CFDA#14.241

EXHIBIT A

AGREEMENT NO.

 

An agreement between the CITY OF PORTLAND, OREGON (City) and Outside-In (SUBRECIPIENT) to provide housing and case management for homeless youth with HIV/AIDS.

 

RECITALS:

 

1.  The provision of safe and sanitary housing for those in need is a goal of the City of Portland.

 

2.  The City has been awarded funds from the Housing Opportunities for Persons with AIDS (HOPWA) program to fund projects within a six-county area that assist individuals with HIV/AIDS.

 

3.  The Portland EMA AIDS Housing Committee has determined that $36,393 should be allocated in FY 2002-03 to provide housing services for homeless youth with HIV/AIDS. These funds are available in the FY 2002-03 Housing and Community Development Budget. These funds are intended to support the operation of two units of housing within Outside In’s new office and housing complex, case management services, and administrative costs, including program development to achieve full utilization of a transitional housing program.

 

4.  Outside-In has significant experience in administering programs for homeless youth, including case management, comprehensive referrals, and secondary HIV prevention education.

 

5.  The City finds it in the public interest to enter into a contract with Outside-In to provide these housing services.

AGREED:

 

I.  Scope of Services: The SUBRECIPIENT will provide the services described below for homeless youth. Services shall be provided only to eligible persons. For the purpose of this contract, an eligible person is defined to mean a person living with HIV, AIDS or related diseases and the person’s family with a gross household income at or below 80% of the area median income for the Portland-Vancouver area as published by HUD. Family means a household composed of two or more related persons and also includes one or more eligible persons living with another person or persons who are determined to be important to their care or well being.  

 

A)  In accordance with the budget identified as Exhibit A, provide operating support under a project-based rental assistance model to support eligible persons who occupy two units of transitional housing in the Outside In Facility in downtown Portland. Rental Assistance shall only be provided for units that are occupied by an eligible person.

 

B)  Taking into consideration the needs of each youth: 1) set up a case management program designed to improve each youth's quality of life; 2) set reasonable work, educational and social goals and work towards them; 3) provide comprehensive referrals; and 4) provide secondary HIV prevention education.

 

C)  Ensure that 100% of clients served will receive linkages to appropriate and needed supportive services. Conduct outreach to underserved communities in the Portland EMA, including Latinos and African Americans to promote full utilization of funding and assistance.

 

D)  Submit at least quarterly reports detailing the required statistical information about all new clients served. The reports shall be submitted within 30 days of the end of each quarter (October 30, January 30, and April 30).

 

E)  Submit a final report which will include a summary of demographic information on all clients participating in the program on the form attached hereto as Exhibit “B,” a narrative summary of all activities undertaken by the Project and an evaluation of the project's strengths as well as areas for improvement. The report shall be submitted within 30 days of the end of the contract.

 

F)  The Transitional Housing Program will be delivered in a manner consistent with all regulations governing the Housing Opportunities for Persons with AIDS Program contained at 24 CFR 574. This includes the following requirements:

 

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

 

2.  Tenant Contribution to Rent:

 

(a)  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.

 

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

 

(1)  30 percent of the households monthly adjusted income.

(2)  10 percent of the households monthly gross income; or

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

 

3.  Termination of assistance to eligible person: SUBRECIPIENT may only terminate assistance (including refusal to renew expiring lease agreement) 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 persons 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 Oregon Law and must accord the tenant with all of his or her rights to due process of law.

 

4.  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.

 

5.  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.

 

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

 

G)  Performance Measures:

 

1.  SUBRECIPIENT shall achieve the following program outputs:

 

(a)  Provide two units of transitional housing for HIV Positive homeless youth. These units will serve 2-4 youth during the contract period.

(b)  Provide case management, support services, and linkages to additional medical and social services.

 

2.  SUBRECIPIENT shall achieve the following program outcomes:

 

(a)  The units will be occupied by an eligible person at least 90% of the time.

(b)  100% of the occupants will be eligible persons who shall receive necessary case management services and social service linkages necessary to transition to permanent housing.

(c)  At least 50% of the graduates shall transition to permanent housing.

(d)  75% of the clients shall obtain employment.

 

H)  Ensure that any changes to the Scope of Services of this Agreement or to the Performance Measures, including the provision of any additional services to clients not specifically listed in this Agreement, will be approved in writing by the City Project Manager before any such activity is undertaken or any costs incurred. If prior written approval is not obtained, costs incurred for those activities will not be covered by this Agreement.

 

II.  City Project Manager

 

A.  The City Project Manager shall be Andy Miller, or such other person as shall be designated in writing by the Director of the Bureau of Housing and Community Development.

 

B.  The Project Manager is authorized to approve work and billings hereunder, to give notices referred to herein, to terminate this agreement as provided herein, and to carry out any other City actions referred to herein.

 

III.  Method of Payment

 

A.  The City shall provide payment to the SUBRECIPIENT through the HOPWA Program. The payment shall reimburse the SUBRECIPIENT for costs incurred in conformance with line items on the attached budget.

 

B.  Payments will be made periodically upon submission of a statement of expenditures on the letterhead of the SUBRECIPIENT. SUBRECIPIENT will keep vendor receipts of materials and services and evidence of payment of personnel costs.

 

C.  It is agreed that total payment under this agreement shall not exceed THIRTY –SIX THOUSAND, THREE HUNDRED AND NINETY-THREE DOLLARS ($36,393).

