CFDA#14.241

EXHIBIT A

AGREEMENT NO.

An Agreement between the CITY OF PORTLAND (CITY) and CLARK COUNTY WASHINGTON acting through its Department of Community Services and Corrections (DCSC) (SUBRECIPIENT), to provide transitional housing for HIV/AIDS-affected people in Clark County.

RECITALS:

1.  The City has been awarded funds from the HOPWA program of the U.S. Department of Housing and Urban Development to fund projects within a six county area to assist individuals with HIV/AIDS.

2.  Clark County DCSC submitted a proposal to provide a Transitional Housing Program of 6 units serving persons with HIV/AIDS who live in Clark County

3.  The proposal is designed to meet the needs of HIV/AIDS residents by providing transitional housing and case management which will create stability to allow participants to become integrated into the community support service network in Clark County. This is intended to enable participants to move to permanent housing following the transition period.

4.  Clark County DCSC has significant experience in providing housing services to persons with special needs.

5.  DCSC has proposed working in collaboration with the Southwest Washington Consortium on HIV/AIDS, the Vancouver Housing Authority, Cascade AIDS Project and other stakeholders to provide transitional housing and appropriate support services to individuals and families living with HIV/AIDS in Clark County.

6.  Data in Clark County indicates that 10 to 20 clients experience a housing crisis in a typical month. The provision of transitional housing for persons living with HIV/AIDS meets the goals of the HOPWA program.

7.  There is funding to provide these services in the approved FY 2002-03 Bureau of Housing and Community Development (BHCD) Budget in the Housing Opportunities for Persons with AIDS fund.

8.  The City now wishes to enter into an agreement with DCSC in the amount of $89,974 to support transitional housing and case management for persons living with HIV/AIDS

AGREED:

I.  Scope of Services

A.  Program Services: Subrecipient will provide the program services described below for the duration of the contract:

1.  The Subrecipient will provide transitional housing placement, case management and related services to families and individuals enrolled in the transitional housing project. These services will be provided on an ongoing basis consistent with the terms of this agreement. Clients currently enrolled in the HIV Transitional Housing Program operated by the Southwest Washington Health District should experience continuity of services and housing. Services will include:

a.  Securing and maintaining 6 units of Transitional Housing with basic furnishings;

b.  Development of case management plans targeted toward stable independent housing;

c.  Linkage to health, mental health, drug and alcohol rehabilitation programs;

d.  Assistance with basic life-management skills such as budget management, using public transportation, locating and accessing community resources for food, child and respite care, part time employment, etc.;

e.  Monitoring clients use of transitional housing units, including client payment of share of rent, unit housekeeping, and adherence to other terms of the rental agreement; and

f.  Assistance with finding permanent housing.

2.  The program will be delivered in a manner consistent with all regulations governing the Housing Opportunities for Persons with AIDS Program contained at 24 CFR. This includes the following requirements:

a.  Units shall comply with the habitability standards set out in 24 CFR 574.310(b) (1997) or in any superseding regulations.

b.  Tenant Contribution to Rent:

(1)  Subrecipient or its designee shall certify the gross monthly household incomes of prospective tenants before entering into a lease agreement and shall otherwise make sure they are eligible persons. Subrecipient or its designee shall calculate and certify the monthly adjusted income of each household who will occupy a HOPWA unit for the purpose of calculating their tenant contribution to rent at the time of initial occupancy and shall recertify the monthly adjusted income and tenant contribution to rent at least annually and more often as necessary to avoid any hardship to tenants whose incomes decline between annual recertifications.

(2)  Tenant contributions to rent in the HOPWA units, including utilities, shall be the greater of:

(a)  30 percent of the household’s monthly adjusted income.

