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Home My WebLink AboutContract 42363-A2 CRY$ECRETARY CONTRACT NO. 41-6 23 AMENDMENT NUMBER TWO TO CITY SECRETARY CONTRACT NO. 42363 WHEREAS, on October 5, 2011, the City of Fort Worth ("City") and Mental Health Association of Tarrant County, Inc. ("Contractor") made and entered into City Secretary Contract No. 42363 (the "Contract"); WHEREAS, the Contract provided funding to Contractor pursuant to a grant received by City from the United States Department of Housing and Urban Development ("HUD") through the Community Development Block Grant Program, ("CDBG") for utilization in connection with its Mental Health Advocate Program; WHEREAS, Amendment Number One to City Secretary Contract No. 42363 added language to EXHIBIT B — BUDGET to reflect the intent of the parties regarding budget details; and WHEREAS, City and Contractor wish to amend "CONTRACT ADDENDUM FOR AGENCIES PERFORMING MENTAL HEALTH ADVOCATE ACTIVITIES WITH CDBG FUNDS"to incorporate proper documentation procedures for client eligibility; and WHEREAS, it is the mutual desire of City and Contractor to amend the Contract to meet Contract objectives. NOW, THEREFORE, City, whose address is 1000 Throckmorton St., Fort Worth TX 76102, acting by and through Fernando Costa, its duly authorized Assistant City Manager, and Contractor, whose address is 3136 W. 4th Street, Fort Worth, TX 76107 acting by and through Dr. Lee LeGrice, its duly authorized Executive Director, do hereby agree as follows: I. "CONTRACT ADDENDUM FOR AGENCIES PERFORMING MENTAL HEALTH ADVOCATE ACTIVITIES WITH CDBG FUNDS" is hereby deleted and replaced with the attached "CONTRACT ADDENDUM FOR AGENCIES PERFORMING MENTAL HEALTH ACTIVITIES WITH CDBG FUNDS —REVISED 12/2/2011". II. All other terms and conditions of the Contract not amended herein remain unaffected and in full force and effect, are binding on the Parties and are hereby ratified by the Parties. Terms used but not defined have the same meaning as the Contract. [REMAINDER OF PAGE LEFT INTENTIONALLY BLANK] Amendment No. 2 to CSC No. 42363 LFT RECORD Mental Health Association of Tarrant County, Inc. RETARY Mental Health Advocate (CDBG) TH, TX This amendment is effective as of Octobee 2011. A p+�c �01# r ST: a QO°o°°°OooaTY OF FORT WORTH O Fri ity Secretary d c x ernando Costa, Assistant City Manager oo-�C� M&C: C-25066 (Revised) Dat��8/ �lob'01 a �4XRS-o" APP VED AS TO FO AND L7143 ITY: Assistant City Attorney MENTAL HEALTH ASSOCIATION OF TARRANT COUNTY, INC. By � ` `��— Dr. Lee LeGrice, Ph.D., LCSW Executive Director Amendment No. 2 to CSC No. 42363 FOFFICIALRECORD I Mental Health Association of Tarrant County. Inc. CITY SECRETARY Mental Health Advocate (CDBG) FT. WORTH,_TX J CONTRACT ADDENDUM FOR AGENCIES PERFORMING MENTAL HEALTH ACTIVITIES WITH CDBG FUNDS REVISED 12/2/2011 For purposes of Section 6.1.3 and 6.2 of the Contract, Contractor must complete the attached form "CERTIFICATION FORM FOR DOCUMENTING CLIENT STATUS AS "SEVERELY DISABLED ADULT". By signing below, Contractor acknowledges the receipt of this addendum and its full inclusion as part of the terms and conditions of the Agreement. AGENCY: f�j\ Nz��—�+ /aux ,�� r� .f '�kcZ r'�-rte, - �. By: Name (Printed) Title OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX CERTIFICATION FORM FOR DOCUMENTING CLIENT STATUS AS "SEVERELY DISABLED ADULT" Client Name: Address: City, State, Zip Client Identification No. CHECK ALL THAT APPLY ❑ Uses a wheelchair, a cane, crutches, or a walker Has a mental or emotional condition that seriously