FY2017 US HUD Continuum of Care (CoC) Program INDEX
Cover page---page 1
Index--page2
Whereas and preamble---page 3
1. Statement of Work
a. Activities---page 3
b. Time Schedule---page 4
c. Budget---page 4,5, 6
2. Records and Reports
a. Financial Management---page 7
b. Records and Access to Records---page 8
c. Public Records---page 9
d. Encouraging Efficient Use of Information Technology and Shared Services---page 10
e. Reports: i) Progress Reports; ii)APR;iii) Survey; iv) Participants'Application for Housing;vJ
Program Income;vi) Program Guidelines;vii)Audit;viii) Incident;ix) COOP through x)
Mandatory Disclosures---pages 10 through 13
3. Special and General Conditions
a. Staff Responsibility---page 13
b. Client Referral Process---page 13
c. Documents to facilitate the Reimbursement of services---page 13
d. Compliance with rules,guidelines of CoC Rental Assistance items i)through v)---page 13
e. VAWA Emergency Transfer Plan---page 14
E Performance Improvement Plans---page 14
g. General Conditions
i. Insurance; ii) Indemnification;iii)Certification and Representation; iv)Conflict of
Interest;v)Affidavits---pages 14 through 17
h. Civil Rights---page 18 through 20
4. Suspension and Termination
a. Suspension---page 21
b. Termination---page 21 through 23
5. Future Funding Applications---page 23
6. Reversion of Assets
a. Term of Commitment---page 24
b. Repayment of Grant---page 24
c. Prevention of Undue Benefit---page 24
d. Revocation of License or Permit---page 25
e. Declaration of Restrictive Covenant and Declaration of Restrictions---page 25
7. Uniform Administrative Requirements
a. Accounting Standards,Costs Principles and Regulations---page 26
b. Retention of Records---page 27
8. Additional Requirements
Items a through gg---pages 27 through 35
9. Religious Organizations---page 36
10. Health Insurance Portability and Accountability Act(HIPAA)---page 36,37
11. Proof of Licensure/Certification and Background Screening
a. Licensure/Certification---page 37
b. Background Screening---page 38
Signature---page 39
Index of Attachments A through L---page 40
CoC Grant#FL0177L4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 2
Subrecipient Agreement between Miami-Dade County and
The City of Miami Beach for the
FY 2017 US HUD CoC Program Grant#FL0177L4D001710
The City of 74.mi Beachch�J Outreach Program
THIS AGREEMENT,entered this L day of /✓ i/ 201 by and between Miami-
Dade County, on behalf of its Homeless Trust (HT) (hereinafter called the "Grantee"), and The City
of Miami Beach, (hereinafter referred to as the"Subrecipient') under this Agreement.
WHEREAS, the Homeless Emergency Assistance and Rapid Transition to Housing Act of 2009
(HEARTH Act) amended the McKinney-Vento Homeless Assistance Act, consolidating three (3)
separate reauthorized McKinney-Vento Homeless Assistance Programs, Supportive Housing
Program (SHP), Shelter Plus Care (S+C) Program, and Section 8 Moderate Rehabilitation Single
Room Occupancy (SRO) Program into a single grant program known as the Continuum of Care
(CoC) Program.
WHEREAS, the Grantee has applied for and received funds from the United States Department of
Housing and Urban Development (US HUD) under the McKinney-Vento Homeless Assistance Act as
amended by The HEARTH Act of 2009 (42 U.S.C. 11301, et seq.).
WHEREAS, the Grantee agrees to comply with all requirements of this Agreement and to accept
responsibility for such compliance by the Subrecipient to which it makes grant funds available; and
NOW,THEREFORE,it is agreed between the parties hereto that;
1. Statement of Work
a. Activities - The Subrecipient shall adhere to the "Continuum of Care Program Grant
Agreement and Exhibit 1 Scope of Work for FY 2017 Competition",Attachment A,which
is incorporated herein and governed by the Continuum of Care (CoC) Program rules and
regulations (the'Rule"). The Subrecipient shall comply with all applicable federal,state and
local laws, regulations and ordinances,including but not limited to 24 CFR Part 578,as may
be amended, the McKinney-Vento Homeless Assistance Act (42 U.S.C. 11301 et seq.) (the
"Act"),as may be amended,the Consolidated and Further Continuing Appropriations Acts of
2013 and 2014 (The Consolidated Appropriations Act of 2014, Public Law 113-76,approved
January 17, 2014 in the"FY 2014 HUD Appropriations Act") as well as with any other terms
and conditions as HUD may have established in the applicable Notice of Funds Availability
(NOFA) and with any applicable guidance, requirements and directives provided by US HUD
and with any applicable guidance, requirements and directives provided by Miami-Dade
County Homeless Trust.
The Subrecipient shall carry out the activities specified in the"Scope of Service and US HUD
eSnaps Documents"Attachment B. The Subrecipient shall also adhere to the Standards of
Housing and Services as set forth in the "Miami-Dade County Homeless Trust Standards of
Care", as may be amended from time to time and incorporated herein by reference. The
Subrecipient shall adhere to all applicable federal,state and local laws,regulations,rules and
standards,as well as with the terms of this Agreement including all attachments.
b. Time Schedule - The Grantee and the Subrecipient agree that this Agreement shall become
effective on June 1.2018.
CoC Grant#FL0177L4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 3
This Agreement shall expire on May 31.2019 one (1)year from the effective date.
Any cost incurred by the Subrecipient beyond this date will not be paid by the Grantee,except
as specifically provided herein. Notwithstanding any provision herein to the contrary,certain
requirements imposed on the Subrecipient by this Agreement and federal regulations may
continue for a term of at least fifteen(15)years from the date of initial occupancy or service,
as provided in this Agreement or as specified by law or regulation. The requirements of this
Agreement shall remain in effect during any time period that the Subrecipient has control
over any funds generated or provided in connection with this Agreement including program
income.
c. Budget-The Grantee agrees,subject to the availability of funds and payment of funds to the
Grantee by the United States Department of Housing and Urban Development and subject to
the Subrecipient's compliance with all applicable laws and agreement terms as determined
by the Grantee, to pay for contracted activities according to the terms and conditions
contained within this Agreement,Subrecipient's application for the CoC Homeless Assistance
Program,and the Subrecipients NOFA application documents as Project Sponsor and"Scope
of Service and US HUD eSnaps documents" including the Budget incorporated herein as
Attachment B,in an amount not to exceed $0.00 for Rental Assistance, $0.00 for Leasing,
$60.946.00 for Supportive Services, $0.00 for Operations, $0.00 for HMIS costs and
$4266.00 for overall Project Administration Costs which added together equals an amount
of$65.212.00 in TOTAL BUDGET.
If the Grantee, Miami-Dade County through its Public Housing and Community Development
Department (PHCD) or such other department or party as may be selected by Miami-Dade
County Homeless Trust, is the Rental Administrator; then the Grantee shall pay the "CoC
Program HAP Contract"Attachment K payments directly to Landlord, owner(s). The total
amount awarded pursuant to this Agreement, in amount up to $0.00 for Rental Assistance
funds has been allocated for use as eligible rental assistance payments on behalf of the
Subrecipient's program participants.
Pursuant to 24 CFR 578.59, the Grantee shall retain 50% of the Overall Project
Administration Costs,except where limitations are imposed as maybe applicable pursuant
to 42 USC § 11383 (a).
If applicable, the Subrecipient shall be reimbursed for capital funding on an incremental
basis, based on the following completion benchmarks: 30%, 30%, 30% and 10% to be
provided when a final Certificate of Occupancy is obtained from the developer,in accordance
with any applicable laws and regulations. All other activities shall be paid on a
reimbursement basis following the submission of a monthly invoice along with the
appropriate supporting documentation.
In accordance with federal requirements including 24 CFR Part 578.73, the Subrecipient
agrees to provide match funds in an amount that represents no less than twenty-five
percent(25%)cash or in-kind contributions on all eligible grant funds, except leasing. If in-
kind services provided through a third party are used to fulfill part of the match, a fully-
executed Memorandum of Understanding(MOU) between the Subrecipient and the third
party that will provide the services must be submitted to the Grantee.
The budget figures above represent the original line item totals as delineated in the
"Continuum of Care Program Grant Agreement" Attachment A. The Subrecipient may
CoC Grant 4FL0177L4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 4
propose to shift funds by less than 10°/u between eligible categories in the"Scope of Service
and US HUD eSnaps Documents"Attachment B,if the appropriate match is provided, the
administrative costs are not increased and the proposed shift is submitted in writing for the
Grantee's consideration. The Grantee may,but is not required to,approve the proposed shift.
Any approval must be in writing. As such, if Attachment B is modified as described above,
the figures within the"eSnaps Application"may not match the contracted figures delineated
in the"US HUD Grant Agreement."
In accordance with 24 CFR 578 the Subrecipient is prohibited from moving more than 10%
from one budget line item in a project's approved budget to another without written"US HUD
grant amendment"and amendment to this Agreement.
This is a Performance-based Agreement to deliver housing and or services to
Subrecipienfs Continuum of Care(CoC)program participants.The Subrecipient shall provide
outreach and emergency placement services(Supportive Services Only(SSO)to three
hundred and fifty(350)homeless individuals and families under the Continuum of Care
Program. The program's main office is located at 1700 Convention Center Drive, Miami
Beach, Florida 33139. Service is located in Miami-Dade County, Florida. The Subrecipient
shall provide services as outlined in the Attachments to this Agreement as required,pursuant
to the FY 2017 US HUD CoC Program NOFA Competition as submitted in the project
application,incorporated herein by reference.
Availability of funds shall be determined in the Grantee's sole discretion.
If this Agreement is for permanent supportive housing or permanent housing for eligible
homeless individuals and /or homeless families; the Subrecipient agrees that, with some
exceptions no undocumented or illegal immigrants shall be eligible for services provided
under this Agreement. Additionally, the Subrecipient shall comply with The Personal
Responsibility and Work Opportunity Reconciliation Act of 1996 ("PRWORA"), as may
be amended and applicable law,in verifying citizenship,residency and immigration status of
potential participants.
The Subrecipient shall comply with The Personal Responsibility and Work Opportunity
Reconciliation Act of 1996 ("PRWORA•'), as may be amended and applicable law, in
verifying citizenship, residency and immigration status of potential participants. The
Subrecipient hereby acknowledges that PRWORA prohibits housing or services provided
under this Agreement to undocumented or illegal immigrants.
When the Grantee, Miami-Dade County through its Homeless Trust is the rental
administrator of the CoC Program (also known as Tenant-Based, Sponsor-Based or Project-
Based Rental Assistance). If this Agreement is for permanent supportive housing or
permanent housing for homeless participants, under the CoC Program and the Grantee,
Miami-I . u e Conn t •u•h its Homeles Trust is there al administrator of payment
of Housing Assistance Payment (HAP) Contracts the following rules, regulations,
responsibilities apply: Agreement specifically for housing under Tenant-based or Sponsor-
based, or Project-based Rental Assistance, it is the Subrecipient's responsibility to identify
eligible rental units for eligible homeless program participants in partnership with the
established CoC's Coordinated Outreach and Assessment System. The Landlord identified by
the Subrecipient must enter into a "Housing Assistance Payment (HAP) Contract",
Attachment K attached to this Agreement.
CoC Grant#FL0177L4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 5
When the Subrecipient is the rental administrator of payments of Housing Assistance
Payment (HAP) Contracts for the Permanent Housing Tenant-Based, Sponsor-Based or
Project Based Rental Assistance or Rapid Re-Housing CoC Program. If this Agreement is for
permanent supportive housing or permanent housing for homeless participants, under the
Legacy SHP or CoC Rental Assistance Program and the Subrecipient is the rental
administrator of the"Housing Assistance Payments(HAP) Contracts"Attachment J,the
following rules, regulations, and responsibilities apply:
It is the Subrecipient's sole responsibility to identify eligible rental units for eligible homeless
program participants in partnership with the established CoC's Coordinated Outreach and
Assessment. It is the Subrecipient's sole responsibility to enter into a"Housing Assistance
Payment (HAP) Contract" Attachment J with the eligible owner of each rental unit
("Landlord"). The Subrecipient must use the HAP Contract template forms in Attachment
attached to this Agreement when the Subrecipient contracts with the Landlord. The
Subrecipient is responsible for ensuring the HAP Contract complies with all program
requirements, terms and conditions of this Agreement, and applicable law. The Grantee,
Miami-Dade County,shall not be a party to the HAP Contract. Should the Subrecipient desire
or require any amendments to the HAP Contract template form;the Subrecipient shall advise
the Grantee of the proposed amendment(s) and explain why the amendment(s) is desired or
required prior to amending the HAP Contract template form.
The Subrecipient is solely responsible for paying rent to the Landlords on time. The
Subrecipient shall develop forms for Landlords' use in collecting late fees arising from
Subrecipient's failure to pay a Landlord rent on time. The Subrecipient shall be solely
responsible for payment of any late fee arising from any late rent payment(s)to Landlord(s).
The Subrecipient shall indemnify the Grantee, Miami-Dade County, and pay all costs of
defense, including attorneys' fees arising from or related to the HAP Contract and this
provision.
2. Records and Reports
a. Financial Management-The Grantee and the Subrecipient shall adhere to the requirements
for financial reporting as required pursuant to the Federal Office of Management and
Budget(OMB) Omni or Super Circular 2 CFR Chapter I,and Chapter Il,Parts 200, 215,
220, 225, and 230 Uniform Administrative Requirements, Cost Principles, and Audit
Requirements for Federal Awards,as may be amended or updated from time to time; 24
CFR Part 578, as may be amended or updated from time to time; and any other applicable
laws,regulations and standards.
Requests for payment shall be submitted to the Grantee by the fifteenth(15th) of the month
in the following manner. All requests shall include supporting documentation for each line
item,including payroll reports,time sheets, invoices, leasing agreements and shall be signed
by the Executive Director, Financial Officer or other duly authorized fiscal agent of the
Subrecipient in the forms incorporated herein as combined"Consolidated Financial Record
and Reports",Attachment E.
Reimbursement shall be provided only for eligible costs associated with the activities
outlined in the budget contained within the "Scope of Service and US HUD e-Snaps
Documents"Attachment B.
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Any reimbursement may be withheld or reduced by the Grantee if missing receipt of
documents verifying the in-kind or cash match expenditures or compliance requirements are
not met. Cash match or in-kind contributions must be used for the costs of activities that are
eligible in the governing regulations.
Any reimbursement maybe withheld pending the receipt of approval by the Grantee of all
reports and documents required herein, including but not limited to the submission of an
accurate and complete Annual Performance Report (APR) "Performance Reports
(Monthly and Annual) HMIS and Fiscal Report" Attachment F. The Subrecipient shall
provide a certification statement for all annual financial reports and requests for payment
which states the following: "By signing this report I(insert name here)certify to the best of my
knowledge and belief that the report is true, complete and accurate and the expenditures,
disbursements and cash receipts are for the purposes and objectives set forth in the terms and
conditions of the federal award. I am aware that any false,fictitious,or fraudulent information
or the omission of any material fact,maysubject me to criminal,civil or administrative penalties
for fraud,false statements,false claims or other offense."
In no event shall the Grantee funds be advanced to any of the Subrecipient's subcontractors
hereunder.
The parties agree that the Subrecipient may request a revision, amendment, or modification
of the schedule of payments or line item budget. However, such revisions, amendments or
modifications shall be, in writing and subject to review and approval by the Grantee and, if
applicable, by US HUD. If there is a request to shift greater than 10% of funds between
funding activities, such requests shall be submitted to the Grantee no later than one
hundred fifty(1501 calendar days prior to the expiration of the grant. If the request is a
shift of less than 10% of funds between funding activities,a modification or revision,shall be
submitted to the Grantee no later than ninety 190) calendar days prior to the expiration of
the grant. Failure to submit the appropriate supporting documentation in a timely manner
may result in the inability of the Grantee to approve,revise, amend or modify the budget.
A final request for reimbursement from the Subrecipient will be accepted by the
Grantee up to thirty (301 days after the expiration of this Agreement. If the
Subrecipient fails to comply, all rights to payments will be forfeited if the Grantee so
chooses.
A final report of expenditures shall be submitted to the Grantee within thirty(301 calendar
days from the termination or expiration of this Agreement. if after the receipt of such final
report,the Grantee determines that the Subrecipient has been paid funds not in compliance
with the Agreement, and to which the Subrecipient is not entitled, the Subrecipient shall be
required to return such funds. However, if the Subrecipient submits documentation
demonstrating that the expenditure was in compliance with this Agreement to the
satisfaction of the Grantee, the funds shall not have to be returned. The Grantee shall have
the sole and absolute discretion to determine if the Subrecipient is entitled to such funds and
the decision of the Grantee in this matter shall be final and binding.
b. Records andAccess to Records-Agreement records are defined as any and all books,records,
client files (including client progress reports, referral forms, case notes and other reports or
work product), documents, information, data, papers, letters, materials, electronic storage
data and media whether written, printed, electronic or electrical, however collected or
preserved which is or was produced, developed, maintained, completed, received, or
CoC Grant#FL0177L4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 7
compiled by or at the direction of the Subrecipient or any subcontractor directly or indirectly
related to the duties and obligations required by terms of this Agreement, including but not
limited to financial books and records, ledgers, drawings, maps, pamphlets, designs,
electronic tapes,computer drives, flash drives and diskettes or surveys.
The Subrecipient shall maintain Agreement records that document all actions to comply with
and that relate to this Agreement, including those on race, ethnicity, gender, disability and
homeless status data;and those in accordance with generally accepted accounting principles,
procedures, and practices as required in OMB Omni or Super Circular Uniform
Administrative Requirements, Cost Principles and Audit Requirements for Federal
Awards which shall sufficiently and properly reflect all revenues and expenditures of funds
provided directly or indirectly by the Grantee pursuant to the terms of this Agreement which
shall include but not limited to a cash receipt journal, cash disbursements journal, general
ledger,and all such subsidiary ledgers as maybe reasonably necessary.
The Subrecipient shall provide to the Grantee, upon request by the Grantee, all Agreement
records. The requested Agreement records shall become the property of the Grantee without
restriction, reservation, or limitation of their use and shall be made available by the
Subrecipient at any time upon request by the Grantee. The Grantee shall have unlimited
rights to all books,articles,or other copyrightable materials developed in the performance of
this Agreement. These unlimited rights include the rights of royalty-free, nonexclusive, and
irrevocable license to reproduce,publish,or otherwise use,and to authorize others to use the
work for public purposes.
The Subrecipient shall ensure that the Agreement records shall at all times be subject to and
available for full access and review, inspection, or audit by Grantee and Federal personnel
and any other persons so authorized by the Grantee.
The Subrecipient shall include in all the Grantee approved subcontracts, language outlining
eligible substantive programmatic services,recordkeeping and audit requirements as
detailed in this Agreement. This includes all subcontractors eligible to carry out
substantive programmatic services as detailed in this Agreement. The Grantee shall, in its
sole and absolute discretion,determine when services are eligible substantive
programmatic services and subject to the audit and recordkeeping requirements described
in this Agreement. These records shall be maintained pursuant to this Agreement.
If the Subrecipient received funds from or is under regulatory control of other
governmental agencies, and those agencies issue monitoring reports, regulatory
examinations, or other similar reports, then the Subrecipient shall provide to the
Grantee a copy of each report and any follow-up communications and reports
immediately upon such issuance unless such disclosure is a violation of those
agencies'rules.
c. Public Records—Pursuant to Section 119.0701, Florida Statutes,the Subrecipient shall:
i. Keep and maintain public records that ordinarily and necessarily would be required
by the Grantee in order to perform the service;
ii. Upon request from the Grantee's custodian of public records identified herein,
provide the Grantee with a copy of the requested records or allow the public with
access to the public records on the same terms and conditions that the Grantee would
provide the records and at a cost that does not exceed the cost provided in the Florida
CoC Grant#FL0177L4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 8
Public Records Act, Miami-Dade County Administrative Order No. 4-48, or as
otherwise provided by law;
iii. Ensure that public records that are exempt or confidential and exempt from public
records disclosure requirements are not disclosed except as authorized by law for the
duration of this Agreement's term and following completion of the services under this
Agreement if the Subrecipient does not transfer the records to the Grantee; and
iv. Meet all requirements for retaining public records and transfer to the Grantee, at no
Grantee cost,all public records created,received,maintained and/or directly related
to the performance of this Agreement that are in possession of the Subrecipient upon
termination of this Agreement. Upon termination of this Agreement,the Subrecipient
shall destroy any duplicate public records that are exempt or confidential and exempt
from public records disclosure requirements. All records stored electronically must
be provided to the Grantee in a format that is compatible with the information
technology systems of the Grantee.
For purposes of this Article, the term "public records" shall mean all documents, papers,
letters, maps, books,tapes, photographs, films, sound recordings, data processing software,
or other material, regardless of the physical form, characteristics, or means of transmission,
made or received pursuant to law or ordinance or in connection with the transaction of
official business of the Grantee.
In addition to penalties set for in Section 119.10, Florida Statutes, for the failure of the
Subrecipient to comply with Section 119.0701, Florida Statutes,and this Article II,Section
2.1 (QQ) of this Agreement, the Grantee shall avail itself of the remedies set forth in this
Agreement.
If the Subrecipient has questions regarding the application of
Chapter 119, Florida Statutes, to the Subrecipient's duty to provide
public records relating to this Agreement, contact Miami-Dade
County's Custodian of Public Records at:
Miami-Dade County
Homeless Trust
111 NW 1st Street, 27th Floor, Suite 310
Miami, Florida 33128
Attention: Victoria L. Mallette, Executive Director
Email: vmallette@miamidade.gov
d. Encouraging Efficient Use of Information Technology and Shared Services — in accordance
with the May 2013 Executive Order on Making Open and Machine Readable the New
Default for Government Information, OMB Omni or Super Circular 2 CFR Chapters I,
Chapters II, Part 200, et al.Section 200.335 Methods for Collection,Transmission and
Storage of Information; the Subrecipient is encouraged whenever practicable, to collect,
transmit and store Federal award-related information in open and machine-readable
formats.
CoC Grant#FL0177L4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 9
e. Reports - The Subrecipient shall submit to the Grantee the reports described below or any
other document in whatsoever form, manner, or frequency as may be requested by the
Grantee. These reports will be used for monitoring the progress, performance, and
compliance with applicable Grantee and Federal requirements.
i. Progress Reports - The Subrecipient shall submit a "Homeless Management
Information System (HMIS) generated "Performance Report",Attachment F, along
with a summary and the specified forms attached hereto as "Consolidated Financial
Record and Reports",Attachment E. These reports may be revised or updated by the
Grantee from time to time; and shall describe the progress made by the Subrecipient in
achieving each of the objectives identified in "Scope of Service and US HUD eSnaps
Documents" Attachment B. The reports shall explain the Subrecipient's progress
including comparison of actual versus planned progress for the period. The reports are
due by the fifteenth 11541 day of the following month. The requests for reimbursement,
are also due by the fifteenth 115t"1 day following the close of the prior month.
Subrecipients that are Domestic Violence Programs shall participate in a HMIS-equivalent
system. Such Subrecipients shall provide proof to the Grantee of the utilization of an
alternative system to compile all required data for the Performance Report.
ii. Annual Performance Report-The Subrecipient shall submit a HMIS generated"US HUD
CoC Annual Performance Report(0625-HUD-CoC-APR)"Attachment F,in addition to
a complete and accurate report using supplemental "eSnaps CoC APR Financial and
Performance Questions" provided by the Grantee Attachment F. The complete and
accurate APR is due to the Grantee no later than thirty (30) days after the end of each
operating year. The above referenced report may be substituted for any other US HUD
required Report if approved by US HUD and the Miami-Dade County Homeless Trust
iii. A Program Rating and Satisfaction Survey Report shall be conducted electronically
utilizing a Miami-Dade County Homeless Trust generated survey tool. This tool will be
issued in the month of May of each calendar year and survey results must be submitted
to the Miami-Dade County Homeless Trust no later than forty-five (45) calendar days
from the date of issuance.
iv. When the Grantee, Miami-Dade County is the Rental Administrator: The Subrecipient
shall submit a complete an accurate CoC Program "Participant Application for
Housing' Package, Attachment K, including all supporting documentation for each
eligible program participant accepted through the CoC's established Coordinated
Outreach and Assessment HMIS system to Miami-Dade County Homeless Trust, 27th
Floor, Suite 310, 111 NW First Street, Miami, Florida 33128. Pursuant to 24 CFR
578.77(c),the Subrecipient must examine program participants'income initially,and at
least annually thereafter, to determine the amount of the contribution toward rent
payable by the program participants. Adjustments to program participants'contribution
toward the rental payment must be made as changes in income are identified. The
Subrecipient is required for each program participant receiving assistance to notify the
Grantee in writing of changes in the participants' income or other circumstances that
affect the program participants' eligibility or need for assistance. The Subrecipient shall
submit "Re-certification of Participation Application for Housing" Package
Attachment K, no later than one hundred-twenty (120) calendar days before the
expiration of term of the Lease Agreement and HAP Contract. The Re-certification
CoC Grant#FL0177L4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 10
application shall include documented evidence of the program participants' continued
lack of sufficient resources and support networks necessary to retain housing without
assistance from the CoC Program.
When the Subrecipient is the Rental Administrator:The Subrecipient shall complete and
maintain an accurate CoC Program "Participant Application for Housing" Package,
Attachment J, including all supporting documentation for each eligible program
participant accepted through the CoC's established Coordinated Outreach and
Assessment HMIS system. Pursuant to 24 CFR 578.77(c),the Subrecipient must examine
program participants' income initially,and at least annually thereafter,to determine the
amount of the contribution toward rent payable by the program participants.
Adjustments to program participants' contribution toward the rental payment must be
made as changes in income are identified. The Subrecipient is required for each program
participant receiving assistance to retain records for the Grantee's review,changes in the
participants' income or other circumstances that affect the program participants'
eligibility or need for assistance. The Subrecipient shall retain records of "Re-
certification of Participation Application for Housing" Package Attachment J, no
later than one hundred-twenty (1201 calendar days before the expiration of term of
the Lease Agreement and HAP Contract. The Re-certification application shall include
documented evidence of the program participants'continued lack of sufficient resources
and support networks necessary to retain housing without assistance from the CoC
Program.
v. Program Income-the income received by the Subrecipient directly generated by a grant-
supported activity. Program income earned during the grant term shall be retained and
may either be 1) added to funds committed to the project by HUD and the recipient and
used for eligible activities in accordance with the requirements pursuant to 24 CFR 578
or 2) used as match. Program Income is reported and submitted to the Homeless Trust
monthly in the"Consolidated Financial Record and Reports",Attachment E
vi. A"CoC Homeless Assistance Program Guidelines" Attachment G shall be completed
and retained by the Subrecipient. This report must be available upon request during any
site visit or comprehensive monitoring or inspection as requested by the Grantee. This
report is an informational guideline to assist in compliance to the CoC Homeless
Assistance Program policies, procedures and requirements and regulations.
vii. Audit Reports - Subrecipients shall submit an audit conducted in accordance with the
provisions of Omni or Super Circular 2 CFR Chapter I,and Chapter II,Parts 200,215,
220, 225, and 230 Uniform Administrative Requirements, Cost Principles, and
Audit Requirements for Federal Awards, as applicable, and with 24 CFR 578.99(g)
which provides that Subrecipients must comply with the audit requirements of OMB
Circular A-133, "Audits of States, Local Governments, and Non-profit Organizations.".
The Subrecipient shall provide such reports no later than one hundred-eighty (1801
calendar days following the end of the Subrecipients fiscal year, for each year during
which this Agreement remains in force or until all funds earned from this Agreement have
been so audited, whichever is later, provided that the Subrecipient has such an opinion
prepared. The Subrecipient shall comply with any and all other applicable audit and
reporting requirements.
viii.Incident Reports-The Subrecipient must report to Miami-Dade County Homeless Trust
information related to any critical incidents occurring during the administration of its
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programs, using form "Incident Report" Attachment H. Such notification shall occur,
within twenty-four f241 hours of the incident occurring. In addition,the Subrecipient
shall report this incident to the appropriate authorities as well as submit in writing a
detailed account of the incident. This Incident Report should be addressed to Miami-Dade
County Homeless Trust's Disaster Coordinator, as well as the Subrecipient's assigned
Contract Officer. The Subrecipient shall comply with the privacy,security and electronic
transfer standards in transmittal of any Incident Report to comply with Health Insurance
Portability and Accountability Act (HIPAA) in using appropriate safeguards to prevent
non-permitted disclosures. This Incident Report shall be addressed to Miami-Dade
County, Homeless Trust, Suite 310, 27th Floor, 111 NW 1n Street, Miami, Florida,
33128; (305) 375-1490 and facsimile(305) 375-2722.
ix. The COOP Report - The Subrecipient shall submit a Continuity of Operations Plan
(COOP),also known as an Agency Wide and Program Specific Disaster Plan in PDF format
and emailed as an attachment to Miami-Dade County Homeless Trust's Disaster
Coordinator and an original paper copy submitted no later than April 1^ of each
operating year
x. Mandatory Disclosure -The Subrecipient is required to disclose in a timely manner and
in writing "all violations of Federal criminal law involving fraud, bribery, or gratuity
violations potentially affecting the Federal award". Failure to make the required
disclosures can result in a number of actions,including suspension and or debarment.
3. Special and General Conditions-
a. The Subrecipient's Staff members providing eligible services under this Agreement are listed
in the budget section of the"Scope of Service,US HUD eSnaps Documents"Attachment B.
