HomeMy WebLinkAbout064638 - General - Contract - AIDS Outreach CenterCSC No. 64638
STATE OF TEXAS
COUNTY OF TARRANT
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This contract ("Contract") is made and entered into by and between the City of Fort Worth
(hereafter "City") and AIDS Outreach Center, Inc. (hereafter "Agency") a Texas non-profit
corporation. City and Agency may be referred to individually as a"Party" and jointly as "the
Parties".
The Parties state as follows:
WHEREAS, City receives grant monies from the United States Department of Housing
and Urban Development through the Housing Opportunities for Persons with AIDS Program
("HOPWA") Program, Program No. TX-H-25-F002, Catalog of Federal Domestic Assistance No.
14.241;
WHEREAS, the HOPWA program is intended to address the needs of eligible persons
associated with the challenge of living with HIV/AIDS and their families;
WHEREAS, Agency submitted a proposal to use HOPWA funds for an eligible program
under the HOPWA Regulations whereby Agency will provide services to low and moderate
mcome persons;
WHEREAS, City citizens, the Community Development Council, and the City Council
have determined that HOPWA programs are needed by the City's citizens;
NOW, THEREFORE, the Parties understand and agree as follows:
1. INCORPORATION OF RECITALS
City and Agency hereby agree that the recitals set forth above are true and correct and form
the basis upon which the Parties have entered into this Contract.
2. DEFINITIONS
In addition to terms defined in the body of this Contract, the terms set forth below shall
have the definitions ascribed to them as follows:
Area Median Income or AMI means the median family income for the Fort Worth-Arlington
metropolitan statistical area as established annually by HUD. The 2025 income limits are
attached hereto as EXHIBIT "A-1" — 2025 HUD Income Limits.
Complete Documentation means the following documentation as applicable:
• Attachments I, TI, and III within Exhibit "D", with supporting documentation
including:
OFFICIAL RECORD
HOPWA PSA CONTRACT 2025-2026
AIDS Outreach Center, Inc.
CITY SECRETARY
Page 1
Rev. 6-12-2024
FT. WORTH, TX
o Proof of expense: copies of timesheets, invoices, leases, service contracts,
utility bill and/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: Source Documentation sufficient to show that
clients participating in the Program are HOPWA Eligible Clients as
described in Section 6, EXHIBIT "E" —-Form of Income Self
Certification or a similar form approved by City, or 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.
DBE means disadvantaged business enterprise in accordance with 49 CFR Part 26.
Director means the Director of the City's Neighborhood Services Department.
Effective Date means October 1, 2025.
HOPWA means Housing Opportunities for Persons with AIDS.
HOPWA Eligible Client means a client whose annual income adjusted for family size does not
exceed 80% of AMI using the most current HUD Income Guidelines and Technical Guidance for
Determining Income and Allowances verified by Source Documentation. The client must also
have a documented diagnosis of HIV/AIDS.
HOPWA Funds means the HOPWA grant funds supplied by City to Agency under the terms of
this Contract.
HOPWA Regulations means regulations found at 24 CFR Part 574 et seq.
HUD means the United States Department of Housing and Urban Development.
IDIS means Integrated Disbursement Information System, HUD's project tracking system.
Neighborhood Services Department means the City's Neighborhood Services Department.
Neighborly Software means the Online database maintained by the City of Fort Worth through
which Agency is required to submit monthly reimbursement requests.
OMB means the Office of Management and Budget.
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AIDS Outreach Center, Inc. Rev. 6-12-2024
Program means the services described in EXHIBIT "A" — Program Summary.
Reimbursement Request means all reports and other documentation described in Section 9.
Resident Rent Payment means Except for persons in short-term supported housing, each
person receiving rental assistance under this program or residing in any rental housing assisted
under this program must pay as rent, including utilities, an amount which is the higher of:
(1) 30 percent of the family's monthly adjusted income;
(2) Ten percent of the family's monthly income;
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.
Supportive Services means health, mental health, assessment, permanent housing placement,
drug and alcohol abuse treatment and counseling, day care, personal assistance, nutritional
services, intensive care when required, and assistance in gaining access to local, State, and Federal
government benefits and services, except that health services may only be provided to individuals
with acquired immunodeficiency syndrome or related diseases and not to family members of these
individuals guided by CFR Part 574.300(b)(7).
Unduplicated Clients means a count of HOPWA Eligible Clients served at least once in the
Contract Term. HOPWA Eligible Clients served 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 (Contract Term) 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 the written mutual agreement of the Parties, if such extension is necessary far
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 HOPWA Funds.
City will provide up to $264,680.00 of HOPWA Funds under the terms and conditions of
this Contract.
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AIDS Outreach Center, Inc. Rev. 6-12-2024
4.2 Monitor.
City will monitor the activities and performance of Agency and any of its contractors,
subcontractars or vendors as necessary, but no less than annually. Monitoring by City will include
determining whether Agency is meeting the requirements of the HOPWA Regulations during the
term of this Contract.
5. DUTIES AND RESPONSIBILITIES OF AGENCY.
5.1 Required Services.
Agency shall perform the services described in EXHIBIT "A" — Program Summary in
accordance with the terms and conditions of this Contract.
5.2 Use of HOPWA Funds.
5.2.1. Compliance with HOPWA Regulations and Contract.
Agency shall be reimbursed for eligible Program costs with HOPWA Funds only if City
determines in its sole discretion that:
5.2.1.1 Costs are eligible expenditures in accordance with HOPWA
Regulations.
5.2.1.2 Costs are in compliance with this Contract and are reasonable and
consistent with industry norms.
5.2.1.3 Complete Documentation, as applicable, is submitted to City by
Agency.
5.2.2 Bud�et
5.2.2.1 The HOPWA Funds will be paid on a reimbursement basis in
accordance with EXHIBIT "B" - Budget.
5.2.2.2 During the term of this Contract, Agency may submit written requests
to increase or decrease line-item amounts in the Budget, including an
explanation of why such increases or decreases are necessary. All
requests shall be approved by Director in writing, with such approval
being in the Director'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 take effect on the first day of the
month following the month in which the Contract amendment is
executed, unless otherwise specified in the amendment. All requests
for Budget amendments must be submitted by June 30, 2026.
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AIDS Outreach Center, Inc. Rev. 6-12-2024
5.2.3 Chan�e in Program Budget.
5.2.3.1 Agency will notify City promptly of any additional funds it receives for
operation of the Program, and City reserves the right to amend this
Contract in such instances to ensure compliance with HUD regulations
governing cost allocation.
5.2.3.2 Agency agrees to utilize the HOPWA Funds to supplement rather than
supplant funds otherwise available for the Program.
5.2.4 Pavment of HOPWA Funds to A�encv.
HOPWA 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 HOPWA 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 HOPWA Funds
not spent or not 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:
% Unduplicated Clients
�� Served (as specified in
EXHIBIT "A" —
Month Expenditures Program Summary)
3 25% 25%
6 50% 50%
9 75% 75%
12 100% 100%
5.3.2 Failure of Agency to meet these milestones or a material deviation from them as
outlined in this Section 5.3 is a breach of this Contract. For the purpose of this Section, "material
deviation" shall mean more than 10% lower than the specified goal. In the event of such breach,
City reserves the right in its sole option to (i) delay or withhold payment of Reimbursement
Requests, (ii) lower Agency's allocation of or deobligate all HOPWA Funds, (iv) terminate this
Contract, or (v) any combination of the above options.
5.3.3 Failure to meet at least 80% of its performance milestone or serve 66
Unduplicated Clients under this Contract may, in City's sole discretion, disqualify Agency for
consideration under the City's Request for Proposals for the 2026-2027 Program Year for federal
grant funds.
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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 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 66 Unduplicated Clients stated
in Section 5.3.3.
5.4 Identifv Pro�ram Expenses Paid with HOPWA Funds.
Agency will keep accounts and records in such a manner that City may readily identify and
account for Program expenses reimbursed with HOPWA Funds. These records shall be made
available to City for audit purposes and shall be retained as required hereunder.
5.5 Program Subcontracts.
Agency shall not enter into a subcontract with another agency, contractor, or vendor to
provide a service to clients for any part of the Program that will be paid with HOPWA Funds
without City's written consent.
6. CLIENT ELIGIBILITY VERIFICATION.
6.1 Client Eligibilitv.
Agency will document the eligibility of all prospective clients. Agency may redact the
client's personal information and substitute a client number. Agency will document client
eligibility as follows:
6.1.1 Income.
Agency must verify all new and upon recertification client's income with either Source
Documentation or the form attached as EXHIBIT "E" — Certification of Income Form or a
similar form approved by City. Agency must use the annual income definition in 24 CFR Part
5.609 to establish client income eligibility and must use the most current HUD Income Guidelines.
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) and use 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).
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6.1.2 Diagnosis.
Agency must submit a signed, dated statement that the client's file contains documentation
of the client's diagnosis of HIV/AIDS. The HIV/AIDS diagnosis must be made by a licensed
health care provider; a client's self-certification of diagnosis is not sufficient. Agency should not
submit the actual diagnosis to City.
6.1.3 Emer�encv Need.
For clients receiving short term rental, mortgage or utility assistance, Agency must also
verify and document that the client has an emergency need, such as sudden loss of income,
eviction, utility shutoff, or extraordinary and uneXpected healthcare costs. Agency must submit
its policy regarding documenting emergency need to City by January 5,
2026
6.2 Submission of Complete Documentation.
Agency must submit copies of documentation of client eligibility described in Section 6.1
with Attachment III in each month's Reimbursement Request for all Unduplicated Clients.
6.3 Maintain Documentation.
Agency must maintain copies of all documentation required by Section 6 for 7 years
following the expiration of the Contract term. This Section shall survive the earlier terminations
or expirations of this Contract.
7. ADDITIONAL HOPWA REOUIREMENTS.
Agency agrees to comply with all requirements of the HOPWA Program as stated in the
HOPWA Regulations, including but not limited to the following:
7.1 Environmental Review.
HOPWA 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 HOPWA Funds it has already received and forfeit any future payments of HOPWA Funds.
7.2 Contract Not Constitutin� 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
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AIDS Outreach Center, Inc. Rev. 6-12-2024
by City of an authorization to use grant funds from HUD under 24 CFR Part 58, (ii) approval of
City's 2025 -2026 Action Plan, and (iii) receipt by City of grant agreement from HUD.
7.3 Monitorin�.
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 HOPWA Regulations for the term
of this Contract. Agency is subject to such monitoring during the term of this Contract and for 7
years after the Contract term ends. Agency will provide reports and access to Program files as
requested by City during this 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 HOPWA Funds, and to
Agency's officers, directors, agents, employees, contractors, subcontractors and vendors for the
purpose of such monitoring.
7.3.3 In addition to other provisions of this Contract regarding frequency of monitoring,
City reserves the right to perform desk reviews or on-site monitoring of Agency's compliance with
the terms and conditions of this Contract. City shall provide Agency with a written report of the
monitor's findings after each monitoring visit. If the monitoring report notes deficiencies in
Agency's performance, the report shall include requirements for the timely correction of said
deficiencies by Agency. Failure by Agency to take the action specified in the monitoring report
may be cause for suspension or termination of this Contract as provided herein.
7.3.4 Subsections 7.3.1 through 7.3.3 shall be applicable for the Contract term and for 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
provision 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 2 CFR Part 200.326.
7.4.1 Contracts in excess of $10,000.00 made by Agency using HOPWA 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 HOPWA Funds are not listed by SAM as being debarred, both
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AIDS Outreach Center, Inc. Rev. 6-12-2024
prior to hiring and prior to submitting a Reimbursement Request which includes invoices from any
such contractor. Failure to submit such proofs of search shall be an event of default.
7.5 Cost Principles/Cost Reasonableness.
Agency shall administer its use of HOPWA Funds in compliance with 2 CFR Part 200, as
applicable. The eligibility of costs incurred for performance rendered shall be determined in
accordance with 2 CFR Part 200.400 through 2 CFR Part 200.475.
7.6 Financial Management Standards.
Agency agrees to comply with 2 CFR Part 200, as applicable. Agency also agrees to adhere
to the accounting principles and procedures required therein, utilize adequate internal controls, and
maintain necessary supporting and back-up documentation for all costs incurred in accordance
with 2 CFR Part 200.302 and Part 200.303.
7.7 Uniform Administrative Requirements, Cost Principles, and Audit
Requirements.
Agency will comply with the Uniform Administrative Requirements, Cost Principles, and
Audit Requirements for Federal Awards in 2 CFR Part 200, as applicable, or any reasonably
equivalent procedures and requirements that City may require.
7.8 Terms Applicable to Contractors, Subcontractors and Vendors.
Agency understands and agrees that all terms of this Contract, whether regulatory or
otherwise, shall apply to any and all contractors, subcontractors and vendors of Agency which are
in any way paid with HOPWA 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 HOPWA Regulations. Agency shall monitor the services and work
performed by its contractors, subcontractors and vendors on a regular basis for compliance with
the HOPWA Regulations and Contract provisions. Agency must cure all violations of the HOPWA
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 HOPWA 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 Copvright 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
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AIDS Outreach Center, Inc. Rev. 6-12-2024
Agency's performance under this Contract.
7.10 Conflict of Interest Disclosure.
In accordance with the requirements of Section 14.13.2.1 and 14.13.4, Agency shall
establish conflict of interest policies for federal awards. Agency shall disclose to City in writing
any potential conflict of interest.
7.11 Compliance with FFATA and Whistleblower Protections.
Agency shall comply with the requirements of 2 CFR 300(b), including provisions of the
Federal Funding Accountability and Transparency Act ("FFATA") governing requirements on
executive compensation and provisions governing whistleblower protections contained in 10
U.S.C. 2409, 41 U.S.C. 4712, 10 U.S.C. 2324, 41 U.S.C. 4304 and 41 U.S.C. 4310.
7.11.1 Agency shall provide City with its DLTNS number.
7.12 Internal Controls.
In compliance with the requirements of 2 CFR Part 200.303, Agency shall:
7.12.1 Establish and maintain effective internal control over the HOPWA Funds that
provides reasonable assurance that Agency is managing the HOPWA 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 ar City designates as sensitive or Agency considers
sensitive consistent with applicable federal, state, local and tribal laws regarding privacy and
obligations of confidentiality.
7.13 Required Certification of Completion of Training.
At least 1 Agency employee must complete the HUD required training titled "Getting to
Work Training Curriculum" by April 15, 2026 and submit the required certifications to the City
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AIDS Outreach Center, Inc. Rev. 6-12-2024
with the April 2026 Reimbursement Request, as further described in EXHIBIT "A-2" —
Requirements for Completion of "Getting to Work Training Curriculum".
7.14 Housin� Oualitv Standards.
All housing assisted under this Contract must meet Housing Quality Standards (HQS) and
habitability standards as required by 24 CFR 982.401, 24 CFR Part 574.310(b). City shall have
the right to inspect to confirm compliance with these standards.
7.15. Violence A�ainst Women Act Reauthorization Act of 2022 Reauirements
7.15.1 Agency shall comply with the Violence Against Women Act Reauthorization Act
of 2022 ("VAWA") and shall ensure that any property owner, manager, or facility assisted by the
HOPWA Funds shall, at the time of application for services, provide all clients receiving rental
assistance with a Notice of Occupancy Rights under the Violence Against Women Act in
substantially the same form as the form attached and incorporated as Exhibit "J"-Notice of
Occupancy Rights Under VAWA in compliance with VAWA and 24 CFR Part 574.604(a)(2),
where applicable.
7.15.2 Agency agrees that no applicant for HOPWA assistance may be denied admission
or assistance under the Program on the basis or as a direct result of the fact that they are or have
been a victim of domestic violence, dating violence, sexual assault, stalking, or economic and
technological abuse as long as they would otherwise qualify for the Program.
7.15.3 Agency shall be responsible for reviewing VAWA and 24 CFR Part 574.604 and
shall respond to all emergency transfer requests in accordance with the requirements of those
provisions. Agency may request that all clients requesting an emergency transfer under VAWA
fill out the form attached and incorporated as Exhibit "K" - VAWA Emergency Transfer
Request Form.
7.15.4 Agency shall document and report to City any VAWA emergency transfer request
and outcome in compliance with 24 CFR Part 91.520 and 24 CFR Part 574
8. RECORD KEEPING; REPORTING AND DOCUMENTATION
REOUIREMENTS; AUDIT.
8.1 Record Keeping.
Agency shall maintain a record-keeping system as part of its performance of this Contract
and shall promptly provide City with copies of any document City deems 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. 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, litigation or audits have been resolved.
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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
term ends. 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 Expend $1,000,000 or more in Federal Funds Per Year
All non-federal entities that expend $1,000,000 or more in federal funds within 1 year,
regardless of the source of the federal award, must submit to City an annual audit prepared in
accordance with specific reference to 2 CFR Part 200.501 through Part 200.521. The audit shall
cover the Agency's fiscal years during which this Contract is in force. The audit must be prepared
by an independent certified public accountant, be completed within 6 months following the end of
the period being audited and be submitted to City within 30 days of its completion. Agency's audit
certification is attached hereto as EXHIBIT "C" —"Audit Certification Form" and "Audit
Requirements". The Audit Certification Form must be submitted to City prior to or with the
first Reimbursement Request. Entities that expend less than $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 Right to Audit.
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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 if City
determines that such audit is necessary for City's compliance with the HOPWA Regulations or
other City policies. Agency agrees to allow access to all pertinent materials as described herein
for such audit. If such audit reveals a questioned practice or expenditure, such questions must be
resolved within fifteen (15) business days after notice to Agency of such questioned practice or
expenditure. If questions are not resolved within this period, City reserves the right to withhold
further funding under this Contract and/or any other contracts with Agency. IF AS A RESULT
OF ANY AUDIT IT IS DETERMINED THAT AGENCY HAS FALSIFIED ANY
DOCUMENTATION OR MISUSED, MISAPPLIED OR MISAPPROPRIATED HOPWA
FUNDS OR SPENT HOPWA 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 Requests.
9.1.1 Reimbursement Requests shall be submitted monthly to the City and must be
received by the City on or before the 15r" 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 15tb 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 11.1.
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) business 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, 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.
9.2 Submission of Reimbursement Requests.
Agency shall provide City with Complete Documentation and the following reports as
shown in EXHIBIT "D" — Reimbursement Forms with each Reimbursement Request:
9.2.1 Attachment I— Request Summary
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This report shall contain the amount requested for reimbursement each month and the
cumulative reimbursement requested to date (inclusive of that month's request).
9.2.1.1 Agency must submit a separate request summary for each activity type,
i.e. Administration, Supportive Services, Short-term Rent, Mortgage
and Utility Assistance ("STRMU"), and Tenant Based Rental
Assistance ("TBRA").
9.2.2 Attachment II — Expenditure Worksheet
This report shall itemize each expense requested for reimbursement by Agency and shall
include the Account corresponding the expense to a Budget line item. In order for this report to
be complete the following must be submitted:
9.2.2.1 For payroll expenses, timesheets signed by employees and approved by
supervisor for all payroll expenses listed. Timesheets must distinguish
between HOPWA-funded time and non-HOPWA funded time and
reflect actual time spent on HOPWA-funded activities. Agency may not
submit payroll eXpenses dated sixty (60) calendar days prior to the date
of the Reimbursement Request.
9.2.2.2 For non-payroll expenses, invoices for each expense listed with an
eXplanation as to how the invoiced eXpense pertains to the Program.
Agency may not submit invoices dated sixty (60) calendar days prior to
the date of the Reimbursement Request.
9.2.2.3 Proof that each expense was paid by Agency. Proof can be satisfied by
canceled 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 ar
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, and upon recertification,
which will either be Source Documentation sufficient to show that
clients participating in the Program are HOPWA Eligible Clients as
described in Section 6, EXHIBIT "M" — Rental Calculation
Worksheet or a similar form approved by City, or if applicable,
confirmation of eligibility through the Systematic Alien Verification for
Entitlements (SAVE) program.
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9.2.4 CAPER Report.
Agency shall submit the CAPER report, attached hereto as EXHIBIT "G" — CAPER
Report on an annual basis.
9.2.5 Delivery of Reimbursement Request.
Reimbursement Requests will be submitted through Neighborly Software by the
designated due date, as outlined in Section 9.1.
9.3 Withholding Pavment.
CITY SHALL HAVE NO OBLIGATION TO PAY ANY REIMBURSEMENT
REQUEST THAT IS NOT RECEIVED BY THE DUE DATE AS OUTLINED HEREIN.
Failure to timely submit accurate and complete Reimbursement Requests and Complete
Documentation along with any required reports shall be an event of default.
10. DEFAULT AND TERMINATION.
10.1 Failure to Submit Reimbursement Request or Required Documentation.
10.1.1 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 10.1.1, IF
AGENCY FAILS TO SUBMIT THE REIMBURSEMENT REQUEST DUE OCTOBER 4,
2026, OR IF THE SUBMITTED REIMBURSEMENT REQUEST FOR OCTOBER 4, 2026
IS LATE, INCOMPLETE OR OTHERWISE NOT IN COMPLIANCE WITH THIS
CONTRACT OR THE HOPWA 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 (i) 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 HOPWA 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 HOPWA Regulations,
or during any period during which Agency is in default of this Contract.
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AIDS Outreach Center, Inc. Rev. 6-12-2024
10.1.5 In the event of termination under this Section 10.1, all HOPWA Funds awarded
but unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency shall
have no further right to such funds.
10.2 Failure to Maintain Records or Submit Reports and Documentation.
If Agency fails to maintain all records and documentation as required in Section 8, or if the
maintained or submitted report or documentation is not in compliance with this Contract or the
HOPWA 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 this Section 10.2, all HOPWA Funds awarded
but unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency shall
have no further right to such funds.
10.2.2 In the event of termination under Section 10.2, any HOPWA Funds paid to Agency
must be repaid to City within thirty (30) days of termination. If such HOPWA Funds are not repaid
to City within the thirty (30) day period, City shall exercise all legal remedies available under this
Contract.
10.3 In General.
10.3.1 Subject to Section 10.2, and unless specifically provided otherwise in this
Contract, Agency shall be in default under this Contract if Agency breaches any term or condition
of this Contract. In the event that such a breach remains uncured after thirty (30) calendar days
following written notice by City (or such other notice period as may be specified herein) or, if
Agency has diligently and continuously attempted to cure following receipt of such written notice
but reasonably requires more than thirty (30) calendar days to cure, as determined by both Parties
mutually and in good faith, City shall have the right to elect in City's sole discretion to (i) extend
Agency's time to cure, (ii) terminate this Contract effective immediately upon written notice of
such intent to Agency, or (iii) pursue any other legal remedies available to City under this Contract.
10.3.2 City's remedies may include:
10.3.2.1 Direct Agency to prepare and follow a schedule of actions for
carrying out the affected activities, consisting of schedules,
timetables and milestones necessary to implement the affected
activities.
10.3.2.2 Direct Agency to establish and follow a management plan that
assigns responsibilities for carrying out the remedial activities.
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10.3.2.3 Reprogram HOPWA Funds that have not yet been expended from
affected activities to other eligible activities or withhold HOPWA
Funds.
10.3.2.4 Any other appropriate action including but not limited to any
remedial action legally available such as declaratory judgment,
specific performance, damages, temporary or permanent
injunctions, termination of this Contract or any other contracts with
Agency, and any other available remedies.
10.3.3 In the event of termination under this Section 10.3, all HOPWA 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 HOPWA Funds already paid to Agency must be repaid
to City within thirty (30) days of the termination. Failure to repay such HOPWA Funds within the
thirty (30) day period will result in City exercising alllegal remedies available under this Contract.
10.4 No Funds Disbursed while in Breach.
Agency understands and agrees that no HOPWA Funds will be paid to Agency until all
defaults are cured to City's satisfaction.
10.5 No Compensation After Date of Termination.
Agency shall not receive any compensation for work undertaken after the date of the
termination.
10.6 Rights of Citv Not Affected.
Termination shall not affect or terminate any of the eXisting rights of City against Agency,
or which may thereafter accrue because of Agency's default and this provision shall be in addition
to any and all other rights and remedies available to City under the law. Such termination does
not terminate any provisions of this Contract that have been expressly noted as surviving the term
or termination of the Contract. No delay or omission by City in exercising any right or remedy
available to it under this Contract shall impair any such right or remedy or constitute a waiver or
acquiescence in any Agency default.
10.7 Waiver of Breach Not Waiver of Subsequent Breach
The waiver of a default or breach of any term, covenant, or condition of this Contract shall
not operate as a waiver of any subsequent default or breach of the same or any other term, covenant
or condition hereof.
10.8 Civil, Criminal and Administrative Penalties
Failure to perform all the Contract terms may result in civil, criminal or administrative
penalties, including, but not limited to those set out in this Contract.
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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 HOPWA 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
HOPWA Funds already paid to Agency must be repaid to City within thirty (30) days of
termination. Failure to repay such HOPWA 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 HOPWA FUNDS FOR A
MINIMUM OF 5 YEARS FROM THE DATE OF TERMINATION.
10.9.2 Agency may terminate this Contract if City does not provide the HOPWA
Funds substantially in accordance with this Contract.
10.10 Termination for Convenience.
In terminating in accordance with 2 CFR Part 200, Appendix II, this Contract may be
terminated in whole or in part only as follows:
10.10.1 By City with the consent of Agency in which case the Parties shall agree upon
the termination conditions, including the effective date and in the case of partial termination, the
portion to be terminated; or
10.10.2 By Agency upon at least thirty (30) days written notification to City, setting
forth the reasons for such termination, the effective date, and in the case of partial termination, the
portion to be terminated. In the case of a partial termination, City may terminate the Contract in
its entirety if City determines in its sole discretion that the remaining portion of the Contract to be
performed or HOPWA Funds to be spent will not accomplish the purposes for which the Contract
was made.
10.11 Dissolution of Agencv Terminates Contract.
This Contract shall terminate in the event Agency is dissolved or ceases to exist. In the
event of termination under this Section, all HOPWA Funds are subject to repayment and/or City
may exercise all of its remedies under this Contract.
10.12 Non-appropriation of Funds.
In the event no funds or insufficient funds are appropriated by City in any fiscal period for
any payments due hereunder, City will notify Agency of such occurrence and this Agreement shall
terminate on the last day of the fiscal period for which appropriations were received without
penalty or expense to City of any kind whatsoever, except as to the portions of the payments herein
agreed upon for which funds have been appropriated.
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10.13 Reversion of Assets.
In the event this Contract is terminated with or without cause, all assets acquired by Agency
with the HOPWA 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 HOPWA Funds, and any real or personal property owned by Agency that was improved with
the HOPWA Funds shall automatically transfer to City or to such assignee as City may designate.
11. REPAYMENT OF HOPWA FUNDS.
All HOPWA Funds are subject to repayment in the event the Program does not meet the
requirements of this Contract or in the HOPWA Regulations. If Agency takes any action that
results in the City being required to repay all or any portion of the HOPWA Funds to HUD,
Agency agrees it will reimburse City within thirty 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
HOPWA Funds is required of City, Agency agrees City may require that 10% of the
HOPWA 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�nding from HUD are
uncertain and would be difficult to ascertain and may include an impact on City's HOPWA grant
or other federal grant funds, in addition to the finding by HUD or a required repayment of funds
to HUD by City. Therefore, the Parties agree that payment under this Section of 10% of the
HOPWA Funds by Agency to City is liquidated damages and not a penalty.
12. CHANGE IN NON-PROFIT STATUS.
Agency must provide City with written notification of any changes to its non-profit status
within 15 calendar days of being notified of the change. Regardless of notice by Agency, if the
non-profit status of Agency changes after the date of this Contract, City may but is not obligated
to, terminate this Contract. In the event of termination under this Section 12, all HOPWA 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
HOPWA Funds already paid to Agency must be repaid to City within 30 calendar days of
termination under this Section.
13. SURVIVAL.
Any provision of this Contract that pertains to auditing, monitoring, indemnity obligations,
client income eligibility, record keeping and reports, City ordinances, or applicable HOPWA
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 and shall be
enforceable by City against Agency.
14. GENERAL PROVISIONS.
14.1 Agencv an Independent Contractor.
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Agency shall operate hereunder as an independent contractor and not as an officer, agent,
servant or employee of City. Agency shall have exclusive control of, and the exclusive right to
control, the details of the work and services performed hereunder, and all persons performing
same, and shall be solely responsible for the acts and omissions of its officers, members, agents,
servants, employees, contractors, subcontractors, vendors, clients, licensees or invitees.
14.2 Doctrine of Respondeat Superior.
The doctrine of respondeat superior shall not apply as between City and Agency, or its
officers, members, agents, servants, employees, contractors, subcontractors, vendors, clients,
licensees or invitees, and nothing herein shall be construed as creating a partnership or joint
enterprise between City and Agency. City does not have the legal right to control the details of
the tasks performed hereunder by Agency, its officers, members, agents, employees, contractors,
subcontractors, vendors, clients, licensees or invitees.
