HomeMy WebLinkAboutWestcare California, Inc. - Agreement to Provide Housing Opportunities for Persons with AIDS Grant Services tot he Homeless and Those at Risk of Becoming Homeless fi
AGREEMENT BETWEEN WESTCARE CALIFORNIA AND THE CITY OF FRESNO TO
PROVIDE HOUSING OPPORTUNITIES FOR PERSONS WITH AIDS GRANT SERVICES
TO THE HOMELESS AND THOSE AT RISK OF BECOMING HOMELESS
THIS AGREEMENT is made and entered into the 1st day of July 2018, by and
between the CITY OF FRESNO, a California municipal corporation (CITY), as a Recipient
of the Housing Opportunities for Persons with AIDS (HOPWA) Grant and West Care
California Inc., a California 501(c)(3) not-for-profit Corporation (PROJECT SPONSOR).
CITY and PROJECT SPONSOR are sometimes hereinafter referred to individually as a
Party and collectively as Parties.
CITY has received a grant commitment from the United States Department of
Housing and Urban Development (HUD) to administer and implement the Housing
Opportunities for Persons with AIDS in the City of Fresno in accordance with the provisions
of 24 CFR Part 574 et seq. and California law.
The purpose of the HOPWA grant is to provide assistance for persons with
HIV/AIDS who are homeless and those at risk of becoming homeless to quickly regain
stability in permanent housing after experiencing a housing crisis and/or homelessness
within the city.
Then CITY issued a Request for Proposal on February 1, 2018, to solicit for
proposals with specific plans to provide eligible HOPWA services in the areas of outreach,
emergency shelter, homeless prevention assistance to households who would otherwise
become homeless, assistance to rapidly re-house persons who are homeless and related
grant administration (up to 7.0% of award). The contract award is contingent upon the
following conditions:
• The Project Sponsor shall participate in City quarterly HOPWA performance
meetings.
• The Project Sponsor shall provide client evaluations to determine eligibility of
other applicable programs and permanent housing solutions.
■ The Project Sponsor shall provide client evaluations to determine eligibility of
other applicable programs and permanent housing solutions.
In response to the Request for Proposal, PROJECT SPONSOR submitted a
Proposal which included a Scope of Work and cost proposal (Budget) as described in
Exhibits A and B, respectively and represents it is capable and qualified to meet all the
requirements of the Letter of Interest and this Agreement.
NOW, THEREFORE, in consideration of the foregoing and of the covenants,
conditions and premises hereinafter combined to be kept and performed by the respective
Parties, it is mutually agreed as follows:
ARTICLE 1
DEFINITIONS. Wherever used in this Agreement or any of the contract documents,
the following words shall have the meaning herein given, unless the context requires a
different meaning.
Previous editions are obsolete form HUD-40110-D(Expiration Date:01/31/2021)
"ACT" — 24 CFR Part 574 et seq. as revised by the Housing Opportunities for
Persons with AIDS and Consolidated Plan Conforming Amendments Interim Rule,
published in the Federal Register on December 5, 2011 (76 Fed. Reg. 75954).
"Administrator" and "Contract Administrator" shall mean the Manager of the
Housing and Community Development Division of the Development and Resource
Management Department of City or his or her designee.
"Bid Proposal" and "Proposal" shall mean PROJECT SPONSOR 's response to the
NOFA including but not limited to the Budget, Scope of Work, certifications and all
attachments and addenda.
"Budget" shall mean PROJECT SPONSOR's Cost Proposal submitted with the Bid
Proposal.
"City Manager" shall mean the City Manager of CITY_
"Contract" or "Contract Documents" shall mean and refer to this Agreement
including its exhibits and the NOFA and Bid Proposal with all attachments and addenda
thereto.
"HOPWA" shall mean Housing Opportunities for Persons with AIDS as set forth in the
ACT.
"General Conditions" or "General Requirements" shall mean the General
Requirements contained in the NOFA.
"Program" shall mean services designed to identify sheltered and unsheltered
homeless persons, as well as those at risk of homelessness, and provide necessary help
to those persons quickly regain stability in permanent housing after experiencing a housing
crisis and/or homelessness within the parameters and requirements of the ACT and the
HOPWA Policies and Procedures.
"Program income" for the specific purpose of this Agreement shall be as defined in
the ACT. Unless otherwise provided for in the ACT, program income shall include any and
all gross income earned by or accruing to PROJECT SPONSOR in its pursuit hereof
provided that the term program income does not include rebates, credits, discounts or
refunds realized by PROJECT SPONSOR in its pursuit hereof.
"Scope of Services or Services" shall mean those services submitted with
PROJECT SPONSOR's bid proposal to be offered in fulfillment of the Program and
included in Exhibit A.
1. Contract Administration. This Agreement including all the Contract
Documents shall be administered according to the order of precedence set forth herein for
CITY by Administrator who shall be PROJECT SPONSOR's point of contact and to whom
PROJECT SPONSOR shall report.
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2. Scope of Services. PROJECT SPONSOR shall provide the Program in
conformance with the Contract Documents and perform to the satisfaction of CITY those
services set forth in Exhibit A and services necessarily related or incidental thereto even
though not expressly set forth therein.
3. Effective Date and Term of Agreement. It is the intent of the Parties that this
Agreement be effective as of the date first set forth above as to all terms and conditions of
the Agreement. Services of PROJECT SPONSOR shall commence as of July 1 , 2018,
and shall end June 30, 2019, which shall be the term of this Agreement, unless terminated
earlier as provided herein. Furthermore, the PROJECT SPONSOR will fully expend
Program Year 2017 funds prior to the commencement of expending Program Year 2018
funds. The contract end dates may be extended three months after if funding has not yet
been fully expended.
4. Compensation and Method of Payment. CITY shall pay PROJECT
SPONSOR the aggregate sum of not to exceed Four hundred forty-one thousand three
hundred four dollars and fifty-six cents ($441,304.56) for satisfactory performance of the
services rendered therefore and as set forth in Exhibit B attached hereto and incorporated
herein. Compensation is based on actual expenditures incurred by PROJECT SPONSOR
in accordance with the Budget set forth in Exhibit B. It is understood that all expenses
incidental to PROJECT SPONSOR's performance of services under this Agreement shall
be borne by the PROJECT SPONSOR. If PROJECT SPONSOR should fail to comply with
any provisions of this Agreement, CITY shall be relieved of its obligation for further
compensation.
(a) Payments shall be made by the CITY to PROJECT SPONSOR in
arrears, for services provided during the preceding month. Such payment by City
shall be made in the normal course of business, generally within forty five days after
the date of receipt by CITY of a correctly completed invoice in accordance with the
provisions of this paragraph, and shall be for the actual expenditures incurred by
PROJECT SPONSOR in accordance with Exhibit B. Payments shall be made after
receipt and verification of actual expenditures. All invoices are to be submitted CITY
at the address given for notices on the signature page hereof or at such address
the CITY may from time to time designate by written notice.
(b) The Administrator may, in his or her sole discretion, agree in writing
to revise the payment schedule in subsection (a), above, upon PROJECT
SPONSOR's showing that such will facilitate delivery of the services; provided,
however, that total payments under this Agreement shall not exceed the total
amount provided for in subsection (a), and any amounts advanced are authorized
and appropriated for that fiscal year of the CITY covering the period for which an
advance is proposed.
(c) Any funds paid by CITY hereunder which remain unearned at the
expiration or earlier termination of the Agreement shall be, and remain in trust, the
property of CITY and shall be remitted to CITY within ten days of expiration or earlier
termination of this Agreement. Any interest thereon must be credited to or returned
to CITY. Upon any dissolution of PROJECT SPONSOR, all funds advanced
pursuant to this Agreement and not expended shall be returned to CITY.
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(d) CITY will not be obligated to make any payments under this
Agreement if the request for payment is received by the CITY more than sixty days
after the date of termination of this Agreement or the date of expiration of this
Agreement, whichever occurs first.
(e) PROJECT SPONSOR understands and agrees that the availability of
HOPWA Funding hereunder is subject to the control of HUD and should the
HOPWA Funding be encumbered, withdrawn, or otherwise made unavailable to
CITY whether earned or promised to PROJECT SPONSOR and/or should CITY in
any fiscal year hereunder fail to appropriate said funds, CITY shall not provide said
funds to PROJECT SPONSOR unless and until they are made available for
payment to CITY by HUD and CITY receives and appropriates said Funds. No other
funds owned or controlled by CITY shall be obligated under this Agreement to the
project(s). Should sufficient funds not be appropriated, the Services provided may
be modified, or this Agreement terminated, at any time by the CITY as provided in
section 9 below.
0 PROJECT SPONSOR shall use the funds provided by CITY solely for
the purpose of providing the services required under subsection 2 (a) of this
Agreement.
5. Matching Funds Not a Requirements of PROJECT SPONSOR: The HOPWA
program does not require PROJECT SPONSOR to agree to match all HOPWA funding
disbursed to it by CITY on a dollar for dollar basis.
6. Loss of Third Party Funding: In the event any funding provided by a party
other than CITY for the Program or services being performed by PROJECT SPONSOR is
suspended, reduced or withdrawn, then Administrator may suspend this Agreement
immediately upon its receipt of notice thereof, or terminate this Agreement as provided in
Section 9 below. PROJECT SPONSOR shall notify CITY in writing within seven days if
any of the following events occur:
(a) Suspension, reduction or withdrawal of PROJECT SPONSOR'S
funding by other funding source(s).
(b) Addition or resignation of any of PROJECT SPONSOR'S Board of
Director members.
(c) Resignation or termination of any of PROJECT SPONSOR'S staff,
including those staff not funded by this Agreement but essential to the delivery of
the services listed in Exhibit A.
(d) The Administrator may, in his or her sole discretion, stay such
suspension of the Agreement for a period not to exceed thirty days to allow
PROJECT SPONSOR to either (i) submit a new service or funding plan for
evaluation by Administrator who may accept or reject in his or her sole discretion,
or (ii) complete an orderly phase out of services. If the Administrator accepts
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such new service or funding plan, then such plan will be subject to the
requirements in Section 14 below.
7. Disposition of Program Income. Absent the CITY's written consent, any
program income generated hereunder shall be used to reduce the CITY's reimbursement
obligations hereunder, or in the absence thereof promptly remitted entirelyto the CITY.
8. Events of Default. When in the opinion of CITY, there is an occurrence of
any one or more of the following provisions it will represent an Event of Default for
purposes of this Agreement.
(a) An illegal or improper use of funds.
(b) A failure to comply with any term, covenant or condition of this
Agreement.
(c) Report(s) are submitted to CITY which are incorrect or incomplete in
any material respect.
(d) The services required hereunder are incapable of or are improperly
being performed by Project Sponsor.
(e) Refusal of PROJECT SPONSOR to accept change under Section
16
0 PROJECT SPONSOR fails to maintain any required insurance.
(g) There is a loss of third-party funding (see Section 6 above).
(h) PROJECT SPONSOR files, or has filed against it, a petition of
bankruptcy, insolvency, or similar law, state or federal, of filing any petition or
answer seeking, consenting to, or acquiescing in any reorganization, arrangement,
composition, readjustment, liquidation, dissolution, or similar relief, where such
petition shall not have been vacated within fourteen days; or if adjudicated bankrupt
or insolvent, under any present or future statute, law, regulation under state or
federal law, and judgment or decree is not vacated or set aside within fourteen days.
Q PROJECT SPONSOR's failure, inability or admission in writing of its
inability to pay its debts as they become due or PROJECT SPONSOR's assignment
for the benefit of creditors.
Q A receiver, trustee, or liquidator being appointed for PROJECT
SPONSOR or any substantial part of PROJECT SPONSOR's assets or properties,
and not removed within ten days.
(k) PROJECT SPONSOR's breach of any other material condition,
covenant, warranty, promise or representation contained in this Agreement not
otherwise identified within this Section.
. .
Previous editions are obsolete form HUD-40110-D(Expiration Date:01/31/2021)
9. Termination and Remedies. Upon the occurrence of an Event of Default,
CITY shall give written notice PROJECT SPONSOR of the Event of Default by specifying
(1) the nature of the event or deficiency giving rise to the default, (2) the action required to
cure the deficiency, if, in the sole discretion of CITY, any action to cure is possible, and
(3) if the Event of Default is curable, a date, which shall not be less than thirty calendar
days from the date of the notice, by which such deficiency must be cured, provided,
however that if such failure cannot be remedied in such time, PROJECT SPONSOR shall
have an additional thirty days to remedy such failure so long as PROJECT SPONSOR is
diligently and in good faith pursuing such remedy.
(a) This Agreement shall terminate without any liability of CITY to
PROJECT SPONSOR upon the earlier of: (i) the happening of an Event of Default
by PROJECT SPONSOR and a failure to cure said Event of Default within the time
specified in the notice of Event of Default; (ii) seven calendar days prior written
notice without cause by CITY to PROJECT SPONSOR; (iii) CITY'S non-
appropriation of funds sufficient to meet its obligations hereunder during any CITY
fiscal year of this Agreement, or insufficient funding for the services provided by
PROJECT SPONSOR; or (iv) expiration of this Agreement.
(b) Immediately upon any termination or expiration of this Agreement,
PROJECT SPONSOR shall (i) immediately stop all work hereunder; (ii) immediately
cause any and all of its subcontractors to cease work; and (iii) return to CITY any
and all unearned payments and all properties and materials in the possession of
PROJECT SPONSOR that are owned by CITY. Subject to the terms of this
Agreement, PROJECT SPONSOR shall be paid compensation for services
satisfactorily performed prior to the effective date of termination. PROJECT
SPONSOR shall not be paid for any work or services performed or costs incurred
which reasonably could have been avoided.
(d) Upon any breach of this Agreement by PROJECT SPONSOR, CITY
may (i) exercise any right, remedy (in contract, law or equity), or privilege which
may be available to it under applicable laws of the State of California or any other
applicable law; (ii) proceed by appropriate court action to enforce the terms of the
Agreement; and/or (iii) recover all direct, indirect, consequential, economic and
incidental damages for the breach of the Agreement. If it is determined that CITY
improperly terminated this Agreement for default, such termination shall be deemed
a termination for convenience.
(d) In no event shall any payment by CITY pursuant to this Agreement
constitute a waiver by CITY of any breach of this Agreement or any default which
may then exist on the part of PROJECT SPONSOR, nor shall such payment impair
or prejudice any remedy available to CITY with respect to the breach or default.
(e) CITY expressly reserves the right to demand of PROJECT
SPONSOR the repayment to CITY of any funds disbursed to PROJECT SPONSOR
under this Agreement which, in the judgment of CITY, were not expended in
accordance with the terms of this Agreement, and PROJECT
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SPONSOR agrees to promptly refund any such funds within 10 days of CITY'S
written demand.
10. Indemnification. To the furthest extent allowed by law, PROJECT SPONSOR
shall indemnify, hold harmless and defend CITY and each of its officers, officials,
employees, agents and volunteers from any and all loss, liability, fines, penalties,
forfeitures, costs and damages (whether in contract, tort or strict liability, including but not
limited to personal injury, death at any time and property damage), and from any and all
claims, demands and actions in law or equity (including reasonable attorney's fees and
litigation expenses) that arise out of, pertain to, or relate to the negligence, recklessness
or willful misconduct of PROJECT SPONSOR, its principals, officers, employees, agents
or volunteers in the performance of this Agreement.