The Subrecipient shall additionally submit job titles and job descriptions upon request.
b. The Subrecipient shall follow the client referral process in the Scope of Service contained
within the"Scope of Service and US HUD eSnaps Documents"Attachment B and through
the Continuum of Care (Cogs Coordinated Outreach and Assessment system. The client
referral process may be amended by the Grantee to meet changing priorities of the
Continuum of Care. All referrals shall be made to the Subrecipient and accepted by the
Subrecipient through the established Coordinated Outreach and Assessment and HMIS
system.
c. The Subrecipient shall provide any documentation necessary, such as the "W-9 Form"
Attachment C,to facilitate the reimbursement of services.
d. The Subrecipient shall comply with all rules, guidelines and regulations governing the CoC
Rental Assistance program under 24 CFR 578, and any other applicable law, rules and
regulations.
i. Rental assistance projects must serve eligible program participants,including but not
limited to retaining records of disability and homeless verification as part of the
recordkeeping requirements.
ii. Rental assistance funds are to pay Landlord owner(s)in the community the difference
between the contract rent amount of the unit and the homeless participants' or
tenants' contribution toward rent. The program participants' or tenants'
CoC Grant#FL0177L4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 12
contribution toward rent is determined by the type of program. Under tenant-based
rental assistance, sponsor-based rental assistance, and project based rental
assistance, program participants are required to pay rent to the landlord as
determined under 24 CFR 57837. It is important to note in all the US HUD CoC
Programs,the program participants enter into a Lease with the Landlord.
iii. The Subrecipient must consistently follow policies and procedures used by the CoC's
established Coordinated Outreach and Assessment (HMIS) system in accepting
referrals of eligible program participants pursuant to 24 CFR 578.7(a)(8).
iv. The Subrecipient shall establish referral protocols,policies and procedures subject to
approval by Miami-Dade County Homeless Trust in documenting rejection of
program participants accepted from the CoC's established Coordinated Outreach and
Assessment (HMIS) system,which must include at a minimum, assurances that such
rejections are justified and that the program participants are able to access another
suitable program within a reasonable amount of time.
v. The Subrecipient shall establish protocols, policies and procedures subject to
approval by Miami-Dade County Homeless Trust and consistent with Miami-Dade
County Homeless Trust's CoC "Standards of Care" pertaining to termination of
assistance to program participants. The Subrecipient may terminate assistance to
program participants who violates program requirements. Termination does not bar
the Subrecipient from providing further assistance at a later date to the same
participants,individual or family(household). The protocol,policies and procedures
must include at a minimum a formal process that recognizes the rights of individuals
receiving assistance under due process of law. This process must also consist of: (1)
Providing the program participant with a written copy of the program rules and the
termination process before the program participant begins to receive assistance; (2)
Written notice to the program participant containing a clear statement of the
reason(s) for termination; (3) A review of the decision, in which the program
participant is given the opportunity to present written or oral objections before a
person other than the person(or a subordinate of that person)who made or approved
the termination decision; and (4) Prompt written notice of the final decision to the
program participant. The Subrecipient providing permanent supportive housing for
hard-to-house populations of homeless persons must exercise judgment and examine
all extenuating circumstances in determining when violations are serious enough to
warrant termination so that program participants' assistance is terminated only in
the most severe cases.
e. The Subrecipient shall comply with the Violence against Women Reauthorization Act(VAWA)
as well as with 24 CFR 5.200, as may be amended, and with all applicable provisions of 24
CFR Parts 5,92,200, 574, 576,578,880, 882,883,884, 886,891, 960,966, 982,and 983 and
with such administrative rules and policy guidance relating to VAWA as may exist, be
adopted,or be amended from time to time,as may be applicable.
f. The Subrecipient may be subject to a Performance Improvement Plan (PIP) at the
discretion of the Grantee.
g. General Conditions-The Subrecipient shall comply with all applicable federal,state and local
laws, regulations and required policies, including but not limited to the Continuum of Care
CoC Grant#FL0177L4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 13
(CoC) Program Final Interim Rule, 24 CFR Part 578, as maybe amended from time to time,
the McKinney-Vento Homeless Assistance Act, as maybe amended from time to time (42
U.S.C. 11301 et seq.) (the "Act") the Consolidated and Further Continuing
Appropriations Acts of 2012, 2013, and 2014 the Homeless Definition Final Rule,
published in the Federal Register on December 5, 2011, as may be amended from time to
time; the "Continuum of Care Program Grant Agreement" Attachment A and all other
federal requirements of this grant. The responsibility for knowledge of and compliance with
all Federal and any other legal requirements is that of the Subrecipient. The Subrecipient
shall also comply with any guidance provided by US HUD regarding this Agreement,program
and the services offered hereunder, as well as with any guidance provided by US HUD
applicable to this Agreement,program and the services offered hereunder.
The Subrecipient shall abide and be governed by the requirements of the Americans with
Disabilities Act(ADA). Subrecipient shall designate with its organization an ADA Coordinator
to ensure that all requirements of the ADA and any related applicable regulations and
requirements are met by the Subrecipient.
In addition,the Subrecipient agrees to comply with the following requirements.
i. Insurance —If the Subrecipient is the State of Florida or an agency or political subdivision
of the State as defined by Section 768.28,Florida Statutes,the Subrecipient shall furnish the
Grantee, uuon request written verification of liability protection in accordance with
Section 768.28,Florida Statutes. The written verification shall be submitted to Miami-Dade
County Risk Management,Internal Services Division,located on the 23rd Floor.111 NW
1st Street.Miami,Florida 33128. Nothing herein shall be construed to extend any party's
liability beyond that provided in Section 768.28, Florida Statutes. If the Subrecipient is a
non-governmental entity said Subrecipient shall maintain required liability insurance
coverage as noted below during this contract period.
The Subrecipient shall maintain required liability insurance coverage as noted below at all
times during this contract period.
Public Liability Insurance on a comprehensive basis in an amount not less than $300,000
combined single limit for bodily injury and property damage. The Grantee must be shown
as an additional insured with respect to this coverage, as evidenced by a Certificate of
Insurance.
Automobile Liability Insurance coverage for all owned,non-owned and hired vehicles used
in connection with this Agreement in an amount not less than $300,000 combined single
limit for bodily injury and property damage.
Workers' Compensation Insurance for all employees of the Subrecipient as required by
Florida Statutes 440.
Flood Insurance shall be maintained as per the requirements in 24 CFR Part 583.330(a).
The insurance coverage required shall include these classifications, listed in standard
liability insurance manuals, which most nearly reflect the operations of the Subrecipient.
All insurance policies required above shall be issued by companies authorized to do
business under the laws of the state of Florida,with the following qualifications:
CoC Grant#FL0177L4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 14
The company must be rated no less than"B" as to management, and no less than "Class V"
as to financial strength by the latest edition of Best's Insurance Guide, published by A.M.
Best Company, Oldwick, New Jersey, or its equivalent, subject to the approval of Miami-
Dade County Risk Management Division.
Or
Compliance with the foregoing requirements shall not relieve the Subrecipient of its
liability and obligations under this section or under any other section of this Agreement.
No modification or waiver of any of the aforementioned insurance requirements shall be
made without thirty(301 days written advance notice to the Grantee,and is subject to the
approval of Miami-Dade County Internal Services Risk Management Division.
ii. Indemnification-The Subrecipient shall indemnify and hold harmless the Grantee and its
past, present, and future employees and agents from and against any and all claims,
liabilities, losses, and causes of action which may arise out of or relate to this Agreement,
or which may arise out of actions or negligence,in whole or in part,of the Subrecipient,its
officers, agents, employees, or assignees in the direct or indirect fulfillment of this
Agreement. The Subrecipient shall pay all claims and losses of any nature in connection
therewith, and shall defend all suits,in the name of the Grantee when applicable,and shall
pay all costs and judgments which may issue thereon. It is expressly understood and
intended that the Subrecipient is an independent contractor and is not an employee or
agent of the Grantee.
iii. Certifications and Representations-Pursuant o OMB 2 CFR Chapter I,Chapter II, Subpart
C (200.208),the Subrecipient shall provide a certification statement for all annual financial
reports and requests for payment that states the following: "By signing this report I(duly
authorized signature) certify to the best of my knowledge and belief that the report is true,
complete and accurate and the expenditures, disbursements and cash receipts are for the
purposes and objectives set forth in the terms and conditions of the Federal award. I am aware
that any false,fictitious, or fraudulent information or the omission of any material fact, may
subject me to criminal,civil or administrative penalties forfraud,false statements,false claims
or other offense."
iv. Conflicts of Interest-The Subrecipient shall disclose to the Grantee in writing any possible
or actual conflicts of interest or apparent improprieties relating to the Subrecipient under
this Agreement. The Subrecipient shall make each disclosure in writing to the Grantee
immediately upon the Subrecipient's discovery of such possible conflict. The Grantee will
then render an opinion which shall be binding on all parties.
v. Affidavits-The Subrecipient shall complete, notarize and provide one (1) original set of
"Miami Dade County Affidavits and Declarations 1 through 16", "Attachment D". One
(1) original set of Affidavits will remain on file with Miami-Dade County Homeless Trust,
two (2) full set of copies will be created and one (1) copy provided to Miami-Dade County
Clerk of the Board and one(1)copy to the Subrecipient.
1. Miami-Dade County Ownership Disclosure Affidavit(Section 2-8.1 of Miami-
Dade County Code"County Code").
2. Miami-Dade County Employment Disclosure Affidavit(County Ordinance 90-
133,Amending Section 2-8.1;Subsection (d) (2) of the County Code).
CoC Grant#FL0177L4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 15
3. Miami-Dade County Affirmative Action/Non-Discrimination of Employment,
Promotion and Procurement Practices (County Ordinance 98-30 codified at
2-8.1.5 of the County Code).
4. Miami-Dade County Criminal Record Affidavit (Section 2-8.6 of the County
Code).
5. Sworn Statement Pursuant to §287.133 Florida Statutes on Public Entity
Crimes.
6. Miami-Dade Employment Family Leave Affidavit (County Ordinance 142-9
codified as Section 11A-29 et. seq of the County Code).
7. Miami-Dade County Disability Nondiscrimination Affidavit (County
Resolution R-385-95).
8. Miami-Dade County Regarding Delinquent and Currently Due Fees or Taxes
(Section 2-8.1(c) of the County Code).
9. Miami-Dade County Current on all County Contracts, Loans and Other
Obligations. (County Ordinance 99-162).
10. Miami-Dade County Domestic Violence Leave (11A-60 et.seq of the County
Code).
11. Miami-Dade County Employment Drug Free Workplace Affidavit (County
Ordinance 92-15 codified as Section 2-8.1.2 of the County Code).
12. Attestation regarding due and proper acknowledgement Miami-Dade County
funding support.
13. Miami-Dade County Affidavit pursuant to Board of Miami-Dade County
Commissioners Resolution No. R-630-13. Pursuant to "Board of Miami-Dade
County Commissioners the Subrecipient will also submit a detailed project
budget, and sources and uses statement as contained within "Scope of
Service and US HUD eSnaps Documents",incorporated into Attachment B,
which shall be sufficiently detailed to show: i) the total project cost; ii) the
amount of funds to be used for administrative and overhead costs; iii)
whether the funds under this Agreement will be'gap'funds meaning that they
would be the last remaining funds needed to ensure funding for the total
project costs;iv]any profit(program income)to be made by the Subrecipient;
and v) the amount of funds devoted toward the provision of the desired
services or activities.
14. Miami-Dade County certification not to use"Pink Slime" in food programs or
related housing programs providing food (County Resolution No.R-478-12)
15. Affidavit of Miami-Dade County Lobbyist Registration for Oral Presentation
[County Ordinance Section 2-11.1(s) of the County Code], Lobbyist
specifically includes the principal,as well as any agent,officer,or employee of
a principal, regardless of whether such lobbying activities fall within the
normal scope of employment of such agent,officer or employee.
16. Subcontract/Supplier Listing (Ordinance 97-104)
The Subrecipient understands that the Grantee has relied on the Subrecipient's
aforementioned representations in entering into this Agreement.
h. Civil Rights - The Subrecipient agrees to abide by Chapter 11A of the Code of Miami-Dade
County( County Code"),as maybe amended,in the exercise of its police power for the public
safety, health and general welfare, to eliminate and prevent discrimination in employment,
family leave, public accommodations, credit and financing practices, and housing
accommodations because of race, color, religion, ancestry, national origin, sex, pregnancy,
CoC Grant#FL0177L4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 16
age, disability, marital status, familial status, gender identity, gender expression, sexual
orientation, or actual or perceived status as a victim of domestic violence, •'ting violence or
stalking. It is further hereby declared to be the policy of Miami-Dade County‘o eliminate and
prevent discrimination in housing based on source of income. Initials her .
DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 24 CFR Parts , 92, 570, 574,
576, and 903 [Docket No. FR-5173-F-04] RIN 2501-AD33 Affirmatively urthering Fair
Housing-The Fair Housing Act(title VIII of the Civil Rights Act of 1968,42 U.S.C.3601-3619)
declares that it is"the policy of the United States to provide,within constitutional limitations,
for fair housing throughout the United States." See 42 U.S.C. 3601. Accordingly, the Fair
Housing Act prohibits,among other things,discriminatio in the sale,rental,and financing of
dwellings, and in other housing-related transactions b e of"race, color, religion, sex,
familial status,national origin, or handicap."Initials her
See 42 U.S.C. 3604 and 3605. Section 808(d) of the Fai ousing Act requires all executive
branch departments and agencies admi .stering housing and urban development programs
and activities to administer these pro s in a manner that affirmatively furthers fair
housing.See 42 U.S.C. 3608.Initials her
The Subrecipient agrees to abide and be overned by Title VI and VII, of the Civil Rights Act
of 1964(42 U.S.C.2000 et.seq.)and Title VIII of the Civil Rights Act of 1968,as amended,and
Executive Order 11063, as may be amended, as well as with any applicable regulations,
which provide in part that there will be no discrimination of race,color,gender/sex,religious
background, ancestry or national origin in performanc of this Agreement, in regard to
persons served, or in regard to employees or applicants or employment or housing. It is
expressly understood that upon receipt of evidence of suc crimination,the Grantee shall
have the right to terminate this Agreement. Initials her
Executive Order 11063 prohibits discrimination in e sale, leasing, rental, or other
disposition of properties and facilities owned or operated by the federal government or
provided with federal funds.Executive Order 12892,as amended,requires federal agencies
to affirmatively further fair housing in their programs and activities, and provides that the
Secretary of HOD will be responsible for coordinating the effort. Executive Order 12898
requires nondiscrimination in federal programs that affect human health and the
environment as well as provides minority and low-income communities' access to public
information and public participation. Executive Order 13166 requires federal agencies to
examine the services they provide,identify any need for services to those with limited English
proficiency (LEP), and develop and implement a system to provide those services so LEP
persons can have meaningful access to them. Executive Order 13217 requires federal
agencies to evaluate their p icies and programs to determine if any can be revised or
modified to improve the avail b of community-based living arrangements for persons
with disabilities. Initials her
Awareness of the Joint tette f clarification dated August 5, 2017 from United States
Department of Justice,United St es Department of Health and Human Services,United States
Department of Housing and Urban Development reminding recipients of federal financial
assistance that they should not withhold certain services based on immigration status when
the services are necessary to protect life or safety. In the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996 ("PRWORA"), Congress restricted immigrant access
to certain public benefits, but also established a set of exceptions to these restrictions. It is
understood that recipients of federal funding that administer programs that(i)are necessary
CoC Grant#FL0177L4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 17
for the protection of life or safety; (ii) deliver in-kind services at the community level; and
(iii) do not condition the provision of assistance, the amount of assistance, or the cost of
assistance on the individual (participant's) recipient's income or resources, that such
programs are not subject to PRWORA's restrictions on immigrant access to ublic benefits
and must be made available to eligible persons without regard to citizenship a ionality, or
immigration status. 8 U.S.C.Section 1611(b)(1)(D); 1621(b)(4).Initials her
It is further understood that the Subrecipient must submit affidavits attesti that it is not in
violation of the American with Disabilities Act,Section 504 of the Rehabilitation Act of 1973,
as amended, (29 U.S.C. 794, et. seq.), the Federal Transit Act, (49 U.S.C. 1612), and the Fair
Housing Act, (42 U.S.C. 3601 et.seq.), as may be amended, as well as with any applicable
regulations. If the Subrecipient or any owner, subsidiary, or other firm affiliated with or
related to the Subrecipient is found by the responsible enforcement agency, the Courts or
Grantee to be in violation of these Acts, the Grantee shall conduct no further business with
the Subrecipient. Any contract entered into based upon a false affidavit shall be voidable by
the Grantee. If the Subrecipient violates any of the Acts during the term of any contract the
Subrecipient has with Miami-Dade County, such contract shall be voidable by the Grantee,
even if the S recipient was not in violation at the time the affidavit(s) were submitted.
Initials her
The Subrecipient agrees that it is in compliance with the Domestic Violence Leave, codified
as (Article 8,Section 11A-60 et.seq.of the County Code),as may be amended,which requires
an employer, who in the regular course of business and has fifty (50) or more employees
working in Miami-Dade County for each working day during each of the twenty(20) or more
calendar work weeks to provide domestic violence leave to its employees. Failur o comply
with this local law may be grounds for voiding or terminating this Agree or for
commencement of debarment proceedings against the Subrecipient. Initials he
The Subrecipient agrees to abide and be governed by the Age Discrimination Ac f 1975,(42
U.S.C. 6101 et seq.) and implementing regulations at(24 CFR Part 146),as may be ame ed,
as well as with any applicable regulations, which provides in part that there shall b no
discrimination against persons in any area of employment because of age.Initials her .
The Subrecipient agrees to abide and be governed by Section 504 of the Rehabilita 'o Act of
1973,as amended, (29 U.S.C.794, et.seq.) as may be amended,as well as with any 'cable
regulations,which prohibits discrimination on the basis of handicap. Initials her .
iull\
e Subrecipient agrees to abide and be governed by the requirements of the Am cans with
ability Act(ADA), as may be amended, as well as with any applicable law. Initials here
rsuant to 24 CFR 578.23, Subrecipient hereby certifies and agrees that:
i. Subrecipient will maintain the confidentiality of records pertaining to any
individual or family that was provided family violence prevention or treatment
services through the project/program;
ii. The address or location of any family violence project/program assisted under this
part will not be made public, except with written authorization of the person
responsible for the operation of such program and in accordance with any
applicable state and local laws that prohibit disclosure of information relating to
domestic violence centers;
CoC Grant#FL0177L4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 18
iii. Subrecipient will establish policies and practices that are consistent with, and do
not restrict the exercise of rights provided by Subtitle B of Title VII of the McKinney-
Vento Homeless Assistance Act, as amended, and other laws relating to the
provision of educational and related services to individuals and families
experiencing homelessness;
iv. In the case of programs that provide housing or services to families, that
Subrecipients will designate a staff person to be responsible for ensuring that
children being served in the program are enrolled in school and connected to
appropriate services in the community including early childhood programs such as
Head Start, Part C of the individuals with Disabilities Education Act, and programs
authorized under Subtitle B of Title VII of the McKinney-Vento Homeless Assistance
Act as amended;
v. The Subrecipient shall use the centralized or coordinated assessment system
established by the Continuum of Care as set forth pursuant to 24 CFR 578.7(a) (8);
vi. Subrecipient,its officers,and employees are not debarred or suspended from doing
business with the federal government; and
vii. Subrecipient will provide information, such as data and reports, as required by US
HUD.
Additionally, Subrecipient agrees:
i. To establish such fiscal controls and accounting procedures as may be necessary to
assure the proper disbursal of, and accounting for grant funds in order to ensure
that all financial transactions are conducted,and records maintained in accordance
with generally accepted accounting principles;
ii. To take the educational needs of children into account when families are placed in
housing and will,to the maximum extent practicable,place families with children as
close as possible to their school of origin so as not to disrupt such children's
education. A Subrecipient that serves families with school-age children shall have
at least one program staff member, knowledgeable of the McKinney-Vento
Education for Children and Youth Act requirements and shall comply with all
requirements related to facilitation of educational opportunities consistent with
Miami-Dade County Homeless Trust's Standards of Care incorporated herein by
reference;
iii. To comply with the provisions of 24 CFR 578.23(c) (9).
iv. To follow the written standards for providing Continuum of Care assistance
developed by the Continuum of Care,including the minimum requirements set forth
in§ 578.7(a)(9);and
v. To operate the project(s) in accordance with the provisions of the McKinney-Vento
Act and all requirements under 24 CFR part 578; and to comply with such other
terms and conditions as US HUD may establish by NOFA (Notice of Funding
Availability).
4. Suspension and Termination
a. Suspension-The Grantee may,for reasonable cause,temporarily suspend the operation and
authority to obligate funds of the Subrecipient,under this Agreement,or withhold payments
to the Subrecipient pending necessary corrective action by the Subrecipient or both.
Reasonable cause shall be determined by the Grantee in its sole and absolute discretion and
may include:
CoC Grant#FL0177L4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 19
I. Ineffective or improper use of any funds provided hereunder by the Subrecipient;
ii. Failure by the Subrecipient to materially comply with any terms, conditions,
representations or warranties contained herein;
iii. Failure by the Subrecipient to submit any documents required by this Agreement; or
iv. Incorrect or incomplete document submittal by the Subrecipient.
b. Termination-
i. Termination at Will-This Agreement,in whole or in part,maybe terminated by the
Grantee upon no less than fifteen (15) working days' notice when the Grantee
determines that it would be in the best interest of the Grantee and / or the
Subrecipient materially fails to comply with the terms and conditions of the award.
Said notice shall be delivered by certified mail, return receipt request, or in person
with proof of delivery. The Subrecipient shall have five (5) days from the day the
notice was delivered to state why it is not in the best interest of the Grantee to
terminate the Agreement. However,it is up to the discretion of the Grantee to make
the final determination as to what is in its best interest.
H. Termination for Convenience - The Grantee or Subrecipient may terminate this
Agreement, in whole or part, when both parties agree that the continuation of the
activities would not produce beneficial results commensurate with the further
expenditure of funds. Both parties shall agree in writing upon the termination
conditions, including the effective date and in the case of partial termination, the
portion to be terminated. However, if the Grantee determines in the case of partial
termination that the reduced or modified portion of the grant will not accomplish the
purposes for which the grant was made it may terminate the grant in its entirety.
Hi. Termination Because of a Lack of Funds-In the event funds to finance this Agreement
become unavailable, the Grantee may terminate this Agreement upon no less than
twenty-four (24) hours' notice in writing to the Subrecipient. Said notice shall be
sent by certified mail, return receipt requested, or in person with proof of delivery.
The Grantee shall be the final and sole authority in determining whether or not funds
are available.
iv. Termination for Breach - Upon terminating this Agreement under this section the
Grantee,in its sole discretion,may require the Subrecipient to pay the Grantee any or
all costs associated with termination of this Agreement, including but not limited to
transfer of the Subrecipient's obligations under this Agreement and or selection of a
new Project Sponsor. The Grantee may terminate this Agreement,in whole or in part,
when the Grantee determines in its sole and absolute discretion that the Subrecipient
is not making sufficient progress in the performance of this Agreement as outlined in
the"Scope of Services" contained within the"Scope of Service and US HUD eSnaps
Documents" Attachment B or is not materially complying with any term or
provision provided herein including but not limited to the following:
1. The Subrecipient ineffectively or improperly used or uses the Grantee funds
allocated under this Agreement;
2. The Subrecipient failed or fails to furnish the Certificates of Insurance
required by this Agreement or as determined by Miami-Dade County Internal
Services Risk Management Division;
CoC Grant#FL0177L4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 20
3. The Subrecipient failed or fails to furnish proof of Licensure, proof of
Certification or proof of Background Screening required by this Agreement;
4. The Subrecipient failed or fails to submit detailed reports of expenditures or
final expenditure reports or submits incompletely or incorrectly;
5. The Subrecipient failed or fails to submit required reports or submits
incompletely or incorrectly;
6. The Subrecipient refused or refuses to allow the Grantee access to records or
refused or refuses to allow the Grantee to monitor, evaluate and review the
Subrecipients program;
7. The Subrecipient discriminates under any of the laws outlined in this
Agreement;
8. The Subrecipient failed or fails to provide Domestic Violence Leave to its
employees pursuant to local law;
9. The Subrecipient falsifies or violates the provisions of a Drug Free Workplace
Affidavit;
10. The Subrecipient attempted or attempts to meet its obligations under this
Agreement through fraud,misrepresentation or material misstatement;
11. The Subrecipient failed or fails within a specified period, to correct
deficiencies found during a monitoring,evaluation or review;
12. The Subrecipient failed or fails to meet the terms and conditions of any
obligation under this Agreement or otherwise of any repayment schedule to
the Grantee or any of its agencies or instrumentalities;
13. The Subrecipient failed or fails to meet any of the terms and conditions of the
Miami-Dade County Affidavits;and
14. The Subrecipient failed or fails to fulfill in a timely and proper manner any
and all of its obligations, covenants, agreements and stipulations in this
Agreement.
The Subrecipient shall be given written notice of the claimed breach and ten (10)
business days to cure same. If the Subrecipient is not provided a written waiver of
the breach by the Grantee,or if the Subrecipient remains in breach of this Agreement
as determined by the Grantee,the Grantee shall initiate written notice to terminate
and said notice will be to terminate effective within no less than twenty-four (24)
hours. Said notice shall be sent by certified mail, return receipt requested, or in
person with proof of delivery. Waiver of Breach or any provision of this Agreement
shall not be construed to be a modification, or revisions of the terms of this
Agreement. The provisions contained herein do not limit the rights to legal or
equitable remedies or any other provision for termination by the Grantee under this
Agreement. The Subrecipient shall be responsible for all direct and indirect costs
associated with such termination or cancellation, including attorney's fees. Any
individual or entity who attempts to meet its contractual obligations with the Grantee
through fraud, misrepresentation or material misstatement maybe disbarred from
Miami-Dade County contracting for up to five(5)years.
S. Notice Regarding Future Funding Applications
Funding under this Agreement is provided by US HUD. The parties understand the Grantee, as the
US HUD funding recipient, is responsible for review and approval of the funding application and
response submitted to US HUD through the annual US HUD CoC Program Notice of Funding
Availability(NOFA) application process.
CoC Grant SFL0177L4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 21
The Subrecipient agrees to timely notify the Grantee of the Subrecipient's intention not to be
available to renew and continue operating or nroviding the program in its entirety as covered
under this Agreement. Timely is defined as the earliest of either 1) six (6) months prior to this
Agreement's expiration; or 2) upon request to confirm allocations in the Grant Inventory
Worksheet(GI W)registration process of the anticipated annual application to US HUD CoC Program
NOFA.
If the Subrecipient is not available to apply for "renewal funding" or for the continuation of the
program outlined in this Agreement,and failed to timely inform the Grantee as described herein,then
the Grantee in its sole discretion may opt not to enter into future grant agreements with the
Subrecipient.
Further,in the event the Subrecipient will not be available to apply for renewal funding applicable to
this Agreement,the Subrecipient agrees to ensure that housing is maintained for persons served by
the Subrecipient under this Agreement after the expiration of this Agreement so that those persons
do not become homeless.
Notice from Subrecipient to Grantee pursuant to this section shall be delivered in writing by certified
mail, return receipt request, or in person with proof of delivery, to the attention of Miami-Dade
County Homeless Trust Executive Director.
6. Reversion of Assets
a. Term of Commitment-If the Subrecipient receives assistance for acquisition, rehabilitation,
or new construction, then the Subrecipient shall agree to operate the "McKinney-Vento Act
housing" or provide "McKinney-Vento Act services" in accordance with this Agreement and
applicable laws, and regulations for a term of at least twenty (20) years or if applicable
fifteen (15) years from the date of initial occupancy or date of initial service provision. If
the United States, Department of Housing and Urban Development (US HUD) determines a
project is no longer needed for use as homeless assistance housing or services,then US HUD
may provide authorization to the Grantee on behalf of the Subrecipient to convert the project
to a project for the direct benefit of low-income persons pursuant to a request for such use
by the Grantee on behalf of the Subrecipient operating the project as Project Sponsor. The
parties hereby agree to this provision shall survive the expiration or termination of this
Agreement pursuant to 24 CFR 578.81 - The request for authorization to US HUD from the
Grantee on behalf of the Subrecipientmust be made while the project is operating as
homeless housing or supportive services for homeless individuals and families, must be in
writing, and must include an explanation of why the project is no longer needed to provide
transitional or permanent housing or supportive services. The primary factor in US HUD's
decision on the proposed conversion is the unmet need for transitional or permanent housing
or supportive services in the Continuum of Care's geographic area.
b. Repayment of Grant-If the Subrecipient does not provide supportive housing or supportive
services for twenty(20)years or if applicable fifteen(15)years following the date of initial
occupancy or date of initial service provision pursuant to this Agreement, then the Grantee
shall require repayment of the entire amount of the grant or partial repayment of the grant
used for acquisition,rehabilitation,or new construction,unless conversion of the project has
been authorized by US HUD pursuant to the terms in the Term of Commitment. The parties
hereby agree this provision shall survive the expiration or termination of this Agreement.
CoC Grant#FL0177L4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 22
c. Prevention of Undue Benefit- Upon the sale or other disposition of a project assisted with
acquisition, rehabilitation or new construction funds occurring before the expiration of the
twenty (20) years or if applicable fifteen (1S) year period,the Subrecipient must comply
with such terms and conditions as US HUD and the Grantee may prescribe to prevent the
Subrecipient from unduly benefiting from such sale or disposition.
The Subrecipient shall return to the Grantee, upon the expiration or termination of the
Agreement,any funds on hand,any accounts receivable attributable to those funds,and any
overpayment due to unearned funds or costs disallowed pursuant to the terms of this
Agreement that were disbursed to the Subrecipient by the Grantee.
d. Revocation of License or Permit - Notwithstanding any provision of this Agreement to the
contrary, revocation of any necessary license, permit, or approval by a governmental
authority may result in immediate termination of this Agreement upon no less than twenty-
four(24)hours'notice. Said notice shall be certified by mail or hand delivery.
e. Declaration of Restrictive Covenant and Declaration of Restrictions-Where grant funds are
used for acquisition, construction or rehabilitation under this Agreement, the Subrecipient
shall record a Declaration of Restrictive Covenants,as well as a Declaration of Restrictions,in
accordance with this section.
The Declaration of Restrictive Covenants{p the Declaration of Restrictions shall restrict the
use of properties located at /vl/1" in Miami-Dade County,
Florida such that the properties must be operated for the provision of homeless housing and
services for homeless persons in accordance with the provisions of(24 CFR Part 578, Code
of Federal Regulations) and any other applicable laws or regulations for a term of at least
twenty (20) years or if applicable fifteen (15) year period or for such other purposes as
maybe approved by the Grantee and US HUD.
