Loading...
2000 Supportive Housing Program GRANT NUMBER: FL14B000005 AGREEMENT BETWEEN MIAMI-DADE COUNTY GOVERNMENT AND THE CITY OF MIAMI BEACH FOR THE 2000 SUPPORTIVE HOUSING PROGRAM THIS AGREEMENT, entered this .ill day of April 2003, by and between Miami-Dade County (herein called the "Grantee") and the City of Miami Beach, a municipal Corporation of the State of Florida (herein called the "Subrecipient"). WHEREAS, the Grantee has applied for and received funds from the United States Government under Title IV of the Stewart B. McKinney Homeless Assistance Act; and WHEREAS, the Grantee agrees to comply with all requirements of this Agreement and to accept responsibility for such compliance by the Subrecipient to which it makes grant funds available; NOW, THEREFORE, it is agreed between the parties hereto that; I. STATEMENT OF WORK: A. Activities The Subrecipient shall carry out the activities specified in the "Scope of Services" (Attachment A-I), "Number of Beds, Bedrooms, and Participants" (Attachment A-2), "Performance Measures/Goals"(Attachments A-3, A-3{t}), "Client Satisfaction Form" (Attachment A-3{2}),"Project Milestones" (Attachment A-4), and in 24 CFR Part 583, Subpart D on Program Requirements 583.300 in Miami-Dade County (Attachment A-5). The Subrecipient shall also adhere to minimum standards of housing and services as set forth in the "Standards of Care" (Attachment A-6), and incorporated herein by reference. B. Time Schedule 1. The Grantee and the Subrecipient agree to the effective dates for the following activities: (a) This fourteen month (14) Agreement shall begin on Aprilt, 2003. (b) Supportive Services shall become effective on or about April 1, 2003. 2. This Agreement shall expire fourteen month (14) month from the effective date of supportive services, May 31, 2004, or when all funds made available pursuant to this Agreement have been expended. Any cost incurred by the Subrecipient beyond this date will not be paid by the Grantee, except as specifically provided herein. Notwithstanding any provision herein to the contrary, certain requirements imposed on the Subrecipient by this Agreement and Federal regulation may continue for a term of at least twenty (20) years, as provided in this Agreement. GRANT NUMBER: FL14B000005 3. The requirements of this Agreement shall remain in effect during any time period that the Subrecipient has control over any funds generated or provided in connection with this Agreement, including program income. 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, to pay for contracted activities according to the terms and conditions contained within this Agreement, the Subrecipient's application for the Supportive Housing Program, and the Subrecipient's Technical Submission incorporated herein by reference in an amount not to exceed $71,193 for supportive services and $1,654.90 (each) for Administrative Cost (2.5%) for the Subrecipient and the Grantee (total, $3,309.80) (Attachment B, the Budget). The Subrecipient agrees to provide match funds in the amount of$57,100.65 for Supportive Services. Outreach services and housing placement will be proyided throughout the City of Miami Beach for the 2000 Supportive Housing Program (Attachment A-I). The Subrecipient shall adhere to the budget. II. RECORDS AND REPORTS A. Financial Management 1. The Grantee and the Subrecipient shall adhere to the requirements for financial reporting as stated in 24 CFR Part 85.41. 2. Requests for payments, along with documentation for each line item, i.e. invoice for services/housing, capital invoice (if applicable), lease agreement, payroll reports, shall be submitted to the Grantee by the fifteenth (15th) of the month and shall be signed by the Executive Director and the Financial Officer of the Subrecipient, in the form incorporated herein as Attachments C and C-l . 3. Reimbursement shall be proyided only for costs associated with the services detailed in the budget, plus general administrative costs (not to exceed 2.5% of direct costs). 4. Any reimbursement may be withheld pending the receipt and approval by the Grantee of all reports and documents required herein, including but not limited to the submission of the Annual Progress Report. 5. In no event shall the Grantee's funds be advanced to any subcontractor hereunder. 6. The parties agree that the Subrecipient may request the revision of the schedule of payments or the line item budget. Howeyer, such reyisions shall be subject to review and approval by the Grantee. Such requests shall only be considered at the end of a contract year, unless otherwise specifically approyed by the grantee. 2 GRANT NUMBER: FL14B000005 7. A final request for reimbursement from the Subrecipient will be accepted by the Grantee up to thirty (30) days after the expiration of this Agreement. If the Subrecipient fails to comply, all rights to payments will be forfeited if the Grantee so chooses. 8. Within thirty (30) days of the termination or expiration of this Agreement, a final report of expenditures shall be submitted to the Grantee. If after the receipt of such final report, the Grantee determines that the Subrecipient has been paid funds not in compliance with the Agreement, and to which it is not entitled, the Subrecipient will be required to return such funds to the Grantee or submit documentation demonstrating that the expenditure was in compliance with this Agreement. The Grantee shall have the sole and absolute discretion to determine ifthe Subrecipient is entitled to such funds and the Grantee's decision in this matter shall be final and binding. B. Records and Access to Records I. Agreement Records are defined as any and all books, records, client files (including client progress reports, referral forms, etc.), documents, information, data, papers, letters, materials, electronic storage data and media whether written, printed electronic or electrical, however collected or preserved which is or was produced, developed, maintained, completed, received, or compiled by or at the direction of the Subrecipient or any subcontractor directly or indirectly related to the duties and obligations required by terms of this contract, including but not limited to financial books and records, ledgers, drawings, maps, pamphlets, designs, electronic tapes, computer drives and diskettes or surveys. 2. The Subrecipient must maintain Agreement Records that document all actions to comply with this Agreement, including those on race, ethnicity, gender, and disability status data; and those in accordance with generally accepted accounting principles, procedures, and practices as required in Circular OMB-122 which shall sufficiently and properly reflect all revenues and expenditures of funds provided directly or indirectly by the Grantee pursuant to the terms of this Agreement which shall include but not be limited to a cash receipt journal, cash disbursement journal, general ledger, and all such subsidiary ledgers as may be reasonably necessary. 3. 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. 4. The Subrecipient shall ensure that the Agreement Records shall at all times be subject to and available for full access and reyiew, inspection, or audit by Grantee and Federal personnel and any other persons so authorized by the Grantee. 5. The Subrecipient shall include in all the Grantee-approved subcontracts used to engage subcontractors to carry out any eligible substantive programmatic services, as such 3 GRANT NUMBER: FL14B000005 services are described in this Agreement and defined by the Grantee, each of the record- keeping and audit requirements detailed in this Agreement. The Grantee shall, in its sole and absolute discretion, determine when services are eligible substantive programmatic services and subject to the audit and record-keeping requirements described in this Agreement. These records shall be maintained as pursuant to this Agreement. 6. If the Subrecipient receiyed funds from or is under regulatory control of other governmental agencies, and those agencies issue monitoring reports, regulatory examinations, or other similar reports, then the Subrecipient shall provide to the Grantee a copy of each report and any follow-up communications and reports immediately upon such issuance unless such a disclosure is a violation of those agencies' rules. C. Reports The Subrecipient shall submit to the Grantee the reports described below or any other document in whatever form, manner, or frequency as may be requested by the Grantee. These will be used for monitoring the Subrecipient's progress, performance, and compliance with applicable Grantee and Federal requirements. I. Progress Reports - The Subrecipient shall submit monthly status reports using the forms attached hereto as Attachments D, E, and F, "Monthly Progress Report (MPR)," "Outcome/Performance Measurement Report," and "Client Contribution Report", as they may be revised by the Grantee, which shall describe the progress made by the Grantee in achieying each of the objectives identified in Attachment A-t. The reports shall explain the Subrecipient's progress including comparisons of actual versus planned progress for the period. The reports are due by the 15th day of the month, following the close of the month. 2. Annual Progress Report - The Subrecipient shall submit an Annual Progress Report using the United States Department of Housing and Urban Development (HUD) form HUD-401 18, "Annual Progress Report (APR) for Competitive Homeless Assistance Programs" (Refer to Attachment G). The APR is due to the Grantee 40 days after the end of each operating year. The Grantee will submit the final APR to HUD 60 days after the end of the operating year. 3. Audit Reports - The Subrecipient shall provide two (2) copies of an annual certified public accountant's opinion and related financial statements on the organization to the Grantee no later than one-hundred and eighty (180) calendar days following the end of the Subrecipient's fiscal year, for each year during which this Agreement remains in force or until all funds earned from this Agreement have been so audited, whicheyer is later, provided that the Subrecipient has such an opinion prepared. 4. Annual Assurance Report- The Subrecipient who receives assistance only for leasing, operating costs, or supportive services costs must proyide an annual assurance report for each year the assistance is received that the project will be operated for the purpose specified in the application. 5. Disaster Plan-The Subrecipient shall submit an Agency Disaster Plan by June 1st of the Contract Year. 4 GRANT NUMBER: FL14B000005 D. StaffResponsibilitx The staff members for this grant are listed in the Budget document (Refer to Attachment B). E. Special Conditions The Subrecipient shall follow the client referral process as listed in the "Scope of Services," Attachment A. The Subrecipient shall provide any documentation, such as the W -9 form (Refer to Attachment H) to facilitate the reimbursement of services. F. General Conditions The Subrecipient shall comply with all Federal laws, and regulations, as specified in the Applicant Certifications (Attachment I), the 24 CFR Part 583, Supportive Housing Program regulations (Attachment A-5), and all other Federal requirements of this grant. The responsibility for knowledge of and compliance with all Federal requirements is that of the Subrecipient. The Subrecipient shall abide and be governed by the requirements of the Americans with Disabilities Act (ADA). In addition, the Subrecipient agrees to comply with the following requirements. 1. Insurance Government Entity - If the Subrecipient is the State of Florida or an agency or political subdivision of the State as defined by section 768.28, Florida Statutes, the Subrecipient shall furnish the County, upon request, written verification of liability protection in accordance with section 768.28, Florida Statutes. Nothing herein shall be construed to extend any party's liability beyond that provided in section 768.28, Florida Statutes. The Subrecipient shall maintain required liability insurance coverage as noted below at all times during this contract period: Public Liability Insurance on a comprehensive basis in an amount not less than $300,000 combined single limit for bodily injury and property damage. The Grantee must be shown as an additional insured with respect to this coverage, as evidenced by a certificate of insurance. Automobile Liability Insurance covering all owned, non-owned and hired vehicles used in connection with this contract in an amount not less than $300,000 combined single limit for bodily injury and property damage. Workman's Compensation Insurance for all employees of the Subrecipient as required by Fl. Statute 440. 5 GRANT NUMBER: FL14B000005 Flood Insurance shall be maintained as per the requirements in 24 CFR Part 583.330(a). The insurance coverage required shall include these classifications, listed in standard liability insurance manuals, which most nearly reflect the operations of the Subrecipient. All insurance policies required above shall be issued by companies authorized to do business under the laws of the State of Florida, with the following qualifications: The company must be rated no less than "B" as to management, and no less than "Class V" as to financial strength by the latest edition of Best's Insurance Guide, published by A. M. Best Company, Oldwick, New Jersey, or its equivalent, subject to the approval of the County Risk Management Division. or Compliance with the foregoing requirements shall not relieve the Subrecipient of its liability and obligations under this section or under any other section of this Agreement. No modification or waiver of any of the aforementioned insurance requirements shall be made without thirty (30) days written advance notice to the Grantee, and is subject to the approval of the Grantee's Risk Management Division. 2. Indemnification a. 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 the actions or negligence, in whole or in part, of the Subrecipient, its officers, agents, employees, or assignees in the direct or indirect fulfillment of this Agreement. The Subrecipient shall pay all claims and losses of any nature 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 agent of the Grantee. b. If the Subrecipient is a government entity, then it shall indemnifY and hold harmless the County and its officers, employees, agents and instrumentalities from any and all liability, losses or damages, including attorneys' fees and costs of defense, which the County or its officers, employees, agents or instrumentalities may incur as a result of claims, demands, suits, causes of actions or proceedings of any kind or nature arising out of, relating to or resulting from the performance of this Agreement by the government entity or its employees, agents, servants, partners, principals, or subcontractors. Government entity shall pay all claims and losses in connection therewith and shall investigate and defend all claims, suits or actions of any kind or nature in the name of the County, where applicable, including appellate proceedings, and shall pay all costs, judgments, and attorneys' fees which may issue thereon. Provided, however, this indemnification shall only be to the extent and within limitations of Section 768.28, Fla. Stat., subject to the provisions of that Statute whereby the government entity shall not be held liable to pay a personal injury or property damage claim or judgment by anyone person which exceeds the sum of 6 GRANT NUMBER: FL14B000005 $100,000, or any claim or judgment or portions thereof, which, when totaled with all other claims or judgment paid by the government entity arising out of the same incident or occurrence, exceed the sum of $200,000 from any and all personal injury or property damage claims, liabilities, losses or causes of action which may arise as a result of the negligence of the government entity. c. The provisions of this section or indemnification shall survive the expiration or termination of this Agreement. 3. Conflict of Interest a. In regard to procurement, the Subrecipient shall comply with the standards contained within OMB Circular A-II O. b. The Subrecipient shall comply with Dade County Ordinance No. 72-82 (Conflict of Interest Ordinance), as amended, which is incorporated herein by reference as if fully set forth herein, in connection with its contract obligations hereunder. (Attachment J, Section XI) The Subrecipient shall disclose to the Grantee in writing any possible or actual conflicts of interest or apparent improprieties of the kind addressed herein. The Subrecipient shall make each disclosure in writing to the Grantee immediately upon the Subrecipient's discovery of such possible conflict. The Grantee will then render an opinion which shall be binding on all parties. 4. Affidavits - Complete and notarize, Attachments J, K, and 0, acknowledging compliance with the following Miami-Dade County Affidavits: a. Disability Nondiscrimination Affidavit (Attachment J, Section VIII). b. Family Leave Plan Affidavit (Attachment J, Section VII). c. Drug-free Workplace Affidavit - Ordinance No. 92-15 (Attachment J, Section VI). d. Miami-Dade County Disclosure Affidavit (Attachment J, Section I). e. Miami-Dade County Employment Disclosure Affidavit (Attachment J, Section I). f. All Subrecipients are advised that in accordance with Section 2-1 I.1 (s) of the Code of Miami-Dade County, the Lobbyists Registration for Oral Presentation Affidavit, (Attachment K) MUST be completed, notarized, and included with the Agreement. Lobbyist specifically includes the principal, as well as any agent, officer, or employee of a principal, regardless of whether such lobbying activities fall within the nonnal scope of employment of such agent, officer or employee. g. Miami-Dade County Criminal Record Affidavit (Attachment J, Section IV). 7 GRANT NUMBER: FL14B000005 h. Delinquent and Currently Due Fees or Taxes - The Subrecipient has duly executed the Affidavit regarding "Delinquent and Currently Due Fees or Taxes" as required by Section 2-8.1 (c) of the County Code and that affidavit is attached hereto as (Attachment J, Section IX). The Subrecipient understands that the County has relied on the aforementioned representation in entering this contract. I. Affirmative Action/Nondiscrimination of Employment, Promotion and Procurement Practices (County Ordinance 98-30) (Attachment J, Section III). J. Project Fresh Start (Resolutions R-702-98 and 358-99) (Attachment J, Section X). k. Public Entity Crimes (Attachment 0). G. Civil Ri!!hts - The Subrecipient agrees to abide by Chapter llA of the Code of Miami-Dade County ("County Code"), as amended, which prohibits discrimination in employment, housing and public accomodations. Where applicable the Subrecipient agrees to abide and be governed by Title VI and VII, Civil Rights Act of 1964 (42 USC 2000 D&E) and Title VIII of the Civil Rights Act of 1968, as amended, and Executive Order 11063 which provides in part that there will be no discrimination of race, color, sex, religious background, ancestry or national origin in performance of this Agreement, in regard to persons served, or in regard to employees or applicants for employment or housing. It is expressly understood that upon receipt of evidence of such discrimination, the County shall have the right to terminate said Agreement. It is further understood that the Subrecipient must submit an affidavit attesting that it is not in violation of the American with Disabilities Act, the Rehabilitation Act, the Federal Transit Act, 49 USC ~ 1612, and the Fair Housing Act, 42 USC ~ 3601 et seq. If the Subrecipient or any owner, subsidiary, or other firm affiliated with or related to the Subrecipient, is found by the responsible enforcement agency, the Courts or the County to be in violation of these Acts, the County will conduct no further business with the Subrecipient. Any contract entered into based upon a false affidavit shall be voidable by the County. If the Subrecipient violates any of the Acts during the term of any Contract the Subrecipient has with the County, such Contract shall be voidable by the County, even if the Subrecipient was not in violation at the time it submitted its affidavit. The Subrecipient agrees that it is in compliance with the Domestice Violence Leave, codified as ~ ll-A60 et. Seq. of the Miami-Dade County Code, which requires an employer, who in the regulare Course of business has fifty (50) or more employees working in Miami-Dade County for each working day during each of twenty (20) or more calendar work weeks to provide domestic yiolence leave to its employees. Failure to comply with this local law may be grounds for yoiding or terminating this Contract or for commencement of debarment proceedings against the Subrecipient. The Subrecipient also agrees to abide and be governed by the Age Discrimination Act of 1975, as amended, which provides in part that there shall be no discrimination against persons in any area of employment because of age. The Subrecipient agrees to abide and be goverened by Section 504 of the Rehabilitation Act of 1973, as amended, 29 USC 794, which 8 GRANT NUMBER: FL14B000005 prohibits discrimination on the basis of handicap. The Subrecipient agrees to abide and be governed by the requirements of the Americans with Disabilities Act (ADA). III. SUSPENSION AND TERMINATION A. Suspension The Grantee may, for reasonable cause, temporarily suspend the Subrecipient's operations and authority to obligate funds under this Agreement or withhold payments to the Subrecipient pending necessary corrective action by the Subrecipient or both. Reasonable cause shall be determined by the Grantee and in its sole and absolute discretion and may include: I. Ineffective or improper use of any funds provided hereunder by the S ubrecipient; 2. Failure by the Subrecipient to materially comply with any terms, conditions, representations or warranties contained herein; 3. Failure by the Subrecipient to submit any documents required by this Agreement; or 4. The Subrecipient's submittal of incorrect or incomplete documents. B. Termination I. Termination at Will - This Agreement, in whole or in part, may be terminated by the Grantee upon no less than fifteen (I 5) working days notice when the Grantee determines that it would be in the best interest of the Grantee and/or the recipient materially fails to comply with the terms and conditions of an award. Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery. The Subrecipient will have five (5) days from the day the notice is delivered to state why it is not in the best interest of the Grantee to terminate the Agreement. However, it is up to the discretion of the Grantee to make the final determination as to what is in its best interest. 2. Termination for Convenience - The Grantee 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 upon the termination conditions, including the effectiye date and in the case of partial termination, the portion to be terminated. However, if the grantee determines in the case of partial termination that the reduced or modified portion of the grant will not accomplish the purposes for which the grant was made it may terminate the grant in its entirety. 3. Termination Because of a Lack of Funds - In the event funds to finance this Agreement become unavailable, the Grantee may terminate this Agreement upon no less than twenty-four (24) hours notice in writing to the Subrecipient. 9 GRANT NUMBER: FL14B000005 Said notice shall be sent by certified mail, return receipt requested, or in person with proof of delivery. The Grantee shall be the final authority to detennine whether or not funds are available. 4. Termination for Breach - The County may tenninate this Agreement, in whole, or in part, when the County determines in its sole and absolute discretion that the Provider is not making sufficient progress in its performance of this Agreement as outlined in Attachment A-I, Scope of Services, or is not materially complying with any term or provision provided herein, including the following: 1) The Provider ineffectively or improperly uses the County funds allocated under this Contract; 2) the Provider does not furnish the Certificates of Insurance required by this contract or as determined by the County's Risk Management Division; 3) the Provider does not furnish proof of licensure/certification or proof of background screening required by this Contract; 4) the Provider fails to submit or submits incomplete or incorrect detailed reports of expenditures or final expenditure reports; 5) the Provider does not submit or submits incomplete or incorrect required reports; 6) the Provider refuses to allow the County access to records or refuses to allow the County to monitor, evaluate and review the Provider's program; 7) the Provider discriminates under any of the laws outlined in Section I1(G) of this Contract; 8) the Provider fails to provide Domestic Violence Leaye to its employees pursuant to local law; 9) the Proyider falsifies or yiolates the proyisions of the Drug Free Workplace Affidavit; 10) the Provider attempts to meet its obligations under this contract through fraud, misrepresentation or material misstatement; 11) the Provider fails to correct deficiencies found during a monitoring, evaluation or review within the specified time; 12) the Provider fails to meet the tenns and conditions of any obligation under any contract or otherwise or any repayment schedule to the County or any of its agencies or instrumentalities; 13) fails to meet any of the tenns and conditions of the Miami-Dade County Affidavits; 14) the Provider fails to comply with the provisions of Section C, No. 18 relating to contracts with municipalities or counties outside Miami-Dade County to provide homeless housing in Miami-Dade County. 15) -l-4) the Provider fails to fulfill in a timely and proper manner any and all of its obligations, covenants, agreements and stipulations in this Contact. The Provider shall be given written notice of the claimed breach and 10 business days to cure same. Unless the Provider's breach is waived by the County in writing, or unless the Provider shall have failed after receiving written notice of the claimed breach by the County to take steps to cure the breach within 10 business days after receipt of the breach, the County may, by written notice to the Proyider, tenninate this Agreement upon no less than twenty-four (24) hours notice. Said notice shall be sent by certified mail, return receipt requested, or in person with proof of delivery. Waiver of breach of any provision of this Agreement shall not be construed to be a modification of the tenns of this Agreement. The provisions contained herein do not limit the County's right to legal or equitable remedies or any other provision for tennination under this contract. Such individual or entity shall be responsible for all direct and indirect costs associated with such tennination or cancellation, including attorney's fees. Any individual or entity who attempts to meet its contractual obligations with the County through fraud, misrepresentation or material misstatement may be disbarred from County contracting for up to fiye (5) years. 10 GRANT NUMBER: FL14B000005 IV. REVERSION OF ASSETS A. Term of Commitment If the Subrecipient receives assistance for acquisition, rehabilitation, or new construction, then the Subrecipient shall agree to operate the supportive housing or proyide supportive services in accordance with this Agreement for a term of at least 20 years from the date of initial occupancy or date of initial service provision. If the United States Department of Housing and Urban Development (HUD) determines a project is no longer needed for use as supportive housing or to proyide supportiye services, then 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 ( 24 CFR 583.305 (a) ). B. Repavment of Grant If the Subrecipient does not provide supportiye housing or supportive services for 10 years following the date of initial occupancy or date of initial service provision pursuant to this Agreement, then the Grantee shall require repayment of the entire amount of the grant used for acquisition, rehabilitation, or new construction, unless conyersion of the project has been authorized pursuant to the terms in the Term of Commitment Section, IV-A of this document (24 CFR 583.305 (b) ). If the supportiye housing is used for such purposes as stated in Section IV -A for more than 10 years, then the Subrecipient's repayment amount will be reduced by 10 percentage points for each year beyond the I O-year period in which the project is used for supportive housing (24 CFR 583.305 (b)). C. Prevention of Undue Benefits Upon the sale or other disposition of a project assisted with acquisition, rehabilitation, or new construction funds occurring before the expiration of the 20-year period, the Subrecipient must comply with such terms and conditions as HUD may prescribe to prevent the Subrecipient from unduly benefiting from such sale or disposition. The Subrecipient will not be required to comply with the terms specified in this section or section IV-B, if the sale or disposition of the project results in the use of the project for the direct benefit of very low- income persons or if all proceeds are used to provide supportive housing meeting the requirements of this part (24 CFR 583.305 (c) ). The Subrecipient shall return to the Grantee, upon the expiration or termination of this Agreement, any funds on hand, any accounts receivable attributable to these funds, and any overpayment due to unearned funds or costs disallowed pursuant to the terms of this Agreement that were disbursed to the Subrecipient by the Grantee. D. Reyocation of License or Permit 11 GRANT NUMBER: FL14B000005 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 tennination of this Agreement upon no less than twenty-four hours notice. Said notice shall be certified by mail or hand delivery V. UNIFORM ADMINISTRATIVE REQUIREMENTS A. Accounting Standards, Cost Principles, and Regulations 1. The Subrecipient shall comply with Federal accounting standards and cost principles according to OMB Circular A-122 and SHP Regulations (24 CFR 583.135). 2. The Subrecipient shall comply with applicable provisions of applicable Federal, State, and County laws, regulations, and rules such as OMB Circular A-II 0, OMB Circular A- 21, and OMB Circular A-133 and with the Energy Policy and Conservation Act (Public Law 94-163) which requires mandatory standards and policies relating to energy efficiency. If any provision of this contract conflicts with any applicable law or regulation, only the conflicting provision shall be deemed by the parties hereto to be modified to be consistent with the law or regulation or to be deleted if modification is impossible. However, the obligations under this contract, as modified, shall continue and all provisions of this contract shall remain in full force and effect. 3. If the amount payable to the Subrecipient pursuant to the tenns of this contract is in excess of $1 00,000, the Subrecipient shall comply with all applicable standards, orders, or regulations issued pursuant to Section 306 of the Clean Air Act of 1970 ( 42 V.S.C. 1857 (h)), as amended; the Federal Water Pollution Control Act (33 U.S.C. 1251), as amended; Section 5080fthe Clean Water Act (33 V.S.C. 1368); Environmental Protection Agency regulations (40 CFR Part 15); Executive Order 11738; and Environmental Review Procedures and Regulations (24 CFR Part 58 and 24 CFR Part 583.230). B. Retention of Records I. The Subrecipient shall retain records pertinent to expenditures and all Agreement Records for a period of at least three (3) years (hereinafter referred to as "Retention Period. ") For all non-Grantee assisted activities the Retention Period shall begin upon the expiration or termination of this Agreement. 2. If the Grantee or the Subrecipient has receiyed or been given notice of any kind indicating any threatened litigation, claim or audit arising out of the services provided pursuant to the terms of this Agreement, the Retention Period shall be extended until such time as the threatened or pending litigation, claim or audit is, in the sole and absolute discretion of the Grantee, fully, completely and finally resolved. 3. The Subrecipient shall allow the Grantee or any persons authorized by the Grantee full access to and the right to examine any of the Agreement Records during the required Retention Period. 12 GRANT NUMBER: FL14B000005 4. The Subrecipient shall notify the Grantee in writing both during the pendency of this Agreement and after its expiration as part of the final close-out procedure, of the address where all the Agreement Records will be retained. 5. The Subrecipient shall obtain the prior written approyal of the Grantee for the disposal of any Agreement Records before disposing of such Records within one year after expiration of the Retention Period. C. Additional Requirements The Subrecipient must comply with the following additional requirements. 1. Client Rules and Regulations - The Subrecipient shall submit a copy of the Client Rules and Regulations that apply to clients referred to the Subrecipient pursuant to this Agreement; due within thirty (30) days following the execution of this Agreement. 2. Personnel Policies and Administrative Procedure Manuals _ The Subrecipient shall submit detailed documents describing the Subrecipient's internal corporate or organizational structure, property management and procurement policies and procedures, personnel management, accounting policies and procedures, etc. The information shall be available to the Grantee upon a request. 3. Monitoring - The Subrecipient shall permit the Grantee and any other persons authorized by the Grantee to monitor, according to applicable regulations, all Agreement Records, facilities, goods and activities of the Subrecipient which are in any way connected to the activities undertaken pursuant to the terms of this Agreement, and/or to interview any clients, employees, subcontractors, or assignees of the Subrecipient. The Grantee shall monitor both fiscal and programmatic compliance with all terms and conditions of this Agreement to include a review of beneficiaries, supportive services, operating costs, program progress, documentation for required match, record keeping, compliance with circulars, administrative costs, technical assistance visits, and environmental review. The Subrecipient shall permit the Grantee to conduct site visits, client assessment surveys, and other techniques deemed reasonably necessary to fulfill the monitoring function. A report of the Grantee's findings may be delivered to the Subrecipient, and if so delivered, the Subrecipient shall rectify all deficiencies cited within the period of time specified in the report. 4. Restrictions of Funds Use - The funds received under this Agreement (or any State or local government funds used to supplement this Agreement) may not be used to replace state or local funds previously used, or designated for use to assist homeless persons ( 24 CPR Part 583.150 (a)). The Subrecipient shall notify the Grantee of any additional funding receiyed for any activity described in this Agreement, other than the "Client Contribution Report" which is addressed in II-C(l). Such notification shall be in writing and received by the Grantee within thirty (30) days of the Subrecipient's notification by the funding source. 13 GRANT NUMBER: FL 14B000005 5. Related Parties - The Subrecipient shall report to the Grantee the name, purpose, and any other relevant information in connection with any transaction conducted between the Subrecipient and a related party transaction. A related party includes, but is not limited to, a for-profit or nonprofit subsidiary or affiliate organization, and organization with overlapping boards of directors or any organization for which the Subrecipient is responsible for appointing members. The Subrecipient shall report this information to the Grantee upon forming the relationship or if already formed, shall report it immediately. Any supplemental information shall be reported in the Grantee required Agency Narrative and Progress Report which are addressed in II-C (1). 6. Required Meeting Attendance - From time to time, the Miami-Dade County Homeless Trust may schedule meetings and/or training sessions to assist the Subrecipient in the performance of its contractual obligations or to inform the Subrecipient of new and/or revised policies and procedures. Attendance at some of these meetings may be mandatory. The Subrecipient shall receiye notice no less than three (3) business days prior to any meeting or training session that requires mandatory participation. A record of attendance at meetings or training sessions where notice was given indicating the Subrecipient's mandatory participation shall be kept, and the Subrecipient's contractual compliance will be monitored. Failure to attend a meeting/training sesion for which a mandatory notice has been provided can result in material non-compliance of the contract/agreement, up to and including breach or default. Proof of notice shall consist of fax record, certified mail, and/or verbal communication with the contract/agreement contact person or other program administrative staff. The Subrecipient may select one or more employees from their agency, directly involved in the contracted program, as their representative at the meeting/training session; the participation of the Agreement contact person is preferred. The Subrecipient may request to be excused from a mandatory meeting. That request must be received at least twenty-four (24) hours prior to the meeting date and time, and justification proyided, including why the agency could not send any representative. The Miami-Dade County Homeless Trust shall determine whether or not the absence will be excused; the Subrecipient shall not be excused from more than two (2) meetings/training sessions during each contract year. The Subrecipieint is encouraged to attend all meetings of the Miami-Dade County Homeless Trust and/or its Committees, as information relevant to their program or services may be discussed. 7. Publicity and Advertisements The Subrecipient shall ensure that all publicity and advertisements prepared and released by the Subrecipient, such as pamphlets and news releases already or indirectly related to activities funded pursuant to this Agreement, and all events carried out to publicize the accomplishments of any activity funded pursuant to this Agreement, recognize the Grantee as its funding source. The Subrecipient shall ensure that all media representatiyes, when inquiring about the activities funded pursuant to this Agreement, are informed that the Grantee is the funding source. 8. Procurement - The Subrecipient shall make a POSItIve effort to procure supplies, equipment, construction or services necessary or related to carrying out the terms of this Agreement from minority and women's businesses, and to provide these sources 14 GRANT NUMBER: FL14B000005 maximum feasible opportunity to compete for subcontracts to be performed pursuant to this Agreement. In conformance with Section 3 (Attachment N) of the Housing and Urban Development (000) Act of 1968, as amended, 12 U.S.C. l70lu (Section 3), work performed under this contract are subject to requirements of this section. The purpose of Section 3 is to ensure that employment and other economic opportunities generated by 000 assistance ofOOD-assisted projects covered by Section 3, shall to the greatest extent feasible, be directed to low and very low-income persons, particularly persons who are recipients of 000 assistance for housing and to businesses that are substantially owned or substantially employ low and very low income persons. 9. Property a. Any real property under the Subrecipient's control that was acquired/improved in whole or in part with funds from the Homeless Trust for $150 or more shall be disposed of, at the expiration or termination of this contract, in accordance with instruction from the Homeless Trust. Real Property is defined as land, land improyements, structures, fixtures and appurtenances thereto, including movable machinery and equipment, vehicles, furniture, and office equipment. b. All real property purchased in whole or in part with funds from this and previous contracts with the Homeless Trust, or transferred to the Subrecipient after being purchased in whole or in part with funds from the Homeless Trust shall be listed in the property records of the Subrecipient and shall include a legal description, size, date of acquisition, value at time of purchase, owner's name if different from the Subrecipient, information on the transfer or disposition of the property, and map indicating whether property is in parcels, lots or blocks and showing adjacent streets and roads. A copy of the purchase receipt for any asset purchased with Homeless Trust funds must also be included in the Subrecipient's monthly reimbursement package submitted to the Homeless Trust in the month in which the item was purchased. c. All real property shall be inventoried annually by the Subrecipient and an inventory report shall be submitted to the Homeless Trust. This report shall include the elements listed in Paragraph 8.II.b above. 