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RESOLUTION #467 - 4/10/80
RESOLUTION
QeT.-BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the Mayor of the City of Lubbock BE and is hereby authorized and
directed to execute for and on behalf of the City of Lubbock a Contract for
Energy Crisis Assistance Program between Texas Department of Community Affairs
and City of Lubbock, Community Services Department attached herewith which
shall be spread upon the minutes of the Council and as spread upon the minutes
of this Council shall constitute and be a part of this Resolution as if fully
copied herein in detail.
Passed by the City Council this 10t h day of April ,1980.
�KcAIJSTER-,�-M,yo,
ILL
I� ATTEST:
J
'I Evelyn Ga fga, City c Treasurer
APPROVED APPROVED AS TO CONTENT:
�E
7 1 Fi%MP
i Denzel Perc ull, Dirl of Public Services
APPROVED AS TO FORM:
^Q 9) 21 7 t AA ki n tP T1
Donald G. Vandiver, Asst. City Attorney
RESOLUTION #467 - 4/10/80
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CONTRACT FOR
ENERGY CRISIS ASSISTANCE PROGRAM
BETWEEN
TEXAS DEPARTMENT OF COMMUNITY AFFAIRS
AND
CITY OF LUBBOCK, COMMUNITY SERVICES DEPARTMENT
RECEIVED
STATE OF TEXAS § 1g80
►� 1
COUNTY OF TRAVIS §pomioOVQa'W"mDIVA
SECTION I. PARTIES TO CONTRACT
This contract and agreement is made and entered into by and between the
Texas Department of Community Affairs, an agency of the State of Texas, herein-
after referred to as "Department," and CITY OF LUBBOCK, COMMUNITY SERVICES
DEPARTMENT hereinafter referred to at 'Contractor."
The Parties hereto have severally and collectively agreed, and by the execution
hereof are bound, to the mutual obligations and to the performance and
accomplishment of the tasks hereinafter described.
SECTION II. CONTRACTOR PERFORMANCE
A: The Contractor shall administer and perform all activities for
the Energy Crisis Assistance Program (hereinafter referred to as "ECAP")
funded by either the United States Community Services Administration
(hereinafter referred to as "CSA") pursuant to Section 222(a)(5) of
the Economic Opportunity Act of 1964, as amended (hereinafter referred
to as the "Act"), or the United States Department of Health, Education
and Welfare (hereinafter referred to as "HEW") through its Supplemental
Energy Allowance Program (Pub.L. 96-126). The Contractor shall perform
all ECAP activities herein in•accordance with the terms and requirements
of this contract and the federal regulations promulgated by CSA and
all revisions thereof (44 Fed. Reg. 58876-53880, as amended by 44 Fed.
Reg. 75645-75647, to be codified at 45 C.F.R. § 1061.70-1, et seq.).
B. Eligible Activities
Funds made available through this contract shall be used to provide
assistance to eligible households that experience energy related crises
which are caused by the high cost of energy to heat their homes. This
assistance shall be provided only in accordance with this contract and
is subject to the limitations stated in this Section.
C. Eligible Households
1. Income Eligibility - only households with income at or below
one hundred twenty-five percent (125%) of the CSA Poverty
Income Guidelines and households whose heads receive SSI
shall be eligible for assistance under this program. Receipt
of energy allowances, such as payments to SSI or AFDC
recipients under the HEW Energy Assistance Program (44 Fed.
Reg. 69032-69040) shall not preclude eligibility under ECAP,
nor shall energy allowances be considered as income in
determining income eligibility. However, receipt of such
energy allowances shall be considered in computing the
amount of energy for which households will be eligible (See
Subsection F(2) of this Section).
Amounts representing one hundred twenty-five percent (125%) of
CSA Poverty Income Guidelines are listed as follows:
Size of Annual Income Annual Income
Family Unit Non -Farm Family Farm Family
1 $ 4,250.00 $ 3,638.00
2 5,625.00 4,800.00
Page 1 of 17
3
Size of Annual Income Annual Income
Family Unit Non -Farm Family Farm Family
3 $ 7,000.00 $ 5,963.00
4 8,375.00 7,125.00
5 9,750.00 8,288.00
6 11,125.00 9,450.00
For family units with more than six (6) members, add ONE
THOUSAND THREE HUNDRED SEVENTY-FIVE AND NO/100 DOLLARS
($1,375.00) for each additional member of a non -farm family,
and ONE THOUSAND ONE HUNDRED SIXTY-THREE AND NO/100 DOLLARS
($1,163.00) for each additional member in a farm family.
2. Determination of Income Eligibility - The Contractor shall require
each applicant for assistance under this program to provide proof
of his or her income eligibility. Such proof may include a Food
Stamp Authorization to Purchase Card, Payroll Check Stub, Social
Security Administration Certification Letter, Supplemental
Security Income Letter, or any other document that clearly gives
evidence of earned income. The period of time for determining
income eligibility shall be the six (6) month period preceding
the request for assistance. When proof of eligibility is unavail-
able, the Contractor shall require the applicant to sign a declara-
tion of income eligibility on a form like that which is hereby
made a part of this contract as Attachment "I." In such cases,
the Contractor shall make a reasonable number of spot checks to
verify income eligibility.
3. Intake/A lication Form - The Contractor shall use the Intake/-
Application Form, which is hereby made a part of this contract
as Attachment "II," or a form similar thereto in its process of
taking application for participation in this program.
D. Denial of Assistance/Appeal
The Contractor shall make known to all applicants for assistance
under this program procedures for review of Contractor's partial
or complete denial of assistance under the program to any house-
hold.
2. Contractor's review of denials of assistance shall be conducted
in accordance with the requirements set forth in Department's
"ECAP Appeals Procedure," copies of which shall be provided to
the Contractor by the Department.
3. The review procedures provided by Contractor herein shall apply
only to denials of requests for assistance provided pursuant to
Subsection E of this Section II, and shall not apply to such
activities as community organization, information and referral,
etc.
4. For the purposes of this contract, a "denial of assistance"
occurs when:
a. the assistance provided under Subsection E of Section II is
currently available;
b. the Contractor has the authority to provide such assistance;
C. the applicant's application for such assistance has been
partially or completely denied by the Contractor; and
d. the applicant falls within or believes that he/she can prove
that he/she falls within the income eligibility and any
other relevant established program guidelines.
Page 2 of 17
1
5. Contractor shall develop, in addition to and consistent with
the review procedures provided in Subsection D.2 of this Section
II, procedures for reviewing denials of assistance which will
include:
a. provisions for notifying the applicant in writing of the
reasons for denial of assistance, that he/she may request
a review of the denial and may submit additional informa-
tion (in writing or orally) which the applicant believes
would warrant a favorable determination;
b. provisions for reviewing the denial of an application for
assistance in a timely manner if such is requested by the
applicant. This should include the specific assignment of
responsibility to a senior level official other than the
person making the initial determination;
c. provisions for notifying the applicant in writing of the
Contractor's final decision; and
d. the methods the Contractor will employ to publicize the
existence of the appeal process.