The Subrecipient agrees that the Declaration of Restrictive Covenants and the Declaration of
Restrictions shall be signed by the Subrecipient, as well as the title owner of the subject
property and any other relevant property interest holders, including but not limited to a
lessee of the title holder subleasing the property to the Subrecipient. If the Subrecipient is
not the title owner of the subject property,the Subrecipient shall be responsible for obtaining
execution of the Declaration of Restrictive Covenants and the Declaration of Restrictions by
the title owner and by any other parties required by US HUD. The Subrecipient shall be
responsible for ensuring that any signatories required by US HUD sign the Declaration of
Restrictive Covenants and the Declaration of Restrictions whether US HUD requires such
signatories by regulation or by guidance provided directly regarding the project and / or
property covered under this Agreement.
The Declaration of Restrictive Covenants executed by the Subrecipient and any other
required parties and recorded by the Subrecipient must be approved by US HUD. The
Subrecipient must provide US HUD with proof of recordation of the approved Declaration of
Restrictive Covenants before funds for Rehabilitation or New Construction may be drawn
down. Acquisition funds may be drawn down before proof of recordation is received by US
HUD;however,no other grant funds will be available for draw down until 115 HUD is satisfied
with the form and recordation of the Declaration of Restrictive Covenants.
The Subrecipient agrees to inform any lender or grantor which has loaned or granted funds
for the purchase of such properties or structure on the subject property or properties covered
CoC Grant#FL0177L4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 23
under this Agreement and obtain their consent to the recordation of and subordination to the
"Declaration of Restrictive Covenants" and the "Declaration of Restrictions". Such consent
shall be in a form acceptable to the Grantee.
The parties hereby agree this provision shall survive the expiration or termination of this
Agreement.
7. Uniform Administrative Requirements,Cost Principles,and Audit Requirements for Federal Awards
a. Accounting Standards,Cost Principles and Regulations.
i. The Subrecipient shall comply with applicable provisions of applicable Federal,State
and County laws,regulations,and rules such as OMB Circular A-110, OMB Circular A-
21,and OMB Circular A-133 and with the Energy Policy and Conservation Act(Public
Law 94-163) which requires mandatory standards and policies related to energy
efficiency. If any provision of this Agreement conflicts with any applicable law or
regulation, only the conflicting provision shall be modified to be consistent with the
law or regulation or be deleted if modification is impossible. However,the obligations
under this Agreement, as modified, shall continue and all provisions of this
Agreement shall remain in full force and effect.
ii. If the amount payable to the Subrecipient pursuant to the terms of this Agreement
are in excess of$100,000, or such other amount as required by applicable law or
regulation; the Subrecipient shall comply with all applicable stands, orders, or
regulations issued pursuant to Section 306 of the Clean Air Act of 1970 (42 U.S.C.
1857(h), as amended: the Federal Water Pollution Control Act (33 U.S.C. 1251), as
amended: Section 508 of the Clean Water Act (33 U.S.C. 1368); the environmental
Protection Agency regulations (40 CFR Part 15); Executive Order 11738; and the
Environmental Review Procedures and Regulations (24 CFR Part 58 and 24 CFR Part
583.230). The Subrecipient shall comply with all applicable laws and regulations
governing this Agreement.
b. The Subrecipient shall comply with the federal uniform administrative requirements and
accounting standards cost principles and audit requirements according to OMB Omni or
Super Circular 2 CFR Chapter I,and Chapter ll,Parts 200,215,220,225 and 230,OMB Circular
A-122, and 24 CFR 78 et.seq., as may be applicable and any other applicable laws and
regulations.
i. Performance Measurements - The Subrecipient shall comply and report all
performance objectives outlined in the "Scope of Service and US HUD eSnaps
Documents" Attachment B and as outlined in the NOFA application and in the
manner specified and outlined in this Agreement.
ii. Additionally, the Subrecipient shall comply with the established United States
Department of Housing and Urban Development's (USHUD) performance measures
related to the Continuum of Care's(CoC) system performance. Specifically:
1. Measure 1: The Length of Time Persons Remain Homeless
2. Measure 2: The Extent to which Persons who Exit Homelessness to
Permanent Housing Destinations Return to Homelessness
3. Measure 3: Number of Homeless Persons
CoC Grant#FL0177L4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 24
4. Measure 4: Employment and Income Growth for Homeless Persons in CoC
Program-funded Projects
5. Measure 5: Number of Persons who Become Homeless for the First Time
6. Measure 6:Homeless Prevention and Housing Placement of Persons Defined
by Category 3 of HUD's Homeless Definition in CoC Program-funded Projects
7. Measure 7: Successful Placement from Street Outreach and Successful
Placement in or Retention of Permanent Housing
iii. HUD-funded agencies must have a minimum of 86% of the organization's total
number of beds/units which are reported to HUD for the Miami-Dade County
Continuum of Care (CoC) through the Housing Inventory Checklist, populated in the
HMIS, regardless of whether the beds are funded by HUD or the Homeless Trust,
whether or not funded by HUD or the Homeless Trust.
iv. Internal Controls-The Subrecipient shall comply with internal control related federal
statutes,regulations,and the terms and conditions of the federal award; evaluate and
monitor and take prompt action when instances of noncompliance are identified
including noncompliance identified in audit findings; and take reasonable measures
to safeguard legally protected personally identifiable information and other
information. These internal controls shall safeguard assets and provide reasonable
assurance of compliance with federal statutes and regulations.
v. Payment-The Subrecipient is required to report deviations from budget or project
scope or objectives and request prior approvals from federal awarding agencies
through the Grantee on any and all changes in scope or key persons and any other
change to the program budget, in accordance with Omni or Super Circular 2 CFR
Chapter I, and Chapter II,Parts 200, 215, 220, 225 and 230 and any other applicable
laws and regulations.
vi. Cost Sharing or Matching-For all federal awards,any shared costs or matching funds
and all contributions, including cash and third party in-kind contributions, must be
accepted as part of the non-federal entity's cost sharing or matching and such
contributions shall meet all of the following criteria:
1. Are verifiable from the non-federal entity's records;
2. Are not included as contributions for any other federal award;
3. Are necessary and reasonable for accomplishment of project or program
objectives;
4. Are allowable under Costs Principles of 2 CFR Part 200, et al.
5. Are not paid by the federal government under another federal award,except
where the federal statute specifically provides that federal funds made
available for such program can be applied to match or cost sharing
requirements of other federal programs;
6. Are provided for in the approved budget when required by the federal
awarding agency; and
7. Conform to 2 CFR Chapter II, Part 200.306,as applicable.
c. Retention of Agreement Records
i. The Subrecipient shall retain financial records, supporting documents, statistical
records and all records pertinent to a federal award for a period of five 151 years
from the date of submission of the final expenditure report or,for Federal awards that
CoC Grant#FL0177L4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 25
are renewed quarterly or annually, from the date of the submission of the quarterly
or annual financial report,respectively, as reported to the federal awarding agency.
1. If any litigation,claim or audit is started before the expiration of the five (5)-
year period, the records must be retained until all litigation, claims, or audit
findings involving the records have been resolved and final action taken. If
the Grantee or the Subrecipient has received or been given notice of any kind
indicating any threatened litigation,claim or audit arising out of the services
provided pursuant to the terms of this Agreement,the Retention Period shall
be extended until such time as the threatened or pending litigation, claim or
audit is, in the sole and absolute discretion of the Grantee, fully, completely
and finally resolved.
2. Records for real property and equipment acquired with federal funds must be
retained for a minimum five (5)years after final disposition.
3. Any leases or mortgages or similar documents or contracts with a term longer
than five (5)years,must be retained for five(5)years beyond the end of the
document's full term.
4. Records for program income transactions after the period of performance:
The Subrecipient must report program income after the period of
performance records pertaining to the earning of program income must be
retained for five (5)years after the end of the non-federal entity's fiscal year
in which the program income is earned.
5. The Subrecipient shall allow the Grantee or any persons authorized by the
Grantee MI access to and the right to examine any of the records pertinent to
the Federal Award and this Agreement.
6. The Subrecipient shall notify the Grantee in writing both during the pendency
of this Agreement and after its expiration as part of the final close out
procedure of, the location and address where all the Agreement records will
be retained.
7. The Subrecipient shall obtain prior written approval by the Grantee for the
disposal of any Agreement records before disposing of such records if it is
within one (1)year after the expiration of the Retention Period.
8. Additional Requirements
The Subrecipient shall comply with the following additional requirements:
a. Client Rules and Regulations - The Subrecipient shall submit to the Grantee a copy of the
Client Rules and Regulations that apply to all program or client participants referred to the
Subrecipient pursuant to this Agreement. This copy is due within thirty(30)calendar days
following the execution of this Agreement.
b. Personnel Policies and Administrative Procedure Manuals - The Subrecipient shall submit
detailed documents describing all the Subrecipient's policies and procedures'for internal
control, corporate, or organizational structure, property management, procurement,
personnel management, accounting and fiscal information. This information shall be
available to the Grantee upon request.
CoC Grant#FL0177L4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 26
c. Monitoring-The Subrecipient shall permit the Grantee and any other persons authorized by
the Grantee to monitor,according to applicable regulations, all Agreement records,facilities,
goods, services and activities of the Subrecipient which are in any way connected to the
activities undertaken pursuant to the terms of this Agreement including interview of any
participant, employee, subcontractor, or assignees of the Subrecipient. The Grantee shall
monitor both fiscal and programmatic compliance with all terms and conditions of this
Agreement including a review of beneficiaries,supportive services,housing,operating costs,
program and performance progress, site habitability, participant eligibility, documentation
for required match, record keeping, and compliance with circulars, administrative costs,
technical assistance visits, and environmental review. The Subrecipient shall permit the
Grantee to conduct site visits, participant assessment surveys,and other techniques deemed
reasonably necessary to fulfill the monitoring function. If the Grantee monitors and there is
a finding of deficiencies report; said report may be delivered to the Subrecipient, and if so
delivered, the Subrecipient shall rectify all deficiencies cited within the period of time
specified in the report. Pursuant to Board of Miami-Dade County Commissioners Resolution
No.630-13,Miami-Dade County Mayor or Mayor's designee may make unannounced,on-site
visits during normal working hours to the Subrecipient's headquarters and/or any locations
or site where the services contracted for are performed.
d. Restrictions of Funds Use-The funds received under this Agreement (and any State or local
government funds used to supplement this Agreement) may not be used to replace State or
local funds previously used, or designated for use to assist homeless persons (24 CFR Part
578.87). The Subrecipient shall notify the Grantee of any additional funding received for any
activity described in this Agreement,other than funding already noted in the"Consolidated
Financial Record and Reports", Attachment E. Such notification shall be in writing and
received by the Grantee within thirty(30) calendar days of the Subrecipient's notification
by the funding source.
e. Related Parties -The Subrecipient shall report to the Grantee the name, purpose and any
other relevant information in connection with any transaction conducted between the
Subrecipient and a related party transaction. A related party includes,but is not limited to; a
for-profit or nonprofit subsidiary or affiliate organization,and organization with overlapping
boards of directors or any organization for which the Subrecipient is responsible for
appointing members. The Subrecipient shall report this information to the Grantee upon
forming the relationship or if already formed,shall report it immediately. Any supplemental
information shall be reported in the Grantee required Agency Narrative and Progress Report
which are addressed in Section 2 b."Records and Access to Records".
f. Required Meeting Attendance - From time to time, Grantee through Miami-Dade County
Homeless Trust may schedule meetings and or training sessions to assist the Subrecipient in
the performance of its contractual obligations or to inform the Subrecipient of new and or
revised policies and procedures. Attendance at some of these meetings may be
mandatory The Subrecipient shall receive notice no less than three (3) business days
prior to any meeting or training session that may require mandatory participation. A record
of attendance shall he kept of meetings or training sessions where notice was given indicating
the mandatory participation of the Subrecipient and the Subrecipient shall be monitored for
compliance on that record of attendance. Failure to attend meetings or training sessions for
which a mandatory notice has been provided can result in material non-compliance of the
Agreement,up to and including Breach or Default. Proof of mandatory notice shall consist
CoC Grant#FL0177448001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 27
of fax record, certified mail, electronic confirmation and or verbal communication with the
Agreement contact person or persons and other program administrative staff of the
Subrecipient. The Subrecipient may select one or more employees from their Agency,directly
involved in the Agreement program, as their representative at the meeting or training
session; the participation of the Agreement contact person or persons is preferred. The
Subrecipient may request waiver from a mandatory meeting. That waiver must be received
no later than twenty-four (24) hours prior to the meeting date and time, and justification
provided, including the reason the Subrecipient could not send any representative. The
Grantee shall have absolute and final approval over any determination to waive mandatory
attendance; and no more than two (2) mandatory attendance waivers shall be allowed
during the term of this Agreement. The Subrecipient is encouraged to attend all meetings of
Miami-Dade County Homeless Trust and or its Committees, as information relevant to their
program or services may be discussed.
g. Publicity and Advertisements - The Subrecipient shall ensure that all publicity and
advertisements prepared and released by the Subrecipient, such as pamphlets and news
releases already or indirectly related to activities funded pursuant to this Agreement,and all
events carried out to publicize the accomplishments of any activity funded pursuant to this
Agreement,recognize the Grantee as its funding source.
h. Procurement - The Subrecipient shall use its own procurement procedures which shall
comply with any and all applicable federal, state and local laws, ordinances and regulations
including but not limited to 2 CFR 200.318 as applicable. The Subrecipient shall maintain
oversight and ensure that its subcontracts perform in accordance with the terms, conditions,
and specifications of their contracts or purchase orders.
The Subrecipient shall make a positive effort to competitively procure supplies, equipment,
construction and services necessary or related to carrying out the terms of this Agreement
from minority and women owned businesses, as may be permitted by applicable law. If this
Agreement involves the expenditure of$100,000 or more by Miami-Dade County, and the
Subrecipient intends to use subcontractors to provide the services listed herein or suppliers
to supply the materials,the Subrecipient shall provide Miami-Dade County with the names of
the"Subcontractor/Supplier Listing",Attachment D. Subrecipient agrees that it will not
change or substitute subcontractors or suppliers from those listed without prior written
approval of Miami-Dade County.
i. Involvement of HUD-assisted individuals and families - per 24 CFR 578.23 (c)(3), the
Subrecipient agrees to ensure to the maximum extent practicable, that individuals and
families experiencing homelessness are involved, through employment, provision of
volunteer services, or otherwise, in constructing, rehabilitating, maintaining and operating
facilities for the project and in providing supportive services for the project. Further,per the
Housing and Urban Development Act of 1968,as amended, (12 U.S.C. 1701u) to the greatest
extent feasible,opportunities for training and employment,for services or programs covered
under this Agreement, should be given to lower-income residents of HUD-assisted projects
and contracts for work in connection with the project be awarded in substantial part to
persons residing in the area of the project.
j. Property - This section applies to equipment with an acquisition cost of greater than
$5,000.00 per unit and all real property. 1) Any real property under the control of the
Subrecipient hat was acquired and or improved in whole or in part with funds from Grantee,
or from Miami-Dade County and any equipment or property purchased for greater than
CoC Grant#FL0177L4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 28
$5,000.00, shall, upon expiration or termination of this Agreement, be disposed in
accordance with instructions from the Grantee. Real Property is defined as land, including
land improvements, structures, and appurtenances thereto, including moveable machinery
and equipment. Equipment means tangible, non-expendable, personal property having a
useful life of more than one(1)year and acquisition costs of greater than$5,000.00 per unit.
2] The Subrecipient shall list in the property records all equipment with an acquisition cost
of greater than $5,000.00 per unit and all real property purchased in whole or in part with
funds from the Grantee or from Miami-Dade County from this Agreement or from previous
agreements. The property record shall include a legal description, size, date of acquisition,
and value at time of purchase, owner's name if different than the Subrecipient, information
on the transfer or disposition of the property, and map indicating where property is in
parcels, lots or blocks and showing adjacent streets and roads. Notwithstanding documents
required for reimbursement purposes, an additional copy of the purchase receipt for any
property described above which was purchased using Grantee or Miami-Dade County funds
must also be included in the reimbursement package along with the "Real Property and
Equipment Asset Inventory"Attachment I in the month it was purchased. 3)All equipment
with an acquisition cost of greater than $5,000.00 per unit and all real property shall be
inventoried annually by the Subrecipient and an Annual Inventory Report submitted to the
Grantee. This report shall include the elements listed above. Pursuant to 2 CFR 200.94,if the
cost of computing devices[inclusive of accessories)falls below the lesser of the capitalization
threshold of the nonfederal entity or$5,000, regardless of the length of useful life, the asset
is a supply.
k. Management Evaluations and Performance Reviews - The Grantee may conduct formal
Management Evaluations and Performance Reviews of the Subrecipient following this
expiration of this Agreement. The Management Evaluations will reflect the compliance of the
Subrecipient with generally accepted fiscal and organizational standards and practices. The
Performance Reviews will reflect the quality of service provided and value received of the
funds using monitoring data such as progress reports,site visits, and participants'surveys.
I. Subcontracts and Assignments—The Subrecipient shall not assign this Agreement without
the Grantee's written consent to the assignment. The Subrecipient shall ensure that all
subcontracts and assignments; 1] Identify the full, correct and legal name of the party; 2)
Describe the activities to be performed; 3) Present a complete and accurate breakdown of all
price components; and 4) Incorporate provisions requiring compliance with all applicable
regulatory and other requirements of this Agreement with any conditions of approval that
the Grantee deems necessary. This applies only to subcontracts and assignments in which
parties are engaged to carry out any eligible substantive programmatic service as set forth in
this Agreement. The Grantee shall in its sole and absolute discretion determine when
services are eligible substantive programmatic services subject to the audit and record
keeping requirements described above.
The Subrecipient shall ensure that all subcontracts and assignments which involve the
expenditure of one hundred thousand dollars ($100,000.00) or more, comply with (Miami-
Dade County Ordinance 97-104, § 1, 7-8-97),which shall require the entity contracting with
Miami-Dade County to list all first tier subcontractors who will perform any part of the
contract and all suppliers who will supply materials for the contract work directly to such
entity. The contract shall also require the entity contracting with Miami-Dade County to
report to Miami-Dade Countythe race,gender,and ethnic origin of the owners and employees
of all such first tier subcontracts. This Agreement shall require the Subrecipient to provide
CoC Grant#FL0177L4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 29
Miami-Dade County the race,gender and ethnic information as soon as reasonably available
and in any event prior to final payment under the contract. The Subrecipient shall not change
or substitute subcontractors or suppliers from those listed except upon written approval of
the County. The Subrecipient must provide the list of all first tier subcontractors and direct
suppliers; see "Subcontractor / Supplier Listing" Attachment D. The Subrecipient shall
incorporate into all consultant subcontracts this additional provision: "The Subrecipient is not
responsible for any insurance or other fringe benefits for the consultant or its employees,
(examples social security, income tax withholdings, retirement or leave benefits). The
consultants assume full responsibility for the provision of all insurance and fringe benefits for
themselves and their employees retained by the consultants in carrying out the Scope of Service
provided in this subcontract". The Subrecipient shall be responsible for monitoring the
contractual performance of all subcontracts. The Subrecipient shall receive written
documentation prior to entering into any subcontract which contemplates performance of
substantive programmatic activities,as such is determined as provided herein. The approval
of the Grantee shall be obtained prior to the release of any funds to the Subrecipient for the
subcontract The Subrecipient shall receive written approval from the Grantee prior to either
assigning or transferring any obligations or responsibilities set forth in this Agreement or the
right to receive benefits or payments resulting from this Agreement. Approval by the Grantee
of any subcontract or assignment shall not under any circumstances he deemed to provide
for the incurring of any obligation by the Grantee in excess of the total dollar amount set forth
in this Agreement.
m. Consultant to the Grantee - The parties understand that in order to facilitate the
implementation of this Agreement, the Grantee may from time to time designate a
development consultant to work with the Subrecipient. The Grantee's Consultant shall be
considered the Grantee's designee with respect to all portions of this Agreement with the
exception of those provisions relating to payment to the Subrecipient for services rendered.
The Grantee shall provide written notification to the Subrecipient of the name, address and
employee representatives of the Grantee's Consultant.
n. Participation in the Homeless Management Information System (HMIS) - The Subrecipient
agrees to participate in a Homeless Management Information System selected and
established by the Grantee. Participation will include, but not be limited to, input of client
data upon intake, daily updates of bed availability information,as well as updates to current
and prior clients records upon client contact, and maintaining current data for statistical
purposes. Subrecipients of Domestic Violence Programs with heightened privacy and
confidentiality concerns are required to participate in an HMIS equivalent system to include
the necessary stricter privacy and confidentiality standards. The Subrecipient understands
that they are responsible for any ongoing costs to access the HMIS system. The Subrecipient
agrees to abide by terms of any HMIS Agreements, which are incorporated herein by
reference. The Subrecipient shall indemnify and hold harmless the Grantee and Miami-Dade
County,its agents and instrumentalities from any and all liability,losses and damages arising
out of or relating to this Agreement or the HMIS system.
o. Miami-Dade County Inspector General review - The Subrecipient understands that Miami-
Dade County, Office of the Inspector General may, on a random basis, perform audits on all
Miami-Dade County contracts,throughout the duration of said contracts.
p. Independent Private-Sector Inspector General review-The Subrecipient understands that
Miami-Dade County Inspector General is also empowered to retain the services of
Independent Private-Sector Inspector Generals, to audit, investigate, monitor, oversee,
CoC Grant#FL0177L4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 30
inspect and review operations,activities,performance and procurement processes including
but not limited to project design,application and project specifications,proposals submittals,
activities of the Subrecipient, its officers, agents and employees, lobbyists, Miami-Dade
County staff, and elected officials to ensure compliance with contract specifications and to
detect fraud and corruption.
q. Renegotiation or Modification-The Subrecipient agrees that modifications to provisions of
this Agreement shall only be valid, when in writing and signed by duly authorized
representatives of all parties. In addition, the Subrecipient may not make any significant
changes to an approved program without prior written approval by the Grantee. Significant
changes include,but are not limited to,changes in the Project Sponsor,changes in the project
site location, additions or deletions in types of program or funding activities outlined in 24
CFR 578.37- 578.63 and the Notice of Funding Availability(NOFA) process approved in the
Technical Submission for this program,or a shift of greater than ten(10)percentage points
between approved funding activities, or a change in the population served, the number of
population served,or any other changes deemed significant by the Grantee. Depending upon
the nature of the change,the Grantee may require a new certification of consistency with the
Consolidated Plan Certification from the United States Department of Housing and Urban
Development. Any approval for changes is contingent upon United States, Department of
Housing and Urban Development Field Office approval of the continuation of the
Subrecipient's renewal ranking in the CoC NOFA application process.
The parties agree to renegotiate this Agreement if the Grantee determines, in its sole and
absolute discretion, that changes are necessary for reasons including but not limited to
changes in Federal, State, County laws or regulations, or increases or decreases in funding
allocations. The Grantee shall have final authority in determining funding availability for this
Agreement caused by changes listed above. Notwithstanding the foregoing, the Grantee
retains all rights of suspension and termination set forth in other section(s) of this
Agreement.
r. Right to Waive-The Grantee may,for good and sufficient cause, determined by the Grantee
in its sole and absolute discretion,waive provisions in this Agreement in writing or seek to
obtain such wavier from the appropriate authority. All waiver requests from the Subrecipient
must be in writing. Any waiver shall not be construed as a modification or revision to this
Agreement.
s. Disputes - In the event that an unresolved dispute exists between the Subrecipient and the
Grantee, the Grantee shall refer the questions, including the views of all interested parties
and the recommendation of the Miami-Dade County Homeless Trust, to the Miami-Dade
County Mayor or the Mayor's designee for determination. The Mayor or Mayor's designee
will issue a determination within thirty (30) calendar days of receipt and so advise the
Grantee and the Subrecipient, or in the event additional time is necessary, the Grantee will
notify the Subrecipient within the thirty (30) day period that additional time is necessary.
The Subrecipient agrees that the determination of the Mayor or the Mayor's designee shall be
final and binding on all parties.
t. Proceedings-This Agreement shall be construed in accordance with the laws of the State of
Florida and any proceedings arising between the parties in any manner pertaining or related
to this Agreement shall, to the extent permitted by law, be held in Miami-Dade County,
Florida.
CoC Grant#FL01771,4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 31
u. No Third Party Beneficiaries -This Agreement has no intended or unintended third party
beneficiaries.
v. Construction of the Agreement- This Agreement shall not be construed against the drafter
of this Agreement.
w. Sovereign Immunity- Nothing in this Agreement shall be considered a waiver of sovereign
immunity.
x. Notice and Contact-The Grantee's representative for this Agreement is Victoria L. Mallette
Executive Director Mia '-Dade Cour e Homel:ss Tr st. The Subrecipient's representatii e
fo thi Agreem:L_ . �t,t is _ 5_0x4 S . The project site location is -'l
i #1 _ . In e event that different representatives are designated by the
S(brecipient after this Agreement is executed, or the Subrecipient changes the address of
either the program site or principal office,the Subrecipient must notify the Grantee prior to
such relocation and obtain all necessary approvals. Notice of the name of the new
representative or new address will be rendered in writing to the Grantee within five(5)
business days of the proposed change.
y. The Subrecipient shall provide to the Grantee,prior to execution of this Agreement,the
Subrecipient's Board Approval or Board Resolution designated authorizing signatories or
their alternative to receive and expend funds,to execute agreements and subcontract
agreements and to exercise modification,renewal and termination clauses contain within
this Agreement.The resolution shall be updated and provided annually.
z. The Subrecipient shall provide the Grantee with a current list of the Subrecipient's Board of
Directors and a Program-Specific Table of Organization,which includes all current job titles
in PDF format and which shall be emailed as an attachment to Miami-Dade County
Homeless Trust's Contract Manager Terrell T.Ellis within five(5) business days of
execution of this Agreement.
aa. Name and Address of Payee-When payment is made to the Subrecipient,it shall be directed
to the name and address�Qf tr e payee Estee ere:
Subrecipig is Na r-: (e. 1. I . !
dd. Severability of Provisions- If any provision of this Agreement is held invalid,the remainder
of this Agreement shall not be affected thereby if such remainder would then continue to
conform to the terms and requirements of all applicable law.
ee. Waiver of Trial-Neither the Subrecipient,subcontractor nor any other person liable for the
responsibilities,obligations,services and representations herein,nor any assignee,successor
heir or personal representative of the Subrecipient,subcontractor or any other such persons
or entities shall seek a jury trial in any lawsuit preceding, counterclaim or other litigation
proceeding based upon or arising out of this Agreement, or the dealings or the relationship
between or among the parties to this Agreement..
ff. Counties and Municipalities outside Miami-Dade County-The Subrecipient agrees to provide
homeless housing within Miami-Dade County and further agrees to abide by, as well as to
post this notice: Notice that all firms, corporations, organizations or individuals desiring to
transact business or enter into a contract with Miami-Dade County for the provision of
homeless housing and or homeless services swears, verifies,affirms and agrees that 1) they
have not entered into any current contracts,arrangements of any kind,or understanding with
any county, or municipality outside of Miami-Dade County to provide housing and services
for homeless persons in Miami-Dade County who are transported to Miami-Dade County by
or at the behest of such counties and municipalities outside Miami-Dade County; and 2)
During the term of this contract, entities listed above will not enter into any such contract,
arrangement of any kind or understanding provided however,Miami-Dade County Homeless
Trust may,in its sole and absolute discretion, find and determine within sixty 1601 days of
an entity's request to waive the requirements of this section,that a proposed contract should
not be prohibited hereby, as the best interests of the homeless programs undertaken by and
on behalf of Miami-Dade County would be served and Miami-Dade County would not be
negatively affected by such contract, arrangement,or undertaking.
gg. Compliance with all applicable Laws, Regulations, Ordinances, Policies and Standards-The
Subrecipient agrees to comply with all applicable Federal, State, and local laws, regulations,
ordinances, and standards including but not limited to any applicable requirements
regarding payment and performance bonds and other requirements for public works,
competitive bid and bid bond requirements, if applicable, as well as with requirements
contained in the Grantee's "Continuum of Care Program Grant Agreement",Attachment
A. The Subrecipient also agrees to sign and provide the Grantee with any required affidavits.
Additionally, the Subrecipient shall comply with any and all guidance that Grantee receives
from US HUD regarding this Agreement,the program and/ or services covered herein, and
clarification of existing laws and regulations
9. Religious Organizations
Pursuant to 24 CFR Part 578.87, a primarily religious organization is eligible to receive US HUD
funding,if the organization agrees to provide homeless housing and services in a manner that is free
from religious influences as described in section 24 CFR Part 578.87 and in accordance with the
following principles;
a. It will not discriminate against any employee or applicant for employment on the basis of
religion and will not limit employment or give preference in employment to persons on the
basis of religion;
CoC Grant#FL0177L4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 33
b. It will not discriminate against any person applying for homeless housing or services on the
basis of religion and will not limit such homeless housing or services or give preference to
persons on the basis of religion;and
c. It will provide no religious instruction or counseling, conduct no religious worship or
religious services,engage in no religious proselytizing and exert no other religious influence
in the provision of homeless housing and services funded hereunder.
d. Alternative Provider-The Subrecipient shall incorporate into their policies and procedures,
a written approved policy to refer, or transfer any program participant or prospective
program participant of the Continuum of Care program who objects to the religious character
of the provider. The policy and procedures shall be reviewed and subject to approval by
Miami-Dade County Homeless Trust. At a minimum the policy and procedures shall include
action to transferor refer within a reasonably prompt time after the objection and undertake
reasonable efforts to identify and refer the participant to an alternative provider to which the
participant has no objection. Except for services provided by telephone, the Internet, or
similar means, the referral must be to an alternative provider in reasonable geographic
proximity to the organization making the referral. In making the referral, the Subrecipient
shall comply with applicable privacy laws and regulations. The Subrecipient shall document
any objections from program participants and prospective program participants and any
efforts to refer such participants to alternative providers in accordance with the
requirements of 24 CFR 578.103(a)(13).