14.3 Agencv Propertv.
City shall under no circumstances be responsible for any property belonging to Agency, or
its ofiicers, 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 HOPWA 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
HOPWA-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 HOPWA 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 HOPWA Funds and participation must be voluntary for clients of a HOPWA-funded service.
HOPWA PSA CONTRACT 2025-2026 Page 20
AIDS Outreach Center, Inc. Rev. 6-12-2024
14.4.3 Reauired Notices.
If Agency constitutes a Faith-based organization under 24 CFR Part 5.109, Agency must
provide all clients of a HOPWA-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
HOPWA-funded program or activity. In addition, if a client or prospective client of a HOPWA-
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 located in Tarrant County, Texas or the United States District
Court for the Northern District of Texas, Fort Worth Division for any action, whether real or asserted,
at law or in equity, arising out of the execution, performance, attempted performance or
non-performance of this Contract.
14.6 Governing Law.
This Contract shall be governed by and construed in accordance with the laws of the State
of Texas. If any action, whether real or asserted, at law or in equity, arises out of the eXecution,
performance or non-performance of this Contract or on the basis of any provision herein, for any
issue not governed by federal law, the choice of law shall be the laws of the State of TeXas.
14.7 Severabilitv.
The provisions of this Contract are severable, and if for any reason a clause, sentence,
paragraph or other part of this Contract shall be determined to be invalid by a court or federal or
state agency, board or commission having jurisdiction over the subject matter thereof, such
invalidity shall not affect other provisions which can be given effect without the invalid provision.
14.8 Written 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 Para�raph Headings for Reference Onlv, No Legal Si�nificance; 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
HOPWA PSA CONTRACT 2025-2026 Page 21
AIDS Outreach Center, Inc. Rev. 6-12-2024
requires, singular nouns and pronouns include the plural, and the masculine gender shall be
deemed to include the feminine or neuter and the neuter gender to include the masculine and
feminine. The words "include" and "including" whenever used herein shall be deemed to be
followed by the words "without limitation".
14.10 Compliance with All Applicable Laws and Re�ulations.
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:
➢ HOPWA Regulations found in 24 CFR Part 574
➢ AIDS Housing Opportunity Act, as amended (42 USC 12901 et seq.)
➢ Title VI of the Civil Rights Act of 1964 (42 U.S.C. Sections 2000d et seq.) including
provisions requiring recipients of federal assistance to ensure meaningful access by
persons of limited English proficiency
➢ The Fair Housing Act, Title VIII of the Civil Rights Act of 1968 (42 U.S.C. Sections
3601 et seq.)
➢ Executive Orders 11063, 11246 as amended by 11375 and 12086 and as supplemented
by Department of Labor regulations 41 CFR Part 60
➢ The Age Discrimination in Employment Act of 1967
➢ The Age Discrimination Act of 1975 (42 U.S.C. Sections 6101 et seq.)
➢ The Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970
(42 U.S.C. Sections 4601 et seq. and 49 CFR Part 24) ("URA")
➢ Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. Sections 794 et seq.) and 24
CFR Part 8 where applicable
➢ National Environmental Policy Act of 1969, as amended, 42 U.S.C. Sections 4321 et
seq. ("NEPA") and the related authorities listed in 24 CFR Part 58.
➢ The Clean Air Act, as amended, (42 U.S.C. Sections 1251 et seq.) and the Clean Water
Act of 1977, as amended (33 U.S.C. Sections 1251 et seq.) and the related EXecutive
Order 11738. In no event shall any amount of the assistance provided under this
Contract be utilized with respect to a facility that has given rise to a conviction under
the Clean Air Act or the Clean Water Act.
➢ Immigration Reform and Control Act of 1986 (8 U.S.C. Sections 1101 et seq.)
specifically including the provisions requiring employer verifications of legal status of
its employees
➢ The Americans with Disabilities Act of 1990 (42 U.S.C. Sections 12101 et seq.), the
Architectural Barriers Act of 1968 as amended (42 U.S.C. Sections 4151 et seq.) and
the Uniform Federal Accessibility Standards, 24 CFR Part 40, Appendix A
➢ Regulations at 24 CFR Part 87 related to lobbying, including the requirement that
certifications and disclosures be obtained from all covered persons
➢ Drug Free Workplace Act of 1988 (41 U.S.C. Sections 701 et seq.) and 24 CFR Part
23, Subpart F
➢ Executive Order 12549 and 24 CFR Part 5.105(c) pertaining to restrictions on
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
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AIDS Outreach Center, Inc. Rev. 6-12-2024
➢ 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
seq.) and implementing regulations at 24 CFR Part 35, subparts A, B, M, and R
➢ Uniform Administrative Requirements, Cost Principles, and Audit Requirements for
Federal Awards, 2 CFR Part 200 et seq.
➢ Federal Funding Accountability and Transparency Act of 2006 ("FFATA") (Pub.L.
109-282, as amended by Section 6205(a) of Pub.L. 110-252 and Section 3 of Pub.L.
113-101)
➢ Federal Whistleblower Regulations, as contained in 10 U.S.C. 2409, 41 U.S.C. 4712,
10 U.S.C. 2324, 41 U.S.C. 4304 and 41 U.S.C. 4310
➢ The Build America, Buy America Act (BABA) enacted under Division G, Title IX of
the Infrastructure Investment and Jobs Act (IIJA, Pub. L. No. 117-58) signed into law
on November 15, 2021
➢ 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 (LJEI) 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.
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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 574.603 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, ar 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
HOPWA PSA CONTRACT 2025-2026 Page 23
AIDS Outreach Center, Inc. Rev. 6-12-2024
all provisions of same and that no employee, or applicant for employment has been discriminated
against under the terms of such ordinances by either or its officers, members, agents, employees
or contractors.
14.12.2 No Discrimination in Emplovment during the Performance of This
Contract.
During the performance of this Contract Agency agrees to the following provision, and
will require that its contractors and subcontractors also comply with such provision by including
it in all contracts with its contractors:
[Contractor's, Subcontractor's or Vendor's name] will not unlawfully discriminate against
any employee or applicants for employment because of race, color, sex, gender, religion, national
origin, familial status, disability or perceived disability, seXual orientation, gender identity, gender
expression or transgender. [Contractor's. Subcontractor's or T�endor's name]will take affirmative
action to ensure that applicants are hired without regard to race, color, sex, gender, religion,
national origin, familial status, disability or perceived disability, sexual orientation, gender
identity, gender expression or transgender and that employees are treated fairly during employment
without regard to their race, color, sex, gender, religion, national origin, familial status, disability
or perceived disability, sexual orientation, gender identity, gender expression or transgender. Such
action shall include, but not be limited to, the following: employment, upgrading, demotion or
transfer, recruitment or recruitment advertising, layoff or termination, rates of pay or other forms
of compensation, and selection for training, including apprenticeship. [Contractor's,
Subcontractor's or Vendor's name] agrees to post in conspicuous places, available to employees
and applicants for employment, notices setting forth the provisions of this nondiscrimination
clause.
[Contractor's Subcontractor's or ilendor's name] will, in all solicitations or
advertisements for employees placed by or on behalf of [Contractor's, Subcontractor's or
Vendor's name], state that all qualified applicants will receive consideration for employment
without regard to race, color, sex, gender, religion, national origin, familial status, disability or
perceived disability, sexual orientation, gender identity, gender expression or transgender.
[Contractor's, Subcontractor's or Vendor's name] covenants that neither it nor any of its
officers, members, agents, employees, or contractors, while engaged in performing this Contract,
shall, in connection with the employment, advancement or discharge of employees or in
connection with the terms, conditions or privileges of their employment, discriminate against
persons because of their age or because of any disability or perceived disability, except on the
basis of a bona fide occupational qualification, retirement plan or statutory requirement.
[Contractor's, Subcontractor's or 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.
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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
ElVIPLOYEES' 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 Agencv Safeguards.
Agency shall establish safeguards to prohibit its employees, board members, advisors and
agents from using positions for a purpose that is or gives the appearance of being motivated by a
desire for private gain for themselves or others, particularly those with whom they have family,
business or other ties. Agency shall disclose to City any such conflict of interest or potential
conflict of interest, immediately upon discovery of such.
14.13.2 General Prohibitions A�ainst 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 HOPWA 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 HOPWA services,
may obtain a financial interest or benefit from a HOPWA-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 HOPWA 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 Involvin� 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 those Sections, the provisions
of 24 CFR Part 574.625 of the HOPWA Regulations shall apply.
HOPWA PSA CONTRACT 2025-2026 Page 25
AIDS Outreach Center, Inc. Rev. 6-12-2024
14.13.3.1 As more particularly described in 2 CFR Part 200.318, Agency shall
maintain and submit to City written standards of conduct covering
conflicts of interest and governing the performance of its employees
engaged in the selection, award, and administration of contracts. No
employee, officer, or agent may participate in the selection, award,
or administration of a contract supported by a federal award if he or
she has a real or apparent conflict of interest. The standards of
conduct must provide for disciplinary actions to be applied for
violations of such standards by officers, employees, or agents of
Agency.
14.13.3.2 The officers, employees, and agents of Agency shall neither solicit
nor accept gratuities, favors, or anything of monetary value from
contractors or parties to subcontracts.
14.13.3.3 Notwithstanding the prohibition contained in Section 14.13.3.2,
Agency may set standards of conduct for situations in which the
financial interest is not substantial or the gift is an unsolicited item
of nominal value. Such standards of conduct must provide for
disciplinary actions to be applied for violations of such standards by
Agency's officers, employees or agents.
14.13.3.4 Agency shall maintain written standards of conduct covering
organizational conflicts of interest. Organizational conflicts of
interest means that because of relationships with a parent company,
affiliate, or subsidiary organization, Agency is unable or appears to
be unable to be impartial in conducting a procurement action
involving a related organization.
14.13.3.5 Agency must maintain records sufficient to detail the history of
procurement. These records will include but are not necessarily
limited to the following: rationale for the method of procurement,
selection of contract type, contractor selection or rejection, and the
basis for the contract price.
14.13.4 Disclosure of Conflicts of Interest.
In compliance with 2 CFR Part 200.112, Agency is required to timely disclose to City in
writing any potential conflict of interest.
14.13.5 Disclosure of Conflicts of Interest for 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
HOPWA PSA CONTRACT 2025-2026 Page 26
AIDS Outreach Center, Inc. Rev. 6-12-2024
conflict of interest by having clients fill out the Conflict of Interest Disclosure Form, attached
hereto as EXhibit "L". 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.
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 HOPWA 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
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 HOPWA 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, 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 HOPWA 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.
HOPWA PSA CONTRACT 2025-2026 Page 27
AIDS Outreach Center, Inc. Rev. 6-12-2024
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 Right to Inspect Agencv Contracts.
It is agreed that City has the right to inspect and approve in writing any proposed contracts
between Agency and any contractor or vendor engaged in any activity in conjunction with this
HOPWA-funded Program prior to any charges being incurred.
14.18 Force Maieure
If Agency becomes unable, either in whole or part, to fulfill its obligations under this
Contract due to acts of God, strikes, lockouts, or other industrial disturbances, acts of public
enemies, wars, blockades, insurrections, riots, epidemics, pandemics, earthquakes, fires, floods,
restraints or prohibitions by any court, board, department, commission or agency of the United
States or of any States, civil disturbances, or explosions, or some other reason beyond Agency's
control (collectively, "Force Majeure Event"), the obligations so affected by such Force Majeure
Event will be suspended only during the continuance of such event. Agency will give City written
notice of the existence, eXtent and nature of the Force Majeure Event as soon as reasonably
possible after the occurrence of the event. Failure to give notice will result in the continuance of
Agency's obligation regardless of the extent of any eXisting Force Majeure Event. Agency will
use commercially reasonable efforts to remedy its inability to perform as soon as possible.
14.19 IMMIGRATION NATIONALITY ACT.
Agency shall verify the identity and employment eligibility of its employees who perform
work under this Contract, including completing the Employment Eligibility Verification Form (I-
9). Upon request by City, Agency shall provide City with copies of all I-9 forms and supporting
eligibility documentation for each employee who performs work under this Contract. Agency
shall adhere to all Federal and State laws as well as establish appropriate procedures and controls
so that no services will be performed by any Agency employee who is not legally eligible to
perform such services. AGENCY SHALL INDEMNIFY CITY AND HOLD CITY
HARMLESS FROM ANY PENALTIES, LIABILITIES, OR LOSSES DUE TO
VIOLATIONS OF THIS PARAGRAPH BY AGENCY, AGENCY'S EMPLOYEES,
SUBCONTRACTORS, AGENTS, OR LICENSEES. City, upon written notice to Agency, shall
have the right to immediately terminate this Contract for violations of this provision by Agency.
15. INDEMNIFICATION AND RELEASE.
AGENCY COVENANTS AND AGREES TO INDEMNIFY, HOLD HARMLESS
AND DEFEND, AT ITS OWN EXPENSE, CITY AND ITS OFFICERS, AGENTS,
SERVANTS AND EMPLOYEES FROM AND AGAINST ANY AND ALL CLAIMS OR
SUITS FOR PROPERTY LOSS OR DAMAGE AND/OR PERSONAL INJURY,
HOPWA PSA CONTRACT 2025-2026 Page 28
AIDS Outreach Center, Inc. Rev. 6-12-2024
INCLUDING DEATH, TO ANY AND ALL PERSONS, OF WHATSOEVER KIND OR
CHARACTER, WHETHER REAL OR ASSERTED, ARISING OUT OF OR IN
CONNECTION WITH THE EXECUTION, PERFORMANCE, ATTEMPTED
PERFORMANCE OR NONPERFORMANCE OF THIS CONTRACT AND/OR THE
OPERATIONS, ACTIVITIES AND SERVICES OF THE PROGRAM DESCRIBED
HEREIN, WHETHER OR NOT CAUSED IN WHOLE OR IN PART, BY ALLEGED
NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS
OR SUBCONTRACTORS OF CITY; AND AGENCY HEREBY ASSUMES ALL
LIABILITY AND RESPONSIBILITY OF CITY AND ITS OFFICERS, AGENTS,
SERVANTS, AND EMPLOYEES FOR ANY AND ALL CLAIMS OR SUITS FOR
PROPERTY LOSS OR DAMAGE AND/OR PERSONAL INJURY, INCLUDING DEATH,
TO ANY AND ALL PERSONS, OF WHATSOEVER KINDS OR CHARACTER,
WHETHER REAL OR ASSERTED, ARISING OUT OF OR IN CONNECTION WITH
THE EXECUTION, PERFORMANCE, ATTEMPTED PERFORMANCE OR
NONPERFORMANCE OF THIS CONTRACT AND/OR THE OPERATIONS,
ACTIVITIES AND SERVICES OF THE PROGRAM DESCRIBED HEREIN, WHETHER
OR NOT CAUSED IN WHOLE OR IN PART BY ALLEGED NEGLIGENCE OF
OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS OR
SUBCONTRACTORS OF CITY. AGENCY LIKEWISE COVENANTS AND AGREES TO
AND DOES HEREBY INDEMNIFY AND HOLD HARMLESS CITY FROM AND
AGAINST ANY AND ALL INJURY, DAMAGE OR DESTRUCTION OF PROPERTY OF
CITY, ARISING OUT OF OR IN CONNECTION WITH ALL ACTS OR OMISSIONS OF
AGENCY, ITS OFFICERS, MEMBERS, AGENTS, EMPLOYEES, CONTRACTORS,
SUBCONTRACTORS, INVITEES, LICENSEES, OR CLIENTS, OR CAUSED, IN
WHOLE OR IN PART, BY ALLEGED NEGLIGENCE OF OFFICERS, AGENTS,
SERVANTS, EMPLOYEES, CONTRACTORS OR SUBCONTRACTORS OF CITY.
IT IS THE EXPRESS INTENTION OF THE PARTIES, BOTH AGENCY AND
CITY, THAT THE INDEMNITY PROVIDED FOR THIS SECTION INCLUDES
INDEMNITY BY AGENCY TO INDEMNIFY AND PROTECT CITY FROM THE
CONSEQUENCES OF CITY'S OWN NEGLIGENCE, WHETHER 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.
HOPWA PSA CONTRACT 2025-2026 Page 29
AIDS Outreach Center, Inc. Rev. 6-12-2024
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
$264,680.00 (Awarded Amount) to insure against loss from the fraud, theft or dishonesty of any
of Agency's officers, agents, trustees, directors or employees. The proceeds of such insurance or
bond shall be used to reimburse City for any and all loss of HOPWA Funds occasioned by such
misconduct. To effectuate such reimbursement, such fidelity coverage shall include a rider stating
that reimbursement for any loss or losses shall name the City as a Loss Payee.
Agency shall furnish to City in a timely manner, but not later than the Effective Date,
certificates of insurance as proof that it has secured and paid for policies of commercial insurance
as specified herein. If City has not received such certificates by the Effective Date, Agency shall
be in default of the Contract and City may, at its option, terminate the Contract.
Such insurance shall cover all insurable risks incident to or in connection with the
eXecution, performance, attempted performance or nonperformance of this Contract. Agency shall
maintain the following insurance coverage and limits:
Commercial General 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
HOPWA PSA CONTRACT 2025-2026 Page 30
AIDS Outreach Center, Inc. Rev. 6-12-2024
Part A: Statutory Limits
Part B: Employer's Liability
$100,000 each accident
$100,000 disease-each employee
$500,000 disease-policy limit
Note: Such insurance shall cover employees performing work on any and all projects
including but not limited to construction, demolition, and rehabilitation. Agency or its
contractors shall maintain coverages, if applicable. In the event the respective contractors
do not maintain coverage, Agency shall maintain the coverage on such contractor, if
applicable, for each applicable contract.
Additional Requirements
Such insurance amounts shall be revised upward at City's reasonable option and no more
frequently than once every 12 months, and Agency shall revise such amounts within 30 days
following notice to Contractor of such requirements.
Agency will submit to City documentation that it has obtained insurance coverage and has
executed bonds as required in this Contract prior to payment of any monies provided hereunder.
Where applicable, insurance policies required herein shall be endorsed to include City as an
additional insured as its interest may appear. Additional insured parties shall include employees,
officers, agents, and volunteers of City.
Any failure on part of City to request certificate(s) of insurance shall not be construed as a waiver
of such requirement or as a waiver of the insurance requirements themselves.
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.
HOPWA PSA CONTRACT 2025-2026 Page 31
AIDS Outreach Center, Inc. Rev. 6-12-2024
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
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
HOPWA PSA CONTRACT 2025-2026 Page 32
AIDS Outreach Center, Inc. Rev. 6-12-2024
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
Copy to:
Neighborhood Services Department
100 Fort Worth Trail
Fort Worth, TX 76102
Attention: Kacey Thomas
Telephone: 817-392-7540
Copy to:
Neighborhood Services Department
100 Fort Worth Trail
Fort Worth, TX 76102
Attention: Julie C. Pena
Telephone: 817-392-753 8
Agencv:
AIDS Outreach Center, Inc.
Contact: Tracy Jones
Address: 400 N. Beach St.
Fort Worth, TX 76111
Telephone: 817-334-1994
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.
HOPWA PSA CONTRACT 2025-2026 Page 33
AIDS Outreach Center, Inc. Rev. 6-12-2024
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 2274 of the Texas Government
Code, as added by Acts 2021, 87th Leg., R.S., S.B. 13, § 2, 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. The terms
"boycott energy company" and "company" have the meaning ascribed to those terms by Chapter
2274 of the Texas Government Code, as added by Acts 2021, 87th Leg., R.S., S.B. 13, § 2. 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 veriiication to the City that
Agency: (1) does not boycott energy companies; and (2) will not boycott energy companies during
the term of this Agreement.
26. PROHIBITION ON DISCRIMINATION AGAINST FIREARM AND
AMMUNITION INDUSTRIES.
Agency acknowledges that except as otherwise provided by Chapter 2274 of the Texas
Government Code, 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
HOPWA PSA CONTRACT 2025-2026 Page 34
AIDS Outreach Center, Inc. Rev. 6-12-2024
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
iirearm entity or firearm trade association. The terms "discriminate," "firearm entity" and "firearm
trade association" have the meaning ascribed to those terms by Chapter 2274 of the TeXas
Government Code, as added by Acts 2021, 87th Leg., R.S., S.B. 19, § 1. 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]
HOPWA PSA CONTRACT 2025-2026 Page 35
AIDS Outreach Center, Inc. Rev. 6-12-2024
IN WITNESS WHEREOF, the Parties hereto have executed this Contract in Fort Worth,
Tarrant County, TeXas.
4poqj°�a
ATTEST: �` ��
a � �y°ad
a°�o ao
�n� h .,��a_�- o• ��: °
B� a�pn aEoosa6
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Jannette Goodall, City Secretary
Date: O1/27/2026
CITY OF FORT WORTH
Dana Bur�hdoff
Y��..,�, �m���ff_:,,�6y�F,������;
Dana Burghdoff, Assistant City Manager
Date: O1/26/2026
M&C: 25-0676
1295 Certification No. 2025-1265806
Date: February 6, 2025
RECOMMENDED BY:
��'
Kacey Thomas, Neighborhood Services Director
APPROVED AS TO FORM AND LEGALITY:
Sophie Pdaehew7
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
�wGie- c. Pena,,„ , I
Julie C. Pena
Title: Sr. Human Services Specialist
AGENCY NAME: AIDS Outreach Center, Inc.
$y_ T�acy��ohes
_ __ _
Tracy Jones, Interim Executive Director
�FFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
HOPWA PSA CONTRACT 2025-2026 Page 36
AIDS Outreach Center, Inc. Rev. 6-12-2024
EXHIBITS:
EXHIBIT "A" — Program Summary
EXHIBIT "A-1" — 2025 HUD Income Limits
EXHIBIT "A-2" - Requirements for Completion of "Getting to Work Training
Curriculum"
EXHIBIT "B" — Budget
EXHIBIT "C" — Audit Certification Form
EXHIBIT "D" — Reimbursement Forms
EXHIBIT "E" — Certification Forms
EXHIBIT "E-1" — Self- Certification Form (to be completed by Agency)
EXHIBIT "E-2" — Certification of No or Limited Income Statement (to be completed by
Client and Agency)
EXHIBIT "F" — Standards for Complete Documentation
EXHIBIT "G" — CAPER Report
EXHIBIT "H" — MBE Reporting Form
EXHIBIT "I" — Notice of Beneficiary Rights
EXHIBIT "J" — Notice of Occupancy Rights Under VAWA
EXHIBIT "K" —VAWA Emergency Transfer Request Form
EXHIBIT "L" — Conflict of Interest Disclosure Form
EXHIBIT "M" — Rental Calculation Worksheet
EXHIBIT "N" — Certificate of Compliance
HOPWA PSA CONTRACT 2025-2026 Page 37
AIDS Outreach Center, Inc. Rev. 6-12-2024
AIDS Outreach Center, Inc.
The Housing Assistance Program
PROGRAM SUMMARY
(HOPWA)
October 1, 2025 to September 30, 2026
PERIOD
EXHIBIT "A"
PROGRAM SUMMARY
$264,680.00
AMOUNT
Capitalized terms not deiined herein shall have meanings assigned them in the Contract.
PROGRAM:
AIDS Outreach Center provides various programs to serve low-moderate income people living
with HIV/AIDS. These programs are available to anyone living with HIV who meet the income
guideline at or below 80% AMI for all counties served.
• Administration- Administrative covers the costs of indirect personnel in decision-making
on behalf of the program.
• Supportive Services: Supportive services provides the household with the following
including, but limited to, case management, behavioral health, housing, transportation,
dental, food pantry, and insurance assistance. For each service provided to the client or
household, a case note must document the service type. Supportive Services dollars will be
used to pay for a portion of staff salaries and fringe benefits.
• Short Term Rental, Mortgage and Utility Assistance (STRMU): The goal of the
program is to provide to persons living with HIV/AIDS to maintain stable housing and
reduce the risk of homelessness. Clients can receive up to 21-weeks of STRMU assistance
and must not exceed the client's current monthly budget deficit caused by an unavoidable,
unplanned, or documented emergency need consisted with HUD guidelines. Clients
receiving other government housing assistance are not eligible for this program or TBRA.
• Tenant Based Rental Assistance (TBRA): TBRA includes long-term monthly rental
assistance. Clients must live in a rental unit that passes HQS, and have an identified housing
need as determine by the client's case manager.
AOC is located at 400 N. Beach Street Ste. 100, Fort Worth, TeXas 76111. Program staff are
available to meet with clients on Monday-Friday from 8:30am to 5:30pm. The program will
provide services to eligible clients residing in Tarrant, Johnson, Parker, and Wise counties.
HOPWA Funds will pay for direct rental assistance for TBRA and short-term rental, mortgage and
utility assistance for STRMU clients and supportive services. HOPWA funds will be used to pay
for a percentage of salaries. The staff position role is fully dedicated to the activities covered under
the grant which aligns with the grant budget, FICA and fringe benefits for the Supportive Services
staff at 400 N. Beach Ste. 100, Fort Worth, TX 76111. No more than 7% of the HOPWA Funds
will be used to pay for a portion of administrative costs, including salaries and fringe benefits and
City-required insurance associated with the program. The percentage of any Program employee's
HOPWA PSA 2025-2026
EXHIBIT "A" — PROGRAM SUMMARY
AIDS OUTREACH CENTER, INC. Page 1
salary will not exceed the percentage of HOPWA clients participaitng in the Program and shall be
cost allocated in accordance with the amount applicable to the Program.
Agency shall not change any locations without prior City approval. Costs incurred at any locations
that have not been approved by City shall not be reimbursed. Service location revisions will trigger
the City's Citizen Participation Plan and will require a 30-day public notice.
Agency will submit documentation which verifies that 100% of all clients served by the Program
are Income Eligible with current household incomes at or below 80% AMI and within the
service delivery areas. Annual re-certifications will be conducted to determine rental payments.
Agency will use the appropriate Utility Allowance Schedule for all TBRA initial rental
calculations and re-certifications.
REGULATORY CLASSIFICATION:
24 CFR 574.300(b)(10) -Administrative
24 CFR 574.300(b)(7) — Supportive Services
24 CFR 574.300(b)(6)- STRMU
24 CFR 574.300(b)(5)- TBRA
PROGRAM GOALS:
Minimum Number of Fort Worth Clients to be Served: The Program must provide Supportive
Services to a minimum of 66 Unduplicated Clients. Unduplicated Clients must be residents of
Tarrant, Johnson, Parker, and Wise counties as shown by the monthly reports on Attachment
III. The Program will provide STRMU to 51 households and TBRA services to a minimum of 15
households.
OTHER AGENCY REOUIREMENTS:
Upon completion of the program year, Agency will provide, with the final reimbursement request,
the results of the measures used to assess the program benefits to the client as described in B.12 of
the Public Service Agency Request for Proposal application.
HOPWA PSA 2025-2026
EXHIBIT "A" — PROGRAM SUMMARY
AIDS OUTREACH CENTER, INC. 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"
REQUIREMENTS FOR COMPLETION OF "GETTING TO WORK TRAINING
CURRICULUM"
HOPWA PSA CONTRACT 2025-2026 Page 1
EXHIBIT "A-2" REQUIREMENTS FOR COMPLETION OF "GETTING TO WORK TRAINING CURRICULUM"
AIDS Outreach Center, Inc.
Getting to Work:
A Training Curriculum for HIV/AIDS Service Providers and Housing Providers
At least 1 Agency employee must complete this required training curriculum by the deadline of April
15, 2023. Proof of completion must be submitted with the April reimbursement request.
The Getting to Work Training Curriculum is divided into 3 online modules:
Module 1: Understanding the Value of Work
Module 2: Adopting an Employment and Training Mindset — Organizationally and Individually
Module 3: Incorporating Employment into the HIV/AIDS Service Menu
To view the modules:
1. Click the module title.
2. You will be prompted to either create or log into your HUD Exchange Learn account.
3. Follow this guidance when creating a HUD Exchange account:
Step 1 of 2 screen: Fill out the required Personal Information, and Login Information sections.
For the Organization Information, if you are not affiliated with a HUD program, choose None
of the Above and I am an Individual.
Step 2 of 2 screen: All HUD Program Experience fields on the Learner Profile page are
optional. Click Update to complete the account creation process.
4. After creating an account or logging in, you will enter the HUD Exchange Learn system.
5. Click the Enroll button on the HUD EXchange Learn course description to access the course.
6. The module name will appear under Activities. Click the Module Name to access the course.
7. The module willlaunch in a new window, so please make sure your pop-up blockers are
turned off.
To receive credit for completin� each module:
1. Take the completion quiz under Activities on the HUD EXchange Learn course description.
Each module has a quiz.
2. Score 80% or better on the quiz. You may take the quiz multiple times.
3. After you pass the quiz, you will be able to print a completion certificate on the HUD
Exchange Learn course description.
