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HomeMy WebLinkAbout110711_ca04 JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST DATE: RE: Board of County Commissioners Aimee Campbell, Chief Accountant November 7, 2011 AMENDEMENT #1 of Subrecioient Aareement for CDBG Public Services between Jefferson County and Olympic Community Action Programs (OlyCap) for the new CDSG grant penod of July 1, 2011 - December 31, 2011 TO: FROM: STATEMENT OF ISSUE: Jefferson County entered Into the anginal agreement with Olympic Community Action Programs for this grant penod on September 6, 2011. That agreement included an 'Attachment l' and 'Attachment 2' which outlined the Scope of Work and Budget for OiyCap as they intended to expend the $69,974 in revenue that they would be receMng in pass-through funds from the County. Shortly after the anginal agreement was signed, OlyCap realized that they would need to amend their Scope of Work and Budget to better reflect the programs that wouid most benefit from the CDBG funding. Attachments 1 and 2 are the only documents being amended; a1i other terms and conditions of the anginal agreement remain intact. FISCAL IMPACT: There Is no increase or decrease being mede to the revenue or total expenditures of this grant The oniy change Is to the specific OiyCap programs which wiil be funded by CDBG and the way that the funds wiil be distributed between those programs. RECOMMENDATION: It Is my recommendatlon that the Board of County Commissioners approves and signs this amendment REVIEWED BY: #~p Date Amendment No.1 Subreclplent Agreement for COBG Public Services Between Jeffereon County and Olympic Community Action Progrems WHEREAS, Jefferson County (the Local Govemment) and Olympic Community Action Programs (the Subreclplent) entered Into an agreement on September 6, 2011 for public services funded by the stele Community Development Block Grant (CDBG) Program. AND WHEREAS, the parties desire to amend the terms of that agreement NOW IT IS AGREED BY AND BETWEEN THE PARTIES HERETO AS FOLLOWS: 1. Attachment #1: Scope of Work, attached, supersedes the existing Attachment #1. 2. Attachment #2: Budget, attached, supersedes the existing Attachment #2. 3. Ail other terms and conditions of said agreement shall remain the same. Dated this day of . 2011. By: John Austin, Chairman Jefferson County Board of County Commissioners Approved as ta form only: 10)2.'1'/'2.011 Jefferson Co. Pro -I~- By: Timothy Hockett, Executive Director Olympic Community ActIon Programs /{)/31!?DJ{ Date Attachment #1 - SCOPE OF WORK A. Service Proarams NOTE: Ust the specific public service activities from the CDBG application's Project Description & Low- and Moderate-Income Benefit Table or reference the public servlca activities found in this application table. Emergency Services Energy Assistance Encorel Senior Nutrition Education Jobs B. Periodic Reoorts 1. Public Services Contract Quarterlv BeneficiaN Reoortino Form (copy attached; provided by the Department of Commerce) with data on the use of CDBG funds, including the number of: . Persons served; . Low- and moderate-income persons served; . Persons with new access to a service; and . Persons with increasedlimproved access to a service. 2. No more than monthly and no less than quarterly, A-19 Invoice Vouchers with a written narrative report on the services and expenditures funded by CDBG as back-up documentation of the CDBG reimbursement payment request. C. Local Government Oversicht Plan 1. Review and approval authority for each payment request for CDBG reimbursement. 2. Annual on-site monitoring visit. 3. Receipt and review of community action agency's annual audit report, Management Letter (if received), and any documentation of any CDBG-related findings. 4. Annual public hearing to receive Input on program performance. 1 Attachment #2 - BUDGET BUDGET - CDBG Public Services Grant Purpose: To deliver the direct services identified in the CDBG Public Services Grant application and this Agreement's Scope of Work Cost Categories: Staffing $54,810.00 Include salary & benefits to be documented by payroll records Goods and services $3,164.00 Treining costs must be tied to the delivery of the COBG public service Equipment $0.00 Items costing $300 or more require Commerce pre-approval Travel $0.00 Out-of-state trevel requires Commerce pre-approval and follow federel trevel ner diem Indirect Costs $12,000.00 Must be tied to a COBG public service through the agency's approved cost allocation oian. Must equal the budget amount listed for public services in the COBG TOTAL $69,974.00 con~t between the Local Government and Commerce. (Not to include coun administretion funds.) All costs must be eligible under OMB Circular A-122 and tied to the delivery of the COBG public service. If unsure, consult Commerce's Contrects Administration Unit. Budget Narrative: Describe what is included in the costs. CDBG will support staff and benefit costs for three services areas: Emergency Services ($20,000); Education ($33,876); and Encorel ($934). CDBG will fund food purchase for the Senior Nutrition program: $1,848 