HomeMy WebLinkAbout064624 - General - Contract - Guardianship Services, Inc.CSC No. 64624
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-pro�t
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-25-MC-48-0010, Catalog of Federal Domestic Assistance No. 14.218;
WHEREAS, a national objective of the CDBG program is to benefit low and moderate
income citizens in accordance with 24 CFR Part 570, as amended from time to time;
WHEREAS, Agency submitted a proposal to use CDBG funds for a program to serve
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 programs are needed by the City's citizens.
NOW, THEREFORE, the Parties understand and agree as follows:
INCORPORATION OF RECITALS.
City and Agency hereby agree that the recitals set forth above are true and correct and form
the basis upon which the Parties have entered into this Contract.
2. DEFINITIONS.
In addition to terms defined in the body of this Contract, the terms set forth below shall
have the definitions ascribed to them as follows:
Area Median Income or AMI means the median family income for the Fort Worth-Arlington
metropolitan statistical area as established annually by HUD. The 2025 income limits are
attached hereto as EXHIBIT "A-1" — 2025 HUD Income Limits.
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:
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026
Guardianship Services,Inc.
OfFICIAL RECORD I
CITY SECRETARY
FT. WORTH, TX
Page 1
Rev. 09/29/2025
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: either (i) verifiable self-certification of income
such as the City's Certification Income Statement attached as EXHIBIT "E"
— Form of Income Self-Certification or a similar form approved by City,
or (ii) Source Documentation and, if applicable, confirmation of eligibility
through the Systematic Alien Verification for Entitlements (SAVE)
program.
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 Funds means the CDBG grant funds supplied by City to Agency under the terms of this
Contract.
CDBG Regulations means regulations found at 24 CFR Part 570 et seq.
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 October 1, 2025.
HUD means the United States Department of Housing and Urban Development.
IDIS means Integrated Disbursement Information System, HUD's project tracking system.
Income Eligible Client means a client whose annual income adjusted for family size does not
exceed 80% of AMI using the most current HUD Income Guidelines and Technical Guidance for
Determining Income and Allowances. The definition of annual income to determine client income
eligibility shall be the definition contained in 24 CFR Part 5.609, as amended from time to time.
National Objective means an activity that benefits low- and moderate-income persons. For the
purposes of this Contract, at least 100% of the clients served by the Program fall into a"presumed
benefit" category as defined in 24 CFR Part 570, and therefore are presumed to be Income Eligible
Clients.
Neighborhood Services Department means the City's Neighborhood Services Department.
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 2
Guardianship Services, Inc. Rev. 09/29/2025
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,
2026, 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 is in compliance 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 Funds.
City will provide up to $ 80,000.00 of CDBG Funds under the terms and conditions of this
Contract.
4.2 Monitor.
City will monitor the activities and performance of Agency and any of its contractors,
subcontractors or vendors as necessary, but no less than annually. Monitoring by City will include
determining whether Agency is meeting the National Objective during the term of this Contract.
5. DUTIES AND RESPONSIBILITIES OF AGENCY.
5.1 Required Services.
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 3
Guardianship Services, Inc. Rev. 09/29/2025
Agency shall perform the services described in EXHIBIT "A" — Program Summary in
accordance with the terms and conditions of this Contract.
5.2 Use of CDBG Funds.
52.1. Comnliance with CDBG Regulations and Contract.
Agency shall be reimbursed for eligible Program costs with CDBG Funds only if City
determines in its sole discretion that:
5.2.1.1
5.2.1.2
5.2.1.3
5.2.2 Budget.
5.2.2.1
Costs are eligible expenditures in accordance with CDBG Regulations.
Costs are in compliance with this Contract and are reasonable and
consistent with industry norms.
Complete Documentation, as applicable, is submitted to City by
Agency.
The CDBG Funds will be paid on a reimbursement basis in accordance
with EXffiBIT "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 ar 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 speciiied in the
amendment. All requests for Budget amendments must be
submitted by Apri115, 2026.
5.2.3 Change in Pro�ram Bud�et.
5.2.3.1 Agency will notify City promptly of any additional funds it receives for
operation of the Program, and City reserves the right to amend this
Contract in such instances to ensure compliance with HUD regulations
governing cost allocation.
5.2.3.2 Agency agrees to utilize the CDBG Funds to supplement rather than
supplant funds otherwise available for the Program.
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 4
Guardianship Services, Inc. Rev. 09/29/2025
5.2.4 Pavment of CDBG Funds to Agencv.
CDBG Funds will be disbursed to Agency upon City's approval of Reimbursement
Requests including submission of Complete Documentation to City in compliance with Section 9.
If Agency expends all funds budgeted for the Program prior to September 30, 2026, City may
hold back a small amount of the CDBG Funds until the end of the term. During this interim period,
Agency must continue to submit Attachment III — Client Data Report in EXHIBIT "D" —
Reimbursement Forms monthly. It is expressly agreed by the Parties that any CDBG Funds not
spent or approved for reimbursement to Agency shall remain with City.
5.3 Pro�ram Performance Milestones, Review and Corrective Action .
5.3.1 Agency represents that the Program will achieve the following milestones in
accordance with EXHIBIT "A" — Program Summary and the table below:
Month
6
9
12
25%
50%
75%
100%
% of Unduplicated
Clients Served (as
speciiied in EXHIBIT
"A" — Program
Summary)
25%
50%
75%
100%
5.3.2 Failure of Agency to meet these milestones or a material deviation from them as
outlined in this Section 5.3 is a breach of this Contract. For the purpose of this Section, "material
deviation" shall mean more than 10% lower than the specified goal. In the event of such breach,
City reserves the right in its sole option to delay or withhold payment of Reimbursement Requests,
(ii) institute a Corrective Action plan as described below, (iii) to lower Agency's allocation of
CDBG Funds, or terminate this Contract.
5.3.2.1 Corrective Action.
Corrective action 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. The City may issue verbal or
informal directive requiring the Agency to take corrective action. A corrective action 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. Informal corrective
action shall not be considered a formal written corrective action plan or amendment to this
Contract. Formal written corrective action shall be required only when expressly stated in writing
by the City.
5.3.3 Failure to meet at least 80% of its performance milestones or serve 164 Unduplicated
Clients under this Contract may, in City's sole discretion, disqualify Agency for consideration
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 5
Guardianship Services, Inc. Rev. 09/29/2025
under the City's Request for Proposals for the 2026-2027 Program Year for federal grant funds.
5.3.4 Amendments to performance milestones must be approved by the Director in
writing, with such approval being in the Director's sole discretion. If Director approves the
Agency's proposed amended performance milestones (as approved, the "Amended Performance
Milestones"), then the Amended Performance Milestones will take effect on the first day of the
month following the month in which it was approved by the Director, unless otherwise specified
in the amendment. All requests for amendments to performance milestones must be submitted by
June 1, 2026. Except in extreme circumstances, notwithstanding the above, any amendments to
performance milestones shall not reduce the number for serving 164 Unduplicated Clients stated
in Section 5.3.3.
5.4 Identifv Program Expenses Paid with CDBG Funds.
Agency will keep accounts and records in such a manner that City may readily identify and
account for Program expenses reimbursed with CDBG Funds. These records shall be made
available to City for audit purposes and shall be retained as required hereunder.
5.5 Meet National Obiective.
Agency shall ensure that the activities carried out in the Program will meet the National
Obj ective.
5.6 Pro�ram Subcontracts.
Agency shall not enter into a subcontract with another agency, contractor, ar vendor to
provide a service to clients for any part of the Program that will be paid with CDBG Funds without
City's written consent.
6. CLIENT ELIGIBILITY VERIFICATION.
6.1 Client Eli�ibilitv.
Agency will document client eligibility as follows:
6. L 1 A�encv Clients.
Agency must document that all clients served by the Program fall under a"presumed
benefit" category as defined in 24 CFR Part 570. For purposes of this Contract, the categories of
presumed benefit are: severely disabled adults, homeless persons, abused or neglected children
and youth, or elderly persons. Eligible forms of documentation for each category include:
6. L 1.1 Severely Disabled Adults. Written, signed and dated diagnosis from a
licensed medical professional. As an acceptable alternative, Agency
may use the form attached hereto as Exhibit "G" — Severely Disabled
Certification Form.
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 6
Guardianship Services, Inc. Rev. 09/29/2025
6.1.1.2 Homeless Persons. Written, signed and dated certification from an
outreach worker.
6.1.1.3 Abused or Neglected Children and Youth. Written, signed and dated
certification from an outreach worker.
6.1.1.4 Elderly Persons. An elderly person is an individual at least 62 years of
age. Copy of a birth certificate, driver's license, passport, immigration
card, military identification, or any other state, local, national or
international documentation, must be provided showing current
information about the age or birth date of the client. The form in
Exhibit "E" — Self-Certification of Income Form, or a similar
document, will also be required in order to collect demographic data.
If applicable, the Agency must comply with the eligibility and verification requirements
that apply under title IV of the Personal Responsibility and Work Opportunity Reconciliation Act
of 1996, as amended (8 U.S.C. 1601-1646) (PRWORA) anduse the Systematic Alien Verification
for Entitlements (SAVE) or an equivalent verification system approved by the Federal
government, to prevent any Federal public benefit from being provided to an ineligible alien who
entered the United States illegally or is otherwise unlawfully present in the United States, unless
the Agency is a nonprofit charitable organization exempt from this requirement under 8 U.S.C. §
1642(d).
6.1.2 Verification of Pro�ram Eligibilitv.
6.1.2.1 At the end of each quarter during the Contract term, Agency shall verify
CDBG Program Eligibility by confirming that at least 100% 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. l, 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 are 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. L2.4 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
Funds, or to terminate this Contract.
6.2 Submission of Complete Documentation.
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 7
Guardianship Services, Inc. Rev. 09/29/2025
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 for 7 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, including but not limited to the following:
7.1 Environmental Review.
CDBG 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 Funds it has already received and forfeit any future payments of CDBG 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
City's 2022-23 Action Plan, and (iii) receipt by City of a grant agreement from HUD.
7.3 Monitoring.
7.3.1 Agency understands and agrees that it will be subject to monitoring by City for
compliance with terms and provisions of this Contract and the CDBG Regulations for the term of
this Contract. Agency is subject to such monitoring during the term of this Contract and for seven
(7) years after the Contract term ends. Agency will provide reports and access to Program files as
requested by City during this seven (7) 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 Funds, and to Agency's
officers, directors, agents, employees, contractors, subcontractors and vendors for the purpose of
such monitoring.