If PROJECT SPONSOR should subcontract all or any portion of the services to be
performed under this Agreement, PROJECT SPONSOR shall require each subcontractor
to indemnify, hold harmless and defend CITY and each of its officers, officials, employees,
agents and volunteers in accordance with the terms of the preceding paragraph.
This section shall survive expiration or termination of this Agreement.
11. Insurance.
(a) Throughout the life of this Agreement, PROJECT SPONSOR shall
pay for and maintain in full force and effect all insurance as required in Exhibit C
or as may be authorized in writing by CITY'S Risk Manager or his or her designee
at any time and in his or her sole discretion.
(b) If at any time during the life of the Agreement or any extension,
PROJECT SPONSOR or any of its subcontractors fail to maintain any required
insurance in full force and effect, all services and work under this Agreement shall
be discontinued immediately, and all payments due or that become due to
PROJECT SPONSOR shall be withheld until notice is received by CITY that the
required insurance has been restored to full force and effect and that the premiums
therefore have been paid for a period satisfactory to CITY. Any failure to maintain
the required insurance shall be sufficient cause for CITY to terminate this
Agreement. No action taken by CITY pursuant to this section shall in any way
relieve PROJECT SPONSOR of its responsibilities under this Agreement. The
phrase "fail to maintain any required insurance" shall include, without limitation,
notification received by CITY that an insurer has commenced proceedings, or has
had proceedings commenced against it, indicating that the insurer is insolvent.
(c) The fact that insurance is obtained by PROJECT SPONSOR shall not
be deemed to release or diminish the liability of PROJECT SPONSOR, including,
without limitation, liability under the indemnity provisions of this Agreement. The
duty to indemnify CITY shall apply to all claims and liability regardless of whether
any insurance policies are applicable. The policy limits do not act as a limitation
upon the amount of indemnification to be provided by PROJECT SPONSOR.
Approval or purchase of any insurance contracts or
Previous editions are obsolete form HUD-40110-D(Expiration Date:01/31/2021)
policies shall in no way relieve from liability nor limit the liability of PROJECT
SPONSOR, its principals, officers, agents, employees, persons under the
supervision of PROJECT SPONSOR, vendors, suppliers, invitees, consultants,
sub-consultants, subcontractors, or anyone employed directly or indirectly by any
of them.
(d) Upon request of CITY, PROJECT SPONSOR shall immediately
furnish CITY with a complete copy of any insurance policy required under this
Agreement, including all endorsements, with said copy certified by the underwriter
to be a true and correct copy of the original policy. This requirement shall survive
expiration or termination of this Agreement.
(e) If PROJECT SPONSOR should subcontract all or any portion of the
services to be performed under this Agreement, PROJECT SPONSOR shall require
each subcontractor to provide insurance protection in favor of CITY and each of its
officers, officials, employees, agents and volunteers in accordance with the terms
of this section, except that any required certificates and applicable endorsements
shall be on file with PROJECT SPONSOR and CITY prior to the commencement of
any services by the subcontractor.
12. On-Site Monitorinq. Authorized representatives of HUD and/or the City shall
have the right to monitor the PROJECT SPONSOR's performance under this Agreement.
Such monitoring may include inspection activities, review of records, and attendance at
meetings: PROJECT SPONSOR shall reasonably make its facilities, books, records,
reports and accounts available for City's inspection in pursuit hereof.
This section 12 shall survive termination or expiration of this Agreement.
13. Records, Reports and Inspection.
(a) PROJECT SPONSOR shall establish and maintain records in
accordance with all requirements prescribed by CITY, HUD and generally accepted
accounting principles, with respect to all matters covered by this Agreement.
As applicable, PROJECT SPONSOR shall comply with all applicable
requirements of 2 CFR PART 200, Uniform Administrative Requirements, Cost
Principles, and Audit Requirements for Federal Awards, including the provision of
a single audit (generally applicable where funding from all federal sources in any
fiscal year exceeds $750,000), and to such extent shall submit to the CITY any
applicable auditor's reports and audited financial statements no later than three
months after the PROJECT SPONSOR's fiscal year end.
PROJECT SPONSOR shall comply with applicable portions of 24 CFR Part 200,
Uniform Administrative Requirements, Cost Principles, and Audit Requirements for
Federal Awards. PROJECT SPONSOR shall be responsible for determining the
applicability of the foregoing:
i. On a quarterly basis, PROJECT SPONSOR shall submit to
Previous editions are obsolete form HUD-40110-D(Expiration Date:01/31/2021)
CITY, in a form acceptable to CITY, a performance report summarizing the number
of unduplicated persons served, including race, ethnicity, and income data. The
performance report shall be submitted within thirty days of the close of each
quarter of the fiscal year for the duration hereof, absent City's prior written consent
in cases of unusual circumstances as determined in the sole discretion of the
CITY. PROJECT SPONSOR shall ensure the ESG grant funds provided by
GRANTEE are clearly identified as a subaward and include the following
information:
0 PROJECT SPONSOR NAME:
A PROJECT SPONSOR ID (DUNS#):
Y Federal Award Identification Number (HOPWA Grant#)
a Federal Award Date:
• Period of Performance:
• Federal Funds Obligated by thisAgreement:
■ Total Federal Funds Obligated to PROJECTSPONSOR:
• Total Amount of the FederalAward:
0 Federal Award project description:
• Name of Federal awarding agency: Dept. of Housing Urban
Development
Name of pass-through entity: City of Fresno,California
e Award Official Contact Information: Name andAddress
e CFDA Number: 14.241
• CFDA Name: Homeless Opportunities for Persons With AIDS
• Identification of R&D: No
• Indirect cost rate for the Federal award: U p t o 7% of combined
administrative and indirect cost rate allowed by City of Fresno
ii. PROJECT SPONSOR shall maintain all records required by
the Federal regulations specified in 24 CFR 574.530
iii. PROJECT SPONSOR shall retain such records for a period
of four (4) years after receipt of the final payment under this Agreement or the
earlier termination of this Agreement, whichever occurs later. The records
retention period may be extended whenever:
a. Any litigation, claim, or audit is started before the
expiration of the five-year period, the records must be retained until all
litigation, claims, or audit findings involving the records have been resolved
and final action taken.
b. The PROJECT SPONSOR is notified in writing by the
CITY to extend the retention period.
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(b) All costs shall be supported by properly executed payrolls, time
records, invoices, contracts, vouchers, orders, or any other accounting documents
pertaining in whole or in part to this Agreement and they shall be clearly identified
and readily accessible to CITY.
(c) During the life of this Agreement and for a period of five years after
receipt of the final payment under this Agreement or the earlier termination of this
Agreement, whichever occurs later, PROJECT SPONSOR shall, at any time during
normal business hours and as often as CITY and/or HUD or the authorized
representative of either CITY or HUD may deem necessary, make available to them
or any one of them, within the City of Fresno, such statements, records, reports,
data and information as they may request pertaining to matters covered by this
Agreement and permit them or any one of them to audit and inspect all records,
invoices, materials, payrolls, records of personnel, conditions of employment, and
other data relating to all matters covered by this Agreement. PROJECT SPONSOR
shall also permit and cooperate with on-site monitoring and personal interviews of
participants, PROJECT SPONSOR'S staff, and employees by Administrator and
other CITY and/or HUD representatives.
(d) The PROJECT SPONSOR is required to submit the HOPWA
Consolidated Annual Performance and Evaluation Report (CAPER) on Form HUD-
40110-D attached hereto as Exhibit E.
(e) PROJECT SPONSOR shall provide reports consistent with HUD
reporting requirements at 24 CFR 91.520, including the number of individuals
assisted and the types of assistance provided, as well as data on emergency
transfers requested under 24 CFR 5.2005(e), pertaining to victims of domestic
violence, dating violence, sexual assault, or stalking, including data on the
outcomes of such requests.
This Section 13 shall survive expiration or termination of this Agreement.
14. Subawards. The PROJECT SPONSOR shall not enter into subawards for
any work contemplated under the Agreement without first obtaining the CITY's written
approval of any subaward and the form of subaward agreement.
(a) An executed copy of every such subcontract approved by the
Administrator shall be provided to CITY prior to implementation for retention in
CITY's files.
(b) PROJECT SPONSOR is responsible to CITY for the proper
performance of any subcontract. No such subcontract shall relieve PROJECT
SPONSOR of its obligations under this Agreement.
(c) Any subcontract shall be subject to all the terms and conditions of this
Agreement.
(d) No officer or director of PROJECT SPONSOR shall have any direct
or indirect financial interest in any subcontract made by PROJECT SPONSOR o r
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in any loan, purchase of property, or any other arrangement made by PROJECT
SPONSOR, by whatever name known.
15. Conflict of Interest and Non-Solicitation.
(a) Prior to CITY'S execution of this Agreement, PROJECT SPONSOR
shall complete a City of Fresno conflict of interest disclosure statement in the form
as set forth in Exhibit D. During the term of this Agreement, PROJECT SPONSOR
shall have the obligation and duty to immediately notify CITY in writing of any
change to the information provided by PROJECT SPONSOR in such statement.
(b) PROJECT SPONSOR shall comply, and require its subcontractors to
comply, with all applicable federal, state and local conflict of interest laws and
regulations including, without limitation, California Government Code Section 1090
et seq., the California Political Reform Act (California Government Code Section
87100 et seq.) and the regulations of the Fair Political Practices Commission
concerning disclosure and disqualification (2 California Code of Regulations
Section 18700 et seq.). At any time, upon written request of CITY, PROJECT
SPONSOR shall provide a written opinion of its legal counsel and that of any
subcontractor that, after a due diligent inquiry, PROJECT SPONSOR and the
respective subcontractor(s) are in full compliance with all laws and regulations.
PROJECT SPONSOR shall take, and require its subcontractors to take, reasonable
steps to avoid any appearance of a conflict of interest. Upon discovery of any facts
giving rise to the appearance of a conflict of interest, PROJECT SPONSOR shall
immediately notify CITY of these facts in writing.
(c) In performing the work or services to be provided hereunder,
PROJECT SPONSOR shall not employ or retain the services of any person while
such person either is employed by CITY or is a member of any CITY council,
commission, board, committee, or similar CITY body or within one year of their
termination therefrom. This requirement may be waived in writing by the City
Manager, if no actual or potential conflict is involved.
(d) PROJECT SPONSOR represents and warrants that it has not paid or
agreed to pay any compensation, contingent or otherwise, direct or indirect, to
solicit or procure this Agreement or any rights/benefits hereunder.
ARTICLE 2
FEDERAL REQUIREMENTS
16. PROJECT SPONSOR warrants, covenants and agrees, for itself and its
contractors and subcontractors of all tiers, that it shall comply with all applicable
requirements of the Lead-Based Paint Poisoning Prevention Act of 42 U.S.C. 4821 et seq.,
24 CFR Part 35 and 24 CFR 982.4010). In this regard PROJECT SPONSOR shall be
responsible for all inspection, testing and abatement activities.
(a) The requirements, as applicable, of the Lead-Based Paint Poisoning
Prevention Act (42 U.S.C. 4821-4846), the Residential Lead-Based Paint H a z a rd
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Reduction Act of 1992 (42 U.S.C. 4851-4856) and implementing regulations at 24
CFR Part 35. In addition, the following requirements relating to inspection and
abatement of defective lead-based paint surfaces must be satisfied: (1) Treatment
of defective paint surfaces must be performed before final inspection and approval
of the renovation, rehabilitation or conversion activity under this part; and (2)
Appropriate action must be taken to protect shelter occupants from the hazards
associated with lead-based paint abatement procedures.
(b) The PROJECT SPONSOR agrees to comply with all applicable
requirements of Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794) as
amended and HUD implementing regulation 24 CFR Part8.
(c) PROJECT SPONSOR agrees to comply with the federal
requirements set forth in 24 CFR Part 5, except as explicitly modified below, and
use of HOPWA grant amounts must comply with the following requirements: (a)
Nondiscrimination and equal opportunity. The nondiscrimination and equal
opportunity requirements at 24 CFR Part 5 are modified as follows:
Q Rehabilitation Act requirements. HUD's regulations at 24 CFR
Part 8 implement section 504 of the Rehabilitation Act of 1973 (29
U.S.C. 794) as amended. For purposes of the emergency shelter grants
program, the term dwelling units in 24 CFR Part 8 shall include sleeping
accommodations.
0 PROJECT SPONSOR shall make known that use of the
facilities and Services are available to all on a nondiscriminatory basis. If the
procedures that the PROJECT SPONSOR intends to use to make known
the availability of the facilities and Services are unlikely to reach persons of
any particular race, color, religion, sex, age, national origin, familial status,
or disability who may qualify for such facilities and Services, the PROJECT
SPONSOR must establish additional procedures that will ensure that such
persons are made aware of the facilities and Services. The PROJECT
SPONSOR must also adopt procedures which will make available to
interested persons information concerning the location of Services and
facilities that are accessible to persons with disabilities.
n The PROJECT SPONSOR shall be responsible for complying
with requirements of 200 PART 200, Uniform Administrative Requirements,
Cost Principles, and Audit Requirements for Federal Awards as they relate
to the acceptance and use of HOPWA grant amounts by private nonprofit
organizations.
(d) The PROJECT SPONSOR will be responsible for all aspects project
contract award and management including the advertising for bids and shall award
the contract to the lowest responsible and responsible bidder. The PROJECT
SPONSOR shall verify with the Labor Relations and Equal Opportunity Division of
the HUD Area Office that the low bidder has not been debarred or suspended from
participating in federal projects.
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(e) PROJECT SPONSOR warrants, covenants and agrees that it shall
perform the Services in a manner that does not engage in inherently religious
activities and that does not engage in any prohibited activities described in 24 CFR
574. Without limitation, PROJECT SPONSOR shall not unlawfully discriminate on
the basis of religion and shall not provide religious instruction or counseling,
conduct religious services or worship, engage in religious proselytizing, or exert
other religious influence in pursuit hereof. Subject to the foregoing, PROJECT
SPONSOR does not intend to utilize HOPWA funding to construct, rehabilitate or
convert facilities owned primarily by religious organizations or to assist primarily
religious organizations in acquiring or leasing facilities to the extent prohibited in 24
CFR 574.
@ PROJECT SPONSOR shall perform the Services in compliance with,
and not to cause or permit the Services to be in violation of, any existing or future
environmental law, rule, regulation, ordinance, or statute. PROJECT SPONSOR
agrees that, if CITY has reasonable grounds to suspect any such violation,
PROJECT SPONSOR shall be entitled to thirty days' notice and opportunity to cure
such violation. If the suspected violation is not cured, CITY shall have the right to
retain an independent consultant to inspect and test the subject facilities for such
violation. If a violation is discovered, PROJECT SPONSOR shall pay for the cost of
the independent consultant.
(g) Uniform Administrative Requirements, Cost Principles, and Audit
Requirements for Federal Awards, 2 CFR 200, is available at
https://www.ecfr.gov/cgi-bin/text-idx?node=2:1.1.2.2.1
17. Relocation.
(a) PROJECT SPONSOR shall assure that it has taken all reasonable
steps to minimize the displacement of persons (families, individuals, businesses,
nonprofit organizations, and farms) as a result of this project and the Services
rendered in pursuit thereof.
