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Teen Job Corps, Inc. $13,000 o7 W3- ag 2 9Z COMMUNITY DEVELOPMENT BLOCK GRANT AGREEMENT :BETWEEN THE CITY OF MIAMI BEACH AND TEEN JOB CORPS, INC. This Agreement made and entered into this day of ri , 2014, by and between the CITY OF MIAMI BEACH, a Florida municipal c rporation having its principal office at 1700 Convention Center Drive, Miami Beach, Florida, 33139, (hereinafter referred to as "City"), and TEEN JOB CORPS, INC., a not-for profit corporation having its principal office at 7356 Gary Avenue, Miami Beach, Florida, 33141 (hereinafter referred to as "Provider"). WHEREAS, the City is an entitlement recipient of U.S. Department of Housing and Urban Development (HUD) grant programs, Community Development Block Grant (CDBG) funds, and HOME Investment funds (HOME), and the City expects to continue to receive entitlement funds from these grant programs to operate the City's housing and community development activities; and WHEREAS, each year, the City prepares a One-Year Action Plan detailing how it intends to allocate funds received from HUD to conduct eligible activities for the benefit of low and moderate-income Miami Beach residents; and WHEREAS, on May 8, 2013, the City's Community Development Advisory Committee (CDAC) approved the funding recommendation of the One-Year Action Plan for Fiscal Year(FY) 2013/2014 activities; and WHEREAS, in accordance with HUD regulations and the City's Citizen Participation Plan concerning the preparation of the One-Year Action Plan, the Administration held two (2) public meetings, receiving citizens' comments, and advertised a 30-day citizen comment period, from June 13, 2013, through July 12, 2013; and WHEREAS, on July 17, 2013, the City Commission approved Resolution No. 2013-28292 approving the One-Year Action Plan for Federal Funds for FY 2013/2014, and Value Added Enhancement Fund, in the amount of$13,000, to Provider for Teen Job corps located at 7356 Gary Avenue, Miami Beach, Florida, 33141. NOW, THEREFORE, in consideration of the mutual benefits contained herein, the City and Provider agree as follows: Section 1. Agreement Documents: Agreement documents shall consist of this Agreement and the following four (4) Exhibits, all of which are attached and incorporated in this Agreement: • Exhibit A- Scope of Services • Exhibit B - Documentation • Exhibit C - Budget • Exhibit D - Financial Management for CDBG-funded activities Section 2. Statement of Work: The Provider agrees to implement the Program in accordance with Exhibits A and B, which Program is summarized as follows: Teen Job Corps To provide at risk, low-income youth with employment training and vocational skills while reducing truancy and delinquency and improving the quality of life for all residents in Miami Beach. Agreement Amount: The City agrees to make available THIRTEEN THOUSAND DOLLARS ($13,000) for use by the Provider during the Term of the Agreement (hereinafter, the aforestated amount including, without limitation, any additional amounts included thereto as a result of a subsequent amendment(s) to the Agreement, shall be referred to as the"Funds"). Section 4. Alterations: Any proposed changes in the Program including, without limitation, the Budget in Exhibit II, shall first be submitted, reviewed, and approved, in writing, by the City Manager, which approval, if given at all, shall be at his sole reasonable judgment and discretion. Section 5. Method of Payment and Reporting Requirements: During the Term, Provider shall submit Monthly Program Progress Reports to the City on the 10th day of each month, respectively. As part of the report submitted in October, 2014 the Provider also agrees to include, a comprehensive final report covering the agreed-upon Program objectives, activities, and expenditures, and including, but not limited to, performance data on client feedback with respect to the goals and objectives outlined in Exhibit A. Exhibit B contains reporting forms to be used in fulfillment of this requirement. Other reporting requirements may be required by the City Manager in the event of Program changes; the need for additional information or documentation arises; and/or legislative amendments are enacted. Reports and/or requested documentation not received by the due date shall be considered delinquent and may be cause for default and termination of this Agreement, pursuant to Section 12 hereof. Section 6. Monitoring: At its discretion, the City may schedule at least one (1) annual on-site monitoring visit with the Provider to evaluate the progress of the Program, and/or to provide technical assistance. At the City's option, a desk top review of the activities may be conducted in lieu of an on-site visit. Section 7. Additional Conditions and Compensation: The parties acknowledge that the Funds originate from CDBG grant funds from HUD, and must be implemented in full compliance with all of HUD's rules and regulations. In the event of curtailment or non- production of said federal funds, the financial sources necessary to continue to pay the Provider all or any portions of the Funds will not be available. In that event, the City may terminate this Agreement, which termination shall be effective as of the date that it is determined by the City Manager, in his sole discretion and judgment, that the Funds are no longer available. In the event of such termination, the Provider agrees that it will not look to, nor seek to hold the City, nor any individual member of the City Commission and/or City Administration, personally liable for the performance of this Agreement, and the City shall be released from any further liability to Provider under the terms of this Agreement. Section 8. Compliance with Local, State and Federal Regulations - The Provider agrees to comply with all applicable Federal regulations as they may apply to Program administration and to carry out each activity in compliance with the laws and regulations as described in 24 CFR 570 Subpart K, as same may be amended from time to time. Additionally, the Provider will comply with all State and local (City and County) laws and ordinances hereto applicable. It shall be the Provider's sole and absolute responsibility to continually familiarize itself with any and all such applicable Federal, State, County, and City regulations, laws, and/or ordinances. Section 9. Restrictions for Certain Resident Aliens - Certain newly legalized aliens, as described in 24 CFR Part 49, are not eligible to apply for benefits under covered activities funded by the CDBG Program. "Benefits" under this section means financial assistance, public services, jobs, and access to new or rehabilitated housing and other facilities made available under activities funded by the CDBG Program. "Benefits" do not include relocation services and payments to which displacees are entitled by law. 2 I Section 10. Assignment/Subcontract: No part of this Agreement may be assigned or subcontracted without the prior written consent of the City, which consent, if given at all, shall be at the City's sole discretion and judgement. Section 11. Term: This Agreement shall be deemed to have commenced retroactively, as of October 1, 2013, and shall terminate on September 30, 2014, (the Term), with the understanding that at, the end of the Term, the City Commission has the authority to reappropriate any remaining unused Funds. Section 12. Termination of Agreement: 12.1 Termination for Convenience: This Agreement may be terminated by the City, for convenience and without cause, through the City Manager, upon 30 days prior written notice to Provider. In the event of such termination for convenience, the City shall cease any payments to Provider for costs resulting from obligations which were not approved before the effective date of termination. Provider shall be solely responsible for immediately returning any unused or unapproved Funds as of the date of termination, and shall also be solely responsible for submitting a final report, as provided in Section 5 hereof, (detailing all Program objectives, activities and expenditures up to the effective date of the termination). Said final report shall be due within five (5) working days following the effective date of termination. Upon timely receipt of Provider's final report, the City, at its sole discretion, shall determine the amount (if any) of any additional portion of the Funds to be returned to the City as a result of any unapproved or unused Funds, or incomplete Program items, and shall provide Provider with written notice of any monies due. Said additional monies shall be due and payable immediately upon receipt of such notice by Provider. Notwithstanding the preceding, the City reserves any and all legal rights and remedies it may have with regard to recapture of all or any portion of the Funds, or any assets acquired or improved in whole or in part with said Funds. 12.2 Termination for Cause: Notwithstanding Subsection 12.1 above, the City may also terminate this Agreement for cause. "Cause" shall include, but not be limited to, the following: a. Failure to comply and/or perform, in accordance with the terms of this Agreement, or any Federal, State, County or City law, or regulation. b. Submitting reports to the City which are late, incorrect, or incomplete in any material respect. c. Implementation of this Agreement, for any reason, is rendered impossible or infeasible. d. Failure to respond in writing to any concerns raised by the City, including substantiating documents when required/requested by the City. e. Any evidence of fraud, mismanagement, and/or waste, as determined by the City's monitoring and applicable HUD rules and regulations. The City shall notify the Provider in writing when the Provider has been placed in default. Such notification shall include: (i) actions taken by or to be taken by the City, such as withholding of payments; (ii) actions to be taken by the Provider as a condition precedent to curing the default; and (iii) a reasonable cure period, which shall be no less than thirty (30) days from notification date. In the event the Provider fails to cure such default within the aforestated cure period, this Agreement shall be considered terminated for cause, without requiring further notice to Provider, and Provider shall be solely responsible for repayment to the City of all or any portion of the Funds disbursed to Provider, as 3 deemed required by the City, in its sole and reasonable discretion. Said monies shall be immediately due and payable by Provider. Notwithstanding the preceding, the City reserves any and all legal rights and remedies it may have with regard to recapture of all or any portion of the Funds, or any assets acquired or improved in whole or in part with said Funds. 12.3 Termination for Lack of Funds: In the event of curtailment of, or regulatory constraints placed on the Funds by HUD, this Agreement will terminate, effective as of the time that it is determined by the City Manager that such Funds are no longer available. Costs of the Provider incurred after termination are not allowable unless expressly authorized in writing by the City Manager (whether in the notice of termination or subsequent thereto), and, in that case, may only be allowable if, in the sole discretion of the City Manager: a. The costs.resulted from obligations which were properly incurred before the effective date of termination, were not in anticipation of it, and are noncancelable; and b. The costs would be allowable if the Agreement expired normally at the end of its Term. Section 13. Equal Employment Opportunities: The Provider shall comply with equal employment opportunities as stated in Executive Order 11246, entitled "Equal Employment Opportunity" as amended Executive Order 11375, and as supplemented in Department of Labor regulations. Section 14. Program Income: Any "Program Income" (as such term is defined under applicable Federal regulations) gained from any activity of the Provider funded by CDBG funds shall be reported to the City and utilized by the Provider in the operation of the Program. Section 15. Religious Organization or Owned Property: CDBG funds may be used by religious organizations or on property owned by religious organizations only with prior written approval from the City Manager, and only in accordance with requirements set in 24 CFR §570.2000). The Provider shall comply with First Amendment Church/State principles, as follows: a. It will not discriminate against any employee or applicant for employment on the basis of religion and will not limit employment or give preference in employment to persons on the basis of religion. b. It will not discriminate against any person applying for public services on the basis of religion and will not limit such services or give preference to persons on the basis of religion. c. It will retain its independence from Federal, State, and local governments, and may continue to carry out its mission, including the definition, practice, and expression of its religious beliefs, provided that it does not use direct CDBG funds to support any inherently religious activities, such as worship, religious instruction, or proselytizing. d. The Funds shall not be used for the acquisition, construction, or rehabilitation of structures to the extent that those structures are used for inherently religious activities. Where a structure is used for both eligible and inherently religious activities, CDBG funds may not exceed the cost of those portions of the acquisition, construction, or rehabilitation that are attributable to eligible activities in accordance with the cost accounting requirements applicable to CDBG funds in this part. Sanctuaries, chapels, or other rooms that a CDBG-funded religious congregation uses as its principal place of worship, however, are ineligible for CDBG-funded improvements. 