Item C53BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
MeetingDate:_. /21/IS
L _, Divlsion:—�2(cial .1111'ervicels,
Bulk fteril: Yes x No Department: —Social Services
Staff Contact _ 'r I Qr4 Liam x45 10
AGENDA 'TFMW0RDIN`(': Re(JUeStapproval or tile l-lomeless Prevenfion 151-ant Subcontrac
J'
#C-OC2beial
tn theonroe Clinty Homeless Contimium of Care, Inc, (Monty Services. I c CoC)and Monroe
ITEM BACKGRO'LJND: Approval ofaie 110111clerss PreVention Grant SUI)COntract #COC21 i
provide funds to assist eligible Farr lilies with, llljnoj� c1lild will
"('11, 10 Fflaintaiti stability in Perilialleril housing,
afte, experiencing a hOUShIg crisis, The grant assistance inay he Ltsed to P4 Past clue rem, Mortgage oi
utilit�v bills. The 2014-2�015 Flotneless prevention Grant #LPZI-')
cocwas applied for on 6/19/14 by t4c N4C
FHEVIOIJS RELEVA I BOCC ACTION: Approval and ratification by Iran
BOCC oil
iten'i C12, of's L, 1,1,11 i,�s -ant appjj(,,atjojj for the Homeless 7/ 16/14,
LPL 1 3�. of a gi, prevention Grant AppHcafinn
CONTRA CT/A GREE ME N'I'('-'HANG ES: New Agreement
STAFF RE COMMENDATIONS: Approval:
TOTAL COST: $20,000.0() BUDGETED, Yes — No —
COST TO COUNTY: I0% cash rilatcl, SOURCE OF FUNDS: Grant
funds.
REVENUE PR()DLJ(.'JN(;: Yes — No X_ AMOUNT PER:
APPROVED BY:
CoLint,y ALty, OMB/Purchasing
Risk Managem�
DOCUMENTATION: InclUded x Not Required_ To, Follow
DISPOSITION: AGENDA ITEM #
Revised 8A)6
MON ROE COUNTY BOARD OF COL)NTY COMMISSIONERS
CONTRACT SUMMARY
Contract witty Monroe Connty ljonle,]ess Contract: 9COC21
Continuum (Coc) Effective Date:
Expiration ee: 06/30/20Contract Purpose/Description: Request approval Of thc Holueless Prevntion Grant Subcontract #G X21 between the
Monroe COLInty Homeless Coil tit, t1unt Of Ca -re, Inc. (MC CoQ and Moll"Oc County Social Services.
Contract Manager: Sheryl Graham 305-292 Social Services/Stop I
4510
For 130CC ineetina oil (Name) IzI3�'#0141 (Ext.) (Department/Stol) #)
l/21/15 A enda Deadline
-, 110115
CONTRACT COSTS
Total Dollar Value of c',ontract, approx, $20,000.00 Current Year Portion:
Budgeted Yes I] No � j Account Codes. 125-61 556 �1(74 iN AccowNy�
countyMatch: I0%CASIJMATC1A
Additional Match, -
Total Match
Estimated Ongoing Costs: ADDITIONAL, 'OSTS
fir
(Not included err v,,,�Jqe �jhovc) For:
n d
(C_g' NLa7micnT,%, wime,, j. ;jT07rjj, ., ejej
Division Director
Li
D t in
17�1 15,
Risk Management
O. M . B ./Pu rc rasirr
[3
County Attorney
")) 1,-61 1 q
I Comments:
OMIR F 911-11A 14,lvieod 71171fill rule-D -U-1
CONTRAFT REVIEW
Changes
Needed
Yes 11 No
Yes Ll No
Yes LJ No I
Yes LJ N 0?
Date Out
J3�_l IV
mol"Oe C01111ty Homeless sel-�jec% (`()jj(jIjtjtjnj
Orcam, 111C.
HOME RE, TION 'RANT
�S T
U
Subcontract Agency: Monroe Coun4,
Address. 1100 Simonton St., Key West, Florida 040
Contact Narne: Skeryl Graham, Sr. Director, MCSS
Phone: 305-2912-4510
WHEREAS this subcontract bet\vecrt tile Mlonr()e COLInty J10nlcless Set -vices Continuum of
Care, Ine- herein retet-red to as MC COC', and Monroe County herein rel'erred to as the
Subcontractor, incorporates all obligations and responsibilities as described in the Florneless
Prevention Grant Application of the 2014 funding cycle, herein referred to s the Application, as,
awarderd U) MC COC by the Florida Department of Children and It"anlifies, Oflice on
11011'elessiless, herein reflerred to a ., a
s the Departryientnd '
WHERE AS,POC coc serves as tile recognized Continumn o,f'Care Lead Agency witilij, N/10111-()c
COLITIty, Florida, and has agreed to accept a 1-10melessness Prevention Orant of $20,000 to
provide homeless prevention services to I'anjilies tl)roLjgjjot,jt the C,o
I ntinULMI; and,
WHEREAS, MC' CoC has delennine(I that those homelessness services Will include
rental/m oil gage assistance, past due utilities,, staff and operating costs and' administrative
expenses.
WHEREAS, MC CoC and SUbcontractor nalned abovL agree to, abide by all terms, and
conditions relat Ing to contract KPZ21 (Attachimlit 1), between NICE CoC" an(] the 1) �j -t[Ijertt
ilICILIding tile, maintellailce of originaubcont
l copies! oj� tilis s epaj
Subcontractor narned above, and, ract on file wit], MC �(�oC and the
�REAS, NIC'CoClhas received, reviewed and approvedaproposal Irom the Subcontractolto provide thepecilic homeless prevention services that are documented as necessary U!"IdU the
CO'ltintlufn OfTare for Monroe Conniv:
NOW, THEREFORE, MC C'OC hereby awards tile sum of $20,000.00 to M0111,0e County
under the fo,llowing terms and conditiorls:
1. 'I'lie proposal filed, with MC Co " by Monroe County (Subcolitractor) dated June 19th,
2014 and attached to this Agreement, was used by MC CoC to prepare the Application
for the fionlelessness Prevention (irant and the a��,ard was granted by the Department
(Contract KPZ21) based upon those col,11,11itmejIls that were outlined in the
SLtbcontractorws proposal,
Subcon I ract#COC21
Moll ")e County "Umelfss Services COntirlut"n of Care, Ine.
2. 'The SUbcontractor hereby ug"Ces to the dcliverables and the perfornlance measures, in
Exhibit D of the Contract KPZ21 ® fit additioSU
ll, tile bcontractor agrees to report on
C01"PleflOn of tasks identified oil Exhibit C using the Monthly Perforryiance Report irl
Exhibit C1 and oil the MiDitnUrn performance Ineasul'es using Exh�ibit El in accordance
Wit], Exhibit E. Monthly Perl: ormance reports 1111LISt be submitted to MC (,()C by the 15th,
daY Of each month �vith the final perlbrrnance report due by July 8, 20M The
SLIbcontractor is elICOUraged to submit the final report earlier than'JUly 8"' ifthe contract
C01111nitinents have been fildfilled, The Subcontndctor ackno wledoes that if tilesc
pert�ormaltce measures Marc deficit,, payment for deliverables may be delayed or denied
and fina"chil consequences may, apply.
I Tinlely Payment& 'fhe sUbcoritractor agrees to provide MC COC with all required
M011thly reports electronically no later the, 15' day of each morit], tile report
period. 1'110, MC COC shall disperse subsequent montilly rein ibUrsementS Upon, receipt of
required monthly dOCUmentation and within 7 working days after receipt of Full or partial
IN-lYments frorri the Departnient in accordance whir section 287.055, F-S,
The Subcontractor Understands and acknowledges that no funds will be paid by MC Coc
to the Subcontractor until ar. s,ti-sfilctory per , "ormance report and Supporting
documentation of expenses ire received by M( CoC, The Subcontractor also
acknowledges that "nolithly reporting of PerformaliCe Measure '
s is reqUIred" lack of
adherence arid/or non-compliance to this standard may result in a reduction and/or loss of
funding,
The firial invoice will f011Ow the final performance report OLIthning accomplishment of
the deliverables arid Proo f'ofexpendit tires to tile mC (,�o(, no more than 30 days after the
subcontract ends, If` tine subcontractor fails to do so, Ail rights to payrnent are 'forfeited'
The total aDIOLBIt distributed will not exceed $2000 ,0.()o 1`61' documented expenditures'
made in accordance with tile Subcontractor's proposal.
4. ON'el-PUYments: Subcontractor agrecs to return to a gift', Cac, ny Overpayments due 'to
unearried finids or I'Linds disallowed plasuant to the terms and conditions of this
Agreement that Nvere disbt:irsed to the Subcontr�aclor by NIC Co(,. In the, event that the
Subcoritnactor or its independent auditor discovers that an overpayment has been rade -n,
the SUbcontractor shall repay said overpayment im niediately
n without Prior notification
from NIC CoC. In the event that MC C"OC first discovers a '
overpayrnent has been made,
the grant manager, on behalf of MC COC, will notify the Subcontractor by letter ol'such
findings. Should repaynient not be made fbill'With, the Subcontractor will be charged at
the lawful rate of interest oil the outstanding balance after Department notir
Subcontractor discovery, eation (),I.
5. 111sul'ance. The Subcontractor shall maintain continuous adeqUate liability i[ISUrance
coverage during tile existence of this Contract and any renewal(s.) arid extensions(s)
thereof. The Subcontractor shall acccP�t full responsibility For identifying and and
deterniining tile type and extent of liability insurance necessary to provide, reasonable
financial protection for the, Subcontractor and time clients that may be served or affected
by this agreement, The S u bcon tractor shall maintain sLich insurance at its own expense,
2 :Snit contraCIOCOC2 f
MOnt,oc, cotlfjttI , A,
Confinuum ot'(,1aj-e, 111c,
and shall furnish a cOPY of the certificate oNhe existerlce Of'SUCh inStil'anCe Ioa MC' Co(
Nvithin 30 days of tile subcontract execLItiffll.
(i, Maildatory Repol-filig Requirements. The Subcontnactor 111LISt COMply with and inform
'is '11100Yecs Of tile, f'oHowing inandatory reporting reqLdrenients. Each employee of the
Subcontractor PrOvidi"19 set -vices in connection With this agreernent who has arly
knowledge of a reportable incidents shall report such incident as Follows: 1) reportable
incidents that may involve an in-i-inediat impending impact On the health or safety of a
client shall be ininlediately reported te'01'
0 the ('ontract Manager, and 2) other reportable
incidents s1lall be reported to the Departnient's ()Mee of t
cOMPleting a Notificati "I Ile l"IsPector Gencral by
]on/ livestigation Request (ForIll (F 1934) and emailing the
request to the ()ffice Of inspector General at iLY conji)iq _� 11 't s
L JR - kc The
SUbcontractor I'llay also mail the completed form to the,office (-)f
�nd f�,Iool ' ITISPector Ciencral, 13 17
Wiliv,wood Blvd., Bldg 5, J'allassee, Florida 32399-07010- Or Via fax at (850)
488-1428.
7, ReeoiAs, Retention, Audits and Data Secul-ity, The Subcontractor agrees to
maintain
COMPlete, accurate and adequate records, MICILKling flinancial records, relating to� fun
received pursuant to this A , ds
greenlent. All records shall be ill SUrfiCiCtit to reflect all
income and expenditures of all ftindS Under this Agreement,, The Subcontractor agrees to
retain all financial records, SUPPOrting doe
Urne"Its, statistical records and any, other
documents (including electronic storage media) pertinent to this Aorcenient during the
term of this agreement and retained tor a period of six (6) years Alcor cornf)Ietion of" tile
Subcontract or longer when required by law, In the event ail audit is reqUired under this
Subcontract, records shall be retained for a minillIUM period of' six (6) years after the,
starling, date of this Agreement, or ifaudit findings have not been resolved at the end of
audit report is issued or until resolLiti011 of any audit findings or litigation based on lhe
terms of this Subcontract at ito additional cos't'lo the Depart, ai ent. State auditors and Ly
Persons duly authorized by MC COC shall have full access to, and shall have the right to
examine arly of the said materials at any time during regular businCSS hours.
The, ubcontractarr agrees to a financial and compliance aUdit to (Ile MC CoC, as specified
in Attachluent I oj'tl,L� (ontract K.PZ2 1.
The Subcontractor agrees to pallicipate it' the 11MIS data operated by MC (.'o(", 'j,he
Subcontractor shall Provide the MC COC vvith the name and contact inforniation of the
individual(s) using tile system, LIPon execLition of tile subcontract agreement, The
SUbcontractor agrees to submit monthly HNIIS reports and data quality reports, to M,('
('0C. These reports shall be received electronically at tile M(., CoC office by close of'
business by the 15th business clay ofth e rn )n It , th t'oljoWingj tile, report period.
8Confidentiai Client and Other Informati011, "I'lle Subcontractor shall comply with 45
Cl`R S-164.504 (e) govenling the safeguarding. use and diSCIOSLIfe of' Protected Health
lill'orniation created. receivcd, maintained, or transmitted, The Subcontractor shall not
use or disclose but shall protect and maintain the confiderltiality ofany client intbrination
and any other infbrtnation made confidential by Florida law or Federal: laws or
regulations that is obtained or accessed incidental to perfornuIlleC Under this Subcontract,
3 SubcontracrgCOC21
Monroe County "c"lleless Services Continuum of Care, file.
The SUbcontractor shall peri-nit Department persorinel, MC' (;O(, or tj,.Ieil. representatives
'to monitor tile services that are the Subject of this I'loineles'sness tarvcrwtion Grant
Agreement.
9, Use of Funds for Lobbying Prohibited: It, accordance with sectioll S 11.062 and
216347, F.S. Which prohibits, the expenditure of co'ntract funds f'or the Purpose of
lobbying the Legislature, tile i udicial branch, or a state agency. Under section 13 52, fitle
31, U.S. Code, the Subcontractor shall complete the C I ertification Regarding Lobbying
(Attachment 3).
10, Whistleblower's Act Requirements. 1,11 accordance witil section 112.3187(2), Florida
Statutes (T`.S,), the Subconlractor shall not retaliate against as e "'Plo.yee fior, reporting
,violations of law, rule or ]VgUlation that creates sub, Untial laid specific danger to the
Public's health, sa-fiety, or well�are to ail appropriate agency, Furthermore, the
Subcontractor shall not retaliate against any persoij who discloses infiormation to an appropriate agency, alleging iniproper use of govertlL.mental office, gross waste of funds,
or any other abuse or gross ncglect of'duty, oil tile part ofan agency, public officer, or
ern ' ployce. I be Subcontractor shall inft)rl-fl ernployees that they and other persons may
fifle a complaint with the 01�tice of Clilier Inspector General, Agency Inspector General,
the Florida Comnlissioll on I lurnan Relations or the Whistle -blower's Hotline nUrnbcr at
1-800-543-5353"
Public Records. As required by section 287,058(l )(c) 1,.S., tile Subcontractor agrees to
allow public access to all docunients, papers, letters, or other public records as defiried in
SUbsectioil 119.01](12), E& as prescribed by subsection J 1 9.07(l )F"'.S., made or received
by the SO grantee in CO[IjUnction with this Subcontract exccpt that public records which
are made confidential by law must be protected from disclosure. It is expressly
understood that the Subcontractor's failure, to Coiljply with this provisl, 0 n shall constitute
this
all iSubconmmediate breach of contract flor the NIC CoC may Lill ilaterally terminate
tract.
12. SuPPOrt tea the VIVO or [lard of Hearing
(a) The Subcontractor shill colilply with Section 504 of the Rehabilitation Act of 197,1,
29 1..J,S.C.794, as implemented by 45 CFR Part 84 (hereinafter referred to as section 504)
and the Americans with Disabilities Act of 1990, 4-1 Ll -S,C„ 1213 1, as implemented by 28
CFR Part 35 (hercinafter referred to as ADA), and�tfie Children and Families OperatIng
Procedure (CFOP) 60-10, Chapter 4, entitled "Auxiliary Aids and Services for the Deal'
or Hard -of Hearino".
(b) ',File Subcontractor shall, ifit erriploys, 15 Or MOLT employees, designate a Single -
Point -of -Contact (One per agency) to ensure, eff�ctjve (;ornmunication with deaf or hard -
of -hearing cUst011' ers, or conipanions in accordance W1111 SeCtiOD 504, the ADl A. and
CFOP 60-10, Chapter 4. The Subcontractor will process tile compliance data into the
Departryient's 1411S cornpliarice reporting Database by the 5,"' business day of -the month,
covering the previous months reporting, and forward confinnation of submissien to the
N4C Cot:.' Administrator, The mare e and contact information for the provider's Sin, lc:-
Pointof this agree -of -Contact steal
be furnished 10 NIC COC within 5 business days of file efiective
date nt.
4 Subcon b'3Ct#COC2 I
Moiiroe Couinty 1401neless Services Con (inu u m or cwire, ine.
(c) Tile Subcontractor Sing] e,- po i r]t-(')f-C on tact shall ensure Iflat employees are aware of
the requirements; roles and responsibilities, and contact points, associated with
compliance with Section 504, the ADA, and CTOP 60-H,), Cliapter 4. This attestation
shall be maintained in the employee's I`,rsonnel file,
(d)ThSu
e bcontractor"s Single -Point--
ol"Contact will enstire Oiat COTISPiCLIOLls Notices
which Provide inforniatioil about the availability of appropriate auxiliary aids and
services at 110-cost to the deal or h-ard-Of-heal-i"19 customers car compank us are po,sted near where people enter or are admitted within the agent locati()j,1 s. Sucl1 N')
otice must be
Posted immediately. 'The approved Notice can be downloaded through the Internet at'.
littp'//iny17nialies,coin/abotit-us/sci�'vices-clea,l'-and-hard,-Iieat-itig/cici"-posters,
(e)The Subcontractor shall document tile cUstortler's or companjon's preferred method of'
coi-m-nURication and any requested auxiliary aids / services provided in the customers
record, DOCLUnentation, With Supporting justification, 01U.St also be made Ifany request
Was not honored, The Subcontractor shall distribLfte Customer Feedback forms to
CUStOrners or coniparlions, and provide assistance in coil, 1,1 jej i I,lg tj,je forins as requested by
the customer or companion.
(t) It customers or Companions are referred to other agencies, the Shibcoritnactor must
C11SUre that the receiving agency is notified of the custorner's Or cornpanion's, 1)referred
method of corunlunication and any, auxiliary aids / services needs.
(9) The Subcontractor is required to have direct service employees complete Se
Customers who, are Deal'or Hard-of-l-lea LN-1 VILQur
and sign the Attestation of Understanding.
Each direct service employee performing under this subcontract will also print their
certificate of completion, aflach it to their Attestation of Understanding, arid maintain
them in their personnel file,
11 The SUbcOntractor agrees to actively participate in the Continuun, of (,,,are, via Incetifig
attendance aild committee membership, An agency rcpresentative will be assigned to
attend and participate in monthly Continuum of Care mectings and one (1) Cotes
committee. An HMIS user will attend all scheduled HNIJS meeting_ Linless absence is
excused by tile HMI S Coordinator, Participation and contribUti011 to these activities will
be, reported ill the monthly reports,
14, '"lls f 101nelessness Prevention ("rant Agreement is CXeCUted and entered into in the State
of'Florida, and shall be construed, performed, and enforced in all respects in accordance
with the applicable State of Florida laws. Each party sliall Perform its obligations herein
in accordance with the terms and conditions of this grant agreement. It is1hereb
,e event fliat litigation by either party, to this grant agree'llient
Tay the parties that in th y a,greed
beconies necessary that venue shall be Proper in Nlonroe Count . y, Florida.
15, The Subcontractor agrces to be. liable for all claims, suits, judgments,, (-)r damages,
Including court costs and attorney's fees, arising; out Of the negligent or intentional acts or
Ln
omissions, of the grantee, and its agents, sub -grantees and employees, during performance
pursuant to this Agreement, Further, the Subcontractor agrees to illdemnif' MC Coc'
against all claims, suits, judgments„ or darnages, including court costs and attorney's fees,
arising OUt of the negligent oi- intentional acts or omissions of t1le Subcontractor, and its
agents, sub -grantees, and ernployees, during performance Pursuant tcthis Agreement,
5 Stabcontract#COC21
Mflnroe Cot"Y JiOmeleSs ServicL's Continimuni of Care, fac,
(NOTE: 'I'llis paragraph is not appficjblc� between state agencies 01- S Lill bdivi sions. as
defined in subsection 768.28(2).
16. Any notice, that is required under this Homelessness Prevention (irant Agreernelit ,,hall
be ill Writing, and sent by hand delivery, U.S. Postal Service Clertified Mail, relUrn 1"ecelpt
requested, or any expedited delivery service that Provides verification of delivery, Said
110tice shall be sent to the representative of the Grantee respoll sill] c for administration at
tile designated address contained in this I-lonlelessness Prevention Grant Agreement.
1'7. This Agreement shall be effective curl October 1, 2014, or on the date oil Nolicl, the
Agreement has been signed by both I)al-ties, whichever is, later. It shall end at midnight,
local time in Monroe, Florida, on June 30, 20M
18. In the event funds for payment pursuant to this [1011'elessness Prevention Grant
Agreenlent beconle unavailable., MC COC may terminate this Stibcontract UpOn no JeSS
than twenty-four (24) 1101-11's notice in v"riting t;aa the Subcontractor. Said notice shall be
delivered by hand delivery, 1J.S, POSIAI Service, or any expedited delivery service that
provides verification of delivery. MC COC Shall be the final authority as to the
availability and adequacy of state IL,Lnds In the event of termination of this Agreerneilt,
the Subcontractor will be conipensated 1,"or any work satisfactorily completed, ifthere are
SLATiCient funds available to MC Co(' to cover work deerned satisfactorily cornpleted
19. Any as of provisions of this Subcontract shall only be valid when tile
, o
been reduced 10 writing and duly signed by both p� -irtles heretoand attached y tthe have
original of tile Horneless 1 less P'TeVentioll Grant Agreenlent.
20l, Official Name of Payee and Representative:
k 'I'he official S U beantrac tor naille, as shown on page one (1) of this AgreenieLit is:
Mo 11 roe Co u n ty
13. The name, address, tejepijlone nurnber, and eniail address ofthe grant nianager for th2 Lojjtt-ajct
minder this "Omelesslless Prevention Grant Agreenient is:
Sherl,d Graham, Sr, Director
N10111toe COUntV SOCial SelViCe,,,4,
I I OlO sialoolton St.
Key West, F'L 33040
Phoue: 305-292-4510
Email: gi-aii:am-sheryi(4l,nioiiroecotin),-n.go
C. The narne, address, telepilolle number, and enlail address, of tile grant manager f6r tfic M(,
COC Linder this Agreement is:
its.. Jeanette MeLernon, MSW, CoC Administrator
Monroe :runty 110mciless Services Continuum of care, Inc.
PO Box 2410, Key West, FL 33045
Phone: (443) 974-6522
Email: mon roehom,e, 1eisc0c(q-,,,'co ni cast. n et
Stjbcorftracj#(1'0C21
Mollr0c C'Ot"ItY Homeless Services Continnum of Care, Inc.
I'llis Agreement and its attachments and any exhibits re6erenced in said attachinews, together
with any documents incorporated by rerel-ence, contah , i all the terms and conclitions agreed upon
by the parties. ]-here are no provisions. tLi-Ins, conditions, or obligations other than those
containedherein, and this A greeinent shall, SUllersede all previous Will mull) cat I oils,
representations, or agreernents, either verbal or written between the parties. It' any term or
provision of this Agreement is legally determined UnlaWfLIJ or 'unenforceable, the ren,iainder of'
the Agreement shall rerlialn in fill], force and effect and'such terni or provision shall be stricken,
IN WITNESS THEREOF the parties hereto have executed this Agreement by their undersigned
officials as dUly authorized,
SUB CON TRACTOR: Monroe County
MEMM
Name- br4j,4t koiloge ,
Title: M A,
LM
S'tibconir,act,r,+rf,edei-ii]'EI.D#,- S<?-. 'Goc)01
Subcontractor Fiscal Year Ending Date: 9/30
GRAN,rEE: Monroe County Homeless Services Continuum of(",tre, Ine,
Signed By:
Name:
Title:
Date:
OE c1r.10"A
'7 SubcontraeUVCOC21
130-X1 1 OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
MeetingD,,ite:_ 7'1fir/ 14
Bulkltenl- Yes Ix No
Division:— Social Services
Depanmeni:, Social � crviccs
S ta ff C(") rl t"'Ic t Fle ]-son:. '511el-N I G i-a h am (_3 05) 29 -4
AGENDA ITEINl WORDING: Approval and ratification of'submission of a grant up'plication for
tile I lonieless Prevention Grant offered by the Florida Department of Children and Families,
011'ice on Homelessness, (irant Application # LPZ13, in the amount of S50,000 for the period of
FV2014-2015.
ITEM BACKGROUND: Due to extremely short response time provided by the Department of
Children and Families for the RITI), Monro"e Counh, Social Services submitted a proposal for the
gran000t. If_awarded, the grant will be worth S50,000 and will require a 10% county cash match of
S5,.
PREVIOUS RELEVANT BOCCACTION: none
('ONI'RACT/AGR,EENIEN'I'CI,IANGES- n/a
STAH" RECOMMENDATIONS- Approval
TOTAL COST: "li0 BUDGEUD: Yes
No
COSTTO COUNTY: S it SOIJRCE OF FUNDS: -n./a
REVENUE PRODUCINCv: Yes No AMOUNTPER: MONTIL_ YEAR.:
A P P RO V E, D BY: C'Mfflty Att) U%'IB/Purchasin 'V Risk Manageme0l'
DOCU V1 E NTA'I'U.)N. Included Not ReqUired
DISPOSITION. -
Revised
KAwfor_ Q-4�v�
T,o Follow
FLN'DA I'TENVI 9
"R tq-CK U P
Alomwe Comiti, Hmveles.s- Serricev C011 fill tire, Me.
Pos' Of'flicc Ro\ 24W
Kc� Wes�- FL 130-4�-241�)
IA 443074V522
ruv 3054111571.
June IQ", 2014
JcW IN Haker
Whee on Homelessness
➢31 Winenw(,xf
B uU& ng 3. RmHu 01
1
mall ahcisse' YL 32-199-07()(')
R F: I hmneiess Prevention ('jraill 4.�ppj icali; 111
LPZ 13
Mar A& Bakm
Please accep�: this lener of transmittal on hehaff of the Monroe County I jo�jjejcss Sea-\,ic S
e
(',I" Care. Inc, antl Nj()jjrt)e Cj,,t, S,,WI Service (sub granIve) hm the 2014
Homelessness Prevention Grant APA3. Morwoe Couny ljOm,k,, S,,&,, Antinmmi M'
Care, Inc, is requesAg the imaxiinum _gt-ant arn(Rint 01'$50,000-00 based on the COC's Planning
area POPLdadon.
.Monroe C�..iunty I lorneless Sel`c ices COMi"Murn of'Care, Inc, reqUCSIS consideration for the
nkith regard to the 2014 f lomejess
I ) The manount Of gmm AsSiMame retWestal-
flvveMion 350A00
2) An owrvievs of'cligiNe granl',activiries jo be assisted:
1humAss WevenNan
A. Rental/Mortgagc assistaancepast due short tel'111/1 to 4 months
B. Past due uldities: electric. gas. n�ater and scv\er I to 4 months
C'Stafiand operaung cost,-,: mandator'� case management
F). Adniinistratike cosB: perkmiance & O'Hallne measures. repoms,
3) The estinmul numher oCehuRAQ c➢,(qjs to f)c sel-n
number nrchgaoe
I po"MA to he sun at
scoU Prid'�'op' � 'haji'man
I Lana f Mani , Secwiar�
me
Alotiroe COU/14' lloiirelevServiee,011 fill "I"'11 -oJ-6ire, hh,.
Kc� West, [1- 1,3045-24W
Ick 44307405-12
4) Tho RUM' 011 W:,er\(: as the point Ofcmyt,j q, [11c if"clUding phone nuililicr. t'�jx
MMIhel, Ljjjc.j e[jj'ffl Lld�jfcis for tj"'e C(qjjact
N-10111-0e County I lowless Servies Umthumm of (Arc 0r :,
Phone:
Fav 305-4 14,85 73
let
5) 'N"O zVo.vlruphic area to he uYved by Me Ibnded Ilcmickss prevultion servkevr�ataraa�in
iN ensety,
IFAIditional infiorniation is requixed or mquemed 10 Chrin any Ofthe above. said jijt;)rj Zvi I he MUM in the lyplicmi0l, Cofflent or Prograni Narrative, 11 1 k �
Nlo,'st SincerOy
E Scou Pridgen
Chairman
"� iLkt 4� IL Phj), � ite-d' hao,
t� IOKII'd q fflVokc!, trQa�m"cr
County of "Allonroe
The Florida Keys
ll�mroc CoIJIM Soo�fl Sm it:�,,
(Jrahwl�, Sr, [)jrCCtI)r
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HCJOILTf)jjrtT 3
TRAN SMITTAL LETTER
WAS Baker
WHISC oil Hornelessness
Departnierat of Children and 1"amilies
1317 Winewood Blvd,
Bfdg-3, ROOM 201
Talkthassee, Fl, 32399-07010,
Dear k4s, Baker,
This transmittai letter- s b6ng smit to convey the follovving information on the 2014 Homeless Prevention
Ch-ant sohchakn and in response to section 4.2 ol'Grant Soficitation # I,PZ 1 -3.
TWO= CDUMY Ward of County C(MmAssioners/Monroe Court), Sociajj SerVices requests Consideration
tbr the tail ondng with regard to the 2'0 14 Homele.9s
Prevention Grant:
Ile mount of grant asAwnce requested:
Thevendon $50JHW
2) An overview oficligible 9r,"I't Lictivides lo, be assisted:
thnneW lAvvenoon:
tk, RentaMortgage assistance: Mist due short term/1 to 4 months
B. Past dUe Utilities: ejeCtdC. g
as. ivziter and sc�,N cr I to 4 montlis
C. Staffand operating costs: 11 , 'a ndator"w case management
D, Adininistrative costs: pej-t'cjTnMnCe & OWCOnle measures. rcpk:,,rt.s
3) t� I N �� �-NC h0USefhfljS ) lay se - -cd- 6
The es6nnned mfllher ofeligible persons to be, serve& 24
w
A 1`hUS1UwpCMonwSenVaN We PAM Of MUM Aw the applicmion, OWN, p0ne nuniher, R-N,
numb& and email address 1�n- Hic cu)fjtjcj
Sheryl Graham, seTjjOr �t�)cijjj Seru ices [�)irecjor
1011R)e Social Services
INWO 005 Q9245 10
Fa,\ NuniberC305) 295-4-359
5) The geogniphic area tca he senned by the Minded homdem pwvmyt,on services: WnroeCournon
A entirey
it'addidonal inl'ormat-ion is reqWred or requested to daHQ aq of,the ahovt-, saitj itifomiation wifl, he
Mined in the zApplication Content or Prognun NarraNve,
'vlost Sincerely.
I Sin
hI I G �e -y aham
Senjor Director
NN'tonroe County. Social Services
Debbi,c r"redOck
DepL11Y County Administrator
Wm` c Counrty Board ol"County Commissioners
Monroe County Homeless Services Continuum of Care, Inc.
I . # ; , , !,
3) Mailing Address of thp_Apjjr cant.
Monroe CoIuinty Homeless Se-rvices ContinUURI of Care, Rnc.
P OL Box 2410
they "lest, Florida 33045
4) The address where the Irant funded, services will be carried out or acce
ad
Monroe County Social Services
1100 Simonton Street, 1 �4 Floor, Key West, FL
4901 63r' Street Ocean, Marathon, FL
8�8820 Overseas Hwy, MM 88.81, Tavernier, FL
for the homeless
coIll gilleted fiscal vearofthe 1111;Ir1fi&!1e It t I I I'll I' o d1 ram/services for the last
Periocovered V fisc U22L
ESG� $131,E308l November 1 2012 through September 30, 20113
Weffare: $34,150 October 1, 20112 through September 30, 201 �3
LIHEAR $256,314 March 1, 2�012 through April
6) List of the sources of 11 revenue received'that s Dorted tI iet. If state
rlIocal overnment 1111!1111rants were received' hstEE!E1lICjI AtDarat,
_y. Grantor
Name and Amount of Grant Award.
Grantor Agency:
Department of Children and Families
Program Name:
Emergency Solutions Grant (ESG)
Amount:
$ 100,0100 (11/1/2012 - 6/301/14)
$1 31',608 (7/ 1120,13 - 6/30/14)
Grantor Agency-,
Monroe County Board of County Commissioners
Program Name:
Welfare/Communlity Support Services
Amount:
Emergency Shelter and Utility (Ad Valorem Taxes/Gene4 Fund)
S 18,450
(10/ 112012 - 9/3 0120 13) Sh e lter
$ 15,700 �rlO/1/2012 - 9/30/20'113) Utility
$ 18,000 (10/1/2013 - 9/30/23114), Shelter -Current Year
$ 151200 ( 10/1/2013 - 9/30/20,14) Utflity-Current Year
Grantor Agency:
Department of Economic Opportunity
Program Name.,
Low lncome Home Energy AsslIstance Program (LIIHEAP)
AmIoIunt,
S 256,314 (3/1/2012 - 3/31/2013)
$ 245,491 (3/1/2013 - 3/31/2C14)
7) Sub- rant Name
and Point of Contact Staff:
Sheryl Graham, Sr Director
Monroe, County Social Services
100 &monton Street, 2-257
Key VVest, Ronda 33040
FS
This repstration surnmary was generated when the MyHoridaMarkelplace Terms of Use were
accepted,
Vendor Name: Monroe HannWess Sarvic�es Continuum of Care, Inc.
Short Name (Does Business as): Monroe HompRss CoC
ArIba Network ID:
Ours and Bradstreet Number 078678672
Website:
Federal Tax 10 Number F461235865
Name that appears an 1099 Form: Monroe Homeless Services Candnijurn of Care, Inc,
Lost Name First Name
Title Phane
Emall
NICLernon Jeanette
Admmstratoe 305-736,41 '3 xr'%Jl
Braddock Rev, SIephvi
BcarlJ Cnairman 305-283•5159 xmill
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"I'll 41 8RR��� Monroe COUnty Board of CountyCommissioners/
Monroe County Social Services
2), 073876757 (See Attached Documentation)
3) !MIL2f.� ar�i atma r�; Local COUnty Government
4)
Sneryl, Graham, Sr, Director
Monroe County Social Services
1100 Simonton Street, 2-257
Key West, Florida 33040
5) ill be carried out, or accessed b
Key West, Ft.
thon, FL
Tavernier, FL
Z 11
6) olicant's toti�l iet for the h Dreveli I 3r ram/servicies for the last
eall
commiletp-d of th, ilicant. State thil Deriod cove 11`11(�!! 111:11 Ill''111111P fiscal
ESiG� $111,608 November 1, 2012 through September 30, 2013
Welfare: $34,150 October 1, 20,12'thrOLgh September 30,, 2013
LIHEAP: $256,314 March 1, 2012 through April' 30, 2013
7) List of the sources of revenue receilved that sIIIIIII Z"I'Dorted the If state federal
or local goyprnmant nr�ntg Were received lisull 1:11rant s'i ru.!I: hy- r4nmnfor
A enc Grant Pro iram Name A of Grant Award.