The Subrecipient shall comply with the provisions of this section and with 24 CFR Part 578.87, as
well as with any other applicable laws or regulations governing a primarily religious organization.
10. Health Insurance Portability and Accountability Act(HIPAA)
Any person or entity that performs or assists Miami-Dade County with a function or activity involving
the use or disclosure of Individually Identifiable Health Information (IIHI) and or Protected Health
Information (PHI)shall comply with the Health Insurance Portability and Accountability Act of 1996
(HIPAA), as may be amended, and any applicable federal, state, county and local laws and policies,
including by not limited to 24 CFR 578.103, 42 CFR Part 2, and Section 39.908, Florida Statutes, as
may be applicable. HIPAA mandates for privacy, security and electronic transfer standards that
include but are not limited to the following:
a. Use of information only for performing services required by the contractor as required by
law;
b. Use of appropriate safeguards to prevent non-permitted disclosures;
c. Reporting to Miami-Dade County of any non-permitted use or disclosure;
d. Assurances that any agents and subcontractors agree to the same restrictions and conditions
that apply to the Subrecipient and provides reasonable assurances that IIHI and PHI will be
held confidential;
e. Making PHI available to the customer;
f. Making PHI available to Miami-Dade County for an accounting of disclosures;
g. Making internal practices,books and records related to PHI and IIHI available to Miami-Dade
County for compliance audits and for other purposes as may be permitted by law; and
h. PHI shall maintain its protected status regardless of the form and method of transmission
(including paper and or electronic transfer of data).
CoC Grant#FLO177L4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 34
The Subrecipient must give its customers written notice of all privacy information practices including
but not limited to description of the types of uses and disclosures that would be made with protected
health information.
11. Proof of Licensure/ Certification and Background Screening
a. Licensure. - If the Subrecipient is required by the State of Florida or Miami-Dade County or
any federal,state or local law or regulation to be licensed or certified to provide the services
or operate the facilities outlined in the Scope of Service contained within the "Electronic
Review, Renewal Adjustment and HEARTH Renewal Application", Attachment B, the
Subrecipient shall furnish to the Grantee a copy of all required current licenses or certificates.
Examples of services or operations requiring such licensure or certification include but are
not limited to childcare,day care,nursing homes,and boarding homes.
If the Subrecipient fails to furnish the Grantee with the licenses, certificates or certifications
required under this Section, the Grantee in its sole discretion, shall not disburse any funds
until it is provided with such licenses or certifications. Failure to provide the required
licenses or certification within sixty(601 days of execution of this Agreement may result in
termination of this Agreement at the Grantee's discretion.
b. Background Screening-The Subrecipient agrees to comply with all applicable federal,state
and local laws, regulations, ordinances and resolutions regarding background screening of
employees, volunteers, subcontractors and independent contractors. Subrecipient's failure
to comply with any applicable laws, regulations, ordinances and resolutions regarding
background screening of employees, volunteers, subcontractors and independent
contractors is grounds for a material breach and termination of this contract at the sole
discretion of Miami-Dade County.
The Subrecipient agrees to comply with all applicable laws, (including but not limited to
chapters 39,402,409, 394,408, 393, 397,943, 984, 985, 1012 and 435, Florida Statutes, and
Section 943.04351, Florida Statutes, as may be amended from time to time), regulations,
ordinances and resolutions regarding background screening of those who may work or
volunteer directly with or in the vicinity of vulnerable persons as defined by Section 435.02
Florida Statutes,as maybe amended from time to time.
In the event criminal background screenings is required by law,the State of Florida and/or
Miami-Dade County, the Subrecipient will permit only employees, volunteers,
subcontractors and independent contractors with a satisfactory national criminal
background check through an appropriate screening agency(i.e.,the Florida Department of
Juvenile Justice,Florida Department of Law Enforcement or Federal Bureau of Investigation)
to work or volunteer in direct contact with or in the vicinity of vulnerable persons. The
Subrecipient shall also comply with Section 943.059, Florida Statutes, regarding court-
ordered sealing of criminal history records,and Section 943.0585,Florida Statutes,regarding
court-ordered expunction of criminal history records,as may be applicable.
The Subrecipient agrees to ensure that employees,volunteers,subcontracted personnel and
independent contractors who work with vulnerable persons satisfactorily complete and pass
Level 2 background screenings before working or volunteering with any vulnerable persons.
The Subrecipient shall furnish Miami-Dade County with proof that employees, volunteers,
subcontracted personnel, and independent contractors who work with vulnerable persons,
CoC Grant#FLO177L4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 35
satisfactorily passed Level 2 background screenings pursuant to Chapter 435 Florida
Statutes,as may be amended from time to time.
If the Subrecipient fails to furnish to Miami-Dade County proof that an employee,volunteer,
subcontractor or independent contractor's Level 2 or other required background screening
was satisfactorily passed and completed prior to that employee,volunteer, subcontractor or
independent contractor working or volunteering with or in the vicinity of a vulnerable person
or vulnerable persons, Miami-Dade County shall not disburse any further funds and this
Agreement may be subject to termination at the sole discretion of Miami-Dade County.
SIGNATURES CONTINUE ON NEXT PAGE
CoC Grant#FL0177L4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 36
IN WITNESS WHEREOF,the parties have caused this 138)thirty-eight nave Agreement to be executed by
their respective and duly authorized officers the day and year first above written.
WITNESSES: ENTITY:
I� The City of Miami Beach
1. 4 ter ♦ ir (•. Subrecipient:
(Si¢• .ture of Witness) (Pri full na e of Provider Agency)
JVCCLI ( DA-PsHEL 1_As
(Print Name of Witness)
2.1a1#12.1144 �I vnrvv.y t_,. mot/ f�1 LES
(Signa/ture . (Print Name of Authorized Agency Signatory)
�( 1&4 /180 QT`t 04AN,4ctE2
(Print Name of Witness) (Print Title of Authorized Agency Signatory)
, e :
.Sppd,
ATfES r
\.
I6 `.INCORP ORATED; * I
Rafael E.Granado, ity Clerk k�,.., ^h '
:LH26
ATTEST: Miami-Dade County,a political subdivision of
The State of Florida
HARVEY RUVIN,C t<
BY:
Deputy C rk GGG s `Carlos A. imenez, Mayor
// /f i P t. MAURICE L. KEMP APPROVED AS FORM LANGGU E -
Date DEPUTY MAYOR &FCR EXECUTION
MIAMI-DADE CTY. FL n )r
See attached memorandum dated (July 20 2018) approved as to form and legal suffiflM4Inn �\; On
Resolution# R-1067-17 '(_.
CoC Grant#FL0177L4D001710.The City of Miami Beach,The City of Miami Beach Outreach Program Page 37
INDEX OF ATTACHMENTS
Attachment A- Continuum of Care Program Grant Agreement & Exhibit 1
Attachment B - Scope of Service and US HUD eSnaps documents
Attachment C - Form W-9 Request for Taxpayer
Attachment D - Miami-Dade County Required Affidavits and Declarations
Attachment E - Consolidated Financial Record and Reports - Excel Format
Attachment F - Performance Reports (Monthly and Annual)
Attachment G - CoC Internal Wellness Checklist and Guidelines
Attachment H - "Incident Report" form
Attachment I - "Real Property & Equipment Asset Inventory' form
Attachment J - When Subrecipient is the Rental Administrator
(Participant's Housing Application)*FLOP &LEASE
Attachment K- When Miami-Dade County is the Rental Administrator
(Participant's Housing Application)* HAP & LEASE
Attachment L - Place-setter- Leave Blank
n#F" hee'!CbCPailicipant Housing Application'contained therein, may be updated and amended from
7 "tinietkr%rtn6 dild re-issued administratively
ova te.ma':h.ea
CoC Grant#FL0177L4D001710,The City of Miami Beach,The City of Miami Beach Outreach Program Page 38
FY2017
Continuum of Care (CoC)
GRANT AGREEMENT
Between
United States Department of Housing and
Urban Development (US HUD)
And
Miami-Dade County
Miami-Dade County Homeless Trust
ATTACHMENT A"1017 US HUD CoC Grant Agreement"
Tax ID No.: 59-6000573
CoC Program Grant Number: FL0177L4D001710
Effective Date: 7/30/2018
DUNS No.: 004148292
EXHIBIT I
SCOPE OF WORK for
FY2017 COMPETITION
(funding 1 project in CoCs with multiple recipients)
1. The project listed on this Scope of Work is governed by the Act and Rule, as they may be
amended from time to time. The project is also subject to the terms of the Notice of Funds
Availability for the fiscal year competition in which the funds were awarded and to the
applicable annual appropriations act.
2. HUD designations of Continuums of Care as High-performing Communities (HPCS) are
published in the HUD Exchange in the appropriate Fiscal Years' CoC Program
Competition Funding Availability page. Notwithstanding anything to the contrary in the
Application or this Grant Agreement,Recipient may only use grant funds for HPC
Homelessness Prevention Activities if the Continuum that designated the Recipient to
apply for this grant was designated an HPC for the applicable fiscal year.
3. Recipient is not a Unified Funding Agency and was not the only Applicant the Continuum
of Care designated to apply for and receive grant funds and is not the only Recipient for
the Continuum of Care that designated it. HUD's total funding obligation for this grant is
$_65212_for project number FL0177L4D001710 . If the project is a renewal to
which expansion funds have been added during this competition,the Renewal Expansion
Data Report, including the Summary Budget therein, in e-snaps is incorporated herein by
reference and made a part hereof. In accordance with 24 CFR 578.105(6), Recipient is
prohibited from moving more than 10%from one budget line item in a project's approved
budget to another without a written amendment to this Agreement. The obligation for this
project shall be allocated as follows:
a. Continuum of Care planning activities $ 0
b. UFA costs $ 0
c. Acquisition $ 0
d. Rehabilitation $ 0
e. New construction $ 0
f. Leasing $ 0
g. Rental assistance $ 0
It Supportive services $ 60946
i. Operating costs S 0
j. Homeless Management Information System $ 0
k. Administrative costs $4266
www.hud.gov espanol.hudgov Pace
I. Relocation Costs $ 0
m. HPC homelessness prevention activities:
Housing relocation and stabilization services $ 0
Short-term and medium-term rental assistance $ 0
4. The performance period for the project begins 06-01-2018_and ends_05-31-2019 .
No funds for new projects may be drawn down by Recipient until HUD has approved site
control pursuant to §578.21 and §57825 and no funds for renewal projects may be drawn
down by Recipient before the end date of the project's final operating year under the grant
that has been renewed.
5 If grant funds will be used for payment of indirect costs,the Recipient is authorized to
insert the Recipient's federally recognized indirect cost rates on the attached Federally
Recognized Indirect Cost Rates Schedule,which Schedule shall be incorporated herein and
made a partof the Agreement. No indirect costs may be charged to the grant by the
Recipient if their federally recognized cost rate is not listed on the Schedule..
6. The project has not been awarded project-based rental assistance for a term of fifteen (15)
years. Additional funding is subject to the availability of annual appropriations.
www hud.gov espanolhudgov Page 6
Tax ID No.: 59-6000573
CoC Program Grant Number: FL0177L4D001710
Effective Date: 7/30/2018
DUNS No.: 004148292
FEDERALLY RECOGNIZED INDIRECT COST RATE SCHEDULE
Grant No. Recipient Name Indirect cost rate Cost Base
FLO177L4 D001710
www.hudgov cspanol.hudgov Page.]
This agreement is hereby executed on behalf of the parties as follows:
UNITED STATES OF AMERICA,
Secretary of Housing and Urban Development
By: i
Ignature)
Ann D. Chavis,Director
(Typed Name and Title)
July 30, 2018
(Date)
RECIPIENT
Miami-Dade County
(Name of Organization)
By:
(Signature of Authorized Official `-
(Typed Name and Ti of Authorized Official)
�
(Date)
I
vvwhud.gov espanol.hud.gov Page
FY 2017
Continuum of Care (CoC) Program
Scope of Service
eSnaps Budget and Performance Objectives
ATTACHMENT B"FY 2017 Scope of Service`
Miami-Dade County Homeless Trust Scope of Service
FL0177L4D001710 City of Miami Beach Outreach
The Subrecipient shall provide at least three hundred fifty (3S0) CoC Program eligible persons placed in
emergency shelters from outreach contacts through the Supportive Services Only(SSO) Program during the
one(1) year grant term.
The Subrecipient shall provide services as proposed in the application to United States Department of Housing and
Urban Development (US HUD) pursuant to the 2017 NOFA (incorporated herein by reference), and pursuant to 24
CFR 578 including but not limited to:
1. Accept eligible homeless persons as defined by US HUD and through Miami-Dade County Homeless Trust
CoC's established Coordinated Outreach and Assessment HMIS referral process;
2. Comprehensive assessment and case management;
3. Residential stability;
4. If applicable, locate and match eligible program participants with eligible Landlords with units in the
community;
5. If Miami-Dade County is the Rental Administrator, provide, complete and submit to the assigned staff all
documentation, records and reports, including but not limited to, Attachment K Participant's Housing
Application;
6. If Miami-Dade County is not the Rental Administrator, provide, complete and maintain all documentation,
records and reports, including but not limited to, Attachment J Participant's Housing Application. Provide,
maintain and complete all documentation and supporting information for HQS Inspections, verify
compliance with federal rules and regulations, verify Program Participants' Income Calculation and Rent
Determination including any applicable utility allowances, review Lease Agreement, Lease Addendum if
applicable, and Housing Assistance Payment (HAP) Contracts, issue move-in authorization, and issue
payments to Landlords;
7. Provide policies and procedures which ensure compliance with Further Fair Housing Act,Client Rights and
Grievance Procedures specifically regarding terminations of housing,termination from program, evictions,
and Landlord Tenant issues and appeals;
8. Provide directly, or refer to all appropriate mainstream services (as applicable) including psychiatric or
psychological evaluations, medical clearances, mental health treatment, substance abuse treatment, social
rehabilitation, legal services, life skills training, family reunification, counseling services, benefits
applications,veteran services,employment,vocation and job assistance services;
9. Provide at a minimum, an annual assessment of the services needs of the program participants and adjust
services accordingly; and
10. Discharge planning to other types of mainstream positive housing.
Conditions:
The Subrecipient shall adhere to the "Continuum of Care Program Grant Agreement", which includes the
"Exhibit 1 Scope of Service FY 2017 Competition" and which is governed by the Continuum of Care (CoC)
program rules and regulations. The Subrecipient shall comply with all applicable federal, state and local laws,
regulations and ordinances, including but not limited to 24 CFR Part 578, as may be amended, the McKinney-
Vento Homeless Assistance Act (42 U.S.C. 11301 et seq.) (the "Act") as may be amended, the Consolidated and
Further Continuing Appropriations Acts of 2013 and 2014 as well as with any other terms and conditions as
HUD may have established in the applicable Notice of Funds Availability and with any applicable guidance,
requirements and directives provided by Miami-Dade County Homeless Trust.
Attachment B"Miami-Dade County Homeless Trust Scope of Service"
Applicant: Miami-Dade County 0041482920000
Project: City of Miami Beach Outreach FL0177L4D001609
6E. Supportive Services Budget
Instructions:
Enter the quantity and total budget request for each supportive services cost.The request
entered should be equivalent to the cost of one year of the relevant supportive service.
Eligible Costs:The system populates a list of eligible supportive services for which funds can
be requested. The costs listed are the only costs allowed under 24 CFR 578.53.
Quantity AND Description: This is a required field. A quantity AND description must be
entered for each requested cost. Enter the quantity in detail (e.g. 1 FTE Case Manager Salary+
benefits,or child care for 15 children)for each supportive service activity for which funding is
being requested. Please note that simply stating"1FTE" is NOT providing"Quantity AND Detail"
and limits HUD's understanding of what is being requested. Failure to enter adequate'Quantity
AND Detail' may result in conditions being placed on an award and a delay of grant funding.
Annual Assistance Requested: This is a required field. Enter the amount of funds requested
for each activity. The amount entered must only be the amount that is DIRECTLY related to
providing supportive services to homeless participants.The request should match the budget
amounts identified on the CoC's HUD-approved FY 2016 GIW.
Total Annual Assistance Requested: This field is automatically calculated based on the sum of
the annual assistance requests entered for each activity.
Grant Term:This field is populated with the value"1 Year"and will be read only.
Total Request for Grant Term:This field is automatically calculated based total amount
requested for each eligible cost multiplied by the grant term.
All total fields will be calculated once the required field has been completed and saved.
Additional Resources can be found at the HUD Resource Exchange:
https://www.hudexchange.i nfo/e-snaps/guides/coc-grog ram-competdlo n-resources/
A quantity AND description must be entered for each requested cost.
Eligible Costs Quantity AND Description Annual Assistance
(max 400 characters) Requested
1.Assessment of Service Needs
2.Assistance with Moving Costs
3.Case Management
4.Child Care -5.Education Services
6.Employment Assistance
7.Food
6.Housing/Counseling Services
9.Legal Services
10.Life Skills
11.Mental Health Services
12.Outpatient Health Services
13.Outreach Services 2 FTE Outreach Case Workers-Salary and Fringe Benefits $60,946
Pae 1 08/17/2018
Renewal Project Application FY2016 9
Applicant: Miami-Dade County 0041482920000
Project: City of Miami Beach Outreach FL0177L4D001609
14.Substance Abuse Treatment Services
15.Transportation
16.Utility Deposits
17.Operating Costs
Total Annual Assistance Requested $60,946
Grant Term
1 Year
Total Request for Grant Term $60,946
Click the 'Save' button to automatically calculate totals.
Renewal Project Application FY2016 Page 2 08/17/2018
Applicant: Miami-Dade County 0041482920000
Project:City of Miami Beach Outreach FL0177L4D001710
Before Starting the Project Application
To ensure that the Project Application is completed accurately, ALL
project applicants should review the following information BEFORE
beginning the application.
Things to Remember
-Additional training resources can be found on the HUD Exchange at
https://www.hudexchange.info/e-snaps/guides/coc-program-competifion-resources/ -Program
policy questions and problems related to completing the application in e-snaps may be directed
to HUD via the HUD Exchange Ask A Question.
- Project applicants are required to have a Data Universal Numbering System (DUNS)
number and an active registration in the Central Contractor Registration(CCR)/System for
Award Management(SAM)in order to apply for funding under the Fiscal Year(FY)2017
Continuum of Care (CoC) Program Competition. For more information see FY 2017 CoC
Program Competition NOFA.
-To ensure that applications are considered for funding, applicants should read all sections of
the FY 2017 CoC Program NOFA and the FY 2016 General Section NOFA.
-Detailed instructions can be found on the left menu within e-snaps. They contain more
comprehensive instructions and so should be used in tandem with onscreen text and the
hide/show instructions found on each individual screen.
-Before starting the project application, all project applicants must complete or update (as
applicable)the Project Applicant Profile in e-snaps.
-Carefully review each question in the Project Application. Questions from previous
competitions may have been changed or removed,or new questions may have been added,and
information previously submitted mayor may not be relevant. Data from the FY 2016 Project
Application will be imported into the FY 2017 Project Application; however,applicants will be
required to review all fields for accuracy and to update information that may have been adjusted
through the FY 2016 post award process ora grant agreement amendment. Data entered in the
post award and amendment forms in e-snaps will not be imported into the project application.
-Expiring Shelter Plus Care projects requesting renewal funding for the first time under 24
CFR part 578, and rental assistance projects can only request the number of units and unit size
as approved in the final HUD-approved Grant Inventory Worksheet(GIW).
-Expiring Supportive Housing Projects requesting renewal funding for the first time under 24
CFR part 578,transitional housing, permanent supportive housing with leasing, rapid re-housing,
supportive services only, renewing safe havens, and HMIS can only request the Annual Renewal
Amount(ARA)that appears on the CoC's HUD-approved GIW. If the ARA is reduced through
the CoC's reallocation process,the final project funding request must reflect the reduced amount
listed on the CoC's reallocation forms.
-HUD reserves the right to reduce or reject any renewal project that fails to adhere to 24 CFR
part 578 and the application requirements set forth in the FY 2017 CoC Program Competition
NOFA.
Renewal Project Application FY2017 Page 1 08/17/2018
Applicant: Miami-Dade County
0041482920000177L4D0011
Project: City of Miami Beach Outreach FL0177L4D001710
1A. SF-424 Application Type
1. Type of Submission: Application
2. Type of Application: Renewal Project Application
If"Revision", select appropriate letter(s):
If"Other", specify:
3. Date Received: 10/19/2017
4. Applicant Identifier:
5a. Federal Entity Identifier:
5b. Federal Award Identifier: FL0177
This is the first 6 digits of the Grant Number,
known as the PIN, that will also be indicated
on Screen 3A Project Detail. This number
must match the first 6 digits of the grant
number on the HUD approved Grant Inventory
Worksheet (GIW).
Check to confrim that the Federal Award X
Identifier has been updated to reflect the
most recently awarded grant number
6. Date Received by State:
7. State Application Identifier:
Renewal Project Application FY2017 Page 2 08/17/2018
Applicant: Miami-DadeCouty 0041482920000
Project: City f Miami Beach Outreach FL0177L4D001710
1 B. SF-424 Legal Applicant
8. Applicant
a. Legal Name: Miami-Dade County
b. Employer/Taxpayer Identification Num
er 59-6000573
):
lc.Organizational DUNS: 004148292 I PLUS 4
d. Address
Street 1: 111 N.W. 1st Street
Street 2: 27th floor, Suite 310
City: Miami
County: Miami-Dade
State: Florida
Country: United States
Zip/ Postal Code: 33128
e. Organizational Unit (optional)
Department Name: Homeless Trust
Division Name: none
f. Name and contact information of person to
be
contacted on matters involving this
application
Prefix: Ms.
First Name: Victoria
Middle Name: L.
Last Name: Mallette
Suffix:
Title: Executive Director
Organizational Affiliation: Miami-Dade County
Telephone Number: (305) 375-1490
Renewal Project Application FY2017 Page 3 08/17/2018
Applicant: Miami-Dade County 0041482920000
Project: City of Miami Beach Outreach FL0177L4D001710
Extension:
Fax Number: (305) 375-2722
Email: vmallette@miamidade.gov
Renewal Project Application FY2017 Page 4 08/17/2018
Applicant: Miami-Dade County 0041482920000
Project: City of Miami Beach Outreach FLO177L4D001710
IC. SF-424 Application Details
9. Type of Applicant: B. County Government
10. Name of Federal Agency: Department of Housing and Urban Development
11. Catalog of Federal Domestic Assistance CoC Program
Title:
CFDA Number: 14.267
12. Funding Opportunity Number: FR-6100-N-25
Title: Continuum of Care Homeless Assistance
Competition
13. Competition Identification Number:
Title:
Renewal Project Application FY2017 Page 5 08/17/2018
Applicant: Miami-Dade County 0041482920000
Project: City of Miami Beach Outreach FL0177L4D001710
1D. SF-424 Congressional District(s)
14. Area(s) affected by the project (State(s) Florida
(for multiple selections hold CTRL key)
15. Descriptive Title of Applicant's Project: City of Miami Beach Outreach
16. Congressional District(s):
a. Applicant: FL-027, FL-026, FL-024, FL-025, FL-023
(for multiple selections hold CTRL key)
b. Project: FL-023
(for multiple selections hold CTRL key)
17. Proposed Project
a. Start Date: 06/01/2018
b. End Date: 05/31/2019
18. Estimated Funding ($)
a. Federal:
b. Applicant:
c. State:
d. Local:
e. Other:
f. Program Income:
g. Total:
Renewal Project Application FY2017 Page 6 08/17/2018
0041482920000
Applicant: of Miami Couty FLO177L4D001710
Project: City of Miami Beach Outreach
1E. SF-424 Compliance
19. Is the Application Subject to Review By b. Program is subject to E.O. 12372 but has not
State Executive Order 12372 Process? been selected by the State for review.
If "YES", enter the date this application was
made available to the State for review:
20. Is the Applicant delinquent on any Federal? No
debt
If "YES," provide an explanation:
Renewal Project Application FY2017 Page 7 08/17/2018
Applicant: Miami-Dade County 0041482920000
Project: City of Miami Beach Outreach FL0177L4D001710
1F. SF-424 Declaration
By signing and submitting this application, I certify (1) to the statements
contained in the list of certifications** and (2) that the statements herein
are true, complete, and accurate to the best of my knowledge. I also
provide the required assurances**and agree to comply with any resulting
terms if I accept an award. I am aware that any false, fictitious, or
fraudulent statements or claims may subject me to criminal, civil, or
administrative penalties. (U.S. Code, Title 218, Section 1001)
I AGREE: X
21. Authorized Representative
Prefix: Mr.
First Name: Carlos
Middle Name: A.
Last Name: Gimenez
Suffix:
Title: County Mayor
Telephone Number: (305) 375-1490
(Format: 123-456-7890)
Fax Number: (305) 375-2722
(Format: 123-456-7890)
Email: cgimenez@miamidade.gov
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 10/19/2017
Renewal Project Application FY2017 Page 8 08/17/2018
Applicant: Miami-Dade County 0041482920000
Project: City of Miami Beach Outreach FLO177L4D001710
1G. HUD 2880
Applicant/Recipient Disclosure/Update Report - Form 2880
U.S. Department of Housing and Urban Development
OMB Approval No. 2510-0011 (exp.11/30/2018)
Applicant/Recipient Information
1. Applicant/Recipient Name, Address, and Phone
Agency Legal Name: Miami-Dade County
Prefix: Mr.
First Name: Carlos
Middle Name: A.
Last Name: Gimenez
Suffix:
Title: County Mayor
Organizational Affiliation: Miami-Dade County
Telephone Number: (305) 375-1490
Extension:
Email: cgimenez@miamidade.gov
City: Miami
County: Miami-Dade
State: Florida
Country: United States
Zip/Postal Code: 33128
2. Employer ID Number (EIN): 59-6000573
3. HUD Program: Continuum of Care Program
4. Amount of HUD Assistance $65,212.00
Requested/Received:
(Requested amounts will be automatically entered within applications)
Renewal Project Application FY2017 Page 9 08/17/2018
Applicant: Miami-Dade County 0041482920000
Project: City of Miami Beach Outreach FLO177L4D001710
5. State the name and location (street City of Miami Beach Outreach 111 N.W. 1st
address, city and state) of the project or Street Miami Florida
activity:
Refer to project name,addresses and CoC Project Identifying Number(PIN)entered into the
attached project application.
Part I Threshold Determinations
1. Are you applying for assistance for a Yes
specific project or activity?
(For further information, see 24 CFR Sec. 4.3).
2. Have you received or do you expect to Yes
receive assistance within the jurisdiction of
the Department (HUD), involving the project
or activity in this application, in excess of
$200,000 during this fiscal year(Oct. 1 -Sep.
30)? For further information, see 24 CFR Sec.
4.9.
Part II Other Government Assistance Provided or Requested/Expected
Sources and Use of Funds
Such assistance includes, but is not limited to, any grant, loan, subsidy, guarantee, insurance,
payment, credit, or tax benefit.
Department/Local Agency Name and Address Type of Assistance Amount Expected Uses of the Funds
Requested!
Provided
N/A
Part Ill Interested Parties
You must disclose:
1.All developers, contractors, or consultants involved in the application for the assistance or in
the planning, development, or implementation of the project or activity and
2. any other person who has a financial interest in the project or activity for which the
assistance is sought that exceeds$50,000 or 10 percent of the assistance(whichever is lower).
Alphabetical list of all persons with a Social Security No. Type of Financial Interest Financial interest
Renewal Project Application FY2017 Page 10 08/17/2018
Applicant: Miami-Dade County 0041482920000
Project: City of Miami Beach Outreach FL0177L4D001710
reportable financial Interest in the or Employee ID No. Participation in Project/Activiity in Project/Activityproject or activity
(For indMduals,, 'the last name
firsSee detailed attachment placed in 59-6000513 CA $31,640,18900 100%
"Other Attachment'
Certification
Warning: If you knowingly make a false statement on this form, you may be subject to civil or
criminal penalties under Section 1001 of Title 18 of the United States Code. In addition,any
intentional al erson nond s losurre,andi is to civilles money penalty uirednot to exceed isclosures f$10,0001for information,including
violation.
I certify that this information is true and complete.
I AGREE: X
Name/Title of Authorized Official: Carlos Gimenez, County Mayor
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/28/2017
Renewal Project Application FY2017 Page 11 08/17/2018
Applicant: Miami-Dade County 0041482920000
Project: City of Miami Beach Outreach FLO177L4D001710
1H. HUD 50070
HUD 50070 Certification for a Drug Free Workplace
Applicant Name: Miami-Dade County
Program/Activity Receiving Federal Grant CoC Program
Funding:
Acting on behalf of the above named Applicant as its Authorized Official, I
make the following certifications and agreements to the Department of
Housing and Urban Development (HUD) regarding the sites listed below:
I codify that the above named Applicant will or will continue to
provide a drug-free workplace by:
a. Publishing a statement notifying employees that the unlawful e. Notifying the agency in writing,within ten calendar days after
manufacture,distribution,dispensing,possession,or use of a receiving notice under subparagraph d.(2)from an employee or
controlled substance is prohibited in the Applicant's workplace otherwise receiving actual notice of such conviction.Employers
and specifying the actions that will be taken against employees of convicted employees must provide notice,Including position
for violation of such prohibition. title,to every grant officer or other designee on whose grant
activity the convicted employee was working,unless the
Federalagency has designated a central point for the receipt of
such notices.Notice shall Include the Identification number(s)
of each affected grant;
b. Establishing an on-going drug-free awareness program to f. Taking one of the following actions,within 30 calendar days of
inform employees-- receiving notice under subparagraph d.(2),with respect to any
(1)The dangers of drug abuse in the workplace employee who Is so convicted—
(2)The Applicant's policy of maintaining a drug-free workplace; (1)Taking appropriate personnel action against such an
(3)Any available drug counseling,rehabilitation,and employee employee,up to and including termination,consistent with the
assistance programs;and requirements of the Rehabilitation Act of 1973,as amended;or
(a)The penalties that may be Imposed upon employees for drug (2)Requiring such employee to participate satisfactorily In a
abuse violations occurring In the workplace. drug abuse assistance or rehabilitation program approved for
such purposes by a Federal,State,or local health,law
enforcement,or other appropriate agency;
c. Making it a requirement that each employee to be engaged In g. Making a good faith effort to continue to maintain a drugfree
the performance of the grant be given a copy of the statement workplace through Implementation of paragraphs a.thru f.
required by paragraph a.;
d. Notifying the employee In the statement required by paragraph
a.that,as a condition of employment under the grant,the
employee will...
