HomeMy WebLinkAboutContract 41938 CITY SECRETARY
CONTRACT NO.
AGREEMENT FOR SERVICES
THIS AGREEMENT
CITY
THIS
FORT WORTH ("Agreement,,) is made and entered into b
(hereinafter referred to as a home rule municipal co Y and between THE
Assistant Ci City'), actin b p rporation of the State of Texas
City Manager, and g Y and through Susan Alanis its duly authorized
duly authorized Executive Direcdto�as "Contractor"), actin b
a nonprofit Texas
. g y and through Dr. Lee LeGrice, its
RECITALS
WHEREAS, Contractor provides mental health services; and
WHEREAS, such services serve a public which benefits the Fort Worth purpose in serving
communit
Y; and g low to moderate income individuals
WHEREAS, City and Contractor desire to enter into a
which benefit the Fort Worth community.
contract to have such services provided
NOW, TgEREFORE� in consideration of the mutual
agree as follows: covenants herein expressed, the
Parties
AGREEMENT
1• SCOPE OF SERVICES.
Contractor covenants
good faith and due diligence, all and services to idly s perform,
incorporated herein for all or cause to be performed
Purposes incident to this Agreement abed in Exhibit ' with
"A," attached and
2. COMPENSATION, ("Services").
In consideration of the Services to be perfo
reimburse Contractor via month] rmed hereunder b
Two Hundred Th' y installments up to a total Y Contractor, City agrees to
Provided in Section 3 shall remain with the City. not to exceed Five
(City. .00) ('Funds"). An Thousand
qty• Y funds not requested as
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
L•i.i
3• REPORTING OF EXPENDITURES.
a. Contractor shall deliver to City a monthly statement of the request for reimbursement
("Request for Reimbursement") of Funds detailing how the Funds were expended by
Contractor to accomplish performance of the Services. All expenditures included in the Request
for Reimbursement must be eligible for reimbursement by federal funds as determined by City in
its sole discretion. The monthly statement shall be in the same format as the attached Exhibit
"B"which is incorporated herein for all purposes.
b. Each month's Request for Reimbursement is due to City by 5:00 p.m. on the 10th day
of the following month (for example, all expenses for June must be submitted to City by July
10th). City will not accept late Requests for Reimbursement. If a timely Request for
Reimbursement is not received for any month, Contractor will not receive reimbursement for that
month. Notwithstanding the above, the Request for Reimbursement for the month of September
shall be due by September 23, 2011. The failure to make such request by September 23, 2011
shall result in no funds being paid for the month of September.
C. Each Request for Reimbursement must be prepared and signed by an authorized
representative of the Contractor.
d. If the Contractor deviates from the reporting requirements in Sections 3(a), 3(c) or
Section 4, the Contractor will be considered in non-compliance with this Agreement. City will
notify Contractor of such non-compliance, and Contractor will have ten (10) business days to
cure such non compliance (the "Cure Period"). If the noncompliance is not cured by the
expiration of the Cure Period to City's satisfaction, Contractor will be in default of this
Agreement and will not receive reimbursement.
e. Any non-compliance by Contractor under Section 3 of this Agreement may jeopardize
the Contractor's ability to receive future funding from the City.
4• REPORTING OF SERVICES.
A report of services shall accompany each Request for Reimbursement. The report of
services shall be in substantial conformity with the attached Exhibit "C" and Exhibit 11C-1"
and Exhibit "C-2", if applicable. Contractor shall be subject to a review by the City of its
services and activities in performance of this Agreement.
5. TERM AND TERMINATION.
a• This Agreement shall be for a term beginning June 1, 2011 and ending September
30, 2011.
b• Either party may cancel this Agreement upon thirty (30) days notice in writing to
the other party of such intent to terminate.
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` C. The City may terminate this Agreement immediately for any violation by
Contractor of Section 3, "Request for Reimbursement" or Section 4, "Reporting of Services,"
above.
d. In the event no funds or insufficient funds are appropriated by the City in any fiscal
period for any payments hereunder, City will notify the Contractor 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 shall have been appropriated.
6. RIGHT TO MONITOR SERVICES.
Contractor covenants and agrees to fully cooperate with City in monitoring the
effectiveness of the Services to be performed under this Agreement, and City shall have access at
all reasonable hours to offices and records of Contractor for the purpose of such monitoring
during the term of this agreement.
7. INDEPENDENT CONTRACTOR.
Contractor shall operate hereunder as an independent contractor and not as an officer,
agent, servant, or employee of City. Contractor shall have exclusive control of and the exclusive
right to control the details of the Services performed hereunder, and all persons performing same,
and shall be solely responsible for the acts and omissions of its officers, agents, servants,
employees, subcontractors and program participants. The doctrine of respondeat superior shall
not apply as between the City and Contractor, its officers, agents, servants, employees,
subcontractors, or program participants, and nothing herein shall be construed as creating a
partnership or joint enterprise between City and Contractor. It is expressly understood and
agreed that no officer, agent, employee, or subcontractor of Contractor is in the paid service of
City.