10. Management Evaluation and Performance Review _ The Grantee may conduct a formal management evaluation and performance review of the Subrecipient following the expiration of this Agreement. The management evaluation will reflect the Subrecipient's compliance with generally accepted fiscal and organizational standards and practices. The performance review will reflect the quality of service provided and the yalue received using monitoring data such as progress reports, site visits, and client surveys. 11. Subcontracts and Assignments a. The Subrecipient shall ensure that all subcontracts and assignments: (1) Identify the full, correct and legal name of the party; 15 GRANT NUMBER: FL14B000005 (2) Describe the activities to be performed; (3) Present a complete and accurate breakdown of its price component; (4) Incorporate a provision requiring compliance with all applicable regulatory and other requirements of this Agreement with any conditions of approval that the Grantee deems necessary. This applies only to subcontracts and assignments in which parties are engaged to carry out any eligible substantive programmatic service as set forth in this Agreement. The Grantee shall in its sole and absolute discretion determine when services are eligible substantive programmatic services subject to the audit and record-keeping requirements described above, and; b. In accordance with Ordinance No. 97-104, all bidders and respondents on County contracts for purchase of supplies, materials or services, including professional services, which involye the expenditure of$100,00 or more and all bidders or respondents on County or Public Health Trust construction contracts which involve the expenditure of $100,000 or more shall include, as part of their bid or proposal submission, a listing (Attachment L) which identifies all first tier subcontractors who will perform any part of the contract work and describes the portion of the work such subcontractor will perform, and all contract work direct to the bidder or respondent and describes the materials to be so supplied. Failure to include such listing with the bid or proposal shall render the bid or proposal non- responsive. Ordinance 97-104 applies to all contracts whether competitively bid by the County or not. Those contracts that have received authorization by the Board of County Commissioners to waive formal bidding procedures must also provide a listing of all first tier subcontractors and direct suppliers. Subcontractor/Supplier Listing, SUB Form 100 (Attachment M) may be utilized to provide the information required by this paragraph. A bidder or respondent who is awarded the contract shall not change or substitute first tier subcontractors or direct suppliers or the portions of the contract work to be performed or materials to be supplied from those identified in the listing submitted with the bid or proposal except upon written approval of the County. c. The Subrecipient shall incorporate in all consultant subcontracts this additional provision: The Subrecipient is not responsible for any insurance or other fringe benefits for the consultant or its employees, e.g., social security, income tax withholdings, retirement or leave benefits. The Consultant assumes full responsibility for the provision of all insurance and fringe benefits for himself or herself and employees retained by the Consultant in carrying out the Scope of Services provided in this subcontract. d. The Subrecipient shall be responsible for monitoring the contractual performance of all subcontracts. 16 GRANT NUMBER: FL14B000005 e. The Subrecipient shall receive written documentation prior to entering into any subcontract which contemplates performance of substantiye programmatic activities, as such is determined as provided herein. The Grantee's approval shall be obtained prior to the release of any funds to the subcontractor. f. The Subrecipient shall receive written approval from the Grantee prior to either assigning or transferring any obligations or responsibility set forth in this Agreement or the right to receive benefits or payments resulting from this Agreement. g. Approval by the Grantee of any subcontract or assignment shall not under any circumstances be deemed to provide for the incurring of any obligation by the Grantee in excess of the total dollar amount agreed upon in this Agreement. 12. The Grantee's Consultant - The Grantee understands that in order to facilitate the implementation of this Agreement, the Grantee may from time to time designate a development consultant to work with the Subrecipient. The Grantee's consultant shall be considered the Grantee's designee with respect to all portions of this Agreement with the exception of those provisions relating to payment of the Subrecipient for services rendered. The Grantee shall provide written notification to the Subrecipient of the name, address, and employees of the Grantee's consultant. 13. Participation in Managed Information System - The Subrecipient agrees to participate in the Managed Information System (MIS) selected and established by the County. Participation will include, but is not limited to, daily updates of bed availability information, updates of client files, and entering data for statistical purposes. The Subrecipient understands that they are responsible for any ongoing cost to access the MIS system. 14. Year 2000 Requirements - The Subrecipient agrees to the following to ensure compliance with the Year 2000 requirements: A. Computer equipment, software and systems must meet the following requirements: 1. The software must perform fault-free in the processing of date and date- related data (including, but not limited to calculating, comparing, and sequencing) by all hardware and software products delivered under this contract/procurement, individually, and in combination, upon installation. Fault-free performance includes the manipulation of data with dates prior to, through, and beyond January 1, 2000,and shall be transparent to the user. 2. Hardware and software products, individually and in combination, shall successfully transition into the Year 2000 with correct system date, without human intervention, including leap year calculations. Hardware and software products, individually and in combination, shall also provide correct results when moving forward or backward in time across the Year 2000. 17 GRANT NUMBER: FL14B000005 15. Miami-Dade County Inspector General Review -According to Section 2-1076 of the Code of Miami-Dade County, as amended by Ordinance No. 99-63, Miami-Dade County has established the Office of the Inspector General which may, on a random basis, perform audits on all County contracts, throughout the duration of said contracts, except as otherwise provided below. The cost of the audit of any Contract issued as a result of this RFP shall be one-quarter (114) of one (1) percent of the total contract amount which cost shall be included in the total proposed amount. The audit cost will be deducted by the County from progress payments to the selected Proposer. The audit cost shall also be included in all change orders and all contract renewals and extensions. Exception: The above application of one quarter (114) of one percent fee assessment shall not apply to the following contracts: (a) IPSIG contracts; (b) contracts for legal services; (c) contracts for financial advisory services; (d) auditing contracts; (e) facility rentals and lease agreements; (f) concessions and other rental agreements; (g) insurance contracts; (h) revenue-generating contracts; (I) contracts where an IPSIG is assigned at the time the contract is approved by the Commission; (j) professional service agreements under $1,000; (k) management agreements; (1) small purchase orders as defined in Miami-Dade County Administrative Order 3-2; (m) federal, state and local government-funded grants; and (n) interlocal agreements. Notwithstanding the foregoing, the Miami-Dade County Board of County Commissioners may authorize the inclusion of the fee assessment of one quarter (1/4) of one percent in any exempted contract at the time of award. Nothing contained above shall in any way limit the powers of the Inspector General to perform audits on all County contracts including, but not limited to, those contracts specifically exempted above. 16. INDEPENDENT PRIVATE SECTOR INSPECTOR GENERAL REVIEW Pursuant to Miami-Dade County Administrative Order 3-20 and in connection with any award issued as a result of this RFP, the County has the right to retain the services of an Independent Private Sector Inspector General ("IPSIG"), whenever the County deems it appropriate to do so. Upon written notice from the County, the selected Proposer shall make ayailable, to the IPSIG retained by the County, all requested records and documentation pertaining to this RFP or any subsequent award, for inspection and copying. The County will be responsible for the payment of these IPSIG services, and under no circumstance shall the Proposer's cost/price for this RFP be inclusive of any charges relating to these IPSIG services. The terms of this provision herein, apply to the Proposer, its officers, agents, employees and assignees. Nothing contained in this provision shall impair any independent right of the County to conduct, audit or investigate the operations, activities and performance of the selected Proposer in connection with this RFP or any contract issued as a result of this RFP. The terms of this provision are neither intended nor shall they be construed to impose any liability on the County by the selected Proposer or third party. 17. Renegotiation or Modification - Modifications of provisions of this Agreement shall be valid only when in writing and signed by duly authorized representatives of each party. Additional conditions are: 18 GRANT NUMBER: FL14B000005 a. A Subrecipient may not make any significant changes to an approved program without prior Grantee approval. Significant changes include, but are not limited to, a change in the Subrecipient, a change in the project site, additions or deletions in the types of actiyities listed in 24 CFR Part 583.100 approved for the program or a shift of more than 10 percent of funds from one approved type of activity to another, and a change in the category of participants to be served. Depending on the nature of the change, the Grantee may require a new certification of consistency with the Consolidated Plan Certification from the United States Department of Housing and Urban Development b. Approval for changes is contingent upon the application ranking remaining high enough after the approved change to have been competitively selected for funding in the year the application was selected. The parties agree to renegotiate this contract if the Grantee determines, in its sole and absolute discretion, that Federal state, and/or Grantee revisions of any applicable law or regulations, or increases or decreases in budget allocations make changes in this Agreement necessary. The Grantee shall be the final authority in determining whether or not funds for this Agreement are ayailable due to Federal, state and/or Grantee revisions of any applicable laws or regulations, or increases in budget allocations. Notwithstanding the foregoing, the Grantee retains all the rights of suspension or termination set forth in Section III of this Agreement. After the initial grant agreement, the Grantee will not make revisions to increase the amount of the award to the Subrecipient. 18. Contracts with Municipalities or Counties Outside Miami-Dade County to Provide Homeless Housing in Miami-Dade County. - The above-named firm, corporation, organization or individual ("provider") desiring to transact business or enter into a contract with the County for the provision of homeless housing and lor services swears, verifies, affirms and agrees that (1) it has not entered into any current contract, arrangement of any kind, or understanding with any municipality outside of Miami-Dade County or any County (collectively "locality") to provide housing and services for homeless persons in Miami-Dade County who are transported to Miami-Dade County by or at the behest of such locality and (2) during the term of this contract, it will not enter into any such contract, arrangement of any kind, or understanding; provided, however, upon the written request of the Contractor prior to entering into such contract, understanding or arrangement, the Miami-Dade County Homeless Trust may, in its sole and absolute discretion, find and determine within 60 days of such request that a proposed contract should not be prohibited hereby, as the best interests of the homeless programs undertaken by and on behalf of Miami-Dade County would not be negatively affected by such contract, arrangement, or undertaking. 19. Right to Waive - The Grantee may, for good and sufficient cause, as determined by the Grantee in this sole and absolute discretion, waive provisions in this Agreement or seek to obtain such waiver from the appropriate authority. Waiver requests from the Subrecipient shall be in writing. Any waiver shall not be construed to be a modification of this Agreement. 19 GRANT NUMBER: FL14B000005 20. Disputes - In the event an unresolved dispute exists between the Subrecipient and the Grantee, the Grantee shall refer the questions, including the views of all the interested parties and the recommendation of the Grantee, to the CountyManager for determination. The County Manager, or an authorized representative, will issue a determination within thirty (30) calendar days of receipt and so adyise the Grantee and the Subrecipient, or in the event additional time is necessary, the Grantee will notify the Subrecipient within the thirty (30) day period that additional time is necessary. The Subrecipient agrees that the County Manager's determination shall be final and binding on all parties. 21. Headings - The article and paragraph headings in this Agreement are inserted for convenience only and shall not affect in any way the meaning or interpretation of this Agreement. 22. Proceedings - This Agreement shall be construed in accordance with the laws of the State of Florida and any proceedings arising between the parties in any manner pertaining or relating to this Agreement shall, to the extent permitted by law, be held in Dade County, Florida. 23. Notice and Contact - The Grantee's representative for this Agreement is David Ra mond The SubresJpient's representative for this Agreement is \ JJ4, Il.JZ.U teL brecipient's principal office is at 17 ~ PIi. . In the event that different representatives are designated by either party after this Agreement is executed, or the Subrecipient changes its address, notice of the name of the new representatiye or new address will be rendered in writing to the other party and said notification attached to the originals of this Agreement. 24. Name and Address of Payee - When payment is made to the Subrecipient's assignee, the name and address of the official payee isC ity o-?' #,Clr>1i ~ . 25. AU Terms and Conditions Included - This Agreement and its attachments as referenced contain all the terms and conditions agreed upon by the parties. 26. Autonomy - Both parties agree that this Agreement recognizes the autonomy of and stipulates or implies no affiliation between the contracting parties. 27. Severability of Provisions - If any provision of this Agreement is held invalid, the remainder of this Agreement shall not be affected thereby if such remainder would then continue to conform to the terms and requirements of applicable law. 28. Waiver of Trial - Neither the Subrecipient, subcontractor nor any other person liable for the responsibilities, obligations, services and representations herein, nor any assignee, successor heir or personal representative of the Subrecipient, subcontractor or any such other persons or entity shall seek a jury trial in any lawsuit, proceeding, counterclaim or other litigation procedure based upon or arising out of this Agreement, or the dealings or the relationship between or among such persons or entities, or any of them. Neither the Subrecipient, subcontractor nor any such person or entity shall seek to consolidate any such action in which ajury trial has been waived. The proyisions of this paragraph have been fully discussed by the parties hereto, and the provision hereof shall be subject to no exceptions. No party has in any way agreed with or represented to any other party that the provisions of this paragraph will not be fully enforced in all instances. 20 GRANT NUMBER: FL14B000005 VI. RELIGIOUS ORGANIZATIONS As reported in 24 CFR Part 583.150, HUD will provide assistance to a recipient that is a primarily religious organization, if the organization agrees to provide housing and supportiye services in a manner that is free from religious influences and in accordance with the following principles: 1. It will not discriminate against any employee or applicant for employment on the basis of religion and will not limit employment or give preference in employment to persons on the basis of religion; 2. It will not discriminate against any person applying for housing or supportiye services on the basis of religion and will not limit such housing or services or give preference to persons on the basis of religion; and 3. It will provide no religious instruction or counseling, conduct no religious worship or services, engage in no religious proselytizing, and exert no other religious influence in the provision of housing and supportive services. HUD will provide assistance to a recipient that is a primarily religious organization if the assistance will not be used by the organization to construct a structure, acquire a structure or to rehabilitate a structure owned by the organization, except as described in 24 CFR Part 583.150 (b )(2)(Attachment A-5). 21 GRANT NUMBER: FL14B000005 IN WITNESS WHEREOF, the parties have caused this twen -t executed by their respective and duly authorized officers the day and y ar WITNESSES: NAME: NAME: NAME: I TURE )h If/{ ;' /I f. M Itfr?1'uP L. (PRINT) ~~ \S){{~L-" (SIGNA TURE) ~-. V NAME: BY: ~Yf~ CITY CLERK ATTEST: BY: ~~~r DE~7h:~~. (DATE) Approved as to form and legal sufficiency: ~ fo/I ~ 22 BY NAME: t MA.~ (TITLE) +.7.0~ (DATE) (SEAL) The City of Miami Beach, Florida, a municipal corporation of the State of Florida ("Subrecipient") ~.A~ J-f'7,03 rge M. Gonzalez Date CITY MANAGER (SEAL) MIAMI-DADE COUNTY, a political subdiyision of the State of Florida a '. "'-.'-\'--'-c,.~'l': APPROVED AS TO FORM & LANGUAGE & FOR EXECUTION ~~ $f&;O? Attachment A-I SCOPE OF SERVICES City of Miami Beach Office of Homeless Coordination: The Contractor agrees to provide outreach and housing placement for a minimum of 360 homeless men and women in a year or 420 over the grant term (14 months). Of these 360 homeless individuals, 25 will be families with children. Of the 25 families, 15 will be disabled, 30 will be adults and 29 will be children. These homeless men and women placed in housing through this initiative will be housed for a minimum of 7 days. Outreach and placement services will include but not be limited to: 1. Based on outreach efforts, a minimum of 360 homeless men and women or 420 over the grant term (14 months) will be placed in housing (not limited to Miami Beach) suited to their immediate needs, for a minimum of 7 days. The contractor shall make its best effort to ensure that housing is provided in excess of 7 days and that persons may avail themselves of the continuum of care. Conditions: 1. Homeless men and women and children living outside as well as the mentally ill homeless will receive outreach priority through this grant. 2. The Contractor shall work closely and cooperatively with the Miami-Dade County and City of Miami outreach and placement teams, as well as other community based outreach efforts. 3. The Contractor shall work closely and cooperatively with other services supported by this grant, e.g., health services, mental health services, employment and job counseling, housing placement. 4. The Contractor shall place homeless individuals and families in appropriate housing _ emergency shelter, transitional or permanent - through Miami-Dade County. 5. The Contractor shall submit monthly fiscal and program reporting forms required and supplied by Miami-Dade County Homeless Trust. 6. The Contractor will achieve the following outcomes in addition to the performance criteria noted above: a. Contact at least 80 homeless individuals per week or a minimum of 4,000 per year. A contact is defmed by a conversation with a homeless person, in which you are trying to engage into services. Contacts will be measured on a Contact Log. b. Place at least 30 homeless individuals a month in housing for a minimum of 7 days, totaling at least 360 per year or 420 over the grant term (14 months). (Measurement of this will be in case follow-up Notes and referral log). c. At least 75% of the responding homeless individuals that are placed in housing will report satisfaction in outreach services received, as measured through the client satisfaction services. 7. Reimbursement shall be limited to services and the costs for providing the services as described in the Sub-recipient's application. 8. Reimbursement shall be made only for the cost incurred for services actually provided to clients, unless the Grantee agrees, in writing, to another mode of payment, as provided for in this Agreement. 9. Monthly Progress Reports signed by the Executive Director of the Sub-recipient's agency shall be submitted by the Sub-recipient as required. 10. The Sub-recipient will make its best effort to accommodate clients referred by the Grantee or its designee for housing and/or services, through the Grantee's established referral process. 11. Services and/or housing shall be provided in accordance with the timeline submitted by the Sub-recipient. 12. Any proposed modification or revision t-o the Sub-recipient's program and/or services must be submitted in writing and must receive prior approval by the Grantee. 13. The Sub-recipient will exercise due diligence in achieving the performance measures delineated in the application to the U.S. HUD. - ATTACHMENT A-2 24 Complete Cbart 1 and Cbart 2 based on tbe following instructions. 1. In the first com""" please enter the requested information for all items at a point in time (a given night). You should only fill out this column if you checked "Yes" in section E or you are proposing a renewal project. If you checked "No" in section E enter "N/ A" in this column. 2. In the S<<:OM cobl""" enter the new number of beds and persons served at a point in time if this project is funded. If this is a renewal project, enter "N/A" in this column. 3. In the third com""" enter the projected level (columns I and 2 added together) that your project will attain at a point in time. 4. In the/ounh com""" enter the number of persons to be served over the grant term. Chart 1: Beds Beds Current Level (if applicable) New Effort or Change in Effort Projected Level (col. 1 + col. 2) N/A Number of Bedrooms. N/A N/A Number of beds. NAN A *00 not complete information on the number of bedrooms and beds for Supportive Services Only (SSO) projects. In those instances, enter "N/A" in the appropriate cells. 2 Cbart : Participants Current Level New Effort or Projected Level No. Projected to Participants (if applicable) change in (col. I + col. 2) be served over the Effort grant tenn Number of families with children 0 0 0 * Of persons in families with children a. number of disabled 0 0 0 * b. number of other adults 0 0 0 * .- . --.-.. '. . I ~~~.::-<~;d~~'~;'~: '~::~..~'. :-/:,>'~: ,.,':,:< .-,.t;~~ 1,..:_ '~~_~i.:.....:~ __}'{Q_.. ..--.'1...',If _'-'1 ~"'~_ _~../.: a. number of disabled individuals 3 6 9 126 b. number of other individuals 5 3 8 294 c. number of children Of sin Ie individuals not in families Total: 8 9 17 420 ** Note that, If your project Is funded, you w/ll be held responsible for achieving the numbers you enter in Section F. *Of the total placements, 25 will be families with children. Of the 25 families, 15 will be disabled, 30 will be adults, and 29 will be children. **The numbers indicated above represent placements only over the term of the grant. Fonn HUD-40076-CoC (2002) OMB Approval No. 2506-0112 (exp. 06/3012003) ATTACHMENT A-3 OUTCOME/PERFORMANCE MEASUREMENTS SERVICES ONLY Outreach P At least ~ns will be contacted during the program year Contact logs~ MIS P At least ~ persons will be placed during the program year Placement repons (FACE 1 , sheets ) i P At least 50% of persons placed into housing will remain placed Follow-up log I I for seven (7) days. I 0 Average consumer satisfaction score for persons placed will be at Consumer satisfaction survey 1 i least 55 for all clients. I OUTCOME MEASUREMENT TOOL ATIACBMENT A-3 (l) Project Number: FL14B00005 Exhibit 1: Project Summary C. Program Goals The Office of Homeless Coordination will operate from the City of Miami Beach, 1700 Convention Center Drive to provide mobile outreach and case management services. Services will be targeted to homeless individuals and families of Miami Beach residing on the streets and/or referred by the Miami Beach Police Department or other community agencies. The outreach team will work flexible hours and conduct early morning, evening and weekend mobile outreach services three times per week or as needed to identify high concentrated encampment areas. The team will interact with the homeless individual and/or family by providing information on services accessible to them and conduct an assessment based on individual needs and link them with available services. The Office to Homeless Coordination staff will also be available to see walk-ins who request assistance with shelter placement, transitional and permanent housing, employment, substance abuse treatment as well as mental health, food vouchers and transportation services. Extensive case management will be provided with an assessment of needs to properly identify appropriate referrals to service providers. Case Management will coordinate shelter/transitional housing placement, employment, substance abuse treatment and mental health referrals among other services. Case Manager will follow up on client progress and successful program completion/disposition. Proiected qoals for the Outreach and Placement Proqram are as follows: Substance Abuse services 25% of the program participants who are referred to substance abuse treatment services will successfully participate in treatment programs within 6 months. Mental Health Services 20% of the mental health program participants who are referred to outpatient, inpatient psychiatric residential treatment services will receive rehabilitation counseling. Housing 50% of program participants who are placed in emergency shelter will secure transitional or permanent housing within 6 months. Employment 50% of program participants who have been referred for day labor will secure permanent employment within 6 months. L! MIAMI-DADE COUNTY HOMELESS TRUST PROGRAM RATING OF SATISFACTION INSTRUCTIONS ATTACHMENT A-3 (2) Carefully read all of the instructions below BEFORE distributing the Program Rating of Satisfaction survey to your program participants. General Information The Program Rating of Satisfaction consists of 11 items which are used to determine a client's satisfaction with services they are receiving from a provider. It is to be completed by all program participants engaged in services at a Trust-funded program. It must be completed - at a minimum _ at time of discharge for all participants. It is strongly recommended that a Program Rating of Satisfaction survey also be completed at intervals as may be applicable to the program; however, only the discharge survey must be forwarded to the Homeless Trust. Case management notes should indicate specifically why a Program Rating of Satisfaction was not obtained, if that is the case (client went A WOL, institutionalized, etc.), and what efforts were made to obtain a survey in those instances. The Program Rating of Satisfaction is available in English, Spanish and Creole. Providers are responsible for reproducing the appropriate survey and providing an envelope (that seals) for each respondent. All responses should be completed in ink If a participant cannot read, providers should encourage them to use the same process they use to have other information read to them. An employee of the agency that is not directly responsible for the client's care can read the form. This should be indicated in Section II. as a separate set of staff initials. Filling out the form 1) A language appropriate survey and an envelope should be provided to all participants who are required to complete the form. Only one form per family is required. The form must be filled out in ink. 2) Section II of the Program Rating of Satisfaction is to be completed by staff prior to providing the survey document to the program participant. Staff initials refers to the initials of the case manager responsible for the client's service delivery. If the survey must be read to the client, the initials of the staff person performing that function should also be included. In no case should the participant's case manager read items aloud to the participant. 3) Section I of the Program Rating of Satisfaction Form is to be filled out ONLY by the program participant. The program participant should be provided a private place and sufficient time to answer the survey. 4) Providers should reassure participants of the confidentiality of their responses. Providers may wish to introduce the survey, as follows: "This survey is one way of helping us determine how well we are helping individuals that come to our agency for assistance. Please take a few minutes after I leave to answer this very short survey as honestly as possible. Your responses are private and we will not look at them. Please seal the envelope and give it to me when you are done (or: put it in the drop box)." 5) The completed survey should be placed in the envelope by the recipient and sealed. Providers are encouraged to provide a "drop box" with a slot for completed forms. 6) The sealed envelope(s) should be forwarded to the Miami-Dade County Homeless Trust on a monthly basis. 7) The provider agency should maintain a log of how many surveys are distributed. DETERMINATION OF MINIMUM AVERAGE SCORE FOR CONSUMER SATISFACTION SURVEY I was informed of my rights and responsibilities N/A 5.0 I was provided with information about different services N/A 5.0 that are available for me I was involved in making decisions about my care/service 11 5.09 plan I was able to talk with staff when I needed to 25 5.15 The building and facilities have usually been clean, safe and 4 5.18 comfortable My rights were respected and protected, including my right N/A 5.0 to file a grievance, if needed My case manager seems qualified to help me I 5.47 I would recommend this program to others 8 5.36 I am treated with respect by the staff 18 5.23 The staff seems to care about whether I get better 20 5.31 Program staff were knowledgeable about available services 14 5.38 that could help me BHRS equivalent avg. score 57.17 RECOMMENDED 57.00 1116/00 . ' . ~. ATTACHMENT A-3(2) MIAMI-DADE COUNTY HOMELESS TRUST PROGRAM RATING OF SATISFACTION Section I. :TO BE COMPLETED BY PROGRAM P ARTICIP ANT Instructions: Please answer each question below by placing an /Xl in the space provided. Your responses to these questions have no bearing on your continued participation in the program. ALL responses are confidential. Why did you choose to enter the program (mark only one box): I decided to come to this program on my own (through outreach, referral, etc.) I was placed here through another program (court intervention, police, etc.) against my will I had previously participated in this or a similar program and decided to return OPTIONAL Information: Name: Today's Date: Sex: male female Please answer the following questions about the services you received. Mark /Xl only one box which best describes your feelings about each statement. These questions are meant to help us improve the services provided, so we ask that you tell us how you really feel, whether or not it is good or bad. Strongly I Agree I Agree a I Disagree I Disagree I Strongly Agree Little A Little Disagree I was informed of my rights and responsibilities, [6] [5] [4] [3] [2] [I] including the agency's grievance procedures I was provided with information about different services [6] [5] [4] [3] [2] [I] that are available for me I was involved in making decisions about my [6] [5] [4] [3] [2] [I] care/service plan I was able to talk with staff when I needed to [6] [5] [4] [3] [2] [1] The building and facilities have usually been -clean, safe [6] [5] [4] [3] [2] [I] and comfortable My rights were respected and protected, including my [6] [5] [4] [3] [2] [I] right to file a grievance, if needed My case manager seems qualified to help me [6] [5] [4] [3] [2] [I] I would recommend this program to others [6] [5] [4] [3] [2] [I] I am treated with respect by the staff [6] [5] [4] [3] [2] [1] The staff seems to care about whether I get better [6] [5] [4] [3] [2] [I] Program staff were knowledgeable about available [6] [5] [4] [3] [2] [I] services that could help me Section II.: TO BE COMPLETED BY PROGRAM STAFF Purpose of Evaluation Current Level of Care provided At Admission emergency housing Provider Name: At discharge transitional housing/tx Project Name: Other: transitional housing/non-tx Staff Initials: permanent housing services only Rev.J 1/6/00 Formslprogramrating MIAMI-DADE COUNTY HOMELESS TRUST , , EVALUACION DE LA SATISFACCION CON EL PROGRAMA Seccion I. COMPLET ADA POR EL P ARTICIP ANTE DEL PROGRAMA Instrucc;ones: Por favor coloque una cruz IXI en el espac;o prov;sto para responder alas preguntas a contilluacioll. Las respuestas que usted de a este cuest;onar;o no ;n(lu;rtin de forma alj!ulla sobre la cont;lIuacioll de su participacioll ell este proj!rama. TODAS las respuestas se mantendrtin confidencialmente. ;,Por que decidi6 usted participar en el programa? (Marque una casilla solamente): [ ] Lo decidi por mi cuenta (porque fui remitido 0 pOT medio de otro programa, etc.) [ ] Fui colocado aqui mediante otro program a (por intervencion de los tribunales, la policia, etc.) en contra de mi voluntad ] Ya habia participado en este programa 0 en uno similar y decidi regresar Informacion OPCIONAL: Nombre y apellido: Fecha de hoy: Genero: M [ ] F [ ] Por favor responda alas preguntas s;gu;entes acerca de los serv;cios que se Ie hall prestado. Indique COIl ulla cruz {XI EN UNA SOLA CASILLA POR PREGUNTA laforma en que usted se s;ente acerca de cada ulla de las cuestiolles desaitas. Como sus respuestas a estas preguntas nos ayudartin a mejorar los serv;cios que prestamos, Ie rogamos que 1I0S haga saber como se s;ente en realidad acerca de nuestros serv;cios, 110 ;mporta si usted los cons;dera buellos 0 malos. Muy de I De I Algo de I Algo en I En I Muyen acuerdo acuerdo acuerdo desacuerdo desacuerdo desacuerdo Se me informaron cuales eran mis derechos y [6] [5] [4] [3] [2] [I] responsabilidades, entre eIlos, los procedimientos de la agencia para someter quejas. Se me dio informaci6n sobre los distintos servicios a los [6] [5] [4] [3] [2] [I] que ten go derecho. Participe en la toma de decisiones referentes a mi plan [6] [5] [4] [3] [2] [I] de atenci6n y servicios, Pude hablar con el personal cuando tuve necesidad d"e [6] [5] [4] [3] [2] [I] hacerlo. EI centro y sus servicios por 10 general se han mantenido [6] [5] [4] [3] [2] [I] Iimpios, sin peligro y accesibles. Se respetaron y protegieron mis derechos, entre eIlos, mi [6] [5] [4] [3] [2] [I] derecho a someter quejas si 10 considero necesario. Aparentemente, la persona encargada de mi caso sabe 10 [6] [5] [4] [3] [2] [I] que tiene que hacer para ayudarme. Yo les recomendaria este proyecto a otras personas. [6] [5] [4] [3] [2] [I] Los empleados me trataron respetuosamente. [6] [5] [4] [3] [2] [I] Aparentemente, a los empleados les interesa que yo [6] [5] [4] [3] [2] [I] mejore. Los empleados sabian que servicios podian servirme de [6] [5] [4] [3] [2] [I] ayuda. Seccion II.: COMPLETADA POR EMPLEADOS DEL PROGRAMA (completed by pro~ram staff) Purpose of Evaluation Currellt Level of Care provided At Admission emergency housing Provider Name: At discharge transitional housing/tx Project Name: Other: transitional housing/non-tx Staff Initials: permanent housing services only . ' MIAMI-DADE COUNTY HOMELESS TRUST PWOGRAM POD EVALYE SATISFAKSYON Section I. TOUT P A TISIP AN NAN PWOGRAM SILA A FET POU RANPLI P AJ SA A Enstriksyon: Tanpri reponn chak keksyon anba la a epi fi yon ti kwa {x] nan espas ki vid la. Repons nou bav vo pap deran;e fason nap kontinve patisipe nan pwoJ!ram sila a. Tout repons yo ap sekre. POUKI W CHWAZI PATISIPE NAN PWOGRAM SILA A (fe yon ti kwa nan yon grenn bwat): [] Se mwen ki chwazi vinn nan pwogram sila a (swa pa referans, swa pa sevis espesyal asistans piblik etc.) [] Se pa chwa mwen, se yon lot pwogram ki voyem (zak tribinal, lapolis etc) [J Mwen te deja patisipe nan yon pwogram konsa epi mwen deside retounnen. Enfomasyon pOll bay si w vie: Non: Dat Jodya: Seks [] Gason [] Fenm Tanpri reponn keksyon sila yo dapre sevis w resevwo. Fe yon kwa {x] nan yon sel ti kare epi c/lwazi repons ki plis matche ave w. Keksyon sila yo la pou ede nou bay pi bon sevis, alo nou mande nou bay repons ki plis matche ave w, ke Ii bon ou po. Bon jan I dako I DaM I Pa finn I Pa dako f Pa dako dako tou piti two dako ditou Yo fem konnen tout dwa mwen yo ak responsabilite [6] [5] [4] [3] [2] [I] mwen yo ak kouman pou mwen plenyen nan ajans la Yo te banmwen enfomasyon sou diferan sevis ke mwen [6] [5] [4] [3] [2] [I] kab jwenn Mwen te patisipe nan tout desizyon sou planifikasyon [6] [5] [4] [3] [2] [I] swen/sevis mwen Amplwaye yo te toujou disponib pou mwen pale avek"yo [6] [5] [4] [3] [2] [I] Kote a ak bilding yo te toujou byen pwop, konfotab ak [6] [5] [4] [3] [2] [I] bon sekirite Tout dwa m te respekte ak pwoteje menm dwa m pou [6] [5] [4] [3] [2] [I] mwen te pote plent si nesese Moun kap okipe ka mwen an sanble Ii kalifye pou Ii [6] [5] [4] [3] [2] [I] edem Mwen ta rekomande pwogram sila a bay lot moun [6] [5] [4] [3] [2] [I] Amplwaye yo trete mwen ak respe [6] [5] [4] [3] [2] [I] Amplwaye yo sanble yo vreman enterese nan mwen [6] [5] [4] [3] [2] [I] Amplwaye pwogram la te byen enfome sou tout sevis ki [6] [5] [4] [3] [2] [I] te disponib pou ede m. Section II.: TO BE COMPLETED BY PROGRAM STAFF Purpose of Evaluation Current Level of Care provided At Admission emergency housing Provider Name: At discharge transitional housing/tx Project Name: Other: transitional housing/non-tx Staff Initials: permanent housing services only Rev.l1/6/00 FormsJprogramrating ATTACHMENT A-4 Project Number FL14B00005 Technical Submission Exhibit 1: Project Summary (con't) _. Chart 2 - Project Milestones To complete Chart 2. Project Milestones. enter the number of days from the execution of the grant agreement that each of the following milestones will occur. for each structure in your project. If your project has only one structure or no structures. complete only column A. Enter "?\I A .. if the event is not applicable. Please note that the milestones you enter will become part of the selectee's grant agreement and. theretore. it is important that the milestones are appropriate given the scope of the project and achievable by the SHP prescribed timetTames in the regulation at Section 583.4 10. Days from Execution elf Grant Agreement Structure A B c D Closing on urchase of land. structure. or execution of lease ., Last unit leased, if leasing scattered units ~ Rehabilitation started 4. Rehabilitation com leted 5. New construction started 6. New construction comoleted 7 0 erations staff hired 8. Residents begin to occu v 9. Su ortive services be!!in 1 10. Facilitv near 100% occupied 11. Enroilment in su ortive services near] 000"0 ca acitv 13 C. Program Goals - The goals for SHP are to help program participants (a) obtain and remain in permanent housing, (b) increase their skills and/or income. and (c) achieve greater self-determination. In order to meet these program goals, each project should develop specific performance measures. Performance measures have three major components. First, they must relate to the outcomes (e.g., the program participant will successfully complete substance abuse treatment), rather than inputs (e.g., the program participant will attend 25 substance abuse sessions). Second, they must have a time frame for achievement and, third. they must have a percentage/number indicating a level of achievement. In a separate narrative. which should be submitted as an attachment to this exhibit. olease describe the perfomlance measures that will be used for each of the SHP f?:oals and how success in meeting each of the goals will be measured. Please include both housing and services in vour discussion. You will be reporting on your success in meeting the performance measures in your Annual Progress Report. Examples of perfomlance measures for each of the SHP goals are: Goal: Obtain and remain in permanent housing · 70% of those families entering the program will receive Section 8 certificates. Goal: Increase skills and/or income · 80% of the participants who receive no benefits upon entry will receive entitlement benefits within 6 months. Goal: Achieve greater self-determination · 85% of clients will meet at least one goal on their Individual Service Plan. OMB Approval No. 2506-0112 (exp. 6/30/2003) HUD-40076-2 (02/200 I) Page no: 131 AITACRMENT A-.5 [Code of Federal RegulatIons] (Title 24, Volume 3, Perts 500 to 699J [Revised as of April 1, 2000] From the U.S. Government PrInting Office via GPO Access [CITE: 24CFRS83.1) [Page 254] TITLE 24--HOUSING AND URBAN DEVELOPMENT SECRETARY FOR COMMUNITY PLANNING AND DEVELOPMENT, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT PART 583-SUPPORTIVE HOUSING PROGRAM--Table of Contents I '" Subpart Ao-General Sec. 513.1 Purpole end .cope. (a) General. The Supportive HOUSing Program IS authorIZed oy tltie IV of the Stewart B. McKinney Homeless Assjs~ance Act (the "1cKinney Ace) (42 U.S,C. 11381-11389). The Supportive HOlJs!ng j:)rogram is desig!'