HomeMy WebLinkAbout25D - AGMT - HOUSING AIDS PRGMREQUEST FOR
COUNCIL ACTION
CITY COUNCIL MEETING DATE:
MAY 7, 2012
TITLE:
FUNDING ALLOCATIONS FOR THE
HOUSING OPPORTUNITIES FOR
PERSONS WITH AIDS PROGRAM
FISCAL YEAR 2012 - 2013
CITY MANAGER
RECOMMENDED ACTION
CLERK OF COUNCIL USE ONLY:
APPROVED
? As Recommended
? As Amended
? Ordinance on 1St Reading
? Ordinance on 2"d Reading
? Implementing Resolution
? Set Public Hearing For_
CONTINUED TO
FILE NUMBER
Authorize the City Manager and the Clerk of the Council to execute the attached cooperative
agreement with the County of Orange Health Care Agency in an amount of $902,159 for a
one-year term to provide supportive housing services to HIV/AIDS individuals in the County of
Orange, subject to non-substantive changes approved by the City Manager and City Attorney.
2. Authorize the City Manager and the Clerk of the Council to execute the attached cooperative
agreement with the City of Santa Ana and the Housing Authority of the City of Santa Ana in
the amount of $600,000 for a one-year term for the implementation of the Housing
Opportunities for Persons with AIDS Tenant-Based Rental Assistance Program, subject to
non-substantive changes approved by the City Manager and City Attorney.
COMMUNITY REDEVELOPMENT AND HOUSING COMMISSION ACTION
At its regular meeting on April 17, 2012, by a vote of 6:0 (Reyes absent), the Community
Redevelopment and Housing Commission approved the recommended actions.
DISCUSSION
Since 1993, the City of Santa Ana has received federal funds through the U. S. Department of
Housing and Urban Development (HUD) for the Housing Opportunities for Persons with AIDS
(HOPWA) Program to be used countywide. The HOPWA Program is designed to provide
resources and incentives for long-term comprehensive strategies to meet the housing needs of
persons with Acquired Immune Deficiency Syndrome (AIDS). The allocation to the City of Santa
Ana for fiscal year 2012-2013 is $1,548,618.
Eligible activities for the HOPWA Program include: 1) new construction, acquisition and
rehabilitation of affordable housing; 2) provision of tenant-based rental assistance; 3) short-term
rental and mortgage payment assistance to prevent homelessness; 4) supportive social services
25D-1
HOPWA Funding
May 7, 2012
Page 2
and housing information services; 5) technical assistance; and 6) administrative expenses incurred
by jurisdictions coordinating local programs. In allocating grant funds for eligible activities, the City
of Santa Ana is required to consider the service needs of eligible persons who reside throughout
Orange County and approve funding for projects which may be located anywhere within the
County.
In order to ensure that the limited funds are prioritized, City staff has worked closely with the
Housing Committee of the Orange County HIV Planning Council, the HIV Planning Council, and
agencies throughout the County of Orange providing services to the HIV/AIDS community. On
December 5, 2011, a strategic planning meeting was held to determine priorities for the fiscal year
2012-2013 funds. Representatives from the Orange County Health Care Agency, service
providers from throughout the county, HIV/AIDS infected and affected individuals and City staff
participated in the meeting.
Based on the strategic planning meeting, the 2012-2013 fiscal year funding recommendations
were established. The recommended funding levels are: 1) $600,000 to continue the Tenant-
Based Rental Assistance Program with the Housing Authority of the City of Santa who will
subcontract with AIDS Services Foundation Orange County to administer the wait list; 2) $902,159
to the Orange County Health Care Agency for supportive housing services to individuals
throughout Orange County; and 3) $46,459 for administrative costs.
FISCAL IMPACT
Funds are available in the HOPWA Program account (nos. 40518760-various and 40518761-
various).
APPROVED AS TO FUNDS AND ACCOUNTS:
Nancy T. Wards Francisco Gutierrez
Interim Ex utive Director Executive Director
Community Development Agency Finance & Management Services Agency
NTE/SLB/TE/mlr
Exhibits: 1. Cooperative Agreement - City & County
2. Cooperative Agreement - City & Housing Authority
25D-2
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,
2012 through June 30, 2013, 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 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:
1. COUNTY SERVICES
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.
EXHIBIT 1
25D-3
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 forty-five (45) days after the
quarter/year ends in a form consistent with HUD publication HUD-40110-D or any other
form that HUD may require. [See Exhibit A (Annual Report) attached hereto and
incorporated herein by reference]. The report 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.
L 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 $902,159.
Supportive Housing Services $839,008
Administration* (see B. below) 63,151
$902,159
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, 2013 and invoiced by
August 15, 2013. 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 forty-
five (45) days after the end of each month. City shall pay County no later than thirty (30)
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25D-4
days following receipt of such invoice and complete documentation of services performed,
cost and number of persons served. Final invoice must be submitted by August 15, 2013.
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 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 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 (15) 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 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. 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,
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25D-5
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 States 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 Department of Health and Human Services, 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
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25D-6
Guidelines of the United States Equal Opportunity Commission and all appropriate state and
federal laws and regulations.
B. SERVICES, BENEFITS, AND FACILITIES -Neither 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
HOPWA Coordinator
20 Civic Center Plaza (M-27)
Santa Ana, California 92702-1988
25D-7
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 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. 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
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 of this
Agreement.
6
25D-8
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 of this 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, agents, or subcontractors, or principal and agent, between
County and City or any of County's employees,. 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
paragraph shall not be exclusive, and are in addition to any other rights and remedies
provided by law or under this Agreement.
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25D-9
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.
25D-10
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:
Maria D. Huizar
Clerk of the Council
CITY OF SANTA ANA:
Paul Walters
Interim City Manager
APPROVED AS TO FORM:
Sonia R. Carvalho, City Attorney
By:
Lisa E. Storck
Assistant City Attorney
COUNTY OF ORANGE
BY:
CHAIRMAN OF THE BOARD OF SUPERVISORS
SIGNED AND CERTIFIED THAT A COPY
OF THIS DOCUMENT HAS BEEN DELIVERED
TO THE CHAIRMAN OF THE BOARD.
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:
DEPUTY
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25D-11
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Housing Opportunities for Persons with AIDS
(HOPWA) Program
Consolidated Annual Performance and
Evaluation Report (CAPER)
Measuring Performance Outcomes
Final Released 1/12/12
OMB Number 2506-0133 (Expiration Date: 1013112014)
The CAPER report for HOPWA formula grantees provides annual information on program accomplishments
that supports program evaluation and the ability to measure program beneficiary outcomes as related to:
maintain housing stability; prevent homelessness; and improve access to care and support. This information is
also covered under the Consolidated Plan Management Process (CPMP) report and includes Narrative
Responses and Performance Charts required under the Consolidated Planning regulations. The public reporting
burden for the collection of information is estimated to average 42 hours per manual response, or less if an
automated data collection and retrieval system is in use, along with 60 hours for record keeping, including the
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. Grantees are required to report on the activities
undertaken only, thus there may be components of these reporting requirements that may not be applicable. This
agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless
that collection displays a valid OMB control number.
Previous editions are obsolete
form HUD-40110-D (Expiration Date: 10/31/2014)
EXHIBIT A
25D-12
Overview. The Consolidated Annual Performance and Evaluation Report
(CAPER) provides annual performance reporting on client outputs and
outcomes that enables an assessment of grantee performance in achieving the
housing stability outcome measure. The CAPER, in conjunction with the
Integrated Disbursement Information System (IDIS), fulfills statutory and
regulatory program reporting requirements and provides the grantee and
HUD with the necessary information to assess the overall program
performance and accomplishments against planned goals and objectives.
HOPWA formula grantees are required to submit a CAPER, and complete
annual performance information for all activities undertaken during each
program year in the IDIS, demonstrating coordination with other
Consolidated Plan resources. HUD uses the CAPER and IDIS data to obtain
essential information on grant activities, project sponsors, Subrecipient
organizations, housing sites, units and households, and beneficiaries (which
includes racial and ethnic data on program participants). The Consolidated
Plan Management Process tool (CPMP) provides an optional tool to integrate
the reporting of HOPWA specific activities with other planning and reporting
on Consolidated Plan activities.
Table of Contents
PART 1: Grantee Executive Summarv
1. Grantee Information
2. Project Sponsor Information
3. Administrative Subrecipient Information
4. Program Subrecipient Information
5. Grantee Narrative and Performance Assessment
a. Grantee and Community Overview
b. Annual Performance under the Action Plan
c. Barriers or Trends Overview
d. Assessment of Unmet Housing Needs
PART 2: Sources of Leveraging and Program Income
1. Sources of Leveraging
2. Program Income and Resident Rent Payments
PART 3• Accomplishment Data: Planned Goals and Actual Outputs
PART 4: Summary of Performance Outcomes
1. Housing Stability: Permanent Housing and Related Facilities
2. Prevention of Homelessness: Short-Tenn )rousing Payments
3. Access to Care and Support: Housing Subsidy Assistance with
Supportive Services
PART 5: Worksheet - Determining Housing Stability Outcomes
PART 6: Annual Certification of Continued Use for HOPWA Facility-
Based Stewardship Units (Only)
PART 7: Summarv Overview of Grant Activities
A. Information on Individuals, Beneficiaries and Households Receiving
HOPWA Housing Subsidy Assistance (TBRA, STRMU, PHP Facility
Based Units, Master Leased Units ONLY)
B. Facility-Based Housing Assistance
Continued Use Periods. Grantees that received HOPWA funding for new
construction, acquisition, or substantial rehabilitations are required to operate
their facilities for HOPWA-eligible beneficiaries for a ten (10) years period.
If no further HOPWA funds are used to support the facility, in place of
completing Section 713 of the CAPER, the grantee must submit an Annual
Certification of Continued Project Operation throughout the required use
periods. This certification is included in Part 6 in CAPER. The required use
period is three (3) years if the rehabilitation is non-substantial.
In connection with the development of the Department's standards for
Homeless Management Information Systems (HMIS), universal data
elements are being collected for clients of I IOPWA-funded homeless
assistance projects. These project sponsor/subrecipicnt records would
include: Name, Social Security Number, Date of Birth, Ethnicity and Race,
Gender, Veteran Status, Disabling Conditions, Residence Prior to Program
Entry, Zip Code of Last Permanent Address, Housing Status, Program Entry
Date, Program Exit Date, Personal Identification Number, and Household
Identification Number. These are intended to match the elements under
HMIS. The HOPWA program-level data elements include: Income and
Sources, Non-Cash Benefits, HIV/AIDS Status, Services Provided, and
Housing Status or Destination at the end of the operating year. Other
suggested but optional elements are: Physical Disability, Developmental
Disability, Chronic Health Condition, Mental Health, Substance Abuse,
Domestic Violence. Date of Contact, Date of Engagement, Financial
Assistance, Housing Relocation & Stabilization Services, Employment,
Education, General Health Status, , Pregnancy Status, Reasons for Leaving,
Veteran's Information, and Children's Education. Other HOPWA projects
sponsors may also benefit from collecting these data elements.
Final Assembly of Report. After the entire report is assembled, please
number each page sequentially.
Filing Requirements. Within 90 days of the completion of each program
year, grantees trust submit their completed CAPER to the CPD Director in
the grantee's State or Local HUD Field Office, and to the HOPWA Program
Office: at HOPWA a hud.¢ov. Electronic submission to HOPWA Program
office is preferred; however, if electronic submission is not possible, hard
copies can be mailed to: Office of HIV/AIDS Housing, Room 7212, U.S.
