HomeMy WebLinkAboutContract 30309 STATE OF TEXAS CITY SECRETARY
CONTRACT NO , `+(
COUNTY OF TARRANT
THIS contract is made and entered into by and between the City of Fort Worth ("City"),
acting and through Charles Boswell, its duly authorized Assistant City Manager, and Mental
Health Association of Tarrant County (Ombudsman) ("Contractor"), by and through Ms.
Lauralee Harris, its duly authorized Program Director. Contractor's business address is 3136 West
4th Street, Fort Worth, TX 76107.
WHEREAS, the City of Fort Worth has been notified that it will receive grant monies from the
United States Department of Housing and Urban Development ("HUD") through the
Community Development Block Grant ("CDBG") for Year XXX; and,
WHEREAS, the primary purpose of the CDBG Program is to benefit low and moderate
income citizens of Fort Worth; and,
WHEREAS, the Catalog of Federal Domestic Assistance (CFDA) assigned Community
Development Block Grants/Entitlement Grants number 14.218; and
WHEREAS, the citizens of Fort Worth, the Community Development Council, and the City
Council of Fort Worth have determined that CDBG Programs are needed by low and moderate
income citizens of Fort Worth;
NOW,THEREFORE,THIS AGREEMENT FURTHER WITNESSETH:
THAT, the parties covenant and agree as follows:
1. Scope of Services
a. Contractor will administer Advocacy services to citizens of the City of Fort Worth under the
program name Long Term Ombudsman ("Program"), for the term June 1, 2004 to May 31,
2005.
b. Contractor will provide the services and activities delineated in Exhibit A-Program
Summary in accordance with Exhibit B-Program Services Schedule.
c. Contractor agrees to meet the National Objective of activities benefiting low and moderate
income individuals and to maintain full documentation supporting fulfillment of this National
Objective in its files.
d. City will monitor the performance of the Contractor against the goals and performance
standards required herein. Substandard performance as determined by City will constitute
non-compliance with this Agreement. If action to correct such substandard performance is not
taken by Contractor within a reasonable period of time after being notified in writing by City,
contract suspension or termination procedures will be initiated.
2. Compensation and Method of Payment
a. City will disburse CDBG Year XXX monies in an amount up to $17,500.00 to Contractor on a
reimbursement of expenses basis.
1 XXX CDBGCNT July 2,2004
b. Payment will be processed by City following receipt from Contractor of the following
monthly financial documents: (1) Attachment I-Sub-Grantee's Request For Funds, (2)
Attachment II-Detail Statement of Costs, and (3) Attachment III-Expenditures Worksheet
Report. Reimbursement for the payment of eligible expenses shall be made against the line
item budget specified in Exhibit C-Program Operating Budget and in accordance with
performance specified in Exhibit B-Program Services Schedule. The City is under no
obligation to disburse funds for expenditures which occurred prior to the first day of the
month for which the report is submitted.
c. Contractor agrees to utilize all disbursed CDBG funds for the benefit of the Program.
Contractor agrees that funds will be expended in accordance with the Program Operating
Budget. Contractor may not increase or decrease line-item amounts in the approved CDBG
Program Operating Budget without prior written approval by the City.
d. It is understood that the total cost for operation of this program is $26,487 and that
Contractor will obtain the remaining funds in excess of the CDBG amount as detailed in the
Program Operating Budget. Contractor will notify City promptly of any additional funding it
receives for operation of the Program, and City reserves the right to amend the Program
Operating Budget in such instances.
e. Contractor agrees to keep all CDBG monies on hand in interest bearing accounts. All
interest earned shall be reported to City on a monthly basis, at the same time as submission of
the monthly report following the end of the contract month during which the interest was
earned. Interest in an amount of $25.00 or less per month may be used for authorized program
expenses. These amounts must be reported on the monthly financial statements filed pursuant
to this contract. Interest earned in excess of $25.00 per month is subject to remittance to City
as directed by City.
f. Contractor will not commingle CDBG monies with any other funds in any manner which
would prevent City from readily identifying program expenditures for operation of the
Program.
3. Uniform Administrative Requirements and Program Management Standards
a. Financial Management
i. Accounting Standards
The Contractor agrees to comply with OMB Circular A-110 and agrees to adhere to the
accounting principles and procedures required therein, utilize adequate internal controls,
and maintain necessary source documentation for all costs incurred.
ii. Cost Principles
Contractor shall administer the Program in conformance with OMB Circular A-122, "Cost
Principles for Non-Profit Organizations" and attachments and revisions thereto, regarding
principles for determining costs for the Program.
b. Documentation and Record Keeping
i. Requirement
Contractor shall maintain all records pertinent to the activities to be funded under this
Agreement required by.HUD regulations specified in 24 CFR § 570.506. In addition,
Contractor agrees to keep records to fully document all expenditures charged to the CDBG
program. The documentation must support the amounts charged to Program and
demonstrate that the expenditures were appropriate to the stated goals of the Program and
allowable under applicable federal, state and City guidelines.
ii. Retention
(1) All records pertaining to Program shall be retained for four (4) years following the date
of termination of this contract. Contractor may destroy Program records at the end of this
four (4) year period if no outstanding audit finding exists.
2 XXX CDBGCNT July 2,2004
(2) Contractor will retain Program loan records until four (4) years after the expiration of
the loan.
iii. Property Records
The contractor shall maintain real property inventory records which clearly identify
properties purchased, improved, or sold. Properties retained shall meet eligibility criteria
and shall conform with 24 CFR§ 570.505.
iv. Close Outs
The Contractor's obligation to City shall not end until all close-out requirements are
completed. Activities during this close-out period shall include, but are not limited to:
making final payments, disposing of program assets (including the return of all unused
materials, equipment, unspent cash advances, program income balances, and accounts
receivable to City), and determining the custodianship of records.
v. Audits and Inspections
(1) City, HUD, and the United States Comptroller General, or their representatives, shall
have access to any books, documents, records and papers relating to the operations of
Contractor under this Agreement for the purpose of audit, examination, exception and
transcription at all reasonable hours at all offices of Contractor.
