HomeMy WebLinkAbout064796 - General - Contract - Trinity Habitat for HumanityCity Secretary Contract NO. 64796
STATE OF TEXAS §
§
COUNTY OF TARRANT §
This contract ("Contract") is made and entered into by and between the City of Fort Worth
(hereafter "City") and Trinity Habitat for Humanity (hereafter "Agency"). City and Agency may
be referred to individually as a"Party" and jointly as "the Parties".
The Parties state as follows:
WHEREAS, City receives grant monies from the United States Department of Housing
and Urban Development through the Community Development Block Grant ("CDBG") Program,
Program No. B-25-MC-48-0010, Catalog of Federal Domestic Assistance No. 14.218;
WHEREAS, a national objective of the CDBG program is to benefit low and moderate
income citizens in accordance with 24 CFR Part 570, as amended from time to time;
WHEREAS, Agency will use CDBG funds for a program to serve individuals and families,
100% of whom must be low and moderate income;
WHEREAS, City citizens, the Community Development Council, and the City Council
have determined that CDBG programs are needed by the City's citizens.
NOW, THEREFORE, the Parties understand and agree as follows:
INCORPORATION OF RECITALS.
City and Agency hereby agree that the recitals set forth above are true and correct and form
the basis upon which the Parties have entered into this Contract.
2. DEFINITIONS.
In addition to terms defined in the body of this Contract, the terms set forth below shall
have the deiinitions ascribed to them as follows:
Area Median Income or AMI means the median family income for the Fort Worth-Arlington
metropolitan statistical area as established annually by HUD. The 2023 income limits are
attached hereto as EXHIBIT "A-1" — 2025 HUD Income Limits.
CDBG means Community Development Block Grant.
Complete Documentation means the following documentation as applicable:
• Attachments I, II, III, IV with supporting documentation including:
o Proof of expense: copies of timesheets, invoices, leases, service or
construction/vendor contracts or other documentation showing that payment
is due by Agency.
o Proof of payment: cancelled checks, bank statements, or wire transfers
necessary to demonstrate that amounts due by Agency were actually paid by
Agency.
�FFICIAL RECORD ,
2o2s-2o26 cDs� coNT�cT - cowTowlv BxusxuP Pxo��M CITY SECRETARY
TRINITY HABITAT FOR HUMANITY
FT. WORTH, TX
o Proof of client eligibility: either (i) verifiable self-certification of income
such as the City's Certification Income Statement attached as EXHIBIT "E"
— Form of Income Self-Certification or a similar form approved by City,
or (ii) Source Documentation and, if applicable, confirmation of eligibility
through the Systematic Alien Verification for Entitlements (SAVE)
program.
Complete Documentation shall meet the standards described in the attached
EXHIBIT "F" - Standards of Documentation.
• Any other document or record reasonably necessary to verify costs spent and client
eligibility for the Program.
CDBG Funds means the CDBG grant funds supplied by City to Agency under the terms of this
Contract.
CDBG Regulations means regulations found at 24 CFR Part 570 et seq.
DBE means disadvantaged business enterprise in accordance with 49 CFR Part 26.
Director means the Director of the Neighborhood Services Department, or the Director's
designee.
Effective Date means the date of execution of the contract.
HUD means the United States Department of Housing and Urban Development.
IDIS means Integrated Disbursement Information System, HUD's project tracking system.
Income Eligible Client means a client whose annual income adjusted for family size does not
exceed 80% of AMI using the most current HUD Income Guidelines and Technical Guidance for
Determining Income and Allowances. The definition of annual income to determine client income
eligibility shall be the definition contained in 24 CFR Part 5.609, as amended from time to time.
National Objective means an activity that benefits low and moderate income persons. For the
purposes of this Contract, 100% of the clients served by the Program must be Income Eligible
Clients.
Neighborhood Services Department means the City's Neighborhood Services Department.
OMB means the Ofiice of Management and Budget.
Program means the services described in EXHIBIT "A" — Program Summary.
Reimbursement Request means all reports and other documentation described in Section 9.
Termination Date means 15 months after the Effective Date of the contract.
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Source Documentation means documentation of full household income of any type described
under the definition of annual income in 24 CFR Part 5.609, including but not limited to copies of
paychecks, Social Security and disability verification letters, interest or rental income statements,
retirement income statements, child support and alimony verification, unemployment benefit
letters, and the like.
Unduplicated Clients means a count of all clients served by the Program at least once in the
Contract Term. Clients served by the Program more than once in the Contract Term will only be
counted the first time they are served when determining the total count of Unduplicated Clients.
3. TERM.
The term of this Contract begins on the Effective Date and terminates 15 months after
contract execution.
4. DUTIES AND RESPONSIBILITIES OF CITY.
4.1 Provide CDBG Funds.
City shall provide up to $500,000.00 of CDBG Funds under the terms and conditions of
this Contract for Agency's Cowtown Brush-up Program.
4.2 Monitor.
City will monitor the activities and performance of Agency and any of its contractors,
subcontractors or vendors as necessary, but no less than annually. Monitoring by City will include
determining whether Agency is meeting the National Objective during the term of this Contract.
5. DUTIES AND RESPONSIBILITIES OF AGENCY.
5.1 Required Services.
Agency shall perform the services described in EXHIBIT "A" — Program Summary in
accordance with the terms and conditions of this Contract.
5.2 Use of CDBG Funds.
5.2.1. Compliance with CDBG Re�ulations and Contract.
Agency shall be reimbursed for eligible Program costs with CDBG Funds only if City
determines in its sole discretion that:
5.2.1.1 Costs are eligible expenditures in accordance with CDBG Regulations.
5.2.1.2 Costs are in compliance with this Contract and are reasonable and
consistent with industry norms.
5.2.1.3 Complete Documentation, as applicable, is submitted to City by
Agency.
5.2.2 Budget.
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5.2.2.1 The CDBG 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 Director approves the
Agency's proposed Budget amendment (as approved, the "Amended
Budget"), then the Amended Budget will take effect on the first day of
the month following the month in which it was approved by Director,
unless otherwise specified in the amendment. All requests for Budget
amendments must be submitted no later than two months prior to
contract termination.
5.2.3 Chan�e in Pro�ram Bud�et.
5.2.3.1 Agency will notify City promptly of any additional funds it receives for
operation of the Program, and City reserves the right to amend this
Contract in such instances to ensure compliance with HUD regulations
governing cost allocation.
5.2.3.2 Agency agrees to utilize the CDBG Funds to supplement rather than
supplant funds otherwise available for the Program.
5.2.4 Pavment of CDBG Funds to A�encv.
CDBG Funds will be disbursed to Agency upon City's approval of Reimbursement
Requests including submission of Complete Documentation to City in compliance with Section 9.
If Agency expends all funds budgeted for the Program prior to Termination Date City may hold
back a small amount of the CDBG Funds until the end of the term. During this interim period,
Agency must continue to submit Attachment III — Client Data Report in EXHIBIT "D" —
Reimbursement Forms monthly. It is expressly agreed by the Parties that any CDBG Funds not
spent or approved for reimbursement to Agency shall remain with City.
5.3 Program Performance Milestones.
5.3.1 Agency represents that the Program will achieve the following milestones in
accordance with EXHIBIT "A" — Program Summary and the table below:
Month � Expenditures
3 25°/a
6 50%
9 75%
Unduplicated Clients as
specified in EXHIBIT
"A" — Program
Summary
25%
50%
75%
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12 � 100% I 100%
5.3.2 Failure of Agency to meet these milestones or a material deviation from them as
outlined in this Section 5.3 is a breach of this Contract. For the purpose of this Section, "material
deviation" shall mean more than 10% lower than the specified goaL In the event of such breach,
City reserves the right in its sole option to (i) delay or withhold payment of Reimbursement
Requests, (ii) lower Agency's allocation of CDBG Funds, or (iii) terminate this Contract.
5.3.3 Failure to meet at least 80% of its performance milestones or serve 68
Unduplicated Clients of the 85 proposed Unduplicated Clients, in City's sole discretion, may
disqualify Agency for consideration of future contract award for federal grant funds.
5.3.4 Amendments to performance milestones regarding CDBG funds must be approved
by the Director in writing, with such approval being in the Director's sole discretion. If Director
approves the Agency's proposed amended performance milestones (as approved, the "Amended
Performance Milestones"), then the Amended Performance Milestones 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 no later than two months prior to Termination Date. Notwithstanding the above, any
amendments to this Contract shall not reduce the number of Unduplicated Clients stated in Section
5.3.3 and in EXHIBIT "A" - Program Summary.
5.4 Identifv Program Expenses Paid with CDBG Funds.
Agency will keep accounts and records in such a manner that City may readily identify and
account for Program expenses reimbursed with CDBG Funds. These records shall be made
available to City for audit purposes and shall be retained as required hereunder.
5.5 Meet National Obiective.
Agency shall ensure that the activities carried out in the Program will meet the National
Objective.
5.6 Program Subcontracts.
Agency shall not enter into a subcontract with another agency, contractor, or vendor to
provide a service to clients for any part of the Program that will be paid with CDBG Funds without
City's written consent.
6. CLIENT ELIGIBILITY VERIFICATION.
6.1 Client Eli�ibilitv.
Agency will document client eligibility as follows:
6.1.1 Agencv Clients.
Agency must verify all new clients' income with Source Documentation. Agency must
use the annual income definition in 24 CFR Part 5.609 to establish client income and must use the
most current HUD Income Guidelines. The income of all Program clients must be documented
and 100% of them must be Income Eligible Clients.
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6.1.1.1 All Program clients must be reported on EXHIBIT "D" —
Reimbursement Forms, Attachment III. Any Agency clients for
which the appropriate Source Documentation is not obtained shall be
presumed ineligible.
6.2 Submission of Complete Documentation.
Agency must submit copies of documentation of client eligibility described in Section 6.1
with Attachment III with each month's Reimbursement Request for all Unduplicated Clients.
6.3 Maintain Documentation.
Agency must maintain copies of all documentation required by this Section 6 for 7 years
following the expiration of the Contract term. This Section shall survive the earlier termination
or expiration of this Contract.
7. ADDITIONAL CDBG REOUIREMENTS.
Agency agrees to comply with all requirements of the CDBG Program as stated in the
CDBG Regulations, including but not limited to the following:
7.1 Environmental Review.
CDBG Funds will not be paid, and costs cannot be incurred on a given site until City has
conducted an environmental review and completed an Environmental Review Record for that site
as required by 24 CFR Part 58. The individual environmental reviews may result in a decision to
proceed with, modify, or cancel the funding for the Program. Further, Agency will not undertake
or commit any funds to physical or choice limiting actions as described in any applicable federal
regulations. Any violation of this provision will (i) cause this Contract to terminate immediately,
and (ii) require Agency to repay City the CDBG Funds it has already received and forfeit any
future payments of CDBG Funds.
7.1.2 Environmental Mitigation.
If applicable, Agency must take the mitigation actions outlined in EXHIBIT "A-2" —
Environmental Review Procedures. Failure to complete the required mitigation action is an
event of default under this Contract.
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
by City of an authorization to use grant funds from HUD under 24 CFR Part 58, (ii) approval of
City's 2023-2027 Consolidated Plan/2024-2025 Action Plan, and (iii) receipt by City of a grant
agreement from HUD.
7.3 Monitorin�.
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7.3.1 Agency understands and agrees that it will be subject to monitoring by City for
compliance with terms and provisions of this Contract and the CDBG Regulations for the term of
this Contract. Agency is subject to such monitoring during the term of this Contract and for 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. For purposes of this Contract, this 7 year period for
monitoring is deemed to begin immediately following the expiration or termination of this
Contract.
7.3.2 Representatives of City, HUD, HUD Office of Inspector General, and the United
States Comptroller General shall have access during regular business hours, upon 48 hours prior
notice, to Agency's offices and records pertaining to the use of the CDBG Funds, and to Agency's
officers, directors, agents, employees, contractors, subcontractors and vendors for the purpose of
such monitoring.
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
of any of its programs and single audits. 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 A�encv Procurement Standards.
Agency shall comply with all applicable federal, state and local laws, regulations, and
ordinances for making procurements under this Contract. In addition to the conflict of interest
provisions in Section 14.13.3, Agency shall establish written procurement procedures to ensure
that materials and services are obtained in a cost effective manner and that provide for full and
open competition. Agency shall provide a copy of such procurement procedures to City before the
first payment for construction services is processed. When procuring materials and services for
this Contract, Agency shall comply at a minimum with the procurement standards in 2 CFR Part
200.317 through Part 200.326.
7.4.1 Contracts in excess of $10,000.00 made by Agency using CDBG Funds must
include provisions governing termination for cause and convenience including the manner by
which such termination shall be affected and the basis for settlement of the terminated contract, if
any, as required by Appendix II(B), 2 CFR Part 200.
7.4.2 Agency shall not make any contract with parties listed on the government wide
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System for Award Management, www.sam.gov ("SAM"). Agency must confirm by search of
SAM that all contractors paid with CDBG Funds are not listed by SAM as being debarred, both
prior to contract execution and prior to submitting a Reimbursement Request which includes
invoices from any such contractor. Failure to submit such proofs of search shall be an event
of default.
7.5 Cost Principles/Cost Reasonableness.
Agency shall administer its use of CDBG Funds in compliance with 2 CFR Part 200, as
applicable. The eligibility of costs incurred for performance rendered shall be determined in
accordance with 2 CFR Part 200.400 through 2 CFR Part 200.475.
7.6 Financial Mana�ement Standards.
Agency agrees to comply with 2 CFR Part 200, as applicable. Agency also agrees to adhere
to the accounting principles and procedures required therein, utilize adequate internal controls, and
maintain necessary supporting and back-up documentation for all costs incurred in accordance
with 2 CFR Part 200.302 and Part 200.303.
7.7 Uniform Administrative Requirements, Cost Princiules, 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 Auqlicable to Contractors, Subcontractors and Vendors.
Agency understands and agrees that all terms of this Contract, whether regulatory or
otherwise, shall apply to any and all contractors, subcontractors and vendors of Agency which are
in any way paid with CDBG Funds or who perform any work in connection with the Program.
Agency shall cause all applicable provisions of this Contract to be included in and made a part of
any contract or subcontract executed in the performance of its obligations hereunder including its
obligations regarding the CDBG Regulations. Agency shall monitor the services and work
performed by its contractors, subcontractors and vendors on a regular basis for compliance with
the CDBG Regulations and Contract provisions. Agency must cure all violations of the CDBG
Regulations committed by its contractors, subcontractors or vendors. City maintains the right to
insist on Agency's full compliance with the terms of this Contract and the CDBG Regulations and
Agency is responsible for such compliance regardless of whether actions taken to fulfill the
requirements of this Contract are taken by Agency or by Agency's contractors, subcontractors or
vendors. Agency acknowledges that the provisions of this Section shall survive the earlier
termination or expiration of this Contract and shall be applicable for 7 years after the Contract term
ends.
7.9 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
Agency's performance under this Contract.
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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. Additionally, all applicants for Agency services shall be required
to complete the attached conflict of interest form incorporated herein as Exhibit "K"—Conflict
of Interest Disclosure Form and disclose any potential conflict of interest to both Agency and
City. If the applicant checks "yes" to any items on the form, Agency must submit the form to its
designated Contract Administrator. City Compliance Specialist(s) will review information to
determine whether CDBG Conflict of Interest requirements will apply. The Contract
Administrator will notify Agency of appropriate next steps at that time.
7.11 Compliance with FFATA and Whistleblower Protections.
Agency shall comply with the requirements of 2 CFR 300(b), including provisions of the
Federal Funding Accountability and Transparency Act ("FFATA") governing requirements on
executive compensation and provisions governing whistleblower protections contained in 10
U.S.C. 2409, 41 U.S.C. 4712, 10 U.S.C. 2324, 41 U.S.C. 4304 and 41 U.S.C. 4310.
7.11.1 Agency shall provide City with its DUNS number.
7.12 Internal Controls.
In compliance with the requirements of 2 CFR Part 200.303, Agency shall:
7.12.1 Establish and maintain effective internal control over the CDBG Funds that
provides reasonable assurance that Agency is managing the CDBG Funds in compliance
with federal statutes, regulations, and the terms and conditions of this Contract. These
internal controls shall be in compliance with guidance in "Standards for Internal Control
in the Federal Government" issued by the Comptroller General of the United States or the
"Internal Control Integrated Framework" issued by the Committee of Sponsoring
Organizations of the Treadway Commission ("COSO");
7.12.2 Comply with federal statutes, regulations, and the terms and conditions of this
Contract;
7.12.3 Evaluate and monitor Agency's compliance with statutes, regulations and the terms
and conditions of this Contract;
7.12.4 Take prompt action when instances of noncompliance are identified including
noncompliance identified in audit findings; and
7.12.5 Take reasonable measures to safeguard protected personally identifiable
information and other information that HUD or City designates as sensitive or Agency
considers sensitive consistent with applicable federal, state, local and tribal laws regarding
privacy and obligations of confidentiality.
7.13 Lead Safe Housing Rule.
Agency will ensure compliance with the Lead Safe Housing Rule at 24 CFR Part 35, as
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applicable. This includes but is not limited to Provision of Lead Hazard Information pamphlet,
use of Lead Certified contractors, use of Lead-Safe work practices, and clearance of the work site,
as applicable to the age of the housing unit and the extent of rehabilitation. Agency shall certify
that work affects only "de minimus" areas as appropriate to specific sites. "de minimus" thresholds
as defined by HUD are as follows: 20 square feet (2 square meters) on exterior surfaces; 2 square
feet (0.2 square meters) in any one interior room; or 10 percent of the total surface area on an
interior or exterior type of component with a small surface area (such as window sills, baseboards,
and trim). Agency shall submit EXHIBIT "J" — Lead Safe Hazard Certification to City when
appropriate.
8. RECORD KEEPING; REPORTING AND DOCUMENTATION
REQUIREMENTS; AUDIT.
8.1 Record Keening.
Agency shall maintain a record-keeping system as part of its performance of this Contract
and shall promptly provide City with copies of any document City deems necessary for the
effective fulfillment of City's monitoring and evaluation responsibilities. Specifically, Agency
will keep or cause to be kept an accurate record of all actions taken and all funds spent, with
supporting and back-up documentation. Agency will maintain all records and documentation
related to this Contract for 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. For purposes of this
Contract, this 7 year period for record retention is deemed to begin immediately following the
expiration or termination of this Contract.
8.2 Access to Records.
Representatives of City, HUD and any duly authorized ofiicials 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. For purposes of this Contract, this 7 year period for access to records is deemed to begin
immediately following the expiration or termination of this Contract.
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 Chan�e in Reportin� Requirements and Forms.
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City retains the right to change reporting requirements and forms at its discretion. City
will notify Agency in writing at least 15 days prior to the effective date of such change, and the
Parties shall execute an amendment to the Contract reflecting such change if necessary.