(b) A displaced person must be provided relocation assistance at the
levels described in, and in accordance with, 49 CFR Part 24, which contains the
government-wide regulations implementing the Uniform Relocation Assistance and
Real Property Acquisition Policies Act of 1970 (URA) (42 U.S.C.4601-4655).
18. Further Assurances.
(a) This Agreement, when executed and delivered, shall constitute the
legal, valid, and binding obligations of PROJECT SPONSOR enforceable against
PROJECT SPONSOR in accordance with its respective terms, except as such
enforceability may be limited by (a) bankruptcy, insolvency, fraudulent conveyance,
reorganization, moratorium, or other similar laws of general applicability affecting
the enforcement of creditors' rights generally and (b) the application of general
principles of equity without the joiner of any otherparty.
Previous editions are obsolete form HUD-40110-D(Expiration Date:01/31/2021)
(b) PROJECT SPONSOR represents and warrants as of the date hereof
that PROJECT SPONSOR has obtained and, to the best of PROJECT SPONSOR's
knowledge, is in compliance with all federal, state, and local governmental reviews,
consents, authorizations, approvals, and licenses presently required by law to be
obtained by PROJECT SPONSOR for the Services as of the date hereof.
(c) In the performance of this Agreement, PROJECT SPONSOR shall
promptly and faithfully comply with, conform to and obey the ACT and all
amendments thereto, and shall maintain all facilities hereunder in compliance with
building, health and safety codes.
(d) PROJECT SPONSOR shall be solely responsible and liable for any
recapture or repayment obligation imposed by HUD due to any act or omission of
PROJECT SPONSOR in pursuit hereof.
(e) PROJECT SPONSOR acknowledges that PROJECT SPONSOR, not
the CITY, is responsible for determining applicability of and compliance with the
ACT and all other applicable local, state, and federal laws including, but not limited
to, any applicable provisions of the California Labor Code, Public Contract Code,
and Government Code. The CITY makes no express or implied representation as
to the applicability or inapplicability of any such laws to this Agreement or to the
Parties' respective rights or obligations hereunder including, but not limited to,
competitive bidding, prevailing wage subcontractor listing, or similar or different
matters. PROJECT SPONSOR further acknowledges that the CITY shall not be
liable or responsible at law or in equity for any failure by PROJECT SPONSOR to
comply with any such laws, regardless of whether the City knew or should have
known of the need for such compliance, or whether the CITY failed to notify
PROJECT SPONSOR of the need for such compliance.
0 PROJECT SPONSOR agrees to comply with the CITY's Fair
Employment Practices and shall not employ discriminatory practices in the
provision of the Services, employment of personnel, or in any other respect on the
basis of race, color, creed, religion, sex, sexual preference, national origin,
ancestry, ethnicity, age, marital status, status as a veteran with disabilities or
veteran of the Vietnam era, medical condition, or physical or mental disability.
During the performance of this Agreement, PROJECT SPONSOR agrees as
follows:
0 PROJECT SPONSOR will comply with all laws and
regulations, as applicable. No person in the United States shall, on the
grounds of race, color, creed, religion, sex, sexual preference, national
origin, ancestry, ethnicity, age, marital status, status as a disabled veteran
or veteran of the Vietnam era, medical condition, or physical or mental
disability be excluded from participation in, be denied the benefits of, or be
subject to discrimination under any program or activity made possible by or
resulting from this Agreement.
Previous editions are obsolete form HUD-40110-D(Expiration Date:01131/2021)
n PROJECT SPONSOR will not discriminate against any
employee or applicant for employment because of race, color, creed,
religion, sex, sexual preference, national origin, ancestry, ethnicity, age,
marital status, and status as a disabled veteran or veteran of the Vietnam
era, medical condition, or physical or mental disability. PROJECT
SPONSOR shall take affirmative action to ensure that applicants are
employed, and the employees are treated during employment, without
regard to their race, color, creed, religion, sex, sexual preference, national
origin, ancestry, ethnicity, age, marital status, status as a disabled veteran
or veteran of the Vietnam era, medical condition, or physical or mental
disability. Such action shall include, but not be limited to, the following:
employment, upgrading, demotion or transfer; recruitment or recruitment
advertising; layoff or termination; rates of pay or other forms of
compensation; and selection for training, including apprenticeship.
PROJECT SPONSOR agrees to post in conspicuous places, available to
employees and applicants for employment, notices setting forth the provision
of this nondiscrimination clause.
n PROJECT SPONSOR will, in all solicitations or
advertisements for employees placed by or on behalf of PROJECT
SPONSOR, state that all qualified applicants will receive consideration for
employment without regard to race, color, creed, religion, sex, sexual
preference, national origin, ancestry, ethnicity, age, marital status, status as
a disabled veteran or veteran of the Vietnam era, medical condition, or
physical or mental disability.
(N) PROJECT SPONSOR will send to each labor union or
representative of workers with which it has a collective bargaining agreement
or other contract or understanding, a notice advising such labor union or
workers' representatives of PROJECT SPONSOR's commitment under this
Section and shall post copies of the notice in conspicuous places available
to employees and applicants foremployment.
ARTICLE 3
GENERAL PROVISIONS
19. Amendment. This Agreement shall not be modified except by written
amendment approved by the City Council and signed by the parties. Where it is determined
by the Administrator that there is a need to make any change in the Program, services to
be performed, fiscal procedures and system, or the terms and conditions of this Agreement
(including, without limitation, any changes necessary to comply with changes in federal,
state, or local laws or regulations), refusal by PROJECT SPONSOR to accept the change
is grounds for termination of this Agreement. Notwithstanding the foregoing, approval of
the City Council is not required for(i) insubstantial adjustments in line items within the total
approved budget, not affecting the total approved budget amount, approved by the
Administrator in his/her sole discretion;
(ii) insubstantial changes in the nature or scope of services specified in this
Agreement approved by the Administrator in his/her sole discretion; and (iii)
changes to the insurance requirements specified in Exhibit C approved by CITY's
Previous editions are obsolete form HUD-40110-D(Expiration Date:01/31/2021)
Risk Manager in his or her sole discretion.
20. Public Information. PROJECT SPONSOR shall disclose all of its funding
sources to CITY which, thereafter, will be public information.
21. Copyrights/Patents.
(a) If this Agreement results in a book or other copyrightable material, the
author may seek any available copyright protection for the work unless a work for
hire. CITY reserves a royalty-free, nonexclusive, irrevocable and assignable license
to reproduce, publish, or otherwise use, and to authorize others to use, all
copyrighted material and all material which can be copyrighted.
(b) Any discovery or invention arising out of or developed in the course
of work aided by this Agreement, shall promptly and fully be reported to CITY for
determination by CITY as to whether patent protection on such invention or
discovery, including rights thereto under any patent issued thereon (reserved
henceforth onto CITY), shall be imposed and administered, in order to protect the
public interest.
22. Political Activity Prohibited. None of the funds, materials, property or services
provided directly or indirectly under this Agreement shall be used for any political activity,
or to further the election or defeat of any ballot measure or candidate for public office.
23. Lobbying Prohibited. None of the funds provided under this Agreement shall
be used for publicity, lobbying or propaganda purposes designed to support or defeat
legislation pending before any legislative body.
24. Third Party6eneficiaries. The rights, interests, duties and obligations defined
within this Agreement are intended for the specific parties hereto as identified in the
preamble of this Agreement. It is not intended that any rights or interests in this Agreement
benefit or flow to the interest of any third parties.
25. Independent Contractor
(a) In the furnishing of the services provided for herein, PROJECT
SPONSOR is acting as an independent contractor. Neither PROJECT SPONSOR,
nor any of its officers, agents, or employees shall be deemed an office, agent,
employee, joint venture, partner or associate of CITY for any purpose. CITY shall
have no right to control or supervise or direct the manner or method by which
PROJECT SPONSOR shall perform its work and functions. However, CITY shall
retain the right to administer this Agreement so as to verify that PROJECT
SPONSOR is performing its obligations in accordance with the terms and conditions
thereof.
(b) This Agreement does not evidence a partnership or joint venture
between PROJECT SPONSOR and CITY. PROJECT SPONSOR shall have n o
Previous editions are obsolete form HUD-40110-D(Expiration Date:01/31/2021)
authority to bind CITY absent CITY'S express written consent. Except to the extent
otherwise provided in this Agreement, PROJECT SPONSOR shall bear its own
costs and expenses in pursuit thereof.
(c) Because of its status as an independent contractor, PROJECT
SPONSOR and its officers, agents and employees shall have absolutely no right to
employment rights and benefits available to CITY employees. PROJECT
SPONSOR shall be solely liable and responsible for providing to, or on behalf of,
its employees all legally required employee benefits. In addition, PROJECT
SPONSOR shall be solely responsible and save CITY harmless from all matters
relating to payment of PROJECT SPONSOR'S employees, including, without
limitation, compliance with Social Security withholding, and all other regulations
governing such matters. It is acknowledged that during the term of this Agreement,
PROJECT SPONSOR may be providing services to others unrelated to CITY or to
this Agreement.
26. Notices. Any notice required or intended to be given to either party under the
terms of this Agreement shall be in writing and shall be deemed to be duly given if delivered
personally, transmitted by facsimile followed by telephone confirmation of receipt, or sent
by United States registered or certified mail, with postage prepaid, return receipt
requested, addressed to the party to which notice is to be given at the party's address set
forth on the signature page of this Agreement or at such other address as the parties may
from time to time designate by written notice. Notices served by United States mail in the
manner above described shall be deemed sufficiently served or given at the time of the
mailing thereof.
27. Binding. Once this Agreement is signed by all parties, it shall be binding
upon, and shall inure to the benefit of, all Parties, and each Parties' respective heirs,
successors, assigns, transferees, agents, servants, employees and representatives.
28. Assi.nnt.
(a) This Agreement is personal to PROJECT SPONSOR and there shall
be no assignment by PROJECT SPONSOR of its rights or obligations under this
Agreement without the prior written approval of the Administrator. Any attempted
assignment by PROJECT SPONSOR, its successors or assigns, shall be null and
void unless approved in writing by the Administrator.
(b) PROJECT SPONSOR hereby agrees not to assign the payment of
any monies due PROJECT SPONSOR from CITY under the terms of this
Agreement to any other individual(s), corporation(s) or entity(ies). CITY retains the
right to pay any and all monies due PROJECT SPONSOR directly to PROJECT
SPONSOR.
29. Compliance with Law. In providing the services required under this
Agreement, PROJECT SPONSOR shall at all times comply with all applicable laws of the
United States, the State of California and CITY, and with all applicable regulations
promulgated by federal, state, regional or local administrative and regulatory agencies,
Previous editions are obsolete form HUD-40110-D(Expiration Date:01/31/2021)
now in force and as they may be enacted, issued, or amended during the life of this
Agreement.
30. Waiver. The waiver by either Party of a breach by the other of any provision
of this Agreement shall not constitute a continuing waiver or a waiver of any subsequent
breach of either the same or a different provision of this Agreement. No provisions of this
Agreement may be waived unless in writing and signed by all Parties to this Agreement.
Waiver of any one provision herein shall not be deemed to be a waiver of any other
provision herein.
31. Governinq Law and Venue. This Agreement shall be governed by, and
construed and enforced in accordance with, the laws of the State of California, excluding,
however, any conflict of laws rule which would apply the law of another jurisdiction. Venue
for purposes of the filing of any action regarding the enforcement or interpretation of this
Agreement and any rights and duties hereunder shall be Fresno County, California.
32. Headings. The Section headings in this Agreement are for convenience and
reference only and shall not be construed or held in any way to explain, modify or add to
the interpretation or meaning of the provisions of this Agreement.
33. Severability. The provisions of this Agreement are severable. The invalidity
or unenforceability of any one provision in this Agreement shall not affect the other
provisions.
34. Interpretation. The Parties acknowledge that this Agreement in its final form
is the result of the combined efforts of the parties and that, should any provision of this
Agreement be found to be ambiguous in any way, such ambiguity shall not be resolved by
construing this Agreement in favor of or against any Party, but rather by construing the
terms in accordance with their generally accepted meaning.
35. Attorney's Fees. If either Party is required to commence any proceeding or
legal action to enforce or interpret any term, covenant or condition of this Agreement, the
prevailing party in such proceeding or action shall be entitled to recover from the other
Party its reasonable attorney's fees and legal expenses.
36. Exhibits. Each exhibit and attachment referenced in this Agreement is, by
the reference, incorporated into and made a part of this Agreement.
37. Precedence of Documents. The order of precedence of documents shall be:
(1) Rules and Regulations of Federal Agencies relating to the source of funds for this
project; (2) Permits from other agencies as may be required by law;
(3) Supplemental Agreements or this Agreement the one dated later having precedence
over another dated earlier; (4) HOPWA Policies and Procedures (5) General Conditions.
Whenever any conflict appears in any portion of the Contract, it shall be resolved
by application of the order of precedence.
.................
Previous editions are obsolete form HUD-40110-D(Expiration Date:01/31/2021)
In the event of any conflict between the body of this Agreement and any Exhibit or
Attachment hereto, the terms and conditions of the body of this Agreement shall control
and take precedence over the terms and conditions expressed within the Exhibit or
Attachment. Furthermore, any terms or conditions contained within any Exhibit or
Attachment hereto which purport to modify the allocation of risk between the Parties,
provided for within the body of this Agreement, are null and void.
38. Cumulative Remedies. No remedy or election hereunder shall be deemed
exclusive but shall, wherever possible, be cumulative with all other remedies at law or in
equity.
39. Extent of Agreement. Each party acknowledges that they have read and fully
understand the contents of this Agreement. This Agreement represents the entire and
integrated agreement between the parties with respect to the subject matter hereof and
supersedes all prior negotiations, representations or agreements, either written or oral.
[SIGNATURES ON FOLLOWING PAGE]
Previous editions are obsolete form HUD-40110-D(Expiration Date:01131/2021)
IN WITNESS WHEREOF, the parties have executed this Agreement at Fresno,
California, the day and year first above written.
CITY OF FRESNO, WESTCARE CALIFORNIA INC.
a munici al r oration
By: '
By: Shawn J nkins
uan-S ect r Senior Vice Pre ' /Cent
City Manager
Dater (Attach Notary Certificate of Acknowledgement
Date:
APPROVED AS TO FORM:
DOUGLAS T. SLOAN
City Attorney By
B Name:
'
Tracy N rvanian
Senior uty Cityp,Attorney Title:
Date: G 1 (Attach Notary Certificate of Acknowledgement
Date:
ATTEST:
YVONNE SPENCE, CMC
City Clerk
-f6puty r PROJECT SPONSOR:
WestCare California, Inc.
Addresses Attention: Shawn Jenkins, Senior Vice
CITY: President
City of Fresno 1505 N. Chestnut Avenue
Attention: Fresno, CA 93703
Wilma Quan-Schecter Phone: (559) 251-4800
City Manager ext. 20902
2600 Fresno Street
Previous editions are obsolete form HUD-40110-D(Expiration Date:01/31/2021)
ACKNOWLEDGEMENT
State of Nevada
County of Clark
The foregoing instrument was acknowledged before me on February 7, 2019 by Shawn
A. Jenkins, Senior Vice President for WestCare California, Inc.
okv-�- "?