CDBG will help cover the Indirect Costs associated with our Energy Assistance Programs: $12,000 CDBG will help cover program costs for the Jobs program: $1,316 2 SUBRECIPIENT AGREEMENT FOR COBG PUBLIC SERVICES SUBRECIPIENT AGREEMENT FOR COBG PUBLIC SERVICES THIS AGREEMENT is between the local government CDBG recipient Jefferson County (herein called the Local Government) and OlympIc Community Action Programs (herein called the Subreclplent) for public services funded by the state Community Development Block Grant (CDBG) Program. As the Washington State Department of Commerce (Commerce) Is authorized by the federal Department of Housing and Urban Development (HUD) to provide funds to units of local government selected to undertake and carry out certain activities and projects under the Washington State CDBG Program In compliance with all applicable local, state, and federal laws, regulations and policies; and As the Local Government has applied for and received a COBG award, contract number 11-64100-004 to fund public services; and As it benefits the Local Government to engage the Subrecipient to accomplish the Scope of Work and the objectives of the local CDBG project; The parties agree that: 1. SCOPE OF WORK A. Local Government Responsibilities The Local Government is responsible for administration of the CDBG contract, and ensuring CDBG funds are used in accordance with all program requirements 1(24 CFR 570.501 (b)] and its CDBG contract with Commerce referenced above. The Local Government will provide such assistance and guidance to the Subrecipient as may be required to accomplish the objectives and cOnditions set forth in this Agreement. B. Subrecipient Responsibilities The Subrecipient shall complete in a satisfactory and proper manner as determined by the Local Government the tasks described in the attached Scope of Work and Budget to accomplish the objectives of the CDBG project. The Subrecipient will periodically meet with the Local Government to review the status of these tasks. 2. TIME OF PERFORMANCE The time of performance for this Agreement will begin the date the parties sign and complete execution.ofthis agreement for funding available as of the effective date established by the Local Government's CDBG contract, and will be in effect for the time period during which the Subrecipient remains in control of CDBG funds or other CDBG assets. The parties to this Agreement acknowledge that the start date for performance of their obligations under this Agreement shall be July 1, 2011 and the end date for performance of their obligations under this Agreement shall be December 31, 2011. Payment to SUbrecipient for work performed under this Agreement may occur after the end date described here. 3. BUDGET The Subrecipient shall follow the budget approved by Commerce and the Local Government and attached to this Agreement (Attachment #2). The Local Government may require a more detailed I budget breakdown, and the Subreclpient shall provide such supplementary budget information in a timely fashion in the form and content prescribed by the Local Government. Any amendments to the budget must first be determined by the Local Government as consistent with its COSG contract with Commerce and then approved in writing by the Local Government and the Subreciplent. 4. PAYMENT The Local Government shall reimburse the Subreciplent in accordance with the public services payment procedures provided by the COSG Program for all allowable expenses agreed upon by the parties to complete the Scope of Work. In no event shall the total amount to be reimbursed by the Local Government to the Subreclplent exceed the sum of Sixty Nine Thousand Nine Hundred Seventy Four Oollars Even ($69,974.00). Reimbursement under this agreement will be based on billings, supported by appropriate documentation of costs actually incurred. it is expressly understood that claims for reimbursement will not be submitted In excess of actual, Immediate cash requirements necessary to carry out the purposes of the Agreement. Funds available under this Agreement will be utilized to supplement rather than supplant funds otherwise available. The Local Government may pay the Subrecipient for overtime, extra-pay shifts, and multi-shift work only with prior approval. Exceptions are as follows: . 1} When necessary to cope with emergencies, such as those resulting from accidents, natural disasters, breakdowns of equipment, or occasional operational bottlenecks of a sporadic nature. 2} When employees are performing indirect functions, such as administration, maintenance, or account. 3} In the performance oftests, laboratory procedures, or other similar operations which are continuous in nature and cannot reasonably be interrupted or otherwise completed. 4} When lower overall cost to the federal Government will result. It is understood that thls Agreement is funded in whole or In part with COSG funds through the Washington state COSG Program as administered by Commerce and is subject to those regulations and restrictions normally associated with federally-funded programs and any other requirements that the state may prescribe. Subrecipient shall be entitled to payment for any work performed between July 1, 2011 and Oecember 31, 2011 pursuant to the terms and conditions of this Agreement regardless of the effective date of this Agreement. 