HomeMy WebLinkAboutExhibitMIAMI•DADE
April 30, 2019
Mr. Emilio T. Gonzalez, City Manager
The City of Miami
444 SW 2°d Avenue
Miami, Florida 33130
Re: FY 2018 US HUD Continuum of Care (CoQ Program — Sub -Recipient Agreement
Dear Mr. Gonzalez:
Homeless Trust
111 NW.1 st Street • 27th Floor
Miami, Florida 33128
T 305-375-1490
miamidade.gov
Enclosed, please find three (3) original sets of the Sub -recipient Agreement between Miami -Dade County, through Miami -
Dade County Homeless Trust and The City of Miami — Metro Miami Homeless Assistance Program (MMHAP)-South
for the FY 2018 US HUD CoC Program under grant number FL0190L4D001811.
Please review the included contract execution instructions. Thereafter, the authorized agency signatory must sign all three
(3) copies 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 Agreements or notarize them
accordingly. All three (3) completed copies must be returned back to the Homeless Trust office no later than May 7.2019.
Please do not alter any of the content in the Agreements. Please do not remove any of the attachments to the Agreements.
If there are any issues or corrections need to be made, please contact Terrell T. Ellis, Manager, Homeless Trust Contracts
Division.
Please feel free to contact us at (305) 375-1490 if you any questions or require additional information. Thank you for your
continued efforts with addressing the needed of the homeless of our community.
Sincerely, o
e
llette
ctor
Signature below confirms receipt of the enclosed documents.
Signature of Authorized Agency Representative Date
Printed Name of Agency Representative &�
COUNTY J
FY 2018
United States Department of Housing and Urban Development
(US HUD)
Continuum of Care (CoC) Program
Grantee: Miami -Dade County through its Homeless Trust
And
Subrecipient: The City of Miami
Program Name: Metro -Miami Homeless Assistance Program
(MMHAP)-South
Grant #: FL0190L4D001811
INDEX
Cover page ---page 1
Index ---page 2
Whereas and preamble ---page 3
1. Statement of Work
a. Activities ---page 3
b. Time Schedule --=page 4
c. Budget ---page 4, 5, 6
2. Records and Reports
a. Financial Management -=-page 7
b. Records and Access to Records ---page 8
c.. Public Records ---page 9
d. Encouraging Efficient Use of Information Technology and Shared Services ---page 10
e. Reports: i) Progress Reports; ii) APR; iii) Survey; iv) Participants' Application for Housing, v)
Program Income; vi) Program Guidelines; vii) Audit; viii) Incident; ix) COOP through x) Mandatory
Disclosures ---pages 10 through 13
3. Special and General Conditions
a. Staff Responsibility ---page 13
b. Client Referral Process ---page 13
c. Documents to facilitate the Reimbursement of services ---page 13
d. Compliance with rules, guidelines of.CoC Rental Assistance items i) through v) ---page 13
e. VAWA Emergency Transfer Plan ---page 14
f. Performance Improvement Plans ---page 14
g. . General Conditions
i. Insurance; ii) Indemnification; iii) Certification and Representation; iv) Conflict of Interest,
v) Affidavits--- pages 14 through 17
h. Civil Rights ---page 18 through 20
4. Suspension and Termination
a. Suspension ---page 21
b. Termination ---page 21 through 23
5. Future Funding Applications ---page 23
6. Reversion of Assets
a. Term of Commitment ---page 24
b. Repayment of Grant ---page 24
c. Prevention of Undue Benefit ---page 24
d. Revocation of License or Permit ---page 25
e. Declaration of Restrictive. Covenant and Declaration of Restrictions ---page 25
7. Uniform Administrative Requirements
a. Accounting Standards, Costs Principles and Regulations ---page 26
b. Retention of Records ---page 27
8. Additional Requirements
Items a through gg ---pages 27 through 35
9. Religious Organizations ---page 36
10. Health Insurance Portability and Accountability Act (HIPAA)---page 36,37
11. Proof of Licensure / Certification and Background Screening
a. Licensure / Certification ---page 37
b. Background Screening ---page 38
Signature ---page 39
Index of Attachments A through L ---page 40
CoC Grant #FL0190L4DO01811, The City of Miami, MMHAP South Program Page 2
Subrecipient Agreement between Miami -Dade County and
The City of Miami
for the
FY 2018 US HUD CoC Program
Grant #FL0190L4D001811
Metro -Miami Homeless Assistance Program South
MMHAP South
THIS AGREEMENT, entered this day of 12 0 1 . by and between Miami -
Dade County, on behalf of its Homeless Trust (HT) (hereinafter called the "Grantee"), and The City
of Miami, (hereinafter referred to as the "Subrecipient") under this Agreement.
WHEREAS, the Homeless Emergency Assistance and Rapid Transition to Housing Act of 2009
(HEARTH Act) amended the McKinney-Vento Homeless Assistance Act, consolidating three (3)
separate reauthorized McKinney-Vento Homeless Assistance Programs, Supportive Housing
Program (SHP), Shelter Plus Care (S+C) Program, and Section 8 Moderate Rehabilitation Single
Room Occupancy (SRO) Program into a single grant program known as the Continuum of Care
(CoC) Program.
WHEREAS, the Grantee has applied for and received funds from the United States Department of
Housing and Urban Development (US HUD) under the McKinney-Vento Homeless Assistance Act as
amended by The HEARTH Act of 2009 (42 U.S.C. 11301, et seq.).
WHEREAS, the Grantee agrees to comply with all requirements of this Agreement and to accept
responsibility for such compliance by the Subrecipient to which it makes grant funds available; and
NOW, THEREFORE, it is agreed between the parties hereto that;
1. Statement of Work
a. Activities - The Subrecipient shall adhere to the "Continuum of Care Program Grant
Agreement and Exhibit 1 Scope of Work for FY 2018 Competition", Attachment A, which
is incorporated herein and governed by the Continuum of Care (CoC) Program rules and
regulations (the "Rule"). 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 (The Consolidated Appropriations Act of 2014, Public Law 113-76, approved
January 17, 2014 in the "FY 2014 HUD Appropriations Act") as well as with any other terms
and conditions as HUD may have established in the applicable Notice of Funds Availability
(NO.FA) and with any applicable guidance, requirements and directives provided by US HUD
and with any applicable guidance, requirements and directives provided by Miami -Dade
County Homeless Trust.
The Subrecipient shall carry out the activities specified in the "Scope of Service and US HUD
eSnaps Documents" Attachment B. The Subrecipient shall also adhere to the Standards of
Housing and Services as set forth in the "Miami -Dade County Homeless Trust Standards of
Care", as may be amended from time to time and incorporated herein by reference. The
CoC Grant #FL01901,0001811, The City of Miami, MMHAP South Program Page 3
Subrecipient shall adhere to all applicable federal, state and local laws, regulations, rules and
standards, as well as with the terms of this Agreement including all attachments.
b. Time Schedule - The Grantee and the Subrecipient agree that this Agreement shall become
effective on June 1, 2019.
This Agreement shall expire on May 31.2020, one (1) year from the effective date.
Any cost incurred bythe Subrecipient beyond this date will not be paid bythe Grantee, except
as specifically provided herein. Notwithstanding any provision herein to the contrary, certain
requirements imposed on the Subrecipient by this Agreement and federal regulations may
continue for a term of at least fifteen (15) years from the date of initial occupancy or service,
as provided in this Agreement or as specified by law or regulation. The requirements of this
Agreement shall remain in effect during any time period that the Subrecipient has control
over any funds generated or provided in connection with this Agreement, including program
income.
c. Budget - The Grantee agrees, subject to the availability of funds and payment of funds to the
Grantee by the United States Department of Housing and Urban Development and subject to
the Subrecipient's compliance with all applicable laws and agreement terms as determined
by the Grantee, to pay for contracted activities according to the terms and conditions
contained within this Agreement, Subrecipient's application for the CoC Homeless Assistance
Program, and the Subrecipients NOFA application documents as Project Sponsor and "Scope
of Service and US HUD eSnaps documents" including the Budget incorporated herein as
Attachment B, in an amount not to exceed $0.00 for Rental Assistance, $0.00 for Leasing,
$132.180.00 for Supportive Services, $0.00 for Operations, $0.00 for HMIS costs and
$9.253.00 for overall Project Administration Costs which added together equals an amount
of $141.433.00 in TOTAL BUDGET.
If the Grantee, Miami -Dade County through its Public Housing and Community Development
Department (PHCD) or such other department or party as may be selected by Miami -Dade
County Homeless Trust, is the Rental Administrator; then the Grantee shall pay the "CoC
Program HAP Contract" Attachment K payments directly to Landlord, owner(s). The total
amount awarded pursuant to this Agreement, in amount up to $0.00 for Rental Assistance
funds has been allocated for use as eligible rental assistance payments on behalf of the
Subrecipient's program participants.
Pursuant to 24 CFR 578.59, the Grantee shall retain 50% of the Overall Project
Administration Costs, except where limitations are imposed as maybe applicable pursuant
to 42 USC § 11383 (a).
If applicable, the Subrecipient shall be reimbursed for capital funding on an incremental
basis, based on the following completion benchmarks: 30%, 30%, 30% and 10% to be
provided when a final Certificate of Occupancy is obtained from the developer, in accordance
with any applicable laws and regulations. All other activities shall be paid on a
reimbursement basis following the. submission of a monthly invoice along with the
appropriate supporting documentation.
In accordance with federal requirements including 24 CFR -Part 578.73, the Subrecipient
agrees to provide match funds in an amount that represents no less than twenty-five
percent (25%) cash or in-kind contributions on all eligible grant funds, except leasing. If in-
CoC Grant #FL0190L4D001811, The City of Miami, MMHAP South Program Page 4
Idnd services provided through a third parry are used to fulfill part of the match, a fully -
executed Memorandum of Understanding (MOU) between the Subrecipient and the third
party that will provide the services must be submitted to the Grantee.
The budget figures above represent the original line item totals as delineated in the
"Continuum of Care Program Grant Agreement" Attachment A. The Subrecipient may
propose to shift funds by less than 10% between eligible categories in the "Scope of Service
and US HUD eSnaps Documents" Attachment B, if the appropriate match is provided, the
administrative costs are not increased and the proposed shift is submitted in writing for the
Grantee's consideration. The Grantee may, but is not required to, approve the proposed shift.
Any approval must be in writing. As such, if Attachment B is modified as described above,
the figures within the "eSnaps Application" may not match the contracted figures delineated
in the "US HUD Grant Agreement."
In accordance with 24 CFR 578 the Subrecipient is prohibited from moving more than 10%
from one budget line item in a project's approved budget to another without written "US HUD
grant amendment" and amendment to this Agreement.
This is a Performance-based Agreement to deliver housing and or services to
Subrecipient's Continuum of Care (CoC) program participants. The Subrecipient shall provide
at least seven hundred and seventy-five (775) outreach contacts and placement
services (465 individuals and 310 families with children)(Supportive Services Only
(SSO)) to homeless individuals and families, including chronically homeless persons under
the Continuum of Care Program. The program's main office is located at 450 SW 5th Street,
Miami, Florida 33130. Services are located in and provided in Miami -Dade County, Florida.
The Subrecipient shall provide services as outlined in the Attachments to this Agreement as
required, pursuant to the FY 2018 US HUD CoC Program NOFA Competition as submitted in
the project application, incorporated herein by reference.
Availability of funds shall be determined in the Grantee's sole discretion.
If this Agreement is for permanent supportive housing or permanent housing for eligible
homeless individuals and /or homeless families; the Subrecipient agrees that, with some
exceptions, no undocumented or illegal immigrants shall.be eligible for services provided
under this Agreement. Additionally, the Subrecipient shall comply with The Personal
Responsibility and Work Opportunity Reconciliation Act of 1996 ("PRWORA"), as may
be amended and applicable law, in verifying citizenship, residency and immigration status of
potential participants.
The Subrecipient shall comply with The Personal Responsibility and Work Opportunity
Reconciliation Act of 1996 ("PRWORA"), as may be amended and applicable law, in
verifying citizenship, residency and immigration status of potential participants. The
Subrecipient hereby aclulowledges that_PRWORA prohibits housing or services provided
under this Agreement to undocumented or illegal immigrants.
When the Grantee, Miami -Dade County through its Homeless Trust is the rental
administrator of the CoC Program (also known as Tenant -Based, Sponsor -Based or Project -
Based Rental Assistance). If this Agreement is for permanent supportive housing or
permanent housing for homeless participants, under the CoC Program and the Grantee,
Miami -Dade County through its Homeless Trust is the rental administrator of payment
CoC Grant #FL0190L4D001811, The City of Miami, MMHAP South Program Page 5
of Housing Assistance Payment (HAP) Contracts the following rules, regulations,
responsibilities apply: Agreement specifically for housing under Tenant -based or Sponsor -
based, or Project -based Rental Assistance, it is the Subrecipient's responsibility to identify
eligible rental units for eligible homeless program participants in partnership with the
established CoC's Coordinated Outreach and Assessment System. The Landlord identified by
the Subrecipient must enter into a "Housing Assistance Payment (HAP) Contract",
Attachment K attached to this Agreement.
When the Subrecipient is the rental administrator of payments of Housing Assistance
Payment (HAP) Contracts for the Permanent Housing Tenant -Based, Sponsor -Based or
Project Based Rental Assistance or Rapid Re -Housing CoC Program. If this Agreement is for
permanent supportive housing or permanent housing for homeless participants, under the
Legacy SHP or CoC Rental Assistance Program and the Subrecipient- is the rental
administrator of the "Housing Assistance Payments (HAP) Contracts" Attachment J, the
following rules, regulations, and responsibilities apply:
It is the Subrecipient's sole responsibility to identify eligible rental units for eligible homeless
program participants in partnership with the established CoC's Coordinated Outreach and
Assessment. It is the Subrecipient's sole responsibility to enter into a "Housing Assistance
Payment (HAP) Contract" Attachment J with the eligible owner of each rental unit
("Landlord"). The Subrecipient must use the HAP Contract template forms in Attachment
J attached to this Agreement when the Subrecipient contracts with the Landlord. The
Subrecipient is responsible for ensuring the HAP Contract complies with all program
requirements, terms and conditions of this Agreement, and applicable law. The Grantee,
Miami -Dade County, shall not be a party to the HAP Contract. Should the Subrecipient desire
or require any amendments to the HAP Contract template form; the Subrecipient shall advise
the Grantee of the proposed amendment(s) and explain why the amendment(s) is desired or
required prior to amending the HAP Contract template form.
The Subrecipient is solely responsible for paying rent to the Landlords on time. The
Subrecipient shall develop forms for Landlords' use in collecting late fees arising from
Subrecipient's failure to pay a Landlord rent on time. The Subrecipient shall be solely
responsible for payment of any late fee arising from any late rent payment(s) to Landlord(s).
The Subrecipient shall -indemnify the Grantee, Miami -Dade County, and pay all costs of
defense, .including attorneys' fees arising from or related to the HAP Contract and this
provision..
2. Records and Reports
a. Financial Management - The Grantee and the Subrecipient shall adhere to the requirements
for financial reporting as required .pursuant to the Federal Office of Management and
Budget (OMB) Omni or Super Circular 2 CFR Chapter I, and Chapter II, Parts 200, 215,
220, 225, and 230 Uniform Administrative Requirements, Cost Principles, and Audit
Requirements for Federal Awards, as may be amended or updated from time to time; 24
CFR Part 578, as may be amended or updated from time to time; and any other applicable
laws, regulations and standards.
Requests for payment shall be submitted to the Grantee by the fifteenth (15th) of the month
in the following manner. All requests shall include supporting documentation for each line
item, including payroll reports, time sheets, invoices, leasing agreements and shall be signed .
CoC Grant #FL0190L4D001811, The City of Miami, MMHAP South Program Page 6
by the Executive Director, Financial Officer or other duly authorized fiscal agent of the
Subrecipient in the forms incorporated herein as combined "Consolidated Financial Record
and Reports", Attachment E.
Reimbursement shall be provided only for eligible costs associated with the activities
outlined in the budget contained within the "Scope of Service and US HUD a -Snaps
Documents" Attachment B.
Any reimbursement may be withheld or reduced by the Grantee if missing receipt of
documents verifying the in-ldnd or cash match expenditures or compliance requirements are
not met. Cash match or in-ldnd contributions must be used for the costs of activities that are
eligible in the governing regulations.
Any reimbursement may be withheld pending the receipt of approval by the Grantee of all
reports and documents required herein, including but not limited to the submission of an
accurate and complete Annual Performance Report (APR) "Performance Reports
(Monthly and Annual) HMIS and Fiscal Report" Attachment F. The Subrecipient shall
provide a certification statement for all annual financial reports and requests for payment
which states the following: 'By signing this report, I (insert name here) certify to the best of my
knowledge and belief that the report is true, complete and accurate and the expenditures,
disbursements and cash receipts are for the purposes and objectives set forth in the terms and
conditions of the federal award. I am aware that anyfalse, fictitious, orfraudulent information
or the omission of any material fact, may subject me to criminal, civil or administrative penalties
for fraud, false statements, false claims or other offense."
In no event shall the Grantee funds be advanced to any of the Subrecipient's subcontractors
hereunder.
The parties agree that the Subrecipient may request a revision, amendment, or modification
of the schedule of payments or line item budget. However, such revisions, amendments or
modifications shall be, in writing and subject to review and approval by the Grantee and, if
applicable, by US HUD. If there is a request to shift greater than 10% of funds between
funding activities, such requests shall be submitted to the Grantee no later than one
hundred fifty (150) calendar days prior to the expiration of the grant. If the request is a
shift of less than 10% of funds between funding activities, a modification or revision, shall
be submitted to the Grantee no later than ninety_(90) calendar days prior to the expiration
of the grant. Failure to submit the appropriate supporting documentation in a timely manner
may result in the inability of the Grantee to approve, revise, amend- or modify the budget.
A final request for reimbursement from the Subrecipient will be accepted by the
Grantee up to thirty (30) days after the expiration of this Agreement. If the
Subrecipient fails to comply, all rights to payments will be forfeited if the Grantee so
chooses.
A final report of expenditures shall be submitted to the Grantee within thiru (30). calendar
days from the termination or expiration of this Agreement. If after the receipt of such final
report, the Grantee determines that the Subtecipient has been paid .funds not in compliance .
with the Agreement, and to which the Subrecipient is not entitled, the Subrecipient shall be
required to return such funds. However, if the Subrecipient submits documentation
demonstrating that the -expenditure was in compliance with this Agreement to the
satisfaction of the Grantee, the funds shall not have to be returned. The Grantee shall have
CoC Grant #FL0190L4D001811, The City of Miami, MMHAP South Program Page 7
the sole and absolute discretion to determine if the Subrecipient is entitled to such funds and
the decision of the Grantee in this matter shall be final and binding.
b. Records andAccess to Records - Agreement records are defined as any and all books, records,
client files (including client progress reports, referral forms, case notes and other reports or
work product), documents, information, data, papers, letters, materials, electronic storage
data and media whether written, printed, electronic or electrical, however collected or
preserved which is or was produced, developed, maintained, completed, received, or
compiled by or at the direction of the Subrecipient or any subcontractor directly or indirectly
related to the duties and obligations required by terms of this Agreement, including but not
limited to financial books and records, ledgers, drawings, maps, pamphlets, designs,
electronic tapes, computer drives, flash drives and diskettes or surveys.
The Subrecipient shall maintain Agreement records that document all actions to comply with
and that relate to this Agreement, including those on race, ethnicity, gender, disability and
homeless status data; and those in accordance with generally accepted accounting principles,
procedures, and practices as required in OMB Omni or Super Circular Uniform
Administrative Requirements, Cost Principles and Audit Requirements for Federal
Awards which shall sufficiently and properly reflect all revenues and expenditures of funds
provided directly or indirectly by the Grantee pursuant to the terms of this Agreement which
shall include but not limited to a cash receipt journal, cash disbursements journal, general
ledger, and all such subsidiary ledgers. as maybe reasonably necessary.
The Subrecipient shall provide to the Grantee, upon request by the Grantee, all Agreement
records. The requested Agreement records shall become the property of the Grantee without
restriction, reservation, or limitation of their use and shall be made available by the
Subrecipient at any time upon request by the Grantee. The Grantee shall have unlimited
rights to all books, articles, or other copyrightable materials developed in the performance of
this Agreement. These unlimited rights include the rights of royalty -free, nonexclusive, and
irrevocable license to reproduce, publish, or otherwise use, and to authorize others to use the
work for public purposes.
The Subrecipient shall ensure that the Agreement records shall at all times be subject to and
available for full access and review, inspection, or audit by Grantee and Federal personnel
and any other persons so authorized by the Grantee.
The Subrecipient shall include in all the Grantee approved subcontracts, language outlining
eligible_ substantive programmatic services, recordkeeping and audit requirements as
detailed in this Agreement. This includes all subcontractors eligible to carry out
substantive programmatic -services as -detailed in this Agreement. The .Grantee shall, in its
sole and absolute discretion, determine when services are eligible substantive
programmatic services and subject to the audit and recordkeeping requirements described
in this Agreement. These records shall be maintained pursuant to this Agreement.
If the Subrecipient received funds from or is under regulatory control of other
governmental agencies, and those agencies issue monitoring reports, regulatory
examinations, or other similar reports, then the Subrecipient shall provide to the
Grantee a copy of each report and any follow-up communications and reports
immediately upon such issuance unless such disclosure is a violation of those
agencies' rules.
CoC Grant #FL0190L4D001811, The City of Miami, MMHAP South Program Page 8
c. Public Records -Pursuant to Section 119.0701, Florida Statutes, the Subrecipient shall:
L Keep and maintain public records that ordinarily and necessarily would be required
by the Grantee in order to perform the service;
ii. Upon request from the Grantee's custodian of public records identified herein,
provide the Grantee with a copy of the requested records or allow the public with
access to the public records on the same terms and conditions that the Grantee would
provide the records and at a cost that does not exceed the cost provided in the Florida
Public Records Act, Miami -Dade County Administrative Order No. 4-48, or as
otherwise provided by law;
iii. Ensure that public records that are exempt or confidential and exempt from public
records disclosure requirements are not disclosed except as authorized by law for the
duration of this Agreement's term and following completion of the services under this
Agreement if the Subrecipient does not transfer the records to the Grantee; and
iv. Meet all requirements for retaining public records and transfer to the Grantee, at no
Grantee cost, all public records created, received, maintained and / or directly related
to the performance of this Agreement that are in possession of the Subrecipient upon
termination of this Agreement. Upon termination of this Agreement, the Subrecipient
shall destroy any duplicate public records that are exempt or confidential and exempt
from public records disclosure requirements. All records stored electronically must
be provided to the Grantee in a format that is compatible with the information
technology systems of the Grantee.
For purposes of this Article, the term "public records" shall mean all documents, papers,
letters, maps, books, tapes, photographs, films, sound recordings, data processing software,
or other material, regardless of the physical form, characteristics, or means of transmission,
made or received pursuant to law or ordinance or in connection with the transaction of
official business of the Grantee.
In addition to penalties set for in Section 119.10, Florida Statutes, for the failure of the
Subrecipient to comply with Section 119.0701, Florida Statutes, and this Article II, Section
2.1 (QQ) of this Agreement, the Grantee shall avail itself of the remedies set forth in this
Agreement.
If the Subrecipient has questions regarding the application of
Chapter 119, Florida Statutes, to the Subrecipient's duty to provide
public records relating to this Agreement, contact Miami -Dade
County's Custodian of Public Records at:
Miami -Dade County
Homeless Trust
111 NW 1St Street, 27th Floor, Suite 310
Miami, Florida 33128
Attention: Victoria L. Mallette, Executive Director
Email: vmallette@miamidade.gov
CoC Grant #FL0190L4D001811, The City of Miami, MMHAP South Program Page 9
d. Encouraging Efficient Use of Information Technology and Shared Services - in accordance
with the May 2013 Executive Order on Making Open and Machine Readable the New
Default for Government Information, OMB Omni or Super Circular 2 CFR Chapters I,
Chapters II, Part 200, et al. Section 200:335 Methods for Collection, Transmission and
Storage of Information; the Subrecipient is encouraged whenever practicable, to collect,
transmit and store Federal award -related information in open and machine-readable
formats.
e. Reports - The Subrecipient shall submit to the Grantee the reports described below or any
other document in whatsoever form, manner, or frequency as may be requested by the
Grantee. These reports will be used for monitoring the progress, performance, and
compliance with applicable Grantee and Federal requirements.
L Progress Reports - The Subrecipient shall submit a "Homeless Management
Information System (HMIS) generated "Performance Report", Attachment F, along
with a summary and the specified forms attached hereto as "Consolidated Financial
Record and Reports", Attachment E. These reports maybe revised or updated by the
Grantee from time to time; and shall describe the progress made by the Subrecipient in
achieving each of the objectives identified in "Scope of Service and US HUD eSnaps
Documents" Attachment B. The reports shall explain the Subrecipient's progress
including comparison of actual versus planned progress for the period. The reports are
due by the fifteenth (15�) day of the following month. The requests for reimbursement,
are also due by the fifteenth (15Lh)day following the close of the prior month.
Subrecipients that are Domestic Violence Programs shall participate in a HMIS-equivalent
system. Such Subrecipients shall provide proof to the Grantee of the utilization of an
alternative system to compile all required data for the Performance Report.
ii. Annual Performance Report - The Subrecipient shall submit a HMIS generated "US HUD
CoC Annual Performance Report (0625-HUD-CoC-APR)" Attachment F, in addition to
a complete and accurate report using supplemental "eSnaps CoC APR Financial and
Performance Questions" provided by the Grantee Attachment F. The complete and
accurate APR is due to the Grantee no later than thirty (30) days after the end of each
operating year. The above referenced report maybe substituted for any other US HUD
required Report if approved by US HUD and the Miami -Dade County Homeless Trust.
iii. A Program Rating and Satisfaction Survey Report shall be conducted electronically
utilizing a Miami -Dade County Homeless Trust generated survey tool. This tool will be
issued in the month of May of each calendar year and survey results must be submitted
to.the Miami -Dade County Homeless Trust no later than forty-five (45) calendar days
from the date of issuance.
iv. When the Grantee, .Miami -Dade County is the Rental Administrator: The Subrecipient
shall submit a complete an accurate CoC Program "Participant Application for
Housing" Package, Attachment K, including all supporting documentation for each
eligible program participant accepted through the CoC's established Coordinated
Outreach and Assessment HMIS system .to Miami -Dade. -County Homeless Trust, 271h
Floor; Suite 310, 111 NW First Street, Miami, Florida 33128. Pursuant to 24 CFR
578.77(c), the Subrecipient must examine program participants' income initially, and at
least annually thereafter, to determine the. amount of the contribution toward rent
payable by the program participants. Adjustments to program participants' contribution
CoC Grant #FL0190L4D001811, The City of Miami, MMHAP South Program Page 10
toward the rental payment must be made as changes in income are identified. The
Subrecipient is required for each program participant receiving assistance to notify the
Grantee in writing of changes in the participants' income or other circumstances that
affect the program participants' eligibility or need for assistance. The Subrecipient shall
submit "Re -certification of Participation Application for Housing" Package
Attachment K, no later than one hundred -twenty (120) calendar days before the
expiration of term of the Lease Agreement and HAP Contract. The Re -certification
application shall include documented evidence of the program participants' continued
lack of sufficient resources and support networks necessary to retain housing without
assistance frons the CoC Program.
When the Subrecipient is the Rental Administrator: The Subrecipient shall complete and
maintain an accurate CoC Program "Participant Application for Housing" Package,
Attachment J, including all supporting documentation for each eligible program
participant accepted through the CoC's established Coordinated Outreach and
Assessment HMIS system. Pursuant to 24 CFR 578.77(c), the Subrecipient must examine
program participants' income initially, and at least annually thereafter, to determine the
amount of the contribution toward rent payable by the program participants.
Adjustments to program participants' contribution toward the rental payment must be
made as changes in income are identified. The Subrecipient is required for each program
participant receiving assistance to retain records for the Grantee's review, changes in the
participants' income or other circumstances that affect the program participants'
eligibility or need for assistance. The Subrecipient shall retain records of "Re-
certification of Participation Application for Housing" Package Attachment J, no
later than one hundred-twenty(120) calendar days before the expiration of term of
the Lease Agreement and HAP Contract. The Re -certification application shall include
documented evidence of the program participants' continued lack of sufficient resources
and support networks necessary to retain' housing without assistance from the CoC
Program.
v. Program Income -the income received by the Subrecipient directly generated by a grant -
supported activity. Program income earned during the grant term shall be retained and
may either be 1) added to funds committed to the project by HUD and the recipient and
used for eligible activities in accordance with the requirements pursuant to 24 CFR 578
or 2) used as match. Program Income is reported and submitted to the Homeless Trust
monthly in the "Consolidated Financial Record and Reports", Attachment E
vi. A "CoC Homeless Assistance Program Guidelines" Attachment G shall be completed
and retained by the Subrecipient. This report must be available upon.request during any
site visit or comprehensive monitoring or inspection as requested by the Grantee. This
report is an informational guideline to assist in compliance to the CoC Homeless
Assistance Program policies, procedures and requirements and regulations.
vii. Audit Reports - Subrecipients shall submit an audit conducted in accordance with the
provisions of Omni or Super Circular 2 CFR Chapter I, and Chapter II, Parts 200, 215,
220, 225, and 230 Uniform Administrative Requirements, Cost Principles, and
Audit Requirements for Federal Awards, as applicable, and with 24 CFR 578.99(g)
which provides that Subrecipients must comply with -the audit requirements of OMB
Circular A-133, "Audits of States, Local Governments, and Non-profit Organizations.".
The Subrecipient shall provide such reports no later than one hundred -eighty (180)
CoC Grant #FL0190L4D001811, The City of Miami, MMHAP South Program Page 11
calendar days following the end of the Subrecipient's fiscal year, for each year during
which this Agreement remains in force or until all funds earned from this Agreement have
been so audited, whichever is later, provided that the Subrecipient has such an opinion
prepared. The Subrecipient shall comply with any and all other applicable audit and
reporting requirements.
viii. Incident Reports - The Subrecipient must report to Miami -Dade County Homeless Trust
information related to aU critical incidents occurring during the administration of its
programs, using form "Incident Report" Attachment H.
The following are identified as critical incidents as defined in CF -OP 215-6 (Attachment H):
• 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
• Other. Any major event not previously identified as a reportable critical incident but
has, or is likely to have, a significant impact on client(s), the Subrecipient, or
Grantee.
Such notification shall occur, within twenty-four (24) hours of the incident occurring.
In addition, the Subrecipient shall report this incident to the appropriate authorities as
well as submit in writing a detailed account of the incident. This Incident Report should
be addressed to Miami -Dade County Homeless Trust's Disaster Coordinator, as well as
the Subrecipient's assigned Contract Officer. The Subrecipient shall comply with the
privacy, security and electronic transfer standards in transmittal of any Incident Report
to comply with Health Insurance Portability and Accountability Act (HIPAA) in using
appropriate safeguards to prevent non -permitted disclosures. This Incident Report shall
be addressed to Miami -Dade County, Homeless Trust, Suite 310, 27th Floor, 111 NW
1st Street, Miami, Florida, 33128; (305) 375-149.0 and facsimile (305) 375-2722.
ix: The COOP Report The Subrecipient shall submit a Continuity of Operations Plan
(COOP), also known as an Agency Wide and Program, Specific Disaster Plan in PDF format
and emailed as an attachment to Miami -Dade. County Homeless Trust's Disaster
Coordinator and an original paper copy submitted no later than April 1st of each
operating year.
CoC Grant #FL0190L4D001811, The City of Miami, MMHAP South Program Page 12
x. Mandatory Disclosure - The Subrecipient is required to disclose in a timely manner and
in writing "all violations of Federal criminal law involving fraud, bribery, or gratuity
violations potentially affecting the Federal award". Failure to make the required
disclosures can result in a number of actions, including suspension and or debarment.
3. Special and General Conditions -
a. The Sub recipient's Staff members providing eligible services under this Agreement are listed
in the budget section of the "Scope of Service, US HUD eSnaps Documents" Attachment B.
The Subrecipient shall additionally submit job titles and job descriptions upon request.
b. The Subrecipient shall follow the client referral process in the Scope of Service contained
within the "Scope of Service and US HUD eSnaps Documents" Attachment B and through
the Continuum of Care (Cog's Coordinated Outreach and Assessment system. The client
referral process may be amended by the Grantee to meet changing priorities of the
Continuum of Care. All referrals shall be made to the Subrecipient and accepted by the
Subrecipient through the established Coordinated Outreach and Assessment and HMIS
system.
- -- c. The Subrecipient shall provide a�ocumen Pion necessary, such as the "W -9 -Form"-
Attachment C, to facilitate the reimbursement of services.
d. The Subrecipient shall comply with all rules, guidelines and regulations governing the CoC
Rental Assistance program under 24 CFR 578, and any other applicable law, rules and
regulations.
L Rental assistance projects must serve eligible program participants, including but not
limited to retaining records of disability and homeless verification as part of the
recordkeeping requirements.
ii. Rental assistance funds are to -pay Landlord owner(s) in the communitythe difference
between the contract rent amount of the unit and the homeless participants' or
tenants' contribution toward rent. The program participants' or tenants'
.contribution toward rent is determined by the type of program. Under tenant -based
rental assistance, sponsor -based rental assistance, and project based rental
assistance, program participants are required to pay rent to the landlord as
determined under 24 CFR 578.77. It is important to note in all the US HUD CoC
Programs, the program participants enter into a Lease with the Landlord.
iii. The Subrecipient must consistently follow policies and procedures used by the CoC's
established Coordinated Outreach and Assessment (HMIS) system in accepting
referrals of eligible program participants pursuant to 24 CFR 578.7(a) (8).
iv. The Subrecipient shall establish referral protocols, policies and procedures subject to
approval by Miami -Dade County Homeless Trust -in documenting rejection of
program participants accepted from the CoC's established Coordinated Outreach and
Assessment (HMIS) system, which must include at a minimum, assurances that such
rejections are justified and that the program participants are able to access another
suitable program within a reasonable amount of time.