(1)Abide by the terms of the statement;and
(2)Notify the employer in writing of his or her conviction for a
violation of a criminal drug statute occurring In the workplace
no later than five calendar days after such conviction;
Sites for Work Performance.
The Applicant shall list(on separate pages)the site(s)for the performance of work done in
connection with the HUD funding of the program/activity shown above: Place of Performance
shall include the street address,city, county, State, and zip code. Identify each sheet with the
Applicant name and address and the program/activity receiving grant funding.)
Workplaces, including addresses, entered in the attached project application.
Refer to addresses entered into the attached project application.
I hereby certify that all the information stated X
herein, as well as any information provided in
the accompaniment herewith, is true and
Renewal Project Application FY2017 Page 12 08/17/2018
Applicant: MiaCoumtyi-Dade0041482920000
Project: Cityof Miami Beach Outreach FL0177L4D001710
accurate.
Warning: HUD will prosecute false claims and statements. Conviction may result in criminal
and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Authorized Representative
Prefix: Mr.
First Name: Carlos
Middle Name A.
Last Name: Gimenez
Suffix:
Title: County Mayor
Telephone Number: (305) 375-1490
(Format: 123-456-7890)
Fax Number: (305) 375-2722
(Format: 123-456-7890)
Email: cgimenez@miamidade.gov
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 10/19/2017
Renewal Project Application FY2017 Page 13 08/17/2018
Applicant: Miami-Dade County 0041482920000
Project: City of Miami Beach Outreach FLO177L4D001710
CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief,
that:
(1) No Federal appropriated funds have been paid or will be paid, by or on
behalf of the undersigned, to any person for influencing or attempting to
influence an officer or employee of an agency, a Member of Congress, an
officer or employee of Congress, or an employee of a Member of Congress
in connection with the awarding of any Federal contract, the making of any
Federal grant, the making of any Federal loan, the entering into of any
cooperative agreement, and the extension, continuation, renewal,
amendment, or modification of any Federal contract, grant, loan, or
cooperative agreement.
2) If any funds other than Federal appropriated funds have been paid or
will be paid to any person for influencing or attempting to influence an
officer or employee of any agency, a Member of Congress, an officer or
employee of Congress, or an employee of a Member of Congress in
connection with this Federal contract, grant, loan, or cooperative
agreement, the undersigned shall complete and submit Standard Form-
LLL, "Disclosure of Lobbying Activities," in accordance with its
instructions.
(3) The undersigned shall require that the language of this certification be
included in the award documents for all subawards at all tiers (including
subcontracts, subgrants, and contracts under grants, loans, and
cooperative agreements) and that all subrecipients shall certify and
disclose accordingly. This certification is a material representation of fact
upon which reliance was placed when this transaction was made or
entered into. Submission of this certification is a prerequisite for making
or entering into this transaction imposed by section 1352, title 31, U.S.
Code. Any person who fails to file the required certification shall be
subject to a civil penalty of not less than $10,000 and not more than
$100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief,
that:
If any funds have been paid or will be paid to any person for influencing
or attempting to influence an officer or employee of any agency, a Member
of Congress, an officer or employee of Congress, or an employee of a
Member of Congress in connection with this commitment providing for the
United States to insure or guarantee a loan, the undersigned shall
complete and submit Standard Form-LLL, "Disclosure of Lobbying
Activities," in accordance with its instructions. Submission of this
statement is a prerequisite for making or entering into this transaction
imposed by section 1352, title 31, U.S. Code. Any person who fails to file
Renewal Project Application FY2017 Page 14 08/17/2018
Applicant: Miami-Dade County 0041482920000
Project: City of Miami Beach Outreach FL0177L4D001710
the required statement shall be subject to a civil penalty of not less than
$10,000 and not more than $100,000 for each such failure.
I hereby certify that all the information stated X
herein, as well as any information provided in
the accompaniment herewith, is true and
accurate:
Warning: HUD will prosecute false claims and statements. Conviction may
result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31
U.S.C. 3729, 3802)
Applicant's Organization: Miami-Dade County
Name/ Title of Authorized Official: Carlos Gimenez, County Mayor
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 10/19/2017
•
Renewal Project Application FY2017 Page 15 08/17/2018
Applicant: Miami-Dade County 0041482920000
Project: City of Miami Beach Outreach FLO177L4D001710
1J. SF-LLL
DISCLOSURE OF LOBBYING ACTIVITIES
Complete this form to disclose lobbying activities pursuant to 31 U.S.C.
1352.
Approved by OMB0348-0046
HUD requires a new SF-LLL submitted with each annual CoC competition and completing this
screen fulfills this requirement.
Answer Wes"if your organization is engaged in lobbying associated with the CoC Program and
answer the questions as they appear next on this screen. The requirement related to lobbying
as explained in the SF-LLL instructions states:"The filing of a form is required for each payment
or agreement to make payment to any lobbying entity for influencing or attempting to influence
an officer or employee of any agency,a Member of Congress, an officer or employee of
Congress, or an employee of a Member of Congress in connection with a covered Federal
action.'
Answer"No"if your organization is NOT engaged in lobbying.
Does the recipient or subrecipient of this CoC No
grant participate in federal lobbying activities
(lobbying a federal administration or
congress) in connection with the CoC
Program?
Legal Name: Miami-Dade County
Street 1: 111 N.W. 1st Street
Street 2: 27th floor, Suite 310
City: Miami
County: Miami-Dade
State: Florida
Country: United States
Zip/ Postal Code: 33128
11. Information requested through this form is authorized by title 31 U.S.C.
section 1352. This disclosure of lobbying activities is a material
representation of fact upon which reliance was placed by the tier above
when this transaction was made or entered into. This disclosure is
required pursuant to 31 U.S.C. 1352. This information will be available for
public inspection. Any person who fails to file the required disclosure
shall be subject to a civil penalty of not less than $10,000 and not more
than $100,000 for each such failure.
I certify that this information is true and X
complete.
Renewal Project Application FY2017 Page 16 08/17/2018
Applicant: Miami-Dade County 0041482920000
Project: City of Miami Beach Outreach FLO177L4D001710
Authorized Representative
Prefix: Mr.
First Name: Carlos
Middle Name: A.
Last Name: Gimenez
Suffix:
Title: County Mayor
Telephone Number: (305) 375-1490
(Format: 123-456-7890)
Fax Number: (305) 375-2722
(Format: 123-456-7890)
Email: cgimenez@miamidade.gov
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 10/19/2017
Renewal Project Application FY2017 Page 17 08/17/2018
Applicant: Miami-Dade County 0041482920000
Project: City of Miami Beach Outreach FLO177L4D001710
Additional Information
Now that you have completed Part 1 of the application, please review Parts
2-7, which are in Read Only mode. Screen 3C, which is mandatory for all
PH-PSH projects and screens 6D, 7A and 78 which are mandatory for all
projects will be editable and must be answered prior to submission.
Once you are done reviewing, you will be guided to a "Submissions
without Changes" screen. At this screen if you decide no edits or updates
are required to any screens other than the mandatory questions for 3C
and/or 6D,7A and 7B, you are allowed to submit the application without
ever needing to edit the rest of the application. However, if you determine
that changes need to be made to the application, we have given you the
ability to open up individual screens for edit, instead of the entire
application.
Once you select the screens you want to edit via checkboxes, you will
click "Save", and those screens will be available for edit. An important
reminder, once you make those selections and click "Save", you cannot
uncheck those boxes. You are allowed to select additional boxes even
after saving your initial selections. Again, you must click "Save" for those
newly selected screens to be available for edit.
If your project is a First Time Renewal, your project will not be able to
utilize the "Submit Without Changes" function. The Submissions Without
Changes page will be automatically set to "Make Changes" and you will be
required to input data into the application for all required fields relevant to
the component type.
Renewal Project Application FY2017 Page 18 08/17/2018
Applicant: Miami-Dade County 0041482920000
Project: City of Miami Beach Outreach FL0177L4D001710
2A. Project Subrecipients
This form lists the subrecipient organization(s)for the project. To add a
subrecipient, select the icon. To view or update subrecipient
information already listed, select the view option.
Total Expected Sub-Awards: $65,212
Organization Type Type Sub-
' Awar
d
Amo
unt
City of Miami C. City or Township Government C.City or Township Government $25,2
Beach
Renewal Project Application FY2017 Page 19 08/17/2018
Applicant: Miami-Dade County 0041482920000
Project City of Miami Beach Outreach FLO177L4D001710
2A. Project Subrecipients Detail
a. Organization Name: City of Miami Beach
b. Organization Type: C. City or Township Government
c. Employer or Tax Identification Number: 59-6000372
d.Organizational DUNS: 020546289 PLUS 4
e. Physical Address
Street 1: 1700 Convention Center Drive
Street 2:
City: Miami Beach
State: Florida
Zip Code: 33139
f. Congressional District(s): FL-023
(for multiple selections hold CTRL key)
g. Is the subrecipient a Faith-Based No
Organization?
h. Has the subrecipient ever received a Yes
federal grant, either directly from a federal
agency or through a State/local agency?
i. Expected Sub-Award Amount: $65,212
j. Contact Person
Prefix: Ms.
First Name: Judy
Middle Name:
Last Name: Hoanshelt
Renewal Project Application FY2017 Page 20 08/17/2018
Applicant: Miami-Dade County 0041482920000
Project: City of Miami Beach Outreach FL0177L4D001710
Suffix:
Title: Grants Manager
E-mail Address: judyhoanshelt@ci.miamibeach.Fl.us
Confirm E-mail Address: judyhoanshelt@ci.miamibeach.fl.us
Phone Number: 305-673-7000
Extension: 6,183
Fax Number: 786-394-4675
Renewal Project Application FY2017 Page 21 08/17/2018
Applicant: Miami-Dade County 0041482920000
Project: City of Miami Beach Outreach FL0177L4D001710
2B. Recipient Performance
This screen is currently read only and only includes data from the
previous grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in response
to Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to account
for a reallocation of funds.
1. Has the recipient successfully submitted Yes
the APR on time for the most recently expired
grant term related to this renewal project
request?
2. Does the recipient have any unresolved No
HUD Monitoring and/or 01G Audit findings
concerning any previous grant term related to
this renewal project request?
3. Has the recipient maintained consistent Yes
Quarterly Drawdowns for the most recent
grant term related to this renewal project
request?
4. Have any Funds been recaptured by HUD No
for the most recently expired grant term
related to this renewal project request?
Renewal Project Application FY2017 Page 22 08/17/2018
Applicant: Miami-Dade County 0041482920000
Project: City of Miami Beach Outreach FLO177L4D001710
3A. Project Detail
1. Expiring Grant Number: FL0177
(e.g.,the "Federal Award Identifier"indicated on form 1A.Application Type)
2a. CoC Number and Name: FL-600 - Miami-Dade County CoC
2b. CoC Collaborative Applicant Name: Miami-Dade County
3. Project Name: City of Miami Beach Outreach
4. Project Status: Standard
5. Component Type: SSO
6. Does this project use one or more No
properties that have been conveyed through
the Title V process?
Renewal Project Application FY2017 Page 23 08/17/2018
Applicant: Miami-Dade County 0041482920000
Project: City of Miami Beach Outreach FL0177L4D001710
3B. Project Description
1. Provide a description that addresses the entire scope of the proposed
project.
The City of Miami Beach conducts street outreach as a part of the Coordinated
Assessment process, Monday through Friday to identify, engage and offer
services to homeless persons with the City of Miami Beach. Via its outreach
efforts and walk-in center (located at 555-17th Street), the City seeks
proactively reaches out to homeless persons with a variety of services
including: intake and assessment for services, shelter placement, replacement
of identification documents, application for entitlements, relocation services and
referral services to providers within the County's Continuum of Care.
Goals and Objectives: The City's goal is to end homelessness in the City by
providing prevention and intervention services to participants who are homeless
or at risk of homelessness. As one of the City's intended outcomes, the City
has prioritized ending homelessness by investing in support services including
shelter beds and transportation services to enable relocation for those with
support networks elsewhere as a means of augmenting our outreach efforts.
Eligibility: The City serves homeless persons within its municipal boundaries
who seek to end their cycle of homelessness. Clients and Population Served:
The City anticipates serving 700 homeless persons (families and individuals) via
its outreach services during the grant period. Of these, we expect to place 350
participants in emergency shelter, housing first and other housing with
supportive services. Hours of Operation: The City's walk-in center operates
8:30am -12:00 pm and 1pm-3:30 pm daily. Street outreach is conducted during
walk-in center operating hours as well as early morning outreach (commencing
at 4am) in conjunction with the Miami Beach Police Department.
2. Does your project have a specific Yes
population focus?
2a. Please identify the specific population focus. (Select ALL that apply)
Chronic Homeless Domestic Violence
X X
Veterans Substance Abuse
X X
Youth(under 25) Mental Illness
X
Families with Children HIV/AIDS
x x
Other
(Click'Save'to update) X
Other: All individuals and families in need of services
Renewal Project Application FY2017 Page 24 08/17/2018
Applicant: Miami-Dade County 0041482920000
Project: City of Miami Beach Outreach FL0177L4D001710
3. Housing First
3a. Does the project quickly move Yes
participants into permanent housing
3b. Does the project ensure that participants are not screened out based
on the following items? Select all that apply.
Having too little or little income X
Active or history of substance use X
Having a criminal record with exceptions X
for state-mandated restrictions
History of victimization X
(e.g.domestic violence,sexual assault,childhood abuse)
None of the above
3c. Does the project ensure that participants are not terminated from the
program for the following reasons? Select all that apply.
Failure to participate In supportive services X
Failure to make progress on a service plan X
Loss of income or failure to improve income X
Any other activity not covered in a lease agreement typically found for unassisted persons in the project's geographic area X
None of the above
3d. Does the project follow a "Housing First" Yes
approach?
4. Please select the type of SSO Project: Street Outreach
Renewal Project Application FY2017 Page 25 08/17/2018
Applicant: Miami-Dade County 0041482920000
Project: City of Miami Beach Outreach FL0177L4D001710
4A. Supportive Services for Participants
This screen is currently read only and only includes data from the
previous grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in response
to Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to account
for a reallocation of funds.
1. For all supportive services available to participants, indicate who will
provide them and how often they will be provided.
Click 'Save' to update.
Supportive Services Provider Frequency
Assessment of Service Needs Subrecipient Daily
Assistance with Moving Costs
Case Management Subrecipient Daily
Child Care
Education Services
Employment Assistance and Job Training Partner As needed
Food Subrecipient Daily
Housing Search and Counseling Services Subrecipient Daily
Legal Services
Life Skills Training
Mental Health Services Partner As needed
Outpatient Health Services Partner As needed
Outreach Services Subrecipient Daily
Substance Abuse Treatment Services Partner As needed
Transportation Subrecipient Daily
Utility Deposits
2. Please identify whether the project
includes the following activities:
2a. Transportation assistance to clients to Yes
attend mainstream benefit appointments,
employment training, or jobs?
2b. Use of a single application form for four Yes
or more mainstream programs?
2c. At least annual follow-ups with Yes
participants to ensure mainstream benefits
Renewal Project Application FY2017 Page 26 08/17/2018
Applicant: Miami-Dade County 0041482920000
Project: City of Miami Beach Outreach FLO177L4D001710
are received and renewed?
3. Do project participants have access to Yes
SSIISSDI technical assistance provided by
the applicant, a subrecipient, or partner
agency?
3a. Has the staff person providing the Yes
technical assistance completed SOAR
training in the past 24 months.
Renewal Project Application FY2017 Page 27 08/17/2018
Applicant: Miami-Dade County 0041482920000
Project: City of Miami Beach Outreach FL0177L4D001710
5A. Project Participants - Households
This screen is currently read only and only includes data from the
previous grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in response
to Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to account
for a reallocation of funds.
Households Households with at Adult Households Households with Total
Least One Adult without Children Only Children
and One Child
Total Number of Households 25 355 0 380
!Characteristics Persons in Adult Persons in Persons In Total
Households with at Households without Households with
Least One Adult Children Only Children
and One Child
Adults overage 24 25 310 335
Adults ages 18-24 3 45 48
Accompanied Children underage 18 32 0 32
Unaccompanied Children under age 18 0 0
I Total Persons 60 355 0 415
Click Save to automatically calculate totals
Renewal Project Application FY2017 Page 28 08/17/2018
Applicant: Miami-Dade County 0041482920000
Project: City of Miami Beach Outreach FLO177L4D001710
5B. Project Participants - Subpopulations
This screen is currently read only and only includes data from the
previous grant. To make changes to this information, navigate to the
Submission without Changes screen, select"Make Changes" in response
to Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to account
for a reallocation of funds.
Persons in Households with at Least One Adult and One Child
Persons
Chronic Victims not
Substan Persons Severely of Physical Develop re_
by
Characteristics at with Mentally Domesti Dlsabilit mental led
Abuse HIV/AID III c y Dlsabliit listed
$ Violence ir s'bpopu
hons
Adults over age 24 5 3 0 0 0 3 5 0 0 10
Adults ages 18-24 3 0 0 0 0 0 0 0 0 0
Children under age 18 0 0 0 0 1 0 3 28
Total Persons 8 3 0 0 I 0 3 6 0 3 38
Click Save to automatically calculate totals
Persons in Households without Children
Persons
Chronic Victims not
Subsfan Persons Severely of Physical Develop represen
Characteristics ce with Mentally Domesti Dlsabilit mental led by
Abuse HIV/AID Ill c y Dlsabilb listed
s Violence y slabtp
bonsu
Adults over age 24 75 1 16 46 50 54 5 60 5 48
Adults ages 18.24 0 0 4 0 25 11 1 0 0 15
Total Persons 75 1 16 50 50 79 6 60 5 63
Click Save to automatically calculate totals
Persons in Households with Only Children
Persons
Chronic Victims not
Substan Persons Severely of Physical Develop represen
Characteristics ce with Mentally Domesti Dlsabilit mental ted by
Abuse HIV/AID Ill c y Disabllh listed
S Violence y sub000u
Accompanied Children under age 18 IIIII-II—_IIIIII■IIII-�
Renewal Project Application FY2017 Page 29 08/17/2018
Applicant: Miami-Dade County 0041482920000
Project: City of Miami Beach Outreach FL0177L4D001710
Unaccompanied Children antler age 18
TOW Persons 0 0 0 0 0 0 0 0
Describe the unlisted subpopulations referred to above:
N/A
Renewal Project Application FY2017 Page 30 08/17/2018
Applicant: Miami-Dade County 0041482920000
Project: City of Miami Beach Outreach FL0177L4D001710
5C. Outreach for Participants
This screen is currently read only and only includes data from the
previous grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in response
to Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to account
for a reallocation of funds.
1. Enter the percentage of project participants that will be coming from
each of the following locations.
100% Directly from the street or other locations not meant for human habitation.
Directly from emergency shelters.
Persons at imminent risk of losing their night time residence within 14 days.have no subsequent housing identified,
and lack the resources to obtain other housing(TH and SSO Pojects Only)
Directly from safe havens.
Persons fleeing domestic violence.
Directly from transitional housing.
Directly from the TH Portion of a Joint TH and PH.RRH Component project.
Persons receiving services through a Department of Veterans AffairspiA)-funded homeless assistance program.
100% Total of above percentages
Irl Renewal Project Application FY2017 Page 31 08/17/2018
Applicant: Miami-Dade County 0041482920000
Project: City of Miami Beach Outreach FL0177L4D001710
6A. Funding Request
This screen is currently read only and only includes data from the
previous grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in response
to Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to account
for a reallocation of funds.
1. Do any of the properties in this project No
have an active restrictive covenant?
2. Was the original project awarded as either No
a Samaritan Bonus or Permanent Housing
Bonus project?
3. Does this project propose to allocate funds No
according to an indirect cost rate?
4. Renewal Grant Term: 1 Year
5. Select the costs for which funding is being
requested:
Leased Structures
Supportive Services X
HMIS
Renewal Project Application FY2017 Page 32 08/17/2018
•
Applicant: Miami-Dade County 0041482920000
Project: City of Miami Beach Outreach FL0177L4D001710
6D. Sources of Match
The following list summarizes the funds that will be used as Match for the
project. To add a Matching source to the list, select the icon. To view or
update a Matching source already listed, select the icon.
Summary for Match
Total Value of Cash Commitments: $1,181,891
Total Value of In-Kind Commitments: $0
Total Value of All Commitments: $1,181$91
1. Does this project generate program income No
as described in 24 CFR 578.97 that will be
used as Match for this grant?
Match Type Source Contributor Date of Value of
Commitment Commitments
Yes Cash Government City of Miami 08/01/2017 $1,181,350
Bea,..
Yes ' Cash Government Miami-Dade 08/30/2016 $541
County...
Renewal Project Application FY2017 Page 33 08/17/2018
Applicant: Miami-Dade County 0041482920000
Project: City of Miami Beach Outreach FL0177L4D001710
Sources of Match Detail
1. Will this commitment be used towards Yes
Match?
2. Type of Commitment: Cash
3. Type of Source: Government
4. Name the Source of the Commitment: City of Miami Beach-Cash for salaries/Outreach
(Be as specific as possible and include the Workers, Emergency shellter beds, other
office or grant program as applicable) supportive services
5. Date of Written Commitment: 08/01/2017
6. Value of Written Commitment: $1,181,350
Sources of Match Detail
1. Will this commitment be used towards Yes
Match?
2. Type of Commitment: Cash
3. Type of Source: Government
4. Name the Source of the Commitment: Miami-Dade County Homeless Trust
(Be as specific as possible and include the
office or grant program as applicable)
5. Date of Written Commitment: 08/30/2016
6. Value of Written Commitment: $541
Renewal Project Application FY2017 Page 34 08/17/2018
FY 2017
Miami-Dade County Homeless Trust
Continuum of Care (CoC) Program
Form W-9
Department of the Treasury
Internal Revenue Service (IRS)
Request for Taxpayer
Identification Number and Certification
ATTACHMENT C"W-9 Request for Taxpayer ID Number and Certification"
Form W'9 Request for Taxpayer requester.Form
to the
noDepartment(Rem December 2014) Identification Number and Certification endto the n.
Department of thedressuy,
'sternal Revenue Service
1 Na (as flown cc your income Pis return).Name is required on this line;do not wave this line blank.
• etIi / e All Der A -
2 Business na afdisre.arded entity name,if different from above
w.
re
o- 3 Check appropriate box for federal tax dassimcatlon;check only one of the following seven boxes: 4 Exemptions(codes apply on),to
certain entities not individuals see
C mdlvidua,/sola proprietor or ❑ C Corporation ❑S Corporaton ❑ Partnership ❑Trust/estate (net/potions on page 3):
single-member LLC Exempt payee code(if any)
Z,(2 J Limitedliabilitycompany.Enter the tax classification(Cue corporation,S=5 coryorafion.P=partnershp)e _ Exemption from FATCA relwrto9
Note.For a single-member LLC that is disregarded,do not coeck LLC:check the appropriate box In tie line above for
t' tic Ne tax classification of the single-member ownercode os any) _
❑Other(see instructions)le tett to ot,.ntt.ottetou1.d.'TeUS)
s Address(number,street,aid apt or suite n0 IRequester's name and address(optlonal)
ITOO @onvvn4,on nfer Ibr.
m 5 Clly state,aid ZIP**de
N '7kt a m•1 �a d i FL • 3 1351
r o t account ber(s)her (optional)
Taxpayer Identification Number(TIN)
Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid I Social security number
backup withholding.For individuals,this is generally your social security number(SSN).However,for aII
III
resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other -
entities,it is your employer identification number(EIN).If you do not have a number see How to get a
TIN on page 3. or
Note.If the acoount is in more than one name,see the instructions for line 1 and the chart on page 4 for I Employer Idenrrfication number I
guidelines on whose number to enter. 0 _ r„ 0 3 �'1 'Z
Part II Certification V 7
Under penalties of perjury,I certify that:
1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me);and
2. I am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue
Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am
no longer subject to backup withholding;and
3. I am a U.S.citizen or other U.S.person(defined below);and
4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct.
Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to repo all interest and dl ' ends on your tax return.For real estate transactions,item 2 does not apply.For mortgage
interest paid,acquisition or aba onment of secur property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and
generally,payments other than i terest and divide ,you are not required to sign the certlficaion,but you must provide your correct TON.See the
instructions on page 3.
Sign Signatureof
Here u.s.person Is nate' LOJLIitti•-
General Instruction •t Form 1095(home mortgage interest),1093-E)student loan interest),1098-T
whot
Section references are to the Internal
eue Code unless otherwise noted. •Form 1099-0(canceled oebt)
Future developments.Information ab developments affecting Form VS-9(such •Form 1J9e-A(acquisiion or abandonment of secured property)
as legislation enacted after we release i is at www.lrs.gov//wg. Use Form W-9 only if you are a U.S.person(including a resident alien),to
Purpose of Form provide your correct TIN.
An iintvidaal or ent (Form W9 requester)who is required to file f of If you do not return F , We to the q ter with a TIN you might be subject
returnth the IRS must obtain your correct taxpayer itl _the t number(TIN) to bckup withholding.g See What is backup ithholding?on page 2
which may be your social security number(SSM individual taxpayer identification Bysgnng the tilled-out form,y u'.
rosmb r(WINS adoption taxpayer deneficaton number(ATIN), employer t Certry mat the T.N you are giving iect(or you are waiting for a number
identification number(EIN),to report on an information return the amount paid to to be issued),
you,or other amount reportable on an information retun.Examples of information
2 certy[haf you are not suHevtlO backup withholding,or
returns include,but are not limited to,the following:
•Form 1099-INT(interest earned or paid) 3.Claim exemption from backup withholding it you are a U.S.exempt payee.If
applicable,you are also certifying that as a U.S.person,your allocable share of
•Form 1059-DIV dividends,including those from stocks or mutual funds) any partnership income from a U.S.trade or business is not subfeot to the
•Form I09 -MISC(various types of income,prizes,awards,or gross proceeds) withholding tax on foreign partners'share of effectively connected income,and
•Form 1099-6(stook or mutual fund sales and certain other transactions by 4.Certify Nat FATCA code(s)entered on this form(if any)indicating that you are
•akers/ exempt from the FATCA reporting,is correct.See What Is FATCA reporting?or.
•Form 1099-S(proceeds from real estate transactions) page 2 for further information.
•Form-1099-K(merchant card and third party network transactions)
Cat No.1o231x Form W-9(Rev.12-2014)
Form W-9(Rev.12-2014) Page 2
Note.If you are a U.S.person and a requester gives you a forth other than Form 3.The IRS tells the requester that you furnished an incorrect TIN,
W-9 to request your TIN,you must use the requester's form if rt Is substantially
similar to this Form W-9. 4.The IRS tells you thayou are But an
backup withholdingrn(fobecause you did
not report all your interest and dividends an your tax return(for reportable interest
Definition of a U.S.person.For federal tax purposes,you are considered a U.B. and dividends only),or
person if you are; 5.You do not certify to the requester that you are not subjectt0 backup
•An individual who's a as,citizen or U.S.resident alert withholding under 4 above(for reportable interest and dividend accounts opened
•A partnership,corporation,company,or assocation created or organized in the after 1983 oily).
United States or under the laws of the United States; Certain payees and payments are exempt from backup wkhholding_See Exempt
•An estate(other than a foreign estate):or payee code on page 3 and the separate Instructions for the Requester of Form
•A domestic rust(as defined In Regulations section 301.7701-7). W-9 for more Inlormafon.
Also see Special rules for partnerships above_
Special odes foe partterships.Partnerhips that conduct a trade or business in
the United States atr generally required to pay a withholding tat under section What is FATCA reporting?
1446 on any foreign partners'share of effectively connected taxable income from
such business Further,in certain cases where a Form W-9 has not been received, The Foreign Account Tax Compliance Act(FATCA)requires a participating foreign
the rules under section 1446 require a partnership to presume tnat a partner is a financial institution to report all United States account holders that are specified
foreign person,and pay the section 1426 withholding tax.Therefore,if you area United States persons.Certain payees are exempt from FATCA reporting.See
U.S.person that is a partner in a partnership conducting a trade or business in the Exemption from FATCA reporting code on page s and the Instructions for the
United States,provide Form W-9 to the partnership to establish your US,status Requester of Form W.9 for more information.
and avoid section 1446 withholding on your share of partnership income. Updating Your Information
In the cases below,the following person must give Form W-9 to the partnership
for purposes of establishing its U.S.status and avoiding withholding on its You must provide updated information to any person to whom you claimed to be
allocable share of net income from the partnership conducting a trade or business an exempt payee if you are nolongeran empt payee and anticipate receiving
in the United States: reportable payments in thefuture from this person.For example,you may need to
•In tie case of a disregarded entity with a U.&owner,the U.S.owner of the provide updated information if you are a C corporation that elects to be an S
corporation,or if you no longer are tax exempt.In addition,you must furnish a new
disregarded entity and not the entity,
•In the case of agranYertmst wRha U.S.grantor owner,oLherUS. generally, Form W-9 if the name or TIN changes for the account;for example,if the grantor
the U.S.grantor or other U.S.owner of ther of a grantor trust dies.
grantor o andr not Ewntruge
•In the case of a U.S.trust(other than a grantor trust),the U.S.trust(other than a Penalties
grantor trust)and not the beneficiaries of Ma trust Failure to furnish TIN.If you fail to fumishyour correct TIN to a requester,you are
Foreign person,If you are a foreign person or the U.S,branch of a foreign bank subject to a penalty of$50 for each such failure unless your falure is due to
that has elected to be treated as a U.S.person,do not use Form W-9.Instead,use reasonable cause and not to willful neglect.
the appropriate Form W-8 or Form 8233(see Publication 515,Withholding of Tax Civil penalty for false information with respect o withholding.If you make a
on Nonresident Alleys and Foreign Entities). false statement with no reasonable basis that results in no backup withholding,
Nonresident alien who becomes a resident alien.Generally,only a nonresident you are subject to a$500 penalty.
alien individual may use the terms of a tax treaty to reduce or eliminate U.S.tax on Willfully falsifying certhmations or
certain types of income.However,most tax treaties contain a provision known as
affirmations may subject you to penalties including fines and/or
a"saving clause."Exceptions specified In the saving ciause may permit animprison
exemption from tax to continue for certain types of income even after tie payee mein.
has otnerwise become a U.S.resident alien for tax purposes. Misuse of TlN&if the requester discloses or uses TINs in violation of federal law,
If you are a U.S.resident alien who is relying on an exception contained In the the requester may be subject to civil and criminal penalties.
saving clause of atax treaty to claim an exemption from U.S.tax on cerin
e you must ataon a statement to Form W-9 that specifies the-followingSpecificSpecific Instructions
f�veeiems:
1.The treaty country.Generaliy,this must be the same treaty under which you Line
claimed Xa
exemption from tax as a nonresident alien. You must eeof he fowi
llong on this line;do not this line blank.The
2.The treaty arid 'n
a addressing tieshould math the name on your tax return.