\ea to promote the development of supportive I'louslng and supportive services, !ncluding innovative approacnes to assist nomeless persons in the transition from homelessness, and to promote the proviSion of supportive housing to homeless persons to enable tt'lem to IIVi!! as Independently as POSSIDle. (b) Components. Funds under tnis part may be usee Tor: 1. Transitional housing to facilitate the movement of homeless individuals and families to permanent liouslng; 2. Permanent hOUSing that provides lon;-rerm houSlnQ for homeless persons With disabilities; 3. Housing that is. or IS part of, a particularly innovative project for, or alternative methods 0', meeting the immediate and long-term needs of homeless persons; or 4. Supportive services for homeless persons not provided in conjunction with supportive housing. [58 FR 13871, Mar. 15, 1993, as amended at 61 FRo 51175, Sept. 30: 1996J Sec. .13.5 D."n'tlon.. As used In this part: Applicant is defined in section 422(1) of tne MCKinney Act (42 U.S.C. 113B2(1}). for purposes of this definition, governmental entities include those that have general governmental powers (such as a city or county), as well as those [l"iat have limited or specIal powers (sucn as pubiic hOUSing agencies). Consolidated plan means the plan that a jUrisdiction prepares and submIts to HUD in accordance with 24 CFR part 91.Date of initial occupancy means the date that the supportive housing's inltlallv occupied by a homeless person for whom HUO provides assistance under tnls part. If the assistance is for an existing homeless faCility, tne date of initial occupancy IS tne date that services are fjrst provided to the residents of supportive housing with funding under this part. Date of initial service provision means the date that ;- supportive services are initially provided with funds under this part to homeless persons who do not reside in supportive housing. This definition applies onlv to projects funded under this part that do not provide supportive housing. Disability is defined in section 422(2) of the McKinney Act (42 U.S.C. 11382(2)). Homeless person means an individual or family that is described in section 103 of the McKinney Act (42 U,S.C. 11302). Metropolitan city is defined in sectIon 102(a)(4) of the Housing and Community Development Act of 1974 (42 U.S.C, 5302(a)(4)). In general, metropolitan cities are those clties that are eligible for an entitlement grant under 24 CFR part 570, subpart D. New constructIon means the building of a structure where none existed or an addition to an existing structure that Increases the floor area by more than 100 percent. Operating costs is defined in section 422(5) of the McKinney Act (42 U.S.C. 11382(5)). Outpatient health services is Clefinea in section 422(6) of the McKinney Act (42 U.S.C. 11382(6)). Permanent housing for homeless persons WIth disabilities i' defined in section 424(c) of the McKinney Act (42 U.S.C. 11384(c)). PrIvate nonprofit organi!ation is defined In section 422(7) (A), (6), and (D) of the McKinney Act: (42 u.s.e. 11382(7) (A), (6), and (D)). The organiZatiOn must also have a functioning accounclng system that is operated in accordance with generally accepted accountJng prinCIples, or designate an entity that will maintain a functioning accounting system for the organization in accordance with generally accepted accounting prinCIples. Project is defined in sections 422(8) and 424(d) of the McKinney Act (42 U.S.C. 11382(8), 11384(d)). Recipient is defined in section 422(9) of the McKinney Act (42 u.s.e. 11382(9)). Rehabilitation means the Improvement or repair of an existing structure or an addition to an eXisting structure that does not increase the floor area by more than 100 percent. Rehiollltatlon aoes not Include minor or routine repairs. State IS oefined in section 422(11) of the McKinney Act (42 U.S.C. 11382(11)). Supportive housing is defined in section 424{a) of the MCKinney Act (42 U.S.C. 11384(a)). Supportive services is defined in section 425 of the McKinney Act (42 u.s.e. 11385). Transitional housing Is defined In section 424(b) of the McKinney Act (42 U.S.C. 11384(b)). See also Sec. 583.300(j). Tribe Is defined In section 102 of the HOUSIng and Community Development Act of 1974 (42 U.S.C. 5302). Urban county is defined in section 102(a)(6) of the Housing and Community Development Act or 1974 (42 U.S.C. 5302(a)(6)), In general, urban counties are those counties that are eligible for an entitlement grant under 24 CFR part 570, subpart D. [61 FR 51175, SePt. 30, 1996] [Code: ufFederzl ReaulBlions] [Title 24, Volume J. Parts 500 tCl 699] [Revised as of April I. 2000] From the U.S. Government PrinTing Office Ilia GPO Access [CITE: 24CfR58J.l 00] TITLE 24-HOUSl'SG AND UIlHAN DEV~LOPMENT SECRETARY FOR COMMUNITY PLANNING.Ai'ID DEVELOPME.~T. DEPARTMENT OF HOUSING AND UREMN DEVELOPMEl'ot'T PART SRl-SVPPORTIVE HOUSING PROCRAM-Table of Contents Subpart B-AJSlItllnc:r Prnv,dcd Sec. S83.100 Types and uses of aulillnee. ia) Grant assistance:. Assistance in the fonn of I!rantA is availahle fnr acquisition of r;mJctUres. ~habilitatlon of il~tulC6. acqUIsition :100 rchabiliblion of stnlcrures, new CClnscruction, leasing. operating COSTS (or stlpponlve hoUSing, and liupponive services. as described in Secs. 583. 1 05 thrl\ugh 583.125. Applicanls may apply for more than one lype:: of assistance. (b) Uses of grant assistance. Gnlnt lU51scance mllY be lISed to: I. ESlilblish new suppomve housms facilities or new facilities to provide supronlve servIces: LXf74l1d eXIsting faciliues m ordc:r 10 increase the number of homeless persons served; 3. Bring existinll filCililles up 10 l\ level thaI mech. State and local gOl/ernment health and safety slandards; 4. Provide additional supponlve services for residents of supponive housing or, for homeless persons not residini: in supportive hClusinc: 5. Purchase HUD-owned single famIly properties cumntly leased by [ne applicant for use as a homeless fecili\y undl!r 24 eFR part 291; and 6. Continue funding supportive hour.ins where the recipient has recell/ed funding under this pan for 1~a.:i1n~. supportive services, or (lflCrallllj; COSlS, (c) Stnlctures ~ for multiple PUf1M1SCS, SlT\Ictures used to provide supportive housins or supponivc scrvic~ may lIi$O be Uiea for other plltpUS~, CltC:C:pr lhat assistance under this pan wilt be lvailablt only in proportion 10 the use of the structure for supponive bousin& or liupportive services. (d) Tcchoical assistance. HUD mllY olTer lechnicalltllsist:lnce. as described in Sec. 583.140. [58 fR 13871, Mar. IS, 1993, os amended al59 FR 36891. July 19, 1994) Sel:. 583.105 Gnnts for Itcqulsillon and rehabllitlltion. il) Use, HUD will grant funds to recipients to: I. Pay it panion of the COSI of the ac:quisilion of real propcny sclected by the recipients for use in the provision of supportive housing or supportive KrViccs. including the repayment of any outstanding debt on a loan made to purchase prapcny thaI has not been used previously as Supportive housing or for supponive services; 2. PlaY it portion of the COS( of rchabi Ii ration of structures, including cost-effective energy measures. selected by the reci!)Il:nlS to provide slIr'pnrlive housina: or supponive services; or 3. ray a ponion of the cost of acquisition and rehabilitation of sl1UClUres. as de&c:ribed in pa...graphs (aX I) llnd (2) of this section. (0) Amount. The maximum grant available for :Jcquisicion. rellabilitatiotl, or acquisifion and roh,biliClttion is the lower of: 1. S200,OOO~ or 2. The tNal teSt of the acquisition. rehabilitation, Or 3cqu"illM :md rehabiluatlon minus the Olpplicant's conlnbution toward the cost (c) Increwd amounts. In Rreas determined by HUD to have hiJh ilcqulsition osnd rehabilitition cosu. srilnt~ of mare than $200,000, but not mon: than $400,000, may be :lvailable, see.. m.no GralllS ror new con5tructlnQ. (:\) Use. HUD will grmt funds lO recipients to J>3Y :I ponion of the COllI of new con!ItrUC:IIOD. includins C:OSI- cITcchvc cncCl:lY mCBliure!l and the COlli of land aSllociated with that COllSlt\lCtion, for use: in th~ provision of supportive lIOusin,. Iftbtl eranl funds are used for new conslTUCtion, the applicant must demonstrate thlLt lhl: COSlS associated witb new conslnlClion are substantiaJly Ies, than lhe CO$(i aiSOcilllCd with rehabilitation or that there: is a IliCk of llvailablc appropriate unit..~ that c:ould be rehabilillced II a ~ost less Ihan new constnAction. For purposes of this cost comparison. costs associated wilh rehabilitatioa or new construction may include the cost of real property acquisition. (b) Amount. The maxImum gram avaIlable for new construction Iii the lower of: 1. $400,000; or 2. Tht Iota! cost ohhe new consrruction, mcludine the cOSt of land :usociated with that construction. minus the applicllnrs contribution toward the COSI of slime. See. 583.115 Grants for leasiD1Z (a) General. HUD will provide gr.InL~ to J1:ty (:is described in Sec. S8J.1JO Oflhis pnn) for the :u:tuall:osts of leasln!: ;I SlnJclun: or structures, or ponions IhcltlOf. used to provide supponive houslng or supJXX1I\1e services for up to five years. (b) 1, loeasine stcUcture5. WheR grants an: used to pay n:nt for all or part of lItTUcturcs, tbe rent raid mull bt r~aS4)rutbl&: in relation 10 rcnts bting characd in the aRll for comparable: spece. In addition, the rent paid m8y nOI exceed reols currcntly bcina: charsed by the: same: owner for comparable spa'e. 2. Leasing individual Ullie.. Where grants are lUed to pay rent for inc:iividual houiing unil$. the rent paid must be reasanable in relation to rentS beinl: charged for comparable unitS, taking !nUl accounl me locarion. size, tYpe, quality, amenities. facilities, and manalle:ment services. Tn addition, the renti rruay not cJLCCeo ren" cumntly bejn~ ,han~ed by the 51me owner for compuable unassiued units. and the ponion of renlS paid wilh grant fUnds may no<< ellceed HUD. delermined fair market rents. Recipients may use grant filnds in an amounl up to one montb's rent 10 p:ly the non-recipient landlord for :any cbmagcs to lcased units by homeless participancs. (58 fR 1381l. Mar. 15, 1993. ~s ollllended al59 fR 36891. July l!l. 1994) Sec. 583.UO Granu for supportive servlctl costs. la) GCIltral. flUD will provuie grants to pay (Il> dtscnbed in Sec. 583.130 of this part) for the actual coses of supponive ~c"s for homeless persons for up to five yem. All or pan of the supronlVe Services may be: provided di~t1y by the re<:ipient or by amn&enlCl1C with public or private service providers. (b) Supponivc 1iCrvU;cs (:Qsrs. Costs associaled with providing supponive services include salanes paid /0 providct$ of supponive services and 1U1)' other costs directly IlSsocialed with providing such. services. far a transitional housing proj"l, supportive ,,;rvices COSlli also include t/1c costs of services provided 10 fonner residents oC transitional housing 1O assisllheir adjustment to independent living. Such services may be provided for up 10 six monlh! alter they leave the transitional houtln, facility. [58 fR 11871, Mar. 15, 1993. as amended at 59 Fa 36891, July 19, 1994] Sec. 583.115 GnlnlS for operannlZ costs. (II) Genenl. HUD will provide grants to pay a portion (a.s described in Sec. 583.130) of the actu:lI operaling costs of supponive hOllsinS for up 10 tive years. (b) Opllratinl eDits. Operating costs are those associated with the d:ly-to-day Of'CT3t1on o(the supponlve housina. They also include the: actual ~J(pcnses that II recipient incurs rOt canductin, on-going assessmenlS DC tha supportivc services nceded by n::udClnts and the availability of such services; r:location lLSsisranc:e under Sec. 583.310, in~luding payments anll Sc;rviccs; and iruutlUlCl:. (e) Recipient sh.re of operating COIb. ASSistance for operating costs will be initially available tor up to 75 pel'ClmI of the tOQI COSI for two yell's and up to 50 perc=at o{the total cost for lhe ncx! lhrec years. The reCipient mu&t p~y the percentage of the aclual opcrdting costs not funded by HUD. At the tnd of each opcnuinS yc:n-. the recipient must demonstrate that it has met ils 5hare of the costs for that YC:lr. [58 FR 13871. Mar. 15, 1993, as amended at 61 FR 51175. Sept. 30. 1996] See. 583.130 Commitment or grant amounts for l"sIRI, sllpportivc scrvlces, and opcntinll costs. Cpon execulion of a groin! agreement cavenne Assistance for IcasinB. supportIve services. or operating costs, Ht.J"D will obligiUc amCUnlS for a period not to exceed five operating years. The 101a1 amwnr obligillCd will be equal 10 an amount necessary for Ihe specified ycan of operation. less the recipient's share of operlUina cos:!. (.A.pproved by the Office of Management Dnd Budget under OMB control number 2S06.Q 112) [59 fR 36891, luly 19.1994] Sec. 513.135 Admlnlslf8tive costs. (al General. Up to five percent of any grant awarded under this part may be uscd for the purpose of paying COS\.li of administeOng the assiscanc:e. (b) Adminiar.live costs. Admini:ltJ'ltive costs include the costs ils50Cialed with accounting for the UK ofcgrant funds, preparing rcpons for submission to HUD. obQinins program ludi". similar cas" rcl~ted to administering che SBnllftc:r the: award, and scalf salaries associated with rhcse administrative costs. They do not include the cost& of carrying out elil;iblc activilies under Sees. 583.1 OS throUlh 583.125. [58 FR 13871. Mar. IS. 1993. as amended at 61 fR 51175. Sept. 30. 1996J Sec. 513.1411 T cc:hnlclll A'Hi'tAnc:o (i) Genenl. HUO may set aside tunas annually to provide Iechnical a5liilitancc, euh~r directly by HUD staff or indirectly dlrough third.pany providers, for IIny .:lupponive housmg proJect. This technical assistance is for the purpose of promoting the development of supponive houllng and s\.Ipponive Sel'V1Ces as pan of a CDntinuum of core approach. including innovaavc approaches to assist homeless pt:rsons in the lransition from homelessncss, aJUll"romoting the provision of supportive: hOUliinS lO homeless pcI)OnS to c:n3ble them to live as independtndv as possible. (b) V.P of Technical Altiltancll. HUD mey US~ these fundi to prOVIde technical assistance to praspective applican~ applil:SlltS. recipients. or other providers of suppomve hOQsinG or services for homeless persons, for supponivc housing projccts. The Ilssistance may include. but is not limited ro, written information such :1$ rapers, ~hs, manuais, guides. and brochures; pcnon-la-person exchanges; and n~inmg and related ~ts. (c) Selection or Providen. From time to timc:, as HL'D detennines lhe need, HVD mllY advC:r1isc: and competitively select providers to d;lillc:r tecrJllcal as~istRncc. HUD may enter infO cOnlnc!s. ~ts. or coopcriltivc agrecmenls, when necessary, to implement the technical ~s.slsr;mce. (59 fR 36892, July 19, 1994} Sec. 583.145 ~btchi~ reqllirernenrs. (II) GelSor.\' The rccipicmt mu"t match the: funds proVIded by HUn for grants for acquisition, rehabilitation, OJnd new "'r\Stnll:tion with an equal ilmOUnl of funds from othcr sourccs (b) Cuh resources. The matchin8 funds muSl. be c~h resourcc:s provided to lhe project by one or man: of the followins: the recipient, the Federal government, Swc and local govcnvnents. and priVale resources. (e) Mlllcuenltncr. of effort. Statc or 10(;&1 govemment funds used in the malchina ",ntribution 8" subject to lhee mllinti:nllncc of effon requirements described at Sec. 583.150(a). Sec. 513.1S0 Limitations on IlU of llssistance, tal Maintenance of effort No !\s.sisl"ncc provided under thiS pan {Of any Slate or local governmenl funds used co suppi~meol !his a.~liiscance} mll)' be: used to replace Slate or local funds previously used. or dcsignated for use, to as,c.ist homeless persons (b) PrimllC1ly religious organi~t\llon~- I. Provision of assistance. (I) HL'D will provuie assistln<:e to a recipient that is a primarily rc:li.:ious orl:anj~ation if tbe: organization agrees to provilk: houlling and supponive scrvices In a manner lhat j!; free from religIOUS influences and In accordance with the following principl~; (A) 11 will not dIscriminAte agaanst any employee or applicant for employment on the basis of religion and will not limit employment (lr give preference in employment to f1er5ans Cln lhc basis otrchgjon; (8) It will no<< discriminare against MY person Mpplying for housing or supportive services on the: bllSis of religion and will not limit such housing or services or iiw preference to p~oon. on the basis of reli;ion; (el ft will provide no religious in.~tnlction or counseling. conduct no rcligious worship or services, engage in no religIous prOllC!ytizmg, and exert no ocher religious influcmcc in the provision of housing and $upportive services. (ii) HUD will provide assisrance ro I recipient thai is a primarily rehgiou.~ organi%arion if rhe aSSIstance wi II not be used by !he organization 10 conslTUct iI slrUCture, acquire a SlruclUrc or to rctlabililue a srruetu~ owned by ltIe organization, except as described in pMiIgTOIph (cX:!) of Ibis section. 2. Rehabiliuuion of SlNClUrt$ owned by a primarily reli~ious organization. RehabililillOt\ granls m;f}' be used to rehabilirare a. slructure owned by a primarily religious ocgani4li1tion, if rhe: [ollowlng condition!> arc met: (i) The $truclllre (or portion (lflhc stnlctun:) thlll is to be rchabiJillled wilh f-!UD assIstance hilS been le~sed to a recipIent thilt is an existine or newly established wholly secular organization (which may be established by the primarily religious organi%&lion under lbe provisions of pararntph (eX)) of this section); (ii) The HUn assistance IS provided CD the wholly secular organizaTion (and not the primarily religious organization) to make the improvements; (iii) The leased srrucNre will be usec1 exc!usively for s~lar plItpO.se.s available to all persons regardless of religion; (iv) The lease p:rymcnr.s pOlid to the primarily n:ligiollS organization do nor exceed the fair maricet rent oflhe srNCtun: bcfoll! Ihe rehabilitation was done; (v) The ponion of the cost of Olny improvemcnlS Ihat benefit any unleased ponion of the s~tlIre will be allocated to, arxJ paid for by, the primarily rcli~ious organization: (....i) The primarily religious oraanizarion agreC$ lhat, ifrhe recipient dam not retain the use of the lC8lilld premises for wbolly seculat puqlOses for the useful life of the improvementS, the: primarily religious oraani%al.ion will pay an amount equ31lo the residual value of me improvements to the Iiecular organIzation, and the secular orgiUlizacion will remit the amount to HUD. 3. Assistance to l wholly secular private nonJ\rofir organizslJon esublished by a primarily relisious organiution. (i) A primarily religious organIzation may establish a wtlolly secular private nonprofit organi7.ation 10 serve lis a n:cipient. Thf wholly sccLllarofsanizatior. mey be elilible to receive O(hef fanns of assistAN:c lvailable ttndcr this plitt. (A) The wholly secular ors:anizltion must IIfIle to provide housing and supponive services in a m8Dner that is free from religious infJuenc::es and in accordance wilh the principles ser fonh in pfttllgraph (e)( 1)(0 of this section. (8) lb.: Wholly scclllar organization may enter into a contract with the primarily religious organization 10 operate the 5Upponive housing or to provide supportive services for the residents. In such a case, the primarily reli,ious organization must :llTee in the contracr ro carTy OUl its contrlcrual respon!libilitiCi in a manner free fronl religious influences and in Iccordance with the principles set fotth ia paragraph (cXIXi) ofmis 5CC:(ion. (C) The rehabilitation grants are subje.:r to the requirements of paragraph (c)(2) orrhi:; :lmion. (ii) HUD will not require the primarily reliaious or]taniurion ro establish the wholly seeulu organizarion before the selection of its application. In such a case, lhe pnmarily rcligjous organjzation may apply on behalf of Ihe: wholly secular orglIllzation. The application will be reviewed on the bl1sis of the: primarily reliriou. organization's financial teSflOnsibiliey md capacity, and ib commitment to provide appropriate resources to tbe wholly secular orglnlz:ltion after formalion The requirement with regard to site control, described in Se~. 583.320, may be salidi.d ,fthe primarily rcligiouli organization dc:momurales site coalrol and a commitment to transfer control of 1h~ sire to the wholly secular oq:ltnization after Its ronnation. If such an OIpplication is ,elected for Junding, the obligation of funds will be conditioned upon the establishment of 3 wholly secular organizlltion thilt meets thc definition of pnviltc nonprofil organization In S\lc. 583.5. (c) Participanr cor:n-ol of liite. Where an Applicant docs not propose to have control of 11 sice or sites bUI rather proposes to assisl & homeless family or individul11 in obtaining a le~, which mOlY inchu1c assistance with rc:nl payments and receiving supponivc services,lIfter which time the &mify or individual remains in the same housing without further assistance under thili parI. IhaI applicant may nOI rcquelit assistance for acquisilion, rehabilitation. or new consfruction. [58 fR 131m, Mar. 15, 1993, as amended at 59 fJl36892. July 19, 1993] Sec. 58:\.155 Conrolidutlld pllln. (a) ^wlicanb thlll are SlOIleS or Unlrs of generilllOC:Il1 soveCMlent. The: applicant must nave a nut). approved complete or abbrcvidtcd consolidated plan, in acc(\rdance with 24 eFR parr 91, and must submit it certification that the application for fundina is consistent with the HUO..pproved consolidated plan. Funded applic::rlls mUJ;t c:enify In a grant agreementtbal they are fOllowinc the HUP-approved consolidattd plan. (b) Applicanu that arc not Slales or units of gcnerallocal government. The llpplicant must submil it cent (italian by the jurisdiction in which the proposed project will be located rhar the I1pplicant's application ror (ufldins is CCJnsili"nt with the jurisd~ion's HUn-approved consolidllted plan. The unification must be made by the unit of (leneralloc:al government or IIlC Slat&:, in accord8nCC with the consistency cenificarion proVisions of the consoiidaled plan regulations. 24 erR pan 91, 5ubpan F. (c) Indian tribes:uld the Inslllar Arc:u of Guam. the U.S. Virgin Islands. American Samoa, and the Nonbcm Marizr.;a Jslill'lds. ThclSC emitics are not required to have a consolidated plan or to make consolidated plan c:eniticalions. An .pplic:Uion by an f"dilln tribe or other applicant foe a project Ihllt will be loclUCd on :a reaervation of 1111 Indian tribe will ncx requiRlI certification by the tribe or the Stace. However, where an Indian rribc is the appIiclIJ1t for a projectlllat will not be located on a reservation, the requirement for a ceni lication under paragraph (b) of rhis seclion will apply. (d) Timing of COlIliolidlted plan ceniticltion lIubmiSliiOfts. UnloSll otherwise set forth in the NOF A. tbe required ceniticallon that the application for fundin/: is consistent with the HUD-approvcd cor.solidated plan must b~ submitted by the funding applie:ation submission deadline announced in the ~OF A. [60 FR 16380, Mar. 30, 1995J [Cade af Federal Reguiatjons] (Title 24, Volume 3, Parts 500 to 699] [Revlsecl as of April 1, 2000) From the U.S. Government Pr,,,ting Office via GPO Access [CITE: 24CFR583.200] mLE 24..HOUSING AND URBAN DEVELOPMENT SECRETARY fOR COMMUNm PLANNING AND DEVELOPMENT, OEPARTMENT OF HOUSING AND URBAN DEVELOPMENT PART S83--SUPPORTIVE HOUSING PROGRAM-- Table of Contents Subpart C.-Application and Grant Award Proce.. Sec. 583.200 Application and grant award. When funds are made avaIlable for assistzmce, HUD will publish a notIce of funding avallabllltv (NOFA) in the Federal Register, in accordance with the requirements of 24 CFft part 4. HUD will review and screen applications in accordance with the requirements in section 426 of the McKinnev Act (42 U.S.C. 11386) and the guidelines, rating criteria, and procedures published in the NOFA. {51 FR 51176, Sept. 3Q, 1996J Sec. &83.230 Environmental review. (a) Generally. Project selection IS subject to completion of an environmental review of the proposed site, and the project may be modified or the site rejected as a result of that review. The environmental effects must be assessed In accordance with the provisions of the National Environmental Policy Act of 196; (42 U.S.C. 4320) (NEPA) and the related environmental laws and authorities listed In HUO's implementing regulations at 24 CFR pal1; 50 or 58, depending on who is responsible for environmental review. (b) Environmental review by HUD. HUD will perform an environmental review, In accordance with part SO of this title, before approval of conditionally selected applications received directly from private nonprofit organizations and governmental entitIes with special or limited purpose powers. Any applicatIon subject to environmental review bV HUO that requires an Environmental Impatt Statement (EIS) in accordance with the procedures in 24 CFR part 50, subpart E, will not be eligible for assistance under this part. (c) Environmental review bV applicants. Applicants that are States, metropolitan cibei, urban counties, tribes, Dr other governmental entities with general purpose powers must assume responslbllitv for environmental review, decision making, and action for each application for assistance in accordance with part 58 of this title. These applicants mu~t Include in their applications an assurance that they will assume all the environmental review responSibility that would otherwise be performed by HUD as the responsible Federal official under NEPA and related authorities listed In 24 CFft part 58. The grant award Is subject to completion of the environmental responsibilitIes set out In 24 Cf=R part 58 within a reasonable time periOd after notification of the award. Applicants may, however, enclose an environmental certification and Request for Release of Funds with their applications. [61 FR 51176, Sept. 30. 1996) Sec. 5.3.~35 Renewa' grant.. (a) Gene,.'. Grants made under thiS part, and grants maDe under subtitles C and 0 (the Supportive Housing Demonstration and SAFAH, respectlvelv) of the Stewart a. MCKinney Homeless Assistance Act as in effect before October 28, 1992, may be renewed on a noncompetitive basis to continue ongoing leasing, operations, and supportive serviceS for additIonal years beyond the inItIal funding perIod. To be consIdered for renewal funding for leasing, operating costs, or supportive services, recipients must submit a request for such funding in the form specified by HUD, must meet the requirements of tnis part, and must submit requests within the time period established by HUD, (b) b.t.tanca .vaUabte1'rle first renewal will be tor a perfod of time not to exceed the difference between the end of the InItial funding period and ten years from the date of Initial occupancy or the date of initial servIce provision, as applicable. Any subsequent renewal will be for a period of time not to exceed five years. Assistance during each year of the renewal period, subject to maintenance of effort requirements under Sec. 583.150(a} may be for: 1. Up to SO percent of the actual operating and leasing costs in the final year of the Initial funding penod; 2. Up to the amount of HUO assIstance for Supportive services in the final year of the Initial funding period; and 3. An allowance for cost increases. (c) HUD review. 1. HUD will review the request for renewai and Will evaluate the redp;ent's performance In previous years against the plans and goa;s established in the initial application for assistance, as amended. HUO will approve the request for renewal unless the reCipient proposes to serve i population that is not homeless, or the reCipient has not shown adequate progress as evic1enced by an unacceptably slow expenditure of fundS, or the reCipient has been unsuccessful in issi5ting participants in achieving and maintaining independent living. In determining the recipIent's success in aSSisting participants to achieve and maintain independent living, consideration will be given to the level and type of problems or participants. For recipients WIth a poor record ot success, HUD will also consider the recipient's willingness to accept technical assIstance and to make changes suggested by technical assistance provIders. Other factors which will affect HUO's decision to approve a renewal request include the following: II continuing history of inadequate financial management accounting practices, indIcations of mismanagement on the part of the recipient, a drastic reduction in the population served by the re(;ipient, program changes made by the redpient without pnor HUO approval, and loss of project site. 2. HUD reserves the right to reject a request from any organization with an outstanding obligation to HUO that IS In arrears or for which a payment sChedule has not been agreed to, or whose response to an audIt finding IS overdue or unsatisfactory. 3. HUO will notify the recipient in writing that the request has ~een approved or disapproved. (Approved by the Office of Management and Budget under control number 2506-0112) [Code of Federal Regulations) (Title 24, Volume 3, Parts 500 to 699] (Revised a5 of April 1, 2000] From the U.S. Government Printing Office via GPO Access [CITE: 24CFRS83.300) mLf 24--HOUSING AND URBAN DEvELOPMENT SeCRETARY FOR COMMUNITY PLANNING AND DEVELOPMENT, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT PART SS3--SUPPORTIVE HOUSING PROGRAM-- Table of Contents Subpart o-..Program Requirement, s.c. 513.300 Ganar.' operation. (a) ltate and local requlrementlEaCh redplent of assistance under this part must provide housing or services that are in compliance with all applicable State and local housing codes, licensing requirements, and any other reqLlirements in the Jurisdiction in which the project Is located regarding the condition of the structure and the operation of the housing or services. (b) H.bigbillty ..ndarel.Except for such variations as are propoSed by the recipient and approved by HUD. supportive housing must meet the follOWing requirements: 1. Structure and materials. The structures must be structurally sound so as not to pose any threat to the health and safety of the occupants and so as to protect the residents from the elements. 2, Access, The housing must be accessible and capable of being utililed without unauthorized use of other private properties, Structures must prOVide alternate means of egress in case of fire. 3. Space and security. EaCh resident must be afforded adequate space and security for themselves and their belongings. Each resident must be provided an acceptabie place to sleep. 4. Interior air quality. every room or space must be provided with nitural or mechanical ventilation. Structures must be free of pollutants in the air at levels that threaten the health of residents. S. Water supply. The water supply must be free from contamination. 6, Sanitary facilities. Residents must have access to sufficient sanItary facilities that are In proper operating condition, may be used in prtvacy, and are adequate for personal deanllness and the diSPOsal of human waste. 7. Thermal environment. The housing must have adequate heating andl or cooling facilities in proper operating condltlon. e. Illumination and electricity. The housing must have adequate natural or artificial illumination to permit normal Indoor actiVities and to support the health and safety of residents. Sufficient electrical sources must be provided to permit use of essential electrical appliances while assuring safety from fire. 9. Food preparation and refuse disposal. Ail food preparation areas must contain suitable space and equipment to store, prepare, and serve food in a sanitary manner. 10. Sanitary condition. The housing and any eQuIpment must be matntained in sanitary condition. 11. Fire safety. (I) Each unit must include at least one battery-operateCl or hard-wired smoke detector, in proper working condition, on each occupied level of the unit. Smoke detectors must be located, to the extent practicable, in a hallwav adjacent to a bedroom. If the unit is occupIed by hearing-Impaired persons, smoke detectors must have an alarm system designed for hearing-Impaired persons in each bedroom occupied by a hearing-Impaired person. (ii) The public areas of all housing must be equipped with a suffiCient number, but not less than one ror each area, of battery-operated or hard.wired smoke detectors. Public areas include, but are not limited to, iaunclry rooms, community rooms, Clay care centers, hallw!ly5, stairwetl$, and other common oreas. (c) M...s. Each recipient of assistance under this part whD provides supportive housIng for homeless persons with disabilities must prOVide meals or meal preparation facilities for residents, Cd) Onlalnl ......m.nt of .upportlve ..rvle.aeh recipient of assistance uncler this part must conduct an ongoing assessment of the supportive services required by the residents of the project and the availability or SuCh services, and make adjustments as appropriate. (e) Residential auperYl.lonEach recipient of assistance under this part must provide residential supervision as necessary to facilitate the adequate provision of supportive services to the residents of the housing throughout the term of the commitment to operate supportive housing. Residential supervision may include the employment of a full- er part-time residential supervisor with suffldent knowledge to provide or to supervise the provision of supportive services to the residents. (f) P-rttclpatlon of homel... p.r.on.. 1. eaCh recipient must provide for the participation of homeless persons as required in seaion 426(g) of the MCKinney Act (4J2 U.S.C, 11386(g)). This requirement is waived If an applicant Is unable to meet it and presents a plan for HUe approval to otherwise consult with : lomeless or formerly homeless persons in considering and making policies and decisions. See also Sec. 583.330(e). 2. Each recIpIent of assistance under this part must, to the maximum extent practicable, involve homeless individuals and families, through employment, volunteer services, Of otherwise, In constructing, rehabilitating, maintainrng, and operating the project and in providing supportive services for the proJect. (g) Recorda anca r.part8~ch reCipient of assistance under this part must keep any reccrds and make any reports (induding those pertaining to race, ethnicity, gender, and disability status data) that HUO may require within the tlmeframe required. (h) Conflclentl.llty.Each recipient that provides family violence preventIon or treatment services must develop and implement procedures to ensure: 1. The confidentiality of records pertaining to any Individual services; anCl 2. That the address or location of any project assisted will not be made public, except with wntten autnonzation of the person or persons responsible for the operation of the project. (I) Termination of housing assIstance. The redpient may terminate assistance to a participant who violates program requirements. Recipients should terminate assistance only in the moit severe cases. Recipients may resume assistance to it partidpant whose assistance was previously terminated. In terminating assistance to it participant, the recipient must provide a formal process that recognizes the rights of Individuals receIving assistance to due process of law. This process, at a minimum, must consist of: 1. Written notice to the participant containing a clear statement of the reasons for termination; 2, A review of the declSlon, in which the participant is gIven the opportunity to present written or oral objections before a person other than the person (or it subordinate of that person) who made or approved the termination decision; and 3. Prompt written notice of the final decision to tt'le participant. U) Umltatlon of my In tranlltlonBI hau8ln"homeless individual or family may remain in transitional hou5ing for is period longer than 24 months, if permanent housing for the Individual or family has not been located or if the IndiVidual or family requires additional time to prepare for independent living. However, HUD may discontinue assistance for a transitional housing project if more than half of the homeless Individuals or families remain in that project longer than 24 months. (k) Ouqa.tl.nt h..lth HrvlC8I.outpatient health services provided by the recipient must be approved as appropriate by HUO and the Department of Health and Human Services (HHS). Upon receipt of an application that proposes the proviSion Or outpatient health services, HUO will consult with HHS with respect to the appropriateness of the proposed services. (I) Annual a.ur.nce.AeClplents who receive assistance only for leasing, operatIng costs or supportIve services casts must provide an annual assurance for eaCh year such assIstance IS received that the project will be operated for the purpose specified in the application. (Approved by the Office of Management and Budget under control numDer 2506-0112) (58 FR 13871, Mar. 15, 1993, as amended at 59 FR 36892, July 19, 1994; 61 FR 511 76, Sept. JO, 1996) sec. 513.305 Term ot commitment; repayment of grant.; prevention at undue benefitl. (a) Term or commItment and converaloraecipients must agre@ to operate the housing Dr provide supportive services in accordance with this part and with sections 423 (b)(l) and (b)(3) of the McKinnev Act (42 U.S.C. 1l383(b)(1), 11383(b)(3)). (b) Repayment 0' ,rant and prevention 0' undue benef1t1a accordance with section 423(c) of the McKinney Act (42 U.S.C. 11383(c)), HUO will require recipients to repay the grant unless HUD has authorized conversion of the project uncer section 423(b)(J) of the McKinney Act (42 U.S.C. 11383(b)(3)), [61 FR 51176, Sept. 30, 1996) Sec. .83.310 DI.placement, ralocatlon, and acqul.ltlon. (a) Minimizing dl,p'acementConsistent with the other goals and objectIves of this part, recipients must assure that the v have taken all reasonable steps to minimize the displacement of persons (families, individuals, businesses, nonprofit organIzations, and farms) as a result of supportive nouslng assisted under this part. e b) aelocatlon ...'.hlnee for displaced ,e...on.. displaced person (defined I" paragraph (f) of this section) must be provided relocation assistance at the levels described in, and in accordance with, the requirements of the Uniform Relocation AsSistance and Real Property Acquisition Policies Act of 1970 (URA) (42 U.S.C. 4601- 4655) and implementing regulations at 49 CFR part 24. (c) Real property acquleltlon requlrementt".he acquisition of real property for supportive hou5ing is subject to the URA and the requirements described in 49 CFR part 24, subpart B. (d) ae.ponelblllty af reciplant. 1, The recipient must certify (I.e., provide assurance of compliance) that It will comply with the URA, the regulations at 49 CFR part 24, and the requirements of this section. and must ensure such compliance notwithstanding any third party's contractual obligation to the recipient to comply with these proviSIons. 2. The cost of required relocation ~sslstance is an eligib'e project cost in the same manner and to the gme extent as other project costs. Such costs also may be paid for with local public funds Dr funds available from other sources. 