4 Section 16. Reversion of Assets: In the event of a termination of this Agreement, or upon expiration of the Agreement, and in addition to any and all other remedies available to the City (whether under this Agreement, or at law or in equity), the Provider shall immediately transfer to the City any Funds on hand at the time of termination (or expiration) and any accounts receivable attributable to the use of the Funds. The City's receipt of any Funds on hand at the time of termination, shall not waive the City's right (nor excuse Provider's obligation) to recoup all or any portion of the Funds, as the City may deem necessary. Any real property under the Provider's control that was acquired or improved in whole or in part with CDBG funds (including CDBG funds provided to the Provider in the form of a loan) in excess of$25,000 must either: a. Be used to meet one of the national objectives in 24 CFR 570.208(formerly section 570.901) until five years after expiration of the term of this Agreement, or for such longer period of time as determined to be appropriate by the City and as memorialized by the City and Provider in an amendment to this Agreement or such instrument as the City, at its discretion, determines appropriate; or b. If not used in accordance with the above subsection (a), the Provider shall pay to the City an amount equal to the current market value of the property less any portion of the value attributable to expenditures of non-CDBG funds for the acquisition of, or improvement to,the property. Section 17. Conformity to HUD regulations: The Provider agrees to abide by guidelines set forth by HUD for the administration and implementation of the CDBG Program, including applicable Uniform Administrative Requirements set forth in 24 CFR 570.502, and applicable federal laws and regulations in 24 CFR 570.600, et seq. In this regard, the Provider agrees that duly authorized representatives of HUD shall have access to any books, documents, papers and records of the Provider that are directly pertinent to this Agreement for the purpose of making audits, examinations, excerpts and transcriptions. The Provider shall comply with the requirements and standards of OMB Circular No. A- 122, "Cost Principles for Non-profit Organizations", or OMB Circular No. A-21, "Cost Principles for Educational Institutions"as applicable. The Provider shall comply with the following provisions of the Uniform Administrative requirements of OMB Circular A-110 (implemented at 24 CFR Part 84, "Uniform Administrative Requirements for Grants and Agreements With Institutions of Higher Education, Hospitals, and Other Non-Profit Organizations")or the related CDBG provision, as specified in this section: a. Subpart A-"General"; b. Subpart B - "Pre-Award Requirements", except for 84.12, "Forms for Applying for Federal Assistance"; C. Subpart C-"Post-Award Requirements", except for: (1) Section 84.22, "Payment Requirements" -Grantees shall follow the standards of 85.20(b)(7)and 85.21 in making payments to sub-recipients; (2) Section 84.23, "Cost Sharing and Matching"; (3) Section 84.24, "Program Income"- In lieu of 84.24, CDBG sub-recipients shall follow 570.504; (4) Section 84.25, "Revision of Budget and Program Plans"; 5 i (5) Section 84.32, "Real Property" - In lieu of 84.32, CDBG sub-recipients shall follow 570.505; (6) Section 84.34(g), "Equipment" - In lieu of the disposition provisions of 84.34(g), the following applies: a. In all cases in which equipment is sold, the proceeds shall be program income (pro-rated to reflect the extent to which CDBG funds were used to acquire the equipment); and b. Equipment not needed by the sub-recipient for CDBG activities shall be transferred to the recipient for the CDBG program or shall be retained after compensating the recipient; (7) Section 84.51(b), (c), (d), (e), (f), (g), and (h), "Monitoring and Reporting Program Performance"; (8) Section 84.52, "Financial Reporting"; (9) Section 84.53(b), "Retention and access requirements for records". Section 84.53(b)applies with the following exceptions: a. The retention period referenced in 84.53(b) pertaining to individual CDBG activities shall be four years; and b. The retention period starts from the date of submission of the annual performance and evaluation report, as prescribed in 24 CFR 91.520, in which the specific activity is reported on for the final time rather than from the date of submission of the final expenditure report for the award; (10)Section 84.61, "Termination"- In lieu of the provisions of 84.61, CDBG subrecipients shall comply with 570.503(b)(7); and d. Subpart D - "After-the-Award Requirements" - except for 84.71, "Closeout Procedures". Section 18. Sponsorships: The Provider agrees that all notices, informational pamphlets, press releases, advertisements, descriptions of the sponsorship of the Program, research reports, and similar public notices prepared and released by the Provider for, on behalf of, and/or about the Program, shall include the statement: "FUNDED BY THE CITY OF MIAMI BEACH COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM" In written materials, the words "CITY OF MIAMI BEACH COMMUNITY DEVELOPMENT BLOCK GRANT FUNDS ADMINISTERED BY THE CITY OF MIAMI BEACH OFFICE OF REAL ESTATE HOUSING AND COMMUNITY DEVELOPMENT DEPARTMENT" shall appear in the same size letters or type as the name of the Provider. Section 19. Examination of Records: The Provider shall maintain sufficient records in accordance with 24 CFR 570.502 and 570.506 to determine compliance with the requirements of this Agreement, the CDBG Program, and all other applicable laws and regulations. This documentation shall include, but not be limited to, the following: 6 a. Books, records and documents in accordance with generally accepted accounting principles, procedures and practices, which sufficiently and properly reflect all revenues and expenditures of funds provided directly or indirectly by this Agreement, including matching funds and Program Income. These records shall be maintained to the extent of such detail as will properly reflect all net costs, direct and indirect labor, materials, equipment, supplies and services, and other costs and expenses of whatever nature for which reimbursement is claimed under the provisions of this Agreement. b. Time sheets for split-funded employees, which work on more than one activity, in order to record the CDBG activity delivery cost by Program and the non-CDBG related charges. C. How the Statutory National Objective(s) as defined in 24 CFR 570.208 and the eligibility requirement(s) under which funding has been received, have been met. These also include special requirements such as necessary and appropriate determinations as defined in 24 CFR 570.209, income certifications, and written Agreements with beneficiaries, where applicable. The Provider is responsible for maintaining and storing all records pertinent to this Agreement in an orderly fashion in a readily accessible, permanent and secured location for a period of four (4) years after expiration of this Agreement, with the following exception: if any litigation, claim or audit is started before the expiration date of the four (4) year period, the records will be maintained until all litigation, claims or audit findings involving these records are resolved. The City shall be informed in writing after closeout of this Agreement, of the address where the records are to be kept. Section 20. Audits and Inspections: At any time during normal business hours, and as often as the City(and/or its representatives) may deem necessary, the Provider shall make available all records, documentation, and any other data relating to all matters covered by the Agreement, for review, inspection or audit. Audits shall be conducted annually and shall be submitted to the City 180 days after the end of the Provider's fiscal year. The Provider shall comply with the requirements and standards of OMB A-133, "Audits of Institutions of High Education and Other Non-Profit Institutions" (as set forth in 24 CFR Part 45), or OMB Circular A-128, "Audits of State and Local Governments" (as set forth in 24. CFR Part 44), as applicable. If this Agreement is closed-out prior to the receipt of an audit report, the City reserves the right to recover any disallowed costs identified in an audit after such closeout. Section 21. Indemnification/Insurance Requirements: The Provider shall indemnify and hold harmless the City, its officers, employees and agents, from any and all claims, liability, losses and causes of action which may arise out of an act, omission, negligence or misconduct on the part of the Provider, or any of its agents, officers, servants, employees, contractors, patrons, guests, clients, licensees, invitees, or any persons acting under the direction, control, or supervision of Provider, pursuant to this Agreement and/or the Program. The Provider shall pay all claims and losses of any nature whatsoever in connection therewith and shall defend all suits in the name of the City, and shall pay all costs (including attorney's fees)and judgements which may issue thereon. This Indemnification shall survive the termination and/or expiration of this Agreement. The Provider shall not commence any work and/or services pursuant to this Agreement until all insurance required under this Section has been obtained and the City's Risk Manager has approved such insurance. In the event evidence of such insurance is not forwarded to the City's Risk Manager within thirty (30) days after the commencement date of the Term, this Agreement shall automatically terminate and become null and void, and the City shall have no obligation under the terms and conditions hereof. 7 The Provider shall maintain and carry in full force during the Term of this Agreement, and/or throughout the duration of the Program contemplated herein, whichever is longer, the following insurance: a. General Liability Policy with coverage for Bodily Injury and Property Damage, in the amount of $1,000,000 single limit, subject to adjustment for inflation. The policy must include coverage for contractual liability to cover the above indemnification. b. Worker's Compensation and Employers Liability, as required pursuant to Florida Statutes. c. Automobile and vehicle coverage shall be required when the use of automobiles and other vehicles are involved in any way in the performance of the Agreement. Limits for such coverage shall be in the amount of$500,000, subject to adjustment for inflation. The City of Miami Beach shall be named as an additional insured under all such insurance contracts. Thirty- (30) day written notice of cancellation or substantial modification of the insurance coverage must be given to the City's Risk Manager by the Provider and its insurance company. The insurance must be furnished by insurance companies authorized to do business in the State of Florida, and approved by the City's Risk Manager. The companies must be rated no less than "B+"as to management, and not less than "Class VI" as to 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 City's Risk Manager. Original Certificates of Insurance for the above coverage must be submitted to the City's Risk Manager for approval prior to any work commencing. These certificates will be kept on file in the Office of the Risk Manager, Third Floor City Hall. The City shall have the right to obtain from the Provider specimen copies of the insurance policies, in the event that submitted Certificates of Insurance are inadequate to ascertain compliance with required coverage. Compliance with the foregoing requirements shall not relieve the Provider of its obligation to indemnify and hold the City harmless, as required in this section. Section 22. Conflict of Interest: The Provider covenants that no person under its employ who presently exercises any functions or responsibilities in connection with community development funded activities has any personal financial interests, direct or indirect, in this Agreement. The Provider covenants that in the performance of this Agreement, no person having such conflicting interest shall be employed. The Provider covenants that it will comply with all provisions of 24 CFR 570.611 "Conflict of Interest", and the, State, County and City of Miami Beach statutes, regulations, ordinances or resolutions governing conflicts of interest. The Provider shall disclose, in writing, to the City any possible conflicting interest or apparent impropriety that is covered by the above provisions. This disclosure shall occur immediately upon knowledge of such possible conflict. The City will then render an opinion, which shall be binding on both parties. Section 23. Venue: This Agreement shall be governed by, and construed in accordance with, the laws of the State of Florida, both substantive and remedial, without regard to principles of conflict of laws. The exclusive venue for any litigation arising out of this Agreement shall be Miami-Dade County, Florida, if in state court, and the U.S. District Court, Southern District of Florida, if in federal court. BY ENTERING INTO THIS AGREEMENT, CITY AND PROVIDER EXPRESSLY WAIVE ANY RIGHTS EITHER PARTY MAY HAVE TO A TRIAL BY JURY OF ANY CIVIL LITIGATION RELATED TO, OR ARISING OUT OF, THIS AGREEMENT. 