3.The article number(or location)in the tax treaty that contains the saving nameI this Form W-9 is for a joint account,list first,and Then circle,the name of the
clause and its exceptions. person r entry whose number you entered in Part I of Form W-9.
4.The type and amount of income that qualifies for the exemption from tax. a. Individual.Generally,enter the name shown on your tax return.If you have
S.Sufficient facts to justify the exemption from tax under the terms of Eno treatychanged your last name without informing the Social Security Administration(SSA)
article. of%re name change,enter your first name,the last name asshown on your social
security card,and your now last name.
Example.Article 20 of the U.S.-China income tax treaty allows an exemption - Note.MN applicant Enter your individual name as it was entered on your Form
from tax for scholarship income received by a Chinese student temporarily present W-7 application,line la.This should also be tce same as the name you entered on
theiUnited States,Under U.S.law,this student will become a resident alien for the Form 11340/1040Att040E2 you filed with your application.
tax purposes it his or her stay in the United States exceeds 5 calendar years.
However,paragraph 2 of the first Protocol to the U.S—China treaty(dated Apbi 30, b. Sole proprietor or single-member LLC.Enter your individual name as
1984)allows the provisions of Article 20 to continue to apply even after the shown on your 1040/1040A/104DEZ on line I.You may enter your business,trade,
Chinese student becomes a resident alien of the United States.A Chinese student or"doing business as"(DBA)name on line 2.
who qualifies for his exception(under paragrapn 2 of the first protocol)and's c Partnership,LLC that is not a single-member LW,C Corporation,ors
relying on this exception to claim an exemption from tax on his or her scholarship Corporation.Enter the entity's name as shown on the entity'stax return on The
or fellowship income would attach 10 Form W-9 a statement that includes the and any business,trade,or DDA name on line 2.
information described above to support-that exemption. d. Other entities Enternameas show
yourrequired U.S.federal tax
If you are a nonresident alien or a foreign entity,give the requester the documents on line 1.This name should matchhenshown on the charter or
m
apaprate completed Form WA or Form 8233. other legal document creating the entity.You may enter any business,trade,or
DDA name on line 2.
Backup Withholding a. Disregarded emir.Forfederal tax purposes,an entity that is
What is backup withholding?Persons making certain payments to you must disregarded as an entity separate from its owner is treated as a garded
under certainConditionswithho withhold and pay to the IRS 213%of such payments.This entity" See Regulations section 3evnline(0)(2)(4.Enterra owner's name on
is ceded backup withholding?" Payments that may be subject to backup line t The name of the entity enteredon name should never be a disregarded
withholding include interest,tax-exempt interest,onmpdividends,brokerand barter entry.The n on line 1 should be the name shown on the income Lax return on
exchange transactions,rents,n
9othidparty nehyoyae pay,payments made in as'which the commantry Mrbe U.S.epedera For examplelfaforeign LLC that Jstreatedis a
settlement
ropayment card and mod.Rea estate
ktasactins are
dt certain Ursperson,the entry Mr owner's name
tax purposes beras
v single owner1.trithea
backup thho fishing boat operators.Real transactions not subject to U.S. owner theUe.owns'soamd lrrgard required to provided fntower the
backup withholding. direct re owner of the feer is also a pits es.disregarded the i enter the nt ownerthat is
You will not be subject to backup withholding on payments not dis2.'Business
tor federal tax purposes.Emr[da disregarded entity'stime on
ed
give the requester your correct TIN,make theyou ifreceiveryou
line t,'Business nerson,sregarded entity name'If the owner of the disregarded
proper certifications,and report all entity is a foreign person,the owner must complete ane ate
Form W-3
your taxable interest and diill b ends on echo ax return.
instead of a Form W-9. This is the case even if the foreignpersonhas a U.S.TIN.
Payments you receive will be subject to backup withholding if:
1.You do not furnish your TIN to the requester.
2_You do not certify your TIN when required(see the Part II instructions on page
3 for details),
Form W-9(Rev.12-2014) page 3
Line 2 'However,roe following payments made to a corporation and reportable on Form
If you have a business name,trade name.DEA name,or disregarded entity name, 1099-MISC are not exempt from bactup withholding:medical aid health care
you may enter it on line 2, payments,attorneys'fees,gross proceeds paid to an attorney reportable under
section 6045( ,and payments for services paid by a federal executive agency.
Line 3 Exemption from FATCA reporting code.The following codes identify payees
Cheek the appropriate box in line 3 for the U S.federal tax ellasslecat'on of the that are exempt Nom reporting under FATCA.These codes app'y to persons
Person whoseentered on line 1.Check only one box in line 3. submitting this form for accounts maintained outside of the United States by
name is certain foreign financial institutions.Therefore,if you are only submitting this form
Limited Liability Company NW).If the name on line 1 Is an LLC treated as a for an account you hold in the United States,you may leave this field blank.
partnership for U.S.federal tax purposes,check the"Limited Liability Company" Consult vkh the person requesting this form It you are uncertain if to financial
box and enter''P°in the space provided.if the LLC has filed Form 8832 or 2553 to institution is subject to these requirements.A requester may indicate that a codes
ee taxed as a corporation,check the"Limited Liability Company"box and in the not required by providing you with a Form W-9 with"Nct Applicable"(or any
space provided
Lenter
rh"C"s Cscpooratinnoiry,tl"0oS corpothe"Limion,If des Liability is a si'nilar lndication)wrtten or pinted on the line for a FATCA exemption code.
single-me.'nber A—An organization exempt from fax under section 501(a)or any individual
Company"box;Insteadcheck the first box in line 3"maiviaaelreole proprietor or retirement plan as defined in secttxundion erse
single-member LLC." B—The United States or any of its agencies or instrumenfarffies
Line 4,Exemptions or
IIexemptfrom=acku 3iM1oltling and/or FATCA refw4ing.enter in the C—A state,the District of Columbia,a U.S.comm ealh or possession.
you are stwig / F to any of their political subdivisions or instrumentalities
nor
appropriate space in lineany code(s)thatYYoo. D—A corporation the stock of which is regularly traded on one or more
Exempt payee code, established securities markets,as described in Reguiahons section
• Generally,individuals @ncluding sole proprietors)are not exempt from backup 1.1472-1(0)111(1)
withholding- F—A corporation that is a member of the same expanded affiliated group as a
• Except as provided below,corporations are exempt from backup wlmholdingcorporation described In Reguefions section 1.1472-1(c)(1)Ii)
for certain payments,including interest and dividends. F—A dealer in securities,commodities,or derivative financial instruments
• Corporations are not exempt from backup withholding for payments made in (including notional principal contracts,futures,forwards,and options)that is
settlement of payment card or third party network transactions. registered as such under the laws of the United States or any state
• Corporations are not exempt from backup withholding with respect to attorneys G—A real estate investment trust
fees or gross proceeds paid to attorneys,and corporations that pmNtle medical or H—A regulated investment company as defined in section 851 or an entity
health care services are not exempt with respect to payments reportable on Fern registered at all times during the tax year under the investment Company Act of
1099-MISC. 1940
The following codes identify payees that are exempt from backup withholding. I--A common bun fund as defined in section 584(a)
Enter he appropriate code in the space in line 4.
1—An organization exempt from tax under section 501(a),any IRA.ore —A bank as defleed in section 581
custodial account antler section 403(b)(7)if the account satisfies the requirements K—A broker
of section 401(f)f2) L—A trust exempt from tax under section 664 or described in section 4947(a)(I)
2—The United States or any of lis agencies or instrumentalities NI—A tax exempt trust under a section 403(b)plan or section 467(g)plan
3—A state,the District of Columbia,a U.S.commonwealth
ealYh or possession,or Note.You may wish to consult with the financial institution requesting tnis form to
any of their political subdivisions or instrumentalities determine whether the FATCA code and/or exempt payee code should be
4—A foreign government or any of its political so:divisions.agents,or completed
'instrumentalities Line 5
5—A corporation Enter your address(number,street.and apartment or suite number).This Is where
6—A dealer in securities or commodNs required to register in the United the requester of this Form W-9 will mail your information returns.
Stats,the District of Columbia,or a U.S.commonwealth or possession
7—A futures commission merchant with se Commodity Futures Line 6
Trading Commission Empryour city,state,and ZIP code.
9—A real estate investment trust
9—An entity registered at all times during the tax year under tie Investment Part I.Taxpayer Identification Number(TIN)
Company Act of 1940 Enter your TIN in the appropriate box.If you are a resident alien and you do not
10—A common Mist fund operated by a bank under section 584(a) have and are not eligible to get an SSN,your TIN is your IRS individual taxpayer
identification number OTIM.Enter it in the social security number box.It you do not
11—A financial institution have an TIN,see,Now to get aTN below.
12—A middleman known in the investment commmiry as a nominee or If you are a sole proprietor and you have an EIN,you may enter either your SSN
custodian or EIN.However,the IRS prefers that you use your 55W.
13—A trust exempt from tax under section 664 or described in section 4949 If you are a single-member LLC that is dsregarded as en entity separate from its
The following chart shows typos of payments that may be exempt-From oackup owner(see LimitW 1Labbity Company(LLC)on this page),enter the owners SSN
withitoiding.The chart applies to the exempt payees lStedd above,1 trough 16. (or EIN,if Ne owner has one).Do not enter the disregarded entity's FIN-If the LLC
is assified as a corporation or partnership.enter the entity's FIN.
IF the payment is for... THEN the payment is exempt for... Note.See the chart on page 4 for further clarification of name and TIN
combinations.
To
Interest and dividend Payments All exempt payees except forHan SSNw to ,get Fora TIN.m SS-55,Application toou do not have a lr a Socialecurity Card,fro.appiy for one m your
oc
ply
foryoappta.
SSA office or get this form online at www-ssa.gov.You may also get this form.by
Broker transactions Exempt payees t through 4 and 6 calling 1-900.772-1213.Use Form W-7,Application for IRS Individual Taxpayer
through 11 and all C corporations.S Identication Number,to apply for an ITIN,or Form 55-4.Application for Employer
corporationsmust not enterexempt IdenLYiwffin Number,to apply for an EIN.You can apply for an EIN online by
payee codbe se they armpt accessing the IRS weosite atwwn,hagov/busmesss and clicking on Employer
orty for sales of noncovered securities Identification Number(EDI)under Starting a Business.You can get Forms W-7 and
acquired prior to 2012, SS-4 from the IRS by visiting lRS.gov or by calling tA00'TAX-FORM
(1-800-829-3676).
Bader exchange transactions and Exempt payees l through 4 If you are asked to complete Form W-9 but do not have a`1N.apply for a TIN
patronage dividends and write"Applied For"In the space for the TIN,sign and date the form,and give it
Payments over$600 required lobe IGenerally, to the requester.For interest and dividend payments,and certain payments made
epoyes :easily exempt with respectto:eatradable instruments,generally you will have 60 days to get
reported and direct sales over 85,0001 1trough Sx a TIN and give itothe requester before you are subject to backup wfhhoiomg on
payments.The 60day rule does not apply to other types of payments.You will be
Payments made in settlement of Exempt payees l through 4 subject to backup withholding on all such payments until you provide your TIN to
payment card or third party network the requester.
transactions Note.Entering"Applied For"means that you have already applied for a TIN or that
you lntendto apply for one soon.
I See Form 1099-MISC,Miscellaneous Income,and its instructions.
Caution:A disregarded U.S.entity that a foreign owner must Use the
appropriate Form W-8.
Form W-9(Rev.12-2014) Page 4
PartII.Certification "You must show individual nameend you may also er youor Newnam
Me- usiness nama'diregerded lty'nano line vas may use ebusinessr 53N or EN ff on
To establish to the withholding agent that you are a U.S.person,or resident alien, have ones but the IRS encourages you to use your 555.
argn Form W-9.You may be to sign by the withholding agent even if 'west and circle the name or trust,estate,or pension trust.I0o not furnish The TIN of tie
items1,4, 56I indicatewotherwise.
For aaccount,onlythepersonal representative or 4umea unless the loos eats tsell is not tladgrcld in the account
joint person whose TIN is shown in Pad I s000ld sign oel Grantorso see Special rules for partnerships on past 2.
(when required).In theof a disregarded entry,the person identified on line l Note. alsoprovidee Form t ee
nomust
must sign.Exempt payees,caseompsee lte the ceeesctli n earlier. Note.cots.Ifed name iscircledof st moremthan one name is listed,the number will be
Signature requirements.Complete the ceNficatlon as indicated In kerns considered to be that of the first nemellstotl.
through 5 below. Secure Your Tax Records from Identity Theft
t Interest,dividend,and barter exchange accounts opened before 1984
and broker accounts considered active during 1983.You must give your Identity theft occurs when someone uses your persnal'nformatlen such as your
correct TIN,but you do not nave to sign the obit lraffin. e,SSN,or other identifying information,without your pecommitn,to comml.Interest,dividend,broker,and barter exchange accounts opened after fraud or other crimes.An identity thief may use your SSN to get a glob or may file a
1983 and broker accounts considered inactive during 1983.You must sign the fax return ming your SSN to received refund
certification or backup withholding will apply.If you are subject tori backup To reduce your risk'.
wthholding and you are merely providing your correct TIN to the requester,you
must cross out item 2 in the certification before signing the form. •Pro[ec[yeur SSN,
gntvg •Ensure your employer is protecting your SSN,and
3.Real estate transactions.You must sign the certification.You may Goss out •Re careful when choosingpreparer.
item 2 of vie certification. a tax
4.Other payments.You must give your correct TIN,hut you do not have to sign If your tax records are affected by identity theft and you receive a notice from
the certification unless you have been notified that you have previously given an the IRS,respond right away to the name and phone numoer printed on the IRS
incorrect 11N."Other payments"include payments made in the course of the notice or letter.
requester's trade or business for rents,royalties,goods(other than bills for If your tax records are not currently affected by identity theft but you think you
merchandise),medical and health care services(including payments to are at risk due to a lost or stolen purse or wallet,questionable credit card activity
corporations),payments to a nonemoloyee for sevices,payments made in or credit report,contact the IRS Itlentrty Tnelt Hotline at 1-800-908-4490 or submit
settlement of payment card and third party network transactions,payments to Form 14039.
ce:tam fishing boat crew members and fishermen,and gross Proceeds paid to For more information,see Publication 4535,Identity Theft Prevention and Victim
attorneys(including payments to corporations). Assistance.
5.Mortgage interest paid by you,acquisition or abandonment of secured
Victims of identitytheft who are experiencing
property,cancellation of debt,qualified tuition program payments(under economic harm or a system
section 529),IRA,Covertlell ESA,Archer MSA or HSA contributions or problem,or are seeking help In resolving tax problems that have not been resolved
distributions,and pension distributions.You must give your correct TIN,bur you
through norma:channels,may be eligible for Taxpayer Advocate Service(TAS)
do not have to sign the certification, assistance.You can reach TAS by caning the TAS toll-free case intake line at
1-977-777-4778 or TTY/TDD 1-800-82944059.
What Name and Number To Give the Requester Protect yourself from suspicious smalls or phishin9 schemes. Phiah:ng is the
creation and use of email and websites designed to mimic legremate business
For this type at account Give name and SSN of: emails and websites.The most common act is sending an email to a user falsely
I.Individual The indrvltlual
claiming to be an established legitimate enterprise in an attempt to scam the user
2.Two or more Individuals t The actual owner of the account eq into surrendering private information that will ne used for identity theft.
Quin The IRS does not initiate contacts with taxpayers via entails.Also,the IRS does
account) if combined funtls,thfirst not request personal detailed Information through email or ask taxpayers for the
dNitlual on the account' PIN numbers,passwords,or similar secret access information for their Credit card,
a.Custodian account of a minor The minor` bank,or other financial accounts.
(Uniform Gift to Minors Act) If you receive an unsolicited emal I claiming to be from the IRS,forward this
4.a.The usual revocable savings The grantor-trusteessage tophishingOirs.gov.You may also report misuse of the IRS name,logo,
trust(grantor s also trustee) or ether IRS properly to the Treasury Inspector General for Tax Administration
b.So-called trust account that is The actual owner' (TIGTA)at 1-800-365-4484.You can forward suspicious entails to the Federal
not a legal or valid trust under Trade Commission at:spam@uce.gov or contact them at hw witc.govlld heft or
state law 1-977-IOTHFFT(1-977-438-4338).
S.Sole proprietorship or disregarded The owner' Visit IRS.gov to lean more about identity theft and how to reduce your risk.
entity owned by an individual
6.Grantor trust filing under Optional The grantor' Privacy Act Notice
Form 1099 Filing Method t(see
Regulations section 1.6711(6)(2)( Section 6106 of the Internal Revenue Code requires you to provide your correct
(A)) TIN to persons(including federal agencies)who are required to fie information
For this type of account Give name and FIN oh you;
with the IRS to report interest,dividends,or certain other Income paid to
mortgage interesty paid:the acquisition or abandonment of secured
7.Disregarded entity not owned by an The owner property;the cancellation of debt:or contributions you made to an IPA,Ascher
individual MSA,or HSA.The person°Betting this form uses the information on the Corm to
8.A valid trust,estate,or pension trust Legal entity' file information returns with the IRS,reporting the above information.Routine uses
of this information include giving it to the Department of Justice for civil and
9.Corporation or LLC electng The corporation criminal itigation and to cities,states,the District of Columbia,and U.S.
corporate status on Form 8832 or commonwealths and possessions for use in administering their laws.The
Form 2553 Into ati n also may be disclosed to other countries under a treaty,to federal and
10_Association,club,religious, 1 The organization state agencies to enforce civil and criminal laws,or to federal law enforcement and
charitable, ducational,other tax- intelligence ragencies to comsatterrorism.Youmustprovide yourTW whether or
exempt organization not yourequired to re a tax return.Under section 3406,payers must generally
11.Partnership or multi-member LLC The oartnership withhold a percentage of taxable interest,dividend,and certain other payments to
a payee who does not give a TIN to the payer.Caftan orates may also appy for
12.A broker or registered nominee The broker or nominee providing false or fraudulent'nformation.
13.Account with the Department of The public entity
Agriculture in the name of a public
entity om5rcof
government,school district, r
prison)that receives agricultural
program payments
14.Grantor trust filing under the Form The trust
1041 Fling Method or the Optional
Form 1099 Filing Method 2(see
Regulations section 1.671-4(b)(2)()
len
'list first and circethe name ofthe person whose umber you!whist If only one pension 2
tint account has an BBN,that person's m numbermust be furnished.'Cline theminer's a 's nam s and lum3h He minor53s SSN.
FY 2017
Miami-Dade County Homeless Trust
Continuum of Care (CoC) Program
"Affidavits and Declarations"
ATTACHMENT D "Affidavits and Declarations"
Miami-Dade County's Affidavits and Declarations
MIAMI-DE
COUNTY
Miami-Dade County requires each party desiring to enter into a contract with Miami-Dade County to;
(1) Sign an affidavit as to certain matters and (2) make a declaration as to certain other matters. This
form contains both Affidavit forms for matters requiring the entity to sign under oath and Declaration
forms for matters requiring only an affirmation or declaration for other matters.
Each section of this form must be read, and initialed in the top right hand box indicating acceptance
and/or compliance with the County's policy related to the particular affidavit. For affidavit sections that
you do not believe are applicable to your organization, please indicate this by placing"B" in the box next
to N/A.
ALL SECTIONS MUST BE COMPLETED
THE FOLLOWING MATTERS REQUIRE THE ENTITY TO SIGN AN AFFIDAVIT UNDER OATH:
STATE OF ( Etc Y ( e_
COUNTY OF ( KkI AI1'L - JAc
COUNTRY OF C;iffit{ Sk
Before me the undersigned authority appeared —
(Print Name), "3.mints 146y-oAks who i personally know!)to me or who has provided
as identification al d who did swear to the following: •
That he or she is the duly authorized representative of(Name of Entity) C1 kLi L }`i i(si , br-dc \
(Address of Entity) la C; ren vOn+,vin (et\#Py-Orr. (\flt(xen Armre(l/ ll-c,331 1 Post Office
addresses are not acceptable.
�600I037 Zj
•
Federal Employment Identification Number
_ (hereinafter referred to as the contracting
"entity"), and that he or she is the entity's (Sole Proprietor)(Partner)(President or Other Authorized Officer)
That he or she has full authority to make this affidavit, and that the information given herein and the documents
attached hereto are true and correct; and
That he or she says for the following fifteen (16) Affidavits and Declarations: •
ATTACHMENT D"Miami-Dade County Affidavits and Declarations" Page 1 of 11
Miami-Dade County's Affidavits and Declarations
1. MIAMI-DADE COUNTY OWNERSHIP DISCLOSURE AFFIDAVIT(SECTION 2-8.1 Pertains ❑
OF THE COUNTY CODE) N/A ❑
Initial ,
If the contract or business transaction is with a corporation,the full legal name and business address shall be
provided for each officer and director and each stockholder who holds directly or indirectly five percent(5%) or
more of the corporation's stock.
If the contract or business transaction is with a partnership,the foregoing information shall be provided for
each partner.
If the contract or business transaction is with a trust,the full legal name and address shall be provided for each
1 trustee and each beneficiary. The foregoing requirements shall not pertain to contracts with publicly traded
fcorporations or to contracts with the United States or any depm[went or agency thereof,the State or any
political subdivision or agency thereof or any municipality of this State. All such names and address are outlined
below:Post Office addresses are not acceptable.
11
(Full Legal Name,Address,%Ownership) �,, (Full Legal Name,Address,%Ownership)
(Full Legal Name,Address,%Ownership) 11 (Full Legal Name,Address,%Ownership)
The full egal names and business address of any other individual (other than subcontractors,material person,
suppliers,laborers, or lenders)who have,or will have,any interest(legal, equitable beneficial or otherwise) in
the contractor business transaction with Miami Dade County are:
Post office addresses are not acceptable
Any person who willfully fails to disclose the information required herein,or who knowingly discloses false
information in this regard, shall be punished by a fine of up to five hundred dollars ($500.00) or imprisonment
in jail for up to sixty (60) days or both.
ATTACHMENT D"Miami-Dade County Affidavits and Declarations" Paget of 11
Miami-Dade County's Affidavits and Declarations
2. MIAMI-DADE COUNTY EMPLOYMENT DISCLOSURE AFFIDAVIT(COUNTY Pertai i s D
ORDINANCE 90133,AMENDING SECTION 2.8-1; SUBSECTION (d)(2) OF THE N/A in
COUNTY CODE) Initial rp )
Except where precluded by Federal or State laws or regulations, each contract or business transaction o V
renewal thereof which involves the expenditure of then thousand dollars($10,000) or more shall require he
entity contracting or transaction business to disclose the following information. The foregoing disclosure
requirements do not apply to contracts with the United States or any department or agency thereof,the State or
any political subdivision or agency thereof or any municipality of this State.
Does your firm have a collective bargaining agreement with its employees? Yes O No
Does your firm provide paid health care benefits for its employees? xf Yes CI No
Provide a current breakdown (number of persons) of your firm's work force and ownership (below):
White: Males 304 Females I'
Black: Males 2 Females S
Hispanic: Males Qg • 1 Females 3g
Asian: Males 1 I Females
American Native: Males 3 Females /
Aleut(Eskimo): Males 9 Females U
ATTACHMENT D"Miami-Dade County Affidavits and Declarations" Page 3 of 11
Miami-Dade County's Affidavits and Declarations
3. MIAMI-DADE COUNTY AFFIRMATIVE ACTION/
NONDISCRIMINATION OF EMPLOYMENT,PROMOTION AND Pertai s ❑
PROCUREMENT PRACTICES (COUNTY ORDINANCE 98-30 CODIFIED N/A (]
AT 2-8.1.5 OF THE COUNTY CODE) Initial i r )
_ 1�
Pursuant to Miami-Dade County's Ordinance No.98-30,Section 2-8.1.5, entities with annual gross revenue !%
excess of$5,000,000 seeking to contract with the County shall,as a condition of receiving a County contract,have:
1) a written affirmative action plan which sets forth the procedures the entity utilizes to assure that it does not
discriminate in its employment and promotion practices and 2) a written procurement policy which sets forth the
procedures the entity utilizes to assure that it does not discriminate against minority and women-owned
businesses in its own procurement of goods,supplies and services.Such affirmative action plans and procurement
, policies shall provide for periodic review to determine their effectiveness in assuring the entity does not
discriminate in its employment,promotion and procurement practices.The foregoing,not withstanding,corporate
entities whose board of directors are representative of the population make-up of the nation shall be presumed to
have non-discriminatory employment and procurement policies,and shall not be required to have a written
affirmative action plan and procurement policy in order to receive a County contract.The foregoing presumption
maybe rebutted.The requirements of this section may be waived upon written recommendation of the County
Manager that it is in the best interest of the County to do so and approval of the County Commission by majority
vote of the members present. Based on the above,please complete the affidavit as directed and return the
completed affidavit along with a cover letter on your company's letterhead,listing the company's address,phone
and fax numbers,and any required documents,to:Miami-Dade County,Department of Procurement
Management Affirmative Action Plan Unit 111 NW 1st Street, 13th Floor Miami,FL 33128
Yes �l No O My company has an.affirmative action plan and procurement policy and is
/ - available for review.
My company has annual gross revenues in excess of$5,000,000.
Yes O No C Therefore,our company's affirmative action plan and procurement policy
b is available for review.
Yes O No O My company has annual gross revenues less than $5,000,000.
L . I
If at any time the Miami Dade County has reason to believe that any person or firm has willfully and knowingly
provided incorrect information or made false statements,the County may refer the matter to the State Attorney's
Office and/or other investigative agencies.The County may initiate debarment and/or pursue other remedies in
accordance with Miami-Dade County policy and/or applicable federal,state and local laws.
- - J
r
4. MIAMI-DADE COUNTY CRIMINAL RECORD AFFIDAVIT Penal- O
(SECTION 2-8.6 OF THE COUNTY CODE) N/A ■
Initial it )
The individual or entity entering into a contractor receiving funding from Miami-Dade County O has XII ot,
as of the date of this affidavit been convicted of a felony during the past ten (10)years.
An officer, director, or executive officer of the entity entering into a contractor receiving funding from Miami-Dade
County O has Xhas not as of the date of this affidavit been convicted of a felony during the past ten(10)years.
ATTACHMENT D"Miami-Dade County Affidavits and Declarations" Page 4 of 11
Miami-Dade County's Affidavits and Declarations
ii
Pertai O
S. PUBLIC ENTITY CRIMES AFFIDAVIT(SECTION N/A ❑
287.133(3)(a),FLORIDA STATUTES) Initial is )
The individual or entity entering into a contract or receiving funding from Miami-Dade County understand•! e
•
following: That a"public entity crime" as defined in Paragraph 287.133 (1) (g) Florida Statutes,means a violation
of any state or federal law by a person with respect to and directly related to the transaction of business with any
public entity or with an agency or political subdivision of any other state of the United States of America,including
but not limited to,any bid or contract for goods or services to be provided to any public entity or an agency or
political subdivision of any other state of the United States of America and involving antitrust,fraud,theft,bribery,
collusion,racketeering, conspiracy, or material misrepresentation.
That"Convicted" or"conviction" as defined in Paragraph 287.133 (1) (b) Florida Statutes means a finding of guilt 1
' or a conviction of a public entity crime,with or without an adjudication of guilt,in any federal state trial court of
record relating to charges brought by indictment or information after July 1, 1989,as a result of a jury verdict,non-
jury trial,or entry of plea of guilty or nolo contendere.
•
That an"affiliate" as defined in Paragraph 287.133 (1) (a)Florida Statutes means a) a predecessor or successor of a
person convicted of a public entity crime; orb) an entity under the control of any natural person who is active in
the management of the entity and who has been convicted of a public entity crime. The term"affiliate" includes
those officers, directors,executives,partners,shareholders, employees,members,and agents who are active in the
management of an affiliate. The ownership by one person of shares constituting a controlling interest in another
•
person,or pooling of equipment or income among persons when not for fair market value under an arm's length
agreement,shall be a prima facie case that one person controls another person. A person who knowingly enters
into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding
136 months shall be considered an affiliate.
That a"person" as defined in Paragraph 287.133 (1) (e) Florida Statutes means any natural person or entity
organized under the laws of any state or of the United States of America with the legal power to enter into a
binding contract and which bids or applies to bid on contracts for the provision of goods or services let by a public
entity, or which otherwise transacts or applies to transact business with a public entity. The term"person"
includes those officers, directors,executives,partners,shareholders, employees,members and agents who are
active in the management of an entity.
Based on information and belief,the statement as marked below,is true in relation to the entity submitting this
sworn statement. (Please indicate which statement applies by applying the individual initials near the box).
g.
Neither the entity submitting this sworn statement nor any of its officers,directors, executives,partners,
shareholders, employees,members or agents who are active in the management of the entity,nor an affiliate of the
entity has been charged with and convicted of a public entity crime within the past 36 months.