3. The recipient must maintain records in sufficient detail to demonstrate compliance with provisions of this section. (e) Appe....A person who disagrees with the redplent's determInation concerning whether the person qualifies as a ' 'displaced person," or the amount of relocation assistance fer which the person Is eligible, may file e written appeal of that determination with the recipient. A low-income person who is dissatisfied 'filth the recipient's determination on his or her appeal may submit a written request for review of that determination to the HUe field office. (f) Definition of dl.placed p....on. l. For purposes of this section, the term . . displaced pe~son" means a person (family, lndlvlduel, business, nonprofit organization, or farm) that moves from real property, or moves personal property from real property permanentlv as a direct result of acquisition, rehablllt8tlon, or demolition for supportive housing projects assisted under this part. The term' . displaced person" includes, but may not be limited to: (i) A person that moves permanently from the real property alter the property owner (or person in control of the site) Issues a vacate notice, or refuses to renew an expiring lease in order to evade the responsibility to provide relocation assistance, if the move occurs on or after the date the recipIent submits to HUO the application or appiication amendment designating the project sIte. (il) AnV person, Induding a person who moves before the date descrIbed in paragraph (f)(1)(I) of this section, if the recipient or HUe determines that the displacement resulted dIrectly from acquisition, rehabilitation, or demolition for the assisted project. (Ili) A tenant-occupant of a dwelling unit who moves permanently from the building/complex on or after the date of the' 'initiation of negotiations" (see paragraph (g) of this section) if the move occurs before the tenant nas been provided written notice offering him or her the opportunity to lease and occupy a suitable, decent, safe and sanitary dwelling in the same building/complex, under reasonable terms and conditions. upon completion of the ~roject. Such reasonable terms and conditions must include ill monthly rent and estimated average monthly utility costs that do not exceed the greater of: (A) The tenant's monthly rent before the initiation of negotiations and estimated average utility costs, or (8) 30 percent of gross household Income. It the initial rent Is at or near the maximum, there must be a reasonable basis for concludIng at the time the project is initiated that future rent increases wilt be modest. (iv) A tenant of a dwelling who is required to relocate temporarily, but does not return to the building/complex, if eitheri (A) A tenant is not offered payment for all reasonable out-of- pocket expenses Incurred in connection with the temporary relocation, or (8) Other conditions of the temporary relocation are not reasonable, (v) A tenant of a dwelling who moves from the building/complex permanently after he or she has been required to move to another unit in the same building/complex, If either: (A) The tenant is not offered reimbursement tor all reasonable out.of-pocket expenses incurrecl in connection WIth the move; or (8) Other conditions of the move are not reasonable. 2. Notwithstanding the provisIons of paragraph (f)( 1) of this section, a person does not qualify as a . , displaced person" (and is not eligible tor relocatIon assistance under the URA or this section), if: (i) The person has been evicted for serious or repeated violation of the terms and conditions of the lease or occupancy agreement, violation of applicable Federal, State, or local or tribal law, or other good cause, and HUD determines that the eviction was not undertaken for the purpose of evading the obligation to provide relocation assistance; (II) The person moved into the property arter the submission of the application and, before signIng a lease and ~mmencing occupancy, was providecl written notice of the project, Its possible impact on the person (e.g., the person may be displaced, temporarily relocated, or suffer a rent increase) and the fact that the person would not qualify as a . . displaced person" (or for any assistance provided under this section), if the project Is approved; (iii) The person Is ineligible under 49 CFR 24.2(g)(2)j or (Iv) HUO determines that the person was not displaced as a direct result of acquisition, rehabilitation, or demolition for the project. 3. The recipient may request, at any time, HUO's C2etermination of whether a displacement is or would be covered under this section. (g) Definition of Initiation of negotJation'or purposes of determining the formula fer computing the replacement housing assistance to be provided to a residential tenant displaced as a direct result of privately undertaken rehabilitation, demolition, or acquiSItion of the real property, the term ' . initiation of negotiations" means the executlon of the agreement between the reCIpient and HUD, (h) Definition of projectFor purposes of this section, the term' . project" means an undertaklnV paid for in whole or In part with assIstance under this part. Two or mare actIvities that are integrally related, each essential to the others, are considered a single project, whether or not ilI11 component activities receive assistance under this part. (S8 fA. 13871, Mar. 15, 1993, as amended at 59 FR 36892, July 19, 1994] Sec. &13.31& Re.'dent rent. (a) C.lcul.tlon af ,...Ident renU:ach ~sident of supportive housing may be requl~d to pay as rent an amount determined by the redplent whiCh may not exceed the highest of; 1. 30 percent of the family's monthly adjusted Income (adjustment factors indude the numDer of people in the family, age of family members, medical expenses, and child care expenses); 2. 10 percent of the family's monthly income; or 3. If the family is receiving payments for welfare assistance from a public agency and a part of the payments, adjusted In accordance with the family's actual housing costs, is specificallV designated by the agency to meet the famlly's housing costs, the portion of the payments that is designated. (b) U.. 0' rent. Resident rent may be used in the operation of the project or may be reserved, In whole or in part, to assist residents of transitional housing In moving to permanent housing. (e) f....ln addition to resident rent, recipients may charge residents reasonable fees for services not paid with grant funds. [58 FR 13871, Mar, 15, 1993, as amenaed at 59 FR 36892, Julv 19, 1994) " Sec. 513.320 SIte cantrol. (a) Site contral. 1. Where grant funds will be used for aCQuisibon, rehabilitabon, or new construction to provide supportive housing or supportive services, or where grant funds will be used for operating costs of supportive housing, or where grant funds will be used to provide supportive services except where an applicant will provide services at sites not operated by the applicant, an applicant must demonstrate site control before HUO will execute a grant agreement (e,g" through a deed, lease, executed contract of sale). If such site control is not demonstrated within one year after Initial notification of the award of assistance under this part, the grant will be deobligated as provided In paragraph (c) of this section. 2. Where grant funds will be used to lease all or part of a structure to provide supportive housing or supportive services, or where grant funds will be used to lease individual housing units for homeless persons who will eventually control the units, site control need not be demonstrated. (b) Site ch.nlle. 1. A recipient may obtain ownership or control of a sUitable site different from the one specified In Its application. Retention of an assistance award is subject to the new site's meeting all requirements under this part for suitable sites. 2. If the ac:quisition, rehabilitation, acquisition and rehabilitation, or new construction costs for the substitute site are Qreater than trle amount of the grant awarded for the site specified in the application, the recipient must provide for all additional COSts. If the recipient Is unable to demonstrate to HUD that it is able to provide for the difference In costs, HUO may deobligate the award of assistance. (c) 'allure to obtain lite control within one yeallWD will recapture or deobligate any award for assistance under this part if the reCipIent IS not in control of a suitable Site before the expiration of one year after initial notlfication of an award. Sec. 513.325 Nondiscrimination and equal opportunity requirements. (a) Gener.'. Notwithstanding the permiSSibility of proposalS that serve designated populations of disabled homeless persons, recipients serving a designated population of disabled homeless persons are required, within the designated population, to comply with these requirements for nondiscrimination on the basis of race, color, religion, sex, national origin, age, familial status, and disability. (b) Nandlserinlnatlon and .qual opportunity requlrtlmentlhe nondiscrimination and equal opportunity requirements set forth at part S of this title apply to this program. The Indian Ovll Rights Act (25 U.S.C. 1301 et seq.) applies to trlbes when they exercise their powers of self-government. and to Indian housing autT10rities (IHAs) when established by the exercise of sucn powers. When an IHA is established under State law, the applicability of the Indian Civil Rights Act will be determined on a case-by-case basis. Projects subject to the Indian Civil Rights Act must be developed and operated in compliance with its provisions and all implementing HUD requirements, instead of title VI and the Fair Housing Act and their implementing regulations. (c) Procedu..... 1, If the procedures that the recipient intends to use to make known the availability ot the supportive housing are unlikely to reach persons of any particular race. color, religion, sex, age, national origin, familial status. or handicap who may qualify for admission to the hOUSing, the recipient must establish additional procedures that will ensure that such persons can obtain Information concerning aval1ablllty ot the "ousing. 2. The recipient must adopt procedures to make availab'e information on the existence and locations of facilities and services that are acceasible to persons with a handicap and maintain evidence of implementation of the procedures. (d) Acce..tblllty requlrement.The recipient must comply with the new construction accessibility requirements or tne Fair Housing Act and section 504 of the Rehabilitation Act of 1973, and the reasonable accommodation and rehabilitation acceSSibility requirements of section S04 85 tollows: n;-nJ '5aldOJ 9aJ~ O~ ~C ~IW!l e S! ClJCll.U ('J9QWnU iiJaJ~-1/0J ~ JOU SI SI~JJ 'Z((L-S6( (ZOZ) 9uo~d919J 'rosoz '0 'uOJ6u!~SI!M 'ISU1PI1ng "WO aA!~~)(:l MON 'aoa WOOJ 'SUO!l~!IqMd 'd'O';i WOJl paUl~qo aq AgW SJelnJJ!:) awo JO S9Ide:>) 'JJRd SIl(.J JO 'Sa1nJ~ leJ9pa:l J9l110 'J;)Y Aauu!>pw a~ JO 5UO!S1^OJd aLl~ ~IM ~ua~5IsUOJU! iiU9LlM ~diOxa 'SUo!:1IfZIURf)JO JIJOJduou 91e^lJd ACI aJu~slsse JO asn pUR iI:JuRJda:JJe iiJ41 01 Aldde (SUOI1mOSUI :llOJduON LlJ!M ~uaw~J6'lf J9LlJO PUI! 5PI2J1uO:) '~ueJ~ 01 alCl~!Iddv sald~u!Jd ~so,) Zzt-v I)Ue (sUo!~IfZ,ue5JO JYOJdUON Jat.Qo pue 'SleJldsoH 'UoIJe:Jnp3 JilLlO!H JO suopnJ/JsuI ~!M SJuawaaJ6v iiJ^RVJadoo:> PU&! 5:JU&!J~) OIl-V 'soN Jeln:)J!:) gWO pue 'sa!l!:1ua leJUaWUJ9^o5 Aq wtJI50Jd iiJl./J Japun a:>u21s!SSI! JO asn pue 'aJu~da;)je 'pJeM2 ;l\,Q ~ ^Idde 59 JJ&!d lJ~:> trz pUR (5:lUaWUJClM~ Il!~ pue aJ~S I./JIM ~uawaaJ5v JiiJ~m pue speJ~uo:> '5:lueJ~ OJ alq~!lddy Sald!JU!Jd ~O') L8-V 'ON JelroJ!) ewe JO sJuaw9JtnbaJ pue 'sau!lap!n6 'sa~!Iod aLll'-l.ln:JJl~ .WO 10 Aalllqlf::lllddy (J) 'pa~sanbaJ 8JU~S!"e a\,Q uo 6uIPuedap 'JJed 51\.1~ Jepun sIesodOJd OJ ^Idde Aew ('ba ~ lOSE ','s'n 9_81 jO ~ ..~no... .......... ,.~.eo~ ..,.1. (q) 'peul~ulew pue piiJU!~Jqo 51 we.J60Jd a:lueJnSUI 1'001::1 leUol'leN 94'l Japun 9JUIlJnsu! POOIJ ~~4'l fiU!JnSS2 JOj ~tQlsuodsiJJ aJe (uO!'le'l!l!qel.jiU t)U!pnIJU!) Uo!+>nJ~SUOJ JO UO!J!s!nb:)! JOj .~ue1S!SSe 6u!^!coaJ pue spJezel./ pOOU j!"ads 6UIM!~ 51! VW::I=' }.q paYIJuap! eaJe ue u! pa~~Ol DU!Sn04 MI~oddns 4JIM SJue:1nddv " 'UOIlt?,,,dde ~4~ JO leAOJdde )0 uO!~!PUO~ e 51! pau!e:lqo S! CJJueJnsu! POOld C!!} pue ~SPJeze~ l,pns 6UII'JQ6;JJ UOIJ~UI10U VW3j a:)u!s passed sell JeaA e uel.jJ ssal JO '(6! 1I6noJ~ 6S sued lj:::l' i* aas) we.J5oJd a:lUl!JnSUI poold leuolllN il4J UI 6uIJedpIJJed 51 paJen:lls 51 ecue a4~ 4::>l4M u! A:I!unWwoJ aLl! (!) :S5aIUn 'spJeze4 pooll lepads BU!AI!4 5e (VW~d) luua6v Juawe5euew ~u"DJeW3 f!Japed al.l~ }.q paypuapl eaJI! UI! UI paJI!JOl 5u!snoLj a^!lJoddns JOl (UOlll1!J!Ql!LlaJ DUlpnl:>UI) UO!+'NJSUlr.) JO UOIJlslnbJ! JOJ CJ,u~s!sse JOJ 5uo!J~"ddl! JO II!^OJdde al,p ~!q!40.Jd (9ltto-tOOtr 'j's'n Zto) EL61 JO ~V UOIlJ~OJd Ja:r.;eslO POOl:! ;)41 "t ".::Iu...n.u, poo,.. (e) :SJUiJW9JlnbiU liJiiJPil.:l 6u!MOII0~ aloA 41!M AldUJo:J Jsnw J,Jed S!L1~ Japun pap!AOJd a:JU~5!SSe JO asn 's ~ed l:l;/, tr'Z U! 4lJOj Jas ~uawaJ!nbaJ a~n o~ uOIJ!ppe UI "lqu.waa,nb... .....P.:t...'IlO JD ~mq~lIddy OEtOEa. o~ [9661 'OE '~das '9lns lH t9 ~966t '6 'q3:1'OtlS lJ:f t9 ~v661 'OE iJUn( 'v68EE lJ;I 65 ~e papuawe se '[661 '~1 'Jew 'USEY lH 85] '(Q)EZ'9 ~.:I' toz JO 5:1UaW;UfnbaJ al./~ ~iJaw 15nw UO!'l~!I!C1e~eJ J3tne '(e)tt'S ~, ~'Z 10 sJu~waJ!"baJ ~~ la3W lsnw 6ulI:mnCl ~u:a JO :ISO:) ;)UgW~eldaJ aLA JO :uow JO ;ua:)Jad !iL aJe uO~C!~!I!Qe4aJ 10 5JSO:;) 4:J'~M UI marOJd " 'SO~'OOt }j:J' VZ 'ialQCClldde se 'pue ZZ'& ~D vl: JO ~uawaJlnbaJ ^J!IlClISStnJI! aLlJ Jaaw Jsnw UOIJ:JMJ~SUO:J Mau IIV 't co corccnr''1'J1 ('n'Tn I'J"Il\r-n r--. ''1'11 WJJI'J~IJJn IWVIW n"lu ~"I (d) L..d-b...d p8lnt.The L.eaa-Based Paint Poisoning Prevention Act (42 U.S.C. 4821-4846), the Residential Lead-Based Paint Hazard Reduction Act of 1992 (42 U.S.C. 4851-4856), and Implementing regulations at part 35, subpartS A, a, J, K, and R of this title apply to activities under this program. (e) Conflicts of interest. 1. In Clddition to the conflict of interest requirements'in 24 CFR part 65, no person who is an employee, agent, consultant, officer, or elected or appointed oftidal of the reCIpient and who exercises or has exercised any functions or responsIbilities with respect to assisted activities, or who is In a position to partidpate in a decision making process or gain inside information With regard to such activities, may obtain a personal or finanCial interest or benefit from the activity, or have an interest in any contract, subcontract, or agreement with respect thereto, or the proceeds thereunder, either for himself or herself or for those with whom he or she has family or business ties, during his or her tenure or for one year thereafter. Partldpation by homeless Individuals who also are participants under the program in policy or decision making unCler Sec. 583.300(f) does not constitute a conflict of interest. 2. Upon the written request of the recipient, HUO may grant an exception to the prOviSions of paragraph (e)(l) of this section on a case-by-case basis when it determines that the exception will serve to further the purposes of the program and the effectJve and efficient administration of tne recipient's project. An exceptIon may be considered only after the recipient has provided the following: (i) For States and other governmental entitles, a disclosure of the nature of the conflict, accompanied by an assurance that there has been public disclosure of the Conflict and a description of how the public disclosure was made; and (ii) For al/ recipients, an opinion of the recipient's attorney that the interest for which the exception is sought would not violate State or local law. J. In determining whether to grant a requested exception after the reCIpient has satisfactorily met the requIrement of paragraph (e)(2) of this section, HUO will consider the cumulative effect of the following factors, where applicable: (i) Whether the exception would provide a significant cost benefit or an essential degree of expertise to the project which would otherwiie not be available; (ii) Whether the person affected is a member of a group or class of eligible persons and the e)(ceptlon will permit such person to receive generally the same interests or benefits as are being made available or provided to the group or class; (Iii) Whether the affected person has withdrawn from his or her functions or responsibilities, or the decision making process with respect to the specific assisted activity in questIon; (Iv) Whether the mterest or benefit was present before the affected person was in a position as described in paragrilph (e)(l) of this section; (v) Whether undue hardship will result either to the recipient or the person affected when weighed against the public interest served by avoiding the prohibited conflIct; and (vi) Any other relevant considerations. en Audit. The financial management systems used bV reCipients under this program mUSit provide for audits in accordance with 24 CFR part 44 or part 45, as applicable. HUD may perform or require additional audIts as It finds necessary or appropriate. (g) Davis-Bacon Act. The provisions of the Davis-Bacon Act do not applv to this program. [58 FR 13871, Mar. 15, 1993, as amended at 61 FR 5211/ Feb. 9, 1996; 64 FR 50226, Sept. 15, 19991 Effective Date Note: At 64 FR 50226, Sept. 15, 1999, Sec. 583.330 was amended by revising paragraph (d), effective Sept. 15, 2000. For the convenience of the user, the superseded text is set forth as follows: Sec. 583.330 Applicability of other Federal requirements. ., * * * * (d) Lead-based paint. Any residential property assisted under thiS part constItutes HUD-associated housing for the purposes of the Lead- Based Paint POisoning Prevention Act and is, therefore, subject to 24 CFR part 35. " '" ,.::~ " (Code of Federal RegulatIons] [Title 24, Volume 3, Parts 500 to 699J [Revised as of April 1, 2000] From the u.s. Government Printing Office via GPO Access (CITE: 24CFRS83.400] TITLE 24--HOUSING AND URBAN DEVELOPMENT SECRETARY FOR COMMUNITY PLANNING AND DEVELOPMENT, DEPARTMENT Of HOUSING AND URBAN DEVELOPMENT PART 583--5UPPORTIVE HOUSING PROGRAM-- Table of Contents Subpart Eo-AdmlnlstratlDn Sec. 583.410 Gr.nt .o....m.nt. (a) Gener.l. The duty to provide supportive hOUSing or supportive servIces in accordance wIth ttle requIrements of this part will be incorporated in a grant agreement executed by HUD and the recIpient, (b) Enforcement.HUD will enforce the obligations In the grant agreement through SUCh action as may be appropriate, including repayment of funds that have already been disbursed to the recipient. Sec. 583,405 Program chang.a. (a) HUD apprDval. 1. A recipient may not make any significant changes to an approved program without prior HUD approval. Significant changes include, but are not limited to, a change In the recipient, a change in the project site, additions or deletions In the types of activities listed in Sec. 583.100 of this part approved for the program or a shift of more than 10 percent of funds from one approved tvpe of activity to another, and a change in the category of participants to be served. Depending on the nature of the change, HUn may require a new certification of conSistency with the consolidated plan (see Sec. 583,155). 2. Approval for changes Is contingent upon the application ranking remaining high enough after the approved change to have been competitively selected for funding in the year the application was selected. (b) Documentation of ather ch8ngetlny Changes to an approved program that do not require prior HUD approval must be fUlly documented in the recipIent's records. [58 FR 13871, Mar. 15, 1993, as amended at 61 FR 51176, Sept. 30, 19961 he. '13.410 Obll,..tlon and deobllgatlon at fundal (a) Obligation of fund.When HUO and the applicant execute a grant agreement, funds are obligated to cover the amount of the approved assistance under subpart B of this part. The rectpient will be expected to carry out the supportive housing or supportive services activities as proposed in the application. (b) Iner......After the initial Obligation of fundS, HUe will not make revisions to inaease the amount obligated. (e) Deobllg8tlan. 1. HUe may deobligate all or parts of grants for acquisition, rehabilitation, acqUIsition ana rehabilitation, or new constructIon; (I) If the actual total cost of acquisition, rehabilitation, aCQui~tjon and rehabilitatIon, or new construction IS less than the total cost anticipated in the application; or (II) If proposed activities for which funding was approved are not begun within three months or residents do not begin to occupy the facility wtenin nine months after grant execution. 2. HUD may deobllgate the amounts for annual leasing costs, operating costs or supportive services in any year: (i) If the actual leasing costs, operating costs or supportive services for that year are less than the total cost anticipated in the application; or (1/) If the proposed supportl"e housing operations are not begun within three months after the units are avai/8ble for occupancy. 3. The grant agreement may set forth in detail other circumstances under which funds may be deoblig8ted, and other sanctions may be imposed. 4. HUD may: (I) Readvertise the availability of funds that have been deobllgated under this section In a notice of fund availability under Sec. 583.200, or Oi) Award deoblig8ted funds to applications previously.. . . submitted in response to the most recently published notice of fUnd aVi!lili!lPility, and in 8ccordance with sub~rt C of this part. ..\ TTACH\lE:'-.i .\- to DADE COUNTY HOMELESS TRUST STANDARDS OF CARE for the DADE COUNTY CONTINUUM OF CARE '. HOMELESS HOUSING AND SERVICE DELIVERY SYSTEM ., j I :!_ I I I i I I I t" 1dofJfc'd January 1:-. 1997 J TABLE OF CONTENTS Purpose and Applicability Definitions 2-3 Outreach, Assessment and Placement 4-10 Temporary Care Facilities . f 1-19 Primary Care Facilities 20-30 Advanced Care Programs 31-35 STANDARDS OF CARE Adopted By the DADE COUNTY HOMELESS TRUST and Applicable to the DADE COUNTY CONTINUUM: OF CARE HOMELESS HOUSING AND SERVICE DELIVERY SYSTE1\f Mandated by the DADE COUNTY COMMUNITY H01\fELESS PLAN (Dade County Ordinance No. 0-94-66) January 17,1997 PURPOSE AND APPLICABILITY: These Standards of Care establish definitions, policies and standards relating to the provision of housing and services directly to homeless individuals and families located in Metropolitan Dade County, Florida within the Continuum of Care homeless housing and service delivery system mandated by the Dade County Community Homeless Plan, Dade County Ordinance No. 0-94-66. The mission of the Continuum of Care homeless housing and services delivery system is to provide homeless individuals and families \\;th the resources and oPportunities by which to attain residential, financial and personal stability and self-sufficiency. Accordingly, this mission is to be adopted by all Trust-funded providers. The purpose of these Standards of Care IS to est3blish the mInImum scope of housing and scrvices to be provided aI1d the minimum level of quality of care when providing such housing and services directly to homeless individuals and families. These Standards of Care apply to all Trust-funded providers who provide housing and/or services directly to homeless individuals and/or families located in Metropolitan Dade County. Trust-funded providers are to establish policies and procedures that retlect and incorporate these Standards of Care, as may apply to the type/category of care provided. It is desired that other providcrs who providc housing and/or services directly to homeless individuals and families, but who are not funded by the Dade County Homeless Trust, \Vill conSIder and adopt thcse Standards of Care. TIICSC Standards of Carc have been adopted by the Board of the Dade Cuunty Homeless Trust. :.J Metropolitan Dade Cuunty entIty created by D:lde County Ordinance No. 0-94-66. It is the responsibility of the st::1I"[ of the Dade Coumy Homeless Trust to cnsure that these Standards of C:.Jre arc followed by Trust-funded prOVIders. , /1 7/<) 7 DEFTh1TIONS: Continuum of Care: "Continuum of Care" or "Continuum" means and refers to the consolidated and integrated homeless housing and services delivery system mandated by the Dade County Community Homeless Plan, Dade County Ordinance No. 0-94-66, and implemented and administered by the Dade County Homeless Trust. Trust-Funded Provider(s): A "Trust-funded provider" (also referred to as "Provider") means a mlUlicipal or state agency, not-for- profit corporation or for-profit corporation, that provides housing and/or services directly to homeless individuals and/or families and that is under contract with the Dade County Homeless Trust and/or funded in whole or in pan by Metropolitan Dade County, Florida, through the Dade County Homeless Trusl Non-Trust Funded Provider(s): A "non-Trust funded provider" means a municipal or State agency, not-for profit corporation or for-profit corporation that provides housing and/or services directly to homeless individuals and/or families and that is not under Contract ",th the Dade o,unty Homeless Trust nor funded in whole or in part by Metropolitan Dade County through the Dade County Homeless Trust. Client(s): "Client(s)" mean homeless individual(s) or familY(ies) referred to a Trust-funded provider by the Dade o,unty Homeless Trust through its Outreach, Assessment and Placement Program or otherwise, by a Trust-funded provider, or by a non-Trust funded provider. Individualized Continuum of Care Plan: "Individualized Continuum of Care Plan" means an individualized contract that is based upon the panicipant's current state, capabilities and personal goals and objectives, a comprehensive assessment of client's conditions and needs, as well as case management recommendations, and that describes the participant's needs for supportive services and outline the steps that the panicipant must take in order to begin the persnnal process towards reSIdential and finanCIal stability and self-sufficiency. Outreach, Assessment and Placement Program: "Outreach, Assessment and Placement Program" (also referred to as "OAP Program") refers to the program coordinated by the Dade County Homeless Trust to locate and engage homeless individuals and families, conduct preliminary assessments of immediate llIlmet needs, and make referrals for appropriate placements in hOUSing and/or services provided by Trust-funded or non-Trust funded providers. The OAP Program is deemed a service provided directly to homeless individuals and families. Outreach, Assessment and Placement Program Provider: "Outreach, Assessment and Pbcemcnt Program Pro,ider" (also rekrred to as "OAP Program Provider") relers to a Trust-funded provider who provides Outreach, assessment and placcment services under thc dircctIon of thc OAP Program. Temporary Care Provider: "Temporary Care Prov,der" reters to a prov,der who provides emer.cenev housmg and core 10 homeless Individuals and/or limIiics and to such provldcr's 13CilItlCS and/or programs. 1117/')7 Primary Care Provider: "Primary Care Provider" refers to a provider who provides housing and supportive services to special need homeless populations comprised of persons with a history of mental illness or dehabilitating mental health conditions, substance abuse, victims of domestic violence, HIV infection or AIDS, as well as homeless individuals and families in order to assist such persons in the transition from homelessness to independent living or to permanent supported housing, as the case may be, and to such provider's facilities and/or programs. Advanced Care Provider: "Advanced Care Provider" refers to a provider who (1) operates or provides access to supported housing for those homeless individuals and families with special needs (i.e. permanent disability, the frail or elderly) and/or (2) assists those homeless individuals and families capable of maintaining independent living with minimal initial support to secure houSing in the affordable housing market Supportive Services: "'Supportive Services" refers to services provided directly to homeless individuals and/or families by a Trust-funded or non-Trust funded provider independent of, or in affiliation with, another provider, Intended to assist homeless individuals and/or families in attaining residential, financial and personal stability and self-sufficiency. Such services include, but are not limited to, health care, case management, out-patient mental health or substance abuse treatment, education or vocational training, Job counseling, training and/or placement, child care and legal services. I 1--,1)7 OUTREACH, ASSESSMENT AND PLACEMENT STANDARDS OF CARE APPLYING TO OUTREACH, ASSESSf'tIENT AND PLACEMENTPROG~ I. CORE FUNCTIONS OF OUTREACH, ASSESSMENT AND PLACEMENT PROGRAM:: · The Mission and Purpose of the Outreach, Assessment and Placement Program (hereinafter referred to as "OAP Program") is to locate and engage homeless individuals and families, conduct preliminary assessments of immediate unmet needs and make referrals to appropriate placements with housing and/or services provided by Trust-funded or non-Trust funded providers. The purpose of the OAP Program is to ensure a coordinated process on a County-wide basis by which to assist homeless individuals and families in accessing the Continuum of Care's housing and/or services that are available. · Core Functions: Outreach, Assessment and Placement Program Providers (hereinafter referred to as "OAP Program Providers") shall provide the following core functions to their clients: . 1/17/'/7 . OutreachfEngagement involving the necessary client contact to form a relationship of trust and understanding benveen OAP Program Provider street teams and the homeless individual or family. . Assessment, fOllowing successful client engagement, of the client's current social, health (including mental health and substance abuse), and employment/education conditions. Such assessment shall form the basis of the recommended service track and shall follow the client to the referral provider. . PlacemenuReferral to referral alternatives currently available and appropriate. Such referral alternatives shall include, but are not limited to, a provider within any level of care within the Continuum of Care, including services related to medical treatment, mental health assessment, medical detoxification, education and vocational programs, day labor, or other appropriate service. . Follow-Up of client progress to be tracked at varying intervals, depending on the needs and requirements of the individual or family engaged, assessed and placed in services to ensure appropriate referral and proper engagement. Rc-Engagcmcnt when :m individual initially engaged and assessed by a OAP Program Provider has left a program or service. Emphasis shall be made on locating and re- establishing contact with the individual, with thc purpose of re-engaging the individual into the Continuum of Care. This process shall begin following notification from a Trust-funded or non-Trust funded provider of thc client's dcp:lr1ure from its program and/or servIces. .1 II. GENERAL STANDARDS A. . CLIENTS · Outreach, assessment and placement shall be conducted in an humanitarian fashion which respects the dignity of the homeless individual or family. A grievance procedure providing for fair notice and hearing shall be made known and available to clients by which to seek redress in the event that a client has a grievance regarding the services offered and/or provided by a OAP Program Provider. · OAP Program Providers shall demonstrate sensitivity to clients' primary language and cultural background. · The OAP Program approach shall be non-judgmental of the homeless, "';thout a pre-detennined program objective, unless requested by the client. · Clients shall be informed of both the privileges and responsibilities relating to prospective placement with a temporary care, primary care or advanced care provider, as the case may be. Clients shall be provided with a copy of the Resident/Client Agreement that the client would be required to sign upon admission to a temporary, primary or advanced care facility or program. B. OAP PROGR.A!\.-f PROVIDER STAFF: · OAP Program Provider administrators shall ensure that the OAP Program Provider staff has the qualifications, proper training and supervision necessary and appropriate to the job function(s) with which such staff members are entrusted. C. COORDINATION, COOPERATION AND Th'TEGRATION: · The OAP Program shall be administered by the Dade County Homeless Trust and shall consist of a coordinated process requiring the coordination and cooperation of county and local municipalities and their respective agencies which may have contact with or provide services to homeless individuals and families, as well as local community-based organizations involved in outreach, assessment and placement services that may be established under the OAP Program. · Each OAP Program Provider shall work closely and cooperatively with the administrators of the OAP Program. other OAP Program Providers and other community-based outreach efforts. · Each OAP Program Provider shall work closely and cooperatively with all other Trust-funded prOVIders as well as other community-oased service providers to homeless individuals and families. D. NON-DISCRI1\lINA TrON IN THE PROVISION OF SERVICES: · 1l1cre shall be no discnmmation on the basis of race, color. gender, sexual orientation. disability, religion, or national ongm in the prOVISion of outreach, assessment and/or placement seryiccs to clients by OAP Program ProViders. No rciI[!lous practice or affiliatIon requIrcment shall be Imposed upon <:ilents or prospectIve cll<.:nr.:; I i I 7 i'n m. OUTREACHlENGAGEM:El\T SERVICES · Ou'reachlEngagement: OUlreachlEngagement is defmed as client engagcment resulting from client COn"'ct on the streets, thl-ough referrals from police agencies or municipalities, referrals from social service providers, self-referrals (walk-ins) and encampment closures. The focus 0 f outreach/engagement activities shall be to develop the relationship needed to bring the homeless individlUl or family imo housing and/or services through the outreach relationship. Street outreach/engagement efforts shall be comprised of multiple, daily, non-threatening, infonnal con",cts with homeless individuals and families fOCUSing primarily on establishing familiarity and developing trust · Street Outreaeh Teams: Outreach services shall be conducted through the use of teams which are to continuously and consistently search for homeless individuals living on the streets, in parks, abandoned buildings, undemeath expressways and other pl3ces not meant for human habi"'tion. · Co m posi tio n of Street 0 u trea cli Teams: Each Street OutreachlEngagement Team shall include a peer outreach worker (fonnall y homeless person) and the support 0 f a trained Socia I IV orker. · Provision of Servic", Outreach, assessment and placement services shall be providcd seven (7) days a week, and weekday nights. Preference shaIl be given to provide outreach/engagement services in a geographical manner, and to assign teams to target different geographical areas. · Referral Opportunities: Services of the OAP Program as well as tliose available within the Continuum of Care shall be offered to homeless individlUls and families whencver such persons arc engaged by a street team. III 7/<)7 I, IV. ASSESSMENT SERVICES · Assessment in General: Assessment shall be performed through an interview process following successful client engagement that determines the most appropriate placement with housing and/or services currently available. These services are to include, but are not limited to, immediate medical attention, mental health assessment, employment services, or a full range of social services, including housing, available within the Continuum of Care, whether provided by a Trust funded provider or non- Trust funded provider. · Method of Assessment: Assessment shall be performed in a manner that respects the dignity and rights of the client. If there is a perceived emergency, an assessment and/or screening for mental health or substance abuse service needs shall be performed as soon as possible (e.g. within two (2) hours of initial engagement). · Identification of Needs and Factors: The assessment shall be performed in a manner that identifies the circumstances, behavior patterns, and psychosocial factors causing and maintaining individuals or families in a state of homelessness. The assessment shall determine the specific in-depth needs of homeless individuals, with an emphasis on those persons living in the most severe and chronic conditions. The assessment shall be performed in a manner that maximizes the making of appropriate reconunendations for housing and/or services with a Trust or non-Trust funded provider who will meet such needs. · Screening for Mental Health or Substance Abuse Service Needs: Screening for emotional disorders and dysfunctions, including substance abuse, and for other serious mental health impediments to independence, shall be performed by, or under the supervision of, qualified mental health or substance :lbuse professionals. · Demographic Information: OAP Providers also shall collect basis demographic information on persons engaged and assessed including, but not limited to, date of birth, gender, and ethnicity. 17.')~ 7 V.' PLACEMEi'i'TIREFERRAL SERVICES · Coordinated Referral: Referral into the Continuum of Care of individuals and families found living m the streets, in parks, abandoned buildings, underneath expressways and other places not meant for :uman habitation, or engaged through referrals from police agencies or municipalities, social ser\1ce 'roVlders or self-referrals, shall be coordinated through the OAP Program. , Availability of Placement/Referral Opportunities: Placement or referral to housing and/or ser\1ces :all be made available to all homeless individuals and families who express a desire to receive housing :dlor services. Client's Sense of Urgency: A client's O\llI1 expression of the urgency of their request for assistance :111 govern the OAP Program Provider in determining how quickly referral and/or placement shall be :deree. ~lient-Directed Referral Process: To the greatest extent possible, the client's goals and objectives 11 govern recommendations for referral. OAP Program ProVIders shall encourage client participation hoice of placement or referral to the greatest extent possible. lpropriate Referral/Placements: OAP Program Providers shall make appropriate Tal/placement of homeless individuals and families as may be available in temporary, primary or .nced care facilities or to services within the Continuum of Care. nimum Length of Stay: OAP Program Providers shall use best efforts to ensure that each housing ment results in a minimum stay of seven (7) days so as to maximize the effectIveness of the "~ment process wIthin the Continuum of Care and the extent to which the client will be able to or be g to avail him or herself of the OPPOrtunities made available within the COntinuum of Care. dsion of Transportation: In cases in which a client is placed in a housing and/or residential ent faCility, OAP ProVIders shall provide the client with transportation to the site of the facility. losure of Assessment and Recommendations: With the consent of the client, a OAP Program :r shal I provide a copy of its assessment of the client as well as it,> service and/or housing ~ 1endatlOns to the Trust-funded or non-Trust funded proVIder to whom the client has been referred 'laced. ,3.1 of Services :lnd/or Housing: OAP Program ProViders sl1311 rn3lntain records documenting ,( placement or refeIT31 and the grounds for such refus31 as expressed by the client. Refusal of a r placement or retCIT31 sh3II not preclude a client's ability (,) request 3nd receIve future sen.'lces \P rro~r311l. :\ VI. FOLLO\V-UP · Follow-up in General: OAP Program Providers shall perform follow-up of individuals and families engaged in services and/or housing opportunities through the OAP Program to ensure that appropriate and effective client engagement, assessment and placement has resulted. · Method of Follow-Up: OAP Program Providers, to the greatest extent possible, shall maintain client contact following placement or referral. Follow-up shall be performed in a manner that permits measurement of client progress through the Continuwn of Care in an effective manner, to ensure that appropriate services are being rendered, and to provide continued support and encouragement to the client · Minimum Follow-Up Thresholds: Following client engagement, assessment and placement, the minimwn follow-up thresholds are as follows: · Persons Referred for Stabilization or Detoxification: Contact and follow-up shall be made with individuals who have been referred directly to mental health stabilization or chemical detoxification within seventy-lt1-'O (72) hours of their referral and placement to ensure continuation of engagement, assessment and placement into appropriate housing and/or services following stabilization. · Contact Following Initial Referral and/or Placement: Contact and follow-up shall be made with individuals who have been referred to and/or placed with services and/or housing within seven (7) days to monitor appropriateness of the placement and the progress of the client and to provide continued support and encouragement · Follow-Up After Placement in Temporary Care Facilities: For clients placed in a temporary care facility, contact and follow~up should take place \vithin sixty (60) days of placement to monitor progress of the client, ensure that the client's needs are being met and that available housing and/or services \vithin the pnmary and advanced care levels are accessible to the client, if needed. · Follm,\f-Up After Placement in Primary Care Facilities: For clients placed in a primary care facility, contact and follow-up should take place within six (6) months of placement to monitor progress of the client, ensure that the client's needs are being met and that available housing and/or services \v1thin the advanced care level are made accessible to the client, if needed. · Additional or More Frequent Follow-up: Additional follow-up before or after these minimum thresholds, depending on the needs and requirements of the individual or family engaged, assessed and placed in services, may be appropnate and may be done as needed, desired or deemed necess:lry by a OAP Program Provider to ensure the effectIveness of its engagement, assessment :lnd placement servIces. I/I7/'n <) YD. RE-ENGAGEl\fENT . Point of Contact: OAP Program Providers shall provide a point of contact for clients and Trust- funded or non-Trust funded providers for the purpose of re-engaging clients who abandon services and/or housing placement opportunities with the objective of re-entry into the Continuum of Care. . Client Re-Engagement: OAP Program Providers shall provide its engagement, assessment and placement/referral services to clients who abandon services and/or housing placement opportunities and to persons who previously rejected assistance, but later express a desire for assistance. . Provider Request for Re-Engagement: OAP Program Providers shall attempt re-engagement of a client upon the request of a Trust-funded or non-Trust funded provider or upon notice by a Trust-funded or non-Trust funded provider that a client has abandoned its housing program and/or services. VIII. CLIEr\T"f CONFIDENTIALITY AND SHARING OF INFORl\1A.TIOI\': · Client Expectation of Priyacy: OAP Program Providers shall comply with all federal and state laws and regulations goyeming the confidentiality of information regarding AlDS/HIV status and medical, substance abuse or mental health history, referral or treatment. Clients may expect a reasonable degree of priyacy with regard to information not otherwise protected from disclosure by federal or state laws and regulations that is shared with the OAP Program Providers staff members. · Exceptions to Client Confidentiality: Client information may be subject to disclosure as provided by law including investigation by law enforcement, probation officers, and HR.S protective services related to minors or the elderly, subject to any limitations on disclosure set forth in state or federal law, including those laws protecting the confidentiality of information regarding AIDS/HIV status and medical, substance abuse or mental health history, referral or treatment. · Sharing of Client Information: Sharing of client information \vith other providers to whom the client may be referred is necessary to ensure effective provision of services, continuity in care, and efficient use of Continuum resources. The necessity of sharing information with other providers shall be explained to the clienL Client information shall only be shared upon the client's written consent. III 7!' J7 10 TEMPORARY CARE I : I I STANDARDS OF CARE APPLYING TO TEMPORARY CARE FACILITIES 1. CORE FUNCTIONS OF TEMPORARY CARE FACILITIES: . The Mission and Purpose of temporary care facilities is to provide emergency housing and care ~o individuals in dire need, including, but not limited to, assessment, case management, linkage and referral to supponive services and housing oppommities within the Continuum of Care and community-at-Iarge. · Core Functions: Temporary care facilities shall provide the follo\\;ng core functions to their dients: . Emergency Housing, induding clothing, meals, and initial health screening for communicable diseases. . Comprehensive Assessment of current social, health (including mental health and substance useJabuse), and employment/education conditions. . Development ofTndividualized Continuum of Care Pl:1ns describing a client's needs for supponive services, establishing a serviceJreferral plan and outlining the client's personal goals towards attaining residential, financial and personal stability and self-sufficiency. . LinkaQ"efReferral to internal and external supponive services including, but not limited to, benefit programs, in-patient or out-patient mental health or substance abuse treatment or support groups, education/vocational opportunities, job counseling, training and placement. child care and legal services, and transportation. . Outplacement to appropriate housing opportunities in the Primary or Advanced Care levels of the Continuum of Care, in the Dade County community or in the local affordable housmg market. 