5. PERFORMANCE MONITORING The Local Government will monitor the performance of the Subreclpient as outlined in the Scope of Work (Attachment #1 to this Agreement) by tracking project progress, reviewing payment requests for applicable costs, managing the timely pass-through of COSG funds, overseeing compliance with COSG requirements, and ensuring recordkeeplng and audit requirements are met. Substandard performance as determined by the Local Government will constitute noncompliance with this Agreement. If action to correct such substandard performance Is not taken by the Subreclplent within a reasonable period of time after being notified by the Local Government, contract suspension or termination procedures will be Initiated. 6. SPECIAL CONOITIONS 2 [This section of the Agreement can be used by Local Government to include special conditions specific to the particular activity or individual Subrecipient.] 7. GENERAL CONDITIONS A. General Compliance The Subreciplent agrees to comply with: a) The requirements of Title 24 of the Code of Federal regulations, Part 570 (HUD regulations concerning CDBG); and b) All other applicable Federal, state and local laws, regulations, and policies, governing the funds provided under this Agreement. B. CDBG National Objective The Sub recipient certifies the activities carried out under this Agreement will meet a CDBG Program National Objective as defined in 24 CFR 570.208. C. "Independent Contractor" Nothing contained in this Agreement is intended to, or shall be construed in any-manner, as creating or establishing the relationship of employer/employee between the parties. The Subrecipient shall at all times remain an "independent contractor" with respect to the services to be performed under this Agreement. The Local Government shall be exempt from payment of all Unemployment Compensation, FICA, retirement, life and/or medical insurance and Workers' Compensation Insurance, as the Subrecipient is an independent contractor. D. Hold Harmless The Subrecipient shall hold harmless; defend and indemnify the Local Government from any and all claims, actions, suits, charges and judgments whatsoever that arise out of the Subrecipient's performance or nonperformance of the services or subject matter called for in this Agreement. E. Workers' Compensation The Subrecipient shall provide Workers' Compensation Insurance Coverage for all of its employees involved in the performance of this Agreement. F. Insurance & Bonding The Subrecipient shall carry sufficient insurance coverage to protect contract assets from loss due to theft, fraud and/or undue physical damage, and as a minimum shall purchase a blanket fidelity bond covering all employees in an amount equal to cash advances from the Local Government. For purposes of commercial general liability insurance (or similarly named insurance intended to insure Subrecipient against tort or personal injury claims from or by third parties) "sufficient insurance" is deemed to mean insurance having a liability cap in the amount of $1 million per occurrence, $2 million aggregate. Said commercial general liability insurance shall be primary. G. Funding Source Recognition The Subrecipient shall insure recognition of the roles of Commerce, the WA State CDBG program, and the Local Government in providing services through this Agreement. All activities, facilities and items utilized pursuant to this Agreement shall be prominently labeled as to funding source. In 3 addition, the Subrecipient will include a reference to the support provided herein in all publications made possible with funds made available under this Agreement. H. Amendments The Local Government or Subrecipient may amend this Agreement at any time provided that such amendments make specific reference to this Agreement, and are executed in writing, signed by a duly authorized representative of each organization, and approved by the Local Government's governing body. Such amendments shall not invalidate this Agreement, nor relieve or release the Local Government or Subreclpient from its obligations under this Agreement. I. Suspension or Termination In accordance with 24 CFR 85.43, the Local Government may suspend or terminate this Agreement if the Subrecipient materially fails to comply with any terms of this Agreement, which include (but are not limited to) the following: a) Failure to comply with any of the rules, regulations or provisions referred to tierein, or such statues, regulations, executive orders, and HUD guidelines, policies or directives as may become applicable at any time; b) Failure, for any reason, of the Subrecipient to fulfill in a timely and proper manner its obligations under this Agreement. c) Ineffective of improper use of funds provided under this Agreement; or d) Submission by the Subrecipient to the Local Government reports that are incorrect or incomplete in any material respect. In accordance with 24 CFR 85.44, this Agreement may also be terminated for convenience by either the Local Government or the Subrecipient, In whole or in part, by setting forth the reasons for such termination, the effective date, and, in the case of partial termination, the portion to be terminated. However, if in the case of a partial termination, the Local Government determines that the remaining portion of the award will not accomplish the purpose for which the award was made, the Local Government may terminate the award in its entirety. 