interferes with everyday ❑ activities (frequently depressed or anxious, trouble getting along with others, trouble concentrating, or trouble coping with day-to-day stress) ❑ Receives federal benefits based on an inability to work. ❑ Has Alzheimer's disease, mental retardation, or another developmental disability. Is unable to perform or needs help to perform one or more functional activities ❑ including but not limited to seeing, hearing, speaking, lifting/carrying, using stairs, walking, or grasping small objects. Is unable to perform or needs help to perform one or more Activities of Daily ❑ Living (ADL) including but not limited to getting around inside the home, getting in or out of bed or a chair, bathing, dressing, eating, and toileting. Is unable to perform or needs help to perform Had difficulty with one or more Instrumental Activities of Daily Living (IADL) including but not limited to ❑ going outside the home, keeping track of money and bills, preparing meals, doing light housework, taking prescription medicines in the right amount at the right time, and using the telephone. ❑ Has a condition that limits the ability to work around the house. ❑ Is age 16 to 67 and has a condition that made it difficult to work at a job or business. The undersigned representative conducted a visual assessment of the client identified on this form and certifies that the client meets the conditions indicated above. Certified by: Date: Signature: City of Fort Worth, Texas Mayor and Council Communication COUNCIL ACTION: Approved on 812/2011 —Ordinance No. 19823-08-2011 DATE: Tuesday,August 02,2011 REFERENCE NO.: C-25066(Revised) LOG NAME: 1714UDACTPLAN—REVISED SUBJECT: Approve City's 1011-2012 Action Plan for the Use of Program Income Totaling$75,000.00 and Federal Grant Funds Totaling$10,2113.616.00 from the United States Department of Housing and Urban Development Cinder the.Community Development Block Grant,HOME Investment Partnerships Program,Emergency Solutions Grant and Housing Opportunities for Persons with AIDS Grant Programs,Authorize Application of Indirect Cost Rates,Authorize Execution of Related Contracts and Interdepartmental Letters of Agreement and Adopt Appropriation Ordinance(ALL COUNCIL DISTRICTS) RECOMMENDATION: + _ ,: .0 FTY MY 101� a wmf WAA � a l= i; e 0 Mm Amount $33.604.00 $42.296.00 $43,300.00 $25,000.00 $117,000.00 $54.000.00 $25,000.00 $25,000.00 $ 11,250.00 $33,605.40 $25,000.00 $25,000.00 $25.000.00 $25.000.00 $25,000.00 $25.000.00 $25,000.00 $133,092.00 $28,154.00 $27,919.00 $135.000.00 $25.000.00 S934,220.40 $50.000.00 S984,220.40 Amount $25.000.00 8197.167.10 $25.000.00 $25,000.00 $ 10.0(().00 $282,167.10 Amount $28,683.00 $66,76.5.00 $33,869.20 $353.194.80 $6,084.00 $ 13,284.00 $25.196.00 $92.199.84 $20,216.00 068.595.00 Man xwus,u86.xr FISCAL INFORMATION: FUND CENTERS: TO Fund/Account/Centers FROM Fund/Account/Ccntcrs GR76 451727 017'06531XXX3�15900 GR76 SXXXXX 017206511XXX 42 812-159.00 GR76 451685 XXX206531XXX $1.000.00 GR76 5XXXXX XXX206531XXX 41.000.0() GR76 451727 017206533XXX 4297.018.00 GR76 5XXXXX 017'?06513XXX $297.018.00 GR76 5417"7 017206S3dXXX 4916 17'(0l GR76 5XXXXX 017106534XXX 4936 171((l GR76 451717 017"00530XXX 46 151.267(01 GR76 5XXXXX 017206510X. 4.6.153167.0(1 GR76 4516X5 XXX)06SZ(IXXX S75(1()(1(1() GR76 5XXXXX XXX'00530XXX 4750(0)00 CER'T'IFICATIONS: Submitted for Citi•NTanauer's Office bv: Susan Alanis (8180) Originating Department Head: lay Chapa (5804) Additional Information Contact: Mark Folden (8634) Robin Bentley (7315) ATTACHMENTS 1. 17HUDACTPLAN AO1 1 Revised.doc