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ATTACHMENT 6 NOFA RFA Renewal Project Application Project Applicant Information: a. Name of Organization: City of Miami Homeless Assistance Program b. Contact person for this application (the provider may list more than one contact person): c. Name: Sergio Torres Title: Program Administrator d. Phone: 786 229 4731 e. Email: _storres@miamigov.com Project Name: Miami Homeless Assistance Program CE Consolidation Federal Award Identifier (first six characters): F L 0211 (i.e. FL0244) 1. Component Type of Submission: [ ]TH:RRH [ ] PSH [ ] RRH [ X ] SSO-SO 2. Have you received capital funding (acquisition, rehab or new construction) and are currently on a Restricted Covenant? [ ] YES If "YES", enter the date the restricted covenant expires : / / [ X] NO Attach current restrictive covenant to your application. 3. Will this renewal project be part of a new application for a Renewal Expansion Grant? [ ] YES If "YES", you must submit a new project application for the expansion component of the application. [X]NO 4. Will this renewal project be part of a consolidation project application? [ ] YES If "YES", you must submit a consolidation project application. [X]NO 5. Does the project propose to allocate funds according to an indirect cost rate? [ ] YES If YES: [ ] This rate been approved by the federal government and I have attached evidence of the federally approved indirect cost rate -OR- [ ] I will be using a 10% de minimis rate [X]NO 6. I certify I have reviewed the GIW, check one of the options below. [ X ] I agree with GIW Budget and number of units -OR- [ ] I have provided edits to the GIW. Page 1 of 2 Please provide narrative edits below: GIW Column Edits 7. Does the project ensure that participants are not screened out based on the following items? Select all that apply: [ x ] Having too little or little income [ x ] Active or history of substance use [ x ] Having a criminal record with exceptions for state -mandated restrictions [ x] History of victimization (e.g. domestic violence, sexual assault, childhood abuse) [ ] None of the above = Housing First 8. Does the project ensure that participants are not terminated from the program for the following reasons? Select all that apply: [ x ] Failure to participate in supportive services [ x ] Failure to make progress on service plan [ x ] Loss of income or failure to improve income [ x ] Any other activity not covered in a lease agreement typically found for unassisted persons in the project's geographic area [ ] None of the above = Housing First 9. Additional Comments: Sergio Torres Provider Representative Name _06/30/2023 Date Page 2 of 2 FY 2022 Continuum of Care (CoC) Program GRANT AGREEMENT Between United States Department of Housing and Urban Development (USHUD) And Miami -Dade County Miami -Dade County Homeless Trust ATTACHMENT A "FY 2022 US HUD CoC Grant Agreement" U.S. Department of Housing and Urban Development Office of Community Planning and Development 909 SE First Avenue Miami, FL 33131 Grant Number: FL0211L4D002215 Recipient's Name: Miami -Dade County Tax ID Number: 59-6000573 Unique Entity Identifier [SAM]: MKEJWVSEURF3 Federal Award Date: 5/22/2023 CONTINUUM OF CARE PROGRAM (CDFA# 14.267) GRANT AGREEMENT This Grant Agreement ("this Agreement") is made by and between the United States Department of Housing and Urban Development ("HUD") and Miami -Dade County (the "Recipient"). This Agreement, the Recipient's use of funds provided under this Agreement (the "Grant" or "Grant Funds"), and the Recipient's operation of projects assisted with Grant Funds are governed by 1. The Consolidated Appropriations Act, 2022 (Pub. L. 117-103, approved March 15, 2022); 2. title IV of the McKinney-Vento Homeless Assistance Act 42 U.S.C. 11301 et seq. (the "Act"); 3. the Continuum of Care Program rule at 24 CFR part 578 (the "Rule"), as amended from time to time; 4. and the Notice of Funding Opportunity for the fiscal year in which the funds were awarded; and 5. the Recipient's application submissions on the basis of which these Grant Funds were approved by HUD, including the certifications, assurances, technical submission documents, and any information or documentation required to meet any grant award condition (collectively, the "Application"). The Application is incorporated herein as part of this Agreement, except that only the project (those projects) listed below are funded by this Agreement. In the event of any conflict between any application provision and any provision contained in this Agreement, this Agreement shall control. Capitalized terms that are not defined in this agreement shall have the meanings given in the Rule. HUD's total funding obligation authorized by this grant agreement is $695,520, allocated between the project(s) listed below (each identified by a separate grant number) and, within those projects, between budget line items, as shown below. The Grant Funds an individual project will receive are as shown in the Application on the final HUD -approved Summary Budget for the project. Recipient shall use the Grant Funds provided for the projects listed below, during the budget period(s) period stated below. www.hud.gov espanol.hud.gov Page 1 Grant No. Grant Term Performance Period Total Amount FL0211L4D002215 12 months 02-01-2023 - 01-31-2024 $695,520 a. Continuum of Care planning activities $0 b. Acquisition $0 c. Rehabilitation $0 d. New construction $0 e. Leasing $0 f. Rental assistance $0 g. Supportive services $650,020 h. Operating costs $0 i Homeless Management Information System $0 j. Administrative costs $45,500 k. Relocation Costs $0 1. HPC homelessness prevention activities: Housing relocation and stabilization services $0 Short-term and medium -term rental assistance {Stmt} www.hud.gov espanal.hud.gov Page 2 Pre -award Costs for Continuum of Care Planning The Recipient may, at its own risk, incur pre -award costs for continuum of care planning awards, after the date of the HUD selection notice and prior to the effective date of this Agreement, if such costs: a) are consistent with 2 CFR 200.458; and b) would be allowable as a post -award cost; and c) do not exceed 10 percent of the total funds obligated to this award. The incurrence of pre - award costs in anticipation of an award imposes no obligation on HUD either to make the award, or to increase the amount of the approved budget, if the award is made for less than the amount anticipated and is inadequate to cover the pre -award costs incurred. These provisions apply to all Recipients: If any new projects fianded under this Agreement are for project -based rental assistance for a term of fifteen (15) years, the funding provided under this Agreement is for the performance period stated herein only. Additional funding is subject to the availability of annual appropriations. The budget period and performance period of renewal projects funded by this Agreement will begin immediately at the end of the budget period and performance period of the grant being renewed, Eligible costs incurred between the end of Recipient's budget period and performance period under the grant being renewed and the date this Agreement is executed by both parties may be reimbursed with Grants Funds from this Agreement. No Grant Funds for renewal projects may be drawn down by Recipient before the end date of the project's budget period and performance period under the grant that has been renewed. For any transition project funded under this Agreement the budget period and performance period of the transition project(s) will begin immediately at the end of the Recipient's final operating year under the grant being transitioned. Eligible costs, as defined by the Act and the Rule incurred between the end of Recipient's final operating year under the grant being transitioned and the execution of this Agreement may be paid with funds from the first operating year of this Agreement. HUD designations of Continuums of Care as High -performing Communities (HPCS) are published on HUD.gov in the appropriate Fiscal Years' CoC Program Competition Funding Availability page. Notwithstanding anything to the contrary in the Application or this Agreement, Recipient may only use grant funds for HPC Homelessness Prevention Activities if the Continuum that designated the Recipient to apply for the grant was designated an HPC for the applicable fiscal year. The Recipient must complete the attached "Indirect Cost Rate Schedule" and return it to HUD with this Agreement. The Recipient must provide HUD with a revised schedule when any change is made to the rate(s) included in the schedule. The schedule and any revisions HUD receives from the Recipient will be incorporated into and made part of this Agreement, provided that each rate included satisfies the applicable requirements under 2 CFR part 200 (including appendices). This Agreement shall remain in effect until the earlier of 1) written agreement by the parties; 2) by HUD alone, acting under the authority of 24 CFR 578.107; 3) upon expiration of the budget period and performance period for all projects funded under this Agreement; or 4) upon the expiration of the period of availability of Grant Funds for all projects funded under this Agreement. www.hud.gov espanol.hud.gov Page 3 HUD notifications to the Recipient shall be to the address of the Recipient as stated in the Recipient's applicant profile in e-snaps. Recipient notifications to HUD shall be to the HUD Field Office executing the Agreement. No right, benefit, or advantage of the Recipient hereunder may be assigned without prior written approval of HUD. Build America, Buy America Act. The Grantee must comply with the requirements of the Build America, Buy America (BABA) Act, 41 USC 8301 note, and all applicable rules and notices, as may be amended, if applicable to the Grantee's infrastructure project. Pursuant to HUD's Notice, "Public Interest Phased Implementation Waiver for FY 2022 and 2023 of Build America, Buy America Provisions as Applied to Recipients of HUD Federal Financial Assistance" (88 FR 17001), any funds obligated by HUD on or after the applicable listed effective dates, are subject to BABA requirements, unless excepted by a waiver. The Agreement constitutes the entire agreement between the parties and may be amended only in writing executed by HUD and the Recipient. By signing below, Recipients that are states and units of local government certify that they are following a current HUD approved CHAS (Consolidated Plan). www.hud.gov espanol.hud.gov Page 4 This agreement is hereby executed on behalf of the parties as follows: UNITED STATES OF AMERICA, Secretary of Housing and Urban Development Lisa A Johnson, Acting Director (Typed Name and Title) May 22, 2023 (Date) RECIPIENT Miami -Dade County (Name of Organization) By: Morris Copeland , Chief Community Services Officer (Signature of Authorized Official) fr Daniella Levine Cava, County Mayor (Typed Name and Title of Authorized Official) 6/22/23 (Date) www.hud.gov espanol.hud.gov Page 5 Agency/Dept./Major Function Indirect Cost Schedule Indirect Cost Rate Direct Cost Base This schedule must include each indirect cost rate that will be used to calculate the Recipient's indirect costs under the grant. The schedule must also specify the type of direct cost base to which each included rate applies (for example, Modified Total Direct Costs (MTDC)). Do not include indirect cost rate inforrnation for subrecipients. For government entities, enter each agency or department that will carry out activities under the grant, the indirect cost rate applicable to each department/agency (including if the de minimis rate is used per 2 CFR §200.414), and the type of direct cost base to which the rate will be applied. For nonprofit organizations that use the Simplified Allocation Method for indirect costs or elects to use the de minimis rate of 10% of Modified Total Direct Costs in accordance with 2 CFR §200.414, enter the applicable indirect cost rate and type of direct cost base in the first row of the table. For nonprofit organizations that use the Multiple Base Allocation Method, enter each major function of the organization for which a rate was developed and will be used under the grant, the indirect cost rate applicable to that major function, and the type of direct cost base to which the rate will be applied. To learn more about the indirect cost requirements, see 24 CFR 578.63; 2 CFR part 200, subpart E; Appendix IV to Part 200 (for nonprofit organizations); and Appendix VII to Part 200 (for state and local governments). www.hud.gov espanol.hud.gov Page 6 FY2022 Continuum of Care (CoC) Program Scope of Service eSnaps Budget and Performance Objectives ATTACHMENT B "FY 2022 Scope of Service and US HUD eSnaps Documents" FY 2022 CoC: Submittal Deadlines Reference Sheet FL0211L4D002215 - Miami Homeless Assistance Program CC Consolidation Contract Term: 2/1/2023 - 1/31/2024 Requests for Reimbursements (Invoicing) ALL, Monthly' 20th of each month ZIL, Adjustments Quarter #1: Feb-2023 - Apr-2023 6/14/2023 Quarter #2: May-2023 - Jul-2023 9/14/2023 (Quarterly) Quarter #3: Aug-2023 - Oct-2023 12/15/2023 Quarter #4*: Nov-2023 - Jan-2024 3/1/2024 Budget Revision (limit: 1 per grant cycle) Amendments (? 1O% shift of funds) 8/4/2023 Modifications (< 100/0 shift of funds) 10/3/2023 Performance Reports Monthly Performance Reports (MPRs) R 20th of each month Midterm Annual Progress Report (M-APR) 9/14/2023 Annual Progress Report (APR)* 3/1/2024 COOP Disaster Preparedness Plan April 1st of each year Incident Reports within one (1) business day of occurrence * CLOSEOUT: FINAL requests for reimbursement (monthly & 4 rh quarterly adjustment) + completed APR required Miami -Dade County Homeless Trust Scope of Service FLO211L4DOO2215 Miami Homeless Assistance Program CE Consolidation The Subrecipient shall provide Street Outreach to eligible homeless persons through the Supportive Services only (SSO) Program during the one (1) year grant term. The Subrecipient shall provide services as proposed in the application to United States Department of Housing and Urban Development (US HUD) pursuant to the 2022 NOFO (incorporated herein by reference), and pursuant to 24 CFR 578 including but not limited to: 1. Accept eligible homeless persons as defined by US HUD and through Miami -Dade County Homeless Trust CoC's established Coordinated Outreach and Assessment HMIS referral process; 2. Comprehensive assessment and case management; 3, Residential stability; 4. If applicable, locate and match eligible program participants with eligible Landlords with units in the community; 5. If Miami -Dade County is the Rental Administrator, provide, complete and submit to the assigned staff all documentation, records and reports, including but not limited to, Attachment K Participant's Housing Application; 6. If Miami -Dade County is not the Rental Administrator, provide, complete and maintain all documentation, records and reports, including but not limited to, Attachment ] Participant's Housing Application. Provide, maintain and complete all documentation and supporting information for HQS Inspections, verify compliance with federal rules and regulations, verify Program Participants' Income Calculation and Rent Determination including any applicable utility allowances, review Lease Agreement, Lease Addendum if applicable, and Housing Assistance Payment (HAP) Contracts, issue move -in authorization, and issue payments to Landlords; 7. Provide policies and procedures which ensure compliance with Further Fair Housing Act, Client Rights and Grievance Procedures specifically regarding terminations of housing, termination from program, evictions, and Landlord Tenant issues and appeals; 8. Provide directly, or refer to all appropriate mainstream services (as applicable) including psychiatric or psychological evaluations, medical clearances, mental health treatment, substance abuse treatment, social rehabilitation, legal services, life skills training, family reunification, counseling services, benefits applications, veteran services, employment, vocation and job assistance services; 9. Provide at a minimum, an annual assessment of the services needs of the program participants and adjust services accordingly; and 10. Discharge planning to other types of mainstream positive housing. Conditions: The Subrecipient shall adhere to the "Continuum of Care Program Grant Agreement", which includes the "Exhibit 1 Scope of Work for FY 2022 Competition Awards" and which is governed by the Continuum of Care (CoC) program rules and regulations, The Subrecipient shall comply with all applicable federal, state and local laws, regulations and ordinances, including but not limited to 24 CFR Part 578, as may be amended, the McKinney-Vento Homeless Assistance Act (42 U.S.C. 11301 et seq.) (the "Act") as may be amended, the Consolidated and Further Continuing Appropriations Acts of 2013 and 2014, Florida Statutes Section 125.0156, as may be amended, Florida Statutes Section 448, as may be amended, as well as with any other terms and conditions as HUD may have established in the applicable Notice of Funds Opportunity and with any applicable guidance, requirements and directives provided by Miami -Dade County Homeless Trust. Attachment B "Miami -Dade County Homeless Trust Scope of Service" Page 2 FY 2022 US HUD CoC ,Program Grant Number: FLOZ11L4D002Z15 Program Name: Miami Homeless Assistance Program CE Consolidation On behalf of the City of Miami, I hereby certify that the enclosed approved FY 2021 US HUD CoC budget has been reviewed. As such it has been deckled to select the following option for inclusion of the FY 2022 US HUD CoC Prograrn's budget for FL0211L4D002215, Miami Homeless Assistance Program CE Consolidation. ❑ Reinstate this budget as is for the FY2022 US HUD CoC Program renewal cycle. © Submit the attached updated budget which corresponds with the grant award for further review and approval by the Homeless Trust for the FY 2022 US HUD CoC Program renewal cycle. Additionally, I hereby certify that the match documentation submitted at the time of our application ❑ is still true and accurate for the FY2022 US HUD CoC Program renewal cycle. is no longer valid for the FY2022 US HUD CoC Program renewal cycle. The updated match documentation is attached. SGi'-(fo To1' 2J 6 1S 2023 Signature: Date: Print Name: Sergio Torres Title: Homeless Program Administrator The CITY OF MIAMI Miami Homeless Assistance Program CE Consolidation Grant Number: FL0211L4D002215 BUDGET SUMMARY (ATTACHMENT B) Eligible Costs Annual Assistance Requested (Renewal Submission) Annual Assistance Requested (HUD Award) Grant Term (Renewal Submission) Grant Term (HUD Award) Total Assistance Requested for Grant Term (Renewal Submission) Increase or Decrease Modification Requested (Award Total) la. Leased Units $ - $ - 1 Year _1 Year $ - 1b. Leased Structures $ - $ - 1 Year 1 Year $ - 2. Rental Assistance $ - $ - 1 Year 1 Year $ - 3. Supportive Services $ - 1 Year 1 Year $ 650,020 $ 650,020 4. Operating Costs $ - $ - 1 Year 1 Year $ - 5. HMIS $ - $ - 1 Year 1 Year $ - 6. Subtotal Costs Requested $ 650,020 $ 650,020 7. Administrative Costs (Up to 10%) $ 45,500 $ 45,500 S. Total Assistance plus Admin Requested $ 695,520 $ 695,520 9. Cash Match $ 650,874 $ 650,874 10. In -kind Match 11. Total Match $ 650,874 12. Total Budget $ 1,346,394 Match: 94% For HT Use Only Reviewed and Approved by; (t)j�' (2) 3. SUPPORTIVE SERVICES BUDGET Eligible Costs Quantity AND Description (max 400 characters) Renewal Submission i ) Annual Assistance Requested (Renewal Submission) Annual Assistance Requested (HUD Award) 1. Assessment of Service Needs 2. Assistance with Moving Costs 3. Case Management 4. Child Care 5. Education Services 6. Employment Assistance 7. Food 8. Housing/Counseling Services 9. Legal Services 10. Life Skills 11. Mental Health Services 12. Outpatient Health Services 13. Outreach Services 15.0 FTE, Information & Referral Specialist, 4.0 FTE, Information & Referral Aide, 1.0 FTE Case Management Assistance, 1.0 FTE. Homeless Housing Supervisor, 2.0 FTE. Homeless Housing Specialist, 1.0 FTE. Special Project Assistant, Transportation and Communications services $ 650,020 14. Substance Abuse Treatment Services 15. Transportation 16. Utility Deposits 17. Operating Costs Total Annual Assistance Requested $ 650,020 $ - Grant Term 1 Year 1 Year Total Request for Grant Term $ 650,020 $ - Itg a# 4F1fliarni ARTHUR NORIEGA, V City Manager MIAMI-DADE MELESS TRUST June 15, 2023 Terrell T Ellis, Contract Monitoring and Management Supervisor Miami -Dade County Homeless Trust 111 NW 1 st Street 27th Floor, Suite 310 Miami, FL 33128 RE: Miami Homeless Assistance Program CE Consolidation — Grant #: F L211 L4D002215. Dear Ms. Ellis: Attached please find the budget narrative for the Project Name: Miami Homeless Assistance Program CE Consolidation for Fiscal Year 2023-2024 (from February 1, 2023, to January] 31, 2024), we are respectfully requesting your reviews and approval. Please feel free to contact me at (305) 960-4988 if you have any questions or need additional information. Sincerely, Sergio Torres Homeless Administrator Enclosure STlag CITY OF MIAMI HOMELESS ASSISTANCE PROGRAM 430 SW 5th Street, Miami, FL 33130 / Phorne:1305 960-4980 Fax: (305) 400-5321 Miami Homeless Assistance Program CE Consolidation — FY-2023-24 BUDGET NARRATIVE SUPPORTIVE SERVICES: 1-SALARIES & FICA: Information and Referral Specialist ($377,183.00), Funds for 15.00 FTE: This is specialized work responsible for providing direct outreach and referral services to homeless individuals. An employee in this classification must be able to identify and engage homeless individuals in public places, under bridges, in abandoned buildings, and other outdoor areas to engage them in a non -threatening way, build relationships, and assist them in recognizing and defining their own service needs. Reports to a higher -level administrator. ti IRS Funds would cover by CE Consolidation Program Funds would cover by MOA Funds would cover by City of Miami 1 20% 0% 80% 1 25% 20% 55% 1 30% 15% 55% 1 30% 16% 54% 3 30% 20% 50% 1 36% 20% 44% 3 70% 30% 0% 3 75% 25% 0% 1 80% 20% 0% -1+15 Informat n & Referral Aide ($53,059.00), Funds for 4.00 FTE: The essential functions for this position are: Maintains files of information gathered on the various governmental and social service agencies, Assists the Information and Referral Specialists or other staff members in distributing information to clients, translating documents and gathering routine background data on clients, either in the office or field, identifies supportive service resources, and makes referrals where appropriate, assists in developing systems for documenting and reporting all activities and services provided for clients. # IRA Funds would cover by CE Consolidation Program Funds would cover by MOA Funds would cover by City of Miami 1 24% 0% 76% 1 30% 20% 50% 1 39% 0%° 61% 1 40% 20% 40% 4 2 Case Manager Assistant (S44,379.00), 1.00 FTE: The CE Consolidation funds would cover salary for 60% of position time, the rest of the amount should be covered by MOA (40 . This position is responsible for assisting Case Managers and Supervisory staff with varied case management activities including following up with clients pursuant to counseling sessions, assisting with the progress of clients in the fulfillment of their individual employment and training program service strategies. Housing Supervisor (S15,964A0), 1.00 FTE: The CE Consolidation funds would cover salary for 25% of one position time, the rest amount should be covered by MOA (50%) and City of Miami (25%). The duties include, but are not limited to, the following: providing outreach and housing services to homeless clients; assessing the housing needs and eligibility of clients; assisting clients in identifying permanent or transitional housing and following up periodically on clients referred through the criminal justice and public health systems. Reports to the Homeless Housing Supervisor or designee. Homeless Housing Specialist ($48,613.00), 2.00 FTE: The duties under this position include, but are not limited to, the following: providing outreach and housing services to homeless clients; assessing the housing needs and eligibility of clients; assisting clients in identifying permanent or transitional housing; placing clients in permanent or transitional housing and following up periodically on clients referred through the criminal justice and public health systems. Reports to the Homeless Housing Supervisor or designee. # HS Funds would cover by CE Consolidation Program ,Funds would cover by MOA Funds would cover by City of Miami 1 30% 20% 50% 1 62% i 38% 0% 2 Special Project Assistant ($68,223.00) 1.00 FTE: The CE Consolidation funds would cover salary for 70% of one position time, the rest amount should be covered by MOA (30%). This is a supervisory position overseeing the information and referral operation. Assist/coordinate special projects; assist with overall program operation. Serve as a liaison between program and outside businesses. Also, this position provides outreach and referral services, 2-Communication ($6,599.00): The requested is needed to cover part of the costs of office cell phones. These are used to communicate with outreach teams out in the field. 3-Transportation ($36,000.00): This amount will be used to cover part of the services GSA for the rent of cars used for client transportation. The total expense for 21 cars assigned to the Homeless Program is $45,000.00 per year, however the real cost for 21 cars is $189,000 (21 cars *$750.00* 12 months). The CE Consolidation Program would be covered $36,000.00 (17 cars), the other $9,000.00 would be covered by Memorandum of Agreement (MOA). 3 4-Total Budget Summary. MHAP- CE-Consolidation-CoC Program -FY 2023-2024 :suppertive Services Expense f 15.0 FTE=>1(20%), 1(25%), 5(30%), 1(36%), 3(70%), 3(75%), 1(80%). information & Referral Specialist Total Salary FICA Budget 377,183 350,379 26,804 4.0 FTE => 1(24%), 1(30%), 1(39%), 1(40%). Information & Referral Aide Total 63,059 Salary 49,288 FICA 3,771 1.0 FTE >> 1 (60%). Case Management Assistance Total 44,379 Salary 41,225 FICA 3,154 1.0 FTE = > 1 (25%). Homeless Housing Supervisor Total 15,964 Salary 14,829 F[CA 1,135 2.0 FTE => 1 (30%), 1(62%). Homeless Housing Specialist Total 48,613 Salary 45,159 FICA 3,454 1.0 FTE _> 1 (70%). Special Project Assistant Total 68,223 Salary 63,375 FICA 4,848 Total Salaries & Fien 607,421 Communication 6,599 Transportation 36,000 Total Supportive Services 650,020 Cash Match In -kind match 650,874 0 Total Match 650,874 Administrative Cost - Homeless Trust Administration (50%) - Homeless Program Administration (50%) 45,500 22,751 22,749 Total Budget 1,346,394 Total Budget MHAP-CE- Consolidation 672,759 4 5-Budget Summary Supportive Services: Awarded Grant Number: :F.1 !: CCi2c Project Name: Miami Homeless AssiStance Program CE Consolidation CoC Number and Name: FL-800 - Miami -Dade County CoC Recipient Legal Name: Miarn-Dade County E9FITIN: 59-3000573 Budget Summary February 9, 2023, through Jan Supportive Service Expense Total Budget SCoC Match In -kind match Info & Referral Specialist IS.UIr1w IO/)%@4',(N6 'n.i,6,e3 100% taxes S 53. rn5 S759:668 S377,183 $382_485 info & Referral Aide 4.41.7'E 101ff, r. 37..191 S 10.762 1fNf3„ lfcr ^s S 11, 3s0 5160,142 553,059 3I07,083 Case Management Assistance 1,n1.71_: 100% * 68,7111 S WIN lrid%saws S 5,256 573964 544.379 $29 565 Homeless Housing Supervisor 1.01.7E 10184 is S9,315 S 59.316 100% laser S A.53N S63,354 S t3,94r4 S47.896 Homeless (lousing Speciallt 2A1.7'F.' mum IS 47,934 $ 95,872 106% caret .l f, 32-1 $103,2 6 S43,613 S54.593 SPA 11"F1l 1011% @ yr7,535 S 90,53S 108% tram S fi, 9ltii $97.46 ] 568223 329,238 Lanalunieadon for Outreach Sripplies.