(b)  10 percent of the household’s monthly gross income; or

(c)  If the household is receiving payments for welfare assistance from a public agency and a part of the payments, adjusted in accordance with the household’s actual housing costs, is specifically designated by the agency to meet the household’s housing costs, the portion of the payments that is designated.

c.  Termination of assistance to eligible person: Subrecipient may only terminate assistance to eligible persons residing in HOPWA units if the eligible person violates material, reasonable conditions of occupancy. Subrecipient must ensure that supportive services are provided prior to any proposed termination, so that an eligible person’s assistance is terminated only in the most severe cases. Termination by Subrecipient must be made upon written notice containing a clear statement of the reasons for termination, must be carried out in compliance with the requirements of Washington Law and must accord the tenant with all of his or her rights to due process of law.

d.  Increased need for care: If the Subrecipient becomes aware that a tenant with HIV or AIDS in a HOPWA unit requires more intensive care than can be provided at the Project, the Subrecipient or its designee shall locate a care provider who can appropriately care for the individual and shall refer the individual to the care provider.

e.  Termination of Assistance to Surviving Family Members: With respect to the surviving family member or members living in a HOPWA unit with the person with AIDS at the time of his or her death, housing assistance and supportive services shall continue for a grace period of at least six months following the death of the eligible person with AIDS. Subrecipient may extend the grace period up to an additional six months and shall notify the family of the duration of their grace period in writing. Subrecipient may assist the family with information on other housing resources and with moving expenses.

f.  Fees: No fees, except rent, will be charged of any eligible person for any housing or services provided by Subrecipient.

3.  Permanent Housing Planning: The Subrecipient will explore opportunities to develop resources and collaboration potential to develop additional permanent housing resources in Clark County for persons living with HIV/AIDS.

B.  Fiscal Services: Subrecipient will provide the following fiscal services for the duration of the Agreement

1.  Fiscal management services for the transitional housing project, including but not limited to keeping the City Project Manger informed of the financial status of the transitional housing program on an on-going basis.

2.  Pay rent on time for units leased from third parties, calculate, collect and account for tenant rents (if any), review and submit accurate billings, maintain supporting documentation and compliance with the approved budget.

3.  Provide all required insurance coverage for the project.

II.  Performance Measures

A.  Subrecipient will maintain four to six occupied, transitional units for PLWH in Clark County at all times.

B.  The program goal is to serve 4-8 eligible households per year; with each household stay being a maximum of 12 months, renewable at the discretion of the Subrecipient for up to an additional six months if transition to permanent housing is, in the opinion of the case manager, not appropriate or likely to be detrimental at the expiration of the initial term. The average period of transitional housing is expected to be nine months.

C.  Outcome measures include:

- Units will be occupied 95% of the time.

- 85% of clients served will obtain permanent housing or be placed in another appropriate treatment facility.

- No more than 15% of clients served will return to homelessness within one year of discharge.

- Of clients placed in permanent housing, at least 70% will remain in housing nine months after placement.

III.  Reporting Requirements

A.  Subrecipient shall submit a quarterly report utilizing the form provided as Attachment B on the progress of the project and to report the required statistical information to track the demographics of program participants to the Bureau of Housing and Community Development within 30 days of the end of each quarter. Quarterly reports are due October 31, January 30, April 30, and July 30. A final report summarizing the program accomplishments and reporting the cumulative statistical information for the year shall be due on July 30, 2003.

B.  The periodic reports will include a narrative progress report which describes the overall status of the project, including major accomplishments, tasks completed or underway, and any proposed changes to the work products or timeliness.

C.  In addition to narrative reports, Subrecipient will provide a demographic report regarding all persons served under this agreement utilizing the form provided as Attachment B.

IV.  Compensation and Method of Payment

A.  The City will reimburse the Subrecipient for anticipated and actual expenses in accordance with the Budget (Attachment A) upon receipt of an itemized statement of expenditures. Funds will be disbursed for:

1.  Actual expenditures, upon submission of copies of receipts or other acceptable documentation, or

2.  Anticipated expenditures, upon submission of a bid, official estimate, purchase orders or other documentation adequate to support anticipated expense. Documentation of the actual expenditure of any anticipated expenses paid by the City shall be submitted to the City promptly after the actual expenditure was incurred. Any adjustments needed will be applied to the next processed payment.

Subrecipient will maintain documentation of all expenses and make such records available for inspection by the City upon request.

B.  All funds received by the Subrecipient, whether for actual or anticipated expenditures, must be disbursed within­­­ three (3) working days of receipt.