8. ADMINISTRATIVE REQUIREMENTS A. Financial Management 1. Accounting Standards The Subrecipient agrees to comply with 24 CFR 84.21-28 and agrees to adhere to the accounting principles and procedures required therein, utilize adequate internal controls, and maintain necessary source documentation for all costs incurred. 2. Cost Principles The Subrecipient shall administer its program in conformance with OMS Circulars A-122, .Cost Principles for Non-Profit Organizations," or A-21 , .Cost Principles for Educational Institutions," as applicable. These principles shall be applied for all costs incurred whether charged on a direct or indirect basis. 3. Duplication of Costs The Subrecipient certifies that work to be performed under this Agreement does not duplicate any work to be charged against any other contract, subcontract or other source. 4 B. Oocumentation and Record Keeping 1. Records to be Maintained The Subrecipient shall maintain all records required by the Federal regulations specified in 24 CFR 570.506 that are pertinent to the activities to be funded under this Agreement. Such records shall include but not be limited to: a) Records providing a full description of each activity undertaken; b) Records demonstrating that each activity undertaken meets one of the National Objectives of the COBG program; c) Records required to determine the eligibility of activities; d) Records required to document the acquisition, improvement, use or disposition of real property acquired or improved with COBG assistance; e) Records documenting compliance with the civil rights components of the COBG program; f) Financial records as required by 24 CFR 570.502, and 24 CFR 84.21-28; g) Other records necessary to document compliance with Subpart K of 24 CFR Part 570. 2. Access to Records and Retention All such records and all other records pertinent to this agreement and work undertaken under this agreement shall be retained by the Subrecipient for a period of six years after final audit of the Local Govemment's COBG contract, unless a longer period is required to resolve audit findings or litigation; In such Cases, the Local Government shall request a longer period of record retention. All records provided to, generated by or held by the Local Government may be "Public Records. in accordance with Ch. 42.56 RCW and as such subject to production to a requesting person unless otherwise exempt from production. 3. Audits and Inspections All Subrecipient records with respect to any matters covered by this Agreement shall be made available to the Local Government, Commerce, and duly authorized officials of the state and federal government, at any time during normal business hours, as often as deemed necessary, to audit, examine, and make excerpts or transcripts of all relevant data. Any deficiencies noted in audit reports must be fully cleared by the Subrecipient within 30 days after receipt by the Subrecipient. Failure of the Subrecipient to comply with the above audit requirements will constitute a violation of this Agreement and may result in the withholding .of Mure payments. The Subrecipient hereby agrees to have an annual agency audit conducted in accordance with current Local Government policy concerning subrecipient audits and OMB CircularA-133. The Catalog of Federal Oomestic Assistance (CFOA) number is 14.228. C. Reporting and Payment Procedures 1. Program Income The Subrecipient shall report annually all program income (as defined at 24 CFR 570.500(a)) generated by activities carried out with COBG funds made available under this Agreement. The use of program income by the Subrecipient shall comply with the requirements set forth at 24 CFR 570.504. 5 2. PeriOdic Reports The Subrecipient, at such times and in such forms as the Local Government may requir.e, shall furnish the Local Government such periodic reports a!'l it may request pertaining to the work or services undertaken pursuant to this Agreement, the costs and obligations incurred or to be incurred in connection therewith, and any other matters covered by this Agreement. D. Use and Reversion of Assets The use and disposition of real property and equipment under this Agreement shall be in compliance with the requirements of 24 CFR Part 84 and 24 CFR 570.502, 570.503, 570.504, as applicable, which include but are not limited to the following: 1. The Subrecipient shall transfer to the Local Government any CDBG funds on hand and any accounts receivable attributable to the use of funds under this Agreement at the time of expiration, cancellation, or termination. 