Department of Housing and Urban Development, 451 Seventh Street, SW,
Washington, D.C..
Record Keeping. Names and other individual information must be kept
confidential, as required by 24 CFR 574.440. However, HUD reserves the
right to review the information used to complete this report for grants
management oversight purposes, except for recording any names and other
identifying information. In the case that HUD must review client level
data, no client names or identifying information will be retained or
recorded. Information is reported in aggregate to HUD without
personal identification. Do not submit client or personal information in
data systems to HUD.
Definitions
Adjustment for Duplication: Enables the calculation of unduplicated
output totals by accounting for the total number of households or units that
received more than one type of HOPWA assistance in a given service
category such as HOPWA Subsidy Assistance or Supportive Services. For
example, if a client household received both TBRA and STRMU during the
operating year, report that household in the category of HOPWA Housing
Subsidy Assistance in Part 3, Chart 1, Column [ 1 b] in the following manner:
[11 Outputs:
Subsidy
HOPWA Housin
g Number of
Assistance
Households
1. Tenant-Based Rental Assistance I
Permanent Housing Facilities:
2a. Received Operating
Subsidies/Leased units
Transitional/Short-term Facilities:
2b. Received Operating Subsidies
Permanent Housing Facilities:
3a Capital Development Projects placed
. in service during the operating year
Transitional/Short-term Facilities:
3b Capital Development Projects placed
. in service during the operating year
4 Short-term Rent, Mortgage, and
I
Utility Assistance
5 Adjustment for duplication
I
subtract
TOTAL Housing Subsidy
6. Assistance (Sum of Rows 1-4 minus I
Row 5
Previous editions are obsolete Page i form HUD-40110-D (Expiration Date: 10/31/2014)
25D-13
Administrative Costs: Costs for general management, oversight,
coordination, evaluation, and reporting. By statute, grantee administrative
costs are limited to 3% of total grant award, to be expended over the life of
the grant. Project sponsor administrative costs are limited to 7% of the
portion of the grant amount they receive.
Benericiary(ies): All members of a household who received HOPWA
assistance during the operating year including the one individual who
qualified the household for HOPWA assistance as well as any other
members of the household (with or without HIV) who benefitted from the
assistance.
Central Contractor Registration (CCR): The primary registrant
database for the U.S. Federal Government. CCR collects, validates, stores,
and disseminates data in support ofagency acquisition missions, including
Federal agency contract and assistance awards. Both current and potential
federal government registrants (grantees) are required to register in CCR
in order to be awarded contracts by the federal government. Registrants
must update or renew their registration at least once per year to maintain
an active status. Although recipients ofdirect federal contracts and grant
awards have been required to be registered with CCR since 2003, this
requirement is now being extended to indirect recipients of federal funds
with the passage of ARRA (American Recovery and Reinvestment Act).
Per ARRA and FFATA (Federal Funding Accountability and
Transparency Act) federal regulations, all grantees and sub-grantees or
subcontractors receiving federal grant awards or contracts must have a
DUNS (Data Universal Numbering System) Number.
Chronically Homeless Person: An individual or family who : (i) is
homeless and lives or resides individual or family who: (i) Is homeless and
lives or resides in a place not meant for human habitation, a safe haven, or
in an emergency shelter, (ii) has been homeless and living or residing in a
place not meant for human habitation, a safe haven, or in an emergency
shelter continuously for at least I year or on at least 4 separate occasions in
the last 3 years; and (iii) has an adult head of household (or a minor head
of household if no adult is present in the household) with a diagnosable
substance use disorder, serious mental illness, developmental disability (as
defined in section 102 of the Developmental Disabilities Assistance and
Bill of Rights Act of 2000 (42 U.S.C. 15002)), post traumatic stress
disorder, cognitive impairments resulting from a brain injury, or chronic
physical illness or disability, including the co-occurrence of 2 or more of
those conditions. Additionally, the statutory definition includes as
chronically homeless a person who currently lives or resides in an
institutional care facility, including ajail, substance abuse or mental health
treatment facility, hospital or other similar facility, and has resided there
for fewer than 90 days if such person met the other criteria for homeless
prior to entering that facility. (See 42 U.S.C. 11360(2))This does not
include doubled-up or overcrowding situations.
Disabling Condition: Evidencing a diagnosable substance use disorder,
serious mental illness, developmental disability, chronic physical illness,
or disability, including the co-occurrence of two or more of these
conditions. In addition, a disabling condition may limit an individual's
ability to work or perfonn one or more activities of daily living. An
HIV/AIDS diagnosis is considered a disabling condition.
Facility-Based Housing Assistance: All eligible HOPWA Housing
expenditures for or associated with supporting facilities including
community residences, SRO dwellings, short-term facilities, project-based
rental units, master leased units, and other housing facilities approved by
HUD.
Faith-Based Organization: Religious organizations ofthree types: (1)
congregations; (2) national networks, which include national
denominations, their social service arms (for example, Catholic Charities,
Lutheran Social Services), and networks of related organizations (such as
YMCA and YWCA); and (3) freestanding religious organizations, which
are incorporated separately from congregations and national networks.
Grassroots Organization: An organization headquartered in the local
community where it provides services; has a social services budget of
$300,000 or less annually, and six or fewer full-time equivalent
employees. Local affiliates of national organizations are not considered
"grassroots."
HOPWA Eligible Individual: The one (1) low-income person with
HIV/AIDS who qualifies a household for HOPWA assistance. This person
may be considered "Head of Household." When the CAPER asks for
information on eligible individuals, report on this individual person only.
Where there is more than one person with HIV/AIDS in the household, the
additional PWH/A(s), would be considered a beneficiary(s).
HOPWA Housing Information Services: Services dedicated to helping
persons living with HIV/AIDS and their families to identify, locate, and
acquire housing. This may also include fair housing counseling for eligible
persons who may encounter discrimination based on race, color, religion,
sex, age, national origin, familial status, or handicap/disability. .
HOPWA Housing Subsidy Assistance Total: The unduplicated number
of households receiving housing subsidies (TBRA, STRMU, Permanent
Housing Placement services and Master Leasing) and/or residing in units
of facilities dedicated to persons living with HIV/AIDS and their families
and supported with HOPWA funds during the operating year.
Household: A single individual or a family composed of two or more
persons for which household incomes are used to determine eligibility and
for calculation of the resident rent payment. The tern is used for
collecting data on changes in income, changes in access to services, receipt
of housing information services, and outcomes on achieving housing
stability. Live-In Aides (see definition for Live-In Aide) and non-
beneficiaries (e.g. a shared housing arrangement with a roommate) who
resided in the unit are not reported on in the CAPER.
Housing Stability: The degree to which the HOPWA project assisted
beneficiaries to remain in stable housing during the operating year. See
Part 5: Determininglfousing Stability Outcomes for definitions of stable
and unstable housing situations.
In-kind Leveraged Resources: These involve additional types ofsupport
provided to assist HOPWA beneficiaries such as volunteer services,
materials, use of equipment and building space. The actual value of the
support can be the contribution of professional services, based on
customary rates for this specialized support, or actual costs contributed
from other leveraged resources. In determining a rate for the contribution
of volunteer time and services, use the rate established in HUD notices,
such as the rate often dollars per hour. The value of any donated material,
equipment, building, or lease should be based on the fair market value at
time of donation. Related documentation can be from recent bills of sales,
advertised prices, appraisals, or other information for comparable property
similarly situated.
Leveraged Funds: The amount of funds expended during the operating
year from non-HOPWA federal, state, local, mid private sources by
grantees or sponsors in dedicating assistance to this client population.
Leveraged funds or other assistance are used directly in or in support of
HOPWA program delivery.
Live-In Aide: A person who resides with the HOPWA Eligible Individual
and who meets the following criteria: (1) is essential to the care and well-
being of the person; (2) is not obligated for the support of the person; and
(3) would not be living in the unit except to provide the necessary
supportive services. See the Code of Federal Regulations Title 24. Part
5.403 and the FIOPWA Grantee Oversight Resource Guide for additional
reference.
Master Leasing: Applies to a nonprofit or public agency that leases units
of housing (scattered-sites or entire buildings) from a landlord, and
subleases the units to homeless or low-income tenants. By assuming the
tenancy burden, the agency facilitates housing of clients who may not be
able to maintain a lease on their own due to poor credit, evictions, or lack
ofsufflcient income.
Operating Costs: Applies to facility-based housing only, for facilities
that are currently open. Operating costs can include day-to-day housing
Previous editions are obsolete Page ii form HUD-401 10-D (Expiration Date: 10/3112014)
25D-14
function and operation costs like utilities, maintenance, equipment,
insurance, security, furnishings, supplies and salary for staffcosts directly
related to the housing project but not staff costs for delivering services.
Outcome: The degree to which the HOPWA assisted household has been
enabled to establish or maintain a stable living environment in housing that
is safe, decent, and sanitary, (per the regulations at 24 CFR 574.310(6))
and to reduce the risks of homelessness, and improve access to HIV
treatment and other health care and support.
Output: The number of units of housing or households that receive
HOPWA assistance during the operating year.
Permanent Housing Placement: A supportive housing service that helps
establish the household in the housing unit, including but not limited to
reasonable costs for security deposits not to exceed two months of rent
costs.
Program Income: Gross income directly generated from the use of
HOPWA funds, including repayments. See grant administration
requirements on program income for state and local governments at 24
CFR 85.25, or for non-profits at 24 CFR 84.24.
Project-Based Rental Assistance (PBRA): A rental subsidy program
that is tied to specific facilities or units owned or controlled by a project
sponsor or Subrecipient. Assistance is tied directly to the properties and is
not portable or transferable.
Project Sponsor Organizations: Any nonprofit organization or
governmental housing agency that receives funds under a contract with the
grantee to provide eligible housing and other support services or
administrative services as defined in 24 CFR 574.300. Project Sponsor
organizations are required to provide performance data on households
served and funds expended. Funding flows to a project sponsor as
follows:
HUD Funding --> Grantee ----> Project Sponsor
Short-Term Rent, Mortgage, and Utility (STRMU) Assistance: A
time-limited, housing subsidy assistance designed to prevent homelessness
and increase housing stability. Grantees may provide assistance for up to
21 weeks in any 52 week period. The amount of assistance varies per
client depending on funds available, tenant need and program guidelines.
Stewardship Units: Units developed with HOPWA, where HOPWA
funds were used for acquisition, new construction and rehabilitation that
no longer receive operating subsidies from HOPWA. Report information
for the units is subject to the three-year use agreement if rehabilitation is
non-substantial and to the ten-year use agreement if rehabilitation is
substantial.
Previous editions are obsolete Page iii
Subrecipient Organization: Any organization that receives funds from a
project sponsor to provide eligible housing and other support services
and/or administrative services as defined in 24 CFR 574.300. If a
Subrecipient organization provides housing and/or other supportive
services directly to clients, the subrecipient organization trust provide
performance data on household served and funds expended. Funding
flows to subrecipients as follows:
HUD Funding -> Grantee •--y Project Sponsor --> Subrecipient
Tenant-Based Rental Assistance (TBRA): TBRA is a rental subsidy
program similar to the Housing Choice Voucher program that grantees can
provide to help low-income households access affordable housing. The
TBRA voucher is not tied to a specific unit, so tenants may move to a
different unit without losing their assistance, subject to individual program
rules. The subsidy amount is determined in part based on household
income and rental costs associated with the tenant's lease.