Grantor Agency:
Departrrent of Children and Families
Program Name:
Emergency Solutions Grant (ESG,)
Amount-
$ 1100,000 (11/1/2012 - 6/30/114)
1
$ 11,608 (7/11/20,113 - 6/30/14)
Grantor Agency:
Monirole County Board of County Commissioners
Program Name:
Welfare/Community S,u'Ppolrt Services
Amount:
Emergency Shelter and Utility (Ad Valorem Taxes/General Fund)
'18,450
$ (101/1 /20 '12 - 9/30/2013) Shelter
$ 15,700 (1011/20112 - 9/30/2013) Utility
$ 18,000 (1 0/ 1 /20113 - 9/30/2 014) Shelter-CUrrent Year
S 15,200 (10/1/2013- 9/30/2014) Utility -Current Year
Grantor Agency:
Department of Econor6c Opportunity
Program Name:
Low Incorne Home Energy Assistance Program (LIHEAP)
Am nit:
$ 256,314 (3/1/2012 - 3/31/2013)
$ 245,491 (3/1/20 -13 - 3/31/20 14)
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The Monroe County Continuurn of Care CoC as the Lead Agency has designated
Monroe County Social Services as the sub -grantee enitity to carry out the prevention
assistance,
Monroe County Social Services (MCSS) is a! Department within Monroe County
Governmient. MCSS operates under the full faith of the Monroe County Board of County
Commissioners (BOCC), which was established in 1823, MCISS programs have been
providing case manageFflent as Well as coordinating and delivering core services for
citizens countywide for more than 40 years. MCSS has existing government centers in the
Upper, Middle and Lower Keys, These 3 locations are staffed with experienced, seasoned
case managers that are currently providing an array of services to citizens throughiout the
Florida Keys, The mission of MCSs is to, Provide outstanding public service that is
responsive to, the needs of our citizens, our unique community, and our environment.
MCSS provides all services and administrative support for the Low -Income Home
Energy Assistance Program (LIHEAP). LIHEAP fuln!ds are used to ensure that income
eligible citizens are not negatively impacted by rising energy costs. LIHEAP funds are,
used solely to pay for energy bills for low-income clients giving priority to families with
children, the elderly and those who are disabled, MCSS also provides, transportation
services throughout Monroe County via our Monroe County Transit (MCT) program. This
para-transit service (doer -to -doer) is available to all citizens of Monroe County, regardless,
of their income, age, or eligibility and serves anyone who is transportation disadvantaged'.
In addition to the aforementioned services, other eligibility -based services are
rouitinely provided to the community on an ongoing basis SLch as � purchasing prescription
drugs for homeless and/or low-income individluals, or those who cannot othermse afford to
do, so; pauper burials, or cremations for low-income, homeless, or unclairned indkviduals,
personal care items-, and/or other emergency related su;)p�ies such as adult diapers,
supplemental or m,eal rep�acement drinks for the elderly, ill or disabted.
R
Since MCSS has extensive historic and current experience providing and managing both
grant and non -grant fuinded rental assistance programs, implementation of the
Homelessness Prevention Grant Program would be immediate,
U__q La� Magggpirrien, T --galy
Currently, MCSS employs three (3) full time case managers, two (2) full time eligibility
specialists, and two (2) case manager supervisors. Because of our case manialgers'
extensive experience in offering homeless prevention funding, we would begin to
immediately serve families usj!ngi these funds,
MCSS Offers the following information as a step-by-step guide of the proposed'
Homelessness Prevention Grant Program:
I ) IMethod by which the apphicant wJ111 take applications for assistance from efigiNe families: Clients
I
will be enrolled inito the program in several different ways,. MCSS is a knowni,
"walk-in"' entity in the Florida Keysi:. Clients: know they can walk' -in or call: at
any time for assistance and if we have fundlingi, they can: be assisted'. Clients
who are home -bound are seen by our case maniagers, during home visits.
Commiuini : ty agencies also continuously refer cl;ients to uls regardless of our
funding. If we are awarded this funding, a press release will be issued and we
will! also advertise with flyers and broichures and icontalc:t all community,
agencies announc�ing thile Homeless Prevention Girant funding,.
2) How ti`Ie appp these families Mformed on the stat�us of tWr request fcrassistance� As with a i 11 programs the MCSS opeirates, clients will be notified verbally of
their eligibility status when their application is being proicessed AND in
writing onice their application is officially finalized andi processed by a
supervisor. While the client is aware that the verbal notifica, tion is not
officiall, they are able to make decisions and be more aware of their
immediate situation and our potential ability to assiist or not. Once the
elligibility papierwork is forwarded to the case manager suipervisor for fina,l
review, whether the appilication isi approved or denied, thie client i's officially
notified in writing. If the file is denied, the client is also called so that he or
she can immediately begin to seek moire appropriate assistance and! so
that additional referrals for assistancie can be given.
1
3) The eligible grant funded services toi be prov�ided, and the specific housing costs to be coveredby the
direct financial, assistance� MCSS Will offer the following grant funded siervices:
Past due rental a mortgage assistance ($38,000); past due utility assistance
($8,000); and'Case management services ($2,000), The specific housing costs
to be covered by the d�irect financial assisitanice are past due rental/mortgage
payments and past due utility assistance for electric, gas,, water and' sewer
on ly.
4) How the grantee MI provide case rnanagernent revuew S document cNent househc1d edigibnlqy
�
After all' paperwork is COMpleted by a case manager or eligibility specialist'
client applications are reviewed by a case manager supervisor to confirm or'
deny final eligibility.
6) The number Of farn0jes, to be assisted,6
7), How often a faftly can app�y and receive assistance: A family found' tO be eligbe
assisted up to the maximUrn Of 4 Months of financial: assistance biut onily once
during the 12 month period of thie grant.
8) The maximum: levell of direct financiai assistance to be provided to, an ekgibie household' Under the
ESG grant award, as well as the estimated average cost per tany served. The maximum I evel
of direct finiancial assistance that will be provided to any one eligible
household under thie Homelessness Prevention grant will be four (4) months
of rent or utility assistance, as applicable, If we are awairded this grant,
MCSS estimates that we will be ab,le to assisit 6 famil:'
Jes thirouighout Monroe
Couinty with the funding available under ESG, thus, the estimated average
cost per household served will be- $7,666-66. As with any estimated figiu!re,
this number could be significantly higher or lower, depending upon the
individual needs of the household, and the cost of their rent/'mortgage oir uitillities.
The cont�entof each appNcant;s case ffle used' to estaNshi the hous�hold's e��gibijitvfoj �sta!nc
The content of each applicant's case file is outlined in the MonroiesCs'ouin 11
Social Services Department, ESG/HoMelessness Prevention Program, Polici
and Procedures, as attached. The idoc'u,menitation oiultlined in the Policies an
Procedures is used to establishi and verify each houseihold's
teligibility
assisance ulndleir Homelessness Prevention.
I'n the case of the denjaif of assistance, describe the process by Which, the houseWd can -appeal the decision The denial of assis,tiance, and the appropriately related
grievance/app,eal process, is outlined in the Moniroe County Social Services, Deipartm�ent, Policies and Procedures Program Written Standards as attached.
The documentation outlined and' referenced in the Pol'icies and Procedures is used to establish a means by which, clients can grieve or appeal any denials of assistance under the E'SG/HOmel'essniess Prevention.
I ON
am 0 x Mz
a
13) How the Program will connect the family to other services and benefits they may need and be e�!ible
to receive: 9
Case management support and follow t�hrough is crucial to the success of this
proigram. Regular androutine follow uP of clients is required to ensure client
success, self-sufficiency and to ensure they are adhering to their case plan in
order to not become homeless once asisistan�ce enidsClients will" have
apipoinitmien,ts with t�heir case manageriIIIn no less than a personaquarterly schedulei. If
a client needs to be seen more often han that�, a lized schedule will be
established and followed for continued assistanice.
POLICIES AND PROCEDURES
WRITTEN STANDARDS FOR PROVISJO,N OF ESG and HoMelesness Prevention ASSISTANCE
DA rF.'i 1,
WASM
I
9
This docui-nent is designed to assist with implementinE the Emergency Solutions Grant
(ESG)
arid! Hornelessness Prevention. It is to be used as a reference by Our agency and its staff fo�r the
administration of this grant and its funding, These written procedures are in accordance with
the Department of Houlsing and Urban Development interim Rule, 576.400 and 24 CFR 91,
The Emergency Solutions Grant (ESG) Program is a federally funded program awarded to thie
State through the Department of Hcusing and Urban Development (HUD), The State is required
to distribute the grant for projects operated by local government agencies or private non-profit
organizations,
The ES G prograrn is designed as the first step in a continuum of assistance that addresses
homelessness and enabVes the homeless population to move steadily towaird independent
living, The Continuum of Care model is based on the understanding that homelessness is not
caused simply by a lack of shelter, but is caused by a variety of underlying human and social
conditions. HUD believes the best apiproalch for alleviating hornelessness is to establish a
corer-nunity-based process that provides a comprehensive response to the diverse needs of
homeless persons, The fundamental components of a, Continuum of Care system are,
1) Outreach and assessment to identify a homeless person's needs;
2) Immediate (emergency) shelter as a safe, decent alternative, to the streets,;
3), Transitional housing with appropriate supportive services to help people achieve
independent living; and
4) Permanent housing or permanent supportive housing for the disabled homieless,
The objective of the Emergency Solutions Grant Program is to fund activities in thle areas
Homeless Prevention and Re -Housing; (2) Shelter Facilities; and (3) Street Outreach,
The Emergency Solutions Grant Program will fund activities that meet the definitions contained
in the U,S. Department of Housing and Urban Development regulations published in the 24
C,F.R Part 5761, as amended, Eligible components of the ESG Program a,re Street Outreach,
Emergency Shelter, Homeless Prevention, Rapid Re -Housing, Homeless Managernent
Information System (HMfS), a:nd administrative costs (capped at 4,5%),
The objective offonroe County Sac:al Services will be to focus on one primary component:
Homeless Prevention and Rapid Re-P-lc
I
a
OBJ'ECTIVE: Provide reinital assistance along with stabilization services necessary to prevent an
individualor family from becoming homelehaving to move inito an eme'rgencY shelter or
oither place not suitablefor human occupancy,
All eligible applicants must have incc,nie below 30 percent of the median income for this
geographic area and have insufficient resources immediately available to attain housing
stability.. They must then meet at least one of the criteria frorn 3 through 9, '
(1) has income below 30 percent of median income for the geographic airea;
(2) has insufficient resources immediately available to attain housing stabdity; and
(3) has i-noved frequently becaiuse of economic reasons,'
(hm
4) is, living in the oe of aniother becaUSe of econornichiard'ship;
(5) leas been notified that their right to occupy their current housing or living situlation will be
terminated;
(6) lives in a hotel or motel;
(7) lives in severely overcrowded housing;
(8) is exiting an institution; or
(9) otherwise lives in housing that has characteristics associated with instability and an
increased risk of homelessness,
Such, term includes all families with children and youth defined as homeless under other
Federal statutes,
Homeless prevention for househiolds at risk of homelessness will assist individuals and families
who, are experiencing a "sudden loss of income" with the possibility of losing their current
housing. HUD expects that these resa',irces will be targeted avid prioritized to serve households
that are most iin need;, of this temporary assistance and are most likely to achieve stable
housing, whether subsidized or unSUbsidized, outside of ESG1 after thie program concWdes.
stem and Proaram Coordination with mainstream resources:
ESG assistance is not intended to provide
de long-term support for program participants, nor MI it
be able to address all of the financial and supportive services need's of households that affect
housing stability. Rather, assistance should be focused on housing stabilization, linking program
participants, to community resources and mainstrearn benefits, and helping them develop a
plan for future housing instability,
ES G funded activities must coordinate and integrate with mainstream housing, health,
Pmpioyrnent, education and youth programs for which individuals , an,d farriiies may be eligible.
Examples of these prograrns InClUde but are not limited to: TANF, Medicaid, Workforce
Development., project based housing, Section 8 and! Head, Start.
I
Prioritizi
2LP�
To address the growing PoPuWicn of homeless families with children and YOUti-1, Monroe
County Social Services will focu,s on and Five first priority to Families with ch,ildren or youth
exiting from state caire or custody. 'These families and, children shall be given preference under
thus award for both prevention and rapid re -housing, to the maximum elxtent passible.
9E�l �ibiht �Re �uirem_ents for All �Partjc�lant�s-
EvaWating individuals" and farnilies' eligibility for ES G Homeless Prevention assistance in order
to receive Financial assistance or housing relocation, and stabilization funded by E-SG,, individuals
arid! families must at least meet the minji-nurn criteria:
Initial interview:
Any individual or family provided with financial assistance through ESG rnust have an
assessment with A, case manager or, eligibility specialist who can determine the appropriate
type of assistance to meet their needs. A plan will be developed with each program participant
on how they will retain permanent housing after the ESG assistance ends, Program participants
will either meet in person or speak with a case manager or eligibility specialist not less than
once per month while they are receiving ESG assistance In order to implement their Plan, and to
monitor thleir progress toward housing stability, Monroe County Social Services (MOSS) has a
process in place to refer persons who are Ineligible for ESG to the appropriate resources or
service providers that can assist them,
Income Verification:
Households receiving Homeless Prevention, aissistance must be below 3001/0 percent of Area
Median Incorne (Ai I) at time of initial aipplicationi. Eligibility Specialist or case managers will
complete income verification forms and subrnit to appropriate income sources for th rd party
verification, Completed Income verifications should then be placed in the participant file.
INCOME LIMITS — Agency will use HUID published guidelines for Area Median Income (AMl), for
applicable year when assistance is provided. An eligible applicant must meet the income
guidelines of 30% of Average Median 11-ILL)FTle (AMI) or felss, for Monroe County, Florida.
Housing Status:
The; household must be at risk ofdosing its housing and meet both of the following
circumstances: (1), no appropriate SUbsequent hO,LJsjn8 options have been Identified; AND, (2)
the househiold lacks the financial resources and support networks needed to obtain immediate
housing or remain in its existing housing.
Colntinuium of Care Centralized or Coordinated Assessment rlistems:
MCSS currently has a Memorandum cif Agreement with the Mionroe County Homeless Services
Continuum of Care to share information about participants, track participant assistan--e, and
l jointly with other agencies to help participants move toward achieving thieir ob ectives
and maintain comphince with the HEARTH Act.
M
KYRj§I.qAct i v i t i e s:
There are three (3) categories of 2hSibJe activities for the ES G program: Rental, assistance,
financial assistance and services,
Rental Assistance:
Rental assistance is for eiigihle participants whereby payments aT e made directly to the housing
p rovider/lia n d lord to prevent families or individuals frorn becoming homeless, in a sheltered Or
unsheltered situation, Rental assistance may be provided for up to a maximun, of '
;)5000.00,
Participants must be recertified for eligibihty every three (3), months, If a participant's rent is
adjusted and the participant seeks additional assistance with MICSS the participant will be
rescreened for eligibility, Project based rental assistance is excluded as an eligible activity for
this grant.
MOSS is riot requiring a share of cost for rent or other financial assistance
When a rental unit has been located, MMSS will assist the, participant in, contacting the landlord
to complete the appropriate paperwork and conduct a habitability standards inspection,
For all] homelessness prevention, Lead Based Paint Poisoning Act requirements must be met
when applicable based on participant household composition, Agencies must certify that the
unit has passed haiNtability standards by caryipletung the Habitability Staindards Certification or
the Habitability Quiality Standard's assessment before any ESG funds may be released. The
Habitability Standards Checklist is Attachment A of this docuirrient, and can also be found on the
Department ESG website located at; rtt�Ov C�Dcd-boh-H-ES Ghtnil,
/cornmerce.w
MOSS will collect and maintain acceptable documentation showing a participant is in need of
rental assistance, Documentation may be in the form of an eviction notice from a landlord,
owner, or property manager and the participant mulst have a written lease,
MCSS will use I-iUD published guidetines for Florida Fair Market Rent (FMRs) for applicable year,
If the applicant's runt is above the FUR, the participant is ineligible for F5G. If it is beneficial to
the applicant MOSS will assist program participants to locate a rental unit at or below FVfR,
Financial Assistance:
Financial, assistance are activities that help families or indlividuas, regain stability in their current
housing or other permanent housing, For ail financial assistance, payments may nut be made
directly to program participants, only payments to thiird parties, such as landlords or utility
companies are allowable. Properties owned by thle grantee, sub -grantee or the parent,
subsidiary or affiliated organization of the sub -grantee may not receive payments that include
ES G funding. MCSS provides the following financial assistance services,
1) Security - one time assistance equal to the FMR
2) Utility deposits — one time assistance not to exceed local utility company requirements
3) Utility payments, — minjjjrjunianiount required to prevent disconnect of service
A) Security and utility deposits may oily be paid With ES G funding if the pro rare participant
,,will otherwise be homeless without this assistance. Security and utility deposits covering the
same period Of time in which assistance is being provided tilrough another hCusing subsidy
program are OjgibIe, is long as they cover different cost and services or Payments and are not
duplicated. Security and utility deposits may be prolvidec as a one-time payment not to exceed
the monthly rental amount. Information documenting the need for a security deposit should be
0bta6ned at the same, tirne the required rental paperwork is being completed by the Participant
and landlord. Agencies may determinie whether to collect the security deposit when the
participant moves. If the security deposit is recovered by the agency, it Must be treated as
program income and reported to the State Office. on, HomellessneS5.
MCSS will conduct a, habitability standards inspection an any unit that a participant will be
moving into using ESG funds for a security or utility deposit. MOSS will certify that the unit has
passed habitability stanldards, before any ESG funds may be released.
B) ESG funds may be Used for the payment of Past due ultiNties not to exceed $60(,00. The
participant, or a member of the housPhold, must have an account in his/her name vvith a utility
company. If the participant does not have an, account in his/her name, they must be able to
show responsibility to make utility payrylents with cancelled checks or receipts from a utility
company. The participant must have a lease with their name on it to prove residency and verify
address of utility service. Copies, of all documentation will' be obtained and maintained in the
Participant file, Utility payments must be made directly to the utility company.
Services are activities which can aid Participants with achieving housing stability as well as
dealing with previous issues related to hiousing instability, MCSS will provide, the following
services to eligible Participants:
1) Housing stability case management - Case management activities for the airrangemelnt,
coordinaltion, monitoring, and delivery of services related to Y-neeting thle housing needs
of participants will be provided with ESG funds. MCSS will include counseling, deveilopling,
securing and coordinating service, obtaiining Federal, State and local benefits, developing
stab ility.
an individualized housing and' service plans, including a path to permanent housing
a,) Case managers will make monthly phnne contact (from date of first interview) with
participants to determine status and to document any household changes.
b) If at the end of three months participant is still receiving financial assistance, the
case, manager will schedule a re-evaluation.
In addition to the above activities and services and to be in compliance for funding received
under thie ESG grant, MCSS will perform two additional services;
a) Deliverables and
b), Performance Measures
1) Deliverables include:
a) Inputtina data into the 0 -Horneles s Management infllorrnationl System, (Hil tirnefy�
b) SUbmitting, monthly, quarerly, and annual reports on ail ictivities provided with "
/unds ESG
6
c) Submitting invoices, for remiburseinent with the required docurnentation for ESG
services
2) PerForniance measures are to be used jointly with the CoC pVanning Lead Agency to
assess performance of ESG funding, MeaSUres include:
a) Reduction in the num�ber of households with children who are hornicless in the CoC
area;
by At least 35% of the participants served remain in permanent housing 6 rnonths
following their last assistance provided under the 'grant
Objective: Rapid Re -Housing will provide rental assistance along with stabilizationservice5 as
necessary to help a homeless individual or family move asquickly as possible Into permanent
housing and achieve stability in that housing.
The funds under this prograrn are intended to target individuals andl families who are
experiencing homelessness (residing in emergency or, transitional shelters or on the street) and
need temporary assistance in order to obtain, 11OLIsing and retain it (rapid re-hoiusing),.
Rapid Re -Housing Is available for persons who are horneless according, to HUD's criteria, Clients
will be assessed according to HUD's criteria for defining homelessness under 24 CFR. Part 576,
System and P,rolgram! Coordination, with mainstream resourcies:
ES ,G assistance i!s not intended to provide long-term support for program participants, nor will it
be able to address all of the financial and supportive services needs of households that affect
housing stability, Rather, assistance should be focused on, housing stabilization, linking program
participants to community resources and mainstream benefits, and helping them develolp a
plan for future housing instability.
ESG funidied activities must coordinate and integrate with mainstream housing, health,
employment, education and youth prograrris for which indlviduals and families may be eligible,
Examples of these programs include but are not limited to: TAN , Medicaid, Workforce
Development, project based housing., Section 8, and Head Start.
Prioritizing:
To address the growing population of homeless families with children and youith, MSS will
focus on and give first priority to families with children or youth exiting from state care or
custody, These families and children shall be, given preference under this award for both
prevention and Rapid Re -Housing, to the rnaximurn extent possible,
I
E
Evaluating ndiOduals' and families' ehgibility for ESG Rap d Re -Housing assistance in order to
0
receive finincial assistance or services funded by ESG, individuals atid families must it least
meet the rninirnum criteria:
Initial interview:
Any individual or family provided with financial assistance through ESG must have an
assessment with a case manager or eligibility specialist who can determine the appropriate
type of assistance to rneet their needs, A plan, MN be developed with, each program participant
on how they will retain permanent housing aifter the ESG assistance ends. Program participants
will either meet in person or speak with a case manager or eligibility specialist not less than
once per month while they are receiving ESG assistance in order to implement their plan and to
monitor their progress toward housing stability. MOSS has a process in place to refer persons
who are ineligible for ESG to the appropriate resources or service providers that cain assist
them.
Income Verification:
For households receiving Rapid Re -Housing aissistance there is no Area Median lricorne (AMI)
requirement at time of initial application. The Al I Would have to be met at the, annual re-
certification. Eligibility speciallist or case manager will complete income verification forms and
submit them to appropriate income sources for thirci party verification, Completed income
verifications should be placed in the participant file.
For re -certifications. Eligible applicant rnust rneet the current HUD, guidelines for AMI for
Monroe County Florida.
Housing Status -
The household roust be literally homeless, at imminent risk of homelessness, horneless under
other Federal Statues, or fleeing/attempting to flee Domestic Violence.
Continuum of Care Centralized or Coordinated' Assess me qt5ystern:
MCSS currently has, a Memorandum of Agreement with the Monlroe County Homeless Services
Continuum of Caire to share information about participants, track participant assistance, aind
work jointly with other agencies to help participants move toward achieving their objectives
and maintain compliance with the HEARTH Act.
Eligible Activities:
There are three (3), categories of eligible activities for the ESG program: Renta�l'i assistance,
financial assistance and services.
Rental Assistance:
Rental as~ irstance for eligible participants whereby payments are made directly to the housing
provider/landlord to aid families or individuals who are homeless move into permianent housing
and achieve stability in that houising, Rental assistance may be provided for up to 12 months,
not to exceed $S000-00 in assistance. participants must be recertified for eligibility every three
(3) months
M
MCSS is not requiring a share of cost for rent or other financial assistance,
Wh�en a rental unit has been located, MCSS will assist the participant in contacting the landlord
to complete the appropriate papervvork and conduct a habitabOity standards, inspection,
For all assistance, Lead Based Paint poisoning Act requirements must be met, when applicable,
baked on participant household composition, Agencies Must certify that the unit has Passed
habitability standards by completing the Habitability Standards Certification or the Habitability
Quality Standards assessment before any ESG funds may be released. Th e habi
tability
Standards Checklist is Attachment A of this document, and can
also be found n the
Department H-ESG website located at: ht�ZLomrnercew -bo�I-H-ES �2ov CID �ccl
MCSS, will miaintain acceptable documentation, showing a participant is in need of rental!
assistance, Documentation will be in thle form of a written lease from a landlord, owner, or
property manager,
MCSS will use HUD Published guidellines, for Florida Fair Market Rent (FMRs) for applicable year,
If the applicaint's rent is above the FMR, the participant is ineligible for ESG. If it is beneficial to
the applicant MCSS will assist program participants to locate a rental unit at or below E.
FinancialAssistance:
Financial assistance hielps farnilies or individuals regain stability in their current housing or other
permanent housing, For all financial assistance, payments may not be made directly to program
participants.- payments are only made to third parties, such as landlords or utility companies,
Properties owned by the grantee, sub -grantee or the parent, subsidiary or affiliated
organization of the sub -grantee may not receive Payments that include ESG funding, Mcss
provides, the following financial assistance services:
a) Security andl Utility deposits
b) Utility payments
a) Security and utility deposits may only be paid with ESG funding if the program participant will
otherwise be homeless without this assistance, Security, and utility deposits covering the same
period of time in which assistance is being provided through another housing subsidy program
are eligible, as long as they cover different types of service, Security and utility deposits may be
provided as a one-timie Payment not to exceed the monthly rental amount. Information
docurnenting the need for a security deposit should be obtained at the same time the required'
rental paperwork is being completed by the participant and landlord, Agencies may determine
whether to collect the security deposit when the participant rnoves. If the security deposit is
recovered by the agency, it must be treated as program mcome and reported to the
Department on Homelessness.
MOSS will conduct a habitability standards inspection on any unit that a Participant will be
nnoving into when ESG funds are used for a Security or utility deposit. MCSs wjIl certify that the
unit has paissed habitability .standards before any ESG funds may be provided,
9
VA
b) ESG funds may be used for utility payments in, arrears Lip to 60MO for up to two rjjonth^
The participant, or a Member of the Participant's household, Must have an account in his/he, , r
narne with ai utility company. lf the, participlaint does not have an account in his/her name, they
must be able to show responsibility to make utilitY Payments with cancelled checks or receipts
from J utility company. 'hie participant must have a lease Mth their narne on it to prove
residency and verify the address of utility service. Copies of the proof of responsibility shou�d
be obtain and maintained in the participant fife. Utility payments must be made directlto
the utility company. y
Services:
These are the activities which can acid participants with achieving housing stability as well as
dealing with previous issues related to housing instability. MCss N/vill provide the following
service to eligible participants. -
a) Housing stability case management - Case management activities for the arrangement,
coordination, monitoring, and delivory of services related to meeting the housing needs
of participants will be provided with ESG funds, MI SS gill include counseling developing,
securing and coordinating service, obtaining Federal, State and local' benefits, developing
and individualizing housing and service plans including a path to permanent housing
stability. Participate will, meet with case manager monthly while in, receipt ESG funds for
Rapid - Rehousing.
in addition to the above activities and services and to be in compliance for funding received
under the ES,G grant, MCSS will perform two additional services:
1) Deliverables and
2) Performance Measures
1) Deliverables includle,
a) inputting data into the Homeless Management Information System (HrVIIS)
b) Submitting rnontWy, quarterly and annual reports on all activity conducted with ESG
funds
c) Submitting invoices for reimbursement with the required documentation for ESG services
2) Performance measures- these measures are to, be 11sed jointly with the COC PlalirlirglLtad
Agency to assess McsS performance of ESG funding, Measures willinclude:
a) Reduction in the nurnber of households with children who are homeless in the Coy area
b) At least 355/o of the participants served remain in permanent housing 6 months following
their last assistance provided under the grant,
HOMELESSNESS PREVENTION GRANT ASSISTANCE OVERVIEW
The objective is to, assist the eligible family to prevent the family from becoming homeless and
to maintain stable housing following the assistance frorn the grant,
ON
IN 20,13, the Florid'a LegislatUre created the Homeless Prevention Grant progran'i to provide
emergency financial' assistance to farni1jes facing tlje loss Of their current housing"Ddue to a
financial or other crisis, The Department of Children and Fan-jilies, (Department)Office onHornelessniess (OfficeO is authorized to provide homelessness prevention grants annually to the
lead agencies designated for the local homeless assistance Continuums of Care (COC) in the
state. The intent of thle program is, to alsist families, to prevent thern fronn becoming homeless,
and to enable them to remain -stably housed following the assistance provided,
ELIGIBLE APPLICANTS
e
The eligible applicants shall be limited to the lead agencies of the homeless assistance 11
CoC
planning areas in, accordance with section 4201-624, Florida Statues, in order to qualify for a
grant, a lead agency must develop and implernent a locM homeless assistance CoC plan for its
designated planning area, The homeless prevention program to be assisted under this grant
solicitation must be included in the CoC plain, See certification required in Appendix V,
The lead agency may sub -grant the administration of the homeless prevention to another,
agency, as consistent with the local CoC plan, The lead agency retaiins overall grant
administration and financial accountability. The lead' agency may share the grant
administrative costs with the sub -grant agency, ZD
The list of eligible lead agencies is included in: Appendix 1.
PARTICIPANTELIGIBILITY
To be eligible for assistance under this grant, farnifies Must reside in Floirida- have at least one
household, member who is a United States citizen or a lawful permanent resident; have a! minor
child! livingi
n the household full-time; and have a hiouseholld income less thatn two-hund'red
percent (20%) of the fedieral poverty level as annually published by the U,& Department of
Health, and Human Services.
A minor child means a child under the age of eighteen, (18); or if age eighteen (18), but not yet
nineteen (19), is attending high school, a General Education Development (GED) program, a
trade school, or other career training program on a full-tir-ne basis. A minor child canniot be
married or divorced.
The adult who applies for the grant assistance must be either the parent, or the relative
caregiver of the minicar child residing in the household.
The household income means both earned and Unearned income received in, the month in
which the family applies for assistance, Earned income is income received from employment or
self-employment, including wages, salary, tips, commissions, and bonuses. Unearned income is
income received for which there is no perforr-na nice, of work, or provision of services as an
employee or self-employed person. The income of all members of the household shall be
reported in determining eligibility of the fam,ily for assistance.
The fan-idy's housing ernergency shall be the result of ,] financial or other crises, as documented
bthe lead agency, or its sub -recipient.
OBJECTIVES TASKS DEL LVERABLEic ND PERFORMANCE ME L,�SURES
1) Objective: To assist the, eligible family to prevent the farnily from, becoming
homeless and to maintain stable housing following the assistance frorn the grant,
2) Tasks: Each recipient of funding from the Homelessness Prevention Grant shall
complete the following tasks:
a) Develop a written, case plan and conduct mandatory case management for each
family applying for financial assistance. The farnjly`s case plan shall set forth all
of the costs that will be covered by the grant, as well as the total dollar amount
of assistance to be, provided to the family. The case plan shall spell out the
family's goal for housing stability, the anticipated date the case plan will be
completed, the recipients schedule for monitoring the family's housirig stability
following the cessation of grant assistance, whether the family as able 'to avoid
becoming horneless, and whether the family remained in permanent housing,
b) Develop, maintain, and retain a case file on each family applying for assistance.
The case file shall contain all information, reqUired to determine the eligibility of
the family, along with the determination of eligibllity. The file shall include
documentation of the household income, in addition, if eligible, the file shall
include copies of all' Payrnents made, the case plan, follow up monitoring of the
family, and the housing outcome achieved,
c) Capture and enter information on the families a,ssisted into the local Homeless
Management lnformation, System (HM15) of the COC planning area. Such data
entry shall rneet the standards in Place, for the information system, Suich data
entry shall rneet the standards in place for the information system,
3) Eligible Activities: The Homelessness Prevention Grant may be used to pay the
following costs in assisting eligible families to avoid homelessness:
a) Past due rent or mortgage Payments, not to exceed four (4) months of rent or
mortgage payment,
b), Past due utility bills, not to exceed four (4) months in arrears for electric, gas,
water an:di sewer only.
C) Staff and operating costs for the provision of the 'mandatory case management
services to be provided to the eligible family.
Z)
d) Administrative costs for the eligible applicant, up to a rnaximurn of three
percent (3%) of the grant award'.
The amount and Percent of the grant award budgeted to the eligible uses will be a local
determnation with 110 state niiiimum or niaxin`IUM levers Prescribed,
12
N
4) Performance Mea.5ures: The, Jead agency must track, monitor and report on each
family aissisted for a period of at least twelve (12) rnonths, after the last date of
assistance was provided to the farnily. The lead agency shall report whether- thle
family was able to avoid" hornelessness, as weld as whether the family rernains, in
permanent housing at th;e enid of monitoring and reporting period,
The statutory goal (subsection 414, 161(15), Florida Statues for the grant program, is
15 to enable at least eighty-five percent (85%) of the farnikes assisted to rernaen in their
permanent housing and avoid becorning, hon-ieless during the year following the date of the
Past rant assistance provided,
Confidentiafity,n
MCSS has procedures in place to ensure thie confidentiality of records pertaining to any
individual provided with assis,tance.
Termination of Housing Assistance and Grievance Procedure,
MCSS may terminate assistance to a program participant Who violates program requirements,
MCSS may resurne assistance to a program participant whose assistance was previously
terminated, In terminating assilstance to a program participant, MOSS has a, formal' pirocess that
recognizes the rights of individuals receiving assistance to due process of law. This process
consists of:
- Written notice to thie program participant containing a clear statement of the reasons for
termination;
o A review of the decision, in which the program participant is given the opportunity to file a
,grievance and present written or oral objections before a person other than the person (or a
subordinaite of that person) who made or approved the termination decision; and
o Prompt written notice of the final decision to the participant
Recor,dkeep,ing,
MICSS will document all client files in accordance with criteria set forth in reco!rdkeeping
requirements established unider HUD's guidelines published I the 24 CFR Part 57,
File Set-up and [Maintenance:
lndividual participant files will be set up as indicated in Attachment B.
Monitoring;
MCSS is responsible for ensuring that the program requirements established by the HUD N'otice
and any subsequent guidance are met. MOSS will follow the monitoring procedures it
established in its substantial amendment submitted for ESG/Homeless Prevention, and ej-nploys
5taff that have responsibility for continuous monitoring of all ESG/HonnOess prevention
activities,
13
M
Attachrnient A
ESG HAMM# Standarcis Certincallor,
Page I
All Iwom"M asomed under the EmcNewy Sublums GNatt ASG) Must Pw"de sail arRi sanitary hounng that is W L'Olnpljance With the Ujitabd"Y standards oudined bebw and mq AQW er Ini repyremmm.
'lark each mat ment at A Ar approwd or D for delkient. Propciny muM Meet A mandards in order N) beapprovol.
1 I,Swucuire and iaaateratakw The qrucwt,es mum be M111clurdly mmind so as not to pose any Sea to
ocuVanN and so as ici prcijeci the residents front hazards.
_IAcee.,ss: 'I'lie howing mum be a"w,bW M ,Phle of being AS& 'vill'Out ullauthorized use of other
PH We PTOWS, Structures in List provide a I I CrThlte I'l cans ofc-ress in case of fire,
in Spce wd Saurity� Each resident nnim he affi.,,rdedadequatespace and security for therriselves and their
lVIOrIL2hI_2,s, An accepuble place to 5feep must be provided for each residerit.
4.h1tCT'i0r "it WHY: Every roorn or ipace must be proAded NAM raftiral or itlechtlnical Ventilation. rnwi be hoe of polluwnN in the at le�,'ehs that direaten the health ofresij�,entStructures
1_Watcr Suppfy; The Water supply 'must be Ace from COrItOrninatinn a! RVA 110 thewlen dw With of'
individuals,
Sanftar-y Re.st'lents must have auress to SURICKI sanim, theilitS that are in proper operadgg condition. maybe me d 5 privacy. and are adequate for personal cicarjdjne.j:; no the dkpaul of human mqsw,
7JhermaI environmew Hw hmsing must have adequate heatuigandOr c00fin.cl filcilifies M proper operating
condition.
