2011 Supportive Housing Program CMB Outreach Program i
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AGREEMMENT BETWEEN MIAMI:DARE COUNTY
AND
CITY OF NIIAMI BEACH
FOR A 2011 SUPPORTIVE HOUSING PROGRAM GRANT F1L0177B4D001104
CITY OF MIAMI BEACH OUTREACH PROGRAM
THIS AGREEMENT, entered this ® day of ockle4e,,-- 2012, by and between
Miami-Dade County(herein called the "Grantee")and City of Miami Beach,(hereinafter referred to as
the"Subrecipient")under this Agreement.
WHEREAS, the Grantee has applied for and received funds from the United States.Government under
Title IV of the Stewart B.McKinney Homeless Assistance Act;and
WHEREAS, the.Grantee agrees to-comply with all requirements.of this Agreement and to accept
responsibility for such compliance by the Subrecipient to which it makes grant funds available;and
NOW,THEREFORE,it is agreed between the parties hereto that;
1. STATEMENT OF WORD:
A. Activities
The Subrecipient shall adhere to the "2011 Supportive Housing Program Grant Agreement"
Attachment A, which is governed by the Supportive Housing Program rules, 24 CFR Part
583. The Subrecipient shall carry out the activities specified in the "Scope of Services"
Attachment A-1; "Type and Scale of Housing", Attachment A-2; "Households in the
Project with Dependents", Attachment A-3; "Households in the Projects without
Dependents, Attachment A4; achieve "Performance Objectives" as stipulated in
Attachment A-5,and"Project Milestones".Attachment A-6 as applicable. The Subrecipient
shall also adhere to minimum standards of housing and services as set forth in the"Standards
of Care", incorporated herein by reference. The Subrecipient shall adhere to all applicable
federal,state and local laws,regulations,rules and standards.
B. Time Schedule
1. The Grantee and the Subrecipient agree that this Agreement shall become effective on
June 1.2012.
2. This Agreement shall expire May 3-1.2013 one (1)year from the effective date. Any
cost incurred by the Subrecipient beyond this date will not be paid by the Grantee,except
as specifically provided herein. Notwithstanding any provision herein to the contrary,
certain requirements imposed on the Subrecipient by this Agreement and Federal
regulation may continue for a term of at least twenty (20) yeses, as provided in this
Agreement.
3. The requirements of this Agreement shall remain in effect during any time period that
the Subrecipient has control over any funds generated or provided in connection with
this Agreement,including program income.
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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; the Subrecipienfs application for the Supportive Housing Program,
and the Subrecipient's Technical Submission Exhibits incorporated herein as Attachment B,
the Budget, in an amount not to exceed $0.00 for Leasing, $60,946.00 for Supportive
Services, $0.00 for Operations and $3,047.00 for administration (minus 2.5% administrative
costs to be retained by the Grantee), for a total budget of$63,993.00. If applicable, in
accordance with Federal Regulations, provider shall be reimbursed for capital funding on an
incremental basis, based on the following completion benchmarks: 30%, 30%, 30%, and
10% to be provided when a final Certificate of Occupancy is obtained from the developer.
All other activities shall be paid on a reimbursement basis following the submission of a
monthly invoice along with the appropriate support documentation.
In accordance with federal requirements, the Subrecipient agrees to provide match funds in
an amount that represents no less than twenty perent (20%) of the total supportive services
budget,or twenty-five percent(25%)of the SHP supportive services funding,and no less than
twenty-five percent(25%)of the total operations budget.
The budget figures above represent the original line item totals as delineated in the grant
agreement. Submitted budgets that shift funds by less than 10% of the original line item
totals of the grant agreement may become official only if the appropriate match is provided,
the administration total is not increased and Miami-Dade County Homeless Trust approves
the shift of funds in writing. As such, the figures in the Technical Submission Exhibits
Attachment B may not match the contracted figures delineated in the original contract and
grant agreement. Notwithstanding the above,changes of more than 10%in any line item total
as delineated in the grant.agreement shall require a formal budget approval and an amendment
to the grant agreement.
The Subrecipient shall provide at least seven hundred (700) supportive services outreach
contacts and three'hundred fifty-five (355) placements. The supportive outreach contacts
shall occur primarily in the City of Miami Beach,.and all supportive outreach, assessments
and placements within Miami-Dade County, Florida. The main program is located at 1700
Convention Center Drive, Miami Beach, Florida, The Subrecipient will provide services as
outlined in the Attachments as well as in the 2011 US HUD Super NOFA application,
incorporated herein by reference.
II. RECORDS AND REPORTS
A. Financial Mans ement
I. The Grantee and the Subrecipient shall adhere to the requirements for financial
reporting as stated in 24 CFR Part 55.41.
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2. Requests for payments, along with documentation for each line item, i.e. invoice for
services/housing,capital invoice(if applicable),lease agreement,payroll reports,shall be
submitted to the Grantee by the twentieth(20a')of the month and shall be signed by the
Executive Director and or the Financial Officer of the Subrecipient, in the form
incorporated herein as Attachments C and C-1.
3. Reimbursement shall be provided only for costs associated with the services detailed in
the budget,plus general administrative costs(not to exceed 2.5%of direct costs).
4. Any reimbursement may be withheld pending the receipt and approval by the Grantee of
all reports and documents required herein,including but not limited to the submission of
the Annual Progress Report(APR).
5. In no event shall the Grantee's funds be advanced to any subcontractor hereunder.
6. The parties agree- that the Subrecipient may request the revision of the schedule of
payments or the line item budget.However,such revisions shall be subject to review and
approval b the Grantee. Such r •
Y requests shall onl be
q y considered at least nine
_ tv !90)
d_ays prior to the expiration of the grant, if there is a shift of 10% or more of funds
between line items of any activity,supportive services,operations,or leasing or there is a
significant change to the program. Requests for minor modifications (for example less
than 10% shift of funds between line items) must be submited at least.forty-five (45)
days prior to the expiration of the grant. ,Failure to submit the appropriate supporting
documentation in a timely manner may result in the Grantee's inability to amend the
budget.
7. 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.
8. Within thirty(30)days of the termination or expiration,of this Agreement,a final report
of expenditures shall be submitted to the Grantee.If after the receipt of such final report,
the Grantee determines that the Subrecipient has been paid funds not in compliance with
the Agreement,and to which it is not entitled,the Subrecipient will be required to return
such funds to the Grantee unless the Subrecipient submits documentation demonstrating
that the expenditure was in compliance with.this Agreement to the satisfaction of the
Grantee. The Grantee shall have the sole and absolute discretion to determine if the
Subrecipient is entitled to such funds and the Grantee's decision in this matter shall be
final and binding.
B. Records and Access to Records
1. Agreement Records are defined as any and all books, records, client files (including
client progress reports,referral forms,etc.),documents,information,data,papers,letters,
materials, electronic storage data and media whether written, printed electronic or
electrical, however collected or preserved which is or was produced, developed,
maintained, completed, received, or compiled by or at the direction of the Subrecipient
or any subcontractor directly or indirectly related to the duties and obligations required
by terms of this contract, including but not limited to financial books and records,
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ledgers, drawings, maps, pamphlets, designs, electronic tapes, computer drives -and
diskettes or surveys. -
2. The Subrecipient must maintain Agreement Records that document all actions to comply
with, and that relate to,this Agreement, including those on race, ethnicity, gender, and
disability status data; and those in accordance with generally accepted accounting
principles, procedures, and practices as required in Circular OMB-122 which shall
sufficiently and properly reflect all revenues and expenditures of funds provided directly
or indirectly by the Grantee pursuant to the terms of this Agreement which shall include
but not be limited to a cash receipt journal, cash disbursement journal, general ledger,
and all such subsidiary ledgers as may be reasonably necessary.
.1 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 ghts of royalty-
free, nonexclusive, and irrevocable license to reproduce, publish, or otherwise use, and
to authorize others to use the work for public purposes.
4. The Subrecipient shall ensure that the Agreement Records shall at all tunes be subject to
and available for full access and review, inspection, or audit by Grantee and Federal
personnel and any other persons so authorized by the Grantee.
5. The Subrecipient shall include in all.the Grantee-approved subcontracts used to engage
subcontractors to carry out any eligible substantive programmatic services, as such
services are described iri this Agreement and defined by the Grantee, each of the record-
keeping and audit requirements detailed in this Agreement. The Grantee shall, in its sole
and absolute discretion, determine when services are eligible substantive programmatic
services and subject to the.audit and record-keeping. requirements described in this
Agreement.These records shall be maintained as pursuant to this Agreement.
6. If the Subrecipient received funds from or is under regulatory control of other
governmental agencies,. and those agencies issue monitoring reports, regulatory
examinations, or other similar reports,then the Subrecipient shall provide to the Grantee
a copy of each report and any follow-up communications and reports immediately upon
such issuance unless such a disclosure is a violation of those agencies'rules.
C. Reports
The Subrecipient shall submit to the Grantee the reports described below or any other document in
whatever form, manner, or frequency as may be requested by the Grantee. These will be used for
monitoring the provider's progress, performance, and compliance with applicable Grantee and
Federal requirements.
1. Progress Reports — Subrecipient shall submit a Homeless Managementlnformation
System CHMS) generated, "Monthly Progress.Report (MPR)," Attachment ID, along
with the following monthly reports using the forms attached hereto as "Client
Contribution Report"Attachment F,as they may be revised by the Grantee,which shall
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describe the progress made by the Subrecipient in achieving each of the objectives
identified in Attachment A-5.
The reports shall explain the Subrecipient's progress including comparisons of actual
versus planned progress for the period. The reports are due by the twentieth (20'ffi)day
of the following month,along with the request for reimbursement,following the close of
the prior.month.
2. Annual Progress.Report - The Subrecipient shall submit a HMIS generated Annual
Progress Report in addition to a complete and accurate report using the United
States Department of Housing and Urban Development (HUD) form HUDA0118,
"Annual Progress Report(APR)for Competitive Homeless Assistance Programs"(Refer
to Attachment.%The complete-and accurate APR is due to the Grantee six 60 days
after the end of each operating year.
3. "Program hating and Satisfaction Survey"Attachment E shall be collected and retained
monthly by the Subrecipient in a separate file and available for review and monitoring,
or as requested by the Grantee.
4. Audit Reports - The Subrecipient shall provide two (2) copies of an annual certified
public accountant's opinion and related financial statements on the organization to the
Grantee no later than one-hundred and eighty(180)calendar days following the end of
the Subrecipienfs fiscal year, for each year during which this Agreement remains in
force or until all funds earned from this Agreement have been so audited,whichever is
later,provided that the Subrecipient has such an opinion prepared.
5. Annual Assurance Report - The Subrecipient who receives assistance only for leasing,
operating costs, or supportive services costs must provide an annual assurance report for
each year the assistance is received that the project will be operated for the purpose
specified in the application.
6. Employee Certification Form — Government Entities ONLY - The Subrecipient is
required to submit semi-annually certifications for those employees working solely on a
particular Supportive Housing Program(SHP)grant. The certification must be signed by
the employee and the supervisor and conform to OMB Circular A-87 Attachment B (h)
(3). "]Employee Certification form" Attachment P, must be submitted in January and
July of each year with the reimbursement request.
7. Incident Reports—The Subrecipient must report to Miami-Dade County Homeless Trust
information related to any critical incidents occurring during the administration term of
its programs, form "Incident Report" Attachment Q. In addition to reporting this
incident to the appropriate authorities the Subrecipient must within twen ,-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; i 11
NW First Street, 27* Floor, Suite 310, Miami, Florida 33128;telephone(3 05) 375-1490
and facsmilie(305)375-2722.
8. Disaster Plan — The Subrecipient shall submit an Agency Disaster Plan by April I" of
each Contract year.
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D. Staff RespgnsibilitL y
The Subrecipient's staff members for this grant are listed in the"Budget"document
Attachment B
E. Special Conditions
The Subrecipient shall follow the client referral process as listed in the "Scope of Services,"
Attachment A-1.
The Subrecipient shall provide any documentation,such as the"W-9 form"Attachment H to
facilitate the reimbursement of services.
F. General Conditions
The Subrecipient shall comply with all Federal laws, and regulations, as specified in the
"Applicant Certifications" Attachment 1, the "Renewal Grant Agreement" and the
accompanying 24 CFR Part 583, Supportive Housing Program regulations Attachment A
(Part A and B), and all other Federal requirements of this grant. The responsibility for
knowledge of and compliance with all Federal requirements is that of the Subrecipient.
The Subrecipient shall abide and be governed by the requirements of the Americans with
Disabilities Act(ADA).
In addition,the Subrecipient agrees to comply with the following requirements.
I. Insurance
A. Government Entities—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-County, upon request, written verification of
liability protection in accordance with Section 768.28,Florida Statutes. Nothing
herein shall be construed to extend any party's liability beyond that provided in
Section 768.28,Florida.Statutes.
B. Non-government Entities—shall maintain required liability insurance coverage as
noted below at all times 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 covering all owned, non-owned and hired vehicles
used in connection with this contract in an amount not less than $300,000 combined
single limit for bodily injury and property damage.
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Workman's Compensation Insurance for all employees of the Subrecipient as
required by Fl.Statute 440.
Flood Insurance shall be maintained as per the requirements in 24 CFR Part 583.330(x).
The insurance coverage required shall include these classifications, listed in standard
liability insurance manuals,which most.nearly reflect the operations of the Subrecipient.
All insurance policies required above shall be issued by companies authorized to do
business under the laws of the State of Florida,with the following qualifications:
The company must be rated no less than"B"as to management,and no less than
"Class .V" as to financial strength-by the latest edition of Best's Insurance Guide,
published by A.M.Best Company,Oldwick,New Jersey,or its equivalent,subject to the
approval of the County Risk Management Division.
or
Compliance with the foregoing requirements shall not relieve the Subrecipient of its
liability and obligations under this section or under any other section of this Agreement.
No modification or waiver of any of the aforementioned insurance requirements shall be
made without thirty(30)days written advance notice to the Grantee,and is subject to the
approval of the Grantee's Risk Management Division.
2. Indemnification
To the extent allowable pursuant to Section 768.28 Florida Statutes, and subject to the
limitations thereto,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 Areement,
or which may arise out of the actions or negligence, in whole or in part, of the
Subrecipient, its officers, agents, employees, or assignees in the direct or indirect
fulfillment of this Agreement. The Subrecipient shall pay all claims and losses of any
nature ini 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.
The Subrecipient shall disclose to the Grantee in writing any possible or actual conflicts
of interest or apparent improprieties of the kind addressed herein.The Subrecipient shall
make each disclosure in writing to the Grantee immediately upon the Subrecipient's
discovery of such possible conflict. The Grantee will then render an opinion which shall
be binding on all parties. Nothing contained in this Section or in this Agreement is in
any way intended to be a waiver of the.limittion placed upon the Subrecipient's liability
as set forth in Section 768.28,Florida Statutes.
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3. Affidavits
Complete and notarize, "Miami-Dade County Required Affidavits", Attachment J,
"Lobbyist Registration for Oral Presentation", Attachment K and "Sworn Statement
]Pursuant to Florida Statutes", Attachment M, acknowledging compliance with the
following Miami-Dade County Affidavits:
a. Disability Nondiscrimination Affidavit Attachment J,Section VU.
b. Family Leave Plan Affidavit Attachment J,Section VI.
C. Drug-free Workplace Affidavit—Ordinance No.92-15 Attachment J,Section V.
d. Miami-Dade County Disclosure Affidavit Attachment J,Section I.
e. Miami-Dade County.Employment Disclosure Affidavit Attachment J,Section H.
f.' All Subrecipients are advised that in accordance with Section 2-11.1 (s) of the
Code of Miami Dade County, the `Lobbyists Registration for Oral Presentation
Affidavit",Attachment I{,MUST be completed,notarized,and included with the
Agreement. Lobbyist specifically includes the principal, as well as any agent,
officer, or employee.of a principal,regardless of whether such lobbying activities
fall within the normal scope of employment of such agent,officer or employee.
g. Miami-Dade County Criminal Record Affidavit Attachment J,Section IV.
h. Delinquent and Currently Due.Fees or Taxes-The Subrecipient has duly executed
the Affidavit regarding"Delinquent and Currently Due Fees or Taxes"as required
by Section 2-8.1(c) of the County Code and that affidavit is attached hereto as
Attachment J, Section VIII. The Subrecipient understands that the County has
relied on the aforementioned representation in entering this contract.
i. Affirmative Action/Nondiscrimination of Employment, Promotion and
Procurement Practices.(County Ordinance 98-30)Attachment J,Section M.
j. Project Fresh Start(Resolutions R-702-98 and 358-99)Attachment J,Section X.
G. Civil Rights
The Subrecipient agrees to abide by Chapter 11A of the Code of Miami-Dade County
("County Code"), as amended, which prohibits discrimination in employment, housing and
public accommodations.
Where applicable the Subrecipient agrees to abide and be governed by Title VI and VII,Civil
Rights Act of 1964 (42 USC 2000 D&E) and Title VIII of the Civil Rights Act of 1968, as
amended, and Executive Order 11063 which provides in part that there will be no
discrimination of race, color, sex, religious background, ancestry or national origin in
performance of this Agreement, in regard to persons served, or in regard to employees or
applicants for-employment.or housing. -It is expressly understood that upon receipt of
evidence of such discrimination,the County shall have the right to terminate said Agreement.
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It is further understood that the Subrecipient must submit an affidavit attesting that it is not in
violation of the American with Disabilities Act, the Rehabilitation Act, the Federal Transit
Act,49 USC § 1612,and the Fair Housing Act,42 USC §3601 et seq. If the Subrecipient or
any owner, subsidiary,or other firm affiliated with or related to the Subrecipient,is found by
the responsible enforcement agency,the Courts or the County to be in violation of these Acts,
the County will conduct no further business with the Subrecipient. Any contract entered into
based upon:a false affidavit shall be-voidable by the County.. Xf the Subrecipient violates any
of the Acts during the term of any Contract the Subrecipient has with the County, such
Contract shall be voidable by the County,even if the Subrecipient was not in violation at the
time it submitted its affidavit.
The Subrecipient agrees that it is in compliance with the Domestice Violence Leave,codified
as § 11 A60 et..Seq.-of the.Miami Dade County Code,-which requires an employer, who in
the regular course of business has fifty (50) or more employees working in Miami-Dade
County for each working day during each of twenty (20) or more calendar work weeks to
provide domestic violence leave to its employees. Failure to comply with this local law may
be grounds for voiding or terminating this Contract or for commencement of debarment
proceedings against the Subrecipient.
The Subrecipient also agrees to abide and be governed by the Age Discrimination Act of
1975,as amended,which provides in part that there shall be no discrimination against persons
in any area of employment because of age.The Subrecipient agrees to abide and be goverened
by Section 504 of the Rehabilitation Act of 1973, as amended, 29 USC 794,which prohibits
discrimination on the basis of handicap. The Subrecipient agrees to abide and be governed by
the requirements of the Americans with Disabilities Act(ADA).
Ill. SUSPENSION AND TERARNATION
A. Suspension
The Grantee may,-for reasonable cause,temporarily suspend the Subrecipient's operations and
authority to obligate funds under this Agreement or withhold payments to the Subrecipient
pending necessary corrective action by the Subrecipient or both.
Reasonable cause shall be determined by the Grantee and in its sole and absolute discretion
and.may include: ,
1: Ineffective or improper use of any funds provided hereunder by the
Subrecipient;
2. Failure by the Subrecipient to materially comply with any terms, conditions,
representations or warranties contained herein;
3. Failure by the Subrecipient to submit any .documents required by this
Agreement;or
4. The Subrecipient's submittal of incorrect or incomplete documents.
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B. Termination
L Termination at Wit! -This Agreement, in whole or in part, may be terminated
by the Grantee upon no less than fifteen (15) working days notice when the
Grantee determines that it would be in the best interest of the Grantee and/or the
recipient materially fails to comply with the terms and conditions of award. Said
notice shall be delivered by certified mail,return receipt requested, or in person
with proof of delivery.The Subrecipient will have five(5)days from the day the
notice is delivered to state why it is not in the best interest of the Grantee to
terminate.the Agreement. However, it is up to the discretion of the Grantee to
make the final determination as to what is in its best interest.
2;
Termination for Convenience-The Grantee or subrecipient may terminate this
Agreement,in whole or part;when both parties agree that the continuation of the
activities would not produce beneficial results commensurate with the further
expenditure of funds.-Both parties shall agree 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.
3. Termination Because of a]Lack of Funds -In the event funds to finance this
Agreement become unavailable,the Grantee may terminate this Agreement
upon no less than twenty-four(24) hours notice in writing to the Subrecipient..
Said notice shall be sent by certified mail,return receipt requested,or in person—
with proof of-delivery: The Grantee shall be the final and sole authority in
determining whether or not funds.are available.
4. Termination for Breach — Unon terminating-this contract under this section
the County, in its sole discretion im inquire the Provider toDav the County
any.or all costs associated with termination of this contract including but not
limited to transfer of the Provider's obligations under this contract and or
selection of a new Provider.. The County may terminate this Agreement, in
whole, or in part,when the County determines in its sole and.absolute discretion
that the Subrecipient ("Provider") is not making sufficient progress in its
performance of this Agreement as outlined in Attachment A, Scope of Services,
or is not materially complying with any term or provision provided herein,
including the following: 1) The Provider ineffectively or improperly uses the
County funds allocated under this Contract; 2)the Provider does not furnish the
Certificates of Insurance required by this contract or as determined by the
County's Risk Management Division; 3) the Provider does not furnish proof of
licensure/certification or proof of background screening required by this
Contract; 4) the Provider fails to submit or submits incomplete or incorrect
detailed reports of expenditures or final expenditure reports; 5)the Provider does
not submit or submits incomplete or incorrect required.reports; 6)the provider
refuses to allow the County access to records or refuses to allow the County to
monitor, evaluate and review the Provider's program; 7) the Provider
discriminates under any of the laws outlined in Section H(G)of this Contract; 8)
the Provider fails to provide Domestic Violence Leave to its employees
pursuant
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to local law, 9)the Provider falsifies or violates the provisions of the Drug Free
Workplace Affidavit; 10)the Provider attempts to meet its obligations under this
contract through fraud, misrepresentation or material misstatement; 11) the
Provider fails to correct deficiencies found during a monitoring, evaluation or
review within the specified time; 12) the Provider fails to meet the terms and
conditions of any obligation under any contract.or otherwise or any repayment
schedule to the County or any of its agencies or instrumentalities; 13) the
Provider fails to meet any of the terms and conditions of the Miami-Dade County
Affidavits; 14)the Provider fails to fulfill in a timely and proper manner any and
all of its obligations,covenants,agreements and stipulations in this Contact. The
Provider shall be given written notice of the claimed breach and 10 business days
to cure saane. Unless the Provider's breach is waived by the County in writing,
or unless. the Provider shall have failed after receiving written notice of the
claimed breach by the County to take steps to cure the breach within 10 business
days after receipt of the .breach, the County may, by written notice to the
Provider, terminate this Agreement upon no less than twenty-four (24) hours
notice. Said notice shall be sent.by certified mail,return receipt requested,or in
person with proof of delivery. Waiver of breach of any provision of this
Agreement shall not be construed to be a modification of the terms of this
Agreement. The provisions contained herein-do not limit the County's right to
legal or equitable remedies or any other provision for termination under this
contract. Such individual or entity shall be responsible for all direct and indirect
costs associated with such termination or cancellation,including attorney's fees.
Any individual or entity who attempts to meet its contractual obligations with the
County through fraud, misrepresentation or material misstatement ma be
disbarred from County contracting for up to five(5)years.
IV. REVERSION OF ASSETS
A. Term of Commitment
If the Subrecipient receives assistance-for acquisition, rehabilitation, or new construction,
then the Subrecipient shall agree to operate the supportive housing or provide supportive
services in accordance with this Agreement and applicable laws and regulations for a term of
at least 20 years from the date of initial occupancy or date of initial service provision.If the
United States Department of Housing and Urban Development(HUD)determines a project is
no longer needed for use as supportive housing or to provide supportive services,then HLJD
may provide authorization to the Grantee on behalf of the Subrecipient to convert the project
to a project for the direct benefit of low-income persons pursuant to a request for such use by
the Grantee on behalf of the Subrecipient operating the project(24 CFR 583.305(a)).
B. Repoment of Grant
If the Subrecipient does not provide supportive housing or supportive services for 10 years
following the date of initial occupancy or date of initial service provision pursuant to this
Agreement, then.the Grantee shall require repayment of the entire amount of the grant used
for acquisition, rehabilitation, or new construction, unless conversion of the project has been
authorized by HUD pursuant to the terms in the Term of Commitment Section, IV-A of this
document(24 CFR 583.305(b)).
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If the supportive housing is used for such purposes as stated in Section IV-A for more than 10
years,then the Subrecipient's repayment amount will be reduced by 10 percentage points for
each year beyond the 10-year period in°which the.project is used for supportive housing
(24 CFR 583.305(b)).
C. Prevention of Undue Benefits
Upon the sale or other disposition of a project assisted with acquisition,rehabilitation,or new
construction funds occurring before the expiration of the. 20-year period, the Subrecipient
must comply with such terms and conditions as HUD and the Grantee may prescribe to
prevent the Subrecipient from unduly benefiting from such sale or disposition.
The: Subrecipient shall return to the Grantee, upon-the expiration or termination of this
Agreement,any funds on hand,any accounts receivable attributable to these funds,and any
overpayment due to unearned funds or costs disallowed pursuant to the terms of this
Agreement that were disbursed to the Subrecipient by the Grantee.
D. Revocation of License or Permit
Notwithstanding any provision of this Agreement to the contrary,revocation of any necessary
license,permit, or approval by a governmental authority may result in immediate termination
of this Agreement upon no less than twenty-four hours notice.Said.notice shall be certified by
mail or hand delivery.
E. Declaration of Restrictive Covenants and Declaration of Restrictions
If'not previously recorded, the Subrecipient and the Titleholder shall. sign and record m set
forth in Attachment O and Attachment 0-1, at the time of contract execution, and
incorporated here by reference, the "Declaration of Restrictive Covenants," and the
"Declaration of Restrictions." The Declaration of Restrictive Covenants is a federal
requirement and the Declaration of Restrictions.is.a local.Requirement on properties that are
acquired, rehabilitated or built with Supportive Housing Program funds. These convenants
restrict the use of properties located at Not applicable such that,the properties must be
operated for the provision. of supportive housing and services for homeless persons in
accordance with the provisions of 24 CFR Part 583, Code of Federal Regulations and any
other applicable laws or regulations for a term of at least 20 years or for such other purposes
as may be approved by the Grantee and HUD. The Subrecipient agrees to inform any lender
or grantor which has loaned or granted funds for the purchase of such properties of structures
thereupon and request their consent to the recordation of and subordination to the Declaration
of Restrictive Covenants and the Declaration of Restrictions. Such consent shall be in a form
acceptable to the Grantee.
V. UNIFORM ADMINISTRATIVE REQUIREMENTS
A. Accounting Standards Cost Principles,and Regulations
1. The Subrecipient shall comply with Federal accounting standards and cost principles
according to OMB Circular A-122 and SHP Regulations (24 CFR 583.135)and any
other applicable laws-and regulations'.
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2. The Subrecipient shall comply with applicable provisions of applicable Federal, State,
and County laws,regulations,and rules such as OMB Circular A-110,OMB'Circular A-
21,and OMB Circular A-133 and with the Energy Policy and Conservation Act(Public
Law 94-163) which requires mandatory standards and policies -relating to energy
efficiency. If any provision- of this contract conflicts with any applicable law or
regulation, only the conflicting provision shall be deemed by the parties hereto to be
modified to be consistent with the law or regulation or to be deleted if modification is
impossible. However., the obligations under this contract, as modified, shall continue
and all provisions of this contract shall remain in full force and effect.
3. If the amount payable to the Subrecipient pursuant to the terms of this contract is in
'excess of$100,000; the Subrecipient shall-comply with all applicable standards, orders,
or regulations issued pursuant to Section 306 of the Clean Air Act of 1970 (42 U.S.C.
1857 (h)), as amended; the Federal Water Pollution Control Act (33 U.S.C: 1251), as
amended; Section 508of the Clean Water Act (33 U.S.C. 1368); Environmental
Protection Agency regulations (40 CFR Part 15); Executive Order 11738;. and
Environmental Review Procedures and Regulations (24 CFR Part 58 and 24 CFR Part
583.230). Subrecipient shall comply with all applicable laws and regulations governing
'this agreement.
B. Retention of Records
1. The Subrecipient shall retain records pertinent to expenditures and all Agreement
Records for a period of at least three (3) years (hereinafter referred to as "Retention
Period."). For all non-Grantee assisted activities the Retention Period shall begin upon
the expiration or termination of this Agreement.
2. If the Grantee or the Subrecipient has received or been given notice of any kind
indicating any threatened litigation, claim or audit.arising out of the services provided.
pursuant to-the terms.of this-.Agreement, the Retention Period shall be extended until
such time as the threatened or pending litigation, claim or audit is, in the sole and
absolute discretion of the Grantee,fully,completely and finally resolved.
3. The Subrecipient shall allow the Grantee or any persons authorized by the Grantee full
access to and the right to examine any of the Agreement Records during the required
Retention Period.
4. The Subrecipient shall notify the Grantee in writing both during,the pendency of this
Agreement and after its expiration as part of the final close-out procedure,of the address
where all the Agreement Records will be retained.
5. The Subrecipient shall obtain the prior written approval of the Grantee for the disposal of
any Agreement Records before disposing of such Records within one year after
expiration of the Retention Period.
