HomeMy WebLinkAbout065098 - General - Contract - The Presbyterian Night Shelter of Tarrant County, Inc.CSC No. 65098
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 The Presbyterian Night Shelter of Tarrant County, Inc. (hereafter
"Agency"), a Texas non-profit corporation. City and Agency may be referred to individually as a
"Party" and jointly as "the Parties".
The Parties state as follows:
WHEREAS, City receives grant monies from the United States Department of Housing
and Urban Development through the Community Development Block Grant ("CDBG") Program,
Program No. B-20-MW-48-0010, Catalog of Federal Domestic Assistance No. 14.218;
WHERAS, City has received an additional allocation of CDBG grant monies under the
Coronavirus Aid, Relief, and Economic Security Act (CARES" Act), referenced by HUD as
"CDBG-CV/CV3";
WHERAS, the CDBG regulations and related HUD guidance publications establish all
requirements for the CDBG-CV/CV3 funds except for those specifically described in this Contract
as deriving from the CARES Act;
WHEREAS, a national objective of the CDBG program is to benefit low and moderate
income citizens in accordance with 24 CFR Part 570, as amended from time to time;
WHEREAS, Agency submitted a proposal and was selected to use CDBG-CV3 funds to provide
eligible public services to individuals and families, of whom 100% must meet the HUD
definition of a presumed benefit population; aims to mitigate financial hardships and
exploitation risks that have disproportionately impacted vulnerable populations as a result
of economic challenges stemming from the COVID-19 pandemic
WHEREAS, City citizens, the Community Development Council, and the City Council
have determined that CDBG-CV/CV3 programs are needed by the City's citizens to respond to
the impact of the Coronavirus Pandemic.
NOW, THEREFORE, the Parties understand and agree as follows:
1. INCORPORATION OF RECITALS.
City and Agency hereby agree that the recitals set forth above are true and correct and form
the basis upon which the Parties have entered into this Contract.
2. DEFINITIONS.
OFFICIAL RECORD
CITY SECRETARY
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026 FT. WORTH, TX
PRESBYTERIAN NIGHT SHELTER
In addition to terms defined in the body of this Contract, the terms set forth below shall
have the definitions ascribed to them as follows:
Area Median Income or AMI means the median family income for the Fort Worth -Arlington
metropolitan statistical area as established annually by HUD. The 2025 income limits are
attached hereto as EXHIBIT "A-1" — 2025 HUD Income Limits.
CDBG means Community Development Block Grant.
Complete Documentation means the following documentation as applicable:
• Attachments I, II, and III within Exhibit "D", with supporting documentation
including:
o Proof of expense: copies of timesheets, invoices, leases, service contracts or
other documentation showing that payment is due by Agency.
o Proof of payment: cancelled checks, bank statements, or wire transfers
necessary to demonstrate that amounts due by Agency were actually paid by
Agency.
o Proof of client eligibility: client eligibility for all clients as outlined in
Section 6.
• Complete Documentation shall meet the standards described in the attached
EXHIBIT "F" - Standards for Complete Documentation.
• Any other document or record reasonably necessary to verify costs spent and client
eligibility for the Program.
CDBG-CV3 Funds/CDBG-CV means the grant funds supplied by City to Agency under the
terms of this Contract. Under the terms of this Agreement, they will collectively be referred to as
"CDBG-CV."
CDBG Regulations means regulations found at 24 CFR Part 570 et seq.
Countywide Agencies means agencies with 10% or more of clients that reside outside of the
boundaries of the City. All other agencies are considered Fort Worth agencies.
DBE means disadvantaged business enterprise in accordance with 49 CFR Part 26.
Director means the Director of the Neighborhood Services Department.
Effective Date means September 1, 2025
HUD means the United States Department of Housing and Urban Development.
IDIS means Integrated Disbursement Information System, HUD's project tracking system.
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
Income Eligible Client means a client whose annual income adjusted for family size does not
exceed 80% of AMI using the most current HUD Income Guidelines and Technical Guidance for
Determining Income and Allowances. The definition of annual income to determine client income
eligibility shall be the definition contained in 24 CFR Part 5.609, as amended from time to time.
National Objective means an activity that benefits low- and moderate -income persons. For the
purposes of this Contract, at least 100% of the clients served by the Program fall into a "presumed
benefit" category as defined in 24 CFR Part 570, and therefore are presumed to be Income Eligible
Clients.
Neighborhood Services Department means the City's Neighborhood Services Department.
Neighborly Software — Online database for Agency to submit monthly reimbursement requests.
OMB means the Office of Management and Budget.
Program means the services described in EXHIBIT "A" — Program Summary.
Reimbursement Request means all reports and other documentation described in Section 9.
Source Documentation means documentation of full household income of any type described
under the definition of annual income in 24 CFR Part 5.609, including but not limited to copies of
paychecks, Social Security and disability verification letters, interest or rental income statements,
retirement income statements, child support and alimony verification, unemployment benefit
letters, and the like.
Unduplicated Clients means a count of all clients served by the Program at least once in the
Contract Term. Clients served by the Program more than once in the Contract Term will only be
counted the first time they are served when determining the total count of Unduplicated Clients.
3. TERM.
The term of this Contract begins on the Effective Date and terminates on May 31, 2026,
unless earlier terminated as provided in this Contract. This Contract may be extended by mutual
agreement of the Parties in writing if such extension is necessary for completion of the program.
Extensions will be memorialized in an amendment to the Agreement so long as the amendment
complies with City policies and all applicable laws and regulations governing the use of federal
grant funds. The Contract term shall include any extension, if exercised, as provided herein.
4. DUTIES AND RESPONSIBILITIES OF CITY.
4.1 Provide CDBG-CV/CV3 Funds.
City will provide up to $143,506.00 of CDBG-CV/CV3 Funds under the terms and
conditions of this Contract.
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
4.2 Monitor.
City will monitor the activities and performance of Agency and any of its contractors,
subcontractors or vendors as necessary, but no less than annually. Monitoring by City will include
determining whether Agency is meeting the National Objective during the term of this Contract.
5. DUTIES AND RESPONSIBILITIES OF AGENCY.
5.1 Required Services.
Agency shall perform the services described in EXHIBIT "A" — Program Summary in
accordance with the terms and conditions of this Contract.
5.2 Use of CDBG-CV/CV3 Funds.
5.2.1. Compliance with CDBG Regulations and Contract.
Agency shall be reimbursed for eligible Program costs with CDBG-CV/CV3 Funds only
if City determines in its sole discretion that:
5.2.1.1 Costs are eligible expenditures in accordance with CDBG Regulations.
5.2.1.2 Costs are in compliance with this Contract and are reasonable and
consistent with industry norms.
5.2.1.3 Complete Documentation, as applicable, is submitted to City by
Agency.
5.2.1.4 Costs are in compliance with HUD guidance regarding use of CDBG-
CV/CV3 funds and HUD CPD Notice published at FR 6218-N-01.
5.2.2 Budget.
5.2.2.1 The CDBG-CV/CV3 Funds will be paid on a reimbursement basis in
accordance with EXHIBIT `B" - Budget.
5.2.2.2 During the term of this Contract, Agency may submit written requests
to increase or decrease line item amounts in the Budget, including an
explanation of why such increases or decreases are necessary. All
requests shall be approved by Director or Director's designee in writing,
with such approval being in the City's sole discretion. If the Agency's
proposed Budget amendment is approved (as approved, the "Amended
Budget"), then the Amended Budget shall be memorialized in a
written amendment to this Contract. The Amended Budget will take
effect on the first day of the month following the month in which the
Contract amendment is executed, unless otherwise specified in the
amendment. All requests for Budget amendments must be
4
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
submitted no later than 90 days prior to the date of the end of the
term of this Contract.
5.2.3 Change in Program Budget.
5.2.3.1 Agency will notify City promptly of any additional funds it receives for
operation of the Program, and City reserves the right to amend this
Contract in such instances to ensure compliance with HUD regulations
governing cost allocation.
5.2.3.2 Agency agrees to utilize the CDBG-CV/CV3 Funds to supplement
rather than supplant funds otherwise available for the Program.
5.2.4 Payment of CDBG-CV/CV3 Funds to Agency.
CDBG-CV/CV3 Funds disbursement to Agency is applicable upon City's approval of
Reimbursement Requests including submission of Complete Documentation to City in compliance
with Section 9. If Agency expends all funds budgeted for the Program prior to completion pf
90% of performance goals, City may hold back a small amount of the CDBG-CV/CV3 Funds
until the end of the term to ensure completion of all performance goals. During this interim
period, Agency must continue to submit Attachment III — Client Data Report in EXHIBIT "D" —
Reimbursement Forms monthly. It is expressly agreed by the Parties that any CDBG-CV/CV3
Funds not spent or approved for reimbursement to Agency shall remain with City.
5.3 Program Performance Milestones, Review and Corrective Action Plans.
5.3.1 Agency represents that the Program will achieve the following milestones in
accordance with EXHIBIT "A" — Program Summary and the table below:
% of Unduplicated
Clients Served (as
specified in EXHIBIT
"A" — Program
Month
Expenditures
Summary)
3
33%
33%
6
66%
66%
9
100%
100%
5.3.2 Failure of Agency to meet these milestones or a material deviation from them is a
breach of this Contract. For the purpose of this Section, "material deviation" shall mean more
than 10% lower than the specified goal. In the event of such breach, City reserves the right in its
sole option to (i) delay or withhold payment of Reimbursement Requests, (ii) institute a Corrective
Action Plan ("CAP") as described below, (iii) lower Agency's allocation of or deobligate all
CDBG-CV/CV3 Funds, (iv) terminate this Contract, or (v) any combination of the above options.
5
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
5.3.2.1 Policy.
To ensure the Program meets the client goals provided by Agency and included herein,
City will periodically review Program performance to ensure the expenditure of the funds is
roughly proportional to the number of eligible, unduplicated clients being served, as described
above in 5.3.1. City expects that most programs will expend funds in a proportional amount to
clients served, but City reserves the ability to take into account unique program characteristics that
may impact the ratio between expenditures and clients served.
5.3.2.2 Review.
At the end of each quarter, City will review the information in the required reports provided
to City by Agency. City will review the amount of funds expended compared to the percentage of
eligible, unduplicated clients served. If City believes in its sole discretion that Agency is (i) in
danger of not spending the full amount of the funds allocated, (ii) in danger of expending all funds
prior to serving 100% of the unduplicated client goal (meaning the percentage of funds expended
relative to the overall funding allocated is not within 10% of the percentage of eligible,
unduplicated clients served relative to the overall client goal), or is (iii) in danger of not otherwise
meeting the performance goals within this Contract, City will notify Agency and set up a Program
Review Meeting ("Review Meeting"). Failure by Agency to attend the Review Meeting is
considered a breach of this contract and City may invoke any and all remedies included herein.
During the Review Meeting, City and Agency will review the information provided, the Program,
and discuss any concerns. If the City believes that no additional action is needed to ensure
Agency's performance, no additional requirements will be put in place; however, if the City, in its
sole discretion, believes that additional requirements are needed to ensure Agency's performance,
City may require the Agency to enter into a Corrective Action Plan or may move forward with
deobligating funds from the Contract.
5.3.2.3 Corrective Action Plans. ("CAP")
A CAP will be unique to the Agency and the Program and will be designed to ensure that
the Agency (i) expends the funds allocated to it by the City, and (ii) serves the required number of
unduplicated clients through the Program. A CAP may require additional outreach or marketing,
additional reporting, additional monitoring, or any other mechanism that will reasonably ensure
the Program goals are met and that expenditures are roughly proportional to the number of eligible,
unduplicated clients served.
5.3.2.4 Deobligation of Funds
If after any quarterly review the City determines that a CAP will not be sufficient to ensure
that the Agency (i) expends the funds allocated to it by the City, and (ii) serves the required number
of unduplicated clients through the Program, City shall be able to deobligate a portion of the funds
provided to Agency that is at -risk of not being expended or that is the proportional amount of funds
compared to the number of eligible, unduplicated clients that are anticipated to not be served. Any
deobligation shall be in the form of a contract amendment. By way of example, if an agency was
allocated $100,000 and was required to serve 100 unduplicated clients, if that agency was expected
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
to only be able to serve 75% of its client goal, then City would allow agency to keep 75% of the
allocated funding and deobligate 25% of the funds to correspond with the 25% of clients that are
anticipated to not be served.
5.3.3 Failure to comply with the Corrective Action Plan (CAP), meet the Program Goals,
or otherwise comply with serving 630 unduplicated clients may, in City's sole discretion,
disqualify Agency for consideration under the City's Request for Proposals for the succeeding
Program Year for federal grant funds.
5.3.4 Amendments to performance milestones regarding CDBG-CV/CV3 Funds must
have approval by the Director in writing, with such approval being in the Director's sole discretion.
If Director approves the Agency's proposed amended performance milestones (as approved, the
"Amended Performance Milestones"), then the Amended Performance Milestones shall be
memorialized in a written amendment to this Contract. The Amended Performance Milestones
will take effect on the first day of the month following the month in which the Contract
Amendment is executed unless otherwise specified in the amendment. Except in extreme
circumstances, Amendments will not reduce the number of Unduplicated Clients stated in Section
5.3.3 and in EXHIBIT "A" - Program Summary. In the event that an Amendment has an approval
for such purpose, the amendment will also likely result in and include a reduction of CDBG-
CV/CV3 funding for the Program.
5.4 Identify Program Expenses Paid with CDBG-CV/CV3 Funds.
Agency will keep accounts and records in such a manner that City may readily identify and
account for Program expenses reimbursed with CD13G-CV/CV3 Funds. These records shall be
made available to City for audit purposes and shall be retained as required hereunder.
5.5 Meet National Objective.
Agency shall ensure that the activities carried out in the Program will meet the National
Objective.
5.6 Program Subcontracts.
Agency shall not enter into a subcontract with another agency, contractor, or vendor to
provide a service to clients for any part of the Program that will have payment with CDBG-
CV/CV3 Funds without City's written consent.
6. CLIENT ELIGIBILITY VERIFICATION.
6.1 Client Eligibility.
Agency will document client eligibility as follows:
6.1.1 Agency Clients.
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
Agency must document that all clients served by the Program fall under a "presumed
benefit" category as defined in 24 CFR Part 570. For purposes of this Contract, the categories of
presumed benefit are: severely disabled adults, homeless persons, abused or neglected children
and youth, or elderly persons. Eligible forms of documentation for each category include:
6.1.1.1 Severely Disabled Adults. Written, signed and dated diagnosis from a
licensed medical professional. As an acceptable alternative, Agency
may use the form attached hereto as Exhibit "G" — Severely Disabled
Certification Form.
6.1.1.2 Homeless Persons. Written, signed and dated certification from an
outreach worker.
6.1.1.3 Abused or Neglected Children and Youth. Written, signed and dated
certification from an outreach worker.
6.1.1.4 Elderly Persons. An elderly person is an individual at least 62 years of
age. Copy of a birth certificate, driver's license, passport, immigration
card, military identification, or any other state, local, national or
international documentation, in st be provided showing current
information about the age or birth date of the client. The form in
Exhibit "E" — Self -Certification of Income Form, or a similar
document, will also be required in order to collect demographic data.
If applicable, the Agency must comply with the eligibility and verification requirements
that apply under title IV of the Personal Responsibility and Work Opportunity Reconciliation Act
of 1996, as amended (8 U.S.C. 1601-1646) (PRWORA) and use the Systematic Alien Verification
for Entitlements (SAVE) or an equivalent verification system approved by the Federal
government, to prevent any Federal public benefit from being provided to an ineligible alien who
entered the United States illegally or is otherwise unlawfully present in the United States, unless
the Agency is a nonprofit charitable organization exempt from this requirement under 8 U.S.C. §
1642(d).
6.1.2 Verification of Prouram Eligibility.
6.1.2.1 At the end of each quarter during the Contract term, Agency shall verify
CDBG Program Eligibility by confirming that at least 100% of clients
served by the Program to date are Income Eligible Clients as reported
on Attachment III.
6.1.2.2 If Agency fails to meet the requirements of Section 6.1.2.1, Agency will
have thirty (30) calendar days, or until the next monthly invoice, to cure.
6.1.2.3 City will notify Agency by e-mail within fourteen (14) calendar days if
the client eligibility requirements outlined in this Section are not cured
within the timeline outline in 6.1.2.2. Agency will have seven (7)
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
calendar days from the date of the e-mail notice to meet these
requirements. If Agency fails to meet the requirements, Agency may
forfeit any payments otherwise due that month and failure to meet the
client eligibility requirements will be considered an event of default as
outlined in Section 10.1.