(2) For all contracts in which Contractor is cumulatively receiving federal monies in the
amount of $300,000 or more, Contractor must submit to City an annual audit prepared in
accordance with 24 CFR Sections § 570.502-570.503 generally, with specific reference to
OMB Circulars (with attachments) A-122 and A-133 as appropriate. The audit may cover
either Contractor's fiscal year during which this contract is in force or cover the period of
this contract. The audit must be prepared by an independent certified public accountant,
be completed within twelve (12) months following the end of the period being audited and
be submitted to City within thirty (30) days of its completion. Contractor's audit schedule
is attached hereto as Exhibit D - Audit Schedule. Costs of preparation of this audit may be
an allowable expenditure of CDBG funds in an amount proportional to that of the CDBG
funds used in contractor's total agency operating budget.
(3) City reserves the right to perform an audit of Contractor's program operations and
finances at any time during the term of this contract, if City determines that such audit is
necessary for City's compliance with OMB Circular A-128. Contractor agrees to allow
access to all pertinent materials. If such audit reveals a questioned practice or
expenditure, such questions must be resolved within fifteen (15) days after notice to
Contractor. If questions are not resolved within this period, City reserves the right to
withhold further funding under this and/or future contract(s).
(4) If as a result of any audit it is determined that Contractor has misused, misapplied or
misappropriated all or any part of the grant funds described herein, Contractor agrees to
reimburse the City the amount of such monies so misused, misapplied or misappropriated,
plus the amount of any sanction, penalty or other charge levied against City because of
such misuse, misapplication or misappropriation.
4. Reporting Procedures
Financial Reports
a. Contractor will submit to City on a monthly basis: (1) Attachment I, Attachment II,
Detailed Statement of costs; and (2) Attachment III, Expenditures worksheet as applicable,
for expenses incurred for services and activities accomplished by Contractor in
performance of this contract, and (3) Actual cash receipts for claimed expenditures must
be provided at the time the request for funds is presented. The reports must be signed by a
3 XXX CDBGCNT July 2,2004
duly authorized agent of the Contractor submitted by the 15`h of the month following the
month being reported.
b. Progress Reports
Contractor will submit monthly Attachment IV- Program Services Report, Attachment V, and
Attachment VI to City for services and activities undertaken by Contractor in performance of
this contract. The report will be signed by a duly authorized agent of Contractor and
submitted by the 15`'' of the month following the month which is reported.
c. Program Income
Contractor agrees that all program income from operation of the Program in proportion to the
amount of CDBG funds received hereunder will be expended prior to expending CDBG
monies and that any such program income is subject to the terms of this contract. CDBG
monies may be expended by the Contractor only if program income is insufficient to meet all
eligible program activity expenses. Contractor agrees to return to City at the end of the
Contract any remaining program income earned from operation of the Program in proportion
to the amount of CDBG funds in the overall operating budget.
d. Procurement
i. Compliance
The Contractor shall comply with City policy concerning the purchase of equipment and
shall maintain inventory records of all non-expendable personal property, as defined by
such policy,procured with funds provided herein.
ii. OMB Standards
The Contractor shall procure all materials, property, or services in accordance with the
requirements of OMB Circular A-110, Procurement Standards, and shall subsequently
comply with Property Management Standards as modified by 24 CFR 570.502(b)(vi),
covering utilization and disposal of property.
5. Reversion of Assets
a. Contractor agrees to return to City any CDBG funds remaining on hand at the end of the
Contract.
b. All property purchased with CDBG funds under this contract will be used solely for
operation of the Program. Contractor agrees to obtain City approval prior to purchase of
property. Contractor agrees to notify City upon receipt of property so that it may be properly
tagged and inventoried. Title to such property will be vested with the City, and, at the
termination of the Program for which CDBG funds have been received, Contractor will deliver
all such property to City for disposition at City's sole discretion.
6. Applicable Laws
a. Federal
Contractor agrees to comply with the following laws and the regulations issued thereunder as
they are currently written or are hereafter amended during performance of this contract:
• Title VI of the Civil Rights Act of 1964 (42 USC 2000d et seq)
• Title VIII of the Civil Rights Act of 1968 (42 USC 3601 et seq)
• Executive Orders 11063, 11246, as amended by 11375 and as supplemented by Department
of Labor regulations (41 CFR, Part 60)
4 XXX CDBGCNT July 27,2004
• The Age Discrimination in Employment Act of 1973 (29 USC 794)
• Section 504 of the Rehabilitation Act of 1973 (29 USC 794)
• The Immigration Reform and Control Act of 1986 (Pub. L. 99-603, 100 Stat. 3359, as
amended), specifically including the provisions requiring employer verification of the legal
status of its employees
• The Housing and Community Development Act of 1987 (Pub. L. 100-242, 101 Stat. 1815,
as amended)
• The Americans with Disabilities Act of 1990 (42 USC 12101 et seq)
b. Other Laws
Contractor covenants and agrees that its officers, members, agents, employees, program
participants and subcontractors shall abide by and comply with all other laws, federal, state
and local, relevant to the performance of this contract, including all ordinances, rules and
regulations of the City of Fort Worth and the Housing and Community Development Act of
1974 (Pub. L. 93-383, 885 Stat. 633,) as amended, and all regulations pertaining thereto.
Contractor further promises and agrees that it has read, and is familiar with, terms and
conditions of the Community Development Block Grant under which funds are granted and
that it will fully comply with same. It is agreed and understood that, if City calls the attention
of Contractor to any such violation on the part of Contractor or any of its officers, members,
agents, employees, program participants or subcontractors, then Contractor shall immediately
desist from and correct such violation.