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 8
Guardianship Services, Inc. Rev. 09/29/2025
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 7
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 Agencv 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 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 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 Princiules/Cost Reasonableness.
Agency shall administer its use of CDBG 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 Mana�ement Standards.
Agency agrees to comply with 2 CFR Part 200, as applicable. Agency also agrees to adhere
to the accounting principles and procedures required therein, utilize adequate internal controls, and
maintain necessary supporting and back-up documentation for all costs incurred in accordance
with 2 CFR Part 200.302 and Part 200.303.
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 9
Guardianship Services, Inc. Rev. 09/29/2025
7.7 Uniform Administrative Requirements, Cost Principles, and Audit
Reauirements.
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 Apnlicable 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 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 7 years after the Contract term
ends.
7.9 Copvri�ht and Patent Ri�hts.
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 Comnliance with FFATA and Whistleblower Protections.
Agency shall comply with the requirements of 2 CFR 300(b), including provisions of the
Federal Funding Accountability and Transparency Act ("FFATA") governing requirements on
executive compensation and provisions governing whistleblower protections contained in 10
U.S.C. 2409, 41 U.S.C. 4712, 10 U.S.G 2324, 41 U.S.C. 4304 and 41 U.S.C. 4310.
7.11.1 Agency shall provide City with its DLTNS number.
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 10
Guardianship Services, Inc. Rev. 09/29/2025
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 Funds that
provides reasonable assurance that Agency is managing the CDBG 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. 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 7 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 7 year
period, the relevant records and documentation must be retained until all such claims, ]itigation or
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 7 years after the Contract
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 11
Guardianship Services, Inc. Rev. 09/29/2025
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 AdditionalInformation.
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 Reportin� 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 Exnend $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 nine 9 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.
8.5.2 Citv Reserves the Ri�ht 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 7 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 far such audit. If such audit reveals a
questioned practice or expenditure, such questions must be resolved within fifteen (15) business
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 12
Guardianship Services, Inc. Rev. 09/29/2025
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 REOUIREMENTS.
9.1 Deadline for Submittin� Reimbursement Reauests.
9.1.1 Reimbursement Requests shall be submitted monthly to the City and must be
received by the City on or before the 15tb 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 15th 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 2026 MUST BE RECEIVED BY OCTOBER
4, 2026. COMPLETE DOCUMENTATION FOR ALL SEPTEMBER 2026 EXPENSES
MUST BE SUBMITTED BY OCTOBER 15, 2026. FAILURE TO SUBMIT A FINAL
REIMBURSEMENT REQUEST WITH COMPLETE DOCUMENTATION BY
OCTOBER 15, 2026 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. At City's sole discretion, Agency may be penalized, in the
Request for Proposal for the 2026-2027 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.
92 Submission of Reimbursement Reauests.
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— Reauest 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).
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 13
Guardianship Services, Inc. Rev. 09/29/2025
9.2.2 Attachment II — Exnenditure 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-funded time and non-CDBG funded time and reflect
actual time spent on CDBG-funded activities. Agency may not submit
payroll expenses dated sixty (60) calendar days prior to the date of the
Reimbursement Request.
9.22.2 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 Reauest.
Reimbursement Requests must be submitted through Neighborly Software or other
reporting software as approved by the City by the deadline in Section 9.1.
9.2.5 Countvwide A�encies
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.
DEFAULT AND TERMINATION.
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 14
Guardianship Services, Inc. Rev. 09/29/2025
10.1 Failure to Submit Reimbursement Request or Required Documentation.
10.1.1 If Agency fails to submit a Reimbursement Request in accordance with Section
9, Agency shall be in default of this Contract. City will notify Agency in writing of such default
and the Agency will have seven (7) calendar days from the date of the written Default Notice to
submit such Reimbursement Request to cure the default. If Agency fails to cure within such time,
Agency shall forfeit any payments otherwise due that month.
10.1.2 NOTWITHSTANDING THE PROVISIONS OF SECTION 10.11, IF
AGENCY FAILS TO SUBMIT THE REIMBURSEMENT REQUEST DUE OCTOBER 4,
2026 OR IF THE SUBMITTED REIMBURSEMENT REQUEST DUE OCTOBER 4, 2026
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 Funds to Agency during the period that any Reimbursement Request, report or
documentation is past due or is not in compliance with this Contract or the CDBG Regulations, or
during any period during which Agency is in default of this Contract.
10.1.5 In the event of termination under this Section 10.1, all CDBG Funds awarded
but unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency shall
have no further right to such funds.
102 Failure to Maintain Records or Submit Renorts 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 Funds awarded but
unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency shall have
no further right to such funds.
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 15
Guardianship Services, Inc. Rev. 09/29/2025
10.2.2 In the event of termination under Section 10.2, any CDBG Funds paid to
Agency must be repaid to City within thirty (30) days of termination. If such CDBG 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.
10.32.2 Direct Agency to establish and follow a management plan that
assigns responsibilities for carrying out the remedial activities.
10.3.2.3 Reprogram CDBG Funds that have not yet been expended from
affected activities to other eligible activities or withhold CDBG
Funds.
10.3.2.4 Any other appropriate action including but not limited to any
remedial action legally available such as declaratary 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 this Section 10.3, all CDBG Funds awarded
but unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency shall
have no further right to such funds, and any CDBG Funds already paid to Agency must be repaid
to City within thirty (30) days of the termination. Failure to repay such CDBG 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 Funds will be paid to Agency until all
defaults are cured to City's satisfaction.
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 16
Guardianship Services, Inc. Rev. 09/29/2025
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 Subseauent Breach.
The waiver of a default or breach of any term, covenant, or condition of this Contract shall
not operate as a waiver of any subsequent default or breach of the same or any other term, covenant
or condition hereof.
10.8 Civil, Criminal and Administrative Penalties.
Failure to perform all the Contract terms may result in civil, criminal or administrative
penalties, including, but not limited to those set out in this Contract.
10.9 Termination for Cause.
10.9.1 City may terminate this Contract in the event of Agency's default, inability, or
failure to perform subject to notice, grace and cure periods. In the event City terminates this
Contract for cause, all CDBG Funds awarded but unpaid to Agency pursuant to this Contract shall
be immediately rescinded and Agency shall have no further right to such funds and any CDBG
Funds already paid to Agency must be repaid to City within thirty (30) days of termination. Failure
to repay such CDBG 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 7 YEARS FROM THE DATE
OF TERMINATION.
10.9.2 Agency may terminate this Contract if City does not provide the CDBG Funds
substantially in accordance with this Contract.
10.10 Termination for Convenience.
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 17
Guardianship Services, Inc. Rev. 09/29/2025
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
farth the reasons for such termination, the effective date, and in the case of partial termination, the
portion to be terminated. In the case of a partial termination, City may terminate the Contract in
its entirety if City determines in its sole discretion that the remaining portion of the Contract to be
performed or CDBG Funds to be spent will not accomplish the purposes for which the Contract
was made.
10.11 Dissolution of A�encv Terminates Contract.
This Contract shall terminate in the event Agency is dissolved or ceases to exist. In the
event of tennination under this Section, all CDBG Funds are subject to repayment and/or City may
exercise all of its remedies under this Contract.
10.12 Non-apnropriation 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 Funds including cash, interest payments from loans or otherwise, all outstanding
notes, mortgages or other security instruments, any accounts receivable attributable to the use of
the CDBG Funds, and any real or personal property owned by Agency that was improved with the
CDBG Funds shall automatically transfer to City or to such assignee as City may designate.
11. REPAYMENT OF CDBG FUNDS.
All CDBG 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 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
Funds is required of City, Agency agrees City may require that 10% of the CDBG 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
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 18
Guardianship Services, Inc. Rev. 09/29/2025
difficult to ascertain and may include an impact on City's CDBG grant or other federal grant funds,
in addition to the iinding 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 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
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 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 7 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,
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 Resnondeat 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 Agencv Propertv.
City shall under no circumstances be responsible for any property belonging to Agency, or
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 19
Guardianship Services, Inc. Rev. 09/29/2025
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 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 Explicitiv Reli�ious 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 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 Explicitiv 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 Funds and participation must be voluntary for clients of a CDBG-funded service.
14.4.3 Repuired Notices.
If Agency constitutes a Faith-based organization under 24 CFR Part 5.109, Agency must
provide all clients of a CDBG-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-funded program or activity. In addition, if a client or prospective client of a CDBG-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 Governin� Law.
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 20
Guardianship Services, Inc. Rev. 09/29/2025
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 A�reement 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 Headin�s for Reference Onlv. No Le�al Significance; Number
and Gender.
The paragraph headings contained herein are for convenience in reference to this Contract
and are not intended to define or to limit the scope of any provision of this Contract. When context
requires, singular nouns and pronouns include the plural and the masculine gender shall be deemed
to include the feminine or neuter and the neuter gender to include the masculine and feminine.
The words "include" and "including" whenever used herein shall be deemed to be followed by the
words "without limitation".
14.10 Comuliance 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
➢ 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
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 21
Guardianship Services, Inc. Rev. 09/29/2025
➢ 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 veri�cations of legal status of
its employees
➢ The Americans with Disabilities Act of 1990 (42 U.S.C. Sections 12101 et seq.), the
Architectural Barriers Act of 1968 as amended (42 U.S.C. Sections 4151 et seq.) and
the Uniform Federal Accessibility Standards, 24 CFR Part 40, Appendix A
➢ Regulations at 24 CFR Part 87 related to lobbying, including the requirement that
certifications and disclosures be obtained from all covered persons
➢ Drug Free Workplace Act of 1988 (41 U.S.C. Sections 701 et seq.) and 24 CFR Part
23, Subpart F
➢ Executive Order 12549 and 24 CFR Part 5.105(c) pertaining to restrictions on
participation by ineligible, debarred or suspended persons or entities
➢ Section 6002 of the Solid Waste Disposal Act, as amended by the Resource
Conservation and Recovery Act
➢ Guidelines of the Environmental Protection Agency at 40 CFR Part 247
➢ For contracts and subgrants for construction or repair, Copeland "Anti-Kickback" act
(18 U.S.C. 874) as supplemented in 29 CFR Part 5
➢ For construction contracts awarded by Agency in excess of $2,000, and in excess of
$2,500 for other contracts which involve the employment of inechanics 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
seg.) 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. ll 0-252 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.
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 22
Guardianship Services, Inc. Rev. 09/29/2025
➢ General Administrative, National, and Departmental Policy Requirements and Terms
for HUD's Financial Assistance Programs (2025), as referenced in the Notice of
Funding Opportunity (NOFO) for this award.
