HomeMy WebLinkAboutResolution - 2019-R0068 - CDBG - Big Brothers Big Sisters - 03_12_2019Resolution No. 2019-R0068
Item No. 7.4
March 12, 2019
RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the Mayor of the City of Lubbock is hereby authorized and directed to execute for and
on behalf of the City of Lubbock, Community Development Block Grant Funding Agreement
14577, and all related documents, between the City of Lubbock and Big Brothers Big Sisters
of Lubbock, Inc., for the funding of youth mentoring programs. Said Contract is attached
hereto and incorporated in this resolution as if fully set forth herein and shall be included in
the minutes of the City Council.
Passed by the City Council on March 12, 2019
HANIEL M. POPE, MAYOR
ATTEST:
Rebta Garza, City Secret
APPROVED AS -TO CONTENT:
Bill erton, A s ity Manager
APPROVED AS TO FORM:
Kelli Leisure, Assistant City Attorney T.
ccdocs/RES, CBDG Contract 14577 Big Brothers Big Sisters of Lubbock, Inc
02.22.19
Resolution No. 2019-R0068
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING AGREEMENT
BETWEEN
THE CITY OF LUBBOCK
AND
BIG BROTHERS BIG SISTERS OF LUBBOCK
This Community Development Block Grant Program Funding Agreement (the "Agreement"),
Contract No. 14577, is made by and between the City of Lubbock, a State of Texas home rule
municipal corporation (the "City") and BIG BROTHERS BIG SISTERS OF LUBBOCK, (the
"Grantee"), (each a "Party," and collectively the "Parties") acting by and through the Parties'
representative officers and officials, and is hereby entered into by the Parties on this day of
-- " 2019 (the "Effective Date").
RECITALS
WHEREAS, the City is obligated to do and perform certain services in its undertaking of a
Community Development Block Grant Program pursuant to the Housing and Development Act of
1975, as amended; and
WHEREAS, the Grantee operates a non-profit center offering services to families and individuals
throughout Lubbock County, Texas.
WHEREAS, the Grantee and the services it provides have been found to meet the criteria for
funding under provision 24 CFR 570.201; and
WHEREAS, the Grantee proposes to provide youth mentoring services to children who have been
affected by familial incarceration (the "Program"); and
WHEREAS, the Grantee's services benefit residents in and around Lubbock, Texas and constitute
a valuable public service, and the City Council of the City (the "City Council") has declared the
services provided by the Grantee to be a public purpose; and
WHEREAS, the accomplishment of the above public purpose is the predominate purpose of this
Agreement; and
WHEREAS, the continuing supervision by the City and State together with statutory and
contractual requirements provide sufficient assurance that the public purpose of this Agreement
will be accomplished; and
WHEREAS, the City Council has found that the Grantee has the special expertise, knowledge,
and experience necessary for the operation of the Program; and, that the City will receive adequate
consideration in the form of substantial public benefit; and NOW, THEREFORE:
THE PARTIES, FOR GOOD AND VALUABLE CONSIDERATION, AGREE AS FOLLOWS:
2018 - 2019 CDBG Funding Agreement Page 1
AGREEMENT
Article 1. SCOPE OF SERVICE
A. The City's Responsibilities
1. The City agrees to provide the Grantee with funding from the US Department of Housing and
Urban Development (HUD) not to exceed the amount as stated in the attached EX_H_IBIT A, to
be distributed and used according to the provisions of this Agreement.
2. The Funding will be limited to the Grantee's performance of the Program, including the
satisfaction of expenses incurred by the Grantee in its performance of the Program.
3. The City's awarding of the Funding under this Agreement is contingent upon the City's receipt
of adequate funds to meet the City's liabilities under this Agreement. If adequate funds are not
made available to the City so that it cannot award the Funding, then the City shall notify the
Grantee in writing within a reasonable time after such fact is determined, the City shall
terminate this Agreement, and the City will not be directly or indirectly liable for failure to
award the Funding to the Grantee under this Agreement.
4. The City shall not be liable to the Grantee for any cost incurred by the Grantee which has been
paid to the Grantee, which is subject to be paid to the Grantee, which has been reimbursed to
the Grantee, or which is subject to reimbursement to the Grantee by any source other than the
City or the Grantee.
5. The City shall not be liable for any cost incurred by the Grantee which is not an allowable cost
as set forth in this Agreement or under 24 CFR §570.207.
6. The City shall not be liable to the Grantee for any cost incurred by the Grantee or for any
performance rendered by the Grantee which is not strictly in accordance with the terms of this
Agreement.
7. The City shall not be liable to the Grantee for any cost incurred by the Grantee in the
performance of this Agreement which has not been billed to the City by the Grantee within
sixty (60) days following the termination of this Agreement.
S. The City shall not be liable for any cost incurred or performance rendered by the Grantee
before the commencement or after termination of this Agreement.
9. The City may, at its sole discretion and convenience, review any work specifications prior to
the beginning of a procurement process under this Agreement, and the City may inspect any
construction for compliance with work specifications prior to the release of the Funding.
B. The Grantee's Responsibilities
2018 2019 CDBG Funding Agreement Page 2
1. The Grantee will be responsible for administering the Program in a manner satisfactory to the
City and in compliance with this Agreement and with any and all statutory standards related to
the Funding.
2. The Grantee certifies that all of its activities carried out for the Program through the Funding
will satisfy 24 CFR Part 570, 24 CFR Parts 84 and 85, including, but not limited to: CDBG's
eligible activities under 24 CFR Part 92 Subpart E; the affordability requirements of 24 CFR
92.252 or 92.254; the applicable uniform administrative requirements described in 24 CFR
92.505; the project requirements in 24 CFR Part 92 Subpart F; all Federal laws and regulations
described in 24 CFR Part 92 Subpart H, including responsibilities for environmental review in
24 CFR 92.352 and the intergovernmental review process in 24 CFR 92.359; and, the
affirmative marketing responsibilities specified in 24 CFR 92.351. The Grantee agrees to repay
any and all of the Funding that does not satisfy the regulations required under this provision.
3. The Grantee shall perform all activities related to the Program in accordance with its budget;
all applicable laws and regulations; and, with the assurance, certifications, and all other terms,
provisions, and requirements set forth in this Agreement.
