HomeMy WebLinkAboutContract 25931 STATE OF TEXAS §
COUNTY OF TA.RRANT § CITY SECRETARY
CONTRACT NO. I
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 Camp Fire ("Contractor"), by
and through Ms. Sharron Spriggs, its duly authorized Assistant Executive Director. Contractor's business
address is 2700 Meacham Blvd., Fort Worth, Texas 76137.
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 XXVI; and,
WHEREAS,the primary purpose of the CDBG Program is to benefit low and moderate income citizens
of Fort Worth; and,
WHEREAS, the citizens of Fort Worth, the Community Development Council, and the City Council
of Fort Worth have determined that Public Services 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 Youth services to citizens of the City of Fort Worth under the program
name DHS Prime Time ("Program"), for the term 1 June, 2000 to 31 May, 2001.
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 XXVI monies in an amount up to $27,000 to Contractor on a
reimbursement of expenses basis.
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XXVI CDBGCNT May 19,2000 1 = N .0 A
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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.
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 $ 93,959 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 five (5) years following the date of
termination of this contract. Contractor may destroy Program records at the end of this five (5)year
period if no outstanding audit finding exists.
(2) Contractor will retain Program loan records until five (5)years after the expiration of the loan.
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XXV1 CDBGCNT May 19,2000 2
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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
a. 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 t.— operating
budget.
b. Progress Reports iQ) �
XXVI CDBGCNT May 19,2000 3
i. Contractor will submit monthly Attachment IV-Program Services Report 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 15fl' of the month following the month
which is reported. 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. 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 Attachment
N, Property Management Standards as modified by 24 CFR 570.502(b)(6), 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)
• 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
XXVI CDBGCNT May 19,2000 4 �� (c1�� (^'F V V
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 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 interes ect-e any
contractor subcontract, or the proceeds thereof, for work to be performed ert ®F ( . V hall
XXVI CDBGCNT May 19,2000 5
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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. 11923, 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, 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,
nor 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.
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XXVI CDBGCNT May 19,2000 6 Ird p�ppyp�nlr R
IN WITNESS WHEREOF, the parties hereto have executed four copies of this contract in Fort Worth,
Tarrant County, Texas, this day of Ckove., A.D. 20 63r—.
CITY OF FORT WORTH Camp Fire
By: 0109lj'�— By:
Charles R. Boswell . Sharron Spn gs
Assistant City Manager Assistant Executive Director
APPROVED AS TO FORM AND LEGALITY:
ityA rney ,
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Date
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contract Authorization
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XXVI CDBGCNT May 19,2000 10 �lite p e
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 this &4-k day of � e ,
A.D. 20 00 .
A
�,�►" "�% Pk 7dCIA A. GARCIA Notary Public in and for
NOTARY PUBLIC the State of Texas
�+ State of Texas
„A comm. Exp. 03+31-2001
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. Sharron Spriggs, 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 Camp Fire and in the capacity therein stated as its
duly authorized officer or representative.
GIVEN UNDER MY HAND AND SEAL OF OFFICE this Y da of
,
A.D. 20 W .
Notary Public in and for
the State of Texas
Oo0o0�00
ANN SHEETS
�:.
.; • Notary Public,State of Texas
�;;F•d ;�My Commission Exp.01-12-2002
NAA 'KIND
XXVI CDBGCNT May 19,2000 11 R. WOO,�117HO 01
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EXHIBIT A
CDBG xxvl
PROGRAM SUMMARY
Camp Fire
AGENCY
DHS Prime Time
PROGRAM
1 June, 2000 to 31 May, 2001 $27,000
CONTRACT NO. PERIOD AMOUNT
PROGRAM DESCRIPTION
After school programming for middle and high school youth
Council District(s)2
PROGRAM GOALS
To provide a safe learning environment for youth 11-15 during non school hours
PROGRAM OBJECTIVES
The objective is to develop self-esteem, self-confidence,and give them the tools to deal with peer pressure,negative influences,
drugs,gangs,and violence
PROGRAM SERVICES and ACTIVITIES GOALS
Homework assistance 25
Educational field trips 25
Prevention Curriculum 25
Service learning curriculm 25
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FoOkTH
FAX Date:
Number of pages including cover sheet:
To: From:
Phone: Phone:
Fax phone: $S� A,7aO Zd Fax phone: (817)871-8383
CC:
REMARKS: ❑ Urgent t For your review Nr Reply ASAP ❑ Please comment
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FISCAL SERVICES
INTERGOVERNMENTAL AFFAIRS AND GRANTS MAN, � 0
THE CrrY of FORT WORTH # 1000 THROCKMORTON STREET * FORT WORTH, TEXAS 76102
FAx (817) 871-8383
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TIME 05..-'19/200CI 16: 31
NAME IAGt-.-!