➢ Compliance with OMB requirements on the Unique Entity Identifier (UEI) and
SAM.gov registration, as well as reporting under 2 CFR Part 25 and Part 170.
➢ Adherence to all applicable requirements related to noncompliance and termination, as
described in 2 CFR §§ 200.339-200.340.
➢ Report suspected fraud, waste, and abuse to HUD and the Office of Inspector General
(OIG), and to inform employees of their protections under 41 U.S.C. § 4712.
14.11 urm � rc;r+,,,a v„�;,,,.+r .,,,a �,,,,,��.,,,,,,,,+ .,,,a �+�,,,�. �,.,,,,,,,,,;,, n,,,,,,,,+.,,,;+;,,n.
c�..+;,,,, � n„�,,;.,,,,,,,,,,+�
14.12 Prohibition A�ainst 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 durin� the Performance of This
Contract.
During the performance of this Contract Agency agrees to the following provision, and
will require that its contractors and subcontractors also comply with such provision by including
it in all contracts with its contractars:
[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
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 23
Guardianship Services, Inc. Rev. 09/29/2025
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 T�endor'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 T�endor's name� will, in all solicitations or
advertisements for employees placed by or on behalf of [Contractor's, Subcontractor's o�
Vendor's narne], 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, Subcont�actor'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 T�endor'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 Agencv's Contractors and the ADA.
In accordance with the provisions of the Americans With Disabilities Act of 1990
("ADA"), Agency warrants that it and any of its contractors will not unlawfully discriminate on
the basis of disability in the provision of services to the general public, nor in the availability, terms
and/or conditions of employment for applicants for employment with, or employees of, Agency or
any of its contractors. AGENCY WARRANTS IT WILL FULLY COMPLY WITH THE
ADA'S PROVISIONS AND ANY OTHER APPLICABLE FEDERAL, STATE AND
LOCAL LAWS CONCERNING DISABILITY AND WILL DEFEND, INDEMNIFY AND
HOLD CITY HARMLESS AGAINST ANY CLAIMS OR ALLEGATIONS ASSERTED BY
THIRD PARTIES, CONTRACTORS SUBCONTRACTORS, VENDORS OR AGENTS
AGAINST CITY ARISING OUT OF AGENCY'S AND/OR ITS CONTRACTORS',
SUBCONTRACTORS', VENDORS' OR AGENTS' OR THEIR RESPECTIVE
EMPLOYEES' ALLEGED FAILURE TO COMPLY WITH THE ABOVE-REFERENCED
LAWS CONCERNING DISABILITY DISCRIMINATION IN THE PERFORMANCE OF
THIS CONTRACT.
14.13 Conflicts of Interest and Violations of Criminal Law.
14.13.1 A�encv Safe�uards.
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 24
Guardianship Services, Inc. Rev. 09/29/2025
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 funds or who are in a position to participate in a decision-making
process or gain inside information with regard to these activities may utilize CDBG services, may
obtain a�nancial interest or benefit from a CDBG-assisted activity, or have an interest in any
contract, subcontract or agreement with respect thereto, or the proceeds thereunder, either for
themselves or those with whom they have family or business ties, during their tenure or for 1 year
thereafter.
14.13.2.1 Agency shall establish conflict of interest policies for federal awards
including the CDBG 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,
ar administration of a contract supported by a federal award if he or
she has a real or apparent conflict of interest. The standards of
conduct must provide for disciplinary actions to be applied for
violations of such standards by officers, employees, or agents of
Agency.
14.13.32 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.
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 25
Guardianship Services, Inc. Rev. 09/29/2025
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 Agencv 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.
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 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. To the extent applicable, Agency agrees to
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 26
Guardianship Services, Inc. Rev. 09/29/2025
comply with all City Ordinances, and all amendments or successor policies or ordinances thereto,
for 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 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 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
shall be void, and shall constitute a breach of this Contract.
14.17 Ri�ht 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-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
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 27
Guardianship Services, Inc. Rev. 09/29/2025
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 far 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 KIND OR
CHARACTER, WHETHER REAL OR ASSERTED, ARISING OUT OF OR IN
CONNECTION WITH THE EXECUTION, PERFORMANCE, ATTEMPTED
PERFORMANCE OR NONPERFORMANCE OF THIS CONTRACT AND/OR THE
OPERATIONS, ACTIVITIES AND SERVICES OF THE PROGRAM DESCRIBED
HEREIN, WHETHER OR NOT CAUSED IN WHOLE OR IN PART, BY ALLEGED
NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS
OR SUBCONTRACTORS OF CITY; AND AGENCY HEREBY ASSUMES ALL
LIASILITY 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,
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 28
Guardianship Services, Inc. Rev. 09/29/2025
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
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
$80,000.00 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 a111oss of CDBG Funds occasioned by such misconduct. To effectuate
such reimbursement, such fidelity coverage shall include a rider stating that reimbursement for
any loss or losses shall name the City as a Loss Payee.
Agency shall furnish to City in a timely manner, but not later than the Effective Date,
certificates of insurance as proof that it has secured and paid for policies of commercial insurance
as specified herein. If City has not received such certificates by the Effective Date, Agency shall
be in default of the Contract and City may, at its option, terminate the Contract.
Such insurance shall cover all insurable risks incident to or in connection with the
execution, performance, attempted performance or nonperformance of this Contract. Agency shall
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 29
Guardianship Services, Inc. Rev. 09/29/2025
maintain the following insurance coverage and limits:
Commercial General Liabilitv (CGL) Insurance
$ 500,000 each occurrence
$1,000,000 aggregate limit
Non-Profit Or�anization Liabilitv or Directors & Officers Liabilitv
$1,000,000 Each Occurrence
$1,000,000 Annual Aggregate Limit
Business Automobile Liabilitv Insurance
$1,000,000 each accident on a combined single-limit basis, or
$ 250,000 Property Damage
$ 500,000 Bodily Injury per person per occurrence
$2,000,000 Aggregate
Insurance policy shall be endorsed to cover "Any Auto", defined as autos owned, hired,
and non-owned. Pending availability of the above coverage and at the discretion of
City, the policy shall be the primary responding insurance policy versus a personal
auto insurance policy if or when in the course of Agency's business as contracted
herein.
Workers' Compensation Insurance
Part A: Statutory Limits
Part B: Employer's Liability
$100,000 each accident
$100,000 disease-each employee
$500,000 disease-policy limit
Note: Such insurance shall cover employees performing work on any and all projects
including but not limited to construction, demolition, and rehabilitation. Agency or its
contractors shall maintain coverages, if applicable. In the event the respective contractors
do not maintain coverage, Agency shall maintain the coverage on such contractor, if
applicable, for each applicable contract.
Additional Requirements
Such insurance amounts shall be revised upward at City's reasonable option and no more
frequently than once every 12 months, and Agency shall revise such amounts within 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.
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 30
Guardianship Services, Inc. Rev. 09/29/2025
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.
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
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 31
Guardianship Services, Inc. Rev. 09/29/2025
agreement, Agency shall complete and submit Standard Form-LLL, "Disclosure Form to
Report Lobbying," in accordance with its instructions.
This certification is a material representation of fact upon which reliance was placed when
this Contract was made or entered into. Submission of this certificate is a prerequisite for
making or entering into this Contract imposed by 31 U.S.C. Section 1352. Any person
who fails to file the required certification shall be subject to a civil penalty of not less than
$10,000.00 and not more than $100,000.00 for each such failure.
Agency shall require that the language of this certification be included in all subcontracts
or agreements involving the expenditure of federal funds.
19. LITIGATION AND CLAIMS.
Agency shall give City immediate notice in writing of any action, including any proceeding
before an administrative agency, filed against Agency in conjunction with this Contract or the
Program. Agency shall furnish immediately to City copies of all pertinent papers received by
Agency with respect to such action or claim. Agency shall provide a notice to City within 10 days
upon filing under any bankruptcy or financial insolvency provision of law.
20. NOTICE.
All notices required or permitted by this Contract must be in writing and are deemed
delivered on the earlier date of the date actually received or the third day following deposit in a
United States Postal Service post office or receptacle; with proper postage, certified mail return
receipt requested; and addressed to the other Party at the address set out below or at such other
address as the receiving Party designates by proper notice to the sending Party.
City
City Attorney's Office
100 Fort Worth Trail
Fort Worth, TX 76102
Telephone: 817-392-7600
Copv to:
Neighborhood Services Department
100 Fort Worth Trail
Fart Worth, TX 76102
Attention: Kacey Thomas
Telephone: 817-392-7540
Copv to:
Neighborhood Services Department
100 Fort Worth Trail
Fort Worth, TX 76102
Attention: Jaylon Scott
Telephone: 817-392-5118
AgencV:
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 32
Guardianship Services, Inc. Rev. 09/29/2025
Agency Name: Guardianship Services, Inc.
Contact: Lyn Scott
Address: 1125 College Avenue
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.
24. PROHIBITION ON CONTRACTING WITH COMPANIES 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 COMPANIES
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.
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 33
Guardianship Services, Inc. Rev. 09/29/2025
26. PROHIBITION ON DISCRIMINATION AGAINST FIREARM AND
AMMUNITION INDUSTRIES
Agency acknowledges that except as otherwise provided by Chapter 2274 of the Texas
Government Code, as added by Acts 2021, 87th Leg., R.S., S.B. 19, § 1, the Agency 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.
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.
[SIGNATURES APPEAR ON NEXT PAGE]
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 34
Guardianship Services, Inc. Rev. 09/29/2025
IN WITNESS WHEREOF, the Parties hereto have executed this Contract in Fort Worth,
Tarrant County, Texas.
ooF`FONTn��
oo �ad
ATTEST: ''� �'�°
p�e °o..o
� .�<� °e»�:=a
����� da� �EX�sqaa
Jannette Goodall
City Secretary
CITY OF FORT WORTH:
7zr' ,, .� �GG
na„aR��.gh��re��,��mFia�= rcr)
Dana Burghdoff
Assistant City Manager
M&C: 25-0676
Date: August 12, 2025
1295 Certification No. 2025-1262955
RECOMMENDED BY:
�,-����`�
Kacey Thomas
Neighborhood Services Director
APPROVED AS TO FORM AND LEGALITY:
so�Gcr'e Ma�l�ewJ
Sophie Mathews
Assistant City Attorney
CONTRACT COMPLIANCE ADMINISTRATOR:
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
i�i7 � �'ce�t
Jaylon Scott, Neighborhood Development Specialist
GUARDIANSHIP SERVICES, INC.
,� y� �ce�t
0
Lyn Scott, CEO
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026
Guardianship Services,Inc.