You can access information about the modules by visiting the HUD EXchange website at
www.hudexchan�e.com or by using the following link: https://www.hudexchan�e.info/trainin�-
events/dol-hud-�ettin�-to-work-curriculum-for-hiv-aids-providers. You may also contact your
assigned contract administrator to get additional information.
HOPWA PSA CONTRACT 2025-2026 Page 2
EXHIBIT "A-2" REQUIREMENTS FOR COMPLETION OF "GETTING TO WORK TRAINING CURRICULUM"
AIDS Outreach Center
EXHIBIT "B" - BUDGET
PERSONNEL
Salaries
F1CA
Life/Disability Insurance
Health/Dental Insurance
Unemployment-State
Worker's Compensation
Contract Labor-Accounting
Mileage
Insurance-Commercial Umbrella
Liability
Insurance-Directors and
Officers
Insurance-Fidelity Bond or
Equivalent
TOTAL ADMINISTRATIVE
EXPENSES
% Administrative Cost
County HUD HINT
Account Grant Budget HOPWA GRANT C
ADMINISTRATIVE
1001
1002
1003
1004
1005
1006
1007
1008
$ 5,919.89 $ 10,365.00 $ 25,000.00
$ 452.87
$ 1,200.00
1009
1010
1011
$
7,572.76 $ ] 0,365.00 $ 25,000.00
7%
Total
$ 41,284.89
$ 452.87
$ 1,200.00
$ 42,937.76
PROGRAM PERSONNEL
SUPPORTIVE SERVICES
Salaries 2001 $ 14,800.00 $ 23,635.00 $ 96,991.18 $ 135,426.18
FiCA 2002 $ 1,132.20 $ 1,808.08 $ 7,419.82 $ 10,36010
Life/Disabiliry Insurance 2003
Health/DentalInsurance 2004 $ 2,918.92 $ 2,918.92
Unemployment-State 2005
Worker's Compensation 2006
SUPPLIES AND SERVICES
Office/Medical Supplies 3001 $ 6,877.00 $ 6,877.00
Office Equipment Rental 3002
Postage 3003
Printing 3004
MISCELLANEOUS
Contract Labor-Nutririonist 4001
Food Supplies 4002
Travel 4003 $ 8,000.00 $ 8,000.00
FACILITY AND UTILITIES
Telephone 5001 $ -
Electric 5002 $ -
Gas 5003 $ -
Water and Wastewater 5004 $ -
Solid Waste Disposal 5005 $ -
Rent (Ciry needs copy of lease
before eapenses can be
reimbursed) 5006
Custodial Services 5007 $ -
Maintenance/Repairs 5008 $ -
Building Security 5009 $ -
AOC HOPWA PSA CONTRACT 2025-2026- EXHIBIT "B" - BUDGET
Page 1
LEGAL, FINANCIAL AND
INSURANCE
Professional LiabilityBusiness
Auto
TOTAL SUPPORTiVE
SERVICE EXPENSES $ 15,932.20 $ 28,362.00 $ 119,288.00 $ 163,582.20
DIRECT ASSISTANCE-STRMU I
Short-term Rent Assistance 7001 $ 48,800.00 $ 48,800.00
I Short-term Mortgage Assistance 7002 $ 7,000.00
� Short-term Uriliries Assistance 7003 $ 14,845.00
$ 7,000.00
$ 14,845.00
Total Direct Assistance-STRMU $ 70,645.00 $ 70,645.00
DIRECT ASSISTANCE-TBRA
Tenant Based Rental Assistance
(TBRA) 8001 $ 170,530.04 $ 36,190.00 $ 206,720.04
Total Direct Assistance-TBRA $ 170,530.04 $ 36,190.00 $ 206,720.04
DIRECT ASSISTANCE-PHP
Permanent Housing Program
(PHP) $ 42,136.00 $ 38,500.00 $ 80,636.00
Total Direct Assistance-PAP $ - $ 42,136.00 � $ 38,500.00 � $ - � $ 80,636.00
DIRECT ASSISTANCE-STSH
Facility Based Housing
Assistance/Short Term Supporrive
Housing (STSH)
Total Direct Assistance-STSH $
6001
$31,030.00
- $31,030.00 $ - $
$ 31,030.00
- $ 31,030.00
9001
9002
9003
9004
9005
9006
FACILITY BASED OPERATIONS
PERSONNEL
Salaries
IFiCA
I Life/Disabiliry Insurance
IHealth/Dental Insurance
� Unemployment-State
IWorker's Compensation
Insurance-Commercial Property
and Professional Liability
�Operaring Cost
IFacilty Operations Leasing Cost
IProgram Expenses
I Capacity Building
TOTAL FACILITY BASED
OPERATION EXPENSES
IBUDGET TOTAL
FUNDING B:
FUNDING C:
FUNDING D:
9007
9008
9009
9010
90ll
$ 66,847.00
$ 475,000.00
$ 64,232.00
$ 30,000.00
$ 636,079.00
$ 264,680.00 $148,083.00 $ 818,867.00
Tarrant County HOPWA (STSH, PHP & TBRA)
HUD HINT Gran (Master Leasing)
$ 66,847.00
$ 475,000.00
$ 64,232.00
$ 30,000.00
$ 636,079.00
$ 1,231,630.00
AOC HOPWA PSA CONTRACT 2025-2026- EXHIBIT "B" - BUDGET
Page 2
The following tables were created for the purpose of preparing, negotiating, and determining the cost
reasonableness and cost allocation method used by the Agency for the line item budget represented
on the first page of this EXHIBIT "B" — Budget. The information reflected in the tables is to be
considered part of the terms and conditions of the Contract. Agency must have prior written approval
by the City to make changes to any line item in the Budget as outlined in Section 5.2.2 in the
Contract. The deadline to make changes to EXHIBIT "B" — Budget is Apri130, 2026.
SALARY DETAIL - ADMINISTRATIVE
Est. Percent to
Position Title Annual Salary Grant
Grant Administrator
TOTAL
FICA
Life/Disability Insurance
Health/Dental Insurance
Unemployment-State
Worker's Compensation
TOTAL
$ 59,198.90 10.0% $
�
Amount to
Grant
5,919.89
5,919.89
FRINGE DETAIL - ADMINISTRATIVE
Percent of Est. Percent to Amount to
Payroll Amount Grant Grant
7.65% $ 4,528.71 10.0% $ 452.87
$
�
4,528.71 10.0°/a $ 452.87
MISCELLANEOUS - ADMINISTRATIVE
Est. Percent to Amount to
Total Budget Grant Grant
Contract Labor-Accounting
Mileage
Insurance-Commercial Umbrella Liability
Insurance-Directors and Officers
Insurance-Fidelity Bond or Equivalent
TOTAL
$ 1,200.00
$ -
$ 1,200.00
100.0% $ 1,200.00
$ -
100.0% $ 1,200.00
SALARY DETAIL - SUPPORTIVE SERVICES
Est. Percent to Amount to
Position Title Annual Salary Grant Grant
Housing Case Manager $ 50,000.00 29.6% $ 14,800.00
TOTAL
FRINGE DETAIL - SUPPORTIVE SERVICES
�
14,800.00
HOPWA PSA CONTRACT 2019-2020 - EXHIBIT "B" - BUDGET
AIDS Outreach Center, Inc. Page 3
FICA
Life/Disability Insurance
Health/Dental Insurance
Unemployment-State
Worker's Compensation
TOTAL
$
Amount
3,825.00
3,825.00
Est. Percent to
Grant
29.6% $
29.6% $
Amount to
Grant
1,132.20
1,132.20
SUPPLIES AND SERVICES - SUPPORTIVE SERVICES
Est. Percent to Amount to
Total Budget Grant Grant
Office/Medical Supplies
Office Equipment Rental
Postage
Printing
TOTAL
� -
MISCELLANEOUS - SUPPORTIVE SERVICES
Est. Percent to Amount to
Total Budget Grant Grant
Contract Labor-Nutritionist
Food Supplies
TOTAL
FACILITY AND UTILITIES - SUPPORTIVE SERVICES
Est. Percent to Amount to
Total Budget Grant Grant
Utilities (Electric, Gas, water, etc)
Electric
Gas
Water and Wastewater
Solid Waste Disposal
Rent (City needs copy of lease before
expenses can be reimbursed)
Custodial Services
Maintenance/Repairs
Building Security
TOTAL
Percent of
Payroll
7.65% $
HOPWA PSA CONTRACT 2019-2020 - EXHIBIT "B" - BUDGET
AIDS Outreach Center, Inc. Page 4
LEGAL, FINANCIAL AND 1NSURANCE - SUPPORTIVE SERVICES
Est. Percent to Amount to
Total Budget Grant Grant
Professional Liability/Business Auto
TOTAL
Short-Term Rent Assistance
Short Term Mortgage Assistance
Short Term Utilities Assistance
TOTAL
Tenant Based Rental Assistance
TOTAL
DIRECT ASSISTANCE - STRMU
Est. Percent to
Total Budget Grant
$ 48,800.00 100.0% $
$ 7,000.00 100.0% $
$ 14,845.00 100.0% $
$ 70,645.00 100.0% $
DIRECT ASSISTANCE - TBRA
Est. Percent to
Total Budget Grant
$ 170,530.04 100.0%
$ 170,530.04
SALARY DETAIL - FACILITY BASED OPERATIONS
Est. Percent to
Position Title Annual Salary Grant
Property Manager
Property Support - Admin Assistant
Driver/Maintenance Manager
Driver/Maintenance Technician
TOTAL
Amount to
Grant
48,800.00
7,000.00
14,845.00
70,645.00
Amount to
Grant
$ 170,530.04
$ 170,530.04
Amount to
Grant
FRINGE DETAIL - FACILITY BASED OPERATIONS
Percent of Est. Percent to Amount to
Payroll Amount Grant Grant
FICA
Life/Disability Insurance
Health/Dental Insurance
Unemployment-State
Worker's Compensation
Retirement
TOTAL
HOPWA PSA CONTRACT 2019-2020 - EXHIBIT "B" - BUDGET
AIDS Outreach Center, Inc. Page 5
MISCELLANEOUS - FACILITY BASED OPERATIONS
Est. Percent to
Total Budget Grant
Insurance-Commercial Property and
Professional Liability
TOTAL
Detailed Total
HOPWA PSA CONTRACT 2019-2020 - EXHIBIT "B" - BUDGET
AIDS Outreach Center, Inc.
Amount to
Grant
264,680.00
Page 6
AUDIT CERTIFICATION FORM AND AUDIT REQUIREMENTS
Agency: AIDS Outreach Center
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 funds will be received, we will not exceed the $1,000,000.00
federal expenditure threshold required for a Single Audit or a Program Specific Audit to be
performed this fiscal year. (Fill out schedule below)
�
�
� �
� �
� Total Federal Expenditures for this Fiscal Year:
� ; .�� �,(��F�- � �" C`�'°',� �`�`'`�°�` 09/25/25
Signatory and Title Date
Failure to submit this or a similar statement or failure to submit a completed single audit package
as described in the federally required audit requirements described in 2 CFR Part 200, as
applicable, by the required due date may result in suspension of funding and may affect eligibility
for future funding. Notwithstandiaag the above, this ee�tifieation ael�aao�ledges the ageney's
commitment to meet all other financial reporting, financial statements, and other audit
requirements as may be set forth in the Contract.
EXHIBIT "C" - PSA CONTRACT AUDIT CERTIFICATION FORM 2
EXHIBIT "D"
REIMBURSEMENT FORMS
Exhibit D
Attachment I- Request Summary
Agency:
Address:
City, State, Zip:
Program:
Month of Service:
Tax ID Number:
Contract Number:
CaseID:
P.O. Number:
FID Number:
IDIS Number:
Amount
Program Account
Original Amount Phis Invoice Cumulativc to Date Remaining Balance
(Program Namc) Casc ID
Salaries ]001 $ - $ $ -
FICA 1002 $ - $ - $ - $ -
Life/Disability Insurance 1003 $ - $ - $ - $ -
Health/DentalInsurance 1004 $ - $ - $ - $ -
Unemployment-State 1005 $ - $ - $ - $ -
Worker's Compensation 1006 $ - $ - $ - $ -
O�ce Supplies 1007 $ - $ - $ - $ -
Food Supplies 1008 $ - $ - $ - $ -
Insurance 1009 $ - $ - $ - $ -
Accounting 1010 $ - $ - $ - $ -
ContractLabor 1011 $ - $ - $ - $ -
$ -
$ -
TOTAL $ - $ - $ - $ -
Client Goals
Oct-24
0
Goal Amount
0
Nov-24
0
Cumulative Total Goal Met %
0 #DIV/0!
Dec-24 Jan-25 Feb-25
0 0 0
Table Total
0
Mar-25
0
r-25 May-25 Jun-25 Jul-25 Aug•
0 0 0 0 0
0
Agrncy:
Pmgiarri.
Line I I
No. Check No. Date
ATTACHMENT ll
Ci[y of For[ Worth
Neighborhood Services Depar[men[
Expenditure Worksheet
Plcasc � i likc acconn[codes.
r Account Code
(Sce Key to
�noidlob Title* Ri¢ht) Amount
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� 19
� 20
� 21
� 22
� 23
� 24
� 25
� 26
� 27
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� 29
� 30
� 31
� 32
� 33
� 34
� 35
� 36
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� 39
� 40
� 41
� 42
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� 44
� 45
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Only highlighted codce cao bc rcimbursed
Expcosc Lioc Itcm
Acc unt
EhtERGENCY5HEL7ER
ESSE\TIALSERVICES
� Salaric.i 1001 �
� FICA 1002 �
� Life/Disabilirylnsurance 1003 �
� Health/Dentel Insurance 1004 �
� Uneinplo�nnent-State 1005 �
� workersco�»i,e�,sedo„ iooe �
� o�r�es„ni�ites ioo� I
I I
I I
� eooa s�nnties ioos �
� Insuiance 1009 �
� Accounting 1010 �
� ConnactLabor 1011 �
� OtlierQ 1012 �
� SHELTER OPERATIONS I
� Maintenance 2001 �
� Suuiiry 2002 �
� Insuiance 2003 �
� Utilities 2004 �
� Supplies 2005 �
� Repairs 2006 �
OtlierQ 2007
HOUSING RELOCATION AND STABILIZATION
PREVENTION
� Salaries 3001 �
� FICA 3002 �
� Life/Disabilirylnsurance 3003 �
� Heal�h/Denrellnsurence 3004 �
� Unemploymeno-S�ete 3005 �
� Workei's Compensanon 3006 �
� Otherp 3007 �
� REHOUSING �
� Selaries 4001 �
� FICA 4002 I
� Life/DisabiGry Inswance 4003 �
� Heal[h/Denrellnsurnnce 4004 �
� Uncmploymcni-Siatc 4005 �
� Wurkei'tiCompcnsution 4006 �
OlhcrQ 4007
FINANCIAL ASSISTANCE
PREVENTION
� Rcntol Astiis�ancc 5001 �
� �
� UtilityPoym�nls 5002 �
� REHOUSING �
� Rrntol Assisiencc 6001 �
� Sccurity Dcposits 6002 �
� UtilityDcposi�s 6003 �
� UnliryPoymcnrs 6004 �
� MovingCos�s 6005 �
Molcl/Iiolcl Vouchc�n 6006
HMIS
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EXHIBIT "E"
CERTIFICATION FORMS
INCOME CERTIFICATION
(NOT SUBJECT TO CITIZENSHIP AND IMMIGRATION VERIFICATION)
INCOME AND CITIZENSHIP/IMMIGRATION CERTIFICATION
(SUBJECT TO CITIZENSHIP AND IMMIGRATION VERIFICATION)
HOPWA PSA CONTRACT 2025-2026
AIDS Outreach Center, Inc.
City of Fort Worth
Applicant Name:
Current Address:
Last Name
First Name
Total Gross Annual Household Income:
TOTAL NUMBER OF FAMILY MEMBERS
CERTIFICATION OF INCOME STATEMENT
Phone #:
City and Zip:
Household Members and Income
(including applicant)
Age � Monthly Income
(Include Yourself, Spouse, Children, etc.)
Source of Income
PERSONAL DEMOGRAPHIC INFORMATION: (Check one box in each category. This information is required for federal reporting under HUD guidelines.)
a. ❑ MALE b. ❑ AMERICAN INDIAN/ALASKAN NATIVE ❑ ASIAN
❑ FEMALE ❑ BLACK/AFRICAN AMERICAN ❑ NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER
❑ WHITE ❑ AMERICAN INDIAN/ALASKAN NATIVE & WHITE
❑ ASIAN & WHITE ❑ BLACK/AFRICAN AMERICAN & WHITE
❑ AMERICAN INDIAN/ALASKAN NATIVE ❑ OTHER MULTI-RACIAL
& BLACK/AFRICAN AMERICAN
c. ETHNICITY d. DISABLED e. IS HEAD OF HOUSEHOLD FEMALE?
❑ HISPANIC ❑ YES ❑ YES
❑ NON-HISPANIC ❑ NO ❑ NO
Certification: I certify that all information I provide is true and may be subject to verification at any time by a third party. I agree to
furnish accurate and truthful information when applying for and receiving services. I understand that providing false or misleading
information may subject me to penalties under applicable Federal, State, and local laws.
Signature of Applicant
Date
WARNING: T�T�E 18, SECTION 1001 OF THE U.S. CODE STATES THAT A PERSON IS GUILTY OF A FELONY FOR KNOWINGLY AND WILLINGLY
MAKING FALSE OR FRAUDULENT STATEMENTS TO ANY DEPARTMENT OF THE UNITED STATES GOVERNMENT.
-----------------For use by Agency staff only-----------------
Household Size:
Applicable Income Limit:
Gross Annual Income:
Is Applicant Eligible?
Check if Applicant refused to provide demographic information:
Staff Assessment of Demographics:
Person Making Determination:
Date:
NOTE: Agency sfaff are required to verify all information provided in this Certification of Income Statement. This form must include the address,
income amounfs, and income sources for all household members, and all information must be verified.
HOPWA PSA CONTRACT 2025-2026
AIDS Outreach Center, Inc.
City of Fort Worth
Applicant Name:
Current Address:
CERTIFICATION OF INCOME & U.S. CITIZENSHIPIIMMIGRATION STATEMENT
Name (First & Last Name)
Total Gross Annual Household Income:
TOTAL NUMBER OF FAMILY MEMBERS
Phone #:
City and Zip:
Household Members and Income
(including applicant)
DOB Monthly Income
Source of Income
Wlth/OUt U.S.
Citizenship/
Immigration
Verification
❑YES ❑NO
❑YES ❑NO
❑YES ❑NO
❑YES ❑NO
❑YES ❑NO
$
(Include Yourself, Spouse, Children, etc.)
PERSONAL DEMOGRAPHIC INFORMATION: (Check one box in each category. This information is required for federal reporting under HUD guidelines.)
a. ❑ MALE
❑ FEMALE
c. ETHNICITY d
❑ HISPANIC
❑ NON-HISPANIC
b. ❑ AMERICAN INDIAN/ALASKAN NATIVE ❑ ASIAN
❑ BLACK/AFRICAN AMERICAN ❑ NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER
❑ WHITE ❑ AMERICAN INDIAN/ALASKAN NATIVE & WHITE
❑ ASIAN & WHITE ❑ BLACK/AFRICAN AMERICAN & WHITE
❑ AMERICAN INDIAN/ALASKAN NATIVE ❑ OTHER MULTI-RACIAL
& BLACK/AFRICAN AMERICAN
DISABLED e. IS HEAD OF HOUSEHOLD FEMALE?
❑ YES ❑ YES
❑ NO ❑ NO
Certification: I certify that all information I provide is true and may be subject to verification at any time by a third party. I agree to furnish accurate
and truthful information when applying for and receiving services. I understand that providing false or misleading information may subject me to
penalties under applicable Federal, State, and local laws.
Signature of Applicant
Date
WARNING: T�T�e 18, SECTION 1001 OF THE U.S. CODE STATES THAT A PERSON IS GUILTY OF A FELONY FOR KNOWINGLY AND WILLINGLY MAKING FALSE OR
FRAUDULENT STATEMENTS TO ANY DEPARTMENT OF THE UNITED STATES GOVERNMENT.
-----------------For use by Agency staff only-----------------
Household Size: Gross Annual Income: $ Applicable Income Limit: $
Is applicant income eligible? ❑YES ❑NO Is everyone in the household a U.S. citizen or able to provide immigration verification?
❑YES ❑NO
Applicant citizenship/immigration status verification method used: ❑SAVE Documentation ❑Government-issued Documents
❑ Check if Applicant refused to provide demographic information:
Staff Assessment of Demographics:
Person Making Determination: Date:
NOTE: Agency staff are required to verify all information provided in this Certification of Income Statement. This form must include the address,
income amounts, and income sources for all household members, citizenship status and all information must be verified.
HOPWA PSA CONTRACT 2025-2026
AIDS Outreach Center, Inc.
City of' Fort Worth
C�RTIFICATION OF INCOMC STAT�MENT
� Occupant Name:
� Current Address:
� Relationship to Property Owner:
Please write in tlie amount fo►• each t��pe of income you re�eive each montl�:
So►n•ce Amount Source
Employment/Wages $ Worl<man's Compensation
Long/Short Term Disability $ Annuity
Severance Pay $ Unemployment
VA Benefits $ TANF
Child Support $ Alimony
Insurance Settlement (installments) � Pension (Private, Government or Military)
Social Security, SSI, SSDI, RSDI, $ Recurring cash gifts from family
Survivor Benefits members/friends/chucch/etc.
Rental Income (from Real Property) $ Other-
Age:
Phone#:
Cit}� and Zip:
Please write in the amount for each type of self-employment income received in the past month:
Source Amount Sow•ce
Babysittii�g $ Mowing lawns
Hair dressing � Construction
Housel<eeping/cleaning houses $ Othec-
Please �vrite in tl�e amount of any assets that you m�y o`vn:
Source Amoimt Source
Stocl<s, Bonds or CDs � Income Taa Refund
401I< $ Gambling or Lottery winnings
Savings $ Other-
Please write iu the �mowit of any assistance that ,you receive each month:
� Source Atnount Sotu•ce
� Food Stamps (SNAP) $ Assistance Paying Utilities
� Rental Assistai�ce (Section 8, ESG, etc.) � Assistai�ce Paying for School (graiits,
Assistance from family $
memUers/frieiids/church to pay for rent,
food, utilities, etc.
loans, etc.)
Other-
Amotu�t
$ -
�
$
�
�
$
�
� I
Amount I
$ j
� �
� I
Amount �
$ I
� �
$ �
Amoiu�t �
$ I
$
$ �
Certification: I certify that the information I am providing is true and correct. I also acl<��owledge that the provision of false
information could leave me subject to the penalties of Federal, State and local law. By signing this form I also authorize the City of
Fort Worth and/or the U.S. Department of Housing and Urban Developuient to verify the above information.
Signature of Occupant
Date
WARNING: TITLE 18, SGC'I'ION 1001 OP THG U.S. CODC STAT�S THAT A PliRSON IS GU[LTY Or A T�LONI' P'Oi2
Kl�'01�'INGLY AND �1'ILLINGLI' �4fU<ING FALSG OR I'RAUDULGN"I' S7'ATGn'iG1VTS TO ANY DLPt1R'I'��I�NT OI' THG Ul�'IT�D
S7'ATIsS GOVGRNn�iGNT.
xx FOR STAFF USE ONLY xX
Total Income: $
Amount Authorized to be E�cluded, if any: $ Income Less Exclusions: $
Person Making Determination: Date:
EXHIBIT "F"
STANDARDS OF DOCUMENTATION
HOPWA PSA CONTRACT -- EXHIBIT "F" -- STANDARDS OF DOCUMENTATION
2024-25 Documentation Standards
for HOPWA Public Service Contract
Employee Salaries and Benefits - City will only reimburse a percentage of any employee's salary and benefits who work directly with the HOPWA-funded Program.
Percentages will be cost allocated and determined prior to the execution of the HOPWA Contract. Agencies requesting the reimbursement of 100°/ of any Agency
employee will require prior City approval. Agencies must show calculation on how the HOPWA portion of employee salaries and benefits were calculated consistently
with the HOPWA Contract.
Salaries
FICA/Medicare
Life Insurance
Health
Insurance
Disability
Insurance
Unemployment
Insurance
Retirement
If an employee works on both a HOPWA eligible and non-HOPWA eligible program(s), the City will only reimburse for a reasonable
portion of the employee's salary. Prior to the execution of the HOPWA Contract, the Agency will provide 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 HOPWA-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 HOPWA-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 signed timesheet and work log that reflects the hours worked by the employee(s) working
directly on the HOPWA-funded Program. For employees who are paid with multiple funding sources, timesheets must reflect all funding
sources. If separate timesheets are kept for each funding source, all such timesheets must be submitted to City. Timesheets must be
signed by employee and supervisor. Agency must show a calculation and documentation of how the employee's salary was calculated
and invoiced to City.
'If employees are paid by direct deposit rather than check, then the agency must submit both the direct deposit payment company's
report (such as an ADT report) and a bank statement or check showing payment to the direct deposit company.
X X X
X X X
x x x If the City pays gross salary, this is already included. If the City pays the employer portion, the Agency must provide proof that the
employee is enrolled in the benefit plan, must show a calculation and documentation of how the invoiced amount was calculated, and
x x x 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.
X X X
If the City pays gross salary, this is already included. If the City pays the employer portion, the Agency must provide proof that the
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 anv time there are chanaes 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 HOPWA-funded Program.
Agencies requesting reimbursement for these items will require prior City approval. Agencies must show calculation on how the HOPWA portion of these expenses
were calculated consistently with the HOPWA Contract.
Office Supplies X X
Office
Equipment X X X X
Rental
Postaqe X X
Printinq X X
Construction &
Building X X X
Materials
Sport and
Recreation X X
Equipment
Cleaning X X
Supplies
I Teaching Aids X X
� Craft Supplies X X
X This category is only available for the REACH Program and Habitat for Humanity.
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 HOPWA-funded Program and shall be cost-allocated in accordance with the amount of space used for the HOPWA-funded Program. These expenses may only be in
support of the HOPWA-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 HOPWA funds. Agencies must show calculation on how the HOPWA portion of these expenses were calculated consistently
with the HOPWA Contract.
Telephone X X
Gas X X
Water/Wastew X X
ater
Electric X X
Solid Waste � �
HOPWA PSA CONTRACT Exhibit "F" -- STANDARDS FOR COMPLETE DOCUMENTATION
Facility This item requires approval by the City prior to the execution of the HOPWA Contract. Repairs may be categorized as major/
Maintenance X X X X minor rehabilitation projects and must be approved through the full HUD Environmental 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
HOPWA-funded program.
Miscellaneous I
This item requires prior approval by the City. Prior to the execution of the HOPWA 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
Contract Labor X X X X X procurement of such 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
Insurance the HOPWA-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
Certifications
Audit Services X X X
Agecies that are required to verify and provide proof of household income to determine eligibility, must require that anyone who is over
the age of 18, living in the housohold, submit a$0 Income Certification.
If an audit is required because federal funds exceed $750,000, then the cost should be split evenly by all grant funding sources.
X Agency must show calculation on how the HOPWA portion of the accounting services were calculated. For example, if the HOPWA
grant is 10% of your Agency's budget, then invoice shall not exceed 10% of the overall cost. Agency must show a calculation and
documentation of how the invoiced amount was calculated, and must provide documentation showing payment.
*Proof of payment effective October 1, 2024: Payments or Expenses must be documented in the following manner:
A) Image of the check AND bank statement showing the check cleared the bank; OR,
B) Image of the cancelled check (ex. At end of bank statement); OR,
C) Payroll Check Stub, "Advice", or Statement AND Bank Statement indicating payroll; OR,
D) For wire or e-transfers: Reciept or statement from payee/vendor OR bank statement.
Revised as of OS-28-2023 TJ
HOPWA PSA CONTRACT Exhibit "F" -- STANDARDS FOR COMPLETE DOCUMENTATION
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Performance Report Cover
Housing Opportunities for Persons With AIDS (HOPWA) Program
Revised:02/24/2022
Consolidated APR/CAPER— Grantee Workbook
OMB Number 2506-0133 (Expirotion Date: 12/31/2024J
Overview
The public reporting burden for this collection of information is estimated to average 40A hours, induding the time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information.
Performance Reports for HOPWA formula grantees and competitive grantees provide HUD with annual information to support program evaluation and measure program beneficiary outcomes related to
maintaining housing stability; preventing homelessness; and improving access to care and support. This collection of information consolidates the information in the APR and CAPER reports and darifies
reporting requirements, which will allow HUD's Office of HIV/AIDS Housing to better respond to data calls from Congress and make better program decisions based on more relevant grantee annual data.