C. Additional Requirements
The Subrecipient must comply with the following additional requirements.
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1. Client Rules and Regulations - The Subrecipient shall submit a copy of the Client
Rules and Regulations that apply to clients referred to the Subrecipient pursuant to this
Agreement;due within thirty(30)days following the execution of this Agreement.
2. Personnel Policies and Administrative Procedure Manuals -The Subrecipient shall
submit detailed documents describing the Subrecipienfs internal corporate or
organizational structure,property management and procurement policies and procedures,
personnel management, accounting policies and procedures, etc. The information shall
be available to the Grantee upon a request.
3. Monitoring - The Subrecipient shall permit the Grantee and any other persons
authorized by the Grantee to monitor,according to applicable regulations,all Agreement
Records, facilities,-goods and activities of the Subrecipient which are in any way
connected to the activities undertaken pursuant to the terms of this Agreement,and/or to
interview any clients, employees, subcontractors, or assignees of the Subrecipient. The
Grantee shall monitor, both fiscal and programmatic compliance with all terms and
conditions of this Agreement. to include a review of beneficiaries, supportive services,
operating costs, program progress, documentation for required match,.record keeping,
compliance with circulars, .administrative costs, technical assistance visits, and
environmental review.
The Subrecipient shall permit the Grantee to conduct site visits, client assessment
surveys, and other techniques deemed reasonably necessary to fulfill the monitoring
function.A report.of the Grantee's findings may be delivered to the Subrecipient,and if
so delivered,the Subrecipient shall rectify all deficiencies cited within the period of time
specified in the report.
4. Restrictions of Funds Use- The funds received under this Agreement(or any State or
local government funds used to supplement this Agreement) may not be used to replace
state or local funds previously used_,or designated for use to assist homeless persons(24
CFR Part 583.150(a)).
The Subrecipient shall notify the Grantee of any additional funding received for any
activity described in this Agreement, other than the "Client Contribution Report,
Attachment F which is addressed in II-C(1). Such.notification shall be in writing and
received by the Grantee within thirty (30)days of the Subrecipient's notification by the
funding source.
5. Related Parties - The Subrecipient shall report to the Grantee the name, purpose, and
any other relevant information in connection with any transaction conducted between the
Subrecipient and a related party transaction. A related party includes, but is not limited
to, a. for-profit or nonprofit subsidiary or affiliate organization, and organization with
overlapping boards of directors or any organization for which the Subrecipient is
responsible for appointing members.The Subrecipient shall report this information to the
Grantee upon forming the relationship or if already formed, shall report it immediately.
Any supplemental information shall be reported in the Grantee required Agency
Narrative and Progress Report which are addressed in Section II Records and Reports,C
Reports(1)Progress.
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-6. Required Meeting Attendance—From time to time,the Miami-Dade County Homeless
Trust may.schedule meetings and/or training sessions to assist the Subrecipient in the
performance of its contractual obligations or to inform the Subrecipient of new and/or
revised policies and procedures. Attendance at some of these meetings may be
mandato . The Subrecipient shall receive notice no less than three (3)business days
prior to any meeting or training session that requires mandatory participation.A record
of attendance at meetings or training sessions where notice was given indicating the
Subrecipient's mandatory participation shall be kept,and the Subrecipient's contractual
compliance will be monitored. Failure to attend a meeting/training sesion for which a
mandatory notice has been provided can result in material non-compliance of the
contract/agreement,up to and including breach or default.Proof of notice shall consist of
fax record, certified mail, and/or verbal communication with the contract/agreement
contact person or other program-administrative staff. The Provider may select one or
more employees from their agency, directly involved in the contracted program,as their
representative at the meeting/training session;the participation of the Agreement contact
person is preferred. The Subrecipient- may request to be excused from a mandatory
meeting. That request must be received at least twenty-four (24),hours prior to the
meeting date and time, and justification provided, including why the agency could not
send gmy representative. The Miami-Dade County Homeless Trust shall determine
whether or not the_absence will be excused,the Subrecipient shall not be excused from
more than two (2) meetings/training sessions during each contract .year. The
Subrecipieint is encouraged to attend all meetings of the Miami-Dade County Homeless
Trust and/or its Committees, as information relevant to their program or services may be
discussed.
7. Publicity and Advertisements - The Subrecipient shall ensure that all publicity and
advertisements prepared and released by the Subrecipient, such as pamphlets and news
releases already or indirectly related to activities funded pursuant to this Agreement;and
all events carried out to publicize the accomplishments of any activity funded pursuant to
this Agreement,recognize the Grantee as its funding source.
The Subrecipient shall ensure that all media representatives, when inquiring about the
activities funded pursuant to this Agreement,are informed that the Grantee is the funding
source.
8. Procurement - The Subrecipient shall make a positive effort to procure supplies,
equipment,construction or services necessary or related to carrying out the terms of this
Agreement from minority and women's businesses, and to provide these sources
maximum feasible opportunity to compete for subcontracts to be performed pursuant to
this Agreement.
In conformance with Section 3 of the Housing and Urban Development(HUD)Act of
1968 Attachment I , as amended, 12 U.S.C. 1701u (Section 3), work performed under
this contract are subject to requirements of this section. The purpose of Section 3 is to
ensure that employment and other economic opportunities generated by HUD assistance
of HUD-assisted projects covered by Section 3, shall to the greatest extent feasible,be
directed to low and very low-income persons,particularly persons who are recipients of
HUD assistance for .housing and to businesses that are substantially owned or
substantially employ low and very low income persons.
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9. Property—This section applies to equipment with an acquisition cost of$5,000 or
more per unit and all real property.
a. Any real property under the Subrecipient's control that was acquired/improved in
whole or in part with funds from the Homeless Trust and any equipment
purchased for$5,000 or more shall be disposed of,at the expiration or termination
of this contract, in accordance with instruction from the Homeless Trust. Real
Property is defined as land, including land improvements, structures,
appurtenances thereto, including movable machinery and equipment. Equipment
means tangible, nonexpendable, personal property having a useful life of more
than one year and an acquisition cost of$5,000 or more per unit.
b. equipment with an acquisition cost of$5,000 or more per units and all real
property purchased in whole or in part.with funds from this and previous contracts
with the Homeless.Trust, or transferred to the Subrecipient after being purchased
in whole or in part with funds from the Homeless Trust shall be listed in the
property records of the Subrecipient and shall include a legal description, size,
date of acquisition, value at time of purchase,owner's name if different from the
Subrecipient, information on the transfer or disposition of the property, and map
indicating whether property is in parcels, lots or blocks and showing adjacent
streets and roads. Notwithstanding documentation required for reimbursement
purposes, a copy of the purchase receipt for any asset described above purchased
with Homeless Trust funds must also be included in the Subrecipient's monthly
reimbursement package submitted to the Homeless Trust in the month in which
the item was purchased along with the"Provider Asset Inventory"Attachment N.
C. All equipment with an acquition cost of$5,000 or more per unit and all real
property shall be inventoried annually by the Subrecipient and an inventory report
shall be submitted to the Homeless Trust. This report shall include the elements
listed in the paragraph listed above.
10. Management Evaluation and Performance Review - The Grantee may conduct a
formal management evaluation and performance review of the Subrecipient following
the expiration of this Agreement. The management evaluation will reflect the
Subrecipienfs compliance with generally accepted fiscal and organizational standards
and practices. The performance review will reflect the quality of service provided and
the value received using.monitoring data such as progress reports, site visits, and.client
surveys.
11. Subcontracts and Assignments
a. The Subrecipient shall ensure that all subcontracts and assignments:
(1) Identify the full,correct and legal name of the party;
(2) Describe the activities to be performed;
(3) Present a complete and accurate breakdown of its price component;
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(4) Incorporate a provision requiring compliance with all applicable regulatory
and other requirements of this Agreement with any conditions of approval
that the Grantee deems necessary. This applies only to subcontracts and
assignments in which parties are engaged to carry out any eligible
substantive programmatic service as set forth in this Agreement. The
Grantee shall in its sole and absolute discretion determine when services
are eligible substantive programmatic services subject to the audit and
record-keeping requirements described above,and;
b.. In accordance with Ordinance No. 97-104, all bidders and respondents on County
contracts for purchase of supplies, materials or services, including professional
services, which involve the expenditure of$100,000 or more and all bidders or
respondents on. County or .Public-Health Trust construction contracts which
involve the expenditure of $100,000 or more shall include, as part of their bid or
proposal submission, a listing of Provider's Disclosure of Subcontractors and
Suppliers Attachment L and L-1 which identifies all first tier subcontractors who
will perform any part.of the contract work and describes the portion of the work
such subcontractor will perform, and all contract work direct to the bidder or
respondent.and describes the materials to be so supplied. Failure to include such
listing with the bid or proposal shall render the bid or proposal non-responsive.
Ordinance 97-104 applies to all contracts whether competitively bid by the County
or not. Those contracts that have received authorization by the Board of County
Commissioners to waive formal bidding procedures must also provide a listing of
all first tier subcontractors and direct suppliers.
Subcontractor/Supplier-Listing, SUB Form 100 Attachment L-1 may be utilized
to provide the information required by this paragraph. A bidder or respondent who
is awarded the contract shall not change or substitute fast tier subcontractors or
direct suppliers or the portions of the contract work to be performed or materials to
be supplied from those identified in the listing submitted with the bid or proposal
except upon written approval of the County.
c. The Subrecipient shall incorporate in all consultant subcontracts this additional
provision:
The Subrecipient is not responsible for any insurance or other fringe benefits for
the consultant or its employees, e.g., social security, income tax withholdings,
retirement or leave benefits. The Consultant assumes full responsibility for the
provision of all insurance and fringe benefits for himself or herself and employees
retained by the Consultant in carrying.out the Scope of Services provided in this
subcontract.
d. The Subrecipient shall be responsible for monitoring the contractual performance
of all subcontracts.
e. The Subrecipient shall receive written documentation prior to entering into any
subcontract which contemplates performance of substantive programmatic
activities, as such is determined as provided herein. The Grantee's approval shall
be obtained prior to the release of any fiends to the subcontractor.
S
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f. The Subrecipient shall receive written approval from the Grantee prior to either
assigning or transferring any obligations or responsibility set forth in this
Agreement or the right to receive benefits or payments resulting from this
Agreement.
g. Approval by the Grantee of any subcontract or assignment shall not under any
circumstances be deemed to provide for the incurring of any obligation by the
Grantee in excess of the total dollar amount agreed upon in this Agreement.
12. The Grantee's Consultant - The Grantee understands that in order to facilitate.the
implementation :of:this Agreement, the Grantee may from time to time 'designate a
development consultant to work with the Subrecipient. The Grantee's consultant shall be
considered the Grantee's.designee with respect to all portions of this Agreement with the
exception of those provisions relating to payment of the Subrecipient for services
rendered. The Grantee shall provide writteo notification to the Subrecipient of the name,
address,and employees of the Grantee's consultant.
13. Participation in Homeless Management Information System-The Provider
(Subrecipient)agrees to participate in the Homeless Management Information
System (EMUS) selected and established by the County. Participation will include, but
is not limited to, input of client data upon intake, daily updates of bed availability
information, as well as updates of client files upon client contact, and maintaining
current data for statistical purposes. The Provider understands that they are responsible
for any ongoing cost.to access the MWS system. The Provider agrees to abide by the
terms of the HMIS agreement previously signed by Provider, which is incorporated
herein by reference. The Provider shall indemnify and hold harmless the County and its
agents and instrumentalities from any and all liability,losses and damages arising out of
or relating to this agreement or the HMIS system.
14. Miami-Dade County Inspector General Review —The Miami-Dade County Office of
the Inspector General may, on a random basis, perform audits on all County contracts,
throughout.the duration of said contracts.
15. Independent Private Sector Inspector General Review-
The Inspector General is also empowered to retain the services of independent private
sector inspectors general (IPSIG) to audit, investigate, monitor, oversee, inspect and
review operations, activities, performance and procurement processes including but not
limited to project design, bid specifications, proposal submittals, activities of the
Provider, its officers, agents and employees, lobbyists,County staff and elected officials
to ensure compliance with contract specifications and to detect fraud and corruption.
16. Renegotiation or Modification-Modifications of provisions of this Agreement shall be
valid only when in writing and signed by duly authorized representatives of each party.
Additional conditions are:
a. A Subrecipient may not make any significant changes to an approved program
without prior Grantee approval. Significant changes include, but are not limited
to, a change. in the Subrecipient, a change in the project site, additions or
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.deletions in the types of activities listed in 24 CFR Part 583.100 approved in the
Technical Submission for the program, or a shift of more than 10 percent of
funds from one approved type of activity to another,or a change in the category
of participants to be served,or other changes deemed significant by the Grantee.
Depending on the nature of the change, the Grantee may require a new
certification of consistency with the Consolidated Plan Certification from the
United States Department of Housing and.Urban Development
b. Approval for changes is contingent upon the application ranking remaining high
enough .after the approved change to have been competitively selected for
funding in the year the application was selected.
The parties agree to renegotiate this contract if the Grantee determines, in its sole and
absolute discretion, that Federal state, and/or Grantee revisions of any applicable law or
regulations, or increases or decreases in. budget allocations make changes in this
Agreement necessary. The Grantee shall be the final authority in determining whether or
not funds for this Agreement are available due to Federal, state and/or Grantee revisions
of any applicable laws or regulations,or increases in budget allocations.
Notwithstanding the foregoing, the Grantee retains all the rights of suspension or
termination set forth in Section IH'of this Agreement. After the initial grant agreement,
the Grantee will not make revisions to increase the amount of the award to the
Subrecipient.
17.. Right. to Waive - The Grantee may, for-good and sufficient cause, as determined by the
Grantee in this sole and absolute discretion,waive provisions in this Agreement in writing
or seek to obtain such waiver from the appropriate authority: Waiver requests from the
Subrecipient shall be in writing.Any waiver shall not be construed to be a modification of this
Agreement.
18. Disputes - In the event. an-unresolved dispute exists.between the Subrecipient and the
Grantee, the Grantee shall refer the.questions, including the views of all the interested parties
and the recommendation of,the Grantee, to the CountyManager for determination. The
County Manager,or an authorized representative,will issue a determination within thirty(30)
calendar days of receipt. and so advise the Grantee and the Subrecipient, or in the event
additional time.is necessary,the Grantee will notify the Subrecipient within the thirty(30)day
period that additional time is necessary. The Subrecipient agrees that the County Manager's
determination shall be final and binding on all parties.
19. Headings - The article and paragraph headings in this Agreement are inserted for
convenience only and shall not affect in any way the meaning or interpretation of this
Agreement.
20. Proceedings- This Agreement shall be construed in accordance with the laws of the State of
Florida and any proceedings arising between the parties in any manner pertaining or relating
to this Agreement shall,to the extent permitted by law,be held in Dade County,Florida.
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21.- Notice and Contact-The Grantee's representative for this Agreement is:
Hilda M. Fernandez, Executive Director. The Subrecipient's representative for this
Agreement is 1�X%Ak6,k VA C0-7 VV The
project/program site is located at
In the event that different representatives are designated by either party after this Agreement
is executed,or the Subrecipient changes the address of either the program site or the principal
office, the- Subrecipient must notify the Grantee prior to such relocation and obtain all
necessary approvals. Notice of the name of the new representative or new address will be
rendered in writing to the other party and said notification attached to the originals of this
Agreement.
22. Name and Address of Payee—Assignments cannot be made without both the Grantee's
express;written permission.in advance and.any necessary approval from HUD.When
payment is made to the Subrecipient's assignee,the name and address of the oBicial payee is:
23.. All Terms and Conditions:Included-This Agreement and its attachments as referenced
contain all the terms and conditions agreed upon by the parties.The following documents are
attached to this agreement:(Attachments A through Q)
24. Autonomy Both parties agree that this Agreement recognizes the autonomy of and stipulates
or implies no affiliation between the contracting parties. The parties acknowledge that the
-relationship of Grantee and Subrecipient is that of independent contractors and that nothing
contained in this Agreement shall be construed to place Grantee and Subrecipient in the
relationship of principal and agent, employer and.employee, master and servant,partners or
joint venturers. Neither party shall have, expressly or-by implication,or represent itself as
having, any authority to make contracts or enter into any agreement.in the name of the other
party,or to obligate or bind the other party in any manner whatsoever.
25. Severability of Provisions-If any provision of this Agreement is held'invalid,the remainder
of this Agreement shall not be affected thereby if such remainder would then continue to
conform to the terms and requirements of applicable law.
26.'Waiver of Trial -Neither the Subrecipient, subcontractor nor any other person liable for the
responsibilities, obligations, services and representations herein, nor any assignee, successor
heir or personal representative of the Subrecipient, subcontractor or any such other persons or
entity shall seek a jury trial in any lawsuit, proceeding, counterclaim or other litigation
procedure based upon or arising out of this Agreement,or the dealings or the relationship
between or among such persons or entities, or any of them. Neither the Subrecipient,
subcontractor nor any such person or entity shall seek to consolidate any such action in which a
jury trial has been waived.The provisions of this paragraph have been fully discussed by
the parties hereto, and the provision hereof shall be subject to no exceptions.No party has in
any way agreed with or represented to any other party that the provisions of this paragraph will
not be fully enforced in all instances.
27. Contracts with Municipalities or Counties Outside Miami Dade County to Provide
Homeless Housing in Miami-Dade County. - The above-named firm, corporation,
organization or individual("provider""subrecipient")desiring to transact business or enter into
a contract with the County for the provision of homeless housing and /or services swears,
.verifies,affirms and agrees that(1) it has not entered into any current contract,arrangement of
v F
GRANT NUMBER FLO 177B4D001104
City of Miami Beach—Miami Beach Outreach Program/Page 21 of 24
any kind,or understanding with any municipality outside of Miami-Dade County or any County
(collectively "locality") to provide housing and services for homeless persons in Miami-Dade
County who are transported to Miami Dade County by or at the behest of such locality and(2)
during the term of this contract, it will not enter into any such contract, arrangement of any
kind, or understanding; provided, however, upon the written request of the Contractor prior to
entering into such contract, understanding or arrangement,the Miami-Dade County Homeless
Trust may,in its sole and absolute discretion,find and.determine within 60 days of such request
that a proposed contract should not be prohibited hereby, as the best interests of the homeless
programs undertaken by and on behalf of Miami-Dade County would not be negatively affected
by such contract,arrangement,or undertaking.
28. The Subrecipient agrees to comply with all applicable federal, state and local laws,
regulations, ordinances;and standards, including but not limited to Part M.Ch.2 and Ch. I 1
of the Miami-Dade County Code, Section 255.05 of the Florida Statutes regarding payment and
performance bonds. and other requirements for public works, competitive bid and bid bond
requirements, and F.A.R. 52.222 as may apply, as well as with requirements of the grant
agreement between Grantee and HUD attached as Attachment A. The.Subrecipient also agrees
to sign and provide the Grantee with any required County affidavits.
V1. RELIGIOUS ORGANIZATIONS
As reported in 24 CFR Part 583.150,.HUD will provide assistance to a recipient that is a primarily
.religious organization, if the organization agrees to provide housing and supportive services in a
manner that is free from religious influences and in accordance with the following principles:
1. It will not discriminate against any employee or applicant for employment on the basis of
religion and will not limit employment or give preference.in employment to persons on the
basis of religion;
.2.. It will not discriminate against any.person applying for housing or supportive services on the
basis of religion and will not limit such housing or services or give preference to persons on
the basis of religion;and
3. It will provide no religious instruction or counseling, conduct no religious worship or
services, engage in no religious proselytizing, and exert no other religious influence in the
provision of housing and supportive services funded hereunder.
HUD will provide assistance to a recipient that is a primarily religious organization if the assistance
will not be used by the.organization to construct a structure,acquire a structure or to rehabilitate a
structure owned by the organization, except as described in 24 CFR Part 583.150 (b)(2)
Attachment A.
V11. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT(H]PAA)
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 (IH) and/or
Protected Health Information (PHI) shall comply with the Health Insurance Portability and
Accountability Act (HIPAA) of 1996 and the Miami-Dade County Privacy Standards
f'
e
,1
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Administrative Ord_er. HIPAA mandates for privacy,security and electronic transfer standards,that
include but are not limited to:
1. Use of information only.for performing services required by the contract or as required by law;
2. Use of appropriate safeguards to prevent non permitted disclosures;
3. Reporting to Miami-Dade County of any non permitted use or disclosure;
4. Assurances that any agents and subcontractors.agree to_the same restrictions and conditions that
apply to the Bidder/Proposer and reasonable assurances that IIHI/PHI will be held confidential;
5. Making Protected Health Information(PHI)available to the customer;
6. Making PHI available to the customer for review;
7. Making PHI available to Miami-Dade County for an accounting of disclosures;and
8. Making internal practices,books and records related to PHI available to Miami Dade County for
compliance audits.
PHI shall maintain its protected status regardless of the form and method of transmission (paper
records,and/or electronic transfer of data). The Subrecipient must give its customers written notice
of its privacy information practices including specifically, a description of the types of uses and
disclosures that would be made with protected health information.
VIII.PROOF OF LICENSURE/CERTIFICATION AND BACKGROUND SCREENING
A. Licensure. If the Subrecipient("Provider")is required by the State of Florida or Miami-
Dade County or any law or regulation to be licensed or certified to provide the services or operate the
facilities outlined in the Scope of.Services (Attachment A), the Provider shall furnish to the County a
copy of all required current licenses or certificates. Examples of services or,operations requiring such
licensure or certification include but are not limited to childcare,day care, nursing homes, and boarding
homes.
If the Provider fails to furnish the County with the licenses or certificates required under this
Section, the County shall not disburse any funds until it is provided with such licenses or certificates.
Failure to provide.the licenses.or certificates within sixty(60) days of execution of this Agreement may
result'in termination of this Agreement at the County's discretion.
B. Backg'ound Screening.The Provider agrees to comply with all applicable
laws, regulations, ordinances and resolutions regarding background screening of employees and
subcontractors. Provider's failure to comply with any applicable laws, regulations, ordinances and
resolutions regarding background screening of employees and subcontractors is grounds for a material
breach and termination of this contract at the sole discretion of the County..
The Provider agrees to comply with all applicable laws(including but not limited to Chapters 39,
402,409,394,408,393,397, 984,985 and 435,Florida Statutes,as may be amended form time to time),
regulations, ordinances and resolutions, regarding background screening of those who may work with
vulnerable persons,as defined by section 435.02,Florida Statutes,as may be amended from time to time.
In the event criminal background screening is required by law, the State of Florida and/or the
County,the Provider will permit only employees and subcontractors 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 in direct
contact with vulnerable persons.
s
GRANT NUMBER FL0177B4D001104
City of Miami Beach—Miami Beach Outreach Program/Page 23 of 24
The Provider agrees to ensure that employees and subcontracted personnel who work with
vulnerable persons satisfactorily complete and pass Level 2 background screening before working with
vulnerable persons. Provider shall furnish the County with proof that employees and subcontracted
personnel, who work with vulnerable persons, satisfactorily passed Level 2 background screening,
pursuant to Chapter.435,Florida Statutes,as may be amended from time to time.
If the Provider fails to furnish to the County proof that an employee or subcontractor's Level 2
background screening was satisfactorily passed and completed prior to that employee or subcontractor
working with a vulnerable person or vulnerable persons,the County shall not disburse any further funds
and this Contract may be subject to termination at the sole discretion of the County.
CONTES UES NEXT ON SIGNATURE PAGE
r.
GRANT NUMBER FL0177B4D001104
City of Miami Beach—Nfiami Beach-Outreach Program/Page 24 of 24
IN WITNESS WHEREOF,the parties have caused this twenty-four(24)page Agreement to be
executed by their respective and duly authorized officers the day and year first above written.
WITNESSES:
NAME BTU D'� +f(D.At,�L PROVIDER: CA (lAt.AMi eCA C-f
(PRT) (FULL NAME OF AGENCY)
OIL..A- ``�'� 1Z
NAME: �� ... I E .(��(zpc�
( I ATURE) (PRINT NAME OF AUTHORIZED
AGENCY REP NTA
NAME:
:INCORP ORATED=
� T) (dGNATURE OF AUTHORIZED
�• AGENCY REPRESENTATIVE)
NAME: "9 '
ly( f�T`�t frnd4
(SIGNATUREI-- l �� l
-._._� (TITLE)
1 OlAt/I L
_.ATTEST_
(AFFIX SUBRECIPIENT INCORPORATION SEAL)
ATTEST: MIAMI-DADS COUNTY
a political subdivision
of the State of Florida
HARVEY RUVIN,CLERK g �
BY:
DEPUTY CLERK Y; `� Carlos A.Gimenez
Mayor
(DATE)
See attached memorandum dated 4lrt IQI�Aa-approved as to form and legal sufficiency:
APPROVED AS TO
FORM & LANGUAGE
& FOR EXECUTION
tomey (f. Date
SUBRECI PIENT AGREEMENT ATTACHMENT LIST
Signature Attachment Title
Re uired
Attachment A US HUD 2011 SIP Renewal Grant Agreement and Codified
Supportive Housing Pro am Re ations
Attachment A-1 Scope of Service
Attachment A-2 Exhibit Chart: Type and Scale of Housing
Attachment A-3 Exhibit Chart:Households with Dependents(Children)
Attachment A-4 Exhibit Chart:Households without Dependents(No children)
Attachment A-5 Performance Objectives
Attachment A-6 Milestones(not applicable for renewals)
Attachment B Technical Submission Exhibits-Budget
Attachment C LOCCSNR.S form HUD-2705'3A
Attachment C-1 Copy of Homeless Trust Invoice(Excel.Spreadsheet)
Attachment D HMIS (HUD-40118)Monthly Progress Report
Attachment E Program Rating of Satisfaction
Attachment F Client Contribution Report
Attachment.G HMIS (HUD-40118)Annual progress Report(APR)-
Signature Attachment 14 Request for Taxpayer Identification and Certification
Signature Attachment I HUD form 40090-4 Applicant Certificate
Signature. Attachment Miami-Dade County Required Affidavits
Signature Attachment K Affidavit Lobbyist Registration for Oral Presentations
Signature Attachment L Disclosure of Subcontractors and Suppliers
Signature Attachment L-1 Subcontractor/Suppliers Listing
Signature Attachment M Sworn Statement Pursuant to Florida Statutes
11'gnature Attachmernt N Provider Asset Inventory form
If applicable "Attachment O Declaration of Restrictive Covenants
H applicable Attachment 0-1 Declaration of Restrictions
Attachment P Employee Certification form
1�ttachment Q Incident Report
s
ATTACHMENT A
U.S. HUD 201, 1 Grant Renewal Agreement
and Codified Support.Ye Program Regulations
(including The Homeless Definition Rule)
U.S.Department of Housing and Urban Development
Office of Community Planning and]development
0 x 909 SE First Avenue
Miami,FL 33131
�eAA1 Dk"V��'�4
Gent Number•.FL0177B4D001104
Project Name:FL-600-REN-City ofMiami Beach Outreach
Total Award Amount:$63,993
Component: SSO
Recipient:Miami Dade County
Official Contact Person and Title:David Raymond,Executive Director
Telephone Number. (305)375-1490
Fax Number:(305)375-2722
E-mail Address:jLm�iamidade.goov
EIN/Tax ID Number. 59-6000573
DUNS Number.004148292
Effective Date: 06-01-2012
Project Location(s):Miami Dade County_
2011 SUPPORTIVE HOUSING PROGRAM
RENEWAL GRANT AGREEMENT
This Grant Agreement is made by and between the United States Department of Housing
and Urban Development(HUD)and the Recipient, which is described in section 1 of
Attachment A,attached hereto and made a part hereof.
The assistance which is the subject_of this Grant Agreement is authorized by the
McKinne -Vento Homele ss Assistance Act 42 U.S.C. 11381 (hereafter the Art"). The
term
"grant"or"grant funds"means the assistance provided under this Agreement.This grant
agreement will be governed by the Act,the Supportive Housing rule codified at 24 CFR 5832
which is attached hereto and made a part hereof as Attachment B,and the Notice of Funding
Availability(NOFA),that was published in two parts.The fast part was the Policy Requirements
and General Section of the NOFA,which was published June 11,2010,at 75 FR 33323,and the
second part was the Continuum of Care Homeless Assistance Programs section of the NOFA,
which is located at bft://www.hud.izov/offices/adm/arants/nofal0/gWoc-efin.7 he term
"Application"means the application submission on the basis of which HUD,including the
certifications and assurances and any information or documentation required to meet any grant
award conditions,on the basis of which HUD approved a grant.The Application is incorporated
herein as part of this Agreement;however,in the event of a conflict between any part of the
Application and any part of the Grant Agreement the latter shall control. The Secretary agrees,
subject to the terms of the Grant Agreement,to provide the grant funds in the amount specified at
section 2 of Attachment A for the approved project described in the application.The Recipient
agrees, subject to the terms of the Grant Agreement,to use the grant funds for eligible activities
during the term specified at section 3 of Attachment A.
www.hud.e+av manol.Nd ov Page 1
E
r.
The Recipient must provide a 25 percent cash match for supportive services.
The Recipient agrees to comply with all requirements of this Grant Agreement and to
accept responsibility for such compliance by any entities to which it makes grant funds available.
The Recipient agrees to participate in a local Homeless Management Information System
(fIWS)when implemented.
The Recipient and project sponsor,if any,will not knowingly allow illegal activities in
any unit assisted with grant funds.
The Recipient agrees to draw grant fiords at least quarterly.