CoC Grant #FL0190L4D001811, The City of Miami, MMHAP South Program Page 13
v. The Subrecipient shall establish protocols, policies and procedures subject to
approval by Miami -Dade County Homeless Trust and consistent with Miami -Dade
County Homeless Trust's CoC "Standards of Care" pertaining to termination of
assistance to program participants. The Subrecipient may terminate assistance to
program participants who violates program requirements. Termination does not bar
the Subrecipient from providing further assistance at a later date to the same
participants, individual or family (household). The protocol, policies and procedures
must include at a minimum a formal process that recognizes the rights of individuals
receiving assistance under due process of law. This process must also consist of: (1)
Providing the program participant with a written copy of the program rules and the
termination process before the program participant begins to receive assistance; (2)
Written notice to the program participant containing a clear statement of the
reason(s) for termination; (3) A review of the decision, in which the program
participant is given the opportunity to present written or oral objections before a
person other than the person (or a subordinate.of that person)who made or approved
the termination decision; and (4) Prompt written notice of the final decision to the
program participant. The Subrecipient providing permanent supportive housing for
hard -to -house populations of homeless persons must exercise judgment and.examine
all extenuating circumstances in determining when violations are serious enough to
warrant termination so that program participants' assistance is terminated only in
the most severe cases.
e. The Subrecipient shall complywith the Violence against Women Reauthorization Act (VAWA)
as well as with 24 CFR 5.200, as may be amended, and with all applicable provisions of 24
CFR Parts 5, 92, 200, 574, 576, 578, 880, 882, 883, 884, 886, 891, 960, 966, 982, and 983 and
with such administrative rules and policy guidance relating to VAWA as may exist, be
adopted, or be amended from time to time, as may be applicable.
f.. The Subrecipient may be subject to a Performance Improvement Plan (PIP) at the
discretion of the Grantee.
g. General Conditions — The Subrecipient shall comply with all applicable federal, state and local
laws, regulations and required policies, including but not limited to the Continuum of Care
(CoQ Progr-am'Final Interim Rule, 24 CFR Part 578, as may amended from time to time,
the McKinney-Vento Homeless Assistance Act, as may be amended from time to time (42
U.S' C. 11301 et seq.) (the "Act") the Consolidated and Further Continuing
Appropriations Acts of 2012, 2013, and 2014 the Homeless Definition Final Rule,
published in the Federal Register on December 5, 2011, as may be amended from time to
time; the "'Continuum of Care Program Grant Agreement" Attachment A and all other
federal requirements of this grant. The responsibility for lmowledge of and compliance with
all Federal and any other legal requirements is that of the Subrecipient. The.Subrecipient
shall also comply with any guidance provided by US HUD regarding this Agreement, program
and the services offered hereunder, as well as with any guidance provided by US HUD
applicable to this Agreement, program and the services offered hereunder.
The Subrecipient shall abide and be governed by the requirements of the Americans with
Disabilities Act (ADA). Subrecipient shall designate with its organization an ADA Coordinator
to ensure that all requirements of the ADA and any related applicable regulations and
requirements are met by the Subrecipient.
CoC Grant #FL0190L4D001811, The City of Miami, MMHAP South Program Page 14
In addition, the Subrecipient agrees to comply with the following requirements.
L . Insurance - If the Subrecipient is the State of Florida or an agency or political subdivision
of the State as defined by Section 768.28, Florida Statutes, the Subrecipient shall furnish the
Grantee, upon request, written verification of liability protection in accordance with
Section 768.28, Florida Statutes. The written verification shall be submitted to Miami -Dade
County Risk Management, Internal Services Division, located on the 23rd Floor, 111 NW
1st Street, Miami, Florida 33128. Nothing herein -shall be construed to extend any party's
liability beyond that provided -in Section 768.28, Florida Statutes. If the Subrecipient is a
non-governmental entity said Subrecipient shall maintain required liability insurance
coverage as noted below during this contract period.
The Subrecipient shall maintain required liability insurance coverage as noted below at all
times during this contract period.
Public Liability Insurance on a comprehensive basis in an amount not less than $300,000
combined single limit for bodily injury and property damage. The Grantee must be shown
as an additional insured with respect to, this coverage, as evidenced by a Certificate of
Insurance.
-- Automobile Liability Insurance coverage for all owned, non-owneda-hired vehicles used
in connection with this Agreement in an amount not less than $300,000 combined single
limit for bodily injury and property damage.
Workers' Compensation Insurance for all employees of the Subrecipient as required by
Florida Statutes 440.
Flood Insurance shall be maintained as per the requirements in 24 CFR Part 583.330(a).
The insurance coverage required shall include these classifications, listed in standard
liability insurance manuals, which most nearly reflect the operations of the Subrecipient.
All insurance policies required above shall be issued by companies authorized to do
business under the laws of the state of Florida, with the following qualifications:
The company must be rated no less than "B" as to management, and no less than "Class V"
as to financial strength by the latest edition of Best's Insurance Guide, published by A.M.
Best Company, Oldwick, New Jersey, or its equivalent, subject to the approval of Miami -
Dade County Risk Management Division.
Or
Compliance with the foregoing requirements shall not relieve the Subrecipient of its
liability and obligations under this section or under any other section of this Agreement.
No modification or waiver of any of the aforementioned insurance requirements shall be
made without thijU (30) days written advance notice to the Grantee, and is subject to the
approval of Miami -Dade County Internal Services Risk Management Division.
ii. Indemnification - The Subrecipient shall indemnify and hold harmless the Grantee. and its
past, present, and future employees and agents from and against any and all.claims,
liabilities; losses, and causes of action which may arise out of or relate to this Agreement,
or which may arise out of actions or negligence, in whole or in part, of the Subrecipient, its
officers, agents, employees, or assignees in the direct or indirect fulfillment of this
CoC Grant #FL0190L4D001811, The City of Miami, MMHAP South Program Page 15
Agreement. The Subrecipient shall pay all claims and losses of any nature in connection
therewith, and shall defend all suits, in the name of the Grantee when applicable, and shall
pay all costs and judgments which may issue thereon. It is expressly understood and
intended that the Subrecipient is an independent contractor and is not an employee or
agent of the Grantee.
iii. Certifications and Representations - Pursuant to OMB 2 CFR Chapter I, Chapter II, Subpart
C (200.208), the Subrecipient shall provide a certification statement for all annual financial
reports and requests for payment that states the following: "By signing this report, I (duly
authorized signature) certify to the best of my knowledge and belief that the report is true,
complete and accurate and the expenditures, disbursements and cash receipts are for the
purposes and objectives setforth in the terms and conditions of the Federal award. I am aware
that any false, fictitious, or fraudulent information or the omission of any material fact, may
subject me to criminal, civil or administrative penaltiesforfraud, false statements, false claims
or other offense."
iv. Conflicts of Interest - The Subrecipient shall disclose to the Grantee in writing any possible
or actual conflicts of interest or apparent improprieties relating to the Subrecipient under
this Agreement. The Subrecipient shall make each disclosure in writing to the Grantee
immediately upon the Subrecipient's discovery of such possible conflict. The Grantee will
then render an opinion which shall be binding on all parties.
v. Affidavits - The Subrecipient shall complete, notarize and provide one (1) original set of
"Miami Dade County Affidavits and Declarations 1 through 16", "Attachment D". One
Cl) original set of Affidavits will remain on file with Miami -Dade County Homeless Trust,
two (2) full set of copies will be created and one (1) copy provided to Miami -Dade County
Clerk of the Board and one (1) copy to the Subrecipient.
1.. Miami -Dade County Ownership Disclosure Affidavit (Section 2-8.1 of Miami -
Dade County Code "County Code").
2. Miami -Dade County Employment Disclosure Affidavit (County Ordinance 90-
133, Amending Section 2-8.1; Subsection (d) (2) of the County Code).
3. Miami -Dade County Affirmative Action / Non -Discrimination of Employment,
Promotion and Procurement Practices (County Ordinance 98-30 codified at
2-8.1.5 of the County Code).
4. Miami -Dade County Criminal. Record Affidavit (Section 2-8.6 of the County
Code).
S. Sworn Statement Pursuant to §287.133 Florida Statutes on Public Entity
Crimes.
6. Miami -Dade Employment Family Leave Affidavit (County Ordinance 142-9
codified as Section 11A-29 et. seq of the County Code).
7. Miami -Dade County Disability Nondiscrimination Affidavit (County
Resolution R-38.5-95).
8. Miami -Dade County Regarding Delinquent and Currently Due Fees or Taxes
(Section 2-8.1(c) of the County Code). .
9. Miami -Dade County Current on all County Contracts, Loans and Other
Obligations. (County Ordinance 99-162). .
10. Miami=Dade County Domestic Violence Leave (11A-60 et.seq of the County
Code).
11. Miami -Dade County Employment Drug Free Workplace Affidavit (County
Ordinance 9245 codified as Section. 2-8.1.2 of the County Code).
CoC Grant #FL0190L4D001811, The City of Miami, MMHAP South Program Page 16
12. Attestation regarding due and proper acknowledgement Miami -Dade County
funding support.
13. Miami -Dade County Affidavit pursuant to Board of Miami -Dade County
Commissioners Resolution No. R-630-13. Pursuant to "Board of Miami -Dade
County Commissioners the Subrecipient will also submit a detailed project
budget, and sources and uses statement as contained within "Scope of
Service and US HUD eSnaps Documents", incorporated into Attachment B,
which shall be sufficiently detailed to show: i) the total project cost; ii) the
amount of funds to be used for administrative and overhead costs; iii)
whether the funds under this Agreement will be'gap' funds meaning that they
would be the last remaining funds needed to ensure funding for the total
project costs; iv) any profit (program income) to be made bythe Subrecipient;
and v) the amount of funds devoted toward the provision of the desired
services or activities.
14. Miami -Dade County certification not to use "Pink Slime" in food programs or
related housing programs providing food (County Resolution No. R-478-12)
15. Affidavit of Miami -Dade County Lobbyist Registration for Oral Presentation
(County Ordinance Section 2-11,1(s) of the County Code), Lobbyist
specifically includes the principal, as well as any agent, officer, or employee of
a-pr-incipal-r-egardless--of-whether-such--lobbying activities -fall -within the
normal scope of employment of such agent, officer or employee.
16. Subcontract/Supplier Listing (Ordinance 97-104)
The Subrecipient understands that the Grantee has relied on the Subrecipient's
aforementioned representations in entering into this Agreement.
h. Civil Rights - The Subrecipient agrees to abide by Chapter 11A of the Code of Miami -Dade
County ("County Code"), as may be amended, in the exercise of its police power for the public
safety, health and general welfare, to eliminate and prevent discrimination in employment,
family leave, public accommodations, credit and financing practices, and housing
accommodations because of race, color, religion, ancestry, national origin, sex, pregnancy,
age, disability, marital status, familial status, gender identity, gender expression, sexual
orientation, or actual or perceived status as a victim of domestic violence, dating violence or
stalking. It is further hereby declared to be the policy of Miami -Dade County to eliminate and
prevent discrimination in housing based on.source of income. Initials here
DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 24 CFR Parts 5; 91, 92, 570, 574,
576; and 903 [Docket No. FR -5173-F-04] RIN 2501-AD33 Affirmatively Furthering Fair
Housing - The Fair Housing -Act (title VIII ofthe Civil Rights Act of 1968,42 U.S.C. 3601-3619)
declares that it is "the policy of the United States to provide, within constitutional limitations,
for fair housing throughout the United States. See 42. U.S.C. 3601. Accordingly, the Fair
Housing Act prohibits, among other things, discrimination in the sale, rental, and financing of
dwellings, and in other housing -related transactions because of "race, color, religion, sex,
familial status, national origin, or handicap:" Initials here
See 42 U.S.C. 3604 and 3605. Section 808(d) of the Fair Housing Act requires all executive
branch departments and agencies administering housing and urban development programs
and activities to administer these programs in a manner that affirmatively furthers fair
housing. See 42 U.S.C: 3608. Initials here
CoC Grant #FL0190L4D001811, The -City of Miami, MMHAP South Program Page 17
The Subrecipient agrees to abide and be governed by Title VI and VII, of the Civil Rights Act
of 1964 (42 U.S.C. 2000 et.seq.) and Title VIII of the Civil Rights Act of 1968, as amended, and
Executive Order 11063, as may be amended, as well as with any applicable regulations,
which provide in part that there will be no discrimination of race, color, gender/sex, religious
background, ancestry or national origin in performance of this Agreement, in regard to
persons served, or in regard to employees or applicants for employment or housing. It is
expressly understood that upon receipt of evidence of such discrimination, the Grantee shall
have the right to terminate this Agreement. Initials here
Executive Order 11063 prohibits discrimination in the sale, leasing, rental, or other
disposition of properties and facilities owned or operated by the federal government or
provided with federal funds.. Executive Order 12892, as amended, requires federal agencies
to affirmatively further fair housing in their programs and activities, and provides that the
Secretary of HUD will be responsible for coordinating the effort. Executive Order 12898
requires nondiscrimination in federal programs that affect human health and the
environment as well as .provides minority and low-income communities' access to public
information and public participation. Executive Order 13166 requires federal agencies to
examine the services they provide, identify any need for services to those with limited English
proficiency (LEP), and develop and implement a system to provide those services so LEP
persons can have meaningful access to them. Executive Order 13217 requires federal
agencies to evaluate their policies and programs to determine if any can be revised or
modified to improve the availability of community-based living arrangements for persons
with disabilities. Initials here
Awareness of the Joint Letter of clarification dated August 5, 2017 from United States
Department of Justice, United States Department of Health and Human Services, United States
Department of Housing and Urban Development reminding recipients of federal financial
assistance that they should not withhold certain services based on immigration status when
the services are necessary to protect life or safety. In the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996 ("PRWORA" ), Congress restricted immigrant access
to certain public'benefits, but also established a set of exceptions to these restrictions: It is
understood that recipients of federal funding that administer programs that (i) are necessary
for the protection of life or safety; (ii) deliver in-kind services at the community level; and
(iii) do not condition the provision of assistance, the amount of assistance, or the cost of
assistance on the individual (participant's) recipient's income or resources, that such
programs are not subject to PRWORA's restrictions on immigrant access to public benefits
and must be made available to eligible persons without regard to citizenship, nationality, or
immigration status. 8 U.S.C. Section 1611Cb)(1)(D);1621(b)(4). Initials here
It is further.understood that the Subrecipient-must submit affidavits attesting that it is not in
violation of the American with Disabilities Act, Section 504 of the Rehabilitation Act of 1973,
as. amended, (29 U.S.C. 794, et. seq.), the Federal Transit Act, (49 U.S.C. 1612), and the Fair
Housing Act, (42'U.S.C. 3601 et.seq.), as may be amended, as'well as with any applicable
regulations. If the Subrecipient or -any owner, subsidiary, or other firm affiliated with or
related to the Subrecipient is found by the responsible enforcement agency, the Courts or
Grantee to be in violation of these Acts, the Grantee shall conduct no further business with
the Subrecipient. Any contract entered into based upon a false affidavit shall be voidable by
the Grantee. If the Subrecipient violates any of the Acts during the term of any contract the
Subrecipient has with Miami -Dade County, such contract shall be voidable by the Grantee,
CoC Grant #FL0190L4D001811, The City of Miami, MMHAP South Program Page 18
even if the Subrecipient was not in violation at the time the affidavit(s) were submitted.
Initials here
The Subrecipient agrees that it is in compliance with the Domestic Violence Leave, codified
as (Article 8, Section 11A-60 et.seq. of the County Code), as maybe amended, which requires
an employer, who in the regular course of business and has fifty (50) or more employees
working in Miami -Dade County for each working day during each of the twenty (20) or more
calendar work weeks to provide domestic violence leave to its employees. Failure to comply
with this local law may be grounds for voiding or terminating this Agreement or for
commencement of debarment proceedings against the Subrecipient. Initials here _.
The Subrecipient agrees to abide and be governed by the Age Discrimination Act of 1975, (42
U.S.C. 6101 et seq.) and implementing regulations at (24 CFR Part 146), as may be amended,
as well as with any applicable regulations, which provides in part that there shall be no
discrimination against persons in any area of employment because of age. Initials here
The Subrecipient agrees to abide and be governed by Section 504 of the Rehabilitation Act of
1973, as amended, (29 U.S.C. 794, et.seq.) as may be amended, as well as with any applicable
regulations, which prohibits discrimination on the basis of handicap. Initials here
T -he Subr-eci-pient agr-ees-to-abide and be-gover-ned-by the requ-irements of-the-Amer-ic-ans with
Disability Act (ADA), as may be amended, as well as with any applicable law. Initials here
Pursuant to 24 CFR 578.23, Subrecipient hereby certifies and agrees that:
i. Subrecipient will maintain the confidentiality of records pertaining to any
individual or family that was provided family violence prevention or treatment
services through the project / program;
ii. The address or location of any family violence project / program assisted under this
part will not be made public, except with written authorization of the person
responsible for the operation of such program and in accordance with any
applicable state and local laws that prohibit disclosure of information relating to
domestic violence centers;
iii. Subrecipient will establish policies and practices that are consistent with, and do
not restrict the exercise of rights provided by Subtitle B of Title VII of the McKinney-
Vento Homeless Assistance Act, as amended, and other laws relating to the
provision of educational and related services to individuals and families
experiencing homelessness;
iv. In the case of programs that provide housing or services to families, that
Subrecipients will designate a staff person to be responsible for ensuring that
children being served in the program are enrolled in school and connectedto
appropriate services in the community including early childhood programs such as
Head Start, Part.0 of the individuals with Disabilities Education Act, and programs
authorized under Subtitle B -of Title VII of the McKinney-Vento Homeless Assistance
Act as amended;
V. The Subrecipient shall use the centralized or coordinated assessment system
established by the Continuum of Care as set forth pursuant to 24 CFR 578.7(a) (8);
vi. Subrecipient, its officers, and employees are not debarred or suspended from doing
business with the federal government; and
CoC Grant #FL0190L4D001811, The City of Miami, MM HAP South Program Page 19
vii. Subrecipient will provide information, such as data and reports, as required by US
HUD.
Additionally, Subrecipient agrees:
L To establish such fiscal controls and accounting procedures as may be necessary to
assure the proper disbursal of, and accounting for grant funds. in order to ensure
that all financial transactions are conducted, and records maintained in accordance
with generally accepted accounting principles;
ii. To take the educational needs of children into account when families are placed in
housing and will, to the maximum extent practicable, place families with children as
close as possible to their school of origin so as not to disrupt such children's
education. A Subrecipient that serves families with school-age. children shall have
at least one program staff member, knowledgeable of the McKinney-Vento
Education for Children and Youth Act requirements and shall comply with all
requirements related to facilitation of educational opportunities consistent with
Miami -Dade County Homeless Trust's Standards of Care incorporated herein by
reference;
iii. To comply with the provisions of 24 CFR 578.23(c) (9).
iv. To follow the written standards for providing Continuum of Care assistance
developed by the Continuum of Care, including the minimum requirements set forth
in § 578.7(a)(9); and
V. To operate the project(s) in accordance with the provisions of the McKinney-Vento
Act and all requirements under 24 CFR part 578; and to comply with such other
terms and conditions as US HUD may establish by NOFA (Notice of Funding
Availability).
4. Suspension and Termination
a. Suspension-- The Grantee may, for reasonable cause, temporarily suspend the operation and
authority to obligate funds of the Subrecipient, under this Agreement, or withhold payments
to the Subrecipient pending necessary corrective action by the Subrecipient or both.
Reasonable cause shall be determined by the Grantee in its sole and absolute discretion and
may include:
L Ineffective or improper use of any funds provided hereunder by the Subrecipient;
ii. Failure by the Subrecipient to materially comply with any terms, conditions,
representations or warranties contained herein;
iii. Failure by the Subrecipient to submit any documents required by this Agreement; or
iv. Incorrect or incomplete document submittal by the Subrecipient.
b. Termination -
L Termination at Will - This Agreement, in whole or in part, may be terminated by the
Grantee upon no less than fifteen (15) working days_' notice when the Grantee
determines that it would be in the best interest of the Grantee and / or the
Subrecipient materially fails to comply with the terms and conditions of the award.
Said notice shall.be delivered by certified mail, return receipt request, or in person
with proof of _delivery. The Subrecipient shall have five (5) .days from the day the
notice was delivered to state why it is not in the. best interest of the Grantee to
terminate the Agreement. However, it is up to the discretion of the Grantee to make
the final determination as to what is in its best interest.
CoC Grant #FL0190L4D001811, The City of Miami, MMHAP South Program. Page 20
ii. Termination for Convenience - The Grantee or Subrecipient may terminate this
Agreement, in whole or part, when both parties agree that the continuation of the
activities would not produce beneficial results commensurate with the further
expenditure of funds. Both parties shall agree in writing upon the termination
conditions, including the effective date and in the case of partial termination, the
portion to be terminated. However, if the. Grantee determines in the case of partial
termination that the reduced or modified portion of the grant will not accomplish the
purposes for which the grant was made it may terminate the grant in its entirety.
iii. Termination Because of a Lack of Funds - In the event funds to finance this Agreement
become unavailable, the Grantee may terminate this Agreement upon no less than
twenty-four (24) hours' notice in writing to the Subrecipient. Said notice shall be
sent by certified mail, return receipt requested, or in person with proof of delivery.
The Grantee shall be the final and sole authority in determining whether or not funds
are available.
iv. Termination for Breach - Upon terminating this Agreement under this section the
Grantee, in its sole discretion, may require the Subrecipient to pay the Grantee any or
all costs associated with termination of this Agreement, including but not limited to
transfer of the Subrecipient's obligations under this Agreement and or selection of a
new Project Sponsor. The Grantee may terminate this Agreement, in whole or in part,
when the Grantee determines in its sole and absolute discretion that the Subrecipient
isnot making sufficient progress in the performance of this Agreement as outlined in
the "Scope of Services" contained within the "Scope of Service and US HUD eSnaps
Documents" Attachment B or is not materially complying with any term or
provision provided herein including but not limited to the following:
1. The Subrecipient ineffectively or improperly used or uses the Grantee funds
allocated under this Agreement;
2. The Subrecipient failed or fails to furnish the Certificates of Insurance
required by this Agreement or as determined by Miami -Dade County Internal
Services Risk Management Division;
.3. The -Sub * recipient failed or fails to furnish proof of Licensure, proof of
Certificaion or proof of Background Screening required by this Agreement;
4. The Subrecipient failed or fails to submit detailed reports of expenditures or
final expenditure reports or submits incompletely or incorrectly;
S. The Subrecipient failed or fails to submit required reports or submits
incompletely or incorrectly,
6. The Subrecipient refused or refuses to allow the Grantee access to records or
refused or refuses to allow the Grantee to monitor, evaluate and review the
Subrecipient's program;
7. The Subrecipient discriminates under any of the laws outlined in this
Agreement;
8. The Subrecipient failed or fails to provide Domestic Violence Leave to its
employees pursuant to local law;
9. The Subrecipient falsifies or violates the provisions of a Drug Free Workplace
Affidavit;
10. The Subrecipient attempted or attempts to meet its obligations under this
Agreement through fraud, misrepresentation or material misstatement;
CoC Grant #FL0190L4D001811, The City of Miami, MMHAP South Program Page 21
11. The Subrecipient failed or fails within a specified period, to correct
deficiencies found during a monitoring, evaluation or review,
12. The Subrecipient failed or fails to meet the terms and conditions of any
obligation under this Agreement or otherwise of any repayment schedule to
the Grantee or any of its agencies or instrumentalities;
13. The Subrecipient failed or fails to meet any of the terms and conditions of the
Miami -Dade County Affidavits; and
14. The Subrecipient failed or fails to fulfill in a timely and proper manner any
and all of its obligations, covenants, agreements and stipulations in this
Agreement.
The Subrecipient shall be given written notice of the claimed breach and ten (10)
business days to cure same. If the Subrecipient is not provided a written waiver of
the breach by the Grantee, or if the Subrecipient remains in breach of this Agreement
as determined by the Grantee, the Grantee shall initiate written notice to terminate
and said notice will be to terminate effective within no less than twenty-four (24)
hours. Said notice shall be sent by certified mail, return receipt requested, or in
person with proof of delivery. Waiver of Breach or any provision of this Agreement
shall not be construed to be a modification, or revisions of the terms of this
Agreement. The provisions contained herein do not limit the rights to legal or
equitable remedies or any other provision for termination by the Grantee under this
Agreement. The Subrecipient shall be responsible for all direct and indirect costs
associated with such termination or cancellation, including attorney's fees. Any
individual or entity who attempts to meet its contractual obligations with the Grantee
through fraud, misrepresentation or material misstatement may be disbarred from
Miami -Dade County contracting for up to five (5) years.
5. Notice Regarding Future Funding Applications
Funding under this Agreement is provided by US HUD. The parties understand the Grantee, as the
.US HUD funding recipient, is responsible for review and approval of the funding application and
response submitted to US HUD through the annual US HUD CoC Program Notice of Funding
Availability (NOFA) application process.
The Subrecipient agrees to timely notify the Grantee of the Subrecipient's intention not to be
available to renew and continue operating or providing the program in its entirety as covered
under this Agreement. Timely is defined as the earliest of either 1) six (6) months prior to this
Agreement's expiration; or 2) upon request to confirm allocations in the Grant Inventory
Worksheet (G1W) registration process of the anticipated annual application to US HUD CoC Program
NOFA. -
If the. Subrecipient is not available to apply for "renewal funding" or for the continuation of the
program outlined in this Agreement, and failed to timely inform the Grantee as described herein, then
the Grantee in its sole discretion may opt not to enter into future grant agreements with the
Subrecipient.
Further, in the event the Subrecipient will not be available to apply for renewal funding applicable to
this Agreement, the Subrecipient agrees_ to ensure that housing is maintained for persons served by
the Subrecipient under this Agreement after the expiration of this Agreement so that those persons
do not become homeless.
CoC Grant #FL0190L4D001811, The City of Miami, MMHAP South Program Page 22
Notice from Subrecipient to Grantee pursuant to this section shall be delivered in writing by certified
mail, return receipt request, or in person with proof of delivery, to the attention of Miami -Dade
County Homeless Trust Executive Director.
6. Reversion of Assets
a. Term of Commitment - If the Subrecipient receives assistance for acquisition, rehabilitation,
or new construction, then the Subrecipient shall agree to operate the "McKinney-Vento Act
housing" or provide "McKinney-Vento Act services" in accordance with this Agreement and
applicable laws, and regulations for a term of at least twenty (20) years or if applicable
fifteen (15) years from the date of initial occupancy or date of initial service provision. If
the United States, Department of Housing and Urban Development CUS HUD) determines a
project is no longer needed for use as homeless assistance housing or services, then US HUD
may provide authorization to the Grantee on behalf of the Subrecipient to convert the project
to a project for the direct benefit of low-income persons pursuant to a request for such use
by the Grantee on behalf of the Subrecipient operating the project as Project Sponsor. The
parties hereby agree to this provision shall survive the expiration or termination of this
Agreement pursuant to 24 CFR 578.81 - The request for authorization to US HUD from the
Grantee on behalf of the Subrecipient must be made while the project is operating as
homeless housing or supportive services for homeless individuals and families, must be in
writing, and must include an explanation of why the project is no longer needed to provide
transitional or permanent housing or supportive services. The primary factor in US HUD's
decision on the proposed conversion is the unmet need for transitional or permanent housing
or supportive services in the Continuum of Care's geographic area.
b. Repayment of Grant - If the Subrecipient does not provide supportive housing or supportive
services for twenty (20) years or if applicable fifteen (15) years following the date of initial
occupancy or date of initial service provision pursuant to this Agreement, then the Grantee
shall require repayment of the entire amount of the grant or partial repayment of the grant
used for acquisition, rehabilitation, or new construction, unless conversion of the project has
been authorized by US HUD pursuant to the terms in the Term of Commitment. The parties
hereby agree this provision shall survive the expiration or termination of this Agreement.
c. Prevention of Undue Benefit - Upon the sale or other disposition of a project assisted with
acquisition, rehabilitation or new construction funds occurring before the expiration of the
twenty (20) years or if applicable fifteen (15) year period, the Subrecipient must comply
with such terms and conditions as US HUD and the Grantee may prescribe to prevent the
Subrecipient from unduly benefiting from such sale or disposition.
The Subrecipient shall return to the Grantee, upon the expiration or termination of the
Agreement, any funds 'on hand, any accounts receivable attributable to those funds, and any
overpayment due to unearned funds or costs disallowed pursuant to the terms of this
Agreement that were disbursed to the Subrecipient by the Grantee.
d. Revocation of License or Permit - Notwithstanding any provision of this Agreement to the
contrary, revocation of any necessary license, permit, or approval by a governmental
authority may result in immediate termination of this Agreement upon.no less than twenty-
four (24) hours' notice.. Said notice shall be certified by mail or hand delivery.
e. Declaration of Restrictive Covenant and Declaration of Restrictions -Where grant funds are
used for acquisition, construction or rehabilitation under this Agreement, the Subrecipient
CoC Grant #FL01.90L4D001811, The City of Miami, MMHAP South Program Page 23
shall record a Declaration of Restrictive Covenants, as well as a Declaration of Restrictions, in
accordance with this section.
The Declaration of Restrictive Covenants and the Declaration of Restrictions shall restrict the
use of properties located at in Miami -Dade County,
Florida such that the properties must be operated for the provision of homeless housing and
services for homeless persons in accordance with the provisions of (24 CFR Part 578, Code
of Federal Regulations) and any other applicable laws or regulations for a term of at least
twenty (20) years or if applicable fifteen (15) year period or for such other purposes as
may be approved by the Grantee and US HUD.
The Subrecipient agrees that the Declaration of Restrictive Covenants and the Declaration of
Restrictions shall be signed by the Subrecipient, as well as the title owner of the subject
property and any other relevant property interest holders, including but not limited to a
lessee of the title holder subleasing the property to the Subrecipient. If the Subrecipient is
not the title owner of the subject property, the Subrecipient shall be responsible for obtaining
execution of the Declaration of Restrictive Covenants and the Declaration of Restrictions by
the title owner and by any other parties required by US HUD. The Subrecipient shall be
responsible for ensuring that any signatories required by US HUD sign the Declaration of
Restrictive Covenants and the Declaration of Restrictions whether US HUD requires such
signatories by regulation or by guidance provided directly regarding the project and / or
property covered under this Agreement.
The Declaration of Restrictive Covenants executed by the Subrecipient and any other
required parties and recorded by the Subrecipient must be approved by US HUD. The
Subrecipient must provide US HUD with proof of recordation of the approved Declaration of
Restrictive Covenants before funds for Rehabilitation or New Construction may be drawn
down. Acquisition funds may be drawn down before proof of recordation is received by US
HUD; however, no other grant funds will be available for draw down until US HUD is satisfied
with the form and recordation of the Declaration of Restrictive Covenants.
The Subrecipient agrees to inform any lender or grantor which has loaned or granted funds
for the purchase of such properties or structure on the subject property or properties covered
under this Agreement and obtain their consent to the recordation of and subordination to the
"Declaration of Restrictive Covenants" and the "Declaration of Restrictions". Such consent
shall be in a form acceptable to the Grantee.
The parties hereby agree this provision shall survive the expiration or termination of this
Agreement.
7. Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards
a. Accounting Standards, Cost Principles and Regulations.
L The Subrecipient shall comply with applicable. provisions of applicable Federal, State
and County laws, regulations, and'rules such as.OMB Circular A-110, OMB Circular A-
21, and OMB Circular A-133 and with the Energy Policy and Conservation Act (Public
Law 94-163) which requires mandatory standards and. policies related to energy
efficiency. If any -provision of this Agreement conflicts with any applicable law or
regulation, only the conflicting provision shall be modified to be consistent with the
law or regulation or be deleted if modification is impossible. However, the obligations
CoC Grant #FL0190L4D001811, The City of Miami, MMHAP South Program Page 24
under this Agreement, as modified, shall continue and all provisions of this
Agreement shall remain in full force and effect.
ii. If the amount payable to the Subrecipient pursuant to the terms of this Agreement
are in excess of $100,000, or such other amount as required by applicable law or
regulation; the Subrecipient shall comply with all applicable stands, orders, or
regulations issued pursuant to Section 306 of the Clean Air Act of 1970 (42 U.S.C.
1857(h), as amended: the Federal Water Pollution Control Act (33 U.S.C. 1251), as
amended: Section 508 of the Clean Water Act (33 U.S.C. 1368); the environmental
Protection Agency regulations (40 CFR Part 15); Executive Order 11738; and the
Environmental Review Procedures and Regulations (24 CFR Part 58 and 24 CFR Part
583.230). The Subrecipient shall comply with all applicable laws and regulations
governing this Agreement.
b. The Subrecipient shall comply with the federal uniform administrative requirements and
accounting standards cost principles and audit requirements according to OMB Omni or
Super Circular 2 CFR Chapter I, and Chapter II, Parts 200, 215, 220, 225 and 230, OMB Circular
A-122, and 24 CFR 78 et.seq., as may be applicable and any other applicable laws and
regulations.
i. Performance Measurements - The Subrecipient shall comply and report all
performance objectives outlined in the "Scope of Service and US HUD eSnaps
Documents" Attachment B and as outlined in the NOFA application and in the
manner specified and outlined in this Agreement.
ii. Additionally, the Subrecipient shall comply with the established United States
Department of Housing and.Urban Development's (USHUD) performance measures
related to the Continuum of Care's (CoC) system performance. Specifically:
1. Measure 1: The Length of Time Persons Remain Homeless
2. . Measure 2: The Extent to which Persons who Exit Homelessness to
Permanent Housing Destinations Return to Homelessness
3. Measure 3: Number of Homeless Persons
4. Measure 4: Employment and Income. Growth for Homeless Persons in CoC
Program -funded Projects
S. Measure 5: Number of Persons who Become Homeless for the First Time
6. Measure 6: Homeless Prevention and Housing Placement of Persons Defined
by Category 3 of HUD's Homeless Definition in CoC Program -funded Projects
7. Measure 7: Successful Placement from Street Outreach and Successful
Placement in or Retention of Permanent Housing
iii.. HUD -funded agencies must have, a minimum of 86% of the organization's total
number of beds/units which are reported to HUD for the Miami -Dade County
Continuum of Care (CoC) through the Housing Inventory Checklist, populated in the
HMIS, regardless of whether the beds are funded by HUD or the Homeless Trust,
whether or not funded by HUD or the Homeless Trust.
iv. Internal Controls - The Subrecipient shall complywith internal control related federal
statutes, regulations, and the terms and conditions of the federal award; evaluate and
monitor and take prompt action when instances of noncompliance are identified
CoC Grant #FL0190L4D001811, The City of Miami, MMHAP South Program Page 25
including noncompliance identified in audit findings; and take reasonable measures
to safeguard legally protected personally identifiable information and other
information. These internal controls shall safeguard assets and provide reasonable
assurance of compliance with federal statutes and regulations.
v._ Payment — The Subrecipient is required to report deviations from budget or project
scope or objectives and request prior approvals from federal awarding agencies
through the Grantee on any and all changes in scope or key persons and any other
change to the -program budget, in accordance with Omni or Super Circular 2 CFR
Chapter I, and Chapter II, Parts 200, 215, 220, 225 and 230 and any other applicable
laws and regulations.
vi. Cost Sharing or Matching — For all federal awards, any shared costs or matching funds
and all contributions, including cash and third party in-kind contributions, must be
accepted as part of the non-federal entity's cost sharing or matching and such
contributions shall meet all of the following criteria:
1. Are verifiable from the non-federal entity's records;
2. Are not included as contributions for any other federal award;
3. Are necessary and reasonable for accomplishment of project or program
objectives;
4. Are allowable under Costs Principles of 2 CFR Part 200, et al.
S. Are not paid by the federal government under another federal award, except
where the federal statute specifically provides that federal funds made
available for such program can be applied to match or cost sharing
requirements of other federal programs;
6. Are provided for in the approved budget when .required by the federal
awarding agency; and
7. Conform -to 2 CFR Chapter II, Part 200.306, as applicable.
c. Retention of Agreement Records
i. The Subrecipient shall retain financial records, supporting documents, statistical
records and all records pertinent to a federal award for a period of five (5) years
from the date of submission of the final expenditure report or, for Federal awards that
are renewed quarterly or annually, -from the date of the submission of the quarterly
or annual financial report, respectively, as reported to the federal awarding agency.
