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HomeMy WebLinkAboutAttachmentsSubrecipient Agreement Attachment List Signature Re wired Attachment Title Attachment A U.S. HUD Grant Renewal Agreement includes: HUD designated Attachments A and B Attachment A-1 Sco of Service Attachment A-2 Umts/Bedrooms/Beds Chart and Participants Chart Attachment. A-3 Program Goals Attachment A4 Milestones (N/A for Renewal Grants) Attachment B Technical Submission Attachment C LOCCS/VRS form HUD -27053A Attachment C-1 Co y of Homeless Trust Invoice Attachment D FMS (ITUD-40118) Monthly Progress Report Attachment E Program Rating of Satisfaction Attachment F Client Contribution Re rt Attachment G Annual Pro ess Report (APR) Attachment G-1 IMS (HUD -40118) Annual Progress Re ort (APR) Signature Attachment H Request for Taxpayer Identification and Certification Signature Attachment I HUD form -40090-4 Applicant Certification Signature Attachment J Miami -Dade County Required Affidavits Signature Attachment K Affidavit Lobbyist Registration for Oral Presentation Signature Attachment L Disclosure of Subcontractors and Suppliers Signature Attachment M Subcontractor / Suppliers Listing Signature Attachment N Section 3 Compliance Requirements lr Signature Attachment O Sworn Statement Pursuant to Florida Statutes Attachment P Provider Asset Inventory form if applicable Attachment Q Declaration of Restrictive Covenants if a licable Attachment Q-1 Declaration of Restrictions Attachment R Em loyee Certification Form Attachment S Incident Report (3 -pages) ATTACHMENT A Recipient: Miami -Dade County Address: 111 NW I" Street, 27`h Floor, Suite 310, Miarni, FL 33128 Tax ID #: 59-6000573 Project Location: Miami -Dade County 2008 SUPPORTIVE HOUSING PROGRAM RENEWAL GRANT AGREEMENT This Grant Agreement is made by and between the United States Department of Housing and Urban Development (HUD) and the Recipient, which is described in section 1 of Attachment A, attached hereto and made a part hereof. The assistance which is the subject of this Grant Agreement is authorized by the McKinney- Vento Homeless Assistance Act 42 U.S.C. 11381 (hereafter "the Act"). The term "grant" or "grant funds" means the assistance provided under this Agreement. This grant agreement will be governed by the Act, the Supportive Housing rule codified at 24 CFR 583, which is attached hereto and made a part hereof as Attachment B, and the Notice of Funding Availability (NOFA) that was published in two parts. The first part was the Policy Requirements and General Section of the NOFA, which was published March 19, 2008 at 73 FR 14882, and the second part was the Continuum of Care Homeless Assistance Programs NOFA Section of the NOFA, which was published July 10, 2008 at 73 FR 39840. The term "Application" means the original and renewal application submissions on the basis of which a Grant was approved by HUD, including the certifications and assurances and any information or documentation required to meet any grant award conditions. The Application is incorporated herein as part of this Agreement, however, in the event of conflict between the provisions of those documents and any provision contained herein, this Renewal Grant Agreement shall control. The Secretary agrees, subject to the terms of the Grant Agreement, to provide the grant funds in the amount specified at section 2 of Attachment A for the approved project described in the Application. The Recipient agrees, subject to the terms of the Grant Agreement, to use the grant funds for eligible activities during the grant term specified at section 3 of Attachment A. The Recipient must provide a 25 percent cash match for supportive services. The Recipient agrees to comply with all requirements of this Grant Agreement and to accept responsibility for such compliance by any entities to which it makes grant funds available. The Recipient agrees to participate in a local Homeless Management Information System (HMIS) when implemented. The Recipient and project sponsor, if any, will not knowingly allow illegal activities in any unit assisted with grant funds. The Recipient agrees to draw grant funds at least quarterly. Miami -Dade County. FLOI89B4D000801 HUD notifications to the Recipient shall be to the address of the Recipient as written above, unless HUD is otherwise advised in writing. Recipient notifications to HUD shall be to the HUD Field Office executing the Grant Agreement. No right, benefit, or advantage of the Recipient hereunder be assigned without prior written approval of HUD. For any project funded by this grant, which is also financed through the use of the Low Income Housing Tax Credit, the following applies: HUD recognizes that the Recipient or the project sponsor will or has financed this project through the use of the Low -Income Housing Tax Credit. The Recipient or project sponsor shall be the general partner of a limited partnership formed for that purpose. If grant funds were used for acquisition, rehabilitation or construction, then, throughout a period of twenty years from the date of initial occupancy or the initial service provision, the Recipient or project sponsor shall continue as general partner and shall ensure that the project is operated in accordance with the requirements of this Grant Agreement, the applicable regulations and statutes. Further, the said limited partnership shall own the project site throughout that twenty-year period. If grant funds were not used for acquisition, rehabilitation or new construction, then the period shall not be twenty years, but shall be for the term of the grant agreement and any renewal thereof. Failure to comply with the terms of this paragraph shall constitute a default under the Grant Agreement. A default shall consist of any use of grant funds for a purpose other than as authorized by this Grant Agreement, failure in the Recipient's duty to provide the supportive housing for the minimum term in accordance with the requirements of Attachment A, noncompliance with the Act or Attachment A provisions, any other material breach of the Grant Agreement, or misrepresentations in the application submissions which, if known by HUD, would have resulted in this grant not being provided. Upon due notice to the Recipient of the occurrence of any such default and the provision of a reasonable opportunity to respond, HUD may take one or more of the following actions: (a) direct the Recipient to submit progress schedules for completing approved activities; or (b) issue a letter of warning advising the Recipient of the default, establishing a date by which corrective actions must be completed and putting the Recipient on notice that more serious actions will be taken if the default is not corrected or is repeated; or (c) direct the Recipient to establish and maintain a management plan that assigns responsibilities for carrying out remedial actions; or (d) direct the Recipient to suspend, discontinue or not incur costs for the affected activity; or Miami -Dade County FL0189B4D000801 (e) reduce or recapture the grant; or (fl direct the Recipient to reimburse the program accounts for costs inappropriately charged to the program; or (g) continue the grant with a substitute recipient of HUD's choosing; or (h) other appropriate action including, but not limited to, any remedial action legally available, such as affirmative litigation seeking declaratory judgment, specific performance, damages, temporary or permanent injunctions and any other available remedies. No delay or omission by HUD in exercising any right or remedy available to it under this Grant Agreement shall impair any such right or remedy or constitute a waiver or acquiescence in any Recipient default. For each operating year in which funding is received, the Recipient shall file annual certifications with HUD that the supportive housing has been provided in accordance with the requirements of the Grant Agreement. This Grant Agreement constitutes the entire agreement between the parties hereto, and may be amended only in writing executed by HUD and the Recipient. More specifically, the Recipient shall not change recipients, location, services, or population to be served nor shift more than 10 percent of funds from one approved type of eligible activity to another, or make any other significant change, without the prior written approval of HUD. Miami -Dade County FL0189B4D000801 SIGNATURES This Grant Agreement is hereby executed as follows: UNITED STATES OF AMERICA Secretary of Housing and Urban Development By: `Signature and Date Maria R. Ortiz -Hill Director Community Planning and Development Title RECIPIENT Miami -Dade County Name of Organization Authorized Signature and Date Print name of signatory Title Miami -Dade County FL0189B4D000801 ATTACHM ENT A 1. The Recipient is Miami -Dade County. 2. HUD's total fund obligation for this project is $ 292,660_, which shall be allocated as follows: a. Leasing $0 b. Supportive services $278,724 c. Operating costs $0 d. HMIS $0 e. Administration $13,936 3. Although this agreement will become effective only upon the execution hereof by both parties, upon execution, the term of this agreement shall run from the end of the Recipient's final operating year under the original Grant Agreement or, if the original Grant Agreement was amended to extend its term, the term of this agreement shall run from the end of the extension of the original Grant Agreement term for a period of one year. Eligible costs, as defined by the Act and Attachment B, incurred between the end of Recipient's final operating year under the original Grant Agreement, or extension thereof, and the execution of this Renewal Grant Agreement may be paid with funds from the first operating year of this Renewal Grant. Miami -Dade County FL0189B4D000801 A-rT-A,f_HMEJ,4T B Pt. 583 submitted in response to the most re- cently published notice of fund avail. ability and select applications for fund- ing with the deobligated funds. Such selections would be made in accordance with the selection process described in §582.22D of this part. Any selections made using deobligated funds will be subject to applicable appropriation act requirements governing the use of deobligated funding authority. (Approved by the orrice of ,Lianagement and Budget under control number 2506-0118) PART 583—SUPPORTIVE HOUSING PROGRAM Subpart A— General S,,c. 583.1 Purpose and scope. 583.5 Definitions. Subpart 8—Assistance Provided 583.100 TN•pes and uses of assistance. 583.105 Grants for acquisition and rehabill- tation. 583.110 Grants for new construction. 583.115 Grants Cor leasing. 583.120 Grants for supportive service costs. 583.125 Grants for operating costs. 583.130 Commitment of grant amounts for leasing. supportive services. and oper- ating costs. 583.135 Administrative costs. 583.140 Technical assistance. 583.145 A4atching requiremencs. 583.150 Limitations an use of assistance. 583.155 Consolidated plan. Subpart C—Application and Grant Award Process 583.200 Application and grant award. 583.230 Environmental review. 583.235 Renewal grants. Subpart D—Program Requirements 583 300 General operation. 583.30S Term or coinmicment: repayment of grants: prevent Ion of undue benefits. 583.310 Displacement. relocation, and acqui- sition. 583.315 Resident rent. 583 320 Site control. 583 325 Nondiscrimination and equal oppor- turnRy requirements. 583.330 ApplicabiJin of other Frderal re- quirements Subpart E—Administrallon 583.400 Crani agreement. 24 CFR Ch. V (4-1-05 Edttion) 583.405 Program changes. 583.410 Obligation and deobligatlon of funds. AIrrHORIW 4Z U.S.C. 11389 and 3535(d). SOURCE: 58 FR 13871. Mar. IS, 1993, unless otherwise noted. Subpart A --General 4583-1 Purpose and scope. (a) General. The Supportive Housing Program is authorized by title IV of The Stewart B. McKinney Homeless As- sistance Act (the McKinney Act) (42 U.S.C. 11381-11389). The Supportive Housing program is designed to pro- mote the development of supportive housing and supportive services, in- cluding innovative approaches to assist homeless persons in the transition From homelessness, and to promote the provision of supportive housing to homeless persons to enable them to Iive as independently as possible. (b) Components. Funds under this part may be used for: (1) Transitional housing to facilitate the movement of homeless individuals and families to permanent housing: (2) Permanent housing that provides long-term housing for homeless persons with disabilities; (3) Housing that is, or is part of, a particularly innovative project for, or alternative methods of, meeting the immediate and long-term needs of homeless persons: or (4) Supportive services for homeless persons not provided in conjunction with supportive housing. [58 FR 13871, Mar. 15, 1993, as amended at 61 FR 51175, Sept. 30. 19961 §583.5 Definitions. As used in this part: .-1pplicant is defined in section 422(1) of the McKinney Act (42 U.S.C. 11382(1)). For purposes of this defini- tion, governmental entities include those that have general governmental potters (such as a city or county), as well as those that have limited or spe- cial powers (such as public housing agencies). Consolidated plan means the plan that a jurisdiction prepares and submits to HUE) in accordance i.vith 24 CFR part 91. 248 Ofc. of Asst. Secy., Comm. Planning, Develop., HUD Date of ovtiai occupancy means the date that the supportive housing is int- tial(y occupied by a homeless person for whom HUU provides assistance under this part. if the assistance Is for an existing homeless facility, the date or initial occupancy Is the date that services are first provided to the resi- dents of supportive housing with fund- ing under this part. Date of initial service provislon means the date that supportive services are initially provided with funds under this part to homeless persons who do not reside In supportive housing. This defi- nition applies only to projects funded under this part that do not provide sup- portive housing. Disability Is defined in section 422(2) of the McKinney Act (42 U.S.C. 11382(2)). Hotneless person means an individual or family that is described in section 103 of the McKinney Act (42 U.S.C. 113112). iWetropolitan city is defined in section 102(a)(4) of the Housing and Commu- nity Development Act of 1974 (42 U.S.C. 5302(a)(4)). In general. metropolitan cit- ies are chose cities that are eligible for an entitlement grant under 24 CPR part 570- subpart D. New construcrion means the building of a structure where none existed or an addition to an existing structure that increases the floor area by more than 100 percent. Operating costs is defined in section 422(5) of the McKinney Act (42 U.S.C. 11382(5)). Outpatient health services is defined in section 422(6) of the McKinney Act (42 U. S.C. 11382(6)) . Permanent housing for homeless persons with disabilities is defined in section 424(c) of the McKinney Act (42 U.S.C. 11384(c)). Private nnnproJ3t organization is de- fined in section 422(7) (A), (B), and (D) of the McKinney Act (42 U.S.C. 11382(7) s (A), (B), and (D)). The organization roust also have a functioning account- f ing system that is operated in accord- s ante with generally accepted account- ing principles, or designate an entity t that will maintain a functioning ac- p counting system for the organization in accordance with generally accepted 1e accounting principles. e 249 § 583.100 Project is defined in sections 422(8) and 424(d) of the McKinney Act (42 U.S.C. 11382(8), 11384(d)). Recipient is defined in section 422(9) of the McKinney Act (42 U.S.C. 11382(9)). Rehabilitation rneans the improve- ment or repair of an existing structure or an addition to an existing structure that does not increase the floor area by more than 100 percent. Rehabilitation does not include minor or routine re- pairs. State is defined in section 4Z2(I1) of the McKinney Act (42 U.S.C. 11382(11)). Supportive housing Is defined in sec- tion 424(a) of the McKinney Act (42 U.S.C. 11384(a)). Supportive services is defined in sec- tion 425 of the McKinney Act (42 U.S.C. 11385). Transitional housing Is defined in sec- tion 424(b) of the McKinney Act (42 U,S,C. 11384(b)). See also § 583.3000). Tribe is defined In section 102 of the Housing and Community Development Act of 1974 (42 U.S.C. 5302). Urban county is defined in section 102(a)(6) of the Housing and Commu- nity Development Act of 1974 (42 U.S.C. 5302(x)(6)). In general. urban counties are those counties that are eligible for an entitlement grant under 24 CFR part 570, subpart D. 161 FR 51175, Sept. 30, 19961 Subpart 0 --Assistance Provided r 4 683.100 Types and uses of assistanee. (a) Grant assistance. Assistance in the form of grants is available for acquisi- tion of structures, rehabilitation of structures, acquisition and rehabilita- tion of structures, new construction, leasing. operating costs for supportive I and supportive services, as de- scribed in §§583.105 through 583.125. Ap- plicants may apply for more than one type of assistance. (b) Uses ofgranr assistance. Grant as- istance may be used to: (1) Establish neve supportive housing acilities or new facilities to provide upportive services: (2) Expand existing facilities in order o increase the number of homeless er.sons served: (3) Bring existing facilities up to a vei that meets State and local gov. nment health and safety standards; § 583.105 (4) Provide additional supportive services for residents of supportive housing or for homeless persons not re- siding in supportive housing; (5) Purchase HUD -owned single fam- ily properties currently leased by the applicant for use as a homeless facility under 24 CFR part 291; and (6) Continue funding supportive hous- ing where the recipient has received funding under this part for leasing, supportive services, or operating costs. (c) Structures toed for multiple pur- poses. Structures used to provide sup- portive housing or supportive services may also be used for other purposes, except that assistance under this part will be available only in proportion to the use of the structure for supportive housing or supportive services. (d) Technical assistance. HUD may Offer technical assistance, as described In §583.140. 158 FR 13871, Mar. 15, 1993, as amended at 59 >=R 36891, July 19, 1994] §583.105 Grants for acquisition and rehabilitation. (a) Use. HUD will grant funds to re- cipients to: (1) Pay a portion of the cost of the acquisition of real property selected by the recipients for use in the provision of supportive housing or supportive services, including the repayment of any outstanding debt on a loan made to purchase property that has not been used previously as supportive housing or for supportive services; (2) Pay a portion of the cost of reha- bilitation of structures, including cost- effective energy measures, selected by the recipients to provide supportive housing or supportive services, or (3) Pay a portion of the cost of acqui- sition and rehabilitation of structures, as described in paragraphs (a)(1) and (2) of this section - (b) .-Amount. The maximum grant available for acquisition, rehabilita- tion, or acquisition and rehabilitation is the lower of. (1) $200.000; or (2) The total cost of the acquisition, rehabilitation. or acquisition and reha- bilitat(on minus the applicant's con- cribu[ion toward the cost. (c) Increaser) amounts. In areas deter. mined by HUD to have high acquisition 250 24 CFR Ch. V (4-1-05 Edition) and rehabilitation costs, grants of more than $200,000, but not more than S400,000, may be available. §583.110 Grants for new construction. (a) Use. HUD will grant funds to re- cipients to pay a portion of the cost of new construction. including cost-effec- tive energy measures and the cost of land associated with that construction, for use in the provision of supportive housing. If the grant funds are used for new construction, the applicant must demonstrate that the costs associated with new construction are substan- tially less than the costs associated with rehabilitation or that there Is a lack of available appropriate units that could be rehabilitated at a cost less than new construction. For purposes of this cost comparison, costs associated with rehabilitation or new construc- tion may include the cost of real prop- erty acquisition. (b) Amount. The maximum grant available for new construction is the lower of. (1) $400,000; or (2) The total cost of the new con- struction. including the cost of land as- sociated with that construction, minus the applicant's contribution toward the cosc of same. §583.115 Grants for leasing. (a) General. HUD will provide grants to pay (as described in §583.130 of this part) for the actual costs of leasing a structure or structures, or portions thereof, used to provide supportive housing or supportive services for up to five years. (b)(1) Leasing structures. Where grants are used to pay rent for all or part of structures, the rent paid must be rea- sonable in relation to rents being charged in the area for comparable space. In addition, the rent paid may not exceed rents currently being charged by the same owner for com- parable space. (2) Leasing individual units. Where grants are used to pay rent for indi- vidual housing units, the rent paid must be reasonable in relation to rents being charged for comparable units, taking into account the location, size. type, quality, amenities, facilities, and management services. In addition, the Ofc. of Asst. Secy., Comm. Planning, Develop., HUD rents may not exceed rents currently being charged by the same owner for comparable unassisted units, and the portion of rents paid with grant funds may not exceed HUD -determined fair market rents. Recipients may use grant funds in an amount up to one month's rent to pay the non -recipient landlord for any damages to teased units by homeless participants. (58 FR 13871, Mar, 15. 1993, as amended at 59 FR 36891, July 19. 1994) 4553.120 Grants for supportive serv- ices costs. (a) General. HUD will provide grants to pay (as described in §583.130 of this part) for the actual costs of supportive services for homeless persons for up to five years. All or part of the supportive services may be provided directly by the recipient or by arrangement with public or private service providers. (b) Supportive services costs. Costs as- sociated with providing supportive services include salaries paid to pro- viders of supportive services and any other costs directly associated with providing such services. For a transi- tional housing project, supportive serv- ices costs also include the costs of serv- ices provided to former residents of transitional housing to assist their ad- justment to independent living. Such services may be provided for up to six months after they leave the. cransi-. tional housing facility. ISS FR 13871. Mar. 15, 1993, as amended at 59 FR 36891- July 19. 19941 §583-125 Grants for operating costs - (a) General. HUD will provide grants to pay a portion (as described in §583.130) of the actual operating costs of supportive housing for up to five _years. (b) Operating casts. Operating costs are those associated with the day-to- day operation of the supportive hous- ing. They also include the actual ex- penses that a recipient incurs for con- ducting on-going assessments of the supportive services needed by residents and the availability of such services; relocation assistance under §583.310, in- cluding payments and services; and in- ,urance. 251 S563.140 (c) Reciplent match requirement ror op- erating costs. Assistance for operating costs will be available for up to 75 per- cent of the total cost In each year of the grant term, The recipient must pay the percentage of the actual operating costs not funded by HUD. At the end of each operating year, the reciplent must demonstrate that it has met its match requirement of the costs for that year. 158 FR 13871. Mar, 15. 1993, as amended at 61 FR 51175. Sept. 30. 1996; 65 FR 30823. May 12. 20001 4 583.130 Commitment of grant amounts for leasing, supportive services, and operating costa. Upon execution of a grant agreement covering assistance for leasing, sup- portive services, or operating costs, HUD will obligate amounts for a period not to exceed five operating years. The total amount obligated will be equal to an amount necessary for the specified years of operation. less the recipient's share of operating costs. (Approved by the Office of Management and Budget under OMB control number 2506-0112) 159 FR 36891. July 19, 19941 4583.135 Administrative costa. (a) Ceneral. Up to five percent of any grant awarded under this part may be used for the purpose of paying costs of administering the assistance. (b) Administrative costs. Administra- tive costs include the costs associated with accounting for the use of grant Funds, preparing reports for submission to HUD, obtaining program audits, similar costs related to administering the grant after the award, and staff sal- aries associated with these administra- tive costs. They do not include the costs of carrying out eligible activities under §§ 583.105 through 583.125. (58 FR 13871, Mar 15, 1993, as amended at 61 FR 51175. Sept. 30. 19%) §583.140 Technical assistance. (a) General. HUD may set aside funds annually to provide technical assist- ance, either directly by 14UD staff or indirectly through third -party pro- viders. for any supportive housing project. This technical assistance is for § 583.145 the purpose of promoting the develop men( of supportive housing and su Pat rive services as part of a conrinuu of care approach, including innovativ approaches to assist homeless person in the transition from homelessness and promoting the provision of sup porrive housing to homeless persons r enable them to live as independently a possible. (b) Uses of technical assistance. HU may use these funds to provide tech nical assistance to prospective appli cants, applicants, recipients, or other providers of supportive housing or serv- ices for homeless persons, for sup- portive housing projects. The assist- ance may include, but Is not limited to, written information such as papers. monographs, manuals, guides, and bro- chures: person-to-person exchanges: and training and related costs. (c) Selection of providers. From time to time, as HUD determines the need, HUD may advertise and competitively select providers to deliver technical as- sistance. HUE) may enter into con- tracts, grants. or cooperative agree- ments, when necessary, to implement the technical assistance. 159 FR 36892, July 19, 19941 3583.145 Matehingrequirements. (a) General. The recipient must match the funds provided by HUD for grants for acquisition, rehabilitation, and new construction with an equal a+nount of funds from other sources. (b) Cash resources. The matching funds must be cash resources provided to the project by one or more of the following: the recipient. the Federal government, State and local govern- ments, and private resources. (c) tMaintenance of effort. State or local government funds used in the snatching contribution are subject to the maintenance or effort requirements described at §583.I50(a). 3583.150 Limitations on use of assist- ance. (a) ,Maintenance of effort. No assist- ance provided under this part (or any State or local government funds used to supplement this assistance) may be used to replace State or local funds previously utied, or designated for use. to assist homeless persons. 252 24 CFR Citi. Y (4-1-05 EdMon) - (b) Faith -based activities. (1) Organiza- ptions that are religious or faith -based rn are eligible. on the same basis as any e other organization, to participate in s the Supportive Housing Program. Nei- , cher the Federal government nor a State or local government receiving o funds under Supportive Housing pro- s grams shall discriminate against an or- ganization on the basis of the organiza- tion's religious character or affiliation. (2) Organizations that are directly funded under the Supportive Housing Program may not engage in inherently religious activities, such as worship, religious instruction, or proselytiza- don as part of the programs or services funded under this part. 1f an organiza- tion conducts such activities, the ac- tivities must be offered separately. in time or location, from the programs or services funded under this part, and participation must be voluntary for the beneficiaries of the HUD -funded pro- grams or services. (3) A religious organization that par- ticipates in the Supportive Housing Program will retain its independence from Federal, State, and local govern- ments, and may continue to carry out its mission, including the definition, practice, and expression of its religious beliefs, provided that It does not use di- rect Supportive Housing Program funds to support any inherently reli- gious activities, such as worship, reli- gious instruction, or proselytization. ,among other things, faith -based orga- nizations may use space in their facili- ties to provide Supportive Housing Program -funded services, without re- moving religious art, icons. scriptures, or other religious symbols. In addition, a Supportive Housing Program -funded religious organization retains its au- thority over its internal governance. and it may retain religious terms in its organization's name, select Its board members on a religious basis, and in- clude religious references In its organi- zation's mission statements and other governing documents. (4) An organization that participates in the Supportive Housing Program shall not, in providing program assist- ance. discrimin<rte against a program beneficiary or prospective program beneficiary on the basis of religion or religious belief. Ofc. of Asst. Secy., Comm. planning, Develop., HUD § 583.155 (5) Program funds may not be usec for the acquisition, construction, or re- habilitation of structures to the extent that those structures are used for In herentiy religious activities. Program funds may be used for the acquisition, construction, or rehabilitation o structures only to the extent that those structures are used for con- ducting eligible activities under this part. Where a structure is used for both eligible and inherently religious activi- ties, program funds may not exceed the cost of those portions of the acquisi- tion, construction, or rehabilitation that are attributable to eligible activi- ties in accordance with the cost ac, Minting requirements applicable to Supportive Housing Program funds in this part. Sanctuaries, chapels, or other rooms that a Supportive Housing Program -funded religious congregation uses as its principal place of worship, however, are ineligible for Supportive Housing Program -funded improve- ments. Disposition of real property after the term of the grant, or any change In use of the property during the term of the grant, is subject to gov- ernment -wide regulations governing real property disposition (see 24 CFR parts 84 and 85). (6) If a State or local government vol- untarily contributes its own funds ro supplement federally funded activities, the State or local government has the option to segregate the Federal funds or commingle them. However, if them funds are commingled, this section ap- plies to all of the corninglcd funds. (c) Participant control ofsite. Where an applicant does not propose to have con- trol of a site or sites but rather pro- poses to assist a homeless family or in- dividual in obtaining a lease, which may include assistance with rent pay- ments and receiving supportive serv- ices. after which time the family or .in- dividual remains in the same housing without further assistance under chis part, that applicant may not request assistance for acqui.sitiun, rehabilita- tion, or new construction. 158 FR 13871. filar. 15. 1993, as amended at i9 FR 36892. July 19. 1993: 6B FR 56407. Sept. 30. ?0031 253 3583.165 Consolidated plan. (a) Applicants that are States or units of general local government. The appli- cant must have a HUD -approved com- plete or abbreviated consolidated plan, f in accordance with 21 CFR part 91. and must submit a certification that the application for funding is consistent with the HUD -approved consolidated plan. Funded applicants must certify in a grant agreement that they are fol- lowing the HUD -approved consolidated pian. (b) Applicants that are not States or units of general local government. The applicant must submit a certification by the jurisdiction in which the pro- posed project will be located that the applicant's application for funding is consistent with the jurisdiction's HUD - approved consolidated plan. The cer- tification must be made by the unit of general local government or the State, in accordance with the consistency cer- tification provisions of the consoli- dated plan regulations. 24 CFR part 91, subpart F. (c) Indian tribes and the Insular Areas of Cuam, the U.S. Virgin Islands, Amer- ican Samoa, and the Northem Mariana Islands. These entities are not required to have a consolidated plan or to make consolidated plan certifications. An ap- plication by an Indian tribe or ocher applicant for a project that will be lo- cated on a reservation of an Indian tribe will not require a certification by the tribe or the State. However, where an Indian cribe is the applicant For a project that will not be located on a reservation, the requirement for a cer- tification under paragraph (b) of this section will apply. (d) Timing of consolidated plan certifi- cation submissions. Unless otherwise set forth in the NOFA, the required certifi- cation that the application for funding is consistent with the HUD -approved consolidated plan muse be submitted by the Funding application submission deadline announr.ed in the NOFA, 160 FI? 16380. filar. 