8 Section 24. Notices: All notices required under this Agreement shall be sent to the parties at the following address: City: Maria L. Ruiz, Director Office of Housing and Community Development City of Miami Beach 1700 Convention Center Drive Miami Beach, FL 33139 Provider: Deborah Ruggiero, Executive Director Teen Job Corps, Inc. 7356 Gary Avenue Miami Beach, FL 33141 Section 25. Limitation of Liability: The City desires to enter into this Agreement only if in so doing the City can place a limit on City's liability for any cause of action for money damages due to an alleged breach by the City of this Agreement, so that its liability for any such breach never exceeds the sum of$10,000. Provider hereby expresses its willingness to enter into this Agreement with Provider's recovery from the City for any damage action for breach of contract to be limited to a maximum amount of$10,000. Accordingly, Provider hereby agrees that the City shall not be liable to Provider for damages in an amount in excess of $10,000, for any action or claim for breach of contract arising out of the performance or nonperformance of any obligations imposed upon the City by this Agreement. Nothing contained in this subparagraph or elsewhere in this Agreement is in any way intended to be a waiver of the limitation placed upon City's liability as set forth in Florida Statutes, Section 768.28. Section 26. This Agreement shall be binding upon all parties hereto and their respective heirs, executors, administrators, successors and assigns. [SIGNATURES TO FOLLOW] 9 IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by their duly authorized officials on the day and date first above indicated. TEEN JOB CORPS, INC. a Florida not-for-profit corporation ATTEST: Sec etary Signature V V-1-1�10 jE Ic O A 11-)) Deborah Ruggiero, Executive Director Print Name Print Name and Title CITY OF MIAMI BEACH a Florida Municipal corporation ATTEST: City Clerk gnature na INCORP ORATED.' XPtir-Ai& evine, Mayor Print Name .�C• •• ;� Name and Title APPROVED AS TO FORM &LANGUAGE &FOR EXECUTION rney Date F:IRHCDI$ALLIHSG-CDICDBGICDBG 2013 2014 Public ServicesUeen Job Corp FY 1314.docx10 10 EXHIBIT "A" "SCOPE OF SERVICES" The Sub-Recipient agrees to provide the following: Service Units of Service To provide employment and vocational Minimum of 9 youth employed skills training to at rick low income youths Related Definitions: Davis-Bacon Act Compliance — The Davis-Bacon Act applies to contractors and subcontractors performing on federally funded or assisted contracts in excess of $2,000 for the construction, alteration, or repair (including painting and decorating) of public buildings or public works. Davis-Bacon Act and Related Act contractors and subcontractors must pay their laborers and mechanics employed under the contract no less than the locally prevailing wages and fringe benefits for corresponding work on similar projects in the area. The Davis-Bacon Act directs the Department of Labor to determine such locally prevailing wage rates. Affordable housing rehabilitation projects of eight (8) or more units using CDBG funds must ensure Davis-Bacon Act compliance. Affordable housing rehabilitation projects of 12 or more units using HOME funds must ensure Davis-Bacon Act compliance. Environmental Review — Projects must have an Environmental Review unless they meet criteria specified in HUD regulations that would exempt or exclude them from Request for Release of Funds (RROF) and environmental certification requirements (24 CFR sections 58.1, 58.22, 58.34, 58.35 and 570.604). Evidence of Procurement—All expenses incurred with grant funds require evidence of procurement according to this Agreement. Please carefully read the Agreement and related HUD rules to ensure compliance. HUD Income Limits — The Sub-Recipient must ensure that HUD Income Limits (household income) are utilized when determining client eligibility for HUD-funded services. Income limits are posted further below. Monthly Progress Report — The Sub-Recipient is required to submit a monthly project progress report by the10th of the following month. The report must be signed by the person who prepared the report as well as the agency's authorizing party. The report summarizes the progress made, expenses incurred and deliverables completed. This report must be completed regardless of whether or not funds are requested. Monthly Financial Report — The Sub-Recipient is required to submit a monthly financial report by the 10th of the following month regardless of whether or not funds are requested. The report delineates project expenses incurred including non-City funds and must include the corresponding evidence of expense incurred for any expense which is being submitted for reimbursement. 1 Monthly Proformas — All Capital projects with multiple (more than one) funding sources require the submission of monthly proformas to the City. Professional Services Contracts — Professional services funded through this Agreement must adhere to procurement guidelines as appropriate and have executed written agreements between the Sub-Recipient and the respective Vendor. Contracts must, at a minimum, specify the cost, timeline and scope of service. A copy of all professional service contracts must be submitted to the City prior to reimbursement request. Proof of Insurance — Evidence of appropriate and required insurance must be submitted prior to contract execution. No City funds will be disbursed prior to submission of required insurance coverage. Retainage — All capital projects are subject to the withholding of 10 percent of appropriate expenses in the form of a retainage. All retained funds will be released when the project fulfills its National Objective. Section 3 Compliance — Any Agreement greater than $200,000 that involves rehabilitation, housing construction, or other public construction, requires the Sub- Recipient complete and submit to the City Form HUD 60002, Section 3 Summary Report, Economic Opportunities for Low- and Very-Low Income Persons (OMB No. 2529-0043). Service Deliverables Services must be delivered as follows: Service Unit of Service Service Location Timeframe To provide Up to 9 youth Scattered sites in I October 1, 2013— employment and Miami Beach September 30,2014 vocational skills training to at rick low income youths Service Benchmarks Service Benchmark(s) To provide employment and vocational Timesheets and work summary reports skills training to at rick low income youths 2 Service Documentation Services will be deemed as provided when the following documentation is provided within the noted timeframes: Service Documentation To provide employment and vocational skills 1. Completed and executed intake training to at rick low income youths form with consents 2. Daily attendance log 3. Copies of payroll checks 4. Evidence of payment for payroll taxes Applicable Federal Regulations The Sub-Recipient must apply to all applicable federal regulations including: I. Non-Discrimination and Equal Access No person in the United States shall on the grounds of race, color, national origin, religion or sex be excluded, denied benefits or subjected to discrimination under any program funded in whole or in part by CDBG/HOME funds. The Provider must take measures to ensure non-discriminatory treatment, outreach and access to program resources. This applies to employment and contracting, as well as to marketing and selection of program participants. Fair Housing and Equal Opportunity The Provider must comply with all the following Federal laws, executive orders and regulations pertaining to fair housing and equal opportunity. They are summarized below: Title VI of the Civil Rights Act of 1964, As Amended (42 USC 2000d et seq.): States that no person may be excluded from participation in, denied the benefits of, or subjected to discrimination under any program or activity receiving Federal financial assistance on the basis of race, color or national origin. The regulations implementing the Title VI Civil Rights Act provisions for HUD programs may be found in 24 CFR Part 1. The Fair Housing Act (42 USC 3601-3620): Prohibits discrimination in the sale or rental of housing, the financing of housing or the provision of brokerage services against any person on the basis of race, color, religion, sex, national origin, handicap of familial status. Fair Housing Act implementing regulations may be found in 24 CFR Part 100-115. Equal Opportunity in Housing (Executive Order 11063, as amended by Executive Order 12259): Prohibits discrimination against individuals on the basis of race, color, religion, sex or national origin in the sale, rental, leasing or other disposition of residential property, or in the use or occupancy of housing assisted with Federal funds. Equal Opportunity in Housing regulations may be found in 24 CFR Part 107. 3 Age Discrimination Act of 1975, As Amended (42 USC 6101): Prohibits age discrimination in programs receiving Federal financial assistance. Age Discrimination Act regulations may be found in 24 CFR Part 146. Section 109 of Title I of the Housing and Community Development Act of 1974: Requires that no person shall be excluded from participation in, denied the benefits of, or be subjected to discrimination under any program or activity funded with CDBG/HOME funds on the basis of race, color, religion, national origin or sex. Affirmative Marketing The Provider must adopt affirmative marketing procedures and requirements for all CDBG/HOME-assisted housing with five or more units. Requirements and procedures must include: 1. Methods for informing the public, owners and potential tenants about fair housing laws and the Provider's policies (for example: use of the Fair Housing logo or equal opportunity language); 2. A description of what owners and/or the Provider will do to affirmatively market housing assisted with CDBG/HOME funds; 3. A description of what owners and/or the Provider will do to inform persons not likely to apply for housing without special outreach; 4. Maintenance of records to document actions taken to affirmatively market CDBG/HOME-assisted units and to assess marketing effectiveness; and 5. A description of how efforts will be assessed and what corrective actions will be taken where requirements are not met. Handicapped Accessibility The CDBG/HOME regulations also require adherence to the three following regulations governing the accessibility of Federally-assisted buildings, facilities and programs. Americans with Disabilities Act (42 USC 12131; 47 USC 155, 201, 218 and 225): Provides comprehensive civil rights to individuals with disabilities in the areas of employment, public accommodations, state and local government services and telecommunications. The Act, also referred to as the ADA, also states that discrimination includes the failure to design and construct facilities (built for first occupancy after January 26, 1993) that are accessible to and usable by persons with disabilities. The ADA also requires the removal of architectural and communication barriers that are structural in nature in existing facilities. Removal must be readily achievable, easily accomplishable and able to be carried out without much difficulty or expense. Fair Housing Act: Multi-family dwellings must also meet the design and construction requirements at 24 CFR 100.205, which implement the Fair Housing Act (42 USC 3601-19) Section 504: Section 504 of the Rehabilitation Act of 1973 prohibits discrimination in federally assisted programs on the basis of handicap. 4 Section 504 imposes requirements to ensure that "qualified individuals with handicaps" have access to programs and activities that receive Federal funds. Under Section 504, recipients and Sub-Recipients are not required to take actions that create unique financial and administrative burdens or after the fundamental nature of the program. For any Provider principally involved in housing or social services, all of the activities of the agency -- not only those directly receiving Federal assistance -- are covered under Section 504. Contractors or vendors are subject to Section 504 requirements only in the work they do on behalf of the Provider or the City. The ultimate beneficiary of the Federal assistance is not subject to Section 504 requirements. The Architectural Barriers Act of 1968 (42 USC 4151-4157): Requires certain Federal and Federally-funded buildings and other facilities to be designed, constructed or altered in accordance with standards that ensure accessibility to, and use by, physically handicapped people. II. Employment and Contracting The Provider must comply with the regulations below governing employment and contracting opportunities. These concern equal opp ortunit y, labor requirements and contracting/procurement procedures. Equal Opportunity The Provider must comply with the following regulations that ensure equal opportunity for employment and contracting: Equal Employment Opportunity, Executive Order 11246, as amended. Prohibits discrimination against any employee or applicant for employment because of race, color, religion, sex or national origin. Provisions to effectuate this prohibition must be included in all construction contracts exceeding $10,000. Implementing regulations may be found at 41 CFR Part 60. Section 3 of the Housing and Urban Development Act of 1968: Requires that, to the greatest extent feasible, opportunities for training and employment arising from CDBG/HOME funds will be provided to low-income persons residing in the program service area. Also, to the greatest extent feasible, contracts for work (all types) to be performed in connection with CDBG/HOME will be awarded to business concerns that are located in or owned by persons residing in the program service area. Minority/Women's Business Enterprise: Under Executive Orders 11625, 12432 and 12138, the City and the Provider must prescribe procedures acceptable to HUD for a minority outreach program to ensure the inclusion, to the maximum extent p ossible of minorities and women, and entities owned by minorities and women, in all contracts (see 24 CFR 85.36(e)). Labor Requirements The Provider must comply with certain regulations on wage and labor standards. In the case of Davis-Bacon and the Contract Work Hours and Safety Standards Acts, every contract for construction (in the case of residential construction, projects with eight or more units) triggers the requirements. 