1. If any litigation, claim or audit is.started before the expiration of the five (5) -
year period, the records must be retained until all litigation, claims, or audit
findings involving the records have been resolved and final action taken. If
the Grantee or the Subrecipient has received or been given notice of any kind
indicating any threatened litigation, claim or audit arising out of the services
provided pursuant to the terms of this Agreement, the Retention Period shall
be extended until such time as the threatened or pending litigation, claim or
audit is, in the sole and absolute discretion of the Grantee, fully, completely
and finally resolved.
2. Records for real property and equipment acquired with federal funds must be
retained for a minimum five (5) years after final disposition.
CoC Grant #FL0190L4D001811, The City of Miami, MMHAP South Program Page 26
3. Any leases or mortgages or similar documents or contracts with a term longer
than five (5) years, must be retained for five (5) years beyond the end of the
document's full term.
4. Records for program income transactions after the period of performance:
The Subrecipient must report program income after the period of
performance records pertaining to the earning of program income must be
retained for five (5) years after the end of the non-federal entity's fiscal year
in which the program income is earned.
S. The Subrecipient shall allow the Grantee or any persons authorized by the
Grantee full access to and the right to examine any of the records pertinent to
the Federal Award and this Agreement.
6. The Subrecipient shall notify the Grantee in writing both during the pendency
of this Agreement and after its expiration as part of the final close out
procedure of, the location and address where all the Agreement records will
be retained.
7. The Subrecipient shall obtain prior written approval by the Grantee for the
disposal of any Agreement records before disposing of such records if it is
within one (1) year after the expiration of the Retention Period.
8. Additional Requirements
The Subrecipient shall comply with the following additional requirements:
a. Client Rules and Regulations - The Subrecipient shall submit to the Grantee a copy of the
Client Rules and. Regulations that apply to all program or client participants referred to the
Subrecipient pursuant to this Agreement. This copy is due within thirty (30) calendar days
following the execution of this Agreement.
b. Personnel Policies and Administrative Procedure Manuals - The Subrecipient shall submit
detailed documents describing all the Subrecipient's policies and procedures for internal
control, corporate, or organizational structure, property management, procurement,
personnel management, accounting and fiscal information.. This information shall be
available to the Grantee upon request.
c. Monitoring - The Subrecipient shall permit the Grantee and any other persons authorized by
the Grantee to monitor, according to applicable regulations, all Agreement records, facilities,
goods, services and activities of the Subrecipient which are in any way connected to the
activities undertaken pursuant to the terms of this Agreement including interview of any
participant, employee, subcontractor, or assignees of the Subrecipient. The Grantee shall
monitor both fiscal and programmatic compliance with all terms and conditions of this
Agreement including a review of beneficiaries, supportive services, housing, operating costs,
program and performance progress, site habitability, participant eligibility, documentation
for required match, record keeping, and compliance with circulars, administrative costs,
technical assistance visits, and environmental review: The Subrecipient shall permit the
Grantee to conduct site visits, participant assessment surveys, and other techniques deemed
reasonably necessary to fulfill the monitoring function. If the Grantee monitors and there is
a finding of deficiencies report; said report may be delivered to the Subrecipient, and if so
delivered, the Subrecipient shall rectify all deficiencies cited within the period of time
CoC Grant #FL0190L4D001811, The City of Miami, MMHAP South Program Page 27
specified in the report. Pursuant to Board of Miami -Dade County Commissioners Resolution
No. 630-13, Miami -Dade County Mayor or Mayor's designee may make unannounced, on-site
visits during normal working hours to the Subrecipient's headquarters and / or any locations
or site where the services contracted for are performed.
d. Restrictions of Funds Use - The funds received under this Agreement (and any State or local
government funds used to supplement this Agreement) may not be used to replace State or
local funds previously used, or designated for use to assist homeless persons (24 CFR Part
578.87). The Subrecipient shall notify the Grantee of any additional funding received for any
activity described in this Agreement, other than funding already noted in the "Consolidated
Financial Record and Reports", Attachment E. Such notification shall be in writing and
received by the Grantee within thirty (30) calendar days of the Subrecipient's notification
by the funding source.
e. Related Parties - The Subrecipient shall report to the Grantee the name, purpose and any
other relevant information in connection with any transaction conducted between the
Subrecipient and a related party transaction. A related party includes, but is not limited to; a
for-profit or nonprofit subsidiary or affiliate organization, and organization with overlapping
boards of directors or any organization for which the Subrecipient is responsible for
appointing members. The Subrecipient shall report this information to the Grantee upon
forming the relationship or if already formed, shall report it immediately. Any supplemental
information shall be reported in the Grantee required Agency Narrative and Progress Report
which are addressed in Section 2 b. "Records and Access to Records".
Required Meeting Attendance - From time to time, Grantee through Miami -Dade County
Homeless Trust may schedule meetings and or training sessions to assist the Subrecipient in
the performance of its contractual obligations or to inform the Subrecipient of new and or
revised policies and procedures. Attendance at some of these meetings may be
mandatory. The Subrecipient shall receive notice no less than three (3) business days
prior to any meeting or training session that may require mandatory participation. A record
of attendance shall be kept of meetings or training sessions where notice was given indicating
the mandatory participation of the Subrecipient and the Subrecipient shall be monitored for
compliance on that record of attendance. Failure to attend meetings or training sessions for
which a mandatory notice has been provided can result in material non-compliance of the
Agreement, up to and including Breach or Default. Proof of mandatory notice shall consist
of fax record, certified mail, electronic confirmation and or verbal communication with the
Agreement contact person or persons and other program administrative staff. of the
Subrecipient. The Subrecipient may select one or more employees from their Agency, directly
involved in the Agreement program, as their representative at the meeting or training
session; the. participation of the Agreement contact person or persons is preferred. The
Subrecipient may request waiver from a mandatory meeting. That waiver must be received
no later than twenty-four (24) hours prior to the meeting date and time, and justification
provided, including the reason the Subrecipient could not send any representative. The
Grantee shall have absolute and final approval over any determination to waive mandatory
attendance_; and no more than two (2) mandatory attendance waivers shall be allowed
during the term of this Agreement. The Subrecipientis encouraged to attend all meetings 'of
Miami -Dade County Homeless Trust and .or its Committees, as information relevant to their
program or services maybe discussed.
CoC Grant #FL0190L4D001811, The City of Miami, MMHAP South Program Page 28
g. Publicity and Advertisements - The Subrecipient shall ensure that all publicity and
advertisements prepared and released by the Subrecipient, such as pamphlets and news
releases already or indirectly related to activities funded pursuant to this Agreement, and all
events carried out to publicize the accomplishments of any activity funded pursuant to this
Agreement, recognize the Grantee as its funding source.
h. Procurement - The Subrecipient shall use its own procurement procedures which shall
comply with any and all applicable federal, state and local laws, ordinances and regulations
including but not limited to 2 CFR 200.318 as applicable. The Subrecipient shall maintain
oversight and ensure that its subcontracts perform in accordance with the terms, conditions,
and specifications of their contracts or purchase orders.
The Subrecipient shall make a positive effort to competitively procure supplies, equipment,
construction and services necessary or related to carrying out the terms of this Agreement
from minority and women owned -businesses, as may be permitted by applicable law. If this
Agreement involves the expenditure of $100,000 or more by Miami -Dade County, and the
Subrecipient intends to use subcontractors to provide the services listed herein or suppliers
to supply the materials, the Subrecipient shall provide Miami -Dade County with the names of
the "Subcontractor / Supplier Listing", Attachment D. Subrecipient agrees that it will not
change or substitute subcontractors or suppliers from those listed without prior written
approval of Miami -Dade County.
i. Involvement of HUD -assisted individuals and families - per 24 CFR 578.23 (c)(3), the
Subrecipient agrees to ensure to the maximum extent practicable, that individuals and
families experiencing homelessness are involved, through employment, provision of
volunteer services, or otherwise, in constructing, rehabilitating, maintaining and operating
facilities for the project and in providing supportive services for the project. Further, -per the
Housing and Urban Development Act -of 1968, as amended, (12 U.S.C. 1701u) to the greatest
extent feasible, opportunities for training and employment, for services or programs covered
under this Agreement, should be given to lower-income residents of HUD -assisted projects
-and contracts for work in connection with the project be awarded in substantial part to
persons residing in the area of the project.
Property - This section applies to equipment with an acquisition cost of greater than
$5,000.00 per unit and all real property. 1) Any real property under the control of the
Subrecipient that was acquired and or improved in whole or in part with funds from Grantee,
or from Miami -Dade County and any equipment or property purchased for greater than
$5,000.00, shall, upon expiration or termination -of this Agreement, be disposed in
accordance with instructions from the Grantee. Real Property is defined as land, including
land improvements, structures, and appurtenances thereto, including moveable machinery
and equipment. Equipment means tangible, non=expendable, personal property having a
useful life of more than one (1:) year and acquisition costs of greater than $5,000.00 per unit.
2) The Subrecipient shall list in the property records all equipment with an acquisition cost
of greater than $5,000.00 per unit and all real property purchased in whole or in part with
funds from the Grantee or from Miami -Dade County from this Agreement or from previous
agreements. The property record shall include a legal description, size, date of acquisition,
and value at time of purchase, owner's name if different than the Subrecipient, information
on the transfer or disposition of the property, and map indicating where property is in
parcels, lots or blocks and showing adjacent streets and roads.- Notwithstanding documents
required for reimbursement purposes; an additional copy of the purchase receipt for any
CoC Grant #FL0190L4D001811, The City of Miami, MMHAP South Program Page 29
property described above which was purchased using Grantee or Miami -Dade County funds
must also be included in the reimbursement package .along with the "Real Property and
Equipment Asset Inventory" Attachment I in the month it was purchased. 3) All equipment
with an acquisition cost of greater than $5,000.00 per unit and all real property shall be
inventoried annually by the Subrecipient and an Annual Inventory Report submitted to the
Grantee. This report shall include the elements listed above. Pursuant to 2 CFR 200.94, if the
cost of computing devices (inclusive of accessories) falls below the lesser of the capitalization
threshold of the nonfederal entity or $5,000, regardless of the length of useful life, the asset
is a supply.
k. Management Evaluations and Performance Reviews - The Grantee may conduct formal
Management Evaluations and Performance Reviews of the Subrecipient following this
expiration of this Agreement. The Management Evaluations will reflect the compliance of the
Subrecipient with generally accepted fiscal and organizational standards and practices. The
Performance Reviews will reflect the quality of service provided and value received of the
funds using monitoring data such as progress reports, site visits, and participants' surveys.
1. Subcontracts and Assignments — The Subrecipient shall not assign this Agreement without
the Grantee's written consent to the assignment. The Subrecipient shall ensure that all
subcontracts and assignments; 1) Identify the full, correct and legal name of the party; 2)
Describe the activities to be performed; 3) Present a complete and accurate breakdown of all
price components; and 4) Incorporate provisions requiring compliance with all applicable
regulatory and other requirements of this Agreement with any conditions of approval that
the Grantee deems necessary. This applies only to subcontracts and assignments in which
parties are engaged to carry out any eligible substantive programmatic service as set forth in
this Agreement. The Grantee shall in its sole and absolute discretion determine when
services are eligible substantive programmatic services subject to the audit and record
keeping requirements described above.
The Subrecipient shall ensure that all subcontracts and assignments which involve the
expenditure of one hundred thousand dollars ($100;000.00) or more, comply with (Miami -
Dade County Ordinance 97-104, § 1, 7-8-97), which shall require the entity contracting with
Miami -Dade County to list all first tier subcontractors who will perform any part of the
contract and all suppliers who will supply materials for the contract work directly to such
entity. -The contract shall also require the entity contracting with Miami -Dade County to
report to Miami -Dade County the race, gender, and ethnic origin of the owners and employees
of all such first tier subcontracts. This Agreement shall require the Subrecipient to provide
Miami -Dade County the race, gender and ethnic information: as soon as reasonably available
and in any event prior to final payment under the.contract. The Subrecipient shall not change
or substitute subcontractors or, suppliers from those listed except upon written approval of
the County. The Subrecipient must provide the list of all first tier subcontractors and direct
suppliers; see "Subcontractor/ $upplier'Listing" Attachment D.. The Subrecipient shall
incorporate into all consultant subcontracts this additional provision: "The Subrecipient is not
responsible for any insurance or other fringe benefits for the consultant or its employees,
(examples social security, income tax withholdings, retirement or leave benefits). The
consultants assume full responsibility for the provision of all insurance and fringe benefits for
themselves and their employees retained by the consultants in carrying out the Scope of Service
provided in this subcontract". The Subrecipient shall be responsible. for. monitoring the
contractual performance of all subcontracts. The Subrecipient shall receive written
documentation prior to entering into any subcontract which contemplates performance of
CoC Grant #FL0190L4D001811, The City of Miami, MMHAP South Program Page 30
substantive programmatic activities, as such is determined as provided herein. The approval
of the Grantee shall be obtained prior to the release of any funds to the Subrecipient for the
subcontract. The Subrecipient shall receive written approval from the Grantee prior to either
assigning or transferring any obligations or responsibilities set forth in this Agreement or the
right to receive benefits or payments resulting from this Agreement. Approval by the Grantee
of any subcontract or assignment shall not under any circumstances be deemed to provide
for the incurring of any obligation by the Grantee in excess of the total dollar amount set forth
in this Agreement.
m. Consultant to the Grantee The parties understand that in order to facilitate the
implementation of this Agreement, the Grantee may from time to time designate a
development consultant to work with the Subrecipient. The Grantee's Consultant shall be
considered the Grantee's designee with respect to all portions of this Agreement with the
exception of those provisions relating to payment to the Subrecipient for services rendered.
The Grantee shall provide written notification to the Subrecipient of the name, address and
employee representatives of the Grantee's Consultant.
n. Participation in the Homeless Management Information System (HMIS) - The Subrecipient
agrees to participate in a Homeless Management Information System selected and
established. by. the Grantee. Participation will include, but not be limited to, input of client
data upon intake, daily updates of bed availability information, as well as updates to current
and prior client's records upon client contact, and maintaining current data for statistical
purposes. Subrecipients of Domestic Violence Programs with heightened privacy and
confidentiality concerns are required to participate in an HMIS equivalent system to include
the necessary stricter privacy and confidentiality standards. The Subrecipient understands
that they are responsible for any ongoing costs to access the HMIS. system. The Subrecipient
agrees to abide by terms of any HMIS Agreements, which are incorporated herein by
reference. The Subrecipient shall indemnify and hold harmless the Grantee and Miami -Dade
County, its agents and instrumentalities from any and all liability, losses and damages arising
out of or relating to this Agreement or the HMIS system.
o. Miami -Dade County Inspector General review - The Subrecipient understands that Miami -
Dade County, Office of the Inspector General may, on a random basis, perform audits on all
Miami -Dade County contracts, throughout the duration of said contracts.
p. Independent Private -Sector Inspector General review - The Subrecipient understands that
Miami -Dade County Inspector General is also empowered to retain the services of
Independent Private -Sector Inspector Generals, to .audit, investigate, monitor, oversee,
inspect and review operations, activities, performance and procurement processes including
but not limited to project design, application and project specifications, proposals submittals,
activities of the Subrecipient, its officers, agents and employees, lobbyists, Miami -Dade
County staff, and elected officials to ensure compliance with contract specifications and to
detect fraud and corruption.
q. Renegotiation or Modification - The Subrecipient agrees that modifications to provisions of
this Agreement- shall only be valid, when in writing and signed by duly authorized
representatives of .all parties. In addition,- the Subrecipient may not make any significant
changes to an approved program without prior written approval by the Grantee. Significant
changes include, but are not limited to, changes in the Project Sponsor, changes in the project
site location; additions or deletions in types of program or funding activities outlined in 24
.CFR 578.37.- 578.63 and the Notice of Funding Availability (NOFA) process approved in the
CoC Grant #FL0190L4D001811, The City of Miami, MMHAP South Program Page 31
Technical Submission for this program, or a shift of greater than ten (10) percentage points
between approved funding activities, or a change in the population served, the number of
population served, or any other changes deemed significant by the Grantee.. Depending upon
the nature of the change, the Grantee may require a new certification of consistency with the
Consolidated Plan Certification from the United States Department of Housing and Urban
Development. Any approval for changes is contingent upon United States, Department of
Housing and Urban Development Field Office approval of the continuation of the
Subrecipient's renewal ranking in the CoC NOFA application process.
The parties agree to renegotiate this Agreement if the Grantee determines, in its sole and
absolute discretion, that changes are necessary for reasons including but not limited to
changes in Federal, State, County laws or regulations, or increases or decreases in funding
allocations. The Grantee shall have final authority in determining funding availability for this
Agreement caused by changes listed above. Notwithstanding the foregoing, the Grantee
retains all rights of suspension and termination set forth in other sections) of this
Agreement.
r. Right to Waive - The Grantee may, for good and sufficient cause, determined by the Grantee
in its sole and absolute discretion, waive provisions in this Agreement in writing or seek to
obtain such wavier from the appropriate authority. All waiver requests from the Subrecipient
must be in writing. Any waiver shall not be construed as a modification or revision to this
Agreement.
s. Disputes - In the event that an unresolved dispute exists between -the Subrecipient and the
Grantee, the Grantee shall refer the questions, including the views of all interested parties
and the recommendation of the Miami -Dade County Homeless Trust, to the Miami -Dade
County Mayor or the Mayor's designee for determination. The Mayor or Mayor's designee
will issue a determination within thirty (30) calendar days of receipt and so advise the
Grantee and the Subrecipient, or in the event additional time is necessary, the Grantee will
notify the Subrecipient within the thirty (3 0) day period that additional time is necessary.
The Subrecipient agrees that the determination of the Mayor or the Mayor's designee shall be
final and binding on all parties.
t. Proceedings - This Agreement shall be construed in accordance with the laws of the State of
Florida and any proceedings arising between the parties in any manner pertaining or related
to this Agreement shall, to the extent permitted by law, be held in Miami -Dade County,
Florida.
u. No Third Party Beneficiaries - This Agreement has no intended or unintended third party
beneficiaries.
v. Construction of the Agreement - This Agreement shall not be construed against the drafter
of this Agreement.
w. Sovereign Immunity -Nothing in this. Agreement shall be considered a waiver of sovereign
immunity.
x. Notice and Contact_ -'The Grantee's representative for this Agreement is Victoria L. Mallette,
Executive Director, Miami -Dade County Homeless Trust. The Subrecipient's representative
for this Agreement is The project site location is
In the event that different representatives are designated by the
Subrecipient after this Agreement is executed, or the Subrecipient. changes the address of
CoC Grant #FL0190L4D001811, The City of Miami, MMHAP South Program Page 32
either the program site or principal office, the Subrecipient must notify the Grantee prior to
such relocation and obtain all necessary approvals. Notice of the name of the new
representative or new address will be rendered in writing to the Grantee within five (5)
business days of the proposed change.
y. The Subrecipient shall provide to the Grantee, prior to execution of this Agreement, the
Subrecipient's Board Approval or Board Resolution designated authorizing signatories or
their alternative to receive and expend funds, to execute agreements and subcontract
agreements and to exercise modification, renewal and termination clauses contain within
this Agreement. The resolution shall be updated and provided annually.
The Subrecipient shall provide the Grantee with a current list of the Subrecipient's Board of
Directors and a Program -Specific Table of Organization, which includes all current job titles
in PDF format and which shall be emailed as an attachment to Miami -Dade County
Homeless Trust's Contract Manager Terrell T. Ellis within five (5) business days of
execution of this Agreement.
aa. Name and Address of Payee -When payment is made to the Subrecipient, it shall be directed
to the name and address of the payee listed here:
Subrecipient's Name:
Address:
bb. All Terms and Conditions Included - this Agreement and its Attachments A through K as
referenced in the Index of Attachment, contain all the terms and conditions agreed upon by
the parties.
cc. Autonomy - Both .parties agree that this Agreement recognizes the autonomy of and
stipulates or implies no affiliation between the contracting parties. The parties acknowledge
that the relationship of Grantee and Subrecipient is that of independent contractors and that
nothing contained in this Agreement shall be construed to place Grantee and Subrecipient in
the relationship of principal and agent, employer and employee, master and servant, partners
or joint ventures. Neither party shall have, expressly or by implication, or represent itself as
having, any authority to make contracts or enter into any agreements in the name of the other
party, or to obligate or bind the'other partyin any manner whatsoever. .
dd. Severability of Provisions - If any provision of this Agreement is held invalid, the remainder
of this Agreement shall not be affected thereby if such remainder would then continue to
conform to the terms and requirements of all applicable law.
ee. Waiver of Trial - Neither the Subrecipient, subcontractor nor any other person liable for the
responsibilities, obligations, services and representations herein, nor any assignee, successor
heir or personal representative of the Subrecipient, subcontractor or any other such persons
or entities shall seek a jury trial in any lawsuit, preceding, counterclaim or other litigation
proceeding based upon or arising out of this Agreement, or the dealings or the relationship
between or among the parties to this Agreement..
ff. Counties and Municipalities outside Miami -Dade County - The Subrecipient agrees to provide
homeless housing within Miami -Dade County and further agrees to abide. by, as well as to
post this notice: Notice that all firms, corporations, organizations or individuals desiring to
transact business' or enter into a contract with Miami -Dade County'for the provision. of
homeless housing and or homeless services swears, verifies, affirms and agrees that 1) they
CoC Grant #FL0190L4D001811, The City of Miami, MMHAP South Program Page 33
have not entered into any current contracts, arrangements of any kind, or understanding with
any county, or municipality outside of Miami -Dade County to provide housing and services
for homeless persons in Miami -Dade County who are transported to Miami -Dade County by
or at the behest of such counties and municipalities outside Miami -Dade County; and 2)
During the term of this contract, entities listed above will not enter into any such contract,
arrangement of any kind or understanding provided however, Miami -Dade County Homeless
Trust may, in its sole and absolute discretion, find and determine within sixty (60) days of
an entity's request to waive the requirements of this section, that a proposed contract should
not be prohibited hereby, as the best interests of the homeless programs undertaken by and
on behalf of .Miami -Dade County would be served and Miami -Dade County would not be
negatively affected by such contract, arrangement, or undertaking.
gg. Compliance with all applicable Laws, Regulations, Ordinances, Policies and Standards — The
Subrecipient agrees to comply with all applicable Federal, State, and local laws, regulations,
ordinances, and standards including but not limited to any applicable requirements
regarding payment and performance bonds and other requirements for public works,
competitive bid and bid bond requirements, if applicable, as well as with requirements
contained in the Grantee's "Continuum of Care Program Grant Agreement", Attachment
A. The Subrecipient also agrees to sign and provide the Grantee with any required affidavits.
Additionally, the Subrecipient shall comply with any and all guidance that Grantee receives
from US HUD regarding this Agreement, the program and / or services covered herein, and
clarification of existing laws and regulations
9. Religious Organizations
Pursuant to 24 CFR Part 578.87, a primarily religious organization is eligible to receive US HUD
funding, if the organization agrees to provide homeless housing and services in a manner that is free
from religious influences as described in section 24 CFR Part 578.87 and in accordance with the
following principles;
a. It will not discriminate against any employee or applicant for employment on the basis of
religion and will not limit employment or give preference in employment to persons on the
basis of religion;
b. It will not discriminate against any person applying for homeless housing or services on the
basis of religion and will not limit such homeless housing -or services or give -preference to
persons on the basis of religion; and
c. It will provide no religious instruction or counseling, conduct no religious worship or
religious services, engage in no religious proselytizing and exert no other religious influence
in the provision of homeless housing and services funded hereunder.
d. Alternative Provider — The Subrecipient shall incorporate into their policies and procedures,
a written approved policy to refer, or transfer any program participant or prospective
program participant of the Continuum of Care program who objects. to the religious character
of the provider. The policy and procedures. shall be reviewed and subject to. approval by
Miami -Dade County Homeless Trust. At a minimum the policy and procedures shall include
action to transfer or refer within a reasonably prompt time after the objection and undertake
reasonable efforts to identify and refer the'participant to an alternative provider to which the
participant has no objection. Except for services provided by telephone, the Internet, or
similar means, the referral must be to an alternative provider in reasonable geographic
CoC Grant #FL0190L4D001811, The City of Miami, MMHAP South Program Page 34
proximity to the organization making the referral. In making the referral, the Subrecipient
shall comply with applicable privacy laws and regulations. The Subrecipient shall document
any objections from program participants and prospective program participants and any
efforts to refer such participants to alternative providers in accordance with the
requirements of 24 CFR 578.103(a)(13)..
The Subrecipient shall comply with the provisions of this section and with 24 CFR Part 578.87, as
well as with any other applicable laws or regulations governing a primarily religious organization.
10. Health Insurance Portability and Accountability Act (HIPAA)
Any person or entity that performs or assists Miami -Dade County with a function or activity involving
the use or disclosure of Individually Identifiable. Health Information (IIHI) and or Protected Health
Information (PHI) shall comply with the Health Insurance Portability and Accountability Act of 1996
(HIPAA), as may be amended, and any applicable federal, state, county and local laws and policies,
including by not limited to 24 CFR 578.103, 42 CFR Part 2, and Section 39.908, Florida Statutes, as
may be applicable. HIPAA mandates for privacy, security and electronic transfer standards that
include but are not limited to the following:
a. Use of information only for performing services required by the contract or as required by
law;
b. Use of appropriate safeguards to prevent no -Ti -permitted disclosures;
c. Reporting to Miami -Dade County of any non -permitted use or disclosure;
d. Assurances that any agents and subcontractors agree to the same restrictions and conditions
that apply to the Subrecipient and provides reasonable assurances that IIHI and PHI will be
held confidential;
e. Making PHI available to the customer;
f. . Making PHI available to Miami -Dade County for an accounting of disclosures;
g. Making internal practices, books and records related to PHI and IIHI available to Miami=Daae
County for compliance audits and for other purposes as may be permitted by law, and
h. PHI shall maintain its protected status regardless of the form and method of transmission
(including paper and or electronic transfer of data).
The Subrecipient must give its customers written notice* of all privacy information practices
including but not limited to description of the types of uses and disclosures that would be made with
protected health information.
11. Proof of Licensure / Certification and Background Screening
a. Licensure. - If the Subrecipient is required by the State of Florida or Miami -Dade County or
any federal, state or local law or regulation to be licensed or certified to provide the services
or operate the facilities outlined in the Scope of Service contained within the "Electronic
Review, Renewal Adjustment and HEARTH Renewal Application", Attachment B, the
Subrecipient'shall furnishto the Grantee a copy of all required current licenses or certificates.
Examples of services or operations requiting such licensure or certification include but are
not limited to childcare, day care, nursing homes, and boarding homes.
If the Subrecipient fails to furnish the Grantee with the licenses,- certificates or certifications
required under this Section, the Grantee in its sole discretion, shall not disburse any funds
until it is provided with such licenses or certifications. Failure to provide the required
licenses or certification.within sixty (60) days of execution of this Agreement may result in
termination of this Agreement at the Grantee's discretion.
CoC Grant #FL0190L4D001811, The City of Miami, MMHAP South Program Page 35
b. Background Screening - The Subrecipient agrees to comply with all applicable federal, state
and local laws, regulations, ordinances and resolutions regarding background screening of
employees, volunteers, subcontractors and independent contractors. Subrecipient's failure
to comply with any applicable laws, regulations, ordinances and resolutions regarding
background screening of employees, volunteers, subcontractors and independent
contractors is grounds for a material breach and termination of this contract at the sole
discretion of Miami -Dade County.
The Subrecipient agrees to comply with all applicable laws, (including but not limited to
chapters 39, 402, 409, 394,408, 393, 397, 943, 984, 985,1012 and 435, Florida Statutes, and
Section 943.04351, Florida Statutes, as may be amended from time to time), regulations,
ordinances and resolutions regarding background screening of those who may work or
volunteer directly with or in the vicinity of vulnerable persons as defined by Section 435.02
Florida Statutes, as may be amended from time to time.
In the event criminal background screenings is required by law, the State of Florida and / or
Miami -Dade County, the Subrecipient will permit only employees, volunteers,
subcontractors and independent contractors with a satisfactory national criminal
background check through an appropriate screening agency (i.e., the Florida Department of
Juvenile Justice, Florida Department of Law Enforcement or Federal Bureau of Investigation)
to work or volunteer in direct contact with or in the vicinity of vulnerable persons. The
Subrecipient shall also comply with Section 943.059, Florida Statutes, regarding court-
ordered sealing of criminal history records, and Section 943.0585, Florida Statutes, regarding
court-ordered expunction of criminal history records, as maybe applicable.
The Subrecipient agrees to ensure that employees, volunteers, subcontracted personnel and
independent contractors who work with vulnerable persons satisfactorily complete and pass
Level 2 background screenings before working or volunteering with any vulnerable persons.
The Subrecipient shall furnish Miami -Dade County with proof that employees, volunteers,
subcontracted personnel, and independent contractors who work with vulnerable persons,
satisfactorily passed Level 2 background screenings pursuant to Chapter 435 Florida
Statutes, as may be amended from time to time.
If the Subrecipient fails to furnish to Miami -Dade County proof that an employee, volunteer,
subcontractor or independent contractor's Level 2 or other required background screening
was satisfactorily passed and completed prior to that employee, volunteer, subcontractor or
independent contractor.working or volunteering with or in the vicinity of a vulnerable person
or vulnerable persons, Miami -Dade County shall not disburse any further funds and this
Agreement may be subject to termination at the sale discretion of Miami -Dade County.
SIGNATURES CONTINUE ON NEXT PAGE
CoC Grant #FL0190L4D001811, The City of Miami, MMHAP South Program Page 36
IN WITNESS WHEREOF, the parties have caused this (37) thirty-seven page Amendment to be
executed by their respective and duly authorized officers the day and year first above written.
WITNESSES:
TODD B. HANNON
CITY CLERK
Approved as to Form and Correctness:
LIM
VICTORIA MENDEZ
CITY ATTORNEY
ATTEST:
HARVEY RUVIN, CLERK
BY:
DEPUTY CLERK
(DATE)
ENTITY: CITY OF MIAMI, FLORIDA
A municipal corporation of
The State of Florida
I�
EMILIO T. GONZALEZ
CITY MANAGER
Approved as to Insurance Requirements:
0
ANN -MARIE SHARPE
RISK MANAGEMENT
Affix
Incorporation SEAL
here
Miami -Dade County, a political subdivision of
The State of Florida
CARLOS A. GIMENEZ
MAYOR
See attached memorandum dated ( ) approved as to form and legal
sufficiency
Resolution #R-1252-18
CoC Grant #FLO 190L4D001811, The City of Miami, MMHAP South Program Page 37
INDEX OF ATTACHMENTS
Attachment A - Continuum of Care Program Grant Agreement & Exhibit 1
Attachment B - Scope of Service and US HUD eSnaps documents
Attachment C - Form W-9 Request for Taxpayer
Attachment D - Miami -Dade County Required Affidavits and Declarations
Attachment E - Consolidated Financial Record and Reports - Excel Format
Attachment F - Performance Reports (Monthly and Annual)
Attachment G - CoC Internal Wellness Checklist and Guidelines
Attachment H - "Incident Report" form
Attachment I - "Real Property & Equipment Asset Inventory" form
Attachment j - When Subrecipient is the Rental Administrator
(Participant's Housing Application)* HAP & LEASE
Attachment K - When Miami -Dade County is the Rental Administrator
(Participant's Housing Application)* HAP & LEASE
Attachment L - Place -setter - Leave Blank
The "CoC Participant Housing Application" contained therein, maybe updated and amended from
time to time and re -issued administratively
CoC Grant #FL0190L4D001811, The City of Miami, MMHAP South Program Page 88
FY 2018
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 VY 2018 US HUD CoC Agreement"
Recipient Name: Miami -Dade County
Grant Number: FL0190L4D001811
Tag ID Number: 59-6000573
DUNS Number: 004148292
SCOPE OF WORK for
FY2018 COMPETITION
(funding 1 project in CoCs with multiple recipients)
1. The project listed on this Scope of Work is governed by the Act and Rule, as they may be
amended from time to time. The project is also subject to the terms of the Notice of Funds
Availability for the fiscal year competition in which the funds were awarded and to the
applicable annual appropriations act.
2. HUD designations of Continuums of Care as High -performing Communities (HPCS) are
published in the HUD Exchange in the appropriate Fiscal Years' CoC Program
Competition Funding Availability page. Notwithstanding anything to the contrary in the
Application or this Grant Agreement, Recipient may only use grant funds for HPC
Homelessness Prevention Activities if the Continuum that designated the Recipient to
apply for this grant was designated an HPC for the applicable fiscal year.
3. Recipient is not a Unified Funding Agency and was not the only Applicant the Continuum
of Care designated to apply for and receive grant funds and is not the only Recipient for
the Continuum of Care that designated it. HUD's total funding obligation for this grant is
$_141433_ for project number _FLO190L4D001811 . If the project is a renewal to
which expansion funds have been added during this competition, the Renewal Expansion
Data Report, including the Summary Budget therein, in a -snaps is incorporated herein by
reference and made a part hereof. In accordance with 24 CFR 578.105(b), Recipient is
prohibited from moving more than 10% from one budget line item in a project's approved
budget to another without a written amendment to this Agreement. The obligation for this
project shall be allocated as follows:
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
$ 132180
h.
Operating costs
$ 0
i.
Homeless Management Information System
$ 0
j.
Administrative costs
$ 9253
k.
Relocation Costs
$ 0
www.hud.gov espanol.hud.gov Page 5
1. HPC homelessness prevention activities:
Housing relocation and stabilization services
Short -term -and medium-term rental assistance
$0
$0.
4. Performance Period in number of months: _12_. The performance period for the
project begins 06-01-2019 and ends 05-31-2020 . No funds for
new projects may be drawn down by Recipient until HUD has approved site control
pursuant to §578.21 and §578.25 and no funds for renewal projects may be drawn down by
Recipient before the end date of the project's final operating year under the grant that has
been renewed.
5. If grant funds will be used for payment of indirect costs, the Recipient is authorized to
insert the Recipient's and Subrecipients' federally recognized indirect cost rates on the
attached Federally Recognized Indirect Cost Rates Schedule, which Schedule shall be
incorporated herein and made a part of the Agreement. No indirect costs may be charged
to the grant by the Recipient if their federally recognized cost rate is not listed on the
Schedule. If no federally recognized indirect cost rate is listed on the Schedule for a
project funded under this Agreement, no indirect costs may be charged to the project by
the subrecipient carrying out that project.