4. Upon the City's request while this Agreement is in effect, the Grantee shall submit to the City
any and all reports, documents, or information on the Grantee's performance of the Funding
or the Program contemplated under this Agreement.
5. In addition to the limitations on liability otherwise specified in this Agreement, it is expressly
understood and agreed to by the Parties that if the Grantee fails to submit to the City in a timely
and satisfactory manner any reports, documents, or information requested by the City under
this Agreement, the City may, at its sole discretion, withhold all, or any part of, the Funding.
If the City withholds all, or any part of, the Funding, it shall notify the Grantee in writing of
its decision and the reasons therefor. Any Funding withheld pursuant to this paragraph may be
held by the City until such time as the obligations for which the Funding is being withheld is
fulfilled by the Grantee to the satisfaction of the City.
6. The Grantee shall refund to the City any Funding that has been paid to the Grantee by the City
for which the City determines is a result of overpayment of the Funding to the Grantee, or for
which the City determines any of the Funding has not been spent by the Grantee strictly in
accordance with the terms of this Agreement. Such refund shall be made by the Grantee to the
City within thirty (30) working days after such refund is requested by the City.
7. The Grantee agrees that all living units acquired and rehabilitated under the Program shall be
made available exclusively to eligible low and moderate income families whose gross
household income does not exceed the income eligibility requirements established by HUD.
8. The Grantee shall submit to the City a request for an environmental assessment to be prepared
and approved on individual construction sites prior to the beginning of any project if
applicable.
2018 — 2019 CDBC Funding Agreement P*V 3
9. The Grantee shall submit to the City a request for a review of all work specifications prior to
the beginning of the procurement process.
10. The Grantee will have Match funds ready and available prior to the start of any project, if
applicable. Failure to have Match funds ready and available may delay or cancel such project.
I I. The Grantee will certify eligibility by completion of Self Certification form to verify low --
mod clientele participates in the program.
12. The Grantee agrees that any interests or assets obtained with the Funding shall revert back to
the City in the event that the Grantee dissolves, files for bankruptcy, or goes out of business
for any reason.
C. Grantee's Match
The CDBG funds must be supplemented with additional funds from sources other than CDBG.
This project must provide 25% or more of the total project costs from non-CDBG sources.
Matching funds may include donations, or other grants.
D. National Objective
The Grantee certifies that the activities carried out with funds provided under this Agreement
will meet the suitable living environment objective by providing eligible activities that benefit
communities, families or individuals by addressing issues in their living environment under the
Community Development Block Grant program - as defined in 24 CFR §576.21 as amended by
the HEARTH Act.
E. Performance Monitoring
1. General Monitoring. The City will monitor the Grantee's performance under this Agreement
in order to ensure that the Grantee complies with the terms of this Agreement and all other
applicable laws and regulations related to this Agreement and the Funding provided through
this Agreement (the "Monitoring"). The Monitoring will be based on a risk analysis and a
monitoring plan developed at the beginning of the fiscal year, and will take place on a monthly
and quarterly basis as described below. Substandard performance as determined by the City
will constitute non-compliance with this Agreement. If action to correct such substandard
performance is not taken by the Grantee within a reasonable period of time after being notified
by the City in writing, the City may suspend or terminate this Agreement.
2. On -site Monitoring. The number of on -site Monitoring visits will be determined by the City.
The City will send a Monitoring notification letter sent to the Grantee at least fifteen (15) days
before a Monitoring visit. The City will send Monitoring report letter to the Grantee within
thirty (30) days of on -site Monitoring visit that will identify the findings of the Monitoring
visit. The Grantee must provide a written response to the Monitoring report within thirty (30)
days that describes how the Grantee will resolve the issues raised by the City in the Monitoring
report. The Grantee must confirm receipt of the Monitoring report within thirty (30) days if no
actionable issues were identified in the Monitoring report.
2018 -- 2019 CDBG Funding Agreement Page 4
Article 2. TIME OF PERFORMANCE
Services of the Grantee shall start on the first (I") day of October, 2018, and end on the thirtieth
(30") day of September, 2019 (the "Term"). The Term and the provisions of this Agreement shall
be extended to cover the period of affordability required as specified under 24 CFR 92.254 and
any additional time period during which the Grantee remains in control of the Funding or other
assets, including income from the Program.
Article 3. BUDGET
The Funding made available to the Grantee under this Agreement shall be specifically drawn from
the sources listed in this section (the "Budget"). The Funding made available to the Grantee under
this Agreement shall be drawn from several fiscal year allocations by HUD to the City. In the
budget listed below, the fiscal year of a HUD allocation to the City is listed to the left of the funding
under that allocation that is made available to the Grantee for the Project under this Agreement.
The Funding made available to the Grantee under this Agreement shall be directly linked to the
specific funding year and amount listed in the attached EXHIBIT A.
Article 4. PAYMENT
A. The Payment
The Funding shall be disbursed on a monthly basis based on the Grantee's submission to the City
of a written request for reimbursement, with such request being in a form acceptable to the City
(the "Payment"). Expenses eligible for Payment to the Grantee by the City shall be those expenses
that have been incurred or paid for by the Grantee prior to the Grantee's submission to the City of
a request for Payment. In its request to the City for the Payment, the Grantee shall submit detailed
documentation to the City that clearly shows the source of the expenses incurred or paid for by the
Grantee that are the subject of the Grantee's request for Payment. Such source documentation
includes, but is not limited to, time sheets, paycheck stubs, receipts, invoices, billing statements,
or other verification in support of all expenditures incurred by the Grantee in its performance of
the Program.
B. Not To Exceed
The total amount of the Funding to be paid by the City under this Agreement shall not exceed the
amount as stated in the attached EXHIBIT A, for the Project. Any drawdowns on the Payment
and any expenses for the general administration of the Program shall be made against the line item
budgets specified in this Agreement and in accordance with the Grantee's performance of
Program.
C. 24 CFR 84
Every Payment may be contingent upon certification of the Grantee's financial management
system in accordance with the standards specified in 24 CFR 84.
Article 5. SPECIAL CONDITIONS
None.
