HomeMy WebLinkAboutContract 41960 AGREEMENT FOR SERVICES CITY SECRETARY
CONTRACT NO. `-)I� (,P �
THIS AGREENIEN T ("Agreement") is made and entered into by and between 'I'll 14
CITY OF FORT WORTH. a home rule municipal corporation of the State of Texas
(hereiriafter referred to as "City"), acting by and through Susan _Tanis, its duly authorized
Assistant (_ INS M nab(-Ye.r, and XWC a nonprofit Texas corporation (hereinafter referred to as
"Contractor"). acting by and through Ms. Carol Klocel , its duly authorized Executive Director.
RECITALS
WHEREAS. Contractor provides counseling services to youth and voting adults; and
W1119 REAS. sUch services serve: a public purpose in serving low to moderate irwonte iridividual>
which benefits the Fort Worth community; and
WHEREAS. City and Contractor desire to enter into a contract to have such services provided
which benefit the Fort Worth community.
NOW, THEREFORE, in consideration of the mutual covenants herein expressed_, the pirlies
agree as hollows:
1. SCOPE OF SERVICES.
Contractor covenants and agrees to fully perform; or cause to be performed, with
good faith and Clue diligence. all services and objectives described in Exhibit "A." attached and
incorporated herein for all purposes incident to this Agreement ("Services").
2. (-.1O IPENSATION.
In consideration of the Services to be performed hereunder by ('ontract r. ('its agrees to
reimburse Contractor via monthly installments up to a total amount not to exceed Four 'I'houKmd
"Three 11widmred Forty Six and No/100 ($4,346.00) ("Funds"). Any funds not requested as
provided in Sectioi-i 3 shall remain kvith the City.
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
3. REPORTING OF EXPENDITURES.
a. £.'ontractor shall deliver to (;ity a monthly statement of the request for zeiznbt:trsernent
("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
"I3" 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 lZecluest for
Reim bursement is not received for any month, Contractor will not receive reimbursement.for that
month. Notwithstanding the above, the Request for Reimbursement for the rrtonth of September
shall be due by September 23, 2011. The failure to make such request by September 23, 2011
shall resti(t 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 =1, 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
care 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 del'atilt of this
Agreement and will riot receive reimbursement.
e. Any non-compliance by Contractor under Section 3 of this Agreement may Jeopardize
the Contractor's ability to receive future funding froze 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 "C-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 'TERM[NATION.
a. 'l his ,agreement shall be for a term beginning June 1. 2011 and ending Septemher
_10, 201 1.
b, k.ithcr party Tray cancel this Agreement upon thirty (M) dams notice in writing to
the othcr p irt% cif such intent to terminate.
C. The City may terminate this Agreement immediately for any violation by
Contractor of Section 3, "iZequest for Reimbursement" or Section 4, "IZeporting of Services,"
alcove.
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 v-vithout 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 'I'O 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 apple- as between the City and Contractor, its officers. agents, servants; erxrployees.
subcontractor's. or progra€n 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
fl. [,]ABILITY AND INDEMNIFICATION.
CITY SHALL IN NO WAY OR UNDER ANY CIRCUMSTA,.NCES B
RESPONSIBLE FOR ANY PROPERTY BELONGING TO CONTRACTOR, ITS
OFFICERS, AGEN'T'S, EMPLOYEES, SIJBCONTRACT'ORS, PROGRAM
PARTICIPANTS, OR RECIPIENTS, WHICH MAY BE LOST, STOLEN, DES'T'ROYED,
OR IN ANY WAY DAMAGED. CONTRACTOR HEREBY AGREES TO INDEMNIFY