Transgender: Transgender is defined as a person who identifies with, or
presents as, a gender that is different from his/her gender at birth.
Veteran: A veteran is someone who has served on active duty in the
Armed Forces of the United States. This does not include inactive military
reserves or the National Guard unless the person was called up to active
duty.
form HUD-40110-D (Expiration Date: 10/31/2014)
25D-15
Housing Opportunities foe Person with AIDS (HOPWA) ',
Collsciladated Annual-Perforinance and Evaluation Repoet (CAPER) _
x . ?.
Measui ing Performance Outputs and Outcomes
OMB Number 2506-0133 (Expiration Date: 10/3112014)
Part 1 ,Grantee Executive Summary
As applicable, complete the charts below to provide more detailed information about the agencies and organizations responsible
for the administration and implementation of the HOPWA program. Chart I requests general Grantee Information and Chart 2 is
to be completed for each organization selected or designated as a project sponsor, as defined by CFR 574.3. In Chart 3, indicate
each subrecipient organization with a contract/agreement of $25,000 or greater that assists grantees or project sponsors carrying
out their administrative or evaluation activities. In Chart 4, indicate each subrecipient organization with a contract/agreement to
provide HOPWA-funded services to client households. These elements address requirements in the Federal Funding and
Accountability and Transparency Act of 2006 (Public Law 109-282).
Note: Please see the definition section for distinctions between project sponsor and subrecipient.
Note: If any information does not apply to your organization, please enter N/A. Do not leave any section blank.
1. Grantee Information
HUD Grant Number Operating Year for this report
From (inni/ddl*) To (nini/dd/yy)
Grantee Name
Business Address
City, County, State, Zip
Employer Identification Number (EIN) or
Tax Identification Number (TIN)
DUN & Bradstreet Number (DUNS): Central Contractor Registration (CCR):
Is the grantee's CCR status currently active?
? Yes ? No
If yes, provide CCR Number:
*Congressional District of Grantee's Business
Address
*Congressional District of Primary Service
Areas
*City(ies) and County(ies) of Primary Service Cities: Counties:
Area(s)
Organization's Website Address Is there awaiting list(s) for HOPWA Housing Subsidy Assistance
Services in the Grantee service Area? ? Yes ? No
If yes, explain in the narrative section what services maintain a waiting
list and how this list is administered.
* Service delivery area information only needed for program activities being directly carried out by the grantee.
Previous editions are obsolete Page 1 form HUD-40110-D (Expiration Date: 10/31/2014)
25D-16
2. Project Sponsor Information
Please complete Chart 2 for each organization designated or selected to serve as a project sponsor, as defined by CFR 574.3.
Use this section to report on organizations involved in the direct delivery of services for client households. These elements
address requirements in the Federal Financial Accountability and Transparency Act of 2006 (Public Law 109-282).
Note: Please see the definitions for distinctions behi,een project sponsor and szibreeipient.
Note: If any information does not apply to your organization, please enter N/A.
Project Sponsor Agency Name Parent Company Name, if applicable
Name and Title of Contact at Project
S onsorA enc
Email Address
Business Address
Phone Number (with area code)
Address, City, County, State
Employer Identification Number (EIN) or
Tax Identification Number (TIN) Fax Number (with area code)
DUN & Bradstreet Number (DUNS):
Congressional District of Project Sponsor's
Business Address
Congressional District(s) of Primary Service
Area(s)
City(ies) and County(ies) of Primary Service
Area(s) Cities Counties
Total HOPWA contract amount for this
Organization for the operating year
Organization's Website Address
Is the sponsor a nonprofit organization? ? Yes ? No
Please check ifyes and afaith-based organization. ?
Please check if yes and a grassroots organization. ? Does your organization maintain awaiting list? ? Yes ? No
If yes, explain in the narrative section how this list is administered.
Previous editions are obsolete Page 2 form HUD-401 10-D (Expiration Date: 10/31/2014)
25D-17
3. Administrative Subrecipient Information
Use Chart 3 to provide the following information for each subrecipient with a contract/agreement of $25,000 or greater that
assists project sponsors to carry out their administrative services but no services directly to client households. Agreements
include: grants, subgrants, loans, awards, cooperative agreements, and other forms of financial assistance; and contracts,
subcontracts, purchase orders, task orders, and delivery orders. (Organizations listed may have contracts with project sponsors)
These elements address requirements in the Federal Funding and Accountability and Transparency Act of 2006 (Public Law 109-
282).
Note: Please see the definitions for distinctions between project sponsor and subrecipient.
Note: If any information does not apply to your organization, please enter N/A.
Subrecipient Name Parent Company Name, ifapplicable
Name and Title of Contact at Subrecipient
Email Address
Business Address
City, State, Zip, County
Phone Number (with area code) Fax Number (include area code)
Employer Identification Number (EIN) or
Tax Identification Number (TIN)
DUN & Bradstreet Number (DUNS):
North American Industry Classification
System (NAICS) Code
Congressional District of Subrecipient's
Business Address
Congressional District of Primary Service
Area
City (ies) and County (ies) of Primary Service
Area(s) Cities Counties
Total HOPWA Subcontract Amount of this
Organization for the operating year
Previous editions are obsolete Page 3 form HUD-40110-D (Expiration Date: 10/31/2014)
25D-18
4. Program Subrecipient Information
Complete the following information for each Subrecipient organization providing HOPWA-funded services to client households.
These organizations would hold a contract/agreement with a project sponsor(s) to provide these services. For example, a
Subrecipient organization may receive funds from a project sponsor to provide nutritional services for clients residing within a
HOPWA facility-based housing program. Please note that subrecipients who work directly with client households must provide
performance data for the grantee to include in Parts 2-7 of the CAPER.
Note: Please see the definition of a subreeipient for more information.
Note: Types of contracts/agreements may include: grants, sub-grants, loans, awards, cooperative agreements, and otherfornrs
offinancial assistance; and contracts, subcontracts, purchase orders, task orders, and delivery orders.
Note: If any information is not applicable to the organization, please report N/A in the appropriate box. Do not leave boxes
blank.
Sub-recipient Name Parent Company Name, ifapplicable
Name and Title of Contact at Contractor/
Sub-contractor Agency
Email Address
Business Address
City, County, State, Zip
Phone Number (included area code) Fax Number (include area code)
Employer Identification Number (EIN) or
Tax Identification Number (TIN)
DUN & Bradstreet Number (DUNS)
North American Industry Classification
System (NA1CS) Code
Congressional District of the Sub-recipient's
Business Address
Congressional District(s) of Primary Service
Area
City(ies) and County(ies) of Primary Service
Area Cities: Counties:
Total HOPWA Subcontract Amount of this
Organization for the operating year
Previous editions are obsolete Page 4 form HUD-40110-D (Expiration Date: 10/31/2014)
25D-19
S. Grantee Narrative and Performance Assessment
a. Grantee and Community Overview
Provide a one to three page narrative summarizing major achievements and highlights that were proposed and completed during
the program year. Include a brief description of the grant organization, area of service, the name(s) of the program contact(s),
and an overview of the range/type of housing activities provided. This overview may be used for public information, including
posting on HUD's website. Note: Tex1 fields are expandable.
b. Annual Performance under the Action Plan
Provide a narrative addressing each of the following four items:
1. Outputs Reported. Describe significant accomplishments or challenges in achieving the number of housing units supported
and the number households assisted with HOPWA funds during this operating year compared to plans for this assistance, as
approved in the Consolidated Plan/Action Plan. Describe how HOPWA funds were distributed during your program year among
different categories of housing and geographic areas to address needs throughout the grant service area, consistent with approved
plans.
2. Outcomes Assessed. Assess your program's success in enabling HOPWA beneficiaries to establish and/or better maintain a
stable living environment in housing that is safe, decent, and sanitary, and improve access to care. Compare current year results
to baseline results for clients. Describe how program activities/projects contributed to meeting stated goals. If program did not
achieve expected targets, please describe how your program plans to address challenges in program implementation and the steps
currently being taken to achieve goals in next operating year. If your program exceeded program targets, please describe
strategies the program utilized and how those contributed to program successes.
3. Coordination. Report on program coordination with other mainstream housing and supportive services resources, including
the use of committed leveraging from other public and private sources that helped to address needs for eligible persons identified
in the Consolidated Plan/Strategic Plan.
4. Technical Assistance. Describe any program technical assistance needs and how they would benefit program beneficiaries.
c. Barriers and Trends Overview
Provide a narrative addressing items 1 through 3. Explain how barriers and trends affected your program's ability to achieve the
objectives and outcomes discussed in the previous section.
1. Describe any barriers (including regulatory and non-regulatory) encountered in the administration or implementation of
the HOPWA program, how they affected your program's ability to achieve the objectives and outcomes discussed, and,
actions taken in response to barriers, and recommendations for program improvement. Provide an explanation for each
barrier selected.
A/HUD Regulations
? Discrimination/Confidentiality ? Multiple Diagnoses ? Eligibility
? Supportive Services ? Credit History ? Rental History
? Housing Affordability ? Geography/Rural Access ? Other, please explain further
? Rent Determination and Fair Market
Rents
? Technical Assistance or Training
? Criminal Justice Ilistory
Previous editions are obsolete Page 5 form HUD-40110-D (Expiration Date: 10/31/2014)
25D-20
2. Describe any trends in the community that may affect the way in which the needs of persons living with HIV/AIDS
are being addressed, and provide any other information important to the future provision of services to this population.
3. Identify any evaluations, studies, or other assessments of the HOPWA program that are available to the public.
d. Unmet Housing Needs: An Assessment of Unmet Housing Needs
In Chart 1, provide an assessment of the number of HOPWA-eligible households that require HOPWA housing subsidy
assistance but are not currently served by any HOPWA-funded housing subsidy assistance in this service area.
In Row 1, report the total unmet need of the geographical service area, as reported in Unniet Needs for Persons ivith HIV/AIDS,
Chart 1B of the Consolidated or Annual Plan(s), or as reported under HOPWA worksheet in the Needs Workbook of the
Consolidated Planning Management Process (CPMP) tool.
Note: Report most current data available, through Consolidated or Annual Plan(s), and account for local housing issues, or
changes in HIV/AIDS cases, by using combination of one or more of the sources in Chart 2.
If data is collected on the type of housing that is needed in Rows a. through c., enter the number of HOPWA-eligible households
by type of housing subsidy assistance needed. For an approximate breakdown of overall unmet need by type of housing subsidy
assistance refer to the Consolidated or Annual Plan (s), CPMP tool or local distribution of funds. Do not include clients who are
already receiving HOPWA-funded housing subsidy assistance.
Refer to Chart 2, and check all sources consulted to calculate unmet need. Reference any data from neighboring states' or
municipalities' Consolidated Plan or other planning efforts that informed the assessment of Unmet Need in your service area.
Note: In order to ensure that the unmet need assessment for the region is comprehensive, HOP WA formula grantees should
include those unmet needs assessed by HOP1,VA competitive grantees operating lvithin the service area.
1. Planning Estimate of Area's Unmet Needs for HOPWA-Eli ible Households
1. Total number of households that have unmet
housing subsidy assistance need.