7. Nondiscrimination
a. Contractor, in the execution, performance or attempted performance of this contract and
agreement, will not unlawfully discriminate against any person or persons because of sex,
race, religion, age, disability, color or national origin, nor will Contractor permit its officers,
members, agents, employees, subcontractors or program participants to engage in such
discrimination.
b. In accordance with the policy of the Executive Branch of the federal government,
Contractor covenants that neither it nor any of its officers, members, agents, employees,
program participants or subcontractors, while engaged in performing this contract, shall, in
connection with the employment, advancement or discharge of employees or in connection
with the terms, conditions or privileges of their employment, discriminate against persons
because of their age except on the basis of bona fide occupational qualification, retirement
plan or statutory requirement.
c. Contractor further covenants that neither it nor its officers, members, agents, employees,
subcontractors, program participants, or persons acting on their behalf, shall specify, in
solicitations or advertisements for employees to work on this contract, a maximum age limit
for such employment unless the specified maximum age limit is based upon a bona fide
occupational qualification, retirement plan or statutory requirement.
d. In accordance with the provisions of the Americans With Disabilities Act of 1990 ("ADA"),
Contractor warrants that it and any and all of its subcontractors will not unlawfully
discriminate on the basis of disability in the provision of services to the general public, nor in
the availability, terms and/or conditions of employment for applicants for employment with
Contractor, or employees of Contractor or any of its subcontractors. Contractor warrants it
will fully comply with ADA's provisions and any other applicable federal, state and local laws
concerning disability and will defend, indemnify and hold City harmless against any claims or
allegations asserted by third parties or subcontractors against City arising out-of Contractor's
5 XXX CDBGCNT July 2,2004
and/or its subcontractors' alleged failure to comply with the above-referenced laws concerning
disability discrimination in the performance of this agreement.
e. This agreement is made and entered into with reference specifically to the ordinances
codified at Chapter 17, Article III, Division 3 ("Discrimination in Employment Practices"), of
the City Code of the City of Fort Worth, and Contractor hereby covenants and agrees that
Contractor, its officers, members, agents, employees and subcontractors, have fully complied
with all provisions of same and that no employee, employee-applicant or program participant
has been discriminated against by the terms of such ordinances by either the Contractor or its
officers, members, agents, employees or subcontractors.
8. Prohibition Against Interest
a. No member, officer or employee of City or its designees or agents; no member of the
governing body of the locality in which the Program is situated; and no other public official of
such locality or localities, who exercises any functions or responsibilities with respect to the
Program funded hereunder during his or her tenure or for one year thereafter, shall have any
interest, direct or indirect, in any contract or subcontract, or the proceeds thereof, for work to
be performed hereunder. Contractor shall incorporate, or cause to be incorporated, like
language prohibiting such interest in all contracts and subcontracts hereunder.
b. No member, officer, employee, or program participant of Contractor or its subcontractors
shall have a financial interest, direct or indirect, in this contract or the monies transferred
hereunder or be financially interested, directly or indirectly, in the sale to Contractor of any
land, materials, supplies or services purchased with any funds transferred hereunder, except on
behalf of Contractor, as an officer, employee, member or program participant. Any willful
violation of this paragraph with the knowledge, expressed or implied, of Contractor or its
subcontractors shall render this contract voidable by the City of Fort Worth.
9. Minority and Women Business Enterprise Commitment
Contractor agrees to abide by the City of Fort Worth's policy to involve Minority and Women
Business Enterprises (MWBEs) in all phases its procurement practices and to provide them an
equal opportunity to compete for contracts for construction, provision of professional services,
purchase of equipment and supplies and provision of other services required by City.
Therefore, Contractor agrees to incorporate City Ordinance No. 15530, and all amendments or
successor policies thereto, into all contracts and will further require all persons or entities with
whom it contracts to comply with said Policy.
10. Non Assignment
Contractor will not assign any or all of its rights or responsibilities under this contract without
the prior written approval of City. Any purported assignment without such approval will be a
breach of this contract and void in all respects.
11. Independent Contractor
a. 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 work and services performed hereunder, and all
persons performing same, and shall be solely responsible for the acts and omissions of its
officers, members, agents, servants, employees, subcontractors, program participants,
6 XXX CDBGCNT July 2,2004
licensees or invitee. The doctrine of respondeat superior shall not apply as between City and
Contractor, its officers, members, agents, servants, employees, subcontractors, program
participants, licensees or invitees, 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, member, agent, employee, subcontractor, licensee or invitee of the
Contractor, not any program participant hereunder, is in the paid service of City and that City
does not have the legal right to control the details of the tasks performed hereunder by
Contractor, its officers, members, agents, employees, subcontractors, program participants,
licensees or invitees.
b. City shall in no way nor under any circumstances be responsible for any property belonging
to Contractor, its officers, members, agents, employees, subcontractors, program participants,
licensees or invitees, which may be lost, stolen, destroyed or in any way damaged; and
Contractor hereby indemnifies and holds harmless City and its officers, agents, and employees
from and against any and all claims or suits.
12. Insurance and Bonding
a. 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 kind or character, whether real or asserted, arising out of or in
connection with the execution, performance, attempted performance or nonperformance of
this contract and agreement and/or the operations, activities and services of the Program
described herein, whether or not caused, in whole or in part, by alleged negligence of officers,
agents, servants, employees, contractors or subcontractors of City; and 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 contract and agreement and/or the operations, activities and services
of the programs 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
or in connection with all acts or omissions of Contractor, its officers, members, agents,
employees, subcontractors, invitees, licensees, or program participants, or caused, in whole or
in part, by alleged negligence of officers, agents, servants, employees, contractors or
subcontractors of City.
b. Contractor will maintain a blanket fidelity coverage in the form of a bond in the amount of
$17,500.00, to insure against loss from the fraud, theft or dishonesty of any of Contractor's
officers, agents, trustees, directors or employees. The proceeds of such bond shall be used to
reimburse City for any and all loss of CDBG monies occasioned by such misconduct. To
effectuate such reimbursement, such bond shall include a rider stating that reimbursement for
any loss or losses thereunder shall be made directly to City for the uses and benefit of
Contractor.