5 Davis-Bacon and Related Acts (40 USC 276(A)-7): Ensures that mechanics and laborers employed in construction work under Federally-assisted contracts are paid wages and fringe benefits equal to those that prevail in the locality where the work is performed. This act also provides for the withholding of funds to ensure compliance, and excludes from the wage requirements apprentices enrolled in bona fide apprenticeship programs. Contract Work Hours and Safety Standards Act, as amended (40 USC 327- 333): Provides that mechanics and laborers employed on Federally-assisted construction jobs are paid time and one-half for work in excess of 40 hours per week, and provides for the payment of liquidated damages where violations occur. This act also addresses safe and healthy working conditions. Copeland (Anti-Kickback) Act (40 USC 276c): Governs the deductions from paychecks that are allowable. Makes it a criminal offense to induce anyone employed on a Federally assisted project to relinquish any compensation to which he/she is entitled, and requires all contractors to submit weekly payrolls and statements of compliance. Fair Labor Standards Act of 1938, As Amended (29 USC 201, et. seq.): Establishes the basic minimum wage for all work and requires the payment of overtime at the rate of at least time and one-half. It also requires the payment of wages for the entire time that an employee is required or permitted to work, and establishes child labor standards. Contracting and Procurement Practices The CDBG/HOME programs are subject to certain Federal procurement rules. In addition, the City and the Provider must take measures to avoid hiring debarred or suspended contractors or Sub-Recipients and conflict-of-interest situations. Each is briefly discussed below. Procurement: For the City, the procurement standards of 24 CFR 85.36 apply. For non-profit organizations receiving CDBG/HOME funds, the procurement requirements at 24 CFR Part 84 apply. Conflict of Interest: The CDBG regulations require grantees (the City), state recipients and Sub-Recipients (the Provider) to comply with two different sets of conflict-of-interest provisions. The first set of provisions comes from 24 CFR Parts 84 and 85. The second, which applies only in cases not covered by 24 CFR Parts 84 and 85, is set forth in the CDBG regulations. Both sets of requirements are discussed below. The provisions at 24 CFR 85.36 and 24 CFR 84.42 apply in the procurement of property and services by grantees (the City), state recipients, and Sub-Recipients (the Provider). These regulations require the City and the Provider to maintain written standards governing the performance of their employees engaged in awarding and administering contracts. At a minimum, these standards must: Require that no employee, officer, agent of the City or the Provider shall participate in the selection, award or administration of a contract supported 6 by CDBG/HOME if a conflict-of-interest, either real or apparent, would be involved; Require that employees, officers and agents of the City or the Provider not accept gratuities, favors or anything of monetary value from contractors, potential contractors or parties to Sub-Agreements; and Stipulate provisions for penalties, sanctions or other disciplinary actions for violations of standards. HOME-funded projects must comply with 24 CFR 92.356. A conflict would arise when any of the following has a financial or other interest in a firm selected for an award: - An employee, agent or officer of the City or the Provider; - Any member of an employee's, agent's or officer's immediate family; - An employee's, agent's or officer's partner; or - An organization that employs or is about to employ an employee, agent or officer of the City or the Provider. - The CDBG/HOME regulations at 24 CFR 570.611 governing conflict-of- interest apply in cases not covered by 24 CFR 85.36 and 24 CFR 84.42. These provisions cover employees, agents, consultants, officers and elected or appointed officials of the grantee (the City), state recipient or Sub-Recipient (the Provider). The regulations state that no person covered who exercises or has exercised any functions or responsibilities with respect to CDBG/HOME activities or who is in a position to participate in decisions or gain inside information: - May obtain a financial interest or benefit from a CDBG activity; or Have an interest in any contract, subcontract or agreement for themselves or for persons with business or family ties. This requirement applies to covered persons during their tenure and for one year after leaving the grantee (the City), the state recipient or Sub-Recipient (the Provider) entity. Upon written request, exceptions to both sets of provisions may be granted by HUD on a case-by-case only after the City has: Disclosed the full nature of the conflict and submitted proof that the disclosure has been made public; and - Provided a legal opinion from the City stating that there would be no violation of state or local law if the exception were granted. Debarred contractors: In accordance with 24 CFR Part 5, CDBG/HOME funds may not be used to directly or indirectly employ, award contracts to or otherwise engage 7 the services of any contractor or Sub-Recipient during any period of debarment, suspension or placement of ineligibility status. The City should check all contractors, subcontractors, lower-tier contractors or Sub-Recipients against the Federal publication that lists debarred, suspended and ineligible contractors. III. Environmental Requirements The City is responsible for meeting a number of environmental requirements, including environmental reviews, flood insurance, and site and neighborhood standards. Environmental Review The City is responsible for undertaking environmental reviews in accordance with the requirements imposed on "recipients" in 24 CFR 58. Reviews must be completed, and Requests for Release of Funds (RROF) submitted to HUD before CDBG/HOME funds are committed for non-exempt activities. Private citizens and organizations may object to the release of funds for CDBG/HOME projects on certain procedural grounds relating to environmental review (see 24 CFR 58.70 - 58.77). To avoid challenges, grantees (the City) and Sub-Recipients (the Provider) should be diligent about meeting procedural requirements. Flood Insurance Section 202 of the Flood Disaster Protection Act of 1973 (42 USC 4106); Requires that CDBG/HOME funds shall not be provided to an area that has been identified by the Federal Emergency Management Agency (FEMA) as having special flood hazard, unless: The community is participating in the National Flood Insurance Program, or it has been less than a year since the community was designated as having special flood hazards; and Flood insurance is obtained. IV. Lead-based Paint On September 15, 1999, the "Requirements for Notification, Evaluation and Reduction of Lead-Based Paint Hazards in Federally Owned Residential Property and Housing Receiving Federal Assistance; Final Rule" was published within title 24 of the Code of Federal Regulations as part 35 (24 CFR 35). The regulation was issued under sections 1012 and 1013 of the Residential Lead-Based Paint Hazard Reduction Act of 1992, which is Title X (ten) of the Housing and Community Development Act of 1992. Sections 1012 and 1013 of Title X amended the Lead- Based Paint Poisoning Prevention Act of 1971, which is the basic law covering lead- based paint in federally associated housing. The regulation sets hazard reduction requirements that give much greater emphasis to reducing lead in house dust. Scientific research has found that exposure to lead in dust is the most common way young children become lead poisoned. Therefore, the new regulation requires dust testing after paint is disturbed to make sure the home is lead-safe. Specific requirements depend on whether the housing is being disposed of or assisted by the federal government, and also on the type and amount of financial assistance, the age of the structure, and whether the dwelling is rental or owner occupied. 8 On April 22, 2008, the EPA issued a rule requiring the use of lead-safe practices and other actions aimed at preventing lead poisoning to protect against the hazards created by exposure to lead dust in existing structures built prior to 1978. Under the rule, all contractors performing renovation, repair and painting projects that disturb lead-based paint in homes, child care facilities, and schools built before 1978 must be certified and follow specific work practices to prevent lead contamination. This rule (40 CFR Part 745) is enforced as of April 22, 2010. The rule must be executed by all sub-contractors. Property Exempt from Lead-based paint regulation: Housing built since January 1, 1978, when lead paint was banned for residential use; Housing exclusively for the elderly or people with disabilities, unless a child under age 6 is expected to reside there; Zero-bedroom dwellings, including efficiency apartments, single-room occupancy housing, dormitories or military barracks; Property that has been found to be free of lead-based paint by a certified lead-based paint inspector; Property where all lead-based paint has been removed; Unoccupied housing that will remain vacant until demolished; Non-Residential property; and Any rehabilitation or housing improvement that does not disturb a painted surface. Types of housing subject to 24 CFR 35: Federally-Owned housing being sold; Housing receiving a federal subsidy that is associated with the property, rather than with the occupants (project-based assistance); Public housing; 9 Housing occupied by a family (with a child) receiving tenant-based subsidy (such as a voucher or certificate); Multifamily housing for which mortgage insurance is being sought; and Housing receiving federal assistance for rehabilitation, reducing homelessness, and other special needs. If you want copies of the regulation or have general questions, you can call the National Lead Information Center at (800) 424-LEAD, or TDD (800) 526-5456 for the hearing impaired. You can also download the regulation and other educational materials at http://www.hud.gov/offices/lead/index.cfm. For further information, you may call HUD at (202) 755-1785, ext. 104, or e-mail HUD at lead requlations(W-hud.gov. V. Displacement, Relocation, Acquisition and Replacement of Housing CDBG/HOME projects involving acquisition, rehabilitation or demolition may be subject to the provisions of the Uniform Relocation Act (UDA). Demolition or 9 conversion of units with CDBG funds may trigger section 104 (d) (also known as the "Barney Frank Amendment" requirements.) VI. Compliance with National Objective The Provider will ensure and maintain evidence that activities assisted with CDBG/HOME funds from the City of Miami Beach comply with the primary National Objective, "Benefit to Low and Moderate Income Persons" and will provide services or activities that benefit at least 51% low and moderate income persons. A low or moderate-income household is defined as: a household having an income equal to or less than the limits cited below. Individuals who are unrelated but are sharing the same household shall each be considered as one-person households. Low and Moderate Household Income Limits (Effective 05/14/2010) (Source: U.S. Department of Housing & Urban Development) (Note: Low-Income (80% of Median Income), Very Low-Income (50 % of Median Income), Extremely Low (30% of Median Income) HUD Income Limits for FY 2013 $13,750 $15,700 $17,650 $19,600 $21,200 $22,750 $24,350 25,900 $22,900 $26,200 $29,450 $32,700 $35,350 $37,950 $40,550 $43,200 $27,480 $31, 440 $35,340 $39,240 $42,420 $45,540 $48,660 $51,840 $36,650 $41,850 $47,100 $52,300 $56,500 $60,700 $64,900 $69,050 10 Change Orders/Budget Amendments The goal should be to limit the use of Change Orders or Budget Amendments. Change Orders and Budget Amendments require prior written approval by the City Manager. To request a Change Order or Budget Amendment, a written request for changes