FAK 8178718383
TEL 8178717550
DATE TIME 05/19 16: 30
FAX
DATE,TIME
98315070
DURATION 00: 00: 55
PAGES) 02
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CITY OF FORT WORTH EXHIBIT C
CDBG YEAR XXVI
Page 1 of 3
CONTRACT PERIOD From: 6/1/00 To: 5/31/01
Name of Sub Grantee Name of Program
Camp Fire Boys and Girls DHS Prime Time
Program CDBG
Cost Category Budget Funds [u] [b] [c] [d]
PERSONAL SERVICES
Salaries $ 61,593.00 $ 20,528.00 $ 8,584.00 $32,481.00
FICA $ 4,711.00 $ 1,570.00 $ 3,141.00
Life Insurance $ -
Health Insurance $ 2,352.00 $ 2,352.00
Unemployment-State $ 1,231.00 $ 410.00 $ 821.00
Unemployment-Federal $ -
Worker's Comp $ 1,232.00 $ 139.00 $ 1,093.00
Retirement $ 2,669.00 $ 2,669.00
SUPPLIES
Office Supplies $ 200.00 $ 200.00
Postage $ 50.00 $ 50.00
Teaching Aids $ 1,000.00 $ 1,000.00
Food Supplies $ -
Other Operating Expenses $ 5,071.00 $ 4,353.00 $ 718.00
CONTRACTUAL SERVICES
Telephone $ 1,000.00 $ 1,000.00
Electric $ 4,000.00 $ 4,000.00
Gas $ 600.00 $ 600.00
Water/Waste Disposal $ 400.00 $ 400.00
Rent[Building] $ 500.00 $ 500.00
Custodial Services $ 3,300.00 $ 3,300.00
Office Equipment Rental $ -
Printing $ 100.00 $ 100.00
Repairs $ 1,000.00 $ 1,000.00
Fidelity Bond $ 750.00 $ 750.00
Liability Insurance $ 1,200.00 $ 1,200.00
Legal&Accounting $ -
Private Auto Allowance- Local $ 500.00 $ 500.00
Advertising $ -
Conference&Seminars $ 500.00 $ 500.00
Contractual Services $ -
Miscellaneous $ -
CAPITAL OUTLAY $ -
Ice Furniture -
Computer Equipment $ -
Other: [Described] $ -
TOTAL $93,959.00 $27,000.001 $15,952.001 $51,007.001 $0.001 $0.00
MATCHING FUND SOURCES
[a] Private Foundations/Contribution
[b] United Way
[c]
[d]
W
BUDGET DETAIL Page 2 of 3
PERSONAL SERVICES
Hourly Annual %of
Position/Title Rate Hours Time Amount
1 Assistant Executive Director $ 18.99 880 10% $ 1,671.00
2 Program Director $ 12.38 1760 30% $ 6,537.00
3 Program Specialist $ 7.00 880 100% $ 6,160.00
4 Program Specialist $ 7.00 880 100% $ 6,160.00
5
6
7
8
9
10
11
TOTAL STAFF SALARIES $ 20,528.00
FRINGE BENEFITS
%of % Paid % Paid
CATEGORY Payroll Amount by Agency by CDBG Amount
0 7.65 $ 1,570.00 100 $ 1,570.00
FICA 0 0
Life Insurance 0 0
Health Insurance 0 0
Unemployment Insurance 2% $ 410.00 100% $ 410.00
Worker's Comp 0.68% $ 139.00 100% $ 139.00
Retirement 0 0
TOTAL FRINGE BENEFITS $ 2,119.00
TOTAL PERSONAL SERVICES $ 22,711.00
R1,RAW
BUDGET DETAIL Page 3 of 3
UTILITIES
Number of Months Amount
Category Average Cost Per Month
Telephone
Electric
Gas
Waste/Water Disposal
Other: Program Supplies and
van transportation $ 428.00 10 $ 4,282.00
Total Utilities $ 4,282.00
BUILDING LEASE
Building
Location No. Square Foot Cost Per Square Foot Amount
1
2
3
TOTAL BUILDING LEASE
OTHER EXPENSES