___Uflurnia'Iatioriand electricity: "fhe h0u5bg at We adecluale natural ()r "Ircificial iflunlination to pe",rriit
TIOn"nal nIdO0r,Ictivitws and to support the health arid safety crfresid provided to permit use of essenthl e`tS. SufficicIlt electrical sources nju,w,: lac
3pphances wlifle as,�unng saf�ty troyll fire'
--mood rimpmdon and rdlise chspo5d: AH' Rjod preparation areas inust contWit suilabte sPace and equiprnerj(, two store. prepare, andserve I't,)otj it, as ��,an ita
ry manner.
I toardwry AnIlMriv -Me housing and any cquipmem inwr be nminiamed 41 Tankary conIthn,
_j I 1"dQued pwnr W Be Mrucmre w3N built ym to 197C and a cjjjjLj under the age ol'six or a preg„,iant
WOI-naia s01 T-Q.�ide in the propcny. md Be pmpmy has a delcive past swcxe C
PI-OPerlY Canxiol be approved unill to dewctj,�e st ' 'We Or Outside Be smthy:iclure,
`tace il Wn)Prialelf treated. Delemive paint sushce means:
oPplicabJe surface on ah1h pmy is scaling, chippin,:. peehng, or loose.
- - — Wwe wiy�
Ewh uk mum include at "am One b3ttery-operated or e.m PwPu "01mg cmdgiom oil
occupied el unit Sninke dewcmB inum he located, to the extent pracnc�,ible. m a hallway ad0cau to a
hvIvOm, It We un" 0 Occupied by heannjimpwred p"wnc YnAt dewcwn must We an alarm simem designst tor pugms m eanh he(li"00111 Occklllted by a hearing-hupaired pej.Ma)t
a.
14
[a
AttachmentA
E,SG 14'A)itaW11tN, Standards Certirmatiol,
2
Fho public areas of:] I] hou+ irli7, mti.qt be equ' ppcd �wit I I,,' Uffil,"MIZ Tiumber, but mm less i'l I an one for C,,adl arena, o
or hard-a� ircd smoke dewcaors, Pubhc Aletts Include. but are, not
COminunay rooms, day care centers,"tall"A'CHS� Wd offier ccmns, iion areap. laundry
Note, (lie fil_fllowing to assist In deterniming if unit can J:ae ajjpj-o%,e(j Oti,� def-Icient:
lhdldin� built rehabbed before 1978'.1
ChOdren uridcr 6 pf-eselic _ycs, No
Pr'C,mlant w,onmn preexlt —Yes No
CERTIFICATION STA"rEMENT
l ccflifY that I I laVe evaluated the property located at Ole address below Lot h e, best, ofmy abifityand find (he
The property rrwets all (,jfTjjC aboa ,e Standards 11-.1—'Yes _Nn
Therefore, I uxake the following derenjjination�
-riie property is approved _,,_N'es --No
Rarlicipant Name,
Rental Unit Street Addres,j� Apartment
C i I V, S I a te Z i P
F`,,,,fluatk,)r's Sionamure:
Date
Print
k1lachruent 13
'G ta
red' 110meless 13re%'eTItiO,,1 File Set Up anti Maintenance
A, FSG Hon , Wle"'s Pre\ CrItioll lilts Wd] he ,et Lirl ttj tJje
1. Fde lre+bQ�Ijj co,rsist
a S r 4 d 1,
P i'll"ticiN nt's SSN and tile C S I wca
()rker'i� se 2.er,, _�
, .) a1 c)r, el,
,�PecMhst's in]'rials. Igibility
2, Right side of the fille tolder (froun tc JP to )Ottotn) will Cont"'un:
HouselitAd demographics, to include drivers license, Social Security
card, and all signed releases to irjcjjde jjN,11S
,3, Left side of the file folder RIM,] top to bu(tojn) will contain:
L ESG/J,fi.,)rreless prevention Case File Review Clie j<jg
C I s
Via. F`SG Staff Affidavit
c, ESG Application and, ifapplicabie,
cl� 'TPlic`rlt aPPOint"Ient letter
Case notes, generated by worker.
Risk Factors ror Hor-nelessness
Self-Declaratior, of jjQLjsijj� Stitus followed by lease and eviction andiLor
late notice from landlord or property owner
SL'tft'ert 1OSS OfilICOMC CIOC Urnen tat 1011
ESG Ifiabitability Flonle Visit Check List
i. Rent Reasonableness Checklist and Certification to inCILIde refit
'01-it'le,160n d0curnentation,
Biank exit 1"orn,
4, 'k'hen the case file is ready For payment processing the documerjtsattached
flier front cover of the case file will iajclLjde:
'L Rccluest to Purcha-se
b� Purchase Order
c. Completed rental verifications
AI I related Vendor set up doeumemation 4 d k neccssilf-y)
N10111hly case notes input by worker MdicatmLy cof1jact %vilh program
participant M, ll i le t hey are rice], Vi lig ES(v h(mi I eless prew entioaj assistance,
Notes wk i I I ct),%,jI 11 i npLit care Plan i niplementat ion and l,,)rogress, 0 1' PlIrt ic iPllf [It
¢OW�Wds housing stability,
I&
0
Statutory Preference: Leverage additional private and public funds,
a. Document the source(s), and amount of public and private funding cornrniLted to the prevention
Program on the grant budget In Appendix W, and the budget narrative to certih/ the bind of
COMMitrnent of these other funds,
Ratio of PuWic and Private $
to Department Grant Request
SCOT
- . (,?zeLa g e -9qLj g
Other $ Committed $ 7'001,763.00
Grant RequL�st $ 50,000,00
Ratio:
Other $ Committed Per $,1. 00 of Grant Funding.Requested
0 No other puMc or private money committed
I Ratio less than Ll
2 Ratio rnore than I I but Mess than 2.1
4 Ratio over 2:1 Score Ojimed: 4
Statutory Preferences Effectiveness in Keeping Families H!ou.rsed
c. Describe method used to capture the holusing stability outcome and data available for the
program year ending Dece,rnber 31, 2012.
provide data on the clients served inn , calendar year 2012 on, success In staying in their housing 12
months after the last program assistance was Provided. Attach the data report, clearly citing the
source of the data and report.
0 Dents 136 Remain Housed Remained Housed
Served in 2012• 96/40 after 12 month5�
— 135 919% after 12 Months
S-c-®re Q-Z! lld--2E 11—Ou 5ML!jra b i lqM
0 No data was reported on clients assisted in Calendar Year 2012,
Less than 35% of the cllien(s, assisted remained in their permanent housing after
12' months,
2 More than 35% but less U'ian: 80% of the clients assisted rPrnained in tlipir
permanent housing after 12 -nanth5,
5 More than 85"Xb, of the clients .assisted were still in their Permanent housing
12 months after the last proprarn assistance was provid'ed
Scnre C,&imer.j5
. ..... ....... .......
Method J�,c�,cj for Data Collection, H-MiS and case files
.... . . ..... .... - .... . .. .....
Monroe CounTy HOMPless Services Continuum of Care, Inc. as the lead Agency and HMIS Lead
does nw pra^,aide Jerect services however the CoC does monNtor ,he activities of the CoC
member agencies/providers, glenerates crm
Munity rt_yport,,,,, ensures adherence to [IUD
reporting guidelines, rhe (nethods Used by service Providers for 2012 were client level data
into HMIIS, jndivldual case hips and case management f011OW UP. Housing stability verificatuon of
99% was, ccirllpleted by HMIS Adrnmn tritor vu,) HT06 data base information if the person
returned for housing services +e erlergenry shelter and/or transitional housing, There is m:)
report at 'LhjS lima generated,
Statutory Preference: COmmitment of Other, sistance to the Farnilly Receiving Hellp
c. The applicant demonstrates the commitment of other assistance available to and ready to be
provided to the families being ass,sted, as evidenced by executed written agreements, Such
agreements must define the role of supporting agency, the responsibility to respond to referrals
for service, and the type and level of service that will be availaWe to the fam0y receMngthe
housing assistance for past clue housing costs,
0
Written agreement provided for the following entities/services:
1. Local wor](force board for job training and placements
2. Local business entity to, make jobs available to the adults in the family assisted
2 3. Local healthcare providers to address farrifly health needs
2 4. Local Menrall health providers to treat family mentalillness needs
2 S. Local substance abuse treatment for Family member's addiction issues
6. Local school disti,ict to ensure child of school age continues to access education
1 7. Local early learning coalition to place young ch0dren in school readlness
programs
& Local Head Start or other day care providers to place the children into daycare
Scare PLLL —11m b P r of —Fx ec�t Le d jef v
01 No executed agreements
I I to 3 executed agreements
2 4 to, 6 executed agreements
3 7 to 8 executed agreements
Score Claimed: 3
( a, b, a n d c)
To,tal Score Claimed, 12
(12 Points max)
In the event of two or, mcore applicants having the sanne total score, the applicant with the highest ratio
of other public and private funding to the grant request will be ranked higher,
Apkl'icant ert�ficatlorn
The responses to the, above scoring criteria are true and accurate.
E. Scott Pridgen
Narre of Autfaorizpa Officer
Dare lune 19, 2014
M
Emergency SOILItIons Grant (ES(,;) Rqiort
AgerICY Nm'llv: �Mowoe ("'IMH Serrjc'2."
Rijn By., �!a n k: � (c' urmrlewilawrw
RUn 011; (41 If,) 2W4 l 1 Rvl)ortin g Period: M 01 "0 -2
Persons Sea r-Al I i f" t D V I
4a -flomeiuss Prevention Activitics
Number of Persons In Howseholds
At ulhs 41
ChdOrcn
Doil'w Koow ed to
%11�mmg
4b -Rapid Re -Housing Activities
.Number of Persons In Households
4c -Shelter Activities
Number of Personf III Households
Adult"
ChIlLherl
Don't Krlow Refttsed
Nh.ism4 hil"orruXion
I' u fa I
4d - StreL.t utreach,
Nulnbel- uf Put -sons Fri lJouscholds
kdluks
hlldrctl
Doll't Know Rl.,111sol
"m
Total
11111m 12
m
1" 3
briergency Qudons Cjm,j
`IIgVIIICv
Run By jsmaw nwomor�
1 '1 2-4,24 RMOONg P"hw: 01 111 1012
4c - Total P'CrSons Served
Nurnbur of flerso"s III HOUseholds Mal
% du hs '16
WWIt "q
Don'r KmAV N,:tumd
\115mg hwwm,jQfj,
Toal 136
5- Gender
Gender Total
%UO III)
FW&C 76
rmnsgendmd dp
1TV QuIx"ReWd
MI-W,�', ltlrtwmallori
Tcial 116
6- Age
Age Total
Uiider Is 39
1804 6
25 and over
rhml KnmvlOUwd CV
%f Sony IMMUOUr,
Mil IN
Special Populations
Special POPU13fiOns SUb-population 'row Tolal Persons Served TOM Persons Served
Prevendun RRFf
4
Now Wo"now",
Purs"ns Mth MahiMie.s
hanowk SAO"= IIIII
lNge 2 of
IOU 12 11 2012
Total Persons Served
In Emerpenry Shelter
Eniergency SojuLioris Gr*,int (E'S(�) Rellotq
AIMICN Name: ktomoQ ("oull[v S�wLd
Run BY: jq°%meue
Run On: (10 -20 21,u94 1 -4 14 Repol-lino Period, M ol,
Prograni Narne
I � PR P- \ I o n ro,� C� Type
0
thru 12 1 1 -`o( 2
Pa lu, e 3 of 3
tl tl l(lt',tEl l`di[t `i —(tI1 t Iit(7 tlUt7l 'c)C
Summarysport
H E'tuple
#E'CtlE7(t'
Axera ge
Enrolled
E-trope E
Bid
serN ice Gt}aE�
#CEierrts=
ill
ill Cher
t=tiElzatioll
9 rrlilsact olls � a�t:med
Null
tAtus
Program
E�itti�ill
E �
Pro -
� rams
rams
aver Date
Indicator
�T e
rogram%
as it End
Rangu(,,,
.rlrtttir°i
°tr uric`
Goals Updates
as (if Lod
tt
zatttsrts BHS
Updated Program i�ai lt? e�
:rt
Bed Reporting
1 eporlill
Period
IDS II"I s } 91 tr (I
'ijlalit� Period
tt [t ES6 201 !r'I"
�
� Ci<i'eaiai€ail
FZ4It6(I ())
(i
ESG g
Etrevenlion(M2)
E' ti KPZo-irl?ap1d
Rapid -1,c-
Ref'Ou%itagt7P 37
I Ilrutiiil�,
`�
Ifltrffiash I'-I.o su(549 )
Permanent
Sup pooh 'e
Ir
_
`.-i `.
I Ic?tisdIlt<supponivc
E'ILiitSi71
N-1t: 'zar1I1v ROLI rs( 496)
I1cF11r'Irri[,t
7Lippo live
!s t=
lousing
It - i IrrI1I ..(S= 06)
I.tmi anom
`Iuppo i vc,
i
�l-
IIrill�Pil
Poiticl.ana Dora °(' ? I
=tiill:lii€ 11t
(g di
`itl Pj-) l-tiV-C
SceI'Iitu�,iil
E c1I 'I 1 u, 4 l
er mal"M
Sullpollive
i [.Ilil ilrz`-.
Its t) tI
liptr,til€
[} 0 St, I ccic` E }
Ver-mallcill
i(i
Jil
Lisp
St- P-r•'alruis HUtr4O(5079
tEctrl�lrtl�
1'rali�itrt r1al
s r
Eitau in
I[ilrNs="51) 77)
=I i'o1[I:ritiE�#l'at
I1€ilj fl"rL!
4
e
Pageof 4.
Community Prograi-ization Summary Report
,
Odlahorali% e Group
iL---,()4
- Mom-()
Ujjv C, C
"J
D11tc 11:111ge 0 1 Al 1/2012
- 12/311201
its offleprat; 06 2tt 2014 1 w5 7(1
#Pcople
#1"Cople
AN erage
hirolled
Enrolled
Bed
Seri ice
Goak
r1cliews-
if)
HOUsi,19
ill Offier
Pnigrams
Uillization
User
N
Transactions
Created
Status
Progrant
Type
Progrn a's
as ail Vild
(IN er Date
Atilhori
Indicator
a-, of Lud
of
�gvnc% -Naniv
zations
IMSA
GOals Updates
of
RuPorling
Updated Program Nanje(Ko)
Bed Reporting
Period
[I\
08 9
4 71
0 121
4 11) KOTS(5w, j
Capacitv Pet -iod
of
4
3 Jel - seni a( io,'4 3 )
22,4
1609
0
Shcher
0
0 0 1 FKOC Nlen Sup portive
-1
0
low"1111, 11rovi all- , N
0483
how'Ing
FKOC' NSJ 1166-24)
supponive
IiLMSJJJ,
FKOC TranNilional
-1 -FEM-N 111011,11
liousing(481 1)
hO WS I I I g,
0
Necce Cciaer Nlen,,
- 111-T4171-Q I I C
F- 1] jjerL1CjjCV Sheltcr(64'34)
SI
157
0 13
1
U _2 C1ubHoLj,,,e14X4X)
scn, jCQ, ()J I I
Progualn
0
PATH( 71 tWj i
SV_1'% ILC., 0111y
1I,-112h1w 0
kn�
0
Program
It
Indqwn"Icm-C 'v, 0
0
0
0 0 Tran_,�Hiondl
Transinonal
KC k" WC1, i I I 0i 1,J
3
Houslnu(4884)
Awhoj i-�\
0 0
0 Old Town
Housing,00781
A M)': I t
0
0 D011 Moore Api,(490 1
11 er11141jent
(M
scaRtfred S,
jl"(50M)
Pen-nalleill
N4
Pape oI 4
Community Progra�," ization Summary Report
i'llagI)tl I
a(lllg"girrtlti) -604
e ;,-IO[IfL)
L �7ttt1(} I_'O
Daie
tii,ctalfle
lEa.`d➢ple
ANcraave
"
Lnuolled
Enrolled
Bed
L
Serx ice
Goals
in
14fttasaaal,,F
tta Other
('rog
U611tatilaaa
it aFt g
C ramis actasslfs
CrCute
Inside
I rogr ain
Program-%
aaats
asfs! I`_lid
aFt air %}iftt
Rauge( l,F)
't iat itlar i
Indicator
as of End
of
l tta .ataa# t atatttia
BUS
Goals Updates
of
Reporting
Updated program attafal+�,e)�)
Re R
Iaalrtat3 g �,
Period
c apaca(o erifid
SG-KPZ06(t#98I }
Pre\ clittattl
i lKPZOftt r(j�S)
Rapid Re-
E ltausill"
Il
I(PRP-NI€ilirti4
1(tt3t l 4gf1
Rapid R -
([;lit.-=}
(
l�t a"mi_
167 Casa cli` ; °I#:rclttff 49,21
Permaliclit
tal�li#lf"t i 1't`
—
E lit
11#]tt�l[a4;
1=1TSLl 'tii 5' 11 lira{`l087)
l:=tiffs"ilYc_v
€ elter
athy'�! IIOpe(jOhK)
Permanent
Supportive
�(t
MTTI7f084)
PtTlllanEIlt
( tF
41 1
d2tl lMobile Otareacat
7Su(7portiv
4
ll#arlfc6o ':
Pro ecif 63261
Otltt r;at h
ti�tti
t
�. iF,i jl:{
[ ^
.-.
tl 1
_
6 J � clod Baia (5594 #
Holnelcss # t evcIilicill
01)
Progr1€l71(628
1 41E,m'llala to
0 Ifs 1624 Spaulum-(50a)t
Permilnont
12
y
1 E44j jl=4
St9Ei Eitia t a 4 C
5€ r
p
(iS.}tIm liv
Page 3 of 4
C"I"WHitY Prograi-, ization Summary Report
Coll aborat i % v Group I- L-oO4 - Moll,-oc CouIlly CoC
D-We Range: () I M 1 '2012 - 12/3 1 12tj 12
m
Unmcd Nuitc,
1-vi Io',% 11111 io
Horida
I I AL
I
Siam ice
N Tactions ransactio
Atilhori
lations 1311EA
109 tl
74 4 X, 1)
Coals Whents-
Created Status Pro -ram
m
Indicator Type
CGals Updates
Updated Program Name(Kev.)
it 0 16 1-10-0:1 House(4866) Pelmatient
Nelson & Sherry Read
Bldg(5) 187)
8 Veterans TJJ(5 196)
0 4 1 o 45 918
Pape
4 of 4
Date oflZspurt: 0612-0/2014 IW57-2()
#People
371,vople
A, cragc
Enrolled
Eilr(ilied
lied
in
in Other
titilizati0fl
110using
Pnigrami,
uN er Date
Prograova
as a,f j,'11d
as ail` End
of
O
Bed f
Reporting
Reporting
1'erj,)d
Capa Perind
10
hill
IN
4
44 4�00
Data SLIminary All' Persons
Note:fl11 t1 page Net desW1.
ried 10 dot � mulraur7itlNA
ro law Ink
Al 1AR
W pHur W
1'cport c,"g?G7 ws M Aw WAR Icw;:arrr"j1 CL VITj,
vP��' r w;Bt till tlrblkll'Crltttl43fV
.wr,hmlrNng
their
surtrr�"Lar p ac ur',,71�° e.urjaj tiaa��a�p��ac.
Ira t�ll
� data
Ra,'1rtwtil } 'al'!'` 10/11/2011 — 9/30/2 1 3
Sju ( Monroe Ct)ujjtN,
Bed Coverage Baths
acqua•
'
p .
P00a IP
rfta Tr flP
10011
-r,
90"
11upNtcated Counts
t 3ear count Wtober I'SePtemI er 30)
7 I
Q�uu .urn arou,raa;�u� a�Iht
1. 11 tar
63
'26
(;
I X7
�y
A ��7'i�t^9p'h.•'�.9it&1�' Wants
13
Yta1
?z
87
49
1 <25
CA t hvr 3 1 2012
'Way, 3Q ,?R,t13
16
17 3
')
"I'
-tru
�.
1 28
d1,Ga r1 .'4, 01.1
Ica
177
27
C�'-�
~�li'
1 ��
,1414' 31, 201 3'
I125
157
23
85
45
124
Number (if Families
tTa FSit
year count (0clober t-Seple ber 30)
TFAt6F°,,wI
I Pint»rat-"Nyasa: Counts
78
2
23
WPaher 3 A 2012
7
,.I�CClpafdd,�""�' .���'�� a��11..'�
I4
Q r1 4, 2013
15
201.3
5
1b
16
Average Household Size
Persons pvr Household old
t: SFA Xt
ITIFAM
t."attt^ANt
210
1.00
�.lfda
(,Wher 31, 012
7.30
Jmmoy MP 2W.3
?„l 0
210
330
4m1 '4 013
210
120
�60
it)
20
Bed and Family L'nit Utilization Rates
I'craMI Rr^u'1S t tabled
E;"wt" Nil
HIF Nil
I t'1I,NO
I SILIh %M INHINI),
dau Jan aitrCag4 ra3Nght
f,a11„
koher 31. 2012
P, a4PJftf+9 tiCl _rIJ1,,a
1ti"
1"we "
-„�,�
ff'a d A 34.1'
I
G91 PV. roC11 Y 4.,..a,. �N C 0k,., R. o. ,.
C.N.. +,a.n
Percent Famil) Crtits Utflized
ESFANI
f"FA)l
1141MI
-AMMA 3(Io M
K30i
Ow",
14P,
juk 3 t 10/3
6w s,
15 1 %
83%
Long of Stay
Pment of Reds LAHzed
ESFAIJ
ESM)
T"FANI
honwl Turnw,C,j, -
T1 U N D
[ISFIFAM
psffjNp
hed; "1 1 vul,
123
6 30
00
1,73
1 42
Missing Data Rates
able
Gcndi,o-
ESFANI
ESIND
THFAM
T H I N"D
PS"FAM
PSHIND
Age
0`11
1`thmcm,
0%
4
0111,10
We
u
011
00 11
0',
b H"g MW& Sq,
01�
01%,
0%
Amy
011
00
Zo Cwk quan pv"mwm A&&M.y
0110
oil,
01a�n
011 o
0`41
00"'0
0111)
hbluehoki Qpe
00%,
Length QQ,
0`01
00,
DO%
Number (.) -
nr
Wl;�
01�
Aymbonlayho-CIMmyn
0%
Destinalion
w,
C11, i
0�1�5
a Per r 7 0 0 1
F ch r f P kq
S of Hmtm, aw U&M Dn d"Wilt Otncc of
651 socmo
Older Zowr,ic w rgft iij,
Exhibit 4.1 Length ol'Stav in E 11" el-Ijency Shelter and 'Transitional Iff-msing I or Persons
FCav 10/1/2012 - 9/30/2013
Si(c, Moriroe 'aunty
PvrSoms in
Families in
Vniergenev
Shcltt!rs
Length ot'Sta.
Cull]. %
It cek , w A,5
5n, 15114
/ m i) a Ih
I 4t),,Q' 30",�
'nim1hv
3 7e',, 661) 1)
MWIths
3 1 Q 7�",
6 9 pnowhv
3 010 d 00 Ile 0
12 uiondis
0111lb i ()00,)
nbimi'a
ou"'j d OfW'o
Persons in
Persons in
Fanli$jcs in
Individuali
lndividuals
Individuals
va In i [ i v"j in
i fl
Transid rin�jjj
Supporr iN e
Ir
Emerguiev
i n
Tra n sit ion I
Permanent
Hijusi ng
Housing
Sh el ters
a
Housing
SUPPOrt ive
Arta
% C as
tlA C as In. 1%
fll CUrn.
n si "a
% culn,
Cum. 'N�`io
0
34(�,,
slT 11 /
5
3%
Y9 591N,
1 951�
WJ 6
40")' 5 1
Gl o
8
Nil 48'11,1
16"
25 ra 7 6
mo"O
9 1
67�1
qi
Y o 79(l
4" j) -4 5
P'o 781�,D
u
501"o
%
5 5 1 Oou/,"'
4 99%
72`� 00 11
50". ()Oil
4yi"" 10 0"1 11
1 001110
Wild 00"
1()%
0011
Exhibit 4,2 Length of Stay
PSH-IND6
TH'-IND
ES-IND —
=7
PSH-FAW,
7—
TH-FAM
ES-FAM — 7-
-I I I I I I
20 .40
-0 80
A "week or Bess F.3 months = 6-9 iponths = 9- 12 rionths = Unknc,,vni
I veek to I "Onth 3 ?-b monzhs
e""' li'4 1-1 e)h , ! '111/"11" "(1 "7
flIJTI 4 j i I d 9
HUD Annual Performance Report (Part 1)
�gtlllc,N NaITW, SQrviau,
rull taus'. Icammc nk, onwn
Program Namc�
Progrtml 1)pc
APR Q7: lj,�11S, or COTTIPal-able Database Data QualitI, RePorfing
Period., M 0 'w
r ti
I otal n Imallmr Of allPlicable records, for Alf Clicotj
1"fal nun'thc"art aPPlicable rwirds for Adults
;6
I'Wal number ofapplicabic records, for UIUCCUraPinied CiOdren
9f
TWA olutober OfAPPlicAble twords for er)
Oata Ellement Don't KTIOKor Refused
First Name sr
NUSjing rj:jfj
Lair Name
al
S.S N
Date of Birth
Ract 4
Ethnicity,
Gender
Veteran Sratus 5
Disabfino Condition
Residence Priar to Entry
Zip ufLaSt PermallentAddress
140usillLl Status (at enta 0
Inconle 1.11 entry)
I ncome (it exit)
"Ile
N"') Fl - C3 s h 11 c fil ts a; I I entrap
Non -Crib Benefits (at eNit) CJ
Physital Disallilit,v (at entry)
6't"'el0PRlei1W Ois,'Ihilfty (at entry) o
Chronic ficalth Condition (at entry, at
23
Ii I N'/,% I f),S (a t entry) is
MenW Health (At entry) tr
Substance Abuse �w entry)
23
Doinestic vinien C L I at 1,T] tr+,)
13
Destination
APR QS: Persons, Served During the Optraftrig Year by Type
f'olal NN ith(otit ("hildren U ith .- Children am] kdults
Wirlt flnK CAIddren
U n k n ow n T% p e
k dulls
Childrerm q
Nn't KnowRcfuivcj 4)
cp
Nfissing
ri
kv'CrifIle Nlimber of Persons Served Fach Night
Flifal Without Children NN ith ChUren
ith
L nknimn J)pc
and Vdilks
(10dren
\%enam, Numberid: Versons 0
1 i1
( 0
m
Noe:
HUD ,knnual Performance Report (pal-t
N
run (I've: Oil 'o
I' Is 1, tA I w -* r-, f d I ,
Voinf-in-1'1111L, COU"t of Perions on the I-ASMAnesdav in
'Total Without With Cliddren Wi t is Uoknowo
C
lanuary I hildren and Uults onilly Children T,) p e
71 61
Oct ober
7
APR Q9.' Ifouscholds Served During the Operating Ve a r
Number Of 110useholds Served During the Operadrig N'ejr
Total renWith Children and Adults Nvitlj only C11ildf-el, Unk n own pe
HoUS01olds 60
I! of I'louseholds, on the La,INN' duesdav in
T o ta I WithOut Children With Children and Adults NVidt only Children Unk-nown Type
,January 00 1 S 1
, kPI-il 60 18
J u 1), 60 18
October (4)
k PR Q 10: Bed Utilization Rate
NOTE- PrOg"'In's %w ill not need to enter any daW for this, quoition. Wnvwwerw otill he derived !it esmaps
upon entering other data. Ilowever, HMIS vvidors tvay choose to generate this question for
validation purposm
Bed Utilization Rate
Average daily utiliyatir)n rate during thie operating year
POIW-in-'Finic bed Utilization rate on (he lust Wednesda,, in
January
April
Juiv
October
k IIR Q l' I. unit I fili7afit)n Rate
Usit Utflizadon Rate
P$')int-in-Tiale unit Utilizahon rate
'Januar v
April
-I It IY
t' kniber
FIUD Annu-411 Performance, Report (Pai-t 1)
run lea: mck2rnon Program Fv;w
run clite: 0h 10 2CH-1 Hi 4.t m
QR Q115: Grfider Rt�l)Ordng Period! (11 10 e'M
Q15a. Gender- Wults
,Male
Female
Tra lus-e nide red
01her
D0,11 Know/Rel'used
fiOurniurion Missing
Subtotal
Q156. Gender -Children
EM
Male
Female
Transgendered
Other
Don't Know/Refused
Inforniation Missing
Subtotal
Gender of-%dults
Nu mber of kdu ks in Households
Total Wilhout Childrvit
ti
With, Children and adults
li
if
, mender of Children Number OfChildren in
With Children and Adults With Only Children
24 0
14 -
Q 1 5c. Gender - Missing kgc
Gender - Pe rsuns %] issi rig - kge I n forin a t ki n Number r) ( Persons j F, I I ouselliflids
thru
Vnkn(mn TYpe
it
dY
Un"known Type
0
fi
tf
)little
Total - Without Cbildren With - 'hildren and Adults ""iomy
d, Cbildren Unknown TNpe
0
Fe In yfle Ij
I ra n r,gcn d ere d Cd Ij
Other
Don't KnowRefused
ffifor-madon Nli0ng
Su bwal
,U25
P:1 Oe:
HIA) Annual Performance Report (Part 1)
AIuncw N I nIL: Vonn,,: ("kiwity Soi;j I sc�r-w
Pnmmm Nmm
)e,Mclic mchl i,mm mamn r1p,
run daw: 06 0) 114 10 44 01
kIN WN We
Rormwting PgH": 01 10 1012
Age Yumber or Pervins W Hguwhw(j
'I otal Without hUdmn With (THdren and Adak "Th unn ChUlfren
Under 5 0 1
1
13- 17 fi3
18- 24 1
ld
25-34 1.;
35- 44
45- 54 29 5 0
55-61 f 6 0 1 1
62 * 4
Dual Know/ReNsed
fnfolrrnafifjn Nfissing
Submal
A ?R Q 17: F t It n ic ity and base
Q 173. L th n i citv/ Rj ctt - Ft 11 nj cj"°
Pin, H Npa n Wan- Lana
Hispanic/Latino
Don't Know/Refused
hmmmmina, missing
'74m]
Q I 7b, EthniciqlRace - Race
An 11 N N�:
Fthnicity Number td"f,ersqjns In Ifous(holds
'I"Otal Without Children %VUh ChUdren and Aduhg NVkh UWY ClAdren Unknown Type
5 1 54 1 1
17 7
17, 2
CI 1) C.1 di
White
Black, of Africa"- American
Wan
kruet-ican Indian car Alaska Nati,,c
%'Whe Hawaiian or Other Pacific Islander
Nfuhiple Rams
IMA WWRefuwd
Information Nlk4isig
rwa1
Race Nurnher or Pennns in Hmseftt=
TmW Without With ClUdren
Children and Aduhs
53
13 114
0 ti
4
9
Page
With only Unknown Type
ChHdren
HUD Annual Performance Report (Part 1)
ran hw fL:JnQM2, wckm)on Program Typc
run dau: Oh TO NM 4 10 44 w
Repor6ng Perrod: M N 21H
OR CPR! PAINal and Nhw Inah CmWW,,
, F,,,
'Q I Ma. Physk a! and Mmial Health Typcg or C WlUuns
Kno"n llh)sicaii and NkMM HeWS Ct"Wuns Number or Persons in "OusAulds
I'mal %N ithout idi C Ir i Id ren % HIS un"
Un Uon n 1) he
Nlenml Illness ChWen and Adults Ch!Mrpn
11mg Abuse
Chronic Health Cosidifion
IUVAUDS and Rdawd Dkemes O
1)(WOOPMentA Disability If 4D
Physkal Dhabifity
QINIJ, Pbyskal and NNmA HIM KIM"11 WAMuns a Ent",
Number ufKnq"," Conditions Number ol'Persons
TMal Houschoids Households with Ho u sell olds
Persons
Unknown
Withom Cllddrvnand wohomy
Humchulds
Chficiren add ulm ChiMran
None
49 60
3+ Condidmis
0
Condition Unknown 13
FMV KAWReNwd 1
ID
2 VD
information Missing 7
It
Tawl
APR Q19: Vianns of I)oun,01,
"3- Past DOnlestic Violence Experience
Numbw or AdMN and U]"Accompanied Children in Houseb(Ads
o I al Hhout C I AM I a With - ChHdmn and Adults %Vhh On" C hilldren
Unknumn Tpre
0
id
Nq 23
Don't kno-Iliefuwd
Information Missing ii.F
2 ti
Total
Id" hen Past 0OUICSIfic Violence Experience (Marred
Nvurnber of Adults and Unoccurnparried ChUdren in Househnkis
rot al Without U Ith ChUMTn Wth On4 Lnknown
Children and Units AlIcImn
T;pv
I Niondis
3 to h MUM kw
h to 12 Mondn %go,
Nfore than a N Lnr \(go
DoWl K114m liol'u-Nk-d
Information: Missing
Y,
HUD Annual f gl eo r (P a l-
koencw Same; waltbaltioc ('o m, Strr Ilal �.a"a la"��Ik
run b) y a,nei'.l"y" roggram 1)pc:
run (hate: 1)h to Im '� lo-l.,Q.bll
a, Repolrtang �y4"1'"Cd6d'�:: M ill
klwll t��lla l�rstad4nl@ h'r'u"iar 0) Program Etatt"4'
t�aru �I
Q20ul. Residencc PHor to Program { tltG}" ^ dl8nrrneda" ti rttauatwr:atos
Residence Prior to PC'PSgf"aniiI EntrY - 11olneless' SitUat4o ns N9N#"tl"kbvr 89f Persons in Households
TNat ad IV khuaet. With Children VV`ith Only'
1 nknoon
Children ;and Adults (Affilren
Tw,lee
Transitional lltauwirtg 1''N)r
l8
Homeless Persons 0 a (b
tB
Place Not Meant For
Human llathkaatlaan is tl 0
1J
Safe Haven
Q 0
ll
„Suhta'etaat
tQ
Q20aa2, Residence Prior to Program Entry - lustitutional Settltlgs.