must be submitted to your Grant Monitor delineating the changes and providing a detailed justification for making the request. Approvals of any changes are at the sole discretion of the City Manager. No budget amendment will be processed after June 30, 2014 for Public Service Projects. No budget amendment will be processed for Capital Projects Budgets after eighty (80) percent of the available funds have been drawn. Budget amendments or Change Orders that deviate from the original scope will be rejected and the funds in question may be subject to recapture at the sole discretion of the City Manager. Compliance with Local Rules, Regulations, Ordinances and Laws The Sub-Recipient must remain incompliance with all local rules, regulations, ordinances and laws (including having an active business license) in addition to those specified in the body of the Agreement. In addition, the Sub-Recipient must not owe any monies to the City at the time of Agreement execution or final release of grant funds. The City will verify with the Finance Department to ensure that no monies are due the City prior to Agreement execution. Employee/ Contractor File Review The following documentation must be included in the Sub-Recipient's employee/contractor file for those employees/contractors providing services under this contract. The following must be included in the employee files: Employment Application Evidence of degree/credentials Job Description Signed by Employee • Evidence of Required Experience • Florida Background Criminal Screening, if applicable • National FBI Background Criminal Screening (Level 2), if applicable Affidavit of Good Moral Character, if applicable • Proof of Knowledge of Policies & Procedures, if applicable 1-9 Verification on File 11 The City reserves the right to inspect those employee/contractor files whose salaries are funded in part or in whole by its funds. Evaluation In its continuing effort to ensure contract compliance and performance, the City will evaluate the Sub-Recipient in its fulfillment of the terms of this agreement including, but not limited to, the following measures: • Agreement compliance • Leverage and fiscal soundness • Accuracy and timeliness of Monthly Progress Reports • Accuracy and timeliness of Monthly Financial Reports • Adherence to project timelines • Fulfillment of prescribed outcomes Fiscal Stability The Sub-Recipient is required to maintain fiscal stability throughout the terms of this Agreement. This is to ensure the Sub-Recipient's ability to fulfill the terms of this Agreement and meeting of the National Objective. For affordable housing developers, fiscal stability policies are encouraged in anticipation of additional HUD guidance regarding fiscal oversight for rental projects. More so, as projects have extended lives, fiscal stability underscores the long-term viability of the housing units. Leverage For HOME-funded projects, the Sub-Recipient must demonstrate the commitment of other sources of funds committed to the City-funded project. Furthermore, all other identified funds must be in place prior to the use of HOME funds. The documentation that demonstrates this fiscal leverage is the Subsidy Layering Review and underwriting. Monitoring & Performance Reviews The City reserves the right to inspect, monitor and/or audit the Sub-Recipient to ensure contractual compliance. This includes, but is not limited to: • Review of on-site service delivery • Inspection and review of client, budgetary and employee files (for those employees providing services under this Agreement) Monitorin g visits will take place within 120 days of the commencement of services. The City will notify the Sub-Recipient a minimum of three (3) business days prior to a monitoring visit. 12 Performance Ratings The Sub-Recipient agrees that its Performance Rating, the score awarded for performance on the following measures, will be posted on the City's website on an annual basis: • Timely and accurate submission of Monthly Progress Report • Timely and accurate submissions of Monthly Financial Reports (reimbursement requests) • Delivery of contracted service units Ratings will be given for each performance measure based on the following: Performance • Rationale Score Timely and accurate submission of ➢ "0" for failing to submit on time Monthly Progress Report ➢ "25" for submitting on time Timely and accurate submissions of ➢ "0" for failing to submit accurate report Monthly Financial Report with back-up material on time (reimbursement requests) ➢ "25" for submitting accurate report on time Delivery of contracted service units Possible score of 0 to 50 based upon within contracted timeframe completion of projected service units. Score is pro-rated if total projected service units are not met. Proformas Capital projects must submit certified monthly proformas that indicate project funding sources and correlating uses. Proformas must be certified by the preparing party as well as the agency's signatory as reflected within this Agreement. Reporting Requirements The Contractor will provide the City with a Monthly Progress Report and Monthly Financial Report by the 10th of the following month. In the event that the 10th of the month lands on a Saturday, Sunday or holiday, the report must be submitted the following business day. 13 The following chart depicts the submission dates for the term of this Agreement: Month Date or October 2013 November 12, 2013 November 2013 December 10, 2013 December 2013 January 10, 2014 January 2014 February 10, 2014 February 2014 March 10, 2014 March 2014 April 10, 2014 April 2014 May 12, 2014 May 2014 June 10, 2014 June 2014 July 10, 2014 July 2014 August 11, 2014 August 2014 September 10, 2014 September 2014 October 10, 2014 Monthly reports will be submitted via any of the following methods: • Standard mail • Hand delivery Monthly reports will not be considered acceptable unless the following is met: • Forms are completely and accurately filled • Necessary back-up materials are included (evidence of expense incurred, invoices, time logs, executed AIA Forms, etc.) • Reports bear the signature of the person preparing the report and the Sub- Recipient's authorized signatory Monthly Progress Reports should encapsulate a project's progress in alignment with the funds expended. Rent Roll Submissions Sub-Recipients using City funds for the creation or rehabilitation of affordable housing must submit tenant rent rolls within thirty (30) days of meeting the National Objective and every year thereafter for a minimum of fifteen (15) years in adherence with the affordability period required with use of these funds. For completed projects, certified tenant rolls must be submitted annually by November Vt. Tenant rolls must be certified by the Sub-Recipient Agency's authorized signatory. Those projects with a longer affordability period require annual tenant rolls for the period of affordability established in the City's Restrictive Covenant and/or mortgage. These tenant rolls must be submitted by November 1St of each year of affordability. Tenant rolls must be certified by the Sub-Recipient Agency's authorized signatory. 14 Retainage All capital projects utilizing HUD funds are subject to a ten (10) percent retainage that will not be released until the National Objective is met. Retainage will be held as appropriate from all submitted reimbursement requests. Subsidy Layering Review All affordable housing projects using CDBG/HOME funds require the completion of an independent Subsidy Layering Review and underwriting. These reviews must be completed prior to the project being submitted via HUD's IDIS system and precedes the incurrence of any related funds. Therefore, no capital projects will be deemed eligible for reimbursement until the Subsidy Layering Review and underwriting have been received and accepted by the City. The expense for the Subsidy Layering Review and underwriting services are eligible for reimbursement if the project proceeds but is not eligible for reimbursement otherwise. Timeliness of Reimbursement Requests Reimbursement requests must be submitted no later than sixty (60) days from the incurrence of the expense. The City will strictly monitor this element. Please note that cancelled checks must be submitted in conjunction with all reimbursement requests. Therefore, the Sub-Recipient should calendar itself accordingly to ensure that reimbursement requests are submitted to the City in a timely manner. Training Requirements The Sub-Recipient must ensure that the person responsible for preparing the Monthly Progress Report and Monthly Financial Report attends the City's Sub-Recipient Reporting Training and places the attendance certificate in the employee's personnel file for inspection by the City during its monitoring visit. Additional Documentation The following documentation must be submitted with this executed agreement: • All required insurance certificates • Copy of current audit • Copy of required business licenses and permits 15 EXHIBIT "B" "DOCUMENTATION" The Sub-Recipient agrees to provide the following documents as part of its reporting requirements: To Document Insurance Coverage: • Copy of insurance policy or binder (with proof of payment) with limits and scope of coverage To Document Client Eligibility and Service: • Client attendance logs • Intake and screening forms • Executed client consent agreements To Document Fiscal Leverage: Monthly project proformas (for capital projects only) To Document Procurement: • Evidence of at least three (3) quotes obtained for service/item • Formal bid process including advertisement, scope, respondents and scoring To Document Expenses Incurred: • Cancelled checks with copy of referenced invoice • Electronic payroll ledgers with corresponding bank transactions (statement) • Executed professional service agreements (subject to procurement) • Executed and notarized AIA Forms (for capital projects only) • Executed and Filed Release of Lien (for capital projects only) • Copies of valid work permits ad clearances (for capital projects only) To Document Construction Completion: Certificate of Occupancy (CO) To Document Lease-up of Affordable Housing: • Rent rolls • Tenant applications (with proof of income) 16 CERTIFICATE OF LIABILITY INSURANCE D 211712roD/YYYY) 2/17/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Blue Ocean Insurance,Inc NAME: Vioieta Amador 4700 Sheridan St,Suite J. PHONE 954-414-9958 FAX No): 954-653153 Hollywood, FL 33021 ADDRIESS: vamador@blueoceaninsurance.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:FWCJUA INSURED Teen Job Corps Inc INSURER B: 7356 GARY aVE INSURER C: MIAMI BEACH, FL 33141 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIM-5'-MADE ❑OCCUR PREM SESOEa..ur,.nce $ MED EXP(Anyone person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑JECOT- E]LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- STATUTE LA ER AND EMPLOYERS'LIABILITY A ANY PROP RIETORIPARTNER/EXECUTIVE Y/" 6FR13UB 2852C288 12/18!2013 12/18/2014 E.L.EACH ACCIDENT $ 100,000.00 OFFICERIMEMBER EXCLUDED? ❑ N I A (Mandatory In NH) E.L-DISEASE-EA EMPLOYE $ 100,000.00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,0 00 00 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Violeta Amador,Agent. ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Produced uslna Forms Boss Web software.www.FormsBoss.com:®Imaresslve Publishina 800-208-1977 I FWCJUA FLORIDA WORKERS COMPENSATION Page 1 of 2 JOINT UNDERWRITING ASSOCIATION,INC 01234-I B Account Bill 2420 LAKEMONT AVENUE P.O.BOX 3556 Account No. 404608078 ORLANDO, FL 32802-3556 Date of This Bill 02/10/14 TOTAL BALANCE $1,697.00 CP 01 6640 G664ONRX 14038 01234 P1 MINIMUM DUE $565.66 TEEN JOB CORPS INC 7356 GARY AVE MIAMI BEACH FL 33141 PAYMENT MUST BE RECEIVED BY: MARCH 01, 2014 ACCOUNT BILLING SUMMARY POLICY TYPE POLICY PERIOD MIN. DUE BALANCE 2852C288 UB Workers Comp 12/18/13 To 12/18/14 $565.66 $1,697.00 TOTAL BALANCE $565.66 $1,697.00 TRANSACTIONS SINCE LAST STATEMENT Previous Account Balance � L) 1 $2,545.00 Payment Received - Thank You -848.00 TOTAL BALANCE $1,697.00 SPECIAL MESSAGES The policy number shown above consists of your billing policy number and policy form. For the complete policy number refer to your policy paper. This bill is rendered by FLORIDA JUA affiliated company indicated on the policy shown on this notice. CONTINUED ON NEXT PAGE TO ENSURE PAYMENT IS PROPERLY APPLIED, detach the return payment stub and mail to the return address below. WORKERS COMPENSA T 10N INSURANCE ......................................................................................................................................... 648842H 2014041 8059 821 078CMB Payment Coupon Make checks payable to: Florida Workers Comp JUA Inc. BLUE OCEAN INSURANCE INC Include Account Number on the check. TEEN JOB CORPS INC 4 0 4 6 C8 0 7 8 Change of Address? TOTAL BALANCE Place an"X"here. $1,697.00 Florida Workers Comp JUA Inc. Print changes on reverse side. MINIMUM DUE Dept. 91521 PO Box 660336 PAYMENT MUST BE RECEIVED BY $565.66 Dallas, TX 75266-0336 MARCH 01, 2014 AMOUNT ENCLOSED IIIIIIIIIIIIIIIIII II Jill Jill 933238353203323838201,40210201,40301 000056566000000000000091,52100000100094 PL-9837 JGMSU-005 Revised 11`05 M ENT OF JUVENILE JUSTICE t'3"-*jj FFICE OF THE INSPECTOR GENERAL I i�� I BACKGROUND SCREENING UNIT L- C. C- FEB 23 Rr-.ov-]ES1j FOR .'—* --JR CONTRACTED PROVIDERS ONLY Detention Residential Probation -.