C.  Any changes to the approved budget must be approved in writing by the City Project Manager before expenditure of funds in new amounts or line items.

D.  No funds under this Agreement may be used to purchase non-expendable personal property or equipment. Funds may be used to pay for lease or rental or equipment if approved in advance by the City Project Manager.

E.  Total compensation under this Agreement shall not exceed EIGHTY-NINE THOUSAND, NINE-HUNDRED AND SEVENTY-FOUR DOLLARS ($89,974).

V.  General Contract Provisions

A.  TERMINATION FOR CAUSE. In accordance with 24 CFR 85.43, if, through any cause, the Subrecipient shall fail to fulfill in timely and proper manner his/her obligations under this Contract, or if the Subrecipient shall violate any of the covenants, agreements, or stipulations of this Contract, the City may avail itself of such remedies as cited in 24 CFR 85.43 by giving written notice to the Subrecipient of such action and specifying the effective date thereof at least 30 days before the effective date of such action. In such event, all finished or unfinished documents, data, studies, and reports prepared by the Subrecipient under this Contract shall, at the option of the City, become the property of the City and the Subrecipient shall be entitled to receive just and equitable compensation for any satisfactory work completed on such documents.

Notwithstanding the above, the Subrecipient shall not be relieved of liability to the City for damages sustained by the City by virtue of any breach of the Contract by the Subrecipient, and the City may withhold any payments to the Subrecipient for the purpose of setoff until such time as the exact amount of damages due the City from the Subrecipient is determined.

B.  TERMINATION FOR CONVENIENCE. In accordance with 24 CFR 85.44, the City and Subrecipient may terminate this contract at any time by mutual written agreement. If the Contract is terminated by the City as provided herein, the Subrecipient will be paid an amount which bears the same ratio to the total compensation as the services actually performed bear to the total services of the Subrecipient covered by this Contract less payments of compensation previously made.

C.  ENFORCEMENT AND REMEDIES. In the event of termination under section A hereof by the City due to a breach by the Subrecipient, then the City may complete the work either itself or by agreement with another subrecipient, or by a combination thereof. In the event the cost of completing the work exceeds the amount actually paid to the Subrecipient hereunder plus the remaining unpaid balance of the compensation provided herein, then the Subrecipient shall pay to the City the amount of excess. Allowable costs shall be determined in accordance with 24 CFR 85.43(c).

The remedies provided to the City under sections A and C hereof for a breach by the Subrecipient shall not be exclusive. The City also shall be entitled to any other equitable and legal remedies that are available.

In the event of breach of this contract by the City, then the Subrecipient's remedy shall be limited to termination of the contract and receipt of payment as provided in section B hereof.

In the event of termination under Section A, the City shall provide the Subrecipient an opportunity for an administrative appeal to the Bureau Director.

D.  CHANGES. The City or Subrecipient may, from time to time, request changes in writing in the scope of services or terms and conditions hereunder. Such changes, including any increase or decrease in the amount of the Subrecipient's compensation, shall be incorporated in written amendments to this contract. Changes to the scope of work, budget line items, timing, reporting, or performance measures may be approved by the Project Manager.

Significant changes to the scope of work, performance measures, or compensation must be approved by ordinance of the City Council.

E.  NON-DISCRIMINATION and EQUAL OPPORTUNITY. During the performance of this Contract, the Subrecipient agrees as follows:

1.  The Subrecipient will comply with the non-discrimination provisions of Title VI of the Civil Rights Act of 1964 (24 CFR 1), Fair Housing Act (24 CFR 100), and Executive Order 11063 (24 CFR 107).

2.  The Subrecipient will comply with prohibitions against discrimination on the basis of age under Section 109 of the Act as well as the Age Discrimination Act of 1975 (24 CFR 146), and the prohibitions against discrimination against otherwise qualified individuals with handicaps under Section 109 as well as section 504 of the Rehabilitation Act of 1973 (24 CFR 8).