For any project funded by this grant,which is also financed through the use of the Low
Income Housing Tax Credit,the following applies:
HUD recognizes that the Recipient or the project sponsor will or has financed this project
through the use of the Low-Income Housing Tax Credit.The Recipient or project sponsor shall be the
general partner of a limited partnership formed for that purpose.If grant funds were used for
acquisition,rehabilitation or construction,then,throughout a period of twenty years from the date of
initial occupancy or the initial service provision,the Recipient or project sponsor shall continue as
general partner and shall ensure that the project is operated in accordance with the requirements of this
Grunt Agreement,the applicable regulations and statutes.Further,the said limited partnership shall
own the project site throughout that twenty-year period.If grant funds were not used for acquisition,
rehabilitation or new consftuction,then the period shall not be twenty years,but shall be for the term
of the grant agreement and any renewal thereof.Failure to comply with the terms of this paragraph
shall constitute a default under the Grant Agraeement
A default shall consist of any use of grant funds for a purpose other than as authorized by
this Grant Agreement,failure in the Recipient's duty to provide the supportive housing for the
mini mum term in accordance with the requirements of the Attachment A provisions,noncompliance
with the Act or Attachment]B provisions,any other material breach of the Grant Agreement,or
misrepresentations in the application submissions which,if known by HUD,would have resulted in
this grant not being provided.Upon due notice to the Recipient of the occurrence of any such
default and the provision of a reasonable opportunity to respond,HUD may take one or more of the
following actions:
direct the Recipient to submit progress schedules for completing approved
(a) activities;or
issue a letter of warning advising the Recipient of the default, establishing a date by
(b) which corrective actions must be completed and putting the Recipient on notice that
more serious actions will be taken if the default is not corrected or is repeated;or
direct the Recipient to establish and maintain a management plan that assigns
(c) responsibilities for carrying out remedial actions;or
direct the Recipient to suspend,discontinue or not incur costs for the affected
(d) any,or
www.hud-My MmolJuxi.mov Page 2
i
J
ATTACHMENT A
(e) reduce or recapture the grant; or
(f) direct the Recipient to reimburse the program accounts for costs inappropriately
charged to the program;or
(g) continue the grant with a substitute Recipient of HUD's choosing;or
(h) other appropriate action including,but not limited to,any remedial action legally
available,such as affirmative litigation seeking declaratory judgment, specific
performance,damages,temporary or permanent injunctions and any other available
remedies.
No delay or omission by HUD in exercising any right or remedy available to it under this
Grant Agreement shall impair any such right or remedy or constitute a waiver or acquiescence m
any Recipient default.
The Grantee shall comply with requirements established by the Office of Management and
Budget(OMB)concerning the Dun and Bradstreet Data Universal Numbering System(DUNS),
the Central Contractor Registration(CCR)database,and the Federal Funding Accountability and
Transparency Act,including Appendix A to Part 25 of the Financial Assistance Use of Universal
Identifier and Central Contractor Registration, 75 Fed.Reg. 55671 (Sept. 14,2010)(to be
codified at 2 CFR part 25)and Appendix A to Part 170 ofthe Requirementsfor Federal Rending
Accountability and Transparency Act Implementation 75 Fed.Reg. 55663(Sept. 14,20 10)
(to be codified at 2 CFR part 170).
This Grant Agreement constitutes the entire agreement between the parties hereto,and
may be amended only in writing executed by HUD and the Recipient.More specifically,the
Recipient shall not change recipients,location,services,or population to be served nor shift more
than 10 percent of funds from one approved type of eligible activity to another without the prior
written approval of HUD.The effective date of this Grant Agreement shall be the date of
execution by HUD,except with prior written approval by HUD.
wwwhud. ov a P9dhud.gov page 3
r
i
SIGNATURES
UNITED STATES AMERICA,
Secretary of H si a t
BY:.�.-
i ati re and Date)
]Maria R Ortiz-Hill
(Print name of signatory)
Director, CONDMJMTY Planning and Development Division
(Title)
RECIPIENT
(Name of Or on) i M.Fernandez,Executive Director
i-Dade County Homeless Trust
hone(305)375-]490
BY:
(Signature of Authorized Official and Date)
Vim- ��-
(Print name of Authorized 4 al)
(Title)
4
1 The Recipient is Miami Dade County. .
2 HMs total fund obligation for this project is$63,993,which shall be allocated as follows:
a. Leasing $0
b. Supportive services $605946
c. Operating costs $0
d. HMIS $0
e. Administration $3,047
3.Although this agreement will become effective only upon the execution hereof by both parties,
upon execution,the term of this agreement shall run from the end of the Recipient's final operating
year under the original Grant Agreement or,if the original Grant Agreement was amended to
extend its term,the term of this agreement shall run from the end of the extension of the original
Grant Agreement term for a period of twelve(12)months.Eligible costs,as defined by the Act
and Attachment B.incurred between the end of Recipient's final operating year under the original
Grant Agreement,or extension'thereof,and the execution of this Renewal Grant Agreement may
be paid with funds from the first operating year of this Renewal Grant.
Grant Number:FL0177B4D001104
- 5
Codified Supportive Housing
Program. Regulation
Ofc.of Asst.Secy.,Comm.Planning,Develop.,HUD §683.1
583.5 Definitions.
Subpart t--Assistance Provided
583.100 Types and uses of assistance.
563.105 Grants for acquisition and rehabili-
tation.
583.110. Grants for new construction.
583.115 Grants for leasing.
56SIM Grants for supportive service costs.
583.125 Grants for operating costs.
583.130 Commitment of grant amounts for
leasing, supportive services, and oper-
ating costs.
588.135 Administrative costs.
583.14D Technical assistance.
58.4.195 Matching requirements.
583.150 Limitations on use of assistance.
583.155 Consolidated plan.
Subpart C—Application and Grant Award
Process
583.200 Application and grant award.
583.230 Environmental review.
583.235 Renewal grants.
Subpart D—Program Requirements
583.300 General operation.
583.305 Term of commitment;repayment of
grants;prevention of undue benefits.
583.310 Displacement,relooation,and acqui-
sition.
583.315 Resident rent.
583.$20 Site control.
583.325 Nondiscrimination and equal oppor-
tunity requirements.
583.330 Applicability of other Federal re-
gnirements.
Subpart E—Admirdstration
563.400 Grant agreement.
STEP is subject to the 563.405 Program changes.
changes mane by the 563.410 Obligation and deobligation of funds.
AvTHO=Y:42 U.B.C.11369 and 3535(d).
Homeless Definition Rule Soumm: W PR 13891, Mar. 15, 19M, unless
that is at the end of this Rule othervnse noted.
Subpart A--General
583.1 Purpose and scope.
(a) General. The Supportive Housing
Program is authorized by title N of
the Stewart B.McKinney Homeless As-
sistance Act (the Moginney Act) (42
PART 583—SUPPORTIVE.HOUSING U.S.C. 11381-11389). The Supportive
PROGRAM
Housing program is designed to pro-
PROGRAM the development of supportive
Subpart A—Generai housing and supportive services, in-
eluding innovative approaches to assist
sec homeless persons in the transition
583.1 Purpose and scope. from homelessness,and to promote the
251
§583.5 24 CFR Ch.V(4r-1-09 Edition)
provision of supportive housing to Homeless person means an individual
homeless persons to enable them to or family that is described in section
live as independently as possible. 103 of the McKinney Act (42 U.S.C.
(b)Components. Funds under this part 11302).
may be used for: Metropolitan city is defined in section
(1)Transitional housing to facilitate 102(a)(4) of the Housing and Comma-
the movement of homeless individuals nity Development Act of 1974(42 U.S.C.
and families to permanent housing; 5302(a)(4)).In general,metropolitan cit-
(2) Permanent housing that provides ies are those cities that are eligible for
long-term housing for homeless persons an entitlement grant under 24 CFR
with disabilities; part 570,subpart D.
(3) Housing that is, or is part of, a New construction means the building
particularly innovative project for, or of a structare where none existed or an
alternative methods of, meeting the addition to an existing structure that
Immediate and long-term needs of increases the floor area by more than
homeless persons;or 100 percent.
(4) Supportive services for homeless Operating costs is defined in section
persons not provided in conjunction 422(5) of the McKinney Act (42 U.S.C.
with supportive housing. 11382(5)).
(58 FR 13871,Max.15,199x,as amended at 61 Outpatient health services is defined in
Fit 51175,Sept-30,1M] section 422(6) of the McKinney Act (42
U.S.C.1138Z(6)).
§583.5 Definition& Permanent housing for homeless persons
As used in this part' with disabilities is defined in section
Applicant is defined in section 422(1) IWO of the McKinney Act (42 U.S.C.
of the McKinney Act (42 U.S.C. 11384(c)).
11382(1)). For purposes of this defini- Private nonprofit organization is de-
• tion, governmental entities include fined in section 422(7) (A), (B), and (D) -
those that have general governmental (`�), (B). end (D)).the McKinney Act(42 U.S.C.11382()). The organization
powers (such as a city or county). as
must also have a functioning account-
well as those that have limited or ape-
- cial powers (such as public housing � system that is operated in accord-
cial pes). ante with generally accepted account-
encie idated plan means the plan that ing principles, or designate an entity
that will maintain a functioning ac-
a jurisdiction prepares and submits to
HUD in accordance with 24 CFR part counting system for the organization
in accordance with generally accepted
Sl.
Date of initial occupancy means the accounting principles.
date that the supportive housing is ini- Project is defined in sections(d) of the McKinney Act
Bally occupied by a homeless person
and 4 ((42
for whom HUD provides assistance U.S.C.11382(8),ll384(d)).
under this part.U the assistance is for Recipient is defined in section 422(9)of
an existing homeless facility. the date the McKinney Act(42 U.S.C.11382(9)).
of initial occupancy is the date that Rehabilitation means the improve-
' services are first provided to the resi- ment or repair of an existing structure
dents of supportive housing with fund- or an addition to an existing structure
ing under this part. that does not increase the floor area by
Date of initial service provision means more than 100 percent. Rehabilitation
the date that supportive services are does not include minor or routine re-
initially provided with funds under this pis•
part to homeless persons who do not State is defined in section 422(11) of
reside in supportive housing:This deft- the McKinney Act(42 U.S.C. 11382(11)).
nition applies only to projects funded Supportive housing is defined in sec-
under this part that do not provide sup- tion 424(a) of the McKinney Act (42
portive housing. U.S.C.113N(a)).
Disability is defined in section 422(2) Support1w services is defined in seo-
of the McKinney Act (42 U.S.C. tion 425 of the McKinney Act(42 U.S.C.
1].382(2)). 11385)-
252
Oft.of Asst.Secy.,Comm.Planning,Develop.,MUD §583.110
Transitional housing is defined in sec- (d) Technical assistance. HUD may
tion 424(b) of the McKinney Act (42 offer technical assistance, as described
U.S.C.11384(b)j. See also§583.300(j). in§583.140.
Tribe is defined in section 102 of the [58 FR 13871;Max 15,1993,as amended at 69
Housing and Community Development FA W91,July 19,19947
Act of 1974(42 U_B.C.5302).
Urban county is defined in section §50.3105 Grants for acquisition and
102(a)(6) of the Housing and Commis- rehabilitation.
nity Development Act of 1974(42 U.S.C. (a) Use. HUD will grant funds to re-
5302(a)(6)). In general, urban counties cipients to:
are those counties that are eligible for (1) Pay a portion of the cost of the
an entitlement grant ender 24 CPR ac"itiop of real property selected by
part 570,subpart D. the recipients for use in the provision
[61 FR 51175,Sept.30,1W of supportive housing or supportive
services, including the repayment of
Subpart B--Assistance Provided any outstanding debt on a.loan made
to purchase property that has not been
§585.100 Types and uses of assistance- used previously as supportive housing
(a)Grant assistance. Assistance in the or for supportive services;
form of grants is available for acquisi- (2)Pay a portion of the cost of reha-
tion of structures, rehabilitation of bilitation of structures,including cost-
structures, acquisition and rehabilita- effective energy measures, selected by
tion of structures, new construction; the recipients to provide supportive
leasing, operating costs for supportive housing or supportive services;or
(3)Pay a portion of the cost of acqui-
housing,and supportive services,as de-
scribed in§§583.105 through 583.125. Ap- sition and rehabilitation of structures,
as described in paragraphs(a)(1)and(2)
plicants may apply for more than one
of this section.
type of assistance.
(b) Uses of grant assistance. Grant as- (b) Amount. The ma�mum grant
sistance may be used to: available for acquisition, rehabilita-
(1) Establish new supportive housing tion,.or acquisition and rehabilitation
facilities or hew facilities to provide the lower
supportive services; (1)X200,000;;o or
(2)The total cost of the acquisition,
(2)Expand existing facilities in order
to increase the number of homeless rehabilitation,or acquisition and reha-
persons served; bilitation minus the applicants con-
(3) Bring existing facilities up to a tr(c) Increased toward the cost.
level that meets State and local gov- (e) Increased amounts. In areas deter-
level health and safety standards; mined by HUD to have high acquisition
- and rehabilitation casts, grants of
(4) Provide additional supportive
more than$204.000, but not more th
services for residents of supportive an
housing or for homeless persons not re- $400.000,may be available.
siding in supportive housing; §588,110 Grants for new construction.
(5) Purchase HUD-owned single fam-
ily properties currently leased by the (a)
applicant for use as a homeless facility cipients to pay a portion of the cost of
under 24 CPR part 291;and new construction, including cost-effec-
(6)Continue funding supportive hous-. tive energy measures and the cost of
ing where the recipient has received land associated with that construction,
funding under this part for leasing, for use in the provision of supportive
supportive services, or operating costs. housing.If the grant funds.are used for
(c) Structures used for multiple pur- new construction, the applicant must
poses. Structures used to provide.sup- demonstrate that the costs associated
portive housing or supportive services with now s than construction ce csts associated
may also be used for other purposes, y
except that assistance under this part with.rehabilitation or that there is a
will be available only in proportion to. lack of available appropriate units that
the use of the structure for supportive could be rehabilitated at a cost less
housing or supportive services. than new construction. For purposes of
253
I
§683.11.5 ?A CFR Ch.V(4-1-09 Edition)
this cost comparison, costs associated services may be provided directly by
with rehabilitation or new construc- the recipient or by arrangement with
tion may include the cost of real prop- public or private service providers.
erty acquisition. (b) Supportive services costs. Costs as-
(b) .Amount. The ma dmum grant sociated with providing supportive
available for new construction is the services include salaries paid to pro-
lower of: viders of supportive services and any
(1)5400,000;or other costs directly associated with
(2) The total cost of the new con- providing such services. For a transi-
straction,including the cost of land as- tional housing project,supportive serv-
sociated with that construction, minus ices costs also include the costs of serv-
the applicant's contribution toward the ices provided to former residents of
cost of same. transitional housing to assist their ad-
justment to independent living. Such
§583.115 Grants for leasing. services may be provided for up to six
(a) General. HUD will provide grants months after they leave the transi-
to pay (as described in §583.130 of this tional housing facility.
part) for the actual costs of leasing a M FR,ISM,Mar.15,L993,as amended at 59
structure or structures,.or portions FR 36891,July 19,1994]
thereof, used to provide supportive
housing or supportive services for up to §583.125 .Grants for operating costs.
five years. (a) General. HUD will provide grants
0)(1)Leasing structures.Where grants to pay a portion (as described in
are used to pay rent for all or part of §583.130) of the actual operating costs
structures, the rent paid must be rea- of supportive housing for up to five
sonable in relation to rents being years.
charged in the area for comparable (b) Operating•costs. Operating costs
space. In addition. the rent paid may are those associated with the day-to-
not exceed rents currently being day operation of the supportive hous-
charged by the same owner for com- mg. They also include the actual ex-
parable space: penes that a recipient incurs for con-
(2) Leasing individual units. Where ducting on-going assessments of• the
grants are used to pay rent for indi- supportive services needed by residents
vidual housing units, the rent paid and the availability of such services;
must be reasonable in relation to-rents relocation assistance under§583.310,in-
being charged for comparable units, cluding payments and services; and in-
taking into account the location, size, surance.
type,quality,amenities, facilities,and (o)Recipient match requirement for op-
management services. In addition, the erating costs. Assistance for operating
rents may not exceed rents currently costs will be available for up to 75 per-
being charged by the same owner for cent of the total cost in each year of
comparable unassisted units, and the the grant term.The recipient must pay
portion of rents paid with grant funds the percentage of the actual operating
may not exceed HUD-determined fair costs not'fnnded by HUD.At the end of
market rents. Recipients may use each operating year,the recipient must
grant funds in an amount up to one demonstrate that it has met its match
month's rent to pay the non-recipient requirement of the costs for that year.
landlord for any damages to leased (56 FR 13871,Mar.15,1993.as amended at 61
units by homeless participants. FR 51175,Sept.30,1996;65 FR 30823,May 12,
[58 FR 13871,mar. 16,1999, as amended at 59 2000]
FR 36891,July 19,1994]
§583,130 Commitment of grant
§583.120 Grants for supportive serv- amounts for leasing, supportive
ices costs. services,and operating costs.
(a) General. HUD will provide grants Upon'exeeution of a grant agreement
to pay (as described in §5M.130 of this covering assistance for leasing, sup-
port)for the actual costs of supportive portive. services, or operating costs,
services for homeless persons:for np to HUD will obligate amounts for a period
five years.All or part of the supportive not to exceed five operating years.The
254
L
Oft.of Asst.Sect'.,Comm.Planning, Develop.,HUD,§583.t5Q
total amount obligated will be equal to HUD may advertise and competitively
an amount necessary for the specified select providers to deliver technical as-
years of operation, less the recipient's sistance. HUD may enter into con-
share of operating costs. tracts, grants, or cooperative agree-
(Approved by the Office of Management and meats, when necessary, to Implement
Budget under OMB control number 2506-0112) the technical assistance.
[59 PR 36891,July 19,1994] [59 FR 86692.July 19,19941
§583.135 dmimistrative costs. §583.145 Matching requirements.
(a) General.Up to five percent of any (a) General. The recipient must
grant awarded under this part.may be match the funds provided by HUD for
used for the purpose of paying costs of giants for acquisition, rehabilitation,
administering the assistance. and new construction with an equal
(b) Administrative costs_ Administra- amount of funds from other sources.
Live costs include the costs associated (b) Cash resources. The matching
with accounting for the use of grant funds must be cash resources provided
funds,preparing reports for submission to the project by one or more of the
to HUD, obtaining program audits, following: the recipient, the Federal
similar costs related to administering government, State and local govern-
the grant after the award,and staff sal- ments, and private resources, in ac-
aries associated with these administra- cordance with 42 U.S.C. 11386. This
tive costs. They do not include the statute provides that a recipient may
costs of caarying out eligible activities use funds from any source, including
under 0583.105 through 583.125. any other Federal source (but exclud-
[58 FR imn,Mar. 15,1993,as amended at 61 ing the specific statutory subtitle from
FR.51175,Sept.SO..19961 which Supportive Housing Program
funds are provided), as well as State,
§583.140 Technical assistance. local, and private sources, provided
(a) General.HUD may set aside funds that funds from the other source are
annually to provide technical assist- not statutorily prohibited to be used as
ance, either directly by HUD staff'or a match.It is the responsibility of the
indirectly through third-party pro- recipient to ensure that any funds used
viders, for. any supportive housing- to satisfy the matching requirements
project.This technical assistance is for of this section are eligible under the
the purpose of promoting the develop- laws governing the funds to be used as
meat of supportive housing and sup- matching funds for a grant awarded
under this program.
portive services as part of a continuum (c) Maintenance or effort. State or
of care approach, including innovative local government funds used in the
approaches to assist homeless persons. matching contribution are subject to
in the transition from homelessness. the maintenance of effort requirements
and promoting the provision of sup- described at§583.150(a).
portive housing to homeless persons to
enable them to live as independently as [58 FR.13871,Mar. 15, 1993,as amended at 73
possible. FR 75326,Dec.11,2fl08]
(b) Uses of technical assistance. HUD
may use these funds to provide tech- §583.150 Limitations on use of essist-
nical assistance to prospective appli- ate'
cants, applicants, recipients, or other (a) Maintenance of effort. No assist-
providers of supportive housing or serv-. ance provided under this part (or any
ices for homeless persons, for sup- State or local government funds used
portive housing projects. The assist- to supplement this assistance)may be
ance may include,but is not limited to, used to replace State or local funds
written information such as papers, previously used, or designated for use,
monographs, manuals, guides,and bro- to assist homeless persons.
chures; person-to-person exchanges; (b)Faith-based activities.(1)Organza-
and training and related costs. tions that are religious or faith-based
(c) Selection of providers. From time are eligible, on the same basis as any,
to time, as HUD determines.the need, other organization, to participate in
255
§583.155 24 CFR Ch.V(4-1-09 Edition)
the Supportive Housing.Program. Nei- herently religious activities. Program
ther the Federal government nor a funds may be used for the acquisition,
State or local government receiving construction, or rehabilitation of
funds under Supportive Housing pro- structures only to the extent that
grams shall discriminate against an or- those structures are used for con-
ganization on the basis of the organza- ducting eligible activities under this
tion's religious character or affiliation. part.Where a structure is used for both
(2) Organizations that are directly eligible and inherently religious activi-
funded under the Supportive Housing ties,program fund8 may not exceed the
Program'may not engage in inherently cost of those portions of the aoquist-
religious activities, such as worship, tion, construction, or rehabilitation
religious instruction, or proselytiza- that are attributable to eligible activi-
tion as part of the programs or services ties in accordance with the cost ac-
funded under this part. If an organize- counting requirements applicable to
tion conducts such activities, the ao- Supportive Housing Program funds in
tivities must be offered separately, in this paw. Sanctuaries, chapels, or
time or location, from the programs or other rooms that a Supportive Housing
services funded under this part, and Program-funded religious congregation
participation must be voluntary for the uses as its principal place of worship,
beneficiaries of the HUD-funded pro- however, are ineligible for Supportive
grams or services. Housing Program-funded improve-
(3)A religious organization that par- meets. Disposition of real property
ticipates in the Supportive Housing after the term of the grant, or any
Program will retain its independence change in use of the property during
from Federal, State, and local govern- the term of the grant,is subject to gov-
ments, and may continue to carty out ernment-wide regulations governing
its mission, including the definition, real property disposition (see 24 CFR
practice.and expression of its religious parts 84 and 85).
beliefs,provided that it does not use di- (6)If a State or local government vol-
rect Supportive' Housing Program untariiy contributes its own funds to
funds to support any inherently reli- supplement federally funded activities,
gioas activities,such as-worship, reli- the State or local government has the
gious instruction, or proselytization.. option to segregate the Federal funds
Among other things, faith-based orga- or commingle them. However, if the
nizations may use space in their facili- funds are oom -tingled, this section&13--
ties to provide Supportive Housing plies to all of the commingled funds.
Program-fended services, without re- (o)Participant control of site.Where an
moving religious art, icons, scriptures, applicant does not propose to.have con-
or other religious symbols.In addition, trol of a site or sites but rather pro-
• aSupportive lousing Program-ftanded dividual in obtaining.
bta a lease, which
Poses to assist a homeless family or in- •
religions organization retains its au- ining
thorny over its internal governance; - may include assistance with rent pay-
and it may retain religious terms in its meets and receiving supportive sere-
ices,after which time'the family or in-
organization's name, select its board
• in- dividual remains in. the same housing
members on a religious basis, and
clods religious references in its organ- that further assistance ender this
zation's mission statements and other Part, that applicant may not request
governing documents. assistance for acquisition, rehabilita-
(4)An organization that participates tion,or new construction.
in the Supportive Housing Program 158 FR 13871,Mar.15,1993,as amended at 59
shall not, in providing program assist- PR 36892,July 19,1993;68 FR 56407;Sept.30,
ante, discriminate against a program 20M)
beneficiary or prospective program $583.166 Consolidated plan
beneficiary on the basis of religion or
religious belief. (a) Applicants that are States or units
(5) Program funds may not be used of general local government. The appli-
for the acquisition,construction,or re- cant must have a HUD-approved com-
habilitation of structures to the extent plete or abbreviated consolidated plan,
that those structures are used for in- in accordance with 24 CFR part 91,and
256
1
Ofc.of Asst.Secy.,Goanm.Planning,Develop.,HUD §583.230
must submit a certification that the section 426 of the McKinney Act (42
application for funding is consistent U.S.C. 11386)and.the guidelines,rating
with the HUD-approved consolidated criteria, and procedures published in
plan.Funded applicants must certify in the NOFA.
a grant agreement that they are fol- [61 FR 51176,Sept.30,1M]
lowing the HUD-approved consolidated
plan. §585.230 Environmental review.
(b) Applicants that are not States or (a)Activities under this part are sub-
units of general local government. The ject to HUD environmental regulations
applicant must submit a certification in part 58 of this title,except that HUD
by the jurisdiction in which the pro- will perform an environmental review
posed project will be located that the in accordance with part 50 of this title
applicant's application for funding is prior to its approval, of any condi-
consistent with the jurisdiction's HUD- tionally selected applications for Fis-
approved consolidated plan. The cer- cal year 2000 and prior years that were
tification must be made by the unit of received directly from private non-
general local government or the State, profit entities and governmental enti-
in accordance with the consistency cer- ties with special or limited purpose
tification provisions of the consoli- powers. For activities under a grant
dated plan regulations, 24 CFR part 91. that generally would be subject to re-
subpart F. view under part 58, HUD may make a
(c)Indian tribes and the Insular Areas finding in accordance with§58.11(d)and
of Guam, thg U.S. Virgin Islands, Amer- may itself perform the environmental
ican Samoa, and the Northern Mariana review under the provisions. of part 50
Islands. These entities are not required of this title if the recipient objects in
to have a consolidated plan or to make writing to the responsible entity's per-
consolidated plan certifications.An ap- forming the review under part 58.Irre-
plication by an Indian tribe or other spective of whether the responsible en-
applicant foi a project that will be lo- tity in accord with part 58 (or HUD in
cated on a reservation of an Indian accord with part 50)performs the envi-
tribe will not require a certification by ronmental review, the recipient shall
the tribe or.the State. However,where• supply all available, relevant informs-
an Indian tribe is•.the applicant for a Lion necessary for the responsible enti-
project that will not be located on a ty (or HUD, if applicable) to perform
reservation,-the requirement for a cer- for each property any environmental
tification under paragraph (b) of this review required by this part. The re-
section will apply. cipient also shall carry out mitigating
(d) Timing of consolidated plan certifi- measures required by the responsible
cation submissions. Unless otherwise set entity(or HUD,if applicable)or select
forth in the NOFA,the required certifi- alternate eligible property. HUD may
cation that the application for funding eliminate from consideration-any ap-
is consistent with the HUD-approved plication that would require an Envi-
consolidated plan must be submitted ronmental Impact Statement(EIS).
by the funding application submission (b)The recipient,its project partners
deadline announced in the NOFA. and.their contractors may not.acquire,
rehabilitate,convert,lease,repair,dis-
[60 FR 16380,Mar.30,19951 pose of,demolish or construct property
for a project under this part, or com-
Subpart C Appliccdion and Grant mit or expend HUD or local funds for
Award Process such eligible activities under this part,
antil the responsible entity (as defined
§583.200 Applicatioxi and grant awar(L in§58.2 of this title)has completed the
When funds are made available for 'environmental review procedures re-
assistance, HUD will publish a notice quired by part 58 and the environ-
of funding availability (NOVA) in the mental certification and RROF have
FEDERAL RMISTm, in accordance with been approved or HUD has performed
the requirements of 24 CFR part 4.HUD an environmental review under part 50
will review and screen applications in and the recipient has received HUD ap-
aceordance with the requirements in proval of the property. HUD will not
257
r
§583.235 24 CFR Ch.V(e1-1-09 Edlfion)
release grant funds if the recipient or ably slow expenditure of funds, or the
any other party commits grant funds recipient has been unsuccessful in as-
(i.e., incurs any costs or expenditures sisting participants in achieving and
to be paid or reimbursed with such maintaining independent living. In de-
funds)before the recipient submits and -termining the recipient's success in as-
HUD approves its RROF (where such sisting participants to achieve and
submission is required). maintain independent living, consider-
j68 FR 56131,Sept 29,20031 ation will be given to the level and
type of problems of participants. For
§583.235 Renewal grants. recipients with a poor record of sus
cess,HUD-will also consider the tecipi-
(a) General. Grants made under this ent's willingness to accept technical
part, and grants made under subtitles assistance and to make changes su.g-
0 and D(the Supportive Hoasing Dem- gested by technical assistance pro-
onstration and SAFAH,respectively)of eiders. Other factors which will affect
the Stewart R.McKinney homeless As- HUD's decision to approve a renewal
sistance Act as in effect before October request include the following: a con-
26, 1992, may be renewed on a non- tinning history of inadequate financial
competitive basis to continue ongoing management accounting practices, in-
leasing, operations, and supportive dications of mismanagement on the
services for additional years beyond part of the recipient, a drastic reduc-
the initial funding period. To be con- tion in the population served by the re-
sidered for renewal funding for leasing, cipient, program changes made by the
operating costs, or supportive services, recipient without prior HUD appf oval,
recipients must submit a request for and loss.of project site.
such funding in the form specified by (2)HUD reserves the right to reject a
HUD, must meet the requirements of request from any organization with an
this part, and must submit requests outstanding obligation to HUD that is
within the time period established by in arrears or for which a payment
HUD. schedule has not been agreed to, or
(b) Assistance available. The first re- whose response to an audit finding is
newal will be for a period of time not overdue or unsatisfactory.
to exceed the difference between the (3) HUD will notify the recipient in
end of the,initial funding period and writing that the request has been ap-
ten years from the date of initial oceu- proved or disapproved.
panoy or the date of initial service pro-
vision, as applicable. Any subsequent (Approved by the Office of Management and
renewal wilfbe for a period of time not Budget under control number 2506-0112)
to exceed five years. Assistance during
each year of the renewal period, sub- Subpart D—Program Requirements
Jett to maintenance of effort require-
ments under§583.150(a)may be for:
(i)Up to 50 percent of the actual op- (a)State and local requirements. Each
erating and.leasing costs in the final recipient of assistance under this part
year of the initial funding period; must provide-housing or services that
(2) Up to the amount of HUD assist- are in compliance with all applicable
ante for supportive services in the final State and local housing codes, licens-
year of the initial funding period;and ing requirements, and any other re
(3)An allowance for cost increases. quirements in the jurisdiction in which
(c) HUD review. (1) HUD will review the project is located regarding the
the request for renewal and will evalu- condition of the structure and the op-
ate the recipient's performance in pre- emtion of the housing or services.
vious years against the plans and goals (b) Habitability standards. Except for
established in the initial application such variations as are proposed by the
for assistance, as amended. HUD will recipient and approved by HUD, sup-
approve the request for renewal unless portive housing must meet the fol-
the recipient proposes to serve a popu- lowing requirements:
lation that is not homeless, or the re- (1)Structure and materials.The strue-
cipient has not shown adequate tares must be structurally sound so as
progress as evidenced by an unaecept- not to pose any threat to the health
258
ofc.of Asst.Secy.,CbmrrL Planning,Develop.,HUD §583.300
and safety of the occupants and so as for hearing-impaired persons in each
to protect the residents from the ele- bedroom occupied by a hearing-im-
ments. paired person.