Residence Prior to Program Entry - Institutional Settings Number of Persons in Households
Tout Without Children "4wa"ith Children and Adults With Only Children
Unknowwn "I'�,pe
PsYchlatric Faciity 0V,k
uN
Substance .%buse der I)erans
Vl
Carter 4:B ty
V
Hospital (Non-Psvehlantrich
1
i}
Jail, prls n, or jUven0edet p 0
it
Foster Caa-e G'R 0
Ci
dp
x 'wularntaa:l
P
Q20-al. Residence Prior to prograana Entry - Otb r 1,1actetiona
Residence Prirar to Prod,raarn Entry - Other Locaadons Nuurnti'r of Persians in ldonsehold:s
l until Without With Children With Only
Unknown
d. hil:dren and' Adults Children
1'w"pe
l�"41B for Homeless personsd) 1)
- _ �._ �� _ _,.. (1
11 law S"li`ent no Subsidw
0
Owned iaw Client, rowa�tln �
"uhrsldy_ fi q
il'
Rental — th
hw C"Herat, no Subsidy tr �.
fk
dlentaI h+ C_ N[Itw w iffi V ASH
P
J
Rental hw' C h ent with Other Suhsla'dv � �—
d1
Paid he t�"Bent tV [y Vt
011rNQcrlf'�lruta�l„
4ta. I air i.uw lra�:1 vith "w rflw 0 0
d
S uroan "tar l.iwing with F'rlendisp 0 t p
Other
tb
Don't KnowRefused
lralanrnnation Nflsring
¢
Subtotal
Total
a
&'alg � to aNl 11
IIUD Annual Performance Repj),,,t (pal-t
kgcno Name: Momo,, Cowl� socl.d S,�Fjk:o
run hl: L�,UWH,' McIcrnoll
run data: 06 TO 20 W 10 44 o
k Pl? Q2 I ; Vereran Status,
PrOmmul %mm�
Programoy pm
RePOI-hrig, Pcrio& 01 0l �'m '
VOerin Status' Number of,wults in ljf)u+efjojd
vocran Tocal Wilhul ChIldre n lVhh COOdmn and Adults
Not j Vo"ju
MWIKmm%NWd
1105maMn nOWng to
Tuwl
WR OIL: MOW and NknUl Heatth Condition at f,A[ I)y E%it "status- Leavers
(22221. Physical and 'Aintal HellIbUndidan Qpes at Evil - Imavers,
KnOWn P40al and Mental Jleahh CmdMms Lea"m - TWW Numbu by T"e
Mll pwrsmls t,4 It I
tdIrn.n
Unknown Qpla
dw
Wt
U S (.1-uldren Un k mi w n
NAMW Dum 0 0
td
XIOAW Ahme
I)mg Abme
CIII-011ic llvaWl Condition
I"VhUDS and ROUNd ENsmams
I)evelopmental Disability
Physical INs ability di 0
if II
Q2242: Number (if known conditions - t,Lavvj-,S
Number Of KnOlyn Conditions Leavers. "1'aatal Nurniber hy'rype,%fl, PersonsAdults Children
None All Permins kdults C'hildren ljrink nwsn
1: Condition
-ol
34- CondithION 0
o
Don't Know/Refused II ii
Owmmii vim ng,
lWal QY
APR Q22b: Phym eat and N" HeAM CnOWHM M E%H by E At Maws,. Stevens
012bl. Physbal and N60W Huhh CmMdmoyps m Fut. %,rN
Known Physical and "Mental Health, Conditions Stayers- Tow Number by Type
%H Mum %dults Children Unknown
NIVIllfl Illness
Acotiol,Ouse
Ikug lihme
nW
Chronic 11calih Condition 0
as
1111 OUDS and Rdawd Diwams 0
Page: I of H
I-IAnnual Performance Report (Part 1)
kgvucti, StXVIL'c:Jh
P"J"M Nmw;
run I)�: Program Typw
�Ua (JAW �16 21H-1 10 14 W
OZ2U, Kfu)��n ph�, Repwting PeH": 1" of pm! 1%
,jcaf jjj Nrv,jLjj liedl1j, [ arneigtttatt at salt. ta) J,�S
NumhnAg Known L'undAWas Myers Tatal Numba by 1) pe
Nonv kit perwns Adults 1. nknovkn
tl
31 Cun?dom,
Disabled - Unknown # 5
D0111 I&WReNsed 3
Inforsnation Missing 7
Twal
APR Q23: Clbnt Cash Income Range - Income •%mount
Nil mber of Aduhq
Inconle at Emry IncOMe 21 Lato'l Follow Up for Stayers Incoone at Exit for Leavers
No Income to
Sl - Sim 0 0
S 151 - 5250 1 0 0
S251 059() 3 0 0
$$01 01000 7 2 0
SLMH -SIYM) 3 3 0
1- 3
's I,io I - 52moo 3 0
52301 + 3 0
D004 Know/ReNse(j
Total 77
APR Q24a: Client Cas
It 'WOMB CAWSY - l3cf)tkle (Mega y - by Entry and 1`0110Y u(r/Exit Status
Number of,%duRs Number ofWulls at rojjotiv_ Number ol'Adu ks
24,a Number o(Adufis By JWotjj(,* C,aregory atFnwy u p at Exit
CS t a ye ri) 1: 1 XMyn),
%dufts Aith Only Earned inconle
Units s0h Only ()ther Incorne
ul
%dults wrath moth Farned Incorne and
(hher Income
4 If
\duhs "ifil No Income
%dulls with D(mlt krjor% I 14efojecl 111coo7e
dl
\(101ts )'wilh Nlissing income Information
wai %dults dr
\qNIrs mth Incijinv lnfi5rrnaHon at yntr) md
Fljlhm-up Exit
M of
1-1 UD Annuld
Performance Report (pal- t 1)
Program Najjaer�
run hlti: ,3ncu w,:jcjjjjjrj
Prouua, 'r,% pe:
ro it datr-, 1 )6 20 20 13 1 o
NPR Q246.k ('jjtnt Incotnt,
f"rj(ry and Latest Sratus,
thru I
24.b.1 Iticome IfAd! Incolne
C h a it g C by ('jteq-4)ry at
Retained
Income
Retained
Re(jined It Not Did Not T"Mall Adults
PcTI'Orinanec Meawrts:
111conle ('alegor), Entry Arid
('Att900'
Income
Category
Income INVO the 1141 e the 0ricluding
Catvgor) Income
)Nhu gained or.
1Uniacrse: Adijit Did Not flave
But Had
and Same
Income (110se NVith no
S and Categary at catcgor%, at inconle)
increascd income I-ron,
Stavvrs with it at F011Mv-
US' S at
at Follovv-
Increased Entry and Fniry or
entri, to ftfflolN-up.
Itioente up
1111"or"lation a,
up as at
at
at Folluil- Gained the Fofluw-up
%Vcrage Gain
EntrIN, and
Than at
FnIry
EntrN
u p inVOiTIC
FIAQW-Up)
Category at
adults who
l„^ained im,
incrcascrd (11 Iwat
foconle a d! u: JI is
Number of,ktilli(s
svith Earned i
1
Income
0
Avcrage. Chmge
in 1?arned -'S 900,00
Income
0 01 0 U
S0
S 31A,00 S 11900 0C S CM,00
S W I 09.l0o
19
Nomber ol'Aduh
with Other
0
Income
50
AverAge change
S
in Other Invome lYlS
w.)
S0
S 2 N (jo S mo So S I 1Y50
S 2 U,)()
,N; iia in b e r o f
Adults Anv
0 0 4
Income
ll
Avvrw Change
-S
880.w
S
SM,
.00 S f 10 50
S()
00
m
HUD Annual
Perfim-mance Report (Part I
A;IvncNanw: %fow-oc l. oiajn
s,L:j.jj
P149"m Name.,
Full by: jc'lnou mklti"�'non
Pragrmn Type,
x0j "
run daw; Nh 2N 2W 4
10 44
—1
Rcpwdng PeHmh
o, of jol I
thru 2
%PH QUIT ("
Cmh "mu WfNe
Ncome Nmrce - by My and Bit
2430 Income
Change by
Had Income Waited
Capgary at Iwome
Rwwnm
Ncume
Retained Did Not Wd Nor
Totat'�kdnjt
Performance Nleasuirvs.
Income
Entry and ('atepry
Cap,,,
Income Have roueHive the
Cawgwy Iwome
Onchiding
Mulls who gained or
Category
Did NM But Had
and Same
Income
and caugmy 21 caumot-y
those soh
inCjr°eased income frorn
L'nivarse;
Have at at 1-c"581
S31exhas
as
Increased EMby3nd FAwynral
nu Ncome)
cH my to edit, Average
Wult Leavvrs
cot exit Phan
at En("
i at eth Gained the U%it
(hill
"hh Immme
at Entry
Inhwmadon at
imume
Entry and EO)
cAnagwy at
e0t
ME who
gained or
inueawd Is or twal
hin2rue, adults
Numba of Adwt's
with Earned
t,a 0
tB
dk 0
Inentueit
0
A wrage change
in Earned
ti00
1wome
W
S
of
001
Number of Adults
'with Other
0
Income.
0 °I'ia
Average change
S 00
in Other income
JtP
(,) so
Ou
S to
Number of
AdWO Any
0
fP
0
Inmme
0
AVO,age Ila nge
in Ovuall
ncome I
so
S 00
,5 5
Page:
I I UD Annual
Performance Report (Part 1),
Agvllcy N�anlv; sor
j
run 6%
Rvpw%R
PeAM: IN Ol Au 2
thni
ash 'Mume
Chu"' -
"tcumc hOul"Ce
- by En"I
and Imml StatuyLqt
24JL3 Income Had Income
(Tang by Category at
Wai"d
Income
ROMned
Relained
Did Not
Did Nof TMW Aduhs
Nrfarrnanee
V WOURaN
egury Ennyand
caugo",
Income
(lww gy
Ina"ne
Cutegwy
Have Me
113�e the Og
AUltS 'A ho gailled or
0"Nem: End Did Nw Have
But Had
mud Same S and
I ncome
calegur)
11100mc dlosencludina%ithno
increadwdinNmur burr,
Mults with it at hohnn
l-css S at
at AMOw-
luereawd S
at
Entry and
(Alegury at income)
Entry or
MIU to KHOWUP/elit,
I noenw, upiexit
InAwmudon at
follow-
nP/exit 'Js
at f011OW-
Gained the
at
fotlow-
%,�cragc (;air]
Entry and ekher
UP501 Than at Entry
UP&M
income
Uwexit
Fullum-up
at Enh.),
(stayers) 01'
Follow
Why oho
ExMLcawrq)
Upowl
gained or
increand
income duhs
Numb" of Aduiti
Vvith Earned
Income
A "rage change
in Earned 4M 00
Income
s 1400,A)OI
s IWO)
5 1
NumWr of Whs 0
%Wth Ether
2
0
2a,
2
Income
50 on
'kverage Anne
s
00
in Other Inconle
so
5 Too
SO s M
s NAD
'Nuit'nher of
MAN Any
Income
%verage Change
In Ow"aM -5 QMWO
s
f I I Ito
s
Income
so
.00
w) s � M,50
�Ilvnc, UIUD Annual Performance Report (Part I'[)
run la)`: 1cxlca lci°'r9aprMarnr pe:
rull dake:
Ol of "w-,
UP Q25: CheM 4014"C9aMe "Imurce'; h) FVt Matus
Q25i 1. cash inewtie r,pt, in exit st4t.
AVers
Sourcloi T ' Npe Sources J)Y Number of Perswt� - Leav ers
Eirned Inc"me tp
Tool �dults Children
Unvniplf)lvrnent Insurance is
SSI
SSDI 0
Private Disabilit y Insurance
1p
Wnrker'j Ompliensadon 0
TANT or Equivalent 0
pi
GOleral Assistance
ti
Redrement (Social Securitil)
Veteran's Pension
Pension rrom Former Joi)
Child Support
Afinlon.v (Spousal Support)
Other Sourte
Total
Q25al (-aih 1"cogle [)v Fxij Stjltu,,
Leavers
Casb-Income, Sources Number orCAsh-Income Sources by "iumhcrol'Pcrsoujs Leavers
wall
No Sources TAdults ChUren
I r Source R.$) to
Don't Know/Refuwd
Nlissjn4 thiis hiffirmation
T ultW
I h ru
IlUD Annual Performance Report (Part 11)
run law MArrlml Vrogram 1 1% pe:
rull (LIW, W) _0 20 11 10 44 4"'
keporting Veriod� W M "i I ." t h r u I , • I , I I i ,
PCI 13Y Va test STAWS - Stag ers
CAsh-111COMe Sourc"i Type of C,ish-lncomt, Sources by Number of Persons - staN ers
Tof A l %A ,, I'
QZ-Sb2. Cash lnc()nlle 1)), 1. jjelt Stgtus-Stayers
Cash -Income Sources Number of Caih-IncoTile Sojja•ce.s I),,, Number of Persoris - Stayers
Total Adults ChUren Unknown
No Sources A
ih
1 4- Source (,S) 3 f
Don't Know/Refuset]
0
\Nssing this hiformation y 3
Total
In
FlUD Annual Perforniance Report (Part 11)
Program Niime:
11), L!11M'H1: Program T, pj!:
run data: 06
l4porsing Perio& W W -'(0 (brut
%l'R Q)26: Client Non-Ca'sh j3cnefirs 6 Bit Status
Q2641. Non-ca$h jivnefl l'yPes bv Exit - Lxavvrs
NOTI-C,15h Beylefits
Non -Cash Benefits b)' Number of Perwits - I'taVers
Chddreu Unknaansn
Supplemental 'Nutri"OnA Assh,tance' Program
MEDICAID Health Insurance
%NEDIC,rknrCF, Health Insurance 0,
Sato (. hildren Is 11-101 Insurunce U
WIC
VA Medical services, 0
TANT Child Care Services
TA N' F Tra rispurta ( i o n Services tN
Other T'AXF-Funded Services
tY
Tonporwry Rental Assistance
0 NN
section 8, Public Housing, Rental Assistance
Other Source
Total
Be'' tits bY [Atest Status - Leavers
Client Non -Cash Beneflis by Exit Stattis
Number of Non.Coa 1p, Benefits by Numler oJ'Persj)rj,.s . 1,e„jvcrs
ToW %dufts Children l"inknown
No -sources
1 4 'samret,
0on't KnowNefused
tN
Nlissim, this Infi[IrmAtion
m
Va (,, e
IIUD ikiinual Performance Report (Part 11)
run date: Ot, 1h `0�4 J(q kcpor6n1: Period: 0� 11l
2 6b I � "ion -(:"alit Be n Q ft I 'I, f,cs t)v $ ;j (CNI St , I u t a Vr,,,
Non -Cash Benefits
Non-( ash Herieflits bY Number of Persons - Stavers
Total Adults (''Wren
SuPpIernental Nutritional AsOstance Program G
\IFDICAID� health Nsurance 0
MEDICARE lleaWi Insurance qh 0
Slate ChOdren's Health Insurance q
0
VA Medical Serviees tj of
TANF Child Care Services 0
TANF 1'r3n5portation Services qp 0
Other TANT-Funded Services
Temporary Rental Assistance
Section 8, Public Housing, Rental Assistance
O(her Source
Total
Q261)2, Non -Cash Henel-fts by latest qitattls -Slavers
Client Non -Cash Benerilj bV Exit, Status
Nutnber ol',Non-Cash Renefirs by Number of Persons - Stayers
Total Adults Children
No Sources 12
i + sourre W, 24
Don't Know/Refused
Missimp this Information
Total!
Un k n ow n
0
HUD Annual Performance Report (Part 11)
%'CMQ N4MV: VOPFOr 2 CO�Jrj¢y S-:�,il Svrvwc,
pnwam
run cari:uo mldcnwn Wgra ni
r-un d3tv: Ub 20 0�44 4 7
Rumism peumb
Yngth or pan jdpad,, 4, ph S,,,,
txn�th of Partjcjpatjo" h) F:Nit Stajus
Number of persons
Tural
30 days or W15
3 1 In 60 d ays
61 to ISO days
IN I to 365 days
366 to 730 1123" (14 W)
73 1 ru 1099 CIRYS QJ Yrs)
1096 to 1460 Days J34 As)
1461 to 1825 Days (55
More than 125 Days f, 5 N,rs)
Information "Missing
VOW
Averoge and Nkdhn Length of p"ym,yn 1, 0,,,
Averuge Length: ModNn Ungth
Unvers,
Slayers
1hru
IN
136
IILW Annual Pertbrinance Report (Part I 1)
O�Okllo Nuauv: Vom-oc Cqow,Soc'"If S'�r1 c'."
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HUD Annual Pei1ormance Report (Part IF)
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Report (Part 11)
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MEM'ORDUM OF AGREEMENT
BeVneen
Monroe County Homeless Services Continuum -of -Care, Inc,
Lower Keys Medical Center, Inc,
Whereas, Lower Keys Medical Center (LKIMC)i Supports the Monroe County
Homeless Services Continuum -of -Care (MC-Coc) in its objectives to.
* MaKe every effort to not discharge patients into homelessness,
* Assure that its discharge pCanning process facilitates the patient finding
and maintaining housing, health care treatment and entitlement benefits
for which he/she may qLi;9ljfy,
Therefore, both agencies ag,ee to cooperate in the gat lization of the Mowing
procedures,
Lower Keys Medical Center Willl:
1 Assess each Patient's indevidual discharge plan,ning, needs, including current
Diving situation, and provide interventions as applicable and in coordination
Wlth the appropriate community organizaltions.
2, Patient's shall be provided information on a'di transportation services
available,
3Provide patients that are being discharged with the MC-CCC toll free
horneless assistance hotline 1-800-273-4558,
With strict adherence to HI'PAA and Protecting patient privacy, refer patients
being discharged to other Community -based providers, as appropriate or as
requested by the patient.
Monroe County Homeless Services CoC Will.,
1, Provide a 24-hour toil free telephone number for the Homeless Services
Hotline avaJable to receive calls from the Lower Kegs Medical Center
discharge planning staff or from patients being discharged.
2, Make a concerted effort to find suitable housing for Patients being discharged
by contacting housing providers in the area
3 Assist with providing or coordinating any other kind of supportive services for
patients being discharged from Lower Keys, Medical Center
4 Maintam records on discharged patents from LKM'C who are referred to, the
mc-coc.
This agreement w0l remain in effect unless terminated by either party
Rev Stephen E Braddock
(date) WN c k i Wql
(date)
MC-00C Chairman Lower Keys Pvledkcal Center CE0
111rent to C'oordin,,me,9erV*--,e,, to
"Vjar� scut, 1-10MCIC3,13
or
-`U Risk, Of liomelessness
Between
Rtirut Health Network of moilroe c((,]nty, 1,11c, (PU IN)
d/b/a
Lwxer Keys comn, ajni Ly fiealth Center (L"I(CHC)
ad
N"lonroe C()tlntY HOTreless Services CoritinLIUln-of-Care, 111C. (.IVIC_CC)C,)
'Pin in -,cat of tiijs karti Of (Understandin, to ensure, tt) the maxinium extent practical
(reared at LKCjJC Who are horncle&j or at risk ref 0 . paCenL�
IMSistaacc obtaining Jjcu,$in�,, h0mclesSness, will be refierred, to die mc-COC For
M TuPP0[-t1N'C SeTlrkes and maijstreanj hmeflts.
RHN will provide in-kiLd Office space to Lhe felt~ -Cue WiOlin the LKC11C, NI -Coe will utilize the office
space &r Aq administrEdve scaff and tli: PrO'viSiOn ofileeds amesssuelit, information, I-eforral, and zssigm,1ce
cbtaLnang mairLsrrearn benefits for pefscms who are homejesrg or at riA of beoajing hamcjcs.j,
Dosigriatud staff r%,Wi LXXI-IC and Nf(,-CoC Mll review the progran1s, and sen'tices avaiiable for ho, ]CICL5S
the Pntient in aced of assistanc, e, lake recornmczdaLions to and referrals ou behalf of
Persuns iuld tbuse at risk of becorning! homeless and n a
Currellt pro rum desetipt jow FOr 110US in 1.1, Upportive scrv' Qle me -cue.
3Q`9 and "Cferral contacts trill be, maiutaLrcc by
Each agency jjutify Ole other When progruITLS are t`c",Jscd, orexpirided,
Ibis Memorandum slluH bu in crf( Erom tk?
CT pclny� "te-and strati c0LLiuuC UJUJI modified or
discor.tinued by eitil is ("
Rual He.11th NetNvorlc j)f,,%,L0 nrl)e Cuunt
Y, la,c.
Printed Narre.
)'10nrO'e C,0t'ntY Holnelm Services COC, jac,
t aware
ME 'ENT
Monroe County Homeless Sel-vices
Continuum of Care
and
Guidance Cairo Center
WHEREAS, The Monroe County Hi orneless, Services Continuum of Care (MC COC) funds human
service organizations in accessing the ClientTrack Homeless Management Information System (HMISi) to track accurate and up-to-date information, about the homeless and at -risk population bei
served by local organizations, and I
WHEREAS, Guidance Care Center wishes to participate in ClientTrack Homeless Management
Information system to shiare information aibout clients and their needs, track client assistance, and
work jointly with other agencies, to help clients move toward achieving their objectives;
NOW THEREFORE, the M:oniroe County Homeless Services Continuum of Care and Guidance Care
Center agree to work cooperatively through the following terms and conditions,
MC Coc wil�l�
1. Provide access fees for the CllientTrack's HMIS system from 9/30/13 through 10/01/2014;
2. Provide all forms necessary for the organization to gain access to the CllientTrack system; 3, Provide User and Confidentiality Training;
4. Provide technical assistance and support in the use of the HIVIIS.
Agency will:
1. Provide services to the homeless, Population in Monroe County and input client data and
services Into the Cl',ientTrackfs HMfS in accordance with the MC Coc;
2 Agree to communicate, collaborate and refer to other service Provlders in Monroe County;
3 - Be an active member in good standing of MC CoC.
4Sign a Memorandum of Agreement with MC Cotes o'utliningthe role of the agency and the Co,C
with respect to HMIS implementatiom
5. Abide by the IVIC CoC HMIS Operating Policies and Procedures.
This Agreement will remain in effect from September 30, 2013 through October 1, 2014
Signature and "rifle of Authorized Representative
Monr County Ho less Services C
a sere Title of A orized , resentative
3 idance re Center
Date
rat
MEMORANDUM OF AGREEMENT
Monroe County Homeless services
continuum of care
and
Heron -Peacock
WHEREAS, The Monroe County Homeiless Services Continuum of Care (MC COC) funds human
service organizations in accessing the C�i fentTrack Homeless Management Information System
(HMIS) to track accurate and up-to-date information about the homeless and at -risk population beim,#,
served by local organizations, and
WHEREAS, Heron -peacock wishes to participate in ClientTrack Homeless Management
Information system to share information about clients and their needs, track client assistance, and
work .jointly with other agencies to, help clients move toward achieving, their objectives;
NOW THEREFORE, the Monroe County Homeless Services Continuum of Care and Heron-Pelacock
agree to work cooperatively through the following terms and conditions,
MC coc will:
1, Provide access fees for the ChentTrack's HMIS system from 9/30/13 through 10/01/2014,,
2. Provide all forms necessary for the organization to gain access to the ClientTrack ,-
3. Provide User and Confidentiality Training; system
4. Provide technical! assistance and support in the use of the HMIS,
Agency will:
1 - Provide services to the homeless POP U lation in Monroe County and input client data a
services into the ClientTrack's HMI S i'
n accordance with the MC COC. nd
Z Agree to comm�unicate, collaborate and refer to other service providers in Monroe County;
3. Be an active member in good standing of mC COC;
4, Sign a Memorandum of Agreement with MC COC outlining the role, of the agency and the CoC
with respect to HMI implementation-
5. Abide by the MC CoC HMIS Operating policies and Procedures,
This Agreement will remain in effect from September 30, 2013 thirough October 1, 2014,
Signature and TMe of Authonzed Representative
Mcijroe COUnty Homeless Services COC
of AuthorizId Tepros entative
Signature and Tifl,
eron'Pacock
M
Date
Datie
M'oinroe County Homeless, Services,
Continuum of Care
and
Florida Keys Outreach Coalition, Inc,
WHEREAS, The Mionroe County Homeless Services Continuum, of Care (MC CoC) funds human,
service organizations in accessing the CllientTrack Homeless Management Information System
(H'IMIS�) to track accurate and up-to-date information about the homeless and at -risk Population being
served by local organizations, and
WHEREAS, Florida Keys Outreach, Coalition, Inc, wishes to Participate in ClientTrack Homeless
M'aniagilement Information system to share information about CIients and their needs, track client
assistance, and work jointly with other agencies to help clients move toward achieving their
objectives;
NOW THEREFORE, the Monroe County Homeless Services, Continuum of Carp and FloridaKeys
Outreach Coalition, Inc. agree to work cooperatively through the following terms and conditions,
AMC Co c will:
1, Provide access fees for the ClientTrack's HMI S system from 9/30/13 through 10101/20114;
2, Provide all forms necessary for the organization to gain access, to the ClientTrack system;
3. Provide User and Confidentiality Training;
4. Provide technical assistance and support in the use of the HMIS,
Agency wilk
I , Provide services to the homeless population in Monroe County and input client data and
services, into the ClientTmck's HMIS in accordance with the MC, CoC;
2, Agree to communicate, collaborate and refer to other service providers in Monroe County,,
3, Be an active member in good standing of MC CoC;
4, Sign a Mennorandurn of Agreement with MC CSC outlining the role of the agency and the CoC
with respect to HMI'S implementatiom
5, Abide by the MC COC HMI S OperatIng PoNcies and Procedures,,
This, Agreement will remain in effect from September 30, 2013 through October 1, 2014
iLL-
3 1 g n a 'I re and Title rf Authonzed Representati,)e
m.
%Ionrqe County Horreless� �Ser Coc,
&gnature and T�:e of Autborized Represenlative
AGENCYNAME
,Date
Date
E
U
MEMORANDUM: OF AGREEMENT
Monroe County Homeless Services
Continuum of Care
and
Samuel' s House, Inc.,
WHEREAS, The Monroe County Homeless Services Continuum of Care (MC COC) funds human
service organizations in accessing the ClientTrack Homeless Managemient Information Systern
(HMJS)1 to track accurate and up-to-date information about the hoimelless and at -risk population being
served by local organizations; and
WHERE a, Samuel' s House, Inc. wishes to participate in CNentTrack Homeless Management
Information system to, share information about clients and their needs, track client ,
work jointly with other agencies to help clients move toward achieving their �objectives; assistanceand
NOW THEREFORE, the Monroe Count/ Homeless Services Continuum of Care and Sa,muel's
House, Inc, agree to work cooperatively through the follovving terms and conditions,
MC CoC will'.
I , Provide access fees for the ClientTrack's HMIS system from 9/30/13 through 10/0 /20 4;
2. Provide all forms necessary for the organization to gain access to the ClientTrack System
3. Provide User and Conficlentiality'Training-
'
4. Provide technical assistance and support in the use of the HP,
Agency will:
I , Provide services to the homeless population, in Monroe County and input client data and
services into, the ClientTrack's HMIS in, accordance with the MC CoC;
2. Agree to communicate, collaborate and refer to other service providers in Monroe Counity,;
3. Be an artive member in good standing of MC CoC.
4. Sign a Memorandum, of Agreement with MC CoC outlining the role of the agency and the CoC
with respect to HMIS implementation;
5, Abide by the MC CoC HMIIS Operating Policies and Procedures.
This Agreement will remain in effect from September 30, 2013 through October 1, 2014,
Ignatu re a!nd Title of Authorized Representative
Morro County Hiom ass Services CoC
Sgnature and Title of presentative.
�amuel's House, Inc
Date
Date
-�,
NWi1+
M IIM � �„%1C�+5%
i�l i(1 Sri.
m
PARTNERSHIP MEMORANDUM OF UNDERSTANDING
BETWEEN
EARLY LEARNING COALITION OF MI1 I-DADE/MON ROE, WC.
AND
MONROE COUNTY HOMELESS SERVICES CONTI N U U'M'-OF-CARE, INC.
i"his Memorandurn of Understanding ("MOU"') is between, Early Learning Coalition of Miami-Dade/Monroe,
Inc,, with a principal address located at 2555 Ponce de Leon, 5'h Floor, Coral Gables, FL, 33134, (hereafter
referred to as the "COALITION"), and Monroe County Homeless, Services ContinuuM-of-Care, Inc., with a
principal address located, at P 0 Box 24 10, Key West. FL 33045, (hereafter referred to as 'MCC SGoC11),
The effective date of this Memorandum of Understanding, is:
July 1, 20114.
BACKC-IRni Wn AkIn, 01 �RPOSE.
Homelessness influences every facet of children's lives, inihit
behavioral development. Horneless women face man obs
abuse, chronic health problems and lack of prenatal care
L
weights and are at greater risk of death. Homelessness expo
their health. Many homeless infants lack essential immuniz
development delays after age 18 months, which influence I@
toddlers are often separated from their parents which, can cai
services than, other toddlers. By the time children reach scho,
and academic lives. Many homeless children suffer acute phy
circumstances accompanying homelessness, Homeless childt
poor children and lack access to consistent health care. They
lead to emotional distress. Their academic performance i-,:
circumstances of homelessness. Studies show that early, con:
" trimentall effects of poverty and homelessness. Priority accE
M supportive housing, dependable quality child care, d
li,:hritjonal support programs and after school tutoring is essent
wial and
hernical
)w birth
Idanger
lnificant
imeless
. fewer
hlysical,
due to
housed
rits that
nt and
-ne any
s long-
Ication,
To that end, pursuant to Sections 420-621 �5), and 1002,87 t i), cintiaren, living in homeless emergency
housing, transitional housing or a continuum of care -funded hotel/motel bed, have been classified as eligibility
Priority 2, which is defined as "at risk children younger than the age of 9", for referrals for the child care services
provided by the COALlTION.
The signing parties understand and' recognize the importance and value of offering prioritized child care services
for parents with children in emergency housing, transitional housing or funded hotel/rniotel bleds. With a, focus on
houlsrng, child advocacy, child care continuity, community, partnership, self sfficiency rehabilitation, and
safety protection & intervention, public education and violence prevention, thisueffort will mobilize communhealth ities to
create lasting changes in our neighborhoods that will imiprove lives.
GENERAL PROVISIONS:
Services may be provided by the COALITlON under this MOLT ait the solve discretion of the COALlTION, Subject
to the foregoing, COALITION will provide services at no cost to MCHSCoC, or its affiliated referring agencies, to a
child of a fami1y served in, the Monroe County Homeless Continuum of Care systems Eligibility consideration is
riot solely dependent on family income or work requjrements, a documented referral must be provided through
MCHSCoC or a contracted Continuum of Care provider identified as an Eligible Referring Agency in Attachment
,A. as such may be modified from time to tpme,
The referral of an eligible chlild may be, renewed/validated in sixty (6o) day mcrements on a case by case basis,
I t to exceed six l6) months The sulormtted referral' form should indicate that the Purpose of care is related to
Unstable living envirorirrient. If the parent refUSeS, to provide or otherwise fails to provide any required income
documentation, services may still be provided to suich eligible child at the sole discretion of COAUT0N
DEFINITIONS:
"«Vhen used in this MOU, the foIlowing, terms shall' have the meanings set forth bellow
"I
a�, Universal Child Care Referral Form: Refer to Attachment B
b, Sect,'on 420, 621(5)1, Florida Statutes, defines homelessness, generally as an individual or fa
c who lacks a fixed, regular and adequate nighttime residence. milt'
Eligible Referring Agency": shall mean emergency housing, transitional housing or agency that
provides Continuum of Care -funded hotel/motel beds to homeless families, and is identified by the
MCHSCOC as eligible to make referrals to the COALITi1ON for the services referenced' herein.
HMIIS. shall mean Homeless Management linformadon, System
COALITION WILL:
1 , As COAUTION funding permits, prioritize referrals as per the COALITION plan and Section, 1002,87 (1),
F-S, with a,n emphasis on the provision of child care services for homeless children by COALITION,
Notwithstanding the foregoing, COALITfON shall have no obligation to provide services under this MOU.
2. Review applications submitted by Eligible Referring Agencies in a timely manner, anid provide a
response to the referring agencies upon receipt of referrals, as to whether the child has been approvedtimely to
receive services,
3, Provide for use by MCHSCgC and its identified Eligible Referring Agencies, the COALITION's Universal
Referral Form for tracking purposes (Attachment 8),
4, Provide eligibility criteria for program participation and referral documentation to MCHSCoC for distribution
to Eligible Referring Agencies,
5 Serve children up to the age of 9 years old within the priority limitations established purSLant to Florida law
and COALITION' Plan.
6. Comply with any and all applicable federal, state and' local laws, regulations, and ordinances ("laws')
pertaining to this MOU, including but not limited Section 119,0701, Florida, Statutes as may be applicable,
and any and all applicable laws relating to confidential information and background screening
individuals who may work or volunteer directly with, children or perform services on behaff of the Coalitici
under this M'OU.
MCH!SCoC WI'LLa
Ensure that the listing of Continuum of Care agencies identified as Eligible Referring Agencies is u,pdatec
on a mointh!ly basis,
2, Ensure that only Eligible Referring Agencies will make referrals to COALITION for eligible services through
MCHSCoC.
3 Ensure adequate training for Eligible Referring Agencies on eligibility criteria for referrals, the referral
process and the use of required referral form().
4, Monitor Eligible Referring Agencies to ensure compliance with referral and! documentation requirements,
5Ensuire that all' Eligible Referring Agencies reflect referrals made and services received from the
COALITION in HMIS, Provide reports to the COALITION as may be requested on referrals, programs
utilization, etc.
6 Comply with any and all applicable federal, state and local laws, regulations, and ordinances ("laws")
pertaining to this MOO, including but not limited Section 119-0701, Florida! Statutes as may be applicable,
C-OALITON: Mary A Williams, Managing Director- Monroe COUnty
I 111 12"' St- Suite 206, Key West, FL 33040
305-646-7220 ext 293
MCHSC()C: Jeanette McLernon
RO. Box 2410, Key 'VVest, FL 33045
443-974-652'2
morroehomellessccc@comcast net
]NATION &Nn urit IFI AT
Unless sooner terminated ais provided herein, the term of this MOU shall commence on the effective date and
shall terminate on June '11, 2015, Notwithstanding the foregoing, either party may terminate this MOU upon therty
(30� days written notice to the other party. This MOU constitutes the enure agreement between the parties, and it
shall not be amended, altered, or changed except by a written agreement exeCUted by the parties hereto,
NO FUNDING:
No funding will be exchanged between the parties under this MOU',
NO THIRD - PARTY 8— E N E 'M C-1 A R 11 E %Sj
T has MOU has no intended or unintended third party beneficiaries.
SOVEREIGN IMMI lk"11-i-N :
Nothing in this MOU shall be considered a waiver of sovereign immunity,
NOT A BlNDlNGAQRFr-MENT:
The parties agree that this M'OU expresses only the general intent of the parties. This MOU is not a legally
binding agreement on either party,
MISCEIL&LANEOUS TERMS.
For Purposes of this MOU, COALITION a!nd'MCH�SCoC are indepenc°ent parties and collaborating solely for the
purposes specified in this MOU. No party shall be liable to the other parties, or to any third party, for the acts,
11 Fissions or liabilities of the other party or such otherpar represent�atives, employees or agents.
'-'iGNATURES�'.
M
M
Evelio C. Torres, President —and CEO
E, Scott Pridgen, Board Chi-a—jr
14M
Applicant: Munroe County Homeless Services COC
Proje,ct� MC CoC FL 604 RegiStr2tjon FY2013 FL-604
COC—REG_2013_085691
3A. Contin,uum of Care (CoC) Pe,rformiance and
Strategic Planning Objectives
Objective I � increase Progress 'Towards Ending Chronic Homelessness
3MMMEM
3 3A-1_1 Objective 1, Increase Progress Towards Ending Chronic
Homelessness
2013 ctua'i
Proposed in 2012 Numeric 2014 Proposed
CDC Achievement 20,15 Proposed
Application Numeric Numiaric
------ and Baseline Achievement Achievement
;I,A&I � I a For ear_4hyear,, gro.)vide thernber
C_� r "3 Of COG -funded PSHI beds not dedicated for use by 0
� , _ Uqd�d M b
the chronically homeless that are avaHable for
,Occupancy.