2018 - 2019 CDBG Funding Agreement PW 5
Article 6. GENERAL CONDITIONS
A. General Compliance
1. The Grantee agrees to comply with the requirements of 24 CFR Part 570 (the HUD regulations
concerning Community Development Block Grants (CDBG), including subpart J and subpart
K; except that: (1) the Grantee does not assume the recipient's environmental responsibilities
described in 24 CFR 570.604; and, (2) the Grantee does not assume the recipient's
responsibility for initiating the review process under the provisions of 24 CFR Part 52.
2. The Grantee also agrees to comply with all other applicable Federal, State and local laws,
regulations, and policies governing the Funding. The Grantee further agrees to utilize the
Funding to supplement, rather than supplant, funds otherwise available.
3. The Grantee shall comply with all applicable Federal laws, regulations, and requirements and
all provisions of this Agreement, which include compliance with the provisions of the HCD
Act and all rules, regulations, guidelines, and circulars promulgated by the various Federal
departments, agencies, administrations, and commissions relating to the CDBG Program. The
applicable laws and regulations include, but are not limited to: 24 CFR Part 570; 24 CFR Parts
84 and 85; 2 CFR Part 200; OMB Circular A-128, "Audits of State and Local Governments;"
The Davis -Bacon Fair Labor Standards Act; The Contract Work Hours and Safety Standards
Act of 1962; Copeland "Anti -Kickback" act of 1934; Uniform Relocation Assistance and Real
Property Acquisition Policies Act of 1970, as amended (URA); Title VI of the Civil Rights
Act of 1964, (Public Law 88-352 implemented in 24 CFR Part 1); Fair Housing Act, Title VIII
of the Civil Rights Act of 1968 (Public Law 90-234 and Executive Order 11063 as amended
by Executive Order 12259 (implemented in 24 CFR Part 107); Section 104(b) and 109 of the
HCD Act of 1974; Section 3 of the Housing and Urban Development Act of 1968; Equal
employment opportunity and minority business enterprise regulations established in 24 CFR
Part 570.904; Non-discrimination in employment, established by Executive Order 11246 (as
amended by Executive Orders 11375 and 12086); Section 504 of the Rehabilitation Act of
1973 Uniform Federal accessibility Standards; The Architectural Barriers Act of 1968; The
Americans With Disabilities Act (ADA) of 1990; The Age Discrimination Act of 1975, as
amended; National Environmental Policy of 1969 (42 USC 4321 et seq.), as amended; Lead
Based paint regulations established in 24 CFR Parts 35, 570.608, and 24 CFR 982.401;
Asbestos guidelines established in CPD Notice 90-44; HUD Environmental Criteria and
Standards (24CFR Part 51); The Energy Policy and Conservation Act (Public Law 94-163)
and 24 CFR Part 39; Historic Preservation Act of 1966, as amended, and related laws and
Executive Orders; Executive Order 11988, floodplain management, 1977 (42 FR 26951 et
seq.); and, Flood Disaster protection Act of 1973.
B. "Independent Contractor"
Nothing contained in this Agreement is intended, or shall be construed in any manner, to create or
establish the relationship of employer and employee between the Parties. The Grantee shall at all
times remain an "independent contractor" with respect to the services to be performed under this
Agreement. The City shall be exempt from payment of all Unemployment Compensation, FICA,
retirement, life, medical insurance, and Workers' Compensation insurance as the Grantee is an
independent contractor.
2018 — 2019 CDBG Funding Agreement Page 6
C. Indemnity and Release
1. THE GRANTEE SHALL INDEMNIFY AND HOLD HARMLESS, TO THE FULLEST EXTENT
PERMITTED BY LAW, THE CITY, AND THE CITY'S RESPECTIVE OFFICERS, EMPLOYEES,
ELECTED OFFICIALS, AND AGENTS, FROM AND AGAINST ANY AND ALL LOSSES, DAMAGES,
CLAIMS, OR LIABILITIES, OF ANY KIND OR NATURE, WHICH ARISE DIRECTLY OR INDIRECTLY,
OR ARE RELATED, IN ANY WAY, MANNER, OR FORM, TO THE ACTIVITIES CONTEMPLATED
HEREUNDER.
2. THE GRANTEE SHALL PAY TO THE CITY, THE CITY'S RESPECTIVE OFFICERS, EMPLOYEES,
ELECTED OFFICIALS, AND OR AGENTS, AS APPLICABLE, ALL ATTORNEYS' FEES INCURRED BY
ENFORCING THE GRANTEE'S INDEMNITY HEREIN.
3. THE CITY, AND ITS RESPECTIVE OFFICERS, EMPLOYEES, ELECTED OFFICIALS, AND AGENTS
SHALL NOT BE LIABLE, AND THE GRANTEE HEREBY RELEASES THE CITY, AND ITS
RESPECTIVE OFFICERS, EMPLOYEES, ELECTED OFFICIALS, AND AGENTS, FOR, FROM, AND
AGAINST ANY LOSSES, DAMAGES, CLAIMS, OR LIABILITIES TO THE GRANTEE.
4. THE INDEMNITY AND RELEASE PROVIDED HEREIN SHALL SURVIVE THIS AGREEMENT.
D. Right to Exercise
The City reserves the right to exercise any right or remedy available to it by law, contract, equity,
or otherwise, including without limitation, the right to seek any and all forms of relief in a court
of competent jurisdiction. Further, the City shall not be subject to any arbitration process prior to
exercising its unrestricted right to seek judicial remedy. The remedies set forth herein are
cumulative and not exclusive, and may be exercised concurrently. To the extent of any conflict
between this provision and another provision in, or related to, this Agreement, the former shall
control.
E. Workers' Compensation
The Grantee shall provide Workers' Compensation insurance coverage for all of its employees
involved in the performance of this Agreement.
F. Insurance and Bonding
The Grantee shall carry sufficient insurance coverage to protect Program assets from loss due to
theft, fraud, or undue physical damage, and as a minimum, shall purchase a blanket fidelity bond
covering all employees in an amount equal to cash advances from the City. The Grantee shall
comply with the bonding and insurance requirements of 24 CFR 84.
G. Grantor Recognition
The Grantee shall insure recognition of the role of the grantor agency in providing services through
this Agreement. All activities, facilities, and items utilized pursuant to this Agreement shall be
prominently labeled as to the Funding source. In addition, the Grantee will include a reference to
the Funding in all publications made possible under this Agreement.