6. If the population served by the Contractor includes a sizable
non-English speaking group, the Contractor shall make available
all ECAP procedures, written materials, and publicity in tte
language spoken by such group.
7. The Contractor shall maintain on file and make available for
public inspection a written description of the procedures
developed pursuant to Subsection D.5 of this Section II.
8. All documents relating to specific denials of assistance and
action(s) taken shall be maintained in Contractor's files for
the length of time required by CSA policy on "Retention and
Custodial Requirement for Records." (See, CSA Instruction
6800-4.) The Contractor shall make these records available
for review by CSA or Department officials upon request.
9. The Contractor shall appoint a staff person to be its appeals
officer for this program. The appeals officer must be at a
senior level to those staff making initial determinations.
The Contractor shall consider only those appeals which have
been presented to its appeals officer.
E. Types of Assistance
Subject to the limitations on payments specified in Subsection F
below, the Contractor shall provide only the following types of assistance
to eligible applicants:
1. payments to vendors and suppliers of fuel and utilities.
Where an eligible household has paid its fuel and/or utility
bills, levels of assistance equal to those bills shall be
provided in forms of assistance as described in Paragraphs
2 and 3 of this Subsection E;
2. the establishment of lines of credit with fuel/utility vendors
for the benefit of eligible households; and
3. payments to landlords on behalf of renters whose utilities are
paid as part of their rent.
F. Limitations on Payments
1. For the purpose of this contract the term "energy related
crisis" shall mean the extent to which an eligible household
(including renters) has suffered a financial hardship in
paying its home heating bills and/or amounts necessary to
secure utility services (including payments for service
connection and reconnection, security deposits, and unpaid
bills) during the period September 1, 1979, through
Page 3 of 17
t
March 31, 1980. The amount of assistance determined as
necessary to ameliorate a household's energy related crisis
should be determined by the Contractor on a case -by -case
basis and should reflect only that portion of fuel/utility
costs which represents an actual financial hardship to the
household.
2. The sum of all assistance made to and/or on behalf of any house-
hold under this program or programs specified in Paragraph
3, below, shall not exceed the actual amount needed to
ameliorate the household's energy -related problem or FOUR
HUNDRED AND NO/100 DOLLARS ($400.00), whichever is less.
3. While energy allowances, such as payments tc SSI or AFDC
recipients under the HEW Energy Assistance Program, received
by a household may not be considered as income for purposes
of determining income eligibility, any allowances received
shall be taken into consideration in determining the
assistance to be provided. (For example, if a household
has received $50 in HEW energy allowances, it will be
eligible to receive the amount of assistance specified in
Paragraph 1, above, less $50.)
4. In no event shall the amount of HEW energy allowances and/or
assistance under this contract received by an eligible house-
hold exceed the amount needed to ameliorate the household's
energy problem, or FOUR HUNDRED AND NO/100 DOLLARS ($400.00),
whichever is less.
G. Assistance to Renters
The Contractor shall provide assistance to eligible persons who
rent their households in the following manner:
1. for renters who have a separate meter or who pay their utilities
and/or fuel bills separately from rent, the provisions of
this contract for assistance to non -renters will apply; and
for renters who pay utility and/or fuel bills as part of
the rent, energy assistance shall be provided only for the
portion of the rent demonstrably attributable to utility and/or
fuel costs. Payments on behalf of these renters shall be made
to their landlords.
3. for renters who pay utilities and/or fuel bills both separately
from rent and as a part of the rent, energy assistance shall
be provided pursuant to Paragraph 2 of this Subsection G for
that portion of the utilities and/or fuel bills paid as a part
of the rent and energy assistance shall be provided pursuant
to Paragraph 1 of this Subsection G for that portion of the
utilities and/or fuel bills paid separately from rent.
H. Heating Fuel Costs Priority
The Contractor shall give priority to those households experiencing
significant increases in heating fuel costs over the last year. In
establishing this priority, the Contractor should take into consideration
the extent to which increases in rent are caused by increases in heating
fuel costs.
Serving American Indians
The Contractor shall provide assistance under this contract to
American Indians on the same basis and to the same extent as low-income
persons in general.
J. Serving Clients - Outreach by Contractor
1. The Contractor shall provide assistance to those households
that do not have access to other supportive service networks
but are eligible for ECAP assistance, as well as to those
who do have such access.
Page 4 of 17
2. The Contractor shall make efforts to notify, inform, and contact
persons, including those individuals receiving unemployment com-
pensation, potentially eligible for ECAP assistance under this
contract. These activities shall be accomplished through the
following:
a. notification of other social services agencies in the area
of the availability of assistance through this program;
b. notification of public agencies having regular contact with
the public (e.g., police, fire departments, public health
organizations, school systems) so that they may inform
eligible persons of this program;
C. contact of community organizations, special interest groups,
churches, social clubs, &c, and providing them information
for distribution to their constituents;
d. use of local media to publicize this program;
e. use of community "hotlines" or "help -lines," if available,
for referrals of persons in need of ECAP assistance;
f. contact of alliiutility vendors and major fuel suppliers in
Contractor's service area. Contractor shall encourage ven-
dors and suppliers to participate in the program and to
help publicize the program through the enclosure of leaflets
(prepared and provided by the Department) in their bills;
g. utilization of Contractor's existing outreach capabilities
and utilization of existing neighborhood facilities to make
services available to eligible persons; and
h. if the population served by the Contractor includes a
sizable non-English speaking group, the Contractor shall
make its procedures, written materials, and outreach avail-
able in the appropriate language.
3. In providing outreach activities, the Contractor shall give
highest priority to serving the elderly. To accomplish this
end, the Contractor shall offer special services to the elderly,
such as:
a. intake and certification by mail;
b. scheduled appointments;
C. transporation to and from the certification office;
d. schedule intake periods at congregate meal centers and
other senior centers where the elderly congregate, and con-
duct orientation and information sessions; and
e. intake and certification by telephone or sending an out-
reach worker to an applicant's residence in cases where
persons are unable to leave their residences due to infirm-
ity or fear of victimization.
4. Expenses for the outreach activities specified in this Subsection
J shall be paid for only from funds provided herein for administra-
tive costs.
t
K. Coordination with Other Energy Assistance Programs
To avoid duplication of outreach and energy assistance services in
areas served by more than one energy assistance program, the Contractor
shall contact other energy assistance Local Administering Agencies (LAA's)
and coordinate their efforts. If in an area jointly served by more than
one program, the Contractor shall:
Page 5 of 17
1. meet with other LAA's to identify areas of duplication of out-
reach activities and make arrangements for joint sponsorship,
assigned responsibilities, or other mutually agreeable outreach
activities;
2. institute intake/application procedures which shall obtain infor-
mation from applicants for assistance as to whether they have
received energy assistance from another energy assistance program.
Intake/application forms utilized by Contractor shall inform
applicants that they are eligible for assistance under only one
ECAP program in order to be eligible for benefits under the
Contractor's program;
3. periodically, (at least once per month) contact other LAA's in
their area, if any, to check whether anv households certified
to receive assistance are also receivinq energy assistance
under other proqrams. The Contractor shall cooperate with
other energy assistance programs by providing, upon request,
information as to which households are receiving assistance
under its program; and
4. coordinate with utilities and fuel providers to assure that no
household served by such utilities or fuel providers is
receiving energy assistance from more than one energy assistance
program providing assistance through such utilities or
fuel providers.