6.1.2.4 In the event the Agency fails to meet the client eligibility requirements,
City reserves the right in its sole option to delay or withhold payment of
Reimbursement Requests, to lower Agency's allocation of CDBG-
CV/CV3 Funds, or to terminate this Contract.
6.2 Submission of Complete Documentation.
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 REQUIREMENTS.
Agency agrees to comply with all requirements of the CDBG Program as stated in the
CDBG Regulations, as well as any further requirements established by HUD regarding CDBG-
CV/CV3 funds upon receiving notification of such additional requirements from City, including
but not limited to the following:
7.1 Environmental Review.
CDBG-CV/CV3 Funds will not be paid, and costs cannot be incurred until City has
conducted an environmental review and completed an Environmental Review Record as required
by 24 CFR Part 58. The environmental review may result in a decision to proceed with, modify,
or cancel the funding for the Program. Further, Agency will not undertake or commit any funds
to physical or choice limiting actions as described in any applicable federal regulations. Any
violation of this provision will (i) cause this Contract to terminate immediately, and (ii) require
Agency to repay City the CDBG-CV/CV3 Funds it has already received and forfeit any future
payments of CDBG-CV/CV3 Funds.
7.2 Contract Not Constituting Commitment of Funds.
Notwithstanding any provision of this Contract, the Parties agree and acknowledge that
this Contract does not constitute a commitment of funds, and that such commitment of funds or
approval may occur only upon (i) satisfactory completion of an environmental review and receipt
by City of an authorization to use grant funds from HUD under 24 CFR Part 58, (ii) approval of
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
any applicable Substantial Amendments to the City's 2020-2021 Action Plan regarding CARES
Act grant funds, and (iii) receipt by City of a grant agreement from HUD.
7.3 Monitoring.
7.3.1 Agency understands and agrees that it will be subject to monitoring by City for
compliance with terms and provisions of this Contract, compliance with the CARES Act, and the
CDBG Regulations for the term of this Contract. Agency is subject to such monitoring during
the term of this Contract and for 7 years after the Contract term ends. Agency will provide reports
and access to Program files as requested by City during this 7 year period.
7.3.2 Representatives of City, HUD, HUD Office of Inspector General, and the United
States Comptroller General shall have access during regular business hours, upon 48 hours prior
notice, to Agency's offices and records pertaining to the use of the CDBG-CV/CV3 Funds, and to
Agency's officers, directors, agents, employees, contractors, subcontractors and vendors for the
purpose of such monitoring.
7.3.3 In addition to other provisions of this Contract regarding frequency of monitoring,
City reserves the right to perform desk reviews or on -site monitoring of Agency's compliance with
the terms and conditions of this Contract. City shall provide Agency with a written report of the
monitor's findings after each monitoring visit. If the monitoring report notes deficiencies in
Agency's performance, the report shall include requirements for the timely correction of said
deficiencies by Agency. Failure by Agency to take the action specified in the monitoring report
may be cause for suspension or termination of this Contract as provided herein.
7.3.4 Subsections 7.3.1 through 7.3.3 shall be applicable for the Contract Term and for 7
years thereafter and shall survive the earlier termination or expiration of this Contract.
7.3.5 Agency shall provide City annually the results of any state or federal monitoring.
Such results shall be submitted within 60 days of receipt of such state or federal monitoring report,
or with the January Reimbursement Request, whichever is earlier.
7.4 Agency Procurement Standards.
Agency shall comply with all applicable federal, state and local laws, regulations, and
ordinances for making procurements under this Contract. In addition to the conflict of interest
provisions in Section 14.13.3, Agency shall establish written procurement procedures to ensure
that materials and services are obtained in a cost effective manner and that provides for full and
open competition. When procuring materials and services for this Contract, Agency shall comply
at a minimum with the procurement standards in 2 CFR Part 200.317 through Part 200.326.
7.4.1 Contracts in excess of $10,000.00 made by Agency using CDBG-CV/CV3 Funds
must address termination for cause and convenience including the manner by which such
termination shall be effected and the basis for settlement of the terminated contract, if any, as
required by Appendix II (B), 2 CFR Part 200.
10
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
7.4.2 Agency shall not make any contract with parties listed on the government wide
System for Award Management, www.sam.gov ("SAM"). Agency must confirm by search of
SAM that all contractors paid with CDBG-CV/CV3 Funds are not listed by SAM as being
debarred, both prior to hiring and prior to submitting a Reimbursement Request which includes
invoices from any such contractor. Failure to submit such proofs of search shall be an event
of default.
7.5 Cost Principles/Cost Reasonableness.
Agency shall administer its use of CDBG-CV/CV3 Funds in compliance with 2 CFR Part
200, as applicable. The eligibility of costs incurred for performance rendered shall be determined
in accordance with 2 CFR Part 200.400 through 2 CFR Part 200.475.
7.6 Financial Management Standards.
Agency agrees to comply with 2 CFR Part 200, as applicable. Agency also agrees to adhere
to the accounting principles and procedures required therein, utilize adequate internal controls, and
maintain necessary supporting and back-up documentation for all costs incurred in accordance
with 2 CFR Part 200.302 and Part 200.303.
7.7 Uniform Administrative Requirements, Cost Principles, and Audit
Requirements.
Agency will comply with the Uniform Administrative Requirements, Cost Principles, and
Audit Requirements for Federal Awards in 2 CFR Part 200, as applicable, or any reasonably
equivalent procedures and requirements that City may require.
7.8 Terms Applicable to Contractors, Subcontractors and Vendors.
Agency understands and agrees that all terms of this Contract, whether regulatory or
otherwise, shall apply to any and all contractors, subcontractors and vendors of Agency which are
in any way paid with CDBG-CV/CV3 Funds or who perform any work in connection with the
Program. Agency shall cause all applicable provisions of this Contract to be included in and made
a part of any contract or subcontract executed in the performance of its obligations hereunder
including its obligations regarding the CDBG Regulations. Agency shall monitor the services and
work performed by its contractors, subcontractors and vendors on a regular basis for compliance
with the CDBG Regulations and Contract provisions. Agency must cure all violations of the
CDBG Regulations committed by its contractors, subcontractors or vendors. City maintains the
right to insist on Agency's full compliance with the terms of this Contract and the CDBG
Regulations and Agency is responsible for such compliance regardless of whether actions taken to
fulfill the requirements of this Contract are taken by Agency or by Agency's contractors,
subcontractors or vendors. Agency acknowledges that the provisions of this Section shall survive
the earlier termination or expiration of this Contract and shall be applicable for 7 years after the
Contract term ends.
7.9 Copyright and Patent Rights.
11
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
No reports, maps, or other documents produced in whole or in part under this Contract shall
be the subject of an application for copyright by or on behalf of Agency. HUD and City shall
possess all rights to invention or discovery, as well as rights in data, which may arise as a result of
Agency's performance under this Contract.
7.10 Conflict of Interest Disclosure.
In accordance with the requirements of Section 14.13.2.1 and 14.13.4, Agency shall
establish conflict of interest policies for federal awards. Agency shall disclose to City in writing
any potential conflict of interest.
7.11 Compliance with FFATA and Whistleblower Protections.
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 CD13G-CV/CV3 Funds
that provides reasonable assurance that Agency is managing the CDBG-CV/CV3 Funds in
compliance with federal statutes, regulations, and the terms and conditions of this Contract. These
internal controls shall be in compliance with guidance in "Standards for Internal Control in the
Federal Government" issued by the Comptroller General of the United States or the "Internal
Control Integrated Framework" issued by the Committee of Sponsoring Organizations of the
Treadway Commission ("COSO");
7.12.2 Comply with federal statutes, regulations, and the terms and conditions of this
Contract;
7.12.3 Evaluate and monitor Agency's compliance with statutes, regulations and the terms
and conditions of this Contract;
7.12.4 Take prompt action when instances of noncompliance are identified including
noncompliance identified in audit findings; and
7.12.5 Take reasonable measures to safeguard protected personally identifiable
information and other information that HUD or City designates as sensitive or Agency considers
sensitive consistent with applicable federal, state, local and tribal laws regarding privacy and
obligations of confidentiality.
12
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
8. RECORD KEEPING; REPORTING AND DOCUMENTATION
REQUIREMENTS; AUDIT.
8.1 Record Keeping.
Agency shall maintain a record -keeping system as part of its performance of this Contract
and shall promptly provide City with copies of any document City deems necessary for the
effective fulfillment of City's monitoring and evaluation responsibilities. Specifically, Agency will
keep or cause to be kept an accurate record of all actions taken and all funds spent, with supporting
and back-up documentation. Agency will maintain all records and documentation related to this
Contract for 7 years after the Contract term ends, regardless of whether or not this Contract is
earlier terminated. If any claim, litigation, or audit is initiated before the expiration of the 7 year
period, the relevant records and documentation must be retained until all such claims, litigation or
audits have been resolved.
8.2 Access to Records.
Representatives of City, HUD and any duly authorized officials of the federal government
will have full access to, and the right to examine, audit, copy, excerpt and/or transcribe any of
Agency's records pertaining to all matters covered by this Contract for 7 years after the Contract
term ends, regardless of whether or not this contract is earlier terminated. Such access shall be
during regular business hours and upon at least 48 hours prior notice.
8.3 Reports.
Agency will submit to City all reports and documentation described in this Contract in such
form as City may prescribe. Agency may also be required to submit a final performance and/or
final financial report if required by City at the termination of this Contract in such form and within
such times as City may prescribe. Failure to submit to City any report or documentation described
in this Contract shall be an event of default of this Contract and City may exercise all of its
remedies for default under this Contract.
8.3.1 Additional Information.
Agency shall provide City with additional information as may be required by state or
federal agencies to substantiate Program activities and/or expenditure eligibility.
8.4 Change in Reporting Requirements and Forms.
City retains the right to change reporting requirements and forms at its discretion. City
will notify Agency in writing at least fifteen (15) days prior to the effective date of such change,
and the Parties shall execute an amendment to the Contract reflecting such change if necessary.
8.5 Audit.
8.5.1 Entities that Expend $1,000,000.00 or more in Federal Funds Per Year.
13
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
All non-federal entities that expend $1,000,000.00 or more in federal funds within 1 year,
regardless of the source of the federal award, must submit to City an annual audit prepared in
accordance with specific reference to 2 CFR Part 200.501 through Part 200.521. The audit shall
cover the Agency's fiscal years during which this Contract is in force. The audit must be prepared
by an independent certified public accountant, be completed within six 6 months following the end
of the period being audited and be submitted to City within thirty 30 days of its completion.
Agency's audit certification is attached hereto as EXHIBIT "C" — "Audit Certification Form"
and "Audit Requirements". The Audit Certification Form must be submitted to City prior to
or with the first Reimbursement Request. Entities that expend less than $1,000,000.00 a year in
federal funds are exempt from federal audit requirements for that year, but records must be
available for review or audit by appropriate officials of the federal agency, City, and General
Accounting Office.
8.5.2 City Reserves the Right to Audit.
City reserves the right to perform an audit of Agency's Program operations and finances at
any time during the term of this Contract and for 7 years after the Contract term ends, regardless
of whether or not this Contract is earlier terminated, if City determines that such audit is necessary
for City's compliance with the CDBG Regulations or other City policies. Agency agrees to allow
access to all pertinent materials as described herein for such audit. If such audit reveals a
questioned practice or expenditure, such questions must be resolved within fifteen (15) business
days after notice to Agency of such questioned practice or expenditure. If questions are not
resolved within this period, City reserves the right to withhold further funding under this Contract
and/or any other contracts with Agency. IF AS A RESULT OF ANY AUDIT IT IS
DETERMINED THAT AGENCY HAS FALSIFIED ANY DOCUMENTATION OR
MISUSED, MISAPPLIED OR MISAPPROPRIATED CDBG FUNDS OR SPENT CDBG
FUNDS ON ANY INELIGIBLE ACTIVITIES, AGENCY AGREES TO REIMBURSE
CITY THE AMOUNT OF SUCH MONIES PLUS THE AMOUNT OF ANY SANCTIONS,
PENALTY OR OTHER CHARGE LEVIED AGAINST CITY BY HUD BECAUSE OF
SUCH ACTIONS.
9. REIMBURSEMENT REQUIREMENTS.
9.1 Deadline for Submitting Reimbursement Requests.
9.1.1 Reimbursement Requests shall be submitted monthly to the City and must be
received by the City on or before the 1511 day of the month following the month expenses were
paid by Agency. For example, the Reimbursement Request for January expenses must be received
by February 151h. In the event the 1511 falls on a weekend or City holiday, Reimbursement
Requests shall be due the next day that the City is open for business. Failure to submit a
Reimbursement Request in a timely fashion will result in City taking the actions outlined in Section
10.1. NOTWITHSTANDING ANYTHING ABOVE, THE REIMBURSEMENT REQUEST
FOR EXPENSES INCURRED FOR MAY 2026 MUST BE RECEIVED BY JUNE 3, 2026.
COMPLETE DOCUMENTATION FOR ALL JUNE 2026 EXPENSES MUST BE
SUBMITTED BY JUNE 15, 2026. FAILURE TO SUBMIT A FINAL REIMBURSEMENT
14
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
REQUEST WITH COMPLETE DOCUMENTATION BY JUNE 15, 2026 WILL RESULT
IN FORFEITURE OF PAYMENT OF THE SEPTEMBER REIMBURSEMENT
REQUEST.
9.1.2 City will notify Agency by e-mail within fourteen (14) calendar days if a
Reimbursement Request is lacking Complete Documentation or corrections are needed. Agency
will have seven (7) calendar days from the date of the e-mail notice to submit any requested
information or missing documentation. Agency may be penalized, at City's sole discretion, in the
Request for Proposal for the following Program Year for any notifications received under this
Section. If Agency fails to submit all the required information or missing documentation within
seven (7) calendar days from the first e-mail, Agency may forfeit any payments otherwise due that
month and failure to submit any requested information will be considered an event of default as
outlined in Section 10.1.2.
9.2 Submission of Reimbursement Requests.
Agency shall provide City with Complete Documentation and the following reports
as shown in EXHIBIT "D" —Reimbursement Forms with each Reimbursement Request:
9.2.1 Attachment I — Request Summary.
This report shall contain the amount requested for reimbursement each month, and the
cumulative reimbursement requested to date (inclusive of that month's request).
9.2.2 Attachment II — Expenditure Worksheet.
This report shall itemize each expense requested for reimbursement by Agency and shall
include the Account corresponding the expense to a Budget line item. In order for this report to
be complete the following must be submitted:
9.2.2.1 For payroll expenses, timesheets signed by employees and approved by
supervisor for all payroll expenses listed. Timesheets must distinguish
between CDBG-CV/CV3 funded time and non-CDBG-CV/CV3 funded
time and reflect actual time spent on CDBG-CV/CV3 funded activities.
Agency may not submit payroll expenses dated sixty (60) calendar days
prior to the date of the Reimbursement Request unless approved in
writing in advance by City as authorized under CARES Act.
9.2.2.2 For non -payroll expenses, invoices for each expense listed with an
explanation as to how the invoiced expense pertains to the Program.
Agency may not submit invoices dated sixty 60 calendar days prior to
the date of the Reimbursement Request.
9.2.2.3 Proof that each expense was paid by Agency. Proof can be satisfied by
cancelled checks, wire transfer documentation, paid receipts or other
appropriate banking documentation.
9.2.3 Attachment III — Client Data Report.
15
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
This report shall list each Unduplicated Client served during the month along with his or
her demographic information. The Client Data Report must maintain a list of all clients served
during the Contract term. In order for this report to be complete, the following must be submitted:
9.2.3.1 Documentation of income verification for each Unduplicated Client the first
time the client is served by the Program, which will either be the completed form
of EXHIBIT "E" — Self- Certification of Income Form or similar form approved
by City, and Source Documentation.
9.2.4 Delivery of Reimbursement Request.
Reimbursement Requests must be submitted through Neighborly Software or other
reporting software as approved by the City by the deadline in Section 9.1.
9.2.5 Countywide Agencies
Countywide Agencies shall submit EXHIBIT "A-2" — Reporting Requirements for
Countywide Agencies quarterly with the December, March, June and September Reimbursement
Requests. Reports due under this section have the same due date as the Reimbursement Request.
9.3 Withholding Payment.
CITY SHALL HAVE NO OBLIGATION TO PAY ANY REIMBURSEMENT
REQUEST THAT IS NOT RECEIVED BY THE DUE DATE AS OUTLINED HEREIN.
Failure to timely submit accurate and complete Reimbursement Requests and Complete
Documentation along with any required reports shall be an event of default.