8. LIABILITY AND INDEMNIFICATION.
CITY SHALL IN NO WAY OR UNDER ANY CIRCUMSTANCES BE
RESPONSIBLE FOR ANY PROPERTY BELONGING TO CONTRACTOR, ITS
OFFICERS, AGENTS, EMPLOYEES, SUBCONTRACTORS, PROGRAM
PARTICIPANTS, OR RECIPIENTS, WHICH MAY BE LOST, STOLEN, DESTROYED,
OR IN ANY WAY DAMAGED. CONTRACTOR HEREBY AGREES TO INDEMNIFY
AND HOLD HARMLESS THE CITY, ITS OFFICERS, AGENTS, AND EMPLOYEES
FROM AND AGAINST ANY AND ALL CLAIMS OR SUITS CONCERNING SUCH
PROPERTY. CONTRACTOR COVENANTS AND AGREES TO INDEMNIFY, HOLD
HARMLESS AND DEFEND, AT ITS OWN EXPENSE, CITY AND ITS OFFICERS,
AGENTS, SERVANTS, AND EMPLOYEES FROM AND AGAINST ANY AND ALL
CLAIMS OR SUITS FOR PROPERTY LOSS OR DAMAGE AND/OR PERSONAL
INJURY, INCLUDING DEATH, TO ANY AND ALL PERSONS, OF WHATSOEVER
HIND OR CHARACTER, WHETHER REAL OR ASSERTED,ARISING OUT OF OR IN
CONNECTION WITH THE EXECUTION, PERFORMANCE, ATTEMPTED
PERFORMANCE OR NONPERFORMANCE OF THIS AGREEMENT AND/OR THE
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OPERATIONS, ACTIVITIES AND SERVICES 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 CONTRACTOR 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 NON-
PERFORMANCE OF THIS AGREEMENT AND/OR THE OPERATIONS,ACTIVITIES
AND SERVICES DESCRIBED HEREIN, WHETHER OR NOT CAUSED IN WHOLE
OR IN PART, BY ALLEGED NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS,
EMPLOYEES, CONTRACTORS OR SUBCONTRACTORS OF CITY. CONTRACTOR
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 CONTRACTOR, ITS
OFFICERS, MEMBERS, AGENTS, EMPLOYEES, SUBCONTRACTORS, INVITEES,
LICENSEES, PROGRAM PARTICIPANTS, OR RECEIPIENTS, WHETHER OR NOT
CAUSED, IN WHOLE OR IN PART, BY ALLEGED NEGLIGENCE OF OFFICERS,
AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS OR SUBCONTRACTORS OF
CITY. CONTRACTOR 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 AGREEMENT, EVEN IF THE INJURY, DEATH, DAMAGE OR LOSS IS
CAUSED BY CITY'S SOLE OR CONCURRENT NEGLIGENCE.
Contractor shall require all of its subcontractors and Recipients to include in their
subcontracts a release and indemnity in favor of City in substantially the same form as
above.
9• MISAPPRORIATION OF FUNDS.
IN THE EVENT IT IS DETERMINED THAT CONTRACTOR HAS MISUSED,
MISAPPLIED OR MISAPPROPRIATED ALL OR ANY PART OF THE FUNDS
PROVIDED HEREUNDER, CONTRACTOR AGREES TO INDEMNIFY, HOLD
HARMLESS AND DEFEND THE CITY OF FORT WORTH, ITS OFFICERS, AGENTS,
SERVANTS, AND EMPLOYEES, FROM AND AGAINST ANY AND ALL CLAIMS OR
SUITS RESULTING FROM SUCH MISUSE, MISAPPLICATION
MISAPPROPRIATION. OR
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10. CHARITABLE IMMUNITY.
If Contractor, as a charitable or nonprofit organization, has or claims an immunity or
exemption (statutory or otherwise) from and against liability for damage or injury, including
death, to persons or property, Contractor hereby expressly waives its rights to plead defensively
such immunity or exemption as against the City.
11. ASSIGNMENT AND SUBCONTRACTING.
Contractor shall not assign or subcontract all or any part of its rights, privileges or duties
under this Agreement without the prior written consent of City, and any attempted assignment or
subcontract of same without such prior written approval shall be void and constitute a breach of
this agreement.
12. COMPLIANCE WITH LAWS, ORDINANCES, RULES AND REGULATIONS.
Contractor, its officers, agents, employees and subcontractors, shall abide by and comply
with all laws, federal, state and local, including all ordinances,rules and regulations of City. It is
agreed and understood that, if City calls to the attention of Contractor any such violation on the
part of Contractor or any of its officers, agents, employees or subcontractors, then Contractor
shall immediately desist from and correct such violation.
13. NON-DISCRIMATION COVENANT.
Contractor, in the execution, performance or attempted performance of this contract and
Agreement, will not discriminate against any person or persons because of disability, age,
familial status, sex, race, religion, color, national origin, gender identity, gender expression or
transgender nor will Contractor permit its officers, agents, employees, or subcontractors to
engage in such discrimination. This Agreement is made and entered into with reference
specifically to Chapter 17, Article III, Division 3, of the City Code of the City of Fort Worth
("Discrimination in Employment Practices"), and Contractor hereby covenants and agrees that
Contractor, its agents, employees and subcontractors have fully complied with all provisions of
same and that no employee or employee-applicant has been discriminated against by either
Contractor, its agents, employees or subcontractors.
14. INSURANCE.
Contractor shall procure and shall maintain during the term of this Agreement the
following insurance coverage:
1. Commercial General Liability (CGL): $1,000,000 per occurrence, with a
$2,000,000.00 annual aggregate limit, in a form that is acceptable to the
City's Risk Manager.