--L,-Vicycwion Contractor/Giant A. TO BE COMPI-ETE4 BY EMPLOYEE/VOLUNWERAWTERN DATE St RMITTED: - -it) - NAM� \F-1*NANIL RR S !AME F1 11-1-MIDDLL J (It-RXEX F jy13-1.-DIX 0 Cl 1L /1-ni w1f.11 C11 1c,-'" ij� � --- - � �•�.J �^/ •� �1 , ter'i 'V Aff SOCA-%I --LCUEUTY NUMBER DRjVL,'SL1CFXRFN AMER SI TO BE COMPLETED BY REQUESTOR (111 .j EAA -k-eq1testor's Nam (Contact Person) Telephone Number&Eat;g Fax Telephone Number NZ, Date of Hiiv: 1-:1-Mail Wdress: V co RATING- TION-TO BE COMPLETED BY THE BACKGROUND SCRffN C. NIT V 1 9 RATUNG: 91 ELIGIBLE MirITGYBLF. TCN4#k:o Lon I This Applicant CAN CAN-NOT apply for an Exemption HrMlin-e-j' P-W ti -I F. FSCULINER 1PI . 61,6f,07t lo N-AT L ()t;R E V I EVVI F R VATL e >y . ACK fi 1 955 NE 2md. . e,llftitt$03 No WamUBch, 33162-1744 :305-651-0400 C i �id . ... .,. off:: DrA. Wit. ioi" that Mere �Ao. tmar �' #C haw or SAP and wing: '1` 0$t 1 YOW`� + ? u 3r hur n__ ' bor rimd tit e ► Ln sor ; ceder t 'maymoorr" + n�atio Asa us i curved ova i can S n ptmt n a=i tb� u ve.ou y c six va e e . is Ow4t6m•r*l Huh" hf''t OMs No. 184��1`I150 30 Eet ofiarizafonatnpt ►fin incirnx Fot4ri t'$p it pt Msuantldgenr s:ectoa p�t hW in 2012 O benefit trust *Watefoundation)()ef a X0' ised rands,organizations that rate ott4:0rat�,e hospital faciiltles, and Certain epettroiiirrg arganbmaoft as defined in section 512(b)(19)Wm*file Form lid(see instructions). r� All oth4WWganwationa with.Orbss recelpts less than$200,000 and total assets less than$500,000 �1piAftiant ofll�ttsasury #te end of the year raF use this bntt. } Reyial ' icas ... - :. �.`Ifte oar't. ►awl! uae:a copy ofaht:rilrn.to satisfy Net reporting r+lgl ,� ,• „ s , to, irements. ?� A f lo.:,ft::�I,Z ndar ar,or I - r `�Id WWI : _ . . IS ttwck K applicable: pe N""oT or�nlzatlan Q EipiayirldrntMic. io».r>tamibrr iedresa Cturw lgrna TMW JOB 92RP8 XNC. Ate non NI#nbK aieNt Loris ?�t+oM.`If a>a>f k npt lq' beat address} ROO.Wo lt.0 Tel10 1Drle - `erminated 5,6 .�3.ARy"JA' as_3 5 7-5 � :� f r,W*mNL or=W*y,end� 4 -4!ndad tetcrr► _ -• MIAMI .$ G"i :F ,3 : 41 beer: : xunti th ` : Cash 1t 1 ?} n - J webails :. - . ►. fax-exern status yin - -*K' 527 elk. Chedc if 00 tUt�l a`; r a r Air l tiDn do " s i Q nat more than * ci A'Bonin Or roan HSO#�e�lm.is'got�squitsd; h rama��` b� �s�e ani ats) B,t if i elxwceaa a a m, W.,gnu ;Owt +fin Las'I said io lifts do>da�l r:. - AO .�a 25,aoiuerte': etl+di 000"orae err, to a� «m 9A -EZ .._.. .. .�. ,, 4 $ .. IMP exer�si ,find1ahgesI�r stet Assets cl 000 ss# tQrlor ?>ltt.1) .. Own tt©n Used cfiedule`b io re -"ii �� - 9 !ts,Wit! s�notutts received -_ < a.y . f�.. f j'1.. a'_s:.iGi JV�M•5' t`t:.tij .�..-:.;1 t:.r.-:c'.i.r.'�-�'t �. indud[ng go:grnO'liillRM: .._: "s•a ;y�• Ya t a:-.s a i �+'f(t _ r+�rrrr ALI p ..+ -- �i,y- a38$e&SlY►eRti .. \��1� �'Y14VR}�!M •.-..•K s.�-a.ra• 1 ....a. t ..Ni.. •.Cr C.�:. c .c 4. mbMMtmel: ._. s;ittf:,1:a.•..-....... ..<.•af�t.ii+e:r.a.: Y :-3`.�k`.wf l,[..., +;:(�: r;� .-i;•.7p..fL,••"',t.►:ii#v./.•I i.t:1`:- .. - .. .. .,... ,1f�1f1.i**of assets oftrVtl9<n`. 6a I ess.: lst ot'ptt> rbasis and_$aks expenses � Sb n otO*U6iWe of assets oliWVM Mven .. ...... � • - all � �IOotrib ierom tats , �I�' �.•..,f: Yr ix's'a .�•,...vS.... .... f ,sY•ia; av its.i,c A3ra-..i - t V" 0. .. . •: _*�� t W,: � ... '4rr�s.�si�is 1�. .�1�d ,•':;�: -. l Y.♦t?� 'JYA Yd'i%Ml: S�;w. t! n•K ,° ,. !i•a'Vi is +.� !'w:Yt f. .iY T. i ..F.l7 +:.p J L. �..1,�. Od 'MI 7Cr �* :�: � t>tfM�llsi: lit• s F . y `w},.:t•a MY ?R/f"• t1 ♦'.tf ni,.•f.t. �_ . � . fi 'i•:t:. a, ,:..�+ f:.:a: wive.'+ a:�'::ti<.a8sa'•a•s'�. .. , ,... .. -+l.i.•'11 w.1:s''ji.i+:1 v'�•s..;:.Wt.7l.•• -.:-•:t.{+a�w:lli --:: )., � �Y: 'rt•.:.i-%ta 3i- :i-a'[w11'a �J�••+:a1 l 1•Fi !:`i .-1. .. Y iil.•Xai•v r•• • -' - :- :Qr�lrl�s' �� . �� •^.i7t•i;-j` N •[if NJ i +•./ li,;Y a�i{-.. ��. .... ... . a.s.::t as•.'!i+ a •.K, tom_..•w .+'•+•k s:, e a . .t� -... r, f t .vlet2ew K e, salaries,ttstpen satOlr,40 eltnyee benefits3 3.5 ' i �gr X •tfd '1 } f..t t 'pfessiortof fieia8 and othOt p> lklts tDdependetrtt tinttti 1' CUpancy,:[rl ,tiilties, dlfkarue 14 _ . CL :..aa'i t,r'.-!..• ii'-.•.7,a i,�_ia-s a�i'.s.:♦ c.� t:,i to }. ev.g,3-»tY1 -rr.. . .4!•,,y 9l# ;I tit ;ptsbli ns,postage,widshipp ,. • ♦, a,+A } r.%. i•r'.i,•K , i r u\ a y".ax +a a Rra t!Yt If 'D Mw- uses(describe in&hedule 0) '1 218 , +. [1li:t• a i.t-f;•1. Y.'+e.!• i•�.f<+,.ix•:6 ,s a.a?.e;i�t aT!•f:y""i i,f�.�:t'•.{.a.f'.+w r .'1 • Ir *Mw ix nses./add Ifies 10 throe h 16 .. 2 3 3 0 3 48 ooess or(deficit)for the year'(Subtract line II*om tine 11).,...•,a.3: fi ,.rt�,� ,..,az•....•.. •Y aY•,1;.y.•.•,•:�,.::.••, ��- ��.: Q _...__ Net assets or fund# ©es at beginning of yeW(frrom: 17.ooNlrrut j, agree with --gnd-of year figure reported on"ryear's retumj :�, �:; a,.!• t 9 0 .. _ hA,rchar intro#assets o r fund balances(axpUb,16.20±sduie •va�ti�•:iifi�i•i�a�si• •v•.i't.stt+:.r+asew�►i II Net assets or fund twiances at and of year.Combine lines 18 thro �h 33 O07 F Paperwork Reduction AWt Notide,809 the separalte ins#ruations. F m 000-x`12) TEM099 00)211 013 2:55 PM Fa 990-Ez _ TRW JO$ CORPS INC. 01-0731644 Page Z IMAM `Balance Sheets(see the*wVucdons for inert lid Ghedc If fhe o aritzation used Schedule 0 toreswondWanyquestion in this Part a (Aj r3eginn 10)End of year *W460,and.and investments .. , -..'a. �..� a f. s a�'s .•J.'-,..'! / -i�i i r• r.ia: !i R�.f 8 _ 5 xt 3 3,O Q.7 33 aiind t�uitdinga : n E 24 -:Other assets(describe in Sitedt "TGI ZbSet$ Ji:Y�'•••w}.ir.i r:a y:wY4 ..a1- •�.E Y: .w.eY:): .aa.f'. Ewri.,•A ,aA��- `.0tal liabilities .. '.T r.,. r'a+.+'S '!3 r",i: .._i.+.a• -♦ ri .i,a F.. 27 Net assets or fund bal '27 5colunm mus#a ree wft Vie.21 29 4a '3, �3�7 ` .-. ►t�lten ertt bf Grp re> ��omm,l >rnDIIAMOWUM(1, e fir s u io flj.. . 6cp . Olux*If Me o anization Aised.Schvdute�3 to m nd to an in#pis Part iii. : eg d*w' . 1ilthat:s the otearabot' puY exempt Ptrtpase ��• i( '� Suffl_ and:section t ascribe# or► pram dery cortip hrtjerrts far oath�f t�thfft i�pi inu» t�tiori�t s n asur�pd by;a Ina °trnf+monk r rrrtsr;Vesc�e the Yi Pr ed._ s srorr er r# o bented:ead oFwf ribrrf artirr each dram f . 28er.lkscablea t> Sao .trimsia ��.ir»r • 4 ..r M E.f:4 . Y j 4:,t i':.,1 .ia i.• rf.:a• a., r .i�:..r EY..•i.FY x Y�!•�i iia-?Sl,:l xpfi '_�s - .w.-+*ae?�+-r•ir'!>,J•4':l;:••ai s.:k".F.-- 'C"e ? ._f - •. .. :ilia i,'• - :-_, '�;7_. •li �f-'4•a�iv'i I�+Y•i^{'F:}..lMl e�f i''1�,.t k'f-i..i T.y f <. !.E_f..i-J• • a•:e>i•�i �+.'=i•-`i.E s..iw?1 r:x1.n t'-� A'l±l:: -s'e.n -.r�i i-E M_:,�! F- ./•"} a�'f:i`i.ri -'.�;t G '+.f.:t ,.a.'i:1 +)& '} '�".'VY 'Hf .T:! : ff:this amciund. dud fcste• n .re. ..-,*.�a. r':.a..2.r>.,'ai......a«i-«f•.i.ti-:a r...i:. ii.,.'�•-..:e,+. .. -... .a .w r..ri.E...,a.:F. •i: yz.' :....-r.: :::......4'.-•.•!�s-•..sYd�::ya.E;.-•'i�.vrfA a�r•.a.r-..a.a,.-•..a.w�i�.tta..r:+ria:V..-a•i sal^.rat':..rr.a...•»s.»-..w.s...id.i.,t».n.:e• :'i.- ..r7:...:'s.�-"� -w.r^.rr. �:?Z 3'.i-!*,♦Y .?arfr »,:.i- a S�,t ,`1.i •:S. .^1.3 + k ra•a-i,r a,*.N. fR +_•t ,J wM r '�l. •..... _.. ... 16113.amOt�rtticludes tone n ntS Cheek. I► :.>- _•....,..:: ri•7.a,"5.:._.'R�'y•.-e; ..,!'e�'r r :e:: a ..f,s!5.,.:,�. . .s.::xr•l r!r.r. t... .. e,.:s.a.r tr� r.p, ,T,F.. X 'ar } r,a-i`E 4 ,i T�fi:e: .�.:rr�+t-•�a;•r >r +..xy ,�:rx a �,rc f.,! .,+ -:.s;wt i�G f,�af.r•.f ryt.+, s��+i-F Fe•a.s.t4, ..- as) 2_!_• 1 .. -'"'l „�.- ... ..`ti ftr r. .f:EV ii---.,r 4'^F•::r:f;;r.-ESS,r:ar F:.rwr r.:f ->«.:f Ra•Pa +':rlr ii t:.r r�,, r:fE r. yi,f, ar -,.s ! i-:RSw ..#. #E:hi mint "uc "o ., .�. 30a t r prepracn; oes(desa 33r3 3 .•yr - r*, t�•S-. t'. • E.ry;r t rt r:< l.,, rats ,tfahis amo _ �t 'total• rdrn service � add Mines'28a �► 3; : I —#:. List of rJffice s pimd*m Trustees,. ! one even na#oomparpsated tees the instruc saris Check'(file - anizatian used Sched stiorr tiils Part N . ge :ccompensation}Repode to i tesith berret9ts to . {ea .no wreek COn u ons piayea 't)F�timated Cpl'` s�n dtm W-?Ji t}9S,MtSC} benefit plans,ar►d oftr compensation not id,enter 4) afar ed compansa#ion rO�II ;. Q Pres3: t `IE#z'itti ti� Q tf _ Q Julio iet�ip "dice Pres:tat t1.'Dtf {� 0: 0 I �....,........ t• .�.. .ayiyGx.,-air -a+,F�r�r secrate 'Dir 0.00 0 0 0 011. Deborah ecti�rdt: _ x.00 t# . : 0 0 Or .....ail ! +n-•L�t�'its=. .`+�- i.Rk w. _P;i l.i ♦Y • ♦ �:i « r•.er .a Er•r_.;+ +a e. 7,.:t,Y,.:sr i..••.• Yi;i •1•.v r>. ,r.:ai.:s...., • +.Y :•A Eyy:v 4.* -i�I: .•_t.,S.a G:•�s ,ac+ ''+:F. - .it . - r.•+., �:...r_. ;b:+.r..yra,.x.s: _ .. a ra. , -.,••...ia•a,aa,s"rf.++i,••.. •••Y:+.f.+.......f.....r,�...♦..• ••.fl i�:......•.r..,• .»•.'acv' •..::�,.: a ';•e-. Rr•:..�». r -..::� a .�..r. -a.i..... :.r»; .:.-:1v-a: i:r:..'...s,�...:i-•a..w-a•,.�s:rrraa-i:s.•r: -aa....a�.U.s.xli.•v..:ii....•. WA Farm: -EZ(2012) • woes 0*2vzn3 it"PM Forrr 990-= 1 2) CORPS .INC. 44 4ther;tr>lforrnatio Mahe Schedule A and�per�sonal benefi#contmd iewement t9quiremlents'in the coons for P rt C N anization used Schedule 0.to son ' n in this Part Yes No 33. Dd.te argnistjon.oVa e in any significant activity not previously reported to the IRS?If'Yes" .detaited.desnr%ti0n`Of,each activity In Schedule 0 33 X t. .r.• :r! :. 3C tkra any.signi�ant Changes made to" organizing or governing documents?9Nes, 0*brthe wftr ded doarmenEs it": -# .o the cuoenizwoni nine.Me4w6a,grin the #saute on mute Q.�s+es finstruciort ) ' .. ,- .... ... , ..-.:. >'...s -%. x f'-r:+..•w.;-y ✓.. .y . aid the. Wlzatbn haws unrelated business gross Income of$4:00 or nngm during#te.yetr from buweiness (such j"those reported on �, � ? eutt pot �? ....,. .. .. >..4W`.. .. •.K G ♦ i3.i +:t• •�1 eV•Y4'.1{�:-3 1i"Yee3,'.tp dirt 358;w the organization filed a-Form 990-T'.-,tar thieye ar?f f"I o, an explana8on Sdtsdt b:fl 35b X ..r........�i.,�. v: `was vganization a section Sp1{ek4)i 501(cX6),g( 'i(o)(6)organizAtion subject torn 6033(e)00000. veporft,and proxy tax requirements during the yew K"Yes, complete Sd mdtite G,Patttit. 4-. - 36. -Did the: ranizatlon,iundergoa.lquidotEion,dissolution; rr on,iair'signiticar dis tsitfian.ofnetaitsets ticsitbie 0 of SOwdu)e N Luring Ehp year?if"'l�'es,` AOW Opp # 'S?# EMO**O t ofpOW ioWifties.dire Or;bft4 its deii6�Iln#tom fta ON the:"amiza an a Fps l . i-POl-fiar aka tr+ear'? Y 37b X y��, '14106#111111 ;w:i� t +tf !•S i ..t�.,.*M•r. tf.x frify .!•? pxt •fs.!' �A l'l�M*� _ Q� n�Wi►ts , 4}s!•: S 5`�f fas.__,•� 11 t$1 1 in i1..,: f at d outow rtg tfie s t.ptthe ( .: i spa X 0 :# b � "�R �uta�.Part ill�arrut entisr#fie a�rrourtt hevah++ed,• •g>,•.•,•y>•a,;s eol�n:.�Ct�r�7y anizet�ins.Enter an a d 'itsil• Mcluded�t IWO l .Yn_ �.��. 7�iMT�ra ' t01 )t3)oianrzetions:.: r mount;ot#ax Wised an the organlratian durtrig .- ' f. talon ly S. o C n o1(cj(3,)a(Ltd:`' Oi(O(�4)grganlzations.Did cite t�+ertization a ny section 4958 excess berfefit , V y � � ,•r, t r tt ltiai09 the year,.et did S engage fn an benefit trap a prior year that has not been f!e rtewd i*0 of 1w-prior'foi�rs�ts 990 or 990- 7 t-acres; Ob X 'Se 11•..+ 't�+/l�)'sntti 1 4). PIS nY1.J•'.'_�_�- >'•J•`•� Yg `{ il>ff ••♦ a �i'if :l+Y -I .eri 1. .ft�i oelnesoridglitfed:psrsons #1cs: or echo ., '444M. id 4"S .y :id-'',w,N.t,�:•t 1 x`ri �.. >:x �.. .... .c>...i,.>.... ''y '�`` r >: X11 Prohibited tax s ��i�t •�ItsttY 'I�r�i that�,f. Party to a pro heftbt j + rSS+rns .." off, s T uio. 70, ! Vir ♦-):t,a'.�`•. .i', ,_.< -, r.>: t -... ,_x.•a.,.1: .(:.y._ .�wN;'Yf 7.H• x ...�. .. Ar�•e(.x � ,r �w4 t•K � -:� Y.;... +...,. ,r vaMar•�rYyl..:s♦ yf":•-. r 9�., -i'?�,t r•..�.�'�.swry q?✓.R .. .. Y W lknet dnitt ttN i i an i�a or+a► th r t es is -� MRi1a� Qt � 'MMw/r ,of iii/.iC7{��gf,WOt acio �f •+-y r..r ,+[•�.r.• R r.H 42b x ttliquirenlents16rformT[iyF8i .1 060dof F6te1Hn Bank Ile,' c Ata izationmt"ertbidstu:8y 42c X 43 -86mm: sind eider Aug aea0nlpt Interest rived or asd #�e tsct ► _. .. - "� t,.<a:..•r.f•xi"i a..Z.:�..a,ai-:ai•a Yes .ft e4a �Nd tit�i n�;�t9titsi�t�f lor�or a�vb+es� _ ng yew�"Y�4 e3prrtplg d tri>s 9f Form g90-EZ r ° - - .; .•.a>!a• i>.•• k..+.s i:.•max, es,E..., itr•• :. it-i,. r,>. f-'...f•• i:.x.x.t r ,••, t _ .. the:.. tt!sbon operate one or more hospital�`scfiUtist duty t .ys . ' `Fta'rn:' 0 ntt be. pe (� M7�,7 .t�ead.otf��omt990-E� ... :i 3. .iJ-.r>.... ...t-•.,...i...Y:'. . ........�.3a..;..'.'- ..•.i>+i.r.�ti'.ra.r.trs..:..�rs:>.::....f.:.�y+i'a•>Y:j'. _ Z did ttre o pnb ation receive any psyments for indoor tanning services during the yes? d lf'Ares"to ltae A4c;ties the organization tiled a Form 020 t0 report these payments't tlF"t1to;' xavids an explanation In Schedule O. _,..,.. .,, ..... .E.r�i t•.•.. r.,.++... ..,,. 450 Did the'o hization hays 00drolled entity wiEiitn the meaning of section$ 3)fi 4bb Did> e'+o�g�iiM!iltksR +iVR. hY P�Y^'� 'ms'sn8�8.i�.wrtY tisnsa 4�lEh: 0e»EroltBd sr+ltfY WilHiiE meaning of section 512(bX13)?tf"Yes, Form 990 end S!c*dWe R may need to tie completed instead of Form 99o-Q tw instructions .... DAA . .. . Form 990-EZ(2012) TEENJOBSOAMU M3'12S3OM Form 99o-EZ(?At TZEN .ZOS CO `PS. ' .�C _.,��.*��`��.��'� „ ...... .. �. NO jO 46 Did.tworganizAbonengs dkoCOy:oirhrmwtly.l,n*polkicalcwnpaignacUvkkmanb*haffoforinapposlOon to candidates for tioe7f'Y�bs'oomi late Schedule ,Part i .. 0 ; . -Section:501(CX3)organizations only 111'sedion 5a1:i��3�argar�i rations must answer questions 47-? b.and�2,end+�amplete ohs fables for s i�. n�ation;usi�Stine�to fpil�t!o ue�tiori in iMs�� .,.f ,;,.h.. ..�;.;:,,•-, .fy�..... Y.0i . No fir t)kt the anase av>ttes have$sacft�On S41�h).elsd�n i effect donna tax plots,... irtl y�.. ..v.