2.  The Subrecipient will comply with the equal employment and affirmative action requirements of Executive Order 11246, as amended by Order 12086 (41 CFR 60). Furthermore, the Subrecipient certifies it has adopted procedures to ensure that all persons who qualify for assistance, regardless of their race, color, religion, sex, age, national origin, familial status, or handicap, know of the HOPWA program, including facilities and services accessible to persons with a handicap, and maintain evidence of implementation of these procedures.

4.  The Subrecipient will comply with the equal employment and non-discrimination requirements of Portland City Code Sections 3.100.005 (City Policies Relating to Equal Employment Opportunity, Affirmative Action and Civil Rights), 3.100.042 (Certification of Contractors), and Chapter 23 – Civil Rights.

F.  SECTION 3: The Subrecipient will comply with the training and employment guidelines of Section 3 of the Housing and Urban Development Act of 1968, as amended (12U.S.C. 1701a), and regulations pursuant thereto (24 CFR Part 135).

G.  ACCESS TO RECORDS. The City, HUD, the Comptroller General of the United States, or any of their duly authorized representatives, shall have access to any books, general organizational and administrative information, documents, papers, and records of the Subrecipient which are directly pertinent to this contract, for the purpose of making audit or monitoring, examination, excerpts, and transcriptions. All required records must be maintained by the Subrecipient for four years after the City makes final payments and all other pending matters are closed.

H.  MAINTENANCE OF RECORDS. The Subrecipient shall maintain fiscal records on a current basis to support its billings to the City. The Subrecipient shall retain fiscal as well as all records relating to program management and operation, program beneficiaries, demographics and eligibility for inspection, audit, and copying for four years from the date of completion or termination of this contract. The City or its authorized representative shall have the authority to inspect, audit, and copy on reasonable notice and from time to time any records of the Subrecipient regarding its billings or its work hereunder.

I.  AUDITS. The Subrecipient is subject to the audit requirements of 24 CFR 45.

Also, the City, either directly or through a designated representative, may audit the records of the Subrecipient at any time during the four year period established by Section H above.

If an audit discloses that payments to the Subrecipient were in excess of the amount to which the Subrecipient was entitled, then the Subrecipient shall repay the amount of the excess to the City.

J.  INDEMNIFICATION. The Subrecipient shall hold harmless, defend, and indemnify the City and the City's officers, agents and employees against all claims, demands, actions, and suits (including all attorney fees and costs) brought against any of them arising from the Subrecipient's work or any subcontractor's work under this contract.

K.  LIABILITY INSURANCE.

(a) The Subrecipient shall maintain public liability and property damage insurance that protects the Subrecipient and the City and its officers, agents, and employees from any and all claims, demands, actions, and suits for damage to property or personal injury, including death, arising from the Subrecipient's work under this contract. The insurance shall provide coverage for not less than $200,000 for personal injury to each person, $500,000 for each occurrence, and $500,000 for each occurrence involving property damages; or a single limit policy of not less than $500,000 covering all claims per occurrence. The limits of the insurance shall be subject to statutory changes as to maximum limits of liability imposed on municipalities of the state of Oregon during the term of the agreement. The insurance shall be without prejudice to coverage otherwise existing and shall name as additional insureds the City and its officers, agents, and employees. Notwithstanding the naming of additional insureds, the insurance shall protect each insured in the same manner as though a separate policy had been issued to each, but nothing herein shall operate to increase the insurer's liability as set forth elsewhere in the policy beyond the amount or amounts for which the insurer would have been liable if only one person or interest had been named as insured. The coverage must apply as to claims between insureds on the policy. The insurance shall provide that it shall not terminate or be canceled without 30 days written notice first being given to the City Auditor. If the insurance is canceled or terminated prior to completion of the contract, the Subrecipient shall provide a new policy with the same terms. The Subrecipient agrees to maintain continuous, uninterrupted coverage for the duration of the contract. The insurance shall include coverage for any damages or injuries arising out of the use of automobiles or other motor vehicles by the Subrecipient.

(b) The Subrecipient shall maintain on file with the City Auditor a certificate of insurance certifying the coverage required under subsection (a). The adequacy of the insurance shall be subject to the approval of the City Attorney. Failure to maintain liability insurance shall be cause for immediate termination of this agreement by the City.