3A-1.1b For each year, provfde the total number
of PSH beds dedicated for use by the chronically,
homeless,
3A-1, I c Total nu nber of PSH beds not dedicated
to the chronicafl� homeless that are made
ava0able throug annual turnover.
3A-1 d lndicate the percentage of the COC-funded
PSH beds not dedicated to the chronically
homeless made available through annual
turnover that will be prioritized for use by the
chronically homeless Over the course of the year.
3A-1-le H'ow many now PSH beds dedicated to
the chronnally homeless wdl be created through
reallocation?
54�
022103/2014
E
Will
Applicant: Monroe County Horne4ess Services CoC
Project: MC CoC FL 604 Registration FY2013
FL-604
COCREG2013085691
3A-of .2 Describe the CoC's tivoi year plan (202015) to increase the
number of permanent supportive housing bedsi available flor chronically
homeless person!s and to meet the proposed numeric goals as indicated
in, the table above. Response should address the specific strategies and
actions the CoC will take to achieve the goal of anding, chronic
hornelessniess, by the end of 20M
(lii-nit 1000 ch,aractersi)
To increase new permanent housing beds for chronically homeless the MC CoC
will: 1',ad'd two permanent supportive housing beds rh ich is 2% in 2014 add 2
permanent supportive housing beds and 4 more in 2015 which 6% through the
ranking and project priorlfizatjon process. The CoC Planning Committee will be
increasing the number of scoring points to providers,who designate CH beds
through conversion as part of the criteria in the. The CoC Planning Committee
will be working closely with providers to establish a process for on -going,
conversion, on a monthly basis. In 2014, one provider has converted 5 TH beds
to CH to assist in the progressive movement of individuals currently in
emergency shelters, 2, 'The CoC will develop a plan to alert ES & TH service
providers when permanent housing, beds become available so they can be filled
asap anid reduce the average length of stay in ES. 3. The CoC will continue to
develop a working relationship with the local PHl for subsidized beds.
3A-1.3 lidentify by name the individual, organization, or committee tha�t
will be, responsible for implementing the goals of increasing the number
of permanent supportive housing beds for persons experiencing chronic
hiomeles;sness,.
(limilt 10100 characters)
Thiei Planning Comrn�ttee and Overs,ight Committee in conjunction with the MO
CoC Board is responsible for ensuring that turnover units are uised for
chronically homeless, The committee's wilil collect and monitor the data on the
use of t�urnover units and report progress on thiis commiitment on a quarterly
basis to the MC CoC Board. The Planning committee is also responsible for th
rainking, rewew and priontization of renewal projeicts and is committed to incl L,
reallocate into the! scoring method.
FY2013 CoC Appkcauon '-�ag e 2 9 02/03�20114
-1 - - — ---- — 1—— -.1-11 L_ - _'__ . . ........ — - - ---- . ..... .
Applicant: Monroe County Homeless Services, CoG FL-604
Project: MC CoC FL 604 Registration FY2013 COC REG 2013 085691
3A. Cont'
Inuum of Care (CoC) Performance and
Straltegic Planning Objectives
Objective 2: Inicrease Housing Stability
ml�
For gu�dance on completing this form, p�ease reference thp- FY 201 3 CoC Application Detailed
�nstructons and thei FY 2013 CoC Program NOFA, P�ease subrilit technical question to the
0neCP0 Ask A Question at https//wwwionei--pdiirifo/ask-a-que,,;ti(-)n/,
In FY2013, applications submitted to HUD for the Continuum Of Care (COC)
Program will be evaluated in part based on the extent in which they further
the achievement of HU'Di's goals as articulated In HU'D"s Strategic Plan and
the Opening Doors:i Federal Strategic Plan to Prevent andEnd
Homelessness (FSP). Achieving housing stability is critical for persons,
experiencing hornelessness. Using data froinn Annual Perfornrianic:e Reports
complete the table below.,
3A-2.1 Does the CoC have any non-HMIS No
projects for which an APR should have been
submitted between October 1, 201'2 and'
September 30, 2013?
3A-i2.2 Objective 2.- Increase Housing StabilitNA
21111 Actual
Num.,i, Achievement 2014 =ed Numeric:
and Baselinis 2015 Proposed Numetir
emant Achievement
2.2, Enter the tote I number of
Pa Jcll pants served by all Coo- as 93
funded Permanent supportive
housing prcujvetts as 'Opor"'d on
a Su i ad during the period
between ctober 1, 2012 and
September 30, 2013.
3A-2 ' 2b Enter the total number of 12� 76 8 0
participants that remain in CoC.
,funded funded PSH projects at
I the eriti of the operaking year
,PLUS the number of participants
'that exited from all CoC-funded
permanent supportive housing
projects to a different permanent
housing desdriation.
3A-2.iPants n 3eCOcentge of ar3%c Eater Ohre
Pmded projects that will achieve housing
Stability in an operating year.
'('2013 COCApp6canon 0age 30 02/03/2014
M
Applicant: Monroe County Homeless Services, Cod:,
Project- MC CoC FL 604 }fie gistratdon FY2o 13
FL-604
COCREG2013085691
3A-2.4 Identify by name the individ'ual,, organization:, or committee that
will be responsible for inc:reasing the rate of housing stability in CoiC-
fundeidprojects.
(limit 10010i characters)
The MC CoC Planning & Oversight corrim�ttee is.responsible for momitoring
service provider data, quarterly APR's and ensuring providers are attaining
increased housing stability in their programs, The committee's will report to the
MC CoC Board qivarterly and service proividers will conduct a presentat�ion to
Board midway through their APR, The Florida Keys Outreach Coalition, CEO
Rev. Stephen Brad,dock�, AidsHelp of Monroe County, Inc, CEO E, Scott
Pridgen, Catholic Charities, CEO Richard Turcott�e, Monroe Association for
ReMarcable Citizens, Executive Director, Diana Flenard and Siamuel's House,
CEO Elmira Lato
FY20 13 CoC Appf�canon Page 31 02/03/2014
0
Applicant: Monrce County Ho,meiess Ser0ces CoC
Project; MC CoC FL 604 , Regi5tr2b0n FY2013 FL�604
COC—REG_2013_085691
3A. Continuum of Care (CoC), Performance and
Strategic Planning Objectives
#lbjective 3: increase project Participants income
IMMMM=
For gwdance on completing this, form, please reference the FY 201'3 CoC Application Detalled
Instructions and the FY 2013 CoC Program NOFA, Please submit technical q uestion to the
0neCPD A5k A Question at �IttPs:/Iw'ww,oriecpd,"�nfo/ask-ai-que,;tion/,
In FY2013, applications submitted to HUD for the Continuum of Care
Program will be evaluated in part based on the extent in whic'h they further
the achievement of HUD's goals as articulated in HUD's Strategic Plan and
the Open,ing Doors: Federal Strategic Plan to Prevent and E�nid
Homelessness (FSP'). Assisting project piarticipants to increase income is
one way to ensure, housing stability a!nd decrease the possibility of
returniing to homelessness., Using data from Annual Performance Reiports,
�APR), complete the table below,
3A-3.1 Number of adults who were in CoC- 253
'Fund�ed projects, as reported on APRs
submitted during the period between October
1, 2012 and Septernber 30,,2013:
3A-3.,2 Objective 3: Increase project participants income
2013 Actual
Numeric Achievement 2014 Prop�o�sed 2015 Pro osed
d as
Ac:
and Baseline Numeric Achievement
N'umeric evement
3A-3,2a Enter the percanage of $ %
participanig in afl COC-fundad 5 7%
projects that increased, their
Pncome from a mptoy ment from
entry date to program, exit?
22%
3A-3,21b Enter the percentage of 24%
partimpants in aill CO -funded
�orojects that increased their
income from sources other than
employment from entry date to
prog ra,m exit?
3A-3,3 in the table: below, provide the total number of adults that were in
CoC-funded projects with each of the cash income sources identified
el'ow, as reported on APRs submitted during the period between October
1, 2012 and September 30, 2013.
Cash income sources
Particii ipatingrr Adufts Total in M-11
Eornied hi . .....W.
CDM9 133,
52
ilJnarnpioyment insurance
FY2013 Cry C Application
Page 32 02103/2014
a
Applicant: iVon roe County Honieless semces coc
Project: MC CoC FL 604 Registration FY20 13
,Vpterars Zabifiy
P6vate disabOity insurance
Worker's compensation
'i�ANF or equivalent
'&erlr.h Assistance
Retirement (Sociat Security)
Veteran's pension
Pension from former jo,b
Child support
Alimony (Spousal support)
No sources
FL-604
CCCREG_2013_085691
1028 %
0 40 %
40 % 0 %
- 0 . 44
1 GAO 'V,
0,40 % 0 9
2 O� 79 %
21 0 79 %
%
%
8 3 16
74J IZ
7 9, 2 5
3A-3.4 Describe the COC's two, year plan (2014-2015) to increase the
percentage of project parti:cipiants in all CoC-funded projects that increase
theiir incomes from non-emptoyment sources from entry date to program,
exit. Response should address the specific strategies and actlohs the
coc I, take to meet the in umerloachievements proposed! in the table
ablove.
(limit 1 O00, characters)
The VIC COC w0t increase each year by 2% the participants, who receive non -
employment dollars, Many participants lose their non -employment income by
becoming employed and moving above the Poverty level!. The HMIS
Administrator runs client ' progr3nI and community level H'MIS data monthly to
monitor progress and diata qua6ty and reports the information to the Planning,
Committee. On a quarterly basis, the Planning committee reports to the MC,
CoC Board and mid way in the APR year each service provider reports to the
CoC Board abioiut participants, nicome from mainstream benefits. The, MC Co
housing provider are trained to use Florida ACCESS to get participants quick
entry to non-emiployment income and benefits. I
3A-3.3 Describe the CoC's two year Plan (2014-2015) to increase the
percentage of project participants in all CoC-fund�ed projects that increase
their incomes, thirouglh employment from entnj date to program exit.
Response should address, the specific strategies and atins the CoC will
take to meet the numeric achievements Proposed in the table above.
(limit 1000 characters)
The MC COC will increase each year by 2%. Employment opportunity are scare
in N/lonroe County, particularly Pn Key West where the service providers are
located therefore the Co C can maintain at least a 55% employment rate, The
HMI S Administrator runs, client, pro rain and community level HMI S data on a
monthly to, mionitor progress and data quality and reports the information to the
Planning Cornmttee. On a quarterly basis, the Planning committee will report
,o the MC COC 902rd and mid way in the APR year each service provider
reports to the Co C Board. The CuC vvill advertise & encourage members to
have partidpants, attend local City and County bob Fairs
. ....... . .
....... ... . . . ..... . ..... . . ...................
`Y2013 CoC Application Pace 33 (3210312014
W
Applicant. Monroe County }son less Services CoC
FL-604
,Project: MC CoC FL 604 Registration FY2013 CO'er REG 2013 085691
3A-3.6 Identify bey name the indiVidllaj, organuization, or committee that vVill
be, responsible nor increasing the rate of, project aril ant in all CoC-
funded projects that increase income from entry date to program exit,
(Nmit 1000 characters)
FY2,013 CoC Appkation 34 02/0'
3/20 14 Y
0
Applicant: Monroe County Homeless Sen/lices CoC FL-604
Project: MC CoC FL 604 Registration FY2013
COC—REG_2013_08569-t
3A. Cont inuum of Care (CoC) Performance and
Strategic Planning Objectives
Objective,4- Increase the number of plrticiparats obtaining mainstream
benefits
Por guldance an completing this form, P�ease reference the FY 2013 CoC A licat
Instrucfilons and the FY 2613 CoC Program N'OFA, Plea PP ion Detaille
ise submit technical question to the Onll Ask A Question at 1ttpsj/www,onecPdJnfo/ask la -question/
In FY2013, applications submitted to HUD for the Continuuml of Care (Co
Program Willi be evaluated in part based on the extent in Which they furth
the achievement of HIU'D'ls goals as articulated in HUD's Strategic Plan an
the Opening Doors: Federal Strategic Plan to Prevent and End ill
HornefeSsness (FSP). Assisti,ng project participants to obtalin mainstream,
benefits is one way to enisiure housing, stability a;nd d:eicrease the
Possibility of returning to homelessness, Ulsi'ng data from Annual
Performance Reports (APR),:, complete the tabile bielow.
3A-4.1 N'umber of adults who were in COC- 253
1
funded projects as reported' on: APRs
esubmittedduring the period between October
1, 2012 and September 30, 2011
3A-4.2 Objective 4: Increase the number of participants obtaining
mainstream benefits
2013 Actua
11
Nhie%ementF
ne
015 Proo,osed• rrr,r�,chieement q iC ACOlp2umeric Achlevoment
3A-4,2a, nter the perce of
participants in ALL CoC=Id 2%
2%
projects that obtained nori-cash
'try
rnastreabenefits from entry
�linm date to program exit.
3A-4.3 In the table below, provide the total number of adullts that were in
COC-fundeld projlects that obtained the non-ca'sh mainstream benefits
from entrj date i to program exit, as reported on APRs submitted during the
period betwelen October 1, 2013 and September X, 2113.
N11111M.0111111
Supplemental nutritional
assistance, program
`il'EDICAM health insurance
ilRE health insurance
slate cniiari-n's hewlth lnlwrance
Numper of
PWticiPating Adults
117
W
Percentage
"I
Total w 3A-4,1
46 25 25
07
P19,�e- 35 i;iL6 4
FY20 13 CoC Applicafion
Applicant: Monroe County Homeless Services COC
Project: PO C CoC FL 604 Regrstra:tion FY2013
A medical services
ANF child care services
TA�NF transportation, somicas
Other TANF-fu:nded services
I'erne orary rental assiste.nce
�Section 8, Public housing, rentat
assistance
Other So'urce
ors scirar c -e —I
a•
�L-604
C0C_REG_2013_085691
2-7
7, Z77
2 0,79
7 38,34
3A-4.5 Identify by name the individual, orga:nization, or committee that
will be responsible for Increasing the rate ofproject participanits in all
COC-funded projects that that access non -cash mainst�ream benefits from
_ntry date to program, exit.
(limit 1000 characters)
The MC CoCi Planning Committee Ml be the responsible entity for increasing
access to non-cashi mainstrearn benefits through HMIS and CoCftjnded
projects reporting to the MC CoC Board at least quarterly the percentage of
participants that are increasing thieir benefits with any explanations if no benefits
have increased, All Housing Providers are trained in S�OAR and use a
Coordinated Asseissiment System,
F7Y201,3 CQC APphcat[on Rage 3 6
02/0,3/2014
M
Applicant: Monroe County Homeless Services COC FL-60�4
Project: MC CoC FL 604 Registration FY2013
COCREG2013085691
3A. Continuum: of Care (Co�C) Performance an,d
Strategic Planning Objectives
Objective.5: Using Rapid Re -Housing 3s a method to reduce fami
homelessness I
mmm
For guidance on completing this form, please reference the FY 2013 Cc C AppNcation Detailed
Instructions and the FY 2013 CoC Program NOFA. POease submit technical question to the
One CPDAsk AQuestionat httpg://'vWW,onecpd.info/ask-a-qup-qinn!
3A-6.1 Olb Jective 5: Using Rapid Re -housing as a method to reduce family
hornelessness.
2013 Actual
creed
Numeric Achievement 2014 Propo 7 2015 Propbsed
L
and Basehne nt
Numeric Act NU mOric Achievement
3A-5. 1 a Enter the total number of
homeless households with 0 0
children per year that are asslsted
through CoC-funded rapid re-
housing projects,
U-5.1b Enter the total number of
hOnleless households with
,children Per year that are assisted
through ESG-funded rapid re-
housing projects,
3A-5,1C Enter the total number of
households with children Chat are
assisted through rapid re-hiousing
rta that do not receive
PVrC KjIn'llaY-Vanto funding,
3A-15,2 Describe the CoC�'s two year plan (2014-2015),to increase the
number homeless households with childlren ass isted th, rough rapid re-
�iousingi projects, that are funded through either PACKInney-Vento fund�ed
progr3ms (CoCi Program, and Emergency Solutioprogram) or
non-McKinney-Vento fuinded sources (eg, TAN'F). Response should
:-iddress ffie specific strategies, and actions the CoC wifl take to meet the
numeric achievemients proplosed in the table above.
(limit 1000 Character5)
FY2013 Co C Apip6cat�cn Page 37 12/03/2014
J
B(O
Applicant: Monroe County H=eless Ser-Oces CoC
Project-, MC CoC FL 604 Registration FY2013
NIA
FL-604
COC—REG,-2013-085691
3A-5.3 Identify by name the Individual, organization:, or commiftee that
Will be responsible for increasing, the number of households with chiildrer,
that are assisted th,rough rapid re-housinig in the CoC geogra!phic area.,
(limit 1000 characters)
N/A
nouseholdis will receive rapid re-housingi
assistance as well as the pplicableam uin,t or percentage of rent that each progra
participant must pay, if a.
Oinlit'1000 characters)
N/A
3A-5.5 How often do RRH providers pide case managernent to
households residing in projects funded under the CoC and ESG:
Programs?
(limlit 1000 characters)
N/A
3A-5.6 Do the RRH providers routinely follow up with previously assisted
hiouseholds to enis,ure that they do not experience additional returns to
hOmielessness within the first 12 months after assistanice ends?
flimit 11000 characters)
N/A
2210312�0
FY2013 COC Application �age IE3�14
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15
9 -
- endix r — Bid t Forms
Horneiessness Prevention Grant
Budget for FY2014 - 1
Eligible Activity grant Funds
_
Leveraged
1. Past due rent or mortgage assistance 38,000
38,000
. Past due utility payments 8,000
$
8,000
(electric, gas, water, serer only)
. Case management
a. Salaries and benefits 2,000
2,000
Nurn pr of FTF'.q
b. Operatinig expenses 500
500
Grant Administration 1 500
11,500
(Maximum = 3% of total award).
TOTAL s01,0 0
50,00
Attach budget narrative to support the request, and document the cornrnitrnent of leveraged
dollars from privateand other public sources.
Grant expenditures must be obligated by Jiune 30, 2015.
monroecount Board of county cornmissiicu'7er5L�ociol Services
Proposed Budget Alarrotive f2r the 2014 H007eleSSneSS Prevention Grant Applicotion
In this application for Homelessness Prevention Grant Funds, Monroe County Social Services, as the
sub -grantee, is proposing and submitting a request for an, award arnount of $50,000. These funds wilil
enable us to serve needy families in Monroe County that are In danger of losing their permanent
housing and prevent thern from homelessness. In the last three years, our agency was very successful
In assisting rnany fanidies, through the Honielessness Prevention and Rapid! Re -housing Grant with a
grant award of $370,000 and we are currently administering the 2011 Emergency Solutions, Grant
award of $131,608,00,
In addition to the ESG Giranit, Monroe County Social Services offers severaill other services through the
assistance of grant funding and in conjunction with COUrIty I-natch dollars which consist of cash and in
kind matches, Currently Monroe County Social Services is the recipient of approximately $2 midlion
dollars. Below is a breakdown, of the numerous grant allocations awarded to Monroe County*
Prograrn _._ Fundine source grant allocation
Commiunity Care foir the Elderly Alliance for Aging $302,5,23.00
(In home seMces-per5anal care, chore, respite)
Hortie Care for the Elderly
icaregiver a5sistance),
Alzheimer's Disease Initiative
(in harrie respite)
Alliance for Aging
Alliance for Aging
Older Arnerica ns Act All:iance, for Aging
(in harne respite, Facility respite, congregate rneal&, hoine delivered rneak)i
Low Income Home Energy Assistance
(A55rst Clients with Pilectrnc bligation)
Weatherization Assistance Program
(rineasures to help reduce energy cost)
COMMW14Y Care for Disable Adults
(in w'iomoe persinnal care, horn(VT)akirig, rne,315l
Monroe coun,y social Services/ Welfare
(utilities and sheite,r)
Department of Economic Opportunity
Department of Econornic Opportunity
Department of Children and Families
BOCC
$34,694.00
$56,746.00
$455,605,00,
$245,491.00
$18,792,00
$81,733,00
$40,86Ci,00
E
For approxim-7it0y the past 28 years, Monroe County Social Services vvO the support of the SOCC
have prowded many services Lo needy residents. The process for acquiring the funding is explainPH as
follows:
Via the approval and execution of the Board of County Commissioners, Our Office of Managernent and
Budget are authorized to commit General revenue funds and required match. The OMB department
completes a resolution which aillocaites the funds, to a designated grant aCCOUnt for the life of the
grant.
The Finance department withiin our Clerk of the Courts office have oversight over all grant spending
following the guidelines of the OMB circulars and county policies and procedures. The grant division of
the Finance department works directly with the Sr, Grant Coordinator and Social Services Director to
ensure appropriate spending levels and compliance to the contracts.
We are requesting and proposing a $SO,0,00 award of whiich, $48,500 will go for direct client assistance
and the remaining 3% of $1,500 will be for administration, Sources For the leveraging consist of the
following,,
* in kind- Bu,ilding, space -The County owns all of their facilities and several buildings throughout the
county so we are able to provide case management and administration space at no cost to the County
or the grant.
* Salaries -Case managers, Grants Coordinator and Social Services Director salaries afire supported by
General Revenue funding and therefore no charge to the grant.
* Office Equipment — the county's, Technical Services Division and Facility maintenance department
provide technical support and general maintenance services via General Revenue dollars, Example of
these services include: Xerox machines, cornputers, telephione, fax machines, postage machine and
overall maintenance of building space.
Given our established infrastructure, years of experience, secured sources of funding and
comMitMent to al5sisting the citizens of Mo�nroe County, we are confident we can utilize these funds
for their intended purposes which is to prevent homelessness,.
98
In thiis application for Homelessness Prevention Grant Funds, Monroe County Social Services is
proposing and !submitting a; request for an awward arnount of $50,000. These funds will enable u3 to serve
approximately 6 eligible households in Monroe County thiat are in danger of losing their permanent
housing and prevent them frorr homelessness or to assist thews in securing houlsing.
The below budget was developed! utilizing data compiled from previous Social Services HPRP and ESG
grants, The following data components were used: rental assistance statistics, average arnOUnt Of
assistance given to clients, average time spent by case managers and administrative staff, supervisors
and director,
Eligible Activi"ty.-
Post due ,Rental/ mortgage Assistance $38,000-00
(proposing to assist approximately 6HH at average of $6,333,33) up to 4 months
Post due utility payments
$8,000,00
(proposing to assist approximately 6HHat average of $1,333-33 per HH foir past due
utilities, such as electric, gas, sewer only) ulp to 4 worths
Case management
(proposing 3 case managers time utilized to perform the above assistance -average
time approximately 7%, of their 40 houir work week)
Operating expenses- data collection and outcorne measures $500.00
(proposed expenditures would include HWS maintenance)
A dr7i in is tra tive Cos ts (cap 3)
Locol government $1,5M 00
(proposing staff time utilized consisting of Sr, Administrator, Compliance Manager
and Director- approximately 3% of their 40 hour work week)
99
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In cornphance with section 414 161(3), Florida Statutes, the home9essne5s prevention prograrn to be
funded must de included in the CoC plan,
As the de5ignaled lead agency for this homeless CoC planning area, B certify that the
Homeless Prevention LPZ13 to be implernented by Monroe County Social Services
(Norne of Prevenbon Program) (Name of Agency)
is contained in the current approved Co,C plan, as submitted for the 2013/2014 CoC competition to the U.S.
Department of Housing and Urban Development
On behalf of this CoC, the above certification is made and is true and accurate. Further„ I am duly authorized to
make this certifica�tion on behaH of the CoC.
Name of Certifying Officiak Jeanette McLernon
71de: MC CoC Administrator and HMISI Administrator
S�Snature�
7
Date signed: Ju . ne 1"', 2014
Participation in the HIM�IS is a requirement for receipt of homeless ,grant funds. HMIS requirements are
Outlined in 24 C,F,R, Part 576. Accordingly, only applicants who commif to, participate in the HMIS wid
be considered for funding iin 2014, Section 605 of the Vcolence Against WOMen Act of 2005 amended
the McKinney-Vento Hom0ess, Assistance Act prohibits victim services providers frnnii entering
personally -identifying information into an HMIS database, this law applies to providers rfceiv-ing
Violence Against Women Act and/or FEIMOY Violence Prevention and Services Act funding, Domestic
viopence services providers are not required to participate in HMIIS, beat shall provide aggregate service
data on persons served and outcomes achieved consdstent with those identified in thus sokitation.
I have read the above statement regarding HMIS and agree on behalf Of the applicant appiyIng for these
homeless prevention grant funds, that the applicant wdl fully participate in HMNS and that receipt of
grant funds is contingent On HMIS participation,
June 19, 2014
're
(Signa ure of cuthorized representative for the applicant) (Date)
Jeanette McCo
Lernon, MC C and HIMIS Administrator
(Printed nume of the above signotory)
21�111M__ -
-
Parti6pation in the HMIS is a requirefne-it fr )r receipt of homeless grant funds, HNIIS requirements are
outlined in 24 C.F,R, Part 576, Accordingly, oMy applicants who commit to partii6pate in the HMIS will
her cnnsiideredi for funding in 2014. Section 605 of the Violence Against Wornen Act of 2005 amended
the McKinney -lento HorneNes,5 Assistance Act prohibits vict'wm services providers, from entering
personally -identifying inforrnaltion into an HIM6 database, This law applies to providers receiving
Violence Agannst Women Act and/or Family Violence Prevention and Services Act funding, Dornestic
violence !services providers are not required to participate in HMIS, but shall provide aggregate service
data on persons served and outcomes achieved consistent with those iden0fied in this solicitation
I have read the above staternent regarding HIMIS, and agree on behalf of the applicant applying for these
homeless prevention grant funds, that the applicant wild fully participate in HMiS and that receipt of
grant funds is contingent on HMIS participation,
(signature of outhorized representarive for the o,pplicant) (Dote)
Sheryl! Graharn, Sr, Director
(Prinnt,ed narne qf the above s(gnctory)
�R -ndix VIN - Completeness Checkfist
Applicants must complete the, Completeness Checklist uswrig this form to help assure that aii required
documents are contained hn th6r grant aplokcabon, The completed checklist shall be included nn the
submission in Tab 6
wcation Content Lt e—M
oaretTab
E,2F_eJs I
N u rn b e r
'I,
Original Application, Plus one cop,y
2.
Trars,mittai Letter, Signed by Authorized
Organization, Official
3,
Organization lnforrnatnon —Tab 1
57'
Addressed all items, I to 6
--------------
Attached supporting docuiments
4.
Project Narrative —Tab 2
3 — 53
Addressed all items, as required
(See p, 2 1)
S.
Application Form,: Criteria Preference
3
* Addressed 0 criteria, a tog
- Attached supporting
documentation?
67-7(;;
# Certification signed by Authorized
Official?
7 7
✓
4
9G
16.
Budget Forms,
Forms completely filled out?
Budget narrative included?
-99
7,
Evidence of My Florida MarketPlace
i0c) _/oz,
registration?
—5
8,
Certification of HMI�S Compliance?
5
9.
If applicant is nonprofit, evidence of IRS
5011(c) (3) status',
SNIA
w
MMIZORME
COMPLETENESS CHECKLIST
S �-e r r� 3 c, e s
et c)utrp3ch
orin and R,?,Hou5i11g
Applicants must complete a checklist: using this forrin to help assure that aH reqijired documeri:5 are
contained in their grant application, The corrpieted checklist shall be included m the subrinission in Tab
6 - II
Appkc3tion _ContentItem
1, Original Application,
plus �cpies
2. Tran5rinittal Letter, Signed by Authorized
Organization official
3. Orga niza tion information— Tab .1
Addressed all iiterris, I to 7? (See p, 21)
Attached supporting docurnents
4. Project Narrative —Tab 2
Addressed aM iterns, as required
(See p, 2 1)1
5, App'�icationi Form: Capacity and
Performance Criteria
* Addressed aH criteria, I to 7?
(See pages 21 to 45)
0 Attached supporting
documentation?
o Certification signed by Authorized
OfficiaI
6, Budget and Ma�tch Forrns,
Form,s completely filled out?
Budget narrative included?
7 Evidence Of MyFloridaMarketPlace
registration?
8, Certification of HMIS Cornpliarce?
9, if aopficant is nonprofit, Certification of
P.ocal Government Approval?
jf applicant is nonprofit, evidence of iRS
ti014c)(3) srtatus P
Corn e te
Tab
Number
2
3
35 -7 7
4 -79
S
2[jl.4 Frnergency Somions Gran't
3u
COMPLETENESS CHECKLIST
-��� Provennon �nd Re'�ousin� F�� 5he|ter rac.m/es 0 ��ree��y�reac�
App|Cants mws, compLeUe a checklist us,ng th/s form to help a�su,e that all required documEnts are
contained in the/r8rant application. The completed check -list shaUbe included in the submission m Tab
6
����
��
���
Number
l. 0ngmell Application, p|um1"copies
2 'Transmittal Letter, Signed by �
Organization Official
�Drganizanmm Information - Tabi I
Addressed al| itemms, 1to7?<5eep, I1>
_-2��-r5_
Attached supporting documents
��`
______
________
4. Project Narrathve—Tab 2
2
Addressed all items, as '
�
(See p,Z1)
.
__..... __
S. Application Form: Capacity and
�
����~r7~7
Performance Criteria
�.
__���__�'
�Addressed all criteria, 1tm77
(See pages 21to45)
w Attached supporting
documentation?
° Certification signed by Authorized
Official
6. Budget and ��mtchForms
.
4
6 �
Forms completely filled om@
______
-_(J�����
8udg,etnarrative included?
7Evidence of MyFlorida Marketplace
~^
registra0om?
5
0CertificanomofHu$|S[onnp|iance?
�
V/
S
u�^
9 if applicant is nonprofit, [e'cihcamon of
' ~'
LocanGovernment Approval?
lQXappbcant �s nonprofit, evidence ofIRS
°
50I(c)(3)sLatus?
�~_
�__
2Ol4Eme,g�lencySolutions Grant
/� '
\��(L)
Contract No. KPZ21 ...... ...... ClientZ Non -Client
CFDA No, 93.55BI
6as
THIS GRANT AGREEMENT* is entered into bemeen the Ronda Depaarnent of Ch0dren and Farnilies, hei,eina'flef refe �ec1 to the
"Department" and Monroe County Homeless Services ConfinUUM of Care, Inc., hereinafter referred to as qie "Provider", The
Department and Provider agree as hollows:
*If this document is denoted above as a GRANT AGREEMENT, the term "Contract" as it may appear hereinafter shall be construed to
mean "GranVoir "Grant Agreement" as the context may provide, imilady, the term "Provider" shall be construed to rnean "Grantee" and
the term "Contract Manager' shall be construed to 'nean "Grant Manager."
1. ENGAGEMENT TERM AND CONTRACT DOCUMENT
1.j Purpose and Contract Amount. -vices to families in Monroe County,
The Departaieni is engaging the Provider for the purpose of providing homeless prevention sei
as furtlier desc6bad in Section 2 hereof, payable as provided in Section 3 hereof, in an amount not to exceed $20,000.00.
1,2 Effective and Ending Dates,
Tian 7 +,.',cj tr,,ct shall, be effective on October 1, 20 14 or the last date executed by a party, whichever is later. The service performance
under phis Contract shaO commence on October 1, 2014 or the effective date of this Contract, whichever is later, and shall end at
rrludnlqrd., Eastern time, on June 30, 2016, subject to the survi4 of terms provis6ls of Section'7A hereof.
Z This Contract may not be renewed.
-
F1 Th is Contract may be re newed in accordance with Section 26 of the PUR 1000 Foirn and, if renewed, costs fear flee renewal
may not, be charged to this Contract.
The renewal, price(s) set foilh in the bid, proposal, or ;eply are shown in Exhibit F subject to negotiation at renewal
per section 287,057(13), Florida Statutes (F.S,), [] Not appkable.
offlcioi Payee and Party Representatives.
a, Th,e name, address, telephone number and e-mail address
of the Provider's official payee to whom the payment shall be
(fifpcted on behalf of the Provider are:
Name° Monroe County Homeless Services
Continuum of Care, Inc.
AddressPO Box 2410
Key West StateYL Zip Code33045
Phone: 443.974-6522
eXL
b. The name of the contact person and address, telephone,
and e-mail address where the Provider's financial and
acirniNstrafive records are maintained are:
Name: Jeanette Mclernon
;kJ'd re
Ciiy;; Key West State:FL Zip Code:330140
Ptjone. 443-974-6522
F,1 X t:
11: rnonroehomele� omcast.net
c, The rarne, address, telephone number and e-real address of
the Contract Manager for the Department for this Contract are:
NarneTheresa Phelan
Address11,11, 1214 Street
. . . ... ....
(',Ity: Key West State: EL. Zip Code 33040
Phone305-293-6350
e X t:
e-maI1 trixie_ploafer�cfs�tatejl.us
d. The name, address, telephone number and e-mail of the
Provider's representative responsible for admiNstratbn of the
prograrn under this Contract hand primary point of contact) are:
Name- Jeanette McLernon
Address
City: Key West State:FL Zip CodeA33040
Phone: 443-974-6522
ext:
e-maiLmonroehorneles coc@ otrcast.net
Per section 4012.7305(1)(a), F.&, the Department's Contract Manager is the primary point of contact througi which all Contracting
information flows between the Department and the Provider, Upon change of representatives (narnes, addresses, telephone numbers or
e-mail addresses) by either party, notice shall be provided in writing to the other party,
CF Integrated Contract 2014 1 Contract No. KPZ21
,1,4 Contract Document,
This Contract is composed of Sections I through 7 hereof, as Well as Exhibits A through F and altachnients, I through 3 and any exhibits
referenced, In sald.attachments,, together with any doc-uments incorporatedby reference, which containallthe terms-and-con0lons
agreed upon by the part'es,
1,41 The definitions found in, the Standard, Contract Definitions, located at.
littp�:llwww,dcf.state,fl.us/adniin/coiitracts/clocs�Stand@r(IContractTerms2O14,pdf are incorporated into and made a part of this
Contract. Additional definitions may be forth in Exhil-A A, Special Provisions,
1.4,2 The PUP '1000 Forni (10/06 version) is hereby incorporated into and made a part of t1his, Contract, Sections 1 .6, 2-4, 6, 8-113,
23, 27 and 31 of the PU R 1000 Form are not applicable to this Contract, in the event of any conflict between the P UR 1000 Form
and away other le rrns or conditions of this C,onlract, such other terns or conditions shall take precedence over Lire P U R 1000 Form.
1,43 The terms of Exhibit A, Special Provisions, supplernent or modify the terms of Sections I through 7 hereof, as provided
therein,
1,4.4 In the event of a conflict between the provisions of the documents, the documents shall be, interpreted in the following order of
preuedence ' a, Exhibits A through F;
b. Any documents incorporated into any exhibit by referenced
c� Tors Standard Contract;
d, Any documents incorporated into this Contract by reference.
e. Attachments 1 through 3,
2, STATEMENT OF WORK,
The Provider shall perform all tasks and provide units of deliverables, including repoirts, findings, and drafts, as specified in Ns Contract.
