HomeMy WebLinkAboutMiami-Dade County Homeless Trust Agreement
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Miami-Dade County Homeless Trust
111 NW 1st Street · Suite 27-310
Miami, Florida 33128-1930
T 305-375-1490 F 305-375-2722
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miamidade.gov
Audit and Management Services December 5, 2006
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Independent Review Panel
Jorge M. Gonzalez, City Manager
City of Miami Beach
1700 Convention Center Drive
Miami Beach, FL 33139
RE: Outreach/FL14B500030
Dear Mr. Gonzalez:
Enclosed, please find for your file, one fully executed original of the Agreement
between Miami-Dade County, through the Miami-Dade County Homeless Trust
and City of Miami Beach, for the above referenced grant.
Please feel free to contact us at (305) 375-1490 if you have any questions or
require additional info . on. Thank you for your continued efforts with
addressing the nee4s the meless of our community.
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I have received one fully executed Agreement for the City of Miami Beach Outreach Program,
grant number FL14B500030.
Signature of Authorized Agency Representative
Date
Printed Name of Agency Representative
eJ
C 7 L- I.2A,0~
:7 O(){:; - .-2C,3 '17
AGREEMENT BETWEEN MIAMI-DADE COUNTY
AND
CITY OF MIAMI BEACH
FOR A 2005 SUPPORTIVE HOUSING PROGRAM GRANT! FL14B500030
OUTREACH PROGRAM
THIS AGREEMENT, entered this ~y of j.)()y: , 200 ~ by and between Miami-Dade County
(herein called the "Grantee") and City of Miami Beach, (hereinafter referred to as the "Subrecipient")
under this Agreement.
WHEREAS, the Grantee has applied for and received funds from the United States Government under
Title IV of the Stewart B. McKinney Homeless Assistance Act; and
WHEREAS, the Grantee agrees to comply with all requirements of this Agreement and to accept
responsibility for such compliance by the Subrecipient to which it makes grant funds available; and
NOW, THEREFORE, it is agreed between the parties hereto that;
I. STATEMENT OF WORK:
A. Activities
The Subrecipient shall adhere to the 2001 Supportive Housing Program Grant Agreement
(Attachment A), which is governed by the Supportive Housing Program rules, 24 CFR Part
583. The Sub recipient shall carry out the activities specified in the "Scope of Services"
(Attachment A-I), "Number of Beds, Bedrooms, and Participants", Attachment A-2, and
achieve "Performance Measures/Goals" as stipulated in Attachment A-3, and "Project
Milestones", Attachment A-4 as applicable. The Subrecipient shall also adhere to minimum
standards of housing and services as set forth in the"Standards of Care", incorporated herein by
reference.
B. Time Schedule
1. The Grantee and the Subrecipient agree that this Agreement shall become effective on
June 1, 2006.
2. This Agreement shall expire Mav 31, 2007, one (1) year from the effective date. Any cost
incurred by the Subrecipient beyond this date will not be paid by the Grantee, except as
specifically provided herein. Notwithstanding any provision herein to the contrary, certain
requirements imposed on the Subrecipient by this Agreement and Federal regulation may
continue for a term of at least twenty (20) years, as provided in this Agreement.
3. The requirements of this Agreement shall remain in effect during any time period that the
Subrecipient has control over any funds generated or provided in connection with this
Agreement, including program income.
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
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actlVltles 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 as Attachment B, the Budget, in an amount not to
exceed $60,949.00 for Supportive Services, and $3,047.00 for administration (minus 2.5%
administrative costs to be retained by the Grantee), for a total budget of $63,993.00. If
applicable, in accordance ''lith Federal Regulations, provider shall be reimbursed for capital
funding on an incremental basis, based on the following completion benchmarks: 30%, 30%,
30%, and 10% to be provided when a final Certificate of Occupancy is obtained from the
developer. All other activities shall be paid on a reimbursement basis following the submission
of a monthly invoice along ,,,rith the appropriate support documentation.
In accordance v.rith federal requirements, the Sub recipient agrees to provide match funds in an
amount that represents no less than twenty perent (20%) of the total supportive services budget,
and no less than twenty-five percent (25%) of the operations budget. The Sub recipient agrees
to provide outreach, assessment and placement services on Miami Beach. The project's office
is located at 555 1 ih Street, Miami Beach. Florida.
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 provided only for costs associated with the services detailed in the
budget, plus general administrative costs (not to exceed 2. 5% of direct costs).
4. Any reimbursement may be withheld pending the receipt and approval by the Grantee of
all reports and documents required herein, induding 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. However, such revisions shall be subject to review and
approval by the Grantee. Such requests shall only be considered at the end of a contract
year, unless otherv.rise specifically approved by the grantee.
7. A final request for reimbursement from the Subrecipient ,viII 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.
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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 Sub recipient ,,,,ill be required to return such
fimds 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 if the Subrecipient is entitled to such funds and the Grantee's decision in this
matter shall be final and binding.
B. Records and Access to Records
1. Agreement Records are defined as any and all books, records, client files (including client
progress reports, referral forms, etc.), documents, information, data, papers, letters,
materials, electronic storage data and media whether written, printed electronic or
electrical, however collected or preserved which is or was produced, developed,
maintained, completed, received, or compiled by or at the direction of the Sub recipient 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 xpenditures 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 joumal, 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 review, inspection, or audit by Grantee and Federal
personnel and any other persons so authorized by the Grantee.
5. The Subrecipient shall include in all the Grantee-approved subcontracts used to engage
subcontractors to carry out any eligible substantive programmatic services, as such
services are described 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 ,,,,hen services are eligible substantive programmatic
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services and subject to the audit and record-keeping requirements described m this
Agreement. These records shall be maintained as pursuant to this Agreement.
6. If the Subrecipient received funds from or is under regulatory control of other
governmental agencies, and those agencies issue monitoring reports, regulatory
examinations, or other similar reports, then the Subrecipient shall provide to the Grantee a
copy of each report and any follow-up communications and reports immediately upon such
issuance unless such a disclosure is a violation of those agencies' rules.
C. Reports
The Subrecipient shall submit to the Grantee the reports described below or any other document in
whatever form, manner, or frequency as may be requested by the Grantee. These ,,,,ill be used for
monitoring the provider's progress, performance, and compliance with applicable Grantee and
Federal requirements.
1. Progress Reports - Subrecipient shall submit a HMIS generated, "Monthly Progress
Report (MPR)," Attachment D, along ,\lith the following monthly reports using the forms
attached hereto as Attachment F "Client Contribution Report", as they may be revised by
the Grantee, which shall describe the progress made by the Subrecipient in achieving each
of the objectives identified in Attachment A-3.
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
following month, along with the request for reimbursement, follO\.ving the close of the prior
month.
2. Annual Progress Report - The Subrecipient shall submit a HMIS generated Annual
Progress Report in addition to a mannual report using the United States Department of
Housing and Urban Development (HUD) form HUD-40118, "Annual Progress Report
(APR) for Competitive Homeless Assistance Programs" (Refer to Attachment G and
G -1). 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. Attachment E "Program Rating and Satisfaction Survey"shall be collected monthly and
retained in a separate file by the Provider and availaable for review and monitoring, or as
requested by the Grantee.
4. Audit Reports - The Subrecipient shall provide two (2) copies of an annual certified public
accountant's opinion and related financial statements on the organization to the Grantee no
later than one-hundred and eif!htv (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, whichever is later,
provided that the Subrecipient has such an opinion prepared.
5 Annual Assurance Report- The Subrecipient who receives assistance only for leasing,
operating costs, or supportive services costs must provide an annual assurance report for
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each year the assistance is received that the project will be operated for the purpose
specified in the application.
6. Disaster Plan - The subrecipient shall submit an Agency Disaster Plan by April I sl of
Each Contract year.
D. Staff Responsibilitv
The staff members for this grant are listed in the Budget document (Attachment B).
E. Special Conditions
The Subrecipient shall follow the client referral process as listed in the "Scope of Services,"
(Attachment A-I).
The Sub recipient shall provide any documentation, such as the W-9 form (Attachment H) to
facilitate the reimbursement of services.
Performance Improvement Plan
. HMIS-Based on past performance in the area of Homeless Management
Information System Compliance as specified in (Section V. C. 13. of the
contract), this contract is subject to a Performance Improvement Plan (PIP).
During this contract term, the provider is required to submit a Monthly
Progress Report and an HMIS generated Monthly Progress Report for each
month of the contract. Compliance will be determined when it is deemed that
the two reports are in substantial conformity (a minimum of 95% accuracy on
all elements) with each other for a period of two consecutive months, At the
time of compliance, the provider shall only be required to submit HMIS
Monthly Progress Report for the duration of the contract.
. The above is subject to the review, approval, and discretion of the Miami-Dade County
Homeless Trust.
F. General Conditions
The Subrecipient shall comply with all Federal laws, and regulations, as specified in the
Applicant Certifications (Attachment I), the Renewal Grant Agreement and the accompanying
24 CFR Part 583, Supportive Housing Program regulations (Attachment A), 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 Sub recipient shall abide and be governed by the requirements of the Americans \vith
Disabilities Act (ADA).
In addition, the Subrecipient agrees to comply with the following requirements.
1 . Insurance
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A. Government Entities - If the Subrecipient is the State of Florida or an agency or
political subdivision of the State as defined by Section 768.28, Florida Statutes, the
Subrecipient shall furnish the County, upon request, written verification ofliability
protection in accordance with Section 768.28, Florida Statutes. Nothing herein
shall be construed to extend any party's liability beyond that provided in Section
768.28, Florida Statutes.
B. Non-government Entities - shall maintain required liability insurance coverage as
noted below at all times during this contract period:
The Sub recipient 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
msurance.
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.
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 \vith 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.
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2. Indemnification
The Subrecipient shall indemnify and hold haml1ess 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 contractor 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.
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 v.'fiting 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.
3. Affidavits
Complete and notarize, Miami-Dade County Required. Affidavits (Attachment J),
Lobbyist Registration for Oral Presentation (Attachment K) and Florida Statutes, on
Public Entity Crimes (Attachment 0), acknowledging compliance with the following
Miami-Dade County Affidavits:
a. Disability Nondiscrimination Affidavit (Attachment J, Section VII).
b. Family Leave Plan Affidavit (Attachment J, Section VI).
c. Drug-free Workplace Affidavit - Ordinance No. 92-15 (Attachment J, Section V).
d. Miami-Dade County Disclosure Affidavit (Attachment J, Section I).
e. Miami-Dade County Employment Disclosure Affidavit (Attachment J, Section II).
f. All Subrecipients are advised that in accordance with Section 2-11.1 (s) of the Code
of Miami-Dade County, the Lobbyists Registration for Oral Presentation Affidavit,
(Attachment 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 normal scope of employment of such agent, officer or employee.
g. Miami-Dade County Criminal Record Affidavit (Attachment J, Section IV). .
h. Delinquent and Currently Due Fees or Taxes - The Subrecipient has duly executed
the Affidavit regarding "Delinquent and Currently Due Fees or Taxes" as
required by Section 2-8.1(c) of the County Code and that affidavit is attached hereto
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as (Attachment J, Section VIII). The Subrecipient understands that the County has
relied on the aforementioned representation in entering this contract.
1. 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).
G. Civil Rights
The Subrecipient agrees to abide by Chapter 11A of the Code of Miami-Dade County ("County
Code"), as amended, which prohibits discrimination in employment, housing and public
accomodations.
Where applicable the Sub recipient 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 \\;11 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 \\;th Disabilities Act, the Rehabilitation Act, the Federal Transit Act,
49 USC g 1612, and the Fair Housing Act, 42 USC g 3601 et seq. If the Subrecipient or any
O\\ner, subsidiary, or other firm affiliated \'lith 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 Sub recipient was not in violation at the time it submitted
its affidavit.
The Sub recipient agrees that it is in compliance with the Domestice Violence Leave, codified as
g ll-A60 et. Seq. of the Miami-Dade County Code, which requires an employer, who in the
regular course of business has fifty (50) or more employees working in Miami-Dade County for
each working day during each of twenty (20) or more calendar work weeks to provide domestic
violence leave to its employees. Failure to comply with this local law may be grounds for
voiding or terminating this Contract or for commencement of debarment proceedings against the
Subrecipient.
The Subrecipient also agrees to abide and be governed by the Age Discrimination Act of 1975,
as amended, which provides in part that there shall be no discrimination against persons in any
area of employment because of age. The Subrecipient agrees to abide and be goverened by
Section 504 of the Rehabilitation Act of 1973, as amended, 29 USC 794, which prohibits
discrimination on the basis of handicap. The Subrecipient agrees to abide and be governed by
the requirements of the Americans with Disabilities Act (ADA).
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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 \vithhold payments to the Subrecipient
pending necessary corrective action by the Subrecipient or both.
Reasonable cause shall be dctermined by the Grantee and in its sole and absolute discretion and
may include:
1. Ineffective or improper use of any funds provided hereunder by the Subrecipient;
2. Failure by the Subrecipient to materially comply with any terms, conditions,
representations or warranties contained herein;
3. Failure by the Subrecipient to submit any documents required by this Agreement;
or
4. The Subrecipient's submittal of incorrect or incomplete documents.
B. T ennination
1. Termination at Will - This Agreement, in whole or in part, may be terminatcd by
the Grantee upon no less than fifteen (15) working days notice when thc
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 fmal determination as to what is in its best interest.
2. Termination for Convenience - The Grantee or sub recipient 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 effective date and in the case of partial termination, the portion to be
terminated. However, if the grantee determines in the case of partial
ternlination 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 financc this
Agreement become unavailable, the Grantee may terminate this Agreement upon
no less than nventy-four (24) hours notice in writing to the Subrecipient. Said
notice shall be sent by certified mail, return receipt requested, or in person with
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proof of delivery. The Grantee shall be the final authority to determine whether or
not funds are available.
4. Termination for Breach - The County may terminate 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, 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 C eltificates of Insurance required by tills 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 II(G) of this Contract; 8)
the Provider fails to provide Domestic Violence Leave to its employees pursuant to
local law; 9) the Provider falsifies or violates the provisions of the Drug Free
Workplace Affidavit; 10) the Provider attempts to meet its obligations under this
contract through fraud, misrepresentation or material misstatement; II) the
Provider fails to correct deficiencies found during a monitoring, evaluation or
review within tlle specified time; 12) the Provider fails to meet the terms and
conditions of any obligation under any contract or otherwise or any repayment
schedule to the County or any of its agencies or instrumentalities; 13) fails to meet
any of the terms and conditions of the Miami-Dade County Affidavits; 14) the
Provider fails to fulfill in a timely and proper manner any and all of its obligations,
covenants, agreements and stipulations in this Contact. The Provider shall be
given written notice of the claimed breach and 10 business days to cure 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 Provider, terminate this
Agreement upon no less than twenty-four (24) hours notice. Said notice shall be
sent by certified mail, return receipt requested, or in person with proof of delivery.
Waiver of breach of any provision of this Agreement shall not be construed to be a
modification of the terms of this Agreement. The provisions contained herein do
not limit the County's right to legal or equitable remedies or any other provision
for termination under this contract. Such individual or entity shall be responsible
for all direct and indirect costs associated vdth such termination or cancellation,
including attorney's fees. Any individual or entity who attempts to meet its
contractual obligations with the County through fraud, misrepresentation or
material misstatement ma be disbarred from County contracting for up to five (5)
years.
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IV. REVERSION OF ASSETS
A. Term of Commitment
If the Subrecipient receives assistance for acquisition, rehabilitation, or new construction, then
the Subrecipient shall agree to operate the supportive housing or provide supportive services in
accordance with this Agreement for a term of at least 20 years from the date of initial
occupancy or date of initial service provision. If the United States Department of Housing and
,Urban Development (HUD) determines a project is no longer needed for use as supportive
housing or to provide supportive services, then 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 supportive housing or supportive services for 10 years
following the date of initial occupancy or date of initial service provision pursuant to this
Agreement, then the Grantee shall require repayment of the entire amount of the grant used for
acquisition, rehabilitation, or new construction, unless conversion of the project has been
authorized pursuant to the terms in the Term of Commitment Section, IV-A of this document
(24 CFR 583.305 (b) ).
If the supportive housing is used for such purposes as stated in Section IV-A for more than 10
years, then the Subrecipient's repayment amount will be reduced by 10 percentage points for
each year beyond the 10-year period in which the project is used for supportive housing
(24 CFR 583.305 (b) ).
C. Prevention of Undue Benefits
Upon the sale or other disposition of a project assisted with acquisition, rehabilitation, or new
construction funds occurring before the expiration of the 20-year period, the Subrecipient must
comply mth such terms and conditions as HUD and the Grantee may prescribe to prevent the
Subrecipient from unduly benefiting from such sale or disposition
The Subrecipient shall return to the Grantee, upon the expiration or termination of this
Agreement, any funds on hand, any accounts receivable attributable to these funds, and any
overpayment due to unearned funds or costs disallowed pursuant to the ternlS of this Agreement
that were disbursed to the Subrecipient by the Grantee.
D, Revocation of License or Permit
Notwithstanding any provision of this Agreement to the contrary, revocation of any necessary
license, permit, or approval by a governmental authority may result in immediate termination of
this Agreement upon no less than twenty-four hours notice. Said notice shall be certified by mail
or hand delivery.
E. Declaration of Restrictive Covenants and Declaration of Restrictions
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City of Miami Beach's Outreach Program! Page 12 of23
The Subrecipient and the Titleholder shall sign and record as set forth in Attachment Q and
Attachment Q-l, at the time of contract execution, and incorporated here by reference, the
"Declaration of Restrictive Covenants," and the "Declaration of Restrictions." The Declaration
of Restrictive Covenants is a federal requirement and the Declaration of Restrictions is a local
Requirement on properties that are acquired, rehabilitated or built with Supportive Housing
Program funds. These convenants restrict the use of properties located at NA
_' such that the properties must be operted for the provision of supportive housing and services
for homeless persons in accordance v.lth the provisions of 24 CFR Part 583, Code of Federal
Regulatins for a term of at least 20 years or for such other purposes as may be approved by the
Grantor. The Subrecipient agrees to inform any lender or grantor which has loaned or granted
funds for the purchase of such properties of structures thereupon and request their consent to
the recordation of and subordination to the Declaration of Restrictive Covenants and the
Declaration of Restrictions. Such consent shall be in a form acceptable to the Grantee.
V. UNIFORM ADMINISTRATIVE REQUIREMENTS
A. Accounting Standards. Cost Principles. and Regulations
1. The Subrecipient shall comply with Federal accounting standards and cost principles
according to OMB Circular A-122 and SHP Regulations (24 CFR 583.135).
2. The Subrecipient shall comply with applicable provisions of applicable Federal, State,
and County laws, regulations, and rules such as OMB Circular A-lIO, 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 ofthis contract conflicts "lth any applicable law or regulation,
only the conflicting provision shall be deemed by the parties hereto to be modified to be
consistent with the law or regulation or to be deleted if modification is impossible.
However, the obligations under this contract, as modified, shall continue and all provisions
of this contract shall remain in full force and effect.
3. If the amount payable to the Subrecipient pursuant to the terms of this contract is in excess
of $100,000, the Subrecipient shall comply ,vith all applicable standards, orders, or
regulations issued pursuant to Section 306 of the Clean Air Act of 1970 ( 42 U.S.c. 1857
(h) ), as amended; the F ederal Water Pollution Control Act (33 U. S. C. 1251), as amended;
Section 5080f the Clean Water Act (33 U.S.c. 1368); Environmental Protection Agency
regulations (40 CFR Part 15); Executive Order 11738; and Environmental Review
Procedures and Regulations (24 CFR Part 58 and 24 CFR Part 583.230).
B. Retention of Records
1. The Subrecipient shall retain records pertinent to expenditures and all Agreement Records
for a period of at least three (3) years (hereinafter referred to as "Retention Period. ") For
all non-Grantee assisted activities the Retention Period shall begin upon the expiration or
termination of this Agreement.
2. If the Grantee or the Subrecipient has received or been given notice of any kind indicating
any threatened litigation, claim or audit arising out of the services provided pursuant to
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City of Miami Beach's Outreach Program! Page 13 of 23
the terms of this Agreement, the Retention Period shall be eAiended until such time as the
threatened or pending litigation, claim or audit is, in the sole and absolute discretion of the
Grantee, fully, completely and finally resolved.
3. The Subrecipient shall allow the Grantee or any persons authorized by the Grantee full
access to and the right to examine any of the Agreement Records during the required
Retention Period.
4. The Subrecipient shall notifY the Grantee in writing both during the pendency of this
Agreement and after its expiration as part of the final close-out procedure, of the address
where all the Agreement Records will be retained.
5. The Subrecipient shall obtain the prior written approval of the Grantee for the disposal of
any Agreement Records before disposing of such Records within one year after expiration
of the Retention Period.
C. Additional Requirements
The Subrecipient must comply with the following additional requirements.
1. Client Rules and Regulations - The Sub recipient shall submit a copy of the Client Rules
and Regulations that apply to clients referred to the Sub recipient 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 stmcture, 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 Sub recipient 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,
progranl 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 rectif)' 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
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City of Miami Beach's Outreach Program/ Page 14 of 23
state or local funds previously used, or designated for use to assist homeless persons ( 24
CFR Part 583.150 (a) ).
The Subrecipient shall notify the Grantee of any additional funding received for any
activity described in this Agreement, other than the "Client Contribution Report,"
(Attachment F) which is addressed in II-C(l). Such notification shall be in writing and
received bv the Grantee vv;.thin thirty (30) days of the Subrecipient's notification by the
..... -
funding source.
5. Related Parties - The Subrecipient shall report to the Grantee the name, purpose, and any
other relevant information in connection with any transaction conducted between the
Subrecipient and a related party transaction. A related party includes, but is not limited to,
a for-profit or nonprofit subsidiary or affiliate organization, and organization with
overlapping boards of directors or any organization for which the Subrecipient is
responsible for appointing members. The Subrecipient shall report this information to the
Grantee upon forming the relationship or if already formed, shall report it immediately.
Any supplemental information shall be reported in the Grantee required Agency Narrative
and Progress Report which are addressed in 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 mandatoIV'.
The Subrecipient shall receive notice no less than three (3) business days prior to any
meeting or training session that requires mandatory participation. A record of attendance
at meetings or training sessions where notice was given indicating the Sub recipient ' 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 ,vith the contract/agreement contact person or other program
administrative staff. The Provider may select one or more employees from their agency,
directly involved in the contracted program, as their representative at the meeting/training
session; the participation of the Agreement contact person is preferred. The Subrecipient
may request to be excused from a mandatory meeting. That request must be received at
least twenty-four (24) hours prior to the meeting date and time, and justification provided,
including why the agency could not send 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.
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City of Miami Beach's Outreach program/ Page 15 of 23
The Sub recipient shall ensure that all media representatives, when inquiring about the
activities funded pursuant to this Agreement, are informed that the Grantee is the funding
source.
8. Procurement - The Subrecipient shall make a pOSitive effort to procure supplies,
equipment, construction or services necessary or related to carrying out the terms of this
Agreement from minority and women's businesses, and to provide these sources maximum
feasible opportunity to compete for subcontracts to be performed pursuant to this
Agreement.
In conformance with Section 3 of the Housing and Urban Development (HUD) Act of
1968 (Attachment N) , 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 HUD assistance of
HUD-assisted projects covered by Section 3, shall to the greatest extent feasible, be
directed to low and very low-income persons, particularly persons who are recipients of
HUD assistance for housing and to businesses that are substantially ovm.ed or substantially
employ low and very low income persons.
9. Property
a. Any real property under the Provider's control that was acquired/improved in whole
or in part with funds from the Homeless Trust for $750 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 improvements,
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 \\'.ith funds from this and previous
contracts \vith the Homeless Trust, or transferred to the Provider after being
purchased in whole or in part \\'.ith funds from the Homeless Trust shall be listed in
the property records of the Provider and shall include a legal description., size, date
of acquisition, value at time of purchase, owner's name if different from the
Provider, 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 \\'.ith Homeless
Trust funds must also be included in the Provider's monthly reimbursement package
submitted to the Homeless Trust in the month in which the item was purchased
along with the Provider Asset Inventory (Attachment P).
c. All real property shall be inventoried annually by the Provider and an inventory
report shall be submitted to the Homeless Trust. TIlls 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
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City of Miami Beach's Outreach Program! Page 16 of 23
compliance with generally accepted fiscal and organizational standards and
practices. The performance review will reflect the quality of service provided and the value
received using monitoring data such as progress reports, site visits, and client surveys.
11. SubcontI"acts and Assignments
a. The Sub recipient shall ensure that all subcontracts and assignments:
(1) Identify the full, correct and legal name of the party;
(2) Describe the activities to be performed;
(3) Present a complete and accurate breakdown of its price component;
(4) Incorporate a provision requiring compliance v.~th all applicable regulatory
and other requirements of this Agreement with any conditions of approval
that the Grantee deems necessary. This applies only to subcontracts and
assignments in which parties are engaged to carry out any eligible
substantive programmatic service as set forth in this Agreement. The
Grantee shall in its sole and absolute discretion determine when services are
eligible substantive programmatic services subject to the audit and record-
keeping requirements described above, and;
b. In accordance with Ordinance No. 97-104, all bidders and respondents on County
contracts for purchase of supplies, materials or services, including professional
services, which involve the expenditure of $100,000 or more and all bidders or
respondents on County or Public Health Trust constmction contracts which involve
the expenditure of $100,000 or more shall include, as part of their bid or proposal
submission, a listing of Provider's Disclosure of Subcontractors and Suppliers
(Attachment L) 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 infonnation 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.
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City of Miami Beach's Outreach Program! Page 17 of 23
c. The Subrecipient shall incorporate m all consultant subcontracts this additional
proViSIOn:
The Subrecipient is not responsible for any insurance or other fringe benefits for the
consultant or its employees, e.g., social security, income tax withholdings, retirement
or leave benefits. The Consultant assumes full responsibility for the provision of all
insurance and fringe benefits for himself or herself and employees retained by the
Consultant in carrying out the Scope of Services provided in this subcontract.
d. The Subrecipient shall be responsible for monitoring the contractual performance of
all subcontracts.
e. The Subrecipient shall receive written documentation prior to entering into any
subcontract which contemplates performance of substantive programmatic activities,
as such is determined as provided herein. The Grantee's approval shall be obtained
prior to the release of any 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 Sub recipient. 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 Homeless Management Information System - The Provider agrees to
participate in the Homeless ManagementInformation System (HMIS) selected and
established by the County. Participation will include, but is not limited to, input of client
data upon intake, daily updates of bed availability information, as well as updates of
client files upon client contact, and maintaining current data for statistical purposes. The
Provider understands that they are responsible for any ongoing cost to access the HMIS
system.
14. Year 2000 Requirements - The provider agrees to the following to ensure compliance with
the Year 2000 requirements:
A. Computer equipment, software and systems must meet the following
requirements:
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City of Miami Beach's Outreach Program/ Page 18 of 23
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 \\lith 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.
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 (1/4) 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 ex1ensions.
Exception: The above application of one quarter (1/4) 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; (t) 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 Coun(v Board of
County Commissioners may authorize the inclusion ofthefee 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 anv
- -
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
GRAl\T'f NlJMBER: FLl4B500030
City of Miami Beach's Outreach Program! Page 19 of 23
make available, 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:
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 activities listed in 24 CFR Part 583.100 approved in the Technical
Submission for the program, or a shift of more than 10 percent of funds from one
approved type of activity to another, and a change in the category of participants
to be served, or other changes deemed significant by the Grantee. Depending on
the nature of the change, the Grantee may require a new certification of
consistency with the Consolidated Plan Certification from the United States
Department of Housing and Urban Development
b. Approval for changes is contingent upon the application ranking remaining high
enough after the approved change to have been competitively selected for funding
in the year the application was selected.
The parties agree to renegotiate this contract if the Grantee determines, in its sole and
absolute discretion, that Federal state, and/or Grantee revisions of any applicable law or
regulations, or increases or decreases in budget allocations make changes in this Agreement
necessary. The Grantee shall be the final authority in detemlining ,,,,hether or not funds for
this Agreement are available due to Federal, state and/or Grantee revisions of any
applicable laws or regulations, or increases in budget allocations.
Notwithstanding the foregoing, the Grantee retains all the rights of suspension or
termination set forth in Section 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. 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.
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City of Miami Beach's Outreach Program! Page 20 of 23
19. 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, ,,,,ill issue a determination within thirty (30) calendar
days of receipt and so advise the Grantee and the Subrecipient, or in the event additional time is
necessary, the Grantee will notify the Subrecipient within the thirty (30) day period that
additional time is necessary. The Subrecipient agrees that the County Manager's determination
shall be final and binding on all parties.
20. 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.
21. Proceedings - This Agreement shall be construed in accordance ,"vith 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.
22. Notice and Contact - The Grantee's representative for this Agreement is:
David Ravmond. Executive Director. The Subrecipient's representative for this Agreement
is . The project/program site is located
at In the event that different
representatives are designated by either party after this Agreement is executed, or the
Subrecipient changes the address of either the program site or the principal office, the
Subrecipient must notify the Grantee prior to such relocation and obtain all necessary
approvals. Notice of the name of the new representative or new address will be rendered in
writing to the other pal1y and said notification attached to the originals of this Agreement.
23. Name and Address of Payee - When payment is made to the Subrecipient's assignee, the name
and address of the official payee is
24. All Terms and Conditions Included - This Agreement and its attachments as referenced
contain all the terms and conditions agreed upon by the parties.
25. Autonomy - Both parties agree that this Agreement recognizes the autonomy of and stipulates
or implies no affiliation between the contracting parties.
26. 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.
27. 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 ,"vhich a
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City of Miami Beach's Outreach Program! Page 21 of 23
jury trial has been waived. The provisions of this paragraph have been fully discussed by the
parties hereto, and the provision hereof shall be subject to no exceptions. No party has in any
way agreed with or represented to any other party that the provisions of this paragraph will not
be fully enforced in all instances.
28. 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 (I) 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.
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 supportive services in a
manner that is free from religious influences and in accordance with the following principles:
1. It will not discriminate against any employee or applicant for employment on the basis of
religion and will not limit employment or give preference in employment to persons on the basis
of religion;
2. It will not discriminate against any person applying for housing or supportive services on the
basis of religion and will not limit such housing or services or give preference to persons on the
basis of religion; and
3. It will provide no religious instmction or counseling, conduct no religious worship or services,
engage in no religious prosel)tizing, 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).
VII. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)
Any person or entity that performs or assists Miami-Dade County ''lith a function or activity involving
the use or disclosure of "individually identifiable health information (Hill) and/or Protected Health
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City of Miami Beach's Outreach Program! Page 22 of23
Information (PHI) shall comply with the Health Insurance Portability and Accountability Act
(HIPAA) of 1996 and the Miami-Dade County Privacy Standards Administrative Order. HIPAA
mandates for privacy, security and electronic transfer standards, that include but are not limited to:
1. Use of information only for performing services required by the contract or as required by law;
2. Use of appropriate safeguards to prevent non-permitted disclosures;
3. Reporting to Miami-Dade County of any non-permitted use or disclosure;
4. Assurances that any agents and subcontractors agree to the same restrictions and conditions that
apply to the BidderlProposer and reasonable assurances that IIHIIPHI \vill be held confidential;
5. Making Protected Health Information (PHI) available to the customer;
6. Making PHI available to the customer for review and amendment; and incorporating any
amendments requested by the customer;
7. Making PHI available to Miami-Dade County for an accounting of disclosures; and
8. Making intemal practices, books and records related to PHI available to Miami-Dade County for
compliance audits.
PHI shall maintain its protected status regardless of the form and method of transmission (paper
records, and/or electronic transfer of data). The Bidder/ Proposer must give its customers written
notice of its privacy information practices including specifically, a description of the types of uses and
disclosures that would be made with protected health information.
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City of Miami Beach's Outreach Program! Page 23 of 23
IN WITNESS WHEREOF, the parties have caused this twenty-three (23) page Agreement to be
executed by their respective and duly authorized officers the day and year first above written.
WITNESSES:
NAME:
NAME:
NAME:
NAME:
ATTEST:
APPROVED AS TO
FORM & LANGUAGE
& FOR EXECUTION
Qe~!jr.k~
(PRINT)
(SIGNATURE)
(PRINT)
(SIGNATURE)
HARVEY RUVIN, CLERK
~
BY:
DEPUTY CLERK
;tJ4\> .!>o ?vc)~
(DATE) I'
Approved as to form and legal sufficiency:
PROVIDER: Gl\'-{ 0 F gvt\ A--rvt \ ~E.AC I-I
(FULL NAME OF AGENCY)
BY NAME: T[)I2y<5 VVl. ~2f'tU:,<
(PRINT NAME OF AUTIIORIZED
AGENCY REPRESENTA TIYE)
c..-e T"1 ~ 4- NAG \::~
(TITLE)
{2..-( ?:J l {O b
(DATE)
(SEAL)
MIAMI-DADE COUNTY
a political subdivision
of the State of Florida
(l}---j
~~J di f r;v
ATTACHMENT A
2005 SUPPORTIVE HOUSING PROGRAM
RENEWAL GRANT AGREEMENT
This Grant Agreement is made by and between the United States Department of
Housing and Urban Development (RUD) and Miami-Dade County, the Recipient, whose
Tax ill number is 59-6000573 for Project Number FL14B500030/Project Identifier
Number FL14079 to be located in the City of Miami Beach, FL.
The assistance which is the subject of this Grant Agreement is authorized by the
McKinney-Vento Homeless Assistance Act 42 U.S.C. 11381 (hereafter "the Act"). The
term "grant" or "grant funds" means the assistance provided under this Agreement. This
grant agreement will be governed by the Act, the Supportive Housing rule codified at 24
CFR 583, which is attached hereto and made a part hereof as Attachment A, and the
Notice of Funding Availability (NOFA) published March 21, 2005 at 70 FR 13576 and
14273. The term "Application" means the original and renewal application submissions
on the basis of which a Grant was approved by HUD, including the certifications and
assurances and any information or documentation required to meet any grant award
conditions. The Application is incorporated herein as part of this Agreement, however, in
the event of conflict between the provisions of those documents and any provision
contained herein, this Renewal Grant Agreement shall control. The Secretary agrees,
subject to the terms of the Grant Agreement, to provide the grant funds in the amount
specified below for the approved project described in the Application.