AND HOLD HARMLESS THE CITE`, ITS OFFICERS, AGENTS, AND EMPLON EI?S
FROM <AIND AGAINST ANY AND ALL CLAIMS OR St ITS C`ONC:'F:12ti1NC; St C'H
PROPERTY . CONTRACTOR COVENANTS AND AGREES TO INDEiLINIFY, HOLD
HARItILESS AND DEFEND, AT ITS OWN EXPENSE, CITY AND ITS OFFICERS,
AGENTS, SERN-ANTS, AND EMPLOYEES FROM AND AGAINST ANA' AND .ALL..,
CI.,AINIS OR St.1ITS FOR PROPERTY LOSS OR DAMAGE AND/OR PERSONAL
IN.II'R1', INC'Lt1DING DEATH, TO ANY AND ALL PERSONS, OF WHATSOEVER
KIND OR CHARACTER, WHETHER REAL OR ASSERTED,ARISING OI TT OF OR IN
CONNFC"TION NN IT I THE EXEC(;TION, PERFORMANCE, A'FTEXIPT1 1)
PF IZFOIZNl 1NCF OR NC)NPF:RFORMANCE OF' 1411S _1CJ0,;FM1,'*s1
OPERATIONS, ACTIVITIES AND SERVICES DESCRIBED HERI`11N, '1' [1 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 A.I.J.,
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 ANN" AND ALL PERSONS, OF WHATSOEVER KINDS OR CIIARA( TER,
WHETHE'R REAI., OR ASSERTED, ARISING OUP" OF Oil IN CONNEC'T'ION WITI-I
THE EXECtITION, PERFORMANCE, ATTEMPTED PERFORMANCE OR NON-
PERFORMANCE OF THIS AGREEMENT AND/OR THE OPERATIONS, ACTIVITIES
AND SERVICES DESCRIBE[) HEREIN, WHETHER OR NOT CAUSEI) IN WIIOI.jE
OR IN FAfff, BY ALLEGED NEGLIGENCE OF OFFICERS, AGENTS, SERX,'.,kN'FS,
EMPLOYEES, CONTRACTORS OR SUBCONTRACTORS OF CITY. CONTRACTOR
LIKEWISE COVENANTS AND AGREES TO AND DOES HEREBY INDEMNIFY AND
ROLD IIARMI.,ESS CITY FROM AND AGAINST ANY AND ALL INAIRY, DAMAGE
OR DESTRuc-riON OF PROPERTY OF CITY, ARISIN(.. 01,11T OF OR IN
CONNECTION WITH ALL ACTS OR OMISSIONS OF CONTRACTOR, ITS
OFFICERS, MEMBERS, AGENTS, EMPLOYEES, SUBCONTRACTORS, INVITEES,
LICENSEES, PROGRAM PARTICIPANTS, OR RECEtPIENTS, WI-IETuER OR NOT
CAUSED, IN WHOLE OR IN PART, BY ALLEGED N.EG.LIGF,N(-,'E OF OFFICERS,
AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS OR SUBCONTRACTORS OF
CITY. CONTRACTOR AGREES TO AND SHALL REI...EA.SE CITY, ITS AGENTS,
FMPLOYI!-,E,S, OFFICERS AND LEGAL REPRESENTATIVES FROM Aljl.j LIABILITY
FOR IN,I RY, DEATH, DAMAGE OR LOSS TO PERSONS OR I)ROPI`jRT-v
SUSTAINED IN CONNECTION WITH OR INCIDENTAL TO PERFORMANCE
UNDER THIS AGREEMENT, EVEN IF THE INJURY, DEATH, DAMAGE OR LOSS IS
CAUSED [IN" CITY'S SOLE OR.CONCURRENT NEGIJIGENCE.
Contractor shall require all of its subcontractors and Recipients to include in their
subcontracts it 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 l`IA.SMISUSED,
MISAPPLIEA) OR MISAPPROPRIATED ALL OR ANN' PART OF THE FUNDS
PROVIDED HEREUNDER, CONTRACTOR AGREES TO INDEMNIFY, HOLD
IIARNIt..ESS AND DEFEND THE CITY OF FORT WORTH, ITS OFFICERS, AGENTS,
SI, RN,_ANr_I-S, AND EMPLOYEES, FROM AN[) AGAINST ANY AND ALL (.:I.,AIMS OR
C) 2
SUITS RESULTING FROM St (:H MIS11SE, MISAPPI-ACATION
MISAPPROPRIATION.
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10. CHARITABLE IMMUNITY.
If Contractor, as a charitable or nonprofit organization, has or claims all hmilurrity or
exemption (statutory or other,,vise) from and against liability for damage or injury, including
death, to p ersons or property, Contractor hereby expressly -waives its rights to plead defensively
such immunity or exemption as against the City.
11. ASSIGN-NWNT AND SI:113CONTRrACTIN(T.
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 LAMA'S, ORDINANCES, RULES AND REC U.LATIONS.
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.
C:ontractor•, in the execution, performance or attempted performance of this contract and
Agreement, will not discriminate against any person or persons because of disability, age.
Falliilial 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 cornplied 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. Comrnercial General Liability {CGI_,): 51.000.000 per occurrence, %Kith a
52,000,000.00 annual aggregate limit. in a firm that is acceptable to tine
City's Risk Manager.