Except for advances, if any, provided for in this Contract, these deliverables must be received and accepted by the Contract Manager in
writing prior to payment, subject to Ribsequenft audit and review and to the satisfaction of the Department, The Department's
determlriation of acceptable services shall be conclusive. Department receipt of reports and other submissions by the Provider does not
constitute acceptance thereof,
which occurs only through a separate and express act of the Contract Manaper. Unless otherwise
provided in the procurement document, if any, or governing law, the Department reserves the right to, increase or decrease the volume of
services and to add tasks that are incidental or complimentary to the original scope of services. Except where the method of payment is
prescribed by law, compensation under Section 3 will be equitably adjusted by the Department to the extent that it prescribes a fixed
price (previously called "fixed fee") payment method or does not provide a rnethod of paynient for added tasks,
21 Scope of Work.
The Scope of Work is described in Exhibit B.
2.2 Task List.
The Provider shall perform all tasks set forth in the Task List, found in Exhibit 0, in the mariner set forth therein.
2,3 Deliverables.
Deliverables shall be as described in Exhibit D.
2,4 Performance Measures,
2.4,1 Performance Measures for Acceptance of Deliverables. The per ornlance measures for acceptance of dellverables are
set forth In Exhibit D, Section D-2,
2,4.2 Minimum Performance Measures, To avoid contract termination, Provider"s performance must rneet the rninimum
performance standards set forth in Exhibit E, 'Minimum Performance kleaSUres, Section E-1, regardless of any other perforMance
measures in this Contract. By execution of this Contract the Provider hereby acknowledges and agrees that its perfOFI-nanGe under
the Contract must rreet these Minimum Performance Measures and that it will be bound by the conditions set forth therein, If the
Provider falls to meet these standards, the Departnient, at its exclusive option, may allow a reasonable period, not to exceed 6
months, for the Provider to correct performance deficiencies, if performance deficiencies are not resoived to the satisfaction of the
Department within the prescribed time, and i' no extenuating circumstances, can be documented by the Provider to the Department's
satisfaction, the department must terminate the Contract, The Department has the sole authority to determine whether there are
extenuating or mitigating circumstances, The Provider further acknowledges and agrees that during any period in which the
CF lntegrated Contract 2014 2 Contract No. KPZ21
Provider, fails to ineet these standards, regardless of any, additional time allowed to correct performance deficiencies,, payrnent for
deliverables may be delayed or denied and financial consequences may apply
1. --PAYME,i E-AND RELATED TE
The Department shall pay for SeMces performed by the Provider during the service performance period of this Contract according to the
terms and conditions of this Contract in an an'iount not to exceed that set fofth in Section 11 hereof, subject to ffie availability of funds
and satisfactory perfoi-mance, of alp terms by the Provider, Except for advances, if any, provided for in this Contract, payment shall be
made only upon written acceptance of all services by the DoparMiei1 and shall remain subject to subsequent audit or review to confirm
contract compliance, The State of Florida's performance and obligation to pay Linder this Conti -act is contingent upon, an annual
appropriation by the Legislature, Any costs or services paid for under any other contract or from any other source are riot eligible for
payment under this Contract,
3,1 Method of Payment.
The Provider sha! I be paid in accordance with Exhibit F Method of Payment and invoices,
3.2 Invoices.
3,2.1 Generally, The Provider shall submit bulls for fees or other compensation for services or expenses in, sufficient detail for
proper pre -audit and post -audit, Where itemized payment for travel expenses is permitted in this Contract, the Provider shall submit
bills for any travel expenses in accordance Mh section 'I 12.Ci61, F,S,, or at such lower rates as may be provided in this Contract
3.2,2 Final Invoice, The final Invoice for payment shall be submitted to the Department no more than 45 ' days after the Contract
ends or is terminated. If the Provider fails to do so, all rights to, payment are forfeited and the Department will not honor any
reizitiests submitted after the aforesaid three period. Any payment due under the terms of this Contract may be Withheld until
performance of services and all reports due frorn the Provider and necessary adjustments thereto, have been, approved by the
Department
33 Financial Consequences,
If the Provider fails to perform In accordance with this Contract or perform the minimum level of service required by this Contract, the
Department will, apply financial consequences as provided for in Section 6,1 hereof, The parties agree that the, penalties provided for
under Section 6,1 hereof constitute financial consequences under sections 287,058(1)(h) and 215,971 (1)(c), F.S. The foregoing does
not limit additional financial consequences, which, may include but are not limited to refusing payment, withholding payments until
deficiency is cured, tendering only partial payments, applying payment adjustments for additional financial consequences or for liquidated
damages to the extent that this Contract so provides, or termination of this Contract, per Section 6,2.3 hereof and requisition of services
from an alternate Source. Any payment made hn reliance on the Provider's evidence of performance, which evidence is subseqUenUy
determined to be erroneous, will be immediately due as an overpayment in accordance with Section 3A hereof, to the extent of such
error,
34 Overpayrnents; and Offsets.
The Provider shall return to the Department any overpayments due to unearned funds or funds disallowed that were disbursed to the
Provider by the Department and any interest attributable to SUCh funds, Should repayment not be imide promptly upon discovery by the
Provider or its auditor or upon written notice by the Department, the Providet will be charged interest at the lawfiJI rate of interest on the
outstanding balance until returned, Payments made for services subsequently determined by the Department to not be in full compliance
with contract repArements shall be deemed overpayments. The Department shall have the right at any time to offset or deduct from any
payment due under this or any other contract or agreement any amount due to the, Department from the Provide- under this or any other
contract or agreement.
3.5 myFlorLd—amarketPIace ha-11sacticLn —Fee,
This Contract is exempt from the MyRorda]Vlar'�etlPlace transaction fee
4, MANCE.
41 Cornpliarice with Statutes, Rules and, Regulations.
In perforrrOg, 'qs obligations Linder this Contract, the Provider shall witliout exception be aware of and comply with all State and Federal
laws, rules and regulations relating to its performance under this Contract as they may be enacted or amended from thne-to-time,
including but not limited to those, described in E. hibit Al, as wed as any court or administrative order, judgment, settlement or compliance
agreement involving the Department which i by its nature affects the services provided under this Contract.
CF lntegraled Contract 20114 3 Contract No, li
4.2 Independent Contractor, Subcontracting and Assignments.
4.2.1 In perlan-ring its, obligations under this Contract, the Provider shall at all firries be acting in ffie, capacity of an independent
contractor.and not as an officer, employee, or agent,of the State of Florida,, except where the Provider is a State agency. -Neither the
Provider nor any of its agertts, employees, subcontractors or assignees shall represent to others that it !is an, agent of or has, the
auffiolrilty to bind the Department by virtue of this Contract, unless spe6fically authorized in wrlt4ig to do so. This Contract does not
create any right in any individual to State retirement, leave benefits or any other benefits of State employees as, a result of
performing the duties or obligations of this Contract,
41.2 The Provider shall take such actions as may be necessary to ensure that it and each subcontractor of the Provider will be
deemed to be an Independent contractor and will not be considered or permitted to be, an officer, employee, or agent of the State of
Florida. The Department will not furnish services of support (e.g., office space, office supplies, telephone service, secretarial or
clerical support) to the Provider, or its subcontractor or assignee, unless, specifically agreed to by the Department in this Contract,
All deductiors for social! security, withholdirg taxes, income taxes, contributions to unemployment compensation funds and all
necessary Insurance for the Provider, the P[ovider's, officers, employees, agents, subcontractors, or assignees shall be the sole
responsibility of the Provider and its subcontractors. The parties agree ffiat no joint employment Is intended and that, regardless of
any provision directing the manner of provision of services, the Provider and' its subcontractors alone shall be responsible for the
supervision, control, hiring and firing, rates of play and terms and condlfions of employment of their own employees,
4.2.3 The Provider shall not assign its resplonsIblities under this Contract to another party, in whole or part, without prior written
approval of the Department, upon, the Department's sole determination that such: assignment wiH not adversely affect the public
interest. No payment shall he made under this Contract to any factor or other person who has been assigned or transferred the
right to receive payment in lieu of or on behalf of the Provider except upon, full and faithful perforMance of the Provider's duties
hereunder. Any assignment or transfer occurring without prior approval of the Department shall be null and void. The Provider shall
not subcontract for any of the work contemplated under this Contract without prior written approval of the Department, which shall
not be unreasonably withheld.
4.2.4 The State, of Florida shall at all tirnes be entitled, to assign or transfer, in whole or part, its rights, duties, or obligations under
this Contract to another governmental agency in the State of Florida or to a provider of the Department's selection, upon giving prior
written notice to the Provider. In the evert of assignment by either party, this Contract shall remain binding upon the lawful,
successors in Interest of the Provider and the Department.
4.15, The Provider is, responsible for all work performed and for all commodities produced pursuant to this Contract whether
actually furnished by the Provider or by its subcontractors. Any subcontracts shall be evidenced by a written document. The
Provider further agrees that the Department shall not be liable to the subcontractor in any way or for any reason relating to this
Contract,
4,2.6 The Provider shall include, in all subcontracts (at any tler� the substance of all clauses contained in this Contract that mention
or describe subcontract compliance, as well as all clauses applicable to that portion of the Provider's performance being pertbrmed
by or through the subcontract,
Section 19 of PUR 10,00 Form shall apply per its terms„ except that the phrase "arising from or relating to personal Injury and damage to
real or personal tangible property" in the first paragraph is replaced with "arising out of or by reason of the execution of this Contractor
arising from or relating to any alleged act or omission by the Provider, its agents, employees, partners, or subcontractors in relation to Ilils
agreement," and the following additional terms will also applya
43,11 If the Provider removes an infringing product because It is not reasonably able to modify that product or secure the
Department the right to continue to use that product, the Provider shall immediately replace that product with a non -infringing product
that the Department determines to be of equal or better functionality or be liaLde for the Department's cost in so doing,
4.3.2 Further, tie Provider shall indemnify the Department for all costs and attorneys fees arising from or relating to Providers clalin
that a record contains, trade secret information that is exempt from, disclosure or the scope of the Provider's redaction of the record,
as provided for under Section 53. hereof, including litigation initiated by the Cepartment,
The Provider's inability to evaluate, liability or its eV810610n of liability shalt/ not excuse its duty to defend and indemnify after receipt of
notice. Only an adjudication or judgment after the highest appeal is exhaLlSted finding the Department negligent shall excuse the
Provider of performance under this provision, in which case the Department shall have no obligation to reimburse the Provider for the
cost of its defense, if the Provider is an agency or subdivision of the State, its obligation to indemnify, defend and hold harmless the
Cr' Integrated Contract 2014 4 Ccntract No, KPZ21
Department shall be to the extent permitted by section 768 2 8, F.S or other appl cable law, and witliout waivmg the limits of sovereign
Immunity.
4,,4 - Insurances
The Provider shall maintain continuous adequate liability insjjranc.e coverage during the exislence of this Contract and any renewal(s)
and extension(s) thereof. With the exception, (if a State agency Or Subdivision as defined by subsection 768,28(2), F.S,, by execution of
this Contract, the Provider accepts frill responsibikty for identifying and determining tile typ�e(s) and extent of liability insurance ner,essary
to provide reasonable financial protections; for the Provider and the c4ents to be served under this Contract, Upon the execution of this
Contract, the Provider shall furnish the Depailment written verification supporting both the determination and existence of such insurance
coverage and shall furnish verification of renewal or replacement thereof prior to the expiration or cancellation, The Department reserves
the right to require additional insurance gas specified in this Contract.
4,5 Notice of Legal Actions,
The Provider shall notify the Depar went of potential or actual legal actions taKen against the Provider related to services provided
through this Contract or that may impact the Pmvider's ability to deliver the contractual services, or that rnay adversely impact the
Department. The Department'o Contract Manager will be notified within 10 days of Provider becoming aware of such actions or potential
actions or frown the day of the legal filing, whichever comes first,
4,6 intellectual Property.
R is agreed that all intellectual property, inventions, written or- electronically created materials, including manuals, presentations, flinls, or
other copyrightable materials, arising in relation to Provider's performance under this Contract, and the performance of all of its officers,
agents and subcontractors 41 relation to this Contract, are works for hire for the benefit of the Departrnent, fully compensated for by the
contract arnWnt, and that neither the Provider nor any of its officers, agents nor subcontractors may claim any interest in any intellectual
property rights accruing under or in connection with the performance of fis Contract. R is specifically agreed that the Department shall
have exclusive rights to all data processing software falling within the terms of section 11 9:,08,4, F. S,, which arises or is developed in tile
course of or as a result of work or services performed tinder this Contract, or in any vmy connected lherewO, Notwithstanding the
foregoing provision,. If the Provider is a University and a member of the State University Systern of Florida, then, section, 1004.23, F,S,,
shall apply,
4.61 If the Provider uses or delivers, to the Department for its use or the use of its ellniployees, agents or contractors, any design,
device, or materials covered by letters, patent, or copyright, It is mutually agreed and understood, that, except as to those items
specifically ksted in Exhibit A as having specific limitations, the compensabc,i paid pursuant to this Contract includes all royalties or
costs arising fi-Orn the Use of such design, device, or materiais in any way involved in the work contemplated by this Contract. For
purposes, of this provision,, the term "use" shall include use by the Provider during tile term of fits Contract and use by the
Department Its employees, agents or contractors during the term of this Gontact and perpetually thereafter.
4,61 All applicable subcontracts shall include a provision that the Federal awarding agency reserves all. patent rights with respect,
to any discovery or Invention that arises or is developed In the course of or under the subcontract, Notwithstanding the foregoing
provision, if Vie Provider or one of its subcontractors is a unuversity and a member of the State University System, of Florida, then
section '1004,23, F.S,, shall apply, but the Department shall retain a perpetual, fully -paid, nonexclusive license forlits use and the use,
of its contractors of any resuitIng, patented, copyrighted or traderrarked work products.
4,7 'Transition Activities.
Continuity of service is critical when service under tNs Contract ends and service commences under a new contract. Accordingly, when
.service will continue through another provider upon the expiration or earlier termination of this Contract, the Provider shall, WithoUt
additional compensation, complete all actions necessary to smoothly transition service to the new provider. This includes but us not
lirnited to the transfer of relevant data and files, as well as property funded or provided pursuant to this Contract. The Provider shall be
required to Support an orderly transition to the rext provider no later than the expiration or earlier termination of this Contract and shall
support tile requirements for transition as specified In a Department -approved Transition Plan, which shall be developed jointly with the
new provider in consultation with the Departmem.
4.13 Real Propeily,
Any State funds provided for the purchase of or improvements to real property are contingent upon the Provider granting to the State a
security interest in the property at least to the amount of the State funds provided for at least five (5) years from the date of purchase or
tile completion of the improvements or as further required by law, As a conditior of receipt of State funding for tl-ds purpose, the Provider
agrees that, if it disposes of the property before the Department's interest is vacated, the Provider will refund the proportionate share of
the State's inlfial investment, as adjusted by depreciation.
GF Integrated Contract 2014 5 Contract No�, KPZ21
4,9 PLIWICRYm
VViflljout lirriKation, the Provider and its employees, agents, and representatives will, not, without prior Departmental written consent in
-in! advertising, publicity or,any-other prornotionai endleavor,any State mark, te name, of,tha-Slate's. "the each instance, use ctly or
the State or any State agency or affiliate or any officer or employee of the State, or any State priceram or service, or represent, dire
indirectly, that any product or service provided by the Provider has been approved or endorsed by the Slate, or refer to the existence of
this Contract in press releases, adverthsingi or materials distributed to the Provider's prospective, MstoMers"
4,10 Sponsorship,
As required by section 286,25, F.S., if the Provider is a non-governrnerilat organization which sponsors a program financed wholly or in
part by State funds, including any funds, obtained through, thus Contract, it shall, in publicizing, advertising, or describing the Sponsorship
of the prograrn state "Sponsored by (Provider's name) and the State of Florida, Department of Children and Fanlikes", if the
Sponsorship reference is in written material, the words "State of Florida, Department of ClAdren arid Families"" shall appear in at least the
same size letters or type as the name of the organization.
4.11 Employee Gifts,
The Provider agrees that it will not offer to give or give any gift to ariy Department employee during the service per?orrnance period of this
Contract and for a period of two years thereafter, In addition to any other rernedies available to the Department, any violafior, of this
provision will result in referral of the Provider's name and description of the violation of this term to the Department of Management
Services for the potential inclusion of the Provider's name on, the suspended vendors list kor an appropriate period. The Provider w4l
ensure that its subcontractors, if any, comply with these Provisions.
4,12 Mandatory Reporting Requirements,
The Provider and any subcontractor must comply with and inform its employees of the following mandatory reporting requirements. Each
employee of the Provider, and of any Subcontractor, providing services fn connection with this Contract who has any knowledge of a
reportable incident shall report such incident as follows: 1) reportable Incidents that may Involve an imrne6ate or impen&g impact on
the health or safety of a client shall be immediately reported to the Contract Managed and 2) other reportable incidents shall be reported
to the Department's Office of inspector General by completing a Notification/Inqestigation Request (Form CF 19134) and, emalling the
request to the Office of inspector General at 4g_cofflp[aints(@.dcf,state.fl.us, The Provider and subcontractor may also mail the completed
form to the office ofInspector General, 1317 Winewood Boulevard, Building 5, 2nd Floor, Tallahassee, Florida, '32399-07001n or via! fax at
(850) 488-1428, A reportable incident is defined in CFOP '1801-4, 'which can be obtained from the Contract Managar,
5. RECORDS, AUDITS AND DATA SECURITY.
5.1 Records,, Retention,, Audits, Inspections and Investigations.
51,1 The Provider shah establish and maintain books, records and documents (including electronic storage niedia) SLIfficient to
reflect all income and expenditures of funds provided by the Department Linder this Contract.
5,1.2 Retention of all client records, finan6al records, supporlJng docl�ments, :statistical records, and any other docuwlenls
(including electronic storage media) pertinent to this Contract shall be maintained by the Provider during the term of this Contract
and retained for a period of six (6) years after completion of the Contract or longer when required by law. In the event an audit is
required under this Contract, records shall be retained for a minimum period of six (6) years after the audit report is issued or until
resolution of any audit findings or llflgation based on the terms of This Contract, at no, additional cost to the Department.
Upon demand, at no additional cost to the Department, the Provider will facilitate the dupl4cafion and transfer of any records
or documents during the term of this Contract and the required retention perilod in Section 51.2 hereof,
5,1 A These records shall be made available at all reasonable times for inspection, review, copying, or audit by Federal, State, or
other personnel duly authorized by the Department.
51,5 At all reasonable times for as long as, records are maintained, persons duly authorized by the Department and Federal
auditors, pursuant to 45 Code of Federal Regulations (CFR) s. 92,36(i)(10), shall be allowed full access to and the right to examine
any of the Provider's contracts and related records and documents, regard1r.-ss of the form in which kept,
5A ,6 A financial and compliance audit shall be provided to the Department as specified in this Contract and in Attachment I
5,13 The Provider shall comply and cooperate immediately ofith, any inspections, re0ews, investigafions, or audits deemed'
necessary by The Office of the Inspector General (section 201,055, F,&).
CF integrated Contract 20,14 6 Contract fro ,,KP,Z21
N�o record may be withheld nor may the Provider attempt to limit the scope, got any of the foregoing Inspections, reviews, copying,
transfers or audits based on a!niy claim that any record is exempt from public insu
pection or is confidential, proprietary or trade secret
in natur% provided, however, that this provision does not liailt any exemption toblic inspection or copying to ,any such record,
5.2 Inspections and Corrective Action.,
The Provider shall permIlt all personswho are duly authorized by ttic Dq)w1ment to inspect and copy iny records, papers, docurnents,
,facilities, goods and setvires of the Provider which are relevant to this Contract, and to interview, any clients, ernpioyees wid
subcontractor employees of the Provider to assure the Department of the satisfactory performance of the terms and conditions of this
Contract, Foliowing such review, the Department will deliver to the Provider a written report of its flndings, and may direct the,
development, by the Provider, of a corrective action plan where appropriate, The Provider hereby agrees to timely correct all deficiendes
identified in the Ceparb-nent's written report, This provision will not limit the Department's termination floltS Linder Section 6.2.3 hereof.
3 Provider's Confidential and Exempt Informatiom,
5,3,1 By executing this Contract, the Provider acknowledges that, having been proMed an opportunity to review ail, provisions
hereof, all provisions of this Contract not specifically identified in writing by the Provider prior to execution hereof as "confidential or
exempt" will be posted by the Department on tile public website maintained by the DepartrIlent of Financial Servgces pursuant to
section 215.985, F,S, The Provider agrees tnat, upon written request of the Department, it shall promptly provide to the Department
a written statement of the basis for the exemption aipplicable to each provision idenfified by the Provider as "'confidential or exempt",
including the statutory citation to, an, exemption created or afforded by statute, and state with particularity the reasons for ffie
conclusion that the provision is exenipt or confidential,
5.3.2 Any claim by Provider of trade secret (proprietary) confidentiality for any information contained in Provider's, documents
(repoits, deliverables, or workpapers, eto., in paper or electronic form), submitted to the Department in connection with this Contract
Mil be waived, unless the claimed confidential information is submitted in accordance with Section 5.3,2,a, hereof.
a, The Provider must clearly label any portion of the docurnents, data, or records submitted that it considers exempt from
public Inspection or disclosure pursuant to Florida's Public Records Law as trade! secret. The labeling wifl include a
justification citing specific statutes and facts that authorize exerniption of the information from public disclosure , If
different exemptions are claimed to; be applicable to different portions of the protected information, the Provider shall
include information correlating the nature of the claims to the particular protected information.
b. The Department, when required to comply with a public records request including documents submitted by the Provider,
may require the Provider to expeditiously submit redacted copies of documents marked as trade secret in accordance
with Section 5.3,2.a hereof. Aco:)rnpanying the submission shall be an updated version of the justification under Secton
5.3,2,a, hereof, correlated specifically to redacted information, either confirming that the statutory and factual basis
originally asserted remain unchanged or indicating any changes affecting the basis for the asserted exemption from
public inspection or disdosure, The redacted copy must exclude or obliterate only those exact portions that are claimed
to be trade secret, If the, Provider fails to Promptly submit a redacted copy, the Department is authorized to produce the
records sought without any redaction of proprietary or trade secret informailon,
The Provider shall be responsible for defending its (,;lairn that each and every portion of the redactions of trade secret information are,
exempt from inspection and copying under Forlda's Public Records Law
54 Health Insurance Portability and Accountability Act,
0 The Provider certifies that neither it nor its subconvactors will have access to, recerve or provide Protected Health Information
within the meaning of the Hea4h, Insurance Portability and Accountability Art (42 IJ,S,C, s,1320d.) and the regulations promulgated
thiereunder (45 C,FR Parts 160,18 and 164) incidental to performance of this Contract.
In compliance will-i 45 CFR s,16,4,504(e), the Provider shall corflpiy with the provisions of Attachment 2 to this Contract,
governing the safeguarding, use and disclosure of Protected Health Information created, received, maintained, or transmitted by the
Provider or its subcontractors Incidental to tile, Provider's performance of ills Contract,
5.5 Confidential Client and Other Information. Except as provided in this Contract, the Provider shall not use or disclose but shall
protect and rna,ntailn the confidentiality of any client information and any other information made confidential by Florida law or Federal
laws or regulations that is obtained or accessed by the Provider or its subcontractors incidental to performance under this Contract.
CF integrated Contract 2014 7 Contract No, KPZ21
5,6 Data fie oiiflty, The Provide[ shall comply with the following data security requirement s whenever the Provider or Its
Subcontractors have access to Department data systems or maintain any client or tither confidential information in electronic 10471:
ty Officar, The- Data,
5M.1 An appropriately skilled individual shall be-ldentiried by -the Provider to -function as its,Data Secul
Security Officer shall act as, the liaison to the Department's secur4y staff and will maintain an appropriate level of data security for
the information the Provider is collectim or using in the performance of th[s Conh'Kt. An appropriate lev�,l of security includes
approving and tracking all Provider employees fiat request or have access to any Departmental data system or intormahon, 1he
Data Security Officer will ensure, that user access to the data system or information has been removed from all terr0iated Provider
employees,
5,6,2 The Provider shall provide the latest Departmental! SeCUrily awareness training to its staff who have access to departmental
inforr'nation.
5,,6,3 All Provider employees who have access to Departmental Information shall comT)pty with, and be provided a copy of CF0P 50
2, and shall sign the DCF Security Agreement form CF 0114 annually, A copy of CF 0114 r-nay be obtained from the Cof*act
Manager,
51,6,4 The Provider shall make every effort to protect arid avoid unauthnd7P.Cl release of any personal or confidenfia9 information by
ensuring both data and mobile storage devices are encrypted! as prescribed in CFnP 50-2. If encryption of theese devices is not
possible, then the Provider shall[ assure that unencrypted personal and confidential Departmental data will not be stored, 011,
unencrypted storage devices.
5.6.5 The Provider agrees to notify die Contract Manager as soon as possible, out no later than five (5) buslness days following the
determination of any breach or potential breach of personal and confidential Departmental data,
5�6.6 The Provider shall at its own cost provide notice to affected parlies no later than 45 clays following the determination of any
potential breach of personal or confidential Departmental data as provided in section 817 .5681, F,S, The ProvIder shall also at its
own cost implement measures deemed appropriate by the Department to avoid or mitigate potential injury lo any person due to a
breach or potential breach of personal and confidential Departmental data.
The Provider shall cause each of Its subcontrFctors having access to Department data systerris, or maintain ng any client or other
confidential information In electronic form to comply with the prov6ons of this Section 5,6 and the term "Provider" shall be deemed to
mean, the subcontractor for such purposes.
6AJ In accordance with the provisions of section 402.73(l), F.S., and Rule 65-29,001, F,A,C,, corrective action plans rimy be
required for noncorr-rpliance, nonperformance, or unacceptable performance under this Contract. Penalties may he imposed for
failures to implement or to make acceptable orogress on such corrective action, plans.
6,11 The !increments of penalty imposition that shall apply, unless the Department determines that extenuating circumstances
exist, shalt be based upon the severity of the noncompliance, nonperformance, or unacceptable performance flat generated the
need, for cor-ective action, plan. The, penalty, If Imposed, shall not exceed ten percent (10%) of the total contract payments during, tfle
period in which the corrective action plan has not been implemented or in which acceptable progress toward implementation has not
been made. Noncompliance that is determined to have a, direct effect on client health and safety shall result in the imposition of a ten
percent (10%) penalty of the tcta� contract payments Burin the period in Mich the corrective action plan has not been implemented
or In which acceptable progress toward Implementation has not b�een made,
6,1.3 Noncompliance Involving the provision of service not having a direct effect on client health and safety shall result in, the
jrnpcsuflon of a five percent (5%) penalty. Noncornpl lance as a result of unacceptable performance of administrative tasks shall, result
in the irnposition of a two percent (2%) penalty,
61.4 The deadline for payment shall be as stated In, the Order 4TIP09ing true financial, penalties. In the event of nonpayment the
Departnient may deduct the amount of the penalty from Invoices submitted by the Provider,
6.2 Term,ination,
6,21 In accordance with Section 22 of PUR 1000 Form, this Contract may be ten-ninaled by the Department without cause upon no
less than thirty (30) calendar days notice in wnting to the Provider unless a sooner time is mutually agreed upon in writing,
CF Integrated Contract 20 14 a Contract No, K1Z2,1
622 M the event funds for payment pursuant to this Contract become unavailable, the Department rniy terminate this Contract
upon no less than, twenty-four (24) hours notice in writing to the Provider, The Department shall be the final authority as to the
availability arid adequacy of funds,
6,2. 11 3 1 1 n, the event the Provider I - I falls to ful lyy comply
y withth
e terms and conditions of this Contract, One Departri-ent may terminate the
Cnntracl� upon no less than twenty-four (24) hours (eWudirig Saturday, Sunday, and Holidays) notice in w1fing to the Provider-,
such notice may be issued without providing an opportunity for cure if it specifies the nature of the nolicomFliance and slates that
provision for cure would adversely affect the interests of the State or is not permitted by law or regulation, Otherwise, notice of
termination will be Issued after the Provider's fa4Ltre to, fijliy cure such noncompliance within the time specified in a written notice of
noncompliance Issued by the Department specifying the nature of the noncompliance and the actions required to cure such
noncom pija rice . In addition, the Department may employ the default provisions in Rule 6OA-1,006(31), FA.0 , but is not required to
do so in order to terminate the Contract, The Department's failure to demand performance of any provision of this Contract shall not
be deemed a waiver of such performance, The Department's, waiver of any one breach of any provision of this Conti -act shall, not be
deerned to be a waiver of any other breach and neither event shall be construed to be a modification of the terms and conditions of
this Contract. The provisions herein do not limit the Department's right to rerry,,des at law or in equity.
6.2.4 Failure to havc performed any contractual obllgatmons undor any other contract with the Depahrnent in a manner satisfactory
to the Department will be, a sufficient cause for terrnjnatjon. To be terminated under this provision, the Provider nriust have: (1)
previously failed to satisfactorily perform in a contract with the Department, been notified by the Department of the unsatisfactory
performance, arid failed to timely correct the unsatisfactory performance to the satisfaction of the Department; or (2) had a contract
terminated by the Department for cause. Termination shall be upon no less than twenty-four (24) hours "notice in writing to the
Provider.
In the event of termination under Sections 6,2.1 or 622 hereof, the Provider will be compensated for any work satisfactorily completed
through the date of termination or an earlier date of suspension of wol* per Section 21 of the PUR '1000,
63 Dispute Resolution,
Any dispute concerning performance of this Contract or payment hereunder shalt/ be decided' by the Department's Contract Manager,
who shall reduce the decision to writing and provide a copy to the Provider. The decision shall be final and conclusbve unless within
twenty-one (21) calendar days, from the date of receipt of the Contract Manager's decision, the Provider deflvers to the Contract Manager
a petition for alternative dispute resolution. After receipt of a petition for alternative dispute resolution the Department and the Provider
shad attempt to amicably resolve the dispute through negofiatrons. Timely delivery of a petition for alternative dispute resolution and
completion of the negotiation process, shaH be a condition precedent to any legal action by the Provider concerning this Contract. After,
timely delivery of a petition, for alternative dispute resolution, the parties may employ any dispute resolution procedures described in the
Attachment l or other attachment, or mutually agree to an alternative binding or nonbMinq dispute resolution process, the terms of which
shall be reduced to writing and executed by both parties, Completion of such agreed process shall be deemed to satisfy the requirement
for completion of the negotiation process, This provision shall not limit the partiesrights of termination under Section 6.2 hereof,
AM notices provided under Section 6 shall be in writing On paper, Pl lYsIcaHY Sent to the person identified in Sectior 1,3,d hereof by tJ,S,
Postal Service or any other delivery service that pirnvOes verification of debivery, of by hand delivery,
M Governing Law and Venue.
This Contract is executed and entered into nn ihe State of Florida, and shall be construed, performed and enforced in all respects in
accordance with Rorida law, without regard to Florida provisions for confict of laws. Courts of competent jurisdiction in Florida shall
have exclusive jurisdiction in any action regard'Mg this Contract and venue shall be in Leon County, Florida. Unless otherwise provided in
any other provision or amenciment hereof, any amendment, extension or renewal (when authorized) may be executed in counterparts as
provided in Section 46 of the PUR 1000 Form.
7.2 No Other Terms.
There are no provisions, terms, conditions, or obligations other than those contained herein, and this Contract shak supersede all
previous communications, representations, or agreements, either verbal or written between the parties,
7,3 Severability of Terms,
If any term or provision of this Contract is legally determined unlawful or unenforceable, the remainder of the Contract shafl remain in 1`0
force and effect and such term or provision, shall be stricken,
CF Integrated Contract 2014 9 Contract No, KPZ21
7A Survival of Terms.
The parties agree that, unless a provision of this Contract, its aftachrnents or incorporated docurnents expressly states otherwise as to
itself or a narned provision, all provisions- of this, Contract concerning obligatimns of the Provider and remedies --available 1o,the
-
Department are intended to survive the "ending date"' or an earlier terr*atjon of this Contract. The Provider's performance pursuant to
qich surviving provisions shall be wqt)out further payment, as the contract payments received during the term of this Contract are,
consideration for such performance.
Modifications of provisions of this Contract shall be valid oniy when they have been reduced to writing and duty signed by both parties..
The rate of payment and the total dollar amount may be adjusted retroactively to refiect price level increases and changes in the rate of
payment when these have been established through the appropriations process and subsequently identified in the Department's
operating budget.
7,6 Most Favored Patty Status.
The Provider represents and warrants that the prices and terms for its services Linder this Contract are no, less favorable to tile
Department than those for surnilar services under any existing contract with any other party, The Pruvlder further agrees that, within 90
days of Provider entering Into a contract or contract amendment or offering to any other party services similar to those under this
Contract under prices or terms more favm'abhe tI',,,,an those provided in this Contract, the Provider will report such prices and terms to the
Department, which prices or terms shallll be effective as an amendment to this Contract Upon the Departmert's written acceptance
thereof. Should the Department discover such other prices Orr te.rMs " the same shall be effective as an arnen,frnent to this Contract
retroactively to the earlier of tile effective date of this Contract for other contracts in effect as of that date) or tie date they were first
contracted or offered to the other party (for subsequent contracts, amendments or offers) and any payment in excess of such pricing
sliali be deemed overpayments, Provider shall submit an affidavit no later than July 31st of each year during the term of this Contract
attesting that the Provider ws In compliance with this provision, as required by section 216,0113, F.S.
7.7 Anti compet Itiv e Agreements,
The Provider will not offer, enter into nor enforce any torm,A or informer agreement with any person, firm or entity under which the parties
agree to refrain from competing for any future service contract or limit in any manner the ability of either par1Y to obtain employment by or
provide services to the Department or a provider of services lio the Department,
7.8 Communications.
Except where othepAtise provided in this Contract, communications between tile parties regarding, this Contract may be by any
commercially reasonable means. Where this Contract calls for communication In writing, such communication includes email, and
attachnients thereto are deemed received when the email is received.
7,91 Accreditation.
The Department is committed to ensuring provision of the highest quality services to the persons we serve, Accordingly, the Departrrent
has expectations that where accreditation is generally accepted nationwide as a clear indicator of quality service, the Majority of the
Department's providers wid either be accredited, have a plan to meet national accreditation standards, or will initiate a plan within a
reasonable period of firne.
7.10 Transitioning Young Adults.
The Provider understands the Department's interest in assisting young adults aging out of the dependency sy9t.em, The Department
encourages Provider participation with the local, Community -Eased Care Lead Agency independent Living Program to offer gainful
employment to youth in, foster care and young adults transitlon4iq from the foster care, system.
7AI DE O and Workforce Florida,
The Provider understands that the Department, tile DepartrPent of Economic Opportunity, and Workforce Florida, 8nc., have jointly
Implemented an initiative to empower recipients in the Temporary Assistance to Needy Fmillhes Program to enter and remain un gainful
employment. The Department encourages Provider participation with the Department of Economic Opportunity and Workforce Florida,
7,12 Purchases by Other Agencies.
The Department of Management Services Play approve this Contract as an alternate contract source pursuant to RiAe 610A- 1,047, Florida
Administrative Code, if requested by another agency, Other State agencies may purchase from the resulting contract, provided that the
Department of Management Services has determined that the contract's use is cost-effective and in the best Interest of the State, Upon
CF Integrated Contract 2014 10 COnlTaG( No, KPZ21
such approval, the Contractor may, at its discreton, sell these corni,iiodifies or serviices to affitional agencies, upon the terms and
coodifions, contahied herein.