30, 19951 5W.200 Subpart C—Application and Grant Aword Process 1583.200 Application and grant award. When funds are made available for assistance, HUD will publish a notice of funding availability (NOFA) In the FEDERAL REGISTER, in accordance with the requirements of 24 CFR part 4. HUD will review and screen applications in accordance with the requirements in section 426 of the. McKinney Act (42 U.S.C. 11386) and the guidelines, rating criteria, and procedures published in the NOFA. 161 FR 51176. Sept. 30. 19961 §583.230 Environmental review. (a) Activities under this part are sub- ject to HUD environmental regulations in part 58 of this title, except that HUD will perform an environmental review in accordance with part 50 of this title prior to its approval of any condi- tionally selected applications for Fis- cal Year 2000 and prior years that were received directly from private non- profit entities and governmental enti- ties with special or limited purpose powers. For activities under a grant that generally would be subject to re- view tinder part 58, HUD may make a finding in accordance with §58.11(d) and may itself perform the environmental review under the provisions of part 50 of this title if therecipient objects In writing to the responsible entity's per- forming the review under part 58. Irre- spective of whether the responsible en- tity in accord with part 58 (or HUD in accord with part 50) perforans the envi- ronmental review, the recipient shall supply all available, relevant informa- tion necessary for the responsible enti- ty (or HUD, if applicable) to perform, for each property any environmental review required by this part. The re- cipient also shall carry out mitigating measures required by the responsible entity (or HUD, if applicable) or select alternate eligible property. HUD may eliminate from consideration any ap- plication that would require an Envi- ronmental Impact Statement (EIS). N The recipient, its project partners and their conrractors may not acquire, rehabilitate. convert, lease, repair, dis- pose of, dernolishh-or construct property 254 24 CFR Ch. V (4-1-05 Edtlon) for a project under this part, or com- mit or expend HUD or local funds for such eligible activities under this part. until the responsible entity (as defined in §58.2 of this title) has completed the environmental review procedures re- quired by part 58 and the environ- mental certification and RROF have been approved or HUD has performed an environmental review under part 50 and the recipient has received HUD ap- proval of the property. HUD will not release grant funds if the recipient or any other party commits grant funds (i.e., incurs any costs or expenditures to be paid or reimbursed with such funds) before the recipient submits and HUD approves its RROF (where such submission is required). 168 FR 56131, Sept. 29. 2003) 4583.235 Renewal grants. (a) General. Grants made under this part, and grants made under subtitles C and D (the Supportive Housing Dem- onstration and SA.FAH. respectively) of the Stewart B. McKinney Homeless As- sistance Act as in effect before October 28, 1992, may be renewed on a non- competitive basis to continue ongoing leasing, operations, and supportive services for additional years beyond the initial funding period. To be con- sidered for renewal funding for leasing, operating costs. or supportive services, recipients must submit a request for such funding in the form specified by HUD, must meet the requirements of this part, and must submit requests within the time period established by HUD. (b) Assistance available. The first re- newal will be for a period of time not to exceed the difference between the end of the initial funding period and ten years from the date of initial occu- pancy or the date of initial service pro- vision. as applicable. Any subsequent renewal will be for a period of time not to exceed five years. Assistance during each year of the renewal period. sub- ject to maintenance of effort require- ments under § 583.150(a) may be for: (1) Up to 50 percent of the actual op- eracing and leasing costs in the final War of the initial funding period: (2) Up to the amount of HUD assist- ance for supportive services in the final near of the initial funding period; and Olc. of Asst. Secy., Comm. Planning, Develop., HUD §583-300 (3) An allowance for cost increases. (c) HUD review (1) HUD will review the request for renewal and will evalu- ate the recipient's performance in pre- vious years against the plans and goal established in the Initial application for assistance, as amended. HUD will approve the request for renewal unless the recipient proposes to serve a popu- lation that Is not homeless, or the re- cipient has not shown adequate progress as evidenced by an unaccept- ably slow expenditure of funds, or the recipient has been unsuccessful in as- sisting participants in achieving and maintaining independent living. In de- termining the recipient's success in as- sisting participants to achieve and maintain independent living, consider- ation will be given to the level and type of problems of participants. For recipients with a poor record of suc- cess, HUD will also consider the recipi- enr's willingness to accept technical assistance and to make changes sug- gested by technical assistance pro- viders. Other factors which will affect HUD's decision to approve a renewal request include the following: a con- tinuing history of inadequate financial management accounting practices, in- dications of mismanagement on the part of the recipient, a drastic reduc- tion in the population served by the re- cipient, program changes made by the recipient without prior HUD approval, and loss of project site. (2) HUD reserves the right to reject a request from any organization with an outstanding obligation to HUD that is in arrears or for which a payment schedule has not been agreed to. or whose response to an audit finding is overdue or unsatisfactory. (3) HUD will notify the recipient in writing that the request has been ap- proved or disapproved. (approved by the Office of Management and Budgec under control number 2506-0112) Subpart D—Program Requirements X1'583.300 General operation. (a) Srate and local reyuireinents. Each recipient of assistance under this part must provide housing or services that are in compliance with all applicable State and focal housing codes, licens- ing requirements, and any usher re- quirements in the jurisdiction In which the project is located regarding the condition of the structure and the op- erarion of the housing or services. s (b) Habltability standards. Except for such variations as are proposed by the recipient and approved by HUD, sup- portive housing must meet the fol- lowing requirements: (1) Structure and materials. The struc- tures must be structurally sound so as not to pose any threat to the health and safety of the occupants and so as to protect the residents from the ele- ments. (2) Acress. The housing must be acces- sible and capable of being utilized without unauthorized use of other pri- vate properties. Structures must pro- vide alternate means of egress in case of fire. (3) Space and security. Each resident must be afforded adequate space and security for themselves and their be- longings. Each resident must be pro- vided an acceptable place to sleep. (4) Interior air quality. Every room or space must be provided with natural or mechanical ventilation. Structures must be free of pollutants in the air at levels that threaten the health of resi- dents. (5) Water supply. The water supply must be free from contamination. (6) Sanitary facilities. Residents must have access to sufficient sanitary fa- cilities that are in proper operating condition, may be used in privacy, and are adequate for personal cleanliness and the disposal of human waste. (7) Thermai environment. The housing must have adequate heating and/or cooling facilities in proper operating condition. (S) Illumination and electricity. The housing must have adequate natural or artificial illumination to permit nor- mal indoor activities and to support the health and safety of residents. Suf- ficient electrical sources must be pro- vided to permit use of essential elec- trical appliances while assuring safety from fire. (9) Food preparation and refuse dis- posal. All food preparation areas must conrain suitable space and equipment to store. prepare, and serve food in a sanitary manner. 255 9583-300 24 CFR Ch. V (4-1-05 Edition) (10) ,Sanitary condition, The housing for HUD approval to otherwise consult and any equipment must be maintained with homeless or formerly homeless in sanitary condition. persons In considering and making (it) Fire safety. (i) Each unit must in- policies and decisions. See also elude at least one battery-operated or .y583.330(e). hardwired smoke detector, in proper (2) Each recipient of assistance under working condition, on each occupied this part must, to the maximum extent level of the unit. Smoke detectors practicable, involve homeless individ- must be located, to the extent prat- uals and families, through employ- ticabie, in a hallway adjacent to a bed- ment, volunteer services. or otherwise, room. If the unit is occupied by hear- in constructing, rehabilitating, maln- ing-Impaired persons, smoke detectors raining, and operating the project and must have an alarm system designed in providing supportive services for the for hearing-impaired persons in each project. bedroom occupied by a hearing-Im- (g) Records and reports. Each recipient paired person. of assistance under this part must keep (ii) The public areas of all housing any records and make any reports (in - must be equipped with a sufficient eluding those pertaining to race, eth- number, but not less than one for each nlcity, gender, and disability status area, of battery-operated or hard -wired data) char HUD may require within the smoke detectors. Public areas include, - timeframe required. but are not limited to, laundry rooms, (h) Confidenrialiry. Each recipient community rooms, day care centers, that provides family violence preven- haliways. stairwells, and other com- tion or treatment services must de- mon areas. velop and implement procedures to en- c) Meals. Each recipient of assist- sure: ante under this part who provides sup- (1) The confidentiality of records per- porUve housing for homeless persons taining to any individual services; and with disabilities must provide meals or (2) That the address or location of meal preparation facilities for rest- any project assisted will not be made dents• public, except with written authoriza- (d) Ongoing assessment of supportive tion of the person or persons respon- services. Each recipient of assistance Bible for the operation of the project. under this part must conduct an ongo- (i) Termination of housing assistance. ing assessment of the supportive serv- The recipient may terminate assist - ices required by the residents of the ante to a participant who violates pro - project. and the availability of such gram requirements. Recipients should services, and make adjustments as ap- terminate assistance only in the most propriate. severe cases. Recipients may resume (e) Residential supervision. Each re- assistance to a participant whose as- cipient of assistance under this part sistance was previously terminated. In must provide residential supervision as terminating assistance to a partici- necessary to facilitate the adequate pant, the recipient must provide a for - provision of supportive services to the teal process that recognizes the rights residents of the housing throughout of individuals receiving assistance to the term of the commitment to operate due process of taw. This process, at a supportive housing. Residential super- minimum, must consist oF: vision may include the employment of (1) Written notice to the participant a full- or part-time residential super- containing a clear statement of the visor with sufficient knowledge to pro- reasons for termination; vide or to supervise the provision of (2) A review of the decision. in which supportive services to the residents. the participant is given the oppor- (f) Participation of homeless persons. (1) runny to present written or oral objec- Each recipient must provide for the tions before a person other than the participation of homeless persons as re- person (or a subordinate of that person) quired in section 426(8) of the hlcKin- who made or approved the termination ney Act (42 U.S,C. 113860). This re- decision: and quiremenc is walved if an applicant is (3) Prompt written notice of the final unable to meet it and presents a plan decision to the participant. . 256 Ofc. of Assf. Secy., Comm- Planning, Develop., HUD (j) Llmifation of stay In transition housing. A homeless individual or fam ily may remain in transitional housin for a period longer than 24 months, i permanent housing for the Individua or family has not been located or if th individual or family requires addi tional time to prepare for independent living. However, HUD may discontinue assistance for a transitional housing project if more than half of the home. less individuals or families remain i that project longer than 24 months. (k) Outpatient health services. Out- patient health services provided by the recipient must be approved as appro- priate by HUD and the Department o Health and Human Services (HHS). Upon receipt of an application that proposes the provision of outpatient health services. HUD will consult with HHS with respect to the appropriate- ness of the proposed services. (1) Annual assurances. Recipients who receive assistance only for leasing, op- erating costs or supportive services costs must provide an annual assur- ance for each _year such assistance is received that the project will be oper- ated for the purpose specified in the ap- plicarion- (Approved by the Office of Management and Budget under control number 2506-0112) f58 FR 13871- Mar. 15, 1993. as amended at 59 FR 36892, July 19. 1994:.61 FR 51175. Sept. 30, 19961 § 583.305 Term of commitment; repay- ment of grants; prevention of undue benefits. (a) Term ofcommitment and conversion. Recipients must agree to operate the housing or provide supportive services in accordance with this part and with sections 423 (b)(1) and (b)(3) of the .McKinney Act (42 U.S.C. 11383(b)(1), 11383(b)(3)). (b) Repayment of grant and prevention of undue beneflrs. In accordance with section 423(c) of the McKinney Act (42 U.S.C. 11383(c)). HUD will require re. cipients to repay the grant unless HUD has authorized conversion of the project under section 423(b)(3) of the ,McKinney Act (42 U.S.C. 11383(6)(3)). 161 FR 51176. Sept. 30, 19%) §583.310 a1 §583.310 Displacement, relocation, and acquisition. g (a) Minimizing displacement. Con - f sistent with the other goals and objec- tives of this part, recipients must as- e sure that they have taken all reason- able steps to minimize the displace - merit of persons (families, individuals, businesses. nonprofit organizations. and farms) as a result of supportive housing assisted tinder this part. n (b) Relocation assistance for dfspiaeed persons. A displaced person (defined in paragraph (f) of this section) must be provided relocation assistance ac the levels described in. and in accordance f with, the requirements of the Uniform Relocation Assistance and Real Prop- erty Acquisition Policies Act of 1970 (URA) (42 U.S.C. 4601-4655) and imple- menting regulations at 49 CFR part 24. (c) Real property acquisition require- ments. The acquisition of real property for supportive housing is subject to the URA and the requirements described in 49 CFR part 24. subpart B. (d) Responsibility of recipient. (1) The recipient must certify (i.e.. provide as- surance of compliance) that it will comply with the LIRA, the regulations at 49 CFR part 24, and the requirements of this section, and must ensure such compliance notwithstanding any third party's contractual obligation to the recipient to comply with these provi- sions. (2) The cost of required relocation as- sistance is an eligible project cost in the same manner and to the same ex- tent as other project costs. Such costs also may be paid for with local public funds or funds available from ocher sources. (3) The recipient must maintain records in sufficient derail to dem- onscrace compliance with provisions of this section. (e) Appeals. A person who disagrees with the recipient's determination con- cerning ,.whether the person qualifies as a "displaced person," or the amount of relocation assistance for which the per- son is eligible, may file a written ap- peal of that determination with the re- cipient. A low-income person who is dissatisfied with the recipient's deter- mination on his or her appeal may sub- mit a written request for review of that determination to the HUD field office. 257 5583-310 24 CFR Ch. V (4-1-05 Edition) (f) Definition of displaced person. (1) does not return to the buildingicom- For purposes of this section, the term plea, if either: "displaced person" means a person (A) A tenant is not offered payment (family, individual. business, nonprofit for all reasonable out-of-pocket ex- organiza[lon, or farm) that moves from penses incurred in connection with the real property, or moves personal prop- temporary relocation, or erty from real property permanently as (B) Other conditions of the tem - a direct result of acquisition, rehabili- porary relocation are not reasonable. tation, or demolition for supportive (v) A tenant of a dwelling who moves housing projects assisted under this from the building/complex perma- part. The term "displaced person" in- nently after he or she has been re- cludes, but may not be limited to: quired to move to another unit In the (i) A person that moves permanently same building/complex, if either: from the real property after the prop- (A) The tenant is not offered reim- erty owner (or person in control of the bursement for all reasonable out -of - site) issues a vacate notice, or refuses pocket expenses incurred in connection to renew an expiring lease in order to with the move; or evade the responsibility to provide re- (B) Other conditions of the move are location assistance, if the move occurs not reasonable. on or after the date the recipient sub- (2) Notwithstanding the provisions of mits to HUD the application or appli- paragraph (f)(1) of this section- a per - cation amendment designating the son does not qualify as a --displaced project site. person" (and is not eligible for reloca- (li) Any person, including a person tion assistance under the URA or this who moves before the date described in section), if: (i) The person has been evicted for se - paragraph (f)(1)(1) of this section, if the rious or repeated violation of the terms recipient or HUD determines that the displacement resulted directly from ac- and conditions of the lease or occu- quisitlon, rehabilitation, or demolition pancy agreement, violation of applica- ble Federal, State, or local or tribal for the assisted project. (iii) Atenant-occupant of a dwelling law, or other good cause, and HUD de- unit who moves permanently from the termines that the eviction was not un - the for the purpose of evading the building/complex on or after the date of -'initiation obligation to provide relocation assist - obligadertation the of negotiations" (see ante: paragraph (g) of this section) if the (r i) The person moved into the prop- move occurs before the tenant has been submission of the pli- after theoresigning provided written notice offering him or a and cation and, before signing a lease and cation her the opportunity to lease and oc- commencing occupancy, was provided cup_y a suitable, decent, safe and sani- written notice of the project, its pos- tary dwelling in the same building/ sible Impact on the person (e.g.. the complex, under reasonable terms and person may be displaced, temporarily conditions, upon completion of the relocated, or suffer a rent increase) and project. Such reasonable terms and the fact that the person would not conditions must include a monthly qualify as a '-displaced person'' (or for rent and estimated average monthly any assistance provided under this sec - utility costs that do not exceed the tion), if the project is approved; greater of: (iii) The person is ineligible under 49 (A) The tenant's monthly rent before CFR 24.2(&)(2); or the initiation of negotiations and esti- (iv) HUD determines that the person mated average utility costs. or was not displaced as a direct result of (B) 30 percent of gross household in- acquisition, rehabilitation, or demoli- come. If the initial rent is at or near cion for the project. the Maximum, there must be a reason- (3) The recipient may request, at any able basis for concluding at the time time, HUD's determination of whether the project is initiated that future cent a displacement is or would be covered increases will be modes[. under this section. (iv) A tenant of a dwelling who is re- (g) Definition of initiation of negotia- quired to relocate temporarily. but tions. For purposes of determining the 258 Ofc. of Asst. Secy., Convn. Plonning, Develop., HUD § 583.320 formula for computing the replacemer housing assistance to be provided to residential tenant displaced as a direr result of privately undertaken rehabil tatlon, demolition, or acquisition r the real property, the term "initiatio of negotiations" means the executio of the agreement between the recipier and HUD. (h) DeRnition of project. For purpose of this section, the terrn ''project means an undertaking paid for I whole or in part with assistance unde this part. Two or more activities tha are integrally related, each essential t the others, are considered a singl project, whether or not all componen activities receive assistance under thi part. 158 FR 13871, Mar, 15. 1993, as amended at 5 FR 36892, July 19, 19941 §583.315 Resident rent. (a) Calculation of resident rent. Each resident of supportive housing may be required to pay as rent an amount de- termined by the recipient which may not exceed the highest of: (1) 30 percent of the family's monthly adjusted Income (adjustment factors include the number of people in the family, age of family members, medical expenses and child care expenses). The calculation of the family's monthly ad- justed income must include the ex- pense deductions provided in 24 CFR 5.611(a), and for persons with disabil- ities, the calculation of the family's monthly adjusted income also must in- clude the disallowance of earned in- come as provided in Z4 CFR 5.617, If ap- plicable: (2) 10 percent of the family's monthly gross income; or (3) If the family is receiving pay- ments for welfare assistance from a public agency and a part of the pay ments. adjusted In accordance with the Family's actual housing costs, is spe- cifically designated by the agency to meet the familv's housing costs, the portion of the payment that is des- ignated for housing costs. (b) Use of rent. Resident rent may be used in the operation. of the project or may be reserved, in whole or in part, to ass(st residents of transitional housing in moving to permanent housing. (e) Fees, in addition to resident rent, recipients may charge residents rea- sonable reel for services not paid with grant funds. (58 FR 13871, Mar. 15. 1993, as arnended at 59 FR 36892. July 19. 1991. 66 FR 6225. Jan. 19. 20011 $83 5.320 Site control. s (a) Site control. (1) Where grant funds will be used for acquisition, rehabilita- n tion, or new construction to provide r supportive housing or supportive serv- t ices, or where grant funds will be used o for operating costs of supportive hous- e Ing, or where grant funds will be used t to provide supportive services except S where an applicant will provide serv- ices at sites not operated by the appli- cant. an applicant must demonstrate site control before FEUD will execute a grant agreement (e.g., through a deed. lease, executed contract of sale). If such site control Is not demonstrated within one year after initial notifica- tion of the award of assistance under this part, the grant will be deobiigated as provided in paragraph (c) of this sec- tion. (2) Where grant funds will be used to lease all or part of a structure to pro- vide supportive housing or supportive services, or where grant funds will be used to lease individual housing units for homeless persons who will eventu- ally control the units, site control need not be demonstrated. (b) Site change. (1) A recipient may obtain ownership or control of a suit- able site different from the one speci- fied in its application. Retention of an assistance award Is subject to the new site's meeting all requirements under this part for suitable sites. (2) if the acquisition, rehabilitation, acquisition and rehabilitation, or new construction costs for the substitute site are greater than the amount of the grant awarded for the site specified in the application. the recipient must pro- vide for all additional costs. If the re- cipient is unable to demonstrate to HUD that it is able to provide for the difference in costs, HUD may dcobligace the award of assistance. (c) Failure ro obtain site control tvithin one near. HUD will recapture or deabligate any award for assistance tinder this part if the recipient is not in 259 §583.325 control of a suitable site before the ex- piration of oneyear after initial notifi- cation of an award. §583.325 Nondiscrimination and equa; opportunity requirements. (a) General. Notwithstanding the per- missibility of proposals that serve des- Ignated populations of disabled home- less persons, recipients serving a des- ignated population of disabled home- less persons are required, within the designated population, to comply with these requirements for nondiscrimina- tion on the basis of race, color, reli- gion, sex. national origin, age, familial status, and disability. (b) Nondiscrimination and equal oppor- tunfty requirements. The nondiscrimina- tion and equal opportunity require- ments set forth at part 5 of this title apply to this program. The Indian Civil Rights Act (25 U.S.C. 1301 et seq.) ap- plies to tribes when they exercise their powers of self-government, and to In- dian housing authorities (IHAs) when established by the exercise of such powers. When an IHA is established under State law, the applicability of the Indian Civil Rights Act will be de- termined on a case-by-case basis. Projects subject: to the Indian Civil Rights Act must be developed and oper- ated in compliance with its provisions and all implementing HUD require- ments, instead of title VI and the Fair Housing Act and their implementing regulations. (c) Procedures. (1) If the procedures that the recipient intends to use to make known the availability of the supportive housing are unlikely to reach persons of any particular race, color, religion, sex, age. national ori- gin, familial status, or handicap who may qualify for admission to the hous- ing, the recipient must establish addi- tional procedures that will ensure that such persons can obtain information concerning availability of the housing. (2) The recipient must adopt proce- dures to make available information on the existence and locations of facili- ties and services chat are accessible to persons with a handicap and maintain evidence of implementation of the pro- cedures. (d) Accessibilfty requirements. The re- cipient must comply with the new con - 260 24 CFR Ch. V (4-1-05 EdMlon) struction accessibility requirements of the Fair Housing Act and section 504 of the Rehabilitation Act of 1973, and the reasonable accommodation and reha- bilitation accessibility requirements of section 504 as follows (1) Ail new construction must meet the accessibility requirements of 24 CFR 8.22 and, as applicable, 24 CFR 100.205. (2) Projects in which costs of reha- bilitation are 75 percent or more of the replacement cost of the building must meet the requirements of 24 CFR $.23(a). Other rehabilitation must meet the requirements of 24 CFR 8.23(b). 158 FR 13871. Mar. I5, 1993, as amended at 59 FR 33894, June 30. 1994; 61 FR 5?10. Feb. 9. 1995: 61 FR 51176. Sept. 30, 1996) 9553.330 Applicability of other Federal requirements. ln.addition to the requirements set forth in 24 CFR part 5, use of assistance provided under this part must comply with the following Federal require- ments: (a) Flood Insurance. (1) The Flood Dis- aster Protection Act of 1973 (42 U.S.C. 4001-4128) prohibits the approval of ap- plications for assistance for acquisition or construction (including rehabilita- tion) for supportive housing located in an area identified by the Federal Emer- gency Management Agency (FEMA) as having special flood hazards, unless: (i) The community in which the area is situated is participating in the Na- tional Flood Insurance Program (see 44 CFR parts 59 through 79), or less than a year has passed since FEMA notifica- tion regarding such hazards; and (ii) Flood insurance is obtained as a condition of approval of the applica- tion. (2) Applicants with supportive hous- ing located In an area identified by FEMA as having special flood hazards and receiving assistance for acquisition or construction (including rehabilita- tion) are responsible for assuring that Hood insurance under the National Flood Insurance Program is obtained and maintained. (b) The Coastal Barrier Resources Act of 1982 (16 L'.S.C. 3501 et seq.) may apply to proposals under this part, de- pending on the assistance requested. Ofc. of Assf. Secy., Convn- Planning, Develop., HUD 5583.330 (c) App/icablliiy of OMB Circulars. The §583,300(o does not constitute a con - policies, guidelines, and requirements flict of interest. of OMB Circular No. A-87 (Cost Prin- (2) Upon the written request or the ciples Applicable to Grants. Contracts recipient, HUD may grant an exception and Other Agreements with State and to the provisions of paragraph (e)(1) of Local Governments) and Z4 CFR part 85 this section on a case-by-case basis apply to the award, acceptance, and when it determines that the exception use of assistance under the program by will serve to further the purposes of governmental entities, and OMS Cir- the program and the effective and effi- cular Nos. A-110 (Grants and Coopera- tient administration of the recipient's tive Agreements with Institutions of project. An exception may be consid- Higher Education, Hospitals, and Other ered only after the recipient has pro - Nonprofit Organizations) and A-122 vided the following: (Cost Principles Applicable to Grants, (i) For States and other govern - Contracts and Other Agreements with mental entities, a disclosure of the na- Nonprofit Institutions) apply to the ac- ture of the conflict, accompanied by an ceptance and use of assistance by prt- assurance that there has been public vale nonprofit organizations, except disclosure of the conflict and a descrip- where Inconsistent with the provisions tion of how the public disclosure was of the McKinney Act, other Federal made: and statutes, or this part_ (Copies of OMS (ii) For all recipients, an opinion of Circulars may be obtained from E.O.P. the recipient's attorney that the inter - Publications, room 2200. New Executive esr for which the exception Is sought Office Building, Washington, DC Z0503, would not violate State or local law. telephone (202) 395-7332. (This is not a (3) 1n determining whether to grant a toll-free number.) There is a limit of requested exception after the recipient two free copies. has satisfactorily met the requirement (d) Lead-based paint. The Lead -Based of paragraph (e)(2) of this section. HUD Paint Poisoning Prevention Act (42 will consider the cumulative effect of U-S.C. 4821-4846), the Residential Lead- the rollowing factors, where applicable: Based Paint Hazard Reduction Act of (1) Whether the exception would pro - 1992 (42 U.S.C. 4851-4856), and imple- vide a significant cost benefit or an es- menting regulations at part, 35, sub- sential degree of experrise to the parts A. B. J. K. and R of this title project which would otherwise not be apply to activities under this program. available: (e) Conl7tcts of interest. (1) In addition (ii) Whether the .person affected is a to the conflict of interest requirements member of a group or class of eligible In 24 CFR part 85, no person who is an persons and the exception will permit employee, agent, consultant, officer, or such person to receive generally the elected or appointed official of the re- same interests or benefits as are being cipient and who exercises or has exer- made available or provided Co the cised any functions or responsibilities group or class: with respect to assisted activities, or (iii) Whether the affected person has who is in a position to participate in a withdrawn from his or her functions or decislonmaking process or gain inside responsibilities, or the decisionmaking information with regard to such accivi- process with respect to the specific as - ties. may obtain a personal or financial sisted activity in question: interest or benefit from the activity. or (iv) Whether the interest or benefit have an interest in any contract, sub- was present before the affected person contract. or agreement with respect was in a position as described in para - thereto, or the proceeds thereunder. ei- graph (e)(1) of this section: [her for himself or herself or for those (v) Whether undue hardship will re - with whom he or she has family or stilt either to the recipient or the per - business ties. during his or her tenure son affected when weighed against the or for one year thereafter. Pariicipa- public interest served by avoiding the cion by homeless individuals who also prohibited conflict: and ere participants under the program in (vi) Any other relevant consider - policy or decisionrriakirtg under ations. 