CHRISMON Notary Public
NOTARY PUBLIC
F-= - STATE OF NEVADA
r` MyCommiselon Expires:09/2212022
CedHloste No:94-07W1
My Commission Expires:
Attachments:
1. Exhibit A— Scope of Services
2. Exhibit B — Budget Summary
3. Exhibit C — Insurance Requirements
4. Exhibit D — Conflict of Interest Disclosure Form
5. Exhibit E — HOPWA CAPER, Form HUD-40110-D
Previous editions are obsolete form HUD-40110-D(Expiration Date:01/31/2021)
EXHIBIT A
FUNDED SCOPE OF SERVICES
Consultant Service Agreement Between the City of Fresno
and WestCare California Inc.
HOUSING OPPORTUNITIES FOR PERSONS WITH AIDS
(HOPWA)
WestCare California Inc. (WCCA), is awarded funding to continue providing rapid rehousing,
homeless prevention, permanent supportive housing, case management and supportive services to
homeless and at-risk of homelessness individuals affected by HIV/AIDS and their families in Fresno.
The goal of HOPWA is housing and healthy stability.
Previous editions are obsolete form HUD-40110-D(Expiration Date:01/3112021)
EXHIBIT B
BUDGET SUMMARY
Consultant Service Agreement Between City of Fresno
and WestCare California Inc.
HOUSING OPPORTUNITIES for PERSONS WITH AIDS
.... (HOPWA
Proposed Expenditure f Proposed Budget Approved Budget
Support Services
Pro ram Director $48,000 $48,000
Case Manager $37,440 $37,440
Fringe Benefits $26,468.40 $26,468.40
Facility Lease $4,860 $4,860
Utilities $2,520 $2,520
Repairs/Maintenance $1,200 $1,200
Supplies/Expendable $2,400 $2,400
Equipment $400 $400
Auto Lease $6 600 $6,600
Staff Travel & Training $7,000 $7,000
HMIS Licensing $550 $550
Communications $1,932.67 $1,932.67
Client Needs $1,030 $1,030
Insurance $1,200 $1,200
Total Support Services $141 619.07 $141,169.07
Emergency Shelter
Bridge Housing $51,000 $51,000
Total Emergency Shelter $51,000 $51,000
Housing Info. Referral Services
Client Services Specialist $36,940 $36,940
Fringe Benefits $11,451.60 $11,451.60
Supplies/Expendable $600 $600
Equipment
Equipment $400 $400
Staff Travel & Training $3,500 $3,500
Client Travel - Bus Tokens $250 $250
HMIS Licensing $500 $500
Communications $966.36 $966.36
Total Housing Information $54,607.96 $54,607.96
TBRA
Contractual $163,214 $163,214
Total TBRA $163,214 $163,214
STRMU
Others STRMU $20,000 $20,000
Total STRMU $20,000 $20,000
Previous editions are obsolete form HUD-40110-D(Expiration Date:01/31/2021)
Indirect Costs
Indirect Costs $10,763.53 $10,763.53
Total Indirect Costs $10,763.53 $10 763.53
GRAND TOTAL $441,304.56 $441 304.56
Previous editions are obsolete form HUD-40110-D(Expiration Date:01/3112021)
EXHIBIT C
Consultant Service Agreement Between City of Fresno
and WestCare California Inc.
HOUSING OPPORTUNITIES for PERSONS WITH AIDS
(HOPWA)
M-INIMI_M.SCOPE OF INSURANCE
Coverage shall be at least as broad as:
1. The most current version of Insurance Services Office (ISO) Commercial General
Liability Coverage Form CG 00 01, providing liability coverage arising out of your
business operations. The Commercial General Liability policy shall be written on an
occurrence form and shall provide coverage for"bodily injury," "property damage" and
"personal and advertising injury" with coverage for premises and operations (including
the use of owned and non-owned equipment), products and completed operations, and
contractual liability (including, without limitation, indemnity obligations under the
Agreement) with limits of liability not less than those set forth under "Minimum Limits
of Insurance."
2. The most current version of ISO *Commercial Auto Coverage Form CA 00 01,
providing liability coverage arising out of the ownership, maintenance or use of
automobiles in the course of your business operations. The Automobile Policy shall be
written on an occurrence form and shall provide coverage for all owned, hired, and
non-owned automobiles or other licensed vehicles (Code 1- Any Auto). If personal
automobile coverage is used, the CITY, its officers, officials, employees, agents and
volunteers are to be listed as additional insureds.
3. Workers' Compensation insurance as required by the State of California and
Employer's Liability Insurance.
4. Professional Liability (Errors and Omissions) that includes Cyber Liability (Privacy and
Data Breach) insurance appropriate to RECIPIENT'S profession.
MINIMUM LIMITS QF INSURANCE
RECIPIENT, or any party the RECIPIENT subcontracts with, shall maintain limits of liability of not less
than those set forth below. However, insurance limits available to CITY, its officers, officials,
employees, agents and volunteers as additional insureds, shall be the greater of the minimum limits
specified herein or the full limit of any insurance proceeds available to the named insured:
1. COMMERCIAL GENERAL LIABILITY:
0) $1,000,000 per occurrence for bodily injury and property damage;
(ii) $1,000,000 per occurrence for personal and advertising injury;
Previous editions are obsolete form HUD-40110-D(Expiration Date:01/31/2021)
(iii) $2,000,000 aggregate for products and completed
operations; and,
(iv) $2,000,000 general aggregate applying separately to the work
performed under the Agreement.
2. COMMERCIAL AUTOMOBILE LIABILITY:
$1,000,000 per accident for bodily injury and property damage. OR*
3. WORKERS'UMPENSATjON INSURANCE as required by the State of
California with statutory limits.
4. EMPLOYER'S LIABILITY:
(i) $1,000,000 each accident for bodily injury;
(ii) $1,000,000 disease each employee; and,
(iii) $1,000,000 disease policy limit.
5. PROFESSIONAL LIABILITY (Errors and Omissions) & (Privacy & Data Breach
coverage):
(i) $1,000,000 per claim/occurrence; and,
(ii) $2,000,000 policy aggregate.
UMBRELLA OR EXCESS INSURANCE
In the event RECIPIENT purchases an Umbrella or Excess insurance policy(ies) to meet the
"Minimum Limits of Insurance," this insurance policy(ies) shall "follow form" and afford no less
coverage than the primary insurance policy(ies). In addition, such Umbrella or Excess insurance
policy(ies) shall also apply on a primary and non-contributory basis for the benefit of the CITY, its
officers, officials, employees, agents and volunteers.
DEDUCTIBLES AND SELF-INSURED RETENTIONS
RECIPIENT shall be responsible for payment of any deductibles contained in any insurance
policy(ies) required herein and RECIPIENT shall also be responsible for payment of any self-
insured retentions. Any deductibles or self-insured retentions must be declared on the Certificate
of Insurance, and approved by, the CITY'S Risk Manager or his/her designee. At the option of the
CITY'S Risk Manager or his/her designee, either:
(i) The insurer shall reduce or eliminate such deductibles or self-insured
retentions as respects CITY, its officers, officials, employees, agents
and volunteers;or
(ii) RECIPIENT shall provide a financial guarantee, satisfactory to
CITY'S Risk Manager or his/her designee, guaranteeing payment of
losses and related investigations, claim administration and defense
expenses. At no time shall CITY be responsible for the payment of
any deductibles or self-insured retentions.
OTHER CE PROVISION51ENDORSEMENTS
The General Liability and Automobile Liability„inswance policies are to contain, or be endorsed to
contain, the following provisions:
Previous editions are obsolete form HUD-40110-D(Expiration Date:01/3112021)
1. CITY, its officers, officials, employees, agents and volunteers are to be covered as
additional insureds. RECIPIENT shall establish additional insured status for the City
and for all ongoing and completed operations by use of ISO Form CG 20 10 11 85
or both CG 20 10 10 01 and CG 20 37 10 01 or by an executed manuscript
insurance company endorsement providing additional insured status as broad as
that contained in ISO Form CG 20 10 1185.
2. The coverage shall contain no special limitations on the scope of protection afforded
to CITY, its officers, officials, employees, agents and volunteers. Any available
insurance proceeds in excess of the specified minimum limits and coverage shall
be available to the Additional Insured.
3. For any claims related to this Agreement, RECIPIENT'S insurance coverage shall
be primary insurance with respect to the CITY, its officers, officials, employees,
agents and volunteers. Any insurance or self-insurance maintained by the CITY, its
officers, officials, employees, agents and volunteers shall be excess of
RECIPIENT'S insurance and shall not contribute with it. RECIPIENT shall establish
primary and non-contributory status by using ISO Form CG 20 01 04 13 or by an
executed manuscript insurance company endorsement that provides primary and
non-contributory status as broad as that contained in ISO Form CG 20 01 04 13.
The Workers'Compensation insurance policy is to contain, or be endorsed to contain,the following
provision: RECIPIENT and its insurer shall waive any right of subrogation against CITY, its officers,
officials, employees, agents and volunteers.
If the Professional Liability (Errors and Omissions) with Cyber Liability insurance policy is written
on a claims-made form:
1. The retroactive date must be shown and must be before the effective date of the
Agreement or the commencement of work by RECIPIENT.
2. Insurance must be maintained, and evidence of insurance must be provided for at
least five (5) years after completion of the Agreement work or termination of the
Agreement, whichever occurs first, or, in the alternative, the policy shall be
endorsed to provide not less than a five (5) year discovery period.
3. If coverage is canceled or non-renewed, and not replaced with another claims-
made policy form with a retroactive date prior to the effective date of the Agreement
or the commencement of work by RECIPIENT, RECIPIENT must purchase
"extended reporting" coverage for a minimum of five (5) years after completion of
the Agreement work or termination of the Agreement, whichever occurs first.
4. A copy of the claims reporting requirements must be submitted to CITY for review.
5. These requirements shall survive expiration or termination of the Agreement.
All policies of insurance required herein shall be endorsed to provide that the coverage shall not
be cancelled, non-renewed, reduced in coverage or in limits except after thirty (30) calendar days
written notice by certified mail, return receipt requested, has been given to CITY. RECIPIENT is
also responsible for providing written notice to the CITY under the same terms and conditions.
Upon issuance by the insurer, broker, or agent of a notice of cancellation, non-renewal, or
reduction in coverage or in limits, RECIPIENT shall furnish CITY with a new certificate and
applicable endorsements for such policy(ies). In the event any policy is due to expire during the
work to be performed for CITY, RECIPIENT shall provide a new certificate, and applicable
Previous editions are obsolete form HUD-40110-D(Expiration Date:01/3112021)
endorsements, evidencing renewal of such policy not less than fifteen (15) calendar days prior to
the expiration date of the expiring policy.
Should any of the required policies provide that the defense costs are paid within the Limits of
Liability, thereby reducing the available limits by any defense costs, then the requirement for the
Limits of Liability of these policies will be twice the above stated limits.
The fact that insurance is obtained by RECIPIENT shall not be deemed to release or diminish the
liability of RECIPIENT, including, without limitation, liability under the indemnity provisions of this
Agreement. The policy limits do not act as a limitation upon the amount of indemnification to be
provided by RECIPIENT. Approval or purchase of any insurance contracts or policies shall in no
way relieve from liability nor limit the liability of RECIPIENT, its principals, officers, agents,
employees, persons under the supervision of RECIPIENT, vendors, suppliers, invitees, consultant,
sub-consultant, subcontractors, or anyone employed directly or indirectly by any of them.
SUBCONTRACTORS — If RECIPIENT subcontracts any or all of the services to be performed
under this Agreement, RECIPIENT shall require, at the discretion of the CITY Risk Manager or
designee, subcontractor(s) enter into a separate Side Agreement with the City to provide required
indemnification and insurance protection. Any required Side Agreement(s) and associated
insurance documents for the subcontractor must be reviewed and preapproved by CITY Risk
Manager or designee. If no Side Agreement is required, RECIPIENT will be solely responsible for
ensuring that it's subcontractors maintain insurance coverage at levels no less than those required
by applicable law and is customary in the relevant industry.
VERIFICATION OF COVERAGE
RECIPIENT shall furnish CITY with all certificate(s) and applicable endorsements effecting
coverage required hereunder. All certificates and applicable endorsements are to be received
and approved by the CITY'S Risk Manager or his/her designee prior to CITY'S execution of the
Agreement and before work commences. All non-ISO endorsements amending policy coverage
shall be executed by a licensed and authorized agent or broker. Upon request of CITY, RECIPIENT
shall immediately furnish City with a complete copy of any insurance policy required under this
Agreement, including all endorsements, with said copy certified by the underwriter to be a true and
correct copy of the original policy. This requirement shall survive expiration or termination of this
Agreement.
Previous editions are obsolete form HUD-40110-D(Expiration Date:01/31/2021)
EXHIBIT D
DISCLOSURE OF CONFLICT OF INTEREST
HOUSING OPPORTUNITIES for PERSONS WITH AIDS
(HOPWA)
YES* NO
1 Are you currently in litigation with the City of Fresno or any of its ❑
agents?
2 Do you represent any firm, organization or person who is in ❑
litigation with the City of Fresno?
3 Do you currently represent or perform work for any clients who do ❑ �'
business with the City of Fresno?
4 Are you or any of your principals, managers or professionals, owners
or investors in a business which does business with the City of ❑
Fresno, or in a business which is in litigation with the City of Fresno?
5 Are you or any of your principals, managers or professionals, related �/
by blood or marriage to any City of Fresno employee who has any ❑ L
significant role in the subject matter of this service?
6 Do you or any of your subcontractors have, or expect to have, any
interest, direct or indirect, in any other contract in connection with
this Project?
* If the answer to any question is yes, please explain in full below.
Explanation:
Signature
�I�Ill �i
Date
[ADDRESS]
i Additional page(s) attached.