2. From the total reported in Row 1, identify the
number of households with unmet housing needs
by type of housing subsidy assistance:
a. Tenant-Based Rental Assistance (TBRA)
b. Short-Tenn Rent, Mortgage and Utility payments
(STRMU)
• Assistance with rental costs
• Assistance with mortgage payments
• Assistance with utility costs.
c. Housing Facilities, such as community residences,
SRO dwellings, other housing facilities
Previous editions are obsolete Page 6 form HUD-401 10-D (Expiration Date: 10/31/2014)
25D-21
2 Recommended Data Sources for Assessing Unmet Need check all sources used
X = Data as reported in the area Consolidated Plan, e.g. Table 1 B, CPMP charts, and related narratives
=Data established by area HIV/AIDS housing planning and coordination efforts, e.g. Continuum of Care
= Data from client information provided in Homeless Management Information Systems (HMIS)
= Data from project sponsors or housing providers, including waiting lists for assistance or other assessments on need including those
completed by HOPWA competitive grantees operating in the region.
= Data from prisons or jails on persons being discharged with HIV/AIDS, if mandatory testing is conducted
= Data from local Ryan White Planning Councils or reported in CARE Act Data Reports, e.g. number of clients with permanent
housing
= Data collected for HIV/AIDS surveillance reporting or other health assessments, e.g. local health department or CDC surveil lance data
End of PART 1
Previous editions are obsolete Page 7 form HUD-401 10-D (Expiration Date: 10/31/2014)
25D-22
PART 2: Sources of Leveraging and Program income
1. Sources of Leveraging
Report the source(s) of cash or in-kind leveraged federal, state, local or private resources identified in the Consolidated or
Annual Plan and used in the delivery of the HOPWA program and the amount of leveraged dollars. In Column [1], identify the
type of leveraging. Some common sources of leveraged funds have been provided as a reference point. You tray add Rows as
necessary to report all sources of leveraged funds. Include Resident Rent payments paid by clients directly to private landlords.
Do NOT include rents paid directly to a HOPWA program as this will be reported in the next section. In Column [2] report the
amount of leveraged funds expended during the operating year. Use Column [3] to provide some detail about the type of
leveraged contribution (e.g., case management services or clothing donations). In Column [4], check the appropriate box to
indicate whether the leveraged contribution was a housing subsidy assistance or another form of support.
Note: Be sure to report on the number of households supported with these leveraged funds in Part 3, Chart 1, Column A. A.
Source of Leveraging Chart
[2] Amount
of Leveraged [3] Type of [4] Housing Subsidy
T _ [l] Source of Leveraging Funds Contribution Assistance or Other Support
-
,RubIicTuadti e
?Housing Subsidy Assistance
Ryan White-Housing Assistance []Other Support
?Housing Subsidy Assistance
Ryan White-Other []Other Support
?Housing Subsidy Assistance
Housing Choice Voucher Program []Other Support
?Housing Subsidy Assistance
Low Income Housing Tax Credit []Other Support
?Housing Subsidy Assistance
HOME []Other Support
?Housing Subsidy Assistance
Shelter Plus Care []Other Support
?Housing Subsidy Assistance
Emergency Solutions Grant []Other Support
?Housing Subsidy Assistance
Other Public: []Other Support
?Housing Subsidy Assistance
Other Public: ?OtherSupport
?Housing Subsidy Assistance
Other Public: []Other Support
?Housing Subsidy Assistance
Other Public: []Other Support
?Housing Subsidy Assistance
Other Public: []Other Support
Private Funding
?Housing Subsidy Assistance
Grants []Other Support
?Housing Subsidy Assistance
In-kind Resources []Other Support
?Housing Subsidy Assistance
Other Private: []Other Support
?Housing Subsidy Assistance
Other Private: []Other Support
Other Fundi ug _
?Housing Subsidy Assistance
Grantee/Project Sponsor/Subrecipient (Agency) Cash []Other Support
R
id
R
b Cli
i
L
P
P
dl
d
es
ent
ent
ent to
r
vate
ayments
an
or
TOTAL Sum of all Rows
Previous editions are obsolete Page 8 form HUD-40110-1) (Expiration Date: 10/31/2014)
25D-23
2. Program Income and Resident Rent Payments
In Section 2, Chart A., report the total amount of program income and resident rent payments directly generated from the use of
HOPWA funds, including repayments. Include resident rent payments collected or paid directly to the HOPWA program. Do
NOT include payments made directly from a client household to a private landlord.
Note: Please see report directions section for definition of prot?i am income. (Additional information on program income is
available in the HOPWA Grantee Oversight Resource Guide).
A. Total Amount Program Income and Resident Rent Payment Collected During the Operating Year
Total Amount of
Program Income
Program Income and Resident Rent Payments Collected (for this operating
year)
1. Program income (e.g. repayments)
2. Resident Rent Payments made directly to HOPWA Program
3. Total Program Income and Resident Rent Payments (Sum of Rows I and 2)
B. Program Income and Resident Rent Payments Expended To Assist HOPWA Households
In Chart B, report on the total program income and resident rent payments (as reported above in Chart A) expended during the
operating year. Use Row I to report Program Income and Resident Rent Payments expended on Housing Subsidy Assistance
Programs (i.e., TBRA, STRMU, PHP, Master Leased Units, and Facility-Based Housing). Use Row 2 to report on the Program
Income and Resident Rent Payment expended on Supportive Services and other non-direct Housing Costs.
Total Amount of
Program Income
Expended
Program Income and Resident Rent Payment Expended on HOPWA (for this operating
year)
programs
1. Program Income and Resident Rent Payment Expended on Housing Subsidy Assistance costs
2. Program Income and Resident Rent Payment Expended on Supportive Services and other non-direct housing
costs
3. Total Program Income Expended (Sum of Rows I and 2)
End of PART 2
Previous editions are obsolete Page 9 form HUD-40110-D (Expiration Date: 10/31/2014)
25D-24
PART 3: `Accomplishment Data Plagncd Goa1 and Actual Outputs
In Chart 1, enter performance information (goals and actual outputs) for all activities undertaken during the operating year
supported with HOP WA funds. Performance is measured by the number of households and units of housing that were supported
with HOP WA or other federal, state, local, or private funds for the purposes of providing housing assistance and support to
persons living with HIV/AIDS and their families.
Note: The total households assisted with HOP RA funds and reported in PART 3 of the CAPER should be the same as reported
in the annualyear-endIDIS data, andgoals reportedshould be consistent with the Annual Plan information. Any discrepancies
or deviations should be explained in the narrative section of PART 1.
1 HOPWA Performance Planned Goal and Actual Out outs
-VIII Outliut: Huu elwlds 12LO iitlrul.llmdin,
IIOPA!'.i ?--ctcr.?Red ?+
C, ltQu;e holtv_- _llt?lwA 1A„??,
HOPWA Performance
Planned Goal a. b. c. d. e. f.
and Actual
d
C7
¢ a
C7
¢ 0 a
°x of a z
°x
sttn c
IiOkrA'?ousLg ?ull?ich t _ t oai'i(r.Irmrdci?rtati..;. z" our?ur t??_nd?,
I . _
fenant-Based Rental Assistance
a. Permanent Housing Facilities:
Received Operating Subsidies/Leased units (Households Served
b. Transitional/Short-term Facilities:
Received Operating Subsidies/Leased units (I louseholds Served)
Households Served)
a. Permanent Housing Facilities:
[
apital Development Projects placed in service during the operating year
Households Served)
b. r"nsitional/Short-term Facilities:
apital Development Projects placed in service during the operating year
Households Served
port-Tenn Rent, Mortgage and Utility Assistance
5. Permanent Housing Placement Services
Adjustments for duplication (subtract)
-
7. Total HOPWA Housing Subsidy Assistance '. -
(Columns a. - d. equal the sum of Roivs 1-5 minus Row 6; Columns e. and f. equal
-
he sum of Rows 1-5) --- _ - --- L r .--
tlousin Developrggpt (Consti action and SCetvn ilshtp,offacihtYbased housin )
- L Out'titt -?"0US Ia tWW .121 omt ot: unitm -
8. I-acility-uased units; -- - T
Capital Development Projects not yet opened (Housing Units)
9. Stewardship Units subject to 3 or 10 year use agreements
10, Total Housing Developed
(Sum of Rows 78 & 9)
-
-
iiN6HiyeSeI ices
.
.:: - ...
? 1 'Out trtllauscholds =
-
T 7
.
12106 uC'rhih hn .,. :.
1 I a. _.
-
upportive Services provided by project sponsors/subrecipient that also delivered _
_
HOPWA housing subsidy assistance
Ilb Supportive Services provided by project sponsors/subrecipientthat only provided
supportive services.
12. Adjustment for duplication (subtract)
13. Total Supportive Services
(Columns a. - d. equal the sum of Rows 11 a. & b. minus Row 12; Columns e. and f.
equal the sum of Rows Ala. & 11 b.) -
- Housing --Information Services II) output Huuseholds 121 outpun Funding . ;
14. ousing Information Services
15. Total Housing Information Services
Previous editions are obsolete Page 10 form BUD-40110-D (Expiration Date: 10/31/2014)
25D-25
1 r [ J ilf) n? tpi,t llau rl uld
,rlfirAdnsmishn and t7tlicr 4ch i tes ,a+i,?p ??
nlp f 7 n?
, 13j_0
16 Y, . -
•
coordinate and develop housing assistance resources
Resource Identification to establish '
. ?
,
e ,a
17. Technical Assistance
ifa roved in grant agreement)
. Y a ?? ? rt a
18. rantee Administration " R
.? .R E 3
Y?Y 8 kz, '?w9
maximum 3% of total HOPWA grant)
19.
Rc
roject Sponsor Administration a' s ^ °x*?* * "*
maximum 7% of onion of HOPWA rant awarded ' " ffi
0..: _otnl Grant Administration and Other Activities
Sum of Rows 17-20)
.
i h
Qpi it
n
E ed
?Y
r
kt.:.r uil e .
,
I: Total Expenditures for program year (Sum of Rows 7, 10, 13, 15, afid20)
2. Listing of Supportive Services
Report on the households served and use of HOPWA funds for all supportive services. Do NOT report on supportive services
leveraged with non-HOPWA funds.
Data check: Total unduplicated households and expenditures reported in Row 17 equal totals reported in Part 3, Chart 1, Row 13.
Supportive Services ]I] Output: Number of Households ]2] Output: Amount of HOPWA Funds
Expended
1. Adult day care and personal assistance
2. Alcohol and drug abuse services
3. Case management
4. Child care and other child services
5. Education
6. Employment assistance and training
7. Health/medical/intensive care services, if approved
Note: Client records must conform with 24 CFR 574.310
8. Legal services
9. Life skills management outside of ease management)
10. Meals/nutritional services
11. Mental health services
12. Outreach
13. Transportation
14. Other Activity (if approved in grant agreement).
Specify:
5.
Sub-Total Households receiving Supportive Services
(Sum of Rows 1-14 Y
it Ye}A^xY< Y'i R1?T Y'? A$'
, aYY?a s` , Y =,Y? , * ti
-
y
16.
Adjustment for Duplication subtract Y 4
Ske ',
r? a` ?• ' ' '
17. TOTAL Unduplicated Households receiving
Supportive Services (Column il] equals Row 15
minus Row 16; Column 121 equals sum of Rows 1-14
Previous editions are obsolete Page 11 form HUD-40110-D (Expiration Date: 10/31/2014)
25D-26
3. Short-Term Rent, Mortgage and Utility Assistance (STRMU) Summary
In Row a., enter the total number of households served and the amount of HOPWA funds expended on Short-Term Rent,
Mortgage and Utility (STRMU) Assistance. In Row b., enter the total number of STRMU-assisted households that received
assistance with mortgage costs only (no utility costs) and the amount expended assisting these households. In Row c., enter the
total number of STRMU-assisted households that received assistance with both mortgage and utility costs and the amount
expended assisting these households. In Row d., enter the total number of STRMU-assisted households that received assistance
with rental costs only (no utility costs) and the amount expended assisting these households. In Row e., enter the total number of
STRMU-assisted households that received assistance with both rental and utility costs and the amount expended assisting these
households. In Row f., enter the total number of STRMU-assisted households that received assistance with utility costs only (not
including rent or mortgage costs) and the amount expended assisting these households. In row g., report the amount of STRMU
funds expended to support direct program costs such as program operation staff.
