Loading...
HomeMy WebLinkAboutExhibitAGREEMENT BETWEEN MIAMI-DADE COUNTY AND CITY OF MIAMI FOR A 2009 SUPPORTIVE HOUSING PROGRAM GRANT FL021IB4D000802 HOMELESS ASSISTANCE PROGRAM THIS AGREEMENT, entered this _ day of 200 , by and between Miami - Dade County (herein called the "Grantee") and City of Miami, (hereinafter referred to as the "Subrecipient") under this Agreement. WHEREAS, the Grantee has applied for and received funds from the United States Government under Title IV of the Stewart B. McKinney Homeless Assistance Act; and WHEREAS, the Grantee agrees to comply with all requirements of this Agreement and to accept responsibility for such compliance by the Subrecipient to which it makes grant funds available; and NOW, THEREFORE, it is agreed between the parties hereto that; L STATEMENT OF WORK: A. Activities The Subrecipient shall adhere to the "2009 Supportive Housing Program Grant Agreement" Attachment A, which is governed by the Supportive Housing Program rules, 24 CFR Part 583. The Subrecipient shall carry out the activities specified in the "Scope of Services" Attachment A-1, "Housing Type, Number of Units, Bedrooms, Beds, and Participants", Attachment A-2, achieve "Performance Measures/Goals" as stipulated in Attachment A-3, and "Project Milestones", Attachment A-4 as applicable. The Subrecipient shall also adhere to minimum standards of housing and services as set forth in the "Standards of Care", incorporated herein by reference. B. Time Schedule 1. The Grantee and the Subrecipient agree that this Agreement shall become effective on June 1, 2010. 2. This Agreement shall expire May 31, 2011, one (1) year from the effective date. Any cost incurred by the Subrecipient beyond this date will not be paid by the Grantee, except as specifically provided herein. Notwithstanding any provision herein to the contrary, certain requirements imposed on the Subrecipient by this Agreement and Federal regulation may continue for a term of at least twenty (20) years, as provided in this Agreement. 3. The requirements of this Agreement shall remain in effect during any time period that the Subrecipient has control over any funds generated or provided in connection with this Agreement, including program income. GRANT NUMBER: FL0211B4D000802 City of Miami — Homeless Assistance Program / Page 2 of 23 C. Budget The Grantee agrees, subject to the availability of funds and payment of funds to the Grantee by the United States Department of Housing and Urban Development, to pay for contracted activities according to the terms and conditions contained within this Agreement, the Subrecipient's application for the Supportive Housing Program, and the Subrecipient's Technical Submission incorporated herein as Attachment B, the Budget, in an amount not to exceed $239,116.00 for Supportive Services, and $11,955.00 for administration (minus 2.5% administrative costs to be retained by the Grantee), for a total budget of $251,071.00. If applicable, in accordance with Federal Regulations, provider shall be reimbursed for capital funding on an incremental basis, based on the following completion benchmarks: 30%, 30%, 30%, and 10% to be provided when a final Certificate of Occupancy is obtained from the developer. All other activities shall be paid on a reimbursement basis following the submission of a monthly invoice along with the appropriate support documentation. In accordance with federal requirements, the Subrecipient agrees to provide match funds in an amount that represents no less than twenty perent (20%) of the total supportive services budget, or twenty-five percent (25%) of the SHP supportive services funding, and no less than twenty-five percent (25%) of the total operations budget. The budget figures above represent the original line item totals as delineated in the grant agreement. Submitted budgets that shift funds by less than 10% of the original line item totals of the grant agreement may become official only if the appropriate match is provided, the administration total is not increased and Miami -Dade County Homeless Trust approves the shift of funds. As such, the figures in the Technical Submission Attachment B may not match the contracted figures delineated in the original contract and grant agreement. Notwithstanding the above, changes of more than 10% in any line item total as delineated in the grant agreement shall require a formal budget approval and an amendment to the grant agreement. The Subrecipient shall provide supportive outreach services to 3,000 homeless persons (individuals and families). Of the 3,000 homeless persons there shall be at least 2,850 assessments and at least 1,500 placements of homeless persons. This shall occur primarily in the City of Miami and outreach, assessments and placements within Miami -Dade County. Additionally, of the 3000 homeless persons, the Subrecipient shall place at least 180 homeless persons into transitional treatment supportive housing. The project's main office is located at 1490 NW 3rd Avenue, Miami, Florida. [1_� 49 00) 451-10100m]"ffn 210120 A. Financial Mana ement The Grantee and the Subrecipient shall adhere to the requirements for financial reporting as stated in 24 CFR Part 85.41. 2. Requests for payments, along with documentation for each line item, i.e. invoice for services/housing, capital invoice (if applicable), lease agreement, payroll reports, shall be submitted to the Grantee by the thirtieth (30th) of the month and shall be signed by the GRANT NUMBER: FL0211B4D000802 City of Miami — Homeless Assistance Program / Page 3 of 23 Executive Director and or the Financial Officer of the Subrecipient, in the form incorporated herein as Attachments C and C-1. Reimbursement shall be provided only for costs associated with the services detailed in the budget, plus general administrative costs (not to exceed 2. 5% of direct costs). Any reimbursement may be withheld pending the receipt and approval by the Grantee of all reports and documents required herein, including but not limited to the submission of the Annual Progress Report. In no event shall the Grantee's funds be advanced to anv subcontractor hereunder. The parties agree that the Subrecipient may request the revision of the schedule of payments or the line item budget. However, such revisions shall be subject to review and approval by the Grantee. Such requests shall only be considered at least ninety (90) days prior to the expiration of the grant, if there is a shift of 10% or more of funds between line items of any activity, supportive services, operations, or leasing or there is a significant change to the program. Requests for minor modifications (for example less than 10% shift of funds between line items) must be submited at least forty-five (45) days prior to the expiration of the grant. Failure to submit the appropriate supporting documentation in a timely manner may result in the Grantee's inability to amend the budget. A final request for reimbursement from the Subrecipient will be accepted by the Grantee up to thirty (30) days after the expiration of this Agreement. If the Subrecipient fails to comply, all rights to payments will be forfeited if the Grantee so chooses. Within thirty (30) days of the termination or expiration of this Agreement, a final report of expenditures shall be submitted to the Grantee. If after the receipt of such final report, the Grantee determines that the Subrecipient has been paid funds not in compliance with the Agreement, and to which it is not entitled, the Subrecipient will be required to return such funds to the Grantee or submit documentation demonstrating that the expenditure was in compliance with this Agreement. The Grantee shall have the sole and absolute discretion to determine if the Subrecipient is entitled to such funds and the Grantee's decision in this matter shall be final and binding. B. Records and Access to Records Agreement Records are defined as any and all books, records, client files (including client progress reports, referral forms, etc.), documents, information, data, papers, letters, materials, electronic storage data and media whether written, printed electronic or electrical, however collected or preserved which is or was produced, developed, maintained, completed, received, or compiled by or at the direction of the Subrecipient or any subcontractor directly or indirectly related to the duties and obligations required by terms of this contract, including but not limited to financial books and records, ledgers, drawings, maps, pamphlets, designs, electronic tapes, computer drives and diskettes or surveys. 2. The Subrecipient must maintain Agreement Records that document all actions to comply with this Agreement, including those on race, ethnicity, gender, and disability status GRANT NUMBER: FL0211134D000802 City of Miami — Homeless Assistance Program / Page 4 of 23 data; and those in accordance with generally accepted accounting principles, procedures, and practices as required in Circular OMB -122 which shall sufficiently and properly reflect all revenues and expenditures of funds provided directly or indirectly by the Grantee pursuant to the terms of this Agreement which shall include but not be limited to a cash receipt journal, cash disbursement journal, general ledger, and all such subsidiary ledgers as may be reasonably necessary. 3. The Subrecipient shall provide to the Grantee, upon request by the Grantee, all Agreement Records. The requested Agreement Records shall become the property of the Grantee without restriction, reservation, or limitation of their use and shall be made available by the Subrecipient at any time upon request by the Grantee. The Grantee shall have unlimited rights to all books, articles, or other copyrightable materials developed in the performance of this Agreement. These unlimited rights include the rights of royalty - free, nonexclusive, and irrevocable license to reproduce, publish, or otherwise use, and to authorize others to use the work for public purposes. 4. The Subrecipient shall ensure that the Agreement Records shall at all times be subject to and available for full access and review, inspection, or audit by Grantee and Federal personnel and any other persons so authorized by the Grantee. 5. The Subrecipient shall include in all the Grantee -approved subcontracts used to engage subcontractors to carry out any eligible substantive programmatic services, as such services are described in this Agreement and defined by the Grantee, each of the record- keeping and audit requirements detailed in this Agreement. The Grantee shall, in its sole and absolute discretion, determine when services are eligible substantive programmatic services and subject to the audit and record-keeping requirements described in this Agreement. These records shall be maintained as pursuant to this Agreement. 6. If the Subrecipient received funds from or is under regulatory control of other governmental agencies, and those agencies issue monitoring reports, regulatory examinations, or other similar reports, then the Subrecipient shall provide to the Grantee a copy of each report and any follow-up communications and reports immediately upon such issuance unless such a disclosure is a violation of those agencies' rules. C. Reports The Subrecipient shall submit to the Grantee the reports described below or any other document in whatever form, manner, or frequency as may be requested by the Grantee. These will be used for monitoring the provider's progress, performance, and compliance with applicable Grantee and Federal requirements. 1. Progress Reports — Subrecipient shall submit a HMM generated, "Monthly Progress Report (MPR)," Attachment D, along with the following monthly reports using the forms attached hereto as "Client Contribution Report" Attachment F, as they may be revised by the Grantee, which shall describe the progress made by the Subrecipient in achieving each of the objectives identified in Attachment A-3. The reports shall explain the Subrecipient's progress including comparisons of actual versus piaimed progress forthe,pe iod. Thr reports are due by the thirtieth (30`h) day of GRANT NUMBER: FL0211B4D000802 City of Miami — Homeless Assistance Program / Page 5 of 23 the following month, along with the request for reimbursement, following the close of the prior month. 2. Annual Progress Report - The Subrecipient shall submit a HMIS generated Annual Progress Report in addition to a complete and accurate report using the United States Department of Housing and Urban Development (HUD) form HUD -40118, "Annual Progress Report (APR) for Competitive Homeless Assistance Programs" (Refer to Attachment G and G -1). The complete and accurate APR is due to the Grantee six days after the end of each operating year. 3. "Program Rating and Satisfaction Survey" Attachment E shall be collected and retained monthly by the Subrecipient in a separate file and available for review and monitoring, or as requested by the Grantee. 4. Audit Reports - The Subrecipient shall provide two (2) copies of an annual certified public accountant's opinion and related financial statements on the organization to the Grantee no later than one -hundred and eighty (180) calendar days following the end of the Subrecipient's fiscal year, for each year during which this Agreement remains in force or until all funds earned from this Agreement have been so audited, whichever is later, provided that the Subrecipient has such an opinion prepared. 5. Annual Assurance Report - The Subrecipient who receives assistance only for leasing, operating costs, or supportive services costs must provide an annual assurance report for each year the assistance is received that the project will be operated for the purpose specified in the application. 6. Employee Certification Form — Government Entities ONLY - The Subrecipient is required to submit semi-annually certifications for those employees working solely on a particular Supportive Housing Program (SHP) grant. The certification must be signed by the employee and the supervisor and conform to OMB Circular A-87 Attachment B (h) (3). "Employee Certification form" Attachment R, must be submitted in January and July of each year with the reimbursement request. 7. 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, form "Incident Report" Attachment S. 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, 27th Floor, Suite 310, Miami, Florida 33128; telephone (305) 375-1490 and facsmilie (305) 375-2722. 8. Disaster Plan — The Subrecipient shall submit an Agency Disaster Plan by April 1St of each Contract year. D. Staff Responsibility The staff members for this grant are listed in the "Budget" document Attachment B. GRANT NUMBER: FL0211 B413000802 City of Miami — Homeless Assistance Program / Page 6 of 23 E. Special Conditions The Subrecipient shall follow the client referral process as listed in the "Scope of Services," Attachment A-1. The Subrecipient shall provide any documentation, such as the "W-9 form" Attachment H to facilitate the reimbursement of services. F. General Conditions The Subrecipient shall comply with all Federal laws, and regulations, as specified in the Applicant Certifications Attachment I, the Renewal Grant Agreement and the accompanying 24 CFR Part 583, Supportive Housing Program regulations Attachment A, and all other Federal requirements of this grant. The responsibility for knowledge of and compliance with all Federal requirements is that of the Subrecipient. The Subrecipient shall abide and be governed by the requirements of the Americans with Disabilities Act (ADA). In addition, the Subrecipient agrees to comply with the following requirements. 1. Insurance Government Entities — If the Subrecipient is the State of Florida or an agency or political subdivision of the State as defined by Section 76828, Florida Statutes, the Subrecipient shall furnish the County, upon request, written verification of liability protection in accordance with Section 768.28, Florida Statutes. Nothing herein shall be construed to extend any party's liability beyond that provided in Section 768.28, Florida Statutes. The Subrecipient shall maintain required liability insurance coverage as noted below at all times during this contract period: Public Liability Insurance on a comprehensive basis in an amount not less than $300,000 combined single limit for bodily injury and property damage. The Grantee must be shown as an additional insured with respect to this coverage, as evidenced by a certificate of insurance. Automobile Liability Insurance covering all owned, non -owned and hired vehicles used in connection with this contract in an amount not less than $300,000 combined single limit for bodily injury and property damage. Workman's Compensation Insurance for all employees of the Subrecipient as required i'y >Fi.Stniizte 44(1. Flood Imsnrmrr *all 'be -maintained as per the requirements in 24 CFR Part 583.330(a). GRANT NUMBER: FL0211B4D000802 City of Miami — Homeless Assistance Program / Page 7 of 23 The insurance coverage required shall include these classifications, listed in standard liability insurance manuals, which most nearly reflect the operations of the Subrecipient. All insurance policies required above shall be issued by companies authorized to do business under the laws of the State of Florida, with the following qualifications: The company must be rated no less than "B" as to management, and no less than "Class V" as to financial strength by the latest edition of Best's Insurance Guide, published by A. M. Best Company, Oldwick, New Jersey, or its equivalent, subject to the approval of the County Risk Management Division. or Compliance with the foregoing requirements shall not relieve the Subrecipient of its liability and obligations under this section or under any other section of this Agreement. No modification or waiver of any of the aforementioned insurance requirements shall be made without thirty (30) days written advance notice to the Grantee, and is subject to the approval of the Grantee's Risk Management Division. 2. Indemnification Pursuant to the provisions of Section 768.28, F.S. (2008), the Subrecipient shall indemnify and hold harmless the Grantee and its past, present, and future employees and agents from and against any and all claims, liabilities, losses, and causes of action which may arise out of the actions or negligence, in whole or in part, of the Subrecipient, its officers, agents, employees, or assignees in the direct or indirect fulfillment of this Agreement. The contractor shall pay all claims and losses of any nature in connection therewith, and shall defend all suits, in the name of the Grantee when applicable, and shall pay all costs and judgments which may issue thereon. It is expressly understood and intended that the Subrecipient is an independent contractor and is not an agent of the Grantee. The Subrecipient shall disclose to the Grantee in writing any possible or actual conflicts of interest or apparent improprieties of the kind addressed herein. The Subrecipient shall make each disclosure in writing to the Grantee immediately upon the Subrecipient's discovery of such possible conflict. The Grantee will then render an opinion which shall be binding on all parties. 3. Affidavits Complete and notarize, Miami -Dade County Required Affidavits Attachment J, Lobbyist Registration for Oral Presentation Attachment K and Florida Statutes, on Public Entity Crimes Attachment O, acknowledging compliance with the following Miami -Dade County Affidavits: a. Disability Nondiscximination Affidavit Attachment J, Section VII. b. family Leave Pian Affidavit Attachment J, Section VI. GRANT NUMBER: FL0211 134D000802 City of Miami — Homeless Assistance Program / Page 8 of 23 C. Drug-free Workplace Affidavit — Ordinance No. 92-15 Attachment J, Section V. d. Miami -Dade County Disclosure Affidavit Attachment J, Section I. e. Miami -Dade County Employment Disclosure Affidavit Attachment J, Section II. f. All Subrecipients are advised that in accordance with Section 2-11.1 (s) of the Code of Miami -Dade County, the Lobbyists Registration for Oral Presentation Affidavit, Attachment K, MUST be completed, notarized, and included with the Agreement. Lobbyist specifically includes the principal, as well as any agent, officer, or employee of a principal, regardless of whether such lobbying activities fall within the normal scope of employment of such agent, officer or employee. g. Miami -Dade County Criminal Record Affidavit Attachment J, Section IV. h. Delinquent and Currently Due Fees or Taxes - The Subrecipient has duly executed the Affidavit regarding "Delinquent and Currently Due Fees or Taxes" as required by Section 2-8.1(c) of the County Code and that affidavit is attached hereto as Attachment J, Section VIII. The Subrecipient understands that the County has relied on the aforementioned representation in entering this contract. Affirmative Action/Nondiscrimination of Employment; Promotion and Procurement Practices (County Ordinance 98-30) Attachment J, Section M. J. Project Fresh Start (Resolutions R-702-98 and 358-99) Attachment J, Section X. G. Civil Rights The Subrecipient agrees to abide by Chapter 11A of the Code of Miami -Dade County ("County Code"), as amended, which prohibits discrimination in employment, housing and public accommodations. Where applicable the Subrecipient agrees to abide and be governed by Title VI and VII, Civil Rights Act of 1964 (42 USC 2000 D&E) and Title VIII of the Civil Rights Act of 1968, as amended, and Executive Order 11063 which provides in part that there will be no discrimination of race, color, sex, religious background, ancestry or national origin in performance of this Agreement, in regard to persons served, or in regard to employees or applicants for employment or housing. It is expressly understood that upon receipt of evidence of such discrimination, the County shall have the right to terminate said Agreement. It is further understood that the Subrecipient must submit an affidavit attesting that it is not in violation of the American with Disabilities Act, the Rehabilitation Act, the Federal Transit Act, 49 USC § 1612, and the Fair Housing Act, 42 USC § 3601 et seq. If the Subrecipient or any owner, subsidiary , or other firm affiliated with or related to the Subrecipient, is found by the responsible enforcement agency, the Courts or the County to be in violation of these Acts, the County will conduct no further business with the Subrecipient. Any contract entered into based upon a false affidavit shall be voidable by the County. If the Subrecipient violates any of the Acts during the term of any Contract the Subrecipient has with the County, such Contract shall .be -voidable by rhe County, even if the Subrecipient was not in violation at the time it submitted its affidavit. GRANT NUMBER: FL0211B4D000802 City of Miami — Homeless Assistance Program / Page 9 of 23 The Subrecipient agrees that it is in compliance with the Domestice Violence Leave, codified as § 11-A60 et. Seq. of the Miami -Dade County Code, which requires an employer, who in the regular course of business has fifty (50) or more employees working in Miami -Dade County for each working day during each of twenty (20) or more calendar work weeks to provide domestic violence leave to its employees. Failure to comply with this local law may be grounds for voiding or terminating this Contract or for commencement of debarment proceedings against the Subrecipient. The Subrecipient also agrees to abide and be governed by the Age Discrimination Act of 1975, as amended, which provides in part that there shall be no discrimination against persons in any area of employment because of age. The Subrecipient agrees to abide and be goverened by Section 504 of the Rehabilitation Act of 1973, as amended, 29 USC 794, which prohibits discrimination on the basis of handicap. The Subrecipient agrees to abide and be governed by the requirements of the Americans with Disabilities Act (ADA). III. SUSPENSION AND TERMINATION A_ Suspension The Grantee may, for reasonable cause, temporarily suspend the Subrecipient's operations and authority to obligate funds under this Agreement or withhold payments to the Subrecipient pending necessary corrective action by the Subrecipient or both. Reasonable cause shall be determined by the Grantee and in its sole and absolute discretion and may include: Ineffective or improper use of any funds provided hereunder by the Subrecipient; 2. Failure by the Subrecipient to materially comply with any terms, conditions, representations or warranties contained herein; 3. Failure by the Subrecipient to submit any documents required by this Agreement; or 4. The Subrecipient's submittal of incorrect or incomplete documents. B. Termination 1. Termination at Will - This Agreement, in whole or in part, may be terminated by the Grantee upon no less than fifteen (15) working days notice when the Grantee determines that it would be in the best interest of the Grantee and/or the recipient materially fails to comply with the terms and conditions of an award. Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of rlelivvry. The Subrecipient will have five (5) days from the day the notice is delivered to state why it is not in the best interest of the Grantee to terminate the Agreement. However, it is up to the discretion of the Grantee to make the final determination as to what is in its best interest. GRANT NUMBER: FL0211B4D000802 City of Miami — Homeless Assistance Program / Page 10 of 23 2. Termination for Convenience - The Grantee or subrecipient may terminate this Agreement, in whole or part, when both parties agree that the continuation of the activities would not produce beneficial results commensurate with the further expenditure of funds. Both parties shall agree upon the termination conditions, including the effective date and in the case of partial termination, the portion to be terminated. However, if the grantee determines in the case of partial termination that the reduced or modified portion of the grant will not accomplish the purposes for which the grant was made it may terminate the grant in its entirety. 3. Termination Because of a Lack of Funds - In the event funds to finance this Agreement become unavailable, the Grantee may terminate this Agreement upon no less than twenty-four (24) hours notice in writing to the Subrecipient. Said notice shall be sent by certified mail, return receipt requested, or in person with proof of delivery. The Grantee shall be the final authority to determine whether or not funds are available. 4. Termination for Breach - The County may terminate this Agreement, in whole, or in part, when the County determines in its sole and absolute discretion that the Provider is not making sufficient progress in its performance of this Agreement as outlined in Attachment A, Scope of Services, or is not materially complying with any term or provision provided herein, including the following: 1) The Provider ineffectively or improperly uses the County funds allocated under this Contract; 2) the Provider does not furnish the Certificates of Insurance required by this contract or as determined by the County's Risk Management Division; 3) the Provider does not furnish proof of licensure/certification or proof of background screening required by this Contract; 4) the Provider fails to submit or submits incomplete or incorrect detailed reports of expenditures or final expenditure reports; 5) the Provider does not submit or submits incomplete or incorrect required reports; 6) the provider refuses to allow the County access to records or refuses to allow the County to monitor, evaluate and review the Provider's program; 7) the Provider discriminates under any of the laws outlined in Section H(G) of this Contract; 8) the Provider fails to provide Domestic Violence Leave to its employees pursuant to local law, 9) the Provider falsifies or violates the provisions of the Drug Free Workplace Affidavit; 10) the Provider attempts to meet its obligations under this contract through fraud, misrepresentation or material misstatement; 11) the Provider fails to correct deficiencies found during a monitoring, evaluation or review within the specified time; 12) the Provider fails to meet the terms and conditions of any obligation under any contract or otherwise or any repayment schedule to the County or any of its agencies or instrumentalities; 13) fails to meet any of the terms and conditions of the Miami -Dade County Affidavits; 14) the Provider fails to fulfill in a timely and proper manner any and all of its obligations, covenants, agreements and stipulations in this Contact. The Provider shall be given written notice of the claimed breach and 10 business days to cure same. Unless the Provider's breach is waived by the County in writing, or unless the Provider shall have failed after receiving written notice of the claimed breach by the County to take steps to cure the breach within 10 business days after receipt of the breach, the County may, by written notice to the Provider, terminate this Agreement GRANT NUMBER: FL0211 B4D000802 City of Miami — Homeless Assistance Program / Page 11 of 23 upon no less than twenty-four (24) hours notice. Said notice shall be sent by certified mail, return receipt requested, or in person with proof of delivery. Waiver of breach of any provision of this Agreement shall not be construed to be a modification of the terms of this Agreement. The provisions contained herein do not limit the County's right to legal or equitable remedies or any other provision for termination under this contract. Such individual or entity shall be responsible for all direct and indirect costs associated with such termination or cancellation, including attorney's fees. Any individual or entity who attempts to meet its contractual obligations with the County through fraud, misrepresentation or material misstatement ma be disbarred from County contracting for up to five (5) years. N. REVERSION OF ASSETS A. Term of Commitment If the Subrecipient receives assistance for acquisition, rehabilitation, or new construction, then the Subrecipient shall agree to operate the supportive housing or provide supportive services in accordance with this Agreement for a term of at least 20 years from the date of initial occupancy or date of initial service provision. If the United States Department of Housing and Urban Development (HUD) determines a project is no longer needed for use as supportive housing or to provide supportive services, then HUD may provide authorization to the Grantee on behalf of the Subrecipient to convert the project to a project for the direct benefit of low-income persons pursuant to a request for such use by the Grantee on behalf of the Subrecipient operating the project (24 CFR 583.305 (a)). B. Repayment of Grant If the Subrecipient does not provide supportive housing or supportive services for 10 years following the date of initial occupancy or date of initial service provision pursuant to this Agreement, then the Grantee shall require repayment of the entire amount of the grant used for acquisition, rehabilitation, or new construction, unless conversion of the project has been authorized pursuant to the terms in the Term of Commitment Section, N -A of this document (24 CFR 583.305 (b)). If the supportive housing is used for such purposes as stated in Section N -A for more than 10 years, then the Subrecipient's repayment amount will be reduced by 10 percentage points for each year beyond the 10 -year period in which the project is used for supportive housing (24 CFR 583.305 (b)). C. Prevention of Undue Benefits Upon the sale or other disposition of a project assisted with acquisition, rehabilitation, or new construction funds occurring before the expiration of the 20 -year period, the Subrecipient must comply with such terms and conditions as HUD and the Grantee may prescribe to prevent the Subrecipient from unduly benefiting from such sale or disposition. The Subrecipient shall return to the Grantee, upon the expiration or termination of this Agreement, any funds on 'hand, any accounts receivable attributable to these funds, and any GRANT NUMBER: FL0211B4D000802 City of Miami — Homeless Assistance Program / Page 12 of 23 overpayment due to unearned funds or costs disallowed pursuant to the terms of this Agreement that were disbursed to the Subrecipient by the Grantee. D. Revocation of License or Permit Notwithstanding any provision of this Agreement to the contrary, revocation of any necessary license, permit, or approval by a governmental authority may result in immediate termination of this Agreement upon no less than twenty-four hours notice. Said notice shall be certified by mail or hand delivery. E. Declaration of Restrictive Covenants and Declaration of Restrictions If not previously recorded, the Subrecipient and the Titleholder shall sign and record as set forth in Attachment Q and Attachment Q-1, at the time of contract execution, and incorporated here by reference, the "Declaration of Restrictive Covenants," and the "Declaration of Restrictions." The Declaration of Restrictive Covenants is a federal requirement and the Declaration of Restrictions is a local Requirement on properties that are acquired, rehabilitated or built with Supportive Housing Program funds. These convenants restrict the use of properties located at N/A , such that the properties must be operated for the provision of supportive housing and services for homeless persons in accordance with the provisions of 24 CFR Part 583, Code of Federal Regulations for a term of at least 20 years or for such other purposes as may be approved by the Grantor. The Subrecipient agrees to inform any lender or grantor which has loaned or granted funds for the purchase of such properties of structures thereupon and request their consent to the recordation of and subordination to the Declaration of Restrictive Covenants and the Declaration of Restrictions. Such consent shall be in a form acceptable to the Grantee. V. UNIFORM ADMINISTRATIVE REQUIREMENTS A. Accounting Standards, Cost Principles, and Regulations The Subrecipient shall comply with Federal accounting standards and cost principles according to OMB Circular A-122 and SIP Regulations (24 CFR 583.135). 