LJ The entity submitting this sworn statement or one or more of its officers,directors,executives,partners,
shareholders, employees,members or agents who are active in the management of the entity,or an affiliate of the
entity has been charged with and convicted of a public entity crime within the past 36 months; and
yes an additional statement is applicable or O no an additional statement is not applicable.
G The entity submitting this sworn statement, or one or more of its officers,directors, executives,partners,
shareholders,employees,members,or agents who are active in the management of the entity has been charged
with and convicted of a public entity crime within the past 36 months. However,there have been subsequent i
proceedings before a Hearing Officer of the State of Florida,Division of Administrative Hearings and the Final
Order entered by the Hearing Officer determined that it was not in the public interest to place the entity submitting
this sworn statement on the"Convicted Vendor List".
The individual or entity entering into a contract or receiving funding from Miami-Dade County understands that he
or she is required to inform the public entity prior to entering into a contract in excess of the threshold amount
provided in Section 287.017 Florida Statues for Category 2 of any change in the information contained in this form.
l
ATTACHMENT D"Miami-Dade County Affidavits and Declarations" Page 5 of 11
•
Miami-Dade County's Affidavits and Declarations
6.MIAMI-DADE EMPLOYMENT FAMILY LEAVE AFFIDAVIT Perta-i s ❑
(County Ordinance No.142-91 codified as Section 11A-29 et. N/A ❑
seq of the County Code) Initial(t )
That in compliance with Ordinance No. 142-91 of the Code of Miami-Dade County, Florida,an employer with fty
(50) or more employees working in Dade County for each working day during each of twenty(20) or more
calendar work weeks,shall provide the following information in compliance with all items in the aforementioned
ordinance:
An employee who has worked for the above firm at least one (1)year shall be entitled to ninety(90) days of family
leave during any twenty-four(24) month period,for medical reasons, for the birth or adoption of a child,or for the
care of a child,spouse or other close relative who has a serious health condition without risk of termination of
employment or employer retaliation.
The foregoing requirements shall not pertain to contracts with the United States or any department or agency
thereof,or the State of Florida or any political subdivision or agency thereof. It shall,however,pertain to
municipalities of this State.
7. MIAMI-DADE COUNTY DISABILITY NONDISCRIMINATION Pertai4s ❑
AFFIDAVIT(County Resolution R-385-95) N/A \ ❑
Initial ! )
That the above named firm,corporation or organization is in compliance with and agrees to continue to co ;sly
with,and assure that any subcontractor, or third party contractor under this project complies with all appli Able
requirements of the laws listed below including,but not limited to,those provisions pertaining to employment,
provision of programs and services,transportation,communications,access to facilities,renovations,and new
construction in the following laws:The Americans with Disabilities Act of 1990 (ADA),Pub.L. 101-336, 104 Stat.
327,42 U.S.C.12101-12213 and 47 U.S. C.Sections 225 and 611 including Title 1,Employment; Title II,Public
Services;Title III, Public Accommodation and Services Operated by Private Entities;Title IV,Telecommunications;
and Title V, Miscellaneous Provisions:The Rehabilitation Act of 1973, 29 U.S.C. Section 794:The Federal Transit
Act,as amended 49 U S. C.Section 1612:The Fair Housing Act as amended,42 U.S.C.Section 3601-3631.The
foregoing requirements shall not pertain to contracts with the United States or any department or agency thereof,
or the State or any political subdivision or agency thereof or any municipality of this State.
8.MIAMI-DADE COUNTY REGARDING DELINQUENT AND CURRENTLY DUE Pe s ❑
FEES OR TAXES (Sec.2-8.1(c) of the County Code) N/A ❑
Initial )
Except for small purchase orders and sole source contracts,that above named firm,corporation, organizatio 4or
individual desiring to transact business or enter into a contract with the County verifies that all delinquent artyl
currently due fees or taxes--including but not limited to real and property taxes,utility taxes and occupational
licenses--which are collected in the normal course by the Dade County Tax Collector as well as Dade County
issued parking tickets for vehicles registered in the name of the firm,corporation,organization or individual have
been paid.
ATTACHMENT D"Miami-Dade County Affidavits and Declarations" Page 6 of 11
Miami-Dade County's Affidavits and Declarations
•
Pertain O
9. CURRENT ON ALL COUNTY CONTRACTS,LOANS AND OTHER OBLIGATIONS N/AI
Initial I )
The individual entity seeking to transact business with the County is current in all its obligations to the Coin and
is not otherwise in default of any contract,promissory note or other loan document with the County or any of its
agencies or instrumentalities
j
Pertai
10. DOMESTIC VIOLENCE LEAVE(Resolution 185-00; 99-5 Codified At 11A- N/A
60 Et.Seq.of the Miami-Dade County Code). Initial I' )
The firm desiring to do business with the County is in compliance with Domestic Leave Ordinance,Ordina e 99-
5,codified at 11A-60 et.seq. of the Miami Dade County Code,which requires an employer which has in the regular
course of business fifty(50) or more employees working in Miami-Dade County for each working day during each
of twenty(20) or more calendar workweeks in the current or proceeding calendar years,to provide Domestic
Violence Leave to its employees.
11. MIAMI-DADE COUNTY EMPLOYMENT DRUG-FREE WORKPLACE Pertai•s ❑
AFFIDAVIT(County Ordinance No.92-15 codified as Section 2- Initial
N/T�[ ED
8.1.2 of the County Code) •
That in compliance with Ordinance No. 92-15 of the Code of Miami-Dade County,Florida,the above named II rson
or entity is providing a drug-free workplace.A written statement to each employee shall inform the employ-
about:
1. danger of drug abuse in the workplace;
2. the firm's policy of maintaining a drug-free environment at all workplaces;
3. availability of drug counseling,rehabilitation and employee assistance programs;
h. penalties that may be imposed upon employees for drug abuse violations.
The person or entity shall also require an employee to sign a statement,as a condition of employment that the
employee will abide by the terms and notify the employer of any criminal drug conviction occurring no later than
five (5) days after receiving notice of such conviction and impose appropriate personnel action against the
employee up to and including termination.
Compliance with Ordinance No.92-15 may be waived if the special characteristics of the product or service offered
by the person or entity make it necessary for the operation of the County or for the health,safety,welfare economic
benefits and well-being of the public. Contracts involving funding which is provided in whole or in part by the
United States or the State of Florida shall be exempted from the provisions of this ordinance in those instances
where those provisions are in conflict with the requirements of those governmental entities.
ATTACHMENT D"Miami-Dade County Affidavits and Declarations" Page 7 of 11
Miami-Dade County's Affidavits and Declarations
12. ATTESTATION REGARDING DUE AND PROPER ACKNOWLEDGEMENT OF Pertain. ❑
COUNTY FUNDING SUPPORT N/A ❑
Initial )
1
By initialing this subsection and accepting County funds,the above named firm, corporation, organization o
i individual agrees to abide by the grant contract requirement to recognize and acknowledge Miami-Dade County's
grant support in a manner commensurate with all contributors and sponsors of its activities at comparable dollar
levels.
13.MIAMI-DADE COUNTY RESOLUTION NO.R-630-13 REQUIRING A DETAILED
PROJECT BUDGET,SOURCES AND USES STATEMENT, CERTIFICATIONS AS Pertai i ❑
TO PAST DEFAULTS ON AGREEMENTS WITH NON-COUNTY FUNDING N/A ❑
SOURCES,AND DUE DILIGENCE CHECK Initial■ )
Pursuant to Miami-Dade County Resolution No. R-630-13,requiring a detailed project budget,sources and'es
statement,certifications as to past defaults on agreements with non-county funding sources and due diligence
check prior to the County Mayor or County Mayor's designee recommending a commitment of Miami-Dade County
funds to Social Services,Economic Development, Community Development,and Affordable Housing Agencies and
Providers.
The undersigned entity certifies,to the best of his or her knowledge and belief,that:
1. Within the past five(5)years,neither the Agency nor its directors,partners,principals,members or board
members:
(i) have been sued by a funding source for breach of contract or failure to perform obligations under a
contract;
(ii) have been cited by a funding source for non-compliance or default under a contract;
(iii) have been a defendant in a lawsuit based upon a contract with a funding source.
Please list any matters which prohibit the Agency from making the certifications required and explain how the
matters are being resolved(use separate sheet if necessary):
14.MIAMI-DADE COUNTY RESOLUTION No.R-478-12 NOT TO USE PRODUCTS Pertains ❑
OR FOODS CONTAINING"PINK SLIME" N/A ❑
Initial(i )
Pursuant to Miami-Dade County Resolution No. R-478-12,the undersigned certifies, not to use meat produc
containing"Pink Slime"in food provided or served as part any food program;urging all who provide foodservices
or operate a food program to immediately discontinue using meat products containing"pink slime"in food
provided or served in these programs.
•ATTACHMENT D"Miami-Dade County Affidavits and Declarations" Page 8 of 11
Miami-Dade County's Affidavits and Declarations
15.MIAMI-DADE COUNTY REQUIRED LOBBYIST REGISTRATION FOR 1 Pertai O
ORAL PRESENTATION Section 2-11.1(i)(2) CONFLICT OF INTEREST N/A O
L AND CODE OF ETHICS ORDINANCE Initialed )
All lobbyists shall register with the Clerk of the Board of County Commissioners within five (5)business d. of
being retained as a lobbyist or before engaging in any lobbying activities,whichever shall come first. Ever ,rson
required to so register shall:
1.Register on forms prepared by the Clerk;
2.State under oath his or her name,business address and the name and business address of each person or entity
which has employed said registrant to lobby.If the lobbyist represents a corporation,the corporation shall also be ,
identified.Without limiting the foregoing,the lobbyist shall also identify all persons holding, directly or indirectly,
a five (5)percent or more ownership interest in such corporation,partnership, or trust.Registration of all
lobbyists shall be required prior to January 15 of each year and each person who withdraws as a lobbyist for a
particular client shall file an appropriate notice of withdrawal.
3. Prior to conducting any lobbying,all principals must file a form with the Clerk of the Board of County
Commissioners,signed by the principal or the principal's representative,stating that the lobbyist is authorized to
represent the principal.Failure of a principal to file the form required by the preceding sentence may be
considered in the evaluation of a bid or proposal as evidence that a proposer or bidder is not a responsible
contractor. Each principal shall file a form with the Clerk of the Board at the point in time at which a lobbyist is no
longer authorized to represent the principal.
By initialing here,the principals or principal's representative have filed with the Clerk of the Board of
County Commissioners stating that a lobbyist is authorized to represent the principal.
4.Any public officer, employee or appointee who only appears in his or her official capacity shall not be required to
register as a lobbyist.
5.Any person who only appears in his or her individual capacity for the purpose of self-representation without
compensation or reimbursement,whether direct,indirect or contingent,to express support of or opposition to any
item,shall not be required to register as a lobbyist.
6.Any person who only appears as a representative of a not-for-profit corporation or entity[such as a charitable
organization,or a trade association or trade union),without special compensation or reimbursement for the
appearance,whether direct,indirect or contingent,to express support of or opposition to any item,shall register
with the Clerk as required by the Ordinance subsection,but, upon request,shall not be required to pay any
registration fees.
The Clerk of the Board of County Commissioners shall notify the Commission on Ethics and Public Trust of the
failure of a lobbyist or principal to file a report and/or pay the assessed fines after notification. A lobbyist or
principal may appeal a fine and may request a hearing before the Commission on Ethics and Public Trust.A request
for a hearing on the fine must be filed with the Commission on Ethics and Public Trust within fifteen (15) calendar
days of receipt of the notification of the failure to file the required disclosure form.The Commission on Ethics and
Public Trust shall have the authority to waive the fine,in whole or part,based on good cause shown.The
Commission on Ethics and Public Trust shall have the authority to adopt rules of procedure regarding appeals from
,
the Clerk of the Board of County Commissioners-
Except as otherwise provided in subsection of the Ordinance,the validity of any action or determination of the
Board of County Commissioners or County personnel,board or committee shall not be affected by the failure of any
person to comply with the provisions of this subsection(s). (Ord. No. 00-19,§1,2-8-00; Ord.No. 01-93,§1, 5-22-
01; Ord.No.01-162, §1,10-23-01;Ord. No. 03-107,§ 1,5-6-03)
ATTACHMENT D"Miami-Dade County Affidavits and Declarations" Page 9 of 11
Miami-Dade County's Affidavits and Declarations
Pertain O
• 16. Disclosure SUBCONTRACTOR/SUPPLIER LISTING(ORDINANCE 97-104) N/A ❑
Initial )
This form,or a comparable form meeting the requirements of Ordinance 97-104,must be completed by all bi ers and
proposers on Miami-Dade County contracts for purchase of supplies, materials or services, including pro essional
services which involve expenditures of $100,000.00 or more, and all bidders and proposers on County or Public
Health Trust construction contracts which involve expenditures of$100,000.00 or more. This form or a comparable
form meeting the requirements of Ordinance 97-104, must be completed and submitted even though the
bidder or proposer will not utilize subcontractors or suppliers on the contract. The bidder or proposer
should enter the word "NONE" under the appropriate heading, in those instances where no subcontractors or
suppliers will be used on the contract. A bidder or proposer who is awarded the contract shall not change or
substitute first tier subcontractors or direct suppliers or the portions of the contract work to be performed or
materials to be supplied from those identified except upon written approval of the County.
Business Name and Address Principal Owner Scope of Work to be Performed by (Principal Owner)
of First Tier Subcontractor/Subconsultant Gender Race
iwtSubcontr.ctor Subconsultant
' Business Name and Address Principal Owner Supplies/Materials/Services to be (Principal Owner)
of Direct Supplier Provided by Supplier Gender Race
0 Ne
I certi that the rep/sentations contained in this Subcontractor/Supplier Listing are to the best of my knowledge
true an accurate.
gnature ,f uthorized RepresentativeDate
n
( - 4,I Mt r . J •: _'S ) ( l%t I . )
Frio Name P int Title
(Duplicate if additional space is needed)
ATTACHMENT D"Miami-Dade County Affidavits and Declarations" Page 10 of 11
Miami-Dade County's Affidavits and Declarations
MIAMI•DADE
COUNTY
I have carefully read this entire 11-page document entitled, "Miami-Dade County's Affidavits and Declarations' and
agree to; (1) sign an affidavit as to certain matters and(2) make a declaration as to certain other matters. This
form contains both Affidavit forms for matters requiring the entity to sign under oath and Declaration forms for
matters requiring only an affirmation or declaration for other matters.
BY SIGNING AND NOTARIZING THIS PAGE YOU ARE ATTESTING TO AFFIDAVITS AND
DISCLOSURES 1-16
1 MIAMI-DADE COUNTY AFFIDAVITS SIGNATURE PAGE /
By: 1 t _,j a � 0 ' (& (21 I ,245
Sign. t e of Witn•. or Secretary Seal Date
-a b�!- X0003Z
Signa • ' of A'r. Federal Employer Identification Number
4-1 nil Lla0rot 112S _ Gaio� Idarn, Rec
Printed N. e o Affiant and// Name of Agency
l U l:p/lV_OnT10)1% &-n-her OR pmt a .
Address of Agency .�t
SUBSCRIBED AND SWORN TO (or affirmed)before methis�lt' day ofd,20 f�
He/She i. personally known . me or has presented as identification.
IN1111111Ugt Type of identification
S ig#atuft C2. i Serial Number
«• 3*?
:. iIG'T11r10 t _ _
Pri • .,- tars, Expiration Date
t V L in rtw`�•oar
Notary Public- State of Fioyv
County of A..,0 T I — hatt e, Rotary Seal
J
ATTACHMENT D"Miami-Dade County Affidavits and Declarations" Page 11 of 11
FY 2017
Miami-Dade County Homeless Trust
Continuum of Care (CoC)
Consolidated Financial Records
Performance Reports
ATTACHMENT E"Financial Records&Performance Reports"
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Agency
Letterhead
oumpile
Date
Attention:Assigned Contracts Officer
Miami-Dade County Homeless Trust
Suite 310,27h Floor
111.NW First Street
Miami,Florida 33128
Subject: FY 2017 US HUD COC Program
#FL0000L4D0017 ,Program Name
Name of Agency is respectfully submitting for your review and release of payment of the enclosed
Consolidated Financial Record and Reports for the above subject program. We request
reimbursement in amount requested is$0.00 for the month of Month.vvvy.
The following documents are included in this checklist outlined below:
O Cover Letter
O Performance Report-0625 HUD CDC Monthly HMIS generated Report
O Homeless Trust Invoice
O HUD form 27053-A SNAPS Request Voucher for Grant Payment
O Summary and Compliance Report
O Attachment E-Program Income Report
O Supporting documents for invoice requirements and match including invoices,cancelled
checks,payroll,time and effort logs,and if applicable copy of Tenant paid utility bills
consistent with utility allowance,documentation of match expenditure compliance
consistent with OMB Omni or Super Circular and 24 CFR 578.
The value of the match demonstrated is$0,00. The amount of program income (if
applicable) is$0.00. This is an adjustment#(_) for the month of Month.vvvy
On behalf of our homeless community members who benefit from this program,we thank you for
your time and assistance. Please call(305) 000-000 extension 0 or email address xvsPxvs.conr
with any concerns or comments about this reimbursement package.
Sincerely,
Name
Title
Enclosures
Attachment E"Consolidated Financial Record and Reports Cover Letter"
MIAMID
COUNTY
Request for Amendment / Modification / for US HUD Grant Funded
Continuum of Care (CoC) Programs
Includes Legacy Programs under the CoC
Supportive Housing Programs (SHP)
Shelter Plus Care Programs (S+C)
Single Room Occupancy for the Homeless (SRO]
24 CFR 578.105 Grant and Project Changes -The recipient or subrecipients may not make any significant changes to a project
without prior US HUD approval,evidenced by a grant amendment signed by HUD and the Recipient Significant changes include a
change of recipient,a change of project site,additions or deletions in the types of eligible activities approved for a project,a shift of
more than 10% from one approved eligible activity to another, a reduction in the number of units, and a change in the
subpopulation served.
By signing this report the duly authorized Project Sponsor/Provider/Subrecipient Official signature below certifies to the best of their knowledge
and belief that the report is true,complete and accurate and is for the purposes and objectives set forth in the terms and conditions of the federal
award;and are aware that any false,fictitious,or fraudulent information or the omission of any material fact may subject the duly authorized official
to criminal,civil or administrative penalties for fraud,fake statements,false claims or other offense.
Print Name and Title of Authorized Project
Bonsor/Provider/Subreci inent Official:
Signature&Date(mm/dd/yyyy):
Reviewed by Miami-Dade County and forwarded to Do Not Sign-for Miami-Dade County ONLY
US HUD for Request to Approve(greater than 10%shift
in funds between categories or significant change)
CHANGE IN PROJECT SPONSOR Signature&Date(mm/dd/yyyy):
Reviewed and Approved by Miami-Dade County; Do Not Sign-for Miami-Dade County ONLY
information forwarded to US HUD(less than 10%shift
in funds between categories).
Signature&Date(mm/dd/yyyy):
Reviewed and NOT Aooroved by Miami-Dade County- Do Not Sign-for Miami-Dade County ONLY
see attached letter for reasons for disapproval.
Signature&Date(mm/dd/yyyy)
Program Name:f 1
Grant Number: f )
Financial Information for CoC Programs
Instructions for budget amendment / modification request:
1. Attach the eSnaps documents in Word Format previously provided for the
applicable budget chart. The charts should include a Summary chart; and
all applicable detailed supportive services, operations, leasing, rental
assistance and project administration charts. Reformat the far right-side
column in the chart to reflect the budget modified or amendment
requested. Please outline and clearly identify the changes to the budget.
2. Attach the eSnaps documents in Word format for summary of program.
Reformat the far right-side column in the chart to reflect the budget
request.
3. Type below or within the applicable Word-formatted eSnaps budget chart
a detailed budget narrative- the justification for the line-item change.
Also if there is a change in match amount - a new letter of match
commitment is required.
4. Assemble and attach page one of this document.
5. Review, sign and submit the paper original to Miami-Dade County
Homeless Trust, 111 NW 1st Street, 27th Floor, Suite 310, Miami, Florida
33128 Attention: Terrell Ellis, Contracts Manager.
FY 2017
Continuum of Care (CoC)
Miami-Dade County
Miami-Dade County Homeless Trust
Annual Progress Report (APR)
ATTACHMENT F"2016 Annual Progress Report APR"
FY 2017
Continuum of Care (CoC)
Miami-Dade County
Miami-Dade County Homeless Trust
Annual Progress Report (APR)
ATTACHMENT F"2017 Annual Progress Report APR"
MIAMI
COUNTY
Annual Progress Report (APR)
for US HUD Grant Funded
Continuum of Care (CoC) Programs
On April 1.2017 Continuum of Care (CoC) Program grant recipients report their CoC Program Annual Performance
Reports (APRs) in Sage HMIS Reporting Repository(Sage). Recipients will be required to upload CSV data from
their HMIS to fulfill the APR reporting requirement in Sage. All Subrecipients are required to continue to submit the
hard copy of the HMIS report as well as the supplemental pages until further notice.
By signing this report,the duly authorized Project Sponsor/Provider/Subrecipient Official signature below certifies to
the best of their knowledge and belief that the report is true, complete and accurate and is for the purposes and
objectives set forth in the terms and conditions of the federal award; and are aware that any false,fictitious, or
fraudulent information or the omission of any material fact,may subject the duly authorized official to criminal,civil or
administrative penalties for fraud,false statements,false claims or other offense.
Project Name I Project Grant Number F
Print Name and Title of Authorized
• Project Sponsor/Provider/Subrecipient Official:
Signature&Date (mm/dd/yyyy): •
Print Name&Title of Authorized Project Grant Do Not Sign-for Miami-Dade County ONLY
• Official
(MDCHT Executive Director or Designee):
Signature&Date(mm/dd/yyyy):
•
Supervisory Review and Entry- Do Not Sign-for Miami-Dade County ONLY
Print Name&Title
Signature&Date(mm/dd/yyyy):
- Updated March 31,2017
•
Attachment F"Annual Progress Report(APR) Supplemental"
Guidance was provided for a-snaps changes that were implemented to improve processing time;completing an"Applicant
Profile";and on Q3,Q5,Q23,Q24,and Q 31-please submit the HMIS generated APR as well.
US HUD-ANNUAL PERFORMANCE REPORT(APR)
CONTINUUM OF CARE(CoC)
Ql.Contact Information
Project Name
I
Recipient/Agency Name
GrantNumber
Prefix(Mr.,Mrs.,Ms.,Dr.,etc.)
First Name
Middle Name
Last Name
Suffix(LCSW,MSW,Etc.)
Title '
Street Address 1
StreetAddress 2
City
State
Zip Code
E-mail address
Phone Number
Extension
Fax Number
Q3.Project Information:Check the corn.onent for the program on which you are reporting _
Continuum of Care Program(CoC) Rental Assistance(RA) Section 8 Moderate
Rehabilitation
❑Transitional Housing ❑Tenant-based Rental AssistanceTRA
( ) ❑Single Room Occupancy ,
0 Permanent Housing for Homeless ❑Project-based Rental Assistance(PRA) U (Sec.8 SRO)
Persons with Disabilities
❑Safe Haven ❑Single Room Occupancy(SRO) ❑HMIS
❑Innovative Supportive Housing ' fSponsor-based Rental Assistance(SRA)
C Supportive Services Only
Is this APR fulfilling the reporting obligation associated with a 20 or 15-year use requirement? (I I)
Number of Years in Operation:(U)
•
Contract operating term or duration is from ( / /20 ) to ( / /20 )
I/
3.Project Information continued:
Is this a Domestic-Violence Program(Yes or No)
Was this project funded under a special initiative?If yes,what type?
(Samaritan Bonus,Permanent Housing Bonus,Reallocation,Etc.)
Amount of Contract or Award $
CoC Number and Name FL-600 Miami-Dade County
Is this an APR for a grant that received a HUD- approved grant
extension?(Yes or No)
Is this a final APR? (Yes or No) i
Attachment F"Annual Progress Report(APR) Supplemental"
Financial Information for CoC Programs
Q31a1 CoC Financial -Development _
Expenditure Type - CoC Program funds Expenditures
Acquisition
Rehabilitation
New Construction
Development-Subtotal $
Q31a2 CoC Expenditures-Supportive Services
Report on all CoC Program funds expended during the operating year on supportive services. If you have no expense for these
items or these items were not included in your grant application enter"0"in each field on the question.
Expenditures type CoC Program Funds
Expenditures
1.Assessment of Service Needs $
2.Assistance with Moving Costs $
3.Case Management $
4.Child Care $
S.Education Services $
6.EmploymentAssistance
•
7.Food
8.Housing/CounselingServices
9.Legal Services
10.Life Skills
11.Mental Health Services
12.Outpatient Health Services �•
13.Outreach Services 6
14.Substance Abuse Treatment Services
15.Transportation 6
16.Utility Deposits
Supportive Services - Su'tota
Attachment F"Annual Progress Report(APR) Supplemental"
Q31a4 CoC Financial -Leasing,Rental Assistance,Operating,and Administration
Total Expenses COC Funds
Development $
Supportive Services $
Real Property Leasing $
Short-/Medium Term Rental Assistance $
Long-term Rental Assistance $
Operating Costs $
HMIS $
SUBTOTAL $
Administration-Provider $
Administration-Homeless Trust $
TOTAL Expenses plus Administration $
Cash Match $
In-Kind Match $
TOTAL Match $
Match%
TOTAL Expenditures and Match $
Program Income $
Attachment F"Annual Progress Report(APR) Supplemental"
Performance for CoC Programs
136: Standard Performance Measures
Performance Measure [target)#of I #of total %expected to Actual Target Actual #of total Actual%of
Persons who were (Universal) accomplish of persons who [Universal) persons to
(Measures are found expected to persons who are this measure accomplished person to achieve achieve this
in the eSnaps(Exhibit accomplish this is expected to (esnaps this measure this measure measure
2)of the HUD measure(eSnaps accomplish this Budget Reported in Reported In HMIS Reported in
application Budget Exhibit 2) measure (esnaps Exhibit2) HMIS HMIS
Exhibit6A-C) 11 Budget Exhibit 2) i
Persons exiting to
permanent housing 11 16 69% 19 20 95%
(subsidized or -F 21 S;Tl'�l;f t`
unsubsidized)during
theo•-ratin• ear.
Housing Stability
Measure
Reported in HMIS
936
Total Income
Measure
Reported in HMIS
936
-
Earned Income
Measure
Reported in HMIS
Q36
Other-specify
Reported in HMIS
Q37:Additional Performance Measures
Performance Measure (Target)#of #of total %expected to Actual Target Actual of Actual%of
Persons who (Universal) accomplish this #of persons total persons to
(Measures are found In were expected persons who are measure who (Universal) achieve this
the eSnaps(Exhibit 2)of to accomplish is expected to (esnaps Budget accomplished person to measure
the HUD application this measure accomplish this Exhibit 2) this measure achieve this Reported in
Exhibit 6 A-C) • (esnaps Budget measure (eSnaps Reported In measure HMIS
Exhibit 2) Budget Exhibit 2) HMIS Reported in
HMIS
`Utilization Rate or
Vacancy Report
Other
Q40: Significant Program Accomplishments
Describe in a brief narrative form(no more than 2,000 characters)all significant accomplishments achieved by your
project during the reporting period:
Q42:Additional Comments
Describe in a brief narrative form(no more than 2,000 characters)based on your experience during the last year any
problems or explanations and or changes or need for technical advice or assistance.
Attachment F"Annual Progress Report(APR) Supplemental"
FY 2017
Miami-Dade County Homeless Trust
Continuum of Care (CoC)
CoC Monitoring Guidelines
Internal Wellness Checklist &
Internal Wellness "Top Ten" List
ATTACHMENT G'Internal Wellness Checklists"
Internal Wellness Checklist for the Continuum of Care (CoC) Program
The Internal Wellness Checklist was developed in an effort to assist homeless providers to proactively
implement its FY_ CoC grant(s),thereby ensuring compliance with applicable regulations codified at
24 CFR Part 578. It is also designed to assist with determining the current"health" status of this CoC
grant. Grant recipients are strongly encouraged to utilize this checklist prior to submitting the required
APR to the U. S. Department of Housing and Urban Development.
Recipient Name: _
Project Name: _ Grant Term: I or 2 Yrs.
