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HomeMy WebLinkAboutORANGE, COUNTY OF - HEALTH CARE AGENCY- 2005 A-2005-156 ~lj ':'.\ <\, '--1,~o'-oS COOPERATIVE AGREEMENT BETWEEN COUNTY OF ORANGE AND CITY OF SANTA ANA This Cooperative Agreement ("Agreement") is hereby entered into for the term of July I, 2005 through June 30, 2006, by and between the City of Santa Ana, a charter city and municipal corporation organized under the Constitution and laws ofthe State of California ("City") and the County of Orange ("County"). Recitals: A. City, on behalf of all jurisdictions in Orange County, has been designated to receive grant funding provided by the U.S. Department of Housing and Urban Development (HUD) pursuant to the Housing Opportunities for Persons with AIDS (HOPW A) program; and B. City has entered into a HOPW A grant agreement with HUD; and C. County has provided leadership and is responsible for planning, providing and contracting for comprehensive HIV services and has prepared, in conjunction with the HIV Planning Council, Orange County's HIV Plan for providing such services; and D. City wishes to contract with County in order that County may obtain supportive housing services by contract for persons with HIV disease, which services shall be administered and monitored by County; and E. County is agreeable to rendering such services on the terms and conditions hereinafter set forth; NOW, THEREFORE, THE PARTIES MUTUALLY AGREE AS FOLLOWS: I. COUNTY SERVICES A. County shall serve as "HOPW A Project Sponsor" for the purpose of contracting with organizations to provide supportive housing services, to persons with HIV/AIDS residing in Orange County. B. Nothing in this Agreement shall prevent City from entering into one or more agreements with other political subdivisions within the County, if deemed necessary and advisable to do so by City; provided however, the obligations and rights covered by this Agreement shall not be altered or reduced, except as mutually agreed to in writing by City and County. C. County shall utilize competitive bidding and contracting procedures for supportive housing services as required in HOPW A program regulations. As HOPW A Project Sponsor, County's responsibilities and payments cover appropriate monitoring and administration of contracts resulting from competitive bid. D. County shall ensure that each agency subcontractor receiving funds through this Agreement operates in accordance with the requirements of the applicable HUD regulations for the HOPW A Program and other federal, state and local regulations as appropriate. I E. County shall conduct an ongoing assessment of the supportive housing services required by the participants in the program. F. County shall assure the adequate provision of supportive services to the participants in the program; and G. County shall comply with such other terms and conditions, including record keeping and reports for program monitoring and evaluation purposes, as HUD may establish for purposes of carrying out the program in an effective and efficient manner. Quarterly and Annual progress reports will be submitted by County within thirty (30) days after the quarter/year ends in a form consistent with HUD publication HUD-4011O-C (11/97) or any other form that HUD may require. [See Exhibit A (Quarterly Report) and Exhibit B (Annual Report) attached hereto and incorporated herein by reference]. These reports shall include copies of all Requests For Proposals (RFPs) released by County pursuant to this Agreement, copies of contracts between County and service providers, as well as a summary of program budgets and financial disbursements made under the terms of this Agreement. H. "Contract Officers" means the County's Health Care Agency Contract Development and Management Manager or designee and the City's Housing and Neighborhood Development Manager. I. County shall ensure that any County Sub grantee/Subcontractor receiving funds through this Agreement is informed that it must abide by the same terms and conditions and responsibilities as set forth in this Agreement for the County to follow. II. BUDGET A. The following budget is an estimate only, of the costs of providing the services hereunder. This budget may be modified by mutual written agreement of the Contract Officers. The maximum obligation hereunder is $776,740. Supportive Housing Services Administration* (see B. below) $722,369 54,371 $776,740 B. The Administration costs shall be seven percent (7%) of the actual expended grant funds. C. All services and expenditures will be performed by June 30, 2006 and invoiced by August 15, 2006. Any remaining