Reporting is required for all HOPWA grantees pursuant to 42 U.S.C. § 12911; 24 CFR §§ 574.520(a) and (b); 24 CFR 4 91.520(f). The information collected regarding grantees, their respective project sponsors, and
the identities of HOPWA program participants will remain confidential pursuant to 42 U.S.0 § 12905(e) and 24 § CFR 574.440.
Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions to reduce this burden, to Colette Pollard, Reports Management Officer, Department of
Housing and Urban Development, 451 7th Street SW, Room 4176, Washington, DC 20410-5000. When providing comments, please refer to OMB Control No. 2506-0133. HUD may not conduct and sponsor, and
a person is not required to respond to, a collection of information unless the collection displays a valid OMB Control Number.
HOPWA formula grentees are required to submit a Performance Report demonstrating coordination with other Consolidated Plan resources. HUD uses the Performance Report data to obtain essential
information on grant activities, project sponsors, housing sites, units and households, and beneficiaries (which includes racial and ethnic data on program participants�. The Consolidated Plan Management
Process tool (CPMP) provides an optional tool to integrate the reporting of HOPWA specific activities with other planning and reporting on Consolidated Plan activities.
In addition, grantees must comply with the Federal Funding Accountability and Transparency Act 2006 (Public Law 109-282), which requires grant recipients to provide general information for all entities
(including contractors and sub-contractors) receiving $25,000+ in federal funding.
HOPWA competitive grentees are required to submit a Performance Report for each operating year in which HOPWA grant funds were expended. Information on each competitive grant is to be reported in a
separate Performance Report. Grantees approved for "Other Activities", as detailed in their grant agreement, are requested to report on their unique program accomplishments.
In addition, grantees must comply with the Federal Funding Accountability and Transparency Act 2006 (Public Law 109-282), which requires grant recipients to provide general information for all entities
(includinR contractors and sub-contractors�receivinR $25,OOO+in federalfundinR.
Continued-use Periods. Grantees that used HOPWA funding for new construction, acquisition, or substantial rehabilitation of a building or structure are required to operate the building or structure for HOPWA-
eligible beneficiaries for a ten (10) years period. If no further HOPWA funds are used to support the facility, in place of completing the °CAP DEV° tab in the Performance Report Worksheet, the grantee must
complete an Annual Report of Continued Project Operation throughout the required use periods. This report is found on the "STEWARD" tab of this workbook. The required use period is three (3) years if the
rehabilitation is non-substantial.
Record Keeping. Names and other individual information must be kept confidential, as required by 24 CFR 574.440. However, HUD reserves the right to review the information used to complete this report for
grants management oversight purposes, except for recording any names and other identifying information. In the case that HUD must review client-level data, no client names or identifying information will be
retained or recorded. Information is reported in aggregate to HUD without personal identification. Do not submit client or personal information in data systems [o HUD.
HMIS. In connection with the development of the DepartmenYs standards for Homeless Management Information Systems (HMIS), universal data elements are being collected for dients of HOPWA-funded
homeless assistance oroiects. These project sponsor records would include: Name, Social Security Number, Date of Birth, Ethnicity and Race, Gender, Veteran Status, Disabling Conditions, Residence Prior to
Program Entry, Zip Code of Last Permanent Address, Housing Status, Program Entry Date, Program Exit Date, Personal Identification Number, and Household Identification Number. These are intended to match
the elements under HMIS. The HOPWA program-level data elements include: Income and Sources, Non-Cash Benefits, HIV/AIDS Status, Services Provided, Housing Status or Destination at the end of the
operating year, Physical Disability, Developmental Disability, Chronic Health Condition, Mental Health, Substance Abuse, Domestic Violence, Medical Assistance, and T-cell Count. Other HOPWA projects sponsors
may also benefit from collecting these data elements. HMIS local data systems must maintain client confidentiality by using a closed system in which medical information and HIV status are only shared with
providers that have a direct involvement in the dienYs case management, treatment and care, in line with the signed release of information from the dient.
Formula Operating Year. HOPWA formula grants are annually awarded for a three-year period of performance with three opereting years. The information contained in this Performance Report must represent a
one-year period of HOPWA program operation that coincides with the grantee's progrem year, this is the operating year. More than one HOPWA formula grant awarded to the same grantee may be used during
an operating year and the Performance Report must capture all formula grant funding used during the operating year. Project sponsor accomplishment information must also coincide with the operating year this
Performance Report covers. Any change to the period of performance requires the approval of HUD by amendment, such as an extension for an additional operating year.
Competitive Opereting Year. HOPWA competitive grants are awarded for a three-year period of performance with Performance Reports submitted for each of the three operating years. The information
contained in this Performance Report should reflect the grantee's operating year with the beginning date determined at the time the grant agreement is signed. Project sponsor accomplishment information
must coincide with the operating year this Performance Report covers. Any change to the period of performance requires the approval of HUD by amendment, such as an extension for one additional operating
year. A PSH renewal/replacement grant start date would be coordinated with the close out of the existing grant.
Grantees with an approved extension period of less than 6-months must submit the Performance Report for the third year of the gran[ term a[ the end of the approved extension period and incorporate data
from the additional months. Grantees with an approved extension period of 6-months or more must turn in a Performance Report at [he end of the operating year and submit a separate extension Performance
Report at the end of the extension period.
Filing Requirements. Within 90 days of the completion of each operating year, grantees must submit their completed Performance Report to the CPD Director in the grantee's State or Local HUD Field Office, and
to the HOPWA Program Office: at HOPWA@hud.gov. Electronic submission to HOPWA Program office is preferred. If electronic submission is not possible, please send an email to the HOPWA@hud.gov email
inbox.
Definitions
Achieved Virel Suppression: When the load or volume of HIV virus present in a person's blood is measured at less than 200 copies per milliliter of blood.
Adjustment for Duplication: Enables the calculation of unduplicated output totals by accounting for the total number of households or units that received more than one type of HOPWA assistance in a given
service category such as HOPWA Subsidy Assistance or Supportive Services.
Administrative Costs: Costs for general management, oversight, coordination, evaluation, and reporting. By statute, grantee administrative costs are limited to 3% of the total grant award, to be expended
over the life of the grant. Project sponsor administrative costs are limited to 7% of the portion of the grant amount they receive.
Anti-Retroviral Therapy: The combination of drugs used to treat HIV.
Area Median Income: The Department of Housing and Urban Development (HUD) sets income limits that determine eligibility for assisted housing programs including the HOPWA program. HUD develops
income limits based on Median Family Income estimates and Fair Market Rent area definitions for each metropolitan area, parts of some metropolitan areas, and each non-metropolitan county. AMI values vary
by location and are published at: https://www.huduser.gov/portal/datasets/il.html
Beneficiary(ies): All members of a household (with or without HIV) who benefitted from HOPWA assistance during the operating year, NOT including the HOPWA eligible individual (see definition).
Chronically Homeless Person: An individual or family who is homeless and lives or resides as an individual or family who a) lives or resides in a place not meant for human habitation, a safe haven, or in an
emergency shelter; b) has been homeless and living or residing in a place not meant for human habitation, a safe haven, or in an emergency shelter continuously for at least one year or on at least four separate
occasions in the last three years; and c) has an adult head of household (or a minor head of household if no adult is present in the household) with a diagnosable substance use disorder, serious mental illness,
developmental disability (as defined in section 102 of the Developmental Disabilities Assistance and Bill of Rights Act of 2000 (42 U.S.C. 15002), post-traumatic stress disorder, cognitive impairments resulting
From a brain injury, or chronic physical illness or disability, including the co-occurrence of two or more of those conditions. Additionally, the statutory definition includes as chronically homeless a person who
currently lives or resides in an institutional care facility, including a jail, substance abuse or mental health treatment facility, hospital or other similar facility, and has resided there for fewer than 90 days if such
person met the other criteria for homeless prior to entering that facility. (See 42 U.S.C. 11360(2)) This does not include doubled-up or overcrowding situations.
�bling Condition: Evidencing a diagnosable substance use disorder, serious mental illness, developmental disability, chronic physical illness, or disability, including the co-occurrence of two or more of these
ditions. In addition, a disabling condition may limit an individual's ability to work or perform one or more activities of daily living. An HIV/AIDS diagnosis is considered a disabling condition.
Facility-Based Housing Assistance: All eligible HOPWA Housing expenditures for or associated with supporting facilities including community residences, SRO dwellings, short-term facilities, project-based rental
units, master leased units, and other housing facilities approved by HUD.
Faith-Based Organization: Religious organizations of three types: (1) congregations; (2) national networks, which include national denominations, their social service arms (for example, Catholic Charities,
Lutheran Social Services), and networks of related organizations (such as YMCA and YWCA); and (3) freestanding religious organizations, which are incorporated separately from congregations and national
networks.
Grassroots Organization: An organization headquartered in the local community where it provides services; has a social services budget of $300,000 or less annually, and six or fewer full-time equivalent
employees. Local affiliates of national organizations are not considered "grassroots."
HOPWA Eligible Individual: The one (1) low-income person with HIV/AIDS who qualifies a household for HOPWA assistance. This person may be considered "Head of Household." When the Performance
Report asks for information on eligible individuals, report on this individual person only. Where there is more than one person with HIV/AIDS in the household, the additional PWH/A(s), would be considered a
beneficiary(s).
HOPWA Housing Information Services: Services dedicated to helping persons living with HIV/AIDS and their families to identify, locate, and acquire housing. This may also include fair housing counseling for
eligible persons who may encounter discrimination based on race, color, religion, sex, age, national origin, familial status, or handicap/disability.
HOPWA Housing Subsidy Assistance Total: The unduplicated number of households receiving housing subsidies (TBRA, STRMU, Permanent Housing Placement services and Master Leasing) and/or residing in
units of facilities dedicated to persons living with HIV/AIDS and their families and supported with HOPWA funds during the operating year.
Household: A single individual or a family composed of two or more persons for which household incomes are used to determine eligibility and for calculation of the resident rent payment. The term is used for
collecting data on changes in income, changes in access to services, receipt of housing information services, and outcomes on achieving housing stability. Live-In Aides (see definition for Live-In Aide) and non-
beneficiaries (e.g., a shared housing arrangement with a roommate) who resided in the unit are not reported in the Performance Report.
Housing Stability: The degree to which the HOPWA project assisted beneficiaries to remain in stable housing during the operating year.
Improved HIV Virel Load: A reduction in the load or volume of HIV present in the HOPWA eligible individual's blood at the end of the reporting period compared to the beginning of the reporting period. Most
PLWHA who are engaged in medical care have routine laboratory tests. The HOPWA eligible individual's latest laboratory report can be used to determine viral load.
In-kind Leveraged Resources: These are additional types of support provided to assist HOPWA beneficiaries such as volunteer services, materials, use of equipment and building space. The actual value of the
support can be the contribution of professional services, based on customary rates for this specialized support, or actual costs contributed from other leveraged resources. In determining a rate for the
contribution of volunteer time and services, use the criteria described in 2 CFR 200. The value of any donated material, equipment, building, or lease should be based on the fair market value at time of
donation. Related documentation can be from recent bills of sales, advertised prices, appraisals, or other information for comparable property similarly situated.
Funds: The amount of funds expended during the operating year from non-HOPWA federal, state, local, and private sources by grantees or sponsors in dedicating assistance to this client population.
funds or other assistance are used directiv in or in su000rt of HOPWA oroeram deliverv.
Live-In Aide: A person who resides with the HOPWA Eligible Individual and who meets the following criteria: (1) is essential to the care and well-being of the person; (2) is not obligated for the support of the
person; and (3) would not be living in the unit except to provide the necessary supportive services. See Code of Federal Regulations Title 24 Part 5.403 and the HOPWA Grantee Oversight Resource Guide for
additional reference.
Master Leasing: Applies to a nonprofit or public agency that leases units of housing (scattered-sites or entire buildings) from a landlord and subleases the units to homeless or low-income tenants. By assuming
the tenancy burden, the agency facilitates housing of clients who may not be able to maintain a lease on their own due to poor credit, evictions, or lack of sufficient income.
Medically Assisted Living Facilities: HOPWA facility-based housing that assists residents with most or all activities of daily living, such as meals, bathing, dressing, and toileting. Regular medical care,
supervision, and rehabilitation are also often available.
Nonbinary: A gender other than singularly female or male.
Operating Costs: Applies to facility-based housing only, for facilities that are currently open. Operating costs can include day-to-day housing function and operation costs like utilities, maintenance, equipment,
insurance, security, furnishings, supplies and salary for staff costs directly related to the housing project but not staff costs for delivering services.
Outcome: The degree to which the HOPWA assisted household has been enabled to establish or maintain a stable living environment in housing that is safe, decent, and sanitary, (per the regulations at 24 CFR
574.310(b)) and to reduce the risks of homelessness and improve access to HIV treatment and other health care and support.
Output: The number of units of housing or households that receive HOPWA assistance during the operating year.
Permanent Housing Placement: A supportive housing service that helps establish the household in the housing unit, including but not limited to reasonable costs for security deposits not to exceed two months
of rent costs.
Program Income: Gross income directly generated from the use of HOPWA funds, including repayments. See grant administration requirements on program income at 2 CFR 200.307.
Project-Based Rental Assistance (PBRA): A rental subsidy program that is tied to specific facilities or units owned or controlled by a project sponsor. Assistance is tied directly to the properties and is not
portable or transferable.
Project Sponsor Organizations: Per HOPWA regulations at 24 CFR 574.3, any nonprofit organization or governmental housing agency that receives funds under a contract with the grantee to provide eligible
housing and other support services or administrative services as defined in 24 CFR 574.300. Project Sponsor organizations are required to provide performance data on households served and funds expended.
SAM: All organizations applying for a Federal award must have a valid registration active at sam.gov. SAM (System for Award Management) registration includes maintaining current information and providing a
valid DUNS number.
Short-Term Rent, Mortgage, and Utility (STRMU) Assistance: A time-limited, housing subsidy assistance designed to prevent homelessness and increase housing stability. Grantees may provide assistance for
up to 21 weeks in any 52-week period. The amount of assistance varies per client depending on funds available, tenant need and program guidelines.
Stewardship Units: Units developed with HOPWA, where HOPWA funds were used for acquisition, new construction and rehabilitation that no longer receive operating subsidies from HOPWA. Report
information for the units is subject to the three-year use agreement if rehabilitation is non-substantial and to the ten-year use agreement if rehabilitation is substantial.
Tenant-Based Rental Assistance (TBRA): TBRA is a rental subsidy program similar to the Housing Choice Voucher program that grantees can provide to help low-income households access affordable housing.
The TBRA voucher is not tied to a specific unit, so tenants may move to a different unit without losing their assistance, subject to individual program rules. The subsidy amount is determined in part based on
household income and rental costs associated with the tenant's lease.
Transgender: Transgender is defined as a person who identifies with, or presents as, a gender that is different from his/her gender assigned at birth
VAWA Internal Emergency Transfers: Per 24 CFR 5.2005e, an emergency transfer under the VAWA protections refers to an emergency relocation of a tenant to another unit where the tenant would not be
categorized as a new applicant; that is, the tenant may reside in the new unit without having to undergo an application process.
VAWA External Emergency Transfers: Per 24 CFR 5.2005e, an emergency transfer under the VAWA protections refers to an emergency relocation of a tenant to another unit where the tenant would be
categorized as a new applicant; that is, the tenant must undergo an application process in order to reside in the new unit.
Veteran: A veteran is someone who has served on active duty in the Armed Forces of the United States. This does not include inactive military reserves or the National Guard unless the person was called up to
active duty.
Instructions
�Instructions for Completing the HOPWA Grantee Performance Report Workbook
What is the HOPWA Grantee Performance Report Warkbook?
This workbook provides information at the Grantee Administration level, including grantee contact information,
annual performance report narratives, and stewardship unit information.
This data will be compiled by the HOPWA Formula or Competitive Grantee, as part of providing annual performance reporting to HUD.
Who completes this form?
This workbook will be completed by the HOPWA Formula or Competitive Grantee ONLY.
Reminder: ANY entity that provides DIRECT HOPWA services - induding the HOPWA Grantee - must also complete a separate HOPWA Sponsor Performance Report Workbook.
What tabs should be completed for this report?
EVERY GRANTEE USER should complete these tabs:
. GRANTEE
. CONTACT
. Narrative
STEWARD: The Stewardship tab should only be completed if the Grantee is reporting on HOPWA Stewardship
U n its.
Grantees that used HOPWA funding for new construction, acquisition, or substantial rehabilitation of a building or structure are require to
operate the building or structure for HOPWA-eligible beneficiaries for a ten (10) years period.
If no further HOPWA funds are used to support the facility, in place of completing the "CAP DEV" tab in the Sponsor Performance Report
workbook, the grantee must complete an Annual Report of Continued Project OperaYion throughout the required use periods found on the
"STEWARD" tab of this workbook. The required use period is three (3) years if the rehabilitation is non-substantial.
Important Information:
To ensure the integrity of this workbook, please to not DELETE or ALTER any rows, columns, tabs, or the NAME of the repor .
This workbook requires the entry of data only where applicable, with no other actions required.
1 Enter text in empty cells next to questions.
2 Enter numbers where the entry reads "0" and the answer is an amount.
The workbook MUST be submitted in this Excel format. The Grantee will be unable to submit it to HUD if it has been converted to any other format, such as a Word or PDF fi e.
HOPWA Grantee Performance Report Submission Instructions: ed in HUD's IDIS
HOPWA Annual Performance reporting is collected and submitted at both the Grantee and Project Sponsor levels.
HUD or a HUD contractor will provide HOPWA Grantees annually with an advance set of named Grantee and Project Sponsor files, based on Project Sponsor activity logg
system relative to the 6rantee's Accomplishment Year on which it will be reporting.
Grantees complete this high-level Grantee workbook covering: Grantee organizational information, Grantee contact information, a narrative of all adivities provided by the Grantee an
its Project Sponsors, and Stewardship Unit information, as applicable.
Project Sponsors (and any Grantee that provides direct HOPWA activities) will complete a separate detailed annual report, called the "Sponsor Performance Report Workbook," wit
every Project Sponsor completing a workbook and submitting It to the Grantee.
The Grantee will then:
• Revlew all Sponsor Performance Report workbooks for accuracy and will request that the Project Sponsor correct any missing or incorrect Information.
• Collect all of the Grantee and Project Sponsor workbooks together.
• Submit the collection of all separate workbook files in a single transmission to HOPWAReports@HUD.gov.
• The entire collection of HOPWA workbook files is considered the 6rantee's submission of annual performance reporting under its HOPWA grant agreement.
• Grantees shall su6mit their annual Performance Report Workbook within 90 days of the completion of their operating (or Accomplishment) year.
Once submitted, the Grantee will receive confirmation regarding the submitted files and may be contacted by HUD or a HUD contractor to confirm or correct reported information, as
necessary.
For assistance with this process, please submit a query to HOPWAReports@HUD.gov,
ent�f��at,��
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Grant
Grantee
Grantee Summary
GRANTEE SUMMARY
Complete the chart below to provide more detailed information about the
agencies and organizations responsible for the administration and
implementation of the HOPWA program.
Question I Responses
For Competitive Grantees Only
For Competitive Grantees only, what is the grant number?
For Competitive Grantees only, which year (1, 2, or 3) of the grant does
this report cover?
Is the Competitive Grantee a nonprofit organization? Yes or No.
Is the Competitive Grantee a grassroots organization? Yes or No.
For Competitive Grantees only, how much was expended on an "Other
Housing Activity" (as approved in the grant agreement)?
For All HOPWA Grantees
What is the name of the Grantee organization?
What is the 6rantee's Unique Entity Identifier (UEI)?
What is the Employer ID Number (EIN) orTax ID Number (TIN) of the
Grantee?
For formula grantees only, are there any changes to your program year?
Yes or No.
Note: HUD must be noti�ed of consolidated program year changes at
least two months before the date the program year would have ended
if it had not been lengthened, or at least two months before the end of
a proposed shortened program year.
If yes above, what is the revised program start date?
If yes above, what is the revised program end date?
What is the street address of the Grantee's office?
In what city is the Grantee's business address?
In what county is the Grantee's business address?
In what state is the Grantee's office located?
What is the zip code for the Grantee's business address?
What is the parent company of the Grantee (if applicable)?
What department at the Grantee organization administers the grant?
What is the Grantee organization's website address?
What is the Facebook name or page of the Grantee?
What is the Twitter handle of the Grantee?
What are the cities of the primary service area of the Grantee?
What are the counties of the primary service area of the Grantee?
What is the congressional district of the Grantee's business address?
What is the congressional district of the Grantee's primary service area?
Is the grantee's Central Contractor Registration (CCR) status currently
active? Yes or No.
What is the grantee's Central Contractor Registration (CCR) number?
Is there a waiting list(s) for HOPWA Housing Subsidy Assistance Services
in the Grantee service area? Yes or No.
Is the Grantee's System for Award Management (SAM) status currently
active for this report? Yes or No.
What is the Grantee's SAM registration number for this report?
Does the Grantee provide HOPWA-funded services directly to clients?
Yes or No.
Does the Grantee take the allowable 3% Grantee Administration
allowance? Yes or No.
How much was expended on Grantee Administration?
Contact
Contact Information for your Organization
Question Responses
Contact Information for Authorizing Official
What is the Authorizing Official contact name?
What is the Authorizing Official contact title?
In what department does the Authorizing Official contact work?
What is the Authorizing Official contact email?
What is the Authorizing Official contact phone number (including
What is the Authorizing Official contact fax number?
Contact Information for Reporting (APR/CAPER) Contact
What is the Reporting contact name?
What is the Reporting contact title?
In what department does the Reporting contact work?
What is the Reporting contact email?
What is the Reporting contact phone number (including extension)?
What is the Reporting contact fax number?
Contact Information for HMIS User
What is the HMIS User contact name?
What is the HMIS User contact title?
In what department does the HMIS User contact work?
What is the HMIS User contact email?
What is the HMIS User contact phone number (including extension)?
What is the HMIS User contact fax number?
Contact Information for IDIS User
What is the IDIS User contact name?
What is the IDIS User contact title?
In what department does the IDIS User contact work?
What is the IDIS User contact email?
What is the IDIS User contact phone number (including extension)?
What is the IDIS User contact fax number?
Contact Information for Primary Program Contact
What is the Primary Program contact name?
What is the Primary Program contact title?
In what department does the Primary Program contact work?
What is the Primary Program contact email?
What is the Primary Program contact phone number (including extension)?
What is the Primary Program contact fax number?
Contact Information for Secondary Program Contact
What is the Secondary Program contact name?
What is the Secondary Program contact title?
In what department does the Secondary Program contact work?
What is the Secondary Program contact email?
What is the contact Secondary Program phone number (including
extensian)?
What is the Secondary Program contact fax number?
Contact Information for Individuals Seeking Services
What is the Services contact name?
What is the Services contact title?
In what department does the Services contact work?
What is the Services contact email?
What is the Services contact phone number (including extension)?
What is the Services contact fax number?
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Complete the Annual Report of Continued Usage for HOPWA Facility-Based
Stewardship Units, as defined in the Definitions, for EACH Stewardship Facility.
If more columns are needed, please contact the HOPWA Validation Team.
Question Facility 1 Facility 2 Facility 3 Facility 4
What is the name of the stewardship facility?
What is the stewardship year (1-10) for this 0 0 0 0
facility?
What date did the facility operations begin?
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stewardship facility?
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What is the name of the authorized official that
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What is the name of the primary program
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What is the email address of the primary
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Performance Report Cover
Housing Opportunities for Persons With AIDS (HOPWA) Program
Revised: 02/24/2022
Consolidated APR/CAPER — HOPWA Provider
OMB Number 2506-0133 (Expiration Date: 12/31/2024)
Overview
The public reporting burden for this collection of information is estimated to average 40.0 hours, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
Performance Reports for HOPWA formula grantees and competitive grantees provide HUD with annual information to support program evaluation and
measure program beneficiary outcomes related to maintaining housing stability; preventing homelessness; and improving access to care and support. This
collection of information consolidates the information in the APR and CAPER reports and clarifies reporting requirements, which will allow HUD's Office of
HIV/AIDS Housing to better respond to data calls from Congress and make better program decisions based on more relevant grantee annual data.
Reporting is required for all HOPWA grantees pursuant to 42 U.S.C. § 12911; 24 CFR §§ 574.520(a) and (b); 24 CFR § 91.520(f). The information collected
regarding grantees, their respective project sponsors, and the identities of HOPWA program participants will remain confidential pursuant to 42 U.S.C. §
12905(e) and 24 § CFR 574.440.
Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions to reduce this burden, to
Colette Pollard, Reports Management Officer, Department of Housing and Urban Development, 451 7th Street SW, Room 4176, Washington, DC 20410-
5000. When providing comments, please refer to OMB Control No. 2506-0133. HUD may not conduct and sponsor, and a person is not required to
respond to, a collection of information unless the collection displays a valid OMB Control Number.
HOPWA formula grantees are required to submit a Performance Report demonstrating coordination with other Consolidated Plan resources. HUD uses
the Performance Report data to obtain essential information on grant activities, project sponsors, housing sites, units and households, and beneficiaries
(which includes racial and ethnic data on program participants). The Consolidated Plan Management Process tool (CPMP) provides an optional tool to
integrate the reporting of HOPWA specific activities with other planning and reporting on Consolidated Plan activities.
In addition, grantees must comply with the Federal Funding Accountability and Transparency Act 2006 (Public Law 109-282), which requires grant
recipients to provide general information for all entities (including contractors and sub-contractors) receiving $25,000+ in federal funding.
HOPWA competitive grantees are required to submit a Performance Report for each operating year in which HOPWA grant funds were expended.
Information on each competitive grant is to be reported in a separate Performance Report. Grantees approved for "Other Activities," as detailed in their
grant agreement, are requested to report on their unique program accomplishments.
In addition, grantees must comply with the Federal Funding Accountability and Transparency Act 2006 (Public Law 109-282), which requires grant
recipients to provide general information for all entities (including contractors and sub-contractors) receiving $25,000+ in federal funding.
Continued-use Periods. Grantees that used HOPWA funding for new construction, acquisition, or substantial rehabilitation of a building or structure are
required to operate the building or structure for HOPWA-eligible beneficiaries for a ten (10) years period. If no further HOPWA funds are used to support
the facility, in place of completing the "CAP DEV" tab in the Performance Report Worksheet, the grantee must complete an Annual Report of Continued
Project Operation throughout the required use periods. This report is found on the "STEWARD" tab of this workbook. The required use period is three (3)
years if the rehabilitation is non-substantial.
Record Keeping. Names and other individual information must be kept confidential, as required by 24 CFR 574.440. However, HUD reserves the right to
review the information used to complete this report for grants management oversight purposes, except for recording any names and other identifying
information. In the case that HUD must review client-level data, no client names or identifying information will be retained or recorded. Information is
reported in aggregate to HUD without personal identification. Do not submit client or personal information in data systems to HUD.
HMIS. In connection with the development of the Department's standards for Homeless Management Information Systems (HMIS), universal data
elements are being collected for clients of HOPWA-funded homeless assistance proiects. These project sponsor records would include: Name, Social
Security Number, Date of Birth, Ethnicity and Race, Gender, Veteran Status, Disabling Conditions, Residence Prior to Program Entry, Zip Code of Last
Permanent Address, Housing Status, Program Entry Date, Program Exit Date, Personal Identification Number, and Household Identification Number. These
are intended to match the elements under HMIS. The HOPWA program-level data elements include: Income and Sources, Non-Cash Benefits, HIV/AIDS
Status, Services Provided, Housing Status or Destination at the end of the operating year, Physical Disability, Developmental Disability, Chronic Health
Condition, Mental Health, Substance Abuse, Domestic Violence, Medical Assistance, and T-cell Count. Other HOPWA projects sponsors may also benefit
from collecting these data elements. HMIS local data systems must maintain client confidentiality by using a closed system in which medical information
and HIV status are only shared with providers that have a direct involvement in the client's case management, treatment and care, in line with the signed
release of information from the client.
Formula Operating Year. HOPWA formula grants are annually awarded for a three-year period of performance with three operating years. The
information contained in this Performance Report must represent a one-year period of HOPWA program operation that coincides with the grantee's
program year; this is the operating year. More than one HOPWA formula grant awarded to the same grantee may be used during an operating year and
the Performance Report must capture all formula grant funding used during the operating year. Project sponsor accomplishment information must also
coincide with the operating year this Performance Report covers. Any change to the period of performance requires the approval of HUD by amendment,
such as an extension for an additional operating year.
Competitive Operating Year. HOPWA competitive grants are awarded for a three-year period of performance with Performance Reports submitted for
each of the three operating years. The information contained in this Performance Report should reflect the grantee's operating year with the beginning
date determined at the time the grant agreement is signed. Project sponsor accomplishment information must coincide with the operating year this
Performance Report covers. Any change to the period of performance requires the approval of HUD by amendment, such as an extension for one
additional operating year. A PSH renewal/replacement grant start date would be coordinated with the close out of the existing grant.
