HomeMy WebLinkAboutExhibit 11(I�►./.Ili.l t
Me �105 111 UM 0 RVAA9.,
1. SUBRECIPIENT understands that the National Objective is assistance to low to moderate income
households.
2. SUBRECIPIENT will recruit program participants that meet the following criteria:
a) Must be a resident of the Lotus House located at 217 NW 15a' Street in the City of
Miami, Florida
b) Must be a member of a low -to moderate income household
C) Must be at least 18 years of age
3. SUBRECIPIENT will submit the following information to the City of Miami Department
of Community Development to obtain certification that proposed participant is eligible to
receive program benefits and for SUBRECIPIENT to invoice the CITY for services
provided.
a) Program Application, in a form provided by the City of Miami Department of
Community Development, signed by prospective participant
b) Proof of residency
C) Proof of income
d) Proof of age
4. SUBRECIPIENT may replace participants who stop receiving program benefits by
providing the information required in 2 above. SUBRECIPIENT will not invoice the
CITY of Miami until the proposed participant is certified as eligible by the CITY.
5. SUBRECIPIENT will provide:
a) Services to a minimum of homeless individuals, on a monthly basis, at the
following sites:
Services will be provided for up to a total of program days. The program is
available between A.M. and P.M.
SUBRECIPIENT will provide program reports for the services provided to the
participants in a form provided by the CITY.
6. Program will commence on October 1, 2009 and will end on September 30, 2010.
SIGNED:
Name: Date
Executive Director
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before me this by
, Executive Director of , Inc., a Florida not-for-profit
corporation, on behalf of the corporation. He/she is personally known to me or has produced
as identification.
Print Notary Public's Name Signature
(SEAL)