funds under this Agreement will be de-obligated upon termination of this Agreement. III. PAYMENTS/COST REPORT A. City shall pay County for the actual costs of providing the services hereunder, whether provided directly by County or its subcontractors, provided, however, the total of all payments to County shall not exceed the Maximum Obligation as specified hereinabove. B. County shall invoice City monthly, in arrears, based on the actual cost of providing and contracting for the services hereunder. County shall submit each invoice within thirty (30) days after the end of each month. City shall pay County no later than thirty (30) days 2 following receipt of such invoice and complete documentation of services performed, cost and number of persons served, and Monthly Invoice Summary (See Exhibit C attached hereto and incorporated herein by reference). Final invoice must be submitted by August 15,2006. C. All invoices submitted by County shall be accompanied by source documentation including, but not limited to, journals, time sheets, canceled checks, invoices and records of services provided. D. At such times and in such a format as the Contract Officers mutually agree in writing, County shall prepare and submit to City report(s) of administrative costs incurred by County in the performance of this Agreement. E. The Cost Report(s) shall be financial and statistical report(s) submitted by County to City, and shall serve as the basis for Final Settlement ofthis Agreement. The Cost Report (s) shall detail all costs incurred by County to provide services hereunder. F. Final Settlement shall be based upon the actual costs incurred by County to provide services hereunder. If the Cost Report(s) indicates the total of City's payments to County are less than County's cost to provide the services hereunder, City shall pay County the difference; provided, however, the total payment shall not exceed the Maximum Obligation. Payment due pursuant to the Cost Report(s) shall be made within thirty (30) days ofthe Final Settlement determination. IV. DISPUTE RESOLUTION A. Either party may give written notice to the other, setting forth in specific terms the existence and nature of any unresolved matter or concern related to the purposes and obligations of this Agreement. Such notice shall be provided by and to the Contract Officers on behalf of the parties. The Officers shall have fifteen (15) working days following such notice to obtain resolution of any issue(s) identified in this manner, provided, however, by mutual consent this period oftime may be extended to thirty (30) days. B. If the Officers are unable to obtain resolution of the issue(s), they shall submit a joint written Statement describing the facts of the issue, within thirty (30) days after the written notice described above to the Orange County Health Care Agency (HCA) Director and to the Executive Director of the Community Development Agency (CDA) or designee for resolution. Ifthe Officers are unable to prepare a joint statement, each shall submit separate statements to the HCA Director and Executive Director of City's Community Development Agency within the thirty (30) day period. Such persons shall meet and make their best effort to resolve the matter within thirty (30) days following submission of the statements. Resolution of the dispute, or lack thereof, by the HCA Director and CDA Director or designee shall be documented in the form of written correspondence exchanged by such persons within ten (10) days following their meeting. 3 V. INDEMNIFICATION Each party agrees to indemnify and hold harmless the other party, its officers, agents, and employees from all liability, claims, losses and demands, including defense costs, whether resulting from court action or otherwise, arising out of the acts or omissions of the indemnifying party, its officers, agents or employees or the condition of property used in the performance of this Agreement. VI. INSPECTIONS AND AUDITS A. Any authorized representative of City, any authorized representative of the State of California, the Secretary of the United State Department of Health and Human Services, the Comptroller General ofthe United States Department of Housing and Urban Development or any of their authorized representatives, shall have access to County books, documents, and records, which such persons deem pertinent to the Agreement, for the purpose of conducting an audit, evaluation, or examination, or making transcripts during the periods of retention set forth in the Records/Confidentiality paragraph of this Agreement and the premises in which they are provided. B. County shall