Grantees with an approved extension period of less than 6-months must submit the Performance Report for the third year of the grant term at the end of
the approved extension period and incorporate data from the additional months. Grantees with an approved extension period of 6-months or more
must turn in a Performance Report at the end of the operating year and submit a separate extension Performance Report at the end of the extension
period.
Filing Requirements. Within 90 days of the completion of each operating year, grantees must submit their completed Performance Report to the CPD
Director in the grantee's State or Local HUD Field Office, and to the HOPWA Program Office: at HOPWA@hud.gov. Electronic submission to HOPWA
Program office is preferred. If electronic submission is not possible, please send an email to the HOPWA@hud.gov email inbox.
Definitions
Achieved Viral Suppression: When the load or volume of HIV virus present in a person's blood is measured at less than 200 copies per milliliter of blood.
Adjustment for Duplication: Enables the calculation of unduplicated output totals by accounting for the total number of households or units that received
more than one type of HOPWA assistance in a given service category such as HOPWA Subsidy Assistance or Supportive Services.
Administrative Costs: Costs for general management, oversight, coordination, evaluation, and reporting. By statute, grantee administrative costs are
limited to 3% of the total grant award, to be expended over the life of the grant. Project sponsor administrative costs are limited to 7% of the portion of
the grant amount they receive.
Anti-Retroviral Therapy: The combination of drugs used to treat HIV.
Area Median Income: The Department of Housing and Urban Development (HUD) sets income limits that determine eligibility for assisted housing
programs including the HOPWA program. HUD develops income limits based on Median Family Income estimates and Fair Market Rent area definitions
for each metropolitan area, parts of some metropolitan areas, and each non-metropolitan county. AMI values vary by location and are published at:
https://www.huduser.gov/portal/datasets/il.html
Beneficiary(ies): All members of a household (with or without HIV) who benefitted from HOPWA assistance during the operating year, NOT including the
HOPWA eligible individual (see definition).
Chronically Homeless Person: An individual or family who is homeless and lives or resides as an individual or family who a) lives or resides in a place not
meant for human habitation, a safe haven, or in an emergency shelter; b) has been homeless and living or residing in a place not meant for human
habitation, a safe haven, or in an emergency shelter continuously for at least one year or on at least four separate occasions in the last three years; and c)
has an adult head of household (or a minor head of household if no adult is present in the household) with a diagnosable substance use disorder, serious
mental illness, developmental disability (as defined in section 102 of the Developmental Disabilities Assistance and Bill of Rights Act of 2000 (42 U.S.C.
15002), post-traumatic stress disorder, cognitive impairments resulting from a brain injury, or chronic physical illness or disability, including the co-
occurrence of two or more of those conditions. Additionally, the statutory definition includes as chronically homeless a person who currently lives or
resides in an institutional care facility, including a jail, substance abuse or mental health treatment facility, hospital or other similar facility, and has
resided there for fewer than 90 days if such person met the other criteria for homeless prior to entering that facility. (See 42 U.S.C. 11360(2)) This does
not include doubled-up or overcrowding situations.
Disabling Condition: Evidencing a diagnosable substance use disorder, serious mental illness, developmental disability, chronic physical illness, or
disability, including the co-occurrence of two or more of these conditions. In addition, a disabling condition may limit an individual's ability to work or
perform one or more activities of daily living. An HIV/AIDS diagnosis is considered a disabling condition.
Facility-Based Housing Assistance: All eligible HOPWA Housing expenditures for or associated with supporting facilities including community residences,
SRO dwellings, short-term facilities, project-based rental units, master leased units, and other housing facilities approved by HUD.
Faith-Based Organization: Religious organizations of three types: (1) congregations; (2) national networks, which include national denominations, their
social service arms (for example, Catholic Charities, Lutheran Social Services), and networks of related organizations (such as YMCA and YWCA); and (3)
freestanding religious organizations, which are incorporated separately from congregations and national networks.
Grassroots Organization: An organization headquartered in the local community where it provides services; has a social services budget of $300,000 or
less annually, and six or fewer full-time equivalent employees. Local affiliates of national organizations are not considered "grassroots."
HOPWA Eligible Individual: The one (1) low-income person with HIV/AIDS who qualifies a household for HOPWA assistance. This person may be
considered "Head of Household." When the Performance Report asks for information on eligible individuals, report on this individual person only. Where
there is more than one person with HIV/AIDS in the household, the additional PWH/A(s), would be considered a beneficiary(s).
HOPWA Housing Information Services: Services dedicated to helping persons living with HIV/AIDS and their families to identify, locate, and acquire
housing. This may also include fair housing counseling for eligible persons who may encounter discrimination based on race, color, religion, sex, age,
national origin, familial status, or handicap/disability.
HOPWA Housing Subsidy Assistance Total: The unduplicated number of households receiving housing subsidies (TBRA, STRMU, Permanent Housing
Placement services and Master Leasing) and/or residing in units of facilities dedicated to persons living with HIV/AIDS and their families and supported
with HOPWA funds during the operating year.
Household: A single individual or a family composed of two or more persons for which household incomes are used to determine eligibility and for
calculation of the resident rent payment. The term is used for collecting data on changes in income, changes in access to services, receipt of housing
information services, and outcomes on achieving housing stability. Live-In Aides (see definition for Live-In Aide) and non-beneficiaries (e.g., a shared
housing arrangement with a roommate) who resided in the unit are not reported in the Performance Report.
Housing Stability: The degree to which the HOPWA project assisted beneficiaries to remain in stable housing during the operating year.
Improved HIV Viral Load: A reduction in the load or volume of HIV present in the HOPWA eligible individual's blood at the end of the reporting period
compared to the beginning of the reporting period. Most PLWHA who are engaged in medical care have routine laboratory tests. The HOPWA eligible
individual's latest laboratory report can be used to determine viral load.
In-kind Leveraged Resources: These are additional types of support provided to assist HOPWA beneficiaries such as volunteer services, materials, use of
equipment and building space. The actual value of the support can be the contribution of professional services, based on customary rates for this
specialized support, or actual costs contributed from other leveraged resources. In determining a rate for the contribution of volunteer time and services,
use the criteria described in 2 CFR 200. The value of any donated material, equipment, building, or lease should be based on the fair market value at time
of donation. Related documentation can be from recent bills of sales, advertised prices, appraisals, or other information for comparable property similarly
situated.
Leveraged Funds: The amount of funds expended during the operating year from non-HOPWA federal, state, local, and private sources by grantees or
sponsors in dedicating assistance to this client population. Leveraged funds or other assistance are used directly in or in support of HOPWA program
delivery.
Live-In Aide: A person who resides with the HOPWA Eligible Individual and who meets the following criteria: (1) is essential to the care and well-being of
the person; (2) is not obligated for the support of the person; and (3) would not be living in the unit except to provide the necessary supportive services.
See Code of Federal Regulations Title 24 Part 5.403 and the HOPWA Grantee Oversight Resource Guide for additional reference.
Master Leasing: Applies to a nonprofit or public agency that leases units of housing (scattered-sites or entire buildings) from a landlord and subleases the
units to homeless or low-income tenants. By assuming the tenancy burden, the agency facilitates housing of clients who may not be able to maintain a
lease on their own due to poor credit, evictions, or lack of sufficient income.
Medically Assisted Living Facilities: HOPWA facility-based housing that assists residents with most or all activities of daily living, such as meals, bathing,
dressing, and toileting. Regular medical care, supervision, and rehabilitation are also often available.
Nonbinary: A gender other than singularly female or male.
Operating Costs: Applies to facility-based housing only, for facilities that are currently open. Operating costs can include day-to-day housing function and
operation costs like utilities, maintenance, equipment, insurance, security, furnishings, supplies and salary for staff costs directly related to the housing
project but not staff costs for delivering services.
Outcome: The degree to which the HOPWA assisted household has been enabled to establish or maintain a stable living environment in housing that is
safe, decent, and sanitary, (per the regulations at 24 CFR 574.310(b)) and to reduce the risks of homelessness and improve access to HIV treatment and
other health care and support.
Output: The number of units of housing or households that receive HOPWA assistance during the operating year.
Permanent Housing Placement: A supportive housing service that helps establish the household in the housing unit, including but not limited to
reasonable costs for security deposits not to exceed two months of rent costs.
Program Income: Gross income directly generated from the use of HOPWA funds, including repayments. See grant administration requirements on
program income at 2 CFR 200.307.
Project-Based Rental Assistance (PBRA): A rental subsidy program that is tied to specific facilities or units owned or controlled by a project sponsor.
Assistance is tied directly to the properties and is not portable or transferable.
Project Sponsor Organizations: Per HOPWA regulations at 24 CFR 574.3, any nonprofit organization or governmental housing agency that receives funds
under a contract with the grantee to provide eligible housing and other support services or administrative services as defined in 24 CFR 574.300. Project
Sponsor organizations are required to provide performance data on households served and funds expended.
SAM: All organizations applying for a Federal award must have a valid registration active at sam.gov. SAM (System for Award Management) registration
includes maintaining current information and providing a valid DUNS number.
Short-Term Rent, Mortgage, and Utility (STRMU) Assistance: A time-limited, housing subsidy assistance designed to prevent homelessness and increase
housing stability. Grantees may provide assistance for up to 21 weeks in any 52-week period. The amount of assistance varies per client depending on
funds available, tenant need and program guidelines.
Stewardship Units: Units developed with HOPWA, where HOPWA funds were used for acquisition, new construction and rehabilitation that no longer
receive operating subsidies from HOPWA. Report information for the units is subject to the three-year use agreement if rehabilitation is non-substantial
and to the ten-year use agreement if rehabilitation is substantial.
Tenant-Based Rental Assistance (TBRA): TBRA is a rental subsidy program similar to the Housing Choice Voucher program that grantees can provide to
help low-income households access affordable housing. The TBRA voucher is not tied to a specific unit, so tenants may move to a different unit without
losing their assistance, subject to individual program rules. The subsidy amount is determined in part based on household income and rental costs
associated with the tenant's lease.
Transgender: Transgender is defined as a person who identifies with, or presents as, a gender that is different from his/her gender assigned at birth
VAWA Internal Emergency Transfers: Per 24 CFR 5.2005e, an emergency transfer under the VAWA protections refers to an emergency relocation of a
tenant to another unit where the tenant would not be categorized as a new applicant; that is, the tenant may reside in the new unit without having to
undergo an application process.
VAWA External Emergency Transfers: Per 24 CFR 5.2005e, an emergency transfer under the VAWA protections refers to an emergency relocation of a
tenant to another unit where the tenant would be categorized as a new applicant; that is, the tenant must undergo an application process in order to
reside in the new unit.
Veteran: A veteran is someone who has served on active duty in the Armed Forces of the United States. This does not include inactive military reserves or
the National Guard unless the person was called up to active duty.
Instructions
� Instructions for Completing the HOPWA Performance Report Workbook
What is the HOPWA Performance Report Workbook?
This workbook provides annual performance data for HOPWA activities. This includes outputs (e.g., households served and
demographic information), outcomes (e.g., access to care and support outcomes) and expenditures (for HOPWA-eligible costs).
This data will be compiled by the HOPWA Formula or Competitive Grantee, as part of providing annual performance reporting to HUD.
Who completes this
form?
This workbook will be completed by any organization that conducts any HOPWA activities other than administrative activities. This
includes HOPWA Formula or Competitive Grantees that conduct other HOPWA activities besides administrative activities, and the
Project Sponsor organizations that Grantees contract to provide HOPWA services (as defined in 24 CFR 574.3).
There should be one organization's HOPWA activities reported in each workbook. Each organization should complete a separate
performance report workbook that only includes the HOPWA activities conducted by that organization.
What tabs should be completed for this report?
The Performance Report Workbook requires the completion of the following tabs:
• DEM (DemographicsJ & Prior Living (see NoteJ
Leveraging
ATC (Access to CareJ & Totals
ONLY PROJECT SPONSORS* should complete these tabs:
HOPWA Provider
CONTACT
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Provider Summary
Please complete for organizations designated to serve as project sponsor, i.e., organizations involved in the direct delivery
of services for client households, as defined by 24 CFR 574.3.
Project Sponsor Questions Responses
What is the organization's name?
What is the organization's Unique Entity Identifier (UEI)?
What is the organization's Employer ID Number (EIN) or Tax
ID Number (TIN)?
What is the HOPWA contract amount for this organization?
What is the organization's business street address?
In what city is the organization's business address?
In what county is the organization's business address?
In what state is the organization's business address?
What is the organization's business address zip code?
What is the organization's parent company, if applicable?
What department administers the organization's grant?
What is the organization's phone number (including
extension)?
What is the organization's fax number?
What is the organization's website?
What is the organization's Facebook page?
What is the organization's Twitter handle?
Is this a faith-based organization? Yes or No.
Is this a nonprofit organization? Yes or No.
0
Is this a grassroots organization? Yes or No.
What are the cities of the organization's primary service
area?
What are the counties of the organization's primary service
area?
In what congressional district is the organization located?
In what congressional district is the primary service area?
Is there a waiting list for HOPWA housing subsidy assistance
services in the organization's service area? Yes or No.
Project Sponsor Non-Direct Service Expenditures
What were the total HOPWA funds expended for
Administration costs?
How much was expended on Technical Assistance?
0
0
How much was expended on Resource Identification? 0
Contact
Contact Information for your Organization
Only organizations designated as project sponsors (see definition of "Project Sponsor Organization" in
Performance Report Cover tab) should complete this tab.
Question Responses
Contact Information for Primary Program Contact
What is the Primary Program contact name?
What is the Primary Program contact title?
In what department does the Primary Program contact work?
What is the Primary Program contact email?
What is the Primary Program contact phone number (including extension)?
What is the Primary Program contact fax number?
Contact Information for Secondary Program Contact * I -
What is the Secondary Program contact name?
What is the Secondary Program contact title?
In what department does the Secondary Program contact work?
What is the Secondary Program contact email?
What is the Secondary Program contact phone number (including extension)?
What is the Secondary Program contact fax number?
Contact Information for Individuals Seeking Services I -
What is the Services contact name?
What is the Services contact title?
In what department does the Services contact work?
What is the Services contact email?
What is the Services contact phone number (including extension)?
What is the Services contact fax number?
Demographics and Prior Living
A. For each racial
category, how many Of the total number of
HOPWA-eligible individuals reported
Individuals identified Male Female Gender Nonbinary Transgender Female Transgender Male Gender not Disclosed for each racial
as such? category, how many
Asian
Asian & White
Black/African American
Black/African American
& White
American
Indian/Alaskan Native
American
Indian/Alaskan Native
& Black/African
American
American
Indian/Alaskan Native
& White
Native Hawaiian/Other
Pacific Islander
Other Multi-Racial
White
also identify as
Hispanic or Latinx?
Younger 51 or Younger 31- 51 or Younger 51 or Younger 51 or Younger 51 or Younger 51 or
Than 18 18-30 31-50 Qlder Than 1S 18-30 50 Older Than 18 18-30 31-50 Older Than 18 18-30 31-50 Older Than 18 18-30 31-50 Older Than 18 18-30 31-50 Older Total Hispanic or Latinx
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0
0
0
0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0
0
0
0
B. For each racial
category, how many
other household
members
(beneficiaries)
identified as such?
Asian
Asian & White
Black/African American
Black/African American
& White
American
Indian/Alaskan Native
American
Indian/Alaskan Native
& Black/African
American
American
Indian/Alaskan Native
& White
Native Hawaiian/Other
Pacific Islander
Other Multi-Racial
W h ite
Of the total number of
individuals reported
for each racial
Male Female Gender Nonbinary Transgender Female Transgender Male Gender not Disclosed
category, how many
also identify as
Hispanic or Latinx?
Younger 51 or Younger 31- 51 or Younger 51 or Younger 51 or Younger 51 or Younger 51 or
18-30 31-50 18-30 18-30 31-50 18-30 31-50 18-30 31-50 18-30 31-50 Total Hispanic or Latinx
Than 18 Older Than 18 50 Older Than 1S Older Than 1S Older Than 18 Older Than 18 Older
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 G 0 0 0 G 0 0 0 C
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
Total number of other household members (beneficiaries) served with
HOPWA assistance (rows 16-25):
How many other household members (beneficiaries) are HIV+?
How many other household members (beneficiaries) are HIV negative or have
an unknown HIV status?
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
�
�
�
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
C
C
C
C
Complete Prior Living Situations for HOPWA-eligible Individuals served by TBRA,
P-FBH ST-TFBH, or PHP
How many HOPWA-eligible individuals continued receiving HOPWA assistance 0
from the previous year?
How many individuals newly receiving HOPWA assistance came from:
A place not meant for human habitation?
An emergency shelter?
A transitional housing facility for formerly homeless persons?
A permanent housing situation for formerly homeless persons?
A psychiatric hospital or other psychiatric facility?
A substance abuse facility?
A non-psychiatric hospital?
A foster care home?
Jail, prison, or a juvenile detention facility?
A rented room, apartment or house?
A house the individual owned?
Staying at someone else's house?
A hotel or motel paid for by the individual?
Any other prior living situation?
How many individuals newly receiving HOPWA assistance didn't report or
refused to report their prior living situation?
How many individuals newly receiving HOPWA assistance during this program
year reported a prior living situation of homelessness [place not for human
habitation, emergency shelter, transitional housing]:
Also meet the definition of experiencing chronic homelessness?
Also were veterans?
�
�
�
�
C
�
�
�
�
0
0
0
0
0
0
0
0
0
Leve ra �i�n
Report the source(s) of cash or in-kind leveraged federal, state, local or private resources identified in either the Consolidated or Annual Plan
(for formula grantees) or the grant proposal/application (for competitive grantees) and used in the delivery of the HOPWA program and the
amount of leveraged dollars.
What is the amount and type of leveraged funding that was provided by
any of these sources?
ESG
HOME
Ryan White
Continuum of Care (CoC)
Low-Income Housing Tax Credit
Housing Choice Voucher Program
Private grants
In-kind resources
Funding for this Report Was this a Housing Subsidy Assistance?
Yes or No.
0
0
0
0
0
0
0
0
Grantee cash 0
I Other types of private or public funding: I I
Other FUNDING_1 0
Other FUNDING_2 0
Other FUNDING_3 0
Other FUNDING_4 0
Other FUNDING_5 0
Other FUNDING_6 0
Other FUNDING_7 0
Other FUNDING_8 0
Other FUNDING_9 0
Other FUNDING_10 0
Other FUNDING_11 0
Other FUNDING_12 0
Other FUNDING_13 0
Other FUNDING_14 0
Other FUNDING 15 0
Program Income I I
What was the amount of program income collected from resident rent
payments in the program year?
What was the amount of program income collected from other sources 0
(non-resident payments) in the program year?
What was the amount of resident rent payment that residents paid 0
directly to private landlords?
Uses of Program Income I
What was the amount of total program income that was spent on housing 0
assistance in the program year?
What was the amount of total program income that was spent on 0
supportive services or other non-housing costs in the program year?
Tenant Based Rental Assistance (TBRA)
Complete this section for all Households served with HOPWA Tenant-Based Rental Assistance (TBRA) by your organization
in the reporting year.
Question
TBRA Households Served and Expenditures
How many households were served with HOPWA TBRA assistance?
What were the total HOPWA funds expended for TBRA rental assistance?
This Report
Other (Non-TBRAJ Rental Assistance
Households Served and Expenditures (Other Non-TBRA Rental Assistance activities must
be approved in the grant agreementJ.
How many total households were served with Other (non-TBRAJ Rental Assistance?
What were the total HOPWA funds expended for Other (non-TBRA) Rental Assistance, as
approved in the grant agreement?
Describe the Other (non-TBRA) Rental Assistance provided. (150 characters).
TBRA Household Total (TBRA + Other)
Income Levels for Households Served by this Activity
What is the number of households with income below 30% of Area Median Income?
What is the number of households with income between 31% and 50% of Area Median
Income?
What is the number of households with income between 51% and 80% of Area Median
Income?
Sources of Income for Households Served by this Activity
How many households accessed or maintained access to the following sources of income
in the past year?
Earned Income from Employment
Retirement
SSI
SSDI
Other Welfare Assistance (Supplemental Nutrition Assistance Program, WIC, TANF,
etc.)
i
E�
0
0
0
o �
0
0
0
0
�
�
�
�
�
�
Private Disability Insurance 0
Veteran's Disability Payment (service or non-service connected payment)
Regular contributions or gifts from organizations or persons not residing in the
residence
Worker's Compensation
General Assistance (GA), or local program
Unemployment Insurance
Other Sources of Income
How many households maintained no sources of income?
Medical lnsurance for Households Served by rhis Acriviry
How many households accessed or maintained access to the following sources of inedical
insurance in the past year?
MEDICAID Health Program or local program equivalent
MEDICARE Health Insurance or local program equivalent
Veterans Affairs Medical Services
AIDS Drug Assistance Program
State Children's Health Insurance Program (SCHIP) or local program equivalent
Ryan White-funded Medical or Dental Assistance
Health Outcomes for Households Served by this Activity
How many HOPWA-eligible individuals served with TBRA this year have ever been
prescribed Anti-Retroviral Therapy?
How many HOPWA-eligible persons served with TBRA have shown an improved viral load
or achieved viral suppression?
Longevity for Households Served by this Activity
How many households have been served with TBRA for less than one year?
How many households have been served with TBRA for more than one year, but less than
five years?
How many households have been served with TBRA for more than five years, but less
than 10 years?
How many households have been served with TBRA for more than 10 years, but less than
15 years?
How many households have been served with TBRA for more than 15 years?
Housing Outcomes for Households Served by this Activity
How many households continued receiving HOPWA TBRA assistance into the next year?
How many households exited to other HOPWA housing programs?
How many households exited to other housing subsidy programs?
0
0
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�
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�
�,
0
0
0
0
0
0
�
�
I
�
�
�
�
�
�
�
�
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How many households exited to an emergency shelter?
How many households exited to private housing?
How many households exited to transitional housing (time limited - up to 24 months)?
How many households exited to an institutional arrangement expected to last less than
six months?
How many households exited to institutional arrangement expected to last more than six
months?
How many households exited to a jail/prison term expected to last less than six months?
How many households exited to a jail/prison term expected to last more than six months?
How many households exited to a situation that isn't transitional, but is not expected to
last more than 90 days and their housing situation after those 90 days is uncertain?
How many households exited to a place not meant for human habitation?
How many households were disconnected from care?
How many of the HOPWA eligible individuals died?
0
0
0
0
0
0
0
0
0
0
0
Permanent Facility Based Housing
Complete this section for all Households served with HOPWA
Permanent Facility-Based Housing assistance by your
organization in the reporting year.
Question
Facility Information
What is the name of the housing facility?
Is the facility a medically assisted living facility? Yes or No.
Was the housing facility placed into service during this program year?
Yes or No.
For housing facilities placed into service during this program year,
how many units were placed into service? [Do not complete if facility
placed in service in prior years.]
Leasing -- Households and Expenditures Served by this Activiry
How many households received Permanent Facility-Based Housing
Leasing support for each facility?
What were the HOPWA funds expended for Permanent Facility-Based
Housing Leasing Costs for each facility?
Operating -- Households and Expenditures Served by this Activity
How many households received Permanent Facility-Based Housing
Operating support for each facility?
What were the HOPWA funds expended for Permanent Facility-Based
Housing Operating Costs for each facility?
Other Housing Support -- Households and Expenditures Served by
this Activity
How many households received Other types of Permanent Facility-
Based Housing support for each facility?
What were the HOPWA funds expended for Other types of
Permanent Facility-Based Housing for each facility?
For households served with Other Permanent Facility-Based Housing,
what type of service were they provided? (150 characters)
PFBH Deduplication
Facility 1
0
�
0
�
U
[�7
0
There are sixty columns for
facilities. lf more columns are
needed, please contact the HOPWA
Validation Team.
Facility 2 Facility 3
0
C�]
0
L�]
C�]
[�7
0
C�'.
L
C
�
L
C�
�i'.
How many households received more than one type of PFBH for each
facility? (Leasing, Operating, Other)
Total Deduplicated Household Count
Income Levels for Households Served by this Activity
What is the number of households with income below 30% of Area
Median Income?
What is the number of households with income between 31% and
50% of Area Median Income?
What is the number of households with income between 51% and
80% of Area Median Income?
Sources of Income for Households Served by this Activity
How many households accessed or maintained access to the following
sources of income in the past year?
Earned Income from Employment
Retirement
SSI
SSDI
Other Welfare Assistance (Supplemental Nutrition Assistance
Program, WIC, TANF, etc.)
Private Disability Insurance
Veteran's Disability Payment (service or non-service connected
payment)
Regular contributions or gifts from organizations or persons not
residing in the residence
Worker's Compensation
General Assistance (GA), or local program
Unemployment Insurance
Other Sources of Income
How many households maintained no sources of income?
Medical lnsurance for Households Served by this Activity
How many households accessed or maintained access to the following
sources of inedical insurance in the past year?
MEDICAID Health Program or local program equivalent
MEDICARE Health Insurance or local program equivalent
Veterans Affairs Medical Services
AIDS Drug Assistance Program
0
0 0
0
0
0
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U
�
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0 0
0
0 0
0 0
C�]
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,�
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,�
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State Children's Health Insurance Program (SCHIP) or local program
equivalent
Ryan White-funded Medical or Dental Assistance
Longevity for Households Served by this Activity
How many households have been served by permanent facility-based
housing for less than one year?
How many households have been served by permanent facility-based
housing for more than one year, but less than 5 years?
How many households have been served by permanent facility-based
housing for more than 5 years, but less than 10 years?
How many households have been served by permanent facility-based
housing for more than 10 years, but less than 15 years?
How many households have been served by permanent facility-based
housing for more than 15 years?
Healih Outcomes for Households Served by this Activity
How many HOPWA-eligible individuals served with PFBH this year
have ever been prescribed Anti-Retroviral Therapy, by facility?
How many HOPWA-eligible persons served with PFBH have shown an
improved viral load or achieved viral suppression, by facility?
Housing Outcomes for Households Served by this Activity
How many households continued receiving this type of HOPWA
assistance into the next year?
How many households exited to other HOPWA housing programs?
How many households exited to other housing subsidy programs?
How many households exited to an emergency shelter?
How many households exited to private housing?
How many households exited to transitional housing (time limited -
up to 24 months)?
How many households exited to institutional arrangement expected
to last less than six months?
How many households exited to institutional arrangement expected
to last more than six months?
How many households exited to a jail/prison term expected to last
less than six months?
How many households exited to a jail/prison term expected to last
more than six months?
0 p
0 p
- - -
0 p
0 p
0 p
0
0
- -
0
0
- -
0
0
0
0
0
0
0
0
0
0
0
0
-
0
0
�
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
�
�
0
Q
0
0
0
0
0
0
0
0
How many households exited to a situation that isn't transitional, but 0 0 0
is not expected to last more than 90 days and their housing situation
after those 90 days is uncertain?
How many households exited to a place not meant for human 0 0 0
habitation?
How many households were disconnected from care? 0 0 0
How many of the HOPWA eligible individuals died? 0 0 0
Short-Term and Transitional Facility-Based Housing
Complete this section for Facilities, Households served with
HOPWA Short-Term or Transitional Facility-Based Housing
assistance by your organization in the reporting year.
Examples include Short-Term and Transitional Housing Types, Facility
eased Housing with a tenure of fewer than 24 months, short-term
treatment or health facilities, hotel-motel vouchers.
There are sixty columns for facilities. lf more
columns are needed, please contact the HOPWA
Validation Team.
Question Facility 1
Facility Information
What is the name of the housing facility?
Is the facility a medically assisted living facility? Yes or No.
Was the housing facility placed into service during this program year?
Yes or No.
For housing facilities placed into service during this program year, how
many units were placed into service? [Do not complete if facility placed
in service in prior years.]
Leasing -- Households and Expenditures Served by this Activiry
How many households received Transitional/Short-Term Facility-Based
Housing Leasing support for each facility?
What were the HOPWA funds expended for Transitional/Short-Term
Facility-Based Housing Leasing Costs for each facility?
Operating -- Households and Expenditures Served by this Activity
How many households received Transitional/Short-Term Facility-Based
Housing Operating support for each facility?
What were the HOPWA funds expended for Transitional/Short-Term
Facility-Based Housing Operating Costs for each facility?
Hotel-Motel -- Households and Expenditures Served by this Activity
How many households received Hotel-Motel cost support for each
facility?
What were the HOPWA funds expended for Hotel-Motel Costs for each
facility?
Other Housing Support -- Households and Expenditures Served by this
Activity
0
0
0
0
0
0
0
Facility 2
0
0
0
0
0
0
0
Facility 3
0
0
0
0
0
0
0
How many households received Other types of Transitional/Short-Term
Facility-Based Housing support for each facility?