8.5 Audit.
8.5.1 Entities that Expend $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 a year in federal funds are
exempt from federal audit requirements for that year, but records must be available for review or
audit by appropriate officials of the federal agency, City, and General Accounting Office.
8.5.2 Citv Reserves the Right to Audit.
City reserves the right to perform an audit of Agency's Program operations and finances at
any time during the term of this Contract and for 7 years after the Contract term ends if City
determines that such audit is necessary for City's compliance with the CDBG Regulations or other
City policies. Agency agrees to allow access to all pertinent materials as described herein for such
audit. For purposes of this Contract, this 7 year period for City audit is deemed to begin
immediately following the eXpiration or termination of this Contract. If such audit reveals a
questioned practice or expenditure, such questions must be resolved within 15 business days after
notice to Agency of such questioned practice or expenditure. If questions are not resolved within
this period, City reserves the right to withhold further funding under this Contract and/or any other
contracts with Agency. IF AS A RESULT OF ANY AUDIT IT IS DETERMINED THAT
AGENCY HAS FALSIFIED ANY DOCUMENTATION OR MISUSED, MISAPPLIED OR
MISAPPROPRIATED CDBG FUNDS OR SPENT CDBG FUNDS ON ANY INELIGIBLE
ACTIVITIES, AGENCY AGREES TO REIMBURSE CITY THE AMOUNT OF SUCH
MONIES PLUS THE AMOUNT OF ANY SANCTIONS, PENALTY OR OTHER
CHARGE LEVIED AGAINST CITY BY HUD BECAUSE OF SUCH ACTIONS.
9. REIMBURSEMENT REOUIREMENTS.
9.1 Deadline for Submitting Reimbursement Repuests.
9.1.1 Reimbursement Requests shall be submitted monthly to the City and must
be received by the City on or before the 15th 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 15rh falls on a weekend or
City holiday, Reimbursement Requests shall be due the next day that the City is
open for business. Failure to submit a Reimbursement Request in a timely fashion
will result in City taking the actions outlined in Section 10.1.
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NOTWITHSTANDING ANYTHING ABOVE, THE REIMBURSEMENT
REQUEST FOR EXPENSES INCURRED FOR MAY 2027 AND ALL
SUPPORTING DOCUMENTATION MUST BE RECEIVED BY JUNE 15,
2027. FAILURE TO SUBMIT A FINAL REIMBURSEMENT REQUEST
WITH OMPLETE DOCUMENTATION BY JUNE 15, 2027 WILL C
RESULT IN AUTOMATIC FORFEITURE OF PAYMENT OF THE MAY
REIMBURSEMENT REQUEST.
9.1.2 City will notify Agency by e-mail within 20 calendar days if a Reimbursement
Request is lacking Complete Documentation or corrections are needed. Agency will have 10
business days from the date of the e-mail notice to submit any requested information ar missing
documentation. Agency may be penalized, at City's sole discretion, in the City's HUD Grant
Request for Proposal or Notice of Funding Availability (NOFA) process for subsequent Program
Years for any notifications received under this Section. If Agency fails to submit all the required
information or missing documentation within 30 calendar days from the first e-mail, Agency shall
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" — Reporting Forms with each Reimbursement Request:
9.2.1 Attachment I — Invoice.
This report shall contain the amount requested for reimbursement each month, the
cumulative reimbursement requested to date (inclusive of that month's request).
9.2.2 Attachment II— Expenditure Worksheet.
This report shall itemize each expense requested for reimbursement by Agency and shall
include the Account corresponding the expense to a Budget line item. In order for this report to
be complete the following must be submitted:
9.2.2.1 For payroll expenses, timesheets signed by employees and approved by
supervisor for all payroll expenses listed. Timesheets must distinguish
between CDBG-funded time and non-CDBG funded time and reflect
actual time spent on CDBG-funded activities. Agency may not submit
payroll expenses dated 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 60 calendar days prior to the date
of the Reimbursement Request.
9.2.2.3 Proof that each expense was paid by Agency, which proof can be
satisfied by cancelled checks, wire transfer documentation, paid receipts
or other appropriate banking documentation.
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9.2.3 Attachment III — Client Data Report. This report shall list each
Unduplicated Client served during the month along with his or her
demographic information. The Client Data Report must maintain a list of
all clients served during the Contract term. In order for this report to be
complete, the following must be submitted:
9.2.3.1 Source Documentation of income verification for
each Unduplicated Client the first time the client is
served by the Program
9.2.4 Attachment IV - Leverage of Funds Reqort. This report shall list all funds
and resources leveraged for the direct costs of the Program, to include
donated funds, donated materials and supplies, the value of discounted
materials and supplies, and donated volunteer labor. The report shall specify
the amounts of each type of leverage, the date it was provided, and the client
addresses at which funds were expended.
9.2.5 Delivery of Reimbursement Request. Reimbursement Requests shall be
submitted electronically via Neighborly. In the event that Neighborly
experiences unforeseen issues or complications, Agency may submit
Reimbursement Requests via email, or by other agreed upon method(s), per
the Agency's designated City contract administrator.
9.3 Withholdin� Pavment.
CITY SHALL HAVE NO OBLIGATION TO PAY ANY REIMBURSEMENT
REQUEST THAT IS NOT RECEIVED BY THE DUE DATE. Failure to timely submit
Reimbursement Requests and Complete Documentation along with any required reports
shall be an event of default.
10. DEFAULT AND TERMINATION.
10.1 Failure to Submit Reimbursement Repuest or Required Documentation.
10.11 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 10 business
days from the date of the written notice to submit such Reimbursement
Request to cure the default. If Agency fails to cure the default within
such time, Agency shall forfeit any payments otherwise due that month.
10.1.2 If Agency fails to submit requested information or missing
documentation as set forth in Section 9.1.2, then Agency shall forfeit
payment due that month and the failure to submit shall be considered an
event of default that shall not be cured.
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10.1.3 Notwithstanding THE PROVISIONS OF SECTION 10.1.1 or
10.1.2, IF AGENCY FAILS TO SUBMIT the Reimbursement
request due January 15, 2027, or if the submitted Reimbursement
Request for December 2026 is LATE, incomplete or OTHERWISE
NOT IN COMPLIANCE WITH THIS CONTRACT OR THE
CDBG REGULATIONS AS DETERMINED BY CITY IN ITS
SOLE DISCRETION, THERE WILL BE NO CURE PERIOD
AND ANY REIMBURSEMENT WILL BE FORFEITED.
10.1.4 In the event of (i) an uncured default under Section 10.1.1 or an event
of default under 10.1.2 or (ii) more than 2 instances of default, cured or
uncured, under these Sections, City reserves the right at its sole option
to terminate this Contract effective immediately upon written notice of
such intent with no penalty or liability to City.
10.1.5 Notwithstanding anything to the contrary herein, City will not be
required to pay any CDBG Funds to Agency during the period that any
Reimbursement Request, report or documentation is past due or is not
in compliance with this Contract or the CDBG Regulations, or during
any period during which Agency is in default of this Contract.
10.1.6 In the event of termination under this Section 10.1, all CDBG Funds
awarded but unpaid to Agency pursuant to this Contract shall be
immediately forfeited and Agency shall have no further right to such
funds.
10.2 Failure to Maintain Records or Submit Reports and Documentation.
If Agency fails to maintain all records and documentation as required in Section 8, or if the
maintained or submitted report or documentation is not in compliance with this Contract or the
CDBG Regulations as determined by City in its sole discretion, City will notify Agency in writing
and Agency will have 30 calendar days from the date of the written request to obtain or recreate
the missing records and documentation or submit or resubmit any such report or documentation to
City. If Agency fails to maintain the required reports or documentation, or fails to submit or
resubmit any such report or documentation within such time, City shall have the right to terminate
this Contract effective immediately upon written notice of such intent with no penalty or liability
to City.
10.2.1 In the event of termination under this Section 10.2, all CDBG Funds
awarded but unpaid to Agency pursuant to this Contract shall be
immediately forfeited and Agency shall have no further right to such
funds, and any CDBG Funds paid to Agency must be repaid to City
within 30 days of termination. If such CDBG Funds are not repaid to
City within the 30 day period, City shall exercise all legal remedies
available under this Contract.
10.3 In General.
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10.3.1 Subject to Section 10.2, and unless specifically provided otherwise in this
Contract, Agency shall be in default under this Contract if Agency breaches any term or condition
of this Contract. In the event that such a breach remains uncured after 30 calendar days following
written notice by City (or such other notice period as may be specified herein) or, if Agency has
diligently and continuously attempted to cure following receipt of such written notice but
reasonably requires more than 30 calendar days to cure, as determined by both Parties mutually
and in good faith, City shall have the right to elect in City's sole discretion to (i) extend Agency's
time to cure, (ii) terminate this Contract effective immediately upon written notice of such intent
to Agency, or (iii) pursue any other legal remedies available to City under this Contract.
10.3.2 City's remedies may include:
10.3.2.1 Direct Agency to prepare
carrying out the affected
timetables and milestones
activities.
and follow a schedule of actions for
activities, consisting of schedules,
necessary to implement the affected
10.3.2.2 Direct Agency to establish and follow a management plan that
assigns responsibilities for carrying out the remedial activities.
10.3.2.3 Reprogram CDBG Funds that have not yet been expended from
affected activities to other eligible activities or withhold CDBG
Funds.
10.3.2.4 Any other appropriate action including but not limited to any
remedial action legally available such as 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 CDBG Funds awarded
but unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency shall
have no further right to such funds, and any CDBG Funds already paid to Agency must be repaid
to City within 30 days of the termination. Failure to repay such CDBG Funds within the 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 CDBG Funds will be paid to Agency until all
defaults are cured to City's satisfaction.
10.5 No Compensation After Date of Termination.
Agency shall not receive any compensation for work undertaken after the date of the
termination.
10.6 Ri�hts of Citv Not Affected.
Termination shall not affect or terminate any of the existing rights of City against Agency,
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or which may thereafter accrue because of Agency's default and this provision shall be in addition
to any and all other rights and remedies available to City under the law. Such termination does
not terminate any provisions of this Contract that have been expressly noted as surviving the term
or termination of the Contract. No delay or omission by City in exercising any right or remedy
available to it under this Contract shall impair any such right or remedy or constitute a waiver or
acquiescence in any Agency default.
10.7 Waiver of Breach Not Waiver of Subsequent Breach.
The waiver of a default or breach of any term, covenant, or condition of this Contract shall
not operate as a waiver of any subsequent default or breach of the same or any other term, covenant
or condition hereof.
10.8 Civil, Criminal and Administrative Penalties.
Failure to perform all the Contract terms may result in civil, criminal or administrative
penalties, including, but not limited to those set out in this Contract.
10.9 Termination for Cause.
10.9.1 City may terminate this Contract in the event of Agency's default, inability, or
failure to perform subject to notice, grace and cure periods. In the event City terminates this
Contract for cause, all CDBG Funds awarded but unpaid to Agency pursuant to this Contract shall
be immediately rescinded and Agency shall have no further right to such funds and any CDBG
Funds already paid to Agency must be repaid to City within 30 days of termination. Failure to
repay such CDBG Funds within 30 days will result in City exercising all legal remedies available
to City under this Contract. AGENCY ACKNOWLEDGES AND AGREES THAT IF CITY
TERMINATES THIS CONTRACT FOR CAUSE, AGENCY OR ANY AFFILIATES OF
AGENCY SHALL NOT BE CONSIDERED FOR ANY OTHER CITY CONTRACT FOR
CDBG FUNDS FOR A MINIMUM OF 7 YEARS FROM THE DATE OF TERMINATION.
10.9.2 Agency may terminate this Contract if City does not provide the CDBG Funds
substantially in accordance with this Contract.
10.10 Termination for Convenience.
In terminating in accordance with 2 CFR Part 200, Appendix II, this Contract may be
terminated in whole or in part only as follows:
10.10.1 By City with the consent of Agency in which case the Parties shall agree upon
the termination conditions, including the effective date and in the case of partial termination, the
portion to be terminated; or
10.10.2 By Agency upon at least 30 days written notification to City, setting forth the
reasons for such termination, the effective date, and in the case of partial termination, the portion
to be terminated. In the case of a partial termination, City may terminate the Contract in its entirety
if City determines in its sole discretion that the remaining portion of the Contract to be performed
or CDBG Funds to be spent will not accomplish the purposes for which the Contract was made.
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10.10.3 Non-Appronriation 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
will terminate on the last day of the fiscal period for which appropriations were received without
penalty or expense to City of any kind whatsoever, except as to the portions of the payments
herein agreed upon for which funds have been appropriated.
10.11 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 CDBG Funds are subject to repayment and/or City may
exercise all of its remedies under this Contract.
10.12 Reversion of Assets.
In the event this Contract is terminated with or without cause, all assets acquired by Agency
with the CDBG Funds including cash, interest payments from loans or otherwise, all outstanding
notes, mortgages or other security instruments, any accounts receivable attributable to the use of
the CDBG Funds, and any real or personal property owned by Agency that was improved with the
CDBG Funds shall automatically transfer to City or to such assignee as City may designate.
11. REPAYMENT OF CDBG FUNDS.
All CDBG Funds are subject to repayment in the event the Program does not meet the
requirements of this Contract or in the CDBG Regulations. If Agency takes any action that
results in the City being required to repay all or any portion of the CDBG Funds to HUD,
Agency agrees it will reimburse City for such repayment. If Agency takes any action that
results in City receiving a finding from HUD about the Program, whether or not repayment
of all or any portion of the CDBG Funds is required of City, Agency agrees City may require
that 10% of the CDBG Funds be repaid to City as liquidated damages. The Parties agree that
City's damages in the event of either repayment to HUD being required or receiving a finding
from HUD are uncertain and would be difficult to ascertain and may include an impact on City's
CDBG grant or other federal grant funds, in addition to the finding by HUD or a required
repayment of funds to HUD by City. Therefore, the Parties agree that payment under this Section
of 10% of the CDBG Funds by Agency to City is liquidated damages and not a penalty.
12. CHANGE IN NON-PROFIT STATUS.
Agency must provide City with written notification of any changes to its non-profit status
within 15 calendar days of being notified of the change. Regardless of notice by Agency, if the
non-profit status of Agency changes after the date of this Contract, City may but is not obligated
to, terminate this Contract. In the event of termination under this Section 12, all CDBG Funds
awarded but not yet paid to Agency pursuant to this Contract shall be immediately rescinded and
Agency shall have no further right to such funds. City, in its sole discretion, may require that any
CDBG Funds already paid to Agency must be repaid to City within 30 calendar days of termination
under this Section.
13. SURVIVAL.
Any provision of this Contract that pertains to indemnity obligations, auditing, monitoring,
client income eligibility, record keeping and reports, reporting requirements, City ordinances, or
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applicable CDBG requirements, and any default and enforcement provisions necessary to enforce
such provisions, shall survive the termination of this Contract for 7 years after the Contract term
ends and shall be enforceable by City against Agency. For purposes of this Contract, this 7 year
period for survival of certain Contract provisions is deemed to begin immediately following the
expiration or termination of this Contract.
14. GENERAL PROVISIONS.
14.1 Agencv an Independent Contractor.
Agency shall operate hereunder as an independent contractor and not as an officer, agent,
servant or employee of City. Agency shall have exclusive control of, and the exclusive right to
control, the details of the work and services performed hereunder, and all persons performing
same, and shall be solely responsible for the acts and omissions of its officers, members, agents,
servants, employees, contractors, subcontractors, vendors, clients, licensees or invitees.
14.2 Doctrine of Resuondeat 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 A�encv Propertv.
City shall under no circumstances be responsible for any property belonging to Agency, or
its officers, members, agents, employees, contractors, subcontractors, vendors, clients, licensees
or invitees that may be lost, stolen or destroyed or in any way damaged and AGENCY HEREBY
INDEMNIFIES AND HOLDS HARMLESS CITY AND ITS OFFICERS, AGENTS, AND
EMPLOYEES FROM ANY AND ALL CLAIMS OR SUITS PERTAINING TO OR
CONNECTED WITH SUCH PROPERTY.
14.5 Religious Or�anization.
Agency shall comply with all applicable requirements as more particularly described in 24
CFR Part 5.109. No portion of the CDBG Funds shall be used in support of any sectarian or
religious activity. In addition, there must be no religious or membership criteria for clients of a
CDBG-funded service.
14.5.1. Senaration of Explicitiv Religious Activities.
Agency retains its independence and may continue to carry out its mission, including the
definition, development practice, and expression of its religious beliefs, provided that it does not
use CDBG Funds to support or engage in any explicitly religious activities (including activities
that involve overt religious content such as worship, religious instruction, or proselytization), or
in any other manner prohibited by law.
14.5.2 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
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activities must be offered separately, in time or location, from the programs or activities supported
by CDBG Funds and participation must be voluntary for clients of a CDBG-funded service.
14.5.3 Reauired Notices.
If Agency constitutes a Faith-based organization under 24 CFR Part 5.109, Agency must
provide all clients of a CDBG-funded service with a Notice of Beneficiary Rights, available upon
request from City staf£ Such notice shall be provided to the client prior to enrollment in any
CDBG-funded program or activity. In addition, if a client or prospective client of a CDBG-funded
service objects to the religious character of Agency, then Agency must promptly undertake
reasonable efforts to identify and refer the client or prospective client to an alternate provider to
which the client or prospective client has no such objection, as more particularly described in 24
CFR Part 5.109.
14.6 Venue.
Venue shall lie in Tarrant County, Texas for any action, whether real or asserted, at law
or in equity, arising out of the execution, performance, attempted performance or
non-performance of this Contract.
14.7 Governing Law.
This Contract shall be governed by and construed in accordance with the laws of the State
of Texas. If any action, whether real or asserted, at law or in equity, arises out of the execution,
performance or non-performance of this Contract or on the basis of any provision herein, for any
issue not governed by federallaw, the choice of law shall be the laws of the State of Texas.
14.8 Severabilitv.
The provisions of this Contract are severable, and if for any reason a clause, sentence,
paragraph or other part of this Contract shall be determined to be invalid by a court or federal or
state agency, board or commission having jurisdiction over the subject matter thereof, such
invalidity shall not affect other provisions which can be given effect without the invalid provision.
14.9 Written Agreement Entire Contract.
This written instrument and the Exhibits, Attachments, and Addendums attached hereto,
which are incorporated by reference and made a part of this Contract for all purposes, constitute
the entire agreement by the Parties concerning the work and services to be performed under this
Contract. Any prior or contemporaneous oral or written agreement which purports to vary the
terms of this Contract shall be void. Any amendments to the terms of this Contract must be in
writing and executed by the Parties.
14.10 Paragraph Headings for Reference Onlv, No Legal Significance; Number
and Gender.
The paragraph headings contained herein are for convenience in reference to this Contract
and are not intended to define or to limit the scope of any provision of this Contract. When context
requires, singular nouns and pronouns include the plural and the masculine gender shall be deemed
to include the feminine or neuter and the neuter gender to include the masculine and feminine.