actively participate and cooperate with any person specified in subparagraph A. above in any evaluation or monitoring ofthe services provided pursuant to this Agreement, and shall provide the above mentioned persons adequate office space to conduct such evaluation or monitoring. VII. LICENSES AND LAW A. County, its officers, agents, employees, and subcontractors shall, throughout the term ofthis Agreement, maintain all necessary licenses, permits, approvals, certificates, waivers and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, State of California, County and any other applicable governmental agencies. B. County shall comply with all laws, rules or regulations applicable to the services provided hereunder, as any may now exist or be hereafter changed. These laws, rules, and regulations shall include, but not be limited to the following: 1. United States Code (U.S.C.A.), Title 42, Section 12901-12912, AIDS Housing Opportunity Act. 2. Code of Federal Regulations (CFR), Title 24, Part 574, Housing Opportunities for Persons with AIDS. 3. CFR Title 24, Part 85, Common Rule to the Community Development Block Grant Entitlement Program. 4. Office of Management and Budget (OMB) Circular No. A-87, Cost Principles for State and Local Governments. 5. OMB Circular No. A-128, Single Audit Act of 1984. 4 VIII. NONDISCRIMINATION A. EMPLOYMENT - County warrants that it has developed and does maintain an Affirmative Action program for employment which includes goals and timetables for employment of women and minorities, which program meets the Affirmative Action Guidelines of the United States Equal Opportunity Commission and all appropriate state and federal laws and regulations. B. SERVICES, BENEFITS, AND FACILITIES - County, nor any of its contractors, shall discriminate in the provision or services, the allocation of benefits, or in the accommodation in facilities on the basis of ethnic group identification, race, religion, ancestry, creed, color, sex, marital status, national origin, age (40 and over), sexual preference, medical condition, or physical or mental handicap in accordance with Title VI of the Civil Rights Act of 1964,42 U.S.C.A. ~2000d and all other pertinent rules and regulations promulgated pursuant thereto, and as otherwise provided by State law and regulations, as all may now exist or be hereafter amended or changed. C. DISABLED INDIVIDUALS - County and its contractors shall agree to comply with the provisions of Section 504 of the Rehabilitation Act of 1973 (29 U.S.C.A 794 et seq., as implemented in 45 CFR 84.1 et seq.), and the Americans with Disabilities Act of 1990 (42 U.S.C.A. 12101 et seq.), pertaining to the prohibition of discrimination against qualified disabled persons in all programs or activities, as they exist now or may be hereafter amended together with succeeding legislation. D. RET ALIA TION - Neither County, nor its employees, agents, or contractors shall intimidate, coerce or take adverse action against any person for the purpose of interfering with rights secured by Federal or State laws, or because such person has filed a complaint, certified, assisted or otherwise participated in an investigation, proceeding, hearing or any other activity undertaken to enforce rights secured by Federal or State law. IX. NOTICES Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by telefacsimile or other telegraphic communication in the manner provided in this Section, to the following persons: To City: Clerk of the City Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, California 92702-1988 telefacsimile (714) 647-6956 5 With courtesy copies to: City of Santa Ana Linda Foster, HOPW A Coordinator 20 Civic Center Plaza (M-27) Santa Ana, California 92702-1988 To County: County of Orange Health Care Agency Contract Development and Management 405 West 5th Street, 6th Floor Santa Ana, CA 92701 A party may change its address by giving notice in writing to the other party. Thereafter, any notice, tender, demand, delivery, or other communication shall be addressed and transmitted to the new address. If sent by mail, any notice, tender, demand, delivery, or other communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by telefacsimile, any notice, tender, demand, delivery, or other communication shall be effective or deemed to have been given twenty- four (24) hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded. X. RECORDS/CONFIDENTIALITY a. The parties, and any subcontractors, shall prepare and maintain any records required by laws, regulations and procedures applicable to their responsibilities under this Agreement. b. The parties agree to maintain the confidentiality of any records which pertain to this Agreement in accordance with applicable state and federal laws and regulations. Financial records related to this Agreement shall be maintained for two (2) years after termination ofthis Agreement. c. "Confidential Information" shall include all nonpublic information. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either party by any subsidiary and/or agent of the other party is covered by this Agreement. XI. JURISDICTIONNENUE This Agreement and all questions relating to its validity, interpretation, performance, and enforcement shall be governed and construed in accordance with the laws of the State of California. This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this 6 Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason ofthis Agreement. XII. SEVERABILITY If a court of competent jurisdiction declares any provision of this Agreement or application thereof to any person or circumstances to be invalid or if any provision of this Agreement contravenes any Federal, State, or County statute, ordinance, or regulation, the remaining provisions of this Agreement or the application thereof shall remain valid, and the remaining provisions ofthis Agreement shall remain in full force and effect, and to that extent the provisions of this Agreement are severable. XIII. INDEPENDENT CONTRACTOR County is, and shall at all times be deemed to be, an independent contractor and shall be wholly responsible for the manner in which it performs the services required of it by the terms of this Agreement. County is entirely responsible for compensating staff and consultants employed by County. This Agreement shall not be construed as creating the relationship of employer and employee, or principal and agent, between County and City or any of County's employees, employee, or principal and agent, between County and City or any of County's employees, agents, or subcontractors. County assumes exclusively the responsibility for the acts of its employees, agents or subcontractors as they relate to the services to be provided during the course and scope of their employment. County, its agents, employees, or subcontractors, shall not be entitled to any rights or privileges of City employees and shall not be considered in any manner to be City employees. XIV. TERM The term ofthis Agreement shall commence and terminate as specified herein, unless otherwise sooner terminated as provided in this Agreement; provided, however, County shall be obligated to perform such duties as would normally extend beyond this term, including but not limited to, obligations with respect to indemnification, audits, reporting and accounting. XV. TERMINATION A. Either party may terminate this Agreement, without cause, upon ninety (90) days written notice given the other party. B. Either party may terminate this Agreement, upon thirty (30) days written notice given the other party for material breach after failure to resolve the breach pursuant to the Dispute Resolution paragraph of this Agreement. C. The rights and remedies of County or City provided in this Termination 7 paragraph shall not be exclusive, and are in addition to any other rights and remedies provided by law or under this Agreement. XVI. THIRD PARTY BENEFICIARY Neither party hereto intends that this Agreement shall create rights hereunder in third parties including but not limited to any subcontractors or any patients provided services hereunder. XVII. WAIVER OF DEFAULT OR BREACH Waiver of any default by County or City shall not be considered a waiver of any subsequent default. Waiver of any breach of County or City of any provision of this Agreement shall not be considered a waiver of any subsequent breach. Waiver of any default or any breach by County or City shall not be considered a modification of the terms of this Agreement. XVIII. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature hereinbelow has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnifY City fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. 8 IN WITNESS WHEREOF, the parties hereto have executed this Agreement in the County of Orange, State of California, on the date and year first above written. ATTEST: CITY OF SANTA ANA: / /' 1/" //22" / " ,;I ,,'.', . ,...... ,,' '".,-. (("", ,,< '/ /, ,/. ----" DAVID N. REAM City Manager c~~~~ PATRICIA E. HEALY (f'\ Clerk ofthe Council APPROVED AS TO FORM: JOSEPH W. FLETCHER City Attorney By: ,~'_ f. "~" Lisa E. Storck Assistant City Attorney COUNTY OF ORANGE BY: CHAIRMAN OF THE B SIGNED AND CERTIFIED THAT A COPY OF THIS DOCUMENT HAS BEEN DELIVERED TO THE CHAIRMAN OF THE BOARD. it Q,.