261 §583.400 (f) Audit. The financial management systems used by recipients under this program must provide for audits in ac- cordance with 24 CFR part 44 or part 45. as applicable. HUD may perform or re- quire additional audits as it finds nec- essary or appropriate. 24 CFR Ch. V (4-1-05 Edtiion) must be fully documented in the recipi- ent's records. (58 FR 13871, Mar. 15. 1993, as amended at 61 FR 51176, Sept. 30. 19%) >583.410 Obligation and deobligation of funds. (g) Davis -Bacon Act. The provisions (a) Obligation offunds. When HUD and of the Davts-Bacon Act do not apply to the applicant execute a grant agree - this program. ment. funds are obligated to cover the (58 FR 13871. Mar. 15. 1993, as amended at 61 FR 5211. Feb. 9, 1996: 64 FR 50226. Sept. 15 1999) Subpart E--Administiation § 583.400 Grant agreement. (a) General. The duty to provide sttp- portive housing or supportive services in accordance with the requirements of this part will be incorporated In a grant agreement executed by HUD and the recipient. (b) Enforcement. HUD will enforce the obligations in the grant agreement through such action as may be appro- priate, including repayment of funds that have already been disbursed to the recipient. §583.405 Program changes. (a) HUD approval (I) A recipient may riot make any significant changes to an approved program without prior HUD approval. Significant changes include, but are not limited to, a change in the recipient, a change in the project site, additions or deletions in the types of activities listed in §583.100 of this part approved for the program or a shift of more than 10 percent of funds from one approved type of activity to another, and a change in the category of partici- pants to be served. Depending on the nature of the change, HUD may require a new certification of consistency with the consolidated plan (see §583.155). (2) Approval for changes is contin- gent upon the application ranking re- maining high enough after the ap- proved change to have been competi- tively selected for funding in the year the application was selected. (b) Documentation of other changes. Any changes to an approved program, that do not require prior HUD approval amount of the approved assistance under subpart B of this part. The re- ciplent will be expected to carry out the supportive housing or supportive services activities as proposed in the application, (b) Increases. After the initial obliga- tion of funds, HUD will not make revi- sions to increase the amount obligated. (c) i'DeobHgation. (1) HUD may deobligate all or parts of grants for ac- quisition, rehabilitation, acquisition and rehabilitation. or new construc- tion: (i) If the actual total cost of acquisi- tion, rehabilitation, acquisition and re- habilitation, or new construction is less than the total cost anticipated in the application; or (ii) 1f proposed activities for which funding was approved are not begun within three months or residents do not begin to occupy the facility within nine months after grant execution. (2) HUD may deobligate the amounts for annual leasing costs, operating costs or supportive services in any year: . (i) if the actual leasing costs. oper- ating costs or supportive services for that year are less than the total cost anticipated to the application; or (i -i) if the proposed supportive hous- ing operations are not begun within three months after the units are avail- able for occupancy. (3) The grant agreement may set forth in detail other circumstances under which funds may be deobligated, and other sanctions may be imposed. (4) HUD may: i (I) Readvertise the availability of funds iliac have been deobligated under this section in d notice of fund avail- ability under §583.209, or (ii) Award deobligated funds to appli- cations previously submitted in re- sponse to the most recently published 262 Oic. of Asst. SOCY-, Comm. Planning, Develop., HUD § 585.3 notice or fund availability, and in ac cordance with subpart C of this part. PART 585—YOUTHBUILD PROGRAM Subpart A --General Sec. 585.1 Authority. 585.2 Programpurpose. 585.3 Program components. 565.4 Definitions. Subpart 5 (Reserved) Subpart C—Youfhbuild Planning Grants 585.201 Purpose. 58S.202 Award limits. 585.203 Grant term. 585.204 Locatlonal considerations. 585.205 Eligible activities. Subpart D--Youthbulld Implementation Grants 585.301 Purpose. 585.302 Award ltmtts. 585.303 Grant term. 585.304 Locational considerations. 585.305 Eligible activities. 585.306 Designation of costs. 585.307 Environmental procedures and standards. 585.308 Relocation assistance and real prop- erty acquisition. 585.309 Project -related restrictions applica- ble. to Youchbuild residential rental lousing. 585.310 Project -related restrictions applica- ble to Youthbulld transitional housing for the homeless. 585.311 Project -related restrictions applica- ble to Youthbuild homeownership hous- tag. 585.312 Wages, labor standards, and non- di5crim ina do n. 585.313 Labor standards. Subpart E—Administration 585.401 Recordkeeping by recipients. 585.402 Grant agreement. 585.403 Report ingrequirements. 595.404 Program changes. 585.405 Obligation and deobligationof funds. 585.406 Faith -based activities. Subpart F—Applicability of Other Federal Requirements 585 501 Appl icarlon „f Utiig Circulars. 585.502 Certifications. 585.503 Conflict of interest. 585.504 Use of debarred, suspended, or ineli- gible contractors. At: ifloRrrvt 42 U.S C. 3535(4) and 8011. 263 SOURCE:: 60 FR 4737. Feb. 21. 1995, unless otherwise noted. Subpart A— General 0 SMA Authority. (a) General. The Youthbuild program is authorized under subtitle D of title IV of the National Affordable Housing Act (42 U.S.C. 8011), as added by section 164 of the Housing and Community De- velopment Act or 1992 (Pub. L. 102-550). (b) Authority restriction. No provision of the Youthbuild program may be con- strued to authorize any agency, officer. or employee of the United States to ex- ercise any direction, supervision. or control over the curriculum. program of instruction, administration, or per- sonnel of any educational institution, school, or school system, or over the selection of library resources, text- books, or other printed or published in- structional materials used by any edu- cational institution or school system participating in a Youthbulld program. 4 585-2 Program purpose. The purposes of the Youthbuild pro- gram are set out in section 451 of the National Affordable Housing Act (42 U.S.C. 12899) ("NAH.A"). (61 FR 52187, Oct. 4, 19961 4595.3 Program components. A Youthbuild implementation pro- gram uses comprehensive and multi- disciplinary approaches designed to prepare young adults who have dropped out of high school for educational and employment opportunities by employ- ing them as construction trainees on work sites for housing designated for homeless persons and low. and very low-income families. A Youthbuild planning grant is designed to give re- cipients sufficient time and financial resources to develop a comprehensive Youthbuild program that can be effec- tively implemented. Youthbuild pro- grams must contain the three compo- nents described in paragraphs (a), (b) and (d) of this section. Other activities described in paragraph (c) of this sec- tion are optional: (a) Edercationalsenices, including: (1) Ser- ices and activities designed to meet the basic educational needs of GRANT NUMBER FL14B800039 / FL.0189B4D000801 City of Miami — Miami Metro Homeless Assistance Program North ATTACEWENT A-1 SCOPE OF SERVICES The Subrecipient shall provide outreach, assessment and placement into housing of homeless persons (individuals and families) comprised of 5,250 contacts, 2,625 assessments and 750 placements with seven (7) day follow up. The Subrecipient will accept referrals from emergency shelters, transitional housing facilities, outreach teams and other service providers in the Continuum of Care. The Subrecipient shall provide a outreach, assessments and placements of homeless persons under this Agreement over the term of the nine (9) month grant. The Subrecipient shall provide services as proposed in the application to U.S. HUD pursuant to the 2008 Super NOFA (incorporated herein by reference), including but not limited to: 1. Extensive outreach; 2. initial assessment and evaluations; 3. Referral and placement in housing where appropriate and available; 4. Referrral to all appropriate and available services; 5. Transportation services; 6. Seven (7) day follow up Conditions: 1. Reimbursement shall be limited to operations, supportive services, leasing, administration, and the costs associated with these activities as described in the Subrecipienfs application; 2. Reimbursement shall be made only for the cost incurred for operations, administration, and supportive services actually provided to clients, unless the Grantee agrees, in writing, to another mode of payment, as provided for in this Agreement; 3. Monthly progress reports and program narratives signed by the Executive Director of the Subrecipient's agency shall be submitted by the Subrecipient, as required; 4. The Subrecipient will serve clients referred by the Grantee within available resources. or its designee for housing and/or services through the Grantee's established referral process; 5. Services shall be provided in accordance with the timeline submitted by the Subrecipient; 6. Any proposed modifications or revisions to the Subrecipient's program and/or services must be submitted in writing and must receive prior approval by the Grantee; and 7. The Provider will achieve the performance measures delineated in their application to U.S. HUD. Technical Project Number: FL0189B4D000801/ FL14B800039 Submission Project Identifier: FL14077 ATTACEMENT A-2 Exhibit 1: Proiect Summary Please indicate below the number of persons you have committed to serve as indicated in your application or as modified by your Field Office (Le., change due to funds being reduced}. D. Number of Beds, Participants, and Supportive Services (Does not apply to EMS projects) Section D is composed of three charts. Chart 1 is for recording the housing type. Chart 2 is for recording the number of unitstheds/bedrooms in the project Do not complete Chart 2 if the project is for supportive services only (SSO). Chart 3 is for recording the number of participants to be served. Information on aU projects should be entered in this section except for EMS activities. Complete Chart 2 and Chart 3 based on the following instructions. 1. In column e., please enter the requested information for all items at a point in time. You should fill out this column only if you checked "Yes" in Section III, Part Y, #9 or you are proposing a renewal project If you checked "No" in section E enter "N/A" in this column. 2. In column It, enter the new number of beds and persons served at a point in time if this project is funded 3. In column c., enter the projected level (columns a and b added together) that your project will attain at a point -in -time. Chart 2: Units, Bedrooms, Beds a. Current Level (Point -in -Time) b. New Effort or Change in Effort (If Applicable) c. Projected Level (col. a +col. b) Number of Units N/A NIA N/A Number of Bedrooms N/A NIA N/A Number of Beds N/A NIA N/A *Do not complete information on the number of units, bedrooms and beds for Sunoortive Services Only (SSO) projects. In those instances, enter "N/A" in the appropriate cells. Chart 3• Participants Cummt Level (Point in Time for DHS Current Lev (Point m Tim City of Miami b. New Effort or Change in Effort (If Applicable) C. Projected Level (col. a+ col. b) a. Number of Families with Children(Family Households) 54 *162 N/A 216 i. Number of adults in families 54 162 N/A 216 ii. Number of children in families 68 205 N/A 273 iii. Number of disabled in families 24 71 94 b. Number of Single Individuals and Other Households w/o Children 128 383 N/A 511 i. Number of disabled individuals56 167 N/A 223 ii. Number of chronically homeless 16 47 N/A 1 62 * Change in project sponsor HUD -40090-3a 9 Project Number. FL0189B4D000801/ FL14B800039 Technical Project Identifier: FL14077 ATTAC M ENT A-3 Submission Exhibit 1: Project Summary (RENEWALS ONLY) C. Program Goals - Goal: Residential Stability Conduct outreach activities to at least 7,000 total homeless persons (individuals and families), with the intent to provide an entry point to residential stability. This' goal is split between Miami -Dade County, Department of Human Services (DHS) operated for 3 months and City of Miami, operated for 9 months. Assess at least 3,500 contacted homeless persons for social services and housing needs. This goal is split between Miami -Dade County, Department of Human Services (DHS) operated for 3 months and City of Miami, operated for 9 months. Place at least 1,000 homeless persons (individuals and families) into emergency housing, transitional housing, permanent housing or other housing opportunities in the continuum of care. This goal is split between Miami -Dade County, Department of Human Services (DHS) operated for 3 months and City of Miami, operated for 9 months. Goal: Increase skill and income Provide outreach, assessment, and placement with seven (7) follow up services for at least 1,000 persons (individuals and families). Of those that were available for the 7 day follow up at least 11 %, of the eligible, assessed, placed participants will be employed. At least 25%, of the eligible, assessed, placed participants will be linked to agencies that provide other sources of income or benefits. This goal is split between Miami -Dade County, Department of Human Services (DHS) operated for 3 months and City of Miami, operated for 9 months. Goal: Achieve greater self-determination Provide .outreach, assessment, and placement with seven (7) follow up services for at least 1,000 persons (individuals and families of various combinations), which will link them to individual service plans that ensure greater self-determination. This goal is split between Miami -Dade County, Department of Human Services (DHS) operated for 3 months and City of Miami, operated for 9 months. D. Number of Units, Beds, Participants and Supportive Services These charts need to be included only if they were incomplete, inaccurate or blank at the time of the original application submission. Please complete these charts if your local HUD Field Office has notified you that they are required. Submit only those that apply. The charts can be found in the New Projects Section of the Technical Submission - HUD -40090-3a 5 ATTACHMENT A-4 PROJECT MILESTONES NTA FOR THIS PROJECT ATTACHMENT B n° Technical Submission for the 2008 °u Supportive Dousing Program °o Ch (an a in Project Sponsor) g = °o U.S. Department of Housing and Urban Development �o° Office of Community Planning and Development Project Sponsor: °0 Cityof Miami °u Project Name: Miami Metro Homeless Assistance ° Program North (MMHAP — North) ia =�oo o0 Project Type: 0°o � t� Supportive Ser ♦ ices Only (SSO) a° f "00 Project Dumber: °o °0 FLO189B4DO00801 °o �•00 ;. do MIAMI �1+.�Jc 0o Submitted by Selectee: 12 0 °o Miami -Dade County Homeless Trust .1 00 111 Northwest First Street, 27th th Floor, Suite 310 "'°o 0o Miami, ]Florida 33128 00l oo Telephone Number: (305) 375-1490 : o0 oa Fax Number: (305) 375-2722 °o MIAMI,DAD e ADA Coordination Agenda Coordination Animal Services April 27, 2009 Homeless Trust 111 NW 1 st Street • 27th Floor • Suite 310 Miami, Florida 33128-1930 T 305-375-1490 F 305-375-2722 miamidade.gov • An in Public Places Audit and Management Services Marlene Kocher, Senior Representative Aviation Community Planning and Development Division Building United States Department of Housing and Urban Development Building Code Compliance 909 SE First Avenue, Suite 500 Business Development Miami, FL 33131 Capital Improvements Citizens' Independent Transportation Trust Re: Change in Project Sponsor for Outreach North (Formerly DHS — HOAP — North) Commiss'on on Ethics and Public Trust FLO 89134D000801 or FL14B800039 Communications Community Action Agency Dear ' Community &Economic Development Plea nd for your review and approval the request to change projed sponsor for the 2008 renewal Community Relations grant. The explanation and justification #or new project sponsor referenced above for the City of Miami Consumer services program is outlined below. As well, Miami -Dade County Homeless Trust is confident in our competitive Corrections & Rehabilitation selection of this project sponsor, as they cumantly operate effective outreach, assessment and Cultural Affairs placement for the City of Miami area. Elections Emergency Management The new project sponsor was competitively selected through Miami -Dade County's selection process Employee Relations to replace the current sponsor, beginning May 1, 2009. This grant was operated as an outreach, Empowerment Trust assessment, and placement program by Miami -Dade County, Department of Human Services (DNS). Miami -Dade County from February 1, 2009 until April 30, 2009. DHS experienced extreme budget Enterprise Technology Services cuts, adversely affecting the two (2) homeless outreach programs, north and south providing services Environmental Resources Management in unincorporated Miami -Dade County area, as such the Homeless Trust and DNS mutually agreed to Fair Employment Practices seek another project sponsor who could maintain the necessary service level. The Homeless Trust Fnance Board published a Request for Applications (RFA) for a new project sponsor. Fire Rescue General Services Administration The budget is based on the most effective and efficient allocation of funds to operate and provide Historic Preservation outreach, temporary and permanent housing placement, intake and supportive services transitioning Homeless Trust individuals and families from homelessness to self-sufficiency. It is in keeping with HUD's goal and the County's 10 -year plan to end homelessness. The grants are for supportive services only. and require Housing Agency no leasing dollars and will provide matching funds as well as leveraged City of Miami funds. Housing Finance Authority Human Services Independent Review Panel International Trade Consortium Juvenile Services Medical Examiner Metro -Miami Action Plan Metropolitan Planning Organization Park and Recreation Planning and Zoning Police Our office has reviewed and is in complete agreement with the requested change in sponsor as outlined in the attached Technical Submission Exhibits as well as the Exhibits for the current sponsor. The agency would request as soon as feasible to reflect the new sponsor in the grant renewal. The Agency has provided a justification to address the Manges in eligible funding acWffies in Supportive Services. They have also provided documentation to demonstrate other funding sources that will used to operate and enhance the program. They have provided job descriptions and job tasks that are consistent with eligible, allowable, allocable activities. Please feel free to information. As., alv needs of the homel> Procurement Management r Property Appraisal Public Library System Si Public Works Safe Neighborhood Packs Seaport Dk Solid Waste Management 5 B ' trategkc usmess Management Enclosures Team Metro Transit Task Force on Urban Economic Revitalization Vizcaya Museum And Gardens Water & Sewer of our at( ) 375-1490 if you have any questions or require additional r or your assistance and support of our efforts in addressing the Technical Project Number: FL0189B4D000801/ FL14B800039 Submission Project Identifier: FL14077 (RENEWALS ONLY) Recipient's Name: Miami -Dade County Homeless Trust HUD Project Number: FLAB800039 / Sponsor's Name: City of Miami F1,0189B413000801 Miami Metro Homeless Assistance Program North May 1, 2009 — January 31, 2010 (9 months) (MMHAP-North) Check the program component/type that classifies your project: ® Supportive Housing ❑ Transitional Housing (TH) ❑ Permanent Housing for Homeless Persons with Disabilities (PH) ❑ Supportive Services Only (SSO) ❑ Safe Haven/Transitional Housing (SH/TH) — Characteristics of TH/participant not required to execute a lease ❑ Safe Haven/Permanent Housing (SH/PH) — Characteristics of PH/participant required to execute a lease ❑ Homeless Management Information System (HMIS) ❑ Innovative Supportive Housing (ISH) Table Of Contents (Enter the page number for each Exhibit in the space provided below.) Q Exhibit 1 Project Summary 701 Certification: Name & Title of the Person who can answer questions about this document: Sergio Torres Exhibit 2 Real Property Leasing, Supportive Services, Operating Budget Letters of Match Commitment and Leveraging hi Phone (include area code): x(305) 576 9900 Address: 1490 NW P Ave. Suite 105 Miami, Florida 33136 Email Address: stoTres@miamigov.com I hereby certify that all the information stated herein is true and accurate. Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802) Name & Title of Authorized Oficial: Signature & Date: Sergio Torres Program Administrator q Z' HUD -40090-3a 2 Project Number: FL0189B4D000801/ FL1413800039 Technical Project Identifier: FL14077 Submission Exhibit 1: Project Summary (cont.) (CHANGE IN PROJECT SPONSOR) A. Selectee, and Sponsor Information - Fill in the information requested below. For HMIS projects fill in the HMIS Lead. When the selectee is the same organization as the project sponsor, complete only the selectee information. Selectee Name Miami -Dade County, Homeless Trust Sponsor Name City of Miami Contact Person David Raymond, Director Contact Person Sergio Torres Phone (305)375-1490 Phone (305)576 9900 FAX Number (305) 375-2722 FAX Number (305) 400 5321 E -Mail Address Dra na miami-dade.gov E -Mail Address storres miami ov.com Street Address 111 N.W. I" Street, Suite 2710 Street Address 1490 NW 3" Ave. Suite 105 City, State, Zip Miami, Florida 33128 City, State, Zip Miami, Florida 33136 HMIS Lead Miami -Dade County, Homeless Trust Contact Person Barbara Golphin Street Address 111 N.W. I' Street, Suite 2710 Phone (305) 375-1490 City, State, Zip Miami, Florida 33128 E -Mail Address Rural Qrniamidade.gov B. Project Budget - This section must be completed by all renewal selectees. 1. Chart 1 - Summary Project Budget To complete Chart 1, Summary Project Budget, enter the amount of SHY funds requested by line -item in the first column. For leasing, supportive services, operations, and HMIS, the amount entered should be for the SHP grant tern selected. In the second column, enter the amount of other cash that will be contributed to the project. This amount plus the SHP request must equal the total budget amount for the project. Note that match requirements for supportive services, operating costs and HMIS apply to renewal projects. The amounts you enter are for all structures in your project. Each line item amount in this chart should match the amounts shown in Your original application as approved or Exhibits 3, 4, 5 and 6. Requested grant term (1, 2, or 3 years): 1 *By law, SHP can pay no more than 80% of the total supportive services or total HMIS budget. **By law, SHP can pay no more than 75% of the total operating budget. ***Bylaw, SHP can pay no more than 5% of the total SHP request. HUD -40090-3a 3 Project Number: FL01.89B4D000801/ FL14B800039 Technical Project Identifier: FL14077 Submission Exhibit l: Project Summary (cont.) (RENEWALS ONLY) iJri�i — 3 months Yebruary 1, 2009 — April 3U, 2UU9 (3 months) h SHP Request Applicant Cash Total Project Budget I. Real Property Leasing 2 Supportive Services* 69,681 17,420 87,101 3. O erations** 4. HWS* 5. SHF Request (subtotal lines 1 thru 4) 69,681 17,420 87,101 6. Administration***'(up to 5% of line 5) 3,484 3,484 7. Total SHP Request (total lines 5 and 6) 73,165 17,420 90,405 "+Ziii1L uFlMVAIIl -'tel 1 ►AItL'lL months) Total 1. Real Property Leasing 2 Supportive Services* 209,043 52,261 261,304 3.Operations** 4. HMIS* 5. SHY Request (subtotal lines 1 thru 4) 209,043 52,261 261,304 6. Administration*** (up to 5% of line 5) 10,452 10,452 7. Total SHY Request (total lines 5 and 6) 219,495 52,261 271,756 HUD -40090-3 a 4 Technical Submission Project Number: FL0189B4D000801/ FL14B800039 Submission Project Identifier: FL14077 Exhibit 4: Supportive Services A. Supportive Services Budget Chart 4A: Selectee's Match (Line 11 minus Line 9) City of City of Total Supportive Service Expense Miami Miami 261,304 (9 months) (1 year) Service Activity: Community Outreach 59,810 79,747 59,810 Specialist 1 Quantity: 4.0 FTE @ $$24,921 plus taxes and fringe benefits - change in project sponsor = $99,684 - i year = S74,763 - 9 months Service Activity: Community Outreach 102,773 137,030 102,773 Specialist 2 Quantity: 6.0 FTE @ $28,548 plus taxes and tinge benefits = $171,288 -1 year= 5128,466 - 9 months Service Activity: Communication for Outreach 9,202 12,269 9,202 Quantity: phone lines, cell phones, radios, network between office and outreach staff = 515,336 -1 year = $11,502 - 9 months Service Activity: Equipment & Related 9,202 12,269 9,202 Services Quantity: bottled water machines and services, copier machine, additional computer software and management equipment = $15,336 -1 year = $11,502 - 9 months Service Activity: Residential Stahilityfollow- 9,202 12,269 9,202 UP Quantity: Items needed to conduct 7- day follow up services for participants placed in various locations in the continuum of care, including residential supplies - blankets, possible transportation needs = $15,336 - i year = $11,502 - 9 months Service Activity: Postage & Related Services 450 601 450 Quantity: mailing of materials printing and reproduction, brochures etc. = $751 (1 Year) $563 (9 months) Service Activity: Supplies 9,202 12,269 9,202 Quantity: safety equipment, first aid kits, sanitary supplies, stationary or office supplies etc = $15,336 -1 year = $11,502 - 9 months Service Activity: Transportation 9,202 12,269 9,202 Quantity: for transporting participants = Cl r 21K _ I .,. - ei I cnl _ o ...,,.,+h. SHP REQUEST= 209,043 278,724 209,043 Selectee's Match (Line 11 minus Line 9) 52,261 69,681 52,261 Total Supportive Services Budget 261,304 348,405 261,304 HUD -40090-3a 12 Project Number: FL0189B4D0008011 FL14B800039 Technical Project Identifier: FL14077 Submission Exhibit 7: Administration (cont.) (all projects requesting administration funds) A. Administrative Costs Please complete the chart below for your administrative costs budget. If you are a selectee who will also be the project sponsor, complete Lines I through 6. If you are the selectee and a different organization will be the project sponsor, complete lines 1 through 8. In the first column, fill in the administrative activity to be paid for using SHP funds. In the Year 1 column, enter the amount of SHP funds to be used to pay administrative costs in the first year. If the grant is multi-year, enter the amount of SHP funds to be used for Year 2, and if applicable, Year 3. In the last column, (d), total the amount of SHP funds requested for the full grant term. Please ensure that the total requested for administrative costs for the entire grant term, Line 6, column (d), matches that which you entered in your project's Summary Budget in Exhibit 1. B. Plan for Distribution of Administration Funds If the selectee is not the same organization as the project sponsor, attach a description of the selectee's plan for distributing its administrative funding to address all, or a portion of the project sponsor's administrative needs. Include a description of how the project sponsor was consulted in formulating the plan. HUD -40090-3a 13 Year 1 Year 2 Year 3 Total Administrative Costs (a) (b) (c) (d) Administrative Activity: Miami -Dade County, Department of Human Services (HOAP-N) $1,742 $1,742 Preparation of Annual Progress Report, audit of SHP, staff time spent reviewing/verifying invoices for grant funds 2.5% (3 months) Administrative Activity: Miami -Dade County $6,968 $6,968 Homeless Trust 2.5% staff time spent reviewing/verifying invoices, preparation of APR, and audit of SHP grant funds. AdiTiluuSuatiVC ACtiVliy' Cly of Miarii (MMII A P- North) Preparation of Annual Progress Report, audit S5,226 $ S5,222 22 6 of SHP, staff time spent reviewing/verifying invoices for grant funds 2.5% (9 months) SHP REQUEST FOR ADMINISTRATIVE $13,936 $13,936 COSTS Amount for Selectee $6,968 $6,968 Amount for Project Sponsor $6,968 $6,968 B. Plan for Distribution of Administration Funds If the selectee is not the same organization as the project sponsor, attach a description of the selectee's plan for distributing its administrative funding to address all, or a portion of the project sponsor's administrative needs. Include a description of how the project sponsor was consulted in formulating the plan. HUD -40090-3a 13 Project Number: FL0189B4D000801 / FL14B800039 Technical Project Identifier: FL14077 Submission Attachment: Budget Narrative The City of Miami is requesting funds for a change in project sponsor for 1 month left on this grant and to renew in the one (1) year renewal program of 2008 for the Miami Metro Homeless Assistance Program South (MMHAP-S), will coordinate services in the current offices at North Dade area 1490 NW 3rd Avenue, Miami, Florida 33136 and add services in the South Dade area at the Homestead Homeless Assistance Center 28205 SW 125 Avenue, Homestead, Florida. The staff for this program will be located in the South Dade area location. SUPPORTIVE SERVICES ONLY Community Outreach Specialist 1 and 2 include three (3) full time COS 1 staff members at $24,921 x 1 month = $6,230 and three (3) full time COS 2 staff members @ $28,548 x 1 month = $7,137. Estimated at $13,367 however, with start up considerations, not all staff being hired = $12,799. See attached job descriptions Fringe Benefits: All fringe benefits are inclusive in the job title line -item in the budget and are figured at approximately: FICA/MICA @ 7.65% Workmen Comp @ 8 % Medical and Dental Health Insurance (Range varies monthly therefore averaged). Communication for Outreach: phone lines, cell phones, radios, network between office and outreach staff $2 Equipment & Related Services: bottled water machines and services, copier machine, additional computer software and management equipment $2 Residential Stability follow-up: Items needed to conduct 7- day follow up services for participants placed in various locations in the continuum of care, including residential supplies — blankets, possible transportation needs $2 Postage & Related Services: mailing of materials printing and reproduction, brochures etc. $2 Supplies safety equipment, first aid kits, sanitary supplies, stationary or office supplies etc $2 ADMINISTRATION Administration ($): 5% administrative fee of the requested supportive services only funding is split equally between City of Miami and Miami -Dade County Homeless Trust, for eligible activities which include staff time spend reviewing, managing and maintaining the records of the invoices, preparation of the Annual Progress Report (APR) and audit of the SHP funds. (For 9 months) HUD -40090-3a 15 COMMUNITY OUTREACH SPECIALIST I, HOMELESS ASSISTANCE PROGRAM Occupational Code: 9282 Salary Range: 04T Status: Temporary FLSA: Non -Exempt Established: 2/08 This is specialized work responsible for providing direct outreach and referral services to homeless individuals. An employee in this classification must be able to identify and engage homeless individuals in public places; under bridges, in abandoned buildings, and other outdoor areas in an attempt to engage them in a non- threatening way, build relationships, and assist them in recognizing and defining their own service needs_ Reports to a higher level administrator. Duties include, but are not limited to: working in a team setting engaging homeless individuals on the streets, conducting outreach assessment to determine needs, and informing them of available services; providing referrals to the various homeless service providers; providing documentation in accordance with program standards; collaborating and coordinating services with other City Departments including but not limited to: NET Offices, MPD, Solid Waste and outside agencies such as shelters, substance abuse and mental health treatment programs; may assist with supervising and training staff, hiring, disciplinary actions and recommending terminations: and performing other related duties as required. An employee in this