L. Coordination with Utility/Fuel Vendors-
1. In each case where payment is certified, the Contractor shall
ensure that:
a. reconnection of utilities and/or delivery of fuel is made
promptly upon certification for payment;
b. for any remaining balances, the customer is offered a
deferred payment or a level payment plan;
c. a reconnection charge is paid only where such a charge
was company policy prior to September 1, 1979. If there
is such a charge, the Contractor w-111 negotiate to have
it reduced to the actual labor and material costs, and
no penalties are assessed for delinquency payments;
d. no security deposit is required to be paid, except where
such a deposit was required by State law or explicit State
regulations prior to September 1, 1979, and, where required
by law or regulation, is included in a deferred payment
arrangement; and
e. where credit balances of ECAP payments remain in any
account after September 30, 1980, Contractor shall require
that such credit balances be returned by vendors and
suppliers of fuel and utilities to Contractor by
October 15, 1980. The Contractor shall submit such
credit balances to the Department by November 1, 1980.
2. No later than March 1, 1980, the Contractor shall submit to
the Department certification of agreements reached with
participating utility and fuel vendors to ensure compliance
with the provisions of Paragraph 1 of this Subsection II.L.
M. Allowable Costs
The Contractor may not use more than six and one quarter
percent (6.25%) of total Departmental liabilities as specified
by Section IV.A. of this contract for administrative expenses.
Such administrative costs may be incurred in the following
cost categories: salaries; fringe benefits; travel; audit
fees; office space; equipment; (only with prior approval
from CSA through Department) telephone; supplies; and,
outreach expenses.
2. The Contractor may use the remaininq balance of funds allo-
cated hereunder to pay for the actual costs of providing
energy assistance in accordance with the terms of this
contract.
Page 6 of 17
' N. Reporting Requirements
1. The Contractor shall submit to the Department the following reports
covering the periods February 1 through April 30 and May 1 through
June 30 of 1980:
a. four (4) copies of a separate Project Progress Review Report,
CSA Form 440 (hereby made a part of this contract as Attach-
ment "IV"); and
b. four (4) copies of a separate Financial Status Report, SF 269,
(hereby made a part of this contract as Attachment "V").
The reports covering the period February 1 through April 30, 1980,
shall be due no later than May 15, 1980. The reports covering
the period May 1 through June 30, 1980, shall be due no later
than July 15, 1980.
2. The Contractor shall submit a final Financial Status Report,
SF 269, within sixty (60) days after the termination of this
contract.
0. Evaluation
In the event that CSA undertakes a national evaluation of this
program, the Contractor agrees that it will cooperate with CSA.
SECTION III. PERIOD OF PERFORMANCE
All services to be performed by Contractor under this contract
shall commence February 20,1980, and shall terminate June 30, 1980,
such period to be referred to herein as the "contract period," unless
expressly provided otherwise herein.
SECTION IV. DEPARTMENT FINANCIAL OBLIGATIONS
A. Measure of Liability
1. In consideration of full and satisfactory performance here-
under, Department shall be liable to Contractor in an amount
equal to the actual costs incurred by Contractor for performance
rendered hereunder subject to the following limitations:
a. Department shall not be liable to Contractor for expendi-
tures made in violation of the ECAP regulations promul-
gated by CSA pursuant to the Act or in violation of any
amendments to the Act or these regulations.
b. Department shall not be liable to Contractor for costs
incurred or performances rendered unless such costs and
performances are strictly in accordance with the terms
of this contract, including but not limited to terms
governing Contractor's promised performance, the description
of that performance in Section II of this contract, and
all amendments hereto signed and agreed to by both Depart-
ment and Contractor or resulting from Contractor's
acceptance of proposed amendments in the manner prescribed
in Section XII of this contract.
c. Notwithstanding any other provision of this Section, it
is understood and agreed by the parties hereto that Depart-
ment's obligations under this subsection are contingent
upon actual receipt of adequate funds from CSA or HEW
to meet putative liabilities under this subsection,
provided that within a reasonable time after Department
receives written and specific notice from CSA or HEW
that Department will not receive adequate funds to
make payments to Contractor, Department shall notify
Contractor in writing to that effect.
2. Department shall not be liable for any costs incurred or
performances rendered by Contractor in the performance of
this contract which have not been billed to Department
within sixty (60) days following the termination of this
contract.
Page 7 of 17
3. Department shall not be liable to Contractor for costs
Incurred or performances rendered by Contractor before the
commencement of this contract or after the termination of
this contract.
4. Department shall not be liable to Contractor for any cost
incurred by Contractor, or portion thereof which:
(1) has been paid to Contractor or is subject to payment
to Contractor, or
(2) has been reimbursed to Contractor or is subject to
reimbursement to Contractor,
by any source other than Department or Contractor.
t
B. Method of Payment
1. Department shall pay to Contractor fifty percent (50%) of
the amount specified in Subsection D of this Section IV,
against Departmental liabilities accrued or to be accrued,
pursuant to Subsection A of this Section IV within five (5)
working days after the execution of this contract.
2. Following receipt by Contractor of Department's payment
pursuant to Subsection B(1) of this Section IV, Contractor
shall submit periodically, but no more often than once in
any monthly period, a Requisition for Payment on a form
like that made a part of this contract as Attachment III.
Such Requisitions for Payment shall bill the Department in
the amount of Departmental liabilities actually accrued
(pursuant to Subsection A of this Section IV) but not
previously billed by Contractor. Within thirty (30) days
after receipt of the Contractor's properly completed Requisi-
tion for Payment, the Department shall pay, subject to
the limitations cited below, to Contractor an amount
equalling Departmental liabilities actually accrued but
not previously billed and paid pursuant to this Subsection
B(2) against Departmental liabilities accrued or to be
accrued as specified in Subsection A of this Section IV.
3. Notwithstanding the provisions of Paragraph 2 of this Sub-
section B, it is expressly understood and agreed by the
parties hereto that payments under this contract are conditioned
upon Contractor's full and satisfactory performance of its
obligations under this contract.
4. In addition to the limitation on payments imposed pursuant
to Paragraph 3 of this Subsection B. it is expressly under-
stood and agreed by the parties hereto that if the Contractor
fails to submit to Department in a timely and satisfactory
manner any report required by this contract or any other
contract the Department has with the Contractor, the Depart-
ment may, at its sole option and in its sole discretion,
withhold any or all payments otherwise due and owing
Contractor hereunder. If Department withholds such payments,
it shall notify the Contractor in writing of its decision
and the reasons therefor. Payments withheld pursuant to this
Paragraph may be held by the Department until such time as
the delinquent obligations for which funds are withheld as
fulfilled by the Contractor.