Data Check: The total households reported as served with STRMU in Row a., column [1] and the total announl of HOP WA funds reported as
expended in Row a., cohunn [2] equals the household and expenditure total reported for STRMU in Part 3, Chart 1, Row 4, Columns b. and f.,
respectively.
Data Cheek: The total number ofhouseholds reported in Column [1], Rows b., c., d., e., and f. equal the total number ofSTRMU households
reported in Column [1], Row a. The total amount reported as expended in Cohonn [21, Rows b., c., d., e., f., and g. equal the total amount of
STRMU expenditures reported in Cohmnn [2], Row a.
Ill Output: Number of 121 Output: Total
Households Served HOPWA Funds Expended
Housing Subsidy Assistance Categories (STRMU) on STRMU during
Operating Year
Total Short-tern mortgage, rent and/or utility (STRMU)
a. assistance
Of the total STRMU reported on Row a. total who received
b. assistance with mortgage costs ONLY.
Of the total STRMU reported on Row a, total who received
C. assistance with mortgage and utility costs.
Of the total STRMU reported on Row a, total who received
d. assistance with rental costs ONLY.
Of the total STRMU reported on Row a, total who received
e. assistance with rental and utility costs.
Of the total STRMU reported on Row a, total who received
f assistance with utility costs ONLY.
Direct program delivery costs (e.g., program operations staff
time)
9.
End of PART 3
Previous editions are obsolete Page 12 form HUD-401 10-D (Expiration Date: 10/31/2014)
25D-27
Part 4: Summary of Performance Outcomes
In Column [1], report the total number of eligible households that received HOPWA housing subsidy assistance, by type.
In Column [2], enter the number of households that continued to access each type of housing subsidy assistance into next
operating year. In Column [3], report the housing status of all households that exited the program.
Data Check: The sum of Columns [2] (Number of Households Continuing) and [3] (Exited Households) equals the total reported in Colunm[l].
Note: Refer to the housing stability codes that appear in Part S: Worksheet - Determining Housing Stability Outcomes.
Section 1. Housing Stability: Assessment of Client Outcomes on Maintaining Housing Stability (Permanent Housing and
Related Facilities)
A Pero,anont t1nncino Cnbsirly Assistance
III Output: Total ]2] Assessment: Number of [3] Assessment: Number of
Number of Households that Continued Households that exited this (4] HOPWA Client
Households Receiving HOPWA Housing HOPWA Program; their Housing Outcomes
Served Subsidy Assistance into the Next Status after Exiting
Operating Year
I Emergency Shelter/Streets Unstable Arrangements
2 Temporary Housing Temporarily Stable, ivith Reduced
Risk of Homelessness
3 Private Housing
Tenant-Based 4 Other HOPWA
Rental i
(PH)
t H
bl
/P
S
Assistance 5 Other Subsidy ous
ermanen
ng
ta
e
6 Institution
7 Jail/Prison
bl
t
U
A
rrangemen
s
nsta
e
8 Disconnected/Unknown
9 Death Life Event
I Emergency Shelter/Streets Unstable Arrangements
2 Temporary Housing Temporarily Stable, with Reduced
Risk of Homelessness
3 Private Housing
Permanent
4 Other HOPWA
Supportive (PH
t H
i
S
bl
/P
Housing
5 Other Subsidy )
ermanen
ous
ng
ta
e
Facilities/ Units
6 Institution
7 Jail/Prison
8 Disconnected/Unknown Unstable Arrangements
9 Death Life Event
B. Transitional Housine Assistance
[1] Output: Total [2] Assessment: Number of [3] Assessment: Number of
Number of Households that Continued Households that exited this
Households Receiving HOPWA Housing HOPWA Program; their [4] HOPWA Client Outcomes
Served Subsidy Assistance into the Next Mousing Status after Exiting
Operating Year
1 Emergency Shelter/Streets Unstable Arrangements
2 Temporary Housing Temporarily Stable lvith Reduced
Risk ofHontelessness
Transitional/
Short-Term 3 Private Housing
Housing 4 Other HOPWA
i
PH
bl
/P
H
S
Facilities/ Units ous
ng (
)
ta
e
ermanent
5 Other Subsidy
6 Institution
7 Jail/Prison
bl
A
U
e
rrangements
nsta
8 Disconnected/unknown
9 Death Life Event
Previous editions are obsolete Page 13 form HUD-40110-D (Expiration Date: 10/31/2014)
25D-28
I B I :Total number of households receiving transitional/short-term housing
assistance whose tenure exceeded 24 months
Section 2. Prevention of Homelessness: Assessment of Client Outcomes on Reduced Risks of Homelessness
(Short-Term Housing Subsidy Assistance)
Report the total number of households that received STRMU assistance in Column [1].
In Column [2], identify the outcomes of the households reported in Column [1] either at the time that they were known to have
left the STRMU program or through the project sponsor or subrecipient's best assessment for stability at the end of the operating
year.
Information in Column [3] provides a description of housing outcomes; therefore, data is not required.
At the bottom of the chart:
• In Row la., report those households that received STRMU assistance during the operating year of this report, and the
prior operating year.
• In Row lb., report those households that received STRMU assistance during the operating year of this report, and the
two prior operating years.
Data Check: The total households reported as served with STRt111U in Column [1] equals the total reported in Part 3, Chart 1,
Rou, 4, Column b.
Data Check: The stmt of Cohann [2] should equal the number of households repotted in Column [I].
Assessment of Households that Received STRMU Assistance
[1] Output: Total [2] Assessment of Housing Status 131 HOPWA Client Outcomes
number of
households
Maintain Private Housing without subsidy
(e.g. Assistance provided/completed and client is stable. not
likely to seek additional support)
Other Private Housing without subsidy
(e.g. client switched housing units and is now stable, not likely
to seek additional support) Stable/Permanent Housing (PH)
Other HOPWA Housing Subsidy Assistance
Other Housing Subsidy (PH)
Institution
(e.g. residential and long-teen care)
Likely that additional STRMU is needed to maintain current
housing arrangements
Transitional Facilities/Short-term Temporarily Stable, lvith
(e.g. temporary or transitional a•rangeniea) Reduced Risk of Homelessness
Temporary/Non-Permanent Housing arrangement
(e.g. gave up lease, and moved in with family orftiends but
expects to lire there less than 90 days)
Emergency Shelter/street
Jail/Prison Unstable Arrangements
Disconnected
Death Life Event
I a. Total number of those households that received STRMU Assistance in the operating year of this report that also received
STRMU assistance in the prior operating year (e.g. households that received STRMU assistance in two consecutive operating
years).
1 b. Total number of those households that received STRMU Assistance in the operating year of this report that also received
STRMU assistance in the two prior operating years (e.g. households that received STRMU assistance in three consecutive
operating years).
Previous editions are obsolete Page 14 form HUD-40110-D (Expiration Date: 10/31/2014)
25D-29
Section 3. HOPWA Outcomes on Access to Care and Support
Ia. Total Number of Households
Line [I]: For project sponsors/subrecipients that provided HOPWA housing subsidy assistance during the operating year
identify in the appropriate row the number of households that received HOPWA housing subsidy assistance (TBRA,
STRMU, Facility-Based, Permanent Housing Placement Services, and Master Leasing) and HOPWA funded case
management services. Use Row c. to adjust for duplication among the service categories and Row d. to provide an
unduplicated household total.
Line [2]: For project sponsors/subrecipients that did NOT provide HOPWA housing subsidy assistance identify in the
appropriate row the number of households that received HOPWA funded case management services.
Note: These numbers will help you to determine which clients to report Access to Care and Support Outcomes for and will be
used by HUD as a basis for analyzing the percentage of households tvho demonstrated or maintained connections to care and
support as identified in Chart 1b. below.
Total Number of Households
I, horPro tSpo?sosS>bra }icnlsthat,pro3ideillfOPR'A`Housi?gSubidyASist?nce iy: 1 offitl.eia
ccened the:fQho?C?ng"?CiOAded`servjces ?.
A,n [d that
=
a. Housing Subsidy Assistance (duplicated)-TBRA, STRMU, PHP, Facility-Based Housing, and Master Leasing
b. Case Management
C. Adjustment for duplication (subtraction)
d. Total Households Served by Project Sponsors/Subrecipients with Housing Subsidy Assistance (Sum of Rows a.+
b. minus Row c.)
lair f ropfi'$ponsot•s7Subrecipi?nls did1VQT pr?rvideHf?Pll Hoosinj' Subaid 'Asci?tnnSc??Jtnlll}n e bid ??
two t
?'. -='.-
je f04igtig~HOYWA=fiinded Benue
d
1' 'recetvcd
old Rif,,
_
_
_ _
a. HOPWA Case Management
b. Total Households Served by Project Sponsors/Subrecipients without Housing Subsidy Assistance
lb. Status of Households Accessing Care and Support
Column [1]: Of the households identified as receiving services from project sponsors/subrecipients that provided HOPWA
housing subsidy assistance as identified in Chart 1 a., Row 1 d. above, report the number of households that demonstrated
access or maintained connections to care and support within the program year.
Column [2]: Of the households identified as receiving services from project sponsors/subrecipients that did NOT provide
HOPWA housing subsidy assistance as reported in Chart 1 a., Row 2b., report the number of households that demonstrated
improved access or maintained connections to care and support within the program year.
Note: For information on types and sources of income and medical insurance/assistance, refer to Charts below.
[11 For project [2] For project
sponsors/subrecipients that
that
sponsors/subrecipients
Categories of Services Accessed provided HOPWA housing subsidy did NOT provide HOPWA
housing subsidy assistance, Outcome
Indicator
assistance, identify the households identify the households who
who demonstrated the following: demonstrated the followin :
Support for
1. Has a housing plan for maintaining or establishing stable on- Stable
going housing Housing
2. Had contact with case manager/benefits counselor consistent
with the schedule specified in client's individual service plan Access to
(may include leveraged services such as Ryan White Medical Support
Case Management)
3. Had contact with a primary health care provider consistent Access to
with the schedule specified in client's individual service plan Health Care
Access to
4. Accessed and maintained medical insurance/assistance Health Care
5. Successfully accessed or maintained qualification for sources Sources of
of income Income
Previous editions are obsolete Page 15 form HUD-40110-D (Expiration Date: 10/31/2014)
25D-30
Chart 1b., Line 4: Sources of Medical Insurance and Assistance include, but are not limited to the following
(Reference only)
• MEDICAID Health Insurance Program, or • Veterans Affairs Medical Services
use local program AIDS Drug Assistance Program (ADAP) Ryan White-funded Medical or Dental
name State Children's Health Insurance Program Assistance
• MEDICARE Health Insurance Program, or (SCH1P), or use local program name
use local program name
Chart lb., Row 5: Sources of Income include, but are not limited to the following (Reference out
• Earned Income • Child Support • General Assistance (GA), or use local
• Veteran's Pension • Social Security Disability Income (SSDI) program name
• Unemployment Insurance • Alimony or other Spousal Support • Private Disability Insurance
• Pension from Former Job • Veteran's Disability Payment • Temporary Assistance for Needy
• Supplemental Security Income (SSI) • Retirement Income from Social Security Families (TANF)
Worker's Compensation • Other Income Sources
lc. Households that Obtained Employment
Column [1]: Of the households identified as receiving services from project sponsors/subrecipients that provided HOPWA
housing subsidy assistance as identified in Chart I a., Row I d. above, report on the number of households that include
persons who obtained an income-producing job during the operating year that resulted from HOPWA-funded Job training,
employment assistance, education or related case management/counseling services.