classification should have knowledge of available community services and programs, effective oral; written and interpersonal skills; ability to maintain effective working relationships with fellow employees, the public and representatives of other agencies, often under complex and stressful situations; ability to work independently, and exercise good professional judgment; and ability to prioritize multiple job responsibilities. REOUIREWNTS: High school graduation or equivalent and (6 months — 2 years) experience performing clerical, administrative or public contact work. Experience working with the homeless population is desirable. A Valid Driver's License from any state (Equivalent to a State of Florida Class E) may. be utilized upon application, however prior to appointment a State of Florida Driver's License (Class E or higher) must be presented to the Department of Employee Relations. SPECIAL NOTE: Must be willing to work flexible hours including evenings, weekends and nights. COMMUNITY OUTREACH SPECIALIST II, HOMELESS ASSISTANCE PROGRAM Occupational Code: 9283 Salary Range: 05T Status: Temporary FLSA: Non -Exempt Established: 2/08 This is specialized work responsible for providing direct outreach and referral services to homeless individuals - An employee in this classification must be able to identify and engage homeless individuals in public places, under bridges, in abandoned buildings, and other outdoor areas in an attempt to engage them' in a non- threatening way, build relationships, and assist them in recognizing and defining their own service needs. This class is distinguished from the classification of Community Outreach Specialist I by the level independent judgment allowed and that this classification will be assigned the more difficult and complex assignments. Reports to a higher level administrator. Duties include, but are not limited to: working in a team setting engaging homeless individuals on the streets, conducting outreach assessment to determine needs, and informing ihem of available SerY ices; providing referr-ls to the various homeless service providers, providing documentation in accordance with program standards- collaborating and coordinating services with other City Departments including but not limited to: -NET Offices, MPD, Solid Waste and outside agencies such as shelters, substance abuse and mental health' treatment programs; may assist with supervising and training staff, hiring, disciplinary actions and recommen g terr3r atrons; an p Forming o er re ate uses as require - An employee in this classification should have knowledge. of available community services and programs-, effedtive oral, written and interpersonal skills; ability to maintain effective working relationships with fellow employees, the public and representatives of other agencies, often under complex and stressful situations; ability to work independently, and exercise good professional judgment; and ability to prioritize multiple job responsibilities. REQUIREMENTS: High school graduation or equivalent and (2 - 4 years) experience performing clerical, administrative or public contact work. Experience working with the homeless population is desirable. A Valid Drive'r's License from any state (Equivalent to a State of Florida .Class E) may be utilized upon application, however prior to appointment a State of Florida Driver's License (Class E or higher) must be presented to the Department of Employee Relations- SPECIAL'NOTE: Must be willing to work flexible hours including evenings, weekends and nights. Project Number: FL0189134D000801/ FL14B800039 Technical Project Identifier: FL14077 Submission Exhibit 2. Real Property Leasing, Supportive Services, Operations and HMIS (RENEWALS ONLY) This exhibit covers Real Property Leasing, Supportive Services, Operations, HMIS as it pertains to Site Control, Match Documentation and other applicable Certifications. Please refer to the narrative under the New Projects Section of the Technical Submission for a more detailed explanation of each of the exhibits. Other sections in this exhibit may need to be completed if required by your local HUD Field Office. ALL RENEWAL GRANTEES/PROJECT SPONSORS MUST COMPLETE SITE CONTROL, MATCH DOCUMENTATION AND JOB AND ADMINISTRATION CERTIFICATIONS. If you are required to resubmit or complete the real property leasing, supportive services, operations or HMIS exhibits, pull the charts from the pages of the New Projects Section of this technical submission that apply. For leasing use Exhibit 3 charts, supportive services use Exhibit 4 charts, operations use Exhibit 5 charts and HMIS use Exhibit 6 charts. You do not have to complete the leveraging and administration exhibits for renewals. A. Site Control Check the appropriate box(es): Leasing ❑ Supportive Services ® Operations ❑ A project sponsor requesting renewal funding for an existing SEP project must complete the information below. No other site documentation is required for renewal projects. As a recipient of SBP funds, the City of Miami (sponsor organization) currently has an executed lease agreement, or a deed or other proof of ownership for the property(ies) in use to house and/or provide services to homeless persons under HUD's existing grant number. In addition, sponsor organizations using SBP funds for leasing activities (uroiect sponsor the conditional grantee, or their parent organizations -fill in the appropriate one-) do not own these leased site(s). This includes organizations that are members of a general partnership where the general partnership owns the structure(s), both parties are parts of the same governmental unit or the governmental unit creates an authority or similar entity to acquire and lease the facilities to the governmental unit and other parties, and no operating grant funds will be used for the payment of utilities, maintenance and repairs, or management fees associated with the leased site(s), under HUD's existing grant number FL0189B4D000801. Signature of authorized representative Name: Sergio Torres Title: Administrator Date: 04/08/09 =-40090-3a Technical Project Number: FL0189B4D000801/ FL1413800039 Submission Project Identifier: FL14077 Exhibit 2. Real Property Leasing, Supportive Services, Operations and HMIS (RENEWALS ONLY) B. Documentation of Match for Year 1 Supportive Services M Operations ❑ HMIS ❑ A selectee must currently have firm commitments for its cash resources for Year 1 for supportive services, operating costs and HMIS and must submit documentation of those resources as an attachment to this Exhibit. These firm commitments must be documented on letterhead stationery, signed and dated by an authorized representative, and attached to this Exhibit. Each letter must, at a minimum, contain the following elements: 1. The name of the organization providing the cash resource; 2. The amount; 3. The type of activity for which the funds will be used (e.g., case management, child care, education); 4. The name of the project sponsor organization to which the cash will be contributed and/or the name of the project; and 5. The date the funds will be available. HUD -40090-3a 7 0211-tij of ffliami Y OF,� r 7Q�COry�y04 Thursday, August 21, 2008 David Raymond, Executive Director Miami -Dade County Homeless Trust 111 NW 1St Street, Suite 2710 Miami, FL 33130 PEDRO G. HERNANDEZ, P.E. City Manager RE: City of Miami / 2008 FL 14B800039 -Metro Miami Homeless Assistance Program Commitment of Matching Funds. Dear Mr. Raymond This letter is to certify that the City of Miami will provide a cash match in the amount of $52,261 for 2007 HUD SHP 2008 Grant. These funds will support the overall operations of the program, including the provision of outreach, assessments, referral and placements of homeless individuals in Miami -Dade County. The funds will be available upon the start of this SHAD contract. Please feel free to contact me at 305 576 9900 if you have any question or require any additional information. Sincerely, Sergio Torres, Administrator City of Miami, Metro Homeless Assistance Program OFFICE OF HOMELESS ASSISTANCE PROGRAMS 1490 NW 3rd Avenue, Suite #105, Miami, FL 33136 / Phone: (305) 576-9900 Fax: (305) 576-9970 Technical Project Number: FL0189B4D000801/ FL14B800039 Submission Project Identifier: FL14077 Exhibit 2. Real Property Leasing, Supportive Services, Operations and HMIS (RENEWALS ONLY) C. Match Certification (continued) The City of Miami (selectee organization) certifies that it will provide cash resources in the amount of $52,261.00 from non-SHP funding sources for Year(s) 1 of this grant term to be used to provide HMIS services and/or for operating costs of housing for homeless persons under HUD's grant number FL14B700031. -� Signature of authorized representative: Name (Print): Sergio Torres Title: Administrator Date: 04/08/09 D. Job Description Certification The City of Miami (selectee organization) certifies that the job responsibilities of each position as it relates to the project are the same as those indicated on the 2006 application budget chart(s)- If the position or responsibilities have changed, submit a new position description for the new or added position. Signature of authorized representative: -�— 1 -----n Name (Printf: Sergio Torres Title: Administrator Date: 04/08/09 E. Administration Certification The City of Miami (selectee organization) certifies that funds are being used for eligible administrative costs. If the Distribution of Funds is not the same, a new/revised plan is submitted. Signature of authorized representative: Name (Print): Sergio Torres Title: Administrator Date: 04/08/09 HUD -40090-3a 8 Titij. of ffliami �G1TY OP r dPF- C FU04` June 26, 2007 David Raymond Executive Director Miami -Dade County Homeless Trust 111 NW 1 s< Street, Ste. 2710 Miami, FL 33130 RE: Authorized Signature Provisions for Grant Reports Dear Mr. Raymond: PEDRO G. HERNANDEZ, P.E. City Manager This letter serves to clarify signature authority provisions concerning grant reports, reimbursement requests, and other day-to-day grant correspondence. Simply, this letter `bridges' the authority given to Department Heads under the City's Administrative Policy APM 8-78 to seek timely reimbursements or other payments from funding sources, for submitting reports to funding agencies, and coordinating the day-to-day activities of grants funded projects. The APM does not explicitly name Department Heads as authorized signatures for reimbursement requests, reports, and other correspondence. Therefore, I offer this letter as clarification: the NET Director, David A. Rosemond or his designee Sergio Torres Administrator of the Miami Homeless Assistance Program, are authorized to sign grant reimbursement request, grant reports, and other day -today grant -related correspondence for appropriately executed grants awarded to the NET Department Sincerel , Pedro G. 'He d z, P.E. City Manager C: David Rosemond, NET Director Sergio Torres, Miami Homeless Assistance Program Administrator OFFICE OF NET ADMINISTRATION 444 5_W. 2nd Avenue, T"Floor Miami, FL 33130 (305) 416-2118 Fax: (30S) 416-1970 Mailing Address: P.O. Box 330708 Miami, Florida 33233-0708 L POLICY NUMBER APM- 8 - 78 DATE: Febniaa 18, 2003 ISSUED BY: Joe Arriola City Manager CITY OF MIAMI ADMINISTRATIVE POLICY SUBJECT= GRANT'S AND GRANT ADMINISTRATION PURPOSE To establish guidelines and general procedures that clarify responsibilities for submitting grant applications, accepting grants, and administering approved grants. Effective this 'date, this Administrative Policy supersedes all previous directives on this subject. It is the policy of the City of Miami to apply for grants that will enhance services for City'residents and businesses, to manage grants effectively and efficiently, and to ensure that all grant reimbursements are requested and received. APPLICATION A. Under the -authority of Resolution 76-919, the City Manager or designee may apply for federal, state, local or other grants on behalf of the City. B. The Office of Grants Administration (OGA) is the designated office that .City Departments contact for assistance in project planning, proposal writing, application assembly, and monitoring financial and budgetary compliance with grantor agency guidelines_ C. The Grants Administrator will be the designated official in charge of the Office of Grants Administration. D. All grant applications shall be submitted to OGA for review, and will subsequently be forwarded to the City Manager for approval, and final signature. E. OGA is responsible for promoting and coordinating grant proposal submissions except for those programs administered by the Department of Community Development. F. The City Commission accepts approved grants via an ordinance that appropriates the money to a designated Special Revenue Fund . G. In the case of construction projects, grant funds awarded are appropriated to the Department's account within the Capital Improvement Program. REVISIONS REVLSED DATE OF SEMO REVISION Created 11/01/78 All Sections 04105/01 All Sections 02/18/03 PURPOSE To establish guidelines and general procedures that clarify responsibilities for submitting grant applications, accepting grants, and administering approved grants. Effective this 'date, this Administrative Policy supersedes all previous directives on this subject. It is the policy of the City of Miami to apply for grants that will enhance services for City'residents and businesses, to manage grants effectively and efficiently, and to ensure that all grant reimbursements are requested and received. APPLICATION A. Under the -authority of Resolution 76-919, the City Manager or designee may apply for federal, state, local or other grants on behalf of the City. B. The Office of Grants Administration (OGA) is the designated office that .City Departments contact for assistance in project planning, proposal writing, application assembly, and monitoring financial and budgetary compliance with grantor agency guidelines_ C. The Grants Administrator will be the designated official in charge of the Office of Grants Administration. D. All grant applications shall be submitted to OGA for review, and will subsequently be forwarded to the City Manager for approval, and final signature. E. OGA is responsible for promoting and coordinating grant proposal submissions except for those programs administered by the Department of Community Development. F. The City Commission accepts approved grants via an ordinance that appropriates the money to a designated Special Revenue Fund . G. In the case of construction projects, grant funds awarded are appropriated to the Department's account within the Capital Improvement Program. H. The Budget Director will review each grant ordinance to assess the budgetary impact prior to City Commission acceptance of a grant. II. LANGUAGE A- All grant ordinance titles must clearly identify the name of the granting agency, pass-through entity, grant contract number, CFDA number, CSFA number, and other required information. B. The ordinance language must indicate the purpose for which the grant funds will be used and specifically state whether the funds are designated for the Special Revenue Fund or a Capital Improvement Project. C. When local match is required, the ordinance shall specify the source by title and account code . M. IMPLEMENTATION A- City Departments are responsible for implementing and managing grants within their jurisdiction. B. All Department heads (including the Chiefs of Fire -Rescue and Police) -- or their designees-- are responsible for seel in.g timely and accurate reimbursement or other payments from the funding source(s) of each grant within their jurisdiction. C. Grant awards are implemented through project codes established by the Finance Department and subsequently recorded by the Office of Grants Administration. D. Department heads shall designate a grant project manager for each grant project who will be responsible for day-to-day operations and for submitting reports to the Office of Grants Administration, the Finance, and Management and Budget Departments, and the funding agency. E. Departments with their own Budget and/or Finance sections, shall - follow their existing procedures provided that these internal procedures are not inconsistent with this policy. F. Project managers must coordinate with the Finance, Budget and Office of Grants Administration on all Grants protocol prior to award. Upon award, grant project managers shall meet with the Office of Grants Administration to coordinate the initiation of the appropriate records and files with Finance, and Management and Budget Departments. For Capital Improvement Program (CIP) projects, grant project managers must also meet with CIP staff. G. To carry out the responsibilities stated above, each department head shall appoint one individual as grant liaison to oversee all grants received by that department. Additionally, there will be a designated project manager for each grant project who is responsible for day-to-day operations and for submitting reports as required by the funding agency. H. Grant project managers must confirm that the Departments of Finance and of Management and Budget have the required account information, the approved grant budget, and the enabling ordinance. I. Grant project managers are responsible for preparing all requests for funds in compliance with the grant contract and will send duplicate reimbursement or draw down requests, accounting records, and copies of any financial reports required by the grantor. J_ Each department administering an awarded grant must ensure that each support department has a copy of the grantor agency rules and regulations which relate to the particular function handled by the support department. IV. COST RECOVERY A The City shall recover all allowable indirect or finance & administration costs. A formula for distributing the recovered rate shall be established at a later date by Administrative Policy. V. RECORDS A. Preaward: I 1. Departments will receive a form to track the grant process from proposal creation to closing herein after called the "Grant Tracking Form." B. Post -award: 1. The Finance Department maintains central financial records for all grant programs - 2. The Finance Department notifies the grantee when funds are received and then deposits the funds in the appropriate accounts. j 3. The Office of Grants Administration beeps a database. of all proposal i submissions and outcomes. VI. MONITORING A The Office of Grants Administration will receive monthly project activity reports from the grant project manager and verify agtivity with Finance and Budget j Departments through the use of the "Grant Trac]cing Form." 1 B. The grant project manager ensures that programmatic and financial reporting requirements and deadlines are observed. VII. AUDITS A The Internal Audit Department is responsible for making random audits on ongoing grant programs to determine compliance with provisions of City Code, Charter, Policies and Procedures; State Statutes; Federal Public Law 104-166, and the Single I Audit Act Amendments of 1996. Additionally, the City Manager may request a special internal audit of any grant awarded to the City of Miami or by the City of Miami to a sub grantee. I ' i Project Number: FL0189B4D000801/ FL14B800039 Technical Project Identifier: FL14077 Submission Exhibit 8: Leveraging If this project was identified as a project that will leverage resources (outside of SHP) in the selectee's original application to HUD (Exhibit 1: Continuum of Care Narrative, Project Leveraging Chart), the selectee is required to submit documentation of the leveraged commitment(s) during the Technical Submission phase HUD awarded up to three points as described in the NOFA for project leveraging for those projects indicated as having a written agreement in place at the time of application. If this project was identified as a project that will leverage resources, please submit: a) copy of a written leveraging agreement in place at the time of application submission that indicates.- b) ndicates: b) the type and value of the contribution; c) the name of the project sponsor organization and; d) the name of the project for which the resource will be contributed. Acceptable documentation includes signed and dated letters, memorandums of agreement and similar documents. Type of Contribution Source of Contribution Identify Source as: Date of Written Value of Written (G) Government* commitment Commitment or Private * Government sources are appropriated dollars TOTAL HUD -40090-3a 14 u, r�---!j .,,.....y,y. v..,, ,.... w.,.ry lvc texp, 1/.j1ILW4) and Urban Development SNAPS Special Needs Assistance Program office of Community Planning Request Voucher for Grant Payment and Development See Instructions and Public Reporting Burden Statement on back ATTACHMENT C 1. Voucher Number 2 LOCOS Pgrm. Area 3. Penoci Covered by this Request (dates) SNAP HPAC IHP 5. Voice Response No. (5 digits, hyphen, 5 more 6. Grantee Organization's Name 8. Grant No. 6a. Grantee Organization's TIN 4. 1 ype Or U13bursement F Partial E]Final 9. Line Item no. Type of Funds Requested Amouni (round to nearest dollar) 1010 Acquisition 1020 Rehabilitation 1021 New Construction 1022 Substantial Rehabilitation 1023 Moderate Rehabilitation 1030 Operating Cost 1040 Rental Assistance 1050 Supportive Services 1060 Administrative Cost 1070 Child Care 1080 Employment Assistance . 1090 Relocation 1100 Leasing 1.110 Repair & Maintenance 1111 Prevention (RH) 1112 Capacity Building (RH) 1120 Other: 10. Voucher Total I hereby certify that all the Information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate. Waming: HUD w will prosecute false claims andstatements. Conviction may result in criminal and/or civil penalties. (18 U.S.C.1001,1010,1012; 31 U.S_C.3729, 3802) 11. Name & Phone Number (including area code) of the Authorized 112 Signature ( 13. Date of Request Person who called SNAPs System VRS X Privacy Statement: Public Law 97-255, Financial Integrity Act, 31 U.S.C. 3512, authorizes the Departmentof Housing and Urban Development (HUD) to collect allthe information (except the Social Security Number (SSN)) which will be used by HUD to protect disbursement data from fraudulent actions. The Housing and Community Development Act of 1987, 42 U.S.C. 3543, authorizes HUDto collect the SSN. The data are used to ensure that individuals who no longer require access to Line of Credit Control System (LOCCS) have their access capability promptly,deleted. Provision of the SSN is mandatory. HUD uses itas a unique identifier for safeguarding LOCCS tram unauthorized access. Failure to provide the information requested may delay the processing of your approval for access to LOCCS. This information will not be otherwise disclosed or released outside of HUD, except as permitted or required by law. Retain this form in your records for audit purposes page 1 of 2 form HUD -27053-A (2/95) Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number. This information collection is to request paymentof grant funds orto designate the appropriate officials who can have access to HUD voice activated payment system. The HUD voice activated payment system has been especially designed to help the recipientwhen calling in for a request of funds and improves the payment process so the recipient will know right away whether their request will be paid or not. This information collection is required under 24 CFA Subpart C, 85.21 -Post Award Requirements, the information collection is needed In order to obtain or retain a benefit. Instructions for the Request Voucher for Grant Payment for the Special Needs Assistance Program (SNAPs) Item 1. Voucher Number: The first 3 digits are the prefix to your program. Enter `001" if grant funds are being requested for a grant awarded under a SHDP or SHP (TH, PH, SAFAH and Renewal) grant. Enter '036' if funds are being requested for a Housing Opportunity for Persons with AIDS (HOPWA) competitive grant. Enter '054' if funds are being requested for an Innovative Housing Program (IHP) grant. (if you do not know your 3-dgit program prefix, contact your local Field Office.) The remaining 6 digits will be assigned by LOCCSNRS during the telephone call_ The entire 9 -digit number will have to be entered prior to ending the call. Item 2- LOCCS Program Area: Circle 'SNAP' (001) for SHDP and SHP grant .requests, 'HPAC' (038) for HOPWA competitive grant requests, and 'IHP' (054) for Innova- tive Homeless Programs. Item 3. Enter the period covered by this request. Item 4. Type of Disbursement: Check 'partial' until the final request for grant funds is made. Item 5. Voice Response No: Enter the 10 digit Voice Response System (VRS) project number which was sent to you by mail. Your regular HUD project number will be repeated back for verification after the VRS project number is entered. Item 6. Grantee Organization's Name: Enter the name of the organization requesting funds. It must be the same name that appears on the Grant Agreement. Item 6a. Grantee Organization's Tax Identification No: Enter the tax (employer) Identification Number (TIN)_ Item 7. Not applicable. Item 8. Grant Number: Enter the project number that appears on the Grant Agreement. Item 9. Type of Funds Requested: SNAPs grant VRS draw- downs are directed against spec funding categories called Budget Line item (Kis). LOCCS associates a 4 - digit number with each line item_ Enter the amount requested in each category (lines 1010 through 1120) and the total funds requested under item 10, Voucher Total. Item 11. Name & phone number (including area code) of the authorized person who completed the call-in to VRS. The authorized person is shown on line 3 of form HUD -27054. Item 12. Signature of the person identified in item 11. item 13. Date of this Request: Enter the date of the call-in to request funds. Retain this forth in your records for audit purposes page 2 of 2 form HUD -27053-A (2195) MONTHLY INVOICE MIAMI-DADE MELESS MONTH: T R U S T PROVIDER NAME: PROGRAM NAME; ATTACHMENTCONTRACT# C-1 HTIPROJECTS 4/1/20082:01 PM HTiPROJECTS 411(20082:01 PM a Home CilentPolnt Resourc_Point HUD Annual Progress Report (HUD -40115) 11 Report Options: ATTACHMENTOD Government ShelterPo n[ 5kanFoint >P,==pn �s =.drain �;e Lo,_cf S_(ect- !"J Unduplicated )eider Miami-Gadi County Government (,'I) erating Year Date Rance 05/0 1/2006 to 05/31/2006 (mm/dd/yyyy) al Adult Age 18 (as defined by foster care law in your state) i Or s�. p1�kxlaC -Select- Cti` 2. Persons Served during the Number of Singles Number of Adults Number of Children in Number of operating P g year. Not in Families in Families Families Families a. Number on the first day of the 0 0 operating year, 0 D program during the0 year.umber 0 0ating Lumberentedno who lef the program during 0 perating year. d. Number in the program on the last day of. the operating year. (a+b-c=d) 0 0 0 0 3, Project Capacity. Number of Singles Number of Adults Number of Children in Number of Not in Families in Families Fatuities Families a. Number on last day (from 2d, columns 1 and 4) 0 0 4. Non-horneless persons. (sec. 8 SRO projects only) How many Income -eligible non -homeless persons were housed by the SRO prograrn during the operating yea r7 0 5. Age and gender. Age (Male Female Other/Nbtgiven Single Persons (from 2b, column 1) a. 62 and over I 0 0 0 �b.51-61 0 0 0 Ic.31-50 0 0 0 d. 13 30 0 0 0 e. 17 and under . I 0 0 0 INot given 0 0 0 Persons in Families (from 2b, columns 2 & 3) If. 62 and over 1 0 I 0 I 0 19.51-61 0 0 ( 0 h. 31 - 50 0 0 0 hrtps: Ah Ivv3.Servicept.comirriiami/scripts/svprep orthud.php6!1 /?OOF, x.16-30 10 1 C' I a. Mental illness b. Alcohol abuse I Ij. 13 17 I 0 0 I 0 Ik.6 1Z I 0 0 0 American Indian or Alaskan Native 0 AsEor 0 Blacan American rd. m. Under I I o n .0 Not given 0 I 0_ I 0 , 6a. Veterans Status. A veteran is anyone v,,ho has ever been on active military duty status. 0 6b. Chronically Homeless. a. Mental illness b. Alcohol abuse How marry participants were chronically homeless individuals? 0 7. Ethnicity. 0 ' a. Hispanic or Latino 0 b. Non -Hispanic or Non -Latino 8. Race. 0 American Indian or Alaskan Native 0 AsEor 0 Blacan American rd. 0 Native Hawallan or Other Pacific Islander 0 e. White ,0 f. American Indian/Alaskan Native & White 0 g. Asian & WhiteI 0 h: Black/African American & White D i. American Indian/Alaskan Native & Black/African American 0 j. Other.Multi-Racial 0 k. Other/Unknown (all that do not match) 0 9a. Special Needs. 0 I I All I Chronic a. Mental illness b. Alcohol abuse 0 0 :0 ;0 c. Drug abuse 0 ' :0 d. HIV/AIDS or related diseases + 0 0 e. Developmental disability 0 0 f. Physical disability I 0 0 g. Domestic violence h. Other (please specify) 9b. Disabled. j 0 + 0 0 0 How many of the participants are disabled? 10. Prior Living Situation. All 0 Chronic a. Non -housing (street, park, car, bus station, etc.) 0 0 b. Emergency shelter 0 0 c._Transitlonal housing For homeless persons 0 d. Psychlatrlc facillty 0 e. Substance abuse treatment facility 0 f. Hospltal I 0 g. Jail/ prison 0 h. Domestic violence situation, 0 i. Living with relatives/friends 0 j. Rental housino 0 •I https:i/�ti�iw .ser i.sept.c0111II11131111/scrlpts/svpreporthud.php 6/14/2006 11. Amount and Source of Monthly Income at Entry and Exit. 0 Amount A. Monthly Income at Entry B. Monthly Income at Exit All Chronic I All Chronic a. No Income b. $1-150 , 0 0 G i 0 0 C.0 - 5250 0 0 0 I 0 d.$251 $500 0 0 0 0 e. $501 $1000 I 0 I 0 + 0 0 f. $1001 $1500 0 0 I 0 0 g. $1501 - $2000 0 0 0 0 h. $2000 + 0 0 0 0 Source C. Income Sources at Entry ( All Chronic D. Income Sources at Exit All Chronic a. Supplemental Security Income (SST) p 0 1 0 0 b. Social Security Disability Insurance (SSDI) 0 0 0 0 c. Social Security 0 4 0 I 0 0 d. General Public Assistance 0 , 0. 0 0 e. Temporary Aid to Needy Families (TANF) I 0 D 0MD f. State Children's Health Insurance Program (SCRIP) 0 0 0 Ig. Veterans benefits , 0 0 0h. Employment Income t 0 0 I 0i. Unemployment Benefits 0 0 0j. Veteran's Health Care 0 0 0 Ik. Medicaid 0 0 I 0 II. Food Stamps I 0 0 0 Im. Other (p)ease speciFy) 0 G 0 n. No financial resources 12a. Length of Stay in Program. (participants who left during operating year) . All Chronic a. Less than 1 month 0 0 b- 1 to 2 months I 0 I 0 c. 3 - 6 months 0 0 d. 7 months - 12 months e. 13 months - 24 months 0 0 0 0 f. 25 months - 3 years 0 0 g. 4 years - 5 years 0 I 0 h, 6 years - 7 years 0 0 i. 8 years- 10 years 0 0 j. over 10 years. 0 12b. Length of Stay in Program. (Participants who did not leave during operating year) 0 All Chronic a. Less than 1 month 0 0 b. 1 to 2 months �c. 0 0 3 - _6'months 0 �, 0 d- 7 months - 12 months e. 13 months - 24 months I 0 I 0 0 0 f. 25 months - 3 years I 0 0 g. 4 years - 5 years 0 I 0 hrips:/J>��t�r3.se.rvice.pt.r.omlmialniiscriptstsvpreporthud.php 6/14/=006 i i. 8 years - 10 years ' 0 0 j. over ! 0 year; 0 I 0 13. Reasons for Leaving. - -I All Chronic a. Left for a housino opoortunity before completing prooram - ll� i 0 I 0 b. Completed program 0 0 c. Non-payment of rent/occupancy charge 0 0 d. Non-compliance +,pith project 0 0 e. Criminal activity / destruccion of property/ violence 0 0 um time allowed in project 0 0 couldt be met by project 0 0 EDisagreement with rules/persons 0 0 0 0 j. Other (please specify) LE 0 k. Unknown/disappeared0 0 0 14. Destination. k. Psychiatric hospital 0 i No supportive services found. ServicePoint version 4.01.013 (db build #0723) Licensed to: Miami Dade Homeless Trust © 1999-2.006 Bowman systems L-,L.C. All Rights Reserved. CPT only (02004 American rledlcal Association. All Right=_ P._served. DShi and DSf l -IV -TR a = renis;=_red trademarks of the Anleric3n PSychi8MC Assoclatlon, ano are used vilih permisslon herein. ICD -9-2—M eF 1994 Nabona! Center for Health Sta-_!sties (ICD-9 :01orld Haalth 0:'gani23tion). All Rights Reserved. Ta:cOnomy (c)19o3-20C-3 Ini•:)rr-atien and RefeGal Federation cf Los Angeles County, Inc. All Rinnts Reserleti. https:i./mvivIservice pt. coni'miami/scripts/svprepo rthud.pllp 11 Ail Chronic a. Rental house or apartment (no subsidy) 0 0 b. Public Housing 0 0 c. Section 8 0 0 KMANENh, �d. Shelter Plus Care e. HOME subsidized house or apartment 0 I 0 0 0 f. Other subsidized house or apartment (g. Homeownership 0 + 0 0 0 h. Moved in with family or friends 0 0 +i. Transitional housing for homeless persons f 0 I 0 j. Moved in with family or friends 0 0 INSTITUTION (k - rn) k. Psychiatric hospital 0 i D 1. Inpatient alcohol/drug treatment facility 0 0 EMERGENCY SHELTER (n) `m. )alljprison n. Emergency shelter 0 0 0 0 OTHER (o q) o. Other sup "portive housing P. Places not meant for human habitation (e.g. street) 0 0 0 0 q. Other (please specify) 0 I 0 UNKNOWN I5. Supportive Services - r. Unknown 0 0 No supportive services found. ServicePoint version 4.01.013 (db build #0723) Licensed to: Miami Dade Homeless Trust © 1999-2.006 Bowman systems L-,L.C. All Rights Reserved. CPT only (02004 American rledlcal Association. All Right=_ P._served. DShi and DSf l -IV -TR a = renis;=_red trademarks of the Anleric3n PSychi8MC Assoclatlon, ano are used vilih permisslon herein. ICD -9-2—M eF 1994 Nabona! Center for Health Sta-_!sties (ICD-9 :01orld Haalth 0:'gani23tion). All Rights Reserved. Ta:cOnomy (c)19o3-20C-3 Ini•:)rr-atien and RefeGal Federation cf Los Angeles County, Inc. All Rinnts Reserleti. https:i./mvivIservice pt. coni'miami/scripts/svprepo rthud.pllp ML NIJ-DADE COUNTY HOMELESS TRY'S I FROGR.:,01 RATING OF SATISFACTION INSTRLCTIO�S Careful]~' read all of the instructions blow BEFORE. distributing the Pro ,ram Raring of Sutisf.:tetiun sun ev to your pro�rarn participants. GeneralInforrnatiun The Program Patine of Satisfaction consists of 1 I items which are used to deterrttine a clients s"tisf.actii' n .with Services they are receiving from a provider. It is to be completed by all program particip;r»t_. enLa_ ed in services ata Trust -funded prog7rarn. It must be completed - at a minimum - at time of dischar_'e for al I participants. It is strongly recommended that a Program Rating of Satisfaction sun,ey also be cornpleted at intervals as may be applicable to the program: however, only the discharge survey must be for%,,arded to the Homeless Trust. Case management notes should indicate specifically why a Program Rating of Satisfaction ivas not obtained, if that is the case (client went AWOL, institutionalized. etc.). and whar efforts 1� ere made to obtain a survey in those instances. The Program Rating of Satisfaction is available in English, Spanish and Creole. Providers are responsible for reproducing the appropriate survey and providing an envelope (that seals) for each respondent. All responses should be completed in ink If a participant cannot read, providers should encourage them to use the.sarne process they use to have other information read to them. An employee of the agency that is not directly responsible for the client's care can read the form. This should be indicated in Section II. as a separate set of staff initials. F111hrrc out the form I) A language appropriate survey and an envelope should be provided to all participants who are required to complete the form. Only one font per family is required. The form must be filled out in ?) Section II of the Program Rating of Satisfaction is to be completed by staff prior to providing the survey document to the program participant. Staff initials refers.to the initials of the case mananer responsible for the client's service delivery. If the survey must be read to the client, the initials of the staff person performing that function should also be included. In no case should the participant's case manager read items aloud to the participant. 