Grant Number: Grant Amt.: Expiration Date:_
Date APR is Due to HUD: Date APR Submitted:
(Not more than 90 days after the end of each CoC grant's performance period)
General Recordkeeping
I. Executed Grant Agreement
24 CFR 578.23(c)
2. Documentation of Grant Amendment(request and approval, if applicable)
24 CFR 578.105
3. Executed Grant Agreements with Subrecipients
24 CFR 578.23(c)(ii)
4. Documentation subrecipients are not debarred
24 CFR 578.23(c)(4)(v)
5. Documentation of annual monitoring of Subrecipients
24 CFR 578.23(c)(8)
6. Executed Memorandum of Understanding with Service Providers
24 CFR 578.73(c)(3)
7. Project Application should be maintained-ensure costs charged against the grant are consistent
with the approved budget items identified in the application
24 CFR 578.59(a)
8. Documentation that Annual Performance Report was submitted timely
24 CFR 578.103(e)
9. Written CoC Program Policies and Procedures to include:
24 CFR 578.103(a)
Intake/screening procedures
24 CFR 578.103(a)(3)and(4)
Internal Wellness Checklist
Page 2
Grant k:
_Personnel Policies and Procedures
2 CFR 200.303,and 24 CFR 578.103(a)
Termination Policy
24 CFR 578.91
Grievance Policy
24 CFR 578.91
Policy Privacy/Confidentiality Policy
24 CFR 578.103(b)
Drug-Free Workforce Policy
24 CFR 5.105(d),24 CFR 2424,24 CFR 225
Policy identifying the involvement of homeless/formerly homeless individuals
24 CFR 578.23(c)(3)
Domestic Violence Policy
24 CFR 578.23(c)(4)(i)(ii),24 CFR 578.103(a)(17)
Housing First Policy, if applicable
HUD CPD Notice 14-02
_10. Documentation of participation of homeless/formerly homeless individuals in policymaking
24 CFR 578.75(g)(1)
I1.Documentation of compliance with environmental review requirements
24 CFR 578.99,24 CFR 578.31
12. Documentation of compliance with fair housing requirements
24 CFR 578.87(b),24 CFR 578.103(a)(14)and(17),24 CFR 578.93(c)(1)
13. Documentation of other federal requirements (i.e.lead based paint, Section 3, Section 504),
if applicable
24 CFR 578.99,24 CFR 35,24 CFR 578.99(b)
Financial Files
1. Written Financial Policies
2 CFR 200.302,24 CFR 578.23(c)(5),24 CFR 578.103(a)
2. Written Procurement Procedures
2 CFR 200.318 and 2 CFR 200.319
3. Written Conflicts of Interest Policy
2 CFR 200.317 and 2 CFR 200.318,24 CFR 578.95(a)
4.Documentation of match (25%of total Grant Amount less leasing)
24 CFR 578.73(a)
5.Documentation of Grant Expenditures(during grant term and for approved items in application)
24 CFR 578.37,24 CFR 578.103
6. Documentation of Indirect Cost Rate Proposal, if applicable
24 CFR 578.63(6),24 CFR 578.103(a)(17)
Internal Wellness Checklist
Page 3
Grant n:
7.Documentation showing compliance with the Single Audit Act
24 CFR 578.99(g),2 CFR 200 subpart F
8. Documentation showing quarterly draw requests
24 CFR 578.85(c)(3)
9. Documentation showing program income was expended prior to HUD draw requests, if applicable
24 CFR 578.97(b)
Participant Program Files
1.Documentation participants are entered into H IS or a comparable database
24 CFR 578.103(a)(3)
2. Documentation participant was screened via centralized or coordinated assessment systems
24 CFR 578.23(c)(9)
3.Documentation of Homelessness at intake
24 CFR 578.103(a)(3)
4. Permanent Supportive Housing-Documentation of disability
24 CFR 578.37(a)(i)
5. Transitional Housing- No more than 24 months of services provided except under documented
extenuating circumstances
24 CFR 578.79
6. Documentation of ongoing assessment of services
24 CFR 578.75(e)
7.Documentation of examination of income(initial and recertification)
24 CFR 578.103(a)(7)(i)
8.Documentation of initial and follow-up Housing Quality Standards inspections
24 CFR 578.75(b)(2)
9. Leasing-Documentation that the unit/structure is not owned by recipient or subrecipient
24 CFR 578.49(a)
10.Leasing-Documentation lease is between agency and landlord
24 CFR 578.49(b)(5)
1 I.Leasing-Is there an occupancy agreement,lease or sublease in the file(for individual units)?
24 CFR 578.103(a)(17)
12.Leasing-Documentation of rent reasonableness for the period of approval for an assisted unit
24 CFR 578.49(6)(1)
13. Rents charged(including utilities) do not exceed HUD-Fair Market Rents
24 CFR 578.49(6)(2)
14.Documentation supporting the correct/current utility allowance schedule is used
24 CFR 578.103(a)(17),24 CFR 578.49(a)(3)
Internal Wellness Checklist
Page 4
Grant N:
15. Leasing-Documentation of occupancy charges with annual income calculations
24 CFR 578.77,24 CFR 578.99(6)(6)
16.Rental-Documentation the participant has a an executed lease agreement with the landlord
24 CFR 578.77,24 CFR 578.51(d)(e)
17.Rental-Documentation of rent reasonableness for the period of approval for an assisted unit
24 CFR 578.51(g)
NOTE: For additional guidance,please refer to the following
resource materials:
(I)Homeless Emergency Assistance and Rapid Transition to
Housing: Continuum of Care Program CoC regulations at 24 CFR
Part 578, and
(2)Monitoring handbook 6509.2 REV-6 CHG-2 that can be
accessed at:
http://portal.hud.gov/hudportal/HUD?src=/program offices/ad
m inistration/hudclips/handbooks/cpd/6509.2.
Completed by:
Signature: Date:
Typed/Printed Name: Title:
This document is to be maintained in the applicable CoC project file.
MIAMPDADE
COUNTY
Attachment G"CoC Program Guidelines" Page 1 of 14
Miami-Dade County Homeless Trust
CoC Program Guidelines
MIAMF
COUNTY
Miami-Dade County Homeless Trust Monitoring Team Information
Staff:
Date of Visit:
CoC Program Subrecipient:Agency and Program Information
Subrecipient:
Program Name:
Subrecipient staff consulted:
Grant Amount:
Grant Number:
Program Type: ❑ PSH C RRH ❑ TH J SH ❑ SSO C Legacy SPC RRH
Number to be served:
Number of chronic beds/units:
Program serves: C Individuals ❑ Families ❑ Both
CoC Program grant funds are used for:
❑ Leasing(no match required)
LI Rental Assistance
❑ Operations
❑ Supportive Services
u HMIS
O Administration
Is the Subrecipient a faith-based organization? L1 Yes C'No
CoC Matching funds (25%) required are: C Cash/Cash Equivalent U In Kind :7 N/A
Is there an active restrictive covenant on one or more of the project's properties?❑Yes ❑ No
Attachment G"CoC Program Guidelines" Page 2 of 14
PART 1: PROGRAM MONITORING:
SUBRECIPIENT OPERATIONS: POLICIES AND PROCEDURES:
Conflict of Interest
1.There are written standards of conduct governing Cl Yes
the performance of covered persons engaged in the El No
award and administration of contracts.24 CFR§
578.95(a); 24 CFR§578.103(a)(11)
2.The Subrecipient has a general conflict-of-interest LI Yes
policy for staff and Board members 24 CFR§ J No
578.95(c);24 CFR§ 578.1031a1111)
—
3.If the Subrecipient is an approved exception to the l Yes
conflict of interest policy,the agency has documented GNo
the exception 24 CFR§578.103(a)111)
Involvement of homeless persons
1.There iS at least one homeless/formerly homeless O Yes
person is on the Board of Directors or equivalent O No
policymaking entity.24 CFR§578.75(g)(11
2.The Subrecipient involves homeless individuals O Yes
and families through employment;volunteer O No
services;or otherwise;in constructing,rehabilitation,
maintaining,and operating the project,and in
providing supportive services for the project 24 CFR
§578.75(g)(2)
Confidentiality
1.The Subrecipient has written policies to ensure: ❑.Yes
• Records containing protected identifying O No
information of any individual/family
receiving assistance will be kept
confidential;
• The location of any family violence project
will not be made public,except with the
written permission of the person
responsible for operating the project;and
• The location of any housing of any program
participant will not be made public,except
as provided in a preexisting privacy and as
provided by law.
24 CFR§578.103(b) [These policies are in addition
to HMIS related confidentiality/security
requirements)
Fair Housing and Equal 0 ottani
1.The Subrecipient has written nondiscrimination O Yes
and equal opportunity policies that apply to housing [i No
and employment 24 CFR§578.93 _
2.The Subrecipient has policies and procedures for C Yes
providing reasonable accommodations and El No
reasonable modifications for persons with
disabilities. 24 CFR§100.204(a),28 CFR§
35.130(b)(7) - - -
Attachment G"CoC Program Guidelines" Page 3 of 14
3.The Subrecipient maintains copies of marketing O Yes
outreach,and other materials used to inform eligible 5 No
persons of the program and these materials show
that the agency markets theirhousing and
supportive services to those least likely to apply in
the absence of special outreach.24 CFR
§578.93(c)(1)
4.The Subrecipient has policies and procedures in O Yes 1
place to provide meaningful access for Spanish- o No
speaking and other Limited English Proficiency
persons to access the Subrecipient's programs and
services. 72 federal regulation 2732
5.The Subrecipient provides program participants O Yes ,
with information on rights and remedies available CD No
under applicable federal,State and local fair housing
and civil rights laws.24 CFR§578.93(c)(3)
Drug-Free Workplace
1.The Subrecipient has a drug-free workplace policy Si Yes
statement which includes the requirement of 5 No
notification to HUD if an employee is convicted for a
criminal drug offense.24 CFR§84.13
POLICIES AND PROCEDURES FOR COC GRANT-FUNDED PROGRAM
Number Served _
1.The Subrecipient serves at least as many program IS Yes
participants as show in its application for assistance. L5 No
24 CFR§578.51(h)(3)
Termination Process
1.The Subrecipient has a written policy for i O Yes
termination of participation for violation of program O No
policies or occupancy agreements.24 CFR§
578.91(b)
Services Related to Housing Stability
1.The Subrecipient has a written policy for 1 J Yes -
terminationofparticipationforviolationofprogram S No
policies or occupancy agreements.24 CFR§
578.91(6)
Residential Supervision
1.The Subrecipient provides adequate residential O Yes
supervision.24 CFR§578.75(f) O No I
Program Fees
1.The Subrecipient does not charge participant's I G Yes
program fees.24 CFR§578.87(d)Program fees are J No
not the same as rent or occupancy rent;program
participants may be charged rent for housing)—
Attachment G"CoC Program Guidelines" Page 4 of 14
Recordkeeping
1. ---
1.The Subrecipient has systems in place to ensure El Yes
that records related to CoC-funded programs are U No
maintained for a 5-year period.24 CFR§578.103
REVIEW OF CDC PROGRAM PARTICIPANT FILES
Eli• bili : Homelessness
11.Each participant file contains verification of O Yes
homelessness status at the time of program entry.24 0 N
CFR§578.103 a 3 24 CFR§576.500 b)
2.The Subrecipient has written policies and O Yes
procedures for documenting homelessness. Intake 0 N
staff document eligibility at intake;documentation is
required for all persons seeking assistance;written
policies state the evidence that may be relied upon to
establish and verify homeless status. The
Subrecipient makes efforts to establish and verify
homeless status and get the appropriate
documentation. Uses Miami-Dade County's homeless
verification forms.
In order of preference: 1)Homeless coordinated
outreach and assessment,2)Third party
documentation,3)Intake worker observations,4)
Certification from the person seeking assistance. •
Eli•ibili : Disabili
1.If the program provides PSH,each participant file O Yes
contains verification of participant's disability.24 LT No
CFR§578.37(a)(1)(i) 1)Verification from a
professional who is licensed to diagnose and treat
condition OR 2) Disability verified by the Social
Security Administration(VA disability check,or an
SSDI check)
Eligibility: Chronic homelessness
1.If the program has units dedicated to persons who O Yes
arc chronically homeless,participant files contain O No
verification of chronic homelessness.
Service Assessment
1.The file contains participant assessments and O Yes
service plans,updated at least annually.24 CFR§ .0 No
578.53(a)
Services Provided and Costs ll
1.The file contains documentation of services O Yes
provided and the agency tracks the amounts spent on O No
those services.24 CFR§578.103(a)(9)
Duration of Services
1.The file reflects that supportive services are made O Yes
available throughout resident's entire time in the C No
proj ect.24 CFR§578.53(b)
2.Rapid rehousing:The file reflects that program O Yes
participant meets with case manager not less than 0] No
once ser month.24 CFR§578.53(b 4)
Attachment G "CoC Program Guidelines" Page 5 of 14
Participants Terminated from Program
1.If a participant has been terminated from the O Yes
program,file includes documentation that the O No
Subrecipient followed its written procedure for
termination of assistance.24 CFR§
578.103(a)(7)(ii);24 CFR§578.91
RENTAL ASSISTANCE OR LEASING (complete this section if the Subrecipient pays rental
assistance or leasing costs for a unit that the program participant lives in)
Rental Al eement Lease
1.The program participant has an occupancy O Yes
agreement or lease with the Recipient/Subrecipient I I No
or Landlord.24 CFR§578.77(a) For tenant and
project based assistance;the program participant
must be the tenant on the lease. For sponsor based
assistance, lease between the Subrecipient and the
Landlord,sub-Lease between participant and
Sabred.ient
2.For project-based,sponsor-based,or tenant-based O Yes
permanent housing(PH) rental assistance;initial O No
lease must be at least one year,terminable for cause.
The leases must he automatically renewable upon
expiration for terms that are a minimum of one
month long,except on prior notice by either party,up
to a maximum term of 24 months.24 CFR§
578.511 1 _
3.For transitional housing;initial lease term must be O Yes
at least one month. The lease must be automatically O No
renewable upon expiration,except on prior notice by
either party,up to a maximum term of 24 months.24
CFR§578.51[1)(2)
Habitability
11.File includes documentation that units passed O Yes
housing quality standards inspection prior to initial rl No
client move-in.24 CFR§578.75(b);and
24 CFR§578.103Ia)(8) _
2.File includes documentation that unit has passed O Yes
annual housing quality standards inspections, O No
including an inspection within the last 12 months.24
CFR§578.75(b)
3.Dwelling unit is correct size:The dwelling unit O Yes
must have at least one bedroom or living/sleeping No
room for each two persons. Children of opposite sex,
other than very young children,may not be required
to occupy the same bedroom or living/sleeping
room.
24 CFR§578(21 _ .. ..
' 4.For supportive housing for persons with O Yes
disabilities; the Subrecipient must make available kg No
meal preparation facilities for residents or provide
meals 24 CFR§578.75(d)
Attachment G"CoC Program Guidelines" Page 6 of 14
Unit Rents
1.Documentation that rents are reasonable in LI Yes
relation to rents charged in the same geographic area [J No
for comparable space 24 CFR§578.49(h)
2.Rents do not exceed the HUD-determined Fair O Yes
Market Rents(FMRs). This documentation must El No
include chart show current year's FMRs.
24 CFR§578.49(b)(4) -
3.Security deposit does not exceed two months'rent; O Yes
in addition to the security deposit,the Subrecipient J No
may also pay the final months'rent in advance 24
CFR§578.49(b)(4)
Annual Income
1.The file contains an income evaluation form O Yes
completed by program participant and source O No
documents verifying income and assets [or,if source
documentation not available,3rd party verification;
or if 3rd party verification not available,written
certification by program participant
24 CFR§578.103(a)(6)
2.The file contains documents demonstrating that i O Yes
income is re-examined annually. 'O No
24 CFR§578.77(c)(2)
Rent Calculation
1.The file contains the annual rent calculation,and O Yes
the calculation is accurate.BEST PRACTICE:The file O No '
contains a printout of the HUD rent calculation
24 CFR§578.103
2.Is the participant charged rent[unless$0 income) El Yes
and is the rent treated as program income? l No
(required)
3.Is rent calculated initially,annually,and when O Yes
there is any change in income? O No
4.Is there documentation of compliance of an eligible 'Yes
"utility allowance"The Subrecipient has received a E No
copy of the Tenants paid utility bill for compliance.
Vacancies
1.The Suhrecipient does not pay rent for more than O Yes
30 days for any unit that has been vacated. Rent may (l No
not be paid on the vacated unit again until there is a
new occupant (NOTE:Brief periods of stays in
institutions,not to exceed 90 days for each occurrence,
are not considered vacancies).
24 CFR§578.51(9)
Attachment G"CoC Program Guidelines' Page 7 of 14
LEASING (complete this section if the Subrecipient leases buildings for the purpose of
• providing program services or if there is a unit lease agreement with a landlord)
Rent Reasonableness(applies to rent for buildings or housing units)
1.Documentation that rents are reasonable in O Yes
relation to rents charged in the same geographic area ' o No
for com lbarable s lace.24 CFR§578.49 .
2.Rents do not exceed rents charged for comparable Li Yes
units rented by the Suhrecipient.24 CFR§576.49(b) Li No
3.Security deposit does not exceed two months'rent; ❑Yes
in addition to the security deposit the Subrecipient LI No
may also pay the final months'rent in advance.
24 CFR§578.49(6)(4) -
•
4.The Subrecipient must have an occupancy LI Yes
agreement,and if applicable a sublease. L7 No
5.Is rent calculated initially and when the tenant ❑Yes •
requests? Li No
6.Is the participant charged rent?(not required) O Yes
LI No
7.Has an occupancy charge been imposed?(not LI Yes
required) If so,the charge cannot exceed the highest 1_-) No
of 1) 30%of the households monthly adjusted
income;2) 10%of the households'monthly income,
or;3)The portion of the households'welfare
assistance,if any that is designated for housing costs.
(not applicable in the State of Florida) -
8.Leasing funds are not used to lease units or ❑Yes
structures owned by the Recipient,Subrecipient, LI No
their parent organization(s)or organizations that are
members of a partnership where the partnership
owns the structure. (Doesn't apply to rental
assistance).
REQUIRED POLICIES AND PROCEDURES FOR SPECIFIC PROGRAMS/ CIRCUMSTANCES
Participant Household Policies(complete this section for any program that serves families with
children)
1.The age and gender of a child under age 18 must O Yes
not be used as a basis for denying any participant No
household's admission to a project that receives
funds under this .art
Faith-based Activities(complete this section if the Subrecipient is a faith-based organization) 1.
1.The Subrecipient serves all potential participants Ll Yes
without regard to religious belief,refusal to hold a Li! No
religious belief or refusal to attend or participate in
reli:ious services.24 CFR§578.87(b)(11 -
2.If the Subrecipient provides explicitly religious LI Yes
activities(including worship,religious instruction,or CJ No
proselytizing),these activities are separate from
HUD-funded activities and beneficiaries of HUD-
funded activities are not required to participate.
Attachment G"CoC Program Guidelines" Page 8 of 14
24CFR§578,87(6)[2) -
(_ Projects involving acquisition,new construction,and rehabilitation
I.Records for acquisition,new construction,and O Yes
rehabilitation must be retained for 15 years O No
following the date the project is first occupied,or
used,by program participants.24 CFR§
578.103(c)(2)r
2.If the project resulted in dislocation of any ii Yes
persons,the Subrecipient complied with the C7 No
obligations of the Uniform Relocation Act?. 24 CFR§
578.83
3.For projects including new construction or O Yes
rehabilitation,do the Recipients records show that O No
Section 3 reports have been completed and
submitted timely? 24 CFR§ 578.990)
Transitional Housing.
1.Participants do not regularly exceed 24 months in ED Yes
the program.24 CFR§578.79 O No
2.When a participant is in the program for longer I O Yes
than 24 months,the file documents the need for O No
extended participation.24 CFR§578.79
3.If participants stay longer than 24 months,is the O Yes
number of participants with longer stays less than O No
50%of the total number served by the project?
24 CFR§578.79
Transfer Due to Domestic Violence
1.If a program participant receiving tenant-based 1 ED Yes
rental assistance has moved to a different Cob due to ' O No
threat of imminent harm,the file must contain
documentation of the domestic violence and
imminent threat F
PART 2: FISCAL MONITORING
INTERNAL REVIEW
Audit - -
1.Is the Subrecipient subject to the OMB A-133 1 O Yes
single audit requirement?(Required if$5000,000 or (-1 No
more in aggregate Federal funds expended)
2.If subject to A-133 audit,has the Subrecipient O Yes
provided its most recent audit and management 0 No
letter?
3.If not bound by A-133 requirement,has the agency V Yes
provided financial statements audited by a CPA? O No
Board of Directors _
rl.Has the Subrecipient provided Miami-Dade County U Yes 1
�a list of the members of its Board ofDirectors? ONo
Authorized Check Signers _
I.Has the Subrecipient provided Miami-Dade County O Yes
with a list of authorized check signers? i I No
Attachment G"CoC Program Guidelines" Page 9 of 14
Invoicing
1.The Subrecipient submits invoices on a monthly O Yes
basis(on time or within time)? O No
—
Procurement
1.The Subrecipient has a written procurement policy O Yes
that meets the requirements of Miami-Dade County ' O No
competitive procurement standards.
2.The Subrecipient retains copies of all procurement O Yes
contracts and documentation of compliance with O No
federal procurement requirements
24 CFR§578.103(a)(16)(iii)
Match
1.The Subrecipient has documentation of the source O Yes
and use of contributions made to satisfy the 25% O No
match requirements(match maybe cash or in kind).
Records must indicate the grant and fiscal year for
which each matching contribution is counted. The
records must show how the value placed on 3'a party
in kind contributions was derived. Costs incurred by
a partnering organization to provide"in kind"
services to the program participants must be
documented by a MOU. Cash or any in kind
contribution used as match for another grant is not
an eligible in kind contribution used as match for
another grant is not an eligible match. 24 CFR§
578.73,24 CFR§578.103(a)(10),24 CFR§84.23 and
24 CFR§578.23(c)(6)
2.Match must be spent on eligible project costs(in r1 Yes
the budget) O No
3.Where match is documented by MOU,the MOU O Yes
must;establish the unconditional commitment O No
identify the service to be provided;identify the
profession of the persons providing the service;and
identify the cost of the service to be provided
Internal Controls
1.The Subrecipient has written job descriptions far O Yes
all HUD-funded positions O No
2.The Subrecipient has written fiscal policies and O Yes
procedures specifying approval authority for all O No
financial transactions and guidelines for controlling
ex.enditures
3.The Subrecipient has written procedures for O Yes
recording financial transactions,and an accounting O No
manual and chart of accounts I
Pro am Income
1.Is all program income spent on eligible costs? Rent O Yes
and Occupancy charges are considered program O No
income as is any utility allowances in rental
programs
2.Is program income part of your match? Program O Yes
income is not an eligible source of match. O No
_J
Attachment G"CoC Program Guidelines" Page 10 of 14
1-- Indirect Costs
1.Does the organization use grant funds for indirect C Yes
costs? J No
2.Are the costs consistent with OMB Super Circulars D yes
as applicable D No
DOCUMENTATION REVIEW
Salary Documentation
1.Original timesheets-signed;grant duties D Yes
identified,if split time(copy in reimbursement D No
package)
2.Payroll sheets 1 D Yes
CD No
3.Cancelled checks to the employee H Yes
J No
4.If time is divided between the CoC Programs and D Yes
another funding source,review time distribution O No
records supporting the allocation of charges among i
the sources. Staff time breakdown allocation chart
Space/Utilities Documentation/Leases
1,Rental or lease agreement-signed by participant; I U Yes
valid lease period;correct rental amount J No
2.Original invoices D Yes
C No
3.Cancelled checks to the landlord/mortgagee; J Yes
utility company,etc. D No
4.Unit inspection report(s);no longer than 1 year old O Yes
C'No
5.Verification of what payment was used for(e.g. ❑Yes
first month's rent,security deposit,etc.) 71 No I
Supplies
1.Purchase orders I D Yes
D No
2.Requisitions D Yes
C No
Cancelled checks J Yes
D No
4.Determine where supplies are being kept D Yes
No
H.Determine what cost objective is being used (DYes
(1No _
Review Inventory list-any equipment shall be H Yes
labeled as property of Miami-Dade County through ,C No
its Homeless Trust
Attachment G"CoC Program Guidelines" Page 11 of 14
INTERNAL CONTROLS
1.Internal control questionnaire O Yes
O No
2. Review organizational chart O Yes
D No
3.Review job descriptions/definitions of employees' ' D Yes
duties O No .__74.Review Subrecipient's system of authorization and D Yes
supervision D No
5.Ensure that there is a separation of duties D Yes
(authorizing recording and custody should be D No
separate)
6.Review control over assets D Yes
O No
EVALUATION OF SELECTED TRANSACTIONS
Is the expenditure allowable
a.Is the expenditure necessary,reasonable and n Yes
directly related to the grant? G No
b.Is the expenditure authorized by the grant? D Yes
G No
Source documentation evaluation
a.Were the expenditures incurred during the term of I O Yes
the grant? D No --
b.Was the money actually paid out? El Yes
O No
c Were the expenditures approved by the U Yes
responsible Subrecipient officials D No
d.Is there adequate documentation to support the ' D Yes
expenditures? 13 No
Does the Subrecipient maintain the appropriate records?
Does the Subrecipient maintain the following?
a.Chart of accounts U Yes
D No
b.Cash receipts journal D Yes
D No
c.Cash disbursements journal it Yes
El No
d.Payroll journal C]Yes
D No
e.General ledger D Yes
D No
1.Does the Subrecipient maintain documentation D Yes
concerning its sources of funding G No -
Attachment G"CoC Program Guidelines" Page 12 of 14
PART 3: HMIS MONITORING
HMIS HOMELESS MANAGEMENT INFORMATION SYSTEMS
HMIS0,erations:Polk and Procedures
1.The Subrecipient has signed an HMIS Participation U Yes
Agreement to use the HMIS license _ C No
2.Are the Subrecipient's HMIS Administers C Yes
registered and approved to enter the data into the C No
HMIS system
3.The Subrecipient has designated an HMIS site U Yes
Administrator(s),who is the Point of Contact for C No
Miami-Dade County through its Homeless Trust as
HMIS Lead Agency.
4.the Subrecipient has ensured that each HMIS user U Yes
within its Organization has signed a user agreement ( I No
stating full understanding of user rules,protocols
and confidentiality.
Privac
1.The Subrecipient has a Data Collection/Privacy C Yes
Notice posted in English and Spanish at each intake 0 No
location
2.The Subrecipient has a written Privacy Policy or C Yes
uses the CoC's written Privacy Policy El No
3.If the Subrecipient has a web site,the Privacy i C Yes
Policy is posted to the web site. C No
4.The Subrecipient has a signed authorization for C Yes
release of information form that it uses for any client 0 No
for which the Suhrecipient uses HMIS for data
stearin. •
5.The Subrecipient ensures that all signed forms are I El Yes
locked in a designated location with limited access to El No
staff -..
6.The Subrecipient has executed the Agency Sharing CI Yes
Data Agreement,if applicable(MOU?) C No i
7.The Subrecipient has a written client complaint C Yes
policy C No
8.The Subrecipient has established a process of it Yes
11 tracking all filed complaints and can provide copies C No
of complaints and resolutions to the HMIS Lead
A ency if requested.
Security
1.The Subrecipient maintains a list of active HMIS C Yes
users El No
2.The Subrecipient regularly contacts the HMIS Lead C Yes
when an employee leaves the Organization,in order CNo
to make sure that the person's HMIS account is
disabled.
3.Are the Subrecipient's HMIS workstations located ,C Yes
in secure locations or,if not,are the workstations •D No
manned at all times?
4.Has the Subrecipient identified a person who will C Yes
serve as the Or•anization's HMIS security officer?
Attachment G"CoC Program Guidelines" Page 13 of 14
❑No
S.Has the HMIS security officer completed an HMIS 1 CD Yes
security self-certification within the last 12 months? J No
6.Does the Subrecipient have in place policies and D Yes
procedures to protect hard copies(paper)with D No
personal identifying information?
Data Quality
At a minimum the Subrecipient collects the Universal O Yes
Data Elements for every client entered and minimum O No
data quality standards are met.
The Subrecipient enters Client Basic Demographic Li Yes
Data into the HMIS system at a minimum within one ❑ No
week of intake
The Subrecipient staff review monthly reports O Yes
•
received from HMIS Program Administrator and O No
addresses any issues noted.
Attachment G"CoC Program Guidelines" Page 14 of 14
FY 2017
Miami-Dade County Homeless Trust
Continuum of Care (CoC) Program
"Incident Report"
ATTACHMENT H"2017 Incident Report"
MIAMFD
MI
yGm.g&.L."fi.q ay
INCIDENT REPORT
IDENTIFYING INFORMATION
Reporting Party Phone# Date of Incident / / _ Time of Incident_ am/pm
Reporting Party Name
Contract Provider Name — —
Program Name
Provider Location
Specific Program'. (check all that apply)
D Miami-Dade County D Primary Care D CoC Program 0 Emergency 0 Challenge D Other
Specific location/address where incident occurred:
TYPE OF INCIDENT
❑ALTERCATION ❑ CLIENT DEATH
❑ CLIENT INJURY OR ILLNESS 0 1HEFT
❑SEXUAL BATTERY ❑SUICIDE ATTEMPT
❑PROPERTY DAMAGE ❑OTHER INCIDENT
Specify
PARTICIPANT (S) /WITNESS (ES)
(Please mark W or P for either Witness or Participant)
LAST NAME,FIRST IDENTIFIER A CLIENT O LOYEE OTHER W/P
— — — ❑ ❑
0
❑ 0 0
DESCRIPTION OF INCIDENT
Give detailed account who,what,where,when,why,how—add pages if necessary
ATTACHMENT H"MDC-HT Incident Report Form"
Page 1 of 2
FY 2017
Miami-Dade County Homeless Trust
Continuum of Care (CoC) Program
"Real Property and Equipment Asset Inventory Report"
ATTACHMENT I"2017 Real Property and Equipment Asset Report"
mimincoyH
De,,3E-d!--E-uNy Real Property and Equipment Asset Inventory
Equipment with an acquisition cost of greater than$5,000.00 per unit and all real property be
inventoried. Real property includes land,land improvements,structures and appurtenances,
moveable machinery and equipment
Property and Property Improvement Record:
Legal description;
Size:
Date of Acquisition:
Value at time of purchase:
Owner's name(if different than the Subrecipient):
Map: (attach map)indicate where property is in parcels,lots or blocks and show adjacent streets and
roads
Equipment 1: _
Description of Property;
Serial/ID Number;
Acquisition Date:
Cost:
Vendor Name:
Wo of Purchase Cost from Grant:
Location of Property:
Use and Condition of Property;
Who Holds Title?
Equipment 2:
Description of Property:
Serial/ID Number:
Acquisition Date:
Cost:
Vendor Name:
of Purchase Cost from Grant:
Location of Property:
Use and Condition of Property:
Who Holds Title? _Equipment 3:
Description of Property:
Serial/ID Number:
Acquisition Date:
Cost:
Vendor Name:
Wo of Purchase Cost from Grant:
Location of Property:
Use and Condition of Property:
Who Holds Title? — J
"(please create additional pages as required)
ATTACHMENT I"Miami-Dade County Real Property and Equipment Asset Inventory"
FY 2017
Miami-Dade County Homeless Trust
Continuum of Care (CoC)
When the Subrecipient is the Housing Administrator
(Leasing or Rental Assistance)
ATTACHMENT "2017 Rental Assistance Forms"
FY 2017
Miami-Dade County Homeless Trust
Continuum of Care (CoC)
When Miami-Dade County is the Rental Administrator
ATTACHMENT K"2017 Rental Assistance Forms"