(2)Access.The housing must be acces- (ii) The public areas of all housing
sible and capable of being utilized _must be equipped with a sufficient
without unauthorized use of other pri- number,but not less.than one for each
vate properties_ Structures must pro- area,of battery-operated or hard-wired
vide alternate means of egress in case smoke detectors. Public areas include,
of fire. but are not limited to,laundry rooms,
(3) Space and security. Each resident community rooms, day care centers,
must be afforded adequate space and hallways, stairwells; and other com-
security for themselves and their be- mon areas.
longings. Each resident must be pro- (c) Meals. Each recipient of assist-
vided an acceptable place to sleep. ance under this part who provides sup-
(4).interior air quality.Every room or portive housing for homeless persons
space must be provided with natural or with disabilities must provide meals or
mechanical ventilation. Structures meal preparation facilities for resi-
must be free of pollutants in the air at dents.
levels that threaten the health of resi- (d) Ongoing assessment of supportive
dents. services. Each recipient of assistance
(5) Water supply. The water supply under this part must conduct an ongo-
must be free from contamination. ing assessment of the supportive serv-
(6) Sanitary facilities. Residents must ices required by the residents of the
have access to sufficient sanitary fa- project and the availability of such
cilities that are in proper operating services, and make adjustments as ap-
condition, may be used in privacy,and propriate.
are adequate for personal cleanliness (e) Residential supervision. Each re-
and the disposal of human waste. cipient of assistance under this part
(7) Thermal environment. The housing must provide residential supervision as
mint have adequate heating and/or necessary to facilitate the adequate
cooling facilities in proper operating provision of supportive services to the
condition. residents of the .housing-throughout
(8) Illuminaiton. and. electricity. The the term of the commitment to operate
housing must have adequate natural or supportive housing. Residential super-
artificial illumination to permit nor- vision may include the employment of
mal indoor activities and to support a hill- or part-time residential super-
the health and safety of residents. Suf- visor with sufficient knowledge to pro-
ficient electrical sources must be pro- vide or to supervise the provision of
vided to permit use of essential elec-
trical appliances while assuring safety
from fire. (f)Participation of homeless persons.(1)
(9) Food preparation and refuse dis- Each recipient must provide for the
posal. All food preparation areas must participation of homeless persons as re-
contain suitable space and equipment qui.red in section 426(g) of the McSin-
to store, prepare, and serve food in a ney Act (42 U.S.C.,11386(g)). This re-
sanitary manner. quirement is waived if an applicant is
(10) Sanitary condition. The housing unable to meet it and presents a plan
and any equipment must be maintained for HUD approval to.otherwise consult
in sanitary condition. with homeless or formerly homeless
(11)Fire safety. (i)-Each unit must in- persons in considering and making
elude at least one battery-operated or policies and decisions. See also
hard-wired smoke detector, in proper §583•330(e)•
working condition, on each occupied (2)Each recipient of assistance under
level of the unit. Smoke detectors this part must,to the maximum.extent
must be located, to the extent prac- practicable, involve'homeless individ-
ticable,in a hallway adjacent to a bed- uals and families, -through employ-
room. If the unit is occupied by hear- ment, volunteer services,or otherwise,
ing-impaired persons, smoke detectors in contracting, rehabilitating, main-
must have an alarm system designed taining, and operating the project and
•259
§583.305 24 CFR Ch.V(4-1-09 Edition)
in providing supportive services for the less individuals or families remain in
project. that project longer than 24 months.
(g)Records and reports.Each recipient (k) Outpatient health services. Out-
of assistance under this part must keep patient health services provided by the
any records and make'any reports (in- recipient.must be approved as appro-
eluding those pertainiug to race, eth- priate by HUD and the Department of
nioity, gender, and disability status Health and Human Services (HHS).
data)that HUD may require within the Upon receipt of an application that
timeframe required. proposes the provision of outpatient
(h) Confidentiality., .Each recipient health services,HUD will consult with
that provides family violence preven- HHS with respect to the appropriate-
tion or treatment services must de- ness of the proposed services.
velop and implement procedures to en- (1)Annual assurances. Recipients who
sure: receive assistance only for leasing, op-
(1)The confidentiality of records per- emting costs or supportive services
taining to any individual services; and costs must provide an annual assur-
(2) 'That the address or location of ante for each year such assistance is
any project assisted will not be*made received that the project will be oper-
public, except with written authoriza- ated for the purpose specified in the ap-
tion of the person or persons respon- plccation.
sible for the operation of the project. (Approved by the Office of Management and
(i) Termination of housing assistance. Budget under control number 2506-0112)
The recipient may terminate assist- [56 FR 13671,Max.15,1993,as amended at 59
ance to a participant who violates pro- FR 36892,July 0.1994;61 FR 51176,Sept.30,
gram requirements. Recipients should
terminate assistance only in the most
severe cases. Recipients may resume $583.305 Term of commitment; repay-
assistance to a participant whose as- ment of grants;prevention of undue
sistance was previously terminated. In benefits.
terminating assistance to a partici- (a)Term of commitment and conversion.
pant, the recipient must provide a for- Recipients must agree to operate the
=1 process that recognizes the rights housing or provide supportive services
of individuals receiving assistance-to in accordance with this part and with
due process of law. This process, at a sections 423 (b)(1) and (b)(3) of the
minimum,must consist of: McKinney Act (42 U.S.C. 11383(b)(1),
(1) Written notice to the participant 11383(10(3)).
containing a clear statement of the (b)Repayment of grant and prevention
reasons for termination; of undue benefits. In accordance with
(2)A review of the decision, in which section 423(c) of the McKinney Act (42
the participant is given the oppor- U.S.C. 11383(c)), HUD will require re-
tunity to present written or oral objet- cipients to repay the grant unless HUD
tions before a person other than the has authorized conversion of the
person(or a subordinate of that person) project under section 423(b)(3) of the
who made or approved.the termination McKinney Act(42 U.S.C.11383(b)(3)).
decision;and
(3)Prompt written notice of the final (61 FR.51176.Sept.3D,19961
decision to the participant. §583.310 Displacement,relocation,and
(j) Limitation of stay in transitional acquisition.
housing. A homeless individual or fam-
ily may remain in transitional housing (a) Minimizing displacement. Con-
for a period longer than 24 months, if sistent with the other goals and objee-
permanent housing for the individual tives of this part, recipients must as-
or family has not been located or if the sure that they have taken all reason-
individual or family'requires addi- able steps to minimize the displace-
tional time to prepare for independent ment of persons (families, individuals,
living. However, HUD may discontinue businesses, nonprofit organizations,
assistance for a transitional housing and farms) as a result of supportive
project if more than half of the home- housing assisted under this part.
260
Ofc.of Asst.Secy.,Comm.Planning,Develop.,HUD §583.310
(b) Relocation assistance for displaced part. The term "displaced person" in-
persons. A displaced person (defined in eludes,but may not be limited to_
paragraph (f) of this section) must be (i)A person that moves permanently
provided relocation. assistance at the from the real property after the prop-
levels described in, and in accordance erty owner(or person in control of the
with, the requirements of the Uniform site) issues a vacate notice, or refuses
Relocation Assistance and Real Prop- to renew an expiring lease in order to
erty Acquisition Policies Act of 1970 evade the responsibility to provide re-
(VRA) (42 U-SX. 4501-4656) and imple- location assistance,if the move occurs
menting regulations at 49 CFR part 24. on or after the date the recipient sub-
(c) Read property acquisition require- wits to HUD the application or appli-
ments. The acquisition of real property cation amendment designating the
for supportive housing is subject to the project site.
URA and the requirements described in (ii) Any person, including a person
49 CFR part 24,subpart B. who moves before the date described in
(d) Responsibility of recipient. (1) The paragraph(f)(1)(i)of this section,if the
recipient must certify (i.e., provide as- recipient or HUD determines that the
surance of compliance) that it will displacement resulted directly from ao-
comply with the URA, the regulations quisition,rehabilitation, or demolition
at 49 CPR part 24,and the requirements for the assisted project.
of this section, and must ensure such (iii) A tenant-occupant of a dwelling
compliance notwithstanding any third unit who moves permanently from the
party's contractual obligation to the building/complex on or after the date of
recipient to comply With these provi- the "initiation of negotiations" (see
sions
(2)The cost of required relocation as- paragraph (g) of this section) if the
move occurs before the tenant has been
sistance is an eligible project cost in
the same manner and to the same•es- provided written notice offering him or .
tent as other project costs. Such costs her the opportunity to lease and oc-
also may be paid for with local public copy a suitable, decent, safe and sani-
funds or funds available from other tai'y dwelling in the same building/
sources. complex, under reasonable terms and
conditions
(3) The recipient must maintain ; upon completion of the
records in sufficient detail to dem- project. Such reasonable terms and
onstrate compliance with provisions of conditions must include a monthly
this section. rent and estimated average, monthly
(e) Appeals. A person who disagrees utility costs that do not exceed the
with the recipient's determination.con- greater
cerning whether the person qualifies as (A)The tenant's monthly rent before
a"displaced person," or the amount of the initiation'of negotiations and esti-
relocation assistance for which the per- mated average utility costs,or
son is eligible, may file a written ap- (B) 30 percent of gross household in
peal of that determination with there- come. If the initial rent is at or near
oipient. A low-income person who is the maximum, there must be a reason-
dissatisfied with the recipient's deter- able basis for concluding at the time
mination on his or her appeal may sub- the project is initiated that future rent
mit a written request for review of that increases will be modest.
determination to the SUD field office. (iv)A tenant of a dwelling who is re,
(f) Definition of displaced person. (1) quired to relocate temporarily, but
For purposes of this section, the term does not return to the building/com-
"displaced person" means a person plez,if either_
(family, individual, business, nonprofit (A) A tenant is not offered payment
organization,or farm)that moves from for all reasonable out-of-pocket ex-
real property, or moves personal prop- penes incurred in connection with the
erty from real property permanently as. temporary relocation,or
a direct result of acquisition, rehabili- (B) Other conditions of the tem-
tat#on, or demolition for supportive orary relocation are not reasonable.
housing projects assisted under this p
• Zfil
§583.315 24 CFR Ch.V(4^1-09 Edition)
(v)A tenant of a dwelling who moves of the agreement between the recipient
from the building/complex perma- and HUD.
nently after he or she has been re- (h)Definition of project. For purposes
quired to move to another unit in the of this section, the term "project"
same building/complex,if either: means an undertaking paid for in
(A) The tenant is not offered reim- whole or in part with.assistanoe under
bursement for all reasonable out-of- this part. Two or more activities that
pocket expenses incurred in connection are integrally related,each essential to
with the move;or the- others, are considered a single
(B) Other conditions of the move are project, whether or not all component
not reasonable. activities receive assistance under this
(2)Notwithstanding the provisions of Part.
paragraph (f)(1) of this section, a per- [58 FR 15871,Mar.15,1993,as amended at 59
son does not qualify as a "displaced FR 36692,Julp,19,19941
person" (and is not eligible for reloca-
tion assistance under the URA or this §583.315 Resident rent.
section),if: (a) Calculation of resident rent. Each
(i)The person has been evicted for se- resident of supportive housing may be
rious or repeated violation of the terms required to pay as rent an amount de-
and conditions of the-lease or oceu- termined by the recipient which may
panty agreement, violation of applica- not exceed the highest of:
ble Federal, State, or local or tribal (1)30 percent of the family's monthly
law,or other good cause, and HUD de- adjusted income (adjustment factors
termines that the eviction was not un- include the number of people in the
dertaken for the purpose of evading the family,age of family members,medical
obligation to provide'relocation assist- expenses and child care expenses). The
ante; calculation of the family's monthly ad-
(ii) The person moved into the prop- jested income must include the ex-
erty after the submission of the appli- pense deductions provided in 24 OFR
cation an before signing a lease and 5.611(a), and for persons with disabil-
commencing occupancy, was provided ities, the calculation of the family's
written notice of the project, its pos- monthly adjusted income also must in.-
sible impact on the: person (e.g.; the elude the-disallowance of earned in-
person may be displaced, temporarily come as provided in 24 CFR 5.617,if ap-
relocated,or suffer a rent increase)and plicable;
the fact -that the person would not (2)10 percent of the family's monthly
qualify as a "displaced person" (or for gross income;or
any assistance provided under this sec- (3) If the family is receiving pay-
tion)',if the project is approved; meats for welfare assistance from a
(iii)The person is ineligible under 49 public agency and a part of the pay-
CPR 24.2(8)(2);or ments.adjusted in accordance with the
(iv) HUD determines that the person family's actual housing costs, is spe-
was not displaced as a direct result of cifically designated by the agency to
acquisition,'rehabilitation, or demoli- meet the family's housing costs, the
tion for the project. portion of the payment that is des-
(3)The recipient may request,at any ignated for housing costs.
time, HUD's determination of whether (b) Use of rent.Resident rent may be
a displacement is or would be covered used in the operation of the project or
under this section. may be reserved,in whole or in part,to
(g) Definition of initiation of negotia- assist residents of transitional housing
tions. For purposes of determining the in moving to permanent housing.
formula for computing the replacement addition
re o rent,
cipie s may chargeres dents ea-
housing assistance to be provided to a
residential tenant displaced as a direct sonable.fees for services not paid with
result of privately undertaken rehabili- grant ids•
tatibn, demolition, or acquisition of [56 FR,13671,Mar.15,1993,as amended at 59
the real property, the term "initiation Fn=92, July 19, 1934; 66 FR 6225. Jan. 19,
of negotiations" means the execution 20011
262
Ofc.of Asst.Secy.,Comm.Planning,Develop.,HUD §583.325
§583.320 Site controL ignated populations of disabled home-
(a)Site control. (1)Where grant funds less persons, recipients serving a des-
will be used for acquisition,rehabilita- ignated population of disabled home-
tion, or new construction to provide less persons are required, within the
supportive housing or supportive sere- designated population, to comply with
ices, or where grant fends will be used these requirements for nondiscrimina-
for operating costs of supportive hoes- tion on the basis of race, color, reli-
gion,or where grant funds will be used gion,sex,national origin.age;familial
lui
to provide supportive services except status,and disability.
where an applicant will provide sere- (b)Nondiscrimination and equal opioor-
ices at sites not operated by the appli- tunity requirements. The nondisarimina-
cant, an applicant must demonstrate Lion and equal opportunity require-
site control before HUD will execute a meats set forth at.part b of this title
grant agreement (e.g., through a deed, apply to this program.The Indian Civil
lease, executed contract of sale). If Rights Act (25 U.S.C. 1301 et seq.) ap-
such site control is not demonstrated plies to tribes when they exercise their
within one year after initial notifica- powers of self-government, and to In-
tion of the award of assistance under dian.housing authorities (1HAs) when
this part, the grant will be deobltgated established by the exercise of such
as,provided in paragraph(c)of this sec- powers. When an IRA is established
tion. under State, law, the applicability of
(2)Where grant funds will be used to the Indian Civil Rights Act will be de-
lease all or part of a structure to pro- termined on a case-by-case basis.
vide supportive housing or supportive Projects subject to the Indian Civil
services, or where grant funds will be Rights Act must be developed and oper-
used to lease individual housing units ated in compliance with its provisions
for homeless persons who will eventu- and all implementing HUD require-
ally control the units,site control need ments,instead of title VI and the Fair
not be demonstrated. Housing Act and their implementing
(b) Site change. (1) A recipient may regulations.
obtain ownership or control of a suit- (e) Procedures. (1) If the procedures
able site different from the one speci- that the recipient intends to use to
fied in its application. Retention of an make known the availability of the
assistance award is subject to the new supportive housing are unli kely to
site's meeting all requirements under reach persons of any particular race,
this part for suitable sites. color, religion, sex, age, national ori-
(2) If the acquisition, rehabilitation, gin, familial status, or handicap who
acquisition and rehabilitation, or new may qualify for admission to the hous-
construetion costs for the substitute ing, the recipient must establish addi-
site.are greater than the amount of'the tional procedures that will ensure that
grant awarded for the site specified in such persons can obtain information
the application, the recipient must pro- concerning availability of the housing.
vide for all additional costs. If the re- (2) The recipient must adopt proce-
cipient is unable to demonstrate -to. dures to make available Information
HUD that it is able to provide for the on the existence and locations of faeili-
difference in costs, HIID may ties and services that are accessible to
deobligate the award of assistance. persons with a handicap and maintain
(c) Failure to obtain site control within evidence of implementation of the pro-
one year. HUD will recapture ' or ' cedures.
deobligate any award for assistance (d) Accessibility requirements. The re-
under this part if the recipient is not in cipient must comply with the new con-
control of a suitable site before the ex- struction accessibility requirements of
piration of one year after initial notifi- the Fair Rousing Act and section 504 of
cation of an award. the Rehabilitation Act of 1973,and the
reasonable accommodation and reha-
§588.325 Nondiscrimination and equal bilitation accessibility requirements of
opportunity requirements. section 504 as follows:
(a) General. Notwithstanding the per- (1) All new construction must meet
missibility of proposals that serve des- the accessibility requirements of 24
263
§583-M 24 CFR Ch.V(4-1-09 Edltlon)
CFR 8.22 and, as applicable, 24 CFR cular Nos. A-110 (Grants and Coopera-
100.205. tive Agreements with Institutions of
(2) Projects in which costs of reha- Higher Education,Hospitals,and Other
bilitation are 75 percent or.more of the Nonprofit .Organizations) and A-122
replacement cost of the building must (Cost Principles Applicable to Grants,
meet the requirements of•24 CFR Contracts and Other Agreements with
8.23(x). Other rehabilitation must meet Nonprofit Institutions)apply to the ao-
the requirements of 24 CFR 8.23(b). ceptance and use of assistance by pri-
[5B FR 13671, Mar.15, 1993, as amended at 59 vats nonprofit organizations. except
FR 33894, June 3o, 1994. 61 FR M o. Feb.9, where inconsistent with the provisions
1996:61 FR 51176.Sept.30,19961 of the McKinney Act, other Federal
statutes, or this part. (Copies of OMB
§583.380 Applicability of other Federal Circulars may be obtained from E.O.P.
requirements. Pablications,room 2200,New Executive
In addition to the requirements set Office Building, Washington, DC 20503,
forth in 24 CFR part 5.use of assistance telephone (202) 395--7332. (This is not a
provided under this part must comply toll-free number.) There is a limit of
with the following Federal require- two free copies.
menu: (d) Lead-based paint. The Lead-Based
(a)Flood insurance. (1)The Flood Dis- Paint Poisoning Prevention Act (42
aster Protection Act of 1973 (42 U.S.C. U.S.C. 4821-4846), the Residential Lead-
4001-1128) prohibits the approval of ap- Based Paint Hazard Redaction Act of
plications for assistance for acquisition 1992 (42 U.S.C. 4851-4856), and imple-
or construction (including rehabilita- menting regulations at part 35, sub-
tion)for supportive housing located in parts A, B. J, S, and R of this title
an area identified by the Federal Emer- apply to.activities under this program.
gency Management Agency (FNMA)as (e) Conflicts of interest. (1)In addition
having special flood hazards,unless: to the conflict of interest requirements
(i1 The community in which the area in 24 CFR part 85, no person who is an
is situated is participating in the Na- employee,agent,consultant,officer,or
tional Flood Insurance Program(see 44 elected or appointed official of the re-
CFR parts 59 through 79), or less than cipient and who exercises or has exer-
a year has passed since-FEMA notifica- -cased any functions or responsibilities
tion regarding such hazards;and with respect to assisted activities, or
(ii) Flood insurance is obtained as a who is in a position to participate in a
condition of approval of the applioa- decisionmaking process or gain inside
tion. . information with regard to such activi-
(2) Applicants with supportive hoes- ties,may obtain a personal or financial
ing located in an area identified by interest or benefit from the activity,or
FFdbIA as having special flood hazards have an interest in any contract, sub-
and receiving assistance for acquisition contract, or agreement with respect
or construction (including rehabilita- thereto,or the proceeds thereunder,ei-
tion) are responsible for assuring that ther for himself or herself or for those
flood insurance under the National with whom he or she has family or
Flood Insurance Program is obtained business ties, during his or her tenure
and maintained, or for one year thereafter. Participa-
(b) The Coastal Earrier Resources tion by homeless individuals who also
Act of 1982 (16 U.S.C. 3501 et seq.) may are participants under the program in
apply to proposals under this part, de- policy of decisionmaking under
pending on the assistance requested. §583.300(f) does not constitute a con-
(o)Applicability of OMB Circulars. The flict of interest.
policies, guidelines, and requirements (2) Upon the written request of the
of OMB Circular No. A-87 (Cost Prin- recipient,HUD may grant an exception
ciples Applicable to Grants, Contracts to the provisions of paragraph (e)(1)of
and Other Agreements with State and this sectidn on a case-by-case basis
Local Governments)and 24 CFR part 85 when it determines that the exception
apply to the award, acceptance, and will serve•to further the purposes of
use of assistance under the program by the program and the effective and effi-
governmental entities, and OMB Cir- - cient administration of the recipient's
264
Ofd.of Asst.Secy.,Comm.Planting,Develop.,HUD §583.405
project. An exception may be consid- (g) Davis-Bacon Act. The provisions
Bred only after the recipient has pro- of the Davis Bacon Act do not apply to
vided the following: this program.
(f) For States and other govern- [58 FR 13871,Mar.15,1993.as amended at 61
mental entities,a disclosure of the na- 1� 11
5 , Feb..9, 1996; 64.FR 50226. Sept. 15,
ture of the conflict,accompanied by an 1999]
assurance that there has been public
disclosure of the conflict and a descrip- Subpart E—Administration
tion of how the public disclosure was
made;and §583.400 Grant agreement.
(11) For all recipients, an opinion of (a)General.The duty to provide sup-
the recipient's attorney that the inter-
est for which the exception is sought portive housing or supportive services in would not violate State or local law. accordance with the requirements of
(3)In determining whether to grant a this part will be incorporated in a
requested exception after the recipient grant agreement executed by HUD and
has satisfactorily met the requirement the recipient.
HUD (b)Enforcement. HUD will enforce the
of paragraph(e)(2)of this section,
obligations in the grant agreement
will consider the cumulative effect of
the following factors,where applicable: through such action as may be appro-
(i)Whether the exception would pro- p�'�' inoluding repayment of fends
vide a significant cost benefit or an es- that have already been disbursed to the
recipient.
sential degree of expertise to the
project which would otherwise not be §553.405 Program changes.
available; (a)HUD approval. (1)A recipient may
(ii) Whether the person affected is a not make any significant changes to an
member of a group or class of eligible
persons and the exception will permit approved program without prior UM"
such person to receive generally the approval. Significant changes include,
same interests or benefits as are being but are not limited to, a change in the
made..available or. provided to the recipient,a change in the project site,
group or class; additions or deletions in the types of
(iii) Whether the affected person has activities listed in§583.100 of this part
withdrawn from his or her functions or approved for the program or a shift of
responsibilities, or the decisionmaking more than 10 percent of funds from one
process with respect to the specific as- approved type of activity to another,
sisted activity in question; and a change in the category of partiei-
(iv) Whether the interest or benefit pants to be served. Depending on the
was present before the affected person nature of the change,HUD may require
was in a position as described in para-
a new certification of consistency with
graph(e)(1)of this section; the consolidated plan(see§588.155).
(v) Whether undue hardship will re- (a) Approval for changes is contin-
sult either to the recipient or the per- gent upon the application ranking re-
son affected when weighed against the mai.ning high enough after the ap-
publio interest served by avoiding the proved change to have been competi-
prohibited conflict;and tively selected for funding in the year
the application was selected.
(vi) Any other relevant consider- (b) Documentation of other changes.
ations. Any changes to an approved program
(f) Audit. The financial management that do not require prior HUD approval
systems used by recipients under this must be fully documented in the recipi-
program must provide for audits in ac- ent's records.
cordance with 24 CFR part 44 or part 45,
as applicable. HUD may perform or re- [58 FR 13871,Mar.15,1993,as amended at 61
quire additional audits es it finds nec- FR 5ll76,Sept.$0.1996]
essary or appropriate.
265
§583A10 24 CFR Ch..V(4-1-09 Edition)
j 583.410 Obligation and deobligation
of funds.
(a)Obligation of funds.When HUD and
the applicant execute a grant agree-
ment, funds are obligated to cover the
amount of the approved assistance
under subpart B of this part. The re-
cipient will be expected to carry out
the supportive housing or supportive
services activities as proposed in the
application.
(b) Increases. After the initial obliga-
tion of funds,HUD will not make revi-
sions to increase the amount obligated.
(c) Deobligation. (1) HUD may
deobligate all or parts of grants for ac-
quisition, rehabilitation, acquisition
and rehabilitation, or new construc-
tion:
(i)If the actual total cost of acquisi-
tion,rehabilitation,acquisition and re-
habilitation, or new construction is
less than the total cost anticipated in
the application;or
(ii) If proposed activities for which
funding was approved are not begun
within three months or residents do
not begin to occupy the facility within
nine months after grant execution.
(2)HUD may deobligate the amounts
for annual leasing costs, operating
costs or supportive services in any
year:
(i) If the actual leasing costs, oper-
ating costs or supportive services for
that year are less than the total cost
anticipated in the application;or
(11) If the proposed supportive hous-
ing operations are not begun within
three months after the units are avail-
able for occupancy.
(3) The grant agreement may set
forth in detail other circumstances
under which funds may be deobligated,
and other sanctions may be imposed.
'(4)HUD may:. ,
(1) Readvertise the availability of
funds that have been deobligated under
this section in a notice of fiend avail-
ability under§583.200,or
(ii)Award deobligated funds to appli-
cations previously submitted in re-
sponse to the most recently published
notice of fund availability, and in ac-
cordance with subpart C of this part.
266
The 2071 Amendments to the Codified
SHP Regulation Billing Code 4210-67
a combination and sequence of special,
interdisciplinary,or generic services,
6. The authority citation for 24 CFR individualized supports,or other forms of
part 583 continues to read as follows: assistance that are of lifelong or extended
duration and are individually planned and
Authority:42 U.S.C.3535(d)and coordinated.
11389• (2)An individual from birth to age 9,
inclusive,who has a substantial
7.In§583.5,the definitions of developmental delay or specific congenital
"Disability"and"Homeless person"are or acquired condition,may be considered to
removed and the definitions of"Disability," have a developmental disability without'
"Developmental disability,"and"Homeless" meeting three or more of the criteria
are added to read as follows: described in paragraphs(1)(i)through(v)of
the definition of"developmental disability"
583.5 Definiti®ns. in this section if the individual,without
services and supports,has a high probability
of meeting those criteria later in life.
Developmental disability means,as
defined in section 102 of the.Developmental
Disabilities Assistance and Bill of Rights Disability means:
Act of 2000(42 U.S.C. 15002):
(1) A condition that:
(1)A severe,_chronic disability of an
individual that (i)Is expected to be long-continuing
or of indefinite duration;
(i)Is attributable to a mental or
physical impairment or combination of (ii)Substantially impedes the
mental and physical impairments; individual's ability to live independently;
Is manifested before the (iii)Could be improved by the
(ii.)
individual attains age 22; provision of more suitable housing
conditions;and
(iii)Is likely to continue indefinitely',
(iv)Is a physical,mental,or
(iv)Results in substantial functional emotional impairment,including an
limitations in three or more of the following impairment caused by alcohol or drug abuse,
areas of major life activity: post-traumatic stress disorder,or brain
(A)Self-care; injury,
(B)Receptive and expressive (2)A developmental disability,as
language;
defined in this section;or
(C)Learning, (3)The disease of acquired
immunodeficiency syndrome(AIDS)or any
(D)Mobility; conditions arising from the etiologic agent
(E)Self-direction; for acquired immunodeficiency syndrome,
including infection with the human
(k)Capacity for independent living;
immunodeficiency virus(HIS.