The words "include" and "including" whenever used herein shall be deemed to be followed by the
words "without limitation".
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14.11 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:
➢ CDBG Regulations found in 24 CFR Part 570
➢ Title I of the Housing and Community Development Act of 1974, as amended, (42
USC 5301)
➢ Title VI of the Civil Rights Act of 1964 (42 U.S.C. Sections 2000d et seq.) including
provisions requiring recipients of federal assistance to ensure meaningful access by
persons of limited English proficiency
➢ The Fair Housing Act, Title VIII of the Civil Rights Act of 1968 (42 U.S.C. Sections
3601 et seq.)
➢ Executive Orders 11063, 11246 as amended by 11375 and 12086 and as supplemented
by Department of Labor regulations 41 CFR Part 60
➢ The Age Discrimination in Employment Act of 1967
➢ The Age Discrimination Act of 1975 (42 U.S.C. Sections 6101 et seq.)
➢ The Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970
(42 U.S.C. Sections 4601 et seq. and 49 CFR Part 24) ("URA")
➢ Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. Sections 794 et seq.) and 24
CFR Part 8 where applicable
➢ National Environmental Policy Act of 1969, as amended, 42 U.S.C. Sections 4321 et
seq. ("NEPA") and the related authorities listed in 24 CFR Part 58.
➢ The Clean Air Act, as amended, (42 U.S.C. Sections 1251 et seq.) and the Clean Water
Act of 1977, as amended (33 U.S.C. Sections 1251 et seq.) and the related Executive
Order 11738. In no event shall any amount of the assistance provided under this
Contract be utilized with respect to a facility that has given rise to a conviction under
the Clean Air Act or the Clean Water Act.
➢ Immigration Reform and Control Act of 1986 (8 U.S.C. Sections 1101 et seq.)
specifically including the provisions requiring employer verifications of legal status of
its employees
➢ The Americans with Disabilities Act of 1990 (42 U.S.C. Sections 12101 et seq.), the
Architectural Barriers Act of 1968 as amended (42 U.S.C. Sections 4151 et seq.) and
the Uniform Federal Accessibility Standards, 24 CFR Part 40, Appendix A
➢ Regulations at 24 CFR Part 87 related to lobbying, including the requirement that
certifications and disclosures be obtained from all covered persons
➢ Drug Free Workplace Act of 1988 (41 U.S.C. Sections 701 et seq.) and 24 CFR Part
23, Subpart F
➢ Executive Order 12549 and 24 CFR Part 5.105(c) pertaining to restrictions on
participation by ineligible, debarred or suspended persons or entities
➢ Section 6002 of the Solid Waste Disposal Act, as amended by the Resource
Conservation and Recovery Act
➢ Guidelines of the Environmental Protection Agency at 40 CFR Part 247
➢ For contracts and subgrants for construction or repair, Copeland "Anti-Kickback" act
(18 U.S.C. 874) as supplemented in 29 CFR Part 5
➢ For construction contracts awarded by Agency in excess of $2,000 that are not for
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single family, owner-occupied, home rehabilitation, and in excess of $2,500 for other
contracts which involve the employment of inechanics or laborers, Sections 103 and
107 of the Contract Wark 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
➢ 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.
1412 HUD-Assisted Proiects and Emplovment and other Economic Opportunities;
Section 3 Reauirements.
14.12.1 Requirement that Law Be Ouoted in Covered Contracts. — Certain
Requirements Pertaining to Section 3 of the Housing and Urban
Develoument Act of 1968 as Amended (12 U.S.C. Sections 1701 et sea.) and
its Related Re�ulations at 24 CFR Part 135.
If the Program results in the creation of new employment, training, or contracting
opportunities on a contractor or subcontractor level resulting from the expenditure of the CDBG
Funds, Agency shall comply with the following and will ensure that its contractors also comply.
If the work performed under this Contract is on a project assisted under a program providing direct
federal financial assistance from HUD, Section 3 of 24 CFR Part 135.38 ("Section 3") requires
that the following clause, shown in italics, be inserted in all covered contracts ("Section 3
Clause"):
Section to be quoted in covered contracts begins:
A. The work to be performed under this contract is subject to the requirements
of Section 3 of Housing and Urban Development Act of 1968, as amended, 12
U. S. C. section 1701 u(Section 3). The purpose of Section 3 is to ensure that
employment and other economic opportunities generated by HUD assisted or
HUD-assisted programs covered by Section 3, shall to the greatest extent feasible,
be directed to low- and very-low income persons, particularly persons who are
recipients of HUD assistance for housing.
B. The parties to this contract agree to comply with HUD's regulations in 24
CFR Part 135, which implement Section 3. As evidenced by their execution of this
contract, the parties to this contract certify that they are under no contractual or
other impediment that would prevent them from complying with the Part 135
regulations.
C. The contractor agrees to send to each labor organization or representative
of workers with which it has a collective bargaining agreement or other
understanding, if any, a notice advising the labor organization or workers'
representatives of the contractor's commitments under this Section 3 clause and
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will post copies of the notice in conspicuous places at the work site where both
employees and applicants for training and employment positions can see the notice.
The notice shall describe the Section 3 preference, shall set forth minimum numbeN
and job titles subject to hire, availability of apprentice and training positions, the
qualifications for each; and the name and location of the peNson(s) taking
applications for each of the positions; and the anticipated date the work shall begin.
D. The contractoN agNees that it will include this Section 3 clause in every
subcontract to comply with regulation in 24 CFR Part 135, and agrees to take
appropriate action, as provided in an applicable provision of the subcontract or in
this Section 3 clause, upon finding that the subcontractor is in violation of the
regulations in 24 CFR Part 135. The contractor will not subcontract with any
subcontractor where it has notice or knowledge that the subcontractor has been
found in violation of regulations in 24 CFR Part 135.
E. The contractor will certify that any vacant employment positions, including
training positions that are filed: (1) afteN the contNactor is selected but before the
contract is executed, and (2) with persons other than those to whom the regulations
of 24 CFR Part 135. The contNactor will not subcontract with any subcontractor
where it has notice or knowledge that the subcontractor has been found in violation
of regulations in 24 CFR Part 135.
F. Noncompliance with HUD's regulation in 24 CFR Part 135 may result in
sanctions, termination of this contNact foN default, and debarment or suspension
fi^om future HUD assisted contracts.
G. With respect to workperformed in connection with Section 3 coveredlndian
housing assistance, section 7(b) of the Indian Self-Determination and Education
Assistance Act (25 U.S.C. Section 450(e) also applies to the work to be performed
under this Contract. Section 7(b) requires that to the greatest extent feasible (i)
preference and opportunities for training and employment shall be given to Indians,
and (ii) preference in the award of contracts and subcontracts shall be given to
Indian organizations and Indian-owned Economic Enterprises. Parties to this
contract that are subject to the provisions of Section 3 and Section 7(b) agree to
comply with Section 3 to the maximum extent feasible, but not in derogation of
compliance with Section 7(b). "
Section to be quoted in covered contracts ends.
14.12.2 A�encv Responsibilities for Section 3 Requirements.
City and Agency understand and agree that compliance with the provisions of Section 3,
the regulations set forth in 24 CFR Part 135, and all applicable rules and orders of HUD shall be a
condition of the federal �nancial assistance provided to the Program binding upon City and
Agency and their respective successors, assigns, contractors and subcontractors. Failure to fuliill
these requirements shall subj ect Agency and its contractors and subcontractors and their respective
successors and assigns to those sanctions specified by the grant agreement through which federal
assistance is provided and to such sanctions as are specified by 24 CFR Part 135. Agency's
responsibilities include:
14.12.2.1 Implementing procedures to notify Section 3 residents and business
concerns about training, employment, and contracting opportunities
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generated by Section 3 covered assistance;
14.12.2.2 Notifying potential contractors working on Section 3 covered
projects of their responsibilities;
14.12.2.3 Facilitating the training and employment of Section 3 residents and
the award of contracts to Section 3 business concerns;
14.12.2.4 Assisting and actively cooperating with the Neighborhood Services
Department in making contractors and subcontractors comply;
14.12.2.5 Refraining from entering into contracts with contractors that are in
violation of Section 3 regulations;
14.12.2.6 Documenting actions taken to comply with Section 3; and
14.12.2.7 Submitting Section 3 Annual Summary Reports (Form HUD-
60002) in accordance with 24 CFR Part 135.90.
14.12.3 Section 3 Reportin� Reauirements.
In order to comply with the Section 3 requirements, Agency must submit the forms attached
hereto as EXHIBIT "G" - Section 3 Reporting Forms.
14.12.3.1 Report to the City on a quarterly basis all applicants for
employment, and all applicants for employment by contractor and
subcontractor. This shall include name, address, zip code, date of
application, and status (hired/not hired) as of the date of the report.
14.12.3.2 Advertise available positions to the public for open competition, and
provide documentation to City with the quarterly report that
demonstrates such open advertisement in the form of printout of
Texas Workforce Commission posting, copy of newspaper
advertisement, copy of flyers and listing of locations where flyers
were distributed, and the like.
14.12.3.3 Report to the City on a quarterly basis all contracts awarded by
contractor and subcontractor. This shall include name of contractor
and/or subcontractor, address, zip code, and amount of award as of
the date of the report.
14.13 Prohibition Against Discrimination.
14.13.1 General Statement.
Agency shall comply in the execution, performance or attempted performance of this
Contract, with all non-discrimination requirements of 24 CFR Part 570.607 and Chapter 17, Article
III, Division 4— Fair Housing of the City Code. Agency may not discriminate against any person
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because of race, color, sex, gender, religion, national origin, familial status, disability or perceived
disability, sexual orientation, gender identity, gender expression, or transgender, nor will Agency
permit its officers, members, agents, employees, or clients to engage in such discrimination.
This Contract is made and entered into with reference specifically to Chapter 17, Article
III, Division 3- Employment Practices of the City Code, and Agency hereby covenants and agrees
that Agency, its officers, members, agents, employees and contractors, have fully complied with
all provisions of same and that no employee, or applicant for employment has been discriminated
against under the terms of such ordinances by either or its officers, members, agents, employees
or contractors.
14.13.2 No Discrimination in 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 T�endor's name] will not unlawfully discriminate against
any employee or applicants for employment because of race, color, sex, gender, religion, national
origin, familial status, disability or perceived disability, sexual orientation, gender identity, gender
expression or transgender. �Contractor's, Subcontractor's or Vendor's name] will take affirmative
action to ensure that applicants are hired without regard to race, color, sex, gender, religion,
national origin, familial status, disability or perceived disability, sexual orientation, gender
identity, gender expression or transgender and that employees are treated fairly during employment
without regard to their race, color, sex, gender, religion, national origin, familial status, disability
or perceived disability, sexual orientation, gender identity, gender expression or transgender. Such
action shall include, but not be limited to, the following: employment, upgrading, demotion or
transfer, recruitment or recruitment advertising, layoff or termination, rates of pay or other forms
of compensation, and selection for training, including apprenticeship. [Contractor's,
Subcontractor's or Vendor's name] agrees to post in conspicuous places, available to employees
and applicants for employment, notices setting forth the provisions of this nondiscrimination
clause.
[Contractor's. Subcontractor's or I�endor's name] will, in all solicitations or
advertisements for employees placed by or on behalf of [Contractor's, Subcontractor's or
T�endor'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 T�endor's name] covenants that neither it nor any of its
officers, members, agents, employees, or contractors, while engaged in performing this Contract,
shall, in connection with the employment, advancement or discharge of employees or in
connection with the terms, conditions or privileges of their employment, discriminate against
persons because of their age or because of any disability or perceived disability, except on the
basis of a bona fide occupational qualification, retirement plan or statutory requirement.
[Contractor's, Subcontractor's or Vendor's name] further covenants that neither it nor its
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officers, members, agents, employees, contractors, or persons acting on their behalf, shall specify,
in solicitations or advertisements for employees to work on this Contract, a maximum age limit
for such employment unless the specified maximum age limit is based upon a bona fide
occupational qualification, retirement plan or statutory requirement.
14.13.3 Agencv's Contractors and the ADA.
In accordance with the provisions of the Americans With Disabilities Act of 1990
("ADA"), Agency warrants that it and any of its contractors will not unlawfully discriminate on
the basis of disability in the provision of services to the general public, nor in the availability, terms
and/or conditions of employment for applicants for employment with, or employees of, Agency or
any of its contractors. AGENCY WARRANTS IT WILL FULLY COMPLY WITH THE
ADA'S PROVISIONS AND ANY OTHER APPLICABLE FEDERAL, STATE AND
LOCAL LAWS CONCERNING DISABILITY AND WILL DEFEND, INDEMNIFY AND
HOLD CITY HARMLESS AGAINST ANY CLAIMS OR ALLEGATIONS ASSERTED BY
THIRD PARTIES, CONTRACTORS SUBCONTRACTORS, VENDORS OR AGENTS
AGAINST CITY ARISING OUT OF AGENCY'S AND/OR ITS CONTRACTORS',
SUBCONTRACTORS', VENDORS' OR AGENTS' OR THEIR RESPECTIVE
EMPLOYEES' ALLEGED FAILURE TO COMPLY WITH THE ABOVE-REFERENCED
LAWS CONCERNING DISABILITY DISCRIMINATION IN THE PERFORMANCE OF
THIS CONTRACT.
14.14. Conflicts of Interest and Violations of Criminal Law.
14.14.1 Agencv Safe�uards.
Agency shall establish safeguards to prohibit its employees, board members, advisors and
agents from using positions for a purpose that is or gives the appearance of being motivated by a
desire for private gain for themselves or others, particularly those with whom they have family,
business or other ties. Agency shall disclose to City any such conflict of interest or potential
conflict of interest, immediately upon discovery of such.
14.14.2 General Prohibitions 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 CDBG funds or who are in a position to participate in a decision-making
process or gain inside information with regard to these activities may utilize CDBG services, may
obtain a financial interest or benefit from a CDBG-assisted activity, or have an interest in any
contract, subcontract or agreement with respect thereto, or the proceeds thereunder, either for
themselves or those with whom they have family or business ties, during their tenure or for 1 year
thereafter.
14.14.3 Conflicts of Interest Involvin� Procurement.
The conflict of interest provisions of 2 CFR Part 200.31, shall apply in the procurement of
property and services by Agency. In all cases not governed by this Section, the provisions of 24
CFR Part 570.611 of the CDBG Regulations shall apply.
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14.14.3.1 As more particularly described in 2 CFR Part 200.318, Agency shall
maintain and submit to City written standards of conduct covering
conflicts of interest and governing the performance of its employees
engaged in the selection, award, and administration of contracts. No
employee, officer, or agent may participate in the selection, award,
or administration of a contract supported by a federal award if he or
she has a real or apparent conflict of interest. The standards of
conduct must provide for disciplinary actions to be applied for
violations of such standards by officers, employees, or agents of
Agency.
14.14.3.2 The officers, employees, and agents of Agency shall neither solicit
nor accept gratuities, favors, or anything of monetary value from
contractors or parties to subcontracts.
14.14.3.3 Notwithstanding the prohibition contained in Section 14.13.3.2,
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.
14.14.3.4 Agency shall maintain written standards of conduct covering
organizational conflicts of interest. Organizational conflicts of
interest means that because of relationships with a parent company,
affiliate, or subsidiary organization, Agency is unable or appears to
be unable to be impartial in conducting a procurement action
involving a related organization.
14.14.3.5 Agency must maintain records sufficient to detail the history of
procurement. These records will include, but are not necessarily
limited to the following: rationale for the method of procurement,
selection of contract type, contractor selection or rejection, and the
basis for the contract price.
14.14.4 Disclosure of Conflicts of Interest.
In compliance with 2 CFR Part 200.112, Agency is required to timely disclose to City in
writing any potential conflict of interest.
14.14.5 Disclosure of Texas Penal Code Violations.
Agency affirms that it will adhere to the provisions of the Texas Penal Code which prohibit
bribery and gifts to public servants.
14.14.6 Disclosure of Federal Criminal Law Violations.
In compliance with 2 CFR Part 200.113, Agency is required to timely disclose to City all
violations of federal criminal law involving fraud, bribery or gratuity violations potentially
affecting the Agency.
14.15 Subcontracting with Small and Minoritv Firms, Women's Business
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Enterprises and Labor Surplus Areas.
14.15.1 For procurement contracts $100,000.00 or larger that are paid for, in part or in
full, with the CDBG Funds, Agency agrees to abide by City's policy to involve Minority
Business Enterprises and Small Business Enterprises and to provide them equal opportunity to
compete for contracts for construction, provision of professional services, purchase of
equipment and supplies and provision of other services required by City. To the extent
applicable, Agency agrees to comply with all City Ordinances, and all amendments or successor
policies or ordinances thereto, for all contracts and subcontracts for procurement larger than
$100,000.00 or larger that are paid for, in part or in full, with the CDBG Funds and will further
require all persons or entities with which it so contracts to comply with said ordinance.
14.15.2 It is national policy to award a fair share of contracts to disadvantaged business
enterprises ("DBEs"), small business enterprises ("SBEs"), minority business
enterprises ("MBEs"), and women's business enterprises ("WBEs"). Accordingly, affirmative
steps must be taken to assure that DBEs, SBEs, MBEs, and WBEs are utilized when possible
as sources of supplies, equipment, construction and services.
14.15.2.1 In order to comply with federal reporting requirements as described
in 24 CFR Part 570.506 (g)(6), Agency must submit the form
attached hereto as EXHIBIT "I" — MBE Reporting Form for each
contract or subcontract with a value of $25,000.00 or more paid or
to be paid with the CDBG Funds. Agency shall submit this form by
the date specified in EXHIBIT "I" — MBE Reporting Form.
14.16 Other Laws.
The failure to list any federal, state or City ordinance, law or regulation that is applicable
to Agency does not excuse or relieve Agency from the requirements or responsibilities in regard
to following the law, nor from the consequences or penalties for Agency's failure to follow the
law, if applicable.
14.17 Assignment.
Agency shall not assign all or any part of its rights, privileges, or duties under this Contract
without the prior written approval of City. Any attempted assignment of same without approval
shall be void, and shall constitute a breach of this Contract.
14.18. Right to Inspect A�encv Contracts.
It is agreed that City has the right to inspect and approve in writing any proposed contracts
between Agency and any contractor ar vendor engaged in any activity in conjunction with this
CDBG-funded Program prior to any charges being incurred.
14.19 Force Maieure
If Agency becomes unable, either in whole or part, to fulfill its obligations under this
Contract due to acts of God, strikes, lockouts, or other industrial disturbances, acts of public
enemies, wars, blockades, insurrections, riots, epidemics, earthquakes, fires, floods, restraints or
prohibitions by any court, board, department, commission or agency of the United States or of any
States, civil disturbances, or explosions, or some other reason beyond Agency's control
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(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.
14.20 IMMIGRATION NATIONALITY ACT.
Agency shall verify the identity and employment eligibility of its employees who perform
work under this Agreement, 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 Agreement. 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 Agreement for violations of this provision by Agency.