1/1 7/')7 11 II. GENERAL STANDARDS - PROGRA!\-f E~rvmOI"{ME~T A. RESIDENTS · Homeless individuals and families served by temporary care facilities shall be accorded dignity and respect. A grievance procedure providing for fair notice and hearing shall be made known and available to clients by which to seek redress in the event that a client has a grievance regarding the operation of the temporary care facility or should a client believe that he or she has been unfairly accused of a rule infraction. or in the event of a decision by the temporary care provider to refuse or terminate services to the client. · Temporary care facilities shall demonstrate sensitivity to clients' primary language and cultural background. · Clients have both privileges and responsibilities relating to their stay at the temporary care facility which shall be set forth in a Resident/Cliem Agreement that each client must sign upon admission to the temporary care facility. B. SAFE ENVIROl\1vIENT: · All temporary care facilities shall establish and enforce house rules governing use of alcohol, illegal use of controlled substances, fighting, violent and/or inappropriate behavior for the purpose of protecting the health and safety of clients and staff. C. TEMPORARY CARE FACILITY STAFF: · Temporary care facility administrators shall ensure that faCIlity staff have the qualifications, proper training and supervision necessary and appropriate to the job function(s) with which such staff members are entrusted. D. NON-DISCRIMINATION IN THE PROVISION OF HOUSING AND SERVICES: · ll1ere shall be no discrimination on the basis of race, color, gender. sexual orientation, disability, religion. or national origin in the provision of emergency housing and services to clients by temporary care providers. No religious practice or affiliation requirement shall be imposed upon clients or prospectIve clients. E, COORDINATION, COOPERATION A1\'D INTEGRATION: · Gch Temporary Care Provider sh:1l1 work closely and cooperativel',' \...ith the Dade County Homeless Trust, the GAP Program :md OAP Progr:Jm Providers, :Jll other Trust-'Cunded rro\,dcrs as w~Il :JS other communlty-b:Jsed service provloers to homeless mdividu:Jls :lnd f:Jmli les. 1/17/07 17 [1. PROVISION OF EMERGENCY HOUSING; A. HOUSING: [...ength of Stay: Length of stay shall be determined by the temporary care facility, consistent with the ,de County Community Homeless Plan goals for emergency care - to encolU'age the client's attainment long-term self-sufficiency through the optimal utilization of housing and services offered through the ntinuum of Care's Primary and Advanced stages of care. Clients are expected to reside at temporary e facilities for a short period of time (i.e. seven (7) to sixty (60) days). Extension of a maximum gthof stay, set by the temporary care facility, shall be made On a case-by-case basis, predicated on the :nt's demonstrated commitment to the goals established by the client with the assistance of case lagement in his or her individualized Continuwn of Care Plan. Violations of temporary care facilities ~e rules may be grounds for terminating a client's length of stay and/or privilege of re-admission. 'parate Sleeping Quarters and Personal Hygiene Facilities: Separate sleeping quarters and Jnal hygiene facilities shall be maintained for (a) single male adults; (b) single female adults and (c) des. Iality of Housing: Temporary care facilities shall maintain safe, clean and sanitary conditions and rtunity to safekeep papers, documents and valuables. Beds, pillows and bed coverings (e.g. sheets )Iankets) shall be clean and sanitary (e.g. free of infestation). rsonal Hygiene Facilities: Personal hygiene facilities shall be made available to each client. Such nal hygiene facilities shall be kept clean and sanitary and maintained in operable working condition tImes, subject to periodic temporary interruptions due to maintenance or repair. .ident Participation in General Housekeeping: Clients may be required to participate in the :l housekeeping of the temporary care facility. B. MEAL STANDARDS: ision of Me:lls: Clients shall be provided a minimum of two meals a day, one of which must be a J1. Standard: All meals served shall be nuuitionally sound and balanced in compliance with is and/or regulations adopted and/or issued by the local public authority responsible for the m of 13cllities which serve meals at residentIal facilities. ( . CLOnllNG STANDARDS: ion of Clothing: Temporary care lacllitIes shall aSSIst cltenlS In obt.::llnlng ::11 least two sets of lte c lotlllng (both under and outer.\'car) and shoes. Approonate clothing 10 the instance of . ~ ;~ 3nd ~;ocks shall mc.1n new or prevIously unused items. .j ('I<llhill~: Donated clol/llng must be \\'ashed/sanlllzcd rnor to dlstnhutlon In clienLs. I \ D. HEAL TIT SCREENINGS: · Immediate Health Screening: To reduce risk of harm to other clients and staff, temporary care facilities shall arrange for health screenings for communicable, air-borne diseases, such as tuberculosis. within thirty-six (36) hours of the client's entry into the facility. Clients determined to pose a direct threat to the health of others shall be quarantined and referred for appropriate medical treatment. · Full Medical Assessment and Evaluation: Temporary care facilities shall arrange for a full medical assessment and evaluation (i.e. complete physical) for each client within seventy-two (72) hours of the client's entry into the facility. E. FACILITIES STANDARDS AND LlCENSING/CERTIF1CATION: · Temporary Care Facilities in General: Temporary care facilities shall comply v.ith all local and state ordinances, regulations or laws governing residential facilities and secure necessary licensing as may be required under such local or state law. · Food Preparation and/or Dining Facilities: Food preparation and/or dining facilities located at temporary care facilities must comply v,ith all local and state ordinances, regulations and laws governing facilities which serve meals to the public in a residential facility or otherwise. Temporary care facilities must secure necessary licensing or certification as may be required by the local public authority responsible for the regulation of facilities which serve meals to the public. · EnvironmentaVStructural Controls and Procedures to PreventJControlSpread of Communicable Diseases: Temporary care facilities shall comply with all local and state ordinances, regulations and laws governing the prevention and/or control of the spread of communicable, air-borne diseases within residential facilities which may include the implementation of structural or envirorunental measures and quarantining, notification and health screening procedures. I; 17 I'): 1.1 IV. TEMPORARY CARE CASE l\1ANAGEMENT: A. CASE MANAGEMENT SERVICES IN GENERAL: · The Mission and Purpose of temporary care facilities is emergency housing and care. The case management function at temporary care facilities shall be one of assessment, advocacy and linkage as opposed to treatment due to the short stay of clients. Assisting the client in obtaining needed housing and services shall be the essential function of the temporary care facility. · The Primary Purpose of Case Management Services is to integrate various internal and external service components into a coherent constellation of services tailored to meet the unique needs of individuals. Case Management shall be concerned with service coordination and problem solving in an attempt to insure appropriate service provision and continuity. · Partnerships: The temporary care facility shall develop parU1erships .....ith government, not-far-profit and community-based agencies or organizations or programs to coordinate and provide services to its clients. · Case l'rbnagers: The case manager shall be responsible for producing a comprehensive assessment of the client's current social, health (including mental health and substance use/abuse) and education/employment conditions and needs. The case manager shall playa major role in assisting the resident in the development and implementation of a Continuum of Care Plan which will enable the client to successfully achieve his or her personal goals and objectives by addressing unrnct needs. · Client Rapport: Development of a rapport between the client and his or her case manager, establishing trust and familiarity, is deemed integral to establishing an effective case management service plan and a realistic, client-developed Continuum of Care Plan. · Scope of Case l\1anagement Services: The scope of case management services provided shall be client directed. B. CORE CASE I\1ANAGEME.!\" FUNCfIONS · Core Functions of a temporary care facilities case management program shall be: Assessment - a thorough evaluation detailing the client's current and potential strengths, weaknesses, service needs and appropnate resources to meet the service needs. Planning - the development of a holistic service plan with each client, containing service goals and appropriate timeliness. Link:1~('lBroker:t~(' - the process of rcfcmng or transferring clients to all required internal and cxternal serYlces. Monitoring - the continUOUS e\'3.luatton of the clicnt's prot,'TCSS, k3.dmg to reassessment and development of new SC!\'lCC plans. linb.gcs, or other dISpOSItIOnS as indicated. :\dVOCIC"V - Ifltcrccd1l1g on bd13.lfof:l (jlcnt or ~rotJr ofellCr1tS to as:;urc :leees:; to necded :;C!\'IeCS and/or rcsourec;" 111 7 I')) I~ . · Areas of Case Management Intervention should include but are not limited to: · Service Planning. · Assistance in obtaining food and clothing and transportation. · Referrals for in:. or out-patient mental health services, substance abuse treaanent, and medical servIces. · Assistance in obtaining benefits. · Referrals to self-sufficiency related programs such as adult education., vocational training, job counseling, training and permanent placement services, child care and legal services and transportation. · Assistance and referral to obtain appropriate housing placement in the Primary or Advanced Care levels of the Continuum of Care, in the Dade County community or in the local affordable housing market. c. MULTI-DISCIPLINARY TEAM CONCEPT: · Recommendation: It is recommended that temporary care providers develop a multi-disciplinary approach towards providing care to the client to ensure an holistic response to the client's needs. Temporary care providers are encow-aged to develop multi-disciplinary care teams, comprised of the client's case manager, a health care worker caring for the client, and/or government or community providers directly serving the client, that would meet to review client progress, make recommendations and ensure successful referral to additional services and resburces. Such approach ensures effective, comprehensive service provision as weil as continuity of care as the client is placed with other housing programs within the Continuum or in the community. 1/17/')7 1(, v. COMPREHENSIVE ASSESS1\-IENT: · Comprehensive Assessment Precedes Case Management Services: Case management services shall be preceded by a comprehensive assessment of the client's current social, health (including mental health and substance use/abuse) and education/employment conditions. Screening for emotional disorders and dysfunctions, including substance abuse, and for other serious mental health impediments to independence, shall be performed by, or under the supervision of, qualified mental health or substance abuse professionals. · Client Rapport: Development of a rapport between the client and facility staff responsible for the assessment function, establishing trust and familiarity, is deemed integral to performing a thorough and accurate comprehensive assessment of the client's needs and to establishing an effective case management service plan and a realistic, c1ient-developed Continuum of Care Plan. · Comprehensive Assessment within 72 Hours: A comprehensive assessment of the client' s current social, health and education/employment conditions shall commence within seventy-two (72) hours of admission of the client to the temporary care facility. · Contents of Comprehensive Assessment: The comprehensive assessment shall include treatment and referral recommendations and will form the basis for the client's individualized Continuum of Care Plan and referral services provided to the client. The comprehensive assessment shall be comprised of information gathered by the GAP Program, by the Dade County Homeless Trust, at intake, through client interviews and through medical and referral information. 17.''l7 17 VI. INDIVIDUALIZED CONTINUUM: OF CARE PLAN: · Client-Developed Continuum of Care Plan - Timeliness: Clients shall be assisted in initiating an individualized Continuum of Care Plan within twenty-four (24) hours of the completion of their comprehensive assessment of their current social, health and education/employment conditions and needs. . · Client Contract: The Continuwn of Care Plan is an individualized contract based upon the participant's current state, capabilities and personal goals. The Continuum of Care Plan shall describe the participant's needs for supportive services and outline the steps that the participant must take in order to begin the personal process towards residential and fmancial stability and self-sufficiency. The client's signature on the Continuwn of Care Plan signifies his or her commitment to obtaining residential, financial and personal stability and self-sufficiency. · Basis of Individualized Continuum of Care Plan: The individualized Continuum of Care Plan shall be based on the comprehensive assessment of client's conditions and needs, as well as case management recommendations, and the client's personal goals and objectives. Goals and/or services sought by the client should be consistent with those articulated by the client during initial engagement and assessment by the Trust-coordinated Outreach, Assessment and Placement Program. · Potential Needs to be Reflected in Client's Goals and Objectives: The individualized Continuum of Care Plan should address the following goals and objectives that respond to the following potential needs: health (physical and mental health, including substance abuse), education, vocational skills and employability, benefits and/or benefits, housing, child care and legal services, as well as family/interpersonal issues and spirituality. · Establish Realistic Goals: Unrealistic goals should be avoided to prevent discouragement with the rehabilitation process. Conversely, too simplistic goals should be discouraged to prevent loss of interest by the client due to the existence of too few challenges. The choices made by the client with the assistance of his or her case manager should be realistic and within the client's range of skills, abilities and present circumstances. · Weekly Monitoring of Client Progress: The participant's progress in meeting goals set forth in the Continuum of Care Plan should be monitored on a weekly basis through weekly meetings with the client's case manager. · Flexibility and Adjustment: Continuum of Care Pbns are intended to be individualized, flexible service plans facilitating steady movement toward independent living at a pace suited to each participant's circumstances and needs. TIle Continuum of Care Pian must be adjusted to reflect progress or identified areas where additional attention IS needed either by the client's own efforts or through the provision of additional services and/or resources. III 7/'17 Vil. CLIENT CONFIDENTIALIIT AND SHARING OF INFOR1\1ATION: · Client Expectation of Privacy: Temporary care facilities shall comply with all federal and state laws and regulations governing the confidentiality of information regarding AIDS/HIV status and medical, substance abuse or mental health history, referral or treatment. Clients may expect a reasonable degree of privacy with regard to information not otherwise protected from disclosure by federal or state laws and regulations that is shared with the temporary care facility staff members. · Personal Mail and Telephone Calls: Temporary care facilities shall respect the privacy of a client's personal mail and telephone calls. · Exceptions to Client Confidentiality: Client information may be subject to disclosure as provided by law including investigation by law enforcement, probation officers, and HR.S protective services related to minors or the elderly, subject to any limitations on disclosure set forth in state or federal law, including those laws protecting the confidentiality of information regarding AIDS/HIV status and medical, substance abuse or mental health history, referral or treatment. · Sharing of Client Information: Sharing of client information \vith other providers to whom the client may be referred is necessary to ensure effective provision of services, continuity in care, and efficient use of Continuum resources. The necessity of sharing information with other providers shall be explained to the client. Client information shall only be shared upon the client's written consent. VITI. OurPLACEMENT SERVICES: ... -,~ ..- 'Ul~~~ili,,'1iti~t.\t~~~T~tM'iii&i11t~jJ'ti?~t'o;iii€'i1ffi~frcJ2; housing aod care to individuals in dire need. In keeping with this purpose', the temporary care facility should make every effort to secure an appropriate housing placement for a client as soon as possible. use manager should be thinking of appropriate out-placement by the time the Continuum of wre Pbn is signed and implemented. · Provider Relationships: Temporary care facility case managers are expected to develop strong working relationships with primary and/or advanced care case managers to ensure an effective planning process and smooth transition between housing programs. · Effective Planning Process to Ensure Smooth Transition: TIle planning process should strive to ensure that minimal disruption OCcurs during the tr.lnsition from one provider to another. TIle planning process is intended to ensure that services provided to the client at or through referral by the temporary care facility are maintaIned and that the provision of additional services are arranged for the client prior to transfer, consistent with the client's individualized Continuum of wre Plan. · Outplacement Packet: TIle necessity to cooperate with both the Temporary Care Provider and the rrovlder with whom the client has been placed in order to ensure effective service provision and conttnuity of care shall be explained to the client. Upon the \\Titten consent of the client, an (JUtplaccment packet shall be prepared for the prOVIder with whom the client has been placed. 1l1e ()utplacement packet shall Con1.3m the client's comprehensive assessment, Continuum of Care I'l:1n and referral history and notes for the [lurpose of ensunrlg contInuIty 10 ser:'lce rrOVISlon ;lnd In thc cllcnt ':: "ommItment to his or her rOJ.ls J.n<i ohleetlvc.~. I 7/<)7 1 <) I' PRIMARY CARE STANDARDS OF CARE APPLYING TO PRIl\fARY CARE FACILITIES 1. CORE FUNCfIONS OF PRIMARY CARE FACILITIES: . The Mission and Purpose of primary care facilities is to provide housing and supportive services to special need homeless populations comprised of persons with a history of mental illness or dehabilitating mental health conditions, substance abuse, victims of domestic violence, HIV infection or AIDS, as well as homeless individuals and families in order to assist 'such persons in the transition from homelessness to independent living or to permanent supported housing, as the case may be. . Core Functions: Primary care facilities shall provide the following core functions to their clients: 1/17/')7 . Housing, including clothing, meals, and initial health screening for communicable diseases. . ComprehensivefRevised Assessment of current social, health (including mental health and substance use/abuse), and employment/education conditions and Development/Revision ofIndividualized Continuum of Care Plans describing a client's needs for supportive services, establishing a service/referral plan and outlining the client' s per.son3.Lgo.al~ t~\var.d~ ~~i~i~~fe~l9~nti~1.J}!}~g~!~L~nd~_g~2~~:.1~~Jl.i~~~,~_ >:~g<l$elf~s~ft!pl~~l~,~;:.. :,~:..;Ji'k;c;~2}~E.).:.~T':;~~j;;1#,;Wf"~?;6,,",-Api,';:'~_70:'c~-::;~~:'!'","~::';-;""" ""';";-:=':.' .........i'1-~~~.'L::;;,fj.;-.f:- ," -_....,..:....,0""_>:.,-.,,,, ~..".~;~;:_;;.:, ~.:}: . ......",-'",:".:.,,'.. :~""",";'-"'.^" Mental Health/Suhstance Ahuse Tre3tment or Reh3hilit3tive Support through on- site treatment for mental illness or dehabilitating mental health conditions, including substance abuse, or referral to out-patient treatment for same, and/or on and off-site support groups and/or acmiues. . LinkagefRcferr31 to intern:ll and external supportive services including, but not limited to, benefit programs, primary health care, education/vocational opportunities, job counseling, training and placement, child care and legal services, and transportation. . Outpl3cement to appropriate housing opportunities in the Advanced Care level of the Continuum of Care, in the Dade County community or in the local affordable housing market and Follow-Up Case !\f3n3gement Services for at least ninety days following outplacement. .' i) IT. GENERALSTANDARDS-PROG~IENVTRO~1E~~ A. RESIDENTS · Homeless individuals and families served by primary care facilities shall be accorded dignity and respect A grievance procedure providing for fair notice and hearing shall be made known and available to clients by which to seek redress in the event that a client has a grievance regarding the operation of the primary care facility or should a client believe that he or she has been unfairly accused of a rule infraction., or in the event of a decision by the primary care provider to refuse or terminate services to the client. · Primary care facilities shall demonstrate sensitivity to clients' primary language and cultural background. · Clients have both priviieges and responsibilities relating to their stay at the primary c:u-e facility which shall be set fonh in a Resident/Client Agreement that each client must sign upon admission to the primary care facility. B. SAFE ENVIRONMENT: · All primary care facilities shall establish and enforce house rules governing useofalcohol,i!legalusc: 'f.-"""""--- .~,,.!i'~?'&"t';?-'~"" ofcontroIled substances, fighting, violen~.,~QLPr.in~rop~t~~~'l:iel"49~'c '_'.. ,... ....... .... ... , .. health and safety ofdieiits andsuff. '. .... ". ... ~- - --- . C. PRL\1ARY CARE FACILITY STAFF:. · Primary c:u-e faciiity admimstrators shall ensure that facility staff have the qualifications, licensing, proper training and supervision necessary and appropriate to the job function(s) with which such staff members are entrusted. D. NON-DISCRIMINATION IN TIlE PROVISION OF IIOUSrnG AND SERVICES: · There shall be no discrimination on the basis of race, color, gender, sexual orientation, disability, religion, or national origin in the provision of housing and services to clients by primary care providers. No religious practice or affiliation requirement shall be imposed upon clients or prospective clients. E. COORDINA nON, COOPEI0\ TION AND INTEGRATION: · Gch Primary Care Provider shall work closely and cooperatively with the Dade County I Iome1css Trust, the OAP Program and OAr Program Providers, all other Trust-funded providers as well as other commumty-u3sed service provldcrs to homcless individu31s 3nd f3milies. 1!l7/'J7 ~ I Ill. PROVISION OF HOUSING: A. HOUSrnG: · Length of Stay: Recognizing the existing scarcity of resources, the Dade County Community Homeless Plan sets forth as guidance a length of stay of six (6) to nine (9) months in primary care facilities (transitional housing). Regulations governing homeless programs funded by the U.S. Department of Housing and Urban Development (U.S. HUn) provide for lengths of stay of up to twenty- four (24) months in transitional housing. Inconsistencies in lengths of stay for various housing types, if any, between the Dade County Community Homeless Plan and U.S. HUD guidelines are not intentional substantive deviations from U.S. HUD guidelines, but rather reflect local funding allocations for various lengths of stay in light of current available resources. Length of stay shall be determined by the primary care facility, consistent with the Dade County Community Homeless Plan goals for primary care - to encourage the client's attainment of long-term self-sufficiency through the optimal utilization of treatment opportunities and/or supportive services provided in the primary care level. Maximum residency at primary care facilities is a period of six (6) months. Extension of a maximum length of stay is subject to the review and approval by the Dade County Homeless Trust and shall be made on a case-by-case basis, predicated on the client's Individualized Continuum of Care Plan and demonstrated commitment to his or her treatment plan and/or the goals established by the client in his or her Individualized Continuum of Care Plan. Violations of primary care facilities house rules may be grounds for terminating a client's length of stay and/or privilege of re-admission, consistent with all local and state ordinances, laws or regulations governing tenancy, if and when applicable. · Housing Placement Options: Housing placement options offered to the client shall be consistent with the client's Individualized Continuum of Care Plan. · Residential Facilities - Separate Sleeping Quarters and Personal Hygiene Facilities: Housing quaners offered to the client shall be consistent with the client's Individualized Continuum of Care Plan. In the case of residential facilities that are not single sex facilities, separate sleeping quarters and personal hygiene facilities shall be maintained for (a) single male adults; (b) single female adults and (c) families. · Quality of Housing: Primary care facilities shall maintain safe, clean and sanitary conditions and shall prOVIde clients the opportunity to safekeep papers. documents and valuables. Beds, pillows and bed covenngs (e.g. sheets and blankets) shall be clean and sanitary (e.g. free of infestation). · Personal Hygiene Facilities: Pcrson::lI hygiene facilities shall be made a\'ailable to. e:lch client. Such persanal hygiene facilities shall be kept clean and sanitary and maintained in operable warking condition 3t all times, subject to. periodic lemporary InlerruptlOns due to maintenance ar repair. · Resident Participation in Gener:ll Housekeeping: Clients may be required to. p3.rticipate In the gener3.1 hausekeepmg af the pnmary C;lre t":1cility. 1/17/')7 " B. MEAL STANDARDS: · Provision of Meals: Clients shall be provided a minimum of two meals a day, one of which must be a hot meal. · Meal Standard: All meals served shall be nutritionally sound and balanced in compliance with standards and/or regulations adopted and/or issued by the local public authority responsible for the regulation of facilities which serve meals at residential facilities. C. CLOTHING STANDARDS: · Provision of Clothing: Primary care facilities shall assist clients in obtaining at least two sets of appropriate clothing (both under and outerwear) and shoes. Appropriate clothing in the instance of underwear and socks shall mean new or previously unused items. · Donated Clothing: Donated clothing must be washed/sanitized prior to distribution to clients. D. HEALTHSCREEl\1NGS: · Immediate Health Screening: To reduce risk of harm to other clients and staff, primary care facilities shall arrange for health screenings for communicable, air-borne diseases, such as tuberculosis, within thirty-six (36) hours of the client's entry into the facility. Clients determined to pose a direct threat to the health of others shall be quarantined and referred for appropriate medical treatment. · Full Medical Assessment and Evaluation: In the absence of documentation that a client has undergone a complete physical within the previous six months, primary care facilities shall arrange for a full medical assessment and evaluation (i.e. complete physical) for each client within seventy-two (72) hours of the client's entry into the facility. E. FACILITIES STAA'DARDS AND LICENSING/CERTIFICATION: · Primary Care Facilities in General: Primary care facilities shall comply with all local and state ordinances, laws or regulations governing residential facilities and/or housing conditions and secure necessary licensing as may be required under such local or state law. Primary care facilities shall also comply with all local and state ordinances, laws or regulations governing providers of substance abuse or mental health treatment and related services. · Food Preparation and/or Dining Facilities: Food preparation and/or dining facilities located at primary care facilities must comply with all local and state ordinances, regulations and laws governing facilities which serve meals to the public in a residential facility or otherwise. Primary care facilities must secure necessary licensmg or certification as may be required by the local public authority responsible for the regulation of facilities which serve meals to the public. · EnvironmentalfStructural Controls and Procedures to Prevent/Control Spread of Communicable Diseases: Primary care facilities shall comply with all local and state ordinances. regulations and laws governing the preventIOn and/or control of the spread of communicable, air-borne diseases WIthin reSidential facilIties which may include the implementation of structural or environmental measures and quarantIning, notIfication and health screening procedures. 1/17/')7 ::" IV. PROVISION OF MENTAL HEALTH AND/OR SUBSTANCE ABUSE TREA ThIENT: · Compliance with State Licensing Rules and Regulations: Primary Care programs that provide treatment for chemical dependence/abuse and/or mental illness shall comply with state licensing rules and regulations as follows: · Chemical Dependencyl Abuse Treatment Providers shall meet with standards and regulations contained in Amended Rule 1 OE-16 and shall obtain a license to operate the program according to definitions and classifications more specifically contained in Section lOE-16.009 F.A.C. · Providers Serving the Mentally III shall comply with Rule lOE-4.016 and shall obtain a license to operate the specific program or "level of care" as classified in Section I OE-4.0 16(4) F.A.C. · Providers Serving the Dually Diagnosed: Where the primary care provider aims to serve the dually diagnosed population, the disability that is primary addressed shall determine whether a substance abuse or mental health treatment license is the appropriate choice. I fl 7/<) 7 24 V. PRIMARY CARE CASE l\tANAGEMENT: A. CASE MANAGEMENT SERVICES IN GENERAL: · The Mission and Purpose of primary care facilities is to provide housing and supportive services to special need populations comprised of persons with a history of mental illness or dehabilitating mental health conditions, includirlg substance abuse, victims of domestic violence, HIV infection or AIDS, as well as homeless families in order to assist such persons in the transition from homelessness to independent living or to permanent supported housing, as the case may be. · The Primary Purpose of Case Management Services is to integrate various internal and external service components into a coherent constellation of services tailored to meet the unique needs of individuals. Case Management shall be concerned with service coordination and problem solving in an attempt to insure appropriate service provision and continuity. · Partnerships: The primary care facility shall develop partnerships with government, not-for-profit and community-based agencies or organizations or programs to coordinate and provide services to its clients. · Case Managers: The case manager shall be responsible for producing a comprehensive or revised assessment, as the case may be, of the client's current social, health (including mental health and substance use/abuse) and education/employment conditions and needs. The case manager shall playa major role in assisting the resident in the development, or revision, and implementation of a Continuum of Care Plan which will enable the client to successfully achieve his or her personal goals and objectives by addressing unmet needs. · Client Rapport: Development of a rapport between the client and his or her case manager, establishing trust and familiarity, is deemed integral to establishing an effective case management service plan and a realistic, client-developed Continuum of Care Plan. · Scope of Case Management Services: The scope of case management services provided shall be client directed. n. CORE CASE MANAGEMENT FUNCTIONS · Core Functions of a primary care facilities case management program should be: Assessment - a thorough evaluation detailing the client's current and potential strengths, weaknesses, service needs and appropriate resources to meet the service needs. Planning - the development of a holistic service plan with each client, containing service goals and appropriate timeliness. Linkage/nroker~'l~c - the process of refcrring or transferring clients to all reqUIred internal and external services. J\Jonitoring - the contmuous evaluation of the client's progress, leading to reassessment and development of new service plans, linkages, or other dispositions as mdlcated. :\dyocacy - mterceding on beh::J.1 f of a c i Icnt or group 0 f cI ienlS to ::J.ssure access to needed ::C'TVlces and/or resources. 1/17/<)7 )r -) . Areas of Case Management Intervention should include but are not limited to: · Service Planning. . Assistance in obtaining food and clothing and transportation. . Referrals for in- or out-patient mental health services, substance abuse treatment, and medical servIces. . Assistance in obtaining benefits. . Provision and/or referrals to self-sufficiency related programs and services such as adult education, vocational training, job counseling, training and permanent placement services, child care and legal services and transportation. · Assistance and referral to obtain appropriate housing placement in the Advanced Care level of the Continuum of Care, in the Dade County community or in the local affordable housing market. C. MULTI-DISCIPLINARY TEAM CONCEPT: · Recommendation: It is recommended that primary care providers develop a multi-disciplinary approach towards providing care to the client to ensure an holistic response to the client's needs. Primary care providers are encouraged to develop multi-disciplinary care teams, comprised of the client's case manager, a health care worker caring for the client, and/or government or community providers directly serving the client, that would meet to review client progress, make recommendations and ensure successful referral to additional services and resources. Such approach ensures effective, comprehensive service provision as well as continUity of care as the client is placed with other housing programs within the Continuum or in the community. I II 7/'n :(, VI. COMPREHENSIVE ASSESSMENT AND INDIVIDUALIZED CONTINUUM OF CARE PLAN: A. COMPREHENSIVE ASSESSMENT: . Comprehensive Assessment Precedes Case Management Services: Case management services shall be preceded by a comprehensive assessment of the client's current social, health (including mental health and substance use/abuse) and education/employment conditions. Screening for emotional disorders and dysfunctions, including substance abuse, and for other serious mental health impediments to independence, shall be performed by, or under the supervision of, qualified mental health or substance abuse professionals. The comprehensive assessment of the client's social, health and education/employment needs shall commence within seventy-two (72) hours of admission of the client to the Primary care facility. In the event that a client was referred by a temporary care provider or another primary care provider, the client's comprehensive assessment documentation prepared by the referral provider shall be reviewed and revised by the current primary care provider. Such review and revision shall commence within seventy-two (72) hours of admission of the client to the primary care facility. . Client Rapport: Development of a rapport between the client and facility staff responsible for the assessment function, establishing trust and familiarity, is deemed integral to performing a thorough and accurate comprehensive assessment or revised assessment, as the case may be, of the client's needs and to establishing an effective case management service plan and a realistic, client-<ieveloped Continuum of Care Plan. . Contents of Comprehensive Assessment: The comprehensive assessment shall include treatment and referral recommendations and will form the basis for the client's individualized Continuum of Care Plan and referral services provided to the client. The comprehensive assessment shall be comprised of information gathered by the OAP Program., by the Dade County Homeless Trust, at intake, through client interviews and through medical and referral information B. INDIVIDUALIZED CONTl1\1JtJM: OF C.A.RE PLAN: · Client-Developed Continuum of Care Plan - Timeliness: Clients shall be assisted in initiating an individualized Continuum of Care Plan within twenty-four (24) hours of the completion of their comprehensive assessment of their current social, health and education/employment conditions and needs. In the event that a client developed a Continuum of Care Plan while in the care of another provider, the primary care provider shall incorporate the client's Continuum of Care Plan into the primary care provider's service plan for the client, subject to revision by the client and his or her primary care case manager. · Client Contract: The ContInuum of Cue Plan is an individualized contract based upon the participant's current state, capabilities and personal goals. TIle Continuum of Care Plan shall describe the participant's needs for supportive services and outline the steps that the participant must take in order to begin the personal process towards reSIdentIal and finanCial stability and self-sufficiency. TIle chent 's slgnature on the Continuum of CJ.re I'l:m slgmtles his or her commitment to obtaining residential. tinanclal and personal stability and :,cIC-sultlciency. 