10. DEFAULT AND TERMINATION.
10.1 Failure to Submit Reimbursement Request or Required Documentation.
10.1.1 Failure to submit a Reimbursement Request in accordance with Section 9 and
Exhibits "D" and "F," may be in default of this Contract. If Agency has not provided the requested
information or missing documentation within the seven (7) calendar day notice period as provided
for in Section 9.1.2, City will provide Agency with a written Default Notice. Agency will have
five (5) calendar days from the date of the written Default Notice to submit information and
documentation to cure the default. If Agency fails to cure the default within such time, Agency
shall forfeit any payments otherwise due that month and the failure to submit shall be considered
an event of default that shall not be cured.
10.1.2 NOTWITHSTANDING THE PROVISIONS OF SECTION 10.1.1, IF
AGENCY FAILS TO SUBMIT THE REIMBURSEMENT REQUEST DUE JUNE 3, 2026
OR IF THE SUBMITTED REIMBURSEMENT REQUEST DUE JUNE 3, 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.
16
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
10.1.3 In the event of an uncured default under this Section, City reserves the right at
its sole option to terminate this Contract effective immediately upon written notice of such intent
with no penalty or liability to City.
10.1.4 Notwithstanding anything to the contrary herein, City will not be required to
pay any CDBG-CV/CV3 Funds to Agency during the period that any Reimbursement Request,
report or documentation is past due or is not in compliance with this Contract or the CDBG
Regulations, or during any period during which Agency is in default of this Contract.
10.1.5 In the event of termination under this Section 10.1, all CDBG-CV/CV3 Funds
awarded but unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency
shall have no further right to such funds.
10.2 Failure to Maintain Records or Submit Reports and Documentation.
If Agency fails to maintain all records and documentation as required in Section 8, or if the
maintained or submitted report or documentation is not in compliance with this Contract or the
CDBG Regulations as determined by City in its sole discretion, City will notify Agency in writing
and Agency will have thirty (30) calendar days from the date of the written request to obtain or
recreate the missing records and documentation or submit or resubmit any such report or
documentation to City. If Agency fails to maintain the required reports or documentation, or fails
to submit or resubmit any such report or documentation within such time, City shall have the right
to terminate this Contract effective immediately upon written notice of such intent with no penalty
or liability to City.
10.2.1 In the event of termination under Section 10.2, all CDBG-CV/CV3 Funds
awarded but unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency
shall have no further right to such funds.
10.2.2 In the event of termination under Section 10.2, any CDBG-CV/CV3 Funds paid
to Agency must be repaid to City within thirty (30) days of termination. If such CDBG-CV/CV3
Funds are not repaid to City within the thirty (30) day period, City shall exercise all legal remedies
available under this Contract.
10.3 In General.
10.3.1
Subject to Section 10.2, and unless specifically provided otherwise in this Contract,
Agency shall be in default under this Contract if Agency breaches any term or condition of this
Contract. In the event that such a breach remains uncured after thirty (30) calendar days following
written notice by City (or such other notice period as may be specified herein) or, if Agency has
diligently and continuously attempted to cure following receipt of such written notice but
reasonably requires more than thirty (30) calendar days to cure, as determined by both Parties
mutually and in good faith, City shall have the right to elect in City's sole discretion to: (i) extend
17
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
Agency's time to cure, (ii) terminate this Contract effective immediately upon written notice of
such intent to Agency, or (iii) pursue any other legal remedies available to City under this Contract.
10.3.2 City's remedies may include:
10.3.2.1 Direct Agency to prepare and follow a schedule of actions for
carrying out the affected activities, consisting of schedules,
timetables and milestones necessary to implement the affected
activities.
10.3.2.2 Direct Agency to establish and follow a management plan that
assigns responsibilities for carrying out the remedial activities.
10.3.2.3 Reprogram CDBG-CV/CV3 Funds that have not yet been expended
from affected activities to other eligible activities or withhold
CDBG-CV/CV3 Funds.
10.3.2.4 Any other appropriate action including but not limited to any
remedial action legally available such as declaratory judgment,
specific performance, damages, temporary or permanent
injunctions, termination of this Contract or any other contracts with
Agency, and any other available remedies.
10.3.3 In the event of termination under Section 10.3, all CDBG-CV/CV3 Funds
awarded but unpaid to Agency pursuant to this Contract shall be immediately forfeited and Agency
shall have no further right to such funds, and any CDBG-CV/CV3 Funds already paid to Agency
must be repaid to City within thirty (30) days of the termination. Failure to repay such CDBG-
CV/CV3 Funds within the thirty (30) day period will result in City exercising all legal remedies
available under this Contract.
10.4 No Funds Disbursed while in Breach.
Agency understands and agrees that no CDBG-CV/CV3 Funds will be paid to Agency until
all defaults are cured to City's satisfaction.
10.5 No Compensation After Date of Termination.
Agency shall not receive any compensation for work undertaken after the date of the
termination.
10.6 Rights of City Not Affected.
Termination shall not affect or terminate any of the existing rights of City against Agency,
or which may thereafter accrue because of Agency's default 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
18
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
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-CV/CV3 Funds awarded but unpaid to Agency pursuant to this
Contract shall be immediately rescinded and Agency shall have no further right to such funds and
any CDBG-CV/CV3 Funds already paid to Agency must be repaid to City within thirty (30) days
of termination. Failure to repay such CDBG-CV/CV3 Funds within thirty (30) days will result in
City exercising all legal remedies available to City under this Contract. AGENCY
ACKNOWLEDGES AND AGREES THAT IF CITY TERMINATES THIS CONTRACT
FOR CAUSE, AGENCY OR ANY AFFILIATES OF AGENCY SHALL NOT BE
CONSIDERED FOR ANY OTHER CITY CONTRACT FOR CDBG FUNDS FOR A
MINIMUM OF 7 YEARS FROM THE DATE OF TERMINATION.
10.9.2 Agency may terminate this Contract if City does not provide the CDBG-
CV/CV3 Funds substantially in accordance with this Contract.
10.10 Termination for Convenience.
In terminating in accordance with 2 CFR Part 200, Appendix II, this Contract may be
terminated in whole or in part only as follows:
10.10.1 By City with the consent of Agency in which the Parties agree upon the
termination conditions, including the effective date and in the case of partial termination, the
portion to be terminated; or
10.10.2 By Agency upon at least thirty (30) days written notification to City, setting
forth the reasons for such termination, the effective date, and in the case of partial termination, the
portion to be terminated. In the case of a partial termination, City may terminate the Contract in
its entirety if City determines in its sole discretion that the remaining portion of the Contract to be
performed or CDBG-CV/CV3 Funds to be spent will not accomplish the purposes for which the
Contract was made.
10.11 Dissolution of Agency Terminates Contract.
This Contract shall terminate in the event Agency is dissolved or ceases to exist. In the
event of termination under this Section, all CDBG-CV/CV3 Funds are subject to repayment and/or
19
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
City may exercise all of its remedies under this Contract.
10.12 Non -appropriation of Funds.
In the event no funds or insufficient funds are appropriated by City in any fiscal period for
any payments due hereunder, City will notify Agency of such occurrence and this Agreement shall
terminate on the last day of the fiscal period for which appropriations were received without
penalty or expense to City of any kind whatsoever, except as to the portions of the payments herein
agreed upon for which funds have been appropriated.
10.13 Reversion of Assets.
In the event this Contract is terminated with or without cause, all assets acquired by Agency
with the CDBG-CV/CV3 Funds including cash, interest payments from loans or otherwise, all
outstanding notes, mortgages or other security instruments, any accounts receivable attributable to
the use of the CDBG-CV/CV3 Funds, and any real or personal property owned by Agency that
was improved with the CDBG-CV/CV3 Funds shall automatically transfer to City or to such
assignee as City may designate.
11. REPAYMENT OF CDBG-CV/CV3 FUNDS.
All CDBG-CV/CV3 Funds are subject to repayment in the event the Program does not
meet the requirements of this Contract or in the CDBG Regulations. If Agency takes any action
that results in the City being required to repay all or any portion of the CDBG-CV/CV3
Funds to HUD, Agency agrees it will reimburse City within thirty (30) days of notice from
the City for such repayment. Additionally, if Agency takes any action that results in City
receiving a finding from HUD about the Program, whether or not repayment of all or any
portion of the CDBG-CV/CV3 Funds is required of City, Agency agrees City may require
that 10% of the CDBG-CV/CV3 Funds be repaid to City as liquidated damages. The Parties
agree that City's damages in the event of either repayment to HUD being required or receiving a
finding from HUD are uncertain and would be difficult to ascertain and may include an impact on
City's CDBG grant or other federal grant funds, in addition to the fording by HUD or a required
repayment of funds to HUD by City. Therefore, the Parties agree that payment under this Section
of 10% of the CDBG-CV/CV3 Funds by Agency to City is liquidated damages and not a penalty.
12. CHANGE IN NON-PROFIT STATUS.
Agency must provide City with written notification of any changes to its non-profit status
within fifteen (15) calendar days of being notified of the change. Regardless of notice by Agency,
if the non-profit status of Agency changes after the date of this Contract, City may but is not
obligated to, terminate this Contract. In the event of termination under this Section 12, all CDBG-
CV/CV3 Funds awarded but not yet paid to Agency pursuant to this Contract shall be immediately
rescinded and Agency shall have no further right to such funds. City, in its sole discretion, may
require that any CDBG-CV/CV3 Funds already paid to Agency must be repaid to City within thirty
(30) calendar days of termination under this Section.
13. SURVIVAL.
20
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
Any provision of this Contract that pertains to auditing, monitoring, indemnity obligations,
client income eligibility, record keeping and reports, City ordinances, or applicable CDBG
requirements, and any default and enforcement provisions necessary to enforce such provisions,
shall survive the termination of this Contract for 7 years after the Contract term ends, regardless
of whether or not this Contract is earlier terminated, and shall be enforceable by City against
Agency.
14. GENERAL PROVISIONS
14.1 Agency an Independent Contractor.
Agency shall operate hereunder as an independent contractor and not as an officer, agent,
servant or employee of City. Agency shall have exclusive control of, and the exclusive right to
control, the details of the work and services performed hereunder, and all persons performing
same, and shall be solely responsible for the acts and omissions of its officers, members, agents,
servants, employees, contractors, subcontractors, vendors, clients, licensees or invitees.
14.2 Doctrine of Respondeat Superior.
The doctrine of respondeat superior shall not apply as between City and Agency, or its
officers, members, agents, servants, employees, contractors, subcontractors, vendors, clients,
licensees or invitees, and nothing herein shall be construed as creating a partnership or joint
enterprise between City and Agency. City does not have the legal right to control the details of
the tasks performed hereunder by Agency, its officers, members, agents, employees, contractors,
subcontractors, vendors, clients, licensees or invitees.
14.3 Agency Property.
City shall under no circumstances be responsible for any property belonging to Agency, or
its officers, members, agents, employees, contractors, subcontractors, vendors, clients, licensees
or invitees that may be lost, stolen or destroyed or in any way damaged and AGENCY HEREBY
INDEMNIFIES AND HOLDS HARMLESS CITY AND ITS OFFICERS, AGENTS, AND
EMPLOYEES FROM ANY AND ALL CLAIMS OR SUITS PERTAINING TO OR
CONNECTED WITH SUCH PROPERTY.
14.4 Religious Organization.
Agency shall comply with all applicable requirements as more particularly described in 24
CFR Part 5.109. No portion of the CDBG-CV/CV3 Funds shall be used in support of any sectarian
or religious activity. In addition, there must be no religious or membership criteria for clients of a
CDBG-funded service.
14.4.1. Separation of Explicitly Religious Activities.
Agency retains its independence and may continue to carry out its mission, including the
definition, development practice, and expression of its religious beliefs, provided that it does not
21
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
use CD13G-CV/CV3 Funds to support or engage in any explicitly religious activities (including
activities that involve overt religious content such as worship, religious instruction, or
proselytization), or in any other manner prohibited by law.
14.4.2 Explicitly Religious Activities.
If Agency engages in explicitly religious activities (including activities that involve overt
religious content such as worship, religious instruction, or proselytization), the explicitly religious
activities must be offered separately, in time or location, from the programs or activities supported
by CD13G-CV/CV3 Funds and participation must be voluntary for clients of a CDBG-CV/CV3-
funded service.
14.4.3 Required Notices.
If Agency constitutes a Faith -based organization under 24 CFR Part 5.109, Agency must
provide all clients of a CD13G-CV/CV3-funded service with the notice attached as EXHIBIT
"I" —Notice of Beneficiary Rights. Such notice shall be provided to the client prior to enrollment
in any CDBG-CV/CV3-funded program or activity. In addition, if a client or prospective client of
a CD13G-CV/CV3-funded service objects to the religious character of Agency, then Agency must
promptly undertake reasonable efforts to identify and refer the client or prospective client to an
alternate provider to which the client or prospective client has no such objection, as more
particularly described in 24 CFR Part 5.109.
14.5 Venue.
Venue shall lie in state courts in Tarrant County, Texas or the United States District
Court for the Northern District of Texas, Fort Worth Division for any action, whether real or
asserted, at law or in equity, arising out of the execution, performance, attempted performance or
non-performance of this Contract.
14.6 Governing Law.
This Contract shall be governed by and construed in accordance with the laws of the State
of Texas. If any action, whether real or asserted, at law or in equity, arises out of the execution,
performance or non-performance of this Contract or on the basis of any provision herein, for any
issue not governed by federal law, the choice of law shall be the laws of the State of Texas.
14.7 Severability.
The provisions of this Contract are severable, and if for any reason a clause, sentence,
paragraph or other part of this Contract shall be determined to be invalid by a court or federal or
state agency, board or commission having jurisdiction over the subject matter thereof, such
invalidity shall not affect other provisions which can be given effect without the invalid provision.
14.8 Written Agreement Entire Contract.
22
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
This written instrument and the Exhibits, Attachments, and Addendums attached hereto,
which are incorporated by reference and made a part of this Contract for all purposes, constitute
the entire agreement by the Parties concerning the work and services to be performed under this
Contract. Any prior or contemporaneous oral or written agreement which purports to vary the
terms of this Contract shall be void. Any amendments to the terms of this Contract must be in
writing and executed by the Parties.
14.9 Paragraph Headings for Reference Only, No Legal Significance; Number
and Gender.
The paragraph headings contained herein are for convenience in reference to this Contract
and are not intended to define or to limit the scope of any provision of this Contract. When context
requires, singular nouns and pronouns include the plural and the masculine gender shall be deemed
to include the feminine or neuter and the neuter gender to include the masculine and feminine.
The words "include" and "including" whenever used herein shall be deemed to be followed by the
words "without limitation".
14.10 Compliance with All Applicable Laws and Regulations.
Agency agrees to comply fully with all applicable laws and regulations that are currently
in effect or that are hereafter amended during the performance of this Contract. Those laws
include, but are not limited to:
CDBG Regulations found in 24 CFR Part 570
Coronavirus Aid, Relief, and Eonomic Security Act of 2020
➢ Title I of the Housing and Community Development Act of 1974, as amended, (42
USC 5301)
Title VI of the Civil Rights Act of 1964 (42 U.S.C. Sections 2000d et seq.) including
provisions requiring recipients of federal assistance to ensure meaningful access by
persons of limited English proficiency
➢ The Fair Housing Act, Title VIII of the Civil Rights Act of 1968 (42 U.S.C. Sections
3601 etseq.)
➢ 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
23
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
the Clean Air Act or the Clean Water Act.
➢ Immigration Reform and Control Act of 1986 (8 U.S.C. Sections 1101 et seq.)
specifically including the provisions requiring employer verifications of legal status of
its employees
➢ The Americans with Disabilities Act of 1990 (42 U.S.C. Sections 12101 et seq.), the
Architectural Barriers Act of 1968 as amended (42 U.S.C. Sections 4151 et seq.) and
the Uniform Federal Accessibility Standards, 24 CFR Part 40, Appendix A
➢ Regulations at 24 CFR Part 87 related to lobbying, including the requirement that
certifications and disclosures be obtained from all covered persons
➢ Drug Free Workplace Act of 1988 (41 U.S.C. Sections 701 et seq.) and 24 CFR Part
23, Subpart F
Executive Order 12549 and 24 CFR Part 5.105(c) pertaining to restrictions on
participation by ineligible, debarred or suspended persons or entities
➢ Section 6002 of the Solid Waste Disposal Act, as amended by the Resource
Conservation and Recovery Act
➢ Guidelines of the Environmental Protection Agency at 40 CFR Part 247
➢ For contracts and subgrants for construction or repair, Copeland "Anti -Kickback" act
(18 U.S.C. 874) as supplemented in 29 CFR Part 5
➢ For construction contracts awarded by Agency in excess of $2,000, and in excess of
$2,500 for other contracts which involve the employment of mechanics or laborers,
Sections 103 and 107 of the Contract Work Hours and Safety Standards Act (40 U.S.C.