By signing this Contract, the parties agree that they -lave -read and agree to thee -.enure Contract, as described in -Section 1.4
hereof.
IN WITNESS THEREOF, the parties hereto have causod this 39, page Contract to be expcuted by their undersigned officials as duly
authohzed.
PROVIDER: Monroe County Homeless Services FLORIDA DEPARTMENT OF CHUREN AND FAMILIES
Corflnuum of Care, line.
Signature� _A&
Signature:
PrintfType
PrintlType
Name,, E, Scott Prid en Name; qBT��tanford
Title: Board Chair Title: R w
Renal Mana'n Director
Date: Date:
The parties agree that any future amendrilent(s) repllacin!g this page will not affect the above execution.
STATE AGENCY 29 DIGIT FLAIR CODE:
Federal Tax ID # (or SSN) : 46-12358,85 Provider Fiscal Year Ending Date: L2/30,
Contract No, KPZ21
CF integrated Contract 2014 11
The following provisilions supplement or rnodify the provisions of Soecfiorls 1 through 7, above, as proOded herein:
mm
SECTION 1 PAYM�ENT, �NVOICE AND RELATED TERMS
ffm���
CF �ntegrated Contract 2014 12 Contract No, KPZ21
As provided, in- Section 4-1, of this. Contract, the- Provider is. required to comply with the following requirNnents,,-as applicable to, Its
performance under this Contract, as they may be enacted or amended from time to time, Provider acknowledges that it is independently
responsible for investgafing and complying with all State and Federal laws, rides and regulations relating to its performance under this
Contract and that the below is only a sample of the State and Federal iejws, rules and regUIZ#1011S that may goveriu its performance under
this Contract.
SNEC��
A1.11A if this Contract contains Federal Funds, the Provider shall comply with the provisions of Federal law and regulations
including, but not limited to, 45 CFR, Parts 74 and 92, and other applicable regulations,
A1-1,2 If this Contract contains $10,0100 or more of Federal Funds, the Provider shall comply with Executive Order 11246, Equal
Employment OPPOrtullitY, as amended by Executive, Order '1137'5 and others, and as supplemented in Department of Labor
regulation 41 CFR, Part 00 and 45 CFR, Part 92, if applicable,
Al-1.3 If this Contract contains over $100,C010 of Federal Funds, the Provider shall cornpiy with all applicable standards, orders, or
regulations issued under section 3b6 of the Clean Air Act, as amended (42 United States Code (U,S.C) 7401 et seq., section 598
of the Federal Water Pollution Control Act, as amended (33 M-C, 1251 et seq), Executive Order 11738, as amended and where
applicable, and Environmental Protectiori, Agency regulations (40 CFR, Pal 30). The Provider shall report any violations of the
above to the Department.
Al .1,4 No Federal Funds received in connection with this Contract may be Used by the Provider, or agent acting for the Provider,
or subcontractor to influence legislation or appropriations pending before the Congress oir any State iegisiatuii,e. If tNs Contract
contains Federal funding in excess, of $100,300, the Provider must, prwor to contract execution, complete the Certification Regarding
Lobbying form, Attachment 3. if a Disclosure of Lobbying Activities form, Standard Form LILL, is, required, if may be obtained from
the contract manager, AM disclosure forms as required by the Certification Regarding Lobbying form must be completed and
returned to, the Contract Manager, prior to payment under this Contract,
A1'-1.5 if this C ontract contains Federali Funds and provides services to children up to age 18, the Provider shall comply with the
Pro -Children Act of 1994 (20 U.S.C. 6081). Failure to comply with the provisions of the law may result in the imposition of a civil
monetary penalty of up to $,1,000 for each violation or the imposition of an administrative compliance order on the responsible
entity, or both.
M-1 6 Unauthorized aliens shaH not be employed. Employment of urmuthorized aliens shalt be Cause for unilateral cancelbtion of
this Contract by the Department for violation of section 274A(e) of the Immigration and Nationality Act (8 U,S,C, 1324 a) and section
101 of the Immigration Reform and Contra] Act of 1986, The Provider and its subcontractors will enroll in and use the E-verify
system es-.ablished by the U. Department of Horndand Security to vu-ffy the employment eligibility of its employees andits
subcontractors' employees performing under this Contract, "Employee assigned to the contract" means M persons employed or
assigned (including subcontractors) by the Provider or a subcontractor during the contract term to perform work pursuant to 1hJ5
contract within the United States and its territories,
A1-2 Civil Rights Requirements. In accordance with Title Vill of the Civil Rights Act of 1964, the Americans with Disabilities Act of
199�0, or the Florida Civil Rights Act of 1992, as applicable the Provider shall not discriminate against any employee (or applicant for
employment) in the performance of this Contract because of race, color, relig,tion, -sex, national origin, disability, age, or marital status.
P
Further, the Provider agrees not to discriminate against any applicant, client, or employee in service delivery or benefits in connection
with any of its programs and activities in accordance with 45 CFR, Parts 80, 83, 84, 90, and 91, Title VI of the Civil Rights Act of '1964, or
the Florida Civil Rights Act of 1992, as applicable and CFOP 60-16, These requirements shall apply to all contractors, subcontractors,
subgrantees or others with whom it arranges to provide services or benefits to dients or employees in connection with its programs and
activities. If employing fifteen or more employees, the Provider shall complete the, Civil Rights Compliance Clhec'dist, CIF Form 946 within
30 days of execution of this Contract and annually thereafter In accordance with CFOP 60-16 and 45 CFR, Part 80,
A1-3, Use of Funds for Lobbying Prohibited, The Provider shall comply voith the provisions of sections fl .062 and 216,347, F.C., which
prohibit the expenditure of contract funds for the purpose of lobbying the Legislature, judicial branch, or a State agency,
Al .4 Publlc Entity Crime and Discriminatory Contractors. Pursuant to sections 287. 133 and 287134, F&, the following restrictions
are placed or) to ability of persons placed on the convicted vendor list or the discriminatory vendor list, uA/her, a person or affiliate has
CF Integrated Contract 2014 13 Contract No, KPZ21
been placed on this convicted vendor list following a convicflon for a public entity crime, or an entity or affiliate has, been placed on, the
discriminatory vendor list, such person, entity or affiliate may not submit a bid, prii N, reply on a contract to provide any goods or
services to a public entity� rnay no( sulbirrijt a bild, pn.,�posal, or reply on a contract with a public entity forpUcentty;
heoctooairoapr ph ' -or� lasesof rela[ pro-effy ttj aj'"rhay not be jw9ded
Public b6ldgl 0'r-'public wo'r'k� rnay not sul bids''" "oposa s, or re es ) e P
or perform work as a contractor, supplier, subcontractor, or consultant Linder a contract vvith any public entity; and may not transact
busiriess, With any public efifity" provided, however, tfiat the prohibition on persons or affiliates placed on the convicted vendor shall be
limited to buisiness, in excess of the threshold amount provided in section 287,017, F.S., for CATEGORY TWO for, a period of thitly-six
(36) months from the date of being placed on the convicted vendor list,
k1-5Whistleblower's Act Requirements, In accordance with subsection 112.3187(2), F,S,, the Provider and its subcontractors shall
not retaliate against an employee flor reporting violations of lavi rule, or regulation that creates substanibal� and specific danger to the
public's health, safety, or welfare to an appropriate agency. Furthermore, agencies or independent contractors shah not retaliate against
arty person who discloses information to an appropriate agency alleging irnproper use of governmental office, gross waste Of funds, or
arty other abuse or gross neglect of duty on the part of an agency, public officer, cr employee, The Provider and any subcontractor shall
inforrn its employees Viat they and other persons may tile a complaint with the office of Chief Inspector General, Agency Inspector
General, the Florida Commission on Hurnain Relations, or the Wh istIle -blower's Hotline number at 1-8001-543-5353.
A1.6 Public Records,
A11-6A As required' by section 287,058(1)(c), FS., the Provider shale allow public access to all docurrients, papers, letters, or other
public recoids as defined in subsection 1119,011(12),, F,S, as prescribed by subsection '119,07(1) F.S,, made or received by the
Provider in, conjunction with this Contract except that public records w*h are made confidential by law must be protected from
disclosure. It is expressly understood ffial the Provider's failure to comply with this provision, shall constitute an immediate breach
of contract for which the Department may unilaterally ternimate this Contract,
A1.6,2 As required by section 1 IU701, F,S,, to the extent that the Provider is acting on behaif of the Deparliment within the
meaning of section 119,1 Fl&, the Provider shall;
a, Keep and nna[rilain public records that ordinarlly and necessaMy woUld be required by the Department in order to
perform the service,
b, Provide the public With access 10 Public records on qie saute terms and conditions that the Department vil provide
the records and at a cost that does not exceed the cost provided, in Chapter 119, F,&, or as otherwise provided by Iavw,
C. Ensure that public records that are exerript or confidential and exerr,,pt from pUblic records disclosure requirements are
not disclosed except as aUftiorized by law,
ii Meet all requirernents for retaining public records and transfer, at no cost, to the E)epwtrnent ali public, records in
possession of the Provider Upon termination of the Contract arid liestroy any duplicate public records ghat are exempt
or confidential and exempt from public records diSclOSLffe requirements, All records stored electronically must be
provided to the Department in a format that is compatible with the information technology systems of the Department,
A1.7 Support to the Deaf or Hard -of -Hearing.
A1.71 Where direct services are provided, the Provider and its subcontractors shall comply with section 504 of the Rehabllitatuon
Act of 1973, 29 US,C, 79l4, as implenneated by 45 CFR Part 84 (hereinafter referred to as Section 504), the Americans 'with
Disabilities Act of 19910, 42 US-C. 12131, as implemented by 28 CFR Past 35 (hereinafter referred to as ADA), and the ChRdren
and Families Operating Procedure (CFOP) 60-10, GhapterLi, entitled "Aux[liary Aids, and Services for the Deaf or Hard -of -Hearing.
A1-7.2 tf the Provider or any of its subcontractors employs 15 or more en-liployees, the Provider shall designate a Single -Point -of -
Contact (one per firm) to ensure effective comMUniCation with deaf or hard -of -hearing customers or companions in accordance with
Section 504 of the ADA, and CFOP 60-101, Chapter 4. The Provider's Single -Point -of -Contact and that of its Subcontractors will
process the compliance data into the Department's HHS Compliance reporting Database by the 51b business day of the month,
covering the previous month's reporting, acid forward confirmation of submission to the Contract Manager, The name and contact
information for the Provider's &ngle-Pojn kof -Cori tact shall be furnished to the Department's Grant or Contract Manager within 14
calendar days of the effective date of this requirement,
A1.7.3 The Provider shall, within 30 days of the effective date of this requirement, contractually require that its subcont'actors
comply with Section 504, the ADA, and CFOP 60-101, Chapter 4, A Singie-Point-of-Contact shall be required for Bach subcontractor
that employs 15 or more employees, This Single-Point-ol`-Contact will ensure effective communication with deaf or hard -of -hearing
OF integrated Contract 2014 '14 Contract No. KPZ21
n,d the ADA ano coordinate activities and reports Wilih the Provider's
custon,jers or conipanions in acco(dance wilh Section 504 a
Sin gle-Point-of-Comact, e of t1le reqLjiremenIs� roleg & responsibiliMs, arid
Al -7.4 The ensure that employeesawcm Chapter 4� Further, employees of
contact points associated with compliance with Section 504, the ADA, and CFOP 60-10,
ctors with 15 o- a)orp, orriployees shall attest in w6ting that they we familiar with the requirements Of
provIdprs Ruud their subcontractors is attestation shall be Tnainta�ned in the ernp�oyoe's Pe"SOMell file-.
Section 504, the ADA, and GFOp 60-10, Chapter 4, Th nf r ation about the avMability
Al -7.5 The Provider's Mk ensure that corlSpiGUOU9 WfICP'S iliCh
o"where
of appropriate auxiliary aids and services at no -cost to the deaf or hard -of -hearing curs or companions are posted near
people enter or are admitted within the agent locations. Such Notices, Must J)e posted immediately by The Provider and its
subcontractors, The approved Notice at can be downloaded through the Inte'net h1qp:j/Wwvv 'myflfamilles,coni/abo tit -ustservices-
deaf-and-hard-hearinqMcf-porkers. the custornei's c�r companion's preferred method of communication and
A1-7.6 The Provider and its SLibcontractors shall dOGUrrient er's record, Documentation, With sul)POrt�ng kistifortcompanio
rl, "n ust alslo be
any requested aLixiliary aids/services provided in the custorn -ibute Customer Feedback forms to cusjomearsns, and
made if any request was not honnired, The Proviider shall disti -
provide assistance in completing the forms as requested by the customer or compan'lon,
M-73 if custorners or cornpanions are referred to other agencies, the ProMer must ensure that the receiving, agency is noturied of
the customer's or comPall"On's preferred method of communication and any actxiljary aids1service needs.
quires each contractisubcontract provider agency's rig:. ernployees to complete Le�
Al-7,8 The Department re I and sign the Attestation of Understanding. Direct service employees performing under
Gustorriers who are Deaf or Hard-of-Hearlin
1:2�� rnple6on, attach it to their Attestation of Understand0g, and maintain thern in their
This Contract will also print their certificate of co
personnel file,
Al .8 Client and Other Confidential Information. Stateproviding for theconfidentialky of client and other infonriation incIude bUt
32, 39,00145, 39102, 39,809, 39.908, 63.162,� 63,165, 383Al2, 394,4615, 397,501, 409,821,, 409A75,
are not limited to sections 391-01
qlt'3107, F,S, Federal laws and regUlations to the same effect inc�lude
410,037, 41(.).605, 414295, 415.107, 415,295, 741,3165 and
2)(A)(viii) of the Chk Abuse Prevention and Treatment Act, 7 US,C-
section 471(a)(8) of the Social Security Act, section 106�b)( 7 CFR §272.1(c), 42 CFR §§21-2.3, 42 CFR §431.300-30645 CFR
§2020(e)(8),, 42 U.S.C. §602 and 42 U.S.C. §1396a(a)(7) and providing for confidente-toy of this and other Wormation are found in
§4M27(a) and 45 CFR
§205M, A surnmary of Florida Statutes PrOv .
Part I,[ of the Attorney General's Government in the Sunshine Manual, as revised from t�rn-time
A1-9 PRIDE. Articles which are the subject of or arad reqUired to carry out this C�ontract sliall be purdiased frorn Phson Rehabilitative
lDE) identified tinder Chapter 946, F,S,, in the same manner and under the procedures
lndustries and Diversified Enterprises, Inc,, (PR of this Contract, the Provider shak be deemed to be substituted for the
set forth in subsections 946,515(2) and (4), F.S, For purposes kable to subcontractors unless otherwise required by �aw, An
Departmont insofar as dealing,; with PRIDE. This clause is, not app
abbreviated list of products/services avj�6l&e from PR0E may be obtained by contacting PRIDE, (800) 643,8459,
Al.1Recycled Products. The Provider sha] procure any recycled products or rnaterials, which are the subject of or are required to
0
carry out this Contract, in accordance with the provisions of sections 4031,7065, F3.
Ai.111 Scrutinized Companies, If this Contract is for an arnount of $,I Millhor or more, "he DepaMment may �errnjnate this Contract at
tion 287,135, FS., or has been placed on the Scrutinized
any time the Provider is found to have submitted a fMse certification under ser
Companies with Activities in Sudan List or the Scrutinized Cornpanieswith Activities, if, the Iran Petroleum Energy Sector List,
A1-12 Federal Funding Accountability and Transparency Act. The Provider will, col"Oete end sign the FFATA Certification of
Executive Compensation Reporting Requirements forma(CF 1111 or successor) if this Contract includes $25,0,00 or more in Federal
Funds (as determined over its entire term)The Provider shall also report the total compensation of its five most highily paid executives if
it also receives in excess o�f 80% of its annual, gross revenues from Federal Funds.
Al-13 Prompt Payment and Vendor Ombudsman Pursuant to section 215,422,the Department has five (5) work�ng days to
iiispect and approve goods and services„ unless the 'bud spec'rflcatlons, purchase order, or ffi�s Contract specify otherw�seAny amount
that is authorized for payment but is not availabie within fortY (40) days, measured from the latter of the date a properly completed
invoice is received by the Depaftent or the goods or services are received, inspected, and approved �or wil.hin 35 days after the date
eligibility for payment of a health care provider is determined), a separate interest penalty as described in section 215.422, F,S., wili be
due and payable un addition to the amount authorized for payment, interest penalties less than one (1) dollar will not be paid unless the
CF Integrated Contract 2014 16 Contract NO, ISPZ21
Provider requests payment, A Vendor Ombudsman has been established withiii the Department of Financial I,'Services, and rimy be
contacted at (B50) 413-5516, Al 14 imely Payment -o�f Subcontractors, To t1e extent that a -subcontrat p crovides 'for payment -after Provider's receipt of payr -nent-
-T
from the Department, the Provider shall make payments to any subcontractor within 7 working days after receipt of full or, partial
payments from the Department in accordance with section 287,,0585, ES, unless otherwise stated in the contract Detween the Provider
and subcontractor. Failure to pay within seven (7) working days will result in a penalty that shall be charged against the Provider and
paid by the Provider to the subcontractor in the amount of one-half of one percent ( 005) of the amount due per day from the expiration of
the period allowed for payment, Such penalty shall be in, addition to actual payments owed and shall not exceed fifteen (15%) percent of
the outstanding balance dlue,
All -15 Employment Screening.
Al .15.1 The Provider shall ensure that all staff utilized by the Provider andIts subcontractors that are required by Florida law to be
screened in accordance with chapter 435, F�.S., are of good moral character and meet the Level 2 Employment Screening
stmidards specified by sections 435,04, 1101.1127, and subsection 39,001(2), F3, as a condition of initial and continued
empioymeni that shall include but riot be limited to:
I Employrnent history checks;
b, Fingerprinting for all c6iiinar record checksl
c, Statewide criminal and juvenile delinquency records checks through the Florida Department of Law Enforcement
(FDLE);
d, Federal criminal, records checks from the Federal Bureau of Investigation via the Florida Department of Law
Enforcement;, and
el Security background invesfigation, which may include local criminal record checks through local law enforcement
agencies,
f, Attestation by each employee, subject to penalty of perjury, to meeting the requirements for qualifying for employment
pursuant to chapter 435 and agreeing to inform the employer rmrnediately if arrested for ar,,y of the disqualifying
offenses while employed by the employer,
A1-15,2The Provider shall sign an affidavit each State fiscal year for the term of the contract stating that all required staff have been
screened or the Provider is awaiting the reSLMS of scree ni ngi ,
Al-1 6 Human Subject Research, The Provider shad) comply with the requirements of CFOP 215-8 for any activity under Ns Contract
involving human subject research within the scope of 45 CFR, Part 46, and 42 U.S.C. section 289, et seq., and may riot commence such
activity until review and approval by the Department's Human Protections Review Committee and a duly constituted Institutional Review
Rn Ird,
A1-17 Coordination of Contracted Services, Section 287,0575, F.S, mandates various duties and responsibilities for certain State
agencies and their contracted service providers, and requires the following Fiorida health and human services agencies to coordinate
their rnonitodngi of contracted services: Department of Children and Farindies, Agency for Persons with Disabilities, Department of
Health, Department of Elderly Affairs, and Department of Veterans Aflairs, where applicable.
In accordance with Section, 287,0575(2), F.S, each contract service provider that has more than one contract with one or more of the five
Florida health and human services agencies must provide a comprehensive list of their health and human services, contracts to their
respective Contract Manager(s), The list roust include the following information:
Narne of each, contracting State agency and the applicable office or program issuing floe contract,
Identifying name and number of the contract,
Starting and ending date of each contract
Amount of each contract.
A brief description of the purpose of the contract and the types of services provided under each contract.
Name and contact information of each G:)ntract Manager,
See NIA for addiflonali liaws, rules and regulations affecting performance of this Contract,
it Integrated Contract 2414 16 Contract NoFEZ
EXHIBIT A2 — SUPPLEMENTAL SPECIAL PROVISIONS
The following provisions supplement or modify the provisions of Section 1, above, as provided hermw
SECTION I-, ENGAGEMENT, TERM AND CONTRACT DOCUMENT
TIe followi rig Section 1.4, 11 is added:
,1.4,11 Program or Service Specific Terms
I A.1,11 Imminent Danger of Loss of Housing —A faniiy who is about to lose their residence, or who face the Loss of sheiter
due to financial crisis or other crisis.
1,41.1.2 CoC — Continuum of Care — A local planning body for a defined geographical area responsible for establishing and
operating a system to prevent and end homelessness for that area; provide funding efforts by nonprofits, p-oviders, and State
and local governments to quickly rehouse homeless Individuals and families while minimizing the trauma and 6s[ocafion caused
to homeless individuals, families, and cornnilunifie5 by h=elessriess: promote access to and effect utilizaJon of n-611streani
programs by homeless individuals and larniljes„ and optimize self-sufficiency among individuals and fainHies experiencing
homelessness,
1.4J A., CoC Plan — A community plan to organize and deliver housing and services to meet the specific needs of people who
are horreiess as, they move to stable housing and maximum self-sufficiency It inClUdes actions steps to end homelessness and
prevent a return to homelessness.
1.4,11A Grantee — The homeless assistance CoC Lead Agency as recognized by the Office on Homelessness, The Lead
Agency is the grant applicant that has been awarded the funding for this grant program,
'I ,4.11,5 HM' IS — The Homeless Management Information System is the information system designated by the Continuum
of'Care to comply with the G.C. Deparinient of Housing and Urban Deve[opme fit's data collection, management, and reporting
standa,rds as referenced in 24 CFI 576.2 and used to collect c1lent-level data and data on the provision ct housing and services
to homeless individuals and families ariO persons at -risk of homelessness.
1A.1 .1,6 Homeless — An individual who iacks a fixed, regular and adequate nighttime residence or an individual who has a
primary nighttime residence that is'
A supervised publidy or privately operated shelter designed to provide ternporary iiving accommodations, including welfare
hotels, congregate shelters, transitional housing for the mentally ill.
An institution that provides a temporary residence for individuals intended to be institutionalized.
A public or private place not designed for, or ordinarily used as, a regular sleeping accommodation for hurnan beings.
Places that may include living on the street or under a bridge, in a park, bus terminal, railroad station, airport, abandoned
budding, or a car/trucklvehlcle.
1AJ,1 .7 Homeless Coalition (Coalition), — An agency/organization (either for profit or non-profit) established and operating
pursuant to section, 420,623, Rodda Statutes, The coalition's mission is do planl, network, coorfinate, and oversee the delivery of
direct client services to the homeless population in the beat area.
1 .4,1.1.8 Minor Chfld{ren) — Means a child less than '18 years of age, or under the age of 19 rf the child s a Ultirne student in a
secondary school or at the equivalent level of vocational or technical training; does not include anyone married or divorced,
1.4.1.1.9 Off Ice an Homelessness — The office created within, the Department of Children and Families to provide interagency
coordination, and support to the Council on Homelessness, and other related coordination on issues relating to homelessness, in
accordance with section 420.622, Florida Statutes,
1A.1.1 a10 Subgrantee — A local agency within the authorized homelessness CoC pianning area that the Lead! Agency
subcontracts with to administer the program. The Subgrantee will participant in the local Homeless Management Information
Service (HMI S) and the homeless CoC Plan for that area,
1,4,1 JAITANF — Temporary Assistance for Needy Families, formerly Aid to Famiiies with Dependent Children (AFDC), TANIF is
the social services block -grant program that funds the Hornelessness, Prevention Grant prograrn and is, administered by the
Office of Family Assistance at the Department of Health and Human, Services in'Washington D,C,, as authorizedi, in, 1996 by
Public Law 104-191
CF integrated Contract 2014 17 Grant Agreement# KPZ21
EXHIBIT B - SCOPE OF WORK
T.1, Sope of Servicehis Homeiessness Prevention Grant is to lie provided to far[Illies w4h minor children who reside in the iol�lowing county* Monroe
County, The grantassistance may be used to pay past due rent, mortgage, or utility balls for tip to four (4) months, case management
services, and program adrninistratwve costs riot to exceed three percent (3%) of the grant award.
8.2 Major Contract Goals
In accordance with section 414,161, Florida Statutes,the primary goal of the Homelessness Prevention Grant is to enable at least eighty-,
five percent (85%) of the families assisted to rernain in their homes and avoid beccming homeless during the eMLIing year,
B-3 Service Areall-ocationsITIrnes
8-11 Graitee's Location: 1624 Spaulding Conch, Key West, Florida 33040
Changes in Location. The Grantee must notify the Department wit*, fjfteeri (15) calendar days of any changes, in location
of the Grantee's administrative office location,
13-3,,2 Service Delivery Location; Nlonroe County Social Services, '1100 Simonton Street, Key West, Florida 33040
8.13 Service Times ' The Grantees administrative office shall be open for busyness from 9:00 a,m. to 5:00 p.m,, Monday through
Friday, eXCept for state holidays, or as otherwise coordinated by both parties,
13.4, Clients to be Served
Pursuant to section 4,14,161, Florida, Statutes, this grant wad provide funding through the Homelessness Prevention Grant program to
families With minor children who are at risk of losing their housing and becoming horneless due to financial or other crisis.
200003MMM
B-5.1 Applicants eligible to receive seMces under this grant MLISt:
B-5,1.1 Reside in Eor[dau
13-5,1,2 Have at least one household rnerTiber, abaci may include a minor child, who is a United States �jften' [Awfill
permanent resident or iawful qualified alienb
13�5,1 .3 Have at least one rnunor cNid, who is not rnartried or divorced, residing in, ffie household;
13-51.4. Bea parent or relative caregiver of the child residing in the household;
B-5,1,5 Have a household monthly income of less than 200% of the federal poverty level as published annually by the U.S,
Depament of Health and Human Se -vices (see Exhibit 81); and
B-5.1.6 Applicants who do not meet the criteria for qualified amen may be provided services if a child or otNr family
household member is a U.S, citizen or qualified alien, the Grantee shall contact the Department regional contract manager for
assistance in determining eligibility,
B-5.2 A quaVied alien under TANF and 8 U,S,C1641 refers fol:
13-521 Legal permanent residents
OF integrated Contract 2014 18 Grant Agreement # KPZ21
B-5,,2,2 Asylees
B-5,2.3 Refugees
B.524 Aliens paroled into the US. lor a[ Veasl: one year
B-525 Alkens, whose deportations are being, withheld
M,2.6 Aliens granted conditloi4 en", prior to April 1, 1980
B-5.2-7 Battered alien SPOUses, battered alien children, the alien parents of battered children and alien 7,hildren of battered
parents who, fit certain crOpria
B-5.2.8 Cuban/Hailian entrants
8-529 Victims of trafficking
B-5,3 Grant Limits
B-5.11 Ali services, provided under thE Grant agreement will be provided in accordance with applicable law, rules,
regulations and Departrnent procedures, Grant Agreement funding will be limited to current federal government appropriation
and Legislative budget spending authm'ity,
B-5.3.2 individuals without at least one Minor Child in the household are not 691ble to receive services under this Grant
Agree,-nent,
9-5.3.3 Funding under this grant Agreement shaH expire on June 30, 2015, NI payments made on behalf of eligUe larnilies,
must be made to landlords, mortgage or utility company on or before June 30, 2015.
B-6 Equipment
The Grantee OH be responsible for supplying,, at its own expense, all equipment necessary Lo performs the Grant Agreement tasks.
B-7 Contract Limits
B.T. I Ali services provided Linder this Agreement will be provided in accordance with applicable laws, rules regulations and
Department procedures, Grant Agreement fUndIng wOi be limited to current federal government apprupriation ar,,,d Legislative budget
spending authority.
B-7,2 Individuals without at least one (1) minor child In tilne household are rot eligOle for funding,
&N Funding under this Agreement shall expire on June 30, 2011& All payments made on behalf of eligible families must be
aiade on or before June 301, 2015.
CF integrated Contract 2014 19 Grant Agreement # KPZ21
Families applyng for assistance under the Homelessness Prevention Grant (TANF) roust have at least one (1) child under
the age of eighteen (18), If there is a child who is eighteen (18), but not yet nineteen (19), the child must be attending
secondary school, trade school, or other career training program full-time. Fan'lilies must reside in Florida full,time and
Brave at least one (1) member of the household who is a United States citizen or lawful permanent resident. The
household incorne must be less than two -hundred percent (200%) of the federal poverty level as anrivally published by
the U.S, Department of Health and Human Services,
CF Integrated Contract 20114
income: Eligibility Guidelines
M
Grant Ag ree ni e nt # K P Z21
EXHIBIT C - TASK LIST
The Provider shall perform all functions necessary for the proper -delivery of serviices iricjuding, but notArnited to,,the
follovvling�
V Service Tasks
C.11,1 The Grantee shall develop a written case plan and conduct mandatory case management for each family approved
for financial assistance. The case plan shall set forth i 41 of the costs that Will be covered under the grant, as well as the total
dollar arriount of assistance to be provided, The case plan shall spell out the family's goals for housing sl@Uily along With a
proposed tinneframe to achieve these goals,
C-1,1.2 Grantee will Rit)Mit, a reVal to the Office on Honidessniessi de -,ailing the number of farnilies who remained stably
housed at least t)Nplvp (1,2) months after the last date of assistance, in addition, the Grantee will idenfify method used to
contact clients to obtain housing Status, This report format will be provided by the Office on dornelessriess-
C-1,13 Grantee shall develop, maintain and retain a case file of each larnty applyfiig for assistance, The case file shall
contain all information required to determine eljgjb[llty of the family, along with the determination,
G-1,1 .4 Grantee shall capture and enter information on each family assisted into the local HMIS of Vie CoC planning area.
C-IiJ 5 Grantee shall develop and ul:11ize an application for all persons seeking assistance, At a mirlmorn, the application
must identify all household members, the arnowil: and type of assistance sought, and the date of the request for assistance,
C-11.6 Eligibility Determination. The Grantee shall determine Homelessness Preventon Grant program eligibility for
those households Mth Minor Children only, Individuals are not eligible for this program.
C�l 1,6,1 Families must reside in Florida and have at least one ljojjsehoid member who is a grated States citizen, a
lawful permanent resident, or qualified alien , resident, The household must contain at [east one Minor Child under the
age of 18 living in the household full-time. If the Minor Child is 19, he or she must be a full-time student in a secondary
school or at the equivalent level of vocational or technical training, A Minor Child does not Include anyone who is
married or divorced, An adult who applies for the grarit assistance must, be either the parent or relative caregiver of
the Minor child residing in Vie household,
C-1 Al ,2 The household monthly ikon ne must be less than 200% of the federal poverty level as published annually
by the HHS (see EXHIBIT 81),
C-11.6.3 If a parent applies who is not a U!, S, citizen, lawful permanent resident, or qualified alien, the family can, still
be assisted if a child or other farnifly household' rnernber is a US. cl6zen, lawful permanent resident, or qualified alien.
If no one in the household is a US. citizen, lawful permanent resident, or qualified alien, please contact the regional
contract manager for help in deterrnining eligibility,
G-1,13 Case Management. The Grantee shall provide case managers for the delivery of case management service to
assist families through care coordination as outlined In the family USE Plan.
C-1 -1.8 Case Plan, The Grantee shall develop a case plan for each famlly assisted, setting forth what costs, will be covered
and lie rnaximurn level of assistance to be offered. The plan sl�-iall address the family's goals for housing stability, Each plan
shall include';
C-1 J .1 The type of assistance to be delivered to the family;
C-1 J 8.2 The anticipated date the case plan wll be completed; and
CF Integrated Contract 2014 21 GrantAgreemeM 4 KPZ21
c-1.1,8,3 The Grantee's schedule for monitoring One family's housing stability following the cessation of grant
assistance,
to far)��ilis at risk of
b
C-I 1,9 Emergency rinan-cial Assistance, The Gran,e shall provide 'krgency fina0c-ial assistance
homelessness. The arnourit of financial assistance necessary to prevent homelessness shall be supported by a late notice or
!intent -o evict frorfl, the landlord or a Irate notice from [lie mortgage company, i)r I pa,,,,t dn ip hill or intent to disconnect notice
frorn the utility company, docuinenbrig seNces to the applicant's address, in a hotisehold mernber's name, and an annount
owed, The notice must ranclude the narne and address of the landlord, mortgage or utility company where the payment should
be mailed,
C-I . 1, 10 Monitori ng. The Grantee shall track, monitor and report on each larniiy assisted for at least twelve (12) months
after the date of last assistance is provided to the family, The Grantee shad submit a final report of families still housed in the
formal provided by the Office on Homelessness by the dates indicated in Section D-31 to the Office on Homelessness and
the regional contract manager,
C-1, 1, 11 Performance Reports. The Grantee. shall submil trionthly performance reports (EXHIBIT Cl) argil one (1) final
report to the Department's regional contract manager and to the Office on Homelessness by the due da-e outlined in Section
D-I 1, Reports shall include the nun-iber of fami�ies who applied for, assistance, the number of families assessed for, eflgibilty,
and the number of families receiving finaric4 assistance.
C-1.1,1 2 Case File. The Grantee shall develop, maintain: and retain a case Me on, each family applying for assistance,
Documentation in the case file shall include, but is not iirnited to, the following:
C-11,12A Eligibility information
C-I.I.IZ2 The Case Pla,-i
C-MJ 23 Documentation of household income and size
C-IJA2,4 Documentation of emergency financial assistance provided to the fanifly„ and
C-M-12,5 Docun entation of monitoring of''the family.
C.1,1,13EIectronic Data Collection, The Grantee slhMi use the HNIIS to submit information on each family assisted by the
Homelessness Prevention Grant program,
C-1,2 Task Limits, The Grantee shall not perform any tasks related to the program, uther those described in the Grant
Agreement and outlined 'in section 420,623, Florida Statues.
C-2 Administrative Tasks
SHEMI=1
C-2.1,1 Staffing Levels
The Grantee shall ensure adequate and sufficient stat, paid or volunteer to satisfactorily meet all Grant Agreement
requirements,
ts,
C-2.1.2 Staffing Changes
The Grantee shall notify the contract manager in writing within five (5) business days of the vacancy or anticipated
vacancy of essential staff and shall also notify the contract manager when a qualified replacement has been: hired,
C-2.2 Professional Qualifications
Proof of professional credentials and position descrip6ons documents shalll be maintained in the ernployee's, file and
proOded to the Department upon request,
CF Integrated Contract 2014 22 Grant Agreement # KPZ21
M
MW
Subcontracting
This, Grant Agreement does allow the Grarylee to sujbcor)tjract the provision of hornelessness prevenVi&i assistance to
anotner local entity, as authorized, by the goverNng body of the CoC planning area and in keeping wiW the w6tterj response
to, Grant app4ca I don L,PZ13, The Grantee (Lead Agency) ren4ns the Department's Grantee, and is responsible for ensuring
compliance with the terms and conditions of the Department's Grant Agreement and the prograrn req*ernents,
C�Zll Records and Documentation
Confidentality of Records, The Grantee shall, keep and maintain the Confidentiality of M records required by law or
administrative rude to be protected from disclosure. The Graritee fu r1herag roes to hold the Department harp -Mess frorn any
claim or darnage, hncluding reasonatIe attorney's fees and costs, or from any fine or penalty imposed as a result of an
improper disclosure by the Grantee of confidential records, whether Public record or hot, and promises to defend the
Department against the same at its expense,
C-2,5 Reports (programmatic and to SUpport payment)
See EXHOT C1,
Standard Contract Requirements, Provider will pefforni all acts required by Sections 4, 5 and 7'oi the Standard Contract,
CF Integrated Contract 2014 3 Grant Agreement # KPZ21
Monthly Performance Report
Provider N a m C'.