Category Total Charge % Charged to CDBG Amount
Fidelity Bond
Liability Insurance
Legal&Accounting
(Other)Food
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
2
3
TOTAL OFFICE EQUIPMENT RENTAL
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EXHIBIT "D"
AUDIT SCHEDULE
INDEPENDENT AUDIT REQUIREMENT
BUSINESS/AGENCY NAME: Camp Fire
PROGRAM: DHS Prime Time
CDBG YEAR: XXVI
AMOUNT FUNDED: $27,000
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
ATTACHMENT I
CITY OF FORT WORTH
INTERGOVERNMENTAL AFFAIRS AND GRANTS MANAGEMENT
CONTRACT MANAGEMENT DIVISION
REQUEST FOR FUNDS
AGENCY: Camp Fire
2700 Meacham Blvd. PROGRAM NAME: DHS Prime Time
Fort Worth,Texas 76137 CONTRACT NUMBER:
CONTRACT AMOUNT: $27,000 CONTRACT DATE:
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.MARS—Purchasing Request
A. MARS INPUT:Vendor/PO Number/Requisition Number:
B. Fund/Account/Center: GR76/539120/013206132370
C. Total Amount of this Request: $
SECTION III
I. Verification
A. Contract Manager Tamika Miller
(Name) (Signature) (Date)
B.MARS—Purchasing
(Name) (Signature) (Date)
C.Accounting
(Name) (Signature) (Date)
II.Authorization
A. Agency
(Name) (Signature) (Date)
B. Contract Compliance Supervisor
(Name) (Signature) (Date)
C. Assistant to the City Manager
(Name) (Signature) (Date)
DISTRIBUTION:
White -Accounting
Blue -IAGM —- -
Green -Agency !Gti i�7i �G_ E"i' LeD
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CITY OF FORT WORTH ATTACHMENT 11
INTERGOVERNMENTAL AFFAIRS AND GRANTS MANAGEMENT
CONTRACT MANAGEMENT DIVISION
DETAIL STATEMENT OF COSTS
AGENCY CONTRACT NO. DATE
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 Comp 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
Water/Waste 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,Computers 541 370
Other Equipment 1 541 320
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
NAME and TITLE OF AUTHORIZED OFFICER SIGNATURE and DATE
PREPARE ONE FORM FOR EACH SOURCE OF FUNDS
DISTRIBUTION:
Whke:AmwtiYq
Bee::A
Green:Agency `FFKULf, RD
Cffy t�tEI [R) °,R,y
ATTACHMENT III
CITY OF FORT WORTH
INTERGOVERNMENTAL AFFAIRS AND GRANTS MANAGEMENT
CONTRACT MANAGEMENT DIVISION
EXPENDITURES WORKSHEET
Camp Fire
Agency Contract Number Date
DHS Prime Time TO
Program REPORT PERIOD
NO DATE CHECK PAYEE DESCRIPTION ACCOUNT NO. AMOUNT
NO.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
26
TOTAL
TITLE OF AUTHORIZED OFFICER SIGNATURE
DISTRIBUTION
White:Accounting (�Orf C'FCC� ny
Blue:IAGM (�� �d1,I�� �, � �Jf
Green: If Co VC JIf�p II LS/No Agency
ATTACHMENT IV
CITY OF FORT WORTH
INTERGOVERNMENTAL AFFAIRS AND GRANTS MANAGEMENT
CDBG XXVI
Youth
1.NAME AND ADDRESS OF SUB-GRANTEE 2.PROJECT NAME: DHS Prime Time
Camp Fire 3.CONTRACT NO: CONTRACT NO:
2700 Meacham Blvd.
Fort Worth,Texas 76137 4.DATE OF
REQUEST:
MONTH&YEAR
5. PROGRAM SERVICES AND ACTIVITIES
CURRENT MONTH CUMULATIVE
Number of New Households and/or Persons Served
6A. DIRECT BENEFIT DATA(New Household and/or Persons Served)
American Total
White Black- Hispanic Asian Pacific Indian Female-
Non- Non- Islander Alaskan Head-
Hispanic Hispanic Native Of
Household
CURRENT MONTH
CUMULATIVE
6B. DIRECT BENEFIT(CONTINUED)
Low/Mod Low Income
Beneficiaries Beneficiaries
CURRENT MONTH
CUMULATIVE
7. AGE
0-4 5-17 18-24 25-54 55-64 64+
CURRENT MONTH
CUMULATIVE
v
8. CERTIFICATION: The undersigned hereby gives assurance that to the best of my knowle ge��id�j�glia=# 1a i luded in
this report is true and accurate, and if a non-profit agency, has been approved by the governing rior to
submission.
Date: Submitted by: Phone Num:
IAGM/IDIS-RPT FORM 3
ATTACHMENT IV
CITY OF FORT WORTH
INTERGOVERNMENTAL AFFAIRS AND GRANTS MANAGEMENT
CDBG XXVI
Youth
1.NAME AND ADDRESS OF SUB-GRANTEE 2.PROJECT NAME: DHS Prime Time
Camp Fire 3.CONTRACT NO: CONTRACT NO:
2700 Meacham Blvd.
Fort Worth,Texas 76137 4.DATE OF
REQUEST:
MONTH&YEAR
5. REPORT NARRATIVE: USE THIS SPACE TO EXPLAIN HOW LONG YOUR PROGRAM HAS BEEN IN OPERATION,
WHAT PERCENTAGE OF LOW AND MODERATE INCOME PERSONS ARE BEING SERVED,AND SUMMARIZE YOUR
PROGRAM IN DETAIL.
8. CERTIFICATION: The undersigned hereby gives assurance that to the best of my knowledge I ed 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:
IAGM/IDIS-RPT FORM 3
ATTACHMENT IV(A)
CITY OF FORT WORTH
INTERGOVERNMENTAL AFFAIRS AND GRANTS MANAGEMENT
1.Name and Address of Sub-Grantee 2.Project Name: DHS Prime Time
Carne Fire 3.Contract No: Contract Date:
2700 Meacham Blvd. Contract Amount: $27,000
Fort Worth,Texas 76137 4.Date of Request:
MONTH&YEAR
5. PROGRAM SERVICES AND ACTIVITIES: CURRENT CUMULATIVE
6. 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 �I2 (It);►ta i is
report is true and accurate,and if a non-profit agency,has been approved by the governing body of the o ada, a�046A�=i n.
c ,� c��IVa')
Date: Submitted by: Phone Num..