• flume hues. cell planter, radio., nem•nrk between office and unclench .Yle S6,599 S6,599 SO Equipment and Related Servlccs 45rpp11ee' [ropier nnnrhine rnklitiwral cvmtlurrersnilume and 1111fniat+anNill CCrlaplir(nm.. Officer maintenance and utilities Supplier: Maintenance, anal, uidiiier Oita other MAT itSRoi`laie with . rhs call center, outreach and reeonts alter_ Residential Stabafty Folla s,11.: s Supplies: hems twee/echotwee/echo eundini 7-day Pillow up s..ritvc-rr$- pitrilcipantr placed in nfriatpx kl irlrrn,s in the conF nun aj cure, including blank:vs, Iwxdhle tronsparearian needs. Pastase and Refuted Services Satppltes- mailing aft ra:Mal, printing and repo ducit n, Mlstellaneo a Suodics Snppkes: Sajrly equipment ,first aid :nix .Nemohu 'srrppl+es. sfaIinnary{iroffice supplier. etc. Tramportation Supplies: Leming. pie and maintenance of sehides du siypx ra i i adi and erampurlaltan rurrckn) a oJ•hum poeves. education suitlrevjar•fail ullecand nxhr'klInik 345.066 S36,660 59,000 Sub.Total Casts Requested ISupportive Services} $850,020 Cash Match $650,874 in -kind match 30 Total Supportive Services Budget S1,309,804 S1,300.804 $e 5 6- Cash Match and In -Kind Match: The Total Cash Match (except for leasing) for the total grant is not less than 25% (56% Actual) percent cash or in -kind match contributions from other sources. MMHAP- CE Consolidation Budget Summary Awarded Grant Number: FL211L4D002215 Project Name: Miami homeless Assistance Program CE Consolidation Recipient Legal Name: Miami -Dade County EIN►TIN: 56-5000573 Performance Pariod: 02-01.2023- 01-31.2024 Eleglole Activities la. Leased Units b. Leased Structures 2. Rental Assistance 3 Supportive Services - wades + Fic6(Ouireach Staff) Communication for Cutreacr, - TranspoRaffion 4. Operating_. . — - 5. HMIs 6. $ulf-total Costs requested 7�AdtnJn(Up to 10%) �Momeiess rust AAdminislrarlon fsa1 - f-iarne►ess Program Admhrisfrafon (50%) 8, Total Assistant Plus Admin Requested $1057 749 9. Cash Match - Cash mach i$i pontive Services} Cash match fAdmin} 10. In -kind Match (cars) 11. Total Match ( Cash Match + In -kind Match) 12. Total Budget Total Grant Exxpenaes Term SO 1 Year 50 1 Year $0 1 Year 51417 894 1 Year $r 258 295 $6599 $ 153 000 S0 1 Year $0 1 Year $1 417 894 $ 239 855 51 867 749 Annual Amount CE Cash Match Consolidation (except for (renewal) leasing) S0 50 90 650 020 $ 658 274 $ 507 421 $ 650 574 $8699 $36000 So S0 S 650 020 $ 45 500 $ 22 751 $ 22 749 $ 695 520 5 845 229 9845 229 $ 650 874 $784355 _ 90 $ 845 229 $1 540 749 h-Kfnd Match S0 $0 SO _.._ $d S 660 874 $ 04 2555 Total Match __8 550 874 $ 650 874 Ratio 529E 1B4 356 81% Ratio Cash Match (except for leasingt:4$650,a74+$164,355}/($7,258.295+$6,599+$239,855J==aa $ 845 229 58% 51% 6 Applicant Miami -Dade County Project Miami Homeless Assistance Program CE Consolidation 0041482920000 FLO211L4D002215 6D. Sources of Match The following Iistsummarizes the funds thatwill be used as Match for this project To add a Match source to the list, selectthe icon. To view or update a Match source already listed, selectthe icon. Summary for Match Total Value of Cash Commitments: $650,874 Total Value of In -Kind Commitments: $0 Total Value of All Commitments: $650,874 I. WII this projectgenerate program income No described in 24 CFR 578.97 to use as Match for this project? Type Source Contributor Value of Commitments Cash Government City of Miami $353,862 Cash Government Miami -Dade County $297,012 Renewal Project Application FY2022 Page 38 06/09/2023 Applicant: Miami -Dade County Project Miami Homeless Assistance Program CE Consolidation 0041482920000 FL0211L40002215 Sources of Match Detail 1. Type of Match Commitment: Cash 2. Source: Government 3. Name of Source: City of Miami (Be as specific as possible and include the office or grantprogram as applicable) 4. Amount of Written Commitment: $353,862 1. Type of Match Commitment Cash 2. Source: Government 3. Name of Source: Miami -Dade County - Homeless Trust (Be as specific as possible and include the office or grant program as applicable) 4. Amount of Written Commitment $297,012 Renewal Project Application FY2022 Page 39 06/09/2023 Applicant: Miami -Dade County 0041482920000 Protect: Miami Homeless Assistance Program CE Consolidation FL0211 L4D002215 Before Starting the Project Application To ensure that the Project applicants should review the application. SS • Iication is completed accurately, ALL project flowing information BEFORE beginning the Things to Remember: - Additional training resources can be found on the HUD.gov at https://www.hud.gov/program_offices/comm_planning/coc. - Questions regarding the FY 2022 CoC Program Competition process must be submitted to CoCNOFO@hud.gov. - Questions related to e-snaps functionality (e.g., password lockout, access to user's application account, updating Applicant Profile)must be submitted to e-snaps©hud.gov. - Project applicants are required to have a Unique Entity Identifier (UEI) number and an active registration in the Central Contractor Registration (CCR)/System for Award Management (SAM) in order to apply for funding under the Fiscal Year (FY) 2022 Continuum of Care (CoC) Program Competition. For more information see FY 2022 CoC Program Competition NOFO. - To ensure that applications are considered for funding, applicants should read all sections of the FY 2022 CoC Program NOFO. - Detailed instructions can be found on the left menu within e-snaps. They contain more comprehensive instructions and so should be used in tandem with navigational guides, which are also found on the HUD Exchange. - Before starting the project application, all project applicants must complete or update (as applicable) the Project Applicant Profile in e-snaps, particularly the Authorized Representative and Alternate Representative forms as HUD uses this information to contact you if additional information is required (e.g., allowable technical deficiency). - Carefully review each question in the Project Application. Questions from previous competitions may have been changed or removed, or new questions may have been added, and information previously submitted may or may not be relevant. Data from the FY 2021 Project Application will be imported into the FY 2022 Project Application; however, applicants will be required to review all fields for accuracy and to update information that may have been adjusted through the post award process or a grant agreement amendment. Data entered in the post award and amendment forms in e-snaps will not be imported into the project application. - Rental assistance projects can only request the number of units and unit size as approved in the final HUD -approved Grant Inventory Worksheet (GIW). - Transitional housing, permanent supportive housing with leasing, rapid re -housing, supportive services only, renewing safe havens, and HMIS can only request the Annual Renewal Amount (ARA) that appears on the CoC's HUD -approved GIW. If the ARA is reduced through the CoC's reallocation process, the final project funding request must reflect the reduced amount listed on the CoC's reallocation forms. - HUD reserves the right to reduce or reject any renewal project that fails to adhere to 24 CFR part 578 and the application requirements set forth in the FY 2022 CoC Program Competition NOFA. Renewal Project Application FY2022 Page 1 06/09/2023 Applicant: Miami -Dade County Project: Miami Homeless Assistance Program CE Consolidation 0041482920000 FL0211L4D002215 1 A. SF-424 Application Type 1. Type of Submission: Application 2. Type of Application: Renewal Project Application If "Revision", select appropriate letters): If "Other", specify: 3. Date Received: 08/31/2022 4. Applicant Identifier: 5a. Federal Entity Identifier: 5b. Federal Award Identifier: FL0211 This is the first 6 digits of the Grant Number, known as the PIN, that will also be indicated on Screen 3A Project Detail. This number must match the first 6 digits of the grant number on the HUD approved Grant Inventory Worksheet (GIW). Check to confrim that the Federal Award Identifier has been updated to reflect the most recently awarded grant number 6. Date Received by State: 7. State Application Identifier: Renewal Project Application FY2022 Page 2 06/09/2023 Applicant: Miami -Dade County Project: Miami Homeless Assistance Program CE Consolidation 0041482920000 FL0211L4D002215 1 B. SF-424 Legal Applicant 8. Applicant a. Legal Name: b. Employer/Taxpayer Identification Number (EIN/TIN): c. Unique Entity Identifier: d. Address Street 1: Street 2: City: County: State: Country: Zip / Postal Code: Miami -Dade County 59-6000573 MKEJWVSEURF3 111 N.W. 1 st Street 27th floor, Suite 310 Miami Miami -Dade Florida United States 33128 e. Organizational Unit (optional) Department Name: Homeless Trust Division Name: none f. Name and contact information of person to be contacted on matters Involving this application Prefix: First Name: Middle Name: Last Name: Suffix: Title: Organizational Affiliation: Telephone Number: Extension: Mr. Manuel Sarria Asst. Executive Director Miami -Dade County (305) 375-1490 Renewal Project Application FY2022 Page 3 06/09/2023 Applicant: Miami -Dade County 0041482920000 Project: Miami Homeless Assistance Program CE Consolidation FL0211 L4D002215 Fax Number: (305) 375-2722 Email: Manuel.Sarria@miamidade.gov r7miamidade.gov Renewal Project Application FY2022 Page 4 06109/2023 Applicant: Miami -Dade County Project; Miami Homeless Assistance Program CE Consolidation 1 C. SF-424 Application Details 0041482920000 FL0211L4D002215 9. Type of Applicant: B. County Government 10. Name of Federal Agency: Department of Housing and Urban Development 11. Catalog of Federal Domestic Assistance Title: CoC Program CFDA Number: 14.267 12. Funding Opportunity Number: FR-6600-N-25 Title: Continuum of Care Homeless Assistance Competition 13. Competition Identification Number. Title: Renewal Project Application FY2022 Page 5 06/09/2023 Applicant: Miami -Dade County 0041482920000 Project Miami Homeless Assistance Program CE Consolidation FL0211 L4D002215 1 D. SF-424 Congressional District(s) 14. Area(s) affected by the project (State(s) only): Florida (for multiple selections hold CTRL key) 15. Descriptive Title of Applicant's Project: Miami Homeless Assistance Program CE Consolidation 16. Congressional District(s): a. Applicant: FL-026, FL-027, FL-023, FL-024, FL-025 (for multiple selections hold CTRL key) b. Project: FL-026, FL-027, FL-023, FL-024, FL-025 (for multiple selections hold CTRL key) 17. Proposed Project a. Start Date: 02/01/2023 b. End Date: 01 /31 /2024 18. Estimated Funding ($) a. Federal: b. Applicant: c. State: d. Local: e. Other: f. Program Income: g. Total: Renewal Project Application FY2022 Page 6 06/09/2023 Applicant: Miami -Dade County Project Miami Homeless Assistance Program CE Consolidation 0041482920000 FL0211L4D002215 IE. SF-424 Compliance 19. Is the Application Subject to Review By State b. Program is subject to E.O. 12372 but has not Executive Order 12372 Process? been selected by the State for review. If "YES", enter the date this application was made available to the State for review: 20. Is the Applicant delinquent on any Federal No debt? If "YES," provide an explanation: Renewal Project Application FY2022 Page 7 06/09/2023 Applicant: Miami -Dade County Project: Miami Homeless Assistance Program CE Consolidation 1 F. SF-424 Declaration 0041482920000 FL0211L4D002215 By signing and submitting this application, I certify (1) to the statements contained in the list of certifications** and (2) that the statements herein are true,. complete, and accurate to the best of my knowledge. I also provide the required assurances"* and agree to comply with any resulting terms if I accept an award. 1 am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 218, Section 1001) 1 AGREE: X 21. Authorized Representative Prefix: Mrs. First Name: Daniella Middle Name: Last Name: Levine Cava Suffix: Title: County Mayor Telephone Number: (305) 375-1490 (Format: 123-456-7890) Fax Number: (305) 375-2722 (Format: 123-456-7890) Email: Daniella.LevineCava@miamidade.gov Signature of Authorized Representative: Considered signed upon submission in e-snaps. Date Signed: 08/31/2022 Renewal Project Application FY2022 Page 8 06/09/2023 Applicant: Miami -Dade County Project: Miami Homeless Assistance Program CE Consolidation 0041482920000 FL0211L4D002215 1 G. HUD 2880 Applicant/Recipient Disclosure/Update Report - form HUD-2880 U.S. Department of Housing and Urban Development OMB Approval No. 2506-0214 (exp.0212812022) Applicant/Recipient Information 1. Applicant/Recipient Name, Address, and Phone Agency Legal Name: Miami -Dade County Prefix: Mrs. First Name: Daniella Middle Name: Last Name: Levine Cava Suffix: Title: County Mayor Organizational Affiliation: Miami -Dade County Telephone Number: (305) 375-1490 Extension: Email: DaniellalevineCava@miamidade.gov miamidade.gov City: Miami County: Miami -Dade State: Florida Country: United States Zip/Postal Code: 33128 2. Employer ID Number (EIN): 59-6000573 3. HUD Program: Continuum of Care Program 4. Amount of HUD Assistance Requested/Received Renewal Project Application FY2022 Page 9 06/09/2023 Applicant: Miami -Dade County Project: Miami Homeless Assistance Program CE Consolidation 0041482920000 FL0211L4D002215 4a. Total Amount Requested for this project: $695,520 5. State the name and location (street address, Miami Homeless Assistance Program CE city and state) of the project or activity: Consolidation 111 N.W. lst Street Miami Florida Refer to project name, addresses and CoC Project Identifying Number (PIN) entered into the attached project application. Part I Threshold Determinations 1. Are you applying for assistance for a specific Yes project or activity? (For further Information, see 24 CFR Sec. 4.3). 2. Have you received or do you expect to receive Yes assistance within the jurisdiction of the Department (HUD), involving the project or activity in this application, in excess of $200,000 during this fiscal year (Oct. 1 - Sep. 30)? For further information, see 24 CFR Sec. 4.9. Part II Other Government Assistance Provided or Requested/Expected Sources and Use of Funds Such assistance includes, but is not limited to, any grant, loan, subsidy, guarantee, insurance, payment, credit, or tax benefit. Department/Local Agency Name and Address Type of Assistance Amount Requested 1 Provided Expected Uses of the Funds Department of Chitdren and Families Staffing Grant $107,143.00 CoC Staffing Part III Interested Parties Renewal Project Application FY2022 Page 10 06/09/2023 Applicant: Miami -Dade County Project: Miami Homeless Assistance Program CE Consolidation 0041482920000 FLO211L4DO02215 You must disclose: 1. All developers, contractors, or consultants involved in the application for the assistance or in the planning, development, or implementation of the project or activity and 2. any other person who has a financial interest in the project or activity for which the assistance is sought that exceeds $50,000 or 10 percent of the assistance (whichever is lower]. Alphabetical fist of ali persons with a reportable financial interest In the project or activity (For individuals give the last name Social Security No. or Employee ID No. Type of P cipation Financial Interest In Project/Activity Financial Interest in Project/Activity AppleTree Technical Assistance $34,5OO.00 100% Certification Warning: If you knowingly make a false statement on this form, you may be subject to civil or criminal penalties under Section 1001 of Title 18 of the United States Code. In addition, any person who knowingly and materially violates any required disclosures of information, including intentional nondisclosure, is subject to civil money penalty not to exceed $10,000 for each violation. I certify that the information provided on this form and in any accompanying documentation is true and accurate. I acknowledge that making, presenting, submitting, or causing to be submitted a false, fictitious, or fraudulent statement, representation, or certification may result in criminal, civil, and/or administrative sanctions, including fines, penalties, and imprisonment. I AGREE: Name / Tile of Authorized Official: ❑aniella Levine Cava, County Mayor Signature of Authorized Official: Considered signed upon submission in e-snaps. Date Signed: 08/31/2022 Renewal Project Application FY2022 Page 11 06/09/2023 Applicant: Miami -Dade County 0041482920000 Project: Miami Homeless Assistance Program CE Consolidation FLO211 L40002215 1 H. HUD 50070 HUD 50070 Certification for a Drug Free Workplace Applicant Name: Miami -Dade County Program/Activity Receiving Federal Grant CoC Program Funding: Acting on behalf of the above named Applicant as its Authorized Official, I make the following certifications and agreements to the Department of Housing and Urban Development (HUD) regarding the sites listed below: I certify that the above named Applicant will or will continue to provide a drug -free workplace by: a. Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the Applicant's workplace and specifying the actions that will be taken against employees for violation of such prohibition. e. No fig the agency In wrltlng, within ten calendar days after receiving notice under subparagraph d.(2) from an employee or otherwise receiving actual notice of such conviction. EmpWws of convicted employees must provide notice, including position title, to every grant officer or other designee on whose grant activity the convicted employee was working, unless the Federalagency has designated a central point for the receipt of such notices. Notice shall include the identification number(s) of each affected grant; b. Establishing an on -going drug -free awareness program to inform employees — 1 The dangers of drub abuse in the workplace 2 The Applicant's policy of maintaining a drug free workplace; 3 Any available drug counseling, rehabilitation, and employee assistance programs; and (4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace. f. Taking one of the following actions, within 30 calendar days of receiving notice under subparagraph d.(2), with respect to any employee who is so convicted — (1) Taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended; or (2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency; e. Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement required by paragraph a.; g. l Making a good faith effort to continue to maintain a drugfree workplace through implementation of paragraphs a. thru f. d. Notifying the employee in the statement required by paragraph a. that, as a condition of employment under the grant, the employee will (1) Abide by the terms of the statement; and (2) Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace no later than five calendar days after such conviction; Sites for Work Performance. The Applicant shall list (on separate pages) the site(s) for the performance of work done in connection with the HUD funding of the program/activity shown above: Place of Performance shall include the street address, city, county, State, and zip code. Identify each sheet with the Applicant name and address and the program/activity receiving grant funding.) Workplaces, including addresses, entered in the attached project application. Refer to addresses entered into the attached project application. Renewal Project Application FY2022 Page 12 06/09/2023 Applicant: Miami -Dade County Project: Miami Homeless Assistance Program CE Consolidation 0041482920000 FL0211L4D002215 I certify that the information provided on this form and in any accompanying documentation is true and accurate. I acknowledge that making, presenting, submitting, or causing to be submitted a false, fictitious, or fraudulent statement, representation, or certification may result in criminal, civil, and/or administrative sanctions, including fines, penalties, and imprisonment. WARNING: Anyone who knowingly submits a fa se claim or makes a false statement is subject to criminal and/or civil penalties, including confinement for up to 5 years, fines, and civil and administrative penalties. (18 U.S.G. §§ 287, 1001, 1010, 1012; 31 U.S.C. §3729, 3802) Authorized Representative Prefix: Mrs. First Name: Danielle Middle Name Last Name: Levine Cava Suffix: Title: County Mayor Telephone Number: (305) 375-1490 (Format: 123-456-7890) Fax Number: (305) 375-2722 (Format: 123-456-7890) Email: Danielia.LevineCava@miamidade.gov Signature of Authorized Representative: Considered signed upon submission in e-snaps. Date Signed: 08/31/2022 Renewal Project Application FY2022 Page 13 06/09/2023 Applicant: Miami -Dade County Project: Miami Homeless Assistance Program CE Consolidation 0041482920000 FL0211L4D002215 CERTIFICATION REGARDING LOBBYING Certification for Contracts, Grants, Loans, and Cooperative Agreements The undersigned certifies, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. 2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying Activities," in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not Tess than $10,000 and not more than $100,000 for each such failure. Statement for Loan Guarantees and Loan Insurance The undersigned states, to the best of his or her knowledge and belief, that: If any funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this commitment providing for the United States to insure or guarantee a loan, the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying Activities," in accordance with its instructions. Submission of this statement is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required statement shall be subject to a civil penalty of not Tess than $10,000 and not more than $100,000 for each such failure. Renewal Project Application FY2022 Page 14 06/09/2023 Applicant: Miami -Dade County 0041482920000 Project: Miami Homeless Assistance Program CE Consolidation FL02111_4D002215 hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate; x Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or evil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802) Applicant's Organization: Miami -Dade County Name / Title of Authorized Official: Danielle Levine Cava, County Mayor Signature of Authorized Official: Considered signed upon submission in e-snaps. Date Signed: 08/31/2022 Renewal Project Application FY2022 Page 15 06/09/2023 Applicant: Miami -Dade County 0041482920000 Project Miami Homeless Assistance Program CE Consolidation FL0211 L4D002215 1 J. SF-LLL DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352. Approved by 0MB0348-0048 HUD requires a new SF-LLL submitted with each annual CoC competition and completing this screen fulfills this requirement. Answer "Yes" if your organization is engaged in lobbying associated with the CoC Program and answer the questions as they appear next an this screen. The requirement related to lobbying as explained in the SF-LLL instructions states: "The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action." Answer "No" if your organization is NOT engaged in lobbying. Does the recipient or subrecipient of this CoC grant participate in federal lobbying activities (lobbying a federal administration or congress) in connection with the CoC Program? Legal Name: Street 1: Street 2: City: County: State: Country: Zip / Postal Code: No Miami -Dade County 111 N.W. 1st Street 27th floor, Suite 310 Miami Miami -Dade Florida United States 33128 11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. Thls Information will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. I certify that this information is true and complete. Renewal Project Application FY2022 Page 16 06/09/2023 Applicant: Miami -Dade County 0041482920000 Project: Miami Homeless Assistance Program CE Consolidation FL0211 L4D002215 Authorized Representative Prefix: Mrs. First Name: Danielle Middle Name: Last Name: Levine Cava Suffix: Title: County Mayor Telephone Number: (305) 375-1490 (Format: 123-456-7890) Fax Number: (305) 375-2722 (Format: 123-456-7890) Email: Daniella.LevineCava@miamidade.gov Signature of Authorized Official: Considered signed upon submission in e-snaps. Date Signed: 08/31 /2022 Renewal Project Application FY2022 Page 17 06/09/2023 Applicant: Miami -Dade County Project: Miami Homeless Assistance Program CE Consolidation 0041482920000 FLO211L4D002215 I K. S F-424 B (SF-424B) ASSURANCES - NON -CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the applicant, I certify that the applicant: 1. Has the legal authority to apply for Federal assistance and the institutional, managerial and financial capability (including funds sufficient to pay the non -Federal share of project cost) to ensure proper planning, management and completion of the project described in thls application. 2. Will give the awarding agency, the Comptroller General of the United States and, if appropriate, the State, through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives. 3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, cr personal gain. 4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency. 5. Will comply with the Intergovemmental Personnel Act of 1970 (42 U.S.C. §§4728-4763) relating to prescribed standards for me it systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F). 6. Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C.§ 1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. §§6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-2 5) as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination an the basis of alcohol abuse or alcoholism, (g) §§5523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee-3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et seeqq.) as amended, relating to nondiscrimination in the sale, rental or financing of housing; (;) any other nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being made; and, (j) the requirements of any other nondiscrimination statutes) which may apply to the application. 7. Will comply, or has already complied, with the requirements of Titles II and III of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal or federally -assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases. 8. Will comply, as applicable, with provisions of the Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328) which limit the political activities of employees whose principal employment activities are funded in whole or in part with Federal funds. Renewal Project Application FY2022 Page 18 06/09/2023 Applicant: Miami -Dade County Project: Miami Homeless Assistance Program CE Consolidation 0041482920000 FL0211 L4D00221 a 9. Will comply, as applicable, with the provisions of the Davis -Bacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act (40 U.S.C. §276c and 18 U.S.C. §874), and the Contract Work Hours and Safety Standards Act (40 U.S.C. §§327-,333), regarding labor standards for federally -assisted construction subagreements. 10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93- 234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000 or more. 11. Will comply with environmental standards which may be prescribed pursuant to the fallowing: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO)11514: (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodptains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. §§1451 et seq.); (1) Canformity of Federal actions to State (Clean Air) Implementation Plans under Section 176(c) of the Clean Air Act of 1955, as amended (42 U.S.C. §§7401 et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended (P.L. 93-523); and, (h) protection of endangered species under the Endangered Species Act of 1973, as amended (P.L. 93-1205). 12. Will comply with the Wild and Scenic Rivers Act of 1968 (10 U.S.G. §§1271 et seq.) related to protecting components or potential components of the national wild and scenic rivers system. 13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. 70), EO 11593 Identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. -1 et seq.). 14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and related activities supported by this award of assistance. 15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. §§2131 et seq.) pertaining to the care, handling, and treatment of warm blooded animals held for research, teacheig, or other activities supported by this award of assistance. 