5. In addition to the limitations on payment imposed pursuant
to Paragraphs 3 and 4 of this Subsection B, it is expressly
understood and agreed by the parties hereto that Department
may, at its sole option and its sole discretion, withhold
from payments to Contractor any amount not exceeding fifteen per-
cent (15%) of each claim by Contractor for reimbursement hereunder
which Department would otherwise be obligated to pay to Con-
tractor but for its option to withhold such amounts. Pay-
ments withheld pursuant to this Paragraph may be held by
Department until such time as all liabilities under this
contract or any other contract between Department and Con-
tractor terminating prior to or concurrently with the
termination of thi-s contract have been finally determined
Page 8 of 17
by the mutual agreement of Department and Contractor or
through administrative or judicial determination. Within
thirty (30) days following such determination, Department
shall pay to Contractor the amount of Department's remaining
liability finally determined.
6. It is further expressly understood and agreed by the parties
hereto that Contractor's performance upon which final payment
is conditioned shall include, but not be limited to the
following:
(a) Contractor's complete and satisfactory performance of
_._its obligations for which final payment is sought;
(b) timely submission to the Department of the final close-
out or expenditure report required under this contract;
and
(c) timely submission of the audit report required under
this contract.
Prior to Contractor's performance of the above -listed obliga-
tions, the Department may, at its sole option and in its
sole discretion, withhold the final payment, in whole or in
part, until such time as Department has determined from such
final report and/or audit the final amount owing under this
contract. Within thirty (30) days following the determination
by the Department of the final amount owing under this con-
tract, the Department shall pay to Contractor the amount
determined by Department to be the final amount owing to
Contractor under this contract.
7. Notwithstanding any other provision of this contract, it is
expressly understood and agreed by the parties hereto that
the Department may, at its sole option and its sole discre-
tion, offset any amounts withheld or otherwise owing to the
Contractor hereunder against any amount owing but unpaid by
Contractor to Department arising from this or any other
contract between Department and Contractor.
It is expressly understood and agreed by the parties hereto
that any right or remedy provided for in this Subsection B
or in any other provision of this contract shall not preclude
the exercise of any other right or remedy under this contract
or under any provisions of law, nor shall any action taken
in the exercise of any right or remedy be deemed a waiver
of any other rights or remedies. Failure to exercise any
right or remedy hereunder shall not constitute a waiver of
the right to exercise that or any other right or remedy at
any time.
C. Excess Payments
1. Contractor shall be liable to Department for any amount paid
under Subsection B of this Section IV for which Department
was not liable to Contractor. Upon termination of this con-
tract and in the event Department has made payments to Con-
tractor in excess of Department's liability hereunder as
measured in accordance with this Section IV, Contractor shall
promptly repay to Department the amount of such excess payments.
•-2. Those payments made by the Contractor to utility/fuel vendors
in accordance with Section II.E.2. not applied by
September 30, 1980, to bills of eligible households shall be
repaid promptly by the utility companies to the Contractor
which will repay the Department by November 1, 1980. For
the purposes of this contract those unutilized amounts
returned to the Contractor by utility/fuel vendors shall
be held in trust by the Contractor for the Department
pending their repayment to the Department.
Page 9 of 17
D. Maximum Department Liability
Notwithstanding any other provision of this contract, Department
shall not be liable hereunder to Contractor in a cumulative amount
greater than One Hundred Seven Thousand Four Hundred Thirty Two and
No/100 Dollars ($107,432.00)
SECTION V. AREA SERVED
A.
The Contractor shall conduct ECAP activities pursuant
contract, and subject tc the provisions of Subsection
Section V, CSA regulations and Department directives
the following counties of Texas only: Lubbock
to this
B of this
in
B. The Contractor shall not operate activities under this contract
in any county of which it does not have authorization to do so
either through geographic restrictions in the Contractor's corporate
charter.
SECTION VI. AUDIT
A. The Contractor will not be required to. have -a separate audit
of this program. The program including its contracted -out components
will be audited at the time of the Contractor's regularly scheduled
audit. Five (5) copies of the audit shall be submitted by Contractor
to the CSA Region VI Auditor concurrent with the submission of three
(3) copies of the audit to the Department. The audit shall be made
in accordance with generally accepted accounting standards including
the standards published by the General Accounting office, "Standards
for Audit of Governmental Organizations, Programs, Activities, and
Functions", and CSA Audit Requirements.'
B. Notwithstanding any other provisions of this contract, including,
but not limited to, any provision of this contract concerning termina-
tion, the obligations of the Contractor pursuant to this Section only
shall continue in force and in effect until such time as Contractor
has completed any auditing undertaken pursuant to this Section.
Department and Contractor agree that. for the purposes of Section IV(A)
of this contract Contractor's actual costs incurred in the satisfactory
performance of this Section only shall be considered to be incurred
prior to June 30, 1980.
SECTION VII. POLITICAL ACTIVITY
None of the performances rendered hereunder shall involve, and
no portion of the funds received by the Contractor hereunder shall be
used for, any partisan political activity (including, but not limited
to, an activity to further the election or defeat of any candidate
for public office) or any activity undertaken to influence the passage,
defeat or final content of legislation.
SECTION VIII. NON-DISCRIMINATION AND EQUAL OPPORTUNITY
The Contractor agrees 0,at it shall comply with the following
Equal Opportunity (EEO) Requirements:
A. The Contractor shall not d'scriminate against any employee or
applicant for employment because of race, religion, color, sex,
age, or national origin. The Contractor shall take affirmative
action'to ensure that applicants are employed and that participants
are treated during employment without regard to their race, religion,
color, sex, age, or national origin. Such action shall include,
but not be limited to, the following: employment, upgrading, demotion
or transfers; recruitment or recruitment advertising; layoff or
termination; rates of pay or other forms of compensation; and selection
for training, including apprenticeship. The Contractor agrees to
post, in conspicuous places available to participants and applicants
for employment, notices.setting forth the requirements of these non-
discrimination provisions.
Page 10 of 17
B. The Contractor shall state in all solicitations or advertisements
for participants and employees placed by or on behalf of the
Contractor that all qualified applicants will receive consideration
for employment without regard to race, religion, color, sex, age,
or national origin.
C. The Contractor shall send to each labor union or representative
of workers with which it has a collective bargaining agreement or
_ other contract or understanding a notice,_ advising the labor union
or workers' representative of the Contractor's commitments to equal
employment opportunity and affirmative action, and shall post
copies of the notice in conspicuous places available to participants
and applicants for employment.
D. The Contractor shall comply with all applicable equal opportunity
laws, other employment laws, rules, regulations and orders, on
federal, state, and local levels.
E. The Contractor shall furnish all information and reports and shall
permit access to its books, records, and accounts for purposes of
investigation to ascertain compliance with equal opportunity and
affirmative action.
F. In the event of the Contractor's noncompliance with equal
opportunity conditions of this contract, the Department may cancel,
terminate, or suspend this contract in whole or in part; the
Contractor may be declared ineligible for further contracts and
such other sanctions may be imposed and remedies invoked as other-
wise provided by law.
G. The Contractor shall include all of subsections (A) through (G)
in every eligible subcontract or purchase order so that such
provisions shall be binding upon each subcontractor or vendor. The
Contractor shall take such action with respect to any subcontract
as the Department may direct to enforce such provisions, including
action for noncompliance.