Although this agreement will become effective only upon the execution hereof by
both parties, the term of this agreement shall run from the end of the Recipient's final
operating year under the original Grant Agreement for a period of one year. Eligible
costs, as defined by the Act and Attachment A, incurred between the end of Recipient's
final operating year under the original Grant Agreement and the execution of this
Renewal Grant Agreement may be paid with funds from the first operating year of this
Renewal Grant.
RUD's total fund obligation for this project is $63,993 allocated as follows:
1. Grant for Operating $0
2. Grant for Supportive Services $60,949
3. Grant for Leasing $0
4. HMIS $0
5. Grant for Administration $3,047
The Recipient must provide a 25 percent cash match for supportive services
pursuant to HUD's FY 2005 Appropriations Act.
The Recipient agrees to comply with all requirements of this Grant Agreement
and to accept responsibility for such compliance by any entities to which it makes grant
funds available.
The Recipient agrees to participate in a local Homeless Management Information
System (HMIS) when implemented.
The Recipient and project sponsor, if any, will not knowingly allow illegal
activities in any unit assisted with grant funds.
HOD notifications to the Recipient shall be to the address of the Recipient as
written above, unless HUD is otherwise advised in writing. Recipient notifications to
HUD shall be to the HUD Field Office executing the Grant Agreement. No right, benefit,
or advantage of the Recipient hereunder may be assigned without prior written approval
of HOD.
For any project funded by this grant that is also financed through the use of the
Low Income Housing Tax Credit, the following applies:
HOD recognizes that the Recipient or the project sponsor will or has
financed this project through the use of the Low-Income Housing Tax
Credit. The Recipient or project sponsor shall be the general partner of a
limited partnership formed for that purpose. If grant funds were used for
acquisition, rehabilitation or construction, then, throughout a period of
twenty years from the date of initial occupancy or the initial service
provision, the Recipient or project sponsor shall continue as general
partner and shall ensure that the project is operated in accordance with the
requirements of this Grant Agreement, the applicable regulations and
statutes. Further, the said limited partnership shall own the project site
throughout that twenty-year period. If grant funds were not used for
acquisition, rehabilitation or new construction, then the period shall not be
twenty years, but shall be for the term of the grant agreement and any
renewal thereof. Failure to comply with the terms of this paragraph shall
constitute a default under the Grant Agreement.
A default shall consist of any use of grant funds for a purpose other than as
authorized by this Grant Agreement, failure in the Recipient's duty to provide the
supportive housing for the minimum term in accordance with the requirements of
Attachment A, noncompliance with the Act or Attachment A provisions, any other
material breach of the Grant Agreement, or misrepresentations in the application
submissions which, if known by HUD, would have resulted in this grant not being
provided. Upon due notice to the Recipient of the occurrence of any such default and the
provision of a reasonable opportunity to respond, HUD may take one or more of the
following actions:
(a) direct the Recipient to submit progress schedules for completing approved
activities; or
(b) issue a letter of warning advising the Recipient of the default, establishing
a date by which correcti ve actions must be completed and putting the Recipient
on notice that more serious actions will be taken if the default is not corrected or
is repeated; or
(c) direct the Recipient to establish and maintain a management plan that
assigns responsibilities for carrying out remedial actions; or
(d) direct the Recipient to suspend, discontinue or not incur costs for the
affected activity; or
(e) reduce or recapture the grant; or
(0 direct the Recipient to reimburse the program accounts for costs
inappropriately charged to the program; or
(g) continue the grant with a substitute recipient of HUD's choosing; or
(h) other appropriate action including, but not limited to, any remedial action
legally available, such as affirmative litigation seeking declaratory judgment,
specific performance, damages, temporary or permanent injunctions and any other
available remedies.
No delay or omission by HUD in exercising any right or remedy available to it
under this Grant Agreement shall impair any such right or remedy or constitute a waiver
or acquiescence in any Recipient default.
For each operating year in which funding is received, the Recipient shall file
annual certifications with HUD that the supportive housing has been provided in
accordance with the requirements of the Grant Agreement.
This Grant Agreement constitutes the entire agreement between the parties hereto,
and may be amended only in writing executed by HUD and the Recipient. More
specifically, the Recipient shall not change recipients, location, services, or population to
be served nor shift more than 10 percent of funds from one approved type of activity to
another, or make any other significant change, without the prior written approval of
HUD.
SIGNATURES
This Grant Agreement is hereby executed as follows:
UNITED STATES OF AMERICA
Secretary of Housing and Urban Development
..........--\
By" /','
. /~/ra. ~ ~.
..~..
G~/ ./ ... f/</Ctf?{/~/.
~/Maria R. Ortiz-Hill, Director Date
Community Planning and Development
RECIPIENT
MIAMI-DADE COUNTY
By:
f, /~~~
Date
David Raymond, Miami-Dade County Homeless Trust
305-375-1490(Tel) 305-375-2722 (Fax)
Official Contact Person and Telephone No. and Fax No.
Approved as to form
and . ...\enCV
u A~ U
r(7 V
f/
Dote
/\'1
j\, (
pt. 583
submitted in response to the most re-
cently published notice of fund avail-
ability and select applications for fund-
ing with the deobligated funds. Such
selections would be made in accordance
with the selection process described in
3582.220 of this part. Any selections
made using deobligated funds will be
subject to applicable appropriation act
requirements governing the use of
deobligated funding authority.
(Approved by the Office of Management and
Budget under control number 2506-0118)
PART 583-SUPPORTlVE HOUSING
PROGRAM
Subpart A-General
Sec.
583.1 Purpose and scope.
583.5 Definitions.
Subpart B-Assistance Provided
583.100 Types and uses of assistance.
583.105 Grants for acquisition and rehabi\!-
tation.
583.110 Grants for new construction.
583.115 Grants for leasing.
583.120 Grants for supportive service costs.
583.125 Grants for operating costs.
583.130 Commitment of grant amounts for
leasing, supportive services, and oper-
ating costs.
583.135 Administrative costs.
583.140 Technical assistance.
583.145 Matching requirements.
583.150 Limitations on use of assistance.
583.155 Consolidated plan.
Subpart C-Application and Grant Award
Process
583.200 Application and grant award.
583.230 Environmental review.
583.235 Renewal grants.
Subpart o-Program Requirements
583.300 General operation.
583.305 Term of commitment; repayment of
grants; prevention of undue benefits.
583.310 Displacement, relocation, and acqui-
sition.
583.315 Resident rent.
583.320 Site control.
583.325 Nondiscrimination and equal oppor-
tunity requirements.
583.330 Applicability of other Federal re-
quirements.
Subpart E-Administration
583.400 Grant agreement.
! /"" .
f'l V j i
" .....
;\
\,~.
24 CFR Ch. V (4-1-05 Edition>
583.405 Program changes.
583.410 Obligation and deobligatlon of funds.
AUTHORITY; 42 V.S.C. 11389 and 3535(d).
SOURCE; 58 FR 13871, Mar. 15, 1993, unless
otherwise noted.
Subpart A-General
9583.1 Purpose and scope.
(a) General. The Supportive Housing
Program is authorized by title IV of
the Stewart B. McKinney Homeless As-
sistance Act (the McKinney Act) (42
U.S.C. 11381-11389). The Supportive
Housing program is designed to pro-
mote the development of supportive
housing and supportive services, in-
cluding innovative approaches to assist
homeless persons in the transition
from homelessness, and to promote the
provision of supportive housing to
homeless persons to enable them to
live as independently as possible.
(b) Components. Funds under this part
may be used for:
(I) Transitional housing to facilitate
the movement of homeless individuals
and families to permanent housing;
(2) Permanent housing that provides
long-term housing for homeless persons
with disabilities;
(3) Housing that is, or is part of, a
particularly innovative project for, or
alternative methods of, 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. IS, 1993, as amended at 61
FR 51175, Sept. 30, 1996]
9 583.5 Definitions.
As used in this part:
Applicant is defined in section 422(1)
of the McKinney Act (42 U.S.C.
11382(1)). For purposes of this defini-
tion, governmental entities include
those that have general governmental
powers (such as a city or county). as
well as those that have limited or spe-
cial powers (such as public housing
agencies) .
Consolidated plan means the plan that
a jurisdiction prepares and submits to
HUD in accordance with 24 CFR part
91.
248
Otc. ot Asst. Secy., Comm. Planning, Develop., HUD
~ 583. 100
Date of initial occupancy means the
date that the supportive housing is ini-
tially occupied by a homeless person
for whom HUD provides assistance
under this part. If the assistance is for
an existing homeless facility, the date
of initial occupancy is the date that
services are first provided to the resi-
dents of supportive housing with fund-
ing 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 defi-
nition applies only to projects funded
under this part that do not provide sup-
portive 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 Commu-
nity Development Act of 1974 (42 U.S.C.
5302(a)(4)). In general. metropolitan cit-
ies are those cities 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 defined in
section 422(6) of the McKinney Act (42
U.s.C. 11382(6)).
Permanent housing for homeless persons
with disabilities is defined in section
424(c) of the McKinney Act (42 U.S.C.
11384(c)).
Private nonprofit organization is de-
fined in section 422(7) (A). (B). and (D)
of the McKinney Act (42 U.S.C. 11382(7)
(A). (B), and (D)). The organization
must also have a functioning account-
ing system that is operated in accord-
ance with generally accepted account-
ing principles, or designate an entity
that will maintain a functioning ac-
counting 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.C. 11382(9)).
Rehabilitation means the improve-
ment 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. Rehabilitation
does not include minor or routine re-
pairs.
State is defined in section 422(11) of
the McKinney Act (42 U.S.C. 11382(11)).
Supportive housing is defined in sec-
tion 424(a) of the McKinney Act (42
U.S.C. 11384(a)).
Supportive services is defined in sec-
tion 425 of the McKinney Act (42 U.S.C.
11385) .
Transitional housing is defined in sec-
tion 424(b) of the McKinney Act (42
U.S.C. 11384(b)). See also 9583.300(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 Commu-
nity Development Act of 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]
Subpart B-Assistance Provided
~ 583.100 Types and uses of assistance.
(a) Grant assistance. Assistance in the
form of grants is available for acquisi-
tion of structures. rehabilitation of
structures. acquisition and rehabilita-
tion of structures. new construction,
leasing. operating costs for supportive
housing. and supportive services. as de-
scribed in 99583.105 through 583.125. Ap-
plicants may apply for more than one
type of assistance.
(b) Uses of grant assistance. Grant as-
sistance may be used to:
(1) Establish new supportive housing
facilities or new facilities to provide
supportive services;
(2) Expand existing facilities in order
to increase the number of homeless
persons served;
(3) Bring existing facilities up to a
level that meets State and local gov-
ernment health and safety standards;
249
~583.105
(4) Provide additional supportive
services for residents of supportive
housing or for homeless persons not re-
siding in supportive housing:
(5) Purchase HUD-owned single fam-
ily properties currently leased by the
applicant for use as a homeless facility
under 24 CFR part 291; and
(6) Continue funding supportive hous-
ing where the recipient has received
funding under this part for leasing,
supportive services, or operating costs.
(c) Structures used for multiple pur-
poses. Structures used to provide sup-
portive housing or supportive services
may also be used for other purposes,
except that assistance under this part
will be available only in proportion to
the use of the structure for supportive
housing or supportive services.
(d) Technical assistance. HUD may
offer technical assistance, as described
in 3583.140.
[58 FR 13871, Mar. IS. 1993, as amended at 59
FR 36891. July 19, 1994]
~ 583.105 Grants for acquisition and
rehabilitation.
(a) Use. HUD will grant funds to re-
cipients to:
(1) Pay a portion of the cost of the
acquisition of real property selected by
the recipients for use in the provision
of supportive housing or supportive
services, including the repayment of
any outstanding debt on a loan made
to purchase property that has not been
used previously as supportive housing
or for supportive services;
(2) Pay a portion of the cost of reha-
bilitation of structures, including cost-
effective energy measures, selected by
the recipients to provide supportive
housing or supportive services; or
(3) Pay a portion of the cost of acqui-
sition and rehabilitation of structures,
as described in paragraphs (a) (1) and (2)
of this section.
(b) Amount. The maximum grant
available for acquisition, rehabilita-
tion, or acquisition and rehabilitation
is the lower of:
(1) $200,000; or
(2) The total cost of the acquisition,
rehabilitation, or acquisition and reha-
bilitation minus the applicant's con-
tribution toward the cost.
(c) Increased amounts. In areas deter-
mined by HUD to have high acquisition
24 CFR Ch. V (4-1-05 Edition)
and rehabilitation costs, grants of
more than $200,000, but not more than
$400,000, may be available.
~ 583,110 Grants for new construction.
(a) Use, HUD will grant funds to re-
cipients to pay a portion of the cost of
new construction, including cost-effec-
tive energy measures and the cost of
land associated with that construction,
for use in the provision of supportive
housing. If the grant funds are used for
new construction, the applicant must
demonstrate that the costs associated
with new construction are substan-
tially less than the costs associated
with rehabilitation or that there is a
lack of available appropriate units that
could be rehabilitated at a cost less
than new construction. For purposes of
this cost comparison, costs associated
with rehabilitation or new construc-
tion may include the cost of real prop-
erty acquisition.
(b) Amount. The maximum grant
available for new construction is the
lower of:
(1) $400,000; or
(2) The total cost of the new con-
struction, including the cost of land as-
sociated with that construction, minus
the applicant's contribution toward the
cost of same.
~ 583.115 Grants for leasing.
(a) General. HUD will provide grants
to pay (as described in 3583.130 of this
part) for the actual costs of leasing a
structure or structures, or portions
thereof, used to provide supportive
housing or supportive services for up to
five years.
(b)(l) Leasing structures. Where grants
are used to pay rent for all or part of
structures, the rent paid must be rea-
sonable in relation to rents being
charged in the area for comparable
space. In addition, the rent paid may
not exceed rents currently being
charged by the same owner for com-
parable space.
(2) Leasing individual units. Where
grants are used to pay rent for indi-
vidual housing units, the rent paid
must be reasonable in relation to rents
being charged for comparable units,
taking into account the location, size,
type, quality, amenities, facilities, and
management services. In addition, the
250
Otc. ot Asst. Secy., Comm. Planning, Develop., HUD
rents may not exceed rents currently
being charged by the same owner for
comparable unassisted units, and the
portion of rents paid with grant funds
may not exceed HUD-determined fair
market rents. Recipients may use
grant funds in an amount up to one
month's rent to pay the non-recipient
landlord for any damages to leased
units by homeless participants.
[58 FR 13871, Mar. IS, 1993, as amended at 59
FR 36891, July 19, 1994]
~ 583.120 Grants for supportive serv-
ices costs.
(a) General. HUD will provide grants
to pay (as described in 3583.130 of this
part) for the actual costs of supportive
services for homeless persons for up to
five years. All or part of the supportive
services may be provided directly by
the recipient or by arrangement with
public or private service providers.
(b) Supportive services costs. Costs as-
sociated with providing supportive
services include salaries paid to pro-
viders of supportive services and any
other costs directly associated with
providing such services. For a transi-
tional housing project. supportive serv-
ices costs also include the costs of serv-
ices provided to former residents of
transitional housing to assist their ad-
justment to independent living. Such
services may be provided for up to six
months after they leave the transi-
tional housing facility.
[58 FR 13871, Mar. IS, 1993, as amended at 59
FR 36891, July 19, 1994J
~ 583.125 Grants for operating costs.
(a) General. HUD will provide grants
to pay a portion (as described in
3583.130) of the actual operating costs
of supportive housing for up to five
years.
(b) Operating costs. Operating costs
are those associated with the day-to-
day operation of the supportive hous-
ing. They also include the actual ex-
penses that a recipient incurs for con-
ducting on-going assessments of the
supportive services needed by residents
and the availability of such services;
relocation assistance under 3583.310, in-
cluding payments and services; and in-
surance.
~ 583. 140
(c) Recipient match requirement for op-
erating costs. Assistance for operating
costs will be available for up to 75 per-
cent of the total cost in each year of
the grant term. The recipient must pay
the percentage of the actual operating
costs not funded by HUD. At the end of
each operating year, the recipient must
demonstrate that it has met its match
requirement of the costs for that year.
[58 FR 13871, Mar. IS, 1993, as amended at 61
FR 5Il75, Sept. 30, 1996; 65 FR 30823, May 12,
2000J
~ 583.130 Commitment of grant
amounts for leasing, supportive
services, and operating costs.
Upon execution of a grant agreement
covering assistance for leasing, sup-
portive services. or operating costs,
HUD will obligate amounts for a period
not to exceed five operating years. The
total amount obligated will be equal to
an amount necessary for the specified
years of operation. less the recipient's
share of operating costs.
(Approved by the Office of Management and
Budget under OMB control number 2506-0Il2)
(59 FR 36891. July 19, 1994J
~ 583.135 Administrative costs.
(a) General. Up to five percent of any
grant awarded under this part may be
used for the purpose of paying costs of
administering the assistance.
(b) Administrative costs. Administra-
tive costs include the costs associated
with accounting for the use of grant
funds, preparing reports for submission
to HUD. obtaining program audits,
similar costs related to administering
the grant after the award. and staff sal-
aries associated with these administra-
tive costs. They do not include the
costs of carrying out eligible activities
under 33583.105 through 583.125.
[58 FR 13871, Mar. IS, 1993, as amended at 61
FR 51175, Sept. 30, 1996]
~ 583.140 Technical assistance.
(a) General. HUD may set aside funds
annually to provide technical assist-
ance, either directly by HUD staff or
indirectly through third-party pro-
viders, for any supportive housing
project. This technical assistance is for
251
9583.145
the purpose of promoting the develop-
ment of supportive housing and sup-
portive services as part of a continuum
of care approach, including innovative
approaches to assist homeless persons
in the transition from homelessness,
and promoting the provision of sup-
portive housing to homeless persons to
enable them to live as independently as
possible.
(b) Uses of technical assistance. HUD
may use these funds to provide tech-
nical assistance to prospective appli-
cants, applicants, recipients, or other
providers of supportive housing or serv-
ices for homeless persons, for sup-
portive housing projects. The assist-
ance may include, but is not limited to,
written information such as papers,
monographs, manuals, guides, and bro-
chures; person-to-person exchanges;
and training and related costs.
(c) Selection of providers. From time
to time, as HUD determines the need,
HUD may advertise and competitively
select providers to deliver technical as-
sistance. HUD may enter into con-
tracts, grants, or cooperative agree-
ments, when necessary, to implement
the technical assistance.
(59 FR 36892, July 19, 1994J
~ 583.145 Matching requirements.
(a) General. The recipient must
match the funds provided by HUD for
grants for acquisition, rehabilitation,
and new construction with an equal
amount of funds from other sources.
(b) Cash resources. The matching
funds must be cash resources provided
to the project by one or more of the
following: the recipient, the Federal
government, State and local govern-
ments, and private resources.
(c) Maintenance of effort. State or
local government funds used in the
matching contribution are subject to
the maintenance of effort requirements
described at 3583.l50(a).
~ 583.150 Limitations on use of assist-
ance.
(a) Maintenance of effort. No assist-
ance provided under this part (or any
State or local government funds used
to supplement this assistance) may be
used to replace State or local funds
previously used, or designated for use,
to assist homeless persons.
24 CFR Ch. V (4-1-05 Edition)
(b) Faith-based activities. (I) Organiza-
tions that are religious or faith-based
are eligible, on the same basis as any
other organization, to participate in
the Supportive Housing Program. Nei-
ther the Federal government nor a
State or local government receiving
funds under Supportive Housing pro-
grams shall discriminate against an or-
ganization on the basis of the organiza-
tion's religious character or affiliation.
(2) Organizations that are directly
funded under the Supportive Housing
Program may not engage in inherently
religious activities, such as worship,
religious instruction, or proselytiza-
tion as part of the programs or services
funded under this part. If an organiza-
tion conducts such activities, the ac-
tivities must be offered separately, in
time or location, from the programs or
services funded under this part, and
participation must be voluntary for the
beneficiaries of the HUD-funded pro-
grams or services.
(3) A religious organization that par-
ticipates in the Supportive Housing
Program will retain its independence
from Federal, State, and local govern-
ments, and may continue to carry out
its mission, including the definition,
practice, and expression of its religious
beliefs, provided that it does not use di-
rect Supportive Housing Program
funds to support any inherently reli-
gious activities, such as worship, reli-
gious instruction, or proselytization.
Among other things, faith-based orga-
nizations may use space in their facili-
ties to provide Supportive Housing
Program-funded services, without re-
moving religious art, icons, scriptures,
or other religious symbols. In addition,
a Supportive Housing Program-funded
religious organization retains its au-
thority over its internal governance,
and it may retain religious terms in its
organization's name, select its board
members on a religious basis, and in-
clude religious references in its organi-
zation's mission statements and other
governing documents.
(4) An organization that participates
in the Supportive Housing Program
shall not, in providing program assist-
ance, discriminate against a program
beneficiary or prospective program
beneficiary on the basis of religion or
religious belief.
252
Otc. of Asst. Secy., Comm. Planning, Develop., HUD
(5) Program funds may not be used
for the acquisition, construction, or re-
habilitation of structures to the extent
that those structures are used for in-
herently religious activities. Program
funds may be used for the acquisition,
construction, or rehabilitation of
structures only to the extent that
those structures are used for con-
ducting eligible activities under this
part. Where a structure is ~~ed for b?t~
eligible and inherently religIOUS actIvI-
ties, program funds may not exceed ~~e
cost of those portions of the acquIsI-
tion, construction, or rehabilitation
that are attributable to eligible activi-
ties in accordance with the cost ac-
counting requirements applicable ~o
Supportive Housing Program funds m
this part. Sanctuaries, chapels, or
other rooms that a Supportive Housing
Program-funded religious congregati~n
uses as its principal place of worshIp,
however. are ineligible for Supportive
Housing Program-funded improve-
ments. Disposition of real property
after the term of the grant, or any
change in use of the property during
the term of the grant, is subject to gov-
ernment-wide regulations governing
real property disposition (see 24 CFR
parts 84 and 85).
(6) If a State or local government vol-
untarily contributes its own funds to
supplement federally funded activities,
the State or local government has the
option to segregate the Federal.funds
or commingle them. However. If the
funds are commingled. this section ap-
plies to all of the commingled funds.
(c) Participant control of site. Where an
applicant does not propose to have con-
trol of a site or sites but rather pro-
poses to assist a homeless family or .in-
dividual in obtaining a lease. whIch
may include assistance with rent pay-
ments and receiving supportive serv-
ices, after which time the family or in-
dividual remains in the same housing
without further assistance under this
part, that applicant may not request
assistance for acquisition, rehabilita-
tion, or new construction.
[58 FR 13871, Mar. IS, 1993, as amended at 59
FR 36892, July 19. 1993; 68 FR 56407, Sept. 30.
2003J
~583.155
9583.155 Consolidated plan.
(a) Applicants that are States or uni~s
of general local government. The applI-
cant must have a HUD-approved com-
plete or abbreviated consolidated plan,
in accordance with 24 CFR part 91, and
must submit a certification that the
application for funding is consistent
with the HUD-approved consolidated
plan. Funded applicants must certify in
a grant agreement that they are fol-
lowing the HUD-approved consolidated
plan.
(b) Applicants that are not States or
units of general local government. The
applicant must submit a certification
by the jurisdiction in which the pro-
posed project will be located th~t t~e
applicant's application for fundmg IS
consistent with the jurisdiction's HUD-
approved consolidated plan. The cer-
tification must be made by the unit of
general local government or the State,
in accordance with the consistency cer-
tification provisions of the consoli-
dated plan regulations, 24 CFR part 91.
subpart F.
(c) Indian tribes and the Insular Areas
of Guam. the U.S. Virgin Islands. Amer-
ican Samoa. and the Northern Mariana
Islands. These entities are not required
to have a consolidated plan or to make
consolidated plan certifications. An ap-
plication by an Indian tribe or other
applicant for a project that will be lo-
cated on a reservation of an Indian
tribe will not require a certification by
the tribe or the State. However, where
an Indian tribe is the applicant for a
project that will not be located on a
reservation. the requirement for a cer-
tification under paragraph (b) of this
section will apply.
(d) Timing of consolidated plan certifi-
cation submissions. Unless otherwise set
forth in the NOF A, the required certifi-
cation that the application for funding
is consistent with the HUD-approved
consolidated plan must be submitted
by the funding application submission
deadline announced in the NOF A.
[60 FR 16380, Mar. 30, 1995J
253
9583.200
Subpart C-Application and Grant
A ward Process
~ 583.200 Application and grant award.
When funds are made available for
assistance, HUD will publish a notice
of funding availability (NOF A) in the
FEDERAL REGISTER, in accordance with
the requirements of 24 CFR part 4. HUD
will review and screen applications in
accordance with the requirements in
section 426 of the McKinney Act (42
U.S.C. 11386) and the guidelines, rating
criteria, and procedures published in
the NO FA.
[61 FR 51176. Sept. 30. 1996]
~ 583.230 Environmental review.
(a) Activities under this part are sub-
ject to HUD environmental regulations
in part 58 of this title, except that HUD
will perform an environmental review
in accordance with part 50 of this title
prior to its approval of any condi-
tionally selected applications for Fis-
cal Year 2000 and prior years that were
received directly from private non-
profit entities and governmental enti-
ties with special or limited purpose
powers. For activities under a grant
that generally would be subject to re-
view under part 58, HUD may make a
finding in accordance with ~ 58.11 (d) and
may itself perform the environmental
review under the provisions of part 50
of this title if the recipient objects in
writing to the responsible entity's per-
forming the review under part 58. Irre-
spective of whether the responsible en-
tity in accord with part 58 (or HUD in
accord with part 50) performs the envi-
ronmental review, the recipient shall
supply all available, relevant informa-
tion necessary for the responsible enti-
ty (or HUD, if applicable) to perform
for each property any environmental
review required by this part. The re-
cipient also shall carry out mitigating
measures required by the responsible
entity (or HUD, if applicable) or select
alternate eligible property. HUD may
eliminate from consideration any ap-
plication that would require an Envi-
ronmental Impact Statement (EIS).
(b) The recipient, its project partners
and their contractors may not acquire,
rehabilitate. convert, lease, repair, dis-
pose of, demolish or construct property
24 CFR Ch. V (4-1-05 Edition)
for a project under this part, or com-
mit or expend HUD or local funds for
such eligible activities under this part,
until the responsible entity (as defined
in ~ 58.2 of this title) has completed the
environmental review procedures re-
quired by part 58 and the environ-
mental certification and RROF have
been approved or HUD has performed
an environmental review under part 50
and the recipient has received HUD ap-
proval of the property. HUD will not
release grant funds if the recipient or
any other party commits grant funds
(i.e., incurs any costs or expenditures
to be paid or reimbursed with such
funds) before the recipient submits and
HUD approves its RROF (where such
submission is required).
[68 FR 56131. Sept. 29,2003]
~ 583.235 Renewal grants.
(a) General. Grants made under this
part, and grants made under subtitles
C and D (the Supportive Housing Dem-
onstration and SAFAH, respectively) of
the Stewart B. McKinney Homeless As-
sistance Act as in effect before October
28, 1992, may be renewed on a non-
competitive basis to continue ongoing
leasing, operations, and supportive
services for additional years beyond
the initial funding period. To be con-
sidered 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
this part, and must submit requests
within the time period established by
HUD.
(b) Assistance available. The first re-
newal will be for a period of time not
to exceed the difference between the
end of the initial funding period and
ten years from the date of initial occu-
pancy or the date of initial service pro-
vision, 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, sub-
ject to maintenance of effort require-
ments under ~ 583.150(a) may be for:
(1) Up to 50 percent of the actual op-
erating and leasing costs in the final
year of the initial funding period;
(2) Up to the amount of HUD assist-
ance for supportive services in the final
year of the initial funding period; and
254
Otc. ot Asst. Secy., Comm. Planning, Develop., HUD
(3) An allowance for cost increases,
(c) HUD review, (I) HUD will review
the request for renewal and will evalu-
ate the recipient's performance in pre-
vious years against the plans and goals
established in the initial application
for assistance, as amended. HUD will
approve the request for renewal unless
the recipient proposes to serve a popu-
lation that is not homeless, or the re-
cipient has not shown adequate
progress as evidenced by an unaccept-
ably slow expenditure of funds, or the
recipient has been unsuccessful in as-
sisting participants in achieving and
maintaining independent living. In de-
termining the recipient's success in as-
sisting participants to achieve and
maintain independent living, consider-
ation will be given to the level and
type of problems of participants. For
recipients with a poor record of suc-
cess, HUO will also consider the recipi-
ent's willingness to accept technical
assistance and to make changes sug-
gested by technical assistance pro-
viders. Other factors which will affect
HUO's decision to approve a renewal
request include the following: a con-
tinuing history of inadequate financial
management accounting practices, in-
dications of mismanagement on the
part of the recipient, a drastic reduc-
tion in the population served by the re-
cipient, program changes made by the
recipient without prior HUD 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) HUD will notify the recipient in
writing that the request has been ap-
proved or disapproved.
(Approved by the Office of Management and
Budget under control number 2506-0112)
Subpart D-program Requirements
~ 583.300 General operation.
(a) State and local requirements. Each
recipient of assistance under this part
must provide housing or services that
are in compliance with all applicable
State and local housing codes, licens-
ing requirements, and any other re-
S 583.300
quirements in the jurisdiction in which
the project is located regarding the
condition of the structure and the op-
eration of the housing or services.
(b) Habitability standards. Except for
such variations as are proposed by the
recipient and approved by HUO, sup-
portive housing must meet the fol-
lowing requirements:
(1) Structure and materials. The struc-
tures 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 ele-
ments.
(2) Access. The housing must be acces-
sible and capable of being utilized
without unauthorized use of other pri-
vate properties. Structures must pro-
vide 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 be-
longings. Each resident must be pro-
vided an acceptable place to sleep.
(4) Interior air quality. Every room or
space must be provided with natural or
mechanical ventilation. Structures
must be free of pollutants in the air at
levels that threaten the health of resi-
dents.
(5) Water supply. The water supply
must be free from contamination.
(6) Sanitary facillties. Residents must
have access to sufficient sanitary fa-
cilities that are in proper operating
condition, may be used in privacy, and
are adequate for personal cleanliness
and the disposal of human waste.
(7) Thermal environment. The housing
must have adequate heating and/or
cooling facilities in proper operating
condition.
(8) Illumination and electrIcity. The
housing must have adequate natural or
artificial illumination to permit nor-
mal indoor activities and to support
the health and safety of residents. Suf-
ficient electrical sources must be pro-
vided to permit use of essential elec-
trical appliances while assuring safety
from fire.
(9) Food preparation and refuse dis-
posal. All food preparation areas must
contain suitable space and equipment
to store, prepare, and serve food in a
sanitary manner.
255
~ 583.300
(10) Sanitary condition. The housing
and any equipment must be maintained
in sanitary condition.
(11) Fire safety. (i) Each unit must in-
clude at least one battery-operated or
hard-wired smoke detector, in proper
working condition, on each occupied
level of the unit. Smoke detectors
must be located, to the extent prac-
ticable, in a hallway acljacent to a bed-
room. If the unit is occupied by hear-
ing-impaired persons, smoke detectors
must have an alarm system designed
for hearing-impaired persons in each
bedroom occupied by a hearing-im-
paired person.
(il) The public areas of all housing
must be equipped with a sufficient
number, but not less than one for each
area, of battery-operated or hard-wired
smoke detectors. Public areas include,
but are not limited to, laundry rooms,
community rooms, day care centers,
hallways, stairwells, and other com-
mon areas.
(c) Meals. Each recipient of assist-
ance under this part who provides sup-
portive housing for homeless persons
with disabilities must provide meals or
meal preparation facilities for resi-
dents.
(d) Ongoing assessment of supportive
services. Each recipient of assistance
under this part must conduct an ongo-
ing assessment of the supportive serv-
ices required by the residents of the
project and the availability of such
services, and make adjustments as ap-
propriate.
(e) Residential supervision. Each re-
cipient 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 super-
vision may include the employment of
a full- or part-time residential super-
visor with sufficient knowledge to pro-
vide or to supervise the provision of
supportive services to the residents.
(f) Participation of homeless persons. (1)
Each recipient must provide for the
participation of homeless persons as re-
quired in section 426(g) of the McKin-
ney Act (42 U.S.C. 11386(g)). This re-
quirement is waived if an applicant is
unable to meet it and presents a plan
24 CFR Ch. V (4-1-05 Edition)
for HUD approval to otherwise consult
with homeless or formerly homeless
persons in considering and making
policies and decisions. See also
9 583.330(e).
(2) Each recipient of assistance under
this part must, to the maximum extent
practicable, involve homeless individ-
uals and families, through employ-
ment, volunteer services, or otherwise,
in constructing, rehabilitating, main-
taining, and operating the project and
in providing supportive services for the
project.
(g) Records and reports. Each recipient
of assistance under this part must keep
any records and make any reports (in-
cluding those pertaining to race, eth-
nicity, gender, and disability status
data) that HUD may require within the
timeframe required.
(h) Confidentiality. Each recipient
that provides family violence preven-
tion or treatment services must de-
velop and implement procedures to en-
sure:
(1) The confidentiality of records per-
taining to any individual services: and
(2) That the address or location of
any project assisted will not be made
public, except with written authoriza-
tion of the person or persons respon-
sible for the operation of the project.
(i) Termination of housing assistance.
The recipient may terminate assist-
ance to a participant who violates pro-
gram requirements. Recipients should
terminate assistance only in the most
severe cases. Recipients may resume
assistance to a participant whose as-
sistance was previously terminated. In
terminating assistance to a partici-
pant, the recipient must provide a for-
mal 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 decision, in which
the participant is given the oppor-
tunity to present written or oral objec-
tions before a person other than the
person (or a subordinate of that person)
who made or approved the termination
decision; and
(3) Prompt written notice of the final
decision to the participant.
256
Otc. ot Asst. Secy., Comm. Planning, Develop., HUD
(j) Limitation of stay in transitional
housing. A homeless individual or fam-
ily may remain in transitional housing
for a period longer than 24 months, if
permanent housing for the individual
or family has not been located or if the
individual or family requires addi-
tional time to prepare for independent
living. However, HUD may discontinue
assistance for a transitional housing
project if more than half of the home-
less individuals or families remain in
that project longer than 24 months.
(k) Outpatient health services. Out-
patient health services provided by the
recipient must be approved as appro-
priate by HUD and the Department of
Health and Human Services (HHS).