2. Non-Profit Organization Liability or Directors & Officers Liability_:
$1,000,000 per occurrence, with a $1,000,000 annual aggregate limit, in a
form that is acceptable to the City's Risk Manager.
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Contractor's insurer(s) must be authorized to do business in the State of Texas for the lines of
insurance coverage provided and be currently rated in terms of financial strength and solvency to
the satisfaction of the City's Risk Manager.
Each insurance policy required herein shall be endorsed with a waiver of subrogation in favor of
the City. Each insurance policy required by this Agreement, except for policies of worker's
compensation or accident/medical insurance shall list the City as an additional insured. City
shall have the right to revise insurance coverage requirements under this Agreement.
Contractor further agrees that it shall comply with the Worker's Compensation Act of Texas and
shall provide sufficient compensation insurance to protect Contractor and City from and against
any and all Worker's Compensation claims arising from the work and services provided under
this Agreement.
15. RIGHT TO AUDIT RECORDS.
Contractor agrees that the City shall, until the expiration of three (3) years after final
payment under this Agreement, have access to and the right to examine, whether in hard copy or
electronic format, any directly pertinent books, documents, papers and records of the Contractor
involving transactions relating to this Agreement. Contractor agrees that the City shall have
access during normal working hours to all necessary Contractor facilities and shall be provided
adequate and appropriate workspace in order to conduct audits in compliance with the provisions
of this section. The City shall give Contractor reasonable advance notice of intended audits.
Contractor further agrees to include in all of its subcontractor and Recipient agreements
hereunder a provision to the effect that the subcontractor and/or the Recipient agrees that the
City shall, until the expiration of three (3) years after final payment under the subcontract or this
Agreement, have access to and the right to examine, whether in hard copy or electronic format,
any directly pertinent books, documents, papers and records of such subcontractor involving
transactions to the subcontract or this Agreement, and further that City shall have access during
normal working hours to all subcontractor or Recipient facilities and shall be provided adequate
and appropriate workspace in order to conduct audits in compliance with the provisions of this
paragraph. City shall give subcontractor or Recipient reasonable advance notice of intended
audits. This Section 16 shall survive the expiration of the term of this Agreement.
16. GOVERNING LAW AND VENUE.
This Agreement shall be governed by and construed under the laws of the state of Texas.
Should any action, whether real or asserted, at law or in equity, arise out of the execution,
performance, attempted performance of this Agreement, venue for said action shall lie in Tarrant
County, Texas.
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17. NOTICES.
Notices to be provided hereunder shall be sufficient if forwarded to the other party by
hand-delivery or via U.S. Postal Service certified mail, postage prepaid, to the address of the
other party shown below:
Jesus "Jay" Chapa Dr. Lee LeGrice
Director of Economic Development Executive Director
City of Fort Worth Mental Health Association
1000 Throckmorton St. 3136 W. 4th Street
Fort Worth, Texas 76102 Fort Worth, TX 76107
18. NO WAIVER.
The failure of City or Contractor to insist upon the performance of any term or provision
of this Agreement or to exercise any right herein conferred shall not be construed as a waiver or
relinquishment to any extent of City's or Contractor's right to assert or rely upon any such term
or right on any future occasion.
19. DISCLOSURE OF CONFLICTS AND CONFIDENTIAL INFORMATION.
Contractor hereby warrants to the City that Contractor has made full disclosure in
writing of any existing or potential conflicts of interest related to Contractor's services under
this Agreement. In the event that any conflicts of interest arise after the Effective Date of this
Agreement, Contractor hereby agrees immediately to make full disclosure to the City in
writing. Contractor, for itself and its officers, agents and employees, further agrees that it shall
treat all information provided to it by the City as confidential and shall not disclose any such
information to a third parry without the prior written approval of the City. Contractor shall store
and maintain City Information in a secure manner and shall not allow unauthorized users to
access, modify, delete or otherwise corrupt City Information in any way. Contractor shall notify
the City immediately if the security or integrity of any City information has been compromised
or is believed to have been compromised.
20. SEVERABILITY.
If any provision of this Agreement is held to be invalid, illegal or unenforceable, the
validity, legality and enforceability of the remaining provisions shall not in any way be affected
or impaired.
21. FORCE MAJEURE.
The City and Contractor shall exercise their best efforts to meet their respective duties
and obligations as set forth in this Agreement, but shall not be held liable for any delay or
omission in performance due to force majeure or other causes beyond their reasonable control
(force majeure), including, but not limited to, compliance with any government law, ordinance
or regulation, acts of God, acts of the public enemy, fires, strikes, lockouts, natural disasters,
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wars, riots, material or labor restrictions by any governmental authority, transportation problems
and/or any other similar causes.
22. HEADINGS NOT CONTROLLING.
Headings and titles used in this Agreement are for reference purposes only and shall not
be deemed a part of this Agreement.
23. ENTIRETY OF AGREEMENT.
This written instrument constitutes the entire agreement by the parties hereto concerning
the work and services to be performed hereunder, and any prior or contemporaneous, oral or
written agreement, which purports to vary from the terms hereof shall be void.
[SIGNATURES APPEAR ON FOLLOWING PAGE.]
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IN WITNESS WHEREOF, the parties hereto have executed this agreement in multiples in Fort
Worth, Tarrant County, Texas, to be effective June 1, 2011.