(G)Economic self-sufficiency, and
(v)Reflects the individual's need for
2
Homeless means: (i)Are defined as homeless under
(1)An individual or family who section 387 of the Runaway and Homeless
regular,and adequate Youth Act(42 U.S.C. 5732a),section 637 of
lacks a fixed, gu the Head Start Act(42 U.S.C.9832),section
nighttime residence,meaning: 41403 of the Violence Against'Women Act
(i)An individual or family with a of 1994(42 U.S.C. 14043e-2),section
primary nighttime residence that is a public 330(h)of the Public Health Service Act(42
or private place not designed for or U.S.C.254b(h)),section 3 of the Food and
ordinarily used as a regular sleeping Nutrition Act of 2008(7 U.S.C.- 2012),
accommodation for human beings,including section 17(b)of the Child Nutrition Act of
a.car,park, abandoned building,bus or train 1966(42 U.S.C. 1786(b)),or section 725 of
station,airport,or camping ground; the.NlcKmney--Vento Homeless Assistance
(ii)An individual or family living in Act(42 U.S.C. 11434a);
a supervised publicly or privately operated. (ii)Have not had a lease,ownership
shelter designated to provide temporary interest,or occupancy agreement in
living arrangements(including congregate permanent housing at any time during the 60
shelters,transitional housing,and hotels and days immediately preceding the date of
motels paid for by charitable organizations application for homeless assistance;
or by federal,state,or local government (iii)Have experienced persistent
programs for low-income individuals);or instability as measured by two moves or
(iii)An individual who is exiting an more during the 60-day period immediately
institution where he or she resided for 90 preceding the date of applying for homeless
days or less and who resided in an assistance;and
emergency shelter or place not meant for (iv)'Can be expected to continue in
human habitation immediately before such status for an extended period of time
entering that institution; . because of chronic disabilities,chronic
(2)An individual or family who will physical health or mental health conditions,
imminently lose their primary nighttime substance addiction,histories of domestic
residence,provided that: violence or childhood abuse(including
(i)The primary nighttime residence neglect),the presence of a child or youth
will be lost within 14 days of the date of with a disability,or two or more barriers to
application for homeless assistance; employment,which include the lack of a
high school degree or General Education
(ii)No subsequent residence has Development(GED),illiteracy,low English
been identified;and - proficiency,a history of incarceration or
cks detention for criminal activity,and a history
(iii)The individual or family la, unstable employment;or
the resources or support networks, e.g.,
family,friends,faith-_based or other social (4)Any individual or family who:
networks,needed to obtain other permanent (i)Is fleeing,or is attempting to flee,
housing; domestic violence,dating violence,sexual
(3)Unaccompanied youth under 25 assault,stalking,or other dangerous or life-
years of age, or families with children and threatening conditions that relate to violence
youth,who do not otherwise qualify as against the individual or a family member,
homeless under this definition,but who: including a child,that has either taken place
3
within the individual's or family's primary entry,and the change made; and if the
nighttime residence or has made the KNITS prevents overrides or changes of the
individual or family afraid to return to their dates on which entries are made.
primary nighttime residence; (1)If the individual or family
(ii)Has no other residence;and qualifies as homeless under paragraph(1)(i)
Lacks the resources or support or(ii)of the homeless definition in§ 583.5,
(iii) acceptable evidence includes a written
networks,e.g.,family,friends,and faith- observation by an outreach worker of the
based or other social networks,_to obtain conditions where the individual or family
other permanent housing. was living,a written referral by another
housing or service.provider,or a
8.A new§ 583.301 is added to read certification by the individual or head of
as follows: household seeking assistance.
§583.301 Recordkeep ng. (2)If the individual qualifies as
homeless under.paragraph(1)(iii)of the
a Reserved.] homeless definition in§ 583.5,because he
or she resided in an emergency shelter or
(b)Homeless status. The recipient place not meant for human habitation and is
must maintain and follow written intake exiting an institution where he or she resided
procedures to ensure compliance with the for 90 days or less,acceptable evidence
homeless definition in§583.5. The includes the evidence described in paragraph
procedures must require documentation at (b)(1)of this section and one of the
intake of the evidence relied upon to following:
establish and verify homeless status. The (i)Discharge paperwork or a written
procedures must establish the order of
priority for obtaining evidence as third party or oral referral from a social worker,case
manager,or other appropriate official of the
documentation first,intake worker
observations second,and certification from institution,stating the beginning and end
the person seeking assistance third. dates of the-time residing in the institution.
However, lack of third-party documentation All oral statements must be recorded by the
intake worker;or
must not prevent an individual or family
from being immediately admitted to (ii) Where the evidence in paragraph
emergency shelter,receiving street outreach (b)(2)(i)of this section is not obtainable,a
services,or being immediately admitted to written record of the intake worker's due
shelter or receiving services provided by a diligence in'attempting to obtain the
victim service provider, as defined in section evidence described in paragraph(b)(2)(i)
401(32) of the McKinney-Vento Homeless and a certification by the individual seeking
Assistance Act,as amended by the assistance that states he or she is exiting or
HEARTH Act. Records contained in an has just exited an institution where he or she
HMS or comparable database used-by resided for 90 days or less.
victim service or legal service providers are (3)If the individual or family
acceptable evidence of third-party qualifies as homeless under paragraph(2)of
documentation and intake worker the homeless definition in§ 583.5,because
observations if the HMIS retains an the individual or family will imminently lose
auditable history of all entries, including the their housing,the evidence must include:
person who entered the data,the date of
4
(i)(A)A court order resulting from (iii)Certification or other written
an eviction action that requires the documentation that the individual or family
individual or family to leave their residence lacks the resources and support networks
within 14 days after the date of their needed to obtain other.permanent housing.
application for homeless assistance;or the (4)If the individual or family
equivalent notice under applicable state law, qualifies as homeless under paragraph(3) of
a Notice to Quit,or a Notice to'Terminate the homeless definition in§ 583.5,because
issued under state law; the individual or family does not otherwise
(B)For individuals and families qualify as homeless under the homeless
whose primary nighttime residence i0 a,hotel definition but is an unaccompanied youth
or motel room not paid for.by charitable under 25 years of age,or homeless family
organizations or federal,state,or local with one or more children or youth,and-is
government programs for low-income' defined as homeless under another Federal
individuals,evidence that the individual or statute or section 725(2)of the McKinney-
family lacks the resources necessary to Vento Homeless Assistance Act(42 U.S.C.
reside there for more than 14 days after the 11434a(2)),the evidence must include:
date of application for homeless assistance; (i)For paragraph(3)(i)of the
or homeless definition in§ 583.5;certification
(C)An oial statement by the of homeless status by the local private
individual or head of household that the nonprofit organization or state or local
owner or renter of the housing in which they governmental entity responsible for
currently reside will not allow them to stay administering assistance under the Runaway
for more than 14.days after the date of and Homeless Youth Act(42 U.S.C. 5701 et
application for homeless assistance. 'The se�g. .),the Head Start Act(42 U.S.C.9831 et
intake worker must record the statement.and se .),subtitle N of the Violence Against
certify that it was found credible. To be Women Act of 1994(42 U.S.C. 14043e et
found credible,the oral statement must sect.),section 330 of the Public Health
either: Be verified by the owner or renter of Service Act(42 U.S.C.254b),the Food and
the housing in which the individual or Nutrition-Act of 2008(7 U.S.C.2011 et
fancily resides at the time of application for sew,.),section 17 of the Child Nutrition Act
homeless assistance and documented by a of 1966(42 U.S.C. 1786),or subtitle B of
written certification by the owner or renter title VII of the McKinney-Vento Homeless
or by the intake worker's recording of the Assistance Act(42 U.S.C. 11431 et sM.),as
owner or renter's oral statement; or if the applicable;
intake worker is unable to contact the owner (ii)For paragraph(3)(ii)of the
or renter,be documented by a written homeless definition in§ 583.5,referral by a
certification by the intake worker of his or housing or service provider,written
her due diligence in attempting to obtain the observation by an outreach worker, or
owner or renter's verification and the written certification by the homeless individual or
certification by the individual or head of head of household seeking assistance;
household seeking assistance that his or her
statement was true and complete;. (iii)For paragraph(3)(iii)of the
homeless definition in§ 583.5,certification
(ii)Certification by the individual or by the individual or head of household and
head of household that no subsequent any available supporting documentation that
residence has been identified-;and the"individual or family moved two or more
5
times during the 60-day period immediately fleeing that situation,that no subsequent
preceding the date for application of residence has been identified,and that they
homeless assistance,including:recorded lack the.resources or support networks,e.g.,
statements or records obtained from each family,friends,faith-based or other social
owner or renter of housing,provider of networks,needed to obtain other housing. If
shelter or housing,or social worker,case the individual or family is receiving shelter
worker,or other appropriate official of a or services provided by a victim service
hospital or instituti on in which the provider,as defined in section 401(32)of
individual or family resided;or,where these the McKinney-Vento Homeless Assistance
statements or records are unobtainable,a Act,as amended by the HEARTH Act,the
written record of the intake worker's due oral statement must be documented by either
diligence in attempting to obtain these a certification by the individual or head of
statements or records. Where a move was household;or a certification by the intake
due to the individual or family fleeing worker.Otherwise,the oral statement that
domestic violence,dating violence,sexual the individual or head of household seeking
assault,or stalking,then the intake worker assistance has not identified a subsequent
may alternatively obtain a written residence and lacks the resources or support
certification from the individual or head of networks,e.g.,family,friends,faith-based
household seeking assistance that they were or other social-networks,needed to obtain
fleeing that situation and that they resided at housing,must be documented by a
that address; and certification by the individual or head of
(iv)For paragraph(3)(iv)of the household that the oral statement is true and
homeless definition in § 583.5,written complete,and,where the safety of the
individual or family would not be
diagnosis from a professional who,is
jeopardized,the domestic violence,dating
licensed by the state to diagnose and treat
that condition(or intake staff recorded violence,sexual assault,stalking,or other
observation of disability that within 45 days dangerous or life-threatening condition must
of the date of application for assistance is be verified by a written observation by the
confirmed by a professional who is licensed intake worker;or a written referral by a
by the state to diagnose and treat that housing or service provider,social worker, .
condition); employment records; department health-care provider,law enforcement
agency,legal assistance
of corrections records; literacy, English assistance provider,pastoral
counselor,or any another organization from
proficiency tests;or other reasonable
documentation of the conditions required whom the individual or head of household
_ under paragraph (3)(iv)of the homeless has sought assistance for domestic violence,
definition. dating violence,sexual assault,or stalking.
The written referral or observation need only
(5)If the individual or family include the minimum amount of information
qualifies under paragraph(4)of the necessary to document that the individual or
homeless definition in§ 583.5,because the family is fleeing,or attempting to flee
individual or family is fleeing domestic domestic violence,dating violence,sexual
violence,dating violence,sexual assault, assault,and stalking.
stalking,or other dangerous or life-
- � threatening conditions related to violence, (c)Disabili .— Each recipient of
then acceptable evidence includes an oral assistance under this part must maintain and
follow written intake procedures to ensure
statement by the individual or head of
household seeking assistance that they are that the assistance benefits persons with
6
disabilities,as defined in§ 583.5. In
addition to the documentation required
under paragraph(b)of this section,the
procedures must require documentation at
intake of the evidence relied upon to
establish and verify the disability of the
person applying for homeless assistance.
The recipient must keep these records for 5
years after the end of the grant term.
Acceptable evidence.of the disability
includes:
(1)Written verification of the
disability from a professional licensed by the
state-to diagnose and treat the disability and
his or her certification that the disability is
expected to be long-continuing or of
indefinite duration and substantially impedes
the individual's ability to live
independently;
(2)Written verification from the
Social Security Administration;
(3)The receipt of a disability check
(e.g., Social Security Disability Insurance
check or Veteran Disability Compensation);
(4)Other documentation approved
by HUD; or
• (5) Intake staff-recorded observation
of-disability that,no later than 45 days of the
application for assistance,is confirmed and
accompanied by evidence in paragraph
(c)(1),(2),(3),or(4)of this section.
ATTACNMNT A-1
Scope of Service
Document provided from Homeless Trust
GRANT NUMBER FW 77ND001104
City of Miami Beach—Miami Beach Outreach Program
ATTACE112ENT A-1
SCOPE OF SERVICES
The Subrecipient shall provide supportive outreach contacts and placement services to homeless
individuals and families,in Miami-Dade.County,primarily Miami Beach,Florida. The Subrecipient will
conduct street outreach as well as respond to service requests from homeless persons and service
providers in the Continuum of Care. The Subrecipient shall provide seven hundred (700) outreach
contacts and at least three hundred /iffy-five (355) supportive service placements of homeless
participants under this one-year Agreement grant.
The Subrecipient shall provide services as proposed in the application to U.S.HUD pursuant to the 2011
Super NOFA(incorporated herein by reference),including but not limited to:
1. Extensive outreach;
2. Initial assessment and evaluation for residential stability;
3. Placement services assistance including emergency,transitional and permanent
housing;
4. Placement in services assistance including hotel or motel if applicable and available;
5. Referral and placement to all appropriate and available housing;
6. Referral to all applicable supportive services and programs;
7. Transportation services;and
8. Seven(7)day follow up to all services provided.
Conditions:
1. Reimbursement shall be limited to operations, supportive services, leasing, administration, and
the costs associated with these activities as described in the Subrecipient's application and
approved by the Grantee;
2. Reimbursement shall be made only for the cost incurred for operations, administration, and
supportive services actually provided to clients,unless the Grantee agrees, in writing,to another
mode of payment,as provided for in this Agreement;
3. Monthly progress reports and program narratives signed by the Executive Director
of the Subrecipient's agency shall be submitted by the Subrecipient,as required;
4. The Subrecipient will serve clients referred by the Grantee within available resources.
or its designee for housing and/or services through the Grantee's established referral
process;
5. Services shall be provided in accordance with.the timeline submitted by the Subrecipient;
6. Any proposed modifications or revisions to the Subrecipient's program and/or services
must be submitted in writing and must receive prior approval by the Grantee;and
7. The Provider will achieve the performance measures delineated in their application to U.S.HUD.
4
ATTACHMENT`A 2-
Technical Project Number: FL0177I34DOOl Id
Subffiissr®® Project Identifier:
lEzhibit 1: Pro°ect Summa
D• Type and Scale of Dousing
This page may be duplicated if there are more than three types of housing.
Dousing type
(select one) ❑ Barracks ❑ Dormitory El Shared II®assn ❑ ��
N/A g 0 units
❑ Clustered Mousing ❑ Scattered-site Apartments
Q Single Fam ly Domes/Townhonies/Duplexes
Address: p
R/N
(dent° the units, bedrooms and beds for'the Units p c of housing lsted ab
ove.
Bedrooms 0
Beds
HUD40090-3a
ATTACHMENT A.;
Technical Project Number.' LL-WMB4D0014a0,
Submission
Project Identifier..
Exhibit 1: Project Summary
D.1. Households in the Project—with rDependents Children
The purpose of this form is to capture the totaI'number of homeless
committed to serve as indicated in the a-snaps application or as mss persons the organization has
change due to funds being reduced),as well as the subpo ulations/dis ified by the field office(i.e.,
member.If the project is not serving households with dependent abilities for each household
Number of Households"field, Enier the same information that was children,enter"0"in the "Total
the original.applications or use this fom-a�to indicate any changes sins tared.into a-snaps in
conmditio*nally-selected. g e the pro)ect was
Total Number of 59
Ho
useholds
" Z'®tap Severely Chronic Veterans Pers
<<°.• , .� -,',r ons Victims of
Persons Mentally Substance �h
` Dome
.. . ..::...... Abuse.
Disabled IMAM Violence
Adults
Non-
4 OR
Disabled
Ad.416A7 :J,F�vciFi.:Z -"aF
Disabl ed
Child
ren � >:�•,,�:���. .
le
On-
gvp
Di sablea xMN• �
WIN-
Y# g Children
Total
Persons
Total 1 S
Number of
Adults.
Total
Number of
Children
HUD-40090-3a
MVI.ACHMENT A44 .
Technical Project Number: FLO177B4D40I I
Submissi°® Project Identifier:
Exhibit is Project Summary(continued)
D.2.Households in the Project–Vi,itbout Dependents(Child
The purpose of this form xs to capture the total pumber o homeless
committed to serve as indicated in the a-snaps application or less persons the organization has
change due to funds being reduced);as well as the subpo uiations/di�fied by the'field office(Le:,
member-If the project is not serving households without dependent children,, for each household
"Total Number of Households'I field Enter the same information en,enter"0"in the
snaps in the original alppilcation or use this form to indicate. that was entered into e-
was conditionaldy_selected. y changes since the project
Total Number of 237
fouselidids
. .:` •� Tote! _
' • `' ': �: Chronically Severely onYc
,• _:•'.;6 Chr Veterans Persons
Persons H_ omeless Mentally Substance Vjct�ans
' Ill with of
Abuse IIIV
/AXDS Domestic
Viole0ce
Disabled Adults.
lion-Disabled
Adults .. VO.—
�•�'- �,
• Disabled '_:.:- :�� ;��;,:�.�� .���;:;� ;��• F,��
TJnacco■bb p ied
Y®ugh Ma
Xoti-:Disabled
ak�, hY tl_ �p 'i '�C•.Y«'cv.may, 7,�? -...y,_.y T
�ry�.s� /� gyp .i• I•l.f ,r,-"4%"Yy+ F+az 1k eL"'�.l' >;•„s�;r. ta.:g: Nr;�-•.n••r.,
Vityceom ` 1 _ r_• '4',••t� '+ +oaf:.+'•7a i..
paned . �-�',:���.,� 'p.. 1 ;.. .�rru•��.' •
i . � !4 ��ab':a�.�p'.?:� _ rC �w�::7;.R�:iF'e�^j :i�,1�e-""F1"{i3•..
Youth �. ¢.,,f��;b,P $:: r. PS . ; �_` :.
• - :-' ;`y > 9'3iKr>1 l
237 �F.
Total Persons
Total Number 237
of Adults
Total Number
of Children
HUD40090-3a
ATT ACA 1ViENT
Page:; _:,d :2
Technical Project Number: FLOMR4D001
Submission �`
'
Project Identifier:
Exhibit 1: Project summary
Residential Stability
Objectives:
• 6%of yearly contacts will result in placement into shelter or tr
placements) eaiment programs(new
o Measurement tool:count the number of placements broken down
disabilities,families with/without children and single homeless individuals p tenth
duals per month.
_ Increase Skills or Ineotne
Objectives:
SQ%of the eligible contacted.participants will be assessed for
supportive services. housing and all applicable
• Measurement tool:count the number of referrals per month.
Greater Self-determination
Objectives:
® 6,000 contacts will be made per year.
® Measurement tool:count the number of
contacts on daily contact forms,sign-in forms;
and intake forms.
IM40090-3a
ATTACHMENT
Applicant;Miami-Dade County Page 2'. of 2
Project.City of Miami Beach Outreach 00414$2920000
FL0177134D0(A j01,4
Standard Performance Mpr
Instructions:
For each applicable question on.this forum,the Applicant must establish performance
measurement goals for this protect. Alt applicants are.required to set a housings tabil'. goal and
to select at least one other po orm6n,ce measur®on which the it g..
In the Annual Performance Report jAPR).. The L.Unlveme j,column spec fie report Oral number f
persons about whom the measure is expected to be reported. In the LTarget#L Column,
applicants should spedfy the number of applic�le.clients e. ., a number of
the goal is relevant)who are expected to achieve the measure.(6.g.,the tha o emPersons for whom
system will calculate a percentage in the"Target V column. For example, 130 out year.
f 100 e
clients are expected to remain in the permanent housing
housing,the target.%should be L80%,&. Program or exit to other permanent
7. Specify the target goal for-each applicable perforrnane6 m a '
. � pure.
Housing Measure
Universe Target,%
' . . (calculat
a.PWRoees planed Into housing(ES,TH,SK or
PH)as a result of the street outreach 700
prograrn"during the operating year. 355 5196
2. Gh®ose at ieatt one.seryk-d-linkage Perf®rn99nce measure
and specify the target numbers for the goal. from below.;
Among persons Who arsterec!wvitb an urirnet service need associated a conditi®n listed below, Intricate h®�n many received the serv' red with
condition by the time they exited. ids f®r that
Housing Measure
Universe(g) Target(g) Tar
et y4
(calIcMiated)
Physical Disability.,
096
Developmental Disability.
0%
Chronic Health.
0%
HN/AIDS.
0%
Mental Health.
096
Substance Abuse.
282 85
30%
. Exhibit 2 Nage 1
t
ATTAC N A°6
PROJECT MILESTONES
NSA
FOR THIS PROJECT
i
t
,1
Technical Project Number: FL0177B4D001104
Submission Project Identifier:
(RENEWALS ONLY)
Recipient's Name:Miami-Dade County Homeless Trust
Sponsor's Name: City of Miami Beach Duration:June 1,2012—May 31,2013
Program Name:Miami Beach Homeless Outreach
Check the program component/type that classifies your project:
❑ Transitional Housing(TH)
❑ Permanent Housing for Homeless Persons with Disabilities(PH)
® Supportive Services Only(SSO)
❑ Safe Haven/Transitional Housing (SH/TH)—Characteristics of TH/participant not required to execute a lease
❑ Safe Haven/Permanent Housing(SH/PH)—Characteristics of PH/participant required to execute a lease
❑ Homeless Management Information System(HMIS)
❑ Innovative Supportive Housing(ISH)
Table of Contents
Budget Exhibits 4 and 7
Certification:
Name&Title of the Person who can answer questions about this document: Phone(include area code):
Katherine Martinez,homeless Program Coordinator (305)6044663
Email:katherinemartinez(a,miamibeachfl.g_ov
Address:555 17tb Street,Miami Beach,Florida 33139
Main Office 1700 Convention Center Drive,
Miami Beach,Florida 33139
I hereby certify that all the information stated herein is true and accurate.
Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties.
18 U.S.C. 1001, 1010, 1012;31 U.S.C.3729,3802
Name&Title of Authorized Official: Signature&Date:
i f-��v�,::- C'-_ e�r—JS 10(.2- 2-
Project Number: FL0177B4D001104
Technical Project Identifier:
Submission Exhibit 1: Project Summary
(cont.) (RENEWALS ONLY
A. Selectee, and Sponsor Information-Fill in the information requested below. For HMIS projects fill in
the HMIS Lead. When the selectee is the same organization as the project sponsor,complete only the selectee
information.
Selectee Name Miami-Dade County Homeless Trust Sponsor Name City of Miami Beach
Contact Person Hilda M.Fernandez,Director Contact Person Katherine Martinez
Phone (305)375-1490 Phone 305)6044663
FAX Number 305 375-2722 FAX Number (305)6044094
E-Mail Address Hildafemandez@,miamidade.gov E-Mail Address katherinemartinez rniamibeachfl. ov
Street Address 111 NW First Street,27 Floor,310 Street Address 555 17 Street
City,State,Zip Miami,Florida 33128 City,State,Zip Miami Beach,Florida 33139
HMIS Lead Miami-Dade County Homeless Trust Contact Person Barbara Golphin
Street Address 111 NW First Street,27'h Floor,310 Phone 305)375-1490
City,State,Zip Miami,Florida 33128 E-Mail Address rmgl@!mamidade.jzov
B. Project Budget -This section must be completed by all renewal selectees.
1. Chart 1 -Summary Project Budget 1
To complete Chart 1,Summary Project Budget,enter the amount of SHP funds requested by line-item in
the first column. For leasing,supportive services,operations,and HMIS,the amount entered should be for
the SHP grant term selected. In the second column,enter the amount of other cash that will be contributed
to the project. This amount plus the SHP request must equal the total budget amount for the project. Note
that match requirements for supportive services,operating costs and HMIS apply to renewal projects. The
amounts you enter are for all structures in your project. Each line item amount in this chart should match
the amounts shown in your original application as approved or Exhibits 3,4,5 and 6 in this document's
New Projects Section.
Requested grant term(1 year):
Chart 1-Summa Pro'ect Bud et
Total
SHP Applicant Project
x Re uest
-Cash- Budget
1. Real Property Leasing
2 Supportive Services* 609946 599954 1209900
3. Operations**
4. HMIS*
5. SHP Request(subtotal lines 1 thru 4) 609946 59 954 1209900
6. Administration***(up to 5%of line 5) 39047 39047
7.Total SHP Request(total lines 5 and 6) 639993 599954 1239947
*By.law,SHP can pay no more than 80%of the total supportive services or total HMIS budget.
**By law,SHP can pay no more than 75%of the total operating budget.
***By law,SHP can pay no more than 5%of the total SHP request.
.1
Technical Submission Project Number: FL0177B4D001104
Submission Project Identifier:
Exhibit 4: Supportive Services
A. Supportive Services Budget
Chart 4A:
Supportive Service Expense 0.5041% Total
1. Service Activity: Outreach Caseworker C09946 609946
Quantity:3.0 FTE @$40,300 includes taxes
and fringe benefits
Total=$120,900
SHP REQUEST* 609946 609946
Selectee's Match 59954 599954
Total Supportive Services Budget 1209900 120920
*The SBP request cannot be more than 80%of the total supportive services budget in Line 11.
a.,
Project Number: FL0177B4D001104
Technical Project Identifier:
Submission Exhibit 7: Administration
(cont.) (all new projects requesting administration funds)
A. Administrative Costs
Please complete the chart below for your administrative costs budget. If you are a selectee who will also be the
project sponsor,complete Lines 1 through 6. If you are the selectee and a different organization will be the
project sponsor,complete lines 1 through 8.
In the first column,fill in the administrative activity to be-paid for using SHP funds. In the Year 1 column,enter
the amount of SHP funds to be used to pay administrative costs in the first year. If the grant is multi-year,enter
the amount of SHP funds to be used for Year 2,and if applicable,Year 3. In the last column,(d),total the
amount of SHP funds requested for the full grant term. Please ensure that the total requested for
administrative costs for the entire grant term,Line 6,column(d),matches that which you entered in your
project's Summary Budget in Exhibit 1.
Total
Administrative Costs
1. Administrative Activity: 2.5%City of 19,523 19523
Miami Beach for costs associated with
accounting for the use of grant funds,
preparation of APR, audit of SHP,staff time
spent reviewing and or verifying invoices for the
grant funds and maintaining records of the use of
funds.
2. Administrative Act ivity: : .2.5%Miami- 19524 19524
Dade County Homeless Trust for costs associated
with accounting for the use of grant funds,
preparation of APR, audit of SHP,staff time
spent reviewing and or verifying invoices for the
grant funds and maintaining records of the use of
funds.
SHP REQUEST FOR 39047 39047
ADMINISTRATIVE COSTS
Amount for Selectee 19524 19524
Amount for Project Sponsor 19523 19523
B. Plan for Distribution of Administration Funds
If the selectee is not the same organization as the project sponsor,attach a description of the selectee's.plan for
distributing its administrative funding to address all,or a portion of the project sponsor's administrative needs.
Include a description of how the project sponsor was consulted in formulating the plan.
t,.
c�.o� U.S.Department of Housing OMB Approval No.2535-0102 (exp. 1/31/2004)
t ®CC
S n and Urban Development
SNAPS Special Needs Assistance Program Office of Community Planning
Request Voucher for Grant Payrnent and Development
See Instructions and Public Reporting Burden Statement on back T- TA
CHMENTC
1.Voucher Number 2.LOCCS Pgrm.Area 3.Period Covered by this Request(dates) 4.Type of DMursement
SNAP HPAC [:]Partial [:]Final
1HP
6.Voice Response No.(5 digits,hyphen,5 more) 6.Grantee Organization's Name
S.Grant No. 6a.Grantee Organization's TIN
9. Line Item W. Type of Funds Requested Amount(round b nearest dollar)
1010 Acquisition
1020 Rehabilitation
1021 New Construction
1022 Substantial.Rehabilitation
1023 Moderate Rehabilitation
1030 Operating Cost
1040 Rental Assistance
1050 Supportive Services
1060 'Administrative Cost
1070 Child Care
1080 Employment Assistance
1090 Relocation
1100 Leasing
1110 Repair b Maintenance
1111 Prevention (RH)
1112 Capacity Building (RH)
1120 Other:
10 Voucher Total
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 andstatements.Conviction may result in criminal and/orc ivii penalties.(18 U.S.C.1001,1010,1012;31 U.S.C.3729.3802)
1 i.Name&Phone Number(including area code)of the Authorized. 12.Signature 13.Date of Request
Person who called SNAPS System VRS
x
Privacy Statetnetnt: Public Law 97-255,Financial Integrity Act,31 U.S.C.3512.,authorizes the Department of Housing.and Urban Development(HUD)
to collect all the information(except the Social Security Number(SSN))which will be used by HUD to.protectAlsburserrient data from fraudulent actions.
The Housing and Community Development Act of 1987,.42 U.S.C.3543,authorizes HUp to collect the SSN.The data are used to.ensure that lndiAduals
who no longer require access to Line of Credit Controt$ystem(LOCOS)have theiraccess capability promptly deleted.Prevision of the SSN is mandatory.
HUD uses it asaunique Identifier focsafeguardingLOCCSfrom unauthorized access.Fallure to provide the Information requested may delaythe processing
of your approval for,access to IOCCS.This information will not be otherwise disclosed or released outside of HUD,except as permitted or required by law.
Retain this form in your records for audit purposes page 1 of 2 form HUD-27053-A (2/95)
Public reporting burden for this collection of information is estimated to average 15 minutes per response,including the time for reviewing instructions.
searching existing data sources,gathering and maintaining the data needed,and completing and reviewing the collection of information.This agency may
not collect this information,and you are not required to complete this form,unless it displays a currently valid OMB control number.