2. Real property under the Subrecipient's control that was acquired or improved, in whole or in part, with funds under this Agreement in excess of $25,000 shall be used to meet one of the CDBG National Objectives pursuant to 24 CFR 570.208 until ten (10) years after the contract between Commerce and the Local Government is closed. If the Subrecipient fails to use CDBG-assisted real property in a manner that meets a CDBG National Objective for this 10- year period of time, the Subrecipient shall pay the Local Government an amount equal to the current fair market value of the property less any portion of the value attributable to expenditures of non-CDBG funds for acquisition of, or improvement to, the property after the . CDBG program's approval. Such payment shall constitute program income to the Local Government. The Subrecipient may retain real property acquired or improved under this Agreement after the expiration of the ten-year period. 3. In cases in which equipment acquired, in whole or in part, with funds under this Agreement is sold, the proceeds shall be program Income. Equipment not needed by the Subrecipient for activities under this Agreement shall be (a) transferred to the Local Government for CDBG- eligible activities as approved by the CDBG program or (b) retained after compensating the Local Government. 9. PERSONNEL & PARTICIPANT CONDITIONS A. Civil Rights Title VI of the Civil Rights Act of 1984: Under TItle VI of the Civil Rights Act of 1964, no person shall, on the grounds of race, color, creed, religion, sex or national origin, be excluded from participation in, be denied the benefIts of, or be subjected to discrimination under any program or activity receiving federal financial assistance. Section 109 of the Housing and Community Development Act of 1974: No person in the United States shall on the grounds of race, color, creed, religion, sex or national origin be excluded from participation in, be denied benefits of, or be subjected to discrimination under any program or activity funded in whole or in part with funds made available under this title. Age Discrimination Act of 1975, as Amended No person shall be excluded from participation, denied program benefits, or subjected to discrimination on the basis of age under any program or activity receiving federal funding assistance. (42 U.S.C. 610 et. seq.) 6 Section 504 of the Rehabilitation Act of 1973, as Amended No otherwise qualified individual shall, solely by reason or his or her disability, be excluded from participation (including employment), denied program benefits, or subjected to discrimination under any program or activity receiving Federal funds. (29 U.S.C. 794) Public Law 101-336, Americans with Disabilities Act of 1990 Subject to the provisions of this title, no qualified individual with a disability shall, by reason of such disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any such entity. B. Section 3 of the Housing and Community Development Act of 1968 Compliance in the Provision of Training, Employment, and Business Opportunities: 1. The work to be performed under this agreement is on a project assisted under a program providing direct federal financial assistance from HUD and is subject to the requirements of Section 3 of the Housing and Urban Development Act of 1968, as amended, 12 U.S.C. 1701u. Section 3 requires that to the greatest extent feasible opportunities for training and employment be given lower-income residents of the project area; and contracts for work in connection with the project be awarded to business concerns which are located in, or owned in substantial part, by persons residing in the area .of the projeCt. 2. The parties to this contract will comply with the provisions of said Section 3 and the regulations issued pursuant thereto by the Secretary of HUD set forth in 24 CFR 135, and all applicable rules and orders of HUD and Commerce issued there under prior to the execution of this contract. The parties to this contract certify and agree that they are under no contractual or other disability that would prevent them from complying with these provisions. 3. The Subrecipient will send to each labor organization or representative of workers with which he has a collective bargaining agreement or other contract or understanding, if any, a notice advising the said labor organization or workers' representative of his commitments under this Section 3 clause and shall post copies of the notice in conspicuous places available to employees and applicants for employment or training. 4. The Subrecipient will include this Section 3 clause in every subcontract for work in connection with the project and will, at the direction of the applicant, or recipient of federal financial assistance, take appropriate action pursuant to the subcontract upon a finding that the subcontractor is in violation of regulations issued by the Secretary of HUD, 24 CFR Part 135. The Subrecipient will not subcontract with any subcontractor where it has notice or knowledge that the latter has been found in violation of regulations under 24 CFR Part 135 and will not let any subcontract, unless the subcontractor has first provided it with a preliminary statement of ability to comply with the requirements of these regulations. 