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HomeMy WebLinkAboutA-2007-182A-2007-182 COOPERATIVE AGREEMENT BETWEEN COUNTY OF ORANGE AND CITY OF SANTA ANA This Cooperative Agreement ("Agreement") is hereby entered into for the term of July 1, 2007 through June 3Q 2008, by and between the City of Santa Ana, a charter city and municipal corporation organized under the Constitution and laws of the 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 (HOPWA) program; and B. City has entered into a HOPWA 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 HN 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. A. County shall serve as "HOPWA 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 HOPWA program regulations. As HOPWA 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 HOPWA Program and other federal, state and local regulations as appropriate. 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-40110-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 Subgrantee/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 $774,650. Supportive Housing Services $720,424 Administration* (see B. below) 54,226 $774,650 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, 2008 and invoiced by August 15, 2008. 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 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, 2008. 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 of this 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 aze 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 of the 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 (1 S) working days following such notice to obtain resolution of any issue(s) identified in this manner, provided, however, by mutual consent this period of time maybe extended to thirty (30) days. B. If the Officers aze 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. If the 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. 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. VL 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 of the 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 of the 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 of this 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. 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. RETALIATION -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 With courtesy copies to: City of Santa Ana Linda Foster, HOPWA 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 5`h Street, 6`h 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. a. The parties, and any subcontractors, shall prepaze 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 of this 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. JURISDICTION/VENUE 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 Califomia. Both parties further agree that Orange County, Califomia, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. XIL 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 of this Agreement shall remain in full force and effect, and to that extent the provisions of this Agreement are severable. XIII. 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 of this 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 paragaph 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. XVIL 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 Ageement, 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 Ageement. 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: PATRICIA E. HEALY Clerk of the Council CITY OF SANTA ANA: DAVID N. RE City Manager APPROVED AS TO FORM: JOSEPH W.FLETCHER City Attorney By:G~'~ f ~.~ Lisa E. Storck Assistant City Attorney COUNTY OF ORANGE BY: CHAIRMAN OF THE BO OF SUPERVISORS SIGNED AND CERTIFIED THAT A COPY OF THIS DOCUMENT HAS BEEN DELIVERED TO///THE CHAIRMAN OF THE BOARD. Y ~P• DARLENE J. BLOOM Clerk of the Board of Supe 'ors of Orange County, California APPROVED AS TO FORM: OFFICE OF THE COUNTY COUNSEL ORANGE COUNTY, CALIFORNIA D UTY~. GAO E};HIBIT A HOUSING OPPORTUNITY FOR PEOPLE WITH AIDS ACCOMPLISHMENT REPORT HOPWA Recipient Name: HOPWA Funded Activity: Location of Activity: 1. Select the one category that best describes service provided with HOPWA Funds: ^ Facility Based Housing: (e.g., Construction, Rehab) .............. Submii