Column [2]: Of the households identified as receiving services from project sponsors/subrecipients that did NOT provide
HOPWA housing subsidy assistance as reported in Chart I a., Row 2b., report on the number of households that include
persons who obtained an income-producing job during the operating year that resulted from HOPWA-funded Job training,
employment assistance, education or case management/counseling services.
Note: This includes jobs created by this project sponsor/subrecipients or obtained outside this agency.
Note: Do not include jobs that resulted from leveraged job training, employment assistance, education or case
manageniendeounseling services.
11 For project sponsors/subrecipients that 121 For project sponsors/subrecipients that did
Categories of Services Accessed provided HOPWA housing subsidy NOT provide HOPWA housing subsidy assistance,
assistance, identify the households who identify the households who demonstrated the
demonstrated the followin : followin :
Total number of households that
obtained an income- roducin job
End of PART 4
Previous editions are obsolete Page 16 form HUD-40110-D (Expiration Date: 10/3112014)
25D-31
PART '5: Worksheet -`Determining Housil ng'Stability Outcomes (optional)
1. This chart is designed to assess program results based on the information reported in Part 4 and to help Grantees determine
overall nroeram nerformance. Completion of this worksheet is optional.
PermanentV Stable Housing Temporary Housing Unstable Life Event
Housing Subsidy (# of households (2) Arrangements (9)
Assistance remaining in program (1+7+8)
plus 3+4+5+6)
Tenant-Based
Rental Assistance
(TBRA)
Permanent Facility-
based Housing
Assistance/Units
Transitional/Short-
Term Facility-based
Housing
Assistance/Units
Total Permanent
HOPWA Housing
Subsidy Assistance
Reduced Risk of Stable/Permanent Temporarily Stable, with Reduced Risk of Unstable Life Events
Homelessness: Housing Homelessness Arrangements
Short-Term
Assistance
Short-Term Rent,
Mortgage, and
Utility Assistance
(STRMU
Total HOPWA
Housing Subsidy
Assistance
Background on HOPWA Housing Stability Codes
Stable Permanent Housing/Ongoing Participation
3 = Private Housing in the private rental or home ownership market (without known subsidy, including permanent placement
with families or other self-sufficient arrangements) with reasonable expectation that additional support is not needed.
4 = Other HOPWA-funded housing subsidy assistance (not STRMU), e.g. TBRA or Facility-Based Assistance.
5 = Other subsidized house or apartment (non-HOPWA sources, e.g., Section 8, HOME, public housing).
6 = Institutional setting with greater support and continued residence expected (e.g., residential or long-term care facility).
Temporary Housing
2 = Temporary housing - moved in with family/friends or other short-term arrangement, such as Ryan White subsidy, transitional
housing for homeless, or temporary placement in institution (e.g., hospital, psychiatric hospital or other psychiatric facility,
substance abuse treatment facility or detox center).
Unstable Arrangements
1 = Emergency shelter or no housing destination such as places not meant for habitation (e.g., a vehicle, an abandoned building,
bus/train/subway station, or anywhere outside).
7 = Jail /prison.
8 = Disconnected or disappeared from project support, unknown destination or no assessments of housing needs were
undertaken.
Life Event
9 = Death, i.e., remained in housing until death. This characteristic is not factored into the housing stability equation.
Tenant-based Rental Assistance: Stable Housing is the sum of the number of households that (i) remain in the housing and (ii)
those that left the assistance as reported under: 3, 4, 5, and 6. Temporary Housing is the number of households that accessed
assistance, and left their current housing for a non-permanent housing arrangement, as reported under item: 2. Unstable
Situations is the sum of numbers reported under items: 1, 7, and 8.
Permanent Facility-Based Housing Assistance: Stable Housing is the sum of the number of households that (i) remain in the
housing and (ii) those that left the assistance as shown as items: 3, 4, 5, and 6. Temporary Housing is the number of households
Previous editions are obsolete Page 17 form 111ID-40110-D (Expiration Date: 10/3I/2014)
25D-32
that accessed assistance, and left their current housing for a non-permanent housing arrangement, as reported under item 2.
Unstable Situations is the sum of numbers reported under items: 1, 7, and 8.
Transitional/Short-Term Facility-Based Housing Assistance: Stable Housing is the sum of the number of households that (i)
continue in the residences (ii) those that left the assistance as shown as items: 3, 4, 5, and 6. Other Temporary Housing is the
number of households that accessed assistance, and left their current housing for a non-permanent housing arrangement, as
reported under item 2. Unstable Situations is the sum of numbers reported under items: 1, 7, and 8.
Tenure Assessment. A baseline of households in transitional/short-term facilities for assessment purposes, indicate the number
of households whose tenure exceeded 24 months.
STRMU Assistance: Stable Housing is the sum of the number of households that accessed assistance for some portion of the
permitted 21-week period and there is reasonable expectation that additional support is not needed in order to maintain
permanent housing living situation (as this is a time-limited form of housing support) as reported under housing status: Maintain
Private Housing with subsidy; Other Private with Subsidy; Other HOPWA support; Other Housing Subsidy; and Institution.
Temporarily Stable with Reduced Risk of Homelessness is the sum of the number of households that accessed assistance for
some portion of the permitted 21-week period or left their current housing arrangement for a transitional facility or other
temporary/non-permanent housing arrangement and there is reasonable expectation additional support will be needed to maintain
housing arrangements in the next year, as reported under housing status: Likely to maintain current housing arrangements, with
additional STRMU assistance; Transitional Facilities/Short-term; and Temporary/Non-Permanent Housing arrangements
Unstable Situation is the sum of number of households reported under housing status: Emergency Shelter; Jail/Prison; and
Disconnected.
End of PART 5
Previous editions are obsolete Page 18 form HUD-40110-D (Expiration Date: 10/31/2014)
25D-33
PART 6: Annual Certification of Continued Usage for HOPWAFFacility-Based Stewardship Units (ONLY)
The Annual Certification of Usage for HOPWA Facility-Based Stewardship Units is to be used in place of Part 7B of the
CAPER if the facility was originally acquired, rehabilitated or constructed/developed in part with HOPWA funds but no
HOPWA funds were expended during the operating year. Scattered site units may be grouped together on one page.
Grantees that used HOPWA funding for new construction, acquisition, or substantial rehabilitation are required to
operate their facilities for HOPWA eligible individuals for at least ten (10) years. If non-substantial rehabilitation funds
were used they are required to operate for at least three (3) years. Stewardship begins once the facility is put into
operation.
Note: See definition ofSteivardship Units.
1. VCIICl Al llll Vl ula Ll Vll
Operating Year for this report
From (mm/dd/yy) To (mm/dd/yy) ? Final Yr
HUD Grant Number(s)
? Yr 1; ? Yr 2; ? Yr 3; ? Yr 4; ? Yr 5; ? Yr 6;
? Yr 7; ? Yr 8; ? Yr 9; ? Yr 10;
Grantee Name Date Facility Began Operations (mm/dd/yy)
N b r 1r 't and Non-HOPWA Expenditures
2. um er o n1 s
Facility Name: Number of Stewardship Units Amount of Non-HOPWA Funds Expended in Support of the
Developed with IIOPWA Stewardship Units during the Operating Year
funds
Total Stewardship Units
subject to 3- or 10- year use periods)
2 T..4 :1.. ..t' Ur nt Lit
J. L aIIJ V
e
Project Sites: Name of HOPWA-funded project
Site Information: Project Zip Code(s)
Site Information: Congressional District(s)
Is the address of the project site confidential? ? Yes, protect information: do not list
? Not con tdential: information can be made available to the public
If the site is not confidential:
Please provide the contact information, phone,
email address/location, ifbusiness address is
different from facility address n
I certify that the facility that received assistance for acquisition, rehabilitation, or new construction from the Housing Opportunities
for Persons with AIDS Program has operated as a facility to assist HOPWA-eligible persons from the date shown above. I also
certify that the grant is still serving the planned number of HOPWA-eligible households at this facility through leveraged resources
and all other requirements of the grant agreement are being satisfied.
I hereby certify that all the information stated herein, as well as any ht ormation provided in the accompaniment herewith, is true and accurate.
Name & Title of Authorized Official of the organization that continues Signature & Date (mm/dd/yy)
to operate the facility:
Name & Title of Contact at Grantee Agency Contact Phone (with area code)
(person who can ansiver questions about the report and program)
End of PART 6
Previous editions are obsolete Page 19 form HUD-401 10-D (Expiration Date: 10/3112014)
25D-34
Part 7:- Summary Overview of Grant Activities
A. Information on Individuals, Beneficiaries, and Households Receiving HOPWA Housing Subsidy Assistance
(TBRA, STRMU, Facility-Based Units, Permanent, Housing Placement and Master Leased Units ONLY)
Note: Reportingfor this section should include ONLY those individuals, beneficiaries, or households that received and/or
resided in a household that received HOPNIA Housing Subsidy Assistance as reported in Part 3, Chart 1, Row 7, Cohrnan b.
(e.g., do not include households that received HOP 1,11/1 supportive services ONL)).
Section 1. HOPWA-Eligible Individuals who Received HOPWA Housing Subsidy Assistance
a. Total HOPWA Eligible Individuals Living with HIV/AIDS
In Chart a., provide the total number of eligible (and unduplicated) low-income individuals living with HIV/AIDS who qualified
their household to receive HOPWA housing subsidy assistance during the operating year. This total should include only the
individual who qualified the household for HOPWA assistance, NOT all HIV positive individuals in the household.
Individuals Served with Housing Subsidy Assistance Total
Number of individuals with HIV/AIDS who qualified their household to receive HOPWA housing subsidy assistance.
Chart b. Prior Living Situation
In Chart b., report the prior living situations for all Eligible Individuals reported in Chart a. In Row 1, report the total number of
individuals who continued to receive HOPWA housing subsidy assistance from the prior operating year into this operating year.
In Rows 2 through 17, indicate the prior living arrangements for all new HOPWA housing subsidy assistance recipients during
the operating year.
Data Check: The total number of eligible individuals served in Row 18 equals the total number of individuals served through
housing subsidy assistance reported in Chart a. above.