H. The Contractor covenants that no person with responsibilities
in the operation of any program funded under this contract will dis-
criminate'with respect to any employee, program participant, or
any applicant for participation in such program, because of race,
color, religion, sex, national origin, age, handicap, or political
affiliation or belief.
I. The Contractor shall comply with Title VI of the Civil Rights
Act of 1964 (42 U.S.C. § 2000d), as amended, which is incorporated
herein by this reference as if fully rewritten, and covenants that
no person in the United States shall, on the grounds of race,
color, sex, national origin, age, handicap, or political affiliation
or belief be excluded from participation in, be denied the benefits
of, or be otherwise subjected to discrimination under any program
or activity for which the Contractor herein receives financial
assistance, and will immediately take any measures necessary to
effectuate this requirement.
J. The Contractor shall comwith Title VII of the Civil Rights
Act of 1964 (42 U.S.C. § 2000p[e�), as amended, and Executive Orders
11246 and'11375, which are incorporated herein by this reference
as if fully rewritten, and covenants that no employee or applicant
for employment will be discriminated against because of race, color,
sex, religion, or national origin.
K. The Contractor shall comply with the Equal Pay Act of 1963
(29 U.S.C. § 201 through 219), as amended, which is incorporated
herein by ',this reference as if fully rewritten, and covenants that
it will not practice wage differentiation in employment based on sex.
L. The Contractor shall comply, with the A e Discrimination In
Employment Act (29 U.S.C. § 621 through 634�, as amended, and
Executive Order 11141, which are incorporated herein by this reference
as if fully rewritten, and covenants that it will not practice
discrimination against an employee or applicant for employment on
the basis of age. The Contractor shall not discriminate in employment
Page 11 of 17
against any person because of his or her age or specify in solicita-
tions or advertisements a maximum age limit except and unless it is
based upon a bona fide occupational qualification, retirement plan,
or statutory requirement.
M. The Contractor shall take Affirmative Action to ensure that
applicants are employed, and that employees are treated during
employment, without regard to their race, color, sex, religion,
national origin, or condition of physical or mental handicaps,
provided, however, in the instance of a handicapped person, that
the person's handicap does not prevent that person from doing the job
that person would be hired to perform. Such action shall include,
but not be limited to, the following: employment, upgrading, demotion,
or transfer; recruitment advertising; layoff or termination; rates
of pay or other forms of compensation; and selection for training,
including apprenticeship. The Contractor also covenants to post in
conspicuous places, available to employees and applicants for
employment, notices to be provided by the Department's EEO Officer
in setting forth the provisions of this nondiscrimination clause.
SECTION IX. AFFIRMATIVE ACTION FOR DISABLED VETERANS OF THE VIETNAM AREA
[This section is applicable pursuant to 41 C.F.R. § 60-250 (1977)
only if the Department's maximum funding obligation under subsection (d)
of Section IV is $10,000.00 or more. The application of this section shall
be governed by the regulations found at 41 C.F.R. § 60-250.]
A. The Contractor agrees that it shall comply with Section 402 of
the Vietnam Era Veterans Readjustment Assistance Act of 1974 and the
rules, regulations and orders relating thereto which are incorporated
herein by this reference as if fully rewritten, and covenants that
it will take affirmative action to employ and advance in employment
qualified veterans and disabled veterans of the Vietnam era and
will not discriminate in an employment situation against mentally
or physically Handicapped or disabled veterans or against otherwise
qualified Vietnam Era Veterans, if such individuals are capable of
performing the work involved in the employment situation.
B. The Contractor will include the provisions of this Section in
every subcontract or purchase order of $10,000.00 or more unless
exempted by rules, regulations, or orders of the Secretary of the
United States Department of Labor, so that such provisions will be
binding upon each subcontractor or vendor. The Contractor will take
such action with respect to any subcontract or purchase order as
the Department may direct to enforce such provisions, including
action for noncompliance.
SECTION X. AFFIRMATIVE ACTION FOR HANDICAPPED
[This Section is applicable pursuant to 41 C.F.R. § 60-741 (1978),
if the Department's maximum funding obligation under Subsection D) of
Section IV is $2,500.00 or more. The application of this section shall
be governed by the regulations found at 41 C.F.R. § 60-741.1
A. Contractor agrees that it shall comply with Section 503 of the
Rehabilitation Act of 1973, Pub. L. 93-112, as amended by the
Rehabilitation Act Amendments of 1974, Pub. L. 93-516, and the
rules, regulations and orders relating thereto, which are incor-
porated herein by this reference as if fully rewritten, and
covenants that it will take affirmative action to employ and
advance in employment qualified handicapped individuals and
will not discriminate in an employment situation against handicapped
individuals if such individuals are capable of performing the
work involved in the employment situation.
B. The Contractor will include the provisions of this section in
every subcontract or purchase order of $2,500.00 or more unless
exempted by rules, regulations, or orders of the Secretary of Labor
issued pursuant to Section 503 of the Rehabilitation Act of 1973,
so that such provisions will be binding upon each subcontractor
or vendor. The Contractor will take such action with respect to
any subcontract or purchase as the Department may direct to enforce
such provisions, including action for noncompliance.
Page 12 of 17
SECTION XI. DEPARTMENT MONITORING
The Contractor shall give the Department and the Community Services
Administration through their authorized representatives, access to and the
right to examine any or all pertinent record, 1=iles, books, or other written
materials relating to this contract and maintained by the Contractor or any
person or other entity with whom any portion of the performance hereunder
has been subcontracted. The Contractor shall give the Department and CSA
the right at all reasonable times to inspect or otherwise evaluate the
work performed or being performed hereunder and the premises in which it
is being performed.
SECTION XII. AMENDMENTS
A. Any alterations or additions to, or deletions from, the terms of
this contract that are required by changes in federal laws or federal
regulations promulgated pursuant thereto are automatically incorporated
into this contract without written amendment hereto and shall go
into effect on the date designated by the law or regulation.
B. If the Contractor cannot conform to the changes required by
federal laws, or federal regulations promulgated pursuant thereto,
the Contractor shall notify the Department in writing no later than
the effective date of such law or regulations to which it cannot so
conform. The Department shall then establish the standards for the
termination of the Contractor's programs and shall terminate the
contract as soon as practicable.
C. It is understood and agreed by the parties hereto that this con-
tract must at all times be in compliance with the regulations promul-
gated by CSA under the Act and that changes, interpretations, and
clarifications of the regulations to be made by CSA during the contract
period will have the effect of qualifying the terms of this contract.
It is therefore agreed by the parties hereto that this contract may
be amended in the following manner. The Department shall have the
right to propose an amendment that will be effective immediately as
if written herein and subscribed by the parties, unless the Contractor
promptly notifies the Department in writing of its rejection of the
proposed amendment, in which case this contract will be terminated
without any further action by either party; such termination will be
effective as of the date on which the Contractor sends its written
rejection. This amendment proposal procedure will be an exception
to Subsection D of this Section, insofar as the subsection requires
all amendments to this contract to be in writing and executed by both
parties hereto. Proposed amendments under the procedure must be
announced by the issuance of written Department Directives. A Depart-
ment Directive must be so denominated, must be uniform throughout the
State, must be issued by the Executive Director of the Department,
and must not alter the terms of this contract so as to relieve the
Department of any obligation under Section IV of reimbursing costs
already incurred by the Contractor by the date of the issuance of
the Directive, if such costs would have been liabilities of the
Department under Section IV prior to the issuance of the Directive.