6. The project has not been awarded project -based rental assistance for a term of fifteen (15)
years. Additional funding is subject to the availability of annual appropriations.
www.hud.gov espanol.hud.gov Page 6
This agreement is hereby executed on behalf of the parties as follows:
UNITED STATES OF AMERICA,
Secretary of Housing and Urban Development
,Signature) I
Ann D. Chavis, Director
(Typed Name and Title)
February 22, 2019
(Date)
RECIPIENT
Miami -Dade County
(Name of Organization)
/' / f
(Signature of Authorized Official)
(Date)
Names and Title of Authorized Official)
KEMP
UV
RPIA aH-DD aD' CTIFL
Tag ID No.: 59-6000573
CoC Program Grant Number: FL0190L4D001811
Effective Date: 2/22/2019
DUNS No.: 004148292
FEDERALLY RECOGNIZED INDIRECT COST RATE SCHEDULE
Grant No. Recipient Name Indirect cost rate Cost Base
FL0190L4D001811
www.hud.gov espanol.hud.gov Page 8
The City of Miami
MMHAP South Program
Grant Number: FL0190L4D001811
ATTACHMENT B, BUDGET
Eligible Costs Annual
Annual Grant Term
Grant Term
Total Assistance
Annual
Assistance
Assistance (Renewal
(HUD
Requested
for
Assistance
Requested
(Renewal
Requested Submission)
(HUD Award)
Award)
Grant Term
(renewal
Requested (HUD
AwardLTotalll
1a. 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
$
132,180.00
$ 132,180.00
4. Operating
1 Year,
1 Year
$
-
$
S. HMIS
1 Year
1 Year
$
$
6. Sub -total Costs Requested
$
132,180.00
$ 132,180.00
7. Administration (Up to 10%)
$
9,253.00
$ 9,253.00
8. Total Assistance plus Admin Requested
$
141,433.00
$ 141,433.00
9. Cash Match
$
35,358.00
$ 35,358.00
10. In-kind Match
$
$
11. Total Match
$
35,358.001
$ 351358.00
12. Total Budget
$
176,791.001
$ 176,791.00
Match % 25%
##########
6E. SUPPORTIVE SERVICES BUDGET
Eligible Costs
Quantity AND Description (max 400
characters) (Renewal Submission)
Annual Assistance
Requested
(Renewal
Submission)
Annual Assistance
Requested (HUD
Award)
1. Assessment of Service heeds
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
3 FTE Community Outreach Specialists 1, 3
FTE Community Outreach Specialists 2 -
Salaries and Fringe Benefits, postage, office
supplies, safety and first aid kits, telephones,
handheld radios, networking.
$ 132,180.00
$ 132,180.00
14. Substance Abuse Treatment Services
15. Transportation
16. Utility Deposits
17. Operating Costs
Total Annual Assistance Requested
$ 132,180.00
$ 132,180.00
Grant Term
1 Year
I 1 Year
Total Request for Grant Term
$ 132,180.00
1 $ 132,180.00
FY 2018
Continuum of Care (CoC) Program
Scope of Service
eSnaps Budget and Performance Objectives
ATTACHMENT B "FY 2018 Scope of Service
Miami -Dade County Homeless Trust Scope of Service
FL0190L4D001811 MMHAP South
The Subrecipient shall provide outreach contacts, assessment and placement services to at least seven -hundred
seventy-five (775) eligible homeless households (465 individuals and 310 families) under the CoC Program
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 2018 NOFA (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 J 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 sldlls 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 Service FY 2018 Competition" 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 as well as with any other terms and conditions as
HUD may have established in the applicable Notice of Funds Availability 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"
Applicant: Miami -Dade County 0041482920000
Project: MMHAP South FL0190L4D001811
Before Starting the Project Application
To ensure that the Project Application is completed accurately, ALL
project applicants should review the following information BEFORE
beginning the application.
Things to Remember
- Additional training resources can be found on the HUD Exchange at
https://www.hudexchange.info/e-snaps/guides/coc-program-competition-resources/ - Program
policy questions and problems related to completing the application in a -snaps may be directed
to HUD via the HUD Exchange Ask A Question.
- Project applicants are required to have a Data Universal Numbering System (DUNS)
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) 2018
Continuum of Care (CoC) Program Competition. For more information see FY 2018 CoC
Program Competition NOFA.
- To ensure that applications are considered for funding, applicants should read all sections of
the FY 2018 CoC Program NOFA and the FY 2017 General Section NOFA.
- 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 onscreen text and the
hide/show instructions found on each individual screen.
- Before starting the project application, all project applicants must complete or update (as
applicable) the Project Applicant Profile in e -snaps.
- 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 2017 Project
Application will be imported into the FY 2018 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 a -snaps will not be imported into the project application.
- Expiring Shelter Plus Care projects requesting renewal funding for the first time under 24
CFR part 578, and rental assistance projects can only request the number of units and unit size
as approved in the final HUD -approved Grant Inventory Worksheet (GIW).
- Expiring Supportive Housing Projects requesting renewal funding for the first time under 24
CFR part 578, 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 2018 CoC Program Competition
NOFA.
Renewal Project Application FY2018 Page 1 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
1A. SF -424 Application Type
1. Type of Submission: Application
2. Type of Application: Renewal Project Application
If "Revision", select appropriate letter(s):
If "Other", specify:
3. Date Received: 09/06/2018
4. Applicant Identifier:
5a. Federal Entity Identifier:
5b. Federal Award Identifier: FLO190
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 X
Identifier has been updated to reflect the
most recently awarded grant number
6. Date Received by State:
7. State Application Identifier:
0041482920000
FL0190L4D001811
Renewal Project Application FY2018 Page 2 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
1B. SF -424 Legal Applicant
8. Applicant
a. Legal Name: Miami -Dade County
b. Employer/Taxpayer Identification Number 59-6000573
(EIN/TIN):
0041482920000
FL0190L4D001811
c. Organizational DUNS: 004148292 PLUS 4
d. Address
Street 1:
111 N.W. 1 st Street
Street 2:
27th floor, Suite 310
City:
Miami
County:
Miami -Dade
State:
Florida
Country:
United States
Zip / Postal Code:
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:
Mr.
First Name:
Manuel
Middle Name:
Last Name:
Sarria
Suffix:
Title:
Asst. Executive Director
Organizational Affiliation:
Miami -Dade County
Telephone Number:
(305) 375-1490
Renewal Project Application FY2018 Page 3 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
Extension:
Fax Number: (305) 375-2722
Email: Manuel.Sarria@miamidade.gov
0041482920000
FL0190L4D001811
Renewal Project Application FY2018 Page 4 04/10/2019
Applicant: Miami -Dade County 0041482920000
Project: MMHAP South FL0190L4D001811
1 C. SF -424 Application Details
9. Type of Applicant: B. County Government
10. Name of Federal Agency: Department of Housing and Urban Development
11. Catalog of Federal Domestic Assistance CoC Program
Title:
CFDA Number: 14.267
12. Funding Opportunity Number: FR -6200-N-25
Title: Continuum of Care Homeless Assistance
Competition
13. Competition Identification Number:
Title:
Renewal Project Application FY2018 Page 5 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
1 D. SF -424 Congressional District(s)
14. Area(s) affected by the project (State(s) Florida
only):
(for multiple selections hold CTRL key)
15. Descriptive Title of Applicant's Project: MMHAP South
16. Congressional District(s):
a. Applicant:
(for multiple selections hold CTRL key)
b. Project:
(for multiple selections hold CTRL key)
0041482920000
FL0190L4D001811
FL -027, FL -026, FL -024, FL -025, FL -023
FL -027, FL -026, FL -024
17. Proposed Project
a. Start Date: 06/01/2019
b. End Date: 05/31/2020
18. Estimated Funding ($)
a. Federal:
b. Applicant:
c. State:
d. Local:
e. Other:
f. Program Income:
g. Total:
Renewal Project Application FY2018 IPage 6 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
1E. SF -424 Compliance
0041482920000
FL0190L4D001811
19. Is the Application Subject to Review By b. Program is subject to E.O. 12372 but has not
State 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 FY2018 Page 7 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
1 F. SF -424 Declaration
0041482920000
FL0190L4D001811
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. I 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)
AGREE: FX
21. Authorized Representative
Prefix: Mr.
First Name: Carlos
Middle Name: A.
Last Name: Gimenez
Suffix:
Title: County Mayor
Telephone Number: (305) 375-1490
(Format: 123-456-7890)
Fax Number: (305) 375-2722
(Format: 123-456-7890)
Email: cgimenez@miamidade.gov
Signature of Authorized Representative: Considered signed upon submission in e -snaps.
Date Signed: 09/06/2018
Renewal Project Application FY2018 Page 8 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
1G. HUD 2880
Applicant/Recipient Disclosure/Update Report - Form 2880
U.S. Department of Housing and Urban Development
OMB Approval No. 2510-0011 (exp.11/30/2018)
Applicant/Recipient Information
1. Applicant/Recipient Name, Address, and Phone
Agency Legal Name:
Miami -Dade County
Prefix:
Mr.
First Name:
Carlos
Middle Name:
A.
Last Name:
Gimenez
Suffix:
Title:
County Mayor
Organizational Affiliation:
Miami -Dade County
Telephone Number:
(305) 375-1490
Extension:
Email:
cgimenez@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 $141,433.00
Requested/Received:
(Requested amounts will be automatically entered within applications)
0041482920000
FL0190L4D001811
Renewal Project Application FY2018 Page 9 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
0041482920000
FL0190L4D001811
5. State the name and location (street MM HAP South 111 N.W. 1st Street Miami Florida
address, city and state) of the project or
activity:
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 Yes
specific project or activity?
(For further information, see 24 CFR Sec. 4.3).
2. Have you received or do you expect to Yes
receive 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 11 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.
DepartmentlLocal Agency Name and Address Type of Assistance
Amount Expected Uses of the Funds
Requested!
Provided
N/A
Part III Interested Parties
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 list of all persons with a Social Security No. Type of Financial Interest Financial Interest
Renewal Project Application FY2018 Page 10 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
0041482920000
FL0190L4D001811
reportable financial interest in the
project or activity
(For individuals, give the last name
first)
or Employee ID No.
Participation
in Project/Activity
in Project/Activity
N
See detailed attachment placed in
"Other Attachment"
59-6000573
CA
$29,811,202.00
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 this information is true and complete.
I AGREE: FX
Name / Title of Authorized Official: Carlos Gimenez, County Mayor
Signature of Authorized Official: Considered signed upon submission in e -snaps.
Date Signed: 09/06/2018
Renewal Project Application FY2018 Page 11 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
1H. HUD 50070
HUD 50070 Certification for a Drug Free Workplace
Applicant Name: Miami -Dade County
Program/Activity Receiving Federal Grant CoC Program
Funding:
0041482920000
FL0190L4D001811
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:
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.
I hereby certify that all the information stated X
herein, as well as any information provided in
the accompaniment herewith, is true and
Renewal Project Application FY2018 I Page 12 1 04/10/2019
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
e.
Notifying the agency in writing, within ten calendar days after
manufacture, distribution, dispensing, possession, or use of a
receiving notice under subparagraph d.(2) from an employee or
controlled substance is prohibited in the Applicant's workplace
otherwise receiving actual notice of such conviction. Employers
and specifying the actions that will be taken against employees
of convicted employees must provide notice, including position
for violation of such prohibition.
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
f.
Taking one of the following actions, within 30 calendar days of
inform employees ---
receiving notice under subparagraph d.(2), with respect to any
(1) The dangers of drug abuse in the workplace
employee who is so convicted --
(2) The Applicant's policy of maintaining a drug-free workplace;
(1) Taking appropriate personnel action against such an
(3) Any available drug counseling, rehabilitation, and employee
employee, up to and including termination, consistent with the
assistance programs; and
requirements of the Rehabilitation Act of 1973, as amended; or
(4) The penalties that may be imposed upon employees for drug
(2) Requiring such employee to participate satisfactorily in a
abuse violations occurring in the workplace.
drug abuse assistance or rehabilitation program approved for
such purposes by a Federal, State, or local health, law
enforcement, or other appropriate agency;
C.
Making it a requirement that each employee to be engaged in
g.
Making a good faith effort to continue to maintain a drugfree
the performance of the grant be given a copy of the statement
workplace through implementation of paragraphs a. thru f.
required by paragraph a.;
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.
I hereby certify that all the information stated X
herein, as well as any information provided in
the accompaniment herewith, is true and
Renewal Project Application FY2018 I Page 12 1 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
0041482920000
FL0190L4D001811
accurate.
Warning: HUD will prosecute false claims and statements. Conviction may result in criminal
and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Authorized Representative
Prefix: Mr.
First Name: Carlos
Middle Name A.
Last Name: Gimenez
Suffix:
Title:
County Mayor
Telephone Number:
(305) 375-1490
(Format: 123-456-7890)
Fax Number:
(305) 375-2722
(Format: 123-456-7890)
Email:
cgimenez@miamidade.gov
Signature of Authorized Representative:
Considered signed upon submission in e -snaps.
Date Signed:
09/06/2018
Renewal Project Application FY2018 Page 13 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
CERTIFICATION REGARDING LOBBYING
0041482920000
FL0190L4D001811
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 less 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
Renewal Project Application FY2018 Page 14 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
0041482920000
FL0190L4D001811
the required statement shall be subject to a civil penalty of not less than
$10,000 and not more than $100,000 for each such failure.
I hereby certify that all the information stated X
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 and/or civil 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: Carlos Gimenez, County Mayor
Signature of Authorized Official: Considered signed upon submission in e -snaps.
Date Signed: 09/06/2018
Renewal Project Application FY2018 Page 15 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
1J. SF -LLL
0041482920000
FL0190L4D001811
DISCLOSURE OF LOBBYING ACTIVITIES
Complete this form to disclose lobbying activities pursuant to 31 U.S.C.
1352.
Approved by OMB0348-0046
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 on 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 No
grant participate in federal lobbying activities
(lobbying a federal administration or
congress) in connection with the CoC
Program?
Legal Name: Miami -Dade County
Street 1: 111 N.W. 1 st Street
Street 2: 27th floor, Suite 310
City:
Miami
County:
Miami -Dade
State:
Florida
Country: United States
Zip / Postal Code: 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. This 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 X
complete.
Renewal Project Application FY2018 Page 16 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
0041482920000
FL0190L4D001811
Authorized Representative
Prefix:
Mr.
First Name:
Carlos
Middle Name:
A.
Last Name:
Gimenez
Suffix:
Title:
County Mayor
Telephone Number:
(305) 375-1490
(Format: 123-456-7890)
Fax Number:
(305) 375-2722
(Format: 123-456-7890)
Email:
cgimenez@miamidade.gov
Signature of Authorized Official:
Considered signed upon submission in e -snaps.
Date Signed:
09/06/2018
Renewal Project Application FY2018 Page 17 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
0041482920000
FL0190L4D001811
Information About Submission without Changes
After Part 1 is completed; including this screen, Recipient Performance
screen, and Renewal Grant Consolidation screen, then Parts 2-6, are
available for review as "Read -Only;" except for 3A, 7A and 7B which are
mandatory for all projects to update. After project applicants finish
reviewing all screens, they will be guided to a "Submissions without
Changes" Screen. At this screen, if applicants decide no edits or updates
are required to any screens other than the mandatory questions, they can
submit without changes. However, if changes to the application are
required, a -snaps allows applicants to open individual screens for editing,
rather than the entire application. After project applicants select the
screens they intend to edit via checkboxes, click "Save" and those
screens will be available for edit. Importantly, once an applicant makes
those selections and clicks "Save" the applicant cannot uncheck those
boxes.
If the project is a first-time renewal or selects "Fully Consolidated" on the
Renewal Grants Consolidation screen, the "Submit Without Changes"
function is not available, and applicants must input data into the
application for all required fields relevant to the component type.
Renewal Project Application FY2018 Page 18 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
Recipient Performance
1. Has the recipient successfully submitted Yes
the APR on time for the most recently expired
grant term related to this renewal project
request?
2. Does the recipient have any unresolved No
HUD Monitoring and/or OIG Audit findings
concerning any previous grant term related to
this renewal project request?
3. Has the recipient maintained consistent Yes
Quarterly Drawdowns for the most recent
grant term related to this renewal project
request?
4. Have any Funds been recaptured by HUD No
for the most recently expired grant term
related to this renewal project request?
0041482920000
FL0190L4D001811
Renewal Project Application FY2018 Page 19 04/10/2019
Applicant: Miami -Dade County 0041482920000
Project: MMHAP South FL0190L4D001811
Renewal Grant Consolidation Screen
HUD encourages the consolidation of renewal grants. As part of the FY
2018 CoC Program project application process, project applicants can
request their eligible renewal projects to be part of a Renewal Grant
Consolidation. This process can consolidate up to 4 renewal grants into 1
consolidated grant. This means recipients no longer must wait for grant
amendments to consolidate grants. All projects that are part of a renewal
grant consolidation must expire in Calendar Year (CY) 2019, as confirmed
on the FY 2018 Final GIW, must be to the same recipient, and must be for
the same component and project type (i.e., PH -PSH, PH-RRH, Joint TH/PH-
RRH, TH, SSO, SSO-CE or HMIS).
1. Is this project application requesting to be No
part of a renewal grant consolidation in the
FY 2018 CoC Program Competition?
If "No" click on "Next" or "Save & Next"
below to move to the next screen.
Renewal Project Application FY2018 Page 20 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
2A. Project Subrecipients
0041482920000
FL0190L4D001811
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: $141,433
Organization
Type
Type
Sub-
Awar
d
Amo
unt
City of Miami
C. City or Township Government
C. City or Township Government
$141,
433
Renewal Project Application FY2018 Page 21 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
ZA. Project Subrecipients Detail
a. Organization Name: City of Miami
b. Organization Type: C. City or Township Government
c. Employer or Tax Identification Number: 59-6000375
0041482920000
FL0190L4D001811
d. Organizational DUNS: 118890230 PLUS 4
e. Physical Address
Street 1:
444 SW 2nd Avenue, 5th Floor
Street 2:
City:
Miami
State:
Florida
Zip Code:
33130
f. Congressional District(s): FL -027, FL -026, FL -024
(for multiple selections hold CTRL key)
g. Is the subrecipient a Faith -Based No
Organization?
h. Has the subrecipient ever received a Yes
federal grant, either directly from a federal
agency or through a State/local agency?
i. Expected Sub -Award Amount: $141,433
j. Contact Person
Prefix: Mr.
First Name: Sergio
Middle Name:
Last Name: Torres
Renewal Project Application FY2018 Page 22 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
0041482920000
FL0190L4D001811
Suffix:
Title: Program Administrator
E-mail Address: storres@miamigov.com
Confirm E-mail Address: storres@miamigov.com
Phone Number: 305-960-4980
Extension:
Fax Number: 305-960-4977
Renewal Project Application FY 2018 Page 23 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
3A. Project Detail
1. Project Identification Number (PIN) of FL0190
expiring grant:
(e.g., the "Federal Award Identifier" indicated on form 1A. Application Type)
0041482920000
FL0190L4D001811
2a. CoC Number and Name: FL -600- Miami -Dade County CoC
2b. CoC Collaborative Applicant Name: Miami -Dade County
3. Project Name: MMHAP South
4. Project Status: Standard
5. Component Type: SSO
6. Does this project use one or more No
properties that have been conveyed through
the Title V process?
7. Will this renewal project be part of a new No
application for a Renewal Expansion Grant?
Renewal Project Application FY2018 Page 24 04/10/2019
Applicant: Miami -Dade County
0041482920000
Project: MMHAP South FL0190L4D001811
3B. Project Description
1. Provide a description that addresses the entire scope of the proposed
project.
The Miami Metro Homeless Assistance Program (MMHAP) South currently
provides outreach supportive services to homeless individuals and families
living on the streets throughout Miami -Dade County. Multilingual teams provide
outreach services for the southern part of the County; from Kendall Drive (S.W.
88 Street) to the Monroe County line. MMHAP Program South Teams are
assigned to search for homeless individuals and families living on the street, in
parks, abandoned buildings, underneath expressways and other places not
meant for human habitation. The focus is to engage the individual (s) into
accepting housing and services available for the homeless individuals and
families. The MMHAP Team provides outreach services via a Coordinated
Entry and Assessment process and the established Homeless Helpline. Teams
complete a comprehensive assessment to determine individuals' needs,
vulnerability and make appropriate recommendations for housing and services.
The Teams identify available housing availability (e.g., shelters), provide
transportation, and monitor initial housing placements for a minimum of seven
days.
Goals & Objectives: The goal of the program is to impact the lives of homeless
individuals and families living on the streets, under bridges, and homeless
encampments in the area south of Kendall Drive, by engaging them in many
services provided by the Miami -Dade Homeless Trust's Continuum of Care.
Program Eligibility Requirements: The MMHAP Program provides outreach,
assessment and placement services to homeless individuals and families who
meet the HUD definition of homeless and are seeking housing services.
MMHAP Program Teams provide services to all individuals and families
requesting services without the need of identification, social security cards,
and/or documented citizenship status. Homeless individuals must be at least
18 years of age or have proof of being an emancipated minor; he/she must be
physically residing in Miami -Dade County or physically in Miami -Dade County
with the intent to make this county his/her home.
Number of Clients and Population Served:
For the purpose of this application, the MMHAP proposes to contact homeless
individuals and families, complete assessments, and place individuals and
families in homeless shelters and/or treatment facilities, or permanent housing
for a minimum of seven days. Characteristics of homeless individuals and
families to be served mirror those of the existing grant project and include
individuals with severe mental illness and/or chronic alcohol or other drug
abuse, the dually -diagnosed, persons with AIDS or related diseases, and other
medical disabilities.
Hours of Operation: The MMHAP Program's working hours are from 8:00 am to
6:00 pm, Monday through Friday.
2. Does your project have a specific No
population focus?
Renewal Project Application FY2018 Page 25 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
3. Housing First
3a. Does the project quickly move Yes
participants into permanent housing
0041482920000
FL0190L4D001811
3b. Does the project ensure that participants are not screened out based
on the following items? Select all that apply.
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
❑
❑X
X
❑
History of victimization
(e.g. domestic violence, sexual assault, childhood abuse)
❑X
None of the above
❑
3c. Does the project ensure that participants are not terminated from the
program for the following reasons? Select all that apply.
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?
4. Please select the type of SSO Project: Street Outreach
Renewal Project Application FY2018 Page 26 04/10/2019
Applicant: Miami -Dade County
0041482920000
Project: MMHAP South FL0190L4D001811
4A. Supportive Services for Participants
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. For all supportive services available to 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
Subrecipient Daily
Assistance with Moving Costs
Case Management
Subrecipient Daily
Child Care
Education Services
Employment Assistance and Job Training
Food
Housing Search and Counseling Services
Legal Services
Life Skills Training
Mental Health Services
Non -Partner As needed
Outpatient Health Services
Partner As needed
Outreach Services
Subrecipient Daily
Substance Abuse Treatment Services
Non -Partner As needed
Transportation
Subrecipient Daily
Utility Deposits
2. Please identify whether the project
includes the following activities:
2a. Transportation assistance to clients to Yes
attend mainstream benefit appointments,
employment training, or jobs?
2b. At least annual follow-ups with No
participants to ensure mainstream benefits
are received and renewed?
3. Do project participants have access to No
Renewal Project Application FY2018 Page 27 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
SSI/SSDI technical assistance provided by
the applicant, a subrecipient, or partner
agency?
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Renewal Project Application FY2018 Page 28 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
5A. Project Participants - Households
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FL0190L4D001811
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.
Households Households with at Adult Households Households with Total
Least One Adult without Children Only Children
and One Child
Total Number of Households 310 465 775
Characteristics
Adults over age 24
Adults ages 18-24
Accompanied Children under age 18
Unaccompanied Children under age 18
Total Persons
Persons in
Households with at
Least One Adult
and One Child
310
0
355
665
Persons in
Households with
Only Children
��
0
0
0
Click Save to automatically calculate totals
Total
775
0
355
0
1,130
Renewal Project Application FY2018 Page 29 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
5B. Project Participants. i Subpopulations
0041482920000
FL0190L4D001811
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.
Persons in Households with at Least One Adult and One Child
Click Save to automatically calculate totals
Persons in Households without Children
Non-. ,
Non-
Persons
Persons
Persons
Chronic
Chronic
Chronic
Chronic
Chronic
Victims
not
Victims
ally ally ally ,
Substan
not
Severely
ally
ally
ally
Substan
Persons
Severely
of
Physical
Develop
represen
Characteristics
Homeles
Homeles
Homeles
ce
with
Mentally
Domesti
Disabilit
mental
ted by
listed
s Non-
s
s
Abuse
HIV/AID
111
c
y
Disabilit
fisted
Veterans
Veterans
Veterans
subpopu
S
Violence
Adults over age 24
y
subpopu
5
30
2
3
0
382
Adults ages 18-24
0 0
0
0
lations
Adults over age 24
0
0
0
20
20
50
10
10
0
200
Adults ages 18-24
382
0
0
0
Children under age 18
0„
W.
k
0
0
0
0
0
355
Total Persons
0
0
0
20
20
50
10
10
0
555
Click Save to automatically calculate totals
Persons in Households without Children
Click Save to automatically calculate totals
Persons in Households with Only Children
Non-. ,
Persons
Persons
Chronic Chronic Chronic'
Chronic
Chronic' Ctirortic
Chronic
Victims
Victims
not
ally ally ally ,
Substan
Persons
Severely
of
Physical
Develop
represen
Characteristics
Homeles Homeles Homeles
ce
with
Mentally
Domesti
Disabilit
mental
ted by
Domesti
s Non- s s '-'
Abuse
HIVIAID
111
c
y
Disabilit
listed
III
Veterans Veterans Veterans
y
S
listed
Violence
Veterans
y
subpopu
S
Violence
y
subpopu
lations
Adults over age 24
30 0
35
5
30
2
3
0
382
Adults ages 18-24
0 0
0
0
0
0
0
0
0
Total Persons
30 0 0
35
5
30
2
3
0
382
Click Save to automatically calculate totals
Persons in Households with Only Children
Renewal Project Application FY2018 Page 30 04/10/2019
Persons
chronic
Chronic' Ctirortic
Chronic
Victims
not
. 'ally .
ay .�=:: ally =
Substan
Persons
Severely
of
Physical
Develop
represen
Characteristics
Homeles
Homeles Homeles
ce
with
Mentally
Domesti
Disabilit
mental
ted by
sNon
zs s }`;
Abuse
HIVfAID
III
c
y
Disabilit
listed
Veterans
Veterans Veterans
S
Violence
y
subpopu
lations
Accompanied Children underage 18
Renewal Project Application FY2018 Page 30 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
0041482920000
FL0190L4D001811
Unaccompanied Children under age 18
_
Total Persons
0 5- �� 0
0
0
0
0 0
0
Describe the unlisted subpopulations referred to above:
These are individuals who are either children or adults who are unable to be
categorized in one of the identified areas.
Renewal Project Application FY2018 Page 31 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
5C. Outreach for Participants
0041482920000
FL0190L4D001811
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. Enter the percentage of project participants that will be coming from
each of the following locations.
100%
Directly from the street or other locations not meant for human habitation.
Directly from emergency shelters.
Persons at imminent risk of losing their night time residence within 14 days, have no subsequent housing identified,
and lack the resources to obtain other housing (TH and SSO Pojects Only)
Directly from safe havens.
Persons fleeing domestic violence.
Directly from transitional housing.
Directly from transitional housing eliminated in a previous CoC Program Competition.
100%
Total of above percentages
Renewal Project Application FY2018 Page 32 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
6A. Funding Request
1. Do any of the properties in this project No
have an active restrictive covenant?
2. Was the original project awarded as either No
a 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: 1 Year
5. Select the costs for which funding is being
requested:
Leased Structures
Supportive Services X
HMIS
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Renewal Project Application FY2018 Page 33 04/10/2019
Applicant: Miami -Dade County
0041482920000
Project: MMHAP South FL0190L4D001811
6D. Sources of Match
The following list summarizes the funds that will be used as Match for the
project. To add a Matching source to the list, select the icon. To view or
update a Matching source already listed, select the icon.
Summary for Match
Total Value of Cash Commitments:
$35,358
Total Value of In -Kind Commitments:
$0
Total Value of All Commitments:
$35,358
1. Does this project generate program income No
as described in 24 CFR 578.97 that will be
used as Match for this grant?
Match
Type
Source
Contributor
Date of
Value of
Commitment
Commitments
Yes
Cash
Government
Miami -Dade
09/10/2018
$35,358
County...
Renewal Project Application FY2018 Page 34 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
Sources of Match Detail
1. Will this commitment be used towards Yes
Match?
0041482920000
FL0190L4D001811
2. Type of Commitment: Cash
3. Type of Source: Government
4. Name the Source of the Commitment: Miami -Dade County Homeless Trust
(Be as specific as possible and include the
office or grant program as applicable)
5. Date of Written Commitment: 09/10/2018
6. Value of Written Commitment: $35,358
Renewal Project Application FY2018 Page 35 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
6E. Summary Budget
0041482920000
FL0190L4D001811
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 2017 GIW or the project budget as reduced due to CoC
reallocation. Please note that, new for FY 2017, 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)
1a. Leased Units
$0
1b. Leased Structures
$0
2. Rental Assistance
$0
3. Supportive Services
$132,180
4. Operating
$0
5. HMIS
$0
6. Sub -total Costs Requested
$132,180
7. Admin
(Up to 10%)
$9,253
8. Total Assistance
plus Admin Requested
$141,433
9. Cash Match
$35,358
10. In -Kind Match
$0
11. Total Match
$35,358
12. Total Budget
$176,791
Renewal Project Application FY2018 Page 36 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
7A. Attachment(s)
0041482920000
FL0190L4D001811
Document Type
Required?
Document Description
Date Attached
1) Subrecipient Nonprofit
Documentation
No
2) Other Attachmenbt
No
3) Other Attachment
No
Renewal Project Application FY2018 Page 37 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
0041482920000
FL0190L4D001811
Attachment Details
Document Description:
Attachment Details
Document Description: FLO190 MMHAP South Match Documentation
Attachment Details
Document Description: 2017 HT CoC Match Documentation
Renewal Project Application FY2018 Page 38 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
7B. Certification
A. For all projects:
Fair Housing and Equal Opportunity
0041482920000
FL0190L4D001811
It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulations
pursuant thereto (Title 24 CFR part 1), which state that no person in the United States shall, on
the ground of race, color or national origin, be excluded from participation in, be denied the
benefits of, or be otherwise subjected to discrimination under any program or activity for which
the applicant receives Federal financial assistance, and will immediately take any measures
necessary to effectuate this agreement. With reference to the real property and structure(s)
thereon which are provided or improved with the aid of Federal financial assistance extended to
the applicant, this assurance shall obligate the applicant, or in the case of any transfer,
transferee, for the period during which the real property and structure(s) are used for a purpose
for which the Federal financial assistance is extended or for another purpose involving the
provision of similar services or benefits.
It will comply with the Fair Housing Act (42 U.S.C. 3601-19), as amended, and with
implementing regulations at 24 CFR part 100, which prohibit discrimination in housing on the
basis of race, color, religion, sex, disability, familial status or national origin.
It will comply with Executive Order 11063 on Equal Opportunity in Housing and with
implementing 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.
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.
Renewal Project Application FY2018 Page 39 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
0041482920000
FL0190L4D001811
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 less than 15 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.
Not applicable.
Name of Authorized Certifying Official Carlos Gimenez
Date: 09/06/2018
Title: County Mayor
Renewal Project Application FY2018 Page 40 04/10/2019
Applicant. Miami -Dade County
Project: MMHAP South
Applicant Organization: Miami -Dade County
PHA Number (For PHA Applicants Only):
I certify that I have been duly authorized by X
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).
0041482920000
FL0190L4D001811
Renewal Project Application FY2018 Page 41 04/10/2019
Applicant: Miami -Dade County 0041482920000
Project: MMHAP South FL0190L4D001811
Submission Without Changes
1. Are the requested renewal funds reduced No
from the previous award as a result of
reallocation?
2. Do you wish to submit this application Make changes
without 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. Subrecipients
X
❑
Part 3 - Project Information
3A. Project Detail
X
❑
3B. Description
X
❑
Part 4 - Housing Services and HMIS
4A. Services ❑
Part 5 - Participants and Outreach Information
5A. Households ❑
5B. Subpopulations ❑
5C. Outreach ❑
Part 6 - Budget Information
6A. Funding Request ❑
X
6D. Match ❑
X
6E. Summary Budget ❑
X
Part 7 - Attachment(s) & Certification
7A. Attachment(s) ❑
X
Renewal Project Application FY2018 Page 42 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
0041482920000
FL0190L4D001811
7B. Certification ❑
X
The applicant has selected "Make Changes" to Question 2 above. Please
provide a brief description of the changes that will be made to the project
information screens (bullets are appropriate):
Update Housing First Assessment and correct Match
The applicant has selected "Make Changes". Once this screen is saved,
the applicant 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 FY2018 Page 43 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
8B Submission Summary
Page
1A. SF -424 Application Type
1 B. SF -424 Legal Applicant
1C. SF -424 Application Details
1D. SF -424 Congressional District(s)
1E. SF -424 Compliance
Last Updated
09/06/2018
No Input Required
No Input Required
09/06/2018
09/06/2018
0041482920000
FL0190L4D001811
Renewal Project Application FY2018 Page 44 04/10/2019
Applicant: Miami -Dade County
Project: MMHAP South
IF. SF -424 Declaration
09/06/2018
1G. HUD -2880
09/06/2018
IH. HUD -50070
09/06/2018
11. Cert. Lobbying
09/06/2018
1J. SF -LLL
09/06/2018
Recipient Performance
09/06/2018
Renewal Grant Consolidation
09/06/2018
2A. Subrecipients
09/06/2018
3A. Project Detail
09/06/2018
3B. Description
09/06/2018
4A. Services
09/06/2018
5A. Households
09/06/2018
5B. Subpopulations
09/06/2018
5C. Outreach
09/06/2018
6A. Funding Request
09/06/2018
6D. Match
09/06/2018
6E. Summary Budget No Input Required
7A. Attachment(s) No Input Required
7B. Certification 09/06/2018
Submission Without Changes 09/06/2018
0041482920000
FL0190L4D001811
Renewal Project Application FY2018 Page 45 04/10/2019
FY 2018
Miami -Dade County Homeless Trust
Continuum of Care (COC) 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 Number and Certification"
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
Social security number
Request for TaxpayerGive
Form to the
Form
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
(Rev. October 2018)
Identification Number and Certification
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
requester. Do not
Department
of the Treasury
TIN, later.
send to the IRS,
Internal Revenue Service
ll� Go to wwwJr:s.gov1FormW9 for instructions and the latest information.
1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
City of Miami
2 Business name/disregarded entity name, if different from above
3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the
4 Exemptions (codes apply only to
following seven boxes.
certain entities, not individuals; see
CL
instructions on page 3):
C
❑ Partnership ❑ Trust/estate
❑ IndividuaVsole proprietor or ❑ C Corporation ❑ S Corporation p
c
single -member LLC
Exempt payee code (if any)
2
❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ►
0 2
Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check
Exemption from FATCA reporting
•' 0
E
LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is
from LLC
code if an y)
(
a
another LLC that is not disregarded the owner for U.S, federal tax purposes. Otherwise, a single -member that
°
is disregarded from the owner should check the appropriate box for the tax classification of its owner.
�
❑✓ Other ► Municipality
(Applies to accounts maintained outside the U.S.)
to
5 Address (number, street, and apt. or suite no.) See instructions.
Requester's name and address (optional)
cn
444 SW 2nd Avenue; 6th Floor
6 City, state, and ZIP code
Miami, FL 33130
7 List account number(s) here (optional)
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
Social security number
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
— m —
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN, later.
or
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and I Employer identification number
Number To Give the Requester for guidelines on whose number to enter.
F51 9 — 6 1 0 1 0 1 0 1 3 7 5
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. 1 am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that 1 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 not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments
other than interest and dividends, you are not requi!9110 sign the certification, but you must provide your correct TIN. See the instructions for Part Il, later.