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Page 35
Rev. 09/29/2025
EXHIBITS:
EXHIBIT "A" —Program Summary
EXHIBIT "A-1" — 2025 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 Bene�ciary Rights
EXHIBIT "J" — Conflict of Interest Disclosure Form
EXHIBIT "K" — Certificate of Compliance: Additional Program-Specific Policy
Requirements
CDBG PRESUMED BENEFIT PSA CONTRACT 2025-2026 Page 36
Guardianship Services, Inc. Rev. 09/29/2025
Guardianship Services, Inc. (GSI)
Prevention of Elder Financial Exploitation
PROGRAM SUMMARY
Community Development Block Grant
(CDBG)
October 1, 2025 to September 30, 2026
PERIOD
Capitalized terms not defined herein shall have meanings assigned them in the Contract.
PROGRAM:
$80,000
AMOUNT
Guardianship Services, Inc. (GSI) is committed to assisting Fort Worth residents who are 62 years of age
and older in aging in place, achieving financial stability, and protecting them from fraud and exploitation.
GSI's Money Smart + program, formerly known as Financial Exploitation Prevention Workshops,
employs evidence-based Money Smart for Older Adults curriculum to empower seniors with the
knowledge and skills to avoid financial exploitation while effectively managing their limited incomes.
These workshops have been instrumental in educating and supporting older residents, particularly those in
low-income neighborhoods. In FY2023-2024, GSI expanded the program to introduce the E3 (Educate �
Engage I Enroll) initiative. This initiative aims to increase enrollment in public benefit programs that can
save seniors thousands of dollars annually and enhancing their financial stability. Money Smart +
combines ongoing financial education with benefits eligibility services, ensuring that seniors can access
healthcare and improve their financial well-being. As the program evolves, it continues to empower older
residents, reducing the risks they face while aging in place and addressing critical financial concerns in
partnership with the community.
Individuals requiring extensive assistance will be referred to partnering agencies or GSPs money
management program for case management. All training materials and workbooks for each participant
will be provided to them. Participants will be given a pretest at entry and post-test at program exit.
CDBG funds will be used to pay for a percentage of salaries for 5 program employees.
Agency's ofiice is located at 1125 College Avenue, Fort Worth, TX 76104 with operating hours of 8:00
a.m. to 5:00 p.m., Monday through Friday.
Program services will be available at the following locations:
Monday through Saturday from 8:00 a.m. — 5:00 p.m.
Location
Andrew Doc Session Center
Atatiana Carr-Jefferson Center
Casa de Esperanza Apartments
Catherine Booth Friendship House Residence
Evangeline Booth Friendship House
Chisholm Trail Community Center
Cobblestone Manor Senior Apartments
Como Community Center
Address
201 S. Sylvania Ave.
1201 E. Maddox Ave.
3804 Tanacross Drive
1901 E. Seminary Dr.
1909 E. Seminary Dr.
4936 McPherson Blvd.
8201 Sartain Dr.
4660 Horne St.
City/State/Zip
Fort Worth, TX 76111
Fort Worth, TX 76104
Fort Worth, TX 76137
Fort Worth, TX 76119
Fort Worth, TX 76119
Fort Worth, TX 76123
Fort Worth, TX 76120
Fort Worth, TX 76107
CDBG Presumed Benefit PSA CONTRACT 2025-2026 — EXHIBIT "A" — PROCRAM SUMMARY
Guardianship Services, Inc. (GSI)
EXHIBIT "A"
Page � 1
Cornerstone Assistance Network
Diamond Hill Community Center
Eugene McCray Senior Center
Fairview Retirement Community
Greenbriar Community Center
Handley Meadowbrook Community Center
Highland Hills Community Center
Jewish Family Services
MLK Communiry Center
North Tri-Ethnic Community Center
Northside Community Center
Silverstone Retirement Community
Southside Community Center
Thomas Place Community Center
Victory Forest Community Center
Worth Heights Community Center
Hanratty Place
Home Town at Matador Ranch
Linwood Square Apartment
Salvation Army Mabee Center
True Worth Place
Community Connections North Texas/Genesis
United Methodist Church
Friendship Group/Resource Connection
3500 Noble Ave.
1701 NE 36`'' St.
4932 Wilbarger St.
7832 Chapin Rd.
5200 Hemphill St.
6201 Beaty St.
1600 Glasgow Rd.
4900 Briarhaven Rd.
5565 Truman Dr.
2950 Roosevelt Ave.
1100 NW 18`" St.
2800 Broadmoor Dr.
959 E. Rosedale St.
4237 LaFayette Ave.
3427 Hemphill St.
3551 New York Ave.
800 South Jennings Av
8500 Crowley Rd.
3201 Sondra Dr.
1855 E. Lancaster Ave.
1513 E. Presidio St.
7635 S. Hulen St.
1100 Circle Dr
REGULATORY CLASSIFICATION:
IDIS Matrix Code(s) and Seroice Category: OSA Senior Services
Fort Worth, TX 761 ll
Fort Worth, TX 76106
Fort Worth, TX 76119
Fort Worth, TX 76ll6
Fort Worth, TX 76115
Fort Worth, TX 76112
Fort Worth, TX 76134
Fort Worth, TX 76109
Fort Worth, TX 76112
Fort Worth, TX 76106
Fort Worth, TX 76164
Fort Worth, TX 76116
Fort Worth, TX 76104
Fort Worth, TX 76107
Fort Worth, TX 76110
Fort Worth, TX 76110
Fort Worth, TX 76104
Fort Worth, TX 76134
Fort Worth, TX 76107
Fort Worth, TX 76103
Fort Worth, TX 76102
Fort Worth, TX 76133
Fort Worth, Texas 76119 �
National Objective Citation: LMC Low/Mod Limited Clientele 24 CFR 570.208(a) (2)
Regulatory Citation(s): 24 CFR 570.201(e)
Based on the nature of the service provided, Agency will maintain documentation that verifies that 100%
of clients served by the Program are Elderly Persons per the Presumed Benefit CDBG clientele categories
and therefore are at or below 80% of Area Median Income (AMI) as established or defined by the United
States Department of Housing and Urban Development (HiJD).
PROGRAM GOALS
Minimum Number of Fort Worth Clients to be Served: The Program must serve a minimum of 164
Unduplicated Clients from Fort Worth as shown by the monthly reports on Attachment III-Client Data
Report.
OTHER AGENCY REOUIREMENTS:
Upon completion of the program year, GSI will submit with the final reimbursement request a summary
of client outcomes measured through attendance and demographic data from the Money Smart + program,
through enrollment in public benefit programs, biannual impact surveys, , and results from internal and
third-party research, and overall program effectiveness.
CDBG Presumed Benefit PSA CONTRACT 2025-2026 — EXHIBIT "A" — PROCRAM SUMMARY
Guardianship Services, Inc. (GSI)
Page � 2
EXHIBIT "A-1"
2025 HUD INCOME LIMITS
AMI
30%
50%
80 %
1 person 2 people 3 people
$22,400 $25,600 $28,800
$37,350 $42,700 $48,050
$59,750 $68,300 $76,850
4 people
$32,200
$53,350
$85,350
5 people
$34,600
$57,650
$92,200
*Income limits are published at least annually by HUD.
6 people
$37,150
$61,900
$99,050
7 people
$39,700
$66,200
$105,850
8 people
$42,250
$70,450
$112,700
Effective 6/01/2025
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 far 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.
January 15, 2026 October 1, 2025 —
December 31, 2025
April 15, 2026 January 1, 2026 —
March 30, 2026
July 15, 2026 April 1, 2026 —
June 30, 2026
October 1, 2026 �uly 1, 2026 —
September 30, 2026
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:
Date:
CDBG PSA CONTRACT-- EXHIBIT "A-2"
REPORTING REQUIREMENTS FOR COUNTYWIDE AGENCIES
PROCRAM BUDGET
� � A - Other � B - Other � C - Other �
Grant Funds Funding Funding Funding
Account Reauested Sources Sources Sources Total Match Total
Elder Justice
PROGRAM PERSONNEL FW CCPD AAA Coalition
Salarics 1001 $ 8Q000.15 $ 49,202.46 $ 90,190.40 $ 29,879.03 $ 357,538.52 $ 606,810.56
�FICA 1002 $ - $ 5,067.84 $ 9,289.58 $ 3,077.53 $ 36,82634 $ 54,261.28
�Life/DisabiLityInsurance 1003 $ 553.46 $ 1,014.52 $ 336.10 $ 4,021.82 $ 5,925.90
�Health/DentalInsurance 1004 $ - $ 10,658.49 $ 19,537.51 $ 6,472.55 $ 77,451.85 $ 114,120.40
�Unemployment-State 1005 $ 946.71 $ 1,735.36 $ 574.91 $ 6,879.43 $ 10,136.41
�Worker'sCompensation 1006 $ 111.86 $ 205.04 $ 67.93 $ 812.83 $ 1,197.66
� Retirement 1007 $ -
Long Term Disability 1008 $ -
SUPPL[ES AND SERV[CES
O�ce/Program Supplies 2001 $ 706.88 $ 1,295.74 $ 429.26 $ 5,136.64 $ 7,568.52
�Postage 2002 $ 218.47 $ 400.47 $ 132.67 $ 1,587.56 $ 2,339.17
�Printing 2003 $ 72.82 $ 133.49 $ 44.22 $ 529.19 $ 779.72
Transportation 2004 $ - $ - $ - $ - $ -
MISCELLANEOUS
Contract I,abor (Ciry needs copy of contract
before expenses can bereimbursed) 3001 $ 280.19 $ 513.60 $ 170.15 $ 2,036.06 $ 3,000.00
�Food Supplies 3002 $ -
�Teaching Aids 3003 $ -
�Craft Supplies 3004 $ -
�Field Trip Expenses 3005 $ -
�Mileage 3006 $ 1,223.44 $ 2,242.62 $ 742.95 $ 8,89035 $ 13,09936
�Other Field Trip Expenses if Approved 3007 $ -
�Other (Office Equipment Rental) 3008 $ 640.85 $ 1,174.71 $ 389.17 $ 4,656.85 $ 6,861.57
�Other (Tech Supplics) 3009 $ 2,242.97 $ 4,1 I1.47 $ 1,362.08 $ 16,298.97 $ 24,015.50
Other(Outreach) 3010 $ 281.59 $ 516.16 $ 171.00 $ 2,046.19 $ 3,O14.93
FACILITY AND UT[LIT[ES
Telephone 4001 $ 915.25 $ 1,677.70 $ 555.80 $ 6,650.83 $ 9,799.57
�Electric 4002 $ 801.06 $ 1,468.38 $ 486.46 $ 5,821.06 $ 8,576.96
�Gas 4003 $ -
� Water and Wastewater 4004 $ -
�Solid WasteDisposal 4005 $ -
Rent (Ciry needs copy of lease before expenses
can be reimbursed) 4006 $ - $ 5,785.69 $ 10,605.45 $ 3,513.46 $ 42,042.79 $ 61,94739
�Cleaning Supplies 4007 $ -
�Repairs and Mainlenance 4008 $ 1,267.13 $ 2,322.72 $ 769.49 $ 9,207.86 $ 13,567.20
Grease Trap Seivice 4009 $ -
LEGAL, FINANCIAL AND INSURANCE
Fidelity Bond or Equivalent 5001 $ -
�Directors and Officers 5002 $ -
�General Commercial Liability 5003 $ - $ 953.99 $ 1,748.71 $ 57933 $ 6,93235 $ 10,21438
�Auto Insurance 10 buses 5004 $ -
�Umbrella Insurance 5005 $ -
�Accidcntlnsurance 5006 $ -
Propertylnsurance 5007 $ -
DIRECT ASSISTANCE
Other (Specify): Technology and Professional
Services 6001 $ 6,991.81 $ 12,81632 $ 4,245.90 $ 50,807.27 $ 74,861.30
�
�BUDGET TOTAL $ 80,000.15 $ 88,922.97 $ 162,999.94 � 53,999.98 $ 646,174.75 $ 1,032,097.79
Fort Worth CDBG
FUNDING A: Fort Worth CCPD
FUNllING B: Area Agency on Aging
FUNDING C: Elder Justice Coalition
Other
$ 80,000.00
$ 88,923.00
$ 80,000.00 $ 88,923.00 $ 163,000.00 $ 54,000.00
$ 163,000.00
$ 54,000.00
$ 80,000.00
$ 88,923.00
$ 163,000.00
$ 54,000.00
$ 646,175.00 $ 646,175.00
$ 646,175.00 $ 1,032,098.00
CDBG 51% PSA CONTRACT 2025-2026 - EXH[B[T "B" - BUDGET
Guardianship Services, Ina (GS�. 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 far 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 May 31, 2025.