ATTE CITY OF FORT WORTH
-� By:Tom I
Viarty endrix a 0000000'0 �� S san Tanis
ty Secretary ��' ° 0) d� As ' ant City Manager
pro OAO
Date: o� 0 0.r°o o Date:
0 0 o0 dd
a 0°000 �a
00000
APPROVED AS TO FORMS CONTRACT
AUTHORIZATION:
'fit ( M&C: C-24905
Leann D. Guzman
Assistant City Attorney Date Approved: 05/17/2011
Date: ;����}-�(�
Mental Health Association:
ATTEST
Name: Name: Dr.Lee LeGrice
Title:
Title:Executive Director
Date:
OFFICIAL RECORD
CITY SECRETARY
FT.WORTH, TX
9
STATE OF TEXAS §
COUNTY OF TARRANT §
BEFORE ME, the undersigned authority, a Notary Public in and for the State of Texas,
on this day personally appeared Dr. Lee LeGrice, known to me to be the person whose name is
subscribed to the foregoing instrument and acknowledged to me that the same was the act of the
Mental Health Association and that she executed the same as the act of said Mental Health
Association for the purpose and consideration therein expressed and in the capacity therein
stated.
GIVEN UNDER MY HAND AND SEAL OF OFFICE this day o L--XC_-,-
2011.
SFpy pue' PEGGY S.HOELSCHER .
x Notary PW'c Nota in and for the State of Texas
* STATE OF TEXAS
0 o My C4W.Exp.03-12.2013
STATE OF TEXAS §
COUNTY OF TARRANT §
BEFORE ME, the undersigned authority, a Notary Public in and for the State of Texas,
on this day personally appeared Susan Alanis, known to me to be the person whose name is
subscribed to the foregoing instrument and acknowledged to me that the same was the act of the
City of Fort Worth for the purpose and consideration therein expressed and in the capacity
therein stated.
GIVEN UNDER MY HAND AND SEAL OF OFFICE this dayofsjunt,
2011.
N tart'Public in and for the St e of Texas
Y"r t LINDA M.HIRRLINGER
__*• '' MY COMMISSION EXPIRES
rr Fftary 2,2014
,Z
OFFICIAL RECORD
CITY SECRETARY
FT.WORTH,TX
10
EXHIBIT A
SERVICES
11
Mental Health Association of Tarrant County EXHIBIT A
Long Term Care Ombudsman SCOPE OF SERVICES
PROGRAM SUMMARY
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)
June 1, 2011 — September 30, 2011
PERIOD
SCOPE OF SERVICES
This Scope of Services is based on the proposal prepared and submitted by the Subrecipient through the City of Fort
Worth's annual Request for Proposal(RFP)process. The Subrecipient agrees to operate this Community Development
Block Grant(CDBG)program in a manner consistent with the program delivery stated in the approved proposal.
However, in the event of any conflict between the proposal and any provision contained,herein,this Agreement shall
control.
The Mental Health Association of Tarrant County will provide long term care ombudsman services to seven or more
inner city nursing homes located within the City of Fort Worth. The Long Term Care Ombudsman program will include
the following tasks and activities; 7 weekly monitoring visits to nursing facilities,conduct resident interviews, investigate
and resolve complaints, and provide in-service educational programs for nursing home staff. All services will be
provided at the identified nursing homes primarily during business hours Monday through Friday. From time to time,
services may be provided on the weekends or in the evenings, as needed by the facilities and their residents.
The purpose of the program will be to prevent abuse and neglect of residents of inner city nursing homes. The specific
objectives, goals and level of services to be provided are listed below along with the geographical location of clients
served. All services will be provided from June 1,2011 to September 30, 2011.
The funds will be used to pay for salary of the ombudsman staff which is consistent with Exhibit C-Detailed Budget.
REGULATORY CLASSIFICATION:
National Objective Citation: 24 CFR 570.208(a)(2)(A) Presumed Benefit
Regulatory Citation: 24 CFR 570.201(e)Public Service
Based on the nature of the service provided,Mental Health Association of Tarrant County will maintain documentation
that verifies that clients served by the Long Term Care Ombudsman program are elderly and/or severely disabled as
defined by the Department of Housing and Urban Development(HUD).
GEOGRAPHICAL LOCATION:
Site Address: 7 or more inner city nursing homes located within Fort Worth city limits.
Client Beneficiary Location (Neighborhood, District, Citywide...): Citywide
PROGRAM GOALS.
Prevent abuse and neglect of residents in long-term care facilities.
PROGRAM OBJECTIVES:
Resolve 95%of substantiated complaints
PROGRAM SERVICES and ACTIVITIES
Level of service should be identified in a quantifiable unit and directly related to specified objectives.