c. Contractor shall furnish certificates of insurance as proof that it has secured and paid for
policies of workers' compensation, public liability and automobile liability insurance covering
all risks incident to or in connection with the execution, performance, attempted performance
or nonperformance of this contract and agreement. The amounts of such insurance shall not
be less than the maximum liability which can be imposed on City under the laws of the State
7 XXX CDBGCNT July 2,2004
of Texas. Contractor understands and agrees that such insurance amounts may be revised
upward at City's option and that Contractor shall revise such amounts within thirty (30) days
following notice to Contractor of such requirements.
d. Contractor will submit documentation to City that it has obtained insurance coverage and
has executed bonds as required in this contract within thirty (30) days of the execution of this
contract and prior to payment of any monies hereunder.
13. Waiver of Immunity
If Contractor, as a charitable or nonprofit organization, has or claims an immunity or
exemption (statutory or otherwise) from and against liability for damages or injury, including
death, to persons or property; Contractor hereby expressly waives its rights to plead defensively
such immunity or exemption as against City. This section shall not be construed to affect a
governmental entity's immunities under constitutional, statutory or common law.
14. Termination
a. In addition to, and not in substitution for, other provisions of this Agreement regarding the
provision of public services with CDBG funds, pursuant to Title I of the Housing and
Community Development Act of 1974, as amended, it is expressly understood and agreed by
and between the parties hereto that this agreement is wholly conditioned upon the actual
receipt by City of Federal CDBG Year XXX funds; that all monies distributed to Contractor
hereunder shall be exclusively from Federal monies received under said grant and not from any
monies of City; and that if such funds under said grant are not timely forthcoming, in whole or
in part, City may, at its sole discretion, terminate this contract and agreement and City shall
not be liable for payment for any work or services performed by Contractor under or in
connection with this contract.
b. City may terminate this contract whenever such termination is determined to be in the best
interest of City, in event of Contractor's default, inability or failure to perform or to comply
with any of the terms herein, or for other good cause.
c. The parties acknowledge that CDBG funds paid hereunder are intended to provide only
partial funding for Contractor's program operations. If non-CDBG funds included in the
Operating Budget are not forthcoming to Contractor during the contract term, City may
terminate this contract.
d. CDBG funds provided hereunder may not be used as collateral for loans to Contractor to
defray program operation expenses, and any attempted use of CDBG funds for this purpose
will result in termination of this contract by City.
e. Termination will be effected by written notice to Contractor, specifying the portions of the
contract affected and the effective date of termination. Upon Contractor's receipt of such
termination notice, Contractor will:
• Stop work under the contract on the date and to the extent specified by City;
• Cease expenditures of CDBG monies, except as necessary for completion of the portions of the
contract not terminated; and
• Terminate all orders and contracts to the extent that they relate to terminated portions of the
contract.
f. Contractor will return to City any unused monies previously advanced by City under this
contract within thirty (30) days of the effective date of contract termination. City will have no
responsibility or liability for Contractor's expenditures or actions occurring after the effective
date of contract termination.
8 XXX CDBGCNT July 2,2004
15. Certification Regarding Lobbying
a. The undersigned representative of Contractor hereby certifies, to the best of his or her
knowledge and belief, that: No federal appropriated funds have been paid or will be paid, by
or on behalf of Contractor, to any person for influencing or attempting to influence an officer
or employee of any agency, a member of Congress, an officer or employee of Congress or an
employee of a member of Congress in connection with the awarding of any federal contract,
the making of any federal grant, the making of any federal loan, the entering into of any
cooperative agreement and the extension, continuation, renewal, amendment, or modification
of any federal contract, grant, loan or cooperative agreement. Contractor shall require that the
language of this certification be included in all subcontracts or agreements involving the
expenditure of federal funds.
b. If any funds other than federal appropriated funds have been paid or will be paid to any
person for influencing or attempting to influence an officer or employee of any agency, a
member of Congress, an officer or employee of Congress, or an employee of a member of
Congress in connection with this federal contract, grant, loan or cooperative agreement,
Contractor shall complete and submit Standard Form-LLL, Disclosure Form to Report
Lobbying," in accordance with its instructions.
16. Miscellaneous Provisions
a. All terms of this contract shall apply to any and all subcontractors of Contractor who are in
any way paid with CDBG funds or who perform any work in connection with Contractor's
program.
b. The provisions of this agreement are severable, and, if for any reason a clause, sentence,
paragraph or other part of this agreement shall be determined to be invalid by a court or
federal or state agency, board or commission having jurisdiction over the subject matter
thereof, such invalidity shall not affect other provisions which can be given effect without the
invalid provision.
c. The failure of the City 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 right to assert or rely upon any such term or right on any
future occasion.
d. Should any action, whether real or asserted, at law or in equity, arise out of the execution,
performance, attempted performance or nonperformance of this contract and agreement,
venue for said action shall lie in Tarrant County,Texas.
e. This written instrument and the exhibits attached hereto, which are incorporated by
reference and made a part of this contract for all purposes, constitute the entire agreement
between 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. Any amendments to the terms of this contract must be in writing
and must be approved by each party to this contract.
9 XXX CDBGCNT July 2,2004
IN WITNESS WHEREOF, the parties heripto have executed four copies of this contract in
Fort Worth,Tarrant County,Texas, this day ofA.D. 20
CITY OF FORT WORTH Mental Health Association of Tarrant
County (Ombudsman)
By: ,� B
Y'.