Category Total HOPWA
Eligible Individuals
Receiving Housing
Subsid Assistance
1. Continuing to receive HOPWA support from the prior operating year
New Individuals who received HOPWA Housing Subsidy Assistance support during Operating Year
2 Place not meant for human habitation
(such as a vehicle, abandoned building, bus/train/subway station/airport, or outside
3. Emergency shelter (including hotel, motel, or campground paid for with emergency shelter voucher)
4. Transitional housing for homeless persons
5: Total nninbei-of new Eligible Individuals wbo received iJOPWAHousing Subside Assistance lyith a Prior
Living Situation that.meets,HUD definition of hontele_ssness (Sum of Rows 2 - 4
6 Permanent housing for formerly homeless persons (such as Shelter Plus Care, SHP, or SRO Mod
Rehab
7. Psychiatric hospital or other psychiatric facility
8. Substance abuse treatment facility or detox center
9. Hospital (non-psychiatric facility)
10. Foster care home or foster care group home
11. Jail, prison or juvenile detention facility
12. Rented room, apartment, or house
13. House you own
14. Staying or living in someone else's (family and friends) room, apartment, or house
15. Hotel or motel paid for without emergency shelter voucher
16. Other
17. Don't Know or Refused
18. TOTAL Number of HOPWA Eligible individuals (sum of Rows 1 and 5-17)
Previous editions are obsolete Page 20 form HUD-40110-D (Expiration Date: 10/31/2014)
25D-35
c. Homeless Individual Summary
In Chart c., indicate the number of eligible individuals reported in Chart b., Row 5 as homeless who also are homeless Veterans
and/or meet the definition for Chronically Homeless (See Definition section of CAPER). The totals in Chart c. do not need to
equal the total in Chart b., Row 5.
Number of Number of Chronically
Category Homeless Homeless
Veteran(s)
HOPWA eligible individuals served with
HOPWA Housing Subsidy Assistance
Section 2. Beneficiaries
In Chart a., report the total number of HOPWA eligible individuals living with HIV/AIDS who received HOPWA housing
subsidy assistance (as reported in Part 7A, Section 1, Chart a.), and all associated members of their household who benefitted
from receiving HOPWA housing subsidy assistance (resided with HOPWA eligible individuals).
Note: See definition of HOPWA Eligible Individual
Note: See definition of Trans ems.
Note: See definition of Beneficiaries.
Data Check: The sum of each of the Charts b. & c. on the following two pages equals the total number of beneficiaries served
with HOPWA housing subsidy assistance as determined in Chart a., Row 4 below.
a. Total Number of Beneficiaries Served with HOPWA Housine Subsidv Assistance
'Individuals and Families; Served. with`HOPWA Housing Subsidy Assistance Total Number
1. Number of individuals with HIV/AIDS who qualified the household to receive HOPWA housing subsidy
assistance (equals the number of HOPWA Eligible Individuals reported in Part 7A, Section 1, Chart a.)
2. Number of ALL other persons diagnosed as HIV positive who reside with the HOPWA eligible individuals
identified in Row 1 and who benefitted from the HOPWA housing subsidy assistance
3. Number of ALL other persons NOT diagnosed as HIV positive who reside with the HOPWA eligible
individual identified in Row 1 and who benefited from the HOPWA housing subsidy
4. TOTAL number of ALL beneficiaries served with Housing Subsidy Assistance (Sum of Rows 1,2, & 3)
Previous editions are obsolete Page 21 form HUD-40110-D (Expiration Date: 10131/2014)
25D-36
b. Age and Gender
In Chart b., indicate the Age and Gender of all beneficiaries as reported in Chart a. directly above. Report the Age and Gender of
all HOPWA Eligible individuals (those reported in Chart a., Row l) using Rows 1-5 below and the Age and Gender of all other
beneficiaries (those reported in Chart a., Rows 2 and 3) using Rows 6-10 below. The number of individuals reported in Row 11,
Column E. equals the total number of beneficiaries reported in Part 7, Section 2, Chart a., Row 4.
H-0PWA Eli iW Individuals Chart a Row l
A. B. C. D. E.
Male
Female
Trans ender M to F
Trans ender F to M TOTAL (Sum of
Columns A-D)
1. Under 18
2. 18 to 30 ears
3. 31 to 50 ears
4. 51 years and
Older
5. Subtotal (Sum
of Rows 1-4
All Qther Beneficiaries Chart , Rows 2 an[13
A. B. C. D. E.
Male
Female
Trans ender M to F
Trans ender F to M TOTAL (Sum of
Columns A-D
6. Under 18
7. 18 to 30 years
8. 31 to 50 years
9. 51 years and
Older
10. Subtotal (Sum
of Rows 6-9)
Total Beneficiaries Chart a, Rpw 4
11. TOTAL (Sum
of Rows 5 & l0)
Previous editions are obsolete Page 22 form HUD-40110-D (Expiration Date: 10/31/2014)
25D-37
c. Race and Ethnicity*
In Chart c., indicate the Race and Ethnicity of all beneficiaries receiving HOPWA Housing Subsidy Assistance as reported in
Section 2, Chart a., Row 4. Report the race of all HOPWA eligible individuals in Column [A]. Report the ethnicity of all
HOPWA eligible individuals in column [B]. Report the race of all other individuals who benefitted from the HOPWA housing
subsidy assistance in column [C]. Report the ethnicity of all other individuals who benefitted from the HOPWA housing subsidy
assistance in column [D]. The summed total of columns [A] and [C] equals the total number of beneficiaries reported above in
Section 2, Chart a., Row 4.
s 410P1V'A' l.hgihle Lidrvidualss ''Ail Other Re cridaries
[A] Race
[BI Ethnicity IC1 Race
[total of
ID] Ethnicity
}
y s [all individuals
[Also identified
individuals
[Also identified
t
j orted in
rep
as Hispanic or
reported in
as Hispanic or
Section 2, Chart
Latinol
Section 2, Chart
Latino]
.: a., Row 11 a., Rows 2 & 31
I . American Indian/Alaskan Native
2. Asian
3. Black/African American
4. Native Hawaiian/Other Pacific Islander
5. White
American Indian/Alaskan Native &
6 White
7. Asian & White
8. Black/African American & White
American Indian/Alaskan Native &
9
Black/African American
10. Other Multi-Racial
11. Column Totals (Sum of Rows 1-10)
Data Cbeck: Sum of Row 11 Column A and Row 11 Column C equals the total number HOPWA Beneficiaries reported in Part 3A,
Section 2, Chart a., Row 4.
*Reference (data requested consistent with Form HUD-27061 Race and Ethnic Data Reporting horn)
Section 3. Households
Household Area Median Income
Report the area median income(s) for all households served with HOPWA housing subsidy assistance.
Data Check: The total number of households served with HOPWA housing subsidy assistance should equal Part 3C, Row 7,
Cohimn b and Part 7A, Section 1, Chart a. (Total HOPWA Eligible Individuals Served with HOPWA Housing Subsidy
Assistance).
Note: Refer to http•//wivip huduser.oMIportal/datasets/il/il2OlO/select Geography mfr.odn for information on area median
incnme in vour community.
Percentage of Area Median Income Households Served with HOPWA Housing Subsidy
Assistance
1. 0-30% of area median income (extremely low)
2. 31-50% of area median income (very low)
3. 51-80% of area median income (low)
4. Total (Sum of Rows 1-3)
Previous editions are obsolete Page 23 form HIID-40110-D (Expiration Date: 10/31/2014)
25D-38
,art 7 Summary Overview of Grant Activities
t. Facility-Basecl Housing Assistance
Complete one Part 7B for each facility developed or supported through HOPWA funds.
Do not complete this Section for programs originally developed with HOPWA funds but no longer supported with
IIOPWA funds. If a facility was developed with HOPWA funds (subject to ten years of operation for acquisition, new
construction and substantial rehabilitation costs of stewardship units, or three years for non-substantial rehabilitation costs), but
HOPWA funds are no longer used to support the facility, the project sponsor or subrecipient should complete Part 6: Annual
Certification of Continued Usage for HOPWA Facility-Based Stewardship Units (ONLY).
Complete Charts 2a., Project Site Information, and 2b., Type of HOPWA Capital Development Project Units, for all
Development Projects, including facilities that were past development projects, but continued to receive HOPWA operating
dollars this reporting year.
Project Sponsor/subrecipient Agency Name (Required)
2. Capital Development
2a. Project Site Information for HOPWA Capital Development of Projects (For Current or Past Capital
Development Projects that receive HOPWA Operating Costs this reporting year)
4 _..;m- --f __ 17-- - -rl vn?or h- nrr-i]ihi tarito ".Gnlforad .Cilo.c ,•
HOPWA Name of Facility:
Type of Funds Non-HOPWA funds
Development Expended Expended
this operating this operating (if applicable)
year year
if applicable)
? New construction $ $ Type of Facility [Check only one box.]
? Permanent housing
? Rehabilitation $ $ ? Short-tern Shelter or Transitional housing
El Supportive services only facility
El Acquisition $ $
? Operating $ $
a. Purchase/lease of property: Date (mm/dd/yy):
b. Rehabilitation/Construction Dates: Date started: Date Completed:
C. Operation dates: Date residents began to occupy:
? Not et occupied
d. Date supportive services began: Date started:
? Not yet providing services
e. Number of units in the facility: IIOPWA-funded units = Total Units=
Yes ? No
E]
f Is a waiting list maintained forthe facility? Ifpes, ;cumber ofparticipan7s on the list at the end of operating pear
g. What is the address ofthe facility (ifditterent from business address)?
h. Is the address of the project site confidential? ? Yes, protect information: do not publish list
? No. can be made available to the public
Previous editions are obsolete Page 24 form HUD-40110-11) (Expiration Da(e: 10/31/2014)
25D-39
2b. Number and Type of HOPWA Capital Development Project Units (For Current or Past Capital
Development Projects that receive HOPWA Operating Costs this Reporting Year)
For units entered above in 2a. please list the number of HOPWA units that fulfill the following criteria:
Number Designated Number
Designated to
Number Energy-
for the Chronically
Assist the
Star Compliant Number 504 Accessible
Homeless Homeless
Rental units constructed
(new) and/or acquired
with or without rehab
Rental units rehabbed
Homeownership units
constructed (if approved)
3. Units Assisted in Types of Housing Facility/Units Leased by Project Sponsor or Subrecipient
Charts 3a., 3b. and 4 are required for each facility, In Charts 3a. and 3b., indicate the type and number of housing units in the
facility, including master leased units, project-based or other scattered site units leased by the organization, categorized by the
number of bedrooms per unit.
Note: The number units may not equal the total number of households served.
Please complete separate charts for each housing facility assisted. Scattered site units may be grouped together.
3a. Check one only
? Permanent Supportive Housing Facility/Units
? Short-term Shelter or Transitional Supportive Housing Facility/Units
3b. Type of Facility
Complete the following Chart for all facilities leased, master leased, project-based, or operated with HOPWA funds during the
reporting year.
Name of Project Sponsor/Agency Operating the Facility/Leased Units:
Total Number of Units in use during the Operating Year
Type of housing facility operated by the Cate orized b the Number of Bedrooms per Units
project sponsor/subrecipient SRO/Studio/0
bdrm 1 bdrm 2 bdrm 3 bdrm 4 bdrm 5+bdrm
a. Single room occupancy dwelling
b. Community residence
c. Project-based rental assistance units or leased units
d.
Other housing facility
Specify'
4. Households and Housing Expenditures
Enter the total number of households served and the amount ofHOPWA funds expended by the project sponsor/subrecipient on
subsidies for housing involving the use of facilities, master leased units, project based or other scattered site units leased by the
organization.
Housing Assistance Category: Facility Based Housing Output: Number of
Households Output: Total HOPWA Funds Expended during
Operating Year b Project S onsor/subreci lent
a Leasing Costs
b Operating Costs
C. Project-Based Rental Assistance (PBRA) or other leased
units
d Other Activity (if approved in grant agreement) Specify:
e Adjustment to eliminate duplication (subtract)
f• TOTAL Facility-Based Housing Assistance
Sum Ro%vs a. through d. minus Row c.)