2018 — 2019 CDOG Funding Agreement Page 7
H. Amendments
1. The City or the Grantee may amend this Agreement at any time, provided that such
amendments make specific reference to this Agreement, are executed in writing, signed by a
duly authorized representative of both Parties, and approved by the City Council. Such
amendments shall neither invalidate this Agreement nor relieve or release the City or the
Grantee from its obligations under this Agreement.
2. The City may, in its discretion, amend this Agreement to conform with Federal, State, or local
governmental guidelines, policies, and available funding amounts, or for any other reason. If
such amendments result in a change in the Funding, the scope of services, or the schedule of
the activities to be undertaken as part of this Agreement, such modifications will be
incorporated only by written amendment signed by both Parties.
I. Suspension or Termination
1. Either Party may terminate this Agreement at any time by giving written notice to the other
Party of such termination and specifying the effective date thereof at least thirty (30) days
before the effective date of such termination. Partial termination of this Agreement may only
be undertaken with the prior approval of the City. In the event of any termination for
convenience, all finished or unfinished documents, data, studies, surveys, maps, models,
photographs, reports, or other materials prepared by the Grantee under this Agreement shall,
at the option of the City, become the property of the City, and the Grantee shall be entitled to
receive just and equitable compensation for any work completed on such documents or
materials prior to the termination.
2. The City may suspend or terminate this Agreement, in whole or in part, if the Grantee fails to
comply with any term of this Agreement, or with any of the rules, regulations, or provisions
referred to herein. Upon such failure of the Grantee, the City may declare the Grantee ineligible
for any further participation in the City's contracts, in addition to other remedies as provided
by law. If the City reasonably believes that the Grantee is in noncompliance with any
requirement of this Agreement, then the City may withhold up to fifteen percent (15%) of the
Funding until such time as the Grantee is found to be, or is otherwise adjudicated, to be in
compliance.
3. The City may terminate this Agreement in the event of an emergency or disaster, whether, an
act of God, natural or manmade, by giving twenty-four (24) hour notice. The City may give
said notice verbally to the Grantee. Any expenditure incurred prior to receiving notice will be
reimbursed; however, in no event shall the City pay any expenses incurred after notice of
termination is received by the Grantee.
Article 7. ADMINISTRATIVE REQUIREMENTS
A. Financial Management
1. Accounting Standards. The Grantee agrees to comply with 24 CFR 84, to utilize adequate
internal controls, and to maintain necessary source documentation for all costs incurred under
this Agreement.
2018 .2019 CDBC Funding Agreement Page 8
2. Cost Principles. The Grantee shall administer its program in conformance with 2 CFR Part
200, which shall be applied to all direct or indirect costs incurred by the Grantee under this
Agreement.
B. Documentation and Record -Keeping
1. Records Maintenance. All of the Grantee's records related to this Agreement shall be kept
according to the standards and regulations in 24 CFR Part 570, with such records including,
but not being limited to: records providing a full description of each activity undertaken by the
Grantee under this Agreement; records demonstrating that each activity undertaken under this
Agreement by the Grantee meets the National Objective of the CDBG program of benefiting
low/moderate income persons; records that determine the eligibility of Grantee's activities
related to this Agreement; records that document the acquisition, improvement, use, or
disposition of real property acquired or improved with CDBG assistance under this Agreement;
records that document the Grantee's compliance with the fair housing and equal opportunity
components of the Program; financial records as required by 24 CFR Part 570.502 and 24 CFR
84; and, all other records necessary to document the Grantee's compliance with Subpart K of
24 CFR 570.
2. Retention. The Grantee shall retain all records related to its expenditures under this Agreement
for a period of four (4) years after the termination of all activities funded under this Agreement.
Records for non -expendable property acquired with the Funding shall be retained for four (4)
years after final disposition of such property. Records for any displaced person must be kept
for four (4) years after the displaced person has received final payment. Notwithstanding the
above, if there is any litigation, claim, audit, negotiation or other action that involves any of
the records cited herein and that has started before the expiration of the four (4) year period,
then such records must be retained until the completion of the actions and resolution of all
issues, or the expiration of the four (4) year period, whichever occurs later.
3. Client Data. The Grantee shall maintain data that demonstrates its clients' eligibility for the
Funding and services provided under this Agreement. Such data shall include, but not be
limited to: client name; client address; client income level; other determination of client
eligibility; and, a description of the service provided to the client related to this Agreement.
Such information shall be made available to the City monitors for review upon request by the
City.
4. Disclosure. The Grantee understands that any of its clients' information collected under this
Agreement is private, and the use or disclosure of such information, when not directly
connected with the administration of the City's or Grantee's responsibilities related to this
Agreement, is prohibited unless written consent is obtained from such client and, in the case
of a minor, that of a responsible parent or guardian, unless otherwise required by law.
5. Property Records. The Grantee shall maintain a real property inventory that clearly identifies
any property purchased, improved, or sold under this Agreement or that is related to the
Funding. Any such property shall throughout the Term remain in compliance with all eligibility
criteria and shall conform with the "changes in use" restrictions specified in 24 CFR Parts
570.503(b)(8).
2018 — 2019 CDBG Funding Agreement PsZe 9
6. Close -Outs. The Grantee's obligations under this Agreement shall not end until all close-out
requirements under this Agreement and under any applicable law and regulation are completed.
Activities during this close-out period shall include, but are not limited to: making final
payments; disposing of Program assets (including the return of all unused materials,
equipment, unspent cash advances, Program income balances, and accounts receivable to the
City); final close-out reports; and, determining the custodianship of records.
7. Audits & Inspections. All of the Grantee's records related to this Agreement shall be made
available at any time during normal business hours as often as the City or its designee deems
necessary to audit, examine, or make excerpts or transcripts of any data relevant to this
Agreement in order for the City to produce an audit report. Any deficiencies noted in an audit
report must be fully cleared by the Grantee within thirty (30) days after receipt by the Grantee.
Failure of the Grantee to comply with the above audit requirements will constitute a violation
of this Agreement and may result in the withholding of Funding. The Grantee hereby agrees
to Have an annual internal audit conducted in accordance with current City policy concerning
Grantee audits and, as applicable, 2 CFR Part 200.