In lieu of filing the certificate of insurance required herein, the Subrecipient shall furnish a declaration that the Subrecipient is self-insured for public liability and property damage for a minimum of the amounts set forth in ORS 30.270.

L.  WORKERS' COMPENSATION INSURANCE.

(a) The Subrecipient, its subcontractors, if any, and all employers working under this Agreement are subject employers under the Oregon Worker's compensation law and shall comply with ORS 656.017, which requires them to provide worker's compensation coverage for all their subject workers. A certificate of insurance, or copy thereof, shall be attached to this Agreement and shall be incorporated herein and made a term and part of this Agreement. The Subrecipient further agrees to maintain worker's compensation insurance coverage for the duration of this Agreement.

(b) In the event the Subrecipient's worker's compensation insurance coverage is due to expire during the term of this Agreement, the Subrecipient agrees to timely renewal of its insurance, either as a carrier-insured employer or a self-insured employer as provided by Chapter 656 of the Oregon Revised Statutes, before its expiration, and the Subrecipient agrees to provide the City of Portland such further certification of worker's compensation insurance as renewals of said insurance occur.

(c) If the Subrecipient believes itself to be exempt from the worker's compensation insurance coverage requirement of (a) of this subsection, the Subrecipient agrees to accurately complete the City of Portland's Questionnaire for Worker's Compensation Insurance and Qualification as an Independent Subrecipient prior to commencing work under this Agreement. In this case, the Questionnaire shall be attached to this Agreement and shall be incorporated herein and made a term and part of this Agreement. Any misrepresentation of information on the Questionnaire by the Subrecipient shall constitute a breach of this Agreement. In the event of breach pursuant to this subsection, the City may terminate the agreement immediately and the notice requirement contained in Section (A) TERMINATION FOR CAUSE, hereof shall not apply.

M.  SUBCONTRACTING AND ASSIGNMENT. The Subrecipient shall not sub-contract its work under this contract, in whole or in part, without the written approval of the City. The Subrecipient shall require any approved subcontractor to agree, as to the portion subcontracted, to fulfill all obligations of the Subrecipient as specified in this contract. Notwithstanding City approval of a subcontractor, the Subrecipient shall remain obligated for full performance hereunder, and the City shall incur no obligation other than its obligations to the Subrecipient hereunder. The Subrecipient agrees that if sub-contractors are employed in the performance of this contract, the Subrecipient and its subcontractors are subject to the requirements and sanctions of ORS Chapter 656, Workers' Compensation. The Subrecipient shall not assign this contract in whole or in part or any right or obligation hereunder, without prior written approval of the City.

The Subcontractor shall be responsible for adhering to all regulations cited within this contract.

N.  INDEPENDENT SUBRECIPIENT STATUS. The Subrecipient is engaged as an independent subrecipient and will be responsible for any federal, state, or local taxes and fees applicable to payments hereunder.

The Subrecipient and its subcontractors and employees are not employees of the City and are not eligible for any benefits through the City, including without limitation, federal social security, health benefits, workers' compensation, unemployment compensation, and retirement benefits.

O.  CONFLICTS OF INTEREST. No City officer or employee, during his or her tenure or for one year thereafter, shall have any interest, direct, or indirect, in this contract or the proceeds thereof.

No board of director member or employee of the Subrecipient, during his or her tenure or for one year thereafter, shall have any interest, direct, or indirect, in this contract or the proceeds.

No City Officer or employees who participated in the award of this contract shall be employed by the Subrecipient during the contract.

On HOPWA-funded projects, the Subrecipient shall further comply with the conflict of interest provisions cited in 24 CFR 574.625.

P.  CONTRACT ADMINISTRATION, 24 CFR 574.605. The Subrecipient shall comply with the policies, guidelines and requirements of OMB Circular Nos. A-122 and A-110 with regard to the acceptance and use of funds.

Q.  OREGON LAWS AND FORUM. This contract shall be construed according to the laws of the State of Oregon.

Any litigation between the City and the Subrecipient arising under this contract or out of work performed under this contract shall occur, if in the state courts, in the Multnomah County court having jurisdiction thereof, and if in the federal courts, in the United States District Court for the State of Oregon.