Charles R. Boswell s. led Harris
Assistant City Manager Program Director
APPROVED AS TO FORM AND LEGALITY:
City Attorney
Date
ATTEST:
J�4L-
&t476toecretary
Cont act Authorization
Date
5
10 XXX CDBGCNT July 2,2004
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 Charles Boswell, 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 and that he/she executed the same as the act of said City of Fort Worth for
the purposes and consideration therein expressed and in the capacity therein stated.
GIVEN UNDER MY HAND AND SEAL OF OFFICE thisy
3 0 da of �-
,A.D. 20 0 q-.
io�PPY.°Lai: ROSELLA BARNES
NOTARY PUBLIC
State of Texas Notary Public in and for
Comm. Exp. 03-31-2005 the State of Texas
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 Ms. Lauralee Harris, known to me to be the person whose name is
subscribed to the foregoing instrument, and acknowledged to me that he\she executed the same
for the purposes and consideration therein expressed, as the act and deed for Mental Health
Association of Tarrant County (Ombudsman) and in the capacity therein stated as its duly
authorized officer or representative.
GIVEN VNDER MY HAND AND SEAL OF OFFICE this r day of ��/
A.D. 20
Notary P c in and for
N01AR1'11r11C QAIE OF TENAfi
.`-` J SEPTEIgg�sR�!�e20gj the State`of Texas
11 XXX CDBGCNT July 2,2004
APPENDIX A CONSTITUTIONAL PROVISION
Contractor represents that it is, or may be deemed to be, a religious or denominational institution or an organization
operated for religious purposes which is supervised or controlled by or in connection with a religious or
denominational institutional or organization. Pursuant to Title 24 CFR CH. V§ 570.2000). Contractor agrees that in
connection with this contract:
a. It will not discriminate against any person applying for such public services on the basis of religion
and will not limit such services or give preference to persons on the basis of religion,and;
b. It will not discriminate against any person applying for such public services on the basis of religion
and will not limit such services or give preference to persons on the basis of religion,and;
c. It vdll provide no religious instruction or counseling, conduct no religious worship or services, engage
in no religious proselytizing, and exert no other religious influence in the provision of such public
services,and;
d. Where public services provided under paragraph 0)(3) of section 24 CFR 570. 200 are carried out on
property owned by the primarily religious entity, CDBG funds may also be used for minor repairs to
such property which are directly related to carrying out the public services where the cost constitutes in
dollar terms only an incidental portion of the CDBG expenditure for the public services.
EXHIBIT A
PROGRAM SUMMARY
Mental Health Association of Tarrant County (Ombudsman)
AGENCY
Long Term Ombudsman
PROGRAM
00000 June 1, 2004-May 31, 2005 $17,500
CONTRACT NO. PERIOD AMOUNT
PROGRAM DESCRIPTION
Provide staff OMBUDSMAN services for residents of inner-city nursing facilities.
OMBUDSMAN will conduct weekly visits to monitor facilities, investigate
complaints, instruct staff and residents, and assist residents and families. CDBG
funds will be used to fund the salary for a Long Term Ombudsman staff person.
COUNCIL DISTRICT (S)
All
PROGRAM GOALS
Prevent abuse and neglect of residents in long-term care facilities.
PROGRAM OBJECTIVES
Resolve 95% of substantiated complaints
PROGRAM SERVICES and ACTIVITIES GOALS
Number of unduplicated clients served 750
Number of monitoring visits 340
Conduct resident interviews 15000
Resolve residents complaints 300
Inservice education 7
m
_m
T-
x
o
0 LO It O O ti
1l- Cl) to M
T O
CMN O N N
m 0
a
Q co to
N N N
r
` m O
:% CD N N N
C
W � a
J O d co N N N `-
V LL
c
W c� Cl) 00 LO to
2 i CD N N N O
\/ U E
X N d CMco D N N N O
W G
U 0 E ' O
Q V O L Z O N N o N 00 LO N
r
>- W u a E LO
-
0
vNi Q � o. ° D � 04 N
U Q d N CO LO LOO
� O N C14 N
(� J
_ o
^ Q CND N 00 N N O
LL
CND N O N
C O
Nco LO LO
CD N N N O
r
C Y �N cla
C_
O
a 0 E O
C0 @
C U
U O V
O_ N Ct C
C O N
' C N E d U
cn w
V O Q/ N `aL
9 E a
E :0 C O
M z U
z
CITY OF FORT WORTH EXHIBIT C
CDBG YEAR XXX
Page 1 of 3
CONTRACT PERIOD From: 6/1/2004 To: 5/31/2005
Name of Sub Grantee Name of Program
Mental Health Association of Tarrant County(Ombudsman) Long Term Ombudsman
Program CDBG
Cost Category Budget Funds a b c d
PERSONAL SERVICES
Salaries $18,437 $ 17,500.00 $ 937.00
FICA $ 1,410.00 $ 1,410.00
Life Insurance
Health Insurance $ 2,594.00 $2,594.00
Employment Tax-State $ 66.00 $ 66.00
Employment Tax- Federal
Worker's Comp $ 177.00 $ 177.00
Retirement $ 1,395.00 $ 1,395.00
SUPPLIES
Office Supplies