~,,~ DARLENE J. BLOOM Clerk of the Board of Supervisors of Orange County, California (;) APPROVED AS TO FORM: OFFICE OF THE COUNTY COUNSEL ORANGE COUNTY, CALIFORNIA BY:~Y~ UTY S"-2c,-()~ 9 EXHIBIT A HOUSING OPPORTUNITY FOR PEOPLE WITH AIDS ACCOMPUSHMENTREPORT HOPWA Recipient Name: HOPWA Funded Activity: Location of Activity: 1. Select the one category that best describes service provided with HOPWA Funds: D Facility Based Housing: (e.g., Construction, Rehab) .............. Submit Report Form A & Supplemental D Facility Based Non-Housing .................................................. Submit Report Form B & Supplemental D Scattered Site Only: (e.g., Tenant Based Rental Assistance).. Submit Report Form C & Supplemental D Housing Information/Resource ID/Admln .............................. Submit Report Form D D Supportive Services Only...................................................... Submit Report Form E 2. Check Box Indicating Report Period: o 1st Quarter (7/1 - 9/30) o 2nd Quarter (10/1 -12/31) o 3rd Quarter (1/1 - 3/31) o 4th Quarter (4/1 - 6/30) 3. Amount of HOPWA Expended During This Report Period: $ 4. Number of Unduplicated Persons Assisted During the Report Period: * '* Must equal "Total Number of Persons .Receivina Assistance" listed in Report Form 5. Number of Units Completed During the Report Period (ifapplicable): For construction projects only I certify that the information within this quarterly report is true and correct. Name: Title: Signature: Date: Telephone No: Fax No: email: 1 of 7 EXHIBIT A REPORT FORM A FACILITY BASED HOUSING (Housing Acquisition, Construction or Rehab) FACILITY NAME: FACILITY TYPE: NUMBER OF UNITS BY FACILITY TYPE SRO o Bdrm 1 Bdrms 2 Bdrms 3 Bdrms 4 Bdrms 5+ Bdrms Date of Closing/Lease Execution: Date Construction/Rehab Started: Completed: Date Operations Staff Hired: Date Residents Began to Occupy: HOPWA EXPENDITURES (in dollars) Acquisition: Rehab/Conversion/Repair: Lease: New Construction: Operating Costs: Technical Assistance: Rental Assistance: Other: Other: TOTAL: $ $ $ $ $ $ $ $ $ $ Is the site owned by a public entity? Is this activity "substantial" rehab? DYes DYes DNo DNo Available HOPWA Funds Ailocated HOPWA Funds: Ailocated HOPWA Program Income: Total HOPWA funds for Project: Total HOPWA Expended to date: Balance HOPWA Funds to date: $ +$ =$ -$ =$ Source of Non.HOPWA Funds Expended To Date $ $ $ Total Non.HOPWA Funds: $ Total Available $ $ $ $ HOPWA Report Form A SUBMIT ~UPpLEMENr~ REPORT FORM 2 of 7 11/12/04 EXHIBIT A REPORT FORM B FACILITY-BASED NON-HOUSING (Property Acquisition, Construction or Rehab) Activity Name: Facility Type: Available HOPWA Funds Allocated HOPWA Funds: $ Allocated HOPWA Program Income: + $ Total HOPWA funds for Project: = $ Total HOPWA Expended to date: - $ Balance HOPWA Funds to date: = $ Date of Closing/Lease Execution: Date Construction/Rehab Started: Date Construction/Rehab Completed: Date Operations Staff Hired: Date Support Services Started: HOPWA Site Expenditures (in dollars) Acquisition: Reha b/Conversion/Repair: Lease: Operating Costs: Other: Other: Is the site owned by a public entity? Is this activity "substantial" rehab? Source Of Non-HOPWA Funds Total Non-HOPWA Funds: TOTAL: $ $ $ $ $ $ $ DYes DYes DNo DNo Total Available $ $ $ $ Expended To Date $ $ $ $ SUBMIl'.$;UI1PLEMEl'li\:AL; RE;!;>ORTf,QRM HOPWA Report Form B 3 of 7 11/12/04 EXHIBIT A REPORT FORM C SCATTERED SITE HOUSING ACTIVITY (Tenant Based Rental Assistance, Emergency Housing/Utility Assistance) Activity Name: Activity Location: Date Payments Began: Number of Units Assisted by Payment Type SRO 0 Bdrm 1 Bdrm 2 Bdrms 3 Bdrms 4 Bdrms 5+ Bdrms Tenant-Based Rent Rent, Mortgage, Utilities Expenditures By Type: Tenant-Based Rent:$ Rent, Mortgage, Utilities: $ Total Families Assisted with Housing Assistance: Program Departure Counts Number of Months Voluntary: Nonpayment of rent: Supportive Service noncompliance: Unknown: Criminal: <3 3-6 7-12 >12 Death: Other HOPWA EXPENDITURES (in dollars) Allocated HOPWA Funds: Allocated HOPWA Program Income: Total HOPWA funds for Project: Total HOPWA Expended to date: Balance HOPWA Funds to date: $ +$ =$ -$ =$ Source of Non-HOPWA Funds Total Available Expended To Date $ $ $ $ Total Non-HOPWA Funds: $ $ $ $ SUBMITSUPPLEI\'lENTAL REPORT FORM HOPWA Report Form C 4 of 7 11112/04 E}HIBIT A REPORT FORM D (Housing Info, Resource 10, Admin) Activity Name: Activity Location: Total Family Units Assisted With Housing Assistance: Estimated Persons Receiving Housing Information: HOPWA EXPENDITURE DETAIL Enter the amount of HOPWA expended during the report period for one or more of the activities