16. Will comply with the Lead -Based Paint Poisoning Prevention Act (42 U.S.C. §§4801 et seq.) which prohibits the use of lead -based paint in construction or rehabilitation of residence structures. 17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and OMB Circular No. A-133,'Audits of States, Local Governments, and Non -Profit Organizations." 18. 19. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations. and policies governing this program. Will comply with the requirements of Section 106(g) of the Trafficking Victims Protection Act (TVPA)of 2000, as amended (22 U.S.G. 7104) which prohibits grant award recipients or a sub-reciiient from (1) Engaging in severe forms of trafficking in persons during the period of time that the award is in effect (2) Procuring a commercial sex act during the period of time that the award is in effect or (3) Using forced labor in the performance of the award or subawards under the award. As the duly authorized representative of the applicant, I certify: Authorized Representative for: Miami -Dade County Prefix: Mrs. First Name: Danielle Renewal Project Application FY2022 Page 19 06/09/2023 Applicant; Miami -Dade County Project: Miami Homeless Assistance Program CE Consolidation 0041482920000 FLO211L4D002215 Middle Name: Last Name: Levine Cava Suffix: Title: County Mayor Signature of Authorized Certifying Official: Considered signed upon submission in e-snaps. Date Signed: 08/31/2022 Renewal Project Application FY2022 Page 20 06/0912023 Applicant: Miami -Dade County Project Miami Homeless Assistance Program CE Consolidation 0041482920000 FL0211L4D002215 Information About Submission without Changes Follow the instructions below making note of the exceptions and limitations to the "Submit Without Changes" process. In general, HUD expects a project's proposed project application information will remain the same from year-to-year unless changes are directed by HUD or approved through the grant agreement amendment process. However, HUD expects applicants to carefully review their information to determine if submitting without changes accurately reflects the expiring grant requesting renewal. The data from previously submitted new and renewal project applications can be imported into a FY 2022 renewal project application. The "Submit without Changes" process is not applicable for: - first time renewing project applications - a project application that did not import last FY 2021 information - a project that had Issues or Conditions that were addressed in FY 2021 Post -Award and updates need to be reflected in the FY 2022 project application - a project that had amendments approved in FY 2020 or FY 2021 that need to be reflected in the FY 2022 project application e-snaps will automatically be set to "Make Changes' and all questions on each screen must be updated. The e-snaps screens that remain "open" for required annual updates and do not affect applicants' ability to select "Submit without Changes" are: - Recipient Performance Screen - Consolidation and Expansion - Screen 3A. Project Detail - Screen 6D. Sources of Match - All of Part 7: Attachments and Certification; and - All of Part 8: Submission Summary. All other screens in Part 2 through Part 6 begin in "Read -Only" format and should be reviewed for accuracy; including any updates that were made to the 2021 project during the CoC Post Award Issues and Conditions process or as amended. If all the imported data is accurate and no edits or updates are needed to any screens other than the mandatory screens and questions noted above, project applicants should select "Submit Without Changes" in Part 8. If project applicants imported data and do need to make updates to the information on one or more screens, they must navigate to Part 8: "Submission Without Changes" Screen, select "Make Changes", and check the box next to each relevant screen title to unlock screens for editing. After project applicants select the screens they intend to edit via checkboxes, click ""Save"" and those screens will be available for edit. Once a project applicant selects a checkbox and clicks ""Save"", the project applicant cannot uncheck the box. Please refer to the Detailed Instructions found on the left side menu of e-snaps or hud.gov to find more in depth information about applying under the FY 2022 CoC Competition. Renewal Project Application FY2022 Page 21 06/09/2023 Applicant: Miami -Dade County 0041482920000 Project Miami Homeless Assistance Program CE Consolidation FL0211L4D002215 Submission Without Changes 1. Are the requested renewal funds reduced from No the previous award due to reallocation? 2. Do you wish to submit this application without Make changes making changes? Please refer to the guidelines below to inform you of the requirements. 3. Specify which screens require changes by clicking the checkbox next to the name and then clicking the Save button. Part 2 - Subrecipient Information 2A. Subrecdpients Part 3 - Project Information 3A Project Detail x 3B. Description Part 4 - Housing Services and HMIS 4A. Services Part 5 - Participants and Outreach Information SA. Households 5B. Subpopulations Part 6 - Budget Information 6A Funding Request BD. Match 6E. Summary Budget Part 7 - Attachrnent(s) & Certification 7A. Attachment(s) x 7B. Certification x Renewal Project Application FY2022 Page 22 06/09/2023 Applicant: Miami -Dade County 0041482920000 Project: Miami Homeless Assistance Program CE Consolidation FLO211 L4D002215 You have selected "Make Changes" to question #2 above. Provide a brief description of the changes that will be made to the project information screens (bullets are appropriate): Update unique ID You have selected "Make Changes." Once this screen is saved, you will be prohibited from "unchecking" any box that has been checked regardless of whether a change to data on the corresponding screen will be made. Renewal Project Application FY2022 Page 23 06109/2023 Applicant: Miami -Dade County 0041482920000 Project: Miami Homeless Assistance Program GE Consolidation FL0211 L4D002215 Recipient Performance 1. Did you submit your previous year's Annual Yes Performance Report (APR) on time? 2. Do you have any unresolved HUD Monitoring No or OIG Audit f nding(s) concerning any previous grant term related to this renewal project request? 3. Do you draw funds quarterly for your current Yes renewal project? 4. Have any funds remained available for No recapture by HUD for the most recently expired grant term related to this renewal project request? Renewal Project Application FY2022 Page 24 06/09/2023 Applicant: Miami -Dade County Piled: Miami Homeless Assistance Program CE Consolidation 0041482920000 FL0211L4D002215 Renewal Grant Consolidation or Renewal Grant Expansion The FY2022 CoC Competition will continue offering opportunities to expand or consolidate CoC projects. 1. Expansions and Consolidations will submit individual applications. a. Expansions will ONLY submit a Stand -Alone Renewal application and a Stand -Alone New application. b. Consolidations will ONLY submit individual renewal project applications, identifying the renewal application that will survive, and the renewal applications that will terminate. Up to 10 grants may be included in a consolidation. 2. HUD HQ will combine the budget data (e.g., units, budgets) for Expansion or Consolidation requests from the individual project applications selected for conditional award and provide a data report with further instructions for the field office and conditional recipient. 1. Is this renewal project application requesting to No consolidate or expand? If No click on "Next" or "Save & Next" below to move to the next screen. Renewal Project Application FY2022 Page 25 06/09/2023 Applicant: Miami -Dade County Project: Miami Homeless Assistance Program CE Consolidation 0041482920000 FL0211L4D002215 2A. Project Subrecipients This screen is currently read only and only includes data from the previous grant. To make changes to this information, navigate to the Submission without Changes screen, select "Make Changes" in response to Question 2, and then check the box next each screen that requires a change to match the current grant agreement, as amended, or to account for a reallocation of funds. This form lists the subrecipient organization(s) for the project. To add a subrecipient, select the icon. To view or update subrecipient information already listed, select the view option. Total Expected Sub -Awards: $695,520 Organization Type Sub -Award Amount The City of Miami C. City or Township Government $695,520 Renewal Project Application FY2022 Page 26 06/09/2023 Applicant: Miami -Dade County 0041482920000 Project Miami Homeless Assistance Program CE Consolidation FL0211 L4D0022215 2A. Project Subrecipients Detail a. Organization Name: The City of Miami b. Organization Type: C. City or Township Government c. Employer or Tax Identification Number: 59-6000375 d. Unique Enhity Identifier: KTJSRFPMWTK5 e. Physical Address Street 1: 444 SW 2nd Avenue, 5th Floor Street 2: City: Miami State: Florida Zip Code: 33136 f. Congressional District(s): FL-024 (for multiple selections hold CTRL key) g. Is the subrecipient a Faith -Based No Organization? h. Has the subrecipient ever received a federal Yes grant, either directly from a federal agency or through a State/local agency? i. E ected Sub -Award Amount: $695,520 j. Contact Person Prefix: Mr. First Name: Sergio Renewal Project Application FY2022 Page 27 06/09/2023 Applicant: Miami -Dade County Project: Miami Homeless Assistance Program CE Consolidation Middle Name: Last Name: Torres Suffix: Title: Program Administrator E-mail Address: storres@rniamigov.com rniamigov.com Confirm E-mail Address: storres@miamigov.com Phone Number: 305-960-4980 Extension: Fax Number: 305-960-4977 0041482920000 FLO211L4D002215 Renewal Project Application FY2022 Page 28 06/09/2023 Applicant: Miami -Dade County 0041482920000 Project: Miami Homeless Assistance Program CE Consolidation FL0211 L4D002215 3A. Project Detail 1. Expiring Grant Project Identification Number FLO211 (PIN): (e.g., the "Federal Award Identifier" indicated on form 1 A. Application Type) 2. CoC Number and Name: FL-600 - Miami -Dade County CoC 3. CoC Collaborative Applicant Name: Miami -Dade County 4. Project Name: Miami Homeless Assistance Program CE Consolidation 5. Protect Status: Standard 6. Component Type: SSO 6a. Please select the type of SSO project: Street Outreach 7. Is your organization, or subrecipient, a victim No service provider defined In 24 CFR 578.3? Renewal Project Application FY2022 Page 29 06/09/2023 Applicant: Miami -Dade County Project: Miami Homeless Assistance Program GE Consolidation 0041482920000 FL0211L4D002215 3B. Project Description This screen is currently read only and only includes data from the previous grant. To make changes to this information, navigate to the Submission without Changes screen, select "Make Changes" in response to Question 2, and then check the box next each screen that requires a change to match the current grant agreement, as amended, or to account for a reallocation of funds. 1. Provide a description that addresses the entire scope of the proposed project. The City of Miami Homeless Assistance Program is the Coe's main CES access point, serving youth, unaccompanied adults and families. Our services extend to persons with and without disabilities. We staff the homeless helpline, provide discharge planning with institutions such as jails and hospitals that discharge into homelessness under an MOU, we canvas the full geography of Miarni-Dade engaging persons experiencing homelessness, and we are the main referral source to shelter. We use mobile devises to perform assessments & referrals, & provide transportation, including handicap accessible City vehicles. MHAP employs and trains persons with lived homeless experience. Our goal is to identify, and engage homeless individuals & families and place them into appropriate housing at least 85% of the times. MHAP's policy is to place families wlchildren in hotel when shelter is not available. They work with law enforcement, DV and youth focused access points, and 2 behavioral health outreach teams to provide a greater level of engagement and comprehensive case planning. MHAP operates weekdays from 7 am to 10 pm, with staff on -call afterhours and weekends. MHAP assigns thirteen teams of two to canvas the streets. MHAP assists with building condemnations & encampments. Program Eligibility Requirements: The program specifically targets persons living on the streets. Funding is needed to provide comprehensive Coordinated Entry services including helpline, street outreach and transportation. Per the CoC's CES policy, SSO-SO and youth and DV access points are the sole source for referrals into the CoC's crisis response system. Last year MHAP served over 9,000 unduplicated persons. 2. Check the appropriate box(s) if this project will have a specific subpopulation focus. (Select all that apply) N/A - Project Serves All Subpopulations Veterans Domestic Violence x Substance Abuse Youth (under 25) Mental Illness Families with Children HIV/AIDS Renewal Project Application FY2022 Page 30 05/09/2023 Applicant: Miami -Dade County Project: Miami Homeless Assistance Program CE Consolidation 0041482920000 FL0211L4D002215 Chronic Homeless Other(CNdc'Save" to update) 3. Housing First 3a. Does the project quickly move participants Yes into permanent housing 3b. Does the project enroll program participants who have the following barriers? Select all that aDDIv. Having too little or little Income X Active or history of substance use x Having a criminal record with exceptions for state -mandated restrictions X History of victimization (e.g. domestic violence. sexual assault, childhood abuse) r X None of the above 3c. Will the project prevent program participant termination for the following reasons? Select all that aooly. Failure to participate in supportive services X Failure to make progress on a service plan X Loss of income or failure to Improve income X Any other activity not covered in a lease agreement typically found for unassisted persons in the project's geographic area X None of the above 3d. Does the project follow a "Housing First" Yes approach? Renewal Project Application FY2022 Page 31 06/09/2023 Applicant Miami -Dade County Project: Miami Homeless Assistance Program CE Consolidation 0041482920000 FL0211L4D002215 4A. Supportive Services for Program Participants This screen is currently read onlyand only includes data from the previous grant. To make changes to this inrmation, navigate to the Submission without Changes screen, select' Make Changes" in response to Question 2, and then check the box next each screen that requires a change to match the current grant agreement, as amended, or to account for a reallocation of funds. 1. For all supportive services available to program participants, indicate who will provide them and how often they will be provided. Click 'Save' to update. Supportive Services Provider Frequency Assessment of Service Needs Applicant Daily Assistance with Moving Costs Case Management Applicant Daily Child Care Education Services Employment Assistance and Job Training Food Housing Search and Counseling Services Applicant Monthly Legal Services Life Skills Training Mental Health Services Outpatient Health Services Outreach Services Applicant Daily Substance Abuse Treatment Services Transportation Applicant Daily Utility Deposits Identify whether the project includes the following activities: 2. Transportation assistance to program Yes participants to attend mainstream benefit appointments, employee training, or jobs? 3. Annual follow-up with program participants to No ensure mainstream benefits are received and renewed? Renewal Project Application FY2022 Page 32 06/09/2023 Applicant: Miami -Dade County Project: Miami Homeless Assistance Program CE Consolidation 0041482920000 FLO211L4D002215 4. Do program participants have access to No SSI/SSDI technical assistance provided by this project, subrecipient, or partner agency? Renewal Project Application FY2022 Page 33 06/09/2023 Applicant: Miami -Dade County 0041482920000 Project: Miami Homeless Assistance Program CE Consolidation FL0211 L4D002215 5A. Program Participants - Households This screen is currently read only and only includes data from the previous grant. To make changes to this information, navigate to the Submission without Changes screen, select "Wake Changes" in response to Question 2, and then check the box next each screen that requires a change to match the current grant agreement, as amended, or to account for a reallocation of funds. Households Total Number of Households Characteristics Persons over age 24 Persons ages 18-24 Accompanied Children under age 18 Unaccompanied Children under age 18 Total Persons Households with at Least One Adult and One Child 765 Persons in Households with at Least One Adult and One Child 650 115 1,912 2,677 Adult Households without Children 3,865 Households with Only Children Click Save to automat cally calculate totals Total 4,630 Total 4,350 280 1,912 0 6,542 Renewal Project Application FY2022 Page 34 06/09/2023 Applicant: Miami -Dade County Project Miami Homeless Assistance Program CE Consolidation 5B. Program Participants - Subpopulations 0041482920000 FL0211L4d002215 This screen is currently read only and only includes data from the previous grant. To make changes to this information, navigate to the Submission without Changes screen, select "Make Changes" in response to Question 2, and then check the box next each screen that requires a change to match the current grant agreement, as amended, or to account for a reallocation of funds. Characteristics Persons over age 24 Persons ages 18-24 Children under age 18 Persons in Households with at Least One Adult and One Child CH (Not Veteran s) 230 5 0 Total Persons CH Veteran s 120 1 Veteran s CH) 100 1 Chronic Substa rice Abuse 150 15 0 HIV/Al DS 35 5 0 Severely Mentally 350 80 0 DV 20 0 5 0 Physical Disability 45 2 0 Developme Disability 4 1 0 Persons Not Represents d by a Listed Subpopulati on 1,912 235 121 I 101 165 40 430 20 5 47 5 1,912 Click Save to automatically calculate totals Persons in Households without Children Characteristics CH (Not Veteran s) CH Veteran s Veteran s (Not CH) Chronic Substa nee Abuse HIV/AI DS Severely Mentally ill DV Physical Disability Developme ntal Disability Persons Not Represente d by a Listed Subpopulatii on Persons over age 24 1,160 120 100 1,000 25 2,000 80 7 5 Persons ages 18-24 1 1 50 5 100 10 2 2 Total Persons 1,160 121 101 1,050 30 2,100 90 9 7 0 Click Save to automatically calculate totals Persons in Households with Only Children Characteristics CH (Not Veteran s) CH Veteran s Veteran s (Not CH) Chronic Substa nee Abuse HIVJAJ DS Severely Mentally Ili DV Physical Disability Developme ntal Disability Persons Not Represente d by a Listed Subpopulatt on Accompanied Children under age 18 Unaccompanied Children under age 18 Total Persons 0 0 0 0 0 0 0 0 Renewal Project Application FY2022 Page 35 06/09/2023 Applicant: Miami -Dade County Project Miami Homeless Assistance Program CE Consolidation 0041482920000 FLO211L4D002215 Describe the unlisted subpopulations referred to above: Children of head's of households Renewal Project Application FY2022 Page 36 06/09/2023 Applicant: Miami -Dade County 0041482920000 Project: Miami Homeless Assistance Program CE Consolidation FL0211 L4D002215 6A. Funding Request This screen is currently read only and only includes data from the previous grant. To make changes to this information, navigate to the Submission without Changes screen, select "Make Changes" in response to Question 2, and then check the box next each screen that requires a change to match the current grant agreement, as amended, or to account for a reallocation of funds. 1. Do any of the properties in this project have an No active restrictive covenant? 2. Was the original project awarded as either a No Samaritan Bonus or Permanent Housing Bonus project? 3. Does this project propose to allocate funds No according to an indirect cost rate? 4. Renewal Grant Term: This field is pre- 1 Year populated with a one-year grant term and cannot be edited: 5, Select the costs for which funding is requested: Leased Structures Supportive Services HMIS X Renewal Project Application FY2022 Page 37 06/09/2023 (REVISED) Applicant Miami -Dade County Project Miami Homeless Assistance Program CE Consolidation 0041482920000 FLO211L4D002215 6D. Sources of Match The following Iisitsummarizes the funds thatwill be used as Match for this project. To add a Match source to the list, select.the icon. To view or update a Match source already listed, select -the icon. Summary for Match Total Value of Cash Commitments: $650,874 Total Value of In -Kind Commihnents: $0 Total Value of All Commitments: $650,874 1. Will this projectgenerate program income No described in 24 CFR 578.97 to use as Match for this project? Type Source Contributor Value of Commitments Cash Government City of Miami $353,862 Cash Government Miami -Dade County $297,012 Renewal Project Application FY2022 Page 38 06/09/2023 (REVISED) Applicant Miami -Dade County Project Miami Homeless Assistance Program CE Consolidation 0041482920000 FL0211 L4D002215 Sources of Match Detail 1. Type of Match Commitment Cash 2. Source: Government 3. Name of Source: City of Miami (Be as specific as possible and include the office or grant program as applicable) 4. Amount of Written Commitment: $353,862 1. Type of Match Commitment Cash 2. Source: Government 3. Name of Source: Miami -Dade County - Homeless Trust (Be as specific as possible and include the office or grant program as applicable) 4. Amount of Written Commitment $297,012 Renewal Project Application FY2022 Page 39 06/09/2023 Applicant: Miami -Dade County Project: Miami Homeless Assistance Program CE Consolidation 0041482920000 FL0211 L40002215 6E. Summary Budget This screen is currently read only and only includes data from the previous grant. To make changes to this information, navigate to the Submission without Changes screen, select "Make Changes" in response to Question 2, and then check the box next each screen that requires a change to match the current grant agreement, as amended, or to account for a reallocation of funds. The following information summarizes the funding request for the total term of the project. Budget amounts from the Leased Units, Rental Assistance, and Match screens have been automatically imported and cannot be edited. However, applicants must confirm and correct, if necessary, the total budget amounts for Leased Structures, Supportive Services, Operating, HMIS, and Admin. Budget amounts must reflect the most accurate project information according to the most recent project grant agreement or project grant agreement amendment, the CoC's final HUD -approved FY 2018 GIW or the project budget as reduced due to CoC reallocation. Please note that, new for FY 2018, there are no detailed budget screens for Leased Structures, Supportive Services, Operating, or HMIS costs. HUD expects the original details of past approved budgets for these costs to be the basis for future expenses. However, any reasonable and eligible costs within each CoC cost category can be expended and will be verified during a HUD monitoring. Eligible Costs Total Assistance Requested for 1 year Grant Term {Applicant) la. Leased Units 10 lb. Leased Structures $a 2. Rental Assistance 3. Supportive Services $654,020 4. Operating $0 5. HMIS $0 6. Sub -total Costs Requested $650,020 7. Admin (Up to 10%) $45:500 8. Total Assistance plus Admin Requested $695,520 9. Cash Match $173 880 10. In -Kind Match $0 11. Total Match $173,880 12. Total Budget $869,400 Renewal Project Application FY2022 Page 40 06/09/2023 1 Applicant: Miami -Dade County 0041482920000 Project Miami Homeless Assistance Program CE Consolidation FL0211 L4D002215 Document Type 1) Subrecipient Nonprofit Documentation 2) Other Attachment 3) Other Attachment 7A. Attachment(s) Required? No No No Document Description Date Attached Renewal Project Application FY2022 Page 41 06/09/2023 Applicant: Miami -Dade County 0041482920000 Project: Miami Homeless Assistance Program CE Consolidation FL0211 L4D002215 Attachment Details Document Description: Attachment Details Document Description: Match Attachment Details Document Description: Certificate of Consistency Renewal Project Application FY2022 Page 42 06/09/2023 Applicant: Miami -Dade County 0041482920000 Project: Miami Homeless Assistance Program CE Consolidation FL0211 L4D002215 7B. Certification A. For all projects: Fair Housing and Equal Opportunity It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulations pursuant thereto (Title 24 CFR part i), which state that no person in the United States shall, on the ground of race, color or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the applicant receives Federal financial assistance, and will immediately take any measures necessary to effectuate this agreement. With reference to the real property and structure(s) thereon which are provided or improved with the aid of Federal financial assistance extended to the applicant, this assurance shall obligate the applicant, or in the case of any transfer, transferee, for the period during which the real property and structure(s) are used for a purpose for which the Federal financial assistance is extended or for another purpose involving the provision of similar services or benefits. It will comply with the Fair Housing Act (42 U.S.C. 3601-19), as amended, and with implementing regulations at 24 CFR part 100, which prohibit discrimination in housing on the basis of race, color, religion, sex, disability, familial status or national origin. It will comply with Executive Order 11063 on Equal Opportunity in Housing and with implementing regulations at 24 CFR Part 107 which prohibit discrimination because of race, color, creed, sex or national origin in housing and related facilities provided with Federal financial assistance. It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter 60-1), which state that no person shall be discriminated against on the basis of race, color, religion, sex or national origin in all phases of employment during the performance of Federal contracts and shall take affirmative action to ensure equal employment opportunity. The applicant will incorporate, or cause to be incorporated, into any contract for construction work as defined in Section 130.5 of HUD regulations the equal opportunity clause required by Section 130.15(b) of the HUD regulations. It will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended (12 U.S.C. 1701(u)), and regulations pursuant thereto (24 CFR Part 135), which require that to the greatest extent feasible opportunities for training and employment be given to lower -income residents of the project and contracts for work in connection with the project be awarded in substantial part to persons residing in the area of the project. It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), as amended, and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based on disability in Federally -assisted and conducted programs and activities. Renewal Project Application FY2022 Page 43 06/09/2023 Applicant: Miami -Dade County 0041482920000 Project. Miami Homeless Assistance Program CE Consolidation FL0211 L4D002215 It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-07), as amended, and implementing regulations at 24 CFR Part 146, which prohibit discrimination because of age in projects and activities receiving Federal financial assistance. It will comply with Executive Orders 11625, 12432, and 12138, which state that program participants shall take affirmative action to encourage participation by businesses owned and operated by members of minority groups and women. If persons of any particular race, color, religion, sex, age, national origin, familial status, or disability who may qualify for assistance are unlikely to be reached, it will establish additional procedures to ensure that interested persons can obtain information concerning the assistance. It will comply with the reasonable modification and accommodation requirements and, as appropriate, the accessibility requirements of the Fair Housing Act and section 504 of the Rehabilitation Act of 1973, as amended. Additional for Rental Assistance Projects: If applicant has established a preference for targeted populations of disabled persons pursuant to 24 CFR 578.33(d) or 24 CFR 582.330(a), it will comply with this section's nondiscrimination requirements within the designated population. B. For non -Rental Assistance Projects Only. 20-Year Operation Rule. 