D. Except as provided elsewhere in this contract, any alteration
or addition to or deletion from the terms of this contract shall be
by amendment in writing and executed by both parties hereto.
SECTION XIII. TERMINATION
Either of the parties hereto shall have the right in such party's sole
discretion and at such party's sole option, to terminate and bring to an
end all performances to be rendered under terms hereof by notifyin the
other party hereto in writing of such termination at least thirty N)
days prior to effective date of such termination. Should neither party
exercise its right to terminate this contract shall terminate in accordance
with provisions of Section II, Section XII, or Section XIX.
SECTION XIV. MAINTENANCE OF EFFORT
The Contractor covenants that resources for similar services scheduled
to be provided this heating season under state and local authorities
will not be reduced because of assistance it provides under this contract
nor shall Contractor's assistance hereunder be used as a substitute for
such services.
Page 13 of 17
SECTION XV. INDEPENDENT CONTRACTOR
It is expressly understood and agreed by both parties hereto that
Department is contracting with Contractor as an independent contractor, and
that Contractor, as such, agrees to hold the Department harmless and
indemnify it from and against any and all claims, demands, and causes of
action of every kind and character which may be asserted by any third party
occurring or in any way incident to, arising out of, or in connection with,
the services to be performed by Contractor under this contract.
SECTION XVI. COMPLIANCE WITH LAW
Contractor shall comply with all applicable laws, ordinances, codes
and regulations of local, state, and federal governments.
SECTION XVII. CONFLICT OF INTEREST
A. The Contractor covenants that neither it nor any employee or
member of its governing body presently has any interest or shall
acquire any interest, direct or indirect, which would conflict in
any manner or degree with the performance of services required to
be performed under this contract. The Contractor further covenants
that in the performance of this contract no person having such interest
shall be employed or appointed as a member of its governing body.
B. The Contractor shall establish and enforce safeguards to prevent
members of its governing body or its staff members, subcontractors
or employees from using their positions for a purpose that is or
gives the appearance of being motivated by desire for private gain
for themselves, or others, particularly those with which they have
family, business or other ties.
C. No officer, member, or employee of Department or Contractor and
no member of their governing bodies, and no other public official of
the governing body of the state or locality or localities in which
the contract is being carried out who exercises any functions or
responsibilities in the review or approval of the undertaking or
carrying out of this contract shall (1) participate in any decision
relating to this contract which affects his personal interest or
the interest of any corporation, partnership, or association in
which he has a direct or indirect interest; or (2) have any interest,
direct or indirect, in this contract or the proceeds thereof.
SECTION XVIII. SUBCONTRACTS
A. The Contractor shall subcontract for the performances described
in this contract only after the Contractor has submitted a subcontract
information summary, on a form prescribed by Department, for each
proposed subcontract and the Department has given Contractor prior
written approval, on the basis of the information submitted, of Con-
tractor's intent to enter into such proposed subcontract. Such approval
by Department must be in writing and must be obtained by Contractor
prior to the execution of such subcontract(s). The subcontract
information summary form is a report required by Department in
accordance with Section III(I), Recordkeeping and Reports, of this
contract, and if Contractor fails to submit such report in the
manner specified by Department, Contractor will be subject to the
sanctions contained in Section IV, Department Financial Obligations,
including subsection B(4) of that Section. Contractor, in sub-
contracting any of the performances hereunder, expressly understands
that in entering into such subcontracts, Department is in no way
liable to subcontracts.
B. In no event shall any provision of this Section, specifically
including the requirement that Contractor obtain the prior approval
of Department on Contractor's subcontracts, be construed as relieving
Contractor of the responsibility for insuring that the performances
rendered under all subcontracts are rendered so as to comply with
all the terms and provisions of this contract as if the performances
rendered were rendered by Contractor hereunder.
Page 14 of 17
C. The Contractor agrees that it will not execute any subcontract for
performances hereunder pursuant to which the funds and resources pro-
vided the subcontractor under the terms of the subcontract would be
substituted for funds and resources from other sources or would in
any way serve to reduce the resources, services or the benefits which
would have been available to, or provided through, the Contractor or
subcontractor had such subcontract not been executed.
D. The Contractor agrees that in all subcontracts it executes for
performances hereunder the contractual relationship shall be governed
by the principles stated in the "Conflict of Interest" and "Nepotism"
provided herein and that all subcontracts shall contractually bind
Contractor and its subcontractors (except subcontractors with ten (10)
or less employees) to abide by such principles.
E. Departmental approval under this Section does not constitute
adoption, ratification, or acceptance of Contractor's or subcontractor's
performance under this contract. Department maintains the right to
insist upon Contractor's full compliance with the terms of this
contract, and by the act of approval under this Section, Department
does not waive any right of action which may exist or which may
subsequently accrue to Department under this contract.
F. Contractor will ensure that its subcontractors, if any, do not
contract for any performance or partial performance of any activity
or service provided or to be provided through this contract which:
1. has been paid to subcontractor or is subject to payment
to subcontractor; or
2. has been reimbursed to subcontractor or is subject to
reimbursement to subcontractor,
by any source other than Contractor or subcontractor.
SECTION XIX. LEGAL AUTHORITY
The Contractor assures and guarantees that it possesses the legal
authority, pursuant to any proper, appropriate and official motion, resolu-
tion or action passed or taken giving the Contractor legal authority to
enter into this contract, receive the funds authorized by this contract
and to perform the services the Contractor has obligated itself to perform
under this contract.
The person or persons signing or executing this contract on behalf of
the Contractor, or representing themselves as signing and executing this
contract on behalf of the Contractor, do hereby warrant and guarantee that
he or they have been duly authorized by the Contractor to execute this
contract on behalf of the Contractor and to validly and legally bind the
Contractor to all the terms, performances and provisions herein set forth.
The Department shall have the right, at its option, to either temporarily
suspend or permanently terminate this contract, if there is a dispute to
the legal authority of the Contractor or the person signing the contract
to enter this contract. .The Contractor is liable to the Department for any
money it has received from the Department for performance of the provisions
of this contract, if the Department has suspended or terminated this con-
tract for reasons enumerated in this Section.
SECTION XX. NEPOTISM
A. Neither the Contractor nor any of its subcontractors shall hire
any person in an administrative capacity or staff position funded
under this contract if a member of such person's immediate family is
employed in an administrative capacity for the Contractor or any
of its subcontractors.
1. For the purposes of this section, the term "member of the
immediate family" includes: wife, husband, son, daughter,
mother, father, brother, brother-in-law, sister, sister-
in-law, son-in-law, daughter-in-law, mother-in-law, father -
Page 15 of 17
K Jr I
in-law, aunt, uncle, niece, nephew, stepparent, stepchild,
grandfather, grandmother, grandson, and granddaughter.