Previous editions are obsolete Page 25 form IIUD-40110-D (Expiration Date: 10131/2014)
25D-40
COOPERATIVE AGREEMENT BETWEEN
THE CITY OF SANTA ANA AND
THE SANTA ANA HOUSING AUTHORITY
This Cooperative Agreement entered into this 1St day of July, 2012, which date is
enumerated for purpose of reference only, is by and between the City of Santa Ana
("City") and the Santa Ana Housing Authority ("Project Sponsor"). This Agreement
shall be administered by the City of Santa Ana.
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. Project Sponsor has provided leadership and is responsible for planning and
providing comprehensive HIV services for clients throughout Orange County and will
maintain the wait list for the program; and
D. Project Sponsor will provide services to support the Tenant-Based Rental
Assistance Program which consists of financial eligibility of tenants, HQS inspections,
and financial responsibility for housing assistance payments to landlords; and
E. The parties have cooperatively written and agree to an Administrative Plan
which identifies guidelines for the operation of the HOPWA Tenant-Based Rental
Assistance Program.
NOW, THEREFORE, the parties mutually agree as follows:
1. ALTERATION OF TERMS
A. The parties anticipate that this Agreement may be amended, or followed by additional
agreements, to implement additional services and funding of the type covered by
this Agreement.
B. This Agreement fully expresses all understanding of City and Project Sponsor
with respect to the subject matter of this Agreement, and shall constitute
the total Agreement between the parties for these purposes. No addition to, or
alteration of, the terms of this Agreement, whether written or verbal, shall be valid
unless made in writing and formally approved and executed by each party.
EXHIBIT 2
25D-41
II. SERVICES
A. City shall serve as "HOPWA Grantee" for the purpose of contracting with
organizations to provide Tenant-Based Rental Assistance to persons disabled
due to HIV/AIDS residing in Orange County.
B. Nothing in this Agreement shall prevent City from entering into one or more
agreements with the other agencies or contractors 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 Project Sponsor.
C. City shall conduct an ongoing assessment of the Tenant-Based Rental
Assistance Program.
D. Project Sponsor shall assure the adequate provision of supportive services to
applicants/participants to ensure program success.
E. Project Sponsor 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. Annual progress reports will be prepared by Project Sponsor in
a form consistent with HUD publications HUD-401 10-C (8/94). In addition,
Project Sponsor shall forward quarterly narrative reports to City identifying
accomplishments as HOPWA Project Sponsor for Tenant-Based Rental
Assistance for persons with HIV disease. These reports are to be submitted in
conjunction with payment/cost reports identified in Section IV of this Agreement
along with a summary of program budgets and financial disbursements made
under the terms of this Agreement.
F. "Contract Officers" means the City's Housing Manager or designee and
Project Sponsor's designee.
III. BUDGET
The following budget is an estimate only of the cost of providing the services hereunder
for the term July 1, 2012 through June 30, 2013. This budget may be modified by mutual
written agreement of the Contract Officers.
Administration $ 42,000.00
Housing Assistance Payments/Program Expense $558,000.00
TOTAL (Maximum Obligation) $600,000.00
2
25D-42
IV. PAYMENTS/COST REPORT
A. 1) City shall pay Project Sponsor for the actual costs of providing the
administration of services hereunder, whether provided directly by
Project Sponsor, provided, however, the total of all
payments to Project Sponsor shall not exceed the Maximum
Obligation as specified in Section III of the Agreement.
2) City shall draw down HOPWA funds designated for rental subsidy
payments on a monthly basis after receipt of certification of
individual of individual tenant subsidy amounts. After final
approval by City, funds will be disbursed to landlords.
B. Project Sponsor shall invoice City monthly exclusive of rental subsidy
payments, in arrears, based on the actual cost of providing and contracting for
the services hereunder. City shall pay Project Sponsor no later than thirty (30)
days following receipt of such invoice. Monthly payments are interim
payments only, and are subject to final settlement and reconciliation to the
final Cost Report submitted by Project Sponsor.
C. All billings by Project Sponsor shall be accompanied by copies of source
documentation including, but not limited to, journals, time sheets, canceled
checks, and records of cost incurred by Project Sponsor in the performance of
this Agreement.
D. At such times and in such a format as the Contract Officers mutually agree in
writing, Project Sponsor shall prepare and submit to City reports of cost
incurred by Project Sponsor in the performance of this Agreement.
E. The Cost Report(s) shall be financial and statistical reports(s) submitted by
Project Sponsor to City, and shall serve as the basis for final Settlement of this
Agreement. The Cost Reports(s) shall detail all costs incurred by Project
Sponsor to provide services hereunder.
F. Final Settlement shall be based upon the actual costs incurred by Project
Sponsor to provide services hereunder. If the Cost Report(s) indicates the total
of City's payments to Project Sponsor are less than Project Sponsor's cost to
provide the services hereunder, City shall pay Project Sponsor the difference;
provided, however, the total payment shall not exceed the Maximum
Obligation. If the Cost Report(s) indicates the total of City's payments to
Project Sponsor are higher than Project Sponsor's cost of providing the
services hereunder, Project Sponsor shall pay City the difference. Payment
due pursuant to the Cost Report(s) shall be made within thirty (30) days of
the Final Settlement determination.
3
25D-43
G. Any funds not expended by fiscal year end, June 30, 2013 shall be returned to
City. Said unexpended funds shall be reallocated by City through the
HOPWA Program.
V. DISPUTE RESOLUTION
A. Any 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 issues(s) identified in this manner;
provided, however, by mutual consent this period of time 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 Executive Director of the Community
Development Agency ("Executive Director") and to City's Housing Manager for
resolution. If the Officers are unable to prepare a joint statement, each shall submit
separate statements to the previously listed 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 Executive Director and the Santa Ana City Manager shall be
documented in the form of written correspondence exchanged by such persons within
ten (10) days following their meeting.
VI. INDEMNIFICATION
Each party agrees to indemnify, defend, 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.
VII. INSURANCE
With respect to performance of work under this Agreement, Project Sponsor shall
maintain and shall require its subcontractors, if any, to maintain insurance as described
below:
1. Worker's compensation insurance within statutory legal limits, and
2. Commercial General Liability insurance with limits of not less than
$1,000,000 per accident/incident.
Project Sponsor shall: (a) prior to exercising any right under this Agreement, furnish
properly executed certificates of insurance and additional insured endorsement to the City
4
25D-44
which shall clearly evidence all coverages required above; (b) provide that such insurance
shall not be materially changed or terminated except on 30 days prior written notice to
the City; (c) maintain such insurance for the period covered by this Agreement; and (d)
replace such certificates for policies expiring prior to the expiration of this Agreement.
VIII. INSPECTIONS AND AUDITS
A. Any authorized representative of City, the Comptroller General of the United States,
the United States Department of Housing and Urban Development or any of their
authorized representatives, shall have access to City books, documents, records,
which such persons deem pertinent to this 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. City shall actively participate and cooperate with any persons specified in
subparagraph A above in any evaluation or monitoring of the services provided
pursuant to the Agreement, and shall provide the above mentioned persons adequate
office space to conduct such evaluation or monitoring.
IX. LICENSES AND LAW
A. Project Sponsor, 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, City, and any other applicable governmental agencies.
B. Project Sponsor 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 limited to the following:
1. United States Code (U.S.C.), 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. Office of Management and Budget (OMB) Circular No. A-122, Cost
Principles for nonprofit organizations.
4. OMB Circular No. A-133, Audits of Institutions of Higher Education and
Other Nonprofit Institutions.
25D-45
IX. NONDISCRIMINATION
A. Employment - Project Sponsor 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 Federal Equal Opportunity Commission and all appropriate state
laws and regulations.
B. Services, Benefits, and Facilities - Project Sponsor and its contractors, shall not
discriminate in the provision of 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, 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. §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 - Project Sponsor and its contractors agree to comply with the
provisions of Section 504 of the Rehabilitation Act of 1973 (20 U.S.C. 794 et seq., as
implemented in 45 CFR 84.1 et seq.), pertaining to the prohibition of discrimination
against qualified handicapped persons in all programs or activities, as they exist now
or may be hereafter amended together with succeeding legislation.
D. Retaliation -Project Sponsor and its employees, agents, or contractors shall not
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.
X. NOTICES
A. Unless otherwise specified, all notices, claims, correspondence, reports and/or
statements authorized or required by this Agreement shall be effective when
written and deposited in the United States mail, first class postage prepaid and
addressed as specified in this Agreement.
B. Termination Notices shall be effective when written and deposited in the United
States mail, certified, return receipt requested, and addressed as specified below.
C. For purposes of this Agreement, any notice to be provided by City may be given
by Contract Officers.
Notices to City and Project Sponsor shall, unless otherwise requested in writing, be sent by
U.S. Mail, postage prepaid, and addressed as follows:
25D-46
city
City of Santa Ana
Attn: Executive Director CDA
20 Civic Center Plaza (M-25)
Santa Ana, CA 92701
Project Sponsor:
Santa Ana Housing Authority
Attn: Housing Manager
20 Civic Center Plaza (M-27)
Santa Ana, CA 92701
XI. 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 of this 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 of this Agreement shall remain in full force and effect, and
to that extent the provisions of this Agreement are severable.
XIII. STATUS OF CONTRACTOR
The Housing Authority is, and at all times shall be deemed to be, an independent
contractor and shall be wholly responsible for the manner in which they perform the
services required by the terms of this Agreement. The Housing Authority is, and at all
times shall be deemed to be, entirely responsible for compensating staff and consultants
employed by the Housing Authority. This Agreement shall not be construed as creating
the relationship of employer and employee, or principal and agent, between City and the
Housing Authority employees, agents, or subcontractors. The Housing Authority
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. The Housing Authority, its agents, employees, or subcontractors, shall
7
25D-47
not be entitled to any rights or privileges of City employees and shall not be considered in
any manner to be City employees.
XIV. NON-ASSIGNABILITY AND DELEGATION
Project Sponsor shall not assign any rights under this Agreement except upon
written authorization from City.
XV. TERM
The term of this Agreement shall commence July 1, 2012 and terminate June 30,
2013, unless terminated earlier as provided in this Agreement; provided, however, the
Santa Ana Housing Authority 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.
XVI. TERMINATION
A. Any party may terminate this Agreement, without cause, upon ninety (90) days
written notice given the other parties.
B. Any party may terminate this Agreement, upon thirty (30) days written notice given
the other parties for material breach after failure to resolve the breach pursuant to the
Dispute Resolution paragraph of this Agreement.
C. The rights and remedies of City and the Housing Authority provided in this
Termination paragraph shall not be exclusive, and are in addition to any other rights
and remedies provided by law or under this Agreement.
XVIL THIRD PARTY BENEFICIARY
No 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.
XVIII. WAIVER OF DEFAULT OR BREACH
Waiver of any default the Housing Authority or City shall not be considered
a waiver of any subsequent default. Waiver of any breach by the Housing Authority or
City of any provision of this Agreement shall not be considered a waiver of any
subsequent breach. Waiver of any default of any breach by the Housing Authority or
City shall not be considered a modification of the terms of this Agreement.
25D-48
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date
stated above.
ATTEST:
Maria D. Huizar
Clerk of the Council
APPROVED AS TO CONTENT:
Paul Walters
Interim City Manager
APPROVED AS TO FORM:
Sonia R. Carvalho, City Attorney
By: Lisa E. Storck
Assistant City Attorney
9
HOUSING AUTHORITY
Nancy T. Edwards
Interim Executive Director
25D-49
25D-50