SALARY DETAIL-PROGRAM PERSONNEL
Est. Percent to
Position Title Annual Salary Grant
Community Outreach and Engagement Manager $ 53,966.85 25.00% $
Money Management Program Administrator $ 64,272.00 50.00% $
Money Management Account Manager (.8 FTE) $ 51,418.00 8.73% $
Director of Accounting & Administration $ 91,797.72 12.50% $
CEO $ 147,259.11 12.50% $
TOTAL
FICA
Life/Disability Insurance
Health/Dental Insurance
Unemployment-State
Worker's Compensation
Retirement
Long Term Disability
TOTAL
$ 31,266.60
19.6% $
Est. Percent to
Grant
0.0% $
0.0%
0.0% $
Amount to
Grant
13,492.00
32,136.00
4,490.00
11,475.00
18,407.00
80,000.00
Amount to
Grant
SUPPLIES AND SERVICES
Ofiice/Program Supplies
Postage
Printing
Transportation
TOTAL
$ 408,713.68
FRINGE DETAIL-PROGRAM PERSONNEL
Percent of Payroll Amount
7.65% $ 31,266.60
Est. Percent to Amount to
Total Budget Grant Grant
$ - 0.0% $ -
CDBG 51% PSA CONTRACT 2025-2026 - EXHIBIT "B" - BUDGET
Guardianship Services, Ina (GSI) Page 1
Est. Percent to Amount to
Total Budget Grant Grant
Contract Labor
Food Supplies
Teaching Aids
Craft Supplies
Field Trip Expenses
Mileage
Other Field Trip Expenses if Approved
Other (Office Equipment Rental)
Other (Tech Supplies)
Other (Outreach)
TOTAL
Telephone
Electric
Gas
Water and Wastewater
Solid Waste Disposal
Rent
Cleaning Supplies
Other(Repairs and Maintenance)
Grease Trap Service
TOTAL
Fideliry Bond or Equivalent
Directors and Officers
General Commercial Liability
Auto Insurance 10 buses
Umbrella Insurance
AccidentInsurance
Property Insurance
TOTAL
OtherQ
� TOTAL
$ - 0.0% $ -
$ - 0.0% $ -
DIRECT ASSISTANCE
Est. Percent to Amount to
Total Budget Grant Grant
CDBG 51% PSA CONTRACT 2025-2026 - EXHIBIT "B" - BUDGET
Guardianship Services, Ina (GSI)
$ - 0.0% $ -
FACILITY AND UTILITIES
Est. Percent to Amount to
Total Budget Grant Grant
$ - 0.0% $ -
$ - 0.0% $ -
LEGAL, FINANCIAL AND INSURANCE
Est. Percent to Amount to
Total Budget Grant Grant
� $ 439,980.28 �
18.2%� $ 80,000.00 �
Page 2
EXHIBIT "C"
AUDIT CERTIFICATION FORM
PSA CONTRACT - EXHIBIT "C" - AUDIT
CERTIFICATION FORM --
AUDIT CERTIFICATION FORM AND AUDIT REQUIREMENTS
Agency:
Fiscal Year Ending: September 30, 2026
� 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 fiznds 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)
Federal Ezpenditure Disclosure
MUST be filled out if Single Audit or Program Audit is NOT required.
Pass Through Program Name & Contract
Federal Grantor Grantor CFDA Number Number Expenditures
IU.S. Dept of Housing 8 Urban Development City of Fort Worth 14.218
IU.S. Dept of Health 8 Human Services Area Agenty on Aging of Tarrent Counly 93.044
IThe Health 8 Human Servirss Commission 93.667
IThe American Rescue Plan Act Tarrant County 21.027
I
�
8�,�00
163,000
H H S001313900004 173,400
M21-DP480200 70,000
� Total Federal Expenditures for this Fiscal Year: aas,aoo
� � � �/ �/�
� � Sign�tory and Title ` � Dat�e
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 2
EXHIBIT "D"
REIMBURSEMENT FORMS
Exhibit D
Attachment I- Request Summary
Agency:
Address:
City, State, Zip:
Pro�ram:
Month of Service:
Tax ID Number:
Contract Number:
Case [D:
P.O. Number:
FID Number:
IDIS Number:
Program Account Amount
Original Amount This Invoice Cumulative to Date Remaining Balance
Salarics 1001 $ - $ - $ - $ -
F1CA 1002 $ - $ - $ - $ -
Life/Disabiliry Insurance 1003 $ - $ - $ - $ -
Health/Dentallnsurance 1004 $ - $ - $ - $ -
Unemployment-State 1005 $ - $ - $ - $ -
Worker's Compensation 1006 $ - S - $ - $ -
Office Supplies 1007 $ - $ - $ - $ -
Food Supplies 1008 $ - $ - $ - $ -
Insurance 1009 $ - $ - $ - $ -
Accounting 1010 $ - $ - $ - $ -
Contract Labor 1011 $ - $ - $ - $ -
TOTAL $ - � - S - $ -
Client Goals
Oct-25
0
0
Goal Amount
Nov-25
0
0
Cumulative Total
0
Dec-25
0
Jun-26
0
Goal Met %
�'DIV/0!
Jan-26
0
Jul-26
0
Feb-26
0
0
Mar-26
0
0
ATTACHMENTII
Cih of Fort W'orfh
Neighborhood Services Department
Ezpenditure Worksheet
A�ency:
i��ct ,.
� 3
� �
� 5
� �
� 7
� K
� y
� ]0
� 11
� 12
� 13
� 14
� 15
� 16
� 17
� 18
� 19
� 20
� 21
� 22
� 23
� 24
I 25
� 26
� 27
� 28
� 29
� 30
� 31
� 32
� 33
� 34
� 35
� 36
� 37
� 38
� 39
� 40
� 41
� 42
� 43
� 44
� 45
� 4G
� 47
� 4kf
� 49
� 50
� Tota(
'For Saleiics, s�aic cmployccB iiilc undcr Dcsciiption/Job Ti�lc. Rcni must idcni'y trnan�
Only AiChliChtcd codes can be reimburecd
Expcnsc Linc ltcm
Accoun[
PROGRAM PERSON\EL
Salancs I 001
� YICA 1002 I
� I.i(c/IJieebility lnsurancc 1003 I
� Heal�h/Deutal Lnsu�ance 1004 �
� Unemplo\�nenaState 1005 �
� Workci's �`omncnsetion 1006 I
Retirement 1007
SUPPLIES AND SERVICES
Olilcc/f'roqram Suppliu 2001
� Postarc 2002 I
� Pr�nline 2003 I
Olher(CAseWorthy, Phones, Cornpulcrs) ?00�
VIISCELLANEOUS
ContracfLabor/YERMITS 3001
Food Supplics 3002
� lezchine Aids 3003 I
� Ciafl Supplics 3004 I
� F�eld Tnp Y,xpe�ses 3005 I
� Mfleaqe 3006
30U7
Other(MATERIALS) 3008
FACIWTY AND UTILITIES
ielcphonc 4001
� Elcciric 4002 �
� Gas 4003 �
� WaicrandWastcwatcr 4004 �
� Solid WasteD�sposal 4005 �
� Rent 4006 �
� Clcaning Supplies 4007 �
011ier(Custodial Services, Repa�rs. Use 4008
LEGAL, FINANCIAL, AND INSURANCL
FideliryBondorEy,uivalent 5001
� Dircciore and Oficcrs 5002 I
� General Commercial Liability 5003 �
O�icrpDC.lntcipiroietion� 5004
DIRECl' ASSISTANCE
Other(�I�[aini�g,T�znsportntion) 6001
�
!, 6 6 � d ! 6 6 S S / i / � d � 6 6 S S /� d
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
TOTAL NUMBER OF FAMILY MEMBERS
Total Gross Annual Household 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 HAWATIAN/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 iS, SECTION lOOl 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.
For use by Agency staff only-----------------
Household Size:
Applicable Income Limit:
Phone #:
Household Members and Income
(including applicant)
Age Monthly Source of Income
Income $$
Gross Annual Income:
Is Applicant Eligible?
Check if Applicant refused to provide demographic information: ❑
Staff Assessment of Demographics:
Person Making Determination:
Date:
NOTE: Address, income amounts and sources for ALL household members are required.