327A 300) as supplemented by 29 CFR Part 5
➢ Lead -Based Paint Poisoning Prevention Act (42 U.S.C. 4801 et seq.), as amended by
the Residential Lead -Based Paint Hazard Reduction Act of 1992 (42 U.S.C. 4851 et
seq.) and implementing regulations at 24 CFR Part 35, subparts A, B, M, and R
➢ Uniform Administrative Requirements, Cost Principles, and Audit Requirements for
Federal Awards, 2 CFR Part 200 et seq.
Federal Funding Accountability and Transparency Act of 2006 ("FFATA") (Pub.L.
109-282, as amended by Section 6205(a) of Pub.L. 110-252 and Section 3 of Pub.L.
113-101)
➢ Federal Whistleblower Regulations, as contained in 10 U.S.C. 2409, 41 U.S.C. 4712,
10 U.S.C. 2324,41 U.S.C. 4304 and 41 U.S.C. 4310.
➢ The Build America, Buy America Act (BABA) enacted under Division G, Title IX of
the Infrastructure Investment and Jobs Act (IIJA, Pub. L. No. 117-58) signed into law
on November 15, 2021.
14.12 Prohibition Against Discrimination.
14.12.1 General Statement.
Agency shall comply in the execution, performance or attempted performance of this
Contract, with all non-discrimination requirements of 24 CFR Part 570.607 and Chapter 17, Article
III, Division 4 — Fair Housing of the City Code. Agency may not discriminate against any person
because of race, color, sex, gender, religion, national origin, familial status, disability or perceived
24
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
disability, sexual orientation, gender identity, gender expression, or transgender, nor will Agency
permit its officers, members, agents, employees, or clients to engage in such discrimination.
This Contract is made and entered into with reference specifically to Chapter 17, Article
III, Division 3 - Employment Practices of the City Code, and Agency hereby covenants and agrees
that Agency, its officers, members, agents, employees and contractors, have fully complied with
all provisions of same and that no employee, or applicant for employment has been discriminated
against under the terms of such ordinances by either or its officers, members, agents, employees
or contractors.
14.12.2 No Discrimination in Employment during the Performance of This
Contract.
During the performance of this Contract Agency agrees to the following provision, and
will require that its contractors and subcontractors also comply with such provision by including
it in all contracts with its contractors:
[Contractor's, Subcontractor's or Vendor's name] will not unlawfully discriminate against
any employee or applicants for employment because of race, color, sex, gender, religion, national
origin, familial status, disability or perceived disability, sexual orientation, gender identity, gender
expression or transgender. [Contractor's, Subcontractor's or Vendor's name] will take affirmative
action to ensure that applicants are hired without regard to race, color, sex, gender, religion,
national origin, familial status, disability or perceived disability, sexual orientation, gender
identity, gender expression or transgender and that employees are treated fairly during employment
without regard to their race, color, sex, gender, religion, national origin, familial status, disability
or perceived disability, sexual orientation, gender identity, gender expression or transgender. Such
action shall include, but not be limited to, the following: employment, upgrading, demotion or
transfer, recruitment or recruitment advertising, layoff or termination, rates of pay or other forms
of compensation, and selection for training, including apprenticeship. [Contractor's,
Subcontractor's or Vendor's name] agrees to post in conspicuous places, available to employees
and applicants for employment, notices setting forth the provisions of this nondiscrimination
clause.
[Contractor's, Subcontractor's or Vendor's name] will, in all solicitations or
advertisements for employees placed by or on behalf of [Contractor's, Subcontractor's or
Vendor's name], state that all qualified applicants will receive consideration for employment
without regard to race, color, sex, gender, religion, national origin, familial status, disability or
perceived disability, sexual orientation, gender identity, gender expression or transgender.
[Contractor's, Subcontractor's or Vendor's name] covenants that neither it nor any of its
officers, members, agents, employees, or contractors, while engaged in performing this Contract,
shall, in connection with the employment, advancement or discharge of employees or in
connection with the terms, conditions or privileges of their employment, discriminate against
persons because of their age or because of any disability or perceived disability, except on the
basis of a bona fide occupational qualification, retirement plan or statutory requirement.
[Contractor's, Subcontractor's or Vendor's name] further covenants that neither it nor its
officers, members, agents, employees, contractors, or persons acting on their behalf, shall specify,
25
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
in solicitations or advertisements for employees to work on this Contract, a maximum age limit
for such employment unless the specified maximum age limit is based upon a bona fide
occupational qualification, retirement plan or statutory requirement.
14.12.3 Agency's Contractors and the ADA.
In accordance with the provisions of the Americans With Disabilities Act of 1990
("ADA"), Agency warrants that it and any of its contractors will not unlawfully discriminate on
the basis of disability in the provision of services to the general public, nor in the availability, terms
and/or conditions of employment for applicants for employment with, or employees of, Agency or
any of its contractors. AGENCY WARRANTS IT WILL FULLY COMPLY WITH THE
ADA'S PROVISIONS AND ANY OTHER APPLICABLE FEDERAL, STATE AND
LOCAL LAWS CONCERNING DISABILITY AND WILL DEFEND, INDEMNIFY AND
HOLD CITY HARMLESS AGAINST ANY CLAIMS OR ALLEGATIONS ASSERTED BY
THIRD PARTIES, CONTRACTORS SUBCONTRACTORS, VENDORS OR AGENTS
AGAINST CITY ARISING OUT OF AGENCY'S AND/OR ITS CONTRACTORS',
SUBCONTRACTORS', VENDORS' OR AGENTS' OR THEIR RESPECTIVE
EMPLOYEES' ALLEGED FAILURE TO COMPLY WITH THE ABOVE -REFERENCED
LAWS CONCERNING DISABILITY DISCRIMINATION IN THE PERFORMANCE OF
THIS CONTRACT.
14.13 Conflicts of Interest and Violations of Criminal Law.
14.13.1 Agency Safeguards.
Agency shall establish safeguards to prohibit its employees, board members, advisors and
agents from using positions for a purpose that is or gives the appearance of being motivated by a
desire for private gain for themselves or others, particularly those with whom they have family,
business or other ties. Agency shall disclose to City any such conflict of interest or potential
conflict of interest, immediately upon discovery of such.
14.13.2 General Prohibitions Against Conflicts of Interest.
No employees, agents, consultants, officers or elected officials or appointed officials of
City or of Agency who exercise or have exercised any functions or responsibilities with respect to
activities assisted with CDBG-CV/CV3 funds or who are in a position to participate in a decision -
making process or gain inside information with regard to these activities may utilize CDBG-
CV/CV3 services, may obtain a financial interest or benefit from a CDBG-CV/CV3-assisted
activity, or have an interest in any contract, subcontract or agreement with respect thereto, or the
proceeds thereunder, either for themselves or those with whom they have family or business ties,
during their tenure or for 1 year thereafter.
14.13.2.1 Agency shall establish conflict of interest policies for federal awards
including the CDBG-CV/CV3 Funds and shall disclose in writing
potential conflicts of interest to City as authorized by 2 CFR Part
200.112.
26
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
14.13.3 Conflicts of Interest Involving Procurement.
The conflict of interest provisions of 2 CFR Part 200.318 shall apply in the procurement
of property and services by Agency. In all cases not governed by this Section, the provisions of
24 CFR Part 570.611 of the CDBG Regulations shall apply.
14.13.3.1 As more particularly described in 2 CFR Part 200.318, Agency shall
maintain and submit to City written standards of conduct covering
conflicts of interest and governing the performance of its employees
engaged in the selection, award, and administration of contracts. No
employee, officer, or agent may participate in the selection, award,
or administration of a contract supported by a federal award if he or
she has a real or apparent conflict of interest. The standards of
conduct must provide for disciplinary actions to be applied for
violations of such standards by officers, employees, or agents of
Agency.
14.13.3.2 The officers, employees, and agents of Agency shall neither solicit
nor accept gratuities, favors, or anything of monetary value from
contractors or parties to subcontracts.
14.13.3.3 Notwithstanding the prohibition contained in Section 14.13.3.2,
Agency may set standards of conduct for situations in which the
financial interest is not substantial or the gift is an unsolicited item
of nominal value. Such standards of conduct must provide for
disciplinary actions to be applied for violations of such standards by
Agency's officers, employees or agents.
14.13.3.4 Agency shall maintain written standards of conduct covering
organizational conflicts of interest. Organizational conflicts of
interest means that because of relationships with a parent company,
affiliate, or subsidiary organization, Agency is unable or appears to
be unable to be impartial in conducting a procurement action
involving a related organization.
14.13.3.5 Agency must maintain records sufficient to detail the history of
procurement. These records will include, but are not necessarily
limited to the following: rationale for the method of procurement,
selection of contract type, contractor selection or rejection, and the
basis for the contract price.
14.13.4 Disclosure of Conflicts of Interest.
In compliance with 2 CFR Part 200.112, Agency is required to timely disclose to City in
writing any potential conflict of interest.
14.13.5 Disclosure of Conflicts of Interest for Agency Clients.
27
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
Agency understands that its clients will be receiving assistance partially or fully funded
utilizing Housing and Urban Development (HUD) funds received by City. Agency will assist City
in determining whether eligible clients have a potential relationship to the City that constitutes a
conflict of interest by having clients fill out the Conflict of Interest Disclosure Form, attached
hereto as Exhibit "J". In the event a conflict of interest exists, this may affect the client's eligibility
to receive services. As a result, if a potential client provides information on the form that a conflict
may exist, Agency must notify City for a determination prior to providing services.
14.13.6 Disclosure of Texas Penal Code Violations.
Agency affirms that it will adhere to the provisions of the Texas Penal Code which prohibit
bribery and gifts to public servants. Agency will timely disclose to City all violations.
14.13.7 Disclosure of Federal Criminal Law Violations.
In compliance with 2 CFR Part 200.113, Agency is required to timely disclose to City all
violations of federal criminal law involving fraud, bribery or gratuity violations potentially
affecting the Agency.
14.14 Subcontracting with Small and Minority Firms, Women's Business
Enterprises and Labor Surplus Areas.
14.14.1 For procurement contracts $100,000.00 or larger that are paid for, in part or in
full, with the CDBG-CV/CV3 Funds, Agency agrees to abide by City's policy to involve Minority
Business Enterprises and Small Business Enterprises and to provide them equal opportunity to
compete for contracts for construction, provision of professional services, purchase of equipment
and supplies and provision of other services required by City. 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-CV/CV3 Funds and will further require all persons
or entities with which it so contracts to comply with said ordinance.
14.14.2 It is national policy to award a fair share of contracts to disadvantaged business
enterprises ("DBEs"), small business enterprises ("SBEs"), minority business enterprises
("MBEs"), and women's business enterprises ("WBEs"). Accordingly, affirmative steps must be
taken to assure that DBEs, SBEs, MBEs, and WBEs are utilized when possible as sources of
supplies, equipment, construction and services.
14.14.2.1 In order to comply with federal reporting requirements 24 CFR Part
570.506 (g)(6), Agency must submit the form attached hereto as
EXHIBIT "H" — MBE Reporting Form for each contract or
subcontract with a value of $25,000.00 or more paid or to be paid
with the CDBG-CV/CV3 Funds. Agency shall submit this form by
the date specified in EXHIBIT "H" — MBE Reporting Form.
28
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
14.15 Other Laws.
The failure to list any federal, state or City ordinance, law or regulation that is applicable
to Agency does not excuse or relieve Agency from the requirements or responsibilities in regard
to following the law, nor from the consequences or penalties for Agency's failure to follow the
law, if applicable.
14.16 Assignment.
Agency shall not assign all or any part of its rights, privileges, or duties under this Contract
without the prior written approval of City. Any attempted assignment of same without approval
shall be void, and shall constitute a breach of this Contract.
14.17 Right to Inspect Agency Contracts.
It is agreed that City has the right to inspect and approve in writing any proposed contracts
between Agency and any contractor or vendor engaged in any activity in conjunction with this
CDB G-CV/CV3 -funded Program prior to any charges being incurred.
14.18 Force Maieure.
If Agency becomes unable, either in whole or part, to fulfill its obligations under this
Contract due to acts of God, strikes, lockouts, or other industrial disturbances, acts of public
enemies, wars, blockades, insurrections, riots, epidemics, pandemics, earthquakes, fires, floods,
restraints or prohibitions by any court, board, department, commission or agency of the United
States or of any States, civil disturbances, or explosions, or some other reason beyond Agency's
control (collectively, "Force Majeure Event"), the obligations so affected by such Force Majeure
Event will be suspended only during the continuance of such event. Agency will give City written
notice of the existence, extent and nature of the Force Majeure Event as soon as reasonably
possible after the occurrence of the event. Failure to give notice will result in the continuance of
Agency's obligation regardless of the extent of any existing Force Majeure Event. Agency will
use commercially reasonable efforts to remedy its inability to perform as soon as possible.
14.19 IMMIGRATION NATIONALITY ACT.
Agency shall verify the identity and employment eligibility of its employees who perform
work under this Contract, including completing the Employment Eligibility Verification Form (I-
9). Upon request by City, Agency shall provide City with copies of all I-9 forms and supporting
eligibility documentation for each employee who performs work under this Contract. Agency
shall adhere to all Federal and State laws as well as establish appropriate procedures and controls
so that no services will be performed by any Agency employee who is not legally eligible to
perform such services. AGENCY SHALL INDEMNIFY CITY AND HOLD CITY
HARMLESS FROM ANY PENALTIES, LIABILITIES, OR LOSSES DUE TO
VIOLATIONS OF THIS PARAGRAPH BY AGENCY, AGENCY'S EMPLOYEES,
SUBCONTRACTORS, AGENTS, OR LICENSEES. City, upon written notice to Agency, shall
have the right to immediately terminate this Contract for violations of this provision by Agency.
29
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
15. INDEMNIFICATION AND RELEASE.
AGENCY COVENANTS AND AGREES TO INDEMNIFY, HOLD HARMLESS
AND DEFEND, AT ITS OWN EXPENSE, CITY AND ITS OFFICERS, AGENTS,
SERVANTS AND EMPLOYEES FROM AND AGAINST ANY AND ALL CLAIMS OR
SUITS FOR PROPERTY LOSS OR DAMAGE AND/OR PERSONAL INJURY,
INCLUDING DEATH, TO ANY AND ALL PERSONS, OF WHATSOEVER KIND OR
CHARACTER, WHETHER REAL OR ASSERTED, ARISING OUT OF OR IN
CONNECTION WITH THE EXECUTION, PERFORMANCE, ATTEMPTED
PERFORMANCE OR NONPERFORMANCE OF THIS CONTRACT AND/OR THE
OPERATIONS, ACTIVITIES AND SERVICES OF THE PROGRAM DESCRIBED
HEREIN, WHETHER OR NOT CAUSED IN WHOLE OR IN PART, BY ALLEGED
NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS
OR SUBCONTRACTORS OF CITY; AND AGENCY HEREBY ASSUMES ALL
LIABILITY AND RESPONSIBILITY OF CITY AND ITS OFFICERS, AGENTS,
SERVANTS, AND EMPLOYEES FOR ANY AND ALL CLAIMS OR SUITS FOR
PROPERTY LOSS OR DAMAGE AND/OR PERSONAL INJURY, INCLUDING DEATH,
TO ANY AND ALL PERSONS, OF WHATSOEVER KINDS OR CHARACTER,
WHETHER REAL OR ASSERTED, ARISING OUT OF OR IN CONNECTION WITH
THE EXECUTION, PERFORMANCE, ATTEMPTED PERFORMANCE OR
NONPERFORMANCE OF THIS CONTRACT AND/OR THE OPERATIONS,
ACTIVITIES AND SERVICES OF THE PROGRAM DESCRIBED HEREIN, WHETHER
OR NOT CAUSED IN WHOLE OR IN PART BY ALLEGED NEGLIGENCE OF
OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS OR
SUBCONTRACTORS OF CITY. AGENCY LIKEWISE COVENANTS AND AGREES TO
AND DOES HEREBY INDEMNIFY AND HOLD HARMLESS CITY FROM AND
AGAINST ANY AND ALL INJURY, DAMAGE OR DESTRUCTION OF PROPERTY OF
CITY, ARISING OUT OF OR IN CONNECTION WITH ALL ACTS OR OMISSIONS OF
AGENCY, ITS OFFICERS, MEMBERS, AGENTS, EMPLOYEES, CONTRACTORS,
SUBCONTRACTORS, INVITEES, LICENSEES, OR CLIENTS, OR CAUSED, IN
WHOLE OR IN PART, BY ALLEGED NEGLIGENCE OF OFFICERS, AGENTS,
SERVANTS, EMPLOYEES, CONTRACTORS OR SUBCONTRACTORS OF CITY.