What were the HOPWA funds expended for Other types of
Transitional/Short-Term Facility-Based Housing for each facility?
For households served with Other Transitional/Short-Term Facility-
Based Housing, what type of service were they provided? (150
characters)
ST-TFBH Deduplication
How many households received more than one type of ST-TFBH for
each facility? (Leasing, Operating, Hotel-Motel, Other)
Total Deduplicated Household Count
Income Levels for Households Served by this Activity
What is the number of households with income below 30% of Area
Median Income?
What is the number of households with income between 31% and SO%
of Area Median Income?
What is the number of households with income between 51% and 80%
of Area Median Income?
Sources of Income for Households Served by this Activity
How many households accessed or maintained access to the following
sources of income in the past year?
Earned Income from Employment
Retirement
SSI
SSDI
Other Welfare Assistance (Supplemental Nutrition Assistance
Program, WIC, TANF, etc.)
Private Disability Insurance
Veteran's Disability Payment (service or non-service connected
payment)
Regular contributions or gifts from organizations or persons not
residing in the residence
Worker's Compensation
General Assistance (GA), or local program
Unemployment Insurance
Other Sources of Income
How many households maintained no sources of income?
�i7
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0
0 0
0
0
0
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0
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0 0
0
0 0
0 0
0
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Medical lnsurance for Households Served by rhis Acriviry
How many households accessed or maintained access to the following
sources of inedical insurance in the past year?
MEDICAID Health Program or local program equivalent
MEDICARE Health Insurance or local program equivalent
Veterans Affairs Medical Services
AIDS Drug Assistance Program
State Children's Health Insurance Program (SCHIP) or local program
equivalent
Ryan White-funded Medical or Dental Assistance
Longevity for Households Served by this Activity
How many households have been served by short-term/transitional
facility-based housing for less than one year?
How many households have been served by short-term/transitional
facility-based housing for more than one year, but less than five years?
How many households have been served by short-term/transitional
facility-based housing for more than five years, but less than 10 years?
How many households have been served by short-term/transitional
facility-based housing for more than 10 years, but less than 15 years?
How many households have been served by short-term/transitional
facility-based housing for more than 15 years?
Housing Outcomes for Households Served by this Activity
How many households continued receiving this type of HOPWA
assistance into the next year?
How many households exited to other HOPWA housing programs?
How many households exited to other housing subsidy programs?
How many households exited to an emergency shelter?
How many households exited to private housing?
How many households exited to transitional housing (time limited - up
to 24 months)?
How many households exited to institutional arrangement expected to
last less than six months?
How many households exited to institutional arrangement expected to
last more than six months?
How many households exited to a jail/prison term expected to last less
than six months?
0
0
0
0
0
0
- -
0
0
0
0
0
- -
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
-
0
0
0
0
0
-
0
�
�
�
�
�
U
0
0
�
�
�
�
�
0
0
0
0
0
0
0
�
�
�
�
�
U
0
0
How many households exited to a jail/prison term expected to last more
than six months?
How many households exited to a situation that isn't transitional, but is
not expected to last more than 90 days and their housing situation after
those 90 days is uncertain?
How many households exited to a place not meant for human
habitation?
How many households were disconnected from care?
How many of the HOPWA eligible individuals died?
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
Short-Term Rent, Mortgage and Utility (STRMU)
Complete this section for all Households served with HOPWA Short-Term Rent, Mortgage, and Utilities Assistance
(STRMU) by your organization in the reporting year.
Question
Households Served by rhis Activity - STRMU ereakdown
a. How many households were served with STRMU mortgage assistance only?
b. How many households were served with STRMU rental assistance only?
c. How many households were served with STRMU utilities assistance only?
d. How many households received more than one type of STRMU assistance?
STRMU Households Total
STRMU Expenditures
What were the HOPWA funds expended for the following budget line items?
This Report
STRMU mortgage assistance
STRMU rental assistance
STRMU utility assistance
Total STRMU Expenditures
Income Levels for Households Served by this Activity
What is the number of households with income below 30% of Area Median Income?
�
What is the number of households with income between 31% and 50% of Area Median Income?
What is the number of households with income between 51% and 80% of Area Median Income?
Sources of Income for Households Served by this Activity
How many households accessed or maintained access to the following sources of income in the past year?
Earned Income from Employment
Retirement
SSI
SSDI
Other Welfare Assistance (Supplemental Nutrition Assistance Program, WIC, TANF, etc.)
Private Disability Insurance
Veteran's Disability Payment (service or non-service connected payment)
�
L
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Regular contributions or gifts from organizations or persons not residing in the residence
Worker's Compensation
General Assistance (GA), or local program
Unemployment Insurance
Other Sources of Income
How many households maintained no sources of income?
Medical lnsurance for Households Served by rhis Acriviry
How many households accessed or maintained access to the following sources of inedical insurance in the
past year?
MEDICAID Health Program or local program equivalent
MEDICARE Health Insurance or local program equivalent
Veterans Affairs Medical Services
AIDS Drug Assistance Program
State Children's Health Insurance Program (SCHIP) or local program equivalent
Ryan White-funded Medical or Dental Assistance
n
�
�
�
�
�
n
�
�
�
�
C�]
I Longevity for Households Served by this Activity I 0
How many households have been served by STRMU for the first time this year? 0
How many households also received STRMU assistance during the previous STRMU eligibility period? 0
How many households received STRMU assistance more than twice during the previous five eligibility 0
periods?
How many households received STRMU assistance during the last five consecutive eligibility periods? 0
Housing Outcomes for Households Served by this Activity p
How many households continued receiving this type of HOPWA assistance into the next year? 0
How many households exited to other HOPWA housing programs? 0
How many households exited to other housing subsidy programs? 0
How many households exited to an emergency shelter? 0
How many households served with STRMU were able to maintain a private housing situation without 0
subsidy?
How many households exited to transitional housing (time limited - up to 24 months)? 0
How many households exited to institutional arrangement expected to last less than six months? 0
How many households exited to institutional arrangement expected to last more than six months? 0
How many households exited to a jail/prison term expected to last less than six months? 0
How many households exited to a jail/prison term expected to last more than six months? 0
How many households exited to a situation that isn't transitional, but is not expected to last more than 90 0
days and their housing situation after those 90 days is uncertain?
How many households exited to a place not meant for human habitation? 0
How many households were disconnected from care? 0
How many of the HOPWA eligible individuals died? 0
How many households are likely to need additional Short-Term Rent, Mortgage and Utilities assistance to 0
maintain the current housing arrangements?
Permanent Housin� Placement (PHP)
Complete this section for all Households served with HOPWA Permanent Housing Placement (PHP) assistance by your organization in
the reporting year.
Question This Report
Households Served by this Activity
How many households were served with PHP assistance?
PHP Expenditures for Households Served by this Activity _
What were the HOPWA funds expended for PHP?
Sources of Income for Households Served by this Activity �
How many households accessed or maintained access to the following sources of income in the past year? 0
Earned Income from Employment
Retirement
SSI
SSDI
Other Welfare Assistance (Supplemental Nutrition Assistance Program, WIC, TANF, etc.)
Private Disability Insurance
Veteran's Disability Payment (service or non-service connected payment)
Regular contributions or gifts from organizations or persons not residing in the residence
Worker's Compensation
General Assistance (GA), or local program
Unemployment Insurance
Other Sources of Income
How many households maintained no sources of income?
Medical lnsurance for Households Served by this Activity
1
How many households accessed or maintained access to the following sources of inedical insurance in the past year?
MEDICAID Health Program or local program equivalent
MEDICARE Health Insurance or local program equivalent
Veterans Affairs Medical Services
AIDS Drug Assistance Program
State Children's Health Insurance Program (SCHIP) or local program equivalent
Ryan White-funded Medical or Dental Assistance
Housing Outcomes for Households Served by this Activity �
0
�
�
N
M
N
M
M
N
M
M
N
M
N
�
M
M
M
N
M
N
�
i
In the context of PHP, "exited" means the housing situation into which the household was placed using the PHP assistance.
How many households exited to other HOPWA housing programs? 0
How many households exited to other housing subsidy programs?
How many households exited to private housing?
Housin� Information Services
Complete for all households served with HOPWA-funded Housin� Information Services by your organization
in the reporting year.
See definition of "Housing Information Services" on "Performance Report Cover" tab.
Question
Households Served by this Activity
How many households were served with housing information services?
Housing Information Services Expenditures
What were the HOPWA funds expended for Housing Information Services?
This Report
0
0
Supportive Services
Complete for all households served with HOPWA funded Supportive Services by your organization in the reporting
yea r.
Note that this table also collects HOPWA Supportive Service expenditures.
Questions
Households and Expenditures for Supportive Service Types
This Report
Number of Households Expenditures
What were the expenditures and number of households for each of the
following types of supportive services in the program year?
Adult Day Care and Personal Assistance
Alcohol-Drug Abuse
Child Care
Case Management
Education
Employment Assistance and Training
Health/Medical Services
Legal Services
Life Skills Management
Meals/Nutritional Services
Mental Health Services
Outreach
Transportation
Any other type of HOPWA funded, HUD approved supportive service?
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
What were the other type(s) of supportive services provided? (150
characters)
Deduplication of Supportive Services
How many households received more than one of any type of
Supportive Services?
0
Access to Ca re (ATC) a n d Tota I s
HOu51ng Other
Activity Review TBRA P-FBH ST-TFBH STRMU PHP Info SUPP $VC Competitive
act���ty
Total Households Served in ALL 0 0 0 0 0 0 0 0
Activities from this report for
each Activity.
Housing Subsidy Assistance Household Count Deduplication
Total Housing Subsidy Assistance (from the TBRA, P-FBH, ST- O
FBH, STRMU, PHP, Other Competitive Activity counts aboveJ
How many households received more than one type of HOPWA
Housing Subsidy Assistance for TBRA, P-FBH, ST-FBH, STRMU, p
PHP, Other Competitive Activity?
Total Unduplicated Housing Subsidy Assistance Household �
Count
Access to Care (ATC)
Complete HOPWA Outcomes for Access to Care and Support for all
households served with HOPWA housing assistance and "other
competitive activities" in the reporting year.
I Questions This Report
How many households had contact with a case manager? 0
How many households developed a housing plan for 0
maintaining or establishing stable housing?
How many households accessed and maintained medical 0
insurance and/or assistance?
How many households had contact with a primary health care 0
provider?
How many households accessed or maintained qualification for 0
sources of income?
How many households obtained/maintained an income- 0
producing job during the program year (with or without any
HOPWA-related assistance)?
Subsidy Assistance with Supportive Service, Funded Case Management
IQuestions This Report
How many households received any type of HOPWA Housing 0
Subsidy Assistance and HOPWA Funded Case Management?
How many households received any type of HOPWA Housing 0
Subsidy Assistance and HOPWA Supportive Services?
Capital Development
Complete for all HOPWA Facility-based Capital
Development Projects that received Capital
Development funds in this reporting year. This
includes projects that received HOPWA Capital
Development funds and opened to residents in
this reporting year.
Note: Scattered site facilities may be reported as one
facilit .
Question Facility 1
Facility Information
What is the name of the facility using HOPWA for
capital development (acquisition or rehabilitation)?
For facilities being rehabilitated, what was the total
amount of funding spent on rehabilitation?
What type of development was funded (new
construction, rehabilitation, acquisition)?
For facilities being rehabilitated only, what is the
final value of the building after rehabilitation is
complete?
What type of housing (Permanent or Short-
term/Transitional) was developed?
For Capital Development facilities, what is the
purchase or lease date of the property?
For Capital Development facilities, what is the date
the construction or rehabilitation started (if
applicable)?
Capital Development Expenditures
How much was expended in this year on
acquisition, for each facility?
�
Capital Development means
the use of HOPWA funds to
construct, acquire, or
rehabilitate a housing facility.
Facility 2 Facility 3 Facility 4
0 0 0
0 0 0 0
01 01 01 0
How much was expended on rehabilitation, for each
facility?
How much was expended on new construction, for
each facility?
Was the development facility placed into service
during this program year? Yes or No.
Complete for Capital Development Facilities
Opened This Year ONLY. If the facility was not
opened this year, skip this section.
How many total units were placed into service this
year?
What date did the supportive services begin?
What date was the construction or rehabilitation
completed?
What date did residents begin to occupy the
facility?
Is there a waiting list maintained for the facility? Yes
or No.
If there is a waiting list, how many households are
on the waiting list?
How many total units (HOPWA and non-HOPWA
units) were developed in this facility?
How many units in this facility were developed with
HOPWA funds?
For all Facilities
0 0
0 0
�
^I
�
�
�
�
0
�
�
�
0 0
0 0
0
�
�
�
0
�
�
�
Total Units
Total Units Total Units 504
Designated for Designated Total Units Accessible
the Chronically to Assist Energy-Star — Mobility
Homeless the Compliant Units —
Homeless Sensory
Units
For units constructed (new) and/or acquired with or
without rehab: 0 0
For rental units rehabbed: 0 0
For homeownership units constructed (if approved): 0 0
�
�
�
�
�
�
Violence Against Women Act (VAWA)
Complete for all households who requested
Violence Against Women Act (VAWA)
protections per 24 CFR 5.2005 with your
organization in the reporting year.
Question
This Report
How many internal emergency transfers were
requested? 0
How many internal emergency transfers were
granted? 0
How many external emergency transfers were
requested? 0
How many external emergency transfers were
granted? 0
How many emergency transfers were denied? 0
Other Competitive Activity
Only Competitive Grantees with an "Other Housing Activity"
approved in their grant agreement should complete this tab.
"Other" Housing Activities -- Households and This Report
Expenditures Served by this Activity
How many households were served with "Other
Housing Activity" assistance?
What were the HOPWA funds expended for
"Other Housing Activity" assistance?
What is the "Other" HOPWA budget line item
approved in the grant agreement? (150
characters)
EXHIBIT "H"
MBE REPORTING FORM
HOPWA PSA CONTRACT -- EXHIBIT "H" -- MBE REPORTING FORM Page 1
COntraCt and SUbCOntrBCt ACtiVity U.S. Department of Housing and Urban Development OMB Approvxl No.: 2577-0088 OMB
Approval No.: 2502-0355
Public reporting burden for this collection of information is estimated to average .5 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The
Information is voluntary. HUD may not wllect this information, a��d you are not required to complete this form, unless it displays a currently valid OMB Conhol Number.
Exccutivc Ordcrs datcd July 14, 1983, dirccts thc Minority Busincss Dcvclopmcnt Plans shaLl bc dcvclopcd by cach Fcdcra] Agcncy and thc thcsc an�ua] plans shall cstablish minority busincss dcvclopmcnt objcctivcs. Thc information is uscd by HUD to monitor and cvaluatc MBE activitics against
the total program activity and the designated minority business enterprise (MBE) goals. The Department requires the information to provide guidance and oversight for programs for the development of minority business enterprise concerning Minority Business Development If the information is
not collected HOD would not be able to establish meaningful MBE goals nor evaluate MBE performance against these goals.
Privacy Act Notice = The United States Department of Housing and Urban Development, Federal Housing Administration, is authorized to solicit the Information requested in this form by virtue of Title 12, United States Code, Section 1701 et seq., and xegulation. 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 L.aw.
1. Grantee/Project OwnedDeveloper/SponsorBuilder/Agency
3a. Name of Contact Pecson
Check if: �� Location (City, State Zip Code)
PH
IH
CPD
Housing
36. Phone Numbec pncluding Area Code) 4. Reporhn¢ 5. Pmgrnm Code (Not applicable for CPD programsJ � fi Dnte Suhmitted m Field
See expinnatfon of Codes et bottum u} page Use a
� Oet I- Sept. 30 (Annurl -FY) �eParzre sheec for each progrzm code.
Conr�actor ur
Grant/Project Number o� HUD Subcontracror
Case Number or oH�er Amount of Type of Trade Business Subcontractor
idcntilicnuon of properry. Contract or Codc Raciel/Ethmc Womnn Owncd B�slnaa Pnmc Contcnctor ldcnuflcetion pD) Idcnuflcetion QD)
subdrvfsloqd���elGngunlr,erc Subcontact (Seebelow) (Seebelow) (YesorNo) number Sec. 3 Number Sec.3
7a. 76. 7c 7d. 7e. 7f. 7g. 7h 7i.
� � � � � � � � Name
CPD:
1 = Vew Constmction
2 — education/Training
3 — Othcr
7c: Typc of Tradc Codcs:
Housing/Public Housiug:
I—NewConstmction 6=Professlonal
2— Substaniial Rehab. 7= Tenant Services
3=Repai� B=Education/iraming
4—Service 9=Arch/Engrg.Apprai,al
5= Proiect Manqt. 0= Otha-
7d: Racial/E[hnic Codcs:
I = White �mericans
2 — Black Americans
3 — Native Americans
4 = Hispanic Americans
5 — Asian/Pacif c Americans
6 = Hasidic lews
Contractor/Subcontractor Name and Address
7j.
Street
City State Zip
5: Program Codes (Complete for Housiug and Public and Indian Housing programe only):
I= All [nsured, including Section8 5= Secnon 202
2= Flexible Subsidy 6= HUD-Held (Management)
3=SeotionBNoninsured,Non-HFDA 7=PublidlndieHousing
4= Iusured (Meuagement) 8= Sutiou Al l
Previous editions are obsolece. form HUD-2516 (A/98)
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EXHIBIT "I"
NOTICE OF BENEFICIARY RIGHTS
HOPWA PSA CONTRACT -- EXHIBIT "P' — NOTICE OF BENEFICIARY RIGHTS Page 1
Notice of Beneficiary Rights
Name of Agency:
Name of Program:
Contact information for Program Staff (name, phone number, and e-mail address, if appropriate):
Because this program is supported in whole or in part by direct Federal financial assistance from
the Federal Government, we are required to let you know that:
• We may not discriminate against you on the basis of religion, religious belief, a refusal
to hold a religious belief, or a refusal to attend or participate in a religious practice;
• We may not require you to attend or participate in any eXplicitly religious activities that
are offered by us and any participation by you in these activities must be purely
voluntary;
• We must separate, in time or location, any privately funded explicitly religious activities
from activities supported by direct Federal financial assistance;
• If you object to the religious character of our organization, we must make reasonable
efforts to identify and refer you to an alternative provider to which you have no such
objection; and
• You may report an organization's violations of these protections, including any denial of
services or benefits, by contacting or filing a written complaint to HUD [or the
intermediary, if applicable].
We must give you this written notice before you enroll in our program or activity, as required by
24 CFR 5.109.
HOPWA PSA CONTRACT -- EXHIBIT "P' — NOTICE OF BENEFICIARY RIGHTS Page 2
NOTICE OF OCCUPANCY RIGHTS LTNDER U.S. Department of Housing and Urban Development
THE VIOLENCE AGAINST WOMEN ACT OMB Approval No. 2577-0286
Expires 06/30/2017
EXHIBIT "J" — Notice of Occupancv Ri�hts Under VAWA
AIDS Outreach Center, Inc.l
Notice of Occupancy Rights under the Violence Against Women Act2
To all Tenants and Applicants
The Violence Against Women Act (VAWA) provides protections for victims of domestic
violence, dating violence, sexual assault, or stalking. VAWA protections are not only available
to women, but are available equally to all individuals regardless of sex, gender identity, or sexual
orientation.3 The U.S. Department of Housing and Urban Development (HUD) is the Federal
agency that oversees that [insert name of program or rental assistance� is in compliance with
VAWA. This notice explains your rights under VAWA. A HUD-approved certification form is
attached to this notice. You can fill out this form to show that you are or have been a victim of
domestic violence, dating violence, sexual assault, or stalking, and that you wish to use your
rights under VAWA."
Protections for Applicants
If you otherwise qualify for assistance under �insert name of pro�ram or rental assistance],
you cannot be denied admission or denied assistance because you are or have been a victim of
domestic violence, dating violence, sexual assault, or stalking.
Protections for Tenants
' The notice uses HP for housing provider but the housing provider should insert its name where HP is used.
HUD's program-specific regulations identify the individual or entity responsible for providing the notice of
occupancy rights.
� Despite the name of this law, VAWA protection is available regardless of sex, gender identity, or sexual
orientation.
3 Housing providers cannot discriminate on the basis of any protected characterisric, including race, color, narional
origin, religion, sex, familial status, disability, or age. HUD-assisted and HUD-insured housing must be made
available to all otherwise eligible individuals regardless of actual or perceived sexual orientation, gender identity, or
marital status.
Form HUD-5380
(12/2016)
2
If you are receiving assistance under �insert name of pro�ram or rental assistance], you may
not be denied assistance, terminated from participation, or be evicted from your rental housing
because you are or have been a victim of domestic violence, dating violence, sexual assault, or
stalking.
Also, if you or an affiliated individual of yours is or has been the victim of domestic violence,
dating violence, sexual assault, or stalking by a member of your household or any guest, you
may not be denied rental assistance or occupancy rights under [insert name of pro�ram or
rental assistance� solely on the basis of criminal activity directly relating to that domestic
violence, dating violence, sexual assault, or stalking.
Affiliated individual means your spouse, parent, brother, sister, or child, or a person to whom
you stand in the place of a parent or guardian (for example, the affiliated individual is in your
care, custody, or control); or any individual, tenant, or lawful occupant living in your household.
Removing the Abuser or Perpetrator from the Household
HP may divide (bifurcate) your lease in order to evict the individual or terminate the assistance
of the individual who has engaged in criminal activity (the abuser or perpetrator) directly relating
to domestic violence, dating violence, sexual assault, or stalking.
If HP chooses to remove the abuser or perpetrator, HP may not take away the rights of eligible
tenants to the unit or otherwise punish the remaining tenants. If the evicted abuser or perpetrator
was the sole tenant to have established eligibility for assistance under the program, HP must
allow the tenant who is or has been a victim and other household members to remain in the unit
for a period of time, in order to establish eligibility under the program or under another HUD
housing program covered by VAWA, or, find alternative housing.
Form HUD-5380
(12/2016)
3
In removing the abuser or perpetrator from the household, HP must follow Federal, State, and
local eviction procedures. In order to divide a lease, HP may, but is not required to, ask you for
documentation or certification of the incidences of domestic violence, dating violence, sexual
assault, or stalking.
Moving to Another Unit
Upon your request, HP may permit you to move to another unit, subject to the availability of
other units, and still keep your assistance. In order to approve a request, HP may ask you to
provide documentation that you are requesting to move because of an incidence of domestic
violence, dating violence, sexual assault, or stalking. If the request is a request for emergency
transfer, the housing provider may ask you to submit a written request or fill out a form where
you certify that you meet the criteria for an emergency transfer under VAWA. The criteria are:
(1) You are a victim of domestic violence, dating violence, sexual assault, or
stalking. If your housing provider does not already have documentation that you
are a victim of domestic violence, dating violence, sexual assault, or stalking, your
housing provider may ask you for such documentation, as described in the
documentation section below.
(2) You expressly request the emergency transfer. Your housing provider may
choose to require that you submit a form, or may accept another written or oral
request.
(3) You reasonably believe you are threatened with imminent harm from
further violence if you remain in your current unit. This means you have a
reason to fear that if you do not receive a transfer you would suffer violence in the
very near future.
Form HUD-5380
(12/2016)
0
�'
You are a victim of sexual assault and the assault occurred on the premises
during the 90-calendar-day period before you request a transfer. If you are a
victim of sexual assault, then in addition to qualifying for an emergency transfer
because you reasonably believe you are threatened with imminent harm from
further violence if you remain in your unit, you may qualify for an emergency
transfer if the sexual assault occurred on the premises of the property from which
you are seeking your transfer, and that assault happened within the 90-calendar-day
period before you expressly request the transfer.
HP will keep confidential requests for emergency transfers by victims of domestic violence,
dating violence, sexual assault, or stalking, and the location of any move by such victims and
their families.
HP's emergency transfer plan provides further information on emergency transfers, and HP must
make a copy of its emergency transfer plan available to you if you ask to see it.
Documenting You Are or Have Been a Victim of Domestic Violence, Dating Violence,
Sexual Assault or Stalking
HP can, but is not required to, ask you to provide documentation to "certify" that you are or have
been a victim of domestic violence, dating violence, sexual assault, or stalking. Such request
from HP must be in writing, and HP must give you at least 14 business days (Saturdays,
Sundays, and Federal holidays do not count) from the day you receive the request to provide the
documentation. HP may, but does not have to, extend the deadline for the submission of
documentation upon your request.
Form HUD-5380
(12/2016)
You can provide one of the following to HP as documentation. It is your choice which of the
following to submit if HP asks you to provide documentation that you are or have been a victim
of domestic violence, dating violence, sexual assault, or stalking.
• A complete HUD-approved certification form given to you by HP with this notice, that
documents an incident of domestic violence, dating violence, seXual assault, or stalking.
The form will ask for your name, the date, time, and location of the incident of domestic
violence, dating violence, sexual assault, or stalking, and a description of the incident.
The certification form provides for including the name of the abuser or perpetrator if the
name of the abuser or perpetrator is known and is safe to provide.
• A record of a Federal, State, tribal, territorial, or locallaw enforcement agency, court, or
administrative agency that documents the incident of domestic violence, dating violence,
sexual assault, or stalking. Examples of such records include police reports, protective
orders, and restraining orders, among others.
A statement, which you must sign, along with the signature of an employee, agent, or
volunteer of a victim service provider, an attorney, a medical professional or a mental
health professional (collectively, "professional") from whom you sought assistance in
addressing domestic violence, dating violence, seXual assault, or stalking, or the effects of
abuse, and with the professional selected by you attesting under penalty of perjury that he
or she believes that the incident or incidents of domestic violence, dating violence, seXual
assault, or stalking are grounds for protection.
• Any other statement or evidence that HP has agreed to accept.
If you fail or refuse to provide one of these documents within the 14 business days, HP does not
have to provide you with the protections contained in this notice.
Form HUD-5380
(12/2016)
3
If HP receives conflicting evidence that an incident of domestic violence, dating violence, sexual
assault, or stalking has been committed (such as certification forms from two or more members
of a household each claiming to be a victim and naming one or more of the other petitioning
household members as the abuser or perpetrator), HP has the right to request that you provide
third-party documentation within thirty 30 calendar days in order to resolve the conflict. If you
fail or refuse to provide third-party documentation where there is conflicting evidence, HP does
not have to provide you with the protections contained in this notice.
Confidentiality
HP must keep confidential any information you provide related to the exercise of your rights
under VAWA, including the fact that you are exercising your rights under VAWA.
HP must not allow any individual administering assistance or other services on behalf of HP (for
example, employees and contractors) to have access to confidential information unless for
reasons that specifically call for these individuals to have access to this information under
applicable Federal, State, or local law.
HP must not enter your information into any shared database or disclose your information to any
other entity or individual. HP, however, may disclose the information provided if:
• You give written permission to HP to release the information on a time limited basis.
• HP needs to use the information in an eviction or termination proceeding, such as to evict
your abuser or perpetrator or terminate your abuser or perpetrator from assistance under
this program.
• A law requires HP or your landlord to release the information.
Form HUD-5380
(12/2016)
VAWA does not limit HP's duty to honor court orders about access to or control of the property.
This includes orders issued to protect a victim and orders dividing property among household
members in cases where a family breaks up.
Reasons a Tenant Eligible for Occupancy Rights under VAWA May Be Evicted or
Assistance May Be Terminated
You can be evicted and your assistance can be terminated for serious or repeated lease violations
that are not related to domestic violence, dating violence, sexual assault, or stalking committed
against you. However, HP cannot hold tenants who have been victims of domestic violence,
dating violence, sexual assault, or stalking to a more demanding set of rules than it applies to
tenants who have not been victims of domestic violence, dating violence, sexual assault, or
stalking.
The protections described in this notice might not apply, and you could be evicted and your
assistance terminated, if HP can demonstrate that not evicting you or terminating your assistance
would present a real physical danger that:
1) Would occur within an immediate time frame, and
2) Could result in death or serious bodily harm to other tenants or those who work on the
property.
If HP can demonstrate the above, HP should only terminate your assistance or evict you if there
are no other actions that could be taken to reduce or eliminate the threat.
Other Laws
VAWA does not replace any Federal, State, or local law that provides greater protection for
victims of domestic violence, dating violence, sexual assault, or stalking. You may be entitled to
Form HUD-5380
(12/2016)
additional housing protections for victims of domestic violence, dating violence, sexual assault,
or stalking under other Federal laws, as well as under State and local laws.
Non-Compliance with The Requirements of This Notice
You may report a covered housing provider's violations of these rights and seek additional
assistance, if needed, by contacting or filing a complaint with [insert contact information for
any intermediary, if applicable] or [insert HUD field office].
For Additional Information
You may view a copy of HUD's final VAWA rule at [insert Federal Register link].
Additionally, HP must make a copy of HUD's VAWA regulations available to you if you ask to
see them.