15. INDEMNIFICATION AND RELEASE.
AGENCY COVENANTS AND AGREES TO INDEMNIFY, HOLD HARMLESS
AND DEFEND, AT ITS OWN EXPENSE, CITY AND ITS OFFICERS, AGENTS,
SERVANTS AND EMPLOYEES FROM AND AGAINST ANY AND ALL CLAIMS OR
SUITS FOR PROPERTY LOSS OR DAMAGE AND/OR PERSONAL INJURY,
INCLUDING DEATH, TO ANY AND ALL PERSONS, OF WHATSOEVER HIND OR
CHARACTER, WHETHER REAL OR ASSERTED, ARISING OUT OF OR IN
CONNECTION WITH THE EXECUTION, PERFORMANCE, ATTEMPTED
PERFORMANCE OR NONPERFORMANCE OF THIS CONTRACT AND/OR THE
OPERATIONS, ACTIVITIES AND SERVICES OF THE PROGRAM DESCRIBED
HEREIN, WHETHER OR NOT CAUSED IN WHOLE OR IN PART, BY ALLEGED
NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS
OR SUBCONTRACTORS OF CITY; AND AGENCY HEREBY ASSUMES ALL
LIABILITY AND RESPONSIBILITY OF CITY AND ITS OFFICERS, AGENTS,
SERVANTS, AND EMPLOYEES FOR ANY AND ALL CLAIMS OR SUITS FOR
PROPERTY LOSS OR DAMAGE AND/OR PERSONAL INJURY, INCLUDING DEATH,
TO ANY AND ALL PERSONS, OF WHATSOEVER 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
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AGAINST ANY AND ALL INJURY, DAMAGE OR DESTRUCTION OF PROPERTY OF
CITY, ARISING OUT OF OR IN CONNECTION WITH ALL ACTS OR OMISSIONS OF
AGENCY, ITS OFFICERS, MEMBERS, AGENTS, EMPLOYEES, CONTRACTORS,
SUBCONTRACTORS, INVITEES, LICENSEES, OR CLIENTS, OR CAUSED, IN
WHOLE OR IN PART, BY ALLEGED NEGLIGENCE OF OFFICERS, AGENTS,
SERVANTS, EMPLOYEES, CONTRACTORS OR SUBCONTRACTORS OF CITY.
IT IS THE EXPRESS INTENTION OF THE PARTIES, BOTH AGENCY AND
CITY, THAT THE INDEMNITY PROVIDED FOR THIS SECTION INCLUDES
INDEMNITY BY AGENCY TO INDEMNIFY AND PROTECT CITY FROM THE
CONSEQUENCES OF CITY'S OWN NEGLIGENCE, WHETHER THAT NEGLIGENCE
IS ALLEGED TO BE THE SOLE OR CONCURRING CAUSE OF THE INJURY,
DAMAGE OR DEATH.
AGENCY AGREES TO AND SHALL RELEASE CITY, ITS AGENTS,
EMPLOYEES, OFFICERS AND LEGAL REPRESENTATIVES FROM ALL LIABILITY
FOR INJURY, DEATH, DAMAGE OR LOSS TO PERSONS OR PROPERTY
SUSTAINED IN CONNECTION WITH OR INCIDENTAL TO PERFORMANCE UNDER
THIS CONTRACT, EVEN IF THE INJURY, DEATH, DAMAGE OR LOSS IS CAUSED
BY CITY'S SOLE OR CONCURRENT NEGLIGENCE.
AGENCY SHALL REQUIRE ALL OF ITS CONTRACTORS AND
SUBCONTRACTORS TO INCLUDE IN THEIR CONTRACTS AND SUBCONTRACTS
A RELEASE AND INDEMNITY IN FAVOR OF CITY IN SUBSTANTIALLY THE SAME
FORM AS ABOVE.
16. WAIVER OF IMMUNITY BY AGENCY.
If Agency, as a charitable or nonprofit organization, has or claims an immunity or
exemption (statutory or otherwise) from and against liability for damages or injury, including
death, to persons or property, Agency hereby expressly waives its rights to plead defensively such
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
$500,000.00 to insure against loss from the fraud, theft or dishonesty of any of Agency's officers,
agents, trustees, directors or employees. The proceeds of such insurance or bond shall be used to
reimburse City for any and all loss of CDBG 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.
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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 Liability Insurance
$1,000,000 each accident on a combined single-limit basis, or
$ 250,000 Property Damage
$ 500,000 Bodily Injury per person per occurrence
$2,000,000 Aggregate
Insurance policy shall be endorsed to cover "Any Auto", defined as autos owned, hired,
and non-owned. Pending availability of the above coverage and at the discretion of
City, the policy shall be the primary responding insurance policy versus a personal
auto insurance policy if or when in the course of Agency's business as contracted
herein.
Workers' Compensation Insurance
Part A: Statutory Limits
Part B: Employer's Liability
$100,000 each accident
$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.
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Agency will submit to City documentation that it has obtained insurance coverage and has
executed bonds as required in this Contract prior to payment of any monies provided hereunder.
Where applicable, insurance policies required herein shall be endorsed to include City as an
additional insured as its interest may appear. Additional insured parties shall include employees,
officers, agents, and volunteers of City.
Any failure on part of City to request certificate(s) of insurance shall not be construed as a waiver
of such requirement or as a waiver of the insurance requirements themselves.
Insurers of Agency's insurance policies shall be licensed to do business in the state of Texas by
the Department of Insurance or be otherwise eligible and authorized to do business in the state of
Texas. Insurers shall be acceptable to City insofar as their financial strength and solvency and
each such company shall have a current minimum A.M. Best Key Rating Guide rating of A-: VII
or other equivalent insurance industry standard rating otherwise approved by City.
Deductible limits on insurance policies shall not exceed $5,000 per occurrence unless otherwise
approved by City.
In the event there are any local, federal or other regulatory insurance or bonding requirements for
the Program, and such requirements exceed those specified herein, the former shall prevail.
Agency shall require its contractors to maintain applicable insurance coverages, limits, and other
requirements as those specified herein; and Agency shall require its contractors to provide Agency
with certificate(s) of insurance documenting such coverage. Also, Agency shall require its
contractors to have City and Agency endorsed as additional insureds (as their interest may appear)
on their respective insurance policies.
Directors and Officers Liability coverage shall be in force and may be provided on a claims-made
basis. This coverage may also be referred to as Management Liability, and shall protect the insured
against claims arising out of alleged errors in judgment, breaches of duty and wrongful acts arising
out of their organizational duties. Coverage shall protect not only the entity, but all past, present
and future directors, officers, trustees, employees, volunteers and committee members.
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
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awarding of any federal contract, the making of any federal grant, the making of any federal
loan, the entering into of any cooperative agreement and the extension, continuation,
renewal, amendment, or modification of any federal contract, grant, loan or cooperative
agreement.
If any funds other than federally appropriated funds have been paid or will be paid to any
person for influencing or attempting to influence an officer or employee of any agency,
member of Congress in connection with this federal contract, grant, loan or cooperative
agreement, Agency shall complete and submit Standard Form-LLL, "Disclosure Form to
Report Lobbying," in accordance with its instructions.
This certification is a material representation of fact upon which reliance was placed when
this Contract was made or entered into. Submission of this certificate is a prerequisite for
making or entering into this Contract imposed by 31 U.S.C. Section 1352. Any person
who fails to file the required certification shall be subject to a civil penalty of not less than
$10,000.00 and not more than $100,000.00 for each such failure.
Agency shall require that the language of this certification be included in all subcontracts or
agreements involving the expenditure of federal funds.
19. LITIGATION AND CLAIMS.
Agency shall give City immediate notice in writing of any action, including any proceeding
before an administrative agency, filed against Agency in conjunction with this Contract or the
Program. Agency shall furnish immediately to City copies of all pertinent papers received by
Agency with respect to such action or claim. Agency shall provide a notice to City within 10 days
upon filing under any bankruptcy or financial insolvency provision of law.
20. NOTICE.
All notices required or permitted by this Contract must be in writing and are deemed
delivered on the earlier date of the date actually received or the third day following deposit in a
United States Postal Service post office or receptacle; with proper postage, certiiied 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.
Citv
Neighborhood Services Department
100 Fort Worth Trail
Fort Worth, TX 76102
Attention: Neighborhood Development Coordinator
Telephone: 817-392-2653
Copy to:
City Attorney's Office
100 Fort Worth Trail
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Fort Worth, TX 76102
Telephone: 817-392-7600
Copy to:
Neighborhood Services Department
100 Fort Worth Trail
Fort Worth, TX 76102
Attention: Housing Development Manager
Telephone: 817-392-7583
A�encv:
Trinity Habitat for Humanity
Gage Yager, C.E.O.
9333 N. Normandale St.
Fort Worth, TX 76116
Telephone: 817-926-9219
21. AGENCY HAS LEGAL AUTHORITY TO ENTER INTO CONTRACT.
Agency represents that it possesses the legal authority, pursuant to any proper, appropriate
and official motion, resolution or action passed or taken, to enter into this Contract and to perform
the responsibilities herein required.
22. COUNTERPARTS.
This Contract may be executed in multiple counterparts, each of which shall be considered
an original, but all of which shall constitute one instrument which may be sufficiently evidenced
by one counterpart.
23. PROGRAM INCOME
Parties agree that no program income as defined by HUD shall be earned as a result of this
contract.
24. PROHIBITION ON CONTRACTING WITH COMPANIES THAT BOYCOTT
ISRAEL
If Agency has fewer than 10 employees or this Agreement is for less than $100,000,
this section does 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.
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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 verification to the City that Agency: (1) does not boycott
energy companies; and (2) will not boycott energy companies during the term of this
Agreement.
26. PROHIBITION ON DISCRIMINATION AGAINST FIREARM AND
AMMUNITION INDUSTRIES
Agency acknowledges that except as otherwise provided by Chapter 2274 of the Texas
Government Code, as added by Acts 2021, 87th Leg., R.S., S.B.19, § 1, the City is prohibited
from entering into a contract for goods or services that has a value of $100,000 or more that
is to be paid wholly or partly from public funds of the City with a company with 10 or more
full-time employees unless the contract contains a written verification from the company that
it: (1) does not have a practice, policy, guidance, or directive that discriminates against a
firearm entity or firearm trade association; and (2) will not discriminate during the term of
the contract against a firearm entity or firearm trade association. 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 Vendor'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 Agreement may be executed by electronic signature, which will be considered as an
original signature for all purposes and have the same force and effect as an original signature. For
these purposes, "electronic signature" means electronically scanned and transmitted versions (e.g.
via pdf file or facsimile transmission) of an original signature, or signatures electronically inserted
via software such as Adobe Sign.
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[SIGNATURES APPEAR ON NEXT PAGE]
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IN WITN�SS WH�I2COF, the Parties hereto have executed this Contract in Foct Worth,
Tai•rant County, Texas.
p.p4vanp��
v°��°��ORt �9.�a
ATT�ST: ° o
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PQ* ��o ���c�
Jannette Goodall �an� nEXAs4pp
City Secretary
M&C: 25-0676
Date: August 12, 2025
1295 Certification No. 1405313
RECOMM�NDED BY:
l�a� �o�
Kacey Thomas (Fet 11, 2026 09:51:57 CSn
Kacey Thomas
Neighborhood Services Director
APPROVED AS TO FORM AND LEGALITY:
Soph(e Mathewt
Sophie Mathews
Assistant City Attorney II
CITY OF FORT WORTH:
ba.r�ca. B�qGuJu�f
IJa�a 13urghAoif (Feb lYi, lOJfi J��1 �N C9T)
Dana Burghdoff
Assistant City Managec
CONTRACT COMPLIANCE ADMINISTRA.TOR:
By signing, I acknowledge that I am the person responsible
for the monitoring and administration of this contract, including
ensuring all performance and repoi�ting requirements
�����
Joshua Hezlep
Tcinity Habitat for Humanity
Gage Yager
Gage Yager CEO
Digilally signed by Gage Yager
Date: 2028.01.29 09:64:25 •O6'00'
2025-2026 CDBG CONTRACT— COWTOWN BRUSHUP PROGRAM
TRINITY HABITAT FOR HUMAMTY
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
�
EXHIBITS:
EXHIBIT "A" — Program Summary
EXHIBIT "A-1" — 2025 HUD Income Limits
EXHIBIT "A-2" —Environmental Review Procedures
EXHIBIT "B" — Budget
EXHIBIT "C" — Audit Certification Form
EXHIBIT "D" — Reporting Forms
EXHIBIT "E" —Income Certification Forms
EXHIBIT "F" — Standards of Documentation
EXHIBIT "G" — Section 3 Reporting Forms
EXHIBIT "H" — Certification of Severe Disability
EXHIBIT "I" — MBE Reporting Form
EXHIBIT "J" — Lead Safe Hazard Certification
EXHIBIT "K" — Conflict of Interest Disclosure Form
EXHIBIT "L" - Certification of Compliance
37
Trinity Habitat for Humanity
Cowtown Brushup Program
EXHIBIT "A"
PROGRAM SUMMARY
PROGRAM SUMMARY
(CDBG)
Date of Execution by City to 15 Months Thereafter
PERIOD
$500,000.00
AMOUNT
Capitalized terms not defined herein shall have meanings assigned them in the Contract.
PRn(�RAM:
This program is a volunteer effort supported with Community Development Block Grant (CDBG)
funds that assists very low-income homeowners by painting the exterior of their houses.
Agency shall identify income-eligible clients and complete all necessary preparatory work for
eligible homes identified through the screening process. Agency shall also recruit volunteers and
solicit donations of paint and supplies. Upon completion of each project, Agency shall conduct a
final inspection to ensure quality control. For purposes of Attachment III (Client Data Report), the
Date Client Received Service shall be the date the client was served and the project was completed,
not the date the ER was released.
Agency is responsible for submitting any applications for City permits or approvals. These
approvals may include but are not limited to Historic & Cultural Landmarks Commission, Board
of Adjustment, Zoning approvals, and building inspections. Cost for permits or approvals are
reimbursable under this Contract.
Agency shall coordinate with City to ensure compliance with the Lead Safe Housing Rule.
CDBG Funds will be used to pay for materials, building permits, contractor labor for the home
repairs, and project delivery costs in the form of salaries and FICA insurance for staff directly
dealing with clients.
Agency is located at 9333 N. Normandale St, Fort Worth, TX 76116, with operating hours of 8:30
a.m. to 5:30 p.m., Monday through Thursday and 8:30 a.m. to 4:00 p.m. on Fridays.
RE(TTTLATnRY CLASSiFiCATinN:
IDIS Matrix Code(s) and Service Category: 14A Rehab: Single-Unit Residential
National Objective Citation: LMH Low/Mod Housing Benefit 24 CFR 570.208(a)( 3)
Regulatory Citation(s): 24 CFR 570.202(b)(11)
2025-2026 CDBG COWTOWN BRUSHUP CONTRACT— EXHIBIT "A" — PROGRAM SUMMARY
Trinity Habitat far Humanity
Agency will maintain documentation that verifies that 100% of clients served by the Program are
Income Eligible Clients.
PRnGRAM GnALS:
Minimum Number of Clients to be Served: The Program must serve a minimum of 68
(80%) of the 85 proposed Unduplicated Clients at or below 80% Area Median Income (AMI)
as shown by the monthly reports on Attachment III.
2024-2025 CDBG COWNTOWN BRUSHUP CONTRACT — EXffiBIT "A" — PROGRAM SUMMARY
Trinity Habitat for Humanity
EXHIBIT "B" - BUDGET
Account COFW Grant A B- Trinity C Total
Budget Matching Funds
PROGRAM PERSONNEL
Salaries 1001 $ 69,670.00 $ 69,670.00
�FICA 1002 $ 5,330.00 $ 5,330.00
�Life/Disability Insurance 1003 $ -
IHealth/DentalInsurance 1004 $ -
IUnemployment-State 1005 $ -
I Worker's Compensation 1006 $ -
Retirement 1007 $ -
SUPPLIES AND SERVICES
Office/Program Supplies 2001 $ -
�Postage 2002 $ -
�Printing 2003 $ -
Othcr(Transportation) 2004 $ -
MISCELLANEOUS
ConstrucrionBuilding Materials 3001 $ 225,000.00 $ 225,000.00
Contract Labor/Pcrmitting (City
needs copy of contract before
expenses can be reimbursed) 3002 $ 200,000.00 $ 200,000.00
�Food Supplies 3003 $ -
ITeaching Aids 3004 $ -
�Craft Supplies 3005 $ -
�Field Trip Expenses 3006 $ -
�Mileage 3007 $ -
� OtherQ 3008
OtherQ 3009
FACILTTY AND UTILTTIES
Telephone 4001 $ -
�Electric 4002 $ -
IGas 4003 $ -
IWater and Wastewater 4004 $ -
I Solid Waste Disposal 4005 $ -
Rent (City needs copy of lease
before expenses can be
reimbursed) 4006 $ -
� Cleaning Supplies 4007 $ -
Other (Building Security) 4008 $ -
LEGAL, FINANCIAL AND
INSURANCE
Fideliry Bond ar Equivalent 5001 $ -
� Directars and Officers 5002 $ -
I General Commercial Liability 5003 $ -
Other (Cvber Ins) 5004 $ -
DIRECT ASSISTANCE
OtherQ 6001
IBUDGET TOTAL $ 500,000.00 $
FUNDING A:
FUNDING B:
2025-2026 CDBG CONTRACT - EXHIBIT "B" - BUDGET
Trinity Habitat for Humanity - Cowtown Brush-up Program
- $ -
$ 500,000.00
Page 1
EXHIBIT "A-1"
2024 HUD INCOME LIMITS
FY �0�5 Incame Limiks �ummar�
� ����
if1C0ITl�
�I mlt Are<i
���
{1{+i5f t�7 -
�r I ii7qt��ti,
r x ri iri�
HCtFo hMR
Arca
M�IcI �1 FtJ 1771 Y_'7{['.17:1� I���� 5 I��oni2 Ll�lk Persarrs �n F,�mIOw
� . . . � - C�k�9��f 1 F � � S �x 7 �
. _ � . . . - - —
4' ��' �r"'' i F��:y �`-i�'..ITS�
� �.. �. �� <. ; � ' �0 ��, T4� ��, 4�0 SJ.3�� �7r65� � 1 �90�0 6�, 2�10 7Q, 45�
F
I kk•�� �•= . �� i!i. . ..