3) Section I of the Program Rating of Satisfaction Form is to be filled out ONLY by the program participant. The program participant should be provided a private place and sufficient time to answer the survey. 4) Providers should reassure participants of the confidentiality of their responses. Providers may swish to introduce the survey, as follows: "This survey is one way of helping us determine ho1,v well we are helping individuals that come to our mercy for assistance. Please take a fe\v minutes after I leave to answer this very short survey as honestly as possible. Your responses are private and 1ve 1- i11 not Tool: at them. Please seal the envelope and Live it to me 1- hen you are done (or: put it in the drop boy:)." �) The completed 5ur-,,-ey should be placed in the envelope by the recipient and sealed. Providers are encouraged to provide a "drop host" �-vlth a slot for completed forms. 6) The Sealcd envelope(s) should be forl:-arded to the Miami -Dade Counts Homeless Trust on a monthly. basis. %) The provider agency should maintain a log, of how roam sur.e,s are distributed. MIAMI -D �.DE COL�TT�' HO NIELFSS TRUST NT R -MING OF S_ USFAC TION IXSTRtCTITN� . Carefully recd all of the instructions below BE FORE distributins, the Prot;,,rnnr Raring, of Saricf::icrion , sun,e�, to ),o u r pro(Trarn participants. General Information The Program Rating of Satisfaction consists of 1 1 items which are used to determine a client S S-ti;factio n With sen ices they are receiving from a provider. it is to be completed bv all program parucip;ints. en ,a_ed in services at a Trust -funded pro«ram. It must be completed - at a minimum - at time of discJ)ar-ne for al l participants. It is strongly recommended that a Program Rating of Satisfaction survey also be completed at intervals as may be applicable to the program; however. only the discharge survey must be for\varded to the Homeless Trust. Case mar,a2ement notes should indicate specifically why a Program Rating of Satisfaction was not obtained, if that is the case (client event AWOL, institutionalized, etc.), and what efforts \' ere 11 -lade to obtain a survey in those instances. The Program Rating of Satisfaction is available in English, Spanish and Creole. Providers are responsible for reproducing the appropriate survey and providing an envelope (that seals) for each respondent. All responses should be completed in ink If a participant cannot read; providers should encourage them to use the.same process they use to have other information read to them. An employee of the agency that is not directly responsible for the clients care can read the form. This should be indicated in Section II. as a separate set of staff initials. Filling out the form 1) A language appropriate survey and an envelope should be provided to all par,.Licipants �vh.o are required to complete the form, . Only one form per family is required. The form must be filled out in irtk.. 2) Section hI of the Program Rating of Satisfaction is to be completed by staff prior to providing the rogram participant. Staff initials. refers to the initials of the case rrranager survey document to the p responsible for the client's service delivery. If the survey must be read to the client, the initials of the staff person performing that function should also be included. In no case should the participant's case manager read items aloud to the participant. 3J Section I of the Program Rating of Satisfaction Form is to be filled out ONLY by the program paricipant. The program participant should be provided a private place and sufficient time to answer the survey. 4) Providers should reassure participants of the confidentiality of their responses. Providers may Nish to introduce the survey, as follows: "This survey is one way of helping us determine ho\v well ,ve are helping individuals that come to our agency for assistance. Please take a feta minutes after I leave to answer this very short survey as honestly as possible. Your responses are private and we �a ill trot look at them. Please seal the envelope and give it to me when you are done (or. put it in the drop bo�:j." f) The completed survey should be placed in the envelope by the recipient and sealed. Providers are encouraged to provide a "drop box" with a slot for completed forms. b) The sealed envelope(s) should be forv-arded to the Miami -Dade County 14orneless Trust on a momhlti- basis. 7) The provider agency should maintain a log of how manv surve-vs are distributed. DETERti-1INA TI0N OF SII'\I)- IDI A FRaGE SCORE FOR CO\`SI_i:�tER SATISFACTIO'� 5URVE1 1116/00 I 1 was informed of m)' ricyhts and responsibilities 1 was provided with information about different sen ices_'.0 j that are available for the 1 was involved in making decisions about mycare/service { 11 '.u9 Ian i I was able to talk with staff when 1 needed to - The building and facilities hive usually been clean, safe and comfortable I MY rights were respected and protected, including my right WA I to file a vrievance, if needed 11y case mana2erseems ualified to help me 1 47 would recommend this rogram to others fl 5.36 am treated with res ect by the staff lQ The staff seems to care about whether I opet better 20 ( x.31 Probram staff Fiere knowledbeable about available services 1 �.'S that could help me D7.17 RECOMMENDED 57.00 1116/00 "1I ANN1I-DADE COUNTY HO.NIELESS TRUST PROGRAM RATENG OF SATISFACTIO Section L JO BE CONIPLETED BY PROGRAM PARTICIPANT 117st,"'criMIS_ Please answer each question below bI, placilr; art /:Il ill Ill space provided. Your responses ro rhese questions hai!e no bearinfr on eour continued purticiparion in flic pro,rranr. ALL responses- are conl'idenrial. Why did you choose to enter the program (marl; onJN one box): ❑ I decided to come to this program on m)• OWn (throuc_h outreach. referral. etc.) ❑ I «a placed here through another program ("court inter ention, police. etc.) againsl niv ill ❑ I had previously participated in this or a similar program and decided to return OPTIONAL Information: Name: Sex: ❑ male ❑ female Today's Date: Please answer the following quesriorzs about the services you received. Mark [kJ 01711• one ho_r which best describes }your feelirrms about euc/r statenreut. These questions are meant to help its irrrpro b re Me services provided, SO we aslr that )lou tell us"how 10a really feel, whether or trot it is good or bad strong()- Agree Agree u I + Disag ret, DLrU; rte Strong%r Agree Lirrre I .4 Lirric Dira tee I vvas informed of my rights and responsibilities,[6] b . [b] [ ] [�] [3] (I] i including the a4ency's grievance raced ores I was provided with information about different servicesI [6] (s) [4) [3] [?] (; ] that are available for me I F,as Involved in making decisions about mY i [6] [6) [4] (3J (3] jl] care/service Ian 1 I was able to taI-k with staff when I needed to + [6) (6) [a) 31 (2] [I The building and facilities have usually been clean, safe (6] [5] [4] [3] (�] [ I) and comfortable My"rights were respected and protecied,"includinc my [6] [j] j4] [3] right to 'file a grievance, if needed Mycasemanogerseems ualifiedtohel me f (j] (d) [3 jz l Iwould recommend this program to others [6) [5 [''] (_] (3 (Ij I am treated with res ect by the staff (6] [5] (1) (3 (3] (I The staff seems to care about whether 12et better [6] 3) [a) [: (?] (1 Program staff here knowledgeable about ovailable [6] (6) [?) [3] [2) jl] services that could hel me Section II.: TO BE COMPLETED BY PROGRAM STAFF Purpose of Evaluation Current Lei,el of Care provided 0 At Admission Q erner2cncy housing Pro N-ider Name: 0 Atdischarse ❑ transitional housinalix Project Name: 0 Other: + ❑ transitional housinv%non-ts Stafflnitials: i ❑ permanent housing j - I ❑ services only F't ,1 116100 Fourvorogramrat u!e TIA.�M-DADS COtiI'�TYHOMELESS TRUST FVALI.i.ACIU:N� DE LA SATISFACCI6N CON EL PROGR-A-M-A Seccion I. CONTPLETADA POP EL PARTICIP.-CN-TE DEL PROGR-AM.A InsrruccioI,es': Por favor coloque una cru, [l% en el espaciu proi-sru parry resprnrd er a lns pr guwuy n conrin u:,ciriu. L u respuesras que usted de a este cuesriwrario no iniluiran de (oriria al!7uiru snorc lu C-imf nuucion dc.vu nariici1%uci1;n cn c,rr .rorarama. TOD.-1Slas respuestas se trial, terrdrein corrfrderrcialinewe. Por que decidi6 usted porticipar en el proorama? (!1larque una casilla solamente): [ ] Lo decidi Por mi cuenta (porque fui remitido o por medio de orro progrzama. etc ) [ ] Fui colocado aqui mediante orro programa (por iniervencion de los tribunal=s, la poJ)'cia, etc.) en contra de mi vol entad [ ] 1'a habia pariicipado en este programa o en uno similar v decidi re,,resar hformac16n OPCIONAL: Nombre 3, npetlido: Fecha de hoy: Generta: 111 j J FJ ) Por -favor respo,vda a las pregunlas siguientes acerca de los'servicios que se le limn preslado. Lrdique con una Cruz JAY EN ON4 SOLA C R.LLA POR PRE'GUNT.4 la forma en que usled se sienle acerca de calla una de las cuesliones descrims. Copra sus respuesras a eslas preguntas rros grudaran a mejorar los semicias que p resranrns, le rngumus que uus lrrl �a saber . C61770 se sielzre en realidad acerca de nuesrros sen icios, no imporra si usred los corzsidera bLicnos o 1721110). Seccion II.: COMPLETADA POR EMPLLADOS DEL PROGR4—NIA (completed bvprooram staf Purpuse of Evaluation( Alu) de I De I alio do I alga c I En 11u� en I Provider .Name: acucrdo acucrdo acucrdo ,l desacucrdu desncuerdo desacuerdo Se me informaron cuales eran mis derechos y [6) (6] (4] [.J [?] [l] responsabiiidades, entre ellos, Jos procedimientos de In j ❑ ser vices only agencia ara someter uejas. Se me dio informaci6n sobre los distintos servicios a los [6] [d] [4] [3J [?] [ I ) Lie tenao derecho. I Participe en la toma de decisiones referenttes a mi planI [6] [3] [4] (3] [?] [I) de atenci6n X servicios. Pude hnblar con el personal cuando tuve necesidad de I [6] (6J [4] [;] [2] [ I J hacerlo. l El centro y sus servicios por Jo general se han manrenido J [6] [51 [4] (;] [?] (J) Jim ios, sin elinro y accesibles. Se respetaron y protecrieron mis derechos, entre ellos, mi [6] [�] [4] [3J ['] [ I] derecho a someter uejas si to considero necesario. Aparentemente, la persona encargada de mi caso sabe to I [63 [?J. [4] [3] [2] (1] ue bene el acer ara avudarme. yo les recomendaria este provecto a otras ersonas. [6] iJ [41 (3) ? (IJ Los em leados me trataron res etuosamente. (6] [5J [4 Aparentemente,'a los empleados les interesa que yo I (6] [6] -,1311 [41 131 me'ore. Los empleados sobian que servicios pbdian servirme de I [6) (d1 (4] [3] (2] (J] avuda. Seccion II.: COMPLETADA POR EMPLLADOS DEL PROGR4—NIA (completed bvprooram staf Purpuse of Evaluation( Curreru Level of Care provided At Admission + p emery*ency housing I Provider .Name: p At dischar_se p transitional housinQirx i Project Name: Other: D rransitional housinc-rnon-n Staff Initials: 0 permanent housing I j ❑ ser vices only -MIA 1I-DADE COUNTY HONTELESS TRUST MVOGIZAM POLI EVALYT S_-.TJS.FA SYO Section 1. TOUT RATISIP.AN Ptii OGR-k,rI SILA A F1=T PC)L` 1t_a'ti"PLI I'. -1.I S -k A .E17striku0n: Tunpri repulln drak keksi Orr unba la u epi fc Marr ii k r a /.t/ lnnu espns ki i itllu. Rcn a 111111 hill' J." p(rn (IM"'(e %n_rr)n nup owinre PO/isi/e nan nx0,,runr Sihi u Tout.repons yo up sckri. POUKI lV CHWAZI PATISIPL NAN J) 'OGRAM1•l SILA .A (FeYon ti kv,-3 nan ion grenn b"'at): (( Se rn en ki chwozi vinn nan pwogram sila a (sn•a pa referans, S ­ pa sevis cspesal .isist;ins piblik etc.) (1 Se pa chtiva mwen, se yon lot pwogram ki vovem (znk tribinal, lapolis etc) O Rfiven to deja pntisipe nan yon prrogram Jconsa epi mei en deside retounnen. Enfornasyon.pou baysi jj' ��Je• Non: Dat Jod),a:` Seks jJ Cason [) Fenrn Tanpri reponn AeksyOn silo yo dapre sevis w resevxla. Fe iron k ova (t% rayl Iran sel 6Aare epi cls )virzi rvpons ki pli.s matche ave w. 'Keksvolr Bila yo la poil ede nou 5(ry pi born sE vis, alb rnoit mnlnde 11011 b(i), repons ki p/is nuttc/re (rve K,, ke .1i bon ou pa. Yo firm konnen tout dwa moven yo ak resp onsabilite mwen vo ak kouman pou mwen plenven nan ajans la �YVIO to baomwen enfomasyon sou diferan sevis ke mwen b "tivenn 'wen to patisipe nan tout desizvon sou planifikasyon swen/sevis mwen Am I�rave vo ie tou ou dis onib ou mwen ale arek vo Kole a ak bilding yo to toujou byen pw6p, konfbtab ak bon sekirite Tout diva m to respekte ak pwbteje menm diva m you mwente 2oteplentsinese5e Moun kap okipe ka mwen an sanble li kalifye you Ii edem Moven to rekomande pwogram Bila a bay lot moue Amplwaye vo trete mwen ak respe Amplwayeyosanble vo vreman enterese nan mwen .Amplwaye pwogram la to bye eenfbme sou tout sevis ki to disponib you ede m - Bon jail dako dako Dal;o tou piti Pa Finn I twb dako Pa dako Pa dako ditou [61 [�] [4] [31 ['J [I] [6] [o) [4] [3] [2) [ll [6l [�) 14] [3] [2] [1) Section II.: TO BE COMPLETED BY PROGRAM STAFF Purpose of £valuation+ Current Le rel of Care pro sided [3J (21 [l] [6] [') [4J ['] [2] [I] [6] [5] [4] [)J [?J [I] [6] [5] [4] [3] [2) [1] [6) [5] [4] [3J 121 (l] [6] [�) 1-41 [3) [2) [ll [6] f>] (4) ['l fel fi] [6J [51 [`J] [-t) [ —'l [1] Section II.: TO BE COMPLETED BY PROGRAM STAFF Purpose of £valuation+ Current Le rel of Care pro sided .At Admission l ❑ emergency housing I Provider Name; j At discharge I ❑ .rransitional houslnclt,% !!I I Project Nome: C Other: 11 jj ❑ transitional housing%non-t:: 1 t Staff initials: i 1 0 permanent housing 1 C ser,•ices only I her.11/6%00 Forms.erozramranns ATTACHMENT F CLIENT CONTRIBUTION REPORT NAME OF AGENCY SUBMITTING REPORT: DATE REPORT SUBMITTED: GRANT NUMBER: REPORT COMPILED BY: MONTH OF SERVICE CLIENT NAME: DATE OF BIRTH: .DATE OF PROGRAM ENTRY: INCOME: SS I/ SSD (DISABILITY): SOC. SECURITY: AFDC/TANF: 'FOOD STAMPS: VETERAN'S BENEFITS: EMPLOYMENT: OTHER ( CHILD SUPPORT ALIMONY, WORKER'S COMP, ETC.) MEDICAID (Check One): IDENTIFICATION NUMER#: AMOUNT FOR MONTH ❑ Yes 0 No **111 TOTAL ADJUSTED MONTHLY INCOME TOTAL: AMOUNT THIS MONTE TO CLIENT TOTAL: S`AMOUNT THIS MONTH TO PROVIDER :'- `* MAXIMUM 30% OF CLIENT'S ADJUSTED INCOME Revised 7/12/2007 U. S_ Dcparthlent of Housia., and Urban Development Office of Community Nanning and Dc elepincnt ON113 Approval No. 25UG-0145 (e.\7. 11130.2009) ATTACHMENT G Annual Progress Report (APR) for Supportive Housing Program Shelter Plus Care and Section 8 Moderate Rehabi�it�tiou for Single Room Occupancy ]Dwell ings (SRO) Program foml HUD 40118(0&;_003) Public reporting burden 1brthis colhxtion ofulforrnation is estimated to averaLe 33 !tours per response, includin, the time l'or reyre'.vtn$ uL5u-u tivlls, searehtng cXisnn, data sources, ratluring and maintains I. die data needed. ;uld completing and reviclyin , di- collection of imornultion. flus agency may no( conduct or sporaor, and a person is nut required to respond�to. n co0cc6ou of inti)rmation unless that collection displays a valid 0MD control number. General Instructions Purpose. Tite Alutual Progress Report (APR) track prograru pro-'7css and accornplislunents in the Department's competitive homeless assistance pro`grarns. Filing Requirements. Recipients of HUD's homeless assistance grants roust submit 2 APR'S to HUD within 90 <lays after the end of each orreratin« `'ear. One copy of the report must be submitted 1.0 the CPD Division Director in the local END Field Office responsible f'or managing the grant. The other copy inust be subulitted to HUD Headquarters. Department of Housing and Urban Development, Attn: APR Data Editor, Rooni 7262, 451 70' Street, SW, Washington, DC. 20410. Failure to submit an APR will delay receivinf, grant funds and may result in a deternunation of lack ol, capacity for future funding. An APR must be submitted for each operating year in which HUD funding is provided. Grantees that received SHI' funding for neiv construction, acquisition, or rehabilitation are required to operate their facilities for 20 years. They must submit an APR 90 days after the end of die first operating year and any year al which ttiey use SHP funding for leasing, supportive services, or operations_ For years in ivNch they do not receive SIIP funding, they must submit an Annual Certification of Continued Project Operation throughout the 20 years. The certification can be found it the back of this APR. A separate report must be submitted for each HUD grant received. For Shelter Plus Care, a separate APR must be submitted for each Shelter Plus Care component For those grantees receiving an ea-teasion, a separate report covering that period must be submitted (see Extension below).. Recordkeeping. Grantees must collect and maintain information. on each participant in order to complete an APR Optional worksheets are attached. The worksheets may be used to record information manually or to design a computerized system to store and tabulate the information. The iuorksheets should not be submitted to HUD with the APR Organization of the Report The APR is organized in the follo«dng manner: Pari is Project Progress. This portion of the report describes the progress in moping homeless persons to self-sufficiency, services received,- project goals; and beds created. Part U: Financial Information. This portion of the report is completed by all grantees receMrig funding tinder SEP, S+C and SRO. Final Assembly of Report After the entire report is assembled, number every page sequentially. Manic any questions that do not apply to your program with. "NW' for not applicable. (See Special Instructions for SSO Projects below.) Definitions. The following terms are used in the APR As indicated, in some cases, terms are applied differently, depending on ivhether the funding is from SHP, S+C, or SRO. Chronically homeless person — HUD defines a chronically homeless person as "an tuiaccompanied homeless individual with a disabling condition wIto leas either been continuously homeless for a year or more OR has had at least four (4) episodes of lioll elessness in the past three (3) years_" - To be considered clironically homeless a Person must have been on the streets or in all emergency shelter (i.e.not transitional housing) during these stays. Disabling condition - HUD defines "disabling condition" as "a diagnosable substance use disorder, serious mental illness, developmental disability, or chronic physical illness or disability, including the co -occurrence of two or more of these conditions. A disabling condition liniits an individual's ability- to work or perforin one or more activities of daily lift lig. Entered the pr-oyrunt for S+C and SRO projects nicans when the participant starts to receive rental assistance. For S+C, sen ices provided prior to this point are recognized as necessan, for outreach/enrollment and are eligible to count as niatcli. Coml HUD -401 18((0S,'2003) An Extension APR applies to SHP and S+C grantees Uiat requested and received an extension of their grant term front die HUD field oflce. The only dMrcnce between an APR for the c.\terlsion period and the regular APR (besides the ar»ount of time covered) is the signarurc page. Grantees should circle "yes" to indicate the APR is for an extension period and circle Uic operabrig year for which the report is an extension. For cx,1 nple, if the gyrantec is extcndirng year �. the Rrantec should submit an APR as usual for scar 3 and submit another APR for the c�ztcnsion period. indicatinff Ute second is an extension and also circling, year 3 on die signature page. Family 111ealis a household composed of two or more related persons. at least one 0111:110111 is an adult. Caregivers are not reported on in the APR. Grantee nlcans a direct recipient of the !-IUD mvard. Left the prop -am for S+C projects nieans 1vlten the participant stops receiving rental assistance and is not expected to return to S+C assisted housing. If the participant returns to S+C assisted housing witltir190 days, the person should not be considered as exiting fr-oin Ute program. If the person returns to S+C assisted !rousing aper 90 days, Uiat person is considered a new participant. The ivorkshect is designed to capture this information. Match for S+C nlcans Ute value of supportive services received by participants in tic S+C project which, in the aggregate, must at least equal die value of die S+C rental assistance provided over the life of the project. For SHIP, match nlcans cash used to provide the 'grantee's portion of acquisition, rehabilitation, new construction, operations and supportive sen -ices expenses - Operating year for SHP means the date when participants begin to receive housing and/or sendces- The f rst operating year begins after development activities for acquisition, rehabilitation, and new construction are complete, after a copy of the Certificate of Occupancy is sent to the local HUD office, and when tie first participant is accepted into the project. For projects without acquisition, rehabilitation, or nein construction, die operating start date begins when the grantee accepts the first participant. For S+C (SRA, PRA and TRA components), the first operating year begins on the date HUD signs the grant agreement For S+C/SRO and for Sec. 8 SRO, the first operating year begins nzth the effective date of the Housing Assistance Payments (HAP) Contract. To determine which operating year to circle on the APR cover page, begin counting from the initial grant operating start date and include renewals ,rants. For e.,cairiIe, a project receiving an initial grant for three years and a renewal grant for two years would circle years 1, Z; and 3 respectively on the APR cover sheet for the initial grant and would circle 4 and 5 respectively for die renewal grant. For any future renewal grants, the grantee would begin by circling 6 on the APR cover sheet. Participant means single persons and -adults in families who received assistance during the operating year. Participant does not include children or caregivers who live with the adults assisted.. Project Sponsor means the organization responsible for carrying out the daily operation of the project, if die organization is an entity other than the grantee. Special Instructions For Supportive Service Only Pro iects. SSO grantees should complete all questions, unless a written agreement has been reached 1i•iti the field office concerning which questions can be ansivered-usingestimates, or in rare instances, skipped. Below is an example oflioiv information could be derived in a large, single -service SSO project: A erantce/sponsor staff member could be assigned to collect inforivadon from Uic ornizabons housing the participants, The sta.Cfperson would contact these individual orgaliizations to request infonuation regarding Ute persons in that facility Uiat use the service. For participants [Mng on die street, the grantec/project sponsor may provide estimates. Information could be collected for each participant or for participants receiving sendces at a point -in -tinge. Ifestimates or point -in -taut counts are used. Clic meUtod used must be described in the APR and the documentation kept on file. fonn H U D -40118((W 2003) As With all projects fiuidcd under HUD's homelessness assistance grants, grantees operatin_g SSO projects arc expected to complete A] APF questions drat are 'applicable (o thein. Note ilia( all projects hive been awarded funds as a result of responding to the program goals of assisting lionicicss persons obtain/remain in permanent housing and increase their shi]ls ,uid inconie. Tire APR documents their progress In nicnng dicse gots. In some circumstances Geld offices and gramees may. siun a Written agreement concerning questions N+hich can be answcrcd using estimates, or in rare instances, slipped. Below arc some considerations for rcporbrig on particular hhes orprojects: Outreach Only Projects - Projects wlticli are solely devoted to street outreach and connection to ]lousing and services arc not required to tract( participants beyond their contact )i-ith persons on the street. I.t is suMcicnt for these projects t:o enter inforuration on questions 1-10 (slipping questions 11-13 arid 17). Estimates for questions 5-9 are allowed, given that participants may be reluctant to answer personal questions. Answering die questions will demonstrate that the grantee is scnving the appropriate number of people, providing basic demographic information for Congress, demonstrating that homeless persons are being scn cd, demonstration the types of housing participants are connccied to and the type of services they are receiving. Hotline Projects. - Hotlinc services are sinular to outreach projects, but contact bettiveen grantee and participant is often of very short duration - people enter and leave the program nearly simultaneously. It is sufficient for these projects to answer questions 1-5 (shipping 4), 10, and 14-19 (skipping 17). Froiects Providing Semi ices To Children Only, - Projects that provide child care, alter school care, counselinc for Children, etc_'make an important contribution toward proving a family out of homelessness. While the main focus of the project is providing services to the children, it is the adults who are reported on in questions 6-16 of the APR Lilce all otlier projects, this type is also targeted toward getting the families into housing and increasing the families' incomes. Grantees may slip question 9; all other questions should be answered (except 17) Transportation, Medical ,Dental and Other Single Short -Du ration Service Projects - Some grantees provide a single service of fairly short duration focused ONLY indirectly on assisting homeless persons to obtain/remain in permanent housing and increase their skills and incomes. It is sufficient for these projects to enter information on questions I-10 and 14-19 (question 17 may be skipped). However, with transportation senices, it is unreasonable to think that someone would have to give their age_ race, and ethnicity to a bus driver to get a ride a fere blocks. For these services, provide a narrative, which gives the number of rides given during the operating year, and provides estimates on the above statistics based on the population that utilizes the service. Special Instructions For- Safe Haven (SH) Proi efts_ - Grantees are reminded that they are to report ONLY on the number of participants the application )vas approved for (carmot exceed 25 participants). Homeless AlanaecMent Information System (TIMIS) Pro iects. -HMiS grantees sliould fill out the cover sheer of the APR (mashing FMS at the bottom) and Part II Financial Information. The APR also has a sheet tItat lists H ffS activides. Fomn HUD -4011 6((0S;!2003) THIS PAGE- TO BE C011fPLETED EPALL GRArvTL•'E,S Grantee: HUI_l Grant or PaJect 1Jtlnlber: Project Sponsor: Project N unc: Uperatirl(' fear: (Circle the operming year being reporiad on) Reporting Period: (monai/danccarl 01 D2 03 Dd 05 ❑6 07 ❑h ❑9 010 011 012 013 Tla 015 ❑16 017 Dls Ell') D20 lildical : if r�teluioll: D Ycs D No lion: lo: Indicate if renewal: ❑ Yes ❑ No Previous Grant Nutilbers for thus project Check the component for the program on which you are reporting. Supportive Sousing Program (SBT) Sbelte.r Plus Care (S -1-C) ❑ Transitional Housing ❑ Permanent Housing for Homeless Persons with Disabilities ❑ Safe Haven ❑ Innovative Supportive Housing ❑ Suppordve Services Only ❑ HMES ❑ Tenant -based Rental Assistance (TRA) ❑ Sponsor -based Rental Assistance (SRA) ❑ Project -based Rental .Assistance (PPA) ❑ Single Room Occupancy (SRO) Section 8 Moderate Rehabilitation ❑ . Single Room Occupancy (Sec. 8 SRO) Summary of die project: (One or two seitenees with a description of population, number se ved and accomplislmients this operating Y=) Mime S, Title of the Person who can anstiver questions --bout this report: Phone: (include area code) Address: Fax Number: (atclude area code) L -mail Address I hereby certify that all the information stated herein is true and accurate. Wuminc: I -IUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802) Name A, Title ofAutlrorized Grantee 01Ticial.• signature & Date: 1 Nunn and Title or.Authorized Project Sponsor Ot icial: Signature K Date: Z form HUO-40118((O;r3003) PART L TO BE COMPLETED B FALL GR4NTFE,5 (EXCEPT H IIS) SSO GRANTEES, PLE4SE.5EE SPLCLAL iiVSTR L%CTI01' S ON PAGE 3 OF THE APR Part I: Project Progress 1. Projected Leti el of Persuns to be sets ed at .1 giti en point in time. (Froin the application, Sf-IP- Sec. F; SPC- Sec. D; SRO- Sec. D) 2. Persons Served during the operating year. Number of, Nunil)eruf Number of Number of a. Number on the first day of the operating year SOIgles Not Alulrs in Children Families b. Number entering program daring the operating year un f,unilics Fuuilic; in Families C. Projected Level a. Persons to be served at a given point in time 2. Persons Served during the operating year. 3. Project Capacity. Number of Number of I Number of I Number of Singles Not in I Adults in. J Children in +I Families Families Families Families a. Number on the last day (from 2d, columns 1 and 4) b. I Number proposed in application (from la, colunms 1 and 4) c. Capacity Rate (divide a by b j = % I % 4. Non -homeless persons. This question is to be completed for Section 8 SRO projects. How many income -eligible non -homeless persons were housed by the SRO program during the operating year? 5. Atte and Gender. Of those who entered the project during the operating }Tear, how many people are in the ibllo«ring age and gender categories? 6 form HUD-40118((OS/20031) Number of Singles Not in Families I Numberuf Adults in. FamiIic; Number of Children in Families Number of Families a. Number on the first day of the operating year b. Number entering program daring the operating year C. Number who left the program during the operating year d. Number in the program on the last day of the operating year 3. Project Capacity. Number of Number of I Number of I Number of Singles Not in I Adults in. J Children in +I Families Families Families Families a. Number on the last day (from 2d, columns 1 and 4) b. I Number proposed in application (from la, colunms 1 and 4) c. Capacity Rate (divide a by b j = % I % 4. Non -homeless persons. This question is to be completed for Section 8 SRO projects. How many income -eligible non -homeless persons were housed by the SRO program during the operating year? 5. Atte and Gender. Of those who entered the project during the operating }Tear, how many people are in the ibllo«ring age and gender categories? 6 form HUD-40118((OS/20031) A.iisiver questions u - 10 onli for participants who entered the pru'ea ducting tic vpuati:nc j'L'd r t.fivfcl 2 , Cvluii I75 2). The teen participant means single persons and adults in families. It does not include children or careancrs. NOTE: The total for questions, 7, S and 10 below should be the &111]e; respond to each of diose questions for all participants. Some of the questions listed throughout the APR ivill be asking information for individuals ;v'ho are chronically homeless. Ga. Veterans Status. A veteran is anyone who has ever been on active ndliwr , duty stank. Hoa- many participants were veterans? Gb. Chronically liorneless person. An wiaeconlhturied homeless individual v.