Sign( Signature I // A"t, / Date►
� /30
Here U.S. personn I-/
"/ �-f
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.gov/Form W9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer
identification number (TIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns include, but are not limited to, the following.
• Form 1099 -INT (interest earned or paid)
• Form 1099 -DIV (dividends, including those from stocks or mutual
funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds)
• Form 1099-6 (stock or mutual fund sales and certain other
transactions by brokers)
• Form 1099-S (proceeds from real 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 (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
If 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. 10-2018)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
Social security number
Request for Taxpayer
Give Form to the
Form
. Forr otherother
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, laterr. F
(Rev. October 2018)
Identification Number and Certification
requester. Do not
DepartentoftheTreasury
mRevenue
send to the IRS.
Internal
Service
► Go to wwwJrs.gov/FormW9 for instructions and the latest information.
or
1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
2 Business name/disregarded entity name, if different from above
M
3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the
P Y
4 Exemptions codes apply only to
P ( PP Y Y
M
0
following seven boxes.
certain entities, not individuals; see
a
instructions on page 3):
C
❑ Individual/sole proprietor or El Corporation El Corporation El Partnership ElTrust/estate
N
Q3 c
single -member LLC
Exempt payee code (if any)
❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ►
`o LNote:
Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check
Exemption from FATCA reporting
+' to
LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC Is
code if an
( Y)
another LLC that is not disregarded from the.owner for U.S. federal tax purposes. Otherwise, a single -member LLC that
d o
t.—
is disregarded from the owner should check the appropriate box for the tax classification of its owner.
❑ Other (see instructions) ►
(Applies to accounts maintained oNside the U.S.)
fA
5 Address (number, street, and apt. or suite no.) See instructions.
Requester's name and address (optional)
a>
a)
6 City, state, and ZIP code
7 List account number(s) here (optional)
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
Social security number
backup withholding. For individuals, this is generally your social security number (SSN. However,. for a
. Forr otherother
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, laterr. F
entities, it is your employer identification number (EIN). if you do not have a number, see How to get a
TIN, later.
or
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and [ Employer identification number
Number To Give the Requester for guidelines on whose number to enter. n1
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. 1 am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must -cross out item 2 above if youhave 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 not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments
other than 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 Signature of
Here U.S, person ► Date 11 -
General
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latestinformationabout developments
related to Form W-9 and its instructions, such as. legislation enacted
after they were published, go to www.irs.gov/FormW9.
Purpose of -Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer -
identification number (TIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption.
taxpayer Identification. number(ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns include, but are not limited to, the following.
Form 1099 -INT (interest earned or paid)
• Form 1099 -DIV (dividends, including those from stocks or mutual
funds)
-.Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds)
• Form 1099-B (stock or mutual fund sales.and certain other
transactions by brokers)
• Form 1099-S (proceeds front real 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 (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
If 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. 10-2018)
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 States 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 FormW-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 1.446 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 `L
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 if:
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
return (for reportable interest and dividends only), or
5. You do not certify to the requester that you are not subject to
backup withholding under 4 above (for reportable interest and dividend.
.accounts opened after 1983 only).
Certain payees and payments are exempt from backup withholding.
See 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 anew 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 TINs. If the requester discloses or uses TINS in violation of
federal law, the requester may be subject to civil and criminal penalties.
Specific Instructions
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 return.
If this Form 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 I 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 1 a. 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/1040E-7 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,.0
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(6)(2)(11). 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
THEN check the box for .. .
a(n) ...
• Corporation
Corporation
• Individual
Individual/sole proprietor or single-
• Sole proprietorship, or
member LLC
• Single -member limited liability
company (LLC) owned by an
individual and disregarded for U.S.
federal tax purposes.
• LLC treated as a partnership for
Limited liability company and enter
U.S. federal tax purposes,
the appropriate tax classification.
• LLC that has filed Form 8832 or
(P= Partnership; C= C corporation;
2553 to be taxed as a corporation,
or S= S corporation)
or
• LLG 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.
• 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 paid 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 all 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 7
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
Exempt payees 1 through 4
patronage dividends
Payments over $600 required to be
Generally, exempt payees .
reported and direct sales over
1 through 52
$5,0001
Payments made in settlement of
Exempt payees 1 through 4
payment card or third party network
transactions
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(% 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 States 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 state
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
below.
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 SS -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 17800-772-1213.
Use Form W-7, Application for IRS Individual Taxpayer Identification
Number, to apply for an ITIN, or Form SS -4, Application for Employer
Identification Number, to apply for an EIN. You can 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.irs.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, Coverdell ESA, Archer MSA or HSA 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: I Give name and SSN of:
1. Individual
2. Two or more individuals (joint
account) other than an account
maintained by an FFI
3. Two or more U.S. persons
(Joint 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 Fling Method 1 (see
Regulations section 1.671-4(b)(2)(1)
(A))
The individual
The actual owner of the account or, if
combined funds, the first individual on
the account
Each holder of the account
The minor2
Page 5
For this type of account: I Give name and EIN of:
14. Account with the Department of The public entity
Agriculture in the name of a public
entity (such as a state or local
government, school district, or
prison) that receives agricultural
program payments
15. Grantor trust filing under the Form The trust
1041 Filing Method or the Optional
Form 1099 Fling Method 2 (see
Regulations section 1.671-4(b)(2)()(B))
I List first and circle the name of the person whose number you furnish.
If only one person on a joint account has an SSN, that person's number
must be furnished.
2 Circle the minor's name and furnish 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
For this type of account: I Give name and EIN of:
S. 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
Form 2553
11. Association, club, religious,
charitable, educational, or other tax-
exempt organization
12. Partnership or multi -member LLC
13. A broker or registered nominee'
rhe owner
Legal entity"
The corporation
The organization
The partnership
The broker or nominee
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 TTY/TDD
1-800-829-4059.
Protect yourself from suspicious smalls or phishing schemes.
Phishing is the creation and use of email and websites designed to
mimic legitimate business smalls 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.
• Be careful when choosing a tax preparer.
The grantor -trustees
If your tax records are affected by identity theft and you receive a
The actual owner s
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
The owner
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
The grantor*
at 1-800-908-4490 or submit Form 14039.
For this type of account: I Give name and EIN of:
S. 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
Form 2553
11. Association, club, religious,
charitable, educational, or other tax-
exempt organization
12. Partnership or multi -member LLC
13. A broker or registered nominee'
rhe owner
Legal entity"
The corporation
The organization
The partnership
The broker or nominee
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 TTY/TDD
1-800-829-4059.
Protect yourself from suspicious smalls or phishing schemes.
Phishing is the creation and use of email and websites designed to
mimic legitimate business smalls 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 phishing@irs.gov. You may also report misuse
of the IRS name, logo, or other IRS property to the Treasury Inspector
General for Tax Administration (fIGTA) at 1-800-366-4484. You can
forward suspicious emails to the Federal Trade Commission at
spam@uce.gov or report them at www.ftc.gov/complaint. You can
contact the FTC at www.ftc.govBdtheft or 877-IDTHEFT (877-438-4338).
If you have been the victim of identity theft, see www.ldentiVMeft.gov
and Pub. 5027.
Visit wwwJrs.gov/ldendWheft 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 HSA. 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 maybe 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 combatterrodsm.-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.
FY 2018
Miami -Dade County Homeless Trust
Continuum of Care (CoC) Program,
"Affidavits and Declarations"
ATTACHMENT D "Affidavits and Declarations"
Miami -Dade County's Affidavits and Declarations
MIAMI -
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 "0" 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)- Post Of
addresses are not acceptable.
TM.
Federal Employment Identification Number
(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 fifteen (16) Affidavits and Declarations;
ATTACHMENT D "Miami -Dade County.Affidavits and Declarations", Page 1 of 11.
Miami -Dade County's Affidavits and Declarations
ATTACHMENT D Miami -Dade 'County Affidavits and Declarations" Page 2 of 11
Pertains D
1. MM1VII-DARE COUNTY OWNERSHIP DISCLOSURE AFFIDAVIT (SECTION 2-8.1
N/A O
OF THE COUNTY CODE)
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 Name, 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 Coilnty's Affidavits and Declarations
2. MIAMI-DADE COUNTY EMPLOYMENT DISCLOSURE AFFIDAVIT (COUNTY
Pertains O
ORDINANCE -90-133, AMENDING SECTION 2.8-1, SUBSECTION (d)(2) OF THE
N O
COUNTY CODE)
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? O Yes ❑ No
Does your firm provide paid health care benefits for its employees? D Yes O No
Provide a current breakdown (number of persons) of your firm's work force and ownership (below):
Whites
Males
Females
Black:
Males
Females
Hispanic.:
Males
Females
Asian:
Males
Females
American Native:
Males
Females
Aleut (EsIdmo):
Males_
Females
ATTACHMENT D "Miami -Dade County Affidavits and Declarations Page 3 of 11
Miami -Dade County's Affidavits and Declarations
3. MIAMI -DADS COUNTY AFFIRMATIVE ACTION
NONDISCRIMINATION OF EMPLOYMENT, PROMOTION AND
Pertains ❑
N/A ❑
PROCUREMENT PRACTICES (COUNTY ORDINANCE 98-30' CODIFIED
Initial (_)
AT 2-8.1.5 OF THE COUNTY CODE)
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 women=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, notwithstanding, corporate
entities whose board of directors are representative of the populationmake-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
maybe rebutted. The requirements of this section maybe 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 1st Street, 13th Floor Miami, FL 33128
Yes ❑ No ❑
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.-
5,000,000:Yes
Yes❑ No ❑
Therefore, our company's affirmative action plan and procurement policy
is available for review.
Yes ❑ No ❑
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 Pertains ❑
(SECTION 2-8.6 OF THE COUNTY CODE) N%A ❑
Initial (_)
The individual or entity entering into a contract or receiving funding from Miami -Dade County. ❑ has .❑ 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 ❑ has ❑ 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
S. PUBLIC ENTITY CRIMES AFFIDAVIT (SECTION Pertains D
287.133(3)(a), FLORIDA STATUTES) N/A OInitial (_)
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 287.1.33 (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 Cl) (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
organizedunder 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).
O 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.
O The entity submitting this sworn statement or'one or moire 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
D yes an .additional statement -is applicable or O: no anadditional 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 orithe"Convicted VendorList". .
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 28.7.017 Florida Statues for Category 2. of any change in the information contained -in this form.
- ATTAC—HMENT D "Miami -Dade County Affidavits and Declarations" Page 5 of 11
Miami -Dade County's Affidavits and Declarations
6. MIAMI-DADE EMPLOYMENT FAMILY LEAVE AFFIDAVIT Pertains D
(County Ordinance No.142-91 codified as Section 11A-29 et. N/A D
seq of the County Code) Initial (_)
That in compliance with Ordinance No. 142-91 of the Code of Miami -Dade County, Florida, an employer with fifty
(5 0) 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 Pertains D
AFFIDAVIT (County Resolution R-385-95) N/A D
- Initial (_)
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. S. C. 12101-12213 and 47 U. S. G. 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 p olitical subdivision or agency thereof or any municipality of this State.
8. MIAMI -DA DE COUNTY REGARDING DELINQUENT AND CURRENTLY DUE Pertains O
FEES OR TAXES (Sec. 2-8.1(c) of the County Code) N/A D
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 6 of 11
Miami -Dade County's Affidavits and Declarations
Pertains O
9. CURRENT ON ALL COUNTY CONTRACTS, LOANS AND OTHER OBLIGATIONS N/A ❑
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- Pertains O
60 Et. Seq. of the Miami -Dade County Code). N/A O
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 workweeks in the current or proceeding calendar years, to provide Domestic
Violence.Leave to its employees.
11. MIAMI-DADE COUNTY EMPLOYMENT DRUG-FREE WORKPLACE Pertains 0.
AFFIDAVIT (County Ordinance No. 92-15 codified as Section 2- N/A O
8:1.2 of the County Code) 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 maybe waived if the special. characteristics of the product or service offered
bythe 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 Pertains D
COUNTY FUNDING SUPPORT N/A O
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 Pertains
TO PAST DEFAULTS ON AGREEMENTS WITH NON -COUNTY FUNDING N/A O
SOURCES, AND DUE DILIGENCE -CHECK - 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 Pertains D:`
OR FOODS CONTAINING "PINK SLIME" N/A O
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 all 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 8 of 11
Miami -Dade County's Affidavits and Declarations
15. MIAMI-DADE COUNTY REQUIRED LOBBYIST REGISTRATION FOR Pertains D
ORAL PRESENTATION Section 2-11.1(i)(2) CONFLICT OF INTEREST N/A D
AND CODE OF ETHICS ORDINANCE 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 shall be, required priorto 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, all 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 isnot 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.
❑ 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.
S. 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
C.omniission 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 th.e 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. 017162, § 1,10-23-01; Ord.. No. 03-107, § 1,.5-6-03)
ATTACHMENT D "Miami=Dade County Affidavits Declarations"Page 9 of 11
Miami -Dade County's Affidavits and Declarations
Pertains D
16. Disclosure SUBCONTRACTOR / SUPPLIER LISTING (ORDINANCE 97-104) N/A O
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
form 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 First Tier
Subcontractor Subconsultant
Principal Owner
Scope of Work to be Performed by
Subcontractor/Subconsultant
(Principal Owner)
Gender Race
Business Name and Address
of Direct Supplier
Principal Owner
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
MIAMDADE
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
Signature of Witness or Secretary Seal
-Signature of Affiant
Printed Name of Affiant and Name of Agency
of Agency
20
Date
Federal Employer Identification Number
SUBSCRIBED AND SWORN TO (or affirmed) before me this _ day of
He/She is personally laiown to me or has presented
Type of identification
Signature of Notary
,Print or Stamp Name of Notary
Notary, -Public State of
County of
Serial Number
Expiration Date
20_
as identification.
Notary Seal
ATTACHMENT D "Miami -Dade County Affidavits and Declarations" Page 11 of 11.
FY 2018
Miami -Dade County Homeless Trust
Continuum of Care (COC)
Consolidated Financial Records
Performance Reports
ATTACHMENT E "Financial Records & Performance Reports"
Agency
Letterhead
Date
Attention: Assigned Contracts Officer
Miami -Dade County Homeless Trust
Suite 310., 27th Floor
111 NW First Street
Miami, Florida 33128
n
VIN111 INDU
Subject: FY 2018 US HUD CoC Program
4FLOOOOL4DO018 : 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 amount requested is IM for the month of Month. vvw.
The following documents are included in this checklist outlined below:
O Cover Letter
O. Performance Report - 0625 HUD CoC Monthly HMIS generated Report.
O Homeless Trust Invoice
O HUD form 27053-A SNAPS Request Voucherfor Grant Payment
O Summary and Compliance Report
.O Attachment E.- Program Income Report
O Supporting documents for invoice requirements and -match including invoices, cancelled
checks, payroll, time and effortlogs, and if applicable -copy 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 fif
applicable) is $0.00. This. is an adjustment #[ ) for the month of Month. XYYX
On behalf of our homeless community members who benefit from this program, we thank you for
your time and assistance. Please call (3 05) 000=000: extension 0 or email address xysPxvs.com
with any concerns or commentsabout this reimbursement package.
Attachment E "Consolidated Financial Record and Reports Cover Letter".. .:
MiamPDade County Homeless Trust ATTACHMENT E
LOCSNRS. U.S. Department of Housing OM.B Approval No. 2535-0102
SNAPS Special Needs Assistance Program and Urban Development
Request Voucher for Grant Payment Office.of Community Planning Name of Agency - Name of program
and Development
See Instructions and Public Reporting Burden Statement on back
1. Voucher Number.. 2. LOCCS PGM AREA: 3. Period Covered by this Request: (dates) 4. Type of Disbursement:
SNAPS HPAC Partial Final
IHP
5. Voice Response No. (5 digits, hyphens, 5 more) 6. Grantee Organization's Name:
7. Grant No: 8. Grantee Organization's TIN:
FL0000L4D0018
9. Line Item no. 10. Tvoe of Funds Requested Amount: (round to nearest dollar)
1010.
Acquisition
$ -
1020
Rehabilitation
$ -
1021
New Construction
$ -
1022
Substantial Rehabilitation
$ -
1023
Moderate Rehabilitation
$ -
1030
Operating Cost-
$ -
1040
Rental -Assistance
$ -
1050
Supportive Services
$
1051
HMIS Costs
$
1060
Administrative Cost
$
1062
Cob -Planning Costs
$ -
107(Y
Child Care
$ -
1080
Employment Assistance
$ -
1090.
Relocation.
$ -
1100
Ceasing
$ -
1110
Repair & Maintenance
$ -
1111
Prevention (RH)
$ -
1112
Capacity Building (RH)
$ -
1120
Other:
$ -
Voucher Total:.•
$ -
I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate.
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 & Phone Number Including area code) of the Authorized 12. Signature: 13.. Date of Request--- - -
Person who, called SNAPs System VRS;
Privacy Statement: Public Law 97-255, Financial Integrity Act, 31 U:S.C. 3512, authorizes the Department of Housing and prban.Deveiopment (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 Community Development Act of 1987, 42 U.S.C. 3543,.authorizes
HUD to collect the SSN. The data are used to ensure that individuals who no longer require access_ to Line of Credit Control System (LOCOS) have their access capability prompt deleted. Provision
of the SSN Is mandatory. HUD uses it as a unique identifier for safeguarding LOCOS from unauthorized access. Failure to provide. the information requested may delay the processing of your
approval for access to LOCOS. This information will not be otherwlse'disclosed or released.outside of HUD, except as permitted by law.
form HUD -27053-A
Miami -Dade County FY2018 CoC Program
PROVIDER NAME:
PROGRAM NAME: M"j _ DADE
GRANT NUMBER: FLOOOOL4DO018_
For the month/year of f )
Adjustment #( ) REQUESTED AMOUNT THIS INVOICE
LEASING
Leasing Structure
Leasing Units -
LEASING TOTAL: $
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:Educatfon services .
6.Employment Assistance
7.Food
8.Housing / Counseling Services
91egalservices
101ife Skills training
11.Menfal Health Services
12.0utpatient-Health Services
13.Outreach. Services
14.Substance Abuse Treatment
1S. -Transportation
16-Utdity Deposits
17. Operating costs for SS0 only
SUPPORTWESERVICES SUBTOTAL: $
OPERATING COSTS
1.Maintenance and Repair -
2.Property Taxes and Insurance -
3.Replacement Reserve -
4.Building Security -
S.Electricity, Gas and Water -
6.Furniture -
7.Equipment (Lease/Buy) -
OPERATINGCOSTSSUBTOTAL: $
HMIS
HMIS generated Activities
HMISSUBTOTAL: $
PROJECT ADMINISTRATION
Project Admibistration costs
ADMINISTRATION SUBTOTAL: $ ..
TOTAL
INVOICE REQUEST AMOUNT '
By signing this report I certify to the best of my knowledge and belief that the reportis true, complete and accurate and the
expenditures, disbursements and cash receipts are for the purposes and objectives set forth in the terms and conditions of the
federal award. I am aware that any false, fictitious, or fraudulent infrmatio or the omission of any material fact may subject_ me to
criminal, civil or administrative penalties for fraud, false statements, false claims or other offense
Prepared this - - .(date)
Certified by: (Title)
MIAMI-DARE COUNTY FY 2018 US HUD COC SUMMARY AND COMPLIANCE REPORT
Agency Name:
Program Name: MI
Grant # FU0001,00018
Month/year of Service ( / Duration: 00/00/2019 - 00/00/2020
Is this an Adjustment? [# )
FY 2018 CoC Pro, am
ACTUAL MONTHLY
PROGRAM EXPENSE
INVOICE
MATCH
PROGRAM INCOME
EXPENDITURES
MONTHLY
BENCHMARK
AMOUNT
TOl'AL YEAR GRANT
AMOUNT
LEASING
Leasing
Units
$
Leasing Structures
...................................
Leasing Units
Subtotal
$
$ $:
$
TOTAL LEASING
$
$ $
$
...........
.......
RENTAL ASSISTANCE
Rental Assistance
Units
$. -
$ -
TRA
SRA
SRO
Program Income to Landlords
Rental Administration costs
-
Subtotal
$
$ _ $
$
TOTAL RENTAL ASSISTANCE
$
$ $
$
...................................
SUPPORTIVE SERVICES
1, Annual Assessment
FTE
$ .
$ -
staffsalary %
Taxes & Fringe
Subtotal
$
$ $
$ -
................
..................
2. Assistance Moving Costs
-Supplies t0 transition
moving expenses
-
Subtotal
$
$ $
...................
3. Case Management
FTE
$
$. -
stadsalary
Taxes & Fringe
Obtaining benefits-
. Subtotal
$
$ $
................
..................
4: Child care-
Childcare vouchers
$
$ $
Meals and Snacks in childcare -
$
$ $
Subtotal
$
$ $
.....•..•.......•.•..•
•.•..•.............
5. Education Servfces
FTE
$
$ -
staff salary - -
Taxes &Fringe
education supplies
I .
Subtotal
$
S $
...................................
G..Employment[Training
FTE.-
staffsalary %
taxes & fringe
Computer training
Eligible job 'Stipends,
_ Subtotal.
$
$ $
...................................
7. Food-
Providing meals
-
Groceries
-
Subtotal
$
$ - $
.Page 1 of 3
FY 2018 CoC Program
ACTUAL MONTHLY
INVOICE
MATCH
PROGRAM INCOME
MONTHLY
ARK BENCHM
TOTAL YEAR GRANT
PROGRAM EXPENSE
EXPENDITURES
AMOUNT
AMOUNT
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-
staffsalary
%
$
$
$
$
Taxes &Fringe
$
$
$
$
Subtotal'
$
$
$
$
................................
11. Mental health services
FTE
$ -
$ -
staff salary
%
Taxes &Fringe
-
Subtotal
$
$
$
$ -
...................................
12. Outpatient health
FTE
$ -
$
staff salary
%
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. Ditect provisions of-
Operational costs for SSO only
-
- Subtotal
$
$- -
$
$
TOTAL SUPPORTIVE SERVICES$
$
$
$.
Page 2 of 3
ACTUAL MONTHLY PROGRAM INCOME MONTHLY TOTAL YEAR GRANT
FY 2018 CoC Program INVOICE MATCH BENCHMARK
PROGRAM EXPENSE EXPENDITURES AMOUNT AMOUNT
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
$ -
$ -
staffsalary %
$
$
$
$
Taxes &Fringe
$
$
$
$
subcontracted security
$
$
$
$
Subtotal
$
$............
$
$
...................
........ ........
5 -Electricity, gas and water
$ -
..............................
$ -
utilities
...
Subtotal
$
$
$
$
6. Furniture
-
furniture
Subtotal
$
$
$
$
...................................
7. Equipment I
$ -
$ -
operational equipment
Subtotal
$
$
$
$ -
TOTAL OPERATION
$
$
$
$ -
HMIS COSTS
HMIS
$ -
$ -
HMIS staff salary %
$ -
$
$
$ -
$ -
$.
$
$
TOTAL HMIS COSTS$
$
$
$
...................................
PROJECT ADMINISTRATION
Project Administration FTE,
$ -
$ -
staffsalary %
$ -
$
$
$
staffsalary %
$. -
$ -
$
$
Taxes & Fringe
$ -
$
$
$
Travel to monitor.
$ . -
$
$
$
3rd Party Administration
$ -
$
$
$
Audit
$
$ -
$
$
Administrative office space
$
$ -
$.
$
CoC Training
$-
$
$
$ -
TOTAL ADMINISTRATION
$ -
$ -
$
$ -
ACTUALMONTHLY
INVOICE
MATCH
PROGRAMINCOME
MONTH BENCHMARK
TOTAL YEAR GRANT
PROGRAM EXPENSE
EXPENDITURES
AMOUNT
AMOUNT
TOTAL
$:. -
$ . -..
$
- $ ... _11$
-1
$ -
By sighing this report, l.certify to the'best of mylmowledge and belief thatthe reportis true, complete and accurate -and
the expenditures, disbursements.
and cash receipts are for the purposes and
objectives set forth
in the terms and conditions of the federal award: I am
aware that any false, fictitious, or .
fraudulent information or omission of any material fact, may subject me to -criminal,
civil or"administrative penalties for fraud, false statements, false :.
Claims or other offense.
Prepared this (
) inm/dd/yyyy
_.
Certified by: (
1 signature Print Name and title•f
_
)
Paee 3 of 3
Prepared by 2/20/2019
FY 2018 CoC TRACKING CHART - for Agency Internal Use Only
Agency Name:
Program Name:
Grant # FLOOOOL4DO018
Duration: 00/00/2019 - 00/00/2020
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
month 4
month 5
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
USED
REMAINING
$0.00
4DIV/0!
#DIV/01
$0.00
#DIV/0!
#DIV/0!
$0.00
#DIV/0!.
#DIV/01
$0.00
#DIV/0!
#DIV/0! I
$0.00
#DIV/0!
#DIV/0! I
$0.00
#DIV/01
#DIV/0!
$0.00
#DIV/0!
#DIV/0!
#DIV/0!
Prepared by 2/20/2019
Income & Rent Option 1
Project Sponsor
Grant Number
Last Name
First Name
HMIS #
Calculating Annual Income
Annual amount not monthly.
1) Subtotal Income
2) Income- Exclusions
$
$
$
$
$
$
$
$
$
$
$
- Supplemental Security Income SSI
- Social Security Disability Income SSDI
- Social Security
- General Public Assistance
- Temporary Aid to Need Families TANF
- Salary from employment
- Child Support
Veteran Benefits
Employment Benefits
- Other
- formula will add rows
Enter income exclusions
3) Annual Income
$
-
Calculating Adjusted Income
Dependant Allowance
4)
_
-0
1 Number of dependants
1 Multipies by $480
5)1
0
Child Care Allowance
6)
Anticipated Unreimbursed Expenses
Disabled Assistance Allowance
7)
Disabled. Assistance Expenses
Multipies Line 3 by 0.03
Subtract Line 8 from Line 7
Member earnings which were dependent on
assistance
Lesser of Line 9 or 10
8)
0
9)
0
10)
11)
-
Medical Expenses.% Elde- ly Family Allowance
12) -
List total for medical expenses .
if row 9>0 enter line 12 otherwise (7+12-8)
Elderly/disabled Adult Allowance
13)
14) if PSH add $40.0.00
$0.00
Adjusted Income
-15)1
add rows 3,5,6,11,13; &-14
row 15- - 3
16) $
Resident Rent Determination-
etermination"17)
17)30% of Monthly Adjusted Income
$
divide row 16 by 12 multiply by 0.3
divide row 3 by 12 multiply by 0.1
not'applicable in State of Florida
if utilities are NOT included in the lease complete
below
18) 10%•6f Monthly lncome
0
1.9) Portion of Welfare
20 Resident Rent *
Utility Allowance
Utility Allowance chart
$
-
PHCD list schedule.ofulilityallowances
if riot included in lease.
water/sewer/trash
21) TOTAL UTILITY ALLOWANCE $
Rent with Utility Allowance: "
22) Resident Rent
$
row 21- Tow 20
ifrow.22 < 0
Payment made to Utility Company only
Client:P.ays no. rent $
23) Utility Reimbursement .' $
Maintain all rental calcuation documents in file/ review rental amounts at lease annually and more often if rent will decrease/meet financial .
management responsibilities for receipt and expenditure of rent/monitor for COMPLIANCE and QUALITY CONTROL
Miami -Dade County Homeless Trust
Income Determination Rent Calculation ATTACHMENT E
Participant/ HMIS:
Unit/Address:
1) $ -
Income
Income exclusion
Annual Gross Income
2) $ -
3)_ $ -
T Calculating
Adjusted Income Dependent Allowances
-
Number of Dependents
Multiply line 4 by $480 (Child Care Allowance)
Child Care Allowance
i4)
s)
$ -
6) $ - Enter anticipated unreimbursed Child Care expenses
Disabled Assistance Allowance
7) _
$ -
Disabled Assistance Expenses
$ -
8)
Multiply Line 3 by 0.03
Subtract Line 8 from Line 7
Amount earned by household members which was
9)
$ -
10)
$ -
dependent upon Disabled assistance expense
Enter the LesserAmount of Line 9 or 10
Expenses / Elderly Household Allowance
11)
$ -
Medical
12)
$ -
Medical expenses
if line 9 is less than zero, enter the amount fi-om line 12,
13)
$ -
otherwise add lines 7 and 12 and subtract line 8
$ -
14)
Elderly or Disabled Family Allowance enter $400
_
Adjusted Income
15) $ - Total Income Adjustments (add lines'S, 6,11, 13 & 14)
Adjusted Income (subtract line 15 from line 3) Resident
I
16) _ $ - Rent Determination
Occupancy Amount Determination - Program Income
30% of Monthly Adjusted Income
17) I $ - (Divide Line 16 by 12 & Multiply by 0.3)
10% of Monthly Gross Income
18). $ - (Divide Line 3.by 12 and Multiply by 0.10)
19) N/A Welfare rent, not applicable in State of Florida
20) Resident Rent- largest of line 17 or 18
Determining Occupancy Amount for Units where Utilites are not included
21)
$ -
Utility Allowance (published by PHCD) .
Resident -Occupancy Charge - Program Income
Utilities Reimbusement T*
22)
$ -
23)
$ -
** 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.
Program Income
LEPORTING:AGENCY:
W.G.RAM NAME:
RANT NUMBER:
�ERVICE MONTH:
FLOOOOL4DO018_
Month/2019
MIAMI-
TOTAL MONTHLY PROGRAM INCOME
TOTAL GTD PROGRAM INCOME
$
$
905.00
3,615.00
U5 HUD FY 2013 Coc Program
Bld/unit
HMIS #
address .
Tenant Name
Total Annual
Adjusted or Gross
Income
Total Monthly
Adjusted or
Gross Income
30% adjusted
u
or 10% gross
ACTUALAMOUNT
DIRECT
TENANT RETAINS LANDLORD/
PROVIDER
Contribution
Grant -to -Date (GTD)
Contribution
1
1A
.(in 3 months)last name, first
$ 4,200.00
$ 350:00
$ 105.00
$
245.00 $ 105.00
30%.$
315.00
2
'113
(new inprogam).lastname, 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
$
1,300.00 $ 500:00
28%
$
3,000.00
4
2B
last name, first
$ -
$ -
$ -
$
- $ -
#DIV/01
$
-
5
3A
last name, first
$ -
$
$ -
$
$ -
#DIV/0!
$
-
6
3B
last name,.first
$ -
$
$ -
$
$
#DIV/01
$
-
7
4A
last name, first
$
$
$ -
$
$ -
#DIV/0!
$
8
.. 4B
last naine, first
$ -
$ -
$ -
$
$
#DIV/O!
$
9
5A
last name, first
$
$
$
$
$
#DIV/0!
$
10
5B
last.name, first
$
$ -
$ -
$
$
#DIV/0!
$
11
last name, first
$
$ -
$ -
$
$
#DIV/0!.
$
1.2
'
last name, first
$ -
$ -
$ -
$
$
#DIV/0!.
$
13
lastname; first
$
$
$.
$
- $
#DIV/0f
$
14
lastnam�;first
$
$ -
$
- $
#DIV/0!
$
-
15.
last name, first
$ -
$ -
$
$
$
#DIV/0!
$
16
last name, first $ -
$ -
$
$
$ -
#DIV/0!
$
-
17
..
last -name, first
$ -
$ -
$ -
$
$ -
#DIV/01
$
18
last name, first
$ -
$ -
$ -
$
$ -
#DIV/01
$
19
last name, first
$ -
$ -
$
$
- $
#DIV/01
$
20
last name, first
$ -
$ -
$ -
$
- $
#DIV 0!
$
21
last name; first
$
$ -
$ -
$
- $ -
#DIV/0!
$
-
2ZI
last name, first
$ -
$ -
$
$
- $ -
#DIV/0!
1 $
COMPLETE ONLY IF APPLICABLE - Occupancy charges and rent collected from program particpants are program income
SUBLEASE or OCCUPANCY AGREEMENT MUST BE IN PLACE
and may be used as provided
under 24 CFR 578.97 a LEASE,
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 repor4 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 setforth 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
. S�orisor/Provider/Subrecipieint Official:
Signature & Date(mm/dd/yyyy):
Reviewed by Miami Dade County and forwarded to
Do Not -Sign - for Miami -Dade County ONLY
US HUD for Request to Approve (greater than 10% shift
in funds between categories or significant change)
CHANGE IN PROJECT SPONSOR
Signature & Date(mm/dd/yyyy):
Reviewed and Approved by Miami -Dade County,
Do Not Sign - for Miami -Dade County ONLY
information forwarded to US HUD (Less than 10%shift
in funds between categories).
Signature & Date mm/dd
Reviewed and NOT Approved by Miami -Dade County --
Do Not Sign - for Miami -Dade County ONLY
r • see attached letter for reasons for disapproval..
Signature & Date(mm/dd/yyyy)
Program Name.:
Grant Number: f
Financial Information for CoC Programs
Instructions for budget amendment / modification request:
1. 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 and project administration charts. Reformat the far right -side
column in the chart to reflect the budget modified or amendment
requested. Please outline and clearly identify the changes to the budget.
2. 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.
3. 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.
4. Assemble and attach page. one of this document.
S. Review, sign and submit the paper original to Miami -Dade County
Homeless Trust, 111 NW 1St Street, 27th Floor, Suite 310, Miami, Florida
33128 Attention: Terrell Ellis, Contracts Manager.
FY 2018
Continuum of Care (CoC)
Miami -Dade County.
Miami -Dade County Homeless Trust
Annual Progress Report (APR)
ATTACHMENT F "2017 Annual Progress Report APR"
Annual Progress Report (APR)
for US HUD Grant Funded
Continuum of Care (CoC) Programs
On April 1, 2617 Continuum of Care (CoC) Program grant recipients report their CoC Program Annual Performance
Reports (APRs) in Sage HMIS Reporting Repository (Sage). Recipients will be required to upload CSV data from
their HMIS to fulfill the APR reporting requirement in Sage. All Subrecipients are required to continue to submit the
hard copy of the HMIS report as well as the supplemental pages until further notice.
By signing this report, the duly authorized Project Sponsor/Provider/Subrecipient Oficial 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 subjectthe duly authorized official to criminal, civil or
administrative penalties forfraud, false statements, false claims or other offense.
Project Name
Project Grant Number
Print Name and Title of Authorized
Project Sponsor/Provider/Subrecipient Official:
Signature & Date'( m.m/dd/yyyy):
'Print Naive & Title -of Authorized Project Grant
Do Not Sigh - for Miami -Dade, County -ONLY
Official
(MD.CHT Executive Director or Designee)
Signature & Date(mm/dd/yyyy):
Supervisory Review and Entry-
Do Not Sign = for Miami -Dade County ONLY
Print Name & Title.
Signature & Date(mm/dd/yyyy):
Updated March 31, 2017
Attachment F "Annual Progress Report (APR) Supplemental"
Guidance was provided for a -snaps changes that were implemented to improve processing time; completing an "Applicant
F
ofile; and on Q3, QS, Q23, Q24, and Q 31- please submit the HMIS generated APR as well.