Postage
Teaching Aids
Food Supplies
Other Operating Expenses
CONTRACTUAL SERVICES
Telephone
Electric
Gas
Water/Waste Disposal $ 1,160.00 $ 1,160.00
Rent [Building]
Custodial Services
Office Equipment Rental
Printing
Repairs
Fidelity Bond $ 5.00 $ 5.00
Liability Insurance $ 260.00 $ 260.00
Legal &Accounting
Private Auto Allowance- Local $ 983.00 $ 983.00
Advertising
Conference & Seminars
Contractual Services
Miscellaneous $ -
CAPITAL OUTLAY $
Office-Furniture -
Computer Equipment $ -
Other: Described $ -
TOTAL $26,487.00 $17,500.00 $8,987.00 $0.00 so.bol $0.00
MATCHING FUND SOURCES
[a] MHA General
[b]
[c]
[d]
BUDGET DETAIL Page 2 of 3
PERSONAL SERVICES
Hourly Annual % of
Position/Title Rate Hours Time Amount
1. Staff Ombudsman LTC CDBG Omb 15.13 1820 64% $ 17,500.00
2
3
4
5
6
7
8
TOTAL STAFF SALARIES $ 17,500.00
FRINGE BENEFITS
%of % Paid % Paid
CATEGORY Payroll Amount by Agency by CDBG Amount
FICA
Life Insurance
Health Insurance
Employment Tax
Worker's Comp
Retirement
TOTAL FRINGE BENEFITS
TOTAL PERSONAL SERVICES
BUDGET DETAIL Page 3 of 3
UTILITIES
AVERAGE COST PER NUMBER OF MONTHS AMOUNT
CATEGORY MONTH
Telephone
Electric
Gas
Waste/Water Disposal
Other
Total Utilities $ -
BUILDING LEASE
BUILDING COST PER SQUARE
LOCATION NO. SQUARE FOOT FOOT AMOUNT
1
2
3
TOTAL BUILDING LEASE 0
OTHER EXPENSES
CATEGORY TOTAL CHARGE % CHARGED TO CDBG AMOUNT
rioenty bona
Liability Insurance
Legal &Accounting
Office Supplies
Postage
Printing
Mileage
Advertising
TOTAL OTHER EXPENSES $ -
CONFERENCES AND SEMINARS
EVENT TOTAL CHARGE % CHARGED TO CDBG AMOUNT
1
2
3
TOTAL CONFERENCES AND SEMINARS $ -
OFFICE EQUIPMENT RENTAL
ITEM TOTAL CHARGE % CHARGED TO CDBG AMOUNT
1 0%
2
TOTAL OFFICE EQUIPMENT RENTAL $ -
EXHIBIT "D"
AUDIT SCHEDULE
INDEPENDENT AUDIT REQUIREMENT
BUSINESS/AGENCY NAME: Mental Health Association of Tarrant County
PROGRAM: Long Term Ombudsman
CDBG YEAR: XXX
AMOUNT FUNDED: $17,500.00
Name of Independent Auditor who will perform agency audit:
Independent Auditor to be contracted during CDBG contract period.
Date audit is to be performed:
Within 60 days of completion of CDBG funded project.
The following language is a condition of your contract with the City:
(1) For all contracts in which Contractor is cumulatively receiving federal
monies in the amount of$300,000 or more, Contractor must submit to City an
annual audit prepared in accordance with 24 CFR Sections § 570.502-570.503
generally, with specific reference to OMB Circulars (with attachments) A-122
and A-133 as appropriate. The audit may cover either Contractor's fiscal year
during which this contract is in force or cover the period of this contract. The
audit must be prepared by an independent certified public accountant, be
completed within twelve (12) months following the end of the period being
audited and be submitted to City within thirty (30) days of its completion.
Contractor's audit schedule is attached hereto as Exhibit D - Audit Schedule.
Costs of preparation of this audit may be an allowable expenditure of CDBG
funds in an amount proportional to that of the CDBG funds used in contractor's
total agency operating budget.
This form is to be completed and submitted to the Intergovernmental Affairs and Grants
Management Division at the beginning of each contract year.
Signature
CITY OF FORT WORTH Attachment
INTERGOVERNMENTAL AFFAIRS AND GRANTS MANAGEMENT
CONTRACT MANAGEMENT DIVISION
REQUEST FOR FUNDS
AGENCY: MHA of Tarrant County PROGRAM: Long Term Ombudsman
ADDRESS: 3136 West 4th Street CONTRACT NUMBER:
Fort Worth, TX 76107 CONTRACT AMOUNT: $17,500.00
CONTRACT DATE: 6/1/2004
DATE OF REQUEST:
SECTION I (AGENCY) CURRENT MONTH CUMULATIVE
I. Reimbursement Request
1. Expenditures: $ $
2. Income
A. Program Income $ $
B. City of Fort Worth $ $
C. Interest Earned CDBG Funds $ $
3. Reimbursement(1 minus 2) $ $
II.Advance Pay Requests/Repayment $ $
III. Reporting Interest
1. Interest over$25 per quarter returned to City of Fort Worth $ $
SECTION II (CITY)
I. BYSPEED -Purchasing Request
A.BYSPEED INPUT:Vendor/PO Number/Requisition Number:
B. Fund/Account/Center: GR76/539120/002206929570
C.Total Amount of this Request: $
SECTION III
I. Verification
A. Contract Compliance Specialist Marilyn Jackson
(Name) (Signature) (Date)
B. BYSPEED-Purchasing
(Name) (Signature) (Date)
C. Accounting
(Name) (Signature) (Date)
II.Authorization
A. Agency Lauralee Harris
(Name) (Signature) (Date)
B. Contract Manager D.Emerson
(Name) (Signature) (Date)
C. Budget Director B. Garrett
(Name) (Signature) (Date)
Distribution:
1 Copy-Accounting
1 Copy-IAGM
1 Copy-Agency
CITY OF FORT WORTH CDBG ATTACHMENT 2
INTERGOVERNMENTAL AFFAIRS AND GRANTS MANAGEMENT