•a,•.•s.,i�•.r•.•r iy........sr..•.v••• edtt�' .4 A . ,: .:.. s a"Y .3.33•.3 �e+l.:k�F' � {.� r�Y":. d'r............. .T..+aC• 4i! I;t organtation-at sdtW as desp!,W jn eec t}, pjb1j(11�37 b`"Yes;•complete Sc lle E . i.�..,...` .� :...•.r. 4aA f C!t! o an. males any tranefars;ta an.e errtpt non tltsble ra 1? :.. � it A� X PP lis: IC`Yes!'was the atnbatiort o 527 idtatbt�? v �YtR1 .��t �i. ,�l�i�n:llrl�l��h� :;... - IR� .:�MYiVi.N�.P{(Yf�xYfl�i..YIrYf1►1//YA:. ... T tt bttspl�iyab Average tc)Reportable benefi iphiount of psfd n�pnr t+ t i1t10 Q0 hours per week iOgmpensation empl :devoted to position (Foitns W-2/1099-MIS s,and qwplop nsation . Y��... 'w S.T- .1�1>!S1 _..i S Y.i R'.:l. "tl i'3„3 tt'.Y-;'.� `f4i • h ¢ Y.:.' ! ..• f`!.Kr�w !'J.. Iw} r�r`tC \ �:.♦ y. � T..�:t.f. •Y i.a" t t t YY1'� �!-.l" r• �:..:lr �•..<.:.•a s.�. .'.,!! ,.F.x; ...._.K':..ice•.. '.f.•� •t !.�f'v i..:t.>r'.^ ..�.��-,:f.� - t '�� + 'i�p� over t�OJ ',.c .��: ••.;' t¢}f :.'r ; � r9 .. 8't tt> are_a anization'>iE:. a t; who each rived more than 1 From the o rater t,ef ll..'F -..`.!w ..+��,.y•ls f,..wxM �•,�. •..., a w rv�s .. + ... .. .. •A,.+Y�.x a�f y.'.� .�:•. •:T..r.st::!'�*}►> -•-.vw.•'�,,.Y•xY ! .Y fi:.:'.. r,'9. ...�.� ..."r♦;1"'. .Y.ky •,.w !r'r u•:..axs�....y.':y.r'J• ••:».�.:::..:•«' o•: : ri' ,•.w.r `".i Yxr:a Fy L+C+:t'ii•i::<?rnz&e:car,3 -'y.<.sue. �.�3 »• !.-:. .. - .. •' ♦.Ci•..-S•w»`FS'v•:.S•++wx:..g3Y;.xJ"S �i i 3.Ya'i+r••S xss l.te :r.P:,.! t+ .. '.r.-xlf.••,.•r'. W� • tl ., A?-NoDi►:.�;�: t unit:: .. 4 � 47{x3 ed�tt d O#MOT �00, nrPanyin9 schedules and ditements,arul io tltlF t+c :t�I f4 a, d bbY (, . of prepare (other than 1s its eW.1dt Infarrnation et'w anepst±ar;l s kno #pe.. sign t> Here 3 Oar" RU, i e DIRECTOR �"^'� Paid check LJ OAM LEVINE, =G14!1! -empla* to3:#it Preparer ► O.F.A. :.. ...., �a�M► 59.-474 X499 .TACK �', �.9'*� Use 0* t faaddma 1 1685.e +C tYB, S1 1 -03 North. �+li arni #teach �+'I� 31,t-162 ��.�+W 4 ,w ...�:� r..�:51-0400 May the IRS discuss this r+etum with the reparer shown above?See instructions . ,. Yes No ........... ....... parr»090-E2 tzolzl DAA 7EENJOBS 08/21/2013 t�i'Plq SCHEDULE A No,1l�t$aDO47 :Pob G ha wty Status -nd t ubj_ u por (Forii or"044 ortlpi af'ttle+oinni"on It as'ectid'o 60'i 4r(Sj o Or on 2012, ( � - 4"?,4 K1)nonexempt t,4rltable Est. :r• Deparbnent of ft woo Key Est1 bA.F0!'rfr1; $Q.O `lRft 89D-E , .�$mt iar$ "emall Reventerncx Name of the ecowOm ion ieaspn. c Pu " tioys Ys �ee'tlX ni art See instrudons: «: The a ani is taot a ptivefaa'iolmt atfan b causb it is:(Fier i s 1 h 11,Eck of►e cap 1 ►! 4trd.;tnva of4rt+rs*ar an #luesrd let #`tl�bxl ►�{t)• A schaoi deed setdf�er�r4 911 (1ti) tct }. A.haspitl ttr riot haspitaiiElf@8n17011 s+ o�4Tbt�Alii� w A°finedioW r �r!afi ac�rmi t!oper�ed�oo�ut n't �"ho�pttst desk�n LJ cat t b i ,T is atene, fir,2110 State.. ....,...�.�._�.�.k.,...... ." .. #�, t wT•-. ems•. , .;. e_r f ? - •.i 's 4 t e f?'{#t f!-.:h s ,s?._i_k�.r r•!!f t sti,. z.f.-' }G;r t -. S . r�a . wit t>' nWof 004m W6 $ 'ON, ow f i or toasted by a govetn�t rf orMOVW st es r s din- �lT j(i l v: 7'' An�t�anitetiatl.tt��f.a i a.�su#�t s[pert`6f 6 support fn&*Oovem l 8 voommy n# dust t� ih 'l 4 i dad#, W i ,. ). t:.oganbn 3arfnalq► oehrea�'t1 #fin 'l9i of#s. •.•.. ayr4dr - firomei;i>ted toffsuncJonesb #rgottanati o: 1l3' Pf its. ettppork trotl'1 pro to ttt+ stir nt;ipoorr4e st.0 w ed b i It :N�c surfs tlirerc.7 the iTiz er l+e X97 °;eess pn i l )• G ';' �4 afticrt:otiz�d it> eiastity to Est fprptl�s> r:fie tl�it 11 ;org$ i ti rganized yam r d psiv jr h+e b t t dorm# . , to ci put ti butpaees tf or rrtat+u policy po iatiois°dessxl, (ski t !Ih t18.(aX3j,l�tm t x#h d # s yps f: pzfrtin �< _.. t1 # i�tt 1h iii T:° ..a Typal ti _ Tjre°Ithloluiini .ii? egi �vt"this bm bW6 ttts�t or�sit�it<t dire by or �d #tfaliiied pst^ na der#an' auindatiai-manitge�a. oti�: s - �Y ns dew in station (��1 ff a tianin n a vi►rien de>bsmh. t t it s1 T t,Type il,Ya firma Ill e - .. ...:. ea�..� r rr..s •...:e a.. .�i.. ..1: .'iri.:. :sar'sq:�.. if�ll�t 1�;,i ;h1p�t�te , ... i'ncattt ttf> s fo. rra7 �1t 0 t #her with Ofto.ft .i<t-(iii �fsYi'.. ►. x , -.. } ! 'li�ya+amnbsi' v.'_...... A-36 l tw. f CH)abovel f -_`:_.... ._:.. ... ... ..., ... ..-. .'s . ..+Jr::.'b...s:a..,. yxp.A'...aw ...�..Y:i.-7es,:e• h • , the fol{o info snizatlon68 a: _. O)tY nrf a[: por rd. {tt}l i (Itlj 7y"*.vo tntslum Is#ha nrgarizatiott DO you nvty (vt)she (dasered 4it1 " !t col,{o fasted in yos� anlz�Uon in organagtion kt tl: pup +above or 1R�tsec�ioe, Or�aing docwt�t a ,M Of ()organized in Ow Imm Ala.,..:. `lw_.: Ito Ito :,..... ..•: WO for iP�pllrMtorlt':iteduatlon Act IJotica,s�the Instructions for $OttwdulwA ate+M0 b1'::�' X Form 990 or 990-EZ. lea T�EJOBS`Q4Rt1�13.t�s�PM . r.. E Schedule A wo 30 2 Tai' -Jos CO P O N l- 7 1,644 ... . : :n � upit Schedule how�p�pan�Zations Qesor4e�1 Sec�ons'tti(b)( 4}(ir�) Id {b1}( Ya, e� ho.box din ling , ': of Part; ar if# u$ War r late ftt if f1 h ff the arliztloh:fails. ua1 under th+e tests istel bow lease torn fete Part I11: on.&;�t t�rHq.§u ort C"dar year,(dr fiscal year tinning in)► 2008 )20x9: {C}2010.:. dy 2091 a 2012 Total. 1 Gifts.,grants,contributions,and msrrti hip fees received (Minot incWude i 0.unusual grants") 64,302 35,021 tt0,307 3i is 7 5# 3D2 i,`IF ! Z #tx rtsvenues levied forte 16140 a#ioWe$benefft er>ti� UW paid to,or,eocpended on ts'bshalf 3 '1't 4"%-s&%itss of tacilities. .v_ lurrtis sti bj►a ,it>fwtal unk-0" W. 4 Tof�at., 1. ,031 go, so �h , -a/A.�FS�v4�,�!fWFF�tF :�.� .... f:--1-:,,•: iy` t:_.. ,• `i{i r IMP EE ki c Is {.r :+i•R T�tst1 Su of JIM lard Ya!r 1 1rft�tlg !!l R b) tinyts fimn - a io3 7 ,Sa �a2 W;aa 1�. inabe ,altvidoncls .- . �� ±aoeilrod vn 9��s�oaai�s,. riffs,tiDyOrilEi�s�nd.in fnorr�simif'�r . !T?,1�...•;a7•.5. )ta...r„fir. [.�.;.�»1,5ti�ti' tY «.:....;. .. - - _ .- ... ... .. sotiit�le�,.:Tat ±CsrK�t�tii0ittlsu ii�. V �+F:'�"+Yi�lk+a.}'f 1 c,i!1�M'ir/r`gra.r •a' . . .:.... .. r. :91� Tt�e�•� �`ugh��' !? .. •. '. - on. t #ion �� .. •� ♦'ixs lFj 11 ari v: •k i.f�.a�•.J'i'a�aAa!'!+'tk x:l4 •kH� •'a.'vjH 1''.r�r1 _ ... Vn l�s l ,:at�i tine IsT�3 9A*W- .&;IN : an b t#d>G1Mf C4!fb►�CzO�i 113 Cr ift>WUU1d;fie�0�. 1 i Of#IIOf�4, HliCii► '.s- i� :} �� -�:� e:: v i,.a, da•.�..: .,e t-a':". .Ry:,.rw.}:.,y Fl_}-;ZN, 1i3t 1tft�'. 1t .rpe'(he frtl�dc his i har+4.E, lain In w P,IOt i l► on irtsats# ' acts-and r ta0t ”L' iir t qualffles as s'per supported organtzatiocr ?,.eef ,.4 - ••fa•a•!.Y_a. ._.••..• � +,_.-r tw:••. r-•,a;.r4 •'�-_s i'W.�;.Y`T! ax uF Y'•♦ ii ►..I1 t: • •1!t'» ;i Y.i't lir lF.,��,. ww»k,r ,r�Fp:•a,as..a t'i'. ;�Y � . 3 ' I± t ences test 2011,tF s brgantzilw d*w-, ecl� t?atl' a sk-'t 6a,�4 Ar x.71 t met t5 ie X10%O.—A -0,4*1 f0 organization its the`facts4nd t ttstancee test;t hs&1h1s box and a . Facpt In in Pail lY filow fps orgertizat�on meets the"fads-and-circumstances"test The organization qualftfp�40 i fit ► suppoir�d brritzatfon ..•.vi,a.i ,•:r t _'.ay♦ •,ii;r:•i,..e^bs'.:xi..s�:. ,F-F.l.r�1 n.`.-x'. s'i:i is i-fyy}.tw.a a` seir...an i'+]-! :iDi:Y•?.wa..a. a. »:•.::a+a'Tt•F}ia�i�:'.1,r'i It Pdif b foundatlon if the organ-limbos did naa�tbidt a tl on f 13,�lt�,'Ob, a.+or 7bF check this box,fuM!sse H7i►N{i _ yf .�'«e .i.. .•...a.- .. .a.•a a.•ax.....c..a.a..l sa..-,..:.»a.s.i+..�a v...s:..�...a..i..a,.sa.l..i•:..a•..ia.w.»..a..:a.iti....•....a i�rt�,i?. J.i � �1 orate i Ot .M4 Om TEEHaoas DMIrAWtiAU-S:PM Schedule A cart 090 or. . 201 EN 41033 G`QRPS. INC.. .G1�-fa'IS1S�� Page 3 Support Schedule for Organizations Dewribed in Section 09(a)(2) Complete:onfy#you I ced the box on fine S t f:Pact .or If an don foiled to qua.i u del Pat#.il ffthe organMorl'#aife to ua uriderthe fiesta Batted below, se coin' fete Part il. Section A.Public Support. Calendar year(or fiaal year ginning In)► r x':008 1"10 . 2011, 11. tQ Total 1 Gifts,grants,-contributions,and membership fees received.(Do not indude any'unusual grants 7 2 Groas'reWipts itbm` missions.ftW wdise iold Or services pelfo*rmed,or f acilifles ftmdshed in any activity that is related to:the organIIation's tax-exempt purpose ' 3 Graf receipts hin activities that arn`r wwpliiito We or business under s oita'I - 4 TAx'.Mwn-ues aeAod fprfhe Als orQa�taetion�berte�and e#hrsr pasiid, - b T1011. of lservioen alr::fitciifties " lth0ute .. .w S.r 1'M I T•.-x 6 ttlf�t` Totem- Ones:�l WS 70. A nourfe W4ded on Hnes 1,X-x;3 4 Amounts kocisiW on ones 2�d ti'Om I ftn dsquAMNied r�lba# .tom $neater of�,OCiQ Vr 1%of ±on:11006 13 for V11e ysbt c . �tld :9 Public strpjscrt(Subtract itne 7c error n t� 3 F � �� € -, - ,i :liirl6.6) ; .., 4 or.fto t beginning In 1 0th : 201 1 e 2012 1intlntss AMM 1t�1 :...�.,.... OF 10a f0o�+lelt,�. � cxlrtties loans,rents,, 00 i cfrioomalxrtsimitars b Unrelated bt ainess taxable income section 511°#axes)firom� busiirimses tMlaYterlt acftv ties 4 included 10 r or rat the business Is. 1-3- t" 1a ms's*A ,-third; ;*ft 1w year as a sett 1501.4 Omanlzatlo :.:Y:. Sectio.n.0,corh utatlot - ic8u . Percents e . p #1 ortpercentagiefpr2012 ;0,l Q)41vided.by 13,columns ' '16 .-_•tb�c av rt rcenta X0'11. • :. tl .11i Section x.:04 utationof.lnv�trfn#et�t lncorne.Percents e 17 lnves0Mnt Incomie.0*rdentage fqr 3"0'12 10a zotumn: ttI ided by 18 ktVestntent I=?he perr+enWis from X011 Odub q,>#'arf 1110 ft 1F, z . .., ..3;. .,:... ...,:.. .... ....,,, ,W;. ..: 1t1� :13.1/3% testa_20,t 0.. o st�porE "anizaWn did rwi t heck the box ; 14,and line 15 is more than 3.2#13 h,and line �� n©tt than 33 t13' i,�fhsoit ids bo�c_end stop here.The organization qualifies as a publicly supported organization Q uppod - 11.I' organlzativn did not heck a box on Nne 14 or line 18a,and line 16 is more than 33 113%,*W -fine 18 is not more thant/39L,check his baoc ant! .h+v.'tit�EMWnt''etualifies as a publicly supported oroanbuktion � . d . ,< ,.}• 20 '•.rlvate foundation.If'he ornignization did not check a box on lire 14 19a of teb check this box and see instructions Scheduta A(Forr",i6b or.190,4030}2 'TEENJOBS 08tZi/j0'f�t�56PM . chedule A 06 or 9 lov TERN :JOB CORPS ;I- NC Page 4 upi�tnental lrtrtom�atio Cor�rjpteie thus artrovexptanations required All 1 #II,dine'( a orb,and Ptr#lU�fine.l2 Also�cirlptetsni :part for any add'ronat :0 information. ♦ ♦r.,•�1'1{i:♦�f•••awr!•.f •..••. .il•a.wT •Ya i,a•J•,r•a•+ (.•:• •wr-4.•. •;.wa• rr._!.•! ...r .r t. •,T 1K.<• rnT•f! �"1 w-lM-a_! f••fr • i{.r`a:ir..i {w...Ta if,i:•:a.}.+�a1.JS r.-..r+••.i.i'4 f.{la..•. ::i.A.{.r..r••R+.i:: r: ..,a•1.4 4 •'i :IY't •.•Y• •wy'1:.'i'Y .Yn 1,•t+..Y'.tW''R!TY i'a...-! a.'k..�`!fl•ra1a Yi:•_ .. ....A.,a.i-4Y'arr••:4, •.a'f ♦ <.♦ <✓:•.4:r• a::f`J/Ri i' :•:/`.i.�.17-JI:,•`Rf•sx}::Jl;i,f!'t`•'fTi SP i..�a,;"�•ilt'f.i.v' - - -- :t.r: i.).`• ••{♦A.:a1.4♦:{.:"• rwa.a Y,•x.•s:-.i..:: rr a�'J r.L';e n,a.•:Yy'.i{ `fa-w,{'•4 X'i.s j:Y♦.. •. <:`r e4"r• f - - • ••:Y r+ ..:..A:'Y •f.•a:�+•:<�i a�♦♦»:A-.a,a'aa.ii•-i•(•a a•I4':ia•r•-�._: w.i'i.aiia•n.�s'.'rr.ia�-.-a'i raa{,a✓.a.{{i-rl i=s).r...r/•�•�i�ti.:a..ri 'i.l.r{.r r.a..a,?•wa./.. r) .-�.).,.w•.rr.Y.d.rV.w r..i::is-.:.•i{�.:a.)... -.�... a :Y'"r .Y.- .aria ♦v�i .sia�x ).--::. •.:.--• .f�a i4'-.if ii -a kt ..f 4 �. .r:.t � .y i^� .+(r 1-i a. � <s b .•. .). <.t..• •r>r:•'a'+t -rX:af .1,.t••+J« +;T.• Y T a, JF i..;, Y...<.-. •! •'T.,a ,..•t. ♦t:r r.•.a.»:�- +.,r.<.�y .e:��•dlP. 7,!,r+ --e..;.. ,r.r. y,i`'a:la i_{ rR iTr.}4 ': i y'4 w.t:�a.a,1{.l4'R. �.,.-w!.C ..li::•5.. -,yw.s ..x.1 vf7 :t.!:.ii.y'i i;Ji Y'. 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Fa . ee). �•r�l��M133��^��f n��riw.�if•1". ........ ...,. I�"s.w'ra_i�ir•I Far Paperwork Red�to o�.�Miogsee the WOUVOM fwform 890 or*90417- DAA IM,131-11OPM 8 a file signature Authorization. 0 rm 88..79mE for an Exempt Organization oli rb s+r' to For calendar year 2012,or fiscal ypv.beginninq M::_ .:.. ,.aRlr�1,and ending Department of to Treasury is Do not send to the IRS.Keep for your records. 2012 Internal Revenue Service - Name of exempt organization TNNN JOB CORPS INC. 01-.0131644 31644 Name and We of Oran Debor-th �t��gie�o DIRSCTOR a of Return:and Retui�i tnforar»a�oo a Doliart nI YOU Check the beX : to*!Or Which tmq a k uaing`t his I=orm I3s7 EQ and order the a1111 b�oploW t,rainy,from the� i1` check the box t a,,?A, .fir Via,below,.and the?amount tart tiros r1ha retum.ba flied t+rf th t Waa o leave.line 1 b, br 4b,of fib, ithk etirer .applicable,b{a lc j w tinter 4- *� �rou ertt d- - return. the applicable ft eit3liu..;l fo complete tnprie than 1 l 0 Pout l,- 9a a+m hem I► <. Total reven^441m,TOM Vot NrtVAHL IW''k(A),i t Total r 2i ForreiZ 'tere.l► n>�, ort» ?.. e: trf!t"'itOt. r shares` - otlti;tau�Fdi1m 11`;L PhQt.,1in b a..»x ,a...ra s g:e q y '+F.,. s ur..�!i!.��rtr�+► 4a Vb t' 990-P.F c hem + b Il l based ort alrsvestment:in+Ots. orrrf0, at# !li itrie ab l I=orM 8868 check We b balance Due'(Frsrm 8868,1'art 1, Cdr fit 8,8tte' 1 pfd s�' 'Sf hoUt a-Aut horkation, Qf leer IJndec penaltlas per.uiy,`l c#�l htrte i am.,"0 of fit a above Qrganlza#ton:anZl that i' b organ fZation'# ot2 Cfr+Ottic il9hlrt!acrd aCtE11p8 !� duleS 8nd itnts: 1 ►' are true,cant►arty 'oft f"er declare # ixart 1 above t t - n =5'i RY the organi>rons�a ttum i canser►t i>tlW rrryrfierrd ., anrleotrt>ver,tranllarnittw; urn or.191rivior ER3j to d#he'd anizoNon a :CO Q IRIa and to retlaive:fiQrn.thae=iRS{>l)an a nowledgerit+r}rtt+ n tsar U1 #rsrr►tsston. the eason for#Cry dsiaY.in prucxursir the nuirr f c)#fill!