US HUD. - ANNUAL PERFORMANCE REPORT (APR_)
CONTINUUM OF CARE (CoC)
Q1. Contact Information
Project Name
Section 8 Moderate
Rehabilitation
Recipient/Agency Name
❑Tenant -based Rental.Assistance (TRA)
GrantNumbe
❑ Permanent H ousing for. Homeless.
Persons with Disabilities
Prefix (Mr., Mrs., Ms., Dr., etc.)
❑ (Sec. 8 SRO)
First Name
❑ Single Room Occupancy. (SRO)
Middle Name
❑ Innovative Supportive Housing
Last Name
Suffix (LCSW, MSW, Etc.)
Title
Is this APR fulfilling the reporting obligation associated with a 20 or 1S -year use. requirement? (❑)
Number of Years in Operation: (❑)
20-
Contract operating term or duration is from 20 to /20-
StreetAddress 1
StreetAddress 2
City
State
Zip Cod
E-mail addr. ess
Phone Number
Extensio
FaxNumberl
13. Proiect Information: Check the component for the nrogram on which you are rebortine
Continuum of Care Program (CoC)
0.1.
Rental Assistance (RA)
Section 8 Moderate
Rehabilitation
❑ Transitional Housing
❑Tenant -based Rental.Assistance (TRA)
❑ Single Room Occupancy
❑ Permanent H ousing for. Homeless.
Persons with Disabilities
❑Project -based Rental Assistance (PRA)
❑ (Sec. 8 SRO)
❑ Safe Haven
❑ Single Room Occupancy. (SRO)
❑ HMIS
❑ Innovative Supportive Housing
❑S onsor-based. Rental Assistance SRA
❑ Supportive Services Qnly
Is this APR fulfilling the reporting obligation associated with a 20 or 1S -year use. requirement? (❑)
Number of Years in Operation: (❑)
20-
Contract operating term or duration is from 20 to /20-
n3. Prniect Information continued:
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 APRfor a grant that received a HUD- approved grant .
extension2 (Yes or No)
Is this a final APR? (Yes or No)
Attachment F "Annual Progress Report (APR) Supplemental"
Financial Information for CoC Programs
031a1 CoC Financial - DevelODment
Expenditure T e
CoC Program funds 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 vour Grant annlication enter "0" in each field on the question.
Expenditures type
CoC Program Funds
Expenditures
1. Assessment of Service Needs
2. Assistance with Moving Costs
$
3. Case Management
$
4. Child Care
$
S. Education Services
6. EmploymentAssistance-
7..Food
$ .
8: Hoiising/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
$
Supportive Services = Su tota
Attachment F "Annual Progress Report (APR) .Supplemental"
Q3 1a4 CoC Financial - Leasing, Rental Assistance, Operating, and Administration
Total Expenses
COC Funds
Development
$
Supportive Services
$
Real Property Leasing
$
Short -/Medium Term Rental Assistance
$
Long-term Rental Assistance
$
:Operating Costs
$
HMIS
$
SUBTOTAL
Administration -Provider
$
Administration - Homeless Trust
$
TOTAL Expenses plus Administration
$
Cash Match
$
In -Kind Match
$
TOTAL Match
$
Match %
TOTAL Expenditures and Match.
$
Program Income
$
-Attachment F' AnAital Progress Report (APR). Supplemental"
Performance for CoC Programs
036: Standard Performance Measures
Performance Measure
(Target) # of
# of total.
% expected to
Actual Target #
Actual # of total
Actual % of
(Measures are found in
Persons who were
(Universal)
accomplish
of persons who
(Universal)
persons to
(Measures are found
expected to
�
persons who are
this measure
accomplished
person to achieve
achieve this
in the eSnaps (Exhibit
.
accomplish this
is expected to
(eSnaps
this measure_
this measure
measure
2)'of the HUD
measure (eSnaps
accomplish this
Budget -
Reported in
Reported in HMIS .
Reported in
application
Budget Exhibit 2),
measure (eSnaps
Exhibit 2)
HMIS
measure
HMIS
Exhibit 6 A -C)
Exhibit 2)
Budget Exhibit 2
HMIS
Reported in
Persons exiting to
HMIS
permanent housing
11
16
69%
19
20
95%
(subsidized or
F.
,
X;! iin
unsubsidized) during
li'
the operating ear.
Housing Stability
Measure
Reported in HMIS.
Q36
Total income
Measure
Reported in HMIS
36
Earned Income
Measure
Reported in HMIS
Q36
Other = specify
Reported in HMIS
037: Additional Performance Measures
Performance Measure
(Target)W# of
# of total
% expected to.
Actual Target
Actual # of
Actual % of
(Measures are found in
Persons who
(universal)
accomplish this
# of persons
total
persons to
the eSnaps (Exhibit 2) of
were expected
persons who are
measure
who
(Universal)
achieve this
to accomplish
is expected to
(eSnaps Budget .
accomplished
person to ,
measure
the HUD application
this measure
accomplish this
Exhibit 2)
this measure
achieve this
Reported in
Exhibit 6 A -C)
(eSnaps Budget
measure (eSnaps
Reported in
measure
HMIS
Exhibit 2)
Budget Exhibit 2)-
HMIS
Reported in
HMIS
* Utiliaation. Rate or
Vacancy Report
Other.
Q40: Significant Program Accomplishments
.Describe in a brief narrative form (no more than 2,000 characters) all significant accomplishments achieved. by your
project during the reporting period:
.Q42; Additional Comments
Describe in a brief narrative form (no more than 2,000 characters) based on your experience during the last year any
problems or explanations and. or changesor need -for technical advice or assistance.
Attachment F "Annual Progress Report (APR) Supplemental'
2/20/2019 Sage: Reports: HUD Annual Performance Report 2018 - CoC
HMIS REPORTING
lageREP,SITORY
HUD Annual Performance Report 2018 - CoC
Grant: Better Way Apartments - FL0170L4D001609 Type: PH
Q01. Grant Information
APR Information
Operating start date for APR.
11/1/2017
Operating end date for APR.
10/31/2018
Are the dates shown above the dates your CSV - APR was generated for?
Yes
Is this an APR for a grant that received a HUD -approved grant extension?
No
What operating year are you reporting on?
21+
Is this APR fulfilling the reporting obligation associated with a use requirement?
No
Is this a final APR?
Yes
-If yes, have you completed your final draw in LOCCS?
Yes
—if yes, have you renewed this project?
Yes
Identify the specific project type of this grant:
PSH
Grant Focus Information
Was this project funded under a special initiative?
No
Target subpopulation(s): Does your project have a specific population focus?
No
Are 100% of the clients in HMIS or where applicable in a comparable data base?
Yes
2/20/2019 Sage: Reports: HUD Annual Performance Report 2018 - CoC
Q02. Bed and Unit Inventory and Utilization
Proposed Bed and Unit Inventory
Total Number of Year Round Beds/Units from Application
Total Units
55
Total Beds
55
Total Dedicated CH Beds
22
Total Non -Dedicated CH Beds
33
PIT Actual Bed and Unit Utilization on the Last Wednesday of the Month
Actual Inventory - Total Units
January
55
April
54
July
.55
October
56
Actual Inventory - Total Beds
January
55
April
54
"July
55
October
56
Utilization Rate - Unit
January
100.0061. -
April
98.18%
July
100.00%
October
101.82%
Utilization Rate - Bed
January
100.00%.
April
98.18%
July
100.00%
October
101.82%
If the number of units. and beds proposed is different from the number'
available on the -last Wednesday of -each month please explain why:
Q03. Contact Information
Prefix Mrs
.First Name Pauline
Middle Name
Last Name Trotman
Suffix
Organization Better Way of Miami, Inc.
Department Permanent Housing Programs
-Title Director, Permanent Housitig Programs
Street Address 1 800 NW 28th Street
Street Address 2
:. City Miami
State / Territory Florida
ZIP Code 33127
E-mail Address ptrotman@bwom.org
Confirm E-mail Address ptrotman@bwom.org
Phone Number. .(305)634-3409
Extension 123
fax Number (305)779-0681
2/20/2019 Sage: Reports: HUD Annual Performance Report 2018 - CoC
Q04a: Project Identifiers in HMIS
Organization Name
Better Way of Miami, Inc.
Organization ID
12
Project Name
Better Way of Miami, Inc. Apts. SRA PSH-+L0170L4D001609
Project ID
144
HMIS Project Type
3
Method of Tracking ES
Is the Services Only (HMIS Project Type 6) affiliated with a residential project?
Identify the Project ID's of the Housing Projects this Project is Affiliated with
CSV Exception?
No
Uploaded via emailed hyperlink?
No
Q05a: Report Validations Table
Total Number of Persons Served
64
Number of Adults (Age 18 or Over)
64
Number of Children (Under Age 18)
0
Number of Persons with Unknown Age
0
Number of Leavers
8
Number of Adult Leavers
8
Number of Adult and Head of Household Leavers
8
Number of Stayers
56
Number of Adult Stayers
56
Number of Veterans
4
Number of Chronically -Homeless Persons
21
Number of Youth Under Age 25
1
Number of Parenting Youth Under Age 25 with Children
0
Number -of Adult Heads of Household
64
Number of Child and Unknown -Age Heads of Household
.0
Heads of Households and Adult Stayers in the Project 365 Days or More
47
Q06a: Data Quality: Personally Identifying Information (PII)
Data Element Client Doesn't Know/Refused Information
Missing
Data Issues of
Error Rate
Name 0 0
0 0.00%
Social Security Number 0 0
0 0.00% .
Date of Birth 0 0
0 0.00% .
Race 0 0
0 0.00%
Ethnicity 0 0
0 0.00%
Gender 0 0
0 0.00%
Overall Score
0.00%
Q06b: Data Quality: Universal Data Elements
Error Count % of
Error Rate
Veteran Status 0 0.00
Project Start Date 0 OM % .
_Relationship to Head.of Household 0 0.00%
Client Location- 0 0.00%
• Disabiling Condition 2 3.131.
2/20/2019 Sage: Reports: HUD Annual Performance Report 2018 - CoC
Q06c: Data Quality: Income and Housing Data Quality
Error Count % of
Error Rate
Destination 0 0.00%
Income and Sources at Start 5 7.81%
Income and Sources at Annual Assessment 3 6.38%
Income and Sources.at Exit 0 0.00 61.
Q06d: Data Quality: Chronic Homelessness
Missing Missing Approximate
% of Record
Count of Total Time Time Date Started
Number of Times Number of Months
Unable to
Records in in
DK/R/missing
DK/R/missing DK/R/missing
Calculate
Institution Housing
ES, SH, Street
0 0 0 0
Outreach
0 0
—
TH 0 0 0 0
0 0
PH (All) 19 0 0 0
0 0.
0.00%
Total 19. 0 0 0
0 0
0.00%
Q06s: Data Quality: Timeliness
Number of Project Number of Project
Start Records Exit Records
0 days 0 0
1-3 Days 1 0
476 Days 0 1
7-10 Days . 5 0
11+ Days 3 7
Q061`.Data Quality: Inactive Records: Street Outreach & Emergency Shelter
# of Records
# of % of
Inactive Records Inactive Records
Contact (Adults and Heads of Household in Street Outreach or ES - NBN) 0
0 —
Bed Night (All Clients in ES - NBN) 0
0
Q07a: Number of Persons Served
Total Without Children With Children and Adults
With Only Children Unknown Household Type
~Adults 64 64 0
0 0
Children 0 0 0"
0 0
Client Doesn't Know/ Client Refused 0 0 0
0 0
Data Not Collected . 0 0 0
0 0
Total 64 64 0
0 0
Q07b: Point -fn -Time •Count of Persons on the Last Wednesday
Total Without Children. With Children and Adults With Only Children
Unknown Household.Type .
January 55. 55 0 0
0
April " 54 . 54 0 0
0
July 55 55 0 0
0
October 56 5.6 0 0
0
Q08a: Households Served
Total Without Children With Children and Adults With Only Children Unknown Household Type
Total Households 64 64 0 0
0
2/20/2019
Sage: Reports: HUD Annual Performance Report 2018 - CoC
0
Q08b: Point -in -Time Count of Households on the Last Wednesday
0
Female
0
Total Without Children
With Children and Adults
With Only Children Unknown Household Type
Trans Male (FTM or Female to Male)
January 55 55
0
0
0
Trans Female (MTF or Male to Female) .
April 54 54
0
0
0
Gender Non -Conforming (i.e. not exclusively male or female)
July 55 55
0
0
0
Client Doesn't Know/Client Refused
October 56 56
0
0
0
Data Not Collected
Q09a: Number of Persons Contacted
0
0
0
Subtotal
All Persons
First contact — NOT staying
on the
First contact — WAS staying on Streets,
First contact —Worker unable to
Contacted
Streets, ES, or SH
ES, or SH
determine
Once 0
0
0
0
2-5 Times 0
0
0
0
6-9 Times 0
0
0
0
10+ Times 0
0
0
0
Total Persons 0
0
0
0
Contacted
Q09b: Number of Persons Engaged
All Persons
First contact — NOT staying
on the
First contact —WAS staying on Streets,
First contact — Worker unable to
Contacted
Streets, ES, or SH
ES, or SH
determine
Once 0
0
0
0
2-5 Contacts 0
0
0
0
6-9 Contacts 0
0
0
0
10+ Contacts 0
0
0
0
Total Persons 0
0
0
0
Engaged
Rate of 0.00
0.00
0.00
0.00
Engagement
Q1 Oa: Gender of Adults
Total
Without Children
With Children and Adults Unknown,Household Type
Male
32
32
0 0
Female
32
32
0 0
Trans Female (MTF or Male to Female)
0
0
0 0
Trans Male (FTM or Female to Male)
0
0
0 0
Gender Non -Conforming (i.e. not exclusively
male or female) 0
0
0 0
Client Doesn't Know/Client Refused
0
0
0 0
Data.Not Collected
0
0
0 0
Subtotal -
64
64
0 0
Q10b: Gender of Children
Total With Children and Adults With Only Children Unknown Household Type
Male
0
0
0
0
Female
0
0'
0
.0
Trans Male (FTM or Female to Male)
0
0
.0
0
Trans Female (MTF or Male to Female) .
0
0
0
0
Gender Non -Conforming (i.e. not exclusively male or female)
0
0
0
0
Client Doesn't Know/Client Refused
0
0
0
0
Data Not Collected
0
0
0
0
Subtotal
0 -
0
0
0
2/20/2019
Q10c: Gender of Persons Missing Age Information
Sage: Reports: HUD Annual Performance Report 2018 - CoC
Total
Without
With Children and
With Only
Unknown Household
Children
Adults
Children
Type
Male
0
0
.0
0
0
Female
0
0
0
0
0
Trans Male (FTM or Female to Male)
0
0
01
0
0
Trans Female (MTF or Male.to Female)
0
0
0
0 .
0
Gender Non -Conforming (i.e. not exclusively
male or
female)
0
0
0
0
0
Client Doesn't Know/Client Refused
0
0
0
0
0 -
Data Not Collected
0
0
0
0
0
Subtotal
0
0
0
0
0
Q11: Age
Total
Without Children
With Children and Adults
With Only Children
Unknown Household Type
Under5
0
0
0
0
0
5-12
0
0
0
0
0
13-17
0
0
0
0.
0
18-24
1
1
0
0
0
25-34
0,
0
0
0
0
35-44
6
6
0
0
0
45 54
27
27
0
0
0
55-61
15
15
0 .
0
0
62+
15
15
0
0
0
Client Doesn't Know/Client Refused '.
0
0
0
0
0
Data Not Collected '
0
0
0
0
0
Total
64
64
0
0
0
Q12a: Race
Total
Without Children
With Children and Adults
With Only Children
Unknown
Household Type
White
15
15
0
0
0
Black or African American
47
47
0
0
0
Asian
0.
0
0
0
0
Amencah lhdian or Alaska Native
0
0
0
0
0
Native Hawaiian or Other Pacific Islander
0
0
0
0
0
Multiple Races ..
?
2
0
0
0
Client Doesn't Know/Client Refused
0
.0
0
0
0
Data Not Collected.
0
0
0
0
0
Total
64
.
64
0
0
0
Q12b: Ethnicity
Total
Without
Children.
With Children and
Adults
With Only Children
Unknown Household
Type
Non-Hispanib/Non-Latino
57
57
0
0
0
Hispanic/Latino
7
7
0
0
0
Client Doesn't Know/Client Refused
0
0
0
0
0
Data Not Collected
0
0
0
0
0
Total
64
64
0
0
0
2/20/2019
Total Persons
Sage: Reports: HUD Annual Performance Report 2018 - CoC
With Children and Adults
Q13a1: Physical and Mental Health Conditions at
Start
None
0.
0
0
0
0
1 Condition
Total Persons
Without
Children
With
Children and Adults
With Only Children
Unknown Household Type
Mental Health Problem 53
53
0
0
3+ Conditions
0
8
0
0
Alcohol Abuse 0
0
0
0
0
0
0
0
0
.Drug Abuse 0
0
0
0
Data Not Collected
0
0
0
0
Both Alcohol and Drug Abuse 62
62
8
0
0
0
0
0
Chronic Health Condition 24
24
0
0
0
HIV/AIDS 12
12
0
0
0
Developmental Disability 5
5
0
0
0
Physical Disability 46
46
0
0
0
Q13a2: Number of Conditions at Start
Total Persons
Without Children
With Children and Adults
With Only Children
Unknown Household Type
None 2
2
0
0
0
1 Condition 0
0
0
0
0
2 Conditions 2
2
0
0
0
3+ Conditions 60
60
0
0
0
Condition Unknown 0
0
0
0
0
Clieht Doesn't Know/Client Refused 0
0
0
0
0
Data Not Collected 0
0
0
0
0
Total 64
64
0
0
0
Q13b1: Physical and Mental Health Conditions at Exit
Total Persons
Without Children
With Children and Adults
With
Only Children
Unknown
Household Type
Mental Health Problem 4
4
0
0
0
Alcohol Abuse 0
0
0
0
0
Drug Abuse 0
0
0
0
0
Both Alcohol and Drug Abuse 8
8
0
0
0
Chronic Health Condition 3
3
0
0
0
HIV/AIDS 1
1
0
0
0
Developmental Disability 0
0
0
0
0
Physical Disabilify 6
8
0
0
0
Q13b2: Number of Conditions at Exit
Total Persons
Without Children
With Children and Adults
With Only Children
Unknown Household Type
None
0.
0
0
0
0
1 Condition
0
0
0
0
0
2 Conditions
0
0
0
0
0
3+ Conditions
8
8
0
0
0
Condition Unknown
0
0
0
0
0
Client Doesn't Know/Client Refused
0
0
0
0
0
Data Not Collected
0
0
0
0
0
Total
8
8
0
0
0
2/20/2019
Total
Without Children
Sage: Reports: HUD Annual Performance Report 2018 - CoC
With Only Children
Q13c1: Physical and Mental Health Conditions for Stayers
Yes
32
32
0
0
0
Total Persons
Without Children
With Children and Adults
With Only Children
Unknown Household Type
Mental Health Problem 49
Client Doesn't Know/Client Refused
49
0
0
0
0
Data Not Collected
0
0
Alcohol Abuse 0
0
0
Total
0
64
0
0
0
Q14bi Persons Fleeing Domestic Violence
Drug Abuse 0
0
0
Total
0
With Children and Adults
0
Unknown Household Type
Both Alcohol and Drug Abuse 54
0
54
0
0
0
0,
20
0
0.
Chronic Health Condition 21
0
21
-0
0
0
0
0
0
12.
HIV/AIDS. 11
0
11
.0
0
32
0
0
0
0
Developmental Disability 5
5
0
0
0
Physical Disability 38
38.
0
0
0
Q13c2: Number of Conditions for Stayers
Total Persons
Without Children
With Children and Adults
With Only Children
Unknown Household Type
None
2
2
0
0
0
1 Condition
.0
0
0
0
0
2 Conditions
2
2
0
0
0
3+ Conditions
52
52
0
0
0
Condition Unknown
0
0
0
0
0
Client Doesn't Know/Client Refused
0
0
0
0
0
Data Not Collected
0
0
0
0
0
Total
56
56
0
0
0
Q14a: Domestic Violence History
Total
Without Children
With Children and Adults
With Only Children
Unknown Household Type
Yes
32
32
0
0
0
No
32
32
0
0
0
Client Doesn't Know/Client Refused
0
0
0
0
0
Data Not Collected
0
0
0
0
0
Total
64.
64
.0.
0
0
Q14bi Persons Fleeing Domestic Violence
Total
Without Children
With Children and Adults
With Only Children
Unknown Household Type
Yes
0
0
0
0
-
0
No
20
20 .
0.
.
0 .
0
Client Doesn f Know/Client Refused
-0
0
0
0
0
Data Not Collected
12.
12
0
0
.0
Total
32
32'
0
0
0
2/20/2019 Sager Reports: HUD Annual Performance Report 2018 - CoC
015: Living Situation
Total Without ' With Children and With Only
Children Adults Children
Homeless Situations
0 '
0
0 0
Emergency shelter, including hotel or motel paid for with emergency
25
25
0 0
shelter voucher
$251 - $500
2
1
Transitional housing for homeless persons (including homeless youth)
2
2
0 0
Place not meant for habitation
7
7
0 0
Safe Haven
0
0
0 0
Interim Housing
0
0
0 0
Subtotal
34
34
0 0
Institutional Settings
0
0
0 0
Psychiatric hospital or other psychiatric facility
0
0
0 0
Substance abuse treatment facility or detox center
28
28
0 0
Hospital or other residential non -psychiatric medical facility
.0
0
0 0
Jail, prison orjuvenile detention facility
1
1
0 0
Foster care home or foster care group home
0
0
0 0
Long-term care facility or nursing home
0
0
0 0
Residential project or halfway house with no homeless criteria
0
0
.0 0
Subtotal
29
29
0 0
Other Locations
0
0
0 0
Permanent housing (other than RRH) -for formerly homeless persons
1
1
0 0
Owned by client, no ongoing housing subsidy
0
0
0 0
Owned by client, with ongoing housing subsidy
0
0
0 0
Rental by client, no ongoing housing subsidy
0
0
0 0
Rental by client, with VASH subsidy
0
0
0 0
Rental by client with GPD TIP subsidy
0
0
0 0
Rental by client, with other housing subsidy (including RRH)
0
0
0 0
Hotel or motel paid for without emergency shelter voucher
0
0
0 0
Staying or living in a friend's room, apartment or house
0
0
0 0
Staying or living in a family member's room, apartment or house
0
0
0 0
Client Doesn't Know/Client Refused
0
0
0 0
Data Not Collected
0
0
0 0
Subtotal
j
j
0 0
Total
64
64
0 0
Q16: Cash Income - Ranges
Unknown Householc
Type
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Income at Start Income at Latest Annual Income at Exit for Leavers
Assessment for Stayers
No income
16
6
$1-$150
3
4
$151 - $250
3
1
$251 - $500
2
1
$501-$1000
22
8
$1,001- $1',500
6
13
$1,501 - $2,000
2
5
$2,001+
10
9
Client Doesn't Know/Client Refused
0
0
Data Not Cbllected
0
0
Number.of Adult Stayers Not Yet Required to Have an Annual Assessment
0
9
Number of Adult Stayers Without Required Annual Assessment
0
0
Total Adults
64
56
0
0
0
0
3
1
3
1
0
0
0
0
8
2/20/2019 Sage: Reports: HUD Annual Performance Report 2018 - CoC
Q17: Cash Income -Sources
Income at Start
Income at Latest Annual
Income at Exit for Leavers
Assessment for Stayers
Earned Income
19
10
3
Unemployment Insurance ..
1
1
0
SSI
28
28
5
SSDI
3
2
0
VA Service -Connected Disability Compensation
0
0
0
VA Non -Service Connected Disability Pension
0
0
0
Private Disability Insurance
0
0
0
Worker's Compensation
0
0
0
TANF or Equivalent
1
0
0
General Assistance
5
3
1
Retirement (Social Security)
1
0
0
Pension from Former Job
1
0
0
Child Support
0
0
0
Alimony (Spousal Support)'
0
0
0
Other Source
13
9
3
Adults with Income Information at.Start and Annual Assessment/E)it
0
34
7
Q18: Client Cash Income Category - Earned/Other Income Category - by Start and Annual Assessment/Exit Status
Number of Adults
Number of Adults at
Number of Adults
at Start
Annual Assessment (Stayers)
at Exit (Leavers)
Adults with Only Earned Income (i.e„ Employment Income)
12
6
2
Adults with Only Other Income
29
31
5
Adults with Both Earned and Other Income
7
4
1
Adults with No Income
16
6
0
Adults with Client Doesn't Know/Client Refused Income Information
0 .
0
0
Adults with Missing Income Information
6
0
0
Number of Adult Stayers Not Yet Required to Have an Annual Assessment
0
9
0
Number of Adult Stayers Without Required Annual Assessment
0
0
0
Total Adults
64
56
8
1 or More Source of Income
51
44
8
Adults with Income, information at Start and Annual Assessment/Exit
0
34
7
2/20/2019
971.00
0.00
Sage: Reports: HUD Annual Performance Report 2018 - CoC .
709.40
23
Q19a1: Client
Cash Income Change - Income Source - by Start and Latest Status
47
32
557.00
927.11
0.00
0.00
661.09
Did Not have
Perfomance
Had Income
Retained
Retained
Retained
the Income
Did Not
Category. at
Income
Income
Income
Category at
have the
Total
Measure: Adults
Perfonnancc
Start and
Category But
Category
Category
Start and
Income
Adults
Who Gained or
measure:
Did Not
Had Less'$
and Same $
and "
Gained the
Category at
(Including
Increased
Percent of
Have it at
at Annual
at Annual
Increased $
Income
Start or at
Those
Income from
persons wh(
Annual
Assessment
Assessment
at Annual
Category at
Annual
with No
Start to Annual
accomplishe
Assessment
Than at Start
as at Start
Assessment
Annual
Assessment
Income)
Assessment;
this measun
Assessment
Average Gain
Number of .
Adults with
Earned
4
3
1
3
1
32
47
5
10.64%
Income (i.e.,
Employment
Income)
Average
Change in -323.25 -905.00 0.00
Earned
Income
Number of
Adults with 0 1 2
Other
Income
Average
Change in -36.00 0.00
Other
Income
Number of
Adults with
Any Income 0 3. 1
(i.e., Total
Income)
Average
Change in -650.33 0.00
Overall
Income
828.67
971.00
0.00
0.00
709.40
23
9
10
47
32
557.00
927.11
0.00
0.00
661.09
30 5 3
592.43 799.20
0.00
47 37
430.00 611.05
0.00%
68.09%
0.00%
78.72%
0.00 %
2/20/2019
Sage: Reports: HUD Annual Performance Report 2018 - CoC
Q19a2: Client Cash Income Change - Income Source - by Start
and Exit
Had
Retained
Retained
Retained
Did Not have the
Did Not
Total
Performance
Performance
Income
Income
Income
Income
Income Category
have the
Adults
Measure: Adults
measure:
Category
at Start
Category
but
Category
Category
at Start and
Income
(Including
Who Gained or
Percent of
and Did
Less $ at
and Same
and
Gained the
Category
Those
Increased Income
persons who
Not Have it
Exit than at
$ at Exit as
Increased
Income Category
at Start or
with No
from Start to Exit;
accomplished
at Exit
Start
at Start
$ at Exit
at Exit
at Exit
Income)
Average Gain
this measure
Number of
Adults with
Earned
1
0
1
1
1
4
8
2
25.00
Income (i.e.,
Employment
Income)
Average
Change in
_841.00
--
0.00
1100.00
1501.00
0.00
0.00
1300.50
0.00%
Earned
Income
Number of
Adults with
0
0
0
5
1
2
8
6
75.00%
Other
Income
Average
Change in
463.20
750.00
0.00
0.00
511.00
0.00%
Other.
Income
Number of
Adults with
Any Income
0
1
0
6
1
0
8
7
87,50%
(i.e., Total
Income)
Average
Change in
_
-91.00
569.33
1501.00
—
603.00
702.43
0.00%
Ovemil
-Income
2/20/2019
Sage: Reports: HUD Annual Performance Report 2018 - CoC
Q19a3: Client
Cash Income Change
- Income Source - by Start and Latest Status/Exit
Employment
Did Not Have the
Performar
Had Income
Retained Income
Retained Income
Retained Income
Income
Did Not have the
Total
Measure:,
Category of Start
Category But
Category and
Category and
Category at Start
Income
Adults
Who Gaini
and Did Not
Had Less $ at
Same $ at
Increased $ at
and Gained the
Category at Start
(Including
Increased
have it at Annual
Annual
Annual
Annual
Income
or Annual
Those
Income frt
Assessment/Exit
Assessment/Exit
Assessment/Exit
Assessment/Exit
Category at
Assessment/Exit
with No
Start to Ar
Than at Start
as at Start
Annual
Income)
Assessme
10
12
55
38
Assessment/Exit
Average G
Number of
Income
Adults with
Average
Earned
5
3
2
4
2
36
55
7
Income (i.e.,
Employment
Income)
Average
Change in 426.80 -905.00
0.00
896.50
1236.00
0.00
0.00
878.29
Earned
Income
Number of
Adults with 0 1
2
28
10
12
55
38
Other
Income
Average
Change in _ -36.00
0.00
540.25
909.40
0.00
0.00
637.39
Other
Income
Number of
Adults with
Any Income 0 4
1
36 .
6
3
55
44
(i.e., total
income)
Average
Change in _ -510.50
0.00
588.58
916.17
0.00
455.00
625.59
Overall
Income
Q20a: Type of Non -Cash Benefit Sources
Benefit
at Start
Benefit at Latest Annual
Benefit at Exit for Leavers
Assessment for Stayers
Supplemental Nutritional Assistance_ Program
58
42
8
WIC
0
0
0
TANF Child Care Services
0
0.
0
TANF Transportation Services
0
0
0
Other TANF-Funded Services
0
0
0
Other Source
51
40
8
Q20b: Number of Nan -Cash Benefit Sources
Benefit at Start
Benefit
at Latest Annual Benefit
at Exit
for Leavers
Assessment
for Stayers
No sources 5
4
0
1+ Source(s) 59
43
8
Client Doesn't Know/Client Refused 0
0
0
Data Not Collected. 0
9
0
Total 64
56
8
2/20/2019
Q21: Health Insurance
Sage: Reports: HUD Annual Performance Report 2018- COC
At Start
At Annual Assessment
'
At Exit for Leavers
for Stayers
Medicaid
33
28
5
Medicare
3
1
1
State Children's Health Insurance Program
0
0
0
VA Medical Services
1
1
0
Employer Provided Health Insurance
0
0
0
Health Insurance Through COBRA
0
0
0
Private Pay Health Insurance
0
0
0
State Health Insurance for Adults
28
20
4
Indian Health Services Program
0
0
0
Other
0 .'
0
0
No Health Insurance
6.
3
0
Client Doesn't Know/Client Refused
0
0
0
Data Not Collected
0
0
0
Number of Stayers Not Yet Required to Have an Annual Assessment
0,
9
0
1 Source of Health Insurance
51
38
6
More than 1 Source of Health Insurance
7
6
2
0,22a1: Length of Participation — CoC Projects
Total Leavers Stayers
30 Days or Less 1 0 -1
31 to 60 Days. 1 0 1
61 to. 90 Days 1 0 . 1
91 to 180 Days 3 0 3
181 to -365 Days 3 .. 0 3
366 to 730 Days (1-2 yrs) 11 1 10
731 to 1,095 Days (2-3 yrs)' 3 0 3
1096 to 1,460 Days (3-4 yrs) 5. 1 4
1451 -to 1,825 Days (4-5 yrs) 3 0 3
More than 1,825 Days (>5 yrs) 33 6 27
Data Not Collected - 0 0 0
Total 64 ' 8 56
Q22b: Average and Median Length of Participation in Days
Leavers
Stayers
Better Way of Miami, Inc. Apts. SRA PSH - FL0170L4D001609
a. Average length in days. 2386.0000
2002.0000
Better Way of Miami, Inc.-Apts. SRA PSH -. FL0170L4D001609
b. Median length
in days 2115.0000
1779.0000
2/20/2019
Sage: Reports: HUD Annual. Performance Report 2018 - CoC-
Q22c: Length of Time between Project Start
Date and Housing Move -in Date (post 10/112016)
Total
_ Without Children With Children and Adults
With Only Children
Unknown Household Type
7 days or less
2
2 0
0
0
8 to 14 days
0
0 0
0
0
15 to 21 days
0
0 0
0
0
22 to 30 days
0
0 0
0
0
31 to 60 days
0
0 0
0
0
61 to 180.days
0
0 0
0
0
1'81 to 365 days
0
0 0
0
0
366 to 730 days (1-2 Yrs)
0
0 0
0
0
Total (persons moved into housing)
2
2 0
0
0
Average length of time to housing
0.00
0.00
—
—
Persons who were exited without move -in
1
1 0
0
0
Total persons
3
3 0
0
0
Q22c: RRH Length of Time between Project
Start Date and Housing Move -in Date (pre 10/112018)
Total Without Children
With Children and Adults With Only Children Unknown
Household Type
no data -
2/20/2049 Sage: Reports: HUD Annual Performance Report 2018 - CoC
Q23a: Exit Destination — More Than 90 Days
Total
Without
With Children
With Only
Unknown
Children
and Adults
Children
'Household Type
Permanent Destinations
0
0
0
0
0
Moved from one HOPWA funded project to HOPWA, PH
0
0
0
0
0
Owned by client, no ongoing housing subsidy
0
0
0
0
0
Owned by client, with ongoing housing. subsidy
0
0
0
0
0
Rental by client, no ongoing housing subsidy
3
.3
0
0
0
Rental by client, with VASH housing subsidy
0
0
0
0
0
Rental by client, with GPD TIP housing subsidy
0
0,-
0
0
0
Rental by client, with other ongoing housing subsidy
3
3
0
0
0'
Permanent housing (other than RRH) for formerly homeless persons
0
0
0
0
0
Staying or living with family, permanent tenure .
0
0
0
0
0
Staying or living with friends, permanent tenure
0
0
0
0
0
Rental by client, with RRH or equivalent subsidy
0
0
0
0
0
Subtotal
6
6
0
0
0
Temporary Destinations
0
0
0
0
0
Emergency shelter, including hotel or motel paid forwith emergency shelter voucher
0
0
0
0
0
Moved from one HOPWA funded project to HOPWA TH
0
0
0
0
0
Transitional housing for homeless persons (including homeless youth)
0
0
0
0
0
Staying or living with family, temporary tenure (e.g. room, apartment or house)
0
0
0
0
0
Staying or living with friends; temporary tenure (e.g. room; apartment or house)
0
0
0
0
0
Place not meant for habitation (e.g., a vehicle, an abandoned building, bus/train/subway
statiohlairport or anywhere outside)
0
0
0
0
0
Safe Haven
0.
0
0
0
0
Hotel or motel paid for without emergency shelter voucher
0
0
0
0
0
Subtotal
0
0
0.
0
0
Institutional Settings
0
0
0
0
0
Foster care home or group foster care home.
b
0
0
0
0
Psychiatric hospital or.other psychiatric facility -
0
0
0
0
0
Substance abuse treatment facility or detox center
0
0
0
0
.0
Hospital or other residential non -psychiatric medical facility
0
0
0
0,
0
Jail, prison, orjuvenile detention facility
0
0
0
0
0
Longterm care facility or -nursing home
0
0
0
0
0
Subtotal
0.