C. Reporting and Payment Procedures
1. Payment Procedures. The City will pay to the Grantee the Funding based upon information
submitted by the Grantee and consistent with any approved budget and City policy concerning
the Payment. With the exception of certain advances, each Payment will be made for eligible
expenses actually incurred by the Grantee, and not to exceed actual cash requirements. Each
Payment will be adjusted by the City in accordance with advance fund and program income
balances available in the Grantee's accounts. Additionally, the City reserves the right to
liquidate any part of the Funding for costs incurred by the City on behalf of the Grantee.
2. Performance and Financial Reports. Throughout the Term, the Grantee shall submit to the
City, in a format prescribed by the City, a monthly Performance Report, a Financial Report,
and a narrative for the Grantee's Program activity and shall include the amount of all of the
Grantee's expenditures for each of its Program activities. The Grantee shall submit such
reports, demographics and narratives no later than the tenth (1 &) day of each month. The End
of Year report is due no later than September 30th. Reporting will continue from the start of
Program activity through the end of the Program year.
D. Procurement
1. Compliance. The Grantee shall comply with the City policy concerning the purchase of
equipment and shall maintain inventory records of all non -expendable personal property as
defined by such City policy as may be procured with any Funding provided herein. All Program
assets purchased with Funding, including unexpended program income, property, or
equipment, shall revert to the City upon the termination of this Agreement.
2. CFR Standards. The Grantee shall procure all materials, property, or services in accordance
with the requirements of 24 CFR 84, Procurement Standards, and shall subsequently follow
Property Management Standards as modified by 24 CFR 570.502(b)(6), covering utilization
and disposal of property.
2018 2019 CDBG Funding Agreement Page 10
3. Travel. The Grantee shall obtain written approval from the City for any travel outside the
metropolitan area that is financed in any way through the Funding.
E. Use and Reversion of Assets
The use and disposition of real property and equipment under this Agreement shall be in
compliance with the requirements of 24 CFR Part 84 and CFR 570.502, 570.503, and 570.504, as
applicable, which include but are not limited to the following:
1. Any subrecipient used by the Grantee under this Agreement (the "Subrecipient") shall transfer
to the Grantee all CDBG funds on hand and any accounts receivable attributable to the use of
the Funding at the time of expiration, cancellation, or termination of this Agreement.
2. Real property under the Subrecipient's control that was acquired or improved, in whole or in
part, with the Funding in excess of twenty-five thousand dollars ($25,000) shall be used to
meet one of the CDBG National Objectives pursuant to 24 CFR 570.208 until five (5) years
after the expiration of this Agreement, or such longer period of time as the Grantee deems
appropriate. If the Subrecipient fails to use CDBG-assisted real property in a manner that meets
a CDBG National Objective for the prescribed period of time, then the Subrecipient shall pay
to the Grantee an amount equal to the current fair market value of the property less any portion
of the value attributable to expenditures of non-CDBG funds for acquisition of, or
improvement to, the property. Such payment shall constitute Program income to the Grantee.
The Subrecipient may retain real property acquired or improved under this Agreement after
the expiration of the five (5) year period, or such longer period of time as the Grantee deems
appropriate.
3. In all cases in which equipment acquired, in whole or in part, with the Funding is sold, the
proceeds shall be Program income prorated to reflect the extent to that funds received under
this Agreement were used to acquire the equipment. Equipment not needed by the Subrecipient
for activities under this Agreement shall be transferred to the Grantee for the CDBG program,
or retained after compensating the Grantee for an amount equal to the current fair market value
of the equipment less the percentage of non-CDBG funds used to acquire the equipment.
Article 8. RELOCATION, REAL PROPERTY ACQUISITION AND ONE -FOR -ONE
HOUSING REPLACEMENT
The Grantee agrees to comply with the Uniform Relocation Assistance and Real Property
Acquisition Policies Act of 1970, as amended (URA), and implementing regulations at 49 CFR
Part 24 and 24 CFR 570.606(b); the requirements of 24 CFR 570.606(c) governing the Residential
Antidisplacement and Relocation Assistance Plan under Section 104(d) of the HCD Act; and, the
requirements in 570.606(d) governing optional relocation policies. The City may preempt the
optional policies. The Grantee shall provide relocation assistance to persons, families, individuals,
businesses, nonprofit organizations, and farms that are displaced as a direct result of acquisition,
rehabilitation, demolition, or conversion for a CDBG-assisted project. The Grantee also agrees to
comply with all applicable City ordinances, resolutions, and policies concerning the displacement
of persons from their residences.
2018 -- 2019 CDBG Funding Agreement Page i 1
Article 9. PERSONNEL & PARTICIPANT CONDITIONS
A. Civil Rights
1. Compliance. The Grantee agrees to comply, and to require its subcontractors to comply, with
Title VI of the Civil Rights Act of 1964 as amended; Title VIII of the Civil Rights Act of 1968
as amended; Section 104(b) and Section 109 of Title I of the Housing and Community
Development Act of 1974 as amended; Section 504 of the Rehabilitation Act of 1973; the
Americans with Disabilities Act of 1990; the Age Discrimination Act of 1975; Executive Order
11063; and, with Executive Order 11246 as amended by Executive Orders 11375 and 12086.
2. Nondiscrimination. The Grantee will not discriminate against any employee or applicant for
employment because of race, color, creed, religion, ancestry, national origin, sex, disability, or
other handicap, age, marital or familial status, or status with regard to public assistance. The
Grantee will take affirmative action to insure that all employment practices are free from such
discrimination. Such employment practices include, but are not limited to, the following:
hiring, upgrading, demotion, transfer, recruitment or recruitment advertising, layoff,
termination, rates of pay or other forms of compensation, and selection for training, including
apprenticeship. The Grantee agrees to post in conspicuous places, available to employees and
applicants for employment, notices to be provided by the contracting agency setting forth the
provisions of this nondiscrimination clause.
