HomeMy WebLinkAboutContract 42385-A2 CITY SECRETARY
CONTRACT NO. AL3 S y ,
AMENDMENT NUMBER TWO TO CITY SECRETARY CONTRACT NO. 42385
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. 42385 (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. 42385 added
language to EXHIBIT B — BUDGET to reflect the intent of the parties regarding budget details;
and
WHEREAS, City and Contractor wish to include an addendum to the Contract 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.
The attached "CONTRACT ADDENDUM FOR AGENCIES PERFORMING MENTAL
HEALTH ACTIVITIES WITH CDBG FUNDS — REVISED 12/2/2011" is hereby included in
the terms and conditions of the Contract.
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)
OFFICIAL RECORD
Amendment No. 2 to CSC No. 42385
CITY SECRETARY
Mental Health Association of Tarrant County. Inc. f
Mental Health Ombudsman (CDBG) J FT. WORTH, TX
This amendment is effective as of Oct, k(;�K�,2�011.
4 IFoArICY
a
EST: 0ow°0000000Y OF FORT WORTH
Af 16.
6,
ity Secretary o oy Fernando Costa, Assistant City Manager
Alo 0000,
M&C: C-25066 (Revised) Date /20; A4i*o
APP VED AS TO FO AND LEGALITY:
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. 42385 OFFICIAL RECORD
Mental Health Association of Tarrant County. Inc. CITY SECRETARY
Mental Health Ombudsman (CDBG) FT. WORTH, TX
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:
Name (Printed) �� �- c L,�G` �- C
Title
OFFICIAL RECORD
CITY SECRETARY
t 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 8/2/2011 —Ordinance No. 19824-08-2011
DATE: Tuesday,Aught 02,220 1 1 REFERENCE NO.: C-25066(Revised)
LOG NANIE: 1714UDACTPLAN—REVISED
SUB_IE('T:
Approve City's 2011-2012 Action Plan for the Use of Program Income Totaling$75.000.00 and Federal
Grant Funds Totaling$10,218,616.00 from the United States Department of Housing and Urban Development
Under 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 Lettere of Agreement
and Adopt Appropriation Ordinance(ALL COUNCIL DISTRICTS)
RECOMMENDATION:
DISCUSSION:
f�
�, i
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
$934,220.10
$50.000.00
S984,220.40
Aiunuul
$25.000.00
$197.167.10
$25,000.00
$25,000.00
$ 10.000.00
V82,167.10
.4 u�ouul
$28.683.00
$66365.00
$33,869.20
$353.194.80
$6,084.00
$ 13,284.00
$25,196.00
$92,199.84
$20,216.00
4;268.595.00
$908,086.84
FISCAL INFORNLATION:
FUND CENTERS:
TO Fund/Account/Centers FROM Fund/Account/Centers
GR76 451727 017206531XXX 12.832.159.00
GR76 5XXXXX 017206531XXX 12.832.159.00
GR76 451685 XXX206531XXX IIM0,00
GR76 5XXXXX XXX206531XXX 11.000.00
GR76 451717 017206533XXX $297.018.00
GR76 5XXXXX 017206533XXX 1297.018.00
GR76 541727 017206-Sl4XXX %916-17')-00
GR76 5XXXXX O17206534XXX %936-171N)
GR76 451727 017206530XXX 16.153.267.00
GR76 5XXXXX 01720651OXXX 16153-267-00
GR76 451685 XXX20653OXX2S75- N1tO
GR76 5XXXXX XXX?06530XXX S75-000-00
.CERTIFICATIONS:
Submitted for City Manaeu-'s Office bv: Susan Alanis (8180)
Originating Department Head: Jay Chapa (5804)
Additional Information Contact: Mark Folden (8634)
Robin Bentley (7315)
ATTACHMENTS
1. 17HUDACTPLAN AOI I Revised.doc