5106,7�0 .�. ,-.. �£�;' ��,d�0 �5.6U0 �8,94U .�2. L50 37.�5� 43, I5�] 48,650 54,1�Q
: �i�5 LiL:I . . .:�i�� I'
I �'!.. ;5.. 5$,7�0 6Br30� �6,850 85,350 $2.�00 �$,OS'J 1�5,85J0 11�,7G0
➢ Income limits are published annually by HUD
➢ Effective 6/1/2025
EXHIBIT "A-1" 2025 HUD INCOME LIMITS
EXHIBIT "A-2"
ENVIRONMENTAL REVIEW PROCEDURES
Items to be performed by Agency:
Before Environmental Review
• Intake and application process
• Client qualification
o Client is an Income Eligible client as defined by contract
o Client is a Fart Worth resident
o Client owns property or has permission from owner(s) to perform work
o Client is up to date on all property taxes
• Contractor/inspector assessment of client needs and assessment of work to be done
o Take color-photos of the following:
■ front of the property
■ left and right side view of property
■ house to the left and right
■ house across the street
■ left street view with neighboring homes
■ right street view with neighboring homes
• Preparation of ER request form and attachments
o Full description of work to be performed using City's request form
o All attachments completed and signed, where applicable, and uploaded to
ER Template accordingly
o Photos as described above and detailed color photos of areas where work is
to be performed
• Submit to City contract administrator for review and approval.
After Environmental Review
• Following notification of approval of work from City, Agency issues Notices to Proceed
to contractor
• Agency performs all work as described in the environmental request
• Agency inspects work to verify work is consistent with environmental request description
• Agency requests reimbursement
CDBG CONTRACT - EXHIBIT "A-2" - ENVIRONMENTAL REVIEW PROCEDURES Page 1
Items to be performed by City:
Before Environmental Review
NOTE: If any of the reviewers in the process described below have questions or need additional
information, City's contract administrator will contact Agency to request the additional
information.
• Compliance Division reviews client qualification information to verify eligibility
• City's contract administrator finalizes Environmental request, sends to Environmental
Coordinator for review and certification / approval
• Environmental Coordinator reviews request and attachments for accuracy and
completeness
• If no environmental impact is anticipated, Environmental Coordinator will sign and send
environmental review to Compliance and Planning Manager or their designee for
signature
• Compliance and Planning Manager or their designee will sign and inform Contract
administrator when environmental review is ready
• City Contract administrator will send Agency a Notice to Proceed and will include the
environmental review with all attachments for Agency records
After Environmental Review
• Agency inspects work to verify work is consistent with environmental request
description
• City reimburses once inspection is complete
CDBG CONTRACT — EXHIBIT "A-2" — ENVIRONMENTAL REVIEW PROCEDURES Page 2
EXHIBIT "C"
AUDIT CERTIFICATION FORM
Agency: Trinity Habitat for Humanity
Fiscal Year Ending: September 30, 2025
❑ During the fiscal year in which funds will be received, we will exceed the federal expenditure
threshold of $1,000,000. We will have our Single Audit or Program Specific Audit
completed and will submit the audit repart 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 federal expenditure threshold required far a Single Audit or a Program Specific
Audit to be performed this fiscal year. (Fill out schedule below)
Federal Expenditure Disclosure
MUST be filled out if Single Audit or Program Audit is NOT required.
Pass Through Program Name & Contract
Federal Grantor Grantor CFDA Number Number Expenditures
� �
� �
� �
� �
� Total Federal Expenditures for this Fiscal Year: �
Signatory and Title
Date
Failure to submit this or a similar statement or failure to submit a completed single audit package
as described in the federally required audit requirements described in 2 CFR Part 200, as
applicable, by the required due date may result in suspension of funding and may affect eligibility
for future funding. Notwithstanding the above, this certification acknowledges the agency's
commitment to meet all other financial reporting, financial statements, and other audit
requirements as may be set forth in the Contract.
EXHIBIT C-AUDIT CERTIFICATION FORM
EXHIBIT "D"
REPORTING FORMS
EXHIBIT "D" REPORTING FORMS
Exhibit D
Attachment I- Request Summary
Agency:
Address:
Ciry, State, Zip:
Program:
Month of Service:
Tax ID Number:
Contract Number:
Case ID:
P.O. Number:
FID Number:
IDIS Number:
Program Account Amount
Original Amount This Invoice Cumulative to Date Remaining Balance
(Program Namc) Casc ID
Salaries 1001 $ - $ -
FICA 1002 $ - $ - $ - $ -
Life/Disability Insurance 1003 $ - $ - $ - S -
Health/DentalInsurance 1004 $ - $ - $ - S -
Unemployment-State 1005 $ - $ - $ - $ -
Worker's Compensation 1006 $ - $ - $ - $ -
Office Supplies 1007 $ - $ - $ - $ -
Food Supplies 1008 $ - $ - $ - $ -
Insurance 1009 $ - $ - $ - $ -
Accounting 1010 $ - $ - $ - $ -
Contract Labor 1011 $ - $ - $ - $ -
$ -
$ -
TOTAL $ - $ - $ - $ -
$
$
$
March 2024 April 2024
- $
�ptember 2024 October 2024
- $
Client Goals
March 2024
1
eptember 2024
0
Goal Amount
xo
April 2024
0
October2024
0
$ - #DN/0!
May 2024 June 2024
$ - $ - $
November2024 December2024
$ - $ - $
Cumulative Total
0
May 2024
0
November 2024
0
Goal Met %
ai
June 2024
0
December 2024
0
2024
2025
2024
0
ry 2025
0
Table Total
$ -
August2024
$ -
February 2025
$ -
Table Total
a
August2024
0
=ebruary 2025
0
ATTACHMENT II
AQency:
Program:
� Z
� 3
� 4
� 5
� �
� �
I R
I y
� 10
� 1l
� 12
� 13
� 14
� 15
� 16
� 17
� 1R
� 19
� 20
� 2l
� 22
� 23
� 24
� 25
� 26
� 27
� 2R
� 29
� 30
� 31
� 32
� 33
� 34
� 35
� 36
� 37
� 3R
� 39
� 40
� 41
� 42
� 43
� 44
� 45
� 46
� 47
� 4R
� 49
�
I To[al
"For Saluies, state employee's title under Daceription/Iob Title. Rent must identify enant
City of Fort Worth
Neighborhood Services Department
Expenditure Worksheet
Plcasc erouo likc account codes.
oo�v n�enuxnrea �aaea �a� ne �e�mn��9ea
Expense Line I[em
Acc unt
EMERGEVCYSHELTER
ESSE�TIALSERVICES
� Salarics 1001 �
� FICA 1002 �
� Lifc/Disabili� Insu�ancc L003 �
� Health/Dental�nsu e 1004 �
� Unc� plovmcnFS[atc � 1005 �
� Worke2s�ompensation 1006 �
� Officc Supplics 1007 �
� �
� �
� Food Suppliac IOOR �
� Inswancc 1009 �
� Accounting 1010 �
� Contrac[Labor LOL1 �
� OtherQ 1012 �
� SHELTEROPERATIIINS I
� Maintenance 2007 �
� Sccurity 2002 �
� Insurance 2003 �
� Utili[ics 2004 �
� Suppliac 2005 �
� R�pairs 2006 �
Otherp 2007
HOUSING RELOCATION AND STABILIZATION
PREVEVTION �
� Salarics 3001 �
� FICA 3002 �
� Lifc/Disabili� Insu�ancc 3003 �
� Health/Dental�nsu e 3004 �
� Unc� plo� cnFS[atc � 3005 �
� Worke2s C'ompensation 3006 �
� OthcrQ 3007 �
� REHOOSINC I
� Salarics 4001 �
� FICA 4002 �
� LifdDisabili� Insuiancc 4003 �
� Health/Dental�nsu e 4004 �
� Unc�PplovmcnFS[atc � 4005 �
� Worke2s�ompensation 4006 �
O[hcrQ 4007
FINANCIAL ASSISTANCE
PRF.VF.VTIO�
� Rental Aaaiatance 5001 �
� �
� UtiliryPayments 5002 �
� REHOUSING I
� Rental Assistance 6007 �
� Sccuri Dcposits 6002 �
� Utility�eposits 6003 �
� ui�r�y vTrmcn�s woa �
� �rt����� cosc boos �
V4oIcVllolcl Vouchcrs 6006
HVIIS
II\4I5 SoflwarcCosts 7001
ATTACHME�T III
CLIENT D,1TA REPORT
Aecncy:
Progran
Month:
• .mt�.���..yi,zazsm������a,zazc�. e
Instructions. �.:�orm inm a�oe�e:�<ao��em�.rma� x i��. ��no. r.e��r..�v�m , r....rc.ri�a:��orema�ro�me�r.��re��mr:n�nr��:win mmm mm: m��i��m�mmx�re:�r�� ir.m.r:� a�i�� �.
UndupCllsfarCl;RRENTNOVTH ���. .g .,, e.��u��.���rie�iwnie
C'LiPro auJClienlGoslPe,rC n'Irzet
% aYMilrsroue Net
I Z Z� � Q 5 6 ] 8 9 10 �� �Z
fliN�aooncl one) N�nRiaieoncl Nisl
- 4A LCAeLpN ��A1e f< <���JJnn»
EXHIBIT "E"
CERTIFICATION OF INCOME STATEMENT
(English / Spanish)
City of Fort Worth
CERTIFICATION OF INCOME STATEMENT
Applicant Name:
Current Address:
City and Zip:
Last Name
Phone No.
Household Members and Income
(Including applicant)
First Name Age Monthly Source of Income
Income $$
TOTAL NUMBER OF FAMILY MEMBERS
Total Gross Annual Household Income:
(Include Yourself, Spouse, Children, etc.)
PERSONAL INFORMATiON: (Check one in each item. This Infarmation is Required for Federal Reporting Purposes)
a. ❑ MALE b. ❑ WHITE ❑ BLACK/AFRICAN AMERICAN ❑ BLACK/AFRICAN AMERICAN & WHITE
❑ FEMALE ❑ AMERICAN INDIAN/ALASKAN NATIVE ❑ ASIAN
❑ AMERICAN INDIAN/ALASKAN NATIVE & WHITE ❑ ASIAN & WHITE
❑ NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER ❑ BALANCE/OTHER
❑ AMERICAN INDIAN/ALASKAN NATIVE & BLACK/AFRICAN AMERICAN
c. ETHNICITY d. DISABLED e. IS HEAD OF HOUSEHOLD FEMALE?
❑ HISPANIC ❑ YES ❑ YES
❑ NON-HISPANIC ❑ NO ❑ NO
Certification: I certify that the information I am providing is true and could be subject to verification at any
time by a third party. I also acknowledge that the provision of false information could leave me subject to the
penalties of Federal, State and locallaw.
Signature of Applicant
Date
WARNING: TITLE 18, SECTION 1001 OF THE U.S. CODE STATES THAT A PERSON IS GUILTY OF A FELONY
FOR KNOWINGLY AND WILLINGLY MAHING FALSE OR FRAUDULENT STATEMENTS TO ANY DEPARTMENT OF
THE UNITED STATES GOVERNMENT.
-----------------For use by Agency staff only-----------------
Household Size:
Applicable Income Limit:
Is Applicant Eligible?
Check if Applicant refused to provide demographic information: O
Staff Assessment of Demographics:
Person Making Determination:
Date:
NOTE: Address, income amounts and sources for ALL household members ar�e required.
Gross Annual Income:
EXHIBIT `B" — Certification of Income Statement (English)
Ciudad de Fort Worth
CERTIFICACION DE DECLARACION DE INGRESOS
Nombre del Solicitante:
Direccion de Actualidad:
Ciudad y Codigo Postal:
Apellido
Telefono:
Miembros Del Ho�ar e In�resos
(Incluyendo el/la Solicitante)
Nombre Edad Ingreso Origen de Ingresos
Mensual
* TOTAL NUMERO DE MIEMBROS DEL HOGAR
(Incluyase Usted.)
Total Anual de Ingresos del hogar:
**INFORMACION PERSONAL: (Seleccione uno en cada articulo. Esta informacion es requerida por el Gobierno federal.)
a. ❑ MASCULINO b. ❑ BLANCO ❑ NEGRO/AFRICANO AMERICANO ❑ NEGRO/AFRICANO AMERICANO & BLANCO
❑ FEMININO ❑ INDIO AMERICANO/NATIVO DE ALASKA ❑ ASIATICO
❑ INDIO AMERICANO/NATIVO DE ALASKA & BLANCO ❑ ASIATICO & BLANCO
❑ NATIVO HAWAIANO/OTRO DE LAS ISLAS PACIFICAS ❑ BALANCE/OTRO
❑ INDIO AMERICANO / NATIVO DE ALASKA & NEGRO/AFRICANO AMERICANO
c. ETHNICIDAD d. INCAPACITADO e. �ES LA CABEZA DEL HOGAR MUJER?
❑ HISPANO ❑ SI ❑ SI
❑ NO-HISPANO ❑ NO ❑ NO
Certi�cacion: Yo certifico que la informacion que yo estoy proporcionando es verdadera y puedo ser sujeto a
verificacion a cualquiera hora por tercera parte. Yo tambien reconozco que la provision de informacion falsa
puede dejarme sujeto a penalidades Federales, Estatales, y a ley local.
Firma del Solicitante
Fecha
ADVERTENCIA: TITULO 18, SECCION 1001 DEL CODIGO DE LOS ESTADOS UNIDOS INDICA QUE UNA
PERSONA ES CULPABLE DE UN DELITO POR SABER Y VOLUNTARIAMENTE HACER DECLARACIONES FALSOS O
FRAUDULENTAS A CUALQUIER DEPARTAMENTO DE GOBIERNO DE LOS ESTADOS UNIDOS.
Para use de empleados de la a�gencia-----------------
# De Miembros de Familia:
Limite de Ingreso:
Ingreso Anual:
�Es solicitante elegible? :
Compruebe si el solicitante se nego a dar su informacion personal: O
Evaluacion del empleado sobre informacion personal:
Persona haciendo la determinacion:
Fecha:
Note: La direccion de la casa y los ingresos (y sus origenes) para todos miembros del hogar son requeridos
EXHIBIT "E" — Cerrification of Income Statement (Spanish)
EXHIBIT "F"
STANDARDS OF DOCUMENTATION
Page 1
CDBG CONTRACT — EXHIBIT "F" —STANDARDS OF DOCUMENTATION
Documentation Standards for CDBG
Contract Expenses
Employee Salaries and Benefits - City will only reimburse a percentage of any employee's salary and benefits who work directly with the CDBG-funded Program.
Percentages will be cost allocated and determined prior to the execution of the CDBG Contract. Agencies requesting the reimbursement of 100°/ of any Agency employee
will require prior City approval. Agencies must show calculation on how the CDBG portion of employee salaries and benefits were calculated consistently with the CDBG
Contract.
If an employee works on both a CDBG eligible and non-CDBG eligible program(s), the City will only reimburse for a reasonable portion
of the employee's salary. Prior to the execution of the CDBG Contract, the Agency will priovide the City with a written statement on how
each employee's time will be allocated. If an employee works 100% of their time directly with the CDBG-funded Program, then 100% of
the employee's salary may be eligible for reimbursement. Agency must submit a written statement that 100% of the employee's time is
spent working directly with the CDBG-funded Program. Statements must be signed by a person authorized to sign on behalf of the
Agency and will be submitted with the October invoice.
Salaries X x° Reimbursement requests must include a timesheet and work log that reflects the hours worked by the employee(s) working directly on
the CDBG-funded Program. For employees who are paid with multiple funding sources, timesheets must reflect all funding sources. If
separate timesheets are kept for each funding source, all such timesheets must be submitted to City. Timesheets must be signed by
employee and supervisor. Agency must show a calculation and documentation of how the employee's salary was calculated and
invoiced to City.
'If employees are paid by direct deposit rather than check, then the agency must submit both the direct deposit payment company's
report (such as an ADT report) and a bank statement or check showing payment to the direct deposit company.
� FICA/Medicare X X X
� Life Insurance x x x
Health x x x If the City pays gross salary, this is already included. If the City pays the employer portion, the Agency must provide proof that the
Insurance employee is enrolled in the benefit plan, must show a calculation and documentation of how the invoiced amount was calculated, and
Disability x x x must provide documentation showing payment. Invoice and proof of payment are only required with the first reimbursement request and
Insurance at any time there are changes to amounts, enrollments, disenrollments, etc.
Unemployment X X X
Insurance
If the City pays gross salary, this is already included. If the City pays the employer portion, the Agency must provide proof that the
Retirement x x x employee is enrolled in the benefit plan, must show a calculation and documentation of how the invoiced amount was calculated, and
must provide documentation showing payment. Invoice and proof of payment are only required with the first reimbursement request and
at any time there are changes to amounts, enrollments, disenrollments, etc.
Materials, Equipment, Goods and Supplies - City will only reimburse for the cost allocated percent or amount spent in support of the CDBG-funded Program. Agencies
requesting reimbursement for these items will require prior City approval. Agencies must show calculation on how the CDBG portion of these expenses were calculated
consistently with the CDBG Contract.
Office Supplies X X X
Office
Equipment X X X X X
Rental
Postaqe X X X
Printinq X X X
Construction &
Building X X X X
Materials
Sport and
Recreation X X X
Equipment
Cleaning X X X
Supplies
I Teaching Aids X X X I
� Craft Supplies X X X �
Food Supplies X X X
Rent, Utilities and Maintenance - City will only pay for a portion of these expenses. The portion of these expenses will be determined by the square footage attributable to
the CDBG-funded Program and shall be cost-allocated in accordance with the amount of space used for the CDBG-funded Program. These expenses may only be in support
of the CDBG-funded Program. The items listed below require prior City approval and the Agency is required to identify any funding source that pays for the portion of the
expenses that is not paid with CDBG funds. Agencies must show calculation on how the CDBG portion of these expenses were calculated consistently with the CDBG
Contract.
Telephone X X
� Gas X X �
Water/Wastew X X
ater
� Electric X X �
I Solid Waste X X I
Page 2
CDBG CONTRACT — EXHIBIT "F" —STANDARDS OF DOCUMENTATION
Facility
Maintenance X X X
and Repairs
Rent X X X
Miscellaneous
X This item requires approval by the City prior to the execution of the CDBG Contract. Repairs may be categorized as major/minor
rehabilitation projects and must be approved through the full HUD Environmetal Review.
City will pay for a portion of the rent for the Program facility so long as its in proportion to the square footage attributable to the CDBG-
funded program.
�
This item requires prior approval by the City. Prior to the execution of the CDBG Contract, the Agency must submit a written statement
Contracted that lists the contracted services to be used during the Contract term. Agency will submit a memo related to the procurement of such
Services X X X X X services and will forward any information pertaining to the procurement process to City. This requirement applies to, but is not limited to,
services retained for security services, legal, accounting, transportation providers, educational facilitators, custodial services,
rehabilitation services, home repair, and like items. 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 iPs in proportion to the square footage attributable to the
Insurance CDBG-funded program.
City requires that the agency submit its fee schedule or formula on how the Agency calculates the childcare scholarship amount. The
fee schedule/formula should demonstrate a breakout of income levels, and for each income level the schedule should demonstrate
Childcare X X which portion of the expense is to be paid by the family and which portion of the expense is to be reimbursed by the City. A fee
Scholarships schedule/formula must be submitted to the City prior to the first payment. Agency must submit documentation supporting that the client
is income eligible and that the household is being charged in conformance with the fee schedule. If the fee schedule/formula changes at
any time during the contract term, the Agency must immediately notify City on the date the new fee schedule/formula takes into effect.