�. Non-Profit Organization Liability or Directors Officers Liability:
51,000,000 per occurrence, w ith a $1,000.000 annual atggregate l unit. in a
form that is acceptable to the City's Risk NJanager.
Contractor's insurers) 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.1medical insurance shall list the City as an additional insured. C:'ity
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 sect ion.. ']'.lie 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.
and 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 durint,
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. GO'Yf1RNING LAW AND VENUE.
This Agreement shall be governed by and construed tinder the laws of thy. state of Texas.
Should anN action. \whether real or asserted. at law or in equity, arise Out of thy: eXecutMILI
performance, attempted performance of this Agreement. venue fior said action shall lie in Tarrant
Countv. Fexas.
6
17. NO"T"ICES.
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 Marty shown below:
Jesus "Jay" ( l7apa Ms. Carol. itlocek
Director of Economic Development Executive Director
City of Fort Worth YWCA
1000 Throck-morton St. 512 West 4th Street
I-`ort Worth. Texas 76102 fort Worth. TX 76102
18. NO WAIVER.
'I'he 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 an-y' such term
or right on any future occasion.
19. D1SCLOSC.RF.. OF CONFLICTS AND CONFIDENTIAL INFORINVIATION.
Contractor hereby \.Narrants to the City that Contractor has made full disclosure in
writing of and existing or potential conflicts of interest related to (_'ontractor"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
great all informmation provided to it by th.e City as confidential and shall not disclose any such
information to a third party 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. 1'ORCI' MMEICRE.
The City and Contractor shall exercise their best eflorls 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 anv government la%,_ ordinance
or regulation_ acts of God. acts of' the public enemy. fires. strikes. Iockout.s. 1KIWI-J] diw,asters_
-r
wars, riots. material or labor restrictions by any governmental authority. transportation problems
and/or any other similar causes.
22. HEADINGS NOT CONTROLLING.
Headings mid 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
L
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.]
FN WITNI"SS WHEIZE0F. the parties hereto have executed this agreement in 1`nU1tij)1eS in Foil
Worth, TalTant County. Texas, to be effective June 1, 20111.
Aj-f CITY OF FORT WORTH
Bv:
-
tar K, I lendrix vo w A sa Alanis
City Secretary FfJ6.0 Assistant City Manager
Date:ate:
�jj X
q�W e- 1 ITS': CONTRACT
APPROVED AS TO FORM ANN
AUTHORIZATION:
M&C: C-24905
Leann D. Guzman
Assistant City, Attorney Date .Approved: 05/17!201 1
Date: (141bg L YWCA:
ATTEST
By:
Maine: Nairte-M.s. Carol. klocek
Title:
Title: Executive Director
Date: (eh/
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
9
S'FATE 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 Ms. Carol Kloeek, known to me to be the person whose name is
subscribed to the foregoing instrument and acknowledged to ine that the same was the act of the
YWCA acid that she executed the same as the act of said YWCA for the purpose and
consideration therein expressed and in the capacity therein stated.
GIVEN UNDER MY HAND AN[) SEA].., OF OFFICE this 164- day of
')011
VICIGE eMGDON ELLIOTT
my commmelon ExpkW 4
Duty 28,2014
Notary Public in alll for the State of Texas
S'I'A'rE OF 'YEXAS §
C0U,NTY OF '['ARRANT §
BEFORE ME. the undersigned authority, a Notary Public in and for the State of Texas.,
on this day r.)ersonally appeared Susan Ala is, known to me to be the person whose name is
o'
subscribedt 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.; I - 71�ay of
GIVEN UNDER MY HAND AND SEAL OF OFFICE thisp,
A
Notary Public in and for the State of Texas
ti
FVONIA DANIELS
4 1 COMMISSION EXPIRES
Y
J*10,2013
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
EXHIBIT A
SERVICES
11
YWCA Fort Worth & Tamrant Comntv EXHIBIT A
SUPPORTIVE LIVING SCOPE OF SERVICES
PROGRAM SUMMARY
EMERGENCY SHELTER GRANT (ESG)
TDDe l, 2011 — SeDte[D},e[ 30, 20} }
P6Ql0D
SCOPE OF SERVICES
This Scope of Services is based on the proposal prepared and submitted by the 8uhrccipicnt through the City of Fort
YVodh,a annual Request for Proposal (RLFP) process. The 5ubreoipient agrees to operate this Emergency Shelter Grant
(ESG) program in a manner consistent with the program delivery stated in the approved proposal. However, iuthe event
ofnuvcoxflici between the proposal and any provision contained, herein, this Agreement shall control.