5. Compliance with the provisions of Section 3, the regulations set forth in 24 CFR Part 135, and all applicable rules and orders of HUD and Commerce issued hereunder prior to the execution of the contract, shall be a condition of the federal financial assistance provided to the project, binding upon the applicant or recipient for such assistance, its successors, and assigns. 1. Assignability The Subrecipient shall not assign or transfer any interest in this Agreement without the prior written consent of the Local Government thereto; provided, however, that claims for money due or to become due to the Subrecipient from the Local Government under this contract may be assigned to a bank, trust company, or other financial institution without such approval. Notice of any such assignment or transfer shall be furnished promptly to the Local Government and Commerce. 2. Conflict of Interest No member of the Local Government's governing body and no other public official of such locality, who exercises any functions or responsibilities in connection with the planning or carrying out of the project, shall have any personal financial interest, direct or indirect, in this agreement; and the Subrecipient shall take appropriate steps to assure compliance. . The Subrecipient agrees to abide by the provisions of 24 CFR 84.42 and 570.611, which includes maintaining a written code or standards of conduct that shall govern the performance of its officers, employees or agents engaged in the award and administration of contracts supported by Federal funds. The Subrecipient covenants that its employees has no interest and shall not acquire interest, direct or indirect, in the study area or any parcels therein or any other interest which would conflict in any manner or degree with the performance of services hereunder. The Subrecipient further covenants that in the performance of this Agreement, no person having such interest shall be employed. 3. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions a) The lower tier contractor certifies, by signing this contract that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. b) Where the lower tier contractor is unable to certify to any of the statements in this contract, such contractor shall attach an explanation to this contract. c) The contractor further agrees by signing this contract that it will not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. D. Copyright If this Agreement results In any copyrightable material or inventions, the Local Government and/or Commerce reserves the right to royalty-free, non-exclusive and irrevocable license to reproduce, publish or otherwise use and to authorize others to use, the work or materials for governmental purposes. E. Religious Activities The Subrecipient agrees that funds provided under this Agreement will not be utilized for inherently religious activities prohibited by 24 CFR 570.2000), such as worship, religious instruction, or proselytization. 10. SEVERABILITY 8 If any provision of this Agreement is held invalid, the remainder of the Agreement shall not be affected thereby and all other parts of this Agreement shall nevertheless be in full force and effect. 11. PERFORMANCE WAIVER The Local Government's failure to act with respect to a breach by the Subrecipient does not waive its right to act with respect to subsequent or similar breaches. The failure of the Local Government to exercise or enforce any right or provisipn shall not constitute a waiver of such right or provision. 9 12. 'ENTIRE AGREEMENT,' This Agreement constitutes the entire agreement between the Local Govemment a!1d t1Je S!,lbreclpient for the use of funds received under this Agreement and It supersedes'QlI prlG!- OF comemporaneous communications and proposals, whether electronic, oral, or written between the Local Government and the SUbreciplent with respect to this Agreement. The attachmentS to this Agreement are identified allfolfows: ' ,', , , , i. Attachment #1, Scope of Work, consisting of 1 page.' Attachment#2, Budget, consisting of 1 page. IN WITNESS WHEREOF, theLocal Government and the Subrecipient have executed this agreement as of the date and year last written below. By TItle B~ctIon Proarams .. Timothy L Hockett Title Exeoutive Director Date ~ to. 7CJ1.1 Date 0/1-1/11 { Approved As To Legal Form: Attorney Approved as 18 form. only: .~ ~. ~~p ieffmon Co. Pro~ 10 Attachment #1 - SCOPE OF WORK A Service Proarams NOTE; Ust the specific public service activities from the CDBG app/lcetlon's Project Description & Low- and Moderate-Income Benefit Table or reference the public seNice activities found In this app//cetlon table. Emergency Services Energy Assistance Home Care Encorel . Senior Nutrition B. Periodic ReDOrts 1. Public SerVices Contract Quarterlv BeneficiaN Reoortina Form (copy attached; provided by the Department of Commerce) with data on the use of CDBG funds, including the number of: . Persons served; · Low- and moderate-income persons served; . Persons with new access to a service; an9 · Persons with increasedlimproved access to a service. . 