\,ith a disablutg condlLJon who has either been conLuulocLsly homeless Cor a year or more OR has had at least four (4) episodes of homelessness in the past dircc (3) years. To be considered chronically homeless a person Must have been on the streets or in an enier cncy shelter (i.e. not transitional housing) during tliese stays. Howniamyparticipants were chronically homeless individuals? 7. Ethnicity. How many participants are in the follovtizn.c, ethnic categories? L Hispanic or Latino b. Non -Hispanic or Non -Latino 8. Puce_ How many participants are in the follo xv io racial categories? 9a. Special Needs. How many participants have the following? Participants may have more than oue. If so, count them in all applicable categories. For Each condition, also indicate the iiumber that were chronically homeless. All Chronic 91). 'No- many of the participants are disabled? = fon HUD -4-0118((0;2003) 10. prior Living Situntion. How many participants slept bi the 161lowin-2 places ui tlic week- prior to entervip the project^ (For each participant, Choose one place). Also, indicate llowmanp chronically homeless participants slept in the tollo%`ing-' places. (Choose one) All Chronic a. thin -housing (street, ppark, car, has station, etc.) b. Einer,cncv shelter c. Transitional housing for homeless persolls d. Psychiatric facility* e. Substance ahuse trealrnent liicility* f. lIos Jail/ risoa* Dometic violence situation Living -Arith re la tives/fri ends R-Rentall(lhlco) usinz Other lease speciFi') *If a participant came from an institution but was there less than 30 1ays and was livuig on the street or ill emergency shelter before entering the treatment facility, he/she should be counted in either the street or shelter category, as appropriate. Complete questions 11 - 15 for all participants who left during the operating year (from 2.c; columns 1 and 2). The term participant means single persons and adults in families. It does not include children or caregivers. The tern chronically homeless person means an unaccompanied homeless individual with a disabling condition who has either been continuously homeless for a year or more OR has had at least four (4) episodes of homelessness in the past three (3) years. To be considered chronically homeless a person. rust hai,e been on the streets or in an emergency shelter (i.e. not transitional housing) during these stays. I L Amount and Source of Monthly Income at Entry and at Eiit. Of those participants who lett during the operating year, how many participants were at each monthly income level and with each source of income? Also, please place the monthly income level and each source of income for chronically homeless persons in the second column of each chart. The number of participants in Chart A and B should be the same. AD, Ciutx-iic A. Monthly hicome at Entry a. No income b. $1-150 C. $151-S250 d- $251- $500 e. $501 - $1,000 f $1001-31500 g $1501-$2000 I H h. S2001+ All Cfuvnic fom HUD -40116((0e;'200;) Al L'. Mon"InCoMe at Exit a. No income b. 31-150 1 c• 311 -s35U I d-1 s2�1- s�OO e. 3501 - 31,0() i'sl(i)t-sli0t) e. Y 13O l - $-OCK) —� r. .12 00 1 + D. Income SOLINzS at E.Xit Supplemental Security Income (SSI) Social Security Dlsabiliti-.hlcozne (SSRI) Social Sccu:ity General Public Assistunez Temporary Aid to Needy Ftnniiics (TANF) Stag Children's Health bsurance Pro' -'rum (SCI -M)) Veter:uis P,coeG is Employment Income Unemployment Bemtits Vcleraus Health C1rc Medicaid Food Stamps Olhei (please specily) No Financial Resources All Chi-,inic 12a Length of Stay in Program. Of those participants alio left during the operating year (from 2c, colurzms 1 and 2), howmmly were in the project for the E0110wing lengths of time? Also, please place the Iength of stay column for chronically hozzzcless persons in the second All Chronic Less than I month I I to 2 months 3 - 6 months 7 months - I2 montILs 13 months - 24 months 25months -3 years 4 years - 5 years 6 years - 7 ears- 8 ars8 years - 10 years Over 10 years 12b- Length of stay in grog rain. For diose participants that did not ]cave during the operating year (from 2(.columzts I and 2), how lon, nave they been ui the project? Also, please place the leagal of stay for chronically homeless persons in the second colunul. J Less than 1 month 1 to 2 months 3 - 6 months 7 rModzs - 12 months 13 months - 24 months 25 months - 3 yens 4 Vears - 5 Vcars 6 Fears - 7 years S Vears; 1G1 �" "rS Over 10 \'ears All Chronic 9 lom HUD-4001I8(('oS'2003) 13. Rcosons for .Leavinta. Of those participants who left the project durin columns the operatillo Year (CrOrtl ?c, colus 1 and 2), hold I iztll`/ left for thr li;llouing reasons? ,Ca Pvnjcipant left for multiple reasons, Prelude nrr/r the primary re¢cun. Also, please place the primun-reason for chronically homeless ncrsoas in the second column. All Chronic rb 1 for a housing opportunity bdbre completulg program pleted prograln C.-pawnent ofrcnVoccupaticy charge -c:omplicuice i`itll projccl a-inal activity / destruction of property / violence ched nlaxinum time allowed in project ds could not be nnet by project greement with rules/persons hr {please specify} k. Unik:novai/disappeared 14. Destination. Of those participants who left during the operating year (from 2c, coluilans 1 and 2), how many left for the following destination? Also, please place the destination of chronically homeless persons in the second colurnn. All Chronic 10 form HUD -40118((O8/2003) 15. Supportive Semites. Of those participants who left duriu;,, the operating year (frons 2, columns 1 Ind-)), t1ovN many received the tollovvvh suplmrIire services dttrin- Their tune iii [lie project" Also. please place die supportive en'ices receit'ad for chrnnicall� homeless participants who lell during the operating near w die second colunui. All Chronic a. Outreach b. Cze management C. Life: skills (outside of case i uta;ernenl) d. Alcohol or druo abuse services e. Mental healdt scrvices f. HN/AIDS-related sen'ices d. Other health care services Ii. Education i. Rousing placement j. Employment assistance k Child care 1. + Transportartion. m- + Legal n Other (please specify) 1 fomi HUD -401 i 8((08/200: ) C. Overall Pro_(Trarn Conk, Under objectives, list your measurable ohjectil-es for flus operatin; Year (from }•our application, Tecl.inical Subitussiori, or/APR) for each of the three goals lister] hLlow. Under Progress, describe= your prozTes s in mertin', the ohj, ctiies. Under Nem Operating Year's Objec6%,ts, shacitj'ale measurable objabves for the ocxt operating•ear. :t. Rcsldeiitm Stability Objectives: Progress: Next Operating Year's Objectives: b. Increased Skills or Income 01 jiectives: Progress: Next Operating Year's Objectives: C. GreaterSelf-determination Objectives: Proeress: Ne --,,t Operating Year's Objectives: 17. Beds. SHF recipients answer 17a. S+C recipients answer 17b. SRO recipients answer 17c. (SHP-SSO projects CIO 12ot Compitto tlids questio1z) a- SHP. Howmany beds were included in the application approved for this project under `Current Level' and under `New Effort'? How many of these New Effort beds were actually in place at the end of the operating year? Current Level New Effort New Effort in Place Number of Beds: b. S+t'. How many beds and dwelling units were being assisted ui do project funds at the end of the operating year? (Include beds for all participants, other ta.tnily members, and care givers.) Number of Beds: _ Number ofDwellui� Units: _ C. SRO. How many dwelling units were being assisted it the end of the operating year? (Include units occupied by "ui place" nbn-lioineless persons who qualify for assistance.) Number ofDwellin2 Units: I? form HUD4011ui(13;;pQ j Part TI: Financial Information 18. Supportive Services. For Suonortive Housing (SH)), this e>:hibit provides information to HUD on how SFY funding for supportive services was spent during the operating retic Enter the amount of SIP Funding spent on lliese supportive services. hiclude I-Rvf[S costs under "Other". For Shelter Flus Care (S+C), this exhibit tracks the supportive services match reilknicnt. Specify the value of supportive services from all sources Buil can be counted as match that all hotuelcss persous received durilia the uperating year. (S+Catt(ecs should keep do camentation on file'_ lncludtllfl source, amntu+l, and hl -)e of supportive services.) For Scction S SRO, flus eNhibit provides information to IIUD ori die value of -supportive services received by homeless persons during the operating year. Supportive 5ecviccs Dolt�rs. a. Oatreach b. Case management C. Life skills (outside of case management) d. .Alcohol and drug abuse services e. Mental health services f AIDS-related services c. Other health care services li Education i. Housing placement J_ Employment assistance I k. + Child care . 1. I Transportation M. I Legal n Other (please specify) o- TOTAL (Sum ofa, through n) . . Cuinulaiive amount of match provided to date for the Shelter Plus Care Program under this grant 13 form HU0-40118((oQ.,,M03) 19. Supportive Housing Pro(,,ram: Leasing, Sup)ortiti°e Sen ices, Operating Costs, PIJVIIS Activities and Administration all ganiecs receiving (iindiug wider the Supportive Housutg Prouzun must complete these charts each operating year. For espansiun projects' [hSIIP rent funds are for the esp;uision of a pre-c.:isting honmle;s facility. only the people mid eependitures for the additional expansion niaY be included. at in the original application ut or any grant atiwminies. Documentalwn of re.ourCeg USCd is IIUt regUiTCd to be submined'whil this -port but should be Upt on ii It fur possible inspediun by HUD Luid Auditors. Dn not include any expenditurc mad • bdbre tir SHP eras+t wzis eNccuied. Sun3mar} uF.Glpcnditures. Enter tht mnount of SIiP «rant funds mid cash match expendeJ dttrin, the operating bear for each actiV1ty. Illis table should acid up bolls Horizontally and vertically. 'Ilio SIP supportive services total should be Ute same as Ute SILP supportive sen -ices in Ouestion I S. SHP Funds Cash Match Total Expenditures a. Leasing b. Supportive Services C.. Operating Costs d. EMS Activities e. I Administration % Total Note: Payments of principal mid urierest ou any loan or mortgage may not be shows as an operating expense. Sources of Cash Matcli. Enter die sources of cash identified in the Cash Mitch column, above, in the followin^ catePries. Use additional sheets, as necessary. Amount a. Grantee/project sponsor cash b. J Local government (please specify) c. I State govermnent (please speciry) I'd- I Federal govermnent (please specify) Conmmnity Development Block Grant (CDBG) I C. I Foundations (please specify) I I f. I Prieate cash resources (please specify) g. I Oceupumv charge / tees h. Total 1 1.1 lorm HUD-4o118((GS:'2003) 20. Supportive Housin,; Program: Acquisition, Rehabilitation, and Nen Canstniction :W ;ranlecs Uuct received SMI' funds for acquisition, rehabilitation, or new construction nnist complete these charts ut the }�esr one APR0111}. This c\Nbit wAj demonslrale to I-ftlD that the erautee has contrihuted onouLli cash to at leant equalh maich the a,notult of SHI' tends spent for acquisition, rehabilitation, or, clew construction. Documcnlation that matclunc liulds were provided is not required to be submitted with this report but should be kept 01) file for j)o$sihle inspection by 14LO and .Auditor.;. SOmmary of Expenditures. Later Che a.n1011rlt of SIT green funds aad cash match cNpcndcd dttriirg Che operating year for each activity. SFT Funds I Cash Match Total Expcnditnires a. Acquisition b. 12ehabililation c. New construction d. Total Cash Match. Enter elle sources of cash idenbEcd in the Cash Match colunm, above, in the following categories. Use additional sheets, as necessary. I i lonn HUD-401I8((N/2003) FOR HKIS :-j CTIPMES O -A71 Y 21. For Sunnortive Huusinfi (SHP) —HMIS Activities This cr;hibit provides information to HUD on how SI -M -I -NIS funding for supi)urtive services seas spent durin ,r the operating, }ear. Enter the amount oCSIT-IiMIS funding spent on these activities. ilAIISAclinities Urrl) Dollars Equipment ment Central Scn er(s) Personal Computers and Printers Networking Security Sublotal SofN,are So -Eh -Vale / User Licensing Softwarc Inst:allation Support and Maintenance Supporting Software Tools Subtotal Services Training by Third Parties . Hosting / Teclmical Services j Programming: Customization Progrartuuing: S}stein Interface Programming: Data Conversion Se urity Assessment and Setup Dn-line Connectivity (Internet Access) Facilitation Disaster and Recovery Subtotal Fersotsnel Project Management / Coordination Data Aalalysis Programnung Tecluiical Assistance and Training Adrninistrative Support Staff Subtotal HMIS Space arul cc Costs rational Costs Total 16 fonn HUD-40118((OS,200 ) DescriUC 2111' PraI)lems and/ar changes 1f11p)uvented during the oiler:,tiog Year. a Technical Assistance and Recommendations Based on your experience during the last year, are there any areas in which you need tecLazical advice or assistance? If so, please describe. 17 fonn HUD -40118((03;3003) Arzrziial Certification cf Cvrrtinric�il ,i�roject Dperrrtr'ori Su por rive Dousing Program Project Number: Project Name: Operating Start Date: Grantees that received Supportive Housing Program funding for new constructioq acquisition, or rehabilitation are required to operate their facilities for Zo years. certify that the facility that received assistance for accltusition, rehabilitation, or new construction from the Supportive Housing Program has operated as a facility to assist homeless persozls from to I also certify that the grant is still serving nunber of (Mo/yr) (iuo/yr) . persons at {site address) and all the requirements of the grant agreement are beuIg satisfied. (Signature) (Title) (Date of Certificadoli) `Current Year is Ibmi HUD -do 116r(M 2003) Persom Servet( Worksheet - HUD Annual Progress Report 'ibis worksh,�el is optional and is intended to help you collect information needed to complete the Atutunl Progress Report. Instntctions and Codes follow. Do not suhmit this Nrorksheet to 1 FUD. Name Relationship Entry Dale Exit Number of A•tonths in Number of Monll(s in New Participant Non -Homeless (SRO Date of Binh Aga C ender Date Project (calculate) Project—Participant (YIN) Only) 5a 5h lNIT) 12a did not leave (Y / N) Sc (calculate) 4 12b 19 HUD -10 l 19 PCI'Sons Served Worksheet (continued) Do not snbntit this worksheet to IND No. velerans chronically Ethnicity Race Special Needs Special Needs Prior Living Montlily Income hlonthly Income =F,,,�,Iry Income S_o rets Status (Y. I) Homeless (code) (code) (code) (code) Situation At Project Entry At Project Emit Al Fejt 6a (YIN) 7 8 9a 9b (code) Ila Ilb (Code) fib l0 Ild 20 I1LU-401 18 Persons Served Workshect (continued) Dn TIM submit this worksbect to HUD !`Ib. Renson ror Leaving Destination Supportive Services Notes Program (code) (code) (code) . 13 'la 15 21 111.iD_401 I S Instructions and Codes for Persons Served'Worksheet The use of [his vrorl:sheet is optional. It was desiened to help you collect information on participants needed to complete the Annual Progress Report. If the worksheet is updated as participants move in and move out of your project, most of the information required for completion will be contained in the worksheet. Do not submit this worksheet with the API:. For projecfs that serve families, HUD only requires reporting on the number of children served, and the age and gender of these children. Only name, relationship, date of birth, and age on the worksheet need to be completed for children. Assign the adults a number, but not each family member. Use this number to transfer to the other pages of the worksheet. Beoinning with number 4, the numbers in the columns refer to the questions on the APR form. If any questions are answered with "Other," please enter the specific "Other" answer for inclusion in the APR. Participant Number. This column allows you to either number participants consecutively or to assign a case number. One number should be assigned to each adult. Name. Names of persons will not be reported to HUD. The use of names is for your record keeping .convenience. Relationship. Enter the appropriate relationship. Examples include: Self, Head of household, Spouse, Child. Entry Date. Enter date participant entered the rp oiect. Usually this will be the date of actual physical move -in for a housing project. Esit Date. Enter date participant left the Droiect. Usually this will be the date the participant physically moved out for a housing project. Do not include a participant who temporarily left the proiect and is expected to return in less than 90 days (e.g. hospitalization). Income-elicible Nou-humcicss in SRO. The SRO proeram allows assistance to units occupied by Section 8 income -eligible persons residing at the SRO prior to rehabilitation. For- SRO projects only, indicate whether the participant is an income -eligible, non -homeless person (Y) or not (N). SHP and S+C projects should skip this item. ;a. Date of Birth. Later date of birth including month, dnv, and year. gib. A,c. Enter auc at entry. ic. Gender. Enler appropriate letter for `ender. 1,1-1,1ale F- Female, 6a. Veterans Status. Indicate if the participant is a veteran. Please note: ,1 veteran is an-voiie who {ins ever been on active military dury slates for llic U17itccl5lcricrs. 6b. Chrunicn 11y humcless person. Indicate the number of participants that are chronically homeless. 7. Ethnicity. Enter appropriate letter for ethnic group. a. Hispanic or Latino b. Non -Hispanic or Non -Latino Race. Enter appropriate letter for race. a_ American Indian or Alaskan Native b. Asian c. Black or African-American d. Native Hawaiian or Other Pacific Islander e. White f. American Indian/Alaskan Native & White g. Asian & White h. Black/African American &White i. American Indian/Alaskan Native &. Black/African American i. Other Multi -Racial 9a. Special Needs- Enter the letters) for the category(ies) that describe the participant's disability(ies). (You may double count). a. Mental illnes's b. Alcohol abuse c. Drug abuse d. HIV/AIDS and related diseases e. Developmental disability f. Physical disabilities g. Domestic violence h. Other (please specify) 9b. Enter the number of participants with a disability. 10. Prior Living Situation. Enter the letter that best describes where the participant slept in the week prior to entering the project. Do not double count. Non -housing (street, park, car, bus station, etc Emergency shelter Transitional housing for homeless persons Psychiatric facility* Substance abuse treatment facility* Hospital* ,Tail/prison * Domestic violence situation Livins with relatives/friends Rental housing ,) 7) HUD -401 18 r. Other (please specify) f pcachecl iva`:]IIILM LimC allowed in project o Meads could not be met by project 'If a participant came from an instilutiort but h. Disa_rcerllent Nvith rules/persons Was thcrc less than 30 clays and vas living on the I. Dcath street or in an emergency shelter before entering the j. Other (phase specify) facility, he/she should be counted in either the strcet k. Unkriov','n/disappeared or shelter category, as appropriate. Instruction Codes for Persons Screed Worksheet (continued) 11a.Gross Monthly Income at Project Entry. Enter the amount of gross monthly income the participant is receiving at entry into the project. Ilb.Gross Monthly Income at Project Exit. Enter the gross monthly income the participant is receiving when exiting the project. 11c.Incolne Sources Received at Project Entry. Enter all types of assistance the participant is receiving at entry to the project. a_ Supplemental Security Income (SSI) b. Social Security Disability Insurance (SSDI) c. Social Security d_ General Public Assistance e_ Temporary Aid Needy Families (TA_NF) f. State Children's Health Insurance Program (SCHIP) �. Veterans benefits h. Employment income i. Unemployment benefits j. Veterans Health Care k. Medicaid 1. Food Stamps in. Other (please specify) n. No Financial Resources 11d.Income Sources Received at Project Exit. Enter all types of income the participant is receiving at project exit. (Use codes as in l lc.) 12a Length in Stay iu Programa Calculated item. (See Entry Date and Exit Date above.) I2b. Length of Stay in Program. (Participant did not Ieave during the operating year. I3ow long have they been in the project?) 13_ Reason for Leaving Project. Euler. the primary reason why the participant left the project. (Complete only for participants who left the project and are not expected to return within 90 days. a. Left for a housing opportunity before corltpletinz the program b. Completed program c_ Non-payment of reut/occupancy charge d. Non-compliance with project e. Criminal activity/destruction of property/ vio.lence 14. Destination. Enter the destination oCthose leaviIlg the projcct. Perm ane nt: a. Rental house or apartment (no subsidy) b. Public Housing C. Section 8 d. Shelter Plus Care e. HOME subsidized house or apartment f. Other subsidized house or apartment g. Homeownership h. Moved in with family or friends Transitional: i_ Transitional housing for homeless persons j. Moved in with family or friends Instituti on: k. Psychiatric hospital. 1. Inpatient alcohol or drug treatment facility m. Jail/prison Emergency: n. Emergency shelter Other: -o. Other supportive housing. p. Places not meant for. human habitation street) q. Other (please specify) Unkaow11: r. Unknown 15. Supportive Services. Enter all types of supportive services the participant received during the time in the project. a. Outreach b. Case management c. Life skills (outside of case management) d. Alcohol or drug abuse services .e. Mental health services F. IiIVIAIDS-related services Other health care services h. Education i. Housing placement J. Employment assistance k. Child care 1. TransporLLtion m. Legal n. Other (please specify) 23 14UD-01lS m Miami -Dade County Government Home I CllentPolnt I Resource Point 1 Sh lterPclnt 1 S:anPGlnt I J,P,eports ?drain yelp _oo r HUD Annual Progress Report (HUD -40118) Report Options: ATTACHMENT G-1 -Select- I; Unduplicated rovlder Miarnl Dade County Government (#1) peratfng Year Date Range 05/01/2006 to 05/31/2006 (MM, dd/yyyy; gal Adult Age 18 (as defined by foster care lain in your state) Or -Select- ]2. Persons Served during the Number of Singles of Adults of Number (Number Not in Families +n Families JCNumber hifdren in Families ofopetingyear. Families a. Number on the first day of the operating year. 0 0 0 0 b. Number entering program during the l operating year. 0 0 I p 0 c. Number who left the program during the operating year. 0 0 I 0 0 d. Number In the program on the fast dayl Of the operating year. (a-I-b-c=d) 0 0 0 p 3. Project Capacity.I Number of Singles Number of Adults i Number of Children in N umber of Not in Families in Families Families Families a. Number on last day (from 2d, Columns 1 and 4) 0 0 4. Non -homeless persons. (Sec. 8 SRO projects only) How many Income -eligible non -homeless persons were housed by the SRO program during the operating year? 0 S. Age and gender. Age ,Male IFemaJe Other/Nbt Single Persons (from 2b, column 1)a. 62 and oder 0 given 0 0 b. 51 61 0 0 0 c. 31 50 0 I 0 0 d. 18 30 0 0 0 !e. 17 and under I 0 0 I 0 Not given 1 0 0 0 Persons in Families (from 2b, columns 2 & 3j if. 62 and over 0 0 0 IQ. 51 - 61 p 0 0 in. 31 - 50 1 0 I 0 0 t rtes:/A',"k nv;.servicept.cf-)m/miallii/scripts/svpreporthud,php 6/14/2 0 0 6 Ij.13 1.7 Ik.o-i1 0 0 1 0 5 0 I, 0 1 0 �m. Under I 0 1 0 0 �Not give n U 0 0 6a. Veterans Status. I f i� A veteran Is anyone who has ever been on active military duty statu,. a. Mental Illness I 0 ( A 6b. Chronically Homeless. 0 How many participants were chronically homeless individuals? 0 0 0 7, Ethnicity. 0, ( a. Hispanic or Latino 0 b. Non -Hispanic or Non -Latino 0 f. Physical disability 0 S. Race. a. Domestic violence a. American Indian or Alaskan Native 0 b. Asian 0 c, Black or African American 0 Native Hawaiian or Other Pacific Islander 0 Howmany of the participants are disabled? 0 Id. e. White 0 f. American Indian/Alaskan Native & White I0 g. Aslan &White h. Black/African American & White 0 i- American Indian/Alaskan Native & Black/African American 0 0 j. Other Multi -Racial 0 k. Other/Unknown (all that do not match) 9a. Special Needs. La -Non -housing (street, park, car, bus station, etc.) b- Emergency shelter c. Transitional housing for homeless persons d. PsychlatrlcfacllIty e- Substance abuse treatment Facility f. Hospltal g. Jail/prison h. Domestic violence situation i. Living with relatives/Friends j. Rental housing All j Chronic 0 0 0 0 0 0 0 0 0�1 00 u 0 https://1 ti,�,;,s�rvicept.con�/zniami%scriptsis -preporthud.php 6/14/2 00 6 All + Chgonic a. Mental Illness I 0 ( A b. Alcohol abuse 0 i0 c. Drug abuse 0 0 � d. HIV/AIDS or related diseases 0, ( 0 e. Developmental disability i 0 0 f. Physical disability 0 0 a. Domestic violence 0 + 0 h. Other (please specify) 0 .0 9b. Disabled. Howmany of the participants are disabled? 0 10. Prior Living Situation. La -Non -housing (street, park, car, bus station, etc.) b- Emergency shelter c. Transitional housing for homeless persons d. PsychlatrlcfacllIty e- Substance abuse treatment Facility f. Hospltal g. Jail/prison h. Domestic violence situation i. Living with relatives/Friends j. Rental housing All j Chronic 0 0 0 0 0 0 0 0 0�1 00 u 0 https://1 ti,�,;,s�rvicept.con�/zniami%scriptsis -preporthud.php 6/14/2 00 6 I11. Amount and Source of Monthly Income at Entry and Exit. All -Chronic a. Less than 1 month J Amount A. Monthly Income at Entry I G. Monthly Income at Exit a. No Income All I 0 Chronic 0 I All I I 0 Chronic 0 0 0 f.'25 months - 3 years 0 0 0 c. $lsl - $250 0 I 0 0 0 d. 5251 - $500 0 U 0 0 e. $501 - $1000 I 0 I 0 I 0 I 0 f. $1001 •$1500 g. $1501 - $2000 0 0 0 I 0 0 0 0 0 h. $2000 + Source 0 0 C. Income So urces at Entry 0 0 D. Income Sources at Exit e. 13 months - 24 months All Chronic All Chronic a. Supplemental Security Income (SSI) 0 I 0 0 0 b. Social Security Disability Insurance (SSDI) c. Soclal Security 0 I 04 0 0 0 0 0 0 d. General Public Assistance e. Temporary Aid to Needy Families (TANF) 0 I 0 1 0 0 0 0 0 0 f. State Children's Health Insurance Program (5CHIP) 0 0 0 ' 0 Veterans benefits 0 0 0 0 1g. h. Employment Income 0 D 0 ! 0 i. Unemployment Benefits + 0 0 0 0 j. Veteran's Health Care k. Medicaid 0 + 0 0 0 0 0 0 0 I. Food Stamps 0 0 m. Other (please specify) 01 0 _-_No flnanclal resources 0 I 0 12a. Length of Stay in Program. (Participants who left during operating year) 0 0 0 0 0 0 I https:/,'�ti,-il.-ti!3.ser�•ice.pt.coni;niiami,,/scr'lptsi'si.-prepor liud.plip 6/1*4/''006 All -Chronic a. Less than 1 month I 0 0 b. 1 to 2 months 0 0 c. 3- 6 months d. 7 months - 12 months 0 I 0 0 0 e. 13 months - 24 months 0 0 f.'25 months - 3 years I 0 0 g. 4 years - S years 0 0 h. 6 years - 7 years 0 , 0 i. 8 years - 10 years 0 0 j. over 10 years 12b. Length of Stay in Program. 0 (Participants who did not leave during operating year) 0 a. Less than 1 month All 0 Chronic 0 b. 1 to 2 months 0 0 c. 3- 6 months I 0 0 d. 7 months - 12 months 0 I 0 e. 13 months - 24 months I 0 I 0 f. 25 months - 3 years 0 0 g- 4 years -. 5 years 0 0 https:/,'�ti,-il.-ti!3.ser�•ice.pt.coni;niiami,,/scr'lptsi'si.-prepor liud.plip 6/1*4/''006 V I s - 10 years V 0 years 0 0 ons for Leaving. All Chronic rRen a housing opportunity before completing program 0 program0 0ted yment of rent,roccupanc/ charge mpllance tiilth project 0 0 e. Criminal activity / destruction of property / violence 0 0 f. Reached maximum time allowed in project 0 I 00 g. Needs could not be met by project I 0 h. Disagreement with rules/persons 0 0 Ii. Death 0 0 j. Other (please specify) 0 0 k. Unknown/disappeared 0 0 14. Destination. AIII Chronic PERMANENT (a - h) a. Rental house or apartment (no subsidy) 0 I 0 b. Public Housing I 1 0 0 c. Section 8 0 0 d. Shelter Plus Care 1 0 0 e. HOME subsidized house or apartment , 0 I 0 r-If. Other subsidized house or apartment 0 I 0 1 19. Homeownership 0 0 Ih- Moved in with family or friends I 0 0 TRANSITIONAL (I - j) i. Transitional housing for homeless persons I 0 0 Ij. Moved in with family or friends 1j. 0 I 0 INSTITUTION (k - m) Psychiatric hospital 01 0 11 Inpatient alcohol/drug treatment facility 0 0 m. Jail/prison 0 I 0 EMERGENCY SHELTER. (n) n. Emergency shelter 0 ( 0 DTHER (o - q) o. Other supportive housing 0 I 0 p. Places not meant for human habitation (e.g. street) 0 0 q. Other (please specify) I 0 I 0 1NKNOWNr. Unknown 0 0 .5. Supportive Services. No supportive services found. t ServicePoint version 4.01.018 (db build #0723) Licensed to: Miami Dade Homeless Trust 1999-2006 Bowman Systems L.L.C. All Flights Reserved. CPT only Cc)200,' American fledical Pssocialion All Riy'hCs Feserved. DSN and D_N-Iv-TR are registered trademarks of t'ne American Psych atrlc Assocladon, and are used with permisslon heron. ICD -9-Q`1 2)1994 I\latlonal Center for HEBIM StabStiCS (ICD-9 '. wGfld Health Organization). All Piohts Reserved. Ta,,:onony _'1923.2003 Inforn2don and Pe.erral Feoeratlon or Los Angeles oupty, inc. All Pugin Reserved. 1lttps:/i•�vvv lservicept.colnimiai-i1i/scripts,'Svpreportliud.plip 6/14/2006 Taxpayer Identification Number {TIN) Enter your TIN in the appropriate box. For individuals, this is your social security number (SSN). Social security nirnber However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identfication number (EIN)_ If you do not have a number, see How to get a TIN on page 3. or Note: ff the account is in more titan one name, see Me chart on page 4 for guidelines on wtiose number Employer identification r "Rnbe 1 to enter 1� J I_ 1 i Under penalties of perjury, I certify that 1. The number shown on this form is my correct taxpayer identification number (or ! am waiting for a number to be issued to me), and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. 1 am a U.S. person (wduding a U.S_ resident alien). Certification instructions. You must cross out dem 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report of interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt contributions to an individual retirement arrangement (IRA), and generally, payments other than ingest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. (See the instructions on page 4.) Sign Signaturf Here us. persone o ► gate 0 - Purpose Purpose of Form A person who is required to file an information return with the IRS, must obtain your correct taxpayer identification number (TIN) to report for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. U -S. person. Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2 Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. Note: If a requester gives you a form other than Form W-9 to request your TIN, you must use the requester's form if it is substantially similar to this Form W-9. Foreign person. If you are a foreign person, use the appropriate Form W-8 (see Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign Entities). Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a "saving clause." Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the recipient has othervifise become a U.S. resident alien for tax purposes. If you are a U.S_ resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement that specifies the following .five items: 1. The -treaty country. Generally, this must be. the same treaty under which you claimed exemption from tax as a nonresident alien. 2. The treaty article addressing the income. 3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions. 4. The type and amount of income that qualifies for the exemption from tax. 5. Sufficient facts to justify the exemption from tax under the terms of the treaty article. Cat. No. 10231X Form W-9 (Rev. 1-2003) w'9 Foran Request for Taxpayer Give fon„ to the (Rev. January 2003) identification Number and Certification requester. SOL Depanrnertt d the rreasuy sendnd to to the IRS. Imernal Revenue Service r,; Name d to Business name, if different from above c O h ` u o Individual Check appropriate box: ❑ Sole proprietor ❑ corporation ❑ Partnership ❑ other ► __________________TE1WMrhW.1ding Ept from backup w Address (number, street, and apt. or suite no.) Requester's name and address iopbonaf ` c 1 U City, state, and ZIP code 0 d 0. in d List account number(s) here (optional) ai (n Taxpayer Identification Number {TIN) Enter your TIN in the appropriate box. For individuals, this is your social security number (SSN). Social security nirnber However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identfication number (EIN)_ If you do not have a number, see How to get a TIN on page 3. or Note: ff the account is in more titan one name, see Me chart on page 4 for guidelines on wtiose number Employer identification r "Rnbe 1 to enter 1� J I_ 1 i Under penalties of perjury, I certify that 1. The number shown on this form is my correct taxpayer identification number (or ! am waiting for a number to be issued to me), and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. 