 

IV.  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).

 

3.  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.

 

V.  Period of Agreement

 

The term of this Agreement shall be effective as of July 1, 2002 and shall remain in effect during any period SUBRECIPIENT has control over HOPWA funds. Work by SUBRECIPIENT shall be completed as of June 30, 2003.

 

Dated this of , 2002.

 

 

CITY OF PORTLAND        OUTSIDE-IN

 

 

 

                       

Erik Sten            Kathy Oliver

Commissioner of Public Works      Director

 

 

 

APPROVED AS TO FORM:

 

 

___________________________

Jeffrey L. Rogers, City Attorney

ATTACHMENT A

OUTSIDE IN

HIV+ Housing Program Budget Summary

2002-03

EXPENSES

 

2001-2002

2001-2002

2002-2003

2002-2003

  

Program

City

Program

City

  

Budget

Funding

Budget

Request

  

Total

 

Total

 

PERSONNEL COSTS

  

Salary, Wages, Benefits, Taxes

 

13,405

13,405

22,686

19,819

Taxes/Benefits

 

3,756

3,756

4,764

4,764

MATERIALS AND SERVICES

  

Other-Direct Client Rental Assistance

 

12,956

12,956

7,500

6,000

Rent

 

333

333

-

-

Utilities/Maintenance

 

226

226

1,005

1,005

Communication

 

412

412

433

433

Equipment

 

172

172

236

118

Operating Supplies (Office &Program)

 

412

412

1,355

355

Education/Training

 

172

172

178

178

Printing/Copying

 

482

482

239

239

Postage

 

104

104

131

131

Local Travel

 

146

146

186

186

Contract Services & Fees

 

284

284

206

206

Insurance

 

391

391

578

578

Support Services

 

2,787

2,325

6,136

2,381

Subtotal Materials & Service

 

$ 18,877

$ 18,415

$ 18,183

$ 11,810

TOTAL BUDGET

 

$ 36,038

$ 35,576

$ 45,633

$ 36,393

 

 

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. At the close of this fiscal year (June 30), you should complete a final fourth quarter report with cumulative information 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:

HOPWA HOUSING SERVICES REPORT

 

Date Supportive Services Began:  ___/___/___

 

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

 

OUTREACH

$

 

CASE MANAGEMENT/CLIENT ADVOCACY/ACCESS TO BENEFITS

 

$

LIFE MANAGEMENT (OUTSIDE OF FORMAL CASE MANAGEMENT

 

$

NUTRITIONAL SERVICES/MEALS

 

$

ADULT DAY CARE AND PERSONAL ASSISTANCE

$

 

CHILD CARE AND CHILDREN’S SERVICES

 

$

EDUCATION

 

$

EMPLOYMENT ASSISTANCE

 

$

ALCOHOL/DRUG ABUSE SERVICES

 

$

 

MENTAL HEALTH SERVICES

 

$

HEALTH/MEDICAL/INTENSIVE CARE SERVICES

$

 

PERMANENT HOUSING PLACEMENT

 

$

OTHER (Describe below)

$

 

 

HOPWA HOUSING ASSISTANCE

Demographics of Participants

For Housing Production, count at initial occupancy

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

 

 

RECEIVING HOUSING ASSISTANCE

 

RECEIVING SUPPORTIVE SERVICES ONLY

RECEIVING HOUSING INFORMATION

ONLY

 

PERSONS WITH HIV/AIDS

 

   

 

OTHER PERSONS IN FAMILY UNITS

   

 

TOTALS

  

 

 

 

 

 

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

 

 

AGE AND GENDER

 

 

UNDER 18

 

18-30

 

31-50

 

50+

 

TOTAL

 

MALE

 

     

 

FEMALE

 

     

.

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.

 

$0 – 250

$251 – 500

$501 – 1000

$1001 – 1500

$1501 – 2000

Over $2000

 

 

 

 
     

RACE, NATIONAL ORIGIN AND ETHNIC GROUP OF CLIENTS SERVED

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

 

 

White

 

 

Black

 

Hispanic

 

Asian/Pacific Islander

 

Native American

 

Other

 

 

 
     

 

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

 

# of months

in Program

 

 

<3

 

3-6

 

7-12

 

 

>12

 

VOLUNTARY

(Left Before Completing)

 

   

 

 

 

 

COMPLETED PROGRAM

 

    

NONPAYMENT

OF

RENT

   

 

 

 

 

SOCIAL

SERVICE

NONCOMPLIANCE

    

UNKNOWN

 

    

CRIMINAL

ISSUES

 

    

DEATH

 

    

OTHER

(Describe)

 

   

 

 

 

 

 

 

RECENT LIVING SITUATION COUNTS

Count the number of new clients who entered

The program or HOPWA units from the following circumstances

 

 

 

HOMELESS/STREETS

 

 

 

TRANSITIONAL HOUSING

 

 

 

EMERGENCY SHELTER

 

 

 

PSYCHIATRIC FACILITY

 

 

 

SUBSTANCE ABUSE TREATMENT

 

 

HOSPITAL/MEDICAL

 

 

 

INCARCERATION

 

 

 

DOMESTIC VIOLENCE

 

 

 

LIVING WITH FRIENDS OR RELATIVES

 

 

 

RENTAL HOUSING

 

 

 

PARTICIPANT-OWNED HOUSING

 

 

OTHER (DESCRIBE)