Number of Unduplicated Clients Served
Conduct weekly monitoring visits to 7 nursing homes
Conduct resident interviews
Investigate/resolve complaints
Provide in-service educational programs for facility staff
EXHIBIT B
FORM OF REQUEST FOR REIMBURSEMENT
[ATTACHED]
12
CITY OF FORT WORTH
HOUSING AND ECONOMIC DEVELOPMENT DEPARTMENT
COMPLIANCE DIVISION
REQUEST FOR FUNDS
AGENCY: PROGRAM:
ADDRESS: CONTRACT NUMBER:
CONTRACT AMOUNT:
CONTRACT DATE:
DATE OF REQUEST:
IDIS NUMBER:
SECTION I(AGENCY) CURRENT MONTH CUMULATIVE
1. Reimbursement Request
A. Expenditures: $ $
B. Reimbursement $ $
2.Requested By:
A. Agency
(Name) (Signature) (Date)
SECTION II(CITY)
1. BUYSPEED-Purchasing Request
A.BUYSPEED INPUT:Vendor/PO Number/Requisition Number:
B. Fund/Account/Center:
C.Total Amount of this Request: $
SECTION III(CITY)
1. Verification
A. Contract Compliance Specialist Mark Folden
(Name) (Signature) (Date)
B. Accounting Benedict George
(Name) (Signature) (Date)
2.Authorization
A. Grants Manager Robin Bentley
(Name) (Signature) (Date)
B.Sr.Admin.Services Mgr Socorro Gray
(Name) (Signature) (Date)
C. Director Jesus Chapa
(Name) (Signature) (Date)
Note:Any Request for Funds that exceeds$25,000 requires the Director's signature
CITY OF FORT WORTH
HOUSING AND ECONOMIC DEVELOPMENT DEPARTMENT
DETAIL STATEMENT OF COSTS
AGENCY CONTRACT NO. DATE
TO
PROGRAM REPORT PERIOD
PROGRAM MONTHLY CUMULATIVE
COST CATEGORY BUDGET EXPENDITURES TO DATE BALANCE
ADMINISTRATIVE COSTS
Salaries
FICA
Life Insurance
Health Insurance
Unemployment Tax
Worker's Comp
Legal and Accounting
Office Supplies
PROGRAMMATIC COSTS
Salaries 4,861.00
FICA 372.00
Life Insurance
Health Insurance
Unemployment—Federal
Unemployment—State
Workers Compensation
Medical Supplies
Security
Utilities(Telephone,Electric,Gas,
Water,Wastewater,Waste Disposal)
Rent
Office Equipment Rental
Printing
Accounting
Postage
Building Maintenance and Repair
Office Supplies
Food
Other Operating Supplies
Liability Insurance
Private Auto Allowance
Childcare Scholarships
Meals
Teaching Aids
Contractual Services
Contract Labor
Conferences and Seminars
Short Term Rent,Mortgage and Utility
Assistance STRMU
Tenant Based Rental Assistance
TBRA)
TOTAL $0.00 $0.00 $0.00 $0.00
Contractor's Certification: I certify that the costs incurred are taken from the books of account and that such costs are valid and
consistent with the terms of the agreement.
NAME and TITLE OF AUTHORIZED OFFICER SIGNATURE and DATE
CITY OF FORT WORTH
HOUSING&ECONOMIC DEVELOPMENT DEPARTMENT
EXPENDITURES WORKSHEET
Agency Contract Number Date
To
Program Report Period
NO DATE CHECK NO PAYEE DESCRIPTION ACCOUNT NO. AMOUNT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
TOTAL $0.00
TITLE OF AUTHORIZED OFFICER SIGNATURE AND DATE
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EXHIBIT C
FORM OF SERVICES REPORT
16
CITY OF FORT WORTH
HOUSING&ECONOMIC DEVELOPMENT DEPARTMENT
I. Name and Address of Sub-Grantee 2. Program Name
Month&Year
5. Program Services and Activities
Current Month Cumulative
Number of New
Households and/or
Persons Served
S.Direct Benefit
(Continued)
Extremely Low Very Low Income Low Income Above Low Income
Income 0<30% 31-50% 51-80% 80%>
Current Month
Cumulative
Household Size 1 2 3 4 5 6 7 8
0.30% $13,850 $15,850 $17,800 $19,800 $21,400 $22,950 $24,550 $26,150
31-50% $23,100 $26,400 $29,700 $33,000 $35,650 $38,300 $40,900 $43,550
51-80% $36,950 $42,250 $47,500 $52,800 1 $57,000 1 $61,250 $65,450 $69,700
Certification: The undersigned,hereby,gives assurance that to the best of my knowledge and belief,the data included in this report is true and accurate. It
is also acknowledged that the provision of false information could leave the certifying official subject to the penalties of federal,state,and local law.
Date: Submitted by: Phone No.
Signature Required
17
CITY OF FORT WORTH
HOUSING&ECONOMIC DEVELOPMENT DEPARTMENT
1. Name and Address of Sub-Grantee
2. Program Name
Month&Year
8. Direct Benefit Data(New Household and/or Persons Served)
Mtest #' t} fc �" :fib 5£
Race:Section Must be Com leted '
r
Current Cr
Month Cumulative `:gin + � frpt
White
Blac k/Africa nAmerican
Asian
American Indian/Alaskan Native
Native Hawaiian/Other Pacific Islander
Indian/Alaskan Native&White
Asian&White
Black/African AmericanBWhite
American Indlan/Alaskan Native&Black
African American
Other Multi-Racial
TOTAL 0 0 0 0 0 0
Female
Head of
Household
Current Month
Cumulative
Certification: The undersigned,hereby,gives assurance that to the best of my knowledge and belief,the data included in this
report is true and accurate. It is also acknowledged that the provision of false information could leave the certifying official
subject to the penalties of federal,state,and local law.