This information collection is to request payment of grant funds or to designate the appropriate officials who can have access to HUD voice activated payment
system.The HUD voice activated payment system has been especially designed to help the recipient when calling in for a request of funds and improves
the payment process so the recipient will know right away whether their request will be paid or not.This information collection is required under 24 CFR
Subpart C.85.21-Post Award Requirements,the information collection is needed in order to obtain or retain a benefit.
Instructions for the Request Voucher for Grant Payment for the Special Needs Assistance Program(SNAPS)
Item 1. Voucher Number: The first3 digits are the prefix to your Item 6. Grantee Organization's Name: Enter the name of the
program. Enter"00.1"if grant funds are being requested organization requesting funds. It must be the same name
for a grant awarded under a SHDP or S 14 (TH, PH, that appears on the Grant Agreement.
SAFAH and Renewal) grant Enter 00380 if funds are Item 6a.Grantee Organization's Tax Identification No: Enter
being requested for a Housing Opportunity for Persons the tax(employer) Identification Number(TIN).
with AIDS (HOPWA) competitive grant Enter"054" if
funds are being.requested for an Innovative Housing Item-7. Not applicable.
Program IHP)grant. (if you do not know your 3-digit Item 8. Grant Number.Enter the project number that appears on
program prefix, contact your local Field Office.) The the Gran.Agreement.
remaining 6 digits iapl.be assigned by LOCCSlVRS during
the telephone call. The entire 9-digit number will have to Item 9. Type of Funds Requested: SNAPS grant VRS draw-
be entered prior to ending the call. downs are directed against_specific funding categories
Item 2. LOCCS Program Area: Circle'SNAP'(001)for SHDP called Budget Line Item(®Lis). LOWS associates a 4-
and SHP grant requests, "HPAC" (038) for HOPWA digit number with each line item. Enter the amount
competitive grant requests,and IMP" (054)for Innova- requested in each category(llrtes 1010 through 1120)and
the total funds requested under item 10,Voucher Total.
five Homeless Programs.
Item 3. Enter the period covered by this request. Item 11.Nance & phone number (including area code) of the
authorized person who completed the cap-in to VRS.The
Item 4. Type of Disbursement: Check 'partial' until the final authorized person is shown on line 3 of form HUD-27054.
request for grant funds is made. Item 12.Signatur®of the person identified in item 11.
Item 5. Voice Response No: Enter the 10 digit Voice Response Item 13.Date of this Request: Enter the date of the call-in to
System.(VRS)project.number which was sent to Vou by request funds.
mail. Your regular HUD project number will be repeated
back for verification after the VRS project number is
entered.
Retain this form in your records for audit purposes page 2 of 2 form FOND-27053-A (2195)
MIAMI-DADE
MONTHLY INVOICE MELESS
• MONTH: •T R U S T
PROVIDER NAME:
PROGRAM NAME: ACHMENT
CDNTRACT#
SUPPORTIVE SERVICES
80% TS.%REOUST
Year to Date
program SHP Year: 1 2 8
POSITtims1DESCRIPTIONS % Total Expenses EApehs Reimbursement Total Suilget For of .ot cxp
T#re Yesf SHP gip.YTD. YTU
lip
9DN/O!
P051TIONS 0°k S - $ $
P051710NS 0% _ - - t#DIVIO!
POSTf10NS 0°k _ - SDlV101 •
ONIONS 0% - _ - - lIDN1O!
POSITIONS 0%
POSITIONS 0% _ - - savio!
POSITIONS 0% - #DIV1Ol
POSITIONS OY. - - ADIV10!
POSITIONS 0%
SIIONS 0% _ - - aavrol
OSIIIONS 0% $DWI
OSITiONS - X01140 !
osmoNs 0% �DNro!
POSITIONS
OS!TIONS 0%.. -
TOTAL SAL WaM' S - S S ; S - Sp1.V101
B maws- -trA of SAL. OS6 S tam/0!e 0!
Total Sat.b_Fil e $ - $. $ is - $. - WNW
ESCRIPTIO 3 S S s - $
NS 0% = *MIDI
_ asDiV101
ESCRIPTIONS 0% SM101
ESCR1PT10NS 0% _ _ _ #011/101
ESCRIPTIONS 0% #DIVIM
ESCRIPTIONS 0% _ _ _ _
ESCRIPTIONS ODA . _ - _ #DN/01
DESCRIPTIONS 0%. #DN/0!
ESCRIPTIONS 00/0 _ itmV
DESCRIPTIONS 0% - _ _ #DNIO!
DESCRIPTIONS 096 . _ _ #DtyJpl
DESCRIPTIONS 0% _ _ - tiIS1l10!
DESCRIPTIONS 0% _ _ 1�DIV10!
ESCRIPT!ONS 0°,b _ _ _ #DIV10!
DESCRIPTIONS 0%
ESCRIPTIONS 0%
Total Supportive
TOTAL SUPPORTIVE SVCS $ - $ _ $ $ - $ - #DIVIO!
I+TA1 ROJECrS
4!';!20082:01 PM
.t jy N■A- w a•s�`.d a '.,' °.:' * 'a1�m.` i3r'a'':-`lea-.r
+'2Y_-•sh +�y qf. +6� _,r.r.-�• :F':, �•F _ _ y •ia]+f—•'y3FV •j_ 'T,V' - �'' 'c' - "• Ik
1'k s a} ~..-f•
°,�►. �¢`u '�*"T=". ••'`rti= .:-.•r": :ra�y[i'.'••."�. _�R ..;T..�,}•�f�?b-�$' ...�'� : r, •a ei�:.;�'Y'"
�r i. �J�..i'�i-a• e.—..� _ 9•. rain=�ytiS� ':,, �.,�� ,•:'��.�•—.', �iT�-:/0 � x�,^'�R�1�'a���.•..r.•.^ ct-"�'.F,T:ik'9;••:.;..• _
r,� ....: ter_^ •'_:.. Year LO Date
Program SHP Total Year SHP Year 12 3
pOSITIONS/DESCRIPTIONS % Total Expenses Expenses Reimbursement Expenses 74 o FTOM
SHP Exp YTD YTD
0%
S - � i i
POSITIONS _ - MV/01
PosmONs 0010 - - _ - amlo!
PosmONS 0% � _ - MV101 .
POSITIONS 001 _ _ - #DIVro!
OSITIONS 00/4 - _ _ - aDIVIM.
POSITIONS 0% - _ - MUM
OSmONS, c°A _ - tRDl M
POSITIONS Me - _ _ - - 2MV101
POSITIONS 0% _ _ _ SDIV/01
POSRIONS 0°k - _ _ - - VDIM
POSMONS _ _ - #DIV/O!
ITI
POSONS 0% _ _ _ - MvloI
POSITIONS 0`/0 _ - 9DN101
POSITIONS 0%
POSITIONS 0% -
MM
�u�s a - s. - $ _ s S s Vml
TOWI.Oal&Fq2je S... . . -
.$.. . �. S f - -. ; .##DIVrof.
DESCRIPTION5 0% - _ _ 8DIV/0!
ESCRIPTIONS 056 #DNN1
ESCRIPTIONS Me - _ _ two.
ESCRIPTIONS 0% 601V101
601V101 ESCRIPTIONS 0°k - SOP
DESCRIPTIONS 0% _ #DN/0!
DESCRIPTIONS 0% _ 9DIV101
DESCRIPTIONS 00/9
DESCRIPTIONS 0% _ - #DIVI01
DESCRIPTIONS 0% _ #DIV/0I
DESCRIPTIONS V%r• - _ _ _ #w/ol•
DESCRMOWS' 0% _ _ - IlWID!
DESCRIPTIONS Dy° Own
DESCRIPTIONS 01y. _
Total Oftee oe afro •Services $
TOTAL-OPERATING:.Wa
Y1W to'Date
Program SHP Total Year SHP _Year 12 3
PO5 S % Total Expenses ExpmseS Reimbursonent Expenses o Elp
SHP Exp YTD YI•D
TOTAL LEASING . °�. S - Is - Is - #QIV109
. YeartgDate .
Program SHP Total Year SHP year 12 3
PosmoMSlDESCRI molvS Total Expenses Expenses Relmisutsenbent Expenses of .
S14P.Exp YTD YTD.
'TOTAL ADMIN COST S - $ - � #131V101
GRAND TOTAL $ - $ - $ - $ - $ - #DIV/01
HT/PROJECTS
4112WZ-01 PM
HM 40118,PR Pagel of 5
-c,,*SMVKXpoinV ATTACHMENT D
com"Mew War GGIMMft.
^�� Wami Dade Homeless Trust Mods: Shadow
Mode
' Miami-Dade County Government Back Date
It ART:Unread
January t2,2491
Messages.
Reports > HUD-40118 APR
HUD Annual Performance Report (HUD-40118)
Choose Reporting r"—
Reporting Group Group Clear
Miami-Dade County
Provider Search My Provider Clear '
I Government (1)
I 0-This provider AND its
1 subordinates O This provider ONLY
EJ Use client unique Id for duplicate checks
Operating Year 0
i 01 / 01 / 2011 01 / 31 / 2011
Date Range
L#gal Adult Age 18 (as defined by foster care law in your state)
®Use pre-HPRP logic
i
i Build Report Print
Number of Number of
2.Persons Served during the Number of Singles Number of
operating year. Adults In Children In
Not In Families Families
Families Families IVumber'ori the first day of the 0 o
operating year. p. 0
b.Number entering program during 0 0 0 0
the operating year.
c.Number who left the program 0 0
during the operating.year.
d.Number in the program.on the last 0 0 0
day of the operating year.(a+b-c=d)
Number of Number of
3.Project Capacity. Number of Singles Adults In Children in Number of
Not In Families Families Families Families
a.Number on last day(from 2d, 0
columns 1 and 4) 0
4..Nona-I meiess persons.(sec.S SRO projects only)
How many i4come-eligible non-homeless persons were housed by the SRO program during the 0
operating year?_
5,Age and'GiOnder,®f those who entered during the operating bear,how many people are in the follawing
age.and gender categorises?
Age 114ale Female Other/Not given
Single Persons(from 26,column 1) ' a.62 and over 0 0 0
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140118,APR. Page 2 of 5
b.51 -61 0 0 0
c.31-SO 0 0 0
d. 18-30 0 0 0
e. 17 and under 0 0 0
Not given .0 6 0
Persdns in Families(from 2b,columns 2>&3) f..62 and over 0 0 0
g..51-61 0- 0 0
6.31--50 0 0 0
1. 18-30 0 0 0
j:13- 17 0. 0 0
k.6-12 0 0 0
1.1 -S 0 0 0
m..Under 1 0 0. 0
Not given 0. 0 0.
0.-1®,Participants who enured durino the operating Year:
6a.Vetarans;Sta.Ws.-
A v¢teran is anyone who has ever-been on.active military duty status.. 0
66.Chronically Idomeidigs.
How many participants were chronically homeless individuals? 0.
7.Ethnicity.
a.Hispanic or Latino 0
b.Non-Hispanic or Non,=Latino 0
S.Race.
a.American.Indian or Alaskan.Native. - 0
b.Asian 0
c. Black or African American. 0
d.Native Hawaiian or Otheir'Pacific Islander 0
e.White 0
f.American.Indian/Alaskan Native&White 0
g.Asian.&White 0
h...Black/Afiican American a White p
i..American Indian/Alaskan Native&Black/African American O.
J,Other Multi-lUdai 0
k..Other/Unknown(all.that do not match) p
9a,Special Needs.
Ail. Chronic
a.,Mental illness 0 0
b.Alcohol abuse 0 0
c. Drug abuse 0 0
d. Hlv/AIDS or related diseases 0 0
e. Developmental disabllity 0 0
G Physical disability 0 0
g. Domestic violence 0. 0
h..Other(please.specify) 0. 0
9b.Disabled.
How many of the participants are disabled? 0
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HUD-40118 APR Page 3 of 5
10.Prior Living Situation.Participants slept in the following places the week prior to entering.
All Chronic
a.Won-housing(street, park,car, bus station,etc) 0 0
b. Emergency shelter 0 0
c.Transitional!lousing for homeless persons 0
d. Psychiatric fadlity 0
e.Substance abuse treatment.facility 0
f. Hospital 0.
g.]ail/prison 0
h.Domestic violence situation 0
1.Living with relatives/Friends 0
j. Mental housing 0
k.Other(please specify) 0
1.1.Amount and Source of Monthly Income at Enter end Exit.Participants who left durinSbiie operating
year.
Amount A.NB�nit..y In 'M6 at S:Monthly Inooen6 at
Entry IExit
All Chronic All Chrorpic
a.No income 0 0 0 0
b..$1-150 0 0 0 0
C.$151.-$250. - 0' 0 0 0
d.$251-$500 0 0 0 0
e..$501-$1000 0 0 0 - 0
f.$1001_$1500 0 0 0 0
g:#1501.-$2006 0 0 0 0
h.$2000± 0 0 0 0
Source. C.Income:Soul at D.Income Sources at
"try. Eklt-
All Chronic All Chronic:
a.Supplemental Security Income(SSI) 0 0 0 0
b.:Soda]Securfity Disability Insurance(SSDI) 0 0 0 0
c. Social.Security . 0 0 0 0
d.General Public Assistance 0, 0
e..Temporary Aid to Needy Families(TANF)i 0. 0 0 0
f:State Children's Health Hnsura.nce Prograni.(SCRIP) 0 0 0 0
g..Veterans benefits 0. 0. 0 0
h.Employment Income 0 0 0 ' 0
L Unemployment.Benefits 0 0 0 0
J.Veteran's Wealth Care 0 1 0 0 0
k. Medicald 0 0 0 0
1. Food Stamps 0 0 0 0
m.Other(please specify} 0 0 0 0
n.. No financial resources 0 0 0 0
12e.Length of Stay in Program.Participants who left during the operating year.
All Chronic
a. Less than.1 month 0 0
b. 1 to 2 months 0 0
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HUD-40118 APR Page 4 of 5
c.3-6 months 0. 0
d.7 months-12 months 0 0
e.13 months-24 months 0 0
f. 25 months-3 years 0 0
g.4.years-5.years. 0 0
h.6 years-7 years 0 0
1.8 years- 10 years 0 . 0
J.over 10 years 0 0
lib..length of stay, in Program. Participants who did not leave during the operating year.
All Chronic
a.Less than 1 month 0 0
b. 1 to 2 months 0 0
c..
3--6 months 0.. 0
d.7 months-12 months 0 0
e: 13 months-24.months 0 0
f.25 months.-3 years 0 0
g..4 years-5 years 0 0
h.0 years 3 years 0 0
I.8 years-10 years 0 0
J..over 10 years 0 0
13.R'easons ftor Leaving.Pae#iciipants who left dLiring the operating year.
411 Chronic.
a. Left]Poor a housing opportunity before completing program. 0 0
b..Completed program 0 0
c. Non-payment of rent/oncupancy charge 0 0
d. Non-compliance with project 0 0.
e. Criminal activity/destruction of property/vid)erice 0 0
f. Reached maximum time allowed' project 0 0
g. Needs could not be met by project. 0 0
h.Disagreement with rules/persons. 0 0
1. Death 0 0
J..Other(please.specify) 0 0
k..Unknowri/disappeared 0 0
14.D6stinatloo.Participants.who left during the opeiratin®y"r.
Ail Chronic
PERMANENT(a-h) a. Recital house or apartment(no subsidy) 0 0
b. Public Housing 0 0
c.Section B 0 0
d.Shelter Plus Care 0 0
e. HOME subsidized house or apartment 0 0
t..Other subsidized house or,apartment 0 0
g.homeownership 0 0
h..Moved In with family orhiends 0 0
TMNSMONAL(i-j) I.Transitional housing for homeless persons 0 0
j.moved in with family or friends 0 0
INSTITUTION(k-m) k. Psychiatric hospital 0 0
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I
HUD-40118 APIA Page 5 of 5
I.Inpatient alcohol/drug treatment facility 0 0
m.fail/prison 0 0
EMERGENCY SHELTER(n) n. Emergency shelter 0 0
OTHER(o-q) o.Other supportive.housing 0 0
p. Places.not meant for human.habitation(e.g.street) 0 0
q.Other(please specify) 0 0
UNKNOWN r.Unkno*p. . 0 0
15.Supga®rtive Services.ParticiiOnts tiFk®4eft:durirn9 the operating year..
N.OTlE:Yhe below servile were given to participants who left during the operating year.Add the foliowing
coup.into,the appropriate.cetegory for questson 15.
Sererice Service Code Aii Chronic
No supportive services found. . -
Legal N®tioe*s
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ATTACHMENT E
Page 1 of a
MIAMI-DADE COUNTY HOMELESS TRUST
PROGRAM RATING OF SATISFACTION
Section I. :TO BE COMPLETED BY PROGRAM PARTICIPANT
Instructions. Pleace answer each question below by placing an I a'j in the space provider) Your responses to these
questions have no hearing on your continued Participation it the rMrant ALL responses are confidential
Why did you choose to enter the program (mark only one boa):
❑I decided to come to this program on my own(through outreach,referral,etc.)
❑I was placed here through another program(court interventiom police,etc.)against my will
❑I had previously participated in this or a similar program and decided to return
OPTIONAL Information:
Names Sex:❑male ❑female
Today's Date:
Please-answer.the following questions about the services ynu.received Mark ni'J only One box wliirlt best describes
your feeling,s aboid each statement. These questions are meant to help us improve the services provided,so we ask that
you tell us)sow you really feel.whether or not it is gtx!d or bad
Strongly Agree Agree a Disagree Disagree Sanaglr
A nc Citric A Lidlt Dao ree
l was informed of my rights and responsibilities, [6] [5] [4] [3] ['-] [1]
including the a g eric 's grkyance pro.cMuircs
I was provided with information about different services [6] [$] Ea] P] [2] [1]
that are available.for.me
I was involved iii making decisions about my [6] [51 [41 [37 ['] [1]
care/service plan
1 was.able.tii talk with staff when,1 needed-to J61 4. [3j ? [1
The'building and facilities have usually beevi clean,safe [6} (S] [4] [3] [2] [1]
1
and comfortable
My rights were respected and protected,including my [6] [5] [4] [3] [2] (1]
ri ht to ilea grievance,if needed .
M case manager q�seems. ualified to he! me 6 5 4 ' 2 [i]
^ ? 1
1 would recommend this rograen to others [6 [5] 4] 3
1 am treated with respect b�the shift. 6 [4)- [3] ('- [1
The staff seems to care about whether I net better 6 5 41 3 '- 1
Program staff wire knowledgeable about available f6] [5] [4] [3] [?] [11
services that could help.me
Section U.: TO BE COMPLETED BY PROGRAM STAFF
Purpose of Evaluation Current Level of Care provided i
I D At Admission 1 ❑ emergency housing Pro��ider Name:
i
D transitional housin-ft Project Name: i
0 At discharge Staff initials:
i 0 Other: ; ❑ transitional housing.'non-tx
0 permanent housing J
i ❑ services only -�
kev.l[/(Woo Farni.!prugrzm ratin,
ATTACHMENT E
Page 2 of
MIAMI-DADE COUNTY HOMELESS TRUST
PROGRAM RATING OF SAI'ISFA.CTI®N
INSTRUCTIONS
Carefully read all of the instructions below BEFORE distributing the Program Rating of Satisfaction
survey to your program participants.
General Information
The Program Rating of Satisfaction consists of 11 items.which are used to determine a client's satisfaction with
services they are receiving from a provider. It is to be completed by all program participants engaged in services
at a Trust-funded program.It must be completed-at a minimum-at tune of discharge for all participants. It is
strongly recommended that a Program Rating of Satisfaction survey Also be completed at intervals as may be
applicable to the program;however,only the discharge survey must be forwarded to the Homeless Trust.Case
manap-ement notes should indicate specifically why a Program Rating of Satisfaction was not obtained,if that is
the case(client went AWOL,institutionalized,etc.),and v��hat efforts were made to obtain a survey in those
instances.
The Program Rating of Satisfaction is available in English.Spanish and Creole.Providers are responsible for
reproducing the appropriate survey and providing an envelope(that seals)for each respondent.All responses
should be completed in ink
If a participant cannot read,providers should encourage them to use the same process they use to-have other
information read to their.An employee of the agency that is not directly responsible for the client's care can
read the form..This should be indicated in Section II. as a separate set of staff initials.
Filling Out the form
I) A language appropriate survey and an envelope should be provided to all participants who are required to
complete the form. Only-one form per family is required.The form must be filled-out in ink.
2) Section II of the Program Rating of Satisfaction is to be completed by staff prior to providing the survey
document to the program participant.Staff will marl:with their initial (usually the case manager responsible
for the client's service.delivery). If the survey must be read to the client,the staff person initials performing
that function should also be included.In no case should the participant's case manager read items aloud to
the participant.
3) Section I of the Progrrarn Rating of Satisfaction Form is to be filled out ONLY by the program participant.
The prram participant should be provided a private place and sufficient time to answer the survey.
program.
4) Providers should reassure participants of the confidentiality of their responses.Providers may wish to
introduce the survey,as follows:
"This survey is one way of helping us determine how well we are helping individuals that
come to our agency for assistance. Please take a few minutes after 1 leave to answer this very
short survey.as honestly as possible. Your responses are private and we will not look at them.
Please seal the envelope and give it to me when you are done(or: put it in the drop box.)."
5) The completed survey should be placed in the envelope by the recipient and sealed. Providers are
encouraged to provide a"drop box-, with-a slot for completed forms.
6) The sealed envelope(s) should be forwarded to the:Miami-Dade County 1-1omeless Trust on a monthly basis.
surve4s are distributed.
7) The provider a._ency should maintain a lob.;of howl many
AT T ACHMEN7 E
Page 3(1f 5
DETERIMINAT'ION OF M.INIMUM AVERAGE SCORE FOR
CONSUMER SATISFACTION SURVEY
BNRS Wore
i i was informed of my rights and responsibilities . I N,A 1 �•0
� 5.0
I was provided with information about different services N I A
that are available fo.r me '
i I was involved in making decisions about my care/service I 1 � '°09
plan
I was able to tall:with staff when I needed to 35 5.15
The building anti facilities have usually been clean,safe and 4 5.18
comfortable
i My rights were respected and protected,including my right N/A 5.0
to.file.a grieva hce,if needed
My case Moans er seems qualified to help.me I 5A7
i would.recommend this roageath to othrs 8 536
1 am trcated vyith res eet biy the staff 18 5.23
The staff seems to care about whether I et better. 20 �•)1.
Program staff were knowledgeable about available services 14 538
that could help one
X7.17
RECOMMENDED 57.00
11/6100
ATTACHMENT E
Page 4 of 5
:MIAMI-DADE COUNTY HOMELESS TRUST
EVALUACION DE LA SATISFACC16N CON EL FROG R 4 MA
Section 1. COMPLETADA POR EL PARTICIPANTE DEL PROGRAMA
Instruccia►ie►_s:Par fuvor coloque una crux J.tJ en ei espacio provisto para responder a las pregunteas a continuaci6n.Las
respuestas que usted de a este eueetionario no inffidihn de fonna alryuna sabre la eontinudd6n lie Nu narticipacihn en cute
row rrrmea. TOD 4S/as respuestos se mantendrdn eonf dencialmente.
;.Por que de.cidib usted participar en el programs?(Marque una casilla solamente):
[ I Lo dec:idi por mi cuenta(porque fui remitido o por media de otro programa,etc.)
( ]Fui colocado aqui rnediante otro progroma(por intervenci6n de los tribunales.la
policia,etc.)en contra de mi voluntad
[ ]Ya habia participado en este programa o en uno similar y decidi regresar
InforM2605 a OPCIONAL:
Genera: M
Nombre y peldido: J �'
a j ]
Fecba de boy:
Por favor retiponde alas preguntav siguientes acerra de Jos servicK►s que se le liars prestedo.Indlque con una cruZ/Xj E,'4 UNA
BOLA CASILLA POR PRECUNTA la fanny ear que usted se siente averse de cads una de las cuestiones descritas.Como sus
respuesctas a esters preguntas nos gvudardn a mejerar las serviciios que prestamos,le rosanws que nos!raga saber c6.mo se siente en
realidad acerca de nuestros sen lclos,no imports si usted los considera buenos o malm
iMuy de De AMo de Algo rn En Muv'cn
aeaerdo aeuerdo ecuerdo desacuerdo desaeuerdo decacoerda
Se me.informaron Guiles eran mis derechos y [6] [5] [4] ['] [21 [1] I
responsabilidades,entre ellos,Ies procedimientos de Is
2wencia para someter qudas.
Se me dio information sobre los distintos servicios a los [46] [5] [4] [3] [2) [1]
ue teriao derecho.
Partac pe en.Is tome de decisiones referentes a mi plan [6] [5] [41 [3] ['] [1l
de atenci6n y siL-rvicios.
Pude hablar can el personal.cuando tuve necesidad de [61 (5] [4] [3] [2] [1]
hacerlo.
El centro y sus seevicios por to general se han mantenido [6] [5] [41 [�] 12] [1]
lim ios,sin peligro v atcesibles.
Se respetaron y protegieron mis derechos,entre ellos,mi [6] [5) 141 P1 ['] [1]
derecho a someter ue'as A to ronsidero necesario.
,Aparentetnente,Is persona cticargads de rni caso sabe to (6) [5] [4] [1] ['-] [1]
gut tiene que hater pars a udairmt.
' vo les.recomendaria est.e p.roveecto.a otrac personas. [6 ' 41 ' I
Los em lesdos me trataron res etuossmente.
16 [5] 4 '� � I]
Aparentemente,a lays empleados let inter""que yo [6) [5] [4] P1 [?) [I]
one'ore.
Los empleados sabian quc servicios podian servirme de [6] 15 [4] ['l] 12] [1]
avuda.
Section U.: COMPLETADA POR ENIPLEADOS DEL PROGRAMA (completed by protyram Sts
Purpose e f Ei-ulrration Current Lei>el of Care prorided i
7 At Admission
o emer!encv housing Provider-Name:
7 At discharge : _► transitional.housin-;r`tx Project Name.
J Other:
J transitional housing-non-u Staff Initials:
1 Permanent housing_
�] services rnilN
ATTACHMENT E
Patye 5 of 5
MIAMI-DADS COUNT' HOMELESS TRUST
PWOGRAM POU EVALYIE SATISFAKSYON
Section I.TOUT PATISiPAN NAN P-vVOGRAM SiLA A FET POU RANPLI PAJ SA A
�nctrikst�un: Tunpri repaanra c laah kek�l�orr n,thn la a epi ft you ti kwa jrj ntin espas ki rid lra. Reg its nnu but,vo pop
derarnie Lifson na kontin a 211fivipe nan pwogj.,ram sila a. Tout reponx J"u ap tekre.
POUKI W CHWAZI PATISIPE NAM PWOGRAM SILA A(fe yon ti kwa nan yon
grenn bwat):
I i Se mwen ki cbwazi virtu nan pwogram-sila a (swa pa referans,swa Pa Bevis�pesyai asista�rs piblik etc.)
Se pa shwa mwen,se yon 16t pwogwant ki voyetn(zak tribiaal,lapc>lis etc)
[[ Wen to deja patisipe nan yon pwogram konsa epi mwen deside retounnen.
Enfonlasyon gtou ha`'si w_vie: Fenan
Non:
Seks ij Gason �]
Dat Jodya:
Tartpri repnarn keksyon sUa yo dapre sevis w resevwa.. R yon kwa JxJ nan yon si'i li bare epi clrwatt reports ki plis
matche ave w. iKeksyon sitar yo la you ede non bay pi harr Bevis,alb non aruuade nnla bay reports ki pliS nwtclre ave w,
ke!i bun on pa.
[ion jaat da1:o Da.kb F=dkb Pa dai:b Pa dakb
dal:® tott iti t ditou
Yo fern konnen toutdwa Mnwen yo ak responsabilite [6] [51 [41 ('] [2] [l J
mwen oak kounian pot,mwen `len en nan.a'adtsla
Yo to 6anmwen enf6� asyon soli diferan sevis ke mwen [6] [51
[4J
kab'wenn
Mwen tc patisipe nan tout desizyon son planif kasyon [6] [5J [4] ['] (?] [I J
swe.nlsevis mwen [2 (11
Am lwave vote tou'ou dis.onib pou mwen le o [51 .[4] [31 [2] [1]
Kote a ak bilding yo to toujou byen pwop,konfo tab ak [bJ
bon sekirite [4] [31 [21 [1]
Tout dwa m to respekteak p*6teje men dwa in you [6]. [5 J
mwen to to plW si neses�
Moun I:ap oiki'pe ka mwen an sanble li kalifye:pon li [61 [51 [41 [�] [�_
] [l�.
edem. S 4 ;] [21 1
Mwen to rekomande woggram sill a bay tut moue [61. 5 41 13 21 i
Am lwa a �o trete mwen ak res 6 �] i; (? I]
Am lwa a vo sanble vo.vreman enterese nan mwcn
Amplwaye pwogram la to byen enforne sou tout scvis ki [6I [5] [`t] [3] [2J [IJ
to dis onib pou ede m.