The YWCA Fort Worth & Tann/8 County will provide 8SG services to homeless persons or persons at risk of
homelessness atYWCA [on Worth /t Tarrant County. The Supportive Living program will include the following tasks
and activities: 7-/nooih transitional housing for 7 mou1ba for women at |ouat 2l ycurs old-, intensive case management,
and Counseling. All services will be provided a15/2W. 4= St. from June [. 2Ol| to September 30,20l ). Business hours
urcMkndmv-Fddu9, 8:00 u.no. - 5:00 p.m.
The purpose of the program will betoprovide intensive case umoua�enoonrand counseling to women in the bmnabionx1
housing program. The specific ohiec1ivex, goals and level of services to be provided are listed below along with the
geo�ruph/ca| location ofc|ieutaserved. /\|| services v/i|| bo provided �onoJune l, 20||- Sepicmuber30, 2O||,
The funds will be used to yuy, fx staff salary which in onnaistcm1 with Exhibit KB - Detailed Statement of Coskm. The
source and amount ofMatch Funds should be documented nnthe Match Funds Report. VVhen: applicable, expenses paid
for with Match /undo should be described (es. Private oemb donations used for salaries and supplies) and documentation
maintained for review.
REGULATORY CLASSIFICATION:
Regulaton, Citation & Activity Allocated Funds % of Total Allocation
24 CFR 576.9; 570.%8(m)(2) Essential Services
24 CV7R 576.3; 576.21(a)(3)Operational Costs N/A N/A
24CFR 576'3. 570'21(u)(4)Homeless Prevention N/A N/A
Based on the no1orc o[rho service provided, YWCA Fort Worth & Tonm8 County will rnuix\aio documentation that
verifies that 10096 clients served are honnc|csn, nr for prevention activities., documentation that verifies clients served by
the homeless prevention program are at risk of homelessness througli eviction notices or notices of termination ofutilitV
services. Bvk1iox/discuonoo(ion notices must bc Supported by documentation verifying: (1) the inability o[the fami|v to
make the required payments is due to u sudden reduction in income; (2) the umaiybonce is necessary to avoid the eviction
or tcnniouhon of services, (3) there is u rcoyonoh|e prospect that the fhmik will be ob|c to resume payments ,vhhix o
rcuamub|c period of time: and (4) the assistance will not supplant funding for preexisting homelessness prevention
o`1iritic^ from odursoxues,
GEOGRAPHICAL LOCATION:
Site Address: 512 W. 4"' St., Fort Worth, TX 76102
Client Beneficiary Location (Neighborhood, District, Citywide...): Citywide
.PROGRAM GOALS:
Provide supportive living serv'ices for women, age 21 and over, who live in on-site transitional services.
PROGRAM OBJECTIVES:
- Provide 7-months of transitional housing for eligible women who are homeless or at risk of homelessness
- Provide Individualized intensive case management to prepare clients for self-sufficiency
- Provide counseling services to address emotional, psychological, and social Issues
PROGRAM SERVICES and ACTIVITIES
Total Unduplicated Clients Served
. ............
Nights of Homing ..........
Hours of Counselinc,
Hours of Case NIajiti
Quarterly HMIS Reports Submitted .................................. ......
EXHIBIT B
FORM OF REQUEST FOR REIMBURSEMENT
[ATTACHED]
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:
m|SmUMoER: _
SECTION |(4GEwcy) CURRENT MONTH CUMULATIVE
1. Reimbursement Request
A, Expenditures:
B, Reimbursement
2.Requested ay:
A. Agency
------�� (mume) (Signature) (Date)
SECTION x(mTv)
1. BUYSPEED-Purcham/wgnequea
*. BUvSpeEO INPUT:Vendor/PO Number/Requisition Number:
B, Fund/Account/Center:
C. Total Amount of this Request:
SECTION III(CITY)
1. Verification
* Contract Compliance Specialist
----� (Date)
(Na ')m� (Signature",
B Aconunung ---- Benedict G __- __-_ ______ _____ __ _ ______
��
'Date)
(Name) (Signature)
z.Authorization
A. Grants Manager Robin------�
(Name) (Signature) (Date)
B Sr.xumin Services mgr Socorro Gray
------��
(Name) (Signature) (Date)
.Jes.us Cha.pa
'wone, 's.g�am.e/ 'ua,*
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 I I
Life Insurance
........................................... ................