Upon receipt of an application that
proposes the provision of outpatient
health services, HUD will consult with
HHS with respect to the appropriate-
ness of the proposed services.
(I) Annual assurances. Recipients who
receive assistance only for leasing, op-
erating costs or supportive services
costs must provide an annual assur-
ance for each year such assistance is
received that the project will be oper-
ated for the purpose specified in the ap-
plication.
(Approved by the Office of Management and
Budget under control number 2506-0112)
[58 FR 13871, Mar. 15, 1993, as amended at 59
FR 36892, July 19, 1994; 61 FR 51176, Sept. 30,
1996]
~ 583.305 Term of commitment; repay-
ment of grants; prevention of undue
benefits.
(a) Term of commitment and conversion.
Recipients must agree to operate the
housing or provide supportive services
in accordance with this part and with
sections 423 (b) (1) and (b) (3) of the
McKinney Act (42 U.s.C. 11383(b)(l),
11383(b)(3)) .
(b) Repayment of grant and prevention
of undue benefits. In accordance with
section 423(c) of the McKinney Act (42
U.S.C. 11383(c)), HUD will require re-
cipients to repay the grant unless HUD
has authorized conversion of the
project under section 423(b) (3) of the
McKinney Act (42 U.s.e. 1I383(b)(3)).
(61 FR 51176. Sept. 30, 1996J
~583.310
~ 583.310 Displacement, relocation, and
acquisition.
(a) Minimizing displacement. Con-
sistent with the other goals and objec-
tives of this part, recipients must as-
sure that they have taken all reason-
able steps to minimize the displace-
ment of persons (families, individuals,
businesses, nonprofit organizations,
and farms) as a result of supportive
housing assisted under this part.
(b) Relocation assistance for displaced
persons. A displaced person (defined in
paragraph (I) 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 Prop-
erty Acquisition Policies Act of 1970
(URA) (42 U.S.C. 4601-4655) and imple-
menting regulations at 49 CFR part 24.
(c) Real property acquisition require-
ments. The acquisition of real property
for supportive housing is subject to the
URA and the requirements described in
49 CFR part 24, subpart B.
(d) Responsibility of recipient. (I) The
recipient must certify (i.e., provide as-
surance 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 provi-
sions.
(2) The cost of required relocation as-
sistance is an eligible project cost in
the same manner and to the same ex-
tent as other project costs. Such costs
also may be paid for with local public
funds or funds available from other
sources.
(3) The recipient must maintain
records in sufficient detail to dem-
onstrate compliance with provisions of
this section.
(e) Appeals. A person who disagrees
with the recipient's determination con-
cerning whether the person qualifies as
a "displaced person," or the amount of
relocation assistance for which the per-
son is eligible, may file a written ap-
peal of that determination with the re-
cipient. A low-income person who is
dissatisfied with the recipient's deter-
mination on his or her appeal may sub-
mit a written request for review of that
determination to the HUD field office.
257
~583.310
(f) Definition of displaced person. (I)
For purposes of this section, the term
"displaced person" means a person
(family, individual. business, nonprofit
organization, or farm) that moves from
real property, or moves personal prop-
erty from real property permanently as
a direct result of acquisition, rehabili-
tation, or demolition for supportive
housing projects assisted under this
part. The term "displaced person" in-
cludes, but may not be limited to:
(i) A person that moves permanently
from the real property after the prop-
erty 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 re-
location assistance, if the move occurs
on or after the date the recipient sub-
mits to HUO the application or appli-
cation amendment designating the
project site.
(ii) Any person, including a person
who moves before the date described in
paragraph (f)(I)(i) of this section. if the
recipient or HUO determines that the
displacement resulted directly from ac-
quisition. rehabilitation, or demolition
for the assisted project.
(iii) 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 has been
provided written notice offering him or
her the opportunity to lease and oc-
cupy a suitable. decent, safe and sani-
tary dwelling in the same building/
complex. under reasonable terms and
conditions, upon completion of the
project. Such reasonable terms and
conditions must include a 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 esti-
mated average utility costs, or
(B) 30 percent of gross household in-
come. If the initial rent is at or near
the maximum, there must be a reason-
able basis for concluding at the time
the project is initiated that future rent
increases will be modest.
(iv) A tenant of a dwelling who is re-
quired to relocate temporarily, but
24 CFR Ch. V (4-1-05 Edition)
does not return to the building/com-
plex. if either:
(A) A tenant is not offered payment
for all reasonable out-of-pocket ex-
penses incurred in connection with the
temporary relocation, or
(B) Other conditions of the tem-
porary relocation are not reasonable.
(v) A tenant of a dwelling who moves
from the building/complex perma-
nently after he or she has been re-
quired to move to another unit in the
same building/complex. if either:
(A) The tenant is not offered reim-
bursement for all reasonable out-of-
pocket expenses incurred in connection
with the move; or
(B) Other conditions of the move are
not reasonable.
(2) Notwithstanding the provisions of
paragraph (f) (1) of this section, a per-
son does not qualify as a "displaced
person" (and is not eligible for reloca-
tion assistance under the URA or this
section), if:
(i) The person has been evicted for se-
rious or repeated violation of the terms
and conditions of the lease or occu-
pancy agreement, violation of applica-
ble Federal. State, or local or tribal
law. or other good cause. and HUD de-
termines that the eviction was not un-
dertaken for the purpose of evading the
obligation to provide relocation assist-
ance;
(ii) The person moved into the prop-
erty after the submission of the appli-
cation and. before signing a lease and
commencing occupancy. was provided
written notice of the project, its pos-
sible 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 sec-
tion). if the project is approved;
(iii) The person is ineligible under 49
CFR 24.Z(g)(Z); or
(iv) HUO determines that the person
was not displaced as a direct result of
acquisition. rehabilitation. or demoli-
tion for the project.
(3) The recipient may request, at any
time, HUO's determination of whether
a displacement is or would be covered
under this section.
(g) Definition of initiation of negotia-
tions. For purposes of determining the
258
Ole. of Asst. Secy., Comm. Planning, Develop.. HUD
formula for computing the replacement
housing assistance to be provided to a
residential tenant displaced as a direct
result of privately undertaken rehabili-
tation, demolition, or acquisition of
the real property, the term "initiation
of negotiations" means the execution
of the agreement between the recipient
and HUD.
(h) DeflnitJon of project. For purposes
of this section, the term "project"
means an undertaking paid for in
whole or in part with assistance under
this part. Two or more activities that
are integrally related, each essential to
the others, are considered a single
project, whether or not all component
activities receive assistance under this
part.
[58 FR 13871, Mar. 15, 1993, as amended at 59
FR 36892, July 19, 1994J
~ 583.315 Resident rent.
(a) Calculation of resident rent. Each
resident of supportive housing may be
required to pay as rent an amount de-
termined by the recipient which may
not exceed the highest of:
(1) 30 percent of the family's monthly
adjusted income (adjustment factors
include the number of people in the
family, age of family members, medical
expenses and child care expenses). The
calculation of the family's monthly ad-
justed income must include the ex-
pense deductions provided in 24 CFR
5.611(a). and for persons with disabil-
ities, the calculation of the family's
monthly adjusted income also must in-
clude the disallowance of earned in-
come as provided in 24 CFR 5.617, if ap-
plicable;
(2) 10 percent of the family's monthly
gross income; or
(3) If the family is receiving pay-
ments for welfare assistance from a
public agency and a part of the pay-
ments, adjusted in accordance with the
family's actual housing costs, is spe-
cifically designated by the agency to
meet the family's housing costs, the
portion of the payment that is des-
ignated for housing costs.
(b) Use of 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.
9583.320
(c) Fees. In addition to resident rent,
recipients may charge residents rea-
sonable fees for services not paid with
grant funds.
[58 FR 13871, Mar. IS, 1993, as amended at 59
FR 36892, July 19, 1994; 66 FR 6225, Jan. 19,
2001J
~ 583.320 Site control.
(a) Site control. (1) Where grant funds
will be used for acquisition, rehabilita-
tion, or new construction to provide
supportive housing or supportive serv-
ices, or where grant funds will be used
for operating costs of supportive hous-
ing, or where grant funds will be used
to provide supportive services except
where an applicant will provide serv-
ices at sites not operated by the appli-
cant, an applicant must demonstrate
site control before HUD 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 notifica-
tion of the award of assistance under
this part, the grant will be deobligated
as provided in paragraph (c) of this sec-
tion.
(2) Where grant funds will be used to
lease all or part of a structure to pro-
vide supportive housing or supportive
services, or where grant funds will be
used to lease individual housing units
for homeless persons who will eventu-
ally control the units, site control need
not be demonstrated.
(b) Site change. (I) A recipient may
obtain ownership or control of a suit-
able site different from the one speci-
fied 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 acquisition, rehabilitation,
acquisition and rehabilitation, or new
construction costs for the substitute
site are greater than the amount of the
grant awarded for the site specified in
the application, the recipient must pro-
vide for all additional costs. If the re-
cipient is unable to demonstrate to
HUD that it is able to provide for the
difference in costs, HUD may
deobligate the award of assistance.
(c) Failure to obtain site control within
one year. HUD will recapture or
deobligate any award for assistance
under this part if the recipient is not in
259
9583.325
control of a suitable site before the ex-
piration of one year after initial notifi-
cation of an award.
9583.325 Nondiscrimination and equal
opportunity requirements.
(a) General. Notwithstanding the per-
missibility of proposals that serve des-
ignated populations of disabled home-
less persons, recipients serving a des-
ignated population of disabled home-
less persons are required, within the
designated population, to comply with
these requirements for nondiscrimina-
tion on the basis of race, color, reli-
gion, sex, national origin, age, familial
status, and disability.
(b) Nondiscrimination and equal oppor-
tunity requirements. The nondiscrimina-
tion and equal opportunity require-
ments set forth at part 5 of this title
apply to this program. The Indian Civil
Rights Act (25 U.S.C. 1301 et seq.) ap-
plies to tribes when they exercise their
powers of self-government, and to In-
dian housing authorities (IHAs) when
established by the exercise of such
powers. When an IHA is established
under State law, the applicability of
the Indian Civil Rights Act will be de-
termined on a case-by-case basis.
Projects subject to the Indian Civil
Rights Act must be developed and oper-
ated in compliance with its provisions
and all implementing HUD require-
ments, instead of title VI and the Fair
Housing Act and their implementing
regulations.
(c) Procedures. (1) If the procedures
that the recipient intends to use to
make known the availability of the
supportive housing are unlikely to
reach persons of any particular race,
color, religion, sex, age, national ori-
gin, familial status, or handicap who
may qualify for admission to the hous-
ing, the recipient must establish addi-
tional procedures that will ensure that
such persons can obtain information
concerning availability of the housing.
(2) The recipient must adopt proce-
dures to make available information
on the existence and locations of facili-
ties and services that are accessible to
persons with a handicap and maintain
evidence of implementation of the pro-
cedures.
(d) Accessibility requirements. The re-
cipient must comply with the new con-
24 CFR Ch. V (4-1-05 Edition)
struction accessibility requirements of
the Fair Housing Act and section 504 of
the Rehabilitation Act of 1973, and the
reasonable accommodation and reha-
bilitation accessibility requirements of
section 504 as follows:
(1) All new construction must meet
the accessibility requirements of 24
CFR 8.22 and, as applicable, 24 CFR
100.205.
(2) Projects in which costs of reha-
bilitation are 75 percent or more of the
replacement cost of the building must
meet the requirements of 24 CFR
8.23(a). Other rehabilitation must meet
the requirements of 24 CFR 8.23(b).
[58 FR 13871. Mar. IS, 1993, as amended at 59
FR 33894, June 30, 1994: 61 FR 5210. Feb. 9,
1996; 61 FR 51176, Sept. 3D, 1996J
9583.330 Applicability of other Federal
requirements.
In addition to the requirements set
forth in 24 CFR part 5, use of assistance
provided under this part must comply
with the following Federal require-
ments:
(a) Flood insurance. (1) The Flood Dis-
aster Protection Act of 1973 (42 US.C.
4001-4128) prohibits the approval of ap-
plications for assistance for acquisition
or construction (including rehabilita-
tion) for supportive housing located in
an area identified by the Federal Emer-
gency Management Agency (FEMA) as
having special flood hazards, unless:
(i) The community in which the area
is situated is participating in the Na-
tional Flood Insurance Program (see 44
CFR parts 59 through 79), or less than
a year has passed since FEMA notifica-
tion regarding such hazards; and
(ii) Flood insurance is obtained as a
condition of approval of the applica-
tion.
(2) Applicants with supportive hous-
ing located in an area identified by
FEMA as having special flood hazards
and receiving assistance for acquisition
or construction (including rehabilita-
tion) are responsible for assuring that
flood insurance under the National
Flood Insurance Program is obtained
and maintained.
(b) The Coastal Barrier Resources
Act of 1982 (16 U.S.C. 3501 et seq.) may
apply to proposals under this part, de-
pending on the assistance requested.
260
Ofc. of Asst. Secy., Comm. Planning, Develop., HUD
(c) Applicability of OMB Circulars. The
policies, guidelines. and requirements
of OMB Circular No. A-87 (Cost Prin-
ciples Applicable to Grants, Contracts
and Other Agreements with State and
Local Governments) and 24 CFR part 85
apply to the award, acceptance, and
use of assistance under the program by
governmental entities. and OMB Cir-
cular Nos. A-110 (Grants and Coopera-
tive Agreements with Institutions of
Higher Education. Hospitals. and Other
Nonprofit Organizations) and A-I22
(Cost Principles Applicable to Grants,
Contracts and Other Agreements with
Nonprofit Institutions) apply to the ac-
ceptance and use of assistance by pri-
vate nonprofit organizations. except
where inconsistent with the provisions
of the McKinney Act, other Federal
statutes, or this part. (Copies of OMB
Circulars may be obtained from E.O.P.
Publications. room 2200, New Executive
Office Building. Washington. DC 20503.
telephone (202) 395-7332. (This is not a
toll-free number.) There is a limit of
two free copies.
(d) Lead-based paint. The Lead-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 imple-
menting regulations at part 35. sub-
parts A. B, J. K. and R of this title
apply to activities under this program.
(e) Conflicts of interest. (I) In addition
to the conflict of interest requirements
in 24 CFR part 85. no person who is an
employee, agent, consultant. officer, or
elected or appointed official of the re-
cipient and who exercises or has exer-
cised any functions or responsibilities
with respect to assisted activities, or
who is in a position to participate in a
decisionmaking process or gain inside
information with regard to such activi-
ties, may obtain a personal or financial
interest or benefit from the activity, or
have an interest in any contract, sub-
contract, or agreement with respect
thereto, or the proceeds thereunder. ei-
ther 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. Participa-
tion by homeless individuals who also
are participants under the program in
policy or decisionmaking under
S 583.330
9583.300(f) does not constitute a con-
fHct of interest.
(2) Upon the written request of the
recipient, HUD 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 effective and effi-
cient administration of the recipient's
project. An exception may be consid-
ered only after the recipient has pro-
vided the following:
(i) For States and other govern-
mental entities, a disclosure of the na-
ture of the conflict, accompanied by an
assurance that there has been public
disclosure of the conflict and a descrip-
tion of how the public disclosure was
made; and
(il) For all recipients, an opinion of
the recipient's attorney that the inter-
est for which the exception is sought
would not violate State or local law.
(3) In determining whether to grant a
requested exception after the recipient
has satisfactorily met the requirement
of paragraph (e)(2) of this section. HUD
will consider the cumulative effect of
the following factors. where applicable:
(I) Whether the exception would pro-
vide a significant cost benefit or an es-
sential degree of expertise to the
project which would otherwise not be
available;
(il) Whether the person affected is a
member of a group or class of eligible
persons and the exception will permit
such person to receive generally the
same interests or benefits as are being
made available or provided to the
group or class;
(ili) Whether the affected person has
withdrawn from his or her functions or
responsibilities, or the decisionmaking
process with respect to the specific as-
sisted activity in question;
(iv) Whether the interest or benefit
was present before the affected person
was in a position as described in para-
graph (e)(l) of this section;
(v) Whether undue hardship will re-
sult either to the recipient or the per-
son affected when weighed against the
public interest served by avoiding the
prohibited conflict; and
(vi) Any other relevant consider-
ations.
261
9583.400
(I) Audit. The financial management
systems used by recipients under this
program must provide for audits in ac-
cordance with 24 CFR part 44 or part 45,
as applicable. HUD may perform or re-
quire additional audits as it finds nec-
essary or appropriate.
(g) Davis-Bacon Act. The provisions
of the Davis-Bacon Act do not apply to
this program.
[58 FR 13871. Mar. 15, 1993. as amended at 61
FR 5211. Feb. 9, 1996; 64 FR 50226. Sept. 15.
1999J
Subpart E-Administration
~ 583.400 Grant agreement.
(a) General. The duty to provide sup-
portive housing or supportive services
in accordance with the 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 appro-
priate, including repayment of funds
that have already been disbursed to the
recipient.
~ 583.405 Program changes.
(a) HUD approval. (I) A recipient may
not make any significant changes to an
approved program without prior HUD
approval. Significant changes include,
but are not limi ted to, a change in the
recipient, a change in the project site.
additions or deletions in the types of
activities listed in ~ 583.100 of this part
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 partici-
pants to be served. Depending on the
nature of the change, HUD may require
a new certification of consistency with
the consolidated plan (see ~583.155).
(2) Approval for changes is contin-
gent upon the application ranking re-
maining high enough after the ap-
proved change to have been competi-
tively selected for funding in the year
the application was selected.
(b) Documentation of other changes.
Any changes to an approved program
that do not require prior HUD approval
24 CFR Ch. V (4-1-05 Edition)
must be fully documented in the recipi-
ent's records.
[58 FR 13871, Mar. IS: 1993, as amended at 61
FR 51176. Sept. 30, 1996]
~ 583.410 Obligation and deobligation
of funds.
(a) Obligation of funds. When HUD and
the applicant execute a grant agree-
ment, funds are obligated to cover the
amount of the approved assistance
under subpart B of this part. The re-
cipient will be expected to carry out
the supportive housing or supportive
services activities as proposed in the
application.
(b) Increases. After the initial obliga-
tion of funds, HUD will not make revi-
sions to increase the amount obligated.
(c) Deobligation. (I) HUD may
deobligate all or parts of grants for ac-
quisition, rehabilitation, acquisition
and rehabilitation, or new construc-
tion:
(i) If the actual total cost of acquisi-
tion, rehabilitation, acquisition and re-
habilitation, or new construction is
less than the total cost anticipated in
the application; or
(ii) If proposed activities for which
funding was approved are not begun
within three months or residents do
not begin to occupy the facility within
nine months after grant execution.
(2) HUD may deobligate the amounts
for annual leasing costs, operating
costs or supportive services in any
year;
(i) If the actual leasing costs, oper-
ating costs or supportive services for
that year are less than the total cost
anticipated in the application; or
(ii) If the proposed supportive hous-
ing operations are not begun within
three months after the units are avail-
able for occupancy.
(3) The grant agreement may set
forth in detail other circumstances
under which funds may be deobligated,
and other sanctions may be imposed.
(4) HUD may:
(i) Readvertise the availability of
funds that have been deobligated under
this section in a notice of fund avail-
ability under ~583.200, or
(ii) Award deobligated funds to appli-
cations previously submitted in re-
sponse to the most recently published
262
Ote. ot Asst. Seey., Comm. Planning, Develop., HUD
notice of fund availability, and in ac-
cordance with subpart C of this part.
PART 585-YOUTHBUILD PROGRAM
Subpart A-General
Sec.
585.1 Authority.
585.2 Program purpose.
585.3 Program components.
585.4 Definitions.
Subpart B [Reserved]
Subpart C-Youthbuild Planning Grants
585.201 Purpose.
585.202 Award limits.
585.203 Grant term.
585.204 Locatlonal considerations.
585.205 Eligible activities.
Subpart D-Youthbuild Implementation
Grants
585.301 Purpose.
585.302 Award limits.
585.303 Grant term.
585.304 Locatlonal considerations.
585.305 Eligible activities.
585.306 Designation of costs.
585.307 Environmental procedures and
standards.
585.308 Relocation assistance and real prop-
ertyacqulsltlon.
585.309 Project-related restrictions applica-
ble to Y outhbuild residential rental
housing.
585.310 Project-related restrictions applica-
ble to Youthbuild transitional housing
for the homeless.
585.311 Project-related restrictions applica-
ble to Youthbuild homeownership hous-
ing.
585.312 Wages, labor standards, and non-
discrimination.
585.313 Labor standards.
Subpart E-Administration
585.401 Recordkeeping by recipients.
585.402 Grant agreement.
585.403 Reporting requirements.
585.404 Program changes.
585.405 Obligation and deobligatlon of funds.
585.406 Faith-based activities.
Subpart F-Applicability of Other Federal
Requirements
585.501 Application of OMS Circulars.
585.502 Certifications.
585.503 Conflict of interest.
585.504 Use of debarred, suspended, or ineli-
gible contractors.
AUTHORITY: 42 U.S.C. 3535(d) and 8011.
9 585.3
SOURCE: 60 FR 9737. Feb. 21. 1995. unless
otherwise noted.
Subpart A-General
* 585.1 Authority.
(a) General. The Youth build program
is authorized under subtitle D of title
IV of the National Affordable Housing
Act (42 U.S.C. 80ll), as added by section
164 of the Housing and Community De-
velopment Act of 1992 (Pub. L. 102-550).
(b) Authority restriction. No provision
of the Youthbuild program may be con-
strued to authorize any agency, officer,
or employee of the United States to ex-
ercise any direction, supervision, or
control over the curriculum, program
of instruction. administration, or per-
sonnel of any educational institution,
school, or school system, or over the
selection of library resources, text-
books. or other printed or published in-
structional materials used by any edu-
cational institution or school system
participating in a Youthbuild program.
* 585.2 Program purpose.
The purposes of the Youthbuild pro-
gram are set out in section 451 of the
National Affordable Housing Act (42
USC. 12899) ("NAHA").
[61 FR 52187, Oct. 4, 1996J
* 585.3 Program components.
A Youthbuild implementation pro-
gram uses comprehensive and multi-
disciplinary approaches designed to
prepare young adults who have dropped
out of high school for educational and
employment opportunities by employ-
ing them as construction trainees on
work sites for housing designated for
homeless persons and low- and very
low-income families. A Youthbuild
planning grant is designed to give re-
cipients sufficient time and financial
resources to develop a comprehensive
Youthbuild program that can be effec-
tively implemented. Youthbuild pro-
grams must contain the three compo-
nents described in paragraphs (a), (b)
and (d) of this section. Other activities
described in paragraph (c) of this sec-
tion are optional:
(a) Educational services, including:
(1) Services and activities designed to
meet the basic educational needs of
263
GRANT NUMBER: FL14B500030
City of Miami Beach's Outreach Program! Page 24 of23
ATTACHMENT A-I
CITY OF MIAMI BEACH
HOMELESS ASSISTANCE PROGRAM FOR
OUTRREACH ASSESSMENRT AND PLACEMENT SERVICES
SCOPE OF SERVICES
The Subrecipient agrees to provide outreach, assessment and placement services to homeless persons,
comprised of 5,471 contacts, 2,735 assessments, and 355 placements into housing during the term ofthe
grant. The Subrecipient will conduct street outreach as well as respond to service requests. The
Subrecipient ,viII work closely with service providers in the continuum of care to identify appropriate
housing/services for homeless persons assisted through outreach. The grant term is one (1) year.
The Subrecipient shall provide services as proposed in the application to U.S. HUD pursuant to the 2005
Super NOF A (incorporated herein by reference), including but not limited to:
1. Assessment;
2. Referral and placement into housing/services programs as may be necessary;
3. Follow-up;
4. Transportation services
Conditions:
1. Reimbursement shall be limited to operations, supportive services, leasing, administration, and the
costs associated with these activities as described in the Subrecipient's application;
2. Reimbursement shall be made only for the cost incurred for operations, administration, and
supportive services actually provided to clients, unless the Grantee agrees, in writing, to another
mode of payment, as provided for in this Agreement;
3. Monthly progress reports and program narratives signed by the Executive Director
of the Subrecipient's agency shall be submitted by the Sub recipient, as required;
4. The Subrecipient will accommodate clients referred by the Grantee
or its designee for housing and/or services through the Grantee's established referral
process;
5. Services shall be provided in accordance with the tinleline submitted by the Subrecipient;
6. Any proposed modifications or revisions to the Subrecipient's program and/or services
must be submitted in writing and must receive prior approval by the Grantee; and
7. The Provider will achieve the performance measures delineated in their application to U.S. HUD.
Jul 11 06 12'17p
Communit~ Services
ATTACHMENT A-3
L-V
City of Miami Beach
Office of Community Services
C. Program Goals (Project Summary)
J
Goal J: Outreach and inform about program
5471 Contacts per year
lyfeasuremenr rool: count number of contacts on daily contact sheet, case note contacr
sheer and intake form.
Goal 2: Assess and confront problems
50% of contacted will be assessed/served per year
lyfeasurement rool: count number of intakes/assessments per moruh.
Goal 3: Shelter Placements
355 placements per year (new placements)
20% placements for persons with disabilities (71)
7% placements for families with children (25)
9% placements for children in families (32)
9% placements of adults in families (32)
i\1easurement tool: count number of placements broken dmtil1/or persons vt:ith
disabilities. families .with/wirhout children and single homeless individuals per month.
Approval No. 2506-0112 (exp. 8/31/2006)
HUD-40076-2
A IT ACHMENT A-4
PROJECT MILESTONES
N/A
FOR THIS PROJECT
ATTACHMENT B
I jU,)-..) I J-l "-tJU J ....JV-,
miamidade.gov
ADA Coor-dln;JIIOn
Agenda CoordlnJtion
AnimalSt'rvlces
Art in Public Places
Audit Jnd Management Services
AViation
Building
Building Code Compliance
August 4, 2006
Business Development
Copi!'11 Improvements
C,tizens' Independent TranspMation Trust Marlene Kocher, Senior Representative
Commission on Ethics and Publ,cTrust Community Planning and Development Division
Communications United States Department of Housing and Urban Development
Community Action Agency 909 SE First Avenue, Suite 500
Community & Economic Development Miami, FL 33131
Community Relations
Consumer Services
RE: City of Miami Beach's Outreach Program/FL 148500030
Corrections & RchabilitJlion
Cultural Affairs
Ejections
Dear Ms. Kocher:
Emergency Management
Employee Relations Enclosed, please find for your review, completed Technical Submission exhibits for
Empowerment Trust the above referenced City of Miami Beach grant.
Enterprise Technology' Ser\/iccs
Environmental Resou'ces Management Please feel free to contact us if you have questions or require additional
Fa" Employment Practices information.
Finance
Fire Rescue
Sincerely, .
General Services Admincstrat,on . ~/ ~ ::1
Homeless Trust . / /v:V 7.tvJp.ufJ
\ "tY ,",". f--'. t:~
Housing A~E'ncy
Housing Finance Auth~~/David ~aym.ond
Htlma:)':;;'7iCf't Executive DIrector
Independent Re~leV'v1~nel
International Trade Consoriium C: Enclosure
Juvenile Services
Medical Examiner
Melr{J-r\~ic1mi Action Plan
Metropolitan Planning Organization
P,Jrk dnd Recreation
PI,lnnlng dm! lOlling
Police
Procurement M,lnilgcment
Property Appr,}isal
f1ublic LllJrMr' SVQf'11l
Puhllc v\!o[-ks
S,l(f' Nelghhorhood F',lrks
SC,lpOrl
Soiid \-\IJst(' ,\.1.)lltlgenlC'nt
Slritleglc 8uslnc~s lVidn,lgf'rIlcnt
It'drll i\1clro
TrelliSI!
lask Fur((' on Ur-btlTi f:cononll(; !\e"'ll.lli;;,ltlfHl
\/12:(,W,l Museum ,And C,ncivrb
\,V,lter- l\. Sewer
~~~~~~~~~~~~~~~~~~~~~~~
filool . OD ~~~~~001 oO~~~DOI!$!DOI~~~~~~~~~; DO'~~
~ Technical Submission tii@
~ For the 2005 ~
~ Supportive Housing Program ~
~ ~
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U.S. Department of Housing and Urban Development
@ Office of Community Planning and Development
Project Sponsor:
@
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City of Miami Beach
Project Name:
Outreach
Supportive Services Only (SSO)
Project Number:
FL14B500030
Submitted by Selectee:
Miami-Dade County Homeless Trust
111 Northwest First Street, 27th Floor, Suite 310
Miami, Florida 33128
Telephone Number:
Fax Number:
(305) 375-1490
(305) 375-2722
~
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El~ II;!JiIIJ ifii1Ej CftllDJ ~ t.-i02J [~J ~~III~ ::IOIOOII~1 ~ ~Dol ~.~ ti~1ft~i'i~ ~DDI~ ij~IW~ ffii:iDJ ~~
u.s. Department of Housing and Urban Development
Office of Community Planning and Development
OMB Approval No. 2506-0] 12 (exp. 8/3] /2006)
2005 Technical Submission
for the
Supportive Housing Program
To be completed by conditionally selected grantees
7
Technical
Submission
Project Number: FL14B500030
Project Identifier
(RENEWALS ONLY)
Recipient's Name: City of Miami Beach
HUD Project Number: FL 148500030
Check the program component/type that classifies your project:
D Transitional Housing (TH)
D Penmnent Housing for Homeless Persons with Disabilities (PH)
~ Supportive Services Only (SSO)
D Safe Haven/Transitional Housing (SH/TH) - Characteristics ofTH/participant not requit-ed to execute a lease
D Safe Haven/Pel1l1anent Housing (S I-l/PH) - Characteristics of PH/panicipant required to execute a lease
D Homeless Management Information System (HMIS)
D Innovative SUPP0l1ive Housing (ISH)
Table Of Contents
(Enter the page number for each Exhibit in the space provided below.)
8/9/20 Exhibit 1: Project Summary
Exhibit 2 Real Property Leasing, SuppOliive Services, HMIS and Operating
Budget
Certification:
Name & Title of the Person who can answer questions about this document:
Maria L. Ruiz f Division Director
Phone (include area code):
305-673-7491
Address:
1700 Convention Center Drive
Miami Beach, FL 33139
I hereby certify that all the information stated herein is true and accurate.
Warning: HUD wil1 prosecute false claims and statements. Conviction may result in criminal and/or civil penalties.
(IS USe. 1001, ]010,1012; 31 USe. 3729, 3802)
Name & Title of Authorized Official: Signature & Date:
Jorge M. Gonzalez, City Manager
"
\\
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,
I
/
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, /
.-.. /".........~
:j/-.--"
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/
)
Approval No. 2506-0112 (cxp. 8/31/2006)
dt.:n)::W076-2
9
(cont. )
Project Number: FL14B500030
Project Identifier
Exhibit 1: Project Summary
(RENEWALS ONLY)
Technical
Submission
C. Program Goals - The goals for SHP are to help program participants (a) obtain and remain in pemlanent
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 perfonnance measures. Perfonnance measures have
three major components. First, they must relate to the outcomes (e.g., the program participant wi]] 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. please describe the
performance measures that wi]] be used for each of the SHP goals and how success in meeting each of the goals
will be measured. Please include both housing and services in your discussion. At least one performance
measure for the skills/income goal must address accessing mainstream health and human service
programs. You will be repOJiing on your success in meeting the performance measures in your Annual
Progress RepOJi.
Examples of perf om lance 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 when exiting the program.
Goal: Increase skills and 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.
~ For Program Goals see page 20 hereafter.
D. Number of Beds, Participants and Supportive Services - These charts need to be included only if
they were incomplete, inaccurate or blank at the time of the original application submission. Please complete
these charts if your local HUD field office has notified you that they are required. Submit only those that apply.
The charts can be found on page] 7 of the New Projects Section ofthe Technical Submission.
Approval No. 2506-0112 (exp. 8/3]/2(06)
J-JUD-40076-2
8
Technical
Submission
Project Number: FL14B500030
Project Identifier
Exhibit 1: Project Summary
( cont.) (RENEWALS ONLY)
A. Selectee, and Sponsor Information - Fill in the infonnation requested below. For HMIS projects fill in
the HMIS Lead. When the selectee is the same organization as the project sponsor, complete only the selectee
infonl1ation.
Selectee Name Miami-Dade Homeless Trust Sponsor Name City of Miami Beach
Contact Person David Raymond Contact Person Maria L. Ruiz
Phone 305-375-1490 Phone 305-673-7491
FAX Number 305-372-6009 FAX Number 305-604-2421
E-Mai] Address dray~miamidade.gov E-Mail Address mariaru iz@miam ibeachfl.~ov
Street Address 111 NW 1st Street, 27th Floor Street Address 1700 Convention Center Drive
City, State, Zip Miami, FL 33128 City, State, Zip Miami Beach, FL 33139
HMIS Lead Barbara Golphin Contact Person Barbara Golphin
305-375-1490 111 NW 1st Street, 27m Floor Phone 305-375-1490
City, State, Zip Miami, FL 33128 E-Mail Address Rma1 (ci)miamidade.aov
B. Project Budget - This section must be completed by all renewal selectees.
1. Chart 1 - Summary Project Budget
To complete Chart 1, Summary Project Budget, enter the amount of SHP funds requested by line-item in
the first column. For leasing, sUPP0l1ive services, operations, and HMIS, the amount entered should be for
the SI-IP grant tem1 selected. In the second column, enter the amount of other cash that will be contributed
to the project. This amount plus the SHP request must equal the total budget amount for the project. Note
that match requirements for supportive services, operating costs and HMIS apply to renewal projects. The
amounts you enter are for all structures in your project. Each line item amount in this chart should match
the amounts shown in your original application as approved or Exhibits 3. 4, 5 and 6.
Requested grant term (1,2, or3 yea.-s): 1 year
Chart] - Summary Pro'ect Bud<Jct
SHP
Request
Applicant
Cash
Total
Project
Budget
]. Real Property Leasing
2 Su p011ive Services*
3. Operations**
4. HMIS*
5. SHP Request (subtotal lines 1 thru 4)
6. Administration*** (up to 5% of line 5)
7. Total SHP Request (total lines 5 and 6)
$60,946
$432,249
$493,195
$3.047
$63,993
$0
$432.249
$3,047
$496.242
*By law, Sill' can pay no more than 80(~'0 of the total supportive services or total HMIS budget.
* * By law, SJ II' can P~lY no more than 75% of the total operating budget.