2. The Subrecipient shall comply with applicable provisions of applicable Federal, State, and County laws, regulations, and rules such as OMB Circular A-110, OMB Circular A- 21, and OMB Circular A-133 and with the Energy Policy and Conservation Act (Public Law 94-163) which requires mandatory standards and policies relating to energy efficiency. If any provision of this contract conflicts with any applicable law or regulation, only the conflicting provision shall be deemed by the parties hereto to be modified to be consistent with the law or regulation or to be deleted if modification is impossible. However, the obligations under this contract, as modified, shall continue and all provisions of this contract shall remain in full force and effect. 3. If the amount payable to the Subrecipient pursuant to the terms of this contract is in -excess of $11NMN, the'Su+recipier t shall comply with all applicable standards, orders, or regulations issued pursuant to Section 306 of the Clean Air Act of 1970 (42 U.S.C. In 1857 (h)), as amended; the Federal amended; Section 508of the Cie Protection Agency regulations Environmental Review Procedures 583.230). Retention of Records C GRANT NUMBER: FL021 l B413000802 City of Miami — Homeless Assistance Program / Page 13 of 23 Water Pollution Control Act (33 U.S.C. 1251), as an Neater Act (33 U.S.C. 1368); Environmental 40 CFR Part 15); Executive Order 11738, and and Regulations (24 CFR Part 58 and 24 CFR Part 1. The Subrecipient shall retain records pertinent to expenditures and all Agreement Records for a period of at least three (3) years (hereinafter referred to as "Retention Period.") For all non -Grantee assisted activities the Retention Period shall begin upon the expiration or termination of this Agreement. 2. If the Grantee or the Subrecipient has received or been given notice of any kind indicating any threatened litigation, claim or audit arising out of the services provided pursuant to the terms of this Agreement, the Retention Period shall be extended until such time as the threatened or pending litigation, claim or audit is, in the sole and absolute discretion of the Grantee, fully, completely and finally resolved. 3. The Subrecipient shall allow the Grantee or any persons authorized by the Grantee full access to and the right to examine any of the Agreement Records during the required Retention Period. 4. The Subrecipient shall notify the Grantee in writing both during the pendency of this Agreement and after its expiration as part of the final close-out procedure, of the address where all the Agreement Records will be retained. The Subrecipient shall obtain the prior written approval of the Grantee for the disposal of any Agreement Records before disposing of such Records within one year after expiration of the Retention Period. Additional Requirements The Subrecipient must comply with the following additional requirements. Client Rules and Regulations - The Subrecipient shall submit a copy of the Client Rules and Regulations that apply to clients referred to the Subrecipient pursuant to this Agreement; due within thirty (30) days following the execution of this Agreement. Personnel Policies and Administrative Procedure Manuals - The Subrecipient shall submit detailed documents describing the Subrecipient's internal corporate or organizational structure, property management and procurement policies and procedures, personnel management, accounting policies and procedures, etc. The information shall be available to the Grantee upon a request. 3. Monitoring - The Subrecipient shall permit the Grantee and any other persons authorized by the Grantee to monitor, according to applicable regulations, all Agreement Records, facilities, goods and activities of the Subrecipient which are in any way connected to the activities undertaken pursuant to the terms of this Agreement, and/or to interview any clients, employees, subcontractors, or assignees of the Subrecipient. The GRANT NUMBER: FL0211B4D000802 City of Miami — Homeless Assistance Program / Page 14 of 23 Grantee shall monitor both fiscal and programmatic compliance with all terns and conditions of this Agreement to include a review of beneficiaries, supportive services, operating costs, program progress, documentation for required match, record keeping, compliance with circulars, administrative costs, technical assistance visits, and environmental review. The Subrecipient shall permit the Grantee to conduct site visits, client assessment surveys, and other techniques deemed reasonably necessary to fulfill the monitoring function. A report of the Grantee's findings may be delivered to the Subrecipient, and if so delivered, the Subrecipient shall rectify all deficiencies cited within the period of time specified in the report. 4. Restrictions of Funds Use - The funds received under this Agreement (or any State or local government funds used to supplement this Agreement) may not be used to replace state or local funds previously used, or designated for use to assist homeless persons (24 CFR Part 583.150 (a)). The Subrecipient shall notify the Grantee of any additional funding received for any activity described in this Agreement, other than the "Client Contribution Report," Attachment F which is addressed in II -C(1). Such notification shall be in writing and received by the Grantee within thirty (30) days of the Subrecipient's notification by the funding source. 5. Related Parties - The Subrecipient shall report to the Grantee the name, purpose, and any other relevant information in connection with any transaction conducted between the Subrecipient and a related party transaction. A related party includes, but is not limited to, a for-profit or nonprofit subsidiary or affiliate organization, and organization with overlapping boards of directors or any organization for which the Subrecipient is responsible for appointing members. The Subrecipient shall report this information to the Grantee upon forming the relationship or if already formed, shall report it immediately. Any supplemental information shall be reported in the Grantee required Agency Narrative and Progress Report which are addressed in lI-C (1). 6. Required Meeting Attendance — From time to time, the Miami -Dade County Homeless Trust may schedule meetings and/or training sessions to assist the Subrecipient in the performance of its contractual obligations or to inform the Subrecipient of new and/or revised policies and procedures. Attendance at some of these meetings may be mandatory. The Subrecipient shall receive notice no less than three (3) business days prior to any meeting or training session that requires mandatory participation. A record of attendance at meetings or training sessions where notice was given indicating the Subrecipient's mandatory participation shall be kept, and the Subrecipient's contractual compliance will be monitored. Failure to attend a meeting/training sesion for which a mandatory notice has been provided can result in material non-compliance of the contract/agreement, up to and including breach or default. Proof of notice shall consist of fax record, certified mail, and/or verbal communication with the contract/agreement contact person or other program administrative staff. The Provider may select one or more employees+from their agency, directly involved in the contracted program, as their representative at the meeting/training session; the participation of the Agreement contact person is preferred. The Subrecipient may request to be excused from a mandatory meeting. That request must be received at least twenty-four (24) hours prior to the GRANT NUMBER: FL0211B4D000802 City of Miami — Homeless Assistance Program / Page 15 of 23 meeting date and time, and justification provided, including why the agency could not send any representative. The Miami -Dade County Homeless Trust shall determine whether or not the absence will be excused, the Subrecipient shall not be excused from more than two (2) meetings/training sessions during each contract year. The Subrecipieint is encouraged to attend all meetings of the Miami -Dade County Homeless Trust and/or its Committees, as information relevant to their program or services may be discussed. Publicity and Advertisements - The Subrecipient shall ensure that all publicity and advertisements prepared and released by the Subrecipient, such as pamphlets and news releases already or indirectly related to activities funded pursuant to this Agreement; and all events carried out to publicize the accomplishments of any activity funded pursuant to this Agreement, recognize the Grantee as its funding source. The Subrecipient shall ensure that all media representatives, when inquiring about the activities funded pursuant to this Agreement, are informed that the Grantee is the funding source. Procurement - The Subrecipient shall make a positive effort to procure supplies, equipment, construction or services necessary or related to carrying out the terms of this Agreement from minority and women's businesses, and to provide these sources maximum feasible opportunity to compete for subcontracts to be performed pursuant to this Agreement. In conformance with Section 3 of the Housing and Urban Development (HUD) Act of 1968 Attachment N , as amended, 12 U.S.C. 170lu (Section 3), work performed under this contract are subject to requirements of this section. The purpose of Section 3 is to ensure that 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 and to businesses that are substantially owned or substantially employ low and very low income persons. 9. Property — This section applies to equipment with an acquisition cost of $5,000 or more per unit and all real property. a. Any real property under the Subrecipient's control that was acquired/improved in whole or in part with funds from the Homeless Trust and any equipment purchased for $5,000 or more shall be disposed of, at the expiration or termination of this contract, in accordance with instruction from the Homeless Trust. Real Property is defined as land, including land improvements, structures, appurtenances thereto, including movable machinery and equipment. Equipment means tangible, nonexpendable, personal property having a useful life of more than one year and an acquisition cost of $5,000 or more per unit. b. All equipment with an acquisition cost of $5,000 or more per units and all real property purclased in whole or in part with funds from this and previous contracts with the Homeless Trust, or transferred to the Subrecipient after being purchased in whole or in part with funds from the Homeless Trust shall be listed in the property records of the Subrecipient and shall include a legal description, size, GRANT NUMBER: FL0211B4D000802 City of Miami — Homeless Assistance Program / Page 16 of 23 date of acquisition, value at time of purchase, owner's name if different from the Subrecipient, information on the transfer or disposition of the property, and map indicating whether property is in parcels, lots or blocks and showing adjacent streets and roads. Notwithstanding documentation required for reimbursement purposes, a copy of the purchase receipt for any asset described above purchased with Homeless Trust funds must also be included in the Subrecipient's monthly reimbursement package submitted to the Homeless Trust in the month in which the item was purchased along with the "Provider Asset Inventory" Attachment P. C. All equipment with an acquition cost of $5,000 or more per unit and all real property shall be inventoried annually by the Subrecipient and an inventory report shall be submitted to the Homeless Trust. This report shall include the elements listed in the paragraph listed above. 10. Management Evaluation and Performance Review - The Grantee may conduct a formal management evaluation and performance review of the Subrecipient following the expiration of this Agreement. The management evaluation will reflect the Subrecipient's compliance with generally accepted fiscal and organizational standards and practices. The performance review will reflect the quality of service provided and the value received using monitoring data such as progress reports, site visits, and client surveys. 11. Subcontracts and Assignments a. The Subrecipient shall ensure that all subcontracts and assignments: (1) Identify the full, correct and legal name of the parry; (2) Describe the activities to be performed; (3) Present a complete and accurate breakdown of its price component; (4) Incorporate a provision requiring compliance with all applicable regulatory and other requirements of this Agreement with any conditions of approval that the Grantee deems necessary. This applies only to subcontracts and assignments in which parties are engaged to carry out any eligible substantive programmatic service as set forth in this Agreement. The Grantee shall in its sole and absolute discretion determine when services are eligible substantive programmatic services subject to the audit and record-keeping requirements described above, and; b. In accordance with Ordinance No. 97-104, all bidders and respondents on County contracts for purchase of supplies, materials or services, including professional services, which involve the expenditure of $100,000 or more and all bidders or respondents on County or Public Health Trust construction contracts which involve the expenditure of $100,000 or more shall include, as part of their bid or pwposal submission, a listing of Provider's Disclosure of Subcontractors and Suppliers Attachment L which identifies all first tier subcontractors who will perforin any }part of the contract work and describes the portion of the work such subcontractor will perform, and all contract work direct to the bidder or respondent GRANT NUMBER: FL0211 B4D000802 City of Miami — Homeless Assistance Program / Page 17 of 23 and describes the materials to be so supplied. Failure to include such listing with the bid or proposal shall render the bid or proposal non-responsive. Ordinance 97-104 applies to all contracts whether competitively bid by the County or not. Those contracts that have received authorization by the Board of County Commissioners to waive formal bidding procedures must also provide a listing of all first tier subcontractors and direct suppliers. Subcontractor/Supplier Listing, SUB Form 100 Attachment M may be utilized to provide the information required by this paragraph. A bidder or respondent who is awarded the contract shall not change or substitute first tier subcontractors or direct suppliers or the portions of the contract work to be performed or materials to be supplied from those identified in the listing submitted with the bid or proposal except upon written approval of the County. C. The Subrecipient shall incorporate in all consultant subcontracts this additional provision: The Subrecipient is not responsible for any insurance or other fringe benefits for the consultant or its employees, e.g., social security, income tax withholdings, retirement or leave benefits. The Consultant assumes full responsibility for the provision of all insurance and fringe benefits for himself or herself and employees retained by the Consultant in carrying out the Scope of Services provided in this subcontract. d. The Subrecipient shall be responsible for monitoring the contractual performance of all subcontracts. e. The Subrecipient shall receive written documentation prior to entering into any subcontract which contemplates performance of substantive programmatic activities, as such is determined as provided herein. The Grantee's approval shall be obtained prior to the release of any funds to the subcontractor. f. The Subrecipient shall receive written approval from the Grantee prior to either assigning or transferring any obligations or responsibility set forth in this Agreement or the right to receive benefits or payments resulting from this Agreement. g. Approval by the Grantee of any subcontract or assignment shall not under any circumstances be deemed to provide for the incurring of any obligation by the Grantee in excess of the total dollar amount agreed upon in this Agreement. 12. The Grantee's Consultant - The Grantee understands that in order to facilitate the implementation of this Agreement, the Grantee may from time to time designate a development consultant to work with the Subrecipient. The Grantee's consultant shall be considered the Grantee's designee with respect to all portions of this Agreement with the exception of those provisions Telating to payment of the Subrecipient for services rendered. The Grantee shall provide written notification to the Subrecipient of the name, address, and employees of the GraTfte's ransuitant. GRANT NUMBER: FL0211 B4D000802 City of Miami — Homeless Assistance Program / Page 18 of 23 13. Participation in Homeless Management Information System - The Provider agrees to participate in the Homeless Managementlnformation System (r.-r�IVIIS) selected and established by the County. Participation will include, but is not limited to, input of client data upon intake, daily updates of bed availability information, as well as updates of client files upon client contact, and maintaining current data for statistical purposes. The Provider understands that they are responsible for any ongoing cost to access the HMIS system. 14. Miami -Dade County Inspector General Review —According to Section 2-1076 of the Code of Miami -Dade County, as amended by Ordinance No. 99-63, Miami -Dade County has established the Office of the Inspector General which may, on a random basis, perform audits on all County contracts, throughout the duration of said contracts, except as otherwise provided below. The cost of the audit of any Contract issued as a result of this RFP shall be one-quarter (1/4) of one (1) percent of the total contract amount which cost shall be included in the total proposed amount. The audit cost will be deducted by the County from progress payments to the selected Proposer. The audit cost shall also be included in all change orders and all contract renewals and extensions. Exception: The above application of one quarter (1/4) of one percent fee assessment shall not apply to the following contracts: (a) IPSIG contracts; (b) contracts for legal services; (c) contracts for financial advisory services; (d) auditing contracts; (e) facility rentals and lease agreements; (f) concessions and other rental agreements; (g) insurance contracts; (h) revenue -generating contracts; (I) contracts where an IPSIG is assigned at the time the contract is approved by the Commission; 0) professional service agreements under $1,000; (k) management agreements; (1) small purchase orders as defined in Miami -Dade County Administrative Order 3-2; (m) federal, state and local government -funded grants; and (n) interlocal agreements. Notwithstanding the foregoing, the Miami -Dade County Board of County Commissioners may authorize the inclusion of the fee assessment of one quarter (114) of one percent in any exempted contract at the time of award Nothing contained above shall in any way limit the powers of the Inspector General to perform audits on all County contracts including, but not limited to, those contracts specifically exempted above. 15. INDEPENDENT PRIVATE SECTOR INSPECTOR GENERAL REVIEW Pursuant to Miami -Dade County Administrative Order 3-20 and in connection with any award issued as a result of this RFP, the County has the right to retain the services of an Independent Private Sector Inspector General ("IPSIG"), whenever the County deems it appropriate to do so. Upon written notice from the County, the selected Proposer shall make available, to the IPSIG retained by the County, all requested records and documentation pertaining to this RFP or any subsequent award, for inspection and copying. The County will be responsible for the payment of these IPSIG services, and under no circumstance shall the Proposer's cost/price for this RFP be inclusive of any charges relating to these IPSIG services. The terms of this provision herein, apply to the Proposer, its officers, agents, employees and assignees. Nothing contained in this provision shall impair any independent right of the County to conduct, audit or investigate t1te operons, activities and performance of the selected Proposer in connection with this RFP or any contract issued as a result of this RFP. The terms of this GRANT NUMBER: FL0211 B413000802 City of Miami — Homeless Assistance Program / Page 19 of 23 provision are neither intended nor shall they be construed to impose any liability on the County by the selected Proposer or third party. 16. Renegotiation or Modification - Modifications of provisions of this Agreement shall be valid only when in writing and signed by duly authorized representatives of each party. Additional conditions are: a. A Subrecipient may not make any significant changes to an approved program without prior Grantee approval. Significant changes include, but are not limited to, a change in the Subrecipient, a change in the project site, additions or deletions in the types of activities listed in 24 CFR Part 583.100 approved in the Technical Submission 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 participants to be served, or other changes deemed significant by the Grantee. Depending on the nature of the change, the Grantee may require a new certification of consistency with the Consolidated Plan Certification from the United States Department of Housing and Urban Development b. Approval for changes is contingent upon the application ranking remaining high enough after the approved change to have been competitively selected for funding in the year the application was selected. The parties agree to renegotiate this contract if the Grantee determines, in its sole and absolute discretion, that Federal state, and/or Grantee revisions of any applicable law or regulations, or increases or decreases in budget allocations make changes in this Agreement necessary. The Grantee shall be the final authority in determining whether or not funds for this Agreement are available due to Federal, state and/or Grantee revisions of any applicable laws or regulations, or increases in budget allocations. Notwithstanding the foregoing, the Grantee retains all the rights of suspension or termination set forth in Section III of this Agreement. After the initial grant agreement, the Grantee will not make revisions to increase the amount of the award to the Subrecipient. 17. Right to Waive - The Grantee may, for good and sufficient cause, as determined by the Grantee in this sole and absolute discretion, waive provisions in this Agreement or seek to obtain such waiver from the appropriate authority. Waiver requests from the Subrecipient shall be in writing. Any waiver shall not be construed to be a modification of this Agreement. 18. Disputes - In the event an unresolved dispute exists between the Subrecipient and the Grantee, the Grantee shall refer the questions, including the views of all the interested parties and the recommendation of the Grantee, to the CountyManager for determination. The County Manager, or an authorized representative, will issue a determination within thirty (30) calendar days of receipt and so advise the Grantee and the Subrecipient, or in the event additional time is necessary, the Grantee will notify the Subrecipient within the thirty (30) day period that additional time is necessary. The Subrecipient agrees that the County Manager's determination:simll be #inial anal:binding on ail parties. GRANT NUMBER: FL0211B41)000802 City of Miami — Homeless Assistance Program / Page 20 of 23 19. Headings - The article and paragraph headings in this Agreement are inserted for convenience only and shall not affect in any way the meaning or interpretation of this Agreement. 20. Proceedings - This Agreement shall be construed in accordance with the laws of the State of Florida and any proceedings arising between the parties in any manner pertaining or relating to this Agreement shall, to the extent permitted by law, be held in Dade County, Florida. 21. Notice and Contact - The Grantee's representative for this Agreement is: David Raymond, Executive Director. The Subrecipient's representative for this Agreement is The project/program site is located at In the event that different representatives are designated by either party after this Agreement is executed, or the Subrecipient changes the address of either the program site or the principal office, the Subrecipient must notify the Grantee prior to such relocation and obtain all necessary approvals. Notice of the name of the new representative or new address will be rendered in writing to the other party and said notification attached to the originals of this Agreement. 22. Name and Address of Payee -When hen payment is made to the Subrecipient's assignee, the name and address of the official payee is 23. All Terms and Conditions Included - This Agreement and its attachments as referenced contain all the terms and conditions agreed upon by the parties. 24. Autonomy - Both parties agree that this Agreement recognizes the autonomy of and stipulates or implies no affiliation between the contracting parties. The parties acknowledge that the relationship of Grantee and Subrecipient is that of independent contractors and that nothing contained in this Agreement shall be construed to place Grantee and Subrecipient in the relationship of principal and agent, employer and employee, master and servant, partners or joint venturers. Neither party shall have, expressly or by implication, or represent itself as having, any authority to make contracts or enter into any agreement in the name of the other party, or to obligate or bind the other party in any manner whatsoever. 