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. 15-Year Operation Rule — 24 CFR part 578 only. Applicants receiving assistance for acquisition, rehabilitation or new construction: The project will be operated for no Tess than 1' 5 years from the date of initial occupancy or the date of initial service provision for the purpose specified in the application. 1-Year 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. Explanation. Where the applicant is unable to certify to any of the statements in this certification, such applicant shall provide an explanation. N/A Renewal Project Application FY2022 Page 44 O6/09/2023 Applicant: Miami -Dade County Project: Miami Homeless Assistance Program CE Consolidation 0041482920000 FL0211L40002215 Name of Authorized Certifying Official Date: Title: Applicant Organization: PHA Number (For PHA Applicants Only): I certify that I have been duly authorized by the applicant to submit this Applicant Certification and to ensure compliance. I am aware that any false, ficticious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties . (U.S. Code, Title 218, Section 1001). Active SAM Status Requirement. I certify that our organization has an active System for Award Management (SAM) registration as required by 2 CFR 200.300(b) at the time of project application submission to HUD and will ensure this SAM registration will be renewed annually to meet this requirement. Daniella Levine Cava 08/31/2022 County Mayor Miami -Dade County x x Renewal Project Application FY2022 Page 45 06/09/2023 Applicant: Miami -Dade County 0041482920000 Project: Miami Homeless Assistance Program CE Consolidation FLO211 L4D002215 8B Submission Summary Page Last Updated 1A. SF-424 Application Type 08/31/2022 1 B. SF-424 Legal Applicant 08/31/2022 1C. SF-424 Application Details No input Required 1 D. SF-424 Congressional Distrlct(s) 08/31/2022 1 E. SF-424 Compliance 08/31/2022 Renewal Project Application FY2022 Page 46 06/09/2023 Applicant: Miami -Dade County 0041482920000 Protect: Miami Homeless Assistance Program CE Consolidation FLO211 L4D002215 1 F. SF-424 Declaration 08/31/2022 1G. HUD-2880 08/31/2022 1 H. HUD-50070 08/31/2022 11. Cert. Lobbying 08/31/2022 1J.. SF-LLL 08/31/2022 IK. SF-424B 08/31/2022 Submission Without Changes 08/31/2022 Recipient Performance 08/31/2022 Renewal Grant Consolidation or Renewal Grant 08/31/2022 Expansion 2A. Subrecipients 08/31/2022 3A. Project Detail 08/31/2022 3B. Description 08/31/2022 4A. Services 08/31/2022 5A. Households 08/31/2022 5B. Subpopulations 08/31/2022 6A. Funding Request 08/31/2022 6D. Match 08/31/2022 6E. Summary Budget No Input Required TA. Attachment(s) No Input. Required 7B. Certification 08/31/2022 Renewal Project Application FY2022 Page 47 06/09/2023 FY2022 Continuum of Care (Cot) Program Form W-9 Department of the Treasury Internal Revenue Service (IRS) Request for Taxpayer Identification Number and Certification ATTACHMENT C "W-9 Request for Taxpayer ID and Certification' Form WV-9 (Rev. October 2018) Depertmen t of the Treasury internal Revenue Service C 5 Address (number, street, and apt. or suite no.) See instructions. 444 SW 2nd Avenue, 6th Floor 0 City. state, and ZIP code Miami, FL 33130 7 fast account number(a) here (optional) Part 1 i Name as shown City of Miami Request for Taxpayer Identification Number and Certification ■ eto to wt+vw.irs.gev/,FormWe for instructions and the Latest Information. on ywr income tax rteum). Name Is required on thie line; do not leave this line blank. 2 business namefdisregerded entity nam& different from above Give Form to the requester. Do not send to the IRS. 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only ones following seven boxes. ❑ Indlviduallsofe proprietor or ❑ G Corporation ❑ S Corporation ❑ Partnership Single -member LLC the ❑ Trust/estate ❑ limited Iiabiley company. Enter the tax ciassiflcation (CeC corporation, S=3 corporation, eepartnerehip) Note: Cheek the appropriate box in the line above for the to classification of the single -member owner. too not check LLC if the LLC to Gassifred as a single mamba LLC that is disregarded from the owner unless the owner of the LLC is another LLG that is not disregarded from the owner tor U.S. federal tax purposes. Otherwlsa, a single -member LLC that is disregarded from the owner should check the appropriate box for the tax ntassiffcation of its owner. 0 Other (®se frrstntctions) Municipa Pity 4 Exemption (codes Apply only to certain entitles, not individuals; see instructions on page 3): Exempt payee code (if any) Exemption horn FATCA reporting code of any) Mi0.16 ro iiecw.nts onoeaned Wed, rAe [rs.J Requester's name and address (optional) Taxpayer Identification Number MN) Enter your TIN in the appropriate box, The TIN provided Must match the name given an line 110 avoid backup withholding. For individuals, this is generally your social security number (SSN), However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later, For other entities, it is your employer identification number (EIN). If you do not have a number, see flow to get a TiN, later. Note: if the account is in More than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter. Part It Certification 1 Social security number or Employer identiffcat on number 5 9 6 0 f) 0 3 7 5 Under penalties of perjury, l certify that: - 1. The number shown on this form is my correct taxpayer identification number (or 1 am waiting for a number to be issued to me); and 2. I 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 dfv#lends. or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. l em a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on the form (if any) indicating that I am exempt from FATCA reporting is correct, 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 failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does nal apply. For mortgage interest paid, acquisition or abandonment of secured property, canceifation of debt, contributions to an individual retirement arrangement (ORA), and generally„ payments outer then interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the Instructions for Part II. later. Sign Here General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest Information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.govfFormiiM9. Purpose of Form An individual or entity (Form W9 requester) who Is required to file an information return with the IRS must obtain your correct taxpayer ldentifleatiptt number (TIN) which may be your social security number (SSN), individual taxpayer identification number (fTlI% , adoption taxpayer identification number (ATIN), or employer identification dumber (EIN), to report on an information return the amount paid to you, or other amount reportable an an information return. Examples of information returns Inch de, but are not limited to, the following. • Form 1099-INT (Interest earned or paid) • Form 1099-D1V (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-8 (stock or mutual fund sales and certain other transactions by brokers) • Forrn 1099-S (proceeds from rear estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canaeied debt) • Form 10994. (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.B. person (including a resident alien), to provide your correct TIN. f you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What Is backup withholding, later. Cat. No.10231X Form W-9 (Rev.1u-2o1 rig Form W-9 (Rev. 10-2018) By signing the filled -out form, you: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners` share of effectively connected income, and 4. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting, is correct. See What is FATCA reporting, later, for further information. Note: If you are a U.S. person and a requester gives you a form other than Form W-9 to request your TiN, you must use the requester's form if it is substantially similar to this Form W-9. Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are: • An individual who is a U.S. citizen or U.S. resident alien; • A partnership, corporation, company, or association created or organized in the United Stales or under the laws of the United States; • An estate (other than a foreign estate); or • A domestic trust (as defined in Regulations section 301.7701-7). Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax under section 1446 on any foreign partners' share of effectively connected taxable income from such business. Further, in certain cases where a Form W-9 has not been received, the rules under section 1446 require a partnership to presume that a partner is a foreign person, and pay the section 1446 withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid section 1446 withholding on your share of partnership income. In the cases below, the following person must give Form W-9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business in the United States. • In the case of a disregarded entity with a U.S. owner, the U.S. owner of the disregarded entity and not the entity; • In the case of a grantor trust with a U.S. grantor or other U.S. owner, generally, the U.S. grantor or other U.S. owner of the grantor trust and not the trust; and • In the case of a U.S. trust (other than a grantor trust), the U.S. trust (other than a grantor trust) and not the beneficiaries of the trust. Foreign person. If you are a foreign person or the U.S. branch of a foreign bank that has elected to be treated as a U.S. person, do not use Form W-9. Instead, use the appropriate Form W-8 or Form 8233 (see Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign Entities). Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a "saving clause." Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise become a U.S. resident alien for tax purposes. If you are a U.S. resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement to Form W-9 that specifies the following five items. 1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien. 2. The treaty article addressing the income. 3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions. 4. The type and amount of income that qualifies for the exemption from tax. 5. Sufficient facts to justify the exemption from tax under the terms of the treaty article. Page 2 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, give the requester the appropriate completed Form W-8 or Form 8233. Backup Withholding What is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS 24% of such payments. This is called "backup withholding." Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, payments made in settlement of payment card and third party network transactions, 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 1. You do not furnish your TIN to the requester, 2. You do not certify your TIN when required (see the instructions for Part II for details}, 3. The IRS tells the requester that you furnished an incorrect TIN, 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 retum (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 Exempt payee code, later, and the separate Instructions for the Requester of Form W-9 for more Information. Also see Special rules for partnerships, earlier. What is FATCA Reporting? The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign financial institution to report all United States account holders that are specified United States persons. Certain payees are exempt from FATCA reporting. See Exemption from FATCA reporting code, later, and the Instructions for the Requester of Form W-9 for more information. Updating Your Information You must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this person. For example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you no longer are tax exempt. In addition, you must furnish a new Form W-9 if the name or TIN changes for the account: for example, if the grantor of a grantor trust dies. 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. Form W-9 (Rev. 10-2018) Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment. Misuse of Ns. If the requester discloses or uses TINs in violation of federal law. the requester may be subject to civil and criminal penalties. Specific Instructions Line 1 You must enter one of the following on this line; do not leave this line blank. The name should match the name on your tax retum. If this Farm W-9 is for a Joint account (other than an account maintained by a foreign financial institution (FFI)), list first, and then circle, the name of the person or entity whose number you entered in Part l of Form W-9. If you are providing Form W-9 to an FFI to document a joint account, each holder of the account that is a U.S. person must provide a Form W-9. a. individual. Generally, enter the name shown on your tax return. If you have changed your last name without informing the Social Security Administration (SSA) of the name change, enter your first name, the last name as shown on your social security card, and your new last name. Note: iTIN applicant: Enter your individual name as it was entered on your Form W-7 application, line la. This should also be the same as the name you entered on the Form 1040/1040A/1040EZ you filed with your application. b. Sole proprietor or single -member LLC. Enter your individual name as shown on your 1040/1040A/1040EZ on line 1. You may enter your business, trade, or "doing business as" (DBA) name on line 2. c. Partnership, LLC that is not a single -member LLC, C corporation, or S corporation. Enter the entity's name as shown on the entity's tax return on line 1 and any business, trade, or DBA name on line 2. d. Other entities. Enter your name as shown on required U.S. federal tax documents on line 1. This name should match the name shown on the charter or other legal document creating the entity. You may enter any business, trade, or DBA name on line 2. e. Disregarded entity. For U.S. federal tax purposes, an entity that is disregarded as an entity separate from its owner is treated as a "disregarded entity." See Regulations section 301.7701-2(o)(2)(iii). Enter the owner's name on line 1. The name of the entity entered on line 1 should never be a disregarded entity. The name on line 1 should be the name shown on the income tax return on which the income should be reported. For example, if a foreign LLC that is treated as a disregarded entity for U.S. federal tax purposes has a single owner that is a U.S. person, the U.S. owner's name is required to be provided on line 1. If the direct owner of the entity is also a disregarded entity, enter the first owner that is not disregarded for federal tax purposes. Enter the disregarded entity's name on line 2, "Business name/disregarded entity name." IF the owner of the disregarded entity is a foreign person, the owner must complete an appropriate Form W-8 instead of a Form W-9. This is the case even if the foreign person has a U.S. TIN. Line 2 If you have a business name, trade name, DBA name, or disregarded entity name, you may enter it on line 2. Line 3 Check the appropriate box on line 3 for the U.S. federal tax classification of the person whose name is entered on line 1. Check only one box on line 3. Page 3 IF the entity/person on line 1 is a(n) ... THEN check the box for... • Corporation Corporation • Individual • Sole proprietorship, or • Single -member limited liability company (LLC) owned by an individual and disregarded for U.S. federal tax purposes. Individual/sole proprietor or single- member LLC • LLC treated as a partnership for U.S. federal tax purposes, • LLC that has filed Form 8832 or 2553 to be taxed as a corporation, or • LLC that is disregarded as an entity separate from its owner but the owner is another LLC that is not disregarded for U.S. federal tax purposes. Limited liability company and enter the appropriate tax classification. (P= Partnership; C. C corporation; or S. 5 corporation) • Partnership Partnership • Trust/estate Trust/estate Line 4, Exemptions If you are exempt from backup withholding and/or FATCA reporting, enter in the appropriate space on line 4 any code(s) that may apply to you. Exempt payee code. • Generally, individuals (including sole proprietors) are not exempt from backup withholding. • Except as provided below, corporations are exempt from backup withholding for certain payments, including interest and dividends. • Corporations are not exempt from backup withholding for payments made in settlement of payment card or third party network transactions. • Corporations are not exempt from backup withholding with respect to attorneys' fees or gross proceeds pald to attorneys, and corporations that provide medical or health care services are not exempt with respect to payments reportable on Form 1099-MiSC. The following codes identify payees that are exempt from backup withholding. Enter the appropriate code in the space in line 4. 1—An organization exempt from tax under section 501(a), any iRA, or a custodial account under section 403(b)(7) if the account satisfies the requirements of section 401(f)(2) 2—The United States or any of its agencies or instrumentalities 3—A state, the District of Columbia, a U.S. commonwealth or possession, or any of their political subdivisions or instrumentalities 4—A foreign government or any of its political subdivisions, agencies, or instrumentalities 5—A corporation 6—A dealer in securities or commodities required to register in the United States, the District of Columbia, or a U.S. commonwealth or possession 7—A futures commission merchant registered with the Commodity Futures Trading Commission 8—A real estate investment trust 9—An entity registered at a!I times during the tax year under the Investment Company Act of 1940 10—A common trust fund operated by a bank under section 584(a) 11—A financial institution 12—A middleman known in the investment community as a nominee or custodian 13—A trust exempt from tax under section 664 or described in section 4947 Form W-9 (Rev. 10-2018) The following chart shows types of payments that may be exempt from backup withholding. The chart applies to the exempt payees listed above, 1 through 13. IF the payment is for ... THEN the payment Is exempt for--. Interest and dividend payments All exempt payees except for? Broker transactions Exempt payees 1 through 4 and 6 through 11 and all C corporations. S corporations must not enter an exempt payee code because they are exempt only for sales of noncovered securities acquired prior to 2012. Barter exchange transactions and patronage dividends Exempt payees 1 through 4 Payments over $600 required to be reported and direct sales over $5,0001 Generally, exempt payees 1 through 52 Payments made in settlement of payment card or third party network transactions Exempt payees 1 through 4 1 See Form 1099-MISC, Miscellaneous Income, and its instructions. 2 However, the following payments made to a corporation and reportable on Form 1099-MISC are not exempt from backup withholding: medical and health care payments, attorneys' fees, gross proceeds paid to an attorney reportable under section 6045(f), and payments for services paid by a federal executive agency. Exemption from FATCA reporting code. The following codes identify payees that are exempt from reporting under FATCA. These codes apply to persons submitting this form for accounts maintained outside of the United Slates by certain foreign financial institutions. Therefore, if you are only submitting this form for an account you hold in the United States, you may leave this field blank. Consult with the person requesting this form if you are uncertain if the financial institution is subject to these requirements. A requester may indicate that a code is not required by providing you with a Form W-9 with "Not Applicable" (or any similar indication) written or printed on the line for a FATCA exemption code. A —An organization exempt from tax under section 501(a) or any individual retirement plan as defined in section 7701(a)(37) B—The United States or any of its agencies or instrumentalities C—A state, the District of Columbia, a U.S. commonwealth or possession, or any of their political subdivisions or instrumentalities D—A corporation the stock of which is regularly traded on one or more established securities markets, as described in Regulations section 1.1472-1(c)(1)(i) E—A corporation that is a member of the same expanded affiliated group as a corporation described in Regulations section 1.1472-1(c)(1)(i} F—A dealer in securities, commodities, or derivative financial instruments (including notional principal contracts, futures, forwards, and options) that is registered as such under the laws of the United States or any stale G—A real estate investment trust H—A regulated investment company as defined in section 851 or an entity registered at all times during the tax year under the Investment Company Act of 1940 I —A common trust fund as defined in section 584(a) J—A bank as defined in section 581 K—A broker L—A trust exempt from tax under section 664 or described in section 4947(a)(1) Page 4 M—A tax exempt trust under a section 403(b) plan or section 457(g) plan Note: You may wish to consult with the financial institution requesting this form to determine whether the FATCA code and/or exempt payee code should be completed. Line 5 Enter your address (number, street, and apartment or suite number). This is where the requester of this Form W-9 will mail your information returns. If this address differs from the one the requester already has on file, write NEW at the top. If a new address is provided, there is still a chance the old address will be used until the payor changes your address in their records. Line 6 Enter your city, state, and ZIP code. Part I. Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. If you are a resident alien and you do not have and are not eligible to get an SSN, your TIN is your IRS individual taxpayer identification number (ITIN). Enter it in the social security number box. If you do not have an ITIN, see How to get a TIN If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN. If you are a single -member LLC that is disregarded as an entity separate from its owner, enter the owner's SSN (or EiN, if the owner has one). Do not enter the disregarded entity's EIN. If the LLC is classified as a corporation or partnership, enter the entity's EIN. Note: See What Name and Number To Give the Requester, later, for further clarification of name and TIN combinations. How to get a TIN. If you do not have a TIN, apply for one immediately. To apply for an SSN, get Form S5-5, Application for a Social Security Card, from your local SSA office or get this form online at www.SSA.gov. 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 55-4, Application for Employer Identification Number, to apply for an EIN. You can apply for an EIN online by accessing the IRS website at www.irs.gov/Businesses and clicking on Employer Identification Number (EIN) under Starting a Business. Go to www.irs.gov/Forms to view, download, or print Form W-7 and/or Form SS-4. Or, you can go to www.rrs.gov/OrderForms to place an order and have Form W-7 and/or SS-4 mailed to you within 10 business days. If you are asked to complete Form W-9 but do not have a TIN, apply for a TIN and write "Applied For" in the space for the TIN, sign and date the form, and give it to the requester. For interest and dividend payments, and certain payments made with respect to readily tradable instruments, generally you will have 60 days to get a TIN and give it to the requester before you are subject to backup withholding on payments. The 60-day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester. Note: Entering "Applied For" means that you have already applied for a TIN or that you intend to apply for one soon. Caution: A disregarded U.S. entity that has a foreign owner must use the appropriate Form W-8, Part II. Certification To establish to the withholding agent that you are a U.S. person, or resident alien, sign Form W-9. You may be requested to sign by the withholding agent even if item 1, 4, or 5 below indicates otherwise. For a joint account, only the person whose TIN is shown in Part I should sign (when required). In the case of a disregarded entity, the person identified on line 1 must sign. Exempt payees, see Exempt payee code, earlier. Signature requirements. Complete the certification as indicated In items 1 through 5 below. Form W-9 (Rev. 10-2018) 1. Interest, dividend, and barter exchange accounts opened before 1984 and broker accounts considered active during 1983. You must give your correct TIN, but you do not have to sign the certification. 2. Interest, dividend, broker, and barter exchange accounts opened after 1983 and broker accounts considered inactive during 1983. You must sign the certification or backup withholding will apply. If you are subject to backup withholding and you are merely providing your correct TIN to the requester, you must cross out item 2 in the certification before signing the form, 3. Real estate transactions. You must sign the certification. You may cross out item 2 of the certification. 4. Other payments. You must give your 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 nonemployee for services, payments made in settlement of payment card and third party network transactions, 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), ABLE accounts (under section 529A), IRA, Coverdetl ESA, Archer MSA or NSA contributions or distributions, and pension distributions. You must give your correct TiN, but you do not have to sign the certification. What Name and Number To Give the Requester For this type of account Give name and SSN of: 1. Individual The individual 2. Two or more individuals toint account) other than an account maintained by an FFi 3. Two or more U.S. persons Quint account maintained by an FFi) 4. Custodial account of a minor (Uniform Gift to Minors Act) 5. a. The usual revocable savings trust (grantor is also trustee) b. So-called trust account that is not a legal or valid trust under state law 6. Sole proprietorship or disregarded entity owned by an individual 7. Grantor trust filing under Optional Form 1099 Filing Method 1 (see Regulations section 1.671-4(b)(2)(i) (A)) The actual owner of the account or, if combined funds, the first individual on the account' Each holder of the account The minor2 The grantor -trustee' The actual owner' The owner/ The grantor* For this type of account 8. Disregarded entity not owned by an individual 9. A valid trust, estate, or pension trust 10. Corporation or LLC electing corporate status on Form 8832 or Farm 2553 11. Association, club, religious, charitable, educational, or other tax- exempt organization 12. Partnership or multi -member LLC 13. A broker or registered nominee Give name and EiN of: The owner Legal entity4 The corporation The organization The partnership The broker or nominee Page 5 For this type of account: Give name and EIN of: 14. Account with the Department of Agriculture in the name of a public entity (such as a state ar local government, school district, or prison) that receives agricultural program payments 15. Grantor trust filing under the Form 1041 Filing Method or the Optional Farm 1 099 Filing Method 2 (see Regulations section 1.671-4{IbX2)(i)B)) The public entity The trust ' List first and circle the name of the person whose number you furnish. If only one person on ajoint account has an SSN, that person's number must be furnished. 