1 am a U.S. person (wduding a U.S_ resident alien). Certification instructions. You must cross out dem 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report of interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt contributions to an individual retirement arrangement (IRA), and generally, payments other than ingest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. (See the instructions on page 4.) Sign Signaturf Here us. persone o ► gate 0 - Purpose Purpose of Form A person who is required to file an information return with the IRS, must obtain your correct taxpayer identification number (TIN) to report for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. U -S. person. Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2 Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. Note: If a requester gives you a form other than Form W-9 to request your TIN, you must use the requester's form if it is substantially similar to this Form W-9. Foreign person. If you are a foreign person, use the appropriate Form W-8 (see Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign Entities). Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a "saving clause." Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the recipient has othervifise become a U.S. resident alien for tax purposes. If you are a U.S_ resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement that specifies the following .five items: 1. The -treaty country. Generally, this must be. the same treaty under which you claimed exemption from tax as a nonresident alien. 2. The treaty article addressing the income. 3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions. 4. The type and amount of income that qualifies for the exemption from tax. 5. Sufficient facts to justify the exemption from tax under the terms of the treaty article. Cat. No. 10231X Form W-9 (Rev. 1-2003) Form WA (Rev. 1-2003) Example. Article 20 of the U.S.-China income tax treaty allows an exemption from tax for scholarship income received by a Chinese student temporarily present in the United States. Under U.S. law, this student will become a resident alien for tax purposes if his or her stay in the United States exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the first protocol) and is relying on this exception to claim an exemption from tax on his or her scholarship or fellowship income would attach to Form W-9 a statement that includes the information described above to support that exemption. If you are a nonresident alien or a foreign entity not subject to backup withholding, give the requester the appropriate completed Form W-8. What is backup withholding? Persons making certain - payments to you must under certain conditions withhold and pay to the IRS 30% of such payments (29% after December 31, 2003; 28% after December 31, 2005). This is called "backup withholding." Payments that may be subject to backup withholding include interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding. You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return. Payments you receive will be subject to backup withholding if. 1. You do not furnish your TIN to the requester, or 2. You do not certify your TIN when required (see the Part II instructions on page 4 for details), or 3. The IRS tells the requester that you furnished an incorrect TIN, or 4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or 5. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only). Certain payees and payments are exempt from backup withholding. See the instructions below and Ute separate Instructions for the Requester of Form W-9. Penalties Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect. Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty. Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment. Misuse of T1Ns. If the requester discloses or uses TINs in violation of Federal iaw, the requester may be subject to civil and criminal penalties. Page L Specific Instructions Name If you are an individual, you must generally enter the name shown on your social security card. However, if you have changed your last name, for instance, due to marriage without informing the Social Security Administration of the name change, enter your first name, the last name shown on your social security card, and your new last name. If the account is in joint names, list first, and then circle, the name of the person or entity whose number you entered in Part I of the form. Sole proprietor. Enter your individual name as shown on your social security card on the "Name" line. You may enter your business, trade, or "doing business as (DBA)" name on the "Business name" line. Limited liability company (LLC). If you are a single -member LLC (including a foreign LLC with a domestic owner) that is disregarded as an entity separate from its owner under Treasury regulations section 301.7701-3, enter the owner's name on the "Name" line. Enter the LLC's name on the "Business name" tine. Other entities. Enter your business name as shown on required Federal tax documents on the 'Name" fine. This name should match the name shown on the charter or other legal document creating the entity. You may enter any business, trade, or DBA name on the "Business name" line. Note- You are requested to check the appropriate box for your status (rndividual/sole proprietor, corporation, etc.). Exempt From Backup Withholding If you are exempt, enter your name as described above and .check the appropriate box for your status, then check the "Exempt from backup withholding" box in the line following the business name, sign and date the form. Generally, individuals (including sole proprietors) are not exempt from backup withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends. Note: If you are exempt from backup withholding, you should stilf complete this form to avoid possible erroneous backup withholding. Exempt payees. Backup withholding is not required on any payments made to. the following payees: 1. An organization exempt from tax under section 501(a), any IRA, or a custodial account under section 403(b)(7) if the account satisfies the requirements of section 401(Q(2); 2- The United States or any of its agencies or instrumentalities; 3. A state, the District of Columbia, a possession of the United States, or any of their political subdivisions or instrumentalities; 4. A foreign government or arty of its political subdivisions, agencies, or instrumentalities; or 5. An international organization or any of its agencies or instrumentalities. Other payees that may be exempt from backup withholding include: 6. A corporation; 7. A foreign central bank of issue; 8. A dealer in securities or commodities required to register in the United States, the District of Columbia, or a possession of the United States; . Form W-9 (Rev. 1-2003) Pa. 3 9. A futures commission merchant registered with the Commodity Futures Trading Commission; 10. A real estate investment trust; 11. An entity registered at all times during the tax year under the Investment Company Act of 1940; 12- A common trust fund operated by a bank under section 584(a); 13. A financial institution; 14. A middleman known in the investment community as a nominee or custodian; or 15. A trust exempt from tax under section 664 or described in section 4947. The chart below shows types of payments that may be exempt from backup withholding. The chart applies to the exempt recipients listed above, 1 through 15. If the payment is for - .. THEN the payment is exempt for... Interest and dividend payments All exempt recipients except for 9 Broker transactions Exempt recipients 1 through 13. Also, a person registered under the Investment Advisers Act of 1940 who regularly acts as a broker Barter exchange transactions Exempt recipients 1 through 5 and patronage dividends Payments over 36W required Generally, exempt recipients to be reported and direct 1 through 7 z sales over $5,11Q0 ' ' See Form 9099-MISC. Miscellaneous Income, and its instructions. Z However, the following payments made to a corporation (including gross proceeds paid to an attorney under section 6045(Q, even if the attorney is a corporation) and reportable on Form 1099-MISC are not exempt from backup withholding: medical and health care payments, attorneys' fees; and payments for services paid by a Federal executive agency. Part 1. Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. If you are a resident alien and you do not have and are not eligible to get an SSN, your TIN is your IRS individual taxpayer identification number (ITIN). Enter it In the social security number box. If you do not have an ITIN, see How to get a TIN below. If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN. However, the IRS prefers that you use your SSN. If you are a single -owner LLC that is disregarded as an entity separate from its owner (see limited liability company (LLC} on page 2), enter your SSN (or EIN, if you have one). If the LLC is a corporation, partnership, etc., enter the entity's EIN. Note: See the chart on page 4 for further clarification of name and TIN combinations. How to get a TINE. if you do not have a TIN, apply for one immediately. To apply for an SSN, get Form SS -5, Application for a Social Security Card, from your local. Social Security Administration office or get this form on-line at www.ssa.gov/ordirie/ssS.htrrg. You may also get this form by calling 1-800-772-1213. Use Form W-7, Application for IRS Individual Taxpayer identification Number, to apply for an {TIN, or Form SS -4f Application for Employer Identification Number, to apply for an EIN. You can get Forms W-7 and SS -4 from the IRS by calling 1 -800 -TAX -FORM (1-800-829-3676) or from the IRS Web Site at www.irs.gov. If you are asked to complete Form W-9 but do not have a TIN, write -Applied For" in the space for the TIN, sign and date the form, and give it to the requester. For interest and dividend payments, and certain payments made with respect to readily tradable instruments, generally you will have 60 days to get a TIN and give it to the requester before you are subject to backup withholding on payments. The 60 -day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester, Note: Writing Applied For" means that you have already applied for a TIN or that you intend to apply for one soon. caution: A disregarded domestic entity that has a foreign owner must use the appropriate Form W-8. Form w-9 (Rev. 1-2003) Part 11- Certification To establish to the withholding agent that you are a U.S. person, or resident alien, sign Form W-9. You may be requested to sign by the withholding agent even if items 1, 3, and 5 below indicate otherwise. For a joint account, only the person whose TIN is shown in Part 1 should sign (when required). Exempt recipients, see Exempt froin backup withholding on page 2. Signature requirements. Complete the certification as indicated in 1 through 5 below. 1. Interest, dividend, and barter exchange accounts opened before 1984 and broker accounts considered active during 1983. You must give your correct TIN, but you do not have to sign the certification. 2. Interest, dividend, broker, and barter exchange accounts opened after 1983 and broker accounts considered inactive during 1983. You must sign the certification or backup withholding will apply. if you are subject to backup withholding and you are merely providing your correct TIN to the requester, you must cross out item 2 in the certification before signing the form. 3. Real estate transactions. You must sign the certification. You may cross out item 2 of the certification. 4. Other payments. You must give your corny TIN, but you do not have to sign the certification unless you have been notified #hat you have previously given an incorrect TIN. 'Other payments" include payments made in the course of the requester's trade or business for rents, royalties, goods (other than bills for merchandise), medical and health care services (including payments to corporations), payments to a nonemployee for services, payments to certain fishing boat crew members and fishermen, and gross proceeds paid to attorneys (including payments to corporations). 5. Mortgage interest paid by you, acquisition or abandonment of secured property, cancellation of debt, qualified tuition program payments (under section 529), NZA or Archer MSA contributions or distributions, and pension distributions. You must give your correct TIN, but you do not have to sign the certification. What Name and Number To Give the Requester For this W2 of accoLO-9: Give nine and SSN of: 1. Individual The individual 2. Two or more individuals (joint The actual owner of the account account) or, if combined funds, the first individual on the account ' 3. Custodian account of a minor The minor 2 (Uniform Gift to Minors Act) 4. a_ The usual revocable The grantor -trustee ' savings trust (grantor is also trustee) b. So-called trust account The actual owner' that is not a legal or valid trust under state law 5. Sole proprietorship or The owner' single -owner LLC For this type of account: Give name and EIN of: 6. Sole proprietorship or The owner' single -owner LLC 7. A valid trust estate, or Legal entity 4, pension trust B. Corporate or LLC electing The corporation corporate status on Form 8832 9. Association, club, religious, charitable, educational, or other tax-exempt organization 10. Partnership or multi -member LLC 11. A broker or registered nominee 17- Account with the Department of Agriculture in the name of a public entity (such as a state or local government, school district. or prison) that receives agricultural program payments The organization The partnership The broker or nominee The public entity 'List fust and circle the name of the person whose number you furnish. If only one person on a joint account has an SSN, that person's number must be furnished. 'Circle the minor's name and fumish the minor's SSN. 3 You must show your individual name, but you may also enter your business or "DBA" name. You may use either your SSN or EIN (if you have one). 'List fust and circle the name of the legal trust estate, or pension trust (Do not furnish the'nN of the personal representative or trustee unless the legal entity itself is not designated in the account title.) Note. If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed. Privacy Act Notice Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons who must file information returns with the IRS to report interest, dividends, and certain other income paid to you, mortgage interest you paid, the acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA or Archer MSA. The IRS uses the numbers for identification purposes and to help verify the accuracy of your tax return. The IRS may also provide this information to the Department of Justice for civil and criminal litigation, and to cities, states, and the District of Columbia to carry out their tax laws. We may also disclose this information to other countries under a tax treaty, or to Federal and state agencies to enforce Federal nortax criminal laws and to combat terrorism. You must provide your TIN whether or not you are required to file a tax return. Payers must generally withhold 30% of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to a payer. Certain penalties may also apply. G'1 Applicant Certification These certified statements are required by law. Previous versions obsolete form HUD400904 A. For the Supportive Housing (SHP), Shelter Plus Care (S+C), and Single Room Occupancy (SRO) programs: Fair Housing and Equal Opportunity. It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulations pursuant thereto (Title 24 CFR part I), which state that no person in the United States shall, on the ground of race, color or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the applicant receives Federal financial assistance, and will immediately take any measures necessary to effectuate this agreement. With reference to the real property and structure(s) thereon which are provided or improved with the aid of Federal financial assistance extended to the applicant, this assurance shall obligate the applicant, or in the case of any transfer, transferee, for the period during which the real property and structure(s) are used for a purpose for which the Federal financial assistance is extended or for another purpose involving the provision of similar services or benefits. It will comply with the Fair Housing Act (42 U_S.C. 3601-19), as amended, and with implementing regulations at 24 CFR part 100, which prohibit discrimination in housing on the basis of race, color, religion, sex, disability, familial status or national origin. It will comply with Executive Order 11063 on Equal Opportunity in Housing and with implementing regulations at 24 CFR Part 107 which prohibit discrimination because of race, color, creed, sex or national origin in housing and related facilities provided with Federal financial assistance. It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter 60- 1), which state that no person shall be discriminated against on the basis of race, color, religion, sex or national origin in all phases of employment during the performance of Federal contracts and shall take affirmative action to ensure equal employment opportunity. The applicant will incorporate, or cause to be incorporated, into any contract for construction work as defined in Section 130.5 of HUD regulations the equal opportunity clause required by Section 130.15(b) of the HUD regulations. It will comply with Section 3 of the Housing and Urban Development Acf of 1968, as amended (12 U.S. C. 1701(u)), and regulations pursuant thereto (24 CFR Part 13 5), which require that to the greatest extent feasible opportunities for training and employment be given to lower-income residents of the project and contracts for work in connection with the project be awarded in substantial part to persons residing in the area of the project. It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C_ 794), as amended, and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based on disability in Federally -assisted and conducted programs and activities. It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-07), as amended, and implementing regulations at 24 CFR Part 146, which prohibit discrimination because of age in projects and activities receiving Federal financial assistance. It will comply with Executive Orders 11625, 12432, and 12138, which state that program participants shall take affirmative action to encourage participation by businesses owned and operated by members of minority groups and women. If persons of any particular race, color, religion, sex, age, national origin, familial status, or disability who may qualify for assistance are unlikely to be reached, it will establish additional procedures to ensure that interested persons can obtain information concerning the assistance. It will comply with the reasonable modification and accommodation requirements and, as appropriate, the accessibility requirements of the Fair Housing Act and section 504 of the Rehabilitation Act of 1973, as amended. Additional for S+C: If applicant has established a preference for targeted populations of disabled persons pursuant to 24 CFR 582.330(a), it will comply with this section's nondiscrimination requirements within the designated population. B. For SHI' Only. 24 -Year Operation Rule. For applicants receiving assistance for acquisition, rehabilitation or new construction: The project will be operated for no less than 20 years from the date of initial occupancy or the date of initial service provision for the purpose specified in the application. 1 -Year Operation Mule. For applicants receiving assistance for supportive services, leasing, or operating costs but not receiving assistance for acquisition, rehabilitation, or new construction: The project will be operated for the purpose specified in the application for any year for which such assistance is provided. C. For S+C Only. Supportive Services. It will make available supportive services appropriate to the needs of the population served and equal in value to the aggregate amount of rental assistance funded by HUD for the full term of the rental assistance. D. Explanation. Where the applicant is unable to certify to any of the statements in this certification, such applicant shall attach an explanation behind this page. Signature of Authorized Certifying Official: 1 Date: Title: Applicant: For PHA Applicants Only: (PHA Number) A. TT (71T.. I r-' : T 1i 1IL4?�SI-D_ DE CCIL,,`,,TY HO.' IELESS TRUST I�TLj �P-D ��Di✓ COz �;vl�' F,EOL�IF�D ,�+.FFID.�.T��I T S Tile contracting individual or entin, (e overnmental or other-,vlse) shall indicaie b', an al) ar,da it - that pe-FL-3111tothis contract and shall indicate by an "N%.;" all affidavits that do not periain to tl;i; conrraci. All blank spaces must be filled. The MJAJ%,Ij-DADE COUYT-YOVW.ERSMF DISCLOSUPF AFFIIDAb'IT; NflA,1II-DADS, COLFl,;7)' EMPLOYNTENT DISCLOSUF.AFFIDAVIT; 1`'IIAiti1I-DADS CRII`,4INAL REC[)p,D AFFIDA 1 ET; DISABILITY NOTZISCR11\UNATION AFFIDAVIT; and the PROJECT FRESH START AFFIDAVIT shall not pertain.to contracts with the United States or any of its departments or agencies thereof, the State or any Political subdivision or agency thereof or any municipality of this State. The NIIAMI-DADE FA•IILY LEAVE AFFIDAVIT shall not pertain to contracts with the United States or any of its departments or agencies or the State of Florida or an), political subdivision or agency thereof, it shall, however, pertain to rn unicipalities of the State of Florida. All other cong-acting entities or individuals shall read carefully each affidavit to determine whether or not it pertains to this contract. I, Affiant being first duly sworn state: The full legal name'and business address of the person(s) or entity contracting or transacting business with Miami -Dade County are (Post Office addresses are not acceptable): Federal Employer Identification Number (If none, Social Security) ane of Entity, Indrvlduzl(s), Pariliers, or Corporation Doing Business As (if same as above, leave blank) street Address it -V State P Code I. MIAMI-DADE COUNTY OWNERSHIP DISCLOSURE AFFIDAVIT (Sec. ?-S.l of the County Code) I. If the contract or business transaction is with a corporation, the full legal name and business address shall be provided for each officer and director and each stockholder who holds directly or indirectly five percent (5%) or more of the corporation's stock. If the contract or business transaction is with a partnership, the foregoing information shall be provided for each partner. If the contract or business transaction is with a trust, the full legal name and address shall be provided for each trustee and each beneficiary.. The foregoing requirements shall not pertain to contracts with pubIicl} traded corporations or to contracts with the United States or an} department or agency thereof, the State or any political subdivision or aryency thereof 'or any municipality of this State. All such names and addresses are (Post Office addresses are not acceptable): I ors Full Legal Name . Address (,�.r,ership 0 0.0 ;o The full legal names and business address of any other individual (other than subcontractors, materia! men, suppliers, laborers, or lenders) who have, or will have, any interest (legal, equitable beneficial or otherwise) in the contract or business transaction . with Dade County are (Post Office addresses are not acceptable).- An), cceptable): An), person who willfully fails to disclose the information required herein, or G+ho kno++in`ly discloses false information in this regard, shall be punished by a fine of up to five hundred dollars (5500.00) or imprisonment in the County jail for up to (60) days or both. II. 1,f1A_NU-DADE COUNTY .EMPLOI�NT DISCLOSURE.AFFIDAVIT (County Ordinance No. 90- 133, Amending sec. 2-8- . Subsection (d)(2) of the County Code)_ Except where precluded by federal or State laws or regulations, each contract or business transaction or renewal thereof which involves the expenditure of ten thousand dollars (Sl 0,000) or more shall require the entity contracting or rransactincl business to disclose the foliowing information. The foregoing disclosure requirements do not apply to contracts with the United States or any department or agency thereof, the State or any political subdivision or agency thereof or any municipality of this State_ l Does your firm have a collective bargaining agreernent with its employees? — Yes No 2- Does your firm provide paid health care benefits for its employees? _ Yes No 3. Provide a current breakdovvm (number of persons) of your firm's work force and ownership as to race, national origin and gender: White: Males Females Asian: Males Females Black: Males Females American Indian: Males Females Hispanics: Males Females Aleut (Eskimo): Males Ferrules Nfales Females: Males Females _III. AFFIF.M,447TVE ACTI0N/N0Nr DISCpjNf NATI0N OF EMPLOYMENT, PROMOTION AND PROCUREMENT PRACTICES (County Ordinance 9S-30 codified at 2-8.1.5 of the County Code.) In accordance v,ith County Ordinance No. 98-30, entities with annual gross revenues in excess of S5,000,000 seeking to contract with the County shall., as a condition of receiving a County contract, hare: i) a .i,ricten affirmative action plan which sets forth the procedures the entity utilizes to assure that it does not discriminate in its employment and promotion practices; and ii) a written procurement policy which sets forth the procedures the entity ytilizes to assure that Lt does not discriminate against minority and women -owned businesses in its OV71 procurement of goods, supplies and services. Such airmativ�e action plans and procurement policies shall provide for periodic movie to determine their effecriVeness in assuring the entire does not discriminate in its emplo}anent, promotion and procurement pracrices. The. foregoing not-Lvithstanding, cont orate entities vrhose boards ofdirecon are reoresenLltive of the population ma}:e-up of the nation shall be presumed to have non diswi ninci_, tmplo,.ment and procurement policies, ani shell not be required ic, have v.-rirten plans and procurement policies in order t;) recei,,,e a( contract. Th_ iorC_oin_ Giesl nptl•�n r ;?: be rebuned. i he recuirement-s ofCounty Ordinance No. 98-30 may be waived upon the wri,.en recommer,datioa _;, the County Manager that it is in the best interest of the Counry to do so and upon approval o; the Bozrd of County• Commissioners by majoriry vote of the members present. The firm does not have annual cross revenues in excess of 53,000,000. The firm does have annual revenues in excess of 53,000,000; hoxcver, its Board of Directors is representailve of the population male -up of the nation and has submitted a v.ritten. detailed listing of its Loard ofDircctors, including the race or ethniciry of each board member, to the County's Department of Business Development, 175 1st Avenue, 2Sth Floor, Miami, Florida 33128. The firm has annual gross revenues in excess of$5,000,000 and rhe firm does have a written affimiative action plan and procurement policy as described above, which includes periodic reviews to determine effectiveness, and has submitted the plan and policy to the County's Department of Business Development 175 N.W. Ist Avenue, 28th Floor, Miami, Florida 33128; The firm does not have an affirmative action plan and/or a procurement policy as described above, but has been granted a warver. —I�• ADAMl-RADE COUNTY CRIMINAL RECORD AFFIDAVIT (Section 2-8.6 of the County Code) The individual or entity entering into a contract or receiving funding from the County has has not as of the date of this affidavit been convicted.of a felony during the past ten (I 5)years. An officer, director, or executive of the entity entering into a contract or receiving funding from the County has has not as of the date of this affidavit been convicted of a felony during the past ten (I0) years. _V. MIAMI -DADS £ItiZPLOY-MENT DRUG-FREE WORKPLACE AFFIDAVIT (County Ordinance No. 92-I5 codified as Section 2-8.1? of the County Code) That in compliance with Ordinance No. 92-15 ofthe Code of Miami -Dade County, Florida, the above naned person or entity is providing a drug-free workplace. A written statement to each employee shall inform the employee about: _ 1. danger of drug abuse in the workplace 2 the firm's policy of maintaining a drug-free environment at all workplaces 3. availability of drug counseling, rehabilitation and employee assistance programs 4. penalties that may be imposed upon employees for drug abuse violations The person of entity shall also require an employee to sign a statement, as a condition of employment that the employee will abide by the terms and notify the employer of any criminal drug conviction occurring no later than five (5) days after receiving notice of such conviction and impose appropriate Personnel action against the employee up to and including termination. Compliance titi ith Ordinance, No. 92-13 may be waived if the special characteristics of the product or service Offered by the person or entity make it necessary for the operation of the County or for the health, safet-Y welfare, economic benefits and well -beim; of the public. Contracts involving funding which is provided -in v,' -hole or in part by the United States or the State of Florida shall be exempted from the provisions of this ordinance in those instances ,;here those provisions are in conflict with the requirements of those L7ovemment2l entities. � 3 3,5- �Y7. AFFTDAqT (Coun -v Ordinanc= ? ,. 14-1-91 codified as ICCIiDn 1 iA-29 et. sea of the That in compliance wl[h Drdinance NO. 1 `-91 of the Cote,- of , liami-Dauz Coun,-,•, Florida, an employer with fifc}, (50) or more ernplo..ees \,corking in Dade Count,' For each � orE,' ing day durin^ each of twenty (30) or more calendar ,vork- v,e6:s, small provid-f th_ follov--ing, information in compliance with all items in the aforementioned ordinance: An employee who has worl:ed for the above firm at least one ( 1) year shall be entitled to niner,• (90) days of family leave durin; any twenty-four (211) month period, for medical reasons, for the birth or adoption of a child, or for the care of a child, spouse or other close relative �vho has a serious health condition without risk of termination of employment or employer retaliation. The foregoing requirements shall not pe.-tain to contracts with the United States or anydepartmenr or agency thereof, or the State of Florida or any political subdivision or agency thereof. It shall, however, pertain to municipalities of this State. `VII. DISABILITY NON-DISCRIMINATION AFFIDAVIT (County Resolution R-355-95) That the above named firm-,, corporation or organization is in compliance with and agrees to continue to comply with, and assure that any subcontractor, or third party contractor under this project complies with all applicable requirements of the laws listed below including, but not limited to, those provisions pertaining to employment, provision of programs and services, transportation, communications, access to facilities, renovations, and new construction in the following lasses: The Americans with Disabilities Act of 1990 (ADA), Pub. L. 101-336, 104 Stat 327, 42 U.S.C. 12101-I2213 and 47 U-S.C. Sections 225 and 611 including Title I, Employment; Title II, Public Services; Title III, Public Accommodations and Services Operated by Private Entities; Title IV, Telecommunications; and Title V, Miscellaneous Provisions; The Rehabilitation Act of 1973, 29 U.S.C. Section 794; The Federal Transit Act, as amended 49 U.S.C. Section 16I2; The Fair Housing Act as amended, 42 U.S.C. Section 3601-3631. The foregoing requirements shall not pe fain to contracts with the United States or any department or agency thereof, the State or any political subdivision or agency thereof or any municipality of this State. —VIIi. MIA-N1I-DARE COUTTTY' REGARDING DELINQUENT AND CURRENTLY DUE FEES OR TAXES (Sec. 2-S.1(c) of the County Code) Except for small purchase orders and sole source contracts, that above named firm, corporation, organization or individual desiring to.transact business or enter into a contract with the County verifies that all delinquent and currently due fees or taxes -- including but not limited to real and property taxes, utility taxes and occupational licenses -- which are collected in the normal course by the Dade County Tax Collector as well as Dade County issued parking tickets for vehicles registered in the name of the ficin, corporation, organization or individual have been paid. _IX. CURRENT ON ALL COUNTY CONTRACTS, LOANS AND OTHER OBLIGATIONS The individual entity seeking to transact business with the County is current in all its obligations to the County and is not other -,A -,Ise in default of any contract, promissory note or other loan document Nvith the County or any of its agencies or instrumentalities. _X. PROJECT FRESH START (Resolutions R-702-95 and 35S-99) Any, firm that ha -s a contract with the Counry that results in actual payment of .5;500,000 or more shall cont ibute to Project Fresh Start, the County's -Welfare to Work Initiative. Hoysever, if eve percent (5io) of the firm's ,vorl: force consists of ir9dividuals ss,ho reside in T41ami-Dade County and who have lost or will lose cash assistance benefits (formerly a id to Families v;ith Dependent Children) as a result of the ,Personal Responsibiliry and Wo6, Opporrunir;} Reconciliation Act of 1996, the furl MU reouest 1;aiver from the rcquiremerLs of R-702-93 and R-353-99 by submitting a waiverrequest dr'Id31'1t. Tne fofccoln requlrfinenf do's not in t0 01'e 7ment enri[ie no, ,fir FrG(1i c'r"2;ii��ilQn, 0rrecipif,ntsvoi ,rant ai�,ardS. —1�.. DOAfcSIIC V70LENCE LEAD -E (Resolution 1S5-00; 99Codii:edAt IIA -60 Et. Sc-;. OF the 1 11ami-Dade Counry Code). The firm desiring to do business v,•ith the County is in compliance with Domestic Leave Ordnance, Ordinance 99-5, codified at I1A-60 et. seq. of the Miami Dade County Code, which requires an employer which has in the recrular course of business firty (50) or more employees Nvorkine in Miami -Dade Counr,! for each worliin, day during each of ttiventy (M or more calendar v. ork eeks in the current or proceeding calendar years, to provide Domestic Violence Leave to its employees. I have carefully read this entire five (5) page document entitled, "Miami -Dade Counry Affidavits" and have indicated by an "X" all affidavits that pertain to this contract and have indicated by an "N/A" all affidavits that do not pertain to this contract. BY: (Signarure of Affiant) SUBSCRIBED AND SIWOFN TO (or affirmed) before me this day of 200_ by known to me or has presented (Type of Identification) (Si_ -nature of Notary) (Print or Stamp of Notary) Notary Public —Stamp State of (State) (Date) _ He/She is personal]}, as identification (Serial Number) (Expiration Date) Notary Seal I + • I I.vI IML -i AFFIDAVIT 0FMI-AA-11-D.