0,
0
0
0
Other Destinations '
0.
0.
0
0
0
Residential project or halfway house with no homeless criteria
0
0
0
0
0
Deceased
2
2
0
0
0
Other
0
.0
0
0
0
-Client Doesn't Know/Client Refused .
0
0
0
0
0
• Data.1 of Collected. (no exit interview completed)
0
0
0
0
0
Subtotal
2
2
0
0
0
Total
8
8
0
0
0
Total persons exiting to positive housing destinations
6
6
0
0
0
Total persons whose destinations excluded them from the calculation
2
2
0
0
0
100.00 .00
100.00 %
—
2/20/2019 Sage: Reports: HUD Annual Performance Report 2018 - CoC
Q23b: Exit Destination — 90 Days or Less '
Permanent Destinations
Moved from one HOPWA funded project to HOPWA PH
Owned by client, no ongoing housing subsidy
Owned by client, with ongoing housing subsidy
Rental by client, no ongoing housing subsidy
Rental by client, with VASH housing subsidy
Rental by client, with GPD TIP housing subsidy
Rental by client, with other ongoing housing subsidy
Permanent housing (other than RRH) for formerly homeless persons
Staying or living with family, permanent tenure
Staying or living with friends, permanent tenure
Rental by client, with RRH or equivalent subsidy
Subtotal
Temporary Destinations
Emergency shelter, including hotel or motel paid for with emergency shelter voucher
Moved from one HOPWA funded project to HOPWA TH
Transitional housing for homeless persons (including homeless youth)
Staying or living with family, temporary tenure (e.g. room, apartment or house)
Staying or living with friends, tempotary tenure (e.g. room, apartment or house)
Place not meant for habitation (e.g., a vehicle, an -abandoned building, bus/train/subway
station/airport or anywhere outside)
Safe Haven
Hotel or motel paid for without emergency shelter voucher
Subtotal
Institutional Settings
Foster care home or group foster care home
Psychiatric hospital or other psychiatric facility
Substance abuse treatment facility or detox center
Hospital or other residential non -psychiatric medical facility
Jail, prison, or juvenile detention facility
Long-term care facility or nursing home
Subtotal
Other Destinations
Residential project or halfway house with no homeless criteria
Deceased
-Other
Client Doesn't Know/Client Refused
Data Not Collected (no exit interview completed)
Subtotal
Total
Total persons exiting to positive housing destinations
Total persons whose destinations excluded -them from the calculation
Percentage
httna•//www.sanahmis.infn/secure/reDorts/filteroaaes/aalactic.aspx?reportlD=33&client ID=86675&157.4340=91630&iid=91630&autoexecute=true&.:. .17/28
Without
With Children
With Only
Unknown
Total
Children
and Adults
Children
Household Type
0
0
0
0
0
0
0
G
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
D
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0.
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
.0
0
0
0
0
0
0
0
0
0
0
0
0
0
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2/20/2019
Sage: Reports: HUD Annual Performance Report 2018 - CoC .
Q25a: Number of Veterans
Total
Without Children
With Children and Adults
Unknown Household Type
Chronically. Homeless Veteran
0
0
0
0
Non -Chronically Homeless Veteran
4
4
0
0
Not a Veteran
60
60
0
0
Client Doesn't Know/Client Refused
0
0.
0
0
Data Not Collected
0
0
0
0
Total
64
64
0
0
Q25b: Number of Veteran Households
Total
Without Children
With Children and Adults
Unknown Household Type
Chronically Homeless Veteran
0
0
0
0
Non -Chronically Homeless Veteran
4
4
0
0
Not a Veteran
60
60
0
0
Client Doesn't Know/Client Refused
0
0
0
0
Data Not Collected
0
0
0
0
Total
64
64
0
0
Q25c: Gender -Veterans
Total
Without Children With Children and Adults Unknown Household Type
Male
4
4 0
0
Female
0
0 0
0
Trans Male (FTM or Female to Male)
0
0 0
0
Trans Female (MTF or Male to Female)
0
0 0
0
Gender Non -Conforming (i.e. not exclusively male or female)
0
0 0
0
Client Doesr&Know/Client Refused
0 _
0 0
0
Data Not Collected
0
0 0
0
Total
4
4 0
0
625d: Age - Veterans
Total
Without Children
With Children and Adult
Unknown Household Type
18-24
0
.0
0
0
25-34
0
0
0
0
35-44
0
0
0
0
45-54.
2
2
0
0
55-61
0
0
0
0
'62+
2
2
0
0
Client Doesn't Know/Client Refused
0
0
0
0
Data Not Collected
0
0
0
0
Total
4
4
0
0
2/20/2019 Sage: Reports: HUD Annual Performance Report 2018 - CoC
Q25e: Physical and Mental Health Conditions -Veterans
Conditions At Start Conditions at Latest Assessment for Stayers Conditions at Exit for Leavers
Mental Health Problam 3
3
1
0
Unemployment Insurance
Alcohol Abuse 0
0
0
0
3
Drug Abuse 0
0
SSDI
0
0
Both Alcohol Abuse and Drug Abuse 4
4
0
0
0
Chronic Health Condition 2
2
0
0
Private Disability Insurance_
HIV/AIDS 0
0
0
0
0
Developmental Disability 1
1
TANF or Equivalent
0
0
Physical Disability 3
3
1
0
0
Q25f: Cash Income Category - Income Category - by Start
and Annual /Exit Status -.Veterans
0
0
Pension from Former Job
Number of Veterans at
Number of Veterans at Annual Assessment
Number of Veterans at Exit
Child Support
Start
(Stayers)
0
(Leavers)
Veterans with Only Earned Income (i.e., Employment
0
0
Other Source ' ..
2
Income) .
0
0
0
0
Veterans with Only Other Income
3
3
0
Veterans with Both Eamed and Other Income
1
1
0
Veterans with No Income
0
0
0
Veterans with Client Doesn't Know/Client Refused Income
Information
0
0
0
Veterans with Missing Income Information
0
0
0
Number of Veterans Not yet Required to Have an Annual
Assessment
0
0
0
Number of Veterans Without Required Annual Assessment
0
0
0
Total Veterans
4
4
0
025g: Type of Cash Income Sources - Veterans
Income at Start Income at Latest Annual Income at Exit for Leavers
Assessment for Stayers
Earned Income
1
1
0
Unemployment Insurance
0
0
0
SSI
3
3
0
SSDI
0
0
0
VA Service -Connected Disability Compensation
0
0
0
VA Non -Service Connected Disability Pension
0
0
0
Private Disability Insurance_
0
0
0
Worker's Compensation
0
0
0
TANF or Equivalent
0
0
0
General Assistance
1
1
0
Retirement (Social Security)
0
0
0
Pension from Former Job
0
0
0
Child Support
0
0
0
Alimony (Spousal Support)
0
0
0
Other Source ' ..
2
2
0
Veterans with Income Information at Start and Annual Assessment/Exit
0
4
0
2/20/2019
Sage: Reports: HUD Annual Performance Report 2018 - CoC
Q25h: Type of Non -Cash Benefit Sources - Veterans
Benefit
at Start Benefit at Latest Annual
Assessment for Stayers
Benefit at Exit for Leavers
Supplemental Nutritional Assistance Program
4
4
0
WIC
0
0
0
TANF Child Care Services
0
0
0
TANF Transportation Services
0
0
0
Other TANF-Funded Services
0
0
0
Other Source
4
4
0
2/20/2079
Q251: Exit Destination -Veterans
Sage: Reports: HUD Annual Performance Report 2018 - CoC
Permanent Destinations
Moved from one HOPWA funded project to HOPWA PH
Owned by client, no ongoing housing subsidy
Owned by client, with ongoing housing subsidy
Rental by client, no ongoing housing subsidy
Rental by client, with VASH housing subsidy -
Rental by client, with GPD TIP housing subsidy
Rental by client, with other ongoing housing subsidy
Permanent housing (other than RRH) fdr formerly homeless persons
Staying or living with family, permanent tenure
Staying or living with friends, permanent tenure
Rental by client, with RRH or equivalent subsidy
Subtotal
Temporary Destinations
Emergency shelter, including hotel or motel paid for with emergency shelter voucher
Moved from one HOPWA funded project to HOPWA TH
Transitional housing for homeless persons (including homeless youth)
Staying or living with family, temporary tenure (e.g. room, apartment or house)
Staying or living with friends, temporary tenure (e.g. room, apartment or house)
Place not meant for habitation (e.g., a vehicle, an abandoned building, bus/train/subway
station/airport or anywhere outside)
Safe Haven
Hotel or motel paid for without emergency shelter voucher
Subtotal
Institutional Settings
Foster care home or group foster care home
Psychiatric hospital or other psychiatric facility
Substance abuse treatment facility or detox center
Hospital or other residential non -psychiatric medical facility
Jail, prison, orjuvenile detention facility
Long-term care facility or nursing home
Subtotal
Other Destinations
"Residential project or halfway house with no homeless criteria
Deceased
Other -
Client Doesn't Know/Client Refused
Data Not Collected (no exit interview completed)
Subtotal
Total
Total persons exiting to positive housing destinations
Total persons whose destinations excluded them from the calculation
Percentage
Total
Without.
With Children
With Only
Unknown
Children
and Adults
Children
Household Type
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2/20/2019
Sage: Reports: HUD Annual Performance Report 2018 - CoC
Q26a: Number of Households wlat least one or more Chronically Homeless person
Total
Without Children
With Children and
Adults
With Only Children
Unknown Household Type
Chronically Homeless 21
21
0
0
0
Not Chronically Homeless 43
43
0
0
0
Client Doesn't Know/Client Refused 0
0
0
0
0
Data Not Collected 0
0
0
0
0
Total' 64
64
0
0
0
Q26b: Number of Chronically Homeless Persons by Household
Total
Without Children
With Children and
Adults
With Only Children
Unknown Household Type
Chronically Homeless 21
21
0
0
0
Not Chronically Homeless 43
.43
0
0
0
Client Doesn't Know/Client Refused 0
0
0
0
0
Data Not Collected 0
0
0
0
0
Total 64
64-
0
0
0
Q26c: Gender of Chronically Homeless Persons
Total
Without
With Children
and
With Only
Unknown Household
Children
Adults
Children
Type
Maier
7
7
0
0
0
Ferrule
1.
14
0
0
0
Trans Male (FTM or Female to Male)
0
0
0
0
0
Trans Female (MTF or Male to Female)
0
0
0
0
0
Gender Non -Conforming (i.e. not exclusively male or
female)
0
0
0
0
0
Client Doesn't Know/Client Refused
0
0
0
0
0
Data Not Collected
0
0
0
0
0
Total
21
21
0
0
0
CiHd: Age of Chronically Homeless Persons
Total
Without Children.
With Children and Adults
With Only Children
Unknown Household Type
0-17 0.
...1..
0
0
0 :.
O
18-24 1
0
0
0
25-34 0
0_
0
0
0
.35-44 1
1
0
0
0
45_54 9
9
0.
0
0
55-61 7
7
0
0
0
62+ 3
3
0
0
0
'Client Doesn't Know/Client ,Refused 0.
0
0
0
0
Data Not Collected 0
0
0
0
0
Total 21
21
0
0
0
2/20/2019
Sage: Reports: HUD Annual Performance' Report 2018 - CoC
Q26e: Physical and Mental Health Conditions - Chronically Homeless Persons
Conditions at Start
Conditions at Latest Assessment (Stayers)
Conditions at Exit (Leavers)
Mental Health Problem 19
19.
0
Alcohol Abuse 0
0
0
Drug Abuse 0
0
0
Both Drug and Alcohol Abuse 21
-20
1
Chronic Health Condition 10
9
1
HIV/AIDS 2
2
0
Developmental Disability 3
3
0
Physical Disability 13
12
1
Q26f: Client Cash Income - Chronically Homeless Persons
Number of Chronically
Number of Chronically Homeless Persons
Number of Chronically Homeles
Homeless Persons at Start
at Annual Assessment (Stayers)
Persons at Exit (Leavers)
Chronically Homeless Persons with Only Eamed
4
4
1
Income (i.e., Employment Income)
Chronically Homeless Persons with Only Other
5
8
0
Income
Chronically Homeless Persons with Both Earned
3
2
0
and Other Income
Chronically Homeless Persons with No Income
9
3
0
Chronically Homeless Persons with Client Doesn't
0
0
0
I(now/Client Refused Income Information
Chronically Homeless Persons with Missing Income
0
0
0
Information
.Number of Chronically Homeless Persons Not yet
0
3
0
Required to Have an Annual Assessment
Number of Chronically Homeless Persons Without
0
0
0
Required Annual Assessment
Total Chronically Homeless Persons
21
20
1
Q26g: Type of Cash Income, Sources -Chronically Homeless Persons
Income at Start
Income at Latest Annual
Income at Exit for Leavers
Assessment for Stayers
Earned Income
.7
6 '
1
Unemployment Insurance
1
1
0
SSI
7
8
0
S5DI
1
1
0
VA Service-Connected Disability Compensation
0
0.
0
VA Non -Service Connected Disability Pension
0
0
0
Private Disability Insurance
0
0
0
Worker's Compensation
0
.0
0
TANF or Equivalent
1
0•
0
General Assistance
1
0
0
Retirement (Social Security)
0
0
0
Pension from Former Job.
0 .0
0
Child Support
0
0
0
Alimony (Spousal Support)
0
0
0
Other Source
4
4
0
Chronically'Homeless Persons with-Income Information at Start and Annual AssessmenbExit
0 .
10
0
2/20/2019
Sage: Reports: HUD Annual Performance Report 2018 - CoC
Q26h: Type of Non -Cash Benefit Sources - Chronically Homeless
Persons
Benefit at Start
Benefit at Latest Annual Benefit at Exit for Leavers
Assessment for Stayers
Supplemental Nutritional Assistance Program .
18
15
1
WIC
0
0
0
TANF Child Care Services
0
0
0
TANF Transportation Services
0
0
0
OtherTAN F -Funded Services
0-
0
0
Other Source
15
13
1
Q27a: Age of Youth
Total
Without Children
With Children and Adults With Only Children
Unknown Household Type
12-17 0
0
D
0
0
18-24 1
1
0
0
0
Client Doesn't Know/Client Refused 0
0
0
0
0
Data Not Collected 0
0
0
0
0
Total. . 1
1
0
0
0
Q27b: Parenting Youth
Total Parenting Youth
Total Children ofParenting Youth Total Persons
Total Households
Parent Youth <18 0
0
0
0
Parent Youth 18 to 24 0
0
0
0
Q27c: Gender - Youth
Total
Without
With Children and
With Only
Unknown Household
Children
Adults
Children
Type
Male
0
0
0
0
0
Female
1
1
0
0
0
Trans Male (FTM orfemale to Male)
0
0
0
0
0
Trans Female..(MTF or Male to Female)
0
0
0
.0
0
Gender Non -Conforming (i.e. not exclusively male or
female)
0
0
0
0
0
Client Doesn't Know/Client Refused
0
0
0
0
0
Rata Not Collected
0
0
0
0
0
-Total
1
1
0
0
0
2120/2019
Q27d: Living Situation -Youth
Sage: Reports: HUD Annual Performance Report 2018 - CoC
Homeless Situations
Emergency shelter, including hotel or motel paid for with emergency
shelter voucher
Transitional -housing for homeless persons (including homeless youth)
Place hot meant for habitation
Safe Haven
Interim .Housing
Subtotal
Institutional Settings
Psychiatric hospital or other psychiatric facility
Substance abuse treatment facility or detox center
Hospital or other residential non -psychiatric medical facility
Jail, prison or juvenile detention facility
Foster care home or foster care group home
Long-term care facility or nursing home
Residential project or halfway house with no homeless criteria
Subtotal
Other Locations
Permanent housing (other than RRH) for formerly homeless persons
Owned by client, no ongoing housing subsidy
Owned by client, with ongoing housing subsidy
Rental by client, no ongoing housing subsidy
Rental by client, with VASH subsidy
Rental by client with GPD TIP subsidy
Rental by client, with other housing subsidy (including RRH)
Hotel or motel paid for without emergency shelter voucher
Staying or living in a friend's room, apartment or house
Staying or living in a family member's room, apartment or house
Client Doesn't Know/Client Refused
Data Not Collected
Subtotal
Total
Q27e: Length of Participation - Youth
Total Leavers Stayers
30 Days or Less
0
0
0
31 to 60 Days
0
0
0
61 to 90 Days.
0
0
0
91 to 180 Days.'
0
0
0.
1a1 to .365 Days
0
0
0
366 to 730 Days (1-2 yrs)
1
0
1
731 to 1095 DaysJ2-3 yrs)
0
0
0
1,096 to 1,460 Days (3-4 yrs)
0
0
0
1,461 to.1,825 Days (44-5 yrs)
0
0
0
More than 1,825. Days (>5 yrs)
0
0
0
Data Not Collected-
0
0
0
Total
1
0
1
Total Without With Childrem and With Only
Children Adults Children
0 0
0
0
1 1
0
0
0 0
0
0
0 0
0
0
0 0
0
0
0 0
0
0
1 1
0
0
0 0
0
0
0 0
0
0
0 0
0
0
0 0
0
0
0 0
0
0
0 0
0
0
0 0
0
0
0 0
0
0
0 0
0
0
0 0
0
0
0 0
0
0
0 0
0
0
0 0
0
0
0 0
0
0
0 0
0
0
0 0
0
0
0 0
0
0
0 0
0
0
0 0
0
0
0 0
0
0
0 0
0
0
0 0
0
0
0 0
0
0
1 1
0
0
Unknown Householc
Type
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2/20/2019 Sage: Reports: HUD Annual Performance Report 2018 - CoC
Q27f:.Exit Destination -Youth
Total
Without
With Children
With Only
Unknown
Children
and Adults
Children
Household Typc
Permanent Destinations
0
0
0
0
0
Moved from one HOPWA funded project to HOPWA PH
0
0
0
0
0
Owned by client, no ongoing housing subsidy
0
0
0
0
0
Owned by client, with ongoing housing subsidy
0
0
0
0
0
Rental by client, no ongoing housing subsidy
0
0
0
-0
0
Rental by client, with VASH housing subsidy
0
0
0
0
0
Rental by client, with GPD TIP housing subsidy
0
0
0
0
0
Rental by client, with other ongoing housing. subsidy
0
0
0
0
0
Permanent housing (otherthan RRH) forforinerly homeless persons
0
0
0
0
0
Staying or living with family, permanent tenure
0
0
0
0
0
-Staying; or living with friends,'permanent tenure
0
0
0
0
0
Rental by client, with RRH or equivalent subsidy
0
0
0
0
0.
Subtotal
0
0
0
0
0
Temporary Destinations
0
0
0_
0
0
Emergency shelter, including hotel'or motel paid for with emergency shelter voucher
0
0
0
0
0
Moved from one HOPWA funded project to HOPWA TH
0
0
0
0
0
Transitional housing for homeless persons (including homeless youth)
0
0
0
0
0
Staying or living with family, temporary tenure (e:g. room, apartment or house)
0
0
0
0
0
Staying or living with friends, temporary tenure (e.g. room, apartment or house)
0
0
0
0
0
Place -not meant for habitation (e.g., a vehicle, an abandoned building, bus/train/subway
station/airport ot.anywhere outside)
0
0
0
0
0
Safe Haven
0
0
0
0
0
Hotel or motel paid for without emergency shelter voucher
0
0
0
0
0
Subtotal
0
0
0
0
0
Institutional Settings
0
0
0
0
0
Foster care home or group foster care home.
0
0
0
0
0
Psychiatric hospital or other psychiatric facility
0
0
0
0
0
Substance abuse.treatment facility or detox center
0
0
0
0
0
Hospital or other residential non -psychiatric medical facility
0
0
0
0
0
Jail, prison, orjuvenile detention facility
0
0
0
0
0
Long-term care facility or nursing home
0
0
0
0
0
Subtotal
0
0
0
0
0
Other Destinations
0
0
0
0
0
Residential projector halfway house with no homeless criteria
0
0
0
0
0
Deceased
0
0
0
0
0
Other
0
0,
0
0
0
Client Doesn't Know/Client Refused
0
0
0
0
0
Data Not Collected (no exit interview completed)
0
0
0
0
0
Subtotal.
0
0
0
0
0
Total
0
0
0
0
0
Total persons exiting to positive housing destinations
0
0
0
0
0
Total persons whose destinations excluded them from the calculation
0
0
0
0
0
Percentage
—
—
2/20/2019 Sage: Reports: HUD Annual Performance Report 2018 - CoC
Q28. Financial Information
Development .
Acquisition
0
Rehabilitation
0
New Construction
0
Development Subtotal
0.00
Supportive Services
Assessment of Service Needs
0
Assistance with Moving Costs
0
Case Management .
0
Child Care
0
Education Services
0
Employment Assistance
0
Food
0
Housing /Counseling Services
0
Legal Services
0
Life Skills.
0
Mental Health Services
0
Outpatient Health Services
0
Outreach Services
0
Substance Abuse Treatment Services
0
Transportation
0
Utility Deposits
0
Operating
0
Supportive Services Subtotal
0.00
HM1S
Equipment (Server, Computers, Printers)
0
Software (Software Fees, User Licenses, Software Support)
0
Services (Training, Hosting, Programming)
0
Personnel (Costs Associated with Staff)
0
5paoe and Operations
0
HMIS Subtotal
0.00
Leasing, Rental Assistance, and Operating
Real Property Leasing (Does Not Require Match)
0
Short /Medium -Term Rental Assistance
0
Long -Term Rental Assistance
432,109.58
Operating Costs
0
Leasing, -Rental Assistance, & Operating Subtotal
432,109.58
Administration
Administration
29,753.00
Administration Subtotal
29,753.00
Total Expenditures
461,862.58
Match
Cash Match
0
In -Kind Match
124,671.00
Total Match
124,671.00
Total.Expenditures Requiring a Match
461,862.58
Percentage Match
26.99% -
Total Budget. (Expenditures Plus Match) 586,533.58
2/20/201.9 Sage: Reports: HUD Annual Performance Report 2018 - CoC
Q29. Performance -Accomplishments .
Please describe any significant The Better Way West Apartments provided housing to 64 single homeless persons with disabilities by. providing 55 Lnits of permanent
accomplishments achieved by housing and supportive services. The program assisted the participants with achieving long term recovery goals, increasing skills and
your program during the operating income, and providing greater self-determination. The program achieved 100% occupancy at the end of this operating year.
year.
Q30. Additional Comments
Please provide any additional comments on other areas of the APR that need . The Miami -Dade County Homeless Trust will. continue. to work with the local Miami HUD
explanations, such as a difference in anticipated and actual program outputs or Field Office to address any issue's related to the submittal of the Annual Progress Repor
bed utilization: '(APRs).
FY 2018
Miami -Dade County Homeless Trust
Continuum of Care (CoC)
CoC Monitoring Guidelines
Internal Wellness Checklist&
Internal Wellness "Top Ten" List
ATTACHMENT G "Internal Wellness Checklists"
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 Part578. 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 Number: 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 Recordkeeping
1. Executed Grant Agreement
24 CFR 578.23( c )
2. Documentation 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 are not debarred
24 CFR 578.23( c )(4)(v)
5. Documentation of annual monitoring of Subrecipients
24 CFR 578.23( 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 identifed 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 CFR 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
RUD CPD Notice 14-02
10. Documentation of participation of homeless/formerly homeless individuals in policymaking
24 CFR 578.75(g)(1)
11. Documentation of compliance with environmental review requirements
24 CFR 578.99, 24 CFR 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 CF .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
Page 3
Grant #•
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 CFR 578.97(b)
Participant Proeram Files.
1. Documentation participants are entered into IMS or a comparable database
24 CFR 578.103(a)(3)
2. Documentation participant was screened via centralized or coordinated assessment systems
24 CFR 578.23( c )(9)
3. Documentation of Homelessness 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 documented
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)(i)
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)
10. Leasing -Documentation lease is between agency and landlord
24 CFR.578.49(b)(5)
11. Leasing -Is there an occupancy agreement, lease 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 correct/current utility allowance schedule is used
24 CFR 579.103(a)(17), 24 CFR 578.49(a)(3)
Internal Wellness.Checklist
Page4 —
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 5.78.77, 24 CFR._578.51(d)(e)
17. Rental -Documentation, of rent reasonableness for the period of approval for an assisted unit
24.CFR 578.51(8)
NOTE: For additional guidance, please refer to the following
resource materials:
(1) Homeless Emergency Assistance and Rapid Transition- to
Housing: Continuum of.Care Program CoC regulations at 24 CFR
Part 578, and
(2) Monitoring handbook 6509.2 REV -6 CHG-2 that can be
accessed at:
http://Portal.hud.gov/hudportal/HUD?src=/program offices/ad
ministration/hudclips/handbooks/cpd/6509.2.
Completed by:
Signature:
Typed/Printed Name:
Date:
Title:
This document is to be maintained in the applicable CoC project file
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: O PSH O RRH O TH O SH O SSO O Legacy SPC O RRH
Number to be served:
Number of chronic beds/units:
Program serves: O Individuals O Families O Both
CoC Program grant funds are used for:
O Leasing (no match required)
O Rental Assistance
O Operations
O Supportive Services
O HMIS-
O Administration
Is. the Subrecipient a faith based organization? O Yes O No
-CoC Matching funds (25%0) required are: O Cash/Cash Equivalent -O In Kind O N/A
Is there an active restrictive covenant on one or more of the project's properties? O Yes'O No
Attachment G."CoC Program. Guidelines" Tage 2 of 14
PART 1: PROGRAM MONITORING:
SUBRECIPIENT OPERATIONS: POLICIES AND PROCEDURES:
Conflict of Interest
1. There are written standards of conduct governing
O Yes
the performance of covered persons engaged in the
O No
award and administration of contracts. 24 CFR §
578.95(a); 24 CFR § 578.103(a)(11
2., The Subrecipient has a general conflict-of-interest
O Yes
policy for staff and Board members 24 CFR §
O No
578.95(c); 24 CFR § 578.103(a)(11)
3. If the Subrecipient is an approved exception to -the
O Yes.
conflict of interest policy, the agency has documented
O No
the exception 24 CFR § 578.103(a)(11)
Involvement of homeless persons
1. There is at least one homeless/formerly homeless
O Yes .
person is on the Board of Directors or equivalent
O No
policyruaking entity. 24 CFR § 578.75'(g) (1
2. The Subrecipient involves homeless individuals
O Yes
and families through employment; volunteer
O No
services; or otherwise; in constructing, rehabilitation,
maintaining, and operating the project, and in
providing supportive services for the project. 24 CFR
§ 578.75 2
iaHty
1. The Subrecipient has written policies to .ensure:
O Yes
• Records containing protected identifying
O No
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_ permission 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)
Fair Housing and E ual Oppqttani
1. The Subrecipiehthas written nondiscrimination:
0'Ye9
and equal. opportunity policies that apply to housing.
_0No
and em loyment 24 CFR §'578-93
2. The. Subrecipient has -.policies and. procedures. for
O Yes
providing. reasonable accommodations. and ' '
O No
reasonable modifications for persons with
disabilities. 24 CFR'§.100.204(a), 2$ CFR §.
35.130(b)(7)
A,ttachriient G "CoC Program Guidelines" Page 3 of 14 -
3. The Subrecipient maintains copies of marketing,
O Yes
1. The Subrecipient serves at least as many program.
outreach, and other materials used to inform eligible
O No
participants as show in its application for assistance..
persons of the program and these materials.show
24. CFR §.578.51(h) (3)
that the agency markets their housing and
Termination Process -
supportive -services to those_ least likely to apply in
O Yes
termination of participation for violation of program
the absence of special outreach. 24 CFR
policies or occupancy agreements. 24 CFR §
§S78.93(c)C1)
Services Related to Housing ability
4. The Subrecipient has policies and procedures in
O Yes
termination of participation for violation of program
place to provide meaningful access for Spanish-
O No
speaking and other Limited English Proficiency
Residential Supervision
persons to access the Subrecipient's programs and
O Yes
services. 72 federal regulation 2732
O No
S. The Subrecipient provides program participants
O Yes
O Yes
with information on rights and remedies available
O No
O No.
under applicable federal, State and local fair housing .
not the same as rent or occupancy -rent; program .
and civil rights laws. 24 CFR §578.93(c)(3)
participants may be charged rent for housing) —
Drug -Free
orkplace,
1. The Subrecipient has a drug-free workplace policy
O Yes -
statement which includes the requirement of
O No
notification to HUD if an employee is convicted for a
criminal drug offense. 24 CFR § 84.13
POLICIES AND PROCEDURES FOR COC GRANT -FUNDED PROGRAM
Number.Served .
1. The Subrecipient serves at least as many program.
O Yes
participants as show in its application for assistance..
O No .
24. CFR §.578.51(h) (3)
Termination Process -
1. The Subrecipient has a written policy for
O Yes
termination of participation for violation of program
O No
policies or occupancy agreements. 24 CFR §
S78.91(b).
Services Related to Housing ability
1. The Subrecipient has a'written policy for
O.Yes
termination of participation for violation of program
O No
policies or occupancy agreements. 24 CFR §
578.91(b)
Residential Supervision
1. The Subrecipient provides adequate.residential
O Yes
supervision. 24 CFR§ 578.75(f) .
O No
..Program Fees
1. The Subrecipient does not charge participant's,
O Yes
program fees. 24 CFR § 578.87(d) Program.fees are
O No.
not the same as rent or occupancy -rent; program .
participants may be charged rent for housing) —
Attachment_G " C.oC.Program Guidelines" Page 4 of 14
Record kee m
1. The Subrecipient has systems in place to ensure
O Yes
O Yes
that records related to CoC-funded programs are
O No
. O No
maintained for a 5 -year period. 24 CFR § 578.103
CFR § 578.103 a (3) 24 CFR § 576.500(b
REVIEW OF C -OC PROGRAM PARTICIPANT FILES
Eligibility: Homelessness
1. Each participant file contains verification of'
O Yes
homelessness status at_the time of program entry. 24
. O No
CFR § 578.103 a (3) 24 CFR § 576.500(b
2. The Subrecipient has written policies and
O Yes
procedures for documenting homelessness. Intake
O No
staff document eligibility at intake; documentation is
required for all persons seeking assistance; 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 forms.
.In order of preference: -1) Homeless coordinated
outreach and assessment, 2-) Third party
documentation, 3) Intake worker observations, 4)
Certification from the person seeking assistance.
Eligibility:
isability
1. If the program provides PSH, each participant file
O Yes
contains verification of participant's disability..24
O No
CFR § 578.37(a)(1)(i) 1) Verification from a
professional who is licensed to diagnose and treat
condition CR -2) Disability verified by the Social
Security Administration (VA disability check, or an
SSD.I check)..
Eli 'bili " : Chronic homelessness -
1. If the.prograin has units dedicated to persons who
O Yes
are chronically horneless;participant files contain
verification of chronic homelessness.
Service Assessment
1. The file contains participant assessments and
.O Yes. .
service plans, updated at least annually.. 24 CFR §
O No.
57.8.:53 a)
Services Provided
and Costs
1. The file contains documentation of services
:O Yes
provided and the agency tracks the amounts spent on
O No
those services. 24 CFR §. 578.10.3(a).(9).
Duration of
Services
1. The file reflects that supportive services are made
O Yes -
available throughout re'sident's entire time:in the
O No •-
pro.ject::24 CFR.§ 578:53
2.'Rapid rehousing: The file reflects that program
0 -Yes
participant meets with- case manager not less than
O No
24'CFR§ 578.2(b)(4)
rnce2.ermonth.
Attachment G "CoC Program Guidelines" Page 5 of 14
Participants Terminated from Pro am
1. If a participant has been terminateProm the
O Yes
1. The program participant has an occupancy
program, file includes documentation that the
O No
agreement or lease with the Recipient/Subrecipient
Subrecipient followed its written procedure for
or Landlord. 24 CFR § 578.77(a) For tenant and
termination of assistance. 24 CFR §
project -based assistance; the program participant
578.103 a 7 ii ; 24 CFR § 578.91
must be the tenant on the lease. Forsponsor based
RENTAL ASSISTANCE .OR LEASING (complete this section if the Subrecipient pays rental
assistance or leasing costsfor a unit that the program participant lives in)
Rental Agree ent Lease
1. The program participant has an occupancy
O Yes
agreement or lease with the Recipient/Subrecipient
O No
or Landlord. 24 CFR § 578.77(a) For tenant and
project -based assistance; the program participant
must be the tenant on the lease. Forsponsor based
assistance,'lease between the Subrecipient and the
Landlord, sub -Lease between participant and
Subrecipient
2. For project -based, sponsor -based, or tenant -based
D Yes
permanent housing (PH) rental assistance; initial
D No
lease mustbe at least one year, terminable for cause.
The leases must be automatically renewable upon
expiration for terms that are a minimum of one
month long, except on prior notice by either parry, up
to a maximum term of 24 months. 24 CFR §
578.51(1) (1)
3. For transitional housing; initial lease term must be
O Yes
at least one month. The lease mustbe automatically
D No
renewable upon expiration, except on prior notice by
either party,' up to a maximum term of 24 months. 24
CFR § 578.51 2.
ility
1. File includes documentation that units passed
O Yes
housing quality standards inspection prior to initial
O No
client move -in. 24 CFR § 598.75(b); and
24 CFR § 578.103(a) (8)
2. File includes documentation that unit has passed
O Yes
annual housing quality standards inspections,
O No
including an inspection within the. last 12 months. 24
CFR § 578.75(b)
3. Dwelling unit is correct size: The dwelling unit
'O Yes
must have at least one bedroom or living/sleeping
O No
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 / sleeping
room. .
24 CFR § 578.(c)
4. For supportive housing for persons with
D Yes
disabilities; the Subrecipient must make available
D No
meal preparation facilities for residents or provide
meals 24 CFR § 578.75(d)
Attachment.G "CoC Program Guidelines" Page 6 of 14
Unit Rents
1. Documentation that rents are reasonable in
O Yes
relation to rents charged in the same geographic area
.O No
for comparable space 24 CFR § 578.49(b)
2. Rents do not exceed the HUD -determined Fair
O Yes
Market Rents (FMRs). This documentation must
ONO
include chart show current year's FMRs.
2.4 CFR § 578.49 ) (4)
3. Security deposit does not -exceed two months' rent;
O Yes
in addition to the security deposit, the Subrecipient
Q No
may also pay the final months' rent in advance 24
CFR § 578.49(b)(4)
Annual Income
1. The file contains m income evaluation form
O Yes
completed by program participant and source
O No
documents verifying income and assets (or, if source
documentation notavailable,'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
O Yes
income is re-examined annually.
O No
24 CFR § 578.77 c)(2)
Rent Calculation
1. The file contains the annual rent calculation, and
O Yes
the calculation is accurate. BEST PRACTICE: The file
. O No
contains a printout:of the HUD rent calculation
24 CFR § 5.78.103
2. Is the participant charged rent (unless $0 income)
O Yes
and is. the rent treated as program income?
ONO
(required)
3. Is rent calculated initially, annually, and when
O Yes
there is any change in income?
O No
4. Is there documentation of compliance of an eligible
O Yes
"utility allowance" The Subrecipient has received a
Q No:
copy of the Tenants paid utility bill -for compliance.