Previous editions are obsolete form HUD-40110-D(Expiration Date:01/31/2021)
EXHIBIT E
Form HUD-40110-D
Iiij
Housing Opportunities for Persons With AIDS
(HOPWA) Program
Consolidated Annual Performance and
Evaluation Report (CAPER)
Measuring Performance Outcomes
OMB Number 2506-0133(Expiration Date:01/3112021)
The CAPER report for HOPWA formula grantees provides annual information on program accomplishments
that supports program evaluation and the ability to measure program beneficiary outcomes as related to:maintain
housing stability;prevent homelessness;and improve access to care and support.This information is also
covered under the Consolidated Plan Management Process(CPMP)report and includes Narrative Responses and
Performance Charts required under the Consolidated Planning regulations. Reporting is required for all
HOPWA formula grantees.The public reporting burden for the collection of information is estimated to average
41 hours per manual response,or less if an automated data collection and retrieval system is in use,along with
60 hours for record keeping,including the time for reviewing instructions,searching existing data sources,
gathering and maintaining the data needed,and completing and reviewing the collection of information.Grantees
are required to report on the activities undertaken only,thus there may be components of these reporting
requirements that may not be applicable. This agency may not conduct or sponsor,and a person is not required
to respond to a collection of information unless that collection displays a valid OMB control number.
i
Overview.The Consolidated Annual Performance and Evaluation Report Identification Number.These are intended to match the elements under
(CAPER)provides annual performance reporting on client outputs and HMIS.The HOPWA program-level data elements include:Income and
outcomes that enables an assessment of grantee performance in achieving Sources,Non-Cash Benefits,HIV/AIDS Status,Services Provided,
the housing stability outcome measure,The CAPER fulfills statutory and Housing Status or Destination at the end of the operating year,Physical
regulatory program reporting requirements and provides the grantee and Disability,Developmental Disability,Chronic Health Condition,Mental
HUD with the necessary information to assess the overall program Health,Substance Abuse,Domestic Violence,Medical Assistance,and T-
performance and accomplishments against planned goals and objectives. cell Count.Other HOPWA projects sponsors may also benefit from
collecting these data elements.HMIS local data systems must maintain
client confidentiality by using a closed system in which medical
HOPWA formula grantees are required to submit a CAPER demonstrating information and HIV status are only shared with providers that have a
coordination with other Consolidated Plan resources.HUD uses the direct involvement in the client's case management,treatment and care,in
CAPER data to obtain essential information on grant activities,project line with the signed release of information from the client,
sponsors„housing sites,units and households,and beneficiaries(which
includes racial and ethnic data on program participants).The Consolidated
Plan Management Process tool(CPMP)provides an optional tool to Operating Year.HOPWA formula grants are annually awarded for a
integrate the reporting of HOPWA specific activities with other planning three-year period of performance with three operating years.The
and reporting on Consolidated Plan activitie& information contained in this CAPER must represent a one-year period of
HOPWA program operation that coincides with the grantee's program
year;this is the operating year.More than one HOPWA formula grant
Table of Contents awarded to the same grantee may be used during an operating year and the
PART 1 at a ExUalin SummerCAPER must capture all formula grant funding used during the operating
1.Grantee Information year. Project sponsor accomplishment information must also coincide
2.Project Sponsor Information with the operating year this CAPER covers.Any change to the period of
5.Grantee Narrative and Performance Assessment performance requires the approval of HUD by amendment,such as an
a.Grantee and Community Overview extension for an additional operating year.
b.Annual Performance under the Action Plan
c.Barriers or Trends Overview Final Assembly of Report.After the entire report is assembled,number
PART 2:.Source 9 of Leveraein2 and Program Income each page sequentially,
1. Sources of Leveraging
2. Program Income and Resident Rent Payments
PART 3:Aceam lishment Data:Planned Goals and Actual Ow guts Filing Requirements.Within 90 days of the completion ofeach program
PAR I'4:Summary of Performance Outcomes year,grantees must submit their completed CAPER to the CPD Director in
1.Housing Stability:Permanent Housing and Related Facilities the grantee's State or Local HUD Field Office,and to the HOPWA
2.Prevention of Homelessness: Short-Term HousingPayments Program Office:at HOPWA Phud.Boy.Electronic submission to HOPWA
3.Access to Care and Support:Housing Subsidy Assistance with Program office is preferred;however,if electronic submission is not
Supportive Services possible,hard copies can be mailed to:Office of HIV/AIDS Housing,
PART 5:Workchcet_-Determining 11o_usina Stability Outcomes Room 7248,U.S.Department of Housing and Urban Development,451
PART G:Annual Report of Continued Use for EIOPWA f acilily-Based Seventh Street,SW,Washington,D.C.,20410.
Stewardship Units fOnlvl
PART 7•Summary Ov_arview arGranI Arlivities Definitions
A.Information on Individuals,Beneficiaries and Households Receiving Adjustment for Duplication:Enables the calculation of unduplicated
HOPWA Housing Subsidy Assistance(TBRA,STRMU,PHP,Facility output totals by accounting for the total number of households or units that
Based Units,Master Leased Units ONLY) received more than one type of HOPWA assistance in a given service
B.Facility-Based Housing Assistance category such as HOPWA Subsidy Assistance or Supportive Services.For
example,if a client household received both TBRA and STRMU during
Continued Use Periods.Grantees that used HOPWA funding for new the operating year,report that household in the category of HOPWA
construction,acquisition,or substantial rehabilitation of a building or Housing Subsidy Assistance in Part 3,Chart 1,Column[lb]in the
structure are required to operate the building or structure for HOPWA- following manner:
eligible beneficiaries for a ten(10)years period.If no further HOPWA
funds are used to support the facility,in place of completing Section 7B of [11 Outputs:
the CAPER,the grantee must submit an Annual Report of Continued HOPWA Housing Subsidy
Project Operation throughout the required use periods.This report is Number of
included in Part 6 in CAPER.The required use period is three(3)years if Assistance
Households
the rehabilitation is non-substantial.
1. Tenant-Based Rental Assistance I
Record Keeping.Names and other individual information must be kept 2a Permanent Housing Facilities:Received
confidential,as required by 24 CFR 574.440.However,HUD reserves the Operating Subsidies/Leased units
right to review the information used to complete this report for grants
management oversight purposes,except for recording any names and other Transitional/Short-term Facilities:
identifying information.In the case that HUD must review client-level 2b' Received Operating Subsidies
data,no client names or identifying information will be retained or Permanent Housing Facilities:Capital
recorded.Information is reported in aggregate to HUD without 3a. Development Projects placed in service
personal identification.Do not submit client or personal information dELn&the operatin.4year
in data systems to HUD. Transitional/Short-term Facilities:
3b. Capital Development Projects placed in
In connection with the development of the Department's standards for service during the operating .ear
Homeless Management Information Systems(HMIS),universal data Short-term Rent,Mortgage,and Utility
elements are being collected for clients of HOPWA-funded Nameless 4' Assistance I
assistance Miects.These project sponsor records would include:Name, 5. Adjustment for duplication(subtract)
Social Security Number,Date of Birth,Ethnicity and Race,Gender, I
Veteran Status,Disabling Conditions,Residence Prior to Program Entry, 6 TOTAL Housing Subsidy Assistance
Zip Code of Last Permanent Address,Housing Status,Program Entry Sum of Rows 1-4 minus Row 5 1
Date,Program Exit Date,Personal Identification Number,and Household
Previous editions are obsolete Page xxix form HUD-40110-D(Expiration Date:0113112021)
Administrative Costs:Costs for general management,oversight, Housing Placement services and Master Leasing)and/or residing in units
coordination,evaluation,and reporting.By statute,grantee administrative of facilities dedicated to persons living with HIV/AIDS and their families
costs are limited to 3%of total grant award,to be expended over the life of and supported with HOPWA funds during the operating year.
the grant.Project sponsor administrative costs are limited to 7%of the
portion of the grant amount they receive. Household:A single individual or a family composed of two or more
persons for which household incomes are used to determine eligibility and
Beneficiary(ies):All members of a household who received HOPWA for calculation ofthe resident rent payment. The term is used for
assistance during the operating year including the one individual who collecting data on changes in income,changes in access to services,receipt
qualified the household for HOPWA assistance as well as any other of housing information services,and outcomes on achieving housing
members of the household(with or without HIV)who benefitted from the stability,Live-In Aides(see definition for Live-In Aide)and non-
assistance. beneficiaries(e.g.a shared housing arrangement with a roommate)who
resided in the unit are not reported on in the CAPER
Chronically Homeless Person:An individual or family who:(i)is
homeless and lives or resides individual or family who:(i)Is homeless and Housing Stability:The degree to which the HOPWA project assisted
lives or resides in a place not meant for human habitation,a safe haven,or beneficiaries to remain in stable housing during the operating year.See
in an emergency shelter;(ii)has been homeless and living or residing in a Part 5:Determining Housing Stability Outcomes for definitions of stable
place not meant for human habitation,a safe haven,or in an emergency and unstable housing situations,
shelter continuously for at least 1 year or on at least 4 separate occasions in
the last 3 years;and(iii)has an adult head of household(or a minor head In-kind Leveraged Resources:These are additional types of support
of household if no adult is present in the household)with a diagnosable provided to assist HOPWA beneficiaries such as volunteer services,
substance use disorder,serious mental illness,developmental disability(as materials,use of equipment and building space.The actual value of the
defined in section 102 of the Developmental Disabilities Assistance and support can be the contribution of professional services,based on
Bill of Rights Act of 2000(42 U,S,C. 15002)),post traumatic stress customary rates for this specialized support,or actual costs contributed
disorder,cognitive impairments resulting from a brain injury,or chronic from other leveraged resources.In determining a rate for the contribution
physical illness or disability,including the co-occurrence of 2 or more of of volunteer time and services,use the criteria described in 2 CFR 200.
those conditions Additionally, h t e statutory definition includes as The value of any donated material,equipment,building,or lease should be
chronically homeless a person who currently lives or resides in an based on the fair market value at time of donation.Related documentation
institutional care facility,including a jail,substance abuse or mental health can be from recent bills of sales,advertised prices,appraisals,or other
treatment facility,hospital or other similar facility,and has resided there information for comparable property similarly situated,
for fewer than 90 days if such person met the other criteria for homeless
prior to entering that facility,(See 42 U.S.C. 11360(2))This does not
include doubled-up or overcrowding situations. Leveraged Funds:The amount of funds expended during the operating
year from non-HOPWA federal,state,local,and private sources by
Disabling Condition:Evidencing a diagnosable substance use disorder, grantees or sponsors in dedicating assistance to this client population
serious mental illness,developmental disability,chronic physical illness, Leveraged funds or other assistance are used directly in or in support of
or disability,including the co-occurrence of two or more of these HOPWA program delivery.
conditions.In addition,a disabling condition may limit an individual's
ability to work or perform one or more activities of daily living An Live-In Aide:A person who resides with the HOPWA Eligible Individual
HIV/AIDS diagnosis is considered a disabling condition, and who meets the following criteria:(1)is essential to the care and well-
being of the person;(2)is not obligated for the support of the person;and
Facility-Based Housing Assistance:All eligible HOPWA Housing (3)would not be living in the unit except to provide the necessary
expenditures for or associated with supporting facilities including supportive services.See t24 CFR 5.403 and the HOPWA Grantee
community residences,SRO dwellings,short-term facilities,project-based Oversight Resource Guide for additional reference.
rental units,master]eased units,and other housing facilities approved by
HUD.
Master Leasing:Applies to a nonprofit or public agency that leases units
Faith-Based Organization:Religious organizations of three types:(1) of housing(scattered-sites or entire buildings)from a landlord,and
congregations;(2)national networks,which include national subleases the units to homeless or low-income tenants.By assuming the
denominations,their social service arms(for example,Catholic Charities, tenancy burden,the agency facilitates housing of clients who may not be
Lutheran Social Services),and networks of related organizations(such as able to maintain a lease on their own due to poor credit,evictions,or lack
YMCA and YWCA);and(3)freestanding religious organizations,which of sufficient income,
are incorporated separately from congregations and national networks.
Operating Costs: Applies to facility-based housing only,for facilities
Grassroots Organization:An organization headquartered in the local that are currently open.Operating costs can include day-to-day housing
community where it provides services;has a social services budget of function and operation costs like utilities,maintenance,equipment,
$300,000 or less annually,and six or fewer full-time equivalent insurance,security,furnishings,supplies and salary for staff costs directly
employees.Local affiliates of national organizations are not considered related to the housing project but not staff costs for delivering services.
"grassroots,"
Outcome:The degree to which the HOPWA assisted household has been
HOPWA Eligible Individual:The one(1)low-income person with enabled to establish or maintain a stable living environment in housing that
HIV/AIDS who qualifies a household for HOPWA assistance,This person is safe,decent,and sanitary,(per the regulations at 24 CFR 574.310(b))
may be considered"Head of Household."When the CAPER asks for and to reduce the risks ofhomelessness,and improve access to HIV
information on eligible individuals,report on this individual person only. treatment and other health care and support
Where there is more than one person with HIV/AIDS in the household,the
additional PWH/A(s),would be considered a beneficiary(s)- Output:The number of units of housing or households that receive
HOPWA assistance during the operating year.
HOPWA Housing Information Services:Services dedicated to helping
persons living with HIV/AIDS and their families to identify,locate,and Permanent Housing Placement:A supportive housing service that helps
acquire housing.This may also include fair housing counseling for eligible establish the household in the housing unit,including but not limited to
persons who may encounter discrimination based on race,color,religion, reasonable costs for security deposits not to exceed two months of rent
sex,age,national origin,familial status,or handicap/disability, costs.
HOPWA Housing Subsidy Assistance Total:The unduplicated number Program Income:Gross income directly generated from the use of
of households receiving housing subsidies(TBRA,STRMU,Permanent HOPWA funds,including repayments. See grant administration
Previous editions are obsolete Page xxx form HUD-40110-D(Expiration Date:01131/2021)
requirements on program income at 2 CFR 200.307,
Stewardship Units:Units developed with HOPWA,where HOPWA
Project-Based Rental Assistance(PBRA): A rental subsidy program funds were used for acquisition,new construction and rehabilitation that
that is tied to specific facilities or units owned or controlled by a project no longer receive operating subsidies from HOPWA.Report information
sponsor.Assistance is tied directly to the properties and is not portable or for the units is subject to the three-year use agreement if rehabilitation is
transferable. non-substantial and to the ten-year use agreement if rehabilitation is
substantial.
Project Sponsor Organizations:Per HOPWA regulations at 24 CFR
574.3,any nonprofit organization or governmental housing agency that Tenant-Based Rental Assistance(TBRA):TBRA is a rental subsidy
receives funds under a contract with the grantee to provide eligible housing program similar to the Housing Choice Voucher program that grantees can
and other support services or administrative services as defined in 24 CFR provide to help low-income households access affordable housing,The
574.300. Project Sponsor organizations are required to provide TBRA voucher is not tied to a specific unit,so tenants may move to a
performance data on households served and funds expended, different unit without losing their assistance,subject to individual program
rules.The subsidy amount is determined in part based on household
SAM:All organizations applying for a Federal award must have a valid income and rental costs associated with the tenant's lease,
registration active at sam.gov.SAM(System for Award Management)
registration includes maintaining current information and providing a valid Transgender:Transgender is defined as a person who identifies with,or
DUNS number. presents as,a gender that is different from his/her gender at birth.
Short-Term Rent,Mortgage,and Utility(STRMU)Assistance:A Veteran:A veteran is someone who has served on active duty in the
time-limited,housing subsidy assistance designed to prevent homelessness Armed Forces of the United States.This does not include inactive military
and increase housing stability.Grantees may provide assistance for up to reserves or the National Guard unless the person was called up to active
21 weeks in any 52-week period. The amount of assistance varies per duty.
client depending on funds available,tenant need and program guidelines.
Previous editions are obsolete Page xxxi form HUD-40110-D(Expiration Date:01/31/2021)
Housing Opportunities for Person With AIDS (HOPWA)
Consolidated Annual Performance and Evaluation Report (CAPER)
Measuring Performance Outputs and Outcomes
OMB Number 2506-0133(Expiration Date:01/31/2021)
Part 1: Grantee Executive Summary
As applicable,complete the charts below to provide more detailed information about the agencies and organizations responsible
for the administration and implementation of the HOPWA program.Chart 1 requests general Grantee Information and Chart 2 is
to be completed for each organization selected or designated as a project sponsor,as defined by 24 CFR 574.3.