3. Land Covenants. This Agreement is subject to the requirements of Title VI of the Civil Rights
Act of 1964 and 24 CFR 570.601-602. In regard to the sale, lease, or other transfer of land
acquired, cleared, or improved with assistance provided under this Agreement, the Grantee
shall cause or require a covenant running with the land to be inserted in the deed or lease for
such transfer, prohibiting discrimination as herein defined, in the sale, lease or rental, or in the
use or occupancy of such land, or in any improvements erected or to be erected thereon,
providing that the City and the United States are beneficiaries of and entitled to enforce such
covenants. The Grantee, in undertaking its obligation to carry out the Program assisted
hereunder, agrees to take such measures as are necessary to enforce such covenant, and will
not itself so discriminate.
4. Section 504. The Grantee agrees to comply with any Federal regulations issued pursuant in
compliance with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 706), which
prohibits discrimination against the handicapped in any Federally -assisted program. The City
shall provide the Grantee with any guidelines necessary for compliance the regulations during
the term of this Agreement.
5. Reports, The Grantee shall maintain a report that documents the race and ethnicity of its
employees. The Grantee shall provide the City a copy with said report upon execution of this
Agreement.
6. Policies. The Grantee shall maintain current copies of its fair housing and equal opportunity
policies. The Grantee shall provide a copy of said policies to the City immediately upon
request.
2018 — 2019 CDSG Funding Agreement Page 12
B. Affirmative Action
1. Approved Plan. The Grantee agrees they shall be committed to carry out pursuant to the City's
specifications an Affirmative Action Program in keeping with the principles as provided in the
President's Executive Order 11246 of September 24, 1965. If the Grantee receives Federal
funds through the City, then the Grantee shall be required to develop a written Affirmative
Action Program to insure that equal opportunity is provided in all aspects of its employment.
2. Women- and Minority -Owned Business. The Grantee will use its best efforts to afford minority -
and women -owned business enterprises the maximum practicable opportunity to participate in
the performance of this Agreement. The term "minority and female business enterprise" means
a business at least fifty-one percent (51 %) owned and controlled by minority group members
or women. The term "minority group members" means Afro-Americans, Spanish-speaking,
Spanish -surnamed or Spanish -heritage Americans, Asian -Americans, and American Indians.
The Grantee may rely on written representations by businesses regarding their status as
minority- and women -owned business enterprises in lieu of an independent investigation.
3. Access to Records. The Grantee shall furnish and cause any Subrecipient or subcontractor to
furnish all information and reports required hereunder and will permit access to its books,
records, and accounts by the City, HUD or its agent, or other authorized Federal officials for
purposes of investigation to ascertain compliance with the rules, regulations, and provisions
stated herein.
4. Notifications. The Grantee will send to each labor union or representative of workers with
which it has a collective bargaining agreement or other contract or understanding, a notice, to
be provided by the agency contracting officer, advising the labor union or worker's
representative of the Grantee's commitments hereunder, and shall post copies of the notice in
conspicuous places available to employees and applicants for employment.
5. EEO/AA Statement. The Grantee will, in all solicitations or advertisements for employees
placed by or on behalf of the Grantee, state that it is an Equal Opportunity or Affirmative
Action employer.
6. Subcontract Provisions. The Grantee will include the provisions of the Civil Rights and
Affirmative Action sections of this Agreement, in every subcontract or purchase order,
specifically or by reference, so that such provisions will be binding upon each Subrecipient or
subcontractor.
C. Employment Restrictions
1. Prohibited Activity. The Grantee is prohibited from using the Funding or personnel employed
in the administration of the Program for political activities, sectarian activity, religious activity,
lobbying, political patronage, or nepotism.
2. Labor Standards. The Grantee agrees to comply with the requirements of the Secretary of
Labor in accordance with the Davis -Bacon Act as amended, the provisions of Contract Work
Hours and Safety Standards Act, the Copeland "Anti -Kickback" Act (40 U.S.C. 276a-276a-5;
2019 2019 CDBG Funding Agreement Page 13
40 USC 327 and 40 USC 276c) and all other applicable Federal, State, and local laws and
regulations pertaining to labor standards insofar as those acts apply to the performance of this
Agreement. The Grantee shall maintain documentation which demonstrates compliance with
hour and wage requirements of this part. Such documentation shall be made available to the
City for review upon request. The Grantee agrees that, except with respect to the rehabilitation
or construction of residential property containing less than eight (8) units, all contractors
engaged under contracts in excess of two thousand dollars ($2,000) for construction,
renovation, or repair work financed in whole or in part with the Funding, shall comply with
Federal requirements adopted by the City pertaining to such contracts and with the applicable
requirements of the regulations of the Department of Labor, under 29 CFR Parts 1, 3, 5 and 7
governing the payment of wages and ratio of apprentices and trainees to journey workers;
provided, that if wage rates higher than those required under the regulations are imposed by
State or local law, nothing hereunder is intended to relieve the Grantee of its obligation, if any,
to require payment of the higher wage. The Grantee shall cause or require to be inserted in full,
in all such contracts subject to such regulations, provisions meeting the requirements of this
paragraph.
D. "Section 3" Clause
1. Compliance. Compliance with the provisions of Section 3 of 24 CFR 135, and all applicable
rules and orders issued hereunder prior to the execution of this Agreement, shall be a condition
of the Funding and shall be binding upon the City, the Grantee, any Subrecipient, and any
subcontractor. Failure to fulfill these requirements shall subject the City, the Grantee, any
Subrecipient, and any subcontractor, to those sanctions specified by the Agreement. The
Grantee certifies that no contractual or other disability exists which would prevent compliance
with these requirements. The Grantee certifies and agrees that no contractual or other legal
incapacity exists which would prevent compliance with these requirements.
2. "Section 3 " Paragraph. The Grantee further agrees to comply with these "Section 3"
requirements and to include the following language in all subcontracts executed under this
Agreement:
"The work to be performed under this contract is a project assisted under a program
providing direct Federal financial assistance from HUD and is subject to the requirements of
Section 3 (of the Housing and Urban Development Act of 1968), as amended, 12 U.S.C. 1701.
Section 3 requires that, to the greatest extent feasible, opportunities for training and
employment be given to low- and very low-income residents of the project area, and contracts
for work in connection with the project be awarded to business concerns that provide
economic opportunities for low- and very low-income persons residing in the metropolitan
area in which the project is located."