R.  AVAILABILITY OF FUNDS. It is understood by all parties to this contract that the funds used to pay for services provided herein are provided to the City through a grant from the U.S. Department of Housing and Urban Development. In the event that funding is reduced, recaptured, or otherwise made unavailable to the City as a result of federal action, the City reserves the right to terminate the contract as provided under Section B hereof, or change the scope of services as provided under Section D hereof.

S.  COMPLIANCE WITH LAWS. In connection with its activities under this contract, the Subrecipient shall comply with all applicable federal, state, and local laws and regulations. For HOPWA-funded projects, the Subrecipient shall carry out its activities in compliance with 24 CFR 574.500.

In the event that the Subrecipient provides goods or services to the City in the aggregate in excess of $2,500 per fiscal year, the Subrecipient agrees it has certified with the City's Equal Employment Opportunity certification process.

T.  PROGRAM AND FISCAL MONITORING. The City through the Bureau of Housing & Community Development shall monitor on a regular basis to assure contract compliance. Such monitoring may include, but are not limited to, on site visits, telephone interviews, and review of required reports and will cover both programmatic and fiscal aspects of the contract. The frequency and level of monitoring will be determined by the City Project Manager.

U.  PROGRAM ACCESS BY THE DISABLED. The Subrecipient shall, to the maximum feasible extent, follow the Bureau of Housing and Community Development's guidelines on ensuring interested persons can reasonably obtain information about, and access to, HUD-funded activities.

V.  SEVERABILITY. If any provision of this agreement is found to be illegal or unenforceable, this agreement nevertheless shall remain in full force and effect and the provision shall be stricken.

W.  INTEGRATION. This agreement contains the entire agreement between the City and the Subrecipient and supersedes all prior written or oral discussions or agreements.

X.  FUND-RAISING. City-funded dollars may be used to cover expenses directly related to the contracted project. Costs associated with general agency fund-raising activities are not eligible.

Y.  PUBLICITY. Publicity regarding the project shall note participation of the City through the Bureau of Housing & Community Development.

Z.  LOBBYING. The Subrecipient shall not utilize these funds for lobbying the Executive or Legislative branches of the Federal Government, in compliance with 24 CFR 87.

AA.  CHURCH-STATE. The Subrecipient agrees to comply with the applicable provisions of 24 CFR 574.300(c).

BB.  DRUG-FREE WORKPLACE. The Subrecipient will maintain a drug-free workplace in conformance with 24 CFR part 24, subpart F.

CC.  INDEPENDENT FINANCIAL AUDITS/REVIEWS. Any subrecipient receiving $300,000 or more in federal funds, from all sources, in any program year is required to obtain an independent audit of the federally-funded program(s), in compliance with federal OMB Circular A-133. Any subrecipient receiving between $25,000 and $300,000 in federal funds, from all sources, in any program year, is required to obtain an independent financial review. Additionally, contractors receiving between $25,000 and $300,000 in federal funds may be required to obtain an A-133 audit, if the City believes it is warranted. Two copies of all required financial audits or reviews will be submitted to the designated City Project Manager within thirty days of their completion.

DD.  PAYMENTS. The Subrecipient shall ensure that grant funds will not be used to make payments for health services for any item or service to the extent that payment has been made, or can reasonably be expected to be made, with respect to that item or service by any state compensation program, under an insurance policy, or under federal or state health benefits program; or by entities that provides health services on a prepaid basis.

EE.  TERMINATION OF ASSISTANCE. With respect to the surviving members of a family who were living in a unit assisted under the HOPWA program with the person with HIV/AIDS at the time of his or her death, housing assistance and supportive services under the HOPWA program shall continue for a grace period following the death of the person with HIV/AIDS. The grantee or project sponsor shall establish a reasonable grace period, in the lease agreement, subject to City approval, for continued participation by a surviving family member, but that period may not exceed one year from the death of the family member with HIV/AIDS. The Subrecipient shall notify the family of the duration of the grace period through a lease clause and written notification and may assist the family with information on other available housing and moving expenses.