Note:If any information does not apply to your organization,please enter N/A. Do not leave any section blank
1.Grantee Information
HUD Grant Number Operating Year for this report
From(mm/dd/yy) To(nvWdd/yy)
Grantee Name
Business Address
City,County,State,Zip
Employer Identification Number(EIN)or
Tax Identification Number TI
DUN&Bradstreet Number(DUNs): System for Award Management(SAM)::
Is the grantee's SAM status currently active?
❑Yes ❑No
If yes,provide SAM Number:
Congressional District of Grantee's Business
Address
*Congressional District of Primary Service
Area(s)
*City(ies)and County(ies)of Primary Service Cities: Counties:
Area(s)
Organization's Website Address Is there a waiting list(s)for HOPWA Housing Subsidy Assistance
Services in the Grantee Service Area? ❑Yes ❑No
If yes,explain in the narrative section what services maintain a waiting
list and how this list is administered.
*Service delivery area information only needed for program activities being directly carried out by the grantee.
Previous editions are obsolete Page 1 form HUD-40110-D(Expiration Date:0113112021)
i
2. Project Sponsor Information
Please complete Chart 2 for each organization designated or selected to serve as a project sponsor,as defined by 24 CFR 574.3.
Use this section to report on organizations involved in the direct delivery of services for client households.
Note:If any information does not apply to your organization,please enter N/A.
Project Sponsor Agency Name Parent Company Name,ifapplicable
... ................
Name and Title of Contact at Project
Sponsor A encv
Email Address
Business Address
City,County,State,Zip,
' Phone Number(with area code)
Employer Identification Number(EIN)or FF.. mber(with area code)
Tax Identification Number(TIN)
DUN&Bradstreet Number(DUNs):
Congressional District of Project Sponsor's
Business Address
Congressional District(s)of Primary Service
Area(s)
City(ies)and County(ies)of Primary Service Cities: Counties:
Area(s)
Total HOPWA contract amount for this
Organization for the operating year
Organization's Website Address
Is the sponsor a nonprofit organization? ❑Yes ❑No Does your organization maintain awaiting list? ❑Yes ❑No
Please check ifyes and a faith-based organization. ❑
Please check ifyes and a grassroots organization. ❑ If yes,explain in the narrative section how this list is administered.
Previous editions are obsolete Page 2 form HUD-40110-D(Expiration Date:01/31/2021)
i
I
S. Grantee Narrative and Performance Assessment
a.Grantee and Community Overview
Provide a one to three page narrative summarizing major achievements and highlights that were proposed and completed during
the program year.Include a brief description of the grant organization,area of service,the name(s)of the program contact(s),
and an overview of the range/type of housing activities provided.This overview may be used for public information,including
! posting on HUD's website. Note: Text fields are expandable.
b.Annual Performance under the Action Plan
Provide a narrative addressing each of the following four items:
1. Outputs Reported.Describe significant accomplishments or challenges in achieving the number of housing units supported
and the number households assisted with HOPWA funds during this operating year compared to plans for this assistance,as
approved in the Consolidated Plan/Action Plan.Describe how HOPWA funds were distributed during your operating year
among different categories of housing and geographic areas to address needs throughout the grant service area,consistent with
approved plans.
2. Outcomes Assessed.Assess your program's success in enabling HOPWA beneficiaries to establish and/or better maintain a
stable living environment in housing that is safe,decent,and sanitary,and improve access to care. Compare current year results
to baseline results for clients.Describe how program activities/projects contributed to meeting stated goals.If program did not
achieve expected targets,please describe how your program plans to address challenges in program implementation and the steps
currently being taken to achieve goals in next operating year. If your program exceeded program targets,please describe
strategies the program utilized and how those contributed to program successes.
3. Coordination.Report on program coordination with other mainstream housing and supportive services resources,including
the use of committed leveraging from other public and private sources that helped to address needs for eligible persons identified
in the Consolidated Plan/Strategic Plan.
4.Technical Assistance.Describe any program technical assistance needs and how they would benefit program beneficiaries.
c.Barriers and Trends Overview
Provide a narrative addressing items 1 through 3.Explain how barriers and trends affected your program's ability to achieve the
objectives and outcomes discussed in the previous section.
1. Describe any barriers(including regulatory and non-regulatory)encountered in the administration or implementation of
the HOPWA program,how they affected your program's ability to achieve the objectives and outcomes discussed,and,
actions taken in response to barriers,and recommendations for program improvement.Provide an explanation for each
barrier selected.
❑ HOPWA/HUD Regulations ❑ Planning ❑Housing Availability ❑Rent Detennination and Fair Market Rents
❑ Discrimination/Confidentiality ❑ Multiple Diagnoses ❑ Eligibility ❑ Technical Assistance or Training
❑ Supportive Services ❑ Credit History ❑ Rental History ❑Criminal Justice History
❑ Housing Affordability
❑ Geography/Rural Access ❑ Other,please explain further
Previous editions are obsolete Page 3 form HUD-40110-D(Expiration Date:01/31/2021)
2.Describe any trends in the community that may affect the way in which the needs of persons living with HIV/AIDS
are being addressed,and provide any other information important to the future provision of services to this population.
3.Identify any evaluations,studies,or other assessments of the HOPWA program that are available to the public.
End of PART 1
Previous editions are obsolete Page 4 form HUD-40110-D(Expiration Date:01/31/2021)
PART 2: Sources of Leveraging and Program Income
1. Sources of Leveraging
Report the source(s)of cash or in-kind leveraged federal,state, local or private resources identified in the Consolidated or
Annual Plan and used in the delivery of the HOPWA program and the amount of leveraged dollars.In Column[1],identify the
type of leveraging. Some common sources of leveraged funds have been provided as a reference point.You may add Rows as
necessary to report all sources of leveraged funds.Include Resident Rent payments paid by clients directly to private landlords.
Do NOT include rents paid directly to a HOPWA program as this will be reported in the next section.In Column[2]report the
amount of leveraged funds expended during the operating year.Use Column[3]to provide some detail about the type of
leveraged contribution(e.g.,case management services or clothing donations).In Column[4],check the appropriate box to
indicate whether the leveraged contribution was a housing subsidy assistance or another form of support.
Note:Be sure to report on the number of households supported with these leveraged funds in Part 3, Chart 1, Column d.
A. Source of Leveraging Chart
[21 Amount of
Leveraged [31 Type of [41 Housing Subsidy
III Source of Leveraging Funds Contribution Assistance or Other Support
Public Funding
❑Housing Subsidy Assistance
Ran White-HousingAssistance ❑Other Support
❑Housing Subsidy Assistance
Ran White-Other ❑Other Support
❑Housing Subsidy Assistance
Housing Choice Voucher Program ❑Other Support
❑Housing Subsidy Assistance
Low Income Housin Tax Credit ❑ Other Support
❑Housing Subsidy Assistance
HOME ❑Other Support
❑Housing Subsidy Assistance
Continuum of Care ❑ Other Support
❑Housing Subsidy Assistance
Emergency Solutions Grant ❑Other Support
❑Housing Subsidy Assistance
Other Public: ❑ Other Support
❑Housing Subsidy Assistance
Other Public: ❑Other Support
❑Housing Subsidy Assistance
Other Public: ❑Other Support
❑Housing Subsidy Assistance
Other Public: ❑Other Su ort
❑Housing Subsidy Assistance
Other Public: ❑Other Support
Private Fmilin
❑Housing Subsidy Assistance
Grants ❑Other Support
❑Housing Subsidy Assistance
In-kind Resources ❑ Other Support
❑Housing Subsidy Assistance
Other Private: ❑Other Support
❑Housing Subsidy Assistance
Other Private: ❑ Other Support
Other Funding
❑Housing Subsidy Assistance
Grantee/Project Sponsor(Agency)Cash ❑ Other Support
Resident Rent Payments bZ Client to Private Landlord
TOTAL Sum of all Rows
Previous editions are obsolete Page 5 form HUD-40110-D(Expiration Date:0113112021)
2. Program Income and Resident Rent Payments
In Section 2,Chart A,report the total amount of program income and resident rent payments directly generated from the use of
HOPWA funds,including repayments.Include resident rent payments collected or paid directly to the HOPWA program.Do
NOT include payments made directly from a client household to a private landlord.
Note:Please see report directions section for definition of (Additional information on program income is
available in the HOP WA Grantee Oversight Resource Guide).
A. Total Amount Program Income and Resident Rent Payment Collected During the OperatingYear
Total Amount of Program
Program Income and Resident Rent Payments Collected Income
(for this operating year)
1. Program income(e.g.repayments)
2. Resident Rent Payments made directly to HOPWA Program
3. Total Program Income and Resident Rent Payments(Sum of Rows 1 and 2)
B. Program Income and Resident Rent Payments Expended To Assist HOPWAHouseholds
In Chart B,report on the total program income and resident rent payments(as reported above in Chart A)expended during the
operating year. Use Row 1 to report Program Income and Resident Rent Payments expended on Housing Subsidy Assistance
Programs(i.e.,TBRA, STRMU,PHP,Master Leased Units,and Facility-Based Housing).Use Row 2 to report on the Program
Income and Resident Rent Payment expended on Supportive Services and other non-direct Housing Costs.
Total Amount of Program
Program Income and Resident Rent Payment Expended on Income Expended
HOPWA programs (for this operating year)
..........
1. Program Income and Resident Rent Payment Expended on Housing Subsidy Assistance costs
2. Program Income and Resident Rent Payment Expended on Supportive Services and other non-
direct housing costs
3. Total Program Income Expended(Sum of Rows 1 and 2)
End of PART 2
Previous editions are obsolete Page 6 form HUD-40110-D(Expiration Date:01/31/2021)
PART 3: Accomplishment Data Planned Goal and Actual Outputs
In Chart 1,enter performance information(goals and actual outputs)for all activities undertaken during the operating year
supported with HOPWA funds.Performance is measured by the number of households and units of housing that were supported
with HOPWA or other federal,state,local,or private funds for the purposes of providing housing assistance and support to
persons living with HIV/AIDS and their families.
1. HOPWA Performance Planned Goal and Actual Outputs
[11 Output:Households [21 Output:Funding
HOPWA Leveraged
HOPWA Performance Assistance Households HOPWA Funds
Planned Goal a. L c_ d_ f.
and Actual 71 a a
O U O U
C7 Q C7 Q o x a
HOPWA Housing Subsidy Assistance I1 Output:Households L21 On ut:Fund'
l Tenant-Based Rental Assistance
2a (Permanent Housing Facilities:
(Received Operating Subsidies/Leased units Households Served)
2b rransitional/Short-term Facilities:
(Received Operating Subsidies/Leased units(Households Served)
'Households Served)
3a Permanent Housing Facilities:
Capital Development Projects placed in service during the operating year
Households Served)
3b. Transitional/Short-term Facilities:
Capital Development Projects placed in service during the operating year
Households Served)
t Short-Term Rent,Mortgage and Utility Assistance
>. Permanent Housing Placement Services
S .Adjustments for duplication(subtract) �i^?�" �i ""i li°.... -ii-iii
...•
1 rotal HOPWA Housing Subsidy Assistance
(Columns a—d equal the sum of Rows 1-5 minus Row 6;Columns a and f equal
the sum of Rows 1-5)
(Housing Development(Construction and Stewardship of facility based housing)
Ill u ut: Housine Units 12J Output:Funding
8. Facility-based units;
apital Development Projects not yet opened(Housing Units)
9. Stewardship Units subject to 3-or 10-year use agreements
10. rotal Housing Developed
'Sum of Rows 8&9
upportive Services
1I Output-Households 121 Output:Fundio
1 la. Supportive Services provided by project sponsors that also delivered HOPWA housing
subsidy assistance
I lb. Supportive Services provided by project sponsors that only provided supportive
services.
12, Adjustment for duplication(subtract)
13. Total Supportive Services
,Columns a—d equals the sum of Rows 11 a&b minus Row 12;Columns a and f 1
equal the sum of Rows Ila&llb) L
(Housing Information Services [1]Output:Households [2]Output:Funding
14. Housing Information Services =iii '° i...
.......
':'
15. total Housing Information Services
'Grant Administration and Other Activities 11]Output:Households [2]Output:Funding
16.(Resource Identification to establish,coordinate and develophousing
t'
g jassistance resources
l}: ti3i�liii"M!
.t. .ii..
17, Technical Assistance •i:i:id:2 ieFikffii iii:i: ifi:":fir"'(;
Previous editions are obsolete Page 7 form HUD-40110-D(Expiration Date:0113112021)
(if approved in grant agreement) ?iiii'r ??i]ig ii:?H =•;' ::i;i;
18.Grantee Administration
TN ... ..
(maximum 3%of total HOPWA grant) ?'i' r isiass. ii
19..Project Sponsor Administration i
(maximum 7%of portion of HOPWA grant awarded)
20-Total Grant Administration and Other Activities
(Sum of Rows 16—19)
1�3
Total
Expended stutas Ex end dWA
Budget Actual
21.Total Expenditures for operating year(Sum of Rows 7,10,
2. Listing of Supportive Services
Report on the households served and use of HOPWA funds for all supportive services.Do NOT report on
supportive services leveraged with non-HOPWA funds.
Data check:Total unduplicated households and expenditures reported in Row 17 equal totals reported in Part 3, Chart
1,Row 13.
Supportive Services 11]Output:Number of Households 121 Output:Amount of HOPWA Funds
Expended
L Adult day care and personal assistance
2 Alcohol and drug abuse services
3. Case management
4. Child care and other child services
5. Education
6. Employment assistance and training
Health/medical/intensive care services,if approved
7. Note: Client records must conform with 24 CFR$574.310
8- Legal services
9. Life skills management outside of case management)
10 Meals/nutritional services
11. Mental health services
12. Outreach
13_ Transportation
Other Activity(if approved in grant agreement).
14, Specify:
in
Sub-Total Households receiving Supportive Services i:= •#aj ry;;E}•iF�i�
PEel a_{:.°tt ois^s:2.3Eii=°tit.?=cs"t:t°ici:P-^ss�i t:i}.1:Si•»•'•i�:i 3':':c r'?:�"rt'r..'•r
sEi u�
1:~> . :..r = ::siaii:3:15. (Sum of Rows 1-14) IN,16. Adjustment for Duplication subtract
TOTAL Unduplicated Households receiving
Supportive Services(Column[11 equals Row 15
17. minus Row 16;Column 121 equals sum of Rows 1-14
3. Short-Term Rent,Mortgage and Utility Assistance(STRMU)Summary
In Row a,enter the total number of households served and the amount of HOPWA funds expended on
Short-Term Rent,Mortgage and Utility(STRMU)Assistance.In Row b,enter the total number of
STRMU-assisted households that received assistance with mortgage costs only(no utility costs)and the
amount expended assisting these households.In Row c,enter the total number of STRMU-assisted
households that received assistance with both mortgage and utility costs and the amount expended assisting
these households.In Row d,enter the total number of STRMU-assisted households that received assistance
with rental costs only(no utility costs)and the amount expended assisting these households. In Row e,
enter the total number of STRMU-assisted households that received assistance with both rental and utility
costs and the amount expended assisting these households.In Row f,enter the total number of STRMU-
assisted households that received assistance with utility costs only(not including rent or mortgage costs)
and the amount expended assisting these households.In row g,report the amount of STRMU funds
expended to support direct program costs such as program operation staff.
