CDBG-CV grant funds to prevent, prepare for and
respond to coronavirus.
2) The grantee agrees to comply with the requirements of the Housing and Community
Development Act of 1974 (42 USC 5301 et seq.) and implementing regulations at 24
CFR part 570, as now in effect and as may be amended from time to time, and as
modified by the rules, waivers and alternative requirements published by HUD from
time to time. Rules, waivers and alternative requirements of Federal Register notices
applicable to CDBG-CV grants are hereby incorporated into and made a part of the
grant agreement.
3) The Grantee may use CDBG-CV funds as reimbursement for previously incurred costs,
provided that those costs are allowable and consistent with the CARES Act's purpose to
prevent, prepare for and respond to coronavirus.
4) The grantee agrees to establish and maintain adequate procedures to prevent any
duplication of benefits as required by section 312 of the Robert T. Stafford Disaster
Relief and Emergency Assistance Act (42 U.S.C. 5155), as amended by section 1210 of
the Disaster Recovery Reform Act of 2018 (division D of Public Law 115-254; 132 Stat.
3442).
5) The period of performance for the funding assistance specified in the Funding
Approval/Agreement ("Funding Assistance") shall be six years. It shall begin on the date
specified in item 4 in the Funding Approval/Agreement and shall end six years later, on
the month and day specified in item 4. The Grantee shall not incur any obligations to be
paid with the Funding Assistance after this period of performance.
6) The Recipient shall attach a schedule of its indirect cost rate(s) in the format set forth
below to the executed Funding Approval/Agreement that is returned to HUD. The
Recipient shall provide HUD with a revised schedule when any change is made to the
rate(s) described in the schedule. The schedule and any revisions HUD receives from
the Recipient shall be incorporated herein and made a part of this Funding
Approval/Agreement, provided that the rate(s) described comply with 2 CFR part 200,
subpart E.
Administering
Direct
Department/Apencv Indirect cost rate Cost Base
o�
o�
o�
o�
o�
Instructions: The Recipient must identify each agency or department of the
Recipient that will carry out activities under the grant, the indirect cost rate
applicable to each department/agency (including if the de minimis rate is used
per 2 CFR §200.414(f)), and the type of direct cost base to which the rate will be
applied (for example, Modified Total Direct Costs (MTDC)). Do not include
indirect cost rates for subrecipients.
7) In addition to the conditions contained in the Funding Approval/Agreement (form HUD
7082), the grantee shall comply with requirements established by the Office of
Management and Budget (OMB) concerning the Dun and Bradstreet Data Universal
Numbering System (DUNS); the System for Award Management (SAM.gov.); the Federal
Funding Accountability and Transparency Act as provided in 2 CFR part 25, Universal
Identifier and General Contractor Registration; and 2 CFR part 170, Reporting Subaward
and Executive Compensation Information.
8) The grantee shall ensure that no CDBG-CV funds are used to support any Federal, State,
or local projects that seek to use the power of eminent domain, unless eminent domain
is employed only for a public use. For the purposes of this requirement, public use shall
not be construed to include economic development that primarily benefits private
entities. Any use of funds for mass transit, railroad, airport, seaport or highway
projects as well as utility projects which benefit or serve the general public (including
energy -related, communication -related, water- related and wastewater -related
infrastructure), other structures designated for use by the general public or which have
other common -carrier or public -utility functions that serve the general public and are
subject to regulation and oversight by the government, and projects for the removal of
an immediate threat to public health and safety or brownfield as defined in the Small
Business Liability Relief and Brownfields Revitalization Act (Public Law 107-118) shall be
considered a public use for purposes of eminent domain.
9) The Grantee or unit of general local government that directly or indirectly receives
CDBG-CV funds may not sell, trade, or otherwise transfer all or any such portion of such
funds to another such entity in exchange for any other funds, credits or non -Federal
considerations, but must use such funds for activities eligible under title I of the Act.
10) E.O. 12372-Special Contract Condition - Notwithstanding any other provision of this
agreement, no funds provided under this agreement may be obligated or expended for
the planning or construction of water or sewer facilities until receipt of written
notification from HUD of the release of funds on completion of the review procedures
required under Executive Order (E.O.) 12372, Intergovernmental Review of Federal
Programs, and HUD's implementing regulations at 24 CFR Part 52. The recipient shall
also complete the review procedures required under E.O. 12372 and 24 CFR Part 52 and
receive written notification from HUD of the release of funds before obligating or
expending any funds provided under this agreement for any new or revised activity for
the planning or construction of water or sewer facilities not previously reviewed under
E.O. 12372 and implementing regulations.
11) CDBG-CV funds may not be provided to a for -profit entity pursuant to section 105(a)(17)
of the Act unless such activity or project has been evaluated and selected in accordance
with Appendix A to 24 CFR 570 - "Guidelines and Objectives for Evaluating Project Costs
and Financial Requirements." (Source —This condition is included as requirement on
the use of fiscal year 2020 CDBG funds by the Community Development Fund heading,
Department of Housing and Urban Development Appropriations Act, 2020, Public Law
116-94, and is made applicable to this grant by the CARES Act).