-0E COUNTY LOBEYIST REGISTRATION FOR ORAL PP,,- TATIO (l) Pr1)ecMtle: (2) D- par7nent: (=) Fvmrproposer;;,ame: Address:— Business Telephone: (_�j Prc't=.Ci:O.: Lip: (d) List All Members ofthe Presentation Team Who Will Be Participating in the Oral Presentation: NIANIE TITLE EMPLOYED BY TEL. 1,10. (ATTACH ADDITIONAL SHEET IF NECESSARY) The individuals named above are Registered and the Registration Fee is not required for the Oral Presentation ONLY. Proposers are advised that any individual substituted for or added to the presentation team after submittal of the proposal and filling by staff, MUST register with the Clerk of the Board and pay all applicable fees. Other than for the oral presentation Proposers who wish to address the county comrrnissi on, a county board or county committee concerning any action, decision or recommendation of county personnel regarding this solicitation MUST register with the Clerk of the Board (Form BCCFORM2DOC) and pay all applicable fees.. I do solemnly swear that all the foregoing facts are true and correct and I have read or am familiar with the provisions of Section 2-11.I(s) of the Code of Nictropo I itan Dade County as amended. Signature of Authorized Representative: Title: STATE OF COUNTY OF The foregoing instrument was acknowledged before me this by a (In.dividual, Officer, Partner or Agent) to me or svho has produced Signature ofperson taking acknowledgement) (Name of,Ac}nawledger ry-ped, printed or stamped) (Title or Ranl.) (Serial Number, if any) w4-2 - Ray. I✓2'93 . ,who is personally known (Sole Proprietor, Corporation or Partnership) as identification and vvho did/did not take an oath. Name of Orcanization: Address: ATTACHMEN I REQL)IRED LISTING OF SUBCONTRACTORS ON COLINT�' CONTR.-,CT In compliance with Mlarni-Dade County Ordinance 97-104, the Community Based Organization must submit the list of first tier subcontractors or sub -consultants who will perform any part of the Scope of Sen -ices Work, if this Agreerrrent is for 5100,000 or more. The Community Based Organization must complete this information. If the Community Lased Organization will not utilize subcontractors, then the Community Based Organization must state, "No Subdontractors will be used", do not state "N/A", Name of Subcontractor or Sub -Consultant .Address City and State REQUIRED LIST OF SUPPLIERS ON COUNTY CONTRACT In compliance with Miami -Dade County Ordinance 97-104, the Community Based Organization must attach a list of suppliers who wlL supply materials for the Scope of Services to the Community Based Organization, if this Contract Agreement is $ I00,000 or more. The Community Based Organization roust fill out this inm formation. If the Comunity Based Organization will not use suppliers, the Community Based Organization must state, "No suppliers will be used", do not state "N/A". Name of Subcontractor- or Sub -Consultant Address City and State Ilzereby cert f that the foregoinb information is true, correct and complete. Sibnature of Authorized Representati�,e: Title: Date: Firm Name: Fed. ID No.: .=address: _ Cit t/State/Zip: Telephone:Fa?:: E -Mail: Aliruni-Dude Comity. Florida firm Nnnte ur Prime Contrnctor/Propwer SU13'CONTRACT OR/SUPPL1Eft LISTING (Ordinance 97-104) RFP Nante 1TFP Number v,Uu,PUII nv. 7r-lut, rtiUJ l oe c04TIp1ele0 Oy'til MOM and proposers on County c•ontr-icis For iurcli0x of supplies, niateriitls or services, including professional -services which involve expenditures of$100,000 or more, and all bidders and proposers on County or public llealtll Trust construction contracts which involve expenditures of $100,000 or more. This form, or a comparable listing meeting tote requirements of Ordinance No. 97-10.1, moist he completed and stibnritted eN-en though.the bidder or proposer will Clot -utilize subcontractor's or suppliers on the contract. The bidder or proposer should enter (lic word "NONE" under the appropriate heading of Form A-7.1 in those instances where no subcontractors or suppliers will be used on (lie contract. 1\ bidder or proposer Who is awtirded tl,c contract shall not change or substitute first tier subconlraclbi-s or direct suppliers.or the portions of the contract work to be performed or materials to be supplied from those identified exce. t u on written approval of the Countyti! I Busutcss Nani 'anti Address of First Tier. Principal Owner Scope of Work to be Peirfonned by (t'rincipal Owncr) Sultconlraclorf5ubconsullant Subcantrac(or/Sut)consullant Gentler Race 1Susiness Name and Address orUireetSupplier I'rill Cij)al Oli't]Ct' StsppNes/I�IaterialsJServices to be (t'rtncri4;tl Otti'ncr) Provided by Supplier (;c»der �Zace 1 certify that the representations contained in this Subcontractor/Supplier Listing are to the best ormy knowledge true anti ncctur-a(c. Signnlure of Proposer's Auihori7ed Representative Print Nnnie (Duplicate iraddilional space is needed) Print Title Ualc I'„I m .%-7.1(nrw S,7;11 ATTACHMENT N APPLICANT OR RECIPIENT SECTION 3 COMPLIANCE REQUIREMENTS FOR HUD -ASSISTED PROJECTS PROJECT NAME: PROJECT LOCATION: PROGRAM FUNDING SOURCE: The work to be performed under this contract is subject to the requirements of Section 3 of the Housing and Urban Development Act of 1968, as amended, 12 U.S.C. 1701u (Section 3). The purpose of Section 3 is to ensure that employment and other economic opportunities generated by Federal assistance of HUD -assisted projects covered by Section 3, shall to the greatest extend feasible, be directed to low and very low-income persons, particularly persons who are recipients of HUD assistance for housing and to businesses that are substantially owned or substantially employ low and very low�ncome persons. The applicant or recipient commits to development and implementation of a Section 3 Economic Opportunity Plan for Miami -Dade Housing Agency (MDHA) approval, prior to selection of an architect or general contractor or other applicable contractor. This Plan shall: describe the outreach procedures the applicant or recipient will use to recruit, solicit, encourage, facilitate and award architectural and general contrails, where applicable, to Section 3 businesses in the project area; make a good faith effort as defined by the regulations, to provide training, employment and business opportunities required by Section 3 to persons from the project area; and incorporate the "Section 3 Clause" (see attachment next page) in all contracts over $100,000 in connection with this project The applicant or recipient commits to including the following contractor certification in all contracts over $100,000: "The contractor certified that any vacant employment positions, including training positions, that are filled (1) after the contractor is selected, but before the contract or agreement is executed; and (2) with persons other than those to whom the Section 3 regulation require employment opportunities to be directed, are not filled to circumvent the contractor's obligation under the Section 3 regulation. The applicant or recipient certifies and agrees that it is under no contractual or other impediment which would prevent it from comllying with these reguirements Non-compliance with the Section 3 regulations may result in sanctions, termination of this contract or agreement for default, and debarment or suspension from future HUD -assisted contracts. OWNEWS FIRM NAME (Print or Type Name): AUTHORIZED SIGNATURE SIGNATURE Affix Notary Seal to the Right All ACI -MEN T N "Section 3 Clause" 24 CFR Part 135 This clause must be included in all Section 3 -covered contracts. A. The work to be performed under this contract is subject to the requirements of Section 3 of the Housing and Urban Development Act of 1968, as amended, 12 U.S.C. 1701u (Section 3). The purpose of Section 3 is to ensure that the employment and other economic opportunities generated by HUD assistance of HUD -assisted projects covered by Section 3, shall, to the greatest extent feasible be directed to low and very low-income persons, particularly persons who are recipients of HUD assistance for housing. B. The parties to this contract agree to comply with HUD's regulations in 24 CFR Part 135, which implement Section 3. As evidenced by their execution of this contract, the parties to this contract certify that they are under no contractual or other impediment that would prevent them from complying with the 24 CFR Part 135 regulations. C. The contractor agrees to send to each labor organization or representative of workers with which the contractor has a collective bargaining agreement or other understanding, if any, a notice advising the labor organization or worker's representative of the contractor's commitments under this Section 3 clause, and will post copies of the notice in conspicuous placed at the work site where both employees and applicants for training and employment positions can see the notice. The notice shall describe the Section 3 preference, shall set forth minimum number and job tides subject bo hire, availability of apprenticeship and training positions, the qualifications for each; and the name and location of the person(s) taking applications for each of the positions; and the anticipated date the work shall begin. D. The contractor agrees to include this Section 3 clause in every subcontract subject to compliance with regulations in 24 CFR Part 135, and agrees to take appropriate action, as provided in the applicable Provision of the subcontract or in this Section 3 clause, upon a finding that the subcontractor is in violation of the regulations in 24 CFR Part 135. The contractor will not subcontract with any subcontractor where the contractor has notice or knowledge that the subcontractor has been found in violation of the regulations in 24 CFR Part 135. E. The contractor will certify that any vacant employment positions, including training positions, that are filled (1) after the contractor is selected but before the contract is executed; and (2) with persons other than those to whom the regulations of 24 CFR Part 135 require employment opportunities to be directed, were not filled to circumvent the contractor's obligations under 24 CFR Part 135. F. Non-compliance with HUD's regulations in 24 CFR Part 135 may result in sanctions, termination of the contract for default, and debarment or suspension from future HUD assisted contracts. G. Wit respect to work performed in connection with Section 3 coverers Indian housing assistance, motion 7(b) of the Indian Self -Determination and Education Assistance Act (25 U.S.C. 450c) also applies to the work to be performed under this contract. Section 7(b) requires that to the greatest extent feasible (1) preference and opportunities for training and emplo9yment shall be given to Indians, and (2) preference in the award of contracts and subcontracts shall be given to Indian organizations and Indian -owned Economic Enterprises Parties to this contract that are subject to the provisions of Section 3 and Section 7(b) agree to comply with Section 3 to the maximum extent feasible, but not in derogation of compliance with Section 7(b). SWORN ST_4TEAIE.-NT FURSU .-NT TO SECTION 237. 1=3 (31 isi, FLOR.If1.A STATUTES. ON PUELIC ENTITY CRI; - IES THIS FORM lvfUST BE —SIGNTED S'vVOR' 1 TO R\1 THE PR,.ESENCE OF NIOTARi' PUBLIC OR OTHER OFFICIAL ,a.t_iTHf �FJZED TO ?.DlVII'NISTER, OATHS. I. This sworn statement is submitted to A9iorni-Dole County: by (print individual's name and title) for (print name ofentity submitting sworn statement) %vhose business address is and (if applicable) its Federal Employer Identification Number (FEIN) is (if the entity has no FEIN, include the Social Security Number of the individual signing this sworn statement:) 1 understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), Florida Statutes means a violation of any state or federal lava, by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state of the United States, including, but not limited to, any bid or contract for goads or services to be provided to any public entity or an agency or political subdivision ofany other state OF the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. I understand that "convicted" br "conviction" as defined in Paragraph 357.133(1)(b) Florida Statutesmeans a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trial court of record relating to charges brought by indictment or information after July 1, 1959, as a result ofa jury verdict, non jury trial, or entry of Plea of guilty or nolo contendere. 4. 1 understand that an "affiliate" as defined in Paragraph 20.133(1)(a) Florida Statutes, means: a. A predecessor or successor ofa person convicted ofa public entity crime; or, b. An entity under the control of any natural person who is active in the management of the entity and who has been convicted ofa public entih, crime.. The tern "affiliate: includes those officers, directors, executives, partners shareholders, erimployees, members, and agents who are active in the management of an affiliate. The ownership by one. person of shares constituting a controlling interest in another person, or pooling of equipment or income among persons when not for fair market value under an arm's length agreement, shall be a prima facie case that one person controls another person. ,A person who Itnowingly enters into a joint venture with a person who has been convicted ofa pubic entity crime in Florida during the preceding 36 months shall be considered an affiliate. I understand that a "person" as defined in Paragraph 2ST1341)(e), Florida Statutes,means any natural person or entity oreanized under the la.vs of any state or of the United States \vith the ler*al poNver to enter into a binding contract and which bids or applies to bid on contracts for the provision of loads or sen ices let by a public entir},, or � hich otherwise transacts or applies to transact business ,with a public entity. The term "person" includes those officers, directors, executives, panners, shareholders, emplo e'fs, rrltnlbers, and agents uwho are active In manazennent of an ennt',. E• bCio.r is 'rue in r,, B sed on is ormation and t sta I ha�, e n;a;,.ed , b: r. th_ te:,�ent, ��,hic,� ��m to entirrsubmirtin? C?is s•,,,orn statement. (Phase indica!e ,�hich,tarmtn1 ap; lies). N''either the entity submrtttn, this sworn state, ten?, nor am, of its Dillcers, directors, executives, partners, shareholders, employ c! -s, members, or agents who are active in the management of the entirr, nor the affiliate of the entity has been charged „ viih and convicted of a public entity crime within the past 36 months. The entity submitting this sworn statement, or one or more of its officers, directors• executives, partners, shareholders, employees, members, or agents who are active in th management of the entity, or an affiliate of the entire has been charged with an convicted or" a public entity crime within the past 36 months AND (Please indicate which additional statement applies) The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or an affiliate of the entity has been charged with an convicted of a public entity crime within the past 36 months. However, there has been a subsequent proceeding before a Hearing Office,, of the State of Florida, division of Administrative Hearings and the Final Order entered by the Hearing Officer determined that it was not in the public interest to place the entity submitting this swom statement on the convicted vendor list (attach a copy of the final order). I UNDERSTAND THAT THE SUBMISSION OF THIS. FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED. IN PARAGRAPH I (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH THE LIFE OF THE CONTRACT. I ALSO UNDERSTAND THAT I A144 REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THP,ESHOLD AMOUNT PROVIDED IN SECTION 287.0I7, FLORIDA STATUTES FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTRAINED IN THIS FORM. (Signature) STATE OF COUNTY OF PERSONALLY APPEARED BEFORE ME, the undersigned authority. (date) (name of individual signing) who, after, first being swom by in e, affixed his/her signature in the space provided above on this day of , 20 NOTARY PUBLIC M), commission e::pires: MIAMI-DADE COUNTY HOMELESS TRUST PROVIDER ASSET INVENTORY Provider Name: Program Name: Funding Source: Reporting Period: ATTACHMENT P Description of Property Serial / ID Acquisition Acquisition Number Date Cost Vendor Name % of Purchase Cost from Grant Location of Property Use and Condition of Property Who holds Title of Property ** Attach invoices for all purchases this grant reporting period. Tn!_ in_irurnen[ .._ pr: -Dred h`,' Th Il iohru-!n ` 13C1:° s ., ssi�cun ",7 -r, \ o :n� Anorn:n '� r ir;ct Ml':um:-Dade Counr.' JI, h in en l () DECL-AIZATION OF RESTRIC'TIV'E COVENANTS THIS DECLARi TION OF RESTrJCTIVE COTE_ TAJN7S (Declaration) dLled as oi" 200, by (Protect SpollSor"') and ("Titleholder"), their successors and asst^ns. is 21ven to the United State Department of I-Iousin,,; and Urban Development (HUD.). RECITALS WHEREAS, the Project Sponsor participated in a consolidated application to HLID- dated as of for a Supportive Housing Grant; which Grant was awarded: and -IATHERE-4S Miami -Dade Couilty (the Recipient) entered III:o a Supportive Housing Grant (FL 1 4B ) on : and �k=PL,AS, the Recipient entered into an Agreement dated Nvith the Project. Sponsor (the Project Sponsor Agreement) in «-hick the Project Sponsor is obligated to acquire and rehabilitate directly or through its single -asset affiliate as defined below and operate a supportive housing project on property described in LI-hibit A Hereto (tl;e "Proper I), ,j,hic]l is to be maintained and operated as supportive housing as def lied by the Agreement; and WHEREAS, the Project Sponsor has created (the "Titleholder"), an affiliated single -asset corporation whose board of directors is the same as the board of directors of the Project Sponsor, for the sole purpose of acquiring and rehabilitating the Propem, ; and WHEREAS, the McKlnnev-Vento Homeless Assistance Act, 4? USC §A I I3Sl et. seq. (':ACT") imposes use and repayment requirements on projects recei�'ln, acquisition, rehabilitation and new construction funding; and WH!✓RE.�S, the Recipient is required by the Agreen?ent to require the Project Sponsor, and the Project Sponsor is required by the Project Sponsor Agreement- to cause to be executed an instrument in recordable form which obligates the Project Sponsor, its successors and assigils, to operate and maintain the supportive housing in accordance ,With the , ,recill ,the ACT, and HUD regulations as provided for in the A ZFeement: and WHEI,LAS, the Project Sponsor and the Titleholder under this Declaration mt nds. declares and cr_>>enants that the restrictive ccvI'etiant_s sei fort;l litreln sl?alt be and are cotienants Cunr ink' l,'lth the Pr_)perr%,• for the term described herein, and ai'e ??i 1�ln� upon aH sub�equ`nt o\vners of the Procer-EV for such term, aid are no: merely, personai co`°en:111ts of the Protect Sponsor and the Titlthoider; ;: FLF<JN F I.P. COI :J-eraIJ�n Ot the C,;OM'.s 317 CC'�'� 'C :i_ 1;'r2!i:C!-t_'.- i0iu; d ','alu c'le CC'P.SId'_r3[lOn. T;le rC '!rJt `r J su:IiC12�C�' i'1 ",'r11-CrI r_ L'-'1. -:1 PrOJ--- C1 sponsJr :i .�" IG11!'i'.' _. 1. Ttlt, Prc?J Cl Sporisor and flit Tidti older, thalr suc'�Lls=i1r: Gf sins. snail 0 -,ii i!i supportive hOLilnC and Trovidt sLpport!�`e e5`IC(S IiUOU'i70ui a pM U Of i'. ',en' {'(}'1 comn]encim] Irorn the date ofinitial occucancv or the provision of lrilri,d sen,iC25. Irl aCC'C;moi ii with. terns of the AL7reUment, the ACT, HUD regulations Lind all applicable fe'dgral. _tate �In local lav"s. . If, pursuant to a request from the Project Sponsor; I -IUD deter -mines that the project is no longer needed for use as supportive housing, HUD may authorize the Project Sponsor and ti]c' Titleholder, their successors or assigns, to convert the use of the project for the direct bznzni of low-income persons. Upon expiration of the period during which the Protect Sponsor is obligated to operate the Property in accordance wiih the Agretmcrit, this Declarailon shall terminate and shall no longer be eFfective. 3. The Project Sponsor and the Titleholder agree, that if the project ceases to be used as supportive housing within ten (10) years after the project is placed in service, the Project Sponsor and the Titleholder, their successors or assigns, shall be obligated to repay HUD one hundred percent (100io) of ar]v assistance received for acquisition, rehabilitation and new construction under the Agreement. If such project is used as supportive housing for more than ten (] D) )'ears, HUD shall reduce the percentage of the amount required to be repaid by ten (10) percentaze points for each vear in excess of ten (10) that the project is used as supporive housinc. 4. HUD; acting by and through a duly authorized official, may approve such action as may be necessan' to allow the transfer,conveyance, assiamient, leasinz -mrig, or encumbering of the Propertyor to accomplish the acts described above. 5. This Declaration and the covenants set forth herein regulating and restriction the use and occupant~' of the Property (i) shall- be and are covenants running ti.viih the Property, encumbering the Properry for the term of this Declaration, and binding upon the Project Sponsor's successors in title and all subsequent owners of the Property, (ii) are not merely Personal covenants of the Project Sponsor, and (iii) shall bind the Project Sponsor and its respective successors and assigns during the term of this Declaration. 6. An- and all requirements of the lows of the State to be satisfied i1] order for the provisions of this Declaration to constitute deed restrictions and covenants rulinmr, witl] the land shall be deemed to be satisfied in full; and that any requirements or privileges of estate are intended to be satisfied, or in the altemate, tl]at an equitable servitude has been created to insure that these restrictions run with the land. For the term of this Declaration, each and .e`'en contract, deed, or other instrument hereafter executed conveying the Property or portion ti]ereof shall expressly Qrovid-_ that such conveyance is subject to this Declaration, provided, however, that these cCVf11i;nts contained herein shall survive and be effective regardless of v,'hether such contracts, deed or oii74r instrument here -`ter executed con�'.'eti'in, it e P n. '� r_pert,, c,r portion thereof provides that such conveyanca is subject to the Deciaraticn. t hf lnvalldlr'' of ��-..r?'` C;;1L';t ):1i Or FIOV'S'C❑ Oi iia: D r3ily + Si1a ! IT,' 147i.'ESS PCOF site Profe t Sp(Drsc)r hes CZL'S_`'dd this .-rf_I,-itn.t !o [ I 'Zi l;'u 0li. a--i'o f rept sen iati� es, as of the day and ycar First above \,, rit PROJECT SP01'dSOR TITLE Hi',LDER Sid>naiure BY: Signature l file Title STATE OF FLORIDA } SS. COUNTY OF KIAMI-DADS I HEREBY CERTIFY thar the foregoing DECLARATION OF RES T RiCTIVE COVENANTS tivas executed and acknowledged before me or. this day by as PRESIDENT, of And by Personal), Y-ilown OR Produced !dent!ficarior7 Type of Identification Produced as PRF_SIDENT, of Personally 1�no�t'n OP, _Produced Identification Type of identification Produced before nte, a ?\rotary public duly authorized in the Srate and count',' named abovc to i.ihc acknowledgments and who O did O did nor take an oath. Wimesseth my hand and official seal in die State and Comm' above- phis 2004. ?\DTAPY PUBLIC. State of"Fiorlda lt, C"Mi nission E Pias: INC. who is: INC. who is: dav of Attachment Q-1 DECL.R4TION OF RESTRJCTI OWNS TINS DECLARATION OF RESTRICTIONS made this day of .200 by the undersigned hereinafrer referred to as the "Declarant", WHEREAS, Miami -Dade Count}', acting through and on behalf of the Miami -Dade County Homeless Trust, has applied for and received funds from the United States Government under Title IV of the Stewart B. Mc icy Homeless Assistance Act; and WIfERAS, Miami -Dade County agreed to comply with requirements of the United States Government in connection «With the receipt of such funds; and «'BRAS, pursuant to the 2 Supportive Housing Program Grant Agreement, which Miami -Dade County entered with the United States Government, acting through its U.S. Department of Housing and Urban Development (the "Grant"), Miami -Dade County is responsible for repaying the Grant ir_ accordance rvdth the provisions of 24 CFR part 593,Code of Federal Regulations; and WHERAS, Ifiarni-Dade County, in the exercise of due diligence, must take steps to ensure that the Grant -funded capital project is used for its intended purpose for a tem of at least -2 0 years from the date of initial occupancy or date of initial service; WHEREAS; Miami -Dade County requires that the subrecipient of the Grant, referred to as the Declarant herein, impose a restrictive covenant on the subject land purchased with the capital funds provided through this Grant; and Legal description: NOW THEREFORE, Declarant declares that said propert}, shall be held, transferred, encumbered, used, sold, conveyed, leased, and occupied, subject to the covenants and restrictions hereinafter set forth expressly and exclusively for the use and benefits of said property and of each and every person or entity who noW or in the future owns any portion or portions of said property, LA2ND USE — The subject Proper -t.; and any reha'b'ilitated structures or new construction thereon must be operated for the provision of supporu"'e housing and sen ices for homeless persons in accol dance with the provision of 34 CFR part 5S3, Code of Federal Reculations (as nav be amended from time to time) for a term of at lest 20 years or for suci of=^,er pu_riroses as rnav be approved by the U.S. ± �epa,-uneni of Housing and U'ro?n, Development. TER I— This covenant is to run v,ith the land and shall be binding on all paries and ail persons claiming under them for a period of rwenr (.0) years from the date the oizgi nal covenant V,'y recorded, the date of initial occupancy, or date of initial ser -.'ice Prov! si on, Whichever is later. ENFORCEMENT — Upon Declaration's, failure to comply v,2t, the requirements of this Declaration, the Declarant shall within 30 days of written notice of non-compliance and request for conveyance shall convey the subject property to Miami -Dade Count}. Enforcement shall be by proceedings at law or inequity against an), person or persons violating or attempting to violate any covenant either to restrain violation, cornpeI compliance with the provision of this declaration or recover darnaves. Such action may be brought by Adiami-Dade County, or its successor in interest. SEVER-A-BILITY — Invalidation of any of these covenants by judgement or court order shall in no wise affect the other provisions that shall remain in full force and effect_ WITNESSES: STATE OF FLORIDA ) SS. COUNTY OF MIAMI-DADE ) DECLARANT: (Marne of President) ATTEST: Secretary of the Board I HEREBY CERTIFY that the foregoing DECLARATION OF RESTR]CTIVE COVENANTS was executed and acknowledged before me on this day of as , df Personally Know -n OR Produced Idelitification Type of identification Produced ,And by , 2004 by as , of I v, -ho is: Ptrsona!j'*' Produced )derin icarion TpTe of ldentificarion Produced before me, allotary public dull authorized in the State and counnv named above to tale acknowledgments and -who ( ) did ( ) did not take an oath. Vditnesseth my hand and official seal in the State and County above, this day of ATTACHMENT R FOR GOVERNMENT ENTITIES ONLY - Semi -Annual Employee Certification for Supportive Housing Programs "This form is to be submitted to the Miami -Dade County Homeless Trust every six months. Agency: Project Number.- Project umber: Project Name: Period Covered: FL14B The following employee/s worked solely on SHP project Employee Name/Names: Name Signature Date Name Signature Date Name Signature Date Name Signature Date By signing, I hereby certify that I have worked 100% of the time on the above referenced SBP project during the period specified above. Supervisor Certification Name Title Signature Date I hereby certify as the supervisor of the above named individual/s that they have worked solely on the above referenced grant during the above referenced time period ATTACHMENT S IMIA MI- A -PE INCIDENT REPORT IDENTIFYING INFORMATION Reporting Party Phone # Date of Incident / / Time of Incident Reporting Party Name Contract Provider Name Program Name Provider Location Specific Program: (check all that apply) ❑ HT ❑ Primary Care ❑ SBP ❑ Emergency ❑ Challenge Spec/fw location/ address where incident occurred: TYPE OF INCIDENT ❑ ALTERCATION ❑ CLIENT INJ(JRY OR ILLNESS ❑ SEXUAL BATTERY ❑ PROPER -TY DAAIM GE ❑ CLIENT DEATH ❑ THEFT ❑ SUICIDE ATTEMPT ❑ OTHER INCIDENT Specify PARTICIPANT (S) / WITNESS (ES) (Please mark W or P for either Witness or Participant) LAST NAME, FIRST IDENTIFIER # CLIENT El 11 1 of 3 am/pm EMPLOYEE OTHER W / P ❑ ❑ _ ❑ ❑ n El MIAMMADE DESCRIPTION OF INCIDENT Give detailed account — who, what, where, when, why, how — add pages if necessary CORRECTIVE ACTION AND FOLLOW UP Immediate corrective action taken Is follow up action needed? ❑ yes ❑ No If yes, specify. INDIVIDUALS NOTIFIED Abase Registry 1-800-962-2873 Applicable Law Enforcement Department Indicate person contacted, if report was accepted, the date and the time, and if by telephone or if copy of report available. Incident Reports — The Subrecipient must report to Miami -Dade County Homeless Trust information related to any critical incidents occurring during the administration term of its programs. In addition to reporting this incident to the appropriate authorities the Subrecipient must within twenty-four (24) hours of any incident, submit in writing a detailed account of the incident. This incident report should be addressed to the Contract Officer or Administrative Officer assigned. This incident report should be addressed to Miami -Dade County Homeless Trust, 111 NW First Street, 27d'Floor, Suite 310, Miami, Florida 33128; telephone (305) 375-1490 and facsmilie (305) 375-2722. 2 of 3 Mi�a�a�iY Definitions of Reportable Incidents a. Altercation. A physical confrontation occurring between a client and employee or two or more clients at the time services are being rendered, or when a client is in the physical custody of the department, which results in one or more clients or employees receiving medical treatment by a licensed health care professional. b. Client Death. A person whose life terminates due to or allegedly due to an accident, act of abuse, neglect or other incident occurring while in the presence of an employee, in Homeless Trust contracted program facility. c. Client Injury or Illness. A medical condition of a client requiring medical treatment by a licensed health care professional sustained or allegedly sustained due to an accident, act of abuse, neglect or other incident occurring while in the presence of an employee, in a Homeless Trust contracted program. d. Other Incident. An unusual occurrence or circumstance initiated by something other than natural causes or out of the ordinary such as a tornado, kidnapping, riot, .or hostage situation, which jeopardizes the health, safety and welfare of clients. e. Sexual Battery. An allegation of sexual battery by a client on a client, employee on a client, or client on an employee as evidenced by medical evidence or law enforcement involvement. f. Suicide Attempt. An act which clearly reflects the physical attempt by a client to cause his or her own death while in the physical custody of the department or a departmental contracted or certified provider, which results in bodily injury requiring medical treatment by a licensed health care professional. Property Damage An incident involving damage to property procured with Homeless Trust funding. Print Name of Person Submitting Report Signature 3 of 3