If an audit is required because federal funds exceed $750,000, then the cost should be split evenly by all grant funding sources. Agency
Audit Services X X X X must show calculation on how the CDBG portion of the accounting services were calculated. For example, if the CDBG grant is 10% of
your Agency's budget, then invoice shall not exceed 10% of the overall cost. Agency must show a calculation and documentation of
how the invoiced amount was calculated, and must provide documentation showing payment.
*Proof of payment effective October 1, 2013: 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.
Final as o( 09/26/2017 OC
Revised 12/4/2020 GKD
Page 3
CDBG CONTRACT — EXHIBIT "F" —STANDARDS OF DOCUMENTATION
EXHIBIT "G"
SECTION 3 REPORTING FORMS
CDBG CONTRACT — EXHIBIT "G" —SECTION 3 REPORTING FORMS Page 1
Section 3 Summary Report U.S. Department of Housing
Economic Opportunities for and Urban Development
Low — and Very Low-Income Persons Office of Fair Housing
And Equal Opportunity
Section back of page for Public Reporting Burden statement
1. Recipient Name & Address: (sheet, city, state, zip) 2. Federal Identification: (grant no.)
4. Contact Person
EXHIBIT "G"
OMB Approval No: 2529-0043
(exp. 11 /30/2010)
HUD Field Office:
3. Total Amount of Award:
5. Phone: (Include area code)
6. Length of Grant: 7. Reporting Period:
8. Date Report Submitted: 9. Program Code: (Use separate sheet 10. Program Name:
for each program code)
Part I: Employment and Training ("" Columns B, C and F are mandatory fields. Include New Hires in E&F)
* Program Codes
1 = Flexible Subsidy
2 = Section 202/811
3 = Public/Indian Housing
A = Development,
B = Operation
C = Modernization
4 = Homeless Assistance
S=HOME
6 = HOME State Administered
7 = CDBG Entitlement
8 = CDBG State Administered
9 = Other CD Programs
10 = Other Housing Programs
Page 1 of 2 form HUD 60002 (6/2001)
Ref 24 CFR 135
Part II: Contracts Awarded
1. Construction Contracts:
A. Total dollar amount of all contracts awarded on the project
B. Total dollar amount of contracts awarded to Section 3 businesses
C. Percentage of the total dollar amount that was awarded to Section 3 businesses
D. Total number of Section 3 businesses receiving contracts
2. Non-Construction Contracts:
A. Total dollar amount all non-construction contracts awarded on the projecUactivity
B. Total dollar amount of non-construction contracts awarded to Section 3 businesses
C. Percentage of the total dollar amount that was awarded to Section 3 businesses
D. Total number of Section 3 businesses receiving non-construction contracts
Part III: Summary
%
%
Indicate the efforts made to direct the employment and other economic opportunities generated by HUD financial assistance for housing
and community development programs, to the greatest extent feasible, toward low-and very low-income persons, particularly those who
are recipients of government assistance for housing. (Check all that apply.)
Attempted to recruit low-income residents through: local advertising media, signs prominently displayed at the project site,
contracts with the community organizations and public or private agencies operating within the metropolitan area (or
nonmetropolitan county) in which the Section 3 covered program or project is located, or similar methods.
Participated in a HUD program or other program which promotes the training or employment of Section 3 residents.
Participated in a HUD program or other program which promotes the award of contracts to business concerns which meet the
definition of Section 3 business concerns.
Coordinated with Youthbuild Programs administered in the metropolitan area in which the Section 3 covered project is located.
Other: describe below.
Public reporting for this collection of information is estimated to average 2 hours per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
This agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB
number.
Section 3 of the Housing and Urban Development Act of 1968, as amended, 12 U.S.C. 1701 u, mandates that the Department ensures that
employment and other economic opportunities generated by its housing and community development assistance programs are directed
toward low- and very-low income persons, particularly those who are recipients of government assistance housing. The regulations are
found at 24 CFR Part 135. The information will be used by the Department to monitor program recipients' compliance with Section 3, to
assess the results of the DepartmenYs efforts to meet the statutory objectives of Section 3, to prepare reports to Congress, and by
recipients as self-monitoring tool. The data is entered into a database and will be analyzed and distributed. The collection of information
involves recipients receiving Federal financial assistance for housing and community development programs covered by Section 3. The
information will be collected annually to assist HUD in meeting its reporting requirements under Section 808(e)(6) of the Fair Housing Act
and Section 916 of the HCDA of 1992. An assurance of confidentiality is not applicable to this form. The Privacy Act of 1974 and OMB
Circular A-108 are not applicable. The reporting requirements do not contain sensitive questions. Data is cumulative; personal identifying
information is not included.
Page 2 of 2 form HUD 60002 (11/2010)
Ref 24 CFR 135
Form HUD-60002, Section 3 Summary Report, Economic Opportunities for Low- and Very Low-Income Persons.
Instructions: This form is to be used to report annual
accomplishments regarding employment and other economic
opportunities provided to low- and very low-income persons under
Section 3 of the Housing and Urban Development Act of 1968. The
Section 3 regulations apply to any public and Indian housing
programs that receive: (1) development assistance pursuant to
Section 5 of the U.S. Housing Act of 1937; (2) operating assistance
pursuant to Section 9 of the U.S. Housing Act of 1937; or (3)
modernization grants pursuant to Section 14 of the U.S. Housing Act
of 1937 and to recipients of housing and community development
assistance in excess of $200,000 expended for: (1) housing
rehabilitation (including reduction and abatement of lead-based paint
hazards); (2) housing construction; or (3) other public construction
projects; and to contracts and subcontracts in excess of $100,000
awarded in connection with the Section-3-covered activity.
Form HUD-60002 has three parts, which are to be completed for
all programs covered by Section 3. Part I relates to employment
and iraining. The recipient has the option to determine numerical
employment/training goals either on the basis of the number of hours
worked by new hires (columns B, D, E and F). Part II of the form
relates to contracting, and Part III summarizes recipients' efforts to
comply with Section 3.
Recipients or contractors subject to Section 3 requirements must
maintain appropriate documentation to establish that HUD financial
assistance for housing and community development programs were
directed toward low- and very low-income persons.' A recipient of
Section 3 covered assistance shall submit one copy of this report to
HUD Headquarters, Office of Fair Housing and Equal Opportunity.
Where the program providing assistance requires an annual
performance report, this Section 3 report is to be submitted at the
same time the program performance report is submitted. Where an
annual performance report is not required, this Section 3 report is to be
submitted by January 10 and, if the project ends before December 31,
within 10 days of project completion. Only Prime Recipients are
required to report to HUD. The report must include
accomplishments of all recipients and their Section 3 covered
contractors and subcontractors.
HUD Field Office: Enter the Field Office name .
1. Recipient: Enter the name and address of the recipient
submitting this report.
2. Federal Identification: Enter the number that appears on the
award form (with dashes). The award may be a grant,
cooperative agreement or contract.
3. Dollar Amount of Award: Enter the dollar amount, rounded to the
nearest dollar, received by the recipient.
4& 5. Contact Person/Phone: Enter the name and telephone number
of the person with knowledge of the award and the recipienYs
implementation of Section 3.
6. Reporting Period: Indicate the time period (months and year)
this report covers.
7. Date Report Submitted: Enter the appropriate date.
Program Code: Enter the appropriate program code as listed at
the bottom of the page.
Program Name: Enter the name of HUD Program corresponding
with the "Program Code" in number 8.
Part I: Employment and Training Opportunities
Column A: Contains various job categories. Professionals are
defined as people who have special knowledge of an occupation (i.e.
supervisors, architects, surveyors, planners, and computer
programmers). For construction positions, list each trade and provide
data in columns B through F for each trade where persons were
employed. The category of "Other" includes occupations such as
service workers.
Column B: (Mandatory Field) Enter the number of new hires for
each category of workers identified in Column A in connection with
this award. New hire refers to a person who is not on the contractor's
or recipienYs payroll for employment at the time of selection for the
Section 3 covered award or at the time of receipt of Section 3 covered
assistance.
Column C: (Mandatory Field) Enter the number of Section 3 new
hires for each category of workers identified in Column A in
connection with this award. Section 3 new hire refers to a Section 3
resident who is not on the contractor's or recipienYs payroll for
employment at the time of selection for the Section 3 covered award or
at the time of receipt of Section 3 covered assistance.
Column D: Enter the percentage of all the staff hours of new hires
(Section 3 residents) in connection with this award.
Column E: Enter the percentage of the total staff hours worked for
Section 3 employees and trainees (including new hires) connected
with this award. Include staff hours for part-time and full-time
positions.
Column F: (Mandatory Field) Enter the number of Section 3
residents that were trained in connection with this award.
Part II: Contract Opportunities
Block 1: Construction Contracts
Item A: Enter the total dollar amount of all contracts awarded on the
project/program.
Item B: Enter the total dollar amount of contracts connected with this
project/program that were awarded to Section 3 businesses.
Item C: Enter the percentage of the total dollar amount of contracts
connected with this project/program awarded to Section 3 businesses.
Item D: Enter the number of Section 3 businesses receiving awards.
Block 2: Non-Construction Contracts
Item A: Enter the total dollar amount of all contracts awarded on the
projecUprogram.
Item B: Enter the total dollar amount of contracts connected with this
project awarded to Section 3 businesses.
Item C: Enter the percentage of the total dollar amount of contracts
connected with this project/program awarded to Section 3 businesses.
Item D: Enter the number of Section 3 businesses receiving awards.
Part III: Summary of Efforts — Self -explanatory
Submit one (1) copy of this report to the HUD Headquarters Office of
Fair Housing and Equal Opportunity, at the same time the The Secretary may establish income ceilings higher or lower than 80 percent
performance report is submitted to the program office. The Section 3 of the median for the area on the basis of the Secretary's findings such that
report is submitted by January 10. Include only contracts executed variations are necessary because of prevailing levels of construction costs
during the period specified in item 8. PHAs/IHAs are to report all or unusually high- or low-income families. Very low-income persons mean
contracts/subcontracts. low-income families (including single persons) whose incomes do not
exceed 50 percent of the median family income area, as determined by the
` The terms "low-income persons" and very low-income persons" have Secretary with adjustments or smaller and larger families, except that the
the same meanings given the terms in section 3(b) (2) of the United Secretary may establish income ceilings higher or lower than 50 percent of
States Housing Act of 1937. Low-income persons mean families the median for the area on the basis of the Secretary's findings that such
(including single persons) whose incomes do not exceed 80 percent of variations are necessary because of unusually high or low family incomes.
the median income for the area, as determined by the Secretary, with
adjustments for smaller and larger families, except that
Page i form HUD 60002 (11/2010)
Ref 24 CFR 135
FORT WORTHO
City of Fort Worth
Section 3 Business Certification for Contracting
Instruction: Enter the following information and select the criteria that applies to certify your business'
Section 3 Business status.
Business Information:
Name of Business:
Address of Business:
Name of Business Owner:
Telephone and Email of
Business Owner:
Type of Business: Corporation Partnership
(check type that applies) Sole Proprietorship Joint Venture
Select from ONE of the following three options that applies:
At least 51 °/o of the business is owned and controlled by low- or very low-income persons. A low-
or very low-income person is an individual who earns at or below 80% AMI or no more than $45,300.00
annually effective April 1, 2021.
At least 51% of the business is owned and controlled by current public housing residents who
currently live in Section 8-assisted housing.
Over 75% of the labor hours performed for the business over the prior three-month period are
performed by Section 3 workers. A Section 3 worker is an individual who earns at or below 80% AMI or
no more than $45,300.00 annually effective April 1, 2021.
Business Af�irmation:
I affirm that the above statements are true, complete, and correct to the best of my knowledge. I understand
that businesses who misrepresent themselves as Section 3 businesses and report false information to the
City of Fort Worth may have their contracts terminated as default and be barred from ongoing and future
considerations for contracting opportunities. I hereby certify, under penalty of law, we meet the definition
of a Section 3 Business under federal regulations of the U.S. Department of Housing and Urban
Development at 24 CFR Part 75, and that the following information is correct to the best of my knowledge.
Print Name:
Signature: Date:
Certification expires within six months of the date of signature.
FOR CFW USE ONLY
Is the business a Section 3 business based upon their certificate? YES NO
EMPLOYERS MUST RETAIN THIS FORM IN THEIR SECTION 3 COMPLIANCE FILE FOR
FIVE YEARS.
City of Fort Worth Neighborhood Services Dept.
Ver.2 Effective as of August 2021
SECTION 3 Reporting Information for CAPER
DEFINITIONS:
Section 3 Business:
• 5% <_ owned by section 3 residents
• 30% <_ FT employees are section 3 residents OR were within 3 years of date of first hire
• A business that subcontracts 25% <_ of the dollar amount awarded to a business that meets the
qualifications of at least one of the aforementioned requirements
• More than 75% of labor hours in past 3months were completed by Section 3 workers
Section 3 Worker:
• An employee who currently fits or when hired within Syrs fits at least one of the following
categories
• A worker's self-certification stating that their income is below the income limit from the prior
calendar year;
• A worker's self-certification of participation in a means-tested program such as public housing or
Section 8-assisted housing;
• A worker's self-certification that the worker is a YouthBuild participant;
• Certification from a PHA, the owner or property manager of Project-Based Section 8-assisted
housing, or the administrator of Tenant-Based Section 8-assisted housing that the worker is a
participant in one of their programs;
• An employer's certification that the worker's income from that employer is below the income
limit when based on an employer's calculation of what the worker's wage rate would translate
to if annualized on a full-time basis; or
• An employer's certification that the worker is employed by a Section 3 business concern.
Targeted Section 3 Worker:
• A worker's self-certification of participation in public housing or Section 8-assisted housing
programs;
• Certification from a PHA, or the owner or property manager of project-based Section 8-assisted
housing, or the administrator of tenant-based Section 8-assisted housing that the worker is a
participant in one of their programs;
• An employer's confirmation that a worker's residence is within one mile of the work site or, if
fewer than 5,000 people live within one mile of a work site, within a circle centered on the work
site that is sufficient to encompass a population of 5,000 people according to the most recent
U.S. Census;
• An employer's certification that the worker is employed by a Section 3 business concern; or
• A worker's self-certification that the worker is a YouthBuild participant.
Please complete the table below on the following page for Section 3 reporting.
Project/ Contractor Name:
Total Labor Hours
Total Number of Activities
Total Labor Hours (all hours worl<ed on activities including non-section 3
labor hours)
Total Section 3 Worker Hours
Total Targeted Section 3 Worl<er Hours
Qualitative Efforts - Number of Activities by
Pro�ram
Outreach efforts to generate job applicants who are Public Housing Targeted
Workers
Outreach efforts to generatejob applicants who are Other Funding Targeted
Workers.
Direct, on-the job training (including apprenticeships).
Indirect training such as arranging for, contracting for, or paying tuition for,
off-site training.
Technical assistance to help Section 3 workers compete forjobs (e.g.,
resume assistance, coaching).
Outreach efforts to identify and secure bids from Section 3 business
concerns.
Technical assistance to help Section 3 business concerns understand and bid
on contracts.
Division of contracts into smaller jobs to facilitate participation by Section 3
business concerns.
Provided or connected residents with assistance in seeking employment
including: drafting resumes, preparing for interviews, finding job
opportunities, connecting residents to job placement services.
Held one or more job fairs.
Provided or connected residents with supportive services that can provide
direct services or refenals.
Provided or connected residents with supportive services that provide one or
more of the following: wark readiness health screenings, interview clothing,
uniforms, test fees, transportation.
Assisted residents with finding child care.
Assisted residents to apply for, or attend community college or a fow�-year
educational inshtution.
Assisted residents to apply for, or attend vocational/technical training.
*this is asking for the number of each action,
if none please leave blank*
Assisted residents to obtain financial literacy training and/or coaching.
Bonding assistance, guaranties, or other efforts to support viable bids from
Section 3 business concerns.
Provided or connected residents with training on computer use or online
technologies.
Promoting the use of a business registry designed to create opportunities for
disadvantaged and small businesses.
Outreach, engagement, or referrals with the state one-stop system, as
designed in Section 121(e)(2) of the Workforce Innovation and Opportuniry
Act.
Other.
Background: Section 3 is a provision of the HUD Act of 1968 that promotes local economic development, neighborhood economic improvement, and individual self-sufficiency. To the greatest extent possible, Section 3 requires that the City of Fort Worth (CFW) as a
recipien[ of certain HUD financial assistance (e.g., CBDG, HOME, and HOPWA program funds) provide job Vaining and employment opportunities to low- or very low-inmme residents im m�nection with projects and activities that these funds help provide in their
neighborhoods. Developers, contractors, or subcontractors receiving CFW funds must make reasonable efforts to comply with this program. This report demonstrates how business entities certify the Section 3 status of their employees and report on their labor
hours that support Section 3 employment goals.
FORT WORTH
Project Name and Address: � I _�'��-
Business Information
Name of Business:
Address of Business:
Name of Contact:
Contact Telephone:
Contact Email:
Employee Certification Informa'ion and Total Labor Hours Report
Employee Name Employee Address
Project Start Date:
Reporting Period:
Employee 7ypes
Within the Past 5 Ye: rs
Employed by Full-time
Employee Date of Lives within the Service Area Hourly Low-
Section 3 YouthBuild Wage Rate
Hire or the Neighborhood of the Wage Rate Income
Business Participant (Annualized)
Project
Worker
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
Total Labor Hours
Total No. of Labor Hours
Construction Professional Section 3
Service Worker
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
Targeted
Section 3
Worker
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
0.00 0.00
Rev.08/2023
bor hours �eP°r<ed are
tot�\\a
d tha� 5 / �f Che
Worke�san o�Nou�s. Workers�
Se�t�on3 tnetota��ab Se�i�on3
bV d to
Urs or<edarePe�formed oursbuto,av^0ie�oU(dareatrr�b�ted TatBeted
_.nac ( of the <a\ \abo� ho reP .,..o sec��on�� oa\`me { at <na f`T'et a fd he`<o a� p� � ot and Ye\\ow rfr �° Cmei .ar comrt'un\tY
to
25°�
C
�rpan
ier B°a\ W as ,.- �de�stan chaebY �e t� Y, under Pe^A,., .
d
tocheb o{mo�taW\� 8°pknoW� dge \�et
est pate:
d �or�ect {or V
�omP�eCe�� fuCu�e cooside�a
� �e�to ihe best °
�rrt�aC�on� tementsarec�uepnB°ing�� \�{QYMat�on��s
ff tabebyrtedfrort�
t at Yhe ab�ve 5
PartjS andthatthefo\\oWm@
BUS\hess an
� affirm deqau\t
ed as
ceten5nat
peve\opmen<a�2`� CP
pr\�t N
ame:
51B�atO���
Rev.08�2023
Definitions
For the purposes of this report, a low or very low-income worker is one who eams at or below SO% and 50% of the area median income (AMI), respectively. For fiscal year 2021, HUD has established a low inmme salary for an individual as no more than $53,600.00
annually (effective June 15, 2023).