Sectittit IL: TO BE COMPLETED zy PROGRAM STAFF
Purpose of Errrlirntion Current Level of Care provided
p emergency housing Provider Name:
D At Admission Project Name:
At discharge l 0 transitional housing'm 1 i
other:_ O
transitional l�ousin- nom-tx
Staff Initials: i
permanent housing r
services only
ATTACHMENT F
CLIENT CONTRIBUTION REPORT
NAME OF AGENCY SUBMITTING REPORT:
GRANT NUMBER:
MONTH OF SERVICE:
CLIENT NAME:
HMIS CLIENT IDENTITY NUMBER:
S TOTAL MONTHLY ADJUSTED INCOME
AMOUNT THIS MONTH TO CLIENT
$ AMOUNT THIS MONTH TO PROVIDER
SHP allows grantees to charge participants rent under specific guidelines outlined in 24 CFR 583.315 .
Rent collected from participants is considered program income.This means that grantees and project
sponsors must comply with the regulations at 24 CFR 84.24 and 24 CFR 85.25 regarding the use of
program income or use rent as permitted by 24 CFR 583.315(b)..
Use the guidance for grantees and project.-sponsors in calculating rents as instructed on
http://www.hudhre.infb/indek.cfm?do=viewShpDcskguideK.Please keep in mind that participants
who are paying utility costs are paying rental costs.
Nothing in the McKinney.-Vento Act or its implementing regulations requires program participants to
pay rent or occupancy charges for participation in-the.project.:However,when the grantee or project
sponsor does decide to charge the program participant, Section 426(d)of the McKinney-Vento Act and
24 CFR 583.315 set the maximum amount that may be charged.The maximum resident rent is the
higher of.
1. 30%of ihonthly adjusted income;
2. 10%of monthly gross income;or
3. the welfare rent(if applicable in your state;if unsure,check with the tRM Field Office).
Charging rent is optional and projects may charge rent as long as the amount does not exceed the
statutory limitations.If grantees or project sponsors decide to charge rent,the SHP Self-Monitoring
Tools worksheet in the"Tips&Tools"box will take you through the steps to arrive at the maximum
rent,and includes a section on determining resident rent for units when utilities are not included in the
rent.
Revised January 2011
ATTACHMENT G
US HUD —Annual Performance Report (APR) .
Continuum of Care for the Homeless including the
Supportive Housing Program (SHP)
Master Document
(This is a template designed to assist grantees required to complete the
Full CoC APR It is a model of the data collected in e-snaps. It is not
intended to replace electronic data collection in e-snaps. Field layout in
e-snaps may differ from the layout presented in this document.)
'A li
......:.... .::..
.:.....:.....
This is a template designed to assist grantees required to complete the Full COC APR. It is a model of the
data collected in e-snaps. It is not intended to replace electronic data collection in e-snaps. Field layout
in a snaps.may differ from the layout presented below.
Q1.Contact Information
Project Name
Project Sponsor
Grantee
Grant Number
Prefix
First Name
Middle Name
Last Name
Suffix
Title
Street Address 2
Street Address 2
city
State
Zip Code
E-mail address
Confirm,E-mail Address
Phone Number
Extension
Fax Number
Q3.Project Information—Content depends on"Type of Grant"selection
Type of Grant
Component Type
Identify if this project is operated by a victim service
provider as defined by the Violence Against Women
and Department of Justice Re-authorization Act of
2005(VAWA)
Was.this project funded under a special initiative
Target Subpopulation
Co.0 Number and Name
Amount of Contract or Award
Operating Year Covered by this APR
Is this an extension APR
Is this a final APR
Is this a corrected APR
Is this APR fulfilling the reporting obligation associated
with a 20-year use requirement
Q4.Site Information
Street/PO Box
City
State
Zip Code
Identify the program site configuration type
Identify the site type for the principal service site
Identify the housing type for the principal service site
Explain any changes made in this section from the Information provided in the original application.
Maximum Characters:2000
QS.Bed and Unit Inventory
Proposed Bed.and Unit Inventory
Total Number of Year Round Beds/Units from Application
Beds CH Beds(PH Only) Units
Households Without Children
Households With Children
-- - yes.[•. - Jjys'IT.;a..
i.�::'r': ... _
Total _ '--��="`^ ,� _ _.x,.,_ _
Actual Bed and Unit Inventory
Total Current Number of Year Round Beds/Units
Beds CH Beds(PH Only) Units
Households Without Children
Households With Children
a
J.11
YY' - _mods:.
is _
'•
Total -_�:.-r;;=:�--:._...._.__.. c
� - - - - -
Explanation of Changes
Explain any difference in the actual inventory from the information provided in the application.
Maximum Characters:2000
Q6. HMIS Bed Participation
HMIS Bed Participation
The total number of year-round beds in HMIS for households without children
The total number of year-round beds in HMIS for households with children
HMIS'bed coverage rate for year-round beds for households without children a-snaps calculates
HMIS bed coverage rate for year-round beds for households with children a-snaps calculates
Total HMIS bed coverage rate for all year-round beds a-snaps calculates
Q7.Data Quality
Total number of Clients
Total number of Adults
Total number of Unaccompanied Children
Total number of Leavers
HMIS or Comparable Database Data Quality
Data Element Don't know or Refused Missing Data
First Name
Last Name
SSN
Date of Birth
Race
Ethnicity
Gender
Veteran Status
Disabling Condition
Residence Prior to-Entry
Zip of Last Permanent Address
Housing Status(at entry)
.income(at entry)
Income(at exit)
Non-Cash Benefits(at,entry)
Non-Cash Benefits(at exit)
Physical Disability(at ent )
Developrnental Disability(at entry)
Chronic Health Condition(at entry)
Hl.v%AIDS'(at entryy
Mental Health(at entry)
Substance Abuse(at entry)
Domestic Violence(at entry)
Destination
i
3
Q8.Persons Served
Number of Persons in Household Served During the Operating Year
Total Without With Children With Only Unknown
Children and Adults Children Household Type
Adults ! _
�?+cata;�ate -
Children _ :}
�'.2#tt�lzl
Don't Know/Refused =%r
Information Missing
t^ ==r 71 pia
�-na
Total ,:....�..,p . :,.:•...,, .._.,:,_.,._...� < :.., '�,,....: w..._ - _-�, __
._ �^'..•:. ..__..c....r.._..-.::':....._ .c tay.-...:r:�....i-::��-cti'ti —iLj-� �!� - _ ^1+." :`<� _
Average Number of Persons Served Each Night
Total Without With Children With Only Unknown
Children and Adults Children Household Type
Average Number of Persons '. .
{'I TT-S:+'., =::yam?
��'es..
Point-in-Time of Persons Served on the Last Wednesday in
Total Without With Children With Only Unknown
Children and Adults Children Household Type
January
April =;#e3}±aps':•:.,:,T<<:
c-F3 Yr}��rjr,Y=i
}:
' 311a -'s
July
October
Q9.Households Served
Number of Households Served During the Operating Year
Total Without With Children With On Unknown
Children and Adults Children Household Type
Households
Point-in-Time Count of Household Served on the Last Wednesday in
Total Without With Children With Only Unknown
Children and Adults Children Household Type
January nP
April sna
July e=sas
acu7�t�s::
October
Q10.and Q11.Utilization Rates
Bed Utilization Rate
Average daily utilization rate during the operating ear
Point-in-Time bed utilization rate on the-last Wednesday in:
January
a jai'
-
e=srl.. 'sue. t :. = '. r>`; ; _ „ - • .:..}.;;.
April
July -
.P October - - -
Unit Utilization Rate
Point-in-Time unit utilization rate on the last Wednesday in:
January
' -- '�:^�v�•+r�s
April �
:..,•==*-c r.,-.,�.-z-;r::`.x'^:Y�:,.r".=a..:r.•s'=_r�•y.,.,�:..��,r,c:^t'r:�;`:�<^�:'°� ':{:•".v-;^'-'�f:,���:`:t�•,.;.
_-__ ���:�- - �c���-��ew,:,:� _-�,;;r;-.�- :'�;:_�='r --�''•^sue :,�x:�-
Jul
Y -?�x.r 3k{� =�a�r:�--::a..1:=rir•<�.:. - -i':r=„� �';r:• - .sue:_;
= ;295:. -- - - y:y,};.:r,".%:t...l::�fa-?:'�i'y': '�5;�,:;lu:::l.:: _ --_ ^.�`:•5W�_-=
October
Q12.Outreach Contacts and Engagements
Number of Persons Contacted During the Operating Year
All Persons First contact was at a First contact was at First Contact First contact
Contacted place not meant for a non-housing was at a housing place was
human habitation service site location missing
Once _...:...... :=r;
2-5 Times
.is fuC>•"L�
6-9 Times =`sari
10+Times
:...atcilate�u,r -
: .�_ �.
� a rra 1 es:.. - �s a �.::.ts
Total : � -- - - •=�-��. 1�!at _ ��,�;_•- ��,•t�.:.Ps�ea1 a e _„_�`
--,�y;i--�-�£':�..r.>'r' rzi =:_-; - v;j.� _
-
-r'r.r- J'• - -`.af, Y �:5:�
See-•.= - - -
::-2!":=,':.':
,! u?�'-: max'• .-
t:
- - -
.r.:=�� t#rte=:z^ •.-�`-
? ,..
Contacted
Number of Persons Engaged by Number of Contacts During the Operating Year
All Persons First contact was at a First contact was at First Contact was First contact
Contacted place not meant for a non-housing at a housing place was
human habitation service site location missing
1 Contact
2-5 Contacts -
6-9 Contacts na ;>
10+Contacts
• n .:tf --r.1aP W.�, _ _BPS �'5....._�_ :� .:::
Total -
.:..._..::•-. ..._... : _:..,..... •'--•::...:,,,.:::r i:�:-.r .;:?cam
l
!
Persons .._,. .s._.._,.:_;._.,.. . :_:.,.....--_.._._............ ...............-.._..,._...�.... �:..,.- `=�.�=:= -�=s..: _ _
-
Engaged
�..
1:.:... _
t.-ul - -Rate of Engagement : s� 3"n
S
Q15a1.Gender-Adults
Gender of Adults
Number of Adults in Households
Total Without With Children Unknown Household
Children and Adults Type
Mate
Female Q
N3:
Tra n sge ndered nzla..psteu `==K
Other _}
a:
Don't Know/Refused aapcai_ii %ratiPS
Information Missing IMP W-.. ff.l
Subtotal
Q15a2.Gender-Children
Gender of Children
Number of Children in Households
Total With Children With Only Unknown Household
and Adults Children Type
Maletsip`eaa;i rtesr
Female. 'fiapattaesJs'>>
Transgendered siaa' acsaTates �
Other _: =tpilat_ es r
Don't Know./Refused-
Information Missing
L ��sn iii":'` :::
_..1cu1: - _ea `iatt :mil :.
Subtotal .,.,�._...R._..._..,r-:�........,..�..�__.:.:, ...:.__-�•�;� - x� - __.:::�.:�=.:_,_„- ;�:�=:::.W
Q15a3.Gender—Missing Age
Gender of Persons Missing Age Information
Number of Persons in Households
Total Without With Children With Only Unknown
Children and Adults Children Household
Type
Male =srapSfa azs<r;%
Female e=snapsal aces;=
TransgenderediipslQuiates r`
Other ;tnaps.`a1fes=
Don't Know/Refused
Information Missing ehapsilailates
1 to 'ate '_��►�"s':ealeufates::-' �.`�?:':esna's:calailaies:
; srr� ala�laYes:::.:;.e=mapsca c� epaps. -
Subtotal _.:...,....�.�._.._�...::... .... . ...... .,>::; _ - _ -
i
Q16.Age
Age
Number of Persons in Household
Total Without With Children With Only Unknown
Children and Adults children Household Type_
Under
5-12
13-17
.. ....
18-24
25-34 e= ap�aceil ads::
35-44
.. ...................
45-54
55-61
... .........
62+ fe
Don't Know/Refused ..........
... ... ....
Information Missing
-total t
Q17a.Ethnicity/Race-Ethnicity
Ethnicity
Number of Persons in Households
Total Without With Children With Oniv Unknown
Children and Adults Children Household Type
Non-Hispanic/Non-Latino
Hispanic/Latino
Don't Know/Refused
Information Missing
jaec
Total
Q17b. Ethnicity/Race-Race
Race
Number of Persons in Households
Total Without With Children With Only Unknown
Children and Adults Children Household
Type
White
Black or African-American
Asian
American Indian or Alaska Native
..............
Native Hawaiian or Other Pacific
..
Islander .
Multiple Races
Don't know/Refused
Information Missing
X 7.
Total
40 RE
Q18a.Physical and Mental Health Conditions at Entry
Known Physical and Mental Health Conditions at Entry
Number of Persons in Households
Total Persons Without With With Only Unknown
Children Children Children Household
and Adults Type
Mental Illness =- = _MI
Alcohol Abuse :ti
_.
Drug Abuse 0004
Chronic Health Condition = iaQsli �atiK
HIV/AIDS and Related Diseases
Developmental Disability apau `s
1:- . '
Physical Disability W--
�eps.�aLc��fates....
Q18b.Number of Physical and Mental Health Known Conditions at Entry
Number of Known Conditions
Number pf.Persons'in Households
Total Persons Without With Children With Only Unknown
Children and Adults Children Household
Type
None
1 Condition serriisa ciae ;•
2 Conditions +!ap�' iTatesF.
3+Condi i O s n
t
Condition.Unknownri
Don't KnoW/Refused ? `%;<
Information Missing ialct? - t'
7 J = xalciilates- "; ates- .;e=spa s mil aft^s::- sna` to c1a.
Total
Q19.Domestic Violence.Experience
. . 19a.-Past Domestic Violence Experience
Number of Adults and Unaccompanied Children in Households
Total Without With Children With 6niv Unknown
Children and Adults Children Household Type
Yes V¢ naacfs==
No
" iapslcita# s:
Don't Know/Refused
Information Missing< = PaR
......, Wit► _ es::�: - _
Total -
19b.When Past Domestic Violence Experience Occurred
Number of Adults and Unaccompanied Children in Households
Total Without With Children With Only Unknown
Children and Adults Children Household Type
Within the past 3 Months =er%apsa5;=
3 to 6 Months Ago `Epc1 !asr'
6 to 12 Months Ago
More Than a Year Ago _ AM
Don't Know/Refused _
�;inaipsia'tes=
Information Missing
8
Q20al.Residence Prior to Program Entry—Homeless Situations
Residence Prior to Program Entry—Homeless Situations
Number of Adults and Unaccompanied Children in Households
Total Without With Children With Only Unknown
Children and Adults Children Household Type
Emergency shelter
Transitional housing for ± _ =-
homeless persons
Place not meant for :
Q21.Veterans Status
Veteran Status
Number of Adults in Household
Total Without With Children Unknown
Children and Adults Household Type
s
Veteran _Ps1
Not a Veteran aPfayi y
Don't Know/Refused °gsuapsiicCats 4
Information Missing gsnpslculaj
.. - a s i' ates >
�.S��Ps;;�_CULe��: =�;_S?1::P:.�.�C_ ,c,.
Total _ - -
Q22a1.Physical and Mental Health Types of Conditions—Leavers
Known Physical and Mental Health Conditions
Number of leavers
All Persons Adults Children Age Unknown
Mental Illness
stiaa3clats
Alcohol Abuse ;<n1: siilas =r=
Drug Abuse ~si aps a at . :,_
LAW
seaula N.
Chronic Health Condition ? ,.�._:µ:t
HIV/AIDS and Related Diseases asat}�
Developmental Disability rsrs, alcrates 'r
Physical Disability =! ► F` "}
1ajlat�s:;::
Q22a2.Physical and Mental Health Number of Conditions—Leavers
Number of Known Conditions
Number of Leavers
All Persons Adults Children Age Unknown
None
1 Condition ;> napscplats;'`= "`
2 Conditions _ ?► ` -`
3+Condiitions ..�::_::-
e;
%ysna taic�la#s' -
Condition Unknown _
Don't know/Refused M?� ''''==''
Information Missing =; Tai_salTaes== =
Total
10
Q22bi.Physical and Mental Health Types of Conditions—Stayers
Known Physical and Mental-Health Conditions
Number of Stayers
All Persons Adults Children Age Unknown
Mental Illness
Alcohol Abuse uiPs "=F ° Y
Drug Abuse
_=`S-:.=.max-.-��=..•i:;,it_..::.._..-:�:'.:fn'
Chronic Health Condition °rapsaCa#es}
HIV/AIDS and Related Diseases 'a ' ? - = _
Developmental Disability n%apsybts `F
Physical Disability =
Q22b2.Known Physical and Mental Health Number of Conditions—Stayers
Number of Known Conditions
Number of Stayers
All Persons Adults Children Age Unknown
.y...--
None 'r
�
3�fip$aiaies% -
1 Conditionapsalw- 1G7Nrf Nr_
2 Conditions `''
.s..
sialp3alaes; tip_
3+Conditions
Disabled—Unknown
Don't Know/Refused . r '=`
Information.Missing : �'.��-.,-:=• -- --- _
total
- - - -::.r•- - _ �.t: `:tom-r:'.
cvYTt ;= =sga
p:V
Q23.Client Monthly Cash-Income Amount—Adult leavers
Client Monthly Cash-Income Amount
Number of Adult Leavers
Program Entry Income Income Less Same More Unknown Average
at Entry at Income Income Income Income Change($)
Exit at Exit at Exit at Exit Change Monthly Income
per Adult
No Income
$•1-$156
$151-$250
$251-$500
$501-$750
$751-$1,000
$1,001-$1,250
$1,251-$1,500
$1,501-$1,750
$1,751-$2,00 0
$2,001+
Don't Know/Refused goo
Information Missing
Total � s= .`'?� ..• �►::w P S�<�41,
n
-
��a l�fes:•= ,�a.� ��r=ca. ..at?�.�,-'' tc�ates.�
Q24.Client Monthly Cash-Income Amount—Adult Stayers
Client Monthly Cash-Income Amount by Entry and Latest Status
Number of Adult Stayers
Program Entry Income Income Less Same More Unknown Average
at at Income at Income at Income at Income Change
Entry Follow-up, Follow-up Follow-up Follow-up Change ($)
Monthly
Income
per Adult
No Income
$1-$15 0
$151-$250
$251-$500
$.561-$750
$751-$1,000
$1;001-$1,250
$1,251-$1,500
$1,751-$2,000
$2,001+
Don't Know/Refused
Information Missing _
Total _
u'
Q25al.Cash Income Sources—Leavers
Type of Cash-Income Sources
Number of Leavers
Total Adults Children Age Unknown
Earned Income --°
Unemployment Insurance
SSI = SdCSIjPSM?
SSDI
e=snaK ? s=r.fi
Veteran's Disability
Private Disability Insurance napscalasr s
Worker's Corn einsation
TAN or Equivalent -: "a ;,si 'a =-M _
General Assistance
Retirement(Social Security) raPsakfat =r
Veteran's Pension firajSscules. -;w
Pension from Former Jobe=snal `r ;� °
Child Support 0904,pS o M
Alimony(Spousal Support) !1K: ±i1tes:=_R`_
Other Sourcesiasaficfia _
12
Q25a2.Cash Income Number of Sources—Leavers
Number of Cash-Income Sources
Number of Leavers
Total Adults Children Age Unknown
No Sourcesia_Rs.: t; r <?
1+Source(s) epsla#±es
Don't Know/Refused-
Information Missing ak:�
<_�sr�a s..��ct�a�es�,•..:.>�r�.'1�s`S:a_cj.des;: --- �e#iiap._cats-�I�,:.s,:_.... _
Total
Q25bl.Cash Income Sources--Stayers
Type of Cash-Income Sources
Number of Stayers
Total Adults Children Age Unknown
tamed Income :?e s"aP1 °-
Unem to ment Insurance fe*5tapsi a[s Y»
SSI =s`rap5la#;e zv
SSDI t,ON'_
..Z_...
Veteran's Disability - a5taes. •
Private Disability Insurance si%asaces3z�Fez
Worker's Compensation pseites A"�`
TANF or Equivalent
General Assistance
Retirement(Social Security) =
Veteran's Pension !'a ? _ `=�-=
Pension from Former Jobap5a ;? R's.
Child Support I?21Fsk3es
Alimony(Spousal Support) !=?'Ps !fi '
Other SourceY^~" � 1 =� «
Q25b2.Cash Income Number of Sources—Stayers
Number of Cash-Income Sources
Number of Stayers
Total Adults Children Age Unknown
No Sources =iapsCalcElas
1+Source(s)
Don't Know/Refused
Information Missing :�Ps> � ± _-`-
_. _
e-ana cakf =r >:e=;aa ea_I:ciitates:::;:;: `e st�a ciila
Total ._. �....,. _...__-.._..r,.._...: .._.�...:.................._.�... ._......_.....�.......-. ��:. -
13
Q26ai.Non-Cash Benefit Sources—Leavers
Non-Cash Benefits
Number of Leavers
Total Adults Children Age Unknown
Supplemental Nutritional Assistance Program
MEDICAIb Health Insurance _
MEDICARE Health Insurance
State Children's Health Insurance ? =
WIC =e's!' 'taV_
VA Medical*Services ,,.r `apsa� a =: r
TANF Child Care Services
a s c eS�F
TANF Transportation Services
h rTA F-F nded Services nascalc�ate-='`
Temporary Rental Assistance ips:ac1 <.
Suction 8,Public Housing,Rental Assistance ,{
Other Source
Q26a2.Number of Non-Cash Benefit Sources—leavers
Number of Non-Cash Benefit Sources
Number of Leavers
Total Adults Children Age Unknown
No Sources. s�afe�iates"rah•
1+Source(s) riap3aliates -
e=sib""
Pon.'t Know/Refused
Information Missing Yeaaps �culs;_ -
►� �Ic�Taes cats
Total
Q26b2.Non-Cash Benefit Sources—Stayers
Non-Cash Benefits
Number of Stayers
Total Adults Children Age Unknown
Supplemental Nutritional Assistance program ' s . '
MEDICAID Health Insurance =? ss? ?!fes
MEDICARE Health Insurance eps'_aicla
State Children's Health Insurance psac}aes'_-
WICs�apsalcafs
VA Medical Services = apslc1aies V
TANF Child Care Servicesps
TANF Transportation Servicessnavps`zacala#s
Other TAN F-Funded Services
Temporary Rental Assistancetaps: clates==_'
Section 8,Public Housing,Rental Assistance == =;s►aipss
Other Source ePsi
14
Q26b2.Number of Non-Cash Benefit Sources—Stayers
Number of Non-Cash Benefit Sources
Number of Stayers
Total Adults Children Age Unknown
No Sources e-sbapatcla#es=F�
1+Source(s) ' -
Don t Know/Refused
Information Missing
ROO .�
�:. ..rte_.•l_"..'<.-:: ..:_. -- - -_- -
t+i-r
-
Total
Q27.Length of Participation
Length of Participation by Exit Status
Number of Persons
Total LeaVers Stayers
30 days or less1" #
31 to 60 days ads° ailats �;
61 to 180 days
181 to 365 days
ha �ltilate3' Y 'Wi=t'
366 to 730 days(1-2 Yrs)
731 to 1,095 days(2-3 Yrs)
1,096 to 1,460 Oa Y s(3-4 Yrs)
1,461 to 1,825 days(4-5 Ws)
_ .. .T:;:;.���:�i;��ter:�;:�•:t
More than 1,825 days(>5Yrs)
Information Missing
- -
`��
Total - •`. - - - -
Average and Median Length of Participation in Days
Average Length Median Length
Leavers
Stayers
15
Q29ai.Destination at Program Exit-Leavers Participating More Than 90 Days
Exit Destination—Persons Participating More Than 90 Days
Number of Leavers In Households
Permanent Destinations
Total Without With With Only Unknown
Children Children Children Household
and Adults Type
Owned by client no ongoing subsidy fi...r.aPs
,.
Owned by client,with ongoing subsidy : -
��sn�pzca�IciFa�es..
Rental by client,no ongoing subsidy � r
Rental by client,VASH subsidy a _ =
Rental by client,other ongoing subsidy aiuF
PSH for homeless persons
Living with family,permanent tenure t ±
Wing with friends,permanent tenure
Subtotal "-Ni'WWmWiW5,4
—.-, f...
Temporary Destinations
Emergency shelter !
Transitional housing for homeless ap''itc '
persons
Staying with family,temporary tenuresaRs'd
Staying with friends,temporary tenure eapates
Ii.
Place not meant for human habitationehapr
Safe Havene' '%apscaisiaes:z4
Hotel or motel,paid by client '' n(�isa ].atesz
- - - -' -°:•.c�z�-:v:_°.:;J-•,:r aa���_-i:_'�,->ai;.r` ='r'� -- ='.r%' - - ^'5::�.
Subtotal ��.I?.�a%ulakes.��. -,P,<_ts==•-�' .:a!P...._,- �.�� _•p�:r.: _ra'
:��-;. .�.�_ :��-%= - la3es_ 'Itu� -�=�.: �a�a•y�ta� __ ..i-. a.
..�•:..._...-..� yid� ._ - ':'.--'� ~�5' 1�.t25=-'<==� ���1.. `:-�s:�`:'.
Institutional Settings
Foster care home or group foster care =eiiapsal ats`=
home
Psychiatric facility - `
eapslt��iate5:;;
Substance abuse or detox facility .I..
%a-s aCiales w
Hospital(non-psychiatric)
Ja'il r'ison or juvenile detention facility e�=3zjapsa is
later:;__
Subtotal --:.:::t.. ..�.� :�:..-�•--',--•��- :.r;;: _ _ _
r-_ =
Other Destinations
Deceased apscafctilaies
Othert %apra# far;`
Don't Know/Refused
ae=5a lci,aes_
Information M"issing
sn sca later," as :mss n Subtotal
-
-
.__._:_:..:;:_�..... ...,... ....:.w:<.._...._..._..:....._._:=.�-_.,_-.. tip':=:.
.;; ;a s,•Y' a€es s,a f's is i _ tta` s'ecsr%a
Total
't�' `�Jw�'- r r]'i-.;.�¢:��A.l_< _ _�J•'�.- -}[''- mot`'-".:•;..c:._..�i��.-c.._i:'-�
16
Q29a2.Destination at Program Exit—Leavers Participating 90 Days or Less
Exit Destination—Persons Participating 90 Days or Less
Number of Leavers in Households
Permanent Destinations
Total Without With Wi h Only Unknown
Children Children Children Household
and Adults Type
Owned by client,no ongoing subsidy asi1 a
Owned by client,with ongoing subsidy ± ax±es==
Rental by client,no ongoing subsidy patches
map;;
Rents!by client,VASH subsidy
Rental by client,other-ongoing subsidy � �
PSH for homeless persons. ? 5
Living with family,permanent tenure
Living with friends,permanent tenure _1?���- ? °}
SubtotalsnapsS. las
_ �a "rte
J:c',-`•hj?,�- < _ - :k`-- _ u?:'-er. e� - °y41�1•yt'' '���•���v`tPIRE
Temporary Destinations
Emergency shelter _ a
Transitional housing for homeless ! rs;
persons
^E.
Staying with family,temporary tenure .:._
Staying with friends,temporary tenure '^ wru
,�c±'latie�r'
Place'not meant for human habitation f ` caje llat
Sz :
Safe Haven
Hotel or motel,paid by client ?_
-h4.: ;r,,:•-_ :'+'=cr.-F_'...; ir=s-=',
t-i:_i_� •.*i:�'=r = ...:•i^.rte vary.._?r_• _ -
-k. - 1 }?_ - U: ;%,, ,:• ;:� . _ :
Subtotal -
ik$pf7r ales; r}
Institutional Settings
Foster care home or group foster carep--
home:.
Psychiatric facility '_ � t_ =
Substance abuse or detox facilitya _y4?' jz
Hospital(non-psychiatric)
Jail,prison,or juvenile detention facility ?! _
- - - -- :r.: -::;ri••+:i 1:-"-xc=. - -=i•� :k. - --- .�pr...T::.r'-r,f:.0=:��::<t::
Subtotal re�naipsalrtate�di � snaps �p ,_•`' rsa?'psY .,- _�e !►aPS �_.
;;Gl_;4i;,�r.._ z r•I. r -S•o_.,z:.1":�c�i-�_ r "-:�""': �' �-:��- �.^ -=,cr;! ..�.
Other Destinations
Deceased =�g=sngpcai ±� `-=
Other J ►ap° tlaess`-
Don't Know/Ref used
=aoapsitaes'
Information.Missing
:f::.=•�+����.%::':i"r:.`.`tea,.•<: ..::� •�
Subtotal ___.
,2+!'
1•
-:T r�Zvi= ..' •rim. - �.v'r:`. - -?T•:.=- -
>,�.;,_,�_ --=.,. _w1•'_ fates:>��; �tlaes::
n rtes,=
Total _�.�� r.:s». t��= _,.� :c jti '7'rT -:.�L::• ��:,^n t _:• ,
;�.''_ ..F,, _ _ r.;{'- _ <C._ s6.__ ��r,.. - •.,;?.-:�:
- =
.. _mss..::.::: ..... . .. ... :.