3. Training & Employment. The Grantee will ensure that opportunities for training and
employment arising in connection with a housing rehabilitation (including reduction and
abatement of lead -based paint hazards), housing construction, or other public construction
project are given to low- and very low-income persons residing within the metropolitan area
in which the Project is located. Where feasible, the Grantee agrees that priority should be given
to low- and very low-income persons within the service area of the Project or the neighborhood
in which the Project is located, and to low- and very low-income participants in other HUD
programs.
2018 2019 CDBG Funding Agreement Page 14
4. Award of Contracts. The Grantee agrees to award contracts for work undertaken in connection
with a housing rehabilitation (including reduction and abatement of lead -based paint hazards),
housing construction, or other public construction project are given to business concerns that
provide economic opportunities for low- and very low-income persons residing within the
metropolitan area in which the Project is located. Where feasible, the Grantee agrees that
priority should be given to business concerns which provide economic opportunities to low -
and very low-income residents within the service area or the neighborhood in which the Project
is located, and to low- and very low-income participants in other HUD programs.
5. Notifications. The Grantee agrees to send to each labor organization or representative of
workers with which it has a collective bargaining agreement or other contract or understanding,
if any, a notice advising said labor organization or worker's representative of its commitments
under this Section 3 clause and shall post copies of the notice in conspicuous places available
to employees and applicants for employment or training.
6. Subcontracts. The Grantee will include this Section 3 clause in every subcontract and will take
appropriate action pursuant to the subcontract upon a finding that the subcontractor is in
violation of regulations issued by the grantor agency. The Grantee will not subcontract with
any entity where it has notice or knowledge that the latter has been found in violation of
regulations under 24 CFR 135 and will not allow any subcontract unless the entity provides a
preliminary statement of ability to comply with the requirements of this Agreement and all
other applicable law.
E. Assignability
The Grantee shall not assign or transfer any interest in this Agreement without the prior written
consent of the City. Claims for money due or to become due to the Grantee from the City under
this Agreement may be assigned to a bank, trust company, or other financial institution without
such approval. Notice of any such assignment or transfer shall be furnished promptly to the City.
F. Subcontracts
1. Approvals. The Grantee shall not enter into any subcontracts with any agency or individual in
the performance of this Agreement without the written consent of the City prior to the
execution of such subcontract.
2. Monitoring. The Grantee will monitor all subcontracted services on a risk analysis basis to
assure contract compliance. Results of monitoring efforts shall be summarized in written
reports and supported with documented evidence of follow-up actions taken to correct areas of
noncompliance.
3. Content. The Grantee shall cause all of the provisions of this Agreement in its entirety to be
included in and made a part of any subcontract executed in the performance of this Agreement.
4. Selection Process. The Grantee shall insure that all subcontracts entered into in the
performance of this Agreement shall be awarded on a fair and open competition basis.
2018 - 2019 CDBC Funding Agreement Page 15
Executed copies of all subcontracts shall be forwarded to the City along with documentation
concerning the selection process.
5. Suspension and Disbarment. The Grantee shall not enter into any subcontracts with an agency,
business, or individual that has been suspended, disbarred, or otherwise excluded from Federal
grants. The Grantee shall maintain records demonstrating that it has reviewed potential
subcontractors against the debarred and excluded list prior to committing any of the Funding
to a subcontract.
G. Hatch Act
The Grantee agrees that no Funding or personnel employed under this Agreement shall be in any
way or to any extent engaged in the conduct of political activities in violation of Chapter 15 of
Title V United States Code.
H. Conflict of Interest
The Grantee shall maintain a written code of conduct to govern the performance of its employees
engaged in the award and administration of this Agreement, with such code of conduct being in
compliance with 24 CFR 84.42. Further, the Grantee covenants that it presently has no financial
interest, direct or indirect, which would conflict in any manner or degree with the performance of
services required under this Agreement. The Grantee further covenants that, in the performance of
this Agreement, no person having such a financial interest shall be employed or retained by the
Grantee. These conflict of interest provisions apply to any person who is an employee, agent,
consultant, officer, elected official, or appointed official of the City, any designated public agency,
or Subrecipient which is receiving funds under the CDBG Entitlement program.
I. Lobbying
The Grantee hereby certifies that:
1. No Federal appropriated funds have been paid or will be paid, by or on behalf of it, to any
person for influencing or attempting to influence an officer or employee of any agency, 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 will be paid to any person
for influencing or attempting to influence an officer or employee 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, it will complete
and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with
its instructions.
3. It will require that the language of Article I O.D.2 of this Agreement 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.
2018 - 2019 CDBG Funding Agreement Page 16
J. Lobbying Certification
Any person who fails to file the required certification imposed by 31 USC 1352 shall be subject to
a civil penalty of not less than ten thousand dollars($10,000) and not more than one hundred
thousand dollars ($100,000) for each such failure. Submission of such certification is a
prerequisite for making or entering into this Agreement, and the certification is a material
representation of fact upon which reliance was placed when this transaction was made or entered
into.
K. Copyright
If this Agreement results in any copyrightable material or inventions, the City reserves the right to
royalty -free, non-exclusive, and irrevocable license to reproduce, publish, or otherwise use and to
authorize others to use, the work or materials for government purposes.
L. Religious Organization
The Grantee agrees that the Funding will not be utilized for religious activities, to promote
religious interests, or for the benefit of a religious organization in accordance with the Federal
regulations specified in 24 CFR 570.2000).
Article 10. ENVIRONMENTAL CONDITIONS
A. Air and Water
The Grantee agrees to comply with the following requirements insofar as they apply to the
performance of this Agreement: Clean Air Act, 42 U.S.C., 7401, et seq; Federal Water Pollution
Control Act, as amended; 33 U.S.C. 1251, et seq., as amended; 1318 relating to inspection,
monitoring, entry, reports, and information; other requirements specified in said Section 114 and
Section 308, and all regulations and guidelines issued thereunder; and, Environmental Protection
Agency (EPA) regulations pursuant to 40 C.F.R., Part 50, as amended.
B. Flood Disaster Protection
In accordance with the requirements of the Flood Disaster Protection Act of 1973 (42 USC 4001),
the Grantee shall assure that, for activities located in an area identified by FEMA as having special
flood hazards, flood insurance under the National Flood Insurance Program is obtained and
maintained as a condition of financial assistance for acquisition or construction purposes, including
rehabilitation.