Repod Form A & Supplemental ^ Facility Based Non-Housing .................................................. Submit Report Form B & Supplemental ^ Scattered Site Only: (e.g., Tenant Based Rental Assistance)..Submit Report Fomt C ~ Supplemental ^ Housing InformatiorilResource ID/Admin .............................. Submit Report Form D ^ Supportive Services Only ......................................................Submit Report Form E 2. Check Box Indicating Report Period: ^ 151 Quarter ^ 2"d Quarter ^ 3`d Quarter ^ 4th Quarter (7/1 - 9/30) (1011 - 12/31) (1/1 - 3/31) (Mi - 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 o/Persons Receiving Ass/stance' listed !n Report Forth 5. Number of Units Completed During the Report Period (if applicable): For construction projects only I certify that the information within this quarterly report is true and correct. Name: Signature: Telephone No: Fax No: Date: email: 1 of 7 EXHIBIT A REPORT FORM A FACILITY BASED HOUSING (Housing Acquisition, Construction or Rehab) FACILITY NAME: FACILfTY TYPE: NUMBER OF UNRS BY FACILIT/ TYPE SRO 0 Bdrm 1 BdlTns 2 Bdrms 3 Bdrnis 4 Bdrms 5+ 6drms Date of Closing/Lease Execution: Date ConstructionlRehab Started: Completed: Date Operations Staff Hired: Date Residents Began to Occupy: HOPWA EXPENDITURES (in dollars) Acquisftion: Reha WConversion/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? Available HOPWA Funds Allocated HOPWA Funds: Allocated HOPWA Program Income: Total HOFWA funds for ProjecL• Total HOPWA Expended to date: Balance HOPWA Funds to date: Source of Non-HOPWA Funds S S i ^Yes ^No ^Yes ^No +; =E -E =a Expended To Date Total Available S S Total Non-HOPWA Funds: E S M3~ST~~t~' a : ~ORe , ia~'M HOPWA Report Form A 2 Of 7 11/12/04 EXHIBIT A REPORT FORM B FACILITY-BASED NON-HOUSING (Property Acquisition, Construction or Rehab) Activity Name: Facility Type: _ Date of Ciosing/Lease Execution: Date Construction/Rehab Started: Date ConstructionlRehab Completed: Date Operations Staff Hired: Date Support Services Started: HOPWA Site Expenditures (in douars) Acquisition: Reha blConversion/Repair: Lease: Operating Costs: Other: Other: Is the ske owned by a public entity? Is this activity "substantial" rehab? 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: Source Of Non-HOPWA Funds Total Non-HOPWA Funds: ^Yes ^Yes S S S ^No ^No S +j =3 -S =E Total Available S t AL1.RY~°a~ 3U A ~`t' ~~R.9~~©'i ~lr'-'i'~.4Y4.1 3 of 7 TOTAL: Expended To Date S HOPWA RepoA form a 11/i?/04 EXHIBIT A REPORT FORM C SCATTERED SITE HOUSING ACTIVITY - (Tenant Based Rental Assistance, Emergency HousinglUtility Assistance) Activity Name: Activity Location: Payments Began: Number of Units Assisted by Payment Tvne SRO 0 Bdrm 1 Bdmt 2 Bdnns 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 <3 Vdunlary: Nonpayment of rent: Supportive Service noncompliance: _ Unknown: Criminal: Death: HOPWA EXPENDITURES (in ddlars) 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 S 3.6 7-12 >12 S Total Non-HOPWA Funds: Expended To Date E E HOPWAr^veport FormC 4 Of 7 11/12/04 L. E};HIBIT A REPORT FORM D (Housing Info, Resource ID, 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: $ ResourcelD: $ Sub-Grantee Administrative Costs: $ Grantee (City of SA) Administrative Costs: $ Total HOPWA Expenditures: ~ $ HOPWA EXPENDITURES (M doAars) Allocated HOPWA Funds: E 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: S of 7 FYJPWA Report Fom D ~ »~~ E},HIBIT A REPORT FORM E SUPPORTIVE SERVICES ONLY Activity Name: Activity Location: Persons Wrth HIVIAIDS Other Persons in Family Unit Total Receiving Supportive Svcs w/ Housing Assistance Receiving Supportive Svcs Ony Supportive Services 1. Outreach 2. Case ManagemenU Advocacy/Access to Benefits Svcs 3. L'rfe Management (outside of Case Management 4. Nutritional ServiceslMeals 5. Adult Day care and Personal Assistance 6. Child Care and other Children's Services 7. Education S. Employment Assistance 9. Alcohd and Drub Abuse Services 10. Mental Health Services 11. Health/MediceUlntens'rve 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 ddlars) 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 Expended S S a ; ; E S ; # of Persons Served E Total Available ; Expended To Date Total