Date: Submitted by:
Signature Required
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CITY OF FORT WORTH
HOUSING&ECONOMIC DEVELOPMENT DEPARTMENT
1. Name and Address of Sub-Grantee 2. Program Name
5. PROGRAM SERVICES AND ACTIVITIES: CURRENT
CUMULATIVE
Unduplicated Clients
6. SCOPE OF WORK NARRATIVE:
7. PROBLEMS ENCOUNTERED / SOLUTIONS
PROPOSED:
8. ANTICIPATED ACTIVITY DURING THE NEXT
MONTH:
Certification: The undersigned,hereby,gives assurance that to the best of my knowledge and belief,the data included in this report is true and
accurate. It is also acknowledged that the provision of false information could leave the certifying official subject to the penalties of federal,
state,and local law.
Date: Submitted B
Phone No.
Signature
Required
19
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EXHIBIT C-1
ADDITIONAL FORM OF SERVICES REPORT-ESG AGENCIES
CITY OF FORT WORTH
HOUSING&ECONOMIC DEVELOPMENT DEPARTMENT
1. Name and Address of Sub-Grantee 2. Program Name
3. Contract Number
4. Date of Request
Date and Year
Beneficiary by Housing Type:EMERGENCY OR TRANSITIONAL SHELTERS
Current Month Cumulative
Chronically Homeless(Emergency Shelter only)
Severely Mentally III
Chronic Substance Abuse
Other Disability
Veterans
Persons with HIV/AIDS
Victims of Domestic Violence
Elder)
TOTAL 0 0
Beneficiary by Housing Type:Number served in Emergency or Transitional Shelters
SHELTER TYPE Current Month Cumulative
Barracks
Group/Large House
Scattered Site A artment
Single Family Detached House
Single Room Occupancy
Mobile Home[Trailer
Hotel/Motel
Other
TOTAL 0 0
ESG Funding Sources: Funding Amount Current Month Cumulative Total
ESG
Other Federal
Local Government
Private
Fees
Other
Total
Certification: The undersigned,hereby,gives assurance that to the best of my knowledge and belief,the data included in this report is true and accurate. It is
also acknowledged that the provision of false information could leave the certifying offici
Date: Submitted by: Phone No.
Signature Required
22
CITY OF FORT WORTH
HOUSING&ECONOMIC DEVELOPMENT DEPARTMENT
I. Name and Address of Sub-Grantee 2. Program Name
3. Contract Number
4. Date of Request
Date and Year
EMERGENCY OR TRANSITIONAL SHELTERS
NUMBER OF INDIVIDUAL HIOUSEHOLDS SINGLES: Current Month Cumulative
Unaccompanied 18 and over Male Female
Unaccom anied under 18 Male Female
NUMBER OF FAMILY HOUSEHOLDS WITH CHILDREN HEADED BY: Current Month Cumulative
Sin le 18 and over Male Female
Single under 18 Male Female
NUMBER OF FAMILY HOUSEHOLDS WITH NO CHILDREN:
TOTAL
Certification: The undersigned,hereby,gives assurance that to the best of my knowledge and belief,the data included in this report is true
and accurate. It is also acknowledged that the provision of false information could leave the certifying offici
Date: Submitted by: Phone No. _
Si nature Re wired
23
EXHIBIT C-2
ADDITIONAL FORM OF SERVICES REPORT-HOPWA AGENCIES
24
CITY OF FORT WORTH
HOUSING&ECONOMIC DEVELOPMENT DEPARTMENT
1. Name and Address of Sub-Grantee 2. Program Name
3. Contract Number
4. Date of Request
Date and Year
5. Program Services and Activities(Report Clients Not Pa ments
HOPWA
CURRENT Assisted Amount of
MONTH With Other Other
ONLY Cumulative Funds Funds
a.#of Tenant-Based Rental Assistance TBRA
b.#of Short-Term Rental,Mort a e and Utility Assistance STRMU
c.#of STRMU clients that have moved to TBRA
d.Total#of Unduplicated Clients a+b-c
Number of Households
HOPWA #
CURRENT ASSISTED AMOUNT
MONTH AMOUNT OF W/OTHER OF OTHER
ONLY CUMULATIVE HOPWA FUNDS FUNDS FUNDS
6.Su ortive Services
7. Resource Identification/Technical Assistance
8. Housing Information Services
9. Permanent Housing Placement Services
10. Monthly Income Groups of Households for all Unduplicated
Clients
$251-
$0-250 500 $501-1000 $1001-1500 $1501-2000 Over$2000 TOTAL
7Mornth
0
s'= T
$251-
Current $0-250 500 $501-1000 $1001-1500 $1501-2000 Over$2000 TOTAL
Month
Cumulative
tv
0
0
$251-
Current $0-250 500 $501-1000 $1001-1500 $1501-2000 ;0ver000 TOTAL
Month
Cumulative
0
0
Certification: The undersigned,hereby,gives assurance that to the best of my knowledge and belief,the data included in this report is true and
accurate. It is also acknowledged that the provision of false information could leave the certifying official subject to the penalties of federal,state,
and local law.