C. Lead -Based Paint
The Grantee agrees that any construction or rehabilitation of residential structures with assistance
provided under this Agreement shall be subject to HUD Lead -Based Paint Regulations at 24 CFR
570.608, and 24 CFR Part 35 and will comply with all applicable requirements.
D. Asbestos
The City agrees to comply with the Texas Asbestos Health Protection Act set forth at Article 4477-
3a Section 12 of the Texas Civil Statutes and the National Emission Standard for Asbestos
Regulations set forth at 40 CFR Part 61.
2018 2019 CDBC Funding Agreement Page 17
E. Historic Preservation
The Grantee agrees to comply with the Historic Preservation requirements set forth in the National
Historic Preservation Act of 1966, as amended (16 U.S.C. 470) and the procedures set forth in 36
CFR, Part 800, Advisory Council on Historic Preservation Procedures for Protection of Historic
Properties, insofar as they apply to the performance of this Agreement. In general, this requires
concurrence from the State Historic Preservation Officer for all rehabilitation and demolition of
historic properties that are fifty (50) years old or older or that are included on a Federal, State, or
local historic property list.
Article 11. SEVERABILITY
If any provision of this Agreement is held invalid, the remainder of the Agreement shall not be
affected thereby, and all other parts of this Agreement shall nevertheless be in full force and effect.
Article 12. SECTION HEADINGS AND SUBHEADINGS
The section headings and subheadings contained in this Agreement are included for convenience
only and shall not limit or otherwise affect the terms of this Agreement.
Article 13. WAIVER
The Grantee's failure to act with respect to a breach by the Subrecipient does not waive its right
to act with respect to subsequent or similar breaches. The failure of the Grantee to exercise or
enforce any right or provision shall not constitute a waiver of such right or provision.
Article 14. CHAPTER 2270, SUBTITLE F, TITLE 10, TEXAS GOVERNMENT CODE
The Grantee warrants that it is in compliance with Chapter 2270, Subtitle F, Title 10 of the Texas
Government Code by verifying that it does not boycott Israel, and that it will not boycott Israel
during the term of this Agreement.
Article 15. ENTIRE AGREEMENT
This Agreement constitutes the entire agreement between the Parties for the use of funds received
under this Agreement and it supersedes all prior or contemporaneous communications and
proposals, whether electronic, oral, or written between the City and the Grantee, and the Grantee
and any Subrecipient, with respect to this Agreement.
IN WITNESS HEREOF, THE PARTIES HAVE EXECUTED AND ENTER INTO THIS
AGREEMENT ON THE EFFECTIVE DATE
[Signature Page to Follow]
2018 - 2019 CDBG Funding Agreement Page 18
SIGNATURES
FOR: THE CITY OF LUBBOCK
DANIEL M. POPE, MAYOR
ATTEST:
— p 14'� , -- - )K�
Re cca Garza, City SecretaU
APPROVED AS TO CONTENT:
40
Karen Murfee, Community Devel rnent Director
APPROVED AS TO FORM:
elli Leisure, Assistant City Attorney
FOR: BIG BROTHERS BIG SISTERS
OF LUBBOCK
Melissa Corley, Executive Direct
op
hewn Vinson, Board President
FED. I.D. # 23-70419I7
2019 2019 CUBG Funding Agreement Page 19
FY 2018 — 2019
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)
EXHIBIT A
GRANTEE- Big Brothers Big Sisters of Lubbock
TERM - October 1, 2018 — September 30, 2019
PROGRAM- Youth Mentoring
ALLOCATION - $22,000
MATCH— (25% of allocation) $5,500
PROGRAM DELIVERY- Provide one-to-one youth mentoring
• Target population: Children impacted by familial incarceration
• Estimated children served: 22
• Enroll children in need of mentoring services
• Recruit, train, and match adult mentors
• Establish and assess the individual needs and goals for each child
• Provide continuous case management and support
• Will self -certify clients
LEVEL OF ACCOMPLISHMENT - In addition to the normal administrative services required as part of this Agreement,
the Grantee agrees to provide the following levels of program services in its performance of the Program.
Activjty Timeline Accompfishments
Mentoring Program October 1, 2018 — 22 youth served - Youth Impacted by Familial Incarceration
September 30, 2019
Monthly Reports and Reimbursement Request are due by the 10'' of each month
Year End and Outcome Report due no later than September 30, 2019
BUDGET- Line Item Fundiay Year AW,QW
Office Supplies 2018-2019 $800
Payroll
Utilities
Promotional/Marketing
Infrastructure
Professional Services
CONTACT INFORMATION
2018-2019
$10,000
2018-2019
$1,700
2018-2019
$1,500
2018-2019
$5,000
2018-2019
$3,000
Communication and details concerning this Agreement shall be directed to the following:
For the City: For the Grantee:
Community Development Melissa Corley, Executive Director Shawn Vinson, Board President
City of Lubbock Big Brothers Big Sisters of Lubbock Big Brothers Big Sisters of Lubbock
P.O. Box 2000 3416 Knoxville Avenue 3416 Knoxville Avenue
Lubbock, TX 79457 Lubbock, TX 79413 Lubbock, TX 79413
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
1 of 1
Complete Nos. 1- 4 and 6 if there are interested parties.
Complete Nos. 1.2, 3.5, and 6 if there are no interested parties.
OFFICE USE ONLY
CERTIFICATION OF FILING
Certificate Number:
2019-459166
Date Filed:
03/03/2019
Date Acknowledged:
i
Name of business entity filing form, and the city, state and country of the business entity's place
of business.
Big Brothers Big Sisters of Lubbock
Lubbock, TX United States
2
Name of governmental entity or state agency that is a party tot the contract for which the form is
being filed.
City of Lubbock
3
Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a
description of the services, goods, or other property to be provided under the contract.
14577
Provide children with strong, enduring and professionally supported one-to-one mentoring in Lubbock and the South Plains area.
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
Intermediary
5
Check only if there is NO Interested Party. ❑
X
6
UNSWORN DECLARATION
My name is and my date of birth is
My address is
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
Executed in County, State of on the day of . 20
(month) (year)
Signature of authorized agent of contracting business entity
(Declarant)Forms
provided by Texas Ethics Commission www.ethics.state.Ix.us Version V1.1.28ab6150