25. Severability of Provisions - If any provision of this Agreement is held invalid, the remainder of this Agreement shall not be affected thereby if such remainder would then continue to conform to the terms and requirements of applicable law. 26. Waiver of Trial - Neither the Subrecipient, subcontractor nor any other person liable for the responsibilities; obligations, services and representations herein, nor any assignee, successor heir or personal representative of the Subrecipient, subcontractor or any such other persons or entity shall seek a jury trial in any lawsuit, proceeding, counterclaim or other litigation procedure based upon or arising out of this Agreement, or the dealings or the relationship between or among such persons or entities, or any of them. Neither the Subrecipient, subcontractor nor any such person or entity shall seek to consolidate any such action in which a jury trial has been waived. The provisions of this paragraph have been fully discussed by the parties herd, and the provision hereof shall be subject to no exceptions. No party has in any way agreed with or represented to any other party that the provisions of this paragraph will not be fully enforced in all instances. GRANT NUMBER: FL021 I B4D000802 Cih, of Miami — Homeless Assistance Program / Page 21 of 23 27. Contracts with Municipalities or Counties Outside Miami -Dade County to Provide Homeless Housing in Miami -Dade County. - The above-named firm, corporation, organization or individual ("provider") desiring to transact business or enter into a contract with the County for the provision of homeless housing and /or services swears, verifies, affirms and agrees that (1) it has not entered into any current contract, arrangement of any kind, or understanding with any municipality outside of Miami -Dade County or any County (collectively "locality") to provide housing and services for homeless persons in Miami -Dade County who are transported to Miami -Dade County by or at the behest of such locality and (2) during the term of this contract, it will not enter into any such contract, arrangement of any kind, or understanding; provided, however, upon the written request of the Contractor prior to entering into such contract, understanding or arrangement, the Miami -Dade County Homeless Trust may, in its sole and absolute discretion, find and determine within 60 days of such request that a proposed contract should not be prohibited hereby, as the best interests of the homeless programs undertaken by and on behalf of Miami -Dade County would not be negatively affected by such contract, arrangement, or undertaking. VI. RELIGIOUS ORGANIZATIONS As reported in 24 CFR Part 583.150, HUD will provide assistance to a recipient that is a primarily religious organization, if the organization agrees to provide housing and supportive services in a manner that is free from religious influences and in accordance with the following principles: It will not discriminate against any employee or applicant for employment on the basis of religion and will not limit employment or give preference in employment to persons on the basis of religion; 2. It will not discriminate against any person applying for housing or supportive services on the basis of religion and will not limit such housing or services or give preference to persons on the basis of religion; and 3. It will provide no religious instruction or counseling, conduct no religious worship or services, engage in no religious proselytizing, and exert no other religious influence in the provision of housing and supportive services. HUD will provide assistance to a recipient that is a primarily religious organization if the assistance will not be used by the organization to construct a structure, acquire a structure or to rehabilitate a structure owned by the organization, except as described in 24 CFR Part 583.150 (b)(2) Attachment A. VII. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) Any person or entity that performs or assists Miami -Dade County with a function or activity involving the use or disclosure of "individually identifiable health information (HIB) and/or Protected Health Information (PHI) shall comply with the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the Miami -Dade County Privacy Standards Administrative Order. WA.A trrandates £crr privacy, security and electronic transfer standards, that include but are not limited to: 1. Use of information only for performing services required by the contract or as required by law; GRANT NUMBER: FL021 I B4D000802 Cit) of Miami — Homeless Assistance Program / Page 22 of 23 2. Use of appropriate safeguards to prevent non -permitted disclosures; 3. Reporting to Miami -Dade County of any non -permitted use or disclosure; 4. Assurances that any agents and subcontractors agree to the same restrictions and conditions that apply to the Bidder/Proposer and reasonable assurances that IIHI/PHI will be held confidential; 5. Making Protected Health Information (PHI) available to the customer; 6. Making PHI available to the customer for review and amendment; and incorporating any amendments requested by the customer; 7. Making PHI available to Miami -Dade County for an accounting of disclosures; and 8. Making internal practices, books and records related to PHI available to Miami -Dade County for compliance audits. PHI shall maintain its protected status regardless of the form and method of transmission (paper records, and,/or electronic transfer of data). The Bidder/ Proposer must give its customers written notice of its privacy information practices including specifically, a description of the types of uses and disclosures that would be made with protected health information. CONTINUES NEXT ON SIGNATURE PAGE GRANT NUMBER: FL0211 B413000802 City of Miami — Homeless Assistance Program / Page 23 of 23 IN WITNESS WHEREOF, the parties have caused this twen4three (23) page Agreement to be executed by their respective and duly authorized officers the day and year first above written. WITNESSES: NAME: (PRINT) NAME: (SIGNATURE) NAME: (PRINT) NAME: (SIGNATURE) ATTEST: HARVEY RUVIN, CLERK VI PROVIDER: (FULL NAME OF AGENCY) BY NAME: (PRINT NAME OF AUTHORIZED .AGENCY REPRESENTATIVE) (SIGNATURE OF AUTHORIZED AGENCY REPRESENTATIVE) (TITLE) (AFFIX SEAL) MIAMI -DARE COUNTY a political subdivision of the State of Florida DEPUTY CLERK George M. Burgess County Manager (DATE) See memorandum dated A n approved as to form and legal sufficiency: Subrecipient Agreement Attachment List slkrLla aI-e Re faired A,,-tachrneflli Tid,e Attacbment A 11-1 U.S. HUD Grant Renewall Agreement' cludes: FFLID designated Attacil-nnents A and B Attachment A-! Scope of Service Attachment A-2 Urihs/Bedrooms/Beds Char, and Pardelipants ChaT-L j Attach -meat. A-3= Pro2Tann Goals —_ Attachment A-41Filtones aj Grants) (N/A for Renew i _t_es Attachment B Technical Submission Attachment C LOCCSAIRS form HUD -27053A Attachment C-I Copy of Homeless Trust Invoice Attachment D SIS (HUD -401 18) Monthly Progress Report Attachment E Program Rating of Satisfaction Attachment F Client Contribution Report A ac hent G Annual Progress Report (APR) Attachment G-1 11MIS (1 -H -M-401 IS) Amnual Prop-ress Report (_EPR) -Y sil-r,,,tu�-e Attachment P. Request for Tay -payer Identification and tlertification _tio. n s panatu re ;,- Attachment AttachI HUD Sorin -400904i 400904 An lc Plcauntcerdflcaton Aftacbmentir� ly 1, Miami -Dade County Requi -d -Al"fidavits {r i�mati re Attachment K Affl-ida-vit Lobbyist Registration for Oral Presentation -uj Sianata,-e Attachment L Disclosure ol'Subcontractors a -no' Suppliers siulature it -lil aa tt Attachment M Subcontractor/ Suppliers Listing Si�rl a it- u r e Attachment N Section 3 Compliance Requirements -V Svznaturre fit, Attachmeiit 0 Sworn- Statement Pursuant 'to Flor, da StatutesAttachment P Pi-ovider Asset Inventory form I a a I ppleabile Attachment Q Declaration of Restrictive Covenants if -qI licable Attachment Q-1 Declaration of Restqictions Attachment R Ern-pioyee Certification Tor, Attachment S Incident Report (3 -pages) Applicant: Miami -Dade County Project: FL -600 - Ren - Miami Homeless Assistance Program 0041482920000 FL0211 B4D000802 Grant Number: FL0211B4D000802 Award Amount: $251,071 Recipient: Miami -Dade County, 111 N.W. 1st Street, 27th floor, Suite 310, Miami, Florida 33128 Tax ID#: 59-6000573 Project Name: FL -600 - Ren - Miami Homeless Assistance Program Component Type: SSO Official Contact Person: Mr. David Raymond, Executive Director Email Address: dray@miamidade.gov Phone: (305) 375-1490 Fax: (305) 375-2722 2009 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. Consolidated Grpnt Agreement Page 1 03/10/2010 Applicant: Miami -Dade County Project: FL -600 - Ren - Miami Homeless Assistance Program 0041482920000 FL0211B4D000802 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 December 29, 2008 at 73 FR 79548, and the second part was the Continuum of Care Homeless Assistance Programs NOFA Section of the NOFA, which is located at http://www.hud.gov/offices/adm/grants/nofa09lcocsec.pdf. 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. 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 Agm-ement. 'No tigtyt,'benefit, or advantage of the Recipient hereunder be assigned without prior written approval of HUD. Consolidated Grant Agreement Page 2 03/10/2010 Applicant: Miami -Dade County 0041482920000 Project: FL -600 - Ren - Miami Homeless Assistance Program FL021 i 84D000802 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 Consolidated Grant Agreement Page 3 03/10/2010 Applicant: Miami -Dade County 0041482920000 Project: FL -600 - Ren - Miami Homeless Assistance Program FL0211134D000802 (e) reduce or recapture the grant; or (f) 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. Consolidated Grant Agreement Page 4 03/10/2010 Applicant: Miami -Dade County 0041482920000 Project: FL -600 - Ren - Miami Homeless Assistance Program FL0211 B4D000802 SIGNATURES This Grant Agreement is hereby executed as follows.- UNITED ollows: UNITED STATES OF AMERICA Secretary of Hou ing and Urban Development "�2 ' v v Print"name of signatory e RECIPIENT Name of Organization By: Authorized Signature and Date Print name of Signatory e Consolidated Grant Agreement Page 5 03/10/2010 Applicant: Miami -Dade County Project: FL -600 - Ren - Miami Homeless Assistance Program ATTACHMENT A The recipient is Miami -Dade County. 0041482920000 FL0211B4D000802 2. HUD's total fund obligation for this project is $251,071, which shall be allocated as follows: Leasing $0 Supportive services $239,116 Operating costs $0 HMIS $0 Administration $11,955 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 12 months. 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. Consolidated Grant Agreement Page 6 03/10/2010 Applicant: Miami -Dade County Project: FL -600 - Ren - Miami Homeless Assistance Program ATTACHMENT B 24 CFR PART 583 --SUPPORTIVE HOUSING PROGRAM Subpart A --General Sec 583.1 Purpose and scope. 583.5 Definitions. Subpart B --Assistance Provided 583.100 Types and uses of assistance. 583.105 Grants for acquisition and rehabilitation. 583.110 Grants for new construction. 583.115 Grants for 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 operating costs. 583.135 Administrative costs. 583.140 Technical assistance. 583.145 Matching requirements. 583.150 Limitations on 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. 583.305 Term of commitment; repayment of grants; prevention of undue benefits. 583.310 Displacement, relocation, and acquisition. 583.315 Resident rent. 583.320 Site control. 583.325 ' Nondiscrimination and equal opportunity requirements. 583.330 Applicability of other Federal requirements. 0041482920000 FL0211 134D000802 Consolidated Grant Agreement Page 7 03/10/2010 Applicant: Miami -Dade County 0041482920000 Project: FL -600 - Ren - Miami Homeless Assistance Program FL0211 B4D000802 Subpart E --Administration 583.400 Grant agreement. 583.405 Program changes. 583.410 Obligation and deobligation of funds. AUTHORITY: 42 U.S.C. 11389 and 3535(d). SOURCE: 58 FR 13871, Mar. 15, 1993, unless otherwise noted. Subpart A --General § 583.1 Purpose and scope. (a) General. The Supportive Housing Program is authorized by title IV of the Stewart B. McKinney Homeless Assistance Act (the McKinney Act) (42 U.S.C. 11381-11389). The Supportive Housing program is designed to promote the development of supportive housing and supportive services, including 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 live 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: Applicant is defined in section 422(1) of the McKinney Act (42 U.S.0 11382(1)). For purposes of this definition, governmental entities include those that have general governmental powers (such as a city or county), as well as those that have limited or special powers (such as public housing agencies). Consolidated plan means the plan that a jurisdiction prepares and submits to HUD in accordance with 24 CFR part 91. Date of initial occupancy means the date that the supportive housing is initially occupied by a homeless person for whom HUD provides assistance under this part. If the assistance is for an existing homeless facility, the date of initial occupancy is the date that services are first provided to the residents of supportive housing with funding under this part. Date of initial service provision 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 definition applies only to projects funded under this part that do not provide supportive housing. Disability is defined in section 422(2) of the McKinney Act (42 U.S.0 11382(2)). Homeless person means an individual or family that is described in section 103 of the McKinney Act (42 U.S.G 11302). Consolidated Grant Agreement Page 8 03/10/2010 Applicant: Miami -Dade County 0041482920000 Project: FL -600 - Ren - Miami Homeless Assistance Program FL0211 B4D000802 Metropolitan city is defined in section 102(a)(4) of the Housing and Community Development Act of 1974 (42 U.S.0 5302(a)(4)). In general, metropolitan cities are those cities that are eligible for an entitlement grant under 24 CFR part 570, subpart D. New construction 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.0 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.0 11384(c)). Private nonprofit organization is defined in section 422(7) (A), (B), and (D) of the McKinney Act (42 U.S.C. 11382(7) (A), (B), and (D)). The organization must also have a functioning accounting system that is operated in accordance with generally accepted accounting principles, or designate an entity that will maintain a functioning accounting system for the organization in accordance with generally accepted accounting principles. 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 means the improvement 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 repairs. State is defined in section 422(11) of the McKinney Act (42 U.S.C. 11382(11)). Supportive housing is defined in section 424(a) of the McKinney Act (42 U.S.C. 11384(a)). Supportive services is defined in section 425 of the McKinney Act (42 U.S.0 11385). Transitional housing is defined in section 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 Community Development Act of 1974 (42 U.S.0 5302(x)(6)). In general, urban counties are those counties that are eligible for an entitlement grant under 24 CFR part 570, subpart D. [61 FR 51175, Sept. 30, 19961 Subpart B --Assistance Provided § 583.100 Types and uses of assistance. (a) Grant assistance. Assistance in the form of grants is available for acquisition of structures, rehabilitation of structures, acquisition and rehabilitation of structures, new construction, leasing, operating costs for supportive housing, and supportive services, as described in §§ 583.105 through 583.125. Applicants may apply for more than one type of assistance. Consolidated Grant Agreement Page 9 03/10/2010 1 Applicant: Miami -Dade County 0041482920000 Project: FL -600 - Ren - Miami Homeless Assistance Program FL0211 B4D000802 (b) Uses of grant assistance. Grant assistance may be used to: (1) Establish new supportive housing facilities or new facilities to provide supportive services; (2) Expand existing facilities in order to increase the number of homeless persons served; (3) Bring existing facilities up to a level that meets State and local government health and safety standards;. (4) Provide additional supportive services for residents of supportive housing or for homeless persons not residing in supportive housing: (5) Purchase HUD -owned single family properties currently leased by the applicant for use as a homeless facility under 24 CFR part 291; and (6) Continue funding supportive housing where the recipient has received funding under this part for leasing, supportive services, or operating costs. (c) Structures used for multiple purposes Structures used to provide supportive 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. [58 FR 13871, Mar. 15, 1993, as amended at 59 FR 36891, July 19, 1994] § 583.105 Grants for acquisition and rehabilitation. (a) Use. HUD will grant funds to recipients 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 rehabilitation 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 acquisition and rehabilitation of structures, as described in paragraphs (a)(1) and (2) of this section. (b) Amount. The maximum grant available for acquisition, rehabilitation, or acquisition and rehabilitation is the lower of: (1) $200,000; or (2) The total cost of the acquisition, rehabilitation, or acquisition and rehabilitation minus the applicant's contribution toward the cost. (c) Increased amounts. In areas determined by HUD to have high acquisition and rehabilitation costs, grants of more than $200,000, but not more than $400,000, may be available. Consolidated Grant Agreement Page 10 03/10/2010 Applicant: Miami -Dade County Project: FL -600 - Ren - Miami Homeless Assistance Program § 583.110 Grants for new construction. 0041482920000 FL0211B4D000802 (a) Use. HUD will grant funds to recipients to pay a portion of the cost of new construction, including cost -'effective 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 substantially 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 construction may include the cost of real property 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 construction, including the cost of land associated with that construction, minus the applicant's contribution toward the cost 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 reasonable 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 comparable space. (2) Leasing individual units. Where grants are used to pay rent for individual 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 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 leased units by homeless participants. [58 FR 13871, Mar. 15, 1993, as amended at 59 FR 36891, July 19, 19941 § 583.120 Grants for supportive services 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 associated with providing supportive services include salaries paid to providers of supportive services and any other costs directly associated with providing such services. For a transitional housing project, supportive services costs also include the costs of services provided to former residents of transitional housing to assist their adjustment to independent living. Such services may be provided for up to six months after they leave the transdianai dousing facility. [58 FR 13871, Mar_ 15, 1993, as amended at 59 FR 36891, July 19, 1994] Consolidated Grant Agreement Page 11 03/10/2010 Applicant: Miami -Dade County Project: FL -600.- Ren - Miami Homeless Assistance Program § 583.125 Grants for operating costs. 0041482920000 FL0211B4D000802 (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 costs. Operating costs are those associated with the day -today operation of the supportive housing. They also include the actual expenses that a recipient incurs for conducting on-going assessments of the supportive services needed by residents and the availability of such, services; relocation assistance under § 583.310, including payments and services; and insurance. (c) Recipient match requirement for operating costs. Assistance for operating costs will be available for up to 75 percent 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 recipient must demonstrate that it has met its match requirement of the costs for that year. [58 FR 13871, Mar. 15, 1993, as amended at 61 FR 51175, Sept. 30, 1996; 65 FR 30823, May 12, 2000] § 583.130 Commitment of grant amounts for leasing, supportive services, and operating costs. Upon execution of a grant agreement covering assistance for leasing, supportive 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) [59 FR 36891, July 19, 1994] § 583.135 Administrative costs. (a) General. 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. Administrative 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 salaries associated with these administrative 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, 1996]-- § 583.140 Technical assistance. Consolidated Grant Agreement Page 12 03/10/2010 Applicant: Miami -Dade County Project: FL -600 - Ren - Miami Homeless Assistance Program 0041482920000 FL0211B4D000802 (a) General. HUD may set aside funds annually to provide technical assistance, either directly by HUD staff or indirectly through third -party providers, for any supportive housing project. This technical assistance is for the purpose of promoting the development of supportive housing and supportive services as part of a continuum of care approach, including innovative approaches to assist homeless persons in the transition from homelessness, and promoting the provision of supportive housing to homeless persons to enable them to live as independently as possible. (b) Uses of technical assistance. HUD may use these funds to provide technical assistance to prospective applicants, applicants, recipients, or other providers of supportive housing or services for homeless persons, for supportive housing projects. The assistance may include, but is not limited to, written information such as papers, monographs, manuals, guides, and brochures; 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 assistance. HUD may enter into contracts, grants, or cooperative agreements, when necessary, to implement the technical assistance. [59 FR 36892, July 19, 1994] § 583.145 Matching requirements. (a) General. The recipient must match the funds provided by HUD for grants for acquisition, rehabilitation, and new construction with an equal amount 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 governments, and private resources, in accordance with 42 U.S.C. 11386. This statute provides that a recipient may use funds from any source, including any other Federal source (but excluding the specific statutory subtitle from which Supportive Housing Program funds are provided), as well as State, local, and private sources are not statutorily prohibited to be used as a match. It is the responsibility of the recipient to ensure that any funds used to satisfy the matching requirements of this section are eligible under the laws governing the funds to be used as matching funds for a grant awarded under this program. (c) Maintenance of effort. State or local government funds used in the matching contribution are subject to the maintenance of effort requirements described at § 583.150(a). § 583.150 Limitations on use of assistance. (a) Maintenance of effort. No assistance 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 used, or designated for use, to assist homeless persons. (b) Faith -based activities. (1) Organizations that are religious or faith -based are eligible, on the same basis as any other organization, to participate in the Supportive Housing Program. Neither the Federal government nor a State or local government receiving funds under Supportive Housing programs shall discriminate against an organization on the basis of the organization'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 proselytization as part of the programs or services funded under this part. If an organization conducts such activities, the activities must be offered separately, in time or location, from the programs or services funded under this part, and participation mustt)e voluntary for the beneficiaries of the HUD -funded programs or services. Consolidated Grant Agreement Page 13 03/10/2010 Applicant: Miami -Dade County Project: FL -600 - Ren - Miami Homeless Assistance Program 0041482920000 FL0211134D000802 (3) A religious organization that participates in the Supportive Housing Program will retain its independence from Federal, State, and local governments, and may continue to carry out its mission, including the definition, practice, and expression of its religious beliefs, provided that it does not use direct Supportive Housing Program funds to support any inherently religious activities, such as worship, religious instruction, or prose Iytization. Among other things, faith - based organizations may use space in their facilities to provide Supportive Housing Program - funded services, without removing religious art, icons, scriptures, or other religious symbols. In addition, a Supportive Housing Program -funded religious organization retains its authority over its internal governance, and it may retain religious terms in its organization's name, select its board members on a religious basis, and include religious references in its organization's mission statements and other governing documents. (4) An organization that participates in the Supportive Housing Program shall not, in providing program assistance, discriminate against a program beneficiary or prospective program beneficiary on the basis of religion or religious belief. (5) Program funds may not be used for the acquisition, construction, or rehabilitation of structures to the extent that those structures are used for inherently religious activities. Program funds may be used for the acquisition, construction, or rehabilitation of structures only to the extent that those structures are used for conducting eligible activities under this part. Where a structure is used for both eligible and inherently religious activities, program funds may not exceed the cost of those portions of the acquisition, construction, or rehabilitation that are attributable to eligible activities in accordance with the cost accounting 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 improvements. 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 government -wide regulations governing real property disposition (see 24 CFR parts 84 and 85). (6) If a State or local government voluntarily contributes its own funds to supplement federally funded activities, the State or local government has the option to segregate the Federal funds or commingle them. However, if the funds are commingled, this section applies to all of the commingled funds. (c) Participant control of site. Where an applicant does not propose to have control of a site or sites but rather proposes to assist a homeless family or individual in obtaining a lease, which may include assistance with rent payments and receiving supportive services, after which time the family or individual remains in the same housing without further assistance under this part, that applicant may not request assistance for acquisition, rehabilitation, or new construction. [58 FR 13871, Mar. -15, 1993, as amended at 59 FR 36892, July 19, 1993; 68 FR 56407, Sept. 30, 2003] 583.155 Consolidated plan. (a) Applicants that are States or units of general local government. The applicant must have HUD -approved complete or abbreviated consolidated plan,. in.accordance_with 24 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 following the HUD -approved consolidated plan. (b) Applicants that are not States or units of general local government. The applicant must submit a certification by the jurisdiction in which the proposed project will be located that the applicant's application for funding is consistent with the jurisdiction's HUD approved consolidated plan. The certification musibe made by the unit of general local government or the State, in accordance with the consistency certification provisions oT the consolidated plan regulations, 24 CFR part 91, subpart F. Consolidated Grant Agreement Page 14 03/10/2010 1 Applicant: Miami -Dade County Project: FL -600 - Ren - Miami Homeless Assistance Program 0041482920000 FL0211B4D000802 (c) Indian tribes and the Insular Areas of Guam, the U.S. Virgin Islands, American Samoa, and the Northern Mariana Islands. These entities are not required to have a consolidated plan or to make consolidated plan certifications. An application by an Indian tribe or other applicant for a project that will be located on a reservation of an Indian tribe will not require a certification by the tribe or the State. However, where an Indian tribe is the applicant for a project that will not be located on a reservation, the requirement for a certification under paragraph (b) of this section will apply. (d) Timing of consolidated plan certification submissions. Unless otherwise set forth in the NOFA, the required certification that the application for funding is consistent with the HUD - approved consolidated plan must be submitted by the funding application submission deadline announced in the NOFA. [60 FR 16380, Mar. 30, 1995] Subpart C --Application and Grant Award Process § 583.235 Renewal grants. (a) General. Grants made under this part, and grants made under subtitles C and D (the Supportive Housing Demonstration and SAFAH, respectively) of the Stewart B. McKinney Homeless Assistance Act as in effect before October 28, 1992, may be renewed on a noncompetitive basis to continue ongoing leasing, operations, and supportive services for additional years beyond the initial funding period. To be considered 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 renewal 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 occupancy or the date of initial service provision, 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, subject to maintenance of effort requirements under § 583.150(a) may be for: (1) Up to 50 percent of the actual operating and leasing costs in the final year of the initial funding period; (2) Up to the amount of HUD assistance for supportive services in the final year of the initial funding period; and (3) An allowance for cost increases. (c) HUD review. (1) HUD will review the request for renewal and will evaluate the recipient's performance in previous years against the plans and goals established in the initial application for assistance, as amended. HUD will approve the request for renewal unless the recipient proposes to serve a population that is not homeless, or the recipient has not shown adequate progress as evidenced by an unacceptably slow expenditure of funds, or the recipient has been unsuccessful in assisting participants in achieving and maintaining independent living. In determining the recipient's success in assisting participants to achieve and maintain independent living, consideration will be given to the level and type of problems of participants. For recipients with a poor record of success, HUD will also consider the recipient's willingness to accept technical assistance and to make changes suggested by technical assistance providers. Other factors which will affect HUD's decision to approve a renewal request include the following: a continuing history of inadequate financial management accounting practices, indications of mismanagement on the part of the recipient, a drastic reduction in the population served by the recipient, program changes made by the recipient without prior HUD approval, and loss of project site. Consolidated Grant Agreement Page 15 03/10/2010 1 Applicant: Miami -Dade County Project: FL -600 - Ren - Miami Homeless Assistance Program 0041482920000 FL021 1 B4D000802 (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 approved or disapproved. (Approved by the Office of Management and Budget under control number 2506-0112) Subpart D --Program Requirements § 583.300 General operation. (a) State and local requirements. Each recipient of assistance under this part must provide housing or services that are in compliance with all applicable State and local housing codes, licensing requirements, and any other requirements in the jurisdiction in which the project is located regarding the condition of the structure and the operation of the housing or services. (b) Habitability standards. Except for such variations as are proposed by the recipient and approved by HUD, supportive housing must meet the following requirements: (1) Structure and materials. The structures 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 elements. (2) Access. The housing must be accessible and capable of being utilized without unauthorized use of other private properties. Structures must provide 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 belongings Each resident must be provided 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 residents. (5) Water supply. The water supply must be free from contamination. (6) Sanitary facilities. Residents must have access to sufficient sanitary facilities that are in proper operating condition, may be used in privacy, and are adequate for personal cleanliness and the disposal of human waste. (7) Thermal environment. The housing must have adequate heating and/or cooling facilities in proper operating condition. (8) Illumination and electricity. The housing must have adequate natural or artificial illumination to permit normal indoor activities and to support the health and safety of residents. Sufficient electrical sources must be provided to permit use of essential electrical appliances while assuring safety from fire. (9) Food preparation and refuse disposal. All food preparation areas must contain suitable space and equipment to store, prepare, and serve food in a sanitary manner. (10) Sanitary condition. The housing and any equipment must be maintained in sanitary condition. Consolidated Grant Agreement Page 16 03/10/2010 Applicant: Miami -Dade County 0041482920000 Project: FL -600 - Ren - Miami Homeless Assistance Program FL0211 B4D000802 (11) Fire safety. (i) Each unit must include at least one battery-operated or hard -wired smoke detector, in proper working condition, on each occupied level of the unit. Smoke detectors must be located, to the extent practicable, in a hallway adjacent to a bedroom. If the unit is occupied by hearing- impaired persons, smoke detectors must have an alarm system designed for hearing-impaired persons in each bedroom occupied by a hearing-impaired person. (ii) The public areas of all housing must be equipped with a sufficient number, but not less than one for each area, of battery-operated or hard -wired smoke detectors. Public areas include, but are not limited to, laundry rooms, community rooms, day care centers, hallways, stairwells, and other common areas. (c) Meals. Each recipient of assistance under this part who provides supportive housing for homeless persons with disabilities must provide meals or meal preparation facilities for residents. (d) Ongoing assessment of supportive services. Each recipient of assistance under this part must conduct an ongoing assessment of the supportive services required by the residents of the project and the availability of such services, and make adjustments as appropriate. (e) Residential supervision. Each recipient of assistance under this part must provide residential supervision as necessary to facilitate the adequate provision of supportive services to the residents of the housing throughout the term of the commitment to operate supportive housing. Residential supervision may include the employment of a full- or part-time residential supervisor with sufficient knowledge to provide or to supervise the provision of supportive services to the residents. (f) Participation of homeless persons. (1) Each recipient must provide for the participation of homeless persons as required in section 426(8) of the McKinney Act (42 U.S.C. 11386(g)). This requirement is waived if an applicant is unable to meet it and presents a plan for HUD approval to otherwise consult with homeless or formerly homeless persons in considering and making policies and decisions. See also § 583.330(e). (2) Each recipient of assistance under this part must, to the maximum extent practicable, involve homeless individuals and families, through employment, volunteer services, or otherwise, in constructing, rehabilitating, maintaining, and operating the project and in providing supportive services for the project. (g) Records and reports. Each recipient of assistance under this part must keep any records and make any reports (including those pertaining to race, ethnicity, gender, and disability status data) that HUD may require within the timeframe required. (h) Confidentiality. Each recipient that provides family violence prevention or treatment services must develop and implement procedures to ensure: (1) The confidentiality of records pertaining to any individual services; and (2) That the address or location of any project assisted will not be made public, except with written authorization of the person or persons responsible for the operation of the project. (3) Prompt written notice of the final decision to the participant. (j) Limitation of stay in transitional housing. A homeless individual or family may remain -in -- transitional housing for a period longer than 24 months, if permanent housing for the individual or family has not been located or if the individual or family requires additional time to prepare for independent living. However, HUD may discontinue assistance for a transitional housing project if more than half of the homeless individuals or families remain in that project longer than 24 months. Consolidated Grant Agreement Page 17 03/10/2010 Applicant: Miami -Dade County 0041482920000 Project: FL -600 - Ren - Miami Homeless Assistance Program FL0211 B4D000802 (k) Outpatient health services. Outpatient health services provided by the recipient must be approved as appropriate by HUD and the Department of 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 appropriateness of the proposed services. (1) Annual assurances. Recipients who receive assistance only for leasing, operating costs or supportive services costs must provide an annual assurance for each year such assistance is received that the project will be operated for the purpose specified in the application. (Approved by the Office of Management and Budget under control number 2506-0112) [58 FR 13871, Mar. 15, 1993, as amended at 59 FR 36892, July 19, 1994; 61 FR 51176, Sept. 30, 1996] § 583.305 Term of commitment; repayment of grants; prevention of undue benefits. (a) Term of commitment 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 benefits. In accordance with section 423(c) of the McKinney Act (42 U.S.C. 11383(c)), HUD will require recipients 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(b)(3)). [61 FR 51176, Sept. 30, 1996] § 583.310 Displacement, relocation, and acquisition. (a) Minimizing displacement. Consistent with the other goals and objectives of this part, recipients must assure that they have taken all reasonable steps to minimize the displacement of persons (families, individuals, businesses, nonprofit organizations, and farms) as a result of supportive housing assisted under this part. (b) Relocation assistance for displaced persons. A displaced person (defined in paragraph (f) of this section) must be provided relocation assistance at the levels described in, and in accordance with, the requirements of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (URA) (42 U.S.C. 4601-4655) and implementing regulations at 49 CFR part 24. (c) Real property acquisition requirements. 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 assurance of compliance) that it will comply with the URA, 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 provisions. (2) The cost of required relocation assistance is an eligible project cost in the same manner and to the same extent as other project costs. Such costs also may be paid for with local public funds or funds available from other sources. (3) The recipient must maintain records in sufficient detail to demonstrate compliance with provisions of this section. Consolidated Grant Agreement Page 18 03/10/2010 Applicant: Miami -Dade County 0041482920000 Project: FL -600 - Ren - Miami Homeless Assistance Program FL0211 B4D000802 (e) Appeals. A person who disagrees with the recipient's determination concerning whether the person qualifies as a "displaced person," or the amount of relocation assistance for which the person is eligible, may file a written appeal of that determination with the recipient. A low-income person who is dissatisfied with the recipient's determination on his or her appeal may submit a written request for review of that determination to the HUD field office. (f) Definition of displaced person. (1) For purposes of this section, the term "displaced person" means a person (family, individual, business, nonprofit organization, or farm) that moves from real property, or moves personal property from real property permanently as a direct result of acquisition, rehabilitation, or demolition for supportive housing projects assisted under this part. The term "displaced person" includes, but may not be limited to: (i) A person that moves permanently from the real property after the property owner (or person in control of the site) issues a vacate notice, or refuses to renew an expiring lease in order to evade the responsibility to provide relocation assistance, if the move occurs on or after the date the recipient submits to HUD the application or application amendment designating the project site. (ii) Any person, including a person who moves before the date described in paragraph (f)(1)(i) of this section, if the recipient or HUD determines that the displacement resulted directly from acquisition, rehabilitation, or demolition for the assisted project. (iii) A tenant -occupant of a dwelling unit who moves permanently from the building/complex on or after the date of the "initiation of negotiations" (see paragraph (g) of this section) if the move occurs before the tenant has been provided written notice offering him or her the opportunity to lease and occupy a suitable, decent, safe and sanitary dwelling in the same building/ complex, under reasonable terms and conditions, upon completion of the project. Such reasonable terms and conditions must include a monthly rent and estimated average monthly utility costs that do not exceed the greater of: (A) The tenant's monthly rent before the initiation of negotiations and estimated average utility costs, or (B) 30 percent of gross household income. If the initial rent is at or near the maximum, there must be a reasonable basis for concluding at the time the project is initiated that future rent increases will be modest. (iv) A tenant of a dwelling who is required to relocate temporarily, but does not return to the building/complex, if either.- (A) ither:(A) A tenant is not offered payment for all reasonable out-of-pocket expenses incurred in connection with the temporary relocation, or (B) Other conditions of the temporary relocation are not reasonable. (v) A tenant of a dwelling who moves from the building/complex permanently after he or she has been required to move to another unit in the same building/complex, if either: (A) The tenant is not offered reimbursement for all reasonable out-of-pocket expenses incurred in connection with the move; or (B) Other conditions of the move are not reasonable. (2) Notwithstanding the provisions of paragraph (f)(1) of this section, a person does not qualify as a "displaced person" (and is not eligible for relocation assistance under the URA or this section), if: (i) Termination of housing assistance Consolidated Grant Agreement Page 19 03/10/2010 Applicant: Miami -Dade County 0041482920000 Project: FL -600 - Ren - Miami Homeless Assistance Program FL0211 134D000802 The recipient may terminate assistance to a participant who violates program requirements. Recipients should terminate assistance only in the most severe cases. Recipients may resume assistance to a participant whose assistance was previously terminated. In terminating assistance to a participant, the recipient must provide a formal process that recognizes the rights of individuals receiving assistance to due process of law. This process, at a minimum, must consist of: (1) Written notice to the participant containing a clear statement of the reasons for termination; (2) A review of the decision, in which the participant is given the opportunity to present written or oral objections before a person other than the person (or a subordinate of that person) who made or approved the termination decision; and (i) The person has been evicted for serious or repeated violation of the terms and conditions of the lease or occupancy agreement, violation of applicable Federal, State, or local or tribal law, or other good cause, and HUD determines that the eviction was not undertaken for the purpose of evading the obligation to provide relocation assistance; (ii) The person moved into the property after the submission of the application and, before signing a lease and commencing occupancy, was provided written notice of the project, its possible impact on the person (e.g., the person may be displaced, temporarily relocated, or suffer a rent increase) and the fact that the person would not qualify as a "displaced person" (or for any assistance provided under this section), if the project is approved; (iii) The person is ineligible under 49 CFR 24.2(g)(2); or (iv) HUD determines that the person was not displaced as a direct result of acquisition, rehabilitation, or demolition for the project. (3) The recipient may request, at any time, HUD's determination of whether a displacement is or would be covered under this section. (g) Definition of initiation of negotiations. For purposes of determining the formula for computing the replacement housing assistance to be provided to a residential tenant displaced as a direct result of privately undertaken rehabilitation, demolition, or acquisition of the real property, the term "initiation of negotiations" means the execution of the agreement between the recipient and HUD. (h) Definition of project. For purposes of this section, the term "project" means an undertaking paid for in whole or in part with assistance under this part. Two or more activities that are integrally related, each essential to the others, are considered a single project, whether or not all component activities receive assistance under this part. f58 FR 13871, Mar. 15, 1993, as amended at 59 FR 36892, July 19, 1994] § 583.315 Resident rent. (a) Calculation of resident rent. Each resident of supportive housing may be required to pay as rent an amount determined 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 adjusted income must include the expense deductions provided in 24 CFR 5.611(a), and for persons with disabilities, the calculation of the family's monthly adjusted income also must include the disallowance of earned income as provided in 24 CFR 5.617, if applicable; Consolidated Grant Agreement Page 20i 03/10/2010 Applicant: Miami -Dade County 0041482920000 Project: FL -600 - Ren - Miami Homeless Assistance Program FL0211134D000802 (2) 10 percent of the family's monthly gross income; or (3) If the family is receiving payments for welfare assistance from a public agency and a part of the payments, adjusted in accordance with the family's actual housing costs, is specifically designated by the agency to meet the family's housing costs, the portion of the payment that is designated 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 assist residents of transitional housing in moving to permanent housing. (c) Fees. In addition to resident rent, recipients may charge residents reasonable fees for services not paid with grant funds. [58 FR 13871, Mar. 15, 1993, as amended at 59 FR 36892, July 19, 1994; 66 FR 6225, Jan. 19, 2001 ] § 583.320 Site control. (a) Site control. (1) Where grant funds will be used for acquisition, rehabilitation, or new construction to provide supportive housing or supportive services, or where grant funds will be used for operating costs of supportive housing, or where grant funds will be used to provide supportive services except where an applicant will provide services at sites not operated by the applicant, an applicant must demonstrate site control before HUD 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 notification of the award of assistance under this part, the grant will be deobligated as provided in paragraph (c) of this section. (2) Where grant funds will be used to lease all or part of a structure to provide supportive housing or supportive services, or where grant funds will be used to lease individual housing units for homeless persons who will eventually control the units, site control need not be demonstrated. (b) Site change. (1) A recipient may obtain ownership or control of a suitable site different from the one specified 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 provide for all additional costs. If the recipient is unable to demonstrate to HUD that it is able to provide for the difference in costs, HUD may deobligate the award of assistance. (c) Failure to obtain site control within one year. HUD will recapture or deobligate any award for assistance under this part if the recipient is not in control of a suitable site before the expiration of one year after initial notification of an award. § 583.325 Nondiscrimination and equal opportunity requirements. (a) General. Notwithstanding the permissibility of proposals that serve designated populations of disabled homeless persons, recipients serving a designated population of disabled homeless persons are required, within the designated population, to comply with these requirements for nondiscrimination on the basis of race, color, religion, sex, national origin, age, familial status, and disability. Consolidated Grant Agreement Page 21 03/10/2010 Applicant: Miami -Dade County Project: FL -600 - Ren - Miami Homeless Assistance Program 0041482920000 FL0211134D000802 (b) Nondiscrimination and equal opportunity requirements. The nondiscrimination and equal opportunity requirements set forth at part 5 of this title apply to this program. The Indian Civil Rights Act (25 U.S.C. 1301 et seq.) applies to tribes when they exercise their powers of self- government, and to Indian housing authorities (IRAs) 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 determined on a case-by-case basis. Projects subject to the Indian Civil Rights Act must be developed and operated in compliance with its provisions and all implementing HUD requirements, 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 origin, familial status, or handicap who may qualify for admission to the housing, the recipient must establish additional procedures that will ensure that such persons can obtain information concerning availability of the housing. (2) The recipient must adopt procedures to make available information on the existence and locations of facilities and services that are accessible to persons with a handicap and maintain evidence of implementation of the procedures. (d) Accessibility requirements. The recipient must comply with the new construction accessibility requirements of the Fair Housing Act and section 504 of the Rehabilitation Act of 1973, and the reasonable accommodation and rehabilitation accessibility requirements of section 504 as follows: (1) All 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 rehabilitation are 75 percent or more of the replacement cost of the building must meet the requirements of 24 CFR 823(a). Other rehabilitation must meet the requirements of 24 CFR 823(b). [58 FR 13871, Mar. 15, 1993, as amended at 59 FR 33894, June 30, 1994; 61 FR 5210, Feb. 9, 1996; 61 FR 51176, Sept. 30, 1996] § 583.330 Applicability of other Federal requirements. In addition to the requirements set forth in 24 CFR part 5, use of assistance provided under this part must comply with the following Federal requirements: (a) Flood insurance. (1) The Flood Disaster Protection Act of 1973 (42 U.S.0 4001-4128) prohibits the approval of applications for assistance for acquisition or construction (including rehabilitation) for supportive housing located in an area identified by the Federal Emergency Management Agency (FEMA) as having special flood hazards, unless: (i) The community in which the area is situated is participating in the National Flood Insurance Program (see 44 CFR parts 59 through 79), or less than a year has passed since FEMA notification regarding such hazards; and (ii) Flood insurance is obtained as a condition of approval of the application. (2) Applicants with supportive housing located in an area identified by FEMA as having special flood hazards and receiving assistance for acquisition or construction (including rehabilitation) are responsible for assuring that flood insurance under the National Flood Insurance Program is obtained and maintained. (b) The Coastal. Barrier Resources Act of 1982 (16 U.S.C. 3501 et seq.) may apply to proposals under this part, depending on the assistance requested. Consolidated Grant Agreement Page 22 03/10/2010 Applicant: Miami -Dade County Project: FL -600 - Ren - Miami Homeless Assistance Program 0041482920000 FL0211B4D000802 (c) Applicability of OMB Circulars. The policies, guidelines, and requirements of OMB Circular No. A-87 (Cost Principles Applicable to Grants, Contracts and Other Agreements with State and Local Governments) and 24 CFR part 85 apply to the award, acceptance, and use of assistance under the program by governmental entities, and OMB Circular Nos. A-110 (Grants and Cooperative Agreements with Institutions of.Higher Education, Hospitals, and Other Nonprofit Organizations) and A-122 (Cost Principles Applicable to Grants, Contracts and Other Agreements with Nonprofit Institutions) apply to the acceptance and use of assistance by private nonprofit organizations, except where inconsistent with the provisions of the McKinney Act, other Federal statutes, or this part. (Copies of OMB Circulars may be obtained from E.O.P. Publications, room 2200, New Executive Office Building, Washington, DC 20503, telephone (202) 395-7332. (This is not a toll-free number.) There is a limit of two free copies. (d) Lead-based paint. The Lead -Based Paint Poisoning Prevention Act (42 U.S.C. 4821- 4846), the Residential Lead- Based Paint Hazard Reduction Act of 1992 (42 U.S.C. 4851-4856), and implementing regulations at part 35, subparts A, B, J, K, and R of this title apply to activities under this program. (e) Conflicts of interest. (1) In addition to the conflict of interest requirements in 24 CFR part 85, no person who is an employee, agent, consultant, officer, or elected or appointed official of the recipient and who exercises or has exercised any functions or responsibilities with respect to assisted activities, or who is in a position to participate in a decisionmaking process or gain inside information with regard to such activities, may obtain a personal or financial interest or benefit from the activity, or have an interest in any contract, subcontract, or agreement with respect thereto, or the proceeds thereunder, either for himself or herself or for those with whom he or she has family or business ties, during his or her tenure or for one year thereafter. Participation by homeless individuals who also are participants under the program in policy or decisionmaking under § 583.300(f) does not constitute a conflict of interest. (2) Upon the written request of the recipient, HUD may grant an exception to the provisions of paragraph (e)(1) of this section on a case-by-case basis when it determines that the exception will serve to further the purposes of the program and the effective and efficient administration of the recipient's project. An exception may be considered only after the recipient has provided the following: (i) For States and other govemmental entities, a disclosure of the nature of the conflict, accompanied by an assurance that there has been public disclosure of the conflict and a description of how the public disclosure was made; and (ii) For all recipients, an opinion of the recipient's attorney that the interest for which the exception is sought would not violate State or local law. (3) In determining whether to grant a requested exception after the recipient has satisfactorily met the requirement of paragraph (e)(2) of this section, HUD will consider the cumulative effect of the following factors, where applicable: (i) Whether the exception would provide a significant cost benefit or an essential degree of expertise to the project which would otherwise not be available; (ii) Whether the person affected is a member of a group or class of eligible persons and the exception will permit such person to receive generally the same interests or benefits as are being made available or provided to the group or class; (iii) Whether the affected person has withdrawn from his or her functions or responsibilities, or the decisionmaking process with respect to the specific assisted activity in question; (iv) Whether the interest or benefit was present before the affected person was in a position as described in paragraph (e)(1) of this section; (v) Whether undue hardship will result either to the recipient or the person affected when weighed against the public interest servadbyavoiding iha prohibited conflict; and Consolidated Grant Agreement Page 23 03/10/2010 Applicant: Miami -Dade County Project: FL -600 - Ren - Miami Homeless Assistance Program (vi) Any other relevant considerations 0041482920000 FL0211 B4D000802 (f) Audit. The financial management systems used by recipients under this program must provide for audits in accordance with 24 CFR part 44 or part 45, as applicable. HUD may perform or require additional audits as it finds necessary or appropriate. (g) Davis -Bacon Act. The provisions of the Davis -Bacon Act do not apply to this program. [58 FR 13871, Mar. 15, 1993, as amended at 61 FR 5211, Feb. 9, 1996; 64 FR 50226, Sept. 15, 1999] Subpart E --Administration § 583.400 Grant agreement. (a) General. The duty to provide supportive 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 appropriate, including repayment of funds that have already been disbursed to the recipient. § 583.405 Program changes. (a) HUD approval. (1) A recipient may not 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 participants 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 contingent upon the application ranking remaining high enough after the approved change to have been competitively 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 must be fully documented in the recipient's records. [58 FR 13871, Mar. 15, 1993, as amended at 61 FR 51176, Sept. 30, 1996] § 583.410 Obligation and deobligation of funds. (a) Obligation of funds. When HUD and the applicant execute a grant agreement, funds are obligated to cover the amount of the approved assistance under subpart B of this part. The recipient will be expected to carry out the supportive housing or supportive services activities as proposed in the application. (b) Increases. After the initial obligation of funds, HUD will not make revisions to increase the amount obligated. (c) Deobligation. (1) HUD may deobligate all or parts of grants for acquisition, rehabilitation, acquisition and reftabilitation, or new construction: Consolidated Grant Agreement Page 24 03/10/2010 Applicant: Miami -Dade County 0041482920000 Project: FL -600 - Ren - Miami Homeless Assistance Program FL0211 B4D000802 (i) If the actual total cost of acquisition, rehabilitation, acquisition and rehabilitation, or new construction is less than the total cost anticipated in the application; or (ii) If 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, operating costs or supportive services for that year are less than the total cost anticipated in the application; or (ii) If the proposed supportive housing operations are not begun within three months after the units are available 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) ay:(i) Readvertise the availability of funds that have been deobligated under this section in a notice of fund availability under § 583.200, or (ii) Award deobligated funds to applications previously submitted in response to the most recently published notice of fund availability, and in accordance with subpart C of this part. Consolidated Grant Agreement Page 25 03/10/2010 GRANT NUMBER: FL021 1 B4D000802 City of Miami — Homeless Assistance Program ATTACHMENT A-1 SCOPE OF SERVICES The Subrecipient shall provide supportive outreach services to 3,000 homeless persons (individuals and families). Of the 3,000 homeless persons, there shall be at least 2,850 assessments and at least 1,500 placements of homeless persons. This shall occur primarily in the City of Miami and all homeless outreach, assessments and placements within Miami -Dade County. Additionally of the 3,000 homeless persons, the Subrecipient shall place at least 180 homeless persons in transitional treatment supportive housing. The Subrecipient will conduct street outreach as well as respond to service requests from homeless persons and service providers in the Continuum of Care. The Subrecipient shall provide outreach, assessment and placement supportive services under this one-year grant Agreement. The Subrecipient shall provide services as proposed in the application to U.S. HUD pursuant to the 2009 Super NOFA (incorporated herein by reference), including but not limited to: 1. Extensive outreach; 2. Assessment for residential stability and supportive services; 3. Housing placement into emergency, transitional and permanent housing, or other positive housing environments; 4. Emergency housing to include hotel or motel assistance; 5. Referral and placement to all appropriate and available housing; 6. Referral to all applicable supportive services and programs; 7. Transportation services; and S. Seven (7) day follow up to all services provided. Conditions: 1 _ Reimbursement shall be limited to operations, supportive services, leasing, administration, and the costs associated with these activities as described in the Subrecipient's 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; S. 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: FL021 IP4D000801 Submission Project Identifier: FL14076 ATTACHMENT A-2 Exhibit 1: Project 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 (i.e., change due to funds being reduced). D. Number of Beds, Participants, and Supportive Services (Does not apply to RMIS projects) Chart 1: Housing Tye la. ❑ Multi -family lb. ❑ Scattered Site (Check all that apply) ❑ Single-family ❑ Project Based ❑ Congre ate Facility ** Supportive Services Only Complete Chart 2 and Chart 3 based on the following instructions. 