IT IS THE EXPRESS INTENTION OF THE PARTIES, BOTH AGENCY AND
CITY, THAT THE INDEMNITY PROVIDED FOR THIS SECTION INCLUDES
INDEMNITY BY AGENCY TO INDEMNIFY AND PROTECT CITY FROM THE
CONSEQUENCES OF CITY'S OWN NEGLIGENCE, WHETHER 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
30
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
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
$143,506.00 to insure against loss from the fraud, theft or dishonesty of any of Agency's officers,
agents, trustees, directors or employees. The proceeds of such insurance or bond shall be used to
reimburse City for any and all loss of CDBG-CV/CV3 Funds occasioned by such misconduct. To
effectuate such reimbursement, such fidelity coverage shall include a rider stating that
reimbursement for any loss or losses shall name the City as a Loss Payee.
Agency shall furnish to City in a timely manner, but not later than the Effective Date,
certificates of insurance as proof that it has secured and paid for policies of commercial insurance
as specified herein. If City has not received such certificates by the Effective Date, Agency shall
be in default of the Contract and City may, at its option, terminate the Contract.
Such insurance shall cover all insurable risks incident to or in connection with the
execution, performance, attempted performance or nonperformance of this Contract. Agency shall
maintain the following insurance coverage and limits:
Commercial General Liabilitv (CGL) Insurance
$ 500,000 each occurrence
$1,000,000 aggregate limit
Non -Profit Organization Liability or Directors & Officers Liability
$1,000,000 Each Occurrence
$1,000,000 Annual Aggregate Limit
Business Automobile Liability Insurance
$1,000,000 each accident on a combined single -limit basis, or
$ 250,000 Property Damage
$ 500,000 Bodily Injury per person per occurrence
$2,000,000 Aggregate
31
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
Insurance policy shall be endorsed to cover "Any Auto", defined as autos owned, hired,
and non -owned. Pending availability of the above coverage and at the discretion of
City, the policy shall be the primary responding insurance policy versus a personal
auto insurance policy if or when in the course of Agency's business as contracted
herein.
Workers' Compensation Insurance
Part A: Statutory Limits
Part B: Employer's Liability
$100,000 each accident
$100,000 disease -each employee
$500,000 disease -policy limit
Note: Such insurance shall cover employees performing work on any and all projects
including but not limited to construction, demolition, and rehabilitation. Agency or its
contractors shall maintain coverages, if applicable. In the event the respective contractors
do not maintain coverage, Agency shall maintain the coverage on such contractor, if
applicable, for each applicable contract.
Additional Requirements
Such insurance amounts shall be revised upward at City's reasonable option and no more
frequently than once every 12 months, and Agency shall revise such amounts within thirty (30)
days following notice to Contractor of such requirements.
Agency will submit to City documentation that it has obtained insurance coverage and has
executed bonds as required in this Contract prior to payment of any monies provided hereunder.
Where applicable, insurance policies required herein shall be endorsed to include City as an
additional insured as its interest may appear. Additional insured parties shall include employees,
officers, agents, and volunteers of City.
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.
32
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
Agency shall require its contractors to maintain applicable insurance coverages, limits, and other
requirements as those specified herein; and Agency shall require its contractors to provide Agency
with certificate(s) of insurance documenting such coverage. Also, Agency shall require its
contractors to have City and Agency endorsed as additional insureds (as their interest may appear)
on their respective insurance policies.
Directors and Officers Liability coverage shall be in force and may be provided on a claims -made
basis. This coverage may also be referred to as Management Liability, and shall protect the insured
against claims arising out of alleged errors in judgment, breaches of duty and wrongful acts arising
out of their organizational duties. Coverage shall protect not only the entity, but all past, present
and future directors, officers, trustees, employees, volunteers and committee members.
Notwithstanding any provision in this Contract to the contrary, when applicable, Agency
shall comply with the requirements of 2 CFR 200.310 and shall, at a minimum, provide the
equivalent insurance coverage for real property and equipment acquired or improved with
CDBG Funds as provided to property owned by Agency.
18. CERTIFICATION REGARDING LOBBYING.
The undersigned representative of Agency hereby certifies, to the best of his or her
knowledge and belief, that:
No federal appropriated funds have been paid or will be paid, by or on behalf of Agency,
to any person for influencing or attempting to influence an officer or employee of any
agency, a member of Congress, an officer or employee of Congress in connection with the
awarding of any federal contract, the making of any federal grant, the making of any federal
loan, the entering into of any cooperative agreement and the extension, continuation,
renewal, amendment, or modification of any federal contract, grant, loan or cooperative
agreement.
If any funds other than federally appropriated funds have been paid or will be paid to any
person for influencing or attempting to influence an officer or employee of any agency,
member of Congress in connection with this federal contract, grant, loan or cooperative
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
33
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
Program. Agency shall furnish immediately to City copies of all pertinent papers received by
Agency with respect to such action or claim. Agency shall provide a notice to City within 10 days
upon filing under any bankruptcy or financial insolvency provision of law.
20. NOTICE.
All notices required or permitted by this Contract must be in writing and are deemed
delivered on the earlier date of the date actually received or the third day following deposit in a
United States Postal Service post office or receptacle; with proper postage, certified mail return
receipt requested; and addressed to the other Party at the address set out below or at such other
address as the receiving Party designates by proper notice to the sending Party.
City:
City Attorney's Office
100 Fort Worth Trail
Fort Worth, TX 76102
Telephone: 817-392-7600
Copy to:
Neighborhood Services Department
100 Fort Worth Trail
Fort Worth, TX 76102
Attention: Kacey Thomas
Telephone: 817-3 92-7540
Copy to:
Neighborhood Services Department
100 Fort Worth Trail
Fort Worth, TX 76102
Attention: Mary Tenorio
Telephone: 817-392-6432
Agency:
The Presbyterian Night Shelter of Tarrant County, Inc.
Toby Owen
2400 Cypress Street,
Fort Worth, TX 76102
Telephone: 817-632-7440
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.
34
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
22. COUNTERPARTS.
This Contract may be executed in multiple counterparts, each of which shall be considered
an original, but all of which shall constitute one instrument which may be sufficiently evidenced
by one counterpart.
23. PROGRAM INCOME
Parties agree that no program income as defined by HUD shall be earned as a result of this
contract.
24. PROHIBITION ON CONTRACTING WITH COMPANIES THAT BOYCOTT
ISRAEL
If Agency has less than ten employees, this contract is for less than $100,000, or Agency
does not meet the definition of a "company" under the applicable section of the Texas Government
Code, this provision shall not apply. Agency acknowledges that in accordance with Chapter 2270
of the Texas Government Code, the City is prohibited from entering into a contract with a company
for goods or services unless the contract contains a written verification from the company that it:
(1) does not boycott Israel; and (2) will not boycott Israel during the term of the contract. The
terms "boycott Israel" and "company" shall have the meanings ascribed to those terms in Section
808.001 of the Texas Government Code. By signing this contract, Agency certifies that Agency's
signature provides written verification to the City that Agency: (1) does not boycott Israel; and (2)
will not boycott Israel during the term of the contract.
25. PROHIBITION ON BOYCOTTING ENERGY COMPANIES
Agency acknowledges that in accordance with Chapter 2276 of the Texas Government
Code, the City is prohibited from entering into a contract for goods or services that has a value of
$100,000 or more that is to be paid wholly or partly from public funds of the City with a company
with 10 or more full-time employees unless the contract contains a written verification from the
company that it: (1) does not boycott energy companies; and (2) will not boycott energy companies
during the term of the contract. To the extent that Chapter 2276 of the Government Code is
applicable to this Agreement, by signing this Agreement, Agency certifies that Agency's signature
provides written verification to the City that Agency: (1) does not boycott energy companies; and
(2) will not boycott energy companies during the term of this Agreement.
26. PROHIBITION ON DISCRIMINATION AGAINST FIREARM AND
AMMUNITION INDUSTRIES
Agency acknowledges that except as otherwise provided by Chapter 2274 of the Texas
Government Code, the City is prohibited from entering into a contract for goods or services that
has a value of $100,000 or more that is to be paid wholly or partly from public funds of the City
with a company with 10 or more full-time employees unless the contract contains a written
verification from the company that it: (1) does not have a practice, policy, guidance, or directive
35
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
that discriminates against a firearm entity or firearm trade association; and (2) will not discriminate
during the term of the contract against a firearm entity or firearm trade association. To the extent
that Chapter 2274 of the Government Code is applicable to this Agreement, by signing this
Agreement, Agency certifies that Agency's signature provides written verification to the City that
Agency: (1) does not have a practice, policy, guidance, or directive that discriminates against a
firearm entity or firearm trade association; and (2) will not discriminate against a firearm entity or
firearm trade association during the term of this Agreement.
27. ELECTRONIC SIGNATURES.
This Contract may be executed by electronic signature, which will be considered as an
original signature for all purposes and have the same force and effect as an original signature. For
these purposes, "electronic signature" means electronically scanned and transmitted versions (e.g.
via pdf file or facsimile transmission) of an original signature, or signatures electronically inserted
via software such as Adobe Sign.
36
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
[SIGNATURES APPEAR ON NEXT PAGE]
37
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
IN WITNESS WHEREOF, the Parties hereto have executed this Contract in Fort Worth,
Tarrant County, Texas.
44ovvnuu
vpo pORl O9pd
Pig o�0
ATTEST: d *oaoo 8
oa
a4np�E%og4aa
Jannette Goodall
City Secretary
M&C: 26-0140
Date: February 24, 2026
1295 Certification No. 2026-1409224
RECOMMENDED BY:
)mil uy4w
Kacey Thomas (Apr 21, 2026 13:42:14 CDT)
Kacey Thomas
Neighborhood Services Director
APPROVED AS TO FORM AND LEGALITY:
Sophie Mathews
Sophie Mathews
Assistant City Attorney
CITY OF FORT WORTH:
Dana &Uhee f
Dana Burghdoff (Apr 2 , 2026 17:19.58 CDT)
Dana Burghdoff
Assistant City Manager
CONTRACT COMPLIANCE ADMINISTRATOR:
By signing, I acknowledge that I am the person responsible
for the monitoring and administration of this contract, including
ensuring all performance and reporting requirements
Mary Tenorio (Apr 21. 2026 11:29:34 CDT)
Mary Tenorio, Neighborhood Development Specialist
THE PRESBYTERIAN NIGHT SHELTER OF TARRANT COUNTY, INC.
Toby O, pr21,2026 11:28:15 CDT) OFFICIAL RECORD
Toby Owen, CEO CITY SECRETARY
FT. WORTH, TX
38
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
EXHIBITS:
EXHIBIT
"A"
-Program Summary
EXHIBIT
"A-1" - 2025 HUD Income Limits
EXHIBIT
"A-2" - Reporting Requirements for Countywide Agencies
EXHIBIT
"B"
- Budget
EXHIBIT
"C"
- Audit Certification Form
EXHIBIT
"D"
- Reimbursement Forms
EXHIBIT
"E"
- Self -Certification of Income Form
EXHIBIT
"F"
- Standards for Complete Documentation
EXHIBIT
"G"
- Severely Disabled Certification Form (only applicable to
Presumed
Benefit contracts)
EXHIBIT
"H"
- MBE Reporting Form
EXHIBIT
"I" - Notice of Beneficiary Rights
EXHIBIT
"J"
- Conflict of Interest Disclosure Form
EXHIBIT
"K"
- Certificate of Compliance: Additional Program -Specific Policy
Requirements
ATTACHMENTS:
FORM 1295
M&C 26-0140
HUD Funding Approval Agreement
Fillable Contract Transmittal Slip
39
CDBG-CV PRESUMED BENEFITS PSA CONTRACT 2026
PRESBYTERIAN NIGHT SHELTER
Presbyterian Night Shelter EXHIBIT "A"
Moving Home Program PROGRAM SUMMARY
PROGRAM SUMMARY
(CDBG-CV)
September 1, 2025 to May 31, 2026
PERIOD
$143,506.00
AMOUNT
Capitalized terms not defined herein shall have meanings assigned them in the Contract.
PROGRA-W
The Program will provide 24/7 emergency shelter and supportive services to individuals
experiencing homelessness, including those with chronic health conditions, disabilities, or
compromised immune systems that place them at increased risk for severe illness from COVID-
19 and other communicable diseases. Services include low -barrier shelter access, basic needs
support, health and safety monitoring, and coordination of resources to promote housing
stability. Program staff will provide continuous supervision and implement enhanced cleaning,
sanitation, and infection control protocols to reduce the spread of COVID-19 within the
congregate shelter setting.
CDBG-CV funds will be used to support Program Staff salaries and benefits for essential
frontline shelter staff and to purchase durable, non -porous poly fiber vinyl fabric sleeping mats
to replace traditional bedding materials that are difficult to disinfect. These mats will improve
infection prevention by allowing for proper cleaning between uses and reducing the risk of cross -
contamination. These activities directly prevent, prepare for, and respond to the impacts of
COVID-19 by strengthening public health protections and ensuring continuity of shelter services.
Services will be available at 2400 Cypress Street (men's shelter) and 2401 Cypress Street
(women's shelter), Fort Worth, TX 76102, 24 hours per day, 365 days per year.
REGULATORY CLASSIFICATION:
IDIS Matrix Code(s) and Service Category: 03T Operating Costs Homelessness/Aids Patient
National Objective Citation: LMC Low/Mod Limited Clientele 24 CFR 208 (a)(2)
Regulatory Citation(s): 24 CFR 570.201 (e)
PROGRAM GOALS:
Minimum Number of Fort Worth Clients to be Served: The Program must serve a minimum
of 630 Unduplicated Clients from Fort Worth as shown by the monthly reports on Attachment
III.
CDBG-CV 2025-2026 — EXHIBIT "A" — Moving Home PROGRAM SUMMARY
Page 1
EXHIBIT "A-1"
2025 HUD INCOME LIMITS
AMI
1 person
2 people
3 people
4 people
5 people
6 people
7 people
8 people
30%
$22,400
$25,600
$28,800
$32,200
$34,600
$37,150
$39,700
$42,250
50%
$37,350
$42,700
$48,050
$53,350
$57,650
$61,900
$66,200
$70,450
80%
$59,750
$68,300
$76,850
$85,350
$92,200
$99,050
$105,850
$112,700
*Income limits are published at least annually by HUD.
Effective 610112025
EXHIBIT 66A-2"
REPORTING REQUIREMENTS FOR COUNTYWIDE AGENCIES
(ONLY APPLICABLE TO COUNTYWIDE AGENCIES)
CDBG PSA CONTRACT-- EXHIBIT "A-2"
REPORTING REQUIREMENTS FOR COUNTYWIDE AGENCIES
REPORTING REQUIREMENTS FOR COUNTYWIDE AGENCIES
Quarterly Report
The purpose of the Quarterly Report is for the Countywide Agencies to report the number of non -Fort
Worth clients who participate in the Program. The Quarterly Report must be submitted with the
December, March, June and September Reimbursement Requests. The submission of the Quarterly
Report is through Neighborly Software. The information provided in the Quarterly Report will be
reviewed and monitored by the Neighborhood Services Department Compliance Division.
TOTALOF OF
# OF FORT
# OF NON -FORT CLIENTS FORT WORTH
DUE DATE
REPORTING RANGE WORTH
WORTH SERVED BY CLIENTS
CLIENTS
CLIENTS -• .
A
B C
D E F
EXAMPLE: 250
200
450
250=450=55%
January 15, 2026
October 1, 2025 —
December 31, 2025
April 15, 2026
January 1, 2026—
March 30, 2026
July 15, 2026
April 1, 2026—
June 30, 2026
October 1, 2026
July 1, 2026 —
September 30, 2026
TOTAL
I, Agency representative, certify that I verified the information I reported this quarter and it is correct
to the best of my knowledge.