1117/<)7 77 . Basis of Individualized Continuum of Care Plan: The individualized Continuwn of Care Plan shall be based on the comprehensive assessment of client's conditions and needs, as well as case management recommendations, and the client's personal goals and objectives. Goals and/or services sought by the client should be consistent with those articulated by the client during initial engagement and assessment by the Trust-coordinated Outreach, Assessment and Placement Program or while in the care of another provider. ' . Potential Needs to be Reflected in Client's {;{}als and Objectives: The individualized Continuum of Care Plan should address the following goals and objectives that respond to the following potential needs: health (physical and mental health, including substance abuse), education, vocational skills and employability, benefits and/or benefits, housing, child care and legal services, as well as family/interpersonal issues and spirituality. . Establish Realistic {;{}als: Unrealistic goals should be avoided to prevent discouragement with the rehabilitation process. Conversely, too simplistic goals should be discouraged to prevent loss of interest by the client due to the existence of too few challenges. The choices made by the client with the assistance of his or her case manager should be realistic and within the client's range of skills, abilities and present circumstances. . Weekly Monitoring of Client Progress: The participant's progress in meeting goals set forth in the Continuum of Care Plan should be monitored on a weekly basis through weekly meetings with the client's case manager. . Flexibility and Adjustment: Continuum of Care Plans are intended to be individualized, flexible service plans facilitating steady movement toward independent living at a pace suited to each participant's circumstances and needs. The Continuum of Care Plan must be adjusted to reflect progress or identified areas where additional attention is needed either by the client's own efforts or through the provision of additional services and/or resources. 1/17/<)7 "0 VITI. OurPLACEMENT SERVICES: · Housing Options: The mission and purpose of primary care facilities is to provide housing and supportive and/or treatment/rehabilitative services necessary to assist the client in the transition from homelessness to independent living or permanent supported housing, as applicable. In keeping with this purpose, the primary care facility should make every effort to assist the client in securing an appropriate housing placement as soon as reasonable and appropriate for the client. · Provider Relationships: Primary care facility case managers are expected to develop strong working relationships with primary and/or advanced care case managers to ensure an effective planning process and smooth transition between housing programs. · Effective Planning Process to Ensure Smooth Transition: The planning process should strive to ensure that minimal disruption occurs during the transition from one provider to another. The planning process is intended to ensure that services provided to the client at or through referral by the primary care facility are maintained and that the provision of additional services are arranged for the client prior to transfer, consistent with the client's individualized Continuum of Care Plan. · Outplacement Packet: The necessity to cooperate with both the Primary Care Provider and the provider with whom the client has been placed in order to ensure effective service provision and continuity of care shall be explained to the client. Upon the written consent of the client, an outplacement packet shall be prepared for the provider with whom the client has been placed. The outplacement packet shall contain the client's comprehensive assessment, Continuum of Care Plan and referral history and notes for the purpose of ensuring continuity in service provision and in the client's commitment to his or her goals and objectives. · Follow-Up Case Management Services: The primary care provider responsible for referral and placerp.ent of a client with an advanced care provider or in permanent housing available to the client in the Dade County community shall provide follow-up case management services to the client for at least ninety days following the date of outplacement. III 7/07 ADVANCED CARE STANDARDS OF CARE APPLYING TO ADVANCED CARE PROVIDERS 1. CORE FUNCfIONS OF ADVANCED CARE PROVIDERS: · The Mission and Purpose of the advanced care level of the Continuwn of Care is two-fold: (1) to provide access to supported housing for those homeless individuals and families with special needs (i.e. permanent disability, the frail or elderly) and (2) to assist those homeless individuals and families capable of maintaining independent living with minimal initial support to secure housing in the affordable housing market Advanced care may be accessed by homeless individuals and families from any stage of the Continuwn of Care, provided that the individual or family meets the eligibility criteria of the particular Advanced Care Provider. · Core Functions: Advanced care providers shall provide the following core functions to their clients: · Housing For those homeless individuals and families in need of permanent supported housing, the provision of housing appropriate to the needs of the homeless individual or family (e.g. assisted community living facilities, single room occupancy, boarding or nursing home or group home) with supportive services necessary to maintain residential and personal stability (e.g. subsidized rent, case management services, nursing care, mental health care management). For those homeless individuals or families seeking housing in the affordable housing market, assistance shall include, but is not limited to, assisting the client in locating suitable housing, assistance with housing applications and lease negotiation, application fees, first and last month's rent, short-term rental subsidies, furniture stipends, utility deposits, back payments, emergency payments, stan-up household supplies and furnishings, start-up food and grocery supplies, and clothing, when necessary or applicable. Such assistance shall also include follow-up case management services for at least ninety (90) days following the date of housing placement . Case Management Services shall include Comprehensive Assessment of current social, health (including mental health and substance use/abuse), and employment/education conditions and Development of Individualized Continuum of Care Pl:1n describing a client's needs for supportive services and establishing a service/referral plan, if an assessment and/or care plan was not performed or developed, as the case may be, while in the care of another provider as well as LinkagefReferral to external supportive services including, but not limited to, benefit programs, care and/or support services related to physical or mental health, including substance abuse, education/vocational opportunities, job counseling, training and placement, child care and transportation necessary to mamtain permanent housing. 1117/07 , , II. GENERAL STANDARDS - PROGRAM ENVIRONMENT A. CLIENTS . Homeless individuals and families shall be offered maximum accessibility to currently available advanced care level resources, subject to eligibility criteria established by the advanced care provider. . Homeless individuals and families served by advanced care providers shall be accorded dignity and respect. A grievance procedure providing for fair notice and hearing shall be made known and available to clients by which to seek redress in the event that a client has a grievance regarding the services of the advanced care provider, in the event that a client believes that he or she has been unfairly accused of a program rule infraction, or in the event of a decision by the advanced care provider to refuse or terminate services to the client . Advanced care providers shall demonstrate sensitivity to clients' primary language and cultural background. . Clients have both privileges and responsibilities relating to the provision of service by the advanced care provider which shall be set forth in a Client Agreement that each client must sign upon acceptance of the client into the advanced care program. Clients shall have a right to full disclosure of all financial responsibilities and/or obligations to landlords, service providers and others involved in the provision of permanent housing to the client. B. SAFE ENVIROm-fENT: . When possible, all advanced care providers shall establish and enforce program rules governing abuse of alcohol, illegal use of controlled substances, and violent and/or inappropriate behavior. c. ADVANCED CARE PROVIDER STAFF: . Advanced care provider administrators shall ensure that the provider's staffhas the qualifications, licensing, proper training and supervision necessary and appropriate to the job function(s) with which staff members are entIusted. D. NON-DISCIUMINA TION IN THE PROVISION OF HOUSING AND SERVICES: · There shall be no discrimination on the basis of race, color, gender, sexual orientation, disability, religion, or national origin in the provision of services to clients by advanced care providers. No religious practice or affiliatIOn requirement shall be imposed upon clients or prospective clients. E. COOIillINATION, COOPERATION AND INTEGRATION: · Each Advanced Care PrOVIder sh:Ill work closely and cooperatively with the D:Ide County Homeless Trust, the OAP Program and OAP Program Providers, all other Trust-funded providers as well :IS other community-based servIce proVldcrs to homeless individuals and f:Imtlies. \117/<)7 ,"l III. HOUSING AND SERVICES: A. HOUSING PLACEMENT OPTIONS: . Housing Placement Options: Housing placement options offered to the client shall be consistent with the client's Individualized Continuum of Care Plan and the client's housing preferences, subject to current availability and eligibility criteria established by the Advanced Care Provider. Housing options shall offer the least restrictive environment to the client as may be appropriate to address the needs of the client. B. ADVANCED CARE PROVIDER-OPERATED HOUSING: . Advanced Care-Operated Housing and/or Residential Facilities in General: Advanced care provider-operated housing and/or residential facilities shall maintain safe, clean and sanitary conditions and shall provide clients the opportunity to safekeep papers, documents and valuables. Advanced care provider-operated housing and/or residential facilities shall comply with all applicable local and state ordinances, laws or regulations governing housing conditions and/or residential facilities, including Housing Quality Standards established by the federal Department of Housing and Urban Development, and shall secure necessary licensing as may be required under such local or state law. Advanced 0,lre Providers shall also comply with all local and state ordinances, laws or regulations governing provision of substance abuse or mental health treatment and care, if applicable to the Advanced Care Provider's housing and/or services program. C. STAl\"DARDS GOVERNING AFFORDABLE MARKET IIOUSI1~G PLACEMENTS: . Advanced Care Provider Inspection and Approval of Housing: Advanced care providers assisting clients in locating and securing affordable market housing shall insure that such housing meets the comparable market rent guidelines and housing quality standards established by local, state and/or federal ordinance, law and regulation, as may be applicable. D. STANDARDS GOVFRJ','TNG TE RJ\UN A TION OF SERVICES AND HOUSING: · Termination of Program Services: Violations of advanced care program rules may be grounds for terminating the provision of program services to a clIent, including, but not limited to, rent subsidies. · Lease Arrangements: Lmdlord-based lease agreements, and breaches thereof, shall be governed by local and state ordin:mccs, laws or regulations !:,:ovemmg tenancy. III 7/<) 7 II E. CASE MANAGEMENT SERVICES: . Case Management Services: Clients shall be offered client-directed case management services to ensure that clients maintain residential, financial and personal stability after advanced care housing placement. Clients provided assistance in locating and securing affordable market housing, shall be provided case management services for a minimum of ninety days following the date of the housing placement. Case management shall commence with a comprehensive or revised assessment, as the case may be, of the client's current social, health (including mental health and substance useJabuse) and education/employment conditions and needs. . Areas of Case Management Intervention should include but are not limited to: service planning; assistance in obtaining food and clothing and transportation; referrals for mental health services, substance abuse treatment, and medical services; assistance in maintaining and/or obtaining benefits; and provision and/or referrals to self-sufficiency related programs and services such as adult education, vocational training, job counseling, training and permanent placement services, child care and legal services and transportation. . Intervention to Prevent Homelessness: In the event that a client is at risk of losing advanced care housing and is in need of an advanced care placement more appropriate for their needs, additional advanced care supportive services, or primary care services within the Continuum to prevent a return to homelessness, case management shall make every effort to ensure that such housing and/or services are made available to the client. F. MISCELLM'EOUS STMrnARDS: . Clothing: Advanced care providers shall assist clients In obtaining appropriate clothing (including appropriate dress for work) if needed. Appropriate clothing in the instance of underwear and socks shall mean new or previously unused items. Donated clothing must be \vashed/sanitized prior to distribution to clients. III 7/')7 \1 VIT. CLIENT CONFIDENTIALITY AND SHARING OF INFORl\IATION: . Client Expectation of Privacy: Advanced care providers shall comply with all federal and state laws and regulations governing the confidentiality of information regarding AIDS/HIV status and medical, substance abuse or mental health history, referral or treatment. Clients may expect a reasonable degree of privacy with regard to information not otherwise protected from disclosure by federal or state laws and regulations that is shared with the advanced care provider staff members. . Personal Mail and Telephone Calls: Advanced care provider-operated residential facilities shall respect the privacy ofa client's personal mail and telephone calls. . Exceptions to Client Confidentiality: Client information may be subject to disclosure as provided by law including investigation by law enforcement, probation officers, and HRS protective services related to minors or the elderly, subject to any limitations on disclosure set forth in state or federal law, including those laws protecting the confidentiality of information regarding AIDSIHIV status and medical, substance abuse or mental health history, referral or treatment. . Sharing of Client Information: Sharing of client information with other providers to whom the client may be referred is necessary to ensure effective provision of services, continuity in care, and efficient use of Continuum resources. The necessity of sharing information with other prO\,;ders shall be explained to the client. Client information shall only be shared upon the client's written consent. 11I7/c)7 3S ~AY-20-03 04:02P MIAMI-DADE HOMELESS TRUST 305 375-2722 ATTACHMENT B P.Ol Project Number FL 14000005 Technical ~uhmiSlli(ln I~xhjbit I: Project Summar)' A. Selectee and Project Sponsor Informalion - Fill in tlle information rcquesll:d bcluw. Whell the ~electee is the S:\lne organi7:lflOn a~ the 1'1'Oject ~I'Clnsnr, complcte nnly the ~clcc:tccinl(lrmllliCln. !oielectre Nanle Cunl.u;t Per-illn Tclcphoru,: Nurnbcr FAX Numbcr .~ami-Dade County Homeless Trust David Raymond, Acting Director 305-375-1490 305-375-2722 27-310 1:-=1 ~ ('2 I'''' c.:J U : '~:---- I- I I I 1 _.'_ ~ U \] ~ G1 I j 11; I I J1 ' , _~~;'2JJ ~ch.:clee Addr..:!!!! 111 NW 1 St. Suite, Miami, Fl 33128 _~ity of Miami Beach Alexander Diaz (lltrcCl. city. !ltalc. ziJ'l) Prnject ~Ilnnllnr Nanlc CunUtcl Per!!on Telephone Number FAX Number Pr~lect Sponsor Addrec;s 305-673-7010 (slrecl, dly. stale. I.il") 8. rroject Dud~er and Mile5tnne5 - Thl!llicclilln mu."il be &.:umplelecl by lI11llclcctecs. including renewals. 305-67'1 7782 1700 Convention Miami Beach, Fl Center Drive 33139 I. Charl I . Summdry ProJccl Bud~cl Tn complete Chm I. SUl'nmlll)' Prlljcl:t ~uug~'l, enter the amollnt of SlIP funds requested by line.ilem in the: lir!lt column. Fnr Ica."iin~. Nuppurli\'e ~crvil~'~. and operations. the amount entered should he tnr the SHP gran I Lcnn selecled (1. 2. ur 3 ye.:Urli). In lh~ second column. enter lhe amount of other ",<;h th:1l will bc cllnLrihulc:d In Ihe prn,lccL. This amnunl flluli the SHP n:quC$t must equal the total budget anlount for the "r~iecT Nnre that match requireml:nls lilr supporlive.: scrvie.:clI and upenlting Cl,)Sl$ apply to both new and renewal projects. Column 2 is new tll the iiflfllicaliun. The amounts you enler are for 0111 strucTures in ynur project. Each line.item amount in thiS..5.~~rl !lhlluld nlatch t!!l';llmnunts shown in Exhibits 2 throu~h (i.a.!lS C1DDroDriille. Requested grant term (1.2. or 3 yean): *14 Months ell tiS p . IU d t , .::r' SliP Applicant ....~ . \'....::1 Total " I Ifequest Cash r'roj ect I. Acquisition ...R.u..~.!....- 0 2, Rehnbilitarion U -.-. 0 1 New Construction ....-... 0 4. Subtotal (lines I thru ))" S. Heal ProDeny LeasinJ!. u .- Ii. ~lJnnnnive ~enliee~" 10193 61.547.61 ........ 132,740. 7. Operations'" 0 ll. SHP ReQuest (~uht()tallin~ 4 thru 7) 71,193 - .....~- 9. AdminislrCltiulI (UD lo So/I of line 8) 3,309.80 10 TC'ltal !\Hf' ReQue~t ftntalline~ II and 91 74,502.80 61,547.61 136 ;050.4 65 ('/ ;:PW ~~~ <P~ 5 · The Sill' requ",,' "" Ilh:su ucllvillc.< "'lInn"l ,,,' mmu Ihun S()% nJ"lhc ,..llIlullquisllilln. Nhil.hllillllllln. anll ne" c.:llIISlrl,c;l;..1Il hud,ct .. Ily la\V. SHI' rllntl. (all '~110 ,nul\: Ih~/1 &O'\~ lit" II,.: 11'1.,/ SII",,"ruVO: scr"ic;~~ hudllCI. ... Hy Ill..... !lll" o:an I'l\~ IOU 1I1Ul': l'mn 7~':,\ nflhc llllollnl"nllin;.: 1'1I1c1R~'. Pit... ",.", rl"'"I~ ill Upfrlli/lfl, 111111\'" f.lMO Appruvtll No. 2506.0 I 12 (e~J'I. (i/.101200.1) PlI~C IlU: D II U 1)..40076.2 (021200 I ) .Ii' .. Technical Submission (con't) Project Number FLI4B00005 Exhibit 4: SupportIVe Services Chart 4A: Supportive Service Expense Service Activity: Homeless Coordinator* Homeless Case Manager* Peer Outreach Worker Intake Worker uanti : 1.0 FTE EACH Service Activity: Transportation Van Lease Bus Token Quantity: (500 tokens = 50 token rolls $10.00 each roll Service Activity: Miscellaneous Office Supplies Mail uanti : Total Supportive Service Bud et SHP Request Selectee's Match Year 1 (a) * 14 months Year 2 (b) Year 3 (c) Total (d) $49,447.00* $32,500.00* $20,000.00 $18,385.65 $49,447.00 $32,500.00 $20,000.00 $18.385.65 Subtotal $120,332.65 $10,000.00 $500.00 $10,000.00 $500.00 Subtotal $10,500.00 $1,663.00 $245.00 $1,663.00 $245.00 Subtotal $1,908.00 * The Homeless Coordinator Salary ($49,447.00) and a portion of the salary for the Homeless Case Manager ($12,100.65) represent the City's matching funds of $61,547.65. . fl ~ j--, r- t\ ~-~ e.L (","1 Project Number FL14BO0005 Technical Submission /. cont.) Exhibit 6: Administration (all projects requesting administration funds) Re v: ~erL~D'~J ~,' ~c A. Administrative Costs Please complete the chart below for your administrative costs budget. (fyou are a selectee who will also be the project sponsor, complete Lines I through 6. If you are the selectee and a different organization will be the project sponsor. complete lines I through 8. In the first column. till in the administrative activity to be paid for using SHP funds. (n the Year I column. enter the amount ofSHP funds to be used to pay administrative costs in the first year. If the grant is multi-year, enter the amount ofSHP funds to be used for Year 2. and ifapplicable. Year 3. In the last column, td), total the amount of SHP funds requested for the full grant tenn. Please ensure that the total requested for administrative costs for the entire grant term, Line 6, column (d), mHtches that which ~'ou entered in your project's Summary Budget in Exhibit 1. * 14 Months Yliar I * Year 1 Year 3 Total Administrative Costs (a) (b) (c) (d) I. Administrative Activity: $1654.90 Grant Manage1lent 2. Administrative Activity: Himai-Dade Boaeless Trust $1654.90 .. Administrative Activity: ~o 4. Administrative Activity: 5. Administrative Activity: I I ! 6. SUP REQUEST FOR ADMINSTRA TIVE COSTS $3309.80 17 Amount for Selectee .'--- o. I -_.. .. $1654.90 18. Amount for Project Sponsor $1654.90 B. Plan for Distribution of Administration Funds If the selectee is not the same organization as the project sponsor. attach a description of the selectee's plan for distributing its administrative funding to address all. or aponion of the project sponsor's administrative needs. Include a description of how the project sponsor was consulted in fonnulating the plan. OMB Approval No. 2506-0112 (exp. 6/3012003) HUD-40076-2 (021200 I) Page no: D LOCCSNRS SNAPS Special Needs Assistance Program Request Voucher for Grant Payment u.s. Department of Housing and Urban Development Office of Community Planning and Development OMS Approval No. 2~102 (exp.8131/2ooo) ATTACHMENT C See Instructions and Public Reporting Burden Statement on back 1. Vouchef Number: I I I I I 5. Voice Response No. (5 digits. hyphen. 5 more ) 2. LOCCS Pgrm. Area: 3. Period Covered by this Request (dates) SNAP HPAC IHP 6. Grant.. OrganIzatIon's Name : 4. Type of DlsburMmInt: o Partial 0 FtnaJ 8. Grant No: 6a. Grantee OrganIzation's TIN : /~ ~ ~~~~ ~~ ~~ i /~~'l. ~ / / 9. Une Item no. Type of Funds Requested oun: 10 nearest dol 1010 Acquisition 1020 Rehabilitation 1021 New Construction 1022 Substantial Rehabilitation 1023 Moderate Rehabilitation 1030 Operating Cost 1040 Rental Assistance 1050 Supportive Services 1060 Administrative Cost 1070 Child Care . 1080 Employment Assistance 1090 Relocation 1100 Leasing 1110 Repair & Maintenance 1111 Prevention (RH) 1112 Capacity Building (RH) 1120 Other: 10. Voucher Total: Am t (round Iar) I hereby certify that all the information stated herein. as well as any information provided in the accompaniment herewith. is true and accurate. Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. OS u.s.c. 1mL 1lllO. 1m2; 31. u.s.c. J7B. 3lUZl 11.tName & Phone Number (including area code) of the AuthoriZed 12. Signature: 13. Date of Request : Person who called SNAPs System VRS:: X Privacy Statement: Public law 97-255. Financial Integrity Act. 31 U.S.C. 3512. authorizes the Department of Housing and Urban Development (HUD) to collect all the information (except the Social Security Number (SSN)) which will be used byHUD to protect disbursement data from fraudulent actions. The Housing and Community Development Act of 1987.42 U.S.C. 3543. authorizes HUD to collect the SSN. The data are used to ensure that individuals who no longer require access to Une of Credit Control System (LOCCS) have their access capability promptly deleted. Provision ofthe SSN Is mandatory. HUD uses it as a unique identifier for safeguarding LOCCS from unauthorized access. Failure to provide the information requested may delay the processing of your approval for access to lOCCS. This information will not be otherwise disclosed or released outside of HUD. except as permitted or required by law. page 1 of 2 form HUD-27053-A (2195) ATTACHMENT C-l .. MONTHLY INVOICE MONTH: HoMMEL'E'SS T R U 5 T PROVIDER NAME: PROGRAM NAME: CONTRACT # , , SUPPORTIVE SERVICES Ii I 0% .. T.S. % REQUST Ii I Year to Date ' I Program SHP Year: 1 2 3 ' POSITIONS/DESCRIPTIONS % Total Expenses E R' b t T d ",- "T t <=. 'III xpenses elm ursemen otal Bu get For ,0 o. o. ~xp II The Year SHP Exp YTD YTD ' ~O~ITIONS 0% $ . $ - $ - $ - $ - #DIV/O' I POSITIONS 0% - - . . - #DIV/O' POSITIONS 0%' - - - . #DIV/O' I POSITIONS 0% - . - - . #DIV/C POSITIONS 0% #DIV/O , POSITIONS 0% #DIV/C' 11 POSITIONS O%! #DIV/O' i POSITIONS 0% I #DIV/O " POSITIONS 0% i #DIV/O' POSITIONS 0% I #DIVIO' , POSITIONS 0% - #DIVIO' POSITIONS 0% - #DIVIO' POSITIONS 0% . #DIV/O' POSITIONS 0% -' #DIVIO' POSITIONS 0% I #DIVIO' I TOTAL SALARIES : II $ I $ . I $ - 1$ - II $ - II #DIV/O! i IFringeBenefits-@iO%ofSAL. I 0% 1$ ~IS - IS - 1$ - . II #DIV/O' I Total Sal & Frinaell $ - $ - $ - $ - - #DIV/O! . .H:lIt;:_%'-~~ ESCRIPTIONS 0% $ - $ - $ - $ - $ - #DIV/O' ESCRIPTIONS 0% - . #DIVlO' ESCRIPTIONS 0%. - - #DIV/OI ESCRIPTIONS 0% - - #DIV/O' DESCRIPTIONS 0% - - - #DIV/O' DESCRIPTIONS 0% - #DIVIO' DESCRIPTIONS 0% #DIVIO' DESCRIPTIONS 0% - #DIVIO' DESCRIPTIONS 0% #DIVIO' DESCRIPTIONS 0% - #DIVIO' DESCRIPTIONS 0%,: - #DIVIO' DESCRIPTIONS 0% - #DIVIO' DESCRIPTIONS 0% - #DIV/O' DESCRIPTIONS 0% - - - #DIV/O' DESCRIPTIONS 0%. - - #DIV/O' I Total Supportive Servicesll $ - II $ - II $ - I $ - I $ - 1~ I TOTAL SUPPORTIVE svcsll $ - II $ - I $ - I $ - $ - It=#DiViO! HT/PROJECTS OPERATING,~ERVICES .. 0% T.S.% REQUST Year to Date POSITIONS/DESCRIPTIONS % Total Expenses Program SHP Total Year SHP Year: 1 2 3 Expenses Reimbursement E'pe"...~ SHP Exp YTD YTD ~it*i~}~t" \"~~; A:_~~h~'~~'t~"::~ ~ POSITIONS 0% $ S S $ . S - #DIV/O' POSITIONS 0% - . #DIV/O' POSITIONS 0% - . - #DIV/O' POSITIONS 0% - - #DIV/O' POSITIONS 0% - - #DIV/O' POSITIONS 0% . - #DIV/O' , POSITIONS 0% #DIV/O' POSITIONS 0% #DIV/O' POSITIONS 0% - #DIV/O' POSITIONS 0% - #DIV/O' POSITIONS 0% - #DIV/O' POSITIONS 0% - #DIV/O' POSITIONS 0% - - #DIV/O' POSITIONS 0% - #DIV/O' POSITIONS 0% - . . #DIV/O' TOTAL SALAR/ES $ - $ - $ - $ - $ - #D/V/O! I . Total Sal & Frin $ . $ . $ . $ . $ . #DIV/O! DESCRIPTIONS 0% $ . S . $ - $ - $ - #DIV/O' DESCRIPTIONS 0% #DIV/O' DESCRIPTIONS 0% . #DIV/O' DESCRIPTIONS 0% . . #DIV/O' DESCRIPTIONS 0% #DIV/O' DESCRIPTIONS 0% - #DIV/O' DESCRIPTIONS 0% #DIV/O' OESCRIPTIONS 0% #DIV/O' DESCRIPTIONS 0% #DIV/O' DESCRIPTIONS 0% - #DIV/O' DESCRIPTIONS 0% #DIV/O' DESCRIPTIONS 0% - #DIV/O' DESCRIPTIONS 0% #DIV/O' DESCRIPTIONS 0% . #DIVlO' DESCRIPTIONS 0% - #DIV/O' I Total Other Operating Services II $ - II $ - lIS . I $ - I $ . #DIV/O! I TOTAL OPERATING svcsll $ . 11$ . I $ - $ . $ . #DIV/O! HT/PROJECTS ~~ l ~----~-----~~--~-- -- ------ -- ~~ ---- - - ------- --~ - ~ L__ __ _ ___ -- ' POSITIONS/DESCRIPTIONS % Total Expenses Program SHP Total Year SHP Expenses Reimbursement Expenses SHP Exp YTD $ POSITIONS/DESCRIPTIONS Total Expenses Program SHP Total Year SHP Expenses Reimbursement Expenses xPI SHP Exp YTD iTOT AL ADMIN COST $ $ $ $ $ GRANO TOTAL $ $ $ $ #DIV/O! HT/PROJECTS Attachment 0 MIAMI-DADE COUNTY HOMELESS TRUST MONTHLY PROGRESS REPORT MONTH OF : PROVIDER NAME: FUNDING SOURCE: 0 Primary Care F&B PREPARED BY: EXECUTIVE DIRECTOR'S SIGNATURE: PROGRAM NAME: o SUP 0 State OOther TITLE: DATE: 1. Total projected service level this month. This figure should reflect the total number of persons that could have been served bv vour ro ram this re ortin eriod Projected Service Level Number of singles Number of Number of Children Number of not in families adults in families in families families Persons served at an iven point in time 2 dd . Persons serve uring the month. Number of singles Number of Number of Children Number of not in families adults in families in families families a) Number on the ftrst day of month I b) Number entering (placed in)program , during month c) Number who left during the month d) Number in the program on the last day of the month (a+b-c)=d 3. Persons referred this month Number of Number of Number of Children Number of singles not in adults in families in families families families a) Total number of referrals b) Number of referrals placed c) Number of referrals not placed (a-b)=c Number of singles not in families Number of families 5. Age and Gender of those placed into the program this month. These numbers should add up to the total in 2.b. Single adults not in families Age Male Female A 62 and over B 51-61 C 31-50 0 18-30 E I 7 and under Persons in Families Age Male Female F 62 and over G 51-61 H 31-50 I 18-30 J 13-17 K 6-12 L 1-5 M Under 1 PAGE 2 THE FOLLOWING QUESTIONS APPLY ONLY TO PARTICIPANTS PLACED IN THE PROGRAM DURING THE MONTH (eitber single person or adults in families) 6. Veteran's Status I How many participants placed this month were veterans? 8. Race. How man artici ants laced into tbe ro ram are in tbe following racial categories? American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White ro ram COMPLETE THE FOLLOWING FOR ALL PARTICIPANTS WHO LEFT THE PROGRAM IN THE PAST MONTH (eitber single person or adults in families). Tbe total sbould matcb tbe number reflected in 2.c. 11. Amount and source of montbly income at entry and exit. Of tbose participants wbo left during tbe reporting montb, b b hi' me level and witb each source of income? ow many participants were at eac mont IV IDCO MONTHLY INCOME AT ENTRY # No Income $1-150 $151-250 $251-500 $501-1.000 $1.001 - 1.500 $1.501 - 2.000 $2.001+ MONTHLY INCOME AT EXIT # No Income $1-150 $151-250 $251-500 $501- 1.000 $1,001 - 1,500 $ 1.50 1 - 2.000 $2.001 + PAGE 3 # INCOME SOURCES AT EXIT Su lemental Securi 'Income (SSI) Social Securi Disability Income(SSDI) Social Securi General Public Assistance Tern 0 Aid to Needv Families (T ANF) Child Su ort Veteran's Benefits Em lovrnent Income Unem 10 ment benefits Medicare Medicaid Food Starn s Other lease s eci ) No fmancial resources # 12. Length of Stay. Of those participants who left during the past month, how many were in the program for the followine: lene:ths of time? # Less than I month I to 2 months , 3 to 6 months 7 months to 12 months 13 months - 24 months 25 months - 3 years 4 years - 5 years 6 years - 7 years 8 years - 10 years Over 19 years 13. Reasons for Leaving. Of those participants who left the program during the past month, how many left for the followin reasons if artici ant left for multi Ie reasons, list ONLY the rimarv reason) # m (WHO) 14. Destination 0 those participants who left the proe:ram durine: the Dast month # PERMANENT HOUSING Rental House or apartment - no subsidy Public Housing Section 8 Shelter Plus Care HOME subsidized house/apartment Other subsidized house/apartment Homeownership Moved in with family or friends TRANSITIONAL Transitional housing for homeless persons Moved in with familv or friends f PAGE 4 I ~STlTUTION I EMERGENCY HOUSING UNKNOWN OTHER 15. Supportive Services. Of tbose participants tbat left during tbe montb, bow many received the following supportive services during their time in the project? # Outreach Case Management Life Skills (outside of case management) Alcohol or drug abuse services Mental Health services HIV / AIDS-related services Other health care services Education Housing Placement Employment assistance Child care Transportation Legal Other (please specify) Number of staff vacancies 17. Follow-up information. Provide the following information on clients being tracked 90-days post discharge. Names of individuals reflected shall be maintained at provider site for confirmation. Of ersons wbo bave left ro ram into ermanent bousin PH: Total placed in PH since contract Number still Number still start date housed 30 days housed .60 da s Number still housed 90+ days Number employed 60 da s Number still employed @ 90 da s Number still employed 90+ da s Of ersons discbar ed substance-free: Total discharged substance-free Number substance free ,30 da s Number substance free 90+ da s Of ersons with mental illness dischar ed: Total discharged since contract start Number institu- tionalized <30 days ost discharge D:files/formsIMPR- 11/6100 Attachment E MIAMI-DADE COUNTY HOMELESS TRUST OUTCOME/PERFORMANCE MEASUREMENTS MONTHL Y REPORT Services Onlv Month of: PROVIDER NAME: FUNDING SOURCE: 0 Primary Care F&B PREPARED BY: PROJECT NAME: o SIfP 0 State TITLE: OOther GOAL ACHIEVED MEASURE M-T-D L-T-D # % # 0/0 D:FILESIFORMS/OUTCOMERPT - 6/6/01 ATTACHMENT F CLIENT CONTRIBUTION REPORT PRIMARY CARE AGENCY SUBMITTING REPORT: DATE REPORT SUBMITTED: REPORT COMPILED BY: PERIOD OF SERVICE: CLIENT NAME: DATE OF BIRTH: -'-'- SSN#: DATE OF ENTRY: _'_'_ CASE MANAGER' COUNSELOR: ENTITLEMENT: DATE AMOUNT TO * AMOUNT TO (CHECK ONE) RECENED: CLIENT: PROVIDER: SS U SSO (OIS.): SOC. SECURITY: AFDCrrANF: FOOD STAMPS: VETERAN'S BENEFITS: MEDICAID: SUBTOTAL: EARNED INCOMElWAGES: PAY DATE: AMOUNT TO **AMOUNT TO (CHECK ONE) CLIENT: PROVIDER: EMPLOYMENT: OTHER: SUBTOTAL: TOTAL: * MAXIMUM 40% AS PER AGREEMENT ** MAXIMUM 30% AS PER AGREEMENT %OF TOTAL: %OF TOTAL: A TTF.WPDfTTIPRIMARYCARE99f2000 ATTACHME~T .~ . U.S. Department of Housing and Urban Development Office of cOmmunity Planning and Development OMS Approval No. 2506~145 (exp.413( Annual Progress Report (APR) for Supportive Housing Program Shelter Plus Care . and Section 8 Moderate Rehabilitation for Single Room Occupancy Dwellings (SRO) Program HUD-40 118 (6/00) Pubfjc rcportiag bunfca for this collection of information is estimared.to average 65 boun; per ~ponsc. induding the time for reviewing instructions. scardting existing da1a sources, gathering and maintaining the daIa necdc:d, and COlIIpletiag and reviewing the collection of information. This agency may not conduct or sponsor, and · ~n is not required to II:Spond to, . collection of inforuwioa unless thu collection displays. valid OMB cootrol number. General Instructions Purpose. The Annual Progress Report (APR) tracks program progress and accomplishments in the Department's competitiv, homeless assistance programs. Filing Requirements. Recipients offfiJD's homeless assistance grants must submit an APR to HUD within 90 days aftec the end of each operating year. Failure to submit an APR will delay receiving grant funds and may result in a determination of lack of capacity for future funding. An APR must be submitted for each operating year in which HUn funding is provided. The report must be submitted to the CPD Division Director in the local HUn Field Office responsible for managing the grant Grantees that received SHP funding for new construction, acquisition., or rehabilitation are required to operate their facilities for 20 years. They must submit an APR 90 days after the end of the first operating year and any year in which they use SHP funding for leasing, supportive services, or operations. For years in which they do not receive SHP funding, they must submit an Annual Certification of Continued Project Operation throughout the 20 years (contact local HUn Field Office). A separate report must be submitted for each HUn grant received. For Shelter Plus Care, a separate APR must be submitted for each Shelter Plus Care component For those grantees receiving an extension, a separate report covering that period must be submitted (see Extension below). Record keeping. Grantees must collect and maintain infonnation on each Participant in order to complete an APR. Optional worksheets are attached. The worksheets may be used to record infonnation manually or to design a computerized system to store and tabulate the infonnation. The worksheets should not be submitted to HUD with the APR. Organization of the Report. The APR is organized in the following manner. . Part I: Project Progress. This portion of the report descn"bes the progress in moving homeless persons to self-sufficiency, services received, project goals, and beds created. Part II: Financial Information. This portion of the report is completed by all grantees receiving funding under SHP, S+C and SRO. Final Assembly of Report. After the entire report is assembled, number every page sequentially. Marie any questions that do not apply to your program with "Nt A" for not applicable. (See Speciallnstructions for SSO Projects below.) Definitions. The following tenns are used in the APR. As indicated, in some cases, terms are applied differently depending on whether the funding is from SHP, S+C. or SRO. Entered the program for S-tC and SRO projcctsmcans when d!e panicipant suns 10 tcCCive~t"l8SSistan...,.For, 'S+C, services provided prior to this point are recogniz~ as necessary for outreachienroU~ent and are eligible to 'count as match. Left the program for S+C projects means when the Participant stops receiving rental assistance and is not expected to return to S+C assisted housing. If the Participant returns to S+C assisted hOUSing within 90 days, the person should not be considered as exiting from the program. If the person returns to S+C assisted housing after 90 days, that person is considered a new participant The worksheet is designed to capture this infonnation. An Extension APR applies to SHP and S+C grantees that requested and received an extension of their grant term from the HUD field office. The only difference between an APR for the extension period and the regular APR (besides the amount of time covered) is the signature page. Grantees should circle yes to indicate the APR is for an extension period and circle the operating year for which the report is an extension. For example, if the grantee is extending year 3, the grantee should submit an APR as usual for year 3 and submit another APR for the extension period. indicating the second is an extension and also circling year 3 on the signature page. Family means a household composed oft\vo or more related persons, at least one of whom is an adult. The term family also includes one or more persons living with an eligible Participant who is determined to be important to their Care or well being. Care givers are not reported on in the APR. 2 Grantee means a direct recipient of the HUD award. Match for S+C means the value of supportive services received by participants in the S+C project which, in the aggregate, must at least equal the value of the S+C rental assistance provided over the life of the project. For SHP, match means cash used to provide the grantee's portion of acquisition, rehabilitation, new construction, operations and supportive services expenses. Operating year means for SHP the date when participants begin to receive housing and/or services. The first operating year begins after development activities for acquisition, rehabilitation, and new construction are complete, after a copy of the Certificate of Occupancy is sent to the local HUD office, and when the first participant is accepted into the project. For projects without acquisition, rehabilitation or new construction the operating start date begins when the grantee accepts the first participant. For S+C (SRA., PRA and TRA components), the flISt operating year begins on the date HUD signs the grant agreement. For S+CISRO and for Sec. 8 SRG, the flISt operating year begins with the effective date of the Housing Assistance Payments (HAP) Contract. To determine which operating year to circle on the APR cover page, begin counting from the initial grant operating start date and include renewals grants. For example, a project receiving an initial grant for three years and a renewal grant for two years would circle years 1,2, and 3 respectively on the APR cover sheet for the initial grant and would circle 4 and 5 respectively for the renewal grant. For any future renewal grants, the grantee would begin by circling 6 on the APR cover sheet Participant means single persons and adults in families who received assistance during the operating year. Participant does not include children or caregivers who live with the adults assisted. Project Sponsor means the organization responsible for carrying out the daily operation of the project, if the organization is an entity other..than the grantee. . Special Instructions for Supportive Services Only Projects. SSG grantees should complete all questions, unless a written agreement has been reached with the field office concerning which questions can be answered using estirnat~, olr in rare instances, skipped. Below is an example of how infonnation could be derived in a large, single-service SSG project A grantee/sponsor staff member could be assigned to collect infonnation from the organizations housing the participants. The staff person would contact these individual organizations to request infonnation regarding the persons in that facility who use the service. For participants living on the street, the grantee/project sponsor may provide estimates. lnfonnation could be collected f2r each participant or for participants receiving services at a point-in-time. . If . . . -.' .' .': Cstunatesor"point-in4ime 'coun..ts-areused, the ,method used mUst'be described in the APR and the doCUmentation kept on file. 3 Grantee: HUO Grant or Project Number. Project Sponsor: Project Name: Operating Year. (Cirde the operating year being reported on) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Indicate if extension: yes no Indicate if renewal: yes no Previous Grant Numbers for this project Reporting Period; (moJdaylyr.) from: I to: Check the component for the program on which you are reporting. Supportive Housing Program (SHP) Shelter Plus Care (S+C) Section 8 Moderate Rehabilitation Transitional Housing Pennanent Housing for Homeless Persons with Disabilities Safe Haven Innovative Supportive Housing Supportive Services Only Tenant-based Rental Assistance (TRA) Sponsor-based Rental Assistance(SRA) Project-based Rental Assistance(PRA) . Single Room Occupancy (SRO) Single Room Occupancy (Sec. 8 SRO) . Summary of the project: (One or two sentences with a deScription of population. number served and accomplishmer this operating year) Name & Title of the Pe~on wtao can answer questions about this report: . .Phone: (indude area COde) Address: Fax Number. (indude area code) I h~reby certify that all the information stated herein is true and accurate. . Warning: HUO will prosecute false daims and statements. Conviction may result in criminal andlorcivil penalties. (18 U.S.C. 1001.1010.1012; 31 U.S.C. 3729. 