DATE: Submitted by: Phone Number:
Signature Required
25
CITY OF FORT WORTH
HOUSING&ECONOMIC DEVELOPMENT DEPARTMENT
1. Name and Address Of Sub-Grantee
2. Program Name
3. Contract Number
4. Date of Request
Date and Year
Tenant Based Rental Assistance-TBRA
Race:Section Must be Comoletedl
�i'G? B 9ss7
Current Month Cumulative ss �
White Cu
Black/African American
Asian '�'� $`
American Indian/Alaskan Native
Native Hawaiian/Other Pacific
Islander
Indian/Alaskan Native&White
Asian&White
Black/African American&White
American Indlan/Alaskan Native&
Black African American
Other Multi-Racial
TOTAL
0 p
0 0 0
0
Current
Month
Undu Itcated Beneflcla Data Unduplicated Female TBRA
Number of persons(Adults and Total A e Male TBRA
Participants Particl ants
Children with HIV/AIDS who
received Housln Assistance 17 and
Number of Other Persons In Family Under
unit who received Housing
Assistance 18 to 30
Years
Households Previousl Homeless 31 to b0
Of Previously Homeless Years
Households,number of those who
were Chronically Homeless 51 Years
and Older
Total
This data relates to participants Female Head
of Household
Current Month
Cumulative
Certification: The undersigned,hereby,gives assurance that to the best of my knowledge and belief,the data included in this report is true and accurate. It is
also acknowledged that the provision of false information could leave the certifying official subject to the penalties of federal,state,and local law.
Date: by:
Phone No.
Signature Required
26
CITY OF FORT WORTH
HOUSING&ECONOMIC DEVELOPMENT DEPARTMENT
1. Name and Address of Sub-Grantee 2. Program Name
3. Contract Number
4. Date of Request
Date and Year
Short Term Rent,Mortgage,and Utility Assistance STRMU
Race:Section Must be Comoletedl
4.
Current Month Cumulative
White
Black/African American
Asian
American Indian/Alaskan Native
Native Hawaiian/Other Pacific
Islander
Indian/Alaskan Native&White
Asian&White
Black/African American&White
American Indlan/Alaskan Native&
Black African American
Other Multi-Racial
TOTAL 0 0
0 p 0 0
Current
Month
Unduplicated Beneficiary Data Total Unduplicated Female TBRA Male TBRA
101der
articl ants Particl ants Number of persons(Adults and Child ren with HIV/AIDS who received Housin Assistance Number of Other Persons In Family unit who received Housing Assistance Households Previous) Homeless Of Previously Homeless Households,number of those who were Chronical Homeless
Female Head
This data relates to participants of Household
Current Month
Cumulative
Certification: The undersigned,hereby,gives assurance that to the best of my knowledge and belief,the data included in this report is true and accurate. It is
also acknowledged that the provision of false information could leave the certifying official subject to the penalties of federal,state,and local law.
Date: Submitted by: Phone No.
Signature Required
27
CITY OF FORT WORTH
HOUSING&ECONOMIC DEVELOPMENT DEPARTMENT
1. Name and Address of Sub-Grantee 2. Program Name
3. Contract Number
4. Date of Request
Date and Year
Supportive Services
ref ' ♦ ec x% 't ay
Race:Section Must be Completed)
Current Month Cumulative
White
Black/African American
Asian
American Indian/Alaskan Native
Native Hawaiian/Other Pacific
Islander
Indian/Alaskan Native&White
Asian&White
Black/African American&White
American Indian/Alaskan Native&
Black African American
Other Multi-Racial
TOTAL 0 0 0 0 0 0
Current
Month
Unduplicated Female TBRA Male TBRA
Unduplicated Beneficiary Data Total Age Participants Participants
Number of persons(Adults and
Children with HIV/AIDS who 17 and
received Housing Assistance Under
Number of Other Persons in Family
unit who received Housing 18 to 30
Assistance Years
31 to 50
Households Previously Homeless Years
Of Previously Homeless
Households,number of those who 51 Years
were Chronically Homeless and Older
Total
Female Head
This data relates to participants of Household
Current Month
Cumulative
Certification: The undersigned,hereby,gives assurance that to the best of my knowledge and belief,the data included in this report is true and accurate. It is
also acknowledged that the provision of false information could leave the certifying official subject to the penalties of federal,state,and local law.
Date: Submitted by: Phone No.
Signature Required
28
CITY OF FORT WORTH
HOUSING&ECONOMIC DEVELOPMENT DEPARTMENT
1. Name and Address of Sub-Grantee 2. Program Name
3. Contract Number
4. Date of Request
Date and Year
"All data reported should be unduplicated for the current month
tg t
kbgs tiEr#b Of ` 't, CUrI@ril7�tij b Q Ilfftk�S
5� }
�]t,.•uS
a. Outreach
b. Case Mana ement
c. Life Management
d. Nutritional Services/Meals
e. Adult Day Care and Personal Assistance
f. Child Care and other Children's Services
. Education
h. Employment Assistance
i. Alcohol and Drug Abuse Services
j. Mental Health Services
k. Health/Medical/Intensive Care Services
I. Transportation
m. Other(specify
n. Other(specify)
o. Number of Jobs that resulted from g.and h.
TOTAL
(current month HOPWA expenditure column
should equal total in supportive service section on
Attachment 1l
Receiving
Supportive
Services w/ Receiving
Current Month Unduplicated Only Housing Supportive Services
Assistance Only
Persons with HIV/AIDS
Other Persons in Family Unit
Certification: The undersigned,hereby,gives assurance that to the best of my knowledge and belief,the data included in this report is true and
accurate. It is also acknowledged that the provision of false information could leave the certifying official subject to the penalties of federal,state,
and local law.