CONTRACT MANAGEMENT DIVISION
DETAIL STATEMENT OF COSTS
MHA of Tarrant County
AGENCY CONTRACT NO. DATE
Long Term Ombudsman TO
PROGRAM REPORT PERIOD
PROGRAM MONTHLY CUMULATIVE
COST CATEGORY ACCOUNT BUDGET EXPENDITURES TO DATE BALANCE
PERSONAL SERVICES
Salaries 516 010
FICA 518 010
Life Insurance 518 050
Health Insurance 518 060
Unemployment Tax-State 518 090
Worker's Com 518 040
Retirement 518 070
SUPPLIES
Office Supplies 521 010
Postage 521 020
Teaching Aids(Equipment) 522 030
Food Supplies 522 030
Other Operating Supplies 523 300
CONTRACTUAL SERVICES
Telephone 535 040
Electric 535 020
Gas[Utility] 535 010
WaterMaste Disposal 535 030
Rent[Building] 537 010
Custodial Services 539 220
Office Equipment Rental 537 030
Printing 533 030
Repairs 536 010
Fidelity Bond 538 210
Liability Insurance 534 020
Legal &Accounting 538 050
Private Auto Allowance-Local 532 130
Advertising 533 010
Conferences&Seminars 531 180
Contractual Services 539 120
CAPITAL OUTLAY
Furniture, Fixtures 541 330
Office Equipment, Com uters 541 370
Other Equipment 541 320
TOTAL
Contractors 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
NAME and TITLE OF AUTHORIZED OFFICER SIGNATURE and DATE
PREPARE ONE FORM FOR EACH SOURCE OF FUNDS
DISTRIBUTION:
I Copy-Accounting
I Copy -IAGM
I Copy -Agency 2 IA&GM FORM April 2002
ATTACHMENT 3
CITY OF FORT WORTH
INTERGOVERNMENTAL AFFAIRS AND GRANTS MANAGEMENT
CONTRACT MANAGEMENT DIVISION
EXPENDITURES WORKSHEET
MHA of Tarrant County
Agency Contract Number Date
Long Term Ombudsman 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
TOTAL
TITLE OF AUTHORIZED OFFICER SIGNATURE AND DATE
Distribution:
1 copy-Accounting
1 copy-IAGM
1 copy-Agency
CDBG ATTACHMENT 4A
CITY OF FORT WORTH
INTERGOVERNMENTAL AFFAIRS AND GRANTS MANAGEMENT
CDBG YEAR XXX
Public Service
1. Name and Address of Sub-Grantee
2. Project Name Long Term Ombudsman
MHA of Tarrant County
3136 West 4th Street 3. Contract No.
Fort Worth, TX 76107 4. Date of Request
Month &Year
5. Program Services and Activities
Current Month Cumulative
Number of New Households and/or Persons Served
6. Direct Benefit(Continued)
Low/Mod Low Income
Current Month
Cumulative
7. Age 0-4 5- 17 18-24 25-54 55.64 64+
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 aurate, and if a non-profit agency, has been approved by the governing body
of the organization prior to submission.
Date: Submitted by: 6Phone No.
Attachment 413
CITY OF FORT WORTH
INTERGOVERNMENTAL AFFAIRS AND GRANTS MANAGEMENT
CDBG YEAR XXX
Public Service
1. Name and Address of Sub-Grantee
2. Project Name Long Term Ombudsman
MHA of Tarrant
3136 West 4th Street 3. Contract No.
Fort Worth, TX 76107 4. Date of Request
Month &Year
8. Direct Benefit Data(New Household and/or Persons Served)
White Black/ Asian American Indian/ Native Hawaiian/ American Indian/ Asian
African Alaskan Native Other Pacific Alaskan Native &White
American Islander &White
#of Hispanic
Current Month
Cumulative
Am.Indian
Alaskan
Black/African Native&
American& Black/African Other Multi- Asian/Pacific
White American racial Islander Hispanic
#of Hispanic
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 curate, and if a non-profit agency, has been approved by the governing body
of the organization prior to submission.
Date: Submitted by: Phone No.
ATTACHMENT 5
CITY OF FORT WORTH
INTERGOVERNMENTAL AFFAIRS AND GRANTS MANAGEMENT
1.Agency/Address 2.Project Name: Long Term Ombudsman
MHA of Tarrant County 3.Contract No: Contract Date: 06/01/2004
3136 West 41h Street Contract Amount: $17,500.00
Fort Worth,TX 76107 4.Date of Request:
MONTH&YEAR
5. PROGRAM SERVICES AND ACTIVITIES: CURRENT CUMULATIVE
G. SCOPE OF WORK NARRATIVE:
7. PROBLEMS ENCOUNTERED / SOLUTIONS PROPOSED:
8. ANTICIPATED ACTIVITY DURING THE NEXT MONTH:
9. 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,and if a non-profit agency,has been approved by the governing body of the organization prior to submission.
Date: Submitted by: Phone Num:
v
a
d
t
O
a �
L .0
H V
Z L '
LU c
W m 0
0 .o 0
Q � 0
� o
Z c 'a
Q �
2 eCa '� c
y� e6 O �
V) E ° ' z
F- M o s , a>
Z O O +' C O
0 LO
E CD
r
2 0 � E � � � y
0 Q7 c N C
Z 0 LUi- m 0
Im
Q." o O -oo�•o
LL
Q ui O d o c
m
c -
LL LL Q E o f E �c c
m Z Q d
LL V >, d
O
,�,, U U w tC C E >0
an
J U t6 t4 0 d
Q } O
C C N d
!- W o 0 0 m
U W J a UUP s LL .0 �+
g V c.i ai 4 L6 c *t 0 -o
Z O
z
LL! U O
> = a
ea
O � �
0
w m
� � a
Z vi s
= x
> c
Q d 0
0 L
iO •O C a
p U0 to
C C
Q1
ax Low 9
M t0 rL+ N
C i '� •O C �
d d t M
w O d7
E
¢ � �' a�
= M t E
0m
� MLL Z ou
4
v
U
Q
O
yz
U
C6
C
O
U
a
m
Q
m
as
b
2
O
LL
a)
0
c
c`n E
d
E
r ca
c o U
d
v
R
R'
k
a7
cn
a,
Q
H
d
W
m
� = m
Q � 0
� o Z
H
W � �
_ � c
J p c
V U Q
L
U
(D
Q
O
a .