For questions regarding VAWA, please contact �insert name of program or rental assistance
contact information able to answer questions on VAWAj.
For help regarding an abusive relationship, you may call the National Domestic Violence Hotline
at 1-800-799-7233 or, for persons with hearing impairments, 1-800-787-3224 (TTY). You may
also contact [Insert contact information for relevant local organizations].
For tenants who are or have been victims of stalking seeking help may visit the National Center
for Victims of Crime's Stalking Resource Center at https://www.victimsofcrime.org/our-
programs/stalking-resource-center.
For help regarding seXual assault, you may contact [Insert contact information for relevant
organizations]
Victims of stalking seeking help may contact [Insert contact information for relevant
organizations].
Attachment: Certification form HUD-5382 [form approved for this program to be included]
Form HUD-5380
(12/2016)
EXHIBIT "K" — Emergency Transfer Request Form
CERTIFICATION OF U.S. Department of Housing OMB Approval No. 2577-0286
DOMESTIC VIOLENCE, and Urban Development Exp. 06/30/2017
DATING VIOLENCE,
SEXUAL ASSAULT, OR STALKING,
AND ALTERNATE DOCUMENTATION
Purpose of Form: The Violence Against Women Act ("VAWA") protects applicants, tenants, and
program participants in certain HUD programs from being evicted, denied housing assistance, or
terminated from housing assistance based on acts of domestic violence, dating violence, sexual assault, or
stalking against them. Despite the name of this law, VAWA protection is available to victims of domestic
violence, dating violence, sexual assault, and stalking, regardless of sex, gender identity, or sexual
orientation.
Use of This Optional Form: If you are seeking VAWA protections from your housing provider, your
housing provider may give you a written request that asks you to submit documentation about the incident
or incidents of domestic violence, dating violence, sexual assault, or stalking.
In response to this request, you or someone on your behalf may complete this optional form and submit it
to your housing provider, or you may submit one of the following types of third-party documentation:
(1) A document signed by you and an employee, agent, or volunteer of a victim service provider, an
attorney, or medical professional, or a mental health professional (collectively, "professional") from
whom you have sought assistance relating to domestic violence, dating violence, sexual assault, or
stalking, or the effects of abuse. The document must specify, under penalty of perjury, that the
professional believes the incident or incidents of domestic violence, dating violence, sexual assault, or
stalking occurred and meet the definition of "domestic violence," "dating violence," "sexual assault," or
"stalking" in HUD's regulations at 24 CFR 5.2003.
(2) A record of a Federal, State, tribal, territorial or local law enforcement agency, court, or
administrative agency; or
(3) At the discretion of the housing provider, a statement or other evidence provided by the applicant or
tenant.
Submission of Documentation: The time period to submit documentation is 14 business days from the
date that you receive a written request from your housing provider asking that you provide documentation
of the occurrence of domestic violence, dating violence, sexual assault, or stalking. Your housing
provider may, but is not required to, extend the time period to submit the documentation, if you request an
extension of the time period. If the requested information is not received within 14 business days of when
you received the request for the documentation, or any extension of the date provided by your housing
provider, your housing provider does not need to grant you any of the VAWA protections. Distribution or
issuance of this form does not serve as a written request for certification.
Confidentiality: All information provided to your housing provider concerning the incident(s) of
domestic violence, dating violence, sexual assault, or stalking shall be kept confidential and such details
shall not be entered into any shared database. Employees of your housing provider are not to have access
to these details unless to grant or deny VAWA protections to you, and such employees may not disclose
this information to any other entity or individual, except to the extent that disclosure is: (i) consented to
Form HUD-5382
(06/2017)
2
by you in writing in a time-limited release; (ii) required for use in an eviction proceeding or hearing
regarding termination of assistance; or (iii) otherwise required by applicable law.
TO BE COMPLETED BY OR ON BEHALF OF THE VICTIM OF DOMESTIC VIOLENCE,
DATING VIOLENCE, SEXUAL ASSAULT, OR STALKING
1. Date the written request is received by victim:
2. Name of victim:
3. Your name (if different from victim's):
4. Name(s) of other family member(s) listed on the lease:
5. Residence of victim:
6. Name of the accused perpetrator (if known and can be safely disclosed):
7. Relationship of the accused perpetrator to the victim:
8. Date(s) and times(s) of incident(s) (if known):
10. Location of incident(s):
In your own words, briefly describe the incident(s):
This is to certify that the information provided on this form is true and correct to the best of my knowledge
and recollection, and that the individual named above in Item 2 is or has been a victim of domestic violence,
dating violence, sexual assault, or stalking. I acknowledge that submission of false information could
jeopardize program eligibility and could be the basis for denial of admission, termination of assistance, or
eviction.
Signature Signed on (Date)
Public Reporting Burden: The public reporting burden for this collection of information is estimated to
average 1 hour per response. This includes the time for collecting, reviewing, and reporting the data. The
information provided is to be used by the housing provider to request certification that the applicant or
tenant is a victim of domestic violence, dating violence, sexual assault, or stalking. The information is
subject to the confidentiality requirements of VAWA. This agency may not collect this information, and
you are not required to complete this form, unless it displays a currently valid Office of Management and
Budget control number.
Form HUD-5382
(06/2017)
���� ����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.
1►l:�u1�11
TELEPHONE:
I:��]�]:��f.�.Yl
E-MAIL ADDRESS (if applicable)
1. Are you employed by the City of Fort Worth?
la. 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:
� YES � � NO
� YES � ❑ NO
3. Are any members of your immediate family currently employed by the City of Fort Worth?
("Immediate Family" includes (whether by blood or adoption): the spouse, parent (includirag a stepparent), � IrES ❑ N�
child (iracluding a stepchild), brother, sister (including a stepbrother or stepsister), grandparent, grandchild,
and in-laws.)
3a. If yes, please provide relarive'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?
Sa. If yes, by which Department and Division:
YES I NO
❑ ❑
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):
Certiitcation: 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 Ig� SEC'I'ION 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 form is completed and if "Yes" is marked on any of the above questions, please return it
to your Compliance Specialist as soon as possible for processing. If you have any questions, please contact Barbara
Asbury, Grants Manager, Compliance Division, at 817-392-7331, or Charletta Moaning, Sr. Contract Compliance
Specialist, at 817-392-7333 or at charlettamoaning�fortwort_h_tcxas.go_v_.
Neighborhood Services Department-Conflict Disclosure Form, Dated September 18, 2014-City Only
Rental Assistance Worksheet
Form I
Must be completed before rental assistance starts & annual eligibility recertifications. Must be completed if household eligibility factors or rent have changed.
Households receiving TBRA or TSH services must pay as rent, including utilities, an amount which is the higher of: (1) 30% of the
household's monthly adjusted income (adjustment factors include the age of the individual, medical expenses, size of household and
child care expenses and are described in 24 CFR §5.611); (2) 10% of the household's monthly gross income; or (3) if the household is
receiving payments for welfare assistance from a public agency and a part of the payments, adjusted in accordance with the household's
actual housing costs, is specifically designated by the agency to meet the household's housing costs, the portion of the payment that is
designated for housing costs. The outlines acceptable forms of deduction
verification and deduction calculation guidance.
Client Name and/or ID Number:
Housing Case Manager Name:
Address:
Section 1: Household Annual and Monthly Gross Income
1 HOUSEHOLD ANNUAL GROSS INCOME (Form C, Line 9)
$0.00
2 HOUSEHOLD MONTHLY GROSS INCOME (Line 1 divided by 12) $0.00
Section 2: Deductions
Project Sponsors must attach documentation of all deductions claimed by the household. Only third-party verification is permitted.
3$480 FOR EACH DEPENDENT 0 $0.00
Dependents include household members who are minors under 18 years of age, members of any age
who are disabled, or members who are full-time students, but not the head of household, co head,
spouse, sole member, foster children, or foster adults.
4$525 FOR ELDERLY OR DISABLED HOUSEHOLDS
This deduction is provided to any household whose head, co-head, spouse, or sole member is at least
62 years of age or is disabled. This deduction always applies to households with persons with
HIV/AIDS if they are the head, co-head, spouse, or sole member. Households that are program
eligible only due to a minor with HIV are not eligible for this deduction.
5 UNREIMBURSED MEDICAL EXPENSES
These are expenses anticipated during the year that will not be reimbursed, to the extent the sum
exceeds 10% of household annua/ gross income. The attendant care and auxiliary apparatus
deduction may not exceed the earned income of household members 18 years of age or older who
are able to work because of such attendant care or auxiliary apparatus. Attendant care expenses
cannot be paid to another household member.
a Unreimbursed medical expenses for elderly or disabled households
b Unreimbursed reasonable attendant care and auxiliary apparatus expenses
for each member who is elderly or disabled that enables that member or any
other member to work
c Total unreimbursed medical expenses (Sum of Lines 5a & 5b)
d 10% of household annual gross income (Line 1 x 0.10)
e Allowable medical expense deduction (Line 5c minus 5d)
If result is a negative number, enter $0.
6 UNREIMBURSED CHILDCARE EXPENSES
These are expenses anticipated during the year that will not be reimbursed for children 12 years of
age and under that enable a household member to work, seek employment, or to further education.
The childcare deduction may not exceed the earned income of household members 18 years of age
or older who are able to work because of such childcare. Childcare expenses cannot be paid to
another household member.
Date:
Effective Date:
Number of Dependents
Yes
Meets Criteria?
$525.00
$0.00
Line Se
C 1 11
$0.00
----------------
$0.00
----------------
$0.00
----------------
$0.00
----------------
$0.00
Section 3: Household Monthly Adjusted Income
7 HOUSEHOLD MONTHLY ADJUSTED INCOME
a Household annual gross income (Line 1)
b Total deductions (Sum of Lines 3, 4, 5, & 6)
$0.00
----------------
$525.00
----------------
$0.00
----------------
$0.00
Line 7d
c Household annual adjusted income (Line 7a minus 7b)
If result is a negative number, enter $L.
d Household monthly adjusted income (Line 7c divided by 12)
$0.00
----------------
DSHS Program Form I 1 of 5 Previous versions are obsolete (09/01/22)
Rental Assistance Worksheet
Form I
Section 4: Household Monthly Rent Payment
8 HOUSEHOLD MONTHLY RENT PAYMENT TO OWNER
a 30% of household monthly adjusted income (Line 7d x 0.30)
b 10% of household monthly gross income (Line 2 x 0.10)
c Household's monthly public assistance designated for housing costs
d Household rent payment (Greater of Lines 8a, 8b, or 8c)
e Utility allowance (Form H)
A household must receive a utility allowance if they pay a separate utility vendor in additi
to rent and utilities paid to the owner. If the allowance is greater than Line Sd, the adju5red
household rent payment is $0 and the difference ("utility reimbursement"J must be paid to the
utility vendor. If the household does not qualify for a utility allowance, enter $0.
f Household rent payment to owner less utility allowance (Lines 8d minus 8e)
If result is a negative number, enter $0.
Section 5: Project Sponsor Monthly Rent Payment
9 PROJECT SPONSOR MONTHLY RENT PAYMENT TO OWNER
a Unit rent to owner per current lease agreement (Form H)
b Household rent payment to owner (Line 8f)
c Project Sponsor rent payment to owner (Line 9a minus 9b)
If Line 9c is $0 or less, household does not qualify for rental assistance sr
10 PROJECT SPONSOR MONTHLY UTILITY REIMBURSEMENT PAYMENT TO UTILITY VENDOR
If Line Se is greater than Sd, the difference ("utility reimbursement"J must be paid to the utility
vendor. Complete Lines 10a through 10d to determine the amount paid to the utility vendor. The
sum of Lines 8, 9, and 10 cannot exceed the lower of the rent standard or reasonable rent for the
unit. If Line Se is not greater than line 8d, enter $0.
a Lower of the rent standard or reasonable rent for the unit (Form H)
b Lower less Project Sponsor rent payment to owner (Line 10a minus 9c)
c Utility allowance balance (Line 8e minus 8d)
If result is a negative number, enter $0.
d Project Sponsor utility payment to utility vendor (Lesser of Lines 10b or 10c)
$0.00
----------------
$0.00
----------------
$0.00
----------------
$0.00
----------------
$0.00
----------------
$0.00
Line Sf
$0.00
----------------
$0.00
----------------
$0.00
----------------
$0.00
----------------
$0.00
----------------
$0.00
----------------
$0.00
----------------
$0.00
----------------
$0.00
Line 9c
$0.00
Line 10d
Section 6: Prorated First and/or Last Month's Rent
Will rental assistance pay the first month's rent? Will rental assistance pay the last month's rent?
a Will the rent be prorated?
b What is the prorated rent?
c What is the move-in date?
d Number of prorated days assisted:
e Household prorated rent:
f Project Sponsor prorated rent:
g Project Sponsor prorated utility reimbursement
a Will the rent be prorated?
$0.00 b What is the prorated rent?
c What is the move-out date?
0 d Number of prorated days assisted:
$0.00 e Household prorated rent:
$0.00 f Project Sponsor prorated rent:
$0.00 g Project Sponsor prorated utility reimbursement
Section 7: Violence Against Women Act (VAWA) Lease Addendum Confirmation
To receive TBRA or TSH services, a household's lease must include a VAWA Lease Addendum. If a lease does not include a
VAWA Lease Addendum, a Project Sponsor cannot approve the unit for TBRA or TSH services. I have retained a copy of the
VAWA Lease Addendum for this assisted unit in the household's record. If the lease agreement already included an
addendum, then I have attached a copy. If it did not, then the lessor and lessee have completed the addendum, provided a
copy to me, and I have attached it.
This unit has not been approved. Complete Form H.
$0.00
�
� ��
� ��
� ��
DSHS Program Form I 2 of 5 Previous versions are obsolete (09/Ol/22)
Rent Standard and Rent Reasonableness Certification
Form H
Must be completed before rental assistance starts & annual eligibility recertifications. Must be completed if household residency, composition, or rent have changed.
The gross rent of TBRA- or TSH-assisted units cannot exceed the rent standard. The gross rent must also be reasonable in relation to
rents for comparable unassisted units in the private market and must not be in excess of rents charged by the owner for comparable
unassisted units. Complete this form for each proposed unit.
Client Name and/or ID Number:
Housing Case Manager Name:
Let's get started! Enter a client name and/or ID number.
1 Is this a TBRA or TSH certification?
2 Is this a shared housing arrangement?
3 What county is the proposed unit located in?
4 How many bedrooms are in the proposed unit?
5 How many bedrooms will the household use?
6 How many household members are in the household?
a Per the (_) Occupancy Standards, the household qualifies for the following number of bedrooms:
b Wfl you grant an exception to the (_) Occupancy Standards?
c Based on your assessment of the household's needs, how many bedrooms will you authorize?
Rent Standard
7 What is the rent standard for a(_)-bedroom unit in (_) County?
8 What is the rent standard for a(_)-bedroom unit in (_) County?
a What is the fiscal year of the rent standard table?
b Are you using Fair Market Rent (FMR) as the rent standard or a community-wide exception rent standard?
c Will you increase the rent standard by up to 10 percent?
Rent Reasonableness
9 Assess the proposed unit.
a Address:
b Wfat is the total unit rent for the proposed unit?
i What is the household's share of the total unit rent for the proposed unit?
ii What is the roommate's share of the total unit rent for the proposed unit?
c Will the household require a utility allowance?
d What is the applicable (_)-bedroom utility allowance for the proposed unit?
10 Compare the proposed unit to other similar (_)-bedroom units.
a Comparison unit 1
i Address:
ii What is the total unit rent for comparison unit 1?
iii Would the household require a utility allowance?
iv What is the applicable (_)-bedroom utility allowance for comparison unit 1?
b Comparison unit 2
i Address:
ii What is the total unit rent for comparison unit 2?
iii Would the household require a utility allowance?
iv What is the applicable (_)-bedroom utility allowance for comparison unit 2?
Notes
Date:
[�]
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Check Spelling
DSHS Program Form I 3 of 5 Previous versions are obsolete (09/01/22)
Rent Standard and Rent Reasonableness Certification
Form H
DSHS Program Form I 4 of 5 Previous versions are obsolete (09/01/22)
Rent Standard and Rent Reasonableness Certification
Form H
Rent Standard
Rent Standard
Attach the Fair Market Rent (FMRJ table used. *Alternatively, Project Sponsors may use a HUD-approved community-wide
exception rent standard if one is locally available. If using an exception rent standard, attach the exception rent standard
table per the household's exception period and area. **On a unit by unit basis, Project Sponsors may increase the rent
standard by up to 10% for up to 20% of the units that receive TBRA or TSH services. If using 110%, enter this value instead.
Rent Reasonableness
Criteria Proposed Unit Comparison Unit 1
Address
Attach comparison unit values
Number of Bedrooms
Square Feet
Type of Unit/Construction
Housing Condition
Location/Accessibility
Amenities
Unit, Property, Community
Age in Years
Utilities Paid by Owner
Select the types paid by the owner or
another source
Utilities Paid by Household
Select the types paid by the hausehold
and enter a monthly allowance for each
Unit Rent
� Heating
❑ Cooking
❑ Other Electric
❑ Air Conditioning
❑ Water heating
❑ Water
❑ Sewer
❑ Trash Collection
❑ Other
� Heating
❑ Cooking
❑ Other Electric
❑ Air Conditioning
❑ Water heating
❑ Water
❑ Sewer
❑ Trash Collection
❑ Range/Microwave
❑ Refrigerator
n Other
0
0
0
� Heating
❑ Cooking
❑ Other Electric
❑ Air Conditioning
❑ Water heating
❑ Water
❑ Sewer
❑ Trash Collection
❑ Other
$0 � Heating
$0 ❑ Cooking
$0 ❑ Other Electric
$0 ❑ Air Conditioning
$0 ❑ Water heating
$0 ❑ Water
$0 ❑ Sewer
$0 ❑ Trash Collection
$0 ❑ Range/Microwave
$0 ❑ Refrigerator
$0 I—I Other
$0.00
Utility Allowance $0.00
Attach utility schedule
Gross Rent $0.00
Unit Rent + Utility Allowance
Average gross rent of comparison units (Sum of comparison units 1& 2 divided by 2)
Certification
Enter the lower of the rent standard or reasonable rent for the unit
This unit has not been approved. Complete the screening and certification.
Comparison Unit 2
0
0
0
� Heating
❑ Cooking
❑ Other Electric
❑ Air Conditioning
❑ Water heating
❑ Water
❑ Sewer
❑ Trash Collection
❑ Other
$0 � Heating
$0 ❑ Cooking
$0 ❑ Other Electric
$0 ❑ Air Conditioning
$0 ❑ Water heating
$0 ❑ Water
$0 ❑ Sewer
$0 ❑ Trash Collection
$0 ❑ Range/Microwave
$0 ❑ Refrigerator
$0 [I Other
$0.00
$0.00
$0.00
$0.00
0
0
0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0.00
$0.00
$0.00
$0.00
$0.00
DSHS Program Form I 5 of 5 Previous versions are obsolete (09/Ol/22)
CERTIFICATE OF COMPLIANCE:
ADDITIONAL POLICY REQUIREMENTS
The terms and conditions set forth in EXHIBIT "N" — Certificate of Compliance: Additional
Policy Requirements are hereby incorporated by reference into this Conri-act and shall be binding
upon the Agency. The Agency shali comply with all applicable provisions of EXHIBIT "K" —
Certificate of Compliance: Additional Program-Specific Policy Reguirements as if fully
stated herein.
In adciitio�� to all applicabie iederal statutes and regulations, the SubreciY;ent certif es 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.:
Prohibition on Use of Funds to Promote Gender ldeology
Grant funds awarded under this Contract shall not be used to promote "gender ideology,"
as defned in Executive Order 14168, Defending Women from Gender ldeology Ex�remism
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. Govemment'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
vioiation of any applicable Federal anti-discrimination laws, including but not limited to
Title VT 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 Opportuniiy (NOFO}, grant
application, or related guidance, this Contract shall not be governed 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
veriiication 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 reiated requirements established by I�UD, the Attorney General, or the U.S.
Citizenship and Immigration Services pursuant to PRWORA, Executive Order ] 4218, or
other applicable federal iznmigration laws or executive orders, except that the verification
requirements do not apply if the Age�cy is a nonprofit charitable arganization deemed
exempt under 8 U.S.C. § 1642(d). .
7. Prohibition on Use of Funds to Promote Illegal Irr�igration
Agency shall not use funds in any way that, by design ar effect, facilitates the subsidization
or promotion of illegal immigratian, or shields illegal aliens from deportation, including
through policies or practices that rz�ate�ially irnpede the enfarcement of federal immigxation
lavvs.
S. Use of SAVE for Immigration Status Verificaiion
Agency shall use the Systerr�atic Alien Veri�cation for Entit�ements (SAVE) program, or
another Federal govern�nent-approved verif cation system, to ensure that no Federal public
benefit is provided under this grazat to any individual who is inelsgible due to unlawful
immigration status.
9. Equal Treatment of Faith-Based Organizations
Faith-based organizations may participate as subrecipients on the sa.n�e basis as any other
eligible organization and shall not be discrimina�ed against any organization on the basis
of religious character, affiliation, or religious exercise.
Certification and Acknowledgement
This certification shall be de�med incorporated by re%rence into the rrxain 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"
— Certificate of Compliance: Additional Program-Specific Pplicy Requirements;
• Agency shall comply with t�ese requirements in both program practice and written policies
and procedures;
• Agency agrees to be in compliance with these requirements is a material condition of this
Contract and a prerequisite to the receipt and cantinued use of grant funds; and
• Agency understands that any violation of these terms may result in the suspension ar
termination of funding, repayment of funds, or other remedies available under law ar
regulation.
Autf�orized Certification
Name of Agency: �()C'
Name of Authorized O ici 1: Tracv 1c>nes
Title: Interim �xecutiv ,D�r.ec�r (�
Signature: � //f /
�
Date: �� �
PziAetiroF
_ * ��O���u * �
� �
H �
�� II�II�II ��
�B�N D[VF.�'�a
U.S. Department of Housing and Urban
Development
451 Seventh Street, SW
Washington, DC 20410
WWW.IIUCI.QOV
2Sp8ftO�.hUd.QOV
Environmenta) Review
for Activity/Project that is Exempt or
Categorically Excluded Not Subject to Section 58.5
Pursuant to 24 CFR 58.34(a) and 58.35(b)
Proiect Information
Project Name: 25018-AOC-ADMIN
HEROS Number: 900000010502425
Start Date: 10/09/2025
State / Local Identifier: 25018
Project Location: 400 N Beach St, Fort Worth, TX 76111
Additional Location Information:
N/A
Description of the Proposed Project [24 CFR 50.12 & 58.32; 40 CFR 1508.25]:
AIDS Outreach Center provides various programs to serve low-moderate income people living with HIV/AIDS.
These programs are available to anyone living with HIV who meet the income guideline at or below 80% AMI
for all counties served. Administration- Administrative covers the costs of indirect personnel in decision-
making on behalf of the program.
Level of Environmental Review Determination
Activity / Project is Exempt per 24 CFR 58.34(a):
58.34(a)(3)
Fundin� Information
� Grant Number HUD Program
I TXH25F002 Community Planning and
Development (CPD)
Estimated Total HUD Funded Amount: $7,572.76
Program Name
Housing Opportunities for Persons
With AIDS (HOPWA)
$7,572.76
Estimated Total Project Cost [24 CFR 58.2 (a) (5)]:
$7,572.76
Miti�ation Measures and Conditions fCFR 1505.2(c)1:
25018-AOC-ADMIN Fort Worth, TX 900000010502425
Summarized below are all mitigation measures adopted by the Responsible Entity to reduce, avoid or
eliminate adverse environmental impacts and to avoid non-compliance or non-conformance with the
above-listed authorities and factors. These measures/conditions must be incorporated into project
contracts, development agreements and other relevant documents. The staff responsible for
implementing and monitoring mitigation measures should be clearly identified in the mitigation plan.
Law, Mitigation Measure or Condition
Authority, or
Factor
Preparer Signature: � �� � i�� ���� •
Comments on Complete
Completed Measures
Date: � ��� � ��
l
Name / Title/ Organization: Juliet Moses // FORT WORTH �
Responsible Entity Agency Official Signature: �'lC"'�' -
/��
Date: l��vL �S
�
Name/Title: ������ l�q►��ss��k�—n��,�l��� s�u� ���i��
. r
This original, signed document and related supporting material must be retained on file by the
Responsible Entity in an Environment Review Record (ERR) for the activity / project (ref: 24 CFR Part
58.38) and in accordance with recordkeeping requirements for the HUD program(s).
10/09/2025 14:40 Page 2 of 2
P�IAENTOF
°* U��O��fl * N�
�� II�II�II �
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U.S. Department of Housing and Urban
Development
451 Seventh Street, SW
Washington, DC 20410
WWVJ.IIUCJ.QOV
@Sp8f10�.hUd.QOV
�nuironmental Review
for Activity/Project that is Exempt or
Categorically Excluded Not Subject to Section 58.5
Pursuant to 24 CFR 58.34(a) and 58.35(b)
Proiect Information
Project Name: 25019-AOC-SS
HEROS Number: 900000010502429
Start Date: 10/09/2025
State / Local Identifier: 25019
Project Location: 400 N Beach St, Fort Worth, TX 76111
Additional Location Information:
N/A
Description of the Proposed Project [24 CFR 50.12 & 58.32; 40 CFR 1508.25]:
AIDS Outreach Center provides various programs to serve low-moderate income people living with HIV/AIDS.
These programs are available to anyone living with HIV who meet the income guideline at or below 80% AMI
for all counties served. Supportive Services: Supportive services provides the household with the following
including, but limited to, case management, behavioral health, housing, transportation, dental, food pantry,
and insurance assistance. For each service provided to the client or household, a case note must document
the service type. Supportive Services dollars will be used to pay for a portion of staff salaries and fringe
benefits.
Level of Environmental Review Determination
Activity / Project is Exempt per 24 CFR 58.34(a):
58.34(a)(3)
58.34(a)(4)
Fundin� Information
Grant Number HUD Program
TXH25F002 Community Planning and
Development (CPD)
Estimated Total HUD Funded Amount: $15,932.20
Program Name
Housing Opportunities for Persons
With AIDS (HOPWA)
$15,932.20
25019-AOC-SS Fort Worth, TX
Estimated Total Project Cost [24 CFR 58.2 (a) (5)]: $15,932.20
Miti�ation Measures and Conditions fCFR 1505.2(c)1:
900000010502429
Summarized below are all mitigation measures adopted by the Responsible Entity to reduce, avoid or
eliminate adverse environmental impacts and to avoid non-compliance or non-conformance with the
above-listed authorities and factors. These measures/conditions must be incorporated into project
contracts, development agreements and other relevant documents. The staff responsible for
implementing and monitoring mitigation measures should be clearly identified in the mitigation plan.
Law, Mitigation Measure or Condition
Authority, or
Factor
[ � � rt
Preparer Signature: / l� I
Name / Title/ Organization: Juliet Moses // FORT WORTH
Comments on Complete
Completed Measures
Date: � V/ `-1. I ��
l
Responsible Entity Agency Official Signature: �GC�t - G� Date: ��Y `^oU
Name/ Title: ��Cti U�r'V �S 1,�� � V�J� �Q./�A�-Li 1/�i��%
�
This original, signed document and related supporting material must be retained on file by the
Responsible Entity in an Environment Review Record (ERR) for the activity / project (ref: 24 CFR Part
58.38) and in accordance with recordkeeping requirements for the HUD program(s).
10/09/2025 14:45 Page 2 of 2
P�1�ENT��
_�* �0����� * �
�� II�II�II �
'e�N D f VF�'�QF
U.S. Department of Housing and Urban
Development
451 Seventh Street, SW
Washington, DC 20410
WWW.IIUd.QOV
espanol.hud.qov
Environmental Review
for Activity/Project that is Exempt or
Categorically Excluded Not Subject to Section 58.5
Pursuant to 24 CFR 58.34(a) and 58.35(b)
Proiect Information
Project Name: 25020-AOC-STRMU
HEROS Number: 900000010502435
Start Date: 10/09/2025
State / Local Identifier: 25020
Project Location: 400 N Beach St, Fort Worth, TX 76111
Additional Location Information:
N/A
Description of the Proposed Project [24 CFR 50.12 & 58.32; 40 CFR 1508.25]:
AIDS Outreach Center provides various programs to serve low-moderate income people living with HIV/AIDS.
These programs are available to anyone living with HIV who meet the income guideline at or below 80% AMI
for all counties served. Short Term Rental, Mortgage and Utility Assistance (STRMU): The goal of the program
is to provide to persons living with HIV/AIDS to maintain stable housing and reduce the risk of homelessness.
Clients can receive up to 21-weeks of STRMU assistance and must not exceed the client's current monthly
budget deficit caused by an unavoidable, unplanned, or documented emergency need consisted with HUD
guidelines. Clients receiving other government housing assistance are not eligible for this program or TBRA.