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IAGM/IDIS-RPT FORM 7A
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City of Fort Worth, Texas
imayor And Council C.001"Munication
DATE REFERENCE NUMBER LOG NAME PAGE
5/2/00 **C-17991 13CONTRACTS 1 of 3
SUBJECT COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) YEAR XXVI, EMERGENCY
SHELTER GRANT (ESG) YEAR 2000-2001, AND HOUSING OPPORTUNITIES FOR
PERSONS WITH AIDS HOP. A YEAR 2000-2001 CONTRACT ACTIVITIES
RECOMMENDATION:
It is recommended that the City Council authorize the City Manager to execute CDBG Year XXVI, ESG
Year 2000-2001 and HOPWA Year 2000-2001 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, 2000, and ending
May 31, 2001:
COMMUNITY DEVELOPMENT BLOCK GRANT(CDBG)
Contract with the listed agencies for an amount not to exceed the following:
A. NHS of Fort Worth, Inc. $ 55,958
B. Habitat for Humanity $ 22,500
C. REACH, Inc. $ 27,000
D. Communities in School $ 40,050
E. Southside Area Ministries (Sam's Kids) $ 7,027
F. Boys and Girls Clubs (JACKS) $ 19,111
G. Boys and Girls Clubs (KEYS) $ 28,344
H. Boys and Girls Clubs (PASS) $ 27,000
I. Bee & Bell Education Center $ 35,429
J. Big Brothers and Big Sisters of Tarrant County $ 15,094
K. Booker T. Sparks School of the Performing Arts $ 36,000
L. Bridge Emergency Youth Services $ 45,000
RVAStone Soup Connection $ 20,120
N. Camp Fire $ 27,000
O. YWCA of Fort Worth (AIM) $ 31,986
P. YWCA of Fort Worth (Child Care) $150,000
Q. Day Care Association $130,000
R. Fort Worth Housing Authority $ 30,000
S. YMCA of Fort Worth $120,375
T. Clayton Child Care $ 31,500
U. Southside Area Ministries (Seniors) $ 2,570
V. Senior Citizens Services of Tarrant County (Como) $ 17,597
W. Meals on Wheels $ 33,696
X. Senior Citizens Services of Tarrant County (Riverside) $ 15,271
Y. Mental Health Association $ 17,500
Z. Near Northside Partners $ 17,100
(list continued next page)
City of Fort Worth, Texas
"Agar AndC oun"R Communication
DATE REFERENCE NUMBER LOG NAME PAGE
5/2/00 **C-17991 1 13CONTRACTS 1 2 of 3
SUBJECT COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) YEAR XXVI, EMERGENCY
SHELTER GRANT (ESG) YEAR 2000-2001, AND HOUSING OPPORTUNITIES FOR
PERSONS WITH AIDS HOPWA YEAR 2000-2001 CONTRACT ACTIVITIES
AA. NSEAM $ 17,100
BB. Women's Center of Tarrant County $ 11,880
CC. Job, Inc. $111,565
DD. Fort Worth SER $110,079
EE. A-Prep Center of Tarrant County $109,350
FF. ACCION Texas $ 54,000
EMERGENCY SHELTER GRANT(ESG)
A. YWCA $°27,214
B. Cornerstone Assistance Network $ 16,750
C. Presbyterian Night Shelter $168,120
D. Bridge Emergency Youth Services $ 8,736
E. Women's Haven of Tarrant County, Inc. $ 26,769
F. Salvation Army $ 10,811
HOUSING OPPORTUNITIES FOR PERSONS WITH AIDS (HOPWA)
A. AIDS Outreach Center, Inc. $412,683
B. Tarrant County Samaritan Housing, Inc. $192,609
C. AIDS Resources of Rural Texas-A.R.R.T. $ 54,858
DISCUSSION:
On April 11, 2000, the City Council approved and adopted the budgets and the appropriation ordinance
increasing estimated receipts and appropriations for the Twenty-Sixth (26th) Year Community
Development Block Grant, (2000-2001) Emergency Shelter Grant (ESG) and (2000-2001) Housing
Opportunities for Persons with AIDS (HOPWA) as part of the City's Consolidated Plan. The
Consolidated 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 HUD's regulations concerning "eligible activities".
t
City of Fort Worth, Texas
4tayor And Coun"R Commansun"9101-cation
DATE REFERENCE NUMBER LOG NAME PAGE
5/2/00 **C-17991 13CONTRACTS 3 of 3
SUBJECT COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) YEAR XXVI, EMERGENCY
SHELTER GRANT (ESG) YEAR 2000-2001, AND HOUSING OPPORTUNITIES FOR
PERSONS WITH AIDS HOPWA YEAR 2000-2001 CONTRACT ACTIVITIES
FISCAL INFORMATION/CERTIFICATION:
The Finance Director certifies that, upon approval and receipt of adequate funding from the U.S.
Department of Housing and Urban Development, funds will be available in the operating budget, as
appropriated, of the Grants Fund.
CB:j
Submitted for City Manager's FUND ACCOUNT CENTER AMOUNT CITY SECRETARY
Office by: (to)
APPROVED
Charles Boswell 8511 CITY COUNCIL
Originating Department Head:
Joe Paniagua 6168 (from) MAY 2 2000
Additions!Information Contact:
City Secretary of the
City of Fort Worth,Terse
Joe Paniagua 6168