2 Circle the minor's name and fumish the minor's SSN. 3 You must show your individual name and you may also enter your business or DBA name on the "Business name/disregarded entity" name line. You may use either your SSN or EIN if you have one), but the IRS encourages you to use your SSN. List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TiN of the personal representative or trustee unless the legal entity itself is not designated in the account title.) Also see Special rules for partnerships, earlier. *Note: The grantor also must provide a Form W-9 to trustee of trust. Note: If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed. Secure Your Tax Records From Identity Theft Identity theft occurs when someone uses your personal information such as your name, SSN, or other identifying information, without your permission, to commit fraud or other crimes. An identity thief may use your SSN to get a job or may file a tax return using your SSN to receive a refund. To reduce your risk: • Protect your SSN, • Ensure your employer is protecting your SSN, and • Be careful when choosing a tax preparer. if your tax records are affected by identity theft and you receive a notice from the iRS, respond right away to the name and phone number printed on the IRS notice or letter. If your tax records are not currently affected by identity theft but you think you are at risk due to a lost or stolen purse or wallet, questionable credit card activity or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit Form 14039. For more information, see Pub. 5027, Identity Theft information for Taxpayers. Victims of identity theft who are experiencing economic harm or a systemic problem, or are seeking help in resolving tax problems that have not been resolved through normal channels, may be eligible for Taxpayer Advocate Service (TAS) assistance. You can reach TAS by calling the TAS toll -free case intake line at 1-877-777-4778 or TTYITDD 1-800-829-4059. Protect yourself from suspicious emaiis or phishing schemes. Phishing is the creation and use of email and websites designed to mimic legitimate business emaiis and websites. The most common act is sending an email to a user falsely claiming to be an established legitimate enterprise in an attempt to scam the user into surrendering private information that will be used for identity theft. Form W-9 (Rev.10-2018) The IRS does not initiate contacts with taxpayers via emails. Also, the IRS does not request personal detailed information through email or ask taxpayers for the PIN numbers, passwords, or similar secret access information for their credit card, bank, or other financial accounts. If you receive an unsolicited email claiming to be from the IRS, forward this message to phishingairs.gov. You may also report misuse of the IRS name, logo, or other IRS property to the Treasury Inspector General for Tax Administration (TIGTA) at 1-800-366-4464. You can forward suspicious emails to the Federal Trade Commission at spam@uce.gov or report them at www.ffc.govfcomplaint. You can contact the FTC at www, ftc.govlidtheft or 877-IDTHEFT (877-438-4338). If you have been the victim of identity theft, see wwwddenfitymeft,gov and Pub. 5027. Visit www.its.govlldentityTheff to learn more about identity theft and how to reduce your risk. Page 6 Privacy Act Notice Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons (including federal agencies) who are required to file information returns with the IRS to report interest, dividends, or certain other income paid to you; mortgage interest you paid; the acquisition or abandonment of secured property; the cancellation of debt; or contributions you made to an IRA, Archer MSA, or RSA. The person collecting this form uses the information on the form to file information returns with the IRS, reporting the above information. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation and to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their laws. The information also may be disclosed to other countries under a treaty, to federal and state agencies to enforce civil and criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You must provide your TIN whether or not you are required to file a tax return. Under section 3406, payers must generally withhold a percentage of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to the payer. Certain penalties may also apply for providing false or fraudulent information. FY2022 Continuum of Care (CoC) Program Affidavits and Declarations ATTACHMENT D "Affidavits and Declarations" Miami -Dade County's Affidavits and Declarations MIAMI•I 1ADE11 COUNTY Miami -Dade County requires each party desiring to enter into a contract with Miami -Dade County to: [1] Sign an affidavit as to certain matters and (2) make a declaration as to certain other matters. This form contains both Affidavit forms for matters requiring the entity to sign under oath and Declaration forms for matters requiring only an affirmation or declaration for other matters. Each section of this form must be read, and initialed in the top right-hand box indicating acceptance and/or compliance with the County's policy related to the particular affidavit. For affidavit sections that you do not believe are applicable to your organization, please indicate this by placing "®" in the box next to N/A. ALL SECTIONS MUST BE COMPLETED THE FOLLOWING MATTERS REQUIRE THE ENTITY TO SIGN AN AFFIDAVIT UNDER OATH: STATE OF ( COUNTY OF ( COUNTRY OF ( ) ) Before me the undersigned authority appeared (Print Name), who is personally known to me or who has provided as identification and who did swear to the following: That he or she is the duly authorized representative of (Name of Entity) (Address of Entity) addresses are not acceptable. Federal Employment Identification Number Post Office (hereinafter referred to as the contracting "entity"), and that he or she is the entity's (Sole Proprietor)(Partner)(President or Other Authorized Officer) That he or she has full authority to make this affidavit, and that the information given herein and the documents attached hereto are true and correct; and That he or she says for the following sixteen (16) Affidavits and Declarations: ATTACHMENT D "Miami -Dade County Affidavits and Declarations" Pagel of l l Miami -Dade County's Affidavits and Declarations 1. MIAMI-DADE COUNTY OWNERSHIP DISCLOSURE AFFIDAVIT (SECTION 2-8.1 OF THE COUNTY CODE) Pertains 0 NSA Initial (___) If the contract or business transaction is with a corporation, the full legal name and business address shall be provided for each officer and director and each stockholder who holds directly or indirectly five percent (5%) or more of the corporation's stock. If the contract or business transaction is with a partnership, the foregoing information shall be provided for each partner. If the contract or business transaction is with a trust, the full legal name and address shall be provided for each trustee and each beneficiary. The foregoing requirements shall not pertain to contracts with publicly traded corporations or to contracts with the United States or any department or agency thereof, the State or any political subdivision or agency thereof or any municipality of this State. All such names and address are outlined below: Post Office addresses are not acceptable. (Full Legal Name, Address, % Ownership) (Full Legal Naive, Address, % Ownership) (Full Legal Name, Address, % Ownership) (Full Legal Name, Address, % Ownership) The full legal names and business address of any other individual (other than subcontractors, material person, suppliers, laborers, or lenders) who have, or will have, any interest (legal, equitable beneficial or otherwise) in the contract or business transaction with Miami Dade County are: Post office addresses are not acceptable Any person who willfully fails to disclose the information required herein, or who knowingly discloses false information in this regard, shall be punished by a fine of up to five hundred dollars ($500.00) or imprisonment in jail for up to sixty (60) days or both, ATTACHMENT D "Miami -Dade County Affidavits and Declarations" Page 2 of 11 Miami -Dade County's Affidavits and Declarations 2. MIAMI-DADE COUNTY EMPLOYMENT DISCLOSURE AFFIDAVIT (COUNTY ORDINANCE 90-133, AMENDING SECTION 2.8-1; SUBSECTION (d)(2) OF THE COUNTY CODE) Pertains 0 N/A v Initial () Except where precluded by Federal or State laws or regulations, each contract or business transaction or renewal thereof which involves the expenditure of then thousand dollars ($10,000) or more shall require the entity contracting or transaction business to disclose the following information. The foregoing disclosure requirements do not apply to contracts with the United States or any department or agency thereof, the State or any political subdivision or agency thereof or any municipality of this State. Does your firm have a collective bargaining agreement with its employees? C] Yes El No Does your firm provide paid health care benefits for its employees? E Yes it No Provide a current breakdown (number of persons) of your firm's work force and ownership (below): White: Black: Hispanic: Asian: American Native: Aleut (Eskimo): Males Males Males Males Males Males Females Females Females Females Females Females ATTACHMENT D "Miami -Dade County Affidavits and Declarations" Page 3 of 11 Miami -Dade County's Affidavits and Declarations 3. MIAMI-DADE COUNTY AFFIRMATIVE ACTION / NONDISCRIMINATION OF EMPLOYMENT, PROMOTION AND PROCUREMENT PRACTICES (COUNTY ORDINANCE 98-30 CODIFIED AT 2-8.1.5 OF THE COUNTY CODE) Pertains ❑ N/A 0 Initial (_) Pursuant to Miami -Dade County's Ordinance No. 98-30, Section 2-8.1.5, entities with annual gross revenue in excess of $5,000,000 seeking to contract with the County shall, as a condition of receiving a County contract, have: 1) a written affirmative action plan which sets forth the procedures the entity utilizes to assure that it does not discriminate in its employment and promotion practices and 2) a written procurement policy which sets forth the procedures the entity utilizes to assure that it does not discriminate against minority and wornen-owned businesses in its own procurement of goods, supplies and services. Such affirmative action plans and procurement policies shall provide for periodic review to determine their effectiveness in assuring the entity does not discriminate in its employment, promotion and procurement practices. The foregoing, not withstanding, corporate entities whose board of directors are representative of the population make-up of the nation shall be presumed to have non-discriminatory employment and procurement policies, and shall not be required to have a written affirmative action plan and procurement policy in order to receive a County contract. The foregoing presumption may be rebutted. The requirements of this section may be waived upon written recommendation of the County Manager that it is in the best interest of the County to do so and approval of the County Commission by majority vote of the members present. Based on the above, please complete the affidavit as directed and return the completed affidavit along with a cover letter on your company's letterhead, listing the company's address, phone and fax numbers, and any required documents, to: Miami -Dade County, Department of Procurement Management Affirmative Action Plan Unit 111 NW lst Street, lath Floor Miami, FL 33128 Yes No 0 Yes 0 No 0 Yes 0 No 0 My company has an affirmative action plan and procurement policy and is available for review. My company has annual gross revenues in excess of $5,000,000. Therefore, our company's affirmative action plan and procurement policy is available for review. My company has annual gross revenues less than $5,000,000. If at any time the Miami Dade County has reason to believe that any person or firm has willfully and knowingly provided incorrect information or made false statements, the County may refer the matter to the State Attorney's Office and/or other investigative agencies. The County may initiate debarment and/or pursue other remedies in accordance with Miami -Dade County policy and/or applicable federal, state and local laws. 4. MIAMI-DADE COUNTY CRIMINAL RECORD AFFIDAVIT (SECTION 2-8,6 OF THE COUNTY CODE) Pertains 0 N/A Initial ( ) The individual or entity entering into a contract or receiving funding from Miami -Dade County 0 has 0 has not, as of the date of this affidavit, been convicted of a felony during the past ten (10) years. An officer, director, or executive officer of the entity entering into a contract or receiving funding from Miami - Dade County 0 has 0 has not as of the date of this affidavit been convicted of a felony during the past ten (10) years. ATTACHMENT D "Miami -Dade County Affidavits and Declarations" Page 4 of 11 Miami -Dade County's Affidavits and Declarations PUBLIC ENTITY CRIMES AFFIDAVIT (SECTION 287.133(3)(a), FLORIDA STATUTES) Pertains ❑ N/A 0 Initial ( ) The individual or entity entering into a contract or receiving funding from Miami -Dade County understands the following: That a "public entity crime" as defined in Paragraph 287.133 (1) (g) Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state of the United States of America, including but not limited to, any bid or contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state of the United States of America and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. That "Convicted" or "conviction" as defined in Paragraph 287.133 (1) (b) Florida Statutes means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal state trial court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, non -jury trial, or entry of plea of guilty or nolo contendere. That an "affiliate" as defined in Paragraph 287.133 (1) (a) Florida Statutes means a) a predecessor or successor of a person convicted of a public entity crime; or b] an entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or pooling of equipment or income among persons when not for fair market value under an arm's length agreement, shall be a prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate. That a "person" as defined in Paragraph 287,133 (1) (e) Florida Statutes means any natural person or entity organized under the laws of any state or of the United States of America with the legal power to enter into a binding contract and which bids or applies to bid on contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term "person" includes those officers, directors, executives, partners, shareholders, employees, members and agents who are active in the management of an entity, Based on information and belief, the statement as marked below, is true in relation to the entity submitting this sworn statement. (Please indicate which statement applies by applying the individual initials near the box). 0 Neither the entity submitting this sworn statement nor any of its officers, directors, executives, partners, shareholders, employees, members or agents who are active in the management of the entity, nor an affiliate of the entity has been charged with and convicted of a public entity crime within the past 36 months. 0 The entity submitting this sworn statement or one or more of its officers, directors, executives, partners, shareholders, employees, members or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime within the past 36 months; and 0 yes an additional statement is applicable or 0 no an additional statement is not applicable. O The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity has been charged with and convicted of a public entity crime within the past 36 months. However, there have been subsequent proceedings before a Hearing Officer of the State of Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer determined that it was not in the public interest to place the entity submitting this sworn statement on the "Convicted Vendor List". The individual or entity entering into a contract or receiving funding from Miami -Dade County understands that he or she is required to inform the public entity prior to entering into a contract in excess of the threshold amount provided in Section 287.017 Florida Statues for Category 2 of any change in the information contained in this form. ATTACHMENT D "Miami -Dade County Affidavits and Declarations" Page 5 of 11 Miami -Dade County's Affidavits and Declarations . MIAMI-DADE EMPLOYMENT FAMILY LEAVE AFFIDAVIT (County Ordinance No.142-91 codified as Section 11A-29 et. seq of the County Code) Pertains 0 N/A LI Initial (_) That in compliance with Ordinance No. 142-91 of the Code of Miami -Dade County, Florida, an employer with fifty (50) or more employees working in Dade County for each working day during each of twenty (20) or more calendar work weeks, shall provide the following information in compliance with all items in the aforementioned ordinance: An employee who has worked for the above firm at least one (1) year shall be entitled to ninety (90) days of family leave during any twenty-four (24) month period, for medical reasons, for the birth or adoption of a child, or for the care of a child, spouse or other close relative who has a serious health condition without risk of termination of employment or employer retaliation. The foregoing requirements shall not pertain to contracts with the United States or any department or agency thereof, or the State of Florida or any political subdivision or agency thereof. It shall, however, pertain to municipalities of this State. 7. MIAMI-DADE COUNTY DISABILITY NONDISCRIMINATION AFFIDAVIT (County Resolution R-385-95) Pertains C7 N/A 0 Initial (i) That the above named firm, corporation or organization is in compliance with and agrees to continue to comply with, and assure that any subcontractor, or third party contractor under this project complies with all applicable requirements of the laws listed below including, but not limited to, those provisions pertaining to employment, provision of programs and services, transportation, communications, access to facilities, renovations, and new construction in the following laws: The Americans with Disabilities Act of 1990 (ADA), Pub. L. 101-336, 104 Stat. 327, 42 U. 5. C. 12101-12213 and 47 U. S. C. Sections 225 and 611 including Title I, Employment; Title II, Public Services; Title III, Public Accommodation and Services Operated by Private Entities; Title IV, Telecommunications; and Title V, Miscellaneous Provisions: The Rehabilitation Act of 1973, 29 U.S.C. Section 794: The Federal Transit Act, as amended 49 U .S. C. Section 1612: The Fair Housing Act as amended, 42 U.S.C. Section 3601-3631. The foregoing requirements shall not pertain to contracts with the United States or any department or agency thereof, or the State or any political subdivision or agency thereof or any municipality of this State. 8. MIAMI-DADE COUNTY REGARDING DELINQUENT AND CURRENTLY DUE FEES OR TAXES (Sec. 2-8.1(c) of the County Code) Pertains 0 N/A 0 Initial (__) Except for small purchase orders and sole source contracts, that above named firm, corporation, organization or individual desiring to transact business or enter into a contract with the County verifies that all delinquent and currently due fees or taxes -- including but not limited to real and property taxes, utility taxes and occupational licenses -- which are collected in the normal course by the Dade County Tax Collector as well as Dade County issued parking tickets for vehicles registered in the name of the firm, corporation, organization or individual have been paid. ATTACHMENT D "Miami -Dade County Affidavits and Declarations" Page 6of11 Miami -Dade County's Affidavits and Declarations 9. CURRENT ON ALL COUNTY CONTRACTS, LOANS AND OTHER OBLIGATIONS Pertains ❑ N/A 0 Initial (.__) The individual entity seeking to transact business with the County is current in all its obligations to the County and is not otherwise in default of any contract, promissory note or other loan document with the County or any of its agencies or instrumentalities. 10. DOMESTIC VIOLENCE LEAVE (Resolution 185-00; 99-5 Codified At 11A-60 Et. Seq. of the Miami -Dade County Code). Pertains 0 NSA 0 Initial (__) The firm desiring to do business with the County is in compliance with Domestic Leave Ordinance, Ordinance 99-5, codified at 11A-60 et, seq. of the Miami Dade County Code, which requires an employer which has in the regular course of business fifty (50) or more employees working in Miami -Dade County for each working day during each of twenty (20) or more calendar work weeks in the current or proceeding calendar years, to provide Domestic Violence Leave to its employees. 11. MIAMI-DADE COUNTY EMPLOYMENT DRUG -FREE WORKPLACE AFFIDAVIT (County Ordinance No. 92-15 codified as Section 2-8.1.2 of the County Code) Pertains ❑ N/A ❑ Initial (`) That in compliance with Ordinance No. 92-15 of the Code of Miami -Dade County, Florida, the above named person or entity is providing a drug -free workplace. A written statement to each employee shall inform the employee about: 1. danger of drug abuse in the workplace; 2. the firm's policy of maintaining a drug -free environment at all workplaces; 3. availability of drug counseling. rehabilitation and employee assistance programs; 4. penalties that may be imposed upon employees for drug abuse violations. The person or entity shall also require an employee to sign a statement, as a condition of employment that the employee will abide by the terms and notify the employer of any criminal drug conviction occurring no later than five (5) days after receiving notice of such conviction and impose appropriate personnel action against the employee up to and including termination. Compliance with Ordinance No. 92-15 may be waived if the special characteristics of the product or service offered by the person or entity make it necessary for the operation of the County or for the health, safety, welfare economic benefits and well-being of the public. Contracts involving funding which is provided in whole or in part by the United States or the State of Florida shall be exempted from the provisions of this ordinance in those instances where those provisions are in conflict with the requirements of those governmental entities. ATTACHMENT D "Miami -Dade County Affidavits and Declarations" Page 7 of 11 Miami -Dade County's Affidavits and Declarations 12. ATTESTATION REGARDING DUE AND PROPER ACKNOWLEDGEMENT OF COUNTY FUNDING SUPPORT Pertains 0 N/A 0 Initial (_) By initialing this subsection and accepting County funds, the above named firm, corporation, organization or individual agrees to abide by the grant contract requirement to recognize and acknowledge Miami -Dade County's grant support in a manner commensurate with all contributors and sponsors of its activities at comparable dollar levels. 13. MIAMI-DADE COUNTY RESOLUTION NO. R-630-13 REQUIRING A DETAILED PROJECT BUDGET, SOURCES AND USES STATEMENT, CERTIFICATIONS AS TO PAST DEFAULTS ON AGREEMENTS WITH NON -COUNTY FUNDING SOURCES, AND DUE DILIGENCE CHECK Pertains D N/A 0 Initial (_) Pursuant to Miami -Dade County Resolution No. R-630-13, requiring a detailed project budget, sources and uses statement, certifications as to past defaults on agreements with non -county funding sources and due diligence check prior to the County Mayor or County Mayor's designee recommending a commitment of Miami -Dade County funds to Social Services, Economic Development, Community Development, and Affordable Housing Agencies and Providers. The undersigned entity certifies, to the best of his or her knowledge and belief, that: 1. Within the past five (5) years, neither the Agency nor its directors, partners, principals, members or board members: (i) have been sued by a funding source for breach of contract or failure to perform obligations under a contract; (ii) have been cited by a funding source for non-compliance or default under a contract; (iii) have been a defendant in a lawsuit based upon a contract with a funding source. Please list any matters which prohibit the Agency from making the certifications required and explain how the matters are being resolved (use separate sheet if necessary): 14. MIAMI-DADE COUNTY RESOLUTION No. R-478-12 NOT TO USE PRODUCTS OR FOODS CONTAINING "PINK SLIME" Pertains 0 N/A 0 Initial ( ) Pursuant to Miami -Dade County Resolution No. R-478-12, the undersigned certifies, not to use meat products containing "Pink Slime" in food provided or served as part any food program; urging al] who provide food services or operate a food program to immediately discontinue using meat products containing "pink slime" in food provided or served in these programs. ATTACHMENT D "Miami -Dade County Affidavits and Declarations" Page 8of11 Miami -Dade County's Affidavits and Declarations 15. MIAMI-DADE COUNTY REQUIRED LOBBYIST REGISTRATION FOR ORAL PRESENTATION Section 2-11.1(i)(2) CONFLICT OF INTEREST AND CODE OF ETHICS ORDINANCE Pertains 0 N/A o Initial ( ) All lobbyists shall register with the Clerk of the Board of County Commissioners within five (5) business days of being retained as a lobbyist or before engaging in any lobbying activities, whichever shall come first. Every person required to so register shall: 1. Register on forms prepared by the Clerk; 2. State under oath his or her name, business address and the name and business address of each person or entity which has employed said registrant to lobby. If the lobbyist represents a corporation, the corporation shall also be identified. Without limiting the foregoing, the lobbyist shall also identify all persons holding, directly or indirectly, a five (5) percent or more ownership interest in such corporation, partnership, or trust Registration of all lobbyists shaII be required prior to January 15 of each year and each person who withdraws as a lobbyist for a particular client shall file an appropriate notice of withdrawal. 3. Prior to conducting any lobbying, ail principals must file a form with the Clerk of the Board of County Commissioners, signed by the principal or the principal's representative, stating that the lobbyist is authorized to represent the principal. Failure of a principal to file the form required by the preceding sentence may be considered in the evaluation of a bid or proposal as evidence that a proposer or bidder is not a responsible contractor. Each principal shall file a form with the Clerk of the Board at the point in time at which a lobbyist is no longer authorized to represent the principal. ri By initialing here, the principals or principal's representative have filed with the Clerk of the Board of County Commissioners stating that a lobbyist is authorized to represent the principal, 4. Any public officer, employee or appointee who only appears in his or her official capacity shall not be required to register as a lobbyist. 5. Any person who only appears in his or her individual capacity for the purpose of self -representation without compensation or reimbursement, whether direct, indirect or contingent, to express support of or opposition to any item, shall not be required to register as a lobbyist. 