Certified by:
Signature/Title:
CDBG PSA CONTRACT-- EXHIBIT "A-2"
REPORTING REQUIREMENTS FOR COUNTYWIDE AGENCIES
Date:
EXHIBIT "B"
BUDGETS
EXHIBIT "B" -BUDGET
Account
Grant Budget
A
E
Total
PROGRAM PERSONNEL
Salaries
1001
$ 21,471.21
S 21,471.21
FICA
1002
$ 1,445.83
$ 1,445.83
Life/Disability Insurance
1003
$ -
Health/Dental Insurance
1004
$ 4,092.58
$ 4,092.58
Unemployment -State
1005
$ -
Worker's Compensation
1006
$
Retirement
1007
$
Staff Training
1008
$ -
SUPPLIES AND SERVICES
Program Supplies
2001
$ 48,649.39
$ 48,649.39
Postage
2002
$ -
Printing
2003
$
Adv/Media, Dues/Pub, Printing,
Bank Fees
$
other
2004
$
MISCELLANEOUS
Contract Labor Food
Supplies/Meals (City needs copy
of contract before expenses can be
reimbursed)
3001
$
Food Supplies
3002
$
Teaching Aids
3003
$
Craft Supplies
3004
$
Field Trip Expenses
3005
$
Mileage
3006
$
FACILITY AND UTILITIES
Telephone
4001
$ -
Electric
4002
$ 25,716.73
$ 25,716.73
Gas
4003
$ 4,914.72
$ 4,914.72
Water and Wastewater
4004
$ 26,543.83
$ 26,543.83
Solid Waste Disposal
4005
$ 10,671.71
$ 10,671.71
Rent (City needs copy of lease
before expenses can be
reimbursed)
4006
$
Cleaning Supplies
4007
$
Repairs
4008
$
Custodial Services
4009
$
Utilities, Transportation, PP &E
4010
$
LEGAL, FINANCIAL AND
INSURANCE
Fidelity Bond or Equivalent
5001
Directors and Officers
5002
General Commercial Liability
5003
Bank fees
volunteer
volunteer
Prof Fees
5004
DIRECT ASSISTANCE
Audit/fr/Legal Volunteer
Recruitment, Misc.
6001
BUDGET TOTAL
$ 143,506.00
$ -
$ -
$ -
$ -
$ -
$ 143,506.00
FUNDING A:
FUNDING B:
FUNDING C:
Page 1
The following tables were created for the purpose of preparing, negotiating, and determining the cost
reasonableness and cost allocation method used by the Agency for the line item budget represented on
the first page of this EXHIBIT "B" — Budget. The information reflected in the tables is to be
considered part of the terms and conditions of the Contract. Agency must have prior written approval
by the City to make changes to any line item in the Budget as outlined in Section 5.2.2 in the
Contract. The deadline to make changes to EXHIBIT "B" — Budget is .
SALARY DETAIL -PROGRAM PERSONNEL
Position Title
Annual Salary
Est. Percent to
Grant
Amount to
Grant
Lead Journey Home Guide
$
46,000.00
6%
$
2,601.94
Journey Home Guide
$
43,000.00
6%
$
2,601.93
Journey Home Guide
$
43,000.00
6%
$
2,601.93
Journey Home Guide
$
43,000.00
6%
$
2,601.93
Journey Home Guide
$
43,000.00
6%
$
2,601.93
Security
$
35,000.00
4%
$
1,346.15
Guest Coordinator
$
30,000.00
4%
$
1,153.85
Guest Coordinator
$
30,000.00
4%
$
1,153.85
Journey Home Advocate
$
25,000.00
4%
$
961.54
Journey Home Advocate
$
25,000.00
4%
$
961.54
Operations Manager
$
25,000.00
4%
$
961.54
Operations Manager
$
25,000.00
4%
$
961.54
Operations Manager
$
25,000.00
4%
$
961.54
TOTAL
$
438,000.00
4.90%
$
21,471.21
FRINGE DETAIL, -PROGRAM PERSONNEL
Percent of
Payroll
Amount
Est. Percent to
Grant
Amount to
Grant
FICA
7.65%
$ 1,642.55
88.0%
$ 1,445.83
Life/Disability Insurance
Health/Dental Insurance
246.87/pay period
$ 4,092.58
100.0%
$ 4,092.58
Unemployment -State
Worker's Compensation
Retirement
Staff Training
TOTAL
$ 5,735.13
96.6%
$ 5,538.41
SUPPLIES AND SERVICES
Total Budget
Est. Percent to
Grant
Amount to
Grant
Program Supplies (new mats for guests)
$ 48,649.39
100.00%
$ 48,649.39
Postage
Printing
Adv/Media, Dues/Pub, Printing, Bank Fees
CDBG-CV PSA CONTRACT 2025-26 - EXHIBIT "B" - BUDGET Page 2
TOTAL 1 $ 48,649.39 1 100.0% $ 48,649.39
MISCELLANEOUS
Total Budget
Est. Percent to
Grant
Amount to
Grant
Contract Labor
Food Supplies
Teaching Aids
Craft Supplies
Field Trip Expenses
Mileage
TOTAL
FACILITY AND UTILITIES
Total Budget
Est. Percent to
Grant
Amount to
Grant
Telephone
Electric
$
25,716.73
100.00%
$
25,716.73
Gas
$
4,914.72
100.00%
$
4,91.4.72
Water and Wastewater
$
26,543.83
100.00%
$
26,543.83
Solid Waste Disposal
$
10,671.71
100.00%
$
10,671.71
Rent
Cleaning Supplies
Repairs
Custodial Services
Utilities, Transportation, PP & E
TOTAL
$
67,846.99
1 100.0%
$
67,846.99
LEGAL, FINANCIAL AND INSURANCE
Total Budget
Est. Percent to
Grant
Amount to
Grant
Fidelity Bond or Equivalent
Directors and Officers
General Commercial Liability
Prof Fees
TOTAL
DIRECT ASSISTANCE
Total Budget
Est. Percent to
Grant
Amount to
Grant
Audit/IT/Legal Volunteer Recruitment, Misc.
TOTAL
$ -
$ -
CDBG-CV PSA CONTRACT 2025-26 - EXHIBIT "B" - BUDGET Page 3
EXHIBIT "C"
AUDIT CERTIFICATION FORM
PSA CONTRACT - EXHIBIT "C" - AUDIT
CERTIFICATION FORM --
AUDIT CERTIFICATION FORM AND AUDIT REQUIREMENTS
Agency: Presbyterian Night Shelter
Fiscal Year Ending: September 30, 2026
❑✓ During the fiscal year in which funds will be received, we will exceed the federal expenditure
threshold of $1,000,000.00. We will have our Single Audit or Program Specific Audit
completed and will submit the audit report described in 2 CFR Part 200 within 7 months
after the end of the audited fiscal year or 30 days within its completion, whichever is the
❑ earlier date.
During the fiscal year in which funds will be received, we will not exceed the
$1,000,000.00 federal expenditure threshold required for a Single Audit or a Program
Specific Audit to be performed this fiscal year. (Fill out schedule below)
1 Federal Expenditure Disclosure
MUST be filled out if Single Audit or Program Audit is NOT required.
Federal Grantor
Pass Through
Grantor
Program Name &
CFDA Number
Contract
Number
Expenditures
Total Federal Expenditures for this Fiscal Year:
lmniiw sag
Signat6ry and Title
9/19/2025
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.
PSA CONTRACT - EXHIBIT "C" - AUDIT CERTIFICATION FORM
EXHIBIT "D"
Exhibit D (REVISED 12/2025)
Attachment I- Request Summary
Agency:
Address:
City, State, Zip:
Program:
Month of Service:
Tax ID Number:
Contract Number:
Case ID:
P.O. Number:
RID Number:
IDIS Number:
Program
Account
Amount
Original Amount
This Invoice
Cumulative to Date
Remaining Balance
(Program Name) Case ID
Salaries
1001
$ 21,471.21
$
$ 21,471.21
FICA
1002
$ 1,445.83
$
$
$ 1,445.83
Life/Disability Insurance
1003
$
$
$ -
Health/Dental Insurance
1004
$ 4,092.58
$
$
$ 4,092.58
Unemployment -State
1005
$ -
$
$
$ -
Worker's Compensation
1006
$ -
$
$
$ -
Program Supplies
2001
$ 48,649.39
$
$
$ 48,649.39
Electric
4002
$ 25,716.73
$
$
$ 25,716.73
Gas
4003
$ 4,914.72
$
$
$ 4,914.72
Water and Wastewater
4004
$ 26,543.83
$
$
$ 26,543.83
Solid Waste Disposal
4005
$ 10,671.71
$
$
$ 10,671.71
Other
6001
$ -
$
$
$ -
TOTAL
$ 143,506.00
$
$
$ 143,506.00
Request Summary
Budget
Expenditure
Percentage Spent
Table Total
$ 143,506.00
$
0%
S
Sep-25
Oct-25
Nov-25
Dec-25
Jan-26
Feb-26
Mar-26 Apr-26 May-26
$ - $ - $ - $ - $ -
$ -
Client Goals
Goal Amount
Cumulative Total
Goal Met %
Table Total
630
0
Sep-25
Oct-25
Nov-25
Dec-25
Jan-26
Feb-26
Mar-26
Apr-26
May-26
Agency:
Program:
ATTACHMENT II
City of Fort Worth
Neighborhood Services Department
Expenditure Worksheet
Please erouo like account codes,
Description/Job
--
*For Salaries,state employee's title under Description/Job Title. Rent must identify tenant
Only highlighted codes can be reimbursed
Expense Line Item
Account
PROGRAM PERSONNEL
Salaries
1001
FICA
1002
Life/Disability Insurance
1003
Health/Dental Insurance
1004
Unemployment -State
1005
Worker's Compensation
1006
Retirement
1007
SUPPLIES AND SERVICES
Program Supplies
2001
Postage
2002
Printing
2003
Other(CaseWorthy. Phones, Computers)
2004
MISCELLANEOUS
Contract Labor
3001
Food Supplies
3002
Teaching Aids
3003
Craft Supplies
3004
Field Trip Expenses
3005
Mileage
3006
Other(Client Employment Incentives)
3007
Other(Client Credentialing Fund)
3008
FACILITY AND UTILITIES
Telephone
4001
Electric
4002
Gas
4003
Water and Wastewater
4004
Solid Waste Disposal
4005
Rent
4006
Cleaning Supplies
4007
Allowance, Occupancy)
4008
LEGAL, FINANCIAL, AND INSURANCE
Fidelity Bond or Equivalent
5001
Directors and Officers
1 5002
General Commercial Liability
5003
Other(IDC, Interpretation)
5004
DIRECT ASSISTANCE
Other 6001
F
CFFa
W�
U O
F �
z
a�
U
�.
��
`e
a
r
�`
em
�`
eC
��
:�
F a
Cd
i�
_€�
s$
�2
&�
=5
i�aa
f�e
�Y8
tl9V
��a
m9
�a9
g �iYY{
U C3°
��o
$�'n
�'m;
�a
n��v
:�z
�r�
t 9`9
�� d
—ee
a n G i
o=
V55 t �_
m d
> U
p a a
B
V �
WYWWIYYYYYYIYWYWY-
Ix PI
EXHIBIT "E"
SELF -CERTIFICATION FORMS
INCOME CERTIFICATION
(NOT SUBJECT TO CITIZENSHIP AND IMMIGRATION VERIFICATION)
INCOME AND CITIZENSHIP/IMMIGRATION CERTIFICATION
(SUBJECT TO CITIZENSHIP AND IMMIGRATION VERIFICATION)
City of Fort Worth
CERTIFICATION OF INCOME STATEMENT
Applicant Name: Phone #:
Current Address: City and Zip:
Household Members and Income
including applicant)
Last Name First Name Age Monthly Income Source of Income
Total Gross Annual Household Income: $
TOTAL NUMBER OF FAMILY MEMBERS (Include Yourself, Spouse, Children, etc.)
PERSONAL DEMOGRAPHIC INFORMATION: (Check one box in each category. This information is required for federal reporting under HUD guidelines.)
a. ❑ MALE b. ❑ AMERICAN INDIAN/ALASKAN NATIVE ❑ ASIAN
❑ FEMALE ❑ BLACK/AFRICAN AMERICAN ❑ NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER
❑ WHITE ❑ AMERICAN INDIAN/ALASKAN NATIVE & WHITE
❑ ASIAN & WHITE ❑ BLACK/AFRICAN AMERICAN & WHITE
❑ AMERICAN INDIAN/ALASKAN NATIVE ❑ OTHER MULTI -RACIAL
& BLACK/AFRICAN AMERICAN
c. ETHNICITY d. DISABLED e. IS HEAD OF HOUSEHOLD FEMALE?
❑ HISPANIC ❑ YES ❑ YES
❑ NON -HISPANIC ❑ NO ❑ NO
Certification: I certify that all information I provide is true and may be subject to verification at any time by a third party. I agree to
furnish accurate and truthful information when applying for and receiving services. I understand that providing false or misleading
information may subject me to penalties under applicable Federal, State, and local laws.
Signature of Applicant
Date
WARNING: TITLE 18, SECTION 1001 OF THE U.S. CODE STATES THAT A PERSON IS GUILTY OF A FELONY FOR KNOWINGLY AND WILLINGLY
MAKING FALSE OR FRAUDULENT STATEMENTS TO ANY DEPARTMENT OF THE UNITED STATES GOVERNMENT.
Household Size:
Applicable Income Limit:
-----------------hor use bV AaerlcV start
Gross Annual Income:
Is Applicant Eligible?
Check if Applicant refused to provide demographic information:
Staff Assessment of Demographics:
Person Making Determination:
Date:
NOTE: Agency staff are required to verify all information provided in this Certification of Income Statement. This form must include the address,
income amounts, and income sources for all household members, and all information must be verified.
2025-2026 CDBG PSA Contract
City of Fort Worth
CERTIFICATION OF INCOME & U.S. CITIZENSHIP/IMMIGRATION STATEMENT
Applicant Name: Phone #:
Current Address: City and Zip:
Household Members and Income
(including applicant)
Name (First & Last Name)
DOB
Monthly Income
Source of Income
With/out U.S.
Citizenship/
Immigration
Verification
❑YES ❑NO
❑YES ❑NO
❑YES ❑NO
❑YES ❑NO
❑YES ❑NO
Total Gross Annual Household Income:
$
TOTAL NUMBER OF FAMILY MEMBERS (Include Yourself, Spouse, Children, etc.)
PERSONAL DEMOGRAPHIC INFORMATION: (Check one box in each category. This information is required for federal reporting under HUD guidelines.)
a. ❑ MALE b. ❑ AMERICAN INDIAN/ALASKAN NATIVE ❑ ASIAN
❑ FEMALE ❑ BLACK/AFRICAN AMERICAN ❑ NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER
❑ WHITE ❑ AMERICAN INDIAN/ALASKAN NATIVE & WHITE
❑ ASIAN & WHITE ❑ BLACK/AFRICAN AMERICAN & WHITE
❑ AMERICAN INDIAN/ALASKAN NATIVE ❑ OTHER MULTI -RACIAL
& BLACK/AFRICAN AMERICAN
c. ETHNICITY d. DISABLED e. IS HEAD OF HOUSEHOLD FEMALE?
❑ HISPANIC ❑ YES ❑ YES
❑ NON -HISPANIC ❑ NO ❑ NO
Certification: I certify that all information I provide is true and may be subject to verification at any time by a third party. I agree to furnish accurate
and truthful information when applying for and receiving services. I understand that providing false or misleading information may subject me to
penalties under applicable Federal, State, and local laws.
Signature of Applicant
Date
WARNING: TITLE 18, SECTION 1001 OF THE U.S. CODE STATES THAT A PERSON IS GUILTY OF A FELONY FOR KNOWINGLY AND WILLINGLY MAKING FALSE OR
FRAUDULENT STATEMENTS TO ANY DEPARTMENT OF THE UNITED STATES GOVERNMENT.
-----------------1-oP use DV AciencV staff
Household Size: Gross Annual Income: $
Applicable Income Limit: $
Is applicant income eligible? DYES El NO Is everyone in the household a U.S. citizen or able to provide immigration verification?
DYES ❑NO
Applicant citizenship/immigration status verification method used: ❑SAVE Documentation ❑ Govern ment-issued Documents
❑ Check if Applicant refused to provide demographic information:
Staff Assessment of Demographics:
Person Making Determination: Date:
NOTE: Agency staff are required to verify all information provided in this Certification of Income Statement. This form must include the address,
income amounts, and income sources for all household members, citizenship status and all information must be verified.
2025-2026 CDBG PSA Contract
EXHIBIT "F"
STANDARDS OF DOCUMENTATION
CDBG PSA CONTRACT -- EXHIBIT "F" -- STANDARDS OF DOCUMENTATION
2025-26 Documentation Standards for
CDBG Public Service Contract Expenses
Budget Line E 'T
> Notes/Other
Items IL
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
If the City pays gross salary, this is already included. If the City pays the employer portion, the Agency must provide proof that the
Life Insurance
X X
X
Health
X X
X
Insurance
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
Disability
Insurance
X X
X
at anytime there are changes to amounts, enrollments, disenrollments, etc.
Unemployment
X X
X
Insurance
If the City pays gross salary, this is already included. If the City pays the employer portion, the Agency must provide proof that the
Retirement
X X
X
employee is enrolled in the benefit plan, must show a calculation and documentation of how the invoiced amount was calculated, and
must provide documentation showing payment. Invoice and proof of payment are only required with the first reimbursement request and
at any time there are changes to amounts, enrollments, disenrollments, etc.