Grant Agreement Nurnber:
Total 4 of fanii[ies to he served under this Agreenient.
Total It of families served this period:
Reporting, Period:
FOR THISREPORTING PERIOD.
Total N of families seeking assistance:
Total Pf of fami5es assesserf for eligibility:
Total ehigible families assisted: with -
Past dUe rent'
Past due. martgage:._,
Past due utflWes:
Total farnifles assessed for eligibility with
Past due rent:
Fast d u e mortgage:
Past due utjfitles;
Total Awarld $
Total funding for this period
Remaining funding
Report completed by:
Date:
CF Integrated Contract 2014 24 Brant Ag reerrie nt # KPZ21
WHEMBEEMEMEM
D-1 Service Units
A service Unit consists of one month of Horneless Prevention activities as identified in the Task List of this Grant
Apreerilient, Section G-1.
0.2 Performance Measures for Acceptance of Deliverables
D.21 Services shad be performed as described ri the Task List, and the minimurr) level of service shall be to assist a
ni[nimurn of one family per month and verified through the subillission of supporting documentation.
0-3 Reporting
0«11 The Gr,,mtele agrees to submit, invoices, budgets, expenditUlk' and programmatic
reports to the Deparli-nent in the
format, frequency and IlUrnber of copies as specified in the following chart;
Report Title
Report
Report Due Date
Number
DCF Office to
Frequency
ies
Receive the Report
Invoice - Reque Tifo-r— --'-'—Mon-t�—Y'
—
—fllko—vAng
---Ori—e—
Cont M—anager
I
ReimbUrsement
the
m.....25-111" of the onth foflowng
One each
Contract Manager and
the report period
Office on Homelessness
Performance
Monqily
251t,of the olowing
One each
itMaar and�leesucew�
Report
mart
threperiod
Office on Homelessness
Tl -aPe �0—rm�;�'e .
..... ..... O—r —ic -e'
—J u —1y 1 —5, 2-0 F5
One each
Contract Manager arid
Report
....... . . ....
Offce, on Homelessness
Final Report of
At least '12
.
July 15,20116
One each
&ntract Manager and,
Farniiies Housed
months after
office, on Homelessness
assistance is
provided
D.3,2 Submit reports and invoices to the contract manager at the foBlowung address:
Theresa Phelan, Grant Manager
Department of ClAdren and Farniies
1111 121hStreet„ #30J
Key West, FL 33040
D-13 Acceptance of Reports, Wherein this Grant Agreement requires the d4verY Of reports to the Deparinnent, mere
receipt by the Department shall, not be construed to mean or imply acceptance of those reports, It is specifically intended by
the par.ies, that acceptance of required reports shalt constitute a separate act, The Department reserves the right to reject
reports as incomplete, inadequate, inaccurate and/or Unacceptable according to the parameters setforth in this Grant
Ag,eement, The Department, at its option may allow addltiona" Liryie within which the Grantee may remedy the objections
noted by the Department or the Department may, after having giver, the Grantee a reasonable opportundy to complete,
make adequate or acceptable, and declare this agreement to be in default,
CF GPtegrated, Contract 2014 25 Grant Acreement 4 KPZ2'1
E-11 Minimum Performance Measures, The fol'om'ng minimurn performance measures, are established PUMMW to Section 2.4.2 of
the Standard Contract and shall be maintained during the terms of this contract.
E-1,1 Performance Measures, The performance standards are calculated per term for each Federal Fiscal Year (FFY) within the
Brant Agreement,
E-1 J.1 At least eight -five percent (85%) of fami'lles assisted sliall remain stably housed and avoid becoming horieless at
ieast twelve (12) months following the last date of assistance pursuant to section 414,161 (5), Florida Statutes,
E-1 A .2 One hundred percent (I 00%)1ol' all families deemed eligible to receive assistance will have a case pian documenting
the amount and type of assistance provided, steps to achieve 110LISIng staWty, and the anticipated date of plan completion,
E-11 3 One hundred percent (1 00%),of the m[nimurn rlUniber of families, applying for, being assessed for eligibility, and
receiving financial assistance for the period of the payment request will be assisted,
E-2 Performance Evaluation Methodology, The Department will monitor the perform ance in achieving the performance measures in
erection
ection E-1 according to the following methodology:
E-2J For the measure in Section E-11 .1, the percentage of performance that nneets the performance Pleasure will be
determined by dividing the number o'"families assisted who, remained stably housed and avoided becoming homeless at
leas- twelve (12), rnonflis following the fast date of assistance by the total number ohfamilies assisted,
Nunierator Number of families assisted who remained stably housed and avoided becoming
homeless at least rn�jnt!js foliovviqq,the last �'of assistanice Target = 85%
Denominator Total number of farnflies assisted
E-21 For the measure in Section E-1,12, the percentage of performance that meets the performance measure will be
determined by dividing the number of farnilles deerned eligible to receive assistance that have a case plan cloan-nenting the arnount
and type of assistance provided, steps to achieve housing stablhty, and the anticipated date of plan completion by the total number
of farrddies assisted.
NURIerator Number of families deemed eligible to receive assistance that have a case, plan
documenting the amount and type of assistance provided,, steps to achieve Target = 100%
lousir71 9 _stability_,nL01e anticipated date of plancqT&fion
Denominator -Total number of families deemed eligible for assistance
E-2,3 For the measure in Section E-1,13, the percentage of performance teat meets the performance measure will be
determined by dividing the number of families assisted by the total number of families applying for, being assessed for eligibility, and
receiving financial assistance for the period of the payment request,
Numerator Nymber of families assisted Target z 100%
Denominator number of families applying for, being assessed for eligibility, a
receiving financial assistance for the period of the payment request
E-14 Performance Standards Statemen.
By execution of this Grant Agreement the Grantee hereby acknowledges and agrees that its performance under the Grant
Agreement must meet the standards set forth above and will be bound by the conditions set forth in this Grant Agreement.
If the Grantee fails to meet these standards, the Department, at its exclusive option, may allow a reasonable period, not to
exceed six (6) monflis, for the Grantee to correct performance deficiencies, If pedormance deficiencies are not resolved to
the satisfaction of the Departmentwithin the prescribed time, and if no extenuating circumstances can be documented by
the Grantee to the Department's satisfaction, the Department must terminate the Grant Agreement, The Department has
the sole authority to determine whether there are extenuating or mitigating, circumstances, The Grantee ftAher hereby
acknowledges and agrees that during the period in which the Grantee fails to meet these standards, regardless of the
additional time allowed to correct performance deficiencies, financial cons,eq!uences will apply as referenced in the secton
six (6) of the, Standard Contract,
CF integrated Contract 2014 26 C' )rant Agreement # KPZ21
A
EXHIBIT El
Performance Measures Report
KPZ21 Sol -vice Month,
Prepared by; Contract
Provider name here
Date:
Signitum:
1. Housing Stability
i # of families assisted who remained stably housed and avoided becoming homeless at
least twelve (12) months following the last date of assistance
L Total # of families assisted
c,. Percentage of families assisted who remained stably housed and avoided becoming
homeless at least twelve (12) months following the last date of assistance. (a divided by b)
The standard target for this measure Is,,
This measure to begin frackingas o0uly 1, 2015 through June 30, 2016
2. Plan to Achieve Housing Stability
a. # of farnMes deemed eligible to receive assistance that have a case plan docurnentilig the
amount and type of assistance provided:, steps to achieve housing stability, and the
anticipated date of plan completion.
L Total # of all farnides deemed eligible to receive assistance
c. Percentage of farnilies that have a case plan documenting the amount and type of
assistance provided, steps to achieve housing stability, and the anticipateddate of plan
completion (a divided by b)
The standard target for this measure, is:
3. Families Assisted
a. ft, of families assisted
b. Total # of families applying for, being assessed for eligibility, and recelving financial
assistance for the period of the payment request
c. Percentage of families assisted. (a divided by b)
The standard target for this measure Is'.
ER
100%
100%
CF ln,tegrateed Contract 2014 '27 Grant Agreamen t # 1PZ21
F-1 This is cost reimbursement Grant Agreement,
F-2 Total Grant Agreement Amount, This is a cost reimbursement Grant Agreement, The Department shall pay the Grantee for
Delivery of service, units provided in accordance with the terms of this Grant Agreement for a total dollar amount not to eXceed
$20,000,00, subject to the availability of funds, The Slate of Florida's performance and obligation to, pay under the Grant
Agreement #KP,Z21 is contingent upon an annual appropriation by the legislature awarded through grant solicitation, LPZ1 1
F-3 Invoice Schedule, The Grantee shail request reimbursement On a monthly basis through submission of a property completed
EXHIBIT F2 Monthly invoice — Request for Reimbursement within twenty-five (25) days WoWrig the end of the rnonth for
which r6mbs.Ksement is being requested. It is the intent of [he parties that, the grant funding provided under this Grant Agreement
I. e available to Granlee for the costs of performing its obligations under section 414 161, Florida Statutes, incurred on and after
the date of execution of this, grant.
F-4 Supploirting Documentation
F-4.1 The Grantee shall submit ad docurneritation necessary to support expenses incurred during the repoOlng period to mc ude
but is not limited to:
F-4.1,11 Expenses, Copies of checksJOCUmenting actuate payrnents to landlords, mortgage or utility companies for client
assistance, Documentation must include proof that the payment was r,qade on behalf of client's past d,uY rent, mortgage or
utility bills, DOCUrnentation for reirriburgernent submitted for rent, mortgage or Witty bills paid on behalf of clients, Include
copies of landlord agreements or leases, past due utillty bills or Intent to disconnect notices, late, notices from landlords of,
mortgage companies, or 3 day intent to evict notices from landlords, Nlust Include the rnininiurn number of clients served for
the invoice period.
F-4,11,2 Service Delivery Documentation, A report reflecting assistance provided for during the invoice period Shall be
submitted with each reirribursement request. Any payment due under the ternns and conditions of this, G rant Agreement may
be withheld pend4ig the receipt and approval by the Department of Department of Firfaricial Services of alli financial and
prograrn reports due as a part of this Grant Agreement, and any adjustments hereto, Requests for ReimbldrserneM, which
cannot be documented with supporting documentation, Mil be returned to the GMntee upon inspection by the Departin-lent.
F-4.1.3 Invoice Approval Process, "The Department wilt have Up to five (5) working! days from receipt of the invoice to
approve or disallow proposed expend!-ures listed. Disallowance of proposed expenditures W01 result in, refection of the invoice The Department Will specify, in writing, the reason(s) for reject on and corrective action(s) that must be taken by the
Gran(ee in order to process the invoice for payaient. The Grantee w0l have fifteen (15) days from the date of rejection of the
initlal invoice to correct and resubmit for payment.
F-5 Additional Financial Consequences,
F-5A Refer to Exhibit F1
CF Integrated Contract 2014 28 Grant Agreement # KPZ21
EMBIT Fl —ADDITIONAL FINANCIAL CONSEQUENCES
The followitig finan(.W consequences appty in addition to the Firjaridaq Consequences provided in SeGfion 61 of this Contract
Fl-1 should the ProMer fai6 to rileet ft critcrIa for aweptance of d6verables specified jin Spd& D-2, the Depalnent, after
determining the absence of m1figating c1rcumstances, shell impose a financial penalty not to exceed 2% of the arTiount that would
otherwise be due to the Provider for die period of r'ion-compllance and dedLWI said arnount from Die invoice,
CF integrated Ocritract 2014 29 Grant Agreement # KPZ21
EXHIBIT F2
MONTHLY INVOICE — Request for Reimbursement
— - — - ------
TANF Contract NUmberP KPZZI
Provider: Monroe County Homeless
Services Continuum of Care, Inc.
Address: PO Box 2410
Key West, FL 33045
Telephone: 443-947-6522
FEI D: 46-1235BBS
Grant Year: SFY 2014-15
Billing Month.
OCA: HPG00
Line Items
App�r'oved Amour -Cf�T,—Invo'lc-e—
it
Da Remaining Budget
Total! to te
Budget
I Past Due Rent or
15'000oo
Mortgage Assistance
2 Past Due Utility
$3,200.0O
Assistance- electric,
gas, water, and sewer I
only
I Case Management
Salaries and Benefits
. . . . . .......
$1,0100.00
. . . . . . ........ — -----
Operating Expenses
$200m
4. Grant Administration
$600,00
. . . . ........ . ..
Lvs,5 A" Ffoirynciril Cvn�5equerices imposed as per 5eck)a F1 -1
Total Amount invoiced,.
I hereby certify that the above report is a true, accurate and correct reflection of the activities of this pehod, and that
the expenditures reported are made only for items that are allowable and directly relate to the purposes of this
referenced grant agreement.
Signature of Provider
Date
CF Integrated Contract 2014 30 Grant Agreement # KPZ21
ATTACHMENTI
The administration of resources awarded by the Department of Chkdren & FaniNes to the Provider may be subject to,
audits as described in this aftaGhment,
ZMEM,
In addifilui to reviews of audits conducted in accordance with OMB Circular A-11 33 and Section 215,917, F,,S,, as revised,
the department may monitor or conduct oversight reviews to evaluale conlPIlancP With contract, management and
programmatic requirements, Such monitoring, or OJI;jer oversight procedures may include, but not be knifted to, on -site
visits by department staff, limited scope audits as defined by OMB Circular A-133, as revised, or other prccedures, By
entering into this agreement, the recipient agrees to comply and cooperate with any monitohng procedurEs, deemed
appropdate by the department, In the event the department determines that a linfited scope audit of the recipient us
appropriate, the iecipierit agrees to cornply with any additional Instructions provided by the department regarding such
audit, The radipieiii. fultha- agrees tO comply and cooperate with any Irlspections, reviews, investigations or audits
deemed necessary by the department'slinspector general, the state's Cl-iief Financial Officer or the Auditor GeneraL
M-AMM
SIR=
"Fhjjs part is appOcable if the recipient is a Slate or local government or .9 non-profit organization as defined 41 OMB
Circular A-1 3 3, as revised,
In the event the recipient expends $500,000 or more in Federal awards during its fiscal year, the recipient must have a
single or program -specific audit conducted in accordance with the provisions of ONIB Circular A-1 33, as revised, The
7�
recipient agrees to provide a copy of the single audit to the Department'S Sin& Audit Unit and Its contract manager. In
the event the recipient expends less than $500,000 in Federal awards during its fiscal, year, the recipient agrees to
provide certification to the Department's, Single Audit Unit and its contract manager that a single audit was not required,
In determining the Federal awards expended during its fiscal year, the recipient shah consider all sources of Federal
awards, including Federal resources received frorn the Department of Clhildren & Families, Federal government (direct),
other state agencies, and other non -state entities, The determination of amounts of Federal awards expended should be
in acccrdance with guidefines established by OMB Circular A-133, as revised, An audit of fie recipient conducted by the
Auditor General in accordance with the provisions of OMB Circular A-1 33, as revised, will rneet the requirements of this
part. In connecticn wPhth the above andil requirements, the recipient shall fulfill, the requirements reIatNe to auditee
responsibilities as provided In Subpart C of OMB Cirmiiar A-1133, as revised,.
The schedule of expenditures should disclose the expenditures by contract number for each contract W7h the
department in effect during the audit period, 'The financial statements should disclose whether or not the matching
requirement was rnet for each applicable contract. All questioned costs and liabullfies due the department shall be fully
disclosed in the audit report package with reference to the specific; contract number.
Single Audit Information for Redpients of Recovery Act Funds:
(a) To maximizc the transparency and accountability of funds authorized under the Arnekan Recovery and
Reinvestment Act of 2009 (Pub, L. 111-5) (Recovery Act) as required by Congress and in accordance with 2 CFR
215,21 "Uniform Administrative Requirements for Grants and Agreements" and OMB Circular A-1 012 Common Rules
provis ons, recipients agree to maintain records that identify adequately the source and application of Recovery Act
funds. OMB Circular A-1 02 Is available at http:w/,o)ww,whitehouse,govlomb/circulars/a1 02/a1O2,htrnl.
(b) For recipients covered by the Single Audit Act Amendments of 1996 and OMB Circular A-1 33, "Audits of States,
Local Governments, and Non -Profit Organizations," recipients agree to separately udenflfy the expenditures for Federal
awards under the Recovery Ad on the Schedule of Expenditures of Federal Awards (SEFA) and the Data Collection,
Form (SF -SAC) required by OMB Circular A-1 33, C)MB Circular A-1 33 is available at
CF Integrated! Contract 2014 31 G,ant Agreement # KPZ21
http.//Wv�w.wh[tehotise,go,u,fsD,r,nb/cif(,Lrla(-qal33ial33,hti,nl, This shall be accomplished by Identifying expenditures for
Federal awards made under the Recovery A(A separately on the SEFA, and as separate rov4s under Item 9 of Part ill on,
the SF -SAC by CFDA number, and inclusion of the prefix "ARRA-" in identifying the narne of [he Federal program an
the SEFA and as the first characters in Itani 9d of Part Ill on the SF -SAC.
(c) Recipients agree to separately identify to each subrecIplent, and document at the time of subaward and at the time of
disbursement of funds, the Federal award number, GFDA nurnber, and amount of Recovery Act funds, When, a recipient
awards Recovery Act funds for an existing program, the information furnished to subrecipierAs 91h,90 distinguish the
subawards of incremental Recovery Act funds from regular subawards under the existing prograrn
(d) Recipients agree to require their subfecipients to include on their SEFA information, to specifically identify Recovery
Act fur)ding similar to the mquirernents for the recipient SEFA described above, This information is, needed to allow the
reciplen- to property monitor subrecIpierit expenditure of A funds aswell as oversight by the Federal awarding
agencies,, Offices of Inspector General a -id the, Government Accountability Office,
This part is applicable if the recipient is a nonstate entity as defined by Section 215,97(2), Florida Statutes,
In the event the recipient expands $500,000 or more in state firmncia[ assistance during its fiscal year, the recipient must
have a State single or project -spec lfic audit conducted in, accordance with Section 2,15,97, Florida Statutes; applicable
rules of the Department of Financial Servicesi and chapters 1 O,550 (local governmental entities) or 10,61N (nonprofit
and for-orofit organizations), Rules: of the Auditor General', The recipient agrees to provide a copy of the single audit to
the Depernent's Single Audit Unit and its contract manager, In the event the recipient expends less than $500,000 in
State financial assistance during its fiscel year, the recipient agrees to provide cedification to the Department's Single
Audit Unit and Its contract manager that a single audit was not required, in determining the state financial assistance,
expended during its fiscal year, the recipient shall consider all sources of state financial assistance, including state
financial assnstance received frorn the Department of Children & Families, other state agencies, and o0er nonslate
entities, State financiai assisl�ance does not include Federal direct or pass-thFOLIgh awards and resources received by a
nonstate entity for Federal program matching requirema)ts.
In connection with lhe audit requirements addressed in the preceding paragraph, the recipient shall ensure Itiat the audit
compiles with the requirements of Section 215,97f8), Florida Statutes, This includes submission of a finndal reporting
paukHye Lis defined by Section 215,97(2), Honda Statutes, and Chaptcrs 1 O510 of, 10,650, Rules of the Auditor
General,
The schedule oaf expenditures should disclose the expenditures by contract number for each contract with the
department in effect during [lie audit period. The financial statements should disclose wheV,ier or not the matching
requirement was met for each appiicable contract. All questioned costs and liabilities due the department shall be fully
disclosed in the audit report package with reference to the specific contract number,
Any reports, management letters, or other information required to be SUIX"nitted to :he department pIJrsu,,.-,.nt to this
agreement shalt be submitted within 180 days after the end of the Provider's fiscal, year or within 30 days of the
recipient's receipt of the audit repmt, whichever occurs first, �,Ijre�rtl to each of the fokoMng Unless otherwise required by
Florida Statutes:
A. Contract manager for this contract (I copy)
CF Integrated Contract2014 32 G rE rit Ag reenient # KPZ21
B, Department of Children & FariAles ( 'I electronic cOPY and management letter, if issued
Office of the Inspector General
Single Audit Unit
Building 5, Room 237
'1317 Nnewood Boulevard
Tallahassee, FL 32399-0700
Ernal address: sin
C. Reporting packages for audits, condOted in accordance with OMB Circular A-1 33, as revised, and recliAred by P, rt I
of this agreement shag be submitted, when required by Section, 320(d), C)MB Circular A-1 33, as revised, by or on
behalf of the recipient qi_r_ecLJY to the Federal Audit Clearinghouse using the Federal Audit CleadnqhMse's Internet
Data Entry System at�
LeCti!, Ldqintq
S
�l
and other Federal agencies and pass -through, entitles in accordance with '�.)ections 3 20(e) arid' , oMB Circular A-
133 as revised.
D, Copies of reporting packages required by Part 11 of this agreernent shall, be submitted by or oil behalf of the recipreint
directly to the fafloMrig address:
Auditor General
Local Government Au(N042
Claude Pepper Building, Room 401
111 West Madison Street
Tallahassee, Florida 32399-1450
Ernail, address' flaudgen—localgovt@aLt(l,stcite,fi Lis
Providers, when submitting audit report packages to the department for audits done in accordance v,jth OMB Circular
A-1,33 or Chapters 11 0,550 (local governmental entities) or 10,650 (nonpmflt or for-Pf0fit organizations), Rules of the
Auditor General,, ShOUld include, when available, correspondence from the auditor indicating the date the audit report
package vas delivered toPhern. When such correspondence is not available, the date that the audit report package
was delivered by the auditor to the Provider must be indicated in correspondence submitted to the department in
accordance with Chapter 10,,558(3) uj Chapter 10,657(2), Rules of the Auditor General,
PART IV: RECORD RETENMN
The recipient shall retain sufficient records demonstrating its compliance with the terms of this agireenient for a period of
six years frorn the date the audit report is issued and shall @6Iow the (lepartrnent or its designee, Chief Financial t 7dicer
or Auditor General access to such records upon request, The recipient shall ensure that audit working papers are made
available to the depannient or its designee,, Chief Financial Officer or Auditor General upon request for a period of three
years frorn the date the audit report is issued, unless extended in writing by the departmlent,
CF Integrated Contract 2014 33 Grant Ag reerneint # IKPZ21
INFIF-AMENEW
This Attachment contains the terns and conditions governing the Provi-lor's access to and use of Protected Health
inforination and provides the permissible uses and disclosures of protected health information by the Provider, also
called "Business Associate,"
Section 1, Definitions
11 Catch-all definitions
The following lenTiS Used in (his Attachment shalt have the same meaning as those terms in the HIPAA
Rules: Breach, Data Aggregation, Designated Record Set, Disclosure, Health Care Operations, individual,
Minimum Necessary, Notice of Privacy Practices, Protected Health Information, Required by Law, Security
Incident, Subcontractor, I.Jinsecured Protected Health Information, and Use.
1,2 Spedfic definifions.
121 Tusuness Associate" shall generally have the same meaning as the term "business
associate' at 45 CFR 160,103, and for purposes of this Attachment shalt specifically refer
to the Provider,
1,2-2 "Covered Entity" shall generally have the same meaning as the term "covered entity" at 45
CFR 160,103, and for purposes of this Attachment shall refer to the Department,
1,23, "HIPAA RUIeS" shali mean the Privacy, Security" Breach Notification, and
Enforcement Pules at 45 CFR Pad 160 and Part: 164.
1,2.4. "Subcontractor" shall generally have the same Meaning as the term "subcontractor" at 45 CFR § 160103
and is defined as an individual to whom a business, associate delegates a function , activity, service , rith,,-,r
than in, the capacity of a member of the workforce, of such bu&ess associate.
Section 2. Obligations and Activities of Business Associate
2.1 Business Associate agrees to:
211.1 Not use or disclose protected health information other than as penny teed or required by this
Attachment or as required by law;
211 Use approprate administrative safeguards as set forth at 45 CFR § 164,308, physical
safeguards as set forth at 45 CFR § 164,310, and technical safeguards as set forth at 45 CFR §
164 312; including, policies and procedures regarding the protection of PHI andior ePH1 set
forth at 45 CFR § 164,316 and the provisions of training on such policies and procedures to
applfc&e employees, independent contractors, and volunteers, that reasonably and
appropriately protect the confidentiaky, integrity, and availability of the PHI and/or ePHI that the
Provider creates, receives, maintains or transrmts on, behalf of the Department
2,1,3 Acknowledge that (a) (he foregoing safeguards, policies and procedures requirements shall
apply to the Business Associate in the same manner that such requirements app y to the
Department, and (b) the Business Associate's and their Subcontractors are directly liable under
the civil and criminaN enforcement provisions set forh at Section 13404 of the HITECH Act and
section 45 CFR § 164.500 and 164,502(E) of the Privacy Rule (42 J&C. 1320d-5 and 1320d-6),
as amended, for faiture to comply wtlh the safeguards, policies and procedures requirements
and any guidance issued by the Secretary of Health and Hurrian Services with respect to such
reqLdrements4
CF Integrated Contract 2014 34 Grant Agreement # KPZ21
214 Report to covered entity any use or &closure of protected health inforroation not provided for by
thus Attadiment of Which it becornes awar a, inclucfing breaches of unsecured protected health
information as required at 45 CFR 164,410, and any security incident of which it becomes aware;
-�tY OffJCP Contract Manager as soon as
21,5 Nnhiy the Department's SeCUI Jr, privacy Officer and
Possible, but nc later than five (5) business days following the determination of any breach or
potential breach of personal and confidential departmental data;
21.6 Nolity the Privacy officer and Contract Manager within (24) hours of notification :)y the US
Department of Health and Human Servo ces of any jnvestjgafions, cornpiance reviews o,r
inquiries by the US Department of Health and Human Services concerning violations of HlPAA
(Privacy, Security Breach),
21 Y Provide any addilional information requested by the Department for purposes of investigating
and responding to a bread);
213 Provide at Business Associate's own cost notice to affected parties no later than 45 days,
following the determination of any potential breach of personal or confidential departmental i data
as provided in section 817,5681, F 3,;
21,9 Implement at Business Associate's own cost measures deemed appropriate by the Department
to avoid or rriNgate potential �injury to any person dLle to a breach or poterlt4 breach of
personal l and confident4l departmental data;
Z1.10 Take immediate steps to limit or avoid the recurrence of any security breach and take any ocher
action pertaining to such Unauthorized access or disclosure required by applicable federal and
state laws and regulations regardless of any actions taken by the Department ;
2,1 A I In accordance with 45 CFR 164 502(e)(1)(fl) and '164,308(b)(2), if applicable, ensure that ally
subcontractors that create, receive, maintain, or uansnilt protected health information on behalf
of the business associate agree to the same restrictions, conditions, and requirements that
apply to the business associate with respect to sUch information, Business Associate's must
attain, satisfactory assurance in the form of a written contract or other- written agreement with
their business associate's or subcontractor's that meets, the applicable requirements Of
164,504(e)(,2) that the Business Associate or Subcontractor will appropriately safeguard the
Wormaton , For prior contracts or other arrangements, the Provider shah[ provide wrluen,
certification that its implementation complies with the terms of 45 CFR '164.532(d),
2.1,12 Make available protected health information in as designated record set to coveTed entity as
necessary to satisfy covered, entity's obligations under 45 CFR 164,54;
2.1,13 Make any aniendment(s) to protected health iritonnation in a desiginated record set ,is directed
or agreed to by the covered entity pursu ant to 45 C F R 164 .526, or take other measures as
necessary to satisfy covered entity's obligations sunder 45 CFR '164,526;
2,1,14 Maintain and make available the inforrTlation required to provide an accounting of disclosures to
I covered entity's obligations under 45 CFR 164 .528„
covered entity as necessary, to satisfy
21,15 To the extent the buslness associate is to carry out one or more of covered entity's dDligation(s)
under Subpart E of 45 CFR Part 164, comply with, the requirements of (Subpart E that apply to
,he covered entity in the performance of such obligation(s); and
21,16 Make its internal practices, books, and records available to the Secretary of the U,S. Department
of Health area Human Services for purposes of determining compliance with the HlPAA Rules,
CF Integrated Contract 2014 35 Grant Agreement # KPZ21
Section 3, Permitted Uses and Disclosures by Business Associate
31 The Business associate njay only use or disclose protected health infojrr-natjon covered under this
Attadiment as listed below: The Business Associate may use and disclose the Depaitinenit's pal 11 andlor ePhl received or
created by Bus' ness Associate (or its agents and, subcontractors) in performing i-s OMgaflons
pursuant to this Attachment,
3.12 The Business Associate may use the Departmeni's PHI and/or ePHI receNed, or created by
Business Assonialte (or its agents and subcontractors) for archival purposes,
3.13 The BLIsiness Associate may use PHI and1or ePHI created or received in its caPBcItY as a
Business Associate, of the Department for the proper planagenient and adirni HSI ration of the
Business Associate, it such use rs necessary (a), for the proper management and, administration
of Business Associate or (b) to carry V.1t the legal responsibiOcs of Business Associate,
3JA The Business Associate may disclose M andior ePHI created or received Mn its capacity as a
Business Associate of the Department for the proper rnanagement and administration of the
Business Associate if (a) the disclosure is required by law or (b) the Business Associate (1),
obtains reas&iable assurances from the person to whom the PHI and/or ePHM is, dis&sed that
it A be hM confidentially and used or further disclosed, oMy as required by haws or for the
e
purpose for which, it was cIisclosed to the person and (2) the person agrees to ruotfy the
Business Associate of any instances of which it becornes aware in which the confidentiality and
s,ecuNty of the PHI and lor ePHI has been breached.
315 The Business Associate array aggreg ate the F-1 I and/or eP H I created or received pursuant this
Attachment + 'oih the PHI and/or ePHI of other covered entities that Business Associate has in
its possession through its capacity as a Business, Associate of such covered entities for the
purpose of providing the Department of GhMren and Families with data analyses relating to the
health care operations of the Department (as defined in 45 C.F.R. a64,501)
3�, 1 ,6 The Business Associate may de -identify any sand M P'HI andior eM received or created
pursuant to this Attachment, provided that the d&jdentification process conforms to the
reqO'enien(s of 45 CFR § 164,514(b),
3.1.7 FOovi guidance (n the HIPAA Buie regardlIng marketing, fundraising and, research located at
Sections 45 CFR § 164,501, 45 CFR § 164.508 and 45 CFR § '1645%
Section 4, Provisions for Covered Entity to Inform Business Associate of Privacy Practices and Restrictions
41 Covered entity shah notify business associate of any inn-utation(s) in the notice of privacy practices of
covered entity under 45 CFR 164,520, to the extent ?hat such limitation may affect business associate's
use or disclosure of protected health information.
42 Covered entity shall notify business associate of any changes in, or revocabon of, the permission by an
individUai to use or disclose his or her protected health Oformation, to the extent that, such changes may
affect business associate's use or dusdosure of protected health information.
43 Covered entity shall, notify business associate of any restriction on the use or disclosure of protected health
information that covered entity has agreed to or is required to allude by under 45 CFR 164,522, to the
extent that such restriction may affect business associate's use or disclosure of protected health
informalJon,
Section S. Termination
CF Integrated Contract 2014 36 Grant Agreement # KPZ21
5.1 Ternninakn for Cause
5:1,1 Upon the Department's knowledge of a rnaterO breach by the Business Associate,, the
Department shall either;
51.11 Provide an opportunity for the Business Associate to cure the breach or end the violation and
terminate the Agreement or discontinue access to M if the Business Associate does not cure
the breach or end the violation wiithki the time specified by the Department of Children and
Farnflie%
5-1 ,1.2 Immediately terminate this Agreement or discontinue access to PH If the Business Associate
has breaOed a rnateriA terni of this Attachment and does not end the violation;; or
5A, 13 if neither ternlinatlon nor cure is feasible, the Department shall report the violation to the
Secretary of the Department of Health and Hurnan Services,
52 Obligations of Business Associate Upon Ter6nal.icn
521 Upon ter6nation of tNs Attachment for any reason, business associate, with respect to
protected health information received from covered entity, or creaied, mainlained, or received
by business associate an behalf of covered entity, chalk:
521' I Retain rarity that protected health information which is necessary for Baseness
Associate to, continue its proper management and adminIstration or to carry out its
legal responsibilities;
521.2 Return to covered entity, or other entity as specified by the Department or, if
permission is granted by the Department, destroy the remaining protected health
infbrma(jon that the Business Associate still maintains in any form:
5,213 Continue to use appropriate safegua-ds arjcj compCy with Subpart C of 45 CIFIR (part
'164 with respect to electronic protected health information to prevent use of
disclosure of the protected health information, other than as, provided for in this
Section, for as long as Business Associate retains the protected health information;
5,21A Not use or disclose the protected health infnmintion retained by Business Associate
other than for the purposes for which such protected heafth infornmation was reta€ned
and subject to the same conditions set out at paragraphs 313 and 3.1.4 above.
under "Permitted Uses and: Disclosures By Business Associate" whichappliedprior
to ternnjnafion� and
5,21.5 Return to covered enbty, or other entity as specified by the Department or, if
permission is granted by the Department, destroy the protected healli information
retained by business associate where it is no longer needed by business associate
for its proper management and adminslraflon or to carry out its legal, responsibilities,
521.6 The oNigabons of IbUsOess associate under this Section shall survive the,
termination of this Attachment,
Section 6, Miscellaneous
6.1 A regulatory reference in this Attachment to a section in the HPAA Rules rneans the section as in affeel or
as amended,
CIF integrated Contract 2014 37 Grant Agreement # KP'Z21
6.2 The Parties agree to take mjchi action as is, necessary to amend tars Attachment from 6MLI to Ume as is
neressary for compliance, with Hie requirements of the HIPAA Rules and any other applicable law.
U Any ambiguily in this Attachment 511,4 ha interpreted to permit compliance with M HIPAA Rules.
CF integ rated Contract 2014 38 Grant Agreement # KPZ21
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing, or attempting to influence an officer or an employee
of any agen cy, a member of congress„ an officer or employee of congress, or an employee of
a Member of congress in connection with the awarding of any federal contract, the making of
any federal grant, the making of any federal loan, the entering into of any cooperative
agreement, and the extension, continuation, renewal, amendment, or modification of any
federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than federal appropriated funds have been paid or wifl be paid, to any person
for influencing o, r aftern ptin g Ao influence: an officer or em ployee of any agency, a member of
congress, an officer or employee'of congress, or an employee of a member of congress in
connection with this federal contract, grant, loan, or cooperative, agreement, the undersigned
shall compWe and submit Standard Form-LLL, 'Disclosure Form to Report Lobibying," in
accord-2,nce witi, its instructions.
(3), The undersigned shall require that the language of this certiflcatlon be included in the award
documents for all subawards at all tiers (including subcontracts, subgrants, and contracts
under grants, loans and cooperative agreements) and that all subrecipients shall certify and
disclose accordingly.
atom
09/03/2014
-
Slrg�nture Date
E. Scott Pridgen, MC CoC Bopfd Chair
Name of Authorized IndMd ual Applicallon or Contrac(Namber
Monroe County Homeless Services Continuurn of Carejnc,
Name of OrganIzaflan
P.0, Box 2410 Key West, Flodda 33045-2410
Address of Organzaflon
CF 1123, PV8 OW96 Page