***13y law, SIlP can pay no more than 5'>0 of the LOlal Sill' request.
Approval No. 2506-01l2 (exp. 8/31/2006)
HUD-40076-2
Jul 11 06 12:17p
Communit~ Services
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20
City of Miami Beach
Office of Comm unity Services
I
C. Program Goals (Project Summary)
-~
Goall:
Outreach and inform about program
5471 Contacts per year
A1easurcmenf rool: COLlnt number of conlaelS 011 daily contact sheet, case note contact
sheel Clnd inlake (orm.
Goal 2: Assess and confront problems
50% of contacted will be assessed/served per year
A1easurement lool: count number a/intakes/assessments per manrh.
Goal3:
Shelter Placements
355 placements per year (new placements)
20% placements for persons \\lith disabilities (71)
7% placements for families with children (25)
9% placements for children in families (32)
9% placements of adults in families (32)
1\1easurement tool: count number o[placemenrs broken down/or persons vl'ith
disabilities, families vvilh/withouf children and single homeless individuals per month.
Appro,,;]! No. 2506-0112 (exp. 8/31/~006)
HUD-40076-2
Jul 1106 12:17p
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21
City of Miami Beach
Office of Community Services
I
B. Job Descriptions (Supportive Services)
Division Director (Office of Child Development Director) (0.2): non-grant-fundcd (Leverage)
The Division Director oversees the Office of Community Services/Holl1eless Outreach including, but net limited to
the following: budget preparation, staff screening and hiring, preparation of reports and public communications.
Time allocated to Homeless Outreach: 2S %
Program Courdinator (Homeless Program Coordinator) (1): nOll-grant -funded (Cash l\1atch)
The Program Coordinator oversees day-to-day operations ofthe Homeless Outreach Unit including, but not limtted
to the fo Ilowing: scheduling of outreach missions, commun ications with shelter providers, review of all client
intakes, assist with cl ient intakes and placements, and preparation of rep01ts.
Time allocated to Homeless Outreach: 100 %
Outreach Worker/Intake Worker (Case \Varker) (4.25): partially grant-funded are 2.25 workers
The Outreach/lntake Worker conducts outreach missions, completes client intakes forms. and transports client to
appropriate shelter providers.
Case Manager/Intake Speci:llist (Case Worker) (1.2): non-grant funded (Cash Match)
The Case Manager/Jntake Specialist assists with client intakes, reviews client intakes to ensure proper completion
and assists with the assessment and referral for client services. He/she also assists wit the preparation ofrepons.
Total Staffing: 6.65
Approval l','o. 2506-0112 (exp. 8/31/2006)
HUD-400iG-2
10
Project Number: FL14B500030
Project Identifier
Exhibit 2: Real Properiy Leasing, SuppOliive
Services, Operations and HM1S
(RENEWALS ONLY)
This exhibit covers Real Propelty Leasing, SuppOltive Services, Operations, HMIS as it pertains to Site
Control, Match Documentation and other applicable Certifications. Please refer to the narrative under
the New Projects Section of the Technical Submission for a more detailed explanation of each of the
exhibits Other sections in this exhibit may need to be completed if required by your local HUD Field
Office.
Technical
Submission
ALL RENEWAL GRA:\TEESfPRO,fECT SPONSORS MUST COMPLETE SITE CONTROL. \lA TCH DOCUMENTATION AND
.lOB AND ADMINISTRATION CERTIFICA TIONS.
If you are required to resubmit or complete real propeIty leasing, suppOltive services, operations or
HMIS, pull the chalts from the pages of the New Proiects Section of this technical submission that apply.
For leasing use pages 21-24, sUPPOltive services pages 25-28, operations pages 29-32 and HMIS pages
33-36 of the New Proiects Section. You do not have to complete the leveraging and administration
exhibits for renewals.
A. Site Control
Check the appropriate box(es)
Leasing 0
SuppOliive Services L8J
Operations 0
A project sponsor requesting renewal funding for an existing SHP project must complete the celtification
below. No other site documentation is required for renewal projects.
As a recipient of SHP funds, the City of Miami Beach (sponsor organization) celiifies that it cumntly
has an executed lease agreement, or a deed or other proof of ownership for the propcrty(ies) in use to house
and/or provide services to homeless persons under HUD's existing grant number. In addition, sponsor
organizations using SHP funds for leasing activities fUliher celiify that the (proiect sponsor, the conditional
grantee. or their parent organizations -fill in the appropriate one-) do not own these leased site(s). This
includes organizations that are members of a general paIinership where the general partnership owns the
structure(s), both panies are pans of the same govemmental unit or the governmental unit creates an
authority or similar entity to acquire and lease the facilities to the governmental unit and other paliies, and
no operating grant funds will be used for the payment of utilities, maintenance and repairs, or management
fees associated with the site(s), under HUD' s existing grant number FL-14B500030.
~
Signature of authorized representative 4i:'.'.::....;-
Name: Jorge M. Gonzalez I c/ I
---- I
Title: City Manager Date':
I
/l.
---I.'~":~.
~_.__.--/ '"
'..,--_.)
i
i ,t/ i"~'" (-,.;(-1-
_. I ' I I ! {.0 '.....
I
Approval No. 2506-0112 (exp. 8/31/2006)
HlJD-40076-2
1 1
Technical
Submission
Project Number: FL14B500030
Project Identifier
Exhibit 2: Real Property Leasing, Supportive
Services, Operations and HMIS
(RENEW ALS ONLY)
B. Documentation of Match for Year 1
SUppo11ive Services [XI
Operations D
HMIS D
A selectee must currently have fim1 commitments for its cash resources for Year 1 for supportive services,
operating costs and HMIS and must submit documentation of those resources as an attachment to this Exhibit.
These finn commitments must be documented on letterhead stationery, signed and dated by an authorized
representative, and attached to this Exhibit. Each letter must, at a minimum, contain the following elements:
I. The name of the organization providing the cash resource;
2. The amount;
3. The type of activity for which the funds will be used (e.g., case management, child care, education);
4. The name of the project sponsor organization to which the cash will be contributed and/or the name of the
project; and
5. The date the funds will be available.
C. Certification of Match for Year 2 and Year 3, if applicable (A1ark all that apply)
Supportive Services D
Operations D
HMIS D
The following ce11ification must be completed for Year 2, and Year 3 ifapplicable, of your grant tenTI to certify
that non-SlIP cash resources will be used to meet your supportive services, operations and HMIS match
requirement in each of these years.
The amount specified in this certification for supportive services must match the amount shown on line 4 ofthe
SUpp011ive Services Chart submitted with your original application OR Line 11 of the SUpp011ive Services
Budget from Exhibit 4 of the New Proiects Section. No other documentation regarding the supportive services
match requirement for Year 2 and Year 3 of your grant tel1l1 is required at this time. However, match
commitment for Years 2 and 3 wiJl be identified at time of submission of Annual Progress Rep01is for those
years.
The amount specified in tbis certification for operations costs must match the amount shown on line 11 of the
Operations Cost Chart submitted with your original application OR Line 13 of the Operations Budget from
Exhibit 5 of the New Project Section. No other documentation regarding the operations match requirement for
Year 2 and Year 3 of your grant teml is required at this time. Hovvever, match commitment for Years 2 and 3
will be identified at time of submission of Annual Progress Rep011s for those years.
The amount specified in this ceJ1ifitation for HMIS must match the amount shown on the "Selectee's Match" on
the last line ofthe HMIS Chat1 submitted with your original application OR the last line of the HMIS Budget
from Exhibit 6 of the New Projects Section. No other documentation regarding the HMIS match requirement
for Year 2 and Year 3 of your grant te1111 is required at this time. However, match commitment for Years 2 and 3
will be identified at time of submission of Annual Progress Reports for those years.
Appmval No. 2506-0112 (exp. 8/3112006)
HUD-40076-2
12
Project Number: FL14B500030
Project Identifier
Exhibit 2. Real Property Leasing, Supportive
Services, Operations and HMIS
(RENEWALS ONLY)
Technical
Submission
C. Match Certification (continued)
The City of Miami Beach (selectee organization) certifies that it will provide cash resources in the
amount of $432.249 from non-SHP funding sources for Y ear(s) 1 of this grant tenn to be used to
provide HM! S, services and/or for operating costs of housing for homeless persons under HUD' s grant
number FL14B500030
Signature of authorized representative: (J{iV-C~-
NaJ1le:Jor~e M. Gonzalez / I c.)
. . i: I
TItle: City Manaqer "
I {
, . . i.
Date: '-I r 7 ! zr::"C'JC;.
!
D. Job Description Certification
I
l. ~~,
\
, l
'_/'
. ----.:.....,
/ -."
( \
'-...............__J
The C jty of Miami Beach (selectee organization) certifies that the job responsibilities of each position
as it relates to the project have not changed since the previous technical submission. !fthe position or
responsibilities have changed, submit a new position description for the new or added position.
Signature of authorized representative: q!Jj'-' ~-
Name:Jor~e M. Gonzalez c/ L.)
Title:
Date:
City Manaqer
[r f II' hue '..,?
E. Administration Certification
,/
Il "-~x"--,,~/
// "\ ""./..............
\.._~/ i.. ')
----,-
The City of Miami Beach (selectee organization) certifies that funds are being used for eligible
administrative costs. If the Distribution of Funds is not the same, a new/revised plan is submitted.
'\
Signature of authorized representative: :t~~'<-.
Name:Jor~e M. Gonzalez / /
Title: City Manaqer
. I
Date: ": f " i}(,,"~
Approval No. 2506-0112 (exp. 8/31/2006)
,,,r
,/\/-........,,.<"~~-:'"........
.' j l \,
\.'".,.r \ 'i
HUD-400i6-2
13
Technical
Project Number: FL14B.
.500030
Submission
Project Identifier
Exhibit 4: Supportive Services
(all projects requesting service funds)
Supportive services are designed to address the special needs of the homeless persons to be served by the project.
Services may be provided directly by the project sponsor and/or through alTangement with public or private service
providers, including the selectee. SHP supportive service funds may be used to pay for the actual costs of supp0l1ive
services and other costs directly associated with providing such services (see Sl-IP rule at Section 583. I 20).
In Fiscal Year 2005, new projects (with the exception of Dedicated HIVIIS projects) can only apply for 3 years
of funding.
By law, SHP funds may be used to pay for up to 80% of the total sUPP0l1ive services budget for each year of the
grant tenn. This means that the selectee must make a cash payment for 20% of the project's total supportive services
budget annually. For Year 1 of your grant term, documentation of fiJlll commitments of the cash resources must be
submitted as an attachment to this Exhibit. The fonn and content requirements of these commitments are explained
in Section D of this Exhibit. For Years 2 and 3, a selectee needs only to certify that cash resources will be provided
using the certification in Section E of this Exhibit. This certification must be completed and submitted as an
attachment to this Exhibit. Please note that, although selectees are not required to have the firm commitment
for the cash resources for Year 2 and Year 3 at this time, the match requirement for Year 2 and Year 3 must
be met by the end of each of those years.
Approval No. 2506-0112 (exp. 8/31/2006)
HlID-40076-2
.Jul 11 06 12: 17p
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1022 _ OFFICE OF CHILD DEVELOPMENT DIRECTOR
NATURE OF \VORK
This is intense specialized detailed work ""hich entails the planning and coordinating ofOfTice of
Children's Affairs (OCA) sub-committees of interested citizens of the City of Miami Beach and
implementation of the ideas and activities generated by then).
ILLUS1RA.TIVE EXAMPLES OF ESSENTIAL DUTIES
Attends community meetings; meets with individual committee members.
Calls local, county, sWte, federal, or national agencies to obt:'lin infomlation 011 children's services.
Meets \vith general committee of the Office of Children's Aftairs; meets with OCAs subcommittees;
meets v,'itn the Mayor and Commissioners and their aid; meets with interofllce department heads to
obtain or provide infomlation on children's issues.
Schedules commitiee ~md subcommittee meetings; advertises publicly for meetings; sends out notices to
all committee members; photocopies packets to present to the comminee members; types minutes of
meetings.
Provides training locally.
Prepares reports and work plan; submits budget; prepares and write grants.
Gives presentations to local and national groups and/or conferences, workshops, symposiums, focus
groups; supervises students.
Submits written evaluation.
Attends community social functions.
Performs related work as required.
KNO\VLEDGE, SKILLS AND ABILITIES
Ability to exercise judgement and discretion in devising, installing and/or interpreting City rules,
regulations, policies or procedures.
Ability to establish and maintain effective working relationships with other employees. supervisors,
department officials, oAlcials of other agencies, and the general public.
Ability to carry out complex verbal and written instructions.
Ability to express ideas and infom1ation clearly and concisely, both verbally and in writing.
Ability to discem and extract pertinent facts from verbal and written guidelines, policies and procedures,
and apply these to a variety of problems.
MINIMUM REQUIREMENTS
Bachelor's Degree plus considerable experience in human services, or related field. Experience can
substitute for education on 3. year-for-year basis.
.Jul 1106 12:17p
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1022 _ OFFICE OF CHILD DEVELOPl\lENT DIRECTOR
PHYSICAL REQUD{E]\lENTS
f\1ust have the use of sensory skills in order to effectively commLmicate and interact with other
employees and the public through the use of the telephone and personal contact. Physical capability to
effectively use and operate various items of office related equipment, such as, but not limited to, \\!ord
processor, calculator, copier, and fa\': machine. No significant standing, walking, moving, climbing,
canying, bending, kneeling, crawling, reaching, and handling, sitting, standing, pushing, and pulling.
SUPERVISION RECEIVED
General and specific assignments are received [yom the City Manager; work is performed with little
direct supervision and with latitude for use of independent judgement in the selection of work methods
and procedures. Work is subject to review for compliance with departmental objectives and standards.
SUPER V1SION EXERCISED
Supervision of depaliment staff and volunteers.
Rev. 11/98
2.
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1048 - HOMELESS PROGRAl\l COORDINATOR
NATURE OF \'lORK
This is field and administrative work involving the day to day operations of homeless
programs, including, but not limited to, \vork coordinating the referral of homeless
individuals and families to appropriate service providers, and establishing and
maintaining cooperative relationships with community groups and service delivery
agencIes.
ILLUSTRA TIYE EXAMPLES OF ESSENTIAL DUTIES
Works closely with the Miami Beach Police Department and the Community/Economic
Development Department in the implementation of all aspects of homeless programs.
Develops a tracking system for clients/services and the necessary referral and internal
fom1s,
Responsible for the collection and preparation of data for daily situation reports, recurrent
progress and evaluation reports, and monthly activities report to the Miami Beach Police
Department the Commun ity/Economic Development Department, and others in the
community.
Performs related work as required.
Coordinates bed availability with intake provided by police officers.
Establishes a system of reservations and admissions for Miami Beach homeless clients
for beds funded through the Miami-Dade Homeless Trust.
Establishes a standardized client information, referral and tracking system modeled after
that used by the City of Miami, and fully compatible with the system under development
by the Homeless Trust.
Participates in Miami- Dade Homeless Trust Providers' Forum activities.
Performs field activities with police officers, which may involve late-night/early morning
and weekend sh i ft duties.
Has direct client contact and collaboration with service providers.
Performs administrative support for Office of Homeless Programs, to include assistance
facilitating Homeless Committee meetings, provider meetings, and task force meetings.
KNOWLEDGE, SKiLLS A1'\l) ABILITIES
Knowledge of community services available for the homeless.
Knowledge of the special needs of the homeless population.
Ability to express ideas and information clearly and concisely, both verbally and Ir1
writing,
Ability to collect and organize data, and prepare reporis,
Familiarity with affordable housing and homeless issues as well as with systems of
service delivery:
Ability to analyze, strategize, and implement problem- solving solutions to service
delivery issues;
Experience \vorking with an advisory committee, task force, or work team:
Ability to write and present information clearly:
Jul 11 OS 12: 18p
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1048 _ HOMELESS PROGRAM COORDL~A TOR
l\IINB1lJM REQUIREMENTS
Bachelor's Degree plus experience in the delivery of socia! services or related field,
Experience may substitute for education on a year-far-year basis. Bilingual skills are
considered an asset.
PHYSICAL REQUIREMENTS
Must have the use of sensory skills in order to effectively communicate and interact with
homeless individuals, other employees and the pub lie through personal contact and the
use of the telephone. Physical capability to effectively use and operate various items of
office related equipment, such as, but not limited to, word processor, calculator, copier,
and fax machine, No significant stan:ling, \valking, moving, climbing, carrying,
kneeling, crawling, reaching, and handling, sining, standing, pushing and pulling.
SUPERVISION RECEIVED
General assignments are received from the Miami Beach Police Department and the
CDBG Projects Coordinator. Work is performed with considerable latitude for use of
independent judgement and is reviewed through periodic conferences and review of
reports, Work is subject to review for compliance with departmental objectives and
standards,
SUPEVISION EXERCISED
Volunteer workers and assigned clerical staff.
Created 7/0]
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1021 - CASE WORKER
(Commission Approval Pending)
NA TURE OF WORK
Responsible, supervisory, clerical or technical work of a specialized nature involving coordinating refcITal
services to individuals and families requiring assistance of social service agencies. Work involves the
perfomlancc of a variety of non- hazardous/non-enforcement field work and office duties. Incumbent
exercises independent judgement in evaluating intonnation and initiating program action, preparing CDmplete
case records within the general framework of good casework techniques, existing Jaws and departmental
and program rules and practices. Work is performed under the supervision of the Department Director
who reviews ,vork for adherence to standards ofthe program requirements. through personal conferences
and analysis of case records and who provides direction in resolving problems resulting from conflicting
philosophies, novel cases, or involving potential danger to c1ient(s) anclJor the facility.
ILLUSTRATIVE EX~l\1PLES OF ESSENTIAL DUTIES
Interviews clients with problems such as personal and family adjustments, school attendance finances,
employment, food, clothing, housing, and physical needs to detennine nature and degree of problem.
Confers with principals and teachers regarding clients.
VisiLs families of clients to resolve truancy problems and makes referral to applicable agency.
Helps client to modify attitudes and patterns of behavior by referral to social agency as necessary.
Refers clients to community resources and other organizations.
Perfonns job search activities and provides job referral oPPOltunities.
Coordinates and organizes community outreach workshops for clients.
Attends staff meetings, workshops, conferences and parents meetings
Compiles records and prepares reports.
Reviews service plans and perfonns follow-up to detemline quantity and quality of service provided client
and status of client=s case.
Accesses and records client and community resource infonnation.
Secures supplementary infonnation such as employment, medical records, or school reports.
Perfomls related vmrk as required.
Kj'\/OWLEDGE, SKILLS AND ABILITIES
Knowledge of social casework theory and practice.
KnO\vledge of interviewing and counseling techniques.
Knowledge of community health, welfare, and other resources.
KnO\vledge of community outreach and grassroots organizing.
Ability 10 esiablish and maintain effective professional relationships with clients. staff. personnel in other
community agencies, other employees and the general public.
Ability to express ideas clearly and concisely. both verbally and in writing.
Ability to maintain required records.
Ability to prepare correspondence and comprehensive reports.
Ability to effectively supel'Vise other employees.
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1021 - CASE WORKER
(Commission Approyal Pending)
MINIMUM REQUIREMENTS
Graduation with an Associate's degree or equivalent in college credits with major course work in Social
Work, Business, Criminal Justice, Sociology cr Psychology, with some experience working in social
service, youth program or related field. Experience can substitute for education on a year- for-year basis.
Valid driverc) license.
PHYSICAL REQUIREMENTS
Must have the use of sensory skills in order to effectively communicate and interact with other employees
and the public through the use of the telephone and personal contact. Physical capability to effectively use
and operate various items of office related equipment, such as, but not limited to, word processor,
calculator, copier, and fax machine. No significant standing, waUJng, moving, climbing, canying, bending,
kneeling, crawling, reaching, and handling, sitting, standing, pushing, and pulling.
SUPERVISION RECEIVED
General and specific assignments are received rrom the supervisor. Work is performed \vith considerable
latitude for use of independent judgement, and is revicvved through periodic conferences and review of case
records and reports.
SUPERVISION EXERCISED
May supervise clerical assistants.
07/01
2
15
Technical
Submission
Project Number: FL14B500030
Project Identifier
Exhibit 4: Supportive Ser.vices
(all projects requesting service funds)
B. Job Descriptions
Attach to this Exhibit naITative statement(s) indicating the job title(s) for each position to be funded. For each
position describe the job responsibilities as they relate to the project.
~ For Job Descriptions see page 22 hereafter.
C. Site Control
A project sponsor must have site control when SHP funds are requested for supportive services at a site
operated by the project sponsor. If the project sponsor does not operate this site (e.g., another organization
does), check the "N/A" (i.e., not applicable) box in #1 below and proceed to the next applicable Exhibit.
I. Does the project sponsor have site control at this time?
~ Yes
o No
ON/A
If the answer to this question is "yes", complete question 2.
If the answer to this question is "no", the project sponsor has one year from the date ofHUD's conditional
award letter to the selectee to obtain site control.
2. Check the appropriate box below to indicate the f0l111 of site control that the project sponsor has now and
at1ach a copy of the document.
D Executed lease agreement
D Executed option to purchase or lease
[:;1 Deed or other proof of ownership
o Executed contract of sale
Arproval No. 2506-01 12 (exp. 8/31/2006)
H U 0-40076-2
Ju1 11 06 12: 19p
Communit~ Services
3056042421
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14
Technical
Submission
Project Num ber: FLI4B500030
Project J dcntifier
Exhibit 4: Suppol.tive Services
(all projects requesting service funds)
A. Supportive Services Budget
Please complete the chart below for your project's total supponive services budget. If you need additional space
for more services, you may reproduce this chal1 and label it Exhibit 4A.
Tn the first column, fill in the supportive service expenses. For staff positions, please include the job title and
quantity (or FTE-full time equivalent); for supportive services, such as transportation services, please include
the type (e.g., bus tokens) and quantity. In the Year I column, emer the amount needed to pay for the service in
the first year. [fthe grant is multi-year, enter the funds needed for Year 2, and if applicable, Year 3. In the last
column, total the amount of funds needed for the full grant tenn. Please ensure that the total supportive
services request on Line 10, column (d) helow, matches the amount you entered in your project's
Summary Budget in Exhibit 1.
Chart 4A:
I Year 1 Year 2 Year 3 Total
I SUpP0l1ive Service Ex.pense (a) (b) ( c) (d)
I. Staffing: $219,119 $219,119
Quantity: 6 FTE and 0.65 PTE
2. Relocation Expense: $20,849 $20,849
Quantity: 14 persons/mo
3. Food for relocations: $1,982 SJ,982
Quantity: 14 persons/mo
4. Food Vouchers for Outreach: $555 $555 i
Quantity: lump sum
15. Vehicle Expense: $4,832 $4,832
Quantitv: 7 Vehicles
6. lO's, Birth Certificates, etc.: $3,000 $3,000
Quantitv: 14.5 documents/month
7. Rent Assistance: $3,806 $3,806
Quantity: lump sum
8. Storage for Clients: SI,500 I $1,500
Quantity: $125/month
9. Total Supportive Services Budget $255,6431 $255,643
10. SHP REQUEST'" I $60,946
11. Selectee's Match (Line 9 minus Line 10) S3 l6,589 1
" fhe SH P request cannot be more than 80% ofthe tOlal supportive services budget in Line 9
Approyal No. 2506-0112 (exp. 8/31/2(06)
HUD--W07G-2
14
Technical
Submission
Project Number: FL14B500030
Project Identifier
Exhibit 4: Supportive Senices
(all projects requesting service funds)
A. Supportive Services Budget
Please complete the chart below for your project's total supportive services budget. If you need additional space
for more services, you may reproduce this chaJ1 and label it Exhibit 4A.
In the first column, fill in the supp0l1ive service expenses. For staff positions, please include the job title and
quantity (or FTE-full time equivalent); for supP0l1ive services, such as transportation services, please include
the type (e.g., bus tokens) and quantity. In the Year I column, enter the amount needed to pay for the service in
the first year. If the grant is multi-year, enter the funds needed for Year 2, and if applicable, Year 3. In the last
column, total the amount of funds needed for the full grant term. Please ensure that the total supportive
services request on Line 10, column (d) below, matches the amount you entered in your project's
Summary Budget in Exhibit 1.
Chart 4A:
Year I Year 2 Year 3 Total
Supportive Service Expense (a) (b) (c) (d)
1. Staffing: $254,350 254,350
Quantity: 6 HE and 1.80 PTE
2. Emergency Shelter: $263,403 $263,403
Quantity: 4] beds
3. Hotel/Motel Expense: $4,800 $4,800
Quantity: lump sum
14. Relocation Expense: $31,025 $31,025
Quantity: 14 persons/mo
I 5. Food for relocations: $2,250 $2,250
I Quantity: 14 persons/mo
6. Food Vouchers: $10,200 $10,200
Quantity: lump sum
I 7. Vehiele Expense: $6,501 $6,SOI
Quantity: 2 Vehicles
8. !D's, Birth Certificates, etc.: $2,892 $2,892
Quantity: 14.5 documents/month
9. Rent Assistance: $0 $0
Quantity: lump sum
I ] o. Storage: $1,598 $1,598
Quantity: $12S/month
11. Total Supportive Services Budget $493,195 $493,195
]2. SHP REQUEST* $60,946 I
13. Selectee's Match (Line 9 minus Line 10) $516,073 I
*The SHP request cannot be more than 80% of the total SUPPOliive services budget in Line 9
Apprcn<ll :\0. 2506-0]]2 (exp. 8/31/2006)
HUD-40076-2
16
Project Number: FL14B500030
Project Identifier
Exhibit 4: Supportive Services
(all proj ects requesting service funds)
D. Documentation of Match for Year 1
Technical
Submission
A selectee must cUITently have finn commitments for its cash resources for Year 1 and must submit
documentation of those resources as an attachment to this Exhibit. These finn commitments must be
documented on letterhead stationery, signed and dated by an authorized representative, and attached to this
Exhibit. Each letter must, at a min imum, contain the following elements:
I. The name of the organization providing the cash resource;
2. The amount;
3. The type of activity for which the funds will be used (e.g., case management, child care, education);
4. The name of the project sponsor organization to which the cash will be contributed and/or the name of the
project; and
5. The date the funds will be available.
-+ For operating budget, leverage and funding sources see pages 22 and 23 hereafter, as well
as attached leverage letter.
E. Certification of Match for Year 2 and Y car 3, if applicable
The following certification must be completed for Year 2, and Year 3 ifapplicable, of your grant term to ce11ify
that non-SHP cash resources wili be used to meet your supportive services match requirement in each of these
years. The amount specified in th is certification must match the amount shown in Ch311 4A, Line 11, of this
Exllibit. No other documentation regarding the supp0l1ive services match requirement for Year 2 and Year 3 of
your grant teml is required at this time. However, match commitment for Years 2 and 3 will be identified at
time of submission of Annual Progress Reports for those years.
the amount of $
(selectee organization) certifies that it will provide cash resources in
from non-SHP funding sources for Year(s)_ of this grant term to
The
be used to provide services to homeless persons under I-IUD's grant number
Signature of authorized representative
Name
Title
Date
Approval No. 2506-0112 (exp. 8/31/2006)
HLiD-40076-2
14316
Attachment 11
Federal Register / Vol. 70, No.53 / Monday 21, 2005/Notices
Exhibit 1: Continuum of Care Supplemental Resources Project Leveraging Chart
Please complete the following Project Leveraging Chart (HUD 40076 COC-N)
Continuum of Care: Project Leveraging
(complete only one chari for the entire Conlinuum of Care and Inscrtm Exhihill. TlJls entire chari wi/! cOllnl as only one page
towards the 30-page IlImtallon).
Projcct I Namc of Projcct Typc of Sourcc or *Value of Writtcn
Priori(y Contribution Providcr Co 11ll1litmcn t
,Number
Staffing Cash City of Miami $254,350
Beach - General
Fund
Hotel/Motel Costs Cash Emergency Food $4,800
and Shelter
Program
Emergency Shelter Cash City of Miami $263,403
Beach - ResOlt
Tax
Re location Cash City of Miami $3] ,025
Expense Beach - ResOlt
Tax
Food Expense (for Cash City of Miami $2,250
relocation only) Beach - ResOlt
Tax
Food Vouchers Cash Emergency Food $] 0,200
and Shelter
Program
!D's / Bilth Cash City of Miami $2,892
Certificates Beach - ResOlt
Tax
Storage Fees (for Cash City of Miami $] ,598
shelter clients) Beach - ResOlt
Tax
Vehicle Expense Cash City of Miami $6,501
Beach - ResOlt
Tax
I Communications Cash City of Miami $2,544
I Beach - ResOlt
Tax
Office Supplies Cash I City afMi,,,,i $5,500
Beach - General
Fund
TOTAL $585,063
Please enter the value of the contribution or which you have a written commitment at time of application submission.
· BUD 40076 CoC-N
~ul 11 Uti 12: l~p
l,ommUnl~~ ..:lei 1,/.L......c'='O
lD
. ~~I
,
'----, I
,
,.,< "
City of Miami Beach, 1700 Conventio" Cenler Drive, Miami Beach, Florida 33139, www miam,beochf!.gc,y
NEIGHBORHOOD SERVICES, Office of Comm'Jnity Services
Tel (305) 604.4663, Fox (305) 604.2421
April 18, 2006
Mr. David Raymond
Acting Executive Director
Miami-Dade County Homeless Trust
Suite 27-310
111 NW First Street
Miami, Florida 33128-1930
Re: Letter of Commitment - Super NOFA 2006
Dear Mr. Raymond -
This letter serves as confirmation of the City of Miami Beach's projected leverage funding
resources committed to the Office of Community Services/Homeless Outreach. Leverage funds
prOjected for supportive services to the Homeless Outreach are as follows:
, Line Item Revenue Source Cash Leverage Amount
Match
I Staffln
Staffin
I Staffin
Hotel/Motel Costs
Emergency Shelter Beds (41 beds)
Relocation Ex ense
~ood Expense (Reloc3!.ion Onl
Food Vouchers (Non-relocation
Vehicle Ex ense 2 vehicles
I DsfBirth Certificates
Communications
Storage Fees (For Shelter
Clients)
Office Su lies
Total Cash Match
Total Levera e
Totals
General Fund
General Fund
Resort Tax
EFSB
Resort Tax
Resort Tax
Resort Tax
EFSB
Resort Tax
Resort Tax
Resort Tax
Resort Tax
../
75,754
51,200 '
127,3961
___4,800 I
263,403
31,025
2,250
10,200
6,501
2,892
2,544
1,598
../
../
../
../
../
../
../
../
5,500
187,641
397,422
585,063
If you have any additional questions, please contact Maria Ruiz, Division Director! Office of
Community Services at (305)673-7491.
Sincerely,
Jorge M. Gorlzalez
City Manager
" ~ I ,.
Jul 11 08 12:18p
Communit~ Services
3056042421
p. 10
vvww.efsp.un itedway. org
Emergency Food and Shelter Program
701 North Fairfax Street, Suite 310
Alexandria, VA 22314-2064
Phone 703-706-9660 Fax 703-706-9677
24-1594-00 076 E 1
05/09/06
1594-00
Miami-Dade County, FL
LRO 076
LRO ID: 159400-076
Maria Rujz
City of Miami Beach
1700 Convention Center Drive
Miami, FL 33139
RE: Account Status for Phase 24
LRO JD: 159400-076
The funds you are receiving are Federal funds as authorized under Public Law PL 109-90. The CFDA
number for the Emergency Food and Shelter Program is 97.02.4.
For access to the EFSP web site, you need a password. If you have not already set one, your temporary
password is your LRO 10 without the hyphens, e.g. 123456789 for LRO 10# 1234-56-789. You will have to
change this the first time you access the Local Board and LRO Information page of the web site.
As of today, our records indicate that your LRO has received the following awards(s) under this phase of
the Emergency Food and Shelter National Board Program: .-
Award Amount
Award Adjustments
Award Total
15,000.00
0.00
15,000.00
Your LRO may begin charging expenses against this total as of 12101/05. Funds must be expended
prior to 11/30/06.
To date, your LRO has received the following payment(s):
EFT E160325 paid on 05/09/06
Bank Account: ABA# 061000104 Acct# 0360002236568
Deposited: 05/12/06
Payment Total
7,50000
7,500.00
Monies still due your'LRO:
$7,500.00
Sincerely,
k~~Ay
Sharon M. Bailey (J
Vice President
'-'UL L.l UO .lC:; LOr-'
L. U 111111 U I I.L '-".:J ...J =- I ..,..&. "-.; "- ~
ElVIERGENCY FOOD & SHELTER PROGRAlVI
P.O. BOX 459007 MIAMI. RORID/\ 33245-9007
.
T:::LEPHONl: (305) 646-7085 / F.~X (305) 646-7D79
Nil. T10NAL BOARD
CHAIR
LAL'RE'iCE W. ZENSlNGER
Federal Em:;rGt:n::y ;-,,/L.lTlJg~mcnt :\gcncy
BOARD ME;VillERS
DlANA A vrv
Unite-d Jewish Cornmuniril':s
BROTHER JOSEPH BERG
Catholic ChJritie.s
LT COL. PAUL E. BOLLWAH,\!
The S,:..dv<ltion Army
BRE:-IDA GlRTON.\lITCHELL
National Councilor the Churches or Chris!
JOH)\" MCDIVlTI
A merican Red Cross
SR lDGET GA V AG HAN
lJnjt~j \V~lY of America
STAFF
DOr-;ALD McKEE
Llllil.ed \v:.!.y ;;f A ::;erj"::l
CAROL COLEMAN
Federal Err~q;ency Man.q~cment Ag~IlCY
SflARON BAlLEY
L'njlcd Way of America
KIMBERLY;-,JANCE
Federal Emergency Management Agency
YVONNE WALKER
Cruled W"y of America
LOCAL BOARD
CHAIR
NADINE JOHNSON
Hope Cenler
VICE.ClL\lR
EDITH HU:V1ES-0."EWBOLD
South Florid" Workforce
MEMBERS
RONALD l3RU.>{MIT
Miami Rescue Mission
LYNNE CAMER01\.
Neighbors 4 Neighbors/CBS.!
VlRGlN1A COTO
Church Warld Services
NEIL C. COX
Brenner & Dlenstag. P.A.