Non-HOPWA Funds: HOF'WA Report Form E 6 of 7 11/t?'04 ~PWA SUPPLEMENTAL FOk,.. DEMO_ G~ S Persons Serviced Number of Persons with HIV/AIDS Number of Other Persons in Family Unit EXHIBIT A Receiving Housing Assistance TOTAL Total Families Assisted with Housing Assistance: Age 8 Gender Under 18 18-30 Male: Female: Total: 31-50 Over 50 Total Income Group of Individuals and Family Units per Month SO-5250 5251-5500 55001-51000 51001-51500 .51501-52000 OverS2000 Race/Ethnicity No. Total No. Hispanic White: Black/African American: Asian: American Indian/Alaskan Native: Native Hawaiian/Other Pacific Islander: American Indian/Alaskan Native 8 White: Asian 8 White: Black/African American 8 White: Am. Indian/Alaskan Native 8 Black/African Am.: Other Multi-Racial: Total: Recent Living Situation Count: Homeless/SVeets: Transitional Housing: Emergency Shelter. Psychiatric Facility: Substance Abuse Treatment: HospitaUMedicai: JaiUPrison: Domestic Violence: Living w/ Relative/Friend: Rental Housing: Participant-owned Housing: Other: SUPPLEMErvTAL 7 of 7 EXHIBIT B HOPWA SUB-GRANTEE YEAR END ACCOMPLISHMENT REPORT HOPWASnb-grantee: HOPWA Funded Activity Name: 1 2. 3. Fiscal Year/Report Period: 11H2/04 Amount of Funds Allocated: $ Amount of Funds Expended: $ Amount of resources used in conjunction with HOPWA funded activities: Cash: $ In-Kind Contributions: Describe activities/funding carried out in collaboration with related programslresources: 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 et Open Subtotal Deduction for Units Reported in More than One Category Total HOPWA YEAR END ACCOMPLISHMENTS REPORT Page 1 of 2 5 EXHIBIT B 11/1v04 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 (anach additional pages to necessary): Barriers Encountered: Trends in Meeting Needs: 7. Sub-Recipient Overview, if applicable (attach additional pages Nnecessary) 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: Name: Telephone Number: Date: Title: Email: HOPWA YEAR END ACCOMPLISHMENTS REPORT Pace2d2 E};HIBIT A HOUSING OPPORTUNITY FOR PEOPLE WITH AIDS ACCOMPLISHMENT REPORT HOPWA Recipient Name: HOPWA Funded Activity: Location of Activity: 1. Select the one category that best describes service provided with HOPWA Funds: ^ Facility Based Housing: (e.g., Construction, Rehab) ..............Submii Report Form A & Supplemental ^ Facility Based Non-Housing .................................................. Submit Report Fonn B 8 Supplemental ^ Scattered Site Only: (e.g., Tenant Based Rental Assisiance)..Submit Report Form C & Supplemental ^ Housing InformationlResource ID/Admin .............................. Submit Report Form D ^ Supportive Services Only ...................................................... Submii Report Form E 2. Check Box Indicating Report Period: ^ 15r Quarter ^ 2"a Quarter ^ 3ra Quarter ^ 4rn Quarter (7/1 - 9/30) (10/i - 12/31) (1/1 - 3/31) (411 - 6/30) 3. Amount of HOPWA Expended During This Report Period: $, 4. Number of Unduplicated Persons Assisted During the Report Period: ", 'Must equal7otal Number o/Persons ReceivinAAssh Lance' listed in Report Form 5. Number of Units Completed During the Report Period (ifapplcabje): For corutnrcfion projects Doty I certify that the information within this quarterly report is true and correct. Name Signature: Telephone No: Fax No: Title: Date: 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 0 Bdnn 1 Bdrms 2 Bdrms 3 Bdnns 4 Bdrms 5+ Bdrms Date of ClosinglLease Execution: Date Construction/Rehab Started: Completed: Date Operations Staff Hired: Date Residents Began to Occupy: HDPWA EXPENDITURES (in dotlars) Acquisition: Rehab/Conversion/Repair. Lease: New Construcfron: Operating Costs: Technical Assistance: Renial Assistance: Other: Other. Is the site owned by a public entity? Is this activity "substantial" rehab? Available HDPWA Funds Allocated HDPWA Funds: Allocated HDPWA Program Income: Total HDPWA funds for Project: Total HDPWA Expended to date: Balance HDPWA Funds to date: Source of Non-HDPWA Funds S S TOTAL: ; ^Yes ^No QYes ^No Expended To Date ; Total Non-HDPWA Funds: E Total Available S HDPWA Report FormA 2 of 7 it/1~/09 EXHIBIT C d m ~ L C ~ u u R ~ E E ~ ~ ~ ~ m v 'o C Q T 'a0 d o O a S m U .~ d _N m II O a U C d Q O U R C O U N U 'v i 0 1 i i i