Health Insurance
Unemployment Tax.......
Worker's Comp
Legal and Accounting
Office Supplies
PROGRAMMATIC COSTS
Salaries 4,346.00
FICA
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
Accountin2
Postage
Building Maintenance and Repair
Office Su lies
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(STRMIJ)
Tenant Based Rental Assistance
(TBRA)
TOTAL $0.00 $0.00 s0-00
-Contractor's-C-et-ifi-ca-t-i-o-n-: 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 TI FLE OF AUTHORIZED OFFICER SIGNATURE and DATE
CITY OF FORT WORTH
HOUSING&ECONOMIC DEVELOPMENT DEPARTMENT
EXPENDITURES WORKSHEET
.................
Agency Contract Number Date
To
Pro ram Report Period
NO DATE CHECK NO PAYEE DESCRIPTION ACCOUNT NO. AMOUNT
.......................
2
3
............. ............ .............
4
5
6
——--------
7
9 ..........-
10
.................
....................-
12
14 ............
15
16 .......—__...._._.__._.-
17
18
19 ................
20
21 ........................................................................................
.............................................. .............................. ................................... . .. ............
22
23 ................................... ........
...............................
24 ................
25
26
.........................
27
28
.................................................................... — ---------- ---------- ................. ............... .................. .............
29 .......... ------ ...............L.---......................... ............................
...............................- ............— ..................- ............................ .........
JG
................................ TOTAL $0.00
............................................ ...................... --------- ....... .... ........................................................—......I..................................................
..
.................. ................
TITLE OF AUTHORIZED OFFICER SIGNATURE AND DATE
EXHIBIT
FORM OF SERVICES REPORT
16
CITY OF FORT WORTH
HOUSING&ECONOMIC DEVELOPMENT DEPARTMENT
1. Name and Address of Sub-Grantee 2. Program Name
Month &Year
5. Pro2ram Services and Activities
Current Month Cumulative
Number of New
Households and/or
Persons Served L
6.Direct Benefit
(Continued)
Extremely Low Very Low Income Low Income Above Low Income
Income(0<3 (31-50%) (51-80%) moo/(>)
Current Month .......... ........
Cumulative
..........
Household Size 1 2 3 4 5 6 7 8
0-30% $13,850 $151850 $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 $401900 $43,550
51-80% 1 $36,950 1 $42,250 1 $52,800 $57,000 1 $61,250 1 $65,450 1 $691700
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 subliect to the penalties of federal,state,and local law.
Date Submitted 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)
..........................................................._...................................._.............._................................_......_...._...._....- ...........................................__................_........_........................._......_......-..__....._........................................................................_........................_..................
..............
Ethnicity:
Section
Must be
Race:Section Must be Com leted Com leted
T Non-
Hispanic Hispanic Non-
( Current Current Hispanic Current Hispanic
Month Cumulative Month Cumulative Month Cumulative
White
Black/AfricanAmerican
Asian
American indian/Alaskan Native
i
Native Hawaiian/Other Pacific Islander
Indian/Alaskan Native&White
Asian White
Black/African American&_White__
_ _._ _ — _. _J __......
....
American Indian/Alaskan Native&Black E
African American __..._. _._. _.. _................._____..........------- ---
Other Multi-Racial _
___ ..-............._ 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
18
CITY OF FORT WORTH
HOUSING&ECONOMIC DEVELOPMENT DEPARTMENT
1. Name and Address of Sub-Grantee 2. Program Name
CURRENT
5. PROGRAM SERVICES AND ACTIVITIES: CUMULATIVE
Unduplicated Clients
6. SCOPE OF WORK NARRATIVE:
7. PRO LEMS 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 By: Phone-N.O......
.............
Signature
Required
19
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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 Housin T pe: EMERGENCY OR TRANSITIONAL SHELTERS
Current Month Cumulative
Chronicall Homeless(Emer enc Shelter only)
Severely Mental) Ilf
Chronic Substance Abuse
Other Disability
Veterans
Persons with HIV/AIDS
Victims of Domestic Violence
Elder)
TOTAL 0
Beneficiary by Housing Type: Number served in Emergency or Transitional Shelters
SHELTER TYPE Current Month Cumulative
Barracks
Grou /Lar e House
Scattered Site A artment
Sin le Family Detached House
.—Single Room 21C at1C
Mobile Homeffrailer
Hotel/Motel
Other
TOTAL 0 0
ESG Fundinq Sources: Fun din 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.