2. For the purposes of this section, the term "administrative
capacity" includes those persons who have overall administra-
tive responsibility for the activities and performances
funded under this contract, including all elected and
appointed officials who have any responsibility for the
obtaining of and/or approval of this contract, as well as
other officials who have influence or control over the
administration of the activities or performance funded
under this contract, such as the project director, deputy
director, or any persons having selection, hiring, placement,
or supervisory responsibilities for the activities and
performances funded under this contract.
3. For the purposes of this section, the term "staff position"
means any employment or position funded under this contract.
B. The Contractor assures that it shall in no way exercise its
authority in the performance of this contract to confer any monetary
or other benefit arising directly or indirectly from this contract
upon any member of the immediate family of persons employed in
an administrative capacity for the Contractor or any of its subcon-
tractors.
C. The Contractor assures that it shall in no way exercise its
authority in the performance of this contract in a manner that would
violate the State law relating to nepotism (Article 5996a, TEX. REV.
CIV. STAT. ANN.).
D. Notwithstanding any other provision of this Section, the provisions
of this Section shall not apply to the employment relationships be-
tween any subcontractor performing services under this contract, which
employs ten (10) or less persons, and its employees.
SECTION XXI. ORAL AND WRITTEN AGREEMENTS
A. All oral and written agreements, relating to the subject matter
of this contract and which were made prior to the date of commencement
specified in Section II between the Contractor and the Department
have been reduced to writing and are contained herein.
B. The below enumerated and denominated attachments of the number of
pages indicated are hereby made a part of this contract.
1. Attachment I - Declaration of Income Eligibility Form; one (1) page;
2. Attachment II - Client Intake Form; two (2) pages;
3. Attachment III - Requisition for Payment/Financial Status
Report, SF 269, one (1) page; and
4. Attachment IV - CSA Form 440, one (1) page.
SECTION XXII. TRAVEL
Except as otherwise provided herein, the Department shall reimburse the
Contractor for travel and per diem expenses at the rates established by law
for the Department's employees in classified positions.
At the Contractor's option, it may submit to the Department a "Local
Travel Policy" for use in lieu of the. Department's policy for travel and
per diem. The Contractor's "Local Ti..vel Policy" shall consist of a written
statement delineating the rates which the Contractor shall use in computing
travel and per diem expenses of its employees. The Department shall review
any "Local Travel Policy" submitted by the Contractor and shall approve it
only in the event that the Department determines that such "Local Travel
Policy" is reasonable and otherwise acceptable for the purposes of this
contract. Upon approval, the Department shall reimburse the Contractor for
travel and per diem expenses at rates which are in accordance with the
Contractor's "Local Travel Policy."
Page 16 of 17
During the period, if any, subsequent to the commencement date of this
contract, but before approval of the "Local Travel Policy" by the Department,
the Department shall reimburse the Contractor for travel and per diem expenses
at the rates established by law for the Department's employees in classified
positions.
The Contractor must have the prior written approval of the Department
before it may use funds under this contract to pay for travel and per diem,
except that travel within the counties specified in Section V(a) of this
contract and to Department headquarters which is necessary for the performance
of this contract by Contractor shall not require prior Departmental approval.
Payment for travel shall be made only for those administrative staff
personnel of the Contractor who incur travel costs in the performance of
Contractor's obligations hereunder.
Notwithstanding any other provision of this Section, this Section is
expressly made subject to the provisions of Section IV, Department
Financial Obligations, and under.no circumstances will Department's
liabilities accrued hereunder for travel costs exceed Contractor's actual
costs incurred for travel.
WITNESS OUR HANDS EFFECTIVE THE TWENTIETH DAY OF FEBRUARY, 1980.
Approved and accepted on behalf of
an agency of the State of Texas.
BILL McALISTER,•Mayor
CITY OF LUBBOCK, COMMUNITY SERVICES
DEPARTMENT
the Texas Department of Community Affairs,
r r
7S--IrIESER Ex utive Direct
Texas Department of Community Affairs
This contract is not effective unless signed the Executive Direc r of
the Department.
REVIEWED: DIVISION DIRECTOR
LEGAL DIVISION k PUhfLs
Page 17 of 17
ATTACHMENT I (Page 1 of 1) FORM OF FEBRUARY, 1980
r ,
TEXAS
SUPPLEMENTAL ENERGY ALLOWANCE PROGRAM
AND
SUPPLEMENTAL ENERGY CRISIS ASSISTANCE PROGRAM
DECLARATION OF INCOME ELIGIBILITY
I certify that I meet the income guidelines of the Supplemental Energy Crisis
Assistance Program and the Supplemental Energy Allowance Program.
The size of my household is
is less than $
County of Residence
Address of Residence
and my total annual household income
Print Name
Signature
CSA POVERTY GUIDELINES FOR ALL STATES EXCEPT ALASKA AND HAWAII
FAMILY SIZE NON -FARM FAMILY FARM -FAMILY
100%
125%
100%
125%
1 $3,400
$ 4,250
$2,910
$3,638
2 4,500
5,625
3,840
4,800
3 5,600
7,000
4,770
5,963
4 6,700
8,375
5,700
7,125
5 7,800
9,750
6,630
8,288
6 8,900
11,125
7,560
9,450
For family units with more than six (6) members add $1,575 for each additional
member in a non -farm family and $1,.338 for each additional member in a farm family.
Income eligibility for all program participants shall be established by the local
administering agency. A copy of income verification (IRS 1040, W-2, check stub, etc.)
shall be verified by the outreach worker and noted on each client's record except for
the following categories:
1) Head of household receives SSI
2) Where obtaining proof of income would constitute an
undue hardship on the participant. In such cases,
a signed income declaration is sufficient. Income
limits will be 125 percent of poverty level for all
households.
Attach This Form To Client's Intake Form
ATTACHMENT II (Page 1 of 2) FORM FOR FEBRUARY, 1980
Date of Intake/Application: , 1980
Name
Address
Telephone #
Social Security
Client Intake Worker
6. Source of Income
TEXAS
SUPPLEMENTAL ENERGY ALLOWANCE PROGRAM
AND
SUPPLEMENTAL ENERGY CRISIS ASSISTANCE PROGRAM
CLIENT INTAKE FORM
Family Data
1. Age of head of household
2. Sex of head of household
3. No. living in household
. No. disabled
4. Owner Renter
5. Race:
Black (not Hispanic)
White (not Hispanic)
Asian of Pacific
Islander
American Indian or
Alaska Native
Hispanic
6. UT family members employed, how
many were migrants/seasonal farm -
workers
PROOF OF INCOME ELIGIBILITY
(Income during 6 months prece ng request for assistance)
AMOUNT
a. Employment $
b. Unemployment Compensation $
c. Social Security $
d. Supplemental Security Income *(SSI) $
e. Retirement $
f. AFDC* $
g. General Local Relief $
h. Other $
TOTAL $
* Amounts of energy allowances received under HEW energy assistance program should
not be considered as income for purposes of determining income eligibility.