Data Check:The total households reported as served with STRMU in Row a, column[1]and the total amount of
HOPWA funds reported as expended in Row a, column[2]equals the household and expenditure total reported for
STRMU in Part 3, Chart 1,Row 4, Columns b and f,respectively.
Data Check:The total number of households reported in Column[1],Rows b,c,d,e,and f equal the total number of
STRMU households reported in Column[1],Row a. The total amount reported as expended in Column[2],Rows b,c,
d, e,f,and g.equal the total amount ofSTRMUexpenditures reported in Column[2],Row a.
[11 Output:Number of [21 Output:Total
Housing Subsidy Assistance Categories(STRMU) Households Served HOPWA Funds Expended
on STRMU during
Operating Year
Total Short-term mortgage,rent and/or utility(STRMU)
a. assistance
Of the total STRMIf reported on Row 21,total who received
b. assistance with mortgage costs ONLY.
Of the total STRMU reported oii stow e9.total who received
c• assistance with mortgage and utility costs.
Of the -otal STRMU mWrted on Row a,total who received
d- assistance with rental costs ONLY.
Of the total STRMU reported on Row a,total who received
e- assistance with rental and utility costs-
Of the total STRMt1 reported on Row a.total who received
f assistance with utility costs ONLY.
Direct program delivery costs(e.g.,program operations staff
time)
g
End of PART 3
Part 4: Summary of Performance Outcomes
In Column[1],report the total number of eligible households that received HOPWA housing subsidy
assistance,by type.
In Column[2],enter the number of households that continued to access each type of housing subsidy
assistance into next operating year.In Column[3],report the housing status of all households that exited
the program.
Data Check:The sum of Columns[2](Number of Households Continuing)and[3](Exited Households)equals the total
reported in Column[1J.
Note:Refer to the housing stability codes that appear in Part 5: Worksheet-Determining Housing Stability Outcomes.
Section 1.Housing Stability:Assessment of Client Outcomes on Maintaining Housing Stability
(Permanent Housing and Related Facilities)
A.Permanent Housing Subsidy Assistance
[11 Output: [21 Assessment:Number of [31 Assessment:Number of
Total Number Households that Continued Households that exited this [41 HOPWA Client
of Households Receiving HOPWA HOPWA Program;their Outcomes
Served Housing Subsidy Assistance Housing Status after
into the Next Operating Exiting
1 Emergency
Shelter/Streets Unstable Arrangements
2 Temporary Housing Temporarily Stable,with
Reduced Risk of
Homelessness
Tenant- 3 Private Housing
Based
Rental 4 Other HOPWA Stable/Permanent Housing
Assistance S Other Subsidy (PH)
6 Institution
7 Jail/Prison
8 Unstable Arrangements
Disconnected/Unknown
9 Death Life Event
1 Emergency
Shelter/Streets Unstable Arrangements
2 Temporary Housing Temporarily Stable,with
Reduced Risk of
Homelessness
Permanent
3 Private Housing
Supportive
Housing 4 Other HOPWA Stable/Permanent Housing
Facilities/
Units 5 Other Subsidy (PH)
6 Institution
7 Jail/Prison
g Unstable Arrangements
Disconnected/Unknown
9 Death Life Event
B.Transitional Homing Assistance
[1] Output: [21 Assessment:Number of [31 Assessment:Number of
Total Number Households that Households that exited this
of Households Continued Receiving HOPWA Program;their [4]HOPWA Client
Served HOPWA Housing Subsidy Housing Status after Outcomes
Assistance into the Next Exiting
Operating Year
1 Emergency Shelter/Streets Unstable Arrangements
2 Temporary Housing Temporarily Stable ivith
Reduced Risk of Homelessness
Transitional/ 3 Private Housing
Short-Term
Housing 4 Other HOPWA Stable/Permanent Housing
Facilities/ 5 Other Subsidy (PH)
Units
6 Institution
7 JaiVPrison
S Unstable Arrangements
Disconnected/unknown
9 Death Life Event
B 1:Total number of households receiving transitional/short-term
housing assistance whose tenure exceeded 24 months
Section 2.Prevention of Homelessness: Assessment of Client Outcomes on Reduced Risks
of Homelessness
(Short-Term Housing Subsidy Assistance)
Report the total number of households that received STRMU assistance in Column[1].
In Column[2],identify the outcomes of the households reported in Column[1] either at the time that they
were known to have left the STRMU program or through the project sponsor's best assessment for stability
at the end of the operating year.
Information in Column[3]provides a description of housing outcomes;therefore,data is not required.
At the bottom of the chart:
• In Row la,report those households that received STRMU assistance during the operating year of
this report,and the prior operating year.
• In Row lb,report those households that received STRMU assistance during the operating year of
this report,and the two prior operating years.
Data Check: The total households reported as served with STRMU in Column[1]equals the total
reported in Part 3, Chart 1, Row 4, Column b.
Data Check: The sum of Column[2]should equal the number of households reported in Column[1].
Assessment of Households that Received STRMU Assistance
[1] Output:Total [2] Assessment of Housing Status [3] HOPWA Client Outcomes
number of
households
Maintain Private Housing without subsidy
(e.g.Assistance providedlcompleted and client is stable,not
likely to seek additional support)
Other Private Housing without subsidy
(e.g.client switched housing units and is now stable,not likely
to seek additional support) Stable/Permanent Housing(PH)
Other HOPWA Housing Subsidy Assistance
Other Housing Subsidy(PH)
Institution
(e.g.residential and long-term care)
Likely that additional STRMU is needed to maintain current
housing arrangements
Transitional Facilities/Short-term Temporarily Stable, with
(e.g,temporary or transitional arrangement) Reduced Risk of Homelessness
Temporary/Non-Permanent Housing arrangement
(e.g.gave up lease,and moved in with family or friends but
expects to live there less than 90 days)
Emergency Shelter/street
Jail/Prison Unstable Arrangements
Disconnected
Death Life Event
1 a.Total number of those households that received STRMU Assistance in the operating year of this report that also received
STRMU assistance in the prior operating year(e.g.households that received STRMU assistance in two consecutive operating
years).
lb,Total number of those households that received STRMU Assistance in the operating year of this report that also received
STRMU assistance in the two prior operating years(e.g.households that received STRMU assistance in three consecutive
operating years).
Section 3.HOPWA Outcomes on Access to Care and Support
Ia. Total Number of Households
Line[1]:For project sponsors that provided HOPWA housing subsidy assistance during the operating year
identify in the appropriate row the number of households that received HOPWA housing subsidy assistance
(TBRA,STRMU,Facility-Based,PHP and Master Leasing)and HOPWA funded case management services.
Use Row c to adjust for duplication among the service categories and Row d to provide an unduplicated
household total.
Line[2]:For project sponsors that did NOT provide HOPWA housing subsidy assistance identify in the
appropriate row the number of households that received HOPWA funded case management services.
Note: These numbers will help you to determine which clients to report Access to Care and Support Outcomes for
and will be used by HUD as a basis for analyzing the percentage of households who demonstrated or maintained
connections to care and support as identified in Chart I b below.
Total Number of Households
1. For Project Sponsors that provided HOPWA Housing Subsidy Assistance:Identify the total number of households that received the
following HOPWA-funded services:
a. Housing Subsidy Assistance(duplicated)-TBRA,STRMU,PHP,Facility-Based Housing,and Master Leasing
b. CaseManagement
c. Adjustment for duplication(subtraction)
d. Total Households Served by Project Sponsors with Housing Subsidy Assistance(Sum of Rows a and b minus
Row c
2, For Project Sponsors did NOT provide HOPWA Housing Subsidy Assistance:Identify the total number of households that received the
followi HOPWA-funded service:
a, HOPWA Case Management
b. Total Households Served by Project Sponsors without Housing Subsidy Assistance
lb. Status of Households Accessing Care and Support
Column[1]:Of the households identified as receiving services from project sponsors that provided HOPWA
housing subsidy assistance as identified in Chart la,Row I above,report the number of households that
demonstrated access or maintained connections to care and support within the operating year.
Column[2]: Of the households identified as receiving services from project sponsors that did NOT provide
HOPWA housing subsidy assistance as reported in Chart la,Row 2b,report the number of households that
demonstrated improved access or maintained connections to care and support within the operating year.
Note:For information on types and sources o income and medical refer to Charts below.
[1]For project sponsors that [21 For project sponsors that
provided HOPWA housing subsidy did NOT provide HOPWA Outcome
Categories of Services Accessed assistance,identify the households housing subsidy assistance, Indicator
who demonstrated the following: identify the households who
demonstrated the following:
1.Has a housing plan for maintaining or establishing stable on- Support for
,going housing Stable
Housing
2,Had contact with case manageribenefits counselor consistent
with the schedule specified in client's individual service plan Access to
(may include leveraged services such as Ryan White Medical Support
Case Management)
.3.Had contact with a primary health care provider consistent Access to
with the schedule specified in client's individual service plan Health Care
4.Accessed and maintained medical insurance/assistance Access to
Health Care
:5.Successfully accessed or maintained qualification for sources Sources of
of income Income
Chart lb,Line 4: Sources of Medical Insurance and Assistance include,but are not limited to the
following(Reference only)
i
• MEDICAID Health Insurance Program, • Veterans Affairs Medical Services
or use local program • AIDS Drug Assistance Program(ADAP) Ryan White-funded Medical or Dental
name • State Children's Health Insurance Assistance
• MEDICARE Health Insurance Program, Program(SCHIP),or use local program
or use local pmgmrnname name
Chart lb,Row 5: Sources of Income include, but are not limited to the following Reference only)
• Earned Income • Child Support . General Assistance(GA),or use local
• Veteran's Pension • Social Security Disability Income program name
• Unemployment Insurance (SSDI) • Private Disability Insurance
• Pension from Former Job • Alimony or other Spousal Support ■ Temporary Assistance for Needy
• Supplemental Security Income(SSI) Veteran's Disability Payment Families(TANF)
• Retirement Income from Social • Other Income Sources
Security
• Worker's Compensation
lc. Households that Obtained Employment
Column[1]:Of the households identified as receiving services from project sponsors that provided HOPWA
housing subsidy assistance as identified in Chart la,Row I above,report on the number of households that
include persons who obtained an income-producing job during the operating year that resulted from HOPWA-
funded Job training,employment assistance,education or related case management/counseling services.
Column[2]: Of the households identified as receiving services from project sponsors that did NOT provide
HOPWA housing subsidy assistance as reported in Chart 1 a,Row 2b,report on the number of households that
include persons who obtained an income-producing job during the operating year that resulted from HOPWA-
funded Job training,employment assistance,education or case management/counseling services.
Note: This includes jobs created by this project sponsor or obtained outside this agency.
Note:Do not include jobs that resulted from leveraged job training, employment assistance, education or case
management/counseling services.
[1 For project sponsors that provided [21 For project sponsors that did NOT provide
Categories of Services Accessed HOPWA housing subsidy assistance,identify HOPWA housing subsidy assistance,identify the
the households who demonstrated the households who demonstrated the following:
following:
'Total number of households that
obtained an income- roducin 'ob
End of PART 4
I
PART 5: Worksheet-Determining Housing Stability Outcomes(optional)
1.This chart is designed to assess program results based on the information reported in Part 4 and to help Grantees
determine overall ra ram perfarmanue.Cam letion of this worksheet is optional.
Permanent Stable Housing Temporary Housing Unstable Life Event
Housing Subsidy (#ofhouseholds (2) Arrangements (9)
Assistance remaining in program (1+7+8)
plus 3+4+5+6
Tenant-Based
Rental Assistance
(TBRA
Permanent Facility-
based Housing
Assistance/Units
Transitional/Short-
Term Facility-based
Housing
Assistance/Units
Total Permanent
HOPWA Housing
Subsidy Assistance
Reduced Risk of Stable/Permanent Temporarily Stable,with Reduced Risk of Unstable Life Events
Homelessness: Housing Homelessness Arrangements
Short-Term
Short-Term Rent,
Mortgage,and
Utility Assistance
STRMU
Total HOPWA
Housing Subsidy
Assistance
Background on HOPWA Housing Stability Codes
Stable Permanent Housing/Ongoing Participation
3=Private Housing in the private rental or home ownership market(without known subsidy,including permanent
placement with families or other self-sufficient arrangements)with reasonable expectation that additional support is
not needed.
4=Other HOPWA-funded housing subsidy assistance(not STRMU),e.g.TBRA or Facility-Based Assistance.
5=Other subsidized house or apartment(non-HOPWA sources,e.g., Section 8,HOME,public housing).
6=Institutional setting with greater support and continued residence expected(e.g.,residential or long-term care
facility).
Temporary Housing
2=Temporary housing-moved in with family/friends or other short-term arrangement,such as Ryan White
subsidy,transitional housing for homeless,or temporary placement in institution(e.g.,hospital,psychiatric hospital
or other psychiatric facility,substance abuse treatment facility or detox center).
Unstable Arrangements
1 =Emergency shelter or no housing destination such as places not meant for habitation(e.g.,a vehicle,an
abandoned building,bus/train/subway station,or anywhere outside).
7=Jail/prison.
8=Disconnected or disappeared from project support,unknown destination or no assessments of housing needs
were undertaken.
Life Event
9=Death,i.e.,remained in housing until death.This characteristic is not factored into the housing stability
equation.
Tenant-based Rental Assistance:Stable Housing is the sum of the number of households that(i)remain in the
housing and(ii)those that left the assistance as reported under:3,4,5,and 6. Temporary Housing is the number of
households that accessed assistance,and left their current housing for a non-permanent housing arrangement,as
reported under item:2.Unstable Situations is the sum of numbers reported under items: 1,7,and 8.
Permanent Facility-Based Housing Assistance:Stable Housing is the sum of the number of households that(i)
remain in the housing and(ii)those that left the assistance as shown as items:3,4,5,and 6.Temporary Housing is
the number of households that accessed assistance,and left their current housing for a non-permanent housing
arrangement,as reported under item 2. Unstable Situations is the sum of numbers reported under items: 1,7,and 8.
Transitional/Short-Term Facility-Based Housing Assistance:Stable Housing is the sum of the number of
households that(i)continue in the residences(ii)those that left the assistance as shown as items:3,4,5,and 6.
Other Temporary Housing is the number of households that accessed assistance,and left their current housing for a
non-permanent housing arrangement,as reported under item 2. Unstable Situations is the sum of numbers reported
under items: 1,7,and 8.
Tenure Assessment.A baseline of households in transitional/short-term facilities for assessment purposes,
indicate the number of households whose tenure exceeded 24 months.
STRMU Assistance: Stable Housing is the sum of the number of households that accessed assistance for some
portion of the permitted 21-week period and there is reasonable expectation that additional support is not needed in
order to maintain permanent housing living situation(as this is a time-limited form of housing support)as reported
under housing status:Maintain Private Housing with subsidy;Other Private with Subsidy;Other HOPWA support;
Other Housing Subsidy;and Institution.Temporarily Stable with Reduced Risk of Homelessness is the sum of the
number of households that accessed assistance for some portion of the permitted 21-week period or left their
current housing arrangement for a transitional facility or other temporary/non-permanent housing arrangement and
there is reasonable expectation additional support will be needed to maintain housing arrangements in the next year,
as reported under housing status:Likely to maintain current housing arrangements,with additional STRMU
assistance;Transitional Facilities/Short-tern;and Temporary/Non-Permanent Housing arrangements Unstable
Situation is the sum of number of households reported under housing status:Emergency Shelter;Jail/Prison;and
Disconnected.