17
i
Q3 0a1.SHP Expenditures—Development Costs
SHP and Cash Match Expenditures During the Operating Year—Development Costs
Expenditure Type SHP Funds Cash Match Match% Total Expenditures
Acquisition -' paps:aiifiater`? ap ;tes
�,_:,,,��1a}•. :r�,:��r
Rehabilitation
New Construction see=n�l�srtclat � iar1_c?as' <
:__cr?�..:::=r:_ —:x.,:^'4k:r..•-:;,. yr-;. � r
X5118 S'°�3 Cti Q - Ga25 - {a'fFatr [' ':
Development Subtotal
Q3Oa2.SHP Expenditures—Supportive Services
SHP and Cash Match Expenditures During the Operating Year-Supportive Services
Expenditure Type SHP Funds Cash Match Match 96 Total Expenditures
Outreach
Case management
Life skills(not case management)
Alcohol and drug abuse services
Mental health services
AIDS—related services
Other health care.services
Education
Housing placement
Employment assistance
Child care
Transportation
Legal
Other
Services-Subtotal
Cash Match Expended ,y.: , - e` ia�slculatessnap� `icultesl =Y°
Q3Oa3.SHP Expenditures—HMIS
SHP and Cash Match Expenditures During the Operating Year—Wit
Expenditure Type SHP Funds Cash Match 96 Total Expenditures
Match
Equipment(server,computers,printers)
Software(software fees,user licenses,
software support)
Services(training,hosting,programming)
Personnel(costs associated with staff)
Space and operations
Stipends to agencies
Other(please specify below)
HMIS-Subtotal s?=psca.�olaties
r
Cash Match Expended
18
Q30a4.SHP Expenditures—Leasing,Operating,and Administration
SHP and Cash.Match Expenditures During the Operating Year—Leasing,Operating,&Admin
Expenditure Type SHP Funds Cash Match Match% Total Expenditures
e=9aa"salctts ivalila :=
Real Property.Leasing
Operating Costs -sna� catc�aa pare
ces= - nap`sal"
Administration
Leasing,Operating,Admin-Subtotal
SHP and Cash Match Expenditures During the Operating Year-Totals
Total SHP Expenses SHP Funds Cash Match Match% Total Expenditures
F ca ` - : si±ale7sri _. a
aps: Cttales. sf±aPz1� _. _= a!!aA:
Development -
- a
tia" ^ICUlates 'na F�: aT s"� _.
Supportive Services
ls
_
- tc�ls�_.,- r%a s_ lc�ates
[iags:#alau ? Sep P- - -
Real Property Leasing " " _ --- :_ _ _
-
Operating Expen ses .' , naz _-:,mss lH M IS it#-l!aa-
te�ess y=
_
-1. � r F•
HP Ex nses—Subtotal = na ?._ 'maps fasiyas ,::,
1c�to �at�s'%%•,-.:.
Administration _-
pa
Total Expenses =� ---- --�--• _�?.: _�_tY _ ���:
Q33.SRO Value of Services Received
Value of Supportive Services Received by SRO Clients During the Operating Year
Supportive Service Match Value($)
Outreach
Case management
Life skills(outside of case management)
Alcohol and drug abuse services
Mental health services
AIDS—related services
Other health care services
Education
Housing placement
Employment assistance
Child care
Transportation
Legal
Other
baps> I
Total :` -
Q34.Percent HUD McKinney-Vento Funding
What percentage of this project's annual budget(services,leasing,operation,
HMIS,administration)is represented by HUD McKinney-Vento funding?
Q40.Significant Program Accomplishments
Please describe any significant accomplishments achieved by your program during the operating year.
Maximum Characters:2000
Q42.Additional Comments
Please provide any additional comments on other areas of the APR that need explanations,such as a
difference in anticipated and actual programs outputs or bed utilization.
Maximum Characters:2000
20
ATTACHMENT H
Form W=9 Request for Taxpayer Give form to the
Rev.Janumy 2003) Identification Number and Certification `eqtesta'°o not
Department of do Treasury send to the IRS.
Internal Reverm Service
N Nanko
UP
Cn
Business name.V afferent from above
C
O
d lndh►Idtsv bwJP
Check appropriate bon: ❑ Sole proprietor ❑ Corporation ❑Partnershlt ❑Other 01 ------------- --- ❑withholding
°
� name and address(optional
Address(number.street end apt.or suite no.) Requester's
coy,state,and ZIP code
Prf V^,L( + (-19 1
fist account number(s)We(optbnall
M. 117-
. Talx' � dr Identification Number
Enter your TIN in the appropriate box.For Individuals,this is.your social security number(SSN). Soil security number
However;.fgr a rasideht alien,sole proprietor,or disregarded.entit y,.see the Part I Mstructions an
page 3..For other ehbties,it.is your employer identfication number(EIN).If you do not have a number,
see Hoar to get a TIN on page 3. or
Note:If the account is in more than one name,see the chart on page 4 for guidaMes on whose number ratification number
to enter.
Certification
Under penalties of perjury,1 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 ORS)that 1 am WbJect to backup withholding as a result of a failure to report all Interest or dividends,or(c)the IRS has
notfied me that I am no longer subject to backup withholding,wW
3. 1 am a-US.person(Including a U.S.resident alien).
Certification instructions.You must cross out item 2 above if you have been notified by the.IRS that you are currently subject to backup
withllidding because you have failed to report all interest and dividends on your tax return.For real estate transactions,ttem 2 does not apply.
For mortgage,interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement
arrange.Morit.ORA),and generally;payments tither than.interest and dividends.you are not required to sign the Certification.but you must
provide your correct TIN.(See the instructio s on.Rage 4.)
Sign Sigrtaa,re of Here U.S.Person 10, Da>Ve b. C> t�S
Purpose of Form Nonresident alien who becomes a resident alien.
-Generally,only a nonresident alien individual.may use the
A person who is required to Fie an information return with terms of a tax.treaty to reduce or eliminate U.S.tau on
the IRS, must obtain your correct taxpayer Identification certain types of income_However,most tax treaties contain a
number(TIN)to report,for example,aicome paid to you:real provision.known as a"saving clause."Exceptions specified
estate transactions, mortgage interest you paid, acquisition in the saving clause may per
an exemption from tax to
or abandonment of secured property,cancellation of debt,or continue for certain types of income even after the recipient
contributlons you made to an IRA. has otherwise become a U.S.resident alien for tax purposes.
ll,S.meson. Use Form W-9 only if you are a U.S.person If you are a U.S.resident alien who is relying on an
(including a resident alien),to provide your correct TIN.to the exception contained in the saving clause of a tax treaty to
person requesting it(the requester)and,when applicable,to: claim an exemption from U.S,tax on certain types of income.
1.Certify that the TIN you are giving is correct(or you are you must attach a statement that specifies the following fire
waiting for a number to be issued), - items:
2.Certify that you are not subject to backup withholding, 1.The treaty country.Generally,this must be the same
or treaty under which you claimed exemption from tax as a
3.Claim exemption from backup withholding if you are a nonresident alien.
U.S.exempt payee. 2.The treaty article addressing the income.
Note:If a requester gives you a form other than Form W-9 3.The article number(or location)in the tax treaty that
to request your TIN,you must use the requester's form if it Is contains the saving clause and its exceptions.
substantially similar to this Form W-9. 4.The type and amount of income that qualifies for the
Foreign person.If you are a foreign person,use the exemption from tax.
appropriate Form W-8(see Pub. 515,Withholding of Tax on S. Sufficient facts to justify the exemption from tax under
Nonresident Aliens and Foreign Entities). the terms of the treaty article.
Cat.No.10231X form W-9(Rev.1-2003)
ATTACHMENT I
Applicant Certification
These certified statements are required by law.
Previous versions obsolete form HU"00"4
• A. For the Supportive Housing (SHP), Shelter Plats Care (S+Q, and Single Room Occupancy
(SRO)programs:
Fair Housing and Equal Opportunity.
It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulations
pursuant thereto (Title 24 CFR part 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 Discrianination 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.
Page 1 of 2
It will comply with Executive Orders 11625, 12432,and 12138, which state that program participants
shall take affirmative action to encourage participation by businesses owned and operated by members
of minority groups and women.
If persons of any particular race, color,religion, sex,age,national origin, familial status, or disability
who may qualify for assistance are unlikely to be reached, it will establish additional procedures to
ensure that interested persons can obtain information concerning the assistance.
It will comply with the reasonable modification and accommodation requirements and,as appropriate,
the accessibility requirements of the Fair Housing Act and section 504 of the Rehabilitation Act of
1973,as amended.
Additional for S+C:
If applicant has established a preference for targeted populations of disabled persons pursuant to 24
CFR 592.330(a), it will comply with this section's nondiscrimination requirements within the
designated population.
D.For SHP Only.
20-Year Operation Rule.
For applicants receiving assistance for acquisition,rehabilitation or new construction: The project will
be operated for no less than 20 years from the date of initial occupancy or the date of initial service
provision for the purpose specified in the application.
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 wiill'be operated
for the purpose specified in the application for any year for which such assistance.is provided.
C.For S+C Only. Supportive Services.
It will make available supportive services appropriate to the needs of the population served and equal
in value to the aggjegate amount of rental assistance funded by HUD for the full term of the rental
assistance.
D.Explanation.
Where the applicant is unable to certify to any of the statements in this certification, such applicant
shall attach an explanation behind this page.
Signature of Autborized Ce ing Official: Date:
ca Ish
2
Title-
VY\ ln�
Applicant: For PHA Applicants Only:
Ct,-TI b � 1� � (PHA Number)
ATTACHMENT 1—FORM HUD 400904 Page 2 of 2
ATTACHMENT J
MIAMI-DA.DE COUNTY HOMELESS TRUST
MIAAH-DADE COUNTY REQUIRED AFFIDAVITS
The contracting individual or entity(governmental or otherwise)shall indicate by an"X"all affidavits that pertain
to this contract and shall indicate by an "N/A" all affidavits that do not pertain to this contract. All blank spaces must be
filled.
The MIAMI-DADS COUNTY OWNERSHIP DISCLOSURE AFFIDAVIT; MIAMI=DADE COUNTY
EMPLOYMENT DISCLOSURE AFFIDAVIT; MIAMI-DADE CRIMINAL RECORD AFFIDAVIT; DISABILITY
NONDISCRIMINATION AFFIDAVIT; and the PROJECT FRESH START AFFIDAVIT shall not pertain to contracts
with the United States or any of its departments or agencies thereof; the State or any political subdivision or agency
thereof or any municipality of this State. The MIAMI-DADE FAMILY LEAVE AFFIDAVIT shall not pertain to
contracts with the.United States or any of its departments or agencies or the State-of Florida or.any political subdivision or
agency thereof; it shall, however, pertain to municipalities of the State of Florida. All other contracting entities or
individuals shall read carefully each affidavit to determine whether or not it pertains to this contract.
I, �+1 c - ��� ,.being first duly sworn state:
Affiant
The full legal name and business address of the person(s)or entity contracting or transacting business with Miami-Dade
County are(Post Office addresses are not acceptable):
Federal Employer Identification Number(If none;Social Security)
Name of Entity,Individual(s),Partners,or Corporation
Doing Business As(if sarhe as above,leave blank)
S t Address City State Zip Code
MIAMI-DADE COUNTY OWNERSHIP DISCLOSURE AFFIDAVIT(Sec.2-5.1 of the County Code)
1. 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 addresses are(Post Office addresses are not acceptable):
1 of 5
Full Legal Name Address Ownership
2. The full legal.names and business address of any other individual(other than subcontractors, material men,
suppliers,laborers,or lenders)who have,or will have;.any interest(legal,equitable beneficial or otherwise)
in the contract or business transaction with Dade County are(Post Office addresses are not acceptable):
3. 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 the County jail for up to sixty(60)days or both.
1I. MIAMI-DARE COUNTY EMPLOYMENT DISCLOSURE AFFIDAVIT(County Ordinance No.90-
133,Amending sec.2.8-1;Subsectiou.(idX2)of the County Code).
Except.where precluded by federal or State laws or regulations, each contract or business transaction or renewal
thereof which involves the expenditure of ten thousand dollars ($10,000) or more shall require the entity
contracting or transacting business to disclose the following information. The foregoing disclosure requirements
do not apply to contracts with the United States or.any department or agency thereof,the State or any political
subdivision or agency thereof or any municipality of this State.
1. s your firm have a collective bargaining agreement with its employees?
Yes No
2. your firm provide paid health care benefits for its employees?
Yes No
3. Provide a current breakdown(number of persons)of your f run's
work force and ownership as to race,national origin and gender:
White:3-�a Males(C"3 Females Asian; �° Males Females
Black:2,116 Male$ Females American Indian: Males Females
Hispanics.--1 Li _Males ' Females Aleut(Eskimo): Mates Females
Males Females: CgAm,.,.s►n: -�� Males Females
I. AFFIRMATIVE ACTION/NONDISCRIMINATION OF EMPLOYMENT, PROMOTION AND
PROCUREMENT PRACTICES(County Ordinance 98-30 codified at 2-8.1.5 of the County Code.)
In accordance with County Ordinance No. 98-30, entities with annual gross revenues in excess of$5,000;000
seeking to contract with the County shall, as a condition of receiving a County contract, have; i) 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 ii)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
boards of directors are representative of the population make-up of the nation shall be presumed to have non-
discriminatory employment and procurement policies..and shall not be required to have written affirmative action
plats and procurement policies in order to receive a- County contract. The foregoing presumption may be
rebutted.
2 of 5
The requirements of County Ordinance No. 98-30 may be waived upon the written recommendation. of the
County Manager that it is in the best interest of the County to do so and upon approval of the Board of County
Commissioners by majority vote of the members present.
The firm does not have annual gross revenues in excess of$5,000,000.
The firm does have annual revenues in excess of $5,000,000; however, its Board of Directors is
representative of the population make-up of the nation and has submitted a written,detailed
listing of its Board of Directors, including.the.race or ethnicity of each board member,to the County's
Department of Business Development, 175 N.W, 1 st Avenue,28th Floor,Miami,Florida 33128.
The firm has annual gross revenues in excess of$5,000,000 and the firm does have a written affirmative
action plan and procurement policy as described above, which includes periodic reviews to determine
effectiveness, and has submitted the plan and policy to the County's Department of Business
Development 175 N.W. 1"Avenue,28th Floor,Miami,Florida 33128;
The firm does not have-an affirmative action plan and/or a procurement policy as described above,but has
been granted a.waiver.
MIAMI-DADE COUNTY CRIMINAL RECORD AFFIDAVIT(Section 24.6 ofthe County Code)
The individual or entity entering into a contractor receiving.funding from the County has no as of
the date of this afdavit been convicted of a felony during the past ten(10)years.
An officer, or,or executive of the entity entering into a contract or receiving funding from the County
has as nol as of the date of this affidavit been convicted of a felony during the past ten(10)years.
MIAMI-DADE EMPLOYMENT DRUG-FREE WORKPLACE AFFIDAVIT(County Ordinance No.
92-15 codified as Section 2-8.1.2 of the County Code)
That in compliance with Ordinance No. 92-15 of the Code of Miami-Dade County, Florida,the above nained
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.r availability of drug counseling,rehabilitation and employee assistance programs
4. penalties that may be imposed upon employees for drug abuse violations
The person or entity shall also require an employee to sign a statement,as a condition of employment that the
employee will abide by the terms and notify the employer of any criminal drug conviction occurring no later
than five(5)days after receiving notice of such conviction and impose appropriate personnel action against the
employee up to and including termination.
Compliance with Ordinance No. 92-15 may be waived if the special characteristics of the product or service
offered by the person or entity make it necessary for the operation of the County or for the health, safety,
welfare, economic benefits and well-being of the public. Contracts involving funding which is provided in
whole or in part by the United States or the State of Florida shall be exempted from the provisions of this
ordinance in those instances where those provisions are in conflict with the requirements of those governmental
entities.
J of 5
1.. MIAMI-DADE EMPLOYMENT FAMILY LEAVE AFFIDAVIT (County Ordinance No.
142-91 codified as Section I 1 A-29 et.seq of the County Code)
That in compliance with Ordinance No. 142-91 of the Code of Miami-Dade County,Florida,an employer with
fifty(50)or more employees working in Dade County for each working day during each of twenty(20)or more
calendar work. weeks, shall provide the following information in compliance with all items in the
aforementioned ordinance:
An employee who has worked for the above-firm at least one(l)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.
VII. DISABILITY NON-DISCRIMINATION AFFIDAVIT(County Resolution R-385-95)
That the above named arm,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 includin employm ent,
g,but not limited to,those provisions pertaining to
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.C.Sections 225 and 611 including Title 1,Employment;Title
II, Public Services; Title III, Public Accommodations and Services Operated by Private Entities; Title IV,
Telecommunications; and Title V, Miscellaneous Provisions; The Rehabilitation Act of 1973, 29 U.S.C.
Section 794;The Federal'transit Act,as amended 49 U.S.C.Section 1612;The Fair Housing Act as amended,
42:t)-.S.C.Section 3601-3631. The foregoing.requirements shall not pertain 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.
III. MIAMI-DADIJ COUNTY REGARDING DELINQUENT AND CURRENTLY'DUE FEES OR
TAXES(Sec.24.1(c)of the County Code)
Except for small purchase orders and sole source contracts,that above named firm,corporation,organization or
individual desiring to transact business or enter into a contract with the County verifies that all delinquent and
currently due fees or takes-- 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.
CURRENT ON ALL COUNTY CONTRACTS,LOANS AND OTHER OBLIGATIONS
The individual entity seeking to transact business with the County is current in all its obligations to the County
and is not:otherwise in default of any contract,promissory note or other loan document with the County or any
of its agencies or instrumentalities.
4 of 5
PROJECT FRESH START(Resolutions R-702-98 and 358-99)
Any firm that has a contract with the County that results in actual payment of$500,000 or more shall contribute
to Project Fresh Start, the County's Welfare to Work Initiative. However, if five percent (5%) of the firm's
work force consists of individuals who reside in Miami-Dade County and who have lost or will lose cash
assistance benefits (formerly Aid to Families with Dependent Children) as a result of the Personal
Responsibility and Work Opportunity Reconciliation Act of 1996; the firm may request waiver from the
requirements of R-702-98 and R-358-99 by submitting a waiver request affidavit.. The foregoing requirement
does not pertain to government entities,not for profit organizations or recipients of grant awards.
DOMESTIC VIOLENCE LEAVE(Resolution 185-00; 99-5 Codified At 11 A-60 Et. Seq. of the Miami-Dade
County Code).
The fine desiring to do business with.the County is in compliance with Domestic Leave Ordinance,Ordinance
99-5,codified at I IA-60 et.seq.of the Miami Dade County Code,which requires an employer which has in the
regular course of.business.fifty(50)or more employees working in.Miami-Dade County for each working day
during each of twenty(20)or more calendar work weeks in the current or proceeding calendar years,to provide
Domestic Violence Leave to its employees..
I have carefully read this entire five (5) page document entitled, "Miami-Dade County Affidavits" and have
indicated by an "X" all affidavits that pertain to this contract and have indicated by an"NIA" all affidavits that do not
pertain to this contract.
:
B y
(Signature of Affiant) (Date)
SUBSCRIBED AND SWORN'TO(or affirmed)-before me this S day of b o^,)
20)X by He/She is personally
known to me or has presented as identification.
(Type of Identification)
(Serial Number)
o�• ��,• W1 AD -PINE
:-
IVY COMMISSION#DD 995837
EXPIRES:September 26,2014
o °.•' Etiended Thru Notary Public Underwriters
( nor p.o _ o ` _ ._-_ (Expiration Date)
Notary Public—Stamp State of Notary Seal
(State)
s®fs
ATTACHMENT K
AFFIDAVIT OF MIAMI-DADS COUNTY
LOBBYIST REOISTRATION FOR ORAL PRESENTATION
(1) Project Title: 00 Project No:
(2) Department:
(3) Firm/Proposer's Name: ,C
Address: 1)C l Zip: '':�31'3�
Business Telephone: (3kAS)_ &_T? >—'7S00
(4) Lint All Members of the Presentation Team Who Will Be Participating in the Oral Presentation
NAME TITLE EMPLOYED BY TEL. O.
+VA-�f t tL STS l�l C'-t n.0 DS X13
A AJ r�i IP4r✓t t `3 °7�,`72�c�
(C-, IAA-P&--�� z �3---�
(ATTACK ADDITIONAL SHEET IF NECESSARY)
The individuals named above are registered and Registration Pee is not required for the Oral Presentation
ONLY. Proposers are advised that any individual substituted for or added to the presentation team after
submittal of the proposal and filling by staff. MUST register with the Clerk of the Board and pay all applicable
fees.
Other than for the oral presentation. Proposers who-wish to address the country commission,:a county board or
county committee. concerning any action, decision or mcorrimbridation of country-personnel regarding this
solicitation MUST register with the Clerk of the Board(pore BCCF0RM2DOC)and pay all applicable fees.
I do solemnly swear that all the foregoing facts are true and correct and.I have read or am familiar with the
provisions of Section 2-11.1(s)of the Code of Metropolitan Dade County as amended.
Signature of Authorized Representative:
Title: t)40n,,Y, L-47n �.•lo+l �—�
STATE OF E)n'
COUNTY OF alt.`
The four/eg"oing instrument was acknowledged before me
by f�t`�'�(,Q e �Y D C)k S ,a ,who is personally known
(Sole Proprietor,Corporation or
(Individual,Officer,Partner or Agent) Partnership)
To me or who has produced as identified and who did/did not take an oath.
(Sign buil )
MY COMMISSION#DD 995887
(Nam di; iovir
(Title of Rank) (Serial Number,if any)
ATTACHMENT L
DISCLOSURE OF SUBCONTRACTORS AND SUPPLIERS
Name of Community Based Organization-Agency:
Program Name: to IQS C_.) )T'P__t,—j4C_t_-
REQUIRED LISTING OF SUBCONTRACTORS ON AHAAH DADIE COUNTY CONTRACTS
In compliance with Miami-Dade County Ordinance 97-104,Agencies must submit a list of both
subcontractors and suppliers who will subcontract and supply materials outlined in the Scope of Services
to this Agency's Agreement A list of suppliers is necessary only if this Agreement is$100,000.00 or
more. This form or a comparable listing-meeting the requirements-of Ordinance No.97-104,must be
completed and submitted even if the Agency will not use subcontractors or suppliers on the contract.
The Agency should enter the word"none"under the appropriate heading in those instances where no
subcontractors or suppliers will be used on the contract.
Name of Subcontractor or Sub-Consultant Street Address City and State
Or Supplier
I hereby certify that the foregoing information is true,correct and complete
Signature of Authorized Representative:
Title:
Date: C 2
Agency Name: Cl i
Federal T.D.Number: - � -
Business Address: 0 L�D Cc>,�9-C�1z1' C TW-"
Telephone number:
Email Address:
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ATTACHMENT M
SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a)FLORIDA STATUTES ON
PUBLIC ENTITY CRIMES THIS FORM MUST BE SIGNED AND SWORN TO IN THE
PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO
ADMINISTER OATHES
1. This sworn statement is submitted to Miami Dade County by J&yTeFV4 p&-% C Vr1 viG*rint individual's
name and title in.blank). For v� 'nt name of entity sub�{th g, sworn.-
statement in blank),whose business address is —7C� C_ t-!�—t
and(if applicable)'whose Federal Employer Identification Number(FEIN)is P?I or if the
entity has no FEIN,include the Social Security Number(SSN)of the individual signing the sworn statement.
2. 1 understand that a "public entity crime"as defined in Paragraph 287.133(1)(g)Florida Statutes,means a
violation of any state or federal law by a person with respect to and directly related to the transaction of business
witb 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 tfie United States of America and involving
antitrust,fraud,theft,bribery,collusion,racketeering,conspiracy,or material misrepresentation.
3. 1 understand that "convicted"or "conviction"as-defined in Paragraph 287:133(1)(b)-Florida:Statutes means
a finding of guilt or a conviction of a public entity crime,with or without:an adjudication of guilt,in any federal
state trial court of record relating to charges brought by indictment or information after July 1, 1999,as a result
of'a jury verdict,non-jury trial,or entry of plea of guilty or bolo contendere.
4. 1 understand that an "affiliate" as defined in Paragraph 28.7.133 (1) (a) Florida Statutes means a) a
predecessor or successor of a person convicted of a public entity crime;or b)an entity under the control of any
natural person who is active in the management of the entity and who has been convicted of a public entity
crime. The term "a0liale" 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 equip'ment or income among persons wben not
for fair market value.under an amt's length agreement, $hall be.a pima.facie case that one person controls
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another person. A persn who knowingly enters into a joint venture with a person who-has been convicted of a
pubic entity crime in Florida during the preceding 36 months shall be considered.an affiliate.
S. 1. understand that a "person" as defined in Paragraph 287.1.33 (1)(e) Florida Statutes means any natural
person or entity organized under the laws of any state or of the United States of America with the legal power to
enter into a binding contract and which bids or applies to bid on contracts for the provision of goods or services
let by a public entity,or which otherwise transacts or applies to transact business with a public entity. The term
"person"includes those offi cers,directors, executives,partners,shareholders,employees,members and agents
who are active in the management of an entity.
6. Based on information and belief,the statement as.marked below and on the next page,is true in relation to the
entity submitting this sworn statement:
lease dedicate'which stalemenl applies by applying Ike IndlWdual Inidials in the blank).
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 35 months.
The entity submitting this sworn statement or one or more of its officers,directors,executives,partners,
shareholders,employees,members or agents who are active in 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
(please indicate IF the additional statement is.applicable)
CONTINUES ON NEXT PAGE
The entity submitting this sworn statement,or one or more of its officers,directors,executives,
partners,shareholders,employees,members,or agents who are active in the management of the
entity has been charged with and convicted of a public entity crime within the past 36 months.
However,there have been subsequent proceedings before a Hearing Officer of the State of Florida,
Division of Administrative Hearings and the Final Order entered by the Hearing Officer determined
that it was not in the public interest to place the entity submitting this sworn statement on the
"Convicted Vendor List"(attached is a copy of the Final Order).
I.UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICE
FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH ONE(1)OF THE PREVIOUS PAGE IS
FOR THAT PUBLIC ENTITY ONLY AND THAT THIS FORM IS VALID THROUGH THE LIFE OF
THE CONTRACT,
I ALSO UNDERSTAND THAT I AM REQUIRED TO:INFORM THE PUBLIC ENTITY PRIOR TO
ENTERING INTO A CONTRACT IN EXCESS- OF THE THRESHOLD AMOUNT PROVIDED IN
SECTION 287.017 FLORIDA STATUTES FOR CATEGORY 2 OF ANY CHANGE IN THE
INFORMATION CONTAINED IN THIS FORM.
(Signature and Date)
y ,
State ofl�Y't t;
County of l C41NU AAd e—
�E ONA LY APPEARED before me,the undersigned authority
� IrD� s (name of individual signing)who,after being sworn by me,
affixed his/her signature in thp s pace provided above on
this the 54"^-day of 0C �2_e_
NAIMA DE PINEDO
MY COMMISSION#DD 995887 NOTARY PUBLIC
EXPIRES:September 26,2014
Bonded Thru Notary Public Underwriters My commission a ims
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ATTACHMENT O
INSERT COPY OF
DECLARATION OF RESTRICTIVE COVENANTS
(IF APPLICABLE)
ATTACHMENT 0-1
INSERT COPY OF
DECLARATION OF RESTRICTIONS
(IF APPLICABLE)
S
ATTACHMENT P
FOR GOVERNMENT ENTITIES ONLY
Semi-Annual Employee Certification for Supportive Housing Programs
*This form is to be submitted to the Miami-Dade County Homeless Trust
every six(6)months.
Agency:
Project Number:
Project Name:
Period Covered:
The following employee(s) listed below worked solely on referenced SHP project
Employee Name(s):
Name Signature Date
Name Signature Date
Name Signature Date
Name Signature Date
By signing,I hereby certify that I have worked 100%of the time on the above referenced
Supportive Housing Program(SHP)project during the period specified above.
I
Supervisor Certification
Name Title
Signature Date
By signing,I hereby certify as the supervisor of the above named individual(s)that each has worked
solely on the above referenced grant during the time period delineated
I
MIAMI ATTACHMENT Q
fit", riw J
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)
❑ HT ❑ Primary Care ❑ SHP ❑ Emergency ❑ Challenge
Specific locatloa/address where Incident occurred:
TYPE OF INCIDENT
❑ ALTERCATION ❑ CLIENT DEATH
® CLIENT INJURY OR ILLNESS Cl THEFT
❑ SEXUAL BATTERY ❑ SUICIDE ATTEMPT
❑ PROPERTYDAMAGE ❑ OTHER INCIDENT
Specify
PARTICIPANT(S)1 WITNESS(ES)
(Please mark W or P for either Witness or Participant)
LAS'S'NAME,FIRST IDENTIFIER# CLIENT EMPLOYEE OTHER W/P
El
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DESCRIPTION OF INCIDENT
Give detailed account—who,what,where,when,why,how—add pages if necessary
CORRECTIVE ACTION AND FOLLOW UP
Immediate corrective action taken
Is follow up action needed? ®Yes ❑ No
If yes,specify
INDIVIDUALS NOTIFIED
Abuse Registry 1-800-962-2873 Applicable Law Enforcement Department
Indicate 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*Floor,Suite 310,Miami,Florida 33128;telephone(305)375-1490 and facsmilie(305)375-2722.
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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 In or mess. A medical condition of a client requiring medical treatment .
by a licensed health care professional sustained or allegedly sustained due to an
accident, act of abuse, neglect or other incident occurring while in the presence of'an
employee;in a Homeless Trust contracted program.
d. 'Other Incident. An unusual.occurrence or circumstance initiated by something other
than natural causes or out of the ordinary such as a tornado, kidnapping, riot, or
hostage situation,which jeopardizes the health,safety and welfare of clients.
e. Sexual Battery. An allegation of sexual battery by a client on a client,employee on a
client,or client on an employee as evidenced by medical evidence or law enforcement .
involvement.
f. Suicide Attempt. An act which clearly reflects the physical attempt by a client to
cause his or her own death while in the physical custody of the department or a
departmental contracted or certified provider,which results in bodily injury requiring
medical treatment by a licensed health care professional.
Property Damage
An incident involving damage to property procured with Homeless Trust funding.
Print Name of Person Submitting Report Signature
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