3802) . Name & Title of Authorized Grantee Official: Signature & Date: Name and Title of Authorized Project Sponsor Official: X Signature & Date: x 4 Part I: Project Progress 1. Projected Level oCPersons to be served at a given point in time. (from the application, SHP- Sec. F; SPC- Sec. c; SRO- Sec. D) Number of Number of Number of Projected Level Singles Not Adults in Children Number of in Families Families in Families Families a. Persons to be served at a given point in time 2. Persons Served during the operating year. Number of NUmber of NUmber of Singles Not Adults in Children in NUmber of in Families Famirles Famirles Families a. Number on the first day of the operating year b. Number entering program during the operating year c. Number who left the program during the operating year d. Number in the program on the last day of the operating year (a+b-c) = d 3. Project Capacity. a. Number on the last day (from 2d. columns 1 and 4) b. Number proposed in application (from la. columns 1 and 4) c. Capacity Rate (divide a by b) = % Number of Singles Not in Families Numbe!of Families % % 4. Non-homeless persons. This question is to be completed for Section 8 SRO projects. How many income-eligible non-homeless persons were housed by the SRO program during the operating year? 5. .Age and Gender. Of those who entered the.project during the operating year how many people are in the.foUowingage.. and gendercategorle's? .' - "'~' . " ': '.... .":. ::". . ~ ../.. . :' . : ..... ' : . . .... . .";".::~ ". ..:;... -~~:;:.single Per'soas (fioni2b, column 1) d. "- Age Male Female , ... . . ~-,~.fi~',: .,_co'":.;.;'';' ':~':'~~~~-:1"t - . a. 62 and over - . . _t_ " - ....}~;:. " "4.'j..... . --~~~~:=:-i'~_'~-:~:~~:. b. 51-61 ' '_4_ '00"0~ " ..::i.~~.:'..~~~::__2::s;rt.7 ~:~~~~r~~~~7.. d ~ c. 31-50 " ..... ;::ft~~~.:~:--=~.$ife~~:~~ .. ,e... ;-.- d. 18-30 ~ .''''Z::~I':_:':~ :~-~:.~.:t-:~~~-z~;.-:'.~~::~. t~t:~.. .-- 17 and under " .. . e. . v":Persons in.f llmilies _((rOnl :2.b.:w1umns 2=&~~) .. f. 62 and over '-.-'f:.:' .-~":':. .... ~ .-l"\- g. 51 - 61 '. -. - 0_.. ,~. . h. 31 50 - i. 18 - 30 j. 13-17 k. 6-12 5 ~~:'er1 Answtt queStions 6 - 10 only for participants who ~ the project during the openting year (from 2b, columns I and 2). The terr participant means single persons and adults in families. It does not include children or caregivers. NOTE: The total for questions., 7, 8 and 10 below should be the same; respond to each of those questions for all participants. 6. Veterans Status. How many participants were veterans? A veteran is anyone who has ever been on active military duty status. o 7. Ethnicity. How many participants are in the following ethnic categories? a. Hispanic or Latino b. Non-Hispanic or Non-Latino 8. Race. How many participants are in the following racial categories? a. American Indian or Alaskan Native b. Asian c. Black or African American d. Native Hawaiian or Other Pacific Islander e. White 9. Special Needs. How many patticipants have the following? Participants may have more than one. If so, count them in all applicable categories. . a. Mental illness b. Alcohol abuse c. Drug abuse d. HlV/AlDS and related diseases e. Developmental disability f. Physical disability g. Domestic violence h. Other (please specify) 10. Prior Uv;ng Situation. How many participants s{ept in the following places in the week prior to entering the project? (Choose one) a. Non-housing (street. park, car, bus station, etc.) b. Emergency shelter c. Transitional housing for homeless persons d. Psychiatric facility" e. Substance abuse treatment facility- f. Hospital- g. JaiVprison. h. Domestic violence situation i. Living with refativeslfriends j. Rental housing k. Other (please specify) -If a participant came from an institution but was there less than 30 days and was living on the street or in emergency shelter before entering the treatment facility. he/she should be counted in either the street or shelter category. as appropriate. 6 Complete Questi9ns 11 - 15 for all participants who left during the operating year (from 2c. columns 1 and 2) The tenn partidpant means single persons and adults in families. It does not indude children or caregivers. 11. Amount and Source of Monthly Income at Entry and at Exit Of those partidpants who left during the operating year. how many partidpants were at each monthly income level and with each source of income? C. Income Sources at Entry A. Monthly Income at Entry a. Supplemental Security Income (SSI) a. No income b. Sodal Security Disability Income (SSDI) b. $1-150 c. $151 - $250 c. Social Security d. $251- $500 d. General Public Assistance e. $501 - $1.000 e. Temporary Aid to Needy Families (fANF) f. $1001- $1500 f. Child Support g. $1501-$2000 g. Veterans Benefits h. $2001 + h. Employment Income i. Unemployment Benetits j. Medicare k. Medicaid I. Food Stamps . m. Other (please specify) n. No Finandal Resources B. Monthly Income at Exit a. No income b. $1-150 c. $151- $250 d. $251-$500 '. e. $501- $1000 f. $1001-$1500 g. $1501- $2000 h. $ 2001 + D. Income Sources at Exit -- a. Supplemental Security Income (SSI) b. Social Security Disability Income (SSDI) c. Social Security d. General Public Assistance e. . . . Temporary Aid to Needy Families(f ANF) ..... ., , f. Child Support g. Veterans Benefits h. Employment Income i. Unemployment Benefits j. Medicare k. Medicaid L Food Stamps m. Other (please specify) n. No Financial Resources 7 12. Length o( Stay in Program. Of those participants who left during the operating year (from 2c, colwnns I and 2), how many were in the project for the following lengths of time? a. Less than 1 month b. 1 to 2 months c. 3 - 6 months d. 7 months - 12 months e. 13 months - 24 months f. 25 months - 3 years g. 4 years - 5 years h. 6 years - 7 years i. S years - 10 years j. Over 10 years . 13. Reasons (or Leaving. Of those participants who left the project during the operating year (from 2c, columns I and 2), how many left for the following reasons? If a participant left for multiple reasons, include onlv the primary reason. a. Left for a housing opportunity before completing program b.. Completed pr<:>gram -". .. .-_.. . ,., ~ " " ." . -. - -. ........ '. c. Non~ayment of rent/occupancy charge "- d. Non~mpliance with proj~ e. Criminal activity I destruction of property I violence f. Reached maximum time allowed in project g. Needs could not be met by project h. Disagreement with rules/persons j. Death j. Other (please specify) k. Unknown/disappeared 8 14. Destination. Of those participants who left during the operating year (from 2c. columns 1 and 2), how many left for the fo~lowing destination? PERMANENT (a41) a. Rental house or apartment (no subsidy) b. Public Housing c. Section 8 d. Shelter Plus Care e. HOME subsidized house or apartment . f. Other subsidized house or apartment g. Homeownership h. Moved in with family or friends TRANSITIONAL (i-D i. Transitional housing for homeless persons j. Moved in with family or friends INSTITUTION (k-m) k. Psychiatric hospital L Inpatient alcohol or other drug treatment facility m. JaiUprison EMERGENCY SHELTER (n) n. Emergency shelter OTHER (o-q) o. Other supportive housing p. Places not meant for human habitation (e.g. street) - q. Other (please specify) . UNKNOWN r. Unknown 15. Supportive Services. Of those participants who left during the operating year (from 2. columns 1 and 2). how many received the following supportive services during their time in the project? a. Outreach b. Case management c. ute skills (outside of case management) d. Alcohol or drug abuse services e. Mental health services . ~"--,,. -' ... ~ '. .... . . . ... . . f. HIVlAID~elated services g. Other health care services h. Education i. Housing placement j. Employment assistance k. Child care I. Transportation m. Legal n. Other (please specify) 9 16. Overall Program Goals. Under Objectives. list your measurable objectives for this operating year (from your application, Technical Submission or APR) for each of the goals listed below. Under Progress, describe your progress in meeting the objectives. Under Next Operating Year's Objectives, specify the measurable objectives for the next operating year. a. Residential Stabifity Objectives: Progress: Next Operating Year's Objectives: b. Increased Skills or Income Objectives: Progress: Next Operating Year's Objectives: c. Greater Self-determination . Objectives: Progress: Next Operating Year's Objectives: 17. Beds. SHP recipients answer 17a. S+C recipients answer 17b. SRO recipients answer 17c. (SHP-SSO projects do fJot . . . c:o~pletethis quest.i~l1.) .. ... . . , a. SHP. How many beds were included in the application approved for this project under 'Current Level' and under 'New Effort'? How many of these New Effort beds were actually in place at the end of the operating year? Current Level New Effort New Effort in Place Number of Beds: b. S+C. How many beds and dwelling units were being assisted with project funds at the end of the operating year? (Include beds for all participants, other family members, and care givers.) Number of Beds: Number of Dwelling Units: c. SRO. How many dwelling units were being assisted at end of the operating year? (Include units occupied by "in place" non- homeless persons who qualify for assistance.) Numb<:r of Dwdling Units: 10 Part II: FinalJciallnformation 18. Supportive Services. For Supportive HousinQ (SHP). this exhibit provides infonnation to HUD on how SHP funding for supportive services was spent during the operating year. Enter the amount of SHP funding spent on these supportive services. For Shelter Plus Care (S+C). this exhibit tracks the supportive services match requirement. Specify the value of supportive services from all sources that can be counted as match that all homeless persons received during the operating year. (S+C grantees should keep documentation on file, induding source. amount. and type of supportive services.) For Section 8 SRO, this exhibit provides information to HUD on the value of supportive services received by homeless persons during the operating year. Supportive Services DoUars a. Outreach b. Case management c. Ute skills (outside of case management) d. Alcohol and drug abuse services e. Mental health services f. AlDS-related services g. Other health care services h. Education - . i. Housing placement j. Employment assistance Ie. Child care I. Transportation m. Legal n. Other (please specify) o. TOTAL (Sum of a thru n) -- - -':~~~~~.~~~~~~~~: . ~~.~-_.~ :*::':'2 .;':"~ ...:t:._"... :....-:.. _ .","=.. __" _.~:: . c.""::" ....... ..'~ ....~...-"<~ . ,'-- ~. ~. p Cumulative amount of match provided to date for the Shelter Plus Care Program under this grant .' . . . '. .......~:. ~. -- ;.'":' II 19. Supportive Housing Program: Leasing, Supportive Services, Operating Costs and Administration All grantees receiving funding under the Supportive Housing Program must complete these charts each operating year. For expansion projects: If SHP grant funds are for the expansion of a pre-<Xisting homeless facility, only the people and expenditures for the additional expansion may be included, as in the original application or any grant amendments.. Documentation of resoW'CCS used is not required to be submitted with this report but should be kept on file for possible inspection by HUn and Auditors. Do not include any expenditures made before the SHP grant was executed.. Summary of Expenditures. Enter the amount of SHP grant funds and cash match expended during the operating year for each activity. SHP Funds Cash Matdl Total Expendnures a. Leasing b. Supportive Services c. Operating Costs d. Administration e. Total Note: Payments of principal and interest on any loan or mortgage may not be shown IS an opeming expense. Sources of Cash Match. Enter the sources of cash identified in the Cash Match column, above, in the following categories. Use additional sheets, an necessary. Amount a. Grantee/project sponsor cash b. Local government (please specify) d. Federal government (please specify) ~mmunity Development Block Grant (CDBG ~.~:.)~~~.~fj.~":'''''-:-.'''!::.-' ~~.",.o~':~""_:' ..... ~..., ~,.,.._.......! ~~r. ~''''~,-'''..af~. -~.. ...~.~ ~-."'-1. . r- ___ _..lo.. , ._,_ . . c. State government (please specify) e. Foundations (please specify) f. Private cash resources (please specify) ~~~.. . . ........... -'. "'"1- -....-... 1'. . .,-". . ..... .:...~~.:~,~... g. Occupancy chargel fees h. Total 12 20. Supportive lIousing Program: Acquisition, Rehabilitation, and New Construction All granteeS ~ received SHP funds for acquisition, rehabilitation, or new COllSttUction must complete these charts in the year one APR only. This exh.ibit will demonstrate to HUn that the grantee has contributed enough cash to at least equally match the amount of SHP funds spent for acquisition, rehabilitation, or new construction. Documentation that matching funds wen: provided is not required to be submittcc with this report but should be kept on file for possible inspection by HUn and Auditors. Summary of Expenditures. Enter the amount of SHP grant funds and cash match expended during the operating year for each activity. SHP Funds Cash Match Total Expenditures a. Acquisition b. Rehabilitation c. New construction d. Total Cash Match. Enter the sources of cash identified in the Cash Match COlumn, above. in the following categories. Use additional sheets. as necessary. Amount a. Grantee/project sponsor cash b. Local govemment (please specify) -~~~ "'~,.",". ~ . f&,;-.;;.., . ., - c. State government (please specify) ..:.~~~~.. -'-.'-.~ - .'.~ ~"-~'-'~'''- ..-~.:;"~.,..,:.... =--;::;-.:::;.- d. Federal government (please specify) ~->., :!.." . - . ~~ -~ "- - Community Development Block Grant (COB G) : .- .... .' . - , .. .' .' e. Foundations (please specify) -.~~~ .~~.:\ ........... - --,; .'. ,. -........ -... . -' - f. Private cash resources (please specify) ~~"!l.'iL~T' h\-:1;~ ~ -, -~~-~~-~~ _..:~~-~~ i\Ir...::.. g. Occupancy chargel fees h. Total 13 Describe any problems and/or changes implemented during the operating year. I Technical Assistance and Recommendations Based on your experience during the last year, are there any areas in wflich you need technical advice or assistance? If so, please describe. '. -.... . [4 1:::: o C. GJ a::: en en GJ .... 0) o .... a.. ro ::J c ...C .<1:: o :J :r: . - G) G) ~ en .lll:: L. o ~ "C G) ~ G) (J) a.. .... . Cl ~ , 'OU.O ;:ElO 0- el.o ~lO O,c Cl t:: III <ii mlO e .. .. Cl ~ G >.~ E CZ... 0 0- ~ Oe- Ca:: 0(1) Z_ C ca .Q.~ oz ~t:_ 01 ~~c. 0 .... .E.. <<l .. ~ ,cel ::I 'Em C 0- C :2~ <t: -IlIN ell ~~-- . = Cl- - .00 ell ECl Q; = E Ci. Za. E 0 (J .E 'tJ el ell -- 'tJ )( ca ell we ell C C 2 ~~ a:l E C CD .... we .E oS Q. ti :c ~ .. C - .. '0 0 _. , . ., (J <ii .. " .. ..'., .. " ::I . p' ., .. <II '" , ":~' a:: - , a. Q; .r= .E 'tJ ell 'tJ C ell :s !!! 'tJ C <ll tii Co .Q~ a.:r: 0 0 .!!! - Qj W 4l G.l E ell .r= '" .r= Z en '" <<I C .-: oX .... 0 a 0 en :: ~ J L. '" In Cl) :c .r= 0 I I I 0- I- Z '. - E ~ ::I to - o c o o ~ ..Q '0 - '" ell 'tJ o CJ 'tJ C <<l en C ..Q ti 2 in .E 1: o a. ell ct: en en ell .... V\ ,~ . cu ' :J .S C o ~ - <I) <I) ..r:::. 0) .::.::: L- a ;: -0 <I) c: <I)' en en c o en .... CI) a.. I ::1 ; Ci' ~~~-g ~<(.....~ j?;o - - G 8Ji~-g c:(.....~ ti ., mE~~ 00..)(...... o w...... :( ~~~~ oo..c...... _w...... <( - Ol C C > 0 ~7iGi" o~-go ~(J)~- .. -0 ., G~ z" -0 ]l8m 0-- G 0. en L-- - , , .-- Cl4) ,. 0-0 .' &!~G) C :::J :I: o >.~ ... ~ C) <<; c -g r-- 0-,=0 ~W~ fD oX ... o ~ z )::: =~:: _~.2(O 4> '" ,g~u; :l (t) ClI o c o 0 OIZ I I I I I ,--.- . I - _ "C .41) ::J C = C o ~ - (1) (1) .c tt.l ..lIl: L- a ~ "C (1) ~ (1) en (I) c:: a (I) a... <l) a.. I I I I I I I I I .. CI '0 z - . ., CI"O ~8 t:- o.-on a,CI..... a,~ ~~ (fJCI ,(fJ , ' - '. - - . , ,~ " : ,,' ,. - ' ,- ..... . .- - c 0 ~'i) .E"O-r :~-- 0 01 C >~ '" <II <<>"0 -,0 0 ~ -.., o ~ -E c '" o ~ '" 01 '" 0 cu ~ a::Q. ci I z f' C :::l :I: o - a; CD .r::. III .:.:: ... o ~ III ::; :::: E .0 ::J III o c: o a lastructions and Codes for Pcrsoos Served Woritsheet The use of this worksheet is optional. It was designed to help you"collect information on participants needed to complete the Annual Progress Report. If the worksheet is updated as participants move in and move out of your project, most of the information required for completion will be contained in the worksheet. Do not submit this worksheet with the APR. For projects that serve families, HUD only requires reporting on the number of children served, and the age and gender of these children. Only name, relationship, date of birth, and age on the worksheet need to be complcted for childr.en. Assign the adults a number, but not each family member. Use this number to transfer to the other pages of the worksheet. Beginning with numbcr 4, the numbers in the columns refer to the questions on the APR form. If any questions are answered with "Other," please enter the specific "Other" answer for inclusion in the APR. Participant Number. This column allows you to either number participants consecutively or to assign a case number. One number should be assigned to each adult. Name. Names of persons will nof be reported to HUD. The use of names is for your record keeping convenience. Relationship. Enter the appropriate relationship. Examples include: Self, Head of household, Spouse. Child. En try Date. Enter date participant entered the proiect. Usually this will be the date of actual physical move-in for a housing project. Exit Date. Enter date participant left the oroiect. Usually this will bc the date the participant physically moved o~t for a housing pr.oject. Do not . 'inch,lde a participant who temporarily left.the project and is expected to return in less than 90 days (e.g. hospitalization). 4. Income-eligible Non-homeless in SRO. The SRO program allows assistance to units occupied by Section 8 income-eligible persons residing at the SRO prior to rehabilitation. For SRO projects only, indicate whether the participant is an income-eligible. non-homeless person (Y) or not (N). SHP and S+C projects should skip this item. 5a. Date of Birth. Enler dale of birth including monlh. day. and year. 5b. Age. Enter age al entry. 5c. Gender. Enter appropriate letter for gender. M-Male F- Female. 6. Veteraas Status. Indicate if the participant is a veteran. Please note: A veteran is anyone who has ever been on active military duty status for the United States. 7. Ethnicity. Enter appropriate letter for ethnic group. a. Hispanic or Latino b. Non-Hispanic or Non-Latino 8. Race. Enter appropriate letter for race. a. American Indian or Alaskan Native b. Asian c. Black or African-American d. Native Hawaiian or Other Pacific Islander e. White 9. Special Needs. Enter the letter(s) for the category(ies) that describe the participant' s disability(ies). (You may double count) a. Mental illness b. Alcohol abuse c. Drug abuse d. HIV/AIDS and related diseases e. Dcvelopmental disability f. Physical;1isability g. Domestic violence h. Other (please specify) 10. Prior Living Situation. Enter the letter that best describes where the participant slept in the week prior to entering the project. Do not double count. a. Non-housing (street, park, car, bus station, etc.) b. Emergency shelter c. Transitional housing for homeless persons d. Psychiatric faci1ity~ e. Substance abuse treatment facility. Hospital. Jail/prison. . :.DomestiC .violence'situation.' ":"":"'::':'::.<~>> i. Living with relatives/friends j. Rental housing k. Other (please specify) f. g. ...:':'h. · If a participant came from an institution but was there less than 30 days and were living on . the street or in an emergency shelter ~efore entering the facility, he/she should be counted in either the street or shelter category, as appropriate. 18 lastruction and Codes (or Persons Served Worksheet (~ontinued) Ila. Gross Monthly Income at Project Entry. Enter the amount of gross monthly income the participant is receiving at entry into the project. lIb. Gross Monthly Income at Project Exit. Enter the gross monthly income the participant is receiving when exiting the project. Ilc. Income Sources Received at Project Entry. Enter all types of assistance the participant is receiving at entry to the project. a. Supplemental Security Income (SSI) b. Social Security Disability Insurance (SSDf) c. Social Security d. General Public Assistance e. Temporary Aid to Needy Families (T ANF) f. Child support g. Veterans benefits h. Employment income I. Unemployment benefits J. Medicare Ie. Medicaid I. Food Stamps m. Other (please specify) n. No Financial Resources lid. Income Sources Received at Project Exit. Enter all types of income the participant is receiving at project exit. (Use codes as in lie.) 12. Length in Stay in Program. Calculated item. (See Entry Date and Exit Date above.) 13. Reason (or Leaving Project. Enter the primary reason why the participant left the project. (Complete only for participants who left the project and are not ~xpected to retur~ with'in90 days;' . a. Left for a housing opportunity before completing the program b. Completed program c. Non-payment of rent/occupancy charge d. Non-compliance with project e. Criminal activity/destruction of property/violence f. Reached maximum time allowed in project g. Needs could not be met by project h. Disagreement with rules/persons I. Death J. Other (please specify) k. Unknown/disappeared 19 14. Destination. Enter the destination of those leaving the project. Permanent a. Rental house or apartment (no subsidy) b. Public Housing c. Section 8 d. Shelter Plus Care e. HOME subsidized house or apartment f. Other subsidized house or apartment g. Homeownership h. Moved in with family or friends Transitional i. Transitional housing for homeless persons j. Moved in with family or' friends Institution Ie. Psychiatric hospital I. Inpatient alcohol or drug treatment facility m. Jail/prison Emergency n. Emergency shelter Other o. Other supportive housing p. Plac~ not meant for human habitation (e.g., street) q. Other (please specify) Unknown r. Unlenown IS. Supportive Services. Enter ill types of supportive services the participant received during the time in the project. a. Outreach b. Case management c. Life sleills (outside of case management) d. Alcohol or drug abuse services e. Mental health services .;.f,...HIV/AIDs-related services '. g~'Other health care services h. Education i. Housing placement j. Employment assistance Ie Child care I. Transportation m. Legal n. Other (please specify) f ".. Form W-g ATTACHMENT H (Rev. March 1994) Request for Taxpayer Identification Number and Certification Give form to the requester. 00 NOT send to the IRS. ~nmenl of tne T,easury 1m_I R-... SeMc. Nam~qint names, list lirst _and circle tile nam. e 01 tile p.~nn or entllv wllose numoe. r you enter in Part I below. SII Inltructlonl on Pllll 2 II your Rlml 1111 ell.nlllll.) -l; - +'fl1l0tY\\ '""Rt~ . Business na (Sole proprietors see Instructions on pag~ Tax a er Identification Number Enter your TIN in the appropriate box. For individuals, this is your social security number \:3\#'~~SocIaI security number (SSN). For sole proprietors. see the instructions ,\...- on page 2. For other entities, it is your employer b identification number (EIN). If you do not have a OR number, see How To Get a TIN below. Note: If the account is in more than one name, I~ jdentifieation num~'2 ,..,1 see the chart on page 2 for guidelines on whose ~~ number to enter. Certification Under penalties of perjury, I certify that: 1, The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. I am not subject to backup withholding because: (a) I am exempt from backup Withholding, or (b) I have not been notified by' the Intemal Revenue Service 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. With,holding. C.artification 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 of underreporting interest or dividends on your tax retum. For real estate transactions, item 2 does not apply. For mortgage interest paid. the acquisition or abandonment of secured property, cancellation of debt. contributions to an individual retirement arrangement <IRA), and generally payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct . TIN. (Also see Part III Instructions on page 2.) . Sign Here Signature ~ Section references are to the Internal Revenue Code. Purpose of Form.-A person who is required to file an information return with the IRS must get your correct TIN to report income paid to you. real estate transactions, mortgage interest you paid, the acquisition or abandonmenLof secured property, cancellation of debt. or contributions you made to an IRA. Use Form W-9 to give your correct TIN to the requester (the person requesting your TIN) and, when applicable. (1 no certify the TIN you are giving is correct (or you are waiting for a number to be iSSued). (2) to certify you are not subject to backup withholding, or (3) to claim exemption from baCkup withholding if you are an exempt payee. Giving your correct TIN and making the appropriate certifications will prevent certain payments from being subject to backup withholding. Note: If a requester gives you a form other than a W-9 to request your nN, you must use the requester's form if it is substantially similar to this Form W-9. What Is Backup Withholding?-Persons making certain payments to you must withhold and pay to the IRS 31 % of such payments under certain conditions. This is called "backup withholding." Payments that could be subject to backup withholding include interest. dividends. broker and barter exchange transactions, rents. royalties. nonemployee pay, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding. If you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return. your payments will not be subject to baCkup withholding. Payments you receive will be subject to backup Withholding if: 1. You do not fumish your TIN to the requester, or 2. The IRS tells the requester that you fumished an incorrect TIN, or 3. The IRS tells you that you are SUbject to baCkup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or 4. You do not certify to the requester that you are not subject to backup withhOlding under 3 above (for reportable Ust aCCOunt number(s) here (optional) For Payees Exempt From Backup Withholding (See Part 1/ instructions on page 2)" ~ Date ~ 'Q)i'o~ _ interest and dividend accounts opened after 1983 only), or 5. You do not certify your TIN. See the Part III instructions for exceptions. Certain payees arid payments are exempt from backup withholding and infonnation reporting. See the Part " instructions and the separate Instructions for the. Requester of Fonn W-9. How To Get a TIN.-lf you do not have a TIN, apply for one immediately, To apply, get Form SS-5, Application for a Social Security Number Card (for individuals), from your local office of the Social Security Administration. or Fonn SS-4, Application for Employer Identification Number (for businesses and all other entities), from your local IRS office. If you do not have a TIN, write "Applied For" in the space for the TIN in Part I, sign and date the form. and give it to the requester. Generally, you will then have 60 days to get a TIN and give it to the requester. If the requester does not receive your TIN within 60 days, backup withholding, if applicable, will begin and continue until you furnish your TIN. Cat. No. 10231X Form W-9 (Rev. 3-94) " ... Form W-9 (Rev. 3-94} Note: Writing MApplied For" on the form means that you have already applied for a nN OR that you intend to apply for one soon. As soon as you receive your TIN, complete another Form W-9, include your TIN, sign and date the form, and give it to the requester. Penalties Failure To Furnish TIN.-lf you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect. Civil Penalty for False Information With Respect to Withholding.-lf you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty. Criminal Penalty for Falsifying Infonnation._ Willfully falsifying certifications or affirmatIons may subject you to criminal penalties including fines and/or imprisonment. Misuse of TINs.-lf the requester discloses or uses TINs in violation of Federal law, the requester may be subject to civil and criminal penalties. Specific Instructions Name.-lf you are an individual, you must generally enter the name shown on your social security card. However, if you have changed your last name, for instance, due to marriage, without informing the Social Security Administration of the name change, please enter your first name, the last name shown on your social security card, and your new last name. Sole Proprietor.-You must enter your individual name. (Enter either your SSN or EIN in Part I.) You may also enter your business name or Mdoing business as" name on the business name line. Enter your name as shown on your social security card and business name as it was used to apply for your ErN on Form SS-4. Part I-Taxpayer Identification Number mN) You must enter your TlN:k1 the appropriate box. If you are a sole proprietor, you may enter your SSN or E/N. Also see the chart on this page for further clarification of name and TIN combinations. If you do not have a TIN, follow the instructions under How To Get a TIN on page 1. Part "-For Payees Exempt From Backup Withholding Individuals (including sole proprietors) are not exempt from backup withholding. Corporations are exempt from baCkup withholding for certain payments, such as interest and dividends. For a complete list of exempt payees. see the separate Instructions for the Requester of Form W-9. If you are exempt from backup withholding, you should still complete this form to avoid POssible erroneous baCkup withholding. Enter your correct TIN in Part I, write MExempt" in Part II, and sign and date the form. If you are a nonresident alien or a foreign entity not subject to backup withholding, give the requester a completed Form W-8, Certificate of Foreign Status. Part "'-Certification For a jOint account, only the person whose TIN is shown in Part I should sign. 1. Interest, Dividend, and Barter Exchange ACcounts Opened Before 1984 and Broker Accounts Considered Active During 1983. You must give your correct TIN, but you do not have to sign the certification. 2. Interest, Dividend, Broker, and Barter exChange Accounts Opened After 1983 and Broker Accounts Considered Inactive During 1983. You must sign the certification or backup withholding will apply. If you are subject to backup withholding and you are merely prOViding your correct TIN to the requester, you must cross out item 2 in the certification before signing the form. 3. Real Estate Transactions. You must sign the certification. You may cross out item 2 of the certification. 4. Other Payments. You must give your correct TIN, but you do not have to sign the certification unless you have been notified of an incorrect TIN. Other payments include payments made in the course of the requester's trade or business for rents, royalties, goods (other than bills for merchandise), medical and health care services, payments to a nonemployee for services (including attomey and accounting fees), and payments to certain fishing boat crew members. 5. Mortgage Interest Paid by You, Acquisition or Abandonment of Secured Property, Cancellation of Debt, or IRA Contributions. You must give your correct TIN, but you do not have to sign the certification. Privacy Act Notice Section 6109 requires you to give your correct TIN to persons who must file information retums with the IRS to report interest, dividends, and certain other income paid to you, mortgage interest you paid, the acquisition or abandonment of secured property, cancellation of debt. or contributions you made to an IRA. The IRS uses the numbers for identification purposes and to help verify the accuracy of your tax return. You must provide your Page 2 TIN whether or not you are required to file a tax return. Payers must generally . withhold 31 % of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to a payer. Certain penalties may also apply. What Name and Number To Give the Requester For this type of account; Give name and SSN of: 1. Individual 2. Two or more individuals (joint accountj 3. . CustOdian account of a minor (Uniform Gift to Minors Act) .. L The usual nIVOCable savmgs trust (grantor IS lIIso trusteel b. So-called trust account that is not a Iega/ or valid trust under state law 5. Sole Pf'OPnetOtS/lip The individual The actual ____ of the 8CCOUnt or. if combtned funds. the first individual on the account ' The monor Z The grantor-trustee ' The ac1ua/ ____ ' The ____ . For this type 4f account; 6. Sole ptOptietOtS/lip 7. A valid trust, estate. or pensjon trust 8. Corpo,-ate 9. Association. club. religious. charrtable. educatJonaJ. or other tax-exempt organization 10. Partnership 11. A broker or registered nomInee 12. Account with the Department of Agriculture in the name of a public entity (SUCh as a state or local !/OV8mInent. school district. or prisont that receives agncultural ptOgram payments Give name and aN of: The ____. . Legal entity . The CXlrporatoon The organization The partnership The bn:Il<er or nominee The public entity , Ust forst and circle the name of the person whose nUmber you fumish. Z Circle the minor's name and fumish the minors SSN. · You must show your individual name. but you may also enter your business 0<" "doing business as' name. You may use either your SSN 0<" fiN. . Ust first and cirde the name of the legal trust, estate. 0<" pensjon trust. (00 not furnish the nN of the P<<SonaI reptesentatrV8 or trustee unless the Iega/ entity itself is not designated in the aCCOUnt title.) Note: If no name is circled when mOte than one name is listed, the number will be considered to be that of the first name listed. -u.s.c.-...,_. Pmang<lllk=.: lllGS- 387~711 Applicant Certification ATTACHMENT I (These certified statements are required by Jaw.) The Applicant hereby ensures and certifies that: A. For the Supportive Housing (SHP), Shelter Plus Care (S+C), and Single Room Occupancy (SRO) programs: I. Fair Housing and Equal Opportunity. It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulations pursuant thereto (Title 24 CFR Part I). which state that no person in the United States shall. on the ground of race, color or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the applicant receives Federal financial assistance, and will immediately take any measures necessary to ef- fectuate this agreement. With reference to the real property and Structure(s) thereon which are pro'/ided or improved with the aid of Federal financial assis- tance extended to the applicant, this assurance shall obligate the applicant, or in the case of any transfer, the transferee, for the period during which the real prop- erty and structure(s) are used for a purpose for which the Federal financial assistance is extended or for another purpose involving the provision of similar services or benefits. It will comply with the Fair Housing Act (42 U.S.C. 3601-19), as amended, and with implementing regulations at 24 CFR Part 100, which prohibit dis- crimination in housing on the basis of race, color, religion, sex, handicap, familial status or national origin, and administer its programs and activities relat- ing to housing in a manner to affU'matively further fair housing. For Indian tribes, it will comply with the Indian Civil Rights Act (25 U.S.C. 1301 el seq.) , instead of Title VI and the Fair Housing Act and their implementing regulations. It will comply wi~ ..executive Order 11063 on Equal Opportunity in Housing and with implementing regulations at 24 CFR Part 107 which prohibit dis- crimination because of race, color, creed, sex or na- tional origin in housi.ng and related facilities provided with Federal financial assistance. It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter 60-1), which state that no person shall be discriminated against on the basis of race, color, religion. sex or national origin in all phases of employment during the perfor- mance of Federal contracts and shall take affU'IIlative action to ensure equal employment opportunity. The applicant will incorporate, or cause to be incorporated, into any contract for construction work as defined in Section 130.5 of HUD regulations the equal opportu- nity clause required by Section 130.15(b) of the HUD regu lalions. /[ will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended (12 U.S.C. 1701(u)). and regulations pursuant thereto (24 CFR Part 135), which require that to the greatest extent feasible opportunities for training and employment be given 10 lower-income residents of the project and contracts for work in connection with the project be awarded in substan- tial part to persons residing in the area of the project. It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794). as amended, and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based on handicap in Feder- ally-assisted and conducted programs and activities. It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-07), as amended, and imple- menting regulations at 24 CFR Part 146, which prohibit discrimination because of age in projects and activities receiving Federal financial assistance. It will comply with Executive Orders 11625,12432, and 12138, which state that program participants sball take affU'IIlative action to encourage participation by businesses Owned and operated by members of minor- ity groups and women. If persons of any Particular race, color religion, sex, age, national origin, familial status, or handicap who may qualify for assistance are unlikely to be reached, it will establish additional procedures to en- sure that interested persons can obtain information concerning the assistance. It will comply with the reasonable modification and accommodation requirements of the Fair Housing Act and, as appropriate, the accessibility requirements of the Fair Housing Act and section 504 of the Reha- bilitation Act of 1973, as amended. Additional for S+C: If applicant has established a preference for targeted populations of disabled persons pursuant to 24 CFR 582.330(a), it will comply with this section's nondis- crimination requirements within the designated popu- lation. 2. Drug-Free Workplace. It will provide drug-free workplaces in accor- dance with the Drug-Free Workplace Act of 1988 (41 U.S.C. 701) by: (a) publishing a stalement notifying employees that the unlawful manufacture, distribution, dispensing, pos- session, or use of a controlled substance is prohib- ited in the grantee's workplace and specifying the actions. that will be taken against employees for violation of such prohibition; (b )establishing an ongoing drug-free awareness pro- gram 10 inform employees about: (I) Ihe dangers of drug abuse m the workplace; ATTACHMENT I-2 (2) the grantees policy ofmaintaining adrug-free work- place; (3)any available drug counseling, rehabilitation. and employee assistance programs; and (4)the penalties that may be imposed upon employ- ees for drug abuse violations occurring in the workplace; (c) making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement required by paragraph (a); (d)notifying the employee in the statement required by paragraph (a) that. as a condition of employment under the grant, the employee will: (l)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; (e) notifying the agency in writing, within ten calendar days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice. including position title, to every grant officer or other designee on whose grant activity the convicted employee was working, unless the Federal agency has designated a central pOlOt for the receipt of such notices. Notice shall include the identification number(s) of each affected grant; (f) taking one of the following actions, within 30 calen- dar days of receiving notice under subparagraph (d)(2). with respect to any employee who is so convicted : (1) taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements of the Rehabili- tation Act of 1973, as amended; or (2)requiring such employee to participate satisfac- torily in a drug..,abuse assistance or rehabilitation program approved for such purposes by a Fed- eral, State. or local health, law enforcement, or other appropriate agency; (g) making a good faith effort to continue to maintain a drug-free workplace through implementation of para- graphs (a), (b), (c), (d). (e) and (f); (h)providing the street address, city, county, state, and zip code for the site or sites where the performance of work in connection with the grant will take place. For some applicants who have functions carried out by employees in several departments or offices, more than one location may need to be specified. It is further recognized that States and other appli- cants who become grantees may add or change sites as a result of changes to program activities during the course of grant-funded activities. Grantees. in such cases. are required to advise the H UD Field Office by submitting a revised Place of Performance form. The period covered by the certification extends until all funds under the specific grant have been expended. 