listed below: Housing Information Services: $ Resource 10: $ Sub-Grantee Administrative Costs: $ Grantee (City of SA) Administrative Costs: $ Total HOPWA Expenditures: $ HOPWA EXPENDITURES (in dollars) Allocated HOPWA Funds: Allocated HOPWA Program Income: Total HOPWA funds for Project: Total HOPWA Expended to date: Balance HOPWA Funds to date: $ +$ =$ -$ =$ Source of Non-HOPWA Funds Total Available Expended To Date Total Non-HOPWA Funds: $ $ $ $ $ $ $ $ 5 of 7 HOPWA Report Form D 11/12/04 E) HIBIT A REPORT FORM E SUPPORTIVE SERVICES ONLY Activity Name: Activity Location: Receiving Supportive Svcs w/ Housing Assistance Persons With HIV/AIDS Other Persons in Family Unit Total Receiving Supportive Svcs Only Supportive Services 1. Outreach 2. Case ManagemenU Advocacy/Access to Benefits Svcs 3. Life Management (outside of Case Management 4. Nutritional Services/Meals 5. Adult Day care and Personal Assistance 6. Child Care and other Children's Services 7. Education 8. Em ployment Assistance 9. Alcohol and Drub Abuse Services 10. Mental Health Services 11. Health/Medical/Intensive Care Services 12. Permanent Housing Placement 13. Emergency Housing 14. Transitional Shelter 15. Other TOTAL . Number of Jobs that Result from # 7 & 8 HOPWA EXPENDITURES (in dollars) Allocated HOPWA Funds: Allocated HOPWA Program Income: Total HOPWA funds for Project: Total HOPWA Expended to date: Balance HOPWA Funds to date: Source of Non-HOPWA Funds Total Available $ $ $ $ # of Persons Served $ Expended $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ +$ =$ -$ =$ Total Non-HOPWA Funds: HOPWA Report Form E 6 of 7 Expended To Date $ $ $ $ 11/12/04 HOPWA SUPPLEMENTAL FORM EXHIBIT A DEMOGRAPHICS Persons Serviced Number of Persons with HIV/AIDS Number of Other Persons in Family Unit Total Families Assisted with Housing Assistance: Age & Gender Under 18 18.30 Male: Female: Total: Receiving Housing Assistance TOTAL 31.50 Income Group of Individuals and Family Units per Month $0.$250 $251.$500 $5001.$1000 $1001.$1500 Race/Ethnicity White: Black/African American: Asian: American Indian/Alaskan Native: Native Hawaiian/Other Pacific Islander: American Indian/Alaskan Native & White: Asian & White: Black/African American & White: Am. Indian/Alaskan Native & Black/African Am.: Other Multi-Racial: Total: Recent Living Situation Count: Homeless/Streets: Transitional Housing: Emergency Shelter: Psychiatric Facility: Substance Abuse Treatment: Hospital/Medical: Jail/Prison: Domestic Violence: Living w/ Relative/Friend: Rental Housing: Participant-owned Housing: Other: SUPPLEMENTAL No. Total Over 50 Total $1501.$2000 Over $2000 No. Hispanic 7 of 7 EXHIBIT B 11/12/04 HOPWA SUB-GRANTEE YEAR END ACCOMPLISHMENT REPORT HOPW A Sub-grantee: Fiscal Year/Report Period: HOPWA Funded Activity Name: 1. Amount of Funds Allocated: $ Amount of Funds Expended: $ 2. Amount of resources used in conjunction with HOPWA funded activities: Cash: $ In-Kind Contributions: 3. Describe activities/funding carried out in collaboration with related programs/resources: a. Ryan White CARE Act: $ Activities: b. AIDS Drugs Assistance Amount: $ Activities: c. Continuum of Care Homeless Assistance Amount: $ Activities: d. Other efforts to assist Persons with HIV/AIDS and their Families: 4. Compare annual planned versus actual accomplishments for this report period: Type of Units Planned Actual Rental Assistance Short Term Emergency Housing Payments Units in Facilities supported with Operating Costs Units in Facilities being Developed with Capital Cost but Not vet Open Subtotal Deduction for Units Reported in More than One Category Total HOPWA YEAR END ACCOMPLISHMENTS REPORT Page 1 of 2 EXHIBIT B 11/12/04 5. Project Accomplishments (attach additional pages if necessary): Summarize Housing Activities: Unique Supportive Service or other Services Delivery Models or Efforts: Other Accomplishments: 6. Barriers or Trends Overview (attach additional pages fn necessary): Barriers Encountered: Trends in Meeting Needs: 7. Sub-Recipient Overview, if applicable (attach additional pages if necessary) Describe how sub-recipients were chosen: Describe your sub-recipient monitoring methods: Provide a summary of sub-recipient performance: I certify that the information in this year-end report is true and correct. Signature: Date: Name: Title: Telephone Number: Email: HOPWA YEAR END ACCOMPLISHMENTS REPORT Page 2 of2 EXHIBIT C f/l - " .!!! U - o ~ " .Q E :l Z - " :l o E <( ~ .!l! '0 c - CI> CI> ..c en ~ I'll E E ;:, en CI> (.) '0 > oS <( 3: a. o :I: " " .~ " l/) - o f/l J: - " o :;: "C " "0 'S: o ~ c.. " " .~ " l/) E III ~ e c.. " " " <( ~ o - " I!! - " o U , .Q :l l/)