6. Any person who only appears as a representative of a not -for -profit corporation or entity (such as a charitable organization, or a trade association or trade union), without special compensation or reimbursement for the appearance, whether direct, indirect or contingent, to express support of or opposition to any item, shall register with the Clerk as required by the Ordinance subsection, but, upon request, shall not be required to pay any registration fees. The Clerk of the Board of County Commissioners shall notify the Commission on Ethics and Public Trust of the failure of a lobbyist or principal to file a report and/or pay the assessed fines after notification. A lobbyist or principal may appeal a fine and may request a hearing before the Commission on Ethics and Public Trust. A request for a hearing on the fine must be filed with the Commission on Ethics and Public Trust within fifteen (15) calendar days of receipt of the notification of the failure to file the required disclosure form. The Commission on Ethics and Public Trust shall have the authority to waive the fine, in whole or part, based on good cause shown. The Commission on Ethics and Public Trust shall have the authority to adopt rules of procedure regarding appeals from the Clerk of the Board of County Commissioners. Except as otherwise provided in subsection of the Ordinance, the validity of any action or determination of the Board of County Commissioners or County personnel, board or committee shall not be affected by the failure of any person to comply with the provisions of this subsection(s). (Ord. No. 00-19, § 1, 2-8-00; Ord. No. 01-93, § 1, 5-22-01; Ord. No. 01-162, § 1, 10-23-01; Ord. No. 03-107, § 1, 5-6-03) ATTACHMENT D "Miami -Dade County Affidavits and Declarations" Page 9 of 11 Miami -Dade County's Affidavits and Declarations 16. Disclosure SUBCONTRACTOR / SUPPLIER LISTING (ORDINANCE 97-104) Pertains IO N/A 0 Initial ( ) This form, or a comparable form meeting the requirements of Ordinance 97-104, must be completed by all bidders and proposers on Miami -Dade County contracts for purchase of supplies, materials or services, including professional services which involve expenditures of $100,000.00 or more, and all bidders and proposers on County or Public Health Trust construction contracts which involve expenditures of $100,000.00 or more. This form or a comparable forth meeting the requirements of Ordinance 97-104, must be completed and submitted even though the bidder or proposer will not utilize subcontractors or suppliers on the contract. The bidder or proposer should enter the word "NONE" under the appropriate heading, in those instances where no subcontractors or suppliers will be used on the contract. A bidder or proposer 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 except upon written approval of the County. Business Name and Address of Principal Owner First Tier Subcontractor/Subconsultant Scope of Work to be Performed by Subcontractor/Subconsultant (Principal Owner) Gender Race Business Name and Address of Principal Owner Direct Supplier Supplies/Materials/Services to be Provided by Supplier (Principal Owner) Gender Race I certify that the representations contained in this Subcontractor/Supplier Listing are to the best of my knowledge true and accurate. ( ) ( } Signature of Authorized Representative Date Print Name (Duplicate if additional space is needed) Print Title ATTACHMENT D "Miami -Dade County Affidavits and Declarations" Page 10 of 11 Miami -Dade County's Affidavits and Declarations MIAMF COUNTY I have carefully read this entire 11-page document entitled, "Miami -Dade County's Affidavits and Declarations" and agree to: (1) sign an affidavit as to certain matters and (2) make a declaration as to certain other matters. This form contains both Affidavit forms for matters requiring the entity to sign under oath and Declaration forms for matters requiring only an affirmation or declaration for other matters. BY SIGNING AND NOTARIZING THIS PAGE YOU ARE ATTESTING TO AFFIDAVITS AND DISCLOSURES 1-16 MIAMI-DADE COUNTY AFFIDAVITS SIGNATURE PAGE By: Signature of Witness or Secretary Seal Signature of Affiant Date , 20 Federal Employer Identification Number Printed Name of Affiant and Name of Agency Address of Agency SUBSCRIBED AND SWORN TO (or affirmed) before me this day of , 20 He/She is personally known to me or has presented as identification. Type of identification Signature of Notary Serial Number Print or Stamp Name of Notary Expiration Date Notary Public — State of County of foray Seal ATTACHMENT D "Miami -Dade County Affidavits and Declarations" Page 11 of 11 FY 202 Continuum of Care (CoC) Program Consolidated Financial Records & Performance Reports ATTACHMENT E "Financial Records & Performance Reports" MIAMI•CaADE COUNTY Request for Amendment / Modification / for US HUD Grant Funded Continuum of Care (CoC) Programs Includes Legacy Programs under the CoC Supportive Housing Programs (SHP) Shelter Plus Care Programs (S+C) Single Room Occupancy for the Homeless (SRO) 24 CFR 578.105 Grant and Project Changes - The recipient or subrecipients may not make any significant changes to a project without prior US HUD approval, evidenced by a grant amendment signed by HUD and the Recipient. Significant changes include a change of recipient, a change of project site, additions or deletions in the types of eligible activities approved For a project, a shift of more than 10% from one approved eligible activity to another, a reduction in the number of units, and a change in the subpopulation served. By signing this report the duly authorized Project Sponsor/ Provider/ Sobrecipfent Official signature below certifies to the best of their knowledge and belief that the report is true, complete and accurate and is for the purposes and objectives set forth in the terms and conditions of the federal award; and are aware that any false, fictitious, or fraudulent information or the omission of any material fact may subject the duly authorized official to criminal, civil or administrative penalties for fraud, false statements, false claims or other offense. Print Name and Title of Authorized Project Sponspr/Provider/Subrecipient Official: Signature & Date(mm/dd/yyyy): Reviewed by Miami -Dade County and forwarded to US HUD for Request to Approve (greater than 10% shift in funds between categories or significant change) CHANGE IN PROJECT SPONSOR Do Not Sign - for Miami -Dade County ONLY Signature & Date[mm/dd/yyyy]: Reviewed and Approved by Miami -Dade County; information forwarded to US HUD (less than 10% shift in funds between categories). Do Not Sign - for Miami -Dade County ONLY Signature & Date(mm/dd/yyyy): Reviewed and NOT Approved by Miami -Dade County - Do Not Sign - for Miami -Dade County ONLY see attached letter for reasons for disapproval. Signature & Date(mm/dd/yyyy) Program Name: ( Grant Number: ( Financial Information for CoC Programs Instructions for budget amendment / modification request: Attach the eSnaps documents in Word Format previously provided for the applicable budget chart. The charts should include a Summary chart; and all applicable detailed supportive services, operations, leasing, rental assistance. Project administration charts are not applicable. Reformat the far right -side column in the chart to reflect the budget modified or amendment requested. Attach the eSnaps documents in Word format for summary of program. Reformat the far right -side column in the chart to reflect the budget request. Type below or within the applicable Word -formatted eSnaps budget chart - a detailed budget narrative - the justification for the line -item change. Also if there is a change in match amount - a new letter of match commitment is required. Assemble with a cover letter on agency letterhead summarizing the requested budget revisions and certifying that the level and standards of care provided to the program participants will not be adversely affected and attach page one of this document. Review, sign and submit the si ned is emai to t e desi nated me ess r st ntra is i er and Terrell Ellis, Contracts Manager. Agency Letterhead Date Attention: Assigned Contracts Officer Miami -Dade County Homeless Trust Suite 310, 27th Floor 111 NW 1st Street Miami, Florida 33128 Subject: FY 20 US HUD CoC Program FL0000L4D00 , Program Name Name of Agency is respectfully submitting for your review and release of payment of the enclosed Consolidated Financial Record and Reports for the above subject program. We request reimbursement in the amount of $0.00 for the month(s) of Month, yyyy The following documents included in this report are outlined below: ❑ Cover Letter ❑ Performance Report - 0625 HUD Monthly HMIS-generated Progress Report (MPR) ❑ Homeless Trust CoC Invoice ❑ HUD Form 27053-A SNAPS Request Voucher for Grant Payment • Summary and Compliance Report ❑ Attachment E - Program Income Report ❑ Supporting documents for invoice requirements and match including invoices, cancelled checks, payroll, time and effort logs, and, if applicable, copies of Tenant paid utility bills consistent with utility allowance, documentation of match expenditure compliance consistent with OMB Omni or Super Circular and 24 CFR 578. The value of the match demonstrated is $0.00. The amount of program income (if applicable) is $0.00. This is an adjustment # (. �) for the month(s) of Month(s). yyyy. On behalf of our homeless community members who benefit from this program, we thank you for your time and assistance. Please call (305) 000-0000 extension 0 or email address@domain.com with any concerns or comments about this reimbursement package. Sincerely, Name Title Enclosures US HUD CoC PROGRAM REIMBURSEMENT REQUEST PROVIDER NAME: PROGRAM NAME: GRANT NUMBER: FLOUOUL4D002215 I++IIAM WADE SERVICE PERIOD: Month(s). YYYY ADJUSTMENT # ( ) Mil 1111 Amount this Invoice _ LEASING Leasing - Units - Leasing - Structure - LEASING TOTAL: I $ iii` RENTAL ASSISTANCE Rental Assistance - Permanent Tenant -Based RA - Rental Assistance - Permanent Sponsor -Based RA - Rental Assistance - Permanent Rapid Re -housing - RENTAL ASSISTANCE TOTAL: $ SUPPORTIVE SERVICES 1. Assessment of Service Needs 2. Assistance with moving costs 3. Case Management - 4. Child Care _ S. Education services 6. Employment Assistance 7. Food 8. Housing Counseling Services - 9.Legal services - 10. Life Skills training - 11. Mental Health Services - 12.Outpatient Health Services - 13.Outreach Services - 14. Substance Abuse Treatment - 15. Transportation - 16. Utility Deposits - 17. Operating costs for SSO only - ■ SUPPORTIVE' SERVICES $ - OPERATING COSTS 1.Maintenance and Repair 2.Property Taxes and Insurance - 3.Replacement Reserve 4.Building Security 5.Electricity, Gas and Water 6.Furniture _ 7.Equipment (Leas Ruy) OPERATING COSTS SUBTOTAL: S HMIS HMIS generated activities HMIS SUBTOTAL: I $ - PROJECT ADMINISTRATION Project Administration Costs I ADMINISTRATION SUBTOTAL: $ INVOICE REQUEST TOTAL Amount this Invoice $ By signing this report, I certify to the best of my knowledge and belief that the report is true, expenditures, disbursements and cash receipts are for the purposes and objectives set forth Federal award. 1 am aware that any false, fictitious, or fraudulent information or the omission criminal, civil or administrative penalties for fraud, false statements, false claims Prepared this (date) complete and accurate and the in the terms and conditions of the of any material fact may subject me to or other offense. (title) Certified by: (signature), LOCSNRS U. S. Department of Housing SNAPS Special Needs Assistance Program and Urban Development Request Voucher for Grant. Payment Office of Community Planning and Development See Instructions and Public Reporting Burden Statement on back OMB Approval No. 2535-0102 Name of Agency- Name of program 1. Voucher Number: 2. LOCCS PGM AREA: SNAPS HPAC IHP 5, Voice Response No. (5 digits, hyphens, 5 more) 3. Period Covered by this Request (dates) 6. Grantee Organization's Name: 7. Grant No: FL0000L4D002215 9. Line Item no. 1010 1020 1021 1022 1023 1030 1040 1050 1051 1060 1062 1070 1080 1090 1100 1110 1111 1112 1120 10. Type of Funds Requested Acquisition Rehabilitation New Construction 5. Grantee Organization's TIN: Substantial Rehabilitation Moderate Rehabilitation Operating Cost Rental Assistance Supportive Services HMIS Cysts Administrative Cost CoC Planning Costs Child Care Employment Assistance Relocation Leasing Repair & Maintenance Prevention (RH) Capacity Building (RH) Other: 4. Type of Disbursement (Partial Final Voucher Total: Amount: (round to nearest dollar) $ $ $ $ $ I hereby certify that all the information stated herein, as well as any Information provided in the accompaniment herewith, Is true and accurate. Warning: HUD will prosecute false claims and statements. Conviction may result in criminal penalties. (18 U.S,C, 1001.1010,1012: 31 U.S.C. 3729, 3802) 11. Name S Phone Number {including area code) or the Authonzed 12. Signature: 113. Date of Request: Person who called $NAPS System VRS: Privacy Statement: Public Law 97-255, Financial 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 (SNN)) which will be used by HUD to protect disbursement data from fraudulent actions. The Housing and Communty Development Act of 1987, 42 U.S.C. 3543, authorizes HUD to collect the SON. The data are used to ensure that individuals who no bnger require access to Line of Credit Control System (LOCCS) have their access capability prompt deleted. Provision of the SSN is mandatory. HUD uses it as a unique Identifier for safeguarding LOCCS from unauthorized access. Failure to provide the information requested may delay the processing of your approval for access to LOCCS. This Information wtI not be otherwise disclosed or released outside of HUD, except as permitted by law. form HUD-27053.A Summary and Compliance Report MIAMI-DADE COUNTY Agency Name: Program Name: Grant #: FL0000L4D002215 Month of Service: mm/yyyy Adjustment #_ FY 2022 US HUD COC SUMMARY AND COMPLIANCE REPORT MIAM I: DE COUNTY Duration: 00/00/2023 - 00/00/2024 ACTUAL MONTHLY PROGRAM EXPENSE INVOICE MATCH PROGRAM INCOME GxPLNDITURES MONTHLY BE MO AMOUNT TOTAL YEAR GRANT AMOUNT LEASING Leasing Units $ - $ - Leasing Structures - - - - Leasing Units - - - - Subtotal $ - $ - $ - $ - TOTAL LEASING $ - $ - $ - $ - RENTAL ASSISTANCE Rental Assistance Units $ - $ PH Tenant -Based RA - - - - PH Project -Based RA - - - - PH Sponsor -Based RA - - - - TH Tenant -Based RA - - - - TH Project -Based RA - - - - TH Sponsor -Based RA - - - - Rental Administration costs - - - - Subtotal - $ - $ - $ - $ - TOTAL RENTAL ASSISTANCE $ - $ - $ - $ - SUPPORTIVE SERVICES 1. Annual Assessment FTE $ - $ - staff salary % - - - Taxes & Fringe - - - - Subtotal $ - $ - $ - $ - 2. Assistance Moving Costs _ $ - $ Supplies to transition - moving expenses - - Subtotal $ - $ - $ 3. Case Management FTE $ staff salary % - - Taxes & Fringe _ - - - Obtaining benefits - - - Subtotal $ - $ - $ 4. Child care $ - 5 Childcare vouchers $ - $ - $ Meals and Snacks in childcare $ - $ - $ - Subtotal $ - $ - $ - 5. Education Services FTE S - $ staff salary % - - - Taxes & Fringe - - - education supplies - - Subtotal $ - $ - $ - 6. Employment / Training FTE $ $ ` staff salary % - - - taxes & fringe - - - Computer training - - - Eligible job Stipends - - - Subtotal $ - $ - $ - 7. Food $ - $ - Providing meals - -1 - Summary and Compliance Report Groceries - - - Subtotal $ - $ - $ - 8. Housing search FTE $ - $ - stafF salary % - - - - Taxes & Fringe - - - - Landlord mediation - - - - Rental application Fee - - - - Credit counseling - - - - Subtotal $ $ - 9. Legal services FTE $ - $ - staff salary % - - - Taxes & Fringe - - - - Subtotal $ - $ - $ - $ - 10. Life Skills Training FTE $ - $ staff salary % $ - $ - $ - $ - Taxes & Fringe $ - $ - $ - $ - Subtotal $ - $ $ - $ - 11. Mental health services FTE $ - S - staff salary % - - - - Taxes & Fringe - - - - Subtotal $ - $ - $ - $ - 12.Outpatient health FTE $ - $ - staff salary 9b - - - - Taxes & Fringe - - - - Subtotal $ - $ - $ - $ - 13.Outreach Services FTE $ $ staffsalary % - - - Taxes & Fringe - - - - Subtotal $ $ - $ - $ - 14. Substance Abuse FTE $ - $ - staff salary % - - - - Taxes & Fringe - - - - supplies - - - Subtotal $ - $ - $ - $ - 15. Transportation $ - $ - Van/ gas/ maintenance - - - - Bus Tokens - - - - Subtotal $ - $ - $ - $ - 16. Utility deposits _ $ one-time fee - - - - Subtotal $ - $ - $ - $ - 17. Direct provisions of $ - $ Operational costs for SSO only - - - - Subtotal $ - $ - $ - $ - TOTAL SUPPORTIVE SERVICES $ - $ - $ - - OPERATIONS 1. Maintenance & Repair FTE _ $ - $ staff salary % - - - - Taxes & Fringe - - - - supplies - - - - Subtotal $ - $ - $ - $ - 2. Property taxes, insurance $ $ - tax - - - - insurance - - - - Subtotal $ - $ - $ - $ - 3. Reserve Replacement $ - $ - major systems reserve $ - $ - $ - $ - 4. Building security FTE $ - S - Summary and Compliance Report staff salary % $ - $ • $ - $ Taxes & Fringe _ $ $ _ - $ - $ - subcontracted security $ - $ - $ 5 Subtotal $ - $ - $ - S - 5. Electricity, gas and water $ - $ utilities _ - - - Subtotal $ - $ - $ - $ - 6. Furniture $ - $ furniture - - - - Subtotal S - $ - $ • $ - 7. Equipment .`ta - $ operational equipment - - - - Subtotal $ - $ - $ - $ - TOTAL OPERATION $ $ $ - $ - HMIS COSTS HMIS - $ - c - costs incurred Not the Lead HMIS $ - $ - $ - $ - $ $ - $ - $ TOTAL HMIS vfIsTs $ - $ - $ - $ - PROJECT ADMINISTRATION Project Administration FTE $ $ - staff salary % $ - $ - $ $ staff salary % $ _ $ - $ - $ - Taxes & Fringe - $ - $ - $ - $ Travel to monitor $ - $ - $ - $ - 3rd Party Administration $ - $ - $ - $ - Audit $ - $ - $ - $ - __ Administrative office space $ - $ - $ - $ - CoC Training $ - $ • $ - $ - TOTAL ADMINISTRATION $ - $ - $ - $ - TOTAL ACTUAL MONTIILY PROGRAM EXPENSE INVOICE MATCH PROGRAM INCOME EXPENDITURES MONTHBENCHMARH AMOUNT TOTAL f. YEAR GRANT ArlouN"I• $ - s - $ - $ - $ - $ - By signing this report, I certify to the best of and cash receipts are for the purposes and fraudulent information or omission of any Prepared this my knowledge and belief that the report is true, complete and accurate and objectives set forth in the terms and conditions of the federal award. I am material fact, may subject me to criminal, civil or administrative penalties claims or other offense. (mm0dd/yyyy) (signature), (title) the expenditures, disbursements aware that any false, fictitious, or for fraud, false statements, false Certified by: (print) MLAMI-DADE COUNTY FY 2022 US HUD CoC EXPENDITURE REPORT Agency Name: MIAMI DARE Program Name: Grant # FL0000L4D002215 Duration: 01/01/2023 - 12/31/2024 573` LEASING RENTAL ASSISTANCE SUPPORT OPERATIONS HMIS ADMIN TOTAL MATCH DATE SUBMITTED DATE PAYMENT RECEIVED eSnaps Budget $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 month 1 - - - - - - - - month 2 - - - - - - . month 3 - - %'l' re/ l�./r'f - f'zr. - - mvnth 4 - /�,.vr , - - month 5 - - 07 ff r }' O ram, 'sr2 - - - month 6 - - - - - - - month 7 - - - - - - - month 8 - - - - - - - month 9 - - - - - - - - month 10 - - - - - - - month 11 - - - - - - - - month 12 - - - - - - - SUBTOTAL $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL REMAINING $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 #D1V/0! % USED #D1V/0! #DIV/04 #DIV/0! #DIV/0! #DIV/O! #DIV/0l #D1V/0! % REMAINING #DIV/0!, #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #D1V/0! REPORTING AGENCY: PROGRAM NAME: GRANT NUMBER: FL0000L4D002215 MIAM TOTAL MONTHLY PROGRAM INCOME $ 1,005.00 SERVICE MONTH: March 2023 CCurrY TOTAL GTO PROGRAM INCOME $ 4,245.00 B1d/unit address HMIS # Tenant Name Total Annual Adjusted Income Total Monthly Adjusted Income 30% adjusted or 10%gross ACTUAL CLIENT AMOUNT DIRECT LANDLORD / PROVIDER % Program Income's Grant -to -Date (GTD) Program Income 1 1A (in 3 months) last name, first $ 4,200.00 $ 350.00 $ 105.00 $ 245.00 $ 105.00 30% $ 945.00 2 1B (new in program) last name, first $ 12,000.00 $ 1,000.00 $ 300.00 $ 700.00 $ 300.00 30% $ 300.00 3 2A (in 6 months) last name, First $ 21,600.00 $ 1,800.00 $ 540.00 $ 1,200.00 $ 600.00 33% $ 3,000.00 4 last name, first $ - $ - $ - $ $ - #DIV/0! $ - 5 last name, first $ - $ - $ - $ - $ - #DIV/0! $ 6 last name, first $ - $ - $ - $ - $ - #DIV/0! $ - 7 last name, first $ - $ - $ - $ - $ - #DIV/0! $ - 8 last name, first , - fl, $ /5 %f;,- ;, $ f?, - $ - $ - #DIV/0! $ - 9 last name, first j r j ✓ /,%. %Pi P $ r - $ - $ - #DIV/0! $ - 10 last name, first .`p ]/ •fr err; rsr: r - $ - $ - #1)IV/0! $ - 11 last name, first , - - - $ - $ - #DIV/0! $ - 12 last name, first $ - $ - $ - $ - $ - #DIV/0I $ - 13 last name, first $ _ - $ - $ - $ - $ - #1)IV/0! $ - 14 _ last name, first $ - $ - $ - $ - $ - #DIV/0! $ - 15 last name, first $ $ - $ $ - $ - #DIV/0! $ - 16 last name, first $ - $ - $ - $ - $ - #DIV/0! $ - 17 last name, first $ - $ - $ - $ - $ - #DIV/0! $ - 18 last name, first $ - $ - $ - $ - $ - #DIV/0! $ - 19 last name, first $ - $ - $ - $ - $ - #DIV/0! $ - 20 last name, first $ $ - $ - , $ $ - #DIV/0! $ 21 last name, first $ $ - $ - $ - $ - 41DIV/0! $ 22 last name, first $ - $ - $ - $ - $ - #DIV/0! $ - 23 last name, first $ - $ - $ - $ - $ - #DIV/0! $ - 24 last name, first $ - $ - $ - $ - $ - #DIV/0I $ - 25 last name, first $ - $ - $ - $ $ - #DIV/0! $ - 26 last name, first $ - $ - $ - $ - $ - #DIV/0! $ - 27 last name, first $ $ - $ - $ - $ - #DrVjo! $ 28 _ last name, first $ - $ - $ - $ - $ - #DIV/0l $ - 29 last name, first $ - $ - $ - $ - $ - #DIV/0! $ - 30 last name, first $ - $ - $ - $ - $ - #DIV/0! $ - COMPLETE ONLY IF APPLICABLE Occupancy charges and rent collected from program particpants are program income and may he used as provided under 24 CFR 578.97. A LEASE or OCCUPANCY AGREEMENT MUST RE 1N PLACE. * REMINDER: %Program Income must not exce d 3Q% qfthe adjusted for 1 O% of the gross) income per client. Should this limit be exceeded. formal documentation is requir • • providing jusCtjication fir' further review and approval by the Homeless Trust. Miami -Dade County Homeless Trust Income Determination Rent Calculation ATTACH ENT E Participant/ HMIS: wsx�:2a��. ,�.._+M�n.�wrrd%nri'-zw�.. r,.'a',•Jf=M1.,�i+--'.. A-�:�M: i'� Unit/Address: 1) 2] 3) 4) 5) .$ ) L 7) 8) 9) 1 0) 11) 12] 13) 14) 17) 18) 19) 20) 21) 22) 23) Income income exclusion Annual Gross income Calculating Adjusted income Dependent A.Ilnwances Number of Dependents Multiply line 4. by $480 (Child Care Allowance) Child Care Allowance Enter anticipated unr'eimbursed Child Care eveuses Disabled Assistance Allowance Disabled Assistance lsxpe.nses Multiply Litre 3 by 0,03 Subtiw t Line 8 from Liter 7 llrnortnt earned by household me IllberS Which rowers dependent upon Disabled a ssjshmee expense Enter the Lesser Anrourrt trf Line 9 or 10 Medical Expenses j Elderly Household Allowance Medical experises ij'lirrr 9 is less than zero, enter the amountfroin line 12, otherwise add !ins 7 and 1.2 and subbact line 8 li'lder•yr or. Disabled.Family Allowance enter .$400 Adjusted Income. Total income Adjustments (add lines 5, 6, 11, 13 14) Adjusted Income (subtract line I5 from litre 3) Resident Rent Deter inirration Occupancy Amount Determination - Program Income ............. 30% of Monthly Adjusted Income (Divide Line. 16 by 12 Multiply by n.3) a.� M ICI% of Monthly Gross Income (Divide .tine 3 by 12 and Multiply lay 0.10) Welfare rent, not applicable in State of Florida Resident Rent lam est of !hie .17 or 18 D where Utilites are not included Occupancy Determining t3ccu anc Amount for tints NIA Utility Allowance (published by Pilo) Resident Occupancy naive Program income [IF.rlitiers Refrrrhusement''* if the amount on line 22 is less than 0, change the minus to a plus. This is the amount that may be paid on behalf of the resident as a utility reimbursment, paid to the Utility Company directly or provide documentation of paid utilities. Project Sponsor Project Name Project information Agency Name Name of Progam Grant Number Participant Information Sample Last Name Last name UNIT # First Name first name HMIS # xx.xx.v.x. Unit # 103 Monthly Duration of Lease & HAPcontract ..., MONTHLY FMR or Rept Reasonable "caniauct rent* Utility Allowance (if utilities included in lease) Monthly 10/1/14 - 09/30/15 $ 994,00 $ 69.00 Monthly 10/1/15 - 09/30/16 $ 1,000,00 $ 69.00 Contract Year July-15 August-15 September-15 October-15 November-1S December-15 January-16 Fe-bruary-16 March-16- April-16 May-16 , , June-16 Subtotal Address leave blank if protected In this sample Tenant's rent calculated at 30% = $125 per month / utilities not included in the Lease therefore, $125 - 69 $56 MONTHLY CONTRACT RENT Tenant Portion 30% or 10% - -utility allowance HAP Amount to Landlord 994.00 $ 1,000.00 HAP Amount to Landlord 938.00 938.00 938.00 944.00 $ $ $ 3,758.00 • HAP Payment directly to Landlord Tenant Pays Landlord Directly - Program Income $ 56.00 $ 56.00 Tenant Portion 56.00 56.00 $. 56.00 56.00 $ $ 224.00 : . 