Si nature Re wired
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
EMERGENCY OR TRANSITIONAL SHELTERS
NUMBER OF INDIVIDUAL HOOUSEHOLDS(SINGLES): Current Month Cumulative
Unaccompanied '18 and over, Male Female
Unaccompanied under 18 Male Female
NUMBER OF FAMILY HOUSEHOLDS WITH CHILDREN HEADED BY: Current Month Cumulative
Single 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.
Signature Required
EXHIBIT C-2
ADDITIONAL FORM OF SERVICES REPORT-HOPWA AGENCIES
24
CITY VF FORT WORTH
HOUSING&ECONOMIC DEVELOPMENT DEPARTMENT
1. mame and Address ofSub-Grantee z. Program Name
3. Contract Number
*. Date of Request
Date and Year
5. Program Services and Activities(Report Clients,Not Payments) ....... ......
CURRENT #Assisted Amount of
MONTH With Other Other
HOPWA
ONLY Cumulative Funds Funds
a.#of Tenant-Based Rental Assistance(TBRAJ
b#of Short-Term Rental,Mortgage and Utilq Assistance(STRMU)
c,#of STRMU clients that have moved to TBRA
Number f Households
HOPWA
CURRENT ASSISTED
MONTH AMOUNT OF W/OTHER OFOTHER
ONLY CUMULATIVE HOPWA FUNDS FUNDS FUNDS
6.Supportive Services
8. Housing Information Services
9. Permanent Housing Placement..Services
,o, Monthly Income Groups af Households for all Unduplicated
Clients
Tenant Based Rental Assistance
$0-250 Soo $501-1000 $1001-1500 $1501-2000 Over$2000 TOTAL
Month
Cumulative
Short,Term,Rent, Utility Asst,
$0-250 500 $501-1000 $1501-2000 Over$2000 TOTAL
Month
Cumulative
d
$0-250 Soo $501-10130 i $1001-1500 $1501-200 Over$2000 TOTAL
Current
Cumulative 01
Certification: The undersigned, xensuy, gives assu�nnathat tomebo�o,my knowledge and uonetthe data included|nmiy,cpo�|etmeand
nccu,ate. u.n also acknowledged mat'the provision or false information could leave the certifying official subject tu the penalties or federal, state.
and local law
Phone DATE: _ _ Submitted»y: __ _._ _ -__-__-_����
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)
Ethnicity:(Section
Must be
Race:Section Must be Completed) Completed)
Non-
Hispanic Non-
Hispanic Hispanic Current Hispanic
Current Month Cumulative Current Month Cumulative 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 do 0 0 0 1 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 pafticipants 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
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)
Ethnicity:(Section
Must be
Race:Section Must be Completed) Completed)
Non-
Hispanic Non-
Hispanic Hispanic Current Hispanic
Current Month Cumulative 1 Current Month Cumulative 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 t 0 0 0 0 0 0
Current
Month
Unduplicated Female TBRA Male TBRA
Unduplicated Beneficiary Data Total A e 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 ----__-
Signature Required
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
Ethnicity:(Section
Must be
Race:Section Must be Completed) Completed)
Non-
Hispanic Non-
Hispanic Hispanic Current Hispanic
Current Month Cumulative 1 Current Month Cumulative 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 0 p
TOTAL 0 0 0 0
Current
Month
Unduplicated Female TBRA Male TBRA
Unduplicated Beneficiary Data Total A e Participant Partici nts
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 30
Years
Assistance Y
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 bYPhone No ._---.._.._._......
___..........___.......
- ---------
Signature Required
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
Number of Current Month Number of households Amount of Other
households Expenditures with Other funds(whether funds(whether
with HOPWA Amount of HOPWA from Grantee or other from Grantee or
Supportive Services funds funds sources)_ other sources)
a. Outreach
b, Case Management
c. Life Management
d, Nutritional ServicestMeals
--
e. Adult Day Care and Personal Assistance
f. Child Care and other Children's Services
g. Education
h. Employment Assistance
i. Alcohol and..Dru2 Abuse Services
j. Mental Health Services
k. Health/Medical/intensive Care Services
I. Transportation
m. Other
n. Other(speci! ) ...........
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/11
Receiving
Supportive
Services w/ Receiving
Housing Supportive Services
Current Month Unduplicated Only Assistance ___Qpjy_
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
M&C Review Pagel of 3
Official site of the City of Fort Worth,Texas
CITY 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=15257&councildate=5/17/2011 6/1/2011
M&C Review Page 2 of 3
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 by: 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