PSA Contract 2025-2026 Page 2
Ciudad de Fort Worth
AUTOCERTIFICACION DE DECLARACION DE INGRESOS
Nombre del Solicitante:
Direccion de Actualidad:
Ciudad y Codigo Postal:
Apellido
Telefono:
Miembros Del Ho�ar e In�resos
"Incluyendo eUla Solicitante)
Nombre Edad Ingreso Origen de Ingresos
Mensual
* TOTAL NUMERO DE MIEMBROS DEL HOGAR
(Incluyase Usted.)
Total Anual de Ingresos del hogar:
**INFORMAC16N 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. �ES 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 lOOl DEL CODIGO DE LOS ESTADOS UNIDOS INDICA QUE UNA
PERSONA ES CULPABLE DE UN DEL1T0 POR SABER Y VOLUNTARIAMENTE HACER DECLARACIONES FALSOS O
FRAUDULENTAS A CUALQUIER DEPARTAMENTO DE GOBIERNO DE LOS ESTADOS UNIDOS.
-PaNa use de empleados de la agencia-----------------
# De Miembros de Familia:
Limite de Ingreso:
Ingreso Anual:
�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 direccion de la casa y los ingresos (y sus origenes) para todos los miembros del hogar, es requerida.
PSA Contract 2025-2026 Page 3
EXHIBIT "F"
STANDARDS OF DOCUMENTATION
CDBG 51 % PSA CONTRACT -- EXHIBIT "F" -- STANDARDS OF DOCUMENTATION
2025-26 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.
Salaries
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.
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.
� FICAIMedicare X X X
� Life Insurance X X X
Health x x x
Insurance
Disability x x x
Insurance
Unemployment X X X
Insurance
*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.
If the City pays gross salary, this is already included. If the City pays the employer portion, the Agency must provide proof that the
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.
If the City pays gross saiary, this is already included. If the City pays the employer portion, the Agency must provide proof that the
Retirement x x x employee is enrolled in the benefit plan, must show a calculation and documentation of how the invoiced amount was calculated, and
must provide documentation showing payment. Invoice and proof of payment are only required with the first reimbursement request and
at any time there are changes to amounts, enrollments, disenrollments, etc.
Materials, Equipment, Goods and Supplies - City will only reimburse for the cost allocated percent or amount spent in support of the CDBG-funded Program. Agencies
requesting reimbursement for these items will require prior City approval. Agencies must show calculation on how the CDBG portion of these expenses were calculated
consistently with the CDBG Contract.
Office Supplies X X X
Office
Equipment X X X X X
Rental
Postage X X X
Printinq X X X
Construction &
Building X X X X This category is only available for the REACH Program and Habitat for Humanity.
Materials
Sport and
Recreation X X X
Equipment
Cleaning X X X
Supplies
Teaching Aids X X X
I Craft Supplies X 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 X X
I Gas X X
Water/Wastew X X
ater
I Electric X X,
I Solid Waste X �
CDBG 51 % PSA CONTRACT 20252026 Exhibi[ "F" — STANDARDS FOR COMPLETE DOCUMENTATION
Facility This item requires approval by the City prior to the execution of the CDBG Contract. Repairs may be categorized as major/minor
Maintenance X X X X rehabilitation projects and must be approved through the full HUD Environmetal Review.
and Repairs
Rent X X X City will pay for a portion of the rent for the Program facility so long as its in proportion to the square footage attributable to the CDBG-
funded program.
Miscellaneous I
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 iYs 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 1,2025: payments or Expenses must be documented in the following manner:
A) Image of the check AND bank statement showing the check cleared the bank; OR,
B) Image of the cancelled check (ex. At end of bank statement); OR,
C) Payroll Check Stub, "Advice", or Statement AND Bank Statement indicating payroll; OR,
D) For wire or e-transfers: Reciept or statement from payee/vendor OR bank statement.
Revised as of 09/29/2025 MT
CDBG 51 % PSA CONTRACT 2025-2026 Exhibil "F"— STANDARDS FOR COMPLETE DOCUMENTATION
EXffiBIT "G"
SEVERELY DISABLED CERTIFICATION FORM
CDBG 51 % PSA CONTRACT - EXHIBIT "G" - SEVERELY DISABLED CERTTFICATION FORM
CERTIFICATION FORM
DOCUMENTING CLIENT STATUS AS "SEVERELY DISABLED ADULT"
Client Name:
Address:
City, State, Zip
Client Identiiication 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 deiinition 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 Developmeot OMB Approval No.: 2577-0088 OMB
Approval No.: 2502-0355
Public reporting burden for this collection of infonnation 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
infom�ation 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.
P.xecutive Orders dated July 14, 19R3, directs the Minoriry 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 activides against
the totaL prograin activity and the designated inii�ority business enterprise (MBE) goals. The Deparhnent reqnires the infonnation to provide guidance and oversight for prograins fo� the developinent of minoriry business enterprise co�cerning Minority Business Development. If the information is
not eollected 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 Uie Information requested in this fonn 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 conseM, except as required or permitted by Law.
7. Grantee/Project Owner/Developer/SponsorBuilder/Agency
Checkif: 2� Location(City,StatcZip Codc)
PH
IH
CPD
Housing
3a. Name ofCon[act Nerson 36. Phone Number pncluding Area Code) 4. Reporting Period 5. Nrograin Code (No[applicable for CND programs.) � 6. Date Submiucd to Cicld O�ec
See explanntion ofCodes at bottom of Page Use a
❑ Oct I- Sept. 30 (Anntrl -F� sepaiate sheer For each progrem code.
Conhac[or or
Granl/Projcct numbc� or HUD Subcontraclor
Case Number or other Amounc of Type of Trade Bus .. Subcontracmr ContraetodSubcontractor Name a��d Address
idcnlificationoCpropcny. Conuzctor Codc Racial/I[ihnic WomanOmmcdRusiness VrimcConiroctorlAcmifcation(ID) IdcmificaiionpD) 'j.
subdfvfrSon, dwcllfng unil, elc. Subcantuct (Scc bdo�s) (Scc hdo�v) (Ycs orNo) Sumbcr SCC. 3 Sumbcr SCC. 3
7a. 76. 7c. 7d. 7e. 7f. 7g. 7h 71.
� Name Sh�et City
7c Type nf Trade Cndes:
CPD: Housing/Public Housiug:
I �cwConslruciion 1=NewConstruction 6 Profcssional
2— Cducaliod/Tcaining �= Subs[antial Rehab. 7= 7'cnanl Scn Iccs
3=0ther }=Rcpair 8=L;duca[ion/"fraining
4 Service 9=AmhJEngrg.Apprau�d
5— Proi�� Manrzt. 0= Other
7d: Racial/Ethnic Codes:
I — \Nhilc Amcricans
2 = Black Americans
3 — Nntive Amencnns
4 = H ispanic Amcncans
5 Asfan/Pacific Ameucans
b — I Iasidic Jews
5: Program Cudes (Cumplete for Huusing and Public and Indian Huusing programs unly):
1— All Insurcd, inclucLing Scclion8 5— Scction 202
2= Flexible Subsidy 6= HUD-Held (Management)
3=Sec[ionBNoninsured,Non-HYI>� 7=Vublic/InJinHousing
4=lns�rod (Managcmcn[) 8=Scc[ion 81 I
State Zip
Prcvious cAitions acc obsolac. focm HUD-2516 (8/98)
EXHIBIT "J"
CONFLICT OF INTEREST DISCLOSURE:
FOR CITY OF FORT WORTH PROGRAMS ONLY
CDBG 51% PSA CONTRACT -- EXHIBIT "J" -- CONFLICT OF INTEREST DISCLOSURE
F���r ����x
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.
NAME:
TELEPHONE:
ADDRESS:
E-MAIL ADDRESS (if applicable)
L Are you employed by the City of Fort Worth?
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?
2a. If yes, by which Department and Division:
I❑YES ��NO
� n YES � NO
3. Are any members of your immediate family currently employed by the City of Fort Worth?
(`7mmedia[e Family"includes (whether by blood or adoption): the spouse, parent (including a stepparent), � j�ES ❑ NO
child (including a stepchild), brother, sister (incl�uding 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? � �
4a. 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? I YES � NO
Sa. 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? � �
6a. If yes, please provide relative's name(s), Department(s), and Division(s):
CeNtifcation: 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 IH, SECTION IOOI 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
-------------------------------------- --------------------------- --------------------------- ---
For_City_Staff Only: Once this farm 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 charlettamoaning�fortworthtexas.gov.
Neighborhood Services Department-Conflict Disclosure Form, Dated September 23, 2024-City Only
EXHIBIT "K"
CERTIFICATE OF COMPLIANCE:
ADDITIONAL POLICY REQUIREMENTS
CERTIFICATE OF COMPLIANCE:
ADDITIONAL POLICY REQUIREMENTS
The terms and conditions set forth in EXHIBIT "K" — Certificate of Compliance: Additional
Policy Requirements aze hereby incorporated by reference into this Contract and shall be binding
upon the Agency. The Agency shall comply with all applicable provisions of EXHIBIT "K" —
Certi6cate of Compliance: Additiooal Program-Specific Policy Requirements as if fully
stated herein.
In addition to all applicable federal statutes and regulations, the Subrecipient certifies that it has
read and agrees to comply with the following policy requirements, if applicable, established under
the federal award agreement between the Department of Housing and Urban Development and the
City of Fort Worth, and which are a material condition of this Agreement.:
1. Prohibition on Use of Funds to Promote Gender ldeology
Grant funds awarded un@er this Contract shall not be used to promote "gender ideology,"
as defined in Executive Order 14168, Defending Women from Gender ldeology Extremism
and Restoring Biological Truth to the Federal Government.
2. Materiality of Compliance with Federal Anti-Discrimination Laws
Agency acknowledges that its compliance in all respects with all applicable Federal anti-
discrimination laws is material to the U.S. Government's payment decisions within the
meaning of 31 U.S.C. § 3729(b)(4).
3. Certification of Compliance with Anti-Discrimination Laws
Agency certifies that it does not operate, and will not operate, any program or activity in
violation of any applicable Federal anti-discrimination laws, including but not limited to
Title VI of the Civil Rights Act of 1964 (42 U.S.C. § 2000d et seq.).
4. Prohibition on Use of Funds for Elective Abortions
Agency shall not use any federal grant funds to fund or promote elective abortions, as
required by Executive Order 14182, Enforcing the Hyde Amendment and any applicable
appropriations laws.
5. Revocation of Prior Executive Orders
Notwithstanding anything in the Notice of Funding Opportunity (NOFO), grant
application, or related guidance, this Contract shall not be govemed by Executive Orders
that have been revoked by Executive Order 14154, including Executive Order 14008, nor
by any NOFO provisions that were based on such revoked Executive Orders.