Materials, Equipment, Goods and Supplies - City will only reimburse for the cost allocated percent or amount spent in support of the CDBG-funded Program. Agencies
requesting reimbursement for these items will require prior City approval. Agencies must show calculation on how the CDBG portion of these expenses were calculated
consistently with the CDBG Contract.
Office Supplies
X
X
X
Office
Equipment
X
X
X
X
X
Rental
Postage
X
X
X
Printing
X
X
X
Construction &
Building
X
X
X
X
This category is only available for the REACH Program and Habitat for Humanity.
Materials
Sport and
Recreation
X
X
X
.Equipment
Cleaning
X
X
X
Supplies
Teaching Aids
X
X
X
Craft Supplies
X
X
X
Food Supplies
X
X
X
This category is only available to the Program provided by Meals on Wheels.
Rent, Utilities and Maintenance - City will only pay for a portion of these expenses. The portion of these expenses will be determined by the square footage attributable to
the CDBG-funded Program and shall be cost -allocated in accordance with the amount of space used for the CDBG-funded Program. These expenses may only be in support
of the CDBG-funded Program. The items listed below require prior City approval and the Agency is required to identify any funding source that pays for the portion of the
expenses that is not paid with CDBG funds. Agencies must show calculation on how the CDBG portion of these expenses were calculated consistently with the CDBG
Contract.
Telephone
X X
Gas
X X
Water/Wastew
X X
ater
Electric
X X
Solid Waste
X X
CDBG PSA CONTRACT 2025-2026 Exhibit "F" — STANDARDS FOR COMPLETE DOCUMENTATION
Facility
Maintenance
X
X
X
X
This item requires approval by the City prior to the execution of the CDBG Contract. Repairs may be categorized as major/minor
and Repairs
rehabilitation projects and must be approved through the full HUD Environmetal Review.
Rent
X
X
X
City will pay for a portion of the rent for the Program facility so long as its in proportion to the square footage attributable to the CDBG-
funded program.
Miscellaneous
This item requires prior approval by the City. Prior to the execution of the CDBG Contract, the Agency must submit a written statement
that lists the contract labor services to be used during the Contract term. Agency will submit a memo related to the procurement of such
Contract Labor
X
X X
X
X
services and will forward any information pertaining to the procurement process to City. This requirement applies to, but is not limited to,
services retained for security services, legal, accounting, transportation providers, educational facilitators, custodial services, etc.
Agencies may not use the contract services of any City of Fort Worth Department.
City -required
X
X
JI-
City will only pay for a percentage of the City -required insurance so long as it's in proportion to the square footage attributable to the
Insurance
CDBG-funded program.
City requires that the agency submit its fee schedule or formula on how the Agency calculates the childcare scholarship amount. The
fee schedule/formula should demonstrate a breakout of income levels, and for each income level the schedule should demonstrate
Childcare
X
X
which portion of the expense is to be paid by the family and which portion of the expense is to be reimbursed by the City. A fee
Scholarships
schedule/formula must be submitted to the City prior to the first payment. Agency must submit documentation supporting that the client
is income eligible and that the household is being charged in conformance with the fee schedule. If the fee schedule/formula changes at
any time during the contract term, the Agency must immediately notify City on the date the new fee schedule/formula takes into effect.
10" Income
Agecies that are required to verify and provide proof of household income to determine eligibility, must require that anyone who is over
Certifications
the age of 18, living in the housohold, submit a $0 Income Certification.
If an audit is required because federal funds exceed $1,000,000.00, then the cost should be split evenly by all grant funding sources.
Audit Services
X
X X
X
Agency must show calculation on how the CDBG portion of the accounting services were calculated. For example, if the CDBG grant is
10% of your Agency's budget, then invoice shall not exceed 10% of the overall cost. Agency must show a calculation and
documentation of how the invoiced amount was calculated, and must provide documentation showing payment.
'Proof of payment effective October 1,2025: Payments or Expenses must be documented in the following manner:
A) Image of the check AND bank statement showing the check cleared the bank; OR,
B) Image of the cancelled check (ex. At end of bank statement); OR,
C) Payroll Check Stub, "Advice", or Statement AND Bank Statement indicating payroll; OR,
D) For wire or e-transfers: Reciept or statement from payee/vendor OR bank statement.
Revised as or 09/29/2025 MT
CDBG PSA CONTRACT 2025-2026 Exhibit "F -- STANDARDS FOR COMPLETE DOCUMENTATION
EXHIBIT "G"
SEVERELY DISABLED CERTIFICATION FORM
CDBG PSA CONTRACT - EXHIBIT "G" - SEVERELY DISABLED CERTIFICATION FORM
CERTIFICATION FORM
DOCUMENTING CLIENT STATUS AS "SEVERELY DISABLED ADULT"
Client Name:
Address:
City, State, Zip
Client Identification No.
x
❑■
x
El
11
❑�
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 toiletin .
Is unable to perform or needs assistance to perform one or more of the following
Instrumental Activities of Daily Living (IADL): going outside the home,
keeping track of money and bills, preparing meals, doing light housework,
taking prescription medications in the right amount and at the right time, and
using the telephone.
Has a condition that prevents them from working at a job or doing housework.
The undersigned Agency representative conducted a visual assessment of the client identified on this
form and certifies that the client meets at least one of the conditions indicated above, which
determines that he/ she meets the definition of "severely disabled" according to the U.S. Census
Bureau.
Certified by:
Signature/Title:
Date:
CFW Neighborhood Services Dept.: Revised 08/29/2019
CDBG PSA CONTRACT - EXHIBIT "G" - SEVERELY DISABLED CERTIFICATION FORM
EXHIBIT "G"
SEVERELY DISABLED CERTIFICATION FORM
CDBG PSA CONTRACT - EXHIBIT "G" - SEVERELY DISABLED CERTIFICATION FORM
CERTIFICATION FORM
DOCUMENTING CLIENT STATUS AS "SEVERELY DISABLED ADULT"
Client Name:
Address:
City, State, Zip
Client Identification No.
x
❑■
x
El
11
0
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 toiletin .
Is unable to perform or needs assistance to perform one or more of the following
Instrumental Activities of Daily Living (IADL): going outside the home,
keeping track of money and bills, preparing meals, doing light housework,
taking prescription medications in the right amount and at the right time, and
using the telephone.
Has a condition that prevents them from working at a job or doing housework.
The undersigned Agency representative conducted a visual assessment of the client identified on this
form and certifies that the client meets at least one of the conditions indicated above, which
determines that he/ she meets the definition of "severely disabled" according to the U.S. Census
Bureau.
Certified by:
Signature/Title:
Date:
CFW Neighborhood Services Dept.: Revised 08/29/2019
CDBG PSA CONTRACT - EXHIBIT "G" - SEVERELY DISABLED CERTIFICATION FORM
EXHIBIT "H"
MBE REPORTING FORM
CDBG PSA CONTRACT -- EXHIBIT "H" -- MBE REPORTING FORM Page 1
N O m itl 'Od
N
z >a
� W —
.-
00
O � �
� O
4l
3
o q
o i x
YN N
G
� y ytl
� C
C � N
v
o F-
°
y O
p F
o - �
•C o
• W ca •o
� ❑ o Y
O O b � :•
� � O •�O U
°• ao k •o o N •A°
a 5 c°i � a •c
.7 c o � o
a Q y C1
° .n � q •a
G O C U
y ° m
° a •v � o
F
v o
A '9 Em
Al
o m Cy
p0 W
�„5 to wo m
0O x
❑ U t0. y q
C
F
•C
.b Cp y y i.a O 49
.�+ o o
U a°. G w •� a w
N
C,
O
y
U
ym.
p
�
Al
�
O
Elo
�
m
A
O
_
C
°
a
N
m
�
U o
0
U
— U
v G
zuA
A
w
o
M
°
�
�O
�s
b
° OU
o
�z^
r
.5
O
M
v
�zr
aVq
9
a
ul
E
e
E
Fi z
z'
o°
3
O a S m h
d
o
F —
T
�
Q
O U
w
W- ••
v�i
E
c
0
6 Uo �
p>
0
1
u a
O3
a W
"S
C7
�
42
ob
UU
a
x
9 m z S Q
u rl a �i
N V
[ :9
EXHIBIT "I"
NOTICE OF BENEFICIARY RIGHTS
CDBG PSA CONTRACT- EXHIBIT "I" - NOTICE OF BENEFICIARY RIGHTS
Notice of Beneficiary Rights
Name of Agency:
Name of Program:
Contact information for Program Staff (name, phone number, and e-mail address, if appropriate):
Because this program is supported in whole or in part by direct Federal financial assistance from
the Federal Government, we are required to let you know that:
• We may not discriminate against you on the basis of religion, religious belief, a refusal
to hold a religious belief, or a refusal to attend or participate in a religious practice;
• We may not require you to attend or participate in any explicitly religious activities that
are offered by us and any participation by you in these activities must be purely
voluntary;
• We must separate, in time or location, any privately funded explicitly religious activities
from activities supported by direct Federal financial assistance;
• If you object to the religious character of our organization, we must make reasonable
efforts to identify and refer you to an alternative provider to which you have no such
objection; and
• You may report an organization's violations of these protections, including any denial of
services or benefits, by contacting or filing a written complaint to HUD [or the
intermediary, if applicable].
We must give you this written notice before you enroll in our program or activity, as required by
24 CFR 5.109.
CDBG PSA CONTRACT- EXHIBIT "I" - NOTICE OF BENEFICIARY RIGHTS
EXHIBIT "J"
CONFLICT OF INTEREST DISCLOSURE:
FOR CITY OF FORT WORTH PROGRAMS ONLY
CDBG PSA CONTRACT -- EXHIBIT "J" -- CONFLICT OF INTEREST DISCLOSURE
FORT WORTH
CONFLICT OF INTEREST DISCLOSURE:
FOR CITY OF FORT WORTH PROGRAMS ONLY
The assistance you are applying for is funded using Housing and Urban Development (HUD) funds and because
of this our office is requesting the following information in order to comply with the funding requirements. Please
complete this form to the best of your ability, sign it, and return it to this Agency at your earliest convenience.
NAME:
TELEPHONE:
ADDRESS:
E-MAIL ADDRESS (if applicable)
1. Are you employed by the City of Fort Worth? I ❑ YES I ❑ NO
1 a. If yes, by which Department and Division:
2. Were you employed by the City of Fort Worth within the most recent 12-month period? I ❑ YES I ❑ NO
2a. If yes, by which Department and Division:
3. Are any members of your immediate family currently employed by the City of Fort Worth?
("Immediate Family " includes (whether by blood or adoption): the spouse, parent (including a stepparent),
child (including a stepchild), brother, sister (including a stepbrother or stepsister), grandparent, grandchild,
and in-laws.)
❑ YES
❑ NO
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
within the most recent 12-monthperiod?
YES
NO
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
5a. If yes, by which Department and Division: ❑ ❑
6. Are any immediate family members an elected or appointed official, or agent or consultant
of the City of Fort Worth?
YES
NO
6a. If yes, please provide relative's name(s), Department(s), and Division(s):
Certification: I understand and agree that the City may/will contact the City of Fort Worth department including all supervisors in
order to determine whether any of these persons' employment or official functions are or were related to the City's use of federal
grant funds and whether federal funds can be provided. I certify that the information I am providing is true and could be subject
to verification at any time by a third party. I also acknowledge that the provision of false information could leave me subject
to the penalties of Federal, State and local law.
WARNING: TITLE 18, SECTION 1001 OF THE U.S. CODE STATES THAT A PERSON IS GUILTY OF A FELONY FOR KNOWINGLY AND WILLINGLY
MAKING FALSE OR FRAUDULENT STATEMENTS TO ANY DEPARTMENT OF THE UNITED STATES GOVERNMENT.
Applicant/Prospective Applicant Signature Date
For -City -Staff -Only: Once this form is completed and if "Yes" is marked on any of the above questions, please return it
to your Compliance Specialist as soon as possible for processing. If you have any questions, please contact Leticia
Rodriguez, Compliance Administrator, Compliance Division, at 817-392-7319, or Charletta Moaning, Sr. Contract
Compliance Specialist, at 817-392-7333 or at charletta,moaning@fortworthtexas.goy.
Neighborhood Services Department -Conflict Disclosure Form, Dated September 23, 2024-City Only
EXHIBIT "K"
CERTIFICATE OF COMPLIANCE:
ADDITIONAL POLICY REQUIREMENTS
CERTIFICATE OF COMPLIANCE:
ADDITIONAL POLICY REQUIREMENTS
The 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:
ADDENDUM 1. POLICY REQUIREMENTS
If applicable:
The Recl;plent shall not use grant funds to promote "gender Ideology," as defined In Executive Order
(E.O.) 14168, Defending Women from Gender Ideology Extremism and Restoring 11101.0gicalTruth to
the Federat Government
2, The Recipient agrees that its compliance in all respects with all. applicable Federal anti-
discrimination laws Is material to the U.S.Government's payment decisions for purposes of section
37(b)(4) of title 31, United States Cade,
S. The Recipient certifies that it does not oWate any programs that violate any applicable Federal
anti -discrimination i.aws, including Title Vl of the Civil. Rights Act of 1WA;
The Recopl e n l shall not use any grant funds to fund or promote elective abortions, as required by
E.0,14182,.Entorcingthe I lyd e Amendment; and that,
NotwritthstandIn,g anything in the NQFO orApplication, this Grant shall not be governed by Executive
Orders revoked by E.O.14154, including E.O.14008, or NOFO requirements implementing
Executive Orders that have bran revoked.
F. the Recipient mustadminister its grant in accordance with all applicable immigration restriciions
and requirements. Including the eliigibllity and verification requirements that apply under titte iV of
the Rersoca(FtesponsibiLityand Work Opportunity Reconciliation Act of 1996, as amended (0_U,%C
16t1 — 646) (PFCWORA) .and any applicable requirements that HUD, the Attorney General. or the U.S.
Citizen ship and Immigration Services may establish from time totime toconnpllywith iaii'WoRA,
Fxecullve Order 14218, another Executive Girders or immigration lam.
7. No state or unit of general local government that receives funding under this grant may use that
funding in a manner that by design or effect facilitates the subsidization or promotion of illegal
Immigration or shields illegal aliens from deportation, including by malataining policies or practices
that materiallyimp.iede anforcement of federal immigration statutes and regulations,
8. The Recipient must use SAVE, or an equivarlentverflication system approved by the Federal
government, to prevent any Federal puNc benefit from being provided to an ineligible alien who
elite red the United States illegally or Is otherwise unlawfully present in the United States_
9. Faith -:based organizations maybe subreciplents for funds on the same basis as any other
organl:tatlon. Recipients may not, in the selection of subrecipients, discriminate against an
organization based on the organVailran's religious character, affiliation, or exercise.
Certification and Acknowledgement
This certification shall be deemed incorporated by reference into the main Contract. By signing
below, the Agency hereby certifies, acknowledges, and agrees that:
• Agency has read and understands all terms and conditions set forth in this EXHIBIT "K"
— Certificate of Compliance: Additional Program -Specific Policy Requirements;
• Agency shall comply with these requirements in both program practice and written policies
and procedures;
• Agency agrees to be in compliance with these requirements as a material condition of this
Contract and a prerequisite to the receipt and continued use of grant funds; and
• Agency understands that any violation of these terms may result in the suspension or
termination of funding, repayment of funds, or other remedies available under law or
regulation.
Authorized Certification
Name of Agency: Presbyterian Night Shelter
Name of Authorized Official: Toby Owen
Title: CEO
Signature: / u 'Outoe' Date: 04/21 /2026
Toby Owe pr 21, 2026 11:28:15 CDT)
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
1 0f 1
Complete Nos. 1- 4 and 6 if there are interested parties.
Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties.
OFFICE USE ONLY
CERTIFICATION OF FILING
Certificate Number:
2026-1409224
Date Filed:
01/15/2026
Date Acknowledged:
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
Presbyterian Night Shelter
Fort Worth , TX United States
2 Name of governmental entity or state agency that is a party to the contract for which the form is
being filed.
City of Fort Worth, Texas
g
Provide the identification number used by the governmental entity or state agency to track or identity the contract, and provide a
description of the services, goods, or other property to be provided under the contract.
CDBG-CV
COVID-19 response for essential homeless shelter services
4
Name of Interested P
Party
City, State, Count lace of business
tY, Country (P )
Nature of interest
(check applicable)
Controlling
I Intermediary
5
Check only if there is NO Interested Party.
X
6
UNSWORN DECLARATION
My name is Toby Owen _ and my date of birth is
My address is 2400 Cypress Street Ft. Worth TX 76102 USA
(city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
Executed in Tarrant County, State of Texas on the 15 day of January . 20 26 .