I-IARY DONWORTH
Uniled \,V:.ly oC tv1;arnj~Dadc
AUGUSTA FLYNN
YWCA
THAMAf<A LABROUSSE
Swirchboa.rd of Miami
MAJOR TOM OVERTON
The Salvation .-\rmy
DA VID RA YMO.\!D
Mj,mi-Dade COllnly Homekss Trust
:VI.ARYUN REI'
Offi.:.::e of the 1\1ayor
ROnERT RUAt-:O
City of .>{iami
DA VlD SALT,\.[,\N
J::\....ish Commuruty Services
RICHARD TURCOTTE
C<..ltholic Charities
1l1LL WILSON
An~ric;Jn Red Cross
CAROL YN WILSON
:-.iev.' Hope Drop In Center
STAFF
V A.'iESSA BEN." VlDES
United W;\}' of !'vL~lmi-DaJc
March 21. 2CXJ6
Maria 1. Ruiz
Ciry of Ivliami Beach
555 17th Street
Miami Bexh.FL33139
Dear Ms. Rlliz,
CongrQtulQtions! The Local Board of the Emergency Focxl and Shelter Program has approved your
organization for funding for Phase 24 in the Miami-Dade County 1594-00] urisdiction. Eligible expenses
may be incurred for the Phase 24 program pericx:l as of this notification through November 30,2006 WlJess
otherwise directed.
All funding is contingent upon your organization clearing audit of Phase 23 document:.ttion and aJl
previoLiS pha.ses~ if applicutJl~. tJso, f~:lding is b2.Sed on th~ eXiX"ct2t!on that your agency ~rilllL~e these
funds to provide assistance to aJl individuals who are eligible, not only those accessing other program
seryjces. Based on your application funding was approved for the following services
Services
Fo..-xI Vouchers
Hotel/l'vlotel
Total
$10200
$4,800
$15,000
As in previous phases, documentation (copies of all canceled checks, invoices, [euers from landlords, or
eviction notices, utility cut-off notices) must be collected for all expenses. Initial distribution of funds win
come directly from the National Board in AJexandria, Virginia. Your second payment will submitted to
you electronically upon your written request to the Local Board Chair. This request wiI! be approved
upon assurances that funds have been used properly and the program is being implemented as intended.
The Local Board Wlll conduct a strategic review of the program during Phase 24. Our objective will be to
. ensure that future EFSP funding decisions are consistent with the intent of the program and that the best
interests of the communities are served_ Active participation ofLRO's will be essential for success and
will occur in a variety of ways. As usual, LRO's will be required to attend a 1\1ANDA TORY providers
meeting. Failure to attend could effect future funding for your organization. The meeting 'Nill take place
on Tuesday, Aprilll1h from 9:00 a..m to 11:00 a.m at the United Way of Miami-Dade, .I".nsin
Building, 3250 SW 3rd Ave, Miami, FL 33129. Enclosed you ,,,,ill find genewl directions to the building
and parking infornw.tior1. -
Also, attached you will find a Local Recipient Organization Certification Form. Please complete and
retum1his form to the EFSP local staff person, Vanessa Benavides at EFSP, P.O. Box 459007, Miami,
Florida, 33245-9007 as soon as possible.
r you ha\.'e any questionr\. se T fececl free to contact Vanessa Benavides at (305) 646-7085. Thill'1).,: you.
. c ~eJ,~l ~
.fd:~
Nc ine Johnson, Chair
Emergency Food cmd Shelter Prob'Tam
Phase 24 Local Board
LOCCSNRS
~NAPS 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. 2535-0102 (exp. 113112004)
ATTACHMENT C
See Instruetions and Public ReportIng Burden Statement on back
1. Voucher Nlmber 2. LOCCS Pgnn. Ar8II 3. Period CoYered by lhis ReqUEllll (dates) <4. Type 01 Disbursement
SNAP HPAC o Partial o Final
I I I I I I IHP
5. VolOll A~ No. (5 digit., hyphen, 5 more ) 6. Gran1M Organization'. Name .
8. Grant No. 6&. Granlee OrglDzBlion'. nN
9. Une Item no. Type of Funds Requested Amount (romd 10 nearest dollar)
1010 Acquisition
1020 Rehabilitation
1021 New Construction
1022 Substantial Rehabilitation
1023 Moderate Rehabilitation
1030 Operating Cost
1040 Rental Assistance
1050 Supportive Services
1060 Administrative Cost
1070 Child Care
1080 Employment Assistance
1090 Relocation
1100 Leasing
1110 Repair & Maintenance
1111 Prevention (RH)
1112 Capacity Building (RH)
1120 Other:
10. Voucher Tota
I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate.
Warning: HUDwlllprosecWl false clams and statemerU CorMc:tionmay result incrimlnaland'orclvi penallles. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C.3729,3802)
11. Name & Phone Number (including area code) of the Authorized 12. Signature 13. 0a1e 01 ReqUMl
Person who caled 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 collec1 all the Information (except the Social Security N~ber (SSN)) which will be used by HUD to protect disbursement data from fraudulent actions.
The Housing and Community Development Act of 1987,42 U.S.C. 3543, authorizes HUD to collect the SSN. The data are used to ensure that Individuals
who no longer require access to Line of Credit Control System (LOCCS) have their access capability promptly deleted. Provision of the SSN is mandatory.
HUD uses It asa unique ldentlfierforsafeguarding 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 dlsctosed or released outside of HUD, except as permitted or required by IBw.
Retain this form In your records for audit purposes
page 1 of 2
form HUD-27053-A (2195)
~C-1
L.....I MIAMI-DADE
...... ~OMELESS
T R U S T
MONTHLY INVOICE
MONTH:
PROVIDER NAME:
PROGRAM NAME:
CONTRACT #
Contract Period:
POSITIONS/DESCRIPTIONS
%
Total Expenses
Program
Expenses
[::;:~::rrt:s:r~~~~::::r::.:r!:=??f'W-5~~,~" 'J.
0"1. $ $ #DIV/OI
0% #DIV/O!
0% #DIV/O!
0% #DIV/O!
0% #DIV/O!
0% #DIV/O!
0% #DIV/O!
0% #DIV/O!
0% #DIV/O!
0% #DIV/O!
0% #DIV/O!
0% #DIV/O!
0% #DIV/O!
0% #DIV/O!
0% #DIV/O!
#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!
DESCRIPTIONS 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% #DIV/O!
DESCRIPTIONS 0% #DIV/O!
DESCRIPTIONS 0% #DIV/O!
Total Supportive Service $ $ $ $ #DIV/OI
TOTAL SUPPORTIVE SVC $ 1$ 1$ $ $ #DIV/O!
HT/PROJECTS
6/10/049:36 AM
~=~~~~~~..
POSITIONS/DESCRIPTIONS
% Total Expenses
Program
Expenses
POSITIONS
POSITIONS
POSITIONS
POSITIONS
POSITIONS
POSITIONS
POSITIONS
POSITIONS
POSITIONS
POSITIONS
POSITIONS
POSITIONS
POSITIONS
POSITIONS
POSITIONS
TOTAL SALAR/ES
0% $
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
#DIV/O!
#DIV/O!
#DIV/O!
#DIV/O!
#DIV/O!
#DIV/O!
#DIV/O!
#DIV/O!
#DIV/O!
#DIV/O!
#DIV/O!
#DIV/O!
#DIV/O!
#DIV/O!
#DIV/O!
#DIV/O!
#DIV/O!
#DIV/O!
DESCRIPTIONS 0%
DESCRIPTIONS 0%
DESCRIPTIONS 0%
DESCRIPTIONS 0%
DESCRIPTIONS 0%
DESCRIPTIONS 0%
DESCRIPTIONS 0%
DESCRIPTIONS 0%
DESCRIPTIONS 0%
DESCRIPTIONS 0%
DESCRIPTIONS 0%
DESCRIPTIONS 0%
DESCRIPTIONS 0%
DESCRIPTIONS 0%
DESCRIPTIONS 0%
I Total Other Operating Services II $
TOTAL OPERATING SVCS $
#DIV/O!
#DIV/O!
#DIV/O!
#DIV/O!
#DIV/O!
#DIV/O!
#DIV/O!
#DIV/O!
#DIV/O!
#DIV/O!
#DIV/O!
#DIV/O!
#DIV/O!
#DIV/O!
#DIV/O!
#DIV/O!
POSITIONS/DESCRIPTIONS
%
Total Expenses
'Program
Expenses
SHP Total Year SHP
Reimbursement Expenses
L~~'_~: _ _~,_, -. _ ~-=~_:._c~' _..=-~~::;.::~...' '. -. _~ :. _._~=~:it~ltill~U;iJ~!~~jf@)f~--=~~~~~-:--~c--~.: -L::'c~~:~_:'~-;:::-~:~~:' ~_"~':'~co.~.;~~'c~-~,;it~~;l!
TOTAL LEASING
0%
$
$
$ $
SHP Exp YTD
$
o xp
YTD
#DIV/OI
POSITIONS/DESCRIPTIONS
Total Expenses
Program
Expenses
SHP
Relmbursemf'nt
Total Year SHP
Expenses
Year to Date
Year: 1 23
I I % of Tot Exp I
. SHP Exp YTD YTD
$ - #DIV/OI
TOTAL ADMIN COST
$
1$
1$
1$
1$
$
GRAND TOTAL $
$
$
II #DIV/O!
HT/PROJECTS
6/10/049:36 AM
ServicePoint - HUD 40118 Report
A TT ACHMENT ])
Page 1 of 4
nf"
munily.
Miami Dade Homeless Trust Jun 14, 2006
Miami-Dade County Government /
Home
C1lentPolnt
ResourcePolnt
ShelterPolnt
SkanPolnt
~Reports
Logoff
HUD Annual Progress Report (HUD-40118)
Report Options:
Provider
I-select-
!Miami-Dade County Government (#1) lit
III Unduplicated C
Operating Year Date Range
.105/01/20061 to 105/31/20061 (mm/dd/yyyy)
Legal Adult Age
~ (as defined by foster care law in your state)
Or
I-select-
11
2. Persons Served during the Number of Singles Number of Adults Number of
Children in
operating year. Not in Families in Families Families
a. Number on the first day of the 0 0 0
operating year.
b. Number entering program during the 0 0 0
operating year.
c. Number who left the program during 0 0 0
the operating year.
d. Number in the program on the last day 0 0 0
of the operating year. (a+b-c=d)
Number of Singles Number of Adults Number of
3. Project Capacity. Children in
Not in Families in Families Families
Number of
FCimilies
o
o
o
o
NlJmber of
Families
a. Number on last day (from 2d, columns
1 and 4)
4. Non-homeless persons. (Sec. 8 SRO projects only)
How many Income-eligible non-homeless persons were housed by the SRO program during the operating
year?
o
. 0
o
5. Age and gender.
Single Persons (from 2b, column 1)
Age Male Female Other/Not given
a. 62 and over 0 0 0
b.51-61 0 0 0
c. 31 - 50 0 0 0
d. 18 - 30 0 0 0
e. 17 and under 0 0 0
Not given 0 0 0
f. 62 and over 0 0 0
g.51-61 0 0 0
h.31-50 0 0 0
Persons in Families (from 2b, columns 2 &. 3)
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ServicePoint - HUD 40118 Report
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i. 18 - 30 0 0 0
j. 13 - 17 0 0 0
k. 6 - 12 0 0 0
I. 1 - 5 0 0 0
m. Under 1 0 0 0
Not given 0 0 0
Ga. Veterans Status.
A veteran is anyone who has ever been on active military duty status. 0
Gb. Chronically Homeless.
How many participants were chronically homeless individuals? 0
7. Ethnicity.
a. Hispanic or Latino 0
b. Non-Hispanic or Non-Latino 0
8. Race.
a. American Indian or Alaskan Native 0
b. Asian 0
c. Black or African American 0
d. Native Hawaiian or Other Pacific Islander 0
e. White 0
f. American Indian/Alaskan Native & White 0
g. Asian & White 0
h. Black/African American & White 0
i. American Indian/Alaskan Native & Black/African American 0
j. Other Multi-Racial 0
k. Other/Unknown (all that do not match) 0
9a. Special Needs.
All Chlionic
a. Mental Illness 0 :0
b. Alcohol abuse 0 0
c. Drug abuse 0 0
d. HIV/AIDS or related diseases 0 0
e. Developmental disability 0 0
f. Physical disability 0 0
g. Domestic violence 0 0
h. Other (please specify) 0 0
9b. Disabled.
How many of the participants are disabled? I 0
10. Prior Living Situation.
All Chronic
a. Non-hOUSing (street, park, car, bus station, etc.) 0 0
b. Emergency shelter 0 0
c. Transitional housing for homeless persons 0
d. Psychiatric facility 0
e. Substance abuse treatment facility 0
f. Hospital 0
g. Jail/prison 0
h. Domestic violence situation 0
i. Living with relatives/friends 0
j. Rental housing 0
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k. Other (please specify) I 0 I
11. Amount and Source of Monthly Income at Entry and Exit.
Amount A. Monthly Income at Entry B. Monthly Incqme at Exit
All Chronic All C/;Ironic
a. No Income 0 0 0 0
b. $1-150 0 0 0 0
c. $151 - $250 0 0 0 0
d. $251 - $500 0 0 0 0
e. $501 - $1000 0 0 0 0
f. $1001 - $1500 0 0 0 0
g. $1501 - $2000 0 0 0 0
h. $2000 + 0 0 0 0
Source C. Income Sources at Entry D. Income Sou~ces at Exit
All Chronic All C~ronic
a. Supplemental Security Income (551) 0 0 0 0
b. Social Security Disability Insurance (SSDI) 0 0 0 0
c. Social Security 0 0 0 0
d. General Public Assistance 0 0 0 0
e. Temporary Aid to Needy Families (TANF) 0 0 0 0
f. State Children's Health Insurance Program (SCHIP) 0 0 0 0
g. Veterans benefits 0 0 0 0
h. Employment Income 0 0 0 0
i. Unemployment Benefits 0 0 0 0
j. Veteran's Health Care 0 0 0 0
k. Medicaid 0 0 0 0
I. Food Stamps 0 0 0 0
m. Other (please specify) 0 0 0 0
n. No financial resources 0 0 0 0
12a. Length of Stay in Program. (Participants who left during operating year)
All .Chronic
a. Less than 1 month 0 0
b. 1 to 2 months 0 0
c. 3 -.6 months 0 0
d. 7 months - 12 months 0 0
e. 13 months - 24 months 0 0
f. 25 months - 3 years 0 0
g. 4 years - 5 years 0 0
h. 6 years - 7 years 0 0
i. 8 years - 10 years 0 0
j. over 10 yea rs 0 0
12b. Length of Stay in Program. (Participants who did not leave during operating year)
All Chronic
a. Less than 1 month 0 0
b. 1 to 2 months 0 0
c. 3 - 6 months 0 0
d. 7 months - 12 months 0 0
e. 13 months - 24 months 0 0
f. 25 months - 3 years 0 0
g. 4 years - 5 years 0 0
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ServieePoint - HUD 40118 Report
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h. 6 years - 7 years 0 0
i. 8 years - 10 years 0 0
j. over 10 years 0 0
13. Reasons for Leaving.
All Chronic
a. Left for a housing opportunity before completing program 0 0
b. Completed program 0 0
c. Non-payment of rent/occupancy charge 0 0
d. Non-compliance with project 0 0
e. Criminal activity 1 destruction of property 1 violence 0 0
f. Reached maximum time allowed in project 0 0
g. Needs could not be met by project 0 0
h. Disagreement with rules/persons 0 0
i. Death 0 0
j. other (please specify) 0 0
k. Unknown/disappeared 0 0
14. Destination.
All Chronic
PERMANENT (a - h) a. Rental house or apartment (no subsidy) 0 0
b. Public Housing 0 0
c. Section 8 0 0
d. Shelter Plus Care 0 0
e. HOME subsidized house or apartment 0 0
f. other subsidized house or apartment 0 0
g. Homeownershlp 0 0
h. Moved in with family or friends 0 0
TRANSITIONAL (i - j) i. Transitional housing for homeless persons 0 0
j. Moved in with family or friends 0 0
INSTITUTION (k - m) k. Psychiatric hospital 0 0
J. Inpatient alcohol/drug treatment facility 0 0
m. Jail/prison 0 0
EMERGENCY SHELTER (n) n. Emergency shelter 0 0
OTHER (0 - q) o. other supportive housing 0 0
p. Places not meant for human habitation (e.g. street) 0 0
q. other (please specify) 0 0
UNKNOWN r. Unknown 0 0
15. Supportive Services.
No supportive services found.
ServicePoint version 4.01.018 (db build #0723)
Licensed to: Miami Dade Homeless Trust
@ 1999-2006 Bowman Systems L.L.C. All Rights Reserved.
CPT only @2004 American Medical Association. All Rights Resel'ved.
DS~1 and DSM-IV- TR are registered trademarks of the American Psychiatric Association, and ar'e used with permission herein.
ICD-9-CM @1994 National Center for Health Statistics (ICD-9 (c)World Health Organization). All Rights Reserved.
Taxonomy @1983-2003 Information and Referral Federation of Los Angeles County, Inc. All Rights Reserved.
https:llwww3 .servicept. com/miamil seri ptsl svpreporthud. php
6/14/2006
ATTACHMENT E
MIAMI-DADE COUNTY HOMELESS TRUST
PROGRAM RATING OF SATISFACTION
INSTRUCTIONS
Carefully read all of the instructions below BEFORE distributing the Program Rating of Satisfaction
survey to your program participants.
General Information
The Program Rating of Satisfaction consists of 11 items which are used to determine a client's satisfaction
with services they are receiving from a provider. It is to be completed by all program participants engaged
in services at a Trust-funded program. It must be completed - at a minimum - at 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
BHRS equivalent
Q1'g score
I was informed of my ri2hts and responsibilities N/A 5.0
I was provided with information about different services N/A I 5.0
that are available for me
I was involved in making decisions about my care/service II 5.09
plan
I was able to talk with staff when I needed to "'5 5.15
The building and facilities have usually been clean, safe and 4 5.] 8 I
I
comfortable
My rights were respected and protected, including my right N/A 5.0
to file a ~rievance, if needed
My case mana2er seems oualified to help me I 5.47
I would recommend this Dro~ram to others 8 5.36
I am treated with respect by the staff 18 - ""
)._.J
The staff seems to care about whether I l!et better 20 5.3]
Program staff were knowledgeable about available services 14 5.38
that could helD me
11/6/00
57.17
RECOMMENDED 57.00
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 bearinf! on vour continued participation in the prof!ram. ALL responses are confidential.
Why did you choose to enter the program (mark only one box):
o I decided to come to this program on my own (through outreach. referral. etc.)
o I was placed here through another program (court intervention, police. etc.) against my will
o I had previously participated in this or a similar program and decided to return
OPTIONAL Information:
Name:
Today's Date:
Sex: 0 male 0 female
Please answer the following questions about the services you received. Mark {XI on~l' 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 ood or bad.
Stro/lgly
A ree
I was informed of my rights and responsibilities, [6] [5] [4 ] [3] [2] [I]
includin the a enc 's rievance rocedures
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 ]
ca re/service Ian
I was able to talk with staff when I needed to [6] [5] [4] [3] [7] I
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]
ri ht to file a rievance, if needed
M case mana er seems ualified to hel me [6] [5] [4] [3]
I would recommend this ro ram to others [6] [5] [4] [3 ]
I am treated with res ect bv the staff [6] [5] [4] [3]
The staff seems to care about whether I et better [6] [5] [4] [3]
Program staff were knowledgeable about available [6] [5] [4] [3 ]
services that could hel me
Section II.: TO BE COMPLETED BY PROGRAM STAFF
Purpose of Evaluation Current Level of Care provided
o At Admission 0 emergency housing Provider Name:
o At discharge 0 transitional housing/tx Project Name:
o Other: 0 transitional housing/non-tx Staff Initials:
0 pennanent housing
0 services only
Rev.] 1/6/00 Forms/programrating
MIAMI-DADE COUNTY HOMELESS TRUST
EV ALUACION DE LA SATISFACCION CON EL PROGRA~lA
Seccion I. COMPLETADA POR EL PARTICIPANTE DEL PROGRAMA
lnstrucciones: Por favor coloque una cruz [Xl en el espacio provisto para responder alas pregulltas a cOlltilluacioll. Las
respuestas que usted de a este cuestionario no influirdn de forma ai/tuna sabre la colltinuacioll de S/l participaciljn ell este
orOf!rama. TODAS las respuestas se malltendrdn COllfidencialmente.
;,Por que decidio usted participar en el programa? (Marque una casilla solamente):
[ ] Lo decidi por mi cuenta (porque fui remitido 0 por medio de otro programa, etc.)
[ ] Fui colocado aqui mediante otro programa (por intervencion de 105 tribunales, la
policia, etc.) en contra de mi voluntad
] Ya habia participado en este program a 0 en uno similar y decidi regresar
Informacion OPCIONAL:
Nombre y apellido:
Fecha de hoy:
Genero: M [ ]
F [ ]
Por favor responda alas pregulltas siguientes acerca de los servicios que se Ie hall prestado. lndique COil una cruz [Xl EN
UNA SOLA CASILLA paR PREGUNTA laforma ell que usted se siente acerca de cada una de las cuestiolles descritas.
Como sus respuestas a estas preguntas nos ayudardn a mejorar los servicios que prestamos, Ie rogamos que IIOS !laga saber
como se siente en realidad acerca de nuestros servicios, no importa si usted los considera buellos 0 malos.
Se me informaron cmiles eran mis derechos y
responsabilidades, entre ellos, los procedimientos de la
a en cia ara someter ue' as.
Se me dio informacion sobre los distintos servicios a los
ue ten 0 derecho.
Participe en la toma de decisiones referentes a mi plan
de atencion V servicios.
Pude hablar con el personal cuando tuve necesidad de
hacerlo.
EI centro y sus servicios por 10 general se han mantenido
lim ios, sin eli ro accesibles.
Se respetaron y protegieron mis derechos, entre ellos, mi
derecho a someter ue' as si 10 considero necesario.
Aparentemente, la persona encargada de mi caso sabe 10
ue tiene ue hacer ara a udarme.
Yo les recomendaria este ro ecto a otras ersonas.
Los em leados me trataron res etuosamente.
Aparentemente, a los empleados les interesa que yo
me'ore.
Los empleados sabian que servicios podian servirme de
a uda.
Muy de
acuerdo
[6]
[6]
[6]
[6]
[6]
[6]
[6]
[6
[6]
[6]
[6]
[5]
[5]
[5]
[5]
[5]
[5]
[5]
[5]
[5]
[5]
[4]
[4]
[4]
[4]
[4]
[4]
[4]
[4]
[4]
[4 ]
[3]
Muyen
desacuerdo
[ I]
[2] [ 1 ]
[2] [ I ]
[2] [I]
[2] [ I]
[2] [ I]
[2] [ I]
[3]
[3]
[3]
[3]
[3]
[3
[3]
[3]
[3]
[2]
[I ]
Seccion II.: COMPLET ADA POR EMPLEADOS DEL PROGRAMA (completed bv proeram staff)
Purpose of Evaluation Current Level of Care provided
o At Admission 0 emergency housing Provider Name:
o At discharge 0 transitional housingltx Project Name:
o Other: 0 transitional housing/non-tx Staff Initials:
0 permanent housing
0 services only
MIAMI-DADE COUNTY HOMELESS TRUST
PWOGRAM POD EVALYE SATISFAKSYON
Section 1. TOUT P A TISIP AN NAN PWOGRAM SILA A FET POll RANPLI P AJ SA A
Enstriksyon: Tanpri reponn cllak keksyon anba la a epi fi yon ti kwa {x] nan espas ki vid la. RerJOns 1l0U bar \'0
pap deranie fason nap kontinve patisipe nan pwoeram sUa a. Tou(repons yo ap sekre.
POUKI W CHWAZI PATlSIPE NAN PWOGRAM SILA A (fe yon ti kwa nan yon
grenn bwat):
[I Se mwen ki chwazi vinn nan pwogram sila a (swa pa referans, swa pa sevis espesyal asistans piblik etc.)
I] Se pa chwa mwen, se yon lOt pwogram ki voyem (zak tribinal, lapolis etc)
I] Mwen te deja patisipe nan yon pwogram konsa epi mwen deside retounnen.
Enfomasyon POll bav si w vIe:
Non:
Dat Jodya:
Seks [] Gason
[] Fenm
Tanpri reponn keksyon sUa yo dapre sevis w resevwa. Fe yon kwa {x] nan yon sel ti kare epi ell wazi repons ki pUs
matclle ave w. Keksyon sUa yo la pou ede nou bay pi bon sevis, alb IIOU mande nou bay repolls ki pUs matelte ave
w, ke U bon ou pa.
Bonjan Pa finn Pa dako
dako two dako ditou
[6] [5] [4] [3 ] [2] [1 ]
[6] [5] [4] [3] [2] [1 ]
[6] [5] [4] [3] [2] [1]
[6] [5] [4] [3] [2] [I]
[6] [5] [4] [3] [2] [ 1 ]
[6] [5] [4] [3 ] [2] [1 ]
[6] [5] [4] [3] [2] [ 1 ]
Section II.: TO BE COMPLETED BY PROGRAM STAFF
Purpose of Evaluation Current Level of Care provided
o At Admission 0 emergency housing Provider Name:
o At discharge 0 transitional housing/tx Project Name:
o Other: 0 transitional housing/non-tx Staff Initials:
0 permanent housing
0 services onlv
Rev. ] 1/6/00 Fonns/programraling
A'I'IT(}MNI' F
CLIENT CONTRIBUTION REPORT
NAME OF AGENCY SUBMITTING REPORT:
GRANT NUMBER:
DATE REPORT SUBMITTED:
REPORT COMPILED BY:
SERVICE PERIOD:
CLIENT NAME:
DATE OF BIRTH: I I
---
SSN#:
DATE OF PROGRAM ENTRY: _1_1_
CASE MANAGER I COUNSELOR:
INCOME:
(CHECK ONE)
TOTAL AMOUNT TO AMOUNT TO
AMOUNT: CLIENT: PROVIDER:
SS II SSD (DIS.): $
SOC. SECURITY: $
AFDcrrANF: $
FOOD STAMPS: $
VETERAN'S BENEFITS: $
MEDICAID (Check One):
$ $ I 0/0
$ $ I 0/0
$ $ I 0/0
$ $ I 0/0
$ $ I 0/0
Yes No
TOTAL AMOUNT TO * AMOUNT TO
AMOUNT: CLIENT: P~OVIDER:
EMPLOYMENT**: $
OTHER( CHILD SUPPORT $
ALIMONY, WORKER'S COMP,
ETC.)
$
$
$
$
I %
I %
TOTAL: $
DATE
RECEIVED:
I I
---
_I_I-
I I
---
I I
---
I I
---
PAY
DATE:
I I
---
_1_1-
AMOUNT THIS MONTH TO CLIENT
TOTAL: $
* AMOUNT THIS MONTH TO PROVIDER
* MAXIMUM 300/0 OF CLIENT'S ADJUSTED GROSS INCOME
, .
ATTACHMENT G
0\18 :'-oorenal \0 :~llt"l'lJ' ,t\r' :
U. S. Depanment of Housing
and Urban Development
Office of Community Planning
and Development
Annual Progress Report (APR)
for
Supportive Housing Program
Shelter Plus Care
and
Section 8 Moderate Rehabilitation
for Single Room Occupancy
Dwellings (SRO) Program
HUD-40118
Public reporting burden for this colleclIon of In fonnall on 15 estimated to average 33 hours per response. including the lime I,'f re\ Ie" In~ In'lfu~lll'n,
searchln2 eXt5tmg data sources. gathertng and malntalnmg the data needed. and comolellng and reVlewmg the c:ulkclIon ulll1l,'mlJIIlHl lhh J~e!1,\ 111~\
not cond"ucl or sponsor. and a pefson 15 not required to respond to. a colleCllon oi Int'onnallon unless that colkC:lIon dlsola\s d \ JItJ U\tl3 ,,'l1lf,'1 r.UI11:->c:
General Instructions
Purpose. The Annual Progress Report (APR) tracks program progress and accomplishments In the Department's competltl\ e
homeless assistance programs.
Filing Requirements. Recipients ofHUD's homeless assistance 2rants must submit 1 APR'S to HL:D within gO days after
the end of each operatin2 Year. One copy of the report must be submined to the CPD DIVISIon Director In the local HllD
Field Office responsible for managing the grant. The other copy must be submined to HUD Headquaners. Depanmem or'
Housing and Urban Development. Ann: APR Data Editor, Room i162. 451 7th Street. S\\'. \\ashingtOn. DC. 20-110. Failure
to submit an APR will delay receiving gram funds and may result in a determination of lack or' capaclt) for future TundIn~ An
APR must be submined for each operating year in which HUD funding is provided.
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 the~ lIse SHP
funding for leasing. supponive services. or operations. For years in which they do not receive SHP funding. the~ must submit
an Annual Certification of Continued Project Operation throughout the 20 years. The cenification can be found at the bad, of
this APR.
A separate report must be submined for each HUD grant received. For Shelter Plus Care. a separate APR must be submtned
for each Shelter Plus Care component.
For those grantees receiving an extension. a separate report covering that period must be submtned I see Extension below)
Recordkeeping. Grantees must collect and maintain information on each participant in order to complete an APR. Optional
worksheets are anached. The worksheets may be used to record information manually or to deSign a computerized system to
store and tabulate the information. The worksheets should not be submined 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 describes the progress in moving homeless persons to self-sufficiency.
services received. project goals. and beds created.
Part II: Financial Information. This' portion of the repon is completed by all grantees recei\ln~ fundin~ under SHP. S-C
and SRO.
Final Assembly of Report. After the entire report is assembled. number every page sequenllall~ \ lark an~ questions that do
not apply to your program with "N A" for not applicable. (See Special Instructions for SSO Prolect~ belo\\.)
Definitions. The following terms are used in the APR. :\5 Indicated. In some cases. terms are applied differentl: depending on
whether the funding is from SHP. S-c. or SRO
Chronically homeless person - HUD defines a chronically homeless person as "an unaccompaIlleJ
homeless individual wlIh a disabling condillon who has either been conlinuousl~ homeless r'or a \ ear or more OR has
had at least four (-I) episodes of homelessness In the past three (3) years. " To be conSidered chronically home less a
person must have been on the streets or in an emergency shelter (I.e.not transitional housing) dUring these stays.
Disabling condition - HUD defines "disabling condition" as "a diagnosable substance use disorder. serious mental
illness. developmental disabilit),. or chronic physical illness or disability. including the co-occurrence of two or more of
these conditions. A. dIsabling condition limits an individual's abilit) to work or perform one or more aCllVllles of dailv
living." .
Entered the program for S-C and SRO projects means when the participant starts to receive rental assistance. For S-c.
services proVided prior to this point are recognized as necessary for outreach/enrollment and are elIgible to count as
match.
:2
HUD-40 118
An Extension APR applies to SHP and S+C grantees that requested and received an extensIOn of their granttern1 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 e:\tenslon
period and circle the operating year for which the report is an extensIOn. For example. if the grantee IS extendIng ~ eJr ~.
the grantee should submit an APR as usual for year 3 and submit another APR for the extension penod. Indl.:atmg the
second is an extension and also circling year 3 on the signature page.
Family means a household composed of two or more related persons. at least one of whom IS In adult. Caregl\ers are
not reported on in the APR.
Grantee means a direct recipient of the HUD award.
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 nOI
be considered as exiting from the program. If the person returns to S-C assisted hOUSing at'terGO days. that person IS
considered a new participant. The worksheet is designed to capture this infonnation.
Match for S-C means the value of supportive services received by participants in the S-C prolect which. in the
aggregate. must at least equal the value of the SorC 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 for SHP means 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 TR..t.. components). the first operatIng ye:lr begins on the date HUD
signs the grant agreement. For S-C'SRO and for Sec. 8 SRO. the first operating year beginS \\llh the effective date of the
Housing Assistance Payments (HAP) Contract.
To detennine which operating year to circle on the APR cover page. begin counting from the initial grant operating stan
date and include renewals grants. For example. a project receiving an initial grant for three ~'ears and a renewal grant for
two years would circle years 1. :::. and 3 respectIvely on the APR cover sheet for the initial grJnt and would circle 4 and 5
respectively for the renewal grant. For any future renewal grants. the grantee would beglll b~ CIri:llI1g b 011 the APR cover
sheet.
Participant means smgle persons and adults In families who received assistance dUring the operating ~e3r 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 Service On I\" Projects. SSO grantees should complete all questions. unless a
wrmen agreement has been reached WIth the field office concernIng which questions can be Jns\\ "red using eSlimates. or in rare
instances. skipped.
Below is an example of how infonnatJOn could be denved in a large. Single-serVice SSO prolecl
.-\ grantee'sponsor staff member could be assigned to collect mfonnatlon from the organizations housing the participants. The
staff person would contact these Individual organizations to request mformalion regardmg the persons In that facility that use
the service. For participants living on the street. the grantee'projecT sponsor may prOVide estimates
lnfonnation could be collected for each participant or for participanTS receiving services at a pOmt-ln-lime. If eStimaTeS or
pOInt-in-time counts are used. the method used must be described in the APR and the documentation Kept on file.
.-\5 wIth all projects funded under HUD's homelessness assistance grants. grantees operating SSO projects are expected to
complete ~ APR questions that are applicable to them. NOTe that all projects have been awarded funds as a result of
3
HUD-40118
responding to the program goals of assisting homeless persons obtairnemain in permanent housm~ Jne Incr~JS~ tn~lr ski! I~ :lrlJ
income. The APR documents their progress in meeting these goals.
In some circumstances field offices and grantees may sign a ....Tinen agreement concerning questions wh Ich can be ans\\er~d
using estimates. or in rare Instances. skipped. Below are some considerations for reporting on particular types of prol~CtS
Outreach Onlv Projects. - Projects which are solely devoted to street outreach and connection to housing. and s~mc~s art
not required to track participants beyond their contact with persons on the street. It is sufficient for thes~ prol~cts to ~nr~r
information on questions] -] 0 (skipping questions 11-13 and ] 7). Estimates for questions 5-9 are Jllo\\ ed. g.1\ en that
participants may be reluctant to answer personal questions.
Answering the questions will demonstrate that the grantee is serving the appropriate number of people. providing baSIC
demographic information for Congress. demonstrating that homeless persons are being served. demonstrating the types of
housing participants are connected to. and the type of services they are receiving.
Hotline Projects. - Hotline services are similar to outreach projects. but contact between grantee and participant IS often of
very short duration - people enter and leave the program nearly simultaneously. It is sufficient for these proiects 10 :ms\\er
questions] -5 (skipping -+), 10. and 14-19 (skipping 17).