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 i. Number of adults in families 464 N/A Number of Bedrooms N/A N/A NT/A Number of Beds NIA N/A *Do not complete information on the number of units, bedrooms and beds for Supponive Services Only (SSO) projects. In those instances, enter"N/A" in the appropriate cells. Chart 3: Participants a Current Level (Point -in -Time) b. New Effort or Change in Effort (1f Applicable) c. Projected Level (col. a+ col- b) a_ Number of Families with 232 Children (Family Households) N/A 232 i. Number of adults in families 464 NWA 464 ii. Number of children in families 1,300 N/A 1,300 iii. Number of disabled in families b. Number of Single Individuals and 1,036 ®tiler Households AT/o Children N/A 1,036 i. Number of disabled individuals 386 N/A 380 ii. Number of chronically homeless 186 N/A 186 ***', participant configuration will vary dependent upon hourrteless. HUD -40090-3a Project Number-: FL0211B4B00080- Technical Project Identifier: FL14076 Submission Exhibit 1: Project Summary ATTACHMENT 4-3 (REINTWALS ONLY) C. Proram Goals - ?n Goal: Residential Stability: At least 95% of 3,000 homeless outreach contacts and assessments will move to emergency shelter from the streets. At least 6% of 3,000 homeless outreach contacts and assessments will move to transitional housing (treatment) frorn the streets. At least 50% of 3,000 of the homeless participants placed into housing will remain housed for at least seven (7) days. Goal: Increase skills and income: At least 20% of the eligible homeless participants placed into housing for up to sever (7) -days will be linked to resources for benefits and employment. Goal: Achieve Neater self-determination: • At least 50% of homeless participants placed will demonstrate greater self-determination by remaining housed for at least seven days. • At least 6% of 3,000 homeless participants will be linked or placed directly into _Mental and or Ding Abuse Treatment facilities which will address their need for greater set f-deternu� _ation. D. Number- of Units, Beds, Participants and Supportive Services These charts need to be included only if they were incomplete, inaccurate or blare c at the time of the original application submission. Please eornplete these charts if your local HUD Field Office has notified you that they are required. Subrut only those that apply. The charts can be found in the New Projects Section of the Technical Submission. HUD -40090-3a ATTACH?,/fLNT A-4 PROJECT MILESTONES N/A FOR THIS PROJECT rr '1 Er i en I;/ er I Fr , Er.:i cr ;i er I it '1 [[ t FF 1 it it :, Er,1'PF r� rr Technical Submission for the 2009 Supportive Housing Program U.S. Department of Housing and Urban Development EF Office of Community Planning and Development `F Project Sponsor: :\ City of Miami 11_.i Ee FI<' F6� Project Dame: rp .,rte P Miami rRomeless Assistance Program (MHAP) At* E€ x kms'` Project Type: Supportive Services Only (SSO) Project Number:IF k�=amu it, ff a WAIF 4D 0" 0` 0 -1 J eej MADE _ Submitted by Selectee fT 1: s I iami-Dade County Homeless 'gust 111 Northwest First Street, 27th Floor, Suite 310 Miami, Florida 33128 Telephone Number.- (305) 375-1494 t Fax Dumber: (305) 375-2722 �y"\ /':': \ `��' �\��6A:x����\�'e f€� ��c�\e/ •\ ���!':':S \ 2' � ��\1...� /�'�' �\ � p � ��'\� �6 x � �¢'1�.-.\ Q �. `.,,F.1+^\ N V �\ F / Rr�i / L[F f/ -i_ [ /�g�i L/ L[ t-- V t.. E�F_i / Rr t- PF! ft_6r.: / FP t .` it OF., , F( t..'Cj 4,t -.._r Ft CC'. �.t _I r it ._BF,. Project Number: FL0211 B4D000801 / Technical Project Identifier: FL14076 Submission Exhibit 1: Project Summary (cont.) (RLNEWALS ONLY) 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 Cit}, of Miami Contact Person David Raymond, Executive Director Contact Person Serio Torres, Prop -am Director Phone (305) 375-1490 Phone (305) 576-9900 FAX Number (305) 375-2722 FAX Number (305) 400-5321 E -Mail Address dray a miarnidade.�ov E -Mai; Address storresna,miamigov.com Street Address 27`l' Floor 1 I 1 NW First Street Street Address 1490 NW 3' Avenue. Suite 105 City, State, Zip HMIS Lead I Miami, Florida 33128 Miami -Dade County Homeless Trust City, State, Zip Contact Person Miami, Florida 33136 I Barbara Golphtn Street Address 27`I' Floor 111 NW First Street Phone (305) 375-1490 City, State, Zip Miami, Florida 33128 E -Mail Address rmL,lntniamidade.Qov B. Project Budget - This section must be completed by all renewal seleciees. 1. Chart 1 - Summary Project Budget To complete Chart 1, Summary Project Budget, enter the amount of SHP funds requested by line -item in the first column. For leasing, supportive services, operations, and HMIS, the amount entered should be tot- the orthe SHP grant term 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 sho«m in your ori. Mal awlication as approved or Exhibits 3. 4. 5 and 6. Requested grant term: 1 year) �_.nart i - summary rrolecr tsuaget SHP Request Applicant Cash Total Project Budget I. Real Property Leasing 2 Supportive Services* 239,116 59,779 298,895 3. Operations*': 4. HMIS* j 5. SHP Request (subtotal lines 1 tlu-u 4) 239,116 59,779 298,915 6. Administration*" (up to 5% of line 5) 11,955 11,955 7. Total SHP Request (total lines 5 and 6) 251,071 59,779 310,850 *By law, SHP can pay no more than 8090 of the total supportive services or total HMIS budget. **By law, SHP can pay no more than 75°/, of the total operating budget. ***By law, SHP can pay no more than 5% of the total SHP request HUD -40090-3a Technical Submission Submission Project Number: FLO211134D000801 i Project Identifier: FL14076 Exhibit 4: Supportive Services A. Supportive Services Budget Chart 4A: 7. Seivice Activity: S. Service Activity: Ouantitv: 9. SHP REQUEST * 80% Year 1 Year 2 Year 3 Total Supportive Service Expense (a) (b) (c) (d) L Service Activity: Outreach and Placomew 230,495 230,495 Quantiry: salaries including fringe benefits for 1:.0 FTE Community Outreach Specialists includinu 7.661/o FICA/MICA, Group Health, Worker's Compensation, Unemployment Compensation Insurances plus overtime for special outreach efforts - Subtotal = S288,119 2. Service Activity: Cellular Phones 2,850 2,850 Quantity: service for Outreach workers to effectively communicate wiib participants, and office to secure tousina Subtotal = 53,562 3. Service Activity: Rent of Equipnaetat 1,100 1,100 Quantity: Satbtotal = 51,375 4. Service Activity: Emergency Food 1,200 1,200 Quantity: Subtotal = S1,500 5. Service Activity: Miscelianeous Supplies and 3,471 l 3,471 Printing ofpampWets, ii ornza!io�� for homeless and camnzu17irn Quantity: Subtotal = S4,339 6. Senvice Activity 7. Seivice Activity: S. Service Activity: Ouantitv: 9. SHP REQUEST * 80% $239,116 $239,116 10. Selectee's Match 20% S59,779 S 59,779 11. Total Supportive Services Rudget 100% $298,895 $298,895 ;''Tire SHP request cannot be more than 80% of the total supportive services budget in Line 12. HUD -40090-3a Miami Homeless Assistance Program US HUD SUPER NOFA SERVICES GRANT Contract # June 1, 2009 to May 31, 2010 PERSONNEL SALARIES & FRINGES OUTREACH TRAINEES Community Outreach Specialists (15 FTE) Overtime for special projects Total Salaries FRINGE BENEFITS FICA C 7.65% Total Findge Benefits SALARIES AND FRINGES FIXED EXPENSES Telephone Service Rent of Equipment Emergency Food Miscellaneous Supplies Printing and Reproduction TOTALEXPENSES (GRAND TOTAL ADMINISTRATIVE COST ATTACHMENT B est 801/, Cash match 20% Total Project Budget I I $ 2,850.00 ! $ 259,344.00 $ 8,300.00 $ 214,115.00 $ 53,529.00 1 $ 267,644.00 16,380.00 $ 16,380.00 S 4,095.00 $ 4,095.00 j S 20,474.77 $ 20,474.77 $ 230,495.00 $ 57,624.00 $ 288,118.77 $ 2,850.00 ! $ 713.00$ 3,562.50 $ 1,100.00 $ 275.00 $ 1,375.00 $ 1,200,00', S 300.00 $ 1,500.00 $ 3,119.00 S 780.00 $ 3,898.75 $ 35200 j S 88.00 $ 440.00 $ 8,621.00 $ 2;156.00 $ 10,776.25 $ 239,116.00 $ 59,780.00 I $ 298,395.02 $ 11,955.00 S 11,955.00 $ 251,071.00 $ 59,780.00 $ 310,850.00 Technical Submission (cont.) A. Administrative Costs Project Number: FLO21IB4DO00801 / Project Identifier: FL14076 Exhibit 7: Administration (all projects requesting administration funds) Please complete the chart below for your adnunistrative costs budget. If von+ are a selectee who will also be the project sponsor, complete Limes l through 6. If you are the selectee and a different organization will be the Project sponsor, complete lines 1 tluou(-;h b. In the first column, fill in the administrative activity to be paid for using SHP funds. In the Year I column, enter the amount of SHP funds to be used to pay administrative costs in the f1rst 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 L B. Plan for Distribution of Admi.nisti-ation Funds -- If the selectee is not the same organization as the project sponsor, attach a description of the selectee's plan for distributing its adnunistrrative finding to address all, or a portion of the project sponsor's administrative needs. Include a description of how the proiect sponsor was consulted in formulating the plan. I-ILID-40090-3 a Year 1 Year 2 Year 3 Total Adnunistrative Costs (a) (b) (c) (d) I. Administrative Activity: 2.5% to City of 5,977 5,977 Nlianri for staff time spent in compilation of information for APR -,review of documents for _reimbursement requests, audit of SHP funis 2. Adnunistradve Activity: Miami -Dade 5,97$ 5,975 County Homeless Trust 2.5 io APR preparation. staff tune reviewing / verifying invoices, audit of SHP proms am i 3. Administrative Activity: 4. Adnunistrative A ctivity: 5_. Administrative Activity: I 6. SHP REQUEST FOR 11,955 ; 11,955 ADMINISTRATIVE COSTS 7. Amount for Selectee 5,977 I 5,977 8. Amount for Project Sponsor 5,976 5,97E B. Plan for Distribution of Admi.nisti-ation Funds -- If the selectee is not the same organization as the project sponsor, attach a description of the selectee's plan for distributing its adnunistrrative finding to address all, or a portion of the project sponsor's administrative needs. Include a description of how the proiect sponsor was consulted in formulating the plan. I-ILID-40090-3 a LOCCSNRS SW *FS Special !Needs Assistance Program Request Voucher for Grant Payment See Instructions and Public Reporting Burden Statement on batt: U.S. Department of Housing OrAB Approval No. 2535-0102 (exp. 1!3112004) and Urban Develops n', Office of Community Planning and Development ATTACHMENT C 1. Voucher Number 2. LOCCS Pgrm. Area 13. Penod Covered by this Request (dates) 4. 1 ype of Disbursement SNAP HPAC I i l Partial E Final 5. Voice Response No. (5 dicits, hyphen, 5 more) 16. Grantee Organization's Name 8. Grant No. 6a. Grantee Organization's TIN 9. Line Item no. i Type of Funds Requested I ,rnoum troune io nearest canar) 1010 Acquisition 1020 F3ehabilitaticn I 1021 New Construction i 1022 I Substantial P.ehabilitaiion i 1023 11 Moderate Rehabi§nation I � 1030 Operating Gos? 1044 I Rental Assistance I i 050, Supportive Services 1060 I Administrative Cost i 1070Chiid Care 1080 Ernipfo_vrrent Assistance I 1090 Relocation 1100 Leasing j I 1110 Fepair $ 1`e(daintenance 1111 Prevention (RH) 1112 I Capacity Building (F1H) 1120 I Other. i0. Voucher t'otai I hereby certify that all the information stated herein, as well as any infornation provided in the accompaniment herewRh, is true and accurate, Warning. HUDwill prosecute falsec€aims and statements. Conviction nay result; in criminal and/orcivi; penalties. (13U.S .1001,1010,1012; 31 U.S.C.37 23, 3802) 11. Name & Phone Number linciuding area code) cf the Authorized 12. Sianature 13. Date of Rea, uest Person who called SNAPS System VRS Privacy Statement; Public Lav; 97-255, Financia! integrity Act, 31 U_S.C. 3512, authorizes the Department of Housing and Urban Development (HUD) to collect all the information (except the Social Security Number (SSN)) which will be used by HUD to protect disbursement data from fraudulent actions. The housing and Communirp D1eveioprnsrtAr ,& 1987, G2ti S.C.3543, eLihorizes HULL to 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 promptlydeletad, Provision of the SSN is mandatory. HUD uses it as a unique identifierforsafeguarding L.GCCS from unauthorized access. Failure to pmvide the information requested may delay the processing of your approval for access to LOCCS. 'This information will nmbe is herwise cfizcfased or released outside of HUD, except as permitted or required by law. Fetain lois f. rrrl it your records for audit .surpeses page 1 of 2 form KLID-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. T nis information collection is to request payment of grant funds orto designate the appropriate officials who car, have access to HUD voice activated payment system. The HUD voice activated payment system has been especially designed to help the recipient when 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 Speclai Heeds 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 '038' if funds are being requested for a Housing Opportunity for Persons with AIDs (HOPWA) competitive grant. Enter '054' if fur -ids are being requested for an Innovative Housing Program (IHP) grant. (If you do not know your 3 -digit program prefix, contact your local Field Office.) The remaining 6 digits will be assigned by LOCCS/VRS 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 specific funding categories called Budget Line Item (BL.Is). 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 form in your records for audit purposes page2 oil form HUD -27053-A (2/95) PROVIDER NAME: PROGRAM NAME: CONTRACT# MONTHLY INVOICEMIAMI -DADE ELESS MONTH: T R U S T ATTACHMENT C-1 :::� PPOSIT SUPPORTIVE SERVICES 80% "V T.S. % REOUS7 - $ $ /O _ Total otai cxpens�s Program SHP Expenses J Reimbursement Year to Date Year: 1 2 3 Total Budget For The Year SHP Exp YTD o 0 of -p YTD -.a. ..lt +� "`h ..rrttr'i�v '� 's .�. • ,:. ., .: _ Y! -c,. 8 iY�, t+ ^#�Y ch^A .4..:i E '�-'"'r POSITIONS 0% $ I $ $ $ $ - #DIV/0! POSITIONS I 0% #DN/01 POSITIONS 0% - #DN/0! POSITIONS 0% - #DIV/0! POSITIONS 0% #DMO! POSITIONS 01/ DESCRIPTIONS 0% #DIV/0! POSITIONS 0% I #DIV/0! POSITIONS 0% - - - - - - -5D-1v/01-POSITIONS 0% - I - - - - #DN/O' POSITIONS 0^/ #DIV/01 POSITIONS p% - I - - - - #5IV/01 POSITIONS0° a - #DIV/01 POSITIONS 0°/ _ _ - - - #DN/O! POSITIONS 0% - #DIV/0! POSITIONS 0% - - I - - - #DIV/0! TOTAL SALArZIES $ $ $ $ - S #DIV/01 Fringe Benefits - e 0% of SAL- 0% $ - I $ - I $ TOTAL SUPPORTIVE SVCS $ Total Sal & Fringe $ - $ - $ - $ - $ - #DIV/0! YG .v. .:,.dna - ., '�.i,:, ..o -i. � - .. .,ms:.µ,,. —. �.^-�C�il'+d _ _ v-; �1Y�t�•-„�T� .,':�Y� Sn;P`�"�C�=" 3.o-✓ �� �� "°�� IuN5 0% $ - $ - $ $ $ #DN/O! SCRIPTIONS I 0% - #DN/O!SCRIPTIONS 0%#DN/0( SCRIPTIONS I 0 /#DN/O1 [DESCRIPTIONS SCRIPTIONS I 0% I - #DSCRIPTIONS 0% #DIV/O! 0 % #DiV(0': DESCRIPTIONS 0% I I #DN/O! DESCRIPTIONS 0% #DN/0! DESCRIPTIONS I 0% - - I - - - #DN/O! DESCRIPTIONS 0 % - #DN/O! DESCRIPTIONS 0°/ ' - - I - - - #DN/01 DESCRIPTIONS 0% I #DIV/0! DESCRIPTIONS 0 f { #DIV/0! DESCRIPTIONS I 0 % #DN/01 IFTotal Supportive Services $ $ - $ - is - $ - #DIV/01 TOTAL SUPPORTIVE SVCS $ - $ - $ - $ - $ - #DIV/O! HT/PROJECTS 4/120082:01 PM HT/PROJECTS 4/120052:01 PM Year to Date POSITIONSJDES%RIFTIONS % Total Expenses Program SHP Total Year SNP Year: 1 2 3 Expenses Reimbursement Expenses a o or p P YTD P x c 2R�_t aid .a ♦ �V :F -i . .�'_'�D'��,+.4 ��i �..::1 � i ^7�'..�' �t .+.*�S�R'it` h4+ !�,�1-r j _ �`'gn�4+'i�°-F.es���iW i.� �a �+�"ih4 l'r+?s,� �A � �1+� � � POSITIONS 0/ $ w f _ POSITIONS g $ j 0% _ $ $ #DIV/0! POSITIONS _ 01A #DN101 POSITIONS 0% #DNl0.' POSITIONS 0 #DN/O! POSITIONS Oaf #DIV/0! POSITIONS 0 #DIV/0! POSITIONS 0% #DIV/O! POSITIONS 0% #DIV/0! POSITIONS 0 i #DIV/01 POSITIONS 0 � #DIV/01 POSITIONS 0% #DIV/0! POSITIONS .,o, #DIVl0! HT/PROJECTS 4/120052:01 PM 11a HUD Annual Proc-ess Report (HUD--;Oa1S) Report Options: I ides 'ii�mi Gads_ �ounhGoverrmen; (1 e' a!- g Ye ,Date Ranor O F rc ? 1 1 CQ6'I r•',rm/u'ui Y. y y cgal Adult Age �f us de F,^ec by rester Ca'e /Z;'1,' n your stet-, .......... { Or iU !LAG -select - 2. Persons -Served during the Number of Singles Number or Adults Number of Children in Number of operating year. Not in Families in Families (Families Families iJumbe,- on the first day of the 0 0 MENTD'��:" 0 operating year. F ATTACH I !!! b. PJumbaI-tin ring progr'an during the i ( O 0 0 1 0 HUD Annual Proc-ess Report (HUD--;Oa1S) Report Options: I ides 'ii�mi Gads_ �ounhGoverrmen; (1 e' a!- g Ye ,Date Ranor O F rc ? 1 1 CQ6'I r•',rm/u'ui Y. y y cgal Adult Age �f us de F,^ec by rester Ca'e /Z;'1,' n your stet-, .......... { Or iU !LAG -select - 2. Persons -Served during the Number of Singles Number or Adults Number of Children in Number of operating year. Not in Families in Families (Families Families iJumbe,- on the first day of the 0 0 0 0 operating year. F I !!! b. PJumbaI-tin ring progr'an during the i ( O 0 0 1 0 operat!ng year. II e. Numberwho !eft the prooram during0 j 0 0 0 the operating year. I �d. IJumberin the program on the last day 0 0 0 0 of the operating year. Number of Singles Number of Adults Number of in Number of 3. Project Capacity. IIIChildren Not in Families in Families Families Families a. [umber on last day (From ?d, co!u ens o o 1 and 4) I 4. Non -homeless persons- (Sec_ S SRO projects only) -iow.many Income -eligible non -homeless persons were housed by the SRO program during the operating 0 /ear? i. Age and gender. (Age IMlale (Female (Other/Not oiiven ,ingle Persons (from 2b, column 1) Ia. 62 and over 0 0 Q �b. 51 61 0 0 0 C. 31 50 U U 0 d. 13 30 0 n 0 �e. 17 and under 0 C 0 Not given I 0 0 I 0 ersons in Families (from 2b, columns 2 & 0) �`• E7., and over C' Q 131 h I I I I I IbC, Veterans StCtus. 5b. Chronica{ly Homeless. �� �p,hrti�eis v.� �_ c r^r� �nliy mete, indnia_iuic r I7. Ethnicity. �a. H!spanlc or _atino 0� , bflon-r'in i c r 1,1 n - L , I&. Race. I 0 a_ merican indlan or Alas:an [,dative AAsa" 0 I� b. c_ Clack or African American Id. f, aDbve Hawallan or Other Pacific Islander I 0 I O e. White f. Amencan Ird'an/Alaskan Native & White S- Asian & V✓hite h. 51ac�;�African Arnerlcan G.✓bite n . American Indian/A.laskan Native & 212ck/African American 0 j. Other 11ulti-glacial 0 k. D_her/Un :nDwn (all that da not rnatchl _ I 0 9a. Special Needs. i All I Chranic , a. Mental iIL ess b. Alcohol ab!se � 0 � 0 c. Druc abuse 0 I 0 E Id. HIV/AIDS or related dlseases 0' E e. Developmental disability I 0 I 0 f, Physical disabillry 0 I G 9. Domestic vic'enre - I - C I 0 n. Other (please speclfy) 9b, Disabled. Hc,.v many of Che participants are disabled? 10, Prior Living Situation. I All Chronic a. 'Jon -housing (street, park, car, bus station, e,lc) C I 0 Ib. Emergency;helter 0 I 0 c. Transitional housing For homeless persons C Id. Psychlatrlc iacillty 0 =Sut-,Lc�n,-,�2DUSE- irec[rni--lt i��[i ,.� I O I If. Ho;pltal I �� �g, Jai�;arison 0 C Amon.,. a n Of t 11 t 7. 1 P ?.'O 7 1 j 0 ChFc7ic C t7 - C n d. 7 mcmns - 12 months IL. 1:3 mcn.-h5 - 24 months c, 0 0 0 f. 25 month; - 3 years g. 4 y e 3) -S - 5 years 0 C -7 h. 6 years 7 years L) 0 8 year, i0 years cj L over 10 Ye"T-5 12b. Lergth of Stay in Program. (Participants who did not leave during operating year) 0 0 E1� Chronic a. Less than MDnth I o "heC S I C il �0501 b. to 2 aon hs c. fS months o d. 7 months - -2 months . 0 o Source C. Income Sources at Entry D. InCOMESOUFce, at Exit a ip lemSec_rj,/ jrcc,e (Es1) pii Ch,,,, Chronic b.EDds7bjMc/ Insurance (S--E C C- s3daleEin C, Ici. Gene -al Publjc Assistance e- Tempora,-vto N'eed,.,� Fa7illes (T ,'-, N' F 0 f. State --hijdre'I's Heal,,7 "nSLI'Ence pFOgF7Dm (SCHIP) o 0 Veterans benefits j 0 h. Empicvmpnt Income I. Ur-,emp�oym, ent Be,7e-F:15 0 0 C 0 j. Veteran's Health Care 0 0 0 0 rn. Other (please slpe-iiy) C, 0 G 0 n. No financial r-csCU.-CC5 0 Length of Stay in Program_ (Participants who left during operating year) 11 l Ali -Chronic Ia. Less than -nonch b- I to 2 months C, 0 c. 3 - 6 months d. 7 mcmns - 12 months IL. 1:3 mcn.-h5 - 24 months c, 0 0 0 f. 25 month; - 3 years g. 4 y e 3) -S - 5 years 0 0 0 h. 6 years 7 years L) 0 8 year, i0 years j 0 0 over 10 Ye"T-5 12b. Lergth of Stay in Program. (Participants who did not leave during operating year) Chronic a. Less than MDnth I o b. to 2 aon hs c. fS months o d. 7 months - -2 months e. 13 m -q,-, 72 months f. 5 months - - Ea, -s o V: C I - P". L c �e C IJ I,C' r r GI l pa syr rce g. Nced ceu!,not uMl E) prole L h. 71 ,.gree Ent wl'h rules%Der�GnS -- i. Death j. her (pi �sr spe y) lc. Un':nown�sisappeared _ 14. Destination. PERMANENT (a - h) �a_ Rental hcuse or apar`ment (no subsidy; TRANS-TIONAL (i _ i) INSTITUTION (k m) EMERGENCY SH_LTER (n) )THER (o - q) INKNOW N S. Supportive Services b_ Public f-Icusing C_ Sec ion S !d_ She! PJuS Care e. HOME subsid --ej hcuse or aparmenr 'f_ Other subsidiued mouse 0- apa7tment Ia. Homeownership h. Moved in with family or Prie.,ds Ii_ Transitional housing for hone!ess persons Ij. h1cved it w(ah fanl!y or friends k. Psychiatric hospital Inpatient EIcchcl/drug treatment ,"acil'ty m. Jail/prison n. Emergency snel_er 0. OthersuDpertive hous!ng P. piaces not rneent for hun-,anrabltation (e.g. street) q. Other (please specify) r. Unb:nown vo supportive services found. All Chronic 0 i G D 0- 0 j 0 0 ' C 0 0 c� 0 I p 0 J � 0 0 o 0� o, -01 1 0 I 0 0 0 Servicepo nt version 4.01.015 (db build m0723) Licensed to: Pvliami Dade Homeless Trust 1999-2006 SOV✓nlan Systems L.L.C. All Rights Reserved. PT 11 C, r..i T -_Lc r , 3f, - u'.'S �� i� ;.yr'nl ;, `trr�.lrl. r.VV,ijj 7c EE C (_ar"14 read alf cif t; u _ IP.. ir'vCC1Ur'iS i�C�t-��� �i (lid,p t� 1 OW r)rUSHM Pam Opan t>. �C11Cra:II11f)Tr:!1,]UIl _FUDI Rapng a F S a n __ C n on win za 0 1:._ no V u S 0 a 1 ECIC .I!il� _ _�'.LI & am Twnvm2.ri_ri j rroQar. K is to be comVcni!;rU�r .'1 pali c paw _ i _ p SC CSS Ci G 'i -Ci iL�it %G pfo�ram11 m us1 It Comllloted - sn a m : rinin - w Amc of Kckyp W1 al l YNCTIMS it Is stron`l} r C'Gl.'.] i ilii', a 'I'Ov'�.'ir RZ]Lin` o sapsomon r , , aiso DE' C—m) tt,Cl_ i h1tC'nis as , 2` , , i � nit, h �ppliCablr o the p o°ri ll, h� �e'ver. ON! the ls. , �r S ;:', cVil,L1Si t� C! Mrd d l0 r, 7OP,leless Trust. C:'se manaLtnnnt nO. S sti o d in!d =t sp Cir�,ia�;1 ivas not obtaincd If that is the Case (chem wo &VO , WKr'.:tl EaNzej. .-,al clfO s 'ta,_, c to obtain a survey in those instances. --he 40=111 11202 f S2 -,-rj; �e i n ' � l `;pa sh d Cmol ^ j ;- spo s e_ i�. �:on is �r�i1�u, _� � 1sh, ... an _te.. _ ,) :s .e n_.bIc fOr Ieproduciri? Eht pprop'iye; su'ri, )' rd r'r'JV1din , an e:'.vdope (that secis) fc, c 2li resporide._.. A,.111 responses shcu?d be colnpietcd in __L "a paNc'pantcar-not read_ Troviders should' eniAui"aD7e them to us-, tGe SaiiOpioctss the; use to }; Win Abr-Iation read to then;. An erh0'iyn of K agency Thar is nor Cfiecjy responsible ST the Clem -s c? --e Car! .e2d -L:'e f0i u. TIIis Shoili7 bt indicated in Scno-ri IL as _ ypamy so of smg 1r1 nAs. Filliri, out the form 1) A Anaua nE . ,-r _ �� arp� pr,ri�_e SllNc�' and aI7 envelope should be r.Ovlucd iC, . pai..!� Ir�1:?S WhC gL:re❑ i0 C7:i,pl2t? the IC-, Cr Oro fOT r I r7i1 ' is required.The form .n.:L'I: be Red CL , 1I"! !!L:. 2) Sec don T1 of the P 0``2-21;] R3;'Il` Qi !.1 ,J s n C :r7:ew b sIE I T. ,3 IG p! C ' ui1iR r11e S _1�cti�r_ i _ be oi� sur' Cv document to the program mart C.parii Staff WAR refers ;O 11iC i, iai- 'C. :,`.- C.Lsc II L1 n,2.,;cr respons!ble K the cHent'S ser'v'ice dobver}'. If the survey nim be read ''0 '.Iio Mean the OWN UK, Skiff DWS011 perI0 T7& That Emcnon UK a1S0 be incl &a. Li no Case should tliE Case manaQcr read items aloud to the participant. 3) Section I of the Propranl ad,,of Satisfaction Form is t_' e i,lle' out ONLt" b the program plamcTav The Tvog m pa±cijD nt should be provided a phvale place and suAdel:� rnt to ns OF 7 a C '7 , 1 i , n v,� the sura y- =') pro','iders should reassure participants of the coif &!i:iAQ Oftheir responses- %VidCi-S may ti,V n to intr0ducc the summy, as foHo"s: Tn!s survy, IS Q way sof hAp111g us det=m:ine how tt'CII mp Llrhelp,irl_ indl','ldunls Ihri, Comm t0 Our agency 5DF 2sSlst.111Ce. Kasc is c 3 f ` I191r'�.'�� n I Pan to ails',,'. i v i ` h � � ` �' dos ; C r,,' shoe survey as honestly as possible. ','our response_, are primate and "t M ]tot loos: at then], 1PleasC scfa: the Cr!VEh*A and t`i1'e A to nit ,'&on )'OU ars_ d c (oF Cul A in K drop boxy" =� the C=iI77pICI? sur' SiCu::G Lie plaCou 11l 'Q en' dopa by Of r& An[ and staled, Pro"ders A 71.0vae a Mtn box "Oh h a SO or Comploi 7 tOr11IS. - Th se'i._j _nve5D S} Cil�d .ie I�'t '.�1r� !� ins the 1',&M o'd- Co" -.7'r" t.a!1C�osS i Pu,t or, ilrrll� C p2—Wer 3g= 1C santii� i 3'.rtiu; a :oL, 0f nov,nian, su.-, e,, s are "T! F A, CTI L ff.'s — -- _ Is Inr� .cst�r�ih�linrs 1 "os pmvOwd wN inAVrm,Imn about diHEum scn mm (hm ;, _. ;il il, r fnr m, F ITY—S LOved in nl::kmg Kamm Mac m, cjrC�5Ci%vc pinn c I �+usahie io talf. �si:h staff •,,lien 1 nreuc� tri � -- ---- The tciidinand facilities liu�e usuu{!) herrn cican, s? c aru I r rnrnfnr? Aly nghts wcrc respuned and Tromctcd, including nnr?ht to Glc a �rrievance, if needcd My case mnnaLcrseemsgunli led to help me _ J would rccornmcnd this program to nihcrs _ S 1 am treated ivith respect by the staff -- , Tire staffseems to care about ,. hether 1 Eet better Progr-.1m staff 1rere knoivledgcabIc about available scr-, ices S f that c,.wld help me 11171 ,-ED Pcl.UlvIt`-�.-wL.__ 5"7 r 0,11 I WIL, PR 0 G RA I FLA TI C, 0 F T I S F--� G T f I- I T f r)T) T I 1" 1 7 ' 11 ' 11 _V/ t � L2 H did 1'Ou chr)u„e to enter [he pru" rLI ri ] f n -'Li I -I r-, 7� 0 �j e hog:): Cr'7 T7 DIO L' C! 6 a C) „_1(_,-,1] _,:]_ i?: "i $'1111 E C" I--, a T -I L" CFCI OPTIONAL Information: Name: --- Todjti's Date: Please alswcf- ------------ of Ei,ahi,7zian llc L11C 0� /1� 'A desCrihcs "?11c scr: CJ on:, hoi.isinr,/[I I Frojec( �,jme- So 41L )SOLI fell 115 /10 Iv YoLi r� -azf 11 _"C C 1, 1C11 L' th Ito iz is °-Ood Or h112. D 1, Tn .- F '-' I I U n L' 17 Ce5 OFIV I etas for -mad of n,,rialits and resDc)rjsjbjjjtjes, r I L nduding Ihe 2uenc) procedures FT — p provjdEd with IFJO=,31iDrl about dffercrllt 5 C r"' C that Le 2vnifAle for me W25 im'glvec , making C ;-R io I I s a b C u I m CDrefsen'�Ce P:'Tj 1 12 talk Frith staff when I needed to 01 Ji The b j1din, 2 n d fDC:]i1j2S 112vC LISU211y been clear, safe and cornfart-c-bit My rights were respected and PTo:ccted, nciudir- my -i right io Nie a —e' needed M " —c2se al:ln--2er seems c u a )iF)ed to h, -In 7je obi f,i aJ F would recommesc ;his 2 r2 TTI 10 otheFS31 I am treated with resp -et by the staff The st,,f'secrfls to care about whether I tet better 12 J serrices that could help me Section FT.: TO 13E COMPLETED BYFR&—,PA.1M STAI p ------------ of Ei,ahi,7zian LU'-'-Cw Lel'ei of CCIrC ['r v icle�/ CMI ere--;iCv hcusinE, F, I i dc r N :j rn (f: CJ on:, hoi.isinr,/[I I Frojec( �,jme- F- trajlsitlomli h o Unon ts n I IL, Is: D 1, Tn .- F '-' I I U n L' 17 Ce5 OFIV J1A-%I1-D_-kDF CO NTY J'UMELLS N T RL �T F�'s_LL . C10N DL L.A SATI T CCL "I" Q1 I Ll!` �i'�f•1_,,,_ ,u_^ -: �c � Ot c7 CSrc ,, .l C -'i :� 7L�IC; 1(J 11711i�/, .!.' .r:' ;r F, �arna. Tr),� 1.S rz�s resDt,cs;�s' rnanlcrrd'tur r r, Yor que uccidI u�iec, perticipar en ei programa' ( lnrque una cas�l!u s nuj: per,mt Caen: f rui cr.ijr roGcia. �:[c.) cn contra d mi : cl!ntau �'a hoeia paIZic Pado en este ora �f7-1a r Informacion OPCIO\'.AL: Nombre ), apeilido: Fecha de hog: Por fpvor respa'rua a lasl7re�>unras srguientes acerca de i'ns senicios que se Ic hart presrsdrr. ; ndiuue cnr, unrr crit;, �.Aj E1' b UI�W SOiA C4SILL A POR P-PEGIr 'T� is forme �n yc�e usreu se S.�t.'�' acerco c'e cctc/c arra Z4< las c;,esiiotres descrirns. COJIIp c,15 IESIIU°Si GS U esI,Zs prem urllpS 11UG Cl „tcZcirfll, �. .I; C�D'JI los Serpi Cl OS y[: err?re�rQl;rus, /C iJ� ri;l: US quP 1lOS %',l� l7 „1Jr'� Como se sienre en realidad de rurFS, ros senuicios, rra imp r;a Si usrec( l�;s eorsidern Buenos v mains. iu, de ( De s i"p de alto cc Er, �lu� c a uerao ct1 arum -de ! de51cac Ju uesscuerdo d0s1cuerdn 7 77 is i) "� Se n informaron cuaies eran rnts derec}�vs �� - -� ( resFcnsabilidades, entre ellos, los procedimientos de la j agencra para scmerer auejas. _ Sc m- dio informocion sobre lo= disrin-os servicios , los 16 =) [ t aue 'ergo derzcho. Part;cipe en is .oma de d cisicnzs re;zrenizs a MJ plan(I) Curr 12N" Let'tl of Car prorrded ^ i Admi_sion O de 2,ten6611 y servicios C . ,.,i?iorrZl nousin�it�. P, oiec(N rte: Cr u mer: Pude hablar con Cl persGrat cuando iu•, e necestdad de SCafi lniricls: �. � � p ztanur� hcasin_, I hacerlo. � O excites oris' Cr EI entr0 ysus servicics por]o general se hon mantenido lir➢DiOs, sin peli2ro y accesibles. Se resnetaron�t y prote�ieron mis cerechos, entre cNos. -nt j 1`J -) der -echo a someter quejas Si to considero necesario. Aporentementc, la persona encargada de mi csso sane to [6] J a u e tiene que hscer para 2%�ud2rmE Yo ies recomendaric este provmc a ctras persot,as. [^; Los empleados me trataron respetuosamente [61 !=) )=] 1 I Aparentemente, a los emPleados !es interesa que �,o : [6J L1 =11 int iii mzjore. _ � _ Los cmplendos sabian que servicios pbdian senirme de avuda. Seccinn I.T.: CONIPLET.ADA POR F.MPLEADOS DEL icomplctcd by proEram staff P;rrpo.tc of Evuluariort Curr 12N" Let'tl of Car prorrded ^ i Admi_sion O P, ovider me: C . ,.,i?iorrZl nousin�it�. P, oiec(N rte: Cr u mer: l ;_� ��arsitio�aJ n�Lsno , non�r: SCafi lniricls: � � p ztanur� hcasin_, O excites oris' F, (-) U E S-; Tll-'FAJJ- VON f I/ L !Zi ri C,'faA h lC. L, !7,:r" ?'NN!'e 2 P F (lr 'T 2, T ' Ll '-"I �17 1 2 I'ATISIPE NA r( r. n Lhw:j i) II Se T3 r,i c 1) c, r iin s i � ;2 irr.r Scc1) rnl,err s c r -.f 0 u I tc I] P:) t is ire nun Son p,p r:j r linL: I I, F n fO m Li 5, or. Non: Leat Jod va Tampri 5,12"yo ja,71-� s, -'-vis it, Feyo.,, i.-wcz/xj iya,!, C'71 i ""alcheavew" s 0!7 Ic 1-:1201i eaL, ?.Toll hcl-v IzOil FL'Tolls - ;S l::LV'l:jj-p nve w, ke !; h,,,il-, o,� pa, Bonj:j ;,fm Flu dakb tou oi-,I: cj�,) Yo Fcln Lollner, 'Plenvc.ri 11 ak- kC)tj[TjLr maven nan a)nns 13 ,T, -C o n N Ir") FE, 2 VkC.r _s 0 L, d I I t-2 F, s c d Is k e r eri Mlverl to p ,11-1 r I'll, 2 v L v o, e d, 5 ou tou 1) is (0,,,,ib you r -m,, ci-, vo Ko te 3 2' bil diii r) u been p �,,6 p, ',- on, fb bon sekjfljfe Tout d�,,,� m It 7,2spLkTe P�i'oteje mu= dwa m, you [ J' rn,,ven to pole pjcfj T si neses,> .Nouji kap ok�pe j.,2 mv.,pr C) L2 n s 3 ,1 b I e I i kali: f), e p Ij f 61 1�1 1-21 7 1 I-) e Id - i e M f wen to 1: T- c Qrna!'Ge P-Ogr-n 5j:j 2 ba,,- lot moor, A.M P w c y c S 2 n b I c V-) —eman enter-ese n2n T-,,,vETi mrpj�Aj}e pwogr-om tL' byen enforne scu tnutse,'!s JJ [6j j (4j 13) j I J Section JI.: IQ -BE CONUTFTED 1-3V I'ROGE-AM STAFF Pu l r Sc o,/'- r-,allo fio!l Cure r,-) l'iA-cl A ch on n c,, h >usin u I s c 1 E- orLli pt i MJ ATTACIINIENT P CLIENT CONTRIB�;TIO-' REPORT N'ANIE OF AGENCY SL13NUTTING REPORT: DATE REPORT SLBn1ITTED: G RAI>IT N-UNIB E R: REPORT COMPILED BY: MONTH OF SERVICE -- CLIENT NAME. DATE OF BIRTH: / / IDENTIFICATION N`LTM- DER#: _ .HATE OF PROGRAM EN -FRY: ITe'COME: ANTO T FORMONTH SS V SSD (DISABILITY): S SOC. SECUTJ T Y: S AFI)CITAl"dF: S FOOD S T AMPS: S VETERAN'S BENEFITS: S E-KPLOYINTEN'T: S OTHER ( CHILD SUPPORT S ALIMONY, WORKER'S COINIP, ETC.) MEDICAID (Check One): ❑ Yes ❑ No S TOTAL ADJUSTED MONTHLY INCOME TO'T'AL: S AMOUNT THIS MONTH TO CLIENT TOTAL: S y AIVIOU NTT THIS NION AH TO PROWDER `v M14XENRTM 30% OF CLIENT1 'S ADRTSTED INTCONTE Revised 712/3007 U. S. Department of Housin and Urban Development Office of Community Planning and Development ONGApproval No. 350n-0;45 iexp.11/30-20G^i ATTACHMENT G Annual Progress Report (APR) I= -= Supportive Rovsing Program Shelter Plus Care 4m See fion 8 Moderate Rehabilitation for Single Room Occupancy Dwellings (SRO) Prograw, Fun -40; i 8 Public reparting burden for this collection ofinformation is estimated to average33 hou,s per reponse, including the time for reviewing instructions, searchin.