3,758.00 224.00 :": $ 938.00 $ 944.00 Total Rent 994.00 994.00 994.00 1,000.00 3,982.00 FY202 Continuum of Care (CoC) Program Miami -Dade County Homeless Trust Midterm Annual Performance Report (M-APR) and Annual Performance Report (APR) ATTACHMENT F "Midterm and Annual Performance Reports (M-APR and APR)" MIAMI•� COUNTY COUNTY Midterm Annual Performance Report (M-APR) for US HUD Grant Funded Continuum of Care (CoC) Programs Includes Legacy Programs under the CoC Supportive Housing Programs (SHP) Shelter Plus Care Programs (S+C) Single Room Occupancy for the Homeless (SRO) This template is designed to assist grantees and subrecipients required to complete the Full CoC APR. It is a model of the data collected in e-Snaps. It is not intended to replace electronic data collection in e-Snaps. Field layout in e- Snaps may differ from the layout presented in this document. By signing this report, the duly authorized Project Sponsor/ Provider/ Subrecipient Official signature below certifies to the best of their knowledge and belief that the report is true, complete and accurate and is for the purposes and objectives set forth in the terms and conditions of the federal award; and are aware that any false, fictitious, or fraudulent information or the omission of any material fact, may subject the duly authorized official to criminal, civil or administrative penalties for fraud, false statements, false claims or other offense. Authorized Project Sponsor/Provider/Subrecipient Official: Print Name & Title Signature & Date [mm/dd/yyyy) (Do Not Sign - for Miami -Dade County ONLY) Authorized Project Grant Official (MDCHT Executive Director or Designee): Print Name & Title Signature & Date (mm/dd/yyyy) Supervisory Review and Entry Print Name & Title Signature & Date (mm/dd/yyyy) Revised June 2023 FLO L4D002 Name of Program Page 1 Guidance was provided for e-snaps changes that were implemented to improve processing time; completing an 'Applicant Profile';• and on Q3, Q5 Q23, Q24, and Q 31 - please submit the HMIS generated APR as well. Q1, Contact Information Project Name Recipient/Agency Name Grant Number Prefix (Mr., Mrs., Ms., Dr., etc.) First Name Middle Name Last Name Suffix (LCSW, MSW, Etc.) Title Street Address 1 Street Address 2 City State Zip Code E-mail address Phone Number Extension Fax Number Q5. Bed and Unit Inventory Proposed Bed and Unit Inventory Total Number of Year Round Reds Units from Aunlleation Beds CH Beds (PH Only) Units Households Without Children Households With Children Households With Only Children Total Actual Bed and Unit Inventory Total Current Number of Year Round Beds Units Beds CH Beds (PH Only) Units Households Without Children Households With Children Households With Only Children Total Explanation of Changes Explain any difference in the actual inventory from the information provided in the application/contractual Agreement. maximum Characters:2000 FLO L4D002 Name of Program Page 2 Financial Information for CoC Programs Q31a1. CoC Financial - Development Eligible Activities CoC Program Expenditures Acquisition $ Rehabilitation $ New Construction s Development - Subtotal $ Q31a2. CoC Expenditures - Supportive Services Report on all CoC Program funds expended during the operating year on supportive services. If you have no expense For these items or these items were not included in your grant application enter "0" in each field on the question. Eligible Activities CoC Program Expenditures 1. Assessment of Service Needs $ 2. Assistance with Moving Costs $ 3. Case Management $ 4. Child Care $ 5. Education Services $ 6. Employment Assistance $ 7. Food is 8. Housing/CounselingServices $ 9. Legal Services $ 10. Life Skills 11. Mental Health Services $ 12. Outpatient Health Services 13. Outreach Services $ 14. Substance Abuse Treatment Services $ 15. Transportation $ 16. Utility Deposits $ 17. Operating Costs for SSO Only $ 18. Indirect Costs $ Supportive Services - Subtotal $ FLO L4D002 Name of Program Page 3 Q31a4. CoC Financial - Leasing, Rental Assistance, Operating, and Administration CoC Funding Types CoC Expenditures Development $ Leasing $ Rental Assistance $ Supportive Services $ Operating Costs S HAMS Administrative Costs (Provider) $ SUBTOTAL - Expenditures $ Cash Match $ In -Kind Match $ SUBTOTAL - Match $ match % 'lo TOTAL - Expenditures + Match $ Program Income $ THIS SECTION TO BE COMPLETED BY MDC HOMELESS TRUST Administrative Costs (Homeless Trust) $ SUBTOTAL - Expenditures $ SUBTOTAL - Match $ Match % TOTAL - Expenditures + Match $ FLO L4D002 Name of Program Page 4 Performance for CoC Programs Q36. Standard Performance Measures Performance Measure #1 - HMIS Bed Inventory: Minimum of 86% of the organization's total number of County Continuum of Care (CoC) through the Housing of whether the beds are funded by HUD or the Trust. beds/units which are reported to HUD for the Miami -Dade Inventory Checklist (HIC), are populated in the HMIS, regardless Homeless Truss" whether or not funded by HUD or the Homeless TOTAL # OP BEDS/UNITS (as reported through HIC) TARGET # OF BEDS/UNITS IN HMIS #Beds/Units) ACTUAL # OF ACTUAL % OF TO BE POPULATED (86% of Total BEDS/UNITS POPULATED IN HMIS BEDS/UNITS POPULATED IN HMIS Performance Measure #2 - Bed Utilization Rate: Average bed utilization rate of 95% minimum of this program's HUD -funded beds/units during this grant term. TOTAL # OF BEDS/UNITS (as reported in eSnaps) TARGET AVERAGE # OF TO BE # Beds/Units) ACTUAL AVERAGE # OF UTILIZED ACTUAL '% OF AVERAGE UTILIZED BEDS/UNITS UTILIZED (95% of Total BEDS/UNITS BEDS/UNITS y performance Measure #3 — Housing.Stability: Retention in or exits to Permanent Housing (PH) TOTAL # OF PARTICIPANTS SERVED TARGET # OF STAYERS +EXITS TO PH (RRH/DV: 80%; PSH/TH: 90W) ACTUAL # OF STAYERS + EXITS TO PH ACTUAL % OF STAYERS + EXITS TO PH y Performance Measure #4 - New/Increased Earned Income: New and/or increased employment income for eligible participants (leavers and stayers) TOTAL # OF TARGET # OF PARTICIPANTS WITH NEW/INCREASED EARNED INCOME ACTUAL # OF PARTICIPANTS INCOME ACTUAL % OF PARTICIPANTS INCOME WITH NEW/INCREASED EARNED WITH NEW/INCREASED EARNED STAYERS LEAVERS STAYERS [B% of Total] LEAVERS 05% of Total) STAYERS LEAVERS STAYERS LEAVERS Performance Measure #5 - New/Increased Non -Employment Income: New and/or increased non - employment income for eligible participants (leavers and stayers) TOTAL # OF TARGET # OF PARTICIPANTS WITH NEW/INCREASED NON -EMPLOYMENT NCOME ACTUAL # OF PARTICIPANTS INCOME ACTUAL % OF PARTICIPANTS INCOME WITH NEW/INCREASED NON -EMPLOYMENT WITH NEW/INCREASED NON -EMPLOYMENT STAYERS LEAVERS STAYERS (10% of Total) LEAVERS (25% of Total) STAYERS LEAVERS STAYERS LEAVERS Comments: (If any measures have not been met, please provide an explanation and corrective action plan) r FLO L4D002 Name of Program Page 5 MIAMI.DADE:1 COUNTY CO#NTY Annual Performance Report (APR) for US HUD Grant Funded Continuum of Care (CoC) Programs Includes Legacy Programs under the CoC Supportive Housing Programs [SHP] Shelter Plus Care Programs (S+C) Single Room Occupancy for the Homeless (SRO) This template is designed to assist grantees and subrecipients required to complete the Full CoC APR. It is a model of the data collected in e-Snaps. it is not intended to replace electronic data collection in e-Snaps. Field layout in e- Snaps may differ from the layout presented in this document. By signing this report, the duly authorized Project Sponsor/ Provider / Subrecipient official signature below certifies to the best of their knowledge and belief that the report is true, complete and accurate and is for the purposes and objectives set forth in the terms and conditions of the federal award; and are aware that any false, fictitious, or fraudulent information or the omission of any material fact, may subject the duly authorized official to criminal, civil or administrative penalties for fraud, false statements, false claims or other offense. Authorized Project Sponsor/Provider/Subrecipient Official: Print Name & Title Signature & Date (mm/dd/yyyy) (!Do Not Sign - for Miami -Dade County ONLY) Authorized Project Grant Official (MDCHT Executive Director or Designee); Print Name & Title Signature & Date (mm/dd/yyyy) 5upt,rvisory Review and Entry: Print Name & Title Signature & Date (mm/dd/yyyy) Revised June 203 FLO L4D002 Name of Program Page 1 Guidance was provided for e-snaps changes that were implemented to improve processing time; completing an "Applicant Profile"; and on Q3, Q5, Q23, Q24, and Q 31 - please submit the HMS generated APR as well. Q1. C Project Name Recipient/Agency Name Grant Number Prefix (Mr., Mrs., Ms., Dr., etc.) First Name Middle Name Last Name Suffix (LCSW, MSW, Etc.) Title Street Address 1 Street Address 2 City State Zip Code E-mail address Phone Number Extension Fax Number Q3. Project Information: Check the component for the program on which you are reporting Continuum of Care Program (CoC) Rental Assistance (RA) Section 8 Moderate Rehabilitation ❑Tenant -based Rental Assistance (TRA) II Transitional Housing ■ Single Room Occupancy ❑ Permanent Housing for Homeless Persons with Disabilities (PRA) • Project -based Rental Assistance IN (Sec. 8 SRO) ❑ Safe Haven 0 Single Room Occupancy (SRO) ❑ HMIS (SRA) ■ Innovative Supportive Housing. ■ Sponsor -based Rental Assistance ❑ Supportive Services Only Is this APR fulfilling the reporting obligation associated with a 20-year use requirement? (❑) Number of Years in Operation: (Q) Contract operating term or duration is from ( / /20 ) to ( / /20 ) Is this a Domestic - Violence Program (Yes or No) Was this project funded under a special initiative? if yes, what type? (Samaritan Bonus, Permanent Housing Bonus, Reallocation, Etc.) Amount of Contract or Award CoC Number and Name FL-600 Miami -Dade County Is this an APR for a grant that received a HUD- approved grant extension? (Yes or No) Is this a final APR? (Yes or No) FLO L4DO02_ Name of Program Page 2 Q4. Site Information (principal project service site - for VAWA/DV providers place administrative office address) Address/PO Box City State Florida Zip Code Identify the program site configuration type - Designate single site or single building or multiple buildings or sites Identify the site type for the principal service site - Identifr type of house, if only services select "not applicable or non-residential" Is this a grant that only funds the services that are provided to a CoC Program funded housing grant(s)? Explain any changes made in this section from the information provided in the original application: 2000 Characters maximum QS. Bed and Unit Inventory Proposed Bed and Unit Inventory Total Number of Year Round Reds Units from Annlication Beds CH Beds (PH Only) Units Households Without Children Households With Children Households With Only Children Total Actual Bed and Unit Inventory Total Current Number of Year Round Beds Units Beds CH Beds (PH Only) Units Households Without Children Households With Children Households With Only Children Total Explanation of Changes Explain any difference in the actual inventory from the information provided in the application contractual Agreement. Maximum Characters: 2000 FLO L4D002_ Name of Program Page 3 Financial Information for CoC Programs Q3�a1. CoC Financial - Development Eligible Activities CoC Program Expenditures Acquisition $ Rehabilitation $ New Construction $ Development - Subtotal $ Q31a2. CoC Expenditures - Supportive Services Report on all CoC Program funds expended during the operating year on supportive services. If you have no expense for these items or these items were not included in your grant application enter "0" in each field on the question. Eligible Activities CoC Program Expenditures 1. Assessment of Service Needs $ 2. Assistance with Moving Costs $ 3. Case Management $ 4. Child Care $ 5. Education Services $ 6. Employment Assistance $ 7. Food $ 8, Housing/Counseling Services $ 9. Legal Services $ 10. Life Skills $ 11. Mental Health Services $ 12, Outpatient Health Services $ 13. Outreach Services $ 14. Substance Abuse Treatment Services $ 15. Transportation $ 16. Utility Deposits $ 17. Operating Costs for SSO Only $ 18. Indirect Costs $ Supportive Services - Subtotal $ FLO L4D002 Name of Program Page 4 Q3 1a4. CoC Financial - Leasing, Rental Assistance, Operating, and Administration CoC Funding Types CoC Expenditures Development $ Leasing $ Rental Assistance $ Supportive Services $ Operating Costs $ HMIS $ Administrative Costs (Provider) $ SUBTOTAL - Expenditures $ Cash Match $ In -Kind Match $ SUBTOTAL - Match $ Match % Io TOTAL - Expenditures + Match $ Program Income $ THIS SECTION TO BE COMPLETED BY MDC HOMELESS TRUST Administrative Costs (Homeless Trust) $ SUBTOTAL - Expenditures $ SUBTOTAL - Match $ Match % % TOTAL - Expenditures + Match $ FLO L4D002 Name of Program Page 5 Performance for CoC Programs Q36, Standard Performance Measures Performance Measure #1 - HMIS Bed Inventory: Minimum of 86% of the organization's total number of County Continuum of Care (CoC) through the Housing of whether the beds are funded by HUD or the Trust. beds/units which are reported to HUD for the Miami Dade Inventory Checklist (HIC), are populated in the HMIS, regardless Homeless Trus4 whether or not funded by HUD or the Homeless TOTAL # OF BEDS/UNITS (as reported through H1C) TARGET # OF BEDS/UNITS IN HMIS #Beds/Units] A_TIIAI. # OF BEDS/UN1TS POPULATED IN HMIS ACTUAL, % OF TO BE POPULATED (8646of Total BEDS/UNITS POPULATED IN HMIS I� Performance Measure #2 - Bed Utilization Rate: Average bed utilization rate of 95% minimum of this program's HUD funded beds/units during this grant term. TOTAL # OF BEDS/UNITS (as reported in eSnaps) TARGET AVERAGE # OF TO BE # Reds/Units) ACTUAL AVERAGE # OF UTILIZED ACTUAL % OF AVERAGE BEDS/UNITS UTILIZED BEDS/UNITS UTILIZED (95% of Total BEDS/UNITS Performance Measure #3 - Housing Stability: Retention in or exits to Permanent Housing (PH) TOTAL # OF PARTICIPANTS SERVED TARGET # OF ACTUAL # OF ACTUAL % OF STAYERS + EXITS TO PH (RRH/DV: 8046; PSH/TH: 9096) STAYERS + EXITS TO PH STAYERS + EXITS TO PH Performance Measure #4 - New/Increased Earned Income: New and/or increased employment income for eligible participants (leavers and stayers) TOTAL # OF TARGET # OF PARTICIPANTS INCOME ACTUAL # OF PARTICIPANTS INCOME ACTI19i, % OF PARTICIPANTS WITH NEW/INCREASED EARNED INCOME WITH NEW/INCREASED EARNED WITH NEW/INCREASED EARNED STAYERS LEAVERS STAYERS (896 of Total) LEAVERS (1596 of Total) STAYERS LEAVERS STAYERS LEAVERS Performance Measure #5 - New/Increased Non -Employment Income: New and/or increased non - employment income for eligible participants (leavers and stayers) TOTAL # OF TARGET # OF PARTICIPANTS NCOME ACT!JAI, # OF PARTICIPANTS INCOME ACTUAL % OF PARTICIPANTS INCOME WITH NEW/INCREASED NON -EMPLOYMENT WITH NEW/INCREASED NON -EMPLOYMENT WITH NEW/INCREASED NON -EMPLOYMENT STAYERS LEAVERS STAYERS (1096 of Total) LEAVERS (25% pinta') STAYERS LEAVERS STAYERS LEAVERS > Comments: (If any measures have not been met, please provide an explanation and corrective action plan) FLO L4D002 Name of Program Page 6 Narrative for CoC Programs Q40: Significant Program Accomplishments Describe in a brief narrative form any significant accomplishments achieved by your project during the reporting period. (Minimum 500 characters) Q42: Additional Comments Describe in a brief narrative form based on your experience during the last year any problems or explanations and or changes or need for technical advice or assistance. (Minimum 500 diameters) FLO L4D002 Name of Program Page 7 FY 202 Continuum of Care (CoC) Program CoC Monitoring Guidelines, Internal Wellness "Top Ten" List, Internal Wellness Checklist ATTACHMENT G "Internal Wellness Checklists" M lAM COUNTY Attachment G "CoC Program Guidelines" Page 1 of 14 : I Miami -Dade County Homeless Trust CoC Program Guidelines Miami -Dade County Homeless Trust Monitoring Team Information Staff: Date of Visit: CoC Program Subrecipient: Agency and Program Information Subrecipient: Program Name: Subrecipient staff consulted: Grant Amount Grant Number: Program Type: 0 PSH 0 RRH 0 TH 0 SH 0 SSO 0 Legacy SPC 0 RIM Number to be served; Number of chronic beds/units: Program serves; 0 Individuals 0 Families 0 Both CoC Program grant funds are used for: 0 Leasing (no match. required) 0 Rental Assistance 0 Operations 0 Supportive Services ❑ HMIS ❑ Adtninistration Is the Subrecipient a faith -based organization? 0 Yes 0 No CoC Matching funds (25%) required are: 0 Cash/Cash Equivalent 0 In Kind 0 N/A Is there an active restrictive covenant on one or more of the projeces properties? 0 Yes 0 No Attachment G "CoC Program Guidelines" Page 2 of 14 PART 1: PROGRAM MONITORING: SUBRECIPIENT OPERATIONS: POLICIES AND PROCEDURES: Conflict of Interest 1. There are written standards of conductgoverning the performance of covered persons engaged in the award and administration of contracts. 24 CPR § 578.95(a); 24 CFR§ 578.1030)(11) 0 Yes CI No 2. The Subrecipient has a general conflict -of -interest policy for staff and Board members 24 CFR § 578.95(c); 24 CFR § 578.103(a)(11) ❑ Yes ❑ No 3. if the Subrecipient is an approved exception to the conflict of interest policy, the agency has documented the exception 24 CFR § 578.103(a)(1t) 0 Yes 0 No Involvement of homeless persons 1. There is at least ane homeless/formerly homeless person is on the Board of Directors or equivalent poiicymakirig,entity. 24 CFR § 578.75(g)(1) 0 Yes 0 No 2. The Subrecipient involves homeless individuals and families through employment; volunteer services; or otherwise; in constructing, rehabilitation, maintaining, and operating the project, and in providing supportive services for the project 24 CFR § 578.75(g) (2) i] Yes 0 No Confidentiality 1. The Subrecipient has written policies to ensure: • Records containing protected identifying information of any individual / family receiving assistance will be kept confidential; • The location of any family violence project will not be made public, except with the written pertnission of the person responsible for operating the project and • The location of any housing of any program participant will not be made public, except as provided in a preexisting privacy and as provided by law. 24 CFR § 578.103(b) (These policies are in addition to HMIS related confidentiality / security requirements) 0 Yes 0 No fair Housing and E ual Opportunity 1. The Subrecipient has written nondisci1nttnatian and equal opportunity policies that apply to housing and employment. 24 CFR § 578.93 0 Yes ❑ No 2. The Subrecipient has policies and procedures for providing reasonable accommodations and reasonable modifications for persons with disabilities. 24 CFR § 100.204(a), ZB CFR § 35.130(b)(7 ❑ Yes 0 No Attachment G "CoC Program Guidelines" Page 3 of 14 3. The Subrecipient maintains copies of marketing, outreach, and other materials used to inform eligible persons of the program and these materials show that the agency markets their housing and supportive services to those least likely to apply in the absence of special outreach. 24 CFR §578.93 (c) (1) 0 Yes 0 No 4. The Subrecipient has policies and procedures in place to provide meaningful access for Spanish- speaking and other Limited English Proficiency persons to access the Subrecipients programs and services. 72 federal regulation 2732 5. The Subrecipient provides program participants with information on rights and remedies available under applicable federal, State and local fair housing and civil rights laws. 24 CFR §578.93(c)(3) ❑ Yes 0 No 0 Yes 0 No Drug -Free Workplace 1. The Subrecipient has a drug -free workplace policy 0 Yes statement which includes the requirement of C] No notification to HUD if an employee is convicted for a criminal drug offense. 24 CFR § 84,13 POLICIES AND PROCEDURES FOR COO GRANT -FUNDED PROGRAM Number Served 1. The Subrecipient serves at least as many program participants as show in Its application for assistance. 24 CFR§ S78.51(h)0) Cl Yes 0 No Termination Process 1. The Subrecipient has a written policy for termination of participation for violation of program policies or occupancy agreements. 24 CFR § 578.91(b) 0 Yes a No Services Related to Housing Stability 1. The Subrecipient has a written policy for termination of participation for violation of program policies or occupancy agreements. 24 CFR § 578.91(b) ❑ Yes 0 No Residential Supervision 1. The Subrecipient provides adequate residential supervision. 24 CFR § 578.7g(f) 0 Yes 0 No Program Fees 1. The Subrecipient does not charge participant's program fees. 24 CFR § 578.87(d) Program fees are not the same as rent or occupancy rent; program participants may be charged rent for housing) -- 0 Yes D No Attachment G "C0C Program Guidelines„ Page 4 of 14 Recordkeeping 1. The Subreclpient has systems in place to ensure that records related to CaC-fundedprograms are maintained for a 5-year period. 24 CFR § 578.103 C] Yes No REVIEW OF CoC PROGRAM PARTICIPANT FILES Eligibility: Homelessness 1. Each participant file contains verification of 0 Yes homelessness status at the time afprogram entry. 24 0 No CFR § 578.103(a)(3) 24 CFR § 57b.500(b) 2. The Subreciplent has written policies and procedures for documenting homelessness. intake staff document eligibility at intake; documentation is required for all persons seekingassistance; written policies state the evidence that may be relied upon to establish and verify homeless status. The Subrecipient makes efforts to establish and verify homeless status and get the appropriate documentation. Uses Miami -Dade County's homeless verification fo rms. In order of preference: 1) Homeless coordinated outreach and assessment, 2) Third party documentation, 3) Intake worker observations, 4) Certification from theperson seeking assistance. © Yes O No Eligibility: Disability 1. If the program provides FSH, each participant file contains verification of participant's disability. 24 CFR § 578.37(a)(1)0] 1) Verification from a professional who is licensed to diagnose and treat condition OR 2) Disability verified by the Social SecurityAdministration (VA disability check, or an SSDI check) El Yes No Eligibility. Chronic homelessness 1. if the program has units dedicated to persons who © yes are chronically homeless, participant files contain 0 No verification of chronic homelessness. Service Assessment 1. The file contains participant assessments and service plans, updated at ]east annually. 24 CFR § 578.53(a) 0 Yes ❑No • Services Provided and Costs 1. The file contains documentation of services 0 Yes provided and the agency tracks the amounts spent an 0 No those services. 24 CFR § 578.103(a)(9) Duration of Services 1. The file reflects that supportive services are made available throughout resident's entire time in the project 24 CFR § 578.53(b) 2. Rapid rehousing The file reflects that program participant meets with case manager not Iess than onceper month. 24 CFR§ 578.53(1:1)(4) 0 Yes L7 No D Yes ❑ No Attachment G "CoC Program Guidelines" Page 5 of 14 Participants Terminated from 1. If a participant has been terminated from the program, file includes documentation that the Subrecipient followed its written procedure for termination of assistance. 24 CFR § 578.103(a)(7)0l); 24 CFR § 578.91 El Yes C� No rogram RENTAL ASSISTANCE OR LEASING (complete this section if the Subrecipient pgys rental assistance or leasing costsfor a unit that the program participant rives in) Rental Agreement / Lease 1. The program participant has an occupancy agreement or lease with the Recipient/Subrecipient or Landlord. 24 CFR § 578.77[a) For tenant and project based assistance; the program participant must be the tenant Orr the lease. For sponsor based assistance, lease between the Subrecipient and the Landlord, sub -Lease between participant and Subrecipient 2. For project -based, sponsor -based, or tenant -based permanent housing (PH) rental assistance; initial lease must be at least one year, terminable for cause. The leases must be automatically renewable upon expiration for terms that are a nmiriimtim of one month long, except on prior notice by either party, up to a maximum term of 24 months- 24 CFR § 578.51(1)(13 3. For transitional housing, initial lease term must be at least one month. The lease must be automatically renewable upon expiration, except on prior notice by either party, up to a maximum term of 24 months. 24 CPR § 578.51(I)(2) Habita 1. File includes documentation that units passed housing quality standards Inspection prior to initial client move -in. 24 CFR § 578.75 (b); and 24 CPR§ 578.103(a)(8) 2. File includes documentation that unit has passed .annual housing quality standards inspections, including an inspection within the last 12 months. 24 CFR § 578,75(h) 3, Dwelling unit is correct size: The dwelling unit must have at least one bedroom or living/sleeping room for each two persons. Children of opposite sex, other than very young children, may not be required to occupy the same bedroom or living / steeping room. 24 CFR § 578.(c) 4. For supportive housing for persons with disabilities; the Subreciplent must make available meal preparation facilities for residents or provide meals 24 CFR § 578.75(d) ❑ Yes 0 No 0 Yes ❑ No ❑ Yes ❑No bility ❑ Yes ❑ No 0 Yes El No ❑ Yes ❑ No ❑Yes 0 No Attachment G "CoC Program Guidelines" Page 6of14 Unit Rents 1. Documentation that rents are reasonable in relation to rents charged in the same geographic area for comparable space 24 CFR § 578,49(b) 2. Rents do not exceed the HUD -determined Fair Market Rents (FMRs), This documentation must include chart show current year's FMRs, 24 CFR § 578.49(b)(4) 3. Security deposit does not exceed two months' rent; in addition to the security deposit the Subrec[pient may also pay the final months' rent in advance 24 CFR § 578.49(b) (4) ❑ Yes 0 No 0 Yes 0No 0 Yes 0 No Annual Income 1, The file contains an income evaluation form completed by program participant and source documents verifying income and assets (or, if source documentation not available, 3rd party verification; or if 3rd party verification not available, written certification by program participant. 24 CFR § 578,103(a)(6) 2. The file contains documents demonstrating that income is re-examined annually. 24 CFR § 578.77(c)(2) 0 Yes 0 No ❑ Yes 0 No Rent Calculation 1, The file contains the annual rent calculation, and the calculation is accurate. BEST PRACTICE: The file contains a printout of the HUD rent calculation 24 CFR § 578.103 ❑ Yes ❑ No 2. is the participant charged rent (unless $0 income) and is the rent treated as program income? (required) 3. Is rent calculated initially, annually, and when there is any change in income? 0 Yes 0 No 0 Yes 0No 4. Is there documentation of compliance of an eligible "utility allowance" The Subrecipient has received a copy of the Tenants paid utility bill for compliance. Vacua 0 Yes 0No des 1. The Suhrecipient does not pay rent for more than 30 days for any unit that has been vacated. Rent may not be paid on the vacated unit again until there is a new occupant, (NOTE: Brief periods of .stays In institutions, not to exceed 90 days for each occurrence, are not considered vacancies). 24 CFR § S713.51(9) 0 Yes 0 No 1 Attachment G "CoC Program Guidelines" Page 7 of 14 I. Documentation that rents are reasonable in relation to rents charged in the same geographic area for comparable space. 24 CFR § 578.49(h) 2, Rents do not exceed rents charged for comparable units rented by the Subrecipient. 24 CFR § S78.4.9(h) 3. Security deposit does not exceed two months' rent in addition to the security deposit, the Subrecipient may also pay the final months' rent in advance. 24 CFR § 578.49 fb) (4) 4. The Subrecipient must have an occupancy agreement, and if applicable a sublease. 6.15 rent calculated initially and when the tenant requests? 6. Is the participant charged rent? (not required) 7. Has an occupancy charge been imposed? (not required) If so, the charge cannot exceed the highest of 1) 30% of the households monthly adjusted income; 2)1.0% of the households' monthly income, or; 3) The portion of the households' welfare assistance, if any that is designated for housing casts. (not applicable in the State of Florida) 8. Leasing funds are not used to lease units or structures owned by the Recipient, Subrecipient their parentorganization(s) or organizations that are members of a partnership where the partnership owns the structure. (Doesn't apply to rental assistance). LEASING ("complete this section if the Subrecipient leases buildings for the purpose of providing program services or if there is a unit lease agreement with a landlord) Rent Reasonableness {applies to rent for buildings or housing units) 0 Yes 0 No 0Yes 0 No 0 Yes 0 No LJ Yes 0 No Yes ONo 0 Yes ❑ No 0 Yes ❑ No 0 Yes CoNo REQUIRED POLICIES AND PROCEDURES FOR SPECIFIC PROGRAMS/ CIRCUMSTANCES Participant Household Policies (complete this secttun fu children) 1. The age and gender of a child under age 18 must not be used as a basis for denying any participant household's admission to a project that receives funds under this part. ❑ Yes 0 No a program that serves families with Faith -based Activities (complete this section if the Suhreciafent is a faith -based or$aniza#on) 1. The Subrecipient serves all potential participants 1 0 Yes without regard to religious belief, refusal to hold a 0 No religious belief or refusal to attend or participate in religious services. 24 CFR § 578,87(b) f 1 2. lithe Subrecipient provides explicitly religious activities (incIudingworship, religious instruction, or proselytizing), these activities are separate from HUD -funded activities and beneficiaries of HUD - funded activities are not required to participate, Attachment G "CoC Program Guidelines" 0 Yes 0 No Page 8 of 14 24 CFR § 578.87(b) 2) Projects involving acquisition, new construction, and rehabilitation 1. Records for acquisition, new construction, and rehabilitation must be retained for 15 years follovving the date the project is first occupied, or used, by program participants. 24 CFR § 578.103(c)f21 2. If the project resulted in dislocation deny persons, the Subredpient complied with the obligations of the Uniform Relocation Act? . 24 CFR § 578.83 3. For projects including new construction or rehabilitation, do the Recipient's records show that Section 3 reports have been completed and submitted. timely? 24 CFR § 578.99[i) O Yes Q No Q Yes Q No ❑ Yes El No Transitional Housing 1. Participants do not regularly exceed 24 months in the program. 24 CFR § 578.79 2. When a participant is in the program for longer than 24 months, the file documents the need for extended participation, 24 CFR§ 578,79 3. If participants stay longer than 24 months, is the number of participants with longer stays less than 50% of the total number served bythe project? 24CFR §578.79 Transfer Due to D 1. If a program participant receiving tenant -based rental assistance has moved to a different CoC due to threat of imminent harm, the file must contain documentation of the domestic violence and imminent threat PART 2: FISCAL MONITORING Q Yes 0 No Q Yes ❑ No 0 Yes Q No omestic Vio Q Yes C]No INTERNAL REVIEW Audit 1. Is the Subrecipient subject to the OMB A-133 single audit requirement? (Required if S5000,000 or more in aggregate Federal funds expended) 0 Yes 0 No 2. If subject to A-133 audit, has the Subrecipient provided its most recent audit and management letter? _ 0 Yes 0 No 3. If not bound by A-133 requirement, has the agency provided financial statements audited by a CPA? 0 Yes [] No Board of Directors 1. Has the Subrecipientprovided Miami -Dade County a list of the members of its Board of Directors? 0 Yes ❑ No Authorized Check Signers 1. Has the Subrecipient provided Miami -Dade County with a list of authorized check signers? 0 Yes 0 No Attachment G "CoC Program Guidelines' Page 9 of 14 1. The Subrecipient submits invoices on a monthly basis (on time or within time)? invoicing 0 Yes O No Procurement 1_ The Subrecipient has a written procurement policy that meets the requirements of Miami -Dade County competitive procurement standards. 