Level of Environmental Review Determination:
Activity / Project is Categorically Excluded Not Subject to per 24 CFR 58.35(b):
58.35(b)(2)
Fundin� Information
Grant Number HUD Program
TXH25F002 Community Planning and
Program Name
Housing Opportunities for Persons
With AIDS (HOPWA)
$70,645.00
Development (CPD)
Estimated Total HUD Funded Amount: $70,645.00
25020-AOC-STRMU Fort Worth, TX
Estimated Total Project Cost [24 CFR 58.2 (a) (5)]: $70,645.00
900000010502435
Miti�ation Measures and Conditions fCFR 1505.2(c)1:
Summarized below are all mitigation measures adopted by the Responsible Entity to reduce, avoid or
eliminate adverse environmental impacts and to avoid non-compliance or non-conformance with the
above-listed authorities and factors. These measures/conditions must be incorporated into project
contracts, development agreements and other relevant documents. The staff responsible for
implementing and monitoring mitigation measures should be clearly identified in the mitigation plan.
Law, Mitigation Measure or Condition
Authority, or
Factor
Preparer Signature: ���'1,,�/l �( / J,r � l( l
Comments on Complete
Completed Measures
Date
r`
Name / Title/ Organization: Juliet Moses // FORT WORTH
Responsible Entity Agency Official Signature:�.��
Name/Title:���f�u 1�u1�� �5��'(X''Ql (VQ,I��jf�.ilY`J� ��-l�l,o
J 1
I �l� I 2�
� �.
Date: � � ����
D1�e,��
This original, signed document and related supporting material must be retained on file by the
Responsible Entity in an Environment Review Record (ERR) for the activity / project (ref: 24 CFR Part
58.38) and in accordance with recordkeeping requirements for the HUD program(s).
10/09/2025 14:51 Page 2 of 2
PP�lAENiQR,
ry�* ��O���u * �
�� II�II�II ��
�e4N D[YF.�.�P
U.S. Department of Housing and Urban
Development
451 Seventh Street, SW
Washington, DC 20410
www.hud.aov
espanol.hud.aov
Environmental Review
for Activity/Project that is Exempt or
Categorically Excluded Not Subject to Section 58.5
Pursuant to 24 CFR 58.34(a) and 58.35(b)
Proiect Information
Project Name: 25021-AOC-TBRA
HEROS Number: 900000010502441
Start Date: 10/09/2025
State / Local Identifier: 25021
Project Location: 400 N Beach St, Fort Worth, TX 76111
Additional Location Information:
N/A
Description of the Proposed Project [24 CFR 50.12 & 58.32; 40 CFR 1508.25]:
AIDS Outreach Center provides various programs to serve low-moderate income people living with HIV/A�DS.
These programs are available to anyone living with HIV who meet the income guideline at or below 80% AMI
for all counties served.Tenant Based Rental Assistance (TBRA): TBRA includes long-term monthly rental
assistance. Clients must live in a rental unit that passes National Standards for the Physical Inspection of Real
Estate (NSPIRE) and have an identified housing need as determine by the client's case manager.
Level of Environmental Review Determination:
Activity / Project is Categorically Excluded Not Subject to per 24 CFR 58.35(b):
58.35(b)(1)
Fundin� Information
� Grant Number HUD Program Program Name
TXH25F002 Community Planning and Housing Opportunities for Persons
Development (CPD) With AIDS (HOPWA)
Estimated Total HUD Funded Amount: $170,530.04
$170,530.04
Estimated Total Project Cost [24 CFR 58.2 (a) (5)]: $170,530.04
25021-AOC-TBRA Fort Worth, TX 900000010502441
Miti�ation Measures and Conditions fCFR 1505.2(c)1:
Summarized below are all mitigation measures adopted by the Responsible Entity to reduce, avoid or
eliminate adverse environmental impacts and to avoid non-compliance or non-conformance with the
above-listed authorities and factors. These measures/conditions must be incorporated into project
contracts, development agreements and other relevant documents. The staff responsible for
implementing and monitoring mitigation measures should be clearly identified in the mitigation plan.
Law, Mitigation Measure or Condition
Authority, or
Factor
Preparer Signature: `� '�`-" /�
r
Name / Title/ Organization: Juliet Moses // FORT WORTH
Comments on Comptete
Completed Measures
Date: _��1f l ' /�
Responsible Entity Agency Official Signature: �P Citi. �.�f W� r Date: ���
�
Name/Title: l'�Q�)`n. ���'d t'1>)��'�l(�1 ��Q,��h�ciW'� �1`�`�� ��
This original, signed document and related supporting material must be retained on file by the
Responsible Entity in an Environment Review Record (ERR) for the activity / project (ref: 24 CFR Part
58.38) and in accordance with recordkeeping requirements for the HUD program(s).
10/09/2025 14:59 Page 2 of 2
Docusign Envelope ID: 60C71E23-8453-402F-89EF-F31BA237FDB8
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
OFFICE OF COMMUNITY PLANNING AND DEVELOPMENT
FEDERAL AWARD AGREEMENT
A. General Federal Award Information
Recipient name (must match Unique Entity Identifier
name) and address:
Fort Worth
100 Fort Worth Trail
FORT WORTH, TX 76102
2. RecipienYs Unique Entity Identifier:
ENS6MKS1ZL18
3. Tax identification number:
756000528
4. Federal Award Identification Number (FAIN)
TXH25F002
5, instrument type:
Grant � Cooperative agreement ❑
Loan Guarantee ❑
6. Period of performance start and end date:
12/5/2025 - 12/4/2028
7. Budget period start antl end date:
12/5/2025 - 12/4/2028
8. Initial Agreement � Amendment ❑ #
9. Indirect cost rate (per � 200.414):
Recipients must complete Addendum 3: Indirect Cost
Rate Schedule
10. Is this award for research and devetopment (per 2
C.F.R. � 200.1)? Yes ❑ No �
12. Assistance listing number and title:
14.241, Housing Opportunities for Persons With AIDS
(HOPWA) Program
13. Amount of federal funds obligated by this action:
$2,726,668.00
14. Total amount of federal funds obligated:
$2,726,668.00
15. Total approved cost sharing (if appticable):
N/A
16. Total federal award amount, inclutling approved cost
sharing:
$2,726,668.00
17. Budget approved by HUD: � 2/5/2�25
18. Fiscalyear:
2025
19. Statutory authority:
42 U.S.C. �§ 12901-12912
20. Applicable appropriations act(s):
Public Law 119 - 4
21. Notice/notice of funding opportunity this award is
made under (if applicable):
N/A
11. Awarding officiat name and contact information:
Leticia lbarra CPD Director
22. Program regulations (if applicable):
24 C. F. R. Pa rt 574
23. Federal award description:
The Housing Opportunities for Persons with AIDS (HOPWA) program was established to provide housing
assistance and related supportive services for low-income persons living with HIV/AIDS and their families.
• Addendum 1. Policy Requirements
• Addendum 2. Program-Specific Requirements
• Addendum 3. Indirect Cost Rate Schedute
AuthorityandAgreement. This agreement between the U.S. Department of Housing and Urban Development (HUD)
and the Recipient is made pursuant to the statutory authority above (box 19) and is subject to the applicable
appropriations act(s) (box 20). This agreement incorporates by reference the Housing Opportunities for Persons With
AIDS program statute 42 U.S.C. 5� 12901-12912, the program regutations at 24 C.F.R. � 574 (as now in effect and as
may be amended from time to time), Recipient's consolidated plan/action plan, the relevant funding notice (box 21),
any attached Specific Terms and Conditions, and the attached addenda (box 23).
Page 1 of 8
Docusign Envelope ID: 60C71E23-8453-402F-89EF-F31BA237FDB8
U.S. Department of Housing and Urban Development— Federal Award Agreement
B. Terms and Cond'ftions
1. General terms and requirements. The Recipient must comptywith alt applicable federal laws, regulations, and
requirements, unless otherwise provided through HUD's formal waiver authorities. This agreement, including
any attachments and addenda, may only be amended in writing executed by parties to this agreement and any
addenda.
2. Administrative requirements. The Recipient must complywith the fotlowing requirement(s) if checl<ed below:
❑ The administrative requirements in the HUD General Administrative, National, and Departmentat Policy
Requirements and Terms for HUD's Financial Assistance Programs 2025, as indicated in the relevant
NOFO, apptyto this agreement.
� The grantee shall comply with requirements established by the Office of Management and Budget (OMB)
concerningthe Unique Entity Identifier (UEI); the System for Award Management (SAM.gov.); the Federal
Funding Accountabitity and Transparency Act as provided in 2 C.F.R. part 25, Universal Identifier and
General Contractor Registration; and 2 C.F.R. part 170, Reparting Subaward and Executive Campensation
Information.
3. Appticabitityof2C.F.R. part200.
� The Recipient must comply with the applicable requirements at 2 C.F.R. part 200, as may be amended
from time to time. If any previous or future amendments to 2 C.F.R, part 200 replace or renumber any part
200 section cited in HUD's regulations in Title 24 of the Code of Federal Regulations, the amended part
200 requirements will govern award activities carried aut after the amendments' effective date.
❑ The Recipient must compty with the applicable requirements at 2 C.F.R. part 200. If any previous
amendments to 2 C.F.R. part 200 replace or renumber any part 200 section cited in HUD's regulations in
Title 24 of the Code of Federai Regulations, the amended part 200 requirements will govern award
activities carried out after the amendments' effective date.
4. Future budget periods. if the period of performance spans multiple budget periods, subsequent budget
periods are subject to the availability of iunds, program authority, satisfactory performance, and compliance
with the terms and conditions of the Federal award.
5. ►ndirect Cost Rate. If the Recipient intends to use a negotiated or de minimis rate for indirect costs, the
Recipient must submit an Indirect Cost Rate form to HUD, either with its application using HUD-426
(competitive grants) or with this agreement using "Addendum #3 "Indirect Cost Rate Schedule" (formula and
congressional grants). The submitted form/addendum will be incorporated into and made part of this
agreement, provided that the rate information is consistent with the applicable requirements under 2 C.F.R. �
200.414. If there is any change in the Recipient's indirect cost rate, it must immediately notify HUD and
execute an amendment to this agreement to reflect the change if necessary.
6. Recipient integrity and performance matters. If the Federal share of this award is more than $500,000 over the
period of performance (box 6), the terms and conditions in 2 C.F.R. part 200 Appendix XII apply to this
agreement.
7. Recordkeeping andAccess io Records. The Recipient hereby agrees to maintain complete and accurate
books of account for this award and award activities in such a manner as to permit the preparation of
statements and reports in accordance with HUD requirements, and to permit timely and effective audit. The
Recipient agrees to furnish HUD such financial and project reports, records, statements, subrecipient data,
and documents at such times, in such form, and accompanied by such reporting data as required by NUD.
HUD and its duly authorized representative shatt have full and free access to all Recipient offices and
facilities, and to all books, documents, and records of the Recipient relevant to the administration, receipt,
and use of this award and award activities, including the right to audit and make copies. The Recipient agrees
to maintain records that identify the source and application of funds, including relevant subrecipient data, in
such a manner as to allow HUD to determine that all funds are and have been expended in accordance with
program requirements and in a manner consistent with applicable law.
[14,241, HOPWA, FY 2025] Page 2 of 8
Docusign Envelope ID: 60C71E23-8453-402F-89EF-F31BA237FDB8
U.S. Department of Housing and Urban Development— Federal Award Agreement
Further, the Recipient hereby acknowledges that HUD is in the process of implementing new grants
management and reporting toots, which will be made available for the Recipient's use in the future. The
Recipient agrees to report on grant performance and financial activities (inctuding vendor and cash
disbursement supporting details for the Recipient and its subrecipients) using these new tools when they are
released. HUD will work with the Recipient to support the Recipient's transition to this new reporting
environment. Once implemented, timely reporting in this new environment will be mandatory. HUD reserves
the right to exercise all of its available rights and remedies for any noncompliance with these grants
management and financial reporting requirements, to include, without timitation, requiring 100% review,
suspension of disbursements, and all other legally available remedies, to the furthest extent permitted by law,
as amended.
Noncomp(iance. If the Recipient fails to comply with the provisions of this agreement, HUD may tal<e one or
more of the actions provided in program statutes, regulations or 2 C.F.R. § 200.339, as applicable. Nothing in
this agreement shall limit any remedies otherwise available to HUD in the case of noncompliance bythe
Recipient. No delay or omissions by HUD in exercising any right or remedy available to it under this agreement
shall impair any such right or remedy or constitute a waiver of or acquiescence in any Recipient
noncompliance.
9. Termination provisions. Unless superseded by program statutes, regulations or NOFOs, the termination
provisions in 2 C.F.R. § 200.340 appty.
10. Bui(dAmerica, BuyAmerica. The Recipient must complywith the requirements of the Buitd America, Buy
America (BABA) Act, 41 U.S.C. � 8301 note, and all applicable rules and notices, as may be amended, if
applicable. Pursuant to HUD's Notice, "Public Interest Phased Implementation Waiver for FY 2022 and 2023
of Build America, Buy America Provisions as Applied to Recipients of HUD Federal Financial Assistance" (88
Fed. Reg. 17001), BABA requirements apply to any infrastructure projects HUD has obligated funds for after
the effective dates, unless excepted by a waiver.
11. Waste, Fraud, Abuse, and Whistfeb(ower Protections. Any person who becomes aware of the existence or
apparent existence of fraud, waste, or abuse of any HUD award must report such incidents to both the HUD
official responsible for the award and to HUD's Office of Inspector General (OIG). Allegations of fraud, waste,
and abuse related to HUD programs can be reported to the HUD OIG hottine via phone at 1-800-347-3735 or
online hotline form. The Recipient must comply with 41 U.S.C. � 4712, which includes informing employees in
writing of their rights and remedies, in the predominant native tanguage of the workforce. Under 41 U.S.C. §
4712, employees of a government contractor, subcontractor, recipient, and subrecipient—as well as a
personat services contractor—who make a protected disclosure about a Federal award or contract cannot be
dischargetl, demoted, or otherwise discriminated against if they reasonably believe the information they
disclose is evidence of (1) gross mismanagement of a Federal contract or award; (2) waste of Federal funds;
(3) abuse of authority relating to a Federal contract or award; (4) substantial and specific danger to public
health and safety; or (5) violations of law, rule, or regulation related to a Federal contract or award.
12. Third-PartyC(aims. Nothing in this agreement shall be construed as creating orjustifying any claim against
the federal government or the Recipient by any third party.
13. Rule ofConstruction and No Construction Against Drafier. Notwithstanding anything contained in this
agreement, the terms and conditions hereof are to be construed to have full and expansive effect in both
interpretation and application, and the parties agree that the principle of interpretation that holds that
ambiguities in terms or conditions are construed against the drafter shall not apply in interpreting this
agreement.
C. Federal Award Performance Goals
The Recipient must meet any appticable performance goals, indicators, targets, and baseline data as required by
applicable program requirements.
D. Specific Terms and Conditions Not applicable � Attached ❑
[14.241, HOPWA, FY 2025] Page 3 of 8
Docusign Envelope ID: 60C71E23-8453-402F-89EF-F31BA237FDB8
U.S. Department of Housing and Urban Development — Federal Award Agreement
Forthe U,S. Department of HUD Signature Date/ Federal
(name and title of authorized official) s�9�ea bY. Award Date
Leticia lbarra CPD Director [I�ua Il�c�.vv'a 12/5/2025
7152240D2832458...
Forthe Recipient Signature Date
(name and title of authorized official)
Dana Burghdoff-Assistant City Manager �Bhdo� R�o�,M� �� Oct 3, 2025
[14.241, HOPWA, FY 2025] Page 4 of 8
Docusign Envelope ID: 60C71E23-8453-402F-89EF-F31BA237FDB8
U.S. Department of Housing and Urban Development— Federal Award Agreement
ADDENDUM 1. POLICY REQUIREMENTS
If applicable:
1. The Recipient shall not use grant funtls to promote "gender ideology," as defined in Executive Order
(E.O.)14168, Defending Women from Gender ldeology Extremism and Restoring Biological Truth to
the Federal Government;
2. The Recipient agrees that its compliance in all respects with alt appticable Federal anti-
discrimination laws is material to the U.S. Government's payment decisions far purposes of section
3729(b)(4) of title 31, United States Code;
3. The Recipient certifies that it does not operate any programs that violate any applicable Federal
anti-discrimination laws, including Title VI of the Civil Rights Act of 1964;
4. The Recipient shall not use any grant funds to fund or promote elective abortions, as required by
E.O. 14182, Enforcing the Hyde Amendment; and that,
5. Notwithstanding anything in the NOFO or Apptication, this Grant shall not be governed by Executive
Orders reval<ed by E.O. 14154, including E.O. 14008, or NOFO requirements implementing
Executive Orders that have been reval<ed.
6. The Recipient must administer its grant in accordance with all applicable immigration restrictions
antl requirements, includingthe eligibility and verification requirements that apply undertitle 1V of
the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, as amended (8 U.S.C.
1601-16�) (PRWORA) and any applicable requirements that HUD, the Attorney General, orthe U,S.
Citizenship and Immigration Services may establish from time to time to comply with PRWORA,
Executive Order 14218, or other Executive Orders or immigration laws.
7. No state or unit of general local government that receives funding under this grant may use that
funding in a manner that by design or effect facilitates the subsidization or promotion of itlegal
immigration or shields iltegal aliens from deportation, including by maintaining policies or practices
that materiatty impede enforcement of federal immigration statutes and regulations.
8. The Recipient must use 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.
Faith-based organizations may be subrecipients for funds on the same basis as any other
organization. Recipients may not, in the selection of subrecipients, discriminate against an
organization based on the organization's religious character, affiliation, or exercise.
j14.241, H OPWA, FY 2025] Page 5 of 8
Docusign Envelope ID: 60C71E23-8453-402F-89EF-F31BA237FDB8
U.S. Departmentof Housingand Urban Development—FederalAward Agreement
ADDENDUM 2. PROGRAM-SPECIFiC REQUIREMENTS
Assistance Listing 14.241, Housing Opportunities for Persons With AIDS (HOPWA) Program
Pre-Award Costs. The funds may be used for costs incurred before the period of
performance/budget period under the conditions specified in HUD Notice CPD-25-02 or another
priorwritten approval by HUD; or if the Recipient is not covered by Notice CPD-25-02, under the
condition that the costs are otherwise allowable and were incurred on or after the date HUD
received the Recipient's Consolidated Plan submission, the Recipient's program year start date, or
90 calendar days before the period of performance start date in Box 6(whichever is latest).
Scope and Requirements. The Recipient and each project sponsor that receives grant funds must
(1) comply with the HOPWA regulations, other applicable HUD regulations, and such other terms
and conditions as HUD may establish for purposes of carrying out HQPWA activities in an effective
and efficient manner; (2) conduct an ongoing assessment of the housing assistance and supportive
services required by the participants in HOPWA activities; (3) assure the adequate provision of
supportive services to the participanis in HOPWA activities; (4) cooperate and coordinate in
providing assistance under HOPWA with the retevant state- and local-government agencies
responsible for services for eligible persons in the area served by the Recipient and with other
pubtic and private organizations and agencies providing services for eligible persons; (5) prohibit
any fee, except rent, from being charged of any eligibte person for any housing or services provided
with grant funds; (6) ensure the canfidentiality of the name of any individual assisted thraugh
HOPWA activities and any other information regarding individuals receiving assistance with grant
funds; and (7j maintain and make availahle to HUD for inspection financial records sufficient, in
HUD's determination, to ensure proper accounting and disbursing of grant funds.
3. ProjectSponsors. The Recipient may only provide grant funds to project sponsors pursuant to
legally binding agreements that contain the provisions required by 2 C.F.R. � 200.332(a) and state
each commitment to which the project sponsor must agree under 24 C.F.R. § 574.500(b)(1)-(4).
4. Funds Drawdown and Reconci(iation. Not less than once every 90 calendar days, starting from the
period of performance start date, the Recipient must draw down grant funds for allowable costs and
in accordance with 2 C.F.R. §§ 200.305 and 200.403 and reconcile its accounting records with the
financial data reported to HUD through the Integrated Disbursement and lnformation System
("iDfS") in accordance with 2 C.F.R. §� 200.3Q2 and 200.303. The Recipient must comply with HUD
instructions regarding use of and reporting in IDiS or its successor.
5. Pertormance Reporting. The Recipient must submit a Consolidated Annual Performance and
Evaluation Report (CAPER) in accordance with 24 C.F.R. �� 91.520 and 574.520(a}, the SF-425 in
accordance with 2 C.F.R. 200.328(a), and provide the NOPWA information using form HUD-4155.
6, Eligibi(ity Records. The Recipient must update client eligibility records no less than annually.
7. Program Income. Program income may be treated as an addition to the grant funds, provided that
the Recipient uses that income for allowable costs under this grant agreement.
8. Environmental Review. If Recipient is a State or Unit of General Local Government antl is the
responsible entity pursuant to 24 C.F.R. part 58, the Recipient agrees to assume the responsibility
[14.241, HOPWA, FY 2025] Page 6 of 8
Docusign Envelope ID: 60C71E23-8453-402F-89EF-F31BA237FDB8
U.S. Department of Housing and Urban Development— Federal Award Agreement
for environmental review, decision-making, and action thatwould otherwise applyto HUD in
accordance with 24 C.F.R. §� 58.4 and 574.510. If Recipient is a State and distributes funds to a
unit of general local government, the Recipient must require the unit of general local government to
assume that responsibility and must comply with the state's responsibilities under 24 C.F.R. 58.4.
Default. A default shall occurwhen the Recipient fails to comply with the provisions of this
agreement, in the event of a default, HUD may tal<e one or more of the actions provided in 2 C.F.R. �
200.339 after providing the Recipient with an opportunity for informal consultation in accordance
with 24 C.F.R. § 574.500(c). Nothing in this Grant Agreement shall limit any remedies otherwise
available to HUD in the case of a default bythe Recipient. No delay or omissions by HUD in
exercising any right or remedy available to it under this Grant Agreement shall impair any such right
or remedy or constitute a waiver or acquiescence in any Recipient default.
10. Closeout. This grant will be closed out as provided by 2 C.F.R. § 200.344 and Notice CPD-23-04,
unless otherwise provitled by a subsequent regulation or HUD notice.
11. Deobligation. To the extent authorized by applicable law, HUD may, by its execution of an
amendment, deobligatefunds underthis GrantAgreementwithoutthe Recipient'sexecution ofthe
amendment or other consent.
[14.241, HOPWA, FY 2025] Page 7 of 8
Docusign Envelope ID: 60C71E23-8453-402F-89EF-F31BA237FDB8
U.S. Department of Housing and Urban Development — Federal Award Agreement
ADDENDUM 3. INDIRECT COST RATE SCHEDULE
As the duly authorized representative of the Recipient, I certify that the Recipient:
� Will not use an indirect cost rate to calculate and charge indirect costs under the grant.
❑ Will calculate and charge indirect costs under the grant by applying a de minimis rate as provided by
2 C.F.R. � 200.414(f), as may be amended from time to time.
❑ Will calculate and charge indirect costs under the grant using the indirect cost rate(s) listed below,
and each rate listed is included in an indirect cost rate proposal developed in accordance with the
applicable appendix to 2 C.F.R. part 200 and, if required, was approved by the cognizant agencyfor
indirect costs.
Agency/department/majorfunction Intlirect cost rate Type of Direct Cost Base
%
%
%
Instructions forthe Recipient:
The Recipient must marl<the one (and only one) checkbox above that best reflects howthe Recipient's
indirect costs will be calculated and charged under the grant. Do not include indirect cost rate information
for project sponsors.
The table following the third box must be completed only if that box is checked. When listing a rate in the
table, enter both the percentage amount (e.g., 10%) and the type of direct cost base to be used. For
example, if the direct cost base used for calculating indirect costs is Modified Total Direct Costs, then enter
"MTDC" in the "Type of Direct Cost Base" column.
If using the Simplified Allocation Method for indirect costs, enter the applicable indirect cost rate and type of
direct cost base in the first row of the table.
If using the Multiple Allocation Base Method, enter each major function of the organization forwhich a rate
was developed and will be used under the grant, the indirect cost rate applicable to that major function, and
the type of direct cost base to which the rate will be applied.
If the Recipient is a government and more than one agency or department will carry out activities under the
grant, enter each agency or department that will carry out activities untlerthe grant, the indirect cost rate(s)
forthat agency or department, and the type of direct cost base to which each rate will be applied.
To learn more about the indirect cost requirements, see 2 C.F.R. part 200, subpart E; Appendix IV to Part 200
(for nonprofit organizations); and Appendix VII to Part 200 (for state and local governments).
[14,241, HOPWA, FY 2025] Page 8 of 8
A
M&C Review
CITY COUNCIL AGEND
Create New From This M�C
DATE: 8/12/2025 REFERENCE NO.: M&C 25-0676 LOG NAME:
CODE: C TYPE: NON- PUBLIC
CONSENT HEARING:
Page 1 of 5
Offcial site of the City of Fort Worth, Texas
FORT ��4'ORTF�
��
192025-2026 HUD
ANNUAL ACTION
PLAN
1'1�
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�acket/mc review.asp?ID=33536&councildate=8/12/2025 9/9/2025
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\°/o) 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
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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\°/o 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
TABLE 1: CDBG AGENCIES
AGENCY
Housing Channel
Meals-On-Wheels, Inc. of
Tarrant County
Guardianship Services Inc
CONSOLIDATED PLAN
GOAL
Affordable Housing
Healthy Living and
Wellness
Aging In Place
United Community Centers, Inc Children and Youth
Services
Boys & Girls Club of Greater Children and Youth
Tarrant County Services
Girls Inc of Tarrant County Children and Youth
Services
Camp Fire First Texas Children and Youth
Services
Junior Achievement of the Children and Youth
Chisholm Trail, Inc. Services
The Women's Center of Tarrant Economic Empowerment
County and Financial Resilience
Easter Seals North Texas, Inc. Economic Empowerment
and Financial Resilience
PROGRAM
Housing Counseling &
Education
Nutrition Program
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
Employment Solutions
Employment Services
AMOUNT
$111,000.00
$120,000.00
'�:� ��� ��
$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
ICDBG Public Services Agencies Total II$1,067,465.00I
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**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
Page 4 of 5
$165,000.00
$500,000.00
�CDBG Subrecipient Agencies Total �� $665,000.00�
ITOTAL CDBG CONTRACTS I�$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 pROGRAM
GOAL
Tarrant County
Samaritan Housing,
Inc.
AIDS Outreach
Center, Inc.
Homelessness Prevention
and Special Needs
Support
Homelessness Prevention
and Special Needs
Support
�TOTAL HOPWA CONTRACTS
Emergency Solutions Grants Contracts
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
The 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
$80,000.00
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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.
FISCAL INFORMATION/CERTIFICATION:
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
I Fund
FROM
Fund
Department
ID
Department
ID
Account PriD ct I Program Activity
Account Project
� ID
Submitted for Citv Manaqer's Office bv:
Oriqinatinq Department Head:
Additional Information Contact:
ATTACHMENTS
Program Activity
Budget
Year
Budget
Year
Dana Burghdoff (8018)
Kacey Bess (8187)
Juliet Moses (6203)
Reference # Amount
(Chartfield 2)
Reference # Amount
(Chartfield 2)
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�ORTWORTHo
City Secretary's Office
Contract Routing & Transmittal Slip
COritTaCtor'S Name: AIDS Outreach Center, Inc.
Subject of the Agreement: 2025-2026 PSA Contract
M&C Approved by the Council? " Yes B No ❑
If so, the M&C must be attached to the corrh•act.
Is this an Amendment to an Existing contract? Yes ❑ No 8
If so, p��ovide the original co»h-act �am�be�• arrd the amerrdment nzrmbeT•.
Is the Contract "Permanent"? �Yes ❑ No 8
If arrrsan°e, see back page for pe��manent conh•act listing.
Is this entire contract Confidential? YYes ❑ No 8 If only specific information is
Confidential, please list what info��matiorr is Confidential and the page it is located.
Effective Date: 10/1/2025 Expiration Date: 9/30/2026
If diffe��errt fi�onz the approval date. If applicable.
Is a 1295 Form required? * Yes ❑ No 8
�If so, please ensure it is attached to the approving M&C or attached to the contract.
Project Number: If applicable.
*Did you include a Text field on the contract to add the City Secretary Contract (CSC)
number? Yes 8 No ❑
Contracts need to be routed for CSO brocessin� in the followin� order:
l. Katherine Cenicola (Approver)
2. Jannette S. Goodall (Signer)
3. Allison Tidwell (Form Filler)
Ylndicates the information is ��eqzrii•ed and if tl�e information is not pr�ovided, the conh-act tii�ill be
�°etZrrned to the depa��tment.