m �
o
•, E
a �
m �
a o
o
a E
m
.o
+ Z
, a>
C:
o
w R a
m 0,
a
c
M w
a) O
ED >4
a a
m O
3 �
O
= c
Y =
E >
wO
O O1
� d
a) w
m �
L a
O �
r >
� a
Y a
m `4
V c
c 0
m m
M
M L
M
N �
a7 V
> c
'� d
� k
t O T
a .n
a -a
� c �
c o �
c
a a a cn
°> c c
L
U 7 f4
Q M
y • V
Z
cU) O m -
c Im- a
o d c
� U �
u-
aJ
a)
o W i
10 U ea, Cl
Page 1 of 3
City of Fort Worth, Texas
Mayor and Council Communication
COUNCIL ACTION: Approved on 6/8/2004
DATE: Tuesday, June 08, 2004
LOG NAME: 02ACTIVITY REFERENCE NO.: **C-20095
SUBJECT:
Community Development Block Grant Year XXX, Emergency Shelter Grant Year 2004-2005, and
Housing Opportunities for Persons with AIDS 2004-2005 Contract Activities
RECOMMENDATION:
It is recommended that the City Council:
Authorize the City Manager to execute Community Develoment Block Grant (CDBG) Year XXX,
Emergency_ Shelter Grant (ESG) Year 2004-2005 and Housing Opportunities for Person with AIDS
(HOPWA) Year 2004-2005, contracts with the following organizations to administer their respective
programs, contingent upon approval and receipt of adequate funding from the U.S. Department of Housing
and Urban Development (HUD), for a term beginning June 1, 2004, and ending May 31, 2005:
I. Community Development Block Grant (CDBG)
Contract with the listed agencies for an amount not to exceed the following:
Southside Area Ministries (SAM'S Kids) $ 4 ,610
Habitat for Humanity $14,762.00
REACH, Inc. $19,683.00
Centro Cultural de las Americas $27,540.00
Boys and Girls Clubs (NINOS) $19,829.00
Boys and Girls Club (KEYS) $18,266.00
JMAC Yough Center of Tarrant County $25,000.00
East Fort Worth Montessori $22,385.00
Latin Arts Associaton $17,250.00
Summerbridge Fort Worth $27,338.00
CJ's Studio of Perfoming Arts $9,000.00
Women's Center of Tarrant County $27,000.00
YWCA of Fort Worth (AIM) $20,986.00
YWCA of Fort Worth (Child Care) $150,000.00
Child Care Associates $130,000.00
Fort Worth Housing Authority (AMAKA) $30,000.00
YMCA $120,375.00
Clayton Child Care $60,000.00
Southside Area Ministries (Mid South Seniors) $2,570.00
Senior Citizen Services of Tarrant County (COMO) $17,597.00
http://www.cfwnet.orq/council_packet/Reports/mc_priot.asp 6/14/2004
Page 2 of 3
Meals on Wheels $33,696.00
Senior Citizen Services of Tarrant County (RIVERSIDE) $15,271.00
Mental Health Association (OMBUDSMAN) $17,500.00
Mental Health Associstion (Advocate) $24,750.00
Northside Inter-Church Agency $28,933.00
Southside Area Ministries (Adult ESL) $3,500.00
Day Resource Center $30,000.00
Presbyterian Night Shelter (Bottle Deposit) $30,000.00
Job, Inc. $73,198.00
Fort Worth SER $72,224.00
A-PREP Center of Tarrant County $71,745.00
Fort Worth Economic Development Corp. (RLF) $51,908.00
TOTAL CDBG $1,216,916.00
II. Emergency Shelter Grant (ESG)
YWCA (Supportive Living) $13,500.00
Cornerstone Assistance Network $13,568.00
Presbyterian Night Shelter (Shelter) $151,308.00
Bridge Emergency Youth Services $7,082.00
Women's Haven of Tarrant County, Inc. $21,683.00
Presbyterian Night Shelter (Infirmary) $15,040.00
MHMR of Tarrant County $16,117.00
YWCA (My Own Place) $19,794.00
TOTAL ESG $258,092.00
III. Housing Opportunities for Persons with HIV/AIDS (HOPWA)
AIDS Outreach Center, Inc. $462,620.00
Tarrant County Samaritan Housing, Inc. $242,539.00
AIDS Resources of Rural Texas $104,791.00
TOTAL HOPWA $809,950.00
DISCUSSION:
On April 6,.2004, the City Council approved and adopted the budgets and the appropriation ordinance
increasing estimated receipts and appropriations for the Thirtieth (30th) Year Community Development
Block Grant (CDBG), (2004-2005), Emergency Shelter Grant (ESG), and (2004-2005) Housing
Opportunities for Persons with AIDS (HOPWA), grant funds as part of the City's Consolidated Action Plan.
The Consolidated Action Plan, as adopted by the City Council, included program descriptions for each of
the above funded programs.
The above programs are consistent with the City's approved priorities and the City Council's prior policies
and meet the requirements of the Department of Housing and Urban Development (HUD) regulations
conceming eligible "activities."
http://www.cfwnet.org/council_packet/Reports/mc_print.asp 6/14/2004
Page 3 of 3
FISCAL INFORMATION/CERTIFICA"PION:
"rhe Finance Director certifies that funds will be available in the current operating budget, as appropriated,
of the Grants Fund contingent upon approval and receipt of adequate funding from the U.S. Department of
Housing and Urban Development (HUD) for the term beginning June 1, 2004, and ending May 31, 2005.
TO Fund/Account/Centers FROM Fund/Account/Centers
GR76 5 $258,092.00
(VARIOUS) XXX206931XXX
GR76 5 $809,950.00
(VARIOUS) XXX206932XXX
GR76 5 $1,216,916.00
(VARIOUS) XXX206929XXX
Submitted for City Manager's Office by_ Charles Boswell (8511)
Originating Department Head: Bridgette Garrett (6183)
Additional Information Contact: Deidra Emerson (7563)
http:�(www.cfwnet.osa,(caonctl__packet/Reports/mc—print.osp 6/14/2004