2. No more than monthly and no less than quarterly, A-19 Invoice Vouchers with a written narrative report on the services and expenditures funded by CDBG as back-up . documentation of the CDBG reimbursement payment request. C. Local Government Oversiaht Plan 1. Review and approval authority for each payment request for CDBG reimbursement. 2. Annual on-site monitoring visit. . 3. Receipt al)d review of community action agency's annual audit report, Management Letter (if received), and any documentation of any CDBG-related findings. 4. Annual public hearing to receive input on program performance. II Attachment #2 - BUDGET BUDGET - CDBG Public Services Grant Purpose: To deliver the direct services identified in the COBG Public Services Grant application and this Agreement's Scope of Work Cost Categories: Staffing $48,000 Inolude salary & benefits to be dooumented by payroll records Goods and services $9,974 Training costs must be tied to the delivery of the CDBG public service Equipment $ Items costing $300 or mora require Commerc:e pre-approval Travel $ Out-of-state travel requires Commerce pre-approval and follow federal . travel Der diem Indirect Costs $12,000 Must be tied to a CDBG public service through the agency's approved. cost allooetion plan. . $69,974 Must equal the bUdget amount listed for public services in the CDBG TOTAL con:ct between the Looat.~ovemment and Commerce. (Not to include coun edministration funds. All costs must be eligible under OMB Ciroular A-122 and tied to the delivery of the CDBG public service. If unsure, consuit Commerc:e's Contracts Administration Unit. Budget Narrative: Oescribe what Is included In the costs. COBG will support staff and benefit costs for three services areas: Emergency Services ($30,000); Home Care ($15,000); and Encore ($3,000). COBG will fund food purchase for the senior nutrition program: $9,974 COBG will help cover the Indirect Costs associated with our Energy Assistance Programs: $12,000 . 12 AIIALIiNlENT :l-A pugUC SERVICES CONTRACT QUARTERLY BENEFICIARY REPORTING FORM . This report is due on April 30 (for 1st qtr.), July 30 (for 2nd qtr.), Oct. 30 (for 3nl qtr) and Jan. 30, 2011 (for 4" qtr.) Grantee: Forward one co Grantee Name: Subrecipient . Name: Reporting Period - 2010: to our contract man er at the Contracts Administration Pro - Retain one co CDHO Contract No: CDBO Project Title: for our records. I" Quarter (Jan.-March) 2 3 Quarter (July-September) 04 Quarter (Oel-Dec.) WHITE ~CK/AFRlCAN AMERICAN ASIAN AMERICAN INDIAN/ALASKAN NATIVE NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER AMERICAN INDIAN/AlASKAN NATNE AND WHITE ASIAN AND WHITE BLACK/AFRIC/(N AMERICAN AND WHITE AMERICAN INDIAN/AlASKAN NATIVE & BLACK/AFRICAN AMERICAN . OTHER MULTI-RACIAL TOTALS HlSPANtC- = HUD HAS DESIGNATED HISPANIC /IS AN ETHNIC GROUP. A P ON CAN BE IDENTIFIED AS BOTH A MEMBER OF A RACIAL GROUP AND PM E1ltNtC BE DESIGNATED ONlY AS AN ETHNIC GROUP. . BUT CANNOT ~'---o..'oi-~~~~~~ gB:~~~- '''" Please provide a narrative explanation of the public services provided (i.e., 150 meals provided to senior citizens, drug counseling provided to 25 people, etc.) . Signature . Date of Signature I certifY that all CDBG funds expended for personnel coats are directly attributed to COHO eligIDle activities. Name, affiliation and phone number of j)erson completing or signing this fonn: Instructions: No Voucher will be paId unless your quarterly reports are up to date. This form should be completed by the contract aubredplent (CAe) aud seut to the QOO Grautee (couuty). The CDOO Grantee (couuty) shoald seud this form to the CAU project manager. Item I: Unduplicated Count of Persons Assisted Reporting Period: Insert the ooduplicated number <if clients served during the reporting period. Unduplicated means that one person served by your agency is counted once during the calendar year. You may report only those persons for whom you maintain written records. This record must he established at the time the person is first served by your agency. Race: Insert the ethnicily for the ooduplicated clients served during this reporting period. When completing this section, if the individual is not Hispanic or Latino, use the first column labeled #Total. If the individual is HispanIc, use the first column to identilY race (which gives us a total), then !'Ooot the individual in the second column, which is a subset of the first column. Single Head of Household; Elderly, and Disabled: Insert the ooduplicated number of single female head of hOuseholds with dependents/children served during the reporting period. Insert the ooduplicated number of Elderly and Disabled, if your agency tracks this data. Ifservices are provided to "Elderly" pupulations with CDBO funds, it is expected that your agency will track this data Income: Insert the oodupIlcated clients (not households) served who are Moderate Income (5 1-8(010), Low-1ncome (31-50%) and Extremely Low-lncome(O- 3(010).