Projects Providin2: Services To Children Onlv. - Projects that provide child care. after school care. counseling for
children. etc. make an important contribution toward moving a family out ofhomelessness. While the main focus of the project
is providing services to the children. it IS the adults who are reponed on in questions 6-16 of the APR. Like all other prOJects.
this type is also targeted toward getting the families into housing and increasing the families' Incomes.
Grantees may skip question 9: all other questions should be answered (except 17).
Transportation. Medical. Dental. and Other Sin2:le. Short-Duration Service Proiects. - Some grantees provide a
single service of fairly shon duration focused ONLY indirectly on assisting homeless persons to obtam,remain in permanent
housing and increase their skills and incomes. It is sufficient for these projects to enter information on questions 1-10 and 14-
19 (question] 7 may be skipped). However. with transponation services. it is unreasonable to think that someone would have
to give their age. race. and ethnicity to a bus driver to get a ride a few blocks.
For these services, provide a narrative. which gives the number of rides given during the operating: ear. and provides estimates
on the above statistics based on the population that utilizes the service.
Special Instructions For Safe Haven (SH) Proiects. - Grantees are reminded that the\ Jrt to report ONL '{ on the
number of panlclpanrs the applicatIOn was approved for (cannot exceed 2:5 participants).
Homeless Manaeement Information Svstem (HMIS) Projects. - HMIS grantees should fill out the cover sheet
of the APR (marking HMIS at the bottom) and Pan II Financial Information. The APR also has a shett that lists HMIS
activities.
-+
HUD-40118
THIS PAGE - TO BE COMPLETED BYALL GRA/\'TEES
Grantee.
CllLi
btc VV"l. \ 4C\-1Yl \
f6 E~C ,-1
HLD Grant or PrOI~;':1 \unH"o:r
ProJect Sponsor:
ProJectl\ame
Operating Year: I Circle the operating \ ear being reported on)
01 O~ 03 o.~ 0' 06 07 08 09 010
011 Ol~ 013 014 oJ~ 016 017 018 019 020
Indicate if extensIOn. [J Yes 0 No
Indicate If renewal: ~ Yes 0 No
PrevIOus Grant Numbers ior thiS proJect:
Repor11ng PO:fJOJ Illt,111111 uJ\ \ ,ar I
from:
Il'
Check the component for the program on which you are reponing.
Supportive Housing Program (SHP)
Shelter Plus Care (S+C)
Section 8 Moderate Rehabilitation
o Transitional Housing
o Permanent Housing for Homeless
Persons with Disabilities
o Safe Haven
o Innovative Supportive Housing
~ Supportive Services Only
o HMIS
o Tenant-based Rental Assistance (TR.A)
o Sponsor-based Rental Assistance (SRA)
o ProJect-based Rental Assistance (PR.A)
o Single Room Occupancy (SRO)
o Singk Room Occupanc~
ISec. S SRO)
Summary of the project: (One or t\\O sentences \\Ilh a description olDopubtlon. numtler s.:r\eJ JnJ Jl:Ll1n1r I 1>llll1l:nt, 1hl' l'n~r~lllng. :<.:arl
''')'''00'
L
.~-----
// ../
" /
C (
erson who can answer quesll~ aboul IS report
Phone Ilnclua, Jr,;l ~"J, I
-\ddress
t;J\ ~umot:r I m..:luCt: .~:~:t \,;Od~l
E -mati Address
I hereby certify that all the Information stated herein is true and accurate.
Warning: HL'D will prosecuto: false claims and statements ConVictIOn ma: result In criminal and or CI\II r,n:JIII<':s II X L'.S C 100].
1010.101::. 31 L'S.C 3-::9. 380::1
"ame 6: Title ut AuthOrized Grantee ufficlal ~I~nalure 6.: Dale
:)Dj2-C\E- ,vl' crO{\..YZ.I\L.E2 \ c.\t'1 MA,.JJf:{tf-
'..3me and Title of Auth',r,zed I'ro.lecl :>pon,or uff'Cl31
')Ignalure 6: Dale
\:
5
HUD-40118
PART 1. TO BE COMPLETED BYALL GRANTEES (EXCEPT HiHIS)
SSO GRANTEES, PLEASE SEE SPECIAL I.\'STRUCTIO.\'S OS PAGE 3 OF THE .4PR
Part I: Project Progress
1. Projected Level of Persons to be served at a given point in time. (from the application. SHP- "~-.:. F. ~PC- "c:, Ii
SRO- Sec. D)
I ~umoer of \.umna (\1 I 'UI1l["l~r ell \'UI11t1t:r l'l!
Singles ~ot Adult; In I ~'hlidrc:n I.JmlllC'~
Proiected Level In Families Famtlles ! In f'amll,,:;
Persons to be served at a gIven pOInt In lime I I i
a. I !
2. Persons Served during the operating year.
~umber of I :--'umber 01 I '-umoc:r (11 I \ umbc:r ,1'
Singles ~ot In Adults In lhlidn:n In I Famill"
I
Families Famtlle, I F.1nl1 11t::- I
a. Number on the tirst day or' the operatIng year I I I I
b. Number entering program dunng the operatIng;. ear I I I
I I
c. Number who left the program during the operallng year I I I I
I
d. Number in the program on the last day of the operatIng year I I I I
(a+b-c\=d
3. Project Capacity.
I \umber of I ~umber LlI I '-umber ,)1 I :\umber 01
Smgles Not In Adults In Chtldren In Famlltes
Famtlles Famtltes F.tmtltes
a. Number on the last day (from 2d. columns I and ~) I
b. Number proposed In appilcallon I from I a. columns 1 and ~) I
c. CapacllY Rate (diVIde a b\ b\ = 00 I 00 I 00
~. Non-homeless persons. This question is to be completed for Secnon S SRO proiects
How many Income-eliglbk non-nameless persons \\ere housd b\ the SRO Drogram dunng the oneralmg : eJ:
5. Age and Gender. Of those who entered the proJect during the operating year. ho\\ mam people are In the follo\\mg age
and gender categones')
Sinl!le Persons (from 2b. column 1) I . -\2.~ \ 1 JIc: : h: 1l1:J Ie
I a , 62 and l)\ er i I
I b i ::] -6] ,
I I
c. I 31-50 , I
I d. I 18-30 i I
e I ] 7 and under I I
I I I I ,
Persons in Families (from 2b. columns 1 & 3) I 1" ! b2 Jnd over I i
g I ::] - 61 I I
h. i 31 - 50 I I
I i J 8 - 3U I I
I
I i 13-17 i I
k. , 6-12 I I
i
I I. i 1-5 I I
I
I m L.nder I !
6
HUD-..O 118
Answer questions 6 _ 10 only for participants who entered the project during the operating year (from 2b. columns IS:::: I
The term participant means single persons and adults in families. It does not include children or caregivers. NOTE. The tot;).l
for questions, 7, 8 and 10 below should be the same; respond to each of those questions for all participants. Some of the
questions listed throughout the APR will be asking information for individuals who are chronicalh homeless.
6a. Veterans Status. A veteran IS anyone who has ever been on aCllye milllary dut) status
How many participaOls were \'eterans0
6b. Chronically homeless person. :'\n unaccompanied homeless individual with a disablmg condition vv ho h:b tither b~en (l)ntJnUL)U~I:
homeless for a year or more OR has had at least four (4) episodes of homelessness In the past three (3) ye;us To be considered
chronically homeless a person must have been on the streets or in an emergency shelter (i.e. not transitional hOUSIn~) dunn~
these stays. - -
How many participants v\ere chronically' homeless individuals?
7. Ethnicity How many partlcipaOls are in the following ethnic categories"
His amc or LatInO
Non-Hispanic or \.ion-Lallno
8. Race. How many partIcipants are In the follOWIng racial categories0
a. Amencan Indian Alaskan \.iatl\'e I
b. Asian
c. Black/African AmerICan
d. Native Hawaiian/Other Pacllic Islander
e. White
f American Indian'AlasKan \iatlve 6: While I
e. Asian & White
h BladJAfrican Amencan 6: White
L I American Indian/Alaskan \.iative &: Black. Afncan A.mencan
I Other t\,'lulti-Raclal
9a. Special1'ieeds. How many oa!1iclpants han: the following' PartlcloaOls mav have more than one
lfso. count them In ~II applicable categones For each condition. also mdlcate the numoer
that were chronically homeless.
a. I MeOlal illness I I
b i Alcohol abuse I ;
~. I Drue abuse I I
J I HIVAIDS ana relatea diseases I I
I
e. I Develoomental dlsabtlll\ I !
1. I Phvsical dlsabilllv I i
c I Domestic violence i I
I
h. i Other I olease SDeclT\ , , ,
I
.~II ChroniC
9b
Hov\
! I:
of
the
rartlclDanb
ar~
dlsahled"
7
HUD-40 118
10. Prior Living Situation. Ho~ many pamcipants slept In the follOWing places In the \\ee\.; Prior to enterIng the prolect' \ ~l'r ':Jch
partiCIpant. Choose one place). Also. Indicate how many chronicall~' homeless partIcIpants slept In the 1'0110\\ I ng plJces I ChlX)S~ ,me I
All Chronic
a. I Non-hOUSing (street. park. car. bus station. etc. I I I
b. Emergencv shelter I
c. TranSitIOnal hOUSInl2 for homeless persons I
d. PsychiatrIc facilit\..
e. Substance abuse treatment facilitv' I
f. Hosoltal'
l2 Jail/orison'
h. Domestic violence situation
I. Livinl2 with relatives/friends i
J Rental housinl2
k. Other (please soecl1'\ I I
'If a partIcipant came from an institution but was there less than 30 days and \\ as lIVing on the street or In
emergency shelter before entering the treatment facility. he/she should be counted In eilher the street or ,Ildtcr
category. as appropriate
Complete questions 11 - 15 for all participants who left during the operating year (from 2c. columns I and 2) The term
participant means single persons and adults in families. It does not include children or caregivers. The tenTI chronically
homeless person means an unaccompanied homeless individual with a disabling condition who has either been continuously
homeless for a year or more OR has had at least four (4) episodes of homelessness ID the past three (:; ) years. To be considered
chronically homeless a person must have been on the streets or in an emergency shelter (i.e. not transitIOnal housmg) during
these stays.
11. Amount and Source of !\tonthly Income at Entry and at Exit. Of those partiCIpants who left dUring the operating year. how many
participants were at each monthly income level and With each source of income~ Also. please place the monthly Income level and each
source of income for chronically homeless persons In the second column ot each chart. The number at partiCipants In Chart A and B
should be the same.
o\1J Chronic
I i .-\ \lonthh I ncome at EnlT\' I I I
a. i '-'0 Income I ! -1
I
b. I 5 I-ISO I I
I I
I 5]51-5::50 I i I
C. I I
d. I 5251- 5500 ! !
e. I 550 I - 51.000 I i I
I
I i 51001.5]500 ! i
g I 5 I 50] - 52000 i i I
I
h , 5::00] - I !
I ,
All Chronic
I I C Income Sourcc:, .,\1 [ntn I
I J. I Suppiemc:ntal Securl1: Incomc (~Sll I I
I
: b i SOCial Securl1\ DIsaPllIt\ Inc0m<: ISSO!I i
I ( I SOCial Sc:curil\ i
,
i d I General PUblIc .-\ssIStancc: I
i c: I T emporar\ .-\Id ((\ "eed: F~mlllC:' II .\" F I i
I t I State Childrens Health insurJncc: I'rl)~,.lm I SCH]P\ I
~
I g. I Veterans BenerJts !
I
I h. i Emplo\ment Income I
I I I Lnemployment Benefits !
,
I I I Veterans Health Care i
i
I J.... I 7\1edlc:l1d I
I
I. I Food Stamps I
mi Other I please speC![) I I
n I ~o FinanCial Resources I
8
HUD..l(} II 8
AJI Cbronic
-\U Chrome
B. Monthly Income at Exit
a. No Income I
b. SI-150
c. S 15] - $250
d. $251- 5500
e. S50 I - S 1.000
f. S100I-S1500 I I
g. S1501- $2000 I
h. $2001. I
I D Income Sources at E\it I I
a. Supplemental Security Income IS5]) ,
b. Social SecurITY DisabilITY Income (SSOl i i
c. Social Security , !
I
d. General Publtc ASSistance I i
e. Temporar: Aid to Needl Fam1ile~ (T.-\'-F I :
r State Children's Health Insurance Pwgranl ("CHIP, I
g. Veterans Benetits I i
h. Emplo:-'ment Income i 1
I. L;nemployment Benefits i
I
J. Veterans Health Care I I
I
1-;. Medicaid I I
L I Food Stamps i
m I Other \please specl!:>) I !
I
I n. I No Financial Resources I I
I
12a. Length of Stay in Program. Of those panicipants who left during the operating year (from 2c. columns 1 and 2). h011 many were In
the project for the following lengths of lime? Also. please place the length of stay for chronically homeless persons In the second
column.
All Chronic
I Less than I month I I
a. I
b lIto 2 months I I
c. I 3 - 6 months I I
,
d. I ..., months - 12 months I !
. I 13 months. 2.. months . I
r j 25 months - ~ I eJrs i I
~. ! .. I ears - 5 lears I
h i 6 I' ears - ..., leJrs
I. I 8 lears - ] 0 I'ears i !
I 1 Over 10 years I
I1b. Length of Stay in Program. For those paniclpants that did not leave during the oDer:ltlng : ear (lrom 2J. c,)lumns 1 and 2). h011
long have they been In the prolec!'.' Also. please place the length 01 stay for chronically homeless persons In the second column.
All
Chronic
J i Less than I month I ,
I
b ! I to 2 months I !
I
C i 3 - (J months ! i
d ' - months - 12 months I ,
, 13 months - 2-1 months I
~ . I ,
f ! 25 months - 3 I ears I !
g I -I I ears - 5 I'ears I
h I olears- ..., I ears i I
I ! 8 I ears - I 0 I eJrs I I
I i Ol'er 10 lears 1 I
9
HUD-40118
13. Reasons for Leaving. Of those panlclpants who left the project dunng the operatIng :ear (tram 2~. -:oiumn, I JnJ : I. hIm m:1r~\
left for the folloWIng reasons" If a panlclpant left for multiple reasons. include onll' the primary reason .-\b,\. rk:l"~ riJ(~ tn~
primary reason for chronically homeless persons in the second column
a. Left for a hOUSIng opportunity before completIng program i
b. Completed program
c. Non-payment ot renvoccupancy charge
d Non-complIance with project
e. CrimInal actIvlt\ destruCtIon of property, vIolence I
f. Reached ma'\tmum time all 0\\ ed In project I
g. Needs could not be met by prolect
h. Disagreement WIth rules/persons
1. Death
J Other (please speclf:> ) I I
k. Unknown/dIsappeared I
All Chronic
14. Destination. Of those partIcipants who left dunng the operating year I from 2c. columns I and 21. ho\\ n1:ln\ [eti for
the followmg destmatlOn" .':"'150. please place the destInatIon of chronically homeless persons In the second cl'iumn
PERMANENT (a-h) i a. Rental house or apanment I no subsld: I I
I b, Public Housing I
c. SectIon 8 I
d Shelter Plus Care i
e. HOME subsidIzed house or apartment I
f. Other subsidized house or apartment !
g Homeo\\'nershlp !
h \loved In \\ith family or fnends I
TR..:...NSlTIONAL II-I) I Transltlonal hOUSIng for homeless persons
I I
I. i \10ved in \\ Ith famil: or fnends
INSTITL'TIO:\ I k-m I i "". I Ps\ch Iatric hosoltal
I I Inpatient alcohol or other drug treatment IJCllil\
I m I JaIl:pnson :
E\lERGE1\iCY SHEL TER I n I i n. I Emergency shelter
OTHER lo-q) I o. I Other supportive housmg I
r p I Places not meant lor human habltatlun leg stn:e: I ,
r'1 I Other I please speclt\ I
L0IK'.J 0 \\1< I r I Lnkno\\n
-\11
Chronic
]0
HUD-40JI8
15. Supportive Services. Of those participants who left dunng the operating year (from 2. columns I :md : j hlm mJn\ n:(::, I \ d Ih"
followmg supportIve serVIces durmg their time In the prolect" Also. please place the supportl\e 5en I(c~ re(<:I\ed I('f chronlca'"
homeless pamclpants who left dunng the operating year In the second column
All Chronic
a. Outreach I
b. Case management
C. Life skills (outSide ot case management) I
d. Alcohol or drug abuse Sel"\'lces I
e. Mental health servIces I
f. HIV / AIDS-related services I
g. Other health care Sel"\'ICeS I
h. Education
I. Housing placement
J Employment assistance I
k. Child care
1. Transportation I
m. Legal
n. Other (please specify)
11 HLJD~OI18
16. Overall Prol!ram Goals. Under objectives. list your measurable objectives for this operating year (tram \ our :lpDiI.:atlon. T ~.:nnl-:J!
SubmIssion. or APRl tor each of the three goals listed beloll L:nder Progress. describe your progress In me.:tll1~ Ine l)hle.:tllC'~
Under Next Operating Year" s ObJectlHs, speclf:. the measurable oblectl\es tor the next operatln~ : ear
a. Residential Stability
Objectives:
Progress:
Next Operating Year" 5 ObJecmes:
b. Increased Skills or Income
ObJectl ves:
Progress:
Next Operating Year' 5 0 bi eC!l\ es:
c. Greater Self-determination
Objectives:
Progress:
Next Operating Year" s Oblectives:
17. Beds. SHP recipients answer lia. S-C recipients answer lib. SRO recipients answer I"'c (SHP-SSO projects do
/lot complete this question)
a. SHP. How many beds Ilere Included in the applical10n approved for !illS prolect under 'Current LCI cl' :mo unoa '"ell Effort'~
How many otthese "ell Effort beds Ilere actual I: In place at the end of the operallng :cJr"'
Curr.:nt LeI::1
'\ell Ellon
'-CII Elllln In I'!J-:c
"umber of Beds
b. S+c. How many beds and dllelling unllS Ilere being aSSisted II Ith prolec! funds althe end 01 lh<: (l[1c:rJllnb' \ c:ar"'
IInclude beds tor all pamclpants. other lamliy members. and .:are gll ers. )
'\umber of Beds
"umber ofD\leiImg Lnlts:
.: SRO. HOII man\ dllelling units were being aSSisted at the end of the operating year~
linclude unllS occupied b\ "In place" non-homeiess persons who quallly lor assiStance. )
"umber ofDwdling Lnlls
12
HUD-40118
Part II: Financial Information
18. Supportive Services,
For Supportive Housing (SHP). this exhibit provides infonnatlon to HUD on how SHP funding tor supportl\C senlces \\as spent during
the operating year. Enter the amount ofSHP funding spent on these supportive ser\"1ces. Include H\1IS COSb under ','Other"
For Shelter Plus Care (S+Cl. this exhibit tracks the supportive services match requirement. Specify the value or' SUppLlrtlve sen Ices (rom all
sources that can be counted as match that all homeless persons received during the operating year, (S-( f:r;:lnlCCS Sh,IUiJ kccr
documentatlon on file. including source. amount. and type of supportive ser.lces.)
For Section 8 SRO. this exhibit pro\'ides infonnation to HUD on the value of supportl\e senlces recel\ cd r\ homeless persLlns dUring the
operating year.
SupportIve Services Dollars
a. Outreach
b. Case management
c. Life skills (outside ot case management!
d. Alcohol and drug abuse servtces I
e. Mental health services I
f. AIDS-related services
g. Other health care services
h. EducatIon
I. HOUSing placement I
J Employment assistance
K, I Child care I
I I T ransportatlon I
I
m. I Legal i
,
n, Other (please spew'. I l
o. TOT AL (Sum or' a lhrough n I I
I Cumulative amount ot match provided to date tor the I
Shelter Plus Care Program under this grant
13
HUD-40118
19. Supportive Housing Program: Leasing, Supportive Services. Operating Costs. HMIS Activities and Administration
All grantees receIVIng funding under the Supportive Housing Program mUSl compkte these chartS each operJtln~ I eJr For f\panSlon
projects: If SHP granl funds are ior the expansIOn of a pre-exisllng homeless facillI:. only the peopk and e'\):'endnure, ll'r tile JuJltll)Il.\;
expansIOn may be included. as In the original applicallon or any grant amendments. Documentallon 01 resources ust:d I, not reqUired r,' bc'
submmed with this report but should be kept on file for possible inspection b~ HUD and AudIlors Do not Include am e'\penonure, malic'
before the SHP \!rant was e'\ecuted
Summary of Expenditures Enterlhe amount ofSHP grant funds and cash match expended dUrIng the oreratlng \t:ar lor each actll 11\
This table should add up both hOrIZontally and vertically. The SHP Support1ve services total should be the same a, the -;HP ,Urp,mlle
services in Question 18
I SHP Funds Cash Match I 1 ,11.11 L,pt:J1uIlUre,
I
a. Leasing I
b. Supportive Services I
c. Operating Costs I
d. HMIS Activities I
e. Administration I I
f. Total I I
~Ole: Payments of pnnclpal ana Inlerest on any loan or mongage may nOI be shown as an operating expense.
Sources of Cash Match. Enter the sources of cash Identiiied in the Cash 1\.latch column. abole. In the 10110" 1J1~
categories. Use additional sheets. as necessa~
I I ..\mount
a. Grantee/project sponsor cash
b. Local government I please speCify)
I
I
c. I State government I please soecI!\ I
I
I I
I I
I I
d. I Federal government I please specl!\)
I CommunlI: Development Block Grant ICDBG I
I I
I I
!
e. I F ounaallons I pleas.: specl!\ I
! I
I I
I !
t I Private cash resources I please speCify)
I
I I
I I
I
g. I Occupancy charge lees I
14
j1LjD..fU J 18
I h Total
15
HLD..WI i8
20. Supportive Housing Program: Acquisition. Rehabilitation. and New Construction
All grantees that received SHP funds for acquisition. rehabilllallon. or new construction must complete these charts In the I ~Jr one .-\..PR
only. This exhibit will demonstrate to HUD that the grantee has contributed enough cash to at least equalh match th<: amount ,)1 SHP tunu'
spent for acqulsllion. rehabilllation. or nell' construction. Documentation that matching funds \\ere prol Ided I:' not re4ulr~j Il' be ,uDmlIIe~
with this repon but should be keDt on file for Dosslble InsDection b\ Hl:D and Audllors
Summary of Expenditures. Enter the amount of SHP grant funds and cash match exp<:nded dUring the l)['l~rJl1n~ \ e.lf (llf ~.leh .lel11 It\
I SHP Funds I Cash \Iatch I T otai 1: \['l<:J1ullUre,
a. Acqulslllon I I
b. Rehabilllallon I i
c. New constructIOn I I i
I
d. Total I I I
Cash Match. Enter the sources oi cash idenllfied in the Cash Match column. above. In the following categories l s<:
addillonal sheets. as necessary.
I I Amount
a. I Grantee:proJect sponsor cash !
b Local government (please speclr) ) I
I
I
I I
c. I State government (please specIl") I
I
I
I I
d. I Federal government Ipiease specl!\l !
I Communll\ De\ eiopment Block Grant I CDBG) I
I
I
I
e. I Foundations (please sDecl!\1 I
i
I I
I i
I
f i Prl\ ate cash resource's I D lease spec I !\) I
! !
I i
I i
g. ! Occupancy charge tees I
I
h I Total !
16 HLD--lOI18
FOR HMIS ACTIVITIES O.NLY
21 For Supportive Housine: (SH?) - HMIS Activities
This exhibit provides mformallon 10 HUD on how SHP-HMIS fundmg tor supponl\e s~[\ Ices \\as srent during the operating \ear. E~,c
the amount of SHP-HMIS funding spent on these aClIvllies.
HMIS Activities Only ! Dol/ars
EQuipment
Central Server! s)
Personal Computers and Printers
Networking
Security i
Subtotal I.
Software
Software I User Licensing I
Software Installation
Support and Maintenance
Supporting Software Tools
Subtotal I
." Services
Training by Third Parties I
Hosting I Technical Services I
Programming: CuslOmization I I
Programming: Systern Interface i
Programming: Data Conversion ,
,
Security Assessrnent and Setup i t
On-line Connect!vln ( Internet Access) i i
F acIlnatlon
Disaster and Recovery
Subtotal
Total
17
IlLD.40 118
Describe any problems and/or changes implemented during the operating year.
Technical Assistance and Recommendations
Based on your experience durmg the last year. are there an~ areas in II hich you need technlc:J.1 ad\ Ice or assl~tanc~') II so. pkase descrIbe
J8
HL:D-.WI18
Annual Certification of Continued Project Operation
Supportive Housing Program
l\J! /1-
. 1/\
Project Number:
Project Name:
Operating Start Date:
Grantees that received Supportive Housing Program funding for new construction. 3cquisition. or
rehabilitation are required to operate their facilities for 20 years.
1, , certify that the facility that
received assistance for acquisition, rehabilitation, or new construction from the
Supportive Housing Program has operated as a facility to assist homeless persons from
to ;. I also certify that the grant is still serving number of
(mo/yr) (mo/yr)
persons at
(site address)
and all the requirements of the grant agreement are being satisiied.
( Signature)
(Title)
(Date of Certification)
"'Current Year
19
HUD-40118
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Instructions and Codes for Persons Served Worksheet
The use of this worksheet is optional. It was designed
to help you collect informallon 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 Informallon required
for completion will be contained 111 the worksheet. Do
not submit this worksheet With the APR.
For projects that serve iamilies. HUD only requires
reporling 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 completed for children. Assign the adults a
number. but not each family member. Lse this number
to transfer to the other pages of the worksheet.
Beginning with number 4. the numbers In the columns
refer to the queslions on the APR form. If an~
questions are answered with "Other." please enter the
specific "Other" answer for InclUSIOn In the APR.
Participant Number. This column allows ~ou
to either number parliclpants conseculively or to
assign a case number. One number should be
assigned to each adult.
Name. Names of persons will not be reported to
HUD. The use of names IS for your record keeping
convenience.
Relationship. Enter the appropriate relationshIp.
Examples include' Selt". He~d of household. Spouse.
Child.
Entry Date. Enter date p~rllclpant entered the
Q.IQ.l.lli. Lsualh this" III be the date or ~ctual
phYSical mo\'e-In ior ~ hOUSing prolect
Exit Date. Enter dat<: partiCipant left the t'fOJect
L'suall; thiS will be [h<: date the partiCipant
ph~slcally mo\ed out ror ~ hOUSing proJect Do not
Include a parllclpant \1 ho temooraril; left th<: proJect
and IS expected to relurn In less than 9U days (e.g'
hospitalization)
-1 Income-eligible :\on-homeless in SRO The SRO
program allows assistance 10 units occupied bl
Seclion 8 Income-eil2.lble oersons resldlnl! at the
SRO prior to rehabliitatlo~ For SRO proJ-ects
onl~. Indicate whether Ihe oartlclpanl IS an
Income-eligible:. non-homeiess person (Y) or not
( :\) S H Pan d S - Cpr 01 e c t s s h 0 u Ids k J P t his It em.
5a Date of Birth. Enter date of birth including
month. da~. and \ear
5~ Age. Enter age at entf\
5c Gender. Enter apprOprlJ.lc Jetter for ge:1der
\1-\lale F - Female
6a. \eterans Status Inolcale If th, rartl,,'lraI11 !' _
\"etC'ran Pleast? nOlL' .-1 \'l~lt'rQn :S J!:' (l!/t \\ ':1'
has e\'er oeen on ri.c!!\'e mlluar\ dUl\ SI...1:1..\ ,'(11"
lil" L nlled S/alfS
6b Chroncally homeless person indlcalC the
number ot" partiCipants that are chrLlnlcalh
homeless
i. Ethnicity. Enter appror,lale iettn It'r elhnlC
group.
a. HispaniC or Lalino
b. 1\on-Hlspanlc or ~on-Latlno
8. Race. Enter appropriate letter for race
a. American Indian or ,Al3skan :\atl\e
b. ASian
c. Black or Afrlcan-Ameflcan
d. ~atlve HawaIIan or Otner Paclt"lc b~Jndcr
e. \lihile
f Am e r 1 can In d I a n .A I ash. J n "3 t I \ e t.: \\ h II C
g. Asian &: While
h Black/African American &: \\hlt<:
I American Indian .Alash.an 'v:atl\e &
Black/African American
Other \:lulll-Raclal
9a. Special !'ieeds. Enter the letter( s I for the
categor~lies) that desolbe the partiCipant's
disabilitY(I<:sl. (You ma~ double count)
a. Mental illness
b. Alcohol abuse
c. Drug abus<:
d. HIV/AIDS and related dls<:3ses
e. De\elopmental dlsabillt\
1'. PhYSical disabilities
g Domestic \ ILJknce
h Other (please SP':CI(I I
C)b Enter th~ numb<:, (11 f1~lrlIClpJI1:S "Ith J dlsabillt\
III Prior Living Situation. :: !1\er the ktter that best
describe, "hne tile [1JI.tl-:l[1aI11 ,lept 111 the \led,
prior [0 entering the prlllect Dn not double
cou n t
:1 ~ 0 n - h 0 U sin g (s t r c c: !. D J r ~, ... Jr. h us:' t 3. t Ion. ~ tel
b Emergen,'~ Sl1ell':,
c TranSitional housln~ fur ~,'mekss persons
J. PsychiatriC lacllltl'
e Substance aDUS<: tr.:atment :.1,'lllt"
r Hospital'
g. Lid/prison'
h Do m es 11 C I 10 I en c <: 'It U a II (1 11
I L j \" I n g \I 1 t h r d 3tl \ e S tr I e no'
.1 Rental hOUSing
I-: Other (please sp~C1I:)
'If a partiCipant came Irom In Institution but
I\as there less than 311 da\ 0 .ll1d \I 3S III In!: on th<:
street or In 3n emergencI snelt<:r berore e;l<:rlnl! th<:
fJClllt\. he. she shouiJ be cLJunl<:d In either the :trc<:t
or shelter categor\. JS Jf1prl'[1rI3te
,,~
-~
HUD-10118
Instruction Codes for Persons Served
Worksheet (conllnued)
lla.Gross Monthly Income at Project Entry
Enter the amount of gross monthly Income the
participant is receivIng at entry Into the project.
Ilb.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 Enlry.
Enter all types of assIstance the partiCipant IS
receiving at entry to the project.
a. Supplemental Security Income (SSI)
b. Social Security Disability Insurance (SSDI)
c. Social Security
d. General Public Assistance
e. Temporary Aid Needy Families (TANF)
f State Children's Health Insurance Program (SCHIP)
g. Veterans benefits
h. Employment Income
i. Unemployment benefits
J. Veterans Health Care
k. Medicaid
1. Food Stamps
m. Other (please specil"y)
n. No Financial Resources
lld.lncome Sources Received at Project Exit
Enter all types of income the partiCipant IS
receiving at project eXit (Use codes as In 1\ c.
I 2a Length in Stay in Program Calculated Item
I See Enlr~ Date and E\lt Date above.)
12b. Length of Stay in Program (PartiCipant did
not leave during the operallng ~ <:ar. Ho\\ long
have the~ been In the projeC1"'1
13 Reason for Leaving Project. Enter the p[lmar~
reason why the participant left the prolect
IComplete on'> for partiCipants I\ho Idtthe
prolect and are not e:vpected to return WIthin 9()
days.
a. Left for a housing oppO[lunlt~ hefore
complellng the program
h Completed progr:lm
"ion-pa\ ment of rent'occupanc~ charge
d. "ion~compllance \\Ith DrOlect
e' Criminal aCllI 1l~ destrucllon of property/
\Iolence
f Reached ma'\lmum lIm<: allowed in project
g >v:eeds could not be met by proJect
h Disagreement 1\ Ith rules pcrsons
I. Death
J Other (please speCify I
K. Lnkno\\'nidlsappeared
14. Destination. Enter the destination of Ihl\~C
leal Ing the prolecl
Permanenl:
:1. R e n tal h 0 u s <: 0 r :1 Dart men I I n l' 'u h ~ I J \ I
b PubliC HOUSing
C Seclion 8
d Shelter Plus Care
e HOME SUbSIQIZeO IlL\U,e or apartment
f. Other subsld Ized hou,c or ap:1rtment
g. Homeownershlp
h Mo\ ed In 1\ Ilh t:1n1II\ l'r f[lcnds
Transitional:
i. Transllional hOUSIng for hom.:le" persL1ns
I Moved In \\ ilh famll~ or friends
Institution:
k. Psychiatric hospilal
1. Inpallent alcohol or drug treatment facilit\
m. Jail/prison
Emergency:
n Emergenc\ shelter
Other:
o. Other SUpportl\ e hOUSing
p. Places not meant for human habItation
(e.goo street)
q. Other (please specify)
Unknown:
r. unknown
15. Supportive Services. Ent.:r ill t~ p<:s of
supportive sen Ices Ih<: partiCipant r<:cclved durIng
th<: time In the fHOJCct
a. Outreach
b Case management
c. Life skills \outsld<: of cas.: management)
d. Alcohol or drug ahuse ,en Ices
e \lental health Ser\IC<:~
f. HI\' .-\lDS-rel:lt.:J SCfI Ices
g. Othn he~lith car~ '~r\ Ices
h. Education
I HOUSing placement
E mp I o\'men I JS>I '\.1 ~ cC
K Child care
I TransDortallOn
m Lega:
n Other [pkase Sp<:CII\ I
2-+
HUD-40118
.t'age 1 or 4
;)erVICerOlm - tiUU ,+VIIO Kepon
ATTACHMENT &--1
Miami Dade Homeless Trust Jun 14, 2006
Servic~oAnf~
Connecting your community.
Home
CllentPolnt
ResourcePolnt
ShelterPolnt
SkanPolnt
~Reports
Miami-Dade County Government /
Logoff
HUD Annual Progress Report (HUD-40118)
Report Options:
[II Undupllcated 0
Provider
I-select-
I Miami-Dade County Government (# 1) .