+ tat harry It , atlthoti�e#ae.0$firoaauryand d$sa�1:F�r> al Aigsnf to'�tt a ��wlrawal�dirt�ct�er�ao the. ftnct!rte aocouM:Indicated Ih the tax ixeparrr scrltware foi ntzation s'federal taxes oh#his . and t;t tutipri td dsttlt !antry°ts� a ynt.T itst: ntadatre t St na ury finlarr al rrt,at��9�3. 3'l•tt�l�er�itan��days�'�o ;. , ;.. l a�riut the�inrautdai ils iaMid�t � �the.eic'ppyme�� tap` n antbt scary tv anstitisir''-tngtt�rlea arxi 1ti►e' .W to p>tyrrrent.tblave .a. IFl1#a ray signet ifie ore t a to 11 11011'$ electron. rl n Ir1d,tf s16&6,tie w9arftationfs:Win` c funds withdrawal. •1 sue,. io��rrt8t PII1i _,: .. ... �i>Iyt a�nure - -.t;[o e�tri+taraA tee flan 1 tar>�it>�ttwri's�c fir;"�. ;�. .!r t a whin=#his retul'n Chef`a copy:'a�the t�um'=1r� beNngy�t�tlr,aiete pertofi#;artl�S�� itta�ral'n,1al>so��ti�.�tc�tmendn �f ► rtly ill wit; screen. D As on otfioer of 1h n lei ab r fignatute wganiza#ion s taz year�'fZ a�cb+DriiCagy t tom: If I have'Irtclice 111 bPf►bftdo'teturtr:Is being filed with a state agency(ies)regulating pf.ot the IRS:Fedt #e PIN on°fto rebates disclosure consent screen. Oficei"s'vignaturme bwe 1 ca errtleation ERO's EFINIPIN.E isd nI&filing Identification number(EFIN)foils 40--selected PIN. 60292346.5-�- .., Rio esh +s 1,cettrly#I7af the:aboyo-l Ic r fs t P1N,viihic�i.b f'efgriatuce on#tar 2t11�i elsdron fwd ftlih for, organization Ito _. alive l.r�tdlrtyt that l:fin ii Vii$return h+.00m*nce with the requlr+emertts-otPO.#1 ,.Modemized. inforrnatlon for M-thorkeed IRE e-fle Provkkws for Business Returns, ` WO bust Retain Fb*ii ir-fie Instrudvorw 0o:Not Submit Thia f=orm To the IRS UMoss Req ue ed Ta Sao So Fnr`+Paperwork Reaiu0 Iles Nye,see back of form. Fom+ -EiQzolb DAA 'VXMM`06'10=3 3:S PM F 88 1icaan far e �c!�:of' flttne To File-an ", mot-JO i'g8f11 �s0.1 return oMSHo,If 1709 Erbv.January.2013j k Inc oca►'n�� Ella a sepawtfe;appiicstlm'i for each tetut'P1. Revenue Service • l.You are filing for an.AUtp1natlC tenth t; rlrgiEtocl,, pmpie ni Part]y and caliedc tic ,, i Pelt N on r 2 ail this 61M Newdt friin0.aoranAdditional(rioti#lt j. -i t i Cfienslgn, a h► f gage )- Do ttpt Iflets Pi>ltt tt riass you have aft.ea�dy botEln gtapnW an�iutomSOC"�=month nelon on a previously fNe rrr18 8: Ele�gyftf 04l�) f�pu can eMc#naniat�t�e t~�rm 8� u t a 3 mcn#b automatic exter>sibn.of.tmte to tnon#hs�+Dr. - a corpartet to lilts i~om1 y,Vr Vn eddibonaCIttvt automatic)3 r th+pension c t tei.You Form 8868 to�t*n,•ilucten h of time to-Se a0Y d the forms r'isted 1h.-Part or mart ii the n ofi dorm 13$70, n Retairr A'*T aasf m Assodeted With r'rertain.Personal Bonet Cai&oM$'jNt0:100,St be sent f0 the.IRS Impopsr furl nit v Indwdlohm.fcir tie`Malls`on the eWimic fl Ogg of this form vj. i+J Aft Ind'dick on e-Me.forCfi�ar N ►utarr ati ` -rllt.onth. xten n. 'Time,i subm ..ina no�o ies nLede A cprpiaraEwtiort.' 4o to 6k 1= 89Q-Tt r+aqut an atriattc 6 month cc this bdx and iof 1.1,001Y.--, : +a'i3.x'.t�..sd -r'*►}rt-'yh-?6#i t:l::i 4 •''..,!i� ...'.V r ,s.. diva a:►c+ 7.i 4. f. r �..,C aw..,. a rr,..•.tr[': AN o#hsr Notations t"'i ii tiists Pa h Lind trusts must U*ft tlP;_ WHO:ittoom±w yetop.. - r , Type or ! !raiza on orb`fir,lam:#nehu e n number ttrl)of print ..... , #. . . ... . Oft ft,iiiiiw b rt01 0A RHO.hoo4 t `: s io�lsa ! j!ntxnber.. d1-R: $for 6 OMY t r irity.min rx#>bsf+e Oe,stete.:gw1, p 6iie.ftfit + .. Wift see ! v 0 11 ... aa'7:'4Y • •.?`-> i(+,,';' 7..''.'Y �'CZ..Y;Al,: Ff'Y r.f Return . rodez or _ 990`ar �� P ..,.990-6L... f 1 1-A ,Fdl`rii 47.20 u` C Fob 6068 rm 99ti<"T. ti�a>e�r a tnr y Firm T ist other than'a . . Form 8870 :i r8 ixiOt7�- ' ..•_ .w,i.s: -. .u.•)'�:4aY r... aa`. ,N.'�:(;i! l.+:..r:<t#.- •:i.a,aa: r,'i.eYX Y;I'31.t.a-•' },«.-.>!-yayh,rAY.a';w:r�v� ,;y< T �.... :t�✓4.>... : T� hena ,: ► is ,. .. ... }may + (t. of business in the'On d.` 1t .;..t..r ci.2 +>� •k:?ei+R+3;ct ; ; �: • lit fs a� tie t�s lOrut dipiEaro*EM ltur er(l x"is fot ff as ► __ ' is::. �ffi i#is fior3wrt o't Vle:$t+0up,:cttecdc th'ia bw and ! s list�ivlth hs'°-" :t�lte`ensron Is � - 1 i;iisgliir a j`' !ei' °motion r*Wk l to file Form"ice?-T} ttera of` e unto , exjrt it ani afion Ti�ttiic�t br"I�e omanizatian riamo—d abm4o Rife` nsidn s `;cabrufer yerar,..__012,x.. or Wd Z Mhe im oar o,%red in 1e ibr%as than 0 months. ck reason: � Initial return MgMe'jn:1MntinQ peiw 38 If this t _j$ -Fwm OW13t..990-PF,Q90 T,4720,or 6W9,enter the tentative tay,less any nonrefundable credits.SewInstructions. 3a $ b If this 01169tion f4'totl= 990-PF.89aT.4r4,6rSW9.'enter any refundable credits and "firnaw takowneft made Include a. , q.. ar nt:allowed as a credit, balance*'w.Subtracf:flne 3b from One 3a.ind�your'jiayment with this form;9 requIredbOlift .:& S JE12Lftnic Foderal Tex P aymont S m.See Instructions. _ So' Caution.if' are of to make an electronic fund wwkhdrawal with this Form SM Fttrmm-6453-1=0 and'Ff WO-E, for enE truic8ans. For Privacy Act and Paperwork Reduction Act Notice,see Instructions. tEonn$$6$iRsrr.4•"3) 'rEENJOP S`O71Z9t2O"f 312:23.PM. W:'` 13 Pa e 2 for'an Addtitional tNot AutoM"i ia)`34ilonth Extension, &plebs anly Part fl and check 06 dau ► X .. Note 3nly rrp F'8cF 11 M46 a . , l� lnra0y bOW Qrarrted sn aufamatic 3,,�mntfi:axtensbn arr4 pinevlously tired F : It. u are filina for an Jitutomatic 3-1Month Extensi soar on!y Part 1 on RIge U ME>:` Additions! Not Automatic 3-Month Extension.a Time Only file the:Oft inl: ies neded : . Eater flier's number lee.#rritnuetians Type or Name of exempt;OQiA* qrt Or'cther , 'instructions. Employer Idefti.0=tion number print .. NC File by the : .. ... : .._. Fire daft for Number,", beet,acrd iaom or itb ttd.9 P 4 tianc,.eee Instructions. 3oc i#rat reset( [ Bing your 73 5$ VARY -AVEMM riWm.See im", poet orm,spate,and ZIP r slareign address,see 1 MOVetions. rL 33141 Enter;the_Retu xx far theturrt that t Iotl a e epaCae applications he m� ¢,..r....� ♦:: , ,::•:-�;.�. ;...,:y:; l4ppfletTtei Fvrr:� cif' �•`-MW ! fbrm M ndfvid b3 FOM,:.:f ::Form: F fvrcttt2iY .3 .10 T'ow4DII it or a to rst orrrt 980-1` ruxt:ol<her than above -.,: ..Form 88T0 Pi POIUA plebe`P t lt'ifyc t to rt�tlre an 1.11tii1 t 11 1 _. vlouaty ft l si► 886$. - ��*�E Gas,�r lA ► A».t If7. Yiim� �yrt 1 s-a .�. ••..1� e.�..•:tfsrct�;r}�'. 5i...R 3'�' ').. st 4. '. '.s e-•! .. ��.F . a Tepttoll9Flb.:► `��- 972 - i♦'a!i'} tY s4 y-•�:�yy� _ . � �`�Fle c��a�t e9fes t��rs�r1�bilioe br plafre of tI'Els'trax ._ ,. ... pti�rt Nttmlalr Ct �. If this is�� for vviwb c boX', ► n f , 'raak tI bpot ».,:.. d attach a U an Est with the_ and EINs of-all rnerA rs tiie$ 1 ttth.extenl j4 �raque�:an a�ditlona � �,� e4 eform :.�- �i��!o f'l�tt�.a.�� -' -S A t 1� ♦ � �' R Yi ��K,�C.' }. •� .It \T+w��` t l q�11 ` ' } . Y♦ :f i.fT',.i.1.4 :.dal f•4-.•�•� -. :I ..._� i.t.i.♦"..,� �.t.l�..T,_w'w}.•.w.:T'Z. .� �s'4 a..•a.:x �!f .'.i !Y't.�• t.a.s.� .. Ir 'I'..,r.ss!%' rj,bS..L..I`.4R'.�Y.-f. ::i�,j<l w<' ♦ '.:%.f•Y 4a.s:Y.i.Tlr:1 f'Y,i,E ^ ... -.Yr Y. R.f":f:'f. -4 ws;i r'!'f,<.w:?. '>,-�.?7lr �I:A_Y C!'F-!.'t....�'4-. ,. tM'?:'�:'0-y•1.l J.E • r re _ - b': + tlmated taX' iidude: it�y T lrMesu ti!'erpgYtt>eint ltd ss=rtreclit at7d.i nY a ruafrlt vi` Ptah&UM. c` �+[�Wj*O d.1* ubtmcc t .,% t.li mat include�otitp at ttt#�harm, f.tiegt�nod,by using EFTPS Eloctronic Federal Tax Rt` ♦:ire i.h4hodltos. .t >n Ina n erlfic> 1W, ,, Ot be c n for Urfider peraltiea'oi'penury,.!declare the :exnied #arm,Iruiudina arxxEmpain ar Ulass and statementq,.OdtD;#tie bWOf y- `knowledge and belief,it h.-true,correct.and corm s, d that I am authorized to prepare this frm• rais► Deborah Ruggiero :-► _s.:_ ..: ...":.:. . ... POM JOB $868 O w to .o TEEN,i 0706, TEEN JOB CORPS, INC. 7.0 13 4:41M 4i kn wed m60 i �e�+�r�a :infvrma#inn for Tax ►em Who Me ze ros �Iec#ronicall� izp YPU r faking part fir► ►e e� le Program. TIJEEN 3B CORK,IiMC. 56 GARY 14 NUE- miAMI 13EAC 1,.Pt._3141 r P it `fir ixtetsiott et 'nn6'#ai an.. +enptcganizaati� r +eaemver : ; tlt1 dtilrR5ye servit opted�y they SRS an 0.12-9/1t3 nd the �ts8 +ell to your.ishi t It 60292320132100005223. 1noe you sm Ellin�g your return elecbxwikally, QUR-RETURN T. Tt E..1R . F ( ?l!Q '1�1' ►E.AY 'H, A0*6 rirrte tssrripnt P yp n *fur sf r lnator tYctrr- rrr;usual within 4 uCSt _ t �Vas.tttf accepted,ItS wit! 1'+ettt originator the reasons for isor�. . I _ - EXHIBIT "C" "BUDGET" The attached budget reflects the scope of expenses that may be incurred through this Agreement. All expenses must comply with applicable rules and regulations including Procurement and Davis Bacon Act. 17 MIAMI CDBG FY 2013/14 -- Project Budget Sub-Recipient: Teen Job Corps Project: Teen Job Corps Please list all items that will be reimbursed by the City of Miami Beach. Total Line Item 0L.Jantitv Unit Cost [ine Personnel (Employees Only)-List Position Title Deborah Ruggiero 125 24.44 3055 Employees: (9 youths 16 hours x 10.39 ph x 12.5 weeks)) 675 10.39 7013.25 0 Other Expenses Accounting Services 1 2750 2750 Office Supplies 1 100 100 Program Supplies 1 81.75 81.75 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Project • 13000 EXHIBIT "D" "FINANCIAL MANAGEMENT" To comply with federal regulations, each program must have a financial management system that provides accurate, current and complete disclosure of the financial status of the activity. This means the financial system must be capable of generating regular financial status reports which indicate the dollar amount allocated for each activity (including any budget revisions), amount obligated (i.e., for which contract exists), and the amount expended for each activity. The system must permit the comparison of actual expenditures and revenues against budgeted amounts. The City must be able to isolate and to trace every CDBG dollar received and prove where it went and for what it was used. The City is responsible for reviewing and certifying the financial management of any operating agency, which is not a City department or bureau, in order to determine whether or not it meets all of the above requirements. If the agency's system does not meet these requirements and modifications are not possible, the City must administer the CDBG funds for the operating agency. Support for Expenditures Sufficient support for expenses depends on the type of expenditure. They normally include the following items: • Salaries - Should be supported by proper documentation in personnel files of hire date, position, duties, compensation, and raises with effective date, termination date, and similar type information. Non-exempt employees are required by law to complete a timesheet showing number of hours they worked during the day. All employees paid in whole or in part from CDBG funds should prepare a time sheet indicating the hours worked on CDBG projects for each pay period. Based on these time sheets and the hourly payroll costs for each employee, a voucher statement indicating the distribution of payroll charges should be prepared and placed in the appropriate files.) • Employee Benefits - Should be supported by personnel policies and procedures manual, describing the types of benefits, eligibility and other relevant information.) • Professional Services - Should be supported by a complete and signed copy of the contract between the organization and the independent contractor, describing at the minimum, period of service, type of service and method for payments, in addition to the invoice from the private contractor.) • Purchases - At a minimum, purchases should be supported by a purchase order, packing list and vendor invoice. Credit card statements, travel itineraries, vendor statements and similar items do not represent support for an expense. Records Accounting records must be supported by source documentation. Invoices, bills of lading, purchase vouchers, payrolls and the like must be secured and retained for four years in order to show for what purpose funds were spent. Payments should not be made without invoices and vouchers physically in hand. All vouchers/invoices should be on vendor's letterhead. Financial records are to be retained for a period of four years, with access guaranteed to the City, to HUD or Treasury officials or their representative. 18 Audits For years beginning after June 30, 1996, all nonprofit organizations, state governments, and local governments that receive Federal funding fall under the revised OMB Circular A-133, Audits of States, Local Governments, and Nonprofit Organizations. Non-Federal entities that expend $500,000 or more in a year in Federal awards must have a single or program- specific audit. One copy of the sub-recipient or vendors' audited financial statement shall be submitted to the City immediately following the end of the fiscal year(s) during which CDBG funds are received. All auditees must submit to the Federal Audit Clearinghouse (FAC) a data collection form (Form SF-SAC) and reporting package upon completion of the annual audit in accordance with OMB Circular A-133. The deadline for this submission is the earlier of the 30 days after receipt of the auditor's report(s), or nine months after the end of the audit period, unless a longer period is agreed to in advance by the cognizant or oversight agency for the audit. Address for submission is: The Federal Audit Clearinghouse 1201 E. 10th Street Jeffersonville, IN 47132 Phone (301) 457-1551 or (800) 253-0696 Email: gov.fac(cDcensus.gov Web: http://harvester.census.gov/sac FARHCDI$ALLIHSG-CMCDBGICDBG 2013 2014 Public Services\Teen Job Corp 13%Teen Job Corp CDBG Scope of Service 10242013.docx 19 I