FF.  CONFIDENTIALITY. The Subrecipient shall agree, and shall ensure the confidentiality of the name of any individual assisted and any other information regarding individuals receiving assistance.

VII.  Period of Agreement

The term of this Agreement shall be effective July 1, 2002 and shall remain in effect during any period the Subrecipient has control of City funds, including program income. Work by the Subrecipient shall terminate as of June 30, 2003.

Dated this _________________ day of ____________________, 2002.

CITY OF PORTLAND      CLARK COUNTY, WASHINGTON

_________________________   ____________________________

Erik Sten          Bill Barron

Commissioner of Public Works    County Administrator

APPROVED AS TO FORM:    APPROVED AS TO FORM:

__________________________    _________________________

Jeffrey L Rogers        Deputy Prosecuting Attorney

City Attorney

ATTACHMENT A

Program Delivery Costs

Accounting/Fiscal --    $2,708

Contract/Reporting    $1,795

Supervision      $1,795

Total Program Delivery    $6,298

ATTACHMENT B

HOPWA HOUSING SERVICES

QUARTERLY REPORT

YEARLY REPORT

To be completed and filed with BHCD within 30 days of the end of each fiscal quarter or by October 30, January 30, April 30, July 30 (yearly report).

INSTRUCTIONS:

Complete one report for each active HOPWA Project for each fiscal quarter. Please attach a narrative in the form you have been providing. After the first fiscal quarter report (July 1 –

Sept. 30), report only new, unduplicated clients served by your program in subsequent quarters. The reports will be entered into a database, which will keep a running total of all unduplicated counts for the fiscal year. Many programs continue to serve the same clients for most of the year, and reports after the first fiscal quarter may contain data on only a few additional clients. For example, if your program provides transitional housing and you support four units, if three of those units are filled the first quarter and the fourth is filled the second quarter and all units remain occupied by the same clients for the full fiscal year, you will have little or nothing to report in quarters three and four. At the close of this fiscal year (June 30), you should complete a fourth quarter report and a year-end narrative and provide that to BHCD by July 30th.

Name of Project:

Address of Project:

Who completed this form:          Date Completed:

Phone Number:

Units funded by HOPWA Assistance

By type of assistance and by unit type

Complete this page if your services include subsidizing housing/utility costs

Tenant-Based Rental Assistance

Provide a count of unduplicated units funded by Rental Assistance with HOPWA funds. Remember, if you have already reported on a unit that you continued to fund this quarter, you should not duplicate that unit in this report. Do not use this category to count short-term or transitional housing that you supported.

Rent, Mortgage, Utility Assistance

Provide a count of unduplicated units for which you used HOPWA funds to provide short-term assistance such as transitional housing, mortgage payments, utility payments or periodic rental assistance that is not ongoing. Do not duplicate units that you previously reported on, even if occupants have changed. You will add new clients later in this report.

Date payments began (typically 7/1): ____/____/_____

Expenditures by Payment Type

Enter the amount spent during the period for which you are reporting on the following two categories of expenditures, which are described above.

HOPWA SUPPORTIVE SERVICES

Complete report only if your organization provided supportive services with HOPWA funds

Date Supportive Services Began:  ___/___/___

Enter dollar amount spent for each category of supportive services you provided during the period for which you are reporting:

HOPWA HOUSING ASSISTANCE

Demographics of Participants

For Housing Production, count at initial occupancy

For Housing Services, report only new, unduplicated counts for reporting period

AGE/GENDER OF CLIENTS SERVED DURING PERIOD

For Housing Production, count initial occupants of HOPWA Units

For Housing Services, report only new, unduplicated clients served during period

.

INCOME GROUP OF CLIENTS SERVED DURING REPORTING PERIOD

Enter Total Number of New Beneficiaries (individuals and family units) that populated the following gross monthly family-income categories at the time of their entry into the program or at the time of initial occupancy of HOPWA housing units.

PROGRAM DEPARTURE COUNTS

Categorize the number of persons leaving the program or housing

During the reporting period

Based upon total duration of assistance and reason for leaving

RECENT LIVING SITUATION COUNTS

Count the number of new clients who entered

The program or HOPWA units from the following circumstances