105/01/20061 to 105/31/20061 (mm/dd/yyyy)
Operating Year Date Range
Legal Adult Age
~ (as defined by foster care law in your state)
t"<"'(~'d~>t\';". ~w?t~ 1<:::'~~: ;."~<^;~ ;<Tj '1
Ii! :j~1..!lJr.'~~ic,j.M'jJ",,\;,.1
l,f;;r,o, "^ (i "~A t.'" .,,0
Or
., ~ ' ~i;~'" ~ft, ~ i' ~I;l'
",0 ~:;j~lpy~.~:,~t\ll!tVgJ;1~"~:, ",;
I-select-
lri
Number of Singles Number of Adults Number of
2. Persons Served during the Children in
operating year. Not in Families in Families Families
a. Number on the first day of the 0 0 0
operating year.
b. Number entering program during the 0 0 0
operating year.
c. Number who left the program during 0 0 0
the operating year.
d. Number In the program on the last day 0 0 0
of the operating year. (a+b-c=d)
Number of Singles Number of Adults Number of
3. Project Capacity. Children in
Not in Families in Families Families
Number of
Families
o
o
o
o
N\.Imber of
F""milies
o
o
a. Number on last day (from 2d, columns
1 and 4)
4. Non-homeless persons. (Sec. 8 SRO projects only)
How many Income-eligible non-homeless persons were housed by the SRO program during the operating
year?
5. Age .and gender.
Single Persons (from 2b, column 1)
Age
a. 62 and over
Male
Persons in Families (from 2b, columns 2 & 3)
b. 51 - 61
c. 31 - 50
d. 18 - 30
e. 17 and under
Not given
f. 62 and over
9.51-61
h.31-50
https://www3 .servicept. com/miami/scripts/svpreporthud. php
o
Female
OtherjNpt given
o
o
o
.0
;0
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
6/14/2006
ServicePoint - HUD 40118 Report
.Page 2of4
i. 18 - 30 0 0 0
j. 13 - 17 0 0 0
k. 6 - 12 0 0 0
I. 1 - 5 0 0 0
m. Under 1 0 0 0
Not given 0 0 0
6a. Veterans Status.
A veteran Is anyone who has ever been on active military duty status. 0
6b. Chronically Homeless.
How many participants were chronically homeless individuals? 0
7. Ethnicity.
a. Hispanic or Latino 0
b. Non-Hispanic or Non-Latino 0
8. Race.
a. American Indian or Alaskan Native 0
b. Asian 0
c. Black or African American 0
d. Native HawaIIan or Other Pacific Islander 0
e. White 0
f. American Indian/Alaskan Native & White 0
g. Asian & White 0
h. Black/African American & White 0
i. American Indian/Alaskan Native & Black/African American 0
j. Other Multi-Racial 0
k. Other/Unknown (all that do not match) 0
9a. Special Needs.
All Ch~onic
a. Mental Illness 0 :0
b. Alcohol abuse 0 iO
c. Drug abuse 0 ;0
d. HIV/AIDS or related diseases 0 :0
e. Developmental disability 0 0
f. Physical disability 0 0
g. Domestic violence 0 0
h. Other (please specify) 0 ,0
9b. Disabled.
How many of the participants are disabled? I 0
10. Prior Living Situation.
All Chronic
a. Non-housing (street, park, car, bus station, etc.) 0 0
b. Emergency shelter 0 0
c. Transitional housing for homeless persons 0
d. Psychiatric facility 0
e. Substance abuse treatment facility 0
f. Hospital 0 .
g. Jail/prison 0
h. Domestic violence situation 0
i. Living with relatives/friends 0
j. Rental housing 0
https://wvvw3.servicept.comlmiami/scripts/svpreporthud.php
6/14/2006
.........._.L '1'.1......."").. '-'-l.L.L... ..L..L'-'~ IV.,I. J.V .a........_!-"V.,l.r..
L '"'"51:0 .J Vi "t
k. Other (please specify) I 0 I
11. Amount and Source of Monthly Income at Entry and Exit.
Amount A. Monthly Income at Entry B. Monthly IncClme at Exit
All Chronic All C~ronic
a. No Income 0 0 0 0
b. $1-150. 0 0 0 0
c. $151 - $250 0 0 0 0
d. $251 - $500 0 0 0 0
e. $501 - $1000 0 0 0 0
f. $1001 - $1500 0 0 0 0
g. $1501 - $2000 0 0 0 0
h. $2000 + 0 0 0 0
Source C. Income Sources at Entry D. Income Sou~ces at Exit
All Chronic All C~ronic
a. Supplemental Security Income (551) 0 0 0 0
b. Social Security Disability Insurance (SSDI) 0 0 0 0
c. Social Security 0 0 0 0
d. General Public Assistance 0 0 0 0
e. Temporary Aid to Needy Families (TANF) 0 0 0 0
f. State Children's Health Insurance Program (SCHIP) 0 0 0 0
g. Veterans benefits 0 0 0 0
h. Employment Income 0 0 0 0
i. Unemployrnent Benefits 0 0 0 0
j. Veteran's Health Care 0 0 0 0
k. Medicaid 0 0 0 0
I. Food Stamps 0 0 0 0
m. Other (please specify) 0 0 0 0
n. No financial resources 0 0 0 0
12a. Length of Stay in Program. (Participants who left during operating year)
All .Chro~ic
a. Less than 1 month 0 0
b. 1 to 2 months 0 0
c. 3 -6 months 0 0
d. 7 months - 12 months 0 0
e. 13 months - 24 months 0 0
f. 25 months - 3 years 0 0
g. 4 years - 5 years 0 0
h. 6 years - 7 years 0 0
i. 8 years - 10 years 0 0
j. over 10 years 0 0
12b. Length of Stay in Program. (Participants who did not leave during operating year)
All Chronic
a. Less than 1 month 0 0
b. 1 to 2 months 0 0
c. 3 - 6 months 0 0
d. 7 months - 12 months 0 0
e. 13 months - 24 months 0 0
f. 25 months - 3 years 0 0
g. 4 years - 5 years 0 0
https://www3 .servicept.com/miamilscripts/svpreporthud. php
6/14/2006
0CIVll,;CrUlllL - nULl ,+VIIO .K.c:;pvn
rage 4 or 4
0 0
h. 6 years - 7 years
i. 8 years - 10 years 0 0
j. over 10 years 0 0
13. Reasons for leaving.
All Chronic
a. Left for a housing opportunity before completing program 0 0
b. Completed program 0 0
c. Non-payment of rent/occupancy cha rge 0 0
d. Non-compliance with project 0 0
e. Criminal activity / destruction of property / violence 0 0
f. Reached maximum time allowed In project 0 0
g. Needs could not be rnet by project 0 0
h. Disagreement with rules/persons 0 0
i. Death 0 0
j. Other (please specify) 0 0
k. Unknown/disappeared 0 0
14. Destination.
All Chronic
PERMANENT (a - h) a. Rental house or apartment (no subsidy) 0 0
b. Public Housing 0 0
c. Section 8 0 0
d. Shelter Plus Care 0 0
e. HOME subsidized house or apartment 0 0
f. Other subsidized house or apartment 0 0
g. Homeownershlp 0 0
h. Moved In with family or friends 0 0
TRANSITIONAL (i - j) i. Transitional housing for homeless persons 0 0
j. Moved In with family or friends 0 0
INSTITUTION (k - m) k. Psychiatric hospital 0 0
I. Inpatient alcohol/drug treatment facility 0 0
m. Jail/prison 0 0
EMERGENCY SHELTER (n) n. Emergency shelter 0 0
OTHER (0 - q) o. Other supportive housing 0 0
p. Places not meant for human habitation (e.g. street) 0 0
q. Other (please specify) 0 0
UNKNOWN r. Unknown 0 0
15. Supportive Services.
No supportive services found.
ServicePoint version 4.01.018 (db build #0723)
licensed to: Miami Dade Homeless Trust
@ 1999-2006 Bowman Systems L.L.C. All Rights Reserved.
CPT only @2004 American Medical Association. All Rights Reserved.
DSM and OSM-IV-TR are registered trademarks of the American Psychiatric Association, and are used with permission herein.
ICD-9-CM @1994 National Center for Health Statistics (ICO'9 (C)World Health Organization). All Rights Reserved.
Taxonomy @1983-2003 Information and Referral Federation of Los Angeles County, Inc. All Rights Reserved.
https://www3 .servicept. com/miamilscripts/svpreporthud. php
6/1412006
ATTACHMENT H
(Rev. January 2003)
Depanment of the Tre3sury
Imernal Revenue Serv1ce
Request for Taxpayer
Identification Number and Certification
Give form to the
requester. Do not
send to the IRS.
Foon W-9
Name
C( --r--\ O;C
r V"\ \ ~L( ,~----A C H
N
Q)
0\
'"
Cl.
t:
o
Gl '"
Q.c
>..2
:-g
o ..
ct:;
._ C
Q:~
'u
~
III
Q)
Q)
l/l
BUSiness name. If different from above
O Individual!
Check appropnate box: Sole propnetCJ"
Address (number. street. and apt. Of surte no.)
t 10 D CO r-.JJ E r0({O~
{~~d
o Corporation
o Partnership 0 Other" .......,.... .. . --.
O Exempt from backup
withholding
Requester's name and address loptlonal)
G7 t::-. (.J (C
~S3\69
List account numberjs) here (optional)
Enter your TIN in the appropriate box. For individuals. this is your social security number (SSN).
However,.'or a resident alien. sole proprietor, or disregarded entity, see the Part I instructions on
page 3. For other entities. it is your employer identification number (EIN). If you do not have a number.
see How to get a TIN on page 3.
Note: If the account is in more than one name. see the chart on page 4 for guidelines on whose number
to enter.
~
or
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 (h) I have not been notified by the Intemal
Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends. or Ie) the IRS has
notified me that I am no longer subject to backup withholding. and
3. I am a U.S. person (including a US resident alien).
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup
withholding because you have failed to report all interest and dividends on your tax retum. For real estate transactions. item 2 does not apply.
For mortgage interest paid. acquisition or abandonment of secured property. cancellation of debt. contributions to an individual retirement
arrangement (IRA). and generally. payments other than interest and dividends. you are not required to sign the Certification, but you must
provide your correct TIN. (See the instructions on page 4.)
Sign Signat..e or
Here u.s. person ~
Purpose of Form II
A person who is requirecKo file an inforrnation return with
the IRS, rnust obtain your correct taxpayer identification
nurnber (TIN) to report, for exarnple, incorne paid to you, real
estate transactions, rnortgage interest you paid, acquisition
or abandonrnent of secured property. cancellation of debt. or
contributions you rnade to an IRA.
U.S. person. Use Forrn W-9 only if you are a U.S. person
Qncluding a resident alien), to provide your correct TIN to the
person requesting it (the requester) and, when applicable, to:
1. Certify that the TIN you are giving is correct (or you are
waiting for a nurnber to be issued),
2. Certify that you are not subject to backup withholding,
or
Date ~
3. Clairn exemption frorn backup withholding if you are a
U.S. exempt payee.
Note: If a requester gives you a form other than Form W-9
to request your TIN, you must use the requester's form if it is
substantially similar to this Form W-9.
Foreign person. If you are a foreign person, use the
appropriate Forrn W-8 (see Pub. 515, Withholding of Tax on
Nonresident Aliens and Foreign Entities).
onre dent alien who becomes a resident alien.
Generally. only a nonresident alien individual rnay use the
terrns of a tax treaty to reduce or eliminate U.S. tax on
certain types of incorne. However, most tax treaties contain a
provision known as a "saving dause." Exceptions specified
in the saving clause rnay perrnit an exernption from tax to
continue for certain types of income even after the recipient
has otherwise becorne a U.S. resident alien for tax purposes.
If you are a U.S. resident alien who is relying on an
exception contained in the saving clause of a tax treaty to
claim an exernption from U.S. tax on certain types of income,
you must attach a staternent that specifies the following five
iterns:
1. The treaty country. Generally. this rnust be the sarne
treaty under which you claimed exemption from tax as a
nonresident alien.
2. The treaty article addressing the incorne.
3. The article number (or location) in the tax treaty that
contains the saving clause and its exceptions.
4. The type and arnount of incorne that qualifies for the
exemption frorn tax.
5. Sufficient facts to justify the exernption from tax under
the terrns of the treaty article.
Cat. No. 10231X
Foon W.9 (Rev. ',2(03)
Foon W-9 (Rev. 1 -2003)
Page 2
Example. Article 20 of the U.S.-China income tax treaty
alloWS an exemption from tax for scholarship Income
received by a Chinese student temporarily present in the
United States. Under U.S. law, this student will become a
resident alien for tax purposes if his or her stay in the United
States exceeds 5 calendar years. However, paragraph 2 of
the first Protocol to the U.S.-China treaty (dated April 30,
1984) allows the provisions of Article 20 to continue to apply
even after the Chinese student becomes a resident alien of
the United States. A Chinese student who qualifies for this
exception (under paragraph 2 of the first protocol) and is
relying on this exception to dairn an exemptJon from tax on
his or her scholarship or fellowship income would attach to
Form W-9 a statement that includes the inforrnation
described above to support that exemption.
If you are a nonresident alien or a foreign entity not
subject to backup withholding, give the requester the
appropriate cornpleted Form W-8.
What is backup withholding? Persons rnaking certain
payments to you rnust under certain conditions withhold and
pay to the IRS 30% of such payrnents (29% after December
31,2003; 28% after Decernber 31,2(05). This is called
"backup withholding." Payments that may be subject to
backup withholding include interest, dividends, broker and
barter exchange transactions, rents, royalties, nonemployee
pay, and certain payments frorn fishing boat operators. Real
estate transactions are not subject to backup withholding.
You will not be subject to backup withholding on payments
you receive if you give the requester your correct TIN, make
the proper certifications, and report all your taxable interest
and dividends on your tax return.
Payments you receive will be subject to backup
withholding if:
1. You do not furnish your TIN to the requester, or
2. You do not certify your TIN when required (see the Part
II instructions on page 4 for details), or
3. The IRS tells the requester that you furnished an
incorrect TIN, or
4. The IRS tells you that you are subject to backup
withholding because you did not report all your interest and
dividends on your tax return (for reportable interest and
dividends only). or
5. You do not certify to the requester that you are not
subject to backup withholding under 4 above (for reportable
interest and dividend accounts opened after 1983 only).
Certain payees and payments are exempt frorn backup
withholding. See the instructions below and the separate
Instructions for the Requester of Form W-9.
Penalties
Failure to furnish TIN. If you fail to furnish your correct TIN
to a requester, you are subject to a penalty of $50 for each
such failure unless your failure is due to reasonable cause
and not to willful neglect.
CIvil penalty for false information with respect to
withholding. If you make a false staternent with no
reasonable basis that results in no backup withholding, you
are subject to a $500 penalty.
Criminal penalty for falsifying information. Willfully
falsifying certifications or affirmations may subject you to
criminal penalties including fines and/or irnprisonrnent.
Misuse of TINs. If the requester discloses or uses TINs in
violation of Federal law, the requester rnay be subject to civil
and crirninal penalties.
Specific Instructions
Name
If 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 inforrning the Social Security Adrninistration of the
name change. enter your first name, the last name shown on
your social security card, and your new last name.
If the account is in joint names. list first, and then circle,
the name of the person or entity whose number you entered
in Part I of the form.
Sole proprietor. Enter your individual name as shown on
your social security card on the "Name" line. You rnayenter
your business, trade, or "doing business as (DBA)" narne on
the "Business name" line.
Limited liability company (LLC). If you are a single-member
LLC Oncluding a foreign LLC with a dornestic owner) that is
disregarded as an entity separate frorn its owner under
Treasury regulations section 301.7701-3. enter the owner's
name on the "Name" line. Enter the LLC's narne on the
"Business name" line.
Other entities. Enter your business narne as shown on
required Federal tax documents on the "Name" line. This
narne should rnatch the name shown on the charter or other
legal document creating the entity. You may enter any
business, trade, or DBA name on the "Business name" line.
Note: You are requested to check the appropriate box for
your status (individual/sole proprietor, corporation, etc.).
Exempt From Backup Withholding
If you are exernpt, enter your narne as described above and
check the appropriate box for your status, then check the
"Exempt from backup withholding" box in the line following
the business narne, sign and date the form.
Generally, individuals (including sole proprietors) are not
exempt from backup withholding. Corporations are exempt
from backup withholding for certain payrnents, such as
interest and dividends.
Note: If you are exempt from backup withholding, you should
sUII complete this form to avoid possible erroneous backup
withholding.
Exempt payees. Backup withholding is not required on any
payments rnade to the following payees:
1. An organization exernpt frorn tax under section 501(a),
any IRA, or a custodial account under section 403(b)(7) if the
account satisfies the requirernents of section 401(1)(2);
2. The United States or any of its agencies or
instrumentalities;
3. A state, the District of Colurnbia, a possession of the
United States, or any of their political subdivisions or
instrumentalities;
4. A foreign government or any of its political subdivisions,
agencies, or instrumentalities; or
5. An international organization or any of its agencies or
instrumentalities.
Other payees that may be exempt frorn backup
withholding indude:
6. A corporation;
7. A foreign central bank of issue;
8. A dealer in securities or cornmodities required to register
in the United States, the District of Colurnbia, or a
possession of the United States;
Form W-9 (Rev 1,2003)
9. A futures commission merchant registered with the
Commodity Futures Trading Commission;
10. A real estate investment trust;
11. An entity registered at all times during the tax year
under the Investment Company Act of 1940;
12. A comrnon trust fund operated by a bank under
section 584(a);
13. A finandal institution;
14. A middlernan known in the investment comrnunity as a
norninee or custodian; or
1 S. A trust exempt from tax under section 664 or
described in section 4947.
The chart below shows types of payments that may be
exernpt frorn backup withholding. The chart applies to the
exempt recipients listed above. 1 through 1 S.
If the payment is for. . . THEN the payment is exempt
for . ..
Interest and dividend payments
All exempt recipients except
for 9
Broker transactions
Exempt recipients 1 through 13.
Also. a person registered under
the Investment Advisers Act of
1940 who regularly acts as a
broker
Barter exchange transactions
and patronage dividends
Exempt recipients 1 through 5
Payments over 5600 required
to be reported and direct
sales over 55.000 '
Generally. exempt recipients
, through 7 2
'See Form 1099-MISC. Miscellaneous Income. and its instructions.
Z However. the followmg payments made to a corporation (including gross
proceeds paid to an attorney under section 6045(0. even if the attorney is a
corporation) and reportable on Form 1099-MISC are not exempt from backup
withholding: medIcal and health care payments. attorneys' fees; and payments
for services paid by a Federal executive agency.
Pa<J€ 3
Part I. Taxpayer Identification
Number (TIN)
Enter your TIN in the appropriate box. If you are a resident
alien and you do not have and are not eligible to get an
SSN. your TIN is your IRS individual taxpayer IdentificatIOn
number (lTIN). Enter it in the sodal secunty number box. If
you do not have an ITIN. see How to get a TIN below.
If you are a sole proprietor and you have an EIN. you may
enter either your SSN or EIN. However. the IRS prefers that
you use your SSN.
If you are a single-owner LLC that is disregarded as an
entity separate frorn its owner (see Limited liability
company (LLC) on page 2), enter your SSN (or EIN. if you
have one). If the LLC is a corporation. partnership. etc., enter
the entity's EIN.
Note: See the chart on page 4 for further clarification of
name and TIN combinations.
How to get a TIN. If you do not have a TIN. apply for one
imrnediately. To apply for an SSN. get Form 55-5.
Application for a Social Security Card, from your local Social
Security Adrninistration office or get this form on-line at
www.ssa.gov/online/sss.html. You rnay also get this form
by calling 1-800-772-1213. Use Form W-7, Application for
IRS Individual Taxpayer Identification Number, to apply for an
ITIN, or Form 55-4. Application for Employer Identification
Nurnber. to apply for an EIN. You can get Forms W-7 and
SS-4 from the IRS by calling 1-800- TAX-FORM
(1-800-829-3676) or frorn the IRS Web Site at www.irs.gov.
If you are asked to complete Forrn W-9 but do not have a
TIN. write "Applied For" in the space for the TIN. sign and
date the form. and give it to the requester. For interest and
dividend payrnents. and certain payrnents rnade with respect
to readily tradable instruments, generally you will have 60
days to get a TIN and give it to the requester before you are
subject to backup withholding on payrnents. The 60-day rule
does not apply to other types of payments. You will be
subject to backup withholding on all such payments until you
provide your TIN to the requester.
Note: WriUng "Applied For" means that you have already
applied for a TIN or that you intend to apply for one soon.
Caution: A disregarded domestic entity that has a foreign
owner must use the appropriate Form W-B.
Form W-9 (Rev. 1.2003)
Part II. Certification
To establish to the withholding agent that you are a U.S.
person, or resident alien, si.9n Forrn W-9. You ma.y be
requested to sign by the withholding agent even If Items 1. 3.
and 5 below indicate otherwise.
For a joint account, only the person whose TI~ is shown in
Part I should sign (when required). Exempt recipients, see
Exempt from backup withholding on page 2.
Signature requirements. Complete the certification as
indicated in 1 through 5 below.
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 itern 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 rnust give your correct TIN, but
you do not have to sign the certification unless you have
been notified that you have previously given an incorrect TIN.
"Other payrnents" include payments made in the course of
the requester's trade or business for rents, royalties, goods
(other than bills for rnerchandise), medical and health care
services (including payments to corporations), payments to a
nonernployee for services, payments to certain fishing boat
crew rnernbers and fisherrnen; and gross proceeds paid to.
attorneys (including payments to corporations).
5. Mortgage interest paid by you. acquisition or
abandonment of secured property. cancellation of debt.
qualified tuition program payments (under section 529).
IRA or Archer MSA contributions or distributions, and
pension distributions. You rnust give your correct TIN, but
you do not have to sign the certification.
page 4
What Name and Number To Give the
Requester
For this type or aCUU'lt
Give name and SSN of;
1. Individual
2. Two or more individuals Ooint
account)
3. Custodian account of a minor
(Uniform Gift to Minors Act)
4. a. The'usual revocable
savings trust (grantor is
also trustee)
b. So-called trust account
that is not a legal or valid
trust under state law
5. Sole proprietorship or
sino Ie-owner LLC
For this type or aCCO<6It
6. Sole proprietorship or
single-owner LLC
7. A valid trust. estate. or
pension trust
8. Corporate or LLC electing
corporate status on Form
8832
9. Association, club. religious.
charitable. educational. or
other tax-exempt organization
10. Partnership or multi-member
LLC
1 1. 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 government.
school district. or prison) that
receives agricultural program
payments
The individual
The actual owner of the account
or. if combined funds. the first
individual on the account 1
The minor '
The grantor,trustee '
The actual owner 1
The owner 3
Give name and EIN or:
The owner 3
Legal entity ·
The corporation
The organization
The partnership
The broker or nominee
The public entity
1 Ust first and CIrcle the name of the p€fson whose number you fumish. If only
one person on a Joint account has an SSN, that person's number must be
furnished.
2 Circle the minors name and furnish the minors SSN.
'You must show your individual name, but you may also enter your
bUSiness or -DBA' name. You may use either your SSN or EIN (if you have
one).
. Ust first and circle the name of the legal trust. estate. or pension trust. (Do
not furnish the TIN of the personal representative or trustee unless the legal
entity itself is not designated in the account title.)
Note: If no name is circled when more than one name ;s
listed, the number will be considered to be that of the first
name listed.
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons who must file information returns
with the IRS to report interest, dividends, and certain other income paid to you, rnortgage interest you paid, the acquisition or
abandonrnent of secured property, cancellation of debt, or contributions you rnade to an IRA or Archer MSA. The IRS uses the
numbers for identification purposes and to help verify the accuracy of your tax return. The IRS may also provide this inforrnation
to the Department of Justice for civil and criminal litigation, and to cities, states, and the District of Colurnbia to carry out their
tax laws. We rnay also disclose this inforrnation to other countries under a tax treaty, or to Federal and state agencies to enforce
Federal nontax crirninal laws and to corn bat terTorisrn.
You rnust provide your TIN whether or not you are required to file a tax return. Payers must generally withhold 30% of taxable
interest, dividend, and certain other payrnents to a payee who does not give a TIN to a payer. Certain penalties rnay also apply.
@
ATTACHMENT 1
27627
Federal Register/Vol. 69, No. 94/Friday. Mav 14. 2004/Notices
Attachment 8:
Applicant Certifications
(These c:ertified ltatements arc required by law.)
A. For the Suppartm HouIDc (SHP), Sbelter PillS
Care (8+C), aod SIDPe RaaIII 0ceuJ-1IC7 (BRO)
protrlIlIII:
1. Fair HoudDlIIDd Equal OpportuDlty.
It will comply witb Title VI ofthc Civil RlJbts Ad of
1964 (42 U.s.c. 2000(d)) IIId reJUlatlOlll puBIIIIIt
therelo (TItle 24 CPR part I). which SlIte lblt no
person in the United Stilet sball. 011 tile JI'OlIIId of
tICe. color or IIItionaI ori,m. be acluded from
participation in. be denied the benefill or. or be
otherwise subjected to cIIscrimlnalioo under Ill)'
proJrlll' or activily for which the applicant m:eMS
Federal ftnmcil1 auistlllCe. IIld wDllrnmeclillely rake
any IIIeISUI'CI necessary to effcctuatC this qreement.
With reference to the ral property IIlcI muClllre(S)
lhereoft which lie provided or improved with the aid
ofFederl1 financial wlstance extended 10 the
applicant, this asurance shall obligate the Ipplicant.
or in the case of any trasCa-, tranaf'eree. far the period
durinl which the real jJroperty 8ld sauc:ture(s) are
DJeCI for a purpose for which the Federal financ;ill
IlSIislancc is exsencJcd or for .-oeher purpose
, involvinl tile provision of similar terYiceI or benefits.
II will comply with the Fair "ousin, Act (42
U.s.c. 3601.19). U &maIded. 8ld wilb impIemenling
reJUllltions at 24 CPR part 100. whic:h prohibit
diJCriminarlon in housln, on me bub of race. color,
~liJion. sex. disability. familial swus or nalional
orisin.
It will comply with Executive Order 11063 on
Equal Opportunity in "ousinJ and with Implementing
resulltions III 24 CPR Put 107 which prohibil
discrimination becluse ofrace. color. creed. sex or
nl1lonll orisin in housin, mid related facilities
provided with Federal fiDancial auistanc:c.
It will comply with Exec:utive Orcl~ I 1246111d all
reJulal.ions purIUIIIt lbereto (41 CPR CbIIpler60-l).
which StIle tlUIt no penon shill be discriminlled
almost 011 the basis of nee. color. reliJlon, sex or
nationll orisin In aU phases of employment during the
performance of Pedc:ra1 conll'lClS IIld shill take
affirmative action 10 ensure equal employmenl
opportunity. The appliclnt will incorponlC. or cause
to be incorpcnted. into III)' COIltl1lCt for conSlNerion
work u defined in Sec:tioD 130.5 of MUD regulations
the equaJ opportunity cllUlC required by Section
I 30. 1 5 (b) oflhe HUD replllllons.
II will comply with Section 3 oftbe Housing and
Urban Development Act of 1968. u amended (12
U.S.c. 1101(u)). 8Ild repl.oonl pul'llulftllherelo (24
CPR PIrt 135). which require that to the JreIICSI
eXlent feuible opponunities for tninlllJ and
employment be liven to lower-income residents of Ihe
project and contracts Cor work in connection with the
project be awWed in substantial part 10 penons . .
raklinlln the arel of the project.
II will comply wtlh Section.504 of tile
P.dlabllilllion Iu:t of 1973 (29 U.S.C. 794). u
IIDIDllded. and with implementing reJUlalions 1124
CPR Part ., which prohibit disc:riminlrion based on
disability in Pedaally-usilted and c:onducted
JlIOIRIIII and activities.
It will comply with the Are Discrimination Act or
J975 (41 u.s.c. 6101.(J7). U amended. and
implementing zeJ1Illlioal 1124 CPR Pan 146. which
prohibit dilCriminlllon because of qe in projects and
ICtlvities recelvinI Federal ftnancil1lS1istance.
II will comply witb Exectltive Orden 11625.
12432. and 1213!. which awe that piocn.m
participantl aha11 take afIlnnative lIClion to encoul'lee
participllioll by busiDeaeI owned and operated b)'
membm ofmlnoril)' JI'Oups ad women.
If persons of lit)' panic:uIar race, color, religion.
sex, qe. natianal orisiD. flmitlllltllUS; or disability
who may qualifY lor ISIlstInCe lie 1IIIlikely to be
reached. It wiD establish additional procedure1 to
ensure thII Inlerelttd penons can obtain infonnation
amc:cmln, the auistDCC. .
It will compl,. with the reucmable modiliClllion and
Kcommoclalloa teot4il,lDtnts and. u appropriate. the
aa:eulbillty requirenIenls of !be Pair Housing Act and . .
section S04 of the Rehabilitation Act of 1973. as
amended.
AdditJonal for S+C:
Ie appliCIIII hu established I preference for largcted
populllions of disabled pel'lOtlS pursuant 10 24 CFR
. 582.330(1). it win comply with this sectioa'l
noncIiscrlminlllon requirements within the designated
popullllon.
B. For SUP Oal,..
1. Mainteswxe of mort.
II will comply with the maintcnanee of effon
. requirements described 1124 CPR 583.150(1).
2. 2f. YaI' Operatloa Rule.
For applicantS reccivinJ assistancc ror acquisition.
rehabililalion or IICW constrUction: The project will be
operaled for no leu dllll 20 years from the date of
inilill 0CCUJlIIlCY or the date or inilill service
provision for the purpose spedtled in the application.
3. 1. Year OperatJoa Rule.
For applicants receiving auislanCC ror supponive
services. lelllins. or opcralinJ cosu bulllOt receiving
HU0-0C0076-CoC (2003)
OMS Approval No. 25~1I2(up. 08131120(6)
.'-/.
, .'
----'
27628
Federal Register/Vol. 69, No. 94/Friday, May 14. 2004 I Notices
wisl1nce for acquisilion, rehabilit.ltion; or new
coastruc:tion: ~. project will be op:rated for the
purpose specified in the application forapy year for
whleh such a.uJstanCC l,pro"l~
C. ForS+C 0JIl)'.
I. Mal.nteoaJU:e of mort.
It will comply with the m.intenance of effOJ1
reQllirements desCribed 1124 CFR. S82; 11S(d).
2. Supportive Seotas.
It wlll make available supponive setVices
appropriate to the needs of the population scrvcd.and
equal In valile toth.e aggregue Il:Dount of ~ta1
wistance funded by HUD for the full term of the
rental assistance and that it wiD fund the supportive
services itself if the planned resources do not become'
available for any ruson.
3, ComponentSl Standards. DefinltloDS;Jnd
$3;OO(l M1nimam.
(a) For the SRO component only. the proposcc1 sile
meets HUD', site Uld neighborhood.standards
(24 C;:FR 882.803(b)( 4). and niects the regulatory
definition of sillgle roodl occupancy housing (24
C.FR882.S(2).
(b) For the SR,Q and PRA with rehabilitation
componcnt5.tbe rehabllita1ion casu will meet the
per unilrehabililation minimum of $3.000.
lL Explanation.
D. For SRO 0nI)'.
1. Standards. De/lDitlollS, .1Id $3.000 Mlnlmum.
The proposed lite meetS HOD's site and
nei,hbo!booc1 ~andanis (24CFR 882.803(b)(4)).
meets the regulalory' delinItlon of sinsle room
oc:cup.ilcy housinl (24 CFR 8&2.802). and the
rthabllitaiion costs w111.~ the ~ unit rehabilitation
minilllll1l\ of $3.000.
Eo For SUP udSRO
1. filODprollt BoArd 01 Directors.
For private nonprofit IPPlicanlS, members oC its
. Board oCDirectoi'i serve in a volUntary capacity and
. receive no compensition. other than reimbursement
for expenses. rortheir services.
F, For SUP .ad S+C.
1. Lud.BuedPalDt.
It will comply with the requirements oC the Lead.
Based Paint Poilonin, Prevention A~ 42 U.S.C,
48214846. and implementing reguJationsl124 CFR
Part 35.
G. For S+C aad SRO.
I.PH! QuaJlflcatJon.
PorPHA applicanlS. that it qualiflCS &S. a Public
Housin, Agency as specified in 24 CFR S82.1 02 and
is legally qualified IIld authorized 10 c:my out the
proposed project(s). .
Where the applicant is unable to~nlCytoany of the stlllements In this certification. such applicant shall altllCh an
ellplan~i Ii .behind this pa&e. . .
Dat~l 4'
(-;, hi
-~ ~,o E;.
Tltlel
c-! 'T"-1t^'h\ ,P4;/'J f-,\ C~tc <<L_
Applicant:
CrT'-'\ t5~ rA l A1'iv"- ( i-bt;, ~ d
For PHA AppUcaab Oal)', (PHA Nu~)
HUD-40076-CoC (2003)
OMB Approval No. 2506'0112 (cxp.08l3112006)
9
ATTACHMENT J
MIAMI-DADE COUNTY HOMELESS TRUST
MIAMI-DADE COUNTY REQUIRED AFFIDAVITS
The contracting individual or entity (governmental or otherwise) shall indicate by an "X" all affidavits
that pertain to this contract and shall indicate by an "N/A" all affidavits that do not pertain to this contract. All
blank spaces must be filled.
The MIAMJ-DADE COUNTY OWNERSIDP DISCLOSURE AFFIDAVIT; MIAMI-DADE COUNTY
EMPLOYMENT DISCLOSURE AFFIDAVIT; MIAMI-DADE CRIMINAL RECORD AFFIDA VIT;
DISABILITY NONDISCRIMINATION AFFIDAVIT; and the PROJECT FRESH START AFFIDAVIT shall
not pertain to contracts with the United States or any of its departments or agencies thereof, the State or any
political subdivision or agency thereof or any municipality of this State. The MIAMI-DADE F AMIL Y
LEA VE 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, :fai-Gt C. (11'\ 6"0;\.J 2.-AL-E:. 2' ,being first duly sworn state:
Affiant
The full legal name and business address of the person(s) or entity contracting or transacting business with
Miami-Dade County are (Post Office addresses are not acceptable):
Sc; - GOOQ .<~-r2
Federal Employer Identification Number (If none, Social Security)
c ( .-( U rr-,~
-1 '-' ((\/11 Ayv-q ~SEA C- l-f
N~e of Entity, Individual(s), Partners, or Corporation
Doing Business As (if same as above, leave blank)
f-<- 53 \2. j
\/00 CO{,v~/\J\(6 D L-lfL ,}i-t U~ \ ,hI \?"Tv'...\., ~~~)<- r-i
Street Address City State Zip Code
~ MIAMI-DADE COUNTY OWNERSIDP DISCLOSURE AFFIDAVIT (Sec. 2-8.1 of the County Code)
/ . 1. If the contrac.t or business transaction is. with a corporation, the full legal name and business address
o shall be prOVided for each officer and director and each stockholder who holds directly or indirectly
five perc~nt (5%) or m.ore .ofthe c~rporation's stock: If the contract or business transaction is with a
partners~lp,. the .foregomg mformatlOn shaH be proVided for each partner. If the contract or business
transac~lOn IS With a trust, ~e fullle.gal name and address shall be provided for each trustee and each
beneficl~. The foregomg. reqUirements shall not pertain to contracts with publicly traded
corpora~l?nS or ~o .c,?n.tracts 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. AH such names and
addresses are (Post Office addresses are not acceptable):
--
10f5
Full Legal Name
Address
Ownership
%
%
%
2. The full legal names and business address of any other individual (other than .
subcontractors, material men, suppliers, laborers, or lenders) who ha~e, or will have.. any
interest (legal, equitable beneficial or otherwise) in the contract or business transaction
with Dade County are (Post Office addresses are not acceptable):
3. Any person who willfully fails to disclose the information required herein, or who knowingly
discloses false information in this regard, shall be punished by a fine of up to five hundred
dollars ($500.00) or imprisonment in the County jail for up to sixty (60) days or both.