- existing data sources. gathering and maintaining the data needed. and completing and reviewing the collection of information. This agency ma} not conduct or sponsor, and a person is not required to respond to, n collection of information uniess that collection dispiays a valid OMB control number. General Instructions Purpose. The Annual Progress Report (APR) is a reporting tool that HUD uses to track program progress and accomplishments and inform the Department's competitive process for homeless assistance fundi,-tg. Filing Requirements. Recipients of Hl ID's homeless assistance grants must submit 2 APR's to HUD within 90 days after the end of each operating year. One copy of the report must be submitted to the Community Planning and Development (CPD) Division Director in the local HUD Field Office responsible for managing the grant. The other copy must be submitted to HID Headquarters, Department of Housing and Urban Development, Atm: APR Data Editor, Room 7262, 4:,1 7"' Street., SW, Washington, DC. 204410. Failure to submit an APR will delay receiving grant funds and may result in a determination of lack of capacity for future funding- An APR must he submitted for each operating year in which HUD funding is provided_ Grantees that received SHP funding for new construction, acquisition, or rehabilitation are required to operate their facilities for 20 years. They must submit an APR 90 days after the end of the first operating year and every year throughout the 20 years. A separate report must be submitted for each HJD grant received. For Shelter Plus Care (S -C), a separate APR must be submitted for each STC component. For those grantees receiving an extension, a separate report covering that period must be submitted (see Exiensiorl below) - Record keeping. elow)-Recordkeep;ing. Grantees must collect and maintain information on each par —Licipant in order to complete an APR. Optional workshee`Ls are attached- The work-sbeets may be used to record information manually or to design a computerized system to store and tabulate the information. The worksheets should not be submitted to HUD with the APR. Organhmtion of the Report The APR is organized in the following manner: Part I: Project Progress. This portion of the report describes the progress in moving homeless persons to self-sufficiency, documenting services received, listing project goals, and accounting for beds/units. Part H: Financial Information. This porton of the report is completed by all grantees receiving funding Lander STIP, S C, and SRO. Final Asset€€€rly of Report. After the entire report is assembled, number every page sequentially- Mann any questions that do not apply to your progr-mm with "NIA" for not applicable. (See Special Instructions for SSG Projects below.) Definitions of ClientfHousehold Types. Each clietivhousehold type is defined below. Note th t a client's client'household type should be based on the client's age andlor household composition at t e prop -ram, erfry dare closest tc the start of the operating year. Families — A family is a household composed of two or more related persons, at least one of bo is a child accompanied by at, adult or a juvenile parent. Singles not in Families — Persons not accompanied by children, including preguant women not accompanied by other children and unaccompanied youth, are singles not in families. When two adults or two unaccompanied youth present together for services, each person should be counted in singles not in f milies.. Clients' household staters should be determined based on their household composition at the pr ograna entry date closest to the start of the operating year. This means that pregnant women Aspected to give mirth daring their program stay should still be counted as singles not in families. Adults in Families — Widiin a famiiy, an adult is any person. 18 years of age or older. For the purposes of APR retorting, the determination of whether a person is an adult in family should be made based on their age and household cornposluor, at the program entry date closest to the start of the operating year. Children in Families — Children in Families zre deemed as children under the age of 18 accompanied by one or more adults (Darent, relati-ve or guardian). Children in families also include both a juvenile parent and :Ire parent's children, For the purposes of APR reporting, the deterrninabon of whether a person is a china in family should be made based on their age and household composition at the program entry date closest to the start of the operating year- For exatr_ple, HUD4011 S ciieiits who are less than 18 years of age on the first day of the operating year or at pro_gam entry i if they entered during the operating year) should be counted as children even if they turn 18 during the course of the operating year. Persons in Families — Persons in families includes adults in families and children in famiiics. Other Key Definitions. The following terms are used in the APR. As indicated, in some cases, terms are applied differently depending on whether the finding is from SHP, S+C, or SRO. Chronically homeless person — HUD defines a chronically homeless person. as "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) year." To be considered chronically homeless, a person must have been on the streets or in an emergency shelter (i.e., not in transitional housing) during these stays. i -IUD's definition of a chronically homeless person is based on the following components: s Unaccompanied homeless individual: an unaccompanied homeless individual has the same characteristics of a Single not in a Family (described above). Disabling condition: see the instructions under disabling condition (below) to determine whetraer a client is disabled. Did not leave the program — This term refers, to clients who were in the program on the last day of the operating year. Disabling condition - 14UD defines a disabling condition as: (1) A disability as defined in Section 223 of the Social Security Act; (2) a physical, mental, or emotional impairment which is (a) expected to be of long -continued and indefinite duration, (b) substantially impedes an individual's ability to live independently, and (c) of such a nature that such ability could be improved by more suitable housing conditions; (3) a developmental disabituty as defined in section 102 of the Developmental Disabilities Assistance and Bill of nights Act; (4) the disease of acquired immunodeficiency syndrome or any condirions arising from the etiological agency for acquired innnunodeficiency syndrome; or (5) a diagnosable substance abuse disorder. Ezatered the program — Entered the program refers to the ,est day a client receives so.—vices- For a residential proms am, this date would represent the First day of residence in the program's housing. For services, this date may represent the day of pr o4 -am enrollment, the say a service was provided, or the first date of a period of continuous participation in a ser -Oce (e.g., daily. weekly, or monthly). For S+C and SRO programs, the program ettLMy, date is the date that the participant starts to receive rental assistance. For S+C, services provided prior to this point are recog ized as necessary for outreach/enrollment and are eligible to count as match. An Extension. APIA applies to St~ -P and S+C grantees that requested and received an extension of their Crane tern, from the HUD field office_ The only difference between an APF for the extension period and the regular APR (besides the amount of time covered) is the signature page. Grantees should circle `fives" to indicate :he APR is for at, extension period and circle the operating year for which the repot is an extension For example, if the grantee is extending year 3; the grantee should submit an APR as usual for year 3 and submit another APR for the extension period, indicating the second is an extension and also circling year 3 on the signature gage. Gr2ntee rneatss a direct recipient of the HUD award. Left the Program — Lei} the program refers to the last day a client receives services. For a residential proerarn, :his date would represent the last day of residence in the prograti 's housing. For services, the exit date may represent the last day a service was provided or tie last date o a period of continuous service, If a client leaves the program temporarily (e.g., for a hospitalization) but is expected to return. within 30 days, do not count that client as having lef, the program. For S+C Fro: -arras, the prpgram exit slate ref—_s to the, late the particip int stops receiving. rental assistance and is not expected to return, to S+C assisted housing. If the participant returns to SyC assisted Housing within 90 days, tine person should not, be considered as exiting from Lhe program. if tip person returns to S_C assisted housing after 90 days, that person is considered a new pa-Licipar t. i tie ovorl sheet is designed to capture this Liforrnation. HUD-4Oi 18 Match for S+C is the value of supportive services received by participants in the S+C project which, in the aggregate, must at least equal the value of the S -C rental assistance provided over the life of the project. For SHP, match is cash used to provide the grantee's portion of acquisition, rehabilitation, new construction. operations and supportive services expenses. Operating year — For STIP programs, the first operating year begins after development activities for acquisition, rehabilitation, and new construction are comp)etc, after a copy of the Certificate of Occupancy is sent to the local HUD office, and when the first participant is accepted into the project. For projects without acquisition, rehabilitation, or new construction, the operating start date begins when the grantee accepts the fust participant. For dedicated HMIS projects, the operating year begins when any eligible cost included in the approved proje--t budget is incurred_ 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 with the effective date of the Housing Assistance Payments (--IAP) Contract. To determine which operating year to circle on the APR cover page, begin counting from the initial grant operating start date and include renewal mr ts_ For example, a project receiving an initial grant for three years and a renewal grant for two years would circle year 1, 2, and 3 respectively on the API? cover sheet for the initial grant and would circle 4 and 5 respectively for the renewal grant. For any future renewal grants, the grantee would begin by circling b on the APR cover sheet Participants— The term participant refers to Singles not in Families and Admits in Fani_ilies as defined above. Participant does not include children or caregivers who live with tl;e adults assisted. P'rojeet Sponsor means the orgartization responsible for carrying out the daily operation of the project, if the organization is an entity other than the grantee. S ial Instructions for SUPROrtive Sen ice 0xily (SSO) Progmirns. SSO grantees should complete ail questions, unless a written agreement has been reached with the field office concerning which quesvi ons car be answered rising estimates, or in rare instances, skipped. Below is an example of how information could be derived in a large, single -service SS0 project: A p aitee/sponsor staff me ober could be assigned to collect information loin tie organ motions housinng the participants. The staffperson would contact these individual organizations to request information regarding the persons in that facility that use the service. For participants living on the street; the grantee/project sponsor may provide estimates. Information could be collected for each participant or for participants receiving sen ices at a point -in -time. if estimates or point -in -time counts are used, the method used must be described in the APR and the documentation kept On file. As with all projects funded under HUD's homelessness assistance grants, grantees operating SSO projects are expected to complete all APR questions that are applicable to therm. Note that all projects have been awarded fiands as a result of responding to the program goals of assisting Homeless persons obtain/remain in permanent housing and increase their skills and income. The APR documents their progress in meeting these goals. In some circumstances field offices and grantees may sign a wAtten agreernent concerning questions that can be answered using estimates, or in rare instances, skipped. See the special instructions below for reporting on special types of projects, such as outreach only projects, projects providing services to children only, and transportation, medical, dental, and other single, short - duration service projects. SSO programs area third priority for local HIMIS implementation, following emergency shelters, transitional housing programs, outreach programs, and penranent supportive housing programs. Once SSO programs are included in the HMIS, SSO grantees will be able to answer all a PR questions using tbeir HMIS data. SSD grantees that are not yet participating in 17 VRS will need to collect data to answer the A.i'R dons using the species-insi=."oas provided above. Outre2ch Only Projects; Projects whi;,h a -re solely devoted to street outreach and connection to housing and services are not required to track: participants beyond their contact with persons on the street, it is sui�cie;,t for these projects to enter HUD -401 19 information on questions 1-10 (skipping questions 11-13 and 17). Estimates for questions 5-9 are allowed_ given that participants may be reluctant to answer personal questions. Answering the questions will demonstrate that the grantee is serving the appropriate number of people, providing basic demographic information for Congress, demonstrating that homeless persons are bei:i, served, demonstrating the types of housing participants are cormected to, and the type of services they are receiving. Hotline Projects. Hotline services are similar to outreach only projects, but contact between grantee and participant is often of very short duration - people enter and Ieave the program nearly simultaneously, it is sufficient for these projects to answer questions 1-5 (shipping 4), 1 G; and 14-19 (skipping 17). Projects Providing Services To Children Only_ Projects that provide child care, after school care, counseling for children, etc. Quake an important contribution toward moving a family out of homeiessness. Whiie the main focus of the project is providing services to the children, it is the adults who are reported on in questions 6-116 of the APR like all other projects, this type is also targeted toward getting the families into housing and increasing the faQnilies, incomes. Grantees may skip question 9; al; other questions should be answered (except 17). Transportation, Medical. Dental, and Other Sinule, Short -Duration Service Projects. Some grantees provide a In single service of fairly short duration focused O?vI Y indirectly on assisting homeless persons to obta_in/remain in permanent housing and increase their shills 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 services, it is unreasonable to think that someone would have to give their age, race, and etlsnicity to a bis driver to get a ride a few blocks. For these services, proNide 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 utnhzes the service. SL-eciai Instruebons For Safe H2ven (Sh—) Projects. Grantees should report on all participants served during the operating year. Now: tis is a chaa2C ion prior i-astrucuors where grantees were irstracted to report on the est 25 pa: ficipants served. Special InstrucfRoas for o f—pi eless Manw�-,ement Intarmalor Systena S) Projects, PATIS ga- wees should fall out the cover sheet of the APR , Pari dt Financial informabort, and the HVIS Activities se-ctioL. :iUi+-4011 & Grantee: Project sponsor: THIS Pg GE - TO EE COMPLETED F F, LL GFUNTE S HUD Grant or Proi:;ct Number: Project Name: Operating Year (Circle the operatinc year being reported on) Reporting Period: (monthlday/vear) ❑1 ❑2 ❑3 ❑4 ❑s 06 ❑7 08 ❑9 ❑lo Oil ❑12 ❑I3 014 ❑15 016 017 ❑II ❑19 ❑20 Indicate if extension: ❑ Yes ❑ No from- to: Indicate if renewal: ❑ Yes ❑ No Previous Grant Numbers for this Proiect: Check the corrmponcm for the progi on avhicli you are ret cr tin=. Supportive Housing Program (SHP3 Shelter Plus Gare (S -C) [] Transitional Housing ❑ Permanent Housing for Homeless Persons with Disabilities ❑ Safe Haven ❑ Innovative Supportive Housing ❑ Supportive Services Drily ❑ xis Section 8 -Moderate Rehabilitation ❑ Tenant -based Rental A.ssistarice (TRAJI ❑ Single Room Occupancy ❑ Sponsor -based mental Assistance (SRA) (Sec. 8 SRO) ❑ Project -based Rental Assistance (PRA) ❑ Shagie Room Occupancy (SRO) SuIilmary of the pF ect (ODD or two, sentences with a description of Dopuiatlor, number served and ar_Lomplis�irnenis this optrest na year) Name & Title of the Person who can answer, questions about t3 is r eport: Addr ;s: E-mail Addrss Piione: (include area code) Fa)., Number. (include area �`) I hereby certify that ail the infor o•ation stated herei l is true and accurate. War -siting.- HUD will prosecute false claims and statements. Conviction ii -my result in chrninal �uid/or 6vii pcmdiies. (19 U.S.C. 100), 1010, 1012; 31 U.S.C. 3729; M2) Name & Title of Author ized Grantee Lucia=: Signature & Bate: X Name and Title of Authorize Pro je t SpanSor C1ffrc=al: Simature L DX,,e: HUC-'0i;F, RARt L TO EE C".PLETFD BI'_ LL GFLN7,EEs (EVCEPT HMIS) SSO GRAA'TEFS, PLE4SE SEE SPECLAL INS'TRUCTIOA'S Ch1 F.46E 3 OF THE, APR Part 1: Project Progress 1. Projected Level of Persons to be served at a given point in time. (This informarion comes from the most recent CoC application) 2. Persons Served touring the operating year. Number of Nurnher of Number of Number of Number of Singles Not Adults in Children Families Projected Level in Families Families in Families Families a. Persons to be served at a given point in time Famines families 2. Persons Served touring the operating year. Explanatory notes: See Definitions of Client, Household Types in the General histructions above to determine which clients should be counted as Singles.Not in Families, Adults in Fanulies, and Children in Families. Note that this table does not account for changes in clicat'household type that may occur during the course of the operating year. histe4 each client should be assigned a single client/household type based on the client's age and/or household composition ar the program ent y date closest to the start of th, operaeing-year. In alis way. each client is counted only once in the table. Use the following graphic and explanations to determine who should be counted in rows a -d: Client m program on first day of operating year, le, during the year Count in 2a and 2c. , Client entered and let, program during operating year count in 2b and 2c. Client entered and left program before start of operating year do not count in question 2. First day of the operating year Client in program on first day of operating year and last ^� day of onerating yea, count m 2. and 2d. Last day of tine operating year Client entered program during operating year and still In program on last day o' year count into and 2d. a. Number or the first day of the operating year: This rovr includes all clients who entered the program before the first day of the operating year and did not leave the program until after the first day of the operating year. h. Number entering the proar2m during the operating year: This row includes all clients who entered the program on or ager the first day of the operating year, up to and including the last day of the operating year. For clients with, multiple program entry dates, use the entry date closest to the start of /tie operating y=z Po not count the client more than once even if he/she entered the program more than once durin_he operating year. c. Number wbG left durang the operating pear: This row includes all clients who left the progmirz or. or ager the first flay of the operatincz year, u✓ to and including the last day of the operating year. For clients with multiple prtygram exit dates, use the exit date WUD-401 18 Numberof Number of Number of Number of Singles Not in Adults in Children in Families Famines families Families ,IN—b--,1 the first day of the operating year I b. ( Number entering program during the operating year c_ i Number who left the program during the operating year R d. Number in the program on the last day of the operating year (a+b-c)=d Explanatory notes: See Definitions of Client, Household Types in the General histructions above to determine which clients should be counted as Singles.Not in Families, Adults in Fanulies, and Children in Families. Note that this table does not account for changes in clicat'household type that may occur during the course of the operating year. histe4 each client should be assigned a single client/household type based on the client's age and/or household composition ar the program ent y date closest to the start of th, operaeing-year. In alis way. each client is counted only once in the table. Use the following graphic and explanations to determine who should be counted in rows a -d: Client m program on first day of operating year, le, during the year Count in 2a and 2c. , Client entered and let, program during operating year count in 2b and 2c. Client entered and left program before start of operating year do not count in question 2. First day of the operating year Client in program on first day of operating year and last ^� day of onerating yea, count m 2. and 2d. Last day of tine operating year Client entered program during operating year and still In program on last day o' year count into and 2d. a. Number or the first day of the operating year: This rovr includes all clients who entered the program before the first day of the operating year and did not leave the program until after the first day of the operating year. h. Number entering the proar2m during the operating year: This row includes all clients who entered the program on or ager the first day of the operating year, up to and including the last day of the operating year. For clients with, multiple program entry dates, use the entry date closest to the start of /tie operating y=z Po not count the client more than once even if he/she entered the program more than once durin_he operating year. c. Number wbG left durang the operating pear: This row includes all clients who left the progmirz or. or ager the first flay of the operatincz year, u✓ to and including the last day of the operating year. For clients with multiple prtygram exit dates, use the exit date WUD-401 18 closest to the end of the operating year. Bo not count the client more than once even if htishe exited the program more than once during the operating year. d. Number in the program on the last day of the operating year: This row includes all clients ivho were in the program as of the first day of the operating year or who entered during the operating year and who did not leave during the operating year. The number of clients or families in the program on the last day of the operating year is calculated based on the responses to rows 2a through 2c. For each column. add the number of clients or families in row 2a to the number of clients or families in row 2b and subtract the number of clients or families in row 2c. Therefore. 2d = 2a - 2b — 2c. 3. Project Capacky- Explanatory Notes: Row, b refer to the most recent CoC application for which the program is reporting. 4. Bore -homeless persons. This question is to be completed for Section 8 SR -0 projects. How many income -eligible non -homeless persons were housed by the SACT program during the operating yea? 5. Age an€i Gerider. Of those wfto entered the project durirtg the operating year, how- many people are in the following age and gender categories? Single Persons from 2b, column 1 I Ase Male Female Number of Singles Not in Families Number of Adults in Families Number of Children in Families Number of Families a Number on the last day (from 2d, columns I and 4) d. 18-30 C., 17 and under b. Number proposed in application (from, I a, columns I and 4) Persons in Families (from 2b, columns 2 & 3) f. 62 and over �. 51 -61 C. Capacity Rate (divide a by b) _ % % j % Explanatory Notes: Row, b refer to the most recent CoC application for which the program is reporting. 4. Bore -homeless persons. This question is to be completed for Section 8 SR -0 projects. How many income -eligible non -homeless persons were housed by the SACT program during the operating yea? 5. Age an€i Gerider. Of those wfto entered the project durirtg the operating year, how- many people are in the following age and gender categories? Single Persons from 2b, column 1 I Ase Male Female a 62 and over b. 51-61 C. 31-50 d. 18-30 C., 17 and under Persons in Families (from 2b, columns 2 & 3) f. 62 and over �. 51 -61 h. 31 -50 j 13-1' I k. 6-12 1. 1-5 m. Under- i Explarztor^f Notes; This question refers only to Singles not in Families and Persons in Families who entered the program dui-ing the operating year. Only clients who meet These critea is can be counted in this table. The total number of clients reported ander Single Persons should be equal to the number reported in question 20, coluam 1. The total number of clients reported wider Persons it,, Families shoo:'d be equal to the sum of columns 2 and 3 in question 2b. Answer questions 6 - 10 only for participants who entered the project during the operating year- (from 2b, columns I & 2). The terra participant means .Singles not in Families and Adults in Families. It does not include children or caregivers, NOTE: The total for questions, 7, 8 and Ito below should be the same; respond to each of those questions for all participants. Some of the questions listed throughout the APP, -will be asku,g information for individuals who are chronimliy howeless. Hirt -40118 6a. Veterans Status. A veteran is anyone who has ever been on active military duh- status. How many participants were veterans? 6b. Chronically homeless person. An unaccompanied homeless individual with a disabling condition who has either been continuously homeless for a vear 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 must have been on the streets or in an emergency shelter (i.e. not transitional housing) during these stays. For further discussion of the definition of chronic bornelessness, see Other Key Definitions under the General Instructions above. How many participants were chroniealiy homeless mdividuals? 7. Ethnicity. How many participants are in the following ethnic categories? Fa— Hispanic or Latino b. I Non -Hispanic or Non -Latino Explanatory Notes: Each participant should be listed in only one categoT_ tie nota! nu nber of participants in this table should equal the number of participants in question 2b, columns 1 and 2. S. Race. How many, participants are in the following racial categories? a i American Indian!Alaskan Native b.j Asian. { c_ Black/African Americ-n d- Native Hawaiian/Other Pacific Islander e. white j £ American Indian/Alaskan Native & LAhite t g Asian & White h. ' Black('African American & Whit , i i. American Indian/Alaskan Native & Black/African American i- Other Multi -Racial Explanatory Notes: Each participant should be listed in only one category. A participariT whose race does not correspond to categories a through i should be counted in j. Other Multi Racial_ The totes number of participants in this table should equal the number of participants in question 2b, columns 1 and 2. If using HMS data, you may combine-TUviIS race response categories to generate the APR response categories. 4a. Special Needs. How many participants have the following? Participants may have more t,'aarj one. If so, count u;em in ail applicabie categories. For each condition also indicate The number that were chronically homeless. All Chronic a. Mental illness b. Alcohol abuse c. Drug abuse d. HIV/AIDS and related diseases e. Developmental disability f. Physical disability Domestic violence h_ Other ( lease specify) j 9b. How many of the par6cip=z-arrdisabled? EspErnatury Notes: To determine which participants mt.