7. Income Eligibility Certification
a. Presentation of Proof
b. Declaration of Income Eligibility
8. Eligible for Assistance
YES NO
------------------------------------------------------------------------------------------. ..
REQUEST FOR ASSISTANCE
9. Type of Assistance Requested
a. Payment to fuel/utilities vendor
b. Establishment of line of credit with fuel/utilities vendor
C. Payment to landlord (only where utilities are paid as part of rent)
10 Amount of Assistance Requested *$
*If the applicant is denied all or part of the amount of assistance requested, the
client intake worker must inform the applicant that he/she has a right to appeal
this denial of assistance and that he/she is entitled to receive upon request a
copy of the program operator's review procedures.
ATTACHMENT �I �Pa�e 2 of 2)
Y k1 tent Inta a or
11. Amounts of Assistance Received/Certified
PROGRAMASSISTANCE
(ECAP,SEAP,SSI,
AFDC OTHER)
ASSISTANCE
ASSISTANCE
SUPPLIER
(NAME OF
AGENCY)
D F
PROVISION
VOUCHER
INVOICE
(YES or NO
E P This Pro ram
ECAP Other
SEAP This Pro ram
SEAP Other
SI
AFDC
ther Programs
TOTAL*
* Total amount of assistance may not exceed the amount needed
to ameliorate the household's energy related problem or $400,
whichever is less.
12. Amount of assistance needed to ameliorate household's energy related crisis $
13. Amount of assistance certified under this application $
Proof of unpaid fuel bills or notices of termination of utility
services are not required to certify this person.
--------------------------------------------------------------------------------------------
(THE FOLLOWING MUST BE READ AND SIGNED BY THE APPLICANT)
I certify that the above listed amounts of energy assistance which my household has received
or is certified to receive is true and correct and that neither I nor other members of my
household have received or are certified to receive amounts not listed above. I understand
that the incorrect listing or failure to list amounts of energy assistance received by my
household may disqualify my household for assistance under this program. I also understand
that, if my request for assistance is totally or partially denied, I have the right to appeal
this denial and to receive upon my request a copy of the program operator's review procedure.
Furthermore, I hereby authorize the release of the information contained in this application
for the purpose of determining whether duplicate payments have been made under other energy.
assistance programs.
Signature
ate
ATTACHMENT III (Page 1 of 1)
FINANCIAL STATUS REPORT
(Foilora tnatruetimu on the bask)
1. FEDERAL AGENCY AND ORGANIZATIONAL ELEMENT TO WHICH REPORT 1S SUBMITTED
2. FEDERAL GRANT OR OTHER IUEN7TFTiNG
"UMBER
OMB Approved
No.80-170180
PAGE OF
PA6E5
& RECIPIENT ORGANIZATION (N.—awd—VI4saddrsr, fwdadiwp ZIPcads)
4. EMPLOYER IDENTIFICATION NUMBER.
S. RECIPIENT ACCOUNT NUMBER OR IDENTIFYING NUMBER
6. FINAL REPORT
YES NO
7. BASIS
CASH D ACCRUAL
S. PROJECT/GRANT PERIOD (S- ias/r.eG—)
A PERIOD COVERED BY THIS RETORT
FROM (M—M dal, v—)
TO (Mswtk d.% yeas)
FROM (M—th. dae. b—) TO (Ar-04 dal. V—)
10.
STATUS OF FUNDS
PROGRAMS/FUNCTIONS/ACTfWiES ►
(a)
(b)
(eJ
(d)
(Q)
(/)
TOTAL
(8)
a. Net outlays previouslyreported
$
$
$
$
$
3
$
b. Total outlays this report period
e. Less: Program income Credits
d. Net outlays this report period
(Li+te b minus line e)
e. Net outlays to date
(Line a pica line d)
f. Lan: Non -Federal share of outlays
g. Total Federal share of outlays
(Line a /ninua hue f)
h. Total unliquidated obligations
I. Lem: Non -Federal share of unriqufdabed
obligations shown on line h
j. Federal share of unliquidated obligations
k Total Federal share of outlays and
unliquidated obligations
I. Total cumulative amount of Federal funds
authorized
m. UnoMigated balance of Federal funds
u.
INDIRECT
I�L TYrt Of RATE
(PhDs "a" in appropriate box) PROVISIONAL PREDETERMINED 0 FINAL CI rMED
13. CERTIFICATION
I certify to the best of my knowledge and be.
lief that this report is correct and complete and
that all outlays and unliquidated obligations
are for the purposes set forth in the award
documents.
SIGNATURE OF AUTHORIZED CERTIFYING
OFFICIAL
DATE REPORT
SUBMITTED
EII►FJtsE
a RATE
a BASE
e. TOTAL AMOUNT
a. FEDERAL SHARE
TYPED OR PRINTED NAME AND TITLE
TELEPHONE (Area code,
number and extettaion)
IL Ewa ls0�_ aa 1 aw bmatfowa dewed waerwry s. ialarrfbw sapab+d M PedarW aPoasor(aa Maaer fw eowpliawcs oitA
t69-101
STANMRD ►ORY 269 f1-76)
Cir. No. A— AY OUflea M ManeamteM and Bu.'.a..
Cir. No. A-110
ATTACHMENT IV (Page 1 of 1)
h'age of
(Check applicable box)
OMB No. 116-RO227
COMMUNITY SERVICES ADMINISTRATION
[rj 1st QI, L] ANNUAL
pproval expires August 199
PROJECT PROGRESS REVIEW REPORT
L, 2nd Qtr.
DATE SUBMITTED
[-� 3rd Qtr. n FINAL
NAME OF GRANTEE
GRANTEE NO.
PROGRAM
PROJECT TITLE
ACCOUNT
I
t
PROJECT GOAL
STANDARD(S) OF EFFEC-
TIVENESS (No.) r
I. ACCOMPLISHMENTS
A. MEASURABLE
B. NON -QUANTIFIABLE
2. PROBLEMS —
9. PLANNED CHANGES
4. TRAINING 6 TECHNICAL ASSISTANCE 14EEDS *
3. ASSESSMENT OF EFFECTIVENESS
+ Do not complete when filing final report or in annual reports for individual projects which will not be refunded.
CERTIFICATION
The undersigned certifies that this report has been completed in accordance with applicable instructions;
that it is true to the best of his/her knowledge, information and belief; and that it has been approved, or
reviewed and approved, as indicated in item 6, below.
9. 'THIS REPORT HAS BEEN (Check appropriate hnx.) 7. DATE OF -
___ -'---- —`_ — I a APPROVED BY GRANTEES REVIEWED REVIEWED BY GRANTEE'S ADMINISTERING APPROVAL
BOARD
GOVERNING BOARD AND APPROVED BY ITS GOVERNING OFFICIALS
9. TYPED NAME A TITLE OF PRINCIPAL GOVERNING OFFICIAL 9. SIGNATURE 10. DATE
OR PRINCIPA4 OFFICER OF GOVERNING BOARD - I I
CSA FORM 440 (REV. AUO 77) IREPLACES OEO FORM 440, DATED AVG 72, WHICH IS OBSOLETE.1 GPO 919-407