Outreach efforts indude but are not limited to the following:
(1) Engage in outreach efforts to generate job applicants who are Targeted Section 3 workers.
(2) Provided training or apprenticeship opportunities.
(3) Provided technical assistance [o help Section 3 workers mmpete forjobs (e.g., resume assistance, coaching).
(4) Held one or more job fairs.
(5) Provided assistance to apply for/or attend community college, a four-year educational institution, or vocational/ technical training.
(6) Provided technical assistance to help Section 3 business concerns understand and bid on contracts.
(7) Divided mntracts into smaller jobs to facilitate participation by Section 3 business mncerns.
Professional services means nonconstruction services that require an advanced degree or professional licensing, including, but not limited to, contracts for legal services, financial consulting, accounting services, environmental assessment, architectural services, and
civil engineering services. Professional service hours are excluded from the total labor hours but can be included in the Section 3 or Targeted Section 3 Labor hours if the employee meets the definition of a Section 3 or Targeted Section 3 worker.
A Section 3 business is one that meets at least one of the following criteria, documented within the prior six-month period of submitting the certification and report
(1) At least 51% owned and controlled by low- or very low-income persons; OR
(2) Over 75% of the labor hours performed for the business over the prior three-month period are performed by Section 3 workers; OR
(3) It is a business at least 51% owned and controlled by current public housing residents or residents who currently live in Section 8-assisted housing.
A Section 3 worker is any worker who currently fits or when hired within the past five years fit at least one of the following categories, as documented:
(1) The worker's income for the previous or annualized calendar year is below the income limit established by HUD; OR
(2) The worker is employed by a certified Section 3 business; OR
(3) The worker is a YouthBuild participant.
A Targeted Section 3 worker for projects receiving housing and communicty development financial assistance means a Section 3 worker who:
(1) is employed by a Section 3 business; OR
(2) currently fits or when hired fit at least one of [he following categories, as documented within the pas[ five years:
(i) Living within the service area or the neighborhood of the project or
(ii) A YouthBuild participant.
Rev.08/2023
EXHIBIT "H"
CERTIFICATION OF SEVERE DISABILITY FORM
AGENCY NAME
Client Name:
Address:
City, State, Zip
Client Identification No.
CHECK ALL THAT APPLY
� Has used a wheelchair, a walker, cane , crutches or other special aid for six
months or longer
Has been diagnosed with one of the following conditions: Alzheimer's disease,
� mental retardation or other developmental disability, senility or dementia,
cerebral palsy, or autism; or has another mental or emotional condition that
seriously interferes with everyday tasks.
Is unable to perform one or more of the following "Functional Activities":
❑ seeing, hearing, speaking and having one's speech understood, lifting or
carrying, using stairs, grasping small objects, or walking.
Is unable to perform or needs assistance to perform one or more of the following
❑ Activities of Daily Living (ADL): getting around inside the home, getting in or
out of bed or a chair, bathing, dressing, eating, and toileting.
Is unable to perform or needs assistance to perform one or more of the following
Instrumental Activities of Daily Living (IADL): going outside the home,
❑ keeping track of money and bills, preparing meals, doing light housework,
taking prescription medications in the right amount and at the right time, and
using the telephone.
❑ Has a condition that prevents them from working at a job or doing housework.
The undersigned Agency representative conducted a visual assessment of the client identified on
this form and certifies that the client meets at least one of the conditions indicated above, which
determines that he/ she meets the definition of "severely disabled" according to the U.S. Census
Bureau.
Certiiied by:
Date:
Signature/Title:
EXHIBIT "I"
M/WBE FORM
EXHIBIT "I" M/WBE FORM
EXHIBIT "I" - MBE REPORTING FORM
OMB Approval No.: 2577-0088 OMB
Appraval No.: 2502-0355
Contract and Subcontract Activity �� �
Public reporting burden Yor this collecrion of information is estimated to average .5 hours per response, including the time fox xeviewing inshuctiuns, seaxching exisring data sources, gathering and maintaining the data needed, and completing and reviewing the collecrion of informarion. The
Information is voluntary. HUD may not collect this informatioq and you are not required to complete this form, unless it displays a currendy valid OMB Control Number.
�cutivc Ordcrs datcd Jul 14, 19A3, dirccts thc Minority Busincss Dcvclopmcnt Plans shall bc dcvclopcd by cach Fcdcral Agcncy and thc thcsc annual plans shall cstablish minority busincss dcvclopmcnt objcetivcs. Thc information is uscd by HUD to monitor and evaluatc MBE activitics
Exc Y
against the total program activity and the designated minority business enterprise (MBE) goals. The Departmen[ requires [he informa[ion to provide guidance and oversight for pro�ams for the development of minoxity business enterpcise concerning Mino�ity Business ➢evelopmenL If the
information is not collcctcd HUD would not bc ablc to cstablish mcaningful MBE goals nor cvaluatc MBE performancc against thcsc goals.
Privacy Act Notice = Thc Unitcd Statcs Dcpartmcnt of Housing and Urban Dcvclopmcnt, Fcdcral Housing Administratioq is authorizcd to solicit thc Information rcqucstcd in this form by virtuc of Titic 12, [Jnitcd Statcs Codc, Scction 1701 ct scq., and regulation It will nat bc discloscd or
relesed outside the United States Deparhnent of Housing and Urban Development without your wnseM, except as required or permitted by Law.
d
Grantee/Project Owner/DevelopedSponsor/Builder/Agency
3a. Name of Contact Person
36. Vhone Number Qncluding Area Code) 4. Repotting Penod
U S Department of Housing and Urban Developmeut
❑ Oct. 1 - Scat. 30 (Annua -FY)
Contractor or
Grnnt/Project Number or HUD Subcontrnctor
Cnsc �umbcr or o[hcr nmoun[ of Typc of Trndc Busincss Subcontrncior
idcnrifcation ofproperty, ConCracT or Codc RaciaVEthnic Woman Ownccl Rusincss Primc ContrncTor ldcntificnTion QD) IdcntificnTion QD) SeC. 3
��umbcr SeC. 3 Vumbcr
subdivisioi�, d�t=cllineuniS ctc Subconracr (Scc bclo�tiq (Sccbclow) (Ycs or �o) �� 7h 7�.
7a. 76. 7c. 7d. 7c. - � �
� � � � I
CPD:
I = New Construction
2 = EduczNon/Trnining
3 = Other
7c: 'Pype of "I�rade Codes:
HousinglPubVic Housing:
I= Vew Comtruclion 6= Rofessional
2= SubsTnnTinl Rchab. 7= Tcnai�t Scrviccs
3=Repzir 8=HducxtioNTrainins
4=Service 9=Areh.Bngrg.Apprais�l
5= Proi�t Manxt. 0= Other
7d: RaciaVEthnic Codes:
1 = White Americans
2 = Black Ame�icans
3 = Vntive Americnns
4 = Hispanic Americans
5 = Asian/Pecific Americuns
6 = Hnsidic lews
Pcevious editions ere o6solete.
Check if: �� �cat�on (C�ty, State Zip Co e)
PH
IH
CPD
Housi�g
5. Program Code (Hot applicable for CPD programs.) �� 6. Daro Submiltcd to F�cld O�cc
Scc cxplanatmn of Codcs at bottom of Pagc Usc a
separate sheet Cor each pro�*ram code.
ContractoclSubconhactor Namc and Address
Tj.
Name
Stteet
City State Zip
5: Program Codes (Complete for Aousing and Publie and Indian Housing programs only):
1= All Insureel, includ�ng Section8 5= Section 202
2= Flexible Subsidy 6= HUD-Held (Management)
3= Section 8 NoninsureA, Non-HFDA 7= Public/Indin Housing
4= Insured (Management) 8= Sution 81 L
form HUD-2516 (8/9A)
This reporc is to be completed by grantees, developers, sponsors, builders, agencies, and/or completed for public and Indian housing and most community development programs. Form HUD- costs or unusually high or low-income families. Very low-income families (including single
project owners for reporting contract and subcontract activities of $10,000 or more onder the 60002 is to be completed by all other HUD pmgrams including State administered commonity persons) whose incomes do not exceed 50 per cenNm of the median family income for the area, as
following programs: Community Development Block Grants (entitlement and small cities); developmeut programs covered under Section3. A Section 3 Contracror/subcontractor is a derermined by the Secretary with adjushnents for smaller and larger families, except that the
Urban Development Action Grants; Hoosing Development Grants; Multifamily Insured and business concem that provides economic opportunities to low and very Low-income residents of secretary may establish income ceilings higher or lowec than 50 per centum of the median for the
Noniusured; Public and Indian Housing Authorities; and contracts entered into by recipients of the metropolitau area (or uoumetropolitan county), including a business concern that is 51 person area on the basis of the Secretary's findings that such variations are necessary because of unusually
CDBG rchabilitation assistancc. or more ov,�ied by low-incomc residcnts; high or low fa.mily incomes.
Contracts/subcontracts of less than $ I Q000 need be reported only if such contracts represent a
significant portion of yoor total contracting activiry. Include only contracts exewted during this
reporting period.
This form has been modified to capture Section 3 contract data in columns 7g and 7i. Section 3
requires that the employment and other economic opportunities generated by HUD flnancial
assistance for housing and commoniry development programs shall, to the greatest extent
feasible, be directed roward low- and very low-iucome persons, particularly those who are
recipients of govemment assistance for housing. Recipients using this fonn to report Section 3
coutract data must also use Pan I of form HUD-60002 to repon employment and training
opportunities data. Form HU0.2516 is to be
or provides subcontracting or business development opponunities to businesses owned by low or
low-income residents. Low and very low-income residents; include participants in Yoothbuild
programs established uuder Subtitle D of Title IV of the Cransron-0onzalez National Affordable
Housing Act.
The terms `9ow-income persons" and `bery low-income persons" have the same meanings given
the terms in seetion3(b)(2) of the United States Housing Act of 1937. I,ow-income pereons mean
families (induding single persons) whose incomes do not exceed AO per centum of the median
income for the area, as determined by the Secretary, with adjustments for smaller an larger families,
except that the Secretary may establish income ceilings higher or lower than AO per centum of the
median for the area ou the basis of the Secretary's fiudings that such variations are necessary
because ofprevailing levels ofconstmction
Submit two (2) copies of thie cepon ro your local HUD Office within ten Q 0) days after the end of
the reporting period you checked in item 4 on the front Complete item 7h. Only once for each
coutractor/subcontractor on each semi-annual repon.
Entec the prime contcactoc's ID in item 7f. foc all contracts and subcontracts. Include only
contracts expecred during this reponing period. PHAs/IHAs are to repon all
contracts/subconhacts.
Community Development Programs Multifamily Housing Programs Public Housing and Indian Housing Programs
L Grautee/Project Owner: Enter the name of the unit of government, agency or mortgagor entiry PHAs/IHAs aze to report all contracts/subcontracts. Indude only contracts exewted during this
L Grantee: Enter the name of the unit of government submitting this report.
submittiug this report. reporting period.
3. Contact Person: Enter name and phone of person responsible for maintaining and l. Project Owner: Enter the name of the unit of govemment, agency or mortgagor entity
submitting contract/subcontract data. 3. Contact Person: Same as item 3 under CPD Programs. submitting this report. Check box as appropriate.
7a. Grant Number. Enter the HUD Community Development Block Grant Identification
Number (with dashes). For example: B32-MG25-0034. For Entitlement Programs and Small 4. Reporting Period: Check only oue period.
City multi-yeaz comprehensive programs, enter the latest approved grant number.
7b. Amount of ContracUSubcontrach Enter the dollar amount rounded ro the nearest dollar. If
subcontcactoc ID number is provided in 7f, the dollar tigore would be for the subcontract only 5. Program Code: Enter the appropriate program code.
and not for the pnme contract.
7c. Type of Trade: Enter the numeric codes which best indicates the 7a. Grant/Project Number. Enter the HUD Project Number or Housing Development Gcant or
contractor's/subcontractor's service. If sobconhactor ID number is provided in 7f, the rype of
trade code would be for the subcontractor onty and not for the pnme contractor. number assigned.
The'bther" category includes supply, professional services and all other activities except .
coustructiou aud education/training activities. 76. Amount of Contract/Subcontract Same as �tem 7b. under CPD Programs.
7d. Business Racial/Ethuic/Geuder Code: Enter the numeric code which indicates the
racial/ethuic/gender character of the owner(s) and controller(s) of 51 % of the business.
When 51 % or more is not owned and controlled by any single racial/ethnic/gender category,
enter the code which seems most appmpriate. If the subcontractor ID number is provided, the
code would apply to the subcontractor and not to the prime contractor.
7c. Type oY Trade: Same as item 7c. under CPD Programs.
7d. Business Racial/Ethuic/Geuder Code: Same as item 7d. under CPD Pcograms.
7e. �i'oman Owned Business. Enter Yes or No.
7e. �i'oman Owned Business. Enter Yes or No.
7£ Contractor ldenfiticafion (ID) Number: Enter the Employer (IRS) Number of the Prime
Contractor as the unique identifier for prime recipient of HUD funds. Note that the Employer 7f. Contracror ldentification (ID) Number: Same as item 7f. under CPD Programs.
(]RS) Numbcr must bc providcd for cach conhact/subconhact awardcd.
7g. Section 3 Contracror: Enter Yes or No. 7g. Section 3 Contracror: Enter Yes or No.
7h. Subcontractor ldentification (ID) Number: Enrer the Employer (IRS) Number of the
subconhactor as the uniqoe identiher for each subcontract awarded from HUD fiinds. When the
subcontractor ID Number is provided, the respective Prime Contracror ID Number must also be �h. Subcontractor ldentification (ID) Number: Same as item 7h. under CPD Programs.
provided.
7i. Section 3 Contractor: Enter Yes or No.
7j. Contractor/Subcontractor Name and Address: Enter this information for each tirm
receiving contracUsubcontract activity onty one time on each repon for each firm.
7i. Section 3 Contractor: Enter Yes or No.
7j. Contractor/Subcontractor Name and Addrese: Same as irem 7j. under CPD Programs.
3. Contact Person: Same as item 3 uuder CPD Programs.
4. Reporfiug Period: Check only one period.
5. Program Code: Enter the appropciate program code.
7a. Grant/Project Number: Enter the HUD Project Number or Housing Development Grant or
number assigned.
76. Amount of Contract/Subcontract Same as item 7b. under CPD Pmgrams.
7c. Type of Trade: Same as item 7c. under CPD Programs.
7d. Business Racial/Ethnic/Gender Code: Same as item 7d. under CPD Programs.
7e. Woman Owned Bueinese: Enter Yes or No.
7f. Contracror ldenti8cation (ID) Number: Same as item 7f. under CPD Programs.
7g. Section 3 Contracror: Enter Yes or No.
7h. Subcontractor ldentification (ID) Number: Same as item 7h. under CPD Programs.
7i. Section 3 Contractor: Enter Yes or No.
7j. Contractor/Subcontractor Name and Address: Same as irem 7j. under CPD Programs.
EXHIBIT "J"
LEAD SAFE HAZARD CERTIFICATION
CDBG CONTRACT — EXHIBIT "J" —LEAD SAFE HAZARD Page 1
CERTIFICATION Trinity Habitat for Humanity
CERTIFICATION REGARDING COMPLIANCE WITH LEAD-SAFE HOUSING RULE
FOR
MINOR REHABILITATION PROGRAMS UNDER$5000
ADDRESS OF PROPERTY TO BE REPAIRED:
YEAR BUILT:
SCOPE OF REPAIR/REHABILITATION:
Painted Surfaces: Will be disturbed
i Will NOT be disturbed.
If Painted surfaces will not be disturbed, explain:
For Painted Surfaces that will be disturbed: (attach photos of worksite)
- Work Area is Interior and is Not_Larger than 2 Square Feet:
- Work Area is Interior and is Lar�er than 2 Square Feet:
- Work Area is Exterior and is Not larger than 20 Square Feet:
- Work Area is Exterior and is Larger than 20 Square Feet:
Housing unit is occupied by Elderly Person and/or Disabled Person: Yes No
Children Under 6 Years of Age Reside at / Regularly Visit this Housing Unit: Yes No
Lead Based Paint Information Pamphlet Provided to Homeowner/Resident: Yes No
Date Pamphlet Provided
In housing built before 1978, for Work Areas Exceeding the above 2 Square Foot / 20 Square Foot De-Minimis Levels,
and where children under 6 are expected to Reside/Regularly Visit the housing unit, Lead-Certified Contractors must
be used, Lead Safe Work Practices must be performed and Dust Wipes/Tests must be performed following completion
of the rehabilitation work.
Housing units constructed a ter 1978, and Pre-1978 Housing Units designated for Elderly or Disabled Persons where
children are not expected to reside/visit regularly, are Exempt from the Lead Safe Housing Rule in accordance with 24
CFR 35.110, Definition of TargetHousing.
I certify that the information provided above is true and correct
Certification by Agency Staff:
Printed Name and Title:
CDBG CONTRACT — EXHIBIT "J" LE.4D SAFE HAZARD Page 2
CERTIFICATION Trinity Habitat for Humanity
EXHIBIT "K"
CONFLICT OF INTEREST DISCLOSURE FORM
CDBG CONTRACT — EXHIBIT "K" — CONFLICT OF INTEREST DISCLOSURE Page 1
FORM Trinity Habitat for Humanity
�(}RT WORTH
�.���.r
CONFLICT OF INTEREST DISCLOSURE:
The assistance you are applying for is funded using Housing and Urban Development (HUD) funds and because of this
our office is requesting the following information in order to comply with the funding requirements. Please complete
this form to the best of your ability, sign it, and return it to this Agency at your earliest convenience.
NAME:
TELEPHONE:
ADDRESS:
E-MAIL ADDRESS (if applicable)
1. Are you employed by the City of Fort Worth?
1 a. If yes, by which Department and Division:
2. Were you employed by the City of Fort Worth within the most recent 12-month period?
2a. If yes, by which Department and Division:
I ❑ YES � ❑ NO
I ❑ YES � ❑ NO
3. Are any members of your immediate family currently employed by the City of Fort Worth?
(' Immediate Family" inchrdes (x�hether by blood or adoption): the spo�rse, parent (incl:rding a sleppar•ent), � yES ❑ NO
child (including a stepchild), brother, sister (inclirding a slepbrother a•stepsiste� j, grandpa•ent, grandchild,
and in-laws.)
3a. If yes, please provide relative's name(s), Department(s), and Division(s):
4. If No, were any members of your immediate family employed by the City of Fort Worth I� yES I❑ 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? �❑ YES �❑ NO
� Sa. If yes, by which Department and Division:
6. Are any immediate family members an elected or appointed official, or agent or consultant � yES I❑ NO
of the City of Fort Worth?