--LTFJr)'s dclinhion of "disable:`," s= "Disabling Condition" uncle; Other Key Definitions in t ;e General Instructions. HUD -401 18 10. Prior Living Situation. Horn many participants slept in the following places in the weei, prior to entering the proiect? (For each participant choose one place. The total number of participants in the "All" column should equal the number of participant= in question 2b, columns I and 2). Also, indicate how many chronically homeless participants slept in the following places. (Choose one) All Chronic a Non -housing (street ark-- car, bus station, etc.) b. Emer enc y shelter C. Transitional housing for homeless persons d. Psvehiatric facilirv* e. Substance abuse treatment facility* f. Hos ital* g. Jail/prison* h. Domestic violence situation i. Livmg with relatives/friends j. Rental housing L Other (please specify) *If a participant cane from an institution (psychiatric facility, substance abuse treatment facility, hospital, or jail), but was there less than 30 days and was living on the street or in emergency shelter before entering the treatment facility, he/she should be counted in either the street or she}ter category, as appropriate. Complete questions l 1 - 15 for aft Participants who left during the operating year (from 2c, columns I and 2). The tern participant means single persons and adults in families. It does not include children or caregivers. The term eltronically 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 must have been on the streets or in nn emergency shelter (Le. not transitional housing) during these stays. IL Amount and Source of Monthly Income at Entry and at Exit Of those participants wi±o left during the opt -litig year, how many participants were at each monthly income level and with each source of income? Also, please place the morthly income level and each source of income for chronically homeless persons in the second coiurnn of each chart. Une number of participants in Chart A and B should be the same. All Chronic All Chronic C. Income Sou ees At Entry A. Monthly Income at Entry a No income b. $1-150 c. 5151 -$250 d. $251-$500 e. $501 - $1,00o d. General Public Assistance $1007-$1500 1h.f: g. $1501-$2000 $200! Y All Chronic C. Income Sou ees At Entry a Supplemental Security Income (SSI) b. Social Security Disability Income (SSKI) e_ Social Security d. General Public Assistance e. Temporary Aid to Needy Families (TANF) f. State Children's Health Insurance Program (SCHT) g. Veterans Benefits h. Employment Income i. Unemployment Benefits j, Veterans Health Care 1:. Medicaid 1. Food Stamps m.. Other (please specify) n. No Financial Resources HUD -40118 AN (hrnnk Monthly Income al Exit Less tlran 1 month a Supplemental Security Income (SSI) jb.B. a. No income b. Social Security Disability Income (SSDI ) 3 - 6 mantis $1-150 7 months - 12 months f d. General Public Assistance C. $151 -S250 e. Temporary Aid to Needy Families (T.ANF) 25 months - 3 vears d. $251-$500 vears - 5 years g_ Veterans Benefits e $501 -$1,000 h. Employment Income & ears - 10 years ° f. —$1001-$1500 Over 10 years j. Veterans Health Care g_ $1501- $2000 k. Medicaid h_ 1 $2001 + M. Other (please specify) AM C hraric D. Income Sources at Exit Less tlran 1 month a Supplemental Security Income (SSI) I to 2 months b. Social Security Disability Income (SSDI ) 3 - 6 mantis c. Social Security 7 months - 12 months f d. General Public Assistance 13 months - 24 months 1 e. Temporary Aid to Needy Families (T.ANF) 25 months - 3 vears f. State Children's Health Insurance Program (SCRIP) v vears - 5 years g_ Veterans Benefits 6 years - 7 years - h. Employment Income & ears - 10 years ° L Unemployment Benefits Over 10 years j. Veterans Health Care k. Medicaid 1. Food Stamps M. Other (please specify) It- No Financial Resources Explanatory Notes: Table A: Monthly income at entre' refers to the participant's monthly income on the day- he,`she entered the prop: am (i.e-, on the program entry date or as close as possibie to that day). You should not report on income received before erte ng the pr© am or income received during the prooiam stay - Table Ps: Monthly income al exit refers to the participant's monthly income on the day he/she left the program, (i.e., on the program exit date or as close as possible to that day). You should not report on income received during the prog�4rn s y - Table C: Income sources at entry refers to the participant's sources of income on the day he she entered the program (i.e., on the program entry date or as close as possible to that day). You should net report on sources of income received before ente mug the prog-am or income received during the program sten. Participants with no income at the time of program entry should be reported in category a No Financia'_ Resources. Table D, Income sources at exit refers to the participant's sources of income on the day he/she left the prograu-n (i.e., on the program exit date or as close as possible to that day). You should not report on sources of income received during the program stay. Participants with no income at the time of program exit should be reported u: category n, No Financial Resources. Ila. Of those pa ticipatts who @efE du ing ttae operating year (fro -n 2c, coiurruts I and ?), how many were m the proiect for the following lengths of time? Also, please place the length of stay for chron-jeally homeless persons who left during the operating year in the second column. &11 E`k—rrin a Less tlran 1 month b. I to 2 months 3 - 6 mantis d. rfc. 7 months - 12 months f e_ 13 months - 24 months 1 25 months - 3 vears 9.4 vears - 5 years h. 6 years - 7 years - i. & ears - 10 years ° Over 10 years Explgsatory Notes: Compute each participant's length of stay using the participant's program entry date and program exit date. If the participant has only one program exit date during the operating y„ar, calculate length of stay by subtracting the program er Lry date from the proms am exit date. If the participant has multiple program exit dates daring the operating year, calculate the length of stay for each grog —'an stay (by subtracting the program entry date from the pr bar exit date for each program stay) and add thea, together to produce a cumulative tengvh of stay. Each HUD -I0118 participant should be associated with only one length of say catego; The tota', number ofparicipants in the first column ("Ail-') should equal the number of participants in question 2c, columns i and 2 12b. Length of Stag in Progi-sm. For those participants who did not leave during the operating year (from 2d. columns 1 and 2), hove ion,, have they been in the project? Also, please place the length of siMy for chronically homeless persons who did not leave during the operating ear in the second column. All Chronic a Less than l month b_ 1 to 2 months c. 3 - 6 months l d. 7 months -I--, months e. 13 months - 24 months l f 25 months - 3 v(iirs g. Needs couid not be met by project 4 years - 5 years h. 6 years - 7 years i_ 8 years - 10 Years j. Over 10 years Explanatory Notes: Compute each participant's length of stay usivrlg the par-ticipant's program entry date and the iast day of the operating year. To calculate length of stay, subtract the prog;-ar entry date front the last day of the operating ye&n Each participani should be assaciated yi ith only one length of staay category. lire total number ofparticipants in the first column l:"All") should equal the number of par"dicipants in question 2d, columns 1 and 2. 13. Reasons for viae. Of those pa<rticipants who left the project darui^ the ope ting year (from 2c, columns 1 and 2L how ma-iy left for the iollo Abg reasons? if a participant left for multiple reasons, inc'hgde on1v the pri.mLTry rear. The total nurnber of palticiparts in the first column ("AD") should equal the rurnbeT of participants in question 2c, columns 1 and 2_ Also, please place the primary reason for chronicaliy homeless persars who left the project ,during the ope_ratinay year in ,e sea ,d cclu nn. All Chrome a Leri for a housing opportunity before compietmg progm l b. l Completed program C. Nen-pa}Ment of r uUoccupancy charge j �- d. Non-compliance u;tb protect e. Crinunal activity / des avuction of property ! violence f. P keached maximum time allowed iv pPU,iect g. Needs couid not be met by project h. Disagmemeat with rules/persons E t i. Heath E j. tither (Please specify) L f 1, Jnknown!disappeared + 14. Destination. Of those panicipants who left during the operating year (from 2c_ columns I and 2), how man'. heft for the follo'kving destination? Also, piease place the destination of chronically homeless persons m:ho left du ing the operating year in the second column. All Chronic PERIvL LNENT (a -h) a. Rental house or apartment (no subsidy) b. Public Housing C. Section 8 d. Shelter Plus Care C. HOVE subsidized house or apartment f. Other subsidized house or apartment g. Homeownership h. Moved in with fanjily or friends TRANSITIONAL (i j) i. ' Transitional housing for homeless persons j. Moved in with family or friends INSTIT ITION(k-m) k. Psychiatric hospital L Inpatient alcohol or other drug tread ent facility m. Jail/prison EMERGENCY SHELTER (n) n. Emergency shelter OTHER (o --q) o. Ot .er supportive housing P. Places not meant for human habitation (e.g_ street) q. Other (please specify) UNKNOWN r. Unknovvn Explanatory Notes: Identify each participant's destination upon leaving the program using the categories provided. The response categories combine "destination" (e.g., rental house or apartment, public housing, homeownership, etc.) and �tenurc' (e.g., permanent, transitional, etc.). Consider both destination and tenure to determine the most appropriate response, and be sure to tool: at ai] c the response categories before making a selection. The table below provides a brief description of each response category. -Enter the number of par cipants under each destination category in either the first colurztr, of the table or in both columns if the participant is chronically homeless. Only one reason for leaving should be recorded per participant. The total number of participants in the firs+_ column ("All") should equal the number of pairticipai s in question 2c, coiumus i and 2. Tenure Destination Description Permanent ! a Rent j house or apartment (no Participant is moving to art apartment or house without any subsidy. Subsidy) b. Public housing Participant is moving to a public housing unit_ j c. Section o Participant will use a Housing choice voucher (formerly lmown as a Section 8 vouche) to rent a house or apartment. d. Shelter Plus Care Paracipa,t is moving to a unit funded by the Shelter Pius Care program (e.g., TBA. SRA. PRA, Section 8 SRO). e. HOIviE subsidized house or Participant is moving to a unit with rental assistance provided by the apartment HO\1 4F program (tenant -based or roject-based assistaice). f Other subsidized house or apartment Participant is moving to a unit subsidized by some prog;z-n other than public housing, housing choice voucher prof am (forraerly Section 8), I Shelter Plus Care, or HONIL I HomeownershipParticipant is moving to a unit that he/she has purchase6. Jr. Moved in with farrifv or friends Participant is moving in etirith family or friends and expects to live there for 90 days or more. ITransitio,ual i. Transitional housing for homeless Participant is moving into a unit funded by a transitional housing people program for hopeless people (e_g., transitional housing funded through the Supportive Program). j. Moved in with family or frienas -Housing f atticipant is moving, in with family or friends and expects to live there less than 90 days. ]nstitution k. Psychiatric hospiuj Participant is moving to a psychianic hospital. HUD -40 11 18 Tenure Outreach 17estination Description c. L Inpatient alcohol or other drug Participant is moving to an inpatient alcohol or drug treatment facility. C. ( Menial health se -vices treatment facility HN/AIDS-related services g. I in Jail/Prison Participant is moving to a jail or prison. Emcrgenc} n. Emergency shelter Participant is moving to an emergency shelter for homeless people. Shelter Child care 1. Transoortalion Other o. Other supportive housing Participant is moving into supportive housing that does not correspon d ran to any of the permanent housing categories (a -h) and is not tsitional housing for homeless people (i), such as Section 811 housing.* p. Places not meant for human Participant is moving to a place not meant for human habitation, such habitation as a car, ark, sidewalk or abandoned building- uildin _Other Other(please specify) Participant is moving to a place that does not correspond to any of the ( categories above (a -p). UnknoWrr r. _ UnUown This response category should be used if you are unsure about where the participant is moving or if the participant has disappeared and there I is no wav to find out where he/she is. � *HUD encourages programs to limit the use of the "Other Supportive Housing" APR response category Programs should report destinatiorz; to housing that are permanent or transitional in _APR categories (a) through (h) or in categories (i) through (j), respectively_ Exits to emergency shelters should be reported in category (n). 15. Supportive Services. Of these participants who left during the operating year (from 2, coimuns 1 and 2), how many received the following supportive services during their time in the project? Also, please place the supportive services received for chronically homeless participants who left during the ope; afing year in the second column. Participants may have received multiple services and all services should be reported in the table. Mi Chronic " a. Outreach b. Case management c. Life sUlls (outside of case maragerient) l d Alcohol or drug abuse services C. ( Menial health se -vices f. HN/AIDS-related services g. Other health care services h. i Education 0 i. Housin¢ placement I ;. Employme t assistance k. Child care 1. Transoortalion m. Legal L Other (please specify) HUD=10:18 16. Overall Program Gog.1s. Under objectives, Iist your measurable objectives for this operating year (from your application, Technical Submission, or APR) for each of the three goals listed below. Under Progress, describe your progress in meeting the objectives. UnderNext Operating Year's Ohiectives, speciffi, the measurable objectives for the nest oper-ating year. a. Residential Stability Objectives: Progress: Next Operating Year's Objectives - b. Increased Skills or Income Objectives: Progress: Next Operating Yea's Objectives: C- Greater Self-tetermins tion Objectives: Progress: Next Operating Year's Objectives: 17. Beds. SIS recipients answer 17a. S+C recipients answer 17b. SRO recipients answer 17c. (SUP-SSOprojects day not complete this question) SHP. How many beds were included m the application approved for this project under `Cw-rent Level' and under 'New Eflort'? How many o= these New Effort beds were actually in place at the tad of the operating year? Current_ Level Neva Effort Nein Effort in Place Number of meds b. STC. How many bees arid, dwelling units were being assisted with project funds at t:. c end of the operating year" (Include beds for all participants, other farnily members, and care givers.) Number of Beds: _ Number of Dwelling Units: _ C SILO. How many dwelling urtits were being assisted at the end of the operating year? (include units occupied by "in place" non -homeless persons who qualify fir assistance.) Number of DweD ng Units: HUD -40118 Part IF: Financial Iuf'araca€iota 18. Supportive Serviees. For Supportive Housing (SHP), this exhibit provides information to HUD on how SHP funding for supportive services was spent during the operating year. Enter the amount of SHP funding spent on these supportive services. Include iiT,51S costs under "Other". for Shelter Plus Care (S-C)this exhibit tracks the supportive services match requirement. Specify the value of supportive sen^ices from all sources that can be counted as match that all homeless persons received during the operating year. (S+C grantees should keep documentation on file, including source. amount, and type of supportive services.) For Section 8 SPO, this exhibit provides information to HUD on the value of supportive services received by homeless persons during the operating year. Supportive Services Dollars at0utrea-ch b.nagement c_ls (outside of case management) d. Alcohol and drug abuse senwes e. Mental health services T_ AIDS-related services g. Other health care services Fi.h. Education N_ousinc placement j. Employment assistance k. Child care 1. Transportation M. Legal P. Other (please specify) o- TOTAL (Sum of through �) Cumulative amount of match provided to date for the Shelter Plus Care Program under this grant H lUD-401 18 19. Supportive housing Program: Leasing, Supportive Services, Operating; Costs, HMIS Activities and Administration All grantees receiving funding under the Supportive Housing Program must complete these charts each operating year. For expansion projects: If SHP grant funds are for the expansion of a pr existing homeless facility, only the people and expenditures for the additional expansion may be included, as in the original application or any grant amendments. Documentation of resources used is not required to be submitted % th this report but should be kept on file for possible inspection by HUD and Auditors. Do not include any expenditures made before the SHP pram was executed. Summary of ;Expenditures Enter the amount of SHP grant funds and cash match expended during the operating year for each activity. This table should add up both horizontally and vertically. The SHP supportive services total should be the same as the SHT supportive - services in Question 18. Note_ Pakments of principal and interest on any loan or mortgage may not be shown as an operating expense_ Sources of Cash Match. Enter the sources of cash identified in the Cash Match coiuran, above, in the following categories. Use additional sheets, as necessar}-. SIP Funds Cash Natch Total Expenditures a_ Leasing b. Local gove-nunent (please specify) b. Supportive Services C. Operating Costs d. HN/11S Activities e. Administration f. Total d_ Federal government (please specify) Note_ Pakments of principal and interest on any loan or mortgage may not be shown as an operating expense_ Sources of Cash Match. Enter the sources of cash identified in the Cash Match coiuran, above, in the following categories. Use additional sheets, as necessar}-. HUD -491 IS Amount a Gramee/project sponsor cash b. Local gove-nunent (please specify) C. State government (please specify) d_ Federal government (please specify) Community Development Block Grant (CDBG) e. Foundations (please specify) f. Private cash resources (please specify) g. Occupancy charge / fees h. Total HUD -491 IS 20. s1ppartive Housing Pr&gr:t;n: Acquisition, Rehabilitation, and New Construction Ali grantees that received SHP funds for acquisition, rehabilitation. or nev: const: action must complete these charts in the year one APR only. This exhibit will dctnonstvate to HUD that the grantee has contributed enough cast, to at least c.ctuatly match the amount of SHF funds sperm for acquisition. rehabilitation. or new construction. Documentation that matching funds were provided is not required to be submitted with this report but should be kept on talc for possible inspection by 1 -IUD and Auditors. _ Sumatary of Expenditures_ Enter the amount of SHP grant Fund, and cash tnatclt expended during the operating ,year for each activity. Cash Match. Enter the sources of cash identified in the Cash Match colunm, above, in the following categories. Use additional sheets, as necessary. I SHP Funds Cash Match Total Expenditures a. Requisition Local government (please specify) E b. Rehabilitation C. New construction C- Stale govetnment (please specify) d. 'total 1 Cash Match. Enter the sources of cash identified in the Cash Match colunm, above, in the following categories. Use additional sheets, as necessary. HUD -40119 Amount a Grantee/project sponsor cash b. Local government (please specify) C- Stale govetnment (please specify) i d. Federal governme-rit (please specify) Community Development Block Grant (CDBG) C. Foundations (please specify) f Private cash resources (please specify) g. Occupancy charge/ fees h. Total HUD -40119 Describe any problems and/or changes implemented during the operating year. Technical Assistance .and Recommendations Based on your experience dt rLig the last year, are there auv areas is which you need technical, advice or assistance? If so. please dtscnbe_ HUD -40118 Narrye. Naines of persons v ill not be reported to HUB. 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 protect. Usually this Evil! be the date of actual physical move -in for a housing project. Exit Date. Enter date participant left the_protect. Usually this will be the date the participant physically moved out for a housing project. Do not include a participant who temporariiy left the project and is expected to return in less than 90 days (e.g., hospitalization). Income -eligible Not -homeless is SRO. The SRO program allows assistance to units occupied by Section 8 incorne-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. 5a. I}ate of Birth. Enter date of birth including month; day, and year. 5b. .age. Enter age at entry. 5c. Gender. Enter appropriate letter for gender. M -Male F- Female. 6a. Veterans Status. Indicate if the participant is a veteran. Please rote: A veteran is anyone who has ever been on active military duty status for the United States - 6b. Chronically homeless person. Indicate tl:e number of participants that are chronically homeless. Ethkieity. Enter appropriate leiter for ethnic group. a. Hispanic or Latino b. Non -Hispanic or Ncn- stint Base. Enier appropriate letter for race. a. American Indian. or Alaskan Native b. Asian c. Slack or African-American d. Native Hawaiian or Other Pacific Islander c. White f. American Indian/Alaska„ Native & White Asian & White h. Siaek/African American Av White i. American Indian/Alaskan Native & Black/African American i. Other Multi -Racial 9a, Special P.eeds. Enter tete letter(s) for tate category(ies) that desmnt-e the participant's disability(ies). (You may doubie count) - a. -Mental illness b. Aleoho! abuse c. Drug abuse d. _PPV/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 a+here the participant slept in the week prior to entering the project. Do not double count. a. Non -housing (street park, car, bus station, etc:) b. Emergency shelter c. Transitional housing for homeless persons d. Psychiatric facility* e. Substance abuse treatment facility* f. Hospital* g. rail/prison* h. Domestic violence situation i. Living with relatives/friends i. Rental housing k. Other (please specify} *If a participant came froi_, an institution, but was there less than 30 days and vas living on the street or in art emergency shelter before entering the facility. he!sbe should be counted in either tiie street Of shelter category, as appropriate. Instruction Codes for Persons Served 'Worksheet (continued) I i z.Gross Monthly Income at Project. Entry. Enter the amount of gross -monthly income the participant is receiving at eriry into the project. I I b.Gross 1MontMy Income at Project Exit. Enter the gross monthly income the participant is receiving when ehiting the project. I Ic.Ancorne Sources Received at Project Entry. Enter alI types of assistance the participant is receiving_at entry to the protect. a. Supplemental Security Incoine (SST) b. Social Security Disability insurance (BBOT} c. Social Securit,; d. General Public Assistance e. Temporary Aid Needy Families (TANF) f. State Children's Health Insurance Program (SCHIP) g. Veterans benefits h. Employment income i. Unemployment benefits j. Veterans Health Care k. Medicaid I. Food Stamps in. Otter (ple=ase specify) r.. No Financial Resources I UD -401 18 I IdAncome Sources Received at Project Exit. Enter all types of income the participant is receiving at project exit. (Use codes as in I I c_) 12a Length in Stay in Program. Calculated item. (See Entry Date and Exit Date above.) l2b. Length of Stay in Program. (Participant did not leave during the operating year. How long have they been in the project?) 13. Reason for Leaving Project. Enter 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 completing the program b. Completed program c_ Non-payment of rent/occupancy, charge d. Non-compliance with project e. Criminal activity/destruction of property/ violence f. Reached maximum time allowed in project g. Needs could not be _net by project h. Disagreement with rules/perscns i. Death J . Other (Tease specify) k. Unknown/disappeared 14. Destination. Enter the desiiriation of those leaving the project. Permanent: a. Rental house or apartment (no subsidy) b. Public Housina c. Section S d_ Shelter Plus Care e. HOME subsidized house or apartment f. Otter subsidized house or anartmcrit g. Homeownership h_ Moved in with family or friends ';Transitional: i. Transitional housing for homeless persons j. Loved in with family or friends Institution: 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 mean* for himen habiiatiod (e.g., street) q. Other (please specify) UnLnown: 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. HIV/AIDS-related services g. Other health care services h. Education i. Housing placemen! j. Employment assistance k. Child care L Transportation m. Legal n. Other (please specify) __ HUD -40118 HCD �nl r_^ort HUJ-�011�� �t�JA C H IblN LI' 1 i ,1 i..!Jr_reri;❑ lc f✓,c �'�_ 2i0� _—_ i 1r Ji t y i .fLLMTitlC `'Laic .+� =Se. E•�`- U:v! ( 2. Persons Served during the operating year. 1 a. Nurno=_r on the first day of the !operating year, ivumbar e,ter'4no crogr r dur the ope ating yea-, c. Number vrho left the program during the year, d, tN'umber in the procrarn on the last da 0 the operating ves ("a -b c=d) 3. Project Capa_ity, NLimbtr of Number of Singles jNumber of Adults ChAdren in Number of Not in Families in FamiliesFamilies 1-3 MHlies i C 0 C Number of Singles j !Number of A.cuits Plumber of Not in Families �in Fami'ies Chiidren in Families la. (dumber on last day (from ?d, columns C �1 and 4. Non -homeless persons. (Sec. B SRO projects only) How many Income-ellaible nonhomeless persons ,.rpm housed by the SRO program durinG u e oper�ting year? G C Number of Families 0 C 5. Age and gender. Age �Ptale jFemale i0ther/Not given Single Persons (from 2b, column 1) Ia. 62 a�rd over D C 0 c.C1 so ie. 1' ani ur�d�r �Ppot given Persons in ramilies (frnm2b, coILM, ns 2 !' f ��},'�`�'•'�,�_i'.il��t.C_I'7�i1L17�;���. li ,.. i � O:.il ] ^1.r n r o o o 1 + ''' _ ; - i � �.._ _.: i �. __ n I - - � I ��. -_ �.�� -- 'j _._ _ - .�_ - -=- - - = � _ - - -_, it il:�?} .,.,� . � , .`�iCi c'E_�;.1 i:=II'�,'illl�.._L i t�)�. . ��� -,rir ��'t_'C,}�i�(�� ,�!:�,�_'U�;��(j crr��l- I I , ` I� _ Q n a. Less than , month 0 I i 0 I a2i D_ Income Sources at Exit C h. G00 C. Income Sources at Entry Sou FCC All I l Chronic 0 I 0 0 a. Supplemental 52curlty Tnco,re (SST) I rJ I 0 b. Sochi Security DlsaLIIiCy Ins;:rance (S=DI) 0 0 0 0 0 C. SDCla Se CUrit':' G U d. General Pub!"-- %.ss!star.ce 1 0 p 0 0 I G 1 Famines APJF) Ald r o Ne �-} � 0 ! 0 fie. Temporary _ I I C f. State Children's Health InsLjrance Program rSC it 0 0 3 Imonths - 2 mnr;ins G I C g v elarans 'oene`''„ s �. _-7 mcntnS 3 v -Drs 0 g. ,—ars - c years D I h. _mployment Income 0 0 Unemployment Benefice 0 I 0 j. Veteran's Health Care 0 G � k. Medicaid I r 0 11. Fooc Stamps n. No Flnoncial resources —�c.. 4er t ) I-,--rar-1 (Participants who left during operating lea. Length o Spay n g All ` I� _ Q n a. Less than , month 0 I i 0 C -i D_ Income Sources at Exit All Chronic 0 I 0 1 0 I - 0 I C C i. 6 years - 10 years I rJ I J J in Program. (Participants .vho did not I 0 I 0 I 0 0 0 G I 0 1 0 D 0 b. i tC 2 month S G 1 G 0 ! 0 lea. Length o Spay n g All a. Less than , month 0 L. i to 2 months 0 c. 3 6 months I 0 d. 7 months - 12 months I C e. 13 months - 24 months I 0 f. 25 months - 3 years Ij g. years - 5 years 0 h. 6 years - i years C i. 6 years - 10 years 0 Ij. over 10 years"e in Program. (Participants .vho did not leave during cpe year) 12b. Length of Stay rating All n a. Less than 1 month 0 b. i tC 2 month S r. c. ' - 6 months d. monti-;s 10 months 0 3 Imonths - 2 mnr;ins n �. _-7 mcntnS 3 v -Drs I g. ,—ars - c years - 1'vI Chronic 0 0 0 0 0 0 0. 0 0 G Chronic 0 0 G -�sc-s 'c- L- 7i c, t c i, pr o P,� v c 1 P u, 7� L r i i c r-' C T -1 o P 2 n k. Lin kno�-,,n, dlss,)-,,earc 114. DestiriE3bon, All Chronic PERT-IANENT ,)fa F-, L e 7, b. Pubfi. housing 0 c. Sec7;, n S, d. Shelter Plus C, C, Ho'r— sub7icj:-ej Nouse or c t -, E 7 S Lo C i 7 P d h o,-, se or a n n t 0 Hoo i C) Move M;1v or -ends TP-ANSITIONAL i. Transitional �j. in with I-Dmk, CF f-iCrr:s 0 Z.NS7TTUTTON (k 1k. Psychj37,-jC 3 C) m. Ja l/prisDn -M-ERGENCY SHELTER "n) 0 o )THER (D G- Other supportive rcusiFlc p- Places F-cL for hamar; habitation q. Othe:- (pleaSe N K N O'WN Ir. Unknown 5. suppc)Ft,ve Services. I)n supp:)rCIVE services ServicePnint version 4.O1.Q13 (db buil'Id `03) Licensed to: r-,icmi Dade Homeless Trust 2: 29913-2006 Ec'�vman Systems L.L.C. AH Ricints Reserved. 7 1� (j - 'i 1 P L D --H pt rr F orm (Rev. Dep.°n W-9 i Request for Taxpayer Give form to the January 2003) Identification Number and Cert➢fication requester. Do not "t of the Treasury provision known as a "saving clause." Exceptions specified' send to the lfcs- kevemx Scrwce or abandonment of secured property, cancellation of debt, or continue for certain types of income even after the recipient Name has otherwise become a U.S. resident alien for tax purposes. Business name, if different from above If you are a U.S. resideclt alien who is relying on an Individual/ El❑ ❑ ❑ OZher ► Exemptfrom backup ❑ withholding Check appropriate box: Soleproprietor Corporation Partnership __________________ claim an exemption from U.S. tax on certain types of income, Address (numoer, street, and apt. or suite no.) Requester's name and address toptional) i City, state, and ZIP code List account numoer(s) here (optional) 1. The treaty country. Generally, this must be the same ' Taxpayer Identification Number (TIN) Enter you- TIN in the appropriate box. For individuals, this is your social security number (SSN)_ Social security number However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, A is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. or Note: If rite account is in more than one name, see the chart on page 4 for guidefrries rxr t4/rose number Employer identification nurrnber to enter. { Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I 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 1 am no longer subject to backup withholding, and 3- 1 am a U.S. person Including a U.S. resident alien). Certification instructions_ You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have faiked to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mor' Wage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. (See the instructions on page 4.) Sign, Simtatrse of Here U -S. person, ► Date ► Purpose of Form Nonresident alien who becomes a resident alien. A person who is required to file an information return with Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on the IRS, must obtain your correct taxpayer identification certain types of income. However, most tax treaties contain a number (TIN) to report, for example, income paid to you, real provision known as a "saving clause." Exceptions specified' estate transactions, mortgage interest you paid, acquisition in the saving clause may permit an exemption from tax to or abandonment of secured property, cancellation of debt, or continue for certain types of income even after the recipient contributions you made to an IRA. has otherwise become a U.S. resident alien for tax purposes. U -S- person. Use Form W-9 only if you are a U.S. person If you are a U.S. resideclt alien who is relying on an (including a resident alien), to provide your correct TIN to the exception contained in the saving clause of a tax treaty to person requesting it (the requester) and, when applicable, to claim an exemption from U.S. tax on certain types of income, 1. Certify that the TIN you are giving is correct (or you are you must attach a statement that specifies the following five waiting for a number to be issued), items: 2. Certify that you are not subject to backup withholding, 1. The treaty country. Generally, this must be the same or treaty under which you claimed exemption from tax as a 3. Claim exemption from backup withholding if you are a nonresident alien. U.S. exempt payee. 2. The treaty article addressing the income. Note. If requester gives you a form other than Form W9 3. The article number (or location) in the tax treaty that to request your TIN, you must use the requester's form if it is contains the saving clause and its exceptions. substantially similar to this Form W-9- 4. The type and amount of income that qualifies for the Foreian person. If you are a foreign person, use the exemption from tax. appropriate Form W-8 (see Pub. 515, Withholding of Tax on 5. Sufficient facts to justify the exemption from tax under Nonresident Aliens and Foreign Entities). the terms of the treaty article. Cat. Nc. 10231X Form VV -9 (Rev. 1-2003) i Form W-9 (Rev. 1-20031 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 mus 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 it 1. You do not furnish your TIN to the requester, or 2. You do not certify your TIN when required (see the Part It 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 the 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 TINS. If the requester discloses or uses TINs in violation of Federal law, the requester may be subject to civil and criminal penalties. 