F
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.
p,oes your firm have a collective bargaining agreement with its employees?
~Yes _No .
Dfes your firm provide paid health care benefits for its employees?
"l Yes _No
2.
3.
Provide a current breakdown (number ofp~rsons) of your firm's
work force and ownership as to race, national origin and gender:
White: Males Females Asian: Males Females
Black: Males Females American Indian: Males Females
Hispanics: Males Females Aleut (Eskimo): Males Females
/ : _ Males_ Females: : _Males_Females
~'i0II. AFFIRMATIVE ACTIONINONDISCRIMINA TION OF EMPLOYMENT, PROMOTION AND
V'-' PROCUREMENT PRACTICES (County Ordinance 98-30 codified at 2-8.1.5 of the County Code.)
I In accordance with County Ordinance No. 98-30, entities with annual gross revenues in excess of
$5,000,000 seeking to contract with the County shall, as a condition of receiving a County contract,
have: i) a written affirmative action plan which sets forth the procedures the entity utilizes to assure
tha~ it doe.s not discriminate in its employment and promotion practices; and ii) a written procurement
p~hcy. which sets forth the proc~dures t~e ~ntitylJtilizes to assure that it does n?t discriminate against
mmon~ and ",:,omen-owned busmesses In Its own procurement of goods, supphes and services. Such
affirmative actIon plans and procurement policies shall provide for periodic review to determine their
effectiveness in assuring the entity does not discriminate in its employment, promotion and
procurement practices. The foregoing notwithstanding, corporate entities whose boards of directors are
~9$
~
representative of the population make-up of the nation shall b.e presumed to h.ave non-disc~iminat?ry
employment and procure~e~t ~olicies, and s~all not be reqUIred to have wntt:n affinnatlv~ actIon
plans and procurement pohcIes 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.
The firm does not have annual gross revenues in excess of $5,000,000. . .,
The firm does have annual revenues in excess of $5,000,000; however, Its Board of DIrectors IS
representative of the population make-up of the nation and h~. submitted a written, detailed
listing of its Board of Directors, including the race or ethmclty of each board member, t? th~
County's Department of Business Development, 175 N.W, 1st Avenue, 28th Floor, MIamI,
Florida 33128.
The firm has annual gross revenues in excess of $5,000,000 and the firm does have a written
affirmative action plan and procurement policy as described above, whi~h includes periodic
reviews to determine effectiveness, and has submitted the plan and polIcy to the County's
Department of Business Development 175 N.W. 1st Avenue, 28th Floor, Miami, Florida
33128;
The firm does not have an affirmative action plan and/or a procurement policy as described
above, but has been granted a waiver.
MlAMI-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 of a felony during the past ten (10) years.
An officer, director, or executive of the entity entering into a contract or receiving funding from the
C unty has has not as of the date of this affidavit been convicted of a felony during the past ten (10)
ears.
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 inform the employee about:
I. danger of drug abuse in the workplace
2. the firm's policy of maintaining a drug-free environment at all workplaces
3. availability of drug counseling, rehabilitation and employee assistance programs
4. penalties that may be imposed upon employees for drug abuse violations
The person or entity ?hall ~Iso require an employee .to sign a statement, as a condition of employment
that th~ employee WIll abide by the terms and notIfy the employer of any criminal drug conviction
occurrIng no ~ater than five (5) days after receiving notice of such conviction and impose appropriate
personnel actIon against the employee up to and including termination.
Co~pliance with Ordinance No. 92-.15 may b~ waived if the special characteristics of the product or
servIce offered by the person o.r entIty make It neces~ary for the operation of the County or for the
he3:lth, .safety,. wel~are, econom~c benefits and w~ll-bemg of the public. Contracts involving funding
which IS proVI.d~d-m who~e or I.n part ?y the U~l.lted States or the State of Florida shall be exempted
from th~ proVISIons of thIS ordInance In those Instances where those provisions are in conflict with
the requirements of those governmental entities.
\3 ~ 5
J<:J
MIAMI-DADE EMPLOYMENT FAMILY LEAVE AFFIDAVIT (County Ordinance No.
142-91 codified as Section 11A-29 et. seq of the County Code)
That in compliance with Ordinance No. 142-91 ~f t~e Code of Miami-Dade Coun~, Florida,. an
employer with fifty (50) or more employees workmg In Dade County for each workmg day durmg
each of twenty (20) or more calendar work weeks, shall provide the following information in
compliance with all items in the aforementioned ordinance:
An employee who has worked for the above firm at least on~ (1) year sh~ll be entitled to ninety (90)
days of family leave during any twenty-fo~r (24) month penod, for med.lcal reasons, for t.he birth or
adoption of a child, or for the car~ of a child, spouse or other close re~at~ve who has a senous health
condition without risk of terminatIOn of employment or employer retalIation.
The foregoing requirements shall not pertain to contracts with the United States or any department or
agency thereof, or the State of Florida or any political subdivision or agency thereof. It shall,
c;.y~ however, pertain to municipalities of this State.
[-.iI( DISABILITY NON-DISCRIMINATION AFFIDAVIT (County Resolution R-385-95)
VI.
That the above named firm, corporation or organization is in compliance with and agrees to continue
to comply with, and assure that any subcontractor, or third party contractor under this project
complies with all applicable requirements of the laws listed below including, but not limited to, those
provisions pertaining to employment, provision of programs and services, transportation,
communications, access to facilities, renovations, and new construction in the following laws: The
Americans with Disabilities Act of 1990 (ADA), Pub. 1. 101-336, 104 Stat 327, 42 V.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
~c tracts with the United States or any department or agency thereof, the State or any political
1- subdivision or agency thereof or any municipality of this State.
I . MIAMI-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 firm, corporation,
organization or individual desiring to. transact business or enter into a contract with the County
verifies that all delinquent and currently due fees or taxes -- including but not limited to real and
property taxes, utility taxes and occupational licenses -- which are collected in the normal course by
v;{the Dade County Tax Collector as well as Dade County issued parking tickets for vehicles registered
in the name of the firm, corporation, organization or individual have been paid.
. >D I. CURRENT ON ALL COUNTY CONTRACTS, LOANS AND OTHER OBLIGATIONS
IJ The individual e?tity seeking .to ~ransact busin~ss with the County is current in all its obligations to
the County and IS not otherwise m default of any contract, promissory note or other loan document
with the County-or any of its agencies or instrumentalities.
C::~'~~/PROJECT FRESH START (Resolutions R-702-98 and 358-99)
7T1/
L Any ~rm that h~ a contract with the County that results in actual payment of $500,000 or more shall
co~trlbute to Pro~ect Fresh Start, th~ Counry's .~elfare to Wor~ Initiative. However, if five percent
(5 Yo) of the fi.rm s work forc7 consists of indiViduals who reSide in Miami-Dade County and who
have lost or Will lose cash asslsta?~e. benefits (formerly Aid ~o Families with Dependent Children) as
a result of the ~ersonal Responsl~lhty 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
It It ~
aftida.vit.. The foregoing requirement does
O t not pertain to government ent t t fi fi
rgamza lOns or recipients of grant awards. i ies, no or pro It
_Xl.. D?~STIC VIOLENCE LEA VB (Resolution 185-00; 99-5 Codified At 11A-60 Et. Seq. of the
MIamI-Dade County Code).
The. firm desiring to .do business with the County is in compliance with Domestic Leave Ordinance,
Ordmance 9~-5, cod~fied at llA-60 et. seq. of the Miami Dade County Code, whi~h requires an
employer whIch has In the regular course of business fifty (50) or more employees working in
Miami-Dade County for each working day during each of twenty (20) or more calendar work weeks
in the current or proceeding calendar years, to provide Domestic Violence Leave to its employees.
I have carefully read this entire five (5) page document entitled, "Miami-Dade County Affidavits" and
have indicated by an "X" all affidavits that pertain to this contract and have indicated by an "N/A" all affidavits
that do not pertain to this contract.
By: ~ ~ ~ /--
() (Si~ of Aff~Q
SUBSCRIBED AND SWORN TO (or affirmed) before me this
(Date)
day of
200_ by
He/She is personally
known to me or has presented
(Type ofIdentification)
as identification.
(Signature of Notary)
(Serial Number)
(Print or Stamp of Notary)
(Expiration Date)
Notary Public - Stamp State of
(State)
Notary Seal
ATTACHMENT K
MIAMI-DADE COUNTY, FLORIDA
. .. .
AFFIDAVIT OF MIAMI-DADE COUNTY
LOBBYIST REGISTRATION FOR ORAL PRESENTATION
(1) ProjectTitle:
(2) Department:
(3) FinnlProposer's Name:
Address:
Business Telephone: L-->
ProjectNo.:
Zip:
(4) List All Members of the Presentation Team Who Will Be Participating in the Oral Presentation:
NAME . TITLE EMPLOYED BY TEL. NO.
. (ATTACH ADDITIONAL SHEET IF NECESSARY)
The individuals named above are Registered and the Registration Fee is not required for the Oral Presentation ONLY.
Proposers are advised that any individual substituted for or added to the presentation team after submittal of the proposal
and filling by staff, MUST register with the Clerk of the Board and pay all applicable fees.
Other than for the oral presentation, Proposers who wish to address the 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 (Fonn BCCFORM2DOC) and pay all applicable fees.
I do solemnly swear that all the foregoing facts are true and correct and I have read or am familiar with the provisions of
. Section 2-1 J.l(s) of the Code of Metropolitan Dade County as amended. .
Signature of Authorized Representative:
Title:
STATE OF
COUNTY OF
The foregoing instrument was acknowledged before me this
py , a
(Individual, Officer, Partner or Agent)
to me or who has produced
,
, who is personally known
(Sole Proprietor, Corporation or Partnership)
as identification and who did/did not take an oath.
Signature of person taking acknowledgement)
(Name of Acknowledger typed, printed or stamped)
(Title or Rank)
(Serial Number, if any)
A-2 - Rev. 1/2/98
ATTACHMENT L
PROVIDER'S DISCLOSURE OF SUBCONTRACTORS AND-SUPPLIERS
(ORDINANCE 97-104)
C{ \'-{ Or. M l Q-AI\- I b'f;CA- C-1-- J
Name of Organization:
Address:
/,00 CO~8I0Tfal\,j c\~ (JL. ~\~\~E:ALM
I
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 perform any part of the
Scope of Services Work, if this Agreement is for $100,000 or more.
The Community Based Organization must complete this information. If the Community Based
Organization will not utilize subcontractors, then the Community Based Organization must state,
"No Suboontractors will be used", do not state "N/A".
Name of Subcontractor or Sub-Consultant
Address
City and State
j\J fA-
REQUIRED LIST OF SUPPLIERS ON COUNTY CONTRACT
In compliance with Miami-Dade County Ordinance 97-104, the Community Based Organization
must attach a list of suppliers who will supply materials for the Scope of Services to the Community
Based Organization, if this Contract Agreement is $100,000 or more.
The Community Based Organization must fill out this information. If the Community Based
Organization will not use suppliers, the Community Based Organization must state, "No suppliers
will be used", do not state "N/A".
Name of Subcontractor or Sub':'Consultant.
Address
City and State
rJ(/t
I hereby certify that the foregoing information is true, correct and complete:
Signature o~ Authorized Representa~ve: > I ~ ~/
Title: C \ \~ - V 1",\ A- !,---II'-\ L-1 ~/. (_ D~te:
Firm Name: ('J T'-1. LY"':- t'--q ~-rv\. \ i~::::.~Fetl. ID No.:
Address: IIOC CO,VJ~rV\l110(.TI~ I JiL City/State/Zip: ~l~'--\
Telephone()Osj ~1~-1qo Fax: (3Dr)01~~ {)g- 2
E-Mail: ~~()\/~'PjM/~G11.~~@ rvtA~(eq~_jGv
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ATTACHMENT N
-'.
APPUCANT OR RECIPIENT SEcnON 3 COMPLL~ REQurREMEr-.-rS FOR
BUD-ASSISTED PROJECTS
PROJECTNA.ME:
PROJECT LOCA nON:
PROGRAM FUNDING SOURCE:
The wod: to be paformed under this contract is subject to the requirements of Section 3 of the
Housing ana Urban Development Act of 1968, as amended, 12 U.S.C. 170Iu(Section 3). The
purpose of Section 3 is to c:nsUrc that employment and other economie oppommities generated
by HUDassisrmcc of HUD-assisted projeC~ covered by Section 3, $hall to the greatest eXtent
feasible, be di.rectcd to low and very low-income persons, particularly persons who arc recipieDts
of HUn assistance: for ho~ and to businesses. that are substantially owned or substantially
c:mplo~ low and very low income perso~. .
The applicant or recipiemcommits to d.evelopmem and implemcmation of a Section 3 Economic
Opportunity Plan for Miami-Dade HouSing Agency (MDHA) approval,.prior to selection of an
arcbitector. gcnc:raJ .cozitractor or other app~cable 'contractOr. .w Plan shall; describe the
oUtreach procedures the applicai1t or recipient will use to recruit, solicit, encourage, facilitAte and
award arcbiteetural and .'general contracts, where applicable, to'SectiOD 3 busitlesses in the
project'irca; make a good faith effort,u defined by the. regulations. to provide training,
employment and business opponunities required by Section 3 to pe~ons from the project area;
and incorporate the "Section 3 Clausc" (see attachment) in an cariuaclS over S100.000 in
connection with this project. .
The applicant or recipic.ar commits to' including the following contractor certification. in all
contracts over SlOO,OOO:'"Thc' cootraCtor certifies tlw any 'va.c:antcmployment positions,.
iccluding training positions, that a.refilled (1) after the contractor is selected, but before the
contIact or agreement ~ executed; and (2) with persons other than those to wtiom the Section 3
regulatiol1 require employment opponunities to be directed, are not filled to circumvent the
contractor's obligations under the Section 3 rei'uJation."
The aoolicanTp or. reeioicnt eenifies andil2TeeS that it is tmder no. CODtI'3ctuaJor other
imoediments which would Driven! it from comolvin2 with these reouirements.
Non-compllancc .with the Section 3 regulation, may result in sanctions, termination of this
contraCt or ~emcnt for dcfau1~ and debannent or suspension from future HUD-assisted
~=:s FIRM NAME (Print Dr Typ<Nam<): N IA .
I
Autl:orized Signntory and Title (Print or Type Name t1na rLt.l~ ):
SIGNATURE:
Affix Notary Sc3J to the Right:
I
. Worall'llnn\ ..",..hc:.at1l ur Rcciplmt Cumpllanec R.:.quircmc:1ltlTtlf HL'o.,Uf/fl'Cd rroj=
i
I'nnn (rertil: ~/I ~
i
I
I
I
I
I .. ~tiOD. 3 Clzu.se"
24 CFR. P:ut 135 . n 135.38. l c1a1Ue must bei.c1wled in all SIXlion 3 ccvered cont=ts.
I
A. The work to be pedonneci UDd~ thiseontr:1.Ct is subject to the requirements of Section 3 of the Housing
md Urban Oe~pm:m Aa ~ 1968, as. amended, 12 U.S.C. ~ 70lu (S~~ 3). The purpose of
. Sc:aion 3 is to ~ ~ the employment U1d other econonuc opporumttIes gen.erued by HUn
assisWlCC of HUO-usisa:d pro~cx:ts covered b): Seetion 3. sb.all. to the ~test extent feasible, be
direc:ted .to low and ve:y low inj= persons, paraeuWir persoas ~i1o an: reCIplCIlts o~ HUDassisun~
forhou.smg. . .'
. .' .
B. The parties to this CQntr.lct agf= to~1y wi;h HUD:s r~~ons it:i 24. ern .flazt 135, v.1Jich
implcmcz:tf Sccticm 3. As cviden by tbcr c::.-c.ecat1ClQ oftbis c:oc:rnct, the p:UUC'S to thiS ",ntnct cc:rtify
~ they are under DO eontractU2l or Other impedime:Jt that would prevent the:m from ",mplyiog ~"ith the
Part. 135 regHI"',;nn~. . .
ATTACHMENT
N
c. The c;cntr2.CtOt' agrees to sead to cadi labor orgit"i~tioa or representa.r1vc of woOO:rs withWhic:h the
coarnetOt has a co.11edive bar . g ~ or other un.dermnding. if any, anotic:e advising ~
labor Ol3i'";~ti"'"'or ~rkct's rFres~,;w cf the ~rs. ~~ ~er.th.is sectiOQ 3
clause. ~ will post ~ies'ofthT notice. in ~ic:uous p1a.ccs ;i ~ wod: sIte.~e both emplo)'teS
aJ:ld app1i(:3JItS for t:ra.ml11g md. ~loymc::at posmoas can see the naaQ;.. The Ilaacc sbal.l describe the
Sc:aion 3 p~ shall set fdrib minintumaumber be! job titlCs~bjcct to'hlre, :a~ility of
apprc:oriccship aDd tI3iniDg . ons. me qua1i{j~ODS for ca.ch; 'w the: name and location of the
. pe:son(s) t3king appllc:aticms for of the positioas;;wi the anticipated ~ the WQrk shall begin.
. .,
D. The coll.tt3.Ctor a;recs fa include. Sectien3 c:1zwc ~ tva)'subcotItrita subjea to compliance with
~. in 24 en Pan. 135, agrees fa W:=ilpproprWe aaion. as' provided in an applicable
provision.. of the- .sub<:ODrna or. this SectiOQ , cbuse. upon :1 Pnding th:Lt the subcontrac:tor' is in
violation of the ~tioo.s in 21 cn ~ut 135. The contnCtOr will not subeomract wItb. CUly
subcontractor where the: CODtr.1c:tof has nonce or knowledge wt the subeontraaor has b=n found in
vioWioa of the regulzticmsm 24 C P~ 135.
. ~ . .
E. The eontT.1ctor Will cC::rtify that an va.c:::mt employmcm positions, includ.iD.g tta..ining positions; tPa! :u-e
filled (1)aitcr the coa:tr.u:tor is seI but before the COatr::LCt is ~ted: and (2) with persons other
than those to whom the regulations' f24 CFR Pzt 135 require employment opportunities to be directed,
wac Ilot filled to ~cumv=tbc: ti':1ctor'S oblig:1tioas UDder 24 CFR. p:u:t. 135.
F. Noacompl~e -cmh HtJD's rqu . iQ 24 CFR.Pm 13.5 !mY re.sulr in smcrions, tennU1ation of this
contract fordc:fuult, and debannent rsaspension from futnre HUn assisted comnc:s..
. I.'.
. G. With rcspea to work pc:rformed in FDIlcaion withSeaion 3 covered Indian housmg assist:ince, SectiOll
7(b) oftbc: Indian Sdf-Der,-"",'""'rior and E:d~oft Assi1unce Act (25 U.S .C. 4SOC) a.lso applies co the
work to be performed ~c:r this ~n.tract. Section 7(b) requires tiu: to t.~ gr::.3.~st l:.'<tCnt fc:LSiblc (i)
prefere:Da: :1nd opportUIlltlCS for tnull.Dgand employment shall b~ giVCtl to Indians, and (ii) pracn:nc:e in
the aW;1Id of contn.CtS arid subcootr1.C.tS slWl be giVQ1 to Indi3.0 orS4J'ULUlOOS 3..Od Ind.i.an-owD~d
Econcr:uc E:L~i"pnsa POU'Oes to this coo.tnct tI13.t are subject to the proV1SlollS of SecoOtl. 3 and Sccnon
7(b) ~gree to comply with Section 3 to the maxlmwn extent feasible. but' not tn dt:Tog61t1oc of complunce
tvrth S~:on 7(0)
Lcluudill:'??
ATTACHMENT 0
--------~~-
SWORN STATEMENT PURSUANT TO SECTION 287.]33 (3) (a),
FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A
NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER
OATHS.
I. This sworn statement is submitted to Miami-Dade County:
JD~tE. tv\.. frO:0cA-U::.-z:..
(print individual's name and title)
by
for
Cl l'-t~' "^-t Pr'fYLl ~e:-A<-!- J
(print name of entity submitting sworn statement)
whose business address is
IIDe>
eoNJE ~\\O~
M I f\;-(\A \ (~E:. I"iC- N
,I
C T(2.. 0 tL fL "'3 31~4
)" 9 - C, c::x:::.x:J 3,{?-
and (if applicable) its Federal Employer Identification Number (FEIN) is
(if the entity has no FEIN, include the Social Security Number of the individual signing this sworn
statement:)
2. I understand that a "public entity crime" as defined in Paragraph 287.133( I )(g), Florida Statutes.
means a violation of any state or federal law by a person with respect to and directly related to the
transaction of business with any public entity or with an agency or political subdivision of any
other state of the United States, including, but not limited to, any bid or contract for goods or
services to be provided to any public entity or an agency or political subdivision of any other state
of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering,
conspiracy, or material misrepresentation.
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 without an
adjudication of guilt, in any federal or state trial court of record relating to charges brought by
indictment or information after July 1, 1989, as a result of a jury verdict, non-jury trial, or entry of
plea of guilty or nolo contendere.
4. I understand that an "affiliate" as defined in Paragraph 287.133(1 )(a) Florida Statutes. means:
a. A predecessor or successor of a person convicted of a public entity crime; or,
b. An entity under the control of any natural person who is active in the management of the
entity and who has been convicted of a public entity crime. The term "affiliate: includes those
officers, directors, executives, partners shareholders, employees, members, and agents who
are active in the management of an affiliate. The ownership by one person of shares
constituting a controlling interest in another person, or pooling of equipment or income
among persons when not for fair market value under an ann's length agreement, shall be a
prima facie case that one person controls another person. A person who knowingly enters
into a joint venture with a person who has been convicted of a pubic entity crime in Florida
during the preceding 36 months shall be considered an affiliate.
5. I understand that a "person" as defined in Paragraph 287.133(1 )(e), Florida Statutes. means any natural
person or entity organized under the laws of any state or of the United States with the legal power to
enter into a binding contract and which bids or applies to bid on contracts for the provision of goods or
services let by a public entity, or which otherwise transacts or applies to transact business with a public
entity. The term "person" includes those officers, directors, executives, partners, shareholders,
employees, members, and agents who are active in management of an entity.
6. Based on information and belief, the. statement, which I have marked below, is true in relation to the
entity submitting this sworn statement. (Please indicate which statement applies).
A Neither the entity submitting this sworn statement, nor any of its officers, directors,
executives, partners, shareholders, employees, members, or agents who are active in the
management of the entity, nor the affiliate of the entity has been charged with and convicted of a
public entity crime within the past 36 months.
The entity submitting this sworn statement, or one or more of its officers, directors,
executives, partners, shareholders, employees, members, or agents who are active in the
management of the entity, or an affiliate of the entity has been charged with an convicted of a
public entity crime within the past 36 months AND (Please indicate which additional statement
applies)
The entity submitting this sworn statement, or one or more of its officers, directors,
executives, partners, shareholders, employees, members, or agents who are active in the
management of the entity, or an affiliate of the entity has been charged with an convicted of a
public entity crime within the past 36 months. However, there has been a subsequent proceeding
before a Hearing Officer of the State of Florida, division of Administrative Hearings and the Final
Order entered by the Hearing Officer determined that it was not in the public interest to place the
entity submitting this sworn statement on the convicted vendor list (attach a copy of the 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 THE LIFE OF
THE CONTRACT. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC
ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD
AMOUNT PROVIDED IN SECTION 287.017, FLORIDA STATUTES FOR CATEGORY TWO OF
ANY CHANGE IN THE INFORMATION CONTRAINED IN THIS FORM.
/ e/~i;?~
(date)
COUNTYOF /?'7t'/:J,'/YJ/'..- L.X2ok
PERSONALL Y APPEARED BEFORE ME, the undersigned authority J 0/71 r> In. 0; () /J:?2? ~,?
(name o-f individual signing) "---'
who, after, first being sworn by me, affixed his/her signature in the space provided above on this
.::? r
J / day of /VOv' ,2000
, P
NOTARY PUBLIC
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My commission expires:
7.......1... ..................................
: PAULA CALDERON :
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This Instrument was prepared by
Cynthia Johnson-Stacks, Esq., Assistant County Attorney
County Attorney's Office
Miami-Dade County
rJ \/>1 . Attachment Q
DECLARATION OF RESTRICTIVE COVENANTS
THIS DECLARATION OF RESTRICTIVE COVENANTS (Declaration) dated as of
, 200 , by ("Project Sponsor")
and ("Titleholder"), their successors and assigns, is given to the
United State Department of Housing and Urban Development (BUD).
RECITALS
WHEREAS, the Project Sponsor participated in a consolidated application to HUD, dated
as of for a Supportive Housing Grant; which Grant was awarded; and
WHEREAS Miami-Dade Countv (the Recipient) entered into a Supportive Housing
Grant (FL14B ), on ; and
WHEREAS, the Recipient entered into an Agreement dated with
the Project Sponsor (the Project Sponsor Agreement) in which the Project Sponsor is obligated to
acquire and rehabilitate directly or through its single-asset affiliate as defined below and operate
a supportive housing project on property described in Exhibit A hereto (the "Property"), which is
to be maintained and operated as supportive housing as defined by the Agreement; and
WHEREAS, the Project Sponsor has created (the "Titleholder"), an
affiliated single-asset corporation whose board of directors is the same as the board of directors
of the Project Sponsor, for the sole purpose of acquiring and rehabilitating the Property; and
WHEREAS, the McKinney-Vento Homeless Assistance Act, 42 use ~~ 11381 et. seq.
("ACT") imposes use and repayment requirements on projects receiving acquisition,
rehabilitation and new construction funding; and
WHEREAS, the Recipient is required by the Agreement to require the Project Sponsor,
and the Project Sponsor is required by the Project Sponsor Agreement to cause to be executed
an instrument in recordable form which obligates the Project Sponsor, its successors and assigns,
to operate and maintain the supportive housing in accordance with the Agreement, the ACT, and
HUD regulations as provided for in the Agreement; and
WHEREAS, the Project Sponsor and the Titleholder under this Declaration intends,
declares and covenants that the restrictive covenants set forth herein shall be and are covenants
running with the Property for the term described herein, and are binding upon all subsequent
owners of the Property for such term, and are not merely personal covenants of the Project
Sponsor and the Titleholder;
NOW, THEREFORE, in consideration of the promises and covenants hereinafter set
forth and of other valuable consideration, the receipt and sufficiency of which is hereby
acknowledged, the Project Sponsor declares as follows:
1. The Project Sponsor and the Titleholder, their successors or assigns, shall operate the
supportive housing and provide supportive services throughout a period of twenty (20) years
commencing from the date of initial occupancy or the provision of initial services, in accordance
with terms of the Agreement, the ACT, HUD regulations, and all applicable federal. state and
local laws.
2. If, pursuant to a request from the Project Sponsor, BUD determines that the project is
no longer needed for use as supportive housing, BUD may authorize the Project Sponsor and the
Titleholder, their successors or assigns, to convert the use of the project for the direct benefit of
low-income persons. Upon expiration of the period during which the Project Sponsor is
obligated to operate the Property in accordance with the Agreement, this Declaration shall
terminate and shall no longer be effective.
3. The Project Sponsor and the Titleholder agree, that if the project ceases to be used as
supportive housing within ten (10) years after the project is placed in service, the Project Sponsor
and the Titleholder, their successors or assigns, shall be obligated to repay BUD one hundred
percent (100%) of any assistance received for acquisition, rehabilitation and new construction
under the Agreement. If such project is used as supportive housing for more than ten (10) years,
BUD shall reduce the percentage of the amount required to be repaid by ten (10) percentage
points for each year in excess of ten (10) that the project is used as supportive housing.
4. BUD, acting by and through a duly authorized official, may approve such action as
may be necessary to allow the transfer, conveyance, assignment, leasing, mortgaging, or
encumbering of the Property or to accomplish the acts described above.
5. This Declaration and the covenants set forth herein regulating and restricting the use
and occupancy of the Property (i) shall be and are covenants running with the Property,
encumbering the Property for the term of this Declaration, and binding upon the Project
Sponsor's successors in title and all subsequent owners of the Property, (ii) are not merely
personal covenants of the Project Sponsor, and (iii) shall bind the Project Sponsor and its
respective successors and assigns during the term of this Declaration.
6. Any and all requirements of the laws of the State to be satisfied in order for the
provisions of this Declaration to constitute deed restrictions and covenants running with the land
shall be deemed to be satisfied in full, and that any requirements or privileges of estate are
intended to be satisfied, or in the alternate, that an equitable servitude has been created to insure
that these restrictions run with the land. For the term of this Declaration, each and every
contract, deed, or other instrument hereafter executed conveying the Property or portion thereof
shall expressly provide that such conveyance is subject to this Declaration, provided, however,
that these covenants contained herein shall survive and be effective regardless of whether such
cont~acts, deed or other instrument hereafter executed conveying the Property or portion thereof
proVIdes that such conveyance is subject to the Declaration.
7. The invalidity of any clause, part or provision of this Declaration shall not affect the
validity of the remaining portions thereof.
IN WITNESS WHEREOF, the Project Sponsor has caused this Agreement to be signed by its authorized
representatives, as of the day and year fIrst above writ
PROJECT SPONSOR
TITLE HOLDER
BY:
BY:
Signature
Signature
Title
Title
STATE OF FLORIDA
)
SS.
)
COUNTY OF MIAMI-DADE
I HEREBY CERTIFY that the foregoing DECLARATION OF RESTRICTIVE
COVENANTS was executed and acknowledged before me on this _ day by
as PRESIDENT, of
, INC. who is:
Personally Known OR
Produced Identification
Type of Identification Produced
And by
as PRESIDENT, of
. INC. who is:
Personally Known OR
Produced Identification
Type of Identification Produced
before me, a Notary public duly authorized in the State and count\' named above to take
acknowledgments and who ( ) did ( ) did not take an oath. .
Witnesseth my hand and official seal in the State and COllnty above, this
,2004.
day of
NOTARY PUBLIC, State of Florida
My Commission Expires:
ex
J\jlf\
Attachment Q-1
DECLARATION OF RESTRICTIONS
TillS DECLARATION OF RESTRICTIONS made this_ day of ,200
by the undersigned hereinafter referred to as the "Declarant",
WHEREAS, Miami-Dade County, acting through and on behalf of the Miami-Dade
County Homeless Trust, has applied for and received funds from the United States
Government under Title IV of the Stewart B. McKinney Homeless Assistance Act; and
WHERAS, Miami-Dade County agreed to comply with requirements of the United
States Government in connection with the receipt of such funds; and
WHERAS, pursuant to the 2_Supportive Housing Program Grant Agreement, which
Miami-Dade County entered with the United States Government, acting through its U.S.
Department of Housing and Urban Development (the "Grant"), Miami-Dade County is
responsible for repaying the Grant in accordance with the provisions of 24 CFR part
583,Code of Federal Regulations; and
WHERAS, Miami-Dade County, in the exercise of due diligence, must take steps to
ensure that the Grant-funded capital project is used for its intended purpose for a term of
at least 20 years from the date of initial occupancy or date of initial service;
WHEREAS, Miami-Dade County requires that the subrecipient of the Grant,
. referred to as the Declarant herein,
impose a restrictive covenant on the subject land purchased with the capital funds
provided through this Grant; and
Legal description:
N\A
NOW THEREFORE, Declarant declares that said property shall be held, transferred,
encumbered, used, sold, conveyed, leased, and occupied, subject to the covenants and
restrictions hereinafter set forth expressly and exclusively for the use and benefits of said
property and of each and every person or entity who now or in the future owns any
portion or portions of said property.
LAND USE - The subject Property and any rehabilitated structures or new construction
thereon must be operated for the provision of supportive housing and services for
homeless persons in accordance with the provision of24 CFR part 583, Code of Federal
Regulations (as may be amended from time to time) for a term of at least 20 years or for
such other purposes as may be approved by the U.S. Department of Housing and Urban
Development.
TERM - This covenant is to run with the land and shall be binding on all parties and all
persons claiming under them for a period of twenty (20) years from the date the original
covenant was recorded, the date of initial occupancy, or date of initial service provision,
whichever is later.
ENFORCEMENT - Upon Declaration's, failure to comply with the requirements of this
Declaration, the Declarant shall within 30 days of written notice of non-compliance and
request for conveyance shall convey the subject property to Miami-Dade County.
Enforcement shall be by proceedings at law or inequity against any person or persons
violating or attempting to violate any covenant either to restrain violation, compel
compliance with the provision of this declaration or recover damages. Such action may
be brought by Miami-Dade County, or its successor in interest.
SEVERABILITY - Invalidation of any of these covenants by judgement or court order
shall in no wise affect the other provisions that shall remain in full force and effect.
. WITNESSES:
DECLARANT:
By:
(Name of President)
ATTEST:
Secretary of the Board
STATE OF FLORIDA )
SS.
COUNTY OF MIAMI-DADE )
I HEREBY CERTIFY that the foregoing DECLARATION OF RESTRICTIVE
COVENANTS was executed and acknowledged before me on this _ day of
,2004 by
as
, of
Personally Known OR
Produced Identification
Type of Identification Produced
And by
, of
. who is:
as
Personally Known OR
Produced Identification
Type of Identification Produced
before me, a Notary public duly authorized in the State and county named above to take
acknowledgments and who ( ) did ( ) did not take an oath.
Witnesseth my hand and official seal in the State and County above, this _ day of
,2004.