Contract Compliance Manager:
By signing I acknowledge that I am the person responsible for the monitoring and administration
of this contract, including ensuring all performance and reporting requirements.
Barbara As ,(Mar 16,202109:15CDT)
Barbara Asbury, Compliance and Planning Manager
Neighborhood Services Department
❑ This form is N/A as No City Funds are associated with this Contract
Printed Name Signature
City of Fort Worth, Texas
Mayor and Council Communication
DATE: 01/28/25 M&C FILE NUMBER: M&C 25-0079
LOG NAME: 19CARES ACT HUD FUNDS CDBG-CV/CV3 AWARDS
SUBJECT
(ALL) Authorize Execution of Contracts Related to Existing Appropriations in the Coronavirus, Aid, Relief, and Economic Security Act Community
Development Block Grant Funds in the Amount of $250,000.00 with Certain Non -Profits to Fund Particular Programs and Activities
RECOMMENDATION:
It is recommended that City Council authorize execution of contracts related to existing appropriations in the Coronavirus, Aid, Relief, and
Economic Security Act Community Development Block Grant Funds in the amount of $250,000.00 to fund particular programs and activities with
the following agencies:
• The Presbyterian Night Shelter of Tarrant County, Inc. for Homelessness Prevention and Special Needs Support in the amount of
$142,905.00
• Guardianship Services, Inc. for Elderly Services/Aging In Place in the amount of $70,000.00
• Meals on Wheels of Tarrant County for Elderly Services/Aging In Place in the amount of $37,095.00
DISCUSSION:
The purpose of this Mayor and Council Communication (M&C) is to request approval of awards of federal grant funds, as approved by M&C 24-
0743, August 27, 2024, amending the City of Fort Worth's 2019-2020 Annual Action Plan, in regards to the use of funding received from the U.S.
Department of Housing and Urban Development (HUD) under the Coronavirus, Aid, Relief, and Economic Security (CARES) Act Community
Development Block Grant (CDBG-CV/CV3) program.
On August 6, 2019, the City Council, through M&C 19-0016, approved the City's 2019-2020 Annual Action Plan summarizing the major housing
and community development activities and proposed expenditures for use of federal grant funds from HUD under various grant programs including
the Community Development Block Grant (CDBG) program.
The CARES Act was signed into law on March 27, 2020, to respond to the impacts of the COVID-19 public health emergency. The CARES Act
included provisions to help local governments prevent, prepare for, and respond to the coronavirus, including providing for additional allocations of
formula grant funds under the CDBG program. The City Council previously awarded the additional allocations of CDBG-CV and CDBG-CV3
funding through M&Cs 20-0330, 20-0471, 20-0940, and 21-0016. Some of the funding received was allocated to cover administration expenses.
On August 27, 2024, the City Council, with M&C 24-0743, approved the staffs recommendation to again amend the 2019-2020 Annual Action
Plan and re -allocate $250,000.00 from administration to Public Service Agencies (PSAs) through a competitive Request for Proposal (RFP)
process to address the following priorities:
• Elderly Services/Aging In Place
• Homelessness Prevention and Special Needs Support
AGENCY NAME
The Presbyterian Night Shelter of
Tarrant County, Inc.
Guardianship Services, Inc.
Meals -On -Wheels, Inc. of Tarrant
County
Center for Transforming Lives
ITOTAL
TABLE 1: CDBG-CV/CV3 AGENCIES
PROGRAM NAME
Homelessness Prevention and
Special Needs Support
Elderly Services/Aging In Place
Elderly Services/Aging In Place
Homelessness Prevention and
,Special Needs Support
APPLICATION
REQUESTED
RECOMMENDED
SCORE
FUNDING
FUNDING
93
$142,905.00
$142,905.00
89.5
$70,000.00I
$70,000.00
81.5
$250,000.00
$37,095.00
74.5
$135,000.00
$0.00
$597,905.001 $250,000.00
The 2019-2020 Annual Action Plan was amended by the City Council on May 19, 2020, to state how CARES Act grant funds were to be used, and
to amend the Citizen Participation Plan to reduce public comment period for CARES Act funds from thirty days to five days as authorized by the
CARES Act (M&C 20-0330). This 5-day public comment period began Monday, December 23, 2024, and ran through Friday, December 27,
2024. Notice of this public comment period was published in the Fort Worth Star -Telegram, on Sunday, December 22, 2024. Any comments
received are maintained by the Neighborhood Services Department in accordance with federal regulations.
These programs are available in ALL COUNCIL DISTRICTS.
FISCAL INFORMATION / CERTIFICATION:
The Director of Finance certifies that upon approval of the above recommendations, funds will be available in the current operating budget, as
appropriated, of the Grants Operating Federal Fund. The Neighborhood Services Department (and Financial Management Services) will be
responsible for the collection and deposit of funds due to the City. Prior to an expenditure being incurred, the Neighborhood Services Department
has the responsibility to validate the availability of funds. This is a reimbursement grant.
Submitted for Citv Manaaer's Office by
Oriainatina Business Unit Head:
Jesica McEachern 5804
Kacey Bess 8187
Pam Rambo Sexton 7556
Additional Information Contact: Juliet Moses 6203
Sharon Burkley 5785
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