End of PART 5
PART 6: Annual Report of Continued Usage for HOPWA Facility-Based Stewardship Units
(ONLY)
The Annual Report of Continued Usage for HOPWA Facility-Based Stewardship Units is to be used in
place of Part 7B of the CAPER if the facility was originally acquired,rehabilitated or
constructed/developed in part with HOPWA funds but no HOPWA funds were expended during the
operating year. Scattered site units may be grouped together on one page.
Grantees that used HOPWA funding for new construction,acquisition,or substantial rehabilitation are
required to operate their facilities for HOPWA eligible individuals for at least ten(10)years.If non-
substantial rehabilitation funds were used,they are required to operate for at least three(3)years.
Stewardship begins once the facility is put into operation.
Note:See definition ofSiewardship Gaits.
1. General information
Operating Year for this report
HUD Grant Number(s) From(mm/ddlyy)To(mmMd/yy) ❑Final Yr
❑ Yr 1; ❑ Yr 2; ❑ Yr 3; ❑ Yr 4; ❑ Yr 5; ❑Yr 6;
❑Yr 7; ❑ Yr 8; ❑ Yr 9; ❑Yr 10
Grantee Name Date Facility Began Operations(mm/dd/yy)
2.Number of Units and Non-HOPWA Expenditures
Facility Name: Number of Stewardship Units Amount of Non-HOPWA Funds Expended in Support of the
Developed with HOPWA Stewardship Units during the Operating Year
funds
Total Stewardship Units
subject to 3-or 10-year useperiods)
3.Details of Project Site
Project Sites:Name of HOPWA-funded 2roject
Site Information:Project Zip Code s
Site hnformation:Congressional District(s)
Is the address of the project site confidential?
❑ Yes,protect information;do not list
❑ Not confidential;information can be made available to thepublic
If the site is not confidential:
Please provide the contact information,phone,
email address/location,ifbusiness address is
different from facility address
End of PART 6
Part 7: Summary Overview of Grant Activities
A. Information on Individuals,Beneficiaries,and Households Receiving HOPWA Housing Subsidy
Assistance(TBRA, STRMU,Facility-Based Units,Permanent Housing Placement and Master
Leased Units ONLY)
Note:Reporting for thisseation should include ONLYthose individuals, beneficiaries, or households that received
and/or resided in a household that received HOPWA Housing Subsidy Assistance as reported in Part 3, Chart 1,
Row 7, Column b. (e.g., do not include households that received HOPWA supportive services ONLY).
Section 1. HOPWA-Eligible Individuals Who Received HOPWA Housing Subsidy Assistance
a. Total HOPWA Eligible Individuals Living with HIV/AIDS
In Chart a.,provide the total number of eligible(and unduplicated) low-income individuals living with HIVIAIDS
who qualified their household to receive HOPWA housing subsidy assistance during the operating year.This total
should include only the individual who qualified the household for HOPWA assistance,NOT all HIV positive
individuals in the household.
Individuals Served with Housing Subsidy Assistance Total
Number of individuals with HIV/AIDS who qualified their household to receive HOPWA housing subsidy
assistance.
Chart b.Prior Living Situation
In Chart b,report the prior living situations for all Eligible Individuals reported in Chart a.In Row 1,report the
total number of individuals who continued to receive HOPWA housing subsidy assistance from the prior operating
year into this operating year.In Rows 2 through 17,indicate the prior living arrangements for all new HOPWA
housing subsidy assistance recipients during the operating year.
Data Check: The total number of eligible individuals served in Row 18 equals the total number of individuals
served through hausin ,subsidy assistance ie orled in Chart a above.
Total HOPWA
Category Eligible Individuals
Receiving Housing
Subsidy Assistance
1. Continuing to receive HOPWA support from the prior operating year
New Individuals who received HOPWA Housing Subsidy Assistance support during Operating Year
2 Place not meant for human habitation
such as a vehicle,abandoned buildin ,bus/train/subway station/airport,or outside)
3. Emergency shelter(including hotel,motel,or campground paid for with emergency shelter voucher)
4. Transitional housing for homeless persons
5. i Total number of new Eligible Individuals who received HOPWA Housing Subsidy Assistance with a Prior
Livinp,Situation that meets HUD definition of homelessness Sum of Rows 2—4
6 Permanent housing for formerly homeless persons(such as Shelter Plus Care,SHP,or SRO Mod
Rehab)
7. Psychiatric hospital or other psychiatric facility
8. Substance abuse treatment facility or detox center
9. Hospital(non-psychiatric facility)
10. Foster care home or foster care group home
11. Jail,prison or juvenile detention facility
12. Rented room,apartment,or house
13. House you own
14. Staying or living in someone else's(family and friends)room,apartment,or house
15. Hotel or motel paid for without emergency shelter voucher
16. Other
17. Don't Know or Refused
18. TOTAL Number of HOPWA Eligible Individuals(sum of Rows land 5-17)
c. Homeless Individual Summary
In Chart c,indicate the number of eligible individuals reported in Chart b,Row 5 as homeless who also are
homeless Veterans and/or meet the definition for Chronically Homeless(See Definition section of CAPER).The
totals in Chart c do not need to equal the total in Chart b,Row 5.
Number of Number of Chronically
Category Homeless Homeless
Veteran(s)
HOPWA eligible individuals served with
HOPWA Housing Subsidy Assistance
Section 2. Beneficiaries
In Chart a,report the total number of HOPWA eligible individuals living with HIV/AIDS who received HOPWA
housing subsidy assistance(as reported in Part 7A, Section 1, Chart a),and all associated members of their
household who benefitted from receiving HOPWA housing subsidy assistance(resided with HOPWA eligible
individuals).
Note:See definition of 110PIVA Eligible Individual
Note:See definition of Transgender.
Note: See definition ofBenefciaries.
Data Check: The sum of each of the Charts b&c on the following two pages equals the total number of
beneficiaries served with HOPWA housing subsidy assistance as determined in Chart a, Row 4 below.
a.Total Number of Beneficiaries Served with HOPWA Housing Subsidy Assistance
Individuals and Families Served with HOPWA Housing Subsidy Assistance Total Number
1.Number of individuals with HIV/AIDS who qualified the household to receive HOPWA housing subsidy
assistance(equals the number of HOPWA Eligible Individuals reported in Part 7A Section 1 Chart a
2.Number of ALL other persons diagnosed as HIV positive who reside with the HOPWA eligible individuals
identified in Row 1 and who benefitted from the HOPWA housing subsidy assistance
3.Number of ALL other persons NOT diagnosed as HIV positive who reside with the HOPWA eligible
individual identified in Row 1 and who benefited from the HOPWA housing subsidy
4.TOTAL number of ALL beneficiaries served with Housing Subsidy Assistance(Sum of Rows 1,2,&3)
b. Age and Gender
In Chart b,indicate the Age and Gender of all beneficiaries as reported in Chart a directly above.Report the Age
and Gender of all HOPWA Eligible Individuals(those reported in Chart a,Row 1)using Rows 1-5 below and the
Age and Gender of all other beneficiaries(those reported in Chart a,Rows 2 and 3)using Rows 6-10 below.The
number of individuals reported in Row 11,Column E. equals the total number of beneficiaries reported in Part 7,
Section 2,Chart a,Row 4.
HOPWA Eligible Individuals(Chart a,Row 1
A. B. C. D. E.
TOTAL(Sum of
Male Female Trans ender M to F Trans ender F to M Columns A-D
1. Under 18
Z 18 to 30.ears
3. 31 to 50 .ears
51 years and
4. Older
Subtotal(Sum
5. of Rows 1-4) _
All Other Beneficiaries Chart a,Rows 2 and 3)
A. B. C. D. E.
TOTAL(Sum of
Male Female Trans ender M to F Trans ender F to M Columns A-D)
6 Under 18
T 18 to 30 vears
8, 31 to 50 Vears
51 years and
9. Older
Subtotal(Sum
10. of Rows 6-9
Total Beneficiaries Chart a,Row 4)
TOTAL(Sum
11. of Rows 5&10
c.Race and Ethnicity*
In Chart c,indicate the Race and Ethnicity of all beneficiaries receiving HOPWA Housing Subsidy Assistance as
reported in Section 2,Chart a,Row 4. Report the race of all HOPWA eligible individuals in Column[A]. Report
the ethnicjjX of all HOPWA eligible individuals in column[B].Report the race of all other individuals who
benefitted from the HOPWA housing subsidy assistance in column[C].Report the cthnici ,of all other individuals
who benefitted from the HOPWA housing subsidy assistance in column [D]. The summed total of columns[A]
and[C] equals the total number of beneficiaries reported above in Section 2,Chart a,Row 4.
HOPWA Eligible Individuals All Other Beneficiaries
[A] Race [C]Race
Category [all individuals [B]Ethnicity [total of [D]Ethnicity
reported in [Also identified as individuals [Also identified as
Section 2,Chart a, Hispanic or reported in Hispanic or
Row 11 Latino] Section 2,Chart a, Latino]
Rows 2&31
1. American Indian/Alaskan Native
2. Asian
3. Black/African American
4, Native Hawaiian/Other Pacific Islander
5. White
6. American Indian/Alaskan Native&White
7. Asian&White
8. Black/African American&White
9 American Indian/Alaskan Native&
Black/African American
10. Other Multi-Racial
11. L Column Totals(Sum of Rows 1-10)
Data Check:Sum of Row 11 Column A and Row 11 Column C equals the total number HOPWA Beneficiaries reported in Part 3A,Section 2,
Chart a,Row 4.
*Reference(data regrrested consistent nvth Fonn IIUD-27061 Race and Ethnic Data Reporting Form)
Section 3. Households
Household Area Median Income
Report the income(s)for all households served with HOPWA housing subsidy assistance.
Data Check: The total number of households served with HOP WA housing subsidy assistance should equal Part
3C, Row 7, Column b and Part 7A, Section 1, Chart a. (Total HOP WA Eligible Individuals Served with HOPWA
Housing Subsidy Assistance).
Note:Refer to by s.'ll1 ivw.huduser. ovIDorialldatasetslil.hitnl for information on area median income in
atrr eonnntrritt .
Percentage of Area Median Income Households Served with HOPWA Housing Subsidy
Assistance
1. 0-30%of area median income(extremely low)
2_ 31-50%of area median income(very low)
3. 51-80%of area median income(low)
4. Total(Sum of Rows 1-3)
Part 7: Summary Overview of Grant Activities
B. Facility-Based Housing Assistance
Complete one Part 713 for each facility developed or supported through HOPWA funds.
Do not corm3lete this Section for programs orieinally developed with HOPWA funds but no longer supported
with HOPWA funds.If a facility was developed with HOPWA funds(subject to ten years of operation for
acquisition,new construction and substantial rehabilitation costs of stewardship units,or three years for non-
substantial rehabilitation costs),but HOPWA funds are no longer used to support the facility,the project sponsor
should complete Part 6:Continued Usage for HOPWA Facility-Based Stewardship Units(ONLY).
Complete Charts 2a,Project Site Information,and 2b,Type of HOPWA Capital Development Project Units,for all
Development Projects,including facilities that were past development projects,but continued to receive HOPWA
operating dollars this reporting year.
1.Project Sponsor Agency Name(Required)
2. Capital Development
2a.Project Site Information for HOPWA Capital Development of Projects(For Current or Past
Capital Development Projects that receive HOPWA Operating Costs this reporting year)
Note:If units are scattered sites; report on them as a group and under e pf Facility write "Scattered Sites."
HOPWA Name of Facility:
Type of Funds Non-HOPWA funds
Development Expended
this operating this operating Expended
(if applicable)
year year
(i applicable)
❑New construction $ $ Type of Facility [Check only one box.]
❑ Permanent housing
❑Rehabilitation $ ❑ Short-term Shelter or Transitional housing
❑Acquisition $ $ ❑ Supportive services only facility
❑Operating $ $
a. Purchase/lease of property: Date(mm/dd/yy):
b. Rehabilitation/Construction Dates: I Date started: Date Completed:
C. Operation dates: Date residents began to occupy:
❑ Not yet occupied
d. Date supportive services began: Date started:
❑ Not yet providing services
C. Number of units in the facility: HOPWA-funded units= Total Units=
f. Is a waiting list maintained for the facility? ❑Yes ❑No
If yes,number ofparticipants on the list at the end of operating year
g. What is the address of the facility(if different from business address)?
h. Is the address of the project site confidential? ❑ Yes,protect information;do notpublish list
❑ No,can be made available to thepublic
2b. Number and Type of HOPWA Capital Development Project Units(For Current or Past
Capital Development Projects that receive HOPWA Operating Costs this Reporting Year)
For units entered above in 2a,please list the number of HOPWA units that fulfill the followin criteria:
Number
Number Designated
for the Chronically Designated to Number Energy- Number 504 Accessible
Homeless Assist the Star Compliant
Homeless
Rental units constructed
(new)and/or acquired
with or without rehab
Rental units rehabbed
Homeownership units
constructed(if approved)
3.Units Assisted in Types of Housing Facility/Units Leased by Project Sponsor
charts 34,3b,and_4 are required,For each facility..In Charts 3a and 3b,indicate the type and number of housing
units in the facility,including master leased units,project-based or other scattered site units leased by the
organization,categorized by the number of bedrooms per unit.
Note: The number units may not equal the total number of households served.
Please complete separate charts for each housing facility assisted. Scattered site units may be grouped
together.
3a. Check one only
❑ Permanent Supportive Housing Facility/Units
❑ Short-term Shelter or Transitional Supportive Housing Facility/Units
3b. Type of Facility
Complete the following Chart for all facilities leased,master leased,project-based,or operated with HOPWA funds
during the reporting year.
Name of Project Sponsor/Agency Operating the Facility/Leased Units:
Total Number of Units in use during the Operating Year
Type of housing facility operated by the Cate orized by the Number of Bedrooms er Units
project sponsor SRO/Studio/0 1 bdrm 2 bdrm 3 bdrm 4 bdrm 5+bdrm
bdrm
a. Single room occupancy dwelling
b. Community residence
C. Project-based rental assistance units or leased units
Other housing facility
d. S Medi
4.Households and Housing Expenditures
Enter the total number of households served and the amount of HOPWA funds expended by the project sponsor on
subsidies for housing involving the use of facilities,master leased units,project based or other scattered site units
leased by the organization.
Housing Assistance Category:Facility Based Housing Output:Number of Output:Total HOPWA Funds Expended during
Households Operating Year by Project Sponsor
a Leasing Costs
b Operating Costs
C. Project-Based Rental Assistance(PBRA)or other leased units
d Other Activity(if approved in grant agreement)Specify:
IAdjustment to eliminate duplication(subtract)
eTOTAL Facility-Based Housing Assistance
f Sum Rows a through d minus Row e)