3, Anti-Lobbying. (a) No Federally appropriated funds have been paid or will be paid. by or on behalf of the undersigned, to any person for influencing or attempting to influ- ence an officer or employee of any agency, a Mem- ber of Congress, an officer or employee of Con- gress, or an employee of a Member of Congress in connection with the awarding of any Federal con- tract. the making of any Federal grant, the making of any Federal loan, the entering into of any coop- erative agreement, and the extension. continuation, renewal. amendment. or modification of any Fed- eral contract. grant, loan. or cooperative agreement. (b)If any funds other than Federally 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 agree- ment. the undersigned shall complete and submit Standard Form-LLL. Disclosure Form to Report Lobbying. in accordance with its instructions. (c)The undersigned shall require that the language of this certification be included in the award docu- ments for all subawards at all tiers (including sub- contracts. 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 me the required certification shall be subject to a civil penalty of not less than $10,000 and of more than $100.000 for each such failure. 4. Debarment. It and its principals (see 24 CFR 24.105(p)): (a)are not presently debarred. suspended. proposed for debarment. declared ineligible. or voluntarily ex- cluded from covered transactions (see 24 CFR 24.110) by any Federal department or agency; (b)have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of embezzle- ment, theft, forgery, bribery, falsification or de- struction of records, making false statements, or receiving stolen property; (c) are not presently indicted for or otherwise criminally ATTACHMENT 1-3 or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated in (b) of this certification; and (d)have not within a three-year period preceding this application/proposal had one or more public trans- actions (Federal. State or local) terminated for cause or default. S. Uniform Act. It will comply with the Uniform Relocation and Real Property Acquisition Policies Act of 1970 (as amended). and the implementing regulations at: 24 CFR 583.310 for SHP. 24 CFR 582.335 for S+C. and 24 CFR 882.810 for SRO. B. For SHP Only. ), Maintenance of Effort. It will comply with the maintenance of effort re- quirements described at 24 CFR 583.150(a). 2. 20- Y ear Operation Rule. For applicants receiving assistance for acquisition. rehabilitation, or new construction: The project will be operated for no less than 20 years from the date of initial occupancy or the date of initial service provision for the pUrpose specified in the application. 3. I-Year Operation Rule. For applicants receiving assistance for supportive services. leasing, or operating costs but not receiv- ing assistance for acquisition. rehabilitation. or new construction: The project will be operated for the purpose specified in the application for any year for which such assistance is provided. 4. Environmental Rule. (a) If the applicant is a State or other governmental entity with general governmental powers (see 24 CFR 583.5). it aSsumes all the environmental re- view responsibility that would otherwise be per- formed by HUD as the responsible Federal official under the National Environmental Policy Act (42 U.S.C. 4321)' (NEPA) and related environmental laws and authorities listed in 24 CFR Part 58. including acceptance of jurisdiction of the Federal courts. and will assess the environmental effects of each application for assistance i~ accordance with the provisions of NEPA and 24 CPR Part 58. (b) If the applicant is a private nonprofit organization or a governmental entity with special or limited purpose powers, it will (i) not enter into a contract for, or otherwise commit HUD or local funds for. acquisition, rehabilitation. conversion, lease. reo paIr. or construction of property to provide housing under the program, prior 10 HUD's completion of an environmental review in accordance with 24 CFR Part 50 and HUD's approval of the application; (ii) supply HUD with information necessary for HUD to perform any applicable environmental review when requested under 24 CFR 583.225(a); and (iii) carry out mitigating measures required by HUD or ensure that alternate sites are utilized. C. For S+C Only. 1. Maintenance of Effort. It will comply with the maintenance of effort re- quirements described at 24 CFR 582.115(d). 2. SUpportive Services. It will make available supportive services appropri- ate to the needs of the population served and equal in value to the aggregate amount of rental assistance funded by HUD for the full term of the rental assistance and that it will fund the supportive ser- vices itself if the planned resources do not become available for any reason. 3. Components: Standards, Definitions. and $3.000 Minimum. (a) For the SRO component only, the proposed site meets HUD's site and neighborhood standards (24 CFR 882.803(b)(4)), and meets the regulatory defi- nition of single room occupancy housing (24 CFR 882.802). . (b)For the SRO and PRA with rehabilitation compo- nents, the rehabilitation costs will meet the per unit rehabilitation minimum of $3.000. 4. Environmental Rule. (a) If the applicant is not a PHA, it assumes all the environmental review responsibility that would oth- erwise be performed by HUD as the responsible Federal official under the National Environmental Policy Act (42 U.S.C, 4321) (NEPA) and related environmental laws and authorities listed in 24 CFR Part 58. including acceptance of jurisdiction of the Federal courts, and will assess the environmental effects of each application for assistance in accor- dance with the provisions of NEP A and 24 CFR Part 58. (b)If the applicant is a PHA. it will (i) not enter into a contract for, or otherwise commit HUD or local funds for. acquisition. rehabilitation. conversion. lease, repair. or construction of property to provide housing under the program. prior to HUD's comple- tion of an environmental review in accordance with 24 CFR Part 50 and HUD's approval of the applica- tion; (ii) supply HUD with information necessary for H UD to perform any applicable environmental review when requested under 24 CPR 583.225(a); and (iii) ATTACHMENT I-4 carry out mitigating measures required by HUD or ensure that alternate sites are utilized. D. For SRO Only. I. Standards. Definitions, and $3,000 Minimum. The proposed site meets HUD's site and neighbor- hood standards (24 CFR 882.803(b)(4)), meets the regulatory definition of single room OCCupancy hous- ing (24 CFR 882.802), and the rehabilitation costs will meet the. per unit rehabilitation minimum of $3,000. 2. Environmental Rule. It will comply with the environmental review re- quirement for the SRO Program at 24 CFR 882.804(d). E. For SHP and SRO. I. Nonprofit Board of Directors. For private nonprofit applicants, members of its Board of Directors serve in a voluntary capacity and receive no compensation. other than reimbursement for expenses, for their services. F. For SHP and S+C. 1. Lead-Based Paint. It will comply with the requirements of the Lead- Based Paint Poisoning Prevention Act, 42 V.S.C. 4821-4846. and implementing regulations at 24 CFR Part 35. G. For S+C and SRO. 1. PHA Qualification. For PHA applicants. that it qualifies as a Public Housing Agency as specified in 24 CFR 882.102 and is legally qualified and authorized to carry out the proposed project(s). 2. IHA Qualification. For iliA applicants. that it qualifies as an Indian Housing Authority as specified in 24 CFR 905.126 and is legally qualified and authorized to carry out the proposed project(s). planation. here he applicant is unable to certify to any of the statements in this certification, such applicant shall ex lanation behind this page. Date: 4,1{. VID DERM Applicant: C i~ tJ,c /lArrJ'1A( &'C~H Ow ~VD\.JTI(yt) ~ Dn'.v[ M;o,-u/ I~ P1 '3)('39 For PHA Applicants Only: PHA Number: Attachmen t J MIAMI-DADE COUNTY AFFIDAVITS The contracting individual or entity (governmental or otherwise) shall indicate by an "X" all affidavits that pertain to this contract and shall indicate by an "N/ A" all affidavits that do not pertain to this contract. All blank spaces must be filled. The MIAMI-DADE COUNTY OWNERSHIP DISCLOSURE AFFIDA VIT; MIAMI-DADE COUNTY EMPLOYMENT DISCLOSURE AFFIDA VIT; MIAMI-DADE CRIMINAL RECORD AFFIDA VIT; DISABILITY NONDISCRIMINA nON AFFIDAVIT; and the PROJECT FRESH START AFFIDA VIT shall not pertain to contracts with the United States or any of its depanments or agencies thereof, the State or any political subdivision or agency thereof or any municipality of this State, The MIAMI-DADE F AMIL Y LEAVE AFFIDA VIT shall not pertain to contracts with the United States or any of its departments or agencies or the State of Florida or any political subdivision or agency thereof; it shall, however, pertain to municipalities of the State of Florida. All other contracting entities or individuals shall read carefully each affidavit to determine whether or not it pertains to this contract. I, :tnv'i c9 T:::l.-:Y1....vv1'e"'- , being first duly sworn state: ~ant The full legal name and business address of the person(s) or entity contracting or transacting business with MiamI-Dade County are (Post Office addresses are not acceptable): C i~ oC- w{tOA-1.; &/.4Ck-1 Name of Entity, dividual(s), Partners, or Corporation *59 . roOCO~7 z.. Doing Business As (if same as above, leave blank) 1100 Street A J)/l State /}1 ,0,41; l3t~ ~L J3/?/ ZIp 0 e t/ /A- I. MIAMI-DADE COUNTY OWNERSHIP DISCLOSURE AFFIDAVIT (Sec. 2-8.1 of the County Code) }, 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 ~d each stockholder who holds directly or indirectly five ~rcent (5%) or more of the c01'J?oration's stock. If the contract or business transaction is WIth a partnership, the foregoing Information shall be provided for each partner. If the ~ontract or business transaction is with a trust, the ful~ legal n~e and address shall be prOVIded for each trustee and each beneficiary. The foregomg reqUIrements shall not pertain to contracts with publicly-traded corporations or to contracts with the United States or any department or agency thereof, the State or any political subdivision or agency thereof or any municipality of this State, All such names and addresses are (Post Office addresses are not acceptable): FuJI Legal Name Address Ownership % % COUNTY AFFIDAVIT Page 2 AJ(I\ % 2. The full legal names and business address of any other individual (ot~er than subcontra~tors, materialmen, suppliers, laborers, or lenders) who have, or will have, any mterest (legal, equItable beneficial or otherwise) in the contract or business transaction with Dade County are (Post Office addresses are not acceptable): utA 3. Any person who wiUfully fails to disclose the information required herein, or who knowingly discloses false information in this regard, shall be punished by a fine of up to five hundred dollars ($500.00) or imprisonment in the County jail for up to sixty (60) days or both. IJ{ IL II. MIAMI-DADE COUNTY EMPLOYMENT DISCLOSURE AFFIDAVIT (County Ordinance No, 90- 133, Amending sec. 2.8-1; Subsection (d)(2) of the County Code), Except where precluded by federal or State laws or regulations, each contract or business transaction or renewal thereof which involves the expenditure of ten thousand dollars ($10,000) or more shall require the entity contracting or transacting business to disclose the following information, The foregoing disclosure requirements do not apply to contracts with the United States or any department or agency thereof, the State or any political subdivision or agency thereof or any municipality of this State. 1. Does your firm have a collective bargaining agreement with its employees? Yes No 2. Does your firm provide paid health care benefits for its employees? Yes No 3. Provide a current breakdown (number of persons) of your firm's work force and ownership as to race, national origin and gender: White: Black: Hispanics: ~. Males Females Males Females Males Females -== Males Females: Asian: American Indian: Aleut (Eskimo): Males Females Males Females - Males~ Females - Males - Females AFFIRMA TIVE ACTlONINONDISCRIMINA nON OF EMPLOYMENT, PROMOTION AND PROCUREMENT PRACTICES (County Ordinance 98-30 codified at 2-8.1.5 of the County Code.) In accordance with County Ordinance No. 98-30, entities with annual gross revenues in excess of $5,000,000 seeking to contract with the County shall, as a condition of receiving a County contract, have: i) a written affirmative action plan which sets forth the procedures the entity utilizes to assure that it does not discriminate in its employment and promotion practices; and ii) a written procurement policy which sets forth the procedures the entity utilizes to assure that it does not discriminate against minority and women-owned businesses in its own procurement of goods, supplies and services, Such affirmative action plans and procurement policies shall provide for periodic review to determine their effectiveness in assuring the entity does not discriminate in its employment, promotion and procurement practices. The foregoing notwithstanding, corporate entities whose boards of directors are representative of the population make-up of the nation shall be presumed to have non-discriminatory employment and procurement policies, and shall not be required to have written affirmative action plans and procurement policies in order to receive a County contract. The foregoing presumption may be rebutted. The requirements of County Ordinance No. 98-30 may be waived upon the written recommendation of the County Manager that it is in the best interest of the County to do so and upon approval of the Board of County Commissioners by majority vote of the members present. COUNTY AFFIDAVIT Page 3 The finn does not have annual gross revenues in excess of$5,000,000. . " The finn does have annual revenues in excess of $5,000,000; however, Its Board of DIrectors IS representative of the population make-up of the nation and has submitted a written, detailed listing of its Board of Directors, including the race or ethnicity of each board member, t? th~ County's Department of Business Development, 175 N,W, 1st Avenue, 28th Floor, MIamI, Florida 33128, The finn has annual gross revenues in excess of $5,000,000 and the finn does have a written affinnative action plan and procurement policy as described above, which includes periodic reviews to detennine effectiveness, and has submitted the plan and policy to the County's Department of Business Development 175 N.W. ISI Avenue, 28th Floor, Miami, Florida 33128; The finn does not have an affinnative action plan and/or a procurement policy as described above, but has been granted a waiver. <A~. MIAMI-DADE COUNTY CRIMINAL RECORD AFFIDAVIT (Section 2-8.6 of the County Code) The individual or entity entering into a contract or receiving funding from the County _ has _ has not as of the date of this affidavit been convicted ofa felony during the past ten (10) years. An officer, director, or executive of the entity entering into a contract or receiving funding from the County _ has _ has not as of the date of this affidavit been convicted of a felony during the past ten (10) years, A~. ~~VI. MIAMI-DADE EMPLOYMENT DRUG-FREE WORKPLACE AFFIDAVIT (County Ordinance No. 92-15 codified as Section 2-8.1.2 of the County Code) That in compliance with Ordinance No. 92-15 of the Code of Miami-Dade County, Florida, the above named person or entity is providing a drug-free workplace, A written statement to each employee shall infonn the employee about: 1. danger of drug abuse in the workplace 2. the finn's policy of maintaining a drug-free environment at all workplaces 3, availability of drug counseling, rehabilitation and employee assistance programs 4. penalties that may be imposed upon employees for drug abuse violations The person or entity shall also require an employee to sign a statement, as a condition of employment that the employee will abide by the tenns 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 tennination. 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. MIAMI-DADE EMPLOYMENT F AMIL Y LEAVE AFFIDAVIT (County Ordinance No. 142-91 codified as Section I IA-29 et. seq of the County Code) That in compliance with Ordinance No. 142-91 of the Code of Miami-Dade County, Florida, an employer with fifty (50) or more employees working in Dade County for each working day during COUNTY AFFIDAVIT Page 4 each of twenty (20) or more calendar work weeks, shall provide the following infonnation in compliance with all items in the aforementioned ordinance: An employee who has worked for the above finn at least one (I) year shall be entitled to nine~ (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 oftennination 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, I{!A- VII. DISABILITY NON-DISCRlMINA nON AFFIDAVIT (County Resolution R-385-95) That the above named finn, corporation or organization is in compliance with and agrees to continue to comply with, and assure that any subcontractor, or third party contractor under this project complies with all applicable requirements of the laws listed below including, but not limited to, those provisions pertaining to employment, provision of programs and services, transportation, communications, access to facilities, renovations, and new construction in the following laws: The Americans with Disabilities Act of 1990 (ADA), Pub. L. 101-336, 104 Stat 327, 42 U,S.C. 12101-12213 and 47 U.S.C. Sections 225 and 611 including Title I, Employment; Title II, Public Services; Title III, Public Accommodations and Services Operated by Private Entities; Title IV, Telecommunications; and Title V, Miscellaneous Provisions; The Rehabilitation Act of 1973, 29 U.S.C. Section 794; The Federal Transit Act, as amended 49 U.S.C. Section 1612; The Fair Housing Act as amended, 42 U.S.C. Section 3601-3631. The foregoing requirements shall not pertain to contracts with the United States or any department or agency thereof, the State or any political subdivision or agency thereof or any municipality of this State. Alt VIII. MIAM~DADE COUNTY REGARDING DELINQUENT AND CURRENTLY DUE FEES OR TAXES (Sec. 2-8.1(c) of the County Code) ~~. Except for small purchase orders and sole source contracts, that above named finn, corporation, organization or individual desiring to transact business or enter into a contract with the County verifies that all delinquent and currently due fees or taxes -- including but not limited to real and property taxes, utility taxes and occupational licenses -- which are collected in the nonnal course by the Dade County Tax Collector as well as Dade County issued parking tickets for vehicles registered in the name of the finn, Corporation, organization or individual have been paid. CURRENT ON ALL COUNTY CONTRACTS, LOANS AND OTHER OBLlGA nONS The individual entity seeking to transact business with the County is current in all its obligations to the County and is not otherwise in default of any contract, promissory note or other loan document with the County or any of its agencies or instrumentalities. t1/~_x. PROJECT FRESH START (Resolutions R-702-98 and 358-99) Any finn that has a contract with the County that results in actual payment of $500,000 or more shall contribute to Project Fresh Start, the County's Welfare to Work Initiative, However, if five percent (5%) of the finn's work force consists of individuals who reside in Miami-Dade County and who have lost or will lose cash assistance benefits (fonnerly Aid to Families with Dependent Children) as a result of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, the finn may request waiver from the requirements of R-702-98 and R-358-99 by submitting a waiver request affidavit. The foregoing requirement does not pertain to government entities, not for profit organizations or recipients of grant awards. COUNTY AFFlDA VIT Page 5 Xl. DOMESTIC VIOLENCE LEAVE (Resolution 185-00; 99-5 Codified At IIA-60 Et. Seq. of the Miami-Dade County Code), The finn desiring to do business with the County is in compliance with Domestic Leave Ordinance, Ordinance 99-5, codified at IIA-60 et. seq. of the Miami Dade County Code, which requires an employer which has in the regular Course of business fifty (50) or more employees working in Miami- Dade County for each working day during each of twenty (20) or more calendar work weeks in the current or proceeding calendar years, to provide Domestic Violence Leave to its employees. I have carefully read this entire five (5) page document entitled, "Miami-Dade County Affidavits" and have indicat by "" all affidavits that pertain to this contract and have indicated by an "N/A" all affidavits that do not e in s contract. 4.'7.03 (Date) day of -APR I L SUBSCRIBED AND SWORN TO (or affinned) before me this 7 '2.003 ~ by lJAVJD DED..MERj MAV'oR known to me. or has presented N/A (Type of Identification) . tie/She ~ personally - as identification. .p,~(~natutq <Ng~ ~ W '" My Commission # CC 820608 .,~ Orl\<:>~ Expires: 05/18/2003 1.llOO-3-NOTARY Fla. Notary Service & Bonding Co ~ 4'\$ ~. ~~~~ ~;;z~ i? ~ o-t.tA {.~ )> :D -< (Serial Number) - a:: " '< jj; () t'""' ~~@cn ~ :;. 2. >- en ~ E. () (II 0 0 . S \i! ~ 0 Q~()>< llO!3()O i~iZ &> (Expiration Date) (Print or Stamp of Notary) Notary Public - Stamp State of (State) Notary Seal MIAMI-DADE COUNTY, FLORIDA (I) ProjectTitle: AFFIDA VIT OF MIAMI-DADE COUNTY LOBBYIST REGISTRATION FOR ORAL PRESENTATION ProjectNo.: F L I L{ 'DCOc:x:> s. Attachment K <1 (4) List All Members of the Presentation Team Who Will Be Participating in the Oral Presentation: ~AME mE EMPLOYED BY TEL. NO. F M 'ClOrJ2D SC ~ C'l~ /L{()JJD~, ~ \ (~I 'tt( 0,(..' M (~ r J. 1$~Lt .~O~ 07S- JOIO . (ATTACH ADDITIONAL SHEET CESSARY) The individuals named above are Registered and the Registrati Fee is Dbt required for the Oral Presentation ONLY. Proposers are advised that any individual substituted for or added to the presentation team after submittal of the proposal and filling by staff, MUST register with the Clerk of the Board and pay all applicable fees. Other than for the oral presentation, Proposers who wish to address the county commission, a county board or county committee concerning any action, decision or recommendation of county personnel regarding this solicitation MUST register with the Clerk of the Board (Fo BCCFORM2DOC) and pay all applicable fees. Signature of Authorized Represen tiv Title: M AYcF.. STATE OF Fl.r')QI1:~. COUNTY OF M IAt...4j - DADE. e and correct and I have read or am familiar with the provisions of ounty as amended. The foregoing instrument was acknowledged before me this 7 -+h de Y ~F A pr; l .' ?OQ~ , by ~VIO DFR~& ,a MAYeR , who is personaIlvknown (Individual, Officer, Partner or Agent) (Sole Proprietor, Corporation or Partnership) _ to me ~ who has produced 'tJ1 A as identification and ~id/did not take an oath. ~~~ (1 ~) Signature of person taking cknowledgement) (Title or Rank) (Serial Number, ifany) ~.....".yp,,~ ~ My Commission # CC 820608 "'.." "'1' I."~ Expires: 05/18/2003 1-~~INOTARY Fla. Notary Service & Bonding Co LISA C. DIXON (Name of Acknowledger typed, printed or stamped) A-2 - Rev. 1/2/98 Attachment L PROVIDER'S DISCLOSURE OF SUBCONTRACTORS AND SUPPLIERS (Ordinance 97-104) nOQ Co.A.JVoN)) u"'\..l Q:WiC lYz.. ~ J<... PH /~;t..4,' ~ Address: r7- ~ S I "?q NameofOrganization:C;~ r>t P1{~; Rc~ REQUIRED LISTING OF SUBCONTRACTORS ON COUNTY CONTRACT In compliance with Miami-Dade County Ordinance 97-104, the Community Based Organization must submit the list of first tier subcontractors or sub-consultants who will perfonn any part of the Scope of Services Work, if this Agreement is for $100,000 or more. The Community Based Organization must complete this infonnation. If the Community Based Organization will not utilize subcontractors, then the Community Based Organization must state "No subcontractors will be used"; do not state "N/A", NAME OF SUBCONTRACTOR OR SUB-CONSULTANT ADDRESS CITY AND STATE - )../0 s..QRC&JrYw~ w\ Ll I-:Je U.s.~. REQUIRED LIST OF SUPPLIERS ON COUNTY CONTRACT In compliance with Miami-Dade County Ordinance 97-104, the Community Based Organization must a list of suppliers who will supply materials for the Scope of Services to the Community Based Organization, if this Contract Agreement is $ 1 00,000 or more. The Community Based Organization must fill out this infonnation. If the Community Bas... Organization will not use suppliers, the Community Based Organization must state ''No suppliers will be used", do not state "N/A". NAME OF SUPPLIER ADDRESS Ala ~o(P,;t^- , UJ \ Ll CITY AND STATE I hereby certify that the foregoing infi '111 . Signature of Authorized Representati . Title: DAvID DER.....ER,MAV()!? Firm Name: CITY a:: IVtIAMI P,PAl.1-I Date:--.1, 1. l1~ Fed.IDNo, Address: J700 CONVENlTON r:LR. .op City/ State/Zip: MBb FL, 3~13~ Telephone: (~Cji) (Pl~.lnJCL-Fax: C3'O!5JCn73, J1e'2-- E-mail: I s eJ ~ ~ :f Co-' Z - Eo-< \/'l - ..J ~ ~- -~ ..J_ c..,. c..,r--- ;:10'1 ~ ~ s- o:: ~ '\ 2.5 a ""C " ~2C Eo-< ~ <+ '-' u () .... u d) '0' ... ~~ ~ = ......, - \/'l r ,- CJ ....1 c d) "'C C o 0.. CIl d) cr: -.::: .9 u C':J ... - c o U d) E '':: c... c- o d) ..... c: C':J Z ..... .:: '. - d) a C':J z ~ -< 5 ou~ > 0'" f: .5 t: .cE,g .~ 0'" ... .c u ~ 0 c. '" 0 ~ u 0._ u 0 0 .- c.... ~-~ ~~ 5 'iio~ 8:lu 'Vi a ~ ~=€5 o = u a 8.,.g llD~- .5 ~ '0 "0 > en :::1- = Y 0 0 = >.- '-:.5 ~ :1 'fi c. u .- u 'E ~ oS ~ rJ S ... u '" o E ~ U'l ... ._ c;="C.. .- 0 c. ... U :::I ~ c: (;') ca 0 _ E .;:: ~ u ... rfE:.o :: (;').... c.=o c.o", :::I U ... '" - 0 <..,.CI)tJ o 2 ca ~f-<t:: ca.c:: 5 .c,=u uca..o 5' u :::I c.::r: '" ~ .... U .... E ,0 ;:.~ :::I -..0-0 ;!3~tiU U ~ ... u ca...t.::.c t::ou_ 5oE'O u =.__ osVig; =u..o 0 :::I ... :::I C '" C. o 0 ... c. U '" 0 ca c - 4,) _ O=QL)- CI) QJ C ~ _""0 <<I.: 55'fi~ "0 c... - C = :1 0 0 g, ... -= c... :1'gc; :::I .... <<s ..c a "0 '" '" U ~ ~ g ~ ",.::g t:: 11) ... ="0 ~~8~ 0- <<S U E ..0"0-::11) c;~~:S: >- 11)- "0 ~ ..0 ... ... 0 "Oo~..c:: ~Eca:: ~ ~.~ g c.. 0 0 c.: Eo..c::"O o 0 ~ 11) u o. '_ 11)0cQ.. ..o_I1)c... "OlO<!"O= -...c", 502.,OJ ..c~V)..o V1 ~ ~ S I=' ::J L.., V) C:.::: 0 - ..2 -g t .~ .~ ~ -0 2 ,c~x~~ 11) .0 C VI o o G o <) C:1 "'T - ~ ... d) ..0 a = z .... u d) '0' ... c... .i T'T' r'u". ENT H _u .. CJ .. . -IX ~ _u .. CJ .. . -IX ~ ii Co .. c 't: ... Cl. u -"0 = u o ii Co .. c 't: ... Cl. u -"0 = u o >. ,.Q "C- ~ = S~ ... : cS ~ ... = ~ Q =-] ~ : ,.Q\/'l QI:: - Q ~- ... tJ Q co: ?;~ c,... Q Q tJ ... ~ - c.: Q\/'l tJ \/'l u f ::r u u a 'l:l c a u .6 u COO 'l:l U "i o = ~ >- E .... o - II> U .c u -= .9 ~ CO E II> ;j ~ ,.Q Q - ~ ... t~ of Co ~ ;- f!2\/'l ~>. o! ,.Q ..."C ~ ~ ="C E .~ ~ ... o~ =- c.. Co : \/'l , o ~ . t '. C .. ~ ... ~ C ~ o c. c. u E ca ;Z C .;: ~ ... ~ C ~ o ::r en "i:: o U <IS ... E o u .c ::r en .!!l -= .: 'l:l OJ C .~ o U II> c .52 ~ E OJ II> ::! c. ::! OJ -= ~ -= c:;- 't: OJ u u ... a ca = QL) fii '" -- = U "0 = o c... '" OJ t& E u ca t:: = o U 11) E .;: ~ - co: C. oc; c .~ c.., - c; Co oc; C .~ c.., ... ~ E= - tJ ~ ... Q c,... Q ~ ~ ~ ... "C "C ~ "C C C'; ~ S co: Z - ~ - ... c ~.s c,...-: Q ~ ~ c ~ Q ~ tJ -5..c "C ~ "C C C'; ~ 5 c; Z - - \/'l "i:: Q - tJ C'; ... - c o tJ ~..Q ~ = tJ\/'l C ... tJ .- c.. Co = \/'l ~ ~ ~ c 'r;; = ,.... - '" - ,.... - APPLICAKT OR RECIPIE!\l SECTION 3 COMPLL~l\"CE REQUrRE::\IE~TS FOR HUD-ASSISTED PROJECTS. I PROJECT NAME: ~ DOl. ~ PROJECTLOCATION: Ci~ 01 II1h~i ~-I PROGRAMFti'NDINGSQURCE: Hub A../i\J ~ ATTACHMENT N The work to be performed under this conlI'act is subject to the requirements of Section 3 of the Housing and Urban Development Act of 1968! as amended. 12 U.S.c. 1701u(Section 3). The purpose of Section 3 is to ensure that employment and othl:!" economic oppommiries gene:-ated by HUn assistance of HUD-assisted projects covered by Section 3, shall to the greatest extent feasible, be directed to low and very low-income persons, particularly persons who are recipients of HUD assistance for housing and to businesses that are substantially owned or substantially employ low and very low income persons. The applicant or recipient commits to development and implementation of a Section 3 Economic Opportunity Plan for Miami-Dade Housing Agency (MDHA) approval. prior to selection of an architect or general contractor or other applicable contractor. This Plan shall: describe the outreach procedures the applicant or recipient ~ill use to recruit, solicit. encourage, facilitate and award architectural and general contracts, where applicable, to Section 3 businesses in the project ar~ make a good faith efron, as defined by the regulations. to provide training, employment and business opponunities required by Section 3 to persons from the project area; and incorporate the "Section 3 Clause" (se~ attachment) in all contracts over $100,000 in connection with this project. The applicant or recipient commits to including the following contractor certification in all contracts over S100,000: "The contractor certifies thaI any vacant employment positions. including training positions, that are filled (1) after the contractor is selected, but before the contract or agreement is executed.; and (2) with persons other than those to whom the Section 3 regulation require employment opponunities to be directed, are not filled to circumvent the contractor's obligations under the Section 3 regulation." The aoolicant or recioient certifies and asrrees that it is under no contractual or other imoediments which would orevent it from comnlvino with these reouirements. Non-compliance with the Section 3 regulation may result in sanctions, termination of this contract or agreement for default. and debarment or suspension from future HUD-assisted contraCts. OWNER'S FIRM NAME (Print or Typ~ Name): c.lr'f 0 ~ M I AU I fL.p-Af' J.4 ry d Title (Print or Type Name and Title ); 4.7.D3 ;-""V P(l~ LISA C. DIXON lU My Commission # CC 820608 ~...~ "1'OFl~I\" Expires: 05/18/2003 1-800-3-NOTARY Fla. Notary Service & Bonding Co Word\Form\ AI'!'licant CT RcC",icnt Cumplt:lnCC Rc.quirc:mena tor Hll[).t\sS,sr::d l'ro;= I'nnn Cl'C\ttd: 5/10199 "Section 3 Clause" 24 CFR Pan 135 - at 135.38. 'This ciause must be included in all SC::tlcn .3 co....ered~...s A. The work to be periozmed \mder this contr3.C't is subject to the requircmcms of SectIon .; of the Housmg and Urban Development Act of 1968, as amendod. 12 U.S.c. 1701u (Section 3) The pUIpose of Section 3 is to eIlSUI'e that the employment and other economic: oppommmes generaIea by BUD assistance of HUD-assisted projects covered b}' Secoon 3, shall, to the greatest extent feasible. be directed to low and very low mcome persons, particularly persons ,,:no are reCIpIents of H1.;D assistance for housing. B. The parties to this contract agree to comply with HtJD's requlmons m 24 CFR Part 135, which implement Section 3. As evidenced by their execution of this comract, the p31'Ces to this contract c:c::rtI:fy that they are under no contractual or other impediment that would pre....enr them from compiying ~'1th the Part 135 rcguh1rians. C. The contractOr agrees to send to each labor Org:;mi~riOD or representative of woricers v.7th which ~ comraetOr bas a collective bargaiIring agreement or other understanding, if any, a nonce am."lS.IDg the labor O~";r.orion or worker's representative of the coa:ttactor's commitmentS under this section 3 clause, and v.ill post copies of the notice in conspicuous places at the work SIte where both employees and applicams for training and employment positions can see the notice. The notice shall describe the Section 3 prcie:re:z1ce, shall set forth minimum number and job titles subjcct to lme, :1vailability of apprcmiecship and training positions. the qualifications for each.; and the name and loc:anon of the person(s) taking applications for c:ach of the positiocs; and the anticipated date the woIk shall begin. D. The contractor agrees to include this Section 3 clause in every subcoIltr.1Ct subject to compliance with regulations in 24 CFR Part 135, and agrees to take appropriate action., as provided in an applicable provision of the subcontraet or in this Section 3 clause, upon a finding that the subcon:ttactor is in violation of the rcgulatioas in 24 CFR Part 135. The contractor will not subcontract with any subcoIItraCtOr where the c:cmtractor has notic(: or knowledge that the subcontractor has b~ found in violation of the regulations in 24 CFR Part 135. E. The contr.lctor will certify that any vacmt employment positions, including training pOSItiOns, that are filled (1) after the COIlttactor is-selec:tcd but before the cOntr:lCt IS executed.: and (2) with persons other than those to whom the regulations of 24 CFR Part 135 require employment opportunities to be directed, ~ not filled to circumvent the cont1"3.Ctor's obligations under 24 eFR. p3.tt 135. F. Noncompliance mth RUD's regu.latioas in 24 CFR Pan 135 may result in sanaicms, termination of this contract for defa.ult, and debannent or suspension from futme HUD assisted contrac:ts. G. WIth respect to work. perfo.cmed in connection with Section 3 covered Indian housing assistance, Section 7(b) of the Indian Sclf-Detc:nn:in.ation and Fd"('"tion Assistance Act (25 V.S.C. 450c) also applies to the work to be perfonned under this contract. Section 7(b) requires that to the greateSt c:<tCnt feasible (i) p~ce:md oppommitic:s for ttainiDg and employment shall be given to Indians, and (ii) ptefc:rcnl:C in the award of contI3.CtS and subcontraCtS shall be given to Indian orpnizations and Indian-owned Economic Enterprises Parties to this contract thaz are subject to the provisions of Section 3 and Section 7{b) 3gt= to comply with Section 3 to the maximum extent feasible, but not in derogation of compliance with Section 7(b). &:clawc:S/12!99 A'ITACBMENT 0 SWORN STATEMENT PURSUANT TO SECTION 287.133 (3) (a), FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES mIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OmClAL AUmORlZED TO ADMINISTER OATHS 1. This sworn statement is submitted to Miami-Dade Countv by T'Y"1\/;J DeY\.HtYl J ;tIayOfL (print individual's name and title) I Ci~ at I]1r(:;M: gc~-f (print Name of entity submitting sworn statement) for wbose business address is '""bb U)Y\JV C-~ 1) Ov--J ~^- D /L 'JAiQ/Yl " Be2\~1 A- "'3 :3>1 ~ '7 and if applicable its Federal Employer Identification Number (FEIN) is S- 9 - 000037 L If tbe entity bas no FEIN, include tbe Social Security Number of tbe individual signing this sworn statement: 2. I understand tbat a "public entity crime" as defined in paragrapb 287.133 (1)(g), Florida Statutes, means a violation of any state or federal law by a person witb respect to and directly related to tbe transactions of business witb any public entity or witb an agency or political subdivision of any other state or witb the United States, including, but not limited to, any bid or contract for goods or services to be provided to public entity or agency or political subdivision of any other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misinterpretation. 3. I understand that "convicted"-or "conviction" as defined in Paragraph 287.133 (1)(b), Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or witbout an adjudication of guilt, in any federal or state trial court of record relating to charges brought by indictment or information after July I, 1989, as a result of a jury verdict, non jury trial, or entry of a plea of guilty or nolo contendere. 4. I understand tbat an "aflUiate" as defined in paragraph 287.133(1)(a), Florida Statutes, means: 1. A predecessor or successor of a person convicted of a public entity crime; or 2. An entity under tbe control of any natural person wbo is active in tbe management of the entity and wbo has been convicted of a public entity crime. The term "affiliate" includes tbose officers, directors, executives, partners, sbareholders, employees, members, and agents who are active in the management of an affiliate. Tbe ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons wben 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 wbo has been convicted of a public entity crime in Florida during tbe preceding 36 montbs sball be considered an affiliate. 5. I understand tbat 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 tbe United States witbin the legal power to enter into a binding contact and wbich 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. Tbe term "person" includes tbose officers, executives, partners, sbareholders, employees. members, and agents who are active in management of an entity. Sworn Statement Pursuant to Section 287.133(3)(a), Florida Statutes on Public Entity Crimes Page 2 6. Based on information and belief, tbe statement wbicb I bave marked below is true in relation to the entity submitting tbis sworn statement. (please indicate wbicb statement applies.) _Neitber tbe entity submitting tbis sworn statement, nor any of its officers. directors, executives, partners, shareholders, employees, members, or agents wbo are active in the management of the entity, nor any affiliate of tbe entity bas been cbarged witb and convicted of a public entit). crime subsequent to July 1, 1989. _The entity submitting tbis sworn statement, or one or more of its officers, directors, executives, partners, sbareholders, employees, members, or agents wbo are active in tbe management of tbe entity, nor any affiliate of the entity bas been cbarged with and convicted of a public entity crime subsequent to July 1, 1989. However, tbere has been a subsequent proceeding before a Hearing Officer of the State of Florida, Division of Administrative Hearings and tbe Final Order entered by the Hearing Officer determined tbat it was not in tbe public interest to place tbe entity submitting this sworn statement on tbe convicted vendor list. (attacb a copy of tbe final order). I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WlDCH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THAT PUBLIC ENTITY PRIOR TO ENTERING INTO A CONT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017 FLORIDA S ~T FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN Tm 0 (Signature) Sworn to and subscribed before me tbis -0 day of A PA I L personaUyknownJb mp4 I DaviclJ)ermer, Mayoi OR Produced Identification N~ Notal)' Public - State of N/.A ' , ,20~. FLORIDA (Type of Identification) My commission expires W'~.~~-4~............... -$~_I t?, /f)~J~ (pnnted typed or stamped c.mmissioned name of notary public) ~",y 'iI~ LISA C. DIXON lU My Commission # CC 820608 : .....~ "'1' On\l\~ Expires: 05/18/2003 HlOO.3-NOTARY Fla. Notary Service & Bonding Co MIAMI-DADE COUNTY, FLORIDA . ,: tcr"~::_-:: MIAMt-pA-.Q!.I:" _t.{"_/;y~. !".-:,~~ STEPHEN P. CLARK CENTER MIAMI-DADE COUNTY HOMELESS TRUST SUITE 27-312 111 N.\<\'. 1s: STRE~ MIAM!. FLORIDA 33126-1930 i305\ 375-149C FAX i305' 375-2722 April 1, 2003 Mr. Jorge M. Gonzalez, City Manager City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 Dear Mr. Gonzalez: Enclosed are three copies of the 2000 Supportive Housing Program Subrecipient Agreement between Miami-Dade County and your agency for the outreach grant. The project number is FL14B000005. Please review the document carefully. There are several new forms in the Agreement. Please execute all copies of the Agreement and return them to our office, attention Barbara Golphin, no later than Tuesday, April 8,2003. One fully executed Agreement will be returned to you for your files. The County requires that the City Manager execute the Agreement on behalf of the agency. A copy of the resolution granting the City Manager this power must be submitted with the Agreement. In addition, your corporate seal must be affixed to the signature page of the document. The Miami-Dade County Homeless Trust looks forward to working with your agency on this project. If you have questions, please contact Barbara Golphin of my staff. Our office telephone number is (305) 375-1490. . -/ ~vid . mon Acting Executive Dire tor Miami-Dade County Homeless Trust / / / Enclosures cc: Julie Edwards Barbara Golphin DR/bg