6a. If yes, please provide relative's name(s), Department(s), and Division(s):
Cerfiircalion: I understand and agree that the City may/will contact the City of Fort Worth department including all supervisors
in order to determine whether any of these persons' employment or official functions are or were related to the City's use of
federal grant funds and whether federal funds can be provided. I certify that the information I am providing is true and
could be subject to verification at any time by a third party. I also acknowledge that the provision of false information
could leave me subject to the penalties of Federal, State and local law.
WARNING: TITLE 18� SECTION lOOl OF T'1� 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 Citv Staff Onlv: 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 charletta.moaning@fortworthgov.org.
CDBG CONTRACT — EXHIBIT "K" — CONFLICT OF INTEREST DISCLOSURE Page 2
Folt1v1 Trinity Habitat for Humanity
EXHIBIT "L"
CERTIFICATE OF COMPLIANCE:
ADDITIONAL POLICY REQUIREMENTS
CERTIFICATE OF COMPLIANCE:
ADDITIONAL POLICY REQUIREMENTS
The following policy requirements set forth in "EXHIBIT "K" — Certificate of Compliance:
Additional Policy Requirements" are dictated by the Department of Housing and Urban
Development (HUD) and are imposed upon the City of Fort Worth as the named Recipient of the
Federal award agreement. The terms outlined in this addendum are hereby incorporated by
reference into this Contract and shall be binding upon the Agency as a subrecipient of this award.
The Agency shall comply with all applicable provisions of EXHIBIT "K" — Certificate of
Compliance: Additional Program-Specific Policy Requirements as if fully stated herein.
This compliance is subject to new guidance, court decisions, or new regulatory actions that could
change the interpretation, application, or enforcement of these requirements. By signing this
certification, the Subrecipient is certifying that they have read and will comply with these
requirements and will monitor HUD guidance and other actions that may require changes or
updates to their own program policies. Any contractual requirement contained herein determined
to be unenforceable by a legal opinion, directive from a federal agency, court order, or executive
order (the "Determination"), shall be performed in a manner that complies with the Determination
to the greatest extent possible even if such compliance means non-performance.
In addition to all applicable federal statutes and regulations, the Subrecipient certifies that it has
read and agrees to comply with the attached 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:
A�[��NDU�1 1. POLIGY F��QIfIREM����
If appli�able:
�. Th� R��Ipient shall nat use �r�nt ¢��r}��� i� �rvmate ";��nd�r ICI��iI�G7y��" �s defined in Executl� �rder
{E,�D.j 1Aifi8, D�fending U4f�men tram �Gende� Ici�:r�logy Extremism and Restorin� [31o1��i�:alTruth t❑
the f�derai ��;��rnment,
2, The F#eci�ient agreesthat i�� rorr�pll2�n�e �� all respecrswlth all appdicable F�deral anri-
di�crimina�tian la� 15 �Tl�k�ertial t�a khe U.S. Grnrcrnm�nk's p�yment dec�sionsfor� �,urp�s�� caf sec:lian
372�(b}(d��oitit�a.;31. U�it�d 5ta#es �ode;
?J, 7he ii�ciR�enk certifies th�t it e��es I�ot �perate any pro�r�a�tti� #t��k vi�late any applicablp F��Ier�I
�nti-di�cr�m9natian 1��, In�ludingTit�eVl �f thfi Civil Rlghls f�ct o119f�d;
Th� R��+�I�i�t �h2ll r�c�t us� any �r�nt fiunds k� fund ar prama�tt� �1�etlV� ab�rrti�n�, �s r�quire�l by
E,O, i418�, Enf�rcin�tF�� H�d� Arr�endmentF and that,
5. Nottviti�stnncll�lg �tt}�tl�(nu hi the NOf"Q ar kEapilct�tior�, this Gr��nt sl�nll ��ot bc E;r�ve�ned Uy E�ecutfvr.
C�i'clr,�s r�yUked f�y E.O.1A16d, Inr.ludl��� L.U.1400a, or Nol�� requirements irnplemant(n�
E�x��cutive C�rtl�is thnt have br.en rnv��l<Ed.
G. Tht� (ieciplc:nt It1u,I �itl►lli►tislc:r Its �;rant hi .�ccrn�d��ilce� tivitli all;�pp�ic�bte imrnigratlon rc�strict+ans
aitd taqUit'�+ttr�itt5, h1ClUdin�; tho ali�ibility ��ttd VCrIIiC�i(ian rec�uirr.mants th�t �pply uncler iitia lV of
the Personai Ii�sponsibitlty and 1h'cyt'Ic Upportunily Racnitcpi<�tlot� Act o11996, ��s antnl�cln,ci (h_11,S,U,
1�(i1•ir„1�►�PRWORI;) rinci at►+/ t�pE�lic�bl�s �equirnilx!��ts ttiat IiUU, the /lttoritn�rGanr!I'11, ►>t� lhu U,S,
Citlzcnship �nd llt�rtll�jrfll�un Seivic�s rnay r,r>tt�lalish (rom ihnc. to tim� tn r,ant+ilywilh I'ltWORA,
f:x��cutlV(� �ltdu► 1�1?. Stl, or othnr f:xr:c:UGVi: Ord�rs or immi�ration tti�n�s,
7. NU skate or unit of �nncl��l loc<�l �;tivetnmont th�t rcr..e�v�!s It►ndin�; under thls grant i�f�y use that
tundin� in a m�nnar ihat by elesi�;n or c�i(er:l i�7clUt�tes lh� subsidization or �rpntotlon UI ille1;�l
fr»migratlo►� or stiiGlds iita�;al �Ilr.n; irorn clepnrlatlon, includln�; hp m�liitalnln� poticles or pr,�r.11ci�s
ll�at m�t�ri�lly impr.de anfnir,e►nent ot iederal irnmi�;rt�tl�n st�tutes and re�;ul��tlon �,
i3. Thr. Rr.ciE�lant must usc SAVE, or an nqulv�le�tt vetillcatiun sy5tent oppr�V��l hy tite Ft�cl�r�l
�;ovnrnnient, to E��ev�i►t any Pedc!r�l �iuhUc Uesletlt ftorn being �rovlttaci to �ti Itl�sll�;ibt� alien v�ho
r;r�teieci ti�e Unit�d Siato� (ll�g�lly n�� Is ulheravise unlatialully ples�Itt in the Uniled 5tates.
9. F.7ith�ts��sed or�altiz�tlo��s irtay ba suUrnr.i�ilettls lor funtls un the samo uo,is �s flity olher
org�i�lz»iton, Nr�ci��ients rnay nnt, in the setection of subrec:ipicnt��, dlSCflillltl8tb ilj;aillst �7n
4f�;�1t11'LflilUrt b��sad an thn o1�81�1't.atlo�i's teli�;ious chat��ct�i; At(IIIt1�lUr1, ot ixercise,
Certifieation anci Aelcuo�vledgemeut
Tl�is certific�tion sl�all be deemed iucorpor�ted by ceference into the mlin Contract. By signing
belo�v, tlie Agency hereby certifies, acknotvlcdgcs, and agrecs that:
• Age�icy has i•ead and ui�derstands �11 teriiis aud conditions set forth i�i this �XHIBIT ��I{"
— Ccrtificatc of Compli�nce: Addition:tl Progr;�m-S��ecific Yolicy Requiremeuts;
� Agency shall coniply �vith tl�ese requirements in both program pcactice and weitten polieies
ancl proceduces;
• Agency agcees to be in compliance �vith these requirements as a material coudition of this
Contract and a prerequisite to the i•eceipt and continued use of brint fiinds; and
• Agency understnnds thAt any violation of these terms may result in the suspension or
terminatio�t of fi�nding, i•epaynient of fii►ids, oc othec remedies available uuder la��� or
regulation.
Autl�orized Certification
Natne of Agency: Fort Warth Area Nabitat for Humaniry, Inc.
Name of Authocized Official; Gage Yager
Title: C.E.O.
Signature: �'��.— � y`�- j,� Date: 02118/2026
�� y
CERT[FICATE OF INTERESTED PARTIES
�oRnn 1295
iarx
Complete Nos. }. - 4 and 6 if there are interested parties.
Complete �[os. 1, 2, 3, 5, and 8 iEthere are no inierested parties.
], Name of business entity filing farrn, anri the city, state and country of the business entity's placc
of business.
�arl WarEh Area Habitat for Fiumanity, tnc. dba Trinity Habitat ior Humaniry
�ort Worfh, TX United States
2 Name of go�ernmental entity or state ageney that is a party to the contract for which the fvrm is
being tiled.
ciry of Fort warth
OFFICE USE ONLY
CERTIFICATION OF FILlNG
Cerfificate Numher:
2026-1405313
Date Filed:
01/06/2026
Date Acknowlectged:
g Pro�ide the identificafion numE�er used by;he gavernmental entity ar state agency to track or identify ihe contract, and pravide a
tfescription oi the services, goods, or other property to be provided under the conirac#.
2026 CDBG Funds for CTBU
2026 CDBG Funded Arogram to assist ho�€sehafds ai SO% AMI and !�elaw wit� exferior minar home repairs and painting.
4 Name af Interested Party
Nature af interest
C9ty, State, Country {place of business} {check applEcablej
Controfling Intermediary
5 Check only if lhere is NO fnterestcd Party. ❑
X
UNSWORN dECLARATfON
Eufy name is � t C VV 'P i I i � Eh n�� � and my date o( birth is �� ��/ !�✓'�.
�
y � /
C] /f�,_/J �%l �� cI / / �1
Nfy eddress is � ��� / � n� 7�1 �O i�lii[�' �f CX � �,, T`�. �/ i) � , �, CJ�, I4�I" .
(c1ry) (statE7 �zip cade) {covntry)
I declare under penalty of perjury that the foregoing is true and enrrect.
Executed in !�'Jf'f �i1�y Gounty, Siate of �e�aS , on EMe�day of , 2U�.
{manth} (year}
l ,
--��
c� �� ���
Sig � E authorized agent of co tr ' t� business entiry .
(Decfarant)
Forms pravided by Texas Ethics Commissian wwvr.ethics.stafe.tx.us Versian V4.1,0.22701b2a
M&C Review
ACITY 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
Official site of the City of Fort Worth, Texas
FDRT�'�'ORTH
-�_
192025-2026 H U D
ANNUAL ACTION
PLAN
YES
SUBJECT: (ALL) Conduct Public Hearing and Approve the City of Fort Worth's 2025-2026 Annual
Action Plan for the Use of Federal Grant Funds in the Amount of $13,273,355.77 to be
Awarded by the United States Department of Housing and Urban Development from the
Community Development Block Grant, HOME Investment Partnerships Program,
Emergency Solutions Grant, and Housing Opportunities for Persons with AIDS Program,
Authorize Collection and Use of Program Income, Authorize Execution of Related
Contracts, Adopt Appropriation Ordinance, and Authorize Waiver of Indirect Costs
(PUBLIC HEARING - a. Staff Available for Questions: Juliet Moses; b. Public Comment c.
Council Action: Close Public Hearing and Act on M&C)
RECOMMENDATION:
It is recommended that City Council:
1. Conduct a public hearing to allow citizen input and consideration of the City's 2025-2026 Annual
Action Plan for use of federal grant funds to be awarded by the United States Department of
Housing and Urban Development in the amount of $13,273,355.77 for the Community
Development Block Grant, HOME Investment Partnerships Program, Emergency Solutions Grant,
and Housing Opportunities for Persons with AIDS grant programs;
2. Approve the City's 2025-2026 Annual Action Plan for submission to the United States Department
of Housing and Urban Development, including allocations of grant funds to particular programs
and activities as detailed below;
3. Authorize the collection and use of an estimated $30,000.00 of program income which is
expected to result from activities using prior years' Community Development Block Grant funds
for the City's Priority Repair Program;
4. Authorize the collection and use of an estimated $30,000.00 of program income which is
expected to result from activities using prior years' HOME Investment Partnerships Program grant
funds for the City's Homebuyer Assistance Program, and authorize the use of 10 percent of the
program income for administrative costs;
5. Authorize the City Manager or his designee to execute contracts for one-year terms with the
agencies listed in Tables 1, 2, and 3 below for Program Year 2025-2026 for Community
Development Block Grant, Emergency Solutions Grant, and Housing Opportunities for Persons
with AIDS grant funds, contingent upon receipt of funding, and satisfactory completion of all
federal regulatory requirements;
6. Adopt the attached appropriation ordinance increasing estimated receipts and appropriations in
the Grants Operating Federal Fund in the total amount of $13,273,355.77 consisting of
$7,116,438.00 in Community Development Block Grant funds, $2,814,431.77 in HOME
Investment Partnerships Program funds, $615,818.00 in Emergency Solutions Grant funds, and
$2,726,668.00 in Housing Opportunities for Persons with AIDS grant funds, all subject to receipt
of such funds; and
7. Authorize a waiver of the Neighborhood Services Department indirect cost of 21.05\%, estimated
total of $264,698.00.
DISCUSSION:
The City's 2025-2026 Annual Action Plan summarizes the major housing and community development
activities and proposed expenditures for the program year beginning October 1, 2025 and ending
http://apps.cfwnet.org/council�acket/mc review.asp?ID=33536&councildate=8/12/2025 8/13/2025
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\% 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\°/o of the grant allocation): Includes social services
for low- and moderate income persons, persons with disabilities, and disadvantaged persons; Housing
Programs -$2,665,000.00: Includes funding for the City's Priority Repair Program, Cowtown Brush-Up, and
accessibility modifications for seniors and persons with disabilities; Major Projects -$1,000,685.00:
Includes funding for street improvements; Program Delivery -$960,000.00: Includes program delivery
costs for housing programs; Administration -$1,423,288.00 (Limited to 20\% of the grant allocation):
Includes costs for administering the CDBG grant; Estimated Program Income -$30,000.00: Includes up to
$30,000.00 in funding for the City's Priority Repair Program. Any CDBG program income over the
estimated amount not used for the Priority Repair Program will be allocated to priority activities in the City's
Consolidated Plan, subject to the City Council approval.
HOME INVESTMENT PARTNERSHIPS PROGRAM (HOME)
For Program Year 2025-2026, it is recommended that the amount of $2,814,431.77 in HOME funds and an
estimated amount of $30,000.00 in HOME program income totaling $2,844,431.77 be allocated as follows:
Homebuyer Assistance Program -$1,110,824.77: Includes funding for down payment and closing cost
assistance for low- and moderate-income homebuyers through the Fort Worth Community Land Trust, the
City of Fort Worth and Trinity Habitat for Humanity; Community Housing Development Organizations
(CHDOs) for affordable housing projects -$422,164.00: These funds will be used by Housing Channel for
the Mason Heights affordable housing development in southeast Fort Worth. Funds will be used for the
acquisition of land and the new construction of 236 units. An estimated 183 units (approximately 77\%) will
be sold to low to moderate income households at or below 80\% Area Median Income (AMI); Major
Projects -$1,000,000.00 allocated to Fort Worth Housing Solutions (FWHS) as a part of Phase Six of the
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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\% 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
Education 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
Handicaps dba REACH, Inc.
**Fort Worth Area Habitat for
Humanity, Inc. DBA Trinity
Habitat for Humanity
Project Ramp
Page 4 of 5
$165,000.00
Housing Preservation and Cowtown Brush Up $500,000.00
Rehabilitation
�CDBG Subrecipient Agencies Total �� $665,000.00�
ITOTAL CDBG CONTRACTS ��$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
HOPWA Program -
Administration, Tenant-
Based Rental Assistance
Tarrant County Homelessness Prevention (TBRA), Short-Term
Samaritan Housing, and Special Needs Rent, Mortgage, and
Inc. Support Utility Assistance
(STRMU), Supportive
Services, Facility-Based
Operations (FBO)
The Housing Assistance
Program
- Administration, Tenant-
AIDS Outreach Homelessness Prevention Based Rental Assistance
Center, Inc. and Special Needs (TBRA), Short-Term
Support Rent, Mortgage, and
Utility Assistance
(STRMU), Supportive
Services
�TOTAL HOPWA CONTRACTS
Emergency Solutions Grants Contracts
AGENCY
The Presbyterian Night
Shelter of Tarrant County,
Inc.
Lighthouse for the
Homeless dba True Worth
Place
The Salvation Army
Center for Transforming
Lives
TABLE 3: ESG AGENCIES
CONSOLIDATED PLAN
GOAL
PROGAM
Homelessness Prevention and Shelter
Special Needs Support Operations/Services
Homelessness Prevention and Day Shelter
Special Needs Support Operations/Services
Homelessness Prevention and Homelessness
Special Needs Support Prevention
Homelessness Prevention and Rapid Re-Housing
Special Needs Support
�� ��
AMOUNT
$1,406,188.00
$264,680.00
$1,670,868.00�
AMOUNT
$139,491.00
$150,000.00
$127,141.00
$73,000.00
II $80,00O.00I
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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.
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��$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
Fund Department Account
ID �
FROM
� Fund � Department � Account
ID
Project
ID
Program � Activity
Budget
Year
Budget
Year
Reference # Amount
(Chartfield 2) �
Project
ID
Submitted for City Manaqer's Office bv:
Oriqinatinq Department Head:
Additional Information Contact:
ATTACHMENTS
Program Activity
Dana Burghdoff (8018)
Kacey Bess (8187)
Juliet Moses (6203)
Reference # Amount
(Chartfield 2)
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F�ORT WORTHo
City Secretary's Office
Contract Routing & Transmittal Slip
Contractor's Name: TRINITY HABITAT FOR HUMANITY
Subject of the Agreement: 2025-2026 CDBG CONTRACT - COWTOWN BRUSHUP PROGRAM
M&C Approved by the Council? * Yes 8 No ❑
If so, the M&C n7arst be attached to the corth•act.
Is this an Amendment to an Existing contract? Yes ❑ No 8
If so, p��ovide the original cond•act nam�ber nnd the amendme»t nirmbe�•.
Is the Contract "Permanent"? *Yes 8 No ❑
If t�rrstn�e, see bnck page for pe�manent conh�act listirrg.
Is this entire contract Con�dential? XYes ❑ No 8 If only specifrc informntion is
Corr�dential, please list i��hnt infornaation is Corrfrdentinl anc� the �age it is locnted.
Effective Date: date of execution of the contract Expiration Date. Date of Execution by Cily to 15 Monihs Thereafter
If different fi�om the approval date. If applicable.
Is a 1295 Form required? * Yes 8 No ❑
*If so, plense enszu�e it is nttached to the app��oving Mc4�C or attached to the cont�•act.
Project Number: Ifapplicable.
*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 processin� in the followin� order:
1. Katherine Cenicola (Approver)
2. Jannette S. Goodall (Signer)
3. Allison Tidwell (Form Filler)
*Indicates the informntion is reqarired and if the informntion is not p�•ovidec� the contract N�ill be
retzn•ned to the depa�•tment.