Date: Submitted by: Phone No.
Signature Required
29
M&C Review Pagel of 3
Official site of the City of Fort Worth,Texas
ITY COUNCIL AGENDA FoRTWoRTH
COUNCIL ACTION: Approved on 5/17/2011
DATE: 5/17/2011 REFERENCE NO.: **C-24905 LOG NAME: 17PSAGAP
CODE: C TYPE: CONSENT PUBLIC HEARING: NO
SUBJECT: Authorize Execution of Contracts and Interdepartmental Letters of Agreement to Extend
Public Service Programs Funded by Community Development Block Grant, Emergency
Shelter Grant and Housing Opportunities for Persons with AIDS Grant Funds from June
through September of 2011 (ALL COUNCIL DISTRICTS)
RECOMMENDATION:
It is recommended that the City Council:
1. Authorize the City Manager or his designee to execute contracts or interdepartmental letters of
agreement to extend public service programs funded with Community Development Block Grant,
Emergency Shelter Grant and Housing Opportunities for Persons with AIDS grant funds for the period
from June to September 2011; and
2. Authorize the City Manager or his designee, to amend the contracts or letter agreements, if
necessary, to achieve program goals, provided any amendment is within the scope of the program
and in compliance with all applicable laws and regulations governing the use of federal grant funds.
DISCUSSION:
On August 17, 2010, the City Council approved contracts with agencies to deliver public services
using federal grant funds from the United States Department of Housing and Urban Development
(HUD) under the Community Development Block Grant(CDBG), HOME Investment Partnerships
Program (HOME), Emergency Shelter Grant(ESG) and Housing Opportunities for Persons With
AIDS Program (HOPWA) (M&C C-24401). The City has traditionally used a June to May Program
Year, but is changing the Program Year to October to September to correspond with the City's Fiscal
Year.
In September, 2010, the City Council requested a change in the City's Program Year for Federal
Funding from a June to May year to an October to September year. When the City made this change
to the Program Year, it caused a funding gap for the public service agencies. In order to ensure
continuity of services, the City Council allocated General Funds to extend services until the beginning
of the new grant year. The City Council's authorization allows for the funding of the public service
agencies from June 1, 2010 to September 30, 2011. In March of 2011, Staff asked agencies with
current contracts to submit budget requests for the four month period. Upon review of the requests,
Staff recommends entering into contracts with the following agencies for the following amounts:
Community Development Block Grant
(CDBG)
Boys & Girls Club $ 4,800.00
FWHA $ 9,500.00
Meals on Wheels $ 11,232.00
Cultural Center of the Americas $ 6,592.00
United Community Centers $ 5,400.00
YMCA $ 15,000.00
Childcare Associates $ 39,000.00
YWCA- Child Care $ 45,000.00
http://apps.cfwnet.org/council_packet/mc—review.asp?ID=I 5257&councildate=5/17/2011 6/1/2011
M&C Review
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YWCA- My Own Place $ 5,876.00
Ladder Alliance $ 6,640.00
Day Resource Center $ 16,667.00
AB Christian Learning Center $ 5,000.00
Clayton YES! -Greenbriar $ 8,300.00
Clayton YES! -After School $ 19,000.00
Senior Citizens-Como $ 6,000.00
Senior Citizens - Doc Sessions $ 5,333.33
Senior Citizens- Diamond Hill $ 6,000.00
Cornerstone $ 5,099.00
PACS -Como $ 2,083.00
PACS - Northside CAP $ 8,748.00
PACS -Woodhaven $ 2,116.00
Northside Inter-Church Agency $ 7,341.00
Mental Health Association -Ombudsman $ 5,233.00
Mental Health Association -Advocate $ 7,425.00
Girls Inc. $ 4,200.00
CDBG Total $ 257,585.33
Emergency Shelter Grant(ESG)
YWCA- Supportive Living $ 4,346.00
PACS -SHIPP $ 16,600.00
SafeHaven -Supportive Childcare $ 5,500.00
SafeHaven -Shelter Operations $ 6,700.00
Presbyterian Night Shelter $ 55,411.00
ESG Total $ 88,557.00
Housing Opportunities for Persons with AIDS (HOPWA)
Samaritan House $ 98,975.00
ARRT $ 35,331.00
AIDS Outreach Center $ 152,947.00
HOPWA Total $ 287,253.00
GRAND TOTAL $ 633,395.33
These programs are available in ALL COUNCIL DISTRICTS.
FISCAL INFORMATION/CERTIFICATION:
The Financial Management Services Director certifies that funds are available in the current operating
budget, as appropriated, of the General Fund.
TO Fund/Account/Centers FROM Fund/Account/Centers
GG01 539180 0171000 $633,395.33
Submitted for City Manager's Office bv• Susan Alanis (8180)
Originating Department Head: Jay Chapa (5804)
Additional Information Contact: Mark Folden (8634)
Robin Bentley (7315)
http://apps.cfwnet.org/council_packet/mc_review.asp?ID=15257&councildate=5/17/2011 6/1/2011
M&C Review
Page 3 of 3
ATTACHMENTS
http://apps.cfwnet.org/council_packet/mc_review.asp?ID=15257&councildate=5/17/2011 6/l/2011