2. The Subrecipient retains copies of all procurement contracts and documentation of compliance with federal procurement requirements 24 CFR § 578.103(a)/16)(i f) Ma 1. The Subrecipient has documentation of the source and use of contributions made to satisfy the 25% match requirements [match may be cash or in kind). Records roust indicate the grant and fiscal year for which each matching contribution is counted. The records must show how the value placed on 3rd party in kind contributions was derived. Costs incurred by a partnering organization to provide "in kind" services to the program participants must be documented by a MOLL Cash or any in kind contribution used as match for another grant is not an eligible in !rind contribution used as match for another grant Ls not an eligible match. 24 CFR § 578.73, 24 CFR § 578.1113(a)(10), 24 CFR § 84.23 and 24 CFR § S78.23(c)(6) 2. Match roust be spent on eligible project costs (in the budget) 3. Where match is documented by MOU, the MOi] must; establish the unconditional commitment identify the service to be provided;'dentiljr the profession of the persons providing the service; and identify the cost of the service to be provided O Yes ❑ No ❑ Yes C] No tch O Yes ONo O Yes ❑No 0 Yes 0 No Internal Controls 1. The Subrecipteat has written jab descriptions for all:HUD-funded positions O Yes O No 2. The Subrecipient has written fiscal policies and procedures specifying approval authority for all financial transactions and guidelines for controlling expenditures 3. The Subrecipient has written procedures for recording financial transactions, and an accounting manual and chart of accounts 0 Yes O No 0 Yes 0 No Program Income L Is all program income spent on eligible costs? Rent and Occupancy charges are considered program income as is any utility allowances In rental programs 2. Is program income part of your snatch? Program, income is not an eligible source of match, 0 Yes 0 No OYes. 0 No Attachment G "CoC Program Guidelines" Page 10 of 14 Indirect Coss 1. Does the organization use grant funds for indirect costs? 0 Yes 0 No 2. Are the costs consistent with OMB Super Circulars as applicable 0 Yes 0 No DOCUMENTATION REVIEW Salary Documentation 1. original timesheets - signed; grant duties identified, if split time (copy in reimbursement package) 0 Yes 0 No 2. Payroll sheets 0 Yes ❑No 3. CanceIled checks to the employee 0 Yes ❑No 4, if time is divided between the CoC Programs and another funding source, review time distribution records supporting the allocation of charges among the sources. Staff time breakdown allocation chart 0 Yes 0 No Space / Utilities Documentation / Leases 1. Rental or lease agreement - signed by participant; valid lease period; correct rental amount 0 Yes 0 No 2. Original invoices U Yes 0 No 3. Cancelled checks to the landlord/mortgagee; utility company, etc. 0 Yes 0 No 4. Unit inspection report(s); no longer than 1 year old 0 Yes 0 No 5. Verification of what payment was used for (e.g. first month's rent, security deposit, etc.) 0 Yes 0 No Supplies 1_ Purchase orders ❑ Yes 0 No 2, Requisitions 0 Yes 0 No 3. Cancelled checks 0 Yes 0 No 4. Determine where supplies are being kept 0 Yes 0 No , 5. Determine what cost objective is being used ❑ Yes 0 No Review Inventory list - any equipment shall be labeled as property of Miami -Dade County through its Homeless Trust 0 Yes 0 No Attachment G "CoC Program Guidelines" Page 11 of 14 INTERNAL CONTROLS 1. Internal control questionnaire 0 Yes 0No 2. Review Organizational chart 0 Yes 0 No 3. Review job descriptions/deffnftions of employees` dudes 0 Yes 0 No 4. Review Subrecipient`s system of authorization and supervision ❑ Yes 0 No 5. Ensure that there is a separation of duties (authorizing, recording and custody should be separate) 0 Yes 0 No 6. Review control over assets 0 Yes 0 No EVALUATION OF SELECTED TRANSACTIONS Ls the expenditure allowable a. [s the expenditure necessary, reasonable and directly related to the grant? 0 Yes 0 No b. Is the expenditure authorized by the grant? 0 Yes 0 No Source documentation evaluation a. Were the expenditures incurred during the term of the grant? 0 Yes 0 No b. Was the money actually paid out? 0 Yes 0 No c. Were the expenditures approved by the responsible Subrecipient officials 0 Yes 0 No d. Is there adequate documentation to support the expenditures? 0 Yes 0 No Does the Subrecipient maintain the appropriate records? Does the Subrecipient maintain the following? a. Chart of accounts 0 Ye5 0 No b. Cash receipts journal 0 Yes 0 No c. Cash disbursements journal ❑ Yes 0 No d. Payroll journal 0 Yes ❑ No e. General ledger 0 Yes 0 No 1. Does the Subrecipient maintain documentation concerning its sources of funding 0 Yes 0 No Attachment G "CoC Program Guidelines" Page 1.2 of 14 PART 3: HMIS MONITORING HMIS HOMELESS MANAGEMENT INFORMATION SYSTEMS HMIS Operations: Policy and Procedures 1. The Subrecipient has signed an HMIS Participation Agreement to use the HMIS license 0 Yes 0 No 2. Are the Subrecipient's HMIS Administers registered and approved to enter the data into the HMIS ystem 0 Yes 0 No 3. The Subrecipient has designated an HMIS site Administrator(s), who is the Point of Contact for Miami -bade County through its Homeless Trust as HMIS Lead Agency. 0 Yes 0 No 4. the Subrecipient has ensured that each HMIS user within its organization has signed a user agreement stating full understanding of user rules, protocols and confidentiality. 0 Yes 0 No Privacy 1. The Subrecipient has a Data Collection / Privacy Notice posted in English and Spanish at each intake location 0 Yes ❑ No 2, The Subrecipient has a written Privacy Policy or uses the CoCs written Privacy Policy 0 Yes ❑ No 3. If the Subrecipient has a web site, the Privacy Policy is posted to the web site. 0 Yes ❑ No 4, The Subrecipienthas a signed authorization for release of information form that it uses for any client for which the Subrecipient uses HMIS for data sharing 0 Yes 0 No 5, The Subrecipient ensures that all signed forms are locked in a designated location with limited access to staff 0 Yes 0 No 6. The Subrecipient has executed the Agency Sharing Data Agreement if applicable (MOO?) 0 Yes i.:J No 7. The Subrecipient has a written client complaint policy 0 Yes 0 No B. The Subrecipienthas established a process of tracking all filed complaints and can provide copies of complaints and resolutions to the HMIS Lead Agency if requested. 0 Yes 0 No Security 1. The Subrecipient maintains a list of active HMIS users 0 Yes ❑ No 2. The Subrecipient regularly contacts the HMIS Lead when an employee leaves the Organization, in order to make sure that the person's HMIS account is disabled. 0 Yes ❑ No • 3. Are the Subrecipient's HMIS workstations located in secure locations or, if not are the workstations manned at ail times? 0 Yes 0 No 4. Has the Subrecipient identified a person who will serve as the Organization's HMIS security officer? 0 Yes Attachment G "CoC Program Guidelines" Page 13 of 14 0 No 5. Has the HMIS security officer completed an HMIS security self -certification within the last 12 months? C7 Yes 0 No S. Does the Subrecipienthave in place policies and procedures to protect hard copies (paper) with personal identifying information? 0 Yes ❑ No Data Quality At a minimum the Subrecipient collects the Universal Data Elements for every client entered and minimum data quality standards are met. 0 Yes 0 No The Subrecipient enters Client Basic Demographic Data into the HMIS system at a minimum within one week of intake 0 Yes 0 No The Subrecipient staff review monthly reports received from HMIS Program. Administrator and addresses any issues noted. 0 Yes 0 No Attachment G "CoC Program Guidelines" Page 14 of 14 CONTII'W MM OF CARE (CoC) PROGRAM INTERNAL WELLNESS "TOP TEN" LIST This "Top Ten" cheoldist is a supplement to the CoCInternal Wellness Checklist. It is intended to highlight ten critical reoordkeeping areas in the operation of the CoC Program., Grantees are encouraged to utilize this resource to proactively monitor the current "health" of their CoC grants, Progrart eivaat-Level Hecurdkeeping The critical records to be maintained for each program participant include: 1. 0 Participant Eligibility Ensure documentation of a participant's hvrneiessness or at -risk of homelessness status and disability, if applicable, is obtained at intake, 24 CFR 576.500(b) or (c); 24 CFR 578.103(a)(3), (4), or (5); and 24 CFR103(aXi7) 4, ❑ Horsing Quality Standards (RQS) Ensure structures or units assisted with Coe funds meet HQS at lease -up and are re-icspeoted at Least annually thereafter. 24 CFR 578.75(b) and 24 CFR 578.iO3(a)(8) 2. ❑ Leasing and Rental Assistance Requirements Ensure rents charged for a structure or unit assisted with leasing or rental assistance funds meet standards of FMR or rent reasonableness. 24 CFR 578.49 and 24 CFR 57851 5. ❑ Use of a Coordinated Entry System Ensure participants are asses..qed and referred using the CoC's coordinated assessment system. 24 CFR 578.23(c)(9) fond 24 CPR 578.103(a)(17) 3, 0 Examination of Income Ensure participant income documentation is examined at intake and re-examined at least annually. 24 CFR 578.77(bX4) and 24 CFR 578.103(a)(6) A. [] Ilse of Homeless Management Information System (HMIS) Ensure partleiparns are entered in the Coe's HM,IS or a comparable database, 24 C.FR 576.500(b) or (c); 24 CFR 578.104a.)(3) General ReeordkeeDing and Itinttrrejal Files The critical records to be maintained by each recipient and/or subrecipieni include: 7.11 Standard Operating Procedures Maintain policies and procedures for intake, program operation, recordkeepin , and subreoipient oversight/ monitoring to ensure That CoC wads are used appropriately. 24 CFR 578.103 a and 24 CPR 578.23 e 9. ❑ Match Sources and Uses Ensure grant funds, except leasing funds, are matched with no less than 25 percent of cash or in -kind contributions from other sources, 24 CFR 578.73 and 24 CFR578.103(a)(10) 8. ❑ Financial Policies and Procedures Maintain fiscal controls, accounting procedures, and procurement procedures to ensure that Coe thuds aro used appropriately, *2 CFR fart 200 10. ❑ Homeless Participation Enable homeless cr formerly homeless persons the opportunity to participate In poiioymeking on the board of directors or other equivalent pn[icymaking entity. 24 CFR 578.75(g)(1) and 24 CM 578.103(a)(12) NOTE: For additional guidance, please refer to the foaming resource materials: (1) Homeless Emergency Assistance and Rapid Transition to Housing: Continuum of Care Program Coe Regulations at 24 CFRPart 578, and (2) C PL) Monitoring Handbook 6509.2 REV-6 C;HG 2 at: Irtt • t o r ❑ 1 7 / ro ate offices/wiministrationill d dbool di6 0 *(DLOC'iC 8) If a recipient chooses to utilize this document for projects funded prior to the FY 2015 Coe competition, please refer to 24 CFR 578.103(a), 24 Cali fart 84 and 24 Cm Part 85 for applicable financial requirements, Internal Wellness Checklist for the Continuum of Care (CoC) Program The Internal Wellness Checklist was developed in an effort to assist homeless providers to proactively implement its FY CoC grant(s), thereby ensuring compliance with applicable regulations codified at 24 CFR Part 578. It is also designed to assist with determining the current "health" status of this CoC grant. Grant recipients are strongly encouraged to utilize this checklist prior to submitting the required APR to the U. S. Department of Housing and Urban Development. Recipient Name: Project Name: Grant Term: 1 or 2 Yrs. Grant Ntunber: Grant Amt.: Expiration Date: Date APR is Due to HUD: Date APR Submitted: (Not more than 90 days after the end of each CoC grant's performance period) General Recordlceening 1. Executed Grant Agreement 24 CFR 578.23( c) 2. Doournetxtation of Grant Amendment (request and approval, if applicable) 24 CFR 578.105 3. Executed Grant Agreements with Subrecipients 24 CFR 578.23( a )(ii) 4. Documentation subrecipients ate not debarred 24 CFR 578.23( c )(4)(v) 5, Documentation of annual monitoring of Subrecipients 24 CFR S78.23( c )(8) 6. Executed Memorandum of Understanding with Service Providers 24 CFR 578.73(c )(3) 7. Project Application should be maintained - ensure costs charged against the grant are consistent with the approved budget items identified in the application 24 CFR 578.59(a) 8. Documentation that Annual Performance Report was submitted timely 24 CFR 578.103(e) 9, Written CoC Program Policies and Procedures to include: 24 CFR 578.103(a) intake/screening procedures 24 CFR 578.103(a)(3)and(4) Internal Wellness Checklist Page 2 Grant #: Personnel Policies and Procedures 2 CFR 200.303, and 24 CPR 578.103(a) Termination Policy 24 CFR 578.91 Grievance Policy 24 CFR 578.91 Policy Privacy/Confidentiality Policy 24 CFR 578.103(b) Drug -Free Workforce Policy 24 CFR 5.105(d), 24 CFR 2424, 24 CFR 225 Policy identifying the involvement of homeless/formerly homeless individuals 24 CFR 578.23(c)(3) Domestic Violence Policy 24 CFR 578.23(c)(4)(i)(ii), 24 CFR 578.103(a)(17) Housing First Policy, if applicable HUD CPO Notice 14-02 la Documentation of participation of homeless/formerly homeless individuals in policymaldng 24 CFR 578.75(g)(1) �11. Documentation of compliance with environmental review requirements 24 CFR 578.99, 24 CF'578.31 12. Documentation of compliance with fair housing requirements 24 CFR 578.87(b), 24 CFR 578.103(a)(14) and (17), 24 CFR 578.93( c )(1) 13. Documentation of other federal requirements (i.e. lead based paint, Section 3, Section 504), if applicable 24 CFR 578.99, 24 CFR 35, 24 CFR 578.99(b) Financial Files 1. Written Financial Policies 2 CFR 200.302, 24 CFR 578.23(c )(5), 24 CFR 578.103(a) 2. Written Procurement Procedures 2 CFR 200.318 and 2 CFR 200.319 3. Written Conflicts of Interest Policy 2 CFR 200.317 and 2 CFR 200.318, 24 CFR 578.95(a) 4. Documentation of match (25% of total Grant Amount less leasing) 24 CFR 578.73(a) 5, Documentation of Grant Expenditures (during grant term and for approved items in application) 24 CFR 578.37, 24 CFR 578.103 6. Documentation of Indirect Cost Rate Proposal, if applicable 24 CFR 578.63(b), 24 CFR 578.103(a)(17) Internal Wellness Checklist Grant #: Page 3 7. Documentation showing compliance with the Single Audit Act 24 CFR 578.99(g), 2 CFR 200 subpart F 8. Documentation showing quarterly draw requests 24 CFR 578.85(c )(3) 9. Documentation showing program income was expended prior to HUD draw requests, if applicable 24 CIIR 578.97(b) Participant Program Files 1. Documentation participants are entered into HMIS or a comparable database 24 CFR 578.103(aX3) • 2. Documentation participant was screened via centralized or coordinated assessment systems 24 CFR 578.23( c )(9) _ 3, Documentation of Homelessisess at intake 24 CFR 578.103(a)(3) 4. Permanent Supportive Housing -Documentation of disability 24 CFR 578.37(a)(i) 5. Transitional Housing- No more than 24 months of services provided except under doctuxtented extenuating circumstances 24 CFR 578.79 6. Documentation of ongoing assessment of services 24 CFR 578.75(e) 7. Documentation of examination of income (initial and recertification) 24 CFR 578.103(a)(7)(1) 8. Documentation of initial and follow-up Housing Quality Standards inspections 24 CFR 578.75(b)(2) 9. Leasing -Documentation that the unit/structure is not owned by recipient or subrecipient 24 CFR 578.49(a) 110. Leasing•Documentatiou lease is between agency and landlord 24 CFR 578.49(b)(5) 11. Leasin-Is there an occupancy agreement, tease or sublease in the file (for individual units)? 24 CFR 578.103(a)(17) 12. Leasing -Documentation of rent reasonableness for the period of approval for an assisted unit 24 CFR 578.49(b)(1) �13. Rents charged (including utilities) do not exceed HUD -Fair Market Rents 24 CFR 578.49(b)(2) 14. Documentation supporting the correcticurrent utility allowance schedule is used 24 CFR 578.103(a)(17), 24 CFR 578.49(a)(3) Internal Wellness Checklist Page 4 Grant #: �15. Leasing -Documentation of occupancy charges with annual income calculations 24 CFR 578.77,24 CFR 578.99(b)(6) 16. Rental -Documentation the participant has a an executed lease agreement with the landlord 24 CFR 578.77, 24 CFR 578.51(d)(e) ^17, Rental-Docmmentatiou of rent reasonableness for the period of approval for an assisted unit 24 CFR 578.51(g) NOTE: For additional guidance, please refer to the following resource materials: (I) Homeless Emergency Assistance and Rapid Transition to Housing: Continuum of Care Program CoC regulations at 24 CFR Paid 578, and (2) Monitoring handbook 6509,2 REV-6 CHO-2 that can be accessed at; httr:/Jportai.hud.acv/hudportal/FIUD?src=/program offices/ad ministrationlhudcii Dslhandbooksjcpd16509.2. Completed by: Signature: Date: Typed/Printed Name: Title: This document is to be maintained in the applicable CoC project file. FY 202 Continuum of Care (CoC] Program Incident Report ATTACHMENT H "Incident Report" MIAMI-DADE COUNTY HOMELESS TRUST POLICY & PROCEDURES POLICY NO: HT004 SUBJECT: INCIDENT REPORTING PROCEDURES EFFECTIVE DATE: 9/9/2015 REVISED DATE: PURPOSE: The purpose of this policy is to define the process for receiving and processing incident reports. SCOPE: Miami -Dade County Homeless Continuum of Care PROCEDURES: Homeless CoC providers contracted with Miami -Dade County Homeless Trust must report the following types of critical incidents, via email, to the attention of our me ess r st a it Ass ran e rdinat r: An e a Mi er at An e a Mi er miamidade . These incidents are defined and outlined in CF-OP 215-6. • Child -on -Child Sexual Abuse • Child Arrest • Child Death • Adult Death • Elopement refers to court ordered clients that run away and do not return • Employee Arrest • Employee Misconduct • Escape • Missing Child • Security Incident - Unintentional • Significant Injury to Clients • Significant Injury to Staff • Suicide Attempt • Sexual Abuse/Sexual Battery For each critical incident, an incident report must be submitted to Miami -Dade County Homeless Trust within one business day. The incident report needs to include: • Facility/Home • Clients Name • Clients Age • Date & Time of Accident/Incident • Place of Accident/Incident • Description of Accident/Incident • Description or nature of injury MIAMI-DADE COUNTY HOMELESS TRUST POLICY & PROCEDURES POLICY NO: HT004 SUBJECT: INCIDENT REPORTING PROCEDURES EFFECTIVE DATE: 9/9/2015 REVISED DATE: • Witness(es) to Accident/Incident • What action(s) were taken? • Parent/Guardian information, and if they were contacted? Time? How? • Other Persons Contacted • Describe Medical Treatment/First Aid • Signature of Staff Completing Form, Date and Time • Signature of Director/Person in Charge, Date and Time 3. When a critical incident occurs, subcontracted provider staff should: • Take action to ensure the health, safety, and welfare of all individuals involved in the incident, and • Contact law enforcement, emergency responders, or the Abuse Hotline. TOOLS: Miami -Dade County Homeless Trust Incident Report Form M;\Policies-Miami-Dade County Homeless Trust \Incident Reporting Process.0515 INCIDENT REPORT ATTACHMENT N CHECK IF CRITICAL ❑ IDENTIFYING INFORMATION Reporting Party Phone # ( ) Date of incident / Reporting Party Name Contract Provider Name Program Name Provider Location Time of Incident : am/pm Specific Category: (check all that apply) ❑ Allegation of wrongdoing 0 Wrongdoing (as acknowledged by a third party designated to investigate these claims i.e. law enforcement detained individual, or DCF accepted abuse report) Specific location/ address where incident occurred: TYPE OF INCIDENT CLIENT RELATED O ALTERCATION 0 CLIENT DEATH ❑ CLIENT INJURY OR ILLNESS ❑ THEFT ❑ SEXUAL BATTERY ❑ SUICIDE ATTEMPT ❑ PROPERTY DAMAGE 0 ABUSE OR NEGLECT* • OTHER INCIDENT Specify * Failure to report any known or suspected abuse of any kind of a child is a third-degree felony that may result in a prison sentence of 5 years, and a fine of $5,000 (Refer to Chapter 39 & 415 of the Florida Statutes). 1 of 4 COUNTY �r crr E, ct«?r;t e 4 f en• Z s ATTACHMENT N STAFF RELATED ❑ INAPPROPRIATE EMPLOYEE ACTS OR OMISSIONS THAT RESULT IN CLIENT INJURY ABUSE, NEGLECT, OR DEATH ❑ FRAUD 0 THEFT O BREACHES OF CONFIDENTIALITY 0IMPROPER EXPENDITURE OR COMMITMENT OF PUBLIC FUNDS -OR-CONTRACT MISMANAGEMENT LJ COMPUTER RELATED MISCONDUCT 0ANY VIOLATION UNDER 035, F.S., TITLE XXXI, EMPLOYEE SCREENING, THAT WOULD RESULT IN DISQUALIFICATION FROM CLIENT CONTACT DUTIES O FALSIFICATION OF OFFICIAL RECORDS ❑ MISUSE OF POSITION OR STATE PROPERTY EMPLOYEES, EQUIPMENT, OR SUPPLIES FOR PERSONAL GAIN OR PROFIT • FAILURE TO REPORT KNOWN OR SUSPECTED NEGLECT OR ABUSE OF A CLIENT ❑ OTHER INCIDENT THAT WOULD BE A VIOLATION OF STATUTE, RULE, REGULATION OR POLICY Specify 2 of 4 zi C.J)'C?17c[ �\i'C:`:C,tLC Emecri, ATTACHMENT N PARTICIPANT (S) / WITNESS (ES) (Please mark W or P for either Witness or Participant) Staff ID # or Client HMIS # CLIENT EMPLOYEE OTHER ❑ IJ 0 0 ❑ W / P EJWor❑P ❑Wor❑P ❑Wor❑P DESCRIPTION OF INCIDENT Give detailed account — who, what, where, when, why, how — add pages if necessary CORRECTIVE ACTION AND FOLLOW UP Immediate corrective action taken Is follow up action needed? ❑ Yes ❑ No If yes, specify INDIVIDUALS NOTIFIED Abuse Registry 1-800-962-2873 Applicable Law Enforcement Department Indicate name of person contacted, if report was accepted, the date and time Weaned or copy of report Incident Reports — The Subrecipient must report to Miami -Dade County Homeless Trust information related to a critical incidents occurring during the administration teen of its programs. In addition to reporting this incident to the appropriate authorities the Subrecipient must within twenty-four (24) hours of any incident, submit in writing a detailed account of the incident. This incident report should be addressed to the Homeless Trust Quality Assurance Coordinator. This incident report should be addressed to Angcla.Miller®7a miamidade,gov. 3 of4 MIAM COUNTY )4: J:' ? 'J)[.( E t'i e, t nt [ :J Definitions of Reportable Client Incidents ATTACHMENT N a. Altercation. A physical confrontation occurring between a client and employee or two or more clients at the time services are being rendered, or when a client is in the physical custody of the department, which results in one or more clients or employees receiving medical treatment by a licensed health care professional. b. Client Death. A person whose life terminates due to or allegedly due to an accident, act of abuse, neglect or other incident occurring while in the presence of an employee, in Homeless Trust contracted program facility. c. Client Injury or Illness. A medical condition of a client requiring medical treatment by a licensed health care professional sustained or allegedly sustained due to an accident, act of abuse, neglect or other incident occurring while in the presence of an employee, in a Homeless Trust contracted program. d. Other Incident. An unusual occurrence or circumstance initiated by something other than natural causes or out of the ordinary such as a tornado, kidnapping, riot, or hostage situation, which jeopardizes the health, safety and welfare of clients. e. Sexual Battery. Any allegation of a program participant or program staff intentionally touching a minor or another person without their consent. This includes incidents of inappropriate verbal offenses, incidents that occur outside of the residence, and incidents were the program participant was victimized by someone outside of the residence. Incidents involving a minor, person who is 60 or older, or someone who is disabled must be reported to the DCF. f. Abuse or Neglect. Any physical maltreatment of a child, disabled person, or someone age 60 or older. Any failure to act on the part of the parent or care taker, which results in harm to a child, disabled person, or someone age 60 or older. g. Suicide Attempt. An act which clearly reflects the physical attempt by a client to cause his or her own death while in the physical custody of the depattitient or a departmental contracted or certified provider, which results in bodily injury requiring medical treatment by a licensed health care professional. h. Property Damage. An incident involving damage to property procured with Homeless Trust funding. 4of4 FY202 Continuum of Care (CoC) Program Real Property and Equipment Asset Inventory Report ATTACHMENT I "Real Property and Equipment Asset Inventory Report" MIAMId�Af71r ouNrr Real Property and Equipment Asset Inventory Equipment with an acquisition cost of greater than $5,000.00 per unit and all real property must be inventoried. Real property includes land, land improvements, structures and appurtenances, moveable machinery and equipment. Property and Property Improvement Record: Legal Description: Size: Date of Acquisition: Value at Time of Purchase: Owner's Name (if different than the Subrecipient]: Map: (attach map) indicate where property is in parcels 1 lots or blocks and show adjacent streets and roads Equipment 1: Description of Property: Serial / ID Number: Acquisition Date: Cost: Vendor Name: % of Purchase Cost from Grant: Location of Property: Use and Condition of Property: Who Holds Title? Equipment 2: Description of Property: Serial / ID Number: Acquisition Date: Cost: Vendor Name: % of Purchase Cost from Grant: Location of Property: Use and Condition of Property: Who Holds Title? Equipment 3: Description of Property: Serial / ID Number: Acquisition Date: Cost: Vendor Name: % of Purchase Cost from Grant: Location of Property: Use and Condition of Property: Who Holds Title? *(please create additional pages as required] ATTACHMENT I "Miami -Dade County Real Property and Equipment Asset Inventory" FY202 Continuum of Care (CoC) Program When the Subrecipient is the Housing Administrator (Leasing or Rental Assistance) ATTACHMENT J "Rental Assistance Farms" FY202 Continuum of Care (CoC) Program When Miami -Dade County is the Rental Administrator ATTACHMENT K "Rental Assistance Farms" MIAMIDADE COUNTY COUNTY July 21, 2023 Mr. Francis Suarez, Mayor City of Miami 444 SW 2°1 Avenue Miami, Florida 33130 Via Email: fsuarez@miamigov.com Miami -Dade County Homeless Trust 111 NW 1" Street, Suite 27-310 Miami, Florida 33128 Office (305) 375-1490 Fax: (305) 375-2722 Re: FY 2022 US HUD Continuum of Care (CoC) Program - Sub -Recipient Agreement Dear Mayor Suarez, Attached, please find an electronic copy of the Sub -recipient Agreement and corresponding attachments between Miami -Dade County, through Miami -Dade County Homeless Trust, and City of Miami for the FY 2022 US HUD CoC Program under grant number FL0211L4D002215, Miami Homeless Assistance Program CE Consolidation. Please review the included contract execution instructions closely, and do not add language or alter any of the content in the Agreement and corresponding attachments. The authorized agency signatory must sign and/or initial (as applicable) all marked sections of the Agreements and the relevant attachments. Miami - Dade County requires that the President/Chairman of the Board execute the Agreement on behalf of the agency. However, the Executive Director may execute the Agreement if approved by a resolution of the agency's Board. A copy of the applicable Board resolution(s) must be submitted with the Agreement. In addition, the agency must affix the corporate seal to the signature page of the Agreement or notarize it accordingly. All completed documents must be returned to the Homeless Trust office via email or SharePoint no later than July 29, 2023. Should you have any questions or concerns regarding this matter, please contact Kristen Joseph (KristenJoseph@miamidade.gov), Administrative Officer 3, and Terrell Thomas Ellis (Terrell.Ellis@miamidade.gov), Manager, Homeless Trust Contracts Division. Thank you for your continued efforts with addressing the needed of the homeless of our community. Sincerely, d ' oria L. Mallette Executive Director / kl cc: FY 2022 Continuum of Care (CoC) Grant File