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' fine_ Enter the LLC's name on the "Business name" line - Other entities. Enter your business name as shown on required Federal tax documents on the "Name" line. This name should match the name shown on the charter or other Icaal 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 Individual/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: !f you are exempt from backup withholding, you should still 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(x), any IRA, or a custodial account under section 403(b)(7) if the account satisfies the requirements of section 401(f)(2); 2. The United States or any of its agencies or instrumentalities; 3. A slate, the District of Columbia, a possession of the United States, or any of their political subdivisions or instrumentalities; 4. A foreign government or any of its politicaf 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) 3. A futures commission merchant registered with the Commodity Futures Trading Commission; 70. A real estate investment trust; 11. An entity registered at all times during the tax year under the lnvestment 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 exemot 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 S 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 S and patronage dividends Payments over $600 required Generally, exempt recipients to be reported and direct 1 through 7 sales over $5,000 ' ' See Form 1099-MISC, Miscellaneous Income, and its instructions. `However, the following payments made to a corporation finduding gross proceeds paid to an a¢orney under section 60A5(Q, even if the attorney is a corporation) and reportable on Form 1099-MISC are rot exempt from backup wPJrholdine: medical and health care payments, attorneys" fees; and payments for services paid by a Federal executive agency. Part I. Taxpayer Identification Number (T -IN) Enter your TIN in the appropriate box. If you are z 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 pave 4 for further clarification of name and TIN combinations. How to get a TINT 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/ordinelss5.htm1. 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 ITIN, or Form SS -4, 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-FOP.M (1-800-829-3676) or from the IRS Web Site at wwwJrs.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 payrnents, 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 -H. Form w-9 (Rev. 1-2003) Part il_ Certification Tb 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 I should sign (when required). Exempt recipients, see Exempt from 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 1963. You must give your correct TIN, but you do not have to sign the certification. Z. 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 correct TIN, but you do not have to sign the certification unless you have been notified that 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 nonempieyee 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), IRA or Archer RISA contributions or distributians, and pension distributions. You must give your correct TIN, but you do not have to sign the certification. What fame and Number To Give the Requester For this type of acro+ n: Give name and SSN oL 1- Individual The individual 2- Two or more individuals 00int 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 = (Uniform Gift to Minors Act) 4. a. The usual revocable The grantor -trustee ' savings trust (grantor is also trustee) b. So-called Lust account The actual owner that is not a legal or valid trust under state law 5. Sole proprietorship or The owner 3 single -owner LLC For this type of accoaart I Give name and EIN of, S. Sole proprietorship orThe owner ' single owner LLC 7. A valid trust, estate, or Legal enti y ° pension trust 8. Corporate or LLC electing The corporatior corporate status on Form 883? 9. Association, club, religious, charitable, educational, or other tax-exempt organization 10. Partnership or multi -member LLC 11. A broker or registered nominee 12- Account with the Department of Agriculture in the name of a public entity (such as a state or local government, school disl or prison) that receives agricultural program payments The organization The partnership The broker or nominee The public entity ' List first and circle the name of the Gerson whose number you furnishif only one person on ajoint account has an SSN, unat persor's number must be furnished. 'Circle rhe minis name and furnish the minors SSN. r You must show yota individuaf name, but you may also enter your business or 'DBA` name. You may use ether your SSN or E!N (fyou have one). ' Lst first and circle the name of the legal trust, estate, or pension trust. (Do no: furnish the TIN 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 writ be considered to be that of the fast 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 otner countries under a tax treaty, or to Federal and state agencies to enforce Federal nontax 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 Dther,payments to a payee who does not give a TIN to a payer. Certain penalties may also apply, L Applicant Certification These certified statements are required by law. Previous versions obsolete form HT -D40090-4 A. For the Supportive Grousing (SHP), Shelter Plus Care (S+C), and Single Room Occupancy (SILO) programs_ Pair 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 1), 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 remulations 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 altrrmative 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 Act 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 pari 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 regvlalions 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 aFurmative action to encourage participation by businesses owned and operated by members of minority groups and worsen. 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. 1B. For SSP Only. 20 -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. i -fear Operation Rule. 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 aggregm ate aount of rental assistance funded by IRD 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 '� a Snail attach an ei8uatloYl �ieiilii� f+fuo page. Signature of Authorized Certifying Official: Date: Title: Applicant: For PHA applicants Only: (PHA Number) TRUST i ALA cr tnaqv _,c,5,,,_ ,ti C 0 n 03 a ai c s _. .reg uz, s,_ s _ _ 04 soac_, most ba QW'. Do DISCLOSUIA! Cir c n F � LY �� r7 ,�I �Il L � AFFID.�\V -d t :c - "Ah At L1CIlt'Ld sows Or 7; o Its CC^ �. u s O� n..IcS �- .]Ll„ PNICY S h non Or Fln-I1cy u. crcof cr a:--,,,) Of Q So= Y t "AMPDADE IL,',' E,.VE ,� iY,'.Vi. �}3�1Jt perL'm -C uaC, l�;L; � �l I: O Lt C c, of 1'S 'o r � 5 �flvlej Or Ll c S"It Ci For1LC or �7� ..,;CSG:11 Sub�i'v1S1�� d," C' scoot ]t °h.. 1]C' ever, r ±r—k 0: r e Smu Gr M I L AP Me, ^n iliiC E....aeS or ?^: hI d als 032 r_ri2 Cdr I ii' Ch giRp d'CiC-iulne wh'irer Cr LGi It pti .airs i0:h:S Coi]1773C�. I ICio^7 f7 --s dLIiV, S�' (-- 7 Stilt_: Affiant the AN kgal name and rbuAness R&US OI At PC S0 Q) Or nbO' CO=Wng or ;._.,,iCA S CL'Si;] - Ix iil ".T:1 -1W COLAV arc (PCS` Micc ai..dnotS an Tut 85 abovC, ,c-Ve D1cPr_) So tet a_ii -- L,i1' �1iP :✓ CON MAWDADE COUNTY 027TZ PiSCLOSU <? Fr I+?r.l%T (Sec. 2-S.1 01 - the Coun , Codc) r Tf t, t: r0 �r"-C, 0, dLSu Lss transaction is cO707:t10TI trle fL11 ! Cal name arC Lrl1SL eSO BCId ^S 1 �,1 0� oviu o for eac1 arf:c"and die or nil each sic noiOP: G-vho bolds dl,e�ily or indi, tl M pc mem (5 'o) or more of the smck IfAt corivat or bLsiress r-a175actl��n is �',;_,� a p3mme "IT, the o acing information shall �c pr ld2d fe; eaci as trier. It t e ecr,s2Cttram cr is Wh a ITRrsalct:Ct7 is wi l a t'11 � At awl le.gA name and address shall be _ rovW c RN a3c.h tmsoeand Oug neAc ry. The fnr going rquimments s:wit not prom to contrazi, %,itl,1„ pu 1 trail conpom6ons rut rc corn 0ts wl she Unite❑ Sues or any dept; �ment or �pen�y' there0, til � nr ed P Statt or °�i p0i: r$] Subdl!'151J.� Oi yi�cV t11ErCOf O: '� l' 711�'lIC,'rd,�l^T Gr 'hL ,SLaie. A1� S!JCh r1aI21CS dd we and s Ore (post Tiri e add. sacs y c not s� c rube , ,,' ; l_: ci li2q,Esany business ONES c V S"e" S JC ii(rcSI r" rj , S-TiaFnev,SUPPNOS, stcrery orlend,Ff who r72V, crow w oa e, ff e m (legal, eqw awe bereumal or ... e vk 5 C o Or l-nV person wno willn,ily Lis To cii-close Lf , 1 I0_it!at10.1 rCgUireCl here 1P., C CiSc:cses iais P Ci „ LI II In `L'llS regarl SM be C'unkhzd by c Of of q rour r; � lF crK r n o, 1 t._:i50_i C:;? In -,:if Cc) P,. 'js. l ICr up iv (60) s 0r beth. C1 �1 (Co �. ti �rcir�nc=?tic: q;1_ 13l ,"-.mcndin^ sec. 2.8-4 SGSeC60_ K'AQ CI the CIOUMV I ,... & X' epi w 1'- F'i e i CeC v' JL' Le - ala STaic ;aws or r t'1,' -,-imzeach ccr1 a:: or du rotes T� ScC`1 t b' renel;�al thereof which 1.-1VIVES the e ,;,mdirum o .n :.,L s n d.,i.a s . D,OIiO) Or more Shah r_aQe conracl�:,-q 07 busincs_ to G S 'G'se the f3'....1C ,iP'_ 1 ._CG'7uLi0:,. ; i: ., rn i_ydcs `B r eQll2 mem dD not ap C'1\% i o C.ona as 0% he ✓P.._ _ Mms OF a7v _ � d P-rt..mC or BQ' LPe �u to Dt any policy subdivision Cr z?mc; <<e vOT 0, any nllli ci7pa iz:v Ot !,'-Is S Does your Iinn have a c0 'e0?11%e ba C'ii R Tz at VviLl lis erPD O`,'eeS? _ Yes No D'OeS VDur `iii. pro Vide paid hca.-h car--_, e iTLs for iLs tmp1oyeeS _ Yes No Frcvide a cone i break:duu (nu ::ben p_;scas) vau; ±1 ,'s work Once ar,J o" 7lersht as w race, namaI ontin anu nezder: White: Males Females Asian:: �4ales Female; D1 ,ar:: Males F ms.es Arne Ica Inciar _ Male, _ F r^ .les hie Cc^:r11Cs: �.Io;��ZS ell 3;eS Y&u[ (LS?,1I.;0Y Mass Fem is Males Females- es,pemales �iII. FFIFI L4, TIu"E ,��'TIGIJ� 1O1 Z iS tiIl'1T A CSN Ur , I FL 0NIL1T F -P AND FF;CCL P -D, ENT PRACTICES (Co mo Crdinance PS -30 codified a -S. i .5 o the Cou:,t} Code.? In accordance %tiLh County C,�rdinancL No.9,S-30. emiiies ul_h annum 2r0„S re✓enaes in excess of J100"000 0"000 Se AMS to c nman with Be Counq shall a a condition of re;ehjq a County conra�� hale. 0 a mmuen annrm t , e avion plan which sm ro, ;h the zc--Lrer ti -It in utilize to assura the it does not C'sz rimi,t, in in emphymmt md prcmotior prQcllc s, ani lei a .,.1. �n prcc r_ment poky "t'' h SCIS crocedums the enry olize, i0 ass.,Te fhLt i.i do --s ,lot dlsCr1i77iI °tP c a `i n f iT In �I (j �YG1 �7]-OD,?7a buynescs in As omm p Lr me ,f oI go7 S n},�' LLiC E°Owes, Smh 17.1'0,is'E_till i; P!aS and 7FDCUT.7M=t p05 3 s3a pt 01'1 L' ^ r1CC ;= C .Iei'r' I7 dP;�T l P %] it . 0�` ❑e :❑ iLP Zhe d �e5 rt dlsr die .h IC 7iu�0+T errroRlC�C!UI C Pmc „s. i rP foreg7mig wards „��Qireciors r_ _j h a A n dows .,_. ,.a. _ 2znjal zross revtzissic wunsThn ,1;"r:7 dots have i:,lny ,.. .': I,.,_5 iG vu=sW M, GO1G.-] , _r rt'-:_wnrnrl '_ ., _' Vt pJ ±Pjn an . . ak -L'* f n .....� - n 1L -� I c - LCLL L. I a Twe or cW&P of =UK H r - r� _ nlr O ,.._ C('[ r^ 2 i _D41iI ew V Euslrn-_ Wdo p`''ut— P5 WV, W Avyw, 21T _` v -r, Mina 331 -f. -Ot flmi h>, amual 27oss r.,b'erw in cKccss 05400100 and rho a7m Urns h2v-C a1 n;2L;Of 1sr, L,d _rn:.- p'!. as d--„ ich 1.11 de_ reel vs to d,temune Mhumntz, v,d JT2s -,.bm;`cd i";e pl ., ar_ a ?icv Lie amen: 3313_ of Bunnc-ss ! nT lane: t 15 N.F;'. I ` T 1_ iir-i d ws not idve an a.rI!; raav ., w or -, _.: 'GI above, but. beengra.,--;c" a CO—,—NT—,f' Cr!1',��_''.vAL r'.`,...'',11 AFFMA b? 1 I; ti: GLIGr; T`hc *7d;VlQa'3- Lr Miiy anwin'g OYD a contract or r cb a irim:Ci_, Z „0:,"1 ihP C Ln7�' hZS n0raS Of 1 date of LAI, "..c^.Invit been convicad_ a felon" L'i ? h r '-- Aid or c r; QIr, c ror, or Exe LTIve of Ae MAYC'fltv r in-Ic Guno has has not a5 oCnt date of to alcma b_cn cD mc! o_ a .clot, a pu I ten (1,0) yeas. -Y ri L,R i�_,..( i i li�t.� : 1 i n- -DA= EITLOYMENT ci,_.y C. �r:,..nce L R� Teo. M5 cGINd as Sec:cn -5.3. o,`:ne Co ,,sy Coy._ ) That it CDM.-JWcc wit O. .ince V. 9_-i; of At Code or Si r WT e7 won 7 cr entlLv 15 pro 1d1P.° 2 d Iree w n, 1phn- edC ctI2L,Ov Irt_smp �h_ emp'oyee a_our: _ i. dancer of drug alb -,s--- i,, the t,piact L t,e fir—'I'S policy of maiP,C mIg a drug tree en%imnmrn at ars wornplacts 3. shirt ' of u cou ischn nab 1 u ton Ij emnJo✓ee t7 � SI rr_n - progarns 4. pcialics that; y be imposed upon e.,,plcye_S rotdr�� ahus ,rolar,ons The neo7n Os ,311 31SC i llI:L an em i Tc m -1 c tis=icmci;L, LS a o .j:tiO; of Lot Olt tmPloyes 011 abidc by the trr ; and nctil" It cm ,roger of any c rmii 1 orin omiction, UCC r l 9 no lit - Man He (5) day; Her rcc�',1'& ilwN of ,uch ccnI 1CtlU,i Ind iT Q., �� rooriatf sA rsonrl, l avion aa;:inpt the e-nplo}gee up to and Inalud;na� Ierinir,atton. ' t DrT pha "wan" dll 10?_ r. C SpfalU� h�3 'r r l ll� r �d by At person or c4—, mage n rya ; roe tt e oft 3[i -,'l of . _' Ccy l r ii1 oaf t' '. ,j� dr�, L:c-"Ion 'c ben . and W 11 OT -1 Jf 17e del iJ( she L � i 'id � _ L.. c)t� ��(�L� rl )r"1 lUri l�.Jl 'i I [ J ;, "IIcAc or I osu U to i 1n"; d Sal hr �c t r n_ {' Gl �d3 ire C F, �d 1 r , clf' or I i :ic_ a a ismn. �.h, _ those rT_, plu,;�or:; awe ,r..._,r.t 1 t 4 o on 1,S QV - % CF MDR ..iii - - `- L L! ...,_, An mA 7� t�2� , ^. - i,:, .. __ on cyl Of LMA-VLMA-V WT d u �.,-n.l 707W, F.r r,WAMY _ ad p W of z CQ_ or too -sic Com,_ of2 CAN.poust c" s�r Csc Rh6v a W haf n ,_ Dr TI'r iLiC" mg -==gU7i:IrI mir-s Sir_' „0,` p4, _.":117 t0 C :.. � .� �; 1:.: f ;:', ✓_in,���..�,.�, or Ln i L" _. „C1 Bond OF tl,e P i0 of FJ03 Or an polkical Sl 1 �]A'isl " i,? - t e:�ziri„ to muni ,pall ,.I A s S130 — `-1 I. DIS: Pii T N0.'`v-DiS' IvAi� - i(i'ti1 .^_F'FIDAY T (l O,:r,ry i .-S"LIiol] !'.-= S` J 712the above naris__ AT e—Dation or crew,.. sin co-::pliancc iih slid acre r SiOC P In tQ 0rnp'Y R z;, ❑ assaw that &m1' G 0 0 d D27Cr��ac Or ,n1p II COT' PH S wAh at aCable r:gl].re:::ents 0. 02 lazz lis'td bt'l, .r,C: L,.,�, tDul',0i 1 n Pp i 3T Iv Sao prOvarns pe a i ` to imp men. pQvA±n of Pnz ' s ncI s oIzw ,w0lo.!4 iq 20mmur,`caiions, dcCess is fa:iIh rP Dvoiian , and r_'. COrsi'L iC�n in ii,B ;Oi]p�1i ap,.s. 110 A,7neri-�rIs i 7 D s'+DIi!ilCs Act Of I'pGC0 {:ai^ )rn'C, 7- 101-- 3 6, lCD-1 Stat 33�7, 42 "i 12101-12213 and 47 U_S.C. Sections 225 and 611 i. li,u nc Title _ Eir.nia, nerT 1e II, Public SwOew Tin UT P,�ptic A ccs; noda�jors and Sn vices 0 ,lied by � r � � � 1 Tole p Pn1a _ rnt lLs: :ir,e , 071:71LIr1CJ =10 .S crlC 71-Jc V, !4Tisocha ncous rrQ'As Ons; T _��?7 j, `, _ Lei Or G' �� ] p i 1jrW Secimri 7`✓4; r -)e 1 -'.,..-neral Transit Acq as a Z&cd 49 U,S.C. SeC 1C 6'2 '..!]c r �1C.�c, 9 Mi as amended, 42 L S,C- Secton 3601-3631.^P.P ;F'`O,T'� rP,-. t.1z �.,;..a is shat; not En p CCntr S'�',l rhe Un,tZQ' S ,res o V D r -Lin r Gr ncv L,e. eG 1r a..e r n . _ or anti poi, el subd vyion OT agwcy L-'C'Zvi or ZT-' hsr.;,,.r..1:?--r MOO Smne- c Iii. I Tib"T-D. DE CGTJNi r' ? G:A Vi t, E j-fNQ ' _AI,D Ci .E TLY DLA r S n^ _ r, 1r-. XE -s, (5��. �-�.i(C� Oi Ii],o ,...:7c).2n rv' C0�t) t?'cvnt fcf EITIal" pa chow orders and sole smmt cooM, ;rioi above na.^,:''C iL,,, C TC'radun' Ui 'wri'?tlOn oT individual dcs;T;.n to t"nsaCi bus:n2sss or enol 111 a cGi7 L , ti'<'is tis. Cj,j �e 1I, 05 Li E:' t all CIthriquEnt and cuPerldy due Ips Or was indud ng but not ArTl,d r to ,1 enc proper, iwe_, utliiy ta',es and 0CMion I licemcs - ti ych arc COMM ir. TO norm] course q N Dade County 1U; Coliecmr as well .s Dade Co n'y ,sued paling Chew rot vg±S, re_cis,eied in the e ` T.7 O the 15 , CD FGi C10::; i11 L[l0t Or i c'ividual }lave been aic, _ p CUR.Ir�NT ON ALL COLS i r CC? 1 r� .'CTS.. CANS AND { i 1 , ODL'(SA Tije indt idual cntih' s pin County is current :r) aj it- obli0ations t, t � COUPrr` G C a d i� not eCh_r- i_,t ir, droAt of any con: act, pro nIs>n ' no' 0r citner loan document vVi2h the COunrP,' or aMy of its aoenc;es or ins�'nlmentalil�es. F' 0YECT FRESH ST:= F. i (p, u1utic-' � R- I yg arl, L -9c;) y`rlt`� Arm lh irh,z a comae 0 tyle COUP, t` a rn uN � Inactual pal g,Cnt Of S500,000 or TUrd� Shall r Fr i S'_n t5' C Unr; ..iia, t, Kink lei a5vC j1 �� r r am. ..j f 1- . sS o t 1T J� U"s V C rr f 1, lti1 �) d� C �L C '.'(,O ,i r 'ill l Ca nc b ,is f1 lerl id i Fa, ii 1 1 a roll ; i Q }-,_ J a nit_ TfqUffr XV0407NEMt t' - lot lan=T; rrv:777n: My VD: F:7--:7 P. �V5LENjE LEA �j jn:; ��q jj�ov -�J 050i 4: Th! :T= d a Ewing odobusinni inin Vt CoiM i a 15 cc mFOxf 1,, ;��i -- Ov , 'iLF� "npc Q C2j"rInEz d2v M= Anch of nVani VIO "I MjR CAOVaM Qk o, -, i - �) L J, �- C -),-O - OT 7&&Mg to pOVt Dommuc OnOca Lca" nitsspIpjvy=, - ha,l,C i.rldical-d L)", L:" "Op, H a5davAs W pt 2K 10 LKS COMM, 2nd h:vc a-1 Lil Zfd�v'ls do, do not Dcnalk 15 An Conpan. ( S i � T-, —1 ary 0: A f,—j Z-nt) S 7 -� E S CR.!E Sl,Fi"10�--,� '�Iis TO bcfc7C' 200 K, �Lnov',T -LD n;f or I= P,-ts-t.ted typs of (PKA 07 SM&P of Nano') Notary P UID I i C — S La 7,-. p S La t 2 of (Dan) or , Hushe is personalis as AnAcanoz. (Senal Numhr) (Expirajop Dne) Air! SO T 1"''..= D J "M Of the P re,oC. tm Tcm RD W li: E�C ,. Li° J."2 _c aEJ1 P.: ` - ,iA _ TITLE ENTLOYE: TEL. NO J i i ACH ADJiTIO?'SAL SHEET Ir The 1 &j above y - a F �S. '71ed dL1 v one t.ePIS elCd �<7C ��r FP � ct �n � � h 0t e0is7i0. lif ✓ E1 Pi?Se. a i0 i CNIi,Y. Pi0170 m am WAY E1a`_ any L,divIdua: SllbS`..ti,?ed for or add& '.0 the . r.:.'_don rEam a er subs ; i._. of the p'opmg a Mg by ``, '11L ST- , e_ z:.h e CI_,kort;e Pohrd a,dpc �r;iC ble r"ee S. 1- r h"G; c! ., CSCpiLr]OR PopOSCrS vvh-, wish i0 3Q�72S e 0 ' CO.i !SS7 P CCL;]i+ Or Cv D O d. -d ec i0 � �C n y pcsmn.'.� ,'e��-CtLa ih S Q,. 15,'00 O; r� 1?Lr:len^_"JO Ci 0 r203 411: _.le CAS: Ci 1-.e(FornnpC 0; r r-rrD -! p2y Cl,, ur. !JCHoie 160 sol vy YNnr ly &I Ac forcgoog fact -- a... c..., arcs correct and 1 have rem; or am r�...:J.sr -,vitS il, .. pro��i�,cr:� o.` -. echos 1. �5) o :I c COd vAR 0,01iC3ilDg^'O n Si 'bolt: e of AL ii0:` _ c he�re5eriat Ve, T!_)e: STATL CF COTUNTY OF n& 10909 1= _'MUt was aclMoplOyd AMC MC AS by a (in.di,-icu-�1, OiTlccr, Partner or Aber[) to me or "'Ac „a produced Si nature ofper--on takin ack="viedecmcrtl ,'iaM Or. A cknoMy T ggcd, priT' cd or ..Ia i".'lr'CCI (TOO or R24) ccT;:11 T"lITJC_'r, j a . 2 ,11E (Sole Proprictor, CorTo atiDTJ or PaFtl]CT3 : p) dcnti_ _anon ani ��"Jo dididid not :a}:e nn 03th1 AUHIVIt:iN I L REQUMED LIST!:','(; OF (__)_N C_U'_�NTYCU�`,TF�!.Cj- hi cowiianct`, j Drlinai-lct ;7- tht !]Sti-,,_, 4q P00.11 1 05' paq o , �. _1 i �: T S 0� su D -C oS Scopf of Seer kes W ON, If Axwfm n or S! 0450D cc rno:. Tl,,_ -=,rwed CTganhahcn mug com&t tlh-S, ;­_t_`]f ELstd coganzanon 00 not ufhze d=, „h(f CcIl-,:nun,E,=�j -Dgan:� MD man Sac "NO v,,il] uscd"% �,o sIa:,2"_N/A Ma Te of Sub conwacwr Or SUM onsultant Address QW, and State REQUIRED LIST OF SUPPLIERS ON COUJINTYCONTRACT 11 AVOW vAh MmMadt Countv OTdinnWe 371M, Q COMMUniqv ?Based TgAZAD-5 Tr 'St ce tD , c T: 'I 'L , a-:�ach -a !W of supphen ",no w,"'! :--aieSals Y Me Scope c: _- v i s COAL= � m n, Based (Drganization, if this (:ojjwact.rq)7ec=fn,', is r-)-- m,-Yt. M Commatty Based CogmaizWon mus: 01 ou'L if w Coniziuniq, AS& Ck gmzativ Noll rot use supplyrs, one (Ionimmity As& Orgamization mnst staff=. e.Nosuipplj,-_-,s 1'vi] bt UsEd', do not S:atU we ofsUbconvac"r or Sub-corsu"nDt Add Jhcrcz?_!, cer,,Ip 1;7L," 1%1E_r01-Cgci!1" is corrcc" [2/?Cl f,01"I z2le: Si�nature or Authorised Representative: We: F i r M "'I" -, me: _address: I &DhGne: 111, E-_Tla i ": Date: Fe? ID No.: C i01% te/zip: City an d State A fl; Iilllf SUBCONT12111;'TOIZ/SUI'PL]ISP_ L IS'LINC (Orrliiiauce 97-10d) I'irnt Nolou (jri'rinic Coll tractur/Proposer Nnnte RFP Nit fit 1)c I- lhls I'min, OF a comparable l'Isting [lie recluiremen1" Of OrdiltanceNo. 97-10'1, MIST be completed by all LIidrlcrs and proposcl, on Count, m0 , I,; i''r puirlll,c (it' supplies, nlnlcriais or services, including professional services which involve expenditures ol 4100,000 or more, and all bidders and propOSers Oil of i'uillic I Ie;tl!It "Itllsl consCrutAIITII contracts v"hicII I[Ivolve ex pendlltrres of 11100,000 or III Ore. This form, or n coIII parnhle listing meefitI (Ile regIIirPIT IClih Of OI (Iill ;incc ftu_ '17-I ll�l, nlusl he coulplett'il anti snl>nli((ed even t110ug11.th,e bidder 01- proposer will 1101, utilize stlbcontr;rclor or suppliers oo file contract. °hlic bidder or Ilrul1u;rr sllnlllll enter fhc word "NCtNG.", under the nfyi opriate licnilim, ofFnr-nt A-7.1 in those instances where no Sllhconlractors or suppliers �%M he used on flee collh:1cl. ;; biddcr w 1�rr,pwxl v,ho a �r;rudcrl tlic contract 91101,1, not cllallpge or substitute first tiff subcontrac(bfs or ditecl suphliers_or file portion; of Ilse conlrua �tiorl. fn he p�'Ifurmc�l lir ul[Ileri[tL lrr Ise su I died Ifoiu lhnse idcnti(ied except upon v"FiLten a_ 1ttv%iuess Nnmc :end Address of l"irst Tier f'rirtcip "I'1, owner -'Scope of Wnrk to Ile Per hp lI'rini ip:rl On lief) Sll1)ClllltraCtOr�5111JCOI15nllan[ - SUhCOrltractorCul7colist] llnnt Gcildcl- 1"':wc ISn IIICSS NOIIIC Ind AddtcS_, oF0irecI Supplier' ��TII1CIhd1 OlY11l'T SUppllli'_C/1\1alCrIf115/SC111Ces to be (l'ruliipal (1�snrr) I'rovidcd li�� Suppllcr t ;rtttlt�r 1�:Icc - 1 -ci (lfy that the representations contained in tlik Suheoulrnclor/Suppllcr Listing arc to file hest of 111)' (r lie ;Incl occur ill. ilUnn III e of l'IoIIoser's Print. Nome (riot f Ille Il.ltr Author iced ltepresenlnhve (Durlicnfe i(ai4ililion;ll space is needed) 1 ,.� �:� t � ll; ., �,r ATTACFDvfEI,'T N APPLICANT OR RECIPIENT SECTION 3 COMPLIANCE REQUIREMENTS FOR HUD -ASSIST ED 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 tie 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-income parsons. I he applicant or recipient commits to development and implementation of a Section 3 Economic Opportunity Flan 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 contracts, 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) extpage) 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: " i he 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 died to circumvent the contractors obligation under the Section 3 regulation. Thi applicant or recipient certifies and agrees fitlat iI i5 under no contraCual or athe� imdiment which would prevent it from complying with these reouirements 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. OWNER'S FIRM NAME (Print or Type Name): AUTHORIZED SIGNATURE SIGNATURE Affix Notary Seal to the Right ATTACI-1?v1EAiT N "Se -tion 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 contractagreeto comply -with HUD's regulations in24CFR Part 135, which implement Section 3. As evidenced by their execution of this contract, the partes to this contract certify that they are under no contractual or other impediment that would prevent them from complying with the 24 CFiR 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 contractors commitments under this Section 3 clause, and will post copies of the nonce 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 titles subject to 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 ttiis 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 uiat any vacant employment positions, including training positions, t hat 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, t and debarment or suspension from future HUD assisted contracts -s. G. Wit respect to work perforated in connection with Section 3 covered Indian housing assistance, SeCIICn 7(b,` of the Tnoian mel{ Dct rriiinauVn and Educations 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 (I) 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). S"ORTATENEXT77KANT TI_ KVJ_lC _ -- FLtir`Ir»,�T-.Tr rl ;_: .I! _ i. 1'..-_._Y FUELIC 02 OTHER .n (Tr- ini inn lona J s n r -:e �'" , (prini ;.am5=.1bi-nj 12 s".t r How hnsve55 addas5 is and Ir pB ble) & FedeA Em,,j'Jye: idcn,-ificaL:cii'�....-rIJOr 'C Cil P,Li�' has PC F�_lti, ir:1—de the SOCH sc_.Ih ambFer O:ht i 0:. Q21 S Ang Its sjvo��"' summon) - - 1 1 uk kwt AW c "pQPc E"1`:Ij' &--Tie" as , ::neL it avgmj _r in Qj 'I ;a , �Tec 173A I Or,u �_._ WARS a viola tion or any sta_e cr .edual " oy a per_c . �o.�a W and d0=k . alt to I e :Tauwdon of C hicss wit any public en, -y 0 r']i1'an age7,c,,' or p CO3ca7T'c l " A_iC of 2.r]�,/ Older WT GI the United ,Son iridud g, bu not li u _ W. 3r'•' to or cvPv_Cf or gOOr1s C UKCc'S i0 be o avj20 W zq pubbc 2nti)' Or 'sri .PC/ i.'( p01 r„.�I SL b J`� 017 CfLn)of 0 aCr SLcie he Un�:e a^_es and jrvolvin�'z arrtt0t, ruin, Oct, b ib;o coda on me _._cring, cnnspiracy, 07 n --.trial ,.,isr prese t tion. t L)-90275 nc� M z onWz tar' ' o scan ti ic:ion, airl p r�'rzp:�,S/. iii I )fib IOOc, Lr[L tCo :77ea,;o c 'RdtPQ oI g..'ij. Cr c con�'i Cliori of T' Di;C r. ,. C r :C, S1'r C;i a YY _10g L. ar; 0 TL11cKcn of itlli n �ny I d dl Ur soil c �✓,i 0 r eco � r iii � .0 ch - , brOU 7: by indic-Imcni UT InrOr”—nation YU uo 1, loo_, a5 a r. _Ll[ OI - j%R' 'rd;cl' i'Cn-i_]"Y-Mal' or em, 0- plea Or or role conterden'f. ? 1 ur' nvand Mat an `1ihQte" as ..r d0ned in Fara0ph 287J ....tl a Q!,1�da Sint,�—. aN5 rRca!l5. A predecessor or successor ofa person convicted &a public entity c, -at os, b. An enQ un e: the control of any narwal Feror. �is active in i,^,e man �e�a:ent of ih,c erffitV 'nd 111h0 has bean convicted of a 'pulls c e n ; crani n, The tern pyj,e OWN tha omc s, directors, executives, parte r ,,isrc.frluers, e : pTo�,c�s, mcrrbe;s, aiiJ L11 7ts ro are MWE in the marlagenent of an affiliate. The o>rner.h;p b,' or.e person of sliarc; wonsli ut:no a conzi-ollinz ilii FC5, in a2c,',hcr PCF. : OF poolnl� Df LgL.Dillr-;-It Or inco.nic 2MA persons when not for fair ma f.er tole under an arm r length r_crrerment, M,n b, pII77a faCIB 225C Coat MC person COP,trol5 ails a h,CMOM fJ 1-Svn VhOr:.n 0il , ' jntt-S into a jnif-t ventllrc i Ah a pe�_On Who ;nus W" or Cod of a pUL'-Ic � lC,jy cr r�i,. in Fwrik j-±9 IT p;ooding 3b names 51211 be cons) Cr �d in fr:'ir� t . 1 WWfvs1nj Oat, _F5=17�� �s ijP � 7a`T a nu f � 1 r r,neC in _ nh _ i; rl%rd jj p'E30E n 010 orlziEzz ander .rt: WE _I L7,.v si2!i: ,i AV Ail.,.j Sits A& Me WJ ,rr'ar to„ COMMS and Which __ or Uphn to Md op cnUUT;I.,. ..On 0i n nds or r )- le- 0: a 7LEZ alis or .i"ii�.” 1 blit xo r is3 a to�:�Lii .r - The tegn iJcrO„ lir 110c_ .rte..: "Wt , m2m5ca and wens zoo =. _ w t in mLn2a -nn n! Irl ,, i 1M is me i. cd we p, nn u_Iinc A t CCS b.._., chuyd vmh n CgWq a PUl iiG Gllu -i.'7;c .. JL,] l c �sI =G InOnL ±L� 1,�1 C1.`;� ILWo t . _ Aq jv ;'.,, gp:vs) till . _wom swt.,man or we or Mae o: a ZICC"2 dIr' wt -, utcAve" ��IT?ler�. 0:40maj C,.ipJo,` ctt 7u2;. kn, or Pjci l5 uno an act ve in tc iP.anvemom of the .;I�a, G cT. X17=V:Ltt uI C:72 b,,., -n --F ur,nd v„lih DUp'�C eill!' _„;;fie WON Me pan 30 awls Evann Ata t'._S b"z 2 _JDoe all r Leicre He .. O ,c , h S M v: =;cn d 1 a au oP.. .__.. t- a n_s d t e Final k vas ❑Gt ... me ,PAR . _o: TMJ #a n we cak, ''iibi_]1 nd At Z 07 „ ,__�IPe.., on ._._ .,0?;012 l e du do (Man C cuy of vc fl& ord ). I UNDERSTAND THAT THE SUBMISS ON. OF THIS, Tv THE CORTIN:-',=N'G, OFFICER FOi THE PUBLIC ENTITY IDENTIFIES IN PA SA GRrAPH 1 (ONK) ,4-BOVE 1S FOR THA T PUPLIC E:'tiTIT`i' OI\'LY AND, THAT THIS FORT+f iS VALi 3 THR0?UC ; THE LIFE OF THE CONTRACT. I ALSO UNDERSTAND I ST:" ND THAT I AM REQUIRED TO i,^Ir 'P'vl THE PUBLIC ENTITY PRIOR TO E vTERENG I^ TO a CON'71'- CT IN EXCESS OF 71-iE T-'HRr SE-jOL.D A 1'iOUVTPPOVIDED IN SEETON --S7.0I7; F'LORID:a 5T IJUTES FOR CAT: GG' Y -Pr'O OF AtiY CH:.t,'GE INT :E I',lFi PA'jA.T 0- .N CJNTi1ALIES LN THIS0TRI I. {SJtrI;3C'!Cel - (dale) STATE .^, E A- E t � r S0NAT L !" A."?E'JR)jD L, E, c1;.� IvIF, t)iLf, gun .. , 5 7,�e d a's(h-ri7�! V,'I10, ahm hot be T7 _, swan by im, a lsed hisocr ..Igaitl, c m to uau Fo KA Arm aq ibis NOTARY PUBLK' it vI;lPll:,_W c?: &i - MIAA41-DADE COUNTY HOAMMESS TRUST PROVIDER ASSET INVENTORY Provider.Naine: Program Name: Funding Source: Reporting Period: ATTACHAIIENT P 1�escription of Pmperty Serial I ID Number Acquisition Date Acquisition Cost Vendor Name '% of Purchase Cost from Grant Location of Property Use7,qndw11,l10 holds Conitle of of Prroperty AA Attach invoices for all purchases this grant reporting period. ATTACHMENT Q INSERT COPY OF DECLAMATION OF RESTRICTIVE COXTNANTS (IF APPLICABLE) ATTACHMENT Q-1 INSERT COPY OF DECLARATION OF RESTRICTIONS (IF APPLICABLE) ATTACHMENT R FOR GOVERNMENT ENTITIES QNLY — Semi -Annual Emplavee Certification for Supportive Housing Programs **This form to be submitted to Miami -Dade County Homeless Trust every six (6) months. Agency Grant Number Program lame Duration I Period Covered to The following employee (s) worked solely on the Supportive Housing program (SFLP) project referenced above. By signing, I hereby certify that I have worked 100% of the time or, the referenced Supportive Housing Frogram (SHIP} proje r during the period specified above. I hereby certx y as d e s=uperviso: of the above named errplo vee (s) that he 'she /they haver worked solely on the referenced Supportive Housing Rrouf arr (SIP) project during the period specified above ATTACHMENT S MIAMI - INCIDENT REPORT IDENTIFYING INFORMATION Reportinc, Party Phone Date of Incident Time of Incident Reporting Party Name Contract Provider Name Program Name Provider Location Specific Program: (check all, that apply) El HT 0 Primary Care 0 SBP 01 Emergency 0 Challenge Spm --�k locatie:Lladilfre-sys whiere- incidept occurred: TYPE OF INCIDENT 11 ALTER CA TION D CLIENTD-EATH El CLIENT INJUR Y OR -ILLATE, SS El ThTEEFT El SUICIDE A TTEA& T ara/prn El PROPERTYDAYNGE D OTHER LNICIDENT Specify PARTICIPAONT (S) I WITNESS (ES) (Please mark W or P for either Witness or Participant) LAST NAME, FIRST IDENTIFIER # CLIENT EMPLOYEE OTHER W/P LS I of MIAMI - 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? 1E Yes 11 No Ifyes, specify INDIVIDUALS NOTIFIED Abuse Registry 1-80€3-962-2873 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 -Bade County Homeless Trust information related to airy 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 i!-icident, submit in writing a detailed account of the incident. This incident report should be addressed to the Contract Offlicer or administrative Officer assiped. This incident report should be addresses to Miami -Dade County Homeless Trust, 1 11 NW First Street, 27`' Floor, Suite 310, Miami, Florida 3312&; telephone (305) 375-1440 and facsmilie (305) 375-2722. 20 3 MIAMI-DADE may; 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 circumstancei t tiated by something other than natural causes or out of the ordinary such as a tornado, Udnapping, not, 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 Art, -MM. 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 cont acted 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