(month) (year)
tqjIlature of authorized agent of contracting business entity
(Declarant)
Forms provided by Texas Ethics Commission www ethics. state .tx.us Version V4 1.0.22701b2a
CSC No. 55416
Funding Approval/Agreement U.S. Department of Housing and Urban Development
Title I of the Housing and Community Office of Community Planning and Development
Development Act (Public Law 930383) Community Development Block Grant Program OMB Approval No. 2506-0193
HI-00515R of20515R exp 5/31/2018
1. Name of Grantee (as shown in item 5 of Standard Form 424) 3a. Grantee's 9-digit Tax ID Number 3b. Grantee's 9-digit DUNS Number
Fort Worth 756000528 073170458
2. Grantee's Complete Address (as shown in item 5 of Standard Form 424) 4. Dale use of funds may begin
1000 Throckmorton 10/01/2020
Fort Worth, TX 76102-0000 5a. Project/Grant No. 1 6a. Amount Approved
B-20-M W-48-0010 $9,828,497
5b. Project/Grant No. 2 6b. Amount Approved
Grant Agreement: This Grant Agreement between the Department of Housing and Urban Development (HUD) and the above named Grantee is made pursuant to the
authority of Title I of the Housing and Community Development Act of 1974, as amended, (42 USC 5301 et seq.). The Grantee's submissions for Title I assistance, the
HUD regulations at 24 CFR Part 570 (as now in effect and as may be amended from time to time), and this Funding Approval, including any special conditions, constitute
part of the Agreement. Subject to the provisions of this Grant Agreement, HUD will make the funding assistance specified here available to the Grantee upon execution
of the Agreement by the parties. The funding assistance specified in the Funding Approval may be used to pay costs incurred after the date specified in item 4 above
provided the activities to which such costs are related are carried out in compliance with all applicable requirements. Pre -agreement costs may not be paid with funding
assistance specified here unless they are authorized in HUD regulations orapproved by waiverand listed in the special conditions to the Funding Approval. The Grantee
agrees to assume all of the responsibilities for environmental review, decision making, and actions, as specified and required in regulations issued by the Secretary
pursuant to Section 104(g) of Title l and published in 24 CFR Part 58. The Grantee further acknowledges its responsibility for adherence to the Agreement by sub -
recipient entities to which it makes funding assistance hereunder available.
U.S. Department of Housing and Urban Development (By Name)
Grantee Name (Contractual Organization)
Shirley Henley
Fort Worth (City Of Fort Worth)
Title
CPD Director
Title
Assistant City Manager
Signature
Date (mmlddlyyyy)
Signature
Date (mm/dd/yyyy)
01 /21 /2021
XFernando Costa (Mar 16. 202112:21 CDT)
7. Category of Title I Assistance for this Funding Action:
8. Special Conditions
9a. Date HUD Received Submission
10. check one
(check one)
01/19/2021
❑ a. ON, Funding
Entitlement, Sec 106(b)
❑ None
El Attached
Approval
® b. Amendment
Amendment Number
9b. Date Grantee Notified
01/21/2021
9c. Date of Start of Program Year
(I OtO1/2020)
11. Amount of Community Development
Block Grant FY 2020
a. Funds Reserved for this Grantee
$9,828,497
b. Funds now being Approved
c. Reservation to be Cancelled
11a minus 11b
12a. Amount of Loan Guarantee Commitment now being Approved
12b. Name and complete Address of Public Agency
I
N/A
City Of Fort Worth
1000 Throckmorton
Loan Guarantee Acceptance Provisions for Designated Agencies:
The public agency hereby accepts the Grant Agreement executed by the
Fort Worth, TX 76102-0000
Department of Housing and Urban Development on the above date with
respect to the above grant number(s) as Grantee designated to receive loan
12c. Name of Authorized Official for Designated Public Agency
guarantee assistance, and agrees to comply with the terms and conditions
of the Agreement, applicable regulations, and other requirements of HUD
Title
now or hereafter in effect, pertaining to the assistance provided it.
Signature
X
HUD Accounting use Only
Batch TAC Program Y A Reg Area Document No. Project Number Category Amount
Effective Date
(mm/dd/yyyy)
CI 7
u
FFTFF1
i
Y
Pro'ectNumber
Amount
OFFICIAL RECORD
I
L,_LLF-1-1-
`OJ:ORr
�aoF FORT .aa
CITY SECRETARY
Date Entered PAS (mm/dd/yyyy) Date Entered LOCCS (mm/ddlyyyy) Batch Number Transa°%9�p Entered By
p_a o=�
FT. WORTH, TX
Approved as to form and legality:
l
Attest C1.
pV8 g 0
°o�� 00000 00
1
Mary J. Kayser,, City Secretary
��� nExAsoap R 570
form HUD-7082 (5/15)
Additional CDBG-CV Requirements
In addition to the terms and conditions in the Funding Approval/Agreement, the following
requirements apply to Grantees receiving CDBG-CV funds in accordance with the Coronavirus
Aid, Relief and Economic Security Act (CARES Act) (Pub. L. 116-136).
1) The Grantee agrees to comply with the requirements in the CARES Act that apply to
CDBG-CV grants and must use the CDBG-CV grant funds to prevent, prepare for and
respond to coronavirus.
2) The grantee agrees to comply with the requirements of the Housing and Community
Development Act of 1974 (42 USC 5301 et seq.) and implementing regulations at 24
CFR part 570, as now in effect and as may be amended from time to time, and as
modified by the rules, waivers and alternative requirements published by HUD from
time to time. Rules, waivers and alternative requirements of Federal Register notices
applicable to CDBG-CV grants are hereby incorporated into and made a part of the
grant agreement.
3) The Grantee may use CDBG-CV funds as reimbursement for previously incurred costs,
provided that those costs are allowable and consistent with the CARES Act's purpose to
prevent, prepare for and respond to coronavirus.
4) The grantee agrees to establish and maintain adequate procedures to prevent any
duplication of benefits as required by section 312 of the Robert T. Stafford Disaster
Relief and Emergency Assistance Act (42 U.S.C. 5155), as amended by section 1210 of
the Disaster Recovery Reform Act of 2018 (division D of Public Law 115-254; 132 Stat.
3442).
5) The period of performance for the funding assistance specified in the Funding
Approval/Agreement ("Funding Assistance") shall be six years. It shall begin on the date
specified in item 4 in the Funding Approval/Agreement and shall end six years later, on
the month and day specified in item 4. The Grantee shall not incur any obligations to be
paid with the Funding Assistance after this period of performance.
6) The Recipient shall attach a schedule of its indirect cost rate(s) in the format set forth
below to the executed Funding Approval/Agreement that is returned to HUD. The
Recipient shall provide HUD with a revised schedule when any change is made to the
rate(s) described in the schedule. The schedule and any revisions HUD receives from
the Recipient shall be incorporated herein and made a part of this Funding
Approval/Agreement, provided that the rate(s) described comply with 2 CFR part 200,
subpart E.
Administering
Direct
Department/Agency Indirect cost rate Cost Base
o�
o�
o�
o�
Instructions: The Recipient must identify each agency or department of the
Recipient that will carry out activities under the grant, the indirect cost rate
applicable to each department/agency (including if the de minimis rate is used
per 2 CFR §200.414(f)), and the type of direct cost base to which the rate will be
applied (for example, Modified Total Direct Costs (MTDC)). Do not include
indirect cost rates for subrecipients.
7) In addition to the conditions contained in the Funding Approval/Agreement (form HUD
7082), the grantee shall comply with requirements established by the Office of
Management and Budget (OMB) concerning the Dun and Bradstreet Data Universal
Numbering System (DUNS); the System for Award Management (SAM.gov.); the Federal
Funding Accountability and Transparency Act as provided in 2 CFR part 25, Universal
Identifier and General Contractor Registration; and 2 CFR part 170, Reporting Subaward
and Executive Compensation Information.
8) The grantee shall ensure that no CDBG-CV funds are used to support any Federal, State,
or local projects that seek to use the power of eminent domain, unless eminent domain
is employed only for a public use. For the purposes of this requirement, public use shall
not be construed to include economic development that primarily benefits private
entities. Any use of funds for mass transit, railroad, airport, seaport or highway
projects as well as utility projects which benefit or serve the general public (including
energy -related, communication -related, water- related and wastewater -related
infrastructure), other structures designated for use by the general public or which have
other common -carrier or public -utility functions that serve the general public and are
subject to regulation and oversight by the government, and projects for the removal of
an immediate threat to public health and safety or brownfield as defined in the Small
Business Liability Relief and Brownfields Revitalization Act (Public Law 107-118) shall be
considered a public use for purposes of eminent domain.
9) The Grantee or unit of general local government that directly or indirectly receives
CDBG-CV funds may not sell, trade, or otherwise transfer all or any such portion of such
funds to another such entity in exchange for any other funds, credits or non -Federal
considerations, but must use such funds for activities eligible under title I of the Act.
10) E.O. 12372-Special Contract Condition - Notwithstanding any other provision of this
agreement, no funds provided under this agreement may be obligated or expended for
the planning or construction of water or sewer facilities until receipt of written
notification from HUD of the release of funds on completion of the review procedures
required under Executive Order (E.O.) 12372, Intergovernmental Review of Federal
Programs, and HUD's implementing regulations at 24 CFR Part 52. The recipient shall
also complete the review procedures required under E.O. 12372 and 24 CFR Part 52 and
receive written notification from HUD of the release of funds before obligating or
expending any funds provided under this agreement for any new or revised activity for
the planning or construction of water or sewer facilities not previously reviewed under
E.O. 12372 and implementing regulations.
11) CDBG-CV funds may not be provided to a for -profit entity pursuant to section 105(a)(17)
of the Act unless such activity or project has been evaluated and selected in accordance
with Appendix A to 24 CFR 570 - "Guidelines and Objectives for Evaluating Project Costs
and Financial Requirements." (Source —This condition is included as requirement on
the use of fiscal year 2020 CDBG funds by the Community Development Fund heading,
Department of Housing and Urban Development Appropriations Act, 2020, Public Law
116-94, and is made applicable to this grant by the CARES Act).
Contract Compliance Manager:
By signing I acknowledge that I am the person responsible for the monitoring and administration
of this contract, including ensuring all performance and reporting requirements.
Barbara As (Mar 16, 202109:15 CDT)
Barbara Asbury, Compliance and Planning Manager
Neighborhood Services Department
❑ This form is N/A as No City Funds are associated with this Contract
Printed Name Signature
City of Fort Worth,
Mayor and
Texas
Council Communication
DATE: 02/24/26 M&C FILE NUMBER: M&C 26-0140
LOG NAME: 19CARES ACT HUD FUNDS SUBSTANTIAL AMENDMENT 3
SUBJECT
(ALL) Authorize a Change in Use of the Coronavirus Aid, Relief, and Economic Security (CARES) Act Community Development Block Grant
Funds in the Amount of $143,506.00 to Fund the Presbyterian Night Shelter of Tarrant County, Inc.'s Moving Home Program; Approve a
Substantial Amendment to the City of Fort Worth's 2019-2020 Annual Action Plan for the Use of Federal Grant Funds in the Amount of
$143,506.00 from the Coronavirus Aid, Relief, and Economic Security Act Community Development Block Grant Program; and Authorize
Execution of Related Contract
RECOMMENDATION:
It is recommended that City Council:
1. Authorize a change in use in the Coronavirus, Aid, Relief, and Economic Security Act Community Development Block Grant Funds in the
amount of $143,506.00;
2. Approve a substantial amendment to the City of Fort Worth's 2019-2020 Annual Action Plan for the change in use of federal grant funds in
the amount of $143,506.00 from the Coronavirus, Aid, Relief, and Economic Security Act Community Development Block Grant program;
and
3. Authorize the City Manager, or his designee, to execute a contract with The Presbyterian Night Shelter of Tarrant County, Inc in the amount of
$143,506.00.
DISCUSSION:
The purpose of this Mayor & Council Communication (M&C) is to request approval of a substantial amendment to the City of Fort Worth's 2019-
2020 Annual Action Plan and approval of an award of federal grant funds under said Action Plan.
On August 6, 2019, the City Council, through M&C 19-0016, approved the City's 2019-2020 Annual Action Plan summarizing the major housing
and community development activities and proposed expenditures for use of federal grant funds from the United States Department of Housing
and Urban Development (HUD) under various grant programs including the Community Development Block Grant (CDBG) program.
The Coronavirus, Aid, Relief, and Economic Security (CARES) Act was signed into law on March 27, 2020 to respond to the many impacts of the
COVID-19 public health emergency. The CARES Act includes provisions to help local governments prevent, prepare for and respond to the
coronavirus, including providing for additional allocations of formula grant funds under the CDBG program.
On April 9, 2020, the City was notified by HUD of its initial award of $4,360,291.00 in CDBG-CV funds. These funds were subsequently awarded
to eligible activities and programs through M&C 20-0330 and M&C 20-0471 in May and June of 2020. The City was notified on September 11,
2020 of the award of its second allocation of CDBG funds, known as CDBG-CV3, in the amount of $5,468,206.00. All funds must be used to
prevent, prepare for, and respond to the coronavirus by July 2026.
City Council subsequently awarded these funds to local nonprofit organizations providing a variety of services to eligible populations through
M&Cs 20-0330, 20-0471, 20-0940, 21-0016, and 25-0079. Some of the funding received was allocated to cover administration expenses. Since
the most recently approved allocation in January 2025, additional funds have become available as shown below.
TABLE
1: CDBG-CV/CV3
AVAILABLE
FUNDS
Action Plan
Year(s)
Program
Funding
Source
Amount(s) not to
Exceed
2019-2020
Unprogrammed
Funds
CDBG-CV
$41,748.03
2019-2020
Unprogrammt[���F
Funds
$101,757.97
Total: $143,506.00
Given the time constraints for the money to be spent, the Neighborhood Services Department (NSD) is proposing to allocate $143,506.00 in
CDBG-CV/CV3 funds to Presbyterian Night Shelter (PNS) for their Moving Home Program. PNS was one of the most recent recipients of CDBG-
CV/CV3 funds through a Request For Proposals completed and awarded through M&C 25-0079. The Moving Home program is designed to
provide homeless services to eligible clients who were and still are one of the most vulnerable populations due to the effects and aftermath of
COVID-19. These services include case management, emergency shelter, housing assistance, employment assistance, and community support.
The Moving Home Program supports the Homelessness Prevention and Special Needs Support goal identified in the City's 2019-2020 HUD
Action Plan.
The five-day public comment period began Monday, January 26, 2026, and ran through Friday, January 30, 2026. Notice of this public comment
period was published in the Fort Worth Star -Telegram, on Wednesday, January 21, 2026. Any comments received are maintained by the NSD in
accordance with federal regulations.
This program is available in ALL COUNCIL DISTRICTS.
FISCAL INFORMATION / CERTIFICATION:
The Director of Finance certifies that funds are available within the Grants Operating Federal Fund CDBG-CV PY19/FY20 project to support the
approval of the recommendations and execution of the contract. The Neighborhood Services Department (and Financial Management Services)
will be responsible for the collection and deposit of funds due to the City. Prior to an expenditure being incurred, the Neighborhood Services
Department has the responsibility to validate the availability of funds. This is a reimbursement grant.
Submitted for City Manager's Office b . Dana Burghdoff 8018
Originating Business Unit Head: Kacey Thomas 8187
Additional Information Contact: Juliet Moses 6203
FONT WORTH.
City Secretary's Office
Contract Routing & Transmittal Slip
Contractor's Name: The Presbyterian Night Shelter of Tarrant County, Inc.
Subject of the Agreement:
CDBG-CV Funded Emergency Shelter Operations and COVID-19 Response Activities
M&C Approved by the Council? * Yes 0 No ❑
If so, the M&C must be attached to the contract.
Is this an Amendment to an Existing contract? Yes ❑ No 0
If so, provide the original contract number and the amendment number.
Is the Contract "Permanent"? *Yes ❑ No 0
If unsure, see backpage for permanent contract listing.
Is this entire contract Confidential? *Yes ❑ No 0 If only specific information is
Confidential, please list what information is Confidential and the page it is located.
Effective Date: September 1, 2025
If different from the approval date.
Expiration Date: May 31, 2026
If applicable.
Is a 1295 Form required? * Yes 0 No ❑
*If so, please ensure it is attached to the approving M&C or attached to the contract.
Project Number: If applicable.
*Did you include a Text field on the contract to add the City Secretary Contract (CSC)
number? Yes 0 No ❑
Contracts need to be routed for CSO processing in the followingorder:
rder:
1. Katherine Cenicola (Approver)
2. Jannette S. Goodall (Signer)
3. Allison Tidwell (Form Filler)
*Indicates the information is required and if the information is not provided, the contract will be
returned to the department.