Vacancies
1. The Subrecipi. ent does not pay rent for more than
O Yes.
30 days for any unit thathas been vacated. Rent may
O No
not be paid on the vacated unit.again until there is a
new occupant (NOTE: Briefperiods ofstays in
institutions, not to exceed 90 daysforeach:occurrence,
are h tconsidered vacancies).. .
24 CFR § 578.51.9.
Attachment G ToC Program Guidelines" Page 7 of 14,.
'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 a�p lies to rent for buil din s or housing units
1' Documentation that rents are reasonable in
O Yes
relation to rents charged in the same geographic area
O No
for comparable space. 24 CFR § 578.49
2. Rents do not exceed rents charged for comparable
O Yes
units rented by the Subrecipient 24 CFR § 578.49(b)
O No
O Yes,
3. Security deposit does not exceed two months' rent,
O Yes
O No
in addition to the security deposit, the Subrecipient
O No
may also pay the final months' rent in advance.
..religious services. 24 CFR § 578.87(h)(1)'. . .
24 CFR § 578.49 4
2. If the Subrecipient provides explicitly religious
O Yes'
4. The Subrecipient must have an occupancy
O Yes
C --).No
agreement, and if applicable a sublease.
O No
S. Is rent calculated initially and when the tenant
O Yes
requests?
O No
6. Is the participant charged. rent? (not required)
O Yes
O No
7. Has an occupancy charge been imposed? (not
O Yes
required) If so, the charge cannot exceed the highest
O No
of 1) 30% of the households monthly adjusted
income; 2) 10% of the households' monthly income,
or; 3) The portion of the households' welfare
assistance, if any that is designated for housing costs.
not applicable in the State of Florida)
8. Leasing funds are not used to lease units or
O Yes
structures owned by the Recipient, Subrecipient,
O No
their parent organization(s) or organizations that are
members of a partnership where the partnership
owns the structure, (Doesn't apply to rental
assistance).
REQUIRED POLICIES AND PROCEDURES FOR SPECIFIC PROGRAMS/ CIRCUMSTANCES
Participant Household Policies (complete this section for any program thatservesfamilies with
children
1. The age and gender of a child under age 18 must
O. Yes
not be used as a basis for denying.any participant
O No
household's admission to a project that receives
funds under this part
Faith -;based Activities (complete this section if -the Subrecipient.is a faith -based organization)
L The Subrecipient serves all potential participants
O Yes,
without regard to religious'belief, refusal to hold a
O No
religious belief, or refusal to attend or participate in.
..religious services. 24 CFR § 578.87(h)(1)'. . .
2. If the Subrecipient provides explicitly religious
O Yes'
activities (including worship, religious instruction, or
C --).No
proselytizing), these activities are separate from
HUD -funded activities and beneficiaries of HUD -
funded activities are not required to participate.
Attachment G `:`CoUrogram Guidelines" _ Page 8 of 14
24 CFR § 578.87 2
Audit
Projects involving acquisition, new construction,
and rehabilitation
1. Records for acquisition, new construction, and
O Yes
2. If subject to A-133 audit, has the Subrecipient
provided its most recent audit and management
letter?
rehabilitation must be retained for 15 years
O No
3. If pot bound byA-133-requirement, has the agency
provided financial statements audited by a CPA?
following the date the project is first occupied, or
Board of -Directors
used, byprogram participants: 24 CFR §
O Yes .
O No
578.103 (c) (2
1. Has the Subrecipient provided Miami -Dade County .O Yes
with a list of authorized check signers? O No .
2. If the project resulted in dislocation of any
O Yes
persons, the Subrecipient complied.with the
O No
obligations of the Uniform Relocation Act?. 24 CFR §
578.83 -
3. For projects including new construction or
O Yes
rehabilitation; do the Recipient's records show that
O No
Section 3 reports have been completed and
submitted timely? 24 CFR § 578:99(i)
Transitional Housing
1. Participants do not.regularly exceed 24 months in
O Yes'
the program. 24 CFR § 578.79
O No
.2. When a participant is in the program for longer
O. Yes
than 24 months, the file -documents -the need for
O No
extended participation. 24 CFR § 578.79
3. If participants stay longer than 24 months, is the
O Yes
number of participants with longer stays less than
O No
50% of the total number served by the project?
24 CFR §-578.79
Transfer Due to Domestic Violence
1. If a program participant receiving tenant -based
O Yes
rental assistance has movectto a'different CoC due to
O No
threat of imminent harm, the file must contain
documentation of the domestic violence and
imminent threat
PART 2: FISCAL MONITORING.
INTERNAL REVIEW
Audit
1. Is the Subrecipient subject to the OMB A-133
'single audit requirement? (Required if $5000,000 or
more in aggregate -Federal funds expended) '
O Yes
O No
2. If subject to A-133 audit, has the Subrecipient
provided its most recent audit and management
letter?
O Yes
❑ No
3. If pot bound byA-133-requirement, has the agency
provided financial statements audited by a CPA?
Q .Yes -
O N0
Board of -Directors
1. Has the Subrecipient provided Miami -Dade County
a list of the members of its Board of Directors?
O Yes .
O No
Authorized Ch_ eck Si * ers
1. Has the Subrecipient provided Miami -Dade County .O Yes
with a list of authorized check signers? O No .
Attachment G "CoC Program Guidelines" Page 9 of 14 `
Invoicm,
1. The Subrecipient submits invoices on a monthly
O Yes
basis (on time or within time)?
O No
Procurement
1. The Subrecipient has a written procurement policy
. O Yes
that meets the. requirements of Miami -Dade County
O No
competitive procurement standards.
2. The Subrecipient retains copies of all procurement
O Yes
contracts and documentation of compliance with
O No
federal procurement requirements
24 CFR§ 5 78.103 (a) (16) (iii).
Match
1. The Subrecipienthas documentation of the source
O Yes
and use of contributions made to satisfy the 25%
O No
match requirements (match maybe cash or in kind).
-
Records must 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 MOU. Cash or any in kind
contribution used as match for another grant is not
an eligible in kind contribution used as match for
another grant is not an eligible match. 24 CFR §
578.73, 24 CFR § 578.103(a) (10), 24 CFR § 84.23 and
24 CFR § 578.23 (c) (6)
2. Match must be spent on eligible project costs (in
O Yes
the budget)
O No
3. Where match is documented by MOU, the MOU
O Yes
must; establish the unconditional commitment
O No
identify the service to be provided; identify the
profession of the persons providing the service; and
identify the cost of the service to be provided
Internal Controls
1. The Subrecipient has written job descriptions for
O Yes
all HUD -funded positions
O No
2. The Subrecipient has written fiscal policies and
O Yes
procedures specifying approval authority for all
O No'
financial transactions and guidelines.for controlling
expenditures*
3. The Subrecipient has written procedures for
O Yes
recording financial transactions, and an accounting.
O No
manual and chart of accounts
Program
Income
1. Is all program income spent on eligible costs? Rent
O Yes
and Occupancy charges are considered program
O No
income as is any utility allowances in rental
programs
2. Is -program income part of your match? Program
O Yes
income is not an eligible source of match.
O No
Attachment G " Co'C Program Guidelines" Page 10 of 14
Indirect Costs
1. Does the organization use grant funds for indirect
costs?
D Yes
O No
O.Yes
2. Are the costs consistent with OMB'Super Circulars
as applicable
O Yes
O No
O No
DOCUMENTATION REVIEW
Salary Documentation
1. Original timesheets — signed; grant duties
O.Yes
identified, if split time (copy in reimbursement
O No
package)
2. Payroll sheets
D Yes
O No
3. Cancelled checks to the employee
D Yes
O No .
4. If time is divided between the CoC Programs and
O Yes
another funding source, review time distribution
D No
records supporting the allocation of charges among
the sources. Staff time breakdown allocation chart
Space . Utilities Documentation Leases
1. Rental or lease agreement - signed by participant;
Yes
valid lease period; correct rental amount
O No
2. Qhginal invoices
D.Yes
O.No
3. Cancelled checks to the landlord/mortgagee;
D Yes
utility company, etc..-
D No
4. Unit inspection report(s); no longer than 1 year old
D Yes
D No
S. Verification of what -payment was used for. (e.g.
O Yes
first month's rent; security deposit, etc.)
0. No
suppl1es
1. Purchase orders
D Yes*.
O No .
2. Requisitions-
O Yes
..O No
3. Cancelled'checks
O Yes
O No
4. Determine where supplies are being kept
O Yes . .
O'No
S. Determine what cost objective is being used
O.Yes
D No
keview Inventory list - any equipment shall be ..
D Yes
labeled as property of Miami -Dade County through
O No
its Homeless Trust
INTERNAL CONTROLS
1. Internal control questionnaire
O Yes
a. Is the expenditure necessary, reasonable and
O Yes
O No
directly related to the grant?
2. Review organizational chart
O Yes
b. Is the expenditure authorized by the grant?
O Yes
O No
3. Review job descriptions/definitions of employees'
O Yes
Source documentation evaluation
duties
O No
4. Review Subrecipient's system of authorization and
O Yes
supervision
O No
S. Ensure that there is as eparation of duties
O Yes
(authorizing, recording and custody should be
O No
separate)
O No
6. Review control over assets
O Yes
expenditures?
O No
Does the. Subrecipient maintain the appropriate records?
EVALUATION OFSELECTED TRANSACTIONS
Is the expenditure allowable
a. Is the expenditure necessary, reasonable and
O Yes
directly related to the grant?
O No
b. Is the expenditure authorized by the grant?
O Yes
O No
Source documentation evaluation
a. Were the expenditures incurred. during the term of
O Yes
the grant?
O No
b. Was the money actually paid out?
O Yes
O No
c. Were the expenditures approved by the'
O Yes
responsible Subrecipient officials
O No
d. Is there adequate documentation to support the
Q Yes
expenditures?
O No
Does the. Subrecipient maintain the appropriate records?
Does the. Subreci ient maintain the followin 7
a. Chart of accounts
O Yes
O No .
b. Cash receipts journal
O Yes
O No .
c. Cash disbursements.journal. _
O Yes
O No
d. Payroll journal
O Yes
O No
e. General ledger
O -Yes
=
O No
1. Does the Subrecipient maintain documentation .
O Yes
concerning its sources of funding
O No
Attachment G "CoC Program Guidelines". Page 12 of 14
PART 3NUMIS MONITORING
HMIS HOMELESS MANAGEMENT INFORMATION SYSTEMS
HMIS Operations: Po cy and Procedures .
1. The Subrecipient has signed an HMIS Participation
D.Yes
Agreement to use the HMIS license
O No .
2. Are the Subrecipient's HMIS Administers
D Yes .
registered and approved to enter the data into. the
D No
HMIS.s stem
3. The Subrecipient has designated an HMIS site'
O Yes
Administrator(s), who is the Point of Contact for
D No
Miami -Dade County through its Homeless Trust as .
HMIS Lead Agency.
4. the Subrecipient has ensured that each HMIS user
D Yes
within its Organization has signeda user agreement
D No
stating full. understanding of user rules, protocols
and confidentiality.
PriyaCY
1. The Subrecipient has a Data Collection / Privacy
D Yes
Notice posted in English and Spanish at each intake
D No -
location
2. The Subrecipient has a written Privacy Policy or
D Yes
uses the CoC's written Privacy Policy .
D No
3. If the Subrecipient has a web site, the Privacy
O Yes
Policy is posted to the web site.
O No
4. The Subrecipient has a signed authorization for
D Yes .
release of information form that it uses for any client
O No
for -which the Subrecipient uses HMIS for data
sharing
5. The Subrecipient ensures that all signed forms are
D Yes
locked in -a designated location with limited access to
D No
staff
6. The Subrecipient has executed the Agency Sharing
D Yes
Data Agreement, if applicable (MOU?)-
O No
7. The Subrecipient has a written client complaint
O.Yes
policy ..
Q No
8. The Subrecipient has established a process of '
D Yes
tracking all filed complaints and can provide copies
D No
of complaints and resolutions to the HMIS Lead
Agency if,re uested.
Securi
1. -The Subrecipient maintains a list of active HMIS
D Yes
users
O No
2. The* Subrecipient regularly contacts the HMIS Lead
D Yes
when an.employee leaves the Organization, in order.'.
D No
to make sure that the person's HMIS_ account is
disabled:
3. Are the Subrecipient's HMIS workstations located
O Yes
in secure locations or, if not;- are the -workstations
D No
manned at all times? -
4. Has the Subrecipient identified a person who will
O Yes
serve as.the. Or anization's. HMIS security officer?
Attachment`G "CoC.Program Guidelines" Page 13 of 14
Attachmeiit G''CoC-Program Guidelines Page 14 of 14
O No
S. Has.the HMIS security officer completed an HMIS
O Yes
security self-certification within the last 12 months?
O No
6. Does the Subrecipient have in place policies and
O Yes
procedures to protect hard copies (paper) with
O No
personal identifying information? -
Data ality
At a minimum the Subrecipient collects the Universal
. O Yes
Data Elements for every client entered and minimum
O No
data quality standards are met.
The'Subrecipient enters Client Basic Demographic
O Yes
Data into the HMIS system at a minimum within one
O No
week of intake
The Subrecipient staff review monthly reports
O Yes
received from HMIS Program Administrator and
O No
addresses any issues noted.
Attachmeiit G''CoC-Program Guidelines Page 14 of 14
FY 2018
Miami -Dade County Homeless Trust
Continuum of Care (CoC) Program
"Incident Report"
ATTACHMENT_ H "2018 Incident Report"
M®0
b../.1..nt,S Fs�riu E 2 y
INCIDENT REPORT
IDENTIFYING INFORMATION
Reporting Party. Phone # Date of Incident / / Time of Incident _ am/pm
Reporting Party Name
Contract Provider Name
Program Name
Provider Location
Specific Program: (check all that apply)
❑ Miami -Dade County 0 Primary Care ❑ C.oC Program ❑ Emergency 0 Challenge 0 Other
Spec fc Zocationl address where incident occurred:
DESCRIPTION OF INCIDENT -
TYPE OF INCIDENT
❑ ALTERCATION
❑ CLIENTDEATH
❑ CLIENTINJURYOR ILLNESS
❑ THEM
❑ SEXUALBATIERY
❑ SUICIDEAYTEMPT
❑ PROPERTi'DAMAGE
13 OTHER INCIDENT
Specify
PARTICIPANT (S) / WITNESS (ES)
(Please. mark W or P for either Witness or7articipant)
LAST NAME, FIRST
IDENTIFIER # CLIENT EMPLOYEE
OTB%R W / P
❑ ❑
❑
❑ ❑
El
n ri
n
DESCRIPTION OF INCIDENT -
MIMI0
0
bzllt Z;cdGm� Eevr 3ry - . .
f CORRECTIVE ACTION AND FOLLOW UP
Immediate corrective action taken
Is follow up action needed? ❑ Yes. D No
If yes, specify.
INDIVMUALS NOTIFIIi1D
Indicate person contacted, if report was accepted, the date and the time, and if by telephone or if copy of report
available.
Incident Reports — The Subrecipient must report to Miami -Dade County Homeless Trust information related to any
critical incidents occurring during the administration. term of its programs. In addition to reporting this incident to
the appropriate authorities the Subrecipient must within twenty-four (24) hours of any incident, submit in writing a
detailed account of the incident: This incident report should be addressed to the Contract Officer or Administrative
Officer assigned. This incident report should be� addressed' to Miami Dade County Homeless Trust, 111 NW First
Street, 27'h Floor, Suite 310, Miami, Florida 33128; telephone (305) 375 -1490 -and facsmilie (305).37 5-2722.
Definitions of Reportable Incidents
a. Altercation. A physical confrontation occurring between a client and employee or two or more clients at the time
services are being rendered, or when a client'is in the physical custody of the department, which results in one or
more clients or employees receiving medical treatment by a licensed health care professional. .
:b. Client Death. A person whose life terminates due to or allegedly due to an accident„ act of abuse, neglect or other
incident occurring while in the presence of an employee, in Homeless Trust contracted program facility.
c. Client Injury or Illness. A medical condition of a client requiring medical treatment by a licensed health care
professional sustained or allegedly sustained due town 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 Batteiy. An allegation of sexual battery by a client on a'client, employee on a client, or client on an
employee as evidenced by medical evidence. or law enforcement involvement. .
f. Suicide Attempt An act -which clearly reflects the physical attempt by a client to cause his' or her own death -while
in. the :physical custody of'the department or a departmental contracted or certified provider, which results in
bodily injury requiring medical treatment by a licensed health care professional.
g. Property damage — an incident involving damage to any property procured with Mianri Dade County Homeless
Trust -funding.
Print Name of Person Submitting Report
Signature
ATTACHMENT H'`MDC-fiT Incident Report Forin" Page 2 of 2
IMLA -DADE COUNTY HOMELESS -TRUST POLICY & PROCEDURES
SUBJECT: INCIDENT REPORTING PROCEDURES
EFFECTIVE DATE: 919/2015
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:
1. -Homeless CoC-providers contracted with Miami -Dade County Homeless Trust must
reportthe followingtypes of critical incidents, via fax (305)375-2722 or email, to
the attention of our Incident Report Coordinator: Miguel Pimentel. 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
'2. For each criticat 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
CIients Ago.
• Date & Time of Accident/Incident .
Place of Accident/Incident
• Description ofAcczderit/Incident
Description -or nature of Jury
Witnesses) to Accident/Incident
MIAMI-DADS COUNTY HOMELESS TRUST POLICY & PROCEDURES
SUBJECT: INCIDENT REPORTING PROCEDURES
EFFECTIVE DATE: 9/9/2015
REVISED DATE:
• What action(s) were takenT
• 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-Maori-Dade County Homeless Trust \Incident Reporting Process.0515
A11AMI-DARE COUNTY HOMELESS TRUST
POLICY & PROCEDURES
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.
1. Homeless CoC providers contracted with Miami -Dade County Homeless Trust must
report the following types of critical incidents, via fax (305)375-2722 or email, to
the attention of our Incident Report Coordinator: MigLieI Pimentel. These incidents
are defined and outlined in CF -OP 21.5-6.
• Child -on -Child Sexual Abuse
• Child Ar --rest
• Child -Death
• Adult Death
• EIopement refers to court ordered clients that runaway and do not return
• Employee Ai rest
• Employee Misconduct
• Escape
• Missing Child
• Security Incident -- Unintentional -
• SignificantInjutyto Clients
• Significant Injury to Staff
• Suicide Attempt.
Sexual Abuse/Sexual Battery
2. 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..Nanie
• Clients Age
• 'Date & Time of Accident/Incident
• Place of Accident/Incident
Description of Accident/Incident :
• . Description or nature of injury
Witnesses) to Accident/Incident
M AMI-DARE COUNTY HOMELESS TRUST POLICY & PROCEDURES.
SUBJECT: INCIDENT REPORTING PROCEDURES
EFFECTIVE DATE: 9/9/2415
REVISED DATE:
• What actions) 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
CFOP 215-6
STATE OF FLORIDA
DEPARTMENT OF
CF OPERATING PROCEDURE CHILDREN AND FAMILIES
NO. 215-6 TALLAHASSEE, April 1, 2013
Safety
INCIDENT REPORTING AND ANALYSIS SYSTEM (IRAS)
1. Purpose. This operating procedure establishes the guidelines for reporting and analyzing critical
incidents as defined below. The analysis of incidents should be considered part of the overall risk
management program and quality improvement process of the Department, its employees, and its
licensed and contracted service providers.
2. Scope.
a. This operating procedure applies to an critical incidents occurring within the following
Department of Children and Families program areas:
(1) ACCESS;
(2) Administration;
. (3) Adult Protective Services;
(4) Family Safety;
.(5) Mental Health; and,
(6) Substance Abuse..
b. Incidents to be reported are those that occur: -
(1) Involving a client, Department employee, or a licensed or contracted provider
serving clients of the Department, or involving an employee of a licensed or contracted provider serving
clients of the Department. in the identified program areas; or,
(2) Involving any licensed public or private substance abuse provider agency licensed in
accordance with Chapter 397, Florida Statutes (F.S.), and Chapter 65D-30, Florida Administrative Code -
(F.A.C.), and their employees. Compliance with this procedure is a.condition-of substance abuse
licensure regardless of whether or not the provider serves any,clients funded by the Department. .
c. The Incident Reporting and Analysis System ([RAS) allows forthe timely notification of
critical incidents, provision of details of the incident and immediate actions taken, and the ability to track
and analyze'ncident-related data..
d. The IRAS is not a, case management system, -and cannot be utilized to.capfure ongoing and
specific case management information, such as the progression of events and actions following the
occurrence of a critical incident.
This operating procedure supersedes CFOP 215=6 dated December -1, 2012.
OPR: Assistant Secretary for Operations
DISTRIBUTION: A
April 1, 2013
CFOP 215-6
e. State mental health treatment facilities, public and private, are required to adhere to
CFOP 155-25, Critical Event Reporting in State Mental Health Treatment Facilities, and are specifically
excluded from compliance with this operating procedure.
f. The incident reporting procedures do not replace:
(1) The mandatory reporting requirements to the Florida Abuse Hotline for abuse,
neglect and exploitation reporting protocols, as required by law. Allegations of abuse, neglect, or
exploitation must always be reported immediately to the Florida Abuse Hotline.
(2) The investigation and review requirements provided for in CFOP 175-17, Child
Fatality Review Procedures.
. (3) The reporting requirements provided for in CFOP 175-85, Prevention, Reporting and
Services to Missing Children.
(4) The reporting requirements provided for in CFOP 180-4, Mandatory Reporting
Requirements to the Office of the Inspector General.
3. Definitions.
a. Abuse. Any willful or threatened actor omission that causes or is likely to cause significant
impairment to a child or vulnerable adult's physical, mental or emotional health.
b. Department. The Department of Children and Families.
c. Hospital. A facility licensed under Chapter 395, F.S. This includes facilities licensed as
specialty hospitals under Chapter 395, F.S.
d. Incident Coordinator. The designated Department or provider/agency staff whose role is to
add and update incidents, create and send initial and updated notifications and change the status of an
incident. Department Incident Coordinators are designated by their respective
Circuit/Region/Headquarters leadership.
e..Neglect. The failure or omission on the part of the caregiver to provide the care, supervision
and services necessary to maintain the physical and mental health of a child or vulnerable adult; or the
failure of a caregiver to make reasonable efforts to protect a child or vulnerable adult from abuse,
neglect, or exploitation by others.
f. Restraint. Any manual method or physical or mechanical device, materials, or equipment
attached or adjacent to the individual's body so that he or she cannot easily remove the restraint and which
restricts freedom of movement or normal access to one's body.
g. Seclusion. The physical segregation of a person in any fashion, or involuntary isolation of a
person in a room or area from which the person is prevented from leaving. The prevention may be by
physical barrier or by a staff member who is acting in a manner, or who is physically situated, so as to
prevent the person from leaving the room or area.
4. Policy. it is the responsibility of all Departmental personnel,'and Department licensed or contracted
providers, to promptly report within one business day all critical incidents in accordance with the
requirements of this operating procedure. Failure by a Department employee to comply with this
operating procedure may lead to disciplinary action. Failure by a Department licensed or contracted
provider to comply with this operating procedure constitutes a lack of compliance with licensure status
or contract provisions.
2
April 1, 2013 CFOP 215-6
5. Critical Incidents To Be Reoorted.
a. Adult Death. An individual 18 years old or older whose life terminates while receiving
services, during an investigation, or when it is known that an adult died within thirty (30) days of
discharge from a treatment facility. For the Adult Protective Services program, deaths that area result
of the vulnerable adult's documented condition are not subject to critical incident reporting
requirements. The manner of death is the classification of categories used to define whether a death is
from intentional causes, unintentional causes, natural causes, or undetermined causes.
(1.) The final classification of an adult's death is determined by the medical examiner.
However, in the interim, the manner of death will be reported as one of the following:
(a) Accident. A. death due to the unintended actions of one's self or another.
(b) Homicide. A death due to the deliberate actions of another.
(c) Suicide. The intentional and voluntary taking of one's own life.
(d) Undetermined. The manner of death has not yet been determined.
(e) Unknown. The manner of death was not identified or made known.
(2) if an adult's death involves a suspected overdose from:alcohol and/or drugs, or
seclusion and/or restraint, additional information about the death will need to be reported in [RAS.
b. Child Arrest. The arrest of a child in the custody of the Department.
c. -Child Death. An individual less than 18 years of age whose life terminates while receiving
services, during an investigation, or when it is known that a child died within thirty (30) days of
discharge from a residential program or treatment facility or when a death review is required pursuant
to CFOP 175.17, Child Fatality Review Procedures. The manner of death is the classification of
categories used to define whether a death is from. intentional causes, unintentional causes., natural
causes, or undetermined causes.
(1) The final classification of a -child's death is determined by the medical examiner.
However, in the interim, the manner of death will be reported as -one of the following:
(a) . Accident. A death due to the unintended actions of one's self or another.
(b) Homicide. A death due to the deliberate actions of another.
(c) Natural Expected. A death that occurs.as a result of, or from complications.
of, a diagnosed illness for which the' prognosis is terminal.
(d) Natural Unexpected. A sudden death that was not anticipated and is
attributed to an underlying disease either known or unknown prior to the death.
(e) Suicide. The intentional and voluntary taking -of one's own life.
(t) Undetermined. The manner of death_ has not yet been determined.
(g) Unknown. The manner of death was not identified or made known. .
(2) If a child's death involves a suspected overdose from alcohol and/or drugs, or
seclusion and/or restraint;.additional information. about the death will need to be reported in IRAS.
3
April 1, 2013
CFOP 215-6
d. Child -on -Child Sexual Abuse. Any sexual behavior between children which occurs without
consent, without equality, or as a result of coercion. This applies only to children receiving services from
the Department or by a licensed, contracted provider, e.g. children in foster care placements or in
residential treatment.
e. Elopement.
(1) The unauthorized absence beyond four hours of an adult during involuntary civil
placement within a Department -operated, Department -contracted or licensed service provider.
(2) The unauthorized absence of a forensic client on conditional release in the
community.
(3) The unauthorized absence of any individual in a Department contracted or licensed
residential substance abuse and/or mental health program.
f. Employee Arrest. The arrest of an employee of the Department or its contracted or licensed
service providers for a civil or criminal offense.
g. Employee Misconduct. Work-related conduct or activity of an employee of the Department
or its contracted or licensed service providers that results in potential liability for the Department; death
or harm to a client; abuse, neglect. or exploitation of a client; or results in a violation of statute, rule,
regulation, or policy. This includes, but is not limited to, misuse of position or state property;
falsification of records; failure to report suspected abuse or neglect; contract mismanagement; or
improper commitment or expenditure of state funds.
h. Escape. The unauthorized absence of a client who is committed by the court to a state
mental health treatment facility pursuant to Chapter 916 or Chapter 394, Part V, Florida Statutes.
i. Missing Child. When the whereabouts of a child in the custody of the Department are
unknown and attempts to locate the child have been unsuccessful.
j. Security Incident — Unintentional. An unintentional action or event that results in
compromised data confidentiality, a danger to the physical safety of personnel, property, or technology
resources; misuse of state property or technology resources; and/or denial of use of property or
technology resources. This excludes instances of compromised client information.
k. Sexual Abuse/Sexual Battery. Any unsolicited or non-consensual sexual activity by one
client to another client, a DCF or service provider employee or other individual to a client, or a client to
an employee regardless of the consent of the client. This may include sexual battery as defined in
Chapter 794 of the Florida Statutes as `oral, anal, or vaginal penetration by, or union with, the sexual
organ of another or the anal or vaginal penetration of another by any other object; however, sexual
battery does not include an act done for a bona fide medical purpose." This includes any unsolicited or
non-consensual sexual battery by one client to another client, a DCF or service provider employee or
other individual to a client, or a client to an employee regardless of consent of the client.
I. Significant Injury to Clients. Any severe bodily.trauma received by a client in a
treatmentiservice program that requires immediate medical or surgical evaluation or treatment in a
hospital emergency department to address and prevent permanent damage or loss of life.
m. Significant Injury to Staff, Any serious bodily trauma received by a staff member as a result
of work related activity that requires immediate medical or surgical evaluation or treatment in a hospital
emergency department to prevent permanent damage or loss of life.
4
April 1, 2013
CFOP 215-6
n. Suicide Attempt: A potentially lethal act which reflects an attempt by an individual to cause
his or her own death as determined by a licensed mental health professional or other licensed
healthcare professional.
o. Other. Any major event not previously identified as a. reportable critical incident but has, or is
likely to have, a significant impact on client(s), the Department, or its.provider(s). These events may
include but are not limited to:
(1) Human acts that jeopardize the health, safety, or welfare of clients such as
kidnapping, riot, or hostage situation;
(2) Bomb or biologicallchemical threat of harm to personnel or property. involving an
explosive device or biological/chemical agent received in person, by telephone, in -writing, via mail,
electronically, or otherwise;
(3) Theft, vandalism, damage, fire, sabotage, or destruction of state or private property
of significant value or importance;
(4) Death of an -em-ployee or visitor while on the grounds of the Department or one of its
contracted or licensed providers;
(5) Significant injury of a visitor (who is not a client) while on the grounds of the
Department or one of its contracted, designated, or licensed providers; or,
(6) Events regarding Department clients or -clients of contracted or licensed service
providers that have led to or may lead to media reports.
6. Guidelines for Reporting Incidents.
a. Notification/Reporting and Actions Taken — Staff Discoveryof an Incident.
(1) Any employee of the *Department, or one of its contracted or licensed providers, who
discovers that a reportable critical incident, as described herein, has occurred, will report the incident as
outlined in this operating procedure. ' .
(2) The e_mployee's firstobligation is to ensure the, health,.safety, and welfare of all
individual(s) involved:
(3) The employee. must- immediately ensure contacts are made.for assistance as
dictated by the'needs of the. individuals involved. `These types of contacts may include, but are not
limited to: emergency medical services (81.1), law enforcement, or the fire department. When the
incident involves suspected abuse, neglect, or exploitation, the employee must call the Florida Abuse
Hotline.to report the incident. The employee must ensure that the client's guardian, representative or -
relative is notified, as applicable:
(4) Once the situation is stabilized and the staff has addressed any immediate physical
or psychological service needs of the person (s)'involved in the incident,1he employee must report the
incident to the Incident Coordinator:. Each service provider/agency will' use their internal reporting
process -and timeframes for. notifying provider/agency leadership of incidents. All critical incidents:mnst
be entered into RAS within ona business day of the incident occurring.
(5) Inthe case of subcontractors, Managing Entities, or Lead Agencies, the
responsibility for reporting critical incidents to the. Department rests with the Departmenf's contracted
provider.
5
April 1, 2013
CFOP 215-6
b. Notification/Reporting and Actions Taken by the Provider's/Aq_engy's Incident Coordinator or
the Coordinator's Designee.
(1) Each Department licensed or contracted service provider will designate one staff
person to be the Incident Coordinator for the provider/agency. This person will manage the
provider's/agency's incident notification process. Additional staff maybe designated to enter incident
information into the [RAS at the discretion of the service provider/agency.
(2) _ When a supervisor is informed of a critical incident, that person shall verify what has
occurred, confirm the known facts with the discovering employee, and ensure that appropriate and
timely notifications and actions occurred. The service provider/agency shall develop internal
procedures regarding reporting incidents to their Incident Coordinator or designee.
(3) If the incident qualifies as a critical incident according to the definitions contained in
this operating procedure, the provider'slagency's incident Coordinator will review the incident
information and clarify or obtain any necessary information before forwarding the incident report to the
Department's designated Incident Coordinator or designee. The provider's/agency's Incident
Coordinator will provide the information regarding the incident to the Department's Incident Coordinator
or designee via the IRAS.
(4) The service provider/agency will ensure timely notification of critical incidents is
made to appropriate individuals or agencies such as emergency medical services (91.1), law
enforcement, the Florida Abuse Hotline, the Agency for.Health Care Administration (ANCA), or Center
for Mental Health Services (for licensed mental health facilities), as required. The IRAS reporting
process does not replace the reporting of incidents to other entities as required by statute, rules or
operating procedure.
c. Notification/Reporting and Actions Taken by Department's Incident Coordinator(s) or the
CoOrdinator's Designee.
(1) The Department's Incident Coordinator or designee at the Circuit/Region level will
review the incident information and clarify or obtain any necessary additional information from the
applicable service provider and make revisions as necessary.
(2) The Department's Incident Coordinator or designee will make a determination
regarding any required notifications that should be sent to Department leadership. The Department's
Incident Coordinator or designee is responsible for ensuring appropriate notification is provided and
serves as -the contact person regarding the IRAS. In addition to Department's leadership staff, the
Department's Incident Coordinator or designee will notify the CircuitlRegion Public Information. Officer
within two (2) hours of any incident that may have Department impact or media coverage.
(3) The entry of the incident into IRAS does not substitute for a direct phone call to the
Departments leadership staff when the incident type or severity of the incident warrants such contact.
This determination is to be made by the Department's incident Coordinator or designee in consultation .
with other Department leadership staff, as needed.
(4) The Department's Incident Coordinator or designee should submit incidents in IRAS
even in cases where there is missing information not readily available. When the information is
obtained, the Incident Coordinator or designee should submit an update in IRAS as soon as possible.
(5) The Department's Incident Coordinator or designeeshall ensure all necessary
information is entered into the IRAS in order to have a complete notification, The incident report is
considered to be "complete" when the initial notifications have been made and sufficient information
regarding the incident has been submitted. Additional information, such as.frorn an autopsy or medical
C.
April 1, 2013
CFOP 215-6
examiner report regarding an incident can be submitted into the IRAS after the incident has been
determined to, be "complete."
(6) Each Circuit/Regionshall develop an internal process for reviewing and analyzing
trends regarding critical incidents within their Circuit/Region across all Department program areas.
Each service provider/agency including Managing Entities will establish a system for reviewing critical
incidents to determine what actions need to be taken, if any, to prevent future occurrences and a follow-
up process to assure such needed actions are implemented.
BY DIRECTION OF THE SECRETARY:
(Signed original copy on file)
PETER DIGRE
Assistant Secretary for
Operations
SUMMARY OF REVISED, ADDED, OR DELETED MATERIAL
This operating procedure was revised to specify the Department of Children and Families programs
which are .subject to the requirements of this operating procedure, and to separate the requirements for
reporting adult deaths and child deaths.
7
FY 2018
Miami -Dade County Homeless Trust
Continuum of Care (CoC) Program
"Real Property and Equipment Asset Inventory Report"
ATTACHMENT I "2018 Real Property and Equipment Asset Report"
I A M Wa=AVMX
M��.
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.
eroperty ana rroperty improvement tcecora:
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, lots or blocks and show adjacent streets and
roads
equipment l:
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:
Wof 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"
FY 2018
Miami -Dade County Homeless Trust
Continuum of Care (CoC)
When the Subrecipient is the Housing Administrator
(Leasing or Rental Assistance)
(Previously Provided to the Provider)
ATTACHMENT J'-'2018 Rental Assistance Forms
FY 2018
Miami -Dade County Homeless Trust
Continuum of Care (CoC)
When Miami -Dade County is the Rental Administrator
(Previously Provided to the Provider)
ATTACHMENT K "2018 Rental Assistance Forms"