6. Compliance with Immigration Restrictions under PRWORA
Agency must administer all aspects of this grant in compliance with the eligibility and
verification requirements of Title IV of the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996 (PRWORA), as amended (8 U.S.C. §§ 1601-1646), as well as
any related requirements established by HL1D, the Attorney General, or the U.S.
Citizenship and Immigration Services pursuant to PRWORA, Executive Order 14218, or
other applicable federal immigration laws or executive orders, except that the verifcation
requirements do not apply if the Agency is a nonprofit charitable organization deemed
exempt under 8 U.S.C. § 1642(d). .
7. Prohibition on Use of Funds to Promote Illegal Immigration
Agency shall not use funds in any way that, by design or effect, facilitates the subsidization
or promotion of illegal immigration, or shields illegal aliens from deportation, including
through policies or practices that materially impede the enforcement of federal immigration
laws.
8. Use of SAVE for Immigration Status Verification
Agency shall use the Systematic Alien Verifcation for Entitlements (SAVE) program, or
another Federal government-approved verification system, to ensure that no Federal public
benefit is provided under this grant to any individual who is ineligible due to unlawful
immigration status.
9. Equal Treatment of Faith-Based Organizations
Faith-based organizations may participate as subrecipients on the same basis as any other
eligible organization and shall not be discriminated against any organization on the basis
of religious character, affiliation, or religious exercise.
Certification and Acknowledgement
This certification shall be deemed incorporated by reference into the main Contract. By signing
below, the Agency hereby certifies, acknowledges, and agrees that:
• Agency has read and understands all terms and conditions set forth in this EXHBIT "K"
— CertiGcate of Compliance: Additional Program-Specific Policy Requirements;
• Agency shall comply with these requirements in both program practice and written policies
and procedures;
• Agency agrees to be in compiiance with these requirements is a material condition of this
Contract and a prerequisite to the receipt and continued use of grant funds; and
• Agency understands that any violation of these terms may result in the suspension or
termination of funding, repayment of funds, or other remedies available under law or
regulation.
Authorized Certific tion f�� /„ ,� ��, /' G� I�� •
Name of Agency: �� (,� �,{� { � N � !�(��� ✓ � �
Name of A o,F�ized O�cial: �_`7i����
Title: � �C� �
Signature: ���-
Date: i � �I�� I
�
M&C Review
CITY COUNCIL AGENDA
Create New From This M&C
DATE: 8/12/2025 REFERENCE NO.: M&C 25-0676 LOG NAME:
CODE: C TYPE: NON- PUBLIC
CONSENT HEARWG:
Page 1 of 5
Offlclal site of the City of Fort Worth, Texas
FJRT��ORTH
_�_
192025-2026 HUD
ANNUAL ACTION
PLAN
YES
SUBJECT: (ALL) Conduct Public Hearing and Approve the City of Fort Worth's 2025-2026 Annual
Action Plan for the Use of Federal Grant Funds in the Amount of $13,273,355.77 to be
Awarded by the United States Department of Housing and Urban Development from the
Community Development Block Grant, HOME Investment Partnerships Program,
Emergency Solutions Grant, and Housing Opportunities for Persons with AIDS Program,
Authorize Collection and Use of Program Income, Authorize Execution of Related
Contracts, Adopt Appropriation Ordinance, and Authorize Waiver of Indirect Costs
(PUBLIC HEARING - a. Staff Available for Questions: Juliet Moses; b. Public Comment c.
Council Action: Close Public Hearing and Act on M&C)
RECOMMENDATION:
It is recommended that City Council:
1. Conduct a public hearing to allow citizen input and consideration of the City's 2025-2026 Annual
Action Plan for use of federal grant funds to be awarded by the United States Department of
Housing and Urban Development in the amount of $13,273,355.77 for the Community
Development Block Grant, HOME Investment Partnerships Program, Emergency Solutions Grant,
and Housing Opportunities for Persons with AIDS grant programs;
2. Approve the City's 2025-2026 Annual Action Plan for submission to the United States Department
of Housing and Urban Development, including allocations of grant funds to particular programs
and activities as detailed below;
3. Authorize the collection and use of an estimated $30,000.00 of program income which is
expected to result from activities using prior years' Community Development Block Grant funds
for the City's Priority Repair Program;
4. Authorize the collection and use of an estimated $30,000.00 of program income which is
expected to result from activities using prior years' HOME Investment Partnerships Program grant
funds for the City's Homebuyer Assistance Program, and authorize the use of 10 percent of the
program income for administrative costs;
5. Authorize the City Manager or his designee to execute contracts for one-year terms with the
agencies listed in Tables 1, 2, and 3 below for Program Year 2025-2026 for Community
Development Block Grant, Emergency Solutions Grant, and Housing Opportunities for Persons
with AIDS grant funds, contingent upon receipt of funding, and satisfactory completion of all
federal regulatory requirements;
6. Adopt the attached appropriation ordinance increasing estimated receipts and appropriations in
the Grants Operating Federal Fund in the total amount of $13,273,355.77 consisting of
$7,116,438.00 in Community Development Block Grant funds, $2,814,431.77 in HOME
Investment Partnerships Program funds, $615,818.00 in Emergency Solutions Grant funds, and
$2,726,668.00 in Housing Opportunities for Persons with AIDS grant funds, all subject to receipt
of such funds; and
7. Authorize a waiver of the Neighborhood Services Department indirect cost of 21.05\%, estimated
total of $264,698.00.
DISCUSSION:
The City's 2025-2026 Annual Action Plan summarizes the major housing and community development
activities and proposed expenditures for the program year beginning October 1, 2025 and ending
http://apps.cfwnet.org/council_packet/mc_review.asp?ID=33536&councildate=8/12/2025 9/26/2025
M&C Review
Page 2 of 5
September 30, 2026 for use of federal grant funds totaling $13,273,355.77 from the United States
Department of Housing and Urban Development (HUD) from the Community Development Block Grant
(CDBG), HOME Investment Partnerships Program (HOME), Emergency Solutions Grant (ESG), and
Housing Opportunities for Persons with AIDS (HOPWA) grant programs, plus program income from the
CDBG and HOME grant programs totaling $60,000.00. It also summarizes the use of program income
resulting from activities using prior years' CDBG and HOME funds, the primary purpose of which is to
benefit low-and moderate-income persons in Fort Worth. ESG funds primarily benefit persons experiencing
homelessness, and HOPWA funds primarily benefit low-and moderate-income persons with HIV/AIDS.
A Request for Proposals from social service agencies and nonprofit organizations seeking grant funding
was published on January 15, 2025. All proposals were received on March 3, 2025. Staff reviewed all
proposals and developed recommendations for the allocation of estimated funding from HUD based on the
capacity of applicant organizations, grant experience, fiscal stability, and compliance with applicable
federal regulations. One public hearing was held on July 14, 2025, to provide citizens with the opportunity
to participate in the development of the Annual Action Plan. Recommendations for award amounts were
considered and adopted by the Community Development Council on June 11, 2025.
A 30-day public comment period was held from June 16, 2025, through July 16, 2025. Notice of this public
comment period was published in the Cleburne Times Review on June 10, 2025; in the Fort Worth Star
Telegram and Weatherford Democrat on June 11, 2025; and in La Vida News and the Wise County
Messenger on June 12, 2025.
Any comments received are maintained by the Neighborhood Services Department in accordance with
federal regulations. The City held two public hearings as a part of the HUD required citizen participation
process. The first public hearing was held by staff on July 14, 2025, and the second public hearing is
scheduled for the City Council Meeeting on August 12, 2025.
A summary of staff's final funding recommendations is provided below in Tables 1, 2, and 3. The 2025-
2026 Annual Action Plan will be submitted to HUD by August 15, 2025.
Indirect costs totaling approximately $264,698.00 could be charged to these grants, as the Neighborhood
Services Department indirect cost rate is 21.05\°/o in the City's most recent Cost Allocation Plan. A waiver
of these costs is requested to allow allocation of these funds to further support the programs and services
to assist low-to-moderate income citizens.
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)
For Program Year 2025-2026, it is recommended that the amount of $7,116,438.00 in CDBG funds and an
estimated amount of $30,000.00 in CDBG program income totaling $7,146,438.00 be allocated as follows:
Public Service Agencies -$1,067,465.00 (Limited to 15\% of the grant allocation): Includes social services
for low- and moderate income persons, persons with disabilities, and disadvantaged persons; Housing
Programs -$2,665,000.00: Includes funding for the City's Priority Repair Program, Cowtown Brush-Up, and
accessibility modifications for seniors and persons with disabilities; Major Projects -$1,000,685.00:
Includes funding for street improvements; Program Delivery -$960,000.00: Includes program delivery
costs for housing programs; Administration -$1,423,288.00 (Limited to 20\% of the grant allocation):
Includes costs for administering the CDBG grant; Estimated Program Income -$30,000.00: Includes up to
$30,000.00 in funding for the City's Priority Repair Program. Any CDBG program income over the
estimated amount not used for the Priority Repair Program will be allocated to priority activities in the City's
Consolidated Plan, subject to the City Council approval.
HOME INVESTMENT PARTNERSHIPS PROGRAM (HOME)
For Program Year 2025-2026, it is recommended that the amount of $2,814,431.77 in HOME funds and an
estimated amount of $30,000.00 in HOME program income totaling $2,844,431.77 be allocated as follows:
Homebuyer Assistance Program -$1,110,824.77: Includes funding for down payment and closing cost
assistance for low- and moderate-income homebuyers through the Fort Worth Community Land Trust, the
City of Fort Worth and Trinity Habitat for Humanity; Community Housing Development Organizations
(CHDOs) for affordable housing projects -$422,164.00: These funds will be used by Housing Channel for
the Mason Heights affordable housing development in southeast Fort Worth. Funds will be used for the
acquisition of land and the new construction of 236 units. An estimated 183 units (approximately 77\%) will
be sold to low to moderate income households at or below 80\% Area Median Income (AMI); Major
Projects -$1,000,000.00 allocated to Fort Worth Housing Solutions (FWHS) as a part of Phase Six of the
http://apps.cfwnet.org/council_packet/mc_review.asp?ID=33536&councildate=8/12/2025 9/26/2025
M&C Review
Page 3 of 5
Choice Neighborhood Initiative (CNI) grant benefiting low-moderate come residents in the Stop Six
Neighborhood of Fort Worth; Administration -$281,443.00 (Limited to 10\% of the grant allocation):
Includes costs for administering the HOME grant; Estimated Program Income -$30,000.00: Includes
funding for the Homebuyer Assistance Program and HOME grant administrative costs. HUD allows the City
to use 10 percent of any HOME program income towards the cost of administering the HOME grant.
HOME program income over the estimated amount not used for the Homebuyer Assistance Program will
be allocated to priority activities in the City's Consolidated Plan, subject to City Council approval.
HOUSING OPPORTUNITIES FOR PERSONS WITH AIDS (HOPWA)
For Program Year 2025-2026, it is recommended that the amount of $2,726,668.00 in HOPWA funds be
allocated as follows: Public Service Agencies -$1,670,868.00; Neighborhood Services Department -
$974,000.00; Administration -$81,800.00 (Limited to 3\°/a of the grant allocation)
EMERGENCY SOLUTIONS GRANT (ESG)
For Program Year 2025-2026, it is recommended that the amount of $615,818.00 in ESG funds to be
allocated as follows: Public Service Agencies -$569,632.00; Administration -$46,186.00 (Limited to 7.5\%
of the grant allocation)
CONTRACT RECOMMENDATIONS
The Community Development Council and Neighborhood Services Department staff recommend that
contracts be executed with the public service and subrecipient agencies listed below for the amounts
shown in the following tables:
Community Development Block Grant Contracts
AGENCY
Housing Channel
Meals-On-Wheels, Inc. of
Tarrant County
TABLE 1: CDBG AGENCIES
ICONSOLGOAL D PLAN I pROGRAM
IAffordable Housing IHousing Counseling &
Education
IHealthy Living and INutrition Program
Wellness
Guardianship Services Inc. Aging In Place
�United Community Centers, Inc IChildren and Youth
Services
�Boys & Girls Club of Greater IChildren and Youth
Tarrant County Services
IGirls Inc of Tarrant County IChildren and Youth
� Services
ICamp Fire First Texas IChildren and Youth
� Services
�Junior Achievement of the IChildren and Youth
Chisholm Trail, Inc. Services
�The Women's Center of Tarrant IEconomic Empowerment
County and Financial Resilience
IEaster Seals North Texas, Inc. IEconomic Empowerment
� and Financial Resilience
Money Smart+ Elder
Financial Fraud
Prevention Workshops
IEducation Literacy
Program
IYouth Development at
Eastside Branch
IWhole Girl Program
ITeens In Action
ICradle to Career
Initiative
IEmployment Solutions
IEmployment Services
AMOUNT
$111,000.00
$120,000.00
'�:1 111 11
$125,000.00
$72,000.00
$90,281.00
$62,184.00
$50,000.00
$90,000.00
$92,000.00
Homelessness
Presbyterian Night Shelter Prevention and Special Moving Home Program $175,000.00
Needs Support
�CDBG Public Services Agencies Total II$1,067,465.00I
http://apps.cfwnet.org/council_packet/mc_review.asp?ID=33536&councildate=8/12/2025 9/26/2025
M&C Review
**Rehabilitation, Education and Accessibility
Advocacy for Citizens with Improvements Project Ramp
Handicaps dba REACH, Inc.
**Fort Worth Area Habitat for Housing Preservation and
Humanity, Inc. DBA Trinity Rehabilitation Cowtown Brush Up
Habitat for Humanity
�CDBG Subrecipient Agencies Total
�TOTAL CDBG CONTRACTS
Page 4 of 5
$165,000.00
$500,000.00
� $665,000.00�
�$1,732,465.00�
**REACH and Trinity Habitat will be funded from the CDBG Housing Programs and Services budget.
Housing Opportunities for Persons with AIDS Contracts
TABLE 2: HOPWA AGENCIES
AGENCY CONSOLIDATED PLAN
GOAL
Tarrant County Homelessness Prevention
Samaritan Housing, and Special Needs
Inc. Support
AIDS Outreach
Center, Inc.
Homelessness Prevention
and Special Needs
Support
TOTAL HOPWA CONTRACTS
Emergency Solutions Grants Contracts
PROGRAM
HOPWA Program -
Administration, Tenant-
Based Rental Assistance
(TBRA), Short-Term
Rent, Mortgage, and
Utility Assistance
(STRMU), Supportive
Services, Facility-Based
Operations (FBO)
'The Housing Assistance
Program
- Administration, Tenant-
Based Rental Assistance
(TBRA), Short-Term
Rent, Mortgage, and
Utility Assistance
(STRMU), Supportive
Services
TABLE 3: ESG AGENCIES
AGENCY CONSOLIDATED PLAN pROGAM
GOAL
The Presbyterian Night Homelessness Prevention and Shelter
Shelter of Tarrant County, Special Needs Support Operations/Services
Inc.
Lighthouse for the Homelessness Prevention and Day Shelter
Homeless dba True Worth Special Needs Support Operations/Services
Place
IThe Salvation Army
�
�Center for Transforming
Lives
Homelessness Prevention and Homelessness
Special Needs Support Prevention
Homelessness Prevention and Rapid Re-Housing
Special Needs Support
�� ��
AMOUNT
$1,406,188.00
$264,680.00
$1,670,868.00�
AMOUNT
$139,491.00
$150,000.00
$127,141.00
$73,000.00
II $80,00O.00I
http://apps.cfwnet.org/council_packet/mc_review.asp?ID=33536&councildate=8/12/2025 9/26/2025
M&C Review
�SafeHaven of Tarrant Homelessness Prevention and Shelter
County Special Needs Support Operations/Services
�TOTAL ESG CONTRACTS
All figures have been rounded to the nearest dollar for presentation purposes.
Page 5 of 5
��$569,632.00�
Each of these grants are an entitlement grant rather than a competitive grant received from the United
States Department of Housing and Urban Development (HUD). Entitlement grants provide funds to
agencies based on a formula prescribed in legislation or regulation, rather than based on review. These
specific grants are allocated to the City of Fort Worth based on population size and per capita income each
year. The grants have been consistently awarded to the City since 1974 with the inception of the
Community Development Block Grant (CDBG) through the Housing and Community Development Act of
1974. The Emergency Shelter (renamed Solutions) Grant (ESG) was authorized in 1987 through the
McKinney-Vento Homelessness Assistance Act. The HOME Investment Partnerships Program (HOME)
and the Housing Opportunities for Persons with AIDS (HOPWA) Program were authorized through the
Cranston-Gonzales National Affordable Housing Act of 1990. With these grants, administrative and
program delivery allocations support approximately 90 FTE positions in the Neighborhood Services
Department, which is funded nearly 60\% with various grants including these entitlement grants.
Positions funded with HUD Entitlement grants are subject to grant availability. In the event of a grant award
being decreased or eliminated, the Neighborhood Services Department would review programs and
services funded by the grants and determine a level of service and staffing that aligns with the available
funding. Alternatives to consider may include staff and program reductions or eliminations.
The City of Fort Worth has certified that all programs receiving funding through the HOPWA, HOME, ESG,
and CDBG grants comply with applicable Executive Orders.
These programs are available in ALL COUNCIL DISTRICTS.
�6��_1��7:7Ji/_��[�PIL��:i�l�C�_��[�]`F
The Director of Finance certifies that upon approval of the above recommendations and adoption of the
attached appropriation ordinance, 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. These are reimbursement grants.
TO
Fund Department Account Project Program Activity Budget Reference # Amount
ID ID � Year (Chartfield 2)
FROM
Fund Department Account Project
ID , I ID
Submitted for Citv Manaqer's Office bv:
Program Activity Budget � Reference # Amount
Year (Chartfield 2)
Dana Burghdoff (8018)
Oriqinatinq Deaartment Head:
Additional Information Contact:
ATTACHMENTS
Kacey Bess (8187)
Juliet Moses (6203)
http://apps.cfwnet.org/council_packet/mc_review.asp?ID=33536&councildate=8/12/2025 9/26/2025
CERTIFICATE OF INTERESTED PARTIES
Complete Nos. 1- 4 and 6 if there are interested parties.
Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties.
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
Guardianship Services, Inc.
Fort Worth, TX United States
2 Name of governmental entity or state agency that is a party to the contract for which the form is
being filed.
Ciry of Fort worth
FORnn 1295
1 of 1
OFFICE USE ONLY
CERTIFICATION OF FILING
Certificate Number:
2025-1262955
Date Filed:
01/30/2025
Date Acknowledged:
g Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a
description of the services, goods, or other property to be provided under the contract.
NSD25-001
2025-2026 PSA RFP (CDBG)
4 Nature ofinterest
Name of Interested Party City, State, Country (place of business) (check applicable)
Controlling Intermediary
5 Check only if there is NO Interested Party. ❑
X
6 UNSWORN DECLA ATION
My name is �• �./ , and my date of birth is �` 1�� IS�
My address is �� I' /�`!� �� � D•
�'�� - ---/�! � ��C���S�
(street) (city) (state) (zip code) (country)
I declare under pen of perjury that the foregoing is true and correct.
Executed in `�� County, St te of —' `—` , on the�day o , 20�
(month) (year)
`�Sig1�t e authorized agent of contracting business entity
(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.bc.us Version V4.1.0.5dd2ace2
��RT�OI�TH��
City Secretary's Office
Contract Routing & Transmittal Slip
Contractor's Name
Guardianship Services, Inc.
Subject of the Agreement: This is a Public Service Agency contract between the Agency and the City
the agency has been awarded $80,000.00 in CDBG funds for their presumed benefit program to serve 164
unduplicated Fort Worth senior citizens from October 1, 2025 to September 30, 2026.
M&C Approved by the Council? * Yes ❑✓ No ❑
If so, the M&C must be attachecl to the cont�act.
Is this an Amendment to an Existing contract? Yes ❑ No ❑✓ N/A
If so, p�ovide the original contract nurnber and the amendment number.
Is the Contract "Permanent"? *Yes ❑ No 0
If unsuNe, see back page fo� permanent cont�^act listing.
Is this entire contract Confidentiial? *Yes ❑ No ❑✓ Ifonly specific info�mation is
Confidentzal, please list what information is Confidential and the page it is loeated.
N/A
Effective Date: 01 october 2025 Expiration Date: 3o September 2026
If �different from the approval date. If �applicable.
Is a 1295 Form required? * Yes ❑✓ No ❑
*If so, please ensure it is attached to the approving M&C or attached to the contract.
PrOjeCt Number: Ifapplicable. N�A
*Did you include a Text field on the contract to add the City Secretary Contract (CSC)
number? Yes ✓❑ No ❑
Contracts need to be routed for CSO nrocessin� in the followin� order:
1. Katherine Cenicola (Approver)